The lowest uric acid in kidney transplant and review of literature

Heredity hypouricemia is caused by renal hypouricemia or xanthinuria. Xanthinuria is divided into type 1 with deficiency of xanthine dehydrogenase and type 2 with xanthine dehydrogenase and aldehyde oxidase deficiency. We report a case of xanthinuria type 1 that developed with kidney failure. Hemodialysis was done for him, but kidney function was not improved, so a kidney transplant was performed for him. His serum uric acid was 0.1 mg/dl before and after transplantation.

Importance of miR-UL-148D Expression Pattern in Cytomegalovirus Infected Transplant Patients

Background

MicroRNAs (miRNAs) are endogenous, 18-22 nucleotide non-coding RNA molecules. Human cytomegalovirus (HCMV) is a ubiquitous and particular herpes virus that encodes miRNAs, which increases gradually in the presence of infection. One of the important viral miRNAs is HCMV-miRUL-148D, which plays a role in establishing and maintaining viral latency.

Objective

The current study aimed to evaluate the expression levels of HCMV-miRUL-148D in active and inactive HCMV infected transplant patient groups compared to healthy individuals.

Methods

Total RNA was extracted from blood samples of 60 solid organ transplant patients and 30healthy controls. In-house SYBR Green Real-Time PCR evaluated the expression levels of studied miRNAand gene.

Results

The expression level of the UL-148D gene was significantly higher in the active HCMV infectedpatients (p=0.001) compared to other groups. While the miRUL-148D expression level significantly increased in the inactive HCMV-infected patients (p<0.001) compared to other groups.

Conclusion

Increased miRUL-148D expression level in the inactive HCMV-infected transplant patients indicates the potential role of this miRUL-148D as a biomarker of the HCMV latent stage.

Virtual Crossmatching in Kidney Transplantation, Shiraz Experience in Development of a Web-Based Program

BACKGROUND

Kidney transplantation can increase survival and quality of life in patients with end-stage renal disease. In any allocation system, the crossmatch test plays an essential role in donor-recipient compatibility.

OBJECTIVE

In this study, we aim to test the benefits of a web-based program that captures HLA antibody analyses and provides a report to allow fast and accurate virtual crossmatches.

METHODS

One hundred potential recipients in the waiting list of renal transplants were selected. The included patients all had a complete HLA antibody profile. Also, 10 potential donors from previous kidney transplants (2020), with available HLA typing results for A, B, and DR locus, were also selected. A comparison was made between 100 recipients against ten potential donors, and virtual crossmatching (VXM) was performed by the web-based program and manually by an experienced immunologist.

RESULTS

The average time for a manual VXM was 30 minutes per patient, while the virtual cross web-based program took 5 minutes per patient. In 12% of the manual VXM cases, a secondary review of data improved final results. In two manual virtual crossmatches, the VXM results had errors in matching recipient antibodies with the donor HLA typing that could affect the final decision for transplantation.

CONCLUSION

In conclusion, a web-based VXM program that assesses HLA data can accurately perform a VXM with fewer human errors. It is especially true for highly sensitized candidates.

Serum LDL Levels are a Major Prognostic Factor for Arteriovenous Fistula Thrombosis (AVFT) in Hemodialysis Patients

Introduction

Arteriovenous fistula thrombosis (AVFT) is still a common cause of morbidity in patients undergoing regular hemodialysis (HD). Many factors have been found to induce AVFT. Some of those factors are local and others are systemic ones. In this study, we evaluated some local and systemic factors simultaneously, to predict the most potent risk factor for AVFT in HD patients.

Patients and methods

One hundred and eighteen patients aged 20–80 yrs with end-stage renal disease (ESRD) were evaluated prospectively for a period of 14 months. First, anticardiolipin antibodies (ACLA), TG, cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL) were analyzed by conventional methods. Other basic data were accessed from patients' medical records. All fistulas were evaluated clinically as patent at the start of this study. Patients were followed-up for any evidence of AVFT within 14 months. Finally, all factors (diabetes, hypertension, presence of ACLA, ultrafiltration ≥3 L, age, gender, weight, hypotension during dialysis, fistula site, epoetin alpha usage, TG, HDL, LDL and total cholesterol) were analyzed in a stepwise regression analysis.

Results

Eighteen episodes of AVFT documented with Doppler sonography occurred in 17 patients (15.3%). Regression analysis showed only LDL values were the AVFT predictor in our patients (p=0.002, β-coefficient=0.3). Kaplan-Meier analysis showed a significantly lower AVF patency time in patients with LDL >130 mg/dl than those with LDL <130 mg/dl (log rank=0.0014).

Discussion

LDL value is a major prognostic factor for AVFT in HD patients and lowering it to <130 mg/dl could improve fistula patency.

Genetic analysis of Iranian autosomal dominant polycystic kidney disease: new insight to haplotype analysis

Autosomal Dominant Polycystic Kidney Disease (ADPKD) caused by mutations in two PKD1 and PKD2 genes. Due to the complexity of the PKD1 gene, its direct mutation screening is an expensive and time-consuming procedure. Pedigree-based haplotype analysis is a useful indirect approach to identify the responsible gene in families with multiple affected individuals, before direct mutation analysis. Here, we applied this approach to investigate 15 appropriate unrelated ADPKD families, selected from 25 families, who referred for genetic counseling. Four polymorphic microsatellite markers were selected around each PKD1 and PKD2 loci. In addition, by investigating the genomic regions, two novel flanking tetranucleotide STR markers were identified. Haplotype analysis and calculating Lod score confirmed linkage to PKD1 in 9 families (60%) and to PKD2 in 2 families (13%). Linkage to both loci was excluded in one family (6.6%). In 2 families (13%) the Lod scores were inconclusive. Causative mutation was identified successfully by direct analysis in two families with confirmed linkage, one to PKD1 and another to PKD2 locus. The study showed that determining the causative locus prior to direct mutation analysis is an efficient strategy to reduce the resources required for genetic analysis of ADPKD families. This is more prominent in PKD2-linked families. Selection of suitable markers, and appropriate PCR multiplexing strategy, using fluorescent labeled primers and 3 primer system, will also add value to this approach.

Antibiotic selective pressure and development of bacterial resistance detected in bacteriuria following kidney transplantation

INTRODUCTION

Bacteriuria (symptomatic and asymptomatic) is the most common infectious complication after kidney transplantation. This study aimed to determine its prevalence among kidney transplant recipients hospitalized after transplantation, respective risk factors, and frequency of isolates and antibacterial susceptibility.

METHODS

Retrospectively, we divided hospitalized patients into 3 groups. Groups 1 and 2 included 78 and 152 recipients with and without bacteriuria, respectively, and the potential risk factors were compared. Cefixime was prescribed as early postsurgical prophylaxis. Group 3 patients were 116 randomly selected nontransplantation patients with urinary tract infection. Frequency of uropathogens and their antibiotic susceptibility were compared in groups 1 and 3.

RESULTS

In total, 103 bacteriuria episodes were detected in 15.2% of the patients. The frequency of risk factors in groups 1 and 2 was similar. Escherichia coli was the most common isolate in groups 1 (40.8%) and 3 (68.1%; P = .03). Streptococcus faecalis was the most common gram-positive isolate in groups 1 (17.5%) and 3 (6.9%; P = .03). Sensitivity rates in group 1 were 9% to trimethoprim-sulfamethoxazole, 20% to ciprofloxacin, and 38.4% to gentamicin, which was not significantly different from group 3. However, the sensitivity rates of gram-negative isolates to ceftriaxone were 9.5% and 28.4% (P = .004) in groups 1 and 3, respectively, and to cefixime 4.5% and 22% (P = .01).

DISCUSSION

High antibacterial resistance of uropathogens isolated from kidney transplantation and nontransplantation patients is alarming. The higher resistance to third-generation cephalosporins in transplant recipients may be due to antibiotic selection pressure secondary to postsurgical prophylaxis with cefixime.

Frequency of Polyomavirus BK Infection in Kidney Transplant Patients Suspected to Nephropathy

BACKGROUND

Polyomavirus BK is a major cause of nephropathy in immunosuppressed transplanted patients. Non-invasive diagnostic protocols such as molecular detection of polyomavirus BK replication are a useful strategy to predict BK virus-associated nephropathy (BKVAN).

OBJECTIVE

To determine the prevalence of polyomavirus BK infection among kidney transplant patients suspected to have BKVAN.

METHODS

In a cross-sectional study 108 kidney transplanted patients whose laboratory and clinical presentation were in favor of nephropathy between 2010 and 2012, were enrolled for analysis. Polyomavirus BK replication was evaluated in plasma and tissue samples of studied patients using a quantitative real-time PCR. Active cytomegalovirus infection was analyzed in studied patients using antigenemia method. A possible association between polyomavirus BK infection with clinical and laboratory risk factors of BKVAN were evaluated.

RESULTS

The polyomavirus BK replication was found in 17 (15.7%) of 108 of plasma and 9 (11%) of 82 tissue samples in kidney transplanted patients. Cytomegalovirus co-infection was found in 3 of 17 and 3 of 9 plasma and tissue samples in polyomavirus BK infected patients, respectively. Significant associations were found between polyomavirus BK infection with tubulointerstitial nephritis and acute cellular rejection, as important pathologic findings of BKVAN.

CONCLUSION

Diagnosis of single and co-infection of polyomavirus BK infection in plasma samples is a useful assay to evaluate the risk of BKVAN in kidney transplant patients. Established threshold values for studied viral infections have beneficial use in screening of kidney transplant patients at risk of BKVAN, need to confirm and standardized in completed further studies.

The effect of exercise training on quality and quantity of sleep and lipid profile in renal transplant patients: a randomized clinical trial

BACKGROUND

Patients undergoing renal transplantation consume immunosuppressive drugs to prevent graft rejection. Cardiovascular complications and reduced quality of sleep are among the side effects of these drugs. Studies have indicated that the use of non-therapeutic methods such as exercise is important to reduce these complications.

OBJECTIVE

To evaluate the effect of a period of exercise training, as a non-therapeutic method, on quality and quantity of sleep and lipid profile in renal transplant patients.

METHODS

44 renal transplant recipients were selected to participate in the study and randomized into exercise (n=29) and control (n=15) groups. The exercise group participated in a cumulative exercise program 3 days a week for 10 weeks in 60-90-minute exercise sessions. Control group subjects did not participate in any regular exercise activity during this period. Sleep quality of the subjects was evaluated using Pittsburgh Sleep Quality Index (PSQI) questionnaire; the sleep quantity was assessed by recording the duration of convenient nocturnal sleep of the subjects. Physiological sleep-related variables (serum triglyceride [TG], and total, high-density lipoprotein [HDL], and low-density lipoprotein [LDL] cholesterol) were measured before and after 10 weeks of exercise training

RESULTS

In exercise training group, sleep quality of the subjects was improved by 27%; the sleep quantity was increased by 30 minutes (p<0.05). TG, cholesterol and LDL values were significantly (p<0.05) decreased after 10 weeks of exercise training in the exercise group compared to the control group, however, no change was observed in serum HDL level in exercise group compared to the control. There was also a significant (p=0.05) difference in sleep quality and quantity between control and exercise groups. However, there was no correlation between changing quality and quantity of sleep with sleep-related physiological factors.

CONCLUSION

10 weeks of exercise activity improved the quality and quantity of sleep as well as a number of sleep-related physiological parameters in renal transplant recipients, and would be an effective approach to treat sleep-related disorders in renal transplant recipients.

Comparison of health status and quality of life of related versus paid unrelated living kidney donors

The aim of this cross-sectional study was to assess the health status and quality of life (QOL) of paid unrelated versus related living kidney donors postdonation at Shiraz Transplant Center in Iran. We invited all donors (n = 580, 347 paid unrelated, 233 related) who underwent donor nephrectomy at our center from 2004 to 2010 to participate in a health survey and physical examination. Of 580 donors, 144 consented to participate; participation of paid unrelated donors was significantly lower than related (52/347 vs. 92/233; p < 0.001). Participants underwent a complete physical examination, QOL assessment (using a 36-item short form health survey [SF-36] questionnaire) and laboratory work-up. The paid unrelated donors compared with related donors were younger (34.2 ± 7.2 vs. 40.7 ± 9.7 years, p < 0.001), had shorter time since donation (2.9 ± 1.6 vs. 3.8 ± 2 years, p = 0.004), had higher estimated GFR (72.6 ± 22 vs. 63.8 ± 15.3 mL/min/1.73 m(2), p = 0.006) and had a higher percentage of patients with microalbuminuria (35% vs. 0%, p < 0.001). Additionally, general health and social functioning scores among paid unrelated donors were significantly lower (p < 0.001 and p = 0.02, respectively) than related donors. Other SF-36 scores, although lower in paid unrelated donors, did not reach statistical significance. Iranian paid unrelated donors have lower QOL and higher incidence of microalbuminuria compared with related donors.

Urinary monocyte chemotactic protein-1 and transforming growth factor-β in systemic lupus erythematosus

The purpose of this investigation was to assess the correlation of two biomarkers with the occurrence of renal flares in systemic lupus erythematosus (SLE). Urine levels of monocyte chemotactic protein-1 (MCP-1) and transforming growth factor beta (TGF-β) were measured at baseline, and at two and four months in five groups of patients: 25 lupus nephritis patients with active disease (active LN), 10 lupus nephritis patients with SLE in remission (remission LN), 25 patients with clinical active SLE and without nephritis (active NLN), 10 patients without nephritis with SLE in remission (remission NLN) and 10 healthy controls. We used repeated measurement and ANOVA with Duncan's post hoc to analyze the data; the urine level of the two proteins could distinguish the groups based on the existence of lupus nephritis and/or activity of SLE disease. Furthermore we performed receiver operating curve analysis to identify a cutoff point with a good sensitivity and specificity to diagnose lupus nephritis with either one of the urine proteins. Finally the samples from active LN were grouped according to whether they were Class IV or other classes. Baseline urinary MCP-1, but not TGF-β, was significantly different between the classes. Further investigation into the use of these cytokines in a prospective study is needed to determine their capacity as diagnostic tools for renal flares.

Half-Saline versus Combined Normal Saline and 1/3-2/3 Intravenous Fluid Therapy in Kidney Transplantation

BACKGROUND

Sufficient intravascular volume should be established for optimal graft function after renal transplantation. However, there is no recommendation for the type of fluid therapy post-operatively. We compared half-saline vs. normal saline and 1/3-2/3 intravenous fluid replacement after renal transplantation.

METHODS

We enrolled all patients who underwent kidney transplantation between June 2008 and March 2010 in Golestan Hospital, Ahwaz, southwestern Iran. Patients were randomly divided into two groups using a blinded allocation technique. Group A patients (Case) received half saline, and group B patients (Control) received normal saline and 1/3-2/3 intravenous fluid. According to our protocol, we replaced as much as 100% of hourly urine output in the first day, followed by 90% and 70% of every 2-hour urine output in the 2nd and 3rd days, respectively. Blood pressure and pulse rate were recorded hourly. Serum sodium, potassium, creatinine and pH were assessed twice a day.

RESULTS

There were 34 and 36 eligible patients in the case and control groups, respectively. The mean±SD 6-hour urine output in the first 5 days after surgery was 2586±725 mL in the control group and 2764±758 mL in the case group (p=0.31). The mean±SD serum creatinine level at the end of the 5th post-operative day was 1.3±0.5 and 1.4±0.7 mg/dL in the case and control groups, respectively (p=0.56). Serum creatinine level did not reduce to 1.5 mg/dL or lower in 6 of 36 control subjects and in 4 of 34 cases at the end of the 5th day (p=0.558). The mean±SD time to creatinine level <1.5 mg/dL was 1.3±1 days in the control group and 1.7±0.8 days in the case group (p=0.635). Hyperkalemia occurred in 3 of 36 patients in the control group and in 2 of 34 patients in the case group (p=0.318). The incidence of hyponatremia in the control group was 11% (4 of 36 patients) vs no patients in the case group (p=0.115).

CONCLUSION

Either half-saline or normal saline and 1/3-2/3 intravenous solution can be safely used as fluid replacement therapy after kidney transplantation.

Endothelial Nitric Oxide Synthase Gene T-786C Polymorphism in Renal Transplant Recipients

BACKGROUND

Nitric oxide (NO) is a major mediator in vascular biology, regulating regional blood flow. NO and the enzymes required for its production contribute to ischemia-reperfusion injury. The T-786C functional polymorphism in the promoter region substantially reduces promoter activity of the endothelial nitric oxide synthase (eNOS) gene and compromises endothelial NO synthesis.

OBJECTIVE

To examine the association between T-786C (rs 2070744) single nucleotide polymorphism (SNP) in eNOS gene and the development of acute rejection in renal transplant patients.

METHODS

60 renal transplant recipients (30 with episodes of acute rejection (ARs) and 30 without rejection (non-ARs)), between June 2008 and March 2010, were included in this study. The polymorphism was determined by PCR-restriction fragment-length polymorphism analysis.

RESULTS

The distribution of the genotypes were TT/TC/CC 60%, 33.4%, 6.6%, and 43%, 46.7%, 13.3% in ARs and non-ARs, respectively (p=0.28). The frequency of T-allele was 76.7% and 66.3%; and for C-allele was 66.6% and 33.3% in ARs and non-ARs, respectively (p=0.09). There were no significant associations between these polymorphisms and acute and chronic kidney allograft rejection.

CONCLUSION

We could not detect any significant association between polymorphism in T-786C of eNOS gene and the development of acute rejection.

The effect of simvastatin on lowering panel reactive antibody titer in sensitized dialysis patients: a randomized placebo controlled clinical trial

BACKGROUND

Patients with panel reactive antibodies (PRA) have many difficulties to find a crossmatch-negative kidney for transplantation and are at a higher risk of post-transplantation rejection.

OBJECTIVE

To evaluate the effect of simvastatin on PRA and post-transplant outcome of these sensitized patients.

METHODS

82 patients with end-stage renal disease (ESRD) with a PRA ≥25% were evaluated. In a one-year follow-up, the patients were treated with simvastatin. These patients were compared with 82 matched controls receiving placebo tablets. At the end of the second and 12(th) month, PRA was rechecked in all patients. Those patients who underwent transplantation continued to take simvastatin six months after transplantation. Serum creatinine levels were checked at monthly intervals post-operation.

RESULTS

The mean±SD PRA level at the end of the second month was 36.63%±31.14% and 45.34%±24.36% in cases and controls, respectively (P=0.012). Seven patients in the case group and 10 in the control group were lost to follow-up. The remaining patients continued to take simvastatin for 12 month. The mean±SD PRA level at the end of the 12(th) month was 24.02%±31.04% in cases and 43.15%±26.56% in controls (P=0.001). 25 patients underwent renal transplantation and continued to receive simvastatin 6 months after transplantation. These patients were matched with 25 controls treating with placebo. The mean±SD creatinine level 6 months after kidney transplantation was 2.05±1.14 mg/dL and 3.15±1.09 mg/dL in cases and controls consecutively (P=0.02).

CONCLUSION

Simvastatin can be safely used to lower PRA and improve post-transplantation outcomes.

Emphysematous pyelonephritis in a transplant kidney

Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the kidney and its surrounding tissues. It is characterized by the production of gas within the kidney and perinephric structures. EPN often affects diabetic women but can also occur in nondiabetic patients who have ureteral obstruction and in immunocompromised patients. Herein, we report EPN in a 23-year-old woman who had a renal transplantation.

Are Large Nonfunctional Kidneys Risk Factors for Posttransplantation Urinary Tract Infection in Patients With End-Stage Renal Disease Due To Autosomal Dominant Polycystic Kidney Disease?

OBJECTIVES

The objective of this study was to evaluate the effect of bilateral nephrectomy on posttransplantation urinary tract infection (UTI) among patients with end-stage renal disease (ESRD) due to autosomal dominant polycystic kidney disease (ADPKD).

METHODS

In a retrospective case-control design, 62 patients with ESRD with ADPKD were divided into 2 groups: (A) 24 patients who underwent bilateral nephrectomies, and (B) 38 patients in whom bilateral nephrectomies had not been done. Pretransplantation and posttransplantation urine cultures were evaluated for UTI.

RESULTS

Sixty-two patients with ESRD with ADPKD were enrolled in this study. The average age was 42 years (range, 6-60 years). Forty patients (64.5%) were male and 22 (35.5%) were female. The mean duration of hemodialysis was 24 months (range, 2-120 months), which was the same for both groups. Bilateral nephrectomies were done for 24 participants (38.7%). There were 38 patients (61.3%) in group B who did not have the operation. UTI occurred in 23 patients (37.1%): 6 patients (25%) in group A and 17 patients (44.7%) in group B. The incidence of UTI was not statistically different between the 2 groups (P>.05). Furthermore, no relationship was found between age, gender, blood group, and UTI in patients with ADPKD (P>.05).

CONCLUSION

According to our study, the presence of large nonfunctional kidneys is not a risk factor for posttransplantation UTI in patients with ADPKD and ESRD.

Serum LDL levels are a major prognostic factor for arteriovenous fistula thrombosis (AVFT) in hemodialysis patients

INTRODUCTION

Arteriovenous fistula thrombosis (AVFT) is still a common cause of morbidity in patients undergoing regular hemodialysis (HD). Many factors have been found to induce AVFT. Some of those factors are local and others are systemic ones. In this study, we evaluated some local and systemic factors simultaneously, to predict the most potent risk factor for AVFT in HD patients.

PATIENTS AND METHODS

One hundred and eighteen patients aged 20-80 yrs with end-stage renal disease (ESRD) were evaluated prospectively for a period of 14 months. First, anticardiolipin antibodies (ACLA), TG, cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL) were analyzed by conventional methods. Other basic data were accessed from patients medical records. All fistulas were evaluated clinically as patent at the start of this study. Patients were followed-up for any evidence of AVFT within 14 months. Finally, all factors (diabetes, hypertension, presence of ACLA, ultrafiltration >or=3 L, age, gender, weight, hypotension during dialysis, fistula site, epoetin alpha usage, TG, HDL, LDL and total cholesterol) were analyzed in a stepwise regression analysis.

RESULTS

Eighteen episodes of AVFT documented with Doppler sonography occurred in 17 patients (15.3%). Regression analysis showed only LDL values were the AVFT predictor in our patients (p=0.002, beta-coefficient=0.3). Kaplan-Meier analysis showed a significantly lower AVF patency time in patients with LDL >130 mg/dl than those with LDL <130 mg/dl (log rank=0.0014).

DISCUSSION

LDL value is a major prognostic factor for AVFT in HD patients and lowering it to <130 mg/dl could improve fistula patency.

Urine Cytology as a Useful Screening Method for Polyoma Virus Nephropathy in Renal Transplant Patients: A Single-Center Experience

Polyoma virus nephropathy occurs in 3% to 4% of renal transplant recipients, causing graft loss in 50% of cases. In this study we sought to identify the incidence of polyoma virus infection among our transplanted patients on the basis of age, sex, creatinine level, and postoperative period. During this study the 1086 urine samples collected from 362 patients were centrifuged and stained with the Papaniclaou method. All slides were classified as negative or positive (>1 decoy cell/sample). Among 1086 urine cytologies from 241 men and 121 women, decoy cells were identified in 26.6% (96) of patients, including 29.9% (n = 72) men and 20% (n = 24) women. The incidence of decoy cells (26.6%) was increased among men and associated with a longer transplantation period (P < .05). A significant relation was detected between older age and positive urine cytology. The patients with positive urine cytology for decoy cells showed a greater incidence of abnormal plasma creatinine values (26%) compared with patients showing a negative urine cytology (13.5%). In conclusion, identification of cells with viral inclusions (decoy cells) may help with the diagnosis of viral replication or active infection, therefore, routine urine cytology may be used as screening method for the detection of polyoma virus infection.

Impact of Adequate Dialysis Before Transplantation on Development of Chronic Renal Allograft Dysfunction in 3-Year Posttransplant Period

INTRODUCTION

Transplantation is the preferred treatment modality for many patients with end-stage renal diseases. Despite all the efforts, allograft dysfunction remains the most important cause of graft loss. Finding new factors that improve graft survival is mandatory.

METHODS

This prospective study included 93 patients transplanted between April 1999 and July 2000. The duration of dialysis prior to transplantation was analyzed with respect to the values before and up to 3 years posttransplantation, including blood urea nitrogen (BUN), creatinine, and blood pressure (BP) using 1-month intervals and triglyceride, cholesterol, low-density lipoprotein and high-density lipoprotein at 3-month intervals. In this study, graft dysfunction was defined as serum creatinine >1.8 mg/dL. Hypertension was defined as BP > 140/90 on two occasions or treatment with antihypertensive medications. Patients in the hypertensive group were divided into controlled versus uncontrolled hypertensives.

RESULTS

The mean BUN and creatinine values of the patients prior to transplantation was 90 +/- 30 and 10.4 +/- 4, respectively. The patients had been on dialysis for an average of 4.7 years. Development of renal allograft dysfunction did not show any relationship to the duration of dialysis ptt. Patients with higher BUN and creatinine levels before transplantation experienced more episodes of renal allograft dysfunction in the 3-year posttransplant period (P < .05 for both BUN and creatinine). The relationship between BUN and creatinine prior to transplantation and risk of renal allograft dysfunction was more powerful among the group of uncontrolled hypertensives.

CONCLUSION

Intensive dialysis prior to transplantation may exert positive effects on long-term graft function and survival.

Comparison of spousal with other donor groups: Study of a single center

In coping with the shortage of living-related and cadaveric donor groups for renal transplantation, and in the fear of organ marketing, spousal donors are considered an invaluable potential source. Survival rates have been reported to be as high as even some related groups. This study evaluated 1039 renal transplantations up to 2003. Patient survival rates in different donor groups were determined using the Kaplan-Meier method. The 3-year patient survival rates were 93% for kidneys from 61 spouses; 92% for kidneys from 433 living-related donors; 91% for kidneys from 427 living-unrelated (excluding spouses) donors; and 90.5% for 118 cadaveric kidneys. Such results were consistent with many other reports which consistently showed that spousal donors were at least as good as living-related donors, representing a reliable source in cases of organ shortage. The high survival rate of spousal donors is probably related to their strong emotional support.

Long-Term Results of Renal Transplantation: A Single-Center Analysis of 1200 Transplants

The present study is a report of long-term results of the first 1200 operations from December 1988 to December 2003. Graft and patient survival rates in eligible cases were computed with Kaplan-Meier analysis. Recipients were 808 men, 392 women of mean age 33.6 +/- 12.5 years. Eighty six percent of cases used organs from living donors (40% related, 41% unrelated, and 5% spouses) and 14% from cadaveric source. The most common causes of end-stage renal disease were chronic glomerulonephritis (18.2%); reflux nephropathy (13.4%); and diabetic nephropathy (10.1%). Among 215 (17.9%) patients, 156 patients (13%) died in the posttransplant period. Most common causes of death were cardiovascular (28.3%), graft loss (20.7%), and infections (19.6%). The 1- and 3-year patient survival rates were 94% and 91.5%, and graft survival rates were 88% and 84%. Although the success rate of operations was not satisfactory at the beginning, the current data reflect a >90% survival rate comparable to the major centers in the world.

Neurological complications of first 100 orthotopic liver transplantation patients in southern Iran

Neurological complications which are responsible for significant mortality and morbidity after orthotopic liver transplantation have been reported in 8.3% to 47% of cases in various series. This prospective study was performed to investigate the prevalence and characteristics of neurological complications in the first 100 patients who have undergone orthotopic liver transplantation from 1993 to 2004. Neurological symptoms and signs as well as routine laboratory tests, including complete blood cell counts, electrolyte levels, drug levels, microbiologic and serological studies, brain computed tomography scans, magnetic resonance imaging, and electrodiagnostic studies were reviewed in all patients. Follow-up periods were from 2 months to 10 years. Nineteen patients of mean age of 34.9 years developed neurological complications after orthotopic liver transplantation. The most common neurological symptoms and signs were confusion (42.1% of cases with neurological complications), convulsions (36.8%), and hallucinations (31.6%). Hepatic encephalopathy (31.6%) and drug toxicity (26.2%) were the most common neurological syndromes. The mortality rate was significantly higher among patients with neurological complications. Compared to other centers, neurological complications were less common in our center.

Incidence of Posttransplantation Diabetes Mellitus in Kidney Transplantation: A Single-Center Experience

Posttransplantation diabetes mellitus (PTDM) is a well-recognized complication of renal transplantation. PTDM is reported to contribute to major infections and cardiovascular complications and leads to increased posttransplantation morbidity. The present study was conducted to evaluate the frequency of PTDM in our center, to identify the role of immunosuppressive therapy and other risk factors in the genesis of PTDM, and to assess the impact of PTDM on graft and patient survival. From December 1998 to December 2003 we followed-up 1200 renal transplant recipients, including 121 recipients with pretransplantation diabetes mellitus and 1079 recipients without diabetes. PTDM occurred in 203 patients (mean age, 35.4 +/- 5.9 years); 131 (64.5%) were male. Graft loss and mortality were significantly higher in patients with PTDM versus those without. The overall reported incidence of PTDM worldwide varies from 3.4% to 46%. The incidence in our center is 18.8%. We also found a significantly higher incidence of PTDM among patients receiving grafts from living-related donors. This may be related to the higher cumulative doses of immunosuppressive drugs administered (in part, due to the greater number of acute rejections) in these patients.

Incidence of Reactive Antibodies Against Epstein-Barr in a Group of Renal Transplant Patients

Epstein-Barr virus (EBV) infection which is common among immunocompromised patients, may lead to life threatening lymphoproliferative diseases. In this study we examined the incidence and serologic status of EBV infection in 116 renal transplant patients including 84 males and 32 females as well as 72 normal volunteers. The time interval between transplantation and sampling was 1 month to 10 years. Twenty-two patients had a history of rejection. All cases were first transplants except for 3 second transplants. Four patients and no normals showed a positive PCR by a qualitative method. VCA IgM was positive in 11/116 patients (0.09%) and 3 of 72 (0.04%) normal volunteers. 99% (115/116) and 98% (65/72) of patients and normal controls were positive for VCA IgG. EA IgG was positive in 36/116 (31%) and 13/72(18%) of patients and normals, respectively. EBNA IgG was positive in 113/116 (97%) and 100% of patients versus normal controls, respectively. In all except one case with a positive VCA IgM there was a history of infectious mononucleosis-like syndrome. According to our previous data in more than 1000 renal transplant patients during more than 10 years, only one case of PTLD has been diagnosed (0.1%) which is lower than that reported. The high incidence of EBV seropositivity may contribute to this low incidence. The rate of EBV seropositivity in renal transplant patients was greater than in the normal population (P = .05). No association was observed between PCR and seropositivity and rejection or the type of treatment. After this study we began routine PCR and antibody testing in all renal transplant patients both pre- and posttransplant to determine the exact rate of reactivation versus primary infection which we plan to evaluate after 2 to 3 years. In conclusion we believe that the best easiest method to detect EBV infection in immunocompromised patients is VCA IgM ELISA; a qualitative PCR alone is not sufficient for this evaluation.

A comparative randomized and placebo-controlled short-term trial of aspirin and dipyridamole for overt type-2 diabetic nephropathy

OBJECTIVE

Our aim was to determine the effect of short-term therapy with anti-platelet drugs on type-2 diabetic nephropathy for which a generally accepted therapy is missing.

MATERIAL AND METHODS

Seventy-six patients with type-2 diabetic nephropathy, who had normal renal function tests were randomized into the 4 groups; each group (n = 19) received one of the following treatments: aspirin (1000 mg), dipyridamole (750 mg), their combination or placebo daily for 2 months. Blood pressure, fasting blood sugar, serum electrolytes, creatinine clearance and 24 hours urine protein excretion rate was measured just before and at the end of the trial.

RESULTS

Proteinuria and urinary protein: creatinine ratio decreased significantly in all 3 groups receiving aspirin and/or dipyridamole compared with the placebo group, also in each of those 3 groups comparing pre- and post-treatment values, while creatinine clearance rate, blood pressure, and blood sugar remained unchanged. At the end of the trial, the percentage proteinuria change was-15.9%,-14.8%,-37.3% and 1.9% in aspirin, dipyridamole, their combination and placebo groups respectively. The percentage proteinuria change had no positive correlation with demographic, clinical and laboratory findings but showed a strong positive correlation with mode of the therapy (r = 0.38, p = 0.0007). The percentage decline in proteinuria was significantly higher in the combination group than in the aspirin and dipyridamole groups. No side effects related to aspirin or dipyridamole was seen during the trial.

CONCLUSIONS

Short-term trial of aspirin and/or dipyridamole significantly reduces proteinuria of type-2 diabetic nephropathy, with the most prominent effect seen with combination of the 2 drugs.