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Abstract: We herein have reported a case of severe nonfebrile dengue infection complicated with refractory pancytopenia and a large perinephric hematoma with shock in a 16-year-old adolescent during the early postoperative period after kidney transplantation. After the diagnosis of end-stage renal disease she underwent living-related kidney transplantation. Thirteen days after successful transplantation, she exhibited a notable amount of ascites, bilateral pleural effusions, thrombocytopenia, and increased hemoglobin without pre-existent fever. Further investigation revealed positive dengue nonstructural protein 1 antigen (dengue NS1 Ag) and dengue virus serotype 1 by a reverse transcriptase-polymerase chain reaction (RT-PCR) in the patient''s serum. She exhibited hemophagocytic syndrome, manifested by refractory pancytopenia and refractory anemia resulting in hypovolemic shock and acute graft failure on day 28 posttransplantation. The anemia was attributed to a large hematoma around the transplanted kidney requiring surgical evacuation of clotted blood. Postoperatively, she gradually recovered with resolution of thrombocytopenia and excellent graft function. Persistent dengue antigenemia and viremia was shown by dengue NS1 Ag and RT-PCR of dengue serotype-1. The viremia was present longer than the dengue antigenemia. Dengue-specific immunoglobulin M (IgM) and IgG by enzyme-linked immunosorbent assay confirmed the primary dengue infection and evidence of a recent donor dengue infection. [Copyright &y& Elsevier]

Background Although the clinical outcomes of pediatric renal transplantation (RT) in developed countries have improved significantly, the data on clinical outcomes in developing countries are wildly different. Methods Children and adolescents who had undergone RT at Ramathibodi Hospital between March 2001 and August 2014 were included. Results Patients were divided into 2 groups: living related donor (LRD) group (n = 13) and deceased donor (DD) group (n = 30). Prolonged cold ischemic time over 13 hours was significantly associated with delayed graft function ( P = .029). The prevalence of infection was 90.7%, in which urinary tract infection (UTI) was the most common infection. Although almost none of the patients in the LRD group received induction therapy, the prevalence of rejection was not significantly different between the 2 groups ( P = .817). The comparison of graft survivals between LRD and DD groups were 100% vs 100%, 92.3% vs 100%, and 85.7% vs 81.8% at 1, 3, and 5 years, respectively ( P = .938). Recurrent UTI and cytomegalovirus (CMV) infection had a negative effect on graft function at 1-year follow-up ( P < .05). Rejections, bladder dysfunction, and donors aged ≥50 years were associated with graft deterioration at 3 years after RT ( P < .01). None of these patients died with functioning graft. Conclusion This study demonstrated good graft and patient survival in Thai pediatric RT recipients. Although recurrent UTI and CMV infection were related to graft dysfunction at 1-year follow-up, infections had no effect on graft and patient survival in long-term follow-up. [ABSTRACT FROM AUTHOR]

Abstract Background Dual kidney transplants (DKTs) from expanded criteria donors (ECDs) have been performed in our hospital since 2014. We needed to review our clinical outcome and update criteria to selected ECDs for DKTs. Materials and Methods Between January 2014 and December 2016, 4 DKTs and 269 deceased donor kidney transplants were performed. The outcome of DKTs was reviewed. The literature was reviewed for surgical technique and indication for DKT. Results Four DKTs were performed between 2014 and 2016. One-year graft survival rate was 100%. One patient developed delayed graft function. No morbidity or mortality occurred. Conclusions DKTs in our center were safe and had good outcome with optimized selected criteria. DKT can improve the rate of kidney transplant in a developing country. [ABSTRACT FROM AUTHOR]