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Introduction: Nonmelanoma skin cancer (NMSC) is the most common malignancy in patients who have received a solid organ transplant. Multiple factors are involved in the onset of posttransplant NMSC., Objectives: To analyze the relationship between new immunosuppressive drugs and the onset of NMSC in renal transplant recipients., Method: This was a combined retrospective and prospective observational study in which we studied 289 patients who received a kidney transplant between January 1996 and December 2010 at Hospital Universitario Doctor Peset in Valencia, Spain., Results: Seventy-three patients (25.2%) developed 162 NMSCs over a median follow-up of 72 months. There were no statistically significant differences in the onset of NMSC on comparing different induction therapy strategies involving monoclonal and polyclonal antibodies. NMSCs occurred less frequently in patients treated with mammalian target of rapamycin (mTOR) inhibitors than in those treated with other immunosuppressive regimens, although the differences were not statistically significant. Three of 5 patients with recurrent NMSC who were switched from calcineurin inhibitors to mTOR inhibitors developed additional NMSCs despite the change., Conclusions: Induction therapy with monoclonal and polyclonal antibodies in renal transplant recipients is not associated with an increased risk of NMSC. While mTOR inhibitors are associated with a lower risk of posttransplant NMSC, it remains to be determined whether a switch to these drugs is useful in the management of patients who develop multiple NMSCs., (Copyright © 2014. Published by Elsevier Espana.)

Delayed graft function (DGF) is a common complication after transplantation. Its incidence is increased among patients receiving a graft from an expanded-criteria donor. Urinary neutrophil gelatinase-associated lipocalin (uNGAL), an acute kidney injury marker, could in the first days after transplantation be an early marker of DGF. We collected urine samples from 38 renal transplant recipients on days 1, 3, 6, and 10 post-transplantation, and months 1 and 6 creatinine to determine uNGAL, serum creatinine, Cystatin C, and albumin/creatinine ratio. We divided the patients into 2 groups, based on whether they developed DGF. We observed that mean uNGAL concentrations, Cystatin C, serum creatinine, and albumin/creatinine ratio were significantly lower in the non-DGF cohort on all measured days. uNGAL at day 3 showed a positive correlation with serum creatinine at day 10 (R = 0.58; P < .00) and day 30 (R = 0.57; P = .016) as well as with the length of hospital stay (r = 0.47; P < .00). Receiver operating characteristic analyses performed to assess the potential of uNGAL to predict DGF showed an area under the curve for day 3 of uNGAL of 0.917 (confidence interval [CI], 0.79-1.00; P = .00), with an optimal cutoff level of 124 ng/mL, sensitivity of 80% (CI, 62%-97%), and specificity of 83% (62%-104%; P = .001). In the first days after transplantation, uNGAL could be an early marker of DGF, providing additional information to standard biomarkers and potentially helping clinicians to take early measures to mitigate DGF., (Copyright © 2013 Elsevier Inc. All rights reserved.)

In a multicenter trial, renal transplant recipients were randomized to tacrolimus with fixed-dose sirolimus (Tac/SRL, N = 318) or tacrolimus with MMF (Tac/MMF, N = 316). Targeted tacrolimus trough levels were lower in the Tac/SRL group after day 14. The primary endpoint was renal function at 6 months using creatinine clearance (Cockcroft-Gault) and was comparable at 66.4 mL/min (SE 1.4) with Tac/SRL and at 65.2mL/min (SE 1.3) with Tac/MMF (completers). Biopsy-confirmed acute rejection was 15.1% (Tac/SRL) and 12.3% (Tac/MMF). In both groups, graft survival was 93% and patient survival was 99.0%. Premature withdrawal due to an adverse event was twice as high in the Tac/SRL group, 15.1% versus 6.3%. Hypercholesterolemia incidence was higher with Tac/SRL (P < .05) while CMV, leukopenia, and diarrhea incidences were higher with Tac/MMF (P < .05). The incidence of any antidiabetic treatment for >30 consecutive days in previously nondiabetic patients was 17.8%, Tac/SRL, and 24.8%, Tac/MMF. Evaluation at 6 months showed comparable renal function using tacrolimus/sirolimus and tacrolimus/MMF regimens.

Though hypogonadism is part of the clinical picture of chronic renal failure, its etiology remains unknown. Because of the consequences it may have on the prostate gland, it was decided to conduct a prospective evaluation on its influence on prostatic signs and symptoms and glandular growth in a group of patients with chronic renal failure undergoing dialysis and a second group with renal transplantation. To this end, the presence of symptoms was assessed in 78 subjects over 50 years of age: 22 healthy controls (group C) (28.2%), 28 in haemodialysis (Group HD) (35.0%) and 28 with renal transplantation (Group RT) (35.9%). All subjects were aged between 53 and 80 years (mean 58.29 +/- 5.45). Determination of degree of prostatism was done by the International Prostate Symptoms Score (IPSS-S and L), flowmetry, ultrasound postmictional residue, transrectal ultrasound with 3 prostatic diameters (cross-sectional, antero-posterior and longitudinal), prostate weight and plasma levels of PSA, testosterone, FSH, LH, PRL and oestradiol. In 26 of 28 patients in the HD group IPSS-L, flowmetry and post-mictional residue was not assessed as they had no spontaneous miction. There were significant differences in IPSS between C and RT (p = 0.003), Qmax between C and RT (p = 0.009), post-mictional residue between C and RT (p = 0.045), cross-sectional diameter between C and HD (p = 0.036), prostate weight between C and HD (p = 0.001), and between HD and RT (p = 0.001), PSA between C and RT (p = 0.026), FSH between C and HD (p = 0.005), LH between HD and RT (p = 0.020), PRL between HD and RT (p = 0.023), Oestradiol between C and HD (p = 0.032). We conclude that hypogonadism is a factor which, in patients with chronic renal failure and renal transplantation, contributes to prevent prostate growth thus minimizing the symptoms of prostatism.

Our service performed a total of 619 kidney transplants between February 1980 and March 1993. Among them, 41 new neoplasias (6.6%) were diagnosed. Most frequent tumour was epithelioma (25) with a presentation age lower than in the normal population. Amongst the remaining tumours (16), the occurrence of 2 lymphoma and 2 Kaposi's sarcoma should be emphasized, together with the fast evolution progression of the others. Using a multiple regression model, an analysis is made on the influence certain factors have in the development of neoplasias, age being selected as the only significant one. The relative risk transplanted subjects have of suffering some type of neoplasia compared with the normal population is 36.

Lymphoceles are a complication of renal transplantation surgery. The source of this lymphatic collections is the lymph draining through the lymphatic vessels located in the transplanted kidney sinus and surrounding the iliac vessels of the receptor. The main etiological factor is the surgical technique used when dissecting these structures for graft placement. Several factors have been suggested as favouring their occurrence, acute rejection being highlighted as one. This paper reviews a series of 517 renal transplantations performed in our service, with a lymphocele incidence of 5.2% (28). Using a log regression model, the influence of age, sex, time in dialysis, presence of tubular acute necrosis in the graft following placement, acute rejection and immunological regime, for the appearance of lymphocele were analyzed. Age and lack of acute tubular necrosis were the only two factors selected by the model. Also, clinical signs and symptoms as well as therapy instituted were analyzed, emphasizing that puncture-drainage and instillation of iodine povidone was 100% effective.

Of a total of 320 renal transplants performed at our center in the last 8 years, two patients presented colonic perforation (0.62%). We emphasize the clinical manifestations, which were masked by the antiinflammatory properties of the steroids; for this reason, careful and repeated physical exams should be made out in the case of any episode of abdominal pain in these patients, as well as ancillary studies for early diagnosis. Surgical measures, which consist of exclusion of the septic focus in the peritoneal cavity, do not differ from those carried out in the general population with the same colonic pathology, although they require more cautious maneuvers and meticulous lavage of the peritoneal cavity. Alternatively, when exclusion is not possible, proximal colostomy and adequate drainage must be performed.

The horseshoe kidney is useful as a graft and should be transplanted. The technical difficulties can be avoided by en bloc removal, perfusion in situ with Collins solution, and bench surgery during graft preparation.