Successful treatment of hepatic and mesh Aspergillosis in a neonate with giant omphalocele.

Aspergillosis is a rare and life-threatening fungal infection in immunocompetent children, particularly in infants. We present a case of invasive Aspergillosis (IA) that developed hepatic and mesh infection due to Aspergillus flavus following the rupture of a giant omphalocele. A male baby was born at 37 weeks of gestation with a giant omphalocele. No other congenital abnormalities were found. In the pediatric surgery operation room, the amniotic membrane seemed to be ruptured in some parts, which had been repaired within a few hours of birth. No further intervention to reduce the volume of visceral organs could be performed due to the tiny abdominal cavity. Postoperatively piperacillin-tazobactam and fluconazole were empirically initiated. Abdominal defects had been covered with polypropylene polylactic acid synthetic Mesh on postnatal day 11 to protect the organs and prevent abdominal infections. Fungal hepatic lesions were observed during surgery, and black necrotic lesions were also observed on the mesh on day 12. On the 16th postnatal day, Aspergillus flavus grew in the wound, graft, hepatic biopsy cultures. Serum galactomannan (GM) assay test was positive (GM:2.9), and voriconazole was initiated. All necrotic lesions resolved with liposomal amphotericin B (L-AmB) and voriconazole treatment, and antifungal therapy was discontinued after 134 days. Eye examination for the retinopathy didn't show any abnormalities. The patient was discharged with full recovery on day 155. In conclusion, IA is a rare and life-threatening infection in the neonatal period. To the best of our knowledge, this is the first case of hepatic and mesh infection caused by Aspergillus flavus that was successfully treated with voriconazole and l-AmB.

Fibromyalgia and its clinical relevance in renal transplant recipients.

OBJECTIVE: Recent evidence suggests that fibromyalgia syndrome (FS) is associated with inflammation and endothelial dysfunction. Our aim was to determine the prevalence of FS in renal transplant recipients and to identify possible links between FS and clinical and laboratory parameters. METHODS: Ninety-nine kidney transplant recipients with normal graft functions (37.15 ± 10.83 years old, 67 male) were enrolled in the study. All subjects completed the Fibromyalgia Impact Questionnaire (FIQ). The biochemical and clinical parameters in the 1st post-transplantation year were retrospectively recorded. Cardiovascular parameters, including body composition analyses (Tanita), ambulatory blood pressure monitoring data, and pulse-wave velocity, were cross-sectionally analyzed. RESULTS: Mean FIQ score for the whole group was 21.4 ± 14.7. Eight patients had FIQ score >50, and these patients had significantly higher left ventricular mass index than patients with lower FIQ score (P = .048). Patients were divided according to their physical impairment score (PIS): PIS ≥5 (n = 50) and PIS <5 (n = 49). Patients with higher PIS had significantly higher serum creatinine (P = .047) and lower eGFR values (P = .008) than patients with lower PIS. Patients were also evaluated with the use of the stiffness score (SS): patients with (n = 41) and without (n = 58) stiffness. Patients with stiffness had significantly higher office systolic (P = .027) and diastolic (P = .044) blood pressure, body mass index (P = .033), and sagittal abdominal diameter (P = .05) than patients without stiffness. Decline in estimated glomerular filtration rate levels were significantly higher in patients with higher FIQ (7.6% vs 9.4%; P = .0001) than in other patients. CONCLUSIONS: FS in renal transplant recipients was strongly associated with hypertension, arterial stiffness, obesity, and renal allograft dysfunction.

Post-transplant Hyperuricemia as a Cardiovascular Risk Factor.

PURPOSE: Uric acid is known to impair endothelial cell function and to stimulate the development of renal interstitial fibrosis. The aim of this study was to evaluate the association between first-year hyperuricemia with graft dysfunction and the development of cardiovascular risk disorders in renal transplant recipients. METHODS: One hundred kidney transplant recipients (31 female, 45.9 ± 9.6 post-transplantation months) with normal graft functions were enrolled. The clinical biochemical parameters in the first post-transplantation year were retrospectively recorded and searched for the predictive value in yearly determined graft function and association with cross-sectionally analyzed cardiovascular parameters, including body composition analyses, ambulatory blood pressure monitoring data, and pulse wave velocity. Hyperuricemia was defined as an uric acid level of ≥ 6.5 mg/dL that persisted for at least 2 consecutive tests. RESULTS: One year after transplantation, 37% of subjects had hyperuricemia. According to cross-sectional data, sagittal abdominal diameter (P = .002) and hip circumferences (P = .013) were significantly higher in hyperuricemic patients than in normouricemic ones. Hyperuricemic patients had higher fat (P = .014) and muscle mass (P = .016) than normouremic patients. Hyperuricemic patients had significantly higher mean systolic BP (P = .044) than normouremic patients. Hyperuricemic patients had significantly higher pulse wave velocity levels (P = .0001) and left ventricular mass index (P = .044) than normouremic patients. The yearly decline in estimated glomerular filtration rate levels was significantly higher in hyperuricemic patients (P = .0001) than in normouricemic ones. CONCLUSION: Post-transplantation hyperuricemia is associated with hypertension, arterial stiffness, and dyslipidemia; it should be accepted not only as a marker for renal allograft dysfunction but also as a cardiovascular risk factor in renal transplant recipients.

Sagittal abdominal diameter as an anthropometric measure of cardiovascular and graft loss risk in renal transplant recipients.

BACKGROUND: Sagittal abdominal diameter (SAD) has been presented as a stronger prognostic factor for all-cause and cardiovascular mortality in the general population. The aim of this study was to evaluate the relationship between SAD and its associated parameters in renal transplant recipients. METHODS: One hundred eighty-one renal transplant recipients were enrolled in the study. All patients were evaluated according to standard clinical and biochemical parameters. Anthropometric measurements were performed for all patients. Pulse-wave velocity (PWV) was determined from pressure tracing over carotid and femoral arteries with the use of the Sphygmocor system. RESULTS: Patients were divided into 2 groups according to SAD measurements. Group 1 (n = 127) was defined as SAD <24.3 cm, and group 2 (n = 54) was defined as SAD ≥ 24.3 cm. Patients in group 2 had significantly higher triglycerides, C-reactive protein (CRP), uric acid, systolic blood pressure, PWV, and body mass index measurements compared with group 1 (P < .05 for all). In group 2, estimated glomerular filtration rate (eGFR) was significantly lower than group 1 (P = .022). SAD had positive correlation with PWV, systolic and diastolic blood pressure, body mass index, triglycerides, fasting glucose, CRP, and uric acid (P < .05 for all). On stepwise linear regression analyses, proteinuria (P = .005), SAD (P = .001), and CRP (P = .015) independently predicted the degree of percentage change of eGFR. CONCLUSIONS: Considering the significant association of visceral fat with inflammation and cardiovascular disease, estimating visceral fat by means of SAD could be a useful tool to stratify cardiovascular risk as well as graft function in renal transplant recipients.

Hyperviscosity in renal transplant recipients.

OBJECTIVE: The resistance of blood to flow is called plasma viscosity. Increased blood viscosity has been described in patients with coronary and peripheral arterial disease. In this study, we evaluated the influence of clinical and laboratory findings on plasma viscosity in renal transplant recipients. METHODS: Eighty-one kidney transplant recipients (37.8 ± 11.3 years old, 50.38 ± 16.8 months post-transplantation period, 27 female) with normal graft functions were enrolled. The biochemical and clinical parameters in the 1st year after transplantation were retrospectively recorded, and graft function was evaluated by means of the yearly decline in eGFR. Plasma viscosity was measured and searched for the association with cross-sectionally analyzed cardiovascular parameters including body composition analyses, ambulatory blood pressure monitoring (ABPM) data, and pulse-wave velocity. RESULTS: Patients were divided into 2 groups according to the median value of serum viscosity. Patients with high viscosity had higher serum low-density lipoprotein (P = .042) and C-reactive protein (P = .046) levels than lower viscosity group. In ABPM, daytime (P = .047) and office systolic (P = .046) blood pressure levels and left ventricular mass index (LVMI; P = .012) were significantly higher in patients with hyperviscosity. Patients with high viscosity had higher hip circumference (P = .038) and fat mass (P = .048). Estimated glomerular filtration rate decline was significantly higher in high-viscosity patients than in patients with low viscosity levels (12.9% vs 17.2%; P = .001) at 2 years' follow-up. CONCLUSIONS: We suggest that the hyperviscous state of the renal transplant recipients may arise from the inflammatory state, hypertension, and increased fat mass and increased LVMI. Hyperviscosity is also closely related to renal allograft dysfunction.

High-grade proteinuria as a cardiovascular risk factor in renal transplant recipients.

BACKGROUND: Proteinuria is a marker of graft damage and is closely associated with a higher risk of morbidity, mortality, and cardiovascular disease in kidney transplant recipients (KTRs). Arterial stiffness is a well-known predictor of vascular calcification and systemic arteriosclerosis. In our study, we aimed to investigate the association between proteinuria and graft/patient survival and to determine whether proteinuria may be a predictor for cardiovascular disease in our KTR population. METHODS: Ninety KTRs (31 women; age, 38.7 ± 11 years, with 45.9 ± 9.6 months post-transplantation period) with normal graft functions in the 3 to 5 years of the post-transplantation period were enrolled. All patients were evaluated for their standard clinical (age, sex, and duration of hemodialysis) parameters. High-grade proteinuria was defined as proteinuria >500 mg/day in the 24-hour urine collection. All patients were evaluated by means of pulse-wave velocity (PWV) measurement at the initiation of the study. RESULTS: Patients were divided into 2 groups: group 1 (high-grade proteinuria) patients with ≥500 mg/24 hours (n = 30) and group 2 (low-grade proteinuria) patients with <500 mg/24 hours (n = 60). High-grade proteinuria was correlated with higher PWV measurements and lower estimated glomerular filtration levels. Proteinuria appears to precede the elevation of serum creatinine and thus may be a useful marker of renal injury and may also be a contributing factor on deterioration of the graft. CONCLUSIONS: High-grade (>500 mg/day) proteinuria in KTRs is strongly associated with poor graft survival and increased risk of cardiovascular events. In our study, we proved the significant difference between high-grade and low-grade proteinuric patients, and we suggest 500 mg/day as the threshold of proteinuria in KTR population.

Pulmonary hypertension is closely related to arterial stiffness in renal transplant patients.

INTRODUCTION AND AIMS: Pulmonary hypertension (PH) is an independent predictor of increased mortality in patients on dialysis and those undergoing renal transplantation. We investigated PH and its association with vascular calcification and endothelial dysfunction in renal transplant patients. METHODS: The records of 300 consecutive patients who underwent renal transplant in our center between 2005 to 2012 were evaluated. PH was defined as systolic pulmonary artery pressure (sPAP) ≥ 35 mm Hg. Demographic information, clinical characteristics, pulse wave velocity (PWv), and renal recessive indices (RRI) were collected and compared among patients with and without PH. RESULTS: Eight patients in PH group (age 36 [19] years) and 87 subjects in nPH group (age 35 [9] years) were evaluated. Demographic and clinical characteristics and laboratory data of the 2 groups were similar. Additionally, sPAP was positively correlated with PWv (r = 0.263, P = .01). In multivariate analyses, RRI (P = .004), serum CRP (P = .025), and PWv (P = .001) were associated with pulmonary artery pressure. CONCLUSION: PH is significantly associated with arterial stiffness in renal transplant recipients who have a high risk for cardiovascular disease. Considering the common prevalence of cardiovascular diseases, including PH, we suggested that all patients with renal transplantation should be evaluated for regular echocardiographic examination in clinical practice.

Dialysis patients with the metabolic syndrome need less recombinant human erythropoietin for similar hemoglobin levels.

INTRODUCTION: The metabolic syndrome (MS) components, such as dyslipidemia, prothrombotic status, and increased blood pressure, are risk factors for patients with renal disease. Visceral fat mass is closely related to the MS and atherosclerosis. We investigated the effects of body compositions and MS on anemia parameters and recombinant human erythropoietin (rHuEPO) requirements in maintenance hemodialysis patients. METHODS: Body composition (body mass index and bioimpedance analysis) and laboratory data were obtained from 110 dialysis patients. The MS was identified according to ATP-III criteria. Anemia parameters, hemoglobin (Hgb), albumin, C-reactive protein (CRP), calcium, phosphorus, parathormone levels, and rHuEPO requirements over the last 6 months were retrospectively analyzed. RESULTS: Patients with the MS seem to reach target Hgb levels more frequently (10-12 g/dL; 66.3% vs 84.8%; P = .03) without any difference in total intravenous iron therapy dosage. MS patients also required lower rHuEPO for reaching similar Hgb levels compared with patients without MS (2679.3 ± 1936.1 vs 3702.5 ± 2213.0 U/kg/6 mo; P = .02). There were no differences in serum CRP, albumin, or Hgb levels between the 2 groups (P > .05). We observed that patients with MS had significantly higher fat mass and visceral fat ratio, but similar muscle mass values compared with no-MS counterparts (P = .0001 and .001, respectively). However, when we compared the ratios of these parameters we observed a significant reduction in muscle ratios and a significant increase in fat ratios of MS patients (P = .0001). CONCLUSION: Our results indicate that MS might be an advantage for reaching higher Hgb levels with lower rHuEPO dosages. The possible reason for this might be the good nutritional state and increased fat mass of patients with MS.

Reliability of bioelectrical impedance analysis in the evaluation of the nutritional status of hemodialysis patients - a comparison with Mini Nutritional Assessment.

INTRODUCTION: Protein-energy wasting (PEW) is a strong predictive factor for morbidity and mortality in patients who have end-stage renal disease (ESRD). Mini Nutritional Assessment (MNA) is an important and confirmed tool to evaluate PEW that has been recommended by many guidelines. Bioelectrical impedance analysis (BIA) is a noninvasive technique for assessing body composition. The aim of the present study was to analyze the reliability of BIA in malnutrition diagnosis by comparing it with standard MNA in a group of 100 ESRD patients. METHODS: One hundred ESRD patients who were medically stable and under dialysis treatment for at least 6 months were enrolled to the study. Monthly assessed serum creatinine, albumin, C-reactive protein (CRP), and lipid profiles from the last 6 months prior to the study were retrospectively collected. A standard Full-MNA and body composition analyses were applied to all patients. Body compositions were analyzed with the BIA technique using the Body Composition Analyzer (Tanita BC-420 MA; Tanita, Tokyo, Japan). Patients were classified into three groups according to MNA scores as PEW (n = 15, score <17), moderate PEW or risk group (n = 49, score 17-23.5), and well-nourished (n = 36, score ≥ 24) patients. RESULTS: Mean duration of maintenance hemodialysis treatment was significantly shorter in the PEW group compared to both of the other groups described (P = .015). Well-nourished and risk groups had lower CRP and higher albumin levels compared to PEW patients; however, these values were statistically similar in these two groups (P = .018, .01, respectively). According to BIA findings, well-nourished patients had the highest fat ratio, fat mass, muscle mass, visceral fat mass, and fat-free mass compared to both moderate the PEW/risk and the PEW groups (P < .05). Risk group patients also had higher muscle mass, visceral fat mass, and fat-free mass values compared to the PEW group (P < .05). A correlation analysis revealed that MNA scores were positively correlated with albumin (P = .005), creatinine (P = .049), fat mass (P = .045), muscle mass (P = .001), visceral fat ratio (P = .007), and BMI (P = .047) and in negative correlation with CRP (r = -0.357, P = .0001) levels. CONCLUSIONS: We recommend BIA as a complementary diagnostic tool to evaluate nutritional status of ESRD along with MNA, anthropometric measures, and classical biochemical markers.

Body composition analysis of patients on waiting list for cadaveric renal transplantation: a comparison of hemodialysis and peritoneal dialysis patients.

BACKGROUND: Bioelectrical impedance analysis is a simple, noninvasive method of assessing body composition. Dialysis modality and selection of buffer type may have an impact on body composition. The aim of our study was to compare body compositions of patients from the waiting list for cadaveric renal transplantation according to the dialysis modality. METHODS: We examined a total of 152 (110 hemodialysis [HD] and 42 continuous ambulatory peritoneal dialysis [CAPD]) patients. Demographic data were collected from patient charts. The last 6 months routine laboratory evaluations including hemoglobin, serum creatinine, intact parathyroid hormone, albumin, C reactive protein, calcium, phosphorus were collected. Body compositions were measured using the Tanita BC-420MA Body Composition Analyzer (Tanita, Tokyo, Japan). We made a subanalysis of the CAPD group according to buffer choices as follows: lactate-buffered (n = 16) and bicarbonate/lactate-buffered (n = 26) solution users. RESULTS: The body weight (P = .022), body mass index (BMI; 25.8 ± 4.7 vs 23.4 ± 4.9 kg/m(2), P = .009), muscle mass (P = .01), fat-free mass (P = .013), and visceral fat ratio (9.5 ± 5.4 vs 7.3 ± 4.1 %, P = .022) were significantly higher in the CAPD group. Total body water of CAPD patients were also higher (P = .003), but total body water ratios of HD and CAPD groups were similar. Fat and fat-free mass ratios of patient groups were also similar. Comparing CAPD subgroups we observed that patients using bicarbonate/lactate-buffered solutions had higher body weights (P = .038), BMI (27.1 ± 5 vs 23.7 ± 3.5 kg/m(2), P = .018) values, and visceral fat ratios (8.0 ± 5.2 vs 4.6 ± 2.5 %, P = .023). These patients also tend to have higher fat mass without statistical significance (P = .074). Fat, muscle, and fat-free mass total body water ratios of peritoneal dialysis subgroups were similar. CONCLUSION: We believe that body composition analysis should be used as a complementary method for assessing nutritional status of PD and CAPD patients as body weight or BMI measurements do not reflect fat, muscle masses, and visceral fat ratios in these patients. Stable, well nourished CAPD patients should be closely observed and be encouraged to increase daily exercise and/or decrease calorie intake from other sources to decrease risks associated with abdominal obesity.

Cytomegalovirus infection in renal transplant recipients: one center's experience.

BACKGROUND: Cytomegalovirus (CMV) is the most common opportunistic viral infection that causes morbidity, graft loss, and mortality among renal transplant recipients (RTRs). The aim of this study was to evaluate the impact of CMV infection on allograft function, graft/patient survival, and the possible asssociations between CMV infection and HLA typing. METHOD: This retrospective study included 162 RTRs who had at least 1 year regular post-transplantatioin follow-up between January 2007 and December 2011. Recipients who had positive quantative CMV-polymerase chain reaction (PCR) were assigned to the study group (n = 17) and PCR-negative patients were assigned to the control group (n = 145). To determine whether CMV infection was related to HLA specificities, the incidence of CMV infection was analyzed in relation to HLA-A, -B, and -DR typing. RESULTS: Study groups were similar in terms of demographic, clinical, and basal laboratory findings. Duration of dialysis before transplantation was significantly longer in this study group (P = .018). Although the total HLA mismatches of both groups were similar, we found that HLA-B51-positive recipients had a lower risk for CMV infection (P = .018). CMV infection was more frequent in patients with a double-J stent (P = .001). Although basal creatinine levels of the two groups were similar, the study group patients' creatinine levels were significantly increased during the 1-year post-transplantation period compared to controls (P = .0001). Frequency of acute rejection was significantly higher in the study group (41.2% vs 11%, P = .001). Graft loss due to any cause was also significantly higher in the study group (29.4% vs 6.9%, P = .01). Patients who had preoperative induction therapy and post-transplantatioin tacrolimus-based regimens were prone to CMV infection (P = .0001, .006). CONCLUSIONS: Despite recent advances in prophylaxis, CMV infection is still a risk factor for RTRs. According to our data, long pretransplantation dialysis duration, being HLA-B51-negative, having a double-J stent, preoperative induction therapy, and post-transplantation tacrolimus-based regimens might induce development of CMV infection by 1-year post-transplantation follow-up.

Evaluation of nutritional status in renal transplant recipients in accordance with changes in graft function.

INTRODUCTION AND AIMS: Renal transplantation (RT) is the ultimate treatment modality for end-stage renal disease (ESRD) patients. Malnutrition is a strong predictor of cardiovascular disease among ESRD patients. Body composition analysis using bioimpedance devices (BIA) is a useful noninvasive tool to detect malnutrition in this population. We investigated the impact of graft function on nutritional status and reliability of BIA to detect malnutrition in RT recipients. METHODS: We evaluated retrospectively 189 RT recipients including 59 females, and of overall mean age of 38.3 ± 10.6 years who had a minimum posttransplant follow-up of 12 months. Body Composition Analyzer (Tanita BC-420MA) determinations were complemented with monthly assessments of biochemical parameters. Patients were divided into 3 groups according to glomerular filtration rate (GFR) levels: normal graft function/high GFR group (group 1, normal creatinine levels, no proteinuria and GFR ≥ 90 mL/min; n = 59); low renal function/low GFR group (normal or high creatinine levels with low GFR levels; group 2; GFR 89-60 mL/min; n = 87) and group 3, (GFR < 60 mL/min; n = 43). RESULTS: Group 3 patients displayed significantly lower as well as hemoglobin albumin and calcium concentrations, with higher phosphorus and parathyroid hormone levels (P = .0001). They also showed significantly lower body weight (P = .0001), body mass index (P = .002), fat (P = .002) and muscle (P = .0001) contents as well as fat-free mass (P = .0001). Group 2 patients had significantly lower values compared with group 1 and higher values than group 3. GFR values positively correlated with albumin, fat, muscle, and fat-free mass (r = 0.337, 0.299, 0.281, 0.278, respectively; P = .0001). GFR values positively correlated with visceral fat ratio (r = 0.170; P = 0.02), body mass index (r = 0.253; P = .0001), and waist-hip ratio (r = 0.218; P = .006). CONCLUSION: Loss of muscle and fat mass is an early sign of malnutrition among RT recipients. It is closely associated with loss of GFR. BIA is a noninvasive and reliable diagnostic tool that should be included in the follow-up of these patients for an early diagnosis of malnutrition-related complications.

Low graft function and ongoing hyperparathyroidism are closely related to post-transplantation osteoporosis.

INTRODUCTION: Renal transplantation (RT) is the gold standard therapy for chronic renal failure. Immunosuppressive drug choice, malnutrition, adynamic bone disease and hyperparathyroidism are important factors impacting the development of posttransplant osteoporosis. Body composition analysis with bioimpedance devices (BIA) is a useful noninvasive tool to detect malnutrition among the RT population. We investigated the effects of graft function, immunosuppressive drug regimens and biochemical characteristics on bone mineral density of RT patients as well as the reliability of BIA measurements to diagnose osteoporosis. METHODS: One hundred three recipients with a minimum of 12 months post-RT follow-up underwent body composition analysis using the Tanita Analyzer. The last 6 months of monthly biochemical parameters and glomerular filtration rates (GFR) as well as drug regimens were collected retrospectively from patient charts. Patients were divided into 2 groups, according to their femoral neck and lumbal T scores, as osteoporosis (n = 42) and control groups (n = 61). RESULTS: The mean GFR of osteoporotic patients was significantly lower (P = .04) and parathyroid hormone (PTH) levels significantly higher (P = .002). According to BIA, osteoporotic patients showed lower bone mass, fat mass, visceral fat ratio, muscle mass, waist-hip ratios, and body mass index values (P < .05). Correlation analysis revealed GFR to negatively correlate with PTH (r = -0.231, P = .010) and positively with femur t scores (r = 0.389, P = .0001) as well as with BIA findings (P = .0001). In contrast, PTH levels in negatively correlated with lumbar and femoral neck t scores (r = -0.22, -0.4 and P = .026, .0001, respectively) but not with BIA findings including bone mass. CONCLUSION: Changes in bone density after RT were affected by graft function. The rapid loss of bone mineral density emphasizes the need for prevention started in the early posttransplant period. BMD measurements provided a guide for treatment and for subsequent evaluation.

Left ventricular mass index and its relationship to ambulatory blood pressure and renal resistivity index in renal transplant recipients.

INTRODUCTION AND AIMS: Left ventricular hypertrophy (LVH) is frequently observed in patients with end-stage renal disease and renal allograft recipients. It is an independent, strong predictor of morbidity and mortality. Renal resistive index (RRI) is an important determinant of graft function in transplant recipients. In essential hypertension, increased RRI is associated with reduced renal function and tubulointerstitial damage. In this present study, we investigated the association of ambulatory blood pressure monitoring parameters and RRI on left ventricular mass index among renal transplant recipients. METHODS: Charts of 98 renal transplant recipients with echocardiography, ambulatory blood pressure monitoring, and renal Doppler ultrasonography as well as laboratory tests including serum creatinine, glomerular filtration rate, and C-reactive protein (CRP) level at the end of post-transplantation year 1 were analyzed in this study. LVMI was calculated using the Devereux formula with echocardiographic findings. RESULTS: Left ventricular mass index (LVMI) positively correlated with mean systolic blood pressure (SBP) (r = 0.512; P = .0001), mean nighttime SBP (r = 0.312; P = .007), mean nighttime diastolic blood pressure (DBP) (r = 0.427; P = .005), renal resistive index (RRI; r = 0.290; P = .004), and age (r = 0.371; P = .001). Multiple logistic regression analysis revealed that mean and maximum nighttime SBP and RRI were independent risk factors for LVMI (P = .001, .035, and .05, respectively). CONCLUSION: High RRI is one of the main indicators of cardiovascular disease in renal transplant recipients. Additionally, older age, high blood pressure, and nondipper pattern are important risk factors of LVH.