International Journal of Organ Transplantation Medicine
Year:2011 | Volume:2 | Issue:1|Papers Count:8

Renal transplantation in Iran dates back to 1967, when the first transplantation was carried out by Dr. Mohammad Sanadizadeh in Shiraz University, then one of the major and most advanced medical universities in Iran. During the next 12 years, the period prior to Islamic revolution, sporadic cases were transplanted, but despite the high expenses and cultural and language barrier, most of the 114 transplantations performed in this period, were carried out abroad, especially in the United Kingdom.

March 10, 2011 will mark the celebration of the 6th World Kidney Day (WKD), an annual event jointly sponsored by the International Society of Nephrology and the International Federation of Kidney Foundations. Since its inception in 2006, WKD has grown dramatically to become the most widely celebrated event associated with kidney disease in the world and the most successful effort to raise awareness among both the general public and government health officials about the dangers of kidney disease, especially chronic kidney disease (CKD).

Surgical transplantation of human organs from deceased as well as living donors to sick and dying patients began after the Second World War. Over the past 50 years the transplantation of human organs, tissues and cells has become a worldwide practice which has extended, and greatly enhanced the quality of hundreds of thousands of lives. The field of transplantation medicine provides an important chance for liaison between psychiatric professionals and other transplant physicians and surgeons. The discrepancy between the ever-increasing demand for organs but the decreasing supply makes it important to evaluate and prioritize individuals who are in dire need of the organ. However, this also gives rise to certain ethical questions. The following paper discusses various psychiatric aspects of organ transplantation in general.

Background: Liver transplantation (LT) is a life-saving treatment for end-stage liver diseases (ESLD). Cytomegalovirus (CMY) infection is one of the important causes of morbidity after LT.Objective: To evaluate the incidence of late-onset (after 6 months of LT) CMV infection in pediatric recipients.Methods: A retrospective analysis was conducted to evaluate SO pediatric patients who underwent LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We retrospectively investigated episodes of CMV infection after 6 months of LT proven by CMV antigen-emia test.Results: Three recipients (6%) developed late-onset CMV infection. These patients finally responded to ganciclovir.Conclusion: CMV infection is one of the most common post-LT viral infections that usually occurs in the first six months of LT. Our study shows that the incidence of late-onset CMV infection is relatively low, but it still remains a significant problem. Therefore, monitoring and management is crucial for improving the survival of children.

Background: Many adverse effects have been reported on using cyclosporine (CSA) in organ transplantation.Objective: To investigate the effects of CSA on paraoxonase (PON) activity and lipid peroxidation metabolites in early and late-stage of peroxidation and also total antioxidant (TA).Methods: Twenty 220-250 g adult male Wistar rats were included in the study. The animals were stored for one week in the animal room before the initial injection to habituate with temperature, humidity, and circadian rhythm of day (12 h) and night (12 h). The temperature was kept at 23 °C. Animals had access to food and water ad libitum.Results: A significant (p=0.002) increase in the serum levels of conjugated diones was observed in the case compared to the control group. At the end of the study, malondialdehyde (MDA) levels in CSA group was significantly (p=0.01) higher than the control group. Serum PON1 activity was significantly (p=0.004) lower in the case than the control group.Conclusion: CSA administration could impair oxidant-antioxidant pathways and increase oxidative stress. Antioxidant therapy could be beneficial in patients treated with CSA.

Surgical procedures involving heart and liver are rare and have been limited to either combined heart and liver transplantation or coronary artery bypass graft surgery (CABG) or aortic valve surgery and orthotopic liver transplantation (OLT). Aortic valve replacement (AVR) and pulmonary valve vegetectomy for bacterial endocarditis after OLT have also been reported. There are only five cases with aortic stenosis and cirrhosis reported to have combined AVR and liver transplantation. In the presence of cirrhosis, AVR has a significant risk for mortality because of bleeding from coagulopathy, renal failure, infection, and poor post-operative wound healing. Herein, we report on a case and management analysis of combined sequential AVR, and OLT in a 40-year-old cirrhotic man with Child and MELD score of C and 29, respectively. Echocardiography detected severe aortic insufficiency (AI) with enlarged left ventricle. Due to severe AI, the cardiologist recommended AVR prior to transplantation. The patient underwent metallic AVR.4 months later, he received OLT. Both operations were successful and uneventful. Prioritizing AVR before OLT was successful in this patient. However, each patient must be evaluated individually and multiple factors should be assessed in pre-operation evaluation.

A 5-year-old boy underwent orthotopic liver transplantation (OLT) for cirrhosis secondary to tyrosinemia. His immediate post-transplant course was unremarkable. After five months, he developed fever (T>38oC). At that time, he was receiving tacrolimus, cellcept and prednisolone. His laboratory findings revealed an ALT of 85 IU/L, AST 86 IU/L, Alk-P 730 IU/L, total billirubin of 2.5 and direct billirubin of 0.7 mg/dL. C-reactive protein (CRP) and Epstein-Barr virus viral capsid antigen IgM (EBV VCA IgM) were also positive. Histopathologic examination of the transplanted liver biopsy showed the above photomicrograph.

INTRODUCTION: Syria is a country with a population of 23 millions. The first kidney transplant in Syria was performed in 1979 at Harasta Hospital in Damascus. The donor was a living relative, the recipient received simple immunosuppressants comprising of azathioprine and steroids as the transplantation took place prior to the cyclosporine era. However, the renal allograft remained functional for more than 25 years. The transplant surgeon was an eminent urologist, Dr. Maher Al-Houssami, who 25 years later, became the Syrian minister of health and played a major role in setting the national guidelines that regulated the legal and medical aspects of organ donation and transplantation in Syria. More importantly, he was a fearless leader who worked hard in both words and deeds for banning commercialism in this field.