International Journal of Organ Transplantation Medicine
Volume:14 Issue: 3, Summer 2024

The incidence of vasoplegic syndrome during liver transplantation is unknown, and it is occasionally confused with postreperfusion syndrome, which is another similar form of hemodynamic instability. In these cases, monitoring patients with the Swan-Ganz catheter may be useful for differential diagnosis.

The main outcome was the incidence of vasoplegic syndrome or postreperfusion syndrome in the patients, and the prognosis of patients with vasoplegic syndrome was the secondary outcome.

This retrospective study included 246 consecutive orthotopic liver transplantation procedures performed in patients aged >18 years who were monitored using a Swan-Ganz catheter. Vasoplegic syndrome was defined as mean arterial pressure <50 mmHg, pulmonary capillary wedge pressure ≤15 mmHg, central venous pressure <5 mmHg, cardiac index >2.5 L/min/m2, systemic vascular resistance <800 dyn/s/cm-5, and increased heart rate and mean pulmonary arterial pressure from the baseline (anhepatic phase). The estimated marginal means and their 95% confidence intervals were determined for the total sample.

Of the 246 patients, only two (0.81%) developed vasoplegic syndrome after unclamping the portal vein. Another patient (0.40%) showed the hemodynamic features of vasoplegic syndrome but was diagnosed with septic shock due to positive blood culture. One patient with vasoplegic syndrome presented with postoperative renal failure and graft rejection, requiring another liver transplantation, and the other patient did not survive.

Most episodes of hemodynamic instability after liver graft reperfusion are due to postreperfusion syndrome, and the occurrence of vasoplegic syndrome is very rare and is associated with poor prognosis.

Candida species are known as one of the most prevalent agents causing opportunistic gastrointestinal infections in immunodeficient patients.

In this study, species distribution of Candida was determined in pediatric heart transplant recipients with and without gastrointestinal symptoms.

In this study, 59 stool samples were collected from heart transplant recipients including patients with and without gastrointestinal symptoms aged between 1-17 years. The patients underwent heart transplant surgery at Rajaei Cardiovascular, Medical & Research Center, in Tehran. Sabouraud dextrose agar was used for the initial culture, and CHROMagar Candida media were used for initial differentiation. Definitive species identification of Candida isolates was performed using PCR-RFLP and sequencing following DNA extraction.

In the present study 13 (22 %) overgrowth isolates associated with patients with gastrointestinal symptoms were positive for Candida spp. using microscopy and culture. The Candida spp. including C. albicans 5 (38.5%), C. glabrata 4 (30.7%), C. guilliermondii 2 (15.4%), and mixed infection of C. albicans and C. glabrata 2 (15.4%) were identified.

C. albicans was the predominant species in pediatric heart transplant recipients with Candida intestinal colonization that was substantiated by the presence of pseudohyphae on microscopy, which could be consider as an evidence of invasion.

Liver transplantation is the main treatment for tyrosinemia. The pre-operative conditions such as presence of failure to thrive (FTT) would affect the prognosis of transplant recipients.

To test whether the survival rate of liver transplant recipients with tyrosinemia was associated with pre-operative presence or absence of FTT.

In a historical cohort study, the survival rate of 42 liver transplant recipients with FTT was compared with that of 68 patients without FTT during 6 months of the transplantation. Kaplan-Meier survival analysis and Cox regression were used for data analysis.

The recipients with and without FTT were matched for age, sex, baseline laboratory test results, and the frequency distribution of the underlying diseases. 35 (83%) of 42 recipients with FTT and 29 (43%) of 68 without FTT had rickets (p<0.001). Histopathological study of the resected livers revealed that 50% of those with FTT and 77% of recipients without FTT had hepatocellular carcinoma or hepatoblastoma (p=0.015). Recipients with FTT were followed for a median (IQR) of 62 (23–99) days; those without FTT, 31 (6–85) days. During the follow-up period, 9 (21%) of 42 recipients with FTT and 32 (47%) of 68 without FTT died. Recipients with FTT had a significantly (p=0.013) better survival. Presence of FTT in recipients was associated with a 65% reduction (HR 0.35, 95% CI 0.158–0.776) in the risk of death within 6 months of the transplantation.

Presence of FTT in patients with tyrosinemia undergoing liver transplantation, would significantly decrease the short-term mortality rate in transplant recipients.

The seroconversion rate is lower in response to COVID-19 vaccination in immunocompromised patients.

This study aimed to investigate the humoral immune response and short-term clinical outcomes in kidney transplant recipients vaccinated with the SARS-CoV-2 vaccine (BBIBP-CorV; Sinopharm).

This prospective cohort was conducted from May to December 2021 in Abu Ali Sina Hospital, Iran. All kidney transplant recipients older than 18 received two doses of the Sinopharm vaccine four weeks apart. Immunogenicity was assessed by evaluating antibodies against the receptor-binding domain (RBD) of SARS-CoV-2 after the first and second vaccine doses. Patients were followed up for six months after vaccination.

Out of 665 kidney transplant patients, 76 patients (11.43%) and 182 patients (27.37%) had acceptable anti-S-RBD immunoglobulin G (IgG) levels after the first and second doses. Forty-six patients (6.91%) were infected with COVID-19, which led to the hospitalization of 34 (5.11%) of them. No deaths were recorded during the follow-up period. An increase in serum creatinine was detected in 86 (12.93%) studied patients. The predominant adverse reactions reported in patients were fatigue, headache, and injection site pain.

Our findings showed that the humoral response rate of kidney transplant recipients to the Sinopharm vaccine is relatively low, and receiving the third dose of the vaccine seems reasonable to a large extent. Also, the care of the COVID-19 disease in people who are in the first year after receiving a kidney transplant should be more accurate and intensive.

 Using kidneys from deceased donors with acute kidney injury (AKI) is one of the options to expand the donor pool. Several studies have reported on the transplantation of kidneys with donor AKI with favorable outcomes. This study aimed to demonstrate the outcomes of kidney transplantation cases where deceased donors developed AKI before organ procurement and show the comparison between the AKI and non-AKI donor kidneys.

 A systematic literature search and meta-analysis of the PubMed and ClinicalTrials.gov registry was performed. A three-stage independent screening method was applied. The inclusion criteria for this review were published prospective, retrospective, clinical trials, and systematic reviews studies using AKI donor kidneys and compared them to non-AKI donor kidneys.
eGFR, serum creatinine level, delayed graft function rate, length of stay and graft, and patient survival rate were demonstrated. 

 18 articles that had AKI kidney functions after transplantation and patients and graft survival rate were included in this meta-analysis. DGF rate was significantly higher in recipients of AKI donor kidneys as expected (P = < 0.00001). Acute rejection, allograft, and patient one and five-year survival rates were comparable, and the difference was not significant.

 Our systematic review shed light on the importance of considering AKI donor kidneys as a source of donor pool expansion and provides more evidence that transplantation of kidneys with AKI has comparable results to non-AKI kidneys, and transplant centers may consider using AKI kidneys more often, which results in kidney donor pool.

British Columbia Transplant (BCT) modified the tacrolimus (TAC) target guideline for patients beyond 6 months post-transplant from 4–6 μg/L to 5–7 μg/L in 2021. Although TAC is the mainstay medication used in the prevention of allograft rejection in kidney transplants, optimal target concentration is still being actively researched and guidelines differ locally. This retrospective case series as a part of a QI project aims to explore the relationship between TAC values < 5 μg/L and the occurrence of biopsy proven acute rejections (BPAR). TAC and serum creatinine values one-year leading to BPAR were collected from 6 patients (PT1–6) in total. One out of the six patients showed TAC trough mean significantly < 5 μg/L (P = 0.0002) while four out of six patients experienced levels < 5 μg/L on at least one occasion. It is observed that baseline-altering drops in TAC were consistently followed by measurable renal function decline which is a potential determinant of BPAR. Further, TAC variability in patients is suggested as a contributing factor for rejections. The previous guideline of 4 μg/L minimum is seen to be effective in some patients and insufficient in others. In result, targeting > 5 μg/L may be beneficial to a wider range of patients when used as a general guideline.