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Saudi Journal of Kidney Diseases and Transplantation
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   2005| October-December  | Volume 16 | Issue 4  
 
 
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ARTICLES
Infectious Complications in Kidney Transplant Recipients: Review of the Literature
Jad A Khoury, Daniel C Brennan
October-December 2005, 16(4):453-497
PMID:18202503
Since the initial successful kidney transplantation in humans, the field of renal transplantation has made significant progress. Patient survival and graft survival have improved tremendously. Our armamentarium of immunosuppressive drugs and antimicrobial agents has expanded, as our understanding of their effects and proper utilization. Enhanced surgical techniques also improved the overall survival of kidney recipients. However, infectious complications remain a major cause of morbidity and mortality in this patient population. In this article, we provide an overview of infections in kidney transplant recipients, a detailed illustration of specific infectious agents with a focus on cytomegalovirus, and finally we lay some general principles for limiting the burden of infectious complications in kidney transplants through proper infection control measures.
  19,302 2,167 -
Infection Control and the Immunocompromised Host
Adel Alothman
October-December 2005, 16(4):547-555
PMID:18202509
  19,081 941 -
Injury to Allografts: Innate Immune Pathways to Acute and Chronic Rejection
Walter G Land
October-December 2005, 16(4):520-539
PMID:18202507
An emerging body of evidence suggests that innate immunity, as the first line of host defence against invading pathogens or their components [pathogen-associated molecular patterns, (PAMPs)], plays also a critical role in acute and chronic allograft rejection. Injury to the donor organ induces an inflammatory milieu in the allograft, which appears to be the initial key event for activation of the innate immune system. Injury-induced generation of putative endogenous molecular ligand, in terms of damage/danger-associated molecular patterns ("DAMPs") such as heat shock proteins, are recognized by Toll-like receptors (TLRs), a family of pattern recognition receptors on cells of innate immunity. Acute allograft injury (e.g. oxidative stress during donor brain-death condition, post-ischemic reperfusion injury in the recipient) induces "DAMPs" which may interact with, and activate, innate TLR-bearing dendritic cells (DCs) which, in turn, via direct allo-recognition through donor-derived DCs and indirect allo-recognition through recipient-derived DCs, initiate the recipient´s adaptive alloimmune response leading to acute allograft rejection. Chronic injurious events in the allograft (e.g. hypertension, hyperlipidemia, CMV infection, administration of cell-toxic drugs [calcineurin-inhibitors]) induce the generation of "DAMPs", which may interact with and activate innate TLR-bearing vascular cells (endothelial cells, smooth muscle cells) which, in turn, contribute to the development of atherosclerosis of donor organ vessels (alloatherosclerosis), thus promoting chronic allograft rejection.
  5,229 900 -
Current Use and Future Trends in Induction Therapy
Flavio Vincenti
October-December 2005, 16(4):506-513
PMID:18202505
Induction therapy has been utilized since the late 70s to reorient the immune system at the time of antigen presentation, decrease acute rejection and improve long-term graft survival. Currently, over 70% of patients undergoing kidney transplantation receive induction therapy. The current agents include OKT3, polyclonal antilymphocyte agents (Thymoglobulin being most frequently used), the anti-interleukin-2 receptor monoclonal antibodies daclizumab and basiliximab and Campath 1H. The current biologic agents are used for short-term therapy although their biologic effects may be prolonged. The next generation of induction agents is being developed for chronic use in calcineurin inhibitor­free and/or steroid-free regimens. These new biologic agents will be developed to simplify immunosuppression regimens, improve compliance and minimize long term toxicities.
  3,921 630 -
Living Donor Renal Transplantation, 1976 - 2003: The Mansoura Experience
Mohamed Adel Bakr, Mohamed Ahmed Ghoneim
October-December 2005, 16(4):573-583
PMID:18202512
Between March 1976 and December 2004, 1690 consecutive allogenic living donor renal transplants were carried out at Mansoura, Egypt. We herewith report on 1600 transplants that had a minimum follow-up period of one year. The overall graft survival rates were 76% and 52% at five and 10-years respectively. The corresponding patient survival rates were respectively 86% and 71%. The projected half-life was 10.7 years for grafts and 18.2 years for patients. Predictors for graft outcome were classified as pre-transplant variables, technical factors or post-transplant predictors. Among the long list of these variables, factors that had a significant impact on outcome by univariate analysis included donor's and recipient's age, donor-recipient consanguinity, HLA-A, cytomegalovirus (CMV) and hepatitis C virus (HCV) markers, ischemia time, primary immunosuppression, ad juvant therapy, total steroid dose within the first three months, number of acute rejection episodes, time to onset of diuresis, hypertension post-transplant, serum creatinine at one year and at last follow-up besides chronic rejection. Only five factors sustained their significance by multivariate analysis: they included recipient's age, primary immunosuppression, post-transplant hypertension and serum creatinine at one year and last follow-up. Some specific complications encountered among the recipients such as hemolytic anemia, post-transplant diabetes mellitus, bone complications, malignancy, erectile dysfunction and surgical complications are discussed. In conclusion, we hope to start the cadaveric donor transplant program soon in our unit. Also, the ambition concerning the transplantation field in the new millennium is to overcome xenotransplantation barriers and to induce immunologic tolerance with neither rejection nor immunosuppression.
  3,940 449 -
Experience of Renal Transplantation at the King Fahd Hospital, Jeddah, Saudi Arabia
Faissal AM Shaheen, Nawal Basri, Zaher Mohammed, Kannam Abdullah, Rashid Haider, Abdulla Awad, Afaf Nasser, Ashraf El Gabarty
October-December 2005, 16(4):562-572
PMID:18202511
The renal transplant program at the Jeddah Kidney Center (JKC), The King Fahd Hospital, Jeddah commenced in November 1990. Since then, 746 patients have undergone renal transplantation in this center. Post-transplantation immunosuppresion in our patients comprised of prednisolone, azathioprine and cyclosporin. More recently, mycophenolate in place of azathioprine and tacrolimus in place of cyclosporine has been used in select groups of patients. Following surgery, delayed graft function was encountered in 131 (17.6%) of our renal transplant patients. Of them, 101 (77.1%) recovered completely while 30 (22.9%) either recovered partially or lost their graft completely and returned to dialysis. We encountered 94 (12.6%) acute rejection episodes. All these patients were treated with methylprednisolone administered in a dose of 250-500 mg intravenously on three consecutive days. Forty-seven (50%) responded favorably while the remaining 47 patients proved to have steroid-resistant rejection. Complete recovery with recovery of normal graft function occurred in 70 cases (74.5%), while 24 cases (25.5%) remained with mild renal impairment. Post-transplant diabetes mellitus was diagnosed in 126 patients (16.8%). Post-transplant hypertension was diagnosed in 399 patients, a prevalence of 53.4%, which agrees with the figures of previous reports. Post-transplant hyperlipidemia was reported in 355 patients (47%). We encountered 12 cases of urine leak and obstruction while lymphoceles were diagnosed in 20 patients. Urinary tract infections were the most prevalent infection in the first month post-transplant and occurred in 59 patients (7.9%). The other common infections in the early post-transplant period were wound infection and infection of subcutaneous collections /hematomas which occurred in 22 patients (2.9%).Overall, the 3, 5 and 10-year graft survival rates are 92%, 90% and 84% respectively. The patient survival after 1, 3, 5 and 10-years post-transplant is 98%, 96%, 90% and 90% respectively. Our results and outcome data of our renal grafts and patients show that renal transplantation is a highly successful modality of renal replacement therapy in our hospital.
  3,969 408 -
Recent Thoughts about the Ethics of Renal Transplantation
Annelies Fitzgerald, David Mayrhofer-Reinhartshuber, Michaela Suske, Robert D Fitzgerald
October-December 2005, 16(4):540-546
PMID:18202508
Ethical controversies in transplantation medicine are frequent and are not only discussed in the medical societies, but also by the pubic at large. Recently, the shortage of donor organs has led to a discussion of the commonly accepted ethical principles applied in transplantation medicine. In this paper, we highlight some of the thoughts expressed in the literature and discuss them in the context of transplantation.
  3,739 380 -
The Kidney Transplant Program at King Faisal Specialist Hospital and Research Center
Khalid Al Meshari
October-December 2005, 16(4):586-597
PMID:18202514
The Kidney Transplant Program at the King Faisal Specialist Hospital and Research Center (KFSH&RC), Riyadh was launched in 1981 when the first living-donor (LD) kidney transplant was performed in the center. The first deceased-donor (DD) kidney transplant was performed in 1982, and the first simultaneous kidney-pancreas (SPK) in 2004. As of February 2005, more than 1,000 kidney transplants (654 living-donor and 347 deceased-donor) have been performed. The Renal Transplant Program at KFSH&RC underwent a major transformation in the year 2001 with the introduction of the concept of designated Renal Transplant Physicians and the emphasis on multi-disciplinary teamwork. This core team of highly qualified, experienced and dedicated physicians worked along side their colleagues, the Renal Transplant Surgeons, to pursue state-of-the-art kidney and pancreas transplantation. A new theme of true collaboration and shared vision was born. This fundamental change has resulted in tripling of the size of the program and in expanding its scope of services to include high-risk patients (immunological and surgical). The above achievements were coupled with outstanding outcome data. The Kidney Transplant Program at KFSH&RC is now a leading transplant center in the region in terms of size and scope of services and it measures up to the top 10% of the leading kidney transplant centers in the world in terms of size, scope of services, and outcome measures. The current program is a multi-disciplinary program composed of three Consultant Surgeons, two Consultant Renal Transplant Physicians, one Associate Consultant Surgeon, two Assistant Consultant Surgeons, two Assistant Consultant Transplant Physicians, two Clinical Co-ordinators, one Nurse Clinician, one Administrative Co-ordinator, one Clinical Pharmacist, one Health Educator, one Social Worker and a qualified Immunologist with HLA/Immunopathology staff.
  3,180 402 -
STUDENTS PUBLICATION SECTION
Ethical Aspects of Stem Cells Research
Rehab A Al-Sayyari
October-December 2005, 16(4):606-611
PMID:18202516
  3,091 333 -
ARTICLES
Post-Transplantation Hypertension
Jose M Morales
October-December 2005, 16(4):443-452
PMID:18202502
  2,985 370 -
Polyomavirus Nephropathy
Emilio Ramos, Cinthia Drachenberg
October-December 2005, 16(4):514-519
PMID:18202506
We have seen the re-emergence of a virus, normally latent in the urinary tract, which becomes activated in renal transplant patients due to potent immunosuppression. Polyomavirus reactivates within the allograft kidney, causing renal dysfunction and graft loss in 40 to70% of patients with overt renal dysfunction and histologically proven Polyomavirus nephropathy. More research and data are needed to further elucidate the pathogenicity of the virus, and to find an effective antiviral agent.
  2,909 328 -
Post-Renal Transplant Proteinuria: The Saudi Experience
Muhammad Ziad Souqiyyeh, Faissal AM Shaheen, Iftikar Sheikh, Abdulla A Al-Khader, Halima Fedhail, Mohammed Al-Sulaiman, Dujana Mousa, Fahd Al-Hawas
October-December 2005, 16(4):556-561
PMID:18202510
We conducted this study to evaluate the risk factors for proteinuria in renal transplant patients. We reviewed the records of the active renal transplant patients at two large transplant centers in Riyadh and Jeddah in Saudi Arabia, transplanted between January 1979 and November 1998. The recipients were grouped according to the presence and magnitude of proteinuria: group I; from zero-0.3 g/L, group II; from 0.4-1.0 g/L, group III; more than one g/L. The records of 340 patients were reviewed in this study. The mean age of the study patients was 39.7 years and the mean duration following transplantation was 82.2 months. There were 209 (61.5%) patients in group I, 92 (27.1%) patients in group II and 39 (11.5%) patients in group III. There was no significant difference among the three groups in terms of mean age, mean duration after transplantation, type of donor (living-related and unrelated, or cadaver), rate of re-transplantation (8.2%), prevalence of hypertension while on dialysis (66.6%), etiology of original renal disease, incidence of acute rejection in the first year, occurrence of diabetes after transplantation (30.6%), or mean serum level of cholesterol (5.9 mmol/L). In comparison to the other groups, group I had significantly more females (44.5 %), more patients with blood pressure within normal limits with or without treatment (56% versus 38% and 17% respectively), lower mean serum creatinine (125 µmol/L versus 149 and 173 µmol/L respectively), higher mean cyclosporine dose (3.28 versus 2.7 and 2.73 mg/kg/day respectively), higher mean prednisolone dose (0.15 mg/kg/day) and less frequency of abnormal electrocardiogram (10% versus 22% and 25% respectively). We conclude that the prevalence of post-transplant proteinuria is high in our study patients. Also, our study suggests that proteinuria may be a marker of renal dysfunction and cardiovascular disease in this group of patients. Further studies are required including allograft histology to delineate better the causes and consequences of post-transplant proteinuria.
  2,854 329 -
Lebanese Experience in Renal Transplantation: Protocol and Complications
Antoine G Stephan
October-December 2005, 16(4):584-585
PMID:18202513
  2,319 302 -
Transplantation Tolerance
Karl L Womer
October-December 2005, 16(4):498-505
PMID:18202504
  2,153 353 -
Renal Transplantation in Seniors - A Review
Ali Alobaidli, Sarbjit V Jassal
October-December 2005, 16(4):431-442
PMID:18202501
  1,942 312 -
DOCTORS DIARY
The Strong Territorial Instincts of Doctors
Abdullah A Al-Sayyari
October-December 2005, 16(4):603-605
PMID:18202515
  1,088 158 -
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