Grand Round in Transplant Nephrology

  1.  Approach on How to Work up a Kidney Transplant Candidate with Multiple Co-morbidities
  2. Post-transplant graft dysfunction case in high infection area
  3. Post-transplant diabetes in paediatric kidney transplant recipients

Robert Freercks

South Africa

Chih-Wei Yang

Taiwan

Maria Theresa Bad-ang

Phillipines

Fritz Diekmann

Spain

Jamailah Macabanding

Philippines

Arpita Lahiri

India

Aniruddha Datta

India

Debasish Banerjee

UK

Rukshana Shroff

UK

Rouba Garro

USA

Naorem Lakshmee Devi

India

Indira Agarwal

India

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Approach on How to Work up a Kidney Transplant Candidate with Multiple Co-morbidities
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Open to view video. This case involves a 56-year-old male with Ankylosing Spondylitis, developing Chronic Kidney Disease due to chronic NSAID use. Comorbidities include hypertension, gouty arthritis, and nephrolithiasis. Despite being on hemodialysis, he pursued a kidney transplant. Complications during transplant evaluation led to the deferral of the procedure and discontinuation of immunosuppression. Subsequent challenges included septic shock, anaphylactic reactions, severe anemia, and thrombocytopenia, requiring multiple interventions. Postponed transplantation, COVID-19, and a catheter-related bloodstream infection further complicated the patient’s journey. Despite setbacks, he resumed the transplant workup, highlighting the intricate management required in navigating complex medical conditions. Learning objectives: To discuss a case of kidney transplant candidate who has several co-morbidities. To discuss the approach to the work-up of a kidney transplant patient. To evaluate the specific transplantation risk factor related to organ system disease of a transplant candidate. Further reading: Danovitch, Gabriel M., Handbook of Kidney Transplantation. 6th edition, 2017. 2022 American College of Rheumatology/ American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients with Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. Timing of Elective Surgery and Risk Assessment after SARS-CoV-2 Infection:2023 Update Kidney Transplantation in Adults: HLA-incompatible Transplantation Interpreting Anti-HLA Antibody Testing Data: A Practical Guide for Physicians.
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Post-transplant graft dysfunction case in high infection area
Open to view video.  |   Closed captions available
Open to view video.  |   Closed captions available A 42-year-old man with diabetes on hemodialysis received a deceased donor kidney transplantation. Immunosuppression included anti-thymocyte globulin, methylprednisolone followed by tacrolimus, mycophenolate mofetil and prednisolone. A week later a biopsy done due to rising creatinine showed acute tubular necrosis from which he recovered and was discharged. Few days later he was admitted with fever, dry cough, lung nodules which responded to broad spectrum antibiotics. He was readmitted with fever, cough, purulent expectoration, hyperglycemia, klebsiella urine infection, reappearance of lung nodules and AKI requiring dialysis. Aspergillus was isolated from sputum. Learning objectives: Early postoperative graft dysfunction: approach to diagnosis Balancing net Immunosuppression and rejection risk. Improving organ allocation algorithm: minimize over immunosuppression, improve long term outcome
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Post-transplant diabetes in paediatric kidney transplant recipients
Open to view video.  |   Closed captions available
Open to view video.  |   Closed captions available Post transplant Diabetes (PTDM) is a well-recognized complication after Kidney transplantation. Recent updates include recognition of impaired glucose tolerance, optimization of immunosuppression, prevention of PTDM and incorporation of new glucose lowering agents. Peri-transplant hyperglycemia is being increasingly identified and treated in paediatric population. We discuss a case series of children who developed post transplant hyperglycemia. Two of them were asymptomatic, two of them had high tacrolimus levels and two of them required insulin therapy. Optimization of immunosuppression and insulin therapy resulted in resolution of hyperglycaemia. Learning objectives: Describe the course of Post transplant diabetes (PTDM) Outline the challenges of balancing immunosuppressive medications in the presence of post-transplant hyperglycaemia Discuss the prevention and treatment strategies of PTDM. Further reading: Adnan Sharif, Harini Chakkera, Aiko P J de Vries, Kathrin Eller et al International consensus on post-transplantation diabetes mellitus, Nephrology Dialysis Transplantation, Volume 39, Issue 3, March 2024, Pages 531–549 Esteban L. Porrini, Armando Torres, Jose M. Díaz et al, Clinical evolution of post-transplant diabetes mellitus, Nephrology Dialysis Transplantation, Volume 31, Issue 3, March 2016, Pages 495–505 Juan M Munoz Pena, Kenneth Cusi, Posttransplant Diabetes Mellitus: Recent Developments in Pharmacological Management of Hyperglycemia, The Journal of Clinical Endocrinology & Metabolism, Volume 109, Issue 1, January 2024, Pages e1–e11
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