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Assessing Long-Term Adverse Outcomes in Older Kidney Transplant Recipients: A Propensity Score-Matched Comparison of Early Steroid Withdrawal Versus Continuous Steroid Immunosuppression Using a Large Real-World Database.

BACKGROUND: Steroids are widely used in maintenance immunosuppression treatment in kidney transplant recipients. Older individuals undergo a … wal recipients experienced significantly fewer infection-related outcomes, such as cytomegalovirus, BK virus, sepsis/bacteremia, and fungal infections, compared with SCI recipients. Last, recipients who underwent ESW experienced fewer incidences of rejection and death-censored graft failure at 5 years post-transplant. CONCLUSIONS: There is currently no st …

Clinical characteristics of 15 cases of renal transplantation with pre-exsiting donor-specific antibody.

OBJECTIVES: Currently, patients with pre-exsiting donor-specific antibody (DSA) are prone to antibody-mediated rejection (AMR) after surgery … nce in the incidence of postoperative haematuria, proteinuria, bacterial and fungal infections, and BK virus infection between the 3 groups (all P>0.05). A total of 11 of the 15 recipients were followed up for more than 1 year, 6 for more than 3 years, and 1 for more than 5 years, and the survival rates of both the recipients and the transplanted kidneys w …

Everolimus leads to a lower risk of BKV viremia than mycophenolic acid in de novo renal transplantation patients: a single-center experience.

BACKGROUND: There are limited published data concerning the effects of different immunosuppressive regimens on the development of polyomavirus (BKV) viremia. We examined the risk of developing BKV viremia in kidney transplant recipients receiving everolimus (EVR) or mycophenolic acid (MPA) as maintenance therapy. METHODS: We observationally analyzed 296 patients who underwent renal transplantation at our center between 2005 and 2010: 58 were treated with EVR and low-dose cyclosporine (LD-CyA) (group 1) and 238 with MPA and standard-dose CyA (group 2). All of the patients received induction th

Incidental COVID-19 in a heart-kidney transplant recipient with malnutrition and recurrent infections: Implications for the SARS-CoV-2 immune response.

The clinical course and outcomes of immunocompromised patients, such as transplant recipients, with COVID-19 remain unclear. It has been postulated that a substantial portion of the disease burden seems to be mediated by the host immune activation to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Herein, we present a simultaneous heart-kidney transplant (SHKT) recipient who was hospitalized for the management of respiratory failure from volume overload complicated by failure to thrive, multiple opportunistic infections, and open non-healing wounds in the setting of worsening

Immunoglobulin A Deposits In Renal Allografts: A Prospective Longitudinal Single-Center Study.

AIMS AND BACKGROUND: To describe the prevalence of IgA deposits (IgAD) in renal allografts in a cohort of renal transplant recipients and to … B had 18 cases (28.1%), comprising T cell-mediated rejections (5), antibody-mediated rejection (8), BK virus nephropathy (1), and interstitial fibrosis and tubular atrophy (4). In group A, 22 (47.8%) presented with graft dysfunction, 8 (17.3%) with isolated proteinuria, and 14 (30.4%) patients presented with a combination. Two (4.3%) patients had neither. …

Steroid avoidance or withdrawal for pancreas and pancreas with kidney transplant recipients.

BACKGROUND: Pancreas or kidney-pancreas transplantation improves survival and quality of life for people with type 1 diabetes mellitus and k … at steroid-sparing and withdrawal strategies had benefits in lowering HbAc1 and risk of infections (BK virus and CMV disease) and improved blood pressure control without increasing the risk of rejection. However, two studies found an increased incidence of acute pancreas rejection (HR 2.8, 95% CI 0.89 to 8.81, P = 0.066 in one study and 43.3% in the steroi …

Grover's Disease in a Kidney Transplant Recipient.

Dear Editor, It is not unusual for patients with renal insufficiency to develop skin pathologies. There are reports in the literature of inc … he lesion was treated successfully with cryotherapy. During this period, a fever prompted a PCR for BK virus DNA which showed a substantial amount of copies, measuring 28,850 copies/mL in urine and 98 copies/mL in blood. The mycophenolate dose was reduced, and tacrolimus trough concentration was maintained at between 3 and 5 µg/L. In 2018 the patient prese …

Hyperbaric oxygen therapy in the treatment of late-onset hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation.

INTRODUCTION: Hemorrhagic cystitis (HC) is a common complication after allogeneic hematopoietic stem cell transplantation (HSCT), characterized by inflammation and bleeding of the bladder. Hyperbaric oxygen therapy (HBOT) has been shown to be effective in the treatment of radiation-induced HC. However, the optimal treatment for HC after allogeneic HSCT has not yet been established. Furthermore, limited research has been conducted on the use of HBOT in this setting. This study aimed to evaluate the effectiveness and safety of HBOT in patients with late-onset HC after allogeneic HSCT. METHODS:

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… Savva-Bordalo J BK-virus-associated hemorrhagic cystitis after allogeneic bone marrow transplantation Bone Marrow Transplant. 2012 47 1095 1098 10.1038/bmt.2011.228 22080970 Savva-Bordalo, J. et al. BK-virus-associated hemorrhagic cystitis after allogeneic bone marrow transplantation. … Successful hyperbaric oxygen therapy for refractory BK virus-associated hemorrhagic cystitis after cord blood transplantation. Transpl. Infect. Dis. 16 , 843–846 (2014). 25040402 10.1111/tid.12266 17. …

Medical Management of the Kidney Transplant Recipient : Infections and Malignant Neoplasms

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… The second group (approximately 10% of patients) consists of those with chronic viral infection that may include HBV, HCV, CMV, EBV, BK virus, or papillomavirus. … After primary infection, BK virus preferentially establishes latency within the genitourinary tract and frequently is reactivated in the setting of immunosuppression. …

Infectious complications after hematopoietic stem cell transplantation: current status and future perspectives in Korea.

Hematopoietic stem cell transplantation (HSCT) is a treatment for hematologic malignancies, immune deficiencies, or genetic diseases, ect. Recently, the number of HSCTs performed in Korea has increased and the outcomes have improved. However, infectious complications account for most of the morbidity and mortality after HSCT. Post-HSCT infectious complications are usually classified according to the time after HSCT: pre-engraftment, immediate post-engraftment, and late post-engraftment period. In addition, the types and risk factors of infectious complications differ according to the stem cell

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… Of these viruses, BK virus (BKV) is the most common; 80% to 90% of adults are BKV seropositive [ 109 - 111 ]. BKV-associated hemorrhagic cystitis is predominant in allogeneic HSCT patients, and BKV-associated nephropathy in KT patients. … Late-onset hemorrhagic cystitis in children after hematopoietic stem cell transplantation for thalassemia and sickle cell anemia: a prospective evaluation of polyoma (BK) virus infection and treatment with cidofovir. …

Efficacy and safety of ruxolitinib in the treatment of chronic graft-versus-host disease: a retrospective analysis.

Steroid-refractory chronic graft-versus-host disease (cGvHD) is associated with significant morbidity and mortality, with ruxolitinib being the first drug approved for its treatment. We retrospectively analyzed the safety and efficacy of ruxolitinib for treatment of cGvHD at our center between 07/2015 and 12/2022 and identified 48 patients receiving ruxolitinib as second (18/48) or advanced (30/48) treatment line. Ruxolitinib was started on median day 340 (range 119-595) after cGvHD onset; median duration of administration was 176 (range, 79-294) days with 16/48 patients continuing treatment a

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… Of note, one patient suffered from severe BK virus reactivation, and 4 patients in total presented with BK viremia. BK virus replication is controlled by binding of interferon-γ to its surface receptor (IFNγR), resulting in JAK/STAT pathway activation. … Abend JR Low JA Imperiale MJ Inhibitory effect of Gamma Interferon on BK Virus Gene expression and replication J Virol 2007 81 1 272 279 10.1128/jvi.01571-06 17035315 PMC1797268 Abend JR, Low JA, Imperiale MJ (2007) Inhibitory effect of Gamma Interferon on BK Virus Gene expression and replication. …

Viruses

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Innovative therapeutic concepts of progressive multifocal leukoencephalopathy.

Progressive multifocal leukoencephalopathy (PML) is an opportunistic viral disease of the brain-caused by human polyomavirus 2. It affects patients whose immune system is compromised by a corresponding underlying disease or by drugs. Patients with an underlying lymphoproliferative disease have the worst prognosis with a mortality rate of up to 90%. Several therapeutic strategies have been proposed but failed to show any benefit so far. Therefore, the primary therapeutic strategy aims to reconstitute the impaired immune system to generate an effective endogenous antiviral response. Recently, an

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… In patients with a human polyomavirus 1 (HPyV-1) (formerly known as: BK virus) infection, a close relative of HPyV-2 sharing immunologically significant epitopes, it has been shown that an increase in antibody titers is associated with a reduction in viral load [ 7 , 8 ]. … Hariharan S Cohen EP Vasudev B Orentas R Viscidi RP Kakela J DuChateau B BK virus-specific antibodies and BKV DNA in renal transplant recipients with BKV nephritis Am J Transplant 2005 5 2719 2724 16212632 10.1111/j.1600-6143.2005.01080.x 9. …

Significance of BK Polyomavirus in Long-Term Survivors after Adult Allogeneic Stem Cell Transplantation.

BackgroundAllogeneic stem cell transplantation (aSCT) is a common treatment for a variety of hematological diseases. Advances in transplantation practices have led to an increasing number of long-term aSCT survivors, but data about health status and late complications are sparse. This analysis focusses on kidney function and urological complications in this population.MethodsThis study is a prospective unicentric non-interventional trial. Before starting the study, we obtained the approval of the local ethics review board. Furthermore, the study was registered at WHO Clinical Trial Registry. T

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… Urological Complications and BK Virus-Associated Diseases Under Allogenic Stem Cell Transplantation. Urol. Int. 2016;97:434–439. doi: 10.1159/000445124. 11. Kwak E.J., Vilchez R.A., Randhawa P., Shapiro R., Butel J., Kusne S. … BK Virus-Specific Immunity Kinetics: A Predictor of Recovery from Polyomavirus BK-Associated Nephropathy. Arab. Archaeol. Epigr. 2011;11:2443–2452. doi: 10.1111/j.1600-6143.2011.03693.x. 22. Ahlenstiel-Grunow T., Sester M., Sester U., Hirsch H.H., Pape L. …

Acute Kidney Injury in Oncology Patients.

With rapid progress in cancer diagnosis and treatment in the last two decades, outcomes in oncological patients have improved significantly. However, the incidence of acute kidney injury (AKI) in this population has also increased significantly. AKI complicates many aspects of patients' care and adversely affects their prognoses; thus, accurately diagnosing the risk factors for AKI ensures appropriate management. AKI may be caused by pre-renal, intrinsic renal, and post-renal reasons, as well as for combined reasons. This review summarizes the potential etiologies of AKI according to the three

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… BK virus and adenovirus deserve special attention regarding kidney injury. Both viruses are found in asymptomatic carriers, and immunosuppression may cause their reactivation in HSCT recipients, leading to HC and, less commonly, AIN 47 . … virus-associated nephropathy following allogeneic hematopoietic cell transplantation Biol Blood Marrow Transplant 2011 17 1589 1593 21767514 10.1016/j.bbmt.2011.07.010 PMC4477525 48 Philippe M Ranchon F Gilis L Cidofovir in the treatment of BK virus-associated hemorrhagic cystitis after allogeneic …

What the Intensivist Needs to Know About Hematopoietic Stem Cell Transplantation?

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… The use of alemtuzumab as part of the conditioning regimen has also been associated with increased risk for BK virus-associated hemorrhagic cystitis [ 49 ]. Reactivation of BK virus has also been associated with delayed immunologic reconstitution [ 1 ]. … Cidofovir is the predominant pharmacologic agent used to treat BK virus infections with an estimated overall response rate of 79% that includes about 66% of complete responses [ 12 ]. …

Kidney Disease and Hematopoietic Stem Cell Transplantation.

Hematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for patients with hematologic malignancies and certain solid tumors and nonmalignant hematologic conditions. Both AKI and CKD occur commonly after HSCT and are associated with significant morbidity and mortality. AKI and CKD in this setting may result from direct effects of the transplant or be caused by pretransplant bone marrow conditioning regimens and/or nephrotoxic agents administered in the post-transplant period. In this article, we review the epidemiology, risk factors, etiologies, pathophysiology, diagnos

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… **Systemic, BK virus, CMV, parvovirus B19, adenovirus. … Viral Infections BK virus reactivation may cause hemorrhagic cystitis, urinary tract obstruction (clot formation, ureteral stenosis), or interstitial nephritis (BK virus-associated nephropathy). 104 – 108 Risk is highest among haploidentical and UCB recipients after myeloablative conditioning. 104 , …

Unraveling the Role of Allo-Antibodies and Transplant Injury.

Alloimmunity driving rejection in the context of solid organ transplantation can be grossly divided into mechanisms predominantly driven by either T cell-mediated rejection (TCMR) and antibody-mediated rejection (ABMR), though the co-existence of both types of rejections can be seen in a variable number of sampled grafts. Acute TCMR can generally be well controlled by the establishment of effective immunosuppression (1, 2). Acute ABMR is a low frequency finding in the current era of blood group and HLA donor/recipient matching and the avoidance of engraftment in the context of high-titer, pref

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… In addition, various infections in some cases were detected, including cytomegalovirus (CMV), BK virus, and Epstein–Barr virus (EBV), indicating that desensitization therapy disposes patients to an increased risk of opportunistic viral infections. …

Recent Advances of Acute Kidney Injury in Hematopoietic Cell Transplantation.

Acute kidney injury (AKI) is a common complication of allogeneic hematopoietic cell transplantation (allo-HCT) and is associated with non-relapse mortality (NRM) and quality of life (QOL). Multiple factors may contribute to AKI during allo-HCT and are often present at the same time making it difficult to determine the cause of AKI in each patient. Nephrotoxic drugs, infections, thrombotic microangiopathy (TMA), and sinusoidal obstruction syndrome (SOS) are well described causes of AKI during allo-HCT. Acute graft-versus-host disease (aGVHD) is a major complication of allo-HCT that mainly targe

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… Hemorrhagic cystitis (caused by adenovirus or BK virus infection) may require surgical decompression with a nephrostomy tube if urinary tract obstruction cannot be relieved by bladder irrigation from a urinary catheter. … The antiviral drug cidofovir is effective for hemorrhagic cystitis caused by adenovirus ( 132 , 133 ) and may be effective for hemorrhagic cystitis caused by BK virus ( 134 ). …

Severe infections and infection-related mortality in a large series of haploidentical hematopoietic stem cell transplantation with post-transplant cyclophosphamide.

Severe infections and their attributable mortality are major complications in recipients of allogeneic hematopoietic stem cell transplantation (alloSCT). We herein report 236 adult patients who received haploSCT with PTCy. The median follow-up for survivors was 37 months. The overall incidence of bloodstream infections by gram-positive and gram-negative bacteria at 37 months was 51% and 46%, respectively. The incidence of cytomegalovirus infection was 69%, while Epstein Barr virus infections occurred in 10% of patients and hemorrhagic cystitis in 35% of cases. Invasive fungal infections occurr