2Background and purpose: Kidney transplantation is still the most important and main treatment for advanced Kidney failure. However, some patients reject the transplant through an immune system reaction. Improvement of immunosuppression with drugs such as rituximab and bortezomib allows these patients to be eligible for transplantation. This study aims to determine the cost-effectiveness of rituximab versus bortezomib in Kidney transplant patients at Farhikhtegan Hospital, Tehran. Materials and methods: The target statistical population in this research was inpatients receiving rituximab and bortezomib in 2022 in Farhikhtegan Hospital. Rituximab with a minimum dose of 375 mg/m2 was administered one day before transplantation. Bortezomib was administered at a dose of 1.3 mg/m2 on four occasions (usually days 1, 4, 8, and 11). The indicators related to the calculation of the cost of the disease and the parameters indicating the effectiveness were determined through library studies and interviews with experts, and finally, the aforementioned information was collected through the examination of the patient's records (hospital database). Cost indicators include the cost of a physician visit (first day, second day, general practitioner, emergency department, discharge day), medicine (main medicine, complementary medicine), hospital hoteling (nursing services, consumables, bed, radiology, ECG, critical care, physiotherapy, preparation of nutrition formulary, examination, and burial permit) and tests (all tests necessary to evaluate and monitor the patient). Efficacy indices included IgG class I, IgG class II, IgM class I, and IgM class II. The data analysis was conducted by SPSS software. Results: 77 Kidney transplant patients including 53 treated with bortezomib and 24 receiving rituximab with an average age of 41.01±8.50 years were studied. Our findings showed that the average cost of the bortezomib group was 19,548,230.86 tomans. Before taking bortezomib, the average level of class I and class II IgG was 68.16±6.34 and 67.11±4.96, respectively, which significantly decreased to 17.28±15.73 and 18.13±16.75 after treatment with bortezomib (P=0.000). The average IgM class I and class II before taking medicine were 5.69±1.30 and 5.54±0.95, respectively, which reached 5.43±0.79 and 5.13±0.39 after taking Bortezomib, respectively. This decrease was significant for IgM class II (P=0.000), but not significant for IgM class I (P=0.223). In patients receiving rituximab, before taking the drug, the average level of class I and class II IgG was 71.66±7.86 and 67.83±4.53, respectively, which significantly decreased to 13.95±13.82 and 15.83±14.15 after treatment with rituximab (P=0.000). The average IgM class I and class II before taking rituximab was 5.70±1.23 and 5.45±0.97, respectively, after taking the drug, it decreased to 5.41±0.65 and 5.16±0.38, respectively, and this decrease was not statistically significant (P>0.05). The average cost of the rituximab group was 28,261,539.29 Tomans and caused a significant decrease in the average level of IgG class I and II. The incremental cost-effectiveness rate (ICER) was 1770997.65, which was lower than the threshold defined by WHO. Conclusion: The results of our study showed that rituximab is cost-effective compared to bortezomib

Introduction: The status of embedded fistula before Kidney transplant is one of the problems in patients after Kidney transplant and without correct management, surely it can lead to severe complications. The vascular access of arteriovenous fistula (AVF) and its possible complications can be found using the registered data in patients who had undergone successful Kidney transplant. This information may be useful to prevent possible complications in future. Objectives: This study was aimed to determine the status of vascular access before Kidney transplant in patients with successful transplantation in Urmia city, Iran. Patients and Methods: This study was a historical cohort conducted on 201 patients from March 2009 to March 2012 who had undergone vascular access before Kidney transplant. The related information about complications and functions of fistula were extracted from available records. Results: According to results, the patients were divided into four groups regarding fistula function including 104 patients (51. 7%) with functional fistula after Kidney transplant, 49 patients (24. 4%) with spontaneously closed fistula, 37 patients (18. 4%) with closed fistula through surgery and 11 patients (5. 5%) with reduced blood flow of fistula. Conclusion: Despite the low incidence of heart failure in functional vascular access after successful renal transplantation, these patients should be followed up by cardiologists to avoid complications. Generally, closing vascular accesses after successful transplantation is not necessary.

Kidney transplantation in patients with end stage renal disease is preferred to dialysis because transplantation provides a better quality of life and improved survival. However, the gap between the supply and demand for a renal allograft is widening and the waiting time is increasing. Iranian protocol, a controlled transplant program supported by the government for living unrelated donors, was initiated for solving the problem of organ shortage. Although this system might experience challenges, clearly it has advantages over other organ procurement systems primarily that thousands in need do not die while waiting for a compatible donor.In the present review I discuss the history of renal transplantation in Iran, "Iranian model" protocol, the situation of Iran’s Kidney transplantation from either living or deceased donors compared with the Middle East countries, and our experiences of unrelated renal transplantation.

Objective: Hypertension is one of the common complications after Kidney transplantation that arises from various etiologies. Hypertension causes an accelerated atherosclerosis after transplantation and is a major factor for cardiovascular morbidity and mortality and chronic allograft failure. The aim of this study was to evaluate the prevalence and the role of common risk factors before and after transplantation on post transplant hypertension.Subjects and Methods: All of the patients were visited monthly or every other month during the first year after transplantation. History and physical examination and necessary laboratory measurements were done (with special emphasis on blood pressure levels). Patients with blood pressure above 140/90 were diagnosed as hypertensive for whom antihypertensive agents were prescribed. Correlation was carried out between risk factors with development of hypertension which included age and gender of donor and recipient, recipient weight, hypertriglyceridemia, hypercholestremia, diabetes and cigarette smoking before and after transplantation. Past history of hypertension and allograft function with hypertension were also studied.Results: Two hundred and seven (70.5 % males) patients were recruited in this study. Hypertension was cumulatively detected in 73.4, 76.5 and 84.5 % of cases after three, six and 12 months of transplantation. In all time intervals studied, no significant statistical correlation was found between age and gender of donors and recipients, recipient weight, history of diabetes, hypertriglyceridemia and cigarette smoking before and after transplantation. However, there was a significant correlation between development of post-transplantation hypertension with hypercholesterolemia after 6 and 12 months of transplantation (p<0.039 and <0.004), history of hypertension before transplantation after 12 months (p<0.043) as well as with function of allograft (p<0.04).Conclusion: This study revealed that hypertension after transplantation has a high prevalence and history of hypertension, function of allograft and hypercholesteremia after transplantation are risk factors. In addition, due to the high risk for cardiovascular morbidity and mortality associated with hypertension in these patients, it is advised that blood pressure must be measured routinely during the follow up periods and where possible the underlying cause be managed and hypertension should be aggressively managed by non-pharmacologic measures, minimization of doses of steroids and cyclosporine and pharmacologic therapy.

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.

Skin cancers are the most common tumors among transplant recipients who receive immunosuppressive agents. Kaposi sarcoma (KS) is one of the most common malignancies to occur in Kidney transplant recipients, especially in the Middle East countries. Its prevalence in comparison with other neoplasms is also relatively higher in Iran (>35%). The KS-associated herpesvirus or human herpesvirus 8 is a newly discovered herpesvirus found in all forms of the KS including those among immunosuppressed transplant recipients. Kaposi sarcoma usually regresses after withdrawal or reduction of immunosuppressive agents.A wide variety of therapies have been used for KS, including radiotherapy and administration of interferon and different chemotherapeutic regimens. Sirolimus exhibits antiangiogenic activity related to impaired production of vascular endothelial growth factor and limited proliferative response of endothelial cells to the stimulation by vascular endothelial growth factor. Therefore, it can inhibit the progression of KS. Accordingly, replacement of calcineurin inhibitors by a sirolimus can show promising results in the prevention of KS.

Background & Aims: A study was carried out to find out the incidence of orthopedic complications in patients with renal transplantation in Urmia medical center of renal transplantation.Materials & Methods: 500 patients with renal transplantation referred to nephrology clinic were investigated for any orthopedic complain including pain, deformity, fracture, limitation of motion, history of acute bone pain, and musculoskeletal infections. Patients who had one of these sign or symptoms referred to orthopedic clinic and were rexamed by an orthopedic surgeon and paraclinical Investigations were performed.Results: Three avascular necrosis of hip, one acute bone pain syndrome and two fractures was found. There were no major or multiple fractures among patients.One patient had osteomyelitis of phalanx Conclusion: The incidence of avascular necrosis in Urmia is less than literature.Little attention has been paid for acute bone pain by orthopedic surgeons and nephrologists. Fracture and infection was not a major problem in our patients.

Experience with horseshoe Kidney transplantation is limited. Horseshoe Kidney may be underutilized for transplantation because of the greater incidence of vascular and other associated urological anomalies. Nowadays, owing to a greater number of patients waiting for a Kidney donation and to a shortage of organs donated, more suitable organ acceptance criteria have been formulated. The aim of this paper is to present the first Iranian experience with horseshoe Kidney transplantation.

Patients with chronic renal failure may develop sensorineural hearing loss. Cochlear implantation has rarely done after organ transplantation. Herein, we report on a 33-year-old Kidney transplantation recipient who underwent cochlear implantation for her progressive sensorineural hearing loss in Khalili Hospital Cochlear Implant Center, affiliated to Shiraz University of Medical Sciences. The implantation was done successfully with no complications. Cochlear implantation may be an appropriate therapeutic option for sensorineural hearing loss caused by chronic renal failure.