Comparison of plasma exchange performances between Spectra Optia and COBE Spectra apheresis systems in repeated procedures considering variability and using specific statistical models.

Repeated therapeutic plasma exchange (TPE) procedures using centrifugation techniques became a standard therapy in some diseases. As the new device Spectra Optia (SPO; Terumo BCT) was available, we studied its performances in repeated procedures in 20 patients in three apheresis units. First we analysed the performance results obtained by SPO. Second we compared the performances of the SPO device to a standard device, COBE Spectra (CSP; Terumo BCT) in the same patients using statistical method of mixed effects linear regression that considers variability between patients, centres and apheresis procedures. The performances analysed were classified according to plasma removal performances and their consequences on patients whose blood disturbances were assessed. Primary outcome was plasma removal efficiency (PRE) and PRE-anticoagulant corrected which was a more accurate parameter. Secondary outcomes corresponded to the volume of ACD-A consumed, platelets content in waste bag, procedure duration and status of coagulation system observed after TPE sessions. Before comparing the performances of both devices we compared the plasma volumes (PVs) processed in both techniques which showed that the PVs processed in SPO procedures were lower than in CSP procedures. In these conditions the statistical analysis revealed similar performances in both apheresis devices in PRE (p = ns) but better performances with SPO when considering higher PRE corrected by anticoagulant volume used (p < 0.05). Comparison of secondary outcomes showed no difference after SPO and CSP. After verifying that pre-apheresis patients' coagulation blood levels were identical before SPO and CSP, we showed identical haemostasis disturbances after SPO and CSP but lower platelet losses and higher fibrinogen post-apheresis blood levels after SPO (p < 0.05). No side effects or technical complications occurred during and after SPO and CSP. This study demonstrated that the Spectra Optia device is an alternative device to today's standard, the COBE Spectra device.

Association between Migraine and Quality of Life, Mental Health, Sleeping Disorders, and Health Care Utilization Among Older African American Adults.

PURPOSE: This study examines the associations between migraine headaches, well-being, and health care use among a sample of underserved older African American adults. Controlling for relevant variables, the association between migraine headaches and (1) health care utilization, (2) health-related quality of life (HRQoL), and (3) physical and mental health outcomes was examined. METHODS: Our sample included 760 older African American adults from South Los Angeles recruited through convenience and snowball sampling. In addition to demographic variables, our survey included validated instruments, such as the SF-12 QoL, Short-Form McGill Pain Questionnaire, and the Geriatric Depression Scale. Data analysis included 12 independent multivariate models using multiple linear regression, log transferred linear regression, binary and multinomial logistic regression, and generalized linear regression with Poisson distribution. RESULTS: Having migraine was associated with three categories of outcomes: (1) higher level of health care utilization measured by (i) emergency department admissions and (ii) number of medication use; (2) lower level of HRQoL and health status measured by (i) lower self-rated health (ii) physical QoL, and (iii) mental QoL; and (3) worse physical and mental health outcomes measured by (i) higher number of depressive symptoms, (ii) higher level of pain, (iii) sleep disorder, and (iv) being disabled. CONCLUSIONS: Migraine headache significantly was associated with quality of life, health care utilization, and many health outcomes of underserved African American middle-aged and older adults. Diagnoses and treatments of migraine among underserved older African American adults require multi-faceted and culturally sensitive interventional studies.

Which primary diagnosis has the highest in-hospital mortality rate for kidney recipients?

OBJECTIVES: Although "in-hospital mortality" for several post-renal transplantation complications has been reported in various studies, there is no single published single-center study that compares their hospital mortality rates. We sought to rank the primary diagnoses post-renal transplantation by means of in-hospital mortality. METHODS: We selected 404 consecutive rehospitalizations following kidney transplantation from 2003 to 2005. The causes of rehospitalization were categorized into infection, allograft rejection, surgical complication, cerebrovascular accidents (CVA), malignancy, medication complications, and miscellaneous. Fatality was defined as the relative frequency of death due to the same cause among all admissions. RESULTS: The mortality rate (MR) was 5.7%. From the 23 cases of death, 17 (74%) had a functioning kidney at the time of death. The MR was 40% for CVA, 14.3% for surgical complications, 11.1% for miscellaneous, 5.3% for drug complications, 7% for infections, and 4.8% for graft rejection (P=.002). No death was observed among cases with a diagnosis of malignancy or nephrolithiasis. Inpatient mortality was higher among those with more than one diagnosis at admission: 42.9% for more than two diagnosis, 7.1% for those with two diagnosis, and 4.2% for those with one diagnosis (P=.001). CONCLUSIONS: The in-patient mortality ranking is totally different from the ranking of causes of death in renal recipients. In other words, infection is the leading cause of death due to high incidence, and not high fatality. More rare complications, including CVA and surgical complications, are more often fatal.

Renal transplantation in Iran over the past two decades: a trend analysis.

BACKGROUND: In this study, we have reported updated statistics of the Iranian Transplantation Registry, the status of the recipients and grafts, and a detailed time trend with respect to patient characteristics. METHODS: We retrospectively reviewed the Iranian Renal Transplantation Registry and information from the Dialysis and Transplant Patients Public Association, to obtain data on all kidney transplantations performed in Iran between 1986 and 2005. Data were gathered regarding the total number of transplantations, graft loss, recipient death, and donor and recipient characteristics, including demographic data, cause of end-stage renal disease (ESRD), and source of kidney. We assessed changes in variables on a biannual basis. RESULTS: A total of 19521 transplantations were registered over the study period, of which, 761 recipients (3.9%) had died and 2333 allografts (11.9%) had been lost. The source of the kidney in 2556 (13%) subjects was a living related donor (LRD), in 16234 (83%) a living unrelated donor (LURD), and in 831 (4%) cadaveric. During the study decades we noted an increase in the number of kidney transplantations (from 22 to 3690), age of recipients (from 30 to 40), male-to-female ratio of recipients (from 0.58 to 0.67), male-to-female ratio of donors (from 0.48 to 0.52), diabetes mellitus (from 0% to 27%), and hypertension (from 4% to 15%), as causes of ESRD, as well as the use of cadaveric kidneys (0% to 11%). CONCLUSION: Analyzing renal transplantation data not only helps to evaluate the effectiveness of transplantation activities in a country, but also provides information to estimate future costs in the health care system.

Prolonged rehospitalizations following renal transplantation: causes, risk factors, and outcomes.

BACKGROUND: Although some studies have described rehospitalization after transplantation, few have focused on risk factors and consequences of prolonged hospital stay. Our goal was to determine the causes, risk factors, and outcomes of prolonged rehospitalizations after renal transplantation. PATIENTS AND METHODS: In this retrospective study, 574 randomly selected rehospitalization records of kidney transplant recipients were reviewed from 1994 to 2006. Admissions were divided into group 1, prolonged stay (length of stay >14 days, n=149), and group II, short stay (length of stay 62% of all hospital costs; however, they comprised only 26% of the patients. High-risk kidney transplant recipients for prolonged hospitalizations should be closely observed for infections and graft rejection.

Changing treatment protocol from azathioprine to mycophenolate mofetil: decrease in renal dysfunction, increase in infections.

INTRODUCTION: Immunosuppression for renal transplantation has shifted from azathioprine (AZA) regimens to those containing mycophenolate mofetil (MMF). This study investigated the impact of this change on the causes for rehospitalization as well as on graft and patient survival. METHODS: In this retrospective cohort study, we reviewed long-term patient and graft survivals as well as the causes of posttransplant admissions for 893 kidney recipients. Data on survival and readmissions were available for 811 subjects, who were divided to into the AZA cohort (n=289, transplantation between 1998 and 1999) and the MMF cohort (n=567, transplantation between 2000 and 2001). Survival, the cause for readmission, time interval between transplantation and readmission, intensive care unit (ICU) admission, mortality, and graft loss were compared between the two cohorts. RESULTS: Five-year patient and graft survival rates were 85% and 67% for the AZA cohort and 91% and 68% for the MMF cohort (P=.013). There were 202 (71%) and 371 (72%) readmissions registered for the AZA and MMF groups, respectively. In comparison with the AZA cohort, while readmissions secondary to graft rejection showed a significant decrease in the MMF cohort (62% vs 35%, P=.000), readmissions secondary to infections exhibited a significant increase (37% vs 50%, P=.002). A marginally significant increased mortality rate (2% vs 5%, P=.087) and ICU admission rate (3% vs 6%, P=.062) were also observed in the MMF cohort by comparison with the AZA cohort. CONCLUSION: The shift in the immunosuppression protocol from AZA to MMF, albeit advantageous in many instances, can sometimes undermine the outcome by giving rise to such complications as high infection rates.

Transplantation research in Iran: a bibliometric study.

BACKGROUND: Scientific articles are indicators of research interest and efforts in every country. The aim of the current study is to describe the characteristics of the transplantation-related research efforts with respect to the domestic published works in Iran between 1993 and 2003. MATERIALS AND METHODS: In a descriptive design, we searched IranMedex (Iranian database for indexing medical articles; available at: http//www.iranmedex.com) for all the biomedical articles published between 1993 and 2003 in 91 Iranian journals. The search was conducted using "transplantation" and "transplant" as key words. A printed copy of the references was reviewed individually so as to identify the transplanted organ, study design, number of authors, and type of article. RESULTS: Among 11371 articles, 545 (4.8%) were related to transplantation. An increasing trend was observed in the number of publications from 1993 to 2003. Most articles were published in Farsi (90%). The most frequently published articles were original articles (84.4%). The main subjects of were kidney (61.7%), followed by liver (12%) and bone marrow transplantation (10.8%). Cornea was the topic of research in only 3% of the papers. Of all manuscripts, 9.5% consisted of clinical trials. The mean number of authors was 3.6 +/- 2.2 (1 to 14). CONCLUSIONS: Iranian researchers seem to be interested in the topic of transplantation; however, some fields of transplantation are neglected. This pooling of valuable information can be used by other countries, especially by researchers from the Middle East Society for Organ Transplantation region. Such databases could form an invaluable network for an exchange of experience in the region to solve common problems.

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.

A logistic regression model for predicting health-related quality of life in kidney transplant recipients.

BACKGROUND: To develop a logistic regression model capable of predicting health-related quality of life (HRQOL) among kidney transplant recipients and determine its accuracy. METHODS: Three groups of patients were selected: 70 healthy controls, 136 kidney transplant patients as a derivation set, and another 110 kidney transplant patients as a validation set. SF-36 score was used for HRQOL measurement. A cutoff point to define poor versus good HRQOL was calculated using the SF-36 scores of healthy controls. A logistic regression model was used to derive predictive parameters from the derivation set. The derived model was then tested among the validation set. HRQOL predictions made by the model for the patients in the validation set and the SF-36 scores were compared. We calculated sensitivity, specificity, positive and negative predictive values, and model accuracy. RESULTS: SF-36 scores below 58.8 were defined as an indication of poor HRQOL. The regression model suggested that poor HRQOL was positively associated with lower education (below high school diploma), being single or widowed, and diabetes/hypertension as etiology. It was negatively associated with younger age (<45 years) at the time of transplantation. Optimal sensitivity and specificity were achieved at a cutoff value of 0.74 for the estimated probability of poor HRQOL. Sensitivity, specificity, positive and negative predictive values, and accuracy of the model were 73%, 70%, 80%, 60%, and 72%, respectively. CONCLUSION: The suggested model can be used to predict poor posttransplant HRQOL among renal graft recipients using simple variables with acceptable accuracy. This modal can be of use in decision making in the recipients for whom achieving good HRQOL is the main aim of transplantation, to select high-risk patients and to start interventional programs to prevent a poor HRQOL.

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.

Primary kidney disease and post-renal transplantation hospitalization costs.

BACKGROUND AND AIM: This study sought to assess posttransplantation hospitalizations costs in diabetic and nondiabetic subjects to see whether diabetes mellitus (DM) as a primary cause of end-stage renal disease (ESRD) increased posttransplantation hospitalization costs. METHODS: From 2000 to 2005, the hospitalization costs of 387 consecutive rehospitalizations of kidney recipients were retrospectively compared for two groups: patients with ESRD due to DM (n=71) and those with ESRD of non-DM etiologies (n=316). The hospitalization costs included the costs of hotel, medications, surgical procedures, paraclinical tests, imaging tests, health personnel time, special services (ie, patient transportation by ambulance), and miscellaneous costs. Societal perspective was used with costs expressed in PPP$ purchase power parity dollars (PPP$) estimated to be equal to 272 Iranian rials. RESULTS: Compared with the non-DM group, DM patients experienced significantly higher median costs both in total (1262 vs 870 PPP$, P=.001) and in cost components related to hotel (384 vs 215 PPP$, P=.001), health personnel time (235 vs 115 PPP$, P<.001), paraclinical tests (177 vs 149 PPP$, P=.012), and special services (100 vs 74 PPP$, P=.041). The mean of age was higher (P<.001), and the transplantation hospitalization time interval was also shorter in the DM group (median: 2.7 vs 12, P=.025). CONCLUSIONS: Considering DM as a leading cause of ESRD and its increasing prevalence in some countries, the association between hospitalization costs of posttransplant patients and DM may be of great economic importance to many transplantation centers.

Medical comorbidities after renal transplantation.

BACKGROUND: Despite the amount of evidence regarding the negative impact of medical comorbidities after transplantation, little attention has been directly paid to the pattern of somatic comorbidities in renal transplant recipients. The aim of this study was to assess the prevalence of medical comorbidities after kidney transplantation. METHODS: In a cross-sectional study during 2006, we evaluated 119 kidney transplant recipients for somatic comorbidities by using the Ifudu comorbidity index, which evaluated the presence of 14 chronic illnesses among patients undergoing maintenance hemodialysis. Correlations of the Ifudu score with demographic and clinical data were also studied. RESULTS: Eighty-three (90.4%) subjects had at least one medical comorbidity. The mean comorbidity score was 5.17 +/- 4.50. The most frequent comorbidities were nonischemic heart diseases including hypertension (n=75; 63%), visual disturbances (n=42; 35.2%), low back pain and spine and joint disorders (n=30; 25.21%), and musculoskeletal disorders (n=28; 23.5%). A higher comorbidity score was significantly correlated with lower economic status (P<.05), but not with age, gender, marital status, educational level, cause, or duration of end-stage renal disease. CONCLUSION: The prevalence of medical comorbidities among kidney transplant recipients seems to be high, with the highest prevalence due to nonischemic heart diseases, visual disturbances, and musculoskeletal disorders. This highlighted the necessity of providing posttransplant care by a multidisciplinary team of specialists.

Anxiety and depression are correlated with higher morbidity after kidney transplantation.

BACKGROUND: Psychiatric comorbidities have been reported to be associated with low quality of life, but less attention has been paid to their impact on other morbidity measures. The aim of this study was to investigate the correlation of anxiety and depression with marital relation, sexual function, and sleep quality in kidney transplant recipients. METHODS: In a cross-sectional study between 2005 and 2006, 88 kidney transplant recipients were divided into four groups according to their scores of anxiety and depression using Hospital Anxiety Depression Scale (HADS): group I(anx) (anxiety score <11; n=64); group II(anx) (anxiety score >or= 11; n=24); group I(dep) (depression score <11; n=68); and group II(dep) (depression score >or= 11; n=20). Morbidity measures including quality of life (Short Form-36), marital adjustment (Revised Dyadic Adjustment Scale), sexual relationship (Relationship and Sexuality Scale), and quality of sleep (Pittsburgh Sleep Quality Index) were separately compared between groups of anxious versus nonanxious and depressed versus nondepressed. RESULTS: Group I(anx), compared with group II(anx), displayed a better state of mental health (48.80 +/- 7.14 vs. 44.45 +/- 7.80; P=.01), general health (49.36 +/- 12.77 vs. 42.91 +/- 16.67; P=.05), marital adjustment (55.13 +/- 8.01 vs. 48.35 +/- 16.62; P=.04), and lower sleep disturbance (1.36 +/- 0.62 vs. 1.66 +/- 0.63; P=.05). Group I(dep), compared with group II(dep), showed lower fatigue score (39.79 +/- 8.30 vs. 46.84 +/- 8.85; P=.002) and better sexual relationships (15.28 +/- 5.50 vs. 19.00 +/- 5.92; P=.03). CONCLUSIONS: Screening for anxiety and depression in kidney transplant recipients is essential. Appropriate treatment of these prevalent psychiatric comorbidities may improve various aspects of patient well-being, including quality of life, sleep, marital relations, and sexual relationship.

Marital quality in kidney transplant recipients: easy to predict, hard to neglect.

BACKGROUND: Given the significant role of post-renal transplant familial support in the patient's adherence to treatment, a study into the contributors to marital quality in this population seems necessary. This study sought to identify the predictors of poor post-renal transplant marital quality. METHODS: This cross-sectional study was conducted in 2006 on 125 married kidney transplant recipients. Marital quality was evaluated using the Revised Marital Adjustment Scale (RMAS). A score below the fourth-quartile MAS score of a group of age- and sex- matched healthy controls was interpreted as poor marital relationship. Multiple logistic regression analysis was utilized to evaluate the predictors of poor marital relationship. RESULTS: The mean time interval between transplantation and assessment of marital quality was 43 +/- 15 months. Poor post-renal transplant marital quality can be predicted by the kidney transplant recipient's sex (M/F) (odds ratio [OR]; 0.31; 95% confidence interval [CI], 0.11 to 0.90; P=.031), age at transplantation (OR, 0.93; 95% CI, 0.89 to 0.98; P=.005), educational level (OR, 0.67; 95% CI, 0.44 to 1.03; P=.067), and monthly family income (OR, 2.20; 95% CI, 1.09 to 4.44; P=.028). CONCLUSION: Presenting a simple prediction model for poor post-renal transplant marital relationship, this study will make it possible to detect patients at a higher risk of poor marital quality and thus avoid treatment noncompliance. At the time of transplantation, using simple demographic variables and providing couple-based health education programs as a part of a familial approach to renal transplantation may improve the outcome of such high-risk patients.

Sleep quality and its correlates in renal transplant patients.

BACKGROUND: The aim of this study was to evaluate correlated morbidity measures with poor sleep quality among kidney transplanted patients. METHODS: In a cross-sectional study of 125 Iranian kidney transplant patients in 2006, we employed self-administered questionnaires to evaluate the quality of sleep (PSQI), quality of life (SF-36), anxiety and depression, sexual activity, marital relationship, and medical comorbidity. Patients with PSQI score of >5 were considered to be "poor sleepers." Students t-test was used to compare the morbidity measures between the two groups: "poor sleeper" versus "good sleepers." RESULTS: Seventy-eight (62%) patients were poor sleepers. This group showed a higher total medical comorbidity score (P=.009), more bodily pain, poorer general mental health, and less physical function on SF- 36 (P=.02), less sexual function, and more severe anxiety (P=.02). There was no significant difference between poor sleepers and good sleepers in the mean of other subscores of the SF-36, marital status, and depressive symptoms. CONCLUSIONS: A poor quality of sleep is common after kidney transplantation. This problem is associated with higher medical comorbidity and poorer emotional state. Therefore, more attention should be paid to evaluation of sleep quality in this patient population.

Prediction of inpatient survival and graft loss in rehospitalized kidney recipients.

INTRODUCTION: Despite a sizeable amount of research conducted hitherto into predictors of renal transplantation outcomes, there are scarce, data on predictors of in-hospital outcomes of post-kidney transplant rehospitalization. This study sought to provide a user-friendly prediction model for inpatient mortality and graft loss among rehospitalized kidney recipients. METHOD: This retrospective review of 424 consecutive kidney recipients rehospitalized after kidney transplantation between the years 2000 and 2005 used multiple logistic regression analysis to evaluate predictors of hospitalization outcomes. RESULTS: Multivariate analysis showed that age at admission, diabetes mellitus as the cause of end-stage renal disease (ESRD), admission due to cerebrovascular accident (CVA), surgical complications were predictors of in-hospital death; age at transplantation, surgical complications, and rejection were predictors of graft loss. Equation for prediction of in-hospital death was Logit(death) -0.304 * age at transplantation (year) + 0.284 age at admission (year) + 1.621 admission for surgical complication + 4.001 admission for CVA-ischemic heart disease + 2.312 diabetes as cause of ESRD. Equation for prediction of in-hospital death was Logit(graft loss) = 0.041 age at transplantation (year) + 1.184 admission for graft rejection + 1.798 admission for surgical complication. CONCLUSIONS: Our prediction equations, using simple demographic and clinical variables, estimated the probability of inpatient mortality and graft loss among re-hospitalized kidney recipients.

Hospitalization databases: a tool for transplantation monitoring.

INTRODUCTION: We sought to account for changes in posttransplant hospitalization patterns in terms of the changes in demographic and transplantation-related variables. METHODS AND MATERIALS: We retrospectively analyzed 1860 cases of kidney transplantation performed between 1992 and 2004 in terms of demographic and transplantation-related variables. Of the 1860 cases, rehospitalization records in the first year posttransplantation were available for 1152 cases, which were assessed for causes of admission, mortality, graft loss, length of stay, and hospital charges. RESULTS: The pattern of rehospitalizations showed the following trends: (1) Increased rate of infection; (2) Decreased rate of graft rejection; and (3) Peak costs of rehospitalization between 1999 and 2000. CONCLUSION: We believed that the increased infection rate and decreased rejection rate may have been related at least partly to the shift in the treatment protocol from azathioprine-based to mycophenolate mofetil regimens in 2000. Furthermore, the peak in the relative frequency of diabetes mellitus and hypertension as the etiology of end-stage renal disease among those having undergone transplantation between 1999 and 2000 may have been responsible for the peak in rehospitalization costs and length of hospital stay. We are strongly of the opinion that hospital statistics are a valuable tool for health care policymakers to monitor transplantation outcomes.

The outcome of diverticulosis in kidney recipients with polycystic kidney disease.

INTRODUCTION: Diverticulosis is a common finding in autosomal-dominant polycystic kidney disease (ADPKD). To avoid the serious complications of diverticulosis after kidney transplantation, some policies have recommended aggressive actions, such as elective colectomy. These policies are not widely agreed upon. This controversy led us to investigate the serious complications and the outcome of diverticulosis in ADPKD kidney recipients to see whether such therapies are justified. MATERIALS AND METHODS: From 2002 to 2006, we followed 18 ADPKD kidney recipient patients with barium enema-documented diverticulosis. All subjects were asymptomatic for diverticulosis at the time of transplantation. The mean value +/- SD of follow-up duration was 25.4 +/- 28.5 months. We documented demographic data, familial history of ADPKD, barium enema findings, and complications as well as graft and patient survivals. RESULTS: Hepatic flexure was the most prevalent site for diverticula. The mean (SD) of diverticular count was 6 +/- 5.1. Patients with a familial history of ADPKD showed a higher number of diverticular (P=.01). Diverticulitis occurred in three patients, all of whom died. CONCLUSION: Diverticulitis is a fatal and not rare complication in ADPKD patients. The rate of complications in our study was similar to previous findings, but we observed serious complications even among patients asymptomatic at the time of transplantation. The decision to take aggressive action such as elective colectomy is still a matter of debate that needs further evaluation.

Outcome of living kidney transplant: pediatric in comparison to adults.

BACKGROUND: Renal transplantation is the most optimal way to manage children with end-stage renal disease. Despite its benefits, pediatric renal transplantation is a challenge for several transplantation centers in terms of achieving a satisfactory outcome. We sought to compare the long-term outcome of pediatric versus adult recipients who underwent renal transplantation. METHOD: We examined, 2631 recipients of a first kidney from a living donor between 1982 and 2002. The two groups were matched for immunosuppressive therapy and number of HLA mismatches. The patients were divided into a pediatric (n=301; age 18 years) to compare 5-year patient and graft survivals. RESULTS: The mean ages of the pediatric and adult groups were 40 +/- 13 and 14 +/- 13 years, respectively. The 5-year graft survival was lower among the pediatric versus the adult group (56% vs 68%; P=.015) with no difference in patient survival (88% vs 86%; P>.05). CONCLUSION: The poorer graft survival in pediatric transplantation may be due to the nature of pediatric transplantation, in terms of inconsistent adherence to medication regimens, worse side effects of medications, higher rate of graft rejection due to recurrent disease, and more intense immunoreactivity of children.