#03#
Revisiones-Clínica-Etiología
& Patología *** Reviews-Clinical-Etiology & Pathology
TRASPLANTE
RENAL *** RENAL TRANSPLANTATION
(Conceptos
/ Keywords: Renal-Kidney transplantation; Kidney donation-procurement; etc).
Enero /
January 2001 --- Marzo / March 2004
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[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: - 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.
----------------------------------------------------
[3]
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.
----------------------------------------------------
[4]
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.
----------------------------------------------------
[5]
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.
----------------------------------------------------
[6]
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
----------------------------------------------------
[7]
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
----------------------------------------------------
[8]
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
----------------------------------------------------
[9]
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
----------------------------------------------------
[10]
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.
----------------------------------------------------
[11]
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
----------------------------------------------------
[12]
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
----------------------------------------------------
[13]
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
----------------------------------------------------
[14]
- 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
----------------------------------------------------
[15]
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
----------------------------------------------------
[16]
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.
----------------------------------------------------
[17]
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.
----------------------------------------------------
[18]
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
----------------------------------------------------
[19]
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.
----------------------------------------------------
[20]
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.
----------------------------------------------------
[21]
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
----------------------------------------------------
[22]
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
----------------------------------------------------
[23]
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
----------------------------------------------------
[24]
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
----------------------------------------------------
[25]
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
----------------------------------------------------
[26]
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.
----------------------------------------------------
[27]
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
----------------------------------------------------
[28]
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.
----------------------------------------------------
[29]
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
----------------------------------------------------
[30]
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
----------------------------------------------------
[31]
- 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
----------------------------------------------------
[32]
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.
----------------------------------------------------
[33]
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
----------------------------------------------------
[34]
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.
----------------------------------------------------
[35]
- 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
----------------------------------------------------
[36]
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
----------------------------------------------------
[37]
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
----------------------------------------------------
[38]
- 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
----------------------------------------------------
[39]
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
----------------------------------------------------
[40]
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
----------------------------------------------------
[41]
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
----------------------------------------------------
[42]
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.
----------------------------------------------------
[43]
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
----------------------------------------------------
[44]
- 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
----------------------------------------------------
[45]
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
----------------------------------------------------
[46]
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
----------------------------------------------------
[47]
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.
----------------------------------------------------
[48]
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
----------------------------------------------------
[49]
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.
----------------------------------------------------
[50]
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
----------------------------------------------------
[51]
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
----------------------------------------------------
[52]
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
----------------------------------------------------
[53]
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.
----------------------------------------------------
[54]
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
----------------------------------------------------
[55]
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
----------------------------------------------------
[56]
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.
----------------------------------------------------
[57]
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
----------------------------------------------------
[58]
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
----------------------------------------------------
[59]
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.
----------------------------------------------------
[60]
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
----------------------------------------------------
[61]
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.
----------------------------------------------------
[62]
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.
----------------------------------------------------
[63]
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.
----------------------------------------------------
[64]
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
----------------------------------------------------
[65]
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.
----------------------------------------------------
[66]
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
----------------------------------------------------
[67]
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.
----------------------------------------------------
[68]
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
----------------------------------------------------
[69]
- 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
----------------------------------------------------
[70]
- 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
----------------------------------------------------
[71]
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
----------------------------------------------------
[72]
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.
----------------------------------------------------
[73]
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
----------------------------------------------------
[74]
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
----------------------------------------------------
[75]
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
----------------------------------------------------
[76]
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
----------------------------------------------------
[77]
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
----------------------------------------------------
[78]
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
----------------------------------------------------
[79]
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
----------------------------------------------------
[80]
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
----------------------------------------------------
[81]
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
----------------------------------------------------
[82]
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
----------------------------------------------------
[83]
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
----------------------------------------------------
[84]
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
----------------------------------------------------
[85]
- 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
----------------------------------------------------
[86]
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.
----------------------------------------------------
[87]
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
----------------------------------------------------
[88]
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.
----------------------------------------------------
[89]
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.
----------------------------------------------------
[90]
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
----------------------------------------------------
[91]
- 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
----------------------------------------------------
[92]
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
----------------------------------------------------
[93]
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.
----------------------------------------------------
[94]
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
----------------------------------------------------
[95]
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
----------------------------------------------------
[96]
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
----------------------------------------------------
[97]
- 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).
----------------------------------------------------
[98]
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
----------------------------------------------------
[99]
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.
----------------------------------------------------
[100]
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
----------------------------------------------------
[101]
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
----------------------------------------------------
[102]
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
----------------------------------------------------
[103]
- 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
----------------------------------------------------
[104]
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
----------------------------------------------------
[105]
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
----------------------------------------------------
[106]
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
----------------------------------------------------
[107]
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
----------------------------------------------------
[108]
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.
----------------------------------------------------
[109]
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
----------------------------------------------------
[110]
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.
----------------------------------------------------
[111]
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
----------------------------------------------------
[112]
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
----------------------------------------------------
[113]
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
----------------------------------------------------
[114]
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
----------------------------------------------------
[115]
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
----------------------------------------------------
[116]
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
----------------------------------------------------
[117]
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.
----------------------------------------------------
[118]
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
----------------------------------------------------
[119]
- 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
----------------------------------------------------
[120]
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.
----------------------------------------------------
[121]
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
----------------------------------------------------
[122]
- 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
----------------------------------------------------
[123]
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
----------------------------------------------------
[124]
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
----------------------------------------------------
[125]
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
----------------------------------------------------
[126]
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
----------------------------------------------------
[127]
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
----------------------------------------------------
[128]
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
----------------------------------------------------
[129]
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
----------------------------------------------------
[130]
TÍTULO / TITLE: - Young age and the risk
for ifosfamide-induced nephrotoxicity: a critical review of two opposing
studies.
REVISTA
/ JOURNAL: - Pediatr Nephrol 2001 Dec;16(12):1153-8.
●●
Enlace al texto completo (gratuito o de pago) 1007/s004670100053
AUTORES
/ AUTHORS: - Aleksa K; Woodland C; Koren G
INSTITUCIÓN
/ INSTITUTION: - Division of Clinical Pharmacology and
Toxicology, Hospital for Sick Children, 555 University Avenue, Toronto, Canada.
RESUMEN
/ SUMMARY: - Ifosfamide has been in use as an effective
antineoplastic agent for solid tumors in both children and adults since the
late 1960s. Although some adverse effects (e.g. hemorrhagic cystitis) can be
overcome by the co-administration of 2-mercaptoethanesulfonate (MESNA), others
such as nephrotoxicity cannot. There is a consensus that factors such as the
cumulative dose of ifosfamide and concomitant cisplatin administration may
influence not only the incidence but also the severity of ifosfamide-induced
renal toxicity. Several preliminary studies suggested young age as a risk
factor for nephrotoxicity; however, there is little agreement on this. The
reasons for this uncertainty may include sample size, study design, dose and
differences in renal function assessment. In this review we examine the two
largest cohort studies conducted in pediatric patients. One study suggests that
ifosfamide-induced renal toxicity is age- related, whereas analysis of the
other failed to show age as an important predictor for ifosfamide-induced renal
toxicity. The studies differed in design, end-points of toxicity and
concomitant drug therapy. Due to the effectiveness of ifosfamide as an
antineoplastic agent, it is important that an understanding of the factors that
predispose pediatric patients to ifosfamide-induced nephrotoxicity be
obtained. N. Ref:: 26
----------------------------------------------------
[131]
TÍTULO / TITLE: - Long-term care of
pediatric renal transplant patients: from bench to bedside.
REVISTA
/ JOURNAL: - Curr Opin Pediatr 2002 Apr;14(2):205-10.
AUTORES
/ AUTHORS: - Samsonov D; Briscoe DM
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Department of
Medicine, Children’s Hospital and Harvard Medical School, Boston, Massachusetts
02115, USA.
RESUMEN
/ SUMMARY: - In this review, we discuss current and
future issues in the management of pediatric renal transplant recipients,
including the optimization of long-term graft function and the minimization of
complications caused by immunosuppression. Long-term management involves not
only the monitoring of graft function but also the identification of patients
at risk for the development of complications. The identification of patients
with immunoreactive or immunoregulatory responses can be performed molecular
monitoring of the immune response. Also, the use of frequent surveillance
kidney biopsies, surrogate markers of chronic rejection, and glomerular
filtration rate will be a part of future management. Identifying high-risk
patients enables the physician to optimize immunosuppression to limit acute
rejection. Short-and long-term management of pediatric transplant patients also
includes adequate monitoring of growth and the monitoring for post-transplant
lymphoproliferative disease. Ongoing clinical trials are underway that focus on
these novel approaches in caring for pediatric transplant recipients. N. Ref:: 41
----------------------------------------------------
[132]
TÍTULO / TITLE: - Minimizing calcineurin
inhibitor drugs in renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2003 May;35(3
Suppl):118S-121S.
AUTORES
/ AUTHORS: - Flechner SM
INSTITUCIÓN
/ INSTITUTION: - Section of Renal Transplantation,
Transplant Center A110, Cleveland Clinic Foundation, Cleveland, Ohio 44195,
USA.
RESUMEN
/ SUMMARY: - Calcineurin inhibitor drugs (CNI),
primarily cyclosporine then tacrolimus, have been the centerpieces of
maintenance immunosuppression for kidney transplantation since their
introduction in the 1980s. While these drugs have been responsible for improved
short-term outcomes and diminished rates of acute rejection, they are
nephrotoxic and can cause permanent renal injury in many patients. Indeed, some
have found that at 10 years after transplantation, the benefits of CNI drugs
have been lost compared to the previous generation of maintenance
immunosuppression. The use of these agents over many years contributes to the
antigen-independent decline in renal function referred to as chronic allograft
nephropathy. However, it remains unclear to what degree the use of CNI drugs
contribute to ultimate graft loss. For these reasons immunosuppressive
alternatives to CNI drugs have begun to emerge during the past few years. The
recent introduction of the potent immunosuppressive agent sirolimus has
afforded an opportunity to develop a regimen designed to maximize prophylaxis
of early acute rejection, absent drug-induced nephrotoxicity. It was our
feeling that the combination of antibody induction therapy combined with
sirolimus substitution in a three-drug maintenance regimen, would provide the
best posttransplant renal function and lowest rates of acute rejection. We have
developed a CNI-free immunosuppressive regimen consisting of basiliximab
induction, followed by sirolimus, MMF and steroids. Using this protocol we
demonstrated comparable transplant outcomes with improved renal function in
adult recipients of primary renal transplants. Limiting nephrotoxic
immunosuppression should be considered an important goal; but requires
sufficient long-term follow-up to support the benefits suggested from initial
analysis of the data. N.
Ref:: 23
----------------------------------------------------
[133]
TÍTULO / TITLE: - Complement activation
in early protocol kidney graft biopsies after living-donor transplantation.
REVISTA
/ JOURNAL: - Transplantation 2003 Apr 27;75(8):1204-13.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000062835.30165.2C
AUTORES
/ AUTHORS: - Sund S; Hovig T; Reisaeter AV; Scott H;
Bentdal O; Mollnes TE
INSTITUCIÓN
/ INSTITUTION: - Department/Institute of Pathology,
Rikshospitalet University Hospital, Oslo, Norway. stale.sund@helse-forde.no.
RESUMEN
/ SUMMARY: - BACKGROUND: To gain insight into
complement activation in kidney grafts, we studied the deposition of components
from all complement pathways in protocol biopsies from living-donor recipients
that were taken 1 week (median 7 days) after transplantation. METHODS: Graft
protocol biopsies (n=37) were taken consecutively and stained for two-color
immunofluorescence, with antibodies to C4d, C3, C1q, factor B, C6, terminal
C5b-9 complement complex, mannose-binding lectin (MBL), and MBL-associated
serine protease-1, combined with an endothelial marker. Light and electron microscopy
were performed in all cases. Clinical acute rejection (AR), graft loss, and
long-term kidney function were recorded. Baseline biopsies from 15 of the
patients served as controls. RESULTS: Endothelial C4d deposition was
demonstrated in peritubular capillaries in 11 of 37 cases (30%), of which 9 of
11 (82%) experienced clinical AR but only 6 of 11 (55%) experienced AR as
defined by histopathologic criteria. Biopsies from three patients, two with
early graft loss, showed diffuse global C4d in the glomerular endothelium with
codeposition of C3 in all patients and MBL-associated serine protease-1 in one
patient. Focal peritubular capillary C3 deposition was found in two additional
C4d-positive cases with AR. No posttransplant deposition was demonstrated for
the other components. CONCLUSIONS: Early diffuse C4d deposition in the kidney
graft capillaries is closely related to acute humoral rejection, whereas focal
staining may occur with mild AR or, rarely, without rejection. Codeposition of
C3 indicates early AR with a higher risk of graft loss. In most cases,
activation was limited to C4d, indicating efficient in situ regulation of
complement activation.
----------------------------------------------------
[134]
TÍTULO / TITLE: - Renal transplantation
studies in genetic hypertension.
REVISTA
/ JOURNAL: - News Physiol Sci. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://nips.physiology.org/contents-by-date.0.shtml
●●
Cita: News in Physiological Sciences: <> 2001 Dec;16:262-5.
AUTORES
/ AUTHORS: - Grisk O; Rettig R
INSTITUCIÓN
/ INSTITUTION: - Department of Physiology, University of
Greifswald, D-17487 Greifswald, Germany.
N. Ref:: 17
----------------------------------------------------
[135]
TÍTULO / TITLE: - Renal artery aneurysm:
ex vivo repair and autotransplantation: case report and review of the
literature.
REVISTA
/ JOURNAL: - Int Surg 2003 Apr-Jun;88(2):61-3.
AUTORES
/ AUTHORS: - El Tayar AR; Labruzzo C; Haritopoulos K;
Hakim NS
INSTITUCIÓN
/ INSTITUTION: - Renal Transplant Unit, St. Mary’s
Hospital, London, United Kingdom.
RESUMEN
/ SUMMARY: - The incidence of renal artery aneurysm is
unknown, its natural history is unclear and unpredictable, and the clinical
symptoms are of little or no value in diagnosis. The risk of rupture is high in
pregnant women, as in splenic artery aneurysms and in aneurysms greater than 2
cm in size. Digital subtraction angiography is the best diagnostic test. When an
aneurysm is identified, surgery is the best treatment option to avoid
hypertension or rupture of the aneurysm. Because of advances in organ
preservation, nephrectomy, ex vivo repair, and autotransplantation is a safe
and successful procedure. We report the case of a 2-cm-wide neck aneurysm that
was treated by nephrectomy, ex vivo repair, and auto-transplantation. N. Ref:: 16
----------------------------------------------------
[136]
- Castellano -
TÍTULO / TITLE:Aplicaciones de la biologia
molecular en el trasplante renal. Applications of molecular biology to renal
transplant.
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):15-26.
AUTORES
/ AUTHORS: - Lario S; Bescos M; Campistol JM
INSTITUCIÓN
/ INSTITUTION: - Unidad de Trasplante Renal, Hospital
Clinic, de Barcelona Villarroel, 170 08036 Barcelona. jmcampis@medicina.ub.es N. Ref:: 35
----------------------------------------------------
[137]
TÍTULO / TITLE: - MR imaging of renal
function.
REVISTA
/ JOURNAL: - Radiol Clin North Am 2003
Sep;41(5):1001-17.
AUTORES
/ AUTHORS: - Huang AJ; Lee VS; Rusinek H
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology-MRI, New York
University Medical Center, 530 First Avenue, HCC Basement, New York, NY 10016,
USA.
RESUMEN
/ SUMMARY: - MR imaging is the only single noninvasive
test that can potentially provide a complete picture of renal status with
minimal risk to the patient, simultaneously improving diagnosis while lowering
medical costs by virtue of its being a single test. The strengths of MR imaging
lie in its high spatial and temporal resolution and its lack of exposure to
ionizing radiation and nephrotoxic contrast agents. This article reviews the
use of MR imaging for quantification of renal functional parameters and its
application to clinical problems, such as RVD, hydronephrosis, and renal
transplantation. Although advances in both the technical and clinical aspects
of functional renal MR imaging have been made, much remains to be done. The
preliminary results reported in the many studies reviewed are exciting, but
these techniques need to be validated against accepted standards where such
standards exist. In addition, and perhaps more important, the effects of these
new diagnostic methods on patient outcomes must be studied. Finally, further
progress in image processing and analysis must be made to make functional renal
MR imaging truly practical. With these advances, one can expect functional
renal MR imaging to play an ever-expanding and influential role in the care and
management of the patient with renal disease.
N. Ref:: 57
----------------------------------------------------
[138]
TÍTULO / TITLE: - Exploring treatment
options in renal transplantation: the problems of chronic allograft dysfunction
and drug-related nephrotoxicity.
REVISTA
/ JOURNAL: - Transplantation 2001 Jun 15;71(11
Suppl):SS42-51.
AUTORES
/ AUTHORS: - Campistol JM; Grinyo JM
INSTITUCIÓN
/ INSTITUTION: - University of Barcelona, España.
RESUMEN
/ SUMMARY: - The immunosuppressive benefits of
cyclosporine and tacrolimus in short-term and medium-term renal allograft
survival are well documented. It is becoming increasingly clear that the basis
of this immunosuppression, the inhibition of calcineurin, may be linked with
nephrotoxicity, hypertension, hyperlipidemia, and new-onset diabetes mellitus,
side effects that may lead to CRAD, death due to CVD, and late renal allograft
loss. This clinical picture presents a clear need for new strategies that
produce adequate immunosuppression to prevent acute rejection while
simultaneously reducing the side effects associated with CNI-related therapies.
Sirolimus combined with cyclosporine and tacrolimus has demonstrated an ability
to reduce incidences of early acute rejection and, used as base therapy, has
provided protection against acute rejection equivalent to that of cyclosporine,
without the consequent nephrotoxicity associated with CNIs. In preliminary
results from an ongoing clinical trial, sirolimus has been used to eliminate
cyclosporine during maintenance immunosuppression, with subsequent improvements
in measures of blood pressure and renal function. In addition, the
antiproliferative properties of sirolimus and its ability to prevent graft vascular
disease in animal studies make sirolimus a promising agent to decrease
incidences of CRAD and improve long-term renal allograft survival. These
findings point to a clear need to further explore both the efficacy of
sirolimus immunotherapy and its long-term effects. N. Ref:: 126
----------------------------------------------------
[139]
TÍTULO / TITLE: - Use of a pelvic kidney
for living transplantation: case report and review of the literature.
REVISTA
/ JOURNAL: - Am J Transplant 2003 Feb;3(2):235-8.
AUTORES
/ AUTHORS: - Luke PP; McAlister VC; Jevnikar AM; House
AA; Muirhead N; Cross J; Hollomby D; Chin JL
INSTITUCIÓN
/ INSTITUTION: - Departments of Surgery and Medicine,
London Health Sciences Center, the Multi-organ Transplant Program, The University
of Western Ontario, London, Ontario, Canada. patrick.luke@ihsc.on.ca
RESUMEN
/ SUMMARY: - Pelvic kidneys have anomalous vascular
supplies and collecting systems. Therefore, careful radiologic and functional
evaluation of these kidneys must be performed prior to procurement for
transplantation. We report the successful use of a pelvic kidney for
living-related transplantation. N.
Ref:: 7
----------------------------------------------------
[140]
TÍTULO / TITLE: - Resolution of oral
non-Hodgkin’s lymphoma by reduction of immunosuppressive therapy in a renal
allograft recipient: a case report and review of the literature.
REVISTA
/ JOURNAL: - Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2002 Dec;94(6):697-701.
●●
Enlace al texto completo (gratuito o de pago) 1067/moe.2002.126889
AUTORES
/ AUTHORS: - Keogh PV; Fisher V; Flint SR
INSTITUCIÓN
/ INSTITUTION: - Department of Oral Surgery, Oral Medicine
and Oral Pathology, Dublin Dental School and Hospital, Trinity College,
Ireland. pakeogh@dental.tcd.ie
RESUMEN
/ SUMMARY: - A case of oral non-Hodgkin’s lymphoma
arising in a patient with insulin-dependent diabetes who had undergone renal
allograft transplantation is described. The resolution of the disease was
achieved by a reduction in her immunosuppressive therapy. The differential
diagnosis is discussed, and the management of posttransplantation lymphoproliferative
disorders is reviewed. N.
Ref:: 40
----------------------------------------------------
[141]
TÍTULO / TITLE: - Ambulatory blood
pressure 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 1:110-3.
AUTORES
/ AUTHORS: - Fernandez-Vega F; Tejada F; Baltar J;
Laures A; Gomez E; Alvarez J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia 1, Hospital Central
de Asturias, C/Celestino Villamil s/n, 33006 Oviedo, España.
RESUMEN
/ SUMMARY: - Renal transplantation has been a usual
medical practice in developed countries for several decades. A large number of
studies report the excellent results obtained with such a practice. The
survival of the graft, although able to be improved, is excellent and gives a
great deal of hope to patients with renal insufficiency. The high level of
investigation into immunosuppressor drugs offers, almost continuously, more
efficient and better tolerated products. Paradoxically, the usual problems of
patients with a renal transplant are not immunological but cardiovascular.
Elevated serum cholesterol levels, obesity, diabetes and other cardiovascular
risk factors (CVRFs) are usual in these patients, arterial hypertension (AHT)
being the most frequent. Nephrologists are increasingly using ambulatory blood
pressure monitoring (ABPM) on a daily basis. In the last 10 years, we have
obtained highly valuable and interesting results with this technique which have
allowed us to study and understand with greater precision the relationship of
AHT to the kidney. Here we analyse and review the most relevant aspects of ABPM
in the different stages of kidney disease, with special emphasis on renal
transplantation. N.
Ref:: 40
----------------------------------------------------
[142]
TÍTULO / TITLE: - Cancer-related anaemia
requires higher doses of epoetin alfa than chronic renal failure replacement
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: <> 2001 Dec;16(12):2289-93.
AUTORES
/ AUTHORS: - Itri LM
N. Ref:: 30
----------------------------------------------------
[143]
TÍTULO / TITLE: - Disseminated acanthamebiasis
in a renal transplant recipient with osteomyelitis and cutaneous lesions: case
report and literature review.
REVISTA
/ JOURNAL: - Clin Infect Dis 2002 Sep 1;35(5):e43-9.
Epub 2002 Aug 2.
AUTORES
/ AUTHORS: - Steinberg JP; Galindo RL; Kraus ES; Ghanem
KG
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, Johns Hopkins
Medical Institutions, Baltimore, MD 21209, USA.
RESUMEN
/ SUMMARY: - Disseminated acanthamebiasis is a rare
disease that occurs predominantly in patients with human immunodeficiency virus
(HIV) infection or acquired immunodeficiency syndrome but also in
immunosuppressed transplant recipients. Few reports have focused on
non-HIV-infected patients, in whom the disease is more likely to go unsuspected
and undiagnosed before death. We describe a renal transplant recipient with
Acanthamoeba infection and review the literature. The patient presented with
osteomyelitis and widespread cutaneous lesions. No causative organism was
identified before death, despite multiple biopsies with detailed histological
analysis and culture. Disseminated Acanthamoeba infection was diagnosed after
death, when cysts were observed in histological examination of sections of skin
from autopsy, and trophozoites were found in retrospectively reviewed skin biopsy
and surgical bone specimens. In any immunosuppressed patient, skin and/or bone
lesions that fail to show improvement with broad-spectrum antibiotic therapy
should raise the suspicion for disseminated acanthamebiasis. Early recognition
and treatment may improve clinical outcomes.
N. Ref:: 32
----------------------------------------------------
[144]
TÍTULO / TITLE: - Histological evaluation
of renal allograft protocol biopsies in the early period and 1 year after
transplantation.
REVISTA
/ JOURNAL: - Clin Transplant 2003;17 Suppl 10:25-9.
AUTORES
/ AUTHORS: - Kanetsuna Y; Yamaguchi Y; Toma H; Tanabe K
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical Pathology, Jikei
University, Kashiwa Hospital, Japan.
RESUMEN
/ SUMMARY: - We histologically evaluated protocol
biopsy specimens of renal allografts obtained in the early period and 1 year
after transplantation. The patients were divided into those with at least one
history of acute rejection (AR group) and no history of rejection (NAR group),
and the histopathological features in the two groups were compared. A total of
45 early protocol biopsy specimens were obtained from 40 patients, and 31
1-year biopsy specimens were obtained from 30 patients. Acute rejection (AR) or
borderline change was observed in the early protocol biopsy specimens from 19
(45.2%) cases. AR or borderline change was observed in 12 of 19 (63.2%) in the
AR group, and in 7/26 cases (26.9%) in the NAR group. The incidence of AR or
borderline change in the AR group was higher than in the NAR group. Toxic
tubulopathy was found in the early protocol biopsy in 16 cases (35.6%). The
1-year biopsies tended to reveal more complicated findings. Chronic rejection
(CR) was seen in 8/16 cases (50.0%) in the AR group, and it was more frequent than
NAR group (two cases, 13.3%). In conclusion, the incidences of both AR and CR
were higher in the cases with a previous episode of AR. The early protocol
biopsy was useful in screening for subclinical AR and toxic tubulopathy. The
1-year biopsy was useful for evaluating various types of chronic graft damage.
We expect that adequate treatment based on protocol biopsy findings in each
patient will lead to better graft survival.
----------------------------------------------------
[145]
TÍTULO / TITLE: - Genetic variability and
transplantation.
REVISTA
/ JOURNAL: - Curr Opin Urol 2003 Mar;13(2):81-9.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mou.0000058635.64616.41
AUTORES
/ AUTHORS: - Marder B; Schroppel B; Murphy B
INSTITUCIÓN
/ INSTITUTION: - Mount Sinai School of Medicine, New York,
USA.
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: The purpose of this
review is to summarize recent advances within the area of genetic polymorphisms
with a specific emphasis on renal transplantation, and to discuss the potential
clinical applications. RECENT FINDINGS: Due to recent advances in molecular
techniques, there has been an abundance of publications describing genetic
variability in molecules relevant to transplant outcome. Many studies are now
demonstrating associations between polymorphisms in these candidate genes and
outcomes in organ transplantation. SUMMARY: These studies emphasize the
potential role of genetic variability in transplantation, and provide the
rationale for large prospective studies to clearly define the potential
benefits of genotyping in the risk stratification of transplant
recipients. N. Ref:: 91
----------------------------------------------------
[146]
TÍTULO / TITLE: - Kidney transplantation
in older patients: benefits and risks.
REVISTA
/ JOURNAL: - Drugs Aging 2002;19(2):79-84.
AUTORES
/ AUTHORS: - Rao VK
INSTITUCIÓN
/ INSTITUTION: - Hennepin County Medical Center,
Minneapolis, Minnesota 55415, USA. raoxx007@tc.umn.edu
RESUMEN
/ SUMMARY: - The proportion of older patients accepted
for dialysis is increasing every year both in the US and abroad. Of the two
treatment modalities for end-stage renal disease, i.e. dialysis and
transplantation, the latter offers more freedom and is associated with better
clinical outcome. Most elderly patients seem to have excellent functional
rehabilitation after a kidney transplant. However, in view of the wide gap
between the availability of cadaver organs and the people in need, giving the
precious organ to the elderly who have a shorter expected lifespan may present
an ethical problem. Therefore, it has become increasingly important to offer
the kidney to only those who have no significant comorbid conditions or other
high risk factors, so as to improve the odds of success after renal
transplantation. N.
Ref:: 26
----------------------------------------------------
[147]
TÍTULO / TITLE: - Anti-interleukin-2
receptor antibodies: basiliximab and daclizumab.
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):1756-60.
AUTORES
/ AUTHORS: - Pascual J; Marcen R; Ortuno J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Hospital Ramon y
Cajal, Universidad de Alcala, Carretera de Colmenar km 9, 100, E-28034 Madrid,
España. N. Ref:: 31
----------------------------------------------------
[148]
TÍTULO / TITLE: - Optimizing dose and mode
of renal replacement therapy in anaemia management.
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 5:60-5.
AUTORES
/ AUTHORS: - Locatelli F
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Dialysis,
Ospedale A. Manzoni, Lecco, Italy.nefrologia@ospedale.lecco.it
RESUMEN
/ SUMMARY: - Iron supplementation is probably the most
important factor affecting response to treatment with recombinant human
erythropoietin (rHuEPO) in patients with renal anaemia. However, the adequacy
of dialysis is also significant. Many factors affect the process of dialysis
and its effects. The purity of water used to make up the dialysate from
concentrate is important. Inhibitors of erythropoiesis including ions and
disinfectants may often be present in treated mains water. In addition,
microbiological and pyrogenic contamination of the dialysate frequently occurs,
sometimes leading to development or aggravation of anaemia in haemodialysis
(HD) patients and also causing an immune response via cytokine activation.
Inhibitors of erythropoiesis are also present in endogenous blood in patients
with impaired renal function. Adequate dialysis is responsible for removing
these mainly small, and possibly medium and large inhibitor molecules, thereby
improving anaemia and enhancing response to rHuEPO. The biocompatibility and
flux of the membrane used in HD may also have an effect. The removal of medium
or large inhibitors of erythropoiesis is inefficient with cellulose membranes,
but can potentially be achieved by using more permeable, high-flux membranes.
However, in patients with adequate dialysis and sufficient iron and vitamin
supplementation, the beneficial effects of a switch from standard cellulose to
high-flux membranes have yet to be proven conclusively. Another area in which
positive results on correction of anaemia have been seen in small studies is in
the use of on-line haemodiafiltration, haemofiltration, or sterile dialysate.
However, further large, controlled studies are needed to confirm these
effects. N. Ref:: 37
----------------------------------------------------
[149]
TÍTULO / TITLE: - Hyperlipidemia: a risk
factor for chronic allograft dysfunction.
REVISTA
/ JOURNAL: - Kidney Int Suppl 2002 May;(80):73-7.
AUTORES
/ AUTHORS: - Castello IB
INSTITUCIÓN
/ INSTITUTION: - Department of Nephology and Renal
Transplantation, Hospital La Fe, Valencia, España. jorjav@ono.com
RESUMEN
/ SUMMARY: - While the early results of renal
transplantation have improved in the last years, but the long-term allograft
survival have not improved to the same extent. The major cause of these graft
losses is chronic allograft dysfunction (CAD). The pathogenesis of CAD is
complex and results from a interaction of immune and nonimmune factors. Between
these non-immunological related factors there are two cardiovascular risk
factors, hypertension and especially hyperlipidemia, that have been implicated
in the development and progression of CAD. Lipid profile abnormalities are very
prevalent in renal transplant patients. In last years several authors have
reported an association between different lipid profile alterations and CAD. We
conducted an observational study in our group to determine the relationship
between different lipid disturbances and CAD. The hypertriglyceridemia and the
Lp(a)>30 mg/dL before and after transplantation were, between the lipid
abnormalities, the two independent risk factors for CAD in a multivarite
analysis. N. Ref:: 43
----------------------------------------------------
[150]
TÍTULO / TITLE: - Membranous lupus
nephritis in a renal allograft: response to mycophenolate mofetil therapy.
REVISTA
/ JOURNAL: - Am J Transplant 2001 Sep;1(3):288-92.
AUTORES
/ AUTHORS: - Denton MD; Galvanek EG; Singh A; Sayegh MH
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA. dentonmd@gis.net
RESUMEN
/ SUMMARY: - Membranous lupus nephritis in a renal
allograft is considered rare. A 43-year-old man with quiescent systemic lupus
erythematosus (SLE) received a HLA identical transplant from his sister and 4
years later developed persistent nephrotic range proteinuria and morphological
features most compatible with membranous lupus nephritis on biopsy.
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor
antagonists, although successful in reducing proteinuria, were associated on
three occasions with acute allograft dysfunction. Sustained reduction of
proteinuria and stable graft function were achieved using mycophenolate mofetil
(MMF). MMF is emerging as a new therapy for primary renal disease in SLE. This
is the first report of successful treatment of membranous lupus nephritis in an
allograft using MMF. We review all cases of transplant-associated membranous
lupus nephritis in the English literature.
N. Ref:: 20
----------------------------------------------------
[151]
TÍTULO / TITLE: - Identifying and
addressing potentially preventable causes of renal allograft loss.
REVISTA
/ JOURNAL: - Kidney Int 2002 Aug;62(2):718-9.
AUTORES
/ AUTHORS: - Langone AJ; Helderman JH N. Ref:: 9
----------------------------------------------------
[152]
TÍTULO / TITLE: - Rejection rate in
living donor kidney transplantation with and without basiliximab in
tacrolimus/mycophenolate mofetil-based protocol.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Mar;35(2):653-4.
AUTORES
/ AUTHORS: - Rahamimov R; Yussim A; After T; Lustig S;
Bar-Nathan N; Shaharabani E; Shapira Z; Shabthai E; Mor E
INSTITUCIÓN
/ INSTITUTION: - Department of Transplantation, Rabin
Medical Center, Beilinson Campus, Petah-Tiqwa, Israel. rutir@clalit.org.il
----------------------------------------------------
[153]
TÍTULO / TITLE: - Clinical trials,
immunosuppression and renal transplantation: new trends in design and analysis.
REVISTA
/ JOURNAL: - Pediatr Nephrol 2002 Aug;17(8):573-84.
Epub 2002 Jun 13.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00467-002-0909-z
AUTORES
/ AUTHORS: - Landais P; Daures JP
INSTITUCIÓN
/ INSTITUTION: - Laboratoire de Biostatistique et
d’Informatique Medicale, Hopital Necker Enfants Malades, Faculte Paris 5, 149
rue de Sevres, 75743 Paris Cedex 15, France. landais@necker.fr
RESUMEN
/ SUMMARY: - Clinical trials provide a framework to
search for more effective and less toxic immunosuppressive agents to control
renal transplant rejection. Some methodological aspects are presented. Patient
selection and the choice of study endpoints are discussed with emphasis on
standardized definitions and classification of histopathology, and on
qualification and quantification of chronic rejection. Choosing a Bayesian or a
frequentist approach and the afferent hypotheses is discussed together with the
interpretation of a P-value and a confidence interval. Strategies for limiting the
number of patients, increasing power and feasibility are reviewed, including
discussion of surrogate endpoints. New approaches to statistical analysis are
then presented, including intention-to-treat versus per-protocol analysis,
analysis of correlated data, dependent censoring, and meta-analysis applied to
renal transplantation. Pharmacoeconomics are finally introduced as necessary
for implementation of decision making regarding therapeutic strategies.
Reporting research increases its standards, and the CONSORT (Consolidated
Standards of Reporting Trials) and QOROM (Quality of Reporting of
Meta-analyses) criteria are to be integrated in the process of clinical trial
procedures. In conclusion, observational studies are presented as part of an
evidence-based approach in the hierarchy of evidence, keeping in mind that high
quality, randomized, controlled trials are still necessary to decrease
uncertainty in the field of renal transplantation. N. Ref:: 100
----------------------------------------------------
[154]
TÍTULO / TITLE: - Principles and clinical
application of assessing alterations in renal elimination pathways.
REVISTA
/ JOURNAL: - Clin Pharmacokinet 2003;42(14):1193-211.
AUTORES
/ AUTHORS: - Tett SE; Kirkpatrick CM; Gross AS;
McLachlan AJ
INSTITUCIÓN
/ INSTITUTION: - School of Pharmacy, University of
Queensland, Brisbane, Australia. s.tett@pharmacy.uq.edu.au
RESUMEN
/ SUMMARY: - Drugs and metabolites are eliminated from
the body by metabolism and excretion. The kidney makes the major contribution
to excretion of unchanged drug and also to excretion of metabolites. Net renal
excretion is a combination of three processes - glomerular filtration, tubular
secretion and tubular reabsorption. Renal function has traditionally been
determined by measuring plasma creatinine and estimating creatinine clearance.
However, estimated creatinine clearance measures only glomerular filtration
with a small contribution from active secretion. There is accumulating evidence
of poor correlation between estimated creatinine clearance and renal drug
clearance in different clinical settings, challenging the ‘intact nephron
hypothesis’ and suggesting that renal drug handling pathways may not decline in
parallel. Furthermore, it is evident that renal drug handling is altered to a
clinically significant extent in a number of disease states, necessitating
dosage adjustment not just based on filtration. These observations suggest that
a re-evaluation of markers of renal function is required. Methods that measure
all renal handling pathways would allow informed dosage individualisation using
an understanding of renal excretion pathways and patient characteristics.
Methodologies have been described to determine individually each of the renal
elimination pathways. However, their simultaneous assessment has only recently
been investigated. A cocktail of markers to measure simultaneously the
individual renal handling pathways have now been developed, and evaluated in
healthy volunteers. This review outlines the different renal elimination
pathways and the possible markers that can be used for their measurement.
Diseases and other physiological conditions causing altered renal drug
elimination are presented, and the potential application of a cocktail of
markers for the simultaneous measurement of drug handling is evaluated. Further
investigation of the effects of disease processes on renal drug handling should
include people with HIV infection, transplant recipients (renal and liver) and
people with rheumatoid arthritis. Furthermore, changes in renal function in the
elderly, the effect of sex on renal function, assessment of living kidney
donors prior to transplantation and the investigation of renal drug
interactions would also be potential applications. Once renal drug handling
pathways are characterised in a patient population, the implications for
accurate dosage individualisation can be assessed. The simultaneous measurement
of renal function elimination pathways of drugs and metabolites has the
potential to assist in understanding how renal function changes with different
disease states or physiological conditions. In addition, it will further our
understanding of fundamental aspects of the renal elimination of drugs. N. Ref:: 135
----------------------------------------------------
[155]
TÍTULO / TITLE: - B19 virus infection in
renal transplant recipients.
REVISTA
/ JOURNAL: - J Clin Virol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.elsevier.com/gej-ng/29/46/32/show/Products/VIRUSINT/index.htt
●●
Cita: J Clinical Virology: <> 2003 Apr;26(3):361-8.
AUTORES
/ AUTHORS: - Cavallo R; Merlino C; Re D; Bollero C;
Bergallo M; Lembo D; Musso T; Leonardi G; Segoloni GP; Ponzi AN
INSTITUCIÓN
/ INSTITUTION: - Virology Unit, Department of Public Health
and Microbiology, University of Turin, Via Santena 9, 10126, Turin, Italy. rossana.cavallo@unito.it
RESUMEN
/ SUMMARY: - BACKGROUND: B19 virus infection with
persistent anaemia has been reported in organ transplant recipients. Detection
of B19 virus DNA in serum is the best direct marker of active infection. OBJECTIVE:
The present study evaluated the incidence and clinical role of active B19 virus
infection in renal transplant recipients presenting with anaemia. STUDY DESIGN:
Forty-eight such recipients were investigated by nested PCR on serum samples.
The controls were 21 recipients without anaemia. Active HCMV infection was also
investigated as a marker of high immunosuppression. RESULTS AND CONCLUSIONS: In
11/48 (23%) patients B19 virus DNA was demonstrated in serum versus only 1/21
(5%) of the controls. Ten of these 11 patients had already been seropositive at
transplantation and active infection occurred in eight of them during the first
3 months after transplantation. The remaining patient experienced a primary
infection 9 months after transplantation. Eight (73%) of these 11 patients
displayed a concomitant HCMV infection and four (36%) showed increasing serum
creatinine levels but none developed glomerulopathy; 3/11 (27%) recovered
spontaneously from anaemia whereas 8/11 (73%) needed therapy. In conclusion, the
relatively high occurrence (23%) of B19 virus infection in patients presenting
with anaemia, suggests that it should be considered in the differential
diagnosis of persistent anaemia in renal transplant recipients. Presence of the
viral DNA should be assessed early from transplantation and the viral load
should be monitored to follow persistent infection and better understand the
relation between active infection and occurrence of anaemia, and to assess the
efficacy of IVIG therapy and/or immunosuppression reduction in clearing the
virus. N. Ref:: 56
----------------------------------------------------
[156]
TÍTULO / TITLE: - Utility of intravenous
immune globulin in kidney transplantation: efficacy, safety, and cost
implications.
REVISTA
/ JOURNAL: - Am J Transplant 2003 Jun;3(6):653-64.
AUTORES
/ AUTHORS: - Jordan S; Cunningham-Rundles C; McEwan R
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatric Nephrology &
Transplant Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. sjordan@cshs.org
RESUMEN
/ SUMMARY: - Intravenous immunoglobulin preparations
(IVIG) are known to be effective in the treatment of various autoimmune and
inflammatory disorders into their immunomodulatory, immunoregulatory, and
anti-inflammatory properties. Recently, IVIG has been utilized in the
management of highly sensitized patients awaiting renal transplantation. The
mechanisms of suppression of panel reactive antibodies (PRA) in patients
awaiting transplantation are currently under investigation and appear to be
related to anti-idiotypic antibodies present in IVIG preparations. In this
review, the various immunomodulatory mechanisms attributable to IVIG and their
efficacy in reducing PRAs will be described. In addition, the use of IVIG in
solid organ transplant recipients will be reviewed. The adverse events, safety
considerations, and economic impact of IVIG protocols for patients awaiting
solid organ transplantation will be discussed.
N. Ref:: 67
----------------------------------------------------
[157]
- Castellano -
TÍTULO / TITLE:Disfuncion endotelial en trasplante
renal. Endothelial dysfunction 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 Suppl 4:52-8.
AUTORES
/ AUTHORS: - Crespo M; Campistol JM
INSTITUCIÓN
/ INSTITUTION: - Unidad de Trasplante Renal, Hospital
Clinic, IDIBAPS (Institut d’Investigacio Biomediques Agusti Pi i Sunyer),
Barcelona. N. Ref:: 55
----------------------------------------------------
[158]
TÍTULO / TITLE: - Loss of living donor
renal allograft survival advantage in children with focal segmental
glomerulosclerosis.
REVISTA
/ JOURNAL: - Kidney Int 2001 Jan;59(1):328-33.
AUTORES
/ AUTHORS: - Baum MA; Stablein DM; Panzarino VM; Tejani
A; Harmon WE; Alexander SR
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Children’s Hospital,
Harvard Medical School, Boston, Massachusetts, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Because of concerns of
increased risk of graft loss with recurrent disease, living donor (LD)
transplantation in children with focal segmental glomerulosclerosis (FSGS) has
been controversial. METHODS: The North American Pediatric Renal Transplant
Cooperative Study (NAPRTCS) database from January 1987 to January 2000 was
examined to determine differences in demographics, treatment, and outcomes in
children with FSGS compared with other renal diseases. RESULTS: Data on 6484
children, 752 (11.6%) with FSGS, demonstrated that FSGS patients were more
likely to be older and black, and were less likely to receive either
pre-emptive or LD transplant (P < 0.001). No differences existed in human
lymphocyte antigen (HLA) matching or immunosuppression regimens. Acute tubular
necrosis occurred in more FSGS patients following LD (11.8 vs. 4.6%) or
cadaveric (CD; 27.9 vs. 16.3%) transplants (P < 0.001). Graft survival was
worse for LD FSGS patients (5 years 69%) compared with no FSGS (82%, P <
0.001) and was not significantly different than CD graft survival in the FSGS
(60%) and No FSGS groups (67%). The LD to CD ratios of relative risk of graft
failure were higher in FSGS patients (test for interaction, P = 0.01).
Recurrence of original disease was the only cause of graft failure that
differed between groups (P < 0.001). A greater percentage of LD FSGS graft
failures was attributed to recurrence (P = 0.06). CONCLUSIONS: The impact of FSGS
on graft survival in children is greatest in LD transplants, resulting in loss
of expected LD graft survival advantage. The rationale for LD grafts in
children with FSGS should be based on factors other than better outcomes
typically associated with LD transplantation.
----------------------------------------------------
[159]
- Castellano -
TÍTULO / TITLE:Nuevos tratamientos
inmunodepresores de induccion en el trasplante renal. New induction
immunosuppression treatments in kidney transplantation.
REVISTA
/ JOURNAL: - Med Clin (Barc). Acceso gratuito al texto
completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://db.doyma.es/
●●
Cita: Medicina Clínica: <> 2001 Jun 30;117(4):147-57.
AUTORES
/ AUTHORS: - Pascual J; Ortuno J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia. Universidad de
Alcala. Hospital Ramon y Cajal. Madrid. jpascual@hrc.insalud.es N. Ref:: 94
----------------------------------------------------
[160]
TÍTULO / TITLE: - Tumour-like calcinosis
causing reversible tetraparesis in a patient on continuous ambulatory
peritoneal dialysis.
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):1958.
AUTORES
/ AUTHORS: - Ritz E; Hergesell O N. Ref:: 9
----------------------------------------------------
[161]
TÍTULO / TITLE: - Continuous renal
replacement therapy in critically ill 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;16 Suppl 5:67-72.
AUTORES
/ AUTHORS: - Ronco C; Bellomo R; Ricci Z
INSTITUCIÓN
/ INSTITUTION: - Divisione di Nefrologia, Ospedale San
Bortolo, Vicenza, Italy.
RESUMEN
/ SUMMARY: - Acute renal failure is an evolving
syndrome in which new pathogenetic mechanisms have recently been elucidated.
The evolution of the field of haemodialysis has led to a parallel development
in the therapeutic approach to patients suffering from this syndrome. In
particular, acute renal failure is more frequently seen as part of a more
complex syndrome, defined as multiple organ failure. In this clinical setting,
patients are almost inevitably confined to intensive care units and sepsis is a
frequent underlying mechanism of organ failure. The use of new devices and new
machines, together with a better understanding of the underlying mechanisms of
solute and water removal, have allowed us to achieve higher levels of
efficiency and clinical tolerance during artificial renal replacement therapy.
The first objective has been reached by increasing the automation of the
extracorporeal circuits and the operational levels of the different techniques;
the second has been achieved by means of a new generation of monitoring
techniques and new machines equipped with specific interfaces and alarms. This
progress has made continuous forms of renal replacement (CRRT) possible and easy
to perform without major problems or complications. The most promising and
effective options for treating acute renal failure in critically ill patients
are today offered by continuous renal replacement therapies. Classic
indications, but also alternative non-renal indications, have been proposed for
these techniques. The most advanced indication is the multiple organ
dysfunction occurring in septic patients. The possible removal of
proinflammatory mediators may permit a blockade of the systemic inflammation, a
modulation of the altered immune response in these patients, and it may lead to
a partial or total restoration of the lost homeostasis. N. Ref:: 58
----------------------------------------------------
[162]
TÍTULO / TITLE: - Thymic microchimerism
correlates with the outcome of tolerance-inducing protocols for solid organ
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: <> 2001
Dec;12(12):2815-26.
AUTORES
/ AUTHORS: - Noris M; Cugini D; Casiraghi F; Azzollini
N; De Deus Viera Moraes L; Mister M; Pezzotta A; Cavinato RA; Aiello S; Perico
N; Remuzzi G
INSTITUCIÓN
/ INSTITUTION: - Department of Immunology and Clinics of
Organ Transplantation, Mario Negri Institute for Pharmacological Research, via
Gavazzeni 11, 24125 Bergamo, Italy. noris@marionegri.it
RESUMEN
/ SUMMARY: - This study found that pretransplant
infusion of donor peripheral blood leukocytes, either total leukocytes
(peripheral blood leukocytes) or peripheral blood mononuclear cells (PBMC),
under appropriate immunomodulating conditions was more effective than donor
bone marrow (BM) in prolonging the survival of rats that received kidney
grafts. A higher percentage of MHCII(+) cells was found in donor PBMC than in
BM cells, and depletion of MHCII(+) cells from donor PBMC abolished their
tolerogenic potential. By the analysis of microchimerism in rats infused with
donor cells and killed at different time points thereafter, the better
tolerogenic potential of leukocyte infusion related to a higher capability of
these cells to engraft the recipient thymus. PCR analysis on OX6-immunopurified
cells revealed the presence of donor MHCII(+) cells in the thymus of these
animals. The role of intrathymic microchimerism was reinforced by findings that
thymectomy at the time of transplant prevented tolerance induction by donor
leukocytes. Donor DNA was found in the thymus of most long-term graft animals
that survived, but in none of those that rejected their grafts. The presence of
intrathymic microchimerism correlated with graft survival, and microchimerism
in other tissues was irrelevant. PCR analysis of DNA from thymic cell
subpopulations revealed the presence of donor MHCII(+) cells in the thymus of
long-term surviving animals. Thus, in rats, donor leukocyte infusion is better
than donor BM for inducing graft tolerance, defined by long-term graft
survival, donor-specific T cell hyporesponsiveness, and reduced interferon
gamma production. This effect appears to occur through migration of donor
MHCII(+) cells in the host thymus.
----------------------------------------------------
[163]
TÍTULO / TITLE: - The effect of locally
synthesised complement on acute renal allograft rejection.
REVISTA
/ JOURNAL: - J Mol Med 2003 Jul;81(7):404-10. Epub 2003
Jun 25.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00109-003-0454-7
AUTORES
/ AUTHORS: - Sacks S; Zhou W
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and
Transplantation, Guy’s Hospital, King’s College London, University of London,
London, SE1 9RT, UK. steven.sacks@kcl.ac.uk
RESUMEN
/ SUMMARY: - The complement system of components and
receptors is one of the earliest forms of defence. Excessive or inappropriate
activation can result in tissue damage, classically illustrated in
immune-mediated nephritis. In addition, complement forms a bridge between
innate and adaptive immunity, helping to prepare and focus T and B lymphocyte
responses. More recent research in renal allograft models has shown that
complement-inhibited and complement-deficient animals have reduced inflammatory
injury and lowered antidonor immune responses. Furthermore, it is known that
the transplanted kidney is a significant site of local synthesis of C3,
although until recently the relative contribution of locally produced C3 to
transplant injury was unknown. Current evidence indicates that defective local
synthesis of C3 both reduces tissue injury and lowers the antidonor T cell response,
substantially increasing graft survival. Among various possible explanations to
account for these findings, the data favours a direct effect of complement on
alloreactive T cell stimulation. Study of complement gene regulation by common
immunosuppressive agents suggests that they do not influence local complement
synthesis. Alternative approaches are therefore required to control the local
effect of complement in the extravascular tissue compartment of the graft. N. Ref:: 88
----------------------------------------------------
[164]
TÍTULO / TITLE: - Renal problems after
lung transplantation of cystic fibrosis 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 Jul;16(7):1324-8.
AUTORES
/ AUTHORS: - Schindler R; Radke C; Paul K; Frei U
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Internal
Intensive Care Medicine, Universitatsklinikum Charite, Campus Virchow Klinikum,
Berlin, Germany. N.
Ref:: 24
----------------------------------------------------
[165]
TÍTULO / TITLE: - Interpreting the
mechanisms of continuous renal replacement therapy in sepsis: the peak
concentration hypothesis.
REVISTA
/ JOURNAL: - Artif Organs 2003 Sep;27(9):792-801.
AUTORES
/ AUTHORS: - Ronco C; Tetta C; Mariano F; Wratten ML;
Bonello M; Bordoni V; Cardona X; Inguaggiato P; Pilotto L; d’Intini V; Bellomo
R
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, St. Bortolo
Hospital, Vicenza, Italy. cronco@goldnet.it
RESUMEN
/ SUMMARY: - Severe sepsis and septic shock are the
primary causes of multiple organ dysfunction syndrome (MODS), which is the most
frequent cause of death in intensive care unit patients. Many water-soluble
mediators with pro- and anti-inflammatory action such as TNF, IL-6, IL-8, and
IL-10 play a strategic role in septic syndrome. In intensive care medicine,
blocking any one mediator has not led to a measurable outcome improvement in
patients with sepsis. CRRT is a continuously acting therapy, which removes in a
nonselective way pro- and anti-inflammatory mediators; “the peak concentration
hypothesis” is the concept of cutting peaks of soluble mediators through
continuous hemofiltration. Furthermore, there is evidence of increased efficacy
of high-volume hemofiltration compared to conventional CVVH, and other blood
purification techniques that utilize large-pore membranes or sorbent
plasmafiltration are conceptually interesting.
N. Ref:: 91
----------------------------------------------------
[166]
TÍTULO / TITLE: - Eradication of
parvovirus B19 infection after renal transplantation requires reduction of
immunosuppression and high-dose immunoglobulin 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 Oct;17(10):1840-2.
AUTORES
/ AUTHORS: - Liefeldt L; Buhl M; Schweickert B;
Engelmann E; Sezer O; Laschinski P; Preuschof L; Neumayer HH
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Charite,
Humboldt-University Berlin, Germany. lutz.liefeldt@charite.de N. Ref:: 17
----------------------------------------------------
[167]
TÍTULO / TITLE: - Recent advances in
immunosuppressive therapy for renal transplantation.
REVISTA
/ JOURNAL: - Semin Dial 2001 May-Jun;14(3):218-22.
AUTORES
/ AUTHORS: - Peddi VR; First MR
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and Hypertension,
Department of Internal Medicine, University of Cincinnati College of Medicine,
Cincinnati, Ohio 45267-0585, USA. ram.peddi@uc.edu
RESUMEN
/ SUMMARY: - Recent advances in immunosuppression have
focused on more effective, safer, and targeted therapies that have resulted in
improved short- and intermediate-term renal allograft survival. During the past
decade there has been a marked decrease in acute rejection rates following
renal transplantation because of the use of newer immunosuppressive agents.
Recent data indicate that the average yearly reduction in the relative hazard
of graft failure beyond 1 year was 4.2% for all recipients (0.4% for those
recipients who had an acute rejection episode and 6.3% for those who did not
have an acute rejection). Despite these improvements the currently available
immunosuppressive agents are associated with significant cardiovascular risk
factors, an increased risk of infection, and the development of malignancies in
the long term. Predictive parameters of donor-specific hyporesponsiveness are
needed so as to allow identification of patients in whom immunosuppressive
therapy can be safely reduced. Immunosuppressive agents that have recently been
approved for use in the United States and those that are in clinical and
preclinical studies are discussed. N.
Ref:: 27
----------------------------------------------------
[168]
TÍTULO / TITLE: - Nutritional
considerations in renal transplant patients.
REVISTA
/ JOURNAL: - Blood Purif 2002;20(2):139-44.
AUTORES
/ AUTHORS: - van den Ham EC; Kooman JP; van Hooff JP
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine,
University Hospital Maastricht, The Netherlands. evha@sint.azm.nl
RESUMEN
/ SUMMARY: - In renal transplant patients, weight gain
generally increases after renal transplantation, which will be influenced by
improved appetite and a reversal of the uremic state. However, at least in the
early posttransplant period, the increase in body weight is mainly due to an
increase in body fat mass. This phenomenon may be partly due to relatively high
doses of steroids in the early period after renal transplantation, possibly
mediated by their inhibiting effect on lipid peroxidation, but also appears to
be related to physical inactivity. The increase in body fat mass may contribute
to posttransplant hyperlipidemia, which is improved but not completely
normalized by dietary intervention. Current dietary recommendations in stable
renal transplant patients do not generally differ from those of the general
population, although intense dietary counselling may be indicated in patients
with excessive posttransplant weight gain. The effect of supervised exercise
training on body composition is currently under investigation. N. Ref:: 57
----------------------------------------------------
[169]
TÍTULO / TITLE: - Skin cancers 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: <> 2003 Jun;18(6):1052-8.
AUTORES
/ AUTHORS: - Dreno B
INSTITUCIÓN
/ INSTITUTION: - Centre Hospitalier Universitaire, Clinique
Dermatologique, Nantes, France. bdreno@wanadoo.fr N. Ref:: 32
----------------------------------------------------
[170]
TÍTULO / TITLE: - Limited dose monoclonal
IL-2R antibody induction protocol after primary kidney transplantation.
REVISTA
/ JOURNAL: - Am J Transplant 2002 Jul;2(6):568-73.
AUTORES
/ AUTHORS: - Ahsan N; Holman MJ; Jarowenko MV; Razzaque
MS; Yang HC
INSTITUCIÓN
/ INSTITUTION: - Nephrology and Transplant Division,
University of Medicine and Dentistry of New Jersey, New Brunswick 08904, USA. ahsanna@umdnj.edu
RESUMEN
/ SUMMARY: - This study prospectively compared
immunoprophylaxis with a single intraoperative dose (2 mg/kg) of monoclonal
interleukin-2 receptor (IL-2R) antibody vs. noninduction in kidney transplant
recipients treated with tacrolimus (FK 506), mycophenolate mofetil (MMF) and a
prednisone-based immunosuppression regimen. One hundred recipients of
first-kidney transplant were enrolled into the study to receive either
anti-IL-2R monoclonal antibody, daclizumab (2 mg/kg intraoperatively, limited
anti-IL-2R) or no induction (control). Each patient also received oral
tacrolimus (dosed to target trough level 10-15 ng/mL), MMF (500 mg bid) and
prednisone. The primary efficacy end-point was the incidence of biopsy proven
acute rejection during the first 6 months post-transplant. The patients were
also followed for 12-month graft function, and graft and patient survival
rates. Other than the donor’s age being significantly lower in the control
group, both groups were comparable with respect to age, weight, gender, race,
human leukocyte antigen (HLA)-DR mismatch, panel reactive antibody (%PRA), cold
ischemic time, cytomegalovirus (CMV) status, causes of renal failure, and
duration and modes of renal replacement therapy (RRT). During the first 6
months, episodes of first biopsy confirmed acute rejection was 3/50 (6%) in the
limited anti-IL-2R group and 8/50 (16%) in the controls (p < 0.05).
Twelve-month patient 100/98 (%) and graft survival 100/96 (%) were not
statistically different. The group receiving limited anti-IL-2R did not have
any adverse reactions. Our study demonstrates that a limited (single) 2 mg/kg
immunoprophylaxis dose with monoclonal IL-2R antibody (daclizumab) when
combined with tacrolimus/MMF/steroid allows significant reduction in early
renal allograft rejection to the single digit level. The therapy with
anti-IL-2R antibody is simple and is well tolerated.
----------------------------------------------------
[171]
TÍTULO / TITLE: - The utility of
monoclonal antibody therapy in renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2002 May;34(3):797-800.
AUTORES
/ AUTHORS: - Loertscher R
INSTITUCIÓN
/ INSTITUTION: - Division of Transplantation, McGill
University Health Centre, Montreal, Quebec, Canada. rolf.loertscher@mcgill.ca N. Ref:: 37
----------------------------------------------------
[172]
TÍTULO / TITLE: - Preimplantation renal
biopsy: structure does predict function.
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 15;75(3):264-6.
AUTORES
/ AUTHORS: - D’Agati VD; Cohen DJ
INSTITUCIÓN
/ INSTITUTION: - Columbia University College of Physicians
and Surgeons, New York, NY, USA. N.
Ref:: 11
----------------------------------------------------
[173]
TÍTULO / TITLE: - Factors associated with
long-term renal allograft survival.
REVISTA
/ JOURNAL: - Ther Drug Monit 2002 Feb;24(1):36-9.
AUTORES
/ AUTHORS: - Kaplan B; Srinivas TR; Meier-Kriesche HU
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Shands University
Hospital, University of Florida, Gainesville, Florida 32610-0224, USA. kaplab@medicine.ufl.edu
RESUMEN
/ SUMMARY: - Major advances in immunosuppression and
reductions in the rates of acute rejection have led to increasing graft and
patient survival rates during the past two decades. Chronic dysfunction of the
renal allograft, however, remains a major clinical problem and probably
represents the end result of the complex interplay between donor and recipient
factors, immunologic injury, nonimmunologic insults, and drug-induced
nephrotoxicity. Optimal function of the renal allograft is obtained by
maintaining a balance between underimmunosuppression and acute rejection and
overimmunosuppression and drug-induced toxicities. To minimize side effects
while maintaining efficacy, immunosuppressive drugs are commonly used as
combination therapy. Pharmacokinetic and pharmacodynamic interactions between
these agents can affect graft survival and function. The evidence supporting
the role of therapeutic drug monitoring as applied to commonly used
immunosuppressants in modern transplantation is presented here, and the
increasing role of therapeutic drug monitoring in the optimization of graft and
patient survival rates in the modern era of renal transplantation is discussed. N. Ref:: 52
----------------------------------------------------
[174]
TÍTULO / TITLE: - Safety and efficacy of
TOR inhibitors in pediatric renal transplant recipients.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Oct;38(4 Suppl
2):S22-8.
AUTORES
/ AUTHORS: - Ettenger RB; Grimm EM
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, Mattel
Children’s Hospital at UCLA, Los Angeles, CA 90095-1752, USA. Rettenger@mednet.ucla.edu
RESUMEN
/ SUMMARY: - Information about the pharmacokinetics,
safety, and efficacy of target of rapamycin (TOR) inhibitors, such as sirolimus
and everolimus, in pediatric renal transplant recipients is limited. In an
ascending single-dose pharmacokinetic study of sirolimus in pediatric dialysis
patients, no clinically significant association was observed between patient
age and absorption of sirolimus from the gastrointestinal tract. However, young
pediatric patients (5 to 11 years of age) exhibited significantly greater
apparent oral clearances, suggesting that pediatric patients require slightly
higher doses than do adults when adjusted for body weight or surface area.
Similarly, in studies performed in pediatric renal transplant recipients, the
half-life of sirolimus was shorter and the clearance was greater in younger
patients. On the other hand, in single-dose pharmacokinetic studies of
everolimus, the apparent clearance was reduced in pediatric renal transplant
recipients compared with clearance in adults. This reduced clearance was
attributed to a smaller apparent volume of distribution in pediatric patients,
rather than to a difference in terminal half-life. This suggested that,
although the adult 12-hour dosing interval was appropriate for pediatric
patients, they would require reduced dosing based on body size compared with
adults. In a large trial (N = 719) of sirolimus versus azathioprine in
combination with cyclosporine microemulsion and prednisone, 6 pediatric
patients (13 to 18 years of age) received sirolimus at 2 mg/d, 3 received
sirolimus at 5 mg/d, and 3 received azathioprine. Seven of the nine patients
who received sirolimus experienced no rejection episodes. Six infectious
episodes occurred in the 6 patients receiving sirolimus at 2 mg/d, 10 episodes
occurred in the 3 patients receiving sirolimus at 5 mg/d, and 8 episodes
occurred in the 3 patients receiving azathioprine. At 6 months after
transplantation, renal function was similar in all 3 groups, although there was
a statistically nonsignificant increase in the group receiving sirolimus at 5
mg/d. The mean cholesterol and triglyceride levels were generally comparable in
all 3 groups. TOR inhibitors are promising agents for the prevention of graft
rejection in pediatric renal transplant recipients, but more pharmacokinetic
data are required to assess the optimal dosing regimens in this population. In
addition, further data are needed on the efficacy and safety of TOR inhibitors
in combination with other agents in pediatric transplantation recipients to
best assess the role of TOR inhibition in corticosteroid and/or calcineurin
inhibitor-sparing regimens. N.
Ref:: 13
----------------------------------------------------
[175]
TÍTULO / TITLE: - Epstein-Barr
virus-associated extranodal NK/T-cell lymphoma, nasal type of the hypopharynx,
in a renal allograft recipient: case report and review of literature.
REVISTA
/ JOURNAL: - Hum Pathol 2001 Nov;32(11):1264-8.
AUTORES
/ AUTHORS: - Stadlmann S; Fend F; Moser P; Obrist P;
Greil R; Dirnhofer S
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, University of
Innsbruck, Innsbruck, Austria.
RESUMEN
/ SUMMARY: - Posttransplant lymphoproliferative
disorders (PTLPDs) are predominantly B-cell lymphoproliferations, whereas a
T-cell origin is rarely observed. In contrast to B-cell PTLPD, T-cell PTLPDs
show an inconsistent association with Epstein-Barr virus (EBV). Until now, only
13 cases of EBV-associated T-cell PTLPDs have been reported. We describe a case
of an EBV-associated T-cell PTLPD in a renal allograft recipient 2 years after
transplantation. Histologic examination showed medium- to large-sized lymphoid
cells with an angiocentric growth pattern and necrosis. The atypical cells
showed a CD2+, CD3epsilon+, CD7+, CD43+, CD45R0+, CD56+, and CD4-, CD5-, CD8-
betaF1- phenotype with expression of the latent membrane protein (LMP)-1 of
EBV. In addition, EBV-specific RNAs (EBER ½) were identified by in situ
hybridization. Molecular analysis of the T-cell receptor (TCR) gamma chain by
polymerase chain reaction (PCR) showed a polyclonal pattern. The morphologic,
immunohistochemical, and molecular findings were consistent with a diagnosis of
an EBV-associated extranodal natural killer (NK)/T-cell non-Hodgkin lymphoma
(NHL) of nasal type. To our knowledge, this is the first reported case of this
rare entity in the posttransplant setting.
N. Ref:: 18
----------------------------------------------------
[176]
TÍTULO / TITLE: - Vascular and cellular
mechanisms of chronic renal allograft dysfunction.
REVISTA
/ JOURNAL: - Transplantation 2001 Jun 15;71(11
Suppl):SS37-41.
AUTORES
/ AUTHORS: - Morris RE
INSTITUCIÓN
/ INSTITUTION: - Stanford University School of Medicine,
California, United States. N.
Ref:: 29
----------------------------------------------------
[177]
TÍTULO / TITLE: - Role of prostanoids and
endothelins in the prevention of cyclosporine-induced nephrotoxicity.
REVISTA
/ JOURNAL: - Prostaglandins Leukot Essent Fatty Acids
2001 Apr-May;64(4-5):231-9.
●●
Enlace al texto completo (gratuito o de pago) 1054/plef.2001.0265
AUTORES
/ AUTHORS: - Darlametsos IE; Varonos DD
INSTITUCIÓN
/ INSTITUTION: - Centre Franco-Hellenique de Recherches
Biomedicales, Nikolaos Papanikolaou, Corporation of the Municipality Agrinion,
Agrinion, 30100, Greece. darlamet@otenet.gr
RESUMEN
/ SUMMARY: - Cyclosporine A nephrotoxicity includes
both functional toxicity and histological changes, whose seriousness is
dependent upon the dose and the duration of the drug administration. Several
vasoactive agents have been found to be implicated in cyclosporine induced
nephrotoxicity, among which prostanoids and endothelins are the most important.
In previous studies we were able to prevent the early stage (7 days) of
cyclosporine (37.4 micromol [45 mg]/kg/day) induced nephrotoxicity in rats
either by the administration, i) of OKY-046, a thromboxane A(2)synthase
inhibitor, ii) of ketanserine, an antagonist of S(2)serotonergic,
a(1)adrenergic, and H(1)histaminergic receptors and iii) of nifedipine, a
calcium channel blocker, or by diet supplementation either with evening
primrose oil or fish oil. All these protective agents elevated ratios of
excreted renal prostanoid vasodilators (prostaglandins E(2), 6ketoF(1 alpha))
to vasoconstrictor (thromboxane B(2)), a ratio which was decreased by the
administration of cyclosporine alone. Nifedipine averted the cyclosporine
induced increase of urinary endothelin-1 release. All protections were
associated with the reinstatement of glomerular filtration rate forwards normal
levels whereas renal damage defence, consisting of a decrease of the
cyclosporine induced vacuolizations, was variable. Ketanserine and evening
primrose oil were the only agents which prevented the animal body weight loss.
These data suggest that prostanoids and endothelin-1 may mediate functional
toxicity while thromboxane A(2)is involved the morphological changes too,
provoked in the early stage of cyclosporine treatment. However, other
nephrotoxic factors and additional mechanisms could also be implicated in the
cyclosporine induced nephrotoxicity. N.
Ref:: 91
----------------------------------------------------
[178]
TÍTULO / TITLE: - Chronic allograft
failure: a disease we don’t understand and can’t cure?
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):1384-90.
AUTORES
/ AUTHORS: - Schratzberger G; Mayer G
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Department of Internal
Medicine, Anichstrasse 35, A-6020 Innsbruck, Austria. N. Ref:: 58
----------------------------------------------------
[179]
- Castellano -
TÍTULO / TITLE:Riesgo cardiovascular y dislipemia
postrasplante renal. Cardiovascular risk and dyslipidemia 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: <> 2002;22 Suppl 4:20-6.
AUTORES
/ AUTHORS: - Guijarro C; Massu ZA
INSTITUCIÓN
/ INSTITUTION: - Servicio de Medicina Interna, Hospital de
Alcorcon, Ayda. Villaviciosa, s/n. 28922 Alcorcon, Madrid. N. Ref:: 26
----------------------------------------------------
[180]
TÍTULO / TITLE: - Inducible nitric oxide
synthase in renal transplantation.
REVISTA
/ JOURNAL: - Kidney Int 2002 Mar;61(3):872-5.
AUTORES
/ AUTHORS: - Joles JA; Vos IH; Grone HJ; Rabelink TJ
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Hypertension,
University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
RESUMEN
/ SUMMARY: - The importance of the endothelial isoform
of nitric oxide synthase (eNOS) has been well established. Endothelium-derived
nitric oxide has been shown to be essential for vascular homeostasis and
modulation of eNOS has thus become a target in prevention of cardiovascular
disease. The role of the inducible form of nitric oxide synthase (iNOS) in
vascular biology, however, is less clear. Classically, iNOS has been regarded
as an enzyme that produces nmolar amounts of the nitric oxide radical, thereby
leading to cellular damage. More recent data, however, have shown that the iNOS
can be a superoxide, peroxynitrite as well as a nitric oxide-producing enzyme,
while the biological effects of iNOS probably depend upon the sort of radical
species released by the enzyme as well as the anti-oxidant capacity of the
cellular microenvironment of the enzyme. This brief review discusses these
aspects in relation to renal transplantation.
N. Ref:: 40
----------------------------------------------------
[181]
TÍTULO / TITLE: -
Trimethoprim-sulfamethoxazole induced aseptic meningitis in a renal transplant
patient.
REVISTA
/ JOURNAL: - Clin Nephrol 2001 Jan;55(1):80-4.
AUTORES
/ AUTHORS: - Muller MP; Richardson DC; Walmsley SL
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, The Toronto
General Hospital, University Health Network, Ontario, Canada.
RESUMEN
/ SUMMARY: - A 45-year-old man underwent renal
transplant for end-stage renal disease complicating systemic lupus
erythematosis. Within 24 hours of initiating Pneumocystis carinii pneumonia
(PCP) prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) he developed
fever and confusion. Cerebrospinal fluid examination revealed a pleocytosis but
cultures were negative. The patient improved within three days after cessation
of the TMP-SMX but symptoms recurred rapidly upon drug rechallenge.
Drug-induced aseptic meningitis is an uncommon but well described clinical
entity. This is the first case described in a patient following renal transplantation.
The literature is reviewed and the clinical features, diagnostic challenges and
possible mechanisms of TMP-SMX-induced aseptic meningitis are discussed. This
problem may be more common in the transplant population than is recognized
given the difficulty of diagnosis combined with the widespread use of TMP-SMX
as PCP prophylaxis. N.
Ref:: 20
----------------------------------------------------
[182]
TÍTULO / TITLE: - Durable and high rates
of remission following chemotherapy in posttransplantation lymphoproliferative
disorders after renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Feb;35(1):256-7.
AUTORES
/ AUTHORS: - Gill D; Juffs HG; Herzig KA; Brown AM;
Hawley CM; Cobcroft RG; Petrie JJ; Marlton P; Kennedy G; Thomson DB; Campbell
SB; Nicol DL; Norris D; Johnson DW
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, Mater
Misericordiae Hospital, Brisbane, Australia.
N. Ref:: 18
----------------------------------------------------
[183]
TÍTULO / TITLE: - Hepatobiliary diseases
after kidney transplantation unrelated to classic hepatitis virus.
REVISTA
/ JOURNAL: - Semin Dial 2002 Sep-Oct;15(5):358-65.
AUTORES
/ AUTHORS: - Ahsan N; Rao KV
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and Transplatation,
Department of Medicine, University of Medicine and Dentistry of New Jersey,
Robert Wood Johnson Medical School, New Brunswick, USA. ahsanna@umdnj.edu
RESUMEN
/ SUMMARY: - Multiple studies during the past decades
have identified chronic liver disease as an important cause of morbidity and
mortality in kidney transplant recipients. It has been reported that up to 25%
of patients will have some degree of abnormal liver functions during the
immediate posttransplant period. In these patients, liver failure has been
implicated as the cause of death in approximately 30% of the long-term
survivors. While infections from hepatitis virus remain the main cause of
ongoing liver damage, many other opportunistic infections with various potential
to alter liver function have also been identified. In addition, posttransplant
patients are also exposed to hepatotoxic adverse effects of many
pharmacotherapeutics including immunosuppressive and nonimmunosuppressive
agents. Since there are numerous reports dealing with classic viral hepatitis
after kidney transplantation, this review primarily focuses on post-kidney
transplant liver diseases which are not due to classic hepatitis viruses. N. Ref:: 59
----------------------------------------------------
[184]
TÍTULO / TITLE: - Glycogen storage
disease type I: indications for liver and/or kidney transplantation.
REVISTA
/ JOURNAL: - Eur J Pediatr 2002 Oct;161 Suppl 1:S53-5.
Epub 2002 Jul 19.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00431-002-1004-y
AUTORES
/ AUTHORS: - Labrune P
INSTITUCIÓN
/ INSTITUTION: - Service de Pediatrie et Consultation de
Genetique, Hopital Antoine Beclere (AP-HP), BP 405, 92141 Clamart cedex, France.
philippe.labrune@abc.ap-hop-paris.fr
RESUMEN
/ SUMMARY: - Even though significant progress has been
achieved in the management of patients with glycogen storage disease type I,
hepatic (mainly adenomas) and renal (proteinuria, renal failure) complications
may still develop. Orthotopic liver transplantation has been reported in less
than 20 patients, and, in most cases, its indications were multiple hepatic
adenomas, sometimes combined with poor metabolic control and/or growth
retardation. Even though short-term outcome seems to be favourable, long-term
complications have been reported in several cases. Thus it appears that
improved metabolic control has to be attempted before performing liver transplantation
in such patients. As for renal transplantation, it has been performed in
patients with terminal renal failure. It is hoped that improving long-term
metabolic control will prevent renal involvement from evolving to terminal
renal failure. Finally, combined liver and kidney transplantation may be
indicated in a few patients. CONCLUSION: organ (liver/kidney) transplantation
in glycogen storage disease type I may be advantageous when long-term metabolic
control has been attempted. Nevertheless, post-transplantat long-term
complications may still develop. N.
Ref:: 24
----------------------------------------------------
[185]
TÍTULO / TITLE: - The inflammatory
component in progressive renal disease—are interventions possible?
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 Mar;17(3):363-8.
AUTORES
/ AUTHORS: - Noronha IL; Fujihara CK; Zatz R N. Ref:: 43
----------------------------------------------------
[186]
TÍTULO / TITLE: - New strategies to
reduce nephrotoxicity.
REVISTA
/ JOURNAL: - Transplantation 2001 Dec 27;72(12
Suppl):S99-104.
AUTORES
/ AUTHORS: - Kreis H
RESUMEN
/ SUMMARY: - Since the introduction of cyclosporine,
CNIs have formed the basis of immunosuppressive therapy in renal
transplantation. The propensity of these agents to ultimately damage the very
organs they were intended to protect was always recognized, but largely ignored
due to their impressive ability to improve short-term outcomes. With the
availability of equally powerful new immunosuppressive agents devoid of major
nephrotoxicity, the irony of this situation has become all too apparent, and
investigators are beginning to reevaluate the role of CNIs in renal
transplantation. In this paper, we looked at strategies using MMF or sirolimus
to reduce, withdraw, or replace CNIs in renal transplantation. Although MMF has
proved effective in combination with CNIs, particularly in reducing acute
rejection rates, its use as base therapy to allow CNI therapy to be withdrawn
or eliminated is questionable. On the basis of initial trials, sirolimus holds
promise for use as base therapy. To date, it is probably the only agent used in
renal transplantation that provides immunosuppression comparable to
cyclosporine or tacrolimus, which may someday allow sirolimus to replace. CNIs
or allow early withdrawal of CNI therapy. Further study is needed to better
clarify the role of sirolimus in improving long-term renal transplantation
outcomes. N. Ref:: 61
----------------------------------------------------
[187]
TÍTULO / TITLE: - Glomerulonephritis
recurrence in the renal graft.
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(2):394-402.
AUTORES
/ AUTHORS: - Chadban S
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Monash Medical
Centre, 246 Clayton Road, Clayton 3168, Australia. Steven.Chadban@med.monash.edu.au N. Ref:: 60
----------------------------------------------------
[188]
TÍTULO / TITLE: - Physiologic and
immunologic hurdles to xenotransplantation.
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
Jan;12(1):182-93.
AUTORES
/ AUTHORS: - Samstein B; Platt JL
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Mayo Clinic,
Rochester, Minnesota, 55905, USA.
RESUMEN
/ SUMMARY: - The major problem in the field of renal
transplantation is currently the shortage of available kidneys. However, the
use of animals as a source of kidneys, i.e., xenotransplantation, is
increasingly being viewed as a potential solution to this problem. One
preeminent hurdle to xenotransplantation is the immune response of the
recipient against the graft; other hurdles include the physiologic limitations
of the transplant, infection, and ethical considerations. This review
summarizes what is currently known regarding the obstacles to
xenotransplantation and some potential solutions to those problems. N. Ref:: 111
----------------------------------------------------
[189]
TÍTULO / TITLE: - Special clinical
problems in geriatric patients.
REVISTA
/ JOURNAL: - Semin Dial 2002 Mar-Apr;15(2):116-20.
AUTORES
/ AUTHORS: - Winchester JF
INSTITUCIÓN
/ INSTITUTION: - RenalTech International, New York, NY
10021, USA. jamesw@renaltech.com
RESUMEN
/ SUMMARY: - The elderly dialysis patient presents
several challenges to the nephrologist. Concurrent illnesses may complicate
management, disabilities may interfere with mobility, hearing, and vision, and
depression and mental incompetence may be present. For these reasons the
physician and health care team should adopt a broad treatment plan, using
expert help if needed in managing the patient and involving family members,
clergy, and friends. While lifestyle changes are inevitable for the elderly
with initiation of dialysis, satisfactory outcomes are possible. In the event
of overwhelming illness and the patient’s perception of the futility of
continuation of dialysis, cessation of dialysis must be approached in a humane,
considerate, and compassionate manner. N.
Ref:: 78
----------------------------------------------------
[190]
- Castellano -
TÍTULO / TITLE:Insuficiencia renal en el
trasplante hepatico. Renal insufficiency in liver 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 5:69-71.
AUTORES
/ AUTHORS: - Rimola A
INSTITUCIÓN
/ INSTITUTION: - Servicio de Hepatologia, Hospital Clinic,
Barcelona. N. Ref:: 28
----------------------------------------------------
[191]
TÍTULO / TITLE: - Renin system activation
and delayed function of the renal transplant.
REVISTA
/ JOURNAL: - Am J Hypertens 2001 Dec;14(12):1270-2.
AUTORES
/ AUTHORS: - Blumenfeld JD; Catanzaro DF; Kinkhabwala
M; Cheigh J; Hartono C; Serur D; Kapur S; Stubenbord WT; Haschemeyer R; Riggio
R
INSTITUCIÓN
/ INSTITUTION: - Rogosin Institute, Department of Surgery,
New York Presbyterian Hospital, Weill Medical College of Cornell University,
New York 10021, USA. blumenj@mail.rockefeller.edu
RESUMEN
/ SUMMARY: - Delayed graft function (DGF), defined as
persistent renal failure that requires dialysis within the first week after
kidney transplantation, occurs commonly after cadaveric renal transplantation
(CRT). This has important implications for long-term outcome because the 1-year
allograft survival rate is significantly reduced when DGF occurs. The
mechanisms contributing to the development of DGF are not well established.
However, several lines of evidence indicate that excess renin system activity,
in both the cadaver kidney donor and recipient, contributes importantly to the
pathogenesis of DGF. If this hypothesis can be verified in clinical studies,
then pharmacologic agents that interrupt the renin-angiotensin system (eg, type
1 angiotensin II receptor blockade, angiotensin converting enzyme inhibition,
and beta-adrenergic blockade) in the donor and recipient might significantly
improve the outcome of cadaveric renal transplants. N. Ref:: 22
----------------------------------------------------
[192]
TÍTULO / TITLE: - Kidney transplantation:
graft monitoring and immunosuppression.
REVISTA
/ JOURNAL: - World J Surg 2002 Feb;26(2):185-93. Epub
2001 Dec 17.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00268-001-0206-1
AUTORES
/ AUTHORS: - Fisher JS; Woodle ES; Thistlethwaite JR Jr
INSTITUCIÓN
/ INSTITUTION: - Section of Transplantation, Department of
Surgery, University of Tennessee, Room A-202, Memphis,Tennessee 38103, USA.
RESUMEN
/ SUMMARY: - Renal transplantation has become the
preferred means of treating end-stage renal disease. Episodes of allograft
rejection have become the exception rather than the rule. The development of
real-time ultrasound-guided allograft biopsy and adoption of the Banff criteria
for histologic evaluation permit safe,accurate monitoring of graft histology.
New immunosuppressive agents have drastically reduced the number of episodes of
both primary and refractory rejection. Novel biologic agents in the form of
monoclonal antibodies and soluble receptor hybrid molecules may serve to reduce
the required doses of toxic chemical immunosuppressants and provide more
specific immune suppression directed at those elements of the immune system
involved in rejection of a given allograft. Development of assays to identify
patients who demonstrate donor antigen-specific hyporeactivity is now feasible.
Hopefully, these assays will serve as a guide for the reduction and possible
removal of immunosuppressive agents from stable renal allograft
recipients. N. Ref:: 81
----------------------------------------------------
[193]
TÍTULO / TITLE: - Glycaemic control and
graft loss following 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 Oct;16(10):1978-82.
AUTORES
/ AUTHORS: - Thomas MC; Mathew TH; Russ GR N. Ref:: 32
----------------------------------------------------
[194]
TÍTULO / TITLE: - Recurrent
glomerulonephritis following renal transplantation: an update.
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(7):1260-5.
AUTORES
/ AUTHORS: - Floege J
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and Immunology,
University of Aachen, Germany. juergen.floege@rwth-aachen.de N. Ref:: 56
----------------------------------------------------
[195]
TÍTULO / TITLE: - Clinical impact of hepatitis
C virus infection in the renal transplant recipient.
REVISTA
/ JOURNAL: - Nephron 2002 Aug;91(4):541-6.
AUTORES
/ AUTHORS: - Kallinowski B; Hergesell O; Zeier M N. Ref:: 55
----------------------------------------------------
[196]
TÍTULO / TITLE: - Long-term kidney
transplant survival.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S44-50.
AUTORES
/ AUTHORS: - Hariharan S
INSTITUCIÓN
/ INSTITUTION: - Froedert Memorial Hospital, Medical
College of Wisconsin, Milwaukee, WI 53226, USA. hari@mcw.edu
RESUMEN
/ SUMMARY: - With improvements in short-term kidney
graft survival, focus has shifted towards long-term survival. There has also
been a substantial improvement in long-term survival as measured by kidney
half-life. Long-term graft failure is secondary to chronic allograft
nephropathy (CAN), recurrent disease, and death with a functioning graft. CAN
is secondary to a combination of chronic rejection, chronic cyclosporine
toxicity, and/or donor kidney disease. Risk factors for chronic rejection have
been attributed to both immunological and nonimmunological causes. With a
marked reduction in acute rejection rates-an important risk factor for
CAN-there is a substantial improvement in kidney half-life. There are still
nonimmunological factors, such as donor age, that adversely affect long-term
graft survival. In addition, African-American recipients continue to have a
shorter graft half-life. Recurrent disease is becoming an important cause of late
graft failure. Despite the introduction of various potent immunosuppressive
agents, there has been little or no impact on the prevalence as well as
progression of recurrent diasease. With the reduction of acute rejection rates
and improved short- and long-term graft survival, further improvements of
long-term graft survival will be an important focus in the 21st
century. N. Ref:: 45
----------------------------------------------------
[197]
TÍTULO / TITLE: - Successful kidney
transplantation using organs from a donor with disseminated intravascular
coagulation and impaired renal function: case report and review of the
literature.
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 Feb;16(2):412-5.
AUTORES
/ AUTHORS: - Pastural M; Barrou B; Delcourt A; Bitker MO;
Ourahma S; Richard F
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, Hopital La
Pitie-Salpetriere, Paris, France. N.
Ref:: 9
----------------------------------------------------
[198]
TÍTULO / TITLE: - Acute renal failure and
multiple organ dysfunction in the ICU: from renal replacement therapy (RRT) to
multiple organ support therapy (MOST).
REVISTA
/ JOURNAL: - Int J Artif Organs 2002 Aug;25(8):733-47.
AUTORES
/ AUTHORS: - Ronco C; Bellomo R
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Dialysis and
Transplantation, St Bortolo Hospital, Vicenza, Italy. cronco@goldnet.it
RESUMEN
/ SUMMARY: - Renal replacement therapy (RRT) has
evolved from the concept that we need to treat the dysfunction of a single
organ (the kidney). As intensive care units have become more and more complex,
it has become clear that the majority of patients with acute renal failure
often have dysfunction of several other organs. In order to facilitate single
organ support in this setting, continuous renal replacement therapy (CRRT)
techniques have been developed. However, CRRT has opened the door to the
concept that targeting renal support as the only goal of extracorporeal blood
purification may be a simplistic view of our therapeutic aims. In this article
we argue that it is now time to move from the simple goal of achieving adequate
renal support. The proper goal of extracorporeal blood purification in ICU
should be multi-organ support therapy (MOST). We explain why MOST represents
the most logical future conceptual and practical evolution of CRRT and
illustrates the biological rationale, supplying animal and clinical evidence
that confirms the need to move rapidly in this direction theoretically,
practically and technologically. N.
Ref:: 104
----------------------------------------------------
[199]
TÍTULO / TITLE: - Tailoring
immunosuppressive therapy based on donor and recipient risk factors.
REVISTA
/ JOURNAL: - Transplant Proc 2001 May;33(3):2207-11.
AUTORES
/ AUTHORS: - First MR
INSTITUCIÓN
/ INSTITUTION: - University of Cincinnati Medical Center,
Cincinnati, Ohio 45267-0585, USA. N.
Ref:: 35
----------------------------------------------------
[200]
TÍTULO / TITLE: - Delayed graft function.
Influence on outcome and strategies for prevention.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):721-32.
AUTORES
/ AUTHORS: - Shoskes DA; Shahed AR; Kim S
INSTITUCIÓN
/ INSTITUTION: - Departments of Urology and Renal
Transplantation, Cleveland Clinic Florida, Weston, Florida, USA. dshoskes@urol.com
RESUMEN
/ SUMMARY: - Delayed graft function remains a prevalent
problem in cadaveric renal transplantation that increases rejection, decreases
graft and patient survival, increases the cost of transplantation, and
complicates patient management. Although current medical and surgical
strategies can reduce the incidence of DGF to 20% or less, newer therapies that
focus on nonimmune and immune forms of renal injury are needed to improve
outcomes further. N.
Ref:: 105
----------------------------------------------------