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

Basiliximab reduces the incudence of acute cellular rejection in live related donor kidney transplatation; a single centre experience

The aim of this work is to determine the therapeutic benefit [s] of basiliximab induction therapy in the living related donor kidney transplantation One hundred adult recipients of their first kidney allograft were randomized to two treatment groups, one group received basiliximab and the second served as a control. All patients received a maintenance triple immunosuppressive therapy [steroids, cyclosporine, microemulsion and azathioprine]. The patients were followed up for a minimum of one year. The end points of evaluations included the incidence of acute rejection episodes, severity of rejection, cumulative steroid dose received, patients and graft survival. Basiliximab significantly reduced the proportion of patients who experienced of patients who experienced an acute rejection [18/50] when compared to the control group [31/50]. The cumulative steroid dose at 3 months as well as at 12 months was significantly lower in the basiliximab group. The overall incidence of post-transplant complications was comparable among the two treatment groups. Prophylactic basiliximab is well tolerated and significantly reduces the incidence of acute refection episodes in living related donor kidney transplantation

Sequential immunochemotherapy [Bacillus Calmette-Guerin and Epirubicin] versus chemoimmunotherapy [Epiviribicin and bacillus calmette-guerin] for stages pTa and pT1 transitional cell carcinoma of the bladder

Sequential immuno-chemotherapy using bacillus Calmette-Guerin [BCG] and epirubicin has been found to be as effective as and less toxic than BCG alone in recurrence prophylaxis of superficial bladder tumors. Some investigators speculated that: if intravesical chemotherapy is instilled before immunotherapy it will produce inflammation and denudation of the mucosa so that the submucosa will be ready for a potentiated effect of the immunotherapy. To test this hypothesis we conducted this study. Between Jan. 1993 and July 1999 a prospective randomized trial was performed on 159 patients who underwent transurethral resection [[TURBT] of bladder transitional cell carcinoma [stages pTa and pTl]. Following TURBT, patients were randomly allocated to 2 treatment arms. Patients in arm I [78] received weekly doses of 150 mg BCG alternating with 50 mg epirubicin for 6 weeks. Maintenance was carried out by a monthly course of the same doses of BCG alternating with epirubicin for 10 months. Patients in arm II [81] received thy same protocol, but with a reversed order with epirubicin being used initially. 154 patients; 108 men and 36 women, mean age 59 years, were evaluable. 5 patients were excluded in view of severe side effects [3 in arm 1 and 2 in arm II]. Follow up ranged from 12 to 74 months [mean 38 +/- 16.9]. Recurrence rate was] comparable in the 2 arms: 11/75 [14.7%] and 13/79 [16.5%], respectively. Recurrence rate per 12 patient months was again; comparable: 0.08 and 0.09, respectively. Interval to first recurrence and progression rate were also comparable. Toxicity developed in 29% and 26.6% of patients, respectively [p > 0.05]. Both treatment policies were comparable in terms of efficacy and loxicity

Mansoura ATG and steroid resistant rejection

ATG is one of the most effective therapeutic agents in the treatment of acute renal allogrqft rejection, especially when the episode is resistant to steroids. Anti thymocyte globulin [ATG] is a hyperirnmune serum produced in rabbits against purified human thymus cells. Fifteen patches of ATG were prepared locally in our lab. Antibody production was done by injection of purified human thymus cells into about 10-12 rabbits/patch. Adsorption, fractionation and purification of rabbit serum, antibody assays, and quality control tests were done. Our ATG was utilized in 20 patients suffering from sterioid resistant rejection [SRR]. Monitoring of the drug by T cell subsets analysis and Anti ATG antibodies revealed depletion of the total T lymphocytes especially in the early doses beside absence of anti ATG antibodies without any side effects of the preparation on the other haematologic series. Regarding the clinical efficacy of our ATG in reversing SRR, 80% of cases respond completely while partial response was noted in 10% and another 10% showed failure. In conclusion our ATG is as effective as other ATG in saving renal transplantation otherwise the graft will be lost

Haemolytic anaemia after ABO-mismatched living-donor kidney transplantation

ABO.mismatched transplants are used frequently. Acquired haemolytic anaemia have been reported after ABO mismatched transplantation. Among 214 ABO.unmatched living-donor kidney transplants tS, 10 cases with cyclosporine based therapy developed haemolysis All studied patients had pre-transplant non specific blood transfusion and received kidneys from one haplotype HLA mismatched living donors. There were 164 males and 50 females. while the mean age was 30.41 years. CsA was stopped in patients treated with triple Immunosuppression while the patients received Pred-CsA were switched to conventional immunosuppression 6 patients were transfused with washed O cells and no plasma exchange was required. The prognosis was excellent in 9 patient, and one died from severe haemolysis. The haemolytic anaemia was more frequent among blood group A recipients [60% of our cases] and more severe among recipients with blood group B. Univariate analysis demonstrated significant impact for recipient age. donor sex, number of pretransplant blood transfusions. primary immunosuppression, time to onset of diuresis, recipient and donor blood groups. On the other hand, multivariate analysis restricted the significance to blood group of donor and recipient. time to onset of diuresis and primary immunosuppression. ABO unmatched kindray transplantation had no impact on patient survival, mean while the graft survival appeared to be better among unmatched ABO group in comparison to the same blood group recipients

application of the modified rectal bladder in management of the compromized urethral damage

Failure to repair the traumatic injuries of the lower urinary tract with loss of urethral sphincteric function usually puts forward the subject of urinary diversion. Ten males and five females presented with extensive urethral damage and with or without vesical fistulas. All attempts of repair were exhausted before the decision of diversion was planned. Continent urinary diversion using the modified rectal bladder [The augmented and valved rectum] was utilized. The procedure entailed functional isolation of the rectum without terminal colostomy and depended on colorectal intussuscepted valve. All the patients are currently evaluated with follow up periods ranging 10-56 months. Evidences proved the effectiveness of the colorectal valve in providing non impeded fecal stream to the functionally isolated rectal reservoir. Continent status is attributed to the ileal patching that produces a low pressure reservoir against the effective high anal resistance. The results support the distinct superiority of the modified rectal bladder to either the conventional methods of urinary diversion to the rectum or the abdominal reservoir with continent catheterizable stomas

Impact of donor age on the outcome of graft after kidney transplantation

Ninety patients who had received kidneys from living relative donors were studied to define the effect of age of the transplanted graft on the outcome of renal transplantation. All patients were subjected to a variety of investigations concerned with evaluation of the graft outcome over extended period of time. Moreover, a composite analysis of functional renal reserve was carried out, based on estimates of maximum glomerular filtration rates obtained after infusion of dopamine and amino acids. Analysis of data showed that the graft function was superior in recipients of kidneys from donors below the age of 40 years compared to those above 50 years at all the studied time points. The frequency of acute rejection episodes increased parallel with age of the graft at the time of transplantation. Also, the frequency of post-transplant proteinuria was significantly higher among recipients of the aged grafts compared to others. From this study, it has been concluded that the transplant age of the renal grafts has significant direct bearing on its performance; both is short and medium term follow up

Selection of susceptible lines of biomphalaria alexandria and bulinus tuncatus snails to S mansoni and S haematobium infection

Selection of progenies from infected B. Alexandrina and B. truncatus snails resulted in higher infection rates. This observation was consistent when the source of micardia were from either infected human or hamsters. Infection rate of B. Alexandrina increased up to 88.2% while B. truncatus did not. Compatibility between the parasites and their intermediate hosts were also studied

Transplant renal artery stenosis [TRAS] and systemic hypertension in renal allograft recipients

One hundred and forty renal allograft recipients were included in this study, 24 had end to side vascular anastomosis to the external iliac artery or common iliac artery and 116 patients had end to end vascular anastomosis. The incidence of TRAS was similar in both groups. Out of successful 123 angiographic exposure, 29 patients [23:6%] were normotensive. Severe hypertension was noticed in about half of the patients with TRAS. A highly significant negative correlation between the grade of graft perfusion and the severity of hypertension was noticed in hypertensive with TRAS, on the other hand, normotensives with TRAS showed good graft perfusion. In this work, 82.8% of TRAS were at anastomosis and 10.3% showed kink stenosis. Erythrocytosis was found to be associated with TRAS but was not a constant finding and not statistically significant. Comparison of the kidney function, plasma renin activity and plasma aldosteron concentration for patients with and without TRAS showed no significant difference

Involucrin expression in bladder carcinoma: an immunohistochemical study

Involucrin is a protein component of the cross-linked envelope synthesized by maturing cells of human stratified squamous epithelia immediately beneath the plasma membrane. The reactivity of this antibody was tested by immunoperoxidase technique on paraffin sections from bladder carcinoma of different morphological and histological grades in order to evaluate the usefulness of involucrin as a tumor marker in bladder neoplasms. Although involucrin is absent from most of transitional epithelium adjacent to bladder carcinoma, it is expressed in squamous metaplasia, but in adjoining areas of carcinoma in situ the staining pattern is altered. Involucrin was present in all cases of grade I squamous cell carcinoma most marked in larger neoplastic cells in the center of squamous cell nest. Focal staining was observed in some adenocarcinoma and invasive high grade transitional cell carcinoma. These cases may represent adenosquamous variant or squamous metaplasia in transitional carcinoma, isolated involucrin positive cells were present in few cases of anaplastic carcinoma. Immunohistochemical staining for involucrin is a sensitive marker for squamous differentiation in bladder carcinoma. Staining pattern in intraepthelial carcinoma may identify abnormal or premature involucrin formation and hence cellular differentaition, areas of special promise include early diagnosis of intraepithelial changes