International Journal of Organ Transplantation Medicine
Volume:3 Issue: 3, Summer 2012

Portal vein thrombosis (PVT) used to be a relative contraindication for liver transplantation (LT). This obstacle has been dealt with following the improvement of LT-related techniques. To compare the outcome of adult patients with PVT who underwent LT before and after adopting MELD. We retrospectively searched our database for deceased donor LT recipients who had PVT, were operated between 1990 and 2009, and were 18 years old or more. The outcome of patients operated in pre-MELD era (1990–2001) was then compared with that of those operated in MELD era (2002–2009). The incidence of patients undergoing LT with PVT has increased from 1.2% (491/40,730) in pre-MELD era to 6% (2540/42,601) in MELD era (p<0.01). Patients with PVT in MELD era were older (53.6 vs 50.5), had higher calculated MELD (21.3 vs 18.9), shorter length of hospital stay after LT (25 vs 21.7 days), more likely to develop HCC (14.8% vs 0), and more likely to receive DCD allograft (3.9% vs 0.8%). Donor risk indices were comparable in both groups (1.9 vs 1.9). The median waiting time before transplantation decreased during MELD era (71 vs 99 days). Allograft and patients survival was comparable between the two eras. However, allograft and patients survival rates were lower in patients with PVT compared to those without. In Cox regression analysis, PVT was associated with worse allograft (HR=1.3, 95% CI: 1.2–1.4, p<0.001) and patient survival (HR=1.3, 95% CI: 1.2–1.5, p<0.001) compared to non-PVT patients. The incidence of patients with PVT has increased in MELD era without improvement in outcomes. Donor and recipients characteristics changed in MELD era. PVT is still associated with poor outcomes compared to patients without PVT.

Kidney transplantation is the best available treatment for patients with end-stage renal disease. To evaluate the en bloc anastomosis technique for unilateral dual kidney transplantation (DKT). From May to October 2011, 5 patients (4 women and 1 man) with mean age of 31.8 years underwent unilateral DKT with this technique in which distal end of the aorta and proximal end of inferior vena cava (IVC) were closed with running sutures. Then, proximal end of the aorta and distal end of the IVC were anastomosed to internal (or external) iliac artery and external iliac vein, respectively. Post-operative course was uneventful. No vascular and urologic complications developed; all patient had acceptable serum creatinine at discharge time and up of 2–6 months of post-operation follow up. Unilateral DKT is a safe method for performing DKT. The proposed en bloc anastomosis can improve the outcome of the graft by reducing the cold ischemia and the operation time.

BK virus nephropathy (BKVN) is one of the complications of renal transplantation that causes graft loss in renal transplant recipients. To determine the incidence of BKVN after renal transplantation in Hasheminejad Hospital, Tehran, Iran. In this analytical cross-sectional study, we evaluated 31 consecutive kidney transplant recipients (21 men and 10 women) for BK and JC viral infections and BKVN during one year after transplantation. Urine of patients was tested for the presence of decoy cells and DNA of BK and JC virus by PCR. The serum load of BK and JC virus was assessed in patients 3, 6, 9, and 12 months after transplantation. Renal biopsy was performed in presence of allograft dysfunction or viral load >107 copies/mL. The prevalences of decoy cells and BK and JC viral DNA in urine of patients were 16%, 29%, and 23%, respectively. BK or JC virus was found in 45% of the urine samples. During one year follow-up, no cases of BKVN was observed. Despite a high rate of BK viral infection, no one with BKVN was observed in our kidney transplant recipients. Therefore, screening of all transplant recipients for BKVN is not recommended.

End-stage liver diseases are common in Iran. The only therapeutic option for these patients is liver transplantation. To present our 2-year experience of liver transplantations in Afzalipoor Hospital, Kerman, southeastern Iran. From November 2009 to September 2011, 12 patients underwent orthotopic liver transplantation in our center. Their data including demographics, indications for transplantation, MELD scores, post-operative complications and their management were collected. Patients (7 women and 5 men) aged between 14 and 55 years. Indications for the transplantation included HBV infection (n=5), cryptogenic cirrhosis (n=2), Wilson’s disease, alcoholism (n=1), HCV infection (n=1), Budd-Chiari syndrome (n=1), and autoimmune hepatitis (n=1). MELD score of patients ranged from 16 to 30. All patients received tacrolimus, mycophenolate mofetile and corticosteroid, postoperatively. 2 patients died of pulmonary and intra-abdominal infections with resultant to multiple organ failure. Nonfunctioning of transplanted liver and ongoing bleeding resulted in death in another patients. 9 patients are well doing and have excellent liver functions. We had relatively successful results in our experience of orthotopic liver transplantation. Vicinity of our center to Shiraz Transplant Center would be an important factor in this success.

The Act of transplantation from deceased and dead-brain donors was ratified in the parliament in 2000. In the subsequent two years, few number of organs were procured from dead-brain patients and transplanted. Later on, a national network was established for organ procurement; units for recognizing brain death were established in Tehran and some other cities to provide the necessary infrastructure for organ transplantation from deceased and dead-brain donors. In this report, we described the outcome of organ procurement from deceased and dead-brain donors after 10 years of its establishment in Iran. To do so, we collected data from some relevant published articles and also reports of the Ministry of Health released between 2001 and 2010. By the year 2010, 3673 organs were harvested from deceased donors and transplanted. The rate of liver transplantation has increased rapidly from 16 cases in 2001 to 280 cases in 2010—almost 18 times. There were 554 cadaveric kidney transplantation in 2010; it comprised 19% of total kidney transplantations that is almost 8 times that in 2001. Over the study period, organ procurement has increased by 6-fold. The rate of organ procurement from deceased and dead-brain donors has increased dramatically over the studied period. Considering the existing potentials for this scheme of organ procurement, it seems that improving the Iranian Network for Transplant Organ Procurement will lead to better results.

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.