Renal Transplantation Obesity and Cardiac Risk after Kidney Transplantation: Experience at One Center and Comprehensive Literature Review. Transplantation 2008; 303–312 Pretransplant Serum Vitamin D Levels and Risk of Cancer after Renal Transplantation. Transplantation

Data from the Framingham Heart Study indicate that in a Caucasian population with normal body mass index (BMI), the long-term risk for becoming overweight or obese exceeds 50% and 25% respectively. In 2007, 25.6% of adults in the United States were reported to be obese. Obesity, in the general population, is associated with an increased risk for cardiovascular disease, diabetes mellitus, hy-pertension, and hyperlipidemia. In dialysis patients, low BMI often reflects underlying comorbidities and malnutrition, and is a marker for increased mortality. In renal transplant recipients, obesity is a predictor for perioperative complications, delayed graft function, graft loss, and increased mortality. Death with a functioning allograft is the most common cause of renal allograft loss, and cardiovascular disease is the leading cause of death post-transplant. The relationship between BMI and post-transplant cardiovascular events is not well described. In this article, Lentine et al. report the findings of a retrospective, single-center study that examined associations, in adult patients, between BMI at transplant and the incidence of congestive heart failure (CHF), atrial fibrillation (AF), and myocardial infarction (MI) post-trans-plant. BMI values were ranked into quartiles, and because of the small number of patients in Transplant recipients are at increased risk for opportunistic infections. Over the past decade, polyoma virus infection, caused by BK virus (BKV) and less often by JC virus, has emerged as an important cause for renal allograft dysfunction and graft loss. The prevalence of BK virus-induced nephropathy (BKVN) has been estimated to be between 1% and 10%. Although there appears to be a correlation between the overall intensity of immunosuppression and risk for BKV infection, no one drug has been incriminated. Reduction in immunosuppression is the cornerstone of the management of BKV infection. In this communication, Saad et al. report their experience with management of 24 patients diagnosed with BK viremia during the process of evaluation of renal allograft dysfunction. Twenty patients received antibody induction, and the maintenance immunosuppressive regimen in all comprised prednisone; mycophenolate mofetil (MMF); and either tacrolimus, cyclosporine, or sirolimus. After the diagnosis of BK virus infection, the dose of MMF and calcineurin inhibitor (CNI) was approximately halved, and target levels for the CNI or sirolimus were reduced to 50% of previous levels. None of the patients received antiviral agents. Renal function and plasma BK viral load were serially monitored. Patients with deteriorating renal function underwent a repeat biopsy, and those diagnosed with acute rejection were treated with pulse steroids. The mean follow-up period after diagnosis of BKV infection was 30.9 mo (range, 17 to 43 mo).