Effect of Isoflurane versus Propofol on the Early Outcome of Living Donor Adult Kidney Transplantation.

Background: Optimizing anesthetic management for the best possible outcome is essential in kidney transplantation (KT). Objective: To evaluate the difference in grafted kidney function and early kidney transplant outcome when the pairs of donor-recipient were anesthetized with isoflurane compared to propofol. Methods: Thirty-eight pairs of kidney transplant donor-recipient were anesthetized with isoflurane, and 22 pairs were anesthetized with propofol. Blood urea nitrogen (BUN), serum creatinine (SCr), estimated glomerular filtration rate (eGFR) were assessed in the preoperative period, on the first postoperative day, before discharge from the hospital, and 6 months after KT. Short-term (6 months) outcomes of KT were assessed by the incidence of delayed graft function, acute rejection episodes, and graft failure. Results: There was no statistically significant difference between the two groups in the serial measurements of SCr, BUN, eGFR, and the early outcomes (6 months) after surgery. Interestingly, donor warm ischemic time in the propofol group was significantly longer than in the isoflurane group (4.05±1.02, 2.93±0.87 minutes, respectively) (p=0.001). Moreover, postoperative hospital stay in the propofol group were significantly shorter compared to the isoflurane group (9.63±2.96, 11.78±4.91 days, respectively) (p=0.02). Conclusion: There were no significant differences in transplanted kidney function and the early outcome of kidney transplantation between the two study groups. However, earlier hospital discharge after surgery in the propofol group suggests that propofol may be a more appropriate anesthetic choice in these patients.

Molecular basis of Bombay phenotype in Mashhad, Iran: identification of a novel FUT1 deletion.

BACKGROUND AND OBJECTIVES: Bombay phenotype is characterized by the lack of H substance both on red blood cell (RBC) surface and in body secretions. Mutations of fucosyltransferase 1 (FUT1) and fucosyltransferase 2 (FUT2) genes are resulted in this rare phenotype. MATERIALS AND METHODS: Five unrelated patients were tested by hemagglutination and adsorption/elution techniques for the presence of ABH antigens. The saliva specimens were analysed by hemagglutination inhibition method. The exons 6 and 7 of ABO gene were sequenced to determine ABO genotype. The coding fragments of FUT1 and FUT2 were amplified and sequenced by specific primers. RESULTS: Serologic investigation confirmed Bombay phenotype in all individuals. FUT1 molecular analysis revealed a novel large deletion. Also two novel homozygous mutations were detected; one was a missense mutation (392T>C, L131P) and the other a three nucleotide deletion (668_670delACT, Y224del). FUT2 sequencing showed one reported null allele (428G>A, W143X) and one homozygous deletion of FUT2. CONCLUSION: Although FUT2 deletion has been reported, this is the first report of FUT1 deletion. Finding two FUT1 novel alleles in Iranian people is indicative of mutation diversity in this gene.

Awareness of Religious Leaders' Fatwa and Willingness to Donate Organ.

BACKGROUND: It is believed that religious leaders' positive attitude towards organ donation can be an effective factor in Muslims' inclination to donate organs. OBJECTIVE: To assess the knowledge of freshmen students in Mashhad University of Medical Sciences about religious leaders' fatwa on organ donation and its effect on their willingness to donate organs. METHODS: This cross-sectional study was conducted in 2013 on 400 freshmen of various medical disciplines, selected using a simple random sampling in Mashhad, Iran. Data were collected by a valid and reliable researcher-made questionnaire. Data were analyzed by multiple logistic regression analysis. RESULTS: 41.5% of the students were aware of religious authorities' views on organ donation and 55.6% were willing to donate organs. Participants' main reasons for lack of willingness to donate organs included the fear of organ donation before the brain death is confirmed (52%), unwillingness to disfigure their body (51%), and belief in the burial of organs (50%). The willingness to organ donation for students who were aware of religious leaders opinion was more than twice more than those who were not (OR: 2.56, 95% CI: 1.75-4.52). Also, female gender, the Shia religion and awareness of the correct definition of brain death were associated factors affecting the desire to donate organs, although their effects were not statistically significant on regression model. CONCLUSION: A considerable proportion of students were not aware of the religious leaders' fatwa on organ donation. The most important factor for the desire to donate organs was the awareness of religious leaders' fatwa. Therefore, it seems necessary that religious leaders' fatwa be known to all by appropriate methods.