Purpose: To evaluate outcomes of percutaneous nephrostomies (PCN) in renal transplant recipients, and compare outcomes of PCN placement before and after 30 days from transplant. Material and methods: A retrospective audit of 1041 transplants undergoing PCN was performed. PCN population was classified into early-PCN and late-PCN groups (<30/>30 days from transplant). Graft survival (GS) was compared between early/late groups and transplants with and without PCN. Results: 79 (7.6%, n = 79/1041) transplants underwent 89 PCN procedures. 67 (75%, n = 67/89) underwent nephroureteral stent (NUS) placement and 12 (25%, n = 12/89) were simple PCN placements. Procedure-related complications in early-vs. late-PCN were 4.3%, (n = 1/23) and 3.0% (n = 2/66) p > 0.05. Catheter-related complications in early-PCN vs. late-PCN were 13%, (n = 3/23) and 11% (n = 7/66) p > 0.05. Graft survival at 12, 36, and 48 months after PCN placement for early-PCN vs. late-PCN was 86% ± 7, 81 ± 8, and 81 ± 10 vs. 93% ± 3, 75 ± 8, and 66 ± 9, respectively (p = 0.50). Graft survival at 1, 4, and 10 years after transplant in early-PCN vs. late-PCN was 86% ± 7, 86 ± 8, and 29% ± 17 vs. 96% ± 2, 81 ± 6, and 61 ± 13, respectively (p = 0.01). Graft survival for all PCN vs. no-PCN transplants at 1, 4, and 10 years were 94% ± 3, 83% ± 5, and 55% ± 11 vs. 92% ± 1, 80% ± 1, and 59% ± 3, respectively (p = 0.50). Conclusion: PCN in renal transplantation is safe and effective with no effect on graft survival. Early PCN poses no additional risk to the graft; however, it is a poor prognostic indicator for long-term graft survival.

Thrombotic microangiopathy (TMA) is an uncommon but serious complication in renal transplant recipients. Posttransplant TMA can either be due the recurrence of the pre-transplant disease or it may occur de-novo. Amongst pre-transplant TMA, majority of the atypical HUS usually lead to renal insufficiency and end-stage kidney disease, while the typical or shiga toxin associated HUS has good prognosis. Post-transplant recurrence is <1% in shiga toxin associated HUS, whereas it is around 80–100% in certain forms of atypical HUS. Due to this high recurrence rates, previously the renal transplant was contraindicated in such patients, however, with better understanding of the pathogenesis of disease and progress in genetic analysis, renal transplant may now be possible in some of these patients. In view of the lack of controlled trials, plasma exchange remains the primary modality of treatment, while further options include isolated kidney transplant, liver transplant, combined liver-kidney transplant, prophylactic and therapeutic eculizumab and judicious use of immunosuppressant. In this review, we have discussed various causes of posttransplant TMA, their pathogenesis, outcomes and different therapeutic options.

Renal transplant from a HBsAg positive living donor to a negative recipient is not routinely done due to risk of transmission of hepatitis B infection following transplantation. Such donors are usually rejected which further reduces the donor pool. We report a case of HBsAg negative recipient transplanted with a kidney from HBsAg positive donor who is free from chronic infection on one year follow up. This to best of our knowledge is first reported case in India.