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Acute pancreatitis (AP) is a rarely encountered complication in patients following kidney transplantation and is associated with significant morbidity and mortality. The diagnosis is often difficult due to the lack of classic symptoms and laboratory findings. Herein, we report the case of azathioprine-induced AP leading to acute kidney injury in a kidney transplant recipient, in whom we have encountered diagnostic difficulty. Patient spontaneously recovered after drug withdrawal. We propose a step-wise diagnostic algorithm for the evaluation of AP in kidney transplant recipients.

Immune response directed towards the allograft is a major barrier to the longterm graft survival in kidney transplantation. The importance of various tools for histocompatibility testing including the significance of panel reactive antibodies in transplant immunology is discussed here.

BK-virus-associated nephropathy (BKVN) is one of the most common causes of viral nephropathy in renal-transplant recipients. The intensity of immunosuppression is the most important risk factor for BKVN. Combined BKVN and rejection can occur rarely, which is difficult to diagnose and manage. Ureteritis, leading to ureteric stenosis, can result in secondary to both rejection and BK-virus (BKV) infection. We herein report a case of BKVN coexistent with the features of acute cellular rejection in a patient with ureteric stenosis probably induced by BKV infection, which was managed successfully with step-wise modification of immunosuppression along with double–J stenting, leading to stabilization of graft function.

Guillain–Barre syndrome (GBS) is an extremely rare complication after solid organ transplantation (SOT) and its clinical course can be more severe in them. Most of the cases of GBS in SOT have been associated with Cytomegalovirus infection. GBS presenting after an ABO-incompatible (ABOi) transplant and during pregnancy has never been reported in the past among SOT recipients. We report a case of a 27-year-old female ABOi renal transplant recipient who presented with acute flaccid paralysis all four limbs during the second trimester of pregnancy, diagnosed to have GBS. Pregnancy and vaccination might have played a role in precipitating GBS in our patient. She was treated with plasma exchange and experienced GBS treatment-related fluctuations but finally recovered completely without any adverse pregnancy outcome.

Renal transplantation is the treatment of choice in most patients with end-stage renal disease, especially with improvement in surgical techniques and immunosuppressive regimens; however, the long-term graft survival remains to be improved. Immunological graft injury leading to rejection plays a major role in long-term graft loss. With pretransplant immunological evaluation using various crossmatch tests, identification of donor-specific antibodies, a better understanding of renal allograft pathology and its standardization with the Banff classification having regular updates led to prevention, early and accurate diagnosis of rejection and its histological differentiation. Some newer biomarkers are in pipeline may enable early and accurate identification of graft pathology noninvasively.

Background and Aim: This study aims to study the long-term outcomes of hepatitis C virus (HCV)-infected renal allograft recipients, which is still debatable. Materials and Methods: In this study (study period - January 2003 to December 2013), we studied long-term outcomes of 106 living donor renal allograft recipients - 53 HCV-infected (33 genotype 3 and 20 genotype 1) and 53 age- and gender-matched HCV-noninfected patients. Results: Thirty-nine (73.6%) patients detected HCV positive during dialysis, while 14 (26.4%) before the start of dialysis. Forty (75.5%) patients were positive for both anti-HCV and HCV RNA, while 13 (24.5%) were HCV RNA positive and anti-HCV negative. Twelve and nine patients died among HCV positive and negative groups, respectively. Major cause of death was sepsis in both groups. Hepatic failure contributed to mortality in four HCV-positive patients, two of them also had graft failure. Patient and death noncensored graft survival rates at 1, 5, and 10 years of follow-up in HCV-positive group were 100% and 100%; 79.8% and 70.8%; 58.9% and 37.8%; respectively; and in HCV-negative group were 100% and 100%; 95.9% and 91.8%; 58.9% and 27.4%; respectively. Conclusions: The long-term survival of HCV-positive renal transplant recipients was not inferior to that of HCV-negative recipients.