#01#
Revisiones
(todas) *** Reviews (all)
TRASPLANTE
RENAL *** RENAL TRANSPLANTATION
(Conceptos
/ Keywords: Renal-Kidney transplantation; Kidney donation-procurement; etc).
Enero /
January 2001 --- Marzo / March 2004
La
biblioteca del conocimiento biomédico© es un servicio GRATUITO. Toda la
información ha sido obtenida de fuentes públicas, de portales de internet que
no requieren registro alguno para su uso, que no requieren estar de acuerdo con
sus Términos de uso, que son de libre acceso a todo el mundo, y son a su vez
gratuitos. La biblioteca (revisiones, guías, protocolos, medicina basada en la
evidencia, etc...) se recopila en base a una patente que permite a Effiloop la
catalogación de los artículos por campos de interés así como por el orden de su
importancia (se proveen las primeras 200 revisiones). Toda la informacion se
ampara en las leyes de libre pensamiento-expresión, y de uso justo. Este
documento sólo contiene artículos escritos en Castellano y/o Inglés.
The
biomedical library© is a FREE service. All the information has been obtained
from public sources, from web sites that do not require registration for their
use, that do not require an agreement with their Terms of use, that provide
free access for all, and are free of charge. The library (reviews, guides,
protocols, medicine based medicine, etc) is arranged according to a patent that
warrants Effiloop to catalogue the articles by fields of interest as well as to
sort articles by true relevance (the first 200 reviews are provided). All the
information is provided according to the freedom of speech and fair use laws.
Only articles written in Spanish and/or English are included.
[1]
TÍTULO / TITLE: - Strategies to improve
long-term outcomes after renal transplantation.
REVISTA
/ JOURNAL: - N Engl J Med. Acceso gratuito al texto
completo a partir de los 6 meses de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://content.nejm.org/
●●
Cita: New England J Medicine (NEJM): <> 2002 Feb 21;346(8):580-90.
●●
Enlace al texto completo (gratuito o de pago) 1056/NEJMra011295
AUTORES
/ AUTHORS: - Pascual M; Theruvath T; Kawai T;
Tolkoff-Rubin N; Cosimi AB
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Department of Medicine,
Massachusetts General Hospital, Boston, MA 02114, USA. mpascual@partners.org N. Ref:: 99
----------------------------------------------------
[2]
TÍTULO / TITLE: - Clinical practice
guidelines for managing dyslipidemias in kidney transplant patients: a report
from the Managing Dyslipidemias in Chronic Kidney Disease Work Group of the
National Kidney Foundation Kidney Disease Outcomes Quality Initiative.
REVISTA
/ JOURNAL: - Am J Transplant 2004;4 Suppl 7:13-53.
●●
Enlace al texto completo (gratuito o de pago) 1111/j.1600-6135.2004.0355.x
AUTORES
/ AUTHORS: - Kasiske B; Cosio FG; Beto J; Bolton K;
Chavers BM; Grimm R Jr; Levin A; Masri B; Parekh R; Wanner C; Wheeler DC;
Wilson PW
RESUMEN
/ SUMMARY: - The incidence of cardiovascular disease
(CVD) is very high in patients with chronic kidney (CKD) disease and in kidney
transplant recipients. Indeed, available evidence for these patients suggests
that the 10-year cumulative risk of coronary heart disease is at least 20%, or
roughly equivalent to the risk seen in patients with previous CVD. Recently,
the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative
(K/DOQI) published guidelines for the diagnosis and treatment of dyslipidemias
in patients with CKD, including transplant patients. It was the conclusion of
this Work Group that the National Cholesterol Education Program Guidelines are
generally applicable to patients with CKD, but that there are significant
differences in the approach and treatment of dyslipidemias in patients with CKD
compared with the general population. In the present document we present the
guidelines generated by this workgroup as they apply to kidney transplant
recipients. Evidence from the general population indicates that treatment of
dyslipidemias reduces CVD, and evidence in kidney transplant patients suggests
that judicious treatment can be safe and effective in improving dyslipidemias.
Dyslipidemias are very common in CKD and in transplant patients. However, until
recently there have been no adequately powered, randomized, controlled trials
examining the effects of dyslipidemia treatment on CVD in patients with CKD.
Since completion of the K/DOQI guidelines on dyslipidemia in CKD, the results
of the Assessment of Lescol in Renal Transplantation (ALERT) Study have been
presented and published. Based on information from randomized trials conducted
in the general population and the single study conducted in kidney transplant
patients, these guidelines, which are a modified version of the K/DOQI
dyslipidemia guidelines, were developed to aid clinicians in the management of
dyslipidemias in kidney transplant patients. These guidelines are divided into
four sections. The first section (Introduction) provides the rationale for the
guidelines, and describes the target population, scope, intended users, and
methods. The second section presents guidelines on the assessment of
dyslipidemias (guidelines 1-3), while the third section offers guidelines for
the treatment of dyslipidemias (guidelines 4-5). The key guideline statements
are supported mainly by data from studies in the general population, but there
is an urgent need for additional studies in CKD and in transplant patients.
Therefore, the last section outlines recommendations for research.
----------------------------------------------------
[3]
TÍTULO / TITLE: - Interleukin-2 receptor
monoclonal antibodies in renal transplantation: meta-analysis of randomised
trials.
REVISTA
/ JOURNAL: - British Medical J (BMJ). Acceso gratuito
al texto completo.
●●
Enlace a la Editora de la Revista http://bmj.com/search.dtl
●●
Cita: British Medical J. (BMJ): <> 2003 Apr 12;326(7393):789.
●●
Enlace al texto completo (gratuito o de pago) 1136/bmj.326.7393.789
AUTORES
/ AUTHORS: - Adu D; Cockwell P; Ives NJ; Shaw J;
Wheatley K
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Queen Elizabeth
Hospital, Birmingham, B15 2TH. dwomoa.adu@uhb.nhs.uk
RESUMEN
/ SUMMARY: - OBJECTIVE: To study the effect of
interleukin-2 receptor monoclonal antibodies on acute rejection episodes, graft
loss, deaths, and rate of infection and malignancy in patients with renal
transplants. DESIGN: Meta-analysis of published data. DATA SOURCES: Medline,
Embase, and Cochrane library for years 1996-2003 plus search of medical
editors’ trial amnesty and contact with manufacturers of the antibodies.
SELECTION OF STUDIES: Randomised controlled trials comparing interleukin-2
receptor antibodies with placebo or no additional treatment in patients with
renal transplants receiving ciclosporin based immunosuppression. RESULTS: Eight
randomised controlled trials involving 1871 patients met the selection criteria
(although only 1858 patients were analysed). Interleukin-2 receptor antibodies
significantly reduced the risk of acute rejection (odds ratio 0.51, 95%
confidence interval 0.42 to 0.63). There were no significant differences in the
rate of graft loss (0.78, 0.58 to 1.04), mortality (0.75, 0.46 to 1.23),
overall incidence of infections (0.97, 0.77 to 1.24), incidence of
cytomegalovirus infections (0.81, 0.62 to 1.04), or risk of malignancies at one
year (0.82, 0.39 to 1.70). The different antibodies had a similar sized effect
on acute rejection (test for heterogeneity P=0.7): anti-Tac (0.37, 0.16 to
0.89), BT563 (0.37, 0.1 to 1.38), basiliximab (0.56, 0.44 to 0.72), and
daclizumab (0.46, 0.32 to 0.67). The reduction in acute rejections was similar
for all ciclosporin based immunosuppression regimens (test for heterogeneity
P=1.0). CONCLUSIONS: Adding interleukin-2 receptor antibodies to ciclosporin
based immunosuppression reduces episodes of acute rejection at six months by
49%. There is no evidence of an increased risk of infective complications.
Longer follow up studies are needed to confirm whether interleukin-2 receptor
antibodies improve long term graft and patient survival.
----------------------------------------------------
[4]
TÍTULO / TITLE: - Prognostic value of
myocardial perfusion studies in patients with end-stage renal disease assessed
for kidney or kidney-pancreas transplantation: a meta-analysis.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Feb;14(2):431-9.
AUTORES
/ AUTHORS: - Rabbat CG; Treleaven DJ; Russell JD;
Ludwin D; Cook DJ
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of
Nephrology, McMaster University, Hamilton, Ontario, Canada. rabbatc@mcmaster.ca
RESUMEN
/ SUMMARY: - The prognostic utility of myocardial
perfusion studies (MPS) such as thallium scintigraphy and dobutamine stress
echocardiography (DSE) for stratifying cardiac risk among candidates for kidney
or kidney-pancreas transplantation is uncertain. This study is a meta-analysis
to determine the prognostic significance of MPS results on future myocardial
infarction (MI) and cardiac death (CD) in patients with end-stage renal disease
(ESRD) assessed for kidney or kidney-pancreas transplantation. MEDLINE was
searched using combinations of MeSH headings and text words for
transplantation, coronary artery disease, prognosis, end-stage renal disease,
and noninvasive cardiac testing (nuclear scintigraphy and DSE) for primary
studies. Studies were included if they reported MPS results and cardiac events
in patients assessed for kidney or kidney-pancreas transplantation.
Methodologic study quality and outcome data were independently abstracted in
duplicate by two researchers. The relative risks (RR) of MI and CD were
calculated using a random effects model. Twelve articles met all inclusion
criteria; 12 studies reported CD, and 9 reported MI. In eight studies, thallium
scintigraphy was used (four with pharmacologic stress, four with exercise
stress), whereas four used DSE. When compared with negative tests, positive
tests had a significantly increased RR of MI (2.73 [95% CI, 1.25 to 5.97]; P =
0.01) and CD (2.92 [95% CI, 1.66 to 5.12]; P < 0.001). Subgroup analyses of
studies of diabetic patients indicated that positive tests were associated with
a RR of CD 3.95 (95% CI, 1.48 to 10.5; P = 0.006) and a RR of MI 2.68 (95% CI,
0.95 to 7.57; P = 0.06) when compared with negative tests. In studies
evaluating mixed populations of diabetic and nondiabetic patients, positive
tests were associated with a RR of CD 2.52 (95% CI, 1.25 to 5.08; P = 0.01) and
with a RR of MI 2.79 (95% CI, 0.85 to 9.21; P = 0.09) when compared with a
negative test. The presence of reversible defects was associated with an
increased risk of MI in diabetic patients and of CD in both subgroups; fixed
defects were associated with an increased risk of CD but not MI. It is
concluded that positive MPS are useful in identifying patients with
significantly increased risk of future MI and CD in both diabetic and
nondiabetic ESRD patients.
----------------------------------------------------
[5]
TÍTULO / TITLE: - Interleukin 2 receptor
antagonists for renal transplant recipients: a meta-analysis of randomized
trials.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):166-76.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000109643.32659.C4
AUTORES
/ AUTHORS: - Webster AC; Playford EG; Higgins G;
Chapman JR; Craig JC
INSTITUCIÓN
/ INSTITUTION: - Cochrane Renal Group, Centre for Kidney
Research, Children’s Hospital at Westmead, Westmead, NSW, Australia.
RESUMEN
/ SUMMARY: - BACKGROUND: Interleukin 2 receptor
antagonists (IL-2Ra) are increasingly used to treat renal transplant
recipients. This study aims to systematically identify and summarize the
effects of using IL-2Ra as induction immunosuppression, as an addition to
standard therapy, or as an alternative to other antibody therapy. METHODS:
Databases, reference lists, and abstracts of conference proceedings were
searched extensively to identify relevant randomized controlled trials in all
languages. Data were synthesized using the random effects model. Results are
expressed as relative risk (RR), with 95% confidence intervals (CI). RESULTS: A
total of 117 reports from 38 trials involving 4,893 participants were included.
When IL-2Ra were compared with placebo (17 trials; 2,786 patients), graft loss
was not significantly different at 1 year (14 trials: RR 0.84; CI 0.64-1.10) or
3 years (4 trials: RR 1.08; CI 0.71-1.64). Acute rejection was significantly
reduced at 6 months (12 trials: RR 0.66; CI 0.59-0.74) and at 1 year (10
trials: RR 0.67; CI 0.60-0.75). At 1 year, cytomegalovirus infection (7 trials:
RR 0.82; CI 0.65-1.03) and malignancy (9 trials: RR 0.67; CI 0.33-1.36) were
not significantly different. When IL-2Ra were compared with other antibody
therapy, no significant differences in treatment effects were demonstrated, but
IL-2Ra had significantly fewer side effects. CONCLUSIONS: Given a 40% risk of
rejection, seven patients would need treatment with IL-2Ra in addition to
standard therapy, to prevent one patient from undergoing rejection, with no
definite improvement in graft or patient survival. There is no apparent
difference between basiliximab and daclizumab.
----------------------------------------------------
[6]
TÍTULO / TITLE: - A randomized long-term
trial of tacrolimus/sirolimus versus tacrolimus/mycophenolate mofetil versus
cyclosporine (NEORAL)/sirolimus in renal transplantation. II. Survival,
function, and protocol compliance at 1 year.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):252-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000101495.22734.07
AUTORES
/ AUTHORS: - Ciancio G; Burke GW; Gaynor JJ; Mattiazzi
A; Roth D; Kupin W; Nicolas M; Ruiz P; Rosen A; Miller J
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, University of Miami School of Medicine, Miami, FL 33101, USA. gciancio@med.miami.edu
RESUMEN
/ SUMMARY: - BACKGROUND: In an attempt to reduce
chronic calcineurin inhibitor induced allograft nephropathy in first cadaver
and human leukocyte antigen non-identical living-donor renal transplantation,
sirolimus (Siro) or mycophenolate mofetil (MMF) was tested as adjunctive
therapy, with planned dose reductions of tacrolimus (Tacro) over the first year
postoperatively. Adjunctive Siro therapy with a similar dose reduction
algorithm for Neoral (Neo) was included for comparison. METHODS: The detailed
dose reduction plan (Tacro and Siro, group A; Tacro and MMF, group B; Neo and
Siro, group C) is described in our companion report in this issue of Transplantation.
The present report documents function, patient and graft survival, protocol
compliance, and adverse events. RESULTS: As mentioned (in companion report),
group demographics were similar. The present study shows no significant
differences in 1-year patient and graft survival but does show a trend that
points to more difficulties in group C by way of a rising slope of serum
creatinine concentration (P=0.02) and decreasing creatinine clearance (P=0.04).
There were more patients who discontinued the protocol plan in group C. Thus
far, no posttransplant lymphomas have appeared, and infectious complications
have not differed among the groups. However, a greater percentage of patients
in group C were placed on antihyperlipidemia therapy, with an (unexpected)
trend toward a higher incidence of posttransplant diabetes mellitus in this
group. Group A required fewer, and group B the fewest, antihyperlipidemia
therapeutic interventions (P<0.00001). CONCLUSIONS: This 1-year interim
analysis of a long-term, prospective, randomized renal-transplant study
indicates that decreasing maintenance dosage of Tacro with adjunctive Siro or
MMF appears to point to improved long-term function, with reasonably few
adverse events.
----------------------------------------------------
[7]
TÍTULO / TITLE: - Renal physicians
association clinical practice guideline: appropriate patient preparation for
renal replacement therapy: guideline number 3.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
May;14(5):1406-10.
AUTORES
/ AUTHORS: - Bolton WK
INSTITUCIÓN
/ INSTITUTION: - University of Virginia School of Medicine,
Charlottesville, Virginia. rpa@renalmd.org
----------------------------------------------------
[8]
TÍTULO / TITLE: - Lamivudine for the
treatment of hepatitis B virus-related liver disease after renal
transplantation: meta-analysis of clinical trials.
REVISTA
/ JOURNAL: - Transplantation 2004 Mar 27;77(6):859-64.
AUTORES
/ AUTHORS: - Fabrizi F; Dulai G; Dixit V; Bunnapradist
S; Martin P
INSTITUCIÓN
/ INSTITUTION: - Center for Liver and Kidney Diseases and
Transplantation, Cedars-Sinai Medical Center, Los Angeles, CA, USA. fabrizi@policlinico.mi.it
RESUMEN
/ SUMMARY: - BACKGROUND: Numerous reports have appeared
on lamivudine use for the treatment of hepatitis B virus (HBV) infection after
renal transplantation (RT). However, the efficacy and safety of lamivudine
after RT remain unclear. METHODS: The authors evaluated the efficacy and safety
of initial lamivudine monotherapy in RT recipients with hepatitis B by
performing a systematic review of the literature with a meta-analysis of
clinical trials. The primary outcomes were hepatitis B (HB) e antigen (Ag) and
HBV-DNA clearance (as measures of efficacy); the secondary outcomes were
biochemical response (as measures of efficacy), dropout rate, and lamivudine
resistance (as measures of tolerability). The authors used the random effects
model of DerSimonian and Laird, and outcomes were analyzed on an intent-to-treat
basis. RESULTS: The authors identified 14 clinical trials (184 patients); all
of these were prospective cohort studies. The mean overall estimate for HBV-DNA
and HBeAg clearance, alanine aminotransferase normalization, and lamivudine
resistance was 91% (95% confidence interval [CI], 86%-96%), 27% (95% CI,
16%-39%), 81% (95% CI, 70%-92%), and 18% (95% CI, 10%-37%), respectively. HBeAg
seroconversion rate was assessed in four (28%) trials and ranged between 0% and
46%. The P value was greater than 0.05 for our test of study homogeneity. There
was no association between rate of patients who were male patients or had
cirrhosis, race, age, lamivudine dose, and HBV-DNA or HBeAg clearance.
Increased duration of lamivudine therapy was positively associated with
frequency of HBeAg loss (r =0.51, P =0.039) and lamivudine resistance (r
=0.620, P =0.019). Only 2 (14%) of 14 studies reported a dropout rate greater
than 0%. CONCLUSIONS: Our meta-analysis showed that the majority of RT
recipients with hepatitis B had high virologic and biochemical response with
lamivudine. Tolerance to lamivudine was good. However, lamivudine resistance
was frequent with prolonged therapy, potentially limiting its long-term
efficacy after RT.
----------------------------------------------------
[9]
TÍTULO / TITLE: - Treatment and outcome
of invasive bladder cancer in patients after renal transplantation.
REVISTA
/ JOURNAL: - J Urol 2004 Mar;171(3):1085-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.ju.0000110612.42382.0a
AUTORES
/ AUTHORS: - Master VA; Meng MV; Grossfeld GD; Koppie
TM; Hirose R; Carroll PR
INSTITUCIÓN
/ INSTITUTION: - Departments of Urology and Surgery,
University of California, San Francisco, California 94143, USA. vmaster@urol.ucsf.edu
RESUMEN
/ SUMMARY: - PURPOSE: Optimal management and clinical
outcome of bladder cancer in renal transplant recipients are not well-defined.
We analyzed single institution treatment strategies and outcomes of these
patients. MATERIALS AND METHODS: We retrospectively reviewed the University of
California, San Francisco transplant database which contains information on
6,288 renal transplants performed between 1964 and 2002. The United Network for
Organ Sharing database and Israel Penn International Transplant Tumor Registry
were also queried to characterize the global nature of bladder cancer in renal
transplant recipients. RESULTS: The United Network for Organ Sharing database
(1986 to 2001) contained information on 31 patients who were found to have
bladder cancer (0.024% prevalence) and the Israel Penn International Transplant
Tumor Registry (1967 to 2001) contained information on 135 patients
representing 0.84% of all reported malignancies. We identified 7 renal
transplant recipients with bladder cancer at our institution. Invasive
transitional cell carcinoma developed in 5 patients at a median of 2.8 years
after transplant. Three patients underwent uncomplicated radical cystectomy and
preservation of the renal allograft. Overall survival at 48 months was 60%.
CONCLUSIONS: Bladder cancer after renal transplantation is not common. For
patients who present with invasive disease, traditional extirpative surgery
should be considered. Moreover, the allograft is rarely the source of
transitional cell carcinoma and can be preserved. In our experience the cancer
and urinary outcomes compare favorably with nontransplant patient outcomes
after treatment. N.
Ref:: 21
----------------------------------------------------
[10]
TÍTULO / TITLE: - Routes to allograft
survival.
REVISTA
/ JOURNAL: - J Clin Invest. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jci.org/
●●
Cita: J Clinical Investigation: <> 2001 Apr;107(7):797-8.
AUTORES
/ AUTHORS: - Bromberg JS; Murphy B
INSTITUCIÓN
/ INSTITUTION: - Recanati/Miller Transplant Institute,
Mount Sinai School of Medicine, New York, New York 10029, USA. jon.bromberg@mountsinai.org N. Ref:: 21
----------------------------------------------------
[11]
TÍTULO / TITLE: - Diagnosis and therapy
of coronary artery disease in renal failure, end-stage renal disease, and renal
transplant populations.
REVISTA
/ JOURNAL: - Am J Med Sci 2003 Apr;325(4):214-27.
AUTORES
/ AUTHORS: - Logar CM; Herzog CA; Beddhu S
INSTITUCIÓN
/ INSTITUTION: - Renal Section, Salt Lake VA Healthcare
System, Department of Medicine, University of Utah School of Medicine, Salt
Lake City, USA.
RESUMEN
/ SUMMARY: - Even though cardiovascular disease is the
leading cause of death in patients with CRF and end-stage renal disease (ESRD),
ill-conceived notions have led to therapeutic nihilism as the predominant
strategy in the management of cardiovascular disease in these populations. The
recent data clearly support the application of proven interventions in the general
population, such as angiotensin-converting enzyme inhibitors and statins to
patients with CRF and ESRD. The advances in coronary stents and intracoronary
irradiation have decreased the restenosis rates in renal failure patients.
Coronary artery bypass with internal mammary graft might be the procedure of
choice for coronary revascularization in these patients. The role of screening
for asymptomatic coronary disease is established as a pretransplant procedure,
but it is unclear whether this will be applicable to all patients with ESRD.
Future studies need to focus on unraveling the mechanisms by which uremia leads
to increased cardiovascular events to design optimal therapies targeted toward
these mechanisms and improve cardiovascular outcomes. N. Ref:: 125
----------------------------------------------------
[12]
TÍTULO / TITLE: - Hemophagocytic syndrome
in renal transplant recipients: report of 17 cases and review of literature.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):238-43.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000107285.86939.37
AUTORES
/ AUTHORS: - Karras A; Thervet E; Legendre C
INSTITUCIÓN
/ INSTITUTION: - Service de Nephrologie et Transplantation
Renale, Hopital Saint-Louis, Paris, France.
RESUMEN
/ SUMMARY: - BACKGROUND: Hemophagocytic syndrome (HPS)
combines febrile hepatosplenomegaly, pancytopenia, hypofibrinemia, and liver
dysfunction. It is defined by bone marrow and organ infiltration by activated,
nonmalignant macrophages phagocytizing blood cells. HPS is often caused by an
infectious or neoplastic disease and has rarely been described in renal
transplant recipients. METHODS: We retrospectively analyzed 17 cases of HPS after
cadaveric renal transplantation (13 men and 4 women, age 41+/-8 years). The
median time between transplantation and hemophagocytosis was 52 days. Eleven
patients (64%) had received antilymphocyte globulins during the 3 months before
presentation. RESULTS: Fever was present in all patients, and
hepatosplenomegaly was present in 9 of 17 patients. Other nonspecific clinical
findings included abdominal, neurologic, and respiratory symptoms. Laboratory
tests showed anemia (hemoglobin 6.1+/-1.3 g/dL), thrombocytopenia
(34,000+/-32,000/mm3), and leukopenia (1,700+/-1,400/mm3). Elevated liver
enzymes were present in 12 of 17 patients, and cholestasis was present in 10 of
17 patients. Elevated triglycerides and ferritin were noted in 75% and 86% of
cases, respectively. HPS was related to viral infection in nine patients
(cytomegalovirus, Epstein-Barr virus, human herpesvirus 6, and human
herpesvirus 8), bacterial infection in three patients (tuberculosis and
Bartonella henselae), and other infections in two patients (toxoplasmosis and
Pneumocystis carinii pneumoniae). Posttransplant lymphoproliferative disease
was present in two patients. Despite large-spectrum anti-infectious treatment
and dramatic tapering of immunosuppression, death occurred in eight patients (47%).
Graft nephrectomy was performed in four of the nine surviving patients.
CONCLUSIONS: We report here the largest series of HPS after renal
transplantation. This rare disease is usually secondary to herpes viridae
infections, mostly cytomegalovirus and Epstein-Barr virus in severely
immunocompromised patients. Despite aggressive treatment, the prognosis remains
poor. N. Ref:: 22
----------------------------------------------------
[13]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.1. Cancer risk after renal transplantation.
Post-transplant lymphoproliferative disease (PTLD): prevention and treatment.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:31-3, 35-6.
RESUMEN
/ SUMMARY: - GUIDELINES: A. In the first year after
organ transplantation, recipients are at the greatest risk of developing
lymphoproliferative diseases (PTLDs), which are induced most often by
Epstein-Barr virus (EBV) infection, and patients should therefore be screened
prior to or at the time of transplantation for EBV antibodies. B. In the rare
cases (<5%) where the recipient is EBV seronegative, he or she has a 95%
likelihood of receiving an organ from an EBV-seropositive donor, which
translates into a high risk of primary EBV infection with seroconversion soon
after transplantation. In such cases, the recipient should receive a
prophylactic antiviral treatment with acyclovir, valacyclovir or ganciclovir,
starting at the time of transplant and lasting for at least 3 months. The
specific recommendations given for CMV prophylaxis could be applicable in this
situation. C. The treatment of PTLD should be based on accurate pathology with
extensive cell markers and phenotyping. The treatment modalities are as
follows. Reduction of basal immunosuppression in all cases (either maintain
only steroids, or decrease by at least 50% the anti-calcineurin drugs and stop
other immunosuppressive drugs). In the case of EBV-positive B-cell lymphoma, antiviral
treatment with acyclovir, valacyclovir or ganciclovir may be initiated for at
least 1 month or according to the blood level of EBV replication when
available. In the case of rare lymphomas from the mucosal-associated lymphoid
tissue (MALT) with positive Helicobacter pylori, full eradication of H. pylori
should be carried out with a validated protocol. Subsequent H. pylori
prophylaxis should be implemented to avoid relapse. In the case of
CD20-positive lymphomas, treatment with rituximab, a chimeric monoclonal
antibody directed against CD20, should be carried out with one i.v. injection
per week for 4 weeks. In the case of diffuse lymphomas or improper response to
previous treatment, CHOP chemotherapy should be used alone or in combination
with rituximab. The CHOP regimen is cyclophosphamide, doxorubicine, vincristine
and prednisone. Complete cessation of immunosuppression with or without graft
nephrectomy should also be considered.
----------------------------------------------------
[14]
TÍTULO / TITLE: - A meta-analysis from
the Cochrane Library reviewing interleukin 2 receptor antagonists in renal
transplantation.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):165.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000112919.54256.8D
AUTORES
/ AUTHORS: - Morris PJ; Monaco AP
----------------------------------------------------
[15]
TÍTULO / TITLE: - Dialysis, kidney
transplantation, or pancreas transplantation for patients with diabetes
mellitus and renal failure: a decision analysis of treatment options.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Feb;14(2):500-15.
AUTORES
/ AUTHORS: - Knoll GA; Nichol G
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Department of
Medicine, University of Ottawa, Canada. gknoll@ottawahospital.on.ca
RESUMEN
/ SUMMARY: - Patients with type 1 diabetes mellitus and
end-stage renal disease may remain on dialysis or undergo cadaveric kidney
transplantation, living kidney transplantation, sequential pancreas after
living kidney transplantation, or simultaneous pancreas-kidney transplantation.
It is unclear which of these options is most effective. The objective of this
study was to determine the optimal treatment strategy for type 1 diabetic
patients with renal failure using a decision analytic Markov model. Input data
were obtained from the published medical literature, the United Network for
Organ Sharing registry, and patient interviews. The outcome measures were life
expectancy (in life-years [LY]) and quality-adjusted life expectancy (in
quality-adjusted life-years [QALY]). Living kidney transplantation was
associated with 18.30 LY and 10.29 QALY; pancreas after kidney transplantation,
17.21 LY and 10.00 QALY; simultaneous pancreas-kidney transplantation, 15.74 LY
and 9.09 QALY; cadaveric kidney transplantation, 11.44 LY and 6.53 QALY;
dialysis, 7.82 LY and 4.52 QALY. The results were sensitive to the value of
several key variables. Simultaneous pancreas-kidney transplantation had the
greatest life expectancy and quality-adjusted life expectancy when living
kidney transplantation was excluded from the analysis. These data indicate that
living kidney transplantation is associated with the greatest life expectancy
and quality-adjusted life expectancy for type 1 diabetic patients with renal
failure. Treatment strategies involving pancreas transplantation should be
considered for patients with frequent metabolic complications of diabetes and
for those patients who favor kidney-pancreas transplantation over kidney
transplantation alone. For patients without a living donor, simultaneous
pancreas-kidney transplantation is associated with the greatest life expectancy.
----------------------------------------------------
[16]
TÍTULO / TITLE: - Treatment of hepatitis
B in special patient groups: hemodialysis, heart and renal transplant,
fulminant hepatitis, hepatitis B virus reactivation.
REVISTA
/ JOURNAL: - J Hepatol 2003;39 Suppl 1:S206-11.
AUTORES
/ AUTHORS: - Tillmann HL; Wedemeyer H; Manns MP
INSTITUCIÓN
/ INSTITUTION: - Department of Gastroenterology, Hepatology
and Endocrinology, Medizinische Hochschule Hannover, Carl-Neuberg-Strassel,
30623 Hannover, Germany. N.
Ref:: 81
----------------------------------------------------
[17]
TÍTULO / TITLE: - 4D imaging to assay
complex dynamics in live specimens.
REVISTA
/ JOURNAL: - Nat Cell Biol 2003 Sep;Suppl:S14-9.
AUTORES
/ AUTHORS: - Gerlich D; Ellenberg J
INSTITUCIÓN
/ INSTITUTION: - Gene Expression and Cell
Biology/Biophysics Programmes, European Molecular Biology Laboratory,
Heidelberg, Germany.
RESUMEN
/ SUMMARY: - A full understanding of cellular dynamics
is often difficult to obtain from time-lapse microscopy of single optical
sections. New microscopes and image-processing software are now making it
possible to rapidly record three-dimensional images over time. This
four-dimensional imaging allows precise quantitative analysis and enhances
visual exploration of data by allowing cellular structures to be interactively
displayed from many angles. It has become a key tool for understanding the
complex organization of biological processes in live specimens. N. Ref:: 55
----------------------------------------------------
[18]
TÍTULO / TITLE: - Pretransplant blood
transfusions revisited: a role for CD(4+) regulatory T cells?
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1
Suppl):S26-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000106469.12073.01
AUTORES
/ AUTHORS: - Roelen D; Brand A; Claas FH
INSTITUCIÓN
/ INSTITUTION: - Department of Immunohematology and
Bloodtransfusion, Leiden University Medical Center, Leiden, The Netherlands. d.l.roelen@lumc.nl.
RESUMEN
/ SUMMARY: - Pretransplant blood transfusions have been
shown to improve organ allograft survival. However, the immunologic mechanism
leading to this beneficial effect of blood transfusions is still unknown. The
observation that transfusions sharing at least one HLA-DR antigen (human
leukocyte antigen) with the recipient are more effective than HLA-mismatched
transfusions has led to the hypothesis that CD(4+) regulatory T cells are
induced that recognize allopeptides of the blood transfusion donor in the
context of the self-HLA-DR molecule on the donor cells. In vitro studies showed
that CD(4+) T cells recognizing an allopeptide in the context of self-HLA-DR
are indeed able to decrease the alloimmune response of autologous T cells by
affecting the activated T cells directly or indirectly by their modulatory
effect on dendritic cells. The first studies in a patient with a
well-functioning kidney graft after receiving an HLA-DR-matched pretransplant
blood transfusion showed that the low organ donor-specific cytotoxic
T-lymphocyte response after transplantation was indeed attributable to the
activity of regulatory CD(4+) T cells. N.
Ref:: 24
----------------------------------------------------
[19]
- Castellano -
TÍTULO / TITLE:Riesgo cardiovascular en pacientes
con insuficiencia renal cronica. Pacientes en tratamiento sustitutivo renal.
Cardiovascular risk in patients with chronic renal failure. Patients in renal
replacement therapy.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22 Suppl 1:68-74.
AUTORES
/ AUTHORS: - Cases A; Vera M; Lopez Gomez JM
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Unidad de
Hipertension Arterial, Hospital Clinic, IDIBAPS, Universidad de Barcelona,
Barcelona. acases@medicina.ub.es
RESUMEN
/ SUMMARY: - Dialysis patients constitute a high-risk
subset of patients for developing cardiovascular disease, which accounts for
nearly 50% of deaths. After stratification for age, race and gender,
cardiovascular mortality is 10-20 times higher in dialysis patients than in the
general population. Cardiovascular disease in this population cannot be fully
explained by the high prevalence of classical cardiovascular risk factors (age,
hypertension, diabetes, hyperlipidemia, smoking, etc.). Thus, the involvement
of “new” cardiovascular risk factors (hyperhomocysteinemia,
hyperfibrinogenemia, high lipoprotein (a) levels, oxidative stress,
inflammation, etc.), and uremia-related factors (anemia, impaired
calcium-phosphorus metabolism, hyperparathyroidism, accumulation of endogenous
inhibitors of nitric oxide synthesis, etc.) has been also invoked to play a
role in the increased cardiovascular risk in these patients. Endothelial
dysfunction is the initial event in the development of atherosclerosis. Uremic
patients exhibit an endothelial dysfunction, even before starting dialysis,
which persists o is even aggravated under dialysis treatment. Uremic patients
must be considered at high risk of developing cardiovascular disease. Thus
cardiovascular risk factors in these patients should be managed early,
aggressive and multifactorially in order to reduce their high cardiovascular
morbidity and mortality. N.
Ref:: 52
----------------------------------------------------
[20]
TÍTULO / TITLE: - The CHORUS
(Cerivastatin in Heart Outcomes in Renal Disease: Understanding Survival)
protocol: a double-blind, placebo-controlled trial in patients with esrd.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Jan;37(1 Suppl
2):S48-53.
AUTORES
/ AUTHORS: - Keane WF; Brenner BM; Mazzu A; Agro A
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Hennepin County
Medical Center, University of Minnesota Medical School, Minneapolis, MN, USA. g.macgregor@sghms.ac.uk
RESUMEN
/ SUMMARY: - The 3-hydroxy-3-methylglutaryl coenzyme A
reductase inhibitor (statin)-mediated lowering of serum cholesterol has been
associated with a significant reduction in cardiovascular morbidity and
mortality. Recent studies suggest that additional non-lipid lowering effects
(eg, endothelial stabilization, anti-inflammatory, antithrombogenic) may be
important in modulating their effectiveness. Dyslipidemia is common in
end-stage renal disease (ESRD), and hemodialysis patients have increased
cardiovascular morbidity and mortality. Cerivastatin, a new statin with
powerful low-density lipoprotein-cholesterol (LDL-C) lowering capabilities,
possesses some unique non-LDL-C-mediated properties that may contribute to a
reduction of coronary events in the patient with ESRD. The primary objective of
this multicenter multinational study of 1,054 hemodialysis patients is to
compare 2 years of treatment with cerivastatin (0.4 mg/d) versus placebo on the
composite clinical event rate of myocardial infarction, sudden cardiac death,
ischemic stroke, and the need for coronary arterial bypass graft (CABG) or
percutaneous transluminal coronary angioplasty (PTCA) procedures in these
patients. Changes in lipids, inflammatory proteins including heat stable
C-reactive protein (hsCRP), interleukin-6 (IL-6), oncostatin-M, intracellular
adhesion molecule-1 (ICAM-1) and monocyte-chemoattractant protein-1 (MCP-1), as
well as markers of cardiac muscle pathology, such as troponin I and troponin T,
will be assessed in a subset of patients. This study is the first of its kind
to assess the effect of a statin on the reduction of cardiovascular morbidity
and mortality in an incident hemodialysis population. It will determine whether
treatment with cerivastatin can effectively reduce the significant
cardiovascular morbidity and mortality.
----------------------------------------------------
[21]
TÍTULO / TITLE: - Dendritic cells and the
mode of action of anticalcineurinic drugs: an integrating hypothesis.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Mar;18(3):467-8;
discussion 469-70.
AUTORES
/ AUTHORS: - Fierro A; Mora JR; Bono MR; Morales J;
Buckel E; Sauma D; Rosemblatt M
INSTITUCIÓN
/ INSTITUTION: - Clinica las Condes, Transplantation Unit,
Santiago, Chile. afierro@vtr.net N. Ref:: 16
----------------------------------------------------
[22]
TÍTULO / TITLE: - Renal transplantation:
can we reduce calcineurin inhibitor/stop steroids? Evidence based on protocol
biopsy findings.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Mar;14(3):755-66.
AUTORES
/ AUTHORS: - Gotti E; Perico N; Perna A; Gaspari F;
Cattaneo D; Caruso R; Ferrari S; Stucchi N; Marchetti G; Abbate M; Remuzzi G
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine and
Transplantation, Ospedali Riuniti di Bergamo, Mario Negri Institute for
Pharmacological Research, Italy.
RESUMEN
/ SUMMARY: - How to combine antirejection drugs and
which is the optimal dose of steroids and calcineurin inhibitors beyond the
first year after kidney transplantation to maintain adequate immunosuppression
without major side effects are far from clear. Kidney transplant patients on
steroid, cyclosporine (CsA), and azathioprine were randomized to per-protocol
biopsy (n = 30) or no-biopsy (n = 29) 1 to 2 yr posttransplant. Steroid or CsA
were discontinued or reduced on the basis of biopsy to establish effects on
drug-related complications, acute rejection, and graft function over 3 yr of
follow-up. Serum creatinine, GFR (plasma clearance of iohexol), RPF (renal
clearance of p-aminohippurate), CsA pharmacokinetics, and adverse events were
monitored yearly. At the end, patients underwent a second biopsy. Per-protocol
biopsy histology revealed no lesions (n = 5, steroid withdrawal), CsA
nephropathy (n = 13, CsA discontinuation/reduction), or chronic rejection (n =
12, standard therapy). Reducing the drug regimen led to overall fewer side
effects related to immunosuppression as compared with standard therapy or
no-biopsy. Steroids were safely stopped with no acute rejection or graft loss.
Complete CsA discontinuation was associated with acute rejection in the first
four patients. Lowering CsA to low target CsA trough (30 to 70 ng/ml) never led
to acute rejection or major renal function deterioration. Biopsy patients on
conventional regimen had no acute rejection, one graft loss, no significant
change in GFR, and significant RPF decline. No-biopsy controls: no acute
rejection, one graft loss, significant decline of GFR and RPF. By serial biopsy
analysis, severe lesions did not develop in patients with steroid
discontinuation in contrast to patients on standard therapy over follow-up. CsA
reduction did not adversely affect histology. Per-protocol biopsy more than 1
yr after kidney transplantation is a safe procedure to guide change of drug
regimen and to lower the risk of major side effects.
----------------------------------------------------
[23]
TÍTULO / TITLE: - Treatment of
posttransplant hypertension: too little, too late?
REVISTA
/ JOURNAL: - Transplantation 2003 Dec 15;76(11):1645-6.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000091290.30262.96
AUTORES
/ AUTHORS: - Paul LC
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Leiden
University Medical Center, Leiden, The Netherlands. lcpaul@lumc.nl N. Ref:: 12
----------------------------------------------------
[24]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.3. Cancer risk after renal transplantation. Solid
organ cancers: prevention and treatment.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:32, 34-6.
RESUMEN
/ SUMMARY: - GUIDELINES: J. All renal transplant
recipients should have regular ultrasonography of their native kidneys (when
applicable) for screening of renal cell carcinomas, which are observed at much
higher incidence in both dialysed and transplant patients. K. Guidelines
published for screening and prevention of solid organ cancers in the general
population should be strictly applied to transplant recipients, who are in
general at higher cancer risk, but would benefit equally or even greater. L.
All male renal transplant recipients aged 50 and over should have a yearly
prostate specific antigen (PSA) test prior to a regular digital rectal
examination. M. All female renal transplant recipients should have a yearly
cervical (PAP) smear together with regular pelvic examination and regular mammography,
according to national recommendations where available. N. All renal transplant
recipients should undergo a faecal occult-blood testing as a screening for
colorectal cancer and other (pre-malignant) lesions, according to national
recommendations where available. O. In all these conditions, it is recommended
to reduce immunosuppression whenever possible.
----------------------------------------------------
[25]
TÍTULO / TITLE: - End-stage renal disease
in India and Pakistan: burden of disease and management issues.
REVISTA
/ JOURNAL: - Kidney Int Suppl 2003 Feb;(83):S115-8.
AUTORES
/ AUTHORS: - Sakhuja V; Sud K
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Postgraduate
Institute of Medical Education and Research, Chandigarh, India. vasakhuja@glide.net.in
RESUMEN
/ SUMMARY: - In the absence of national registries, no
reliable data are available on the incidence and prevalence of end-stage renal
disease (ESRD) in India and Pakistan. The incidence of ESRD is likely to be
higher than that reported from the developed world, with chronic
glomerulonephritis being the most common cause, accounting for more than one
third of patients, while diabetic nephropathy accounts for about one fourth of
all patients in India. Patients are generally younger (mean age 42 years) at
the time of detection of ESRD and two-thirds first see a nephrologist after
they have reached end stage. Treatment of ESRD is a low priority for the
cash-strapped public hospitals and in the absence of health insurance plans,
less than 10% of all patients receive any kind of renal replacement therapy.
The vast majority of patients starting hemodialysis die or stop treatment
because of cost constraints within the first three months, and less than 2%
patients are started on ambulatory peritoneal dialysis. Although renal
transplantation is the cheapest option, only about 5% of all patients with ESRD
end up having a transplant. Living related donor transplants constitute 30 to
40% of all transplants in India, but there is a conspicuous gender bias with
female donors donating kidneys for their male relatives. Cadaveric
transplantation has yet to pick up and accounts for less than 2% of all
transplants. The enactment of legislation to regulate renal transplantation in
India has not been able to prevent unrelated (paid) donor transplants, which
constitute 60 to 70% of all renal transplants. Cyclosporine, azathioprine and
prednisolone continue to be the backbone of post-transplant immunosuppression,
with cyclosporine being stopped in a significant proportion at one year
post-transplant to cut down costs. Increasing awareness of renal disease
amongst the population and general practitioners could result in early
diagnosis of chronic renal failure and give opportunity for preventive
strategies to delay the onset of ESRD. Preemptive transplantation and use of
generic cyclosporine can help bring down the costs of treatment. Innovative and
affordable health insurance policies can also increase the number of patients
who receive effective treatment for ESRD in these two countries. N. Ref:: 10
----------------------------------------------------
[26]
TÍTULO / TITLE: - Regulatory T cells in
kidney transplant recipients: active players but to what extent?
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Jun;14(6):1706-8.
AUTORES
/ AUTHORS: - Zhai Y; Kupiec-Weglinski JW N. Ref:: 20
----------------------------------------------------
[27]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.1. Cardiovascular risks. Cardiovascular disease
after renal transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:24-5.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Post-transplant cardiovascular
disease is very common, an important cause of morbidity and the first cause of
mortality in renal transplant recipients. Therefore, detection and early
treatment of post-transplant cardiovascular disease are mandatory. B. Specific
risk factors for developing post-transplant cardiovascular disease include
pre-transplant cardiovascular disease, arterial hypertension, uraemia (graft
dysfunction), hyperlipidaemia, diabetes mellitus, smoking and immunosuppressive
treatment. These factors should be targeted for intervention. C. Pre-transplant
cardiovascular disease is a major risk factor for post-transplant
cardiovascular disease. Therefore, prior to transplantation, it is mandatory to
detect and treat symptomatic coronary artery disease, heart failure due to
valvular failure or cardiomyopathy, and pericardial constriction. This policy
should also be followed in asymptomatic diabetic patients.
----------------------------------------------------
[28]
TÍTULO / TITLE: - Interleukin 2 receptor
antagonists for kidney transplant recipients.
REVISTA
/ JOURNAL: - Cochrane Database Syst Rev
2004;1:CD003897.
●●
Enlace al texto completo (gratuito o de pago) 1002/14651858.CD003897.pub2
AUTORES
/ AUTHORS: - Webster A; Playford E; Higgins G; Chapman
J; Craig J
INSTITUCIÓN
/ INSTITUTION: - Centre for Kidney Research, The Children’s
Hospital at Westmead, Locked Bag 4001, Westmead, NSW, AUSTRALIA, 2145.
RESUMEN
/ SUMMARY: - BACKGROUND: Interleukin 2 receptor
antagonists (IL2Ra) are used as induction therapy for prophylaxis against acute
rejection in kidney transplant recipients. Use of IL2Ra has increased steadily,
with 38% of new kidney transplant recipients in the United States, and 23% in
Australasia receiving IL2Ra in 2002. OBJECTIVES: This study aims to
systematically identify and summarise the effects of using an IL2Ra, as an
addition to standard therapy, or as an alternative to other antibody therapy.
SEARCH STRATEGY: The Cochrane Renal Group’s specialised register (June 2003),
the Cochrane Controlled Trials Register (in The Cochrane Library issue 3,
2002), MEDLINE (1966-November 2002) and EMBASE (1980-November 2002). Reference
lists and abstracts of conference proceedings and scientific meetings were
hand-searched from 1998-2003. Trial groups, authors of included reports and
drug manufacturers were contacted. SELECTION CRITERIA: Randomised controlled
trials (RCTs) in all languages comparing IL2Ra to placebo, no treatment, other
IL2Ra or other antibody therapy. DATA COLLECTION AND ANALYSIS: Data was
extracted and quality assessed independently by two reviewers, with differences
resolved by discussion. Dichotomous outcomes are reported as relative risk (RR)
with 95% confidence intervals (CI). MAIN RESULTS: One hundred and seventeen
reports from 38 trials involving 4893 participants were included. Where IL2Ra
were compared with placebo (17 trials; 2786 patients), graft loss was not
significantly different at one (RR 0.83, 95% CI 0.66 to 1.04) or three years
(RR 0.88, 95% CI 0.64 to 1.22). Acute rejection (AR) was significantly reduced
at six months (RR 0.66, 95% CI 0.59 to 0.74) and at one year (RR 0.67, 95% CI
0.60 to 0.75). At one year, cytomegalovirus (CMV) infection (RR 0.82, 95% CI
0.65 to 1.03) and malignancy (RR 0.67, 95% CI 0.33 to 1.36) were not
significantly different. Where IL2Ra were compared with other antibody therapy
no significant differences in treatment effects were demonstrated, but adverse
effects strongly favoured IL2Ra. REVIEWER’S CONCLUSIONS: Given a 40% risk of
rejection, seven patients would need treatment with IL2Ra to prevent one
patient having rejection, with no definite improvement in graft or patient
survival. There is no apparent difference between basiliximab and daclizumab.
IL2Ra are as effective as other antibody therapies and with significantly fewer
side effects
----------------------------------------------------
[29]
TÍTULO / TITLE: - Calcium channel
blockers for preventing acute tubular necrosis in kidney transplant recipients.
REVISTA
/ JOURNAL: - Cochrane Database Syst Rev
2004;1:CD003421.
●●
Enlace al texto completo (gratuito o de pago) 1002/14651858.CD003421.pub2
AUTORES
/ AUTHORS: - Shilliday I; Sherif M
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Monklands Hospital, Monkscourt
Avenue, Airdrie, UK, ML6 0JS.
RESUMEN
/ SUMMARY: - BACKGROUND: The incidence of delayed graft
function in cadaveric grafts has increased over the last few years due in part
to the large demand for cadaveric kidneys necessitating the use of kidneys from
marginal donors. Calcium channel blockers have the potential to reduce the
incidence of post-transplant acute tubular necrosis (ATN) if given in the
peri-operative period. However, there is controversy surrounding their use in
this situation with no consensus as to their efficacy. OBJECTIVES: To evaluate
the benefits and harms of using calcium channel blockers in the peri-transplant
period in patients at risk of ATN following cadaveric kidney transplantation.
SEARCH STRATEGY: We searched the Cochrane Renal Group’s specialised register,
the Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane
Library issue 2, 2003) MEDLINE (1966 to January 2003) and EMBASE (1980 -
January 2003). The Trials Search Coordinator was contacted to develop the
search strategy. SELECTION CRITERIA: Randomised controlled trials comparing
calcium channel blockers given in the peri-transplant period with controls were
included. Quasi-randomised trials were excluded. DATA COLLECTION AND ANALYSIS:
Data was extracted and quality assessed independently by two reviewers, with
differences resolved by discussion. Dichotomous outcomes are reported as
relative risk (RR) and measurements on continuous scales are reported as
weighted mean differences (WMD) with 95% confidence intervals (CI). MAIN
RESULTS: Nine trials were suitable for inclusion. Treatment with calcium
channel blockers in the peri-transplant period was associated with a
significant decrease in the incidence of post transplant ATN (RR 0.57, 95%CI
0.40 to 0.82) and delayed graft function (RR 0.44, 95% CI 0.28 to 0.69). There
was no difference between control and treatment groups in graft loss,
mortality, requirement for haemodialysis. There was insufficent information to
comment on adverse events. REVIEWER’S CONCLUSIONS: These results suggest that
calcium channel blockers given in the peri-operative period may reduce the
incidence of ATN post-transplantation. The result should be treated with
caution due to the heterogeneity of the trials which made comparison of studies
and pooling of data difficult.
----------------------------------------------------
[30]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.2. Cancer risk after renal transplantation. Skin
cancers: prevention and treatment.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:31-6.
RESUMEN
/ SUMMARY: - GUIDELINES: D. Due to the high prevalence
of skin cancers after organ transplantation, it is highly recommended to inform
patients about self-awareness. E. Primary prevention should include the
avoidance of sun exposure, use of protective clothing and use of an effective
sunscreen (protection factor >15) for unclothed body parts (head, neck,
hands and arms) in order to prevent the occurrence of squamous-cell carcinoma.
This is the most frequent skin tumour in transplant recipients, and its
preferential location is the head. F. Recipients with pre-malignant skin
lesions (warts, epidermodysplasia verruciformis or actinic keratoses) should be
referred early to a dermatologist for active treatment and close follow-up. G.
All skin cancers should be completely removed by a dermatologist with
appropriate techniques, such as electro-desiccation with curettage, cryotherapy
or surgical excision. H. Secondary prevention for recipients should include
close follow-up by a dermatologist (at least every 6 months), the use of
topical retinoids to control actinic keratoses and to diminish squamous-cell
carcinoma recurrence, and reduction of immunosuppression whenever possible. I.
In recipients with multiple and/or recurrent skin cancers, the use of systemic
retinoids, such as low-dose acitretin, could be recommended for months/years,
if well tolerated, in addition to further reduction in immunosuppression
whenever possible.
----------------------------------------------------
[31]
TÍTULO / TITLE: - Multicentric papillary
renal carcinoma in renal allograft.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Aug;42(2):381-4.
AUTORES
/ AUTHORS: - DeLong MJ; Schmitt D; Scott KM; Ramakumar
S; Lien YH
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
Arizona Health Sciences Center, Tucson, AZ 85724, USA.
RESUMEN
/ SUMMARY: - A renal transplant recipient with 13 years
of excellent allograft function was found incidentally to have a malignant mass
in his transplanted kidney. After resection, pathological analysis showed 29
separate lesions of renal cell carcinoma. All tumors were confined within the
renal capsule. The majority of tumors (21 of 29 tumors) were chromophil
basophilic carcinoma with papillary architecture, 5 tumors were clear cell, 2
tumors were mixed cell type, and 1 tumor was chromophil eosinophilic papillary
carcinoma. These histological findings are similar to those reported in
hereditary papillary renal carcinoma. To our knowledge, this is the first case
of multicentric papillary renal carcinoma occurring in the renal allograft. We
speculate that the allograft in this case is predisposed to malignant changes because
of preexisting genetic mutations, as well as prolonged immunosuppression. N. Ref:: 13
----------------------------------------------------
[32]
TÍTULO / TITLE: - Review of solid-organ
transplantation in HIV-infected patients.
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 27;75(4):425-9.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000046943.35335.18
AUTORES
/ AUTHORS: - Roland ME; Stock PG
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
California, San Francisco, California, USA. mroland@php.ucsf.edu N. Ref:: 47
----------------------------------------------------
[33]
TÍTULO / TITLE: - Potential role of major
histocompatibility complex class II peptides in regulatory tolerance to
vascularized grafts.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1
Suppl):S35-7.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000106472.91343.8D
AUTORES
/ AUTHORS: - LeGuern C
INSTITUCIÓN
/ INSTITUTION: - Transplantation Biology Research Center,
Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA. leguern@helix.mgh.harvard.edu
RESUMEN
/ SUMMARY: - The inactivation of persisting T
lymphocytes reactive to self- and non-self-antigens is a major arm of
operational immune tolerance in mammals. Silencing of such T cells proceeds
mostly by means of suppression, a process that is mediated by regulatory T-cell
subsets and especially by CD4(+)CD(25high) regulatory T cells (Treg). Although
Treg activation and ensuing suppressive activity appear to be major
histocompatibility complex class II dependent, the fine specificity of Treg
T-cell receptors has not yet been elucidated. Recent data from the author’s
laboratory on a class II gene therapy induction of tolerance to allogeneic
kidney grafts suggest that class II peptides are involved as generic signals
for Treg activation. A brief compilation of results that would support this
hypothesis is discussed in the present article. N. Ref:: 31
----------------------------------------------------
[34]
TÍTULO / TITLE: - Mycophenolate mofetil
versus azathioprine therapy is associated with a significant protection against
long-term renal allograft function deterioration.
REVISTA
/ JOURNAL: - Transplantation 2003 Apr 27;75(8):1341-6.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000062833.14843.4B
AUTORES
/ AUTHORS: - Meier-Kriesche HU; Steffen BJ; Hochberg
AM; Gordon RD; Liebman MN; Morris JA; Kaplan B
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine,
University of Florida College of Medicine, Gainesville, FL 32610-0224, USA. meierhu@medicine.ufl.edu.
RESUMEN
/ SUMMARY: - BACKGROUND: To evaluate the association of
long-term continuous mycophenolate mofetil (MMF) versus azathioprine (AZA)
therapy and renal allograft function, as measured by the slope of reciprocal
creatinine, we analyzed 49,666 primary renal allograft recipients reported to the
United States Renal Data System between October 31, 1988 and June 30, 1998.
METHODS: The primary study endpoint was defined as a greater than 20% decrease
below a 6-month baseline of 1/serum creatinine (SCr) (slope of reciprocal
creatinine) at or beyond 1 year after transplantation. A secondary endpoint was
defined as reaching an SCr value greater than 1.6 mg/dL. Univariate
Kaplan-Meier analysis and multivariate Cox proportional hazard models were used
to investigate the risk of reaching the study endpoints. Multivariate analyses
were corrected for potential confounding covariates. RESULTS: According to the
Cox proportional hazard model, 12-month continued therapy of MMF versus AZA was
associated with a protective effect against declining renal function, as
measured by the slope of reciprocal creatinine (relative risk [RR]=0.84,
confidence interval 0.78-0.91, P<0.001). For 24-month continued therapy of
MMF versus AZA, MMF was associated with a further decreased risk for a decline
in renal function (RR=0.66, confidence interval=0.57-0.77, P<0.001).
Furthermore, MMF was associated with a protective effect against reaching the
SCr threshold of 1.6 mg/dL (RR=0.80, P<0.001) beyond 12 months
posttransplantation. CONCLUSIONS: Continuous use of MMF versus AZA was associated
with a protective effect against declining renal function beyond 1 year after
transplantation. Further study is needed to confirm that continued MMF therapy
is protective against long-term deterioration in renal function.
----------------------------------------------------
[35]
TÍTULO / TITLE: - Transcriptional
regulation of inflammatory genes before transplantation: a role for hypoxia
inducible factor-1alpha?
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 27;75(4):437-8.
AUTORES
/ AUTHORS: - Koo DD; Fuggle SV
INSTITUCIÓN
/ INSTITUTION: - Nuffield Department of Surgery, University
of Oxford, Oxford Transplant Centre, United Kingdom. N. Ref:: 5
----------------------------------------------------
[36]
TÍTULO / TITLE: - Liver and kidney preservation
by perfusion.
REVISTA
/ JOURNAL: - Lancet 2002 Feb 16;359(9306):604-13.
AUTORES
/ AUTHORS: - St Peter SD; Imber CJ; Friend PJ
INSTITUCIÓN
/ INSTITUTION: - Nuffield Department of Surgery, John
Radcliffe Hospital, University of Oxford, OX3 9DU, Oxford, UK.
RESUMEN
/ SUMMARY: - The clinical boundaries of transplantation
have been set in an era of simple cold storage. Research in organ preservation
has led to the development of flush solutions that buffer the harsh molecular
conditions which develop during ischaemia, and provide stored organs that are
fit to sustain life after transplantation. Although simple and efficient, this
method might be reaching its limit with respect to the duration, preservation,
and the quality of organs that can be preserved. In addition, flush
preservation does not allow for adequate viability assessment. There is good
evidence that preservation times will be extended by the provision of
continuous cellular substrate. Stimulation of in-vivo conditions by ex-vivo
perfusion could also mean that marginal organs will be salvaged for
transplantation. Perfusion will also allow for assessing the viability of
organs before transplantation in a continuous fashion. The cumulative effect of
these benefits would include expansion of the donor pool, less risk of primary
non-function, and extension of the safe preservation period. Use of
non-heart-beating donors, international organ sharing, and precise calculation
of the risk of primary organ failure could become standard. N. Ref:: 140
----------------------------------------------------
[37]
TÍTULO / TITLE: - Subcutaneous black
fungus (phaeohyphomycosis) infection in renal transplant recipients:three
cases.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1):140-2.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000107287.70512.E7
AUTORES
/ AUTHORS: - Yehia M; Thomas M; Pilmore H; Van Der
Merwe W; Dittmer I
INSTITUCIÓN
/ INSTITUTION: - Auckland Renal Transplant Group, Auckland
Hospital, Auckland, New Zealand. mahay@adhb.govt.nz
RESUMEN
/ SUMMARY: - We describe three cases of subcutaneous
phaeohyphomycosis developing in the lower limbs of renal transplant recipients
shortly after transplantation. Each case presented with dark-colored nodules
that subsequently ulcerated. Histopathologic examination revealed dematiaceous
fungal hyphae with a surrounding granulomatous reaction. The fungi were
subsequently identified as Alternaria alternatum in two cases and Phialophora
richardsiae in one case. In one case, the lesions resolved during a prolonged
(6-month) course of itraconazole without the requirement for surgical excision.
In the other two cases, combined medical and surgical treatment resulted in
cure. A review of the literature on phaeohyphomycosis is presented. N. Ref:: 11
----------------------------------------------------
[38]
TÍTULO / TITLE: - Protocol core needle
biopsy and histologic Chronic Allograft Damage Index (CADI) as surrogate end
point for long-term graft survival in multicenter studies.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Mar;14(3):773-9.
AUTORES
/ AUTHORS: - Yilmaz S; Tomlanovich S; Mathew T;
Taskinen E; Paavonen T; Navarro M; Ramos E; Hooftman L; Hayry P
INSTITUCIÓN
/ INSTITUTION: - Data Analysis Center, Division of
Transplantation, Department of Surgery, University of Calgary, Alberta, Canada.
RESUMEN
/ SUMMARY: - This study is an investigation of whether
a protocol biopsy may be used as surrogate to late graft survival in
multicenter renal transplantation trials. During two mycophenolate mofetil
trials, 621 representative protocol biopsies were obtained at baseline, 1 yr,
and 3 yr. The samples were coded and evaluated blindly by two pathologists, and
Chronic Allograft Damage Index (CADI) score was constructed. At 1 yr, only 20%
of patients had elevated (>l.5 mg/100 ml) serum creatinine, whereas 60% of
the biopsies demonstrated an elevated (>2.0) CADI score. The mean CADI score
at baseline, 1.3 +/- 1.1, increased to 3.3 +/- 1.8 at 1 yr and to 4.1 +/- 2.2
at 3 yr. The patients at 1 yr were divided into three groups, those with CADI
<2, between 2 and 3.9, and >4.0, the first two groups having normal (1.4 +/-
0.3 and 1.5 +/- 0.6 mg/dl) and the third group pathologic (1.9 +/- 0.8 mg/dl)
serum creatinine. At 3 yr, there were no lost grafts in the low CADI group, six
lost grafts (4.6%) in the in the elevated CADI group, and 17 lost grafts
(16.7%) in the high CADI group (P < 0.001). One-year histologic CADI score
predicts graft survival even when the graft function is still normal. This
observation makes it possible to use CADI as a surrogate end point in
prevention trials and to identify the patients at risk for intervention trials.
----------------------------------------------------
[39]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.4. Chronic graft dysfunction. De novo renal disease
after transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:15-6.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Acute pyelonephritis is
relatively frequent in the transplanted kidney and carries a risk of
septicaemia. The condition should be recognized and the patient should be
treated promptly in the hospital. B. After initiation of any drugs known to
induce the development of interstitial nephritis in the transplant patient, it
is recommended to monitor renal function and abnormalities in order to detect
any side effects rapidly. If interstitial nephritis is observed, it is
recommended to stop the offending drug, and to initiate appropriate treatment.
C. De novo membranous nephropathy should be considered in cases of proteinuria
and nephrotic syndrome after transplantation. Viral infection, such as HCV,
should be excluded. D. In the case of the development of graft dysfunction in a
transplant patient with Alport’s syndrome, one should consider additionally the
possibility of de novo anti-glomerular basement membrane (anti-GBM)
glomerulonephritis.
----------------------------------------------------
[40]
TÍTULO / TITLE: - Complement and the
kidney.
REVISTA
/ JOURNAL: - J Immunol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jimmunol.org/
●●
Cita: J. of Immunology: <> 2003 Oct 1;171(7):3319-24.
AUTORES
/ AUTHORS: - Quigg RJ
INSTITUCIÓN
/ INSTITUTION: - Section of Nephrology, University of
Chicago, Chicago, IL 60637, USA. rqigg@medicine.uchicago.edu N. Ref:: 94
----------------------------------------------------
[41]
TÍTULO / TITLE: - Incidence of ESRD and
survival after renal replacement therapy in patients with type 1 diabetes: a
report from the Allegheny County Registry.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Jul;42(1):117-24.
AUTORES
/ AUTHORS: - Nishimura R; Dorman JS; Bosnyak Z; Tajima
N; Becker DJ; Orchard TJ
INSTITUCIÓN
/ INSTITUTION: - Department of Epidemiology, Graduate
School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. rimei@excite.co.jp
RESUMEN
/ SUMMARY: - BACKGROUND: Little information is
available regarding the long-term incidence of end-stage renal disease (ESRD)
and survival after the introduction of renal replacement therapy (RRT) in
patients with type 1 diabetes. METHODS: We studied 1,075 patients with type 1
diabetes (onset age < 18 years) diagnosed between 1965 and 1979, who
comprise the Allegheny County population-based registry. Onset of ESRD was
defined as the introduction of RRT (dialysis or transplantation). RESULTS: Of
1,075 registrants, the living status of 975 patients (90.7%) and complication
status of 798 patients (74.2%) were ascertained as of January 1, 1999. During
the observation period, 104 patients (13.0%) developed ESRD, for an incidence
rate of 521/100,000 person-years (95% confidence interval, 424 to 629). The
cumulative incidence of ESRD was 11.3% at 25 years of diabetes. A significant
decline was observed in 20-year cumulative incidence rates of ESRD for patients
diagnosed between 1965 and 1969, 1970 and 1974, and 1975 and 1979 (9.1%, 4.7%,
and 3.6%, respectively; P = 0.006). Of 104 patients with ESRD, 29 patients
(28%) received dialysis alone, 44 patients (42%) received dialysis followed by
kidney transplantation, 26 patients (25%) underwent successful transplantation
alone, and 5 patients (5%) underwent a failed kidney transplantation followed
by dialysis therapy. The cumulative survival rate 10 years after the
introduction of RRT was 51.2%. The cumulative survival rate of dialysis therapy
followed by kidney transplantation was significantly greater than that of
dialysis therapy alone (P < 0.001). No difference was detected in survival
between pancreas-kidney transplant recipients and kidney-alone transplant recipients
(P = 0.7). CONCLUSION: The incidence of ESRD observed in this cohort has
declined, probably reflecting the better glycemic and blood pressure control
available since the early 1980s. N.
Ref:: 35
----------------------------------------------------
[42]
TÍTULO / TITLE: - The economic value of
valacyclovir prophylaxis in transplantation.
REVISTA
/ JOURNAL: - J Infect Dis. Acceso gratuito al texto
completo a partir de los 2 años de la publicación; - http://www.journals.uchicago.edu/
●●
Cita: J. of Infectious Diseases: <> 2002 Oct 15;186 Suppl 1:S116-22.
AUTORES
/ AUTHORS: - Squifflet JP; Legendre C
INSTITUCIÓN
/ INSTITUTION: - University Clinic Saint Luc, 1200
Brussels, Belgium. Jean-Paul.Squifflet@chir.ucl.ac.be
RESUMEN
/ SUMMARY: - Cytomegalovirus (CMV) infection and
disease, with its extensive direct and indirect consequences, adds considerably
to the cost of patient management in both solid organ and bone marrow
transplantation. Antiviral prophylaxis for CMV infection can offer cost
advantages over preemptive therapy and “wait-and-treat” approaches.
Valacyclovir has demonstrated efficacy for CMV prophylaxis in renal, heart, and
bone marrow transplantation and is cost-effective when compared with placebo in
renal transplant recipients at high risk of CMV infection. In reducing CMV
infection and disease, valacyclovir prophylaxis appears to be associated with
reductions in indirect effects of CMV (acute graft rejection, other
opportunistic infections) and, if these effects are considered, the potential
exists for even greater savings to be made with valacyclovir therapy. Benefits
of valacyclovir in transplantation extend beyond CMV to other herpesviruses and
may be increased in some clinical situations by prolonging prophylaxis beyond 3
months. N. Ref:: 32
----------------------------------------------------
[43]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.13 Analysis of patient and graft survival.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:60-7.
RESUMEN
/ SUMMARY: - GUIDELINES: A. It is important for a
transplant unit to follow-up on the results of their transplant activities. In
order to achieve correct reports on graft and patient outcome in all patients,
it is necessary to have sufficient resources, such as a computerized database,
and continuous updates of patient information. All data collected should be
subjected to validation procedures to ensure completeness and accuracy. B.
Improved outcomes following implementation of new protocols, based on
evaluation of clinical multi-centre trials, should be verified at local
transplant centres since centres often include a range of patients different
from those selected for the trial. C. The most widely accepted descriptor of
outcome is the Kaplan-Meier probability estimate of patient and graft survival.
Survival estimates should be calculated at intervals of time after
transplantation and should always be expressed with their 95% confidence
intervals. D. Kaplan-Meier survival estimates may be calculated in three ways.
(i) ‘Patient survival’ should be calculated from the date of transplantation to
the date of death or the date of the last follow-up. (ii) ‘Graft survival’
(non-censored for death) should be calculated from the date of transplantation
to the date of irreversible graft failure signified by return to long-term dialysis
(or retransplantation) or the date of the last follow-up during the period when
the transplant was still functioning or to the date of death. Here, death with
graft function is treated as graft failure. (iii) ‘Graft survival censored for
death with a functioning graft’ (death-censored graft survival) should be
calculated from the date of transplantation to the date of irreversible graft
failure signified by return to long-term dialysis (or retransplantation) or the
date of last follow-up during the period when the transplant was still
functioning. In the event of death with a functioning graft, the follow-up
period is censored at the date of death. E. The outcome of transplants carried
out at a centre should be compared with those achieved across a range of data
from centres collated by national and international multi-centre registries.
Interpretation of a centre’s performance should take into account the number of
transplants performed and the prevalence of major risk factors. F. Major risk
factors that influence transplant outcome are identifiable by applying
multivariate analytical methods to large multi-centre follow-up databases.
Although these major risk factors may not be identifiable in individual centre
data, they should nonetheless be taken into account in patient management. G.
When designing a clinical trial or evaluating data from a recent trial, the
expected improvement in graft survival resulting from a reduction in acute
rejection may be estimated from a knowledge of the rejection and graft survival
rates that existed prior to the introduction of the new therapeutic regimen. H.
When designing or evaluating a clinical trial, it is important to analyse the
power of the study to verify statistically the difference (in graft survival)
that might be expected and its statistical significance. A study resulting in
absence of statistically significant differences between two treatment groups
with insufficient statistical power to verify a difference at the expected
level should not be taken as evidence of absence of a true difference.
----------------------------------------------------
[44]
TÍTULO / TITLE: - Treatment of
HCV-related liver diseases after renal transplantation: modern views.
REVISTA
/ JOURNAL: - Int J Artif Organs 2003 May;26(5):373-82.
AUTORES
/ AUTHORS: - Fabrizi F; Bunnapradist S; Aucella F;
Lunghi G; Martin P
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Maggiore Hospital,
IRCCS, Milano, Italy. fabrizi@policlinico.mi.it N. Ref:: 76
----------------------------------------------------
[45]
TÍTULO / TITLE: - Renal function as a
predictor of long-term graft survival in renal transplant patients.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 May;18 Suppl 1:i3-6.
AUTORES
/ AUTHORS: - First MR
INSTITUCIÓN
/ INSTITUTION: - Research and Development, Fujisawa
Healthcare, Inc., Deerfield, IL 60015, USA. roy_first@fujisawa.com
RESUMEN
/ SUMMARY: - Acute rejection is a major risk factor for
kidney graft failure. However, as acute rejection has been progressively
reduced by recent immunosuppressive regimens, other risk factors are becoming
increasingly important. Evidence is accumulating that early renal function
predicts long-term outcome. A recent registry survey of more than 100 000
kidney transplants found that 6- and 12-month serum creatinine levels, as well
as the change between 6 and 12 months, are strongly associated with long-term
graft survival. A survey of paediatric renal transplant recipients showed that
poor creatinine clearance (<50 ml/min) as early as 30 days post-transplant
predicted an annual rate of graft loss of 13% compared with <3% in patients
with 30-day clearance >50 ml/min. This association between early renal
function and long-term outcome was confirmed in multicentre studies. Renal
transplant recipients (n=572) with 6-month serum creatinine levels >1.5
mg/dl suffered 3-year graft loss of 19.3% compared with only 8.5% in patients
with levels <1.6 mg/dl (P<0.001). Significantly fewer patients receiving
tacrolimus had 12-month serum creatinine levels >1.5 mg/dl compared with
cyclosporin (42 versus 54%, P<0.05). Interestingly, a single-centre study
(n=436) found that while glomerular filtration rate (GFR) at 6 months
post-transplant had remained stable over the last decade, the rate of loss of
renal function had decreased. A lower rate of GFR loss was associated with
absence of rejection, use of mycophenolate mofetil rather than azathioprine and
use of tacrolimus rather than cyclosporin (P<0.01). In conclusion, early
measures of renal function allow identification of those patients at highest
risk of graft failure and provide an invaluable tool for improving outcomes by
tailored immunosuppression. The choice of such immunosuppression should be
guided not only by its ability to prevent rejection, but also by its impact on
renal function. N.
Ref:: 11
----------------------------------------------------
[46]
TÍTULO / TITLE: - Postmenopausal
tubo-ovarian abscess due to Pseudomonas aeruginosa in a renal transplant
patient: a case report and review of the literature.
REVISTA
/ JOURNAL: - Transplantation 2001 Oct 15;72(7):1241-4.
AUTORES
/ AUTHORS: - El Khoury J; Stikkelbroeck MM; Goodman A;
Rubin RH; Cosimi AB; Fishman JA
INSTITUCIÓN
/ INSTITUTION: - Infectious Disease Division, GRJ 504,
Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Pseudomonas aeruginosa is an
uncommon cause of infection in the female genital tract. We report a case of
postmenopausal tubo-ovarian abscess (TOA) due to P. aeruginosa in a renal
transplant recipient. The presentation included mild abdominal symptoms with
rapid progression of peritonitis and surgical abscess drainage. This is the
first such case in an organ transplant recipient described in the English
literature. METHODS AND RESULTS: Published reports of 1040 cases of TOA were
reviewed. The most common features were a history of sexually transmitted
disease or pelvic inflammatory disease, and symptoms including abdominal pain
and fever. Escherichia coli, Bacteroides spp., and Klebsiella pneumoniae were
the most frequently encountered pathogens. Neisseria gonorrhoeae and Chlamydia
trachomatis, which are frequently isolated from cervical cultures, are
uncommonly isolated from tubo-ovarian abscesses. Forty percent of patients were
treated with antibiotics alone, 18.8% with abdominal surgery, and 32% with
surgery and antimicrobial therapy. CONCLUSION: This report illustrates the muted
presentation and atypical microbiology of gynecologic infection in an organ
transplant recipient. N.
Ref:: 59
----------------------------------------------------
[47]
- Castellano -
TÍTULO / TITLE:Polimorfismo del receptor de la
vitamina D y enfermedad osea postrasplante renal. Polymorphism of the vitamin D
receptor and bone disease after renal transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2001;21 Suppl 1:56-60.
AUTORES
/ AUTHORS: - Torres A; Barrios Y; Salido E
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia y, Hospital
Universitario de Canarias, Instituto Reina Sofia de Investigacion Nefrologica,
Tenerife, España. atorres@ull.es N. Ref:: 29
----------------------------------------------------
[48]
TÍTULO / TITLE: - Immunosuppression
minimization: current and future trends in transplant immunosuppression.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Jul;14(7):1940-8.
AUTORES
/ AUTHORS: - Vincenti F
INSTITUCIÓN
/ INSTITUTION: - Kidney Transplant Service, University of
California-San Francisco, 505 Parnassus Avenue, M884, San Francisco, CA
94143-0780, USA. vincentif@surgery.ucsf.edu N. Ref:: 54
----------------------------------------------------
[49]
TÍTULO / TITLE: - Management of the
waiting list for cadaveric kidney transplants: report of a survey and
recommendations by the Clinical Practice Guidelines Committee of the American
Society of Transplantation.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2002 Feb;13(2):528-35.
AUTORES
/ AUTHORS: - Danovitch GM; Hariharan S; Pirsch JD; Rush
D; Roth D; Ramos E; Starling RC; Cangro C; Weir MR
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, University of
California, Los Angeles, School of Medicine, Los Angeles, California 90025,
USA. gdanovitch@mednet.ucla.edu
RESUMEN
/ SUMMARY: - The Clinical Practice Guidelines Committee
of the American Society of Transplantation developed a survey to review the
policies of kidney transplant programs in the United States with respect to the
management of the steadily expanding waiting list for cadaveric kidneys. The
survey was sent to 287 centers, and 192 (67%) responded. The survey indicated
that regular follow-up monitoring, most frequently on an annual basis, is
required by the majority (71%) of programs. Patients considered to be at high
risk and candidates for combined kidney-pancreas transplantation may be
monitored more frequently. Annual screening for coronary artery disease is
typically required for asymptomatic patients considered to be at high risk for
covert disease. Noninvasive techniques are typically used, and a designated
cardiologist is usually available to the transplant program. The dialysis
nephrologist or the potential transplant recipient is expected to inform the
transplant program of intercurrent events that may affect transplant candidacy.
Standard health maintenance screening is required, together with the routine
updating of serologic and other blood tests that may be relevant to the
posttransplant course. Smaller transplant programs (<100 patients on the
waiting list) are more likely to maintain closer contact with the wait-listed
patients and to attempt to influence their treatment during dialysis and are
less likely to cancel transplants because of unanticipated pretransplant
medical problems. The work load necessitated by the follow-up monitoring of
wait-listed patients was assessed and, in the absence of specific
evidence-based information, a series of recommendations were developed to
reflect current standards of practice and to suggest future research
initiatives.
----------------------------------------------------
[50]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.8. Cardiovascular risks. Immunosuppressive therapy.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:30-1.
RESUMEN
/ SUMMARY: - GUIDELINE: Immunosuppressive therapies,
especially corticosteroids and anticalcineurin inhibitors; contribute to the
prevalence of cardiovascular risk factors, such as arterial hypertension,
hyperlipidaemia and hyperglycaemia, and this effect is dose dependent.
Reduction of the dose, withdrawal and/or switching to another drug could be
useful to control these risk factors.
----------------------------------------------------
[51]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.6. Chronic graft dysfunction. Late recurrence of
other diseases.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:18-9.
RESUMEN
/ SUMMARY: - GUIDELINES: A. In the rare case of
recurrent lupus nephritis, no particular treatment is recommended. Only in the
few patients with clinically evident flare up is a reinforcement of
immunosuppression recommended. B. Recurrence of Henoch-Schonlein purpura may
occur even in the absence of clinical signs and symptoms. The prognosis for the
graft may be severe, particularly in adults. C. In the case of recurrent
ANCA-associated renal or systemic vasculitis, it is recommended to reinforce
the immunosuppression with appropriate agents. D. Since diabetic nephropathy
recurs almost invariably after transplantation, strict control of diabetes and
hypertension, and the use of ACE inhibitors and/or angiotensin II receptor
antagonists are recommended in order to prevent or slow the risk of recurrence.
----------------------------------------------------
[52]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.1. Organization of follow-up of transplant patients
after the first year.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:3-4.
RESUMEN
/ SUMMARY: - GUIDELINES: A. All renal transplant
recipients should undergo regular laboratory check-ups (at least every 2 or 3
months) and regular medical visits as out-patients (at least every 4-6 months)
after the first year post-transplant. B. All renal transplant recipients should
be seen at least once a year in the transplant centre where the transplantation
has been performed or referred to a closer transplant centre for a complete
annual evaluation.
----------------------------------------------------
[53]
TÍTULO / TITLE: - Nonmelanoma skin cancer
in organ transplant patients.
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 15;75(3):253-7.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000044135.92850.75
AUTORES
/ AUTHORS: - Jemec GB; Holm EA
INSTITUCIÓN
/ INSTITUTION: - Division of Dermatology, Department of
Medicine, Roskilde Hospital, 4000 Roskilde, Denmark. ccc2845@vip.cybercity.dk
RESUMEN
/ SUMMARY: - Nonmelanoma skin cancer (NMSC) is more
frequent in immunocompromised patients, for example, patients with organ
transplants. A number of studies have been published from different countries
that present a similar picture of tumors in transplant patients. In addition,
the behavior of these tumors is often more aggressive in this group of
high-risk patients. The multitude of NMSC and precancerous lesions presents a
clinical diagnostic and therapeutic challenge to the managing dermatologists.
Technology is being developed to cope with the clinical diagnosis and medical
adjunct treatment to broaden the therapeutic options. It is suggested that the
optimal use of these new developments occurs if patients are seen in
specialized clinics aimed at providing preventive measures, diagnosis, and
treatment. N. Ref:: 50
----------------------------------------------------
[54]
TÍTULO / TITLE: - Ambulatory blood
pressure measurement in kidney transplantation: an overview.
REVISTA
/ JOURNAL: - Transplantation 2003 Dec 15;76(11):1643-4.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000091289.03300.1A
AUTORES
/ AUTHORS: - Tomson CR
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine, Southmead
Hospital, Bristol, UK. charlie.tomson@north-bristol.swest.nhs.uk
RESUMEN
/ SUMMARY: - Adequate control of hypertension is among
the most important aims of medical management of the kidney transplant
recipient, with the aim of reducing the risk of premature cardiovascular
disease and preserving graft function. Antihypertensive therapy should be
adjusted according to the best available estimates of usual resting blood
pressure. If clinic measurements are used, care should be taken to ensure that
these measurements are taken under optimal conditions. Home blood pressure
monitoring is a useful adjunct in many patients. Ambulatory blood pressure
monitoring gives valuable additional data; mean ambulatory blood pressure
correlates better with markers of target organ damage such as left ventricular
hypertrophy. However, current treatment thresholds and targets are based on
clinic measurements. Ambulatory blood pressure monitoring is certainly a useful
adjunct to clinic and home blood pressure measurement, but its role in routine
clinical practice in the transplant clinic remains to be defined. N. Ref:: 11
----------------------------------------------------
[55]
TÍTULO / TITLE: - European best practice guidelines
for renal transplantation. Section IV: Long-term management of the transplant
recipient. IV.3.2. Long-term immunosuppression. Therapy conversion.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:20-1.
RESUMEN
/ SUMMARY: - GUIDELINE: Conversion of immunosuppressive
drug therapy is recommended to avoid or reduce drug-specific adverse effects,
and is generally safe for long-term graft outcome.
----------------------------------------------------
[56]
- Castellano -
TÍTULO / TITLE:Linfoma de prostata secundario en
paciente trasplantado renal. Secondary prostatic lymphoma in a kidney
transplant patient.
REVISTA
/ JOURNAL: - Actas Urol Esp. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aeu.es/actas/
●●
Cita: Actas Urológicas Españolas: <> 2002 Jun;26(6):429-31.
AUTORES
/ AUTHORS: - Mallen Mateo E; Trivez Boned MA; Garcia
Garcia MA; Sancho Serrano C; Allepuz Losa C; Rioja Sanz LA
INSTITUCIÓN
/ INSTITUTION: - Servicio de Urologia, Hospital
Universitario Miguel Servet, Zaragoza.
RESUMEN
/ SUMMARY: - Lymphoma involving the prostate is rare,
both as a primary and as a secondary presenting. Usually the prognosis remains
poor. The clinical presentation is similar to that of other lower urinary tract
obstructions, in fact prostatic lymphoma must be considered in patients with
these symptoms, particularly in patients with prior history of systemic lymphoma.
We report a case of a kidney transplantation in a male patient, diagnosis of
lymphoma non Hodgkin, with later recurrence in prostate. N. Ref:: 6
----------------------------------------------------
[57]
TÍTULO / TITLE: - Disseminated ochroconis
gallopavum infection in a renal transplant recipient: the first reported case
and a review of the literature.
REVISTA
/ JOURNAL: - Clin Nephrol 2003 Dec;60(6):415-23.
AUTORES
/ AUTHORS: - Wang TK; Chiu W; Chim S; Chan TM; Wong SS;
Ho PL
INSTITUCIÓN
/ INSTITUTION: - Centre of Infection, Department of
Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR,
China.
RESUMEN
/ SUMMARY: - Ochroconis gallopavum is a potentially
fatal dematiaceous fungus causing opportunistic infections in immunocompromised
hosts. We report the first case of disseminated O. gallopavum infection in a
13-year-old renal transplant recipient, which involved the brain, lung and
spleen. He was treated with amphotericin B, itraconazole and voriconazole, a
new antifungal agent first used to treat such an infection. Besides antifungal
treatment, all immunosuppressive agents were stopped and automated peritoneal
dialysis was resumed. The initial infection was under control with both
clinical and radiological improvements after treatment. However, the patient
later acquired Acremonium spp. peritonitis; he failed to respond to high-dose
amphotericin B, and finally succumbed. A total of 13 reported O. gallopavum
human infections, including the one described here, are reviewed. The most
common site of involvement is the brain and the crude mortality rate is up to
46%. As the disease is potentially lethal in immunocompromised hosts, empirical
antifungal coverage should be considered in post-renal transplant recipients
with suspected brain abscess. Early biopsy of lesion for histopathological and
microbiological diagnosis would be essential in managing such cases. N. Ref:: 23
----------------------------------------------------
[58]
TÍTULO / TITLE: - Bone disease after
renal transplantation.
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 15;75(3):315-25.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000043926.74349.6D
AUTORES
/ AUTHORS: - Heaf JG
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology B, Copenhagen
University Hospital in Herlev, Denmark. heaf@dadlnet.dk
RESUMEN
/ SUMMARY: - Bone disease is common after renal
transplantation. The main syndromes are bone loss with a consequent fracture
rate of 3% per year, osteonecrosis of the hip, and bone pain. The causes of
disease include preexisting uremic osteodystrophy (hyperparathyroidism,
aluminum osteomalacia, beta2-associated amyloidosis, and diabetic osteopathy),
postoperative glucocorticoid therapy, poor renal function, and ongoing
hyperparathyroidism, as the result of either autonomous transformation of the
parathyroid gland or ongoing physiologic stimuli. Cyclosporine A treatment,
hyperphosphaturia, and a pathogenic vitamin D allele have also been implicated.
Bone loss is particularly pronounced during the first year after operation,
amounting to up to 9% of bone mass. The clinical and biochemical picture is
consistent with a high turnover bone disease, but histomorphometric studies do
not completely support this. Principal prophylactic options include
preoperative osteodystrophy prophylaxis; postoperative calcium, vitamin D, or
calcitriol therapy; estrogen therapy for postmenopausal women; and parathyroidectomy
for medically intractable hyperparathyroidism. Recently, prophylactic
biphosphonate treatment has shown promise, but the exact indications for
treatment remain to be determined. N.
Ref:: 221
----------------------------------------------------
[59]
- Castellano -
TÍTULO / TITLE:La influencia de los factores
geneticos en la patogenesis de dislipidemias posteriores al trasplante renal.
The effect of genetic factors on the pathogenesis of the dyslipidemias
following kidney transplantation.
REVISTA
/ JOURNAL: - Rev Invest Clin. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.imbiomed.com/
●●
Cita: Revista de Investigacion Clinica: <> 2002 Sep-Oct;54(5):472-3.
AUTORES
/ AUTHORS: - Lerman Garber I
INSTITUCIÓN
/ INSTITUTION: - Departamento de Endocrinologia y
Metabolismo, Instituto Nacional de Ciencias Medicas y Nutricion Salvador
Zubiran. lerman@netservice.com.mx N. Ref:: 11
----------------------------------------------------
[60]
TÍTULO / TITLE: - Frequency and impact of
nonadherence to immunosuppressants after renal transplantation: a systematic
review.
REVISTA
/ JOURNAL: - Transplantation 2004 Mar 15;77(5):769-76.
AUTORES
/ AUTHORS: - Butler JA; Roderick P; Mullee M; Mason JC;
Peveler RC
INSTITUCIÓN
/ INSTITUTION: - University Mental Health Group, Royal
South Hants Hospital, Southampton, United Kingdom. jab7@soton.ac.uk
RESUMEN
/ SUMMARY: - Nonadherence to immunosuppressants is
recognized to occur after renal transplantation, but the size of its impact on
transplant survival is not known. A systematic literature search identified 325
studies (in 324 articles) published from 1980 to 2001 reporting the frequency
and impact of nonadherence in adult renal transplant recipients. Thirty-six
studies meeting the inclusion criteria for further review were grouped into
cross-sectional and cohort studies and case series. Meta-analysis was used to
estimate the size of the impact of nonadherence on graft failure. Only two
studies measured adherence using electronic monitoring, which is currently
thought to be the most accurate measure. Cross-sectional studies (n=15) tended
to rely on self-report questionnaires, but these were poorly described; a
median (interquartile range) of 22% (18%-26%) of recipients were nonadherent.
Cohort studies (n=10) indicated that nonadherence contributes substantially to
graft loss; a median (interquartile range) of 36% (14%-65%) of graft losses
were associated with prior nonadherence. Meta-analysis of these studies showed
that the odds of graft failure increased sevenfold (95% confidence interval,
4%-12%) in nonadherent subjects compared with adherent subjects. Standardized
methods of assessing adherence in clinical populations need to be developed,
and future studies should attempt to identify the level of adherence that
increases the risk of graft failure. However, this review shows nonadherence to
be common and to have a large impact on transplant survival. Therefore, significant
improvements in graft survival could be expected from effective interventions
to improve adherence.
----------------------------------------------------
[61]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.8. Bone disease.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:43-8.
RESUMEN
/ SUMMARY: - GUIDELINES: A. All kidney-transplanted
patients should undergo a systematic evaluation of their skeletal status,
including pre-transplant history of renal osteodystrophy, history of fractures
and plasma concentrations of calciotropic hormones and other parameters, and if
possible measurement of bone mineral density (BMD). B. Glucocorticoid therapy
should be given at the lowest possible dosage. As long as patients are
receiving steroids, vitamin D treatment (ergocalciferol or
1,25-dihydroxyvitamin D) is highly recommended. C. Optimal prevention of bone
disease by vitamin D treatment, sufficient calcium intake, sex hormone
substitution and appropriate use of thiazide diuretics should be considered in
all transplant patients. D. In established osteopenia, bisphosphonate treatment
should be considered despite limited information in transplant recipients. E.
Persistent tertiary hyperparathyroidism should be observed for 1 year after
transplantation whenever possible to allow for a spontaneous involution. F. In
patients with GFR <50 ml/min after transplantation, uraemic osteodystrophy
should be prevented.
----------------------------------------------------
[62]
TÍTULO / TITLE: - Solid organ
transplantation in patients with HIV infection.
REVISTA
/ JOURNAL: - Transplantation 2001 Jul 27;72(2):177-81.
AUTORES
/ AUTHORS: - Gow PJ; Pillay D; Mutimer D
INSTITUCIÓN
/ INSTITUTION: - Liver and Hepatobiliary Unit, Third Floor,
Nuffield House, Queen Elizabeth Hospital, Birmingham, England. N. Ref:: 43
----------------------------------------------------
[63]
TÍTULO / TITLE: - A benefit-risk
assessment of basiliximab in renal transplantation.
REVISTA
/ JOURNAL: - Drug Saf. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.csmwm.org/
●●
Cita: Drug Safety: <> 2004;27(2):91-106.
AUTORES
/ AUTHORS: - Boggi U; Danesi R; Vistoli F; Del Chiaro
M; Signori S; Marchetti P; Del Tacca M; Mosca F
INSTITUCIÓN
/ INSTITUTION: - Division of General Surgery and
Transplants, Department of Oncology, Transplants and Advanced Technologies in
Medicine, University of Pisa, Pisa, Italy. uboggi@med.unipi.it
RESUMEN
/ SUMMARY: - Interleukin-2 (IL-2) and its receptor
(IL-2R) play a central role in T lymphocyte activation and immune response
after transplantation. Research on the biology of IL-2R allowed the
identification of key signal transduction pathways involved in the generation
of proliferative and antiapoptotic signals in T cells. The alpha-chain of the
IL-2R is a specific peptide against which monoclonal antibodies have been
raised, with the aim of blunting the immune response by means of inhibiting
proliferation and inducing apoptosis in primed lymphocytes. Indeed,
basiliximab, one of such antibodies, has proved to be effective in reducing the
episodes of acute rejection after kidney and pancreas transplantation. The use
of basiliximab was associated with a significant reduction in the incidence of
any treated rejection episodes after kidney transplantation in the two major
randomised studies (placebo 52.2% vs basiliximab 34.2% at 6 months, European
study; placebo 54.9% vs basiliximab 37.6% at 1 year, US trial). Basiliximab and
equine antithymocyte globulin (ATG) administration resulted in a similar rate
of biopsy-proven acute rejection at 6 months (19% for both) and at 12 months
(19% and 20%, respectively). The use of basiliximab appears not to be
associated with an increased incidence of adverse events as compared with
placebo in immunosuppressive regimens, including calcineurin inhibitors,
mycophenolate mofetil or azathioprine and corticosteroids, and its safety
profile is superior to ATG. Moreover, a similar occurrence of infections is
noted in selected studies (65.5% after basiliximab vs 65.7% of controls),
including cytomegalovirus infection (17.3% vs 14.5%), and cytokine-release
syndrome is not observed. Finally, economic analysis demonstrated lower costs
of overall treatment in patients treated with basiliximab. Therefore, the use
of basiliximab entails a very low risk, allows safe reduction of corticosteroid
dosage and reduces the short- and mid-term rejection rates. However, the
improvement in the long-term survival of kidney grafts in patients treated
according to modern immunosuppressive protocols is still to be demonstrated.
These conclusions are based on a systematic review of the scientific
literature, indexed on Medline database, concerning the mechanism of action,
therapeutic activity, safety and pharmacoeconomic evaluation of basiliximab in
renal transplantation. N.
Ref:: 62
----------------------------------------------------
[64]
TÍTULO / TITLE: - New immunosuppressive
agent: expectations and controversies.
REVISTA
/ JOURNAL: - Transplantation 2003 Mar 27;75(6):741-2.
AUTORES
/ AUTHORS: - Alsina J; Grinyo JM
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Bellvitge
Hospital, Barcelona, España. N.
Ref:: 5
----------------------------------------------------
[65]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.7.1 Late infections. Pneumocystis carinii pneumonia.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:36-9.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Approximately 5% of
patients develop Pneumocystis carinii pneumonia (PCP) after renal
transplantation if they do not receive prophylaxis. PCP is a severe disease,
with a very high fatality rate. Therefore, all renal transplant recipients
should receive PCP prophylaxis. The treatment of choice is
trimethoprim-sulfamethoxazole (TMP-SMX), at a dose of 80/400 mg/day or 160/800
mg every other day, for at least 4 months. Patients who are treated for
rejection should receive TMP-SMX prophylaxis for 3-4 months. B. In the case of
TMP-SMX intolerance, aerosolized pentamidine (300 mg once or twice per month)
is an alternative for prophylaxis. C. The first-line treatment of PCP is
high-dose TMP-SMX. Patients with a PaO2 of <70 mmHg initially should be
treated parenterally, and the administration of additional steroids should be
considered.
----------------------------------------------------
[66]
TÍTULO / TITLE: - Updated protocol for
the examination of specimens from patients with carcinoma of the urinary
bladder, ureter, and renal pelvis.
REVISTA
/ JOURNAL: - Arch Pathol Lab Med. Acceso gratuito al
texto completo.
●●
Enlace a la Editora de la Revista http://arpa.allenpress.com/
●●
Cita: Archives of Pathology & Laboratory Medicine: <> 2003
Oct;127(10):1263-79.
AUTORES
/ AUTHORS: - Amin MB; Srigley JR; Grignon DJ; Reuter
VE; Humphrey PA; Cohen MB; Hammond ME
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, Emory University
Hospital, Atlanta, Ga, USA.
----------------------------------------------------
[67]
TÍTULO / TITLE: - Renal transplantation
in HBsAg+ patients: is lamivudine your “final answer”?
REVISTA
/ JOURNAL: - J Clin Gastroenterol 2003 Jul;37(1):9-11.
AUTORES
/ AUTHORS: - Fontana RJ N. Ref:: 30
----------------------------------------------------
[68]
- Castellano -
TÍTULO / TITLE:Aneurisma disecante de la arteria
renal en paciente trasplantado. Presentacion de un caso. Revision de la
literatura. Dissecting aneurysm of the renal artery in patient with
transplantation. Report of a case. Review of the literature.
REVISTA
/ JOURNAL: - Arch Esp Urol 2003 Nov;56(9):1059-62.
AUTORES
/ AUTHORS: - Canovas Ivorra J; Guardiola Mas A; Nicolas
Torralba JA; Jimeno Garcia L; Llorente Vinas S; Garcia Hernandez JA; Polo Perez
J; Banon Perez V
INSTITUCIÓN
/ INSTITUTION: - Servicio de Urologia, Hospital
Universitario Virgen de la Arrixaca, Murcia, España.
RESUMEN
/ SUMMARY: - OBJECTIVES: Aneurysmatic processes of the
renal artery after transplant are rare entities, generally secondary to
technical defects or infectious pictures. Among other presentations, dissecting
aneurysm are exceptional, having a particularly difficult diagnosis due to the
lack of specific clinical data which could differentiate them from other
processes such as graft rejection or acute tubular necrosis, as well as the
absence of characteristic representative images. METHODS: We report one case of
dissecting aneurysm after a kidney transplant resulting in graft loss. RESULTS:
We analyze the presentation form, diagnostic procedures, pathologic studies,
and possible therapeutic options. CONCLUSIONS: Dissecting aneurysm of the renal
artery is a rare entity of difficult diagnosis due to the poorness of
presenting symptoms and the difficulty of finding it in routine tests, being
necessary to think of it and to perform angiography as the only diagnostic
test. Treatment is carried out by hilar reconstruction or transplant
nephrectomy when the former is not possible.
N. Ref:: 10
----------------------------------------------------
[69]
TÍTULO / TITLE: - De novo minimal change
disease associated with reversible post-transplant nephrotic syndrome. A report
of five cases and review of literature.
REVISTA
/ JOURNAL: - Clin Transplant 2002 Oct;16(5):350-61.
AUTORES
/ AUTHORS: - Zafarmand AA; Baranowska-Daca E; Ly PD;
Tsao CC; Choi YJ; Suki WN; Truong LD
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, Renal Section,
Baylor College of Medicine and the Methodist Hospital, Houston, TX 77030, USA.
RESUMEN
/ SUMMARY: - Nephrotic syndrome (NS) is frequent in
renal transplant recipients and may be related to a large variety of glomerular
lesions. In some of these cases, the transplant biopsy showed no significant
glomerular changes and the NS was reversible, but the primary renal disease was
not minimal change disease (MCD), suggesting that MCD may develop de novo in
renal transplant setting. Knowledge of this entity, however, is limited. Among
67 cases of post-transplant NS encountered in a 12-yr period, five were found
to be associated with de novo MCD. A critical review of the literature revealed
nine additional cases of de novo MCD. The data from these 14 cases show that
patients with de novo MCD had a large variety of primary renal diseases but MCD
or focal segmental glomerulosclerosis was not among them. Eight of the 14
transplanted kidneys (60%) were from living related donors, suggesting this as
a risk factor. Nephrotic range proteinuria (3-76 g/d) developed immediately or
shortly after transplantation (within 4 months for all reported cases, except
for one at 24 months). The serum creatinine when NS was first diagnosed was
normal or mildly elevated, but acute renal failure occurred in three patients.
On biopsy, the glomeruli were normal or, more frequently, displayed mild, focal
segmental mesangial sclerosis, hypercellularity, deposition of IgM/C3, or
accumulation of mononuclear inflammatory cells in some glomerular capillaries.
The tubulointerstitial compartment was normal in cases with normal renal
function; displayed mild acute and/or chronic rejection that correlated with a
mildly elevated serum creatinine; or showed acute changes including acute
rejection, acute tubular necrosis, or acute cyclosporin A toxicity, which
accounted for both acute renal failure at presentation and its subsequent
reversibility. Under various treatments, including increased steroids,
angiotensin converting enzyme inhibitors, calcium channel blockers and
angiotensin receptor blockers, sustained remission of NS was achieved in 13
cases, within a year (0.5-12 months) in 10 and later (24, 34 and 98 months,
respectively) in three. In the remaining case, the patient died of septic shock
2 months after transplantation. After remission of the NS, the grafts
functioned well without or with minimal proteinuria for several years. De novo
MCD has characteristic clinical and pathologic features. It represents an
important but hitherto underemphasized cause of post-transplant NS, which is
potentially reversible and does not adversely affect the renal transplants. N. Ref:: 37
----------------------------------------------------
[70]
TÍTULO / TITLE: - Infectious disease
prophylaxis in renal transplant patients: a survey of US transplant centers.
REVISTA
/ JOURNAL: - Clin Transplant 2002 Feb;16(1):1-8.
AUTORES
/ AUTHORS: - Batiuk TD; Bodziak KA; Goldman M
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Indiana University
Medical Center, Indianapolis, USA. tbatiuk@iupui.edu
RESUMEN
/ SUMMARY: - Definitive approaches to most infectious
diseases following renal transplantation have not been established, leading to
different approaches at different transplant centers. To study the extent of
these differences, we conducted a survey of the practices surrounding specific
infectious diseases at US renal transplant centers. A survey containing 103
questions covering viral, bacterial, mycobacterial and protozoal infections was
developed. Surveys were sent to program directors at all U.S. renal transplant
centers. Responses were received from 147 of 245 (60%) transplant centers and
were proportionately represented all centers with respect to program size and
geographical location. Pre-transplant donor and recipient screening for
hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus
(HIV) and cytomegalovirus (CMV) is uniform, but great discrepancy exists in the
testing for other agents. HCV seropositive donors are used in 49% of centers.
HIV seropositivity remains a contraindication to transplantation, although 13%
of centers indicated they have experience with such patients. Post-transplant,
there is wide variety in approach to CMV and Pneumocystis carinii (PCP)
prophylaxis. Similarly divergent practices affect post-transplant vaccinations,
with 54% of centers routinely vaccinating all patients according to customary
guidelines in non-transplant populations. In contrast, 22% of centers indicated
they do not recommend vaccination in any patients. We believe an appreciation
of the differences in approaches to post-transplant infectious complications
may encourage individual centers to analyse the results of their own practices.
Such analysis may assist in the design of studies to answer widespread and
important questions regarding the care of patients following renal transplantation. N. Ref:: 38
----------------------------------------------------
[71]
TÍTULO / TITLE: - Graft function and
other risk factors as predictors of cardiovascular disease outcome.
REVISTA
/ JOURNAL: - Transplantation 2001 Sep 27;72(6
Suppl):S16-9.
AUTORES
/ AUTHORS: - Forsythe JL
INSTITUCIÓN
/ INSTITUTION: - Transplant Unit, The Royal Infirmary of
Edinburgh, UK. john.forsythe@luht.scot.nhs.uk
RESUMEN
/ SUMMARY: - The high incidence of cardiovascular
disease after renal transplantation is related to a high prevalence and
accumulation of risk factors before and after transplantation. Hypertension,
posttransplantation diabetes, and hyperlipidemia are well-recognized risk
factors for the development of cardiovascular events after renal
transplantation and are strongly associated with immunosuppressive therapy.
Hyperhomocysteinemia is a potential risk factor for cardiovascular disease in
renal transplant recipients, but although a growing matter of study, a direct
association with immunosuppressive agents is not yet proven. In addition to
treatment intervention, risk management should also involve tailoring the
immunosuppressive regimen to minimize the more indirect cardiovascular risk
factors such as renal dysfunction and acute rejection. N. Ref:: 41
----------------------------------------------------
[72]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.2. Cardiovascular risks. Arterial hypertension.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:25-6.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Arterial hypertension is
often present after renal transplantation and is of multifactorial origin. Pre-transplant
arterial hypertension, chronic allograft nephropathy and immunosuppressive
therapy are the most frequent causes of post-transplant arterial hypertension.
Careful monitoring and treatment of high blood pressure are recommended
following transplantation. B. Post-transplant arterial hypertension is
associated with an increased incidence of cardiovascular disease in renal
transplant patients and is an independent risk factor for graft failure.
Therefore, blood pressure control (<130/85 mmHg for renal transplant
recipients without proteinuria, and <125/75 mmHg for proteinuric patients)
is mandatory in these patients. General measures and pharmacological
intervention are necessary in many cases. In proteinuric patients,
anti-hypertensive and anti-proteinuric agents could be used, and stricter blood
pressure control is recommended. C. In patients with uncontrolled arterial
hypertension and/or renal function deterioration, underlying causes should be
excluded, especially transplant renal artery stenosis.
----------------------------------------------------
[73]
TÍTULO / TITLE: - Fragility fractures in
dialysis and transplant patients. Is it osteoporosis, and how should it be
treated?
REVISTA
/ JOURNAL: - Perit Dial Int 2001;21 Suppl 3:S247-55.
AUTORES
/ AUTHORS: - Hodsman AB
INSTITUCIÓN
/ INSTITUTION: - University of Western Ontario and Division
of Nephrology, London Health Sciences Centre, Canada. Anthony.hodsman@sjhc.london.on.ca
RESUMEN
/ SUMMARY: - The term “osteoporosis” must be applied
with caution to the uremic population, which has a complex range of metabolic
bone disease. Trials of therapeutic interventions to prevent fractures in non
uremic populations with osteoporosis cannot be generalized to uremic patients.
It is unclear what, if any, role systematic bone densitometry measurement can
play in the management of uremic patients who suffer “fragility”
fractures—either for diagnostic purposes or to determine the effectiveness of
therapy. Estrogen therapy—and perhaps SERMs (raloxifene)--appear to be a
reasonable addition to conventional management of secondary HPT with calcium
salts and vitamin D analogs. Using bisphosphonates to manage patients who have
pre-existing fractures should be considered experimental at best. In certain
circumstances, such treatment may be harmful. While the evidence is better that
early therapy with intravenous pamidronate in the peri-transplant interval may
mitigate the steroid-induced bone loss seen in those patients during the first
12 postoperative months, even that indication needs to be subjected to
systematic clinical studies to develop appropriate clinical practice
guidelines. N. Ref:: 48
----------------------------------------------------
[74]
TÍTULO / TITLE: - Clinicopathological
evaluation of renal allografts of four patients by 20-year protocol biopsies.
REVISTA
/ JOURNAL: - Clin Transplant 2003;17 Suppl 10:20-4.
AUTORES
/ AUTHORS: - Okamoto M; Nobori S; Higuchi A; Kadotani
Y; Ushigome H; Nakamura K; Akioka K; Omori Y; Yoshimura N
INSTITUCIÓN
/ INSTITUTION: - Department of Transplantation and
Endocrine Surgery, Kyoto Prefectural University of Medicine, Kyoto 602, Japan. amoto@koto.kpu-m.ac.jp
RESUMEN
/ SUMMARY: - Twenty-year protocol biopsies were
performed in four cases of renal transplant recipients with grafts that had
survived 20 years or more. All four recipients received transplants from their
parents, and never had episodes of acute rejection. They were maintained with
the conventional immunosuppressive protocol including azathioprine, mizoribine,
and prednisolone. Three of them had past history of malignant diseases such as
breast cancer and tongue cancer. In spite of fair graft function, the microscopic
findings of 20-year protocol biopsy showed various degrees of histological
damage; e.g. obsolescence of the glomeruli, glomerulosclerosis, arteriole wall
thickening, interstitial fibrosis and tubular atrophy. Although two of the four
grafts were functioning with low serum creatinine levels (1.3-1.4 mg dL-1) at
24 years and 26 years following transplantation, respectively, the function of
the other two grafts had decreased more than 20 years after transplantation. In
the two grafts with decreased function, glomerulosclerosis and arteriole wall
thickening tended to be more severe (Banff classification of chronic allograft
nephropathy [CAN] grade II and III) at the 20-year protocol biopsy compared
with the two well-functioning grafts (CAN grade I and II). We conclude that the
protocol biopsies even at 20 years can contribute to predict the fate of renal
allografts.
----------------------------------------------------
[75]
TÍTULO / TITLE: - Current treatment
strategies in ANCA-positive renal vasculitis-lessons from European randomized
trials.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Jul;18 Suppl 5:v2-4.
AUTORES
/ AUTHORS: - Tesar V; Rihova Z; Jancova E; Rysava R;
Merta M
INSTITUCIÓN
/ INSTITUTION: - First Medical Department, First Medical
Faculty, Charles University, Prague, Czech Republic. tesar@beba.cesnet.cz
RESUMEN
/ SUMMARY: - Antineutrophil cytoplasmic antibody (ANCA)-positive
renal vasculitis is the most common cause of rapidly progressive (crescentic)
glomerulonephritis. Its life-threatening natural course may be modified
substantially by current treatment modalities. The European Vasculitis Study
Group (EUVAS) developed a subclassification of ANCA-positive vasculitides based
on the disease severity at presentation, and have organized (so far) two waves
of clinical trials. The first wave of randomized clinical trials had the aim of
optimizing the existing therapeutic regimens; the second wave concentrated on
testing some newer therapeutic approaches. Here, the design and available
results of the first wave and the design of some second wave trials are
reviewed briefly. The potential of the new targeted approaches (e.g.
anti-tumour necrosis factor therapy) is also briefly mentioned. N. Ref:: 9
----------------------------------------------------
[76]
TÍTULO / TITLE: - How should the
immunosuppressive regimen be managed in patients with established chronic
allograft failure?
REVISTA
/ JOURNAL: - Kidney Int Suppl 2002 May;(80):68-72.
AUTORES
/ AUTHORS: - Danovitch GM
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, UCLA School of
Medicine, USA. gdanovitch@mednet.ucla.edu N. Ref:: 25
----------------------------------------------------
[77]
TÍTULO / TITLE: - Angiotensin II type 1
(AT1) receptor antagonists in the treatment of hypertension after renal
transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001;16 Suppl 1:117-20.
AUTORES
/ AUTHORS: - Holgado R; Anaya F; Del Castillo D
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Hospital Reina
Sofia, 14012 Cordoba, España.
RESUMEN
/ SUMMARY: - Hypertension is highly prevalent after
renal transplantation and has been associated with lower graft survival.
Optimum management of post-transplant hypertension remains to be defined.
Losartan, a potent, orally active and selective non-peptide blocker of the
angiotensin subtype 1 receptor, could represent a useful drug for treating
post-transplant hypertension. Recently, a prospective study of 12 weeks
treatment with losartan has showed a satisfactory control of arterial
hypertension associated with a decrease in proteinuria in this high-risk group
of renal transplant patients. A retrospective study was performed to review the
role of losartan as a renoprotective agent (evaluating blood pressure and
proteinuria) in renal transplant recipients in a long-term follow-up. A total
of 150 transplant recipients were included in the study. None of the patients
had a serum creatinine >3 mg/dl, or suspected renal artery stenosis, or
other severe concomitant diseases. The indication for losartan therapy was
hypertension, proteinuria and/or post-transplant erythrocytosis. The values of
blood pressure, results of fasting haematology, blood chemistry and total proteinuria
in 24-h urine samples were recorded at the time of initiation of losartan
therapy, 6 and 3 months before the start, and at 3, 6, 12, 18 and 24 months
thereafter. A tendency analysis by linear regression comparing two slopes
before and after treatment was realized. A decrease in mean blood pressure and
proteinuria, from 106.7+/-0.9 to 98.2+/-2.1 mmHg and from 1253.9+/-188 to
91.2+/-33.7 mg/24 h, P<0.05, respectively, was observed after introduction
of losartan. A progressive increase in creatinine clearance was observed after
the third month of losartan treatment. No significant changes were seen in
haematocrit or serum potassium levels. We can conclude that a progressive
decrease in mean arterial pressure associated with a decrease in proteinuria was
observed during long-term follow-up. Based on the capacity of losartan to
improve renal function, this drug could be decisive for the treatment and
prevention of chronic allograft nephropathy.
N. Ref:: 32
----------------------------------------------------
[78]
TÍTULO / TITLE: - Calcineurin-free
protocols with basiliximab induction allow patients included in “old to old”
programs achieve standard kidney transplant function.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Jun;35(4):1326-7.
AUTORES
/ AUTHORS: - Emparan C; Laukotter M; Wolters H; Dame C;
Heidenreich S; Senninger N
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, Uniklinikum Munster, Munster, Germany. cemparan@teleline.es
RESUMEN
/ SUMMARY: - INTRODUCTION: The EuroTransplant “old to
old” program establishes that patients older than 60 years can receive offers
of organs from donors older than 60 years. The compromised function of these
organs makes it a priority to preserve their initial kidney function.
HYPOTHESIS: Calcineurin-sparing protocols using anti-IL-2 receptor (IL-2R)
antibody induction (Simulect) may benefit initial kidney function in these
patients, as assessed by the rates of delayed graft function and of rejection
during the first month after transplant. PATIENTS AND METHODS: A cohort of 15
consecutive elderly patients were prospectively compared with 30 cadaveric
kidney transplants in younger recipients. Study patients were induced with
Simulect (20 mg, 30 minutes before reperfusion and 4 days after
transplantation) and steroids, delaying the introduction of CsA until the serum
creatinine was below 3 mg/dL. The other cohort of patients were
immunosuppressed with tacrolimus (trough 8 to 12), mycophenolats mofetil (MMF,
1 g/d), and an identical taper of steroids. The analysis compared donor and
recipient ages, mean cold ischemic time, incidence of initial kidney function
(diuresis in the first 24 h) serum creatinine levels, glomerular filtration
rate (GFR), number of dialysis sessions, and rejection rate in the two groups.
RESULTS: Except for the donor and recipient ages (72 vs 54 in donors, and 67
versus 52 years in recipients), no significant differences were observed
between the groups among the rates of acute rejection (6.6% vs 13.2%), delayed
graft function (13.2% required dialysis), or infection (6.6%). Within 1 month
all 45 grafts showed primary function with equal creatinine levels (mean 1.65).
CONCLUSIONS: Calcineurin-free protocols using IL-2 therapy as the initial
suppression allow patients in the “old to old” ET program to display equal
results to cadaveric kidney transplants with initial treatment with calcineurin
antagonists.
----------------------------------------------------
[79]
TÍTULO / TITLE: - ACE inhibitors and AII
receptor antagonists in the treatment and prevention of bone marrow transplant
nephropathy.
REVISTA
/ JOURNAL: - Curr Pharm Des 2003;9(9):737-49.
AUTORES
/ AUTHORS: - Moulder JE; Fish BL; Cohen EP
INSTITUCIÓN
/ INSTITUTION: - Department of Radiation Oncology, Medical
College of Wisconsin, Milwaukee, WI 53226, USA. jmoulder@its.mcw.edu
RESUMEN
/ SUMMARY: - Radiation nephropathy has emerged as a
major complication of bone marrow transplantation (BMT) when total body
irradiation (TBI) is used as part of the regimen. Classically, radiation
nephropathy has been assumed to be inevitable, progressive, and untreatable.
However, in the early 1990’s, it was demonstrated that experimental radiation
nephropathy could be treated with a thiol-containing ACE inhibitor, captopril.
Further studies showed that enalapril (a non-thiol ACE inhibitor) was also
effective in the treatment of experimental radiation nephropathy, as was an AII
receptor antagonist. Studies also showed that ACE inhibitors and AII receptor
antagonists were effective in the prophylaxis of radiation nephropathy.
Interestingly, other types of antihypertensive drugs were ineffective in
prophylaxis, but brief use of a high-salt diet in the immediate
post-irradiation period decreased renal injury. A placebo-controlled trial of
captopril to prevent BMT nephropathy in adults is now underway. Since excess
activity of the renin-angiotensin system (RAS) causes hypertension, and
hypertension is a major feature of radiation nephropathy; an explanation for
the efficacy of RAS antagonism in the prophylaxis of radiation nephropathy
would be that radiation leads to RAS activation. However, current studies favor
an alternative explanation, namely that the normal activity of the RAS is
deleterious in the presence of radiation injury. On-going studies suggest that
efficacy of RAS antagonists may involve interactions with a radiation-induced
decrease in renal nitric oxide activity or with radiation-induced tubular cell
proliferation. We hypothesize that while prevention (prophylaxis) of radiation
nephropathy with ACE inhibitors, AII receptor antagonists, or a high-salt diet
work by suppression of the RAS, the efficacy of ACE inhibitors and AII receptor
antagonists in treatment of established radiation nephropathy depends on blood
pressure control. N.
Ref:: 108
----------------------------------------------------
[80]
TÍTULO / TITLE: - Clinical epidemiology
of cardiac disease in renal transplant recipients.
REVISTA
/ JOURNAL: - Semin Dial 2003 Mar-Apr;16(2):106-10.
AUTORES
/ AUTHORS: - Rigatto C
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Section of
Nephrology, St. Boniface General Hospital, University of Manitoba, Winnipeg,
Canada. crigatto@sbgh.mb.ca
RESUMEN
/ SUMMARY: - Cardiovascular disease (CVD) is the major
cause of death among renal transplant recipients (RTRs), accounting for 17-50%
of deaths. Both cardiomyopathy (congestive heart failure [CHF] and left
ventricular hypertrophy [LVH]) and ischemic heart disease (IHD) are important
complications of renal transplantation, although the morbid impact of
cardiomyopathy has been overlooked until recently. Echocardiographic disorders
and clinical CHF occur far more frequently in RTRs than in the general
population, suggesting that renal transplantation may be a state of accelerated
heart failure. In contrast, the incidence of IHD in RTRs is similar to that in
the Framingham cohort. Age, diabetes, and gender remain important markers of
risk for both disorders. Smoking, hyperlipidemia, and hypertension appear to be
the major reversible risk factors for IHD, while anemia and hypertension are
major reversible risk factors for cardiomyopathy. Definitive evidence on
optimal intervention is lacking. Clinical trials are needed to define optimum
targets for treatment of these risk factors, especially hypertension and
anemia. N. Ref:: 33
----------------------------------------------------
[81]
TÍTULO / TITLE: - Mycophenolate mofetil:
implications for the treatment of glomerular disease.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001 Sep;16(9):1752-6.
AUTORES
/ AUTHORS: - Badid C; Desmouliere A; Laville M
INSTITUCIÓN
/ INSTITUTION: - Departement de Nephrologie et EA645,
Universite Claude Bernard, Hopital Edouard Herriot, 5 place d’Arsonval, F-69437
Lyon Cedex 03, France. N.
Ref:: 44
----------------------------------------------------
[82]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.7. Cardiovascular risks. Obesity and weight gain.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:29-30.
RESUMEN
/ SUMMARY: - GUIDELINE: Obesity (BMI >30 kg/m2) and
weight gain are associated with increased prevalence of cardiovascular disease
after transplantation. Appropriate dietary and lifestyle measures should be
recommended to these patients.
----------------------------------------------------
[83]
TÍTULO / TITLE: - Renal dopaminergic
mechanisms in renal parenchymal diseases and hypertension.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001;16 Suppl 1:53-9.
AUTORES
/ AUTHORS: - Pestana M; Jardim H; Correia F;
Vieira-Coelho MA; Soares-da-Silva P
INSTITUCIÓN
/ INSTITUTION: - Departments of Nephrology, and Institute
of Pharmacology and Therapeutics, Faculty of Medicine, 4200 Porto, Portugal.
RESUMEN
/ SUMMARY: - The present report addresses the status of
the renal dopaminergic system activity in patients afflicted with different
renal disorders and in the remnant kidney of uninephrectomized (UNX) rats,
based on the urinary excretion of L-DOPA, dopamine and amine metabolites. In
renal transplant recipients with good recovery of graft function (group 1,
n=11), the daily urinary excretion of DOPAC, but not that of HVA, was found to
increase progressively throughout the first 12 days post-transplantation from
698+/-57 nmol in the first day to 3498+/-414 nmol on day 9, and then remained
constant until day 12. This resulted in a 6-fold increase in the urinary
DOPAC/dopamine ratios. In renal transplant recipients with acute tubular
necrosis (group 2, n=8), the urinary levels of dopamine, DOPAC and HVA were
approximately 30% of those in group 1. In a group of 28 patients with chronic
renal parenchymal disorders, the daily urinary excretion of L-DOPA, free
dopamine and dopamine metabolites (DOPAC and HVA) correlated positively with
the degree of deterioration of renal function (P<0.01). However, the
U(Dopamine/(L)-DOPA) and U(DOPAC/Dopamine) ratios in patients with chronic
renal insufficiency were found to be similar to those observed in patients with
normal renal function. In 14 IgA nephropathy (IgA-N) patients with near normal
renal function, the changes in 24 h mean blood pressure when going from 20 to
350 mmol/day sodium intake correlated negatively with the daily urinary
excretion of dopamine (r(2)=0.597, P<0.01). The urinary excretion of L-DOPA
and dopamine in IgA-N patients with salt-sensitive (SS) blood pressure was
lower than in salt-resistant (SR) patients (P<0.05), irrespective of their
daily sodium intake. However, the rise in urinary dopamine output during salt
loading (from 20 to 350 mmol/day) was greater (P<0.05) in IgA-N SS patients
(21.2+/-2.5% increase) than in SR patients (6.3+/-1.4% increase). Fifteen days
after the surgery, uninephrectomy (UNX) in the rat was accompanied by an
enhanced (P<0.05) urinary excretion of dopamine (36+/-3 vs 26+/-2), DOPAC
(124+/-11 vs 69+/-6) and HVA (611+/-42 vs 354+/-7) (nmol/g kidney/kg body
weight). This was accompanied by an increase in V(max) values for renal
aromatic L-amino acid decarboxylase in the remnant kidney of UNX rats
(P<0.05). Sch 23390, a D1 dopamine receptor antagonist, produced a marked
reduction in the urinary excretion of sodium in UNX rats, whereas in
sham-operated rats the decrease in urinary sodium did not attain a significant
difference. It is concluded that the study of the renal dopaminergic system in
patients afflicted with renal parenchymal disorders should address parameters
other than free urinary dopamine, namely the urinary excretion of L-DOPA and
dopamine metabolites (DOPAC and HVA). It is also suggested that in SS
hypertension of chronic renal parenchymal diseases, renal dopamine produced in
the residual tubular units may be enhanced during a sodium challenge, thus
behaving appropriately as a compensatory natriuretic hormone. N. Ref:: 25
----------------------------------------------------
[84]
TÍTULO / TITLE: - Costs and consequences
of cytomegalovirus disease.
REVISTA
/ JOURNAL: - Am J Health Syst Pharm 2003 Dec 1;60(23
Suppl 8):S5-8.
AUTORES
/ AUTHORS: - Schnitzler MA
INSTITUCIÓN
/ INSTITUTION: - Washington University, 4547 Clayton
Avenue, Box 8084, St. Louis, MO 63110, USA. schnitz@wueconc.edu
RESUMEN
/ SUMMARY: - The impact of prophylactic oral
ganciclovir therapy on the incidence of cytomegalovirus (CMV) disease, patient
and graft survival, and costs in patients receiving kidney and liver
transplants is described. CMV disease is a common cause of morbidity and
mortality in solid organ transplant recipients unless prophylactic drug therapy
is used. Prophylactic oral ganciclovir therapy reduces the incidence of CMV
disease in kidney and liver transplant recipients. It is more effective for
recipients who are seronegative before the transplant and receive organs from
seronegative (D-/R-) donors than in seronegative recipients of organs from
seropositive (D+/R-) donors. CMV disease remains a problem in the latter. CMV
disease increases the risk of graft failure, which decreases the likelihood of
patient survival. The extent of matching of the DR subregion of the human
leukocyte antigen complex in the donor and recipient may affect graft survival
in patients with CMV disease. Graft failure is costly and should be considered
in economic analyses of CMV prophylaxis regimens because of the potential
impact of prophylaxis on CMV disease. The use of oral ganciclovir for CMV prophylaxis
has reduced the incidence of CMV disease in kidney and liver transplant
recipients. N. Ref:: 10
----------------------------------------------------
[85]
TÍTULO / TITLE: - Health economic
evaluations: the special case of end-stage renal disease treatment.
REVISTA
/ JOURNAL: - Med Decis Making 2002
Sep-Oct;22(5):417-30.
AUTORES
/ AUTHORS: - Winkelmayer WC; Weinstein MC; Mittleman
MA; Glynn RJ; Pliskin JS
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Brigham and
Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. wolfgang@post.harvard.edu
RESUMEN
/ SUMMARY: - This article synthesizes the evidence on
the cost-effectiveness of renal replacement therapy and discusses the findings
in light of the frequent practice of using the cost-effectiveness of
hemodialysis as a benchmark of societal willingness to pay. The authors
conducted a meta-analytic review of the medical and economic literature for
economic evaluations of hemodialysis, peritoneal dialysis, and kidney
transplantation. Cost-effectiveness ratios were translated into 2000 U.S.
dollars per life-year (LY) saved. Thirteen studies published between 1968 and
1998 provided such information. The cost effectiveness of center hemodialysis
remained within a narrow range of $55,000 to $80,000/LY in most studies despite
considerable variation in methodology and imputed costs. The cost-effectiveness
of home hemodialysis was found to be between $33,000 and $50,000/LY. Kidney transplantation,
however, has become more cost-effective over time, approaching $10,000/LY.
Estimates of the cost per life-year gained from hemodialysis have been
remarkably stable over the past 3 decades, after adjusting for price levels.
Uses of the cost-effectiveness ratio of $55,000/LY for center hemodialysis as a
lower boundary of society’s willingness to pay for an additional life-year can
be supported under certain assumptions.
----------------------------------------------------
[86]
TÍTULO / TITLE: - The spectrum of kidney
disease in American Indians.
REVISTA
/ JOURNAL: - Kidney Int Suppl 2003 Feb;(83):S3-7.
AUTORES
/ AUTHORS: - Narva AS
INSTITUCIÓN
/ INSTITUTION: - Indian Health Service Kidney Disease
Program, Albuquerque, New Mexico, USA. anarva@abq.ihs.gov
RESUMEN
/ SUMMARY: - American Indians and Alaska Natives
(AI/AN) experience high rates of chronic kidney disease. Several studies have
demonstrated increased rates of early kidney disease among AI/AN, both in
diabetics and non-diabetics. Among some tribes of the American Southwest, high
rates of mesangiopathic glomerulonephritis have been documented. The epidemic
of diabetes among AI/AN, which began in the middle of the 20th
century, appears to be driving the increase in end-stage renal disease (ESRD).
At the end of 1999, AI/AN had a national prevalence rate of treated ESRD that
was 3.5 times greater than that of white Americans. There is significant
regional variation as well as differences among the approximately 550 tribes
that make up the American Indian community, with some tribes experiencing ESRD
rates over twenty times the rate of whites. Although graft survival is
excellent, AI/AN ESRD patients are less likely than whites to be placed on the
transplant waiting list, and those listed wait longer for a transplant. Despite
socioeconomic barriers and high rates of co-morbid illness, survival among
AI/AN ESRD patients is better than among whites. The burden of kidney disease,
particularly the multigenerational occurrence in some families, is perceived as
a major threat to the well-being of native communities. There is a sense of
urgency among tribal leaders to address this epidemic, and research that may
decrease its burden is likely to be welcomed.
N. Ref:: 13
----------------------------------------------------
[87]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.3.4. Long-term immunosuppression. Non-compliance.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:23-4.
RESUMEN
/ SUMMARY: - GUIDELINES: A. The detection of
non-compliers should be a permanent concern of the transplant team (doctors,
nurses and others). B. Because non-compliance is associated with late graft
dysfunction and graft loss, it is important to reduce the proportion of
non-compliers by implementing specific educational programmes addressing this
problem and the importance of immunosuppressive medications. C. Non-compliance
starts during the first year and may increase thereafter. Therefore, the
specific educational programme should be repeated and adapted to the need of
the transplant recipient, with delivery of few but clear messages.
----------------------------------------------------
[88]
TÍTULO / TITLE: - Protocol for the
examination of specimens from patients with Wilms tumor (nephroblastoma) or
other renal tumors of childhood.
REVISTA
/ JOURNAL: - Arch Pathol Lab Med. Acceso gratuito al
texto completo.
●●
Enlace a la Editora de la Revista http://arpa.allenpress.com/
●●
Cita: Archives of Pathology & Laboratory Medicine: <> 2003
Oct;127(10):1280-9.
AUTORES
/ AUTHORS: - Qualman SJ; Bowen J; Amin MB; Srigley JR;
Grundy PE; Perlman EJ
INSTITUCIÓN
/ INSTITUTION: - Department of Laboratory Medicine,
Children’s Hospital, Columbus, Ohio 43205, USA. qualmans@pediatrics.ohio-state.edu
----------------------------------------------------
[89]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.4. Cardiovascular risks. Post-transplant diabetes
mellitus.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:28.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Post-transplant diabetes
mellitus (PTDM) should be identified by regular (every 3 months) fasting blood
glucose and/or glycated haemoglobin (HbA1c) measurements. PTDM should be
treated as appropriate to achieve normoglycaemia. B. Immunosuppressive therapy
should be adjusted to reverse or ameliorate PTDM.
----------------------------------------------------
[90]
TÍTULO / TITLE: - What is the renal
replacement method of first choice for intensive care patients?
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2001 Feb;12 Suppl
17:S40-3.
AUTORES
/ AUTHORS: - Vanholder R; Van Biesen W; Lameire N
INSTITUCIÓN
/ INSTITUTION: - Nephrology Unit, Department of Internal
Medicine, University Hospital, Gent, Belgium. raymond.vanholder@rug.ac.be
RESUMEN
/ SUMMARY: - Renal replacement therapy for the patient
with acute renal failure on the intensive care unit can be offered in several
different formats: intermittent hemodialysis (IHD), continuous renal
replacement therapy (CRRT), and slow low-efficient daily dialysis (SLEDD). It
is frequently claimed that CRRT offers several advantages over IHD, but most of
these, such as correction of metabolic acidosis, better recovery of renal
function, better clinical outcome due to application of biocompatible dialysis
membranes, correction of malnutrition, and better removal of cytokines, are not
corroborated by the results of controlled prospective studies. There is also no
evidence that CRRT results in a better survival, compared with IHD. The only
potential advantages of CRRT that stood the test of clinical evaluation
(hemodynamic stability, correction of hypervolemia, better solute removal) can
be offered as well by SLEDD. In addition, the latter strategy is less expensive
because the same infrastructure is used as for IHD, while the patient is not
immobilized continuously, which leaves time free for other activities such as
nursing care and technical investigations. SLEDD is a relatively young
technique, so thorough clinical studies are lacking. Nevertheless, the
hypothesis is proposed that SLEDD offers a valuable alternative to the
classical dialysis strategies, applied in the intensive care patient. N. Ref:: 25
----------------------------------------------------
[91]
TÍTULO / TITLE: - Protocol biopsy of the
stable renal transplant: a multicenter study of methods and complication rates.
REVISTA
/ JOURNAL: - Transplantation 2003 Sep 27;76(6):969-73.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000082542.99416.11
AUTORES
/ AUTHORS: - Furness PN; Philpott CM; Chorbadjian MT;
Nicholson ML; Bosmans JL; Corthouts BL; Bogers JJ; Schwarz A; Gwinner W; Haller
H; Mengel M; Seron D; Moreso F; Canas C
INSTITUCIÓN
/ INSTITUTION: - Clinical Sciences Laboratories, Leicester
General Hospital, Leicester, United Kingdom.
RESUMEN
/ SUMMARY: - BACKGROUND: Clinical trials in renal
transplantation must use surrogate markers of long-term graft survival if
conclusions are to be drawn at acceptable speed and cost. Morphologic changes
in transplant biopsies provide the earliest available evidence of damage, and
“protocol” biopsies from stable grafts can be used to reduce the number of
patients needed in clinical trials. This approach has been inhibited by
concerns over safety, but the risk of biopsy of a stable kidney, with no active
inflammation or acute functional impairment, has never been formally estimated.
METHODS: In accordance with a predefined set of questions, a retrospective
audit of a sequential series of protocol biopsies was performed in four major
transplant centers. RESULTS: A total of 2,127 biopsy events were assessed for
major complications, and 1,486 were assessed for minor ones. There were no
deaths. One graft was lost, under circumstances indicating that the loss should
have been prevented. Three episodes of hemorrhage required direct intervention.
Three further patients required transfusion. There were two episodes of
peritonitis, but one was arguably an unrelated event. All serious complications
presented within 4 hr of biopsy. CONCLUSIONS: The incidence of clinically
significant complications after protocol biopsy of a stable renal transplant is
low. Direct benefits to the patients concerned (irrespective of the benefit
that may accrue in clinical trials) were not formally assessed but seem likely
to outweigh the risk of the procedure. We believe that it is ethically
justifiable to ask renal transplant recipients to undergo protocol biopsies in
clinical trials and routine care.
----------------------------------------------------
[92]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.3. Cardiovascular risks. Hyperlipidaemia.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:26-8.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Hyperlipidaemia risk
profiles should be identified by regular screening (at least once a year) for
cholesterol, HDL-cholesterol, LDL-cholesterol and triglyceride blood levels in
renal transplant patients. B. In renal transplant patients, hyperlipidaemia
must be treated in order to keep the cholesterol/lipid levels within
recommended limits according to the number of risk factors. C. Management of
hyperlipidaemia after renal transplantation should be the same as for the
dialysis population, with, in addition, modification of the immunosuppressive
protocol when appropriate. D. Patients should be carefully monitored for
adverse effects of lipid-lowering agents or interactions with immunosuppressive
drugs.
----------------------------------------------------
[93]
- Castellano -
TÍTULO / TITLE:Analisis estadistico de la
incidencia de canceres “de novo” en pacientes trasplantados renales: una nueva
metodologia de estudio. Statistic analysis of “de novo” cancer incidence in
renal transplant patients: a new study methodology.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2003 Sep-Oct;23(5):395-8.
AUTORES
/ AUTHORS: - Virto J; Orbe J; Lampreabe I; Zarraga S;
Urbizu JM; Gainza FJ
INSTITUCIÓN
/ INSTITUTION: - Departamento de Econometria y Estadistica
de la Facultad de Ciencias Economicas y Empresariales, Servicio de Nefrologia,
Unidad docente, Hospital de Cruces, Baracaldo.
N. Ref:: 16
----------------------------------------------------
[94]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.3.1 Long-term immunosuppression. Late steroid or
cyclosporine withdrawal.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:19-20.
RESUMEN
/ SUMMARY: - GUIDELINES: A. In order to reduce or avoid
long-term serious adverse effects of corticosteroids, such as bone fractures,
diabetes mellitus, arterial hypertension, osteoporosis and eye complications,
steroid withdrawal should be considered. B. Steroid withdrawal is safe only in
a proportion of graft recipients and is recommended only in low-risk patients.
The efficacy of the remaining immunosuppression should be considered. C. After
steroid withdrawal, graft function has to be monitored very carefully because
of the risk of a delayed but continuous loss of function due to chronic graft
dysfunction. In the case of functional deterioration or dysfunction, steroids
should be re-administered. D. Cyclosporine withdrawal might be considered in
order to ameliorate nephrotoxicity, arterial hypertension, lipid disorders and
hypertrichosis. This can be carried out with no significant long-term risk of progressive
graft loss. The efficacy of the remaining immunosuppression should be
considered. After cyclosporine withdrawal, careful monitoring for acute
rejection is recommended.
----------------------------------------------------
[95]
TÍTULO / TITLE: - Angiopoietin growth
factors and Tie receptor tyrosine kinases in renal vascular development.
REVISTA
/ JOURNAL: - Pediatr Nephrol 2001 Feb;16(2):177-84.
AUTORES
/ AUTHORS: - Woolf AS; Yuan HT
INSTITUCIÓN
/ INSTITUTION: - Nephro-Urology Unit, Institute of Child
Health, University College London, UK. a.woolf@ich.ucl.ac.uk
RESUMEN
/ SUMMARY: - Angiopoietin-1 (Ang-1) is a secreted
growth factor which binds to and activates the Tie-2 receptor tyrosine kinase.
The factor enhances endothelial cell survival and capillary morphogenesis, and
also limits capillary permeability. Ang-2 binds the same receptor but fails to
activate it: hence, it is a natural inhibitor of Ang-1. Ang-2 destabilises
capillary integrity, facilitating sprouting when ambient vascular endothelial
growth factor (VEGF) levels are high, but causing vessel regression when VEGF
levels are low. Tie-1 is a Tie-2 homologue but its ligands are unknown.
Angiopoietin and Tie genes are expressed in the mammalian metanephros, the
precursor of the adult kidney, where they may play a role in endothelial
precursor growth. Tie-1-expressing cells can be detected in the metanephros
when it first forms and, based on transplantation experiments, these precursors
contribute to the generation of glomerular capillaries. During glomerular
maturation, podocyte-derived Ang-1 and mesangial-cell-derived Ang-2 may affect
growth of nascent capillaries. After birth, vasa rectae acquire their mature
configuration and Ang-2 expressed by descending limbs of loops of Henle would
be well placed to affect the growth of this medullary microcirculation.
Finally, preliminary data implicate angiopoietins in deregulated vessel growth
in Wilms’ kidney tumours and in vascular remodelling after nephrotoxicity. N. Ref:: 64
----------------------------------------------------
[96]
TÍTULO / TITLE: - Steroid-resistant
kidney transplant rejection: diagnosis and treatment.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2001 Feb;12 Suppl
17:S48-52.
AUTORES
/ AUTHORS: - Bock HA
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Kantonsspital,
Aarau, Switzerland. bock@ksa.ch
RESUMEN
/ SUMMARY: - Decreases in transplant function may be
attributable to a variety of conditions, including prerenal and postrenal
failure, cyclosporin A (CsA) toxicity, polyoma nephritis, recurrent
glomerulonephritis, and rejection. The diagnosis of rejection should therefore
be made on the basis of a transplant biopsy of adequate size, before the
initiation of any therapy. Pulse steroid treatment (three to five 0.25- to
1.0-g pulses of methylprednisolone, administered intravenously) is the usual
first-line therapy and has a 60 to 70% success rate, although orally
administered prednisone (0.25 g) may be just as efficacious. Even if reverted,
any rejection should trigger an at least temporary increase in basal
immunosuppression, consisting of an increase in CsA or tacrolimus target
levels, the addition of steroids or an increase in their dosage, the addition
of mycophenolate mofetil, or a switch from CsA to tacrolimus. The addition of
rapamycin or its RAD derivative may fulfill the same purpose. Steroid
resistance should not be assumed before the fifth day of pulse steroid
treatment, although histologic features of vascular rejection may indicate the
need for more aggressive treatment earlier. Steroid-resistant rejection is
traditionally treated with poly- or monoclonal antilymphocytic antibodies, with
success rates of 60 to 70%. Their potential benefit must be carefully balanced
against the risks of infection and lymphoma. More recently, mycophenolate
mofetil has been successfully used to treat steroid-resistant rejection, but
only of the interstitial (cellular) type. Switching from CsA to tacrolimus for
treating recurrent or antibody-resistant rejection is successful in
approximately 60% of cases. Plasmapheresis and intravenously administered Ig
have been used in some desperate cases, with surprising success. Because none
of the available drugs has a significantly better profile of therapeutic versus
adverse effects, the possible benefits of continued rejection therapy must be
continuously balanced with the potential for serious, sometimes fatal, side
effects. N. Ref:: 35
----------------------------------------------------
[97]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.6. Cardiovascular risks. Smoking.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:29.
RESUMEN
/ SUMMARY: - GUIDELINE: Cigarette smoking is associated
with a high frequency of post-transplant cardiovascular disease and may
adversely influence patient and graft survival. Active measures against tobacco
smoking are recommended.
----------------------------------------------------
[98]
TÍTULO / TITLE: - Cardiovascular disease
after renal transplantation.
REVISTA
/ JOURNAL: - Kidney Int Suppl 2002 May;(80):78-84.
AUTORES
/ AUTHORS: - Dimeny EM
INSTITUCIÓN
/ INSTITUTION: - Department of Public Health and Clinical
Medicine, Umea University, Sweden. emoke.dimeny@vll.se
RESUMEN
/ SUMMARY: - Cardiovascular disease is a major hazard
limiting the life expectancy of renal transplant recipients and the most frequent
cause of late allograft loss. Patients with renal disease have usually been
exposed for both traditional, and for them unique, risk factors over a
prolonged period of time and may carry the burden of advanced atherosclerotic
disease already at the time of transplantation. The observed survival benefit
of transplantation is probably from elimination of the numerous uremia-related
risk factors. However, immunosuppressive therapy and the chronic inflammatory
state, together with genetic susceptibility and not infrequently impaired renal
function, may bring about new potentially atherogenic conditions. Metabolic
risk factors may jeopardize both patient and graft survival. Several
observational studies provide evidence for the negative impact of preexisting
metabolic abnormalities on long-term outcomes. Identification of modifiable
cardiovascular risk factors may enable risk reduction also in renal transplant
recipients. Results of ongoing intervention trials are awaited. The observed
improvement of patient survival after renal transplantation during the past
decade may reflect the increasing awareness and more optimal care of patients
throughout the course of renal disease.
N. Ref:: 67
----------------------------------------------------
[99]
TÍTULO / TITLE: - Early prognosis of the
development of renal chronic allograft rejection by gene expression profiling
of human protocol biopsies.
REVISTA
/ JOURNAL: - Transplantation 2003 Apr 27;75(8):1323-30.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000068481.98801.10
AUTORES
/ AUTHORS: - Scherer A; Krause A; Walker JR; Korn A;
Niese D; Raulf F
INSTITUCIÓN
/ INSTITUTION: - Novartis Institutes for BioMedical
Research/Transplantation, Novartis Pharma AG, Basel, Switzerland.
RESUMEN
/ SUMMARY: - BACKGROUND: Chronic allograft rejection
(CR) is the major cause of failure of long-term graft survival and is so far
irreversible. Early prognosis of CR by molecular markers before overt
histologic manifestation would be a valuable aid for the optimization of
treatment regimens and the design of clinical CR trials. Oligonucleotide
microarray-based approaches have proven to be useful for the diagnosis and
prognosis of a variety of diseases and were chosen for the unbiased
identification of prognostic biomarkers. METHODS: Renal allograft biopsies were
taken at month 6 posttransplantation (PT) from two groups who were, at that
time, healthy recipients: one group developed CR at month-12 PT, the other
group remained healthy. Gene expression profiles from the two groups at month-6
PT biopsies were analyzed to identify differentially expressed genes with
prognostic value for CR development at month 12. RESULTS: A set of 10 genes was
identified that showed differential expression profiles between the two patient
groups and had a complete separation of the 15% to 85% quantile range for each
individual gene. This set of genes was sufficient to allow the correct
prediction of the occurrence or nonoccurrence of CR in 15 of 17 (88%) patients
using cross-validation (occurrence for a patient was predicted on the basis of
the other patients’ data only). In addition, a correct prediction could be made
that a recipient with a normal biopsy 12 months PT developed CR within the
following 6 months. CONCLUSIONS: Identified expression patterns seem to be
highly prognostic of the development of renal CR.
----------------------------------------------------
[100]
TÍTULO / TITLE: - Vitamin D as
immunomodulatory therapy for kidney transplantation.
REVISTA
/ JOURNAL: - Transplantation 2002 Oct 27;74(8):1204-6.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000031949.70610.BB
AUTORES
/ AUTHORS: - Becker BN; Hullett DA; O’Herrin JK; Malin
G; Sollinger HW; DeLuca H
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, B-3063 UW
Nephrology, University of Wisconsin, 2500 Overlook Terrace, Madison, WI 53705,
USA. bnb@medicine.wisc.edu
RESUMEN
/ SUMMARY: - Vitamin D (1alpha,25-dihydroxyvitamin D(3)
[1alpha,25-(OH)(2)D(3)]) has been studied in the past for its immunosuppressive
properties, and, in that context, it may also have potential utility as an
immunomodulatory agent for transplantation. A number of studies have
demonstrated that 1alpha,25-(OH)(2)D(3) or its analogs regulate immune cell
proliferation, differentiation, and responsiveness. A burgeoning number of
studies have also explored using 1alpha,25-(OH)(2)D(3) and its analogs directly
as therapy in animal models of kidney transplantation with success in
prolonging allograft function and preventing acute rejection. Some of these in
vivo effects may well be caused by alterations in immune cell function, but it
is also possible that exogenous 1alpha,25-(OH)(2)D(3) and its analogs are
altering the intragraft milieu as well, specifically through changes in the
TGF-beta signaling cascade. Such provocative data and the availability of newer
1alpha,25-(OH)(2)D(3) analogs that may limit side effects (e.g. hypercalcemia)
have created interest in examining this secosteroid clinically in kidney
transplantation. N.
Ref:: 34
----------------------------------------------------
[101]
TÍTULO / TITLE: - Transplantation in
elderly patients.
REVISTA
/ JOURNAL: - Arch Surg 2003 Oct;138(10):1089-92.
●●
Enlace al texto completo (gratuito o de pago) 1001/archsurg.138.10.1089
AUTORES
/ AUTHORS: - Randall HB; Cao S; deVera ME
INSTITUCIÓN
/ INSTITUTION: - Baylor University Medical Center, Baylor
Regional Transplant Institute, Dallas, Tex 75246, USA. henryran@baylorhealth.edu N. Ref:: 2
----------------------------------------------------
[102]
- Castellano -
TÍTULO / TITLE:Prevencion del riesgo
cardiovascular en el trasplante renal. Documento de consenso. Prevention of
cardiovascular risk in renal transplantation. Consensus document.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22 Suppl 4:35-56.
AUTORES
/ AUTHORS: - Morales JM; Gonzalez Molina M; Campistol
JM; del Castillo D; Anaya F; Oppenheimer F; Gil Vernet JM; Grinyo JM; Capdevila
L; Lampreave I; Valdes F; Marcen R; Escuin F; Andres A; Arias M; Pallardo L
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia Hospital 12 de
Octubre Ctra, Andalucia km 5,400 28041 Madrid. jmorales@h12o.es N. Ref:: 122
----------------------------------------------------
[103]
- Castellano -
TÍTULO / TITLE:Riesgo cardiovascular en el
paciente trasplantado renal. Cardiovascular risk in patients with renal
transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22 Suppl 4:7-11.
AUTORES
/ AUTHORS: - Campistol JM
INSTITUCIÓN
/ INSTITUTION: - Unidad de Trasplante Renal, Hospital
Clinic, Universidad de Barcelona, Villarroel, 170 08036 Barcelona. jmcampis@clinic.ub.es N. Ref:: 10
----------------------------------------------------
[104]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.7.2. Late infections. Tuberculosis.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:39-43.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Tuberculosis (TB) is not
rare after renal transplantation, and can be life-threatening. Treatment of
active TB in renal transplant recipients should be the same as in the general
population, i.e. 2 months of quadruple therapy combining rifampin, isoniazid,
ethambutol and pyrazinamide, followed by a 4-months double therapy with
isoniazid and rifampin. The drug ethambutol should not be used initially if the
rate of resistance to isoniazid is less than 4% in the community. B. As
rifampin will reduce the plasma concentration of calcineurin antagonists and
rapamycin, the blood levels of these agents must be monitored closely.
Rifabutin may be used as an alternative to rifampin, as this drug is a less
potent inducer of the microsomal P450 enzymes. C. Renal transplant candidates
and renal transplant recipients should be screened for latent TB infection.
Patients considered to have latent TB infection are defined as: (i) those who
display a 5 mm (renal transplant recipients) or a 10 mm (dialysis patients)
induration after tuberculin skin testing; (ii) those with chest X-ray images
suggestive of past TB infection; (iii) those with a history of past TB
infection that was not treated adequately; and (iv) those who have been in
close contact with infectious patients. The preferred treatment of latent TB infection
is isoniazid 300 mg/day for 9 months.
----------------------------------------------------
[105]
TÍTULO / TITLE: - Pharmacokinetic,
pharmacodynamic, and outcome investigations as the basis for mycophenolic acid
therapeutic drug monitoring in renal and heart transplant patients.
REVISTA
/ JOURNAL: - Clin Biochem 2001 Feb;34(1):17-22.
AUTORES
/ AUTHORS: - Shaw LM; Korecka M; DeNofrio D; Brayman KL
INSTITUCIÓN
/ INSTITUTION: - Departments of Pathology & Laboratory
Medicine and Surgery, University of Pennsylvania Medical Center, Philadelphia,
PA, USA. shawlmj@mail.med.upenn.edu
RESUMEN
/ SUMMARY: - Mycophenolate mofetil is widely used in
combination with either cyclosporine or tacrolimus for rejection prophylaxis in
renal and heart transplant patients. Although not monitored routinely nearly to
the degree that other agents such as cyclosporine or tacrolimus, there is an
expanding body of experimental evidence for the utility of monitoring mycophenolic
acid, the primary active metabolite of mycophenolate mofetil, plasma
concentration as an index of risk for the development of acute rejection. The
following are important experimentally-based reasons for recommending the
incorporation of target therapeutic concentration monitoring of mycophenolic
acid: (1) the MPA dose-interval area-under-the-concentration-time curve, and
less precisely, MPA predose concentrations predict the risk for development of
acute rejection; (2) the strong correlation between mycophenolic acid plasma
concentrations and expression of important cell surface activation antigens,
whole blood pharmacodynamic assays of lymphocyte proliferation and median graft
rejection scores in a heart transplant animal model; (3) the greater than 10-fold
interindividual variation of MPA area under the concentration time curve values
in heart and renal transplant patients receiving a fixed dose of the parent
drug; (4) drug-drug interactions involving other immunosuppressives are such
that when switching from one to another (eg, from cyclosporine to tacrolimus or
vice-versa) substantial changes in MPA concentrations can occur in patients
receiving a fixed dose of the parent drug; (5) significant effects of liver and
kidney diseases on the steady-state total and free mycophenolic acid area under
the concentration time curve values; (6) the need to closely monitor
mycophenolic acid when a major change in immunosuppression is planned such as
steroid withdrawal. Current investigations are focused on determination of the
most optimal sampling time and for mycophenolic acid target therapeutic
concentration monitoring. Further investigations are needed to evaluate the
pharmacologic activity of the newly described acyl glucuronide metabolite of
mycophenolic acid which has been shown to inhibit, in vitro, inosine
monophosphate dehydrogenase. N.
Ref:: 37
----------------------------------------------------
[106]
TÍTULO / TITLE: - Renal replacement
therapy in the patient with acute brain injury.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Mar;37(3):457-66.
AUTORES
/ AUTHORS: - Davenport A
INSTITUCIÓN
/ INSTITUTION: - Royal Free and University College Hospital
Medical School, Centre for Nephrology, Royal Free Hospital, London, UK. andrew.davenport@rfh.nthames.nhs.uk
RESUMEN
/ SUMMARY: - The patient with an acute brain injury
requiring renal replacement therapy presents a major problem in that
conventional intermittent hemodialysis may exacerbate the injury by
compromising cerebral perfusion pressure, either after a reduction in cerebral
perfusion or because of increased cerebral edema. Compared with standard
intermittent hemodialysis, the continuous forms of renal replacement therapy
(CRRT) provide an effective therapy in terms of solute clearance, coupled with
improved cardiovascular and intracranial stability. The disadvantage of CRRT is
that anticoagulation may be required, and anticoagulants with systemic effects
may provoke intracerebral hemorrhage, either at the site of damage or around
the intracranial pressure monitoring device. Although peritoneal dialysis does
not require anticoagulation, the clearances achieved are often less than those
of CRRT, and sudden changes in intraperitoneal volume may provoke
cardiovascular and thus intracranial instability. N. Ref:: 39
----------------------------------------------------
[107]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.5. Cardiovascular risks. Hyperhomocysteinaemia.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:28-9.
RESUMEN
/ SUMMARY: - GUIDELINE: Based on the present data, it
is not recommended to measure homocysteine levels.
----------------------------------------------------
[108]
TÍTULO / TITLE: - Calcium metabolism and
skeletal problems after transplantation.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2002
Feb;13(2):551-8.
AUTORES
/ AUTHORS: - Torres A; Lorenzo V; Salido E
INSTITUCIÓN
/ INSTITUTION: - Nephrology Section and Research Unit,
University Hospital of the Canary Islands, Instituto Reina Sofia de
Investigacion, Tenerife, España. atorres@ull.es N. Ref:: 59
----------------------------------------------------
[109]
TÍTULO / TITLE: - Kidney and liver
transplantation in HIV-infected patients: case presentations and review.
REVISTA
/ JOURNAL: - AIDS Patient Care STDS 2003
Oct;17(10):501-7.
●●
Enlace al texto completo (gratuito o de pago) 1089/108729103322494294
AUTORES
/ AUTHORS: - Roland ME; Adey D; Carlson LL; Terrault NA
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
California, San Francisco, San Francisco, California, USA. mroland@php.ucsf.edu
RESUMEN
/ SUMMARY: - Until recently, HIV-infected patients have
been excluded from consideration for solid organ transplantation. The
relatively high mortality rates among HIV-infected transplant recipients
observed in the era prior to the use of highly active antiretroviral therapy
(HAART), coupled with long waiting times for cadaveric organs, made it
difficult to support organ transplantation in this patient group. However, in
response to the marked reductions in morbidity and mortality associated with
HIV infection, several transplant centers have developed pilot studies or
revised their clinical criteria to allow transplantation in this group of
patients. We describe two cases, one kidney and one liver transplant recipient,
and review the major clinical and research issues related to this topic.
Reports of transplantations in the pre-HAART era highlight two important findings.
First, some HIV-infected transplant recipients did very well with long survival
periods. However, overall progression to AIDS and death appeared accelerated.
We recently reported on our preliminary experience with 45 selected transplant
recipients in the HAART era. One-year patient survival rates were similar to
unmatched survival data from the United Network for Organ Sharing (UNOS)
database. Median CD4+ T-cell counts remained stable in the follow-up period
compared to pretransplant. HIV-1 RNA nearly uniformly continued to be
suppressed below the limits of detection. Preliminary data are promising and
support the current efforts to evaluate patient and graft survival among
HIV-infected transplant recipients and to explore the mechanisms underlying the
many potential complications of transplantation in this population. N. Ref:: 21
----------------------------------------------------
[110]
TÍTULO / TITLE: - Volume replacement in
critically ill patients with acute renal failure.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2001 Feb;12 Suppl
17:S33-9.
AUTORES
/ AUTHORS: - Ragaller MJ; Theilen H; Koch T
INSTITUCIÓN
/ INSTITUTION: - Department of Anesthesiology and Intensive
Care Medicine, University Hospital Carl Gustav Carus Medical Faculty, Technical
University Dresden, Harvard Medical International Associated Institution,
Dresden, Germany. ragaller@rcs.urz.tu-dresden.de
RESUMEN
/ SUMMARY: - Maintenance and restoration of
intravascular volume are essential tasks of critical care management to achieve
sufficient organ function and to avoid multiple organ failure in critically ill
patients. Inadequate intravascular volume followed by impaired renal perfusion
is the predominate cause of acute renal failure. Crystalloid solutions are the
first choice to correct fluid and electrolyte deficits in these patients.
However, in case of major hypovolemia, particularly in situations of increased
capillary permeability, colloid solutions are indicated to achieve sufficient
tissue perfusion. Whereas albumin should be avoided for correction of
intravascular hypovolemia, synthetic colloids can restore intravascular volume
and stabilize hemodynamic conditions. In addition to a faster, more effective
and prolonged restoration of intravascular volume, colloid solutions are able
to improve microcirculation. Of the synthetic colloids, hydroxyethyl starch
(HES) solutions with a low in vivo molecular weight, such as HES 200/0.5, offer
the best risk/benefit ratio. These solutions are safe with respect to effects
on coagulation, platelets, reticuloendothelial system, and renal function, if
used below their upper dosage limits. For patients with acute renal
dysfunction, daily monitoring of renal function is necessary if colloids are
required to stabilize hemodynamic conditions. In these patients, measurement of
the colloidal osmotic pressure and adequate amounts of crystalloid solutions
will reduce the risk of hyperoncotic renal failure. Of all colloids, gelatin
and HES solutions with low in vivo molecular weight are preferred in these
cases. In the very specific situation of kidney transplantation, colloid
solutions should be administered in a restricted manner to organ donors and
kidney recipients. N.
Ref:: 52
----------------------------------------------------
[111]
TÍTULO / TITLE: - The impact of impaired
insulin release and insulin resistance on glucose intolerance after renal
transplantation.
REVISTA
/ JOURNAL: - Clin Transplant 2002 Dec;16(6):389-96.
AUTORES
/ AUTHORS: - Hjelmesaeth J; Hagen M; Hartmann A;
Midtvedt K; Egeland T; Jenssen T
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Section of
Nephrology, Oslo, Norway. joran@online.no
RESUMEN
/ SUMMARY: - The current knowledge of the pathogenesis
of post-transplant glucose intolerance is sparse. This study was undertaken to
assess the relative importance of insulin secretion (ISec) and insulin
sensitivity (IS) in the pathogenesis of post-transplant diabetes mellitus
(PTDM), impaired glucose tolerance (IGT) and impaired fasting glucose (IFG)
after renal transplantation. An oral glucose tolerance test (OGTT) was
performed in 167 non-diabetic recipients 10 wk after renal transplantation.
Fasting, 1-h and 2-h insulin and glucose levels were used to estimate the
insulin secretory response and IS. One year after transplantation 89 patients
were re-examined with an OGTT including measurements of fasting and 2 h
glucose. Ten weeks after transplantation the PTDM-patients had significantly
lower ISec and IS than patients with IGT/IFG, who again had lower ISec and IS
than those with normal glucose tolerance (NGT). One year later, a similar
difference in baseline ISec was observed between the three groups, whereas
baseline IS did not differ significantly. Patients who improved their glucose
tolerance during the first year, were mainly characterized by a significantly
greater baseline ISec, and they received a significantly higher median
prednisolone dose at baseline with a subsequent larger dose reduction during
the first year, than the patients who had their glucose tolerance unchanged or
worsened. In conclusion, both impaired ISec and IS characterize patients with
PTDM and IGT/IFG in the early course after renal transplantation. The presence
of defects in insulin release, rather than insulin action, indicates a poor
prognosis regarding later normalization of glucose tolerance. N. Ref:: 29
----------------------------------------------------
[112]
TÍTULO / TITLE: - Transplant Mac attack:
humor the macrophages.
REVISTA
/ JOURNAL: - Kidney Int 2003 May;63(5):1953-4.
AUTORES
/ AUTHORS: - Colvin RB
N. Ref:: 10
----------------------------------------------------
[113]
TÍTULO / TITLE: - Insulin resistance as
putative cause of chronic renal transplant dysfunction.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Apr;41(4):859-67.
AUTORES
/ AUTHORS: - de Vries AP; Bakker SJ; van Son WJ; Homan
van der Heide JJ; The TH; de Jong PE; Gans RO
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology Department of
Medicine, Groningen University Medical Center, Groningen, The Netherlands. a.p.j.de.vries@int.azg.nl
RESUMEN
/ SUMMARY: - Transplantation is the preferred organ
replacement therapy for most patients with end-stage renal disease. Despite
impressive improvements over recent years in the treatment of acute rejection,
approximately half of all grafts will loose function within 10 years after
transplantation. Chronic renal transplant dysfunction, also known as transplant
atherosclerosis, is a leading cause of late allograft loss. To date, no
specific treatment for chronic renal transplant dysfunction is available.
Although its precise pathophysiology remains unknown, it is believed that it
involves a multifactorial process of alloantigen-dependent and
alloantigen-independent risk factors. Obesity, posttransplant diabetes
mellitus, dyslipidemia, hypertension, and proteinuria have all been identified
as alloantigen-independent risk factors. Notably, these recipient-related risk
factors are well-known risk factors for cardiovascular disease, which cluster
within the insulin resistance syndrome in the general population. Insulin
resistance is considered the central pathophysiologic feature of this syndrome.
It is therefore tempting to speculate that it is insulin resistance that
underlies the recipient-related risk factors for chronic renal transplant
dysfunction. Recognition of insulin resistance as a central feature underlying
many, if not all, recipient-related risk factors would not only improve our
understanding of the pathophysiology of chronic renal transplant dysfunction,
but also stimulate development of new treatment and prevention strategies. N. Ref:: 99
----------------------------------------------------
[114]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.3.3. Long-term immunosuppression. Toxicity of
immunosuppression.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:21-3.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Careful long-term
monitoring of graft recipients is mandatory to discover signs of
immunosuppressive drug toxicity, in particular nephrotoxicity. B. In the case
of a discrepancy between the drug dose and signs of toxicity, then a thorough
pharmacokinetic analysis should be performed. C. Cardiovascular, renal and
metabolic risks and the risk of de novo malignancy must be considered in a
long-term monitoring programme.
----------------------------------------------------
[115]
TÍTULO / TITLE: - Pulsatile machine
perfusion vs. cold storage of kidneys for transplantation: a rapid and
systematic review.
REVISTA
/ JOURNAL: - Clin Transplant 2003 Aug;17(4):293-307.
AUTORES
/ AUTHORS: - Wight JP; Chilcott JB; Holmes MW; Brewer N
INSTITUCIÓN
/ INSTITUTION: - Department of Public Health, School of
Health and Related Research, University of Sheffield, Sheffield, UK.
RESUMEN
/ SUMMARY: - OBJECTIVE: To identify and prioritize key
areas for further research in kidney preservation systems. MATERIALS AND
METHODS: We conducted a systematic review and meta-analysis of the
effectiveness of machine perfusion and cold storage techniques in reducing
delayed graft function (DGF) and improving graft survival in recipients of kidneys
from beating and non-heart-beating donors. Literature quantifying the link
between DGF and graft survival was used to evaluate the potential long-term
impact of machine perfusion and cold storage systems. Cox proportional hazards
modelling was used to predict graft survival and graft years gained over 10 yr.
Monte Carlo sensitivity analysis was conducted to evaluate stochastic
uncertainties within the model. RESULTS: Machine perfusion leads to a relative
risk of DGF of approximately 80% (67%, 96%) compared with cold storage,
although the evidence base is limited in quality and study size. Direct
evidence on graft survival at 1 yr demonstrates no statistically significant
difference between machine perfusion and cold storage. Predictions based upon
quantifying the link between DGF and graft survival suggest potential
improvements of between 0 and 6% at 10 yr. DISCUSSION: Studies of high
methodological quality and sufficient size are required to determine whether
machine preservation leads to reduce rates of DGF. Predicted impact on graft
survival implies that direct evidence would require a large population followed
up over a long period of time. Registry database analysis supported by
validation of the link between DGF and graft survival may be preferable and
more feasible than randomized controlled trials.
----------------------------------------------------
[116]
TÍTULO / TITLE: - Basiliximab: a review
of its use as induction therapy in renal transplantation.
REVISTA
/ JOURNAL: - Drugs 2003;63(24):2803-35.
AUTORES
/ AUTHORS: - Chapman TM; Keating GM
INSTITUCIÓN
/ INSTITUTION: - Adis International Limited, Auckland, New
Zealand. demail@adis.co.nz
RESUMEN
/ SUMMARY: - Basiliximab (Simulect), a chimeric
(human/murine) monoclonal antibody, is indicated for the prevention of acute
organ rejection in adult and paediatric renal transplant recipients in
combination with other immunosuppressive agents.Basiliximab significantly
reduced acute rejection compared with placebo in renal transplant recipients
receiving dual- (cyclosporin microemulsion and corticosteroids) or
triple-immunotherapy (azathioprine- or mycophenolate mofetil-based); graft and
patient survival rates at 12 months were similar. Significantly more basiliximab
than placebo recipients were free from the combined endpoint of death, graft
loss or acute rejection 3 years, but not 5 years, after transplantation.The
incidence of adverse events was similar in basiliximab and placebo recipients,
with no increase in the incidence of infection, including cytomegalovirus (CMV)
infection. Malignancies or post-transplant lymphoproliferative disorders after
treatment with basiliximab were rare, with a similar incidence to that seen
with placebo at 12 months or 5 years post-transplantation. Rare cases of
hypersensitivity reactions to basiliximab have been reported.The efficacy of
basiliximab was similar to that of equine antithymocyte globulin (ATG) and
daclizumab, and similar to or greater than that of muromonab CD3. Basiliximab
was as effective as rabbit antithymocyte globulin (RATG) in patients at
relatively low risk of acute rejection, but less effective in high-risk
patients. Numerically or significantly fewer patients receiving basiliximab
experienced adverse events considered to be related to the study drug than ATG
or RATG recipients. The incidence of infection, including CMV infection, was
similar with basiliximab and ATG or RATG.Basiliximab plus baseline
immunosuppression resulted in no significant differences in acute rejection
rates compared with baseline immunosuppression with or without ATG or
antilymphocyte globulin in retrospective analyses conducted for small numbers
of paediatric patients. Limited data from paediatric renal transplant
recipients suggest a similar tolerability profile to that in adults.
Basiliximab appears to allow the withdrawal of corticosteroids or the use of
corticosteroid-free or calcineurin inhibitor-sparing regimens in renal
transplant recipients.Basiliximab did not increase the overall costs of therapy
in pharmacoeconomic studies.CONCLUSION: Basiliximab reduces acute rejection
without increasing the incidence of adverse events, including infection and
malignancy, in renal transplant recipients when combined with standard dual- or
triple-immunotherapy. The overall incidence of death, graft loss or acute
rejection was significantly reduced at 3 years; there was no significant
difference for this endpoint 5 years after transplantation. Malignancy was not
increased at 5 years. The overall efficacy, tolerability, ease of
administration and cost effectiveness of basiliximab make it an attractive
option for the prophylaxis of acute renal transplant rejection. N. Ref:: 85
----------------------------------------------------
[117]
TÍTULO / TITLE: - Hepatitis B and renal
transplantation: securing the sword of damocles.
REVISTA
/ JOURNAL: - Hepatology 2002 Nov;36(5):1041-5.
●●
Enlace al texto completo (gratuito o de pago) 1053/jhep.2002.36805
AUTORES
/ AUTHORS: - Perrillo RP N. Ref:: 37
----------------------------------------------------
[118]
TÍTULO / TITLE: - Successful treatment of
mucor infection after liver or pancreas-kidney transplantation.
REVISTA
/ JOURNAL: - Transplantation 2002 Feb 15;73(3):476-80.
AUTORES
/ AUTHORS: - Jimenez C; Lumbreras C; Aguado JM; Loinaz
C; Paseiro G; Andres A; Morales JM; Sanchez G; Garcia I; del Palacio A; Moreno
E
INSTITUCIÓN
/ INSTITUTION: - Department of General and Digestive
Surgery and Abdominal Organ Transplantation, Hospital Universitario Doce de
Octubre, 28041-Madrid, España. emorenog@hdoc.insalud.es
RESUMEN
/ SUMMARY: - BACKGROUND: Mucormycosis is a rare and
opportunistic infection usually associated with hematologic diseases, diabetes
mellitus, renal failure, solid tumors, and organ transplantation. METHODS: We
present five cases of mucor infection after transplantation (three after a
series of 750 orthotopic liver transplantation and two after a series of 13
simultaneous pancreas-kidney transplantation in patients with type 1 diabetes)
subjected to medical and surgical treatment and analyze the factors related to
the development of this infection. RESULTS: The clinical forms were two cutaneous
(laparotomy wound or prior surgical drain site), two rhino-maxillary, and one
pulmonary. As risk factors for mucormycosis all patients had pre- or
posttransplantation diabetes, and showed at least one episode of acute
rejection that required aggressive immunosuppression (2-7 g of
methylprednisolone; also three patients were treated with antithymocyte
globulin [ATG] monoclonal antibody [orthoclone and/or OKT3]). We also found
renal failure, acidosis, malnutrition, and Candida and cytomegalovirus infections
as factors related to mucor infection. Diagnosis of fungal infection was
confirmed by exudate or fluid culture in three cases and by biopsy in two. All
patients were treated with liposomal amphotericin B (from 3.5 to 5.6 g of total
dose) and resection until the surgical margins were free of infection. All
patients survived after this severe infection. CONCLUSIONS: With an early
diagnosis of mucormycosis by clinical findings, culture, or tissue biopsy, and
aggressive treatment consisting of administration of liposomal amphotericin B
and surgical resection of all infected tissue, excellent results are
achieved. N. Ref:: 18
----------------------------------------------------
[119]
TÍTULO / TITLE: - De novo thrombotic
microangiopathy in renal transplant recipients: a comparison of hemolytic
uremic syndrome with localized renal thrombotic microangiopathy.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Feb;41(2):471-9.
●●
Enlace al texto completo (gratuito o de pago) 1053/ajkd.2003.50058
AUTORES
/ AUTHORS: - Schwimmer J; Nadasdy TA; Spitalnik PF;
Kaplan KL; Zand MS
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Nephrology Unit,
University of Rochester Medical Center, Rochester, NY, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Thrombotic microangiopathy
(TMA) is a well-recognized and serious complication of renal transplantation,
affecting 3% to 14% of patients administered calcineurin-inhibitor-based
immunosuppression. METHODS: We reviewed 1,219 biopsy reports of 742 kidney and
kidney-pancreas transplants performed during 15 years at our center and found
21 biopsy-confirmed cases of TMA. RESULTS: On presentation, the majority (62%)
had systemic TMA with manifest hemolysis and thrombocytopenia, whereas a subset
had TMA localized only to the graft (38%). There were no statistically
significant differences in sex, type of transplant, age, race, or type of
immunosuppression. Patients with systemic TMA were more likely to be treated
with plasma exchange (38% versus 13%; P < 0.05), more often required
dialysis therapy (54% versus 0%; P = 0.01), and had a greater rate of graft
loss (38% versus 0%; P < 0.05). No patient with the localized variant had
TMA-related graft loss. Patients with localized TMA often responded to
reduction, conversion, or temporary discontinuation of
calcineurin-inhibitor-based immunosuppression therapy and did not routinely
require plasma exchange for graft salvage. We compare our findings with the
literature regarding the prognosis of TMA. CONCLUSION: Classifying patients
with post-renal transplantation TMA into those with localized and systemic
disease is clinically useful because each group has distinct characteristics
and clinical courses. N.
Ref:: 37
----------------------------------------------------
[120]
TÍTULO / TITLE: - Pharmacokinetics of
tacrolimus-based combination therapies.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 May;18 Suppl 1:i12-5.
AUTORES
/ AUTHORS: - Undre NA
INSTITUCIÓN
/ INSTITUTION: - Fujisawa GmbH, Neumarkter Str. 61, D-81673
Munich, Germany. nas.undre@fujisawa.de
RESUMEN
/ SUMMARY: - This paper reviews the pharmacokinetics of
tacrolimus, with special reference to its combination with adjunctive
immunosuppressants. Oral bioavailability of tacrolimus, which is variable
between patients, averages approximately 25%. This is largely due to
extrahepatic metabolism of tacrolimus in the gastrointestinal epithelium.
Nevertheless, intra-patient variability is low, as evidenced by the small
number of dose changes required to maintain patients within the recommended
tacrolimus target levels. Tacrolimus is distributed extensively in the body
with most partitioned outside the blood compartment. Concentrations of
tacrolimus in blood are used as a surrogate marker of clinically relevant
concentration of the drug at the site(s) of action. Convenient whole-blood
sampling within a +/-2-h window around 12 h post-dose (C(min)) is highly
predictive of systemic exposure to tacrolimus and is thus used to optimise
therapy. Sampling at other time-points offers no advantage over C(min)
monitoring. The interactions of tacrolimus with other immunosuppressive agents
are well characterized. After cessation of concomitant corticosteroid
treatment, exposure to tacrolimus increases by approximately 25%. In contrast,
there is no pharmacokinetic interaction between mycophenolate mofetil (MMF) and
tacrolimus. Therefore, systemic exposure to the active metabolite of MMF,
mycophenolic acid, is higher with MMF-tacrolimus combination than with
MMF-cyclosporin combination. Therefore, 1 g/day MMF may be an adequate
maintenance dose in tacrolimus-based regimens. Co-administration of tacrolimus
and sirolimus, while having no effect on exposure to sirolimus, results in
reduced exposure to tacrolimus at sirolimus doses of 2 mg/day and above. In
conclusion, tacrolimus levels should be monitored when sirolimus is
co-administered at doses >2 mg/day and after cessation of corticosteroid
treatment. N. Ref:: 13
----------------------------------------------------
[121]
TÍTULO / TITLE: - Hypertension after
kidney transplantation: are treatment guidelines emerging?
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002 Jul;17(7):1166-9.
AUTORES
/ AUTHORS: - Midtvedt K; Hartmann A N. Ref:: 31
----------------------------------------------------
[122]
TÍTULO / TITLE: - Hypertension after
kidney transplantation: impact, pathogenesis and therapy.
REVISTA
/ JOURNAL: - Am J Med Sci 2003 Apr;325(4):202-8.
AUTORES
/ AUTHORS: - Zhang R; Leslie B; Boudreaux JP; Frey D;
Reisin E
INSTITUCIÓN
/ INSTITUTION: - Section of Nephrology, Department of
Medicine, Louisianna State University Health Sciences Center, New Orleans
70112-2822, USA.
RESUMEN
/ SUMMARY: - Hypertension (HTN) contributes to the high
incidence of cardiovascular disease mortality as well as chronic allograft
nephropathy (CAN) and late graft failure in renal transplant recipients. The
mechanisms are complex and may involve pathogenic factors attributable to the
host, allograft, and immunosuppressive drugs. Calcium channel blockers should
be used to ameliorate the nephrotoxicity of calcineurin inhibitors in the early
years after transplantation. Angiotensin-converting enzyme inhibitors and
angiotensin-2 type-1 receptor blockers are safe and effective, have
antiproteinuric effects, slow the progression of CAN, and may provide survival
benefits. Diuretics and/or beta-adrenergic receptor blockers are frequently
added in combination regimen. Appropriate adjustment of the immunosuppressive
drugs should also be considered for the long-term care of kidney recipients
with HTN. N. Ref:: 53
----------------------------------------------------
[123]
TÍTULO / TITLE: - Bone remodeling after
renal transplantation.
REVISTA
/ JOURNAL: - Kidney Int Suppl 2003 Jun;(85):S125-8.
AUTORES
/ AUTHORS: - Bellorin-Font E; Rojas E; Carlini RG;
Suniaga O; Weisinger JR
INSTITUCIÓN
/ INSTITUTION: - Centro Nacional de Dialisis y Trasplante,
Division of Nephrology, Hospital Universitario de Caracas, Venezuela. ebellori@telcel.net.ve
RESUMEN
/ SUMMARY: - Several studies have indicated that bone
alterations after transplantation are heterogeneous. Short-term studies after
transplantation have shown that many patients exhibit a pattern consistent with
adynamic bone disease. In contrast, patients with long-term renal
transplantation show a more heterogeneous picture. Thus, while adynamic bone
disease has also been described in these patients, most studies show decreased
bone formation and prolonged mineralization lag-time faced with persisting bone
resorption, and even clear evidence of generalized or focal osteomalacia in
many patients. Thus, the main alterations in bone remodeling are a decrease in
bone formation and mineralization up against persistent bone resorption,
suggesting defective osteoblast function, decreased osteoblastogenesis, or
increased osteoblast death rates. Indeed, recent studies from our laboratory
have demonstrated that there is an early decrease in osteoblast number and
surfaces, as well as in reduced bone formation rate and delayed mineralization
after transplantation. These alterations are associated with an early increase
in osteoblast apoptosis that correlates with low levels of serum phosphorus.
These changes were more frequently observed in patients with low turnover bone
disease. In contrast, PTH seemed to preserve osteoblast survival. The
mechanisms of hypophosphatemia in these patients appear to be independent of
PTH, suggesting that other phosphaturic factors may play a role. However,
further studies are needed to determine the nature of a phosphaturic factor and
its relationship to the alterations of bone remodeling after
transplantation. N.
Ref:: 27
----------------------------------------------------
[124]
TÍTULO / TITLE: - Peritoneal dialysis
should be the first choice of initial renal replacement therapy for more
patients with end-stage renal disease.
REVISTA
/ JOURNAL: - ASAIO J 2001 Jul-Aug;47(4):309-11.
AUTORES
/ AUTHORS: - Mehrotra R; Nolph KD N. Ref:: 30
----------------------------------------------------
[125]
TÍTULO / TITLE: - Recurrent disease in
renal transplants.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Aug;18 Suppl
6:vi68-74.
AUTORES
/ AUTHORS: - Newstead CG
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine, St James’s
University Hospital, Leeds, UK.
RESUMEN
/ SUMMARY: - Histology compatible with minimal change
glomerulonephritis and associated with nephrotic syndrome has been reported as
an occasional curiosity post-renal transplantation. Focal segmental
glomerulosclerosis (FSGS) has a recurrence rate of approximately 20%. Age
<15 years, an aggressive clinical course of the original disease and diffuse
mesangial proliferation on native biopsy, are considered predictive of relapse.
At present there are no tests that can accurately predict the likelihood of
recurrence. Data from paediatric patients whose primary disease was FSGS were,
on average, 90% more likely to lose a graft from a live donor and 50% more
likely to lose a graft from a cadaveric donor compared with recipients with
structural disorders. Recurrence in a subsequent graft is expected if the first
graft was affected, but not if the first graft did not demonstrate recurrence.
The best-established and most effective treatment of recurrent disease requires
both plasma exchange and cyclophosphamide. Familial focal and segmental
glomerulosclerosis, although rare, is important to recognize, as it is a
different syndrome to idiopathic FSGS of childhood and overall transplant
survival is good. Adults with ‘secondary’ FSGS would not be expected to be at
risk of recurrent disease in a renal transplant. N. Ref:: 70
----------------------------------------------------
[126]
- Castellano -
TÍTULO / TITLE:La enfermedad linfoproliferativa
difusa postrasplante renal y su relacion con el virus Epstein-Barr. Experiencia
de un centro. Diffuse lymphoproliferative disease after renal transplantation
and its relation with Epstein-Barr virus. Experience at one center.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22(5):463-9.
AUTORES
/ AUTHORS: - Franco A; Jimenez L; Aranda I; Alvarez L;
Gonzalez M; Rocamora N; Olivares J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia Hospital General
Alicante Maestro Alonso, 109 03010 Alicante. franco_ant@gva.es
RESUMEN
/ SUMMARY: - Post-transplant lymphoproliferative disorders
(PTLD) are a group of heterogeneous lymphoid proliferations in chronic
immunosuppressed recipients which appear to be related to Epstein Barr Virus
(EBV). Receptor EBV seronegativity, use of antilymphocyte antibodies and CMV
disease have been identified as risk factors that may tigger development of
PTLD. We have studied the incidence of PTLD and its relationship with EBV in
588 adult renal transplant recipients who were transplanted in our hospital
from 1988 to 2001. We have also evaluated the diagnostic and therapeutic
methods used, the risk factors and outcome of the patients who developed PTLD.
We identified 8 recipients (4 males and 4 females), range from 18 to 67 years
(mean age 45.6 years) with a median time between grafting and PTLD of 4.1 years
(0.1-7 years), who developed PTLD (1.3%). Only 1 patient received OKT3 and had
CMV disease, two of them (25%) had been treated with hight doses of
prednisolone, another was EBV seronegative, but the rest of them (50%) had no
risk factors. Two patients were diagnosed at autopsy, the diagnosis of 5 was
based on the histology of biopsy and the last one by CT scans of chest-abdomen
and cytology. The presence of EBV in the lymphoproliferative cells was assessed
in 5 out of the 7 studied patients (71.4%). The outcome of our recipients was
poor. Five out of 8 patients died shortly after diagnosis as a direct
consecuence of PTLD and another of an infectious complication of the treatment
(75%). The 2 patients alive started dialysis and 1 of them died 2 years later of
a non-related cause. In conclusion, PTLD is a relatively frequent disease with
a poor prognosis in renal transplant patients. It seems to have a close
relationship with EBV and can develop in the absence of the classical risk
factors. N. Ref:: 18
----------------------------------------------------
[127]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.2 Chronic graft dysfunction. Immunological factors
(alloimmunity).
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:8-11.
RESUMEN
/ SUMMARY: - GUIDELINE: All recipients of an allogeneic
kidney graft should take life-long maintenance immunosuppressive medication.
Whereas there is no immunological test to diagnose chronic allograft
dysfunction, circumstantial evidence suggests that immunological factors play
an important role in its pathogenesis. This evidence is based on experimental
data, the beneficial effect of sharing HLA antigens between donor and recipient
and post-transplantation immunological monitoring studies.
----------------------------------------------------
[128]
TÍTULO / TITLE: - Capillary C4d
deposition as a marker of humoral immunity in renal allograft rejection.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2002
Sep;13(9):2420-3.
AUTORES
/ AUTHORS: - Watschinger B; Pascual M N. Ref:: 38
----------------------------------------------------
[129]
TÍTULO / TITLE: - Current status of renal
transplantation. Patient evaluations and outcomes.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):677-86.
AUTORES
/ AUTHORS: - Barry JM
INSTITUCIÓN
/ INSTITUTION: - Division of Urology and Renal Transplantation,
Department of Surgery, Oregon Health Sciences University, Portland, Oregon,
USA.
RESUMEN
/ SUMMARY: - A systematic team approach to the
assessment of renal transplant candidates is one of several factors that have
resulted in improved kidney transplant and recipient survival rates, rates that
were only imagined 4 decades ago. N.
Ref:: 47
----------------------------------------------------
[130]
TÍTULO / TITLE: - Effects of
catecholamine application to brain-dead donors on graft survival in solid organ
transplantation.
REVISTA
/ JOURNAL: - Transplantation 2001 Aug 15;72(3):455-63.
AUTORES
/ AUTHORS: - Schnuelle P; Berger S; de Boer J; Persijn
G; van der Woude FJ
INSTITUCIÓN
/ INSTITUTION: - University Hospital Mannheim, Theodor
Kutzer Ufer 1-3, 68167 Mannheim, Germany. schnuell@rumms.uni-mannheim.de
RESUMEN
/ SUMMARY: - BACKGROUND: In a recent single-center
study, donor use of catecholamines was identified to reduce kidney allograft
rejection. This study investigates the effects of donor employment of
adrenergic agents on graft survival in a large data base, including liver and
heart transplants. METHODS: The study was based on the registry of the
Eurotransplant International Foundation including 2415 kidney, 755 liver, and
720 heart transplants performed between January 1 and December 31, 1993. A
total of 1742 donor record forms referring to the cadaveric donor activities in
1993 were systematically reviewed with regard to employment of adrenergic
agents. Catecholamine use was simply coded dichotomously and divided into three
strata according to zero, single, and combined application. Multivariate Cox
regression including age, gender, cause of brain death, cold ischemia,
HLA-mismatching, number of previous transplants, and urgency in liver
transplants was applied for statistical analysis. RESULTS: Donor employment of
catecholamines was associated with increased 4-year graft survival after kidney
transplantation (hazard ratio [HR], 0.85; 95% confidence interval [95% CI],
0.74-0.98). The benefit is conferred in a dose-dependent manner and compares in
quantitative terms with prospective HLA matching on class I and class II
antigens (HR, 0.90; 95% CI, 0.84-0.97). Use of norepinephrine was predictive of
initial nonfunction after heart transplantation (HR, 1.66; 95% CI, 1.14-2.43),
but did not compromise liver grafts (HR, 0.94; 95% CI, 0.67-1.32). CONCLUSIONS:
Optimizing the management of brain-dead organ donors, including the possibility
of selective administration of adrenergic agents, may provide a major benefit
on graft survival without adverse side effects for the recipients. Further
investigation on best use of adrenergic drugs, optimum dosage, and duration is
warranted.
----------------------------------------------------
[131]
TÍTULO / TITLE: - TGF-beta(1) gene
expression in protocol biopsies from patients with stable renal allograft
function.
REVISTA
/ JOURNAL: - Transplant Proc 2001
Feb-Mar;33(1-2):342-4.
AUTORES
/ AUTHORS: - Hueso M; Bover J; Espinosa L; Moreso F;
Seron D; Canas C; Raulf F; Blanco A; Gil-Vernet S; Carreras M; Castelao AM;
Grinyo JM; Alsina J
INSTITUCIÓN
/ INSTITUTION: - Nephrology Department, CSUB, L’Hospitalet
de Llobregat, Barcelona, España.
----------------------------------------------------
[132]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.1 Differential diagnosis of chronic graft
dysfunction.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:4-8.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Any significant
deterioration in graft function should be investigated using the appropriate
diagnostic tools and, if possible, therapeutic interventions should be
initiated. The usual causes of a decline in glomerular filtration rate after
the first year include transplant-specific causes such as chronic allograft
nephropathy, acute rejection episodes, chronic calcineurin inhibitor
nephrotoxicity, transplant renal artery stenosis and ureteric obstruction, as
well as immunodeficiency-related causes and non-transplant-related causes, such
as recurrent or de novo renal diseases and bacterial infections. B. Any new
onset and persistent proteinuria of >0.5 g/24 h should be investigated and
therapeutic interventions should be initiated. The usual causes include chronic
allograft nephropathy and transplant glomerulopathy, and recurrent or de novo
glomerulonephritis.
----------------------------------------------------
[133]
TÍTULO / TITLE: - Primary intestinal
posttransplant T-cell lymphoma.
REVISTA
/ JOURNAL: - Transplantation 2003 Jun 27;75(12):2131-2.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000060253.54333.F3
AUTORES
/ AUTHORS: - Michael J; Greenstein S; Schechner R;
Tellis V; Vasovic LV; Ratech H; Glicklich D
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Albert Einstein
College of Medicine, Montefiore Medical Center, Bronx, New York 10467, USA.
RESUMEN
/ SUMMARY: - There have been only five reported cases
of primary posttransplant T-cell lymphoma. We report the first case associated
with the use of sirolimus (Rapamycin, Wyeth-Ayerst, Philadelphia, PA). The
patient, receiving prednisone, cyclosporine, and sirolimus treatment, developed
ascites, diarrhea, and weight loss 7 months after his second renal transplant.
Tissue obtained at laparotomy established the diagnosis of primary T-cell
lymphoma. Latent membrane protein-1 for Epstein-Barr virus was negative, but
in-site hybridization test for Epstein-Barr-encoded RNA was positive. Despite
aggressive chemotherapy, the patient died 8 months posttransplant. This is the
sixth reported case of primary intestinal posttransplant T-cell lymphoma, but
it is the first case associated with the use of sirolimus. The incidence of
posttransplant lymphoproliferative disease in patients receiving sirolimus
should be studied. N.
Ref:: 6
----------------------------------------------------
[134]
- Castellano -
TÍTULO / TITLE:Alteraciones del metabolismo oseo
tras el trasplante renal. Bone metabolism alterations after kidney
transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2003;23 Suppl 2:122-6.
AUTORES
/ AUTHORS: - Torres A; Garcia S; Barrios Y; Hernandez
D; Lorenzo V
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Unidad de
Investigacion, Hospital Universitario de Canarias, Instituto Reina Sofia de
Investigacion. atorres@ull.es
RESUMEN
/ SUMMARY: - Early after renal transplantation (RT) a
rapid decrease in bone mineral density at the lumbar spine, femoral neck, and
femoral shaft has been documented. In addition, an appreciable proportion of
patients still remain losing bone late after RT. As a consequence, RT patients
are at a high risk of bone fractures as compared to general population. Most
fractures involve appendicular skeleton, particularly the feet and ankles, and
the diabetic patient is at increased risk of fractures. Thus, early institution
of preventive measures and treatment of established osteoporosis are central.
The major cause of post-transplantation bone loss is corticosteroid treatment,
and this should be used at the lower dose compatible with graft survival.
Preexisting hyperparathyroidism also affects the early cancellous bone loss at
the spine, and post-transplantation bone loss reflects variable individual
susceptibility, resembling the polygenic determination of bone mineral density
in general. Clinical trials have demonstrated that bisphosphonates or vitamin D
plus calcium supplementation, prevent post-transplantation bone loss during the
first 6-12 months. However, their role in preventing bone fractures has not
been proven. Finally, recommendations for management, prevention and treatment,
are summarized. N.
Ref:: 24
----------------------------------------------------
[135]
TÍTULO / TITLE: - Lamivudine therapy for
severe acute hepatitis B virus infection after renal transplantation: case
report and literature review.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Sep;33(6):2948-9.
AUTORES
/ AUTHORS: - Nakhoul F; Gelman R; Green J; Khankin E;
Baruch Y
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Molecular
Medicine, Rambam Medical Center, Haifa, Israel. N. Ref:: 13
----------------------------------------------------
[136]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.10. Pregnancy in renal transplant recipients.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:50-5.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Renal transplantation
restores fertility, and successful pregnancies have been reported in renal
transplant women. In women with normal graft function, pregnancy usually has no
adverse effect on graft function and survival. Therefore, women of childbearing
age who consider pregnancy should receive complete information and support from
the transplant team. B. Pregnancy could be considered safe about 2 years after
transplantation in women with good renal function, without proteinuria, without
arterial hypertension, with no evidence of ongoing rejection and with normal
allograft ultrasound. C. Pregnancy after transplantation should be considered a
high-risk pregnancy and should be monitored by both an obstetrician and the
transplant physician. Pregnancy should be diagnosed as early as possible. The
principal risks are infection, proteinuria, anaemia, arterial hypertension and
acute rejection for the mother, and prematurity and low birth weight for the
foetus. D. Pregnant women and transplanted patients are at increased risk of
infections, especially bacterial urinary tract infections and acute
pyelonephritis of the graft. Urine cultures should be performed monthly and all
asymptomatic infections should be treated. Monitoring of viral infections is
also recommended. (Evidence level B) E. Acute rejection episodes are uncommon
but may occur after delivery. Therefore, immunosuppression should be
re-adjusted immediately after delivery. F. Because pre-eclampsia develops in
30% of pregnant patients, especially those with prior arterial transplant hypertension,
blood pressure, renal function, proteinuria and weight should be monitored
every 2-4 weeks, with more attention during the third trimester.
Anti-hypertensive agents should be changed to those tolerated during pregnancy.
ACE inhibitors and angiotensin II receptor antagonists are absolutely
contra-indicated. G. Immunosuppressive therapy based on cyclosporine or
tacrolimus with or without steroids and azathioprine may be continued in renal
transplant women during pregnancy. Other drugs, such as mycophenolate mofetil
and sirolimus, are not recommended based on current information available.
Because of drug transfer into maternal milk, breastfeeding is not recommended.
H. Vaginal delivery is recommended, but caesarean section is required in at
least 50% of cases. Delivery should occur in a specialized centre. In the
puerperium, renal function, proteinuria, blood pressure,
cyclosporine/tacrolimus blood levels and fluid balance should be closely
monitored.
----------------------------------------------------
[137]
TÍTULO / TITLE: - Efficacy and toxicity
of a protocol using sirolimus, tacrolimus and daclizumab in a nonhuman primate
renal allotransplant model.
REVISTA
/ JOURNAL: - Am J Transplant 2002 Apr;2(4):381-5.
AUTORES
/ AUTHORS: - Montgomery SP; Mog SR; Xu H; Tadaki DK;
Hirshberg B; Berning JD; Leconte J; Harlan DM; Hale D; Kirk AD
INSTITUCIÓN
/ INSTITUTION: - NIDDK/Navy Transplantation and
Autoimmunity Branch, Naval Medical Research Center, Bethesda, Maryland 20892,
USA.
RESUMEN
/ SUMMARY: - A regimen combining sirolimus, tacrolimus,
and daclizumab has recently been shown to provide adequate immunosuppression
for allogeneic islet transplantation in humans, but remains unproven for
primarily vascularized allografts. We evaluated this regimen for renal
allograft transplantation in mismatched nonhuman primates. Dosages of sirolimus
and tacrolimus were adjusted for trough levels of 10-15 ng/mL and 4-6 ng/mL,
respectively. Treated monkeys (n = 5) had significantly prolonged allograft
survival, with a mean survival of 36 days vs. 7 days in untreated controls (n =
6, p = 0.008). Four of five treated animals, but none of the controls,
developed fibrinoid vascular necrosis of the small intestine. A review of gut
histology from animals on other immunosuppressive protocols performed by our
laboratory suggested that these lesions were a result of sirolimus exposure. In
summary, this regimen prolongs the survival of vascularized renal allografts,
but is limited by profound GI toxicity in rhesus macaques.
----------------------------------------------------
[138]
- Castellano -
TÍTULO / TITLE:Trasplante renal en pacientes con
enterocistoplastia. Renal transplantation in patients with enterocystoplasty.
REVISTA
/ JOURNAL: - Actas Urol Esp. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aeu.es/actas/
●●
Cita: Actas Urológicas Españolas: <> 2003 Apr;27(4):281-5.
AUTORES
/ AUTHORS: - Alapont Alacreu JM; Pacheco Bru JJ;
Pontones Moreno JL; Alonso Gorrea M; Sanchez Plumed J; Jimenez Cruz FJ
INSTITUCIÓN
/ INSTITUTION: - Servicio de Urologia, Hospital
Universitario La Fe, Valencia.
RESUMEN
/ SUMMARY: - OBJECTIVES: To asses the impact of
augmentation enterocystoplasty on the success of cadaveric renal
transplantation in patients with dysfunctional bladders. PATIENTS AND METHODS:
Between 1980 and 2001, 3 men and a woman with severe dysfunctional lower
urinary tract underwent a total of 4 cadaveric renal transplantations. The
etiologies of the bladder dysfunction were bladder contraction secondary to
urinary tuberculosis in all cases. In 3 patients were performed an
enterocystoplasty with ileocecal segment and one with ileon. RESULTS: The
overall allograft survival was 58.7 months. Two patients have functioning
grafts 27 and 74 months after transplant, 1 has died due to an intestinal
disease and other had chronic rejection after follow-up of 98 months. Technical
complications occurred in 3 patients. All patients remain continent without
catheterization after the transplantation. CONCLUSIONS: Enterocystoplasty is a
safe and effective method of restoring lower urinary tract function in the
patient with end stage renal disease and a small non compliant bladder. N. Ref:: 14
----------------------------------------------------
[139]
TÍTULO / TITLE: - Bone disease after
renal transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 May;18(5):874-7.
AUTORES
/ AUTHORS: - Sperschneider H; Stein G
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine IV,
Friedrich-Schiller-University, Jena, Germany. heide.sperschneider@kfh-dialyse.de N. Ref:: 36
----------------------------------------------------
[140]
TÍTULO / TITLE: - Current status of
kidney transplant: update 2003.
REVISTA
/ JOURNAL: - Pediatr Clin North Am 2003
Dec;50(6):1301-34.
AUTORES
/ AUTHORS: - Benfield MR
INSTITUCIÓN
/ INSTITUTION: - Division of Pediatric Nephrology,
University of Alabama at Birmingham, 1600 7th Avenue S-ACC 516,
Birmingham, AL 35233, USA. mbenfield@peds.uab.edu
RESUMEN
/ SUMMARY: - Pediatric transplantation has seen
remarkable advances over the past two decades with reduced morbidity and
mortality, reduced rejection rates, and improved long-term patient and
allograft survival. Infants currently have short-term patient and allograft
survival rates better than any other age group; short-term allograft survival
rates in CD recipients are equal to those in LD recipients. With decreased
rejection, long-term allograft survival is improving dramatically.
Transplantation allows for much reduced risks and improved metabolic status,
growth and development, and more normal social interactions. The future of
transplantation continues to be exciting, with opportunities for reduced
immunosuppressive medications and their side effects, and the elusive goal of
transplantation tolerance seems within reach.
N. Ref:: 266
----------------------------------------------------
[141]
TÍTULO / TITLE: - Does growth hormone
treatment affect the risk of post-transplant renal cancer?
REVISTA
/ JOURNAL: - Pediatr Nephrol 2002 Dec;17(12):984-9.
Epub 2002 Sep 11.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00467-002-0962-7
AUTORES
/ AUTHORS: - Mehls O; Wilton P; Lilien M; Berg U;
Broyer M; Rizzoni G; Waldherr R; Opelz G
RESUMEN
/ SUMMARY: - According to the analysis of the
Collaborative Transplant Study (CTS), the incidence of renal carcinoma in
patients with renal transplantation as well as with heart transplantation is
significantly increased at any given patient age. The cumulative incidence 10
years after kidney transplantation is 185 per 100,000 patients in children
below the age of 19 years at the time of transplantation. Age and
immunosuppressive treatment seem to be the major risk factors. The majority of
cancers develop within the native kidneys. Chronic transplant nephropathy and
accelerated senescence may be further risk factors for the development of
cancer within a kidney transplant. Growth hormone (GH) treatment could not be
identified as an additional risk factor.
N. Ref:: 26
----------------------------------------------------
[142]
- Castellano -
TÍTULO / TITLE:Bioequivalencia e intercambio
terapeutico de especialidades farmaceuticas: aplicacion a ciclosporina en
trasplante renal. Bioequivalence and therapeutic exchange of pharmaceutical
specialties: application to cyclosporin in renal transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2003;23(1):71-80.
AUTORES
/ AUTHORS: - Perez Ruixo JJ; Porta B; Jimenez Torres NV
INSTITUCIÓN
/ INSTITUTION: - Global Clinical Pharmacokinetics and
Clinical Pharmacology Division, Johnson & Johnson Pharmaceutical Research
and Development, Turnhoutseweg, 30, B-2230 Beerse, Belgica. jperezru@janbe.jnj.com
RESUMEN
/ SUMMARY: - The aim of this study was to perform a
quantitative meta-analysis of the average bioequivalence criteria between
Sandimmun and Sandimmun Neoral in kidney transplant patients, and to review the
new bioequivalence criteria and their application to generic formulation of
cyclosporin. In Medline, we searched for clinical trials evaluating the
bioequivalence between Sandimmun and Sandimmun Neoral in kidney transplant
patients and we collected the information regarding the bioequivalence, study
design, sample size, and time post-transplant. The effect was measured by the
Wolf method; publication bias was evaluated by the Galbraith method and the
Rosenthal formula was used to calculate the number of additional studies with
no statistical differences needed to get a statistically non-significant
overall estimation. We selected 6 clinical trials with a latin square design
and 4 clinical trials with sequential design. The average bioequivalence
criteria between Sandimmun Neoral and Sandimmun were 1.327 (90% CI: 1,311 a
1,344), 1,663 (90% CI: 1,635 a 1,692) and 0.559 hours (90% CI: 0.544 a 0.574
hours) for logharitmic transformation of area under the curve and maximum
concentration, and time to maximum concentration, respectively. For these three
outcomes, we found statistical differences between different study designs and
for area under the curve and maximum concentration, the average bioequivalence
criteria significantly fall with the post-transplant time. We conclude
Sandimmun Neoral and Sandimmun are not bioequivalents and the experience
reached with these two drugs is not applicable to the evaluation of generic
formulations of cyclosporin.
----------------------------------------------------
[143]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.9.3. Haematological complications. Erythrocytosis.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:49-50.
RESUMEN
/ SUMMARY: - GUIDELINE: In the case of erythrocytosis,
the first-line treatment should be administration of ACE inhibitors or
angiotensin II receptor antagonists.
----------------------------------------------------
[144]
TÍTULO / TITLE: - Calcium channel
blockers as the treatment of choice for hypertension in renal transplant
recipients: fact or fiction.
REVISTA
/ JOURNAL: - Pharmacotherapy 2003 Jun;23(6):788-801.
AUTORES
/ AUTHORS: - Baroletti SA; Gabardi S; Magee CC; Milford
EL
INSTITUCIÓN
/ INSTITUTION: - Department of Pharmacy Services, Brigham
and Women’s Hospital, Boston, Massachusetts 02115, USA. Sbaroletti@partners.org
RESUMEN
/ SUMMARY: - Posttransplantation hypertension has been
identified as an independent risk factor for chronic allograft dysfunction and
loss. Based on available morbidity and mortality data, posttransplantation
hypertension must be identified and managed appropriately. During the past
decade, calcium channel blockers have been recommended by some as the
antihypertensive agents of choice in this population, because it was theorized
that their vasodilatory effects would counteract the vasoconstrictive effects
of the calcineurin inhibitors. With increasing data becoming available,
reexamining the use of traditional antihypertensive agents, including diuretics
and beta-blockers, or the newer agents, angiotensin-converting enzyme (ACE)
inhibitors and angiotensin II receptor blockers, may be beneficial. Transplant
clinicians must choose antihypertensive agents that will provide their patients
with maximum benefit, from both a renal and a cardiovascular perspective.
Beta-blockers, diuretics, and ACE inhibitors have all demonstrated significant
benefit on morbidity and mortality in patients with cardiovascular disease.
Calcium channel blockers have been shown to possess the ability to counteract
cyclosporine-induced nephrotoxicity. When compared with beta-blockers,
diuretics, and ACE inhibitors, however, the relative risk of cardiovascular
events is increased with calcium channel blockers. With the long-term benefits
of calcium channel blockers on the kidney unknown and a negative cardiovascular
profile, these agents are best reserved as adjunctive therapy to beta-blockers,
diuretics, and ACE inhibitors. N.
Ref:: 68
----------------------------------------------------
[145]
TÍTULO / TITLE: - The first international
consensus conference on continuous renal replacement therapy.
REVISTA
/ JOURNAL: - Kidney Int 2002 Nov;62(5):1855-63.
AUTORES
/ AUTHORS: - Kellum JA; Mehta RL; Angus DC; Palevsky P;
Ronco C
INSTITUCIÓN
/ INSTITUTION: - Department of Critical Care Medicine and
Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. kellumja@anes.upmc.edu
RESUMEN
/ SUMMARY: - BACKGROUND: Management of acute renal
failure (ARF) in the critically ill is extremely variable and there are no
published standards for the provision of renal replacement therapy in this
population. We sought to review the available evidence, make evidence-based practice
recommendations, and delineate key questions for future study. METHODS: We
undertook an evidence-based review of the literature on continuous renal
replacement therapy (CRRT) using MEDLINE searches. We determined a list of key
questions and convened a 2-day consensus conference to develop summary
statements via a series of alternating breakout and plenary sessions. In these
sessions, we identified supporting evidence and generated practice guidelines
and/or directions for future research. RESULTS: Of the 46 questions considered,
we found consensus for 20. We found inadequate evidence for 21 questions and
for the remaining five we found data but no consensus. Full versions of
workgroup findings are available on the Internet at http://www.ADQI.net. CONCLUSIONS: Despite
limited data, broad areas of consensus exist for use of CRRT and guideline
development appears feasible. Equally broad areas of disagreement also exist
and additional basic and applied research in acute renal failure is
needed. N. Ref:: 70
----------------------------------------------------
[146]
TÍTULO / TITLE: - Continuous versus
intermittent renal replacement therapy: a meta-analysis.
REVISTA
/ JOURNAL: - Intensive Care Med 2002 Jan;28(1):29-37.
Epub 2001 Dec 4.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00134-001-1159-4
AUTORES
/ AUTHORS: - Kellum JA; Angus DC; Johnson JP; Leblanc
M; Griffin M; Ramakrishnan N; Linde-Zwirble WT
INSTITUCIÓN
/ INSTITUTION: - Department of Anesthesiology and Critical
Care Medicine, University of Pittsburgh Medical Center, Division of Critical
Care Medicine, 200 Lothrop Street, Pittsburgh, PA 15213-2582, USA. kellumja@anes.upmc.edu
RESUMEN
/ SUMMARY: - OBJECTIVE: Patients with critical illness
commonly develop acute renal failure requiring mechanical support in the form
of either continuous renal replacement therapy (CRRT) or intermittent
hemodialysis (IRRT). As controversy exists regarding which modality should be
used for most patients with critically illness, we sought to determine whether
CRRT or IRRT is associated with better survival. DESIGN: We performed a
meta-analysis of all prior randomized and observational studies that compared
CRRT with IRRT. Studies were identified through a MEDLINE search, the authors’
files, bibliographies of review articles, abstracts and proceedings of
scientific meetings. Studies were assessed for baseline characteristics, intervention,
outcome and overall quality through blinded review. The primary end-point was
hospital mortality, assessed by cumulative relative risk (RR). MEASUREMENTS AND
RESULTS: We identified 13 studies ( n=1400), only three of which were
randomized. Overall there was no difference in mortality (RR 0.93 (0.79-1.09),
p=0.29). However, study quality was poor and only six studies compared groups
of equal severity of illness at baseline (time of enrollment). Adjusting for
study quality and severity of illness, mortality was lower in patients treated
with CRRT (RR 0.72 (0.60-0.87), p<0.01). In the six studies with similar
baseline severity, unadjusted mortality was also lower with CRRT (RR 0.48 (0.34
-0.69), p<0.0005). CONCLUSIONS: Current evidence is insufficient to draw
strong conclusions regarding the mode of replacement therapy for acute renal
failure in the critically ill. However, the life-saving potential with CRRT
suggested in our secondary analyses warrants further investigation by a large,
randomized trial.
----------------------------------------------------
[147]
TÍTULO / TITLE: - Factors governing
cardiovascular risk in the patient with a failing renal transplant.
REVISTA
/ JOURNAL: - Perit Dial Int 2001;21 Suppl 3:S275-9.
AUTORES
/ AUTHORS: - Rigatto C; Parfrey P
INSTITUCIÓN
/ INSTITUTION: - Section of Nephrology, University of
Manitoba, St. Boniface General Hospital, Winnipeg, Canada. crigatto@sbgh.mb.ca
RESUMEN
/ SUMMARY: - Cardiomyopathy and IHD are important
morbid complications among renal transplant recipients. Age, diabetes, and sex
remain important markers of risk. Smoking, hyperlipidemia, and hypertension
appear to be the major reversible risk factors for IHD. Anemia and hypertension
predict CHF. Definitive evidence on optimal intervention is lacking.
Similarities in the renal transplant recipients to CRI patients with respect to
cardiomyopathy and to the general population with respect to IHD suggest that
extrapolation from those groups is reasonable in the interim. N. Ref:: 27
----------------------------------------------------
[148]
- Castellano -
TÍTULO / TITLE:Reporte preliminar. Utilidad de la
angiotomografia renal en el protocolo del donador renal. Preliminary report.
Usefulness of computed tomographic angiography in the protocol of a kidney
donor.
REVISTA
/ JOURNAL: - Cir Cir. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.medigraphic.com/
●●
Cita: Cirugia y Cirujanos: <> 2003 Sep-Oct;71(5):379-82.
AUTORES
/ AUTHORS: - Ramirez-Bollas J; Hernandez-Dominguez M;
Arenas-Osuna J; Romero-Huesca A; Albores-Zuniga O
INSTITUCIÓN
/ INSTITUTION: - Cirujano General, Hospital de
Especialidades del Centro Medico Nacional “La Raza,” IMSS, Mexico D.F., Mexico.
juliobollas@yahoo.com.mx
RESUMEN
/ SUMMARY: - OBJECTIVE: To determine clinical
correlation of reports of computed tomographic angiography renal (CT-AR) and
surgical findings of the kidney donor patient. MATERIAL AND METHODS: Patients
were submitted nephrectomy in the related live donor renal transplant program
between January and December 2002 as paut of life to which he is made as he
CT-AR study protocol. Statistical analysis was carried out by descriptive
statistics. RESULTS: Anatomical characteristics of 35 kidneys of the same
number of live donors (AD) submitted CT-AR were evaluated and comparison with
report of surgical technique was made. Incidence of accessory renal arteries
was 23%. As reported by CT-AR, the were 39 renal arteries (91%) compared with
43 arteries found during surgery. CT-AR identified four supernumerary renal
arteries (50%) of eight identified during surgical technique; 36 hiliar
arteries (90%) and three polar arteries were identified by CT-AR (100%). Only
one a case report of early bifurcation of renal artery (20%) by CT-AR was
recorded. Anatomical characteristics of veins were described in their totality.
CT-AR is a useful instrument to identify alterations in anatomical structure of
the renal vasculature, with results similar to other studies for description of
renal arteries and veins. We propose ATR as the initial study for evaluation of
the renal architecture of the live kidney (LKD).
----------------------------------------------------
[149]
TÍTULO / TITLE: - Why study kidney
transplant risk factors?
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 15;75(3):266-7.
AUTORES
/ AUTHORS: - Matas AJ; Humar A
INSTITUCIÓN
/ INSTITUTION: - Medical School, University of Minnesota,
Minneapolis, MN, USA. N.
Ref:: 10
----------------------------------------------------
[150]
TÍTULO / TITLE: - The impact of
cytomegalovirus infections and acute rejection episodes on the development of
vascular changes in 6-month protocol biopsy specimens of cadaveric kidney
allograft recipients.
REVISTA
/ JOURNAL: - Transplantation 2003 Jun 15;75(11):1858-64.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000064709.20841.E1
AUTORES
/ AUTHORS: - Helantera I; Koskinen P; Tornroth T;
Loginov R; Gronhagen-Riska C; Lautenschlager I
INSTITUCIÓN
/ INSTITUTION: - Department of Virology, Helsinki
University Central Hospital and University of Helsinki, Helsinki, Finland.
RESUMEN
/ SUMMARY: - BACKGROUND: The role of cytomegalovirus
(CMV) in chronic kidney allograft rejection remains controversial. The purpose
of this study was to examine the impact of CMV infection on histopathologic
changes in 6-month protocol biopsy specimens of kidney allografts. METHODS:
Altogether, 52 renal allograft recipients were studied. CMV infection was diagnosed
by CMV antigenemia test, viral cultures from blood and urine, or both. CMV was
demonstrated in the biopsy specimens by antigen detection and hybridization in
situ. Acute rejections were diagnosed by biopsy histology, and biopsy specimens
were graded according to the Banff ‘97 classification. RESULTS: CMV infection
was diagnosed in 41 patients. The 11 patients in whom CMV infection was not
detected were used as controls. Acute rejection was diagnosed in 22 of 41 CMV
patients and in 6 of 11 control patients. CMV was demonstrated in the biopsy
specimens of 19 of 41 CMV patients. CMV was not associated with increased
glomerular, tubular, or interstitial changes. However, the arteriosclerotic
changes in small arterioles were significantly increased in the subgroup of
patients where CMV was demonstrated in the graft as compared with controls
(P<0.01). Analysis of the impact of acute rejection on arteriolar thickening
showed that only a positive history of both acute rejection and CMV found in
the graft was associated with significantly increased vascular changes compared
with CMV-free recipients (P<0.05). CONCLUSIONS: Neither CMV nor acute
rejection alone was associated with increased vascular or other histopathologic
changes in 6-month protocol biopsy specimens of kidney allografts, but a
previous history of both acute rejection and the presence of CMV in the graft
was associated with increased vascular changes.
----------------------------------------------------
[151]
TÍTULO / TITLE: - Transplant capillaropathy
and transplant glomerulopathy: ultrastructural markers of chronic renal
allograft rejection.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Apr;18(4):655-60.
AUTORES
/ AUTHORS: - Ivanyi B
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, University of
Szeged, Szeged, Hungary. ivanyi@patho.szote.u-szeged.hu N. Ref:: 21
----------------------------------------------------
[152]
TÍTULO / TITLE: - Adenovirus
pyelonephritis in a pediatric renal transplant patient.
REVISTA
/ JOURNAL: - Pediatr Nephrol 2003 May;18(5):457-61.
Epub 2003 Mar 18.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00467-003-1080-x
AUTORES
/ AUTHORS: - Kim SS; Hicks J; Goldstein SL
INSTITUCIÓN
/ INSTITUTION: - Baylor College of Medicine, Texas, USA.
RESUMEN
/ SUMMARY: - Gross hematuria, graft pain, and rising
serum creatinine are classic signs of acute rejection, obstruction, or
bacterial pyelonephritis for patients with renal transplants. This presentation
often prompts percutaneous renal allograft biopsy. If subsequent evaluation
fails to show evidence of acute rejection, obstruction, or bacterial infection,
viral etiologies should be considered. We report a 14-year-old Hispanic female
with a living-related renal transplant who had gross hematuria, graft
tenderness, and increased serum creatinine, but did not have evidence of acute
rejection, obstruction, or bacterial pyelonephritis. To our knowledge, this is
the first report of adenovirus pyelonephritis in a transplanted kidney of a
pediatric patient, with isolation of adenovirus in the urine and in the
allograft using immunocytochemical techniques.
N. Ref:: 26
----------------------------------------------------
[153]
TÍTULO / TITLE: - Interleukin 18 and
interleukin 18 binding protein: possible role in immunosuppression of chronic
renal failure.
REVISTA
/ JOURNAL: - Blood Purif 2003;21(3):258-70.
●●
Enlace al texto completo (gratuito o de pago) 1159/000070699
AUTORES
/ AUTHORS: - Dinarello CA; Novick D; Rubinstein M;
Lonnemann G
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
Colorado Health Sciences Center, Denver, Colo 80262, USA.
RESUMEN
/ SUMMARY: - Although interleukin (IL)-18 is a member
of the IL-1 family of ligands, IL-18 appears to have unique characteristics,
particularly in the regulation of the T helper type 1 (Th1) response. Th1
responses are required for tumor surveillance, killing intracellular organisms,
and to provide help for antibody production. In patients with chronic renal
failure, the well-known immunosuppression contributes to a failure to respond
to infectious challenges and vaccinations. The most salient biological property
of IL-18, linking this cytokine to the Th1 response, is its ability to induce
interferon gamma (IFN-gamma). In fact, IL-18 was originally identified as an
IFN-gamma-inducing factor, and IFN-gamma production is the hallmark of the Th1
response. Dysregulation of IFN-gamma production resulting from reduced activity
of IL-18 would explain one of the mechanisms of immunosuppression in patients
with chronic renal failure. The activity of IL-18 can be regulated by the
IL-18-binding protein (IL-18BP), a glycoprotein of 40,000 daltons, which is
constitutively expressed and appears to be the natural inhibitor of IL-18
activity. Unlike soluble receptors for IL-18, IL-18BP does not have a
transmembrane domain; IL-18BP is a secreted protein possessing a high-affinity
binding and ability to neutralize IL-18. IL-18BP was discovered in human urine and
is excreted in health following glomerular filtration. With decreasing renal
function, the concentrations of IL-18BP in the circulation are elevated as
compared with subjects with a normal renal function, and these elevated levels
may result in a decreased IL-18 activity. Because of the importance of IL-18
and IFN-gamma in the Th1 response, the biology of IL-18 and IL-18BP is reviewed
here in the context of the immunosuppression of chronic renal failure. N. Ref:: 81
----------------------------------------------------
[154]
- Castellano -
TÍTULO / TITLE:Enfermedad coronaria en trasplante
renal. Coronary disease in renal transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22 Suppl 4:12-9.
AUTORES
/ AUTHORS: - Marcen R
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Hospital Ramon y
Cajal, Ctra. de Colmenar Viejo, km. 9,1 28034 Madrid. N. Ref:: 79
----------------------------------------------------
[155]
TÍTULO / TITLE: - Rapamycin in
transplantation: a review of the evidence.
REVISTA
/ JOURNAL: - Kidney Int 2001 Jan;59(1):3-16.
AUTORES
/ AUTHORS: - Saunders RN; Metcalfe MS; Nicholson ML
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Leicester General
Hospital, Leicester, England, United Kingdom. rnsaunders@hotmail.com
RESUMEN
/ SUMMARY: - Rapamycin in transplantation: A review of
the evidence. The calcineurin inhibitors have been the mainstays of
immunosuppression for solid organ transplantation over the last two decades,
but nephrotoxicity limits their therapeutic benefit. Rapamycin is a new drug with
both immunosuppressant and antiproliferative properties that has a unique
mechanism of action distinct from that of the calcineurin inhibitors. It has a
role as a maintenance immunosuppressant either alone or in combination with a
calcineurin inhibitor and can also be used to treat refractory acute rejection.
Theoretical evidence suggests that it may limit the development and progression
of chronic rejection in transplant recipients, but this has yet to be
confirmed. This review examines the current in vitro animal and human work
underlying the use of rapamycin and, in addition, comments on the
pharmacokinetics and side-effect profile of this promising new agent. N. Ref:: 122
----------------------------------------------------
[156]
TÍTULO / TITLE: - Pathophysiology of
renal disease associated with liver disorders: implications for liver
transplantation. Part I.
REVISTA
/ JOURNAL: - Liver Transpl 2002 Feb;8(2):91-109.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2002.31516
AUTORES
/ AUTHORS: - Davis CL; Gonwa TA; Wilkinson AH
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of
Nephrology, University of Washington, Seattle, WA 98195, USA. cdavis@u.washington.edu
RESUMEN
/ SUMMARY: - Renal and hepatic function are often
intertwined through both the existence of associated primary organ diseases and
hemodynamic interrelationships. This connection occasionally results in the
chronic failure of both organs, necessitating combined liver-kidney
transplantation (LKT). Since 1988, more than 850 patients in the United States
have received such transplants, with patient survival somewhat less than that
for patients receiving either organ alone. Patients with renal failure caused
by acute injury or hepatorenal syndrome have classically not been included as
candidates for combined transplantation because of the reversibility of renal
dysfunction after liver transplantation. However, the rate and duration of
renal failure before liver transplantation is increasing in association with
prolonged waiting list times. Thus, the issue of acquired permanent renal
damage in the setting of hepatic failure continues to confront the transplant community.
The following article and its sequel (Part II, to be published in vol 8, no 3
of this journal) attempt to review the problem of primary and secondary renal
disease in patients with end-stage liver disease, elements involved in renal
disease progression and recovery, the impact of renal disease on liver
transplant outcome, and results of combined LKT; outline the steps in the
pretransplantation renal evaluation; and provide the beginnings of an algorithm
for making the decision for combined LKT.
N. Ref:: 219
----------------------------------------------------
[157]
TÍTULO / TITLE: - Hepatitis C
virus-positive patients on the waiting list for transplantation.
REVISTA
/ JOURNAL: - Semin Nephrol 2002 Jul;22(4):361-4.
AUTORES
/ AUTHORS: - Campistol JM; Esforzado N; Morales JM
INSTITUCIÓN
/ INSTITUTION: - Renal Transplant Unit, Hospital Clinic,
University of Barcelona, Institut d’Investigacio Biomediques August Pi i Sunyer
(IDIBAPS), Barcelona, España. jmcampis@medicina.ub.es
RESUMEN
/ SUMMARY: - Hepatitis C virus (HCV) infection is a
common problem in renal transplant patients, associated with an increase in
morbidity and mortality. HCV infection is associated with a lower graft and
patient survival. The problem of HCV infection is the increase in viral load
and liver transaminases after renal transplantation secondary to
immunosuppressive therapy. After renal transplantation, interferon therapy is
not recommended because of the risk for acute rejection and acute nephritis. In
this context, it is absolutely necessary to consider the evaluation and
treatment of HCV infection during the dialysis period. Several studies have
defined the benefits of interferon therapy in dialysis patients, with rates of maintenance
response significantly higher than in the general population. The difference in
the pharmacokinetic profile of interferon in dialysis patients could justify
its higher efficacy. N.
Ref:: 17
----------------------------------------------------
[158]
TÍTULO / TITLE: - Quality of life after
kidney and pancreas transplantation: a review.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Sep;42(3):431-45.
AUTORES
/ AUTHORS: - Joseph JT; Baines LS; Morris MC; Jindal RM
INSTITUCIÓN
/ INSTITUTION: - Royal Bournemouth Hospital, Bournemouth,
UK.
RESUMEN
/ SUMMARY: - There is an increasing amount of data on
quality of life (QOL) in most chronic illnesses; some of the instruments used
are generic, but recently, there is a tendency to use disease-specific instruments.
We propose that recipients of organ transplants be assessed routinely for QOL
by means of the 36-Item Short-Form Health Survey or a disease-specific
instrument; for compliance, by means of the Long-Term Medication Behavior
Self-Efficacy Scale; and for psychological status, by means of the Beck
Depression Inventory Brief Symptom Inventory or the Symptom Checklist. The
widespread use of QOL data in recipients of organ transplants will increase
accountability of service providers and eventually increase patient
satisfaction because these instruments are patient reported. N. Ref:: 92
----------------------------------------------------
[159]
TÍTULO / TITLE: - Obesity as a risk
factor in renal transplant patients.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001 Jan;16(1):14-7.
AUTORES
/ AUTHORS: - Pischon T; Sharma AM N. Ref:: 16
----------------------------------------------------
[160]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.5. Chronic graft dysfunction. Late recurrence of
primary glomerulonephritides.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:16-8.
RESUMEN
/ SUMMARY: - GUIDELINES: A. In the case of recurrent
focal and segmental glomerulosclerosis (FSGS), aggressive treatment with
high-dose cyclosporine in children, ACE inhibitors and/or Angiotensin II
antagonists, plasma exchange or immunoadsorption may result in remission in
some patients. B. In the case of recurrent membranous nephropathy (MN), there
is no specific treatment. However, control of risk factors, such as
hypertension, heavy proteinuria and hyperlipidaemia, and prevention of
thrombotic complications are recommended. C. In the case of recurrent
membranoproliferative glomerulonephritis (MPGN), there is no specific
treatment. However, control of risk factors, such as hypertension, heavy
proteinuria and hyperlipidaemia, and prevention of thrombotic complications are
recommended. D. In the case of recurrent IgA glomerulonephritis, use of
additional steroids is not yet a validated treatment. The control of risk
factors, such as hypertension, heavy proteinuria and hyperlipidaemia, is
recommended. E. In the rare case of recurrent anti-glomerular basement membrane
(anti-GBM) glomerulonephritis with reappearance of anti-GBM antibodies, it is
recommended to initiate plasma exchange and to treat with appropriate
immunosuppressive agents (e.g. cyclophosphamide).
----------------------------------------------------
[161]
TÍTULO / TITLE: - C4d and the fate of
organ allografts.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2002
Sep;13(9):2417-9.
AUTORES
/ AUTHORS: - Platt JL
N. Ref:: 16
----------------------------------------------------
[162]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.3 Chronic graft dysfunction. Non-alloimmune factors.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:11-5.
RESUMEN
/ SUMMARY: - GUIDELINES. A. Whereas immunological
mechanisms dominate in the initiation and propagation of the injury that leads
to chronic allograft dysfunction and nephropathy, there is circumstantial
evidence that non-immunological factors, such as advanced donor age,
hyperfiltration, overweight, delayed graft function, heavy proteinuria,
smoking, arterial hypertension, hypercholesterolaemia and
hypertriglyceridaemia, play a role as aggravating or progression factors. It is
recommended to prevent or, if possible, treat all these factors. B. As arterial
hypertension is very frequent among renal transplant patients and associated
with increased graft (and patient) loss, it is recommended to aim at a blood
pressure less than 130/85 mmHg in renal transplant patients and <125/75 mmHg
in recipients with proteinuria >1 g/day.
----------------------------------------------------
[163]
TÍTULO / TITLE: - Treatment of de novo
and recurrent membranous nephropathy in renal transplant patients.
REVISTA
/ JOURNAL: - Semin Nephrol 2003 Jul;23(4):392-9.
AUTORES
/ AUTHORS: - Poduval RD; Josephson MA; Javaid B
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Section of
Nephrology, University of Chicago, Pritzker School of Medicine, IL 60637, USA.
RESUMEN
/ SUMMARY: - Membranous nephropathy (MN) is one of the
common glomerular diseases diagnosed in transplanted kidneys. The exact impact
of posttransplantation MN on the risk for graft loss and long-term graft
outcome is not defined clearly. In recent reports, it has emerged as the third
most frequent glomerulonephritis (de novo or recurrent) associated with renal
allograft loss. Most cases of posttransplantation MN are thought to be
idiopathic but cases associated with established secondary causes also have
been reported. Patients can present with varying degrees of proteinuria and
graft dysfunction. Risk factors that predict a poor outcome are not well
established and unlike MN in the native kidneys, spontaneous remission is rare.
Patients should be evaluated carefully for complications associated with
nephrotic syndrome or graft dysfunction and managed accordingly. The beneficial
effects of steroids, cyclosporine, mycophenolate mofetil, cyclophosphamide,
chlorambucil, or other agents have not been validated. The role of specific
treatments in cases of secondary MN is uncertain. Retransplantation is a
reasonable option for patients who develop graft failure secondary to MN. N. Ref:: 34
----------------------------------------------------
[164]
TÍTULO / TITLE: - Treatment of renal
transplant ureterovesical anastomotic strictures using antegrade balloon
dilation with or without holmium:YAG laser endoureterotomy.
REVISTA
/ JOURNAL: - Urology 2003 Nov;62(5):831-4.
AUTORES
/ AUTHORS: - Kristo B; Phelan MW; Gritsch HA; Schulam
PG
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, University of
California, Los Angeles, School of Medicine, Los Angeles, Medical Center, Los
Angeles, California 90095, USA.
RESUMEN
/ SUMMARY: - OBJECTIVES: To report our results after
antegrade endoscopic treatment of ureteral stenosis with balloon dilation with
or without holmium laser endoureterotomy. Ureteral stenosis is the most common
long-term urologic complication of renal transplantation. METHODS: From July
2000 to October 2002, 9 renal transplant patients with ureteral obstruction
diagnosed by an increase in serum creatinine and radiologic evidence presented
for endoscopic treatment. All patients were treated with nephrostomy tube
drainage followed by antegrade flexible nephroureteroscopy and balloon dilation
of the stricture. Three patients required holmium laser endoureterotomy during
the same procedure because of fluoroscopic and endoscopic evidence of
persistent stricture. All patients were treated with ureteral stents and
nephrostomy tubes postoperatively. The median follow-up was 24 months (range 6
to 32). RESULTS: The site of stenosis was at the ureterovesical anastomosis in
all patients, and the mean stricture length was 0.28 cm. Two patients had
previously undergone ureteroneocystostomy for prior ureteral stenosis. Six
patients (66%) required only balloon dilation, and 3 patients (33%) also
required holmium laser endoureterotomy. The median ureteral stent and
nephrostomy tube duration was 40 and 62 days, respectively. The mean serum
creatinine level was 2.3 mg/dL at presentation and 1.7 mg/dL at the last
follow-up visit. After a median follow-up of 24 months, the ureteral patency
and graft function rates were both 100%. No perioperative complications
occurred. CONCLUSIONS: Balloon dilation with or without holmium laser
endoureterotomy was successful and safe in this group of renal transplant
patients with short ureterovesical anastomotic strictures. N. Ref:: 19
----------------------------------------------------
[165]
TÍTULO / TITLE: - Hormone replacement
therapy in postmenopausal women with end-stage renal disease: a review of the
issues.
REVISTA
/ JOURNAL: - Semin Dial 2001 May-Jun;14(3):146-9.
AUTORES
/ AUTHORS: - Holley JL; Schmidt RJ
RESUMEN
/ SUMMARY: - Hormone replacement is an integral part of
therapies to prevent osteoporosis in postmenopausal women and may be considered
a component in the treatment of dyslipidemia, cardiovascular disease, and
possibly cognitive function. The indications for, and efficacy and prescription
of, hormone replacement therapy in postmenopausal women with ESRD have been
infrequently studied and less than 10% of postmenopausal women on dialysis are
receiving hormone replacement. Small studies suggest that hormone replacement
therapy is valuable in treating the dyslipidemia of women on dialysis, but
indicate that a reduction in the dosage of hormone replacement may be needed. A
potential role for hormone replacement therapy in the treatment and/or
prevention of osteoporosis and sexual dysfunction in postmenopausal women on
dialysis exists as well. N.
Ref:: 33
----------------------------------------------------
[166]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.9.1. Haematological complications. Anaemia.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:48-9.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Because anaemia is
relatively common after kidney transplantation, regular screening and careful
evaluation of its causes are recommended. In many cases, post-transplant
anaemia is caused by allograft dysfunction. The use of purine synthesis
inhibitors (azathioprine and MMF), ACE inhibitors and angiotensin II receptor
antagonists may frequently cause post-transplant anaemia. Anaemia is reversible
after withdrawing the offending agent. Haemolytic anaemia may develop in
transplant recipients. B. Treatment of anaemia should follow the European best
practice guidelines for treatment of anaemia in chronic renal failure.
----------------------------------------------------
[167]
- Castellano -
TÍTULO / TITLE:Valoracion del tratamiento
sustitutivo integrado en pacientes en insuficiencia renal terminal: seleccion
versus eleccion. Assessment of integrated replacement therapy in patients with
terminal renal insufficiency: selection vs election.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2001;21 Suppl 5:4-13.
AUTORES
/ AUTHORS: - Lampreabe I; Muniz ML; Zarraga S; Amenabar
JJ; Erauzkin GG; Gomez-Ullate P; Gainza FJ
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Hospital de
Cruces, Facultad de Medicina, Universidad del Pais Vasco. ilampreave@hcru.osakidetza.net N. Ref:: 36
----------------------------------------------------
[168]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.9.2. Haematological complications. Leukopenia.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:49.
RESUMEN
/ SUMMARY: - GUIDELINE: Because leukopenia is
relatively common after kidney transplantation, regular screening and careful
evaluation of its causes are recommended. Azathioprine and mycophenolate
mofetil may lead to leukopenia. The combination of allopurinol and azathioprine
should be avoided. Leukopenia is often associated with viral infections.
----------------------------------------------------
[169]
TÍTULO / TITLE: - Renal transplantation:
can we reduce calcineurin inhibitor/stop steroids? Evidence based on protocol
biopsy findings.
REVISTA
/ JOURNAL: - J Urol 2003 Sep;170(3):1056.
AUTORES
/ AUTHORS: - Goldfarb DA
----------------------------------------------------
[170]
TÍTULO / TITLE: - Nonheart-beating kidney
donation: current practice and future developments.
REVISTA
/ JOURNAL: - Kidney Int 2003 Apr;63(4):1516-29.
AUTORES
/ AUTHORS: - Brook NR; Waller JR; Nicholson ML
INSTITUCIÓN
/ INSTITUTION: - Division of Transplant Surgery, The
Department of Surgery, University of Leicester, Leicester General Hospital,
Leicester, United Kingdom. nicholasbrook@gfastmail.fm
RESUMEN
/ SUMMARY: - BACKGROUND: Nonheart-beating kidney
donation (NHBD) is gaining acceptance as a method of donor pool expansion.
However, a number of practitioners have concerns over rates of delayed graft
function, acute rejection, and long-term graft survival. The ethical issues
associated with NHBD are complex and may be a further disincentive. Tailored
strategies for preservation, viability prediction, and immunosuppression for
kidneys from this source have the potential to maximize the number of available
organs. This review article presents the current practice of NHBD kidney
transplantation, examines the results and draws comparisons with cadaveric
kidneys, and explores some areas of potential development. METHODS: A review of
the current literature on NHBD kidney donation was performed. RESULTS: The
renewed interest in NHBD kidneys is driven by a continuing shortfall in
available organs. Those centers involved in NHBD report an increase in kidney
transplants of the order of 16% to 40% and there is no evidence that the
financial costs are higher with NHBDs. The majority of experience comes from
Maastricht category 2 NHBDs, where an estimation of warm time is possible. This
is generally limited to 40 minutes. There are variations in the technique for
kidney preservation prior to retrieval, but most centers use an aortic balloon
catheter. Much work has looked at the ideal technique for kidney preservation
prior to implantation. Evidence suggests that machine perfusion produces the
best initial function rates, decreased use of adjuvant immunotherapy and fewer
haemodialysis sessions than static cold storage. CONCLUSION: Despite being
associated with poorer initial graft function, the long-term allograft survival
of NHBD kidneys does not differ from the results of transplantation from
cadaveric kidneys. Further, serum creatinine levels are generally equivalent.
Constant reassessment of the ethical issues is required for donation to be
increased while respecting public concerns. Use of viability assessment and
tailoring of immune suppression for NHBD kidneys may allow a further increase
in donation from this source. N.
Ref:: 132
----------------------------------------------------
[171]
TÍTULO / TITLE: - Are peritoneal dialysis
patients with and without residual renal function equivalent for survival
study? Insight from a retrospective review of the cause of death.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 May;18(5):977-82.
AUTORES
/ AUTHORS: - Szeto CC; Wong TY; Chow KM; Leung CB; Li
PK
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Prince of Wales
Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China. ccszeto@cuhk.edu.hk
RESUMEN
/ SUMMARY: - BACKGROUND: It remains unknown whether
results of survival studies in anuric patients can be extrapolated to those who
still have significant urine output. It is possible that after a prolonged
period on dialysis, anuric patients are qualitatively different from patients
with residual renal function. METHODS: We performed a retrospective review to
study the cause of death of 296 peritoneal dialysis patients of our centre over
a 7 year period, and compared the mortality and distribution of cause of death
between patients with and without residual renal function. RESULTS: One hundred
and forty-two cases (48.0%) died of vascular diseases, 82 cases (27.7%) died of
infections and 72 cases (24.3%) died of other causes. Anuric patients had a
higher overall mortality rate than non-anuric patients (14.9 vs 9.9%,
P=0.0005), and the difference was almost completely attributed to the
difference in mortality from vascular diseases (8.0 vs 4.1%, P<0.0001).
Vascular disease was a more common cause of death in anuric patients than those
with residual renal function (55.3 vs 40.8%, P=0.011). The difference was
largely explained by the higher prevalence of sudden cardiac death in anuric
patients (39 in 149 vs 19 in 147 cases). Patients without pre-existing
cardiovascular disease more commonly died of vascular disease after they became
anuric (47.4 vs 34.0%, P=0.017). The difference could not be explained by the
longer duration of dialysis in anuric patients because there was no significant
change in the distribution of cause of death with time on dialysis (chi-square
test, P=0.341). CONCLUSIONS: Our observation suggests that peritoneal dialysis
patients with and without residual renal function are qualitatively different.
Studies on peritoneal dialysis adequacy and survival in anuric patients should only
be extrapolated to the general dialysis population with caution.
----------------------------------------------------
[172]
TÍTULO / TITLE: - Epstein-Barr
virus-associated pulmonary leiomyosarcoma arising twenty-nine years after renal
transplantation.
REVISTA
/ JOURNAL: - J Thorac Cardiovasc Surg 2003
Sep;126(3):877-9.
AUTORES
/ AUTHORS: - Ferri L; Fraser R; Gaboury L; Mulder D
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, McGill University
Health Centre, Montreal General Hospital, Room D10.168, 1650 Cedar Avenue,
Montreal, Quebec H3G 1A4, Canada. lferri@po-box.mcgill.ca N. Ref:: 5
----------------------------------------------------
[173]
TÍTULO / TITLE: - Cardiovascular disease
and the renal transplant recipient.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S36-43.
AUTORES
/ AUTHORS: - Kendrick E
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, University of
California—Los Angeles Medical Center, Los Angeles, CA 90095, USA. ekendrick@mednet.ucla.edu
RESUMEN
/ SUMMARY: - Cardiovascular complications contribute to
a significant proportion of the morbidity and mortality in renal transplant
patients. Underlying disease states such as diabetes and hypertension as well
as risk factors associated with chronic dialysis may cause many patients to
have established coronary artery and peripheral vascular disease at the time of
transplantation. Progression or new onset of disease can occur after
transplantation due to the continued presence of risk factors for
cardiovascular disease. The benefit of modification of these risk factors such
as hypertension and hyperlipidemia has been well established in the general
population and has more recently been explored in the renal transplant
population, although long-term studies documenting an improvement in morbidity
and mortality are not available. This article focuses on the potential benefit
of modification of risk factors in this setting. N. Ref:: 90
----------------------------------------------------
[174]
TÍTULO / TITLE: - Mechanisms and
consequences of arterial hypertension after renal transplantation.
REVISTA
/ JOURNAL: - Transplantation 2001 Sep 27;72(6
Suppl):S9-12.
AUTORES
/ AUTHORS: - Koomans HA; Ligtenberg G
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Hypertension,
University Hospital Utrecht, The Netherlands. h.a.koomans@digd.azu.nl
RESUMEN
/ SUMMARY: - The high incidence of hypertension after
renal transplantation contributes to the risk of cardiovascular morbidity and
mortality in renal transplant recipients. Although cyclosporine has been
influential in the improvement of transplant outcome, it has emerged as a major
cause of hypertension after organ transplantation. The underlying
pathophysiological mechanisms of cyclosporine-induced hypertension include
enhanced sympathetic nervous system activity, renal vasoconstriction, and
sodium/water retention. Hypertension is also significantly associated with
reduced graft survival and thereby requires aggressive treatment intervention.
Calcium channel blockers may offer some advantages over angiotensin-converting
enzyme inhibitors for the treatment of hypertension in stable renal transplant
recipients. Nevertheless, selection of the most appropriate antihypertensive
agent should take into account the possibility of pharmacokinetic interactions
with immunosuppressive agents. There is evidence to suggest that the use of tacrolimus-based
immunosuppression induces less hypertension compared with cyclosporine. Not
only do patients receiving tacrolimus tend to require less antihypertensive
therapy, but converting patients from cyclosporine to tacrolimus has been shown
to result in significant reductions in blood pressure. Thus, tacrolimus may be
associated with an improved cardiovascular risk profile in renal transplant
recipients. N. Ref:: 26
----------------------------------------------------
[175]
TÍTULO / TITLE: - Apoptosis and
inflammation in renal reperfusion injury.
REVISTA
/ JOURNAL: - Transplantation 2002 Jun
15;73(11):1693-700.
AUTORES
/ AUTHORS: - Daemen MA; de Vries B; Buurman WA
INSTITUCIÓN
/ INSTITUTION: - Department of General Surgery, University
of Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands.
RESUMEN
/ SUMMARY: - Ischemia followed by reperfusion (I/R) has
cardinal implications in the pathogenesis of organ transplantation and
rejection. Apoptosis and inflammation are central mechanisms leading to organ
damage in the course of renal I/R. General aspects of apoptosis, morphology,
induction, and biochemistry are discussed. Activated caspases, the classical
effector enzymes of apoptosis, are able to induce not only apoptosis but also
inflammation after I/R in experimental models. This redefines the involvement
of apoptosis in I/R injury toward a central and functional role in the
development of organ damage. Our purpose is to assess aspects of apoptosis and
inflammation in terms of involvement in the pathogenesis of I/R-induced organ
damage. Moreover, the implications of recent experimental advances for
diagnosis and treatment of renal I/R injury in clinical practice will be
discussed. N. Ref:: 101
----------------------------------------------------
[176]
TÍTULO / TITLE: - Assessing
cardiovascular risk profile of immunosuppressive agents.
REVISTA
/ JOURNAL: - Transplantation 2001 Dec 27;72(12
Suppl):S81-8.
AUTORES
/ AUTHORS: - Jardine A
N. Ref:: 57
----------------------------------------------------
[177]
TÍTULO / TITLE: - Renal pathological
changes in Fabry disease.
REVISTA
/ JOURNAL: - J Inherit Metab Dis 2001;24 Suppl 2:66-70;
discussion 65.
AUTORES
/ AUTHORS: - Sessa A; Meroni M; Battini G; Maglio A;
Brambilla PL; Bertella M; Nebuloni M; Pallotti F; Giordano F; Bertagnolio B;
Tosoni A
INSTITUCIÓN
/ INSTITUTION: - Nefrologia e Dialisi, Ospedale di
Vimercate, Italia. adsess@tin.it
RESUMEN
/ SUMMARY: - Fabry disease is a rare X-linked disorder,
characterized by deficient activity of the lysosomal enzyme alpha-galactosidase
A. This leads to systemic accumulation of the glycosphingolipid
globotriaosylceramide (Gb3) in all body tissues and organs, including the
kidney. Renal manifestations are less evident in female heterozygotes than in
male hemizygotes, according to the Lyon hypothesis. Accumulation of Gb3 occurs
mainly in the epithelial cells of Henle’s loop and distal tubule, inducing
early impairment in renal concentrating ability; involvement of the proximal
tubule induces Fanconi syndrome. All types of glomerular cells are involved,
especially podocytes, and glomerular proteinuria may occur at a young age. The
evolution of renal Fabry disease is characterized by progressive deterioration
of renal function to end-stage renal failure (ESRF). Ultrastructural study of
kidney biopsies reveals typical bodies in the cytoplasm of all types of renal
cells, characterized by concentric lamellation of clear and dark layers with a
periodicity of 35-50 A. Management of progressive renal disease requires
dietetic and therapeutic strategies, usually indicated in developing chronic
renal failure, with dialysis and renal transplantation required for patients
with ESRF. The recent development of enzyme replacement therapy, however,
should make it possible to prevent or reverse the progressive renal dysfunction
associated with Fabry disease. N.
Ref:: 17
----------------------------------------------------
[178]
TÍTULO / TITLE: - Renal imaging in
patients requiring renal replacement therapy.
REVISTA
/ JOURNAL: - Semin Dial 2002 Jul-Aug;15(4):237-49.
AUTORES
/ AUTHORS: - Cowie A
INSTITUCIÓN
/ INSTITUTION: - Department of Diagnostic Radiology,
Manchester Royal Infirmary, United Kingdom. agcowie1@hotmail.com
RESUMEN
/ SUMMARY: - Recent advances in imaging technology and
interventional radiologic procedures have resulted in an increased variety of
radiological techniques that can be used to assess patients who present with renal
failure and require renal replacement therapy. This chapter provides an
overview of the relative strengths and weaknesses of the available imaging
methods. In particular, it covers the expanding role of the cross-sectional,
noninvasive, multiplanar imaging techniques such as gray-scale and Doppler
ultrasound, magnetic resonance imaging (MRI) and angiography (MRA), and
nonenhanced helical or multislice computed tomography (CT). These imaging
methods are increasingly replacing those used in the past, such as the
conventional radiographic urogram, which requires a high dose of intravenous
contrast media, and digital subtraction arteriography. The chapter also covers
the radiologic investigation of complications of acquired renal cystic disease,
including renal cell carcinoma, hemorrhage, cyst infection and rupture, and
nephrolithiasis. N.
Ref:: 57
----------------------------------------------------
[179]
TÍTULO / TITLE: - The evolving role of
chemokines and their receptors in acute allograft rejection.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002 Aug;17(8):1374-9.
AUTORES
/ AUTHORS: - Inston NG; Cockwell P
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Renal
Transplantation, Queen Elizabeth Hospital, University Hospital Birmingham NHS
Trust, Birmingham, UK. N.
Ref:: 64
----------------------------------------------------
[180]
TÍTULO / TITLE: - Effect of
immunosuppressive treatment protocol on malignancy development in renal
transplant patients.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2133-5.
AUTORES
/ AUTHORS: - Haberal M; Moray G; Karakayali H; Emiroglu
R; Basaran O; Sevmis S; Demirhan B
INSTITUCIÓN
/ INSTITUTION: - Baskent University Faculty of Medicine,
Ankara, Turkey. melekk@baskent-ank.edu.tr
----------------------------------------------------
[181]
TÍTULO / TITLE: - A pilot protocol of a
calcineurin-inhibitor free regimen for kidney transplant recipients of marginal
donor kidneys or with delayed graft function.
REVISTA
/ JOURNAL: - Clin Transplant 2003;17 Suppl 9:31-4.
AUTORES
/ AUTHORS: - Shaffer D; Langone A; Nylander WA; Goral
S; Kizilisik AT; Helderman JH
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Vanderbilt
University Medical Center, Nashville, TN 37232, USA. david.schaffer@vanderbilt.edu
RESUMEN
/ SUMMARY: - The worsening shortage of cadaver donor
kidneys has prompted use of expanded or marginal donor kidneys (MDK), i.e.
older age or donor history of hypertension or diabetes. MDK may be especially
susceptible to calcineurin-inhibitor (CI) mediated vasoconstriction and
nephrotoxicity. Similarly, early use of CI in patients with delayed graft
function may prolong ischaemic injury. We developed a CI-free protocol of
antibody induction, sirolimus, mycophenolate mofetil, and prednisone in
recipients with MDK or DGF. METHODS: Adult renal transplant recipients who
received MDK or had DGF were treated with a CI-free protocol consisting of
antibody induction (basiliximab or thymoglobulin), sirolimus, mycophenolate
mofetil, and prednisone. Serial biopsies were performed for persistent DGF.
Patients were followed prospectively with the primary endpoints being patient
and graft survival, biopsy-proven acute rejection, and sirolimus-related
toxicity. RESULTS: Nineteen recipients were treated. Mean follow-up was 294
days. Actuarial 6- and 12-month patient survival was 100% and 100% and graft
survival was 93% and 93%, respectively. The only graft loss was due to primary
non-function (PNF). The incidence of AR was 16%. Mean serum creatinine at last
follow-up was 1.6 mg/dL. Sirolimus-related toxicity included lymphocele (1),
wound infection (2), thrombocytopenia (1). and interstitial pneumonitis (1).
CONCLUSION: A CI-free protocol with antibody induction and sirolimus results in
low rates of AR and PNF and excellent early patient and graft survival in
patients with MDK and DGF. CI-free protocols may allow expansion of the kidney
donor pool by encouraging utilization of MDK at high risk for DGF or
CI-mediated nephrotoxicity.
----------------------------------------------------
[182]
TÍTULO / TITLE: - De novo SLE after
cadaveric renal transplantation.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Sep;42(3):E24-7.
AUTORES
/ AUTHORS: - Laboi P; Dedi R; Campbell H; Hartley B;
Turney JH
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine and
Histopathology, Leeds General Infirmary, Leeds, United Kingdom. paullaboi396@hotmail.com
RESUMEN
/ SUMMARY: - De novo lupus nephritis in a renal
transplant recipient has not been previously reported. We present a transplant
recipient with long-standing insulin-dependent diabetes mellitus who presented
9 years posttransplant with hematoproteinuria and acute renal failure. New
findings of positive antinuclear antibody and double-stranded deoxyribonucleic
antibody and renal histology findings consistent with lupus nephritis suggest a
diagnosis of de novo systemic lupus erythematosis. N. Ref:: 8
----------------------------------------------------
[183]
TÍTULO / TITLE: - Chronic kidney disease
and the transplant recipient.
REVISTA
/ JOURNAL: - Blood Purif 2003;21(1):137-42.
AUTORES
/ AUTHORS: - Gill JS; Pereira BJ
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Tufts-New England
Medical Center, Boston, Mass 02111, USA.
RESUMEN
/ SUMMARY: - The recent Kidney Disease Outcomes Quality
Initiative (K/DOQI) classification of chronic kidney disease (CKD) includes
transplant recipients. Although there are important differences between kidney
transplant recipients (KTRs) and patients with native kidney disease, the
inclusion of KTRs along with other CKD patients is an important step to improve
long-term outcomes among transplant recipients. In this article we discuss the
applicability of the K/DOQI classification of CKD to transplant recipients and
the importance of premature patient death with graft function as a cause of
graft loss. The implementation of a comprehensive program of CKD care beginning
prior to transplantation and continuing after graft failure is discussed as a
strategy to improve patient outcomes and specific areas of concern for KTRs are
highlighted. N.
Ref:: 35
----------------------------------------------------
[184]
- Castellano -
TÍTULO / TITLE:Enfermedad cardiovascular en
transplante renal. Cardiovascular disease in kidney transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2001 Mar-Apr;21(2):104-14.
AUTORES
/ AUTHORS: - Marcen R; Pascual J N. Ref:: 143
----------------------------------------------------
[185]
TÍTULO / TITLE: - Proposed guidelines for
re-evaluation of patients on the waiting list for renal cadaver
transplantation.
REVISTA
/ JOURNAL: - Transplantation 2002 Mar 15;73(5):811-2.
AUTORES
/ AUTHORS: - Matas AJ; Kasiske B; Miller L
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, University of
Minnesota, Minneapolis, MN 55455, USA.
RESUMEN
/ SUMMARY: - Transplant candidates are extensively
evaluated before being wait-listed for cadaver transplantation. Yet many wait a
number of years before being transplanted. We propose guidelines for regular
cardiac re-evaluation for patients on the waiting list.
----------------------------------------------------
[186]
TÍTULO / TITLE: - Random sample (DOPPS)
versus census-based (registry) approaches to kidney disease research.
REVISTA
/ JOURNAL: - Blood Purif 2003;21(1):85-8.
AUTORES
/ AUTHORS: - Port FK; Wolfe RA; Held PJ; Young EW
INSTITUCIÓN
/ INSTITUTION: - University of Renal Research and Education
Association (URREA), Ann Arbor, Mich, USA. fport@urrea.org
RESUMEN
/ SUMMARY: - This review describes advantages and
limitations of registries that base their analyses on the census of all
patients. Registries may utilize the random sample approach to enrich their
data for more detailed and informative research. The Dialysis Outcomes and
Practice Pattern Study (DOPPS) and its random sample approach is discussed here
in detail, with examples on the value of this method. The DOPPS is currently
being expanded to allow for even more valuable studies. This methodology can
also be applied to large countries that do not have an existing registry, as it
is an effective way of collecting detailed information at a relatively low cost
that is representative of the country or population as a whole. N. Ref:: 12
----------------------------------------------------
[187]
TÍTULO / TITLE: - Extragonadal seminoma
after renal transplantation and immunosuppression; treatment in the presence of
renal dysfunction: a case report and literature review.
REVISTA
/ JOURNAL: - Med Oncol 2001;18(3):221-5.
AUTORES
/ AUTHORS: - Kosmas C; Tsavaris NB; Vadiaka M; Chiras
T; Boletis J; Kostakis A
INSTITUCIÓN
/ INSTITUTION: - Department of Pathophysiology, Athens
University School of Medicine, Laikon General Hospital, Greece. ckosm@ath.forthnet.gr
RESUMEN
/ SUMMARY: - A 37-yr-old man who had undergone renal
transplantation for end-stage renal failure presented with a large right pelvic
mass obstructing the transplanted kidney. Initially, this was diagnosed as an
anaplastic tumor while he had been on immunosuppressive treatment for kidney
allograft rejection after transplantation. Despite difficulties of classic histopathology
to reveal the origin of his tumor, FISH analysis revealed the presence of
chromosome 12p abnormalities, strongly indicative of a germ-cell tumor-more
likely seminoma-with extragonadal presentation. Because of renal dysfunction,
he was treated with carboplatin (dose adjusted according to renal clearance)
and etoposide, and when he experienced a rather atypical progression with bone
metastases, he was treated with single-agent paclitaxel, and died almost 13 mo
after initial presentation. The case adds further to the existing small list of
seminoma/GCTs developing in transplant recipients, points to the unusual
presentation patterns and diagnostic histopathology challenges, and presents
the difficulty in therapeutic options, as a result of frequent renal
dysfunction and intercurrent immunosuppressive therapy. All of these issues
together with an extensive literature review are discussed in detail.
----------------------------------------------------
[188]
TÍTULO / TITLE: - Non-malignant skin
changes in transplant patients.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002 Aug;17(8):1380-3.
AUTORES
/ AUTHORS: - Avermaete A; Altmeyer P; Bacharach-Buhles
M
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Ruhr-University
Bochum, Bochum, Germany. N.
Ref:: 7
----------------------------------------------------
[189]
- Castellano -
TÍTULO / TITLE:Trasplante renal en pacientes virus
de la hepatitis C positivos. Kidney transplantation in patients positive for
hepatitis C virus.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22 Suppl 5:62-6.
AUTORES
/ AUTHORS: - Campistol JM; Esforzado N; Morales JM;
Barrera JM
INSTITUCIÓN
/ INSTITUTION: - Unidad de Trasplante Renal, Hospital
Clinic, IDIBAPS (Institut d’Investigacio Biomedique Agusti Pi i Sunyer),
Universidad de Barcelona, Barcelona, Hospital 12 de Octubre, Madrid. N. Ref:: 11
----------------------------------------------------
[190]
TÍTULO / TITLE: - Posttransplant
erythrocytosis.
REVISTA
/ JOURNAL: - Kidney Int 2003 Apr;63(4):1187-94.
AUTORES
/ AUTHORS: - Vlahakos DV; Marathias KP; Agroyannis B;
Madias NE
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Aretaieion
University Hospital and Intensive Care Unit, Onassis Cardiac Surgery Center,
Athens, Greece. vlahakos@aretaieio.uoa.gr
RESUMEN
/ SUMMARY: - Posttransplant erythrocytosis (PTE) is
defined as a persistently elevated hematocrit to a level greater than 51% after
renal transplantation. It occurs in 10% to 15% of graft recipients and usually
develops 8 to 24 months after engraftment. Spontaneous remission of established
PTE is observed in one fourth of the patients within 2 years from onset,
whereas in the remaining three fourths it persists for several years, only to
remit after loss of renal function from rejection. Predisposing factors include
male gender, retention of native kidneys, smoking, transplant renal artery
stenosis, adequate erythropoiesis prior to transplantation, and rejection-free
course with well-functioning renal graft. Just as in other forms of
erythrocytosis, a substantial number (approximately 60%) of patients with PTE
experience malaise, headache, plethora, lethargy, and dizziness. Thromboembolic
events occur in 10% to 30% of the cases; 1% to 2% eventually die of associated
complications. Posttransplant erythrocytosis results from the combined trophic
effect of multiple and interrelated erythropoietic factors. Among them,
endogenous erythropoietin appears to play the central role. Persistent
erythropoietin secretion from the diseased and chronically ischemic native
kidneys does not conform to the normal feedback regulation, thereby establishing
a form of “tertiary hypererythropoietinemia.” However, erythropoietin levels in
most PTE patients still remain within the “normal range,” indicating that
erythrocytosis finally ensues by the contributory action of additional growth
factors on erythroid progenitors, such as angiotensin II, androgens, and
insulin-like growth factor 1 (IGF-1). Inactivation of the renin-angiotensin
system (RAS) by an angiotensin-converting enzyme (ACE) inhibitor, or an
angiotensin II type 1 AT1 receptor blocker represents the most effective, safe,
and well-tolerated therapeutic modality.
N. Ref:: 98
----------------------------------------------------
[191]
TÍTULO / TITLE: - Rapamycin in
combination with cyclosporine or tacrolimus in liver, pancreas, and kidney transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2003 May;35(3
Suppl):201S-208S.
AUTORES
/ AUTHORS: - MacDonald AS
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Dalhousie
University, Halifax, Nova Scotia, Canada. Allan.macdonald@dal.ca
RESUMEN
/ SUMMARY: - A 10-year experience with the
immunosuppressive drug rapamycin that begins in the laboratory then extends
through multicentre trials in combination with cyclosporine in kidney
transplant recipients, exploration of its use as a single agent and in
combination with tacrolimus, and its potential in nonrenal organs is described.
Rapamycin is a potent inhibitor of endothelial injury in rat aortic allografts.
When added to full-dose cyclosporine it achieves low rejection rates, but it
augments the nephrotoxicity and hyperlipidemia of cyclosporine. On the other
hand, it allows discontinuation of calcineurin inhibitors in stable kidney and
liver patients suffering from nephrotoxicity late posttransplant. At least in
Caucasian patients, discontinuation of cyclosporine is possible as early as 3
months post-kidney transplant. In combination with low-dose tacrolimus,
exceptionally low rates of rejection were seen in recipients of kidney,
pancreas, and liver recipients with preservation of excellent renal function.
These pilot studies have been confirmed in several single-centre and, more
recently, multicentre trials in kidney and pancreas transplantation. The
side-effect profile of hyperlipidemia, lymphocoeles, delayed wound healing, and
possible liver effects are coming into focus, and ways of minimizing these
problems being introduced. The lessons learned include the need for early
adequate blood levels, the lack of correlation between dose and drug exposure,
and the potency that allows marked dose reductions in calcineurin inhibitors
and steroids. N.
Ref:: 36
----------------------------------------------------
[192]
TÍTULO / TITLE: - HCV-associated renal
diseases after liver transplantation.
REVISTA
/ JOURNAL: - Int J Artif Organs 2003 Jun;26(6):452-60.
AUTORES
/ AUTHORS: - Fabrizi F; Aucella F; Lunghi G;
Bunnapradist S; Martin P
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and Dialysis,
Maggiore Hospital, IRCCS, Milano, Italy. fabrizi@policlinico.mi.it N. Ref:: 43
----------------------------------------------------
[193]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.12. Elderly (specific problems).
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:58-60.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Because renal
transplantation can extend the duration and quality of life in elderly patients
(age 60-70 years) with end-stage renal disease, transplantation should be
considered in all patients, particularly if special programmes and preparations
are applied. B. In elderly kidney transplant recipients, immunosuppression has
to be adapted to avoid both rejections and adverse effects. C. Accurate
diagnosis and aggressive treatment of cardiovascular disease in elderly
recipients are recommended because of the high number of deaths with functioning
grafts. D. The high risk of concomitant diseases, such as diabetes mellitus,
bone disease and malignancies, needs special consideration.
----------------------------------------------------
[194]
TÍTULO / TITLE: - The evolving role of
sirolimus in renal transplantation.
REVISTA
/ JOURNAL: - Qjm. Acceso gratuito al texto completo a
partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://qjmed.oupjournals.org/
●●
Cita: QJM: <> 2003 Jun;96(6):401-9.
AUTORES
/ AUTHORS: - Dupont P; Warrens AN
INSTITUCIÓN
/ INSTITUTION: - Division of Medicine, Imperial College
London, London, UK. N.
Ref:: 66
----------------------------------------------------
[195]
TÍTULO / TITLE: - Delayed renal allograft
dysfunction and cystitis associated with human polyomavirus (BK) infection in a
renal transplant recipient: a case report and review of literature.
REVISTA
/ JOURNAL: - Clin Nephrol 2003 Dec;60(6):405-14.
AUTORES
/ AUTHORS: - Gupta M; Miller F; Nord EP; Wadhwa NK
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Department of
Medicine, School of Medicine, State University of New York at Stony Brook, New
York 11794, USA.
RESUMEN
/ SUMMARY: - Human polyomavirus type BK (BKV)
associated nephritis (BKVAN) has recently emerged as an important cause of
renal allograft dysfunction and failure. Early recognition of this entity as a
cause of allograft dysfunction is extremely important since misdiagnosis can
accelerate graft loss. We report a case of BKVAN that presented with symptoms
related to cystitis, and review the risk factors, the diagnostic tools and the approach
to treatment of BK virus associated allograft nephropathy. N. Ref:: 32
----------------------------------------------------
[196]
TÍTULO / TITLE: - Early renal allograft
loss in a patient with crescentic glomerulonephritis in the native kidney.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Jan;37(1):202-209.
AUTORES
/ AUTHORS: - Gross M; Zand MS; Nadasdy T
INSTITUCIÓN
/ INSTITUTION: - Nephrology Unit, Department of Medicine,
University of Rochester Medical Center, Rochester, NY 14642, USA. N. Ref:: 29
----------------------------------------------------
[197]
TÍTULO / TITLE: - Sirolimus and
mycophenolate mofetil for calcineurin-free immunosuppression in renal
transplant recipients.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Oct;38(4 Suppl
2):S16-21.
AUTORES
/ AUTHORS: - Pescovitz MD; Govani M
INSTITUCIÓN
/ INSTITUTION: - Departments of Surgery,
Microbiology/Immunology, and Medicine, Indiana University, Indianapolis, IN
46202, USA. mpescov@iupui.edu
RESUMEN
/ SUMMARY: - Calcineurin inhibitors, such as
cyclosporine and tacrolimus, have been available for almost 20 years. Although
these drugs are highly effective and represent the mainstay of transplant
immunosuppression, they are associated with acute and chronic nephrotoxicity.
Acute nephrotoxicity, which occurs in the early period after transplantation,
leads to a higher rate of dialysis, and chronic nephrotoxicity may eventually
result in graft loss. Acute and chronic nephrotoxicity is becoming more common
as the use of marginal kidneys for transplantation increases. Two recently
available immunosuppressive agents, mycophenolate mofetil and sirolimus
(rapamycin), have no nephrotoxicity. The use of these drugs in combination with
other agents has led to the development of new paradigms of immunosuppressive
therapy. This paper reviews the results of clinical trials that have
investigated these new approaches to immunosuppression in renal transplant
recipients. N. Ref:: 9
----------------------------------------------------
[198]
TÍTULO / TITLE: - Post-transplant renal
tubulitis: the recruitment, differentiation and persistence of intra-epithelial
T cells.
REVISTA
/ JOURNAL: - Am J Transplant 2003 Jan;3(1):3-10.
AUTORES
/ AUTHORS: - Robertson H; Kirby JA
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, The Medical School,
University of Newcastle, Newcastle upon Tyne, UK.
RESUMEN
/ SUMMARY: - Tubulitis is used by the Banff protocol as
a major criterion to grade acute renal allograft rejection. This review
integrates results from in vitro and in vivo studies to develop a chronological
model to explain the development and functions of tubular inflammation during
the rejection process. Proteoglycan-immobilized chemokines are the primary
motivators for the vectorial recruitment of specific immune cell populations
from the blood, through the endothelium and interstitial tissues to the renal
tubules. After penetration of the basement membrane, T cells encounter TGF-beta
that can induce expression of the alphaEbeta7 integrin on proliferating cells.
This allows adhesion to E-cadherin on the baso-lateral surfaces of tubular
epithelial cells and provides an explanation for the epithelial-specific
cytotoxicity observed during acute rejection. Tubular epithelium is also a rich
source of IL-15 that can stimulate IL-15 receptor-expressing intratubular CD8+
T cells. This anti-apoptotic microenvironment may explain the long-term
persistence of cycling T cells within intact tubules after episodes of acute
rejection. These memory-like T cells may have local immunoregulatory
properties, including the production of additional TGF-beta, but could also
modify normal tubular homeostasis resulting in epithelial to mesenchymal
transdifferentiation, tubulointerstitial fibrosis and, ultimately, graft
failure. N. Ref:: 94
----------------------------------------------------
[199]
TÍTULO / TITLE: - Renal transplantation
in developing countries.
REVISTA
/ JOURNAL: - Kidney Int Suppl 2003 Feb;(83):S96-100.
AUTORES
/ AUTHORS: - Rizvi SA; Naqvi SA; Hussain Z; Hashmi A;
Akhtar F; Hussain M; Ahmed E; Zafar MN; Hafiz S; Muzaffar R; Jawad F
INSTITUCIÓN
/ INSTITUTION: - Sindh Institute of Urology and
Transplantation (SIUT), Dow Medical College, Karachi, Pakistan. siut-1@cyber.net.pk
RESUMEN
/ SUMMARY: - Healthcare in developing countries less
funded than developed nations (0.8 to 4% vs. 10 to 15%, respectively), and must
contend against approximately 1/3 of the population living below the poverty line
($1US/day), poor literacy (58% males/29% females), and less access to potable
water and basic sanitation. Cultural and societal constraints combine with
these economic obstacles to translate into poor transplantation activity. Donor
shortage is a universal problem. Paid donation comprises 50% of all transplants
in Pakistan. Post-transplant infections are a major problem in developing
countries, with 15% developing tuberculosis, 30% cytomegalovirus, and nearly
50% bacterial infections. The solutions to these problems may seem simplistic:
alleviate poverty, educate the general population, and expand the transplant
programs in public sector hospitals where commerce is less likely to play a
major role. The SIUT model of funding in a community-government partnership has
increased the number of transplantations and patient and organ survival
substantially. Over the last 15 years, it has operated by complete financial
transparency, public audit and accountability. The scheme has proven effective
and currently 110 transplants/year are performed, with free after care and
immunosuppressive drugs. Confidence has been built in the community, with
strong donations of money, equipment and medicines. We believe this model could
be sustained in other developing nations. N. Ref:: 12
----------------------------------------------------
[200]
- Castellano -
TÍTULO / TITLE:Tratamiento renal sustitutivo en el
paciente diabetico. Quien, cuando, como?. Replacement renal treatment in the
diabetic patient. Who, when, how?.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2001;21 Suppl 3:88-96.
AUTORES
/ AUTHORS: - de Francisco AL; Fernandez-Fresnedo G;
Pinera C; Rodrigo E; Herraez I; Ruiz JC; Arias M
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia Hospital
Universitario Valdecilla Santander. martinal@unican.es N. Ref:: 67
----------------------------------------------------