Expression of Pancreatic Endocrine Markers by Mesenchymal Stem Cells From Human Umbilical Cord Vein

Background

Mesenchymal stem cells (MSCs) from human umbilical cord vein have great potential for use in cell therapy because of their ease of isolation, expansion, and differentiation, in addition to their relative acceptance from the ethical point of view. Obtaining the umbilical cord at birth does not present any risk to either mother or child.

Objective

To isolate and promote in vitro expansion and differentiation of MSCs from human umbilical cord vein into cells with a pancreatic endocrine phenotype.

Methods

Mesenchymal stem cells obtained from human umbilical cord vein via collagenase digestion were characterized at cytochemistry and fluorescent-activated cell sorting, and expanded in vitro. Differentiation of MSCs into an endocrine phenotype was induced using high-glucose (23 mmol/L) medium containing nicotinamide, exendin-4, and 2-mercaptoethanol. Expression of insulin, somatostatin, glucagon, and pancreatic and duodenal homeobox 1 was analyzed using immunofluorescence.

Results

Cells isolated from the umbilical cord vein were MSCs as confirmed at cytochemistry and fluorescent-activated cell sorting. Expression of somatostatin, glucagon, and pancreatic and duodenal homeobox 1 by differentiated cells was demonstrated using immunofluorescence. Insulin was not expressed.

Conclusions

The MSC differentiation protocol used in the present study induced expression of some endocrine markers. Insulin was not produced by these cells, probably because of incomplete induction of differentiation.     

Expression of Pancreatic Endocrine Markers by Prolactin-Treated Rat Bone Marrow Mesenchymal Stem Cells

Background

Mesenchymal stem cells (MSCs) are an attractive source for generation of cells with β-cell properties. Previous studies have demonstrated the ability of prolactin to induce an increase in β-cell mass and maturation, which suggests beneficial effects of its use in MSC differentiation protocols.

Objective

To evaluate the expression of endocrine differentiation markers in rat MSCs treated in vitro with prolactin.

Methods

Mesenchymal stem cells from bone marrow of Wistar rats were isolated, expanded, and characterized. Differentiation of MSCs was induced in medium containing 23 mmol/L of glucose, and nicotinamide, 2-mercaptoethanol, and exendin-4, in the presence or absence of 500 ng/mL of rat recombinant prolactin. Expression of endocrine markers and prolactin receptor genes was evaluated using real-time polymerase chain reaction, and compared between culture stages and presence vs absence of prolactin in the culture medium. Expression of insulin, somatostatin, glucagon, and pancreatic and duodenal homeobox 1 was also evaluated at immunofluorescence microscopy.

Results

Isolated cells were mostly MSCs, as confirmed at fluorescent-activated cell sorting and cytochemistry. Pax6, Ngn-3, Isl1, NeuroD1, Nkx2.2, and Nkx6.1 exhibited varied expression during culture stages. The long form of the prolactin receptor messenger RNA was induced in prolactin-treated cultures (P < .05). The somatostatin gene was induced in early stages of differentiation (P < .05), and its expression was induced by prolactin, as confirmed using immunofluorescence.

Conclusion

Culture of rat bone marrow MSCs in differentiation medium induces expression of pancreatic endocrine-specific genes, and somatostatin and prolactin receptor expression was also induced by prolactin.     

Human cytokine expression profile in various conditioned media for in vitro expansion bone marrow and umbilical cord blood immunophenotyped mesenchymal stem cells

Introduction

Bone marrow (BM) represents the major source of mesenchymal stem cells (MSCs); however, umbilical cord blood (UCB) MSCs have some advantages over BM, such as a higher differentiation capability and noninvasive collection methods.

Objectives

We compared antigen expression and cytokine-secretion by MSC from BM and UCB expanded with media supplemented with fetal bovine serum (FBS) or human platelet lysate (HPL).

Materials and Methods

We compared protocols for the expansion of hMSC starting from samples of BM or UCB by morphological analysis, calculation of population doubling numbers, and cytometry techniques using monoclonal antibodies (BD Biosciences). Using the last technique, cytokines were detected in brain homogenate supernatant fluids of MSC cultured in various media, using the Bio-Plex cytokine assay system (BD Biosciences).

Results

Calculating the number population doubling (PD) and colony-forming unit-¹fibroblast (CFU-F) assays showed significantly better expansion with HPL compared with a selected batch of FBS and within fewer days: PD about 5 for 10%HPL versus 25 for fibroblast growth factor2 (FGF2) medium. By flow cytometry, we observed a greater number of BM MSCs compared with UCB MSCs, as well as differences in the expression of some MSC antigens, particularly CD105, CD90, and CD31. Analysis of cytokines: FGFb, RANTES, VEGF, IL-6, IL-8, G-CSF, and GM-CSF showed only some of them to be expressed: namely, IL-6, IL-8, and VEGF. MSCs derived from UCB showed low concentrations of these cytokines compared with MSCs derived from BM.     

American Academy of Pediatrics Section on Surgery hernia survey revisited

Background

The aim of the study was to describe current treatment and trends in surgical management of pediatric inguinal hernias (IHs), specifically contralateral exploration.

Methods

Surveys were sent to 599 Surgical Section members. Questions paralleled the 1993 American Academy of Pediatrics survey and addressed recent controversial topics. Statistical analysis by χ² was performed.

Results

Three hundred ninety-five (66%) surveys returned. For full-term boys with reducible IH, 79% (82%) repair electively, regardless of age or weight. For full-term girls with reducible ovary, 49% (27%) repair electively, 36% (59%) next available slot, 5% (10%) emergently (P < .01). In former premature infants, 53% (65%) repair reducible IH when convenient, regardless of age. For unilaterally presenting IH, 44% (65%) routinely explore contralateral groins in boys 2 years or younger (P < .01); 47% (84%) routinely explore girls 4 years or younger (P < .01). No significant association between routine exploration patterns and years in practice, region of country, or training program affiliation was found. Laparoscopic evaluation for contralateral IH was reported by 37% (6%), (P < .01) 1993 results italicized.

Conclusion

Reports of routine contralateral inguinal exploration had absolute decreases of 21% for boys 2 years or younger, 37% for girls 4 years or younger. There has been a shift toward elective repair for girls with reducible ovaries. Use of laparoscopy for diagnostic contralateral evaluation has increased dramatically.     

The mechanism of intestinal motility in homozygous mutant Ncx/Hox11L.1-deficient mice--a model for intestinal neuronal dysplasia

Purpose

Homozygous mutant Ncx/Hox11L.1-deficient (Ncx−/−) mice develop mega-ileo-ceco-colon with a caliber change in the proximal colon. This study investigated the mechanism of intestinal motility in these mice.

Method

Five-week-old male and female Ncx−/− mice with mega-ileo-ceco-colon (n = 8) were compared with age-matched male BDF1 mice used as controls (n = 8). All mice were sacrificed, and uniform-sized strips of jejunum, ileum, proximal colon, and distal colon were exposed to electrical field stimulation and pretreatment with atropine sulfate, guanethidine, or tetrodotoxin. Contractile responses were recorded and compared.

Results

Longitudinal muscle from strips of jejunum and ileum from all mice (BDF1 and Ncx−/−) did not respond to electrical field stimulation, whereas ileal circular muscle contracted in BDF1 mice and contracted and relaxed in Ncx−/− mice. Pretreatment with atropine sulfate and guanethidine inhibited the responses of circular muscle of distal colon and ileum in BDF1 mice significantly (P < .05), but no effect was observed in Ncx−/− mice.

Conclusion

In ileum, BDF1 mice have cholinergic and adrenergic dominant contraction patterns, whereas Ncx−/− mice have relaxation-dominant patterns because of nonadrenergic, noncholinergic nerves. Based on this, there would appear to be some kind of variation in the gastrointestinal nerve supply in Ncx−/− mice.     

Deletion of the heparin-binding epidermal growth factor-like growth factor gene increases susceptibility to necrotizing enterocolitis

Background

Necrotizing enterocolitis (NEC) is the leading surgical cause of death in premature infants. We have accumulated evidence supporting a role for heparin-binding epidermal growth factor (EGF)-like growth factor (HB-EGF) in protection of the intestines from NEC. The aim of the current study was to evaluate the effect of loss-of-function of endogenous HB-EGF on susceptibility to NEC.

Methods

Neonatal HB-EGF^(−/−) knockout (KO) mice and their HB-EGF^(+/+) wild-type (WT) counterparts were exposed to experimental NEC. An additional group of HB-EGF KO pups were also exposed to NEC but had HB-EGF added to their formula. To examine gut barrier function, HB-EGF KO and WT pups received intragastric fluorescein isothiocyanate-labeled dextran (FITC dextran) under basal and stressed conditions, and serum FITC dextran levels were measured.

Results

The WT mice had an incidence of NEC of 53%, whereas HB-EGF KO mice had a significantly increased incidence of NEC of 80% (P = .04). Importantly, administration of exogenous HB-EGF to HB-EGF KO pups significantly reduced the incidence of NEC to 45% (P = .04). Heparin-binding EGF KO mice had significantly increased intestinal permeability compared to WT mice under basal and stressed conditions.

Conclusions

Our results provide evidence that loss of the HB-EGF gene increases susceptibility to NEC and that administration of exogenous HB-EGF reverses this susceptibility.     

Magnetic resonance with diffusion-weighted imaging in the evaluation of transplanted kidneys: updating results in 35 patients

Background

We compared values of apparent diffusion coefficient (ADC) with renal function indices among a population of kidney transplant recipients who underwent magnetic resonance with diffusion-weighted imaging (DWI) of their grafts.

Materials and Methods

Thirty-five patients with right iliac transplanted kidneys were studied using 1.5-T magnetic resonance. Diffusion echo-planar sequences with several b-values were acquired to investigate transplanted grafts. Patients were divided into 3 groups according to their creatinine clearances; Group A, clearance >60 mL/min; Group B, clearance >30 and ≤60 mL/min; and Group C, clearance ≤30 mL/min. ADC values between groups were compared using Mann-Whitney U test. Receiver operating characteristic (ROC) curves were used to predict the normal function (Group A) versus renal failure cohorts (Group C).

Results

Comparing mean values of ADC between Group A and Group C patients, we observed a significant difference (P = .0003) with higher ADC values among patients with a normal creatinine clearance (>60 mL/min). Comparing Groups B and C did not show a significant difference (P = .05); nor did Group A and Group B reveal a significant difference (P = .38). To predict normal clearance values, the Group A ROC curve showed an area under curve (AUC) of 0.780 with a sensitivity of 92.3% and a specificity of 68.2% at a threshold ADC value of ≥2.08 × 10⁻³ mm²/sec. In the prediction of low clearance values, the Group C ROC curve showed an AUC of 0.846 with a sensitivity of 83.3% and a specificity of 82.6% using a threshold ADC value of ≤2.07 × 10⁻³ mm²/sec.

Conclusions

Updating our experience among 35 patients, DWI was confirmed to be a promising noninvasive tool to assess renal function; an ADC ≥2.08 × 10⁻³ mm²/sec may be used as a threshold to predict a normal clearance. However, an overlap of ADC values between groups is a limit.     

Murine model of Hirschsprung-associated enterocolitis II: Surgical correction of aganglionosis does not eliminate enterocolitis

Background

Hirschsprung disease (HD) results from aganglionosis of the colon, is linked to acute and chronic enterocolitis (known as Hirschsprung-associated enterocolitis) despite successful corrective surgery, and can lead to bacteremia and even death. The genetic and molecular mechanisms underlying these disorders are largely unknown.

Methods

We developed a microsurgical corrective pull-through procedure in mice, and applied that to Ednrb^−/− mice, which manifest aganglionic megacolon that is very similar to HD. Wild-type littermates (Ednrb^+/+) also underwent identical surgery. At prespecified time points postoperatively, mice were sacrificed, and histopathologic analyses of intestinal inflammation were performed. Mice of both genotypes were sacrificed after the postoperative recovery period to determine if corrective surgery itself caused inflammation. Stooling patterns were assessed as well to determine if intestinal function normalized after surgery.

Results

There was no difference in histopathological enterocolitis scores after recovery from surgery. Stooling patterns in Ednrb^−/− and Ednrb^+/+ mice were similar postoperatively, suggesting normalization of intestinal function. However, with time, approximately 40% of Ednrb^−/− mice developed clinical illness consistent with enterocolitis. No control (Ednrb^+/+) mice developed clinical enterocolitis. Histopathological enterocolitis scores in the 40% of Ednrb^−/− mice that developed clinical enterocolitis postoperatively were significantly worse than those of healthy postoperative Ednrb^−/− mice. In contrast, none of the Ednrb^+/+ control mice exhibited postoperative long-term inflammation.

Conclusions

Microsurgical pull-through operation in Ednrb^−/− mice produces a mouse model that closely resembles key features of Hirschsprung-associated enterocolitis, enabling controlled study of genetic and molecular mechanisms in Ednrb^−/− mice and other genotypes that produce similar phenotypes.     

Assessing Dexterity Function: A Comparison of Two Alternatives for the NIH Toolbox

Study Design

Clinical measurement.

Introduction

Manual dexterity is an important aspect of motor function across the age span.

Purpose of the Study

To identify a single measure of manual dexterity for inclusion in the National Institutes of Health (NIH) Toolbox Assessment of Neurological and Behavioral Function.

Methods

A total of 340 subjects participated in our study. Two alternatives, Rolyan^® 9-Hole Peg Test (9-HPT) and Grooved Pegboard test, were compared by assessing their score range across age groups (3-85 yr) and their test-retest reliability, concurrent, and known groups validity.

Results

The 9-HPT was a simple, efficient, and low-cost measure of manual dexterity appropriate for administration across the age range. Test-retest reliability coefficients were 0.95 and 0.92 for right and left hands, respectively. The 9-HPT correlated with Bruininks-Oseretsky Test (BOT) of Motor Proficiency, dexterity subscale, at −0.87 to −0.89 and with Purdue Pegboard at −0.74 to −0.75. The Grooved Pegboard had good test-retest reliability (0.91 and 0.85 for right and left hands, respectively). The Grooved Pegboard correlated with BOT at −0.50 to −0.63 and with Purdue Pegboard at −0.73 to −0.78. However, the Grooved Pegboard required longer administration time and was challenging for the youngest children and oldest adults.

Conclusions

Based on its feasibility and measurement properties, the 9-HPT was recommended for inclusion in the motor battery of the NIH Toolbox.

Level of Evidence

NA.     

Pledgeted mattress sutures reduce recurrent reflux after laparoscopic Nissen fundoplication

Introduction

In response to a perceived increase in the incidence of recurrent reflux after adopting the laparoscopic Nissen fundoplication, we adjusted our technique to include the use of pledgeted, horizontal mattress sutures for crural closure and wrap construction.

Methods

We assessed the impact of this technical modification in children who underwent laparoscopic fundoplication between 1997 and 2007 at a large children's hospital. The medical history, indications, technical details, and outcomes were reviewed. Differences between groups were assessed with χ², logistic regression, and Kaplan-Meier analysis.

Results

A total of 384 subjects were identified. Neurologic deficits were present in 77%. The crural closure and wrap were constructed with simple sutures in 226 and with pledgeted, horizontal mattress sutures in 158. The cumulative incidences of recurrent reflux, gagging/retching, wrap failure on imaging studies, and reoperation were significantly greater with the use of simple sutures (P < .01, .03, < .01, and < .01, respectively). Kaplan-Meier analysis confirmed a significant difference in the probability of recurrent reflux with simple sutures despite a significant difference in postoperative follow-up. Operative time was the same with both methods.

Conclusions

The use of pledgeted, horizontal mattress sutures for crural closure and wrap construction in laparoscopic Nissen fundoplication may reduce the incidence of recurrent reflux.     

Fenoldopam prophylaxis of postoperative acute renal failure in high-risk cardiac surgery patients

Background

Acute renal failure requiring replacement therapy occurs in 1% to 2% of patients who have undergone cardiac surgery with cardiopulmonary bypass and is associated with a very high mortality rate. The aim of this study was to determine if prophylactic treatment with fenoldopam mesylate of patients at high risk of postoperative acute renal failure reduced the incidence of this event.

Methods

This was a multicenter, prospective, cohort study in which 108 patients at high risk of postoperative acute renal failure and undergoing cardiac surgery with cardiopulmonary bypass were treated with fenoldopam mesylate (0.08 μg · kg⁻¹ · min⁻¹) starting at the induction of anesthesia and throughout at least the next 24 hours. A homogeneous control group of 108 patients was created using a propensity-score analysis.

Results

Fenoldopam prophylaxis was significantly associated with a reduction in acute renal failure incidence (from 22% to 11%, p = 0.028), a less pronounced creatinine clearance decrease (p = 0.05), and a lower mortality rate (6.5% versus 15.7%, p = 0.03) by the univariate analysis, but these results were not confirmed by a multivariable analysis. Within the subgroup of patients who suffered a postoperative low output syndrome, fenoldopam prophylaxis was an independent protective factor for postoperative renal failure (odds ratio, 0.14; 95% confidence interval, 0.03 to 0.7; p = 0.017).

Conclusions

Given the limitations of a nonrandomized prospective trial, our results support the hypothesis that fenoldopam may reduce the risk of acute renal failure in patients in whom endogenous and exogenous cathecolamines action may induce a renal vascular constrictive condition.     

Dexamethasone induces osteogenesis via regulation of hedgehog signalling molecules in rat mesenchymal stem cells

Purpose

Hedgehog signalling plays an important role during the development of tissues and organs, including bone and limb. Dexamethasone (DEX), a synthetic and widely used glucocorticoid, affects osteogenesis of bone marrow mesenchymal stem cells (MSCs), while the signalling pathway by which DEX affects osteoblast differentiation remains obscure. This study aimed to investigate expressions of hedgehog signalling molecules Shh, Ihh and Gli1 during DEX-induced osteogenesis of rat MSCs in vitro.

Methods

DEX promoted osteoblast differentiation of MSCs at 10⁻⁸ mol/L from seven days to 21 days, demonstrated by enhancing alkaline phosphatase (ALP) activity and osteoblast-associated marker type I collagen expression during osteoblastic differentiation. Gene and protein expressions of hedgehog signalling molecules, Shh, Ihh and Gli1 were tested by RT-PCR and western blot analysis during osteoblast differentiation.

Results

Shh expression was increased compared to the control while Ihh and Gli1 expressions were decreased on both mRNA and protein level during DEX-induced osteoblast differentiation of MSCs from seven days to 21 days. Altogether, these data demonstrate that DEX can enhance Shh expression via a Gli1-independent mechanism during osteoblast differentiation of MSCs.

Conclusions

These results indicate that different patterns of hedgehog signalling are involved in DEX-induced osteogenesis and these findings provide insights into the mechanistic link between glucocorticoid-induced osteogenesis and hedgehog signalling pathway.     

Sirolimus in Kidney Transplant Donors and Clinical and Histologic Improvement in Recipients: Rat Model

Background

Ischemia-reperfusion (I/R) injury is one of the risk factors for delayed graft function, acute rejection episodes, and impaired long-term allograft survival after kidney transplantation. This antigen-independent inflammatory process produces tissue damage. Isogeneic transplantation in a rat model is a useful method for study of nonimmunologic risk factors for kidney damage.

Objective

To study the effect of sirolimus on I/R injury using only 1 dose of the drug in the donor.

Materials and Methods

Eighteen rats were allocated to 3 groups of 6 rats each: sham group, control group, and rapamycin group.

Results

Improved renal function and systemic inflammatory response were observed in the rapamycin group compared with the control group (Δurea, Δcreatinine, and ΔC3, all P < .01). The number of apoptotic nuclei in the renal medulla in the control group was higher than in the rapamycin group (P < .01). Tubular damage was less severe in the rapamycin group compared with the control group (P < .01). Complement 3 and tumor necrosis factor-α expression in the kidney samples were significantly decreased when rapamycin was given to the donor rats (P > .01). Bcl-2 protein was upregulated in the rapamycin group compared with the control group (P < .01).

Conclusion

Administration of rapamycin in donors attenuates the I/R injury process after kidney transplantation in a rat model.     

Prospective study of antibiotic protocols for managing surgical site infections in children

Purpose

We adopted antibiotic (Ab) protocols for managing surgical site infections in children and assessed their effectiveness.

Methods

We used our protocols on 1313 children between 2004 and 2005. All wounds were monitored for 30 days and classified as clean, clean-contaminated, contaminated, or dirty-infected. Infections were defined as superficial, deep, or organ/space. A retrospective study involving 721 children who had surgery in 2003 was also performed. χ² Statistical analysis was performed.

Results

Postprotocol, all Abs were administered accurately by anesthesiologists and infections developed in only 22 cases (1.7%): 0.2% (clean), 2.6% (clean-contaminated), 5.8% (contaminated), and 20.8% (dirty-infected), respectively; 21 were superficial or deep and 1 was organ/space. Age at surgery and sex did not influence incidence, neither did length of surgery for clean-contaminated, contaminated, and dirty-infected wounds; clean wounds were excluded because all surgery was minor. Overall, incidence of infections was 1.2% for elective surgery and 4.5% for emergency surgery (P < .01). Preprotocol, only 67% had Ab and infections developed in 27 cases (3.7%), which is significantly higher than in postprotocol (P < .01).

Conclusions

Accurate administration of Ab and careful supervision by an infection control team appear to be effective for preventing wound infections in children.     

Vacuum-assisted closure for complicated neonatal abdominal wounds

Background

Neonatal experience in vacuum-assisted closure (VAC) for complex abdominal wounds remains scant.

Methods

A neonatal VAC protocol was instituted in 2004. The medical records of patients treated with this protocol for the ensuing 3 years were retrospectively reviewed. Continuous data are reported as mean ± SD (range).

Results

Ten VAC applications occurred in 8 neonates for a 3-year period. Gestational age and age at VAC application were 30 ± 6.9 (24-40) weeks and 84.5 ± 51 (21-165) days, respectively. Birth weight and weight at VAC application were 1495 ± 1118 (615-3415) g and 3515 ± 2118 (989-7965) g, respectively. All wound complications occurred after laparotomies (7 elective, 3 emergent). Three wounds included intestinal stomas, and 3 included enterocutaneous fistulae. Average wound area at VAC initiation was 13.6 ± 6.0 (8.5-25) cm². Duration of VAC use was 19.1 ± 15.3 (7-60) days. Vacuum-assisted closure resulted in complete wound closure in all cases and did not result in any local or systemic complications. Five patients (63%) survived to discharge.

Conclusions

Vacuum-assisted closure for complicated abdominal wounds is safe and successful in neonates of any gestational age and birth weight. It provides effective wound management, even in the presence of stomas or enterocutaneous fistulae.     

Effects of rapid distraction rate on new bone formation during mandibular distraction osteogenesis in goats

Objective

Distraction osteogenesis typically requires a long treatment period, which can lead to bone and soft-tissue infection and considerable patient discomfort. Use of a rapid distraction rate in craniofacial distraction osteogenesis to shorten the distraction period is possible owing to the unique characteristics of craniofacial bones, including an abundant blood supply and rapid bone healing compared with long bones. The effects of using a rapid distraction rate in the treatment of craniofacial deformities are currently unclear, however. The objective of this study was to investigate the effects of a rapid distraction rate on new bone formation during mandibular distraction osteogenesis in goats.

Methods

Sixteen goats were randomly divided into four groups consisting of four goats each. In Groups A, B, and C, the right mandible of each goat was distracted at a rate of 0.8 mm/d, 1.6 mm/d, and 2.0 mm/d, respectively; Group D was the control group and did not undergo distraction. Six weeks after the conclusion of distraction, bone densitometry and three-point bending testing were performed in all groups.

Results

The mean bone density value of goats in Group A was significantly higher than those of all the other groups (p < 0.05), and the mean bone density value of goats in Group C was significantly lower than those of all the other groups (p < 0.05). The mean curve slope, peak stress, bending modulus, and energy to failure values of Groups A, B, and C were all significantly lower than those of the control group (p < 0.05). As the distraction rate increased, the curve slope and peak stress values gradually declined (p < 0.05).

Conclusions

Use of a rapid distraction rate in mandibular distraction osteogenesis may have detrimental effects on the quality of new bone, despite the abundant blood supply of craniofacial bones.     

Universal prophylaxis with gancyclovir preparation is not necessary in our kidney allograft recipients

Background

Cytomegalovirus (CMV) infection is a common cause of morbidity, graft loss, and mortality among kidney recipients due to its direct and indirect influences on organs and systems. In this study, we evaluated CMV infection in transplant recipients in Iran.

Materials and methods

We performed a retrospective study of 104 renal allograft recipients and their donors transplanted between January 2005 and January 2010. We included all patients (recipients and donors) with least one valid laboratory result for CMV immunoglobulin (Ig)G and CMV IgM. We evaluated the occurrence of CMV disease in allograft recipients in at least the first 3 years after renal transplantation.

Results

Fifty-seven renal allograft recipients (54.8%) were males and 47 (45.2%) were females. The overall mean (± standard error) age was 40.32 ± 13.30 years. CMV IgG was positive in 95 cases (91.3%), negative in 9 (8.7%). Serologically, 76.9% patients were D⁺/R⁺ 14.4% D⁻/R⁺, and 8.7% D⁺R⁻. Due to the proccurrence of rejection rendering them high-risk patients for CMV infection about 15% of subjects were treated with anti thymocyte globulin (ATG) followed by prophylactic intravenous gancyclovir for 2 weeks, at doses based on allograft function. Confirmed CMV infection and CMV disease occurred in less than 5% of recipients in the first year after transplantation. About 6% of renal allograft recipients died due to infections during the first 3 years posttransplantation but CMV disease was not confirmed in these patients.

Conclusion

Due to the living donor-based renal transplantation program, the selection of low-risk patients (panel-reactive antibodies 30%), the low percent of D⁺/R⁻ patients (8.7%) and the low use of ATG for induction therapy in the Iranian model, universal prophylaxis with gancyclovir is not routinely recommended for our cases.