Post-kidney transplant malignancy in Egypt has a unique pattern: a 3-decade experience

The prevalence and type of post-transplant malignancy vary among different transplant units. We hereby report on our 30-year single center experience. Between March 1976 and January 2007, 1866 kidney transplantations were carried out [1390 males and 476 females, mean age = 29.84 +/- 10.47 years]. Recipients who developed post-transplant malignancy [74 patients] were evaluated. Furthermore, characteristics of this group were compared to those of the malignancy-free recipients [1792 patients]. Seventy four patients [3.97%] developed 76 malignancies. Kaposi sarcoma was the commonest type [36.8%]. The majority of patients had cutaneous lesions and mortality was relatively low [10.7%]. Skin/oral cancers were the 4th among post-transplant malignancies [9.2%]. The majority of cases were basal cell carcinoma. In our series, two variables were identified as independent risk factors for the development of post-transplant malignancy: age and prior blood transfusion. In conclusion, posttransplant malignancy represents a continuous challenge for the outcome of kidney transplantation. Nevertheless, its prevalence and type vary due to many factors including environmental and genetic factors. In our series, Kaposi sarcoma was the commonest type dictating further evaluation of its preventive strategies and newer therapies

Subclinical neurological affection in patients with chronic renal failure

Chronic renal insufficiency is associated with neurological derangements that involve both central and peripheral nervous systems. Subclinical involvement of the nervous system in uremic adults has been detected by certain neurophysiological techniques. The electrical monitoring of the central nervous system has allowed the early detection of uremic neural injury and the evaluation of various treatments employed. Similar studies concerning Egyptian patients are lacking. Therefore, the aim of the present study was to assess subclinical involvement of the central nervous system in Egyptian patients with different degrees of chronic renal dysfunction. A prospective controlled study was carried out. The study included a patient group and a control group. The patient group consisted of 45 chronic renal failure patients [age ranged from 18 to 67 years]. The patient group was primarily designed to include 3 equal groups according to the degree of chronic renal failure. The control group included 15 healthy volunteers. Both patient and control groups were subjected to a clinical, laboratory and electrophysiological assessment. Cognitive function was assessed using the bedside Mini-Mental State Examination [MMSE]. Electrophysiological assessment included Visual Evoked Potentials [VEPs]. Brainstem Auditory Evoked Potentials [BAEPs] and Event-related Potentials [P300]. The whole patient group as well as the three patient groups were comparable to the control group regarding age and sex. MMSE score and P300 amplitude were significantly lower while P300 latency and reaction time were significantly higher in the whole patient group compared to the control group [p=0.03, <0.001. 0.001 and 0.018. respectively]. Various parameters of VEPs and PAEPs were significantly affected in the whole patient group. Furthermore, significant differences were noted among the three patient groups. A significant positive correlation was found between each of serum creatinine, potassium, calcium and phosphorus and each of VEPs and PAEPs. In conclusion. MMSE, P300 VEPs and PAEPs are simple, non-invasive and reliable tools for detection of subclinical involvement of central nervous system in patients with chronic renal failure. Additionally, the more severe the degree of renal Impairment, the more the affected evoked potential parameters. Further more, some of these tools are more sensitive than others detection of early nervous system affection