Kidney Function

Background: Few risk factors for quality-of-life outcomes of simultaneous pancreas and kidney transplant recipients are known because of a paucity of data from prospective studies.Study Design: Pretransplant assessment and prospective 3-year follow-up.Setting & Participants: Consecutive potential recipients at a university teaching hospital assessed by Liaison Psychiatry.Predictors: Demographic data; pretransplant Transplant Evaluation Rating Scale scores; current, past 12 months, and prior lifetime psychiatric disorder.Outcomes & Measurements: 36-Item Short Form Health Survey (SF-36) scores.Results: 37 simultaneous pancreas and kidney transplant recipients were assessed pretransplant and at 4 months posttransplant. Posttransplant at 1 year, 29 (81% of survivors); at 2 years, 26 (79% of survivors and those reaching 2 years); and at 3 years, 22 (92% of survivors and those reaching 3 years) patients were assessed. SF-36 Mental Component Summary (MCS) scores (mean pretransplant, 46.8 ± 8.2 [SD]; 4 months, 51.7 ± 8.5; 1 year, 50.1 ± 9.7; 2 years, 51.8 ± 8.9; and 3 years, 50.8 ± 13.8) and Physical Component Summary (PCS) scores (pretransplant, 40.6 ± 10.6; 4 months, 43.6 ± 12.0; 1 year, 45.6 ± 11.3; 2 years, 48.1 ± 10.2; and 3 years, 46.8 ± 9.1) showed sustained improvement posttransplant. MCS scores became similar to population norms. Functionally significant decreases in MCS and PCS scores were seen in 4%-21% and 8%-30% at times posttransplant. Male sex predicted higher scores at 4 months for the MCS (P = 0.003; regression coefficient, −8.28 [95% CI, −13.6 to −2.9]; effect size, 0.22) and PCS (P = 0.05; regression coefficient, −6.91 [95% CI, −13.9 to 0.9]; effect size, 0.08). Current psychiatric disorder at pretransplant evaluation predicted higher PCS scores at 4 months (P = 0.002; regression coefficient, −15.42 [95% CI, −24.6 to −6.2]; effect size, 0.22) and 1 year (P = 0.002; regression coefficient, −17.3 [95% CI, −27.9 to −6.7]; effect size, 0.29). Psychiatric disorder before the 12 months before the pretransplant evaluation predicted lower PCS scores at 4 months posttransplant (P < 0.001; regression coefficient, 14.98 [95% CI, 7.1-22.8]; effect size, 0.29).Limitations: Cohort size.Conclusions: Although half experienced sustained quality-of-life improvement, up to one-third experienced a decrease. Past psychiatric disorder is a risk factor. Patients should be educated and monitored appropriately.

Ingestion of a very large amount of methanol usually causes serious toxicity. Methanol is metabolized by alcohol dehydrogenase in the liver to formaldehyde and then quickly transformed by aldehyde dehydrogenase to formic acid. Although methanol is directly responsible for the initial signs and symptoms of inebriation, formaldehyde and formate are responsible for the characteristic blindness and metabolic acidosis with a high plasma anion gap. Lactic acid accumulation also can occur through inhibition of mitochondrial cytochrome oxidase by formate.

There are many causes of late kidney transplant dysfunction. Common causes include chronic transplant injury resulting from rejection and nonimmunologic causes, such as hypertension, calcineurin-inhibitor nephrotoxicity, urinary obstruction, viral or bacterial infections, and, less commonly, recurrent disease. We present an interesting case in which the cause of late transplant dysfunction was identified on a transplant biopsy.