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Reuse of a previously transplanted kidney: does success come with a price?

Kadambi PV, Chon WJ, Josephson MA, Desai A, Thistlethwaite JR, Harland RC, Meehan SM, Garfinkel MR - Clin Kidney J (2012)

Bottom Line: Longer wait times for deceased donor kidney transplant have prompted newer initiatives to expedite the process.Reuse of a previously transplanted kidney might be appropriate in certain circumstances.Despite the challenges, the allograft function remained stable 5 years after reuse.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology and Hypertension, Department of Medicine , University of Texas Medical Branch , Galveston, TX , USA.

ABSTRACT
Longer wait times for deceased donor kidney transplant have prompted newer initiatives to expedite the process. Reuse of a previously transplanted kidney might be appropriate in certain circumstances. However, one must also consider the unique issues that may arise after such transplants. We describe our experience in one such case where the donor kidney had lesions of focal and segmental glomerulosclerosis and signs of alloreactivity (positive C4d staining) prior to transplantation and the recipient developed ganciclovir-resistant cytomegalovirus (CMV) infection, which was perhaps transmitted from the donor. Despite the challenges, the allograft function remained stable 5 years after reuse.

No MeSH data available.


Related in: MedlinePlus

Timeline of clinical events after transplantation. As noted in the figure, CMV decreased dramatically after starting foscarnet. Also noted in the figure are the serum creatinine values, tacrolimus levels and urine protein-to-creatinine ratios.
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SFS086F1: Timeline of clinical events after transplantation. As noted in the figure, CMV decreased dramatically after starting foscarnet. Also noted in the figure are the serum creatinine values, tacrolimus levels and urine protein-to-creatinine ratios.

Mentions: On day 24 post transplant, his white blood cell count decreased to 2400 cells/mm3, which led to the lowering of the MMF (from 2000 mg to 1000 mg/day). The leukopenia persisted for another week and his blood tested positive for CMV DNA by PCR (307 000 copies/mL) at which point MMF was discontinued and intravenous ganciclovir at 2.5 mg/kg/day was substituted for oral valganciclovir. He then became symptomatic with fever and malaise and the CMV levels in the blood rose to 1 199 000 copies/mL over a 2-week period despite adequate doses of ganciclovir. The possibility of mutant CMV strain resistant to ganciclovir was considered and intravenous foscarnet 3 g every 12 h (50 mg/kg every 12 h for estimated GFR of 58 mL/min) was started. His symptoms improved quickly and as depicted in Figure 1, CMV decreased dramatically over the next 2 weeks to 3000 copies/mL. A mutation for ganciclovir resistance tested positive at the UL-97 location. On day 75 post transplant, CMV was no longer detectable in his blood. Foscarnet was continued for a total of 3 months, his tacrolimus level during this episode was 5–8 ng/mL and the U P/Cr ranged between 1.25 and 2.5. His maintenance immunosuppression was changed to tacrolimus, leflunomide and prednisone.Fig. 1.


Reuse of a previously transplanted kidney: does success come with a price?

Kadambi PV, Chon WJ, Josephson MA, Desai A, Thistlethwaite JR, Harland RC, Meehan SM, Garfinkel MR - Clin Kidney J (2012)

Timeline of clinical events after transplantation. As noted in the figure, CMV decreased dramatically after starting foscarnet. Also noted in the figure are the serum creatinine values, tacrolimus levels and urine protein-to-creatinine ratios.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3755571&req=5

SFS086F1: Timeline of clinical events after transplantation. As noted in the figure, CMV decreased dramatically after starting foscarnet. Also noted in the figure are the serum creatinine values, tacrolimus levels and urine protein-to-creatinine ratios.
Mentions: On day 24 post transplant, his white blood cell count decreased to 2400 cells/mm3, which led to the lowering of the MMF (from 2000 mg to 1000 mg/day). The leukopenia persisted for another week and his blood tested positive for CMV DNA by PCR (307 000 copies/mL) at which point MMF was discontinued and intravenous ganciclovir at 2.5 mg/kg/day was substituted for oral valganciclovir. He then became symptomatic with fever and malaise and the CMV levels in the blood rose to 1 199 000 copies/mL over a 2-week period despite adequate doses of ganciclovir. The possibility of mutant CMV strain resistant to ganciclovir was considered and intravenous foscarnet 3 g every 12 h (50 mg/kg every 12 h for estimated GFR of 58 mL/min) was started. His symptoms improved quickly and as depicted in Figure 1, CMV decreased dramatically over the next 2 weeks to 3000 copies/mL. A mutation for ganciclovir resistance tested positive at the UL-97 location. On day 75 post transplant, CMV was no longer detectable in his blood. Foscarnet was continued for a total of 3 months, his tacrolimus level during this episode was 5–8 ng/mL and the U P/Cr ranged between 1.25 and 2.5. His maintenance immunosuppression was changed to tacrolimus, leflunomide and prednisone.Fig. 1.

Bottom Line: Longer wait times for deceased donor kidney transplant have prompted newer initiatives to expedite the process.Reuse of a previously transplanted kidney might be appropriate in certain circumstances.Despite the challenges, the allograft function remained stable 5 years after reuse.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology and Hypertension, Department of Medicine , University of Texas Medical Branch , Galveston, TX , USA.

ABSTRACT
Longer wait times for deceased donor kidney transplant have prompted newer initiatives to expedite the process. Reuse of a previously transplanted kidney might be appropriate in certain circumstances. However, one must also consider the unique issues that may arise after such transplants. We describe our experience in one such case where the donor kidney had lesions of focal and segmental glomerulosclerosis and signs of alloreactivity (positive C4d staining) prior to transplantation and the recipient developed ganciclovir-resistant cytomegalovirus (CMV) infection, which was perhaps transmitted from the donor. Despite the challenges, the allograft function remained stable 5 years after reuse.

No MeSH data available.


Related in: MedlinePlus