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62: Complications of Pediatric Live-Donor Kidney Transplantation in Developing Country: Single Center’s Experience from Egypt
NKF 2008 Spring Clinical Meetings Abstracts
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63 USE OF BEHAVIORAL MODELING IN PATIENT-TAILORED EDUCATION ON PHOSPHOROUS CONTROL Sana Ghaddar, Hafez Elzein. Wael Shamseddine American University of Beirut, Beirut – Lebanon We examined the relationship between patients’ perceptions of barriers, benefits, seriousness, susceptibility and self efficacy of compliance with dietary phosphorus intake based on the Health Behavior Model (HBM) constructs, and their placement across stages of readiness to change utilizing the Transtheoretical model (TTM). This cross sectional study examined 235 hemodialysis (HD) patients in three HD units in Lebanon. Collected data included two questionnaires (HBM and TTM) and prior three-month values for serum phosphorus. The TTM questionnaire contains an algorithm that facilitates placement of patients into stages based on their phosphate binder and dietary phosphorus intake practices in the last 6 months. Univariate analyses were conducted to summarize the demographic, clinical and behavioral characteristics of study participants. Multivariate statistics (ANOVA, MANOVA, and post hoc LSD) were used to examine the interface between constructs of HBM with TTM stages of change. This study included 51.2% males, mean age was 58.5 ± 14.2 and average years on dialysis were 4.7 ± 4.7 years. The distribution of the participants across the TTM stages was 35% in the precontemplation, 8.5 % in the contemplation, 24% in the preparation, 14% in the action, and 18.5% in the maintenance stage. Individual constructs that had significant correlations across the five stages were perception of barriers (p = .02) and self-efficacy (p < .01). Post hoc LSD analysis showed that patients in the precontemplation stage had significantly less perception of barriers compared to those in the preparation and maintenance stages, while for perception of self-efficacy, patients in the precontemplation stage had significantly lower scores compared to those in the preparation, action and maintenance stages. TTM stages were not significantly associated with gender (p = .28), age (p = .58), or number of years on dialysis (p = .07). Counselling tailored to individual needs was found to be more effective than traditional programs. We recommend using the TTM and HBM assessments to tailor patient-specific educational approach.
62 COMPLICATIONS OF PEDIATRIC LIVE-DONOR KIDNEY TRANSPLANTATION IN DEV ELOPING COUNTRY: SINGLE CENTER'S EXPERIENCE FROM EGYPT Amr A El-Husseini , Mohamed A Sobh; Urology & Nephrology Center, Mansoura University, Egypt Objectives. To study complications of chronic renal failure (CRF) among pediatric live-donor kidney transplant recipients. Methods. Between March 1976 and December 2005, 1785 livedonor kidney transplants were carried out in our center, out of them 292 were 20 years old or younger (mean age 12.8 years, ranging from 4 to 20 years). Clinical and laboratory parameters were analyzed retrospectively in these 292 patients. They were 182 boys and 110 girls. Patients transplanted before 1988 were treated with prednisolone and azathioprine as combined therapy. From 1988 to 1998 a triple regimen comprising of prednisolone, azathioprine and cyclosporine A (CsA) was administered. Tacrolimus and mycophenolate mofetil (MMF) were introduced as a primary therapy since 1998. Assessment of the growth, anemia, infections, and surgical, cardiac, neurologic, bone and other medical complications was performed. Results. Triple immunosuppression (prednisone + CsA + azathioprine) was used in 68.2% of transplants. Acute rejection rate was 47.6%, chronic rejection rate was 31%. Hypertension (62%) was the commonest complication. Anemia was diagnosed in 61%. A substantial proportion of patients (48%) were short, with height standard deviation score (SDS) less than -1.88. The overall infection rate was high and the majority (54%) was bacterial. Malignancy was diagnosed in 8 (3%) patients. The incidence of urological complications was 14% and vascular complications 1%. Cardiac complications included left ventricular hypertrophy (LVH) in 47.9% of patients, left atrial enlargement (31.5%) and left ventricular dilatation and systolic dysfunction (13.7% for each). Neuropathic changes were found in 19% of our cases with more affection of the distal muscles of lower limbs. Other complications included avascular bone necrosis in 8% (all of them in the hip joint) and bone loss in 60% of patients. Conclusion. Despite long-term success results of pediatric renal transplantation in a developing country, there is a risk for significant morbidity.
64 ASSOCIATION BETWEEN SINUS HISTIOCYTOSIS AND RENAL CELL CARCINOMA: A CASE SERIES Ziad El-Zoghby; Nelson Leung Department of Medicine, Division of Nephrology, Mayo Clinic, Rochester, MN Background: Rosai and Dorfman described in 1969 a rare entity characterized clinically by massive lymphadenopathy (LAD) and histologically by S-100 positive histiocytes with phagocytosis of leucocytes. This entity is known as sinus histiocytosis (SH) and is usually benign. SH involves frequently many organs including the kidneys and an association with different types of malignancy has been reported but none including renal cell carcinoma (RCC). Methods: We performed a systematic search by diagnostic codes of all cases of SH associated with RCC seen at our institution from 1976 to 2007. Results: We found five cases of SH associated with RCC. Two of five were male. Age at diagnosis of RCC ranged from 22 to 85 years. RCC was diagnosed 7 years after the diagnosis of SH in one case, 1 and 4 years prior to SH in 2 cases respectively, and at the time of SH diagnosis in 2 cases. RCC was found at autopsy (1 case), during work up of cholelithiasis (1 case), back pain (1 case) and LAD (1case). The type of RCC was clear cell in 3 cases, chromophobe and unknown in the remaining 2 cases. SH presented as inguinal or axillary LAD in 3 cases. In the other 2 cases, SH was found incidentally on paraaortic LAD removed during a nephrectomy for RCC. In all cases SH resolved spontaneously. RCC recurred in only one case. Conclusion: SH is a rare entity and to our knowledge this is the first case series reporting an association with RCC. The significance of such association remains to be determined.
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63 USE OF BEHAVIORAL MODELING IN PATIENT-TAILORED EDUCATION ON PHOSPHOROUS CONTROL Sana Ghaddar, Hafez Elzein. Wael Shamseddine American University of Beirut, Beirut – Lebanon We examined the relationship between patients’ perceptions of barriers, benefits, seriousness, susceptibility and self efficacy of compliance with dietary phosphorus intake based on the Health Behavior Model (HBM) constructs, and their placement across stages of readiness to change utilizing the Transtheoretical model (TTM). This cross sectional study examined 235 hemodialysis (HD) patients in three HD units in Lebanon. Collected data included two questionnaires (HBM and TTM) and prior three-month values for serum phosphorus. The TTM questionnaire contains an algorithm that facilitates placement of patients into stages based on their phosphate binder and dietary phosphorus intake practices in the last 6 months. Univariate analyses were conducted to summarize the demographic, clinical and behavioral characteristics of study participants. Multivariate statistics (ANOVA, MANOVA, and post hoc LSD) were used to examine the interface between constructs of HBM with TTM stages of change. This study included 51.2% males, mean age was 58.5 ± 14.2 and average years on dialysis were 4.7 ± 4.7 years. The distribution of the participants across the TTM stages was 35% in the precontemplation, 8.5 % in the contemplation, 24% in the preparation, 14% in the action, and 18.5% in the maintenance stage. Individual constructs that had significant correlations across the five stages were perception of barriers (p = .02) and self-efficacy (p < .01). Post hoc LSD analysis showed that patients in the precontemplation stage had significantly less perception of barriers compared to those in the preparation and maintenance stages, while for perception of self-efficacy, patients in the precontemplation stage had significantly lower scores compared to those in the preparation, action and maintenance stages. TTM stages were not significantly associated with gender (p = .28), age (p = .58), or number of years on dialysis (p = .07). Counselling tailored to individual needs was found to be more effective than traditional programs. We recommend using the TTM and HBM assessments to tailor patient-specific educational approach.
62 COMPLICATIONS OF PEDIATRIC LIVE-DONOR KIDNEY TRANSPLANTATION IN DEV ELOPING COUNTRY: SINGLE CENTER'S EXPERIENCE FROM EGYPT Amr A El-Husseini , Mohamed A Sobh; Urology & Nephrology Center, Mansoura University, Egypt Objectives. To study complications of chronic renal failure (CRF) among pediatric live-donor kidney transplant recipients. Methods. Between March 1976 and December 2005, 1785 livedonor kidney transplants were carried out in our center, out of them 292 were 20 years old or younger (mean age 12.8 years, ranging from 4 to 20 years). Clinical and laboratory parameters were analyzed retrospectively in these 292 patients. They were 182 boys and 110 girls. Patients transplanted before 1988 were treated with prednisolone and azathioprine as combined therapy. From 1988 to 1998 a triple regimen comprising of prednisolone, azathioprine and cyclosporine A (CsA) was administered. Tacrolimus and mycophenolate mofetil (MMF) were introduced as a primary therapy since 1998. Assessment of the growth, anemia, infections, and surgical, cardiac, neurologic, bone and other medical complications was performed. Results. Triple immunosuppression (prednisone + CsA + azathioprine) was used in 68.2% of transplants. Acute rejection rate was 47.6%, chronic rejection rate was 31%. Hypertension (62%) was the commonest complication. Anemia was diagnosed in 61%. A substantial proportion of patients (48%) were short, with height standard deviation score (SDS) less than -1.88. The overall infection rate was high and the majority (54%) was bacterial. Malignancy was diagnosed in 8 (3%) patients. The incidence of urological complications was 14% and vascular complications 1%. Cardiac complications included left ventricular hypertrophy (LVH) in 47.9% of patients, left atrial enlargement (31.5%) and left ventricular dilatation and systolic dysfunction (13.7% for each). Neuropathic changes were found in 19% of our cases with more affection of the distal muscles of lower limbs. Other complications included avascular bone necrosis in 8% (all of them in the hip joint) and bone loss in 60% of patients. Conclusion. Despite long-term success results of pediatric renal transplantation in a developing country, there is a risk for significant morbidity.
64 ASSOCIATION BETWEEN SINUS HISTIOCYTOSIS AND RENAL CELL CARCINOMA: A CASE SERIES Ziad El-Zoghby; Nelson Leung Department of Medicine, Division of Nephrology, Mayo Clinic, Rochester, MN Background: Rosai and Dorfman described in 1969 a rare entity characterized clinically by massive lymphadenopathy (LAD) and histologically by S-100 positive histiocytes with phagocytosis of leucocytes. This entity is known as sinus histiocytosis (SH) and is usually benign. SH involves frequently many organs including the kidneys and an association with different types of malignancy has been reported but none including renal cell carcinoma (RCC). Methods: We performed a systematic search by diagnostic codes of all cases of SH associated with RCC seen at our institution from 1976 to 2007. Results: We found five cases of SH associated with RCC. Two of five were male. Age at diagnosis of RCC ranged from 22 to 85 years. RCC was diagnosed 7 years after the diagnosis of SH in one case, 1 and 4 years prior to SH in 2 cases respectively, and at the time of SH diagnosis in 2 cases. RCC was found at autopsy (1 case), during work up of cholelithiasis (1 case), back pain (1 case) and LAD (1case). The type of RCC was clear cell in 3 cases, chromophobe and unknown in the remaining 2 cases. SH presented as inguinal or axillary LAD in 3 cases. In the other 2 cases, SH was found incidentally on paraaortic LAD removed during a nephrectomy for RCC. In all cases SH resolved spontaneously. RCC recurred in only one case. Conclusion: SH is a rare entity and to our knowledge this is the first case series reporting an association with RCC. The significance of such association remains to be determined.