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The use of intravesical cidofovir for the treatment of adenovirus-associated haemorrhagic cystitis in a kidney transplant recipient.

ABSTRACT: Adenovirus is an important cause of haemorrhagic cystitis in kidney transplant recipients. The optimal treatment for adenovirus-associated haemorrhagic cystitis (AAHC) is unknown. Intravenous cidofovir may be effective, but nephrotoxicity is a major concern. The use of intravesical cidofovir for viral haemorrhagic cystitis has been reported in haematopoietic stem cell transplant recipients and may be associated with a lower risk of nephrotoxicity, but its use has not been reported in kidney transplant recipients. We report the use of intravesical cidofovir for the treatment of AAHC in a kidney transplant recipients, along with a review of the literature.

SUBMITTER: Ho QY

PROVIDER: S-EPMC6768302 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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The use of intravesical cidofovir for the treatment of adenovirus-associated haemorrhagic cystitis in a kidney transplant recipient.

Ho Quan Yao QY Tan Chieh Suai CS Thien Siew Yee SY Kee Terence T Chlebicki Maciej Piotr MP

Clinical kidney journal 20190218 5

Adenovirus is an important cause of haemorrhagic cystitis in kidney transplant recipients. The optimal treatment for adenovirus-associated haemorrhagic cystitis (AAHC) is unknown. Intravenous cidofovir may be effective, but nephrotoxicity is a major concern. The use of intravesical cidofovir for viral haemorrhagic cystitis has been reported in haematopoietic stem cell transplant recipients and may be associated with a lower risk of nephrotoxicity, but its use has not been reported in kidney tran ...[more]

PMID: 31583099

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Project description:Rationale & objectiveKidney function can be adversely affected by significant tricuspid regurgitation (TR) owing to effects on cardiac output and systemic venous congestion. However, the impact of significant TR on short- and long-term kidney function following a kidney transplant remains uncertain.Study designRetrospective observational cohort.Setting & participantsKidney transplant recipients from a single center between 2016 and 2019.ExposureSignificant TR, defined by at least moderate regurgitation, on echocardiogram before kidney transplantation.OutcomesPrimary end points included the estimated glomerular filtration rate (eGFR) at the following 3 time points: 2 weeks, 3 months, and 1 year after transplantation. Secondary end points included major adverse cardiac events including nonfatal myocardial infarction, all-cause mortality, and hospitalization owing to cardiovascular disease.Analytical approachPropensity score matching was performed in 1:3 ratio between patients treated with significant TR and controls, within a caliper 0.05 standard deviation of the propensity score, to analyze for the primary end point.ResultsAmong 557 kidney transplant recipients, 26 (5%) exhibited significant TR pretransplantation. According to propensity score matching analysis, with 1:3 ratio between 24 patients with significant TR and 72 controls, the presence of significant TR was associated with a lower eGFR posttransplantation. Specifically, the mean eGFR was 41.2 mL/min/1.73 m2 compared to 53.3 mL/min/1.73 m2 at 2 weeks (P < 0.01), 50.0 mL/min/1.73 m2 versus 60.3 mL/min/1.73 m2 at 3 months (P < 0.01), and 49.4 mL/min/1.73 m2 versus 61.2 mL/min/1.73 m2 at 1 year (P < 0.01). Delayed graft function was observed in 41.7% of the patients with significant TR compared to 12.5% of those without significant TR (P < 0.01). No patients with significant TR required dialysis after 1 year. 1-year major adverse cardiac events were nonsignificantly higher among patients with significant TR (20.8% vs 8.1%; P = 0.16).LimitationsRetrospective design and relatively small TR population.ConclusionsThe presence of significant TR among kidney transplant recipients was associated with a lower eGFR at 2 weeks, 3 months, and 1 year following transplant, although all remained dialysis independent at 1 year.

Project description:BackgroundThe Living Kidney Donor Profile Index (LKDPI) was derived in a cohort of kidney transplant recipients (KTR) from the United States to predict the risk of total graft failure. There are important differences in patient demographics, listing practices, access to transplantation, delivery of care, and posttransplant mortality in Canada as compared with the United States, and the generalizability of the LKDPI in the Canadian context is unknown.ObjectiveThe purpose of this study was to externally validate the LKDPI in a large contemporary cohort of Canadian KTR.DesignRetrospective cohort validation study.SettingToronto General Hospital, University Health Network, Toronto, Ontario, Canada.PatientsA total of 645 adult (≥18 years old) living donor KTR between January 1, 2006 and December 31, 2016 with follow-up until December 31, 2017 were included in the study.MeasurementsThe predictive performance of the LKDPI was evaluated. The outcome of interest was total graft failure, defined as the need for chronic dialysis, retransplantation, or death with graft function.MethodsThe Cox proportional hazards model was used to examine the relation between the LKDPI and total graft failure. The Cox proportional hazards model was also used for external validation and performance assessment of the model. Discrimination and calibration were used to assess model performance. Discrimination was assessed using Harrell's C statistic and calibration was assessed graphically, comparing observed versus predicted probabilities of total graft failure.ResultsA total of 645 living donor KTR were included in the study. The median LKDPI score was 13 (interquartile range [IQR] = 1.1, 29.9). Higher LKDPI scores were associated with an increased risk of total graft failure (hazard ratio = 1.01; 95% confidence interval [CI] = 1.0-1.02; P = .02). Discrimination was poor (C statistic = 0.55; 95% CI = 0.48-0.61). Calibration was as good at 1-year posttransplant but suboptimal at 3- and 5-years posttransplant.LimitationsLimitations include a relatively small sample size, predicted probabilities for assessment of calibration only available for scores of 0 to 100, and some missing data handled by imputation.ConclusionsIn this external validation study, the predictive ability of the LKDPI was modest in a cohort of Canadian KTR. Validation of prediction models is an important step to assess performance in external populations. Potential recalibration of the LKDPI may be useful prior to clinical use in external cohorts.

Project description:Background: Urolithiasis of transplant kidneys usually encompasses a challenging clinical situation due to specific anatomical conditions and the patients' immunological status. In this case report, we describe the treatment of a rare Proteus mirabilis matrix staghorn stone applying percutaneous nephrolithotomy in combination with matrix stone extraction by morcellation while utilizing endo-urological equipment designed for transurethral prostate surgery. Case Presentation: We present the case of a 44-year-old Caucasian woman who had undergone a post-mortal kidney transplant at age 37. After recurrent urinary tract infections, symptomatic obstructions of the transplant ureter, and multiple surgical interventions (73 Double-J stent and nephrostomy placements and three ureter re-implantations), permanent percutaneous nephrostomy drainage was established 6 years after her kidney transplantation. The patient was referred to our department due to recurrent dysfunction of the nephrostomy tube caused by blockage due to stone-matrix material and a staghorn calculus in the transplant kidney's collecting system. Microbiological examination of the stone material retrieved from the nephrostomy tube revealed massive P. mirabilis contamination. In this work, we present a novel percutaneous technique of matrix stone removal by relying on endoscopic equipment usually employed during prostate surgery by urologists. Conclusion: Percutaneous matrix stone morcellation is a technically challenging but feasible method that might be considered as a salvage treatment strategy in situations described earlier and in highly selective cases. However, for this extremely rare stone entity and individual clinical presentations, matrix stone morcellation seems to be a reasonable alternative before considering more radical interventions such as open nephrolithotomy. Selection criteria are a very soft stone, large-caliber percutaneous access to the collecting system, and enough space in the collecting system to execute morcellation.

Dataset Information

The use of intravesical cidofovir for the treatment of adenovirus-associated haemorrhagic cystitis in a kidney transplant recipient.

Publications

The use of intravesical cidofovir for the treatment of adenovirus-associated haemorrhagic cystitis in a kidney transplant recipient.

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