Comparative study of the outcomes of the second kidney transplantation from the young deceased donors versus living-unrelated donors.

PURPOSE: To compare the kidney graft function and survival in patients who had second kidney transplantation from living donors versus those who had a second transplant from young deceased donors. METHODS: In this retrospective cohort study, a total of 86 patients who underwent second kidney transplantation in Shariati hospital from 2001 until 2017 were enrolled. Baseline clinical data on the age, sex, type of kidney donor (living unrelated or deceased), duration of pretransplant dialysis, and the length of hospitalization were recorded. As the indicators of the graft function, we used the serum creatinine level and estimated glomerular filtration rate (eGFR) at time intervals during the study. The 1, 5, and 10-year graft survival rates were reported using life tables and the relative hazard ratios of the graft failure were calculated using the forward stepwise Cox proportional hazard model. RESULTS: Forty-six of our patients were men (53.5%), with a mean ± SD age of 44.3 ± 12.3 years at the time of transplantation. The majority of the enrolled patients received the kidney from living unrelated donors (50 vs. 36 patients). In terms of serum creatinine and eGFR, at time intervals, no significant difference was found between the two recipient groups. In the living donor group, the 1, 5, and 10-year graft survival rates of the second transplant were 91% (95%CI: 73-96%), 87% (95%CI: 69-95%), and 82% (95%CI: 59-92%), and for the deceased donor group were 95% (95% CI: 69-99%), 95% (95%CI: 69-99%), and 79% (95%CI: 31-95%), respectively. CONCLUSION: Considering the long-term outcomes of the second kidney transplantation, in our experience, the graft function and survival, either from the living or deceased donors, were favorable; and the type of organ donation had no significant effect on the risk of graft failure.

The Effect of Renal Transplant on Hypogonadism and Erectile Dysfunction due to End-stage Renal Disease.

Hypogonadism is common in patients with chronic kidney disease especially for end-stage renal disease (ESRD), which is referred to as uremic hypogonadism. Men with ESRD are prone to reproductive and sexual disorders such as sexual desire loss, abnormalities in orgasm, sexual dysfunction, and erectile dysfunction (ED). The mechanism of this complex disorder is not well known. Considering the above, we decided to study the effect of renal transplantation on hypogonadism and sexual activity in patients with ESRD. This study was performed on 45 patients with ESRD undergoing renal transplantation. Patients were included into two groups of live donor (24) and cadaveric (21), according to the type of kidney donors. The International Index of Erectile Function-5 (IIEF5) questionnaire was filled out for evaluation of erectile and sexual status. Laboratory parameters were assessed before the renal transplant in a single and valid laboratory including blood urea nitrogen, creatinine, thyroid function tests, luteinizing hormone, follicle-stimulating hormone, testosterone, and prolactin. We refilled the ED questionnaire and checked the laboratory tests again three and six months after transplantation. The mean age of the patients was 51.7 ± 8.0. The mean blood testosterone level in the live group was 347.1 ± 64.9 before transplantation, which reached 413.1 ± 25.9 in six months after transplantation. The same variable for the cadaveric group was 306 ± 56.2 and 355.3 ± 56.9, respectively. The IIEF5 scores before and six months after transplantation were 17.2 ± 4.5 and 24.6 ± 3.3 respectively for the live group and 10.8 ± 2.4 and 13.9% ± 4.1% for the cadaveric one, all of which were statistically significant. Renal transplantation significantly improves the condition of hypogonadism and ED in patients with ESRD. This improvement is not related to the type of donation.

Correction to: Impact of the donor-recipient gender matching on the graft survival from live donors.

An amendment to this paper has been published and can be accessed via the original article.

Impact of the donor-recipient gender matching on the graft survival from live donors.

BACKGROUND: Several factors such as recipient age, BMI, serum cratinine, and positive history of dialysis are important in predicting graft survival among kidney transplant recipients. One factor affecting the transplant outcomes is donors and recipients gender, which is usually ignored. METHODS: A total of 1113 kidney transplant recipients were studied in this retrospective cohort study. Several factors were taken into account for graft survival and outcomes such as donors and recipients gender and age in addition to common recipient factors like cratinine, eGFR, BMI, and positive history of dialysis. RESULTS: The most successful transplant based on donor-recipient gender was observed in male donor to male recipient, and then male donor to female recipient. In female transplant recipients, level of serum cratinine and eGFR, positive dialysis history before transplant, and low donor hemoglobin level can be considered as good prognostic factors recommended for kidney transplant survival. CONCLUSIONS: Our results suggested gender matching for kidney transplant. Only in some exceptional conditions, male donor to female recipient kidney transplant may be successful and female donors to male recipients are not suggested, especially in aged patients with the history of dialysis.

The first experience of sequential liver-kidney transplantation for the treatment of primary hyperoxaluria type-1 in Iran as a developing country.

Primary hyperoxaluria Type-1 (PH-1) is caused by a deficiency of alanine-glyoxylate aminotransferase manifesting as urolithiasis, nephrocalcinosis, and end-stage renal disease (ESRD). Among treatment options, best outcomes have been achieved by sequential liver-kidney transplantation (Seq-LKT). Herein, we report a patient with PH-1 and ESRD who underwent Seq-LKT in Iran. Criteria for diagnosis included a history of recurring calcium oxalate renal stones and elevated urine oxalate level combined with liver biopsy and absent enzymatic activity at the age of 13 years. Conservative treatment including pyridoxine, potassium citrate solution, high fluid intake, and hemodialysis was administered initially. Liver transplantation was performed at the age of 17 years from a deceased donor followed 4½ months later by a living-unrelated donor kidney transplantation. After two years of follow-up, the patient experienced no complications and had normal liver and renal function. This is the first successful experience of Seq-LKT in the treatment of PH-1 in Iran as a developing country with limited access to equipment and medications.

Seminal insulin-like growth factor-I may be involved in the pathophysiology of infertility among patients with clinical varicocele.

Varicocele, the most common cause of male infertility, is defined as abnormal dilation of the pampiniform plexus. Although different mechanisms have been proposed to explain the pathophysiology of infertility caused by varicocele, it is still open to debate. Previous studies have demonstrated the effect of insulin-like growth factor-I (IGF-I) on semen quality in animals and humans, but there are no studies on the probable role of seminal IGF-I in the pathophysiology of infertility among patients with clinical varicocele. We therefore aimed to examine the seminal IGF-I concentration in 49 patients with varicocele and primary infertility before and after varicocelectomy and compare the results with those of 50 healthy fertile men (in the control group). Mean seminal IGF-I level of patients before varicocelectomy (93.7 ± 67.2 ng/mL) was significantly different (P < 0.001) from that following varicocelectomy (58 ± 35.1 ng/mL) and from that of the controls (57.6 ± 22.1 ng/mL). However, mean seminal IGF-I levels of patients after varicocelectomy and the controls were not significantly different. Seminal IGF-I level was not correlated with grade and side of varicocele, and semen quality. We conclude that locally secreted IGF-I in the semen may be involved in the pathophysiology of infertility in patients with varicocele or semen.

Failure of isolated kidney transplantation in a pediatric patient with primary hyperoxaluria type 2.

PH type 2 is caused by decreased activity of GRHPR enzyme that eventually leads to ESRD and systemic oxalosis. Here, we describe an Iranian pediatric patient with PH2 and early ESRD development who received recommended treatment by undergoing isolated kidney transplantation. Diagnosis criteria included a history of reoccurring calcium oxalate renal stones and elevated oxalate levels combined with liver biopsy and decreased enzymatic activity at age five. ESRD prompted transplantation and was performed at age nine. On Day 12 post-op, his serum creatinine level increased. A graft biopsy showed calcium oxalate crystal deposits in renal tubes with no evidence of acute rejection, which resolved with intensive hydration and administration of a potassium citrate solution. Subsequent biopsies confirmed results found in first biopsy. Despite the immunosuppressive therapy, his serum creatinine level increased again after 11 months. Renal tubular obstruction then led to graft nephrectomy. Pathological analysis of tissue confirmed findings of past biopsies. This was a very rare case of early ESRD in PH2 resulting in a failed isolated kidney transplant. As the GRHPR enzyme is predominantly expressed in liver, we suggest a combined liver-kidney transplant may be beneficial in patients with PH2.

Comparison of nitric oxide concentration in seminal fluid between infertile patients with and without varicocele and normal fertile men.

INTRODUCTION: Elevated nitric oxide (NO) levels have been shown to have toxic effects on sperm function and motility. This study was conducted to compare NO levels in the seminal fluid of infertile men with varicocele with those of infertile and fertile men without varicocele. MATERIALS AND METHODS: Semen samples were obtained from 40 infertile men with varicocele (group 1), 40 infertile men without varicocele (group 2), and 40 fertile volunteers without varicocele (group 3). NO levels in the seminal plasma of patients in each group were measured and compared. In infertile men with varicocele, semen parameters, including sperm count and motility, and grade of varicocele were also determined. RESULTS: Mean NO concentrations were 52.34 +/- 26.62 micromol/L, 37.06 +/- 20.39 micromol/L, and 33.7 +/- 18.99 micromol/L in groups 1, 2, 3, respectively. Concentrations in group 1 were significantly higher than were those in groups 2 and 3 (P = 0.001). In group 1, no significant correlations were seen between NO concentrations and grades of varicocele, sperm count, sperm motility, or ages of the patients. CONCLUSION: Data from the current study suggest a possible role of NO in damaging the sperm function in varicocele as demonstrated by an increased concentration of NO in the seminal fluid of infertile men with varicocele compared with the seminal fluid of fertile and infertile men without varicocele.