Renal transplantation Research Papers - Academia.edu (original) (raw)

Objective: While treating anaemia in end stage renal disease (ESRD) patients, recombinant human erythropoietin (EpO) is the therapy of choice. However, it is rarely used in developing countries because of the financial constrains to the healthcare as well as the patient. Keeping the point of view in mind, the objective of this research was to identify the use of Epo, its frequency, and dosage in the patients of ESRD receiving continuous haemodialysis in Quetta city, Pakistan. Methods: This was a retrospective, single cantered study. The selected population was subject with ESRD and on dialysis with prolonged anaemia. All recipients of dialysis in the past one year were targeted for the study. Data of the patients regarding anaemia and the use of erythropoietin was collected through a data collection sheet. Evaluation of the biochemical parameters of ESRD patients on haemodialysis was also be taken into consideration. Demographics of the selected patients were recorded carefully for the evaluation and analysis. SPSS 20.0 was used for data analysis and based on the objectives; both descriptive and inferential statistics were used for data elaboration. Results: A total of 97 ESRD patients that fulfilled the inclusion criteria were enrolled. Out of the 97, (52.6%) had age of more than 47 years and the cohort was dominated by males (63, 64.9%). Seventy two patients were on EPo use with majority on dose of 10000 IU with once a week frequency. The Man Whitney U test was used to compare erythropoietin use / non use and biochemical parameters. Haemoglobin percentage was significantly associated with erythropoietin use (p<0.05). The mean rank interpretation revealed erythropoietin users significantly associated with improved haemoglobin percentage. The Kruskal Wallis test was used to compare erythropoietin usage frequency and biochemical parameters. Haemoglobin percentage was again significantly associated with erythropoietin use frequency. The Bonferroni correction revealed erythropoietin frequency of twice a week was significantly associated with improved haemoglobin percentage. Conclusion: Although the use of EPO among ESRD was reasonable, few patients were not prescribed EPo for anaemia associated with ESRD. We do understand that availability and affordability can be a major reason here; policy makers should make sure about the use of EPo because of its evidence-based advantages over other procedures.

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- Nephrology, Renal transplantation, Renal failure

B ECAUSE of a large number of dialysis patients in Iran who needed renal transplantation (Tx) who had no living related donors (LRD) and the absence of cadaveric organ donation program, a controlled living unrelated donor (LUD) renal Tx program was adopted in Iran in 1988. As a result, in last 12 years more than 7,000 renal Tx from LUD and more than 2500 from LRD have been performed. The waiting list for renal Tx in this country has been eliminated. The characteristics, advantages, and disadvantages of this Tx program have previously been published and will briefly be discussed below. 1,2 This study compares the socioeconomic characteristics of LUD and their recipients in this program to see which socioeconomic group of the country are being transplanted more from LUD.

- by Shahrzad Ossareh
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- Poverty, Kidney transplantation, Social Class, Iran

Renal transplant recipients have a well-recognized increased risk of de novo neoplasia. In this study, we investigated whether lymphocyte subset count could predict the risk of developing noncutaneous neoplasia (NCSC) in renal transplant recipients (RTR). Between January 1995 and December 1995, lymphocyte subsets (CD4, CD8, CD19) were measured in 28 1 RTR. This population was studied until November 1999 for the development of NCSC. The mean follow-up was 42 k 9 months. Neoplasm was diagnosed in 22 patients (7.9%). Patients who developed a cancer were significantly older (53.8 * 6 years vs 38 & 16 years, P < O.OOOl), had lower CDq (234 f 126/mm3 vs 543 i214/pm3, P < 0.005) and CD19 (19 k 9/mm3 vs 51 * 22/mm3, P < 0.0001) levels, and more frequently had past histories of skin cancer (24% vs 4%, P < 0.01). Cox regression revealed that high CD4 levels (RR 0.73, 95% CI 0.62-0.89 for each 100/mm3 increase in CD4 cell count) were associated with decreased risk of NCSC, whereas age (RR 2.49, 95% CI 1.12-5.92 for each l0-year increase in age) was predictive of the subsequent development of NCSC. To conclude, CD4 cell depletion is associated with the development of solid cancers and lymphoma in RTR.

- by Jean-marc Chalopin and +2
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- Risk, Kidney transplantation, Renal transplantation, Clinical Sciences

The incidence of neoplastic complications after solid organ transplantation is increasing tremendously probably as the consequence of long term immunosupression. Beside usual risk factors, the oncogenic role of some viruses like Epstein-Barr virus is well established. We report a case of a primitive EBV-induced liver leiomyosarcoma after renal transplantation.

- by Lidia Albano
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- Kidney transplantation, Adolescent, Renal transplantation, Case Report

The use of elderly donors has been advocated to expand the organ donor pool because of increased needs and organ shortage. The aim of the study was to analyse whether old age of donors affects the outcome of renal transplantation and the long term safety of retrieval for the donors. We present data of 335 consecutive living related kidney transplants, performed in our centre the last 10 years, where in 174 patients the donor was less than 60 years of age, while in the rest 161 patients the donor was more than 60 years of age. No statistical difference was noted in either group at the incidence of irreversible acute rejections, early acute tubular necrosis, vascular complications and patient deaths. The graft survival was 86.7%, 80.4% and 78.1% for the 3rd, the 5th and the 8th year for the younger group of donors, while it was 83.6%, 78.2% and 67.8% for the older group (p = 0.13). Patient survival of the younger group was 95.9%, 94.7% and 94.7%, while for the older was 94.4%, 92.0% a...

- by G. Zavos
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- Quality of life, Kidney transplantation, Adolescent, Renal transplantation
- by Stephen Brown
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- Renal transplantation, Pediatric radiology, Radiofrequency Ablation, Abdominal Fat

Introduction. The success of renal transplantation as a treatment for end-stage renal disease has created a chronic shortage of donor organs. We present our experience in transplanting kidneys from donors with hepatitis B virus (HBV) or hepatitis C virus (HCV) among matched serology-positive recipients. Materials and Methods. From January 2002 to November 2005, 44 patients with end-stage renal disease and HCV seropositivity underwent kidney transplantation. In 28 transplants in HCVϩ recipients, the donor was HCVϩ (DCϩ/RCϩ) and in 16 of these cases the donor (one living donor) was HCVϪ (DCϪ/RCϩ). In the same period 14 patients with HBV infection and HbsAg seropositivity underwent kidney transplantation: eight received their graft from a cadaveric HbsAg-positive donor (DBϩ/RBϩ), while six patients received their graft from an HbsAg-negative donor.

- by Vito Sparacino and +1
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- Kidney transplantation, Survival Analysis, Treatment Outcome, Hepatitis C

Hypophosphatemia caused by renal phosphate loss occurs frequently after kidney transplantation. In assumption of systemic phosphorus depletion, the presumed deficit commonly is replaced by oral phosphate supplements. However, such treatment is debatable, because intracellular phosphorus stores have not been assessed in this setting and may not be accurately reflected by serum phosphate concentrations. Moreover, disturbances in mineral metabolism from chronic renal failure, such as hypocalcemia and hyperparathyroidism, may be prolonged with oral phosphate supplements. Conversely, a neutral phosphate salt might improve renal acid excretion and systemic acid/base homeostasis for its properties as a urinary buffer and a poorly reabsorbable anion. Twenty-eight patients with mild early posttransplantation hypophosphatemia (0.3-0.75 mmol/L) were randomly assigned to receive either neutral sodium phosphate (Na 2 HPO 4 ) or sodium chloride (NaCl) for 12 weeks and examined with regard to (1) correction of serum phosphate concentration and urinary phosphate handling; (2) muscular phosphate content; (3) serum calcium and parathyroid hormone (PTH); and, (4) renal acid handling and systemic acid/base homeostasis. Mean serum phosphate concentrations were similar and normal in both groups after 12 weeks of treatment; however, more patients in the NaCl group remained hypophosphatemic (93% versus 67%). Total muscular phosphorus content did not correlate with serum phosphate concentrations and was 25% below normophosphatemic controls but was completely restored after 12 weeks with and without phosphate supplementation. However, the percentage of the energy-rich phosphorus compound adenosine triphosphate (ATP) was significantly higher in the Na 2 HPO 4 group, as was the relative content of phosphodiesters. Also, compensated metabolic acidosis (hypobicarbonatemia with respiratory stimulation) was detected in most patients, which was significantly improved by neutral phosphate supplements through increased urinary titratable acidity. These benefits of added phosphate intake were not associated with any adverse effects on serum calcium and PTH concentrations. In conclusion, oral supplementation with a neutral phosphate salt effectively corrects posttransplantation hypophosphatemia, increases muscular ATP and phosphodiester content without affecting mineral metabolism, and improves renal acid excretion and systemic acid/base status. 1999 by the National Kidney Foundation, Inc. INDEX WORDS: Hypophosphatemia; renal transplantation; renal phosphate handling; muscular phosphate content; parathyroid hormone; calcium; acid/base homeostasis.

- by Ulrike Dydak
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- Skeletal muscle biology, Kidney transplantation, Calcium, Treatment Outcome

Donor gender plays a role in the outcome of renal transplantation, but the mechanisms responsible for this effect are unclear. In this study, actuarial graft survival in 1049 recipients transplanted at Montefiore Medical Center between 1979 and 1994 was examined. It was found that donor gender had no influence on graft survival in recipients treated with precyclosporine immunosuppressive agents. In contrast, graft survival time was greater in cyclosporine-treated recipients of male donor kidneys compared with female kidneys (p < 0.05). This survival time difference was evident in the early post-transplant period and was entirely accounted for by the survival advantage of kidneys from white male donors. There was no gender-related difference in graft survival time among recipients of African-American donor kidneys. Recent attention has focused on the hypothesis that a mismatch between female donor kidney nephron supply and male recipient functional demand results in hyperfiltratio...

- by Vivian Tellis
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- Kidney transplantation, Survival Analysis, Renal transplantation, The

P OST-TRANSPLANTATION lymphoproliferative disorder (PTLD) is increasingly recognised as an important and potentially devastating complication of organ transplantation. 1 The condition occurs in 1% to 10% of patients, depending on the type of organ transplant. 2 It has been associated with a poor clinical outcome, namely, median survival times ranging between 5 and 14 months. The pathogenesis of PTLD in most cases appears to be related to B-cell proliferation induced by Epstein-Barr virus (EBV) infection in the setting of chronic immunosuppression. 5 EBV-encoded RNAs (EBER-1 and -2) have been demonstrated by in situ hybridisation in between 59% and 100% of PTLD tumours. 6,7 These observations prompted the use of antiviral therapy, such as high-dose acyclovir. Although there is some anecdotal support for this strategy, 7,8 acyclovir has been associated with disappointing outcomes in other studies. Similarly, early studies reported that conventional combination chemotherapy and/or radiotherapy were ineffective in the setting of PTLD, resulting in complete remission rates of between 11% and 31%. 3,4,10 The dismal outcomes for PTLD reported in these studies, however, generally have been limited by small numbers, organ transplant heterogeneity, outdated data, and delayed initiation of combination chemoradiotherapy (often following a failed response to immunosuppression reduction and antiviral therapy).

- by David Nicol
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- Kidney transplantation, Treatment Outcome, Renal transplantation

Posttransplant bacterial infections are important because of their influence on patient and graft outcomes. Therefore, prevention of infection as well as prompt diagnosis and appropriate treatment are crucial. In this retrospective analysis, we reviewed all posttransplant bacterial infections occurring during the admission of kidney transplant patients from January 2000 to May 2004. Of our patients, 25% had at least one episode of infection. Patients with immunosuppression based on an mTOR inhibitor showed the highest rate of wound infections compared to those receiving a calcineurin inhibitor (odds ratio 5.6, P Ͻ .001). Patients with renal failure caused by a urologic disease revealed a increased risk of a urinary tract infections (odds ratio 5.9, P Ͻ .001). Although infection complications are an important cause of morbidity in renal transplantation, the extensive use of antibiotics should be avoided in favor of a strict policy for infection prevention and control.

The proper measures for assessing quality of life (QOL) in patients with chronic kidney disease (CKD) remain unclear. QOL measures are subjective or objective, functional or satisfaction-based, and generic or disease-specific. Treatment of end-stage renal disease with transplantation and treatment of anemia with erythropoietin in patients with CKD have been associated with dramatic improvements of QOL. Other factors such as age, ethnic or national background, stage of CKD, modality of dialytic therapy, exercise interventions, sleep disturbances, pain, erectile dysfunction, patient satisfaction with care, depressive affect, symptom burden, and perception of intrusiveness of illness may be associated with differential perception of QOL. Recent studies showed an association between assessment of QOL and morbidity and mortality in end-stage renal disease patients, suggesting the measures do matter. Further studies are necessary in patients with early stages of CKD and in children. QOL m...

- by Carolina Andrade
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- Depression, Quality of life, Chronic kidney disease, Erectile dysfunction

Introduction. Delayed graft function (DGF) is a common complication in kidney transplantation. We sought to evaluate possible correlates for DGF including intraoperative parameters, focusing on fluid replacement and central venous pressure (CVP) values among patients undergoing kidney transplantation at our center. Methods. One hundred fifty-five cadaveric donor transplantations performed at our center between 2001 and 2005 were selected for the study. We compared intraoperative parameters together with 15 other clinical and socio-demographic recipient and donor variables among patients experiencing DGF (n ϭ 58) versus those with immediate graft function (IGF; n ϭ 97). All significant variables at P Ͻ .05 upon univariate analysis were entered into a multivariate logistic regression model to identify risk factors for DGF.

A 35-year-old black man with end-stage renal disease from biopsy-proven focal segmental glomerulosclerosis developed worsening function of his renal allograft 160 days after living related donor renal transplantation. Renal biopsy showed necrotizing and crescentic glomerulonephritis (NCGN) and presence of intraglomerular viral inclusions confirmed by immunocytochemical stain and in situ hybridization techniques to be cytomegaloviral in origin. Electron microscopy showed no immune complexes, and workup for other causes of NCGN was negative. The patient was treated with ganciclovir without other changes in his immunosuppressive regimen. After 8 weeks of ganciclovir therapy, a second renal transplant biopsy showed resolution of the glomerular process and disappearance of the cytomegalovirus (CMV) inclusions. The resolution of the glomerular process with treatment for CMV infection, and without other change in therapy, strongly supports a causative link between CMV and NCGN in this patient. This case represents the first report of CMV-associated NCGN in a renal transplant patient. 1998 by the National Kidney Foundation, Inc.

- by harinder singh
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- Electron Microscopy, Kidney transplantation, Immunohistochemistry, Biopsy

We wanted to develop an immunostaining method of urine cytopreparations to detect polyoma virus infection by using fresh urine samples and staining with the monoclonal SV40 antibody and to compare the findings to the demonstration of decoy cells in the urine or to kidney histology. Routine urine samples from pediatric kidney transplant patients were collected either early after transplantation or later, cytocentrifuged, and immunostained with SV40-T-antibody. The number of SV40-T-antigen-positive epithelial cells was counted in the cytopreparations and compared to the findings in routine urine cytology and transplant histology. Immunostaining of urine cytology with SV40-T-ab demonstrated clearly that the infected epithelial cells and the rate of infection could be estimated by semiquantitative counting. There was strong correlation between the findings in the urine and in the biopsies, but in the urine preparations the number of infected cells was much higher than in the biopsies. The high number of SV40-positive cells in the urine also correlated to the severity of clinical infection and to the state of transplant. Immunostaining of urine cytology with SV40-T-antibody seems to be useful in the diagnosis and follow-up of polyoma virus reactivation disease in transplant patients, especially in children with renal transplants.

- by Jussi Merenmies
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- Kidney transplantation, Immunohistochemistry, Biopsy, Transplantation

Forty-seven patients answered a questionnaire about stress, feelings of indebtedness toward the donor, and psychosocial adjustment following kidney transplantation. The combination of age, general life stress, and transplant-related stress explained 47% of the variance in psychosocial adjustment. Areas of adjustment most influenced by this combination of predictors included attitudes toward health care, domestic, vocational, social adjustment, and psychological distress. Younger patients endorsed higher levels of transplant-related stress and higher levels of psychological distress. Moderate to intense feelings of indebtedness toward the donor were common but were unrelated to psychosocial adjustment posttransplant.

- by Marie Achille
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- Psychology, Health Care, Renal transplantation, Clinical

Renal transplantation is associated with frequent gastrointestinal complications. Intestinal metaplasia is a feature of atrophic gastritis whereas the diagnosis of Barrett's esophagus is based on histological demonstration of specialized metaplasia. Both conditions are associated with increased risk of adenocarcinoma. The aim of the present study was to assess whether magnification endoscopy improves the diagnostic accuracy of intestinal metaplasia in stomach and in esophagus. In this non-randomized, feasibility study thirty one (12 women and 19 men) renal transplant recipients, with a mean age of 44.0 years were evaluated for the presence of intestinal metaplasia. Standard esophagogastroscopy with methylene blue staining was followed by magnification endoscopy. The presence of gastritis and intestinal metaplasia was classified according to modified updated Sydney classification. Of 31 patients, 16 patients had endoscopic and histopathological evidence of gastric intestinal meta...

Introduction. Kidney transplant recipients have a higher quality of life and consume fewer health care resources compared with patients on dialysis. However, optimal timing of transplantation has been controversial. Recent studies have clearly demonstrated that preemptive renal transplantation is associated with better graft survival, lower complications, and better cost-effective outcomes. We evaluated differential effects on long-term outcomes according to dialysis type/duration versus no dialysis. Materials and Methods. We retrospectively analyzed 499 cases of first living-donor kidney transplantations performed in our center from January 1990 to January 2007. We compared 3 groups according to graft survival, acute and chronic rejection, postoperative complication, and delayed graft function rates. The mean duration of follow-up was 119.1 Ϯ 47.2 months. Results. Among 499 cases, 81 cases were preemptive renal transplantations with 418 cases hemodialysis [HD], 343 cases, peritoneal dialysis [PD] 75 cases) performed after dialysis. The 1-, 5-, and 10-year graft survival rates were 98.8%, 89.5%, 79.4% among the preemptive renal transplantation group and 92.4%, 78.2%, and 69.2% and 85.3%, 74.5%, and 68.2% (P ϭ .03) in the dialysis groups (HD, PD), respectively. The differential effect of pretransplantation HD or PD was not significant. However, the graft survival rates in the HD group were not significantly higher than the PD group (P ϭ .61). The duration of dialysis was not associated with graft survival. Conclusion. We suggest that preemptive renal transplantation should be the first choice of treatment for patients with end-stage renal disease.

- by Esra Baskin
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- Health Care, Family, Quality of life, Kidney diseases

Central venous access for long term dialysis has always been a major difficulty, especially in cases where the traditional sites are no longer available. We present a case of a pediatric patient where the usual sites were occluded and he needed a reliable venous access for his dialysis. The inferior vena cava has been used in adult patients, but no reports were found in the pediatric literature. We chose this site as an alternative for this patient. The catheter was placed via a percutaneous translumbar approach, and remained in place for almost 2 years until the patient received a renal transplant.

- by juan perez
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- Long Term Care, Renal transplantation, Child, End Stage Renal Disease

Acute fulminant fungal sinusitis is characterized by acute symptoms and rapid progress with a mortality rate of 60-80%. A large number of survivors have permanent neurological, visual and cosmetic disabilities. This clearly underscores the need of early recognition of this disease in at risk population in order to start urgent treatment. The at-risk population of diabetics, AIDS and other immunosupressed is likely to increase, as will the incidence of acute fulminant fungal sinusitis. In the present study we have reviewed nine cases of acute fulminant fungal sinusitis to determine clinical presentation, related radiological picture and optimum treatment. Most common presenting features were fever, headache, facial swelling and proptosis. Many patients presented with blindness, facial paralysis and meningitis. Predisposing causes were uncontrolled diabetes with ketoacidosis in four out of six cases, post renal transplant immunosuppression and leukemia. All patients were treated with of amphotrecin B or liposomal amphotericin B (AmBisome). Diagnosis was confirmed by biopsy and culture of sinus mucosa, soft tissues of cheek, or orbit. Mucor (Zygomycetes) was identified on culture or histopathology in all cases. Surgical debridement was performed in seven cases. Six out of nine patients survived but morbidity was high: only two patients survived without any permanent disability.

- by M. Khabori
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- Adolescent, Biological Sciences, Renal transplantation, Mucormycosis

Abstract: Introduction: Thrombotic microangiopathy (TMA) is a well known complication of cyclosporine (CsA)-treated renal transplantation but optimum treatment strategies are not clearly defined.Patients and methods: All patients transplanted between January 1996 and December 2001 at our center who had biopsy-proven TMA and in whom CsA was withdrawn were studied retrospectively.Results: The TMA was found in nine of 688 patients (1.3%). All except one donor were living related. HLA matching was one haplotype in all except one where both haplotypes were different. There were five males and four females and the mean age was 24.9 ± 9 yr. All of them developed TMA within 3 months of transplant. Five of nine had evidence of microangiopathic hemolysis on peripheral film. Serum creatinine at the time of diagnosis of TMA was 3.1 ± 1.3 mg/dL. Cyclosporine was discontinued in all and mycophenolate mofetil was substituted for azathioprine. No episode of acute rejection occurred after CsA withdrawal. Graft function did not improve in four who eventually became dialysis-dependent after a mean duration of 12.6 ± 8.3 months. Remaining patients showed stabilization or improvement in function and all had serum creatinine below 2 mg/dL after a mean follow up of 24 months.Conclusion: The CsA withdrawal in cases with TMA at a stage when significant functional deterioration has not taken place can salvage the graft.

- by SA Rizvi
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- Microcirculation, Kidney transplantation, Adolescent, Biopsy

Alemtuzumab (ALT), a humanized monoclonal anti-CD52 antibody, was introduced in solid organ transplantation as an induction agent. ALT associated with anticalcineurins has provided a low incidence of acute rejection episodes (ARE) and potential tolerogenic properties. We analyzed the clinical outcomes and effects on peripheral Treg of renal transplant recipients treated with ALT. Six-month data on kidney alone or kidney combined with pancreas or liver patients treated with ALT and tacrolimus (TAC) in standard doses were compared with those on renal transplant recipients of similar demography who were not treated with ALT. We evaluated patient and graft survivals, ARE incidence, hematological parameters, renal function, adverse events, and CD4ϩCD25ϩFoxP3ϩ T cells in peripheral blood. Demographics of recipients, donors, and transplants were similar in both groups. Mean HLA mismatch was slightly greater among ALT-treated patients (3.5 vs 2.5). No combined transplantation was performed in the ALT-untreated group. Patient and graft survivals were 100% without rejection or serious infections in both groups. ALT-treated recipients showed anemia and leukopenia in 3 patients as well as severe lymphopenia in 5 recipients, who partially recovered on day 90. Final mean plasma creatinine was 1.4 mg/dL, while calculated creatinine clearance was approximately 65 mL/min in both groups. Mean Treg cell percentage was higher among ALT-treated recipients than the comparative group or healthy controls (P Ͻ .05). In conclusion, renal transplantation results obtained using ALT with rigorous immunosuppressive therapy were excellent; serious adverse events and acute rejection were absent. The effect of the increased proportion of Treg cells must be evaluated with longer observation.

- by Mario Ferrario and +2
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- Kidney diseases, Kidney transplantation, Treatment Outcome, Transplantation
- by Jeffrey Pernica and +1
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- Pediatrics, Child Development, Kidney transplantation, Growth Hormone

treated with povidone-iodine percutaneous sclerotherapy. Percuta-Marco A. Amendola, MD neous catheters were placed by means of sonographic, computed Daniel Seckinger, MD tomographic, or combined fluoroscopic and sonographic guidance. Sclerotherapy was initiated while patients were in the hospital, and the patients then instilled povidone-iodine twice a day at Index terms: Kidney, transplantation, home. 81.455 Lymphatic system, intenentional procedure, 99.126 Lymphocele, RESULTS: One patient had an inadequate trial period of therapy 81.4556

- by George Burke
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- Kidney transplantation, Renal transplantation, Follow-up studies, Vascular

Objective: To determine patterns of weight gain after renal transplant. Design: A survey of a consecutive sample of renal transplant recipients evaluated at day 0, day 14,3 months, and 6 months after transplant for weight changes. Gender; race; donor type; presence of diabetes as etiology of renal disease; response to glucose load at 1, 3, and 6 months; rate of rejection or infection; and lipid changes were compared.

S IROLIMUS (rapamycin) is a new immunosuppressive drug with a mechanism of action distinct from that of cyclosporine and tacrolimus despite being structurally homologous to tacrolimus. 1 Sirolimus does not inhibit calcineurin, thus it is anticipated that sirolimus will lack the nephrotoxic profile of the calcineurin inhibitors. In addition to its action on cells of the immune system, sirolimus inhibits growth factor-induced smooth muscle cell proliferation and migration. 2 For both of these unique features, sirolimus is considered as a good candidate to fulfill the need for a nonimmunosuppresive agent Experimentally, in a rat model, it has been demonstrated that sirolimus does not induce nephrotoxicity at doses three times higher than its effective immunosuppressive doses. In addition, infusion of sirolimus in therapeutic doses had no deleterious effects on renal function in pigs. 4 In a more recent report, it was shown that only calcineurin inhibitors resulted in glomerular dysfunction in an acute experimental rat model of nephrotoxicity. Sirolimus is not a nephrotoxic drug, at least not at the doses that are used in human transplantation, and it does not have any hypertensive effect. In fact, in the two Phase II studies performed in Europe comparing sirolimus with cyclosporine as basic immunosuppression, renal function was better in the sirolimus group of patients. 6 -8 However, sirolimus can potentiate the nephrotoxic effect of cyclosporine when both drugs are used in combination. On the other hand, in the most important clinical trials in Phase II and III, hypokalemia was recorded more frequently in patients under sirolimus immunosuppression. The presence of hypokalemia varied between 8% to 27% in sirolimus patients. This finding prompted us to study the tubular function in patients treated with sirolimus after renal transplantation.

- by Beatriz Domínguez-gil
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- Kidney transplantation, Renal transplantation, Cyclosporine, Hypokalemia
- by Danny Frederick
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- Health Promotion, Health Economics, Health inequality, Health Inequalities
- by Sanjay Guleria
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- Surgery, Treatment, Kidney transplantation, Developing Countries

The transplantation program in Bulgaria started in 1968 with renal transplantations to a child and adult woman. In 1986 the first heart transplantation was performed. To date a total of 10 heart transplants have been performed, including one combined heart/lung. A liver transplantation program was launched in 2005 with a total number of 16 transplantations-7 from living donors and 9 from deceased donors. The highest transplantation activity is registered in the field of renal transplantation. During the period 1980-2006, 462 Bulgarian recipients of kidney were transplanted in Bulgaria. The ratio between transplantations from deceased and living related donors is approximately 1:0.9. Annual transplantation activity varies among the years from 1 to 12 renal transplantations p.m.p./per year. The 1-(80.7% vs. 63.1%), 5-(57.86% vs. 39.0%) and 10-year (42.65% vs. 23.62%) graft survival rates are higher for recipients of living donor kidneys compared to those of deceased donor. In 1983 a

- by Anastassia Mihaylova and +2
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- Bulgaria, Kidney transplantation, Transplantation, Renal transplantation

Ultrasound and computed tomographic images are described in a patient who underwent renal transplantation and presented with hydronephrosis and partial ureteral obstruction secondary to herniation of the transplant ureter into a left inguinal hernia. To our knowledge, this is the first report of herniation of a transplanted ureter in the inguinal canal resulting in or exacerbating ureteral obstruction.

- by Claudia Furtado
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- Computed Tomography, Gastroenterology, Kidney transplantation, Nuclear medicine
- by Vesa Närhi
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- Nonparametric Statistics, Quality of life, Kidney transplantation, Social Support
- by Oliver Watts
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- Health Psychology, Photography, Contemporary Art, Performance Art

It is estimated that over 10% of the adult population in developed countries have some degree of chronic kidney disease (CKD). CKD is a progressive and irreversible deterioration of the renal excretory function that results in implementation of renal replacement therapy in the form of dialysis or renal transplant, which may also lead to death. CKD poses a growing problem to society as the incidence of the disease increases at an annual rate of 8%, and consumes up to 2% of the global health expenditure. CKD is caused by a variety of factors including diabetes, hypertension, infection, reduced blood supply to the kidneys, obstruction of the urinary tract and genetic alterations. The nephropathies associated with some of these conditions have been modeled in animals, this being crucial to understanding their pathophysiological mechanism and assessing prospective treatments at the preclinical level. This article reviews and updates the pathophysiological knowledge acquired primarily from experimental models and human studies of CKD. It also highlights the common mechanism(s) underlying the most relevant chronic nephropathies which lead to the appearance of a progressive, common renal phenotype regardless of aetiology. Based on this knowledge, a therapeutic horizon for the treatment of CKD is described. Present therapy primarily based upon renin-angiotensin inhibition, future diagnostics and therapeutic perspectives based upon anti-inflammatory, anti-fibrotic and hemodynamic approaches, new drugs targeting specific signaling pathways, and advances in gene and cell therapies, are all elaborated.

- by Francisco Hernandez V
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- Pharmacology, Genetics, Global Health, Chronic kidney disease

Cytomegalovirus (CMV) and BK polyomavirus (BKV) infections have been described in a high percentage of renal transplant patients and are known to cause various complications in renal transplantation. They are closely related to immunosuppressive therapy and implicated in the progression of graft failure. This review focuses on the clinical aspects of CMV and BKV infection after renal transplantation, optimal monitoring, and recent preventive measures and interventions to improve graft function and recipient survival. (G Ital Nefrol 2009; 26 (Suppl. S45): S46-53)

- by Paolo De Paolis and +1
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- Renal transplantation

- by Jussi Merenmies
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- Kidney transplantation, Immunohistochemistry, Biopsy, Transplantation

This is a prospective cohort study in renal transplant patients who fasted or who did not fast for three consecutive Ramadans. The baseline estimated glomerular filtration rate (GFR), mean arterial pressure (MAP), and urinary protein excretion before the first Ramadan were compared to those after the third Ramadan in 35 fasters and 33 nonfasters. The effect of age, time after transplantation, presence of diabetes mellitus (DM), and proteinuria on changes in the GFR were studied. The two groups were comparable in gender, age, donor source, time posttransplantation, presence of DM, hypertension, proteinuria, serum creatinine, and MAP. Among the fasters, there was no change in estimated GFR after fasting for three Ramadans (56.4 mL/min versus 55.4 mL/min, Pϭ0.8) even after adjusting for age, DM, baseline GFR, proteinuria, or time after transplantation. There were no significant differences between the fasters and the nonfasters in the changes in GFR, MAP, and urinary protein excretion between baseline and the third Ramadan.

- by Junaid Qureshi
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- Religion, Aging, Kidney transplantation, Islam
- by Monica L Tambutti
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- Immunology, Renal transplantation, Hemodialysis, Statistical Significance

Recent years has seen an increasing interest in the quality of life (QOL) of children with chronic kidney disease (CKD). The objective of this cross-sectional study was to investigate the prevalence of behavioral disorders and to assess the health-related QOL (HRQOL) in 136 patients with CKD. To estimate the prevalence of behavior disorders and analyze HRQOL, we used the Strengths and Difficulties Questionnaire (SDQ) and Pediatric Inventory of Quality of Life (PedsQL) Core Scales as assessment tools for both the patients and caregivers. When compared to healthy controls, the CKD group had significantly lower scores in almost all PedsQL domains. After adjustment, only absence of religion/other religions remained significantly associated with a lower global HRQOL score [odds ratio (OR) 6.2, P = 0.009]. Among the parents, two factors remained significantly associated with a lower global HRQOL score: patients’ age >10 years (OR 5.4, P = 0.033) and absence of religion/other religions (OR 3.2, P = 0.038). The CKD group demonstrated a higher proportion of behavioral and emotional disorders in all SDQ domains. There was a negative correlation between the presence of behavior and emotional disorders and HRQOL score (r = −0.552, P < 0.001). Our findings suggest the importance of evaluating behavioral and social repercussions of CKD in order to improve the life quality of this pediatric population.

- by Carla Diniz
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- Nonparametric Statistics, Quality of life, Chronic kidney disease, Adolescent
- by Emel Öztürk
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- Kidney transplantation, Renal transplantation, Blood Pressure, Propofol

Although widely believed to resolve within 6 to 12 months of successful renal transplantation, hyperparathyroidism may persist or develop after renal transplantation and eventually require parathyroidectomy. Avid calcium retention by demineralized bones (hungry bone syndrome) is well-recognized after parathyroidectomy and usually resolves after a few weeks. This report documents the case of a renal transplant recipient with persistent hyperparathyroidism who developed a pathological fracture of the pelvis and required parathyroidectomy 1 year after transplant and then manifested severe and prolonged hungry bone syndrome lasting for more than 20 months postoperatively. The clinical features and treatment of hyperparathyroidism in renal transplant recipients are discussed, as are diagnosis, pathogenesis, and management of hungry bone syndrome. Recognition of renal transplant recipients at greater risk for severe hungry bone syndrome should permit earlier and more aggressive management...

- by Anne-Marie Miles and +1
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- Kidney transplantation, Calcium, Renal transplantation, The

This article reflects on contributions from medical anthropology to our understanding of the bio-social and bio-political implications of renal transplantation. Taking up the idea of transplantation as a 'complex', a vast assemblage of people, places, practices and procedures which intersect medical, social and cultural domains, I point to a reliance in the anthropological literature on overly pre-determined conceptual frameworks, organised around a distinct polarisation between organ giving and receiving, where one side (supply) takes analytical, and indeed moral, precedence over the other (receipt). These frameworks tend to fail us when it comes to thinking about the wider social, cultural and political implications of transplant technologies. In an attempt to offer a less polarised view, I draw attention to the material and symbolic role of the immune system in transplantation and the ways in which it simultaneously shapes opportunities for procurement and the lived realities of recipiency. This helps us see the many complex ways in which suffering and inequality are constituted all along the variegated chains of supply and demand that are internal to, and made possible by, transplantation practices themselves.

- by Ciara Kierans
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- Sociology, Anthropology, Medical Anthropology, Evidence Based Medicine

En dehors des problèmes posés par le risque de rejet, les suites d'une transplantation rénale peuvent être émaillées de diverses complications non immunologiques qui peuvent entre autres mettre en jeu le pronostic fonctionnel du greffon. À la phase précoce, l'insuffisance rénale aiguë ou le retard de récupération fonctionnelle est le plus souvent en rapport avec une néphropathie ischémique liée aux conditions de la transplantation. Les complications tardives peuvent toucher de nombreux organes. La qualité de la surveillance à long terme est de ce fait un élément essentiel du pronostic après transplantation. La néphropathie chronique de l'allogreffe peut être aggravée par la toxicité rénale des immunosuppresseurs ou par des lésions de rejet chronique. La perte du contenu minéral osseux doit être prévenue ou enrayée. Les complications métaboliques et cardiovasculaires tardives sont aujourd'hui la première cause de mortalité après transplantation. Les facteurs de risque cardiovasculaire (diabète, dyslipidémie et surtout hypertension artérielle) doivent être soigneusement contrôlés. Les complications pouvant toucher les autres organes ou systèmes sont également passées en revue. © 2005 Elsevier SAS. Tous droits réservés.

- by Ilan Szwarc
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- Drug metabolism, Acute renal failure, Renal transplantation, High Blood Pressure
- by Paul Gill and +1
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- Medical Anthropology, Gift Exchange, Kidney transplantation, Longitudinal Research

Background. Despite the amount of evidence regarding the negative impact of medical comorbidities after transplantation, little attention has been directly paid to the pattern of somatic comorbidities in renal transplant recipients. The aim of this study was to assess the prevalence of medical comorbidities after kidney transplantation. Methods. In a cross-sectional study during 2006, we evaluated 119 kidney transplant recipients for somatic comorbidities by using the Ifudu comorbidity index, which evaluated the presence of 14 chronic illnesses among patients undergoing maintenance hemodialysis. Correlations of the Ifudu score with demographic and clinical data were also studied. Results. Eighty-three (90.4%) subjects had at least one medical comorbidity. The mean comorbidity score was 5.17 Ϯ 4.50. The most frequent comorbidities were nonischemic heart diseases including hypertension (n ϭ 75; 63%), visual disturbances (n ϭ 42; 35.2%), low back pain and spine and joint disorders (n ϭ 30; 25.21%), and musculoskeletal disorders (n ϭ 28; 23.5%). A higher comorbidity score was significantly correlated with lower economic status (P Ͻ .05), but not with age, gender, marital status, educational level, cause, or duration of end-stage renal disease. Conclusion. The prevalence of medical comorbidities among kidney transplant recipients seems to be high, with the highest prevalence due to nonischemic heart diseases, visual disturbances, and musculoskeletal disorders. This highlighted the necessity of providing posttransplant care by a multidisciplinary team of specialists.

- by Mohammad Dezfuli
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- Kidney transplantation, Comorbidity, Iran, Transplantation