Objectives: Urinary tract infection is the most common type of bacterial infection in kidney transplant procedures, with adverse effects on graft and patient survival. We aimed to evaluate the risk factors of recurrent urinary tract infection in renal transplant recipients and its impact on patient and graft survival. Materials and Methods: In a cohort of 1019 patients who were transplanted between 2000 and 2010 at Hamed Al-Essa Organ Transplant Center in Kuwait, 86% developed at least 1 episode of urinary tract infection, with only 6.2% of patients having recurrent infections. We compared patients with recurrent urinary tract infections (group 1) with those who had no recurrence (group 2) regarding their risk factors. Results: Patients in group 1 were significantly younger than those in group 2 (34.9 ± 23 vs 42.8 ± 16 y; P < .001), with female preponderance (P < .001). The percentage of patients with thymoglobulin induction (21.5%) was significantly higher in group 1. Patients with pretransplant urologic problems experienced significantly more recurrent urinary tract infections (P < .001). Hepatitis C infections were significantly more prevalent among group 1 (10.8% vs 3.8%; P = .008). Long-term graft outcome (functioning and failed) were 78.5% and 21.5% in group 1 versus 85.1% and 13.9% in group 2 (P = .18). Patient outcomes (living and deceased donors) were 98.4% and 1.6% in group 1 versus 95.7% and 4.3% in group 2 (P = .187). Conclusions: Adult females, thymoglobulin induction, pretransplant urologic problems, and hepatitis C infection were the risk factors of recurrent urinary tract infection among our renal transplant patients. However, recurrence did not adversely affect graft or patient survival.
Objectives: Acute rejection in renal transplant is considered a risk factor for short-term and long-term allograft survival. The expected reversal rate for the first acute cellular rejection, by steroid pulse, ranges between 60% and 100%, and lack of improvement within 1 week of treatment is defined as steroidresistant rejection. This work sought to evaluate factors that lead to steroid-resistant acute cellular rejection among patients with first live-donor renal allotransplant and its effect on graft and patient survival. Materials and Methods:Patients with an improvement in serum creatinine levels were considered controls (group 1; n=100); while the others were considered an early steroid-resistant group (group 2; n=99). Both groups were matched demographically. Results: Patients with a target cyclosporine level below accepted therapeutic levels were significantly higher in group 2 (P = .02). We found no significant differences between the groups regarding posttransplant complications (P > .05). Mean hospital stay was longer in group 2 (P = .021). Living patients with functioning graft were more prevalent in group 1, while those alive on dialysis were more prevalent in group 2. The groups were comparable regarding long-term patient and graft survival despite significantly lower creatinine values in patients of group 1 at 6 months' follow-up (P ≤ .001).Conclusions: Prebiopsy low cyclosporine trough levels and associated chronic changes among patients who were maintained on calcineurin inhibitor-based regimens represented the most-important risk factors for the early steroid-resistant group. Rescue therapies improve short-term graft outcome; however, they did not affect either patient or long-term graft survival after 5 years' follow-up.
Background:Vitamin D deficiency is not uncommon among kidney transplant recipients which may lead bone diseases, graft aging and vascular disease. We aimed to evaluate the prevalence of hypovitaminosis D among renal transplant recipients and its relation to graft interstial fibrosis in graft biopsies. Methods:We recruited 99 renal transplant recipients with recent graft biopsies performed during the period between 2016 and 2017 in the nephrology department, organ transplant center of Kuwait. We excluded 2 nd transplants, previous rejecters, extremes of ages (<18,>70years), postmenopausal women, and conditions that interfered with vitamin D metabolism as hepatic disease, gastric bypass, cystic fibrosis; extensive burns and chronic diarrhea. Patients were divided the into two groups: recent transplants (<1-year post-transplant, n=49) and older transplants (>1-year post-transplant, n=50). We measured serum 25(OH) vitamin D, iPTH, albumin, creatinine, calcium, phosphorus, cholesterol and uric acid. Graft biopsies were assessed according to Banff classification 2013. Results:Most of patients (81.8%) had hypovitaminosis D with variable degrees' deficiency (48.5 % had insufficiency, 24.2 % had mild deficiency, and 9.1 % had severe deficiency). In our study, both groups were comparable regarding their demographic data except longer dialysis duration and higher number of patients receiving tacrolimus-based therapy in group 1. Vitamin D level was lower in group 1 but did not rank to significance (p>0.05), however, it had significant negative correlation with iPTH and the degree of renal graft interstitial fibrosis and vitamin D deficiency. Conclusion: The prevalence of 25-OH vitamin D deficiency is high post-transplant and it might contribute to the graft interstitial fibrosis.
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