A single-center experience of renal transplantation in elderly patients.

BACKGROUND: We retrospectively reviewed the results of renal transplantation in patients over 60 years of age at our center. MATERIAL/METHODS: A retrospective study was conducted of 212 Bahraini patients receiving renal transplants from January 1979 to December 2007. All medical records were reviewed for demographic data, graft function and survival. Patient and graft survival was compared for patients above and below the age of 60. RESULTS: Seventeen patients >60 years with a mean age of 64.1+/-3.6 years at the time of transplantation. Diabetic nephropathy (52%) was the most common causes of end-stage renal disease. Mean donor age was 26+/-6 years and most of them were unrelated (82%). Of the elderly patients, 4 died: 3 with a functioning graft, 1 within one year of transplantation. Cardiovascular causes (3 patients, 75%) were the most common cause of death. Causes of graft loss were death with a functioning graft (4) and chronic rejection (1). Cox's proportional-hazards regression analysis showed on univariate analysis that pre-transplant hypertension, diabetes mellitus and vascular surgery (CABG) before transplant significantly affected the dependent variable of graft loss. Multivariate analysis did not show these variables to be significant. Kaplan Meier patient survival curves showed statistically significant differences between study (>60 years) and control (18-59 years) patients (p=0.04) at 10 year. CONCLUSIONS: We conclude that Patients older than 60 yr of age can be transplanted safely and successfully, especially when they are properly screened for the presence of significant risk factors such as severe cardiovascular disease and diabetes.

Renal biopsy findings in the kingdom of bahrain: a 13-year retrospective study.

Glomerular diseases continue to be the leading cause of end-stage renal disease globally. Hence, it is important to recognize the pattern of these diseases in any given geographical area. A total of 498 renal biopsies performed on patients with proteinuria, hematuria and mild to moderate renal impairment during a period of 13 years (between January 1990 and December 2002) at the Salmaniya Medical Complex (a tertiary care hospital of the Kingdom of Bahrain), were reviewed and categorized. Primary glomerular disease accounted for two-third of the glomerular diseases, which in turn constituted 44.8% of all renal biopsies. The most common histological lesion was minimal change disease (30%). Focal and segmental glomerulosclerosis was the second most common lesion (23.8%) followed by membranoproliferative glomerulonephritis (14.3%). Secondary glomerular disease comprised 33.6% of glomerular diseases (22.7% of all the renal biopsies) with lupus nephritis forming the commonest lesion (38.9%) followed by diabetic nephropathy (31.9%) and hypertension (20.4%). Tubulointerstitial diseases accounted for 13.1% of all renal biopsies whereas transplant diseases were noted in 12.2%. The miscellaneous group including inadequate biopsies constituted 7.2% of all the biopsies. The results of this analysis were compared with surveys from other parts of the World.

Brunner's gland polyp with upper gastrointestinal bleeding managed by endoscopic polypectomy: a report of two cases.

We report 2 rare cases of Brunner's gland adenoma presenting with upper gastrointestinal bleeding. They were removed by endoscopic polypectomy. In skilled hands, this method is safe and effective.

Role of sequential biopsy study in the evaluation of renal transplant.

Renal biopsy is indicated in all cases of renal transplants showing renal dysfunction. This not only helps in the diagnosis but also in the institution of proper management. Study of sequential biopsies is essential for establishing the cause of renal dysfunction, evaluation of the effect of treatment and the progress of the disease. This report is based on the study of 14 samples (including three nephrectomy specimens) belonging to six patients who underwent two or more sequential renal transplant biopsies at the Salmaniya Medical Centre, Bahrain, between 1995-2000 because of deteriorating renal functions. Based on the sequential biopsies, the graft dysfunction was attributed to rejection in four cases and recurrence of primary glomerular disease in two. An important finding in this series is one case of type I membranoproliferative glomerulonephritis due to hepatitis C noticed five years after transplant and two cases of acute vascular rejection superimposed upon chronic rejection.