Patient M, a 54 year old gentleman, had undergone live emotionally related renal allograft transplantation in 2004. He presented with history of swelling over both his lower limbs associated with redness and pain of 10 days duration. There was associated low-grade fever, recurrent loose stools of 10 days duration. He was found to have anemia (Hb: 10.2 mg/dL), leucocytosis (TLC: 14,200), acute graft dysfunction (Serum creatinine: 5.24 mg/dL). Venous Doppler of the lower limbs revealed thrombosis of the superficial venous system (great saphenous vein) bilaterally. His serum CMV-PCR revealed significant viral load (10,400 copies/mL). Colonoscopic biopsy revealed CMV DNA positivity on immunohistochemistry. He was managed with anticoagulation (low molecular weight heparin for 3 weeks adjusted to the renal dysfunction), antibiotics and intravenous ganciclovir (for 2 weeks). Thereafter, he recieved oral valganciclovir for another 10 weeks. Swelling in the lower limb and pain reduced after 3 weeks and serum CMV-PCR revealed undetectable viral copies after 4 weeks of therapy. Repeat venous doppler for venous thrombosis after 4 weeks revealed recanalised superficial venous system. We attribute the present episode of superficial vein lower limb thrombosis involving both his lower limbs to cytomegalovirus.
Vascular complications are common in immediate post renal transplant, which can be due to immunological and non-immunological causes. Major vascular events are clinically obvious which present with graft dysfunction; minor segmental defects are not clinically significant. We a report a case with segmental vascular complication secondary to perfusion related problem posing a diagnostic dilemma of vascular rejection.
Infections following renal transplantation remain a major cause of morbidity and death. Aspergillus fumigates is an invasive opportunistic fungal infection with a rapid course and grave prognosis. Early diagnosis is critical for a favourable outcome in invasive aspergillusis, but is difficult to achieve with easy methods of diagnosis; deep tissue diagnostic specimens are often difficult to obtain from critically ill patients. We report a case of cadaver donor renal allograft recipient who had a fatal pulmonary infection with rapid downhill course due to Aspergillus fumigatus.
Objectives: Both the ureter and bile duct are vulnerable during transplantation. The aim of this study was to compare ureteric and bile duct complications following kidney and liver transplant respectively. Methods: We analysed the rate of urological complications in 423 renal transplant operations performed on 419 patients in our unit from 2007 till 2011. The donor source was after brain death – DBD, after cardiac death – DCD and live donors. 138 liver transplants from cadaveric donors were reviewed for biliary complications. In live donors kidneys were procured laparoscopically. Results: In the kidney group there was a urological complication rate of 4.2% in recipients from deceased donor and 3.6% from living donors. The difference between the rate of ureteric complications from deceased and living donors was not statistically significant. In 138 liver recipients with duct to duct anastomotic technique 29 developed bile duct complications (21%). The difference between the rate of bile duct strictures between DCDs and DBDs was not statistically significant. Conclusion: The rate of bile duct complications in cadaveric liver recipients was significantly higher than the rate of ureteric strictures in kidney recipients, p < 0.01. Biliary strictures were often multiple and longer than ureteric strictures.
The release of National Institute of Health and Clinical Excellence guidelines for improving donor identification and consent rates and British Medical Association opinion regarding reintroduction of concept of ‘Elective Ventilation’ has started the debate in the realm of medical ethics. The concept of elective ventilation was earlier introduced by Royal Devon & Exeter Hospital in 1988 and finally declared unlawful by the Department of Health, United Kingdom in 1994 when ethical concerns were raised by the medical fraternity. Growth and development of safer and effective immunosuppressive drugs is hooked to the optimum number of cases of organ transplantation in research protocol. Toxic profile of these drugs and poor compliance has decreased their effectiveness. The drug discovery and development of safer immunosuppressants has been quite sluggish especially in last two decades. Very few randomised clinical trials have been performed in children and lesser subjects are being enrolled even in adult organ transplant clinical research. Without optimum number of clinical trial participants, it is difficult to extrapolate finding on larger population thus resulting in region specific divergent treatment protocols. Introduction of improved organ donation guidelines will enhance the number of cases of immunosuppressants used.
Background: Hepatic arterial inflow to the liver graft following liver transplantation is critical to graft survival. When recipient hepatic artery is not available due to injury or recipient hepatic artery flow is inadequate extra anatomic hepatic arterial reconstruction during deceased donor liver transplantation is required to ensure adequate hepatic arterial blood flow to the graft. The outcome in such patients is analyzed and compared with patient with standard hepatic artery reconstruction. Methods: Retrospective analysis of 30 patients who underwent Deceased Donor Liver Transplantation (DDLT) from March 2007 to May 2010 was done to assess the outcome of extra anatomic arterial inflow reconstruction. DDLT with standard end to end Hepatic Artery anastomosis performed in 24 patients (n = 24) served as control. Extra anatomic hepatic arterial reconstruction (EAHAR) was performed in 6 patients. The preferred choice of EAHAR was to fashion an infrarenal aortic conduit using stored donor iliac artery graft routed through the base of the transverse mesocolon. Results: Extra anatomic hepatic arterial reconstruction is not associated with increased morbidity, mortality, blood loss, operating room time or thrombosis. Conclusion: Extra anatomic hepatic arterial reconstructions are associated with excellent long-term outcomes and provide acceptable alternatives for arterial reconstruction.
Kidney transplantation is the treatment of choice employed the world over for end stage kidney disease. Anastomotic leakage and stricture formation at site of ureterovesical anastomosis complicates 3–9% of all renal transplants and are the commonest complications encountered with the practice of renal transplantation. Patients with urinary anastomotic complications require significantly longer and more frequent hospitalization. There is also higher incidence of urinary tract and non-urinary tract infections with greater risk of developing acute renal failure. We report a case of an allograft renal transplant recipient who presented with recurrent episodes of transplant kidney hydronephrosis and was diagnosed with ureteric stricture 10 years post transplant. Detailed percutaneous interventional management of post transplant ureteric stricture has been described here.