Search

Objectives: End-stage kidney disease has dramatic health effects and life consequences in children. Presently, kidney transplant has been globally accepted as a treatment of choice for end-stage kidney disease in both children and adults, leading to better quality of life and longer patient survival. Because of lack of comprehensive information on the outcome of kidney transplant among children in Iran, we aimed to present a proper vision of pediatric kidney transplant in Iran by systematically reviewing the current literature., Materials and Methods: Major databases were searched, including Medline, Web of Knowledge, Google Scholar, Scopus, Cochrane, and the Iranian Scientific Information Database for all eligible studies in accordance with specific keywords. The inclusion criteria forthe retrieved studies were determination of graft survival, patient survival, and reasons for graft failure. The exclusion criteria were as follows: (1) a lack of clearresults; (2) non-English or non-Persian language format; (3) lack of access to the full-text manuscripts; and (4) case reports, case series, and review papers. A total of 115 studies were initially assessed based on the keywords; of these, 8 met inclusion criteria and were considered for final analysis; these were published between 2005 and 2017., Results: According to our results, 1-year graft survival rates were overall 89.7%, and 5-year graft survival rates were 65.4%. The 1-year patient survival rates were estimated to be 97.1%, and 5-year patient survival rates were estimated to be 89.8%. Acute rejection, dialysis status before transplant, and inappropriate immunosuppression were the main risk factors., Conclusions: Our systematic review and meta-analysis indicated a high success rate of childhood kidney transplant in Iran according to long-term graft and patient survival rates.

Introduction: Kidney transplantation is the treatment of choice in the majority of end-stage renal disease (ESRD) patients. However, most of the incident ESRD patients are not given the necessary information regarding kidney transplantation. The aim of this study was to evaluate awareness and knowledge about kidney transplantation in ESRD patients who were on dialysis., Methods: In this cross-sectional study, a total of 300 ESRD patients who underwent hemodialysis or peritoneal dialysis and could be eligible for kidney transplant, were included. A questionnaire with 15 multiple choice questions (MCQs) was designed to collect the data. SPSS version 16 was used for data analysis and a P value less than .05 was considered statistically significant., Results: Two hundred thirty- four patients participated in the study (response rate of 78%). Among them 58.1% were male with the mean age (SD) of 52.5 (12.1) years. The majority of the patients (94.0%) were on hemodialysis. About 87.6% wanted to receive kidney transplant; but despite the desire of the patients, this method was initially offered to about 11.5 % of the patients as a possible method of renal replacement therapy. Patients who had desire to receive kidney transplantation were significantly younger, male, married, employed, and had high level of education (P < .05)., Conclusion: Although most of the patients wanted to receive a kidney transplant, it was initially offered to a small population. Age, gender, marital status, employment condition, and level of education were significant factors for the patient's tendency to receive a kidney transplant. DOI: 10.52547/ijkd.6512.

In this short communication we briefly discuss some aspects of organ shortage for transplantation with a brief characterization of the Iranian model of kidney transplantation, and we present 3 interesting stories related to this model.

Introduction: The purpose of the present study was to identify the prevalence of sleep disturbances in ESRD, and to compare the sleep quality before and after kidney transplantation., Methods: A semi-experimental study was performed on 40 participants with ESRD from September 2017 to September 2018 in Mashhad, Iran. Participants were in the waiting list of kidney transplantation, aged 18-years-old or more, had no history of any major psychological problems. They were excluded from the study if new medical condition or psychiatric disorder was initiated throughout the study. Patients' medical information including the duration of dialysis and laboratory data was extracted from medical records. Their sleep quality was assessed with the Pittsburgh sleep quality index (PSQI) within1-month prior the kidney transplantation and at the 3rd and 6th months after it. Collected data was analyzed using SPSS-16. P < .05 considered as significant., Results: The frequency of poor sleepers was 37.5%, 37.5%, and 20.0%; before the kidney transplantation, 3 months and 6 months after the surgery; respectively. The average sleep quality score decreased significantly 6-month post-operation compared to pre-transplant phase (P < 0.05). We found a significant relationship between the gender and quality of sleep before transplant surgery, whereas no correlation was found between sleep quality and the age, type or duration of dialysis, serum phosphorus or hemoglobin level, and the cause of kidney failure (P < .05, > .05, > .05, > .05, > .05, > .05, and > .05; respectively)., Conclusion: Kidney transplantation has a positive effect on patients' sleep quality after 6 months.

Upper gastrointestinal (GI) abnormality is believed to be higher in patients with end-stage renal disease (ESRD) which can make a big trouble for whom undergo kidney transplant. We conducted this study to assess upper GI findings of patients with ESRD. In the present retrospective study we recorded upper GI endoscopy results in hemodialysis patients who were candidate for renal transplantation during a 10-year period. We reviewed files of 1256 patients with a mean age of 37.6 ± 13.4 years. Half of patients (50.6%) had an abnormal endoscopy. Two most common abnormalities were mild gastritis (35.6%) and gastro-esophageal reflux disease (16.7%). GI ulcers were observed in 11% of patients. Duodenal ulcer was the most common ulcer which was seen in 6.8% of patients. Helicobacter pylori was positive in 32.9% of patients and correlated with GI lesions (P = 0.000, r = 0.371). Longer dialysis duration and older patients revealed more upper GI abnormality (P = 0 .032, <0.001). As long as more than half of our patients have at least one upper GI involvement, we recommended that endoscopy must be done as a pretransplantation evaluation for patients without symptoms who have risk factors for ulcers.

Significant weight gain following renal transplantation is common in adult and pediatric recipients and mostly depends on receiving higher doses of steroids, changes in mood and feelings, as well as their level of physical activities. This study was performed to evaluate body weight and body mass index (BMI) before and after kidney transplantation in children and adolescents. In this cross-sectional study, 71 pediatric renal transplant recipients (42 boys and 29 girls) were included. World Health Organization criteria were used for comparing Z-score BMI for age in our cases. Overweight was defined as Z-score BMI >+1 SD (standard deviation) and obesity as >+2 SD. At the time of transplantation, the mean age was 10.8 ± 3 years (5-16 years) and based on BMIZ-score, the patients were found to be thin (BMIZs <-2 SD) in 16.9%, normal (BMIZs = -2 to +1 SD) in 67.6%, overweight (>+1 SD to +2 SD) in 9.9%, and obese (BMIZs >+2 SD) in 5.6%.The mean follow-up duration after transplantation was 3.57 ± 1.68 years (1-7 years) and at the time of reevaluation after transplant, their mean age was 14.4 years (6-18 years). The mean BMI was 22 ± 5.3 kg/m 2 , and for BMI grouping, the patients were thin in 7%, normal in 54.9%, overweight in 21.1%, and obese in 17%. Pretransplant thinness (BMIZs <-2 SD) was found in 12 patients (16.9%), equally in boys and girls, and in most of them (83.3%), BMIZs changed to normal or even >+1 SD after transplant. Chronic continuous decrease of glomerular filtration rate (CCD/GFR) was found in 27 cases (38%); 74.1% were male (P = 0.045), hypertriglyceridemia was found in 74.1% (P = 0.023%), hypercholesterolemia in 63% (P = 0.032),and obesity in 18.5% (p = 0.5). The incidence of obesity has tripled after kidney transplantation. It was not a risk factor for graft or patient survival in our experience, whereas pretransplant obesity had some effects on long-term graft outcome.

Objectives: In this randomized controlled trial, our aim was to compare bipolar cautery of lymphatic vessels with standard silk-tie ligation in renal transplant procedures for prevention of lymphocele formation., Materials and Methods: Sixty end-stage renal disease patients were enrolled in a prospective randomized controlled trial. The mean age of recipients in the suture ligature group was 41.6 years (range, 6-65 years) and 40.9 years in the bipolar cautery group. Patients were assessed by symptoms; however, ultrasonography was also used as the primary diagnostic procedure in all patients to find lymphocele collection within 5 months., Results: Of 60 patients, 25 received living-donor kidney transplant and 35 received deceased-donor kidney transplant. Fifty-threeprocedures were first-time kidney transplants, 6 were retransplants, and 1 was for a third-time transplant. No lymphocele collection (symptomatic or asymptomatic) was diagnosed by ultrasonography at the 5-month follow-up. Postoperative pain was not significantly different between the 2 groups (P = .245). The time for ligation or cauterization of lymphatic vessels was similar between the 2 groups. Mean duration of operative field drainage was 5.6 days in the suture ligature group and 6.07 days in the bipolar cautery group (not significantly different; P = .547)., Conclusions: Bipolar cautery of lymphatic vessels to prevent lymphocele formation in kidney transplant seems to be an effective, easy, and safe method.

Objectives: Autosomal dominant polycystic kidney disease is the most common hereditary disorder resulting in end-stage renal disease that can affect other organs besides kidneys. Extrarenal involvement may increase mortality and morbidity. Approximately 50% of patients with this disorder require renal transplant. Posttransplant complications have been reported to be equal in these patients versus other recipients. We conducted this study to determine and compare characteristics and outcomes of transplanted patients with this disease versus other recipients at the only transplant center in southern Iran., Materials and Methods: Detailed data of patients with autosomal dominant polycystic kidney disease were collected from medical records from the Shiraz Organ Transplantation Center. We also gathered data on a matched control group of transplant recipients who had end-stage renal disease due to other reasons, including other congenital kidney diseases and type 2 diabetes mellitus. Medical records of patients before and after transplant were reviewed. Statistical analyses were performed with SPSS software version 19 (Chicago, IL, USA)., Results: We collected data from 2002 to 2012 on 101 patients with autosomal dominant polycystic kidney disease and 100 control patients, including 74 female (36.8%) and 127 male patients (63.2%). Average duration of pretransplant dialysis was 14.9 ± 10.3 months in study patients and 12.8 ± 8.1 months in control patients. Rejection rate was statistically greater in recipients with this disease (30 patients; 68%) versus controls (14 patients; 32%) (P = .010)., Conclusions: Short- and long-term survival rates of patients with autosomal dominant polycystic kidney disease were not statistically different from control patients. However, graft survival was significantly lower. In short- and long-term follow-up of autosomal dominant polycystic kidney disease patients, hemoglobin and hematocrit levels were slightly higher than those of the control group. Autosomal dominant polycystic kidney disease is not a risk factor for posttransplant diabetes mellitus.

Organ Transplantation in Iran has come a long way with many different policies and approaches addressing demand and supply. The first successfully kidney transplantation was performed at Namazi Hospital in Shiraz from a living donor in 1967. However, there had been only limited transplant activities in Iran until mid-1970. Previously, patients compensated the lack of organ transplants in Iran by travelling outside the country including the United Kingdom for living related transplants or to India, taking advantage of commercially available organs, usually with poor outcomes. There have also been attempts in the past to import allografts from Europe and the United States. After 1979 revolution, kidney transplantation was activated in Iran by using living donors which was know as Iranian model. Recently, there has been emphasis to expand deceased donor kidney transplantation. However, there are several challenges to expand transplant care in Iran.

Background: Kidney transplantation is the best strategy for the management of end-stage renal disease; however, the outcomes need to improve further. Macrolides show antimicrobial and anti-inflammatory properties in chronic diseases and intraoperatively, and can accumulate in tissues for extended periods. Therefore, theoretically, when administered to a donor and because of accumulation in the donor kidney, macrolides can cause graft immunomodulation and improve kidney transplantation outcomes., Methods: This study is a single-center, randomized clinical trial. A total of 60 kidney donors will be randomly allocated to the azithromycin or placebo group and treated with a single dose (1 g) of azithromycin or placebo, respectively, 1 day before surgery. Recruitment commenced in September 2016 and is expected to be completed by March 2018. The primary outcome is kidney graft function. The secondary outcomes include rejection rate, urinary tract infections in graft recipients, pain and systemic inflammatory response syndrome in live donors, and complications in both donors and recipients. Outcomes will be evaluated at baseline and every day in the first week after transplantation, as well as at 1 and 3 months post transplantation. Adverse reactions will be documented. If the efficacy of azithromycin in reducing adverse outcomes is confirmed, it would serve as an easy to use, economic intervention able to lower post-transplantation risks., Discussion: Short and mid-term analyses of blood and urine samples as well as immunological assays will facilitate a more in-depth analysis of the effects of azithromycin on transplantation outcomes., Trial Registration: Iranian Clinical Trial Registry, IRCT201606141853N11 , registered on September 5, 2016.

Kidney transplantation has become the treatment of choice for patients with end-stage renal disease. Six decades of success in the field of transplantation have made it possible to save thousands of lives every year. Unfortunately, in recent years success has been overshadowed by an ever-growing shortage of organs. In the United States, there are currently more than 100 000 patients waiting for kidneys. However, the supply of kidneys (combined cadaveric and live donations) has stagnated around 17 000 per year. The ever-widening gap between demand and supply has resulted in an illegal black market and unethical transplant tourism of global proportions. While we believe there is much room to improve the Iranian model of regulated incentivized live kidney donation, with some significant revisions, the Iranian Model could serve as an example for how other countries could make significant strides to lessening their own organ shortage crises.

As the cases of kidney transplant are increasing, the need to apply the factors to increase the success of transplant seems necessary. Mannitol increases the osmotic pressure and urine volume as a protective agent on renal tubules. We aimed to evaluate the effect of mannitol on short-term outcome of kidney transplantation by comparing two groups based on prescribing mannitol to donors. In a randomized clinical trial, 60 kidney recipients were assigned in two groups (30 in each), except that in one group donors received mannitol. They were studied with respect to age, gender, weight, blood urea nitrogen (BUN), creatinine (Cr), sodium (Na), potassium (K) and arterial blood gas (ABG) before and after surgery, and their pulse rate (PR) and blood pressure (BP) before, during and after surgery. Their urine volume was assessed in the operation room and the first 24 h after surgery. The short-term outcome, including BUN and Cr in the first 10 days after transplant, have been charted. Both the case (mannitol-positive donor patient) and the control (mannitol negative) groups were the same regarding the results gained for pre- and post-operative parameters. Follow-up assessments showed no significant differences in renal function. Based on this, we conclude that mannitol administration to donors does not have a beneficial effect on the prognosis and short-term outcome of transplantation on recipients; therefore, we feel that it should not be advised for kidney donors.

Kidney transplantation is the best treatment option for the patients with end-stage renal disease. Viral infections and genetic factors such as HLA-II antigens may affect the kidney transplant outcome. The compatibility of HLA-DRB1 molecules in the survival of kidney transplant is important. Also, the correlation between these molecules and viral infections is significant. The current study investigates the allele frequency of HLA-DRB1 in 41 recipient kidney transplant and 203 normal healthy controls by polymerase chain reaction using sequence specific primers. Moreover the relation between HLA-DRB1 allelic groups and hepatitis B, hepatitis C and cytomegalovirus viral infections was also studied. However statistical analysis of the allele frequencies didn't show any significant association between HLA-DRB1 allelic group distributions or sharing and susceptibility to acute kidney transplant rejection (P > 0.05). Comparing the allele frequencies between HLA-DRB1*14 and DRB1*04 allelic showed a significant difference in controls and patients (P = 0.03 and P = 0.05 respectively). The results of the present study also showed a significant association between possession of HLA-DRB1*07 allele in kidney transplant recipients and hepatitis C virus infection (P = 0.009). In conclusion however the results of the present study did not showed relation between HLA-DRB1 allele's frequencies or sharing and kidney transplantation outcome, the results indicated that HLA-DRB1 alleles may susceptible individuals to renal disease or play a role in susceptibility to viral infection in kidney transplant patients.

Introduction: Hyperhomocysteinemia (hyperHcy) is an important risk factor for atherosclerosis, which is currently a major cause of death in renal transplant patients (RTRs). The aim of this study was to determine the associated factors of hyperHcy in RTRs in northern Iran., Methods: In 148 stable RTRs, total serum homocysteine (tHcy) level, folate, serum albumin and creatinine, creatinine clearance, lipid status, body mass index (BMI), and blood cyclosporine levels (C0 and C2) were determined. The mean doses of cyclosporine A (mg/kg/day) were recorded., Results: In this analytic cross-sectional study the prevalence of hyperHcy was 70.3%. Hyperhomocysteinemia was defined as total serum homocysteine of 12 μmol/L or greater. The comparison of the group of 44 patients with tHcy level less than 12 and the group of 104 patients with tHcy level of 12 μmol/L or greater revealed that those subjects with hyperHcy were mostly younger, male, with lower BMI, history of glomerulonephritis, higher serum level of uric acid, and blood cyclosporine trough level (C0) and used higher doses of cyclosporine A. Significant correlation was found between tHcy level and recipients age, serum creatinine, BUN, folate concentrations, and creatinine clearance. However, multivariate analysis indicated that serum folate (P=0.01), vitamin B12 (P=0.05), creatinine (P=0.03), and BUN (P=0.05), and blood cyclosporine trough level (C0, P=0.005) were independently associated with tHcy levels., Conclusion: HyperHcy persists after successful kidney transplantation in the majority of RTRs. Serum creatinine, BUN, folate and vitamin B12, and blood cyclosporine trough level (C0) are independently associated with tHcy levels.

Combined heart and kidney transplant has become an accepted therapy for patients with coexisting heart and kidney failure. This method, compared with single-organ transplant, has a better outcome. Here, we report the first successful combined heart and kidney transplant in Iran. The patient was a 36-year-old man with end-stage renal disease owing to IgA nephropathy, admitted to Masih Daneshvari Hospital in Tehran, Iran for progressive dyspnea and chest pain. In-patient evaluations revealed cardiomyopathy leading to end-stage heart failure. Owing to concurrent heart and kidney end-stage diseases, combined cardiorenal transplant was done. Eight months after his transplant, routine follow-ups have not shown any signs of acute rejection. He is now New York Heart Association functional class I. Both cardiac and renal functions are within normal ranges. Good outcome during follow-up for this case justifies simultaneous heart plus kidney transplants as an alternate treatment for patients with advanced disease of both organs.

Objectives: Pediatric renal transplant recipients are at increased risk of Epstein-Barr virus infection which may be due to the high percentage of Epstein-Barr virus seronegative recipients at the time of transplant in the pediatric age group. We aimed to assess the Epstein-Barr virus serostatus of recipients and donors and the incidence of posttransplant lymphoproliferative disorder in pediatric renal transplant at the Labafinejad Hospital in Tehran, Iran., Materials and Methods: We reviewed the clinical records of 183 children who had a renal transplant at the Labafinejad Hospital in Tehran, Iran, between 2003 and 2011., Results: Of all the patients, 61.2% were Epstein-Barr virus seropositive at the time of transplant. Graft survival rate and the rate of acute rejection episodes were not statistically different between the seropositive and seronegative recipients. Three patients (0.005%) had posttransplant lymphoproliferative disorder after transplant., Conclusions: We showed that the rate of seronegative recipients in our cohort is similar to other studies, but the rate of posttransplant lymphoproliferative disorder was low in our recipients.

Kidney transplantation is generally considered the best option for most patients with end-stage renal disease requiring renal replacement therapy, even for patients with graft failure. Here, we describe a case of a 49-year-old man who received his 1st kidney transplant the United Kingdom from his brother when he was 18 years old in. Thirty-one year after the first transplant, he underwent successful 4th living-unrelated kidney transplantation with no serious complications at our transplant center. He continued to have excellent allograft function and his latest serum creatinine 33 months after his 4th transplant was 1.2 mg/dL. To our knowledge, this is the first case of 4th kidney transplantation from Iran.

Objectives: Nitric oxide is a major mediator in vascular biology and regulator of regional blood flow. Its production is catalyzed by the enzyme endothelial nitric oxide synthase. Protective actions of nitric oxide in ischemia and reperfusion are due to its potential as an antioxidant and anti-inflammatory agent, along with its inhibitory effects on cell signaling pathways of nuclear proteins, such as NF-kB. The endothelial nitric oxide synthase gene polymorphisms affect endothelial nitric oxide synthase activity and are associated with endothelial dysfunction. This study sought to examine the association between single nucleotide polymorphisms in endothelial nitric oxide synthase gene (rs 2070744, 27VNTR, and rs1799983) and the development of acute rejection in renal transplant patients., Materials and Methods: Sixty-six renal transplant recipients (33 patients with an episode of acute rejection and 33 recipients an episode of acute rejection), between June 2010 and March 2011, were included. The polymorphism was determined by simple polymerase chain reaction and polymerase chain reaction-restriction fragment-length polymorphism analysis., Results: There was only a significant association of endothelial nitric oxide synthase -786T allele and acute rejection (P = .03). Recessive model of T-786C alleles (TT vs TC+CC) and acute rejection confirmed a significant association (odds ratio: 3.12; 95% CI: 0.01-9.83; P = .025). Haplotype CbG was higher in recipients without rejection as compared to rejection group (OR: 0.42, 95% CI: 0.16-1.13; P < .05). Respecting the endothelial nitric oxide synthase gene 894G/T single nucleotide polymorphisms and 27VNTR, no significant association between the allele/genotype and acute rejection was seen., Conclusion: Recipient endothelial nitric oxide synthase gene polymorphisms do not alter the risk of acute rejection after a renal transplant. Rejection is a complex immunologic event. Therefore, finding associated genetic variants demands a multicentric larger sample size.

Background: Cytomegalovirus (CMV) infection is one of the most common infectious problems following kidney transplantation. In this study we sought to investigate CMV infection in the setting of renal transplant recipients in Urmia, Iran, using polymerase chain reaction (PCR) detection., Methods: Ninety-six randomly selected renal transplant recipient were enrolled in a cross-sectional study. Blood sampling via venipuncture, yielded sera investigated for anti-CMV IgM. Seropositive as well as 14 randomly selected seronegative cases were investigated with PCR assays., Results: Thirty-three patients (34.3%) were seropositive for anti-CMV IgM; 3 (3.1%) borderline, and 60 (62.5%) seronegative. Considering borderline anti-CMV IgM levels as seropositive, 37.5% were seropositive for anti-CMV IgM. Among the 36 seropositive cases, a CMV infection was confirmed in 19 (52.7%) using PCR. Age (P = .40), educational status (P = .77), history of pretransplantation dialysis (P = .52), prior blood transfusion (P = .52), and immunosuppressive regimen were not significantly different among positive versus negative CMV PCR recipients., Conclusions: The seroprevalence of CMV infection was high among renal transplant recipients of Urmia, Iran, as confirmed by PCR study., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Introduction: Left ventricular diastolic dysfunction, which is prevalent in end-stage renal disease, predicts morbidity and mortality among affected patients. The aim of this study was to evaluate diastolic function changes in end-stage renal disease patients before as well as 3 and 6 months after kidney transplantation., Methods and Materials: This longitudinal study from November 2008 to November 2009, enrolled 27 consecutive kidney transplant patients. Systolic and diastolic blood pressures and echocardiograghic parameters such as ejection fraction, left ventricular mass, and diastolic functions were measured before, as well as 3 and 6 months after transplantation. Data were analyzed by repeated-measure analysis of variance and Friedman tests using SPSS version 18., Results: The mean patients age was 39.47 ± 12.27 years with 55.6% males. The mean systolic and diastolic blood pressure and left ventricular mass decreased significantly in the first 3 (125.44 ± 11.35, 78.51 ± 6.32, 141.94 ± 3.32) and 6 months (121.48 ± 10.63, 72.96 ± 4.21, 138.25 ± 3.12) after renal transplantation compared to the values before the procedure (136.77 ± 14.09, 81.92 ± 9.01, 158.30 ± 3.58 respectively; P < .05). The left ventricular ejection fraction increased significantly at 3 (63.00 ± 6.49) and 6 months (66.11 ± 5.87) compared with preoperative (62.48 ± 5.74; P < .05). Step mean diastolic function also decreased significantly at 3 (1.94) and 6 months (1.81) compared with before transplantation (2.24; P < .05)., Conclusion: According to our findings, transplantation can correct ejection fraction and systolic and diastolic blood pressure and lead to regression of left ventricular hypertrophy. Diastolic function was improved after transplantation., (Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.)

Organ shortage for transplantation remains a worldwide serious problem for kidney patients with end-stage renal failure, and several countries have tried different models to address this issue. Iran has 20 years of experience with one such model that involves the active role of the government and charity foundations. Patients with a desperate demand for a kidney have given rise to a black market of brokers and other forms of organ commercialism only accessible to those with sufficient financial resources. The current Iranian model has enabled most of the Iranian kidney transplant candidates, irrespective of socioeconomic class, to have access to kidney transplantation. The Iranian government has committed a large budget through funding hospital and staff at the Ministry of Health and Medical Education by supporting the brain death donation (BDD) program or redirecting part of the budget of living unrelated renal donation (LURD) to the BDD program. It has been shown that it did not prevent the development and progression of a BDD program. However, the LURD program is characterized by several controversial procedures (e.g., confrontation of donor and recipient at the end of the evaluation procedure along with some financial interactions) that should be ethically reviewed. Operational weaknesses such as the lack of a registration system and long-term follow-up of the donors are identified as the 'Achilles heel of the model'.

Objectives: Hyperlipidemia is a significant metabolic disorder that is commonly encountered in renal transplant recipients. This study was conducted to investigate lipid disturbances and define its pattern in kidney recipients., Materials and Methods: The records of 103 patients who had undergone a renal transplant between the years of 2004 and 2005 were retrospectively investigated. The lipid profile of these patients including total cholesterol, low-density lipoproteins, high-density lipoproteins, and triglyceride levels before and within 2 years' follow-up after transplant was evaluated. The demographics of the patients, cause of the end-stage renal failure, along with their immunosuppressive regimens were also considered., Results: The study group included 43 women (41.8%) and 60 men (58.2%) (mean age, 39.25 ± 13.9 y). After transplant, laboratory analyses yielded significantly increased levels of total cholesterol, low-density lipoproteins, triglyceride levels, and high-density lipoproteins despite statin therapy, and the most important predictor for developing hypercholesterolemia and hypertriglyceridemia-pre-existing dyslipidemia. The effects of the various drugs on lipid metabolism were not different. These effects seen on the lipid profiles also were independent of the patients' age, sex, and cause of end-stage renal failure., Conclusions: Despite statin treatment, renal transplants in our subjects were associated with a characteristic pattern of lipid disturbance with raised total cholesterol, low-density lipoproteins, high-density lipoproteins, and a concomitant increase in triglycerides. A more-aggressive approach to managing posttransplant hypercholesterolemia is warranted, especially in patients with pre-existing dyslipidemia.

The human T lymphocyte virus-1 (HTLV-1) is the responsible pathogen for diseases such as HTLV-1 associated myelopathy (HAM) and adult T-cell leukemia (ATL). Mashhad, in northeast Iran, with high instances of this infection, has a noticeable number of infected renal failure patients. Since immunosuppressive drugs might decrease the latency period of HTLV-1 or increase its complications, the question arises whether HTLV-1 positive renal failure patients are suitable candidates for kidney transplants. To answer this, HTLV-1 positive recipients were evaluated in our study. Patients were divided into two groups. First group consisted of patients at the Imam Reza Hospital dialysis center. Second group had 20 kidney transplantation recipients consisting of ten infected and ten uninfected recipients as control from Imam Reza. Medical history of these patients was recorded and evaluated. The follow-up periods were between one and six years. Among them, 3.8% of patients undergoing dialysis were infected. The most important fact resulting from this study is that none of the infected recipients suffered from HAM or ATL during the follow-up period. In addition, it did not show any significant difference in the incidence of post-transplant complications between the infected and non-infected groups. Our study indicates that HTLV-1 positive patients may undergo kidney transplant without fear of increased incidence of side effects than those found in uninfected recipients. Because of short-term follow-up, probable long latency period of the virus, and the limited number of infected recipients, further work on this issue would be prudent.

Objectives: Health-related quality of life after kidney transplant in adolescents is a major concern; nevertheless, there is a paucity of data on the variables that have an effect on it. This study evaluated the extent to which socioeconomic, clinical, and psychological characteristics explain the variance in the health-related quality of life of adolescent Iranian kidney transplant recipients., Materials and Methods: Into a hierarchical regression analysis, the cross-sectional socioeconomic, clinical, and psychological characteristics were entered among 55 adolescent Iranian kidney transplant recipients., Results: The relative predictive power of socioeconomic, clinical, and psychological variables with respect to health-related quality of life was 21.8% (P = .088), 21.2% (P = .014), and 27.6% (P = .001)., Conclusions: Psychological factors had a greater relative predictive power in postrenal transplant health-related quality of life of adolescents than did socioeconomic and clinical characteristics. Further research should target improvement of health-related quality of life in adolescent kidney recipients by psychological intervention.

The quality of life of patients with end-stage renal disease is an important indicator of disease burden. To achieve a better quality of life, some medical treatment might be replaced by other approaches. The aim of this study was to compare the quality of life of renal-transplanted and hemodialysis patients in Iran. Two hundred hemodialysis and 200 renal transplantation patients were recruited from 5 major hospitals and renal patients' support society in Tehran, Iran. The data were collected using the Persian versions of the Ferrans and Powers Quality of Life Index-Dialysis and Transplantation Version. The quality-of-life mean scores of renal transplantation patients were significantly better compared with those of the hemodialysis patients (21.36 [SD, 4.06] vs 20.35 [SD, 5.14]; P = .03). The questionnaire demonstrated significant differences in health/functioning and familial subscale of quality of life between the transplanted and hemodialysis patients (p < .05). The better quality of life of transplant patients, in comparison with hemodialysis patients, is an important reason for advising kidney transplants in renal failure patients. To improve the patients' quality of life, kidney transplantation might be effective for the end-stage renal disease. With regard to socioeconomic problem in most of the patients with renal failure, comprehensive insurance and referral to renal and transplanted patients' support society are suggested for those who have undergone different renal replacement therapies.

Living donor kidney transplantation has strong opposition and proponents. Opponents argue that this would exploit poor and female while proponents discuss the high mortality rate of ESRD patients and the low risk of a living donation. In this debate, we reviewed disputes in ethical aspects of living donor kidney transplantation to reach to a good overview of the current concepts on the issue.

Background: We report, for the first time, the data on the outcome of kidney transplantation activities in the Afghan population from Iran., Material/method: We extracted the demographic, clinical and the outcome related data of all Afghan kidney transplanted patients, from 1998 to April 2006, from the United Nations High Commissioner for Refugees (UNHCR) and the Dialysis and Transplant Patients Association (DATPA) databases., Results: During this period 103 Afghan patients (70.9% male, 29.1% female) underwent renal transplantation in Iran. The mean age at transplantation was 32.7 years. The kidney sources were living unrelated donors (LURD) in 82.5%, living related donors (LRD) in 15.5% and cadaver in 2% patients. The graft and patient survival rates for 1, 3 and 5 years were 97 and 98, 86 and 95, 73 and 95 percent, respectively., Conclusions: Both graft and patient survival rates were good and comparable to those reported previously in Iranian patients.

Background: The outcome of renal transplantation in the elderly, with respect to both patient and graft survival, is not as unambiguous as that in the young. Our aim was to compare the outcomes of kidney transplantation in old and young recipients., Material/methods: This historical cohort study, conducted at Baqyiatallah Hospital, Tehran, Iran, enrolled 358 young (<60 years old) and 44 old (> or =60 years old) renal recipients. The main outcomes comprised the subjects' estimated glomerular filtration rate (e-GFR), graft survival (death-censored and death-uncensored), and patient survival at 6 months, 1 year, 2 years, 3 years, and 5 years. Additionally, the causes of death were registered in each group., Results: There was no significant difference as regards 6-month, 1-year, and 5-year e-GFR and death-censored graft survival between the elderly and young recipients (p>0.05), but 5-year patient survival and death-uncensored graft survival were significantly worse in the elderly recipients (p<0.05). The frequency of death due to cardiac or cerebrovascular disease was not significantly different between the 2 groups (p>0.05)., Conclusions: Given the similar death-censored graft-survival rates in our old and young kidney recipients, it would be ill-advised to exclude transplant candidates on the basis of their age.

Objectives: To evaluate the efficacy of intravesically applied amikacin for the prophylaxis of urinary tract infections (UTIs) occurring in the first 3 months after kidney transplantation., Methods: In a prospective, randomized, controlled trial, 200 consecutive renal transplant recipients were randomly divided into two equal groups. The bladders of the first group, the amikacin group, were filled with saline solution containing amikacin (1 g in adults and 30 mg/kg in pediatric patients) whereas the bladders of the patients of the second group, the control group, were filled with saline solution. Patients were followed up for 3 months after transplantation with urine cultures to evaluate the prevalence of posttransplantation UTIs in both groups., Results: The overall incidence of UTIs was found to be significantly lower in the amikacin group (25 vs. 49%; p = 0.0007). In addition, male patients, patients with end-stage renal disease due to glomerulonephritis, patients receiving renal transplantation for the first time, or those from the amikacin group receiving a living-related graft had a significantly lower incidence of UTIs than their counterparts in the control group (p < 0.05). UTIs were most frequently caused by Escherichia coli (28.9%)., Conclusions: Perioperative bladder irrigation with amikacin solution significantly decreases the overall incidence of UTIs in the first 3 months after kidney transplantation., (Copyright (c) 2010 S. Karger AG, Basel.)

We analyzed survival of 185 adult patients on maintenance hemodialysis (9 h/wk to 12 h/wk) at Emam Khomini Hospital in Ahvaz, Iran. Patient survival at 1, 3, and 5 years was 89.2%, 69.2%, and 46.8%, respectively. There was no significant difference between diabetic and nondiabetic patients in 1-year survival (87.1% versus 89.7%, P = .66). But, 3- and 5-year survival rates of diabetic patients were significantly lower than those of nondiabetic patients (52.2% versus 73.8%, P = .04; zero versus 56.9%, P < .001; respectively). Based on our findings, the survival of diabetic patients undergoing hemodialysis was much worse than survival of nondiabetic patients. Thus, prevention of diabetic nephropathy should be more emphasized; and if end-stage renal disease is present, other renal replacement therapies such as kidney transplantation must be considered as soon as possible.

During the past decades, the number of altruistic living unrelated kidney donations has substantially increased in developed countries. However, the altruistic supply of transplantable kidneys has remained much less than the demand. As a result, severe kidney shortage has been associated with increasing number of patient deaths and increasing number of commercial transplants and transplant tourism. Studies have shown that there is still a need for living kidney donation because even all potential brain-dead donors cannot supply the escalating need for kidneys. The use of living unrelated kidney donors should be morally and ethically justified and should be compatible with ethical principles. Many experts believe that increasing number of patient deaths and commercial transplants will continue to happen if kidney donation system remains merely altruistic. While some transplant professionals support a paid and regulated system to eliminate kidney shortage, others argue that it will be destructive. Iran has a 20-year experience with a compensated and regulated living unrelated kidney donation program. This transplantation model was adopted in 1988, and successfully eliminated kidney transplant waiting list by the end of 1999. Currently, more than 50% of patients with end-stage kidney disease in Iran are living with a functioning graft. This Iranian transplantation model has many ethical successes. However, because it has not been well regulated by transplant ethicists, some ethical shortcomings have remained. Unfortunately, due to lack of interest and expertise in health authorities, the number of serious ethical failures is also increasing in this transplantation model.

Objective: Kidney transplantation is the selective treatment of end-stage renal disease. Although most previous studies have concluded that living kidney donation achieves better graft survival, some factors may limit this type of donation. This study investigated the survival rates of living and deceased donor kidney transplantations among Iranian patients., Materials and Methods: The records of kidney transplantations up to year 2005 were used to compare 50 deceased (group I) with 50 living donor transplants (group II). The recipients were matched by transplantation time. We used SPSS version 15 software to analyze the data., Results: Group I patients included 28 males and 22 females of mean age of 38 +/- 13 years, while 26 males and 24 females in group II had a mean age of 34.6 +/- 14 years. The rejection and graft nephrectomy rates were significantly higher among group I than group II (P = .01, P = .02). The first-year graft survival was higher in group II (P = .001). The graft survival was significantly lower in recipients who needed a biopsy or dialysis (P = .006 and P = .02, respectively) and higher among those who had a urine volume >4200 mL within the first 24 hours after transplantation (P = .003). Patient survivals were not significantly different between the groups., Conclusion: Living donor kidney transplantations showed higher graft survival and lower acute rejection rates compared with those from deceased donors.

Objectives: There is no knowledge on the outcome of renal transplant for end-stage renal disease secondary to neurogenic bladder caused by spinal cord injury. In this study, we evaluated the outcome of kidney allograft recipients with spinal cord injury., Materials and Methods: We evaluated graft survival, clinical course, laboratory findings, and imaging studies in 21 men (veterans) with spinal cord injury and renal failure secondary to neurogenic bladder. They underwent renal transplant between 1990 and 2006. Bladder dysfunction was appropriately managed before or with receiving the kidney allograft., Results: Mean (-/+ SD) age of patients was 43.8 -/+ 5.9 years. Mean glomerular filtration rate at the closing date of the study was 89.5 -/+ 33.6 mL/min. During follow-up (median: 6 years, range: 1-17 years), mean duration of graft survival was 15.4 -/+ 1.0 years (95% confidence interval, 13.2-17.5 years). Following renal transplant, mean nadir level of serum creatinine was 74.25 -/+ 16.79 micromol/L (0.84 -/+ 0.19 mg/dL). Six patients (28.6%) had kidney stones before renal transplant, and 2 patients (9.5%) after (1 patient with new kidney stones and 1 patient with kidney stones before and after transplant). Pyelonephritis occurred in 18 patients (85.7%) before transplant, and in 9 patients (42.9%) patients after (P = .07). Graft loss occurred in 2 patients (9.5%) 4 and 18 months after the transplant., Conclusions: Spinal cord injury patients who receive allograft kidney transplants have acceptable outcomes, and transplantmay reduce urolithiasis and upper urinary tract infection.

Data regarding the socioeconomic status in Iranian kidney transplant (KT) recipients is lacking. In this cross sectional descriptive study we evaluated the socio-economic status of 100 KT recipients in Shiraz organ transplantation center. In a cross-sectional design, we randomly selected and interviewed 100 RT recipients (50 males and 50 females). Data regarding age, gender, martial status, occupation, level of education, number of children, type of insurance, monthly household income, place of residence, ownership of a personal transportation device, duration and frequency of pre-transplant dialysis, family history of CRF (Chronic renal failure), and etiology of renal disease were obtained. There were 50 (50%) patients aged between 16 and 35 years, 55 had a family history of CRF, 60 had been on dialysis for more than a year, 61 were married, 47 did not have any children, 41 had more than 3 children, and 65 were unemployed due to physical and emotional impairment as a result of their disease. The majority (73%) did not have a high school diploma, 15% were illiterate, 85% were below the poverty line, 52% were from rural areas, and 98% were covered by insurance. We conclude that patients with CKD in our study had acquired this condition possibly due to negligence and lack of basic health care in the lower socioeconomic class. In addition, KT is an available therapeutic modality to lower socio-economic level in Iran.

Background: Therapeutic drug monitoring of cyclosporine (CsA) blood values in renal transplant recipients is of extreme importance; hence, finding contributing factors in this issue is relevant. In this study, we aimed to evaluate potential associations of some characteristics of the recipients including their human leukocyte antigen haplotypes with their drug bioavailability., Material/methods: 616 patients who had a valid HLA typing result concomitant with other demographic data in our local data registry were consecutively selected. We extracted their HLA typing, age, gender, weight, cause of renal failure, first measured CsA trough level (C0) and concomitantly measured creatinine, CsA administered dosage, time duration from transplantation, routine laboratory test results, panel reactive antibodies percentage, and immunosuppression type. Bivariate and multivariate linear regressions were employed to evaluate associations of these factors with blood C0 values., Results: 64.5% of patients were male. Mean age at transplantation was 40.7+/-15.8. Mean first measured C0 was 271+/-178 ng/ml. Analysis showed that the only factors which had independent association with C0 were age at transplantation, dose/weight ratio and HLA-B27., Conclusions: genetic factors as well as age of patients are two founded factors in this study which are recommended to be considered in monitoring drug administration in organ transplant recipients.

Transplantation is the best treatment of end-stage renal disease (ESRD. Life expectancy, the quality of life and reduced medical expenses are greater with kidney transplantation than with maintenance dialysis. However, organ shortage remains the central problem in kidney transplantation. To tackle this problem, we, in Iran, have initiated a living unrelated donor (LURD) program using emotionally related persons, friends and well-motivated volunteers as organ donors, which resulted in eliminating the waiting list. The Iranian transplant program is the most active in the Middle East region in providing equitable, quick, and intermediary-free access to affordable kidney transplantation for everyone regardless of gender and economic circumstances. The results of transplants from living unrelated donors have been very encouraging. This article deals with the kidney transplantation practice in Iran and other Middle Eastern countries, and describes Iran's kidney transplantation experience with cadaveric, living related and living unrelated donors. In conclusion, kidney transplantation experience in the Middle East region is an active practice. Most countries have uplifting trends and effective programs are establishing inside countries. However, the practice should be further promoted and organized towards allograft procurement from deceased donors and in this way passing and enacting proper legislations must be more seriously taken into consideration.

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 +/- 4.50. The most frequent comorbidities were nonischemic heart diseases including hypertension (n=75; 63%), visual disturbances (n=42; 35.2%), low back pain and spine and joint disorders (n=30; 25.21%), and musculoskeletal disorders (n=28; 23.5%). A higher comorbidity score was significantly correlated with lower economic status (P<.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.

Background: Following renal transplantation, serum erythropoietin (EPO) levels gradually increase during the first 2 to 3 months. However, some transplant recipients continue to remain anemic. The aim of the present study was to correlate serum EPO concentrations with hematocrit (Hct) and hemoglobin (Hb) levels in hemodialysis (HD) patients and renal allograft recipients., Methods: In a comparative cross-sectional study, serum EPO concentrations and Hb and Hct levels were measured in 35 chronic HD patients and 40 transplant recipients who had stable kidney function for at least 6 months after transplantation (group 1). The HD patients were further divided based on their recombinant human (rHu) EPO supplementation into those who received rHu EPO during dialysis (group 2A, n=15) and those who were not on rHu EPO (group 2B, n=20). Data are presented as mean values +/- SD. The statistical analysis was performed by SPSS version 11.0 using chi-square, ANOVA, and Pearson correlation tests. A general linear model (GLM) was used to compensate for the effects of age. The P value for significance was set at .05., Results: Group 2B patients tended to be older than groups 1 and 2A (P=.014). The sex ratios were comparable among groups. Mean EPO level was 17.09 +/- 10.99 mIU/mL in recipients, which was comparable with that of HD patients (18.54 +/- 26.18 mIU/mL; P>.05). No significant correlation was observed between the serum EPO concentrations and Hb and Hct levels in recipients (P>.05). When comparing the 3 groups, EPO was not correlated with Hct and Hb in any group. Hb and Hct were significantly higher among HD patients not on rHu EPO therapy (P=.02). GLM, with age as a covariate, did not yield a significant difference between EPO levels of the studied groups (P=.36)., Conclusions: This study showed that serum EPO level was in the normal range in recipients and HD patients. We were not able to find any correlation between Hb and Hct levels and EPO concentrations in any group of patients irrespective of rHu EPO supplementation. Hence, impaired EPO stimulatory effects may be considered a potential contributor to anemia in these patients.

Background: In this study, we have reported updated statistics of the Iranian Transplantation Registry, the status of the recipients and grafts, and a detailed time trend with respect to patient characteristics., Methods: We retrospectively reviewed the Iranian Renal Transplantation Registry and information from the Dialysis and Transplant Patients Public Association, to obtain data on all kidney transplantations performed in Iran between 1986 and 2005. Data were gathered regarding the total number of transplantations, graft loss, recipient death, and donor and recipient characteristics, including demographic data, cause of end-stage renal disease (ESRD), and source of kidney. We assessed changes in variables on a biannual basis., Results: A total of 19521 transplantations were registered over the study period, of which, 761 recipients (3.9%) had died and 2333 allografts (11.9%) had been lost. The source of the kidney in 2556 (13%) subjects was a living related donor (LRD), in 16234 (83%) a living unrelated donor (LURD), and in 831 (4%) cadaveric. During the study decades we noted an increase in the number of kidney transplantations (from 22 to 3690), age of recipients (from 30 to 40), male-to-female ratio of recipients (from 0.58 to 0.67), male-to-female ratio of donors (from 0.48 to 0.52), diabetes mellitus (from 0% to 27%), and hypertension (from 4% to 15%), as causes of ESRD, as well as the use of cadaveric kidneys (0% to 11%)., Conclusion: Analyzing renal transplantation data not only helps to evaluate the effectiveness of transplantation activities in a country, but also provides information to estimate future costs in the health care system.

Background: That hypertension (HTN) as a leading cause of end-stage renal disease (ESRD) is linked to sleep disorders in the general population can be the basis of a hypothesis that HTN may be a contributing factor to the poor quality of sleep in some kidney transplant recipients. This study was designed to investigate the correlation between ESRD secondary to HTN and sleep quality among kidney transplant recipients., Methods: In this case control study, 201 kidney transplant recipients were divided into group I (ESRD) secondary to HTN, (n=82) and group II (ESRD secondary to other causes, n=119). The groups were matched for medical comorbidities, demographic and clinical data, and symptoms of anxiety and depression. Sleep quality assessed by means of the Pittsburgh Sleep Quality Index (PSQI) was compared between the study groups., Results: The mean (SD) of the total PSQI score was significantly high in group I compared with group II (7.42 +/- 2.36 vs 6.60 +/- 3.07, P=.042). Similar results were observed for the sleep duration scores in the groups (1.22 +/- 1.12 vs 0.86 +/- 1.12, P=.026). In group I, all the other PSQI components were higher than those in group II, difference that were statistically significant., Conclusion: Sleep quality and duration was poorer among our kidney transplant recipients with ESRD secondary to HTN compared with the controls. Further studies, however, are required to investigate whether HTN is responsible for the reported poor quality of sleep in some kidney transplant recipients.

Background and Aim: This study sought to assess posttransplantation hospitalizations costs in diabetic and nondiabetic subjects to see whether diabetes mellitus (DM) as a primary cause of end-stage renal disease (ESRD) increased posttransplantation hospitalization costs., Methods: From 2000 to 2005, the hospitalization costs of 387 consecutive rehospitalizations of kidney recipients were retrospectively compared for two groups: patients with ESRD due to DM (n=71) and those with ESRD of non-DM etiologies (n=316). The hospitalization costs included the costs of hotel, medications, surgical procedures, paraclinical tests, imaging tests, health personnel time, special services (ie, patient transportation by ambulance), and miscellaneous costs. Societal perspective was used with costs expressed in PPP$ purchase power parity dollars (PPP$) estimated to be equal to 272 Iranian rials., Results: Compared with the non-DM group, DM patients experienced significantly higher median costs both in total (1262 vs 870 PPP$, P=.001) and in cost components related to hotel (384 vs 215 PPP$, P=.001), health personnel time (235 vs 115 PPP$, P<.001), paraclinical tests (177 vs 149 PPP$, P=.012), and special services (100 vs 74 PPP$, P=.041). The mean of age was higher (P<.001), and the transplantation hospitalization time interval was also shorter in the DM group (median: 2.7 vs 12, P=.025)., Conclusions: Considering DM as a leading cause of ESRD and its increasing prevalence in some countries, the association between hospitalization costs of posttransplant patients and DM may be of great economic importance to many transplantation centers.

Background and Aim: We studied bone mineral density (BMD) changes in Iranian patients with end-stage renal disease (ESRD) within 11 months after renal transplantation., Methods: Among 68 ESRD candidates for renal transplantation, the BMD at the femur and the spine were assessed using a DEXA Norland scanner. Linear regression analysis was used to identify risk factors associated with low bone density., Results: Mean BMD, T-score and Z-score of femur and spine were significantly reduced (at femur, 0.78 +/- 0.14, -2.4 +/- 1.1, -1.6 +/- 1.0; at spine, 142.25 +/- 105, -1.09 +/- 1.1, -1.07 +/- 0.9). Osteoporosis and osteopenia were found 55.2% and 36.2% at the femur and 8.6% and 58.6% at the spine, respectively. The BMD showed a significant negative association with age (r=0.615), female gender (r=0.394), and corticosteroid intake (r=0.286), and a positive association with weight (r=0.394) and body mass index (r=0.626). There was no significant association between BMD measurements and calcium, phosphorous, or parathyroid hormone levels. At 11 months follow-up, in 20 patients, the subject had lost a mean of 2.4% T-score and 2.8% Z-score at spine (P=.027 and .13, respectively), but did not experience significant declines at the femur. BMD showed a decrease in 80% of recipients in the spine area; there was a 15% BMD increase at the hip., Conclusion: Low bone density is common among ESRD Iranian patients. Early screening and treatment of this group is recommended. Significant loss in lumbar density occurred within 11 months of transplantation in more than one third of a prospective cohort of renal transplant recipients.

There are more than 8 million refugees worldwide with the Middle East bearing the brunt. Socioeconomic factors are the major obstacles that refugees encounter when seeking health care in the host country. It, therefore, comes as no surprise that refugees are denied equal opportunities for one of the most sophisticated and expensive medical procedures in the world, kidney transplantation. With respect to transplantation, refugees are caught between a rock and a hard place: as recipients they have to single-handedly clear many hurdles on the arduous road to renal transplantation and as donors they are left unprotected against human organ trafficking. It should be the moral responsibility of the host country to provide this population with a support network. The ways and means of establishing this network should be defined locally; nevertheless, enabling refugees to receive a transplant is the most basic step, which should be followed by the provision of financial support and follow-up facilities in a concerted effort to ensure the continued function of the invaluable graft. It is also necessary that refugees be protected from being an organ reservoir on the black market. There are no precise regional or international data available on kidney transplantation in refugees; among the Middle East Society for Organ Transplantation countries, only Iran, Saudi Arabia, Pakistan, and Turkey have thus far provided data on their respective kidney transplantation regulations and models. Other countries in the region should follow suit and design models tailored to the local needs and conditions. What could, indubitably, be of enormous benefit in the long term is the establishment of an international committee on transplantation in refugees.

Pulmonary complications are common in patients with chronic renal failure (CRF). The objective of this study was determine the effect of renal transplantation on pulmonary function, using a methacholine challenge test. This interventional study included 14 CRF patients on maintenance dialysis who underwent serial spirometry and astography before and after renal transplantation. None of them was known to have clinically important pulmonary or heart disease. The results of spirometry, astography, echocardiography, and chest X-ray were normal. Five patients were men and all others were women. The overall age range was 15 to 45 years (mean age = 28.6 +/- 10.9). For every patient four times astography was done. The mean values of spirometric and astography indices before and after renal transplantation were within normal limit. But by repeated measure analysis of variance, the results actually showed improved airway responsiveness (although within normal limits). The most common pathological lung condition in CRF is pulmonary edema, usually due to a combination of fluid overload and abnormal permeability of the pulmonary microcirculation. However, our patients had no symptomatic pulmonary edema, but minor degrees of fluid retention are virtually impossible to detect clinically and could not be excluded. Therefore, it seems that disappearance of subclinical pulmonary edema was the likeliest cause of an increase in minimum dose of methacholine, and therefore improvement in airway responsiveness after renal transplantation.

Kidney transplantation is the treatment of choice for children with end-stage renal disease. In Iran, a kidney transplantation program was started in the Labfi Nejad Hospital, Tehran in 1985. From 1985 to 2003, 278 children (mean age 11.6 years, 59.7% males) received their first renal transplant. All transplants were donations from live donors (12.5% live-related donors); 30.8% of patients were preemptively transplanted. The overall 1-year patient survival rate was 92% and the 5-year survival rate 74%. The median graft survival time was 7.2 years. The rate of graft survival was 88.8% at 1 year, 77% at 3 years, 67% at 5 years, 50% at 7 years, and 43% at 10 years after transplantation. The survival rate of patients and transplants improved significantly with time (p<0.05). In patients transplanted before 1997, the 5-year graft survival was 50% and 82% in patients transplanted after 1997. At the same time intervals, the frequency of acute rejection episodes was 66.6 versus 40.8% and of chronic rejection 50.5 versus 28.7%. The outcome in children below the age of 6 years was poor. Graft survival was negatively correlated with the frequency and an early time point of acute rejection episodes. The modus of transplantation (preemptive or postdialysis) did not influence the results. In conclusion, patient and graft survival in transplanted children significantly improved with time, thus reflecting greater medical and surgical experience, new immunosuppressive drugs, and better compliance.