RESUMO
BACKGROUND: Kidney transplantation is the optimal treatment for end-stage renal disease in children. However, long-term graft survival has not significantly improved among pediatric patients. OBJECTIVE: To investigate the determinants of long-term graft survival among Iranian pediatric recipients of kidney transplantation. METHODS: In a single-center cohort study, we studied 314 pediatric kidney transplantations performed from 1989 to 2013 at Dr. Shariati Hospital, Tehran, Iran. Different variables were collected for each patient and graft survival rates were calculated. RESULTS: After a mean±SD follow-up period of 15.8±4.0 years, the mean±SD graft survival rate was 14.5±0.5 years; the 1-, 5-, 10-, and 20-year mean graft survival rates were 90%, 81%, 62%, and 62%, respectively. The corresponding patient survival rates were 100%, 99.4%, 97.8%, and 96.5%, respectively. Pre-emptive transplantation (p=0.006), and living graft donation (p=0.002) led to higher graft survival, while acute rejection (p=0.002), and primary disease of primary hyperoxaluria (p=0.001) led to lower graft survival. Chronic rejection was the most frequent cause of graft loss. CONCLUSION: Short-term graft survival still outpaces the long-term outcome. Modifying the mentioned determinants, with more intense immunosuppression for greater prevention of acute and chronic rejection, and increased rate of pre-emptive transplantation and living donor transplantation, long-term graft survival may significantly improve in future.
RESUMO
OBJECTIVE: The purpose of this study was to investigate folate status in healthy, nonpregnant women (18 to 45 years) following folic acid (FA) fortification of the food supply. DESIGN: This was a cross-sectional study design in which a fasting blood sample was obtained from socio-economically advantaged (n=85) and disadvantaged (n=50) women residing in Southern California who had not consumed supplemental FA within the past 12 months. Serum folate (SF), red cell folate (RCF) and plasma homocysteine (tHcy) concentrations were measured and methylene tetrahydrofolate reductase (MTHFR) genotype (C677T) was determined. RESULTS: SF and RCF concentrations (mean+/-SD) for socio-economically advantaged (54+/-18, 1387+/-329 nmol/L, respectively) and disadvantaged women (41+/-18, 1172+/-342 nmol/L, respectively) greatly exceeded the levels deemed acceptable for SF (> or = 13.6 nmol/L) and RCF (> or = 362 nmol/L). Moreover, 95% of socio-economically advantaged women and 78% of disadvantaged women achieved RCF concentrations > or = 906 nmol/L, which are associated with very low risk of neural tube defects (NTD). Plasma tHcy concentrations for both socio-economically advantaged (5.2+/-1.6 micromol/L) and disadvantaged women (6.1+/-1.6 micromol/L) were within the lower limit of normal range and indicative of adequate folate status. For the combined groups (n=135), the frequency of the C/C, C/T and T/T genotype was 56.0, 37.3 and 6.7%, respectively. MTHFR genotype was not associated with SF, RCF or tHcy. CONCLUSIONS: These data suggest that women of childbearing age are achieving positive folate balance and RCF concentrations associated with reduced risk of NTD following FA fortification of the food supply.