Gerardo Oliveira

Mycobacterium gordonae urinary infection in a renal transplant recipient

Abstract: The authors present a case of urinary infection by a non‐tuberculous mycobacteria (NTM) species, Mycobacterium gordonae, in a renal transplant recipient. A 29‐year‐old female patient had persistent sterile pyuria after her second kidney transplant. An NTM, M. gordonae, was isolated, and the patient was started on antituberculous treatment, with resolution of leukocyturia. Ureteral stenosis with hydronephrosis and deterioration of allograft function was diagnosed later on and, despite the introduction of intraureteral catheter and resolution of hydronephrosis, there was no recovery of baseline renal function. She ultimately resumed dialysis after a severe pyelonephritis. The authors discuss the problems of establishing diagnosis of infection (versus colonization) by NTM and highlight the difficulty of treating these infections, especially because of the possible interaction with immunosuppressant agents, facilitating anti‐allograft immune response.

Cerebral coccidioidomycosis after renal transplantation in a non‐endemic area

C. Carvalho, I. Ferreira, S. Gaião, S. Guimarães, R. Costa, J. Santos, S. Sampaio, M. Bustorff, G. Oliveira, M. Pestana. Cerebral coccidioidomycosis after renal transplantation in a non‐endemic area.
Transpl Infect Dis 2010: 12: 151–154. All rights reserved

Conversion from sirolimus to everolimus in kidney transplant recipients receiving a calcineurin‐free regimen

Carvalho C, Coentrão L, Bustorff M, Patrício E, Sampaio S, Santos J, Oliveira G, Pestana M. Conversion from sirolimus to everolimus in kidney transplant recipients receiving a calcineurin‐free regimen.
Clin Transplant 2011: 25: E401–E405.

Kidney Transplantation from Non-Heart-Beating Donors (NHBD) after Extracorporeal Membranous Oxygenation (ECMO) – initial experience and comparison to brain-dead donors (BDD) outcomes

Introduction NHBD have emerged as a new source of kidneys available for transplantation. We assessed the outcomes of the first Portuguese experience of kidney transplantation using NHBD and compared the results with those from BDD, including standard (SCD) and expanded (ECD) criteria. Materials and Methods We performed a prospective analysis that included 30 kidney transplants from NHBD (Maastricht classes IIa and IIb, using ECMO) and 63 from BDD (SCD: n=31; ECD: n=32), since January 2016 to September 2017. One-month and 6-month graft function and postoperative complications were investigated. We also evaluated the potential determinants (donor and recipient sex and age, donor kidney function and cold ischemia time) for those outcomes, using multilinear and logistic regression analyses. Sex-, age- and cold ischemia time- adjusted comparisons of the graft function and complication rates among NHBD, SCD and ECD were estimated. Results and Discussion The median follow-up time was 9 months. NHBD kidneys were in 73.3% (n=22) from male donors and were implanted in men in 63.3% (n=19) of the cases. The median age of NHBD and their recipients was 51 (p25-p75: 35-53) and 54 years (48-62), respectively. The median cold ischemia time was 14 hours (12-16). We observed a delayed-graft function (DGF) of 63.3% (n=19) and the 1-month graft function showed a median creatinine (Cr) of 1.77mg/dL (1.45-2.42), corresponding to a median estimated glomerular filtration rate (eGFR) of 39.0mL/min (27.8-54.3). The 6-month graft function showed a median Cr of 1.44mg/dL (1.07-1.74) and a median eGFR of 52.2mL/min (37.1-62.6). In transplants from BDD, we found a DGF of 31.8% (n=20). In SCD, 1-month median Cr and eGFR were 1.13mg/dL (0.94-1.7) and 67.3mL/min (32.3-89.8), respectively, being of 1.23mg/dL (0.96-1.54) and 57.8mL/min (50.9-87.1) at 6-month. In ECD, 1-month median Cr and eGFR were 1.55mg/dL (1.12-1.95) and 45.5mL/min (33-54.5), respectively, being of 1.49mg/dL (1.14-1.86) and 46.0mL/min (34.1-58.8) at 6-month. Cold ischemia time was predictive of a lower 1-month graft function within the unadjusted analysis. In the sex-, age- and donor kidney function- adjusted analysis, cold ischemia time was not significantly predictive. The multivariable linear regression analysis comparing graft function among NHBD, SCD and ECD showed a statistically significant lower function at 1-month and 6-month within NHBD and a significantly decrease of 6-month function within the older donors. The incidence of postoperative complications in NHBD was 33.3% (n=10), mainly due to vascular thrombosis (40.0%). There were no differences regarding the incidence of postoperative complications among the three groups. Conclusion Despite presenting a DGF, with a lower initial plasma Cr and eGFR, we found a graft function recovery in patients with kidneys from NHBD, being similar to ECD.

An integrated program of extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation and uncontrolled donation after circulatory determination of death in refractory cardiac arrest

AIM To assess the feasibility of an integrated program of extracorporeal cardiopulmonary resuscitation (ECPR) and uncontrolled donation after circulatory determination of death (uDCDD) in refractory cardiac arrest (rCA). METHODS Single center, prospective, observational study of selected patients with in-hospital (IHCA) and out-of-hospital (OHCA) rCA occurring in an urban area of ∼1.5 million inhabitants, between October-2016 and May-2018. 65 year old or younger patients without significant bleeding or comorbidities with witnessed nonasystolic cardiac arrests were triaged to ECPR if they had a reversible cause and high quality CPR lasting < 60 min. Otherwise they were considered for uDCDD after a ten minute no touch period using normothermic regional perfusion. RESULTS 58 patients were included, of which 41 (71%) were OHCA and 18 (31%) had ECPR initiated. Median age was 52 (IQR 45-56) years. Cannulation was successful in 49/58 (84%) cases. Compared to ECPR, patients referred for uDCDD were more frequently OHCA (90 vs. 28%), had bystander CPR (28 vs. 83%) and prolonged low-flow period (40 (35-50) vs. 60 (49-78) min). Survival to hospital discharge with full neurological recovery (cerebral performance category 1) occurred in 6/18 (33%) ECPR patients. uDCDD resulted in transplantation of 44 kidneys. CONCLUSIONS An integrated program for rCA consisting of a formal pathway to uDCDD referral in ECPR ineligible patients is feasible. ECPR-referred patients had a reasonable survival with full neurologic recovery. Successful kidney transplantation was achieved with uDCDD.

Metastatic calcification detected on bone scintigraphy.

PURPOSE To show the value of bone scintigraphy in the diagnosis of metastatic calcification in end-stage renal insufficiency. MATERIAL AND METHODS The authors present a fifty-one-year-old male with terminal renal insufficiency of hypertensive renovascular etiology, on hemodialysis for the last 10 years, referred for a bone scan because of osteoarticular complaints, and no other associated symptoms or findings on physical examination. RESULTS Whole body bone scintigraphy images (HMDP-99mTc, 925MBq), showed increased uptake in the lower half of both lungs, the stomach and renal parenchyma, compatible with metastatic calcification. CONCLUSIONS Bone scintigraphy, due to its high sensitivity, even in the detection of early changes, might be a useful instrument in the initial evaluation and follow-up of patients with high risk of developing metastatic calcification.