#06#
Revisiones-Clínica-Pronóstico
*** Reviews-Clinical-Prognosis
TRASPLANTE
RENAL *** RENAL TRANSPLANTATION
(Conceptos
/ Keywords: Renal-Kidney transplantation; Kidney donation-procurement; etc).
Enero /
January 2001 --- Marzo / March 2004
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[1]
TÍTULO / TITLE: - Strategies to improve
long-term outcomes after renal transplantation.
REVISTA
/ JOURNAL: - N Engl J Med. Acceso gratuito al texto
completo a partir de los 6 meses de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://content.nejm.org/
●●
Cita: New England J Medicine (NEJM): <> 2002 Feb 21;346(8):580-90.
●●
Enlace al texto completo (gratuito o de pago) 1056/NEJMra011295
AUTORES
/ AUTHORS: - Pascual M; Theruvath T; Kawai T;
Tolkoff-Rubin N; Cosimi AB
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Department of Medicine,
Massachusetts General Hospital, Boston, MA 02114, USA. mpascual@partners.org N. Ref:: 99
----------------------------------------------------
[2]
TÍTULO / TITLE: - Clinical practice guidelines
for managing dyslipidemias in kidney transplant patients: a report from the
Managing Dyslipidemias in Chronic Kidney Disease Work Group of the National
Kidney Foundation Kidney Disease Outcomes Quality Initiative.
REVISTA
/ JOURNAL: - Am J Transplant 2004;4 Suppl 7:13-53.
●●
Enlace al texto completo (gratuito o de pago) 1111/j.1600-6135.2004.0355.x
AUTORES
/ AUTHORS: - Kasiske B; Cosio FG; Beto J; Bolton K;
Chavers BM; Grimm R Jr; Levin A; Masri B; Parekh R; Wanner C; Wheeler DC;
Wilson PW
RESUMEN
/ SUMMARY: - The incidence of cardiovascular disease
(CVD) is very high in patients with chronic kidney (CKD) disease and in kidney
transplant recipients. Indeed, available evidence for these patients suggests
that the 10-year cumulative risk of coronary heart disease is at least 20%, or
roughly equivalent to the risk seen in patients with previous CVD. Recently,
the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative
(K/DOQI) published guidelines for the diagnosis and treatment of dyslipidemias
in patients with CKD, including transplant patients. It was the conclusion of
this Work Group that the National Cholesterol Education Program Guidelines are
generally applicable to patients with CKD, but that there are significant
differences in the approach and treatment of dyslipidemias in patients with CKD
compared with the general population. In the present document we present the
guidelines generated by this workgroup as they apply to kidney transplant
recipients. Evidence from the general population indicates that treatment of
dyslipidemias reduces CVD, and evidence in kidney transplant patients suggests
that judicious treatment can be safe and effective in improving dyslipidemias.
Dyslipidemias are very common in CKD and in transplant patients. However, until
recently there have been no adequately powered, randomized, controlled trials
examining the effects of dyslipidemia treatment on CVD in patients with CKD.
Since completion of the K/DOQI guidelines on dyslipidemia in CKD, the results
of the Assessment of Lescol in Renal Transplantation (ALERT) Study have been
presented and published. Based on information from randomized trials conducted
in the general population and the single study conducted in kidney transplant
patients, these guidelines, which are a modified version of the K/DOQI
dyslipidemia guidelines, were developed to aid clinicians in the management of
dyslipidemias in kidney transplant patients. These guidelines are divided into
four sections. The first section (Introduction) provides the rationale for the
guidelines, and describes the target population, scope, intended users, and
methods. The second section presents guidelines on the assessment of
dyslipidemias (guidelines 1-3), while the third section offers guidelines for
the treatment of dyslipidemias (guidelines 4-5). The key guideline statements
are supported mainly by data from studies in the general population, but there
is an urgent need for additional studies in CKD and in transplant patients.
Therefore, the last section outlines recommendations for research.
----------------------------------------------------
[3]
TÍTULO / TITLE: - Prognostic value of
myocardial perfusion studies in patients with end-stage renal disease assessed
for kidney or kidney-pancreas transplantation: a meta-analysis.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Feb;14(2):431-9.
AUTORES
/ AUTHORS: - Rabbat CG; Treleaven DJ; Russell JD;
Ludwin D; Cook DJ
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of
Nephrology, McMaster University, Hamilton, Ontario, Canada. rabbatc@mcmaster.ca
RESUMEN
/ SUMMARY: - The prognostic utility of myocardial perfusion
studies (MPS) such as thallium scintigraphy and dobutamine stress
echocardiography (DSE) for stratifying cardiac risk among candidates for kidney
or kidney-pancreas transplantation is uncertain. This study is a meta-analysis
to determine the prognostic significance of MPS results on future myocardial
infarction (MI) and cardiac death (CD) in patients with end-stage renal disease
(ESRD) assessed for kidney or kidney-pancreas transplantation. MEDLINE was
searched using combinations of MeSH headings and text words for
transplantation, coronary artery disease, prognosis, end-stage renal disease,
and noninvasive cardiac testing (nuclear scintigraphy and DSE) for primary
studies. Studies were included if they reported MPS results and cardiac events
in patients assessed for kidney or kidney-pancreas transplantation.
Methodologic study quality and outcome data were independently abstracted in
duplicate by two researchers. The relative risks (RR) of MI and CD were
calculated using a random effects model. Twelve articles met all inclusion
criteria; 12 studies reported CD, and 9 reported MI. In eight studies, thallium
scintigraphy was used (four with pharmacologic stress, four with exercise
stress), whereas four used DSE. When compared with negative tests, positive tests
had a significantly increased RR of MI (2.73 [95% CI, 1.25 to 5.97]; P = 0.01)
and CD (2.92 [95% CI, 1.66 to 5.12]; P < 0.001). Subgroup analyses of
studies of diabetic patients indicated that positive tests were associated with
a RR of CD 3.95 (95% CI, 1.48 to 10.5; P = 0.006) and a RR of MI 2.68 (95% CI,
0.95 to 7.57; P = 0.06) when compared with negative tests. In studies
evaluating mixed populations of diabetic and nondiabetic patients, positive
tests were associated with a RR of CD 2.52 (95% CI, 1.25 to 5.08; P = 0.01) and
with a RR of MI 2.79 (95% CI, 0.85 to 9.21; P = 0.09) when compared with a
negative test. The presence of reversible defects was associated with an
increased risk of MI in diabetic patients and of CD in both subgroups; fixed defects
were associated with an increased risk of CD but not MI. It is concluded that
positive MPS are useful in identifying patients with significantly increased
risk of future MI and CD in both diabetic and nondiabetic ESRD patients.
----------------------------------------------------
[4]
TÍTULO / TITLE: - A randomized long-term
trial of tacrolimus/sirolimus versus tacrolimus/mycophenolate mofetil versus
cyclosporine (NEORAL)/sirolimus in renal transplantation. II. Survival,
function, and protocol compliance at 1 year.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):252-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000101495.22734.07
AUTORES
/ AUTHORS: - Ciancio G; Burke GW; Gaynor JJ; Mattiazzi
A; Roth D; Kupin W; Nicolas M; Ruiz P; Rosen A; Miller J
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, University of Miami School of Medicine, Miami, FL 33101, USA. gciancio@med.miami.edu
RESUMEN
/ SUMMARY: - BACKGROUND: In an attempt to reduce
chronic calcineurin inhibitor induced allograft nephropathy in first cadaver
and human leukocyte antigen non-identical living-donor renal transplantation,
sirolimus (Siro) or mycophenolate mofetil (MMF) was tested as adjunctive
therapy, with planned dose reductions of tacrolimus (Tacro) over the first year
postoperatively. Adjunctive Siro therapy with a similar dose reduction
algorithm for Neoral (Neo) was included for comparison. METHODS: The detailed
dose reduction plan (Tacro and Siro, group A; Tacro and MMF, group B; Neo and
Siro, group C) is described in our companion report in this issue of
Transplantation. The present report documents function, patient and graft
survival, protocol compliance, and adverse events. RESULTS: As mentioned (in
companion report), group demographics were similar. The present study shows no
significant differences in 1-year patient and graft survival but does show a
trend that points to more difficulties in group C by way of a rising slope of
serum creatinine concentration (P=0.02) and decreasing creatinine clearance
(P=0.04). There were more patients who discontinued the protocol plan in group
C. Thus far, no posttransplant lymphomas have appeared, and infectious
complications have not differed among the groups. However, a greater percentage
of patients in group C were placed on antihyperlipidemia therapy, with an
(unexpected) trend toward a higher incidence of posttransplant diabetes
mellitus in this group. Group A required fewer, and group B the fewest,
antihyperlipidemia therapeutic interventions (P<0.00001). CONCLUSIONS: This
1-year interim analysis of a long-term, prospective, randomized
renal-transplant study indicates that decreasing maintenance dosage of Tacro
with adjunctive Siro or MMF appears to point to improved long-term function,
with reasonably few adverse events.
----------------------------------------------------
[5]
TÍTULO / TITLE: - Treatment and outcome
of invasive bladder cancer in patients after renal transplantation.
REVISTA
/ JOURNAL: - J Urol 2004 Mar;171(3):1085-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.ju.0000110612.42382.0a
AUTORES
/ AUTHORS: - Master VA; Meng MV; Grossfeld GD; Koppie
TM; Hirose R; Carroll PR
INSTITUCIÓN
/ INSTITUTION: - Departments of Urology and Surgery,
University of California, San Francisco, California 94143, USA. vmaster@urol.ucsf.edu
RESUMEN
/ SUMMARY: - PURPOSE: Optimal management and clinical
outcome of bladder cancer in renal transplant recipients are not well-defined.
We analyzed single institution treatment strategies and outcomes of these
patients. MATERIALS AND METHODS: We retrospectively reviewed the University of
California, San Francisco transplant database which contains information on
6,288 renal transplants performed between 1964 and 2002. The United Network for
Organ Sharing database and Israel Penn International Transplant Tumor Registry
were also queried to characterize the global nature of bladder cancer in renal
transplant recipients. RESULTS: The United Network for Organ Sharing database
(1986 to 2001) contained information on 31 patients who were found to have
bladder cancer (0.024% prevalence) and the Israel Penn International Transplant
Tumor Registry (1967 to 2001) contained information on 135 patients
representing 0.84% of all reported malignancies. We identified 7 renal
transplant recipients with bladder cancer at our institution. Invasive
transitional cell carcinoma developed in 5 patients at a median of 2.8 years
after transplant. Three patients underwent uncomplicated radical cystectomy and
preservation of the renal allograft. Overall survival at 48 months was 60%.
CONCLUSIONS: Bladder cancer after renal transplantation is not common. For
patients who present with invasive disease, traditional extirpative surgery
should be considered. Moreover, the allograft is rarely the source of
transitional cell carcinoma and can be preserved. In our experience the cancer
and urinary outcomes compare favorably with nontransplant patient outcomes
after treatment. N.
Ref:: 21
----------------------------------------------------
[6]
TÍTULO / TITLE: - Routes to allograft
survival.
REVISTA
/ JOURNAL: - J Clin Invest. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jci.org/
●●
Cita: J Clinical Investigation: <> 2001 Apr;107(7):797-8.
AUTORES
/ AUTHORS: - Bromberg JS; Murphy B
INSTITUCIÓN
/ INSTITUTION: - Recanati/Miller Transplant Institute,
Mount Sinai School of Medicine, New York, New York 10029, USA. jon.bromberg@mountsinai.org N. Ref:: 21
----------------------------------------------------
[7]
TÍTULO / TITLE: - The CHORUS
(Cerivastatin in Heart Outcomes in Renal Disease: Understanding Survival)
protocol: a double-blind, placebo-controlled trial in patients with esrd.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Jan;37(1 Suppl
2):S48-53.
AUTORES
/ AUTHORS: - Keane WF; Brenner BM; Mazzu A; Agro A
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Hennepin County
Medical Center, University of Minnesota Medical School, Minneapolis, MN, USA. g.macgregor@sghms.ac.uk
RESUMEN
/ SUMMARY: - The 3-hydroxy-3-methylglutaryl coenzyme A
reductase inhibitor (statin)-mediated lowering of serum cholesterol has been
associated with a significant reduction in cardiovascular morbidity and
mortality. Recent studies suggest that additional non-lipid lowering effects
(eg, endothelial stabilization, anti-inflammatory, antithrombogenic) may be
important in modulating their effectiveness. Dyslipidemia is common in
end-stage renal disease (ESRD), and hemodialysis patients have increased
cardiovascular morbidity and mortality. Cerivastatin, a new statin with
powerful low-density lipoprotein-cholesterol (LDL-C) lowering capabilities,
possesses some unique non-LDL-C-mediated properties that may contribute to a
reduction of coronary events in the patient with ESRD. The primary objective of
this multicenter multinational study of 1,054 hemodialysis patients is to
compare 2 years of treatment with cerivastatin (0.4 mg/d) versus placebo on the
composite clinical event rate of myocardial infarction, sudden cardiac death,
ischemic stroke, and the need for coronary arterial bypass graft (CABG) or
percutaneous transluminal coronary angioplasty (PTCA) procedures in these
patients. Changes in lipids, inflammatory proteins including heat stable
C-reactive protein (hsCRP), interleukin-6 (IL-6), oncostatin-M, intracellular
adhesion molecule-1 (ICAM-1) and monocyte-chemoattractant protein-1 (MCP-1), as
well as markers of cardiac muscle pathology, such as troponin I and troponin T,
will be assessed in a subset of patients. This study is the first of its kind
to assess the effect of a statin on the reduction of cardiovascular morbidity
and mortality in an incident hemodialysis population. It will determine whether
treatment with cerivastatin can effectively reduce the significant
cardiovascular morbidity and mortality.
----------------------------------------------------
[8]
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.
----------------------------------------------------
[9]
TÍTULO / TITLE: - Incidence of ESRD and
survival after renal replacement therapy in patients with type 1 diabetes: a
report from the Allegheny County Registry.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Jul;42(1):117-24.
AUTORES
/ AUTHORS: - Nishimura R; Dorman JS; Bosnyak Z; Tajima
N; Becker DJ; Orchard TJ
INSTITUCIÓN
/ INSTITUTION: - Department of Epidemiology, Graduate
School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. rimei@excite.co.jp
RESUMEN
/ SUMMARY: - BACKGROUND: Little information is
available regarding the long-term incidence of end-stage renal disease (ESRD)
and survival after the introduction of renal replacement therapy (RRT) in
patients with type 1 diabetes. METHODS: We studied 1,075 patients with type 1
diabetes (onset age < 18 years) diagnosed between 1965 and 1979, who
comprise the Allegheny County population-based registry. Onset of ESRD was defined
as the introduction of RRT (dialysis or transplantation). RESULTS: Of 1,075
registrants, the living status of 975 patients (90.7%) and complication status
of 798 patients (74.2%) were ascertained as of January 1, 1999. During the
observation period, 104 patients (13.0%) developed ESRD, for an incidence rate
of 521/100,000 person-years (95% confidence interval, 424 to 629). The
cumulative incidence of ESRD was 11.3% at 25 years of diabetes. A significant
decline was observed in 20-year cumulative incidence rates of ESRD for patients
diagnosed between 1965 and 1969, 1970 and 1974, and 1975 and 1979 (9.1%, 4.7%,
and 3.6%, respectively; P = 0.006). Of 104 patients with ESRD, 29 patients
(28%) received dialysis alone, 44 patients (42%) received dialysis followed by
kidney transplantation, 26 patients (25%) underwent successful transplantation
alone, and 5 patients (5%) underwent a failed kidney transplantation followed
by dialysis therapy. The cumulative survival rate 10 years after the
introduction of RRT was 51.2%. The cumulative survival rate of dialysis therapy
followed by kidney transplantation was significantly greater than that of
dialysis therapy alone (P < 0.001). No difference was detected in survival
between pancreas-kidney transplant recipients and kidney-alone transplant
recipients (P = 0.7). CONCLUSION: The incidence of ESRD observed in this cohort
has declined, probably reflecting the better glycemic and blood pressure
control available since the early 1980s.
N. Ref:: 35
----------------------------------------------------
[10]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.13 Analysis of patient and graft survival.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:60-7.
RESUMEN
/ SUMMARY: - GUIDELINES: A. It is important for a
transplant unit to follow-up on the results of their transplant activities. In
order to achieve correct reports on graft and patient outcome in all patients,
it is necessary to have sufficient resources, such as a computerized database,
and continuous updates of patient information. All data collected should be
subjected to validation procedures to ensure completeness and accuracy. B.
Improved outcomes following implementation of new protocols, based on
evaluation of clinical multi-centre trials, should be verified at local
transplant centres since centres often include a range of patients different
from those selected for the trial. C. The most widely accepted descriptor of
outcome is the Kaplan-Meier probability estimate of patient and graft survival.
Survival estimates should be calculated at intervals of time after
transplantation and should always be expressed with their 95% confidence
intervals. D. Kaplan-Meier survival estimates may be calculated in three ways.
(i) ‘Patient survival’ should be calculated from the date of transplantation to
the date of death or the date of the last follow-up. (ii) ‘Graft survival’
(non-censored for death) should be calculated from the date of transplantation
to the date of irreversible graft failure signified by return to long-term dialysis
(or retransplantation) or the date of the last follow-up during the period when
the transplant was still functioning or to the date of death. Here, death with
graft function is treated as graft failure. (iii) ‘Graft survival censored for
death with a functioning graft’ (death-censored graft survival) should be
calculated from the date of transplantation to the date of irreversible graft
failure signified by return to long-term dialysis (or retransplantation) or the
date of last follow-up during the period when the transplant was still
functioning. In the event of death with a functioning graft, the follow-up
period is censored at the date of death. E. The outcome of transplants carried
out at a centre should be compared with those achieved across a range of data
from centres collated by national and international multi-centre registries.
Interpretation of a centre’s performance should take into account the number of
transplants performed and the prevalence of major risk factors. F. Major risk
factors that influence transplant outcome are identifiable by applying
multivariate analytical methods to large multi-centre follow-up databases.
Although these major risk factors may not be identifiable in individual centre
data, they should nonetheless be taken into account in patient management. G.
When designing a clinical trial or evaluating data from a recent trial, the
expected improvement in graft survival resulting from a reduction in acute
rejection may be estimated from a knowledge of the rejection and graft survival
rates that existed prior to the introduction of the new therapeutic regimen. H.
When designing or evaluating a clinical trial, it is important to analyse the
power of the study to verify statistically the difference (in graft survival)
that might be expected and its statistical significance. A study resulting in
absence of statistically significant differences between two treatment groups
with insufficient statistical power to verify a difference at the expected
level should not be taken as evidence of absence of a true difference.
----------------------------------------------------
[11]
TÍTULO / TITLE: - Renal function as a
predictor of long-term graft survival in renal transplant patients.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 May;18 Suppl 1:i3-6.
AUTORES
/ AUTHORS: - First MR
INSTITUCIÓN
/ INSTITUTION: - Research and Development, Fujisawa
Healthcare, Inc., Deerfield, IL 60015, USA. roy_first@fujisawa.com
RESUMEN
/ SUMMARY: - Acute rejection is a major risk factor for
kidney graft failure. However, as acute rejection has been progressively
reduced by recent immunosuppressive regimens, other risk factors are becoming
increasingly important. Evidence is accumulating that early renal function
predicts long-term outcome. A recent registry survey of more than 100 000
kidney transplants found that 6- and 12-month serum creatinine levels, as well
as the change between 6 and 12 months, are strongly associated with long-term
graft survival. A survey of paediatric renal transplant recipients showed that
poor creatinine clearance (<50 ml/min) as early as 30 days post-transplant
predicted an annual rate of graft loss of 13% compared with <3% in patients
with 30-day clearance >50 ml/min. This association between early renal
function and long-term outcome was confirmed in multicentre studies. Renal
transplant recipients (n=572) with 6-month serum creatinine levels >1.5
mg/dl suffered 3-year graft loss of 19.3% compared with only 8.5% in patients with
levels <1.6 mg/dl (P<0.001). Significantly fewer patients receiving
tacrolimus had 12-month serum creatinine levels >1.5 mg/dl compared with
cyclosporin (42 versus 54%, P<0.05). Interestingly, a single-centre study
(n=436) found that while glomerular filtration rate (GFR) at 6 months
post-transplant had remained stable over the last decade, the rate of loss of
renal function had decreased. A lower rate of GFR loss was associated with
absence of rejection, use of mycophenolate mofetil rather than azathioprine and
use of tacrolimus rather than cyclosporin (P<0.01). In conclusion, early
measures of renal function allow identification of those patients at highest
risk of graft failure and provide an invaluable tool for improving outcomes by
tailored immunosuppression. The choice of such immunosuppression should be
guided not only by its ability to prevent rejection, but also by its impact on
renal function. N.
Ref:: 11
----------------------------------------------------
[12]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.1. Organization of follow-up of transplant patients
after the first year.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:3-4.
RESUMEN
/ SUMMARY: - GUIDELINES: A. All renal transplant
recipients should undergo regular laboratory check-ups (at least every 2 or 3
months) and regular medical visits as out-patients (at least every 4-6 months)
after the first year post-transplant. B. All renal transplant recipients should
be seen at least once a year in the transplant centre where the transplantation
has been performed or referred to a closer transplant centre for a complete
annual evaluation.
----------------------------------------------------
[13]
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
----------------------------------------------------
[14]
TÍTULO / TITLE: - A benefit-risk
assessment of basiliximab in renal transplantation.
REVISTA
/ JOURNAL: - Drug Saf. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.csmwm.org/
●●
Cita: Drug Safety: <> 2004;27(2):91-106.
AUTORES
/ AUTHORS: - Boggi U; Danesi R; Vistoli F; Del Chiaro
M; Signori S; Marchetti P; Del Tacca M; Mosca F
INSTITUCIÓN
/ INSTITUTION: - Division of General Surgery and
Transplants, Department of Oncology, Transplants and Advanced Technologies in
Medicine, University of Pisa, Pisa, Italy. uboggi@med.unipi.it
RESUMEN
/ SUMMARY: - Interleukin-2 (IL-2) and its receptor
(IL-2R) play a central role in T lymphocyte activation and immune response
after transplantation. Research on the biology of IL-2R allowed the
identification of key signal transduction pathways involved in the generation
of proliferative and antiapoptotic signals in T cells. The alpha-chain of the
IL-2R is a specific peptide against which monoclonal antibodies have been
raised, with the aim of blunting the immune response by means of inhibiting
proliferation and inducing apoptosis in primed lymphocytes. Indeed,
basiliximab, one of such antibodies, has proved to be effective in reducing the
episodes of acute rejection after kidney and pancreas transplantation. The use
of basiliximab was associated with a significant reduction in the incidence of
any treated rejection episodes after kidney transplantation in the two major
randomised studies (placebo 52.2% vs basiliximab 34.2% at 6 months, European
study; placebo 54.9% vs basiliximab 37.6% at 1 year, US trial). Basiliximab and
equine antithymocyte globulin (ATG) administration resulted in a similar rate
of biopsy-proven acute rejection at 6 months (19% for both) and at 12 months
(19% and 20%, respectively). The use of basiliximab appears not to be
associated with an increased incidence of adverse events as compared with
placebo in immunosuppressive regimens, including calcineurin inhibitors,
mycophenolate mofetil or azathioprine and corticosteroids, and its safety
profile is superior to ATG. Moreover, a similar occurrence of infections is
noted in selected studies (65.5% after basiliximab vs 65.7% of controls),
including cytomegalovirus infection (17.3% vs 14.5%), and cytokine-release
syndrome is not observed. Finally, economic analysis demonstrated lower costs
of overall treatment in patients treated with basiliximab. Therefore, the use
of basiliximab entails a very low risk, allows safe reduction of corticosteroid
dosage and reduces the short- and mid-term rejection rates. However, the improvement
in the long-term survival of kidney grafts in patients treated according to
modern immunosuppressive protocols is still to be demonstrated. These
conclusions are based on a systematic review of the scientific literature,
indexed on Medline database, concerning the mechanism of action, therapeutic
activity, safety and pharmacoeconomic evaluation of basiliximab in renal
transplantation. N.
Ref:: 62
----------------------------------------------------
[15]
TÍTULO / TITLE: - Graft function and
other risk factors as predictors of cardiovascular disease outcome.
REVISTA
/ JOURNAL: - Transplantation 2001 Sep 27;72(6
Suppl):S16-9.
AUTORES
/ AUTHORS: - Forsythe JL
INSTITUCIÓN
/ INSTITUTION: - Transplant Unit, The Royal Infirmary of
Edinburgh, UK. john.forsythe@luht.scot.nhs.uk
RESUMEN
/ SUMMARY: - The high incidence of cardiovascular
disease after renal transplantation is related to a high prevalence and
accumulation of risk factors before and after transplantation. Hypertension,
posttransplantation diabetes, and hyperlipidemia are well-recognized risk
factors for the development of cardiovascular events after renal
transplantation and are strongly associated with immunosuppressive therapy.
Hyperhomocysteinemia is a potential risk factor for cardiovascular disease in
renal transplant recipients, but although a growing matter of study, a direct
association with immunosuppressive agents is not yet proven. In addition to
treatment intervention, risk management should also involve tailoring the
immunosuppressive regimen to minimize the more indirect cardiovascular risk
factors such as renal dysfunction and acute rejection. N. Ref:: 41
----------------------------------------------------
[16]
- Castellano -
TÍTULO / TITLE:Analisis estadistico de la
incidencia de canceres “de novo” en pacientes trasplantados renales: una nueva
metodologia de estudio. Statistic analysis of “de novo” cancer incidence in
renal transplant patients: a new study methodology.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2003 Sep-Oct;23(5):395-8.
AUTORES
/ AUTHORS: - Virto J; Orbe J; Lampreabe I; Zarraga S;
Urbizu JM; Gainza FJ
INSTITUCIÓN
/ INSTITUTION: - Departamento de Econometria y Estadistica
de la Facultad de Ciencias Economicas y Empresariales, Servicio de Nefrologia,
Unidad docente, Hospital de Cruces, Baracaldo.
N. Ref:: 16
----------------------------------------------------
[17]
TÍTULO / TITLE: - Early prognosis of the
development of renal chronic allograft rejection by gene expression profiling
of human protocol biopsies.
REVISTA
/ JOURNAL: - Transplantation 2003 Apr 27;75(8):1323-30.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000068481.98801.10
AUTORES
/ AUTHORS: - Scherer A; Krause A; Walker JR; Korn A;
Niese D; Raulf F
INSTITUCIÓN
/ INSTITUTION: - Novartis Institutes for BioMedical
Research/Transplantation, Novartis Pharma AG, Basel, Switzerland.
RESUMEN
/ SUMMARY: - BACKGROUND: Chronic allograft rejection
(CR) is the major cause of failure of long-term graft survival and is so far
irreversible. Early prognosis of CR by molecular markers before overt
histologic manifestation would be a valuable aid for the optimization of
treatment regimens and the design of clinical CR trials. Oligonucleotide
microarray-based approaches have proven to be useful for the diagnosis and
prognosis of a variety of diseases and were chosen for the unbiased
identification of prognostic biomarkers. METHODS: Renal allograft biopsies were
taken at month 6 posttransplantation (PT) from two groups who were, at that
time, healthy recipients: one group developed CR at month-12 PT, the other
group remained healthy. Gene expression profiles from the two groups at month-6
PT biopsies were analyzed to identify differentially expressed genes with
prognostic value for CR development at month 12. RESULTS: A set of 10 genes was
identified that showed differential expression profiles between the two patient
groups and had a complete separation of the 15% to 85% quantile range for each
individual gene. This set of genes was sufficient to allow the correct
prediction of the occurrence or nonoccurrence of CR in 15 of 17 (88%) patients
using cross-validation (occurrence for a patient was predicted on the basis of
the other patients’ data only). In addition, a correct prediction could be made
that a recipient with a normal biopsy 12 months PT developed CR within the
following 6 months. CONCLUSIONS: Identified expression patterns seem to be
highly prognostic of the development of renal CR.
----------------------------------------------------
[18]
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
----------------------------------------------------
[19]
TÍTULO / TITLE: - Current status of renal
transplantation. Patient evaluations and outcomes.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):677-86.
AUTORES
/ AUTHORS: - Barry JM
INSTITUCIÓN
/ INSTITUTION: - Division of Urology and Renal
Transplantation, Department of Surgery, Oregon Health Sciences University,
Portland, Oregon, USA.
RESUMEN
/ SUMMARY: - A systematic team approach to the
assessment of renal transplant candidates is one of several factors that have
resulted in improved kidney transplant and recipient survival rates, rates that
were only imagined 4 decades ago. N.
Ref:: 47
----------------------------------------------------
[20]
TÍTULO / TITLE: - Effects of
catecholamine application to brain-dead donors on graft survival in solid organ
transplantation.
REVISTA
/ JOURNAL: - Transplantation 2001 Aug 15;72(3):455-63.
AUTORES
/ AUTHORS: - Schnuelle P; Berger S; de Boer J; Persijn
G; van der Woude FJ
INSTITUCIÓN
/ INSTITUTION: - University Hospital Mannheim, Theodor
Kutzer Ufer 1-3, 68167 Mannheim, Germany. schnuell@rumms.uni-mannheim.de
RESUMEN
/ SUMMARY: - BACKGROUND: In a recent single-center
study, donor use of catecholamines was identified to reduce kidney allograft
rejection. This study investigates the effects of donor employment of
adrenergic agents on graft survival in a large data base, including liver and
heart transplants. METHODS: The study was based on the registry of the
Eurotransplant International Foundation including 2415 kidney, 755 liver, and
720 heart transplants performed between January 1 and December 31, 1993. A
total of 1742 donor record forms referring to the cadaveric donor activities in
1993 were systematically reviewed with regard to employment of adrenergic
agents. Catecholamine use was simply coded dichotomously and divided into three
strata according to zero, single, and combined application. Multivariate Cox
regression including age, gender, cause of brain death, cold ischemia,
HLA-mismatching, number of previous transplants, and urgency in liver
transplants was applied for statistical analysis. RESULTS: Donor employment of
catecholamines was associated with increased 4-year graft survival after kidney
transplantation (hazard ratio [HR], 0.85; 95% confidence interval [95% CI],
0.74-0.98). The benefit is conferred in a dose-dependent manner and compares in
quantitative terms with prospective HLA matching on class I and class II
antigens (HR, 0.90; 95% CI, 0.84-0.97). Use of norepinephrine was predictive of
initial nonfunction after heart transplantation (HR, 1.66; 95% CI, 1.14-2.43),
but did not compromise liver grafts (HR, 0.94; 95% CI, 0.67-1.32). CONCLUSIONS:
Optimizing the management of brain-dead organ donors, including the possibility
of selective administration of adrenergic agents, may provide a major benefit
on graft survival without adverse side effects for the recipients. Further
investigation on best use of adrenergic drugs, optimum dosage, and duration is
warranted.
----------------------------------------------------
[21]
TÍTULO / TITLE: - Are peritoneal dialysis
patients with and without residual renal function equivalent for survival
study? Insight from a retrospective review of the cause of death.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 May;18(5):977-82.
AUTORES
/ AUTHORS: - Szeto CC; Wong TY; Chow KM; Leung CB; Li
PK
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Prince of Wales
Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China. ccszeto@cuhk.edu.hk
RESUMEN
/ SUMMARY: - BACKGROUND: It remains unknown whether
results of survival studies in anuric patients can be extrapolated to those who
still have significant urine output. It is possible that after a prolonged
period on dialysis, anuric patients are qualitatively different from patients
with residual renal function. METHODS: We performed a retrospective review to
study the cause of death of 296 peritoneal dialysis patients of our centre over
a 7 year period, and compared the mortality and distribution of cause of death
between patients with and without residual renal function. RESULTS: One hundred
and forty-two cases (48.0%) died of vascular diseases, 82 cases (27.7%) died of
infections and 72 cases (24.3%) died of other causes. Anuric patients had a
higher overall mortality rate than non-anuric patients (14.9 vs 9.9%,
P=0.0005), and the difference was almost completely attributed to the
difference in mortality from vascular diseases (8.0 vs 4.1%, P<0.0001).
Vascular disease was a more common cause of death in anuric patients than those
with residual renal function (55.3 vs 40.8%, P=0.011). The difference was
largely explained by the higher prevalence of sudden cardiac death in anuric
patients (39 in 149 vs 19 in 147 cases). Patients without pre-existing
cardiovascular disease more commonly died of vascular disease after they became
anuric (47.4 vs 34.0%, P=0.017). The difference could not be explained by the
longer duration of dialysis in anuric patients because there was no significant
change in the distribution of cause of death with time on dialysis (chi-square
test, P=0.341). CONCLUSIONS: Our observation suggests that peritoneal dialysis
patients with and without residual renal function are qualitatively different.
Studies on peritoneal dialysis adequacy and survival in anuric patients should
only be extrapolated to the general dialysis population with caution.
----------------------------------------------------
[22]
TÍTULO / TITLE: - Kidney transplantation
from living-unrelated donors: comparison of outcome with living-related and
cadaveric transplants under current immunosuppressive protocols.
REVISTA
/ JOURNAL: - Urology 2003 Dec;62(6):1002-6.
AUTORES
/ AUTHORS: - Chkhotua AB; Klein T; Shabtai E; Yussim A;
Bar-Nathan N; Shaharabani E; Lustig S; Mor E
INSTITUCIÓN
/ INSTITUTION: - National Centre of Urology, Tbilisi,
Georgia.
RESUMEN
/ SUMMARY: - OBJECTIVES: Living-unrelated donors may
become an additional organ source for patients on the kidney waiting list. We
studied the impact of a combination of calcineurin inhibitors and
mycophenolate-mofetil together with steroids on the outcomes of living-related
(LRD), unrelated (LUR), and cadaver transplantation. METHODS: Between September
1997 and January 2000, 129 patients underwent LRD (n = 80) or LUR (n = 49)
kidney transplantation, and another 173 patients received a cadaveric kidney.
Immunosuppressive protocols consisted of mycophenolate-mofetil with
cyclosporine-Neoral (41%) or tacrolimus (59%) plus steroids. We compared the
patient and graft survival data, rejection rate, and graft functional parameters.
RESULTS: LRD recipients were younger (33.6 years) than LUR (47.8 years) and
cadaver (43.7 years) donor recipients (P <0.001). HLA matching was higher in
LRD patients (P <0.001). Acute rejection developed in 28.6% of LUR versus
27.5% of LRD transplants and 29.7% of cadaver kidney recipients (P = not
significant). The creatinine level at 1, 2, and 3 years after transplant was
1.63, 1.73, and 1.70 mg% for LRD patients; 1.48, 1.48, and 1.32 mg% for LUR
patients; and 1.75, 1.68, and 1.67 mg% for cadaver kidney recipients (P = not
significant), respectively. No difference in patient survival rates was found
among the groups. The 1, 2, and 3-year graft survival rates were significantly
better in recipients of LRD (91.3%, 90.0%, and 87.5%, respectively) and LUR
transplants (89.8%, 87.8%, and 87.8%, respectively) than in cadaver kidney
recipients (81.5%, 78.6%, 76.3%, respectively; P <0.01). CONCLUSIONS:
Despite HLA disparity, the rejection and survival rates of LUR transplants
under current immunosuppressive protocols are comparable to those of LRD and
better than those of cadaveric transplants.
----------------------------------------------------
[23]
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
----------------------------------------------------
[24]
TÍTULO / TITLE: - Preparing the patient
for renal replacement therapy. Teamwork optimizes outcomes.
REVISTA
/ JOURNAL: - Postgrad Med. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.postgradmed.com/journal.htm
●●
Cita: Postgraduate Medicine: <> 2002 Jun;111(6):97-8, 101-4, 107-8.
AUTORES
/ AUTHORS: - Bolton WK; Owen WF Jr
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, University of
Virginia School of Medicine, PO Box 800133, Charlottesville, VA 22908, USA. wkb5s@virginia.edu
RESUMEN
/ SUMMARY: - Proper preparation of a patient with CKD
for the development of ESRD and the need for RRT is essential to optimize the
patient’s quality and quantity of life and to help ensure positive economic and
societal outcomes. A collaborative team approach involving the primary care
physician team, the patient and his or her family and friends, and the nephrology
team should result in improved care of the CKD patient and improved outcomes.
It is not possible, feasible, or practical to attempt to provide the inclusive
care necessary to attain these goals in a system that does not take advantage
of the strengths of a team approach. Adopting this concept of care for patients
with kidney disease results in a win-win situation for all of the
participants—the patients, the physicians, and society. N. Ref:: 17
----------------------------------------------------
[25]
TÍTULO / TITLE: - Loss of living donor
renal allograft survival advantage in children with focal segmental
glomerulosclerosis.
REVISTA
/ JOURNAL: - Kidney Int 2001 Jan;59(1):328-33.
AUTORES
/ AUTHORS: - Baum MA; Stablein DM; Panzarino VM; Tejani
A; Harmon WE; Alexander SR
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Children’s
Hospital, Harvard Medical School, Boston, Massachusetts, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Because of concerns of
increased risk of graft loss with recurrent disease, living donor (LD)
transplantation in children with focal segmental glomerulosclerosis (FSGS) has
been controversial. METHODS: The North American Pediatric Renal Transplant
Cooperative Study (NAPRTCS) database from January 1987 to January 2000 was examined
to determine differences in demographics, treatment, and outcomes in children
with FSGS compared with other renal diseases. RESULTS: Data on 6484 children,
752 (11.6%) with FSGS, demonstrated that FSGS patients were more likely to be
older and black, and were less likely to receive either pre-emptive or LD
transplant (P < 0.001). No differences existed in human lymphocyte antigen
(HLA) matching or immunosuppression regimens. Acute tubular necrosis occurred
in more FSGS patients following LD (11.8 vs. 4.6%) or cadaveric (CD; 27.9 vs.
16.3%) transplants (P < 0.001). Graft survival was worse for LD FSGS
patients (5 years 69%) compared with no FSGS (82%, P < 0.001) and was not
significantly different than CD graft survival in the FSGS (60%) and No FSGS
groups (67%). The LD to CD ratios of relative risk of graft failure were higher
in FSGS patients (test for interaction, P = 0.01). Recurrence of original
disease was the only cause of graft failure that differed between groups (P
< 0.001). A greater percentage of LD FSGS graft failures was attributed to
recurrence (P = 0.06). CONCLUSIONS: The impact of FSGS on graft survival in
children is greatest in LD transplants, resulting in loss of expected LD graft
survival advantage. The rationale for LD grafts in children with FSGS should be
based on factors other than better outcomes typically associated with LD
transplantation.
----------------------------------------------------
[26]
TÍTULO / TITLE: - Thymic microchimerism
correlates with the outcome of tolerance-inducing protocols for solid organ
transplantation.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2001
Dec;12(12):2815-26.
AUTORES
/ AUTHORS: - Noris M; Cugini D; Casiraghi F; Azzollini
N; De Deus Viera Moraes L; Mister M; Pezzotta A; Cavinato RA; Aiello S; Perico
N; Remuzzi G
INSTITUCIÓN
/ INSTITUTION: - Department of Immunology and Clinics of
Organ Transplantation, Mario Negri Institute for Pharmacological Research, via
Gavazzeni 11, 24125 Bergamo, Italy. noris@marionegri.it
RESUMEN
/ SUMMARY: - This study found that pretransplant
infusion of donor peripheral blood leukocytes, either total leukocytes
(peripheral blood leukocytes) or peripheral blood mononuclear cells (PBMC),
under appropriate immunomodulating conditions was more effective than donor
bone marrow (BM) in prolonging the survival of rats that received kidney
grafts. A higher percentage of MHCII(+) cells was found in donor PBMC than in BM
cells, and depletion of MHCII(+) cells from donor PBMC abolished their
tolerogenic potential. By the analysis of microchimerism in rats infused with
donor cells and killed at different time points thereafter, the better
tolerogenic potential of leukocyte infusion related to a higher capability of
these cells to engraft the recipient thymus. PCR analysis on OX6-immunopurified
cells revealed the presence of donor MHCII(+) cells in the thymus of these
animals. The role of intrathymic microchimerism was reinforced by findings that
thymectomy at the time of transplant prevented tolerance induction by donor
leukocytes. Donor DNA was found in the thymus of most long-term graft animals
that survived, but in none of those that rejected their grafts. The presence of
intrathymic microchimerism correlated with graft survival, and microchimerism
in other tissues was irrelevant. PCR analysis of DNA from thymic cell
subpopulations revealed the presence of donor MHCII(+) cells in the thymus of
long-term surviving animals. Thus, in rats, donor leukocyte infusion is better
than donor BM for inducing graft tolerance, defined by long-term graft
survival, donor-specific T cell hyporesponsiveness, and reduced interferon
gamma production. This effect appears to occur through migration of donor
MHCII(+) cells in the host thymus.
----------------------------------------------------
[27]
TÍTULO / TITLE: - Factors associated with
long-term renal allograft survival.
REVISTA
/ JOURNAL: - Ther Drug Monit 2002 Feb;24(1):36-9.
AUTORES
/ AUTHORS: - Kaplan B; Srinivas TR; Meier-Kriesche HU
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Shands University
Hospital, University of Florida, Gainesville, Florida 32610-0224, USA. kaplab@medicine.ufl.edu
RESUMEN
/ SUMMARY: - Major advances in immunosuppression and
reductions in the rates of acute rejection have led to increasing graft and
patient survival rates during the past two decades. Chronic dysfunction of the
renal allograft, however, remains a major clinical problem and probably
represents the end result of the complex interplay between donor and recipient
factors, immunologic injury, nonimmunologic insults, and drug-induced
nephrotoxicity. Optimal function of the renal allograft is obtained by
maintaining a balance between underimmunosuppression and acute rejection and
overimmunosuppression and drug-induced toxicities. To minimize side effects
while maintaining efficacy, immunosuppressive drugs are commonly used as
combination therapy. Pharmacokinetic and pharmacodynamic interactions between
these agents can affect graft survival and function. The evidence supporting
the role of therapeutic drug monitoring as applied to commonly used
immunosuppressants in modern transplantation is presented here, and the
increasing role of therapeutic drug monitoring in the optimization of graft and
patient survival rates in the modern era of renal transplantation is
discussed. N. Ref:: 52
----------------------------------------------------
[28]
TÍTULO / TITLE: - Long-term kidney
transplant survival.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S44-50.
AUTORES
/ AUTHORS: - Hariharan S
INSTITUCIÓN
/ INSTITUTION: - Froedert Memorial Hospital, Medical
College of Wisconsin, Milwaukee, WI 53226, USA. hari@mcw.edu
RESUMEN
/ SUMMARY: - With improvements in short-term kidney
graft survival, focus has shifted towards long-term survival. There has also
been a substantial improvement in long-term survival as measured by kidney
half-life. Long-term graft failure is secondary to chronic allograft
nephropathy (CAN), recurrent disease, and death with a functioning graft. CAN
is secondary to a combination of chronic rejection, chronic cyclosporine
toxicity, and/or donor kidney disease. Risk factors for chronic rejection have
been attributed to both immunological and nonimmunological causes. With a
marked reduction in acute rejection rates-an important risk factor for
CAN-there is a substantial improvement in kidney half-life. There are still
nonimmunological factors, such as donor age, that adversely affect long-term
graft survival. In addition, African-American recipients continue to have a
shorter graft half-life. Recurrent disease is becoming an important cause of late
graft failure. Despite the introduction of various potent immunosuppressive
agents, there has been little or no impact on the prevalence as well as
progression of recurrent diasease. With the reduction of acute rejection rates
and improved short- and long-term graft survival, further improvements of
long-term graft survival will be an important focus in the 21st
century. N. Ref:: 45
----------------------------------------------------
[29]
TÍTULO / TITLE: - Delayed graft function.
Influence on outcome and strategies for prevention.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):721-32.
AUTORES
/ AUTHORS: - Shoskes DA; Shahed AR; Kim S
INSTITUCIÓN
/ INSTITUTION: - Departments of Urology and Renal
Transplantation, Cleveland Clinic Florida, Weston, Florida, USA. dshoskes@urol.com
RESUMEN
/ SUMMARY: - Delayed graft function remains a prevalent
problem in cadaveric renal transplantation that increases rejection, decreases
graft and patient survival, increases the cost of transplantation, and
complicates patient management. Although current medical and surgical
strategies can reduce the incidence of DGF to 20% or less, newer therapies that
focus on nonimmune and immune forms of renal injury are needed to improve
outcomes further. N.
Ref:: 105
----------------------------------------------------
[30]
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
----------------------------------------------------
[31]
TÍTULO / TITLE: - End-stage renal disease
survival in blacks and whites.
REVISTA
/ JOURNAL: - Am J Med Sci 2002 Feb;323(2):100-1.
AUTORES
/ AUTHORS: - Salem M
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
Mississippi Medical Center, Jackson 39216, USA. msalem@medicine.umsmed.edu N. Ref:: 15
----------------------------------------------------
[32]
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.
----------------------------------------------------
[33]
TÍTULO / TITLE: - Donor specific
transfusion in kidney transplantation: effect of different immunosuppressive
protocols on graft outcome.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Aug;33(5):2787-8.
AUTORES
/ AUTHORS: - Barbari A; Stephan A; Masri MA; Joubran N;
Dagher O; Kamel G
INSTITUCIÓN
/ INSTITUTION: - Department ofNephrology and
Transplantation, Rizk Hospital, Beirut, Lebanon.
----------------------------------------------------
[34]
TÍTULO / TITLE: - Kidney transplantation in
rats: an appraisal of surgical techniques and outcome.
REVISTA
/ JOURNAL: - Microsurgery 2003;23(4):387-94.
●●
Enlace al texto completo (gratuito o de pago) 1002/micr.10139
AUTORES
/ AUTHORS: - Schumacher M; Van Vliet BN; Ferrari P
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, Inselspital, Berne,
Switzerland. martin.schumacher@insel.ch
RESUMEN
/ SUMMARY: - Renal transplantation in rats is an
essential experimental tool in transplantation research. The surgical procedure
per se could affect the outcome of an experiment, independent of the hypothesis
addressed, therefore requiring a standardized method which should be comparable
across studies. To date, however, there is little information on the optimal
surgical technique. We performed a Medline search on original articles
published between 1965-2001 in order to evaluate whether specific technical
issues affecting the outcome of the procedure could be defined. Articles that
reported on a novel microsurgical procedure, or whose main purpose was the outcome
of a surgical technique itself, were included in the analysis. From 2,060
retrieved publications, 34 corresponded to the selection criteria (rats and
microsurgery and technique and kidney or renal transplantation). Among the
essential determining factors for a good outcome, body weight >200 g and
warm ischemic time <30 min were identified. Other important factors were the
techniques used for vascular (end-to-end and end-to-side procedure or sleeve
technique) and ureteral (bladder patch or end-to-end procedure) anastomosis.
Gender, animal strain, type of anesthesia, prophylactic administration of
antibiotics, and type of flushing solution did not affect the success of renal
allografts. In order to avoid a bias related to the surgical procedure in rat
renal transplantation, a warm ischemia time <30 min in animals with a body
weight >200 g seems to be essential. Also, end-to-end or end-to-side
vascular anastomoses are preferable to the sleeve technique. Other factors do
not influence the immediate function of the graft. N. Ref:: 40
----------------------------------------------------
[35]
TÍTULO / TITLE: - Strategies to reduce
toxicities and improve outcomes in renal transplant recipients.
REVISTA
/ JOURNAL: - Pharmacotherapy 2002 Mar;22(3):316-28.
AUTORES
/ AUTHORS: - Lo A; Alloway RR
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, University of
Cincinnati Medical Center, Ohio 45267-0585, USA.
RESUMEN
/ SUMMARY: - Ongoing improvements in immunosuppression
and posttransplantation care have dramatically improved patient and graft
outcomes after transplantation. The frequency of graft loss due to acute
rejection has declined considerably as a result of the availability of a
variety of more potent immunosuppressive agents and probably also because of refined
clinical care and follow-up. Complications of long-term administration of
corticosteroids (steroids) and calcineurin inhibitors, however, have become
increasingly apparent as patients live longer with their transplant, and
attention is shifting to long-term issues. Use of both steroids and calcineurin
inhibitors is associated with metabolic toxicities such as hypertension,
hyperlipidemia, diabetes, bone loss, and cataracts. These contribute to
posttransplantation morbidity and may negatively affect patient and allograft
survival. A variety of troublesome cosmetic side effects, such as hirsutism,
gingival hyperplasia, alopecia, obesity, and cushingoid appearance, also are
associated with these drugs. These effects can detract from patient self-esteem
and compliance with the immunosuppressive regimen. In the past 2 decades, the
introduction of second-generation immunosuppressive drugs, such as tacrolimus,
mycophenolate mofetil, sirolimus, and anti-interleukin-2 receptor monoclonal
antibodies, has provided some alternatives to classic immunosuppressant
choices. Patients experiencing undesirable adverse events now can be converted
to another immunosuppressive regimen that ultimately will improve graft and
patient survival rates and improve quality of life after transplantation. N. Ref:: 99
----------------------------------------------------
[36]
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
----------------------------------------------------
[37]
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.
----------------------------------------------------
[38]
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.
----------------------------------------------------
[39]
TÍTULO / TITLE: - HLA-specific
alloantibodies and renal graft outcome.
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 May;16(5):897-904.
AUTORES
/ AUTHORS: - Sumitran-Holgersson S
INSTITUCIÓN
/ INSTITUTION: - Division of Clinical Immunology,
Karolinska Institutet, Huddinge University Hospital, Huddinge, Sweden.
RESUMEN
/ SUMMARY: - HLA-specific humoral immunity, as a result
of recipient allosensitization, induces hyperacute rejection of allogenic
kidney grafts. Cross-match tests are performed to avoid this complication.
However, current techniques do not allow determination of HLA-specificity of
donor-reactive antibodies in the acute cadaver-donor situation. New methods are
described and discussed in this report as well as the alloantibody
specificities that are of clinical importance. Alloantibodies not only mediate
hyperacute rejection but may also participate in the acute rejection of organ
grafts. Clinical associations between early immunological complications, such
as acute rejection, in heart, liver and kidney allografted patients and
pre-transplantation humoral alloimmunity emphasize the need for proper
determination of donor-specific humoral immunity prior to transplantation. N. Ref:: 35
----------------------------------------------------
[40]
TÍTULO / TITLE: - Evaluation, selection,
and follow-up of live kidney donors: a review of current practice in French
renal transplant centres.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito al
texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001 Oct;16(10):2048-52.
AUTORES
/ AUTHORS: - Gabolde M; Herve C; Moulin AM
INSTITUCIÓN
/ INSTITUTION: - Laboratoire d’Ethique medicale et de Sante
publique, Faculte de Medecine Necker, Universite Paris V, France. martine.gabolde@bct.ap-hop-paris.fr
RESUMEN
/ SUMMARY: - BACKGROUND: A resurgence of interest in
the concept of live-donor renal transplantation has prompted a closer look at
methods of live donor evaluation, selection, and follow-up. The aim of this
study was to describe these methods in all 46 French renal transplant centres.
METHODS: Questionnaires were sent to all chief renal physicians. RESULTS: The
survey was completed by 78% of centres, which accounted for 95% of all
live-donor renal transplants carried out in France in 1995 and 1996. There was
a substantial variation in all three steps of live-donor management. For
example, we observed variations in the screening for specific short- or
long-term risk factors (especially cardiovascular or thrombotic risk factors
and diabetes). In addition the exclusion criteria differed, especially the
cut-off age for donation, which ranged from 45 to 75 years. The composition of
teams evaluating and selecting potential donors and the role of the potential
donors in the decision-making process varied greatly among centres. Finally, we
observed less variation in the methods of donor follow-up. CONCLUSIONS: The
current survey revealed a marked disparity in the management of live donors in
France. It raises the question of whether these practices should be codified
into a set of guidelines for live-donor transplantation.
----------------------------------------------------
[41]
TÍTULO / TITLE: - African Americans and
renal transplantation: disproportionate need, limited access, and impaired
outcomes.
REVISTA
/ JOURNAL: - Am J Med Sci 2002 Feb;323(2):94-9.
AUTORES
/ AUTHORS: - Young CJ; Gaston RS
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, University of Alabama at Birmingham, 35294-0006, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Renal transplantation is the therapy
of choice for patients with end-stage renal disease (ESRD). However, African
Americans’ (AA) access to this modality is not commensurate with that of other
races. This imbalance, coupled with AA disproportionately representing those
with ESRD, has kept AA disadvantaged compared with other races, especially
whites. METHODS: We reviewed published reports that examined the connection
between race and the incidence of chronic renal failure, access to optimal
therapy, and outcomes of renal transplantation. RESULTS: The incidence of ESRD
in AA is 4 times greater than in whites, but AA remain less likely than whites
to be referred for or undergo renal transplantation. Also, AA are at greater
risk than whites to experience premature graft failure. CONCLUSIONS: ESRD
management has improved dramatically with the advent of successful renal
transplantation. However, AA remain significantly disadvantaged in both access
and outcomes compared with whites. Further evaluation of underlying causes and
development of specific remedies is warranted.
N. Ref:: 81
----------------------------------------------------
[42]
TÍTULO / TITLE: - Intensive care and
immediate follow-up of children after renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Aug;33(5):2821-4.
AUTORES
/ AUTHORS: - Seikaly MG; Sanjad SA
INSTITUCIÓN
/ INSTITUTION: - Children’s Medical Center of Dallas,
Nephrology Office, Dallas, Texas, USA. N.
Ref:: 16
----------------------------------------------------
[43]
TÍTULO / TITLE: - Hepatitis C and the
incidence of diabetes mellitus after renal transplant: influence of new
immunosuppression protocols.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Aug;35(5):1748-50.
AUTORES
/ AUTHORS: - Gentil MA; Lopez M; Gonzalez-Roncero F;
Rodriguez-Algarra G; Pereira P; Lopez R; Martinez M; Toro J; Mateos J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Hospital
Universitario Virgen del Rocio, Sevilla, España.
RESUMEN
/ SUMMARY: - BACKGROUND: Hepatitis C has been
associated with an increased incidence of diabetes mellitus (DM) following
renal transplantation (RT). METHODS: Patients who underwent RT between 1985 and
2001 were excluded if they showed DM prior to RT, graft survival of less than
90 days, and unknown anti-HCV status (n=15). Two groups (G1 and G2) were
distinguished according to the immunosuppressive regimen: G1 (transplanted
1985-1996) received steroids, azathioprine, and cyclosporine (n=330), whereas
G2 (1997-2000) received new drugs in several combinations (MMF in 87% and/or
tacrolimus in 35% [n=240]). Patients with HCV antibodies pre- and/or post-RT
were considered HCV-positive. Post-RT DM requiring prolonged treatment with
oral antidiabetics or insulin (>1 month) was assessed using Kaplan-Meier
curves and Cox analysis. RESULTS: G2 patients were significantly older, had a
greater body mass index (BMI), and suffered significantly less from acute
rejection episodes during the first year than G1 patients. Furthermore, fewer
required maintenance steroids. HCV-positivity was more common in G1 than in G2
(n=96, 29.1% vs n=27, 11.3%). Six G2 patients were successfully treated with
interferon pre-RT, achieving negative PCR-HCV status (maintained post-RT). DM
incidence at 4 years was similar in G1 and G2 (8.8% and 8.2%). G1 HCV-positive
patients showed a greater risk of developing DM than HCV-negative patients
(28.0% vs 6.2% at 10 years; P=001). In G1, multivariate analysis showed that
age, BMI, and HCV-positivity were significant risk factors predicting DM
(relative risk, 5.7; 95% confidence interval 2.7-12). In G2 patients, HCV was
not associated with an increased risk of DM; in the multivariate analysis only
age appeared to be a risk factor. CONCLUSIONS: The reported relationship
between hepatitis C and post-RT DM was not observed among patients receiving
new immunosuppressive treatments. Confirmation of this finding requires
extended follow up. The reduced use of steroids and effective pre-RT use of
interferon may also be responsible for the benefit.
----------------------------------------------------
[44]
TÍTULO / TITLE: - Causes of death after
renal transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001 Aug;16(8):1545-9.
AUTORES
/ AUTHORS: - Briggs JD
N. Ref:: 24
----------------------------------------------------
[45]
TÍTULO / TITLE: - Outcome of renal
transplantation in fibrillary glomerulonephritis.
REVISTA
/ JOURNAL: - Clin Nephrol 2001 Feb;55(2):159-66.
AUTORES
/ AUTHORS: - Samaniego M; Nadasdy GM; Laszik Z; Nadasdy
T
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, Johns Hopkins
University Baltimore, Maryland, USA.
RESUMEN
/ SUMMARY: - Fibrillary glomerulonephritis (FGN) is a
rare but progressive glomerular disease usually with end-stage renal disease
(ESRD) developing within months or few years following the diagnosis. Little is
known about the outcome of renal transplantation in patients with ESRD due to
FGN. We report four patients with FGN who received renal allografts. Two
patients developed recurrent FGN in their grafts. One patient was diagnosed to
have recurrent FGN 9 years post-transplant, and lost his graft 4 years
thereafter. Another patient had recurrent disease 2 years post-transplant but
has stable graft function after 7 years. One patient died with normal renal
allograft function 7 years following transplantation. The fourth patient has
chronic transplant nephropathy 34 months post-transplant without evidence of
recurrent FGN. A literature review revealed 10 additional patients who received
11 renal allografts due to ESRD caused by FGN. Four of these 10 patients had
biopsy-proven recurrence (one patient in two subsequent grafts), but this
caused graft loss only in 2 patients 56 months and 7 years post-transplant,
respectively. The earliest recurrence was diagnosed 2 years post-transplant. We
conclude that although the recurrence rate of FGN in renal transplants is high
(around 50%), the recurrent disease has a relatively benign course and
prolonged graft survival is possible. N.
Ref:: 16
----------------------------------------------------
[46]
TÍTULO / TITLE: - Outcomes in kidney
transplantation.
REVISTA
/ JOURNAL: - Semin Nephrol 2003 May;23(3):306-16.
AUTORES
/ AUTHORS: - Djamali A; Premasathian N; Pirsch JD
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine and Surgery,
University of Wisconsin Medical School, Madison, WI 53792, USA.
RESUMEN
/ SUMMARY: - It is estimated that there are greater
than 100000 kidney transplant recipients with a functioning graft in the United
States. Recent advances in immunosuppression have improved short-term graft
survival rates and decreased early mortality by decreasing the incidence and
therapy for acute rejection episodes. For those accepted on the waiting list,
transplant prolongs patient survival compared with remaining on dialysis.
During the 1990s, 3 new immunosuppressive drugs were introduced in clinical
kidney transplantation. All were approved for use by the Food and Drug
Administration after large, controlled, randomized trials. Mycophenolate
mofetil (MMF), when combined with cyclosporine (CSA) and prednisone, lowered
acute rejection rates by nearly 50% compared with control. Tacrolimus compared
with CSA also significantly reduced acute rejection rates in kidney transplant
recipients, but was associated with a significant increase in posttransplant
diabetes mellitus (PTDM) in the early trials. When evaluated in combination
with MMF, the incidence of PTDM was much lower. At the end of the decade,
sirolimus was shown in several randomized trials to lower acute rejection rates
and is believed to be less nephrotoxic compared with calcineurin inhibitors.
All of the randomized trials were not statistically powered to assess long-term
superiority. Registry analyses have been performed that appear to show some
long-term benefit of immunosuppressive therapy with MMF. Other outcome
assessments in kidney transplant recipients include risk factors for chronic
allograft nephropathy, hypertension, hyperlipidemia, and bone disease. Although
there are few randomized trials, understanding of the significance of these
common complications has progressed and strategies for therapy and intervention
have been developed. This article focuses on the randomized trials of
immunosuppressive therapy and complications associated with use of these drugs.
In addition, we review the current management and intervention for the
comorbidities associated with the long-term clinical management of the kidney
transplant recipient. N.
Ref:: 78
----------------------------------------------------
[47]
TÍTULO / TITLE: - Impact of peritoneal
dialysis on patient and graft outcome after kidney transplantation.
REVISTA
/ JOURNAL: - Contrib Nephrol 2003;(140):226-41.
AUTORES
/ AUTHORS: - Lameire N; Van Biesen W; Vanholder R
INSTITUCIÓN
/ INSTITUTION: - Renal Division, University Hospital,
Ghent, Belgium. norbert.lameire@rug.ac.be N. Ref:: 49
----------------------------------------------------
[48]
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
----------------------------------------------------
[49]
TÍTULO / TITLE: - Pregnancy in kidney
transplantation: satisfactory outcomes and harsh realities.
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 Nov-Dec;16(6):792-806.
AUTORES
/ AUTHORS: - Stratta P; Canavese C; Giacchino F;
Mesiano P; Quaglia M; Rossetti M
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine,
Nephrology Section, University of Turin, S. Giovanni Molinette Hospital, Turin,
Italy. trattanefro@hotmail.com
RESUMEN
/ SUMMARY: - Since the first successful case of a
pregnancy reported 40 yrs ago in a woman receiving a kidney transplant from her
identical twin sister who did not receive immunosuppressive medications, the
dream of a pregnancy in a renal transplant recipient has become reality. In
women of childbearing age with a functioning transplant, the pregnancy rate has
improved from 2 to 5%. Approximately 35% of pregnancies do not progress beyond
the 1st trimester; the success rate is > 90% after the 1st
trimester. In this review, different aspects of this topic are discussed: the
consequences of pregnancy on renal grafts and maternal morbidity (hemodynamic
changes, immunological problems, hypertension/preeclampsia, urinary tract
infections and renal damage progression), the influence of renal grafts on
pregnancy (perinatal mortality, prematurity, intrauterine growth retardation,
low birth weight, malformations, handicaps and immunological problems) and the
role of drugs used for renal transplants. A pregnancy can have a successful outcome
if pre-conceptional graft function is good, if hypertension is absent and if
the interval from grafting is at least 2 yrs. However, the majority of
live-born outcomes are premature and many are low birth weight. Recipients must
be advised that their offspring can also suffer from immunological
abnormalities, malformations, long-term handicaps, and that the deleterious
effects of pregnancy on long-term graft function cannot be excluded. In
conclusion, women of childbearing age who have had renal transplantation should
be counselled before conception about possibility and risks of pregnancy. N. Ref:: 99
----------------------------------------------------
[50]
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.
----------------------------------------------------
[51]
TÍTULO / TITLE: - The impact of delayed
graft function on the long-term outcome of renal transplantation.
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 Jan-Feb;15(1):17-21.
AUTORES
/ AUTHORS: - Geddes CC; Woo YM; Jardine AG
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Western Infirmary, Glasgow,
UK. Colin.Geddes.WG@NorthGlasgow.NHS.UK
RESUMEN
/ SUMMARY: - Recent studies provide conflicting
conclusions regarding the impact of delayed graft function (DGF) on the
long-term outcome of renal transplantation. Some centres report DGF as an
independent risk factor for reduced long-term graft and patient survival, while
others report no impact on long-term outcome. Further scrutiny of data from
these studies reveals differences in the definition of DGF, definition of
long-term outcome, and statistical methods that may partly explain the
variability. The commonest definition of DGF is the need for dialysis in the
first week post-transplant, but this may be less informative than definitions
that consider DGF as a continuous variable such as time to achieving creatinine
clearance > 10ml/min. Acute rejection (AR) occurs more commonly in patients
with DGF and variability in the impact of DGF may also relate to strategies to
detect and treat AR during DGF. Centres with a vigilant strategy are likely to
note a lower impact of DGF because the associated long-term adverse impact of
AR is minimised. Furthermore, many centres reduce the dose of calcineurin
inhibiting drugs and/or use polyclonal antibody therapy during DGF but the
long-term impact of this strategy is unclear. Newer agents such as humanised
anti-IL2 monoclonal antibodies and rapamycin may have a role, but controlled
studies are required to define the optimal immunosuppressive regimen for
patients with DGF. In the meantime, measures to minimise ischaemic damage to
the transplant kidney and intensive surveillance for AR with weekly renal
biopsy in patients with DGF are recommended.
N. Ref:: 49
----------------------------------------------------
[52]
TÍTULO / TITLE: - Post-transplant
diabetes: incidence, relationship to choice of immunosuppressive drugs, and
treatment protocol.
REVISTA
/ JOURNAL: - Adv Ren Replace Ther 2001 Jan;8(1):64-9.
AUTORES
/ AUTHORS: - Markell MS
INSTITUCIÓN
/ INSTITUTION: - Division of Transplant Nephrology, State
University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA. mmarkell@hscbklyn.edu
RESUMEN
/ SUMMARY: - Post-transplant diabetes mellitus (PTDM)
is one of the feared complications of immunosuppressive therapy. Despite
advances, including the introduction of the steroid-sparing calcineurin
inhibitors, cyclosporine and tacrolimus, the incidence rate remains greater than
10% to 30%, especially in minority populations. PTDM increases the subsequent
risk of both graft loss and patient death, and predisposes patients to all
complications of diabetes, including retinopathy and neuropathy. Patients
should be monitored closely, especially during the first 3 months
post-transplant, and treated aggressively, should glucose intolerance be
detected. Minimization of immunosuppression dose, diet, oral hypoglycemic
agents, and insulin have all been used in the treatment of PTDM, however, the
insulin-sensitizing agents have not been studied. It is hoped that newer
immunosuppressive regimens and, ultimately, the ability to achieve tolerance
will eventually solve the problem of PTDM.
N. Ref:: 53
----------------------------------------------------
[53]
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
----------------------------------------------------
[54]
TÍTULO / TITLE: - Death with functioning
graft—a preventable cause of graft loss.
REVISTA
/ JOURNAL: - Ann Transplant 2001;6(4):17-20.
AUTORES
/ AUTHORS: - Evenepoel P; Vanrenterghem Y
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of
Nephrology, University Hospital Leuven, Leuven, Belgium. Pieter.Evenepoel@uz.kuleuven.ac.be
RESUMEN
/ SUMMARY: - Patient death continues to be a leading
cause of renal transplant failure. This mortality of transplant patients is
mainly due to cardiovascular disease (CVD). Identification of predictions of
early CVD may provide targets for intervention. N. Ref:: 45
----------------------------------------------------
[55]
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
----------------------------------------------------
[56]
TÍTULO / TITLE: - Renal
ischemia—reperfusion injury: an inescapable event affecting kidney
transplantation outcome.
REVISTA
/ JOURNAL: - Folia Microbiol (Praha) 2001;46(4):267-76.
AUTORES
/ AUTHORS: - Bohmova R; Viklicky O
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical Immunology,
Institute for Clinical and Experimental Medicine, 140 00 Prague, Czechia.
RESUMEN
/ SUMMARY: - Ischemia—reperfusion (I-R) injury has been
shown to be a common cause of late and irreversible complications during a
variety of standard medical and surgical procedures. The pathogenesis of events
which follow the I-R involves both injured endothelium and activated leukocytes
and their interaction. In kidney transplantation, an I-R injury occurs in
situations such as graft harvesting, cold storage and surgery. Clinical
consequences of I-R injury have been considered to be delayed graft function
and acute rejection in the short term and chronic rejection late after
transplantation. Here we focused on current knowledge of pathophysiology of
renal I-R injury in kidney transplantation and on possibilities of experimental
therapy. N. Ref:: 70
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