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We compared the incidence of urological and anastomotic complications for the ureteroureterostomy and Lich–Gregoir techniques in kidney transplant recipients. Between May 2003 and February 2004, 75 kidney transplant recipients from living donors were divided into two similar groups to receive ureteroureterostomy (n = 41, 28 male, 13 female) and Lich–Gregoir techniques (n = 34, 24 male, 10 female) for ureteral reimplantation. Patients with vesicoureteral reflux (VUR) to the native kidneys were excluded from the study. The urological complications included complicated hematuria, ureteral stenosis, symptomatic VUR, recurrent urinary tract infection (UTI). There was no statistical significance between two groups in terms of gender, age, end-stage renal disease etiology, human leucocyte antigen (HLA) mismatch numbers, type and duration of dialysis, and cold ischemia time. The incidence of urologic and anastomotic complications was 12%. Complications in the Lich–Gregoir group included symptomatic VUR in 8.8% and stent migration in 2.9% of cases. Complications observed in the ureteroureterostomy group were ureteral stricture 7.3% and complicated hematuria in 4.9% of cases. However, symptomatic reflux was not observed in the ureteroureterostomy group. UTI frequency was similar in both groups. Ureteroureterostomy can be safely performed as a primary choice in kidney transplant recipients.

Objectives: Tacrolimus (FK506) is a potent immunosuppressive drug used for prevention of rejection following transplantation. Several methods including immunoassays have been used for monitoring tacrolimus levels. The purpose of the present study was to compare the effects of various hematological parameters on whole blood tacrolimus concentrations which were measured with two different analytical methods, namely the microparticle enzyme immunoassay (MEIA II) and enzyme multiplied immunoassay technique (EMIT).

Objective This study was planned to determine the efficacies of single plasma sample methods (SPSMs) in indicating glomerular filtration rate (GFR) by taking two plasma sample method (TPSM) as reference in the determination of the GFR in cases with clinically stable renal transplantation. Methods Ninety-six renal transplantation cases (33 female, 63 male; age interval 18-67, mean age 37.46 ± 11.81 years) progressing stably clinically and as laboratory, with minimum 6 months after transplantation were included in the study. The GFR values of the cases were measured with SPSM and TPSM. Results It is observed that all SPSMs have a strong correlation with TPSM. Highest correlation was observed between Groth&Aasted SPSM and TPSM GFR (intraclass correlation coefficient: 0.965). In the analyses performed by using the Bland-Altman analysis, GFR values calculated by all SPSMs were concordant to the TPSM which is the gold standard method in 95 % confidence interval (average ± 1.96 standard deviation) and were within the clinically acceptable limits. The narrowest concordance interval was obtained between Groth&Aasted Tc-99 m DTPA SPSM and Tc-99 m DTPA TPSM..Besides, we have obtained the minimum bias and precision value by the Groth&Aasted method. Conclusions As a result; we can see that all the SPSMs give reliable results in measuring GFR in cases with renal transplantation; besides, we suggest Groth&Aasted method as the first option.

Bone marrow transplantation (BMT) is the treatment of choice for some malignant diseases, and acquired or congenital non-malignant disorders such as aplastic anemia and immunodeficiency disorders (1). The preparative regimen, development of graft-vs.-host disease (GVHD) and immunosuppression in allogeneic stem cell transplantation, suppress the host's immune system (2). Suppression of the recipient's immune system and reconstitution with the donor's

In this study we investigated the influence of a tacrolimus (TAC) plus mycophenolate mofetil (MMF) immunosuppressive regimen on the acute rejection rate and side effect profile in renal transplant recipients. The study included 80 living-related and 40 cadaveric donor renal transplant recipients (82 men, 38 women) of mean age 35 Ϯ 10 years (range, 16 to 58) who were operated between August 1999 and September 2002. The mean HLA mismatches was 3 Ϯ 1 (range, 0 to 5). All patients received prednisolone, MMF (2 g/d for the first 14 days posttransplant and then 1 g/d) plus TAC (0.2 mg/kg/d). They were followed for the development of rejection attacks and side effects. Diabetes mellitus developed in 13 patients (9 men, 4 women; 10.8%). Initially, patients required insulin therapy but after 6 months, 5 recipients no longer needed insulin therapy and were switched to oral hypoglycermic agents and diet control. Hypertension was diagnosed in 58 patients (48.3%). Neither gender nor donor origin (P ϭ .14; P ϭ .79, respectively) produced a significant difference in diabetes mellitus development.

Noncompliance with regard to diet, medications and routine physician visits is frequently observed among some patient groups. This results in late graft dysfunction and behavior loss. In the present study, we defined compliance as attendance at 80% or more outpatient visits. The study included 63 cadaveric and 158 living-related renal transplant recipients namely, 150 men and 76 women of 8 to 70 years of age (median 38 ± 12) who were operated between 1986 and 2001.Demographic data, number of visits attended per month, cigarette smoking, and alcohol intake were probed with a questionnaire that was delivered to the patients, 8 of whom died; hemophagocytic syndrome (n = 4), cardiovascular disease (n = 2), Kaposi' sarcoma (n = 1), and cerebrovascular bleeding (n = 1). Twenty-three patients had lost their graft.Compliance among men was lower than among women, a result that trended toward statistical significance (P = .087). Compliance was not related to marital status (P = .297), but tended to increase with educational background (P = .059). Graft loss (P = .546) and aging (P = .509) were not related to compliance. There was no relationship between compliance and mortality rate (P = .526). Interestingly, living-related kidney transplant recipients showed lower compliance than cadaveric kidney recipients, a result that was statistically significant (P = .04). Noncompliance was also related to cigarette smoking during the pre- and posttransplant periods (P = .008 and P = .03, respectively), as well as alcohol intake (P = .000).In conclusion, male gender and living-related donation are related to noncompliance, but (in contrast with literature) not young age, graft loss, or mortality. Compliance increases with educational status of the patients. Smoking and alcohol intake are closely related to noncompliance.

Iron deficiency is an important factor in the management of anemia in both dialysis and transplant patients. Serum ferritin and transferrin saturation (TS) may be influenced by the presence of inflammation. Recently, the soluble transferrin receptor (s-TfR) has been considered to be a marker of functional iron stores. In this study, parameters of the iron state were investigated in terms of agreement (assessed by kappa) with the diagnosis of iron deficiency and with inflammation. The study was performed in 38 hemodialysis, 31 continuous ambulatory peritoneal dialysis, and 21 anemic renal transplant patients. CRP and amyloid A protein (AAP) were studied as markers of inflammation. Iron deficiency was defined as ferritin <100 mg/L, TS <20%, or s-TfR >1.76 mg/mL. We observed that s-TfR levels were significantly related to both dialysis duration (r = 0.28 in dialysis and r = 0.60 in transplant patients, both P < .05) and PTH levels (r = 0.23 in dialysis and r = 0.55 in transplant patients, both P < .05). Among the transplant group, ferritin and TS, as well as TS and s-TfR were significantly related (r = 0.84 and r = −0.64, respectively), but not s-TfR and ferritin. Among the dialysis group, ferritin and TS, and also TS and s-TfR, were significantly related (r = 0.35 and r = −0.30, respectively), whereas s-TfR and ferritin were not. In the transplant group, the kappa value for agreement between ferritin and TS in the diagnosis of iron deficiency was 0.76 (P = .006), and 0.33 (P = .04), respectively. Among patients with CRP levels <0.3 mg/L or AAP levels <6.4 mg/L, the relation between parameters of iron state was more robust. The kappa value for agreement between ferritin and s-TfR was 0.49 (P = .006) in the dialysis group and 1 (P = .002) for that between ferritin and TS in the transplant group. Our results suggest that PTH levels may influence s-TfR levels. Discordance between ferritin, TS, and s-TfR as markers of iron deficiency might be explained by the effects of inflammation.

Management of renal transplant patients requires periodic measurement of renal function, which is usually assessed by measuring the glomerular filtration rate (GFR). The most commonly used marker for GFR is serum creatinine, although muscle wasting and tubular secretion may lead to overestimation of the actual GFR. Serum concentrations of the low-molecular-weight proteins, cystatin C and β2-microglobulin (B2M), may afford useful markers to determine a reduced GFR. We investigated whether these molecules provide reliable indicators of renal function in 75 renal transplant patients. Cystatin C and B2M correlated significantly with creatinine (r = .648, P < .05 and r = .578, P < .05, respectively). Inverse serum creatinine was superior to inverse cystatin C and inverse B2M when renal function equations were used (r = .95, P < .05, according to MDRD; r = .87, P < .05, according to Cockroft–Gault). Receiver operating characteristic (ROC) analysis was performed to quantitate the accuracy of the different markers to detect reduced GFR using a cutoff value of 70 mL/min. No significant difference between the areas under the ROC curves comparing cystatin C and B2M was observed; however, serum creatinine demonstrated a significantly greater value than cystatin C (.981 vs .724, P = .001). We conclude that serum creatinine is a more efficacious marker than serum cystatin C to assess renal function.

Bladder cancer is the most prevalent malignancy of the urinary tract. About 90% of bladder cancers are urothelial carcinomas. Seventy percent of cases newly diagnosed are superficial diseases; roughly 30% of newly diagnosed cases are muscle-invasive metastatic diseases. Bladder urothelial carcinoma primarily metastasizes into regional lymph nodes and then into liver, lung, mediastinum, bone, and adrenal gland. In our case, non-muscle-invasive bladder cancer metastasized into the bone, mediastinum, iliac lymph node, and adrenal and thyroid glands. This is the first reported case in the current literature in which urothelial carcinoma metastasized into the thyroid gland.