Iranian model of paid and regulated living-unrelated kidney donation.

Since the 1980s, many countries have passed legislation prohibiting monetary compensation for organ donation. Organ donation for transplantation has become altruistic worldwide. During the past two decades, advances in immunosuppressive therapy has led to greater success in transplantation and to increased numbers of patients on transplant waiting lists. Unfortunately, the altruistic supply of organs has been less than adequate, and severe organ shortage has resulted in many patient deaths. A number of transplant experts have been convinced that providing financial incentives to organ sources as an alternative to altruistic organ donation needs careful reconsideration. In 1988, a compensated and regulated living-unrelated donor renal transplant program was adopted in Iran. As a result, the number of renal transplants performed substantially increased such that in 1999, the renal transplant waiting list was completely eliminated. By the end of 2005, a total of 19,609 renal transplants were performed (3421 from living related, 15,356 from living-unrelated and 823 from deceased donors). In this program, many ethical problems that are associated with paid kidney donation also were prevented. Currently, Iran has no renal transplant waiting lists, and >50 of patients with ESRD in the country are living with a functioning graft. In developed countries, the severe shortage of transplantable kidneys has forced the transplant community to adopt new strategies to expand the kidney donor pool. However, compared with the Iranian model, none of these approaches has the potential to eliminate or even alleviate steadily worsening renal transplant waiting lists

The Incidence and Risk Factors of Delayed Graft Function in 689 Consecutive Living Unrelated Donor Renal Transplantation

Due to the severe shortage of deceased donor kidneys, the number of renal transplantation from living-related and living-unrelated donors has increased worldwide. The incidence and risk factors of delayed graft function after deceased donor renal transplantation have been extensively studied. In this analysis, the incidence and predictors of delayed graft function was investigated in 689 living-unrelated kidney recipients. In 53 recipients, dialysis was needed within the first week after renal transplantation (7.7). The risk factors for delayed graft function upon univariate analysis models were: female gender of kidney donor (P = .027), renal allograft with multiple arteries (P = .005) and previous transplantation (P < .005). Upon multivariate analysis, the only risk factor for development of delayed graft function was retransplantation (P = .001). © 2007 Elsevier Inc. All rights reserved

Effect of Angiotensin II receptor type 1 antibodies on kidney allograft function

Introduction. Non-human leukocyte antigen antibodies are an independent risk factor for acute rejection in kidney transplant recipients. Among them, angiotensin II receptor type 1 (ART1) antibodies can induce various effects, but their clinical importance in kidney transplant recipients has not been properly explained. This study aimed to evaluate the effect of ART1 antibodies on allograft function and hypertension in stable kidney transplant recipients. Materials and Methods. Eighty-one kidney recipients from non- human leukocyte antigen antibodies-matched donors with stable allograft function were examined for estimated glomerular filtration rate (Chronic Kidney Disease-Epidemiology Collaboration formula) and ART1 antibodies (measured using an enzyme-linked immunosorbent assay method). The result was considered positive if the anti-ART1 level was greater than 17 U/mL. Results. The mean age of the participant was 51.1 ± 11.9 years with the mean time from transplantation was 83.5 ± 6.5 months. Fifteen recipients (18.5) had a high ART1 antibodies level. Those with low titers of ART1 antibodies had better allograft function. The mean estimated glomerular filtration rate was 63.0 ± 13.7 mL/min in those with low ART1 antibodies and 42.3 ± 13.9 mL/ min in those with high ART1 antibodies (P < .001). There were no significant correlation between high ART1 antibodies levels and hypertension, cause of end-stage renal disease, age, sex, transplant and dialysis duration, cytomegalovirus infection, antihypertensive medication, or immunosuppressive agents. Conclusions. A high level of ART1 antibodies was a risk factor for allograft function; however this indicator was not correlated with hypertension in our study. © 2018, Iranian Society of Nephrology. All rights reserved

Effect of Angiotensin II receptor type 1 antibodies on kidney allograft function

Introduction. Non-human leukocyte antigen antibodies are an independent risk factor for acute rejection in kidney transplant recipients. Among them, angiotensin II receptor type 1 (ART1) antibodies can induce various effects, but their clinical importance in kidney transplant recipients has not been properly explained. This study aimed to evaluate the effect of ART1 antibodies on allograft function and hypertension in stable kidney transplant recipients. Materials and Methods. Eighty-one kidney recipients from non- human leukocyte antigen antibodies-matched donors with stable allograft function were examined for estimated glomerular filtration rate (Chronic Kidney Disease-Epidemiology Collaboration formula) and ART1 antibodies (measured using an enzyme-linked immunosorbent assay method). The result was considered positive if the anti-ART1 level was greater than 17 U/mL. Results. The mean age of the participant was 51.1 ± 11.9 years with the mean time from transplantation was 83.5 ± 6.5 months. Fifteen recipients (18.5) had a high ART1 antibodies level. Those with low titers of ART1 antibodies had better allograft function. The mean estimated glomerular filtration rate was 63.0 ± 13.7 mL/min in those with low ART1 antibodies and 42.3 ± 13.9 mL/ min in those with high ART1 antibodies (P < .001). There were no significant correlation between high ART1 antibodies levels and hypertension, cause of end-stage renal disease, age, sex, transplant and dialysis duration, cytomegalovirus infection, antihypertensive medication, or immunosuppressive agents. Conclusions. A high level of ART1 antibodies was a risk factor for allograft function; however this indicator was not correlated with hypertension in our study. © 2018, Iranian Society of Nephrology. All rights reserved

Bile cast nephropathy due to cholestatic jaundice after using stanozolol in 2 amateur bodybuilders

Elevated level of bile can cause bile cast nephropathy, which can be seen in patients with severe cholestatic liver disease. Stanozolol is a C17a-alkylation steroid derived from dihydrotestosterone and its major adverse effect is cholestatic jaundice. We report 2 bodybuilders who received stanozolol for 6 weeks and developed icterus. Serum total bilirubin was around 50 mg/dL. Liver biopsy showed intrahepatic cholestasis. In spite of fluid and albumin therapy, serum creatinine increased and the patients experienced oliguria. Urine sediment showed granular cast and normal erythrocyte count. Protein excretion in 24-hour urine was less than 1000 mg in both patients. Hemodialysis was started on and renal biopsy revealed acute tubular epithelial cell damage along with bile pigment (cast) deposition, compatible with bile cast-related nephropathy. Serum bilirubin decreased gradually and urine output increased. Serum creatinine was around 1.5 mg/dL in both of the patients 2 months after discharge. © 2015, Iranian Society of Nephrology. All rights reserved