De Novo Minimal Change Disease following Vaccination with the Pfizer/BioNTech SARS-CoV-2 Vaccine in a Living Kidney Donor

Coronavirus disease 2019 has developed as a pandemic. Immunization with the introduction of vaccines against COVID-19 seems be the only way to end this pandemic. We report on a case of a kidney donor, who developed minimal change disease (MCD) within 4 days post-vaccination with the SARS-CoV-2 BNT162b2 mRNA vaccine (Pfizer/BioNTech). She donated her kidney to her husband 4 years ago. After receiving the 1st vaccine dose, she presented with nephrotic syndrome, with complete remission 5 days later. She proceeded with the second dose of the BNT162b2 vaccine at the appointed time. Two days later, she presented with a relapse of full-blown nephrotic syndrome with preserved renal function. We performed an ultrasound-guided percutaneous kidney biopsy and the final diagnosis was consistent with minimal change disease. Oral prednisolone was promptly initiated at a dosage of 1 mg/kg daily and complete remission was achieved 10 days later. More data about this rare appearance of de novo glomerular diseases after SARS-CoV-2 vaccination are emerging and should be interpreted rigorously.

RELATIONSHIP BETWEEN WARM ISCHEMIC TIME AND RESISTIVE INDEX ON CREATININ REDUCTION RATIO DAY TWO AFTER LIVING KIDNEY DONOR TRANSPLANTATION

Kidney transplantation (KT) may improve kidney function, via filtration, excretion, and hormonal function better than other kidney replacement therapies. Many factors may cause graft rejection or delayed graft function which may decrease the prognosis for graft survival. This study aims to determine associated factors of serum creatinine reduction ratio day 2 (CRR2) after living kidney donor transplants. This research used a retrospective cohort study design, with total sampling based on complete documents was done. A total 44 respondents (from 2012 to January 2020) and 22 respondents (based on the complete Resistive Index (RI) were recorded since 2018). Early Graft Function was defined using CRR2. Immediate Graft Function (IGF) was defined if CRR2 > 30% and Delayed Graft Function (DGF) if CRR2 ≤ 30%. The results of Multiple logistic regression analysis from 44 samples showed that Warm Ischemic Time (WIT) ≤ 40 minutes was significantly associated with IGF (OR 10.78; 95%CI: 1.66 to 70.16; p=0.01). A result with 22 samples showed that, only RI ≤ 0.7was significantly associated with IGF (OR 0.11; 95%CI: 0.03-0.41; p=0.002). In conclusion, WIT and RI influence on EGF with parameters CRR2 of living-donors. KT Patients with WIT ≤40 minutes and RI ≤0.7 had a higher risk of IGF.

Challenging (Organ and Global) Boundaries

The original living kidney paired exchanges (KPE) involved two donors who were ABO- or crossmatch incompatible with their intended recipients but were compatible with the other’s recipient such that they could “swap” kidneys. This chapter examines the ethical issues raised by two novel expansions of KPE: bi-organ (also known as trans-organ) exchange involving a living liver donor (donor-L)-kidney recipient (recipient-K) and a living kidney donor (donor-K)-liver recipient (recipient-L), and global kidney exchange (GKE) between a living kidney donor-recipient pair from a low to middle income country and living kidney donor-recipient pair(s) from a high income country. Although this chapter describes a case report of an ethical bi-organ exchange, bi-organ exchanges and GKE are usually unjust because they challenge the fair selection of donors. Bi-organ exchanges and GKE also raise significant deferential and infrastructural vulnerability challenges that threaten the donor’s ability (autonomy) to provide a voluntary and informed consent.

Is It Time to Utilize Genetic Testing for Living Kidney Donor Evaluation?

Living donor kidney transplantation is an effective strategy to mitigate the challenges of solid organ shortage. However, being a living kidney donor is not without risk, as donors may encounter short- and long-term complications including the risk of developing chronic kidney disease, end-stage kidney disease, hypertension, and possible pregnancy-related complications. Although the evaluation of potential living donors is a thorough and meticulous process with the intention of decreasing the chance of complications, particularly in donors who have lifetime risk projection, risk factors for kidney disease including genetic predispositions may be missed because they are not routinely investigated. This type of testing may not be offered to patients due to variability and decreased penetrance of symptoms and lack of availability of appropriate genetic testing and genetic specialists. We report a case of a middle-aged woman with a history of gestational diabetes and preeclampsia who underwent an uneventful living kidney donation. She developed postdonation nonnephrotic range proteinuria and microscopic hematuria. Given the risk of biopsy with a solitary kidney, genetic testing was performed and revealed autosomal dominant Alport syndrome. Our case underscores the utility of genetic testing. Hopefully, future research will examine the incorporation of predonation genetic testing into living kidney donor evaluation.

Safety, clinical and laboratory characteristics of donors with thalassemia minor in living donor kidney transplant: a case series

Background Due to the increasing demand for kidney transplants, sometimes donors with underlying medical conditions can be considered for living kidney donor transplant. Thalassemia is amongst the most common inherited disorders of hemoglobin globally, which is not restricted as an exclusion criterion. However, there is currently no study examine the safety and characteristics of kidney donors with thalassemia minor. Methods All eligible live kidney donors between 2016 and 2019 with thalassemia minor at a tertiary hospital were recruited. Baseline characteristics, clinical and laboratory outcomes were investigated. Results Fifteen donors (11 women, 55.5 ± 15.0 year-old) were included with a follow-up duration of 2 (1-4) years since operation. The most prevalent gene mutation among participants was DEL-SEA. No clinical manifestations of anemia were seen but 10 participants had mild anemia diagnosed from blood tests. Cardiovascular, liver and renal function were normal before nephrectomy. Until now, all donors are alive and maintain overall good health. Anemia condition is not affected, and the post-donation eGFR = 71.04 ± 11.54 mL/min/1.73m2 is comparable to outcomes of healthy donors reported in previous studies. Two donors are at risk of proteinuria at 1-year post-transplant with A/C ratio > 30 mg/g. Conclusions Thalassemia minor individuals who are non-transfusion-dependent, without anemia clinical manifestations and have no contraindications to kidney donation are safe to be donors in short-term. An eGFR of at least 80 mL/min/1.73m2 should be considered to avoid low post-donation eGFR, and awareness should be raised on thalassemia donors with even mild albuminuria. Nephrectomy does not worsen thalassemia.

Die Sicherheit des Lebendnierenspenders – Das Deutsche Lebendspende Register SOLKID-GNR – Entstehung und Struktur eines nationalen Registers in der Versorgungsforschung

ZusammenfassungIm Deutschen Lebendspende Register SOLKID-GNR (Safety of the Living Kidney Donor – The German National Register) werden medizinische und psychosoziale Daten zum Outcome von Lebendnierenspender erhoben. Die prospektive Datenerhebung ermöglicht erstmals in Deutschland eine wissenschaftlich fundierte Langzeitanalyse, wie sich eine Lebendnierenspende auf die psychische und physische Gesundheit von Lebendnierenspendern auswirkt. Dies trägt direkt zu einer Verbesserung der Information und Versorgung der Lebendnierenspender bei.

Pattern of menstrual cycle after kidney transplant in reproductive women

Background. In reproductive women, transplant disturbs the menstrual cycle pattern. The two major conditions usually encountered are amenorrhea and menorrhagia.The objective of the study was to assess the pattern of menstrual cycle after kidney transplant in reproductive women.Materials and methods. This cross-sectional study was carried out in a public sector hospital of Karachi, Pakistan. A total 69 patients of reproductive age were included who underwent living kidney donor transplant for more than a year ago. Women having genital tract infection, using hormonal treatment, organic cause of genital tract, clotting disorder and severe cardiac and/ or peripheral vascular disease were excluded. Frequency and percentages were calculated for demographic characteristics. Correlation and association analysis was calculated for type of menstruation with menstrual cycle pattern. A P-value less than 0.05 was considered statistically significant.Results. Majority of female included in the study aged between 35–39 years (36, 52.2%). The most frequent menstrual disturbance observed was heavy menstrual bleeding (22, 31.9%) and amenorrhea (21, 30.4%). Only 2.9% cases showed normal menstrual pattern. The cross tabulation indicated that 26.1% patients had amenorrhea, 24.6% had oligomenorrhea and 31.9% had menorrhagia. The Durbin–Watson value of 0.656 indicated a strong positive relationship between menstruation cycle pattern (dependent variable) and type of menstruation, marital status, donor’s age, children and living location of the patients (independent variables).Conclusion. From the result of the present study, it is concluded that the reproductive age women have shown a disturbed pattern of menstrual cycle after kidney transplant. The major observation was that such patients reported amenorrhea, menorrhagia, oligomenorrhea and hypomenorrhea.