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Allograft artery mycotic aneurysm after kidney transplantation: A case report and review of literature

World Journal of Clinical Cases 2020年第5期8卷 912-921页

作者： Marco Bindi Mariano Ferraresso Maria Letizia De Simeis Nicholas Raison Laura Clementoni serena delbue Marta Perego Evaldo Favi Renal Transplantation Fondazione IRCCS Ca’Granda Ospedale Maggiore PoliclinicoMilan 20122Italy Department of Clinical Sciences and Community Health University of MilanMilan 20122Italy MRC Centre for Transplantation King’s College LondonLondon WC2R 2LSUnited Kingdom Department of Biomedical Surgical and Dental SciencesUniversity of MilanMilan 20100Italy

BACKGROUND Allograft artery mycotic aneurysm(MA)represents a rare but life-threatening complication of kidney *** is widely considered the safest *** to the rarity of the disease and the substantial risk of fatal consequences,experience with conservative strategies is *** date,only a few reports on surgical repair have been *** describe a case of true MA successfully managed by aneurysm resection and arterial *** SUMMARY An 18-year-old gentleman,on post-operative day 70 after deceased donor kidney transplantation,presented with malaise,low urinary output,and worsening renal *** organ preservation fluid cultures,collected at the time of surgery,were positive for Candida *** ultrasound and contrastenhanced computer tomography showed a 4-cm-sized,saccular aneurysm of the iuxta-anastomotic segment of the allograft artery,suspicious for *** lesion was wide-necked and extended to the distal bifurcation of the main arterial branch,thus preventing endovascular stenting and *** multidisciplinary discussion,the patient underwent surgical exploration,aneurysm excision,and re-anastomosis between the stump of the allograft artery and the internal iliac *** procedure was *** and microbiology evaluation of the surgical specimen confirmed the diagnosis of MA caused by Candida *** years after the operation,the patient is doing very well with excellent allograft function and no signs of recurrent *** Surgical repair represents a feasible option in carefully selected patients with allograft artery ***-fungal prophylaxis is advised when preservation fluid cultures are positive.

关键词： Aneurysm Candida Kidney transplant Infection Complication Case report

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Systematic review of ablative therapy for the treatment of renal allograft neoplasms

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World Journal of Clinical Cases 2019年第17期7卷 2487-2504页

作者： Evaldo Favi Nicholas Raison Federico Ambrogi serena delbue Maria Chiara Clementi Luca Lamperti Marta Perego Matteo Bischeri Mariano Ferraresso Renal Transplantation Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilan 20122Italy MRC Centre for Transplantation King’s College LondonLondon WC2R 2LSUnited Kingdom Department of Clinical Sciences and Community Health University of MilanMilan 20122Italy Department of Biomedical Surgical and Dental SciencesUniversity of MilanMilan 20100Italy

BACKGROUND To date,there are no guidelines on the treatment of solid neoplasms in the transplanted ***,allograft nephrectomy has been considered the only reasonable *** recently,nephron-sparing surgery (NSS) and ablative therapy (AT) have been proposed as alternative procedures in selected *** To review outcomes of AT for the treatment of renal allograft *** We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 *** was searched in March 2019 without time restrictions for all papers reporting on radiofrequency ablation (RFA),cryoablation (CA),microwave ablation (MWA),high-intensity focused ultrasound (HIFU),and irreversible electroporation (IRE) of solid tumours of the kidney *** original manuscripts describing actual cases and edited in English were *** relevant articles were accessed in full *** searches included all pertinent *** studies were also assessed for methodological quality using a tool based on a modification of the Newcastle Ottawa *** on recipient characteristics,transplant characteristics,disease characteristics,treatment protocols,and treatment outcomes were extracted and *** the nature and the quality of the studies available (mostly retrospective case reports and small retrospective uncontrolled case series),a descriptive summary was *** Twenty-eight relevant studies were selected describing a total of 100 AT procedures in 92 *** age at diagnosis ranged from 21 to 71 years whereas time from transplant to diagnosis ranged from 0.1 to 312 *** of the neoplasms were asymptomatic and diagnosed incidentally during imaging carried out for screening purposes or for other clinical *** diagnostic modality was Doppler-ultrasound scan followed by computed tomography scan,and magnetic resonance *** tumour types were: pa

关键词： Ablative therapy Cryoablation Radiofrequency ablation Microwave ablation High-intensity focused ultrasonography Irreversible electroporation Neoplasm Kidney transplant Renal allograft Systematic review

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Incidence, risk factors, and outcome of BK polyomavirus infection after kidney transplantation

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World Journal of Clinical Cases 2019年第3期7卷 270-290页

作者： Evaldo Favi Carmelo Puliatti Rajesh Sivaprakasam Mariano Ferraresso Federico Ambrogi serena delbue Federico Gervasi Ilaria Salzillo Nicholas Raison Roberto Cacciola Renal Transplantation Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico Renal Transplantation Barts Health NHS Trust Royal London Hospital Department of Clinical Sciences and Community Health University of Milan Department of Biomedical Surgical and Dental Sciences University of Milan MRC Centre for Transplantation King’s College London

BACKGROUND Polyomavirus-associated nephropathy is a leading cause of kidney allograft failure. Therapeutic options are limited and prompt reduction of the net state of immunosuppression represents the mainstay of treatment. More recent application of aggressive screening and management protocols for BK-virus infection after renal transplantation has shown encouraging results. Nevertheless,long-term outcome for patients with BK-viremia and nephropathy remains obscure. Risk factors for BK-virus infection are also *** To investigate incidence, risk factors, and outcome of BK-virus infection after kidney *** This single-centre observational study with a median follow up of 57(31-80) mo comprises 629 consecutive adult patients who underwent kidney transplantation between 2007 and 2013. Data were prospectively recorded and annually reviewed until 2016. Recipients were periodically screened for BK-virus by plasmaquantitative polymerized chain reaction. Patients with BK viral load ≥ 1000 copies/mL were diagnosed BK-viremia and underwent histological assessment to rule out nephropathy. In case of BK-viremia, immunosuppression was minimized according to a prespecified protocol. The following outcomes were evaluated: patient survival, overall graft survival, graft failure considering death as a competing risk, 30-d-event-censored graft failure, response to treatment,rejection, renal function, urologic complications, opportunistic infections, newonset diabetes after transplantation, and malignancies. We used a multivariable model to analyse risk factors for BK-viremia and *** BK-viremia was detected in 9.5% recipients. Initial viral load was high(≥ 10000 copies/mL) in 66.7% and low(< 10000 copies/mL) in 33.3% of these ***-associated nephropathy was diagnosed in 6.5% of the study population. Patients with high initial viral load were more likely to experience sustained viremia(95% vs 25%, P < 0.00001), nephropathy(92.

关键词： Polyomavirus BK virus Kidney transplantation Outcome Risk factors Immunosuppression Human leukocyte antigen Rejection Cytomegalovirus Ethnicity

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