Browsing by Author "Muller, E"

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    Open Access
    The incidence and impact of Human Papillomavirus in HIV infected transplant patients
    (2018) Botha, Janie; Muller, E
    Background: Human Papillomavirus (HPV) is a common sexually transmitted infection, associated with condylomata acuminata, anogenital squamous intraepithelial lesions, and ultimately invasive squamous cell carcinoma. HPV types 16 and 18 are the most common subtypes in individuals with cervical cancer. The association with these two subtypes in individuals with squamous carcinoma of the anus is fundamentally the same as with cervical cancer, and also affects the same high risk phenotype. Human imunnodeficiency virus (HIV) positive transplant patients have two modes of immunosuppression - the disease itself and the additional immunosuppression required after transplantation, which intuitively places them at a higher risk for this type of infection, if compared to their HIV negative counterparts. Aim: The first aim is to determine the prevalence of HPV-associated cytological and pathological abnormalities of the anus in HIV positive kidney transplant recipients and the second aim is to determine if HIV positive solid organ recipients carry higher risk for having HPV of the anus than HIV negative solid organ recipients. Materials and methods: This is a cross sectional study, conducted at the Transplant unit of Groote Schuur Hospital. 14 HIV positive renal transplant recipients and 14 age matched HIV negative renal transplant recipients with similar immunosuppression regimens and time from transplantation were selected. Ethical approval for the study was obtained from the UCT Ethics committee (HREC/REF: 595/2014). Informed consent was obtained from all participants. Samples for cytology and histology were taken from the anal canal. Demographic data was collected, date of HIV diagnosis, duration on anti-retroviral drugs, time since transplant, type of immunosuppression, whether there was visible condylomata or not and if there were any lesions suspicious of cancer. Cytology and histology was correlated with clinical findings. The statistics were analysed with Stata® software. Results: Mean age was 40.8y ±7.5 (range 27-52) in the HIV positive study group and 41y ±14.4 (range20-62) in the HIV negative control group. HIV positive patients were screened 40.1 months ± 21 (range 13-74.6m) post renal transplant. HIV negative patients were screened 55.9 months ± 23.3 (range 8.9-80 m) post renal transplant. Two HIV positive patients had anal warts, compared to 1 in the HIV negative group. No statistically significant difference could be demonstrated between the occurrence of intra-epithelial neoplasm on cytology in the HIV positive and negative groups. However, HIV positive patients had a higher incidence of HPV on histology that was statistically significant. There was no evidence of squamous intra-epithelial neoplasm found on histology in either group. Conclusions: Evidence of HPV of the anus was demonstrated in both groups, there was no demonstrable statistical significance in occurrence between the two groups' cytology. Histology, however, yielded a significant number of patients with HPV in the HIV positive group. None of the patients had evidence of invasive malignancy.
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    Liver transplantation at Red Cross War Memorial Children's Hospital
    (2006) Spearman, C W N; McCulloch, M; Millar, A J W; Burger, H; Numanoglu, A; Goddard, E; Gajjar, P; Davies, C; Muller, E; McCurdie, FJ; Kemm, D; Cywes, S; Rode, H; Kahn, D
    The liver transplant programme for infants and children at Red Cross War Memorial Children’s Hospital is the only established paediatric service in sub-Saharan Africa. Referrals for liver transplant assessment come from most provinces within South Africa as well as neighbouring countries. Patients and methods. Since 1987, 81 children (range 6 months - 14 years) have had 84 liver transplants with biliary atresia being the most frequent diagnosis. The indications for transplantation include biliary atresia (48), metabolic (7), fulminant hepatic failure (10), redo transplants (3) and other (16). Four combined liver/kidney transplants have been performed. Fifty-three were reduced-size transplants with donor/recipient weight ratios ranging from 2:1 to 11:1 and 32 children weighed less than 10 kg. Results. Sixty patients (74%) survived 3 months - 14 years post transplant. Overall cumulative 1- and 5-year patient survival figures are 79% and 70% respectively. However, with the introduction of prophylactic intravenous ganciclovir and the exclusion of hepatitis B virus (HBV) IgG core Ab-positive donors, the 1-year patient survival is 90% and the projected 5-year paediatric survival is > 80%. Early (< 1 month) postliver-transplant mortality was low. Causes include primary malfunction (1), inferior vena cava thrombosis (1), bleeding oesophageal ulcer (1), sepsis (1) and cerebral oedema (1). Late morbidity and mortality was mainly due to infections: de novo hepatitis B (5 patients, 2 deaths), Epstein-Barr virus (EBV)- related post-transplantation lymphoproliferative disease (12 patients, 7 deaths) and cytomegalovirus (CMV) disease (10 patients, 5 deaths). Tuberculosis (TB) treatment in 3 patients was complicated by chronic rejection (1) and TB-drug-induced subfulminant liver failure (1). Conclusion. Despite limited resources, a successful paediatric programme has been established with good patient and graft survival figures and excellent quality of life. Shortage of donors because of infection with HBV and human immunodeficiency virus (HIV) leads to significant waiting-list mortality and infrequent transplantation.
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    Overview of a paediatric renal transplant programme
    (2006) McCulloch, M; Gajjar, P; Spearman, W; Burger, H; Sinclair, P; Savage, L; Morrison, C; Davies, C; Ruysch van Dugteren, GPA; Maytham, D; Wiggelinkhuizen, J; Pascoe, M D; McCurdie, F J; Pontin, A; Muller, E; Numanoglu, A; Millar, A J W; Rode, H; Khan, D
    INTRODUCTION: Renal transplantation is the therapy of choice for children with end-stage renal failure. There are many challenges associated with a paediatric programme in a developing country where organs are limited. METHODS: A retrospective review was undertaken of 149 paediatric renal transplants performed between 1968 and 2006 with specific emphasis on transplants performed in the last 10 years. Survival of patients and grafts was analysed and specific problems related to drugs and infections were reviewed. RESULTS: On review of the total programme, 60% of the transplants have been performed in the last 10 years, with satisfactory overall patient and graft survival for the first 8 years post transplant. At this point, transfer to adult units with non-compliance becomes a significant problem. Rejection is less of a problem than previously but infection is now a bigger issue--specifically tuberculosis (TB), cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections with related complications. A wide variety of drugs are available for tailoring immunosuppression to minimise side-effects. CONCLUSION: It is possible to have a successful paediatric transplant programme in a developing country. However, to improve long-term outcomes certain issues need to be addressed, including reduction of nephrotoxic drugs and cardiovascular risk factors and providing successful adolescent to adult unit transition.