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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2008  |  Volume : 19  |  Issue : 6  |  Page : 1015-1019
Iranian kidney transplantation society seeks to answer its questions through a link between scientists and young researchers


Clinical Research Unit and Baqiyatallah University of Medical Sciences, Tehran, Iran

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   Abstract 

The Iranian Society of Organ Transplantation (ISOT), in an effort to further invest in transplantation-related research, established a scientific link with Baqiyatallah University of Medical Sciences (BUMS) at the beginning of the year 2006. BUMS instituted a network encom­passing 1) Nephrology and Urology Research Center (NURC), directed by prominent nephro­logists and urologists, 2) Clinical Research Unit (CRU), managed by qualified and competent young researchers, and 3) Medicine and Health Promotion Institute (mhpinstitute.ir ), which is a private research and development institute. Study titles were then extracted in discussion sessions between the NURC and CRU, the latter also being responsible for writing research protocols to be reviewed by the University ethical board for research grants. The CRU has hitherto carried out several research grants based on the following criteria: 1) accommodating the main objectives of the ISOT, i.e. the improvement in survival rates and well-being standards as well as the mini­mization of costs, 2) conducting low-budget yet cutting-edge research, and 3) ensuring publi­cation-worthy study titles. This is a review of the tie between scientists and research and metho­dological assistants, which has already come to realization in the face of financial constraints.

Keywords: Young researchers, Scientists, Medical Research, Iran, Kidney transplantation

How to cite this article:
Einollahi B, Bahaeloo-Horeh S, Assari S, Ghanei M. Iranian kidney transplantation society seeks to answer its questions through a link between scientists and young researchers. Saudi J Kidney Dis Transpl 2008;19:1015-9

How to cite this URL:
Einollahi B, Bahaeloo-Horeh S, Assari S, Ghanei M. Iranian kidney transplantation society seeks to answer its questions through a link between scientists and young researchers. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2020 Nov 27];19:1015-9. Available from: https://www.sjkdt.org/text.asp?2008/19/6/1015/43486

   Introduction Top


The overriding concern of medicine is to offer humans a longer and better life. [1] Longevity is synonymous with lower mortality and higher survival rates with decreased morbidities andelevated mental and physical well-being stan­dards. [2]

In today's economy-oriented world, health economy involves cost limitation of any diag­nostic, treatment, and rehabilitation modality tends to be a high priority. [3]

A first-choice treatment modality for patients with chronic renal failure, [4] kidney transplan­tation in Iran is mainly the responsibility of The Iranian Society of Organ Transplantation (ISOT). The ISOT has invested further in re­search in recent years with the aim of up­grading the country's health care system. To that end, the ISOT established a close tie with the reputable Baqiyatallah University of Medi­cal Sciences (BUMS) at the beginning of the year 2006. The BUMS Research Deputy esta­blished a network comprising 1) the Nephro­logy and Urology Research Center (NURC), administered by high-ranking nephrologists and urologists with numerous publications in the field, and 2) the Clinical Research Unit (CRU), managed by qualified young resear­chers with remarkable previous research expe­rience. The CRU is also supported by Medi­cine and Health Promotion Institute, which is a private research and development institute (www.mhpinstitute.ir ).

Discussion sessions between the NURC and CRU for the extraction of study titles and research protocols, written by CRU, were re­viewed by the ethical board of the University for Grants. The CRU, under the auspices of the NURC and BMSU, has thus far conducted several research grants based on the following criteria: 1) accommodating the main objectives of the ISOT, i.e. the improvement in survival rates and well-being standards as well as the minimization of costs; 2) conducting a low­budget yet cutting-edge research, and 3) ensu­ring publication-worthy study titles.

Here we present a review of this link between scientists and research and methodological assistants, which has proved to be a great success story in a developing country with its own financial constraints. For example, 42 of 54 abstracts submitted to the 10th Middle East Society for Organ Transplantation (MESOT) Congress were accepted, and later 30 full pa­pers based on these studies were submitted to the Journal of Transplantation Proceedings and published in May 2007 issue. From further submissions to other journals, another 5 ma­nuscripts have met publication criteria from other MEDLINE- or ISI-indexed journals at the time of writing this paper. Another 10 manuscripts are in the process of review in peer review journals.


   CRU activities Top


The CRU took the following steps before designing any research:

1. A survey of previous transplantation research in Iran : We carried out a systematic bibliometric study into the existing literature so as to identify the areas that lacked in re­search and empirical data in the country's renal transplantation system. [5] The survey revealed that despite the great interest shown in the topic of transplantation, the Iranian researchers were inclined to neglect certain fields of trans­plantation. Nevertheless, we found a pool of invaluable information that could be used by other countries, not least those in the MESOT countries. [6]

2. An assessment of the quality of the pre­vious MESOT Congress : Presenting the re­sults in the MESOT Congress being a priority for the CRU, an evaluation of the quality of the abstracts presented in the previous 9th Congress of the MESOT helped highlight the weak and strong points of the materials. [7]

3. A determination of the stability of our kidney transplantation data set : By utilizing meticulous analysis we succeeded in demons­trating the high stability of our transplantation data set. Needless to say, the higher the accu­racy of the databank, the higher is the accuracy of the analysis of the findings. [8]

4. A study into the ethical issues in the Iranian model of kidney transplantation : Iran has witnessed a rapid growth in kidney transplantation in recent years: [9] the Iranian health care system covers the costs and pro­vides a generous insurance coverage regardless of the socio-economic status of the candidates. It is, therefore, expected that a higher number of transplantation candidates with a low socio­economic status will seek transplantation in the future. [10] We noted a surge in the deceased­donor kidney transplantation in Iran thanks to an intensive media campaign for heightening public awareness, recruitment of more trans­plantation centers, enhancement of the system of cadaveric donations registration, and faci­litation of the process of finding and relating the donor with the potential recipient. [11] Iran has sought to design models tailored to the local needs and conditions and has called for the establishment of an international committee on transplantation in refugees. [12] None­theless, it is a field that has yet to be fully explored and lacks a standard protocol. [13]

The CRU, then, took the following steps to design research:

1. An investigation into kidney transplan­tation survival rates:

1.1. Overall outcome
: We entered the largest number of renal transplant subjects into our survival analysis (the latest and largest in the country thus far). One-, 5-, 10-, and 15-year graft survival rates were 85%, 68%, 46%, and 24%, respectively; and patient survival rates were 93%, 86%, 79%, and 66%, respectively. [14]

We also found that C2, but not C0, in the early 6 months' post-transplantation period [15] and the number of Human Leukocyte Antigen type B (HLA-B) mismatches, [16] but not preg­nancy, [17] affected long-term graft survival. The graft survival in pediatric transplantation was poor, which could be due to a whole host of reasons, such as insufficient skill in our trans­plantation teams. [18]

1.2. Inpatient outcome : A simple demographic and clinical variables helped us design a pre­diction model to estimate the probability of inpatient mortality and graft loss. [19] We also noted that the ranking in our inpatient morta­lity was totally different from that of causes of death in renal recipients. Furthermore, we found such rare complications as cerebrovas­cular accident (CVA) and surgical compli­cations to have high fatality rates. [20]

1.3. Post-renal transplantation re-hospitali­zations : We demonstrated that the shift in the immunosuppression protocol from azathioprine (AZA) to mycophenolate mofetil (MMF) in 2000 brought about two noticeable changes worldwide: an increase in the rate of infection and re-hospitalization and a decrease in the rate of graft rejection. [21] In another study, we concluded that taking the variables of age and diabetes as the cause of end-stage renal disease (ESRD) into account could significantly im­prove the diagnosis of cytomegalovirus (CMV) disease in post-renal transplantation re-hospi­talized patients. [22] In addition, the most fre­quent site of mucormycosis infection was the lungs in our patients, with a high fatality. [23] In the case of autosomal dominant polycystic kidney disease (ADPKD) patients, we arrived at the conclusion that without elective colec­tomy for diverticulitis, the fatal complications were not rare. [24]

2. Morbidity in kidney transplantation:

2.1. Somatic comorbidities
: The prevalence of medical comorbidities in our kidney-trans­plant recipients was high; the highest preva­lence was due to non-ischemic heart diseases, followed by visual disturbances, and musculo­skeletal disorders. [25] This directed the trans­plantation team to a multidimensional approach.

2.2. Psychological status : We discovered that restlessness and psychomotor agitation imposed high degrees of morbidity on renal-transplant recipients. [26] Due to the fact that depressive symptoms did not seem to improve after renal transplantation, we screened our renal reci­pients for it, especially those with a history of rejection or young age at the time of transplan­tation. [27] We noted that anxiety and depression were affecting different aspects of our pa­tients' well-being as the quality of life, sleep, marital relation, and sexual relationship. [28] We concluded that increasing age did not result in poor Health-Related Quality of Life (HRQoL) in all domains, which further favored the case for renal transplantation in the elderly. [29] We provided equations for the prediction of poor post-transplantation HRQoL [30] and marital rela­tionship [31] by using simple variables with ac­ceptable accuracy, which can be used in deci­sion-making in clinical settings. These two factors are of great importance because achie­ving a good HRQoL is one of the main aims of transplantation, [30] and marital relationship is correlated with mortality, morbidity, immune function, and non-compliance. [31] Our assess­ment of the quality of sleep in our kidney­transplant patients revealed that a poorer qua­lity of sleep was associated with higher medi­cal comorbidity and poorer emotional state [32] and that it was more prevalent in recipients with ESRD secondary to hypertension. [33] We illustrated that chronic pain decreased the quality of life in renal transplantation patients, albeit less than that experienced by patients under chronic hemodialysis. [34] We stressed the need for further attention to renal-transplant recipients with diabetes-induced ESRD in follow-up programs. [35] We also revealed that improvement of sexual function of female and male kidney-transplant recipients required spe­cial attention to mental and physical health, respectively. [36]

2.3. Cost of kidney transplantation : Given the increasing prevalence of diabetes mellitus (DM) in some countries, we found that the association between hospitalization costs of post-transplant patients and DM is of great economic importance to many transplantation centers. [37] Age of the recipients at the time of transplantation was also a main factor affec­ting post-renal transplantation re-hospitalization in our patients. [38] We noted that the severity of pain seemed to amplify the amount of health care use among kidney-transplant patients. [39] Our investigations showed that prolonged hospital stays accounted for more than 62% of all hospital costs; however, they comprised only 26% of the kidney-transplant recipients. [40] Hospital statistics can be employed as a valua­ble tool for health care policy makers to moni­tor transplantation outcomes. [41]

We conclude that a network of well-esta­blished scientists and young researchers, eager to conduct research and to publish was rea­lized in Iran. We advocate the utilization of such models by other countries' health care systems under the supervision of universities.

 
   References Top

1.The Benefits of Medical Research and the Role of the NIH. Office of the Chairman, Connie Mack. May 17, 2000.  Back to cited text no. 1    
2.Periago MR. Longevity and the quality of life: A new challenge for public health in the Americas. Pan Am J Public Health 2005;17 (5/6):297-8 .  Back to cited text no. 2    
3.Linjer E, Jornmark J, Hedner T, Jonsson B; Stop Hypertension-2 Group. Predictors for high costs of hospital care in elderly hypertensive patients. Blood Press 2006;15(4):245-50.  Back to cited text no. 3    
4.Suthanthiran M, Strom TB. Renal trans­plantation. N Engl J Med 1994;331(6):365-7.  Back to cited text no. 4    
5.Petrak J. Bibliometric indicators in evaluation of research activity. 1. Publishing and evalua­tion of research. Lijec Vjesn 2001;123:77-81.  Back to cited text no. 5    
6.Aslani J, Khedmat H, Assari S, et al. Trans­plantation research in Iran: a bibliometric study. Transplant Proc 2007;39(4):788-9.  Back to cited text no. 6    
7.Nourbala MH, Einollahi B, Khoddami-Vishte HR, Assari S, Simforoosh N. IX(th) MESOT Congress: Quality of the Abstracts. Transplant Proc 2007;39(4):786-7.  Back to cited text no. 7    
8.Hollisaaz MT, Khedmat H, Effatmanesh-Nik M, et al. Data-entropy analysis of renal trans­plantation data. Transplant Proc 2007;39(4): 930-1.  Back to cited text no. 8    
9.Noorbala MH, Rafati-Shaldehi H, Azizabadi­Farahani M, Assari S. Renal transplantation in Iran over the past two decades: A trend analysis. Transplant Proc 2007;39(4):923-6.  Back to cited text no. 9    
10.Nourbala MH, Einollahi B, Kardavani B et al The cost of kidney transplantation in Iran. Transplant Proc 2007;39(4):927-9.  Back to cited text no. 10    
11.Einollahi B, Nourbala MH, Bahaeloo-Horeh S, Assari S, Lessan-Pezeshki M, Simforoosh N. Deceased-donor kidney transplantation in Iran: trends, barriers and opportunities. Indian J Med Ethics 2007;4(2):70-2.  Back to cited text no. 11    
12.Einollahi B, Noorbala MH, Kardavani B, et al. Kidney transplantation: is there any place for refugees? Transplant Proc 2007;39(4):895-7.  Back to cited text no. 12    
13.Nourbala MH, Ghaheri H, Kardavani B. Our experience with third renal transplantation: results, surgical techniques and complications. Int J Urol 2007;14(12):1057-9;  Back to cited text no. 13    
14.Einollahi B, Pourfarziani V, Ahmadzad-Asl M, et al. Iranian model of renal allograft trans­plantation in 3028 recipients: Survival and risk factors. Transplant Proc 2007; 39(4):907-10.  Back to cited text no. 14    
15.Nemati E, Einollahi B, Taheri S, et al. Cyclosporine trough (C0) and 2-hour postdose (C2) levels: Which one is a predictor of graft loss? Transplant Proc 2007;39(4):1223-4.  Back to cited text no. 15    
16.Pourfarziani V, Einollahi B, Assari S, et al. A link between the outcome of living unrelated kidney transplantation and HLA compatibility: a preliminary report. Arch Med Sci 2007; 3(2):108-111.  Back to cited text no. 16    
17.Kashanizadeh N, Nemati E, Sharifi-Bonab M, et al. Impact of pregnancy on the outcome of kidney transplantation. Transplant Proc 2007; 39(4):1136-8.  Back to cited text no. 17    
18.Torkaman M, Khalili-Matin-Zadeh Z, Azizabadi­Farahani M, et al. Outcome of living kidney transplant: pediatric in comparison to adults. Transplant Proc 2007;39(4):1088-90.  Back to cited text no. 18    
19.Nemati E, Pourfarziani V, Jafari AM, et al. Prediction of inpatient survival and graft loss in rehospitalized kidney recipients. Transplant Proc 2007;39(4):974-7.  Back to cited text no. 19    
20.Khedmat H, Araghizadeh H, Assari S, Moghani-Lankarani M, Aghanassir M. Which primary diagnosis has the highest in-hospital mortality rate for kidney recipients? Transplant Proc 2007;39(4):901-3.  Back to cited text no. 20    
21.Pourfarziani V, Panahi Y, Assari S, Moghani­Lankarani M, Saadat SH. Changing treatment protocol from azathioprine to mycophenolate mofetil: Decrease in renal dysfunction, increase in infections. Transplant Proc 2007;39(4): 1237-40.  Back to cited text no. 21    
22.Nemati E, Eizadi M, Lankarani MM, et al Cytomegalovirus disease after kidney trans­plantation: Clues to accurate diagnosis. Transplant Proc 2007;39(4):987-9.  Back to cited text no. 22    
23.Aslani J, Eizadi M, Kardavani B, et al. Report of Mucormycosis after kidney transplantations. Scan J Infect Dis 2007;39(8):703-6.  Back to cited text no. 23    
24.Pourfarziani V, Mousavi-Nayeeni SM, Ghaheri H, et al. The outcome of diverticulosis in kidney recipients with polycystic kidney disease. Transplant Proc 2007;39(4):1054-6.  Back to cited text no. 24    
25.Hollisaaz MT, Aghanassir M, Lorgard­Dezfuli-Nezad M, Assari S, Hafezie R, Ebrahiminia M. Medical comorbidities after renal transplantation. Transplant Proc 2007; 39(4):1048-50.  Back to cited text no. 25    
26.Noohi S, Tavalaii SA, Bazzaz A, Khoddami­Vishteh HR, Saadat SH. Restlessness and psychomotor agitation after kidney trans­plantation: Their impact on perceived health status. Psychol Health Med 2008;13(2):249-56.  Back to cited text no. 26    
27.Karaminia R, Tavallaii SA, Lorgard-Dezfuli­Nejad M, et al. Anxiety and depression: a comparison between renal transplant recipients and hemodialysis patients. Transplant Proc 2007;39(4):1082-4.  Back to cited text no. 27    
28.Noohi S, Khaghani-Zadeh M, Javadipour M, et al. Anxiety and depression are correlated with higher morbidity after kidney transplantation. Transplant Proc 2007;39(4):1074-8.  Back to cited text no. 28    
29.Noohi S, Karami GR, Lorgard-Dezfuli-Nejad M, Najafi M, Saadat SH. Are all domains of quality of life poor among elderly kidney recipients? Transplant Proc 2007;39(4):1079-81.  Back to cited text no. 29    
30.Khedmat H, Karami GR, Pourfarziani V, Assari S, Rezailashkajani M, Naghizadeh MM. A logistic regression model for predicting health-related quality of life in kidney transplant recipients. Transplant Proc 2007; 39(4):917-22.  Back to cited text no. 30    
31.Fathi-Ashtiani A, Karami GR, Einollahi B, et al. Marital quality in kidney transplant recipients: Easy to predict, hard to neglect. Transplant Proc 2007;39(4):1085-7.  Back to cited text no. 31    
32.Kachuee H, Ameli J, Taheri S, et al. Sleep quality and its correlates in renal transplant patients. Transplant Proc 2007;39(4):1095-7.  Back to cited text no. 32    
33.Ameli J, Kachuee H, Assari S, et al. Does etiology of end-stage renal disease affect sleep quality in kidney transplant recipients? Transplant Proc 2007;39(4):1091-4.  Back to cited text no. 33    
34.Nourbala MH, Hollisaaz MT, Nasiri M, et al. Pain affects health-related quality of life in kidney transplant recipients. Transplant Proc 2007;39(4):1126-9.  Back to cited text no. 34    
35.Ramezani M, Ghoddousi K, Hashemi M, et al. Diabetes as the cause of end-stage renal disease affects the pattern of post kidney transplant rehospitalizations. Transplant Proc 2007;39(4):966-9.  Back to cited text no. 35    
36.Tavallaii SA, Fathi Ashtiani A, Nasiri M, Assari S, Maleki P, Einollahi B. Correlation between sexual function and post-renal transplant quality of life: Does gender matter? J Sex Med 2007;4(6):1610-8.  Back to cited text no. 36    
37.Ghoddousi K, Ramezani MK, Assari S. Primary kidney disease and post-renal trans­plantation hospitalization costs. Transplant Proc 2007;39(4):962-5.  Back to cited text no. 37    
38.Nemati E, Saadat AR, Hashemi M, Khoddami­Vishteh HR, Moghani-Lankarani M. Causes of rehospitalization after renal transplantation; Does age of recipient matter? Transplant Proc 2007;39(4):970-3.  Back to cited text no. 38    
39.Hollisaaz MT, Noorbala MH, Irani N, et al. Severity of chronic pain affects health care utilization after kidney transplantation. Trans­plant Proc 2007;39(4):1122-5.  Back to cited text no. 39    
40.Naderi M, Aslani J, Hashemi M, et al. Prolonged rehospitalizations following renal transplan­tation: causes, risk factors, and outcomes. Transplant Proc 2007;39(4):978-80.  Back to cited text no. 40    
41.Pourfarziani V, Rafati-Shaldehi H, Assari S, MT, et al. Hospitalization databases: A tool for transplantation monitoring. Transplant Proc 2007;39(4):981-3.  Back to cited text no. 41    

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Correspondence Address:
Shervin Assari
Medicine and Health Promotion Institute, Vanak Sq., Mollasadra Ave. 19945-587, Tehran
Iran
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