#05#
Revisiones-Clínica-Diagnóstico
*** Reviews-Clinical-Diagnostics
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: - 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
----------------------------------------------------
[2]
TÍTULO / TITLE: - 4D imaging to assay
complex dynamics in live specimens.
REVISTA
/ JOURNAL: - Nat Cell Biol 2003 Sep;Suppl:S14-9.
AUTORES
/ AUTHORS: - Gerlich D; Ellenberg J
INSTITUCIÓN
/ INSTITUTION: - Gene Expression and Cell
Biology/Biophysics Programmes, European Molecular Biology Laboratory,
Heidelberg, Germany.
RESUMEN
/ SUMMARY: - A full understanding of cellular dynamics
is often difficult to obtain from time-lapse microscopy of single optical
sections. New microscopes and image-processing software are now making it
possible to rapidly record three-dimensional images over time. This
four-dimensional imaging allows precise quantitative analysis and enhances
visual exploration of data by allowing cellular structures to be interactively
displayed from many angles. It has become a key tool for understanding the
complex organization of biological processes in live specimens. N. Ref:: 55
----------------------------------------------------
[3]
TÍTULO / TITLE: - Renal transplantation:
can we reduce calcineurin inhibitor/stop steroids? Evidence based on protocol
biopsy findings.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Mar;14(3):755-66.
AUTORES
/ AUTHORS: - Gotti E; Perico N; Perna A; Gaspari F;
Cattaneo D; Caruso R; Ferrari S; Stucchi N; Marchetti G; Abbate M; Remuzzi G
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine and
Transplantation, Ospedali Riuniti di Bergamo, Mario Negri Institute for
Pharmacological Research, Italy.
RESUMEN
/ SUMMARY: - How to combine antirejection drugs and
which is the optimal dose of steroids and calcineurin inhibitors beyond the
first year after kidney transplantation to maintain adequate immunosuppression
without major side effects are far from clear. Kidney transplant patients on
steroid, cyclosporine (CsA), and azathioprine were randomized to per-protocol
biopsy (n = 30) or no-biopsy (n = 29) 1 to 2 yr posttransplant. Steroid or CsA
were discontinued or reduced on the basis of biopsy to establish effects on
drug-related complications, acute rejection, and graft function over 3 yr of
follow-up. Serum creatinine, GFR (plasma clearance of iohexol), RPF (renal
clearance of p-aminohippurate), CsA pharmacokinetics, and adverse events were
monitored yearly. At the end, patients underwent a second biopsy. Per-protocol
biopsy histology revealed no lesions (n = 5, steroid withdrawal), CsA
nephropathy (n = 13, CsA discontinuation/reduction), or chronic rejection (n =
12, standard therapy). Reducing the drug regimen led to overall fewer side
effects related to immunosuppression as compared with standard therapy or
no-biopsy. Steroids were safely stopped with no acute rejection or graft loss.
Complete CsA discontinuation was associated with acute rejection in the first
four patients. Lowering CsA to low target CsA trough (30 to 70 ng/ml) never led
to acute rejection or major renal function deterioration. Biopsy patients on
conventional regimen had no acute rejection, one graft loss, no significant
change in GFR, and significant RPF decline. No-biopsy controls: no acute
rejection, one graft loss, significant decline of GFR and RPF. By serial biopsy
analysis, severe lesions did not develop in patients with steroid
discontinuation in contrast to patients on standard therapy over follow-up. CsA
reduction did not adversely affect histology. Per-protocol biopsy more than 1
yr after kidney transplantation is a safe procedure to guide change of drug
regimen and to lower the risk of major side effects.
----------------------------------------------------
[4]
TÍTULO / TITLE: - Regulatory T cells in
kidney transplant recipients: active players but to what extent?
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Jun;14(6):1706-8.
AUTORES
/ AUTHORS: - Zhai Y; Kupiec-Weglinski JW N. Ref:: 20
----------------------------------------------------
[5]
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.
----------------------------------------------------
[6]
TÍTULO / TITLE: - Postmenopausal
tubo-ovarian abscess due to Pseudomonas aeruginosa in a renal transplant
patient: a case report and review of the literature.
REVISTA
/ JOURNAL: - Transplantation 2001 Oct 15;72(7):1241-4.
AUTORES
/ AUTHORS: - El Khoury J; Stikkelbroeck MM; Goodman A;
Rubin RH; Cosimi AB; Fishman JA
INSTITUCIÓN
/ INSTITUTION: - Infectious Disease Division, GRJ 504,
Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Pseudomonas aeruginosa is an
uncommon cause of infection in the female genital tract. We report a case of
postmenopausal tubo-ovarian abscess (TOA) due to P. aeruginosa in a renal
transplant recipient. The presentation included mild abdominal symptoms with
rapid progression of peritonitis and surgical abscess drainage. This is the
first such case in an organ transplant recipient described in the English
literature. METHODS AND RESULTS: Published reports of 1040 cases of TOA were
reviewed. The most common features were a history of sexually transmitted
disease or pelvic inflammatory disease, and symptoms including abdominal pain
and fever. Escherichia coli, Bacteroides spp., and Klebsiella pneumoniae were
the most frequently encountered pathogens. Neisseria gonorrhoeae and Chlamydia
trachomatis, which are frequently isolated from cervical cultures, are
uncommonly isolated from tubo-ovarian abscesses. Forty percent of patients were
treated with antibiotics alone, 18.8% with abdominal surgery, and 32% with
surgery and antimicrobial therapy. CONCLUSION: This report illustrates the
muted presentation and atypical microbiology of gynecologic infection in an
organ transplant recipient. N.
Ref:: 59
----------------------------------------------------
[7]
- Castellano -
TÍTULO / TITLE:Polimorfismo del receptor de la
vitamina D y enfermedad osea postrasplante renal. Polymorphism of the vitamin D
receptor and bone disease after renal transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2001;21 Suppl 1:56-60.
AUTORES
/ AUTHORS: - Torres A; Barrios Y; Salido E
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia y, Hospital
Universitario de Canarias, Instituto Reina Sofia de Investigacion Nefrologica,
Tenerife, España. atorres@ull.es N. Ref:: 29
----------------------------------------------------
[8]
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.
----------------------------------------------------
[9]
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
----------------------------------------------------
[10]
TÍTULO / TITLE: - Ambulatory blood
pressure measurement in kidney transplantation: an overview.
REVISTA
/ JOURNAL: - Transplantation 2003 Dec 15;76(11):1643-4.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000091289.03300.1A
AUTORES
/ AUTHORS: - Tomson CR
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine, Southmead
Hospital, Bristol, UK. charlie.tomson@north-bristol.swest.nhs.uk
RESUMEN
/ SUMMARY: - Adequate control of hypertension is among
the most important aims of medical management of the kidney transplant
recipient, with the aim of reducing the risk of premature cardiovascular
disease and preserving graft function. Antihypertensive therapy should be
adjusted according to the best available estimates of usual resting blood
pressure. If clinic measurements are used, care should be taken to ensure that
these measurements are taken under optimal conditions. Home blood pressure
monitoring is a useful adjunct in many patients. Ambulatory blood pressure
monitoring gives valuable additional data; mean ambulatory blood pressure
correlates better with markers of target organ damage such as left ventricular
hypertrophy. However, current treatment thresholds and targets are based on
clinic measurements. Ambulatory blood pressure monitoring is certainly a useful
adjunct to clinic and home blood pressure measurement, but its role in routine
clinical practice in the transplant clinic remains to be defined. N. Ref:: 11
----------------------------------------------------
[11]
TÍTULO / TITLE: - Updated protocol for
the examination of specimens from patients with carcinoma of the urinary
bladder, ureter, and renal pelvis.
REVISTA
/ JOURNAL: - Arch Pathol Lab Med. Acceso gratuito al
texto completo.
●●
Enlace a la Editora de la Revista http://arpa.allenpress.com/
●●
Cita: Archives of Pathology & Laboratory Medicine: <> 2003
Oct;127(10):1263-79.
AUTORES
/ AUTHORS: - Amin MB; Srigley JR; Grignon DJ; Reuter
VE; Humphrey PA; Cohen MB; Hammond ME
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, Emory University
Hospital, Atlanta, Ga, USA.
----------------------------------------------------
[12]
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
----------------------------------------------------
[13]
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
----------------------------------------------------
[14]
TÍTULO / TITLE: - Current treatment
strategies in ANCA-positive renal vasculitis-lessons from European randomized
trials.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Jul;18 Suppl 5:v2-4.
AUTORES
/ AUTHORS: - Tesar V; Rihova Z; Jancova E; Rysava R;
Merta M
INSTITUCIÓN
/ INSTITUTION: - First Medical Department, First Medical
Faculty, Charles University, Prague, Czech Republic. tesar@beba.cesnet.cz
RESUMEN
/ SUMMARY: - Antineutrophil cytoplasmic antibody
(ANCA)-positive renal vasculitis is the most common cause of rapidly
progressive (crescentic) glomerulonephritis. Its life-threatening natural
course may be modified substantially by current treatment modalities. The
European Vasculitis Study Group (EUVAS) developed a subclassification of
ANCA-positive vasculitides based on the disease severity at presentation, and
have organized (so far) two waves of clinical trials. The first wave of randomized
clinical trials had the aim of optimizing the existing therapeutic regimens;
the second wave concentrated on testing some newer therapeutic approaches.
Here, the design and available results of the first wave and the design of some
second wave trials are reviewed briefly. The potential of the new targeted
approaches (e.g. anti-tumour necrosis factor therapy) is also briefly
mentioned. N. Ref:: 9
----------------------------------------------------
[15]
TÍTULO / TITLE: - How should the
immunosuppressive regimen be managed in patients with established chronic
allograft failure?
REVISTA
/ JOURNAL: - Kidney Int Suppl 2002 May;(80):68-72.
AUTORES
/ AUTHORS: - Danovitch GM
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, UCLA School of
Medicine, USA. gdanovitch@mednet.ucla.edu N. Ref:: 25
----------------------------------------------------
[16]
TÍTULO / TITLE: - Costs and consequences
of cytomegalovirus disease.
REVISTA
/ JOURNAL: - Am J Health Syst Pharm 2003 Dec 1;60(23
Suppl 8):S5-8.
AUTORES
/ AUTHORS: - Schnitzler MA
INSTITUCIÓN
/ INSTITUTION: - Washington University, 4547 Clayton
Avenue, Box 8084, St. Louis, MO 63110, USA. schnitz@wueconc.edu
RESUMEN
/ SUMMARY: - The impact of prophylactic oral
ganciclovir therapy on the incidence of cytomegalovirus (CMV) disease, patient
and graft survival, and costs in patients receiving kidney and liver
transplants is described. CMV disease is a common cause of morbidity and
mortality in solid organ transplant recipients unless prophylactic drug therapy
is used. Prophylactic oral ganciclovir therapy reduces the incidence of CMV
disease in kidney and liver transplant recipients. It is more effective for
recipients who are seronegative before the transplant and receive organs from
seronegative (D-/R-) donors than in seronegative recipients of organs from
seropositive (D+/R-) donors. CMV disease remains a problem in the latter. CMV
disease increases the risk of graft failure, which decreases the likelihood of
patient survival. The extent of matching of the DR subregion of the human
leukocyte antigen complex in the donor and recipient may affect graft survival
in patients with CMV disease. Graft failure is costly and should be considered
in economic analyses of CMV prophylaxis regimens because of the potential
impact of prophylaxis on CMV disease. The use of oral ganciclovir for CMV
prophylaxis has reduced the incidence of CMV disease in kidney and liver
transplant recipients. N.
Ref:: 10
----------------------------------------------------
[17]
TÍTULO / TITLE: - Protocol for the
examination of specimens from patients with Wilms tumor (nephroblastoma) or
other renal tumors of childhood.
REVISTA
/ JOURNAL: - Arch Pathol Lab Med. Acceso gratuito al
texto completo.
●●
Enlace a la Editora de la Revista http://arpa.allenpress.com/
●●
Cita: Archives of Pathology & Laboratory Medicine: <> 2003
Oct;127(10):1280-9.
AUTORES
/ AUTHORS: - Qualman SJ; Bowen J; Amin MB; Srigley JR;
Grundy PE; Perlman EJ
INSTITUCIÓN
/ INSTITUTION: - Department of Laboratory Medicine,
Children’s Hospital, Columbus, Ohio 43205, USA. qualmans@pediatrics.ohio-state.edu
----------------------------------------------------
[18]
TÍTULO / TITLE: - Protocol biopsy of the
stable renal transplant: a multicenter study of methods and complication rates.
REVISTA
/ JOURNAL: - Transplantation 2003 Sep 27;76(6):969-73.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000082542.99416.11
AUTORES
/ AUTHORS: - Furness PN; Philpott CM; Chorbadjian MT;
Nicholson ML; Bosmans JL; Corthouts BL; Bogers JJ; Schwarz A; Gwinner W; Haller
H; Mengel M; Seron D; Moreso F; Canas C
INSTITUCIÓN
/ INSTITUTION: - Clinical Sciences Laboratories, Leicester
General Hospital, Leicester, United Kingdom.
RESUMEN
/ SUMMARY: - BACKGROUND: Clinical trials in renal
transplantation must use surrogate markers of long-term graft survival if
conclusions are to be drawn at acceptable speed and cost. Morphologic changes
in transplant biopsies provide the earliest available evidence of damage, and
“protocol” biopsies from stable grafts can be used to reduce the number of
patients needed in clinical trials. This approach has been inhibited by
concerns over safety, but the risk of biopsy of a stable kidney, with no active
inflammation or acute functional impairment, has never been formally estimated.
METHODS: In accordance with a predefined set of questions, a retrospective
audit of a sequential series of protocol biopsies was performed in four major
transplant centers. RESULTS: A total of 2,127 biopsy events were assessed for
major complications, and 1,486 were assessed for minor ones. There were no
deaths. One graft was lost, under circumstances indicating that the loss should
have been prevented. Three episodes of hemorrhage required direct intervention.
Three further patients required transfusion. There were two episodes of
peritonitis, but one was arguably an unrelated event. All serious complications
presented within 4 hr of biopsy. CONCLUSIONS: The incidence of clinically
significant complications after protocol biopsy of a stable renal transplant is
low. Direct benefits to the patients concerned (irrespective of the benefit
that may accrue in clinical trials) were not formally assessed but seem likely
to outweigh the risk of the procedure. We believe that it is ethically
justifiable to ask renal transplant recipients to undergo protocol biopsies in
clinical trials and routine care.
----------------------------------------------------
[19]
TÍTULO / TITLE: - Steroid-resistant
kidney transplant rejection: diagnosis and treatment.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2001 Feb;12 Suppl
17:S48-52.
AUTORES
/ AUTHORS: - Bock HA
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Kantonsspital,
Aarau, Switzerland. bock@ksa.ch
RESUMEN
/ SUMMARY: - Decreases in transplant function may be
attributable to a variety of conditions, including prerenal and postrenal
failure, cyclosporin A (CsA) toxicity, polyoma nephritis, recurrent
glomerulonephritis, and rejection. The diagnosis of rejection should therefore
be made on the basis of a transplant biopsy of adequate size, before the
initiation of any therapy. Pulse steroid treatment (three to five 0.25- to
1.0-g pulses of methylprednisolone, administered intravenously) is the usual
first-line therapy and has a 60 to 70% success rate, although orally
administered prednisone (0.25 g) may be just as efficacious. Even if reverted,
any rejection should trigger an at least temporary increase in basal
immunosuppression, consisting of an increase in CsA or tacrolimus target
levels, the addition of steroids or an increase in their dosage, the addition
of mycophenolate mofetil, or a switch from CsA to tacrolimus. The addition of
rapamycin or its RAD derivative may fulfill the same purpose. Steroid
resistance should not be assumed before the fifth day of pulse steroid
treatment, although histologic features of vascular rejection may indicate the
need for more aggressive treatment earlier. Steroid-resistant rejection is
traditionally treated with poly- or monoclonal antilymphocytic antibodies, with
success rates of 60 to 70%. Their potential benefit must be carefully balanced
against the risks of infection and lymphoma. More recently, mycophenolate
mofetil has been successfully used to treat steroid-resistant rejection, but
only of the interstitial (cellular) type. Switching from CsA to tacrolimus for
treating recurrent or antibody-resistant rejection is successful in
approximately 60% of cases. Plasmapheresis and intravenously administered Ig
have been used in some desperate cases, with surprising success. Because none
of the available drugs has a significantly better profile of therapeutic versus
adverse effects, the possible benefits of continued rejection therapy must be
continuously balanced with the potential for serious, sometimes fatal, side
effects. N. Ref:: 35
----------------------------------------------------
[20]
TÍTULO / TITLE: - Vitamin D as
immunomodulatory therapy for kidney transplantation.
REVISTA
/ JOURNAL: - Transplantation 2002 Oct 27;74(8):1204-6.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000031949.70610.BB
AUTORES
/ AUTHORS: - Becker BN; Hullett DA; O’Herrin JK; Malin
G; Sollinger HW; DeLuca H
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, B-3063 UW
Nephrology, University of Wisconsin, 2500 Overlook Terrace, Madison, WI 53705,
USA. bnb@medicine.wisc.edu
RESUMEN
/ SUMMARY: - Vitamin D (1alpha,25-dihydroxyvitamin D(3)
[1alpha,25-(OH)(2)D(3)]) has been studied in the past for its immunosuppressive
properties, and, in that context, it may also have potential utility as an
immunomodulatory agent for transplantation. A number of studies have
demonstrated that 1alpha,25-(OH)(2)D(3) or its analogs regulate immune cell
proliferation, differentiation, and responsiveness. A burgeoning number of
studies have also explored using 1alpha,25-(OH)(2)D(3) and its analogs directly
as therapy in animal models of kidney transplantation with success in
prolonging allograft function and preventing acute rejection. Some of these in
vivo effects may well be caused by alterations in immune cell function, but it
is also possible that exogenous 1alpha,25-(OH)(2)D(3) and its analogs are
altering the intragraft milieu as well, specifically through changes in the
TGF-beta signaling cascade. Such provocative data and the availability of newer
1alpha,25-(OH)(2)D(3) analogs that may limit side effects (e.g. hypercalcemia)
have created interest in examining this secosteroid clinically in kidney
transplantation. N.
Ref:: 34
----------------------------------------------------
[21]
TÍTULO / TITLE: - Pharmacokinetic,
pharmacodynamic, and outcome investigations as the basis for mycophenolic acid
therapeutic drug monitoring in renal and heart transplant patients.
REVISTA
/ JOURNAL: - Clin Biochem 2001 Feb;34(1):17-22.
AUTORES
/ AUTHORS: - Shaw LM; Korecka M; DeNofrio D; Brayman KL
INSTITUCIÓN
/ INSTITUTION: - Departments of Pathology & Laboratory
Medicine and Surgery, University of Pennsylvania Medical Center, Philadelphia,
PA, USA. shawlmj@mail.med.upenn.edu
RESUMEN
/ SUMMARY: - Mycophenolate mofetil is widely used in
combination with either cyclosporine or tacrolimus for rejection prophylaxis in
renal and heart transplant patients. Although not monitored routinely nearly to
the degree that other agents such as cyclosporine or tacrolimus, there is an
expanding body of experimental evidence for the utility of monitoring
mycophenolic acid, the primary active metabolite of mycophenolate mofetil,
plasma concentration as an index of risk for the development of acute
rejection. The following are important experimentally-based reasons for
recommending the incorporation of target therapeutic concentration monitoring
of mycophenolic acid: (1) the MPA dose-interval
area-under-the-concentration-time curve, and less precisely, MPA predose
concentrations predict the risk for development of acute rejection; (2) the
strong correlation between mycophenolic acid plasma concentrations and
expression of important cell surface activation antigens, whole blood
pharmacodynamic assays of lymphocyte proliferation and median graft rejection
scores in a heart transplant animal model; (3) the greater than 10-fold
interindividual variation of MPA area under the concentration time curve values
in heart and renal transplant patients receiving a fixed dose of the parent
drug; (4) drug-drug interactions involving other immunosuppressives are such
that when switching from one to another (eg, from cyclosporine to tacrolimus or
vice-versa) substantial changes in MPA concentrations can occur in patients
receiving a fixed dose of the parent drug; (5) significant effects of liver and
kidney diseases on the steady-state total and free mycophenolic acid area under
the concentration time curve values; (6) the need to closely monitor
mycophenolic acid when a major change in immunosuppression is planned such as
steroid withdrawal. Current investigations are focused on determination of the
most optimal sampling time and for mycophenolic acid target therapeutic
concentration monitoring. Further investigations are needed to evaluate the
pharmacologic activity of the newly described acyl glucuronide metabolite of
mycophenolic acid which has been shown to inhibit, in vitro, inosine
monophosphate dehydrogenase. N.
Ref:: 37
----------------------------------------------------
[22]
TÍTULO / TITLE: - Capillary C4d
deposition as a marker of humoral immunity in renal allograft rejection.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2002
Sep;13(9):2420-3.
AUTORES
/ AUTHORS: - Watschinger B; Pascual M N. Ref:: 38
----------------------------------------------------
[23]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.1 Differential diagnosis of chronic graft
dysfunction.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:4-8.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Any significant
deterioration in graft function should be investigated using the appropriate
diagnostic tools and, if possible, therapeutic interventions should be
initiated. The usual causes of a decline in glomerular filtration rate after
the first year include transplant-specific causes such as chronic allograft
nephropathy, acute rejection episodes, chronic calcineurin inhibitor
nephrotoxicity, transplant renal artery stenosis and ureteric obstruction, as
well as immunodeficiency-related causes and non-transplant-related causes, such
as recurrent or de novo renal diseases and bacterial infections. B. Any new
onset and persistent proteinuria of >0.5 g/24 h should be investigated and
therapeutic interventions should be initiated. The usual causes include chronic
allograft nephropathy and transplant glomerulopathy, and recurrent or de novo
glomerulonephritis.
----------------------------------------------------
[24]
- Castellano -
TÍTULO / TITLE:Reporte preliminar. Utilidad de la
angiotomografia renal en el protocolo del donador renal. Preliminary report.
Usefulness of computed tomographic angiography in the protocol of a kidney
donor.
REVISTA
/ JOURNAL: - Cir Cir. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.medigraphic.com/
●●
Cita: Cirugia y Cirujanos: <> 2003 Sep-Oct;71(5):379-82.
AUTORES
/ AUTHORS: - Ramirez-Bollas J; Hernandez-Dominguez M;
Arenas-Osuna J; Romero-Huesca A; Albores-Zuniga O
INSTITUCIÓN
/ INSTITUTION: - Cirujano General, Hospital de Especialidades
del Centro Medico Nacional “La Raza,” IMSS, Mexico D.F., Mexico. juliobollas@yahoo.com.mx
RESUMEN
/ SUMMARY: - OBJECTIVE: To determine clinical
correlation of reports of computed tomographic angiography renal (CT-AR) and
surgical findings of the kidney donor patient. MATERIAL AND METHODS: Patients
were submitted nephrectomy in the related live donor renal transplant program
between January and December 2002 as paut of life to which he is made as he
CT-AR study protocol. Statistical analysis was carried out by descriptive
statistics. RESULTS: Anatomical characteristics of 35 kidneys of the same
number of live donors (AD) submitted CT-AR were evaluated and comparison with
report of surgical technique was made. Incidence of accessory renal arteries
was 23%. As reported by CT-AR, the were 39 renal arteries (91%) compared with
43 arteries found during surgery. CT-AR identified four supernumerary renal
arteries (50%) of eight identified during surgical technique; 36 hiliar
arteries (90%) and three polar arteries were identified by CT-AR (100%). Only
one a case report of early bifurcation of renal artery (20%) by CT-AR was
recorded. Anatomical characteristics of veins were described in their totality.
CT-AR is a useful instrument to identify alterations in anatomical structure of
the renal vasculature, with results similar to other studies for description of
renal arteries and veins. We propose ATR as the initial study for evaluation of
the renal architecture of the live kidney (LKD).
----------------------------------------------------
[25]
TÍTULO / TITLE: - The impact of
cytomegalovirus infections and acute rejection episodes on the development of
vascular changes in 6-month protocol biopsy specimens of cadaveric kidney
allograft recipients.
REVISTA
/ JOURNAL: - Transplantation 2003 Jun
15;75(11):1858-64.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000064709.20841.E1
AUTORES
/ AUTHORS: - Helantera I; Koskinen P; Tornroth T;
Loginov R; Gronhagen-Riska C; Lautenschlager I
INSTITUCIÓN
/ INSTITUTION: - Department of Virology, Helsinki
University Central Hospital and University of Helsinki, Helsinki, Finland.
RESUMEN
/ SUMMARY: - BACKGROUND: The role of cytomegalovirus
(CMV) in chronic kidney allograft rejection remains controversial. The purpose
of this study was to examine the impact of CMV infection on histopathologic
changes in 6-month protocol biopsy specimens of kidney allografts. METHODS:
Altogether, 52 renal allograft recipients were studied. CMV infection was diagnosed
by CMV antigenemia test, viral cultures from blood and urine, or both. CMV was
demonstrated in the biopsy specimens by antigen detection and hybridization in
situ. Acute rejections were diagnosed by biopsy histology, and biopsy specimens
were graded according to the Banff ‘97 classification. RESULTS: CMV infection
was diagnosed in 41 patients. The 11 patients in whom CMV infection was not
detected were used as controls. Acute rejection was diagnosed in 22 of 41 CMV
patients and in 6 of 11 control patients. CMV was demonstrated in the biopsy
specimens of 19 of 41 CMV patients. CMV was not associated with increased
glomerular, tubular, or interstitial changes. However, the arteriosclerotic
changes in small arterioles were significantly increased in the subgroup of
patients where CMV was demonstrated in the graft as compared with controls
(P<0.01). Analysis of the impact of acute rejection on arteriolar thickening
showed that only a positive history of both acute rejection and CMV found in
the graft was associated with significantly increased vascular changes compared
with CMV-free recipients (P<0.05). CONCLUSIONS: Neither CMV nor acute
rejection alone was associated with increased vascular or other histopathologic
changes in 6-month protocol biopsy specimens of kidney allografts, but a
previous history of both acute rejection and the presence of CMV in the graft
was associated with increased vascular changes.
----------------------------------------------------
[26]
TÍTULO / TITLE: - Transplant
capillaropathy and transplant glomerulopathy: ultrastructural markers of
chronic renal allograft rejection.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Apr;18(4):655-60.
AUTORES
/ AUTHORS: - Ivanyi B
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, University of
Szeged, Szeged, Hungary. ivanyi@patho.szote.u-szeged.hu N. Ref:: 21
----------------------------------------------------
[27]
TÍTULO / TITLE: - Adenovirus
pyelonephritis in a pediatric renal transplant patient.
REVISTA
/ JOURNAL: - Pediatr Nephrol 2003 May;18(5):457-61.
Epub 2003 Mar 18.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00467-003-1080-x
AUTORES
/ AUTHORS: - Kim SS; Hicks J; Goldstein SL
INSTITUCIÓN
/ INSTITUTION: - Baylor College of Medicine, Texas, USA.
RESUMEN
/ SUMMARY: - Gross hematuria, graft pain, and rising
serum creatinine are classic signs of acute rejection, obstruction, or
bacterial pyelonephritis for patients with renal transplants. This presentation
often prompts percutaneous renal allograft biopsy. If subsequent evaluation
fails to show evidence of acute rejection, obstruction, or bacterial infection,
viral etiologies should be considered. We report a 14-year-old Hispanic female
with a living-related renal transplant who had gross hematuria, graft
tenderness, and increased serum creatinine, but did not have evidence of acute
rejection, obstruction, or bacterial pyelonephritis. To our knowledge, this is
the first report of adenovirus pyelonephritis in a transplanted kidney of a
pediatric patient, with isolation of adenovirus in the urine and in the
allograft using immunocytochemical techniques.
N. Ref:: 26
----------------------------------------------------
[28]
TÍTULO / TITLE: - Treatment of renal
transplant ureterovesical anastomotic strictures using antegrade balloon
dilation with or without holmium:YAG laser endoureterotomy.
REVISTA
/ JOURNAL: - Urology 2003 Nov;62(5):831-4.
AUTORES
/ AUTHORS: - Kristo B; Phelan MW; Gritsch HA; Schulam
PG
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, University of
California, Los Angeles, School of Medicine, Los Angeles, Medical Center, Los
Angeles, California 90095, USA.
RESUMEN
/ SUMMARY: - OBJECTIVES: To report our results after
antegrade endoscopic treatment of ureteral stenosis with balloon dilation with
or without holmium laser endoureterotomy. Ureteral stenosis is the most common
long-term urologic complication of renal transplantation. METHODS: From July
2000 to October 2002, 9 renal transplant patients with ureteral obstruction
diagnosed by an increase in serum creatinine and radiologic evidence presented
for endoscopic treatment. All patients were treated with nephrostomy tube
drainage followed by antegrade flexible nephroureteroscopy and balloon dilation
of the stricture. Three patients required holmium laser endoureterotomy during
the same procedure because of fluoroscopic and endoscopic evidence of
persistent stricture. All patients were treated with ureteral stents and
nephrostomy tubes postoperatively. The median follow-up was 24 months (range 6
to 32). RESULTS: The site of stenosis was at the ureterovesical anastomosis in
all patients, and the mean stricture length was 0.28 cm. Two patients had
previously undergone ureteroneocystostomy for prior ureteral stenosis. Six
patients (66%) required only balloon dilation, and 3 patients (33%) also
required holmium laser endoureterotomy. The median ureteral stent and
nephrostomy tube duration was 40 and 62 days, respectively. The mean serum
creatinine level was 2.3 mg/dL at presentation and 1.7 mg/dL at the last
follow-up visit. After a median follow-up of 24 months, the ureteral patency
and graft function rates were both 100%. No perioperative complications
occurred. CONCLUSIONS: Balloon dilation with or without holmium laser
endoureterotomy was successful and safe in this group of renal transplant
patients with short ureterovesical anastomotic strictures. N. Ref:: 19
----------------------------------------------------
[29]
TÍTULO / TITLE: - Renal transplantation:
can we reduce calcineurin inhibitor/stop steroids? Evidence based on protocol
biopsy findings.
REVISTA
/ JOURNAL: - J Urol 2003 Sep;170(3):1056.
AUTORES
/ AUTHORS: - Goldfarb DA
----------------------------------------------------
[30]
TÍTULO / TITLE: - Epstein-Barr
virus-associated pulmonary leiomyosarcoma arising twenty-nine years after renal
transplantation.
REVISTA
/ JOURNAL: - J Thorac Cardiovasc Surg 2003
Sep;126(3):877-9.
AUTORES
/ AUTHORS: - Ferri L; Fraser R; Gaboury L; Mulder D
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, McGill University
Health Centre, Montreal General Hospital, Room D10.168, 1650 Cedar Avenue,
Montreal, Quebec H3G 1A4, Canada. lferri@po-box.mcgill.ca N. Ref:: 5
----------------------------------------------------
[31]
TÍTULO / TITLE: - Renal imaging in
patients requiring renal replacement therapy.
REVISTA
/ JOURNAL: - Semin Dial 2002 Jul-Aug;15(4):237-49.
AUTORES
/ AUTHORS: - Cowie A
INSTITUCIÓN
/ INSTITUTION: - Department of Diagnostic Radiology,
Manchester Royal Infirmary, United Kingdom. agcowie1@hotmail.com
RESUMEN
/ SUMMARY: - Recent advances in imaging technology and
interventional radiologic procedures have resulted in an increased variety of
radiological techniques that can be used to assess patients who present with
renal failure and require renal replacement therapy. This chapter provides an
overview of the relative strengths and weaknesses of the available imaging
methods. In particular, it covers the expanding role of the cross-sectional,
noninvasive, multiplanar imaging techniques such as gray-scale and Doppler
ultrasound, magnetic resonance imaging (MRI) and angiography (MRA), and
nonenhanced helical or multislice computed tomography (CT). These imaging
methods are increasingly replacing those used in the past, such as the
conventional radiographic urogram, which requires a high dose of intravenous
contrast media, and digital subtraction arteriography. The chapter also covers
the radiologic investigation of complications of acquired renal cystic disease,
including renal cell carcinoma, hemorrhage, cyst infection and rupture, and
nephrolithiasis. N.
Ref:: 57
----------------------------------------------------
[32]
- Castellano -
TÍTULO / TITLE:Aplicaciones de la biologia
molecular en el trasplante renal. Applications of molecular biology to renal
transplant.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2003;23(1):15-26.
AUTORES
/ AUTHORS: - Lario S; Bescos M; Campistol JM
INSTITUCIÓN
/ INSTITUTION: - Unidad de Trasplante Renal, Hospital
Clinic, de Barcelona Villarroel, 170 08036 Barcelona. jmcampis@medicina.ub.es N. Ref:: 35
----------------------------------------------------
[33]
TÍTULO / TITLE: - MR imaging of renal
function.
REVISTA
/ JOURNAL: - Radiol Clin North Am 2003
Sep;41(5):1001-17.
AUTORES
/ AUTHORS: - Huang AJ; Lee VS; Rusinek H
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology-MRI, New York
University Medical Center, 530 First Avenue, HCC Basement, New York, NY 10016,
USA.
RESUMEN
/ SUMMARY: - MR imaging is the only single noninvasive
test that can potentially provide a complete picture of renal status with
minimal risk to the patient, simultaneously improving diagnosis while lowering
medical costs by virtue of its being a single test. The strengths of MR imaging
lie in its high spatial and temporal resolution and its lack of exposure to
ionizing radiation and nephrotoxic contrast agents. This article reviews the
use of MR imaging for quantification of renal functional parameters and its application
to clinical problems, such as RVD, hydronephrosis, and renal transplantation.
Although advances in both the technical and clinical aspects of functional
renal MR imaging have been made, much remains to be done. The preliminary
results reported in the many studies reviewed are exciting, but these
techniques need to be validated against accepted standards where such standards
exist. In addition, and perhaps more important, the effects of these new
diagnostic methods on patient outcomes must be studied. Finally, further
progress in image processing and analysis must be made to make functional renal
MR imaging truly practical. With these advances, one can expect functional
renal MR imaging to play an ever-expanding and influential role in the care and
management of the patient with renal disease.
N. Ref:: 57
----------------------------------------------------
[34]
TÍTULO / TITLE: - Resolution of oral
non-Hodgkin’s lymphoma by reduction of immunosuppressive therapy in a renal
allograft recipient: a case report and review of the literature.
REVISTA
/ JOURNAL: - Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2002 Dec;94(6):697-701.
●●
Enlace al texto completo (gratuito o de pago) 1067/moe.2002.126889
AUTORES
/ AUTHORS: - Keogh PV; Fisher V; Flint SR
INSTITUCIÓN
/ INSTITUTION: - Department of Oral Surgery, Oral Medicine
and Oral Pathology, Dublin Dental School and Hospital, Trinity College,
Ireland. pakeogh@dental.tcd.ie
RESUMEN
/ SUMMARY: - A case of oral non-Hodgkin’s lymphoma
arising in a patient with insulin-dependent diabetes who had undergone renal
allograft transplantation is described. The resolution of the disease was
achieved by a reduction in her immunosuppressive therapy. The differential
diagnosis is discussed, and the management of posttransplantation
lymphoproliferative disorders is reviewed.
N. Ref:: 40
----------------------------------------------------
[35]
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
----------------------------------------------------
[36]
TÍTULO / TITLE: - Cancer-related anaemia
requires higher doses of epoetin alfa than chronic renal failure replacement
therapy.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001 Dec;16(12):2289-93.
AUTORES
/ AUTHORS: - Itri LM
N. Ref:: 30
----------------------------------------------------
[37]
TÍTULO / TITLE: - Optimizing dose and mode
of renal replacement therapy in anaemia management.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 5:60-5.
AUTORES
/ AUTHORS: - Locatelli F
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Dialysis,
Ospedale A. Manzoni, Lecco, Italy.nefrologia@ospedale.lecco.it
RESUMEN
/ SUMMARY: - Iron supplementation is probably the most
important factor affecting response to treatment with recombinant human
erythropoietin (rHuEPO) in patients with renal anaemia. However, the adequacy
of dialysis is also significant. Many factors affect the process of dialysis
and its effects. The purity of water used to make up the dialysate from
concentrate is important. Inhibitors of erythropoiesis including ions and
disinfectants may often be present in treated mains water. In addition,
microbiological and pyrogenic contamination of the dialysate frequently occurs,
sometimes leading to development or aggravation of anaemia in haemodialysis
(HD) patients and also causing an immune response via cytokine activation.
Inhibitors of erythropoiesis are also present in endogenous blood in patients
with impaired renal function. Adequate dialysis is responsible for removing
these mainly small, and possibly medium and large inhibitor molecules, thereby
improving anaemia and enhancing response to rHuEPO. The biocompatibility and
flux of the membrane used in HD may also have an effect. The removal of medium
or large inhibitors of erythropoiesis is inefficient with cellulose membranes,
but can potentially be achieved by using more permeable, high-flux membranes.
However, in patients with adequate dialysis and sufficient iron and vitamin
supplementation, the beneficial effects of a switch from standard cellulose to
high-flux membranes have yet to be proven conclusively. Another area in which
positive results on correction of anaemia have been seen in small studies is in
the use of on-line haemodiafiltration, haemofiltration, or sterile dialysate.
However, further large, controlled studies are needed to confirm these
effects. N. Ref:: 37
----------------------------------------------------
[38]
TÍTULO / TITLE: - B19 virus infection in
renal transplant recipients.
REVISTA
/ JOURNAL: - J Clin Virol. Acceso gratuito al texto completo.
●●
Enlace a la Editora de la Revista http://www.elsevier.com/gej-ng/29/46/32/show/Products/VIRUSINT/index.htt
●●
Cita: J Clinical Virology: <> 2003 Apr;26(3):361-8.
AUTORES
/ AUTHORS: - Cavallo R; Merlino C; Re D; Bollero C;
Bergallo M; Lembo D; Musso T; Leonardi G; Segoloni GP; Ponzi AN
INSTITUCIÓN
/ INSTITUTION: - Virology Unit, Department of Public Health
and Microbiology, University of Turin, Via Santena 9, 10126, Turin, Italy. rossana.cavallo@unito.it
RESUMEN
/ SUMMARY: - BACKGROUND: B19 virus infection with
persistent anaemia has been reported in organ transplant recipients. Detection
of B19 virus DNA in serum is the best direct marker of active infection.
OBJECTIVE: The present study evaluated the incidence and clinical role of
active B19 virus infection in renal transplant recipients presenting with
anaemia. STUDY DESIGN: Forty-eight such recipients were investigated by nested
PCR on serum samples. The controls were 21 recipients without anaemia. Active
HCMV infection was also investigated as a marker of high immunosuppression.
RESULTS AND CONCLUSIONS: In 11/48 (23%) patients B19 virus DNA was demonstrated
in serum versus only 1/21 (5%) of the controls. Ten of these 11 patients had
already been seropositive at transplantation and active infection occurred in
eight of them during the first 3 months after transplantation. The remaining
patient experienced a primary infection 9 months after transplantation. Eight
(73%) of these 11 patients displayed a concomitant HCMV infection and four
(36%) showed increasing serum creatinine levels but none developed
glomerulopathy; 3/11 (27%) recovered spontaneously from anaemia whereas 8/11
(73%) needed therapy. In conclusion, the relatively high occurrence (23%) of
B19 virus infection in patients presenting with anaemia, suggests that it
should be considered in the differential diagnosis of persistent anaemia in renal
transplant recipients. Presence of the viral DNA should be assessed early from
transplantation and the viral load should be monitored to follow persistent
infection and better understand the relation between active infection and
occurrence of anaemia, and to assess the efficacy of IVIG therapy and/or
immunosuppression reduction in clearing the virus. N. Ref:: 56
----------------------------------------------------
[39]
- Castellano -
TÍTULO / TITLE:Nuevos tratamientos
inmunodepresores de induccion en el trasplante renal. New induction
immunosuppression treatments in kidney transplantation.
REVISTA
/ JOURNAL: - Med Clin (Barc). Acceso gratuito al texto
completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://db.doyma.es/
●●
Cita: Medicina Clínica: <> 2001 Jun 30;117(4):147-57.
AUTORES
/ AUTHORS: - Pascual J; Ortuno J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia. Universidad de
Alcala. Hospital Ramon y Cajal. Madrid. jpascual@hrc.insalud.es N. Ref:: 94
----------------------------------------------------
[40]
TÍTULO / TITLE: - Cytomegalovirus in
renal transplantation.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2001
Apr;12(4):848-55.
AUTORES
/ AUTHORS: - Brennan DC
INSTITUCIÓN
/ INSTITUTION: - Department of Transplant Nephrology,
Barnes-Jewish Hospital, Washington University School of Medicine, 6107 Queeny
Tower, One Barnes-Jewish Hospital Plaza, St. Louis, MO 63110, USA. brennand@msnotes.wustl.edu
RESUMEN
/ SUMMARY: - Cytomegalovirus (CMV) was first isolated
from the salivary gland and kidney of two dying infants with cytomegalic
inclusion bodies and reported in 1956 (1). Two other laboratories isolated CMV
at approximately the same time. Thus, CMV was initially called “salivary gland
virus” or “salivary gland inclusion disease virus”. In 1960, Weller et al. (2)
proposed the use of the term cytomegalovirus. Klemola and Kaarianinen (3) first
described CMV mononucleosis, the principal presentation of previously healthy
individuals, in 1965. CMV was first isolated in a renal transplant patient in
1965, N. Ref:: 63
----------------------------------------------------
[41]
TÍTULO / TITLE: - Eradication of
parvovirus B19 infection after renal transplantation requires reduction of
immunosuppression and high-dose immunoglobulin therapy.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002 Oct;17(10):1840-2.
AUTORES
/ AUTHORS: - Liefeldt L; Buhl M; Schweickert B;
Engelmann E; Sezer O; Laschinski P; Preuschof L; Neumayer HH
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Charite,
Humboldt-University Berlin, Germany. lutz.liefeldt@charite.de N. Ref:: 17
----------------------------------------------------
[42]
TÍTULO / TITLE: - Recent advances in
immunosuppressive therapy for renal transplantation.
REVISTA
/ JOURNAL: - Semin Dial 2001 May-Jun;14(3):218-22.
AUTORES
/ AUTHORS: - Peddi VR; First MR
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and Hypertension,
Department of Internal Medicine, University of Cincinnati College of Medicine,
Cincinnati, Ohio 45267-0585, USA. ram.peddi@uc.edu
RESUMEN
/ SUMMARY: - Recent advances in immunosuppression have
focused on more effective, safer, and targeted therapies that have resulted in
improved short- and intermediate-term renal allograft survival. During the past
decade there has been a marked decrease in acute rejection rates following
renal transplantation because of the use of newer immunosuppressive agents.
Recent data indicate that the average yearly reduction in the relative hazard
of graft failure beyond 1 year was 4.2% for all recipients (0.4% for those
recipients who had an acute rejection episode and 6.3% for those who did not
have an acute rejection). Despite these improvements the currently available
immunosuppressive agents are associated with significant cardiovascular risk
factors, an increased risk of infection, and the development of malignancies in
the long term. Predictive parameters of donor-specific hyporesponsiveness are
needed so as to allow identification of patients in whom immunosuppressive
therapy can be safely reduced. Immunosuppressive agents that have recently been
approved for use in the United States and those that are in clinical and
preclinical studies are discussed. N.
Ref:: 27
----------------------------------------------------
[43]
TÍTULO / TITLE: - Preimplantation renal
biopsy: structure does predict function.
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 15;75(3):264-6.
AUTORES
/ AUTHORS: - D’Agati VD; Cohen DJ
INSTITUCIÓN
/ INSTITUTION: - Columbia University College of Physicians
and Surgeons, New York, NY, USA. N.
Ref:: 11
----------------------------------------------------
[44]
TÍTULO / TITLE: - Epstein-Barr
virus-associated extranodal NK/T-cell lymphoma, nasal type of the hypopharynx,
in a renal allograft recipient: case report and review of literature.
REVISTA
/ JOURNAL: - Hum Pathol 2001 Nov;32(11):1264-8.
AUTORES
/ AUTHORS: - Stadlmann S; Fend F; Moser P; Obrist P;
Greil R; Dirnhofer S
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, University of
Innsbruck, Innsbruck, Austria.
RESUMEN
/ SUMMARY: - Posttransplant lymphoproliferative
disorders (PTLPDs) are predominantly B-cell lymphoproliferations, whereas a
T-cell origin is rarely observed. In contrast to B-cell PTLPD, T-cell PTLPDs
show an inconsistent association with Epstein-Barr virus (EBV). Until now, only
13 cases of EBV-associated T-cell PTLPDs have been reported. We describe a case
of an EBV-associated T-cell PTLPD in a renal allograft recipient 2 years after
transplantation. Histologic examination showed medium- to large-sized lymphoid
cells with an angiocentric growth pattern and necrosis. The atypical cells showed
a CD2+, CD3epsilon+, CD7+, CD43+, CD45R0+, CD56+, and CD4-, CD5-, CD8- betaF1-
phenotype with expression of the latent membrane protein (LMP)-1 of EBV. In
addition, EBV-specific RNAs (EBER ½) were identified by in situ hybridization.
Molecular analysis of the T-cell receptor (TCR) gamma chain by polymerase chain
reaction (PCR) showed a polyclonal pattern. The morphologic,
immunohistochemical, and molecular findings were consistent with a diagnosis of
an EBV-associated extranodal natural killer (NK)/T-cell non-Hodgkin lymphoma
(NHL) of nasal type. To our knowledge, this is the first reported case of this
rare entity in the posttransplant setting.
N. Ref:: 18
----------------------------------------------------
[45]
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
----------------------------------------------------
[46]
TÍTULO / TITLE: - Renal transplant artery
stenosis.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Jul;18 Suppl 5:v74-7.
AUTORES
/ AUTHORS: - Buturovic-Ponikvar J
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, University
Medical Center, Ljubljana, Slovenia. jadranka.buturovic@mf.uni-lj.si
RESUMEN
/ SUMMARY: - Renal transplant artery stenosis is a
relatively frequent complication after transplantation, with an incidence of up
to 23% being reported. The gold standard for the diagnosis still remains renal
arteriography. Several imaging techniques are available to confirm the
diagnosis (duplex-Doppler, nuclear magnetic resonance, spiral computerized
tomography), and their use depends, in part, on the centre’s experience. The
treatment can either be conservative (providing graft perfusion is not
jeopardized) or by revascularization (surgical or percutaneous transluminal
angioplasty). There are several unresolved questions concerning
revascularization of the graft: whether and when to intervene? Is the stenosis
progressive in the long term? Is hypertension alone an indication for
angioplasty? How do we assess the haemodynamic significance of the stenosis?
What is a significant stenosis-50, 60, 80 or 90%? Is stenosis ‘good’ for
something? In Slovenia, since 1990, all renal transplant recipients are
screened regularly for the presence of stenosis by duplex-Doppler (performed by
nephrologists), and also in cases of deterioration of graft function or
hypertension. In the majority of patients with a diagnosed stenosis, the latter
was found to be stable over time (assessed by regular Doppler, graft function
and hypertension control). In some patients, spontaneous regression of the
stenosis was observed. Frequent Doppler assessment of these patients helps to
be more conservative with angioplasty and angiography. Deterioration of graft
function (with stenosis diagnosed by Doppler) is the main indication for
angiography (and angioplasty). Better definition of significant stenosis and
randomized studies comparing conservative treatment vs angioplasty are
warranted. Duplex-Doppler seems to be the ideal screening and follow-up test. N. Ref:: 19
----------------------------------------------------
[47]
TÍTULO / TITLE: - Kidney transplantation:
graft monitoring and immunosuppression.
REVISTA
/ JOURNAL: - World J Surg 2002 Feb;26(2):185-93. Epub
2001 Dec 17.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00268-001-0206-1
AUTORES
/ AUTHORS: - Fisher JS; Woodle ES; Thistlethwaite JR Jr
INSTITUCIÓN
/ INSTITUTION: - Section of Transplantation, Department of
Surgery, University of Tennessee, Room A-202, Memphis,Tennessee 38103, USA.
RESUMEN
/ SUMMARY: - Renal transplantation has become the
preferred means of treating end-stage renal disease. Episodes of allograft
rejection have become the exception rather than the rule. The development of
real-time ultrasound-guided allograft biopsy and adoption of the Banff criteria
for histologic evaluation permit safe,accurate monitoring of graft histology.
New immunosuppressive agents have drastically reduced the number of episodes of
both primary and refractory rejection. Novel biologic agents in the form of
monoclonal antibodies and soluble receptor hybrid molecules may serve to reduce
the required doses of toxic chemical immunosuppressants and provide more
specific immune suppression directed at those elements of the immune system
involved in rejection of a given allograft. Development of assays to identify
patients who demonstrate donor antigen-specific hyporeactivity is now feasible.
Hopefully, these assays will serve as a guide for the reduction and possible
removal of immunosuppressive agents from stable renal allograft
recipients. N. Ref:: 81
----------------------------------------------------
[48]
TÍTULO / TITLE: - Laparoscopic donor
nephrectomy.
REVISTA
/ JOURNAL: - Br J Surg 2003 Nov;90(11):1323-32.
●●
Enlace al texto completo (gratuito o de pago) 1002/bjs.4340
AUTORES
/ AUTHORS: - Handschin AE; Weber M; Demartines N;
Clavien PA
INSTITUCIÓN
/ INSTITUTION: - Department of Visceral and Transplant
Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich,
Switzerland.
RESUMEN
/ SUMMARY: - BACKGROUND: Living kidney donation
represents an important source of organs for patients with end-stage renal
failure. Over the past decade, laparoscopic donor nephrectomy has replaced the
conventional open procedure in many transplant centres. Using evidence-based
methods, this study examines the current status of laparoscopic donor
nephrectomy. METHOD: A Medline literature search (PubMed database, 1999-2002)
and manual cross-referencing were performed to identify all articles relating
to laparoscopic donor nephrectomy. Safety and efficacy criteria were analysed
systematically for each study. Studies included were categorized using an evidence-based
level grading system. RESULTS: Of 687 publications, 20 studies with level I-II
evidence and 12 with level III evidence were analysed. Only one level I study
could be identified. Level I and level II evidence suggests superiority of the
laparoscopic approach in regard to postoperative analgesic consumption,
hospital stay and return to work. Other safety and efficacy criteria, including
donor and recipient outcomes, were similar between the two techniques.
CONCLUSION: Laparoscopic donor nephrectomy has gained community acceptance by
physicians and patients over the past decade. Despite a lack of strong
evidence, such as large prospective randomized studies, laparoscopic donor
nephrectomy is likely to become the ‘gold standard’ for donor nephrectomy in
the near future. N.
Ref:: 78
----------------------------------------------------
[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: - Maintenance
immunosuppression in the renal transplant recipient: an overview.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S25-35.
AUTORES
/ AUTHORS: - Gaston RS
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, University of
Alabama at Birmingham, Birmingham, AL 35294, USA. rgaston@nrtc.uab.edu
RESUMEN
/ SUMMARY: - Managing maintenance immunosuppressive
regimens after kidney transplantation is often challenging and confusing,
requiring careful attention to efficacy, dosing, adverse effects, and costs of
multiple medications. Most protocols combine a primary immunosuppressant
(cyclosporine or tacrolimus) with one or two adjunctive agents (azathioprine,
mycophenolate mofetil, sirolimus, corticosteroids). Avoiding drug-drug interactions
is a major part of effective immunosuppressant management, and special
situations (eg, pregnancy, intravenous dosing, caring for minority patients)
can prove especially daunting. This review summarizes available data regarding
current practices in maintenance immunosuppression, emphasizing issues that
arise in day-to-day management of renal transplant recipients. N. Ref:: 69
----------------------------------------------------
[51]
TÍTULO / TITLE: - Minimization of
immunosuppression in kidney transplantation. The need for immune monitoring.
REVISTA
/ JOURNAL: - Transplantation 2001 Oct 27;72(8
Suppl):S32-5.
AUTORES
/ AUTHORS: - Hricik DE; Heeger PS
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Case Western
Reserve University, Cleveland, Ohio, USA. deh5@po.cwru.edu N. Ref:: 16
----------------------------------------------------
[52]
TÍTULO / TITLE: - Atypical generalized
zoster with suspicious esophageal involvement and early relapse in an adult
renal transplant recepient.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Jun;34(4):1174-7.
AUTORES
/ AUTHORS: - Oh KH; Ahn C; Kim YS; Han JS; Kim S; Lee
JS; Kim EC; Oh MD; Chung JH
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine, Seoul National
University Hospital, Seoul, North Korea.
N. Ref:: 18
----------------------------------------------------
[53]
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.
----------------------------------------------------
[54]
TÍTULO / TITLE: - Ultrasonography in
renal transplantation.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2002 Apr;39(4):663-78.
AUTORES
/ AUTHORS: - O’neill WC; Baumgarten DA
INSTITUCIÓN
/ INSTITUTION: - Renal Division, Department of Medicine,
Emory University School of Medicine, Atlanta, GA 30322, USA. woneill@emory.edu
RESUMEN
/ SUMMARY: - Sonography is a simple, inexpensive, and
readily available imaging modality that has become an essential component of
the management of renal transplantation. It is indicated in almost all patients
with acute renal failure and also is useful in the evaluation of pain,
infection, and hematuria and the performance of percutaneous biopsy. Although
many aspects of sonography are similar in native and transplanted kidneys,
there are important differences and problems unique to the renal allograft,
which form the basis for this review. The anatomy of renal transplantation and
changes that accompany parenchymal disorders are discussed, but particular
attention focuses on problems related to the urinary tract, fluid collections,
and vascular disorders. By becoming more familiar with transplant sonography,
nephrologists will be better able to incorporate this indispensable tool into
the care of their patients. N.
Ref:: 66
----------------------------------------------------
[55]
TÍTULO / TITLE: - The case against
protocol kidney biopsies.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Aug;34(5):1716-8.
AUTORES
/ AUTHORS: - Ponticelli C; Banfi G
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, IRCCS Ospedale
Maggiore di Milano, Via Commenda 15, 20122 Milan, Italy. ponticelli@policlinico.mi.it N. Ref:: 30
----------------------------------------------------
[56]
TÍTULO / TITLE: - Protocol biopsies in
renal transplant patients: three-years’ follow-up.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Mar;34(2):500-1.
AUTORES
/ AUTHORS: - Veronese FV; Noronha IL; Manfro RC;
Edelweiss MI; Goldberg J; Oliveira SG; Oliveira IB; Leitao TG; Goncalves LF
INSTITUCIÓN
/ INSTITUTION: - Renal Division, Hospital de Clinicas de
Porto Alegre and Post-Graduation Nephrology Program, Rio Grande do Sul Federal
University, Rua Ramiro Barcelos 2.350, Porto Alegre, RS 90035-003, Brazil.
----------------------------------------------------
[57]
TÍTULO / TITLE: - Sequential protocol
biopsies from renal transplant recipients show an increasing expression of
active TGF beta.
REVISTA
/ JOURNAL: - Transpl Int 2002 Dec;15(12):630-4. Epub
2002 Oct 19.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00147-002-0472-3
AUTORES
/ AUTHORS: - Jain S; Mohamed MA; Sandford R; Furness
PN; Nicholson ML; Talbot D
INSTITUCIÓN
/ INSTITUTION: - University Department of Surgery,
Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. sj34@le.ac.uk
RESUMEN
/ SUMMARY: - Chronic allograft nephropathy (CAN) is a
major cause of graft loss after renal transplantation. Implicated in the
pathogenesis of this complication is overproduction of the cytokine
transforming growth factor beta (TGF beta). In this study we measured changes
in CAN’s expression in stable patients early after transplantation, and studied
links with established risk factors for CAN, such as delayed graft function,
acute rejection, and cyclosporine exposure. We took biopsies from 40 renal
allografts at time of transplantation (pre-perfusion), and then, using
ultrasound guidance, at 1 week and 6 months after transplantation. An
immunofluorescence technique was used to stain sections for active TGF beta.
These were then assessed by semi-quantitative scanning laser confocal
microscopy. There was very little variation in active TGF-beta expression among
patients in their pre-perfusion biopsies. Expression had increased by 1 week
and then very significantly by 6 months ( P<0.0001). Patients who suffered
delayed graft function had increased TGF-beta expression at both time points.
There was no difference regarding donor type, acute rejection, and immunosuppressive
drug (cyclosporine or tacrolimus). There was no correlation between the amount
of TGF-beta expression at any time-point and isotope glomerular filtration rate
(GFR) at 12 months. This study demonstrated that in a group of stable renal
allograft recipients, TGF-beta expression in the kidney increased after
transplantation. As the study used protocol biopsies, this increase is unlikely
to be due to acute events, and probably represents a genuine increase.
----------------------------------------------------
[58]
TÍTULO / TITLE: - Long-term outcome of
ABO-incompatible renal transplantation.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):769-80.
AUTORES
/ AUTHORS: - Toma H; Tanabe K; Tokumoto T
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, Tokyo Women’s
Medical University, Tokyo, Japan. toma@kc.twmu.ac.jp
RESUMEN
/ SUMMARY: - Based on the long-term experience with
ABO-incompatible kidney transplantation, the following can be concluded: 1.
Renal transplantation across ABO incompatibility is an acceptable treatment for
patients with end-stage renal failure. [table: see text] 2. Long-term patient
and graft survival in ABO-incompatible kidney transplantation is influenced
primarily by acute rejection episodes occurring within 1 year. 3. Despite the
removal of anti-ABO natural antibodies before transplantation, hyperacute
rejection crises may occur in some cases. 4. Humoral rejection is the most
prominent type of rejection in ABO-incompatible renal transplantation. Even
though most of this rejection is controllable with anti-rejection therapy, the
prognosis for a graft that undergoes humoral rejection is significantly poor.
5. The maximum IgG titers of anti-A/B antibody before transplantation may have
a harmful effect on graft acceptance in ABO-incompatible kidney
transplantation. 6. Renal transplantation across ABO incompatibility is
principally the most significant risk factor to affect long-term allograft
function in ABO-incompatible living kidney transplantation. N. Ref:: 24
----------------------------------------------------
[59]
TÍTULO / TITLE: - Tailoring
immunosuppressive therapy in renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2478-9.
AUTORES
/ AUTHORS: - Vathsala A
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine, Singapore
General Hospital, Singapore. N.
Ref:: 13
----------------------------------------------------
[60]
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.
----------------------------------------------------
[61]
TÍTULO / TITLE: - Diagnosis of acute
renal allograft rejection: evaluation of the Banff 97 Guidelines for Slide
Preparation.
REVISTA
/ JOURNAL: - Transplantation 2002 May 15;73(9):1518-21.
AUTORES
/ AUTHORS: - McCarthy GP; Roberts IS
INSTITUCIÓN
/ INSTITUTION: - Department of Histopathology, Manchester
Royal Infirmary, Manchester, United Kingdom.
RESUMEN
/ SUMMARY: - BACKGROUND: Arteritis and tubulitis, the
diagnostic features of acute renal allograft rejection, are typically focal
lesions. To avoid under-diagnosis, the Banff ‘97 schema recommends the
preparation of multiple slides, of which three should be stained with
hematoxylin and eosin (H&E) and three with periodic acid-Schiff (PAS) or
silver. In this study, we examine the validity of the Banff ‘97 recommendations
and determine how widely these recommendations are applied. METHODS: We
reviewed 52 consecutive renal transplant biopsy specimens showing both acute
tubulointerstitial and vascular rejection. Arteritis was graded for each
H&E slide, and tubulitis was graded for each H&E and PAS/silver. The
handling of renal allograft biopsy specimens in the U.K. was determined by
means of a questionnaire. RESULTS: When two, as opposed to three, H&E
slides were examined, arteritis was missed in 11.4% of cases; when only one
H&E slide was examined, arteritis was missed in 33.3% of cases. When only
one, as opposed to three, PAS/silver slide was examined, tubulitis was
under-graded in 33.3% of cases. In the U.K., 40% of laboratories stain at least
three slides with H&E, and 42% stain at least three slides with PAS/silver.
Only 30% of laboratories conform to all the Banff guidelines for slide
preparation. CONCLUSIONS: There is likely to be significant under-diagnosis and
under-grading of acute rejection if the Banff ‘97 guidelines for slide
preparation are not implemented. Most laboratories in the U.K. do not conform
to these guidelines.
----------------------------------------------------
[62]
TÍTULO / TITLE: - Protocol biopsies
should be part of the routine management of kidney transplant recipients. Pro.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2002 Oct;40(4):671-3.
AUTORES
/ AUTHORS: - Rush D
INSTITUCIÓN
/ INSTITUTION: - Winnipeg Transplant Program Winnipeg,
Manitoba, Canada.
----------------------------------------------------
[63]
TÍTULO / TITLE: - Review. The resistive
index in renal Doppler sonography: where do we stand?
REVISTA
/ JOURNAL: - AJR Am J Roentgenol 2003
Apr;180(4):885-92.
AUTORES
/ AUTHORS: - Tublin ME; Bude RO; Platt JF
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, University of
Pittsburgh School of Medicine, 200 Lothrop St., Pittsburgh, PA 15213, USA. N. Ref:: 98
----------------------------------------------------
[64]
TÍTULO / TITLE: - Kidney morcellation in
laparoscopic nephrectomy for tumor: recommendations for specimen sampling and
pathologic tumor staging.
REVISTA
/ JOURNAL: - Am J Surg Pathol 2001 Sep;25(9):1158-66.
AUTORES
/ AUTHORS: - Rabban JT; Meng MV; Yeh B; Koppie T;
Ferrell L; Stoller ML
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, University of
California, San Francisco 94143, USA. josra@itsa.ucsf.edu
RESUMEN
/ SUMMARY: - Laparoscopic nephrectomy is a novel
approach for small renal tumors in selected patients; however, removal of the
kidney through the small laparoscopic abdominal wall incision site requires the
kidney to be morcellated into small fragments while still in situ. Morcellation
presents two problems for the pathologist. First, guidelines for optimal
sampling of morcellated fragments have not been described. Second, morcellation
precludes complete pTNM tumor staging, in particular, tumor size, margins, and
renal vein involvement. Based on our initial experience with 23 laparoscopic
nephrectomies/nephroureterectomies (13 clinically suspected neoplasms,
confirmed pathologically as renal cell carcinoma [RCC, n = 7], urothelial
carcinoma of the renal pelvis [n = 3], angiomyolipoma [n = 1], and cystic
nephroma [n = 1], and 10 clinically benign entities) and a conservative
statistical model, we present a decision analysis model of various specimen
sampling protocols that optimize cost, labor, or time to diagnosis (single vs
sequential sampling). Using the tumor-to-kidney volume ratio (TKR), calculated
from preoperative radiologic imaging and specimen gross weight, several
specimen sampling algorithms were compared. For the average situation in which
TKR is > or =0.15, the algorithm that most significantly optimizes cost and
labor is one that initially samples 5% of the morcellated specimen. However,
additional sampling may be required in one fourth of the cases. The optimal
amount of sampled tissue may indeed be less than 5% because this assumes no
suspicious tissue is grossly visible and in all our cases of RCC grossly
visible tumor was identified. Additional nomograms for a spectrum of TKR,
sampling success, and cost are presented to allow pathologists their own
discretion in determining optimal sampling of the morcellated kidney. Tumor
staging is severely limited by morcellation. Tumor size, renal capsule
involvement, and renal vein involvement cannot be fully pathologically
evaluated for RCC, whereas invasion cannot be definitively assessed for
urothelial carcinoma of the renal pelvis. Knowledge of the radiologic features
(lesion size, capsule, and vein involvement) is important in sampling and
staging morcellated kidneys removed laparoscopically.
----------------------------------------------------
[65]
TÍTULO / TITLE: - Evolution of
immunosuppression and continued importance of acute rejection in renal
transplantation.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S2-9.
AUTORES
/ AUTHORS: - Chan L; Gaston R; Hariharan S
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine, University
of Colorado Health Sciences Center, Denver, CO 80262, USA. Larry.Chan@uchsc.edu
RESUMEN
/ SUMMARY: - As steady improvement in short-term kidney
graft survival and long-term outcomes prolongs the lives of transplant
patients, responsibility for their care is shifting away from transplant
specialists and into the hands of community nephrologists. Therefore, community
nephrologists need to have a deeper understanding of immunosuppressive therapies
than ever before. Pharmacologic immunosuppression has been continuously
evolving over the past two decades. Azathioprine was introduced in the early
1960s. Introduction of cyclosporine (CsA) in 1983 revolutionized short-term
outcomes after renal transplantation. The first monoclonal antibody
immunosuppressant, OKT3, was introduced in 1986. The 1990s saw the introduction
of a number of important new agents, including mycophenolate mofetil (MMF),
tacrolimus, and a microemulsion CsA, as well as two new monoclonal antibodies.
Combinations of these new agents, along with improving clinical care, have
produced 1-year patient survival approaching 100% and graft survival exceeding
90%. The newest class of agents, the first of which is sirolimus, is called target
of rapamycin (TOR) inhibitors and is used with CsA for maintenance therapy.
Immunosuppressive drug therapy after kidney transplantation continues to
evolve. There is a variety of pharmacologic combinations from which to choose,
based on immunologic risk and side effect profiles. As new regimens are
developed, ongoing communications between the transplant center and community
nephrologists will be required to implement therapeutic changes and optimize
patient care successfully. N.
Ref:: 59
----------------------------------------------------
[66]
TÍTULO / TITLE: - Promising early
outcomes with a novel, complete steroid avoidance immunosuppression protocol in
pediatric renal transplantation.
REVISTA
/ JOURNAL: - Transplantation 2001 Jul 15;72(1):13-21.
AUTORES
/ AUTHORS: - Sarwal MM; Yorgin PD; Alexander S; Millan
MT; Belson A; Belanger N; Granucci L; Major C; Costaglio C; Sanchez J; Orlandi
P; Salvatierra O Jr
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Stanford University
Medical Center, 703 Welch Road, Suite H-5, Palo Alto, CA 94304, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Corticosteroids have been a
cornerstone of immunosuppression for four decades despite their adverse side
effects. Past attempts at steroid withdrawal in pediatric renal transplantation
have had little success. This study tests the hypothesis that a complete
steroid-free immunosuppressive protocol avoids steroid dependency for
suppression of the immune response with its accompanying risk of acute
rejection on steroid withdrawal. METHODS: An open labeled prospective study of
complete steroid avoidance immunosuppressive protocol was undertaken in 10
unsensitized pediatric recipients (ages 5-21 years; mean 14.4 years) of first
renal allografts. Steroids were substituted with extended daclizumab use, in
combination with tacrolimus and mycophenolate mofetil. Protocol biopsies were
performed in the steroid-free group at 0, 1, 3, 6, and 12 months
posttransplantation. Clinical outcomes were compared to a steroid-based group
of 37 matched historical controls. RESULTS: Graft and patient survival was 100%
in both groups. Clinical acute rejection was absent in the steroid-free group
at a mean follow-up time of 9 months (range 3-13.7 months). Protocol biopsies
in the steroid-free group (includes 10 patients at 3 months, 7 at 6 months, and
4 at 12 months) revealed only two instances of mild (Banff 1A) subclinical
rejection (reversed by only a nominal increase in immunosuppression) and no
chronic rejection. At 6 months the steroid-free group had no hypertension
requiring treatment (P=0.003), no hypercholesterolemia (P=0.007), and
essentially no body disfigurement (P=0.0001). Serum creatinines, Schwartz GFR,
and mean delta height Z scores trended better in the steroid-free group. In the
steroid-free group, one patient had cytomegalovirus disease at 1 month and
three had easily treated herpes simplex stomatitis, but with no significant
increase in bacterial infections or rehospitalizations over the steroid-based
group. The steroid-free group was more anemic early posttransplantation
(P=0.004), suggesting an early role of steroids in erythrogenesis;
erythropoietin use normalized hematocrits by 6 months. CONCLUSIONS: Complete
steroid-free immunosuppression is efficacious and safe in this selected group
of children with no early clinical acute rejection episodes. This protocol
avoids the morbid side effects of steroids without increasing infection, and
may play a future critical role in avoiding noncompliance, although optimizing
renal function and growth.
----------------------------------------------------
[67]
TÍTULO / TITLE: - Humoral rejection in
kidney transplantation: new concepts in diagnosis and treatment.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002
Nov;11(6):609-18.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000040046.33359.cf
AUTORES
/ AUTHORS: - Mauiyyedi S; Colvin RB
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, University of
Texas-Houston, Health Sciences Center, USA.
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: Evidence from several
transplant centers indicates that a substantial proportion of acute and chronic
renal allograft rejection is caused by antibodies to donor antigens.
Antibody-mediated injury arises despite potent anti-T cell pharmacological
agents, and probably requires different therapy. RECENT FINDINGS: Acute humoral
rejection occurs in 20-30% of acute rejection cases, has a poorer prognosis
than cellular rejection, and is refractory to conventional immunosuppressive
therapy. C4d deposition in peritubular capillaries of renal allografts has been
demonstrated to be a sensitive and diagnostic in-situ marker of acute humoral
rejection that correlates strongly with the presence of circulating
donor-specific antibodies. Biopsies with chronic allograft arteriopathy or
glomerulopathy also have a high frequency of C4d deposition and donor-specific
antibodies. The vessels of other organs, notably the heart, can also be targets
of humoral rejection. New polyclonal C4d antibodies work in paraffin sections.
Pitfalls in C4d staining have been identified and must be considered in the
valid interpretation of results. SUMMARY: As the histology is variable, the
current diagnosis of humoral rejection in biopsies relies on the demonstration
of C4d, a component of the classical complement pathway, in peritubular
capillaries. The new classification of renal allograft rejection incorporates
humoral and cellular mechanisms of injury, with the diagnostic criteria of
each. This should prove useful in guiding clinical treatment, and stratifying
drug trials, replacing obsolete terms such as ‘vascular rejection’. Specific
therapeutic strategies for humoral rejection with controlled trials targeting
the humoral limb of immunosuppression are needed. N. Ref:: 47
----------------------------------------------------
[68]
TÍTULO / TITLE: - Genitourinary
tuberculosis after renal transplantation: report of 3 cases and review.
REVISTA
/ JOURNAL: - Clin Infect Dis 2001 Feb 15;32(4):662-6.
Epub 2001 Feb 7.
AUTORES
/ AUTHORS: - Dowdy L; Ramgopal M; Hoffman T; Ciancio G;
Burke G; Roth D; Mies C; Jones B; Miller J
INSTITUCIÓN
/ INSTITUTION: - Division of Infectious Diseases,
Department of Medicine, University of Miami School of Medicine, Miami, FL
33136, USA. ldowdy@med.miami.edu
RESUMEN
/ SUMMARY: - Mycobacterium tuberculosis infection of
the genitourinary tract is an uncommon disease in renal transplant recipients
and presentation is atypical. Genitourinary tuberculosis is associated with
graft rejection, and this diagnosis should be considered for renal transplant
recipients with unexplained fever and constitutional symptoms. N. Ref:: 8
----------------------------------------------------
[69]
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
----------------------------------------------------
[70]
TÍTULO / TITLE: - Therapeutic drug
monitoring of immunosuppressive drugs in kidney transplantation.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002
Nov;11(6):657-63.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000040053.33359.26
AUTORES
/ AUTHORS: - Holt DW
INSTITUCIÓN
/ INSTITUTION: - Analytical Unit, St George’s Hospital
Medical School, London, UK. d.holt@sghms.ac.uk
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: Drug monitoring has
become an accepted adjunct to optimizing therapy with immunosuppressive drugs.
This review assesses publications that relate to the analytical techniques used
to measure cyclosporin, tacrolimus, mycophenolic acid, sirolimus and
everolimus, as well as the clinical data obtained for these drugs. For all of
these drugs there has been a substantial and continuing investment in assessing
the clinical value of drug monitoring. RECENT FINDINGS: Fundamental
controversies still persist regarding which time point to use for monitoring.
The most significant single development has been the move towards using a timed
blood sample 2 h after drug administration (C2) to monitor cyclosporin therapy
with the Neoral formulation. The favourable clinical results obtained with this
approach have had an impact on reevaluating monitoring data for some of the
other drugs. The newest drugs to reach clinical evaluation, sirolimus and
everolimus, have been studied in the context of concentration-controlled dosing
and there is a good rationale for their measurement. There have also been
developments in the analytical techniques used, mostly to improve the
selectivity of the assays or to adapt them to new monitoring strategies.
SUMMARY: Interpretation of drug concentration data is becoming ever more
complex in this field as the number of potential drug combinations expands. The
relatively narrow therapeutic index of these agents and the ever-present risk
of clinically significant pharmacokinetic drug interactions makes drug
monitoring an important aspect of their prescription. N. Ref:: 77
----------------------------------------------------
[71]
TÍTULO / TITLE: - An induction versus
no-induction protocol in anticalcineurin-based immunosuppression using very
low-dose steroids.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Jun;33(4
Suppl):3S-10S.
AUTORES
/ AUTHORS: - Charpentier B
INSTITUCIÓN
/ INSTITUTION: - University Hospital of Bicetre, Le
Kremlin-Bicetre, France.
----------------------------------------------------
[72]
TÍTULO / TITLE: - Protocol biopsies
should be part of the routine management of kidney transplant recipients. Con.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2002 Oct;40(4):674-7.
AUTORES
/ AUTHORS: - Salomon DR
INSTITUCIÓN
/ INSTITUTION: - Department of Molecular and Experimental
Medicine, The Scripps Research Institute, and Center for Organ and Cell
Transplantation, Scripps Health, La Jolla, CA, USA.
----------------------------------------------------
[73]
TÍTULO / TITLE: - Laparoscopic live donor
nephrectomy. A review of the first 5 years.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):709-19.
AUTORES
/ AUTHORS: - Ratner LE; Montgomery RA; Kavoussi LR
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery and Pathology,
Thomas Jefferson University (LER), Philadelphia, Pennsylvania, USA. lloyd.ratner@mnil.tju.edu
RESUMEN
/ SUMMARY: - Laparoscopic live donor nephrectomy is
technically feasible. The operation has evolved over the last 5 years and is
greatly improved compared with the procedure originally described. Advantages
to the donor when compared with the standard open operation are decreased
postoperative pain, shorter hospitalization, a quicker recuperation, an earlier
return to driving, and an earlier return to employment. These improvements have
resulted in fewer lost wages and a lower financial burden for donors. Live
donor nephrectomy also provides improved cosmetic results. It successfully
removes many of the disincentives to live kidney donation and has resulted in
an increased willingness of individuals to donate their kidneys. The operative
risk seems to be equivalent to that of the open donor operation performed
through a flank approach. Although there is no financial advantage of the
laparoscopic operation in terms of hospital costs, the increase seen in live
donor transplantation may result in long-term cost savings overall. Kidneys
procured laparoscopically function well in recipents in the short and long
term. There is no increased risk for rejection or technical complications, and
the recipent’s length of hospitalization is unaffected. The laparoscopic donor
operation does not have any apparent deleterious effect on the recipient. The
procedure is being adopted rapidly by transplant centers around the world and
has been performed at more than 100 centers on five continents. The authors
believe that laparoscopic live donor nephrectomy will become the standard of
care in the not too distant future. N.
Ref:: 51
----------------------------------------------------
[74]
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.
----------------------------------------------------
[75]
TÍTULO / TITLE: - Reproducibility of the
Banff schema in reporting protocol biopsies of stable renal allografts.
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 Jun;17(6):1081-4.
AUTORES
/ AUTHORS: - Gough J; Rush D; Jeffery J; Nickerson P;
McKenna R; Solez K; Trpkov K
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, University of
Manitoba Health Sciences Centre, Winnipeg, Manitoba, Canada. gough@ucalgary.ca
RESUMEN
/ SUMMARY: - BACKGROUND: There is evidence that biopsy
of stable renal allografts may be of value in predicting chronic allograft
nephropathy, the main cause of graft loss. However, the reproducibility of such
histological evaluation has not been tested in this setting. We tested the reproducibility
of the Banff schema for this purpose. METHODS: We rated acute and chronic
changes in 184 protocol biopsies. Individual pathologists at two different
Canadian transplant centres reported independently. RESULTS: There was
agreement in 73.53, 42.86, and 77.08% of cases in assigning a diagnosis of
acute rejection, borderline changes (as defined in the schema), and no acute
rejection, respectively. Applying kappa statistics, there was very good
agreement in making the diagnosis of acute rejection vs no acute rejection
(kappa 0.77). There was good inter-observer agreement in scoring glomerulitis,
intimal arteritis, interstitial infiltrates, tubulitis, and arteriolar
hyalinosis. Rating chronic changes also gave good inter-observer agreement
(kappa=0.53, 0.65, and 0.62, respectively, for mild, moderate, and severe
chronic allograft nephropathy). Agreement on transplant glomerulopathy was,
however, poor. CONCLUSIONS: We conclude that the Banff classification provides
a reproducible method for the histological assessment of protocol renal
allograft biopsies in stable grafts. Such biopsies may be valuable in detecting
subclinical rejection and early chronic allograft nephropathy and may also be
used as surrogate end-points in the evaluation of therapy to prevent the
latter.
----------------------------------------------------
[76]
TÍTULO / TITLE: - Renal transplantation
and prostate cancer: guidelines for screening and treatment.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Dec;34(8):3196-9.
AUTORES
/ AUTHORS: - Whang M; Geffner S; Khachikian Z; Kumar A;
Bonomini L; Mulgaonkar S
INSTITUCIÓN
/ INSTITUTION: - Division of Transplantation, St Barnabas
Medical Center, Livingston, NJ, USA.
----------------------------------------------------
[77]
TÍTULO / TITLE: - The case for protocol
kidney biopsies.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Aug;34(5):1713-5.
AUTORES
/ AUTHORS: - Isoniemi H
INSTITUCIÓN
/ INSTITUTION: - Transplantation and Liver Surgery Clinic,
Helsinki University Hospital, Kasarmik 11, FIN 00130 Helsinki, Finland. N. Ref:: 21
----------------------------------------------------
[78]
TÍTULO / TITLE: - Chromomycosis due to
Exophiala jeanselmei in a renal transplant recipient.
REVISTA
/ JOURNAL: - Eur J Dermatol 2003 May-Jun;13(3):305-7.
AUTORES
/ AUTHORS: - Pena-Penabad C; Duran MT; Yebra MT;
Rodriguez-Lozano J; Vieira V; Fonseca E
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Complejo
Hospitalario Juan Canalejo, Servicio de Dermatologia, Xubias de Arriba, 84,
15006. a Coruna, España.
RESUMEN
/ SUMMARY: - Chromomycosis is a rare mycotic infection
that is more frequent in tropical and subtropical regions. Dematiaceous fungi
are the causal agents of this mycosis. Several cases of chromomycosis in organ
transplant recipients have been reported. We present a case of chromomycosis by
Exophiala jeanselmei in a Spanish male who had received a renal transplant
several months previously, and was receiving treatment with tacrolimus,
prednisone and mycophenolate mofetil. Very few cases of chromomycosis due to
Exophiala have been reported, and this is, to our knowledge, the first European
case. N. Ref:: 16
----------------------------------------------------
[79]
TÍTULO / TITLE: - Histological
alterations in implant and one-year protocol biopsy specimens of renal
allografts.
REVISTA
/ JOURNAL: - Transplantation 2001 Sep 27;72(6):1138-44.
AUTORES
/ AUTHORS: - Lehtonen SR; Taskinen EI; Isoniemi HM
INSTITUCIÓN
/ INSTITUTION: - Transplantation and Liver Surgery,
Department of Surgery, Helsinki University, FInland.
RESUMEN
/ SUMMARY: - BACKGROUND: The natural course of
histological changes and their correlations with clinical parameters have not
been studied in large numbers in renal allograft specimens. The aim of this
study was to determine whether any histological alterations developed during
the first posttransplantation year. Immunological and nonimmunological factors
possibly associated with subsequent histopathological changes and development
of chronic rejection were also assessed. METHODS: We studied 102 cadaveric
kidney allografts for which both implant and 1-year protocol biopsy specimens
were available. The chronic allograft damage index (CADI) was used to quantify
the extent of histological changes that developed during the first year.
RESULTS: Overall, an increase in histological alterations were seen during the
first posttransplantation year, and the CADI increased significantly. The mean
CADI was 0.7 in relation to implant biopsy samples and 2.9 in relation to
1-year biopsy samples (P<0.05). Although the degree of changes increased
during the first posttransplantation year, they were seldom severe. Significant
increases in incidences of interstitial inflammation and fibrosis, tubular
atrophy, and basement-membrane thickening were seen. Vascular intimal
proliferation and glomerular mesangial matrix increase and glomerular sclerosis
were also noted. In contrast, anisometric vacuolization in the tubular
epithelium decreased significantly in incidence during the first year. CADI
values 1 year after transplantation were significantly affected by donor age,
occurrence of acute rejection episodes, and prevalence of HLA-DR mismatches.
CADIs were also significantly higher in grafts with decreased function.
CONCLUSIONS: Histopathological alterations increased in almost every graft,
even well-functioning grafts, during the first year. The CADIs relating to
alterations seen in cases of chronic rejection increased significantly and were
strongly affected by both immunological and nonimmunological factors.
----------------------------------------------------
[80]
TÍTULO / TITLE: - Doppler examination of
the allografted kidney.
REVISTA
/ JOURNAL: - Acta Radiol 2003 Jan;44(1):3-12.
AUTORES
/ AUTHORS: - Jakobsen JA; Brabrand K; Egge TS; Hartmann
A
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, Rikshospitalet,
Oslo, Norway. j.a.jakobsen@labmed.uio.no
RESUMEN
/ SUMMARY: - A comprehensive ultrasound examination of
the transplanted kidney includes a Doppler examination. Duplex Doppler, color
Doppler and power Doppler can all reveal important information. In addition,
calculation of the resistance and pulsatility indices to quantify changes in
the spectral Doppler waveform can be of great help, particularly in the first
weeks and months following a transplantation. The Doppler part of the
examination should evaluate the vessels to and from the transplant, as well as
the parenchyma with calculations of indices to detect the presence of increased
vascular resistance. The conclusions drawn from the Doppler-derived information
combined with the results from gray-scale scanning and clinical information
will very often be of clinical significance for the handling of the patient. N. Ref:: 43
----------------------------------------------------
[81]
- Castellano -
TÍTULO / TITLE:Pielonefritis Xantogranulomatosa
asociada a embarazo, en rinon unico de antigua donante para trasplante.
Xanthogranulomatous pyelonephritis associated with pregnancy, in ex-transplant
donor with single kidney.
REVISTA
/ JOURNAL: - Actas Urol Esp. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aeu.es/actas/
●●
Cita: Actas Urológicas Españolas: <> 2002 Jan;26(1):20-3.
AUTORES
/ AUTHORS: - Ballesteros Sampol JJ; Ballesteros Monzo
C; Pares Puntas ME
INSTITUCIÓN
/ INSTITUTION: - Unidad Quirurgica de Trasplante Renal del
I.M.A.S. de Barcelona.
RESUMEN
/ SUMMARY: - We present the first case, up to our
knowledge, of XGP in pregnant woman, in solitary kidney (related living kidney
donor). Therapeutic abortion was not resolutive and nephron sparing surgery
(espeleostomy) was successfully performed. Fourteen years later the renal
function is still normal and 2/3 of renal parenchima are preserved. Literature
review is pointed out. N.
Ref:: 14
----------------------------------------------------
[82]
TÍTULO / TITLE: - Postural renal
transplant obstruction: a case report and review of the literature.
REVISTA
/ JOURNAL: - Clin Nucl Med 2001 Aug;26(8):673-6.
AUTORES
/ AUTHORS: - Cohn DA; Gruenewald S
INSTITUCIÓN
/ INSTITUTION: - Department of Nuclear Medicine and
Ultrasound, Westmead Hospital, Westmead, New South Wales, Australia.
RESUMEN
/ SUMMARY: - A 48-year-old woman underwent cadaveric
renal transplantation for end-stage renal failure secondary to polycystic
kidney disease. Nine months after transplantation, intermittent renal
dysfunction and severe graft hydronephrosis developed despite the presence of a
ureteric stent. A Tc-99m MAG3 scan performed with the patient standing showed
complete transplant obstruction. Rapid tracer clearance with progressive
bladder filling was present when the patient was imaged in the supine position.
Ureteric obstruction is the most common urologic complication of renal
transplantation. However, postural ureteric obstruction has been described only
rarely. This case indicates that posture may affect ureteric patency and
highlights this potential pitfall in the evaluation of intermittent graft
dysfunction by diuretic renography. N.
Ref:: 10
----------------------------------------------------
[83]
TÍTULO / TITLE: - Open vs laparoscopic
donor nephrectomy in renal transplantation.
REVISTA
/ JOURNAL: - Bju Int. Acceso gratuito al texto completo
a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.bjui.org/
●●
Cita: BJU International: <> 2002 Jan;89(2):162-8.
AUTORES
/ AUTHORS: - Lind MY; Ijzermans JN; Bonjer HJ
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, University Hospital
Rotterdam-Dijkzigt, The Netherlands. N.
Ref:: 37
----------------------------------------------------
[84]
TÍTULO / TITLE: - Laparoscopic surgery in
renal transplant recipients.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):759-67.
AUTORES
/ AUTHORS: - Desai MM; Gill IS
INSTITUCIÓN
/ INSTITUTION: - Section of Laparoscopic and Minimally
Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Cleveland,
Ohio, USA.
RESUMEN
/ SUMMARY: - An exponential increase has occurred in
the use of laparoscopic surgery in patients who have undergone prior renal
transplantation. The main indications are the treatment of symptomatic pelvic
lymphoceles and native kidney nephrectomy for various reasons. Most reports
have shown laparoscopy to be equally effective and less morbid than
conventional open surgery. In addition to conferring the benefits of a
minimally invasive approach, laparoscopy potentially offers three advantages
specific to this immunosuppressed population of patients. First, it avoids the
potential wound-related problems inherent in open surgery. Second, by reducing
hospitalization, it reduces the risk for nosocomial infections. Third, by
allowing an earlier resumption of oral intake, it enables the continuation of
oral immunosuppression. Proper perioperative management of fluid and
electrolyte balance is critical in this group of patients. Despite concerns,
there is no evidence showing that laparoscopy adversely affects allograft
function. N. Ref:: 40
----------------------------------------------------
[85]
TÍTULO / TITLE: - Molecular diagnosis of
viral infections in renal transplant recipients.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002
Nov;11(6):665-72.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000040054.33359.e8
AUTORES
/ AUTHORS: - Middeldorp JM
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, VU Medical Center,
Amsterdam, the Netherlands. j.middeldorp@vumc.nl
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: To discuss biological
and methodological aspects of virus infection monitoring in the renal
transplant setting. RECENT FINDINGS: New insights on the molecular pathogenesis
of acute and persistent virus infections and rapid developments in real-time
monitoring techniques are changing the current diagnostic routine. Accurate
risk-assessment prior to transplantation and quantitative monitoring of
parameters that reflect virus activity in the post-transplant period, including
genome load fluctuations and aberrant viral mRNA or protein expression, provide
early signs of undesired viral behaviour and allow pre-emptive therapeutic
intervention. As opposed to prophylactic administration of antiviral drugs, a
pre-emptive approach is more selective and will allow for antiviral immune
responses to build, which may have a long-term beneficial effect. In addition,
these virus-monitoring techniques allow for on-line assessment of therapeutic
efficacy and rapid identification of emerging resistant strains. The
combination of virus-monitoring techniques with rapid assessment of host immune
responses using FACS and ELISPOT techniques, will improve overall patient
management and long-term survival. SUMMARY: Viral infections continue to be a
significant complication in the transplant setting. Diagnostic monitoring
allows timely and accurate therapeutic intervention. Knowledge of pathogenic mechanisms
leading to disease is important for clinical decision making as well as for the
selection of appropriate molecular parameters discriminating normal and
disease-related activity of human pathogenic viruses. The increasing
availability of effective antiviral drugs permits pre-emptive intervention that
strongly depends on accurate viral monitoring procedures. N. Ref:: 57
----------------------------------------------------
[86]
TÍTULO / TITLE: - TGF-beta1 expression
and chronic allograft nephropathy in protocol kidney graft biopsy.
REVISTA
/ JOURNAL: - Physiol Res. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.biomed.cas.cz/physiolres/
●●
Cita: Physiological Research: <> 2003;52(3):353-60.
AUTORES
/ AUTHORS: - Viklicky O; Matl I; Voska L; Bohmova R;
Jaresova M; Lacha J; Lodererova A; Striz I; Teplan V; Vitko S
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Transplant
Center, Institute for Clinical and Experimental Medicine, Prague, Czech
Republic. ivo.matl@medicon.cz
RESUMEN
/ SUMMARY: - Chronic allograft nephropathy (CAN)
represents a frequent and irreversible cause of long-term renal graft loss.
TGF-beta1 is a key profibrogenic cytokine associated with CAN pathogenesis.
Because of clinical diagnostic inaccuracy, protocol biopsy has been suggested
to be a beneficial method for early CAN detection. Protocol core biopsy was
carried out in 67 consecutive cyclosporine-based immunosuppression-treated
kidney transplant recipients with stable renal function 12 months after renal
transplantation. Biopsy specimens were analyzed morphologically according to
Banff-97’ criteria and immunohistologically for TGF-beta1 staining. The data
obtained were correlated with plasma TGF-beta1 levels and clinical data. CAN
(grade I-III) was found in 51 patients (76 %). CAN grade I was found to be the
most frequent one (44 %). A normal finding within the graft was made in only 12
patients (18 %). Clinically silent acute rejection Banff IA was present in 4
patients (6 %). In 8 patients (12 %) with CAN, borderline changes were present.
We found a significant correlation between CAN grade and creatinine clearance,
as measured by the Cockroft-Gault formula (p<0.01) as well as body mass
index (p<0.01). There was a significant correlation between chronic
vasculopathy (Banff cv) and creatinine clearance, and between the degree of
TGF-beta1 staining and chronic vasculopathy (p<0.01). There were no
relations between morphological findings and TGF-beta1 plasma levels,
cyclosporine levels, plasma lipids, HLA-mismatches, panel reactive antibodies
(PRA), proteinuria, and the donor’s age. In conclusion, CAN is a frequent
finding in protocol kidney graft biopsies 12 months after transplantation.
TGF-beta1 tissue expression is linked with chronic vasculopathy.
----------------------------------------------------
[87]
TÍTULO / TITLE: - Evaluation of
prospective living renal donors for laparoscopic nephrectomy with multisection
CT: the marriage of minimally invasive imaging with minimally invasive surgery.
REVISTA
/ JOURNAL: - Radiographics. Acceso gratuito al texto
completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://radiographics.rsnajnls.org/
●●
Cita: Radiographics: <> 2001 Oct;21 Spec No:S223-36.
AUTORES
/ AUTHORS: - Rydberg J; Kopecky KK; Tann M; Persohn SA;
Leapman SB; Filo RS; Shalhav AL
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, Indiana
University Hospital, 550 N University Blvd, Rm 0279, Indianapolis, IN
46202-5253, USA. jrydberg@iupui.edu
RESUMEN
/ SUMMARY: - Laparoscopic technique for excision of a
kidney from a living donor has advantages over conventional open surgery, but
operative visibility and surgical exposure are limited. Preoperative
multisection computed tomography (CT) can provide necessary anatomic
information in a minimally invasive procedure. A three-phase examination is
suggested: (a) imaging from the top of the kidneys to the pubic symphysis with
a section width of 2.5 mm and no contrast medium, (b) scanning of the kidneys
and upper pelvis during the arterial phase of enhancement with a section width
of 1.0 mm, and (c) scanning of the kidneys and upper retroperitoneum during the
nephrographic phase of enhancement with a section width of 1.0 mm. Emphasis in
this article is placed on analysis of the venous anatomy because most
radiologists are unfamiliar with the anatomic variations. Conventional
radiography of the abdomen and pelvis is performed after CT to evaluate the
collecting system and ureters and to provide a lower total radiation dose than
if CT were used. Of several postprocessing techniques that may be used, the
authors prefer maximum intensity projection for arterial evaluation and
multiplanar reformatting for venous evaluation. N. Ref:: 14
----------------------------------------------------
[88]
TÍTULO / TITLE: - Serial protocol
biopsies to quantify the progression of chronic transplant nephropathy in
stable renal allografts.
REVISTA
/ JOURNAL: - Am J Transplant 2001 May;1(1):82-8.
AUTORES
/ AUTHORS: - Moreso F; Lopez M; Vallejos A; Giordani C;
Riera L; Fulladosa X; Hueso M; Alsina J; Grinyo JM; Seron D
INSTITUCIÓN
/ INSTITUTION: - Nephrology Department, Hospital de
Bellvitge, Barcelona, España.
RESUMEN
/ SUMMARY: - AIM: To evaluate the utility of intimal
thickness and interstitial width as a primary efficacy variable in the design
of clinical trials aimed to modify the natural history of chronic allograft
nephropathy. METHODS: A donor and a 4-month protocol biopsy were evaluated in
40 stable grafts according to the Banff schema. In 27 patients, a second
protocol biopsy was done at 1 yr. Arterial intimal volume fraction
(Vvintima/artery) and cortical interstitial volume fraction
(Vvinterstitium/cortex) were estimated with a point counting technique.
RESULTS: Chronic Banff scores increased during follow-up, while acute scores
reached its peak at 4 months. Vvintima/artery and Vvinterstitium/cortex
significantly increased at 4 months, but not at 1 yr. Vvintima/artery at 4
months correlated with donor Vvintima/artery (r = 0.57, p < 0.001),
histocompatibility (r = 0.38, p = 0.01) and serum cholesterol (r = 0.31, p =
0.047). Vvinterstitium/cortex at 4 months correlated with recipient body
surface area (r = 0.44, p = 0.004) and delayed graft function (p = 0.016).
Power calculations showed that Vvintima/artery and Vvinterstitium/cortex allow
an important reduction in minimum sample size of a hypothetical trial aimed to
prevent chronic allograft nephropathy. CONCLUSIONS: Intimal thickening and
interstitial widening progresses rapidly during the first 4 months after
transplantation and slowly thereafter. These parameters can be considered as a
primary efficacy variable in trials aimed to prevent chronic allograft
nephropathy.
----------------------------------------------------
[89]
TÍTULO / TITLE: - Laparoscopic donor
nephrectomy: why not?
REVISTA
/ JOURNAL: - Arch Esp Urol 2002 Jul-Aug;55(6):714-20.
AUTORES
/ AUTHORS: - Jacobs SC; Cho E
INSTITUCIÓN
/ INSTITUTION: - Divisions of Urology and Videoscopic
Surgery, Department of Surgery, University of Maryland School of Medicine,
Baltimore, Maryland, USA. sjacobs@smail.umaryland.edu
RESUMEN
/ SUMMARY: - OBJECTIVES: Laparoscopic donor nephrectomy
has undergone explosive worldwide growth as the method of choice for removal of
living donor kidneys. However, the method does have some distinct disadvantages
as well. The objective is to define real and potential difficulties with the
generalized uncritical acceptance of this surgical technique. METHODS: The
literature and personal experience at the largest laparoscopic donor program
were reviewed and consolidated. Critical areas of technique and management were
analyzed. RESULTS: Laparoscopic living donor nephrectomy has increased the pool
of willing potential renal donors. In experienced has the recipient renal
function results are equivalent to open nephrectomy. CONCLUSIONS: There are
risks in performing the operation to the donor and to the allograft. These
risks are potentially catastrophic and mitigate against any casual attitudes
about embarking on a laparoscopic donor nephrectomy program. N. Ref:: 27
----------------------------------------------------
[90]
TÍTULO / TITLE: - Helical CT in renal
transplantation: normal findings and early and late complications.
REVISTA
/ JOURNAL: - Radiographics. Acceso gratuito al texto
completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://radiographics.rsnajnls.org/
●●
Cita: Radiographics: <> 2001 Sep-Oct;21(5):1103-17.
AUTORES
/ AUTHORS: - Sebastia C; Quiroga S; Boye R; Cantarell
C; Fernandez-Planas M; Alvarez A
INSTITUCIÓN
/ INSTITUTION: - Institute for Diagnostic Imaging, Hospital
General Universitari Vall d’Hebron, Passeig Vall d’Hebron 119-129, Barcelona
08035, España. sebastia@hg.vhebron.es
RESUMEN
/ SUMMARY: - Over a 5-year period, 346 helical computed
tomographic (CT) studies were performed in renal transplant recipients. Helical
CT proved useful in this context by depicting parenchymal, perirenal, renal
sinus, pyeloureteral, and vascular complications in great detail. CT often
delineates fluid collections and their anatomic relationship to adjacent structures
better than ultrasonography (US), particularly in obese patients. CT-guided
puncture and drainage can be performed in cases in which US is deemed
inadequate. CT angiography can depict arterial diseases such as stenosis,
thrombosis, arteriovenous fistulas, aneurysms, and pseudoaneurysms in the graft
artery and in the recipient iliac arterial system, thereby obviating
conventional angiography in some cases. Helical CT with three-dimensional image
reformatting allows accurate imaging of the entire course of ureteral and
periureteral diseases (eg, hydronephrosis, ureteral leak and stricture,
pyeloureteral obstruction). CT can be used in the confirmation and staging of
malignancies of the renal parenchyma and urothelium. It is also helpful in
evaluating associated disease in the native kidneys, acute and chronic
rejection, graft embolization, and end-stage disease. Although US and nuclear
medicine examination are the imaging modalities of choice in renal
transplantation, helical CT is a valuable alternative when these techniques are
inconclusive. N.
Ref:: 28
----------------------------------------------------
[91]
TÍTULO / TITLE: - Complications of renal
transplantation: MR findings.
REVISTA
/ JOURNAL: - J Comput Assist Tomogr 2001
Nov-Dec;25(6):836-42.
AUTORES
/ AUTHORS: - Fang YC; Siegelman ES
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, University of
Pennsylvania Medical Center, Philadelphia, PA 19104-4283, USA.
RESUMEN
/ SUMMARY: - Because of its direct multiplanar
capability, superb soft tissue contrast and ability to obtain dynamic
three-dimensional angiograms using contrast agents without nephrotoxicity,
magnetic resonance (MR) imaging and magnetic resonance angiography are ideal
techniques for evaluating renal transplants. The following pictorial essay
reviews the normal MR appearance of the transplant kidney as well as
parenchymal, vascular, and peritransplant complications. N. Ref:: 14
----------------------------------------------------
[92]
TÍTULO / TITLE: - Laparoscopic live donor
nephrectomy for transplantation: urgent need for standardising procedures.
REVISTA
/ JOURNAL: - Transpl Int 2001;14(1):52-4.
AUTORES
/ AUTHORS: - Mosimann F; Bettschart V; Schneider R N. Ref:: 23
----------------------------------------------------
[93]
TÍTULO / TITLE: - Hand-assisted
laparoscopic renal surgery: current trends and applications.
REVISTA
/ JOURNAL: - Arch Esp Urol 2002 Jul-Aug;55(6):756-66.
AUTORES
/ AUTHORS: - Yohannes P; Smith AD; Lee BR
INSTITUCIÓN
/ INSTITUTION: - Long Island Jewish Medical Center, New
Hyde Park, New York, USA.
RESUMEN
/ SUMMARY: - OBJECTIVE: Hand-assisted laparoscopic
surgery has recently been introduced in order to help ease the learning process
associated with standard laparoscopic surgery. It has various urological
applications in the management of malignant and benign disease of the kidney.
The purpose of this study is to review the applications and the success rate
associated with hand-assisted laparoscopic surgery. METHODS: A comprehensive
literature review of hand-assisted urological surgery was performed using
MEDLINE search. RESULTS: Hand-assisted laparoscopic nephrectomy has been
performed for benign and malignant disease, donor renal transplant, and nephron
sparing surgery with good success. Patients who undergo the hand-assisted
procedure seem to have less perioperative morbidity than those who undergo an
open procedure. This approach minimized the warm-ischemia time in renal
transplantation. CONCLUSION: Hand-assisted nephrectomy is a useful tool facilitating
the learning process in laparoscopy. N.
Ref:: 44
----------------------------------------------------
[94]
TÍTULO / TITLE: - Rectal cancer following
a kidney-pancreas transplant.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Jun;34(4):1189-90.
AUTORES
/ AUTHORS: - Dabney A; Longo WE; Garvin PJ
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, St. Louis
University School of Medicine, St. Louis, Missouri 63110, USA. N. Ref:: 14
----------------------------------------------------
[95]
TÍTULO / TITLE: - Renal transplantation
dysfunction: the role of interventional radiology.
REVISTA
/ JOURNAL: - Clin Radiol 2002 Sep;57(9):772-83.
AUTORES
/ AUTHORS: - Sandhu C; Patel U
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, St George’s Hospital,
London, UK.
RESUMEN
/ SUMMARY: - The aim of this article is to review the
radiological management of complications following renal transplant. N. Ref:: 46
----------------------------------------------------
[96]
TÍTULO / TITLE: - Thoracic radiology in
kidney and liver transplantation.
REVISTA
/ JOURNAL: - J Thorac Imaging 2002 Apr;17(2):122-31.
AUTORES
/ AUTHORS: - Fishman JE; Rabkin JM
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, University of
Miami School of Medicine, Jackson Memorial Hospital WW 279, 1611 N.W. 12th
Avenue, Miami, FL 33136, USA. jfishman@med.miami.edu
RESUMEN
/ SUMMARY: - Renal transplantation accounts for more
than half of all solid organ transplants performed in the U.S., and the liver
is the second most commonly transplanted solid organ. Although abdominal
imaging procedures are commonplace in these patients, there has been relatively
little attention paid to thoracic imaging applications. Preoperative imaging is
crucial to aid in the exclusion of infectious or malignant disease. In the
perioperative time period, thoracic imaging focuses both on standard intensive
care unit care, including monitoring devices and their complications, and on
the early infections that can occur. Postoperative management is divided into
three time periods, and the principles governing the occurrence of infections
and malignancies are reviewed. Anatomic and pathologic aspects unique to kidney
and liver transplantation patients are also discussed. N. Ref:: 35
----------------------------------------------------
[97]
TÍTULO / TITLE: - Homocysteine levels
among transplant recipients: effect of immunosuppressive protocols.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Sep;33(6):2945-6.
AUTORES
/ AUTHORS: - Mor E; Helfmann L; Lustig S; Bar-Nathan N;
Yussim A; Sela BA
INSTITUCIÓN
/ INSTITUTION: - Department of Transplantation, Rabin
Medical Center, Petach-Tikva, Israel.
----------------------------------------------------
[98]
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.
----------------------------------------------------
[99]
TÍTULO / TITLE: - Angiographic evaluation
and treatment of transplant renal artery stenosis.
REVISTA
/ JOURNAL: - Curr Opin Urol 2001 Mar;11(2):197-205.
AUTORES
/ AUTHORS: - Spinosa DJ; Isaacs RB; Matsumoto AH; Angle
JF; Hagspiel KD; Leung DA
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, University of
Virginia Health System, Charlottesville, Virginia, USA. djs4m@virginia.edu
RESUMEN
/ SUMMARY: - Transplant renal artery stenosis is an
uncommon but important complication of renal transplantation. It is a
potentially reversible cause of patient morbidity and allograft dysfunction,
which can present both early and late in the post-transplant period. Although
transplant renal artery stenosis can be detected using noninvasive imaging,
definitive diagnosis and percutaneous treatment typically require the use of
invasive angiographic techniques. In experienced hands, these studies can be
performed safely, effectively and with a low risk of contrast induced
nephrotoxicity when alternative contrast agents are used. N. Ref:: 61
----------------------------------------------------
[100]
TÍTULO / TITLE: - Immunosuppressive
regimens for 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 6:153-5.
AUTORES
/ AUTHORS: - Briggs JD
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Western Infirmary, Glasgow,
UK. N. Ref:: 15
----------------------------------------------------
[101]
TÍTULO / TITLE: - Posttransplantation
primary cutaneous CD30 (Ki-1)-positive large-cell lymphoma.
REVISTA
/ JOURNAL: - J Am Acad Dermatol 2001 Dec;45(6
Suppl):S197-9.
AUTORES
/ AUTHORS: - Seckin D; Demirhan B; Oguz Gulec T; Arikan
U; Haberal M
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Baskent
University Faculty of Medicine, Ankara, Turkey.
RESUMEN
/ SUMMARY: - We describe the case of a 51-year-old
female renal transplant recipient with primary cutaneous CD30-positive
large-cell lymphoma of T-cell origin. Cutaneous T-cell lymphomas are rarely
reported in organ transplant recipients, and we believe they should be
considered in the differential diagnosis of cutaneous neoplastic and infectious
diseases affecting this patient group. N.
Ref:: 20
----------------------------------------------------
[102]
TÍTULO / TITLE: - Ultrasound of renal
transplantation.
REVISTA
/ JOURNAL: - Clin Radiol 2001 Oct;56(10):802-18.
AUTORES
/ AUTHORS: - Baxter GM
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, Western
Infirmary, Glasgow, UK. g.m.baxter@clinmed.gla.ac.uk
RESUMEN
/ SUMMARY: - The most effective primary treatment of
chronic renal failure is renal transplantation. A significant improvement in
lifestyle and family life in conjunction with it being an extremely
cost-effective procedure has resulted in an intense monitoring and imaging
programme to help ensure a successful outcome. Ultrasound, both grey-scale and
colour-flow Doppler, are useful monitoring techniques when interpreted in the
clinical context, and in the delineation of peri-transplant collections, some
of which can be drained under ultrasound guidance. After the early
post-operative period it can also be utilized in the diagnosis of chronic vascular
complications including transplant artery stenosis and arteriovenous fistula,
although it is of limited use in the diagnosis of chronic rejection. This
article will discuss the role of ultrasound in all its guises and how its
efficacy in both the early transplant period in the monitoring of graft
dysfunction and in the detection of the more chronic conditions including
transplant artery stenosis and arteriovenous fistulae. A more limited role for
ultrasound also exists in the long-term follow-up of patients and to aid the
detection of complications including susceptibility to malignancy. N. Ref:: 48
----------------------------------------------------
[103]
TÍTULO / TITLE: - Protocol biopsy program
after renal transplantation: structure and first results.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2238-9.
AUTORES
/ AUTHORS: - Schwarz A; Mengel M; Gwinner W;
Eisenberger U; Hiss M; Radermacher J; Fiebeler A; Abou-Rebyeh F; Haller H
INSTITUCIÓN
/ INSTITUTION: - Nephrology Department, Hanover Medical
School, Hanover, Germany.
----------------------------------------------------
[104]
TÍTULO / TITLE: - Cell-free DNA in urine:
a marker for kidney graft rejection, but not for prenatal diagnosis?
REVISTA
/ JOURNAL: - Ann N Y Acad Sci 2001 Sep;945:250-7.
AUTORES
/ AUTHORS: - Zhong XY; Hahn D; Troeger C; Klemm A;
Stein G; Thomson P; Holzgreve W; Hahn S
INSTITUCIÓN
/ INSTITUTION: - Department of Obstetrics and Gynecology,
University of Basel, Switzerland.
RESUMEN
/ SUMMARY: - Intrigued by the rapid clearance of free
fetal DNA from the maternal circulation, we have investigated whether this
fetal genetic material could be cleared via the kidney. For this purpose, we
examined for the presence of Y chromosome-specific DNA sequences in urine
samples obtained from 8 women pregnant with male fetuses. No male-specific
sequences could be detected, despite the use of a very sensitive nested PCR
assay nor a highly reproducible real-time PCR assay. We did, however, detect
maternal DNA sequences. To determine if this cell-free DNA was derived from the
kidney or another source, we next examined urine from female kidney transplant
patients who had received male kidneys. Y chromosome-specific sequences were
indeed detectable by both nested and real-time PCR in these samples, thereby
confirming a recent report describing urinary DNA microchimerism. Quantitative
analysis of serially obtained samples furthermore suggests that
transplant-derived sequences are elevated during periods of graft rejection.
These results imply that the measurement of graft-derived urinary DNA may serve
as a new marker for kidney graft tolerance.
N. Ref:: 18
----------------------------------------------------
[105]
TÍTULO / TITLE: - Testicular hematocele
mimicking a testicular tumor: a case report and review of literature.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2141-2.
AUTORES
/ AUTHORS: - Shamsa A; Kadkhodayan A; Feiz-zadeh B;
Rasulian H
INSTITUCIÓN
/ INSTITUTION: - Mashhad University of Medical Sciences,
Department of Urology, Anesthesiology and Kidney Transplant, MUMS, Mashhad,
Iran.
----------------------------------------------------
[106]
TÍTULO / TITLE: - Histopathological
findings of 10-year protocol biopsy in pediatric kidney transplant recipients.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Dec;34(8):3130-1.
AUTORES
/ AUTHORS: - Kamimaki I; Shishido S; Ikeda M; Honda M
INSTITUCIÓN
/ INSTITUTION: - Division of Pediatrics, Clinical Research
Department, National Saitama Hospital, Saitama, Japan.
----------------------------------------------------
[107]
TÍTULO / TITLE: - Hand-assisted
urological laparoscopy.
REVISTA
/ JOURNAL: - Curr Opin Urol 2002 May;12(3):233-7.
AUTORES
/ AUTHORS: - Pietrow PK; Albala DM
INSTITUCIÓN
/ INSTITUTION: - Division of Urology, Department of
Surgery, Section of Endourology and Minimally Invasive Surgery, Duke University
Medical Center, Durham, North Carolina 27710, USA.
RESUMEN
/ SUMMARY: - Hand-assisted laparoscopy has been
successfully applied to various applications within the field of urology. Many
authors have proved the safety and efficacy of this technique, as well as
demonstrating improved patient recovery for such procedures as radical
nephrectomy, radical nephroureterectomy and donor nephrectomy. The recent
literature regarding this topic is reviewed and evaluated here. N. Ref:: 32
----------------------------------------------------
[108]
TÍTULO / TITLE: - Pretransplant
evaluation of renal transplant candidates.
REVISTA
/ JOURNAL: - Semin Nephrol 2002 Nov;22(6):515-25.
AUTORES
/ AUTHORS: - Gallon LG; Leventhal JR; Kaufman DB
INSTITUCIÓN
/ INSTITUTION: - Departments of Medicine and Surgery,
Feinberg School of Medicine of Northwestern University, Chicago, IL 60611, USA.
L-Gallon @nwu.edu
RESUMEN
/ SUMMARY: - Kidney transplantation should be strongly
considered for all medically suitable patients with chronic and end-stage renal
disease (ESRD). Improvements in outcomes after renal transplantation have
resulted in a more liberal selection of patients. High-risk category patients
including human immunodeficiency virus (HIV)-positive, highly sensitized
patients, T-cell positive cross-match, and ABO blood group-incompatible
patients are now considered potential renal transplant candidates.
Unfortunately, the demand for kidney transplants far exceeds the supply of
available organs, causing a persistent increase in the number of patients on
the waiting list with a parallel increase in the waiting time for a cadaveric
kidney transplant. This has 2 major consequences. First, patients on the
waiting list are getting sicker and older. Second, living donors have assumed
increasing importance in renal transplantation. Pre-existing morbidities
including malignancies, cardiovascular disease, infections, and coagulopathies
should be extensively evaluated before proceeding to transplantation. Special
attention should be given to cardiovascular risk factors because the leading
cause of death after renal transplant is cardiovascular disease. A full
immunologic evaluation with ABO blood group determination, human leukocyte
antigen (HLA) typing, screening for antibody to HLA phenotypes, and
cross-matching need to be gathered before transplantation to avoid
antibody-mediated hyperacute rejection or to proceed with specific protocols in
highly sensitized or in positive T-cell cross-match patients. With the
increased rate of donation from living donors, regular follow-up evaluation of
kidney donors is recommended to detect hypertension or proteinuria in those who
may develop it. N.
Ref:: 72
----------------------------------------------------
[109]
TÍTULO / TITLE: - Laparoscopic live donor
nephrectomy.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Feb;28(1):127-35.
AUTORES
/ AUTHORS: - Novotny MJ
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, University of
California, Davis School of Medicine, Sacramento, California, USA.
RESUMEN
/ SUMMARY: - Laparoscopic donor nephrectomy offers
numerous advantages when compared with the traditional open approach. For the
donor, it has resulted in a shorter hospital stay, fewer postoperative
analgesic requirements, earlier return to activities of daily living and
employment, and decreased financial loss owing to absence from the workforce.
For the recipient, the procedure does not adversely impact on allograft
function, graft survival, or patient survival.
N. Ref:: 39
----------------------------------------------------
[110]
TÍTULO / TITLE: - Refining
immunosuppressive protocols in pediatric renal transplant recipients.
REVISTA
/ JOURNAL: - Transplant Proc 2001
Nov-Dec;33(7-8):3587-9.
AUTORES
/ AUTHORS: - Hoyer PF; Vester U
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatric Nephrology,
University Essen, Essen, Germany.
----------------------------------------------------
[111]
TÍTULO / TITLE: - Laparoscopic donor
nephrectomy: an update.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2001
Nov;10(6):771-5.
AUTORES
/ AUTHORS: - Roberts WW; Kavoussi LR
INSTITUCIÓN
/ INSTITUTION: - The Brady Urological Institute of the
Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. wroberts@jhmi.edu
RESUMEN
/ SUMMARY: - Laparoscopic donor nephrectomy was
developed primarily to increase the number of kidneys available for donation.
Further evidence of the safety and efficacy of laparoscopic donor nephrectomy
has been reported in the literature, as have studies on the cost-effectiveness
of this procedure and its role in removing disincentives for renal donation.
Specific technical modifications have been developed and refined that improve
outcomes when performing laparoscopic harvesting of right kidneys. Other
technical modifications have been developed for use in obese patients. With the
adoption of these modified techniques, equivalent results to open donor nephrectomy
have been reported. Recently, a wide range of alternative approaches
(hand-assisted, retroperitoneal, and gasless laparoscopy) have been utilized
for laparoscopic donor nephrectomy. N.
Ref:: 30
----------------------------------------------------
[112]
TÍTULO / TITLE: - High-resolution
magnetic resonance imaging to assess trabecular bone structure in patients
after transplantation: a review.
REVISTA
/ JOURNAL: - Top Magn Reson Imaging 2002
Oct;13(5):365-75.
AUTORES
/ AUTHORS: - Link TM
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, Technische
Universitat Munchen, Ismaninger Strasse 22, D-81675 Munich, Germany. tmlink@roe.med.uni-muenchen.de
RESUMEN
/ SUMMARY: - After organ transplantation patients have
a higher incidence of osteoporotic fractures. Bone mineral density (BMD)
measurements to assess fracture risk are of limited value in these patients. On
the other hand, structure-based techniques have shown promise. In this review,
the use of high-resolution magnetic resonance imaging in the analysis of the
trabecular bone structure in patients before and after renal and cardiac
transplantation cross-sectionally is presented. The analyses of calcaneal
trabecular structure were compared with BMD with regard to the prediction of
therapy-induced bone loss and osteoporotic fracture status. Sagittal and axial
T1-weighted spin-echo sequences with a voxel size of 0.2 x 0.2 x 1 mm were
performed at 1.5 T and structure measures analogous to bone histomorphometry
were calculated. In addition, fracture status of the spine and of the
peripheral skeleton was assessed. Structure measures showed significant
differences between healthy controls and patients before and after renal and
cardiac transplantation (p < 0.01). Osteoporotic fractures were found in
approximately 35% of the transplant patients; the percentage was higher in the
cardiac transplants. Structure measures and BMD were lower in patients with
fractures; differences were more significant in the cardiac transplant
patients. Using receiver operating characteristic analyses the diagnostic
performance in differentiating patients with and without fractures was highest
when BMD and structure measures were combined. Structure measures performed better
than BMD in the cardiac transplant patients, whereas results were comparable in
the renal transplant patients. In conclusion, structure measures determined in
high-resolution magnetic resonance images may be useful in assessing changes of
trabecular bone after organ transplantation and may improve the prediction of
fracture risk.
----------------------------------------------------
[113]
TÍTULO / TITLE: - Management of selected
lipid abnormalities: hypertriglyceridemia, isolated low HDL-cholesterol, lipoprotein(a),
and lipid abnormalities in renal diseases and following solid organ
transplantation.
REVISTA
/ JOURNAL: - Cardiol Clin 2003 Aug;21(3):377-92.
AUTORES
/ AUTHORS: - Rosas S; Szapary P; Rader DJ
INSTITUCIÓN
/ INSTITUTION: - University of Pennsylvania Medical Center,
654 BRBII/III Labs, 421 Curie Boulevard, Philadelphia, PA 19104-6160, USA.
RESUMEN
/ SUMMARY: - Although the focus in treating lipid
disorders is on reducing LDL-C levels, additional lipid-related independent
risk factors, such as TG, HDL-C, and Lp(a) levels, should be used clinically to
assess cardiovascular risk. Decisions to initiate drug therapy for LDL-C
reduction may be influenced by levels of these other lipoprotein fractions.
Data supporting intervention to modify these factors are less abundant than for
LDL-C reduction, but in certain circumstances. drug therapy targeted at TGs or
HDL-C may be appropriate. Patients who have nephrotic syndrome and end-stage
renal disease are at particularly high risk for the development of CVD and
should be treated aggressively for their lipid disorders. Finally, solid organ
transplant recipients are almost always hyperlipidemic and appropriate therapy
could reduce cardiovascular events. N.
Ref:: 146
----------------------------------------------------
[114]
TÍTULO / TITLE: - Neoral monitoring 2
hours post-dose and the pediatric transplant patient.
REVISTA
/ JOURNAL: - Pediatr Transplant 2003 Feb;7(1):25-30.
AUTORES
/ AUTHORS: - Dunn SP
INSTITUCIÓN
/ INSTITUTION: - Alfred I. duPont Hospital for Children,
Wilmington, Delaware 19899, USA. Sdunn@nemours.org
RESUMEN
/ SUMMARY: - Cyclosporin A therapy has evolved greatly
over the past 25 years of clinical experience. Sophisticated studies of CsA
pharmacokinetics and pharmacodynamics have led to a better understanding of the
relationship between dose response and biological effect. It has become
apparent that achieving target drug exposure is necessary for optimal clinical
outcomes. Monitoring dose response has become a key aspect of immunosuppressive
management. This review presents the information available supporting
cyclosporin drug concentration drawn two hours post dose (C-2) in children who
have been transplanted as the best single indicator of CsA exposure. Further
studies evaluating the clinical benefit of achieving C-2 targets in children
are indicated. N.
Ref:: 30
----------------------------------------------------
[115]
TÍTULO / TITLE: - Glomerular filtration
rate as a putative ‘surrogate end-point’ for renal transplant clinical trials
in children.
REVISTA
/ JOURNAL: - Pediatr Transplant 2003 Feb;7(1):18-24.
AUTORES
/ AUTHORS: - Filler G; Browne R; Seikaly MG
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, Children’s
Hospital of Eastern Ontario, Ottawa, Canada.
RESUMEN
/ SUMMARY: - Only with prospective randomized
controlled trials is it possible to evaluate the several immunosuppressive
regimens available to renal allograft recipients. Commonly used surrogate
markers of clinical outcome, such as patient and graft survival, are constantly
improving. Current immunosuppressive protocols have improved 1-yr graft
survival to over 90%. The small differences in graft survival among the various
immunosuppressive regimes require large patient cohorts in order to establish
statistical significance. Such studies are often difficult to conduct in a
timely manner, particularly in children. This necessitates the search for
better surrogate markers sensitive enough to detect differences in smaller
cohorts and in a shorter period of time. While the degree of fibrosis in
transplant biopsies might well predict long-term graft survival, protocol
biopsies are expensive, invasive, and unpopular among clinicians. In native
kidneys, glomerular filtration rate (GFR) closely correlates with disease
progression and interstitial fibrosis and appears to be well positioned as a
less invasive surrogate marker for long-term outcome. Nonetheless, the ideal
marker for GFR remains obscure. Serum creatinine has several major drawbacks,
making it a poor predictor of GFR. This review discusses the several methods
used to estimate or measure GFR with emphasis on 125I-iothalamate clearance and
serum cystatin C (cys-C). Of all the serum markers, cys-C is the most reliable and
the most promising. However, cys-C and other endogenous markers cannot replace
the diagnostic sensitivity and reliability of radiolabeled markers of GFR such
as 125I-iothalamate in renal transplant clinical trials. Unfortunately,
clearance of most radiolabeled markers of GFR including 125I-iothalamate remain
costly and time consuming. N.
Ref:: 70
----------------------------------------------------
[116]
TÍTULO / TITLE: - Transplantation of
kidneys from HCV-positive donors: a safe strategy?
REVISTA
/ JOURNAL: - J Nephrol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jnephrol.com/
●●
Cita: Journal of Nephrology: <> 2003 Sep-Oct;16(5):617-25.
AUTORES
/ AUTHORS: - Fabrizi F; Bunnapradist S; Lunghi G;
Martin P
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Dialysis,
Transplantation, Maggiore Hospital, IRCCS, Milan, Italy. fabrizi@policlinico.mi.it
RESUMEN
/ SUMMARY: - Hepatitis C Virus (HCV) infection is the
most important cause of liver disease after renal transplantation (RT). The
impact of HCV on patient and graft survival after RT remains controversial;
however, the great majority of studies with large size and adequate follow-up
have shown the detrimental impact of HCV on long-term patient and graft
survival after RT. The use of kidneys from anti-HCV positive donors could help
decrease the continuing disparity between the number of patients on the
transplant waiting list and the number of patients receiving a transplant each
year. Single-center experiences have suggested transplanting kidneys from
anti-HCV positive donors only in anti-HCV positive dialysis patients. Such
practice has not demonstrated any adverse effect on the short-term patient
survival; the waiting times for RT were shortened. A better alternative seems
to be a policy of transplanting kidneys from anti-HCV positive donors only in
HCV RNA positive recipients. This requires HCV RNA testing of all anti-HCV
positive dialysis patients awaiting RT. Matching donors and recipients for HCV
genotype has been suggested; however, the assessment of donor HCV genotype is
currently hampered by time constraints. Recent evidence based on large data
base demonstrated that RT recipients of HCV-positive donors are at independent
increased risk of mortality; unadjusted 3-year patient survival was 85% versus
93% (P=0.01) in all recipients of donor HCV-positive and HCV-negative kidneys,
respectively. This was observed in all recipient subgroups including elderly
and HCV-positive recipients. In the near future, rapid nucleic acid testing
(NAT) of donors and recipients will allow the assessment of the HCV viremic
status in order to maximize organ use. With appropriate informed consent, use
of a renal graft from an HCV positive donor may be offered to an HCV infected
recipient. Additional studies are needed to clarify the link between donor
HCV-positive kidneys and patient mortality.
N. Ref:: 69
----------------------------------------------------
[117]
TÍTULO / TITLE: - Polyclonal antibodies
induction therapy in kidney transplantation: a single center experience.
REVISTA
/ JOURNAL: - Ann Transplant 2002;7(4):46-8.
AUTORES
/ AUTHORS: - Malaise J; De Meyer M; Mourad M; Squifflet
JP
INSTITUCIÓN
/ INSTITUTION: - Department of Renal and Pancreatic
Transplantation, Universite Catholique de Louvain Medical School, Brussels,
Belgium. Jacques.Malaise@chir.ucl.ac.be N. Ref:: 18
----------------------------------------------------
[118]
TÍTULO / TITLE: - Pyogenic granuloma in a
renal transplant patient: case report.
REVISTA
/ JOURNAL: - Spec Care Dentist 2001
Sep-Oct;21(5):187-90.
AUTORES
/ AUTHORS: - al-Zayer M; da Fonseca M; Ship JA
INSTITUCIÓN
/ INSTITUTION: - Department of Orthodontics and Pediatric
Dentistry, University of Michigan School of Dentistry, 1011 N. University Ave.,
Ann Arbor, MI 48109, USA.
RESUMEN
/ SUMMARY: - This case report describes a 14-year-old
female referred to Pediatric Dentistry for evaluation and treatment of
cyclosporine-induced gingival hyperplasia. Examination of the anterior
maxillary area showed a red, vascular, exophytic, soft-tissue mass which had
been excised a few months earlier without a histopathologic examination being
done. The mass did not appear consistent with gingival overgrowth induced by
long-term use of medication, and thus an excisional biopsy was performed, which
diagnosed the lesion as a pyogenic granuloma. A review of the literature and
management recommendations are discussed.
N. Ref:: 20
----------------------------------------------------
[119]
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.
----------------------------------------------------
[120]
TÍTULO / TITLE: - Pulmonary-renal
vasculitic disorders: differential diagnosis and management.
REVISTA
/ JOURNAL: - Curr Rheumatol Rep 2003 Apr;5(2):107-15.
AUTORES
/ AUTHORS: - Jara LJ; Vera-Lastra O; Calleja MC
INSTITUCIÓN
/ INSTITUTION: - Clinical Research Unit and Rheumatology
Department, Hospital de Especialidades, Centro Medico La Raza, Mexico City, CP
02990, Mexico. luis_jara_quezada@hotmail.com
RESUMEN
/ SUMMARY: - Pulmonary-renal syndrome (PRS) is a
combination of diffuse pulmonary hemorrhage and glomerulonephritis.
Pulmonary-renal syndrome is not a single entity and is caused by a variety of
conditions, including Goodpastures syndrome associated with autoantibodies to
the glomerular and alveolar basement membranes, various forms of primary
systemic vasculitis associated with serum positivity for antineutrophil
cytoplasmic antibodies (ANCA), cryoglobulinemia, systemic lupus erythematosus,
systemic sclerosis, antiphospholipid syndrome, environmental factors, and
drugs. The majority of cases of PRS are associated with ANCAs. The antigen
target in Goodpastures syndrome is the alpha-3 chain of type IV collagen. The
antigen target in PRS associated with systemic vasculitis is proteinase-3 and
myeloperoxidase. Pulmonary-renal syndrome has been observed from the first to
the ninth decade of life. The widespread adoption of serologic testing
performed in an appropriate clinical context hopefully will limit diagnostic
delay. The goals of treatment in PRS are to remove the circulating antibodies,
to stop further production of autoantibodies, and to remove any antigen that
stimulates antibody production. Treatment is based on plasmapheresis, steroids,
and cyclophosphamide; however, infections are frequent contributors to death,
and less toxic alternatives may improve outcome and prognosis resulting in a
long-term survival. The degree of renal function and the percent of crescents
on renal biopsy are better predictors of outcome. Renal transplantation can be
safely carried out in PRS. N.
Ref:: 52
----------------------------------------------------
[121]
TÍTULO / TITLE: - On the horizon:
tailor-made immunosuppression in renal transplantation.
REVISTA
/ JOURNAL: - Nephron Clin Pract 2003;94(1):c5-10.
●●
Enlace al texto completo (gratuito o de pago) 1159/000070818
AUTORES
/ AUTHORS: - Warrens AN
INSTITUCIÓN
/ INSTITUTION: - Faculty of Medicine, Imperial College
London, Hammersmith Campus, London, UK. a.warrens@ic.ac.uk
RESUMEN
/ SUMMARY: - Immunosuppression for renal
transplantation has undergone more changes over the last 8 years than at any
other time in its history. It is now possible to be more selective in the
matching of drugs with a given patient. This brings with it the option of
improving graft outcome and also minimizing adverse effects. It is an ongoing
process that will utilize agents working at different points in the activation
cascade of the CD4+ ‘helper’ T lymphocyte. It may also be possible to
manipulate the immune system such that the organ-specific immune response may
be switched off, or rendered ‘tolerant’, thus removing the need for any
immunosuppressive drugs. In this brief review, we shall address each of these
approaches and discuss other therapeutic avenues being investigated. N. Ref:: 13
----------------------------------------------------
[122]
TÍTULO / TITLE: - Cat scratch disease and
acute rejection after pediatric renal transplantation.
REVISTA
/ JOURNAL: - Pediatr Transplant 2002 Aug;6(4):327-31.
AUTORES
/ AUTHORS: - Dharnidharka VR; Richard GA; Neiberger RE;
Fennell RS 3rd
INSTITUCIÓN
/ INSTITUTION: - The Division of Pediatric Nephrology,
Shands Children’s Hospital and University of Florida College of Medicine,
Gainesville, Florida 32610, USA. vikasmd@ufl.edu
RESUMEN
/ SUMMARY: - Cat scratch disease (CSD) can lead to
unexplained fever, generalized lymphadenopathy and organomegaly in immunocompetent
individuals. CSD has rarely been reported in immunocompromised transplant
recipients, where its clinical features would mimic the more common
post-transplant lymphoproliferative disease (PTLD). We report three cases of
CSD seen recently in children who had received prior kidney transplants. The
three children were between 7 and 9 yr old, and had received kidney transplants
2-4 yr prior, with stable renal function. In each case, there was unexplained
fever with either lymphadenopathy or organomegaly. The diagnosis of CSD was
suggested by a history of new cats being introduced into each household and
confirmed in all cases by the serological presence of a significant titer (>
1 : 64) of IgM antibodies to Bartonella henselae. Tests for other bacterial
infections, cytomegalovirus and Epstein-Barr virus infections were negative.
All the patients showed a clinical improvement with anti-microbial therapy. In
patients A and B, the CSD was associated with an acute rejection episode
shortly after diagnosis. The rejection episodes were reversed by intravenous
steroid pulse therapy. Only four cases of CSD have been previously reported
following solid organ transplantation. Acute rejection following CSD has not
been previously reported. CSD should be included in the differential diagnosis
of fever in the post-transplant setting, especially where PTLD is
suspected. N. Ref:: 12
----------------------------------------------------
[123]
TÍTULO / TITLE: - Immune profiling:
molecular monitoring in renal transplantation.
REVISTA
/ JOURNAL: - Front Biosci 2003 Sep 1;8:e444-62.
AUTORES
/ AUTHORS: - Hoffmann SC; Pearl JP; Blair PJ; Kirk AD
INSTITUCIÓN
/ INSTITUTION: - Transplantation Section, Transplantation
and Autoimmunity Branch, National Institute of Diabetes and Digestive and
Kidney Diseases, National Institutes of Health, Department of Health and Human
Services, Bethesda, Maryland 20889, USA.
RESUMEN
/ SUMMARY: - Molecular techniques have become a
mainstay for most biomedical research. In particular, sensitive methods for
gene transcript detection and advanced flow cytometry have been crucial in
fostering our understanding of the basic mechanisms promoting allosensitization
and adaptive immune regulation. These technologies have been validated in
vitro, and in pre-clinical settings, and as such their clinical application is
now clearly appropriate. It is becoming increasingly clear that these robust
techniques hold much promise to better elucidate human transplant biology, and
more importantly, guide clinical decision making with mechanistically-based
information. This article will discuss our laboratory’s use of several novel
technologies, including gene polymorphism analysis, real-time polymerase chain
reaction transcript quantification, and multi-color flow cytometry in clinical
human renal transplantation. Specific technical methodology will be presented
outlining keys for effective clinical application. Clinical correlations will
be presented as examples of how these techniques may have clinical relevance.
Suggestions for the adaptation of these methods for therapeutic intervention
will be given. We propose that clinical transplantation should proceed in close
step with modern molecular diagnostics.
N. Ref:: 84
----------------------------------------------------
[124]
TÍTULO / TITLE: - Annual trends and
triple therapy--1991-2000.
REVISTA
/ JOURNAL: - Clin Transpl 2001;:247-69.
AUTORES
/ AUTHORS: - Nishikawa K; Terasaki PI
INSTITUCIÓN
/ INSTITUTION: - Terasaki Foundation Laboratory, Los
Angeles, CA, USA.
RESUMEN
/ SUMMARY: - 1. Although the number of cadaver donor
transplants did not increase substantially over the past 10 years, unrelated
living donor grafts increased from 153 in 1991 to 1,661 through 2000. Use of
spousal and other unrelated donor organs contributed to this increase. There
was a modest increase in living-related donor transplants from 2,328 in 1991 to
3,451 in 2000. 2. Cadaver donor graft survival at one year improved from 84% in
1991 to 90% in 2000. In contrast, one-year graft survival of living donor
transplants only improved from 93% in 1991 to 95% in 2000. 3. Throughout the
10-year period, approximately 13% of transplants were repeat transplants from
cadaver donors and roughly 8% were regrafts from live donors. 4. Cadaver donor
transplants into White recipients declined from 68% in 1991 to 60% in 2000. For
living donors, the percentage of White patients remained constant at about 70%.
5. Graft survival in patients of all races was about equal at one year but
diverged at 3 years, with Asians having the highest and Blacks having the
lowest 3-year graft survival rates. 6. Average donor age increased from 31.7 in
1991 to 36 in 2000 for cadaveric donor transplants and 37.9 in 1991 to 40.4 in
2000 for living donor transplants. Cadaveric kidneys from donors older than 50
years of age yielded significantly lower 3-year graft survival. 7. Average
recipient age for cadaveric donor transplants increased from 42.1 in 1991 to
46.8 in 2000. The average recipient age for living donor transplants also
increased steadily from 33.7 in 1991 to 42.9 in 2000. There was relatively
little effect on graft survival rates for advanced age recipients. 8. The
percentage of sensitized recipients receiving cadaver donor grafts declined
from 27% in 1991 to 21% in 2000. Similarly, sensitized recipients receiving
living donor grafts decreased from 17% in 1991 to 13% in 2000. Graft survival
in patients with more than 50% PRA was lower at 3 years for patients receiving
cadaveric donor grafts. Highly sensitized patients receiving living donor
grafts had graft survival rates similar to those who were not sensitized. 9.
Cold ischemia times decreased from an average of 24.2 hours in 1991 to 18.9
hours in 2000. Improved graft survival rates over those 10 years were noted in all
groups, and even cold ischemia times more than 36 hours yielded 3-year graft
survivals comparable to those with lower cold ischemia times in 1998. 10. The
need for dialysis has remained constant at about 23% over the last 10 years for
patients receiving kidneys from cadaveric donors. The rate of dialysis for
patients receiving kidneys from living donors was about 5% for each of the 10
years examined. First day anuria increased from 11% in 1991 to 16% in 2000 for
cadaver donor transplants and 3% in 1999 to 5% in 2000 for living donor grafts.
11. Cadaveric donor patients requiring dialysis had a 3-year graft survival
rate of 63% if there was no first day anuria and 56% if they had first day
anuria. This is in contrast to 80% 3-year graft survival for those with
immediate diuresis and no need for dialysis. The 3-year graft survival rate for
those receiving living donor grafts and needing dialysis was 58% if they had
first day diuresis and 41% if they ware anuric on the first day. Conversely,
those who had first day function and did not require dialysis had 89% 3-year
graft survival. 12. Among the patients receiving cadaveric grafts with first
day diuresis there was a marked reduction in those with rejection, from 21% in
1991 to 5% in 2000. Similarly, for this type of patient receiving living donor
grafts, the reduction was 17% in 1991 to 5% in 2000. However, graft survival
among these patients did not change significantly. The greatest improvement was
noted in those with first day anuria and no rejection. 13. Patients who did not
require dialysis, and had rejection prior to discharge decreased markedly from
17% in 1991 to 3% in 2000 in those receiving cadaveric grafts and 15% in 1991
to 3.9% in 2000 for those receiving living donors. Graft survival of cadaveric
transplants in those needing dialysis, with and without rejection, improved the
most in the 10 year period. 14. Hospitalization days for cadaveric transplant
recipients were reduced from 19 days in 1991 to 10 days in 2000 and 16 days in
1991 to 8 days in 2000 for recipients of living donor grafts. There was an
increase in discharge serum creatinine values from 2.3 mg/dl in 1991 to 3.3
mg/dl in 2000 for cadaver donor grafts. 15. Double therapy was utilized for
about 15% of cadaveric and living donors. There was a sharp increase in
induction therapy, peaking at 51% in 1994 and decreasing to 5% by 2000 for
cadaveric donor transplants. Induction did not improve graft survival for
either cadaver or living donor transplant recipients. 16. Triple therapy
improved graft survival of White and Black patients, but did not affect the
half-lives in either race. 17. The lower graft survival from older donors was
not affected by triple therapy for cadaver donor transplants. Triple therapy
removed the donor age effect for recipients of living donor grafts. 18. Triple
therapy practically eliminated the effect of sensitization for cadaveric donor
grafts. Both double and triple therapy virtually eliminated the sensitization
effect for living donors. 19. Triple therapy significantly improved the
survival of kidneys with more than 36 hours cold ischemia time so that 3-year
graft survival was 76% at 3 years compared with 81% for kidneys stored 1-12
hours. 20. Triple therapy improved the 3-year graft survival of kidneys with
first day anuria from 50% for double therapy to 69% for triple therapy in
cadaver donor transplants. For living donor transplants, there was a similar
improvement from 57% with double therapy to 72% with triple therapy. 21. Triple
therapy improved the 3-year cadaveric graft survival rate of kidneys requiring
dialysis from 51% with double therapy to 67% for triple therapy. There was a
similar improvement for living donors needing dialysis from 37% to 61% at 3
years.
----------------------------------------------------
[125]
TÍTULO / TITLE: - Pneumatosis
intestinalis and diarrhea in a child following renal transplantation.
REVISTA
/ JOURNAL: - Pediatr Transplant 2003 Jun;7(3):236-9.
AUTORES
/ AUTHORS: - Chelimsky G; Blanchard S; Sivit C; Davis
I; Czinn S
INSTITUCIÓN
/ INSTITUTION: - Division of Pediatric Gastroenterology
& Nutrition, Department of Pediatrics, Rainbow Babies & Children’s
Hospital, University Hospital of Cleveland & CWRU, Cleveland, OH, USA. gisela.chelimsky@uhhs.com
RESUMEN
/ SUMMARY: - Pneumatosis intestinalis is an uncommon
finding beyond the neonatal period, but it has been reported in
immunocompromized pediatric patients. The association of pneumatosis
intestinalis in children following renal transplantation has to the best of our
knowledge been only reported once in children. We describe a 4-year-old female
who developed intermittent emesis, weight loss, and intermittently loose bloody
stools after cadaveric renal transplantation at age 3.5 years. An abdominal
x-ray demonstrated extensive pneumatosis in the colon. The infectious work-up
was negative. Histologically, she had increased eosinophils throughout the
lamina propria in the rectum. A glucose breath test was suggestive of small
bowel bacterial overgrowth. She was treated with 10 days of metronidazole with
resolution of the diarrhea and occult blood in stools. One month after the
treatment she had radiologic resolution of her pneumatosis. Based on this
report, pneumatosis intestinalis should be considered in the differential
diagnosis of children after organ transplant suffering from diarrhea, abdominal
pain, or blood in the stool. N.
Ref:: 24
----------------------------------------------------
[126]
TÍTULO / TITLE: - Laparoscopic live donor
nephrectomy: a step forward in kidney transplantation?
REVISTA
/ JOURNAL: - JSLS 2003 Jul-Sep;7(3):197-206.
AUTORES
/ AUTHORS: - Skrekas G; Papalois VE; Mitsis M; Hakim NS
INSTITUCIÓN
/ INSTITUTION: - Transplant Unit, St. Mary’s Hospital,
London, UK.
RESUMEN
/ SUMMARY: - Open donor nephrectomy for live donor
kidney transplantation is a safe procedure that has been used for more than 30
years with excellent results. Laparoscopic donor nephrectomy is a relatively
new technique that has the potential of decreased postoperative pain, less
incisional morbidity, and shorter recovery time. Furthermore, it has been
reported that this potentially less traumatic approach increases the number of
potential live donors. This review article focuses on the currently used
laparoscopic techniques in live kidney donation as well as the controversy
regarding its efficacy, safety, and future.
N. Ref:: 64
----------------------------------------------------
[127]
TÍTULO / TITLE: - Transmission of viral
hepatitis by kidney transplantation: donor evaluation and transplant policies
(Part 1: hepatitis B virus).
REVISTA
/ JOURNAL: - Transpl Infect Dis 2002 Sep;4(3):124-31.
AUTORES
/ AUTHORS: - Natov SN
INSTITUCIÓN
/ INSTITUTION: - Tufts University School of Medicine, Tufts-New
England Medical Center, Boston, Massachusetts, USA.
RESUMEN
/ SUMMARY: - This two-part article discusses serologic
testing of prospective donors for viral hepatitis B and C as part of the
comprehensive donor evaluation and reviews of the current policies and
practices aimed at preventing donor-to-recipient transmission of hepatitis B
and C viruses (HBV, HBC). This second part of the review discusses HCV. Organs
procured from HCV-infected donors can transmit the virus to their recipients.
Because a number of studies have associated infections with HCV with increased
morbidity and mortality among renal transplant recipients, it is important to
prevent HCV transmission with renal transplantation. The majority of organ
procurement organizations (OPOs) perform routine screening of organ donors for
antibodies to HCV (anti-HCV). The prevalence of HCV infection among cadaver
organ donors, ascertained based on a positive anti-HCV test by ELISA2, varies
worldwide between 1.08% and 11.8%. The use of kidneys from donors negative for
anti-HCV by ELISA2 carries negligible or no risk of transmitting HCV infection.
The use of organs from anti-HCV-positive donors has been restricted to
life-saving transplants (heart, liver or lung) by the majority of OPOs
worldwide. However, discarding kidneys from all anti-HCV positive donors would
lead to unnecessary waste of organs because not all anti-HCV positive donors
are infectious. Recently, the policy of unconditional restriction on the use of
kidneys from anti-HCV positive donors has been challenged, and transplantation
of organs from anti-HCV-positive donors into anti-HCV-positive recipients has
been found to be safe. An even better alternative might be a policy of
transplanting kidneys from anti-HCV-positive donors only in HCV RNA-positive
recipients. However, until more data become available, these two strategies
remain experimental treatments. N.
Ref:: 51
----------------------------------------------------
[128]
TÍTULO / TITLE: - Imaging in renal
transplantation.
REVISTA
/ JOURNAL: - Ultrasound Q 2003 Sep;19(3):123-38.
AUTORES
/ AUTHORS: - Baxter GM
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, Western Infirmary
NHS Trust, Glasgow, Scotland, UK. g.m.baxter@clinmed.gla.ac.uk
RESUMEN
/ SUMMARY: - Renal transplantation is the best
treatment option for chronic renal failure, with marked improvement in social
activity, work, and family life. In addition to these obvious improvements, it
is an extremely cost-effective procedure when successful. Ultrasonography plays
a major role in the imaging of these patients, and ultrasound (including color
Doppler) is helpful to the transplant physician in detecting graft dysfunction
and peritransplant collections, some of which may be drained under ultrasound
guidance. It is also helpful in the diagnosis of chronic vascular complications
including transplant artery stenosis and arteriovenous fistula. It has no
specific application in the diagnosis of chronic rejection. N. Ref:: 48
----------------------------------------------------
[129]
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
----------------------------------------------------
[130]
TÍTULO / TITLE: - Ambulatory blood pressure
monitoring in pediatric renal transplantation.
REVISTA
/ JOURNAL: - Pediatr Transplant 2003 Apr;7(2):86-92.
AUTORES
/ AUTHORS: - Mitsnefes MM; Portman RJ
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, Division of
Nephrology and Hypertension, University of Cincinnati College of Medicine and
The Children’s Hospital Research Foundation, Cincinnati, OH, USA.
RESUMEN
/ SUMMARY: - Over last two decades ABPM has evolved
from a research device to an established and valuable clinical tool for BP evaluation.
More than 10 yrs ago ABPM was introduced to pediatrics and since that time, its
importance has been increasing in the management of hypertension in children
and adolescents. This review summarizes the information gathered from the
studies of ABPM in adult and pediatric patients with renal transplants. We will
review the importance of hypertension in this patient subset, discuss the
advantage of ABPM over CBP and focus on specific abnormalities and clinical
significance of ABPM in renal transplant recipients. N. Ref:: 57
----------------------------------------------------
[131]
TÍTULO / TITLE: - Blood pressure after
renal transplantation.
REVISTA
/ JOURNAL: - Ann Transplant 2001;6(4):21-4.
AUTORES
/ AUTHORS: - Zeier M; Dikow R; Ritz E
INSTITUCIÓN
/ INSTITUTION: - Department Internal Medicine, Ruperto
Carola University, Heidelberg, Germany.
RESUMEN
/ SUMMARY: - Hypertension is extremely common in renal
allograft recipients, mainly as the result of impaired renal function and
cyclosporin A therapy. Blood pressure is a powerful independent predictor of
longterm graft outcome. This adverse effect is presumably mediated by both
hemodynamic and non-hemodynamic factors. There is also evidence for activation
of the renin angiotensin system in the renal allograft. Antihypertensive
treatment is of known benefit on graft outcome in experimental models, but this
has so far not been documented in clinical trials. Proteinuria is another
independent predictor of longterm graft outcome. There is recent documentation
of a specific antiproteinuric effect of ACE inhibitors on proteinuria which is
of interest since proteinuria is an independent predictor of longterm graft
outcome. N. Ref:: 32
----------------------------------------------------
[132]
TÍTULO / TITLE: - Transmission of viral
hepatitis by kidney transplantation: donor evaluation and transplant policies
(Part 1: hepatitis B virus).
REVISTA
/ JOURNAL: - Transpl Infect Dis 2002 Sep;4(3):117-23.
AUTORES
/ AUTHORS: - Natov SN; Pereira BJ
INSTITUCIÓN
/ INSTITUTION: - Tufts University School of Medicine,
Tufts-New England Medical Center, Boston, Massachusetts, USA.
RESUMEN
/ SUMMARY: - This two-part article discusses serologic
testing of prospective donors for viral hepatitis B and C, as part of the comprehensive
donor evaluation, and reviews the current policies and practices aimed at
preventing donor-to-recipient transmission of hepatitis B and C viruses (HBV,
HBC). This first part of the review discusses HBV. Organs procured from
HBV-infected donors can transmit the virus to their recipients. Because
infections with HBV have been associated with increased morbidity and mortality
among renal transplant recipients, it is important to prevent HBV transmission
with renal transplantation. Routine serologic evaluation of prospective organ
donors for markers of HBV infection includes testing for hepatitis B surface
antigen (HBsAg), anti-hepatitis B surface antigen antibody (HBsAb), and
antibody to hepatitis B core antigen (anti-HBc). The risk of HBV transmission
with kidney transplantation is a function of the serologic status of both donor
and recipient. Knowledge of this risk is essential for the rational use of
kidney allografts. HBsAg-positive donors are at high risk of transmitting HBV
infection to their organ recipients, particularly if these donors are
concurrently positive for hepatitis B e antigen (HBeAg). Kidneys from donors
with isolated presence of HBsAb are unlikely to transmit HBV infection to their
recipients. The risk of HBV transmission with the use of kidneys from IgG
anti-HBc-positive, HBsAg-negative donors is low. Kidneys from donors negative
for both HBcAg and anti-HBc are at low-to-negligible or no risk of transmitting
HBV to their recipients. Under certain conditions, kidneys from HBV-infected
donors can be safely used and thus prevent unnecessary discarding of organs.
Kidneys from HBsAg-positive donors, who are negative for HBeAg, carry no risk
or only minimal risk of transmitting HBV infection to their recipients if these
recipients are immune to HBV or HBsAg-positive. However, the safety of these
policies deserves further evaluation. N.
Ref:: 33
----------------------------------------------------
[133]
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.
----------------------------------------------------
[134]
TÍTULO / TITLE: - Disseminated Dactylaria
constricta infection in a renal transplant recipient.
REVISTA
/ JOURNAL: - Transpl Infect Dis 2001 Mar;3(1):40-3.
AUTORES
/ AUTHORS: - Malani PN; Bleicher JJ; Kauffman CA;
Davenport DS
INSTITUCIÓN
/ INSTITUTION: - Division of Infectious Diseases, Department
of Internal Medicine, Veterans Affairs Healthcare System, University of
Michigan Medical School, Ann Arbor, Michigan 48105, USA.
RESUMEN
/ SUMMARY: - We report the case of a 32-year-old renal
transplant recipient who developed disseminated Dactylaria constricta
infection. The patient died despite treatment with amphotericin B,
itraconazole, and fluconazole. N.
Ref:: 17
----------------------------------------------------
[135]
TÍTULO / TITLE: - Intraoperative vascular
localization to facilitate endopyelotomy after renal transplantation.
REVISTA
/ JOURNAL: - ANZ J Surg 2001 Aug;71(8):485-6.
AUTORES
/ AUTHORS: - Siddins M; Kanchanabat B; Rao MM
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Transplantation, Queen
Elizabeth Hospital, Woodville, South Australia, Australia. siddinsmark@hotmail.com
RESUMEN
/ SUMMARY: - BACKGROUND: Pelviureteric junction (PUJ)
obstruction after renal transplantation is uncommon. Surgical correction can be
technically challenging due to dense perinephric adhesions and variable hilar
vascular anatomy. Endopyelotomy is well established in the treatment of PUJ
obstruction in native kidneys. METHODS: The present paper reports the first
experience of antegrade visual cold-knife endopyelotmy performed in a renal
allograft. In orientating the incision at the PUJ, preoperative imaging was
supplemented by intrarenal Doppler ultrasound, using a probe designed for
transoesophageal cardiac monitoring. To the authors’ knowledge this approach
has not previously been reported. RESULTS: Renal vascular relationships were
readily indentified by identifying arterial and venous waveforms. CONCLUSIONS:
For this uncommon procedure the use of intrarenal Doppler ultrasound provides
greater security in avoiding inadvertent vascular injury. N. Ref:: 5
----------------------------------------------------
[136]
TÍTULO / TITLE: - Maintenance
immunosuppression.
REVISTA
/ JOURNAL: - Clin Transpl 2001;:223-36.
AUTORES
/ AUTHORS: - Takemoto SK
RESUMEN
/ SUMMARY: - An “intent-to-treat” analysis was
developed to examine the administration of primary and adjunctive
immunosuppressive agents by year of transplant for unsensitized, sensitized,
multi-organ and living donor transplant recipients by centers reporting to the
UNOS Registry of Renal Transplant Recipients. Based on these analyses, several
trends were noted: Tacrolimus became the dominant primary agent for multi-organ
transplant recipients in 1998, sensitized recipients in 2000, and unsensitized and
living-donor transplant recipients in 2001. MMF became the dominant adjunctive
agent for all transplants studied in 1996. The combination of CsA-MMF was most
often administered to unsensitized and living donor recipients while Tac-MMF
was most often used for multi-organ transplants. The trend of decreasing
rejection rates from 60% in 1996 to 20% in 2001 was similar for each type of
transplant studied. Rejection rates were highest with the Csa-Aza combination
and lowest with the Tac-MMF combination. Combinations with the lowest rates of
rejection did not necessarily have the highest graft outcome. HLA matching
decreased rejection rates and improved graft outcome for each type of
transplant and immunosuppression combination. Graft outcome in HLA-matched living
donor transplants was highest with the less potent CsA-Aza combination and
lowest with the Tac-MMF combination. Treatment crossover from CsA to Tac or Aza
to MMF was least frequent among HLA-matched recipients. Crossover from MMF to
Aza was highest in HLA-matched living donor transplants.
----------------------------------------------------
[137]
TÍTULO / TITLE: - Induction immunotherapy
with IL-2Ra monoclonal antibody in kidney transplantation.
REVISTA
/ JOURNAL: - Minerva Urol Nefrol 2003 Mar;55(1):67-79.
AUTORES
/ AUTHORS: - Ahsan N
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and
Transplantation, University of Medicine and Dentistry of New Jersey, Robert
Wood Johnson Medical School, New Brunswick, NJ 08903, USA. ahsanna@umdnj.edu
RESUMEN
/ SUMMARY: - The development of new immunosuppressive
agents is designed to reduce the incidence and severity of early acute
post-transplant rejection. One potential target for more specific
immunosuppressive therapy with monoclonal antibodies is the high affinity a
chain of interleukin-2 receptors (IL-2Ra). Clinical investigation of murine
IL-2Ra monoclonal antibodies (IL-2Ra mAb) in renal transplantation has
indicated that a complete blockade of IL-2Ra during the critical first
post-transplant months allows effective immunoprophylaxis, especially in the
early post-transplant period. Efficacy of these agents, however, is hampered by
their short disposition half-lives in humans and their immunogenicity in the
form of neutralizing human antimouse antibodies. These inherent problems can be
partially overcome by chi-meric, hyper-chimeric (humanized) products and
multiple dose regimens. Both IL-2Ra mAbs: daclizumab (humanized) and
basiliximab (chimeric) currently approved for clinical use have been found to
reduce the frequency of acute rejections in renal transplant recipients without
an apparent increase in short-term toxicities. In most transplant centers where
these agents are utilized, they are being routinely administered as induction
immunoprophylaxis in recommended multiple dose regimens to recipients of solid
organ transplants. Others have restricted their use to certain high-risk
patients such as those undergoing multi-organ transplantation, recipients with
high panel-reactive antibodies, African-Americans, patients at risk for
developing delayed graft function (DGF), and children. Recently some
investigators have successfully administered these antibodies co-administered
with newer immunosuppressive agents in limited dose protocols thus developing
cost effective and simplified regimens. Therefore, in the absence of a
favorable long-term efficacy, it is likely that these agents will be
administered in limited dose protocols along with one of the modulators of IL-2,
i.e. calcineurin inhibitors (CNI), to a selected group of patients in whom
additional immunosuppression in the early post-transplantation period is
desirable. N. Ref:: 59
----------------------------------------------------
[138]
TÍTULO / TITLE: - New monoclonal
antibodies in renal transplantation.
REVISTA
/ JOURNAL: - Minerva Urol Nefrol 2003 Mar;55(1):57-66.
AUTORES
/ AUTHORS: - Vincenti F
INSTITUCIÓN
/ INSTITUTION: - Kidney Transplant Service, University of
California, San Francisco, CA 94143-0780, USA. vincentif@surgery.ucsf.edu
RESUMEN
/ SUMMARY: - A decade of spectacular innovation in
maintenance immunosuppression drugs has resulted in dramatic reductions in
acute rejection and improvement in short and long term outcome after renal
transplantation. However the new drugs continue to lack specificity, many
require frequent therapeutic drug monitoring and all are associated with acute
and chronic toxicities. The new biologic agents, monoclonal antibodies
(chimeric, humanized, and fully human) and receptor-fusion proteins, lack
immunogenicity, have long half-life and prolonged biologic effects, require
intermittent administration and have minimal toxicity. The specificity and
selectively of the targets of the new biologic agents render them less toxic
than the oral maintenance drugs and thus could possibly replace the maintenance
drugs most associated with long-term toxicity such as the corticosteroids and
the calcineurin inhibitors. The recently introduced anti-interleukin 2 receptor
(IL-2R) monoclonal antibodies (mAbs) are the prototype of future biologic
agents; selective, safe, and inducing prolonged biologic effects. The IL-2R
mAbs have been used with a variety of maintenance immunosuppression regimens
double therapy with cyclosporine and prednisone, triple therapy with
cyclosporine, azathioprine and prednisone and with newer regimens such as
cyclosporine or tacrolimus, mycophenolate mofetil (MMF) and prednisone, and
most recently with sirolimus, MMF and prednisone. The major thrust of the new
biologics in clinical development is to block the co-stimulatory pathway. The
first attempt at blockade of the CD40-CD154 with anti-CD154 mAbs was
disappointing. Anti-CD 154 therapy was associated with thromboembolic events
and acute rejection. Attempts at blocking the CD28-B7s (CD80-CD86) pathway are
currently underway with the receptor fusion protein, LEA29Y a second generation
CTL4Aig, and humanized mAbs to CD 80 and CD86. LFA1, an adhesion molecule that also
participates in the co-stimulatory pathway, has also been targeted with a mAb
that binds to the CD11a chain of LFA1. Efalizumab, a humanized anti-CD11a mAb,
was shown in a phase I trial to be potentially effective in renal
transplantation. A humanized anti-CD45 RB mAb is currently in pre-clinical
studies and will likely be tested in a phase I trial of renal transplantation
within 1 year. While excellent results with anti-CD45 RB mAbs have been
published in experimental transplantation, the mechanism of action of anti-CD45
RB mAbs remains to be determined. Several antibodies that are currently
approved for non-transplant indications are currently used in single center
clinical trials in renal transplantation including Campath 1 H, a humanized
anti-CD52 mAb, Rituxamab, an anti-CD20 chimeric mAb, and Infliximab an
anti-TNFa chimeric mAb. In addition, several humanized mutagenized anti-CD3
mAbs, huOKT3g1, aglycosyl CD3 and HuM291 have been used in limited trials in
renal transplantation but have yet to have a formal clinical development.
Humanized mAbs and receptor fusion proteins offer the potential of providing
renal transplant recipients with a novel algorithm for immunosuppression that
relies on chronic intermittent intravenous administration of safe, non-toxic
agents replacing oral drug therapy maintenance. N. Ref:: 50
----------------------------------------------------
[139]
TÍTULO / TITLE: - An update in transplant
immunosuppressive therapy.
REVISTA
/ JOURNAL: - Med Health R I 2002 Apr;85(4):131-3.
AUTORES
/ AUTHORS: - Thursby MA; Yango AF; Gohh RY
INSTITUCIÓN
/ INSTITUTION: - Rhode Island Hospital, Division of Renal
Diseases, 593 Eddy Street, Providence, RI 02903, USA. Mthursby@lifespan.org N. Ref:: 10
----------------------------------------------------
[140]
TÍTULO / TITLE: - Protocol biopsy and
subclinical rejection in patients after kidney transplantation treated by
tacrolimus (Prograf).
REVISTA
/ JOURNAL: - Biomed Pap Med Fac Univ Palacky Olomouc
Czech Repub 2003 Dec;147(2):193-6.
AUTORES
/ AUTHORS: - Zadrazil J; Krejci K; Al-Jabry S; Horcicka
V Jr; Tichy T; Hrabalova M; Bachleda P
INSTITUCIÓN
/ INSTITUTION: - 3rd Clinic of Internal
Medicine, Teaching Hospital, I. P. Pavlova 22, Olomouc, 775 00, Czech Republic.
RESUMEN
/ SUMMARY: - The article deals with the contribution of
tacrolimus (Prograf) to improvement in kidney transplant results. Tacro-limus,
in comparison with cyclosporine significantly reduces the incidence of acute
rejection and improves survival of grafts as well as patients. Based on the
literature, the primary immunological differences between tacrolimus and
cyclosporine effects are pointed out. These differences explain the better
immunosuppressive effectiveness of tacrolimus. Based on analysis of the
results, subclinical rejection problems and significance of protocol biopsy for
present-day transplantology are discussed. There is also a critical analysis of
the questions, which priority, in relationship to the expanding availability of
immunosuppressive substances currently has high interest for nephrologists
researching subclinical rejection.
----------------------------------------------------
[141]
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
----------------------------------------------------
[142]
TÍTULO / TITLE: - Kidney transplantation
from living donors: comparison of results between related and unrelated donor
transplants under new immunosuppressive protocols.
REVISTA
/ JOURNAL: - Isr Med Assoc J 2003 Sep;5(9):622-5.
AUTORES
/ AUTHORS: - Chkhotua AB; Klein T; Shabtai EL; Yussim
A; Bar-Nathan N; Shaharabani E; Lustig S; Mor E
INSTITUCIÓN
/ INSTITUTION: - National Center of Urology, Tbilisi,
Georgia.
RESUMEN
/ SUMMARY: - BACKGROUND: Recent advances in
immunosuppressive therapy have led to a substantial improvement in the outcome
of kidney transplantation. Living unrelated donors may become a source of
additional organs for patients on the kidney waiting list. OBJECTIVES: To study
the impact of the combination of calcineurin inhibitors and
mycophenolate-mofetile, together with steroids, on outcomes of living related
and unrelated transplants. METHODS: Between September 1997 and January 2000,
129 patients underwent living related (n = 80) or unrelated (n = 49) kidney
transplant. The mean follow-up was 28.2 months. Immunosuppressive protocols
consisted of MMF with cyclosporine (41%) or tacrolimus (59%), plus steroids.
Patient and graft survival data, rejection rate, and graft functional
parameters were compared between the groups. RESULTS: LUD recipients were older
(47.8 vs. 33.6 years) with a higher number of re-transplants (24.5% vs. 11.2%
in LRD recipients, P < 0.05). Human leukocyte antigen matching was higher in
LRD recipients (P < 0.001). Acute rejection developed in 28.6% of LUD and
27.5% of LRD transplants (P = NS). Creatinine levels at 1, 2 and 3 years
post-transplant were 1.6, 1.7 and 1.7 mg/dl for LRD patients and 1.5, 1.5 and
1.3 mg/dl for LUD recipients (P = NS). There was no difference in patient
survival rates between the groups. One, 2 and 3 years graft survival rates were
similar in LRD (91.3%, 90% and 87.5%) and LUD (89.8%, 87.8% and 87.8%)
recipients. CONCLUSIONS: Despite HLA disparity, rejection and survival rates of
living unrelated transplants under current immunosuppressive protocols are
comparable to those of living related transplants.
----------------------------------------------------
[143]
TÍTULO / TITLE: - The diagnostic
challenge and management of pulmonary Kaposi’s sarcoma in renal transplant
recipients.
REVISTA
/ JOURNAL: - Saudi Med J 2001 Dec;22(12):1061-4.
AUTORES
/ AUTHORS: - Krayem AB; Wali SO; Samman YS
INSTITUCIÓN
/ INSTITUTION: - Pulmonary Section, Department of Medicine,
King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia.
RESUMEN
/ SUMMARY: - Kaposi’s sarcoma is a multicentric low
grade tumor that usually begins with the development of violaceous skin lesions
and is associated with the presence of human herpes virus 8. Kaposi’s sarcoma
has been described in immunocompromised patients, particularly following renal
transplantation, with cutaneous involvement being the most salient finding.
Infectious and non-infectious pulmonary disorders in immunocompromised patients
can simulate the radiological manifestations of pulmonary Kaposi’s sarcoma.
This report highlights the dilemma in reaching an accurate diagnosis of
pulmonary Kaposi’s sarcoma as a complication of immunosuppression post-renal
transplant and reviews the management of immunosuppression related Kaposi’s
sarcoma. N. Ref:: 31
----------------------------------------------------
[144]
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
----------------------------------------------------
[145]
TÍTULO / TITLE: - A model for nurse-led
skin cancer surveillance following renal transplantation.
REVISTA
/ JOURNAL: - Nephrol Nurs J 2002 Jun;29(3):257-9, 267.
AUTORES
/ AUTHORS: - Reece SM; Harden PN; Smith AG; Ramsay HM
INSTITUCIÓN
/ INSTITUTION: - Departments of Nephrology and Dermatology,
North Staffordshire Hospital, Stoke-on-Trent, UK.
RESUMEN
/ SUMMARY: - Renal transplant recipients are at high
risk for multiple non-melanoma skin cancers (NMSC) that occur at a younger age
and behave more aggressively. Consequently, the American Society of
Transplantation has recommended that physicians conduct annual screenings for
NMSC in this population. Few centres currently offer a dedicated surveillance
programme. This article discusses a model for skin cancer surveillance in which
a trained nurse works within a validated competency programme to provide annual
skin surveillance and education in the renal transplant outpatient clinic. N. Ref:: 9
----------------------------------------------------