Objectives: To determine the morbidity and graft survival rate in kidney recipients aged between 6 and 18 years who had undergone kidney transplantation in Imam Reza Hospital, Mashhad, northeastern Iran during 1992-2009.Methods: Of 1585 kidney recipients who had undergone kidney transplantation in our center during 1992- 2009, 168 patients aged from 6–18. Neurogenic bladder, reflux nephropathy, posterior urethral valve, prunebelly syndrome and chronic glomerulonephritis were diagnosed to be the cause of renal failure in these patients.22% of the donors were related living, 66% were unrelated living and 12% were cadaveric. Immunosuppressive therapy was initiated with cyclosporine, mycophenolate mofetile, azathiporine and prednisolone. Kaplan-Meier survival analysis was used to assess graft and patient survival while log-Rank test was used to assess the effect of kidney source and the time of renal transplant.Results: All the studied patients developed immediate diuresis. Surgical complications included 2 urinary fistulas, 2 ureteral strictures and 3 clinical lymphoceles all of which were surgically managed. Chronic rejection and recurrence of the underlying renal disease were the most common cause of graft loss. Graft survival rate after 1, 2, 5, and 10 years of kidney transplantation were 97%, 88%, 79%, 65% and 53%, respectively.Conclusion: Kidney transplantation in children results in physical growth improvement and mental development. Graft survival rate due to chronic rejection, underlying kidney disease recurrence and incompliance in taking medicines remain to be a problem.

Introduction: The aim of this study was to evaluate the frequency of skin diseases in kidney transplant recipients.Materials and Methods: This cross-sectional study was performed on 233 kidney transplant recipients in Ekbatan Hospital of Hamedan in 2004. The patients were examined by a dermatologist and diagnosis was made on the basis of clinical observations. Biopsies and scraping of the lesions were taken whenever necessary.Results: Of the patients, 226 (97%) suffered from one or more skin lesions.The most common lesions were drug related, including hypertrichosis, gingival hyperplasia, acne, and cushingoid feature which were detected in 86.7% of the patients. Also, infectious and premalignant or malignant lesions (actinic keratosis, squamous cell carcinoma, and basal cell carcinoma) were seen in 48.9% and 14.2% of the patients. The mean duration of immunosuppressive therapy was significantly higher in patients with infectious skin diseases (P<.001).Conclusion: Skin lesions are a significant problem in kidney transplant recipients. A careful monitoring of these patients is recommended in order to detect these lesions in early stages and treat them.

Introduction. Undergoing transplantation is extremely stressful, and a recipient is likely leave the hospital burdened with fears of an uncertain future. A paucity of knowledge on the long-term survival of rehospitalized kidney transplant recipients is the likely the reason that physicians fail to provide this group of patients with promising information and reassurance about their future. We sought to describe the long-term patient and graft survival after nonfatal rehospitalization in kidney recipients with a normal graft function after discharge.Materials and Methods. We reviewed the follow-up data (from the time of discharge after first rehospitalization) of 253 kidney transplant recipients who had been discharged from rehospitalization with a normal kidney function (serum creatinine less than 1.6 mg/ dL). Patient and graft survival rates 6 months and 1, 2, and 5 years after discharge were determined.Results. The mean duration of follow-up (from the time of discharge after the first rehospitalization) was 38.9 ± 11.2 months (range, 6 to 84 months). The overall patient survival rates were 98%, 97%, 95%, and 93% at 6 months, 1 year, 2 years, and 5 years, respectively.Graft survival rates at these times were 88%, 82%, 77%, and 63%, respectively. After the firstposttransplant rehospitalization, 54 patients (21.9%) experienced more hospitalization episodes (mean, 2.6±2.0 times), while 193 (78.1%) had no further hospitalizations during the follow-up period.Conclusion. Kidney transplant recipients who are rehospitalized should be reassured about favorable chances of survival if discharged with a normal graft function.

BACKGROUND: The efficacy of phosphodiesterase-5 inhibitors (PDE5Is) on the improvement of erectile dysfunction (ED) in second kidney transplant (KT) recipients has not been well investigated previously. OBJECTIVE: We aimed to compare the efficacy of tadalafil in three groups: hemodialysis (HD) patients, first KT recipients (KT1), and second KT recipients (KT2) with bilaterally ligated internal iliac arteries. METHODS: Age-matched men with erectile dysfunction were included in the study. Patients had been divided into three groups: HD, KT1, and KT2. The International Index of Erectile Function 15 (IIEF-15) was used to assess baseline erectile function. Tadalafil was administered in a dose-escalation method for three months. Patients were reevaluated by the questionnaire at 3 months. The mean score evolution was compared between the study groups by one-way ANOVA test. RESULTS: Total number of 106 patients in three groups was included in the final analysis. There was no significant difference between the study groups in terms of age, body mass index (BMI), blood pressure, and frequency of smoking, opium, or alcohol use. Tadalafil was safe and effective in all three groups. The mean IIEF score evolution in HD, KT1, and KT2 groups was 16. 4 (58. 7% increase from baseline), 19. 3 (45. 0% increase), and 20. 4 (52. 7% increase), respectively (p=0. 66). CONCLUSIONS: Tadalafil is effective and safe in the management of ED after the second kidney transplantation where the internal iliac arteries are cut bilaterally. The response rate is similar to first kidney transplant recipients and hemodialysis patients.

Introduction: Doppler ultrasonography (DU) is mostly used for assessment of both graft and native kidneys’ vascular status. In this study, correlation between the DU indexes and kidney allograft function was evaluated. Materials and Methods: Hospital records of 273 kidney transplant patients (154 men and 119 women) were reviewed. In all cases, DU had been performed 1 month after kidney transplantation. We evaluated the data on the resistive index (RI) and pulsatility index (PI) in the interlobar arteries and renal artery stenosis (RAS), and renal vessels thrombosis were determined. Concurrent serum creatinine and cyclosporine values were assessed in relation to the DU findings. Results: The RI and PI had significant linear correlations with serum creatinine (P=.03 and P=.002, respectively). Also, there were direct linear correlations between the age of the patients and the RI and PI values. The frequency of RAS was 10.3%. In patients with RAS, the mean creatinine level (2.08±1.70 mg/ dL) was significantly higher than that in patients without RAS (1.48±0.97 mg/dL; P=.004). Despite this finding, RI and PI were significantly lower in patients with RAS than in the patients with patent renovascular tributary (0.59±0.15 versus 0.65±0.11; P=.03 and 1.02±0.40 versus 1.18±0.46; P=.049, respectively). There were no associations between serum cyclosporine level or panel reactive antibodies and the RI or PI.Conclusions: The RI and PI are valuable DU markers for determining the kidney allograft function and the related vascular complications.

Introduction. After kidney transplantation, patients appear to have vitamin D deficiency due to the use of immunosuppressive treatment and prevention of sunlight. This study was designed to determine vitamin D serum levels in kidney transplant patients in comparison with healthy individuals.Materials and Methods. Forty-six kidney transplant patients with a creatinine clearance greater than 60 mL/min and 46 healthy individuals with normal kidney function were tested for serum levels of calcium, phosphorus, 25-hydroxyvitamin D, and parathyroid hormone at the end of the summer.Results. Thirty-one participants were men and 15 were women in each group. The mean age was 41.0 ± 14.2 years in kidney transplant recipients and 41.4 ± 13.7 years in the control group. Inadequate serum 25-hydroxyvitamin D was seen in 93.5% of the transplant patients and in 89.1% of the controls. There was a 58.7% vitamin D insufficiency (20 ng/mL to 30 ng/mL) and a 34.8% deficiency (lower than 20 ng/mL) in the patients, and these rates were 58.7% and 26.0% in the control group, respectively. There was no significant difference between the two groups.Conclusions. Vitamin D deficiency is prevalent in kidney transplant patients. Lack of a significant difference between our two groups may be attributable to the high prevalence of vitamin D deficiency in general population and the use of vitamin D supplementation in transplant patients. Indeed, adequate doses of vitamin D in these patients are undetermined. They may need higher doses for normalization of serum vitamin D and metabolic requirements.