Cytomegalovirus (CMV) remains an important pathogen in organ transplant patients. However, cutaneous lesions are rare manifestation of systemic CMV infection. We report a case of CMV panniculitis in a 47-year-old renal transplant recipient. She admitted due to fever, local pain in the left pelvic area, and erythematous tender palpable mass for 2 weeks. Twenty years ago, she underwent renal transplantation and had taken azathioprin 100 mg and prednisone 10 mg daily. Serum creatinine had been preserved between 2.5 and 3.5 mg/dL. Bacterial, fungal, and AFB cultures of skin lesion and drained pus were negative. CMV antigenemia was noted. Skin biopsy revealed multinucleated dermal histiocytes and positive for CMV antibody by immunohistochemical staining. Polymerase chain reaction testing of skin tissue and drained pus revealed CMV DNA. She was treated with ganciclovir for four weeks and skin lesion was completely resolved without recurrence.
Biopsy ; Creatinine ; Cytomegalovirus* ; DNA ; Fever ; Ganciclovir ; Histiocytes ; Humans ; Kidney Transplantation* ; Middle Aged ; Panniculitis* ; Polymerase Chain Reaction ; Prednisone ; Recurrence ; Skin ; Suppuration ; Transplantation ; Transplants

Kidney Transplantation* ; Respiratory Distress Syndrome, Adult ; Tuberculosis, Miliary*

Varicella is usually a benign childhood disease, while in the adult is an infrequent but potentially serious infection. Varicella pneumonia is a potentially life-threatening complication that should be suspected in any adult with chickenpox and respiratory symptoms. In the adult it may be complicated by pneumonia with high morbidity and mortality rates. We present a case of varicella pneumonia complicated the course of chickenpox in the living-related donor renal transplant recipient. A 30-year-old male received an allograft kidney from his father following treatment with cyclosporine and low-dose steroids. Allograft function was stable over the next 27 months. He was admitted hospital with a week history of generalized varicelliform rash, malaise, fever, chills and a cough. Three weeks ago, his nephew (7-year-old) had chickenpox who was living together in the same house. On examination he looked severely ill, febrile and his skin was covered with typical chickenpox eruption. Auscultatory examination was unremarkable while chest X-rays revealed bilateral interstitial infiltration. HRCT findings showed multiple variable sized nodules, patchy ground-glass opacities, and some consolidation in both lower lung. Treament with i.v. acyclovir was started and continued for 10 days. The patient response to the treatment was excellent with complete resolution of pneumonia.
Acyclovir ; Adult* ; Allografts ; Chickenpox* ; Chills ; Cough ; Cyclosporine ; Exanthema ; Fathers ; Fever ; Humans ; Kidney ; Kidney Transplantation* ; Lung ; Male ; Mortality ; Pneumonia* ; Skin ; Steroids ; Thorax ; Tissue Donors ; Transplantation

PURPOSE: Results of the US randomized, comparative, multicenter study demonstrated that tacrolimus (Tac) was equivalent to cyclosporine (CyA) in 1-year patient and graft survival in recipients of cadaveric renal transplants. However, the incidence and severity of acute rejection was significantly lower in Tac-treated patients compared with CyA-treated patients. This retrospective, non-randomized single center study represents results of follow-up to 3 years posttransplant. METHODS: A total of 97 kidney transplant recipients were included; 41 received Tac-based immunosuppression, and 56 received CyA-based immunosuppression and followed for 3 years posttransplant. Serious adverse events were also monitored over 3 years. RESULTS: The three-year patient survival rates were 95.0% and 96.5% for Tac and CyA, respectively (P=NS). Corresponding graft survival rates were 90.2% and 91.0%, respectively (P=NS). However, the incidence of acute rejection was significantly less in the Tac-group compared with the CyA-group (17.1% vs. 35.7%, P=0.043). The rate of crossover was significantly higher in the CyA-group (4.9% vs. 21.4%, P=0.013). Renal function at 3 years was similar in both treatment groups. The incidence of posttransplant diabetes mellitus (PTDM), head-ache and alopecia was significantly less in the CyA-group, and that of hypertension, hypercholesterolemia after transplantation was significantly less in Tac-group. The incidence of hirsutism and gingival hyperplasia was negligible in Tac-group. Incidence of hand tremor, hyperkalemia, bacterial and viral infection, and malignancy was comparable in both groups. The incidence of PTDM was significantly less in CyA-group (26.8% vs. 7.1%, P=0.008). Nine (81.8%) of the 11 Tac patients with PTDM were off of insulin at 3 years. CONCLUSIONS: Tacrolimus is a very effective primary immunosuppressive agent in renal transplant recipient. The reduced incidence of acute rejection along with decreased incidence of hypertension and hyperlipidemia after transplantation suggests potential long-term advantage with the use of this drug.
Alopecia ; Cadaver ; Cyclosporine ; Diabetes Mellitus ; Follow-Up Studies ; Gingival Hyperplasia ; Graft Survival ; Hand ; Hirsutism ; Humans ; Hypercholesterolemia ; Hyperkalemia ; Hyperlipidemias ; Hypertension ; Immunosuppression ; Incidence ; Insulin ; Kidney Transplantation* ; Kidney* ; Retrospective Studies ; Survival Rate ; Tacrolimus* ; Transplantation ; Tremor

PURPOSE: Five hundreds of renal transplantation were performed in the our institute from November, 1982 to April, 2000. During this period, there were two big changes of immunosuppressive regimen. These are introduction of cyclosporin microemulsion formula (Neoral(R)) in April, 1994 and mycophenolate mofetil (MMF) in April, 1997. So, the result of our 500 consecutive renal transplantation was analysed and compared according to the regimen. METHODS: We analysed the result of our 500 renal transplantation by retrospective chart review. And we compared the result according to the regimen. RESULTS: Mean age of recipients were 33.6 years and male to female ratio was 2.14 : 1. There was 18 retransplantation and 18 pediatric transplantation. Overall 1 year, 3 year and 5 year graft survial was 95.38%, 81.65% and 70.56%. And the patient survival was 96.78%, 92.31% and 89.46%, respectively. Before the introduction of Neoral(R)(n=285), acute rejection during first 6 months (AR6mo) was 0.52+/-1.09 and serum creatinine level at 12 months posttranplant (Cr12mo) was 1.954+/-1.488 and 1 year (1YSR), 3 year (3YSR) and 5 year (5YSR) graft survival was 93.64%, 77.66% and 65.32%. After introduction of Neoraland before MMF (n=134), AR6mo and Cr12mo was 0.62+/-1.83 and 1.625+/-1.203 and 1YSR, 3YSR and 5YSR was 96.27%, 87.03% and 79.97%, respectively. After addition of MMF (n=74), AR6mo and Cr12mo was 0.19+/-0.39 and 1.434+/-0.773 and 1YSR and 3 YSR was 95.93% and 95.93%. Because of short term follow up for the last group, long term survival rate was indefinable. CONCLUSION: With advancement of immunosuppressive agents and accumulation of clinical experiences, short term result of the kidney transplantation was improved. Further evaluation of long term result is needed.
Creatinine ; Cyclosporine ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Immunosuppressive Agents ; Kidney Transplantation* ; Male ; Retrospective Studies ; Survival Rate ; Transplants

Herpes simplex esophagitis usually occurs in immunocompromised or severely debilitated patients. Odynophagia and dysphagia are major symptoms and the prognosis of immunocompromised patients is variable. We present the case of a cadeveric donor renal transplantation recipient who developed herpes simplex esophagitis shortly after anti-rejection therapy. A 43-years-old female had cadaveric renal transplantation and following treatment with cyclosporine, prednisolone, mycophenolate mofetile. Twelve months later, renal insufficieny and proteinuria were developed. Allograft kidney biopsy showed some evidence of acute rejection. She was treated with 3 successive days of intravenous methylpredinisolone (500 mg/d) therapy and continued tapering of steroids. Two weeks later, she had oral cavity ulceration, odynophagia, dysphagia, epigastric pain, and nausea. Esophagoscopy reveals multiple confluent ulceration in the whole part of esophagus and biopsies showed the epithelial cell were enlarged with prominent nuclei. Immunohistochemically, the epithelial cell were positive with a monoclonal antibody to herpes simplex virus type 1. Treatment was started on intravenous ayclovir and changed to oral agent for 10 days. After treatment, her symptoms and repeat endoscopic findings were improved.
Allografts ; Biopsy ; Cadaver* ; Cyclosporine ; Deglutition Disorders ; Epithelial Cells ; Esophagitis* ; Esophagoscopy ; Esophagus ; Female ; Herpes Simplex* ; Herpesvirus 1, Human ; Humans ; Immunocompromised Host ; Immunosuppression ; Kidney ; Kidney Transplantation* ; Mouth ; Nausea ; Prednisolone ; Prognosis ; Proteinuria ; Steroids ; Tissue Donors ; Ulcer

The risk of tuberculosis in renal transplant recipients may be related to immunosuppressive therapy, and it continues to complicate transplantation in the cyclosporine era. Extrapulmonary manifestation and dissemination also common clinical findings in the transplant recipients. Intestinal tuberculosis that develops with the involvement of other organs is common. We present a case of tuberculous intestinal perforation in the living-related donor renal transplant recipient. A 42-year-old male was admitted because of sudden onset acute abdomen. In April 1995, he received allograft kidney from HLA-identical sister following treatment with cyclosporine-A and low-dose steroids. Allograft function was stable over the next 36 months. About 3 years later, multiple cervical lymph node swelling was observed. Initial lymph node biopsy was performed, which showed granulomatous lesions with positive AFB stain. The patient was treated with antituberculous therapy regimen included isoniazid, ethambutol and rifampicin for a month. A ultrasonography and CT of the abdomen showed multiple adhesions in the peritoneum and enlargement of the mesenteric lymph nodes. A laparatomy finding was inflammatory thickening of the bowel wall in the terminal ileum with necrotic perforation. The involved terminal ileum was removed together with end-to-end anastomosis and peritoneal lavage was done. The patient was improved two weeks after surgical laparotomy.
Abdomen ; Abdomen, Acute ; Adult ; Allografts ; Biopsy ; Cyclosporine ; Ethambutol ; Humans ; Ileum ; Intestinal Perforation* ; Isoniazid ; Kidney ; Kidney Transplantation* ; Laparotomy ; Lymph Nodes ; Male ; Peritoneal Lavage ; Peritoneum ; Rifampin ; Siblings ; Steroids ; Tissue Donors ; Transplantation ; Tuberculosis ; Tuberculosis, Lymph Node ; Ultrasonography

PURPOSE: The medical records of 524 renal recipients who have been transplanted until December 2000 in our hospital were reviewed in order to compare the incidence of the surgical and medical complications according to their different treatment protocols. METHODS: To compare the surgical complications, the recipients were divided according to their ureter reconstruction method and donor type. Group 1; living donor and modified Politano method are done. Group 2; living donor but an extravesical ureteroneocystostomy. Group 3; cadaver donor and an extravesical anastomosis. Regarding the medical complications, recipients who received Sandimmun based immunosuppression (with steroid and/or azathioprine) were grouped as 1, those recipients with Neoral based immunosuppression (with steroid and/or cellcept) were grouped as 2, and re-cipients immunosuppressed by prograf based immunosuppression (with steroid and/or cellcept) were grouped as 3. The incidence of complications and adverse effects in each group and per recipient were described as the percentage of the total incidence. RESULTS: Most of the surgical complications including an allograft rupture, ureteral fistula, lymphocele and reoperation due to bleeding were developed during the first month after transplantation but decreasing in group 2 and 3. An ureter stricture and renal artery stenosis developed after 6 months. Infectious complications were developed in 60.7% of recipients and among them, a viral infection occurred in 41.9% which was followed by bacterial and fungal infection. However, the incidence of infection also decreased in group 3. Herpes infections were the most common in viral infection and their incidence showed a dual peak (within 6 months and after 1 year). The recurrence of the original disease, mostly a focal sclerosing glomerulosclerosis, and de novo cancer showed lower incidence in group 3 but the follow up duration should be considered. Tremor and hirsutism are two of the most common adverse effects but showed a different incidence in group 3. Some side effects such as diarrhea, post-transplant diabetes were more common in group 3 than in group 1 and 2. CONCLUSION: The decreasing incidence of complications and the drug side effects in recent days might be due to a better understand of the surgical procedures and the development of new immunosuppressants. However, new side effects or toxicity by new immunosuppressant must be considered seriously.
Allografts ; Cadaver ; Clinical Protocols ; Constriction, Pathologic ; Cyclosporine ; Diarrhea ; Fistula ; Follow-Up Studies ; Hemorrhage ; Hirsutism ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Incidence ; Kidney Transplantation* ; Living Donors ; Lymphocele ; Medical Records ; Recurrence ; Renal Artery Obstruction ; Reoperation ; Rupture ; Tacrolimus ; Tissue Donors ; Tremor ; Ureter

PURPOSE: Tacrolimus (FK-506) represents a major advance in the prevention of rejection following solid organ transplantation. Previous clinical trials in Japan, Europe, and the US suggest that tacrolimus is an effective primary immunosuppressive agent in kidney transplantation. This prospective, non-randomized single center study was done to confirmed the efficacy of tacrolimus in kidney transplantation. METHODS: A total of 50 renal transplant recipients who followed-up at least one year after transplantation was included in this study. Thirty six cases (72%) recived triple drug therapy consists of tacrolimus, mycophenolate mofetil (MMF), and low dose steroid. RESULTS: The overall incidence of acute rejection was 10%, all episodes of rejection were treated effectively with steroid pulse therapy. The incidence of treatment failure was six percent. One and two year graft survival were 98% and 96%, respectively. Adverse effects of tacrolimus therapy included tremor of the hand (56%), diarrhea (34%), alopecia (26%), hyperkalemia (22%), nephrotoxicity (18%), post transplant diabetes mellitus (14%), hypertension (14%), and hypercholesterolemia (10%). However, the incidence of gum hypertrophy and hirsutism were 6% and 2%, respectively. CONCLUSION: This short-term study indicates that tacrolimus appears to provide safe and effective primary immunosuppression in kidney transplantation.
Alopecia ; Diabetes Mellitus ; Diarrhea ; Drug Therapy ; Europe ; Gingiva ; Graft Survival ; Hand ; Hirsutism ; Hypercholesterolemia ; Hyperkalemia ; Hypertension ; Hypertrophy ; Immunosuppression* ; Incidence ; Japan ; Kidney Transplantation* ; Organ Transplantation ; Prospective Studies ; Tacrolimus* ; Transplantation ; Transplants ; Treatment Failure ; Tremor

BACKGROUND: TGF-beta is involved in the pathogenesis of various kidney diseases characterized by glomerulosclerosis and tubulointerstitial fibrosis. It is reported that urinary TGF-beta reflects the grade of interstitial fibrosis in glomerular disease. Here, we evaluated the relationship between the histological findings and beta ig-h3 in IgA nephropathy. METHODS: In patients with IgA nephropathy, we measured blood pressure (BP), serum creatinine, 24-hour urinary protein excretion (UTp), creatinine clearance (Ccr), serum and urine beta ig-h3 levels, and urine TGF-beta levels at the time of renal biopsy. Histologic findings were semiquantitively scored according to the extent of glomerulosclerosis (GG), tubulointerstitial fibrosis (TIG) and hyaline arteriolosclerosis (HA) by the criteria suggested by To. Semiquantitive scoring of immunohistochemistry for beta ig-h3 was done. RESULTS: Mean BP 95.4+/-14.5 mmHg, serum creatinine 1.06+/-0.35 mg/dL, 24-hour UTp 1, 423+/-1, 439 mg/day, and Ccr was 97.84+/-59.73 mL/min. The number of patients that showed GG 3 were 5, GG 2 was 1, GG 1 were 12. And, the number of patients that showed TIG 3 were 2, TIG 2 were 5, TIG 1 were 11. HA was shown in 4 patients. beta ig-h3 immunostaining was observed in glomerular Bowman's capsules and basement membrane of proximal tubules. The degree of beta ig-h3 immunostaining was positively correlated with the degree of glomerulosclerosis (r=0.72, p<0.001), interstitial fibrosis (r=0.91, p<0.001), serum creatinine (r=0.592, p<0.05) and Ccr (r=-0.626, p<0.05), but not with 24-hour UTp. Serum and urine beta ig-h3 levels did not correlate with any of these parameters. CONCLUSION: Renal beta ig-h3 expression in patients with IgA nephropathy may be related to glomerulosclerosis and interstitial fibrosis. However, urinary beta ig-h3 levels did not represent the pathologic changes of IgA nephropathy. Long-term study to measure renal beta ig-h3 expression and urinary beta ig-h3 is required to elucidate the roles of beta ig-h3 in IgA nephropathy.
Arteriolosclerosis ; Basement Membrane ; Biopsy ; Blood Pressure ; Capsules ; Creatinine ; Fibrosis ; Glomerulonephritis, IGA* ; Humans ; Hyalin ; Immunoglobulin A* ; Immunohistochemistry ; Kidney Diseases ; Transforming Growth Factor beta ; Uridine Triphosphate