Impact of cigarette smoking on kidney transplant recipients. a systematic review

Cigarette smoking has adverse effects on kidney transplant recipients, causing cardiovascular disease, kidney function impairment, and cancer. However, there are surprisingly few studies on the impact of cigarette smoking among kidney transplant recipients and its consequences after transplantation. We performed a systematic review of the literature to identify the effects of cigarette smoking on patient and graft survival rates among kidney transplant recipients. We searched the PubMed from 1968 to 2009 to identify studies on the effect of cigarette smoking on kidney transplant recipients, using the following keywords: kidney transplantation, cigarette, smoking, tobacco, and nicotine. The electronic and manual searches yielded 357 articles, of which 39 were considered potentially relevant by titles and abstracts and were selected for full text review. Twenty-seven irrelevant reports were excluded. A total of 12 papers were selected for review, comprising of 1801 kidney transplant recipients with a history of smoking. The impact of cigarette smoking on kidney recipient survival was only evaluated by 6 studies and the relative risk of smoking for death was available in 3 reports, varying between 0.8 and 2.2. Cigarette smoking was an independent risk factor for patient death. In addition, on univariable and multivariable analyses, graft survival correlated with a history of cigarette smoking and the relative risk for graft failure ranged from 1.06 to 2.3. Cigarette smoking was associated with an increased risk of death and graft loss. Therefore, every attempt should be made to encourage kidney transplant candidates to stop smoking

Costs and length of hospitalization following kidney transplantation

We assessed the costs of hospital admissions and length of hospital stay in kidney allograft recipients admitted to our center, in order to rank hospitalization causes in terms of costly and prolonged admissions, to bring to light the respective correlates of costly and prolonged admissions, and to investigate the relationship between costs and length of rehospitalizations. Among rehospitalizations, 83.3% of those due to cerebrovascular accident were costly and 51% of those with graft rejection resulted in prolonged hospital stays. Costly admissions had a high regularity in cases of patients older than 60 years, end-stage renal disease due to diabetes mellitus, graft loss, intensive care unit admission, and hospitalizations accompanied by in death. Prolonged stays were more common in those who were admitted to intensive care unit and those who ultimately died. The Costs showed a significant correlation with the length of rehospitalization [r = 0.626, P = .001]. The strong correlation between the length of hospitalization and posttransplant hospitalization costs means that the former should be curtailed by focusing on such correlates of high-cost admissions as high age and diabetes mellitus as the cause of kidney failure

Survival of rehospitalized kidney allograft recipients

Undergoing transplantation is extremely stressful, and a recipient is likely leave the hospital burdened with fears of an uncertain future. A paucity of knowledge on the long-term survival of rehospitalized kidney transplant recipients is the likely the reason that physicians fail to provide this group of patients with promising information and reassurance about their future. We sought to describe the long-term patient and graft survival after nonfatal rehospitalization in kidney recipients with a normal graft function after discharge. We reviewed the follow-up data [from the time of discharge after first rehospitalization] of 253 kidney transplant recipients who had been discharged from rehospitalization with a normal kidney function [serum creatinine less than 1.6 mg/dL]. Patient and graft survival rates 6 months and 1, 2, and 5 years after discharge were determined. The mean duration of follow-up [from the time of discharge after the first rehospitalization] was 38.9 +/- 11.2 months [range, 6 to 84 months]. The overall patient survival rates were 98%, 97%, 95%, and 93% at 6 months, 1 year, 2 years, and 5 years, respectively. Graft survival rates at these times were 88%, 82%, 77%, and 63%, respectively. After the first posttransplant rehospitalization, 54 patients [21.9%] experienced more hospitalization episodes [mean, 2.6 +/- 2.0 times], while 193 [78.1%] had no further hospitalizations during the follow-up period. Kidney transplant recipients who are rehospitalized should be reassured about favorable chances of survival if discharged with a normal graft function

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

Percutaneous nephrostomy for treatment of posttransplant ureteral obstructions

We report our experience with percutaneous management of urologic complications following kidney transplantation. Of 1402 consecutive kidney transplant recipients form living donors at our hospital, 21 required percutaneous nephrostomy [PCN] for the treatment of obstructive lymphocele [n=11], urinary calculus [n=8], and stricture of ureterovesical junction anastomosis [n=2]. We had also 11 kidney recipients with urine leakage from the ureter who were treated only by indwelling ureteral catheter. Urinary complications were diagnosed based on the clinical symptoms, elevated serum creatinine levels, ultrasonography and renal scintigraphy. Patients with ureteral obstruction or urine leakage were compared with kidney recipients without urologic complications. A mean decline of 3.1 +/- 3.0 mg/dL [range, 0.1 to 10.7 mg/dL] in serum creatinine level was detected [P<0.001] after PCN. All of the patients remained symptom free for a mean follow-up period of 34.2 +/- 20.1 months [range, 3 to 81 months]. Patients and graft survival rates were not different between the patients undergoing PCN and other kidney recipients. The only difference was the history on using antilymphocyte globulin which was significantly more frequentin the patients of the PCN group [P=0.01]. In our experience PCN is a safe and effective method for the treatment of ureteral obstructions in kidney allograft recipients. This method provided long-term success with few recurrences and low morbidity and mortality rates