Background: Thrombotic microangiopathy is a severe complication of renal transplantation. Little is known about risk factors, incidence of autoantibodies against complement components, and prognosis. Methods: Clinical and laboratory data were retrospectively collected for 13 patients diagnosed with post-transplant thrombotic microangiopathy (PT-TMA) in 2011-2018. Enzyme-linked immunosorbent assay (ELISA) results were compared to transplant recipients without PT-TMA and healthy controls. Results: Nine patients (69%) had potential PT-TMA risk factors other than exposure to calcineurin inhibitors (CNIs). Stratification by time to PT-TMA yielded two groups. Patients diagnosed within 6 months of transplantation (n = 6) were characterized by positive donor-specific antibody (DSA) test, complement-associated renal disease, and acute rejection. Two had IgG and IgA autoantibodies to complement Factors H and I, respectively. Patients diagnosed ≥ 3 years after transplantation (n = 7) had a high rate of infection. Renal biopsy yielded dense deposits in 6 patients, and only one with primary immune complex renal disease. Within 2 years, graft failure requiring dialysis occurred in 6 patients (46%). Three patients with early-onset PT-TMA showed improved renal function and remained stable under eculizumab treatment. Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disorder (EPTLD) developed in 3 patients, 2 of whom had received eculizumab for more than 5 years. Five patients (39%) died during follow-up. Conclusion: In this study, PT-TMA was associated with other risk factors besides CNI exposure, with differences by time of onset from transplantation. Prognosis was generally poor but better for early-onset PT-TMA managed with eculizumab. The development of late EPTLD in 3 patients raises concerns.

Background: Peritoneal Cancer Index (PCI) and complete cytoreduction are the best outcome predictors following cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Lesions in critical areas, regardless of PCI, complicate surgery and impact oncological outcomes. We prospectively defined "Critical lesions" (CL) as penetrating the hepatic hilum, diaphragm at hepatic outflow, major blood vessels, pancreas, or urinary tract. Methods: Retrospective analysis of a prospective database of 352 CRS + HIPEC patients from 2015 to 2019. Excluded patients with aborted/redo operation (n = 112), or incomplete data (n = 19). Patients categorized by CL status and compared: operative time, estimated blood loss (EBL), PCI, transfusions, hospital stay, post-operative complications and mortality, overall survival (OS) and disease-free survival (DFS). Results: Included 221 patients (78 CL; 143 no-CL). No difference in patients' characteristics: age, BMI, gender or co-morbidities noted. Operative time longer (5.3 h vs 4.3 h, p < 0.01), EBL higher (769 ml vs 405 ml, p < 0.01), transfusions higher (1.9 vs 0.7 Units, p < 0.001) and PCI higher (15.5 vs 9.5, p < 0.01) in CL. No difference in major complications. Postoperative complications, CL, OR-time and transfusions were predictive of OS in univariate analysis, while only complications remained on multivariate analysis. Median follow up of 21.4 months, 3-year DFS/OS was 22% vs 30% (p < 0.037) and 73% vs 87% (p < 0.014) in CL and non-CL, respectively. Despite CL complete resection, 17/38 patients (4 4.7%) that recurred had recurrence at previous CL site. Conclusions: Critical lesions complicate surgery and may be associated with poor oncological outcomes with high local recurrence rate, despite no significant difference in complications. Utilizing adjuvant or intra-operative radiation may be beneficial. (c) 2021 Elsevier Ltd, BASO The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Background:Post liver transplantation anemia (PLTA) in adults is a very common finding, but its characteristics and long‐term effect on major patients’ outcomes is still to be elucidated.Aims:To evaluate PLTA incidence, characteristics and predictors at 6 months (early PLTA) and 2 years (late PLTA) post liver transplantation. In addition, PLTA impact on various long‐term outcomes, including mortality, graft failure or mortality, malignancy and cardiovascular outcomes was assessed.Methods:This is a single center retrospective cohort study using prospectively collected data from a transplantation department registry. Liver transplantations of adult patients between the years 2007–2015 were identified and patients’ medical records evaluated. We assessed PLTA incidence, characteristics and predictors at different time points and evaluated whether PLTA is associated with 4 outcomes: (1) mortality, (2) the composite of mortality or graft failure, (3) major adverse cardiovascular events and (4) malignancy during a follow up of 3 years (available for all patients), as well as during the maximal individual follow‐up for each patient. Characteristics of patients who developed PLTA were compared in a univariate and multivariate analyses in order to find predictors for PLTA. Kaplan‐Meier survival analysis, using the log‐rank test, was used to compare time‐to‐event outcomes. Effect of different variables including PLTA on long term outcomes were evaluated through a univariate and multivariate analysis. Logistic regression was used to calculate univariate and multivariate odds ratios.Results:150 liver transplantations were included in the analysis. There was a 79% prevalence of anemia pre‐transplantation, whereas early and late PLTA were evident in 58% and 40% of patients, respectively. Pre‐transplantation anemia was associated with early PLTA and early PLTA was predictive of late PLTA. PLTA was normocytic, with increased RDW and increased in percentages of hypochromic RBCs. Chronic kidney disease was present in a quarter of patients with anemia. At a follow‐up of 3 years, patients with early PLTA or anemia at 1‐year post transplantation had a higher mortality rate compared with patients with normal hemoglobin level (12.79% vs. 3.17%, P = 0.0442 and 12.86% vs. 2.9%, P = 0.0552, respectively). In a multivariable analysis, existence of early PLTA (odds ratio [OR] 3.838, 95% CI 1.114–13.226) remained significantly associated with mortality or graft failure at 3 years of follow‐up. At a longer follow‐up (mean 5.5 ± 2.5 years) patients with anemia 1 year post transplantation had a higher mortality rate (p = 0.0323) and a higher rate of mortality or graft failure (p = 0.0249, Figure 1) according to survival analysis. Late PLTA was not significantly associated with worse long‐term outcomes.Summary/Conclusion:Early and late PLTA are prevalent among liver transplanted patients. Early PLTA is associated with long‐term mortality or graft failure.image

Background: Acute kidney injury (AKI) was found to be associated with an increased risk of major adverse cardiovascular events (MACE) in the general population. Patients after kidney transplantation are prone to AKI events and are also at an increased risk of cardiovascular (CV) disease. The association between AKI and MACE in kidney transplant patients is yet to be studied. Methods: This retrospective single-center cohort study reviewed 416 adult renal allograft recipients transplanted between 2005 and 2010. AKI events were recorded starting 2 weeks after transplantation, or following discharge with a functioning graft. AKI was defined, according to the KDIGO criteria. The primary outcome was the composite of MACE starting 6 months after transplantation and all-cause mortality. For survival analysis, we used univariate and multivariate time varying Cox proportional hazard model. Results: One hundred and twenty-four patients (29.8%) had at least one episode of AKI. During the median follow-up time of 7.2 years (interquartile range 4.3–9.1), 144 outcome events occurred. By time varying Cox regression analysis, AKI was associated with an increased rate of CV outcomes or death (hazard ratio [HR] 1.96, 95% CI 1.36–2.81, p < 0.001), and the association remained significant by multivariate adjusted model (HR 1.76, 95% CI 1.18–2.63, p = 0.005). As for the different components of MACE, all-cause mortality and CV mortality were the only outcomes that were significantly associated with AKI. No interaction between AKI timing and MACE was found. Conclusion: AKI in kidney transplant recipient is associated with an increased risk of CV disease.

Objective:Primary abdominal wall closure can be difficult after liver transplantation（LT）,mostly in cases involving an oversized liver graft with edema of the intestine.Conventional closure with extensive tension may compromise graft perfusion.An open abdomen significantly increases the risk of infection and fluid loss.In one of our patients who recently underwent

Background. Guidelines for bladder augmentation (BA) in kidney transplantation (KT) recipients are not well-defined. In our center, simultaneous BA with KT (BA-KT) is performed. We assessed transplantation outcomes of this unique extensive procedure. Methods. A case-control single center retrospective study. Transplantation outcomes were compared with those of KT recipients who did not need BA. Results. Compared with 22 patients who underwent KT only, for 9 who underwent BA-KT, surgical complications and the need for revision in the early posttransplantation period were similar; early graft function was better: estimated glomerular filtration rate, 96.5 +/- 17.1 versus 79.4 +/- 16.6 mL/min at 0 to 6 months (P = 0.02); posttransplantation clean intermittent catheterization was more often needed: by 78% (7/9) versus 13% (3/22); and asymptomatic bacteriuria was more common: 100% versus 9% during the first 6 months (P < 0.001), 55% versus 9% (P = 0.02) and 66.6% versus 9% during the first and second years, respectively (P = 0.004). Urinary tract infection (UTI) incidence was also higher: 100% versus 23% during the first 6 months and 44% versus 9% during the second year posttransplantation. Graft function deteriorated significantly in the BA-KT group by the fifth posttransplantation year: estimated glomerular filtration rate was 47.7 +/- 39.7 mL/min versus 69 +/- 21.3 mUmin, with only 6 (66%) of 9 functioning grafts versus 100% in the KT only group. Causes of graft loss were noncompliance with drug therapy in 2 patients and recurrent UTls in 2 patients. Conclusions. Excellent short-term outcome for simultaneous BA-KT is threatened by graft loss due to a high prevalence of UTIs and patient noncompliance with the demanding complex posttransplantation therapy.

OBJECTIVE:Clinical outcomes in individuals with new onset diabetes after transplantation (NODAT) and the optimal treatment for this complication are poorly characterized. This study was intended to better define these issues.METHODS:Patients who underwent kidney transplantation and did not have diabetes prior to transplantation were included in the study. Clinical outcomes were compared between those who developed NODAT and those who did not. In those who developed NODAT, oral therapy was compared with insulin based therapy.RESULTS:A total of 266 kidney transplant recipients were included, of which 71 (27%) developed NODAT during the time of the follow-up. Using Cox multivariate analysis adjusted for age and gender, hazard ratio for overall mortality among patients with NODAT versus those without NODAT was 2.69 (95% CI 1.04-7.01). Among patients who developed NODAT, 29 patients (40%) were treated with an insulin-based regimen. At the end of follow-up, no difference was found in mean HbA1c, and therapy regimen was not associated with greater mortality.CONCLUSIONS:New onset diabetes in kidney transplanted patients is associated with increased mortality compared with kidney transplanted patients without NODAT.