Background: Since the outbreak of COVID-19, various treatments have been frequently reported for patients infected with this virus, especially in transplant patients/recipients. Objective: Investigating of kidney transplant patients under IMMUNOSUPPRESSIVE THERAPY infected with COVID-19 can pave the way to understanding, handling, and treatment of COVID-19. Methods: We had a brief review of the literature on IMMUNOSUPPRESSIVE THERAPY in kidney transplants infected with COVID-19. This was based on the PubMed Database with keywords “, kidney, transplant, COVID-19, and immunosuppress”,after hospitalization of kidney transplantation infected with COVID-19. He had already been recorded in the Organ Transplant Registry (ID≠,64510) of Tabriz University of Medical Sciences /Iran. Results: We reported the clinical course of a 45-year-old man with a history of kidney transplantation and immunoTHERAPY who was infected with COVID-19 with respiratory infections and positive RT-PCR (Real-time polymerase chain reaction). He was treated with hydroxychloroquine, Kaletra, CellCept, and prednisolone for 5 days, and finally discharged from the hospital. In addition, reviewing of 47 papers with 851 samples showed that immunosuppressant medications alone could be a therapeutic choice in kidney transplants infected with COVID-19 with careful management. Conclusion: Patients with organ transplantation infected with COVID-19 may show different clinical signs, clinical course, and prognosis due to underlying diseases and the use of immunosuppressant medications. It might be best to continue taking the immunosuppressant medications but modify them based on the patients' conditions such as clinical symptoms, laboratory results, paraclinical examinations.

Background: Treatment of steroid-resistant nephrotic syndrome (SRNS) remains a huge challenge in pediatric patients. IMMUNOSUPPRESSIVE agents including cyclosporine A (CsA), tacrolimus (TAC) and mycophenolate mofetil (MMF) are recommended for the management of children with SRNS. The aim of this study was to compare the efficacy of CsA, TAC and MMF in children with SRNS and provide guidance for clinical practice.Methods: This is a retrospective analysis of the records of 70 children with SRNS recruited from a children hospital over a period of seven years. They were treated with CsA, TAC and MMF as initial IMMUNOSUPPRESSIVE THERAPY in addition to steroids. Complete or partial remission was considered a good response.Results: Five (41.7%) of 12 children who were on CsA THERAPY achieved remission at 6 months and 5 (41.7%) at 12 months. Nine (19.1%) of 47 patients treated with TAC achieved remission at 6 months, 20 (42.6%) at 12 months and 6 (12.8%) within or over 24 months. The remission achieved at 6 months and 12 months was 4 (36.4%) and 2 (18.2%) respectively in MMF group. The relapse rates in children who had achieved remission were 30.0%, 45.7% and 50.0% in CsA, TAC and MMF group respectively.Conclusions: Based on similar baseline characteristics, CsA and TAC as initial THERAPY for SRNS have a better remission and relapse rates whereas MMF shows a rapid remission effect.

Post-transplant malignancy is recognised as being a major limitation to the success of solid organ transplantation and it is currently considered one of the unavoidable costs of long-term IMMUNOSUPPRESSIVE THERAPY.However, the continual introduction of new IMMUNOSUPPRESSIVE drugs and the growing knowledge about their different oncogenic profiles, requires a continuous evaluation of the available evidence on this topic.The incidence and risk of malignancy is elevated in solid organ transplant recipients compared with the general population. As proof of the relationship between IMMUNOSUPPRESSIVE THERAPY and post-transplant malignancy, epidemiological data reveal that the length of exposure to IMMUNOSUPPRESSIVE THERAPY and the intensity of THERAPY are clearly related to the post-transplant risk of malignancy, and that once cancer has developed, more intense immunosuppression can translate into more aggressive tumour progression in terms of accelerated growth and metastasis and lower patient survival. The association between malignancy and IMMUNOSUPPRESSIVE THERAPY is mediated through several pathogenic factors. Indirectly, IMMUNOSUPPRESSIVE drugs greatly increase the post-transplant risk of malignancy by impairing cancer surveillance and facilitating the action of oncogenic viruses.However, the direct pro- and anti-oncogenic actions of immunosuppressants also play an important role. The cancer-promoting effect of calcineurin inhibitors, independently of depressed immunosurveillance, has been demonstrated in recent years, and currently only mammalian target of rapamycin (mTOR) inhibitors have shown simultaneous IMMUNOSUPPRESSIVE and antitumour properties. Reports of the initial results of the reduced incidence of cancer in organ transplant recipients receiving mTOR inhibitor THERAPY strongly indicate separate pathways for pharmacological immunosuppression and oncogenesis. The role of mTOR inhibitors has been firmly established for the treatment of post-transplant Kaposi's sarcoma and its role in the management of patients with other post-transplant malignancies should be clarified as soon as possible.Prevention of morbidity and mortality resulting from post-transplant malignancy should become a main endpoint in solid organ transplant programmes, and the choice and management of IMMUNOSUPPRESSIVE THERAPY in each phase of transplantation plays a central role in this objective. Although comprehensive and rigorous information about the management of IMMUNOSUPPRESSIVE THERAPY in transplant recipients at risk of or affected by cancer is still lacking, new experimental and clinical data about mTOR inhibitors offers novel approaches to this problem.

utoimmune diseases, once developed, are often hard to control and thus prevention of disease development is obviously of great importance. Postpartum onset of autoimmune diseases, especially autoimmune thyroid disease, is frequently observed and postpartum hypothyroidism is a good candidate for investigation of prediction and a trial of prevention of disease development. Materials and Methods: In order to clarify the method of prediction of postpartum onset of hypothyroidism, 9 patients who had had previous episodes of postpartum hypothyroidism and high titers (more than 5 × 103) of anti-thyroid microsomal antibodies were examined during the postpartum period of their current pregnancies. Thyroid function, size of goiter and titer of anti-microsomal antibodies were observed every month for 12 months after delivery. The other two patients, who were expected to develop postpartum hypothyroidism after present parturition and had high anti-thyroid microsomal antibody titers of more than 5 × 103, were treated with short-term glucocorticoid THERAPY. Results: All 9 patients, who had previous postpartum transient hypothyroidism and had had high anti-thyroid microsomal antibodies, developed recurrence of postpartum hypothyroidism at almost the same postpartum time. A shortterm glucocorticoid THERAPY was tried for two other cases who were expected to have recurrence of postpartum hypothyroidism. In the first case, occurrence of postpartum hypothyroidism was delayed by 2 months and peak value of TSH was lower than that of the previous episode. In the second case, duration and dose of predonisolone was doubled and development of postpartum hypothyroidism was successfully prevented. Conclusion: Postpartum recurrence of hypothyroidism was predicted in patients who had previous episodes of postpartum transient hypothyroidism and higher titers of anti-thyroid microsomal antibodies. The short-term predonisolone THERAPY successfully prevented postpartum development of hypothyroidism in one case.

Background – Bone marrow transplantation (BMT) and IMMUNOSUPPRESSIVE THERAPY are two choices of THERAPY for aplastic anemia. In BMT, abnormal cells are replaced by normal donor’s hematopoetic stem cells in those patients who have an HLA-identical match donor and are aged < 45 years old. In IMMUNOSUPPRESSIVE THERAPY, antilymphocyte globulin (ALG) and cyclosporin are used in patients who do not have an HLA-identical match donor and are aged > 45 years old. Methods – In this study we compared these two modalities of treatment in acquired severe aplastic anemia. We had 70 patients in two groups. Twenty-nine patients had completed BMT and 41 patients had completed non-BMT treatment. The conditioning regimen in BMT group was cyclophosphamide plus ALG. Patients with severe aplastic anemia who had been referred to the Hematology Clinic of Shariati Hospital from 1990 through 2001, were selected according to age (< 45 or > 45 years) and presence of HLA match donor. Ethical considerations were strictly followed. Data were analyzed by SPSS version 10. Survival probabilities were estimated using Kaplan-Meier method. Results – The 5 years overall survival in BMT group was 67% and in cyclosporin group was 36.6% and we found that after the day 200 postTHERAPY overall survival in BMT group was higher in comparison with non-BMT treatment (p = 0.02). Conclusion – BMT has the best results and long-term survival in severe aplastic anemia patients.