Osteoporosis and Related Risk Factors in Renal Transplant Recipients

Decreased bone mineral density is a common problem after kidney transplantation. Osteoporosis has a major role in morbidity in these patients. We evaluated the incidence of osteoporosis and determined risk factors in 77 patients aged 17 to 50 years who had undergone renal transplantation 6 months to 2 years previously. Bone mineral densitometry was performed using dual-energy x-ray absorptiometry. The incidence of osteoporosis was 26% (20 of 77 patients). Mean (SD) age of affected patients was 34.6 (8.7) years. The most common sites of osteoporosis were the hip (osteoporotic in 19 patients [24.7%] and osteopenic in 42 [54.5%]) and the spine (osteoporotic in 6 patients [7.8%] and osteopenic in 52 [67.5%]). There was a significant relationship between posttransplantation creatinine concentration and hip osteoporosis (P = .01). No relationship was observed between osteoporosis and age, sex, body mass index, duration of hemodialysis therapy, cumulative dosage of any drugs, or use of pulsed methylprednisolone therapy. A hip or spine z score of 1 or less had no relationship to the number of steroid pulse sessions but was significantly related to the total dosage of cyclosporine (P < .001), prednisolone (P < .001), and mycophenolate mofetil (P < .05). A hip z score of less than 1 was related to the posttransplantation period (P = .02). In conclusion, osteoporosis is a frequent complication that requires detection and treatment to reduce morbidity.     

Assessment of Cardiovascular Risk in Renal Transplant Recipients: Preliminary Results

Background

Cardiovascular (CV) diseases are the most common cause of death in patients with chronic kidney disease, including patients after kidney transplantation. The aim of the study was to do a retrospective analysis of CV risk in renal transplant recipients (RTRs).

Assessment of Cardiovascular Risk During Peritransplant Period in Renal Transplant Recipients

Background

Cardiovascular (CV) diseases are the leading cause of death among patients with chronic kidney disease, including patients on dialysis and after kidney transplantation. The aim of study was the retrospective assessment of CV risk in renal transplant recipients during the peritransplant period.

Material and Methods

Evaluation of CV risk was made using the Revised Cardiac Risk Index (RCRI). One hundred kidney transplant recipient (60 males/40 females) participated in the study. In 82 recipients (82%), the RCRI index was 2 points, which was associated with a 6.6% risk of cardiac events. The remaining 18 patients (18%) had ≥3 RCRI points, which was associated with an 11% risk. The median RCRI score in the study group was 2.26, which was related to a risk of 7.39%.

Results

In the perioperative period, there were no CV events. The study group was observed for 5 years after transplantation, and during this time, 11 CV incidents occurred. Most of CV incidents occurred during the first 25 months after transplantation. Among patients, who underwent a CV incident, the RCRI was 3 and 2 points in 4 and 5 patients, respectively. Significant correlations were found between RCRI and both age and time spent on dialysis (P < .001).

Conclusions

Patients who qualify for a transplant are at a significant risk of having a CV incident in the peri- and postoperative periods. CV incidents did not occur in the perioperative period, although as many as 6% of patients experienced CV incidents within 2 years after transplant. Four (44%) of the 9 patients who experienced CV incidents after transplantation had a very high RCRI. This indicates the need for a very thorough long-term cardiologic supervision of transplanted patients.     

Cytomegalovirus Infection Renal Transplant Recipients: Risk Factors and Outcome

Objective

Cytomegalovirus (CMV) is the most common viral infection after allotransplantation; it can be a major cause of morbidity and mortality. Our aim was to analyze the main risk factors that lead to development of CMV infection and disease.

Patients and Methods

We retrospectively analyzed 207 patients who received a renal allograft from May 2003 to December 2007. Three patients (D−/R−) were excluded. CMV infection was defined by the detection of 2 or more positive tests for pp65 antigenemia and CMV disease by evidence of attributable symptoms in need of antiviral treatment.

Results

Thirty-two patients (15.7%) presented active CMV infections and another 35 (17.2%), CMV disease. The mean follow-up was 27.8 ± 17 months. Prior to transplantation, 9.2% of patients were seronegative (D+/R−) and 77.9% seropositive (D+/R+). Compared with noninfected patients, those with CMV infection/disease were older and received an allograft from an older donor. Upon logistic regression analysis, recipient age older than 55 years, induction therapy with Thymoglobulin, and maintenance immunosuppression with cyclosporine were the major risk factors to develop CMV disease. An early acute rejection episode was more frequent and renal function measured by serum creatinine poorer until 18 months posttransplantation among CMV-infected versus noninfected patients.

Conclusions

Our data showed that CMV infection is a common complication after kidney transplantation associated with older age, induction treatment with antilymphocyte globulin, worse renal function, and increased patient morbidity.     

Evolution of Immunosuppressive Treatment Modalities for Renal Transplant Recipients

The addition of novel immunosuppressive agents and transfusion regimens to the therapy of human kidney transplantation has significantly improved the outcome of transplants that are performed today. At its inception, kidney transplantation quickly gained a foothold as an effective treatment modality for end-stage kidney disease because of the availability of living related donors and the drug azathioprine. That the procedure has established itself as acceptable, thus allowing for the development of the interventions to be discussed here, was largely due to our gradual understanding of how to use azathioprine safely, coupled with the fact that a viable alternative for prolonging life was not then available. When chronic hemodialysis emerged as a safe, effective, and readily available therapeutic regimen, the use of less noxious drugs and procedures in transplant recipients was virtually mandated. The interventions that subsequently gained a place in transplantation then were those that had relatively little down-side risk for the patient using azathioprine and corticosteroids as the reference standard. This procedural approach largely reduced the number of experimental immunosuppressive regimens initially deemed worthy of sustained clinical investigation. Often, however, the risk-benefit ratio approach proved to be difficult to assess. Indeed, the finding of associated side effects with dramatically effective drugs such as cyclosporin have presented new problems and decisions for the investigator to cope with.     

Progression of Metabolic Syndrome in Renal Transplant Recipients

Background

Metabolic syndrome, which is closely related to insulin resistance, is highly prevalent in renal transplant recipients.

Purpose

We aimed to investigate prevalence, risk factors, and progression of metabolic syndrome in renal transplant recipients.

Methods

One hundred fifty-eight renal transplant recipients who had been on transplantation for more than 1 year and 79 age-sex matched healthy controls were included in the cross-sectional phase of the study. We measured baseline characteristics, blood pressure, fasting blood glucose, and lipid profiles and we defined metabolic syndrome using the National Cholesterol Education Program Adult Treatment Panel III criteria. One hundred twenty-four renal transplant recipients were eligible for the second evaluation after 22.9 ± 3.8 months. Metabolic syndrome prevalence and homeostasis model assessment insulin resistance levels were evaluated during the follow-up period.

Results

Overall, metabolic syndrome was present in 34.2% of the patients and 12.7% of the controls at the cross-sectional phase of the study (P = .000). Only the hypertension component of metabolic syndrome was significantly increased in patients compared to controls (P = .000). Pretransplantation weight and body mass index were significantly higher in patients who had metabolic syndrome (P = .000). During the follow-up period, prevalence of metabolic syndrome did not change (P = .510); however, body mass index and blood pressure increased and the high density lipoprotein cholesterol component of metabolic syndrome decreased (P = .001). We did not find any significant difference in glomerular filtration rate change among patients with and without metabolic syndrome (−2.2 ± 11.36 vs −6.14 ± 13.19; P = .091). Glucose metabolism parameters including hemoglobin A1c, insulin, and homeostasis model assessment insulin resistance were disturbed in patients with metabolic syndrome (P = .000, P = .001, P = .002, respectively).

Conclusion

Metabolic syndrome is highly prevalent in renal transplant recipients and closely associated with insulin resistance. The prominent criterion of metabolic syndrome in patients seems to be hypertension, especially high systolic blood pressure. The identification of metabolic syndrome as a risk factor may yield new treatment modalities to prevent it.     

Incidence of Aspirin Resistance and Its Relationship With Cardiovascular Risk Factors and Graft Function in Renal Transplant Recipients

Background

Aspirin (ASA) is frequently used to prevent cardiovascular events and improve renal graft function after renal transplantation. Clinical studies have demonstrated that decreased responsiveness to ASA therapy is associated with an increased risk of atherothrombotic events. However, no clinical trial to date has evaluated the incidence and clinical importance of ASA resistance among renal transplant recipients.

Aim

To assess the incidence of ASA resistance and its association with cardiovascular risk factors (CRF) and renal graft function after renal transplantation.

Methods

We prospectively included 40 patients undergoing living related donor renal transplantation using ASA (80 mg/d) in the study. ASA resistance was defined using a platelet function analyzer (PFA-100). Glomerular filtration rate (GFR) was measured by postoperative Tc-99m diethylenetriaminepentaacetic acid renal scintigraphy. We investigated the incidence of ASA resistance and its relationship to CRF and renal graft function.

Results

ASA resistance was noted in 11 patients (27.5%). The demographic characteristics of the patients were similar in both groups (P > .05). Compared with patients in the ASA-sensitive group, patients in the ASA-resistant group showed significantly higher total cholesterol, low-density lipoprotein cholesterol, triglyceride, C-reactive protein, and fibrinogen levels and lower GFRs (44 ± 21 mL/min vs 63 ± 26 mL/min, P = .03). The incidence of ASA resistance was higher among patients with GFRs < 60 mL/min compared with those with a GFR ≥ 60 mL/min (10% vs 1%; P = .012).

Conclusion

ASA resistance is associated with higher lipid levels and inflammatory and thrombotic cardiovascular risk factors and lower GFRs in renal transplant recipients.     

Relationship of Renal Resistive Index and Cardiovascular Disease in Renal Transplant Recipients

Background

Cardiovascular disease is the primary cause of death in renal transplant recipients, and elevated renal allograft resistive index (RI) has been associated with patient survival.

Objective

To evaluate the predictive value of intrarenal RI on atherosclerotic disease.

Patients and Methods

Ninety-seven patients who had undergone renal transplantation between 1999 and 2001 and had stable renal function were included in the study. Patients with renal artery stenosis, urinary tract obstruction, clinical symptoms of acute rejection, or chronic allograft nephropathy were excluded. Clinical and laboratory information was obtained from the medical records and included demographic data, medications used, body mass index, blood pressure, and laboratory values. Intrarenal RI and carotid intima-media thickness (IMT) were determined using Doppler ultrasonography.

Results

At linear regression analysis, RI was significantly correlated with recipient age, C-reactive protein concentration, systolic blood pressure, pulse pressure, body mass index, smoking, and carotid IMT. At multivariate linear regression analysis, only pulse pressure was an independent predictor of intrarenal RI.

Conclusion

Intrarenal RI is associated with traditional cardiovascular risk factors and carotid IMT. Elevated intrarenal graft RI may be predictive of cardiovascular disease in renal transplant recipients without complications.     

Cardiovascular and Renal Outcomes of Renin-Angiotensin System Blockade in Renal Transplant Recipients

Background

There is considerable controversy over the benefits of renin-angiotensin system (RAS) blockade in renal transplant recipients (RTRs). The aim of the study was to research the effects of RAS blockade on allograft and patient outcome.

Chronic Renal Disease in Renal Transplant Patients: Management of Cardiovascular Risk Factors

Kidney transplantation is the treatment of choice for patients with end-stage renal disease. Despite improvements in short-term patient and graft outcomes, there has been no major improvement in long-term outcomes. The aim of this study was to determine the prevalence of cardiovascular risk factors, such as hypertension, dyslipidemia, diabetes, chronic kidney disease, and obesity, and the impact of their control among 526 stable renal transplant recipients according to the guidelines in the general population. Mean blood pressure was 133 ± 16/81 ± 9 mm Hg. The proportion of patients on antihypertensive therapy was 75%, and on ACE inhibitors or angiotensin II receptor blockers, 26%. The mean cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides were 195 ± 41, 115 ± 32, 51 ± 17, and 137 ± 75 mg/dL, respectively. The proportion of patients on statin treatment was 49.7%, and those with body mass indices between 25 and 30, 30 and 35, and >35 kg/m² were 35%, 15%, and 4%. We observed a high prevalence of chronic kidney disease, hypertension, dyslipidemia, and obesity among renal transplant patients. Suboptimal control was frequent and control of some of these complications was far below targets established for nontransplant patients despite progressive intensification of therapy with functional graft decline. The findings of this study may have an impact on the management of renal transplant recipients.     

Native Renal Cysts and Dialysis Duration Are Risk Factors for Renal Cell Carcinoma in Renal Transplant Recipients

Urinary tract cancers are the third most common cancers in renal transplant recipients (RTX). This study examined the impact of dialysis duration and native renal cyst(s) (NRC) on renal cell carcinoma (RCC) occurrence among 1036 RTX followed‐up from 1995 to July 2007. Abdominal ultrasonography was planned within 1‐month of transplant, then every 5 years, or 2 years if renal cysts developed. Based on presence and time of development of NRC, RTX were grouped into those with no (No‐NRC), new (New‐NRC), preexisting (Pre‐NRC) and time‐indeterminate NRC (TI‐NRC). Ten asymptomatic RTX were diagnosed with RCC at a median of 5.8 years posttransplant and had 5‐year graft and patient survivals of 90% and 100%, respectively, following appropriate therapy. RCC occurred only in Pre‐NRC and TI‐NRC who had significantly longer dialysis duration than No‐ or New‐NRC (6.7 ± 3.9 and 3.3 ± 3.2 vs. 2.7 ± 3.1 and 2.6 ± 2.4 years, respectively). These results suggest that NRC and increased dialysis duration are risk factors for RCC posttransplant. Since early treatment of RCC gives excellent outcomes, regular ultrasonography performed within a month of transplantation, then every 5 years for those without cysts and every 2 years for those with cysts for early detection of RCC is recommended.     

Immunosuppressive Agents and Bone Disease in Renal Transplant Patients With Hypercalcemia

Renal transplantation is the definitive treatment for many metabolic abnormalities of uremic patients, although it is only partially effective for renal osteodystrophy, which may interact with posttransplant renal osteopathy. Osteopenic-osteoporotic syndrome represents, together with fractures secondary to osteoporosis and osteonecrosis, the bone complication most related to renal transplantation. Several factors contribute to the pathogenesis of posttransplantation osteoporosis, particularly immunosuppressive treatment. In this study, we evaluated the prevalence of factors related to posttransplant renal osteopathy and the clinical impact of immunosuppressive protocols. We studied 24 renal transplant recipients with hypercalcemia. Glomerular filtration rate was >50 mL/min. Mean age, time on dialysis, and time from transplantation were 49.6, 5.4, and 6.9 years, respectively. We evaluated serum and urine calcium and phosphorus, calcitonin, parathormone, bone-specific alkaline phosphatase, osteocalcin, urine deoxypyridinoline, telopeptide of type 1 procollagen, 1,25-(OH)₂ and 25-OH vitamin D, parathyroid ultrasound, and computerized bone mineralometry. The combination of sirolimus and steroids resulted in the most disadvantageous outcomes regarding alkaline phosphatase and mineralometry. Calcineurin inhibitors did not significantly influence bone metabolism markers; mycophenolate mofetil evidenced no effect on bone. According to the literature, steroids account for the abnormalities found in our patients and in severe osteopenia. Several factors may contribute to the development of osteoporosis and fractures in transplantation patients, although they are overcome by the prominent effect of steroids. In patients at high risk of osteoporosis, steroid-free therapy should be considered. Everolimus is indicated for diseases with bone loss. Combined therapy with everolimus and mycophenolic acid without cyclosporine and steroids, seemed to be particularly indicated. Prophylactic treatments should be commenced early. No single marker was useful to diagnose posttransplant renal osteopathy. The definitive diagnosis should be made by bone biopsy during transplantation, and noninvasive procedures, such as densitometry and evaluation of biologic markers, may be useful during follow-up.     

Fibroblast Growth Factor 23 and Klotho as Cardiovascular Risk Factors in Heart Transplant Recipients

Background

Fibroblast growth factor (FGF) 23 is one of the most recently discovered FGFs. This phosphaturic hormone produced in bones is a risk factor for cardiovascular diseases and thus mortality. Klotho is an essential coreceptor for FGF23 and at the same time it is known as a “longevity” hormone. There are no data considering FGF23 and Klotho roles in heart transplant (HT) recipients. The aim of this study was to assess Klotho and FGF23 serum concentration in heart transplant recipients depending on immunosuppressive therapy regimen and comorbidities.

Methods

Eighty-four stable heart transplant recipients were enrolled in the study; 22 healthy volunteers served as control subjects. FGF23 and Klotho protein concentration, markers of renal function, such as cystatin C and neutrophil gelatinase–associated lipocalin (NGAL), and heart failure markers, such as copeptine and N-termiinal pro–B-type natriuretic peptide (NT-proBNP), were evaluated.

Results

FGF23 concentration was significantly higher in the HT group whereas Klotho protein was significantly lower. FGF23 correlated with creatinine level (r = 0.72; P < .001), estimated glomerular filtration rate (eGFR; r = −0.32; P < .01), cystatin C (r = 0.36; P < .01), NGAL (r = 0.51; P < .001), hemoglobin (r = −0.39; P < .001), NT-proBNP (r = 0.51; P < .001), high-density lipoprotein (HDL; r = 0.27; P < .05), intraventricular septum thickness (r = 0.42; P < .01) and right ventricular systolic pressure (r = 0.34; P < .05). Klotho protein correlated only with age (r = −0.21; P < .05), creatinine (r = −0.21; P < .05), and eGFR (r = −0.31; P < .01). FGF23 concentration was significantly higher in patients with eGFR <60 mL/min whereas Klotho protein was significantly lower. FGF23 predictors were renal function (creatinine concentration; β = 0.45; P = .0001), HDL (β = 0.33; P = .003), intraventricular septum thickness (β = 0.38; P = .0003), and right ventricular systolic pressure (β = 0.34; P = .003), explaining 70% of FGF23 variability.

Conclusions

FGF23/Klotho system disorders in HT recipients are related to cardiovascular system function and kidney failure and could cause increased risk of cardiovascular disease.     

Cytomegalovirus Status of Kidney Transplant Recipients and Cardiovascular Risk

Background

Cytomegalovirus (CMV) infection is associated with an increased risk of cardiac complications in kidney transplant recipients (KTRs). Some data suggest that CMV may be involved in atherogenesis. The aim of the study was the analysis of CMV medical history in KTRs and its influence on cardiovascular (CV) incidents.

Maintenance Immunosuppressive Treatment of Renal Transplant Recipients in the Critical Care Unit

BackgroundIn intensive care unit (ICU), although there is no standard protocol for maintenance of immunosuppressive (IS) treatments for the kidney transplant recipients (KTx), the dose and the number of IS drugs are decreased according to the center’s experience. The aim of this study is to evaluate the changes in IS treatment during stays in the ICU and to evaluate the safety and results of this modification on the IS treatment in the ICU arbitrarily.MethodWe evaluated retrospectively our kidney transplant recipients in ICU between 2012 and 2017. The immunosuppressive protocols and the results were taken from the ICU documents.ResultsA total of 31 (18 male, 13 female) patients were suitable for the analysis. They were all under the triple IS protocol including Tacrolimus (Tac) + Mycophenolate mofetil (MMF) + steroid before the admission. The reason for ICU admission were severe sepsis in all patients. In ICU, 16 patients (51.6%) died, and a total of 10 patients were lost with functional graft. Change in IS treatment is as follows: a total of the 23 patients (74.2%) were given only steroids, and 8 patients (25.8%) were changed from triple to 2 drugs. Acute kidney injury developed in 42% (13 patients) of the patients in ICU.ConclusionIn our study, we observed that life-threatening severe infections were the main cause of ICU admission in KTx. Reduction in IS treatments are common practice, and reduction to a single dose of steroid was the most frequently chosen IS treatment. Eighty percent of patients are discharged with reduction of steroid gradually. None of the patients developed acute rejection and permanent graft injury.     

The Incidence of Tumours in Renal Transplant Recipients with Long-Term Immunosuppressive Therapy

INTRODUCTION: The incidence of cancers after renal transplantation is significantly higher than in population that have not undergone transplantation. It is increased by a long-term survival of functional graft requiring long-term immunosuppressive therapy. MATERIAL AND METHODS: Since 1972, 620 renal transplantations have been performed for different causes of end stage renal disease. The authors report a group of 18 renal transplant patients (2.9%) who had cancer. Patients with malignancies are reviewed according to their age, sex, type of immunosuppression, interval between transplantation and the diagnosis of cancer, method of treatment and survival. RESULTS: All patients received cadaver kidneys, and secondary transplantation was performed in two patients. Five patients received conventional immunosuppression--azathioprine with prednisone, another 13 patients received cyclosporine with prednisone and/or azathioprine. In 13 males and 5 females (mean age 46.1 years) the malignant disease developed about 62.4 months after renal transplantation. Six patients had epithelial skin cancers (four of them had squamous cell carcinomas and two basal cell carcinomas). Two patients had breast cancer, colorectal carcinoma, renal cell carcinoma and bladder cancer, respectively, one patient had gastric cancer, thyroid carcinoma, carcinoma of tonsilla, and monocytic leukaemia with blastic transformation, respectively. The average survival of patients with malignancies was 20.3 months. Of 17 patients with cancer, 13 underwent surgical treatment, four patients with advanced disease received radiotherapy, hormonal treatment or only symptomatic therapy. In one patient the malignant disease was only discovered at autopsy. Five patients died of progressive malignant disease, four of intercurrent disease. Nine (50%) patients are alive, with no evidence of disease (NED), 31.9 months in average following the diagnosis of malignancy. Three patients returned to dialysis treatment, other 6 patients live with well functioning graft. CONCLUSIONS: In patients surviving long time after kidney transplantation the possibility of development of malignant disease should be considered. Preventive evaluation should guarantee early detection of cancer. Appropriate treatment, without cessation of immunosuppressive therapy, is indicated with the intention to prolong the patients' life with a functional graft and without dialysis treatment.     

Short-Term Prospective Study of Metabolic Syndrome in Renal Transplant Recipients

Background

Metabolic syndrome (MS) may affect patient and graft survival in renal transplant recipients. However, the evolution of MS during prospective follow-up remains uncertain.

Methods

Renal transplant patients were recruited for a study of MS in 2010 and then prospectively followed for 2 years. The modified Adult Treatment Panel III criteria adopted for Asian populations were used to define MS.

Results

A total of 302 cases (male:female = 154:148) with a mean duration of 10.5 ± 5.7 years after transplantation were enrolled. At initiation, 71 cases (23.5%) fulfilled the criteria of MS. At the end of follow-up, 11 cases had died and 21 had graft failure. Nine cases had insufficient data for reclassification. The remaining 261 cases completed a 2-year follow-up, and the prevalence of MS was 26.1% at the end of study. Of these, 7.79% (18 cases) of patients without MS had developed new-onset MS. Conversely, 16.9% (12 cases) with MS were free from MS at the end of study (P = .362). Patients with MS were associated with older age (57.1 ± 10.4 vs 52.6 ± 12.4 y; P = .006), more chronic allograft nephropathy (17.4% vs 7.1%; P = .01), proteinuria (22.5% vs 10.8%; P = .012), and use of more antihypertensive agents (1.49 ± 0.86 vs 0.80 ± 0.98; P < .0001). There was no significant change in serum creatinine in each subgroup.

Conclusions

The status of MS in renal transplant patients is dynamic. MS patients were associated with more chronic allograft nephropathy and proteinuria.     

Clinical Outcomes in Pediatric Renal Transplant Recipients Who Received Steroid-Based Immunosuppressive Regimen

Background

Although the clinical outcomes of pediatric renal transplantation (RT) in developed countries have improved significantly, the data on clinical outcomes in developing countries are wildly different.

Intrauterine Growth Restriction in Pregnant Renal and Liver Transplant Recipients: Risk Factors Assessment

Background

Nowadays pregnancy after organ transplantation is possible due to advances in surgical and immunosuppressive therapies. One of the possible complications in pregnancy after organ transplantation is intrauterine growth restriction (IUGR). This may lead to various adverse perinatal outcomes. Prevalence of IUGR in the general population is estimated at 3%–10% with smoking being the most frequent maternal risk factor. The aim of this study was to determine the risk factors of IUGR in pregnant renal transplant recipients (RTR) or liver transplant recipients (LTR) in comparison with healthy pregnant women.

Methods

Retrospective analysis included 48 RTR and 52 LTR. IUGR was defined as estimated fetal weight less than the 10th percentile for gestational age. IUGR was diagnosed in 15 (31.3%) pregnant RTR and in 10 (19.2%) LTR. The control group consisted of 60 healthy pregnant women diagnosed with IUGR. Fisher exact test and Student t test were used to assess the differences in fractions and means, respectively, between distinguished groups of patients. Test for fractions based on asymptotic normal distribution was used to compare the proportion of patients with IUGR with the proportion of 10% in the general population. The logistic regression model was used to assess the statistical significance of correlations between the assumed risk factors and the prevalence of IUGR in multivariate settings.

Results

Hypertension, anemia, and proteinuria were the most frequent complications in the study group. They were more prominent in RTR than in LTR. Hypertension was diagnosed in all RTR, whereas severe anemia requiring erythropoietin treatment or blood transfusion was found in 4 RTR and in 1 LTR.

Conclusion

IUGR is more common in organ recipients. Therefore, vigilant obstetric care is highly recommended in pregnant patients after renal or liver transplantation. Hypertension, severe anemia, and proteinuria proved not to be statistically significantly correlated with the prevalence of IUGR among patients after transplantation.     

Obesity is Associated with Worsening Cardiovascular Risk Factor Profiles and Proteinuria Progression in Renal Transplant Recipients

Obesity is associated with adverse cardiovascular (CV) parameters and may be involved in the pathogenesis of allograft dysfunction in renal transplant recipients (RTR). We sought the spectrum of body mass index (BMI) and the relationships between BMI, CV parameters and allograft function in prevalent RTR. Data were collected at baseline and 2 years on 90 RTR (mean age 51 years, 53% male, median transplant duration 7 years), categorized by BMI (normal, BMI < or = 24.9 kg/m2; pre-obese, BMI 25-29.9 kg/m2; obese, BMI > or = 30 kg/m2). Proteinuria and glomerular filtration rate (eGFR(MDRD)) were determined. Nine percent RTR were obese pre-transplantation compared to 30% at baseline (p < 0.001) and follow-up (25 +/- 2 months). As BMI increased, prevalence of metabolic syndrome and central obesity increased (12 vs 48 vs 85%, p < 0.001 and 3 vs 42 vs 96%, p < 0.001, respectively). Systolic blood pressure, fasting blood glucose and lipid parameters changed significantly with BMI category and over time. Proteinuria progression occurred in 65% obese RTR (23 (13-59 g/mol creatinine) to 59 (25-120 g/mol creatinine)). BMI was independently associated with proteinuria progression (beta 0.01, p = 0.008) but not with changing eGFR(MDRD.) In conclusion, obesity is common in RTR and is associated with worsening CV parameters and proteinuria progression.