Time-dependent Doppler ultrasonographic findings in transplanted kidneys from living donors: a 5-year follow-up study.

INTRODUCTION: Ultrasonography and color Doppler have been used extensively to evaluate transplanted kidneys. Several recent studies have suggested its value to assess renal transplant dysfunction, particularly in the early postoperative period. The aim of the present study was to evaluate the time-dependent changes in color Doppler ultrasonography (DUS) findings during the first 5 years after renal transplantation. METHODS: Among a prospective cohort we evaluated the results of collar Doppler findings in renal allograft recipients over 5 years after transplantation. For this purpose we compared the DUS findings of kidney size, pulsatile index (PI), resistive index (RI) and renal artery flow before transplantation in living donor kidneys versus 6-12 months as well as 5 years after transplantation in 23 patients. The statistical analysis was performed using SPSS version 16. P value was set at .05. RESULTS: The mean length of the transplanted kidney was 110.60±7.92 mm before transplantation in the living donors body versus 120.29±9.01 mm and 119.36+/-9.9 mm at 6-12 months versus more than 5 years after transplantation, respectively. Mean PI and RI were 1.00+/-0.14 and 0.60+/-0.05 before transplantation and 1.00+/-0.22 and 0.61+/-0.08 and 1.07+/-0.26 and 0.63+/-0.07 at 6-12 months versus more than 5 years after transplantation, respectively. There was no significant difference in mean PI and RI during the 5 years of the follow-up study. Mean length and anteroposterior diameter increased significantly at 6-12 months and 5 years after transplantation when compared with the results before transplantation (P<.05). No significant difference was present in Doppler findings of transplanted kidneys between 6-12 months and 5 years after transplantation. In conclusion we observed increasing kidney size after transplantation that remained constant during 5 year follow-up among renal allograft recipients.

Universal prophylaxis with gancyclovir preparation is not necessary in our kidney allograft recipients.

BACKGROUND: Cytomegalovirus (CMV) infection is a common cause of morbidity, graft loss, and mortality among kidney recipients due to its direct and indirect influences on organs and systems. In this study, we evaluated CMV infection in transplant recipients in Iran. MATERIALS AND METHODS: We performed a retrospective study of 104 renal allograft recipients and their donors transplanted between January 2005 and January 2010. We included all patients (recipients and donors) with least one valid laboratory result for CMV immunoglobulin (Ig)G and CMV IgM. We evaluated the occurrence of CMV disease in allograft recipients in at least the first 3 years after renal transplantation. RESULTS: Fifty-seven renal allograft recipients (54.8%) were males and 47 (45.2%) were females. The overall mean (±standard error) age was 40.32±13.30 years. CMV IgG was positive in 95 cases (91.3%), negative in 9 (8.7%). Serologically, 76.9% patients were D+/R+ 14.4% D-/R+, and 8.7% D+R-. Due to the proccurrence of rejection rendering them high-risk patients for CMV infection about 15% of subjects were treated with anti thymocyte globulin (ATG) followed by prophylactic intravenous gancyclovir for 2 weeks, at doses based on allograft function. Confirmed CMV infection and CMV disease occurred in less than 5% of recipients in the first year after transplantation. About 6% of renal allograft recipients died due to infections during the first 3 years posttransplantation but CMV disease was not confirmed in these patients. CONCLUSION: Due to the living donor-based renal transplantation program, the selection of low-risk patients (panel-reactive antibodies 30%), the low percent of D+/R- patients (8.7%) and the low use of ATG for induction therapy in the Iranian model, universal prophylaxis with gancyclovir is not routinely recommended for our cases.

Safety of low-dose cyclosporine therapy before transplantation in kidney allograft recipients.

INTRODUCTION: Graft dysfunction immediately posttransplantation can vary from subtle slowing of the expected decrease in creatinine concentration to frank oliguria requiring dialysis therapy for days to weeks. Risk factors for slow and delayed graft function include prolonged preservation, older donor age, and high plasma renin activity in the recipient. Cyclosporine (CsA) nephrotoxicity is another cause of early kidney allograft dysfunction. OBJECTIVE: To evaluate early kidney allograft function in patients who received low-dose CsA therapy for 48 hours before transplant surgery for comparison with that in recipients who received CsA therapy after improvement in allograft function. PATIENTS AND METHODS: In a case-control comparative study, 66 kidney recipients were divided into 2 groups on the basis of time of initiation of CsA therapy. In group 1, patients received CsA, 100 mg twice a day, for 48 hours before surgery, and in group 2, patients received CsA therapy after surgery when allograft function had improved (serum creatinine concentration