Viral Infection and Renal Transplant Rejection

Abstract

had developed a duodenal ulcer, one a gastric ulcer, one a combined duodenal and gastric ulcer, and one was found to have radiological evidence of achalasia of the cardia. These patients were referred for surgical treatment, with excellent results in all except the patient with achalasia. Of the four remaining patients, further radiological investigation had shown renal disease in -two, but with no evidence of gastrointestinal disease, and two were again found to have no abnormality.When the radiological diagnosis for the 1964 barium-meal study was compared with the follow-up diagnosis six years later it changed in eight cases. Six, as indicated above, developed upper gastointestinal lesions, and two were found to have renal disease. None of these patients experienced gastrointestinal haemorrhage or perforation during the period of follow-up. Six had died, but in none was the recorded cause of death attributable to a lesion in the upper gastrointestinal tract. DiscussionAn increasing number of patients with dyspepsia are referred for radiological investigations by their general practitioners because a peptic ulcer is suspected. In this series few (3 5%) of those patients with a normal finding on barium-meal examination in 1964 were later found to have a peptic ulcer. Most showed appreciable symptomatic improvement, 65 (76%) claiming to have little or no dyspepsia when questioned in 1970. Fifteen patients claimed there had been no change in their symptoms. The five patients shown by the questionnaire to have deteriorated symptomatically were reinvestigated, and in two a positive diagnosis was obtained.Similar groups of patients studied over an extended period have shown a much higher incidence of peptic ulceration in follow-up. In a group of 174 hospital patients who were followed for 27 years, 40 % were shown to have a peptic ulcer at subsequent investigations (Krag, 1965). Brummer and Hakkinen (1959) followed 102 patients over a six-year period and found that 12 had developed a peptic ulcer. Barfred (1959) followed 235 patients over a 10-year period, and 30% developed a peptic ulcer during this time.The lower incidence of peptic ulcer in our study may be related to two factors. Firstly, all of the present patients were referred directly from general practitioners, whereas the reports referred to above all dealt with a hospital population. Secondly, a longer follow-up period would possibly have given a higher incidence of the subsequent development of peptic ulceration. We believe that this would be unlikely as 76% of the present patients were virtually symptomless six years later.If we assume that "x-ray-negative dyspepsia" represents a separate disease entity then its prognosis is more favourable than for peptic ulcer, most patients showing appreciable improvement with time. If further investigations are reserved only for those patients who show a deterioration symptomatically then the burden of repeated reinvestigations both for the radiological services and the patients will be eased, so reducing unnecessa...

Acute rejection and graft survival in renal transplanted patients with viral diseases

“…47 How viral infections are involved in the development of chronic allograft nephropathy is not yet understood. We, as many other authors, [4][5][6][7][8][9] have observed that the number of acute rejections in renal transplanted patients with infections is higher than in patients who do not undergo infections. The occurrence of acute rejections is known as a risk factor for development of chronic allograft nephropathy.…”

“…1 Active CMV infection is the most frequent infection in renal transplanted patients, 2,3 and it has been shown to be a risk factor for the occurrence of acute rejection episodes. [4][5][6][7][8][9] CMV infection induces activation and proliferation of B lymphocytes in mice as in humans. 10,11 In renal transplanted patients experiencing CMV infection, an early transient increase in peripheral B lymphocyte levels has been documented.…”

Humoral and Cellular Immune Responses after Influenza Vaccination in Kidney Transplant Recipients

“…Theoretical concerns have been raised regarding the potential for triggering allograft rejection with vaccination (1,(18)(19)(20)(21)(22) (23)(24)(25) …”

Randomized Controlled Trial of High-Dose Intradermal Versus Standard-Dose Intramuscular Influenza Vaccine in Organ Transplant Recipients

“…In addition to increased rates of lower respiratory infection with influenza, studies have also reported increased acute and chronic allograft rejection after infection, specifically in lung and kidney transplant recipients (1,(3)(4)(5). Therefore, SOT patients are recommended to receive the annual trivalent inactivated influenza vaccine (6,7).…”