RESUMEN
BACKGROUND: There is a relative lack of recent information about late post kidney transplantation anaemia (PTA), especially in the developing countries; data are scarce about the prevalence and risk factors of PTA. Sudan was a leading country in Africa and Arab world in kidney transplantation. The first kidney transplantation in Sudan was in 1973. METHODS: This is a cross-sectional hospital analytic study enrolling all kidney transplanted recipients following in the transplant referral clinics at Ahmed Gassim, Selma and Ibn Sina Hospitals, Khartoum/Sudan, in the period from 1/8/2010 to 1/9/2010, clinical and laboratory data were obtained from 114 patients, anaemia was defined as Hb levels of < 13 g/dl for male patients and < 12 g/dl for female patients, exclusion criteria were pregnancy, below 18 years old patients, multiple organ transplantation, and patients with less than one year from the transplantation. RESULTS: The study showed that 39.5% of the patients were anaemic. Univariate analysis showed that late PTA is significantly associated with not using Erythropoietin (EPO) in the pre-transplant period (p = < 0.001), history of rejection (p = 0.003), longer time from transplantation (p = 0.015), and eGFR (p < 0.0001). Multivariate analysis showed that eGFR (p = < 0.001) and not use of EPO in the pre transplant period (p < 0.001) are strong predictors of PTA. The use of Angiotensin converting enzyme inhibitors/Angiotensin receptors blockers (ACEI/ARB), immunosuppressive treatments, presence or absence of co-morbidities, donor type and donor age are not significantly associated with late PTA. CONCLUSION: The study concluded that late PTA is common and under recognized. Risk factors for late PTA include renal dysfunction, history of rejection, longer duration of transplantation and not using EPO in the pre-transplant period. Renal dysfunction and not using EPO in the pre-transplant period are major predictors of late PTA.
Asunto(s)
Anemia/etnología , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/etnología , Complicaciones Posoperatorias/etnología , Adulto , Anemia/etiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Factores de Riesgo , Sudán/etnología , Factores de TiempoRESUMEN
INTRODUCTION: Castleman's disease is a rare lymphoid disorder. It comprises two pathological entities. These are the hyaline-vascular type which is usually localized (uni-centeric) and the plasma-cell type which is usually multicenteric and rather aggressive. CASE REPORT: Here we present a 53 years old Sudanese male who underwent kidney transplantation in August 2009 from a related live-donor. During transplantation, he was accidently found to have an abnormal looking lymph node at the site of the graft bed. The lymph node was totally excised and sent for histopathology. Based on the histopathological examination, the diagnosis of Castleman's disease of the hyaline vascular type was made. The patient gained normal graft function and was maintained on tacrolimus, azathioprine and prednisolone. He maintained normal graft function for more than twelve months post transplantation with a serum creatinine level of 0.9 mg/dl. He remained free from recurrence of Castleman's disease during the follow up period. CONCLUSION: Unicenteric Castleman's disease may be completely asymptomatic. Surgical excision of the lesion was curative for our patient despite maintenance on immunosuppression.