Some renal transplant patients show cognitive, emotional, and behavioral changes as part of possible neurotoxic effects associated with immunosuppressive medication, especially tacrolimus. This study evaluated effects of immunosuppressive drugs on some cognitive tasks. Patients treated with sirolimus and cyclosporine reported some of the noncognitive side effects related to immunosuppressive treatment. We observed attention and working memory impairment in patients treated with sirolimus or tacrolimus. Performance of cyclosporine-treated subjects was similar to that of healthy volunteer controls. Since the mood, anxiety, and sleep patterns measured were unaffected, it could be concluded that the cognitive deficit found was partly related to treatment.

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Thrombotic microangiopathy is a rare but serious complication that affects kidney transplant recipients. It appears in 0.8–14% of transplanted patients and negatively affects graft and patient survival. It can appear in a systemic form, with hemolytic microangiopathic anemia, thrombocytopenia, and renal failure, or in a localized form, with progressive renal failure, proteinuria, or arterial hypertension. Post-transplant thrombotic microangiopathy is classified as recurrent atypical hemolytic uremic syndrome or de novo thrombotic microangiopathy. De novo thrombotic microangiopathy accounts for the majority of cases. Distinguishing between the 2 conditions can be difficult, given there is an overlap between them. Complement overactivation is the cornerstone of all post-transplant thrombotic microangiopathies, and has been demonstrated in the context of organ procurement, ischemia-reperfusion phenomena, immunosuppressive drugs, antibody-mediated rejection, viral infections, and post-transplant relapse of antiphospholipid antibody syndrome. Although treatment of the causative agents is usually the first line of treatment, this approach might not be sufficient. Plasma exchange typically resolves hematologic abnormalities but does not improve renal function. Complement blockade with eculizumab has been shown to be an effective therapy in post-transplant thrombotic microangiopathy, but it is necessary to define which patients can benefit from this therapy and when and how eculizumab should be used.

Summary Hepatitis C virus (HCV) positive donors are identified in Spain by antibody detection (HCV‐Ab) techniques while a HCV nuclear acid‐testing (HCV‐NAT) is not mandatory. Since it has been shown that HCV‐Ab positive HCV‐NAT negative donors do not universally transmit the infection, we designed a protocol based on the identification of viremia in HCV‐Ab positive donors to start treatment if needed. HCV‐Ab‐positive donors were identified and we performed HCV‐NAT immediately. Donors coinfected with HIV were excluded. Recipients with a low chance to receive a transplant, with no history of liver disease and who were negative for HCV‐Ab were selected after informed consent was signed. Kidney recipients from HCV‐NAT‐positive donors received glecaprevir and pibrentasvir from 6 h before the transplant until 8 weeks after. Recipients from HCV‐NAT‐negative donors were not treated. Regular monitoring by HCV‐NAT was performed to initiate antiviral treatment. We included 11 recipients from six deceased donors Four recipients received grafts from HCV‐NAT‐positive donors and seven patients received grafts from HCV‐NAT‐negative donors. None of our recipients exhibited HCV‐NAT positivity during the minimum follow‐up period of 6 months. Recipients from HCV‐NAT‐positive donors exhibited sustained virologic response at 12 weeks. One recipient from an HCV‐NAT‐negative donor lost his graft via a process thought to be unrelated to HCV. The remaining 10 patients had a stable functioning graft at the end of the follow‐up period. Our preliminary data suggest that renal transplantation from HCV‐Ab‐ positive donors to HCV‐Ab negative recipients is safe when only the recipients of organs from HCV‐NAT‐positive donors are treated.

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