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Background. Hyponatremia (HN) can be associated with osteoporosis, falls and bone fractures in the elderly. Recent researches demonstrated different results about the correlation of HN with bone mineral density and bone fractures.

Long-term immunosuppressive therapy after renal transplantation increases the risk of developing malignancy. The aim of this study was to determine the demographic parameters and immunosupression protocol in kidney transplant recipients with and without malignancy. This case-control study was undertaken on 12 renal transplant recipients with malignancy and 48 with-out malignancy at The Shahid Beheshti Kidney Transplantation Center in Babol (north of Iran). Data including age, gender, number of anti-rejection therapies and immunosupression regimen were recorded and analyzed with SPSS and Mann-Whitney Fisher′s exact t-test. P value < 0.05 was considered significant. The prevalence of malignancy in 380 renal allograft recipients was 3.15% during six years of follow-up. The malignancies noted after renal transplantation included: Kaposi′s sarcoma (n = 5), lymphoma (n = 3), cutaneous basal cell carcinoma (n = 2), cutaneous squamous cell carcinoma (n = 1) and brain tumor (n = 1). Age of patients at the time of trans-plantation, duration of immunosupression treatment and number of anti-rejection therapies were not significantly different in patients with and without malignancy (P > 0.05). Males were signi-ficantly more affected with malignancy compared to females (P < 0.05). Our study shows that there was no significant correlation between age at transplantation, duration of immunosupression treatment and number of anti-rejection therapies and occurrence of post-renal transplantation malignancy; however, the prevalence of malignancy was significantly higher in male patients. The most common malignancy seen was Kaposi′s sarcoma followed by lymphoma.

Background: The ability of regulatory T cells (Tregs) to limit inflammatory responses has been demonstrated. However, different subpopulations of this cell have varying abilities to suppress alloreactive immune responses. The primary goal of this study was to assess the frequency of CD4 + FOXP3 + CD39 + CD73 + Tregs and Deltex-1 gene expression on long-term renal transplant function., Methods: A total of 49 subjects were divided into 3 groups: (i) the excellent long-term graft function (ELTGF) group, (ii) the chronic graft dysfunction (CGD) group, and (iii) the healthy control (HC) group. Following sample collection, peripheral blood mononuclear cells (PBMCs) were isolated, and the Deltex-1 gene expression level and the frequency of CD4 + FOXP3 + CD39 + CD73 + Tregs were evaluated., Results: The ELTGF group had more CD4 + FOXP3 + Tregs than the CGD group, but the difference was not statistically significant (P = 0.07). However, the frequency of CD4 + FOXP3 + CD39 + CD73 + Tregs and the ratio of these cells to total CD4 + lymphocytes significantly increased in the ELTGF group than in the CGD group (P = 0.04 and P = 0.02 respectively). In addition, the expression level of the Deltex-1 gene was significantly lower in the CGD group than in the other 2 groups (P = 0.01 and P = 0.04 respectively)., Conclusions: Given the increased frequency of CD4 + FOXP3 + CD39 + CD73 + Tregs and the expression level of the Deltex-1 gene in the ELTGF group, it appears that these factors probably improved function and long-term survival of the transplanted organ through the suppression of alloreactive responses and reduction of inflammation. In other words, one of the immunological mechanisms involved in the CGD group may be a deficiency in Tregs., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background and Objective: Lupus nephritis (LN) is one of the common manifestations of systemic lupus erythematosus (SLE), affecting the quality of life of patients. Abnormality in the adaptive immune response, such as T cell response, plays the main role in the pathogenesis of SLE and LN. In this study, we aimed to evaluate the role of different subpopulations of regulatory T cells (Tregs) and effector T cells (Teff) in LN patients and compare them with SLE patients., Materials and Methods: A total of 48 participants were enrolled in this study and divided into 3 groups: (i) patients with SLE; (ii) patients with LN; and (iii) healthy controls (HCs). The frequencies of CD4 + CD25 ++ CD45RA - Foxp3 hi activated Tregs (aTregs), CD4 + CD25 + CD45RA + Foxp3 lo resting Tregs (rTregs), CD4 + CD25 + CD45RA - Foxp3 lo non-Tregs, CD4 + CD25 + Foxp3 - Teff, and Tregs were analyzed in all subjects using a flow cytometer., Results: LN patients had a significantly increased frequency of aTregs and Tregs compared with SLE patients (standardized mean difference [SMD] = 0.50; 95% CI [-0.26, 1.25]; p > 0.05 and SMD = 0.60; 95% CI [-0.16, 1.36]; p > 0.05, respectively). Patients with LN had a significantly increased frequency of Teff compared with SLE patients (SMD = 0.49; 95% CI [-0.26, 1.24]; p > 0.05). However, an increased ratio of Tregs/Teff was observed in LN patients compared with SLE patients (SMD = -0.25; 95% CI [-0.97, 0.48]; p > 0.05)., Conclusion: Patients with LN showed immunoregulatory properties, in which both aTregs and Tregs had increased frequencies., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.)

Background: The present study aimed to investigate the one-year prevalence of SARS-CoV-2, common comorbidities and demographic information among negative- and positive rRT-PCR in health care workers (HCW), hospitalized and outpatients. Also, the association between SARS-CoV-2 cycle threshold (Ct) and the outcomes of patients were analyzed in Babol, northern Iran., Methods: This large retrospective cross-sectional study was performed between March 2020 and March 2021. The records of 19232 hospitalized, outpatients and HCW suspected to COVID-19 were collected from teaching hospitals in the North of Iran., Results: Out of the 19232 suspected to COVID-19 patients, 7251 (37.7%) had a positive rRT-PCR result; 652 (9%), 4599 (63.4%) and 2000 (27.6%) of those were categorized as HCW, hospitalized and outpatients, respectively. Moreover, between the hospitalized and the outpatient group, 10.2 and 0.8% cases died, whereas no death cases were reported in the HCW. Furthermore, it seems that death rate was significantly different between the three groups of Ct value, the highest mortality in those with Ct between 21 and 30 (group B=7.6%) and the lowest in the group with the highest Ct (between 31 and 40 = 5.5%) ( p <0.001)., Conclusion: In summary, 37.7% of cases were positive for SARS-CoV-2; of which, 63.4, 27.6 and 9% were hospitalized, outpatients and HCW, respectively. With regard to the mortality rate in hospitalized patients and the significant association with Ct under 20 and 30, it seems that the early detection and the initial quantification of SARS-CoV-2 in the first week of the conflict and therapeutic considerations to reduce the relative load can reduce the mortality rate., Competing Interests: The authors report no conflicts of interest in this work.

Background: It was found that regulatory T cells (Tregs) importantly affect the maintenance of the kidney graft. However, Tregs are a heterogeneous population with less to more suppressive activity. The aim of this study was to determine the effects of different subsets of Tregs, as well as their ratio to effector T cells (Teff), on kidney transplantation outcomes., Methods: A total of 58 participants were enrolled in this study and divided into four groups: (i) first kidney transplant recipients (stable 1); (ii) second kidney transplant recipients (stable 2); (iii) transplant recipients with acute rejection (AR); and (iv) healthy control subjects. By using flow cytometer, the frequencies of CD4 + CD25 ++ CD45RA - Foxp3 hi activated Tregs (aTregs), CD4 + CD25 + CD45RA + Foxp3 lo resting Tregs (rTregs), CD4 + CD25 + CD45RA - Foxp3 lo non-suppressive T cells, CD4 + CD25 + Foxp3 - cells Teff, and total Tregs were analyzed in all subjects., Results: The frequency of aTregs (as well as the ratio of aTregs/Tregs) was significantly lower in the AR patients than the other three groups. In contrast to AR patients, stables 1 and 2 had a higher aTreg/Treg ratio than those in the control group. Although patients with AR had a significantly lower total Tregs than the other three groups, the balance of total Tregs and Teff was similar between patients with and without AR., Conclusion: Patients with AR had poorer immunoregulatory properties than those with normal graft functioning, as well as those in the control group. These reduced immunoregulatory properties in patients with AR could lead to graft rejection., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Bardet- biedl syndrome (BBS) is a rare heterogenous autosomal recessive disease due to defects in primary cilia which until now, up to 21 types have been detected. A few reports of BBS in Iran have been published but this is the first type 9 genotyped and clinically discussed case. This type can cause severe and delayed onset renal failure.

Background: The aim of this study was to use the volume of the graft as an adjunct tool for better decision making., Methods: Kidney transplanted patients with acute azotemia and documented volume and finally a biopsy were enrolled in this study‌. Graft volumes between rejected patients (antibody-mediated rejection {AMR} and cell - mediated rejection {CMR}) and ‌non rejected but azotemic patients were compared., Results: A total of 76 patients were enrolled in this study ‌(45 case and 31 control‌). 53.3% of the case group were‌ (AMR)‌ and 46.7% belonged to ‌(CMR). There was no difference between kidney volume according to age or sex. But the case group had a significantly bigger volume than controls (253.09 cm 3 and 186.45 cm 3 ; p< 0.001). In addition, there was a significant difference between the volumes of AMR kidneys with CMR and controls ‌(286.24+66.70‌, 224.08+76.79 and 186.95+39.92; P=0.003 and p<0.001, respectively), but not between CMR and controls ‌(P=0.067). A cutoff point of 200 cm 3 was determined as rejection with sensitivity and specificity of 70% and a cutoff point of 250 cm 3 could be used as AMR cut off with sensitivity of 76% and specificity of 70%., Conclusion: There was a significant difference in volume between rejection and control group and between AMR and CMR. So, kidney volume determination is an easy and valuable tool to help the clinician to have a more rapid and better decision making., Competing Interests: None declared.

The half-life of transplanted kidneys is <10 years. Acute or chronic rejections have a negative impact on transplant outcome. Therefore, achieving to allograft tolerance for improving long-term transplant outcome is a desirable goal of transplantation field. In contrast, there are evidence that distinct immunological characteristics lead to tolerance in some transplant recipients. In contrast, the main reason for allograft loss is immunological responses. Various immune cells including T cells, B cells, dendritic cells, macrophages, natural killer, and myeloid-derived suppressor cells damage graft tissue and, thereby, graft loss happens. Therefore, being armed with the comprehensive knowledge about either preimmunological or postimmunological characteristics of renal transplant patients may help us to achieve an operational tolerance. In the present study, we are going to review and discuss immunological characteristics of renal transplant recipients with rejection and compare them with tolerant subjects., (© 2018 Wiley Periodicals, Inc.)

Introduction: Lecithin cholesterol acyltransferase (LCAT) deficiency is an autosomal recessive disorder occurred by different mutations in the LCAT gene that cause two extremely rare syndromes including familial LCAT deficiency (FLD) and fish-eye disease (FED). Unlike FED in FLD renal failure is the most important defect due to deposition of abnormal lipoproteins in the renal stroma. In this study, FLD patients from the North of Iran were investigated for mutations in the LCAT gene., Materials and Methods: Eight patients with corneal opacification and renal defect were analyzed for mutations in the LCAT gene by PCR sequencing., Results: Sequencing analysis revealed a missense pathogenic variation c.301 G>A in exon 2 of LCAT gene in all patients changing the amino acid aspartate to asparagine at the conserved position of amino acid 101 of LCAT protein., Conclusion: In this study, a very rare variation was reported for the first time in this part of the world. Investigation of a larger number of LCAT patients in different parts of Iran can provide availability of mutations panel that is useful for phenotype prediction and also prenatal diagnosis programming in families with a previous history of the disease., (© 2018 Wiley Periodicals, Inc.)

Background: There are some uncertainties among the risk factors of vascular calcification in the hemodialysis patients. This study was planned to examine the association between abdominal aortic calcification and concerned biochemical parameters in hemodialysis patients., Methods: In this cross- sectional study, 84 stable hemodialysis patients admitted on hemodialysis section of Shahid Beheshti Hospital in 2013 were enrolled after obtaining informed consent. Pre-dialysis venous blood samples were taken from patients to determine the amount of intact parathyroid hormone (iPTH), alkaline phosphatase (Alk.P), C - reactive protein (CRP), calcium (Ca) and phosphorus (P). Patients underwent abdominal CT scanning and ACI (ACI) was calculated. Statistical analysis was performed using SPSS Version 20. Chi-square, Kruskal Wallis and One Way ANOVA tests were used. P-values < 0.05 were considered significant., Results: The average age of participants was 50.15±17.03 years (18-83 y/o).A statistically significant correlation was observed between ACI and ALK-P serum levels (p=0.01). It was found that ACI had a significant relationship with phosphorus in women (p=0.01). ALK-P serum levels in men also had a significant relationship with ACI (p=0.02). In addition, there was a significant correlation between ACI and history of cerebro-cardiovascular disease and also duration of dialysis (p=0.004 and 0.0001, respectively)., Conclusions: In patients with longer duration of dialysis, and patients with a history of cardiovascular and cerebrovascular events, ACI levels were significantly higher. ALK-P and phosphorus were correlated with aortic calcification in males and females respectively. No significant correlation was found between iPTH serum levels and aortic calcification., Competing Interests: None declared.

Urinary tract anomalies are common and comprise about 20% to 30% of total congenital anomalies. This spectrum consists of many different anomalies of the urinary tract that may be syndromic or nonsyndromic with different etiologies. In this case report, a patient with single kidney and urinary tract signs is introduced that was diagnosed accidentally. The finding of different anomalies in different organ systems should lead us to examination of the intactness of the urinary tract. In these disorders, if there is no need for immediate intervention, long-term follow-up can be helpful to postpone chronic kidney disease progression.

Background: Cytomegalovirus (CMV) disease is an important cause of death and possibly transplant rejection in kidney transplant (KT) patients. This study was conducted to investigate the incidence and risk factors of CMV disease in kidney transplant patients., Methods: All end-stage renal disease (ESRD) patients who underwent kidney transplantation during 1998-2014 and their donors were assessed. All samples were followed-up for approximately 70 months. CMV was identified by polymerase chain reaction (PCR) and/or PP65 antigen in peripheral blood leukocytes along with clinical manifestations., Results: A total of 1450 cases participated in the current study. CMV was diagnosed in 178 out of 725 (24.6%) kidney recipients. The annual incidence of CMV disease was 4.2%. Patients older than 40 years had a higher incidence of CMV disease. The level of CMV disease incidence in the 41-60 age group was 4 fold compared to those under 20 of age group (P=0.001)., Conclusion: This study demonstrated that the incidence of CMV disease in our region is relatively low and also age more than 40 years and EBV infection are the important risk factors in kidney transplant patients. So care and monitoring of these patients are crucial in the first 5 months., Competing Interests: No authors have conflict of interest related with this article.

Perfluorooctanesulfonic acid (PFOS) and related substances have been listed in Annex B of the Stockholm Convention. The implementation requires inventories of use, stockpiles, and environmental contamination including contaminated sites and measures for (risk) reduction and phase out. In most countries monitoring capacity is not available and therefore other approaches for assessment of contaminated sites are needed. Available informations about PFOS contamination in hot spot areas and its bio-accumulation in the food webs have been merged to build up a worst-case scenario We model PFOS transfer from 1 to 100ngL(-1) range in water to extensive and free-range food producing animals, also via the spread of contaminated sludges on agriculture soils. The modeling indicates that forages represented 78% of the exposure in ruminants, while soil accounted for >80% in outdoor poultry/eggs and pigs. From the carry-over rates derived from literature, in pork liver, egg, and feral fish computed concentration falls at 101, 28 and 2.7ngg(-1), respectively, under the 1ngL(-1) PFOS scenario. Assuming a major consumption of food produced from a contaminated area, advisories on egg and fish, supported by good agriculture/farming practices could abate 75% of the human food intake. Such advisories would allow people to become resilient in a PFOS contaminated area through an empowerment of the food choices, bringing the alimentary exposure toward the current Tolerable Daily Intake (TDI) of 150ngkg(-1)bodyweightd(-1) proposed by the European Food Safety Authority (EFSA)., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Perfluorooctane sulfonate (PFOS) and PFOS-related substances have been listed as persistent organic pollutants in the Stockholm Convention. From August 2012, Parties to the Convention needed to address the use, storage, and disposal of PFOS-including production sites and sites where PFOS wastes have been deposited-in their national implementation plans. The paper describes the pollution in Minnesota (USA) caused by the 3M Company at one of the largest per/polyfluorinated chemical (PFC) production facilities. From early 1950s until the end of 2002, when 3M terminated PFOS and perfluorooctanoic acid (PFOA) production, PFOS, PFOA, and other PFC production wastes were disposed around the plant and in local disposal sites. Discharges from the site and releases from deposits caused widespread contamination of ground and surface waters including local drinking water wells. Fish in the river downstream were contaminated with PFOS to levels that led to fish consumption advisories. Human exposures resulted from ingesting contaminated drinking water, requiring installation of water treatment facilities and alternate water supplies. The critical evaluation of the assessments done revealed a range of gaps in particular of human exposure where relevant exposure pathways including the entire exposure via food have not been taken into consideration. Currently, the exposure assessment of vulnerable groups such as children or Hmong minorities is inadequate and needs to be improved/validated by epidemiological studies. The assessment methodology described for this site may serve-with highlighted improvements-as a model for assessment of other PFOS/PFC production sites in the Stockholm Convention implementation.

Background: Thymoglobuline (TG), is used for both induction and rejection therapy in kidney transplantation (TX). This study was conducted to compare between adding TG or not to the conventional drugs to evaluate the rate of rejections, infections and costs., Methods: In two groups of patients, each of 45 cases; group A received conventional drugs (cyclosporine, mycophenolate and prednisolone) and in group B, TG was added; both groups were then compared. TG was administered for 5 doses (1.5 mg/kg/d for the first 3 days and 1 mg/kg/d for the last 2 days. Suspicious signs of rejection (fever, graft tenderness, graft enlargement and increase in length and depth), creatinine rise, diethylene triamine penta-acetic acid scan (DTPA) results and urinary tract infections (UTI) with counts > 10(5) CFU/ml were recorded. The duration of the first hospitalization, the CMV incidence of infection in the first 6 months and their costs were finally compared., Results: There was no difference for age, duration of hospitalization and CMV infection between the two groups. UTI occurred more frequently in TG group (p=0.049). Creatinine rise, suspicious signs of rejection occurred more frequently in TG group (p<0.05). Creatinine rise and suspicious signs of rejection occurred more frequently in conventional group (p=0.020, p<0.000, respectively). The need for additional steroid pulses was more frequent in conventional group (p<0.000). The total costs of TG, ganciclovir, antibiotics and steroid pulses in both groups were similar., Conclusion: The results show that the posttransplantation problems (signs of rejection, rise of creatinine, graft losses and delayed graft function) occurred rarely in TG group. The incidence of infection and the cost of both regimens were similar. We strongly recommend this protocol as induction therapy.

Malignancy is a common complication after renal transplantation. However, limited data are available on post-transplant malignancy in living kidney transplantation. Therefore, we made a plan to evaluate the incidence and types of malignancies, association with the main risk factors and patient survival in a large population of living kidney transplantation. We conducted a large retrospective multicenter study on 12525 renal recipients, accounting for up to 59% of all kidney transplantation in Iran during 22 years follow up period. All information was collected from observation of individual notes or computerized records for transplant patients. Two hundred and sixty-six biopsy-proven malignancies were collected from 16 Transplant Centers in Iran; 26 different type of malignancy categorized in 5 groups were detected. The mean age of patients was 46.2±12.9 years, mean age at tumor diagnosis was 50.8±13.2 years and average time between transplantation and detection of malignancy was 50.0±48.4 months. Overall tumor incidence in recipients was 2%. Kaposis' sarcoma was the most common type of tumor. The overall mean survival time was 117.1 months (95% CI: 104.9-129.3). In multivariate analysis, the only independent risk factor associated with mortality was type of malignancy. This study revealed the lowest malignancy incidence in living unrelated kidney transplantation.

Background: Diabetic nephropathy is considered to be the most common cause of end stage renal disease (ESRD). Proteinuria is declared as the most marked risk factor in progression towards ESRD. The aim of this study was to evaluate the efficacy of pentoxifylline for reduction of proteinuria in type II diabetic patients., Methods: From May 2007 to June 2008, this randomized clinical trial study was performed on 60 type II diabetic patients with proteinuria over 500 mg/day despite receiving angiotensin receptor or angiotensin converting enzyme inhibitors. These patients were randomly divided into group A (Placebo) and group B (Pentoxifylline 400 mg 3 times daily). A twenty-four hour urine protein and creatinine clearance were assessed before and after three months of treatment., Results: Among the 56 patients, 38 were females and 18 were males. The mean age of patients in the placebo group was 57.6±9.3 and in the treatment group was 55.3±9.3 years. The duration of the disease in the placebo group was 14.03±5.7 and in the treated group was 11.9±6.2 years. The reduction of proteinuria in placebo group was 294±497 mg/dl and in the case group was 979±695 mg/dl (p<0.05). The mean creatinine clearance in placebo group was 79.4±19.9 and in the case group was 80.6± 22.8 mL/min (p>0.05)., Conclusion: The results show that adding pentoxifylline to other approved angiotensin system inhibitors can significantly reduce proteinuria in diabetic nephropathy and influence progression of the disease with no effect on renal function.

The landfilling and dumping of persistent organic pollutants (POPs) and other persistent hazardous compounds, such as polychlorinated biphenyls (PCBs), hexachlorocyclohaxane (HCH), polybrominated diphenylether (PBDEs) or perfluorooctane sulfonic acid (PFOS) can have significant adverse environmental consequences. This paper reviews past experiences with such disposal practices and highlights their unsustainability due to the risks of contamination of ecosystems, the food chain, together with ground and drinking water supplies. The use and associated disposal of POPs have been occurring for over 50 years. Concurrent with the phase-out of some of the most hazardous chemicals, the production of new POPs, such as brominated and fluorinated compounds has increased since the 1990s. These latter compounds are commonly used in a wide range of consumer goods, and as consumer products reach the end of their useful lives, ultimately enter waste recycling and disposal systems, in particular at municipal landfills. Because of their very slow, or lack of degradability, POPs will persist in landfills for many decades and possibly centuries. Over these extended time periods engineered landfill systems and their liners are likely to degrade, thus posing a contemporary and future risk of releasing large contaminant loads to the environment. This review highlights the necessity for alternative disposal methods for POP wastes, including destruction or complete removal from potential environmental release. In addition to such end of pipe solutions a policy change in the use pattern of persistent toxic chemicals is inevitable. In addition, inventories for the location and quantity of POPs in landfills, together with an assessment of their threat to ecosystems, drinking water and food resources are identified as key measures to facilitate appropriate management of risks. Finally the challenges of POP wastes in transition/developing countries, the risk of increased leaching of POPs from landfills due to climate change, and the possible negative impact of natural attenuation processes are considered.

Background: Incidence and risk factors for skin tumors following renal transplantation can vary geographically; therefore, a retrospective study was performed to determine the incidence of and potential risk factors for skin cancer at 14 Transplant Centers in Iran between 1984 and 2008., Material/methods: We enrolled 11,255 kidney transplant recipients who were examined for all skin tumors. All skin cancers were established by histological examination. The data collection included the patient's age and sex, immunosuppressive regimen before and after diagnosis of tumor, rejection episodes, post-transplant latency period, other concurrent neoplastic problems, renal allograft function and outcome., Results: One hundred and twenty-eight (1.14%) renal recipients had skin tumor, representing half of all post-transplant malignancies (128 out of 245 cases). Kaposi's sarcoma was the most common post-transplant cancer compared with other skin tumors. Male recipients had more tumors than did females (P=0.04); the male-to-female ratio in the affected patients was 2.5:1. The age at transplantation of patients with skin tumor was higher compared to RTRs without skin tumor (47±11 vs. 38±15 years, P=0.000), and individuals older than 45 years were at higher risk (odds ratio=3.8, 95%CI 2.6-5.5) of skin cancers. Patients consuming azathioprine were at risk more of skin cancer compared with those were on MMF (odds ratio =2.9, 95%, CI 2.0-4.2). The overall mortality was low (7.8%) in cases with skin cancer., Conclusions: This study showed that male sex, increased age, prolonged immunosuppression and azathioprine increased the risk of skin tumors after renal transplantation.

Introduction: Kaposi's sarcoma (KS) is one of the most common tumors to occur in kidney recipients, especially in the Middle East countries. Limited data with adequate sample size exist about the development of KS in living kidney recipients., Methods: Therefore, we made a plan for a multicenter study, accounting for up to 36% (n = 7,939) of all kidney transplantation in Iran, to determine the incidence of KS after kidney transplantation between 1984 and 2007., Results: Fifty-five (0.69%) recipients who developed KS after kidney transplantation were retrospectively evaluated with a median follow-up of 24 (1-180) months. KS occurred more often in older age when compared to patients without KS (49 +/- 12 vs. 38 +/- 15 years, P = 0.000). KS was frequently found during the first 2 years after transplantation (72.7%). Skin involvement was universal. Furthermore, overall mortality rate was 18%, and it was higher in patients with visceral involvement compared to those with mucocutaneous lesions (P = 0.01). However, KS had no adverse affect on patient and graft survival rates compared to those without KS. Forty-four patients with limited mucocutaneous disease and four with visceral disease responded to withdrawal or reduction of immunosuppression with or without other treatment modalities. Renal function was preserved when immunosuppression was reduced instead of withdrawn in patients with and without visceral involvement (P = 0.001 and 0.008, respectively)., Conclusion: The high incidence of KS in this large population studied, as compared to that reported in other transplant patient groups, suggests that genetic predisposition may play a pathogenetic role.

Introduction: Limited data with adequate sample size exist on the development of posttransplant lymphoproliferative disorder (PTLD) in living donor kidney recipients. We conducted a retrospective cohort study on the data of 10 transplant centers to identify the incidence of PTLD in Iran., Materials and Methods: Data of 9917 kidney transplant recipients who received their kidneys between 1984 and 2008 were reviewed. Fifty-one recipients (0.5%) who developed PTLD were evaluated with a median follow-up of 47.5 months (range, 1 to 211) months., Results: Patients with PTLD represented 24% of all posttransplant malignancies (51 out of 211 cases). There was no relationship between PTLD and sex (P = .20). There were no statistically significance differences considering the age at transplantation between patients with and without PTLD. The late-onset PTLD (70.6%) occurred more frequently compared to the early form. There was no signification relationship between early-onset and late-onset groups in terms of clinical course and outcome. In patients who received azathioprine, PTLD was more frequent when compared to those who received mycophenolate mofetil (P < .001). The lymph nodes were the predominantly involved site (35.3%), followed by the gastrointestinal tract, brain, kidney allograft, lung, ovary, vertebrae, and palatine. Age at diagnosis and the time from transplantation to diagnosis were comparable for various involvement sites of PTLDs. The overall mortality in this series of patients was 51.0%., Conclusions: Posttransplant lymphoproliferative disorder is a rare but devastating complication and long-term prognosis can be improved with early recognition and appropriate therapy.