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Tumour in transplanted kidney: Case report
74
indian journal of transplantation 9 (2015) 73–81
Abstract #: ISOT2015-62 Tumour in transplanted kidney: Case report R.M. Meyyappan, Chiranjeevi Professor, M.R. Hospital, SRM Medical College Hospital and Research Centre, Chennai, India Background: A 42-year-old female underwent renal transplantation in September 2005. 9 years later, patient had recurrent episodes of painless haematuria for a period of 3 months. She was investigated and imaging studies showed a 3 cm SOL in upper pole of the graft kidney. CT-guided biopsy showed evidence of malignancy. Patient was subjected to graft nephroureterectomy. Final biopsy report revealed clear cell variant of renal cell carcinoma. Subsequently, patient is on regular dialysis. Aims: A rare and interesting case report in a transplanted kidney. Methodology: Case report. Results: Properly evaluated and managed case of post-transplant malignancy in graft kidney. Conclusions: A patient who underwent renal transplant has presented a decade later with tumour in the transplanted kidney. Though immunosuppression is known to cause certain tumours, renal cell carcinoma arising de novo in the transplanted kidney may not be attributed to the immunosuppression. http://dx.doi.org/10.1016/j.ijt.2015.09.065
Abstract #: ISOT2015-49 Clinical study of new onset diabetes mellitus after transplantation in a tertiary care hospital Rakesh Yarlagadda, Praveen Kumar Kolla, Varaprasad Narayana Medical College, Nellore, Andhra Pradesh, India Background: NODAT is a frequent complication in the posttransplant period and contributes to graft dysfunction, cardiovascular disease, infections and mortality. It also contributes to increased medical expenditure. Aims: To study the risk factor profile and clinical outcome of NODAT. Methodology: A retrospective and observational study of patients who underwent renal transplantation in the last 5 years at our institute. Subjects with pre-existing diabetes were excluded. All subjects were evaluated for various risk factors including demographic, anthropometric, clinical, biochemical and therapeutic parameters. All subjects recieved 3 doses of pulse methyl prednisolone followed by oral prednisolone at 0.5 mg/kg which was gradually tapered, Tacrolimus 0.1 mg/kg/day and mycphenolate 1–2 g/day as per weight. Rejection episodes recieved pulse methyl prednisolone. Results: There were 52 patients included in the study. NODAT was seen in 19% of them. NODAT was more common with increasing age of recipient (mean: 42 yrs); 29% had family history of Diabetes Mellitus-2. There was increased incidence of infections including admissions compared to those without NODAT. They also had greater incidence of graft dysfunction. Conclusions: NODAT is common in post-transplant period. It also increases morbidity in the post-transplant period. Therefore, all patients on immunosuppression should be regularly monitored and therapeutic interventions as necessary need to be taken. http://dx.doi.org/10.1016/j.ijt.2015.09.066
Abstract #: ISOT2015-81 Renal transplant in paediatric patient with abnormal urinary bladder: A case report Sethia Rajiv Kumar, Ahmed Shafiq, Gogoi Sanjay Department of Urology and Renal Transplant, Fortis Memorial Research Institute, Gurgaon, Haryana, India Background: Dysfunctional lower urinary tract resulting in end stage renal disease constitute 15% of patients in adult population and about 20–30% in pediatric population. It is no more a contraindication for renal transplant, but if renal transplantation is done in these patients without reconstruction of lower tract, it may result in graft failure. With adequate reconstruction of lower tract followed by renal transplant the results are as good as in general transplant population. Aims: Here, we present a case of renal transplant in a child with abnormal lower urinary tract. Methodology: A 12-year-old boy with end stage renal disease due to neurogenic bladder presents for renal transplant with father as a donor. He underwent surgery for meningomyelocele at the age of 3 years and later on improperly managed for neurogenic bladder which finally he resulted in chronic kidney disease. To preserve the upper urinary tract function, he underwent left end to side uretero-ureterostomy on right ureter and right cutaneous loop ureterostomy at some other center, but despite this the ultimately developed end stage renal disease and started on peritoneal dialysis at the age of 10. Finally he presented to us for renal transplant which was a difficult task because of abnormal bladder and poorly performed upper tract diversion surgery. On evaluation (Imaging and Urodynamics), we found that urinary bladder was poorly compliant and of small capacity. Native urine output was 1.5 litre. Results: So we did the augmentation cystoplasty with small intestine, left ureteric re-implantation to keep the bladder moist and made a mitrofanoff neourethra using distal right ureter as conduit for CISC on the right side of abdomen (as there was dense midline scar of previous surgery). Postoperatively, he was started on cycling of reservoir twice a day with 300 ml normal saline and CISC (Clean intermittent self catheterization). After 3 months, he was taken for renal transplant, graft kidney was placed on the left side of abdomen and graft vessels were anastomosed to common iliac vessels. Graft ureter was anastomosed to augmented bladder in single layer over 6/16 size stent. Foley catheter was placed in conduit for 10 days and then later on CISC started through this conduit. Patient received triple immunosuppression. Gradually serum creatinine came down to 0.6 on POD-5. Conclusions: With modified reconstructive technique good result can be obtained after renal transplant in pediatric patient with abnormal lower urinary tract who has been mismanaged earlier by irrational upper urinary tract diversion surgery. http://dx.doi.org/10.1016/j.ijt.2015.09.067 Abstract #: ISOT2015-82 Management of renal stone in transplant patient: Surgeons graveyard a case report Jamal Azmi, Umesh Oza, Areef Tamboli, D.R. Devendra, Prashant Pattnaik Bombay Hospital, Mumbai, India Background: Urolithiasis is least but a well recognized complication in renal transplant patients the etiology and management of which is similar to non-transplanted patients. A study involving 1224 transplant recipients showed that stone
indian journal of transplantation 9 (2015) 73–81
Abstract #: ISOT2015-62 Tumour in transplanted kidney: Case report R.M. Meyyappan, Chiranjeevi Professor, M.R. Hospital, SRM Medical College Hospital and Research Centre, Chennai, India Background: A 42-year-old female underwent renal transplantation in September 2005. 9 years later, patient had recurrent episodes of painless haematuria for a period of 3 months. She was investigated and imaging studies showed a 3 cm SOL in upper pole of the graft kidney. CT-guided biopsy showed evidence of malignancy. Patient was subjected to graft nephroureterectomy. Final biopsy report revealed clear cell variant of renal cell carcinoma. Subsequently, patient is on regular dialysis. Aims: A rare and interesting case report in a transplanted kidney. Methodology: Case report. Results: Properly evaluated and managed case of post-transplant malignancy in graft kidney. Conclusions: A patient who underwent renal transplant has presented a decade later with tumour in the transplanted kidney. Though immunosuppression is known to cause certain tumours, renal cell carcinoma arising de novo in the transplanted kidney may not be attributed to the immunosuppression. http://dx.doi.org/10.1016/j.ijt.2015.09.065
Abstract #: ISOT2015-49 Clinical study of new onset diabetes mellitus after transplantation in a tertiary care hospital Rakesh Yarlagadda, Praveen Kumar Kolla, Varaprasad Narayana Medical College, Nellore, Andhra Pradesh, India Background: NODAT is a frequent complication in the posttransplant period and contributes to graft dysfunction, cardiovascular disease, infections and mortality. It also contributes to increased medical expenditure. Aims: To study the risk factor profile and clinical outcome of NODAT. Methodology: A retrospective and observational study of patients who underwent renal transplantation in the last 5 years at our institute. Subjects with pre-existing diabetes were excluded. All subjects were evaluated for various risk factors including demographic, anthropometric, clinical, biochemical and therapeutic parameters. All subjects recieved 3 doses of pulse methyl prednisolone followed by oral prednisolone at 0.5 mg/kg which was gradually tapered, Tacrolimus 0.1 mg/kg/day and mycphenolate 1–2 g/day as per weight. Rejection episodes recieved pulse methyl prednisolone. Results: There were 52 patients included in the study. NODAT was seen in 19% of them. NODAT was more common with increasing age of recipient (mean: 42 yrs); 29% had family history of Diabetes Mellitus-2. There was increased incidence of infections including admissions compared to those without NODAT. They also had greater incidence of graft dysfunction. Conclusions: NODAT is common in post-transplant period. It also increases morbidity in the post-transplant period. Therefore, all patients on immunosuppression should be regularly monitored and therapeutic interventions as necessary need to be taken. http://dx.doi.org/10.1016/j.ijt.2015.09.066
Abstract #: ISOT2015-81 Renal transplant in paediatric patient with abnormal urinary bladder: A case report Sethia Rajiv Kumar, Ahmed Shafiq, Gogoi Sanjay Department of Urology and Renal Transplant, Fortis Memorial Research Institute, Gurgaon, Haryana, India Background: Dysfunctional lower urinary tract resulting in end stage renal disease constitute 15% of patients in adult population and about 20–30% in pediatric population. It is no more a contraindication for renal transplant, but if renal transplantation is done in these patients without reconstruction of lower tract, it may result in graft failure. With adequate reconstruction of lower tract followed by renal transplant the results are as good as in general transplant population. Aims: Here, we present a case of renal transplant in a child with abnormal lower urinary tract. Methodology: A 12-year-old boy with end stage renal disease due to neurogenic bladder presents for renal transplant with father as a donor. He underwent surgery for meningomyelocele at the age of 3 years and later on improperly managed for neurogenic bladder which finally he resulted in chronic kidney disease. To preserve the upper urinary tract function, he underwent left end to side uretero-ureterostomy on right ureter and right cutaneous loop ureterostomy at some other center, but despite this the ultimately developed end stage renal disease and started on peritoneal dialysis at the age of 10. Finally he presented to us for renal transplant which was a difficult task because of abnormal bladder and poorly performed upper tract diversion surgery. On evaluation (Imaging and Urodynamics), we found that urinary bladder was poorly compliant and of small capacity. Native urine output was 1.5 litre. Results: So we did the augmentation cystoplasty with small intestine, left ureteric re-implantation to keep the bladder moist and made a mitrofanoff neourethra using distal right ureter as conduit for CISC on the right side of abdomen (as there was dense midline scar of previous surgery). Postoperatively, he was started on cycling of reservoir twice a day with 300 ml normal saline and CISC (Clean intermittent self catheterization). After 3 months, he was taken for renal transplant, graft kidney was placed on the left side of abdomen and graft vessels were anastomosed to common iliac vessels. Graft ureter was anastomosed to augmented bladder in single layer over 6/16 size stent. Foley catheter was placed in conduit for 10 days and then later on CISC started through this conduit. Patient received triple immunosuppression. Gradually serum creatinine came down to 0.6 on POD-5. Conclusions: With modified reconstructive technique good result can be obtained after renal transplant in pediatric patient with abnormal lower urinary tract who has been mismanaged earlier by irrational upper urinary tract diversion surgery. http://dx.doi.org/10.1016/j.ijt.2015.09.067 Abstract #: ISOT2015-82 Management of renal stone in transplant patient: Surgeons graveyard a case report Jamal Azmi, Umesh Oza, Areef Tamboli, D.R. Devendra, Prashant Pattnaik Bombay Hospital, Mumbai, India Background: Urolithiasis is least but a well recognized complication in renal transplant patients the etiology and management of which is similar to non-transplanted patients. A study involving 1224 transplant recipients showed that stone