Although the number of children with end-stage renal disease (ESRD) in need for renal transplantation is small compared with adults, the problem associated with renal transplant in children are numerous, varied, and often peculiar. Pre-emptive transplantation has recently been growing in popularity as it avoids many of the associated long-term complications of ESRD and dialysis. Changes in immunosuppression to more potent agents over the years will have affected transplant outcome; there is also evidence that tacrolimus is more effective than cyclosporine. This review will discuss the short- and long-term complications such as acute and chronic rejection, hypertension, infections, and malignancies as well as factors related to long-term graft function.Chronic allograft nephropathy is the leading cause of renal allograft loss in pediatric renal transplant recipients. It is likely that it reflects a combination of both immune and nonimmune injury occurring cumulatively over time so that the ultimate solution will rely on several approaches. Transplant and patient survival have shown a steady increase over the years. The major causes of death after transplantation are cardiovascular disease, infection and malignancy. Transplantation in special circumstances such as children with abnormal urinary tracts and children with diseases that have the potential to recur after transplantation will also be discussed in this review. Non-compliance with therapeutic regimen is a difficult problem to deal with and affects patients and families at all ages, but particularly so at adolescence. Growth may be severely impaired in children with ESRD which may result in major consequences on quality of life and self-esteem; a better height attainment at transplantation is recognized as one of the most important factors in final height achievement.Although pediatric kidney transplantation is active in some parts of many developing countries, it is still inactive in many others and mostly relying on living donors. The lacking deceased programs in most of these countries is one of the main issues to be addressed to adequately respond to organ shortage.In conclusion, transplantation is currently the best option for children with ESRD. Although improvement in immunosuppression demonstrated excellent results and has led to greater 1-year graft survival rates, chronic graft loss remains relatively unchanged and opportunistic infectious complications remain a problem.

Background: Successful renal transplantation enables previously infertile females to conceive and carry a pregnancy. Although permitted, but pregnancy should be considered high risk in this population. Materials and Methods: We describe the outcomes of 131 pregnancies in 95 women with kidney transplant in three university hospital. All were treated with of women at (±SD) combination immuno-suppressive drugs. Results: mean age 5.4 years, average time interval from transplantation to pregnancy was 28.7±5/4 months. Pregnanciec had been most commonly complicated by hypertension (48.8%), prematurely (27.4%), UTI (16.2%) and preec1ampsia (11%). Pregnancies resulted in 96 surviving neonates (72.8%), 21 spontaneous and therapeutic abortion (16.8%), 13 stillbirth (10.4%), 3 neonatal death (2.8%). Mean preconception creatinine was 1.22±0.79 mg/dl. Graft loss was evident in 15 women (12.6%) within 2 years of parturition. There was no graft loss during pregnancy. Conclusion: Although our cases were insufficient, it seems that pregnancy should not adversely affect graft function provided that, graft function was well preserved at the time of conception.

Background: Hyperuricemic patients have been predisposed to cardiovascular disease, hypertension, and renal disease. Hyperuricemia is implicated in endothelial dysfunction and in increased production of inflammatory mediators including C-reactive protein.Objective: To evaluate the prevalence of hyperuricemia and its risk factors among renal transplant recipients.Methods: A retrospective observational study was conducted among 4217 renal transplant recipients between April 2008 and January 2011. All patients referred from different kidney transplant centers, Tehran, Iran to a single laboratory. The mean±SD age of transplantation was 5±4 (median: 4.2) year. During this period, uric acid was measured in 17, 686 blood samples of 4217 renal transplant recipients (64% male and 36% female). Hyperuricemia was defined as a serum uric acid (SUA) level ³7.0 mg/dL in males and ³6.0 mg/dL in females that persisted for at least two consecutive tests performed. Moderate to severe hyperuricemia was also defined as a SUA level ³8.0 mg/dL. Multivariate regression analysis was used for identifying risk factors for hyperuricemia.Results: The median age of recipients was 38 years. The majority of cases were male (63%). The median age of the donor was 28 years. The majority of grafts came from living donors (84.6% unrelated and 7.8% related), whereas 7.6% of patients received a deceased donor graft. We found that 1340 (31.8%) of recipients had hyperuricemia. Moderate to severe hyperuricemia was observed in 572 (13.6%) of patients. Although hyperuricemia was frequently occurred in women (34% in women vs 25% in men, p<0.001), the rate of moderate to severe hyperuricemia was higher in men compared to women (15.5% vs 10.3%, p<0.001). There was a significant relationship between SUA and serum creatinine (p<0.001) as well as cyclosporine levels (p<0.001). In multivariate logistic regression, we found that, the increased trough level of cyclosporine was a risk factor of hyperuricemia.Conclusion: Since hyperuricemia is frequently seen in renal transplant recipients and high level of cyclosporine is the most important risk factor for developing hyperuricemia, the effective treatment would be cyclosporine dose reduction as much as possible.

Context: The current study aimed at providing an evidence-based and up-to-date review of the literature regarding the assessment and outcomes of pregnancy in patients with renal transplant. Design: It was a review of the current literature. Conclusions: According to the current study findings, the function or survival of renal allograft was not adversely affected by getting pregnant. Therefore, ideal care for these patients needs a multidisciplinary approach including maternal-fetal medicine, nephrology, and neonatology specialists.

Introduction: The adverse effects of hyperuricemia on renal function are of interest. Patients with a history of kidney transplantation are at the risk of hyperuricemia and its associated complications. Therefore, the identification and management of the factors that cause hyperuricemia in these patients can be helpful and may eliminate the need for taking uric acid-lowering drugs. This study aimed to determine the prevalence of hyperuricemia and its related factors in patients who underwent renal transplantation. Materials & Methods: This analytical cross-sectional study was conducted on patients over 18 years of age who underwent kidney transplantation and referred to Mahdieh Clinic in Kermanshah, Iran, during 2019. The sampling was performed using the available and purposeful method. Ethics code: KUMS. REC. 1396. 574 Findings: This study was performed on 165 patients with renal transplantation. The prevalence of hyperuricemia in this study was obtained at 58. 8%. The hyperuricemic patients had a lower glomerular filtration rate and higher proteinuria (P<0. 05). High levels of uric acid were significantly associated with male gender, and the consumption of diuretic medications as well as immunosuppressive drugs, especially cyclosporine (P<0. 05). Discussion & Conclusions: In this study, hyperuricemia was highly prevalent in patients with kidney transplantation and was associated with poorer kidney function. It seems that early diagnosis of hyperuricemia and the implementation of some actions, such as less diuretic usage and selection of immunosuppressive drugs with less hyperuricemic effects, can improve the function and survival of the transplanted kidney with fewer needs for the use of uric acid-lowering drugs.

Renal transplantation is the treatment of choice for most patients with end-stage renal disease which has resulted in improving the quality of life of these patients. Despite all improvements in the field of renal transplantation, mortality after renal transplantation remains a serious problem. Regarding survival and mortality of these patients, several studies rove been conducted which have produced varied results. This study was undertaken to examine survival and cause of death after renal transplantation in 207 patients who received a renal transplant between March 1993 and Jun 1996 at the Shariati Hospital.Eighteen patients died after renal transplantation in 4 (22-2%) of cases Where the cause was infection in 5 cases (27.8%), CNS problems in 5 cases (27.8%) and cardiovascular problems. The survival of patients was 94% at 1 year, 93% at 2 years and around 91% at 3 years.In the present study contrarily to other studies, cardiovascular problems were not the leading cause of death which could be due to the lower age of patients in this study. Malignancy was not found as a cause of death in this study although it has been reported as the frequent cause of death in other parts of the world. Perhaps low dosage of immunosuppressive drugs, less number of patients and limited follow up could be the reasons for this difference.

Introduction: Although observing fast is a fundamental duty and is mandatory for all Moslems, but in certain circumstances, those who are ill are exempted. Until now more than 8000 renal transplantations has been performed in Iran and question of fasting has become more significant. In order to determine the effect of fasting on renal transplantation we performed a prospective study from 1994 to 1996.Material & Methods: 41 months of Ramadan fasting in 19 patients with normal graft function compared to 20 patients who did not fast. Both groups were matched in terms of age, sex, graft function, blood pressure, history of acute rejection, mean interval time from transplantation surgery and immunosuppression regimen.Results: mean serum creatinine concentration in fasting group was 1.07±0.24 mg/ dl before Ramadan and 1.08±0.22 mg/ dl after it. In control group it was 1.00±O.24 mg/ dl before Ramadan and 1.03±0.28 mg/ dl after it. (P>0.05).Conclusion: this study, although small in size shows that renal transplant patients with normal graft function can observe fasting during the month of Ramadan without any deleterious effect on renal function. However for better clarification of this issue we need larger studies.

During the end of 2019 a group of patients with pneumonia were described in Wuhan city of china with progression to ARDS with variable outcome. Mortality rate was higher in the oldest and in those with comorbid conditions. Kidney transplant recipients as a group of immunocompromised hosts are believed to be a high risk group in case of infection by SARS-CoV-19 virus with unfavorable outcome. On the other hand, cytokine storm with its severe inflammatory response as a major risk factor of mortality may be prevented by ongoing immunosuppressive therapy. Our knowledge about the pathophysiology and treatment options of COVID-19 in kidney transplant recipients are growing on daily bases and at the time being is derived mainly from the few published case reports, reviews and some society guidelines in the published literature.

Introduction. This study was performed to evaluate complications after transplantation and to compare result of transplantation in diabetic patinets and non-diabetic patients.Methods. In this study, medical records of all patients with diabetic nephropathy undergone this procedure from 1987 to 2000 in Namazi hospital (Shiraz, Iran) in 5 years of follow-up were reviewed (n = 50), and one hundred of non-diabetic patients in this center were chosen as control group. We matched both groups with regard to sex, age, and type of donor and year of transplantation. In order to evaluate both groups, we made a criteria with regard to post operation omplications, serum creatinine flactuations and 5 years follow up remarks and according to this ceiteria we divided patients into good, moderate and poor prognosis.Results. Mean age was 49±9 (Mean±SD) years in diabetic patients and 51±11.05 in non-diabetic patients. Retinopathy (23.1%) and Cardiovascular diseases (30.8%) were the most prevalent complication in diabetic patients. Serum creatinine flactuations showed more acceptable in non-diabetics during 5 years, but the average was the same after 5 years in both groups. (Mean serum crateanine=2). In contrast to other studies, post operation evaluation difference between both groups was statistically significant (P<0.0001), it means that non-diabetics had better results in renal transplantation.Discussion .As diabetic nephropathy usually occurs many years after the onset of diabetes, renal transplantation should be preserved for patients with relatively less complication of diabetes.