In neonates with bacterial infection (defined by a combination of clinical signs and increased C-reactive protein and immature-total quotient values) no differences in the overall pattern nor in any of the particular phases of the C-reactive protein response curves could be observed between neonates with positive (n = 13) or negative blood cultures (n = 47).

We evaluated the impact of human leukocyte antigen (HLA) disparity (immunogenicity; IM) on long-term kidney allograft survival. The IM was quantified based on physicochemical properties of the polymorphic linear donor/recipient HLA amino acids (the Cambridge algorithm) as a hydrophobic, electrostatic, amino acid mismatch scores (HMS\AMS\EMS) or eplet mismatch (EpMM) load. High-resolution HLA-A/B/DRB1/DQB1 types were imputed to calculate HMS for primary/re-transplant recipients of deceased donor transplants. The multiple Cox regression showed the association of HMS with graft survival and other confounders. The HMS integer 0-10 scale showed the most survival benefit between HMS 0 and 3. The Kaplan-Meier analysis showed that: the HMS=0 group had 18.1-year median graft survival, a 5-year benefit over HMS>0 group; HMS ≤ 3.0 had 16.7-year graft survival, a 3.8-year better than HMS>3.0 group; and, HMS ≤ 7.8 had 14.3-year grafts survival, a 1.8-year improvement over HMS>7.8 group. Stratification based on EMS, AMS or EpMM produced similar results. Additionally, the importance of HLA-DR with/without -DQ IM for graft survival was shown. In our simulation of 1,000 random donor/recipient pairs, 75% with HMS>3.0 were re-matched into HMS ≤ 3.0 and the remaining 25% into HMS≥7.8: after re-matching, the 13.5 years graft survival would increase to 16.3 years. This approach matches donors to recipients with low/medium IM donors thus preventing transplants with high IM donors.

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Fulminant Clostridium Difficile Colitis (FCDC) is a highly lethal disease with mortality rates ranging between 12% -80%. In patients status-post allograft solid organ transplant this rate is increased. Treatment, however, is the same as the general population; emergent exploratory laparotomy and subtotal colectomy. However, this procedure done in an emergent setting carries a mortality rate up to 34% as well as significant patient morbidity. To our knowledge, only a few studies have examined a less aggressive treatment. The technique involves creating a divergent ileostomy to deliver antibiotics directly into the colon. This patient, a 68 yearold male who underwent renal transplant 7 days earlier, developed abdominal distension and paralytic ileus with eventual diarrhea. C. difficile was confirmed by microbiological studies. Despite treatment with oral vancomycin and intravenous metronidazole, this patient developed sepsis and required laparotomy. The index case was complicated by cardiac arrest and aborted. Because of the poor clinical course, he underwent placement of cecostomy tube followed by antibiotic irrigation. Full recovery was achieved and complete anatomy of the colon was preserved. In patients with FCDC, less aggressive surgical options should be investigated, as they could have benefits on the subsequent quality of life of the patient.

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