#04#
Revisiones-Clínica-Epidemiología,
Higiene & Prevención *** Reviews-Clinical-Epidemiology, Hygiene &
Prevention
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: - 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
----------------------------------------------------
[4]
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.
----------------------------------------------------
[5]
- 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
----------------------------------------------------
[6]
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.
----------------------------------------------------
[7]
TÍTULO / TITLE: - Calcium channel
blockers for preventing acute tubular necrosis in kidney transplant recipients.
REVISTA
/ JOURNAL: - Cochrane Database Syst Rev
2004;1:CD003421.
●●
Enlace al texto completo (gratuito o de pago) 1002/14651858.CD003421.pub2
AUTORES
/ AUTHORS: - Shilliday I; Sherif M
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Monklands Hospital, Monkscourt
Avenue, Airdrie, UK, ML6 0JS.
RESUMEN
/ SUMMARY: - BACKGROUND: The incidence of delayed graft
function in cadaveric grafts has increased over the last few years due in part
to the large demand for cadaveric kidneys necessitating the use of kidneys from
marginal donors. Calcium channel blockers have the potential to reduce the
incidence of post-transplant acute tubular necrosis (ATN) if given in the
peri-operative period. However, there is controversy surrounding their use in
this situation with no consensus as to their efficacy. OBJECTIVES: To evaluate
the benefits and harms of using calcium channel blockers in the peri-transplant
period in patients at risk of ATN following cadaveric kidney transplantation.
SEARCH STRATEGY: We searched the Cochrane Renal Group’s specialised register,
the Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane
Library issue 2, 2003) MEDLINE (1966 to January 2003) and EMBASE (1980 -
January 2003). The Trials Search Coordinator was contacted to develop the
search strategy. SELECTION CRITERIA: Randomised controlled trials comparing
calcium channel blockers given in the peri-transplant period with controls were
included. Quasi-randomised trials were excluded. DATA COLLECTION AND ANALYSIS:
Data was extracted and quality assessed independently by two reviewers, with
differences resolved by discussion. Dichotomous outcomes are reported as
relative risk (RR) and measurements on continuous scales are reported as
weighted mean differences (WMD) with 95% confidence intervals (CI). MAIN
RESULTS: Nine trials were suitable for inclusion. Treatment with calcium
channel blockers in the peri-transplant period was associated with a
significant decrease in the incidence of post transplant ATN (RR 0.57, 95%CI
0.40 to 0.82) and delayed graft function (RR 0.44, 95% CI 0.28 to 0.69). There
was no difference between control and treatment groups in graft loss,
mortality, requirement for haemodialysis. There was insufficent information to
comment on adverse events. REVIEWER’S CONCLUSIONS: These results suggest that
calcium channel blockers given in the peri-operative period may reduce the
incidence of ATN post-transplantation. The result should be treated with
caution due to the heterogeneity of the trials which made comparison of studies
and pooling of data difficult.
----------------------------------------------------
[8]
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.
----------------------------------------------------
[9]
TÍTULO / TITLE: - Mycophenolate mofetil
versus azathioprine therapy is associated with a significant protection against
long-term renal allograft function deterioration.
REVISTA
/ JOURNAL: - Transplantation 2003 Apr 27;75(8):1341-6.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000062833.14843.4B
AUTORES
/ AUTHORS: - Meier-Kriesche HU; Steffen BJ; Hochberg
AM; Gordon RD; Liebman MN; Morris JA; Kaplan B
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine,
University of Florida College of Medicine, Gainesville, FL 32610-0224, USA. meierhu@medicine.ufl.edu.
RESUMEN
/ SUMMARY: - BACKGROUND: To evaluate the association of
long-term continuous mycophenolate mofetil (MMF) versus azathioprine (AZA)
therapy and renal allograft function, as measured by the slope of reciprocal
creatinine, we analyzed 49,666 primary renal allograft recipients reported to
the United States Renal Data System between October 31, 1988 and June 30, 1998.
METHODS: The primary study endpoint was defined as a greater than 20% decrease
below a 6-month baseline of 1/serum creatinine (SCr) (slope of reciprocal
creatinine) at or beyond 1 year after transplantation. A secondary endpoint was
defined as reaching an SCr value greater than 1.6 mg/dL. Univariate
Kaplan-Meier analysis and multivariate Cox proportional hazard models were used
to investigate the risk of reaching the study endpoints. Multivariate analyses
were corrected for potential confounding covariates. RESULTS: According to the
Cox proportional hazard model, 12-month continued therapy of MMF versus AZA was
associated with a protective effect against declining renal function, as
measured by the slope of reciprocal creatinine (relative risk [RR]=0.84,
confidence interval 0.78-0.91, P<0.001). For 24-month continued therapy of
MMF versus AZA, MMF was associated with a further decreased risk for a decline
in renal function (RR=0.66, confidence interval=0.57-0.77, P<0.001).
Furthermore, MMF was associated with a protective effect against reaching the
SCr threshold of 1.6 mg/dL (RR=0.80, P<0.001) beyond 12 months
posttransplantation. CONCLUSIONS: Continuous use of MMF versus AZA was
associated with a protective effect against declining renal function beyond 1
year after transplantation. Further study is needed to confirm that continued
MMF therapy is protective against long-term deterioration in renal function.
----------------------------------------------------
[10]
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.
----------------------------------------------------
[11]
TÍTULO / TITLE: - Incidence of ESRD and
survival after renal replacement therapy in patients with type 1 diabetes: a
report from the Allegheny County Registry.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Jul;42(1):117-24.
AUTORES
/ AUTHORS: - Nishimura R; Dorman JS; Bosnyak Z; Tajima
N; Becker DJ; Orchard TJ
INSTITUCIÓN
/ INSTITUTION: - Department of Epidemiology, Graduate
School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. rimei@excite.co.jp
RESUMEN
/ SUMMARY: - BACKGROUND: Little information is
available regarding the long-term incidence of end-stage renal disease (ESRD)
and survival after the introduction of renal replacement therapy (RRT) in
patients with type 1 diabetes. METHODS: We studied 1,075 patients with type 1
diabetes (onset age < 18 years) diagnosed between 1965 and 1979, who
comprise the Allegheny County population-based registry. Onset of ESRD was defined
as the introduction of RRT (dialysis or transplantation). RESULTS: Of 1,075
registrants, the living status of 975 patients (90.7%) and complication status
of 798 patients (74.2%) were ascertained as of January 1, 1999. During the
observation period, 104 patients (13.0%) developed ESRD, for an incidence rate
of 521/100,000 person-years (95% confidence interval, 424 to 629). The
cumulative incidence of ESRD was 11.3% at 25 years of diabetes. A significant
decline was observed in 20-year cumulative incidence rates of ESRD for patients
diagnosed between 1965 and 1969, 1970 and 1974, and 1975 and 1979 (9.1%, 4.7%,
and 3.6%, respectively; P = 0.006). Of 104 patients with ESRD, 29 patients
(28%) received dialysis alone, 44 patients (42%) received dialysis followed by
kidney transplantation, 26 patients (25%) underwent successful transplantation
alone, and 5 patients (5%) underwent a failed kidney transplantation followed
by dialysis therapy. The cumulative survival rate 10 years after the
introduction of RRT was 51.2%. The cumulative survival rate of dialysis therapy
followed by kidney transplantation was significantly greater than that of
dialysis therapy alone (P < 0.001). No difference was detected in survival
between pancreas-kidney transplant recipients and kidney-alone transplant
recipients (P = 0.7). CONCLUSION: The incidence of ESRD observed in this cohort
has declined, probably reflecting the better glycemic and blood pressure
control available since the early 1980s.
N. Ref:: 35
----------------------------------------------------
[12]
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
----------------------------------------------------
[13]
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.
----------------------------------------------------
[14]
TÍTULO / TITLE: - Management of the
waiting list for cadaveric kidney transplants: report of a survey and
recommendations by the Clinical Practice Guidelines Committee of the American
Society of Transplantation.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2002
Feb;13(2):528-35.
AUTORES
/ AUTHORS: - Danovitch GM; Hariharan S; Pirsch JD; Rush
D; Roth D; Ramos E; Starling RC; Cangro C; Weir MR
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, University of
California, Los Angeles, School of Medicine, Los Angeles, California 90025,
USA. gdanovitch@mednet.ucla.edu
RESUMEN
/ SUMMARY: - The Clinical Practice Guidelines Committee
of the American Society of Transplantation developed a survey to review the
policies of kidney transplant programs in the United States with respect to the
management of the steadily expanding waiting list for cadaveric kidneys. The
survey was sent to 287 centers, and 192 (67%) responded. The survey indicated
that regular follow-up monitoring, most frequently on an annual basis, is
required by the majority (71%) of programs. Patients considered to be at high
risk and candidates for combined kidney-pancreas transplantation may be
monitored more frequently. Annual screening for coronary artery disease is
typically required for asymptomatic patients considered to be at high risk for
covert disease. Noninvasive techniques are typically used, and a designated cardiologist
is usually available to the transplant program. The dialysis nephrologist or
the potential transplant recipient is expected to inform the transplant program
of intercurrent events that may affect transplant candidacy. Standard health
maintenance screening is required, together with the routine updating of
serologic and other blood tests that may be relevant to the posttransplant
course. Smaller transplant programs (<100 patients on the waiting list) are
more likely to maintain closer contact with the wait-listed patients and to
attempt to influence their treatment during dialysis and are less likely to
cancel transplants because of unanticipated pretransplant medical problems. The
work load necessitated by the follow-up monitoring of wait-listed patients was
assessed and, in the absence of specific evidence-based information, a series
of recommendations were developed to reflect current standards of practice and
to suggest future research initiatives.
----------------------------------------------------
[15]
TÍTULO / TITLE: - Nonmelanoma skin cancer
in organ transplant patients.
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 15;75(3):253-7.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000044135.92850.75
AUTORES
/ AUTHORS: - Jemec GB; Holm EA
INSTITUCIÓN
/ INSTITUTION: - Division of Dermatology, Department of
Medicine, Roskilde Hospital, 4000 Roskilde, Denmark. ccc2845@vip.cybercity.dk
RESUMEN
/ SUMMARY: - Nonmelanoma skin cancer (NMSC) is more
frequent in immunocompromised patients, for example, patients with organ
transplants. A number of studies have been published from different countries
that present a similar picture of tumors in transplant patients. In addition,
the behavior of these tumors is often more aggressive in this group of
high-risk patients. The multitude of NMSC and precancerous lesions presents a
clinical diagnostic and therapeutic challenge to the managing dermatologists.
Technology is being developed to cope with the clinical diagnosis and medical
adjunct treatment to broaden the therapeutic options. It is suggested that the
optimal use of these new developments occurs if patients are seen in specialized
clinics aimed at providing preventive measures, diagnosis, and treatment. N. Ref:: 50
----------------------------------------------------
[16]
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
----------------------------------------------------
[17]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.7.1 Late infections. Pneumocystis carinii pneumonia.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:36-9.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Approximately 5% of patients
develop Pneumocystis carinii pneumonia (PCP) after renal transplantation if
they do not receive prophylaxis. PCP is a severe disease, with a very high
fatality rate. Therefore, all renal transplant recipients should receive PCP
prophylaxis. The treatment of choice is trimethoprim-sulfamethoxazole
(TMP-SMX), at a dose of 80/400 mg/day or 160/800 mg every other day, for at
least 4 months. Patients who are treated for rejection should receive TMP-SMX
prophylaxis for 3-4 months. B. In the case of TMP-SMX intolerance, aerosolized
pentamidine (300 mg once or twice per month) is an alternative for prophylaxis.
C. The first-line treatment of PCP is high-dose TMP-SMX. Patients with a PaO2
of <70 mmHg initially should be treated parenterally, and the administration
of additional steroids should be considered.
----------------------------------------------------
[18]
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
----------------------------------------------------
[19]
TÍTULO / TITLE: - Infectious disease
prophylaxis in renal transplant patients: a survey of US transplant centers.
REVISTA
/ JOURNAL: - Clin Transplant 2002 Feb;16(1):1-8.
AUTORES
/ AUTHORS: - Batiuk TD; Bodziak KA; Goldman M
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Indiana University
Medical Center, Indianapolis, USA. tbatiuk@iupui.edu
RESUMEN
/ SUMMARY: - Definitive approaches to most infectious
diseases following renal transplantation have not been established, leading to
different approaches at different transplant centers. To study the extent of
these differences, we conducted a survey of the practices surrounding specific
infectious diseases at US renal transplant centers. A survey containing 103
questions covering viral, bacterial, mycobacterial and protozoal infections was
developed. Surveys were sent to program directors at all U.S. renal transplant
centers. Responses were received from 147 of 245 (60%) transplant centers and
were proportionately represented all centers with respect to program size and
geographical location. Pre-transplant donor and recipient screening for
hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus
(HIV) and cytomegalovirus (CMV) is uniform, but great discrepancy exists in the
testing for other agents. HCV seropositive donors are used in 49% of centers.
HIV seropositivity remains a contraindication to transplantation, although 13%
of centers indicated they have experience with such patients. Post-transplant,
there is wide variety in approach to CMV and Pneumocystis carinii (PCP)
prophylaxis. Similarly divergent practices affect post-transplant vaccinations,
with 54% of centers routinely vaccinating all patients according to customary
guidelines in non-transplant populations. In contrast, 22% of centers indicated
they do not recommend vaccination in any patients. We believe an appreciation
of the differences in approaches to post-transplant infectious complications
may encourage individual centers to analyse the results of their own practices.
Such analysis may assist in the design of studies to answer widespread and
important questions regarding the care of patients following renal
transplantation. N.
Ref:: 38
----------------------------------------------------
[20]
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
----------------------------------------------------
[21]
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
----------------------------------------------------
[22]
TÍTULO / TITLE: - Clinical epidemiology
of cardiac disease in renal transplant recipients.
REVISTA
/ JOURNAL: - Semin Dial 2003 Mar-Apr;16(2):106-10.
AUTORES
/ AUTHORS: - Rigatto C
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Section of
Nephrology, St. Boniface General Hospital, University of Manitoba, Winnipeg,
Canada. crigatto@sbgh.mb.ca
RESUMEN
/ SUMMARY: - Cardiovascular disease (CVD) is the major
cause of death among renal transplant recipients (RTRs), accounting for 17-50%
of deaths. Both cardiomyopathy (congestive heart failure [CHF] and left
ventricular hypertrophy [LVH]) and ischemic heart disease (IHD) are important
complications of renal transplantation, although the morbid impact of
cardiomyopathy has been overlooked until recently. Echocardiographic disorders
and clinical CHF occur far more frequently in RTRs than in the general
population, suggesting that renal transplantation may be a state of accelerated
heart failure. In contrast, the incidence of IHD in RTRs is similar to that in
the Framingham cohort. Age, diabetes, and gender remain important markers of
risk for both disorders. Smoking, hyperlipidemia, and hypertension appear to be
the major reversible risk factors for IHD, while anemia and hypertension are
major reversible risk factors for cardiomyopathy. Definitive evidence on
optimal intervention is lacking. Clinical trials are needed to define optimum
targets for treatment of these risk factors, especially hypertension and
anemia. N. Ref:: 33
----------------------------------------------------
[23]
TÍTULO / TITLE: - The spectrum of kidney
disease in American Indians.
REVISTA
/ JOURNAL: - Kidney Int Suppl 2003 Feb;(83):S3-7.
AUTORES
/ AUTHORS: - Narva AS
INSTITUCIÓN
/ INSTITUTION: - Indian Health Service Kidney Disease
Program, Albuquerque, New Mexico, USA. anarva@abq.ihs.gov
RESUMEN
/ SUMMARY: - American Indians and Alaska Natives
(AI/AN) experience high rates of chronic kidney disease. Several studies have
demonstrated increased rates of early kidney disease among AI/AN, both in
diabetics and non-diabetics. Among some tribes of the American Southwest, high
rates of mesangiopathic glomerulonephritis have been documented. The epidemic
of diabetes among AI/AN, which began in the middle of the 20th
century, appears to be driving the increase in end-stage renal disease (ESRD).
At the end of 1999, AI/AN had a national prevalence rate of treated ESRD that
was 3.5 times greater than that of white Americans. There is significant
regional variation as well as differences among the approximately 550 tribes
that make up the American Indian community, with some tribes experiencing ESRD
rates over twenty times the rate of whites. Although graft survival is
excellent, AI/AN ESRD patients are less likely than whites to be placed on the
transplant waiting list, and those listed wait longer for a transplant. Despite
socioeconomic barriers and high rates of co-morbid illness, survival among
AI/AN ESRD patients is better than among whites. The burden of kidney disease,
particularly the multigenerational occurrence in some families, is perceived as
a major threat to the well-being of native communities. There is a sense of
urgency among tribal leaders to address this epidemic, and research that may
decrease its burden is likely to be welcomed.
N. Ref:: 13
----------------------------------------------------
[24]
- Castellano -
TÍTULO / TITLE:Analisis estadistico de la
incidencia de canceres “de novo” en pacientes trasplantados renales: una nueva
metodologia de estudio. Statistic analysis of “de novo” cancer incidence in
renal transplant patients: a new study methodology.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2003 Sep-Oct;23(5):395-8.
AUTORES
/ AUTHORS: - Virto J; Orbe J; Lampreabe I; Zarraga S;
Urbizu JM; Gainza FJ
INSTITUCIÓN
/ INSTITUTION: - Departamento de Econometria y Estadistica
de la Facultad de Ciencias Economicas y Empresariales, Servicio de Nefrologia,
Unidad docente, Hospital de Cruces, Baracaldo.
N. Ref:: 16
----------------------------------------------------
[25]
- 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
----------------------------------------------------
[26]
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
----------------------------------------------------
[27]
TÍTULO / TITLE: - De novo thrombotic
microangiopathy in renal transplant recipients: a comparison of hemolytic
uremic syndrome with localized renal thrombotic microangiopathy.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Feb;41(2):471-9.
●●
Enlace al texto completo (gratuito o de pago) 1053/ajkd.2003.50058
AUTORES
/ AUTHORS: - Schwimmer J; Nadasdy TA; Spitalnik PF;
Kaplan KL; Zand MS
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Nephrology Unit,
University of Rochester Medical Center, Rochester, NY, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Thrombotic microangiopathy
(TMA) is a well-recognized and serious complication of renal transplantation,
affecting 3% to 14% of patients administered calcineurin-inhibitor-based
immunosuppression. METHODS: We reviewed 1,219 biopsy reports of 742 kidney and
kidney-pancreas transplants performed during 15 years at our center and found
21 biopsy-confirmed cases of TMA. RESULTS: On presentation, the majority (62%)
had systemic TMA with manifest hemolysis and thrombocytopenia, whereas a subset
had TMA localized only to the graft (38%). There were no statistically
significant differences in sex, type of transplant, age, race, or type of
immunosuppression. Patients with systemic TMA were more likely to be treated
with plasma exchange (38% versus 13%; P < 0.05), more often required
dialysis therapy (54% versus 0%; P = 0.01), and had a greater rate of graft
loss (38% versus 0%; P < 0.05). No patient with the localized variant had
TMA-related graft loss. Patients with localized TMA often responded to
reduction, conversion, or temporary discontinuation of
calcineurin-inhibitor-based immunosuppression therapy and did not routinely
require plasma exchange for graft salvage. We compare our findings with the
literature regarding the prognosis of TMA. CONCLUSION: Classifying patients
with post-renal transplantation TMA into those with localized and systemic
disease is clinically useful because each group has distinct characteristics
and clinical courses. N.
Ref:: 37
----------------------------------------------------
[28]
TÍTULO / TITLE: - Recurrent disease in
renal transplants.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito al
texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Aug;18 Suppl
6:vi68-74.
AUTORES
/ AUTHORS: - Newstead CG
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine, St James’s
University Hospital, Leeds, UK.
RESUMEN
/ SUMMARY: - Histology compatible with minimal change
glomerulonephritis and associated with nephrotic syndrome has been reported as
an occasional curiosity post-renal transplantation. Focal segmental
glomerulosclerosis (FSGS) has a recurrence rate of approximately 20%. Age
<15 years, an aggressive clinical course of the original disease and diffuse
mesangial proliferation on native biopsy, are considered predictive of relapse.
At present there are no tests that can accurately predict the likelihood of
recurrence. Data from paediatric patients whose primary disease was FSGS were,
on average, 90% more likely to lose a graft from a live donor and 50% more
likely to lose a graft from a cadaveric donor compared with recipients with
structural disorders. Recurrence in a subsequent graft is expected if the first
graft was affected, but not if the first graft did not demonstrate recurrence.
The best-established and most effective treatment of recurrent disease requires
both plasma exchange and cyclophosphamide. Familial focal and segmental
glomerulosclerosis, although rare, is important to recognize, as it is a
different syndrome to idiopathic FSGS of childhood and overall transplant survival
is good. Adults with ‘secondary’ FSGS would not be expected to be at risk of
recurrent disease in a renal transplant.
N. Ref:: 70
----------------------------------------------------
[29]
- 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
----------------------------------------------------
[30]
TÍTULO / TITLE: - Current status of renal
transplantation. Patient evaluations and outcomes.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):677-86.
AUTORES
/ AUTHORS: - Barry JM
INSTITUCIÓN
/ INSTITUTION: - Division of Urology and Renal
Transplantation, Department of Surgery, Oregon Health Sciences University,
Portland, Oregon, USA.
RESUMEN
/ SUMMARY: - A systematic team approach to the
assessment of renal transplant candidates is one of several factors that have
resulted in improved kidney transplant and recipient survival rates, rates that
were only imagined 4 decades ago. N.
Ref:: 47
----------------------------------------------------
[31]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.10. Pregnancy in renal transplant recipients.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:50-5.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Renal transplantation
restores fertility, and successful pregnancies have been reported in renal
transplant women. In women with normal graft function, pregnancy usually has no
adverse effect on graft function and survival. Therefore, women of childbearing
age who consider pregnancy should receive complete information and support from
the transplant team. B. Pregnancy could be considered safe about 2 years after
transplantation in women with good renal function, without proteinuria, without
arterial hypertension, with no evidence of ongoing rejection and with normal
allograft ultrasound. C. Pregnancy after transplantation should be considered a
high-risk pregnancy and should be monitored by both an obstetrician and the
transplant physician. Pregnancy should be diagnosed as early as possible. The
principal risks are infection, proteinuria, anaemia, arterial hypertension and
acute rejection for the mother, and prematurity and low birth weight for the
foetus. D. Pregnant women and transplanted patients are at increased risk of infections,
especially bacterial urinary tract infections and acute pyelonephritis of the
graft. Urine cultures should be performed monthly and all asymptomatic
infections should be treated. Monitoring of viral infections is also
recommended. (Evidence level B) E. Acute rejection episodes are uncommon but
may occur after delivery. Therefore, immunosuppression should be re-adjusted
immediately after delivery. F. Because pre-eclampsia develops in 30% of
pregnant patients, especially those with prior arterial transplant
hypertension, blood pressure, renal function, proteinuria and weight should be
monitored every 2-4 weeks, with more attention during the third trimester.
Anti-hypertensive agents should be changed to those tolerated during pregnancy.
ACE inhibitors and angiotensin II receptor antagonists are absolutely
contra-indicated. G. Immunosuppressive therapy based on cyclosporine or
tacrolimus with or without steroids and azathioprine may be continued in renal
transplant women during pregnancy. Other drugs, such as mycophenolate mofetil
and sirolimus, are not recommended based on current information available.
Because of drug transfer into maternal milk, breastfeeding is not recommended.
H. Vaginal delivery is recommended, but caesarean section is required in at
least 50% of cases. Delivery should occur in a specialized centre. In the
puerperium, renal function, proteinuria, blood pressure,
cyclosporine/tacrolimus blood levels and fluid balance should be closely
monitored.
----------------------------------------------------
[32]
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
----------------------------------------------------
[33]
TÍTULO / TITLE: - Are peritoneal dialysis
patients with and without residual renal function equivalent for survival
study? Insight from a retrospective review of the cause of death.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 May;18(5):977-82.
AUTORES
/ AUTHORS: - Szeto CC; Wong TY; Chow KM; Leung CB; Li
PK
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Prince of Wales
Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China. ccszeto@cuhk.edu.hk
RESUMEN
/ SUMMARY: - BACKGROUND: It remains unknown whether
results of survival studies in anuric patients can be extrapolated to those who
still have significant urine output. It is possible that after a prolonged
period on dialysis, anuric patients are qualitatively different from patients
with residual renal function. METHODS: We performed a retrospective review to
study the cause of death of 296 peritoneal dialysis patients of our centre over
a 7 year period, and compared the mortality and distribution of cause of death
between patients with and without residual renal function. RESULTS: One hundred
and forty-two cases (48.0%) died of vascular diseases, 82 cases (27.7%) died of
infections and 72 cases (24.3%) died of other causes. Anuric patients had a
higher overall mortality rate than non-anuric patients (14.9 vs 9.9%,
P=0.0005), and the difference was almost completely attributed to the
difference in mortality from vascular diseases (8.0 vs 4.1%, P<0.0001).
Vascular disease was a more common cause of death in anuric patients than those
with residual renal function (55.3 vs 40.8%, P=0.011). The difference was
largely explained by the higher prevalence of sudden cardiac death in anuric
patients (39 in 149 vs 19 in 147 cases). Patients without pre-existing
cardiovascular disease more commonly died of vascular disease after they became
anuric (47.4 vs 34.0%, P=0.017). The difference could not be explained by the
longer duration of dialysis in anuric patients because there was no significant
change in the distribution of cause of death with time on dialysis (chi-square
test, P=0.341). CONCLUSIONS: Our observation suggests that peritoneal dialysis
patients with and without residual renal function are qualitatively different.
Studies on peritoneal dialysis adequacy and survival in anuric patients should
only be extrapolated to the general dialysis population with caution.
----------------------------------------------------
[34]
TÍTULO / TITLE: - Cardiovascular disease
and the renal transplant recipient.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S36-43.
AUTORES
/ AUTHORS: - Kendrick E
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, University of
California—Los Angeles Medical Center, Los Angeles, CA 90095, USA. ekendrick@mednet.ucla.edu
RESUMEN
/ SUMMARY: - Cardiovascular complications contribute to
a significant proportion of the morbidity and mortality in renal transplant
patients. Underlying disease states such as diabetes and hypertension as well
as risk factors associated with chronic dialysis may cause many patients to
have established coronary artery and peripheral vascular disease at the time of
transplantation. Progression or new onset of disease can occur after
transplantation due to the continued presence of risk factors for
cardiovascular disease. The benefit of modification of these risk factors such
as hypertension and hyperlipidemia has been well established in the general
population and has more recently been explored in the renal transplant
population, although long-term studies documenting an improvement in morbidity
and mortality are not available. This article focuses on the potential benefit
of modification of risk factors in this setting. N. Ref:: 90
----------------------------------------------------
[35]
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
----------------------------------------------------
[36]
TÍTULO / TITLE: - Effect of
immunosuppressive treatment protocol on malignancy development in renal transplant
patients.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2133-5.
AUTORES
/ AUTHORS: - Haberal M; Moray G; Karakayali H; Emiroglu
R; Basaran O; Sevmis S; Demirhan B
INSTITUCIÓN
/ INSTITUTION: - Baskent University Faculty of Medicine,
Ankara, Turkey. melekk@baskent-ank.edu.tr
----------------------------------------------------
[37]
TÍTULO / TITLE: - Random sample (DOPPS)
versus census-based (registry) approaches to kidney disease research.
REVISTA
/ JOURNAL: - Blood Purif 2003;21(1):85-8.
AUTORES
/ AUTHORS: - Port FK; Wolfe RA; Held PJ; Young EW
INSTITUCIÓN
/ INSTITUTION: - University of Renal Research and Education
Association (URREA), Ann Arbor, Mich, USA. fport@urrea.org
RESUMEN
/ SUMMARY: - This review describes advantages and
limitations of registries that base their analyses on the census of all
patients. Registries may utilize the random sample approach to enrich their
data for more detailed and informative research. The Dialysis Outcomes and
Practice Pattern Study (DOPPS) and its random sample approach is discussed here
in detail, with examples on the value of this method. The DOPPS is currently
being expanded to allow for even more valuable studies. This methodology can
also be applied to large countries that do not have an existing registry, as it
is an effective way of collecting detailed information at a relatively low cost
that is representative of the country or population as a whole. N. Ref:: 12
----------------------------------------------------
[38]
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
----------------------------------------------------
[39]
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
----------------------------------------------------
[40]
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
----------------------------------------------------
[41]
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
----------------------------------------------------
[42]
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.
----------------------------------------------------
[43]
TÍTULO / TITLE: - Is kidney donation in
the donor’s best interest?
REVISTA
/ JOURNAL: - Transplantation 2003 Sep 15;76(5):753-4.
AUTORES
/ AUTHORS: - Ross LF
INSTITUCIÓN
/ INSTITUTION: - MacLean Center for Clinical Medical
Ethics, University of Chicago, Illinois, USA.
N. Ref:: 9
----------------------------------------------------
[44]
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
----------------------------------------------------
[45]
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
----------------------------------------------------
[46]
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
----------------------------------------------------
[47]
TÍTULO / TITLE: - Viral infections after
renal transplantation.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Apr;37(4):659-76.
AUTORES
/ AUTHORS: - Smith SR; Butterly DW; Alexander BD;
Greenberg A
INSTITUCIÓN
/ INSTITUTION: - Divisions of Nephrology and Infectious
Diseases, Duke University Medical Center, Durham, NC 27710, USA.
RESUMEN
/ SUMMARY: - Viral infections are a leading cause of
posttransplantation morbidity and mortality. A number of recent developments
have altered our understanding and management of these disorders. The
pathogenetic roles of several viruses, including human herpesviruses 6 and 8,
have been newly established. Molecular-based diagnostic tests now make more
rapid diagnosis possible. The licensing of new potent antiviral agents offers a
wider choice of drugs for viral prophylaxis and treatment. The use of more
potent immunosuppressive agents is responsible in part for the increasing
incidence of some viral infections, but this varies among drugs, and individual
viruses differ in their sensitivity to immunosuppressive agents. This review
summarizes the natural history, diagnosis, prevention, and treatment of many
common viral infections after renal transplantation. N. Ref:: 103
----------------------------------------------------
[48]
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
----------------------------------------------------
[49]
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
----------------------------------------------------
[50]
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
----------------------------------------------------
[51]
TÍTULO / TITLE: - The role of newer
monoclonal antibodies in renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2001
Feb-Mar;33(1-2):1000-1.
AUTORES
/ AUTHORS: - Vincenti F
INSTITUCIÓN
/ INSTITUTION: - University of California, San Francisco,
California, USA. N.
Ref:: 5
----------------------------------------------------
[52]
TÍTULO / TITLE: - Reliability of chronic
allograft nephropathy diagnosis in sequential protocol biopsies.
REVISTA
/ JOURNAL: - Kidney Int 2002 Feb;61(2):727-33.
AUTORES
/ AUTHORS: - Seron D; Moreso F; Fulladosa X; Hueso M;
Carrera M; Grinyo JM
INSTITUCIÓN
/ INSTITUTION: - Nephrology and Pathology Departments,
Hospital de Bellvitge, Universitat de Barcelona, L’Hospitalet, Barcelona,
España. 17664dsm@comb.es
RESUMEN
/ SUMMARY: - BACKGROUND: Chronic allograft nephropathy
(CAN) progresses rapidly during the first few months and slowly thereafter.
Although the presence of CAN in protocol renal biopsies is a predictor of
outcome, the reliability of this diagnosis according to Banff criteria has not
been characterized. METHODS: Renal lesions were evaluated according to the
Banff criteria in sequential protocol biopsies performed at 4 and 14 months in
310 biopsies obtained from 155 patients. RESULTS: CAN progressed from 40 to 53%
(P=0.001) while serum creatinine remained stable (146 +/- 44 vs. 147 +/- 48
micromol/L, P=NS). Graft survival in patients with and without CAN in the first
biopsy was 74 versus 91% (P < 0.05), and in the second biopsy 75 versus 94%
(P < 0.05). In 54 patients (35%) no CAN was present in both biopsies, 39
(25%) showed progression to CAN, 19 (12%) showed regression of CAN, and 43
(28%) showed CAN in both biopsies. Graft survival was: 100%, 81.6%, 82.6% and
69.4%, respectively (P < 0.01). Assuming that CAN does not regress and
sampling error is normally distributed, we estimated that 25% of biopsies
cannot be properly classified. CONCLUSIONS: The increase in the incidence of
CAN between the 4th and 14th month is lower than the
proportion of misclassified biopsies. Thus, monitoring the progression of CAN
by means of two sequential biopsies at 4 and 14 months is inaccurate. We
suggest that progression of scarring be monitored by means of a donor and a
protocol biopsy performed during the first year evaluated with a quantitative
approach.
----------------------------------------------------
[53]
TÍTULO / TITLE: - End-stage renal disease
survival in blacks and whites.
REVISTA
/ JOURNAL: - Am J Med Sci 2002 Feb;323(2):100-1.
AUTORES
/ AUTHORS: - Salem M
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
Mississippi Medical Center, Jackson 39216, USA. msalem@medicine.umsmed.edu N. Ref:: 15
----------------------------------------------------
[54]
TÍTULO / TITLE: - Strategies to reduce
toxicities and improve outcomes in renal transplant recipients.
REVISTA
/ JOURNAL: - Pharmacotherapy 2002 Mar;22(3):316-28.
AUTORES
/ AUTHORS: - Lo A; Alloway RR
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, University of
Cincinnati Medical Center, Ohio 45267-0585, USA.
RESUMEN
/ SUMMARY: - Ongoing improvements in immunosuppression
and posttransplantation care have dramatically improved patient and graft
outcomes after transplantation. The frequency of graft loss due to acute
rejection has declined considerably as a result of the availability of a
variety of more potent immunosuppressive agents and probably also because of
refined clinical care and follow-up. Complications of long-term administration
of corticosteroids (steroids) and calcineurin inhibitors, however, have become
increasingly apparent as patients live longer with their transplant, and
attention is shifting to long-term issues. Use of both steroids and calcineurin
inhibitors is associated with metabolic toxicities such as hypertension,
hyperlipidemia, diabetes, bone loss, and cataracts. These contribute to
posttransplantation morbidity and may negatively affect patient and allograft
survival. A variety of troublesome cosmetic side effects, such as hirsutism,
gingival hyperplasia, alopecia, obesity, and cushingoid appearance, also are
associated with these drugs. These effects can detract from patient self-esteem
and compliance with the immunosuppressive regimen. In the past 2 decades, the
introduction of second-generation immunosuppressive drugs, such as tacrolimus,
mycophenolate mofetil, sirolimus, and anti-interleukin-2 receptor monoclonal
antibodies, has provided some alternatives to classic immunosuppressant
choices. Patients experiencing undesirable adverse events now can be converted
to another immunosuppressive regimen that ultimately will improve graft and
patient survival rates and improve quality of life after transplantation. N. Ref:: 99
----------------------------------------------------
[55]
TÍTULO / TITLE: - An analysis of early
renal transplant protocol biopsies—the high incidence of subclinical tubulitis.
REVISTA
/ JOURNAL: - Am J Transplant 2001 May;1(1):47-50.
AUTORES
/ AUTHORS: - Shapiro R; Randhawa P; Jordan ML;
Scantlebury VP; Vivas C; Jain A; Corry RJ; McCauley J; Johnston J; Donaldson J;
Gray EA; Dvorchik I; Hakala TR; Fung JJ; Starzl TE
INSTITUCIÓN
/ INSTITUTION: - University of Pittsburgh, Thomas E. Starzl
Transplantation Institute, PA 15213, USA. shapiror@msx.upmc.edu
RESUMEN
/ SUMMARY: - To investigate the possibility that we
have been underestimating the true incidence of acute rejection, we began to
perform protocol biopsies after kidney transplantation. This analysis looks at
the one-week biopsies. Between March 1 and October 1, 1999, 100 adult patients
undergoing cadaveric kidney or kidney/pancreas transplantation, or living donor
kidney transplantation, underwent 277 biopsies. We focused on the subset of
biopsies in patients without delayed graft function (DGF) and with stable or
improving renal function, who underwent a biopsy 8.2+/-2.6 d (range 3-18 d)
after transplantation (n = 28). Six (21%) patients with no DGF and with stable
or improving renal function had borderline histopathology, and 7 (25%) had
acute tubulitis on the one-week biopsy. Of the 277 kidney biopsies, there was
one (0.4%) serious hemorrhagic complication, in a patient receiving low
molecular weight heparin; she ultimately recovered and has normal renal
function. Her biopsy showed Banff 1B tubulitis. In patients with stable or
improving renal allograft function early after transplantation, subclinical
tubulitis may be present in a substantial number of patients. This suggests
that the true incidence of rejection may be higher than is clinically appreciated.
----------------------------------------------------
[56]
TÍTULO / TITLE: - Tacrolimus: a further
update of its use in the management of organ transplantation.
REVISTA
/ JOURNAL: - Drugs 2003;63(12):1247-97.
AUTORES
/ AUTHORS: - Scott LJ; McKeage K; Keam SJ; Plosker GL
INSTITUCIÓN
/ INSTITUTION: - Adis International Limited, Auckland, New
Zealand. demail@adis.co.nz
RESUMEN
/ SUMMARY: - Extensive clinical use has confirmed that
tacrolimus (Prograf) is a key option for immunosuppression after
transplantation. In large, prospective, randomised, multicentre trials in
adults and children receiving solid organ transplants, tacrolimus was at least
as effective or provided better efficacy than cyclosporin microemulsion in
terms of patient and graft survival, treatment failure rates and the incidence
of biopsy-proven acute and corticosteroid-resistant rejection episodes.
Notably, the lower incidence of rejection episodes after renal transplantation
in tacrolimus recipients was reflected in improved cost effectiveness. In bone
marrow transplant (BMT) recipients, the incidence of tacrolimus grade II-IV
graft-versus-host disease was significantly lower with tacrolimus than
cyclosporin treatment. Efficacy was maintained in renal and liver transplant
recipients after total withdrawal of corticosteroid therapy from
tacrolimus-based immunosuppression, with the incidence of acute rejection
episodes at up to 2 years’ follow-up being similar with or without
corticosteroids. Tacrolimus provided effective rescue therapy in transplant
recipients with persistent acute or chronic allograft rejection or drug-related
toxicity associated with cyclosporin treatment. Typically, conversion to
tacrolimus reversed rejection episodes and/or improved the tolerability
profile, particularly in terms of reduced hyperlipidaemia. In lung transplant
recipients with obliterative bronchiolitis, conversion to tacrolimus reduced
the decline in and/or improved lung function in terms of forced expiratory volume
in 1 second. Tolerability issues may be a factor when choosing a calcineurin
inhibitor. Cyclosporin tends to be associated with a higher incidence of
significant hypertension, hyperlipidaemia, hirsutism, gingivitis and gum
hyperplasia, whereas the incidence of some types of neurotoxicity, disturbances
in glucose metabolism, diarrhoea, pruritus and alopecia may be higher with
tacrolimus treatment. Renal function, as assessed by serum creatinine levels
and glomerular filtration rates, was better in tacrolimus than cyclosporin
recipients at up to 5 years’ follow-up. CONCLUSION: Recent well designed trials
have consolidated the place of tacrolimus as an important choice for primary
immunosuppression in solid organ transplantation and in BMT. Notably, in adults
and children receiving transplants, tacrolimus-based primary immunosuppression
was at least as effective or provided better efficacy than cyclosporin
microemulsion treatment in terms of patient and graft survival, treatment
failure and the incidence of acute and corticosteroid-resistant rejection
episodes. The reduced incidence of rejection episodes in renal transplant
recipients receiving tacrolimus translated into a better cost effectiveness
relative to cyclosporin microemulsion treatment. The optimal immunosuppression
regimen is ultimately dependent on balancing such factors as the efficacy of
the individual drugs, their tolerability, potential for drug interactions and
pharmacoeconomic issues. N.
Ref:: 261
----------------------------------------------------
[57]
TÍTULO / TITLE: - Hepatitis C and renal
disease.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2429-31.
AUTORES
/ AUTHORS: - Van Thiel D; Nadir A; Shah N
INSTITUCIÓN
/ INSTITUTION: - Division of Gastroenterology and
Hepatology, Stritch School of Medicine, Loyola University of Chicago, Loyola
University Medical Center, Maywood, IL 60153, USA. dvanthi@lumc.edu N. Ref:: 23
----------------------------------------------------
[58]
TÍTULO / TITLE: - Cutaneous neoplasms in
renal transplant recipients.
REVISTA
/ JOURNAL: - Eur J Dermatol 2002 Nov-Dec;12(6):532-5.
AUTORES
/ AUTHORS: - Rubel JR; Milford EL; Abdi R
INSTITUCIÓN
/ INSTITUTION: - Renal Division, MRB-4, Brigham and Women’s
Hospital, 75 Francis Street, Boston, MA 02115, USA. jrubel@massmed.org
RESUMEN
/ SUMMARY: - Cutaneous neoplasms are much more common
in renal transplant recipients than in the general population, and are the most
common malignancies in these patients. This is the case with basal cell
carcinoma, and even more so with squamous cell carcinoma. Many risk factors for
development of such malignancies are similar to those in the general
population. However, in the transplant population, such cancers appear at an
earlier age, behave more aggressively, and frequently appear at multiple sites.
Therefore, diligence on the part of the patient and on the part of his or her
health care providers is of utmost importance. Treatment options include
reduction in immunosuppression, but preventive maintenance remains the primary
focus of efforts to limit these malignancies.
N. Ref:: 37
----------------------------------------------------
[59]
TÍTULO / TITLE: - Immunosuppression
protocols for HLA identical renal transplant recipients.
REVISTA
/ JOURNAL: - Transplant Proc 2003 May;35(3):1074-5.
AUTORES
/ AUTHORS: - Keitel E; Santos AF; Alves MA; Neto JP;
Schaefer PG; Bittar AE; Goldani JC; Pozza R; Bruno RM; See D; Garcia CD; Garcia
VD
INSTITUCIÓN
/ INSTITUTION: - Renal Transplant Unit, Santa Casa
Hospital, Porto Alegre, RS, Brazil. keitel@terra.com.br
----------------------------------------------------
[60]
TÍTULO / TITLE: - Contemporary immunosuppression
in renal transplantation.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):733-50.
AUTORES
/ AUTHORS: - Luke PP; Jordan ML
INSTITUCIÓN
/ INSTITUTION: - Departments of Surgery and Urology,
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
RESUMEN
/ SUMMARY: - Over the past 3 decades, renal allograft
survival has improved significantly as a result of the development of powerful
immunosuppressive agents. Nevertheless, the overall half-life of renal
allografts has increased marginally during that time period, owing to
drug-related nephrotoxicity and chronic rejection. New immunosuppressive agents
are being evaluated because of the need for a reduction in the dose of
nephrotoxic calcineurin inhibitors and corticosteroids. Additional agents have
demonstrated the ability to retard the onset of chronic rejection in
preclinical transplant models. In concert with these efforts, approaches are in
development to alleviate the ever increasing shortage of donor organs,
including the as yet unrealized goals of successful and practical
xenotransplantation and the bioartificial kidney. Further identification and
development of novel agents that target the specific components of the
allograft response will provide the key to the achievement of donor-specific
tolerance, the “Holy Grail” of solid organ transplantation. N. Ref:: 165
----------------------------------------------------
[61]
TÍTULO / TITLE: - Steroid-free
immunosuppression in kidney transplantation: an editorial review.
REVISTA
/ JOURNAL: - Am J Transplant 2002 Jan;2(1):19-24.
AUTORES
/ AUTHORS: - Hricik DE
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Case Western
Reserve University School of Medicine, University Hospitals of Cleveland, Ohio
44106, USA. deh5@po.cwru.edu N. Ref:: 33
----------------------------------------------------
[62]
TÍTULO / TITLE: - To what extent can
limiting cold ischaemia/reperfusion injury prevent delayed graft function?
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):1982-5.
AUTORES
/ AUTHORS: - Hauet T; Goujon JM; Vandewalle A N. Ref:: 38
----------------------------------------------------
[63]
TÍTULO / TITLE: - Sirolimus (Rapamune) in
renal transplantation.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002
Nov;11(6):603-7.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000040045.55337.97
AUTORES
/ AUTHORS: - Johnson RW
INSTITUCIÓN
/ INSTITUTION: - Manchester Postgraduate Health Sciences
Centre, Manchester Royal Infirmary, Manchester.
RESUMEN
/ SUMMARY: - There has been a necessary change in
attitude to transplantation; there is much less concern with short-term outcome
and more concern with long-term kidney function, overall health and quality of
life. Nephrotoxicity is an invariable consequence of long-term treatment with
calcineurin antagonists and it is one of the most underestimated causes of late
graft loss; it has been reported as a serious threat to both patient and graft
survival following heart, liver and bone marrow transplantation. Sirolimus has
been shown in many recent studies to be of great value in allowing patients to
be weaned from cyclosporine with excellent patient and graft survival at 24
months a significant improvement in renal function with resolution of hirsutism
and gum hyperplasia. Patients maintained on the combined regime of cyclosporine
and sirolimus had significantly higher blood pressure, much more cyclosporine
nephrotoxicity and hyperuricaemia at 12 months. The experimental studies have
found cyclosporine and sirolimus potentiate with each other’s good and adverse
effects. Cyclosporine therefore augments hyperlipidaemia caused by sirolimus,
and sirolimus augments nephrotoxicity caused by cyclosporine. The results of
these studies indicate that sirolimus is a suitable replacement for
cyclosporine or tacrolimus for long-term maintenance therapy. By contrast the
use of sirolimus in combination with cyclosporine results in potentiation of
side effects. The principal disadvantages being increased cyclosporine
associated nephrotoxicity and sirolimus associated hyperlipidaemia N. Ref:: 32
----------------------------------------------------
[64]
TÍTULO / TITLE: - Polyomavirus BK
nephropathy: a (re-)emerging complication in renal transplantation.
REVISTA
/ JOURNAL: - Am J Transplant 2002 Jan;2(1):25-30.
AUTORES
/ AUTHORS: - Hirsch HH
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine,
University of Basel, Switzerland. hans.hirsch@unibas.ch
RESUMEN
/ SUMMARY: - Persisting polyomavirus replication is now
widely recognized as a (re-)emerging cause of renal allograft dysfunction. Up
to 5% of renal allograft recipients can be affected about 40weeks (range 6-150)
post-transplantation. Progression to irreversible failure of the allograft has
been observed in up to 45% of all cases. The BK virus strain is involved in the
majority of the cases. Risk factors may include treatment of rejection episodes
and increasing viral replication under potent immunosuppressive drugs such as tacrolimus,
sirolimus or mycophenolate. The diagnosis requires the histological
demonstration of nuclear polyomavirus inclusions in affected tubular epithelial
cells. Interstitial inflammatory infiltrates and fibrosis become more prominent
in the persisting disease and may be difficult to distinguish from (coexisting)
rejection. Detection of polyomavirus-inclusion bearing cells (‘decoy cells’) in
the urine and quantification of BK virus DNA in the plasma have been proposed
as surrogate markers for polyomavirus replication and allograft disease,
respectively. Antiviral treatment is not yet established; however, reports of
treatment with cidofovir are encouraging. Current management aims at the
judicious modification and/or reduction of immunosuppression which, in view of
preceding or concurrent rejection, is not without risk. N. Ref:: 51
----------------------------------------------------
[65]
TÍTULO / TITLE: - Induction versus
non-induction protocols in anti-calcineurin-based immunosuppression.
REVISTA
/ JOURNAL: - Transplant Proc 2001
Nov-Dec;33(7-8):3334-6.
AUTORES
/ AUTHORS: - Charpentier B
INSTITUCIÓN
/ INSTITUTION: - Service de Nephrologie, University
Hospital of Bicetre, Bicetre, France.
----------------------------------------------------
[66]
TÍTULO / TITLE: - Nephrotoxicity of
immunosuppressive drugs: new insight and preventive strategies.
REVISTA
/ JOURNAL: - Curr Opin Crit Care 2001 Dec;7(6):384-9.
AUTORES
/ AUTHORS: - Olyaei AJ; de Mattos AM; Bennett WM
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Hypertension and
Clinical Pharmacology, Oregon Health Sciences University and Solid Organ and
Cellular Transplantation, Legacy Good Samaritan Hospital, Portland, Oregon
97201, USA. olyaeia@ohsu.edu
RESUMEN
/ SUMMARY: - Cyclosporine and tacrolimus reduce
allograft rejection, improve allograft half-life and patient survival.
Ironically, the nephrotoxicity of these agents may adversely affect allograft
survival in renal transplant recipients or cause end-stage renal diseases in
other solid organ and bone marrow transplant recipients. Acute dose-dependent
and chronic non-dose-dependent nephrotoxicity has been reported in both
transplant recipients and patients with autoimmune disorders. Preliminary evidence
suggests that drug therapeutic monitoring has little value in the diagnosis or
management of nephrotoxicity associated with calcineurin inhibitors. Although
the exact mechanism of nephrotoxicity is not fully understood, several factors
have been implicated in the pathogenesis of immunosuppressive-induced
nephrotoxicity. Renal and systemic vasoconstriction, increased release of
endothelin-1, decreased production of nitric acid and increased expression of
TGF-beta are the major adverse pathophysiologic abnormalities of these agents.
Reducing the dose of a calcineurin inhibitor, or using protocols without
calcineurin inhibition may ultimately minimize the risk of drug toxicity and
improve allograft and patient survival. New experiences with non-nephrotoxic agents
and protocols including mycophenolate and sirolimus allow for early calcineurin
inhibitor reduction or elimination without increasing the risk of allograft
rejection. N. Ref:: 55
----------------------------------------------------
[67]
TÍTULO / TITLE: - Rejection-free protocol
using sirolimus-tacrolimus combination for pediatric renal transplant
recipients.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Aug;34(5):1942-3.
AUTORES
/ AUTHORS: - El-Sabrout R; Weiss R; Butt F; Delaney V;
Qadir M; Hanson P; Butt K
INSTITUCIÓN
/ INSTITUTION: - Departments of Transplantation/Vascular
Surgery, New York Medical College, Valhalla, New York, USA.
----------------------------------------------------
[68]
TÍTULO / TITLE: - Immunosuppression in
elderly renal transplant recipients: are current regimens too aggressive?
REVISTA
/ JOURNAL: - Drugs Aging 2001;18(10):751-9.
AUTORES
/ AUTHORS: - Meier-Kriesche HU; Kaplan B
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
Florida, Gainesville, Florida 32610-0024, USA.
RESUMEN
/ SUMMARY: - Renal transplantation is an accepted and
successful treatment modality in elderly patients with end-stage renal disease.
In comparison with maintenance dialysis, transplantation has been shown to
confer a mortality benefit as well as improvements in quality of life in older
individuals with end-stage renal disease. Despite this, overall outcomes of
renal transplantation in elderly individuals have, in general, been less
successful than those of younger renal transplant recipients. Largely, this has
been due to the particular vulnerability of elderly patients to the
immunosuppressive medications used in renal transplantation. This review
article covers these issues in some detail and briefly discusses some of the
pharmacokinetic, pharmacodynamic, physiological and immunological differences
between younger and older transplant recipients. Elderly renal transplant
recipients have both a higher rate of patient death and allograft loss censored
for death. Upon multivariate analysis, age of the recipient is strongly
associated with allograft loss independent of other known factors. Acute
rejections are less frequent in older individuals; however the consequence of a
rejection if it occurs is negative for long-term graft survival. On the other
hand, death by infection is vastly increased in older versus younger renal
transplant recipients. In general, the pharmacokinetics of the
immunosuppressive agents are little affected by age, but the tolerance to these
agents seems to decrease with increasing age. Elderly renal transplant
recipients present a very difficult clinical challenge. As the elderly become
an ever-increasing segment of the renal transplant population, new and
innovative immunosuppressive strategies will have to be considered and
applied. N. Ref:: 75
----------------------------------------------------
[69]
TÍTULO / TITLE: - A case of traumatic
renal graft rupture with salvage of renal function.
REVISTA
/ JOURNAL: - Clin Transplant 2001 Aug;15(4):289-92.
AUTORES
/ AUTHORS: - Akabane S; Ushiyama T; Hirano Y; Ishikawa
A; Suzuki K; Fujita K
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, Hamamatsu
University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka 431-3192,
Japan.
RESUMEN
/ SUMMARY: - An 18-yr-old man received a kidney graft
from a 60-yr-old female cadaver donor on February 8, 1996. Postoperative course
was uneventful and his serum creatinine level was stable at about 1.8 mg/dL. On
April 30, 1999, he collided with a truck while riding a motor cycle.
Macroscopic hematuria was observed and CT showed an extensive retroperitoneal
hematoma. Because his anemia and hypotension were becoming worse after
transfusion of 9 units of blood, he was operated on as an emergency case. A
large rupture reaching the pelvis and calyces was observed in the upper pole of
the grafted kidney. There were also numerous shallow lacerations, but the major
arteries and veins were not injured. The rupture was closed by suturing the
renal parenchyma with the peritoneum, and the other shallow lacerations were
closed by suturing the renal capsule. The kidney could be salvaged without
requiring hemodialysis. The serum creatinine was maintained at 2.1 mg/dL during
follow-up. A review of the literature showed that 6 cases of traumatic renal
graft rupture with salvage of the kidney have been reported. Our present case
was the seventh, and was the most severe graft rupture reported so far. N. Ref:: 7
----------------------------------------------------
[70]
TÍTULO / TITLE: - Place of mycophenolate
mofetil in renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2001
Feb-Mar;33(1-2):997-9.
AUTORES
/ AUTHORS: - Grinyo JM
INSTITUCIÓN
/ INSTITUTION: - Hospital de Bellvitge, Barcelona,
España. N. Ref:: 23
----------------------------------------------------
[71]
TÍTULO / TITLE: - Polyomavirus BK.
REVISTA
/ JOURNAL: - Lancet Infect Dis 2003 Oct;3(10):611-23.
AUTORES
/ AUTHORS: - Hirsch HH; Steiger J
INSTITUCIÓN
/ INSTITUTION: - Division of Infectious Diseases,
Department of Internal Medicine, University Hospitals Basel, and
Transplantation Virology Laboratory, Institute of Medical Microbiology,
University of Basel, Switzerland. hans.hirsch@unibas.ch
RESUMEN
/ SUMMARY: - Polyomavirus hominis 1, better known as BK
virus (BKV), infects up to 90% of the general population. However, significant
clinical manifestations are rare and limited to individuals with impaired
immune functions. BKV has been associated with diverse entities such as
haemorrhagic cystitis, ureteric stenosis, vasculopathy, pneumonitis,
encephalitis, retinitis, and even multi-organ failure. In addition, BKV has
been implicated in autoimmune disease and possibly cancer. Due to high
prevalence and frequent reactivation, the role of BKV in some of these
pathologies has been difficult to define. Development of BKV diseases is likely
to require complementing determinants in the host, the target organ, and
possibly the virus, that are subject to modulators such as immunosuppression.
These complex aspects are highlighted in polyomavirus-associated nephropathy
(PAN), an emerging disease in renal allograft recipients that may jeopardise
the progress in renal transplantation accomplished in the past 10 years.
Intervention is difficult due to the lack of specific antivirals and relies
mostly on improving immune control. Diagnostic strategies using urine cytology
and BKV load measurements in plasma have led to earlier diagnosis of PAN, which
increased the success rate of intervention. Case series suggest that cidofovir
might be effective, especially when combined with reduced
immunosuppression. N.
Ref:: 156
----------------------------------------------------
[72]
TÍTULO / TITLE: - Hepatitis B virus and
renal transplantation.
REVISTA
/ JOURNAL: - Nephron 2002 Mar;90(3):241-51.
AUTORES
/ AUTHORS: - Fabrizi F; Martin P; Ponticelli C N. Ref:: 91
----------------------------------------------------
[73]
TÍTULO / TITLE: - African Americans and
renal transplantation: disproportionate need, limited access, and impaired
outcomes.
REVISTA
/ JOURNAL: - Am J Med Sci 2002 Feb;323(2):94-9.
AUTORES
/ AUTHORS: - Young CJ; Gaston RS
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, University of Alabama at Birmingham, 35294-0006, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Renal transplantation is the
therapy of choice for patients with end-stage renal disease (ESRD). However,
African Americans’ (AA) access to this modality is not commensurate with that
of other races. This imbalance, coupled with AA disproportionately representing
those with ESRD, has kept AA disadvantaged compared with other races,
especially whites. METHODS: We reviewed published reports that examined the
connection between race and the incidence of chronic renal failure, access to
optimal therapy, and outcomes of renal transplantation. RESULTS: The incidence
of ESRD in AA is 4 times greater than in whites, but AA remain less likely than
whites to be referred for or undergo renal transplantation. Also, AA are at
greater risk than whites to experience premature graft failure. CONCLUSIONS:
ESRD management has improved dramatically with the advent of successful renal
transplantation. However, AA remain significantly disadvantaged in both access
and outcomes compared with whites. Further evaluation of underlying causes and
development of specific remedies is warranted.
N. Ref:: 81
----------------------------------------------------
[74]
TÍTULO / TITLE: - Hepatitis C virus and
renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2433-5.
AUTORES
/ AUTHORS: - Van Thiel D; Nadir A; Shah N
INSTITUCIÓN
/ INSTITUTION: - Division of Gastroenterology and
Hepatology, Stritch School of Medicine, Loyola University of Chicago, Loyola
University Medical Center, Maywood, Illinois 60153, USA. dvanthi@lumc.edu N. Ref:: 22
----------------------------------------------------
[75]
TÍTULO / TITLE: - Hyperlipidemia and
graft loss.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2423-5.
AUTORES
/ AUTHORS: - Stephan A; Barbari A; Karam A; Kilani H;
Kamel G; Masri A
INSTITUCIÓN
/ INSTITUTION: - Nephrology and Transplantation Unit, Rizk
Hospital, Beirut, Lebanon. lird@cyberia.net.lb N. Ref:: 30
----------------------------------------------------
[76]
TÍTULO / TITLE: - Hepatitis C and the
incidence of diabetes mellitus after renal transplant: influence of new
immunosuppression protocols.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Aug;35(5):1748-50.
AUTORES
/ AUTHORS: - Gentil MA; Lopez M; Gonzalez-Roncero F;
Rodriguez-Algarra G; Pereira P; Lopez R; Martinez M; Toro J; Mateos J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Hospital
Universitario Virgen del Rocio, Sevilla, España.
RESUMEN
/ SUMMARY: - BACKGROUND: Hepatitis C has been
associated with an increased incidence of diabetes mellitus (DM) following
renal transplantation (RT). METHODS: Patients who underwent RT between 1985 and
2001 were excluded if they showed DM prior to RT, graft survival of less than
90 days, and unknown anti-HCV status (n=15). Two groups (G1 and G2) were
distinguished according to the immunosuppressive regimen: G1 (transplanted
1985-1996) received steroids, azathioprine, and cyclosporine (n=330), whereas
G2 (1997-2000) received new drugs in several combinations (MMF in 87% and/or
tacrolimus in 35% [n=240]). Patients with HCV antibodies pre- and/or post-RT
were considered HCV-positive. Post-RT DM requiring prolonged treatment with
oral antidiabetics or insulin (>1 month) was assessed using Kaplan-Meier
curves and Cox analysis. RESULTS: G2 patients were significantly older, had a
greater body mass index (BMI), and suffered significantly less from acute
rejection episodes during the first year than G1 patients. Furthermore, fewer
required maintenance steroids. HCV-positivity was more common in G1 than in G2
(n=96, 29.1% vs n=27, 11.3%). Six G2 patients were successfully treated with
interferon pre-RT, achieving negative PCR-HCV status (maintained post-RT). DM
incidence at 4 years was similar in G1 and G2 (8.8% and 8.2%). G1 HCV-positive
patients showed a greater risk of developing DM than HCV-negative patients
(28.0% vs 6.2% at 10 years; P=001). In G1, multivariate analysis showed that
age, BMI, and HCV-positivity were significant risk factors predicting DM
(relative risk, 5.7; 95% confidence interval 2.7-12). In G2 patients, HCV was
not associated with an increased risk of DM; in the multivariate analysis only
age appeared to be a risk factor. CONCLUSIONS: The reported relationship
between hepatitis C and post-RT DM was not observed among patients receiving
new immunosuppressive treatments. Confirmation of this finding requires
extended follow up. The reduced use of steroids and effective pre-RT use of
interferon may also be responsible for the benefit.
----------------------------------------------------
[77]
TÍTULO / TITLE: - Polyomavirus in kidney
and kidney-pancreas transplantation: a defined protocol for immunosuppression
reduction and histologic monitoring.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Aug;34(5):1788-9.
AUTORES
/ AUTHORS: - Trofe J; Cavallo T; First MR; Weiskittel
P; Peddi VR; Roy-Chaudhury P; Alloway RR; Safdar S; Buell JF; Hanaway MJ;
Woodle ES
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, The University of Cincinnati, 231 Albert Sabin Way,
Cincinnati, OH 45267-0558, USA.
----------------------------------------------------
[78]
TÍTULO / TITLE: - Causes of death 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 Aug;16(8):1545-9.
AUTORES
/ AUTHORS: - Briggs JD
N. Ref:: 24
----------------------------------------------------
[79]
TÍTULO / TITLE: - Long-term allograft
surveillance: the role of protocol biopsies.
REVISTA
/ JOURNAL: - Curr Opin Urol 2001 Mar;11(2):133-7.
AUTORES
/ AUTHORS: - Nickerson P; Jeffery J; Rush D
INSTITUCIÓN
/ INSTITUTION: - Section of Nephrology, Department of
Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
RESUMEN
/ SUMMARY: - The safety of the renal allograft biopsy
and the standardization of allograft histopathology interpretation have renewed
interest in the performance of protocol (surveillance) biopsies. Recent
surveillance biopsy studies in the areas of pre-implantation and in the early
and late post-transplant periods are discussed. N. Ref:: 40
----------------------------------------------------
[80]
TÍTULO / TITLE: - Chronic graft
dysfunction: donor factors.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Aug;33(5):2695-8.
AUTORES
/ AUTHORS: - Barbari A; Stephan A; Masri MA; Kamel G;
Kilani H; Barakeh A
INSTITUCIÓN
/ INSTITUTION: - Nephrology and Transplantation Unit at
Rizk Hospital, Beirut, Lebanon. N.
Ref:: 68
----------------------------------------------------
[81]
TÍTULO / TITLE: - Anti-interleukin-2
receptor antibodies for the prevention of rejection in pediatric renal
transplant patients: current status.
REVISTA
/ JOURNAL: - Paediatr Drugs 2003;5(10):699-716.
AUTORES
/ AUTHORS: - Swiatecka-Urban A
INSTITUCIÓN
/ INSTITUTION: - Department of Physiology, Dartmouth
Medical School, Hanover, New Hampshire 03755, USA. Agnieszka.Swiatecka-Urban@Dartmouth.edu
RESUMEN
/ SUMMARY: - The anti-interleukin-2 receptor
(anti-IL-2R) antibody therapy is an exciting approach to the prevention of
acute rejection after renal allograft transplantation whereby immunosuppression
is exerted by a selective and competitive inhibition of IL-2-induced T cell
proliferation, a critical pathway of allorecognition. The anti-IL-2R antibodies
specifically block the alpha-subunit of the IL-2R on activated T cells, and
prevent T cell proliferation and activation of the effector arms of the immune
system. The anti-IL-2R antibodies are used as induction therapy, immediately
after renal transplantation, for prevention of acute cellular rejection in
children and adults. During acute rejection, the IL-2Ralpha chain is no longer
expressed on T cells; thus, the antibodies cannot be used to treat an existing
acute rejection. Two anti-IL-2R monoclonal antibodies are currently in clinical
use: daclizumab and basiliximab. In placebo-controlled phase III clinical
trials in adults, daclizumab and basiliximab in combination with calcineurin
inhibitor-based immunosuppression, significantly reduced the incidence of acute
rejection and corticosteroid-resistant acute rejection without increasing the
risk of infectious or malignant complications, and neither antibody was
associated with the cytokine-release syndrome. Children who receive calcineurin
inhibitors and corticosteroids for maintenance immunosuppression, as well as
children who receive augmented immunosuppression to treat acute rejection, are
at increased risk of growth impairment, hypertension, hyperlipidemia,
lymphoproliferative disorders, diabetes mellitus, and cosmetic changes. In
older children, the cosmetic adverse effects frequently reduce compliance with
the treatment, and subsequently increase the risk of allograft loss. Being
effective and well tolerated in children, the anti-IL-2R antibodies reduce the
need for calcineurin inhibitors while maintaining the overall efficacy of the
regimen; thus, the anti-IL-2R antibodies increase the safety margin (less
toxicity, fewer adverse effects) of the baseline immunosuppression. Secondly,
the anti-IL-2R antibodies decrease the need for corticosteroids and muromonab
CD3 (OKT3) in children as a result of decreased incidence of acute rejection.
The recommended pediatric dose of daclizumab is 1 mg/kg intravenously every 14
days for five doses, with the first dose administered within 24 hours
pre-transplantation. This administration regimen maintains daclizumab levels
necessary to completely saturate the IL-2Ralpha (5-10 microg/mL) in children
for at least 12 weeks.The recommended pediatric dose of basiliximab for
recipients <35 kg is 10 mg, and 20 mg for recipients > or =35 kg, intravenously
on days 0 and 4 post-transplantation. This administration regimen maintains
basiliximab levels necessary to completely saturate the IL-2Ralpha (>0.2
microg/mL) in children for at least 3 weeks.
N. Ref:: 88
----------------------------------------------------
[82]
TÍTULO / TITLE: - Pharmacotherapeutic
approach to prevent or treat chronic allograft nephropathy.
REVISTA
/ JOURNAL: - Curr Drug Targets Cardiovasc Haematol
Disord 2002 Dec;2(2):79-96.
AUTORES
/ AUTHORS: - Scholten EM; de Fijter JW; Paul LC
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Leiden
University Medical Center, 2300 RC Leiden, The Netherlands.
RESUMEN
/ SUMMARY: - In the current paper we will review the
evidence that drug therapy may be of value to prevent or treat chronic
allograft nephropathy. We will review the immunosuppressive therapy and
non-immune therapies in use to treat risk factors associated with chronic
allograft nephropathy and evaluate their efficacy with respect to long term
outcome as well as their effect on markers of long-term survival. In the last
part of this review, we will indicate possible benefits of new approaches being
explored but most of these data are obtained in in vitro test systems and
rodent models. N.
Ref:: 147
----------------------------------------------------
[83]
TÍTULO / TITLE: - Fungal infections in
solid organ transplant patients.
REVISTA
/ JOURNAL: - Surg Infect (Larchmt) 2003
Fall;4(3):263-71.
●●
Enlace al texto completo (gratuito o de pago) 1089/109629603322419607
AUTORES
/ AUTHORS: - Hagerty JA; Ortiz J; Reich D; Manzarbeitia
C
INSTITUCIÓN
/ INSTITUTION: - Albert Einstein Medical Center,
Philadelphia, Pennsylvania 19141, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Solid organ transplantation is
becoming increasingly more common in the treatment of end-stage organ failure.
Opportunistic fungal infections are a frequent life-threatening complication of
transplantation. MATERIALS AND METHODS: In this article, a review of the
infections in the different organ transplant recipients is presented. RESULTS:
The incidence of fungal infections in organ transplant patients ranges from 2%
to 50% depending on the type of organ transplanted, kidney recipients being the
least frequent and liver recipients having the highest rate of infection. New
antifungal medications and immunosuppressants have changed the spectrum of
fungal treatment and prevention. CONCLUSION: Prompt recognition and treatment
of infection is imperative for successful therapy. Further advancements in
early detection and the development of less toxic medications will lead to
refinements in the treatment of fungal infections. N. Ref:: 66
----------------------------------------------------
[84]
TÍTULO / TITLE: - Use of basiliximab and
daclizumab in kidney transplantation.
REVISTA
/ JOURNAL: - Prog Transplant 2001 Mar;11(1):33-7; quiz
38-9.
AUTORES
/ AUTHORS: - Olyaei AJ; Thi K; deMattos AM; Bennett WM
INSTITUCIÓN
/ INSTITUTION: - Oregon Health Sciences University,
Portland, Ore., USA.
RESUMEN
/ SUMMARY: - Kidney transplantation represents a major
medical victory in patients with whom dialysis and medical therapy have failed.
To increase survival rates and optimize the use of limited organs, both patient
care and immunosuppression therapy must be improved. Reduction in rejection
episodes or severity of rejection may ultimately improve long-term allograft
survival. Traditional engineered monoclonal antibodies have been associated
with severe cytokine release reactions and an increased risk of opportunistic
infections. Basiliximab and daclizumab are chimeric and humanized monoclonal
antibodies which inhibit thymus-dependent lymphocyte proliferation.
Interleukin-2 also affects the proliferation of natural killer cells,
macrophages and monocytes, bursa-equivalent lymphocytes, epidermal dendritic
cells, and lymphokine-activated killer cells. Interleukin-2 receptor
antagonists have been shown to reduce the incidence of acute rejection without
increasing the incidence of opportunistic infections or malignancy. Further
studies are needed to evaluate the overall effect of these agents on long-term
patient and allograft survival. N.
Ref:: 28
----------------------------------------------------
[85]
TÍTULO / TITLE: - At-home self-care of
patients of long-term survival after renal transplantation: a survey of current
status.
REVISTA
/ JOURNAL: - Di Yi Jun Yi Da Xue Xue Bao 2002
Jan;22(1):86-7.
AUTORES
/ AUTHORS: - Wang JX; Shi HM
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Transplantation,
Nanfang Hospital, First Military Medical University, Guangzhou 510515.
RESUMEN
/ SUMMARY: - OBJECTIVE: To understand the current
status of at-home self-care implemented by patients with renal transplantation
of long-term survival, so as to provide the patients with adequate professional
advice and follow-up care after discharge from hospital. METHOD: A survey was
conducted in 248 patients who survived for over 3 years with functioning
transplanted kidneys by utilizing a self-designed questionnaire. RESULTS: The
at-home self-care was generally not well practiced by the patients with
apparent lack of self-care awareness and abilities. Though the current status
problematic, the survey showed that 96.32% of the patients wished to be informed
about self-care knowledge and skills. CONCLUSION: The patients currently lack
at-home self-care abilities and the medical staff should carefully design
self-care plans tailored to the needs of individual patient to improve the
survival of the patients and the transplanted kidneys as well.
----------------------------------------------------
[86]
TÍTULO / TITLE: - Treatment and
prevention of cytomegalovirus in renal transplant patients: weighing the
evidence.
REVISTA
/ JOURNAL: - CANNT J 2003 Jul-Sep;13(3):69-73; quiz
74-5.
AUTORES
/ AUTHORS: - Hakkert A; Dykeman-Sharpe J
INSTITUCIÓN
/ INSTITUTION: - Dalhousie University, Halifax, Nova
Scotia. N. Ref:: 37
----------------------------------------------------
[87]
TÍTULO / TITLE: - Post-transplant
diabetes: incidence, relationship to choice of immunosuppressive drugs, and
treatment protocol.
REVISTA
/ JOURNAL: - Adv Ren Replace Ther 2001 Jan;8(1):64-9.
AUTORES
/ AUTHORS: - Markell MS
INSTITUCIÓN
/ INSTITUTION: - Division of Transplant Nephrology, State
University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA. mmarkell@hscbklyn.edu
RESUMEN
/ SUMMARY: - Post-transplant diabetes mellitus (PTDM)
is one of the feared complications of immunosuppressive therapy. Despite
advances, including the introduction of the steroid-sparing calcineurin
inhibitors, cyclosporine and tacrolimus, the incidence rate remains greater
than 10% to 30%, especially in minority populations. PTDM increases the subsequent
risk of both graft loss and patient death, and predisposes patients to all
complications of diabetes, including retinopathy and neuropathy. Patients
should be monitored closely, especially during the first 3 months
post-transplant, and treated aggressively, should glucose intolerance be
detected. Minimization of immunosuppression dose, diet, oral hypoglycemic
agents, and insulin have all been used in the treatment of PTDM, however, the
insulin-sensitizing agents have not been studied. It is hoped that newer
immunosuppressive regimens and, ultimately, the ability to achieve tolerance
will eventually solve the problem of PTDM.
N. Ref:: 53
----------------------------------------------------
[88]
TÍTULO / TITLE: - Sirolimus: a
comprehensive review.
REVISTA
/ JOURNAL: - Expert Opin Pharmacother 2001
Nov;2(11):1903-17.
AUTORES
/ AUTHORS: - Kahan BD
INSTITUCIÓN
/ INSTITUTION: - Division of Immunology and Organ
Transplantation, University of Texas-Houston, 6431 Fannin, Suite 6.240,
Houston, TX 77030, USA. barry.d.kahan@uth.tmc.edu
RESUMEN
/ SUMMARY: - Sirolimus (Rapamune), Wyeth-Ayerst,
Madison, NJ) is a new, potent, immunosuppressant that is emerging as a
foundation for long-term immunosuppressive therapy in renal transplantation.
The drug acts during both co-stimulatory activation and cytokine-driven
pathways via a unique mechanism: inhibition of a multifunctional
serine-threonine kinase, mammalian target of rapamycin (mTOR). Although there
is no a priori reason to assume it, sirolimus displays a synergistic
interaction to enhance the efficacy of cyclosporin A (CsA). In trials wherein
the concentrations of CsA and sirolimus were tightly controlled, rates of acute
rejection episodes were < 10%, despite markedly reduced exposures to each
agent. In pivotal multi-centre blinded dose-controlled trials, the rates of
acute rejection episodes within 12 months following administration of 2 or 5
mg/day sirolimus in combination with CsA and steroids were reduced to 19 and
14%, respectively. Since the inhibitory effect of sirolimus disables virtually
all responses to cytokine mediators due to the widespread involvement of mTOR
in multiple signalling pathways, the agent is likely also to retard
proliferation of endothelial and vascular smooth muscle cells, an important
component of the immuno-obliterative processes associated with chronic
rejection. The advantages of this unique therapeutic action combined with an
intrinsic lack of nephrotoxicity are counterbalanced by myelosuppressive and
hyperlipidaemic side effects. Ongoing studies are assessing whether the
long-term benefits of sirolimus to permit reduction in exposure to or
elimination of calcineurin inhibitors ameliorate the progression of chronic
nephropathy, the condition that erodes long-term renal transplant
survival. N. Ref:: 108
----------------------------------------------------
[89]
TÍTULO / TITLE: - New developments in
immunosuppressive therapy in renal transplantation.
REVISTA
/ JOURNAL: - Expert Opin Biol Ther 2002
Jun;2(5):483-501.
AUTORES
/ AUTHORS: - Gourishankar S; Turner P; Halloran P
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and Immunology,
University of Alberta, Edmonton, Canada. gsita@hotmail.com
RESUMEN
/ SUMMARY: - The introduction of new immunosuppressive
agents and protocols has improved outcomes for renal transplant recipients by
decreasing the risk of rejection and by increasing the function and lifespan of
the allograft. This article reviews the major changes in the combinations of
therapies used: calcineurin inhibitors, target of rapamycin inhibitors,
mycophenolate mofetil, non-depleting monoclonal versus depleting monoclonal and
polyclonal antibodies for induction and increasing emphasis on protocols for
reduction or avoidance of steroids and calcineurin inhibitors. The new agents
with novel immunological targets such as anti-CD40 ligand, LEA29Y, FTY720,
anti-CD20 (rituximab, Rituxan, Mabthera) and anti-CH52 (alemtuzumab, Campath), which
are under development but have yet to survive the rigors of clinical trials are
also discussed. In the presence of low early rejection rates, immunosuppressive
therapy is setting new goals such as better graft function (glomerular
filtration rates), reduction in adverse effects such as hypertension,
hyperlipidaemia and drug toxicity and, above all, the prevention of late graft
deterioration. N.
Ref:: 156
----------------------------------------------------
[90]
TÍTULO / TITLE: - Historical overview of
the use of cytomegalovirus hyperimmune globulin in organ transplantation.
REVISTA
/ JOURNAL: - Transpl Infect Dis 2001;3 Suppl 2:6-13.
AUTORES
/ AUTHORS: - Snydman DR
INSTITUCIÓN
/ INSTITUTION: - Division of Geographic Medicine and
Infectious Diseases, New England Medical Center, Boston, Massachusetts 02111,
USA. dsnydman@lifespan.org
RESUMEN
/ SUMMARY: - A historical review of the development of
cytomegalovirus hyperimmune globulin (CMV-IG, CytoGam) shows its increasing use
in solid organ transplant (SOT) recipients, either alone or in combination with
ganciclovir. A review of clinical trials of CytoGam in renal transplant
recipients shows reductions in CMV-associated syndromes and fungal and
parasitic superinfections, and increases in graft survival, while CytoGam
prophylaxis trials in orthotopic liver transplant (OLT) recipients have
produced reductions in severe CMV-associated disease and invasive fungal
disease. A combination of CytoGam plus ganciclovir in OLT recipients has
resulted in reductions in CMV hepatitis and infection, and CMV disease and
viremia, plus a trend in improved 1- and 2-year survival rates. N. Ref:: 18
----------------------------------------------------
[91]
TÍTULO / TITLE: - Use of sirolimus in
kidney transplantation.
REVISTA
/ JOURNAL: - Prog Transplant 2001 Mar;11(1):29-32.
AUTORES
/ AUTHORS: - Podbielski J; Schoenberg L
INSTITUCIÓN
/ INSTITUTION: - University of Texas Medical School at
Houston, Houston, Tex., USA.
RESUMEN
/ SUMMARY: - Sirolimus, which has a distinctive
mechanism of action that inhibits cytokine-driven cell proliferation and
maturation, provides an exciting addition to the immunosuppressive regimen for
organ transplantation. A significant decrease in the number and severity of
rejection episodes has been noted when sirolimus is used; it also offers the
potential for patients to be withdrawn from steroids, making kidney
transplantation an option for many more potential recipients. Toxic conditions
such as hyperlipidemia, thrombocytopenia, and leukopenia become transient and
manageable with reduction of the sirolimus dose and/or countermeasure
therapy. N. Ref:: 9
----------------------------------------------------
[92]
TÍTULO / TITLE: - Varicella vaccination
in pediatric kidney transplant candidates.
REVISTA
/ JOURNAL: - Pediatr Transplant 2002 Apr;6(2):97-100.
AUTORES
/ AUTHORS: - Furth SL; Fivush BA
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, the Welch Center
for Prevention, Epidemiology and Clinical Research, The Johns Hopkins Medical
Institutions, Baltimore, Maryland, USA. sfurth@jhmi.edu
RESUMEN
/ SUMMARY: - Existing studies support the use of
varicella vaccine in a two-dose regimen in patients with renal disease prior to
transplantation. Levels of anti-varicella zoster virus antibody should be
monitored on a regular basis after immunization, and where a loss of a
previously protective antibody titer occurs, a third booster dose should be
considered pretransplant. Further data need to be collected regarding the use
of the vaccine in seronegative patients who have already undergone
transplantation. N.
Ref:: 22
----------------------------------------------------
[93]
TÍTULO / TITLE: - Death with functioning
graft—a preventable cause of graft loss.
REVISTA
/ JOURNAL: - Ann Transplant 2001;6(4):17-20.
AUTORES
/ AUTHORS: - Evenepoel P; Vanrenterghem Y
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of
Nephrology, University Hospital Leuven, Leuven, Belgium. Pieter.Evenepoel@uz.kuleuven.ac.be
RESUMEN
/ SUMMARY: - Patient death continues to be a leading
cause of renal transplant failure. This mortality of transplant patients is
mainly due to cardiovascular disease (CVD). Identification of predictions of
early CVD may provide targets for intervention. N. Ref:: 45
----------------------------------------------------
[94]
TÍTULO / TITLE: - Transplanting kidneys
from donors with prior hepatitis B infection: one response to the organ
shortage.
REVISTA
/ JOURNAL: - J Nephrol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jnephrol.com/
●●
Cita: Journal of Nephrology: <> 2002 Nov-Dec;15(6):605-13.
AUTORES
/ AUTHORS: - Fabrizio F; Bunnapradist S; Martin P
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Dialysis and
Transplantation, Maggiore Hospital, Policlinico IRCCS, Milano, Italy. fabrizi@policlinico.mi.it
RESUMEN
/ SUMMARY: - While the number of cadaveric organ donors
remains relatively stable, the number of patients awaiting transplantation
continues to increase, creating a shortage of donor organs. To address this
imbalance, there is interest in transplanting organs formerly considered
marginal or undesirable. Thus, more organs are currently transplanted from
living donors, older donors, hemodynamically unstable donors, non-heart-beating
donors and donors with markers of prior hepatitis B virus (HBV) infection. A
large number (up to 93.8%) of liver transplant seronegative recipients from
anti-HBc antibody positive donors have acquired HBsAg after liver
transplantation in the absence of immunoprophylaxis. Based on experience in
liver transplantation programs, transmission of HBV from donors without HBsAg
but with antibody to HBV core antigen (anti-HBc), although conventionally
defined as evidence of resolved infection, can have adverse consequences on
both graft and recipient. On the contrary, HBV appears to be in-frequently
transmitted from HBsAg negative/anti-HBcAb positive kidney donors: the
incidence of de novo HBsAg seropositivity after renal transplantation ranges
between 0 and 5.2%. A significantly higher incidence of anti-HBc antibody
seroconversion (without developing HBsAg) after renal transplantation with
anti-HBc antibody positive donors was seen. However, anti-HBc antibody positive
renal allografts should be considered, especially for recipients who have been
successfully immunized with HBV vaccine. Prospective long-term studies are in
progress to assess the risk of de novo HBV infection (HBsAg seroconversion) in
renal transplant recipients who have not been successfully immunized with
vaccine against HBV. N.
Ref:: 58
----------------------------------------------------
[95]
TÍTULO / TITLE: - Health related quality
of life (HRQOL) in the elderly on renal replacement therapy.
REVISTA
/ JOURNAL: - J Nephrol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jnephrol.com/
●●
Cita: Journal of Nephrology: <> 2002 May-Jun;15(3):220-4.
AUTORES
/ AUTHORS: - Ortega F; Rebollo P
INSTITUCIÓN
/ INSTITUTION: - Institute Reina Sofia de Investigacion
Nefrologica, Renal Foundation Inigo Alvarez de Toledo Renal Unit, Asturias
Central Hospital, Oviedo, España. fortega@hca.es
RESUMEN
/ SUMMARY: - Various opinions have been presented about
the influence of age on the health-related quality of life (HRQOL) of patients
on renal replacement therapy (RRT). Some authors sustain that age worsens
HRQOL, while others show the opposite. It has been seen that a psychological
adjustment occurs with aging, even when chronic illness is also present. In
addition, elderly patients appear to adapt better to RRT than younger ones. N. Ref:: 42
----------------------------------------------------
[96]
TÍTULO / TITLE: - The UNOS renal
transplant registry.
REVISTA
/ JOURNAL: - Clin Transpl 2001;:1-18.
AUTORES
/ AUTHORS: - Cecka JM
INSTITUCIÓN
/ INSTITUTION: - UCLA Immunogenetics Center, Department of
Pathology, UCLA School of Medicine, Los Angeles, California, USA.
RESUMEN
/ SUMMARY: - The shortage of cadaver kidneys relative
to increasing demand for transplantation has lead to a remarkable rise in
transplantation from living donors. Based upon data reported to UNOS, the
number of living donor kidneys transplanted in 2000 (5,106) nearly equaled the
number of cadaver kidneys from preferred donors aged 6-50. HLA-mismatched
siblings, offspring, spouses and other genetically unrelated donors accounted
for nearly 80% of increased living donor transplantation during 1994-2000.
Despite the increased use of poorly HLA-matched living donor kidneys, the
actuarial 10-year graft survival rates for transplants between 1988-2000 were
clustered between 53-57% for HLA-mismatched living donor grafts, except for
offspring-to-parent transplants (49%) when the recipients were generally older.
The 10-year survival rate for 96,053 cadaver grafts was 38% during the same
period. The 5-year graft survival rates for more recent (1996-2000) cadaver
donor transplants were 66%, 62% and 56% for recipients of first, second and
multiple grafts, respectively (p < 0.001). The comparable results among
recipients of living donor kidneys were 67%, 66% and 59% (p = ns). The 5-year
graft survival rates for HLA-matched first grafts were 7% higher than those for
HLA-mismatched transplants when the kidney was from a living or cadaver donor.
HLA-identical sibling transplants provided the best long-term graft survival
(85% at 5 years and a 32 year half-life). Even with improved crossmatch tests
and stronger immunosuppression, sensitization was associated with 8% lower
graft survival at 5 years and with a higher rate of late graft loss among first
cadaver kidney recipients. Sensitization also was associated with an increase
in delayed graft function from 22% of unsensitized first transplant recipients
to as much as 36% among multiply retransplanted patients. Recipient race was a
key factor in long-term graft survival of both living and cadaver donor
kidneys. The rate of late graft loss was double among blacks compared with
recipients with other racial origins whether the kidney was from a living or
cadaver donor. Black recipients accounted for 29% of first cadaver transplants
during 1996-2000, but only 14% of living donor grafts. Thus an important
component of long-term differences in graft survival comparing living and
cadaver donor transplants is the disparate racial demographics. Both the
recipient and donor populations are aging. The proportion of cadaver kidney
recipients over age 50 increased from 26% to 45% and the proportion of living
donor kidney recipients over age 50 rose from 10% to 35% between 1988 and 2000.
The aging population affects the transplant outcome as 65% of graft losses
among young recipients (ages 10-15) were attributed to acute or chronic
rejection compared with only 25% of grafts lost among patients over age 60.
More than half of graft losses among older recipients were due to death with a
functioning graft. Kidneys from donors over age 60 comprised 9% of first
cadaver transplants and yielded a 50% 5-year graft survival rate compared with
70% when the donor was aged 19-45. Kidneys from donors over age 60 accounted
for only 3% of first living donor transplants and their 84% 5-year graft
survival rate was comparable to that for younger donor kidneys. Despite
declining immunological graft losses with advancing recipient age, the effect
of HLA matching was similar among recipients of first cadaver transplants aged 50
or under and those over age 50. Completely HLA-mismatched grafts had a 10%
lower 5-year graft survival rate than HLA-matched grafts when the recipient was
over 50 compared with a 14% lower survival rate in younger recipients. The
graft half-lives were shorter by 5-7 years for HLA-mismatched kidneys
transplanted to older or younger recipients, respectively.
----------------------------------------------------
[97]
TÍTULO / TITLE: - Prevention and
management of late renal allograft dysfunction.
REVISTA
/ JOURNAL: - J Nephrol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jnephrol.com/
●●
Cita: Journal of Nephrology: <> 2001 Mar-Apr;14(2):71-9.
AUTORES
/ AUTHORS: - Seron D; Moreso F; Grinyo JM
INSTITUCIÓN
/ INSTITUTION: - Nephrology Department, Hospital de
Bellvitge, L’Hospitalet, Barcelona, España.
RESUMEN
/ SUMMARY: - Chronic allograft nephropathy is the
leading cause of return to dialysis after transplantation. At present, no
efficient therapies are available to modify the natural history of chronic
allograft nephropathy, mainly because of difficulties in designing prospective
clinical trials to prevent or treat this entity. The main risk factors for
chronic allograft nephropathy, the utility of protocol biopsies in the design
of trials, and different strategies to prevent or treat this problem are
reviewed. N. Ref:: 87
----------------------------------------------------
[98]
TÍTULO / TITLE: - Racial disparities in
renal replacement therapy.
REVISTA
/ JOURNAL: - J Natl Med Assoc 2002 Aug;94(8
Suppl):45S-54S.
AUTORES
/ AUTHORS: - Gadegbeku C; Freeman M; Agodoa L
INSTITUCIÓN
/ INSTITUTION: - Medical University of South Carolina,
Charleston, USA. gadegbek@muscusc.edu
RESUMEN
/ SUMMARY: - Renal replacement therapy
(RRT)--encompassing hemodialysis, peritoneal dialysis, and kidney
transplantation—provides life-sustaining treatment for the expanding end-stage
renal disease (ESRD) population. There is an excess burden of ESRD in
African-American, Hispanic, Native Americans, and Asian/Pacific Islanders.
Moreover, there is mounting evidence to suggest that significant racial and
ethnic disparities exist in RRT—including referral and initiation of dialysis,
adequacy of dialysis, and anemia management—with non-white patients usually at
a disadvantage. In addition, there are cultural and sociodemographic
differences that lead to racial variation in the choice of ESRD modality.
Lastly, in certain ethnic ESRD populations, there are a series of complex
issues, from biologic to socioeconomic, which limit kidney transplantation—the
treatment of choice. Despite these inequalities, which are often associated
with negative outcomes, these non-white groups have better hemodialysis
survival rates than white patients. It is essential to develop strategies to
address the disparities in ESRD treatment among minority groups in order to
minimize the differences in RRT provision and identify the factors that confer
improved dialysis survival-thus improving care for all Americans with kidney
disease. N. Ref:: 64
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[99]
TÍTULO / TITLE: - Crossmatch tests—an
analysis of UNOS data from 1991-2000.
REVISTA
/ JOURNAL: - Clin Transpl 2001;:237-46.
AUTORES
/ AUTHORS: - Cho YW; Cecka JM
RESUMEN
/ SUMMARY: - Based on more than 20,000 cadaver donor
transplants reported to UNOS between 1991-2000 with crossmatch results, the
following observations were made: 1. One-hundred sixty-nine transplants
performed despite a positive T-cell NIH crossmatch (usually with an historical
serum sample) were reported to UNOS and had 5%, 6%, 7%, and 11% lower graft
survival at one, 6, 12, and 24 months after transplantation compared with
negative crossmatch transplants, respectively. 2. Transplants with a positive
T-cell FCXM (n = 714) yielded 4%, 7%, and 9% lower graft survival at one, 6,
and 12 months after transplantation compared with negative crossmatch
transplants, respectively. 3. Transplants with a positive B-cell crossmatch
using NIH, Wash, AHG or flow cytometry XM yielded statistically significantly
lower (4-6%) graft survival rates compared with B-cell negative crossmatch
transplants. 4. The differences in graft survival rates comparing recipients
with a positive versus a negative T-cell crossmatch test (NIH, AHG, and FCXM)
were significant in univariate analyses; however, only the NIH and FCXM showed
a significant effect on graft survival after adjustment of other factors in a
multivariate analysis. 5. Regrafted patients with a positive T- and B-cell FCXM
experienced a higher incidence of primary nonfunction (12%) compared with those
who had a negative T- and B-cell FCXM (1%; P < 0.001). Flow cytometric or
ELISA screening of patient sera in addition to conventional cytotoxic
crossmatch tests can provide additional information to aid in the final
decision of renal transplantation.
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[100]
TÍTULO / TITLE: - Sensitization 2001.
REVISTA
/ JOURNAL: - Clin Transpl 2001;:271-8.
AUTORES
/ AUTHORS: - Hardy S; Lee SH; Terasaki PI
INSTITUCIÓN
/ INSTITUTION: - Terasaki Foundation Laboratory, Los
Angeles, California, USA.
RESUMEN
/ SUMMARY: - 1. The rate of transfusion decreased from 64%
in 1992 to 36% in 2000. This need for transfusions continued despite the
introduction of erythropoetin. Females were transfused more frequently than
males. SLE patients were transfused more often than those with other diseases.
2. Transfusions no longer had a beneficial effect on the outcome of
transplantation, but rather with more transfusions, the graft outcome became
lower, as might be expected. 3. Rejection of a kidney transplant had the
strongest effect on sensitization, followed by transfusion and then
pregnancies. Females were more susceptible to sensitization than males.
Although non-transfused males should not have been sensitized, as many as 13%
were reported to have antibodies. As many as 20% of nulliparous females without
transfusions also were reported to have antibodies. 4. SLE patients were most
often sensitized among patients with various diseases. Females of all diseases
were more sensitized than males. 5. Unsensitized regraft patients had a 3%
lower 3-year graft survival than unsensitized first graft patients. Among
sensitized patients, regraft patients had a 4% lower graft survival than
sensitized first graft patients. 6. Patients with polycystic kidney disease had
the highest 3-year graft survival in both the sensitized and non-sensitized
patients. Sensitization to a PRA level of less than 50% was not detrimental to
patients with all the various diseases. 7. For cadaver donor regraft patients,
HLA-DR mismatch had a greater effect than AB mismatch. There was a 10
percentage point lower 3-year graft survival in cadaver donor regraft patients
mismatched for 2 DR antigens than mismatched for 0 DR antigens. 8. For living
donor transplants, regrafts from 0 AB or 0 DR mismatched transplants had the
same graft survival as first transplants.
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[101]
TÍTULO / TITLE: - Renin-angiotensin
system in chronic renal allograft dysfunction.
REVISTA
/ JOURNAL: - Contrib Nephrol 2001;(135):222-34.
AUTORES
/ AUTHORS: - Shihab FS
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, University of Utah
School of Medicine, Salt Lake City, Utah, USA. Fuad.Shihab@hsc.utah.edu N. Ref:: 44
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[102]
TÍTULO / TITLE: - Gender imbalance in
living organ donation.
REVISTA
/ JOURNAL: - Med Health Care Philos 2002;5(2):199-204.
AUTORES
/ AUTHORS: - Biller-Andorno N
INSTITUCIÓN
/ INSTITUTION: - Department of Medical Ethics and History
of Medicine/Center for Psychosocial Medicine, University of Gottingen, Germany.
nbiller@gwdg.de
RESUMEN
/ SUMMARY: - Living organ donation has developed into
an important therapeutic option in transplantation medicine. However, there are
some medico-ethical problems that come along with the increasing reliance on
this organ source. One of these concerns is based on the observation that many
more women than men function as living organ donors. Whereas discrimination and
differential access have been extensively discussed in the context of cadaveric
transplantation and other areas of health care, the issue of gender imbalance
in living organ donation has received less attention. This paper presents
relevant data from the Eurotransplant and UNOS transplantation systems (1) and
discusses possible explanations for the documented gender discrepancies. The
conclusion calls for a review of existing practice guidelines in order to
secure effective protection of particularly vulnerable potential donors and an
equitable donor-recipient-ratio in living organ donation. N. Ref:: 45
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[103]
TÍTULO / TITLE: - Cardiovascular risk
reduction in renal transplantation. Strategies for success.
REVISTA
/ JOURNAL: - Minerva Urol Nefrol 2002 Jun;54(2):51-63.
AUTORES
/ AUTHORS: - Kiberd BA
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Dalhousie
University, Halifax, Nova Scotia, Canada. bkiberd@is.dal.ca
RESUMEN
/ SUMMARY: - One of the aims of transplantation is to
restore the potential for a full life to individuals with ESRD. To obtain this
strategies that allow better and longer allograft function and a reduction in
adverse events that lead to premature death are required. To this end, the
recommendations below showed reduce cardiovascular disease and help present and
future transplant recipients live a full life. Focusing on traditional risk
factors (hypertension, hyperlipidemia, discontinuation of smoking, and
prevention and treatment of diabetes mellitus) in patients at risk and striving
for the recommended targets will have the greatest clinical benefit. These
strategies should begin in the pre-dialysis and dialysis phases in order to
reduce the cumulative burden of disease. Failing this, early and hopefully
pre-emptive transplantation should be the goal. N. Ref:: 112
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[104]
TÍTULO / TITLE: - The next generation of
medications for kidney transplant patients.
REVISTA
/ JOURNAL: - Crit Care Nurs Clin North Am 2002
Mar;14(1):99-109.
AUTORES
/ AUTHORS: - Sims TW; Good EW
INSTITUCIÓN
/ INSTITUTION: - Digestive Health Center of Excellence and
Surgical Services, University of Virginia Health System, Charlottesville 22906,
USA. tws4m@virginia.edu
RESUMEN
/ SUMMARY: - Transplant pharmacotherapy evolves as new
agents are investigated and approved for use. Clinical immunosuppression has
been plagued with maintaining a balance between rejection of the transplanted
organ and complications of over-immunosuppression, including infection and
malignancy. Clinicians must understand current immunosuppressive regimens and
their associated effects when caring for transplant patients. While all transplant
patients receive some form of immunosuppressive therapy, the combinations and
choices increase as new drugs are developed. In the critical and acute care
settings, newly transplanted patients will likely receive induction therapy.
The goal of induction therapy is to increase long-term patient and allograft
survival while preventing or reducing rejection episodes. Several agents are
available for induction therapy, and each transplant center designs its own
protocol. The foundation for maintenance therapy rests on the combining
immunosuppressives to prevent rejection through a variety of pathways. An
understanding of the mechanism of action and additive effects of a drug allows
practitioners to optimize therapy while decreasing adverse effects. Immunosuppressive
therapy offers potential for reducing detrimental patient outcomes and
improving allograft survival. It is well established that repeated rejection
episodes correlate with poor long-term graft survival. Challenges facing
researchers and clinicians focus on improved patient outcomes and options to
address financial constraints of transplantation. N. Ref:: 33
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[105]
TÍTULO / TITLE: - Nutritional assessment
and support of kidney transplant recipients.
REVISTA
/ JOURNAL: - J Infus Nurs 2004 Jan-Feb;27(1):45-51.
AUTORES
/ AUTHORS: - Tritt L
INSTITUCIÓN
/ INSTITUTION: - Kidney and Pancreas Transplant Program,
Indiana University Hospital, Indianapolis, USA.
RESUMEN
/ SUMMARY: - Kidney transplant has become a viable
option for patients with end-stage renal disease (ESRD). The number of kidney
transplants has steadily increased during the past 50 years. Advances in
surgical technique and immunosuppressive drugs have led to significant
improvements in survival rates. Many chronic diseases that lead to ESRD
negatively affect nutritional status. To minimize nutritional depletion and
optimize nutritional status, a complete and thorough evaluation by a registered
dietitian should be performed. The posttransplant nutritional goal is to
provide adequate nutrition to promote wound healing and anabolism, to prevent
infection, and to minimize side effects of medications. Providing adequate
nutrition and reducing the long-term side effects are essential for graft
survival in kidney transplant recipients
N. Ref:: 30
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[106]
TÍTULO / TITLE: - Update in
immunosuppression.
REVISTA
/ JOURNAL: - Nephrol Nurs J 2002 Jun;29(3):261-7.
AUTORES
/ AUTHORS: - Huizinga R
INSTITUCIÓN
/ INSTITUTION: - University of Alberta Hospital, Edmonton,
Alberta, Canada.
RESUMEN
/ SUMMARY: - This article briefly reviews the current
status of renal transplantation and the current focus of immunosuppression in
the prevention of chronic rejection. Four paradigms involved in the
understanding of the immune system and their role in rejection are discussed.
The paradigms are co-stimulation, quantifying immunosuppression, changing the
direction of lymphocytes, and inhibition of antibody. Examples of each of these
paradigms are given. N.
Ref:: 30
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