فهرست مطالب
International Journal of Organ Transplantation Medicine
Volume:7 Issue: 3, Summer 2016
- تاریخ انتشار: 1395/05/01
- تعداد عناوین: 7
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Page 149BackgroundNon-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in developing and developed countries. Estimating the total prevalence of NAFLD by means of appropriate statistical methods can provide reliable evidence for health policy makers.ObjectiveTo determine the prevalence of NAFLD in Iran using a systematic review and meta-analysis.MethodsWe identified relevant studies by searching national and international databases. Standard error of the prevalence reported in each study was calculated assuming a binomial distribution. The heterogeneity between the results of the studies was determined using Cochrans Q and I square indices. We used a random effect model to combine the prevalence rates reported in the studies.ResultsWe entered 23 eligible studies in this systematic review investigated NAFLD among 25,865 Iranian people. The total prevalence of NAFLD, prevalence of mild, moderate and severe fatty liver disease were estimated at 33.9% (95% CI 26.4%41.5%), 26.7% (95% CI 21.7%31.7%), 7.6% (95% CI 5.7% 9.4%), and 0.5% (95% CI 0.1%0.9%), respectively. The majority of studies reported that NAFLD was more common among men (seven of eight studies), obese person (15 of 15 studies), older people (10 of 10 studies), patients with systolic hypertension (5 of 8 studies), patients with diastolic hypertension (7 of 9 studies), patients with hypertriglyceridemia (14 of 16 studies), patients with high HOMA level (4 of 4 studies), patients with metabolic syndrome (4 of 4 studies), and those with elevated serum ALT (8 of 12 studies).ConclusionOur study showed that the prevalence of NAFLD in Iran was relatively high and male gender, old age, diabetes, metabolic syndrome, systolic/diastolic hypertension, high serum ALT, and hypertriglyceridemia may be determinants of NAFLD.Keywords: Prevalence, Non, alcoholic fatty liver disease, Meta, analysis
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Page 161BackgroundRenal transplantation is the best treatment for end stage renal disease. Acute graft rejection is one of the main complications and may influence graft survival.ObjectiveTo determine the incidence and features of acute cellular rejection (ACR) episodes confirmed by biopsy.MethodsWe studied a cohort of 175 patients who underwent renal transplantation between 2004 and 2012 to determine the cumulative incidence of ACR confirmed by biopsy and to identify the associated risk factors using multivariate analysis.ResultsThe one-year patient survival was 96.6%; the graft survival was 93.7%. The incidence of ACR within one year was 14.3%, of which 46% were observed within 6 months following transplantation. The most frequently observed ACR type was 1B according to the Banff classification system (42%). A relationship between ACR and receipt of a kidney from expanded criteria donors was observed, both in univariate and adjusted multiple log-binomial regression analyses, but only 6.3% of patients received extended criteria donor kidneys. No other relationships between variables were found.ConclusionACR frequency in this study was similar to that of other cohorts reported previously. We need a bigger sample of renal transplants from expanded criteria donors, PRA and DSA test to support the results.
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Page 167BackgroundTacrolimus is the main immunosuppressive agent in many kidney transplant protocols with an initial recommended daily dose of 0.2 mg/kg of ideal body weight (IBW). However, due to the high inter- and intra-patient variability in its pharmacokinetics, the required tacrolimus doses may differ markedly from patient to patient.ObjectiveTo assess the required tacrolimus dose to achieve the desired whole blood concentration within the first three weeks after kidney transplantation among Iranian patients.MethodsThis cross-sectional study was performed at kidney transplantation ward of Imam Khomeini Hospital Complex where almost all patients receive thymoglobulin induction therapy and a calcineurin inhibitor, mainly tacrolimus, plus mycophenolate, and prednisolone as maintenance immnosuppressive drugs with the target tacrolimus whole blood concentration of 812 ng/mL for the first month after transplantation.ResultsThe mean±SD administered daily dose of tacrolimus during the first three weeks after transplantation was 0.085±0.024 mg/kg of IBW that resulted in a mean±SD whole blood concentration of 10.34±5.44 ng/mL. The required mean±SD dose of the drug to achieve the desired whole blood level of 810 ng/mL was 0.08±0.02 mg/kg. Only 27.4% of the assessed tacrolimus blood levels were within the desired range. Compared with males, females needed 19% more daily dose of tacrolimus to reach similar whole blood levels. Tacrolimus blood levels were significantly correlated with daily tacrolimus doses (r=0.307, p=0.001) and patients age (r=0.283, p=0.003).ConclusionIt seems that Iranian kidney transplant recipients need lower daily doses of tacrolimus to achieve the desired whole blood levels; compared with males, females need a higher dose.Keywords: Iran, Kidney transplantation, Tacrolimus, Immunosuppressive Agents, Pharmacokinetics
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Page 173BackgroundNew-onset diabetes mellitus after transplantation (NODAT) is a well-known complication of transplantation.ObjectiveTo determine the correlation between CMV infection and NODAT.MethodsRetrospectively, we detected CMV replication (PCR) in every month after renal transplantation in the first 12 months of the procedure in a homogenous group of patients from the immunosuppression point of view.ResultsIn 167 patients (64 with NODAT and 103 in the control group), the average amount of CMV viremia was not significantly different between the NODAT and the control group (p=0.929). In the 10th month of transplantation, we recorded a significantly higher CMV viremia in the NODAT group (pConclusionCMV is not a risk factor for NODAT.Keywords: Diabetes mellitus, Diabetes mellitus, type 2, Diabetes mellitus, type 1, Cytomegalovirus, Transplantation, kidney transplantation, Chemoprevention, Immunosuppressive agents, Immunosuppression
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Page 183BackgroundAcute rejection is the main problem in liver transplantation that occurs in the first days or months of transplantation. It includes histological and cellular rejection. Acute histological rejection is confirmed by biopsy. Glutathione S-transferase family is the most important genes in phase II detoxification working in xenobiotic and drug metabolism. GSTO2 is one of the members of this family. GSTO2 (N142D) polymorphism may influence metabolism of immunosuppressive drugs.ObjectiveTo determine if GSTO2 polymorphism has association with acute liver rejection.MethodsThe present study included 120 patients with histological-proven acute liver rejection and 182 patients without acute rejection. Both groups were matched for sex and age. To determine variants of GSTO2, we used polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).ResultsThere was a significant association between the GSTO2 genotype and acute liver rejection (NN: OR: 3.642, 95% CI: 1.1795.444) and (ND: OR: 2.533, 95% CI: 1.6728.149) compared to those with DD geneotype.ConclusionRecipients with either NN or ND genotype for GSTO2 are more likely to develop acute liver rejection compared to those with DD genotype.Keywords: Graft rejection, Glutathione S, Transferase, Polymorphism, genetic, transplantation, Metabolic Detoxication, Phase II
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Page 188BackgroundLooking for an appropriate skin substitute for temporary and permanent coverage of wounds remains one of the main obstacles of medical researchers.ObjectiveTo investigate the rate of inflammation, symbiosis, and survival of grafted allograft skin from brain-dead donors (BDDs) in rabbits.MethodsAfter receiving negative serologic tests of BDDs, we prepared partial thickness skin grafts. They were then used in treating wounds of 5 rabbits in comparison with split-thickness skins taken from cardiac dead donors.ResultsOn histopathological examinations, we found no difference between the skins. All samples were separated from the baseline in 1520 days.ConclusionGamma-irradiated freeze-dried human split-thickness skin taken from BDDs is safe and can be used for the treatment of deep skin burns.Keywords: Inflammation, Symbiosis, Survival, Graft, Graft rejection, Biological dressings
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Page 193Organ transplantation in patients with prior malignancy increases the risk of tumor recurrence post-transplantation due to immunosuppression. Only two cases of liver transplantation have so far been reported in children with hepatic metastases from pancreatoblastoma, a rare malignant neoplasm originating from the epithelial exocrine cells of the pancreas. Herein, we describe a case of a successful multi-visceral transplant in a man with intestinal failure after surgical resection of pancreatoblastoma.Keywords: Transplantation, Immunosuppression, Short bowel syndrome, Liver failure, Neoplasms, Neoplasm Metastasis