Fat and bone marrow embolization in a donor as the cause of death in a lung recipient.

The cause of death in organ donors may have a great impact on organ recipient outcomes. Trauma is the prevailing cause of death among brain-dead patients in Iran and many other countries. Such patients may have many complications, among them vascular embolization with fat and other tissues. We have described herein a case of vascular embolization in a donor and its consequence on the recipient's outcome. The recipient was a 36-year-old woman with pulmonary fibrosis, who received a single lung transplant from a patient brain dead due to trauma. Donor had no obvious fractures; the oxygen challenge test was ideal. The harvested lung was normal upon bronchoscopy and it was clear on plain chest radiography. The day after lung transplantation, the recipient was extubated successfully with normal O(2) saturation. On computed tomography scan, there was a fixed infiltration at the base of the transplanted lung. On day 5 posttransplantation, the infiltrate expanded and the patient developed acute respiratory distress syndrome (ARDS). The patient's condition deteriorated rapidly and she expired on day 10 posttransplantation due to ARDS. The pathologic examination of the brain-dead patient, which was obtained from another patient's lung, was available after our recipient's death, showed massive vascular fat and bone marrow embolization. In the mentioned case, all criteria for lung harvest from the brain-dead patient were met. Looking for embolization is not among the criteria for lung transplantation if chest radiography is clear and O(2) challenge test is acceptable, but we observed a poor recipient outcome due to bone and fat embolization in the donor's lung. When transplanting from a traumatic patients, such complications should be kept in mind.

Kidney transplantation: is there any place for refugees?

There are more than 8 million refugees worldwide with the Middle East bearing the brunt. Socioeconomic factors are the major obstacles that refugees encounter when seeking health care in the host country. It, therefore, comes as no surprise that refugees are denied equal opportunities for one of the most sophisticated and expensive medical procedures in the world, kidney transplantation. With respect to transplantation, refugees are caught between a rock and a hard place: as recipients they have to single-handedly clear many hurdles on the arduous road to renal transplantation and as donors they are left unprotected against human organ trafficking. It should be the moral responsibility of the host country to provide this population with a support network. The ways and means of establishing this network should be defined locally; nevertheless, enabling refugees to receive a transplant is the most basic step, which should be followed by the provision of financial support and follow-up facilities in a concerted effort to ensure the continued function of the invaluable graft. It is also necessary that refugees be protected from being an organ reservoir on the black market. There are no precise regional or international data available on kidney transplantation in refugees; among the Middle East Society for Organ Transplantation countries, only Iran, Saudi Arabia, Pakistan, and Turkey have thus far provided data on their respective kidney transplantation regulations and models. Other countries in the region should follow suit and design models tailored to the local needs and conditions. What could, indubitably, be of enormous benefit in the long term is the establishment of an international committee on transplantation in refugees.

The cost of kidney transplantation in Iran.

BACKGROUND: Kidney transplantation has gained widespread popularity by improving the outcome of end-stage renal disease (ESRD) patients. However, this is a highly complicated and expensive procedure that puts much pressure on the health system in developing countries. We report the costs in Iran model of kidney transplantation. MATERIALS AND METHODS: We reviewed the regulations for kidney transplantation using Dialysis and Transplant Patients Association (DATPA) information, 2005. All data regarding the cost of transplantation procedure, immunosuppression, and the money given to donors were included. The cost of transplantation procedure was categorized into personnel, drugs, paraclinics, hospital bed, and other expenses. To achieve more comprehensive results, all costs were converted into US dollars (1 USD = 9000 Rials). RESULTS: The total cost of kidney transplantation procedure was $9224. Of this, 65.8% ($6076) was related to the immunosuppression therapy in the first year, 22.2% ($2048) to the transplantation procedure, and 12% ($1100) to organ procurement. The details of donor nephrectomy were as follows: personnel, $183; accommodations, $107; drugs, $39; paraclinics, $23; and other, $22. These values for kidney recipient were personnel, $331; drugs, $367; paraclinics, $278; accommodations, $475; and other, $222. CONCLUSION: Compared with other countries, the kidney transplantation cost is low in Iran. The health system also pays for all the expenses. These, along with full medical insurance coverage of kidney recipients, make kidney transplantation available for every patient, regardless of the socioeconomic status due to its low cost. It is expected that a higher number of transplantation candidates with a low socioeconomic status will select transplantation.

Cytomegalovirus disease after kidney transplantation: clues to accurate diagnosis.

BACKGROUND: The clinical diagnosis of cytomegalovirus (CMV) disease after kidney transplantation is often not accurate. We evaluated the factors associated with a correct diagnosis of CMV disease in these patients. MATERIALS AND METHODS: This retrospective study of all renal transplant patients between 2004 and 2005 with a clinical diagnosis of CMV disease included both donors and recipients who were seropositive for CMV at transplantation. We assessed the rate and correlated factors with a correct diagnosis. RESULTS: Among 127 cases, the 30 (23.6%) patients who had a correct diagnosis of CMV disease. Showed higher ages at transplantation (48.8 +/- 15.3 vs. 39.8 +/- 14.4 years; P=.004) and a shorter interval between transplantation and symptom presentation (9.7 +/- 20.7 vs. 25.6 +/- 33.6 days; P=.048). Diabetes mellitus (DM) was the cause of end-stage renal disease (ESRD) in 41% of patients with a correct diagnosis, whereas it was the cause in 11% of CMV disease-negative patients (P<.001). A multiple logistic regression model showed that DM as the cause of ESRD (P=.001; odds ratio [OR] 16.331), >5 months duration between transplantation and the presence of symptoms (P=.001; OR, 0.060), and age at transplantation >55 years (P=.022; OR, 3.833) were predictors of a correct diagnosis of CMV disease (chi(2)=46.45; P<.001). CONCLUSION: The results herein showed that considering some variables significantly improved the accuracy of a correct diagnosis of CMV disease after kidney transplantation.