Impact of Hepatitis C virus infection on kidney transplantation

Hepatitis C virus [HCV] infection increases morbimortality in renal transplantation. Hepatitis C virus positive kidney transplant candidates who remain on the waiting list show a greater risk of mortality than those who are transplanted. The aim of this study was to examine the impact of HCV infection on patient and allograft survival after kidney transplantation. Eighty two patients with end stage renal disease underwent kidney transplantation were included in this study. The patients were classified into group I including 46 HCV negative patients [HCV-] and group II including 36 HCV antibody and HCV-RNA positive patients [HCV+]. The immunosuppressive protocols were similar in both groups. All recipients were followed up for 3 years

Results: There were statistically insignificant differences [P>0.05] between both groups as regard age, gender and donor type [living related or unrelated]. Hemodialysis duration before transplantation was highly significant [P< 0.01] longer among HCV+ group [4.9 +/- 3.7 years] compared to HCV- patients [2.4 +/- 4.3 years].One patient died from each group showing insignificant difference [P>0.05]; 2 grafts [4.3%] lost in HCV- group and 3 [8.3%] in HCV+ group with also insignificant difference [P>0.05]. Five recipients [10.9%] in group I experienced delayed graft function compared to 2 [5.6%] recipients in group II with statistically insignificant difference. There was a significantly [P< 0.05] more number of acute rejection episodes among HCV+ patients [11=30.6%] than HCV- patients [5=10.9%].New onset diabetes mellitus occurred more among HCV+ [19.4%] than HCV- [8.7%] recipients, however the difference was insignificant. There was a significant [P<0.05] higher incidence of cytomegalovirus disease among HCV+ [11.1%] than HCV- [2.2%] recipients

Conclusion: This study suggested that HCV positivity does not significantly affect patient and graft survival despite the significant increased incidence of acute rejection episodes and cytomegalovirus disease. Lastly, all measures should be taken to prevent HCV transmission in dialysis population

Non-invasive diagnosis to predict adynamic bone disease in haemodialysed patients

Precise evaluation of the underlying type of bone disease in hemodialysed patients frequently requires bone histomorphometry [including static and kinetic variables after double tetracycline labeling], which is an invasive and costly method. Due to the prevalence of Adynamic bone disease in hemodialysis patients, different biochemical noninvasive markers such as [serum intact osteocalcin, serum intact parathyroid hormone [iPTH] and bone specific alkaline phosphatase [bAP] have been shown to be helpful in differentiation between low and high bone turnover. Our study was conducted to detect the usefulness of measuring serum intact osteocalcin and its correlation with serum iPTH and bAP to distinguish Adynamic bone disease from other forms of renal osteodystrophy in hemodialysed patients. The study included 60 patients and 20 normal control subjects, presented at renal dialysis units, Ain Shams University hospitals. The hemodialysed patients were classified according to the results serum iPTH and bAP into two groups: Group I: Included 18 patients [30%] with serum iPTH level £150 pg/ml and serum bAP >/= 27 ng/ml. Group II: Included 42 patients [70%] with serum iPTH level > 150 pg/ml and serum bAP > 27 ng/ml. The serum level of intact osteocalcin was measured for the control group and for all hemodialysed patients. The results revealed highly significant statically differences in serum level of intact osteocalcin between all patients group and the control subjects being lower in control group. Also, the results revealed that 30% of all patients group had Adynamic bone disease and comparison between serum level of intact osteocalcin in Adynamic bone disease group versus other patients group was highly significant, being higher in other patients group. There was no significant difference between Adynamic bone disease patients and other patients as regard serum phosphorus, and serum calcium but there was a significant difference as regard age, while highly significant difference as regard sex, duration of hemodialysis, serum intact osteocalcin, iPTH and bAP. These results suggest that combined estimation of serum iPTH, serum intact osteocalcin, and bAP can provide a useful information on the bone status in uremic patients and represent reliable noninvasive diagnostic tools for the prediction of Adynamic bone disease

Impact of tissue typing matching on early graft function

Our study was conducted in Nasser institute. 60 patients were included in the study. They -were on regular hemodialysis and underwent kidney transplantation [46 males and 14 females], with a mean age of [32.03 +/- 10.57] years. 17 cases had related living donors and 43 cases had unrelated living donors. Patients were followed for six months. There was non significant relationship [P>0.05] between Zero match, one mismatch out of 6, two mismatches out of 6 [of HLA-A, HLA-B and HLA-DR] and the survival of the graft. Also there was only significant difference between acutely rejected grafts and non-rejected grafts [P<0.05], with only one successful match out of 6, being having even more successful matches out of 6 but didn't have significant effect on survival of the graft. Having more than one halotype or less, in common between donor and recipient at tissue matching didn't differ much on outcome of the graft [P>0.05]- Being related or unrelated donors, gender of donors and recipients and blood grouping didn't affect much the outcome of the graft [P>0.05]. Cases with more than 1 successful match out of 6 had significant difference in serum creatinine between rejected and non rejected grafts

Comparison of intradialytic calcium changes between bicarbonate dialysate and acetate dialysate in chronic hemodialysis patients

Renal osteodystrophy affects patients with end- stage renal failure, resulting in significant skeletal and extra- skeletal morbidity. The aim of the work is to study the intradialytic changes of calcium, phosphorus and parathyroid hormone [PTI-l] in acetate and bicarbonate dialysis. The present study was conducted on 10 chronic renal failure patients [their age ranged from 19 to 60 years and consisted of 7 males 3 females] selected from Ain Shams University Specialized Hospital on regular hemodialysis thrice weekly 4 hours each, first using acetate dialysate and investigations were done then patients were shifted to bicarbonate dialysate and the same investigations were done [Ionized calcium, phosphorous and parathyroid hormone] measured at start of hemodialysis session, after 2 hours from start of session and at the end of session. All patients were ordered to fix their dry weight, protein diet [about 0.8-1gm/Kg/day] and current medications. Non of patients had diabetes, neoplasia, liver disease, cachexia or had been previously parathyroidectomised. This study demonstrated that, calcium level significantly increased in bicarbonate dialysate session and did riot significantly increase in acetate dialysate sessions. Phosphorus level significantly decreased in both acetate and bicarbonate session. PTH level did not significantly decrease in both types of dialysate but in three patients [one in bicarbonate and 2 in acetate], PTH level was markedly raised