Abstract: Large numbers of patients with end-stage kidney disease caused by IgA nephropathy are transplanted every year, and each of these patients faces the risk of recurrence in their kidney graft. We review the epidemiology, diagnosis, and outcomes of recurrent IgA nephropathy. Mechanistic insights, therapeutic options, and knowledge gaps are reviewed, and we discuss future options to better understand and manage this disorder.
Abstract: Transplant recipients are at increased risk for tuberculosis (TB), which can adversely affect graft viability and patient survival. Scientific societies and official organizations have therefore issued guidelines and consensus statements for TB prevention and treatment. However, due to the poor supporting evidence, the current recommendations largely rely on expert opinion rather than on properly designed studies. In this overview, we aim to gather together the previous experience and compare and contrast the main current guidelines on the prevention and treatment of TB in solid organ transplantation and hematopoietic stem cell transplantation.
Background: Chronic norovirus infection is an emerging challenge in the immunocompromised host, in whom it may be asymptomatic or present as chronic diarrhea. The mechanisms of diarrhea in chronic norovirus infection are not well understood, but in analogy to Gardia lamblia and rotavirus infections, secondary lactose maldigestion (LM) might be implicated. Methods: Adult renal transplant recipients (RTRs) who had symptomatic chronic norovirus infection with diarrhea were asked to participate in this prospective parallel cohort study. RTRs with otherwise unexplainable chronic diarrhea but absent infection served as control group. In both groups, a lactose hydrogen breath test (LHBT) and a lactose tolerance test (LTT) were performed after exclusion of primary LM by a negative lactase gene test. Results: Of approximately 800 patients in the cohort of RTRs at our institution, 15 subjects were included in the present study. Of these, 7 had chronic symptomatic norovirus infection with diarrhea (noro group) and 8 had diarrhea in the absence of norovirus (control group). LHBT and LTT were positive in all 7 patients (100%) in the noro group, whereas only 1 of 8 patients (12.5%) in the control group had a positive test. Thus, secondary LM was highly prevalent in the noro compared to the control group with an odds ratio of 75.0 (95% CI 2.6, 2153, p=0.01). Conclusions: This is the first report showing a positive association of chronic norovirus infection and secondary LM. Further studies with larger patient numbers and longer follow-up are needed to test a causative relationship between both entities. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.