Infection with high-risk genotypes of human papillomavirus and cervical cytological findings among kidney transplant recipients in Kenya: a single centre experience

Background: High-risk human papillomavirus (hrHPV) infection is linked with uterine cervix premalignant lesions and invasive carcinoma of the uterine cervix. Methods: Descriptive cross sectional study carried out among female kidney transplant (KTx) recipients in Kenyatta National Hospital, Nairobi-Kenya. We studied the risk factors for acquisition of hrHPV, examined cervical cytology and assayed for 14 hrHPV DNA using Cervista® HPV HR test and Cervista® MTA (Hologic®) automated platforms. Results: The 14-hrHPV genotypes assayed were 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68 and the prevalence rate was 31.25 % (10/32). Abnormal cervical cytology was noted in 4/32 (12.5%) and included low-grade squamous intraepithelial lesion (2/32), atypical squamous cells of undetermined significance (1/32) and atypical glandular cells (1/32). The average age was 41.9years with mean age at first coitus being 20.4 years. Majority of the women 20(62.5%) were married while 8(25%) were single. About 18(56.3%) had only one sexual partner. About 20% of women were nulliparous and 4(12.5%) had a parity of five. Duration sincetransplantation ranged between 1-21 years. Conclusions: The burden of hrHPV and abnormal cervical cytology in our study seemed lower than that reported elsewhere and even in general population. This study may form basis for further studies about HPV infections and carcinoma of the uterine cervix among the kidney allograft recipients in our setting

Adherence to Immunosuppressive Medications in Kidney Transplant Patients at Three Centers in Khartoum State, Sudan: A Cross-sectional Hospital Study

Background: Graft survival post-kidney transplantation is of paramount importance to patients and nephrologists. Nonadherence to immunosuppressive therapy can be associated with deterioration of renal function and graft rejection. This study aimed to evaluate the adherence to immunosuppressive medications in kidney transplant patients at three centers in Khartoum, Sudan. Methods: In this descriptive cross-sectional hospital-based survey, 277 post-kidneytransplant patients were recruited. Data were collected using a questionnaire and analyzed using the SPSS v.23. Our scoring method was calculated based on Morisky Medication Adherence Scale (MMAS-8) related to immunosuppressive medications and was expressed as questions in the questionnaire; every correct answer was given one mark, then the marks were gathered and their summation was expressed. Results: Overall, 33% ,45%, and 22% of the studied participants reported high, medium, and low adherence, respectively. The major factor for nonadherence was forgetfulness affecting 36.1% of those who did not adhere. The cost of the immunosuppressive medications did not negatively affect any of the participants' adherence (100%). However, a significant association was seen between adherence and occupational status, duration of transplantation, shortage of immunosuppressants, recognizing the name of immunosuppressant, side effect, and forgetfulness (P-values = 0.002, 0.01, 0.006 , 0.000, 0.022, and 0.000, respectively). Logistic regression analysis showed a significant association with occupational status, side effects, and forgetfulness.

Suivi post-greffe rénale à Kinshasa : analyse de survie et des facteurs associés à la perte de la fonction rénale du greffon

Contexte et objectifs. La greffe rénale n?est pas encore pratiquée en RDC, ce qui oblige les patients à se faire opérer à l?étranger. Le suivi post-greffe est fait localement par des médecins congolais, mais n?a pas encore été évalué. Nos objectifs étaient de déterminer la survie des greffons et d?identifier les facteurs associés à la perte de la fonction rénale du greffon chez les patients suivis à Kinshasa.Méthodes. Nous avons colligé les dossiers des patients qui ont bénéficié d?une greffe rénale à l?étranger (86% en Inde) et dont le suivi post-greffe a été effectué dans les hôpitaux de Kinshasa entre 2000 et 2017. Les paramètres d?intérêt étaient : l?âge au moment de la greffe, le type de greffe, la spécialité du médecin qui avait sélectionné le donneur et qui a fait le suivi post-greffe à Kinshasa, la régularité de prise des immunosuppresseurs et l?issue de la greffe (complications, rejet ou non, reprise ou non en dialyse). Les facteurs associés à la perte de la fonction rénale du greffon (défini par le rejet, une néphropathie chronique du greffon ou la reprise en dialyse) étaient recherchés en analyse univariée. La survie des greffons a été décrite par la méthode de Kaplan-Meier.Résultats. Au total, 29 sujets (moyenne d?âge à la greffe : 48±15 ans ; 83% d?hommes) ont été ou sont suivis en post-greffe rénale à Kinshasa. La greffe avec donneur vivant a été majoritaire (97%), avec 7% de donation ABO différent.Le rejet a été diagnostiqué dans 24% des cas. Les autres complications rapportées étaient : la néphropathie chronique du greffon (24%), les complications urologiques ou vasculaires per-opératoires (3%), la nécrose tubulaire aiguë transitoire (7%), les cancers (10%), le diabète cortisonique (7%) et la réactivation d?une infection par le VHC (3%). 0nze patients (38%) ont été repris en dialyse. La prise irrégulière des immunosuppresseurs (0R :3,33 ; IC 95% : 1,71-6,49 ; p=0,002) et le suivi par un médecin non néphrologue (OR: 2,88 ; IC 95% : 1,64-5,03 ; p=0,004) étaient les deux facteurs associés à la perte de la fonction rénale du greffon. La survie moyenne des greffons était de 61 mois dans le groupe entier, meilleure lorsque la préparation/le suivi était fait par un néphrologue (83 mois vs 41 mois ; p=0,026).Conclusion. Nonobstant un faible échantillonnage, ces donnent révèlent une moins bonne survie des greffons après la transplantation rénale chez les patients suivis à Kinshasa, notamment lorsque la prise en charge n?est pas faite en milieu spécialisé. Une prise de conscience collective et la nécessité d?établir des normes et de bien préparer les patients s?imposent

New-onset diabetes after transplant: Incidence, risk factors and outcome

Background. The outcome of renal transplantation depends on achieving effective immunosuppression while minimising the consequences of such treatment. The occurrence of new-onset diabetes in the post-transplant period has been associated with several risk factors including some immunosuppressive medication. Better understanding of the clinical and genetic risk factors associated with new-onset diabetes after transplant (NODAT) could enable risk stratification of patients in the pre-transplant period, with the goal of applying measures that will reduce the incidence.Objectives. To ascertain the incidence of and clinical and genetic risk factors that predispose to NODAT, and to examine its effect on the outcome of renal transplantation.Methods. We performed a retrospective cohort review of all renal transplants at Groote Schuur Hospital, Cape Town, South Africa, between 2004 and 2008. Patients who were lost to follow-up or had pre-transplant diabetes or primary non-function were excluded. A subset of the cohort who gave informed consent was enlisted for genetic tests.Results. We identified 111 patients who met the inclusion criteria. The incidence of NODAT was 18.0% (n=20 patients). Risk factors for NODAT included age at transplant (p=0.03), body weight (p=0.04), treatment for acute cellular rejection (p=0.02) and polycystic kidney disease as the cause of renal failure (p=0.005). None of the genes investigated (TCF7L2 rs11196205, rs12255372 and rs7903146 and HNF1ß rs1800575, rs121918671 and rs121918672) was found to be significantly associated with the risk of NODAT. The genotype frequencies for the single-nucleotide polymorphisms studied were closer (although not identical) to those reported for Caucasians than to those reported for the Yoruba (black) population in West Africa. Overall patient survival was 78% at five years, while graft survival was 72%. There was no significant difference in patient or graft survival between the group with NODAT and the group without.Conclusions. NODAT was common in renal transplant recipients. Some risk factors predate transplant and could be used to risk-stratify patients to determine appropriate risk-reduction strategies. The genetic determinants for NODAT in this population may differ from those reported elsewhere. NODAT had no impact on patient or graft survival in this cohort

La greffe rénale dans l'Afrique sub-saharienne : une réalité à développer

De nombreux pays africains se sont équipés pour prendre en charge l'insuffisance rénale chronique terminale (IRCT) en créant des unités de dialyse rénale. Or, la dialyse coûte plus cher que la greffe rénale. Le but de cet article est de faire un état des lieux de la prise en charge de l'IRCT en Afrique sub-saharienne et de discuter des conditions du développement des programmes de greffes rénales dans cette partie du monde

Surgical Complications after Kidney Transplantation

Background: Incidence and severity of surgical complications after kidney transplantation have decreased significantlyThe aim of our work is to evaluate the prevalence of these complications and their impact on graft survival.Methods: This is a retrospective study over a period of 16 years (June 1998 - June 2013) about 40 patients transplanted who presented 55 surgical complications.Results: The mean age of our patients was 35.3 +/- 11.2 years with a sex ratio of 1.4. Initial nephropathy is unknown in 67.5% of cases. Urological complications are found in 19 cases (vesico ureteral reflux in 3 cases; ureteral stenosis in 2 cases and lymphocoele in 14 cases). Vascular complications are found in 36 renal transplants: vascular thrombosis in 3 cases; stenosis of the artery graft in 25 cases; rupture of the graft in two patients and graft hematoma in 6 patients. Mean creatinine was 14.5 +/- 5.3 mg / l in patients with vascular complication and 14.6 +/- 3.5 mg / l in patients with urological complications. Conclusion: Surgical complications remain an important risk factor that can influence the final outcome of the transplantation. Rapid diagnosis and management determine the prognosis

Living kidney donor transplants over a 16-year period in South Africa: a single center experience

BACKGROUND:Kidney transplantation is the treatment of choice for end-stage renal disease (ESRD). The number of patients on the waiting list is increasing due to an imbalance between organ supply and demand. This has led to an increase in the number of living donor transplants in most parts of the world. The benefits to the recipients must, however, be weighed against the risks to the donors. Long-term follow-up of the donors is therefore imperative to ascertain the risks of living kidney donation.MATERIALS AND METHODS:We reviewed the records of 571 potential living kidney donors (PLDs) in Johannesburg hospital over a 16-year period between 1990 and 2005.RESULTS:There were 1030 kidney transplants during this period, with 800 cadaveric and 230 actual living donor (ALD) transplants. There were 571 PLDs; however, 341 (59.7%) withdrew or were withdrawn because of medical and non-medical reasons. Among the 230 ALDs, the mean age of the donors was 35.2 ± 8.3 years; 55% were females; 24% were Blacks. Eighty-five percent were related to the recipients while 15% were unrelated. Mean duration of follow-up was 8.6 ± 6.4 years. The pattern of post-donation follow-up was excellent in 29.7%, adequate in 34% and unacceptable/poor in 36.3%, based on the number of clinic visits post-donation. Hypertension was noted in 24% of the donors during long-term follow-up. Three of the donors also developed significant microalbuminuria.CONCLUSION:There is a need to encourage living kidney donation, especially amongst the Black populations, and to emphasize the value and significance of post-donation follow-up visits to all potential donors

L'érythrocytose après transplantation rénale: étude rétrospective à propos de 11 receveurs

Introduction: L'érythrocytose après transplantation rénale (ETR) survient chez 5 à 20 % des transplantés rénaux. Le but de notre travail est de déterminer la prévalence de l'érythrocytose chez les transplantés rénaux et de connaître les facteurs de risque d'apparition de cette érythrocytose et son impact sur la fonction rénale. Méthodes: Notre étude est rétrospective portant sur 74 transplantés rénaux. Nous avons distingué 2 groupes de patients selon la présence ou non de l'érythrocytose, celle-ci étant définie par un taux d'hématocrite supérieur à 51% selon les recommandations de Kidney Disease Improving Global Outcomes (KDIGO). Résultats: L'érythrocytose est retrouvée chez 11 patients, soit une prévalence estimée à 14,8%. On note une nette prédominance masculine (63,6% vs 36,4%). L'âge moyen de nos patients était de 40 ± 11 ans pour le Groupe1 vs 36 ± 13 ans pour le Groupe 2. La durée de transplantation rénale était de 42 ± 33 mois pour le groupe1 vs 36±26 mois pour le groupe2. Le délai d'apparition de l'érythrocytose par rapport à la transplantation rénale est de 9±7 mois. Aucun facteur de risque n'a été retrouvé dans notre série. Quatre patients ont nécessité des saignées et 9 ont été traités par un inhibiteur de l'enzyme de conversion. La rémission a été notée chez tous les patients. On n'a pas noté de complication thrombo-embolique. Conclusion: L'érythrocytose après transplantation rénale reste une complication, le plus souvent, bénigne. Le traitement est basé sur les saignées mais surtout les inhibiteurs de l'enzyme de conversion

Factors Influencing Attitude Towards Kidney Donation for Transplantation in Ilorin

Background: Chronic renal failure (CRF) is a major cause of premature death and morbidity in Nigeria. Majority of patients with end stage renal disease (ESRD) are in the productive age bracket. Haemodialysis is the most commonly available mode of renal replacement therapy. The quality of life of the few that can afford the cost of haemodialysis is poor when compared to the transplanted patients. A survey is carried out to assess factors affecting attitudes towards kidney donation in Ilorin; Nigeria. Methods: A total of 600 self administered; semi-structured questionnaires were distributed amongst asymptomatic adults (aged 17years) with a response rate of 88. Data analysis was done using statistical package for social studies (SPSS) version 14. Results: There were 282 males (53.4) and 246 females (46.6) with age range of 17-65years and a mean of 34.76+14.9. Two hundred and ninety two (55) were willing to donate a kidney (165 males; 127 females). Majority of the willing donors (86) were between 30 and 50 years of age. Though educational level positively influenced the knowledge about the kidney failure; it did not influence willingness to donation of a kidney. There was religion related gender disparity in the willingness to donate a kidney as more male Christians and Muslims were willing to donation than their females. Conclusions: The main constraints to kidney donation were fear of surgical pains; belief in life after death and uncertainty of donor outcome. This calls for awareness programmes on the safety of kidney donation for transplantation

Effets à long terme des inhibiteurs de l'enzyme de conversion de l'angiotensine et des inhibiteurs des canaux calciques sur la fonction rénale des transplantés rénaux

Contexte : La néphropathie chronique d'allogreffe (NCA) représente la première cause de perte de greffe chez le transplanté rénal. Objectif : Comparer les effets à long terme des IEC et des IC sur la fonction rénale des transplantés rénaux au CHU de Montpellier Patients et Méthodes : De 1986 à 2000, tous les transplantés rénaux qui ont été traités par les IEC ou les IC ont recrutés dans une étude rétrospective. Les patients dont la durée de prescription a été plus d'une année ont été inclus dans l'étude. Pour chaque patient recruté, des facteurs immunologiques et non immunologiques ont été répertoriés. Résultats : 41 patients ont été recrutés pendant la période d'étude, dont 21 étaient traités par IEC et 20 par IC. La prévalence globale de la NCA était de 36.6%. Elle était survenue après un délai de 4094.452 + 148.50 jours. Quand on considère le traitement, la prévalence de la NCA était identique dans les 2 groupes (38.09% contre 35%), tout comme les fonctions rénales (146.06 + 51.91 contre 155 + 75.48 mmol/l), respectivement pour les IEC et les IC. Lorsque seuls les patients qui ont présenté un rejet chronique sont considérés pour chaque groupe, les fonctions de greffon étaient aussi identiques 198.57 + 53.6 contre 229 + 77.64 mmol/l) tout comme le délai de survenue du rejet chronique (4107 + 1580 contre 4123 + 1293 jours), respectivement pour les IEC et les IC. Conclusion : La prévalence de la NCA était identique dans les groupes. L'évolution de la NCA n'a pas été aussi différente dans les deux groupes

Hypertension arterielle apres transplantation renale : Influence du profil tensionnel au stade de dialyse

L'objectif de ce travail cooperatif est d'etudier l'influence d'une hypertension pre-existante en dialyse (D); sur la frequence de l'hypertension arterielle (HTA) chez les transplantes renaux (TR); et de definir ses caracteristiques cliniques

Quality assurance scheme in monitoring renal transplant patients

Quality assessment methodologies for cyclosporin (CYA) monitoring in renal transplant patients were evaluated with a view to identifying more appropriate methods for use in the Middle East; Gulf and North African countries. The quality assessment methods used were radioimmunoassays (RIA125 and RIAH3) and specific (SP) and non-specific (NSP) fluorescence polarization (TDxSP and TDxNSP). Results indicate that TDxSP was the most accurate quality assessment technique while TDxNSP was the least accurate. The drug CYA was also found to have a narrow therapeutic range. These results justify the need for standardization of quality assessment techniques for monitoring CYA in transplant patients

Renal transplantation in a developing country: the Egyptian 17 year experience

This article addresses some of the major epidemiological; clinical; financial and social issues related to the practice of renal transplantation in Egypt. It highlights the limited availability facing the tremendous need for this line of treatment. It provides an overview of the transplant activity in the country; with a brief description of the medical and surgical protocols generally adopted by most groups. As a representative sample; the results of treatment of the Cairo Kidney Centre are given; emphasising the importance of local ecological factors in modifying the outcome; expressed as short and long term patient and graft survival. The effects of the high prevalence of 6 infective agents are described; including cytomegalovirus (CMV); Hepatitis B and C viruses; salmonellosis; tuberculosis and schistosomiasis. [abstract terminated]