Risk factors and laboratory diagnostics for post renal transplant tuberculosis: a case-controlled, country-wide study on definitive cases

Tuberculosis [TB] is a common cause of morbidity and mortality in renal transplant recipients. It is usually misdiagnosed because of lack of medical awareness and its infrequency in renal transplant recipients. 44 cases [0.3%] with post-transplant TB out of 12820 patients who had renal transplants performed between 1984 to 2003 were found from the hospital records of 12 major kidney transplantation centers in Iran. These cases were compared with 184 healthy transplant subjects whose transplants were performed by the same surgical team as the controls. The mean age of cases and controls was 37.7 [13-63] and 35.6 [8-67] years [p=0.3], respectively. The mean duration of pre-transplantation hemodialysis was 30.3 [3-168] months in cases and 18.2[1-180] months in controls [p=0.03]. A past history of tuberculosis was detected in 2 cases and 1 control [p=0.3]. The mean doses of initial and maintenance immunosuppressive drugs in cases and controls were not significantly different. A total of 25 cases [56.8%] and 60[32.6%] controls had rejection prior to diagnosis of TB [p=0.004; OR=2.7, CI95%: 1. 3-5.6]. To our knowledge, this is the first study that demonstrated increasing risk of post-transplant TB by extending the duration of pre-transplant hemodialysis and the number of post-transplant rejection episodes. Further study is needed to clarify our new findings specifically in respect of different immunosuppressive regimens

Refractory anemia after epoetin therapy in patients with chronic renal failure

Anemia is the most frequent complication of chronic renal failure. Epoetin therapy reveals to be an effective therapy; however, development of anti-erythropoietin antibodies has been reported. The present study was conducted to determine the etiology of refractory anemia after Epoetin therapy in patients with chronic renal failure. All adult patients [530 patients] who had been prescribed regular hemodialysis and rHUEPO for at least three months were followed in seven hemodialysis units in Tehran. During a 6- month period, Venofer-Eprex dose and hemoglobin was recorded monthly. Having ruled out hemolysis and iron deficiently state in severe anemic patients, bone marrow examination was ordered. Of 530 patients, 58% were men with median age of 59 years. About%80 of patients had received baseline dose of at least 4000 units Eprex per week, prescribed subcutaneously after hemodialysis. Approximately, 21% were not anemic, while 19% did suffer from severe anemia [Hb<8]. There were statistically significant associations between severity of anemia and age [p<0.001], longer Epoetin therapy [p<0.001], co-treatment with Venofer [p<0.011] and lack of underlying disease [p<0.04]. Bone marrow aspiration was performed for 30 patients and the most frequent findings were anemia due to chronic disease, bone marrow dysplasia, amd megaloblastic anemia. In case of poor response to Epoetin therapy, discontinuing the drug is strongly recommended. Bone marrow examination is an appropriate tool to find the cause of refractoriness to Epoetin therapy in hemodialysis patients

Pre-symptomatic human cytomegalovirus disease diagnosis in renal transplant recipients by the virus DNA PCR

Human cytomegalovirus [HCMV, CMV] is a major infectious complication of renal transplantation. The objective of this survey was to optimize and establish a polymerase chain reaction [PCR] technique for rapid and early detection of CMV disease in renal transplant recipients. In a cross sectional study, a total of eighty-one EDTA-blood samples were collected as simple nonrandomized [sequential] weekly from thirty-seven renal transplant recipients during a 1-6 months period after their transplantation in Kidney Transplant Center of Shaheed Labbafinejad Hospital of Tehran. Peripheral blood leukocytes [PBLs] were isolated and DNA was extracted. HCMV DNA in PBLs was detected by PCR using a conserved set of primers. Amplified fragment was confirmed by restriction fragment length polymorphism [RFLP] and sequencing. Correlation between PCR results and patients' data was analyzed. Twelve patients from thirty-seven renal transplant recipients had positive samples containing HCMV DNA in PBLs [32.4%], whereas, five of them showed symptomatic CMV disease [13.5%] and seven of them did not show symptomatic CMV disease, but had some signs of pre-symptomatic CMV disease. Twenty-five patients had negative PCR results, and all of them did not have symptomatic CMV disease. Considering type one error [alpha = 0.05], a nonparametric Fisher's exact test showed a good correlation between two variables of positive PCR results and symptomatic CMV disease in renal transplant recipients [P=0.002]. In conclusion, establishing methods for early detection of HCMV DNA, even prior to showing symptomatic CMV disease, has been shown to be an effective way for starting antiviral therapy, prior to patients' experience of symptomatic CMV disease