Transplantation proceedings
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Dilutional coagulopathy might cause life-threatening hemorrhages in liver transplantation. Liver insufficiency is usually accompanied by alteration in fibrinogen (Fib) synthesis, which is one of the main clotting factors providing appropriate hemostasis. Intraoperative hemodilution results in further Fib concentration reduction enhancing coagulopathy and blood loss. Exogenous Fib substitution might prevent this. ⋯ Clot formation is disturbed more profoundly by hemodilution in cirrhotic patients. Fib concentrate substitution might be effective in the management of dilutional coagulopathy.
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Estimation of glomerular filtration rate (eGFR) after renal transplantation is performed with the use of methods that are standardized for a population of nontransplantation patients with chronic kidney disease. The aim of the study was to compare the performance of GFR estimation formulas in renal transplant recipients. ⋯ Measured and estimated creatinine clearance overestimate values of eGFR calculated by the MDRD or CKD-EPI formula in a population of kidney transplant recipients, especially in subjects with obesity and worse renal function. Accuracy of analyzed GFR estimation formulas decreases with deterioration of renal graft function.
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Recurrence of focal segmental glomerulosclerosis (FSGS) is an important cause of graft loss after kidney transplantation. The management of patients with recurrent FSGS is not well established because there are no prospective randomized studies with a view to the impact of FSGS on graft survival. Recent studies suggest that rituximab, an anti-B-CD20 monoclonal antibody, may be a therapeutic alternative in selected cases resistant to conventional therapy. ⋯ Ten months after transplantation and 5 months after the first dose of rituximab was administered, severe PJP pneumonia developed and the patient died despite all efforts with antibiotic therapy. It seems essential that all renal transplant recipients treated with rituximab should currently be considered at an increased risk for PJP. This case suggests that prolonged or restarted prophylaxis for PJP should be recommended not only after conventional treatment for acute rejection episodes but also after use of rituximab in combination with other immunosuppressive therapy as well.
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Faced with a shortage of organs for liver transplantation, the use of grafts from older donors is justified. However, there remains little consensus on how this use impacts the graft and patient outcomes after transplantation from these older donors. The aim of the present analysis was to assess the graft and patient outcomes after liver transplantation from deceased donors >60 years of age. ⋯ A more advanced age of a donor should not be a contraindication for liver transplantation. The present analysis shows that liver grafts from donors >60 can be used safely in older recipients who presented with relatively low MELD scores. Analyses also indicate that high MELD obtained before transplantation may be an important prognostic factor for graft and patient survival.
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Recently, research has focused on the association of neutrophil gelatinase-associated lipocalin (NGAL) with acute and/or active kidney injury. However, it should be remembered that NGAL is involved in iron metabolism and antimicrobial defense mechanisms. ⋯ Plasma and urine NGAL levels are strongly correlated not only with kidney function parameters, but also with red and white blood cell parameters and patient's age and sex.