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

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

Primary tuberculosis of the penis in a renal transplant patient

Extrapulmonary tuberculosis is a complication of pulmonary tuberculosis that is disseminated through hematogenous or lymphatic system and may involve any organs. We present a case of primary tuberculosis of the penis that is a very rare presentation of tuberculosis. The patient was a 43-year-old man who had kidney transplantation. He admitted with painful ulceration on the glans of penis. Physical examination strongly suggested ulcer lesion that resemble to carcinoma or herpetic ulcer. He did not have any evidence of pulmonary tuberculosis. Having received empiric treatment against herpetic, bacterial and fungal infection, his condition did not improve and he was ordered biopsy of the lesion. Histopathologic studies and PCR revealed Mycobacterium tuberculosis, thus, anti-TB drugs were commenced. The ulcer was improved without any recurrence during a two-year follow up. In patients with kidney transplantation especially in countries endemic for Mycobacterium tuberculosis, chronic ulcer not responding to empiric therapy should be evaluated for Mycobacterium tuberculosis infection

Prediction of rejection in renal transplantation by immune parameters

Monitoring of phenotypic characteristics of T-lymphocytes in peripheral blood is commonly performed to give the clinical parameters in the management of kidney transplant recipients. To predict rejection in renal transplantation by immune parameters. 16 non-diabetic kidney transplant candidates [4 females and 12 males, age = 20-65 yr,-first time transplant] were selected. The transplanted patients were divided into two groups based on the rejection during 3 weeks post transplant: group I [n = 9] without rejection and group II [n = 7] with a rejection episode. Immune parameters including lymphocytes subpopulations [by flowcytometry] and immunoglobulin classes [IgM, IgG, IgA and IgE by nephlometric assay] before and 45 days after transplantation were determined. The results of this investigation showed that the level of immunoglobulin IgG, IgM, IgA and IgE decreased post transplantation due to immunosuppressive drugs. CDS, CD4, CDS T cells count, CD56 NK cells count and CD20 B cells count pre- and post-transplantation did not show any significant differences. The amount of IgE [220 vs. 462 Ill/ml], CDS [62% vs. 69.7%] and CD4 [35% vs. 41.3%] cells increased in group II during rejection episode pre-transplantation. In addition, IgA increased pre-transplantation in group I those without rejection episode in comparison with group II with a rejection episode. Forty five days post transplantation IgA [209 vs. 152 mg/dl], IgG [1009 vs. 703 mg/dl] and CD20 [15% vs. 10%] increased in group 1 patients. It is suggestive that pre-transplantation increases IgE, CDS and CD4 are predictive of acute rejection