J. de Arteaga

Expanded criteria donors, histological scoring, and prolonged cold ischemia: impact on renal graft survival.

The use of expanded donors or kidneys with preexistent chronic damage remains controversial, but they offer the opportunity to expand the donor pool. We investigated the impact of these conditions as predictors of graft survival among a cohort of recipients with prolonged cold ischemia times and a high incidence of delayed graft function. We included 70 consecutive cadaveric kidney allografts implanted between 2001 and 2005, which had undergone an early graft biopsy. Delayed graft function was present in 84% of cases with moderate or severe preexistent chronic damage in 63% and 27% of biopsies, respectively, and acute rejection was diagnosed in 14.3% of overall cases. The graft survival was 73.3% at 48 months. Primary nonfunctioning kidneys were more frequent using kidneys from expanded compared with standard donors (20.0% vs 0.0%, P < .002). Multivariate analysis showed that only the donor condition (standard vs expanded) was independently associated with graft survival (hazard ratio: 0.12; 95% confidence interval: 0.01-0.87; P < .03). Our results suggested that the donor characteristics prevail over other variables to predict graft outcomes.

Thrombophilic Mutations: No Association With Thrombotic Events in Renal Transplant Recipients

Factor V Leiden and mutation of prothrombin gene G20210A have been associated with poor results in the early post-kidney transplantation period. Its long-term importance in stable patients has yet to be evaluated. We studied the prevalence of these inherited mutations and their relationship to thrombotic events in 82 Argentine renal transplant recipients with adequate long-term kidney function. In aggregate, 7.2% of patients were carriers of these mutations; however, their presence did not show any association with thrombotic events or renal function alterations. The routine evaluation for these mutations does not seem to be cost-effective in renal transplant patients.

Hydrocele Caused by Peritoneal Fluid Leakage Through Inguinal Canal

C. parapsilosis infection again, whereas biopsy samples from the omentum revealed inflammatory changes, foci of liponecrosis, and fungal spores consistent with Candida (Figure 2). Due to unresolved infection (persistent fever and elevated white blood cell (WBC) and CRP levels for 12 days after admission), fluconazole was substituted for caspofungin. Serial blood cultures were persistently negative. Infection signs persisted for a further 7 days. Antifungal therapy was continued for 1 month. The patient was finally discharged in good clinical condition and is currently being treated with hemodialysis. The case presents some remarkable points. First, fungal peritonitis usually occurs with predisposing factors, such as prolonged use of antibiotics and previous bacterial peritonitis (1). Surprisingly, our patient had no predisposing factors. Secondly, inflammatory signs and symptoms may persist for weeks despite appropriate antifungal treatment and early catheter removal, especially for Candida parapsilosis cases (2,3). Finally, intraoperative findings of erythematous plaques, characteristic of fungal infection, are the definitive proof of the diagnosis. To our knowledge, no similar images of C. parapsilosis peritonitis have been published in the literature.