Mitra Mahdavi-Mazdeh

To bridge the gap in the current knowledge, the present study was conducted to obtain evidences relating to clinical outcomes of the ESRD population in Iran over the last two decades. The records of 84,652 incident ESRD patients from 1995 up to and including 2014 in the national registry of ESRD patients were analyzed retrospectively. Data were collected from dialysis and transplant centers in Iran from 1995 to 2008 via paper forms and from 2009 to 2014 through web-based records. Mean age (SD) in incident cases of ESRD (57.7% male) was 52.5 (16.6) years. The prevalence of ESRD patients grew on average 14.9% and 5.3% annually in the periods of 1995-2004 and 2005-2014, respectively. Adjusted mortality rate among dialysis patients in 1995, 2005, and 2014 was 145, 154, and 177/ 1000 patient-years, respectively. Median graft half-life (IQR) and median expected remaining life-years (IQR) for dialysis patients in the 2003 incident patient cohort were 4.4 (1.9-8.3) and 4.2 (1.8-8.2) years, respectively. The overall slightly decreasing, and still comparable, survival trend in dialysis patients, despite the accessible and free dialysis treatment, may be the result of the counterbalance of different contributory factors, including increased age and the higher proportion of patients with co-morbidities resulting from diabetes and hypertension. The half-lives of renal allografts were generally shorter compared to thus far shared evidences which this may be due to tissue incompatibility. The decreasing trend, in this context, can be attributable to the increased number of transplantation from deceased donors with expanded criteria.

To delineate the kidney transplantation programs in the Middle East and to provide a comparative summary with other international datasets where deemed appropriate. Data regarding kidney transplantation as the treatment of choice amongst renal replacement therapies in different countries in the Middle East was analyzed from 2004 to 2013. The number of kidney transplants and the source of kidneys were important topics of comparison. All data was collected from published reports and international registries. Eight of 23 countries in the Middle East had active kidney transplantation programs from both living and deceased donors in 2013. The kidney transplantation rate in 2013 was 11.5 per million population in the Middle East compared with 31.68 in America, 27.38 in Europe, 5.68 in the Western Pacific, 3.38 in South Asia, and 0.5 in Africa. The proportion of kidney transplants from deceased donors was 69.5%, 63.1%, 60.9%, 30.2%, 19.4%, and 6.2% in Europe, America, the Western Pacific, the Middle East, South Asia, and Africa, respectively. Public education on the subject of brain death and cadaveric organs as a reliable source of saving lives and provision of better infrastructure could increase the rate of kidney transplantation from brain-dead donors. Lack of funds and a negative attitudes towards organ donation are the main barriers in the Middle East.

Durability and the rate of complications of homograft heart valves, adjusted for patient-related contributors and surgical techniques, rely mainly on the quality of allografts which in turn are mirrored in the donor characteristics and most importantly recovery and processing procedures. Aimed to assess the quality, a study was conducted to figure out the durability and late outcome following homograft replacement with valved conduits procured by the Iranian Tissue Bank. Retrospectively, the pre-implantation, perioperative and follow-up data of 400 non-consecutive recipients of cryopreserved heart valves (222 pulmonary and 178 aortic) from 2006 to 2015 were collected and analyzed in terms of variables reflecting late outcome including adverse events and durability. In the context of durability, the event of interest was defined as the need for homograft replacement and homograft-related death. The mean follow-up time (SD) of study entrants (male/female ratio, 1.4) was 49.8 (36.3) months. Median age at the time of implantation was 11 years. Total 10-years mortality was 21 % (84/400), including 66.7 % early (30-days mortality: 56/84) and 33.3 % late (28/84). Overall late complication rate was 2 %. Median survival time was 120 months (95 % CI 83.3–156.6). The pulmonary valves appeared to be more durable (P value P value 0.008). One-, five-, and ten-year graft survival was 82, 76 and 73 %, respectively. The evidences suggest that the homografts function satisfactory with low rate of late complications; nevertheless, more emphasis should be given to make long-term durability comparable.

The ability of kidney transplantation to improve quality of life has made this therapeutic modality the treatment of choice among renal replacement therapies; however, the continuing organ shortage has forced the use of marginal kidneys as a supplementary source of allografts. It has been repeatedly suggested that failed kidney transplant recipients have greater morbidity and mortality compared with dialysis patients with no renal transplant history. Achieving an optimal balance between the advantages of kidney transplant and disadvantages of allografts with marginal quality is a topic of controversy in transplant medicine. The major and potentially life-threatening complications of immunosuppressive therapies and shorter lifespan following graft failure necessitate a reappraisal of kidney transplant programs from expanded-criteria deceased donors, which can neither necessarily give dialysis patients a better quality of life nor a significant survival benefit, especially in settings with additional diminished graft survival due to HLA-mismatch. It should be offered just to those with short life expectancy and with HLA-matching. The last item is very important in countries without mandatory HLA-matching protocols for kidney transplantation programs.

Tissue transplantation is a life-enhancing therapeutic modality for damaged or non-functioning tissues. In most cases, there is no alternative other than human tissue as replacement, and taking into account the ever-increasing demand for tissue grafts, it makes sense to set up an establishment in charge of human tissue procurement to meet local needs. A quality assurance system, clearly defined standards, and regular audits complement the infrastructure which make this activity feasible. The process of tissue procurement consists of donor identification, consent, tissue recovery, donor screening and testing, tissue processing, preservation, packaging, labeling, terminal sterilization, storage and distribution. The transplantation of homograft heart valves remains controversial, due to the availability of prosthetic and bioprosthetic alternatives. The limited durability of homografts has not yet outweighed the advantages which this graft offers. Adherence to regulations and regularly revised guidelines improve long-term efficacy and minimizes complications or malfunction. Furthermore, the lower price of homograft heart valves and the removal of the need for a lifetime of anticoagulation therapy are noteworthy advantages of this replacement. In our practice, the proportion of homograft heart valves meeting release criteria and successfully implanted grafts were 83% and 95%, respectively.

Middle East, with more than 650 million inhabitants, has one the lowest mean donation rate in the world in the context of organ procurement from deceased donors with <2 per million population as actual deceased organ donation rate in 2014. Tissue processing and transplantation in this region are also restricted to a few countries among those representing Middle East Society for Organ Transplantation. Aiming to promote human tissue processing and transplantation in this region, as a life-enhancing therapeutic modality, we have to share our know-how and facilities in order so that the patients in different countries gain almost equal benefit of this vital procedure. To take different infrastructure of Middle Eastern countries into consideration and their plans to extend their activities, this intention will be come to the reality and materialized by primarily sharing the processed tissues among member states in a centralized manner and to offer processing services and banking to locally retrieved tissues.

The aim of this systematic review and meta-analysis was to evaluate the efficacy-related events and adverse events of 2 different doses of everolimus in kidney transplant recipients. The Cochrane, PubMed, and Google Scholar databases were searched for randomized controlled trials published by the end of 2015 on the use of everolimus in kidney transplant recipients at doses of 1.5 mg/d and 3 mg/d. Two independent reviewers assessed the studies for quality and eligibility and extracted the data. The relative risk (RR) and 95% confidence interval (CI) for treated efficacy-related events and adverse events were collected to calculate pooled measures. A total of 8 articles describing 7 randomized controlled trials (n = 2148 participants) were included in this study. The overall RR in adverse event outcomes was significantly in favor of the lower dose of everolimus (RR, 0.96; 0.95% CI, 0.93 to 0.99; P < .001). The overall risk of graft loss was lower with 1.5 mg/d of everolimus (RR, 0.76; 0.95% CI, 0.59 to 0.99; P = .04, I2 = 25.0%). There was no relationship between the rates of efficacy failure, biopsy-proven acute rejection, death, or loss to follow up outcomes in all the three time follow-up times between the two doses of everolimus. The result of this systematic review and meta-analysis showed that the overall outcomes of adverse events and graft loss were better with everolimus, 1.5 mg/d, than with everolimus, 3 mg/d, when combined with other kidney transplantation medications.