Incentives for organ donation: proposed standards for an internationally acceptable system.

Incentives for organ donation, currently prohibited in most countries, may increase donation and save lives. Discussion of incentives has focused on two areas: (1) whether or not there are ethical principles that justify the current prohibition and (2) whether incentives would do more good than harm. We herein address the second concern and propose for discussion standards and guidelines for an acceptable system of incentives for donation. We believe that if systems based on these guidelines were developed, harms would be no greater than those to today's conventional donors. Ultimately, until there are trials of incentives, the question of benefits and harms cannot be satisfactorily answered.

Effect of Angiotensin II Receptor Type 1 Antibodies on Kidney Allograft Function.

INTRODUCTION: Non-human leukocyte antigen antibodies are an independent risk factor for acute rejection in kidney transplant recipients. Among them, angiotensin II receptor type 1 (ART1) antibodies can induce various effects, but their clinical importance in kidney transplant recipients has not been properly explained. This study aimed to evaluate the effect of ART1 antibodies on allograft function and hypertension in stable kidney transplant recipients. MATERIALS AND METHODS: Eighty-one kidney recipients from non- human leukocyte antigen antibodies-matched donors with stable allograft function were examined for estimated glomerular filtration rate (Chronic Kidney Disease-Epidemiology Collaboration formula) and ART1 antibodies (measured using an enzyme-linked immunosorbent assay method). The result was considered positive if the anti-ART1 level was greater than 17 U/mL. RESULTS: The mean age of the participant was 51.1 ± 11.9 years with the mean time from transplantation was 83.5 ± 6.5 months. Fifteen recipients (18.5%) had a high ART1 antibodies level. Those with low titers of ART1 antibodies had better allograft function. The mean estimated glomerular filtration rate was 63.0 ± 13.7 mL/min in those with low ART1 antibodies and 42.3 ± 13.9 mL/min in those with high ART1 antibodies (P < .001). There were no significant correlation between high ART1 antibodies levels and hypertension, cause of end-stage renal disease, age, sex, transplant and dialysis duration, cytomegalovirus infection, antihypertensive medication, or immunosuppressive agents. CONCLUSIONS: A high level of ART1 antibodies was a risk factor for allograft function; however this indicator was not correlated with hypertension in our study.

Transplant tourism and the Iranian model of renal transplantation program: ethical considerations.

Currently, the buying and selling of kidneys through "transplant tourism" is occurring at an increasing rate, both in developed and developing countries. Since 1988, Iran has adopted a compensated and regulated living-unrelated donor renal transplant program, and by providing financial incentives to volunteer living donors, has eliminated the renal transplant waiting list. In the Iranian model of renal transplantation program, regulations have been put in place to prevent transplant tourism. Foreigners are not allowed to undergo renal transplantation from Iranian living-unrelated donors. They also are not permitted to volunteer as kidney donors for Iranian patients. A study at the transplant unit of Hashemi Nejad Kidney Hospital in Tehran, Iran, showed that of 1881 renal transplant recipients, 19 (1%) were Afghani or Iraqi refugees, 11 (0.6%) were other foreign nationals, and 18 (0.9%) were Iranian immigrants. Renal transplantations seemed ethically acceptable to all refugees and foreign nationals. However, transplantation of Iranian immigrants who had been residing abroad for years constituted true transplant tourism.

Current status of organ transplant in Islamic countries.

OBJECTIVES: The Organization of Islamic Cooperation consists of 57 member states whose people are mainly followers of the Islamic religion. During the past several decades, organ transplants have been increasingly used for the treatment of end-stage organ failures worldwide. This study is to investigate the current status of organ transplant in Islamic countries. MATERIALS AND METHODS: For data collection a literature, review was carried out. Information from international registries was used and key persons from some countries were contacted. RESULTS: In all 5 Islamic countries of North Africa, living-donor kidney transplant was performed. Tunisia was the only country with deceased-donor organ transplant in North Africa. In 22 Islamic countries of sub-Saharan Africa, living-donor kidney transplant was performed only in Sudan and Nigeria. Deceased-donor organ transplant was illegal and nonexistent in this region. In all 14 Islamic countries of the Middle East, living-donor kidney transplant was an established practice. Turkey, Iran, and Saudi Arabia had the highest rates of organ transplant activity. In 2013, Turkey performed the highest rate of living-donor kidney and liver transplants, and Iran performed the highest rate of deceased-donor kidney and liver transplants. For 7 Islamic countries of Central Asia, organ transplant was nonexistent in Afghanistan and Turkmenistan; in the other 5 countries, a limited number of living-donor kidney or liver transplants were performed. In all 6 countries located in South and Southeast Asia, living-donor kidney transplant was performed. Only Malaysia had a limited-scale deceased-donor transplant program. Albania in the Balkans, and 2 countries (Suriname and Guyana) in South America, were also member states of the Organization of Islamic Cooperation; in these countries, only few living-donor kidney transplants were performed. CONCLUSIONS: The organ transplant rates, especially for deceased-donor transplant, in most Islamic countries were less than expected. Some of the causes of low transplant activity included lack of public education and awareness, lack of approval and support by Islamic scholars, and lack of government infrastructure and financial resources.

Governed financial incentives as an alternative to altruistic organ donation.

In 1984, an offensive proposal for kidney sales by a US physician led the National Organ Transplant Act to become a law in the United States. Similar legislation passed in many other countries. An ethical consensus developed around the world that there should be no monetary compensation for transplantable organs, either from living or deceased persons. Unfortunately, the altruistic supply of organs has been much less than adequate, and thousands of patients die each year waiting for organ transplantation. As the altruistic system of organ donation has met with failure, some from the transplant community believe that altruism alone is not enough to satisfy the needs of the thousands of patients on organ transplant waiting lists, and providing some financial incentives or social benefits to organ sources is necessary to increase the number of cadaveric or living organ donations. In this article, the many controversies surrounding altruistic and compensated organ donation systems are discussed. The Iran model for renal transplantation, a compensated and well-regulated living-unrelated donor renal transplantation program that has successfully eliminated a renal transplant waiting list in Iran, is briefly reviewed.

Noncompliance with immunnosuppressive medications after renal transplantation.

Noncompliance with immunosuppressive medications in renal transplant recipients results in higher rate of acute rejection episodes, allograft dysfunction, graft loss and patient death. We studied incidence and risk factors of medications noncompliance in 286 renal transplant recipients who were consecutively seen in our renal transplant clinic between February and April 2002. One hundred and seventy were male, 116 female. Their age ranged from 12 to 70 years (mean 39.1+/-11.6). The length of time since the date of transplantation ranged from 5 to 231 months (mean 76.7+/-53.5). The results of study showed that 70 patients (24.5%) to be noncompliant (7.7% noncompliant minor and 16.8% noncompliant major). The time since the date of transplanation was a significant risk factor in both noncompliant minor and major groups (P<0.001 and P<0.001). The other risk factors associated with major noncompliance was young age (P<0.001), lower level of education (P<0.01), lower socioeconomic class (P<0.05), addiction and psychiatric disorders (P<0.05). Transplant recipients with major noncompliance also had more acute rejection episodes (P<0.001) and allograft dysfunction (P<0.01). We conclude that noncompliance with immunosuppressive medications is very common in renal transplant recipients and it results to significant acute rejection episodes and allograft failure.

Middle East Society for Organ Transplantation (MESOT) Transplant Registry.

During the seventies, sporadic renal transplants were performed in few MESOT-region countries, mainly Turkey, Iran, Egypt, and Lebanon. Since the introduction of cyclosporine in the early eighties, transplantation has become the preferred therapeutic modality for end-stage renal failure. In 1986, the Islamic theologians (Al Aloma) issued what became known as the Amman declaration, in which they accepted brain death and retrieval and transplantation of organs from living and cadaveric donors. Based on this and similar declarations, all Middle Eastern countries except Egypt passed laws that allow cadaveric transplantation and regulate live donations. Iran, Turkey, Saudi Arabia, Kuwait, Tunisia, Jordan, and Lebanon all have current active cadaveric programs and perform liver, heart, pancreas, and lung transplants. More than 5088 renal transplants/year are performed in the region with Iran leading with 1600. The cumulative number of renal transplant patients is now nearly 60,000. With a 2003 population of 600,682,175, the rate/million for renal transplantation in the MESOT region is a mere 9/million. Rates of renal transplantation range from 31/million in some countries to 0 in others. The major obstacle in establishing an accurate number of transplants is "tourist transplantation," in which the same transplanted patients are registered in different countries. Although cadaveric programs have been active for more than 10 years, live-related and nonrelated transplants account for nearly 85% of the total transplants. The data presented were collected from MESOT representatives in the region and from publications. For proper compilation of the registry, a format is being proposed that will be presented at the Congress for review and adaptation. Even with the limited resources in the region, immunosuppressive drugs for induction and maintenance therapy are available and are used. Costs for transplantation and immunosuppressive therapy are either totally or heavily supported by governmental agencies.

The history of organ donation and transplantation in Iran.

The first kidney transplant in Iran was performed in 1967, and this was the first organ transplant in countries that are current members of the Middle East Society for Organ Transplantation. In 1988, in response to the long waiting list at the Iranian Ministry of Health for kidney transplant, a state-regulated living-unrelated donor kidney transplant program was adopted. By 1999, the kidney transplant waiting list in Iran was eliminated. In 1989, a fatwa (religious approval) from the Supreme Religious Leader was obtained that recognized brain death and allowed deceased-donor organ transplant. Subsequently, transplant centers began performing deceased-donor kidney, liver, and heart transplants. In 2000, the Brain Death and Organ Transplantation Act was passed by the Iranian parliament, legalizing deceased-donor organ transplant. The transplant team at Shiraz began performing more deceased-donor kidney and liver transplants and became a successful deceased-donor organ transplant model in the country. By the end of 2012, there were 34166 kidney (including 4436 deceased-donor) and 2021 liver (including 1788 deceased-donor), 482 heart, 147 pancreas, 63 lung, and several intestine and multiorgan transplants performed in Iran. In 2011, there were 2771 solid-organ transplants performed in Iran (37 transplants per million population), and Iran ranked as number 33 among the 50 most active countries worldwide. In 2011 and 2012, Iran was ahead of all country members of the Middle East Society for Organ Transplantation in performing deceased-donor kidney and liver transplants.

Experimental and clinical transplantation: a commitment to integrity, accountability, and ethics in publication.

For the past few years, the social, economic, and political issues surrounding the field of organ transplantation have entered into many ethical discussions. Transplant tourism, and organ trade in particular, have finally received the attention they deserve and many commendable developments have ensued. The "Declaration of Istanbul on Organ Trafficking and Transplant Tourism," the result of a collective effort by hundreds of transplant professionals the world over, is one such example and is now considered the universal charter for ethical conduct in the field of transplantation. The Middle East Society for Organ Transplantation and its official journal Experimental and Clinical Transplantation were among its first endorsers, and it is our policy to ensure that all authors of articles published in our Journal adhere fully to the rules and regulations stated in The Declaration of Istanbul and by the Committee on Publication Ethics. We believe that the medical community must ensure that a foundation of ethical conduct and scientific integrity is maintained throughout the field, and we must strive toward this goal in all our clinical and scholarly efforts.

Risk factors profile and cardiovascular events in solid organ transplant recipients.

By advances in surgical techniques, success in prevention and treatment of transplant-related infections, and introduction of new immunosuppressive drugs, the patient and graft survival rates in solid organ transplant recipients has steadily and remarkably improved. It has been shown that the longer the transplant patients survival rate, the more saturation with cardiovascular risk factors and the greater risk of cardiovascular mortality. Currently, cardiovascular disease is the primary cause of death after kidney transplantation and is among the three most common causes of death after heart and liver transplantation. Over the past decades, because of risk factor reduction, mortality from coronary artery disease has substantially decreased in the general population. Recent studies suggest that risk factors reduction also significantly decreases cardiovascular events and deaths in solid organ transplant recipients.

Multifocal cranial plasmablastic lymphoma as a rare manifestation of posttransplant lymphoproliferative disorder.

We present an unusual case of a young woman who developed multiple cranial masses and unilateral facial palsy 10 years after a successful living-unrelated kidney transplant. She was diagnosed with diffuse large B-cell plasmablastic differentiated lymphoma, a rare form of posttransplant lymphoproliferative disorder. She responded to 5 cycles of cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy with resolution of all cranial masses. However, her facial palsy did not resolve, and she died 6 months after diagnosis with pneumonia and sepsis.

The deleterious effect of metabolic acidosis on nutritional status of hemodialysis patients.

One of the main causes of protein-energy malnutrition in patients on maintenance hemodialysis (MHD) is metabolic acidosis. The aim of this study was to evaluate the effect of metabolic acidosis on nutritional status in a group of MHD patients with adequately delivered dialysis treatment. Of 165 eligible anuric MHD outpatients with Kt/V ≥ 1 and no underlying inflammatory diseases, 47 subjects were enrolled. In order to evaluate the effect of different parameters on serum albumin, we measured the pre-dialysis serum albumin, blood pH, serum bicarbonate (HCO 3‾ ), Kt/V, normalized protein catabolic rate (nPCR) and body mass index (BMI) in these patients. The mean age of the study patients was 55 ± 13.8 years; there were 22 females and six diabetics. The average Kt/V was 1.22 ± 0.16, pH was 7.40 ± 0.15, serum HCO 3‾ was 23.18 ± 2.38 mEq/L, serum albumin was 4.03 ± 0.56 g/dL, nPCR was 1.00 ± 0.16 g/kg/day, post-dialysis body weight was 58.50 ± 11.50 kg and BMI was 23.47 ± 2.70 kg/m 2 . There was a statistically significant direct correlation between serum albumin and BMI (r = 0.415, P = 0.004), and between serum albumin and serum HCO 3 (r = 0.341, P = 0.019). On multiple regression analysis, the predictors of serum albumin were serum HCO3‾ and BMI (direct effect) and nPCR (inverse effect). In 17 patients on MHD with serum HCO3‾ <22 mEq/L, there was a significant inverse correlation between HCO 3 and nPCR (r = 0.492, P = 0.045), and these patients had significantly lower serum albumin compared with patients with serum HCO3‾ >22 mEq/L (P = 0.046). These data demonstrate that patients on MHD with metabolic acidosis had a lower serum albumin concentration despite adequate dialysis treatment. The inverse effect of nPCR on serum albumin concentration in acidotic MHD patients may be due to hypercatabolism in the setting of metabolic acidosis, leading to deleterious effects on the nutritional status of patients on MHD.

Measurement of serum levels of mannose-binding lectin in hemodialysis patients: a comparison with healthy individuals.

INTRODUCTION: Mannose-binding lectin (MBL) is a part of the innate immune system. Many studies showed an association of low serum MBL levels with decreased host defense against various infectious agents. Considering paradoxical reports about the serum level of MBL in hemodialysis patients, this study aimed to measure and compare serum MBL levels in hemodialysis patients and healthy individuals. MATERIALS AND METHODS: In a cross-sectional study, 70 hemodialysis patients and 70 volunteers with normal routine laboratory tests and physical examination were assessed for serum MBL level (measured by an enzyme-linked immunosorbent assay). In addition, serum C-reactive protein levels in hemodialysis patients were measured to rule out correlation of increased serum MBL level with inflammation. RESULTS: In hemodialysis patients, 32 (45.7%) were men and 38 (54.3%) were women. In the control group, 34 (48.6%) were men and 36 (51.4%) were women (P = .87). The mean age showed no significant difference in hemodialysis (44.5 ± 13.5 year) and control (46.4 ± 12.4 years) groups. Serum level of MBL was significantly higher in hemodialysis patients (2.12 ± 1.49 microg/mL) than that in the controls (1.49 ± 2.12 microg/mL; P < .001). No significant correlation was found between serum MBL and C-reactive protein levels (r = 0.002, P = .98) among the hemodialysis patients. CONCLUSIONS: Serum MBL level in hemodialysis patients was significantly higher than that in the control group of healthy individuals. This may have some implications in management of patients and prediction of kidney allograft survival.

Recurrence of primary hyperoxaluria after kidney transplantation.

Primary hyperoxaluria is a genetic disorder in glyoxylate metabolism that leads to systemic overproduction of oxalate. Functional deficiency of alanine-glyoxylate aminotransferase in this disease leads to recurrent nephrolithiasis, nephrocalcinosis, systemic oxalosis, and kidney failure. We present a young woman with end-stage renal disease who received a kidney allograft and experienced early graft failure presumed to be an acute rejection. There was no improvement in kidney function, and she was required hemodialysis. Ultimately, biopsy revealed birefringent calcium oxalate crystals, which raised suspicion of primary hyperoxaluria. Further evaluations including genetic study and metabolic assay confirmed the diagnosis of primary hyperoxaluria type 1. This suggests a screening method for ruling out primary hyperoxaluria in suspected cases, especially before planning for kidney transplantation in patients with end-stage renal disease who have nephrocalcinosis, calcium oxalate calculi, or a family history of primary hyperoxaluria.

Renal biopsy findings in Iran: case series report from a referral kidney center.

BACKGROUND: Several registries and single centers have reported the results of their renal biopsies from different parts of the world. As there are only few data regarding the epidemiology of glomerulonephritides in Iran, this study was conducted to determine the results of renal biopsy findings during the last 10 years in our center. METHODS: Data from 1,436 patients who had undergone a renal biopsy in our center between 1998 and 2007 were collected retrospectively for the first 989 patients and prospectively for the rest of them, including demographic data, renal syndrome at presentation and laboratory findings. All kidney specimens were studied with light and immunofluorescent microscopies. RESULTS: Among 1,407 patients with a definite pathologic diagnosis, 1,052 (74.8%) had a primary glomerular disease, 241 (17.2%) had a secondary glomerular disease, 66 (4.6%) had tubular disease, 19 (1.3%) had vascular disease and 7 (0.5%) had end-stage kidney disease. The most frequent types of biopsy-proven renal diseases were membranous glomerulopathy (MG) (377 patients, 26.8%), IgA nephropathy (IgAN) (155 patients, 11%), lupus nephritis (155 patients, 11%), focal segmental glomerulosclerosis (141 patients, 10%) and minimal change disease (117 patients, 8.3%). The predominant presentation was nephrotic syndrome in almost all cases, with the exception of chronic glomerulonephritis, acute tubular necrosis and acute tubulointerstitial nephritis. The epidemiology of our renal biopsy findings was similar to reports from most European countries and United Arab Emirates, but different from many other neighboring countries, North America and Far East. CONCLUSIONS: In our report of 1,407 renal biopsy specimens, MG and IgAN were the most frequent biopsy-proven renal diseases. FSGS was the third cause of primary glomerular disease, and lupus nephritis was the most common secondary glomerular disease. The unusually high frequency of presentation as nephrotic syndrome may be due to referral nature of our center and less liberal indications for renal biopsy.

Ethical issues and living unrelated donor kidney transplantation.

During the past decades, the number of altruistic living unrelated kidney donations has substantially increased in developed countries. However, the altruistic supply of transplantable kidneys has remained much less than the demand. As a result, severe kidney shortage has been associated with increasing number of patient deaths and increasing number of commercial transplants and transplant tourism. Studies have shown that there is still a need for living kidney donation because even all potential brain-dead donors cannot supply the escalating need for kidneys. The use of living unrelated kidney donors should be morally and ethically justified and should be compatible with ethical principles. Many experts believe that increasing number of patient deaths and commercial transplants will continue to happen if kidney donation system remains merely altruistic. While some transplant professionals support a paid and regulated system to eliminate kidney shortage, others argue that it will be destructive. Iran has a 20-year experience with a compensated and regulated living unrelated kidney donation program. This transplantation model was adopted in 1988, and successfully eliminated kidney transplant waiting list by the end of 1999. Currently, more than 50% of patients with end-stage kidney disease in Iran are living with a functioning graft. This Iranian transplantation model has many ethical successes. However, because it has not been well regulated by transplant ethicists, some ethical shortcomings have remained. Unfortunately, due to lack of interest and expertise in health authorities, the number of serious ethical failures is also increasing in this transplantation model.

High frequency of clinically significant infections and cytomegalovirus disease in kidney transplant recipients with serum mannose-binding lectin deficiency.

INTRODUCTION: Mannose-binding lectin (MBL) constitutes defense against infections when adaptive immune response is compromised. Elevation in serum MBL levels has been shown in patients with kidney failure. We compared serum MBL levels before and after kidney transplant and evaluated association of MBL deficiency with infectious complications in kidney transplant recipients. MATERIALS AND METHODS: This study was performed in 71 kidney transplant recipients and 48 healthy controls. In 36 recipients (group 1), serum MBL levels were tested before and on days 7 and 14 after transplantation. They were followed up for 6 months. In 35 recipients (group 2), serum MBL was measured during their posttransplant follow-up visits. In both groups, frequencies of clinically significant infections and acute rejection were compared between those with low MBL (< 500 ng/mL) and normal/high MBL (> or = 500 ng/mL). RESULTS: Serum MBL levels (1744 +/- 905 ng/mL) were not higher in group 1 before transplantation than in controls. One and 2 weeks after transplantation, MBL levels decreased to 1699 +/- 1030 ng/mL and 1562 +/- 1020 ng/mL, respectively. Five patients who had low serum MBL levels experienced more frequent episodes of infections (P = .008) and CMV disease (P < .001). Ten patients in group 2 with low MBL levels had more frequent episodes of CMV disease (P = .01). CONCLUSIONS: These findings suggest a potential role for MBL in defense against developing posttransplant CMV disease and that low serum MBL levels in kidney transplant recipients be considered an indicator of the need for CMV prophylaxis.

Estimation of glomerular filtration rate with creatinine-based versus cystatin C-based equations in kidney transplant recipients.

INTRODUCTION: Serum cystatin C is more sensitive for glomerular filtration rate (GFR) measurement, but it is not available for clinical use in all laboratories. Regarding the importance of accurate estimation of GFR in kidney transplant recipients, we compared cystatin C-based equations with creatinine-based formulas to estimate GFR as precisely and simply as possible in kidney transplant recipients. MATERIALS AND METHODS: Seventy living donor kidney transplant recipients with stable kidney function were enrolled in our study. The patients' GFRs were estimated by 3 creatinine-based equations (the modification of diet in renal disease [MDRD], abbreviated MDRD, and Cockcroft-Gault) and 5 cystatin C-based equations (Filler, Le Bricon, Rule, Hoek, and Larsson), and the results were analyzed. RESULTS: The mean age of the recipients was 38.7 +/- 13.4 years. The mean GFRs were 67.1 +/- 25.9 mL/min/1.73 m2, by the Cockcroft-Gault; 61.0 +/- 17.7 mL/min/1.73 m2, by the abbreviated MDRD; and 60.0 +/-18.6 mL/min/1.73 m2, by the MDRD formulas. Cystatin C-based GFR estimations were 43.6 +/- 16.2 mL/min/1.73 m2, 44.0 +/- 13.2 mL/min/1.73 m2, 33.8 +/- 14.1 mL/min/1.73 m2, 35.6 +/- 13.7 mL/min/1.73 m2, and 36.9 +/- 13.6 mL/min/1.73 m2 by the Filler, Le Bricon, Larsson, Rule, and Hoek equations, respectively. The estimates by creatinine-based and cystatin C-based equations were significantly different and the MDRD estimate was the closest to the cystatin C-based GFRs. CONCLUSIONS: Our findings revealed the MDRD equation could be provide a closer estimate of GFR to the cystatin C-based equations than other creatinine-based GFR calculations in kidney transplant recipients.

Improvement of maximum corrected QT and corrected QT dispersion in electrocardiography after kidney transplantation.

INTRODUCTION: The electrocardiography (ECG) markers of corrected QT interval (QTc) and QTc dispersion are prolonged in patients on hemodialysis. This study was carried out to investigate if changes in these markers will reverse by successful kidney transplantation. MATERIALS AND METHODS: Twenty-six kidney allograft recipients with functioning grafts, 26 patients on maintenance hemodialysis, and 22 healthy individuals were underwent a 12-lead ECG and laboratory studies for electrolytes and arterial blood gas. In the patients on dialysis, ECG and laboratory studies were performed prior to the start of a hemodialysis session. Both QT dispersion and maximum QT were corrected for heart rate (QTc dispersion and maximum QTc). The results were compared between the three groups. RESULTS: The mean QTc dispersion was 30.3 +/- 15.2 ms, 27.6 +/- 8.3 ms, and 24.5 +/- 9.0 ms, and the mean maximum QTc was 464.7 +/- 23.0 ms, 436.3 +/- 19.0 ms, and 415.0 +/- 85.0 ms in the patients on dialysis, transplant recipients, and controls, respectively. The QTc dispersion value was lower in the transplant group than in the hemodialysis group, but the differences were not statistically significant. Whereas, the maximum QTc was significantly shorter in the transplant recipients as compared with the patients on hemodialysis (P < .02). There was a significant correlation between the maximum QTc and serum calcium level (P < .001), serum magnesium level (P < .001), and pH (P < .001). CONCLUSIONS: Prolonged maximum QTc decreases towards normal by successful kidney transplantation. These corrections are most likely due to normalization of electrolytes and the acid-base status from a uremic state to the normal kidney function.

Posttransplant diabetes mellitus in kidney allograft recipients at Shaheed Hasheminejad Hospital.

INTRODUCTION: Our aim was to evaluate the frequency and risk factors of posttransplant diabetes mellitus (PTDM) at our kidney transplant center, and to compare graft and patient outcomes between the kidney recipients with and without PTDM. MATERIALS AND METHODS: We studied 203 kidney transplant recipients with a negative history of diabetes mellitus before transplantation. We examined them for PTDM and made diagnosis on the basis of the American Diabetes Association criteria. Measurements of plasma glucose were carried out from 3 months to 24 months after transplantation. All data including recipient and donor demographics, cause of end-stage renal disease, cytomegalovirus and hepatitis C virus antibody tests, and patient and graft outcomes were assessed in relation to PTDM. RESULTS: High fasting plasma glucose was seen in 24 (11.8%), 19 (9.4%), 16 (7.9%), and 13 (6.4%) patients at 3, 6, 12, and 24 posttransplant months, respectively. Moreover, impaired glucose tolerance was seen in 17 (8.4%), 16 (7.9%), 17 (8.4%), and 19 (9.4%) patients at the corresponding times, respectively. Accordingly, 39 patients (19.2%) were diagnosed to have PTDM. The mean age of the kidney recipients with PTDM was 46.5 +/- 12.3 years as compared to 38.6 +/- 13.4 years in nondiabetic kidney recipients (P = .02). The 5-year patient and graft survival rates were not significantly different between the kidney recipients with and without PTDM. CONCLUSIONS: This study showed that PTDM is a common metabolic disorder in our kidney transplant patients. We recommend a less diabetogenic immunosuppressive protocol, especially for our older recipients.