Gingival enlargement and its risk factors in kidney transplant patients receiving cyclosporine A

Gingival enlargement is one of the most cumbersome complications of cyclosporine A. It affects patient's life style by impairing the appearance and function of masticatory tract. This study was conducted on a sample of Iranian kidney transplant recipients to determine the frequency and risk factors of cyclosporine-induced gingival enlargement. A total of 200 kidney transplant recipients [mean age, 39.7 +/- 13.2 years] were enrolled in this study. All of the participants were receiving cyclosporine for at least 12 months prior to the study. Factors including age, gender, cyclosporine dose, serum concentration of cyclosporine, duration of immunosuppressive administration, plaque, and gingival indexes were evaluated. Seventy kidney transplant recipients [35%] showed various degrees of gingival enlargement. Serum cyclosporine concentration and the intensity of gingival enlargement [McGraw index] had a significant correlation [r = 0.35, P < .001]. Multiple regression analysis revealed an independent association between gingival enlargement and either serum concentrations of cyclosporine and plaque index [P < .05]. The other variables failed to show a significant relationship with gingival enlargement. The prevalence of cyclosporine-induced gingival enlargement in our patients seems to be almost greater than the prevalence reported in previous studies. There was a significant relationship between cyclosporine immunosuppressive treatment and gingival overgrowth in Iranian kidney transplant recipients

Long-term progression pattern of chronic allograft dysfunction among kidney transplant recipients

There is little data about the pattern of disease progression in kidney transplant recipients with chronic allograft dysfunction [CAD]. Extrapolating the current classification of chronic kidney disease for CAD, we studied the pattern of progression of CAD in 5 stages among our kidney transplant recipients. We performed a retrospective cohort study on 214 kidney transplant recipients with CAD. The selection criteria were a functioning kidney allograft for at least 1 year after transplantation and a progressive decline in allograft function. An event history analysis in survival data was carried out based on the stages of CAD at baseline and the end of the study. At the beginning of the study, 54.7% of the patients had CAD stage 1; 37.9%, stage 2, and 7.5%, stage 3. At the end of study, 10.3% were in stage 2; 39.7%, stage 3; 23.4%, stage 4; and 26.6%, stage 5. Patients with CAD stage 5 were 17.1% of those in stage 1, 32.1% of those in stage 2, and 67.7% of those in stage 3 at baseline. There was a significant correlation between stage of CAD at the beginning of the study and the stage of CAD at the end [r = 0.465, P < .001]. Because the decline in kidney allograft function was relatively faster in advanced stages of CAD, strategies to increase allograft survival by improving the baseline level of allograft function can be more effective than strategies to slow down progression of advanced stages of CAD

Seroprevalence of herpes simplex virus-2 in kidney transplant recipients: a single-center experience

Viral infections are a real threat in kidney transplant recipients because of their immunocompromised condition. This study aimed to evaluate herpes simplex virus-2 [HSV-2] seropositivity among kidney transplant recipients. Serum samples of 91 kidney transplant recipients from Urmia, Iran, were examined serologically for antibodies against HSV-2 using an enzyme-linked immunosorbent assay. The mean time from transplantation at HSV-2 testing was 5.04 +/- 4.45 years. The anti-HSV-2 immunoglobulin G antibody was positive in 5.4% of the kidney transplant recipients. Seropositive patients did not present any clinical manifestations of genital herpes infection. There was no association between HSV-2 seropositivity and age, gender, history of hemodialysis and transplantation, blood transfusion, or immunosuppressive regimen. Seroprevalence of HSV-2 is not high among our kidney transplant recipients. However, it remains a source of concern, considering the compromised immune system in this specific population

Glutathione, glutathione-related enzymes, and total antioxidant capacity in patients on maintenance dialysis

Oxidative stress due to overproduction of reactive oxygen species and impairment in antioxidant defense mechanisms have been suggested as possible factors contributing to the pathogenesis of atherosclerosis in patients with end-stage renal disease. We compared glutathione levels, glutathione peroxidase and glutathione reductase activities, and total antioxidant capacity between patients on hemodialysis and peritoneal dialysis and healthy individuals. Thirty patients receiving regular hemodialysis and 12 on continuous ambulatory peritoneal dialysis were recruited as well as 25 healthy volunteers. Diabetes mellitus, recent febrile or infectious episodes, and hospitalization during the past month were the exclusion criteria. Erythrocyte glutathione level, plasma activities of glutathione peroxidase and glutathione reductase, total antioxidant capacity were determined and compared between the three studied groups. Glutathione levels and glutathione peroxidase activity were markedly lower in the patient groups than in the controls. Conversely, higher activity of glutathione reductase and total antioxidant capacity were noted in the patients than in the controls. There were no significant differences between antioxidant markers of the patients on hemodialysis and peritoneal dialysis. Strong positive correlation were observed between total antioxidant capacity and uric acid in the patients [r = 0.59, P = .045 and r = 0.63, P = .03, respectively]. Although total antioxidant capacity of plasma is increased in patient on dialysis, depletion of glutathione as a key antioxidant component and disturbances in its related enzymes show oxidative stress. This condition may increase the risk of developing cardiovascular disease in patients with end-stage renal disease

Cystic changes of breast in a family with autosomal dominant polycystic kidney disease

Autosomal dominant polycystic kidney disease is associated with cysts in many organs including the liver, pancreas, lungs, spleen, ovaries, testes, thyroid, and uterus. However, there is no report, to our knowledge, of cystic changes of the breast along with this disease. We describe 3 members of a family with multiple bilateral breast cysts in association with autosomal dominant polycystic kidney disease

Posttransplant lymphoproliferative disorders in kidney transplant recipients. An Iranian multicenter experience

Limited data with adequate sample size exist on the development of posttransplant lymphoproliferative disorder [PTLD] in living donor kidney recipients. We conducted a retrospective cohort study on the data of 10 transplant centers to identify the incidence of PTLD in Iran. Data of 9917 kidney transplant recipients who received their kidneys between 1984 and 2008 were reviewed. Fifty-one recipients [0.5%] who developed PTLD were evaluated with a median follow-up of 47.5 months [range, 1 to 211] months. Patients with PTLD represented 24% of all posttransplant malignancies [51 out of 211 cases]. There was no relationship between PTLD and sex [P = .20]. There were no statistically significance differences considering the age at transplantation between patients with and without PTLD. The late-onset PTLD [70.6%] occurred more frequently compared to the early form. There was no signification relationship between early-onset and late-onset groups in terms of clinical course and outcome. In patients who received azathioprine, PTLD was more frequent when compared to those who received mycophenolate mofetil [P < .001]. The lymph nodes were the predominantly involved site [35.3%], followed by the gastrointestinal tract, brain, kidney allograft, lung, ovary, vertebrae, and palatine. Age at diagnosis and the time from transplantation to diagnosis were comparable for various involvement sites of PTLDs. The overall mortality in this series of patients was 51.0%. Posttransplant lymphoproliferative disorder is a rare but devastating complication and long-term prognosis can be improved with early recognition and appropriate therapy