Cytomegalovirus (CMV ) 是影响肝移植的结果的普通病毒的病原体。除了 CMV 症候群和织物侵略的疾病的直接效果， CMV 与增加的倾向被联系到尖锐、长期的紧密相联的接枝拒绝，加速的丙肝复发，和另外的机会主义的感染，以及减少了全面耐心、紧密相联的接枝幸存。为 CMV 疾病的风险因素经常被互连，并且包括 CMV D+/R- serostatus，尖锐拒绝，女性，年龄，高剂量的 mycophenolate mofetil 和泼尼松的使用，和免疫的全面的州。除了 CMV 特定的 CD4+ 和 CD8+ T 淋巴细胞的角色，有数据建议天生的免疫系统的功能贡献 CMV 疾病致病。在一研究，有在作为像使用费的受体知道的天生的有免疫力的分子的特定的多型性的肝 transplant 接受者是更可能的开发 CMV 复制和临床的疾病的高水平。因为 CMV 疾病的直接、间接的不利效果，它的预防，是否通过抗病毒的预防或抢先式的治疗，是在改进肝移植的结果的一个必要部件。在 transplant 中心的多数，抗病毒的预防是在为在肝的 CMV-seronegative 接受者的 CMV 疾病的预防的抢先式的治疗上的比较喜欢的策略从 CMV-seropositive 施主(D+/R-) 的紧密相联的接枝。然而，抗病毒的预防的主要缺点是延期发作的出现主要 CMV 疾病。在几未来、回顾的研究，延期发作的发生主要 CMV 疾病从 16% ～ 47% CMV D+/R- 肝 transplant 接受者。当前的数据建议那延期发作 CMV 疾病在肝移植以后与增加的死亡被联系。因此，为预防优化了策略，有行动的唯一的模式的新奇的药被需要。当前，当对在肝的主要 CMV 疾病的预防移植接受者，使随机化的控制临床的试用正在被执行比较 maribavir，新奇苯并咪唑核糖甙，和口头的 ganciclovir 的功效和安全。CMV 疾病的处理由主要组成静脉内(IV ) ganciclovir，并且如果可行，在免疫力的抑制的度的减小。最近的控制临床的试用�

Cytomegalovirus infection after liver transplantation： Current concepts and challenges

Background: In end-stage renal disease (ESRD), gut-derived uremic toxins play a crucial role in the systemic inflammation and oxidative stress promoting the excess morbidity and mortality. The biochemical derangement is in part a consequence of an insufficient generation of short-chain fatty acids (SCFA) due to the dysbiosis of the gut and an insufficient consumption of the fermentable complex carbohydrates. Aim of the study: The primary end-point was to evaluate the potential efficacy of SCFA (specifically, sodium propionate (SP)) for patients on maintenance hemodialysis (MHD) on systemic inflammation. Secondary end-points included potential attenuation of oxidative stress markers, insulin resistance and production of gut-derived uremic toxins indoxyl sulfate and p-cresol sulfate, as well as health status after SP supplementation. Study design: We performed a single-center non-randomized pilot study in 20 MHD patients. They received the food additive SP with a daily intake of 2 × 500 mg in the form of capsules for 12 weeks. Pre-dialysis blood samples were taken at the beginning, after six weeks and at the end of the administration period, as well as four weeks after withdrawal of the treatment. Results: The subjects revealed a significant decline of inflammatory parameters C-reactive protein (−46%), interleukin IL-2 (−27%) and IL-17 (−15%). The inflammatory parameters IL-6 and IFN-gamma showed a mild non-significant reduction and the anti-inflammatory cytokine IL-10 increased significantly (+71%). While the concentration of bacterial endotoxins and TNF-α remained unchanged, the gut-derived uremic toxins, indoxyl sulfate (−30%) and p-cresyl sulfate (−50%), revealed a significant decline. The SP supplementation reduced the parameters of oxidative stress malondialdehyde (−32%) and glutathione peroxidase activity (−28%). The serum insulin levels dropped by 30% and the HOMA-index by 32%. The reduction of inflammatory parameters was associated with a lowering of ferritin and a significant increase in transferrin saturation (TSAT). Four weeks after the end of the treatment phase, all improved parameters deteriorated again. Evaluation of the psycho-physical performance with the short form 36 (SF-36) questionnaire showed an enhancement in the self-reported physical functioning, general health, vitality and mental health. The SP supplementation was well tolerated and without important side effects. No patient had left the study due to intolerance to the medication. The SP supplementation in MHD patients reduced pro-inflammatory parameters and oxidative stress and improved insulin resistance and iron metabolism. Furthermore, SP effectively lowered the important gut-derived uremic toxins indoxyl and p-cresol sulfate. These improvements were associated with a better quality of life. Further controlled studies are required in a larger cohort to evaluate the clinical outcome.

https://www.mdpi.com/2077-0383/7/10/315/pdf

Supplementation of Short-Chain Fatty Acid, Sodium Propionate, in Patients on Maintenance Hemodialysis: Beneficial Effects on Inflammatory Parameters and Gut-Derived Uremic Toxins, A Pilot Study (PLAN Study)

Resistance to recombinant human erythropoietin is a common condition in dialyzed patients with chronic kidney disease and is associated with more hospitalizations, increased mortality and frequent blood transfusions. The main cause of hyporesponsiveness to recombinant human erythropoietin in these patients is iron deficiency. However, a high proportion of patients does not respond to treatment, even to the use of intravenous iron, which indicates the presence of other important causes of resistance. In addition to the iron deficiency, the most common causes of resistance include inflammation, infection, malnutrition, inadequate dialysis, and hyperparathyroidism, although other factors may be associated. In the presence of adequate iron stores, other causes should be investigated and treated appropriately.

http://www.scielo.br/pdf/rbhh/v37n3/1516-8484-rbhh-37-03-00190.pdf

Resistance of dialyzed patients to erythropoietin.

Haemolysis in haemodialysis, although rare in current times, is associated with significant mortality and morbidity. As such prompt recognition, treatment, analysis of root cause and correction of underlying causative factors is crucial. Dialysate, extracorporeal circuit and patient related factors all contribute to haemolysis risk. Haemolysis can manifest with non-specific signs and symptoms including but not restricted to hypertension, nausea, pain (abdominal, chest, back) and dyspnoea. It may present acutely during the dialysis session or may take a protracted course. Potential life threating consequences include; hyperkalaemia induced cardiac arrhythmias, profound anaemia and associated acute coronary events and respiratory distress, and severe necrotizing pancreatitis. Chronic haemolysis results in impaired endothelial function thus contributing to the long-term cardiovascular risk profile in haemodialysis patients. Stringent national and international standards, technological advancements in membrane and dialysis equipment design, dialyser purification methods and water treatment systems have greatly reduced the incidence of haemolysis. Despite these improvements recognition of haemolysis risk and ongoing clinical vigilance is important.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/nep.13119

Haemolysis in haemodialysis.

Dynamics of the erythropoiesis stimulating agent resistance index in incident hemodiafiltration and high-flux hemodialysis patients

Cytokines signatures in short and long-term stable renal transplanted patients.

Parvovirus B19 (B19) and cytomegalovirus (CMV) infections and anti-erythropoietin (anti-EPO) antibodies in patients on dialysis hyporesponsive to erythropoietin therapy.

Parvovirus B19 presents tropism for human erythroid progenitor cells, causing chronic anemia in organ transplant recipients, due to their suppressed humoral and cellular responses. Diagnosis may be achieved through serological tests for detection of anti-B19 antibodies. However, renal transplant recipients are not routinely tested for parvovirus B19 infection, since there is scanty data or consensus on screening for B19 infection, as well as for treatment or preventive management of transplanted patients. Herein we report a kidney transplant recipient, who was unresponsive to treatment of severe anemia, and presented hypocellular hematopoietic marrow, megaloblastosis and hypoplasia of erythroid lineage with larger cells with clear nuclei chromatin and eosinophilic nuclear inclusions. This patient was seropositive for Epstein-Barr and Cytomegalovirus infections and negative for anti-parvovirus B19 IgM and IgG antibodies, although symptoms were suggestive of parvoviruses infection. A qualitative polymerase chain reaction testing for B19 in serum sample revealed positive results for B19 virus DNA. This case report suggests that the diagnostic process for parvovirus B19 in renal transplant recipients should include a polymerase chain reaction assay to detect B19-DNA, since specific serological tests may be unreliable given their impaired humoral responses. These results also indicate the importance of considering parvovirus B19 infection in the differential diagnosis of persistent anemia in transplanted patients.

/pdf/human-parvovirus-b19-infection-in-a-renal-transplant-2teqbzkw8q.pdf

Sandra Simone Vilaça

Papers

Resistance of dialyzed patients to erythropoietin.

Cytokines signatures in short and long-term stable renal transplanted patients.

Parvovirus B19 (B19) and cytomegalovirus (CMV) infections and anti-erythropoietin (anti-EPO) antibodies in patients on dialysis hyporesponsive to erythropoietin therapy.

Human parvovirus B19 infection in a renal transplant recipient: a case report