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Objectives: Low-dose valganciclovir prophylaxis is still under investigation in renal transplant procedures. Our aim was to assess the cost effectiveness of 450 mg versus 900 mg valganciclovir prophylaxis in kidney transplant recipients. Materials and Methods: In this prospective trial, 201 kidney transplant patients were randomized (1:1) to receive 450 mg/d (group 1, n = 100) or 900 mg/d (group 2, n = 101) valganciclovir prophylaxis for the first 6 months after transplant. Patients were studied for incidence of cytomegalovirus disease, leukopenia episodes, rejection episodes, and graft outcomes along with associated costs over 1 year. Costs (in US dollars) of treatment of rejection were also analyzed. Results: Demographic features of the studied groups were comparable. We found that the cost of cytomegalovirus care in group 1 patients was significantly lower (by 50% at 6 months; P < .001), with less leukopenia episodes (P = .04), lower doses of granulocyte colony-stimulating factor (by 30% at 6 months; P = .03), higher doses of mycophenolate mofetil (P = .04), and less rejection episodes (P = .01) compared with group 2. In group 2, there were more episodes of cytomegalovirus infection (P = .052) and BK virus nephropathy (P = .04). Graft and patient outcomes were satisfactory in both groups. Conclusions: Low-dose valganciclovir for cytomegalovirus prophylaxis after renal transplant is safer, effective and without breakthrough infection, and less costly than using the usual dose.

Objectives: The idea of transplanting organs is not new, nor is the disease of obesity. Obese transplant recipients have greater risk of early death than their cohorts, which is not due to increased rejection but due to obesity-related complications, including arterial hypertension, diabetes, and delayed graft function. Here, our aim was to evaluate the effects of bariatric surgery versus lifestyle changes on outcomes of moderate to severely obese renal transplant recipients. Materials and Methods: Twenty-two morbidly obese patients with stable graft function who underwent bariatric surgery were compared with 44 obese patients on lifestyle management (control group). Both groups were evaluated regarding graft and patient outcomes. Results: The studied groups were comparable demographically. In the bariatric study group versus control group, we observed that the mean body mass index was 38.49 ± 9.1 versus 44.24 ± 6 (P = .024) at transplant and 34.34 ± 7.6 versus 44.38 ± 6.7 (P = .002) at 6 months of bariatric surgery. Both groups received a more potent induction immunosuppression, but this was significantly higher in the obese nonbariatric control group (P < .05). There were more patients with slow and delayed graft functions in the same nonbariatric group. The 2 groups were comparable regarding new-onset diabetes after transplant, total patients with diabetes, and graft outcomes (P > .05). Conclusions: Bariatric surgeries are feasible, safe procedures for selected obese renal transplant recipients.

The current final height of low-body-weight transplant Egyptian children has remained suboptimal. The management of growth retardation posttransplant is multifactorial and should start early before transplantation, with optimal care of growth in children with chronic kidney disease. Moreover, expedited transplantation, whenever indicated, and optimization of posttransplant graft function with minimal steroid exposure are essential factors which were shown to be possible using immunosuppression based on tacrolimus plus mycophenolate mofetil, after basiliximab induction.

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Background: Pandemic H1N1 infection has been associated with significant morbidity in general population. Immuno compromised transplanted patients are one of at risk groups. Handling of immunosuppressive drugs in such population was not discussed in details in literatures.Patients &Methods: Fifty-two renal transplants recipients (RTR) started oseltamivir upon clinical suspicion. 25/52 of them were proved to suffer from H1N1. Nasopharyngeal swabs were subjected to specific testing for H1N1 by standard methodology using real-time reverse transcriptase polymerase chain reaction (RT-PCR). Of the confirmed cases; 21 patients were admitted and isolated due to pneumonia, bronchitis, gastroenteritis and or shock while the other 4 patients treated on outpatient basis.Results: Twelve cases suffered from respiratory symptoms; six cases suffered from H1N1 pneumonia, while other 6 cases suffered from acute bronchitis. The other 13 admitted patients suffered from gastroenteritis, high fever and or shock. Twenty-three out of 25 RTR showed dramatic response to oseltamivir, high grade fever resolved 1-2 days after initiation of the antiviral drug. Most of patients discharged to home 4-6 days after admission. Conclusion:Early clinical suspicion and starting oseltamivir immediately upon clinical suspicion is to decrease the morbidity and mortality. Doubling the dose, extension of duration of treatment and reduction of immunosuppressive drugs (when indicated) are the keys for successful management of H1N1 infection in RTR.