Structural and chemical properties of NiOx thin films: the role of oxygen vacancies in NiOOH formation in a H2O atmosphere

NiOx films grown from 50 nm thick Ni on Si(111) were put in contact with oxygen and subsequently water vapor at elevated temperatures. Near ambient pressure (NAP)-XPS and -XAS reveal the formation of oxygen vacancies at elevated temperatures, followed by H2O dissociation and saturation of the oxygen vacancies with chemisorbing OH. Through repeated heating and cooling, OH-saturated oxygen vacancies act as precursors for the formation of thermally stable NiOOH on the sample surface. This is accompanied by a significant restructuring of the surface which increases the probability of NiOOH formation. Exposure of a thin NiOx film to H2O can lead to a partial reduction of NiOx to metallic Ni accompanied by a distinct shift of the NiOx spectra with respect to the Fermi edge. DFT calculations show that the formation of oxygen vacancies and subsequently Ni0 leads to a state within the band gap of NiO which pins the Fermi edge.

Structural and Chemical Properties of NiOx Thin Films: Oxygen Vacancy Formation in O2 Atmosphere

NiOx films on Si(111) were put in contact with oxygen at elevated temperatures. During heating and cooling in oxygen atmosphere Near Ambient Pressure (NAP)-XPS and -XAS and work function (WF) measurements reveal the creation and replenishing of oxygen vacancies in dependence of temperature. Oxygen vacancies manifest themselves as a distinct O1s feature at 528.9 eV on the low binding energy side of the main NiO peak as well as by a distinct deviation of the Ni2p3/2 spectral features from the typical NiO spectra. DFT calculations reveal that the presence of oxygen vacancies leads to a charge redistribution and altered bond lengths of the atoms surrounding the vacancies causing the observed spectral changes. Furthermore, we observed that a broadening of the lowest energy peak in the O K-edge spectra can be attributed to oxygen vacancies. In the presence of oxygen vacancies, the WF is lowered by 0.1 eV.

The effect of lithium intercalation on the electronic structure of the ternary compound semiconductors ZrSe(2-x)S(x)

The electronic properties of the lithium intercalated layered transition metal dichalcogenide semiconductors ZrS(x)Se(2-x) for x = 0-2 have been calculated by density functional theory (DFT) using the WIEN2k code. The calculations have been carried out by the PBE functional and the TB-MBJ potential as proposed by Tran and Blaha. The calculations have been performed with and without spin-orbit coupling and reveal that the intercalation of lithium causes the conduction bands of LiZrS(x)Se(2-x) to shift by about 2 eV towards lower binding energy. From this, a Fermi level crossing and metallic behavior in the three intercalated compounds result. Moreover, a number of trends can be observed. Due to the contributions of the dichalcogenide p-states in the valence band the inclusion of SO coupling in the calculations lifts the degeneracy at the points Γ and A of the Brillouin zone in the same way as in the parent compounds. With regard to crystal field effects for each compound the splitting is larger at the A point than at the Γ point and the absolute value of the splitting increases with the atomic number of the chalcogenide. In particular, the simple Fermi surface consisting solely of barrels centered along the LML line makes LiZrS(x)Se(2-x) a promising Fermi liquid reference compound.

Sildenafil citrate can improve erectile dysfunction among chronic hemodialysis patients

Erectile dysfunction (ED) is common among patients with end-stage renal disease (ESRD), who undergo hemodialysis (HD). The aim of this study was to evaluate the safety and effectiveness of sildenafil in male HD patients with ED. Twenty-seven HD patients were recruited for this prospective, randomized, double-blind, placebo-controlled, clinical trial study of sildenafil during a period of 1 week. Efficacy was assessed by using the International Index of Erectile Function (IIEF) before and 1 week after treatment. Baseline demographic and clinical features were similar in both the groups. There was a weak correlation between ED and duration of undergoing dialysis (P = 0.073). There was significant relationship between sildenafil usage and improvement in erectile function (P < 0.0001). Placebo improved significantly the erectile function (P = 0.016), perhaps by psychological way. However, sildenafil had a more significant effect than placebo in increasing IIEF score among HD patients (P = 0.00 compared to 0.016). Sildenafil is effective and safe for treating ED among HD patients.

Cadaveric renal transplantation: a single-center experience

INTRODUCTION

Renal transplantation remains the treatment of choice for end-stage renal disease (ESRD) in regard to patient survival. Iran was one of the first countries in the Middle East that began renal transplantation.

METHODS

In a follow-up study, we enrolled all of our cadaveric renal transplant recipients from 2001 to 2007, namely, 39 cases. Related variables collected through checklists were entered into SPSS software version 16 and analyzed using the Kaplan-Meier method and by descriptive statistics.

RESULTS

The mean age of the recipients was 35.18 +/- 14.27 years. Twenty-one patients (53.8%) were men. The underlying disease for development of ESRD was diabetes (7 cases, 21.2%), hypertension (24.2%), glomerulopathies (36.4%), polycystic disease (PKD; 2.6%), and 5 (15.2%) were unknown. Four recipients (10.3%) were hospitalized again because of acute tubular necrosis after transplantation. An acute rejection episode was diagnosed in 7 (17.9%) graft recipients. Surgical complications after transplantation were as follows: urinoma, lymphocele, and surgical site leakage (each 1 case). One-year patient survival rate was 89.7% in this study; 4 recipients died within 1-9 months after transplantation. Death-censored 1-year graft survival rate was 100%.

DISCUSSION

The survival rate of cadaveric transplant was in an acceptable range.

Relationship between serum homocysteine and other parameters in renal transplant patients

INTRODUCTION

Hyperhomocysteinemia frequently occurs after renal transplantation. We therefore assessed whether serum homocysteine (Hcy) concentrations were correlated with clinical, paraclinical, and arterial Doppler parameters among renal transplant patients.

METHODS

A cross-sectional study was performed on 47 patients (30 males, 17 females) who received unrelated living donor renal transplants.

RESULTS

The mean serum Hcy concentration was 21.7 +/- 8.4 micromol/L (range = 5.8-48 micromol/L); 37 patients (79%) showed hyperhomocysteinemia (Hcy >or= 15 micromol/L). Serum Hcy was strongly related to body mass index (BMI; r = .43, P = .002), cyclosporine trough level (r = .44, P = .005), and serum creatinine concentration (r = .32, P = .028), but not to age, transplant duration, or sex. Multivariate analysis showed that only BMI (P = .003) and cyclosporine trough level (P = .0037) were independent predictors of serum Hcy concentrations. Hyperhomocysteinemia was more prevalent among patients taking mycophenolate mofetil (MMF) than azathioprine (86% vs 50%; P = 0.017). The hyperhomocysteinemia and normohomocysteinemia groups did not differ significantly in mean carotid intima-media thickness (IMT; 0.78 +/- 0.348 vs 0.77 +/- 0.419 mm, P = .97) or mean intrarenal resistive index (RI) (0.7 +/- 0.06 vs 0.7 +/- 0.06, P = .85). The two groups also did not differ in sex prevalence, diabetes, C-reactive protein >or= 5 mg/L, or mean low-density lipoprotein, high-density lipoprotein, and mean arterial pressure (MAP) values.

CONCLUSION

Serum Hcy correlated with higher cyclosporine trough levels and obesity. Hyperhomocysteinemia was more common among patients taking MMF than azathioprine, but had no effect on intrarenal RI or carotid IMT.

Effect of angiotensin II type-1 receptor blockers on stable allograft kidneys: prospective randomized study

OBJECTIVE

Is assess the effects of angiotensin II type-I receptor blockers on outcomes in renal transplant recipients without proteinuria or posttransplantation erythrocytosis.

PATIENTS AND METHODS

Fifty renal transplant recipients (30 men and 20 women, with a mean [SD] age of 40 [13] years) were randomized into 2 groups of 25 patients each; 1 group was treated with losartan for 1 year, and the other was not (control group). Blood pressure and other biochemical parameters were measured at baseline and at 6 and 12 months posttransplantation.

RESULTS

After 1 year, the losartan group had significantly lower systolic blood pressure (113 [22] mm Hg vs 126 [18] mm Hg; P = .04) and hemoglobin concentration (12.8 [1.9] g/dL vs 14.5 [2.1] g/dL; P = .006) and significantly higher serum high-density lipoprotein cholesterol concentration (58 [22] mg/dL vs 47 [10] mg/dL; P = .03) compared with the control group; however the incidence of anemia did not differ (37% vs 20%; P = .20). In the losartan group, there were significant changes in hemoglobin concentration between baseline and 6 months (14.5 [1.6] g/dL vs 12.9 [1.49] g/dL; P < .001), but not between 6 and 12 months (12.9 [1.49] g/dL vs 12.8 [1.96] g/dL; P = .43). After 1 year, there were no significant between-group differences in diastolic hypertension, serum creatinine concentration, creatinine clearance, and serum potassium, low-density lipoprotein cholesterol, triglyceride, and uric acid concentrations.

CONCLUSION

Losartan significantly increased high-density lipoprotein concentration and significantly decreased systolic hypertension. Although losartan decreased the hemoglobin concentration during the first 6 months, its effect did not progress with longer use. To determine the effect of losartan on renal function, additional studies with longer follow-up are needed.

Effect of topical aprotinin on early postoperative bleeding and ICU stay after coronary artery bypass graft surgeries

We evaluate the effect of topical application of aprotinin to the heart, pericardia and mediastinum before sternal closure, on early post operative bleeding, blood transfusion requirement and ICU staying time after coronary artery bypass graft surgeries. In a randomized double blinded clinical trial, 128 patients who were scheduled for elective coronary artery bypass graft were allocated into two groups. In group A (aprotinin), patients received 500,000KIU (50 mL) aprotinin and in group S (saline group) the same volume of normal saline was applied. The amount of blood loss collected in chest bottle, the number of pack cells requirement during first 24 h after operation and duration of ICU staying time were recorded. The amount of blood loss in group A (aprotinin) was 451 +/- 218 mL compared with 707 +/- 269 mL in group S (saline) (p = 0.003). The number of pack cells consumption was 0.5 +/- 0.7 units in group A (aprotinin) compared with 1.7 +/- 1 units in saline group (p = 0.002). Intensive Care Unit (ICU) staying time was 48.8 +/- 13.6 h in group A (aprotinin) and 69.4 +/- 16.6 h in saline group (p = 0.001). This study showed that topical application of aprotinin at the end of coronary artery surgeries, significantly reduce postoperative bleeding and blood transfusion requirement during first 24 h after operation and also ICU staying time.

Offspring-to-mother and husband-to-wife renal transplantation: a single-center experience

BACKGROUND

It has been demonstrated that graft survival rates of offspring-to-mother and husband-to-wife renal transplants are equivalent to those of other living donors. Although the vast majority of these transplants proceed without incident, hyperacute rejection can result from an anamnestic reaction subsequent to the in utero exposure of the mother to human leukocyte antigen (HLA) of the fetus with sensitization developing during the pregnancy.

PATIENTS AND METHODS

Among 1350 renal transplants performed at our center, 12 corresponded to offspring-to-mother (G1) and 9 were husband-to-wife transplantations (G2). All recipients were multiparous (2 to 5 children). We compared these patients with other multiparous women (n = 150) who received grafts from living unrelated donors (G3).

RESULTS

Two subjects in G1 (16.6%), two in G2 (22.2%), and none in G3 developed hyperacute rejection, which led to graft loss. One, 3-, and 5-year patient and graft survival rates were different between the remaining patients.

CONCLUSIONS

Our limited experience suggested that, for some women, pregnancy is in fact a sensitizing event. A pretransplantation cross-match testing negative result was by no means an absolute guarantee that an adverse anamnestic immunological event would not occur.

Impact of donor/recipient body weight mismatch on allograft outcome in renal transplant recipients

BACKGROUND

There have been conflicting reports that kidneys from small donors may be at risk for graft loss if they are transplanted into large recipients. The aim of this work was to examine the impact of donor/recipient body weight ratio (D/RBWR) on allograft outcome.

PATIENTS AND METHODS

Two hundred and seventeen kidney transplant recipients from living unrelated donor with 5-year follow-up underwent immunosuppression with cyclosporine, mycophenolate mofetil (or azathioprine), and prednisolone. According to the D/RBWR, the patients were divided into 3 groups: low (less than 0.8; G1), medium (0.81-1.1; G2), and high (more than 1.1; G3). We recorded 1-, 3-, and 5-year graft survivals, episodes of acute rejection, and mean serum creatinine values.

RESULTS

Among the patients, 126 (58%) were female and the overall mean age was 41.62 years. There were no significant differences in 1-, 3-, and 5-year allograft survivals between the groups.

CONCLUSION

We concluded that low D/RBWR had no effect on short- or long-term renal allograft survival.

BK polyoma virus nephropathy among Iranian renal transplant recipients

BACKGROUND

BK virus nephropathy (BKVN) is recognized as a cause of graft loss in renal transplant patients. The disorder may be related to the introduction of new, potent immunosuppressive regimens. We sought to assess the prevalence, outcome, and clinical characteristics of BKVN.

MATERIALS AND METHODS

We retrospectively analyzed 160 specimens from episode biopsies. BKVN was diagnosed by light microscopic examination and positive immunohistochemical staining.

RESULTS

Among 160 patients, 21 (13.1%) were diagnosed as BKVN. The mean interval between biopsy and transplantation was 13.6 +/- 10.67 months. There were no significant differences between BKVN patients and non-BKVN patients with respect to age, sex, interval between diagnosis and transplantation, cyclosporine blood level, and azathioprine versus mycophenolate mofetil immunosuppression. Graft loss occurred in 57.1% of BKVN versus 12.2% of non-BKVN subjects (P = .005). There was a significant difference between antilymphocyte globulin (ALG)- and non-ALG-treated groups with respect to the incidence of BKVN (6.6% in non-ALG versus 19% in ALG groups; P < .01). BKVN was diagnosed by immunohistochemistry in 61% of specimens with acute rejection according to light microscopic evaluation.

CONCLUSIONS

This is the first report of BKVN in Iranian renal allograft recipients. In our hospital, the prevalence of BKVN was higher than that previously reported for non-Iranian recipients. BKVN had a negative impact on graft survival.

Pregnancy after renal transplantation: ten-year single-center experience

There has been an increase in the number of pregnancies among renal transplant recipients. Our experience included 61 pregnancies in 53 patients from January 1997 to April 2007, with 6 patients having multiple pregnancies. Patients were studied for clinical, obstetrical, and perinatal outcomes. The mean patient age was 24.5 years (range, 19-38). They all received living donor kidneys. The mean transplantation-pregnancy interval was 2.7 years (range, 1.7-5.3 years). Immunosuppressive drugs consisted of cyclosporine (CsA), mycophenolate mofetil (MMF), and prednisolone (pred) in 38 patients (72%); CsA, azathioprine (AZA), plus pred were used in 15 patients (28%). Pregnancy complications were chronic hypertension in 21 patients (40%), anemia in 28 (52.6%), and urinary tract infection in 18 (34%). Twelve patients (22.6%) received blood transfusions. Pre-eclampsia was diagnosed in 14 cases (26.4%) and renal dysfunction in 11 (20.7%) with pre-eclampsia assumed to be the main cause. Three patients (5.6%) had graft losses as a result of hemorrhagic shock, sepsis, and eclampsia. Premature rupture of membranes occurred in 6 cases (11.3%), and preterm delivery occurred in 14 cases (26.4%). Eleven (20.7%) newborns were small for gestational age. One club foot and one large facial hemangioma occurred in 2 infants, respectively. One case of neonatal death was registered as a result of excessive prematurity. One mother died due to sepsis. Cesarean section was performed in 24 patients (45.2%), the main indications being related to hypertension and fetal distress. There were no significant differences between MMF-treated and AZA-treated patients with respect to clinical, obstetrical, and perinatal outcomes. This group of patients was characterized by a wide range of antenatal and perinatal problems that must be managed in specialized tertiary units to achieve the best results. MMF may be as safe as AZA in pregnancy.

Impact of hepatitis B and hepatitis C virus infections on patients and allograft outcomes in renal transplant recipients: a single center study

BACKGROUND

Hepatitis C virus (HCV) and hepatitis B virus (HBV) infections occur frequently among end-stage renal disease (ESRD) patients. We analyzed our data to address concern that these patients are at increased risk for mortality or allograft dysfunction after renal transplantation compared with noninfected patients.

PATIENTS AND METHODS

We retrospectively compared outcomes and survivals among 1350 patients who received renal allografts from 1990 to 2006.

RESULTS

Fourteen patients were positive for both hepatitis B surface antigen (HBsAg) and HCV antibody (anti-HCV; group 1); 23 were HBsAg-positive and anti-HCV-negative (group 2); 29 were HBsAg-negative and anti-HCV-positive (group 3); and 1284 were negative for both markers (group 4). With respect to mean serum creatinine, there were significant differences between groups 1 and 4 (P < .01), and groups 2 and 4 (P < .01), but no significant difference between groups 3 and 4. With respect to graft survival, there were significant differences between groups 1 and 4 (P < .01), and between groups 2 and 4 (P < .01). There was no significant difference for survival among groups.

CONCLUSIONS

HBV or HCV infections are not a contraindication to kidney transplantation in Iranian patients; they had no effect on patient survival. However, allograft outcomes were worse among HBV- or HCV-infected patients.

Effect of prophylaxis with low-dose anti-thymocyte globulin on prevention of acute kidney allograft rejection

INTRODUCTION

During kidney transplantation, the first contact between the recipient's immune system and the donor organ takes place immediately following the arterial anastomosis. The aim of this study was to evaluate the efficacy of a single, low-dose anti-thymocyte globulin (ATG) prophylaxis in the reduction of early acute rejection in renal allograft recipients.

METHODS

In a randomized, controlled clinical trial, we studied the rate of acute rejection within the first month of kidney transplantation in patients who had received their transplant at a single center between the years 2004 and 2007. The patients were divided into 2 groups: group 1 (n = 37) received cyclosporine, mycophenolate mofetil or azathioprine, and prednisolone; group 2 (n = 31) received the above-mentioned agents plus a single ATG bolus (Thymoglobulin; SangStat, Lyon, France; 4-5 mg/kg) the night before the transplantation ( approximately 12 hours before the operation). Blood urea and serum creatinine levels were measured regularly in the posttransplantation period. Acute allograft rejection was justified clinically and/or pathologically. Statistical analysis was performed by SPSS 13.0 using Student t test and Fisher exact test. A P value < or = .05 was considered to indicate statistical significance.

RESULTS

There were no significant differences regarding the age and gender ratio between the 2 groups. Acute allograft rejection was found in 32.4% (n = 12) of group 1 patients, and was reduced to 12.9% (n = 4) in group 2 (P = .05). Hence, the first-month acute rejection episodes decreased by approximately 60% with ATG prophylaxis in renal transplant recipients.

CONCLUSION

Prophylactic administration of a single and low-dose ATG the night before kidney transplantation could reduce the risk of acute allograft rejection in renal transplant recipients. However, further studies with a greater number of patients should be conducted to confirm these results.

Low-dose versus high-dose cyclosporine induction protocols in renal transplantation

BACKGROUND

Current immunosuppressive therapies are effective to prevent acute rejection episodes (ARE) and graft loss following renal transplantation. Newer agents now make it possible to develop equally efficacious but better tolerated, less toxic strategies. We compared the efficacy of early low- versus high-dose cyclosporine (CsA) induction therapy in living donor renal transplantation.

METHODS

In this single-center study, 90 consecutive recipients of living donor kidney transplants between November 2002 to October 2003 including 51 females and mean average age of 48.23 years were treated with either CsA (5 mg/kg/d) plus mycophenolae mofetil (MMF; 30 mg/kg/d) and prednisolone (1 mg/kg/d; group 1; n=42); or CsA (8 mg/kg/d) plus MMF (30 mg/kg/d) and prednisolone (1 mg/kg/d; group 2; n=48). The 2 groups were matched with respect to age, sex, underlying renal diseases, pretransplantation dialysis period, number of transplantations, and panel-reactive antibody tests. CsA dose tapering was initiated in the 2 group 3 months after transplantation. At the end of the first year, the CsA dose was 3.5 +/- 0.65 mg/kg in group 1 and 3.4 +/- 0.34 mg/kg in group 2. Prednisolone was tapered within the first 2 months, reaching 10 mg/d in all patients. The MMF dose remained unchanged. The 2 groups were compared with respect to ARE, patient and graft survivals, and clinical outcomes within 2 years after transplantation.

RESULTS

There were no significant differences between the 2 groups with respect to clinical outcomes, including 2-year patient survival (97.62% vs 97.92%; P=.76), 2-year graft survival (80.32% vs 80.41%; P=.82), ARE (47.61% vs 52.08%; P=.09), or length of immediate postsurgical hospital stay, number of readmissions, total hospitalization days, posttransplantation diabetes mellitus, and infectious, cardiovascular, gastrointestinal, and hematologic complications. There was more hypertension (67.5% vs 50.23%; P=.007), hypertriglyceridemia (45.5% vs 32.64%; P=.005), and elevated liver enzymes in group 2 (12.5% vs 7.14%; P=.018).

CONCLUSIONS

Compared with 8 mg/kg CsA induction therapy, the lower doses of CsA were effective, well tolerated, and safe with relatively fewer side effects.

Transplantation of a Kidney With a Renal Cell Carcinoma After Living Donation: A Case Report

Transmission of cancer is a serious risk in organ transplantation. We present a case of renal cell carcinoma (RCC) in a kidney obtained from a living donor. A 48-year-old mother was evaluated for donation to her 12-year-old daughter. Donor renal ultrasound, intravenous pyelography, and angiography were normal. A 5 x 5 mm nodule found on the surface of the kidney during harvesting was totally excised before transplantation. The histology revealed RCC with free margins at 2 weeks after transplantation. The immunosuppressive drugs consisted of cyclosporine, mycophenolate mofetil, and prednisolone. The graft function remained stable. Donor and recipient are without evidence of tumor recurrence at 15 months after transplantation. This experience indicated that donor kidneys with small, incidental RCC may be managed with excision and transplantation, without tumor recurrence in recipients who are informed of the potential risks of recurrence and metastases.

Serum T-Lymphocyte Cytokines Cannot Predict Early Acute Rejection in Renal Transplantation

Despite numerous studies, the precise role of Th1/Th2 cytokines in acute renal allograft rejection remains unclear. To provide insight into the role of cytokines in acute allograft rejection, we measured serum T-cell cytokine concentrations for correlation with clinical events after renal transplantation in adults. Serum Th1 (interleukin-2 [IL-2] and interferon-gamma [IFN gamma] and Th2 (IL-4, IL-10) cytokine concentrations were measured in 60 consecutive living donor kidney transplant recipients namely, 40 males, overall mean age 38.82 years), on the day before as well as 7 and 14 days posttransplantation using ELISA. Patients were stratified based upon acute rejection episode (ARE) in the first month after transplantation. Immunosuppression consisted of cyclosporine, mycophenolate mofetil, and prednisolone. ARE was diagnosed based on an increased plasma creatinine of more than 50%, sonographic analysis, radioisotope scan, pathologic findings, or measured cyclosporine blood levels. Twelve ARE were diagnosed among patients (20%). There was no significant difference between the 2 groups with respect to the mean serum concentration values of IL-2, IL-10, IL-4, and IFN gamma on the day before or 7 or 14 days after transplantation. This study showed that there was no correlation between the Th1/Th2 serum cytokine profiles and early ARE in living donor kidney transplantation.

Seroprevalence of Human Herpes Virus-8 in Renal Transplant Recipients: A Single Center Study From Iran

The long-term risk of malignancy among renal transplant patients is approximately 100 times that of the general population. Unlike North America and many European countries, Kaposi's sarcoma is the most common cancer after renal transplantation in most series reported from the Middle East. Human herpes virus-8 (HHV-8) has a major role in the pathogenesis of Kaposi's sarcoma. The risk of posttransplantation Kaposi's sarcoma is 23% to 28% among seropositive patients compared with 0.7% among seronegative patients. This study was conducted to investigate the seroprevalence of HHV-8 among our transplant recipients. The sera from 100 renal transplant recipients were examined by indirect immunofluorescence against latent nuclear antigen. Sixty of 100 patients were males. The overall mean age was 41.1 years (range, 17-74 years) with 17 patients older than 55 years. The mean transplantation duration was 41.6 months. Twenty-five percent of patients were seropositive for HHV-8. There was statistically significant seropositivity for HHV-8 among recipients older than 55 years (P=.02). Eight of 17 patients older than 55 years were seropositive (47%), whereas 17/83 patients younger than 55 years were seropositive (20%). There were no significant differences for HHV-8 seropositivity regarding sex, transplantation duration, and immunosuppressive regimen, including dose of immunosuppressive drugs and cyclosporine blood levels. In this study, we showed seropositivity for HHV-8 among a significant percentage of our renal transplant recipients, a finding which may render them at risk to develop Kaposi's sarcoma. Seropositive and seronegative patients were followed for 16 months. One HHV-8 seropositive patient (1/25) developed Kaposi's sarcoma.

Tuberculosis in Iranian Kidney Transplant Recipients: A Single-Center Experience

INTRODUCTION

Renal transplantation recipients are at a high risk of developing tuberculosis (TB) following transplantation, especially in developing countries, with high incidences of morbidity and mortality. In this report, we examined the risk factors and impact of TB on the outcome of kidney transplantation.

PATIENTS AND METHODS

Among 1350 living donor Iranian kidney transplantations, 52 (3.9%) had TB diagnosed in various organs. Of these, 7 (13.5%) had TB pretransplantation and 40 (76.9%) were men. The overall mean age was 32.6 +/- 10.5 years.

RESULTS

The interval between transplantation and diagnosis was 54.6 +/- 48.23 (range 4 to 140) months. In 34 (65.6%) patients TB was diagnosed after the first year posttransplantation. Pleuro/pulmonary TB was the most common form (68%). All posttransplant TB patients received a quadriple antituberculosis therapy; pyrazinamide, rifampicin, ethambutol, and isoniazide). Hepatotoxicity was seen in 16 (30%) patients, including 12 mild cases with normalization after temporary withdrawal of isoniazide and rifampicin, and four were severe, but mortality was not attributable to hepatocellular failure. Twelve patients (23%) died. Chronic allograft dysfunction occurred in 34 (65%) patients, 19 (37%) with graft loss. Pre-TB patients showed comparable posttransplant courses.

CONCLUSION

TB is a common infection among renal transplant recipients in developing countries. The peak incidence is after the first year of transplantation and mortality is considerable. Hepatoxicity is a considerable risk of treatment, possibly as a result of additive toxic effects of immunosuppressive drugs. Chronic allograft nephropathy is a serious complication that has a negative impact on the graft survival.

Antineutrophil Cytoplasmic Antibody–Associated Glomerulonephritis in Chronic Graft-Versus-Host Disease After Allogenic Hematopoietic Stem Cell Transplantation

Graft-versus-host disease (GVHD) is one of the most frequent complications that occur after hematopoietic stem cell transplantation (HSCT). Recently, renal involvement, including membranous nephropathy, focal segmental glomerulosclerosis, and minimal change disease, has been described as a manifestation of chronic GVHD. This case report describes a patient who developed antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis after HSCT. Following preparation with chemotherapy, a 29-year-old man with chronic myeloid leukemia underwent allogenic peripheral blood stem cell (PBSC) transplantation, after which first acute and then chronic GVHD developed. Treatment with prednisone resulted in improvement in the patient's GVHD. After the termination of steroid therapy and about 10 months after PBSC transplantation, nephritic syndrome appeared and the patient's serum creatinine value increased to 1.7 mg/dL. Laboratory evaluation revealed perinuclear antineutrophilic cytoplasmic antibody (p-ANCA) in the serum. Histological examination of renal biopsy tissue showed focal segmental proliferative glomerulonephritis with glomerulosclerosis in 20% of available glomeruli, large cellular crescents in 6% of glomeruli, and no staining of immunoglobulins or complement along the capillary walls. Electron microscopy revealed no immune deposits. After treatment with prednisone 60 mg/d, diltiazem 120 mg/d, and enalapril 10 mg/d, the proteinuria gradually decreased, and p-ANCA was undetectable. These findings suggest that in this patient the ANCA-associated glomerulonephritis was associated with renal involvement that occurred during the course of chronic GVHD.