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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 1996  |  Volume : 7  |  Issue : 4  |  Page : 409-411
Medical Complications Following Live Related Renal Transplantation: A Single Center Experience


Jordan Refinery, P.O. Box 176, Zarka, Jordan

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How to cite this article:
Al-Nimri M, Akash N, Gneimat M, El-Lozi M. Medical Complications Following Live Related Renal Transplantation: A Single Center Experience. Saudi J Kidney Dis Transpl 1996;7:409-11

How to cite this URL:
Al-Nimri M, Akash N, Gneimat M, El-Lozi M. Medical Complications Following Live Related Renal Transplantation: A Single Center Experience. Saudi J Kidney Dis Transpl [serial online] 1996 [cited 2020 Jan 21];7:409-11. Available from: http://www.sjkdt.org/text.asp?1996/7/4/409/39415
To the Editor:

Renal transplantation is now considered to be the ideal therapy for patients with end­stage renal disease. In this paper, we present our experience with live related kidney transplantations performed at the King Hussein Medical Center, Amman, Jordan focusing particularly on the medical problems encountered following transplantation. The study included 183 patients who underwent live related kidney transplantation between September 1983 and September 1994; 140 patients (76.5%) were males and 43 (23.5%) were females. The mean age was 36 years and the follow-up period ranged between 14 and 132 months. All patients received prednisolone, started at a dose of 60 mg daily on the first post-operative day and gradually tapered to reach 10 mg/day by the 12th post-­transplant week. Azathioprine was given at a dose of 2 to 3 mg/kg/day and cyclosporine A, which was first introduced in 1986, was given at a dose of 10 mg/kg/day, to be adjusted according to the serum trough level.

During the follow-up period, a total of 54 episodes of acute rejection were encountered. Of them, eight episodes occurred in 27 patients (29.6%) who shared one antigen match allograft, 34 episodes in 89 patients (38.2%) with two antigen match, nine episodes in 41 patients (21.9%) with three antigen match and three episodes occurred in 31 patients (9.7%) with four antigen match. All acute rejection episodes were managed by intravenous pulse methyprednisolone; 42 episodes (77.7%) had good response and 12 (22.3%) had partial or poor response. In general, second or more rejection episodes responded poorly. Thus, in the present survey, acute rejection episodes were more prevalent in patients with one or two antigen match which is in broad agreement with other studies [1] .

Chronic rejection was diagnosed in 27 patients; by kidney biopsy in 20 patients and by exclusion in seven others. Sixteen of these patients are back on dialysis. Thus, chronic rejection is still a great barrier to renal allograft survival with recurrent acute rejection episodes and infections contributing greatly to this complication [1],[2],[3] .

Hypertension following kidney transplantation is usually of multi-factorial etiology. Among the implicated causes are the presence of native kidneys, cyclosporine and steroid therapy, graft renal artery stenosis and chronic rejection [4],[5],[6] . In this study, post-transplant hypertension, defined as dia­stolic blood pressure of more than 100 mm Hg, occurred in 55 patients (30%). In contrast, the blood pressure status improved in 18 patients (10%) following transplantation. Similar findings have been described in earlier reports [7] .

Post-transplant diabetes mellitus (DM), defined as fasting blood glucose >7.8 mmol/L, at least on three occasions, developed in 16 patients (8.7%). Of them, 10 patients (63%) developed DM in the first three months post-transplant. Ten patients required insulin therapy while six needed oral hypoglycemic drugs. The etiology of post-transplant DM is multi-factorial resulting from the interaction of genetic susceptibility, immunosuppressive drugs like cyclosporine A and steroids [8],[9] .

Polycythemia, defined as hematocrit > 52% occurred in 25 patients (13.6%) and was associated with chronicrejection in seven.

The reported prevalence rates of this complication vary from 5-15% in different series. It is caused by a variety of mechanisms including chronic rejection, renal artery stenosis, hydronephrosis and treatment with cyclosporine A and azathioprine [10],[11],[12] .

Other medical complications seen included infections, cardiovascular problems and malignancies [Table - 1].

Infections still constitute an important cause of morbidity and mortality with urinary tract infection (UTI) being the most common cause of bacteremia in the early post-transplant period [13] . A total of 39 (21.3%) patients in our study developed UTI with the commonest involved pathogens being  Escherichia More Details coli and Klebsiella.

Malignancy is well known to occur following transplantation and is related to immunosuppressive treatment [14] . In the present survey we were able to detect three cases of malignancy; Kaposi's sarcoma, non­Hodgkins lymphoma, and squamous cell carcinoma which were detected after a mean of 25.6 months post-transplantation.

A total of 38 patients (20.7%) lost their grafts between 1 and 5 years post­transplantation. The causes of graft loss are presented in [Table - 2]. Fifteen patients (8%) died and the causes of death included infection in eight cardiovascular problems in two, pulmonary embolism in one, gastrointestinal bleeding in two and Kaposi's sarcoma and undetermined in one patient each.

In conclusion, although renal transplantation is currently the management of choice in patients with end-stage renal disease, it is nevertheless complicated by a relatively high incidence of acute and chronic rejections together with a variety of infections and non­infectious complications that could adversely affect patient and graft survival. Newer and possibly more potent immunosuppressive drugs with minimal side effects would minimize such complications.

 
   References Top

1.Paul LC. Chronic renal transplant loss. Kidney Int1995;47:1491-9.  Back to cited text no. 1  [PUBMED]  
2.Almond PS, Matas A, Gillingham K, et al. Risk factors for chronic rejection in renal allograft recipients. Transplantation 1993;55(4):752-7.  Back to cited text no. 2    
3.Hostetter TH. Chronic transplant rejection. Kidney Int 1994;46:266-79.  Back to cited text no. 3  [PUBMED]  
4.Tejani A. Post-transplant hypertension and hypertensive encephalopathy in renal allograft recipients. Nephron 1983;34:73-8.  Back to cited text no. 4  [PUBMED]  
5.Sturroek ND, Lang CC, Struthers AD. Cyclosporine-induced nephrotoxicity and hypertension. Br J Hosp Med 1992;48(8):483-9.  Back to cited text no. 5    
6.Shu KH, Lian JD, Lu YS, Yang CR, Chang CH. Hypertension following successful renal transplantation. Transplant Proc 1992;24(4):1583-4.  Back to cited text no. 6    
7.Curtis JJ, Luke RG, Dustan HP, et al. Remissioof essential hypertension after renal transplantation. N Engl J Med 1983;309(17): 1009-15.  Back to cited text no. 7    
8.Akash N, Smadi I, Malkawi O, Hadidi M, El Lozi M. Diabetes mellitus after kidney transplantation, Journal of the Royal Medical Services inpress.  Back to cited text no. 8    
9.Barri N, Aman H, Adiku W, Baraqdar A,Bonatero I, Nezamuddin N. Diabetes mellitus after renal transplantation. Transplant Proc1992;24(5):1780-l.  Back to cited text no. 9    
10.Perazella MA, Bia MJ. Post-transplant erythrocytosis: case report and review of newer treatment modalities. J Am Soc Nephrol 1993;3(10):1653-9.  Back to cited text no. 10    
11.Ilan Y, Dranitzki-Elhallel M, Rubinger D, Silver J, Popovtzer MM. Erythrocytosis after renal transplantation. The response to the ophylline treatment.Transplantation 1994;57(5):661-4.  Back to cited text no. 11    
12.Gaston RS, Julian BA, Curtis JJ. Post­transplant erythrocytosis: an enigma revisited. Am J Kidney Dis 1994;24(1):1-11.  Back to cited text no. 12    
13.Peterson PK, Anderson RC. Infection in renal transplant recipients. Current approaches to diagnosis, therapy, and prevention. Am J Med1986;81:2-10.  Back to cited text no. 13    
14.Al-Akash N, Gneimat M, Hadidi M, El­ Lozi M Malignancy in renal transplant recipients at King Hussein Medical Center. Saudi J Kidney Dis Transplant 1995;4:400-3.  Back to cited text no. 14    

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Correspondence Address:
Muna Al-Nimri
Jordan Refinery, P.O. Box 176, Zarka
Jordan
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PMID: 18417774

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