Living unrelated kidney donor transplantation in Iran

In the September and November 2006 issues of Nature Clinical Practice Nephrology, two articles regarding living unrelated kidney donor transplantation alluded to the practices in Iran. Having served in the planning, supervision and implementation of various aspects of health care in Iran, including organ transplantation [ANH], and as transplant nephrologists who have actively participated in the care of transplanted patients in Iran [ANH and NG], we feel obligated to elucidate the realities surrounding organ transplantation in Iran. So that unbiased researchers are provided with information to judge for themselves

Disparities in care of patients with end-stage renal disease review of literature and action plan

Disparities in access to care for patients with end-stage renal disease [ESRD] and particularly to kidney transplantation, as well as discrepancies in follow-up and outcomes have been extensively documented as they relate to race, ethnicity, gender, socioeconomic factors, urban/rural residence, and geographic region. Furthermore, these inequalities seem to be increasing in various parts of the world and it is imperative to develop policies to address them among various population groups, identifying factors that might provide improved care for all patients with kidney disease. Numerous studies from various parts of the world have demonstrated racial, ethnic, and geographic differences regarding the delivery of healthcare to patients with ESRD. To the author's knowledge, although this issue has been studied at transplant centers in Iran on an individual basis, it has not been extensively studied on a national scale. In this paper, the current world literature will be reviewed, with the goal of emphasizing the need to initiate and expand full-scale studies to detect and remedy any existing inequalities in Iran, a vast country with an ethnically, culturally, and economically diverse population. The author proposes the designation, at the national level, of a task force to study disparities and to provide insight into the means of correcting them. As Iran continues to attain a position of regional leadership in the realm of organ transplantation, it seems prudent to invest in research aimed at detecting and remedying any inequalities in the provision of equivalent and just care for patients with ESRD

Role of immunosuppression minimization protocols in renal transplation: a review

The subject of transplant immunosuppression has generated significant interest in recent years. Excellent immunosuppression, advances in surgical technique, post-transplantation care, and infection control have resulted in excellent outcomes. There is widespread support for the notion that the fundamental objective in transplant immunology should be the achievement of specific graft tolerance. However, until this objective evolves into reality, investigators are in search of the "ideal immunosuppressant", which should target predominantly the immune system with minimal consequences for other tissues and minimal metabolic, cardiovascular and renal complications. While immunosuppressants have been associated with a tremendous trade-off in terms of morbidity, new agents have provided the investigators with the opportunity to formulate strategies that employ combination therapies with the goal of decreasing doses of individual agents and minimizing their toxicities. Multiple small studies have addressed the issue of minimizing immunosuppressants, but there is a need for well-designed clinical trials which should evaluate protocols that will reduce acute rejection, as well as chronic allograft nephropathy. They should address methods to identify subsets of patients who would maximally benefit from avoidance or withdrawal of steroids or calcineurin inhibitors. Other promising areas of research include tolerance studies among the sensitized recipients, and development of optimal immunosuppression based on genotype. In general, future trials must include a more diverse population of recipients, particularly the immunologically high risk groups