The Relationship Between Pre-Transplant Serum Phosphorus Before Kidney Transplantation with Early Graft Dysfunction.

INTRODUCTION: Pre-transplant serum phosphorus level is shown to be associated with some transplant outcomes in patients with chronic kidney disease. However, its association with Delayed graft function (DGF) has an aura of ambiguity. DGF means either the patient needs dialysis during the first week after transplantation or the creatinine level is ≥ 3. This study was aimed to assess the relationship between pre-transplant serum phosphorus levels with DGF. METHODS: A total of 306 patients, who had undergone kidney transplantation in the Montaserieh organ transplantation hospital in Mashhad, Iran, during 2016 to 2019; were enrolled in this study. Demographic data and clinical characteristics of patients including dialysis type and duration, donor type, medications, pre-transplant serum levels of calcium, phosphorus and DGF development were measured. Then, all patients were divided into five groups according to their serum phosphorus: P < 3.5, 3.5 ≤ P < 5.5, 5.5 ≤ P < 7.5, 7.5 ≤ P < 9.5, and P ≥ 9.5 mg/dL. The association with DGF was evaluated by statistical analysis. RESULTS: Patients age ranged from 18.00 to 64.00 years old, with an average of 37.08 ± 10.9. About 55.6% of them were men, and 26.1% came up with DGF. Among patients with DGF, 36.25% were recipients with pre-transplant phosphorus level of 3.5 ≤ P < 5.5 and 50% of 5.5 ≤ P < 7.5. CONCLUSION: Our study suggested that pre-transplant serum phosphorus might be associated with an increased risk of delayed graft function. Further studies are needed to assess, whether adjusting serum phosphorus level before kidney transplantation could reduce delayed graft function or not.

Relationship Between Pulmonary Hypertension Before Kidney Transplantation and Early Graft Dysfunction.

INTRODUCTION: Pulmonary hypertension (PHTN) is a common complication in patients with chronic kidney disease. Delayed Graft Function (DGF), on the other hand; is an essential complication after kidney transplantation. These two complications increase morbidity and mortality in patients. The effect of PHTN on cardiovascular and graft blood supply, as well as the same mechanisms underlying PTHN and DGF; led us to investigate the relationship between them. METHODS: In this retrospective cohort study, 306 patients aged 18 years or older who underwent kidney transplantation at our center over a 4-year were enrolled. PTHN was diagnosed by transthoracic echocardiography performed by a cardiologist. DGF refers to the cases where the patient needs dialysis in the first week after kidney transplantation or if serum creatinine is ≥ 3 mg/dL on the 5th day after surgery. RESULTS: The prevalence of PHTN was 43 (14.1%), and the prevalence of DGF was 80 (26.1%). PHTN was not correlated with age, sex, duration of dialysis, type of dialysis, and cause of renal failure. But DGF was associated with the duration and type of dialysis. DGF was found to be higher in patients undergoing hemodialysis (P < .05), and patients with a higher mean duration of dialysis were also more likely to have DGF (P < .05). Also, we concluded that there was a significant relationship between PHTN and DGF (P < .05), meaning that patients with PTHN before transplantation were more likely to develop DFG. CONCLUSION: This study found that pre-transplant PTHN is an independent predictor of DGF in renal transplant patients.

Comparing Sleep Quality in Patients Before and After Kidney Transplantation.

INTRODUCTION: The purpose of the present study was to identify the prevalence of sleep disturbances in ESRD, and to compare the sleep quality before and after kidney transplantation. METHODS: A semi-experimental study was performed on 40 participants with ESRD from September 2017 to September 2018 in Mashhad, Iran. Participants were in the waiting list of kidney transplantation, aged 18-years-old or more, had no history of any major psychological problems. They were excluded from the study if new medical condition or psychiatric disorder was initiated throughout the study. Patients' medical information including the duration of dialysis and laboratory data was extracted from medical records. Their sleep quality was assessed with the Pittsburgh sleep quality index (PSQI) within1-month prior the kidney transplantation and at the 3rd and 6th months after it. Collected data was analyzed using SPSS-16. P < .05 considered as significant. RESULTS: The frequency of poor sleepers was 37.5%, 37.5%, and 20.0%; before the kidney transplantation, 3 months and 6 months after the surgery; respectively. The average sleep quality score decreased significantly 6-month post-operation compared to pre-transplant phase (P < 0.05). We found a significant relationship between the gender and quality of sleep before transplant surgery, whereas no correlation was found between sleep quality and the age, type or duration of dialysis, serum phosphorus or hemoglobin level, and the cause of kidney failure (P < .05, > .05, > .05, > .05, > .05, > .05, and > .05; respectively). CONCLUSION: Kidney transplantation has a positive effect on patients' sleep quality after 6 months.

The effect of cytomegalovirus infection on acute rejection in kidney transplanted patients.

INTRODUCTION: It is known that cytomegalovirus (CMV) infection is a common problem among kidney transplant patients. This infection can be increased morbidity and decreased graft survival. This problem has been associated with acute rejection too. PATIENTS AND METHODS: One hundred and thirty renal transplant patients were included in a prospective, case-control study. The renal transplant patients were divided into two groups; patients group with CMV infection and control group without CMV infection. Serum CMV-IgG in all patients was positive (donor and recipients). None of patients had received anti-thymocyte-globulin and thymoglobulin. CMV infection was diagnosed by quantitative CMV-PCR (polymerase chain reaction) test (more than 500 copies/µg). Rejection episode was defined by kidney isotope scan or biopsy. RESULTS: In the group of 66 CMV infection patients (41 male [62.1%] and 25 female [37.9%]) the incidence of graft rejection was 36%, however in the group of 64 control patients the incidence of graft rejection was 9.4 % (P < 0.005). CONCLUSION: CMV infection is important predisposing factor for acute allograft rejection after kidney transplantation. The results of this study suggests that the control of CMV infection could decrease episodes of acute kidney rejection.