Publications by authors named "Jalal Azmandian"

22 Publications

  • Page 1 of 1

Inflammatory and fibroblastic effects of azithromycin on cyclosporine-induced gingival overgrowth in renal transplanted patients with and without scaling: A randomized clinical trial.

J Oral Biosci 2020 06 18;62(2):175-181. Epub 2020 May 18.

Department of Social Medicine, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.

Background: This study aimed to evaluate the effect of azithromycin (AZM) on the inflammatory and fibroblastic part of cyclosporine A (CsA)-induced gingival overgrowth (GO) in renal transplanted patients.

Methods: In this randomized clinical trial, subjects with GO receiving CsA were randomly divided into two groups: those receiving 5-day AZM only (n = 12; group 1) and those receiving scaling and prescribed AZM after 2 months (n = 12; group 2). Both groups were evaluated for several indices (gingival hyperplastic index, plaque and bleeding index, clinical crown length) at the first visit and the 4th and 8th week in group 1, and at the first visit and the 4th, 8th, 12th, and 16th week in group 2.

Results: The sample included 24 individuals. The mean (SD) age of participants was 30.81 (11.13) and 34.80 (9.33) years in group 1 and 2, respectively. Based on ANCOVA, the changes in the hyperplastic index (GHI) and apico-coronal dimension (ACD) of it were statistically significant in professional scaling accompanied by AZM group (P = 0.012 and 0.031, respectively). However, no significant change was observed in mean indices after prescribing AZM in 5-day AZM regimen group (P = 0.664 and 0.882, respectively). According to one-way ANOVA, we found a statistically significant correlation in GHI, ACD, bleeding index (BI), and plaque index (PI) accounting for P = 0.012, 0.003, 0.002, and <0.001, respectively.

Conclusions: Findings suggest that AZM cannot influence the fibroblastic part of GO in presence of gum inflammation while the therapy can improve GO after resolving it with scaling.
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http://dx.doi.org/10.1016/j.job.2020.04.001DOI Listing
June 2020

Comparing Therapeutic Efficacy and Safety of Epoetin Beta and Epoetin Alfa in the Treatment of Anemia in End-Stage Renal Disease Hemodialysis Patients.

Am J Nephrol 2018 25;48(4):251-259. Epub 2018 Sep 25.

Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Background: Anemia is one of the most prevalent complications in patients with chronic kidney disease, which is believed to be caused by the insufficient synthesis of erythropoietin by the kidney. This phase III study aimed to compare the efficacy and safety of CinnaPoietin® (epoetin beta, CinnaGen) with Eprex® (epoetin alfa, Janssen Cilag) in the treatment of anemia in ESRD hemodialysis patients.

Methods: In this randomized, active-controlled, double-blind, parallel, and non-inferiority trial, patients were randomized to receive either CinnaPoietin® or Eprex® for a 26-week period. The primary endpoints of this study were to assess the mean hemoglobin (Hb) change during the last 4 weeks of treatment from baseline along with the evaluation of the mean weekly epoetin dosage per kilogram of body weight that was necessary to maintain the Hb level within 10-12 g/dL during the last 4 weeks of treatment. As the secondary objective, safety was assessed along with other efficacy endpoints.

Results: A total of 156 patients were included in this clinical trial. There was no statistically significant difference between treatment groups regarding the mean Hb change (p = 0.21). In addition, the mean weekly epoetin dosage per kg of body weight for maintaining the Hb level within 10-12 g/dL showed no statistically significant difference between treatment arms (p = 0.63). Moreover, both products had comparable safety profiles. However, the incidence of Hb levels above 13 g/dL was significantly lower in the CinnaPoietin® group.

Conclusion: CinnaPoietin® was proved to be non-inferior to Eprex® in the treatment of anemia in ESRD hemodialysis patients. The trial was registered in Clinicaltrials.gov (NCT03408639).
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http://dx.doi.org/10.1159/000493097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6381861PMC
January 2020

Role of Donors and Recipients' Glutathione S-Transferase Gene Polymorphisms in Association of Oxidative Stress With Delayed Graft Function in Kidney Allograft Recipients.

Iran J Kidney Dis 2017 May;11(3):241-248

Gastroenterology and Hepatology Research Centre, Institute of Basic and Clinical Physiology Sciences; Department of Pharmacology and Toxicology, School of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran.

Introduction: Oxidative stress contributes to delayed graft function (DGF). Glutathione S-transferases (GSTs) are polymorphic genes which produce enzymes with protective effect against oxidative stress. This study aimed to investigate the association between donors' and recipients' GSTM1 and GSTT1 polymorphisms and DGF, creatinine clearance, and oxidative stress parameters in kidney allograft recipients.

Materials And Methods: One hundred and eighty-two donor-recipient pairs were studied. Lipid peroxidation and total antioxidant capacity were measured in the recipients' plasma as the parameters of oxidative stress. Delayed graft function was determined based on at least 10% increase, no change, or less than 10% decrease in the serum creatinine level in 3 consecutive days during the 1st week after transplantation.

Results: Lipid peroxidation was significantly greater in the recipients with DGF (P < .001). The frequency of GSTM1 null was significantly higher in the patients with DGF (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.17 to 0.86; P = .02). There was also a significant association between the donors' GSTM1 polymorphism and DGF (OR, 0.31; 95% CI, 0.14 to 0.68; P = .003). A significant association was detected between combination of recipients and donors' GSTM1 polymorphism and DGF (OR, 0.20; 95% CI, 0.07 to 0.64, P = .006). The recipients' GSTM1 polymorphism, alone and in combination with donors' GSTM1 and GSTT1, significantly affected the creatinine clearance on discharge day.

Conclusions: These results suggest that the donors and recipients' GSTM1 polymorphism may be a major risk factor for oxidative stress and poor kidney allograft transplantation outcomes.
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May 2017

Association of Handgrip Strength With Malnutrition-Inflammation Score as an Assessment of Nutritional Status in Hemodialysis Patients.

Iran J Kidney Dis 2016 Jan;10(1):30-5

Department of Occupational Health, Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran.

Introduction:   Protein-energy wasting (PEW) is very common in patients with chronic kidney disease and those undergoing maintenance dialysis. Reduced handgrip strength is associated with PEW and considered as a reliable nutritional parameter that reflects loss of muscle mass. This study aimed to evaluate the handgrip strength and its relationship with the Malnutrition-Inflammation Score (MIS) among Iranian dialysis patients.

Materials And Methods: The study population consisted of 83 randomly selected hemodialysis patients from the dialysis centers in Kerman, Iran. Handgrip strength was measured using a dynamometer according to the recommendations of the American Society of Hand Therapists. All the patients were interviewed and the MIS of the patients were recorded.  Results. The PEW was prevalent in Kerman hemodialysis patients, with 83% and 17% having mild and moderate PEW based on MIS, respectively. Handgrip strength was significantly associated with age, sex, height, weight, and diabetes mellitus. After adjustment for age, handgrip strength was significantly associated with nutritional assessment markers on the basis of the MIS.

Conclusions: Handgrip strength can be incorporated as a reliable tool for assessing nutrition status in clinical practice. However, further research is needed to determine the reference values and cutoff points both in healthy people and in hemodialysis patients to classify muscle wasting.
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January 2016

Study of the association between the donors and recipients angiotensin-converting enzyme insertion/deletion gene polymorphism and the acute renal allograft rejection.

J Nephropathol 2015 Jul 1;4(3):62-8. Epub 2015 Jul 1.

Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran.

Background: Angiotensin converting enzyme (ACE) is involved in various pathophysiological conditions including renal function. ACE levels are under genetic control.

Objectives: This study was designed to investigate the association between the donors and recipients ACE-I/D gene polymorphism and risk of acute rejection outcome in renal allograft recipients.

Patients And Methods: ACE-I/D polymorphism was determined in 200 donor-recipient pairs who had been referred to Afzalipour hospital in Kerman. ACE-I/D polymorphism was detected using polymerase chain reaction (PCR). Acute rejection (AR) during at least six months post-transplantation was defined as a 20% increase in creatinine level from the postoperative baseline in the absence of other causes of graft dysfunction which responded to antirejection therapy.

Results: The observed allele frequencies were II 9.8%, ID 35.6% and DD 44.4% in donors and II 9.8%, ID 35.1% and DD 52.7% in recipients. There were no significant association between ACE genotypes and AR episodes (ORID=0.96 [0.18-5.00] and ORDD: 1.24 [0.25-6.07] for the donors) and (ORID: 0.29 [0.06-1.45] and ORDD: 0.75 [0.19-2.90] for the recipients).

Conclusions: It seems that donor and recipient ACE-I/D genotype might not be a risk factor for acute renal allograft rejection. However, due to conflicting results from this and other studies, multicenter collaborative studies with more participants and concomitant evaluation of ACE polymorphism with other polymorphisms in renin-angiotensin system (RAS) are suggested to determine whether ACE genotypes are significant predictors of renal allograft rejection.
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http://dx.doi.org/10.12860/jnp.2015.13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544556PMC
July 2015

One-Year Multicenter Double-Blind Randomized Clinical Trial on the Efficacy and Safety of Generic Cyclosporine (Iminoral) in De Novo Kidney Transplant Recipients.

Exp Clin Transplant 2015 Jun;13(3):233-8

Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: Iminoral is the generic microemulsion of cyclosporine. We performed a randomized double-blind multicenter trial to evaluate its efficacy and safety compared with the innovator medication Neoral for preventing acute rejection episodes in adult patients during the first year after renal transplant.

Materials And Methods: We used 221 de novo renal transplant recipients from 6 transplant centers in Iran enrolled between April 2008, and January 2010. They were randomized to receive either Iminoral or Neoral as the calcineurin inhibitor component of the immunosuppressive regimen in addition to mycophenolate mofetil and oral corticosteroids. They were followed-up for 1 year. The primary endpoint was the rate of acute allograft rejection. Secondary endpoints consisted of 1-year graft survival rates, daily dosages of cyclosporine, trough and C2 cyclosporine blood level, serum creatinine levels, patient death rates, discontinuing the study drug, tolerability, and adverse events.

Results: The risk of acute rejection episode during the first month after transplant was 9% for Iminoral and 10% for Neoral; these declined to 4% and 2% during next 11 months. One-year graft survival rate was 0.86 for both groups. Renal function stabilized during the first month. Declination of the creatinine levels was similar between the 2 groups and reached a stable value of 114.9 μmol/L five months after the transplant. The frequency of clinical complications was similar between the groups.

Conclusions: Iminoral is safe and effective when used in de novo kidney transplant patients as an immunosuppressive medication.
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June 2015

Utility of cystatin C-derived equations for evaluation of residual renal function in peritoneal dialysis patients.

Ren Fail 2015 Feb 30;37(1):50-6. Epub 2014 Sep 30.

Department of Nephrology, Imam Khomeni Hospital, Nephrology Research Center, Tehran University of Medical Sciences , Tehran , Iran .

Background: Residual renal function (RRF) plays a key role in the follow-up of the patients undergoing chronic ambulatory peritoneal dialysis (CAPD). Available methods for measurement of RRF are cumbersome and rarely used, and alternatively, cystatin C-derived equations have been proposed.

Methods: Seventy-six adult CAPD patients were recruited. RRF was measured using the 24-hour urea-creatinine clearance method. Serum concentrations of cystatin C were determined. Glomerular filtration rate (GFR) was estimated using the two published equations of Hoek and colleagues, and Yang and colleagues. GFR was also estimated from serum creatinine using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula.

Results: Patients (age range 18-86 years) were on CAPD for a median of 24 months. Average serum concentrations of cystatin C was 5 ± 1.2 mg/L. Average RRF was 0.7 ± 1.6 mL/min/1.73 m(2). All three methods significantly overestimated the measured RRF values (Hoek: 4 ± 1.4; Yang: 4.5 ± 1.5; 7.4 ± 4 mL/min/1.73 m(2)). Based on Bland-Altman plots, all three methods yielded poor agreement with RRF (p < 0.001 for all tests), with Hoek's equation providing the narrowest limits of agreement [mean difference (limits of agreement): 3.4 (2.9-3.9)] and CKD-EPI the widest [6.7 (5.9-7.5)]. Although the Hoek's method outperformed CKD-EPI, the within 30 and 50% accuracy rates were unsatisfactory (10.5 and19.7 %, respectively).

Conclusions: Cystatin C-derived equations outperform the CKD-EPI formula in approximating the RRF values. Yet, these methods still significantly overestimate the measured RRF and their routine application in clinical practice is not advised.
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http://dx.doi.org/10.3109/0886022X.2014.964146DOI Listing
February 2015

Investigation of association between donors' and recipients' NADPH oxidase p22(phox) C242T polymorphism and acute rejection, delayed graft function and blood pressure in renal allograft recipients.

Transpl Immunol 2015 Jan 28;32(1):46-50. Epub 2014 Aug 28.

Physiology Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran; Department of Nephrology, Urology and Renal Transplantation, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran. Electronic address:

Background: Production of reactive oxygen species (ROS) and thereby induction of oxidative stress seem to be one of the major mediators of inflammatory adverse outcomes after renal transplantation. p22(phox) is a polymorphic subunit of NAD(P)H-oxidase that is critical for activation and stabilization of the enzyme. This enzyme is involved in the production of superoxide that triggers inflammatory injuries to the kidney. So in this study, the association between donors and recipients' C242T polymorphism of p22(phox) and acute rejection (AR), delayed graft function (DGF), creatinine clearance (CrCl), and blood pressure in renal-allograft recipients was studied.

Methods: One hundred ninety six donor-recipient pairs were studied. The C242T polymorphism of p22(phox) was determined using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). According to p22 genotype, the subjects were divided in wild-type (CC) and T allele carriers (CT+TT). Transplantation outcomes were determined using acute rejection and delayed graft function criteria. The mean arterial pressure was also measured monthly after transplantation.

Results: There was a significant association between the recipients' p22(phox) polymorphism and DGF occurrence (OR=2.5, CI: 1.2-4.9, p=0.0009). No significant association was detected between donors' p22(phox) polymorphism and AR and DGF events. CrCl during the six months follow-up after transplantation was lower in the patients who received allograft from donors carrying 242T allele (B=-12.8, CI: -22.9-12.8 (-22.9 to -2.6)). Changes in the blood pressure were not different among the patients having different genotypes of p22(phox).

Conclusion: These results suggest that the recipients' p22(phox) C242T polymorphism may be a major risk factor for DGF in renal transplantation. Moreover, the donors' 242T allele seems to affect the rate of CrCl in the renal allograft recipients.
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http://dx.doi.org/10.1016/j.trim.2014.08.004DOI Listing
January 2015

Short-term and long-term survival of kidney allograft: cure model analysis.

Iran J Kidney Dis 2014 May;8(3):225-30

Departments of Nephrology, Urology and Renal Transplantation, Kerman University of Medical Sciences, Kerman, Iran.

Introduction: Kidney allograft failure is a major concern in kidney transplant recipients. We separately assessed risk factors for long-term and short-term survival of death-censored kidney allograft.

Materials And Methods: This study included 397 kidney recipients who underwent surgery in Afzalipour Hospital, Kerman, Iran, from 2004 to 2010. The Cox mixture cure model was used to fit independent variables for prediction of graft survival in short-term and long-term.

Results: Allograft failure occurred in 43 kidney transplant recipients (10.8%). Among the long-term survivors, hypertension (odds ratio, 3.35; 95% confidence interval [CI], 1.6 to 6.7), a serum creatinine level greater than 1.6 at hospital discharge (odds ratio, 15.1; 95% CI, 7.2 to 31.9), and donor age (odds ratio, 1.14; 95% CI, 1.09 to 1.18) were significant predictors of allograft failure. Overweight, obesity, and male donor were associated with better survival. In short-term survivors, a high body mass index (hazard ratio, 3.59; 95% CI, 1.2 to 10.7) and longer duration of pretransplant dialysis (hazard ratio, 2.4; 95% CI, 1.07 to 5.7) were associated with graft failure, while the risk of allograft failure decreased in recipients who received kidney transplants from living donors versus deceased donors (hazard ratio, 0.3; 95% CI: 0.11 to 0.78) and with each 1-year increase in donor age (hazard ratio, 0.91; 95% CI, 0.86 to 0.96).

Conclusions: Many efforts have been made to improve short-term survival of kidney allograft. The cure analysis extends the knowledge by showing that control of which variables can improve both long-term and short-term survival rates.
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May 2014

Patient Survival in Renal Allograft Failure: A Time-dependent Analysis.

Nephrourol Mon 2014 Jan 30;6(1):e13589. Epub 2013 Oct 30.

Physiology Research Center, Departments of Nephrology, Urology and Renal Transplantation, Kerman University of Medical Sciences, Kerman, IR Iran.

Background: To improve patient survival after a renal transplant, it is important to detect which variables affect it.

Objectives: This study aimed to assess the effect of renal allograft failure on patient survival.

Patients And Methods: This retrospective cohort study included 405 renal transplant patients from Kerman University of Medical Sciences hospital, Kerman, Iran from 2004 to 2010. Kaplan-Meier method was used to estimate survival rates of patients, and time-dependent Cox regression was used to examine the effect of allograft failure on patient survival.

Results: During 4.06 years (median) of follow-up 28 (6.9%) patients died and 20 (71.4%) of dead patients had allograft failure. Survival rate of patients with allograft failure at 1-, 3-, 5-, and 7-year were 0.98, 0.8, 0.53, and 0.53, respectively; in patients with allograft function these values were 0.99, 0.98, 0.97, and 0.96, respectively. The unadjusted death rate was 0.5 per 100 patient years for the maintained allograft function, which increased to 9 per 100 patient years for patients following allograft failure. In fully adjusted model the risk of death increased in patients with allograft failure (HR = 2.09; 95% CI: 1.56-2.81), pretransplant diabetes (HR = 2.81; 95% CI: 1.2-6.7), patients with BMI ≥ 25 (vs. 18.5 ≤ BMI < 25) (HR = 3.56; 95% CI: 1.09-11.6). With an increase in recipient age this risk increased (HR = 1.04 per year increase; 95% CI: 1.01-6.7). Receiving a living kidney transplant decreased this risk (HR = 0.52; 95% CI: 0.39-0.69).

Conclusions: An increase in recipient age and BMI, affliction with diabetes, allograft failure, and receiving deceased kidney transplant increased the risk of death.
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http://dx.doi.org/10.5812/numonthly.13589DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968962PMC
January 2014

One-Year Multicenter Double-Blind Randomized Clinical Trial on the Efficacy and Safety of Generic Cyclosporine (Iminoral) in De Novo Kidney Transplant Recipients.

Exp Clin Transplant 2013 Nov 8. Epub 2013 Nov 8.

From the Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: Iminoral is the generic microemulsion of cyclosporine. We performed a randomized double-blind multicenter trial to evaluate its efficacy and safety compared with the innovator medication Neoral for preventing acute rejection episodes in adult patients during the first year after renal transplant.

Materials And Methods: We used 221 de novo renal transplant recipients from 6 transplant centers in Iran enrolled between April 2008, and January 2010. They were randomized to receive either Iminoral or Neoral as the calcineurin inhibitor component of the immunosuppressive regimen in addition to mycophenolate mofetil and oral corticosteroids. They were followed-up for 1 year. The primary endpoint was the rate of acute allograft rejection. Secondary endpoints consisted of 1-year graft survival rates, daily dosages of cyclosporine, trough and C2 cyclosporine blood level, serum creatinine levels, patient death rates, discontinuing the study drug, tolerability, and adverse events.

Results: The risk of acute rejection episode during the first month after transplant was 9% for Iminoral and 10% for Neoral; these declined to 4% and 2% during next 11 months. One-year graft survival rate was 0.86 for both groups. Renal function stabilized during the first month. Declination of the creatinine levels was similar between the 2 groups and reached a stable value of 114.9 μmol/L five months after the transplant. The frequency of clinical complications was similar between the groups.

Conclusions: Iminoral is safe and effective when used in de novo kidney transplant patients as an immunosuppressive medication.

Key Words: Graft rejection, Iran, Calcineurin inhibitors.
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http://dx.doi.org/10.6002/ect.2013.0139DOI Listing
November 2013

Seventeen years' experience of peritoneal dialysis in Iran: first official report of the Iranian peritoneal dialysis registry.

Perit Dial Int 2014 Sep-Oct;34(6):636-42. Epub 2013 Jun 3.

Division of Nephrology, Shariati Hospital, and Nephrology Research Center, Tehran University of Medical Sciences, Tehran; Division of Nephrology, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran; Division of Nephrology, Sadoughi Hospital, Yazd University of Medical Sciences, Yazd; Division of Nephrology, Ali-ebn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan; Division of Nephrology, Imam Khomeini Hospital, Urmiah University of Medical Sciences, Urmiah; Division of Nephrology, Imam Hospital, Tabriz University of Medical Sciences, Tabriz; Division of Nephrology, Shafa Hospital, Kerman University of Medical Sciences, Kerman; Pegahsoft, Khorasan Science and Technology Park, Mashad; Division of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran; and Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: To facilitate planning, national renal registries provide reliable and up-to-date information on numbers of patients with end-stage renal disease (ESRD), developing trends, treatment modalities, and outcomes. To that end, the present publication represents the first official report from Iranian Peritoneal Dialysis Registry.

Methods: The prevalence, demographics, and clinical characteristics of patients on peritoneal dialysis (PD) were collected from all PD centers throughout the country.

Results: By the end of 2009, the prevalence of ESRD was 507 per million population in Iran. The most common renal replacement modality was hemodialysis (51.2%), followed by kidney transplantation (44.7%), and then PD (4.1%). The mean age of PD patients was 46 years, and the most common causes of ESRD were diabetes (33.5%), hypertension (24.4%), and glomerulonephritis (8.2%). Overall patient mortality was 25%, with cardiac events (46%), cerebral stroke (10%), and infection (8%) being the main causes of death. The 1-, 3-, and 5-year survivals were 89%, 64%, and 49% respectively. The most common cause of dropout was peritonitis (17.6%). Staphylococcus (coagulase-negative and S. aureus) was the most prevalent causative organism in peritonitis episodes; however, in more than 50% of episodes, a sterile culture was reported. Mean baseline serum hemoglobin and albumin were 10.7 g/dL and 3.6 g/dL respectively.

Conclusions: Our registry results, representing the second largest report of PD in the Middle East, is almost comparable to available regional data. We hope that, in future, we can improve our shortcomings and lessen the gap with developed countries.
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http://dx.doi.org/10.3747/pdi.2012.00054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164408PMC
June 2015

Combination of a low dose of daclizumab and standard regimen for prevention of rejection in men and women receiving a kidney transplant.

Iran J Kidney Dis 2013 Mar;7(2):142-6

Physiology Research Center and Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.

Introduction: This study aimed to investigate the effectiveness of low-dose daclizumab for prevention of acute kidney allograft rejection and to evaluate differences between men and women receiving living donor transplants.

Materials And Methods: This randomized controlled trial was performed on 120 living donor kidney transplant recipients. Participants in the case group received a low dose of daclizumab (1 mg/kg) before and 14 days after transplantation in addition to their standard immunosuppressant regimen. Participants in the control group received the standard treatment protocol only. Acute rejection episodes and graft survival were compared between the two groups. Additionally, graft survival of women and men was compared separately between the two groups.

Results: Acute rejection was significantly less frequent in the daclizumab group than in the controls (6.7% versus 18.3%; P = .048). The 6-month survival rates were 95% (95% CI, 92% to 98%) in the daclizumab group and 85% (95% CI, 81% to 89%) in the control group (P = .03). The 6-month graft survival rates of the women were 97% (95% CI, 95% to 99%) in the daclizumab group and 74% (95% CI, 65% to 83%) in the control group (P = .02). However, the difference in graft survival rates was not significant among the men.

Conclusions: The use of induction therapy with two doses of daclizumab reduces the incidence of acute rejection and improves graft survival of living donor kidney transplant recipients. This study shows that these effects are prominent among the female recipients.
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March 2013

Effect of donor tumor necrosis factor-alpha and interleukin-10 genotypes on delayed graft function and acute rejection in kidney transplantation.

Iran J Kidney Dis 2013 Mar;7(2):135-41

Physiology Research Center; Department of Nephrology and Renal Transplantation, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran.

Introduction: This study evaluated the influence of interleukin-10 (IL10) gene -1082G>A and tumor necrosis factor-alpha (TNF) gene -308G>A polymorphisms in the donor and recipients on the acute rejection (AR) episodes and delayed graft function (DGF) in kidney transplant recipients.

Materials And Methods: The IL10 -1082G>A and TNF -308G>A polymorphisms were determined in 100 kidney allograft recipients and their donors using the polymerase chain reaction-amplification refractory mutation system polymerase chain reaction-restriction fragment length polymorphism methods. Transplantation outcomes were determined in terms of AR and DGF criteria.

Results: The A allele of the TNF polymorphism (high producer) in the donors was associated with DGF in the recipients (odd ratio, 3.1; 95% confidence interval, 1.2 to 8.1). There was also a significant association between the combination of donor's IL10-TNF genotypes and DGF (odd ratio, 4.8; 95% confidence interval, 1.4 to 17.1); the frequency of a combination of IL10 AA or GA and TNF AA or GA was higher in the recipients with DGF. No association was found between the donors and recipients' IL10 -1082G>A and TNF -308G>A polymorphisms and AR. No association was detected between recipients and donors' IL10 polymorphisms or recipients' TNF polymorphisms and DGF.

Conclusions: This study showed that donors with high TNF production may have increased risk of DGF in their recipients. Routine screening of these gene polymorphisms may have a clinical role in identifying patients at risk of DGF.
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March 2013

Incidence of malignancy after living kidney transplantation: a multicenter study from iran.

J Cancer 2012 5;3:246-56. Epub 2012 Jun 5.

1. Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.

Malignancy is a common complication after renal transplantation. However, limited data are available on post-transplant malignancy in living kidney transplantation. Therefore, we made a plan to evaluate the incidence and types of malignancies, association with the main risk factors and patient survival in a large population of living kidney transplantation. We conducted a large retrospective multicenter study on 12525 renal recipients, accounting for up to 59% of all kidney transplantation in Iran during 22 years follow up period. All information was collected from observation of individual notes or computerized records for transplant patients. Two hundred and sixty-six biopsy-proven malignancies were collected from 16 Transplant Centers in Iran; 26 different type of malignancy categorized in 5 groups were detected. The mean age of patients was 46.2±12.9 years, mean age at tumor diagnosis was 50.8±13.2 years and average time between transplantation and detection of malignancy was 50.0±48.4 months. Overall tumor incidence in recipients was 2%. Kaposis' sarcoma was the most common type of tumor. The overall mean survival time was 117.1 months (95% CI: 104.9-129.3). In multivariate analysis, the only independent risk factor associated with mortality was type of malignancy. This study revealed the lowest malignancy incidence in living unrelated kidney transplantation.
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http://dx.doi.org/10.7150/jca.3042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376775PMC
October 2012

Chemokine receptor 2-V64I and chemokine receptor 5-Delta32 polymorphisms and clinical risk factors of delayed graft function and acute rejection in kidney transplantation.

Iran J Kidney Dis 2012 Jan;6(1):56-62

Physiology Research Center and Department of Pharmacology and Toxicology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran.

Introduction: Chemokines and chemokine receptors have a pivotal role in immunity and inflammation. We aimed to evaluate their role in kidney transplant rejection.

Materials And Methods: The association of chemokine (C-C motif) receptor 2 (CCR2)-V64I and CCR5-Delta32 gene polymorphisms with acute rejection (AR) and delayed graft function (DGF) were examined in 100 donor-recipient pairs. The CCR2-V64I and CCR5-Delta32 alleles were determined using polymerase chain reaction and polymerase chain reaction-restriction fragment length polymorphism, respectively.

Results: No associations were found between donors or recipients' CCR2-V64I and CCR5-Delta32 gene polymorphisms and AR or DGF. Of the characteristics of the donors, recipients, and transplantation, glomerulonephritis as a cause of kidney failure in the recipients was weakly associated with AR (relative risk, 6.1; 95% confidence interval, 0.8 to 46.0; P = .07). Transplantation of kidney from females to males was weakly associated with DGF (relative risk, 5.5; 95% confidence interval, 0.9 to 33.0; P = .06). There was a significant association between AR, but not DGF, and graft loss in the patients (relative risk, 28.6; 95% confidence interval, 1.7 to 487.0; P = .03).

Conclusions: Our study failed to suggest CCR2-V64I or CCR5-Delta32 gene polymorphisms as risk factors for AR and DGF in kidney transplantation. Sex-matching between donors and recipients should be considered for living donor kidney transplantation.
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January 2012

Epidemiology of culture-negative peritonitis in Iranian patients on continuous ambulatory peritoneal dialysis.

Iran J Kidney Dis 2011 Sep;5(5):332-7

Division of Nephrology, Department of Medicine, Hasheminejad Clinical Research Development Center, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Culture-negative peritonitis is a major challenge in the treatment of peritonitis in continuous ambulatory peritoneal dialysis (CAPD). This study aimed to evaluate the culture-negative peritonitis in patients from the Iranian CAPD Registry.

Materials And Methods: Data of 1472 patients from 26 CAPD centers were analysed. Peritonitis was defined as any clinical suspicion together with peritoneal leukocyte count of 100/mL and more.

Results: The patients had been on PD for a mean of 500 ± 402 days. There were a total of 660 episodes of peritonitis observed among 299 patients (peritonitis rate of 1 episode in 34.1 patient-months). Excluding patients with both negative and positive culture results, there were 391 episodes of peritonitis in 220 patients (174 culture-positive episodes in 97 patients and 217 culture-negative episodes in 123). The 1- to 4-year patient survival rates were 85%, 75%, 69%, and 59% for the patients with culture-positive peritonitis, and 92%, 78%, 73% and 63% for the patients with culture-negative peritonitis, respectively (P = .34). The technique survival rates were 90%, 57%, 42%, and 27% and 95%, 85%, 74%, and 40%, respectively (P = .001). On follow-up, there were higher rates of active PD patients, lower rates of PD dropouts, and higher rates of kidney transplantation in patients with culture-negative peritonitis compared to those with culture-positive peritonitis.

Conclusions: In our patients, the prevalence of culture-negative peritonitis was high (55.9%). Patient survival with culture-negative peritonitis was comparable to those with culture-positive peritonitis and technique survival was higher among those with culture-negative peritonitis.
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September 2011

Skin cancer after renal transplantation: Results of a multicenter study in Iran.

Ann Transplant 2010 Jul-Sep;15(3):44-50

Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.

Background: Incidence and risk factors for skin tumors following renal transplantation can vary geographically; therefore, a retrospective study was performed to determine the incidence of and potential risk factors for skin cancer at 14 Transplant Centers in Iran between 1984 and 2008.

Material/methods: We enrolled 11,255 kidney transplant recipients who were examined for all skin tumors. All skin cancers were established by histological examination. The data collection included the patient's age and sex, immunosuppressive regimen before and after diagnosis of tumor, rejection episodes, post-transplant latency period, other concurrent neoplastic problems, renal allograft function and outcome.

Results: One hundred and twenty-eight (1.14%) renal recipients had skin tumor, representing half of all post-transplant malignancies (128 out of 245 cases). Kaposi's sarcoma was the most common post-transplant cancer compared with other skin tumors. Male recipients had more tumors than did females (P=0.04); the male-to-female ratio in the affected patients was 2.5:1. The age at transplantation of patients with skin tumor was higher compared to RTRs without skin tumor (47±11 vs. 38±15 years, P=0.000), and individuals older than 45 years were at higher risk (odds ratio=3.8, 95%CI 2.6-5.5) of skin cancers. Patients consuming azathioprine were at risk more of skin cancer compared with those were on MMF (odds ratio =2.9, 95%, CI 2.0-4.2). The overall mortality was low (7.8%) in cases with skin cancer.

Conclusions: This study showed that male sex, increased age, prolonged immunosuppression and azathioprine increased the risk of skin tumors after renal transplantation.
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March 2011

Posttransplant lymphoproliferative disorders in kidney transplant recipients: an Iranian multicenter experience.

Iran J Kidney Dis 2008 Oct;2(4):227-33

Nephrology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.

Introduction: Limited data with adequate sample size exist on the development of posttransplant lymphoproliferative disorder (PTLD) in living donor kidney recipients. We conducted a retrospective cohort study on the data of 10 transplant centers to identify the incidence of PTLD in Iran.

Materials And Methods: Data of 9917 kidney transplant recipients who received their kidneys between 1984 and 2008 were reviewed. Fifty-one recipients (0.5%) who developed PTLD were evaluated with a median follow-up of 47.5 months (range, 1 to 211) months.

Results: Patients with PTLD represented 24% of all posttransplant malignancies (51 out of 211 cases). There was no relationship between PTLD and sex (P = .20). There were no statistically significance differences considering the age at transplantation between patients with and without PTLD. The late-onset PTLD (70.6%) occurred more frequently compared to the early form. There was no signification relationship between early-onset and late-onset groups in terms of clinical course and outcome. In patients who received azathioprine, PTLD was more frequent when compared to those who received mycophenolate mofetil (P < .001). The lymph nodes were the predominantly involved site (35.3%), followed by the gastrointestinal tract, brain, kidney allograft, lung, ovary, vertebrae, and palatine. Age at diagnosis and the time from transplantation to diagnosis were comparable for various involvement sites of PTLDs. The overall mortality in this series of patients was 51.0%.

Conclusions: Posttransplant lymphoproliferative disorder is a rare but devastating complication and long-term prognosis can be improved with early recognition and appropriate therapy.
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October 2008

Kaposi's sarcoma following living donor kidney transplantation: review of 7,939 recipients.

Int Urol Nephrol 2009 14;41(3):679-85. Epub 2008 Nov 14.

Nephrology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.

Introduction: Kaposi's sarcoma (KS) is one of the most common tumors to occur in kidney recipients, especially in the Middle East countries. Limited data with adequate sample size exist about the development of KS in living kidney recipients.

Methods: Therefore, we made a plan for a multicenter study, accounting for up to 36% (n = 7,939) of all kidney transplantation in Iran, to determine the incidence of KS after kidney transplantation between 1984 and 2007.

Results: Fifty-five (0.69%) recipients who developed KS after kidney transplantation were retrospectively evaluated with a median follow-up of 24 (1-180) months. KS occurred more often in older age when compared to patients without KS (49 +/- 12 vs. 38 +/- 15 years, P = 0.000). KS was frequently found during the first 2 years after transplantation (72.7%). Skin involvement was universal. Furthermore, overall mortality rate was 18%, and it was higher in patients with visceral involvement compared to those with mucocutaneous lesions (P = 0.01). However, KS had no adverse affect on patient and graft survival rates compared to those without KS. Forty-four patients with limited mucocutaneous disease and four with visceral disease responded to withdrawal or reduction of immunosuppression with or without other treatment modalities. Renal function was preserved when immunosuppression was reduced instead of withdrawn in patients with and without visceral involvement (P = 0.001 and 0.008, respectively).

Conclusion: The high incidence of KS in this large population studied, as compared to that reported in other transplant patient groups, suggests that genetic predisposition may play a pathogenetic role.
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http://dx.doi.org/10.1007/s11255-008-9483-zDOI Listing
August 2009

Posttransplant malignancies and their relationship with human leukocyte antigens in kidney allograft recipients.

Iran J Kidney Dis 2007 Oct;1(2):98-101

Department of Nephrology, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran.

Introduction: Kidney transplant recipients are at increased risk of cancers, most frequently skin cancers, and in some regions, Kaposi sarcoma and non-Hodgkin lymphoma. We sought to investigate the associate of the most frequent malignancies among our patients with human leukocyte antigens (HLAs).

Materials And Methods: We performed a retrospective study on 44 kidney allograft recipients who had posttransplant malignancy and 44 kidney allograft recipients without malignant lesions (control group). All of the patients had been treated by immunosuppressive regimens including cyclosporine plus prednisolone or cyclosporine, prednisolone, and mycophenolate mofetil. Data on HLA typing were achieved from their transplant records.

Results: There were 15 patients (34.1%) with Kaposi sarcoma; 13 (29.6%) with non-Hodgkin lymphoma, 6 (13.6%) with skin cancer, 2 (4.5%) with ovary cyst adenocarcinoma, and 8 (18.2%) with other tumors. The mean interval from transplantation to diagnosis of malignancy was 15.3 month. Twelve patients died of cancer during the follow-up (mean, 12.3 years). No significant difference was noted in the age, sex, and time of transplantation between these patients and those in the control group. Kaposi sarcoma was associated with HLA-CW4 (P = .03) with an odds ratio of 4.96 (95% confidence interval, 2.90 to 8.12).

Conclusions: We found HLA-CW4 as a risk factor of Kaposi sarcoma in kidney allograft recipients. Screening for malignancies after kidney transplantation sounds very important with special attention to the specific environmental and genetic factors in each population.
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October 2007

Infertility among kidney transplant recipients.

Saudi J Kidney Dis Transpl 2007 Mar;18(1):79-82

Tehran University of Medical Sciences, Tehran, Iran.

We studied 122 women with a transplanted kidney to evaluate their reproductive performance. 15 of the patients were either post-menopausal or underwent hysterectomy and 33 were unmarried. Of the 76 married reproductive age women, 10 (13.1%) were infertile. Three had male factor infertility, three had ovulatory problems and in four cases, the cause was uncertain. Six of these patients were actively treated by ovulation induction with or without IUI and two of these patients became pregnant. The remaining four patients refused treatment for infertility. We conclude that the incidence of infertility among kidney transplant recipients is similar to the general population, but they are less motivated to be treated for infertility.
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March 2007