Introduction After kidney transplantation, several factors should be checked to predict the risk of rejection. Liver enzymes are such predicting factors so liver function test abnormalities (LFTA) can consider the rejection possibility in kidney transplant recipients (KTR). Methods Through a retrospective cohort study, 659 KTR were studied. The source of all grafts was from deceased donors. Amongst these cases, 67 patients showed a significant rise in creatinine as the rejection indication. Several liver indexes like alanine transaminase (ALT), aspartate transaminase (AST), direct bilirubin (Bil D), total bilirubin (Bil T), and liver ultrasound reports, gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), prothrombin time (PT) INR in addition to creatinine were examined for three-six post-transplant in KTR. Results Our study exposed that liver functional tests regularly had considerable statistical differences between KTR with creatinine increase and with no creatinine increase. Despite these differences between the two groups AST, ALT and ALP serum levels were still within the normal range in both groups. The same result was seen over the Bil D, and Bil T. Conclusions Liver function test abnormalities can not adequately predict the rejection. Some other elements should be taken into consideration like inflammation factors like erythrocyte sedimentation rate (ESR or sed rate), and C-reactive protein (CRP).

Background & Aim: Delayed graft function (DGF) generally refers to oliguria or the requirement for dialysis in the first week post-transplantation. It is the earliest and most frequent post- transplantation complication that can occur. DGF is an extremely important post- transplantation complication because its occurrence has short-term or long-term consequences for allograft survival. However, limited studies have been conducted on DGF and its complications in pediatric renal transplantation. Therefore, the aim of the present study was to determine short-term and long-term effects of DGF on allograft outcome in kidney transplanted children.Patients and Method: In this historical cohort study, 230 children who received kidney transplants between 1985 and 2005 in Labafi Nejad Hospital in Tehran were assessed through a mean follow-up period of 60.96(SD=40.46) months (ranging from 1 to 180 months). The children were divided into two groups: 183 children in group B (no DGF) as the control group and 47 patients in group A (DGF) as the case group. Risk factors of DGF and the impact of DGF on renal function within the first year, long-term graft survival, and post-transplantation complications were investigated and compared using Logistic regression model and Kaplan–Meier survival analysis.Results: The incidence of graft failure at the end of follow-up period was significantly higher in DGF group (53.2% vs. 22.4%, P<0.001). The mean graft survival length was 134.2(SEM=6.17) months in group B and 76.52(SEM=12.41) months in group A (P<0.001). The graft survival rate was 94.9%, 91.9%, 83.9%, 79.2% and 72% at 1, 3, 5, 7 and 12 years after transplantation in children without DGF versus 75.6%, 53.2%, 47.2%, 31.9% at 1, 3, 5 and 8 years after transplantation in patients with DGF. Dialysis before transplantation (P=0.039), acute rejection (P<0.001), immunosuppressive protocol without celcept (P<0.001) and the presence of DGF (P<0.001) were found as the significant risk factors for the occurrence of graft failure in the future.Conclusion: The results of our study showed that delayed graft function could remarkably and independently affect graft survival and worsen both short-term and long-term transplantation outcomes. This result is in contrast with the studies that only believe in the effect of DGF on short-term graft survival. However, in our study when patients whose grafts had failed during the first year after transplantation were censored, still significant differences were noted in graft survival between patients with and without DGF. Thus, the prevention of DGF is one of the most important issues in graft survival improvement.

Background: Liver dysfunction is a rare complication with high mortality and morbidity rate in coronary artery bypass grafting (CABG) surgery. Pulsatile blood flow probably maintains liver function during cardiopulmonary bypass (CPB). Methods: In this randomized clinical trial study, 68 patients who underwent CABG surgery were divided into two groups: pulsatile and non-pulsatile groups. We transferred continuous blood flow to pulsatile blood flow during proximal graft by using cardiac contraction. Results: There was no significant difference in Alanine transaminase (ALT) and alkaline phosphatase (ALP) values at variable times between the groups. In addition, the procedure of ALT and ALP in the case and control groups was not significantly different in three days. There was no significant difference between AST values at variable times in two groups. However, the trend of AST in the case group was significantly increased while it was not significantly different in the control group during the next three postoperative days. Conclusion: It seems that hemodynamic stability is more important than type of blood flow in maintaining liver function.

Introduction: Hyperglycemia is common and a contributing factor to the undesirable outcomes in kidney transplant recipients. This study investigates the relationship of pretransplant blood glucose levels and the occurrence of delayed graft function among kidney transplant recipients without a diagnosis diabetes mellitus before transplantation.Materials and Methods: Eighty-one patients on long-term hemodialysis with no history of clinically diagnosed diabetes mellitus were enrolled in this study. Correlation of the occurrence of delayed graft function with age, gender, donor source, underlying cause of kidney failure, insulin resistance, and blood glucose levels before transplantation was evaluated.Results: There was a significant correlation between abnormal glucose metabolism categories and occurrence of delayed graft function (P=.004). Logistic regression analysis showed that fasting blood glucose before kidney transplantation is an independent predictor of delayed graft function immediately after transplantation (odds ratio=1.042, P=.04).Conclusions: Hyperglycemic patients have an increased risk for delayed graft function and should be treated by more potent immune therapy and further restriction of blood glucose regulation in peritransplantation period.

Background and Objectives: Given the advances in treatment and use of new therapies in kidney transplantation, there is always a need to evaluate the survival of graft and patient and to investigate the effect of new therapies. Therefore, the purpose of this study was to assess the survival rate of kidney graft and patient in patients transplanted in ShahidHasheminejad hospital during 2008-2013. Methods: This retrospective study was conducted on 750 transplant patients. Using a checklist, demographic characteristics of recipients and donors, kidney failure (ESRD) characteristics, history of transplantation, transplantation source and its function, transplant rejection, and patient's status in last follow-up, were recorded. The data were entered into SPSS software version 23 and the survival rates of the transplanted kidney and the patient, was calculated using life tables and Kaplan-Meier analysis. Results: According to Kaplan-Meier analysis, the Mean survival time of the patients was 85 ± 1 month. The survival rate in patients aged over 40 years and graft survival rate in patients with unknown causes of ESRD and diabetes, were lower. The survival rate of transplanted kidneys in patients with DGF was lower than in patients with SGF or EGF. Sex, blood group, pre-transplantation dialysis, transplantation source, and donor sex had no effects on the survival of graft and patients. Conclusion: The findings of the present study showed that the 7-year survival rate of the transplanted kidney and patient in patients who underwent transplantation, was 79% and 80%, respectively, and the mean survival time of graft and patient, were 84 and 85 months, respectively.

Reduced graft function (RGF) in donor renal transplant recipients is caused by oxidative damage due to extensive ischemia-reperfusion (I/R) injury during transplantation. Neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker to detect tubular injury early after renal transplantation. N-acetylcysteine (NAC) is a potent antioxidant that can reduce I/R injury by improving oxidative damage. The aim of the present study is to assess the efficacy of NAC in improving graft function and reducing renal tubular injury in deceased donor renal transplant recipients. A double-blind, randomized clinical trial was conducted on 50 deceased donor renal transplant recipients. The patients were randomized into two groups, receiving either 600 mg NAC twice daily, or placebo (days 0 to 5). Results were assessed based on the rate of RGF, levels of plasma NGAL (p-NGAL) and the estimated glomerular filtration rate (eGFR). The rate of RGF was significantly lower in the patients receiving NAC vs. placebo (21. 4% vs. 50%). The measurement of p-NGAL levels showed that the patients in the NAC group had significantly greater reduction of p-NGAL by both days 1 and 5 post-transplantation than those in the placebo group. A near steady-state eGFR level was reached by week 1 in the NAC group, however, the improvement of eGFR was significantly slower in the placebo group and a near steady-state was only achieved by week 4. NAC has promising potential in reducing tubular injury and improving graft function, evidenced by significant reduction in the rate of RGF and levels of p-NGAL.

Background and Objective: In the field of vascular surgery, the use of tissue-engineered vascular grafts is advancing and new synthetic tissues are being utilized to replace damaged blood vessels. These synthetic vessels, made through tissue engineering techniques, must mimic the shape and mechanical properties of native vessels. This study was performed to assess the function of an artificial vascular graft in an animal model. Materials and Methods: The evaluation of artificial vessels was carried out on rat and sheep models. The artificial vascular scaffolds were made of Polyethylene terephthalate (PET), Polyurethane (PU), and Polycaprolactone (PCL) polymers. In the first phase, the fabricated scaffolds were implanted in rats and after 45 days, the grafts were removed and evaluated pathologically. In the second phase, the structures were implanted into the carotid arteries of sheep. Doppler ultrasound and angiography imaging were done to assess changes in carotid blood flow. Eleven months later, the artificial grafts and surrounding tissues were removed and evaluated pathologically. Results: In the rat samples, no hypodermic infections, systemic inflammation, or fibrosis of adjacent tissues were observed. In the sheep samples, no local or systemic complications were reported one week after surgery. No complications were seen after 11 months in the two sheep that received PCL/PU grafts. In contrast, ultrasound evaluation showed thrombosis in the two other sheep that received PET/PU/PCL grafts. Conclusion: This study shows that the implanted artificial vessel used in sheep carotid arteries has a favorable patency rate and satisfactory clinical results, and in terms of mechanical properties, it may be a good candidate for vascular replacement.