Hyperuricemia after renal transplantation

Background

Hyperuricemia is a common complication after kidney transplantation, and may adversely affect graft survival.

Objective

To assess the prevalence of and predictors for development of hyperuricemia after renal transplantation.

Materials and Methods

Hyperuricemia was defined as a serum uric acid concentration of at least 7.0 mg/dL in men and 6.0 mg/dL in women. From March 2008 to May 2010, uric acid concentration was measured in 12,767 blood samples from 2961 adult renal transplant recipients (64% male and 36% female patients).

Results

Hyperuricemia was observed in 1553 patients (52.4%). The disorder frequently occurred in women (P = .003) and in patients with impaired renal graft function (P = .00). After adjustment for sex, serum creatinine concentration, diabetes mellitus, cyclosporine concentration, and dyslipidemia, only female sex (P = .03) and renal allograft dysfunction (P = .05) were associated with hyperuricemia after kidney transplantation.

Conclusion

Hyperuricemia is a common complication after kidney transplantation, and renal allograft insufficiency predisposes to higher uric acid concentration.     

The role of obesity in kidney transplantation outcome

Background

The number of obese kidney transplant candidates has been growing. However, there are conflicting results regarding to the effect of obesity on kidney transplantation outcome. The aim of this study was to investigate the association between the body mass index (BMI) and graft survival by using continuous versus categoric BMI values as an independent risk factor in renal transplantation.

Methods

We retrospectively reviewed 376 kidney transplant recipients to evaluate graft and patient survivals between normal-weight, overweight, and obese patients at the time of transplantation, considering BMI as a categoric variable.

Results

Obese patients were more likely to be male and older than normal-weight recipients (P = .021; P = .002; respectively). Graft loss was significantly higher among obese compared with nonobese recipients. Obese patients displayed significantly lower survival compared with nonobese subjects at 1 year (76.9% vs 35.3%; P = .024) and 3 years (46.2% vs 11.8%; P = .035).

Conclusions

Obesity may represent an independent risk factor for graft loss and patient death. Careful patient selection with pretransplantation weight reduction is mandatory to reduce the rate of early posttransplantation complications and to improve long-term outcomes.     

Risk factors for immediate anemia in renal transplant recipients: a single-center experience

Background

Although endogenous erythropoietin secretion returns via the renal allograft a few hours following successful engraftment, anemia is a common early or late complication. In addition, anemia is a risk factor for ischemic heart disease and graft loss. We sought to determine risk factors for and the prevalence of severe anemia immediately posttransplantation (PTA).

Methods

This cross-sectional retrospective study performed between 2006 and 2009 enrolled 864 adult subjects of mean age 40.7 ± 13.8 (range = 6-75) years. On the basis of The World Health Organization criteria, a hemoglobin (Hb) level less than 11 g/dL for men and less than 10 g/dL for women was defined as severe anemia.

Results

Severe anemia occurred frequently (62.7%) among these patients whose most common underlying disease was hypertension 311 (58.2%). Their mean Hb level was 9.9 ± 1.8 g/dL at the time of hospital discharge, namely, almost 2 weeks after transplantation. More than 90% (n = 778) of subjects received a kidney from a living donor. Immediate severe anemia associated with delayed graft function (DGF; P = .01), antithymocyte globulin (ATG)/antilymphocyte globulin (ALG) administration (P = .000), acute rejection (P = .000), recipient gender (P = .000), cold ischemic time (P = .01), pretransplant Hb (P = .000), posttransplant creatinine (P = .001), and acute rejection episodes (P = .000). Upon logistic regression analysis donor age (P = .04, confidence interval [CI] = 0.7-0.9), recipient female gender (P = .009, CI = 0.08-0.7), and ATG/ALG use (P = .009, CI = 1.7-43.4) showed significant effects to cause severe PTA.

Conclusion

Immediate anemia after renal transplantation is a consequence of poor renal function. In addition, ATG/ALG use and DGF can induce severe PTA, which may play roles in ischemic heart disease and graft loss.     

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.     

Risk of cardiovascular disease associated with refractory hypertension in renal transplant recipients

Background

Hypertension is common after renal transplantation, affecting as many as 80% of recipients. It is generally accepted that hypertension is associated with poor graft survival and reduced life expectancy because of increased cardiovascular risk factors. The prevalence of refractory hypertension in renal transplant recipients is unknown, and could be associated with a poor prognosis.

Objective

To investigate the effects of refractory hypertension on cardiovascular disease (CVD) after renal transplantation in 486 patients with grafts functioning for longer than 1 year.

Patients and Methods

Patients were classified into 2 groups: (1) 57 with refractory hypertension, that is, systolic blood pressure 130 mm Hg or greater or diastolic blood pressure 80 mm Hg or greater, and receiving treatment with at least 3 drugs, one of which was a diuretic; and (2) the remaining 429 patients. Patient and graft survival, and posttransplantation CVD were analyzed.

Results

Refractory hypertension was associated with male sex (82.5% vs 66.5% [P < .01]), poor renal function (mean [SD] serum creatinine concentration 2.2 [1.2] mg/dL vs 1.6 [0.6] mg/dL; Modification of Diet in Renal Disease score 39.2 [20.0] mL/min/1.73 m² vs 49.2 [18.0] mL/min/1.73 m² [P = .000]; and steroid therapy (94.7% vs 79.0% [P = .001]). In the group with refractory hypertension, 5-year patient and graft survival rates were lower, and the incidence of posttransplantation CVD was greater (relative risk, 1.7; 95% confidence interval, 1.05-2.18; P = .03).

Conclusion

Refractory hypertension is an independent risk factor for increased cardiovascular morbidity and mortality in renal transplant recipients.     

Association Between Serum Soluble CD30 and Serum Creatinine Before and After Renal Transplantation

Objective

There is increasing evidence that circulating levels of soluble CD30 (sCD30) may represent a biomarker for outcome in kidney transplantation. The aim of this study was to measure the pre- and posttransplantation serum levels of sCD30 in cadaveric kidney transplant recipients and correlate them with serum creatinine.

Patients and Methods

Serum sCD30 was measured by a commercial enzyme-linked immunosorbent assay (ELISA) from prospective samples of 38 kidney allograft recipients serially transplanted at our center. Samples were collected at day 0 pretransplantation and at months 6, 12, 18, and 24 posttransplantation. We also studied sera from 29 patients with chronic kidney disease (CKD) at different stages of the K/DOQI guidelines, as a control group.

Results

Serum levels of sCD30 decreased significantly in samples posttransplantation compared with pretransplantation. The significant decrease after transplantation may be related to the improvement in renal function since we observed a significant correlation between serum levels of sCD30 and creatinine (sCr) at all times of the study. In addition, the patients with chronic renal failure showed a significant association between serum sCD30 and sCr (r = .454; P = .013).

Conclusions

Our results did not suggest that the measurement of sCD30 may be used as a valuable biomarker in renal transplantation. Increased levels may be related to a decrease in its renal elimination.     

Prevalence and predictive factors of anemia after renal transplantation: a Moroccan report

Objective

Anemia, a common multifactorial problem in kidney transplant recipients, represents an important cardiovascular risk factor. The purpose of this study was to assess anemia prevalence after kidney transplantation, the main factors involved in its occurence, its cardiovascular consequences, and its impact on patient survival and graft function.

Methods

This retrospective study evaluated 69 patients undergoing renal transplantation between January 1998 and September 2008 with ≥1 year of follow-up. For all of the patients, we recorded hemoglobin concentrations before and at 1, 3, 6, 12, 36, and 60 months after transplantation. Anemia was defined as recommended by the American Society of Transplantation: hemoglobin level <12 g/dL in women and <13 g/dL in men. To determine the factors involved in anemia occurrence, we compared 2 groups of patients, with versus without anemia, at various times after renal transplantation.

Results

This study showed a high prevalence of anemia in the early posttransplantation period of 82.7% and 42% of kidney transplantation patients at 1 month and 6 months, respectively. It was mainly related to a low pretransplant hemoglobin level. The prevalence declined to 37.7% at 1 year. Renal graft dysfunction was the most important factor in the occurrence of late post-renal transplantation anemia. The presence of anemia increased the risk of renal graft functional deterioration by a factor of 2.9. The decreased prevalence at 1 year after transplantation was significantly associated with a reduction in left ventricular hypertrophy.

Conclusion

The management of anemia is essential to improve renal graft survival, reduce cardiovascular morbidity, and ensure a better quality of life for renal transplant recipients.     

Early postoperative spectral Doppler parameters of renal transplants: the effect of donor and recipient factors

Background

The objective of this study was to explore the donor and recipient factors related to the spectral Doppler parameters of the transplant kidney in the early posttransplantation period.

Methods

This retrospective study included 76 patients who underwent renal transplantation assessed using Doppler ultrasonography (US) on the first postoperative day. We compared spectral Doppler parameters (peak systolic velocity [PSV] and resistive index [RI]) of the segmental artery of the transplant kidney according to the type of renal transplant, level of serum creatinine (SCr) of donor prior to organ donation, and donor/recipient age.

Results

RI was significantly higher in deceased-donor kidney transplantation (DDKT) as compared with living-donor kidney transplantation (LDKT; 0.73 ± 0.10 vs 0.66 ± 0.11; P = .007). In the DDKT recipients, multivariate analysis showed donor SCr was the only factor affecting PSV (P = .023), whereas recipient age was the only factor affecting RI (P = .035). In the LDKT recipients, multivariate analysis showed recipient age was the only factor affecting both PSV (P = .009) and RI (P = .018).

Conclusion

Spectral Doppler parameters in the early posttransplantation period are related to the type of renal transplant, donor renal function, and recipient age. These factors should be taken into consideration when interpreting the results of spectral Doppler US.     

Anemia Is a Predictor of Outcome in Heart Transplant Recipients

Background

Cardiovascular disease and kidney disease share similar characteristics. It has been recently recognized that many patients with cardiovascular disease have anemia, which often is associated with kidney dysfunction. Even the term “cardiorenal anemia syndrome” was endorsed to stress the dangerous association.

Objective

To assess the prevalence of anemia in relation to chronic kidney disease in 160 patients after orthotopic heart transplantation.

Results

According to the World Health Organization definition of anemia (hemoglobin concentration <13 g/dL in males and <12 g/dL in females), 41% of our patients had anemia. Patients with anemia exhibited a significantly lower mean (SD) glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease formula vs the Cockcroft-Gault formula: 44.46 (26.84) mL/min vs 62.70 (24.15) mL/min and 48.93 (27.80) mL/min vs 72.11 (29.76) mL/min, respectively (P < .001). In addition, they demonstrated lower creatinine clearance, red blood cell count, hemoglobin concentration, and ejection fraction and significantly higher creatinine and N-terminal probrain natriuretic peptide concentrations. Presence of anemia was associated with time since transplantation, GFR, creatinine clearance, N-terminal probrain natriuretic peptide and cholesterol concentrations, and ejection fraction. At multiple regression analysis, the only predictor of anemia was kidney function (GFR or creatinine clearance), which accounts for 22% of the variation. Type of immunosuppression regimen (calcineurin inhibitors vs mammalian target of rapamycin) did not seem to affect prevalence of anemia in the study population.

Conclusions

The prevalence of anemia is relatively high in heart allograft recipients and is not adequately treated. In patients with cardiovascular disease, GFR should be estimated because renal dysfunction and subsequent anemia are important risk factors for cardiovascular morbidity and mortality. Chronic heart failure is also more common in patients with anemia.     

Erectile Dysfunction in Living Donor Kidney Transplant Recipients Associated With Chronic Hepatitis B Infection

Objectives

The objectives of this study were to investigate the prevalence of erectile dysfunction (ED) among living donor kidney transplant (LDKT) recipients associated with chronic hepatitis B infection in China and to assess the effect of successful LDKT to improve ED.

Materials and Methods

From January 2006 to May 2009, erectile function of 26 LDKT recipients associated with chronic hepatitis B infection (Group 1) was evaluated predialysis, during dialysis, and at 6 months posttransplantation using the International Index of Erectile Function, version 5 (IIEF-5). We enrolled 61 age-matched LDKT recipients without hepatitis B/C infection as a control group (Group 2).

Results

The prevalences of ED in Group 1 at predialysis, on dialysis, and 6 months posttransplantation were 23.1%, 80.7%, and 65.3%, respectively. Among Group 2, it was 4.9%, 72.1%, and 41.0%, respectively. The difference in ED between groups was significant at predialysis (P = .031) and 6 months posttransplantation (P = .037). Compared with the dialysis stage, the prevalence of ED at 6 months posttransplantation was significantly decreased in Group 2 (72.1% vs 41.0%; P = .001), but it was not significantly difference from Group 1 (80.7% vs 65.3%; P = .211).

Conclusions

The incidence of ED among hepatitis B recipients was higher than among hepatitis B/C-negative patients at the predialysis and posttransplantation stages. Kidney transplantation is a key treatment to reduce the prevalence of ED among hepatitis B/C-negative recipients, but not those with hepatitis B.     

Importance of Renal Mass on Graft Function Outcome After 12 Months of Cadaveric Donor Kidney Transplantation

Background

Few studies have measured cadaveric kidney weight to investigate its relation to recipient kidney function related to it. The aim of this study was to evaluate kidney weight (cadaveric donor) and its relationship to creatinine clearance (CrCl) after 12 months posttransplantation.

Methods

We evaluated 81 renal transplantation recipients from cadaveric donors. We collected donor and recipient demographic, clinical and anthropometric data. Data about kidney weight were obtained through kidney measurement using an electronic machine at the moment of transplantation.

Results

The mean kidney weight was 201.4 ± 10.2 g (200.5 ± 11.6 g in women and 210.3 ± 14.1 g in men). Kidney weight correlated with CrCl at 12 months (0.001). The CrCl at 12 months showed a significant correlation of graft weight/recipient weight ratio (P < .01).

Conclusion

The cadaveric donor kidney weight significantly influenced the CrCl at 12 months after transplantation.     

Anemia in Living Donor Kidney Transplantation

Background

We evaluated the prevalence of pretransplantation and posttransplantation anemia and its effect on serum creatinine levels among living donor kidney transplant recipients.

Methods

We reviewed retrospectively 170 adult patients who underwent living donor kidney transplantation between 1994 and 2009. We defined anemia as hemoglobin (Hb) ≤12 g/dL for women and ≤13 g/dL for men with severe anemia as Hb <11 g/dL for both men and women (World Health Organization criteria). Patients were also categorized according to Hb levels less than or greater than 10 g/dL for correlation with recipient serum creatinine levels at months 1, 3, 6, and 12.

Results

Mean recipient and donor ages were 33 ± 10 and 45 ± 12 years, respectively. Mean cold ischemia time was 76 ± 43 minutes. At the time of transplantation, anemia and severe anemia prevalences were 86.7% and 58.8%, respectively. Anemia was observed in 64 patients (42.1%) at posttransplantation month 3. Pretransplantation severe anemia was a good predictor of both Hb levels and anemia presence posttransplantation. Pretransplantation anemia and severe anemia caused greater requirements for posttransplantation blood transfusions (P < .05). Younger age and female gender were significant risk factors for severe anemia pretransplantation. There was a significant correlation between posttransplantation Hb levels and serum creatinine levels at 12 month (P = .01). Recipient female gender and longer hospital stay were significant risk factors for both anemia and severe anemia posttransplantation. Higher recipient weight and history of acute rejection episode were also significant for posttransplantation severe anemia.

Conclusion

This study indicated that successful kidney transplantation had a positive effect on Hb levels. Posttransplantation anemia predicted worse graft function in the first month after transplantation.     

Autosomal-Dominant Polycystic Kidney Disease and Kidney Transplantation: Experience of a Single Center

Background

Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary disease that frequently leads to end-stage renal disease and is a common indication for kidney transplantation. We sought to evaluate the demographic characteristics, graft and patient survival, and some posttransplantation complications among ADPKD recipients.

Methods

This retrospective study included 445 renal transplant recipients, among whom 48 had ADPKD. We excluded patients with pretransplantation diabetes mellitus. We evaluated patient and graft survivals as well as posttransplantation complications.

Results

There was no difference between the 2 groups with respect to demographic or transplant characteristics, except for older age among the ADPKD group (51.2 ± 8.6 years vs 44 ± 13.1 years; P < .001). We also observed no significant difference with regard to immediate graft function, immunological graft, or patient survival. Although not significant, there was a lower incidence of proteinuria and a greater number of acute rejections among ADPKD patients. As for posttransplantation complications, there was no difference regarding the prevalence of hypertension, but there was more erythrocytosis among the ADPKD group. The incidence of posttransplantation diabetes mellitus was significantly greater in ADPKD patients (33.3% vs 17.1%; P = .009), and remained significant after adjusting for confounding variables by multivariate analysis with an adjusted odds ratio of 2.3 (95% confidence interval, 1.008-5.136; P = .048).

Conclusion

Our results suggested that ADPKD patients display a greater incidence of diabetes mellitus posttransplantation; ADPKD emerged as an independent predictor for this complication.     

Safety of Low-Dose Cyclosporine Therapy Before Transplantation in Kidney Allograft Recipients

Introduction

Graft dysfunction immediately posttransplantation can vary from subtle slowing of the expected decrease in creatinine concentration to frank oliguria requiring dialysis therapy for days to weeks. Risk factors for slow and delayed graft function include prolonged preservation, older donor age, and high plasma renin activity in the recipient. Cyclosporine (CsA) nephrotoxicity is another cause of early kidney allograft dysfunction.

Objective

To evaluate early kidney allograft function in patients who received low-dose CsA therapy for 48 hours before transplant surgery for comparison with that in recipients who received CsA therapy after improvement in allograft function.

Patients and Methods

In a case-control comparative study, 66 kidney recipients were divided into 2 groups on the basis of time of initiation of CsA therapy. In group 1, patients received CsA, 100 mg twice a day, for 48 hours before surgery, and in group 2, patients received CsA therapy after surgery when allograft function had improved (serum creatinine concentration ≤3 mg/dL). Other immunosuppression medications were the same in both groups. Statistical analysis was performed to compare kidney allograft function in the first month posttransplantation.

Results

In group 1 vs group 2, at day 1 posttransplantation, mean (SD) blood urea concentration was 73.72 (31.00) mg/dL vs 87.52 (29.82) mg/dL, serum creatinine concentration was 5.11 (1.83) mg/dL vs 6.42 (3.64) mg/dL, and urine volume in 24 hours was 11,052 (4290) mL vs 9629 (45.30) mL. At the end of the study, blood urea concentration was 49.61 (12.18) mg/dL vs 69.11 (33.76) mg/dL, serum creatinine concentration was 1.22 (0.28) mg/dL vs 1.47 (0.79) mg/dL, and urine volume in 24 hours was 3202 (986) mL vs 3095 (726) mL. No significant difference was noted between the 2 groups for age, sex, and immunosuppression medications.

Conclusion

Low-dose CsA therapy before transplant surgery preserves early allograft function without deleterious effects.     

Impact of Donor Age on Renal Allograft Function and Survival

Background

The lack of cadaveric donors coupled with a rapidly growing number of potential recipients have stimulated the implementation of several strategies, including the acceptance of older donors, to increase the organ pool and reduce the waiting list for kidney transplantation. However several studies have demonstrated higher incidences of delayed graft function and poor graft outcomes among kidneys harvested from older donors.

Objective

The objective of this study was to evaluate the influence of donor age on the function and long-term survival of renal allografts.

Patients

We performed a retrospective review of the clinical data from 441 adult kidney transplantation from cadaveric heart-beating donors performed in our unit from May 1989 to May 2007.

Results

Recipients of kidney allografts from older donors were significantly older (49.2 vs 43.7 years; P < .0001) and had a higher incidence of delayed graft function (15.1% vs 5.4%; P = .005). Renal function was superior following kidney transplantation using younger donors not only at 3 months (P < .0001) and 12 months (P < .0001) posttransplantation, but also upon long-term follow-up at 60 months (P < .0001) and 96 months (P = .030). Allograft survival censored for death with a functioning graft and patient survival were not different when comparing older versus younger donors. Multivariate analysis confirmed the lack of correlation between donor age and allograft failure.

Conclusion

Donor age showed no influence on allograft survival. However, kidney allografts from older donors displayed lower first year and long-term renal function.     

Treatment of Anemia in Renal Transplantation: Impact of a Stricter Application of Hemoglobin Targets

Objective

The CREATE and CHOIR studies showed a higher risk for cardiovascular events associated with hemoglobin (Hb) values >13 g/dL in patients with stage 3-4 chronic kidney disease. In 2007, a stricter policy on the use of erythropoietin (EPO) was adopted at our center, with an Hb target of 11 to 12 g/dL and withdrawal or reduction of EPO when Hb was >12.5 to 13 g/dL. This study was designed to evaluate this new approach.

Materials and Methods

The study included patients under follow-up at the transplant outpatient clinic on December 31, 2006 (n = 725), and December 31, 2007 (n = 768). Data were compared between the study populations concerning renal function, Hb, use of EPO, and associated costs.

Results

No significant differences in creatinine or Hb values were observed between the 2 groups (1.47 ± 0.6 vs 1.42 ± 0.9 mg/dL and 13.7 ± 1.5 vs 13.7 ± 1.6 g/dL, respectively). After implementation of the new protocol, the frequency of severe anemia (Hb <11 g/dL) increased (2% vs 4%; P = .10), the use of EPO decreased (22.1% vs 17.2%; P = .017), and the mean Hb of EPO-treated patients decreased (12.5 ± 1.4 vs 11.9 ± 1.0; P < .001). The Hb target (11-12 g/dL) was met in fewer than one third of patients, with no significant differences between the 2 study times.

Conclusions

A strict policy on EPO application reduces its use and the rate of patients with “excessive” Hb values (which are associated with increased cardiovascular risks), with an acceptable slight increase in severe anemia cases.     

Delayed graft function and long-term outcome in kidney transplantation

Background

There are still many controversies about the impact of delayed graft function (DGF) on kidney transplantation outcome. The aims of this study were to define factors associated with DGF and to ascertain the relative impact of DGF on kidney transplantation outcome, both in the early postoperative period and in long-term follow-up.

Patients and Methods

Four hundred kidney transplant recipients were reviewed to assess the clinical impact of DGF on long-term outcome.

Results

The overall prevalence of DGF was 24.3%. DGF was significantly associated with increasing recipient and donor age, duration of dialysis, and cold ischemia time. Patients with DGF displayed a significantly worse graft (P = .005) and patient (P < .001) survival compared with recipients with immediate function.

Conclusion

DGF is a frequent complication of renal transplantation and may be associated with a reduced graft and even patient survival. Strategies to prevent graft injury and, more specifically, DGF may be an important clue to provide a better long-term outcome in kidney transplantation.     

Infectious Complications After Deceased Kidney Donor Transplantation

Background

Despite improvements in immunosuppressive therapy, infections remain a complication of renal transplantation that is associated with increased morbidity and graft rejection. The aim of this study was to evaluate the relationship between initial renal function after deceased donor transplantation and viral infections.

Methods

We included patients 18 years and older who received a deceased donor transplantation between January 1995 and December 2004. They were divided into 2 groups: cases from 1994 to 1999, versus from 2000 to 2004. Initial renal function was classified as immediate (IGF), slow (SGF), or delayed (DGF). Infections were classified according to Centers for Disease Control and prevention standards.

Results

Among 534 patients, SGF and DGF patients who underwent immunosuppression between 2000 and 2004 show a higher infection rate than IGF patients (P = .005). SGF patients showed a higher incidence of tissue-invasive cytomegalovirus disease (P < .001). Second episodes of viral infections were more common among all patients in this period. However, DGF patients were more susceptible to second episodes of viral infection. In the first group, OKT3 use (P = .013) and donor age (P = .012) were the major risk factors associated with viral infections whereas in the second group, thymoglobulin use (P = .002), acute rejection episode (P = .003), and anemia (P = .044) were the risk factors for viral infection.

Conclusion

Initial renal function after deceased donor transplantation was correlated with viral infection. DGF patients had a higher risk for second infection episodes. SGF patients had a higher risk for tissue-invasive cytomegalovirus infection.     

Hyperhomocysteinemia after kidney transplantation

Objective

To determine the prevalence of hyperhomocysteinemia (plasma homocysteine[Hcy] concentration ≥15 μmol/L) and evaluate its correlation with allograft function.

Materials and Methods

The study included 159 stable renal transplant recipients (104men and 55 women). The prevalence and severity of hyperhomocysteinemia werecompared in the transplant recipients vs 72 patients (48 men and 24 women) receivinghemodialysis therapy.

Results

The mean (SD; range) fasting total Hcy concentration was higher in thehemodialysis group compared with the renal transplantation group: 27.4 (18.3; 10-95)μmol/L vs 16.6 (9.5; 4.5-45.0) μmol/L (P = .00). Hyperhomocysteinemia occurred morefrequently in patients receiving hemodialysis therapy (74% vs 49%). No significantcorrelation was observed between Hcy concentration and recipient sex, cyclosporinetrough concentration and concentration at 2 days after dosing, dyslipidemia,cytomegalovirus infection, diabetes mellitus, or aspartate or alanine aminotransferaseconcentration. Multivariate regression analysis revealed that serum creatinineconcentration (P = .02) was the major determinant of increased total Hcy concentration inrenal transplant recipients.

Conclusion

A high prevalence of moderate hyperhomocysteinemia was observed in renaltransplant recipients. There was no correlation between graft function and Hcyconcentration.