Tehran University Medical Journal

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Some of ICU patients with Acute Renal Failure (ARF) require dialysis. Conventional or intermittent hemodialysis (HD) may cause hypotension and insufficient loss of fluids and toxins from blood. Peritoneal dialysis also my cause peritonitis and has lower efficiency than HD. We did continuous Venovenous Hemodialysis (CVVHD) for three ICU patients with ARF in Saint-Zahra Medical Center for the first time in our country. Method and Material: With a polysulfone membrane, blood pump, peritoneal dialysis solution, heparin, and a fix nurse, HD was done for 12-24 hours. Results: 1) Urea clearance was 18-50 ml/h. 2) Ultrafiltration was 160-1000 ml/h. 3) With dialysis, hemorrhage, coagulation disorder, and oxygenation recovered. 4) All of patients developed hyperglycemia and hypothermia. 5) All of patients died (two with septicemia and one with hypotension). Conclusion: In the absence of hemodialysis or peritoneal dialysis, CVVHD with present preliminary equipments is suitable and can excrete more toxins and fluids.

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Background: Long term use of immunosuppressive therapy in transplant recipients in order to prevent acute and chronic rejection increases the long term risk of cancer. This study evaluates the incidence of different organs’ cancer after renal transplantation and immunosuppressive therapy.
Methods: This is a retrospective analysis of malignant tumors in renal graft recipients with more than one year graft survival. Patients were assessed according to their age, sex, diagnosis of cancer, immunosuppressive drugs, donors and period of dialysis before transplantation.
Results: Evaluating all existing files in selected private clinics in Isfahan 350 patients were reviewed and 289 of them had entrance criteria. A total of 186 men and 103 women (mean age: 42.17±13.09 years) were included. They were followed up over a mean period of 52.46±33.24 months. A total of six cases (2.1%) of cancer were diagnosed in six recipients: All patients with cancer were male with a mean age of 51.17±14.7 years (range: 26-68 years). Tumor presented at a mean time of 51 months (rang: 15-82 months) after transplantation. There were two patients with BCC, two patients with SCC and two patients with lymphoma. Two patients died of progressive malignant disease. Age, period of dialysis before transplantation, and using immunosuppressive and anti-rejection drugs had no significant impact on development of post transplant malignancy.
Conclusion: The frequency of tumors in these patients is lower than what reported by other centers, probably due to short period of follow up and low incidence of cancer in our general population. The risk of malignancy was 28 fold higher among transplant recipients than in general population. High risk of cancer in this group, confirms the necessity of routine examination for organ transplant recipients both before and after transplantation.