Predictability and Risk Factors for Development of New-Onset Type 2 Diabetes Mellitus After Transplant in the Saudi Population.

OBJECTIVES: The study objective was to investigate the predictability and risk factors for the development of new-onset type 2 diabetes mellitus after transplant in the Saudi population. MATERIALS AND METHODS: This was a retrospective observational cohort study in adult kidney transplant recipients who developed new-onset type 2 diabetes mellitus after transplant. Patients with and without new-onset type 2 diabetes mellitus after transplant were compared for demographic factors, blood glucose levels at 4-hour intervals for 24 hours after transplant, and serum creatinine levels at 6 and 12 months after transplant. RESULTS: Of 279 patients included in our study, 15.5% developed new-onset type 2 diabetes mellitus after a mean follow-up of 4.6 ± 2.1 years after transplant. Patients with new-onset type 2 diabetes mellitus after transplant were significant older (P = .001), had a higher body mass index (P = .001), and had higher fasting blood glucose levels 24 hours after transplant (P = .03). No significant differences were observed regarding sex, transplant type, or serum creatinine levels at 6 and 12 months. Risk factors for new-onset type 2 diabetes mellitus after transplant are body mass index (P = .001; relative risk of 1.26), fasting blood glucose at 24 hours (P = .001; relative risk of 1.3), age (P = .001; relative risk of 1.44), and family history of diabetes mellitus (P = .001; relative risk of 31.3). CONCLUSIONS: Risk factors for developing new-onset type 2 diabetes mellitus were age, heavier weight, body mass index, family history of diabetes mellitus, and having higher fasting blood glucose levels 24 hours after transplant, with family history of diabetes mellitus being an especially very high significant risk factor.

Cytomegalovirus disease in renal transplant recipients: a single-center experience.

OBJECTIVES: Cytomegalovirus is the most common viral infection following kidney transplant, with overall frequencies of 50% to 80% for the infection and 20% to 60% for cytomegalovirus disease. MATERIALS AND METHODS: We retrospectively analyzed the medical records of 689 kidney transplant recipients at Jeddah Kidney Center in the Kingdom of Saudi Arabia between January 2000 and December 2005 for cytomegalovirus infection and disease. We examined the source of the donated kidneys (deceased versus living donor), the cytomegalovirus serostatus of the donor and recipient, the immunosuppressive protocol, the presence of cytomegalovirus prophylaxis, the clinical presentation of acute cytomegalovirus disease, the patient's response to treatment, and the effect of cytomegalovirus disease on graft and patient survival. RESULTS: Of 689 kidney transplant recipients, 25 (3.6%) had acute cytomegalovirus disease. All 25 patients had cytomegalovirus IgG positive/IgM negative test results prior to transplant. We noticed 2 distinct groups of patients: the first group included 9 patients with cytomegalovirus syndrome, 6 of whom received cytomegalovirus prophylaxis with ganciclovir. All patients in this group had low cytomegalovirus viral loads on polymerase chain reaction, mild disease, and responded to treatment with complete recovery and no adverse effects with respect to themselves or their grafts. The second group included 16 patients with invasive cytomegalovirus disease, 3 of whom received cytomegalovirus prophylaxis. All patients in this group had very high cytomegalovirus viral loads on polymerase chain reaction. Thirteen patients in this group (81%) responded to treatment with full recovery, and normal graft function was maintained in 10 (62%). Of the original 16 patients in this group, 3 (18.8%) died from cytomegalovirus disease and its complications. CONCLUSIONS: We report a low incidence (3.6%) of cytomegalovirus disease at our center. Cytomegalovirus prophylaxis was associated with a milder form of the disease. At our center, treatment of invasive cytomegalovirus disease produced a patient survival rate of 81% and a graft survival rate of 62%.

Posttransplant erythrocytosis in renal transplant recipients at Jeddah Kidney Center, Kingdom of Saudi Arabia.

OBJECTIVES: Posttransplant erythrocytosis is a well-known complication of renal transplant. It is a persistently elevated hematocrit level equal to or greater than 51%, or a hemoglobin level equal to or greater than 16 g/L, or both, in the absence of other causes. MATERIALS AND METHODS: We retrospectively reviewed this complication in patients who had received a renal transplant at our center between January 1991 and December 2005. RESULTS: Of 1655 renal transplant recipients, 159 patients (9.6%; 154 men, 5 women; mean age, 42 +/- 9 years) developed posttransplant erythrocytosis. The mean follow-up was 96 +/- 4 months. Posttransplant erythrocytosis appeared at an average of 8.2 +/- 5 months after transplant (range, 3-40 months) and lasted an average of 10.3 +/- 3 months (range, 7-35 months). In all 159 patients, the immunosuppressive medication regimen included prednisolone; in 144, cyclosporine was used, and in 108 patients, azathioprine was used, while in another group of patients, the latter 2 were changed to mycophenolate mofetil (n=38) and tacrolimus (n=13). Twenty-four patients (15%) were treated with phlebotomies, while 29 patients (18.2%) were given angiotensin-converting enzyme inhibitors. One hundred six patients were left untreated including 92 patients (57.9%) who received prophylactic anti-platelet medications. Remission of posttransplant erythrocytosis was seen in all treated and untreated patients. No thromboembolic complications occurred. Only 9 patients (5.7%) developed chronic allograft nephropathy during follow-up. CONCLUSIONS: Our findings suggest that posttransplant erythrocytosis is a benign condition affecting males more than females, usually manifesting in the first year after transplant. Remission of posttransplant erythrocytosis can be seen in all patients; however, some patients may require treatment with phlebotomy or angiotensin-converting enzyme inhibitors. Posttransplant erythrocytosis has no adverse effects on renal graft function.

Experience of renal transplantation at the king fahd hospital, jeddah, saudi arabia.

The renal transplant program at the Jeddah Kidney Center (JKC), The King Fahd Hospital, Jeddah commenced in November 1990. Since then, 746 patients have undergone renal transplantation in this center. Post-transplantation immunosuppresion in our patients comprised of prednisolone, azathioprine and cyclosporin. More recently, mycophenolate in place of azathioprine and tacrolimus in place of cyclosporine has been used in select groups of patients. Following surgery, delayed graft function was encountered in 131 (17.6%) of our renal transplant patients. Of them, 101 (77.1%) recovered completely while 30 (22.9%) either recovered partially or lost their graft completely and returned to dialysis. We encountered 94 (12.6%) acute rejection episodes. All these patients were treated with methylprednisolone administered in a dose of 250-500 mg intravenously on three consecutive days. Forty-seven (50%) responded favorably while the remaining 47 patients proved to have steroid-resistant rejection. Complete recovery with recovery of normal graft function occurred in 70 cases (74.5%), while 24 cases (25.5%) remained with mild renal impairment. Post-transplant diabetes mellitus was diagnosed in 126 patients (16.8%). Post-transplant hypertension was diagnosed in 399 patients, a prevalence of 53.4%, which agrees with the figures of previous reports. Post-transplant hyperlipidemia was reported in 355 patients (47%). We encountered 12 cases of urine leak and obstruction while lymphoceles were diagnosed in 20 patients. Urinary tract infections were the most prevalent infection in the first month post-transplant and occurred in 59 patients (7.9%). The other common infections in the early post-transplant period were wound infection and infection of subcutaneous collections /hematomas which occurred in 22 patients (2.9%).Overall, the 3, 5 and 10-year graft survival rates are 92%, 90% and 84% respectively. The patient survival after 1, 3, 5 and 10-years post-transplant is 98%, 96%, 90% and 90% respectively. Our results and outcome data of our renal grafts and patients show that renal transplantation is a highly successful modality of renal replacement therapy in our hospital.

Visual loss in uremic patients on dialysis: a case report and review of literature.

We report a 40-year-old female patient who was on maintenance hemodialysis for end-stage renal disease. She was initially noted to have severe hypertension necessitating use of four anti-hypertensive drugs. Gradually, and with regular dialysis, her blood pressure normalized without any medications, and subsequently she was noted to have pre- and post-dialysis blood pressure respectively of 90/60 mm Hg and 70/40 mm Hg which was asymptomatic. Following one session of dialysis during which she had severe hypotension associated with dizziness and headache, corrected by saline infusion, she noticed loss of vision affecting both eyes. Detailed evaluation including fundoscopy, magnetic resonance imaging, fluorescein angiography, color doppler and electroretinogram was performed. Empirical treatment with pulse methyl prednisolone and plasma exchange did not help. A diagnosis of anterior ischemia optic neuropathy due to hypotension was arrived at. Our case suggests that intra-dialytic hypotension can be problematic and should be treated aggressively.

Pre-end stage chronic renal failure: the jeddah kidney center experience.

A retrospective review of data of pre-end stage renal disease patients being followed-up at the Jeddah Kidney Center, Jeddah, Saudi Arabia was performed. A total of 99 patients fulfilled the inclusion criteria. There were 58 males (58.6%) and 87 were Saudis (87.9%). The mean age of the patients was 49.5 years (11-90 years). Diabetes was the commonest cause (29.2%) followed by unknown etiology in 20.2%. Hypertension was a predominant co-morbid factor seen in 83.8% of the patients. Optimal control of blood pressure was achieved in 30% of the patients, an area where improvement is required. The mean serum creatinine at first visit to nephrology service of 300 micromol/l reflects delayed referral from other services. The levels of calcium, phosphate, cholesterol, albumin and hemoglobin were satisfactory. Our study suggests that more efforts are needed to promote early referral of patients with chronic renal failure to nephrology care. Also, greater emphasis is needed towards achieving rigid blood pressure control.