Long-term efficacy of atorvastatin in allograft rejection following renal transplantation: A randomized clinical trial.

Statins are a class of drug that can efficiently reduce the level of low-density lipoprotein (LDL) as well as increase the LDL receptors. Several non-lipid-lowering effects of this type of drug have been described. It is reported that they have an influence in preventing graft rejection, especially of the acute type. In this study, patients with end-stage renal disease and candidates for kidney transplantation were divided into two groups. Group A (intervention group) received atorvastatin for two weeks prior to their transplant surgery while group B (control group) received placebo. The lipid profile was tested (triglycerides, cholesterol, LDL) in all patients two weeks before the transplantation. After transplantation, drug use was stopped. We also checked the LDL serum levels in patients with raised lipid levels (LDL >100) every two weeks. After this period, the serum lipid levels were checked monthly up to six months. Hyperlipidemia, when present, was controlled by fibrates. Concerning the rejection episodes, there was no significant difference between the two groups. In group A (13 men and nine women), three (14.3%) cases of rejection were observed whereas four (21.3%) cases of rejection were seen in group B (11 men and 10 women) (P = 0.5). Within group A, five (22.7%) cases of delayed graft function were found while four (19%) similar cases were observed in group B (P = 0.7). There was no statistically significant difference concerning delayed graft function between the two groups. Despite all the mechanisms attributed to the probable anti-rejection properties of statins, we found no significant correlation with the administration of these drugs before transplantation and the protection against graft rejection episodes.

The new technique of using the epigastric arteries in renal transplantation with multiple renal arteries.

The most common anatomic variant seen in the donor kidneys for renal transplantation is multiple renal arteries (MRA), which can cause an increased risk of complications. We describe the long-term outcomes of 16 years of experience in 76 kidney transplantations with MRAs. In a new reconstruction technique, we remove arterial clamps after anastomosing the donor to the recipient's main renal vessels, which cause backflow from accessory arteries to prevent thrombosis. By this technique, we reduce the ischemic times as well as the operating times. Both in live or cadaver donor kidneys, lower polar arteries were anastomosed to the inferior epigastric artery and upper polar arteries were anastomosed to the superior epigastric arteries. Injection of Papaverine and ablation of sympathic nerves of these arteries dilate and prevent them from post-operative spasm. Follow-up DTPA renal scan in all patients showed good perfusion and function of the transplanted kidney, except two cases of polar arterial thrombosis. Mean creatinine levels during at least two years of follow-up remained acceptable. Patient and graft survival were excellent. No cases of ATN, hypertension, rejection and urologic complications were found. In conclusion, this technique can be safely and successfully utilized for renal transplantation with kidneys having MRAs, and may be associated with a lower complication rate and better graft function compared with the existing techniques.

Warfarin maintenance dose in Iranian patients. A cross sectional study in 5 cities of Iran.

OBJECTIVE: To determine the warfarin maintenance dose in Iranian patients. METHODS: This multicenter study was conducted between January 2007 and January 2008 in 5 different large cities of Iran. Patients older than 12 years receiving warfarin were included. During the first days of warfarin use, international normalized ration (INR) was measured daily and after that every 1-2 weeks, with a duration of at least one month. The warfarin dose was considered to be stabilized if the INR remained unchanged on 3 consecutive measurements at a level between 2-3. Then mean dose of the last 3 warfarin doses was calculated. RESULTS: One hundred and fifty patients receiving warfarin took part in this study. No significant differences were noted in the mean warfarin dosage among the 5 cities, and between men and women (p=0.228). The warfarin daily dose and INR did not shown any statistical difference between men and women. The warfarin dose statistically decreased in patients older than 60 years old (p=0.004 versus 45-60 years, and p=0.002 versus 30-45 years). This study showed that the required mean warfarin dose in Iranian patients was approximately 4 mg to achieve an INR between 2-3. CONCLUSION: Considering geographic and ethnic differences of Iranian patients, attention to the dose determination of warfarin is of importance.

Non-Hodgkin's lymphoma in autosomal dominant polycystic kidney disease, 12 years after renal transplantation.

Autosomal dominant polycystic kidney disease (ADPKD) is a systematic disease which accounts for 10-15% of patients receiving dialysis or renal transplantation. It has a statistically significant association with malignancy in renal transplant recipients. We report a 47-year-old ADPKD female who developed a large renal tumor in the right kidney 12 years after kidney transplantation. During the follow-up, her ultrasound and laboratory tests were within normal limits. Bilateral nephrectomy of the native kidneys was performed, and followed by radiotherapy on the right side because pathology of the tumor suggested non-Hodgkin's lymphoma (NHL).