In adult patients a significant proportion of chronic renal failure after liver transplantation (LTX) has been described. This was attributed mainly to nephrotoxicity caused by Calcineurin inhibitors (CNI). If these results are transferable to pediatric patients was the aim of this study. Forty-five pediatric patients with a LTX performed between 1988 and 2003 were evaluated. Glomerular filtration rate was calculated using the Schwartz formula (calculated GFR (cGFR) (mL/min/1.73 m2) = kx height (cm)/serum creatinine (mg/dL)). Median age at LTX was 4 yr (range 0.3-18.1). Pretransplant median cGFR was significantly elevated with 157.5 mL/min/1.73 m2. Within the first 3 months after LTX median cGFR normalized to a median value of 102.7 (p < 0.05 vs. pretransplant cGFR). During long-term follow-up median cGFR remained stable with calculated values of 108.0 two years and 112.6 five years after transplantation. Using a linear and an exponential one compartment mathematical modeling of renal function the calculated GFR was stable even for very long observation times (n > 10 yr). Liver insufficiency prior to transplantation was associated with glomerular hyperfiltration. After successful liver transplantation cGFR normalized within the first 3 month and, in contrast to the reported GFR impairment in adult liver transplant recipients, remained stable, even in long-term follow-up.

Summary Nocardiosis is a localized or disseminated bacterial infection caused by aerobic Actinomyces that commonly affects immunocompromised hosts. The aim of this study was to retrospectively review clinical course and outcome of nocardiosis in solid organ recipients at our centre. Five cases of nocardiosis were identified in a series of more than 4000 consecutive solid organ transplants performed at Innsbruck university hospital during a 25‐year period. Of the five patients with nocardiosis, two had undergone multivisceral, one liver, one kidney and one lung transplantation. Three patients with Nocardia asteroides infection were treated successfully and recovered from their infectious disease, however, one lost his renal graft following withdrawal of immunosuppression. The lung recipient recovered from nocardiosis but died later on from Pseudomonas pneumonia. One multivisceral recipient died from Nocardia farcinica‐disseminated infection. Nocardiosis is a rare, difficult‐to‐diagnose‐and‐treat complication following solid organ transplantation. Intestinal recipients might be at increased risk to develop this infection.

The coronavirus disease 2019 (COVID-19) pandemic is currently a challenge worldwide. In Austria, a crisis within the healthcare system has so far been prevented. The treatment of patients with community-acquired pneumonia (CAP), including SARS-CoV-2 infections, should continue to be based on evidence-based CAP guidelines during the pandemic; however, COVID-19 specific adjustments are useful. The treatment of patients with chronic lung diseases

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Letaler Verlauf eines Clostridium difficileassoziierten toxischen Megakolons nach unverwandter Stammzelltransplantation Zusammenfassung. Grundlagen: Eine nosokomiale Clostridium difficile-assoziierte Kolitis tritt in 1-4 % aller chirurgischen Patienten auf. In 3-5 % kann hieraus ein toxisches Megakolon mit schwerer Sepsis entstehen, welches dann einer chirurgischen Intervention bedarf.Methodik: Fallbericht. Ergebnisse: Bei einer Patientin mit ausgeprägter Neutropenie nach Stammzelltransplantation, die wegen einer akuten lymphatischen Leukämie durchgeführt wurde, entwickelte sich trotz adäquater Therapie mit Metronidazol und Vancomycin ein toxisches Megakolon. Nach erfolgloser medikamentöser Therapie wird zunächst eine Hemikolektomie rechts, dann eine subtotale Kolektomie durchgeführt. Dadurch wird zwar das TM erfolgreich therapiert, jedoch gelingt es der anhaltend neutropenischen Patientin trotzdem nicht sich suffizient zu erholen, sodass sie in ein Multiorganversagen verfällt, in dem sie letztendlich verstirbt.Schlussfolgerungen: Patienten mit zu erwartender länger anhaltender Neutropenie, die ein toxisches Megakolon entwickeln, sollten möglichst rasch mit einer subtotalen Kolektomie operativ behandelt werden, da die Infektion auch unter optimaler antibiotischer Therapie zu einem unkontrollierbarem Mulitorganversagen fortschreiten kann.