SummaryTacrolimus has become an important cornerstone in the prevention of rejection after kidney transplantation. However, its use has been complicated by several side effects, including chronic allograft nephropathy, diabetes mellitus, arterial hypertension, and neurotoxicity. Tacrolimus-induced neutropenia is a less recognized, but potentially harmful complication. Three patients with severe neutropenia developing within 3 months after kidney transplantation are described. After having excluded other well known causes, tacrolimus was considered the most probable culprit. Definitive proof of this hypothesis was obtained by discontinuation of tacrolimus and switching to cyclosporine, which led to recovery of white blood cell count in all three patients.
Here we present the case of a patient with diagnosis of chronic lymphocytic leukaemia (CLL) on routine protocol biopsy 3 months following kidney transplantation. Genetic analysis confirmed the origin of the malignancy, being the recipient. Differential diagnosis with post-transplant lymphoproliferative disorder (PTLD) is extremely important in order to avoid unnecessary devastating treatment. This case is challenging, both in terms of making the correct diagnosis and in terms of optimal treatment. The case underscores that it is extremely important to distinguish between a pre-existing lymphoma diagnosis after transplantation and a true PTLD as the treatment options of both are very divergent.
Diabetes is associated with several serious chronic complications, impacting quality of life and health costs and decreasing survival. These complications can be reduced by obtaining an adequate glycaemic control. The use of current insulin preparations, however, is associated with many disadvantages, leading to suboptimal use and hence decreased efficacy. Therefore, there is an urgent need for new types of basal insulin analogues, providing a very stable and long basal insulin supply. Degludec and Degludecplus, a combination of degludec and a short-acting insulin analogue, are the first developed new insulin formulations fulfilling these criteria. Promising Phase II and preliminary Phase III data have shown that this new therapy is both efficacious and safe. In combination with a healthy lifestyle, this new generation of insulin might become the new standard of care in type 1 and 2 diabetes, reducing both fatal and non-fatal complications and improving quality of life.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.