Human parvovirus B19-associated early postoperative acquired pure red cell aplasia in simultaneous pancreas-kidney transplantation:A case report

BACKGROUND Acquired pure red cell aplasia(aPRCA)related to human parvovirus B19(HPV B19)is rarely reported in simultaneous pancreas-kidney transplantation(SPKT)recipients;there has yet to be a case report of early postoperative infection.In this current study,we report the case of a Chinese patient who experienced the disease in the early postoperative period.CASE SUMMARY A 63-year-old man,with type 2 diabetes and end-stage renal disease,received a brain dead donor-derived SPKT.Immunosuppression treatment consisted of tacrolimus,prednisone,enteric-coated mycophenolate sodium(EC-MPS),and thymoglobulin combined with methylprednisolone as induction.The hemoglobin(Hb)level declined due to melena at postoperative day(POD)3,erythropoietinresistant anemia persisted,and reticulocytopenia was diagnosed at POD 20.The bone marrow aspirate showed decreased erythropoiesis and the presence of giant pronormoblasts at POD 43.Metagenomic next-generation sequencing(mNGS)of a blood sample identified HPV B19 infection at POD 66.EC-MPS was withdrawn;three cycles of intravenous immunoglobulin(IVIG)infusion therapy were administered;and tacrolimus was switched to cyclosporine.The HPV B19-associated aPRCA resolved completely and did not relapse within the 1-year follow-up period.The diminution in mNGS reads was correlated with Hb and reticulocyte count improvements.CONCLUSION HPV B19-associated aPRCA can occur at an early period after SPKT.An effective therapy regimen includes IVIG infusion and adjustment of the immunosuppressive regimen.Moreover,mNGS can be used for the diagnosis and to reflect disease progression.

Suture ligation for submucosal hemostasis during hand-sewn sideto-side duodeno-ileostomy in simultaneous pancreas and kidney transplantation

BACKGROUND Enteric anastomotic(EA)bleeding is a potentially life-threatening surgical complication associated with enteric anastomosis during simultaneous pancreas and kidney transplantation(SPKT).AIM To investigate whether suture ligation(SL)for submucosal hemostasis during hand-sewn enteric anastomosis could decrease the morbidity of early EA bleeding in SPKT.METHODS We compared the outcomes of 134 patients classified into SL(n=44)and no SL(NSL)groups(n=90).This study adheres to the declarations of Istanbul and Helsinki and all donors were neither paid nor coerced.RESULTS During the first postoperative week,the EA bleeding rate in the SL group was lower than that in the NSL group(2.27%vs 15.56%;P=0.021);no relationship was found between EA bleeding and donor age,mean pancreatic cold ischemia time,platelet count,prothrombin time international normalized rate,activated partial thromboplastin time,and thrombin time.Anastomotic leakage was observed in one case in the SL group at postoperative day(POD)14 and in one case at POD 16 in the NSL group(P=0.754).No significant difference was found between the two groups in the patient survival,pancreas graft survival,or kidney graft survival.CONCLUSION SL for submucosal hemostasis during hand-sewn enteric anastomosis in SPKT can decrease the morbidity of early EA bleeding without increasing the anastomotic leakage rate.