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Background/Objectives: The novel coronavirus disease 2019 (COVID-19) has led to significant morbidity and mortality among kidney transplant recipients. SARS-CoV-2 has been hypothesized to cause an unusual immunological dysregulation triggering alloimmunity and leading to graft rejection. Methods: This prospective observational cohort study assessed 321 kidney transplant recipients who had COVID-19 infection. After the infection, patients' sera were tested for the presence of anti-HLA de novo DSA and non-DSA specificities. Logistic regression analysis and a stepwise multivariable logistic regression analysis were used to analyze the independent risk factors associated with the development of antibodies, adjusting for known confounders. The variables evaluated were acute COVID-19 characteristics (i.e., presentation, and need for hospitalization), demographic characteristics (i.e., age, gender, and primary renal disease), clinical characteristics (i.e., various comorbidities), and post-COVID-19 sequelae. Results: Anti-HLA de novo DSA developed in 18.7% of patients, while anti-HLA class I and class II non-DSA antibodies developed de novo in 84 (26.3%) and 83 (25.9%) patients, respectively. The development of DSA, HLA-DQ, and HLA-DR antibodies was predicted by the history of graft rejection. Obesity appeared to be protective against the emergence of de novo DSA. De novo DSA and HLA-DR antibody formation was positively linked with intravenous immunoglobulin use, CMV-hyperimmune globulin use, and decreased doses of immunosuppression during acute infection. Better allograft function during the acute disease was a protective factor against the formation of HLA-DQ and HLA-DR antibodies. Positive predictors of de novo DSA development were graft biopsy and the reactivation of EBV after infection. Conclusions: These findings suggest that the SARS-CoV-2 virus has an immunomodulatory effect and may be associated with an increased mortality in this population. [ABSTRACT FROM AUTHOR]

Breast cancer is the 5th leading malignant cause of death worldwide. The mechanism behind its development is multifactorial and involves a combination of hormonal, genetic, environmental, and age-related factors affecting DNA damage. Due to their chronic immunosuppressive therapy, kidney transplant recipients are exposed to an increased risk of carcinogenesis. We present an unusual case of an 80-year-old kidney transplant recipient who developed an invasive breast cancer 8 years after cadaveric kidney transplantation. Chronic immunosuppressive therapy at the time of diagnosis included cyclosporine (100mg/day), mycophenolate mofetil (1000mg/day), and prednisolone (5mg/day). A core needle biopsy was performed after the ultrasound examination. The patient was treated with modified radical mastectomy and axillary lymph node resection. The pathohistological report confirmed invasive stage T3N1Mx breast carcinoma with metastatic lymph node involvement. The results of the pathohistological examination demonstrated the presence of breast carcinoma, characterized by positive expression of estrogen receptors (ER) and progesterone receptors (PR), while human epidermal growth factor receptor 2 (HER2) had a negative status. The patient began adjuvant hormone therapy with tamoxifen 10 mg 2x1 per day. He was switched from cyclosporine to an mTOR inhibitor. To date, the patient has been consistently monitored per scheduled follow-up appointments and continues to remain in remission without any further complications. Due to decreased awareness and minimal degree of suspicion, more than 40% of patients with male breast cancer (MBC) first present at the advanced stage, which typically takes the form of a lump or nipple inversion. As a result, MBC patients experience worse prognosis than their female counterparts. This case report demonstrates the importance of thorough and regular clinical examinations of male kidney transplant recipients. Although MBC is rare, the possibility of its existence should be emphasized, especially in a vulnerable population such as kidney transplant recipients. [ABSTRACT FROM AUTHOR]

Introduction. Our stady aimed toinvestigate the rate of dermatologic disorders in kidney transplant recipients during the COVID-19 pandemic. Methods. We performed a retrospective observational single-center cohort study including all adult renal transplant recipients with a functioning kidney allograft and who have recovered from the SARS CoV-2 infection. The study was conducted at a tertiary center in Croatia from March 2020 to August 2022. The study included 321 patients (57% were male). Data were obtained retrospectively from hospital charts and records, while selfreported cosmetic problems were reported prospectively. Results. The study included 321 patients (57% were male). Overall, 59 patients (18%) reported or were diagnosed with dermatological conditions. Eleven patients presented with facial eruptions that were most pronounced in the area covered by the mask, one patient developed similar changes in the skin of her hands. Hair loss was reported by twenty female patients, with the hair loss persisting in three patients. Six patients were diagnosed with skin cancer in the areas covered by facial masks. Three had squamous cell skin cancer, two were diagnosed with basal cell skin cancer, and one had a neuroendocrine skin tumor on the chin. Conclusion. Dermatologic problems are frequent in kidney transplant recipients recovered from acute COVID- 19. Besides cosmetic problems, skin malignancies may be diagnosed with a delay. Kidney transplant recipients should be advised to regularly self-examine their skin for potential skin cancer with dermatologic evaluation when necessary. [ABSTRACT FROM AUTHOR]

Introduction. Anti-CMV immunoglobulin (CMV-HIG) contains antibodies against various infective pathogens and not only against the cytomegalovirus (CMV), thus possibly mimicking the convalescent plasma. Methods. A retrospective analysis concerning the practice of CMV-HIG off-label use during acute COVID- 19 in kidney transplant recipients (KTR). Results. From March 2020 to August 2022, 403 KTR (59.8% male) who developed COVID-19 were eligible for investigation. 151(44.4%) patients required hospitalization, and eighteen (5,6%) mechanical ventilation. Thirty-four (8.4%) patients received CMVHIG. Two patients had CMV reactivation and received CMVHIG 2 ml/kg in five doses. Others had hypogammaglobulinemia which was an additional off-label indication for using CMVHIG during acute COVID-19. 22 patients (6.5%) died, 4 of them from the CMVHIG group. Conclusion. A correction of hypogammaglobulinemia, potential remodeling of the immunological response, and CMV reactivation during acute infection, may justify the use of CMVHIG during acute COVID-19. [ABSTRACT FROM AUTHOR]

Introduction. The purpose of this case report is to describe our experience in the treatment of potential tacrolimus-induced pancreatitis in a renal transplant patient. Case report. We present a case of a 35-year Caucasian female kidney transplant patient who developed an acute exacerbation of chronic calcifying calculous pancreatitis twice in the early posttransplant period. Before undergoing a kidney transplant, she had been hospitalized on three occasions due to episodes of acute pancreatitis, which was successfully treated with conservative therapy. The second episode of acute exacerbation of chronic pancreatitis, which occurred two months after kidney transplantation, was much more severe than the first, which occurred on the sixth day after transplantation, and was complicated by the formation of multiple pseudocysts in the head and body of the pancreas, with a further tendency to grow. The resulting compression on the surrounding structures required surgical drainage of the cysts. Furthermore, tacrolimus was switched to parenteral cyclosporine due to intolerance of oral food and fluid intake, and oral cyclosporine therapy was continued after recovery. The patient was discharged without recurrent clinical and laboratory signs of acute exacerbation of chronic pancreatitis during the further follow-up of 6 months. Conclusion. Tacrolimus is the most likely cause of acute exacerbation of chronic pancreatitis in our patient. Switching from tacrolimus to cyclosporine should be considered. [ABSTRACT FROM AUTHOR]

Multisystem inflammatory syndrome after COVID-19 (MIS-A) is a consequence of an abnormal inflammatory response after COVID-19 resolution. Current criteria for diagnosis consist of the involvement of several organ systems. We present two cases, one in an immunosuppressed kidney transplant recipient and one in a patient on hemodialysis currently not on immunosuppression. The different clinical presentations and disease development may indicate that the current criteria for MIS-A diagnosis may be inadequate for immunosuppressed patients, as chronic immunosuppression may alter disease presentation. Both patients were treated with corticosteroids and intravenous immunoglobulins, and in both cases the treatment resulted in a prompt resolution of symptoms and stabilization of inflammatory parameters. [ABSTRACT FROM AUTHOR]