#07#
Revisiones-Clínica-Complicaciones
*** Reviews-Clinical-Complications
TRASPLANTE
RENAL *** RENAL TRANSPLANTATION
(Conceptos
/ Keywords: Renal-Kidney transplantation; Kidney donation-procurement; etc).
Enero /
January 2001 --- Marzo / March 2004
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[1]
TÍTULO / TITLE: - Strategies to improve
long-term outcomes after renal transplantation.
REVISTA
/ JOURNAL: - N Engl J Med. Acceso gratuito al texto
completo a partir de los 6 meses de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://content.nejm.org/
●●
Cita: New England J Medicine (NEJM): <> 2002 Feb 21;346(8):580-90.
●●
Enlace al texto completo (gratuito o de pago) 1056/NEJMra011295
AUTORES
/ AUTHORS: - Pascual M; Theruvath T; Kawai T;
Tolkoff-Rubin N; Cosimi AB
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Department of Medicine,
Massachusetts General Hospital, Boston, MA 02114, USA. mpascual@partners.org N. Ref:: 99
----------------------------------------------------
[2]
TÍTULO / TITLE: - Interleukin-2 receptor
monoclonal antibodies in renal transplantation: meta-analysis of randomised
trials.
REVISTA
/ JOURNAL: - British Medical J (BMJ). Acceso gratuito
al texto completo.
●●
Enlace a la Editora de la Revista http://bmj.com/search.dtl
●●
Cita: British Medical J. (BMJ): <> 2003 Apr 12;326(7393):789.
●●
Enlace al texto completo (gratuito o de pago) 1136/bmj.326.7393.789
AUTORES
/ AUTHORS: - Adu D; Cockwell P; Ives NJ; Shaw J;
Wheatley K
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Queen Elizabeth
Hospital, Birmingham, B15 2TH. dwomoa.adu@uhb.nhs.uk
RESUMEN
/ SUMMARY: - OBJECTIVE: To study the effect of
interleukin-2 receptor monoclonal antibodies on acute rejection episodes, graft
loss, deaths, and rate of infection and malignancy in patients with renal
transplants. DESIGN: Meta-analysis of published data. DATA SOURCES: Medline,
Embase, and Cochrane library for years 1996-2003 plus search of medical
editors’ trial amnesty and contact with manufacturers of the antibodies.
SELECTION OF STUDIES: Randomised controlled trials comparing interleukin-2
receptor antibodies with placebo or no additional treatment in patients with
renal transplants receiving ciclosporin based immunosuppression. RESULTS: Eight
randomised controlled trials involving 1871 patients met the selection criteria
(although only 1858 patients were analysed). Interleukin-2 receptor antibodies
significantly reduced the risk of acute rejection (odds ratio 0.51, 95%
confidence interval 0.42 to 0.63). There were no significant differences in the
rate of graft loss (0.78, 0.58 to 1.04), mortality (0.75, 0.46 to 1.23),
overall incidence of infections (0.97, 0.77 to 1.24), incidence of
cytomegalovirus infections (0.81, 0.62 to 1.04), or risk of malignancies at one
year (0.82, 0.39 to 1.70). The different antibodies had a similar sized effect
on acute rejection (test for heterogeneity P=0.7): anti-Tac (0.37, 0.16 to
0.89), BT563 (0.37, 0.1 to 1.38), basiliximab (0.56, 0.44 to 0.72), and
daclizumab (0.46, 0.32 to 0.67). The reduction in acute rejections was similar
for all ciclosporin based immunosuppression regimens (test for heterogeneity
P=1.0). CONCLUSIONS: Adding interleukin-2 receptor antibodies to ciclosporin
based immunosuppression reduces episodes of acute rejection at six months by
49%. There is no evidence of an increased risk of infective complications.
Longer follow up studies are needed to confirm whether interleukin-2 receptor
antibodies improve long term graft and patient survival.
----------------------------------------------------
[3]
TÍTULO / TITLE: - 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.
----------------------------------------------------
[4]
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
----------------------------------------------------
[5]
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
----------------------------------------------------
[6]
TÍTULO / TITLE: - Hemophagocytic syndrome
in renal transplant recipients: report of 17 cases and review of literature.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):238-43.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000107285.86939.37
AUTORES
/ AUTHORS: - Karras A; Thervet E; Legendre C
INSTITUCIÓN
/ INSTITUTION: - Service de Nephrologie et Transplantation
Renale, Hopital Saint-Louis, Paris, France.
RESUMEN
/ SUMMARY: - BACKGROUND: Hemophagocytic syndrome (HPS)
combines febrile hepatosplenomegaly, pancytopenia, hypofibrinemia, and liver
dysfunction. It is defined by bone marrow and organ infiltration by activated,
nonmalignant macrophages phagocytizing blood cells. HPS is often caused by an
infectious or neoplastic disease and has rarely been described in renal
transplant recipients. METHODS: We retrospectively analyzed 17 cases of HPS after
cadaveric renal transplantation (13 men and 4 women, age 41+/-8 years). The
median time between transplantation and hemophagocytosis was 52 days. Eleven
patients (64%) had received antilymphocyte globulins during the 3 months before
presentation. RESULTS: Fever was present in all patients, and
hepatosplenomegaly was present in 9 of 17 patients. Other nonspecific clinical
findings included abdominal, neurologic, and respiratory symptoms. Laboratory
tests showed anemia (hemoglobin 6.1+/-1.3 g/dL), thrombocytopenia
(34,000+/-32,000/mm3), and leukopenia (1,700+/-1,400/mm3). Elevated liver
enzymes were present in 12 of 17 patients, and cholestasis was present in 10 of
17 patients. Elevated triglycerides and ferritin were noted in 75% and 86% of
cases, respectively. HPS was related to viral infection in nine patients
(cytomegalovirus, Epstein-Barr virus, human herpesvirus 6, and human
herpesvirus 8), bacterial infection in three patients (tuberculosis and
Bartonella henselae), and other infections in two patients (toxoplasmosis and
Pneumocystis carinii pneumoniae). Posttransplant lymphoproliferative disease
was present in two patients. Despite large-spectrum anti-infectious treatment
and dramatic tapering of immunosuppression, death occurred in eight patients (47%).
Graft nephrectomy was performed in four of the nine surviving patients.
CONCLUSIONS: We report here the largest series of HPS after renal
transplantation. This rare disease is usually secondary to herpes viridae
infections, mostly cytomegalovirus and Epstein-Barr virus in severely
immunocompromised patients. Despite aggressive treatment, the prognosis remains
poor. N. Ref:: 22
----------------------------------------------------
[7]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.1. Cancer risk after renal transplantation.
Post-transplant lymphoproliferative disease (PTLD): prevention and treatment.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:31-3, 35-6.
RESUMEN
/ SUMMARY: - GUIDELINES: A. In the first year after
organ transplantation, recipients are at the greatest risk of developing
lymphoproliferative diseases (PTLDs), which are induced most often by
Epstein-Barr virus (EBV) infection, and patients should therefore be screened
prior to or at the time of transplantation for EBV antibodies. B. In the rare
cases (<5%) where the recipient is EBV seronegative, he or she has a 95%
likelihood of receiving an organ from an EBV-seropositive donor, which
translates into a high risk of primary EBV infection with seroconversion soon
after transplantation. In such cases, the recipient should receive a
prophylactic antiviral treatment with acyclovir, valacyclovir or ganciclovir,
starting at the time of transplant and lasting for at least 3 months. The
specific recommendations given for CMV prophylaxis could be applicable in this
situation. C. The treatment of PTLD should be based on accurate pathology with
extensive cell markers and phenotyping. The treatment modalities are as
follows. Reduction of basal immunosuppression in all cases (either maintain
only steroids, or decrease by at least 50% the anti-calcineurin drugs and stop
other immunosuppressive drugs). In the case of EBV-positive B-cell lymphoma, antiviral
treatment with acyclovir, valacyclovir or ganciclovir may be initiated for at
least 1 month or according to the blood level of EBV replication when
available. In the case of rare lymphomas from the mucosal-associated lymphoid
tissue (MALT) with positive Helicobacter pylori, full eradication of H. pylori
should be carried out with a validated protocol. Subsequent H. pylori
prophylaxis should be implemented to avoid relapse. In the case of
CD20-positive lymphomas, treatment with rituximab, a chimeric monoclonal
antibody directed against CD20, should be carried out with one i.v. injection
per week for 4 weeks. In the case of diffuse lymphomas or improper response to
previous treatment, CHOP chemotherapy should be used alone or in combination
with rituximab. The CHOP regimen is cyclophosphamide, doxorubicine, vincristine
and prednisone. Complete cessation of immunosuppression with or without graft
nephrectomy should also be considered.
----------------------------------------------------
[8]
- Castellano -
TÍTULO / TITLE:Riesgo cardiovascular en pacientes
con insuficiencia renal cronica. Pacientes en tratamiento sustitutivo renal.
Cardiovascular risk in patients with chronic renal failure. Patients in renal
replacement therapy.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22 Suppl 1:68-74.
AUTORES
/ AUTHORS: - Cases A; Vera M; Lopez Gomez JM
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Unidad de
Hipertension Arterial, Hospital Clinic, IDIBAPS, Universidad de Barcelona,
Barcelona. acases@medicina.ub.es
RESUMEN
/ SUMMARY: - Dialysis patients constitute a high-risk
subset of patients for developing cardiovascular disease, which accounts for
nearly 50% of deaths. After stratification for age, race and gender,
cardiovascular mortality is 10-20 times higher in dialysis patients than in the
general population. Cardiovascular disease in this population cannot be fully
explained by the high prevalence of classical cardiovascular risk factors (age,
hypertension, diabetes, hyperlipidemia, smoking, etc.). Thus, the involvement
of “new” cardiovascular risk factors (hyperhomocysteinemia,
hyperfibrinogenemia, high lipoprotein (a) levels, oxidative stress,
inflammation, etc.), and uremia-related factors (anemia, impaired
calcium-phosphorus metabolism, hyperparathyroidism, accumulation of endogenous
inhibitors of nitric oxide synthesis, etc.) has been also invoked to play a
role in the increased cardiovascular risk in these patients. Endothelial
dysfunction is the initial event in the development of atherosclerosis. Uremic
patients exhibit an endothelial dysfunction, even before starting dialysis,
which persists o is even aggravated under dialysis treatment. Uremic patients
must be considered at high risk of developing cardiovascular disease. Thus
cardiovascular risk factors in these patients should be managed early,
aggressive and multifactorially in order to reduce their high cardiovascular
morbidity and mortality. N.
Ref:: 52
----------------------------------------------------
[9]
TÍTULO / TITLE: - Renal transplantation:
can we reduce calcineurin inhibitor/stop steroids? Evidence based on protocol
biopsy findings.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Mar;14(3):755-66.
AUTORES
/ AUTHORS: - Gotti E; Perico N; Perna A; Gaspari F;
Cattaneo D; Caruso R; Ferrari S; Stucchi N; Marchetti G; Abbate M; Remuzzi G
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine and
Transplantation, Ospedali Riuniti di Bergamo, Mario Negri Institute for
Pharmacological Research, Italy.
RESUMEN
/ SUMMARY: - How to combine antirejection drugs and
which is the optimal dose of steroids and calcineurin inhibitors beyond the
first year after kidney transplantation to maintain adequate immunosuppression
without major side effects are far from clear. Kidney transplant patients on
steroid, cyclosporine (CsA), and azathioprine were randomized to per-protocol
biopsy (n = 30) or no-biopsy (n = 29) 1 to 2 yr posttransplant. Steroid or CsA
were discontinued or reduced on the basis of biopsy to establish effects on
drug-related complications, acute rejection, and graft function over 3 yr of
follow-up. Serum creatinine, GFR (plasma clearance of iohexol), RPF (renal
clearance of p-aminohippurate), CsA pharmacokinetics, and adverse events were
monitored yearly. At the end, patients underwent a second biopsy. Per-protocol
biopsy histology revealed no lesions (n = 5, steroid withdrawal), CsA
nephropathy (n = 13, CsA discontinuation/reduction), or chronic rejection (n =
12, standard therapy). Reducing the drug regimen led to overall fewer side
effects related to immunosuppression as compared with standard therapy or
no-biopsy. Steroids were safely stopped with no acute rejection or graft loss.
Complete CsA discontinuation was associated with acute rejection in the first
four patients. Lowering CsA to low target CsA trough (30 to 70 ng/ml) never led
to acute rejection or major renal function deterioration. Biopsy patients on
conventional regimen had no acute rejection, one graft loss, no significant
change in GFR, and significant RPF decline. No-biopsy controls: no acute
rejection, one graft loss, significant decline of GFR and RPF. By serial biopsy
analysis, severe lesions did not develop in patients with steroid
discontinuation in contrast to patients on standard therapy over follow-up. CsA
reduction did not adversely affect histology. Per-protocol biopsy more than 1
yr after kidney transplantation is a safe procedure to guide change of drug
regimen and to lower the risk of major side effects.
----------------------------------------------------
[10]
TÍTULO / TITLE: - Treatment of
posttransplant hypertension: too little, too late?
REVISTA
/ JOURNAL: - Transplantation 2003 Dec 15;76(11):1645-6.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000091290.30262.96
AUTORES
/ AUTHORS: - Paul LC
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Leiden
University Medical Center, Leiden, The Netherlands. lcpaul@lumc.nl N. Ref:: 12
----------------------------------------------------
[11]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.3. Cancer risk after renal transplantation. Solid
organ cancers: prevention and treatment.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:32, 34-6.
RESUMEN
/ SUMMARY: - GUIDELINES: J. All renal transplant
recipients should have regular ultrasonography of their native kidneys (when
applicable) for screening of renal cell carcinomas, which are observed at much
higher incidence in both dialysed and transplant patients. K. Guidelines
published for screening and prevention of solid organ cancers in the general
population should be strictly applied to transplant recipients, who are in
general at higher cancer risk, but would benefit equally or even greater. L.
All male renal transplant recipients aged 50 and over should have a yearly
prostate specific antigen (PSA) test prior to a regular digital rectal
examination. M. All female renal transplant recipients should have a yearly
cervical (PAP) smear together with regular pelvic examination and regular mammography,
according to national recommendations where available. N. All renal transplant
recipients should undergo a faecal occult-blood testing as a screening for
colorectal cancer and other (pre-malignant) lesions, according to national
recommendations where available. O. In all these conditions, it is recommended
to reduce immunosuppression whenever possible.
----------------------------------------------------
[12]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.1. Cardiovascular risks. Cardiovascular disease
after renal transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:24-5.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Post-transplant cardiovascular
disease is very common, an important cause of morbidity and the first cause of
mortality in renal transplant recipients. Therefore, detection and early
treatment of post-transplant cardiovascular disease are mandatory. B. Specific
risk factors for developing post-transplant cardiovascular disease include
pre-transplant cardiovascular disease, arterial hypertension, uraemia (graft
dysfunction), hyperlipidaemia, diabetes mellitus, smoking and immunosuppressive
treatment. These factors should be targeted for intervention. C. Pre-transplant
cardiovascular disease is a major risk factor for post-transplant
cardiovascular disease. Therefore, prior to transplantation, it is mandatory to
detect and treat symptomatic coronary artery disease, heart failure due to
valvular failure or cardiomyopathy, and pericardial constriction. This policy
should also be followed in asymptomatic diabetic patients.
----------------------------------------------------
[13]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.2. Cancer risk after renal transplantation. Skin
cancers: prevention and treatment.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:31-6.
RESUMEN
/ SUMMARY: - GUIDELINES: D. Due to the high prevalence
of skin cancers after organ transplantation, it is highly recommended to inform
patients about self-awareness. E. Primary prevention should include the
avoidance of sun exposure, use of protective clothing and use of an effective
sunscreen (protection factor >15) for unclothed body parts (head, neck,
hands and arms) in order to prevent the occurrence of squamous-cell carcinoma.
This is the most frequent skin tumour in transplant recipients, and its
preferential location is the head. F. Recipients with pre-malignant skin
lesions (warts, epidermodysplasia verruciformis or actinic keratoses) should be
referred early to a dermatologist for active treatment and close follow-up. G.
All skin cancers should be completely removed by a dermatologist with
appropriate techniques, such as electro-desiccation with curettage, cryotherapy
or surgical excision. H. Secondary prevention for recipients should include
close follow-up by a dermatologist (at least every 6 months), the use of
topical retinoids to control actinic keratoses and to diminish squamous-cell
carcinoma recurrence, and reduction of immunosuppression whenever possible. I.
In recipients with multiple and/or recurrent skin cancers, the use of systemic
retinoids, such as low-dose acitretin, could be recommended for months/years,
if well tolerated, in addition to further reduction in immunosuppression
whenever possible.
----------------------------------------------------
[14]
TÍTULO / TITLE: - Multicentric papillary
renal carcinoma in renal allograft.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Aug;42(2):381-4.
AUTORES
/ AUTHORS: - DeLong MJ; Schmitt D; Scott KM; Ramakumar
S; Lien YH
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
Arizona Health Sciences Center, Tucson, AZ 85724, USA.
RESUMEN
/ SUMMARY: - A renal transplant recipient with 13 years
of excellent allograft function was found incidentally to have a malignant mass
in his transplanted kidney. After resection, pathological analysis showed 29
separate lesions of renal cell carcinoma. All tumors were confined within the
renal capsule. The majority of tumors (21 of 29 tumors) were chromophil
basophilic carcinoma with papillary architecture, 5 tumors were clear cell, 2
tumors were mixed cell type, and 1 tumor was chromophil eosinophilic papillary
carcinoma. These histological findings are similar to those reported in
hereditary papillary renal carcinoma. To our knowledge, this is the first case
of multicentric papillary renal carcinoma occurring in the renal allograft. We
speculate that the allograft in this case is predisposed to malignant changes
because of preexisting genetic mutations, as well as prolonged
immunosuppression. N.
Ref:: 13
----------------------------------------------------
[15]
TÍTULO / TITLE: - Review of solid-organ
transplantation in HIV-infected patients.
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 27;75(4):425-9.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000046943.35335.18
AUTORES
/ AUTHORS: - Roland ME; Stock PG
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
California, San Francisco, California, USA. mroland@php.ucsf.edu N. Ref:: 47
----------------------------------------------------
[16]
TÍTULO / TITLE: - Subcutaneous black
fungus (phaeohyphomycosis) infection in renal transplant recipients:three
cases.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1):140-2.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000107287.70512.E7
AUTORES
/ AUTHORS: - Yehia M; Thomas M; Pilmore H; Van Der
Merwe W; Dittmer I
INSTITUCIÓN
/ INSTITUTION: - Auckland Renal Transplant Group, Auckland
Hospital, Auckland, New Zealand. mahay@adhb.govt.nz
RESUMEN
/ SUMMARY: - We describe three cases of subcutaneous
phaeohyphomycosis developing in the lower limbs of renal transplant recipients
shortly after transplantation. Each case presented with dark-colored nodules
that subsequently ulcerated. Histopathologic examination revealed dematiaceous
fungal hyphae with a surrounding granulomatous reaction. The fungi were subsequently
identified as Alternaria alternatum in two cases and Phialophora richardsiae in
one case. In one case, the lesions resolved during a prolonged (6-month) course
of itraconazole without the requirement for surgical excision. In the other two
cases, combined medical and surgical treatment resulted in cure. A review of
the literature on phaeohyphomycosis is presented. N. Ref:: 11
----------------------------------------------------
[17]
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.
----------------------------------------------------
[18]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.4. Chronic graft dysfunction. De novo renal disease
after transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:15-6.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Acute pyelonephritis is
relatively frequent in the transplanted kidney and carries a risk of
septicaemia. The condition should be recognized and the patient should be
treated promptly in the hospital. B. After initiation of any drugs known to
induce the development of interstitial nephritis in the transplant patient, it
is recommended to monitor renal function and abnormalities in order to detect
any side effects rapidly. If interstitial nephritis is observed, it is
recommended to stop the offending drug, and to initiate appropriate treatment.
C. De novo membranous nephropathy should be considered in cases of proteinuria
and nephrotic syndrome after transplantation. Viral infection, such as HCV,
should be excluded. D. In the case of the development of graft dysfunction in a
transplant patient with Alport’s syndrome, one should consider additionally the
possibility of de novo anti-glomerular basement membrane (anti-GBM)
glomerulonephritis.
----------------------------------------------------
[19]
TÍTULO / TITLE: - The economic value of
valacyclovir prophylaxis in transplantation.
REVISTA
/ JOURNAL: - J Infect Dis. Acceso gratuito al texto
completo a partir de los 2 años de la publicación; - http://www.journals.uchicago.edu/
●●
Cita: J. of Infectious Diseases: <> 2002 Oct 15;186 Suppl 1:S116-22.
AUTORES
/ AUTHORS: - Squifflet JP; Legendre C
INSTITUCIÓN
/ INSTITUTION: - University Clinic Saint Luc, 1200
Brussels, Belgium. Jean-Paul.Squifflet@chir.ucl.ac.be
RESUMEN
/ SUMMARY: - Cytomegalovirus (CMV) infection and
disease, with its extensive direct and indirect consequences, adds considerably
to the cost of patient management in both solid organ and bone marrow
transplantation. Antiviral prophylaxis for CMV infection can offer cost
advantages over preemptive therapy and “wait-and-treat” approaches.
Valacyclovir has demonstrated efficacy for CMV prophylaxis in renal, heart, and
bone marrow transplantation and is cost-effective when compared with placebo in
renal transplant recipients at high risk of CMV infection. In reducing CMV
infection and disease, valacyclovir prophylaxis appears to be associated with
reductions in indirect effects of CMV (acute graft rejection, other opportunistic
infections) and, if these effects are considered, the potential exists for even
greater savings to be made with valacyclovir therapy. Benefits of valacyclovir
in transplantation extend beyond CMV to other herpesviruses and may be
increased in some clinical situations by prolonging prophylaxis beyond 3
months. N. Ref:: 32
----------------------------------------------------
[20]
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.
----------------------------------------------------
[21]
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
----------------------------------------------------
[22]
TÍTULO / TITLE: - Postmenopausal
tubo-ovarian abscess due to Pseudomonas aeruginosa in a renal transplant
patient: a case report and review of the literature.
REVISTA
/ JOURNAL: - Transplantation 2001 Oct 15;72(7):1241-4.
AUTORES
/ AUTHORS: - El Khoury J; Stikkelbroeck MM; Goodman A;
Rubin RH; Cosimi AB; Fishman JA
INSTITUCIÓN
/ INSTITUTION: - Infectious Disease Division, GRJ 504,
Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Pseudomonas aeruginosa is an
uncommon cause of infection in the female genital tract. We report a case of
postmenopausal tubo-ovarian abscess (TOA) due to P. aeruginosa in a renal
transplant recipient. The presentation included mild abdominal symptoms with
rapid progression of peritonitis and surgical abscess drainage. This is the
first such case in an organ transplant recipient described in the English
literature. METHODS AND RESULTS: Published reports of 1040 cases of TOA were
reviewed. The most common features were a history of sexually transmitted
disease or pelvic inflammatory disease, and symptoms including abdominal pain
and fever. Escherichia coli, Bacteroides spp., and Klebsiella pneumoniae were
the most frequently encountered pathogens. Neisseria gonorrhoeae and Chlamydia
trachomatis, which are frequently isolated from cervical cultures, are
uncommonly isolated from tubo-ovarian abscesses. Forty percent of patients were
treated with antibiotics alone, 18.8% with abdominal surgery, and 32% with
surgery and antimicrobial therapy. CONCLUSION: This report illustrates the
muted presentation and atypical microbiology of gynecologic infection in an
organ transplant recipient. N.
Ref:: 59
----------------------------------------------------
[23]
- Castellano -
TÍTULO / TITLE:Polimorfismo del receptor de la
vitamina D y enfermedad osea postrasplante renal. Polymorphism of the vitamin D
receptor and bone disease after renal transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2001;21 Suppl 1:56-60.
AUTORES
/ AUTHORS: - Torres A; Barrios Y; Salido E
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia y, Hospital
Universitario de Canarias, Instituto Reina Sofia de Investigacion Nefrologica,
Tenerife, España. atorres@ull.es N. Ref:: 29
----------------------------------------------------
[24]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.8. Cardiovascular risks. Immunosuppressive therapy.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:30-1.
RESUMEN
/ SUMMARY: - GUIDELINE: Immunosuppressive therapies,
especially corticosteroids and anticalcineurin inhibitors; contribute to the
prevalence of cardiovascular risk factors, such as arterial hypertension,
hyperlipidaemia and hyperglycaemia, and this effect is dose dependent.
Reduction of the dose, withdrawal and/or switching to another drug could be
useful to control these risk factors.
----------------------------------------------------
[25]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.6. Chronic graft dysfunction. Late recurrence of
other diseases.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:18-9.
RESUMEN
/ SUMMARY: - GUIDELINES: A. In the rare case of
recurrent lupus nephritis, no particular treatment is recommended. Only in the
few patients with clinically evident flare up is a reinforcement of
immunosuppression recommended. B. Recurrence of Henoch-Schonlein purpura may
occur even in the absence of clinical signs and symptoms. The prognosis for the
graft may be severe, particularly in adults. C. In the case of recurrent
ANCA-associated renal or systemic vasculitis, it is recommended to reinforce
the immunosuppression with appropriate agents. D. Since diabetic nephropathy
recurs almost invariably after transplantation, strict control of diabetes and
hypertension, and the use of ACE inhibitors and/or angiotensin II receptor
antagonists are recommended in order to prevent or slow the risk of recurrence.
----------------------------------------------------
[26]
- Castellano -
TÍTULO / TITLE:Linfoma de prostata secundario en
paciente trasplantado renal. Secondary prostatic lymphoma in a kidney
transplant patient.
REVISTA
/ JOURNAL: - Actas Urol Esp. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aeu.es/actas/
●●
Cita: Actas Urológicas Españolas: <> 2002 Jun;26(6):429-31.
AUTORES
/ AUTHORS: - Mallen Mateo E; Trivez Boned MA; Garcia
Garcia MA; Sancho Serrano C; Allepuz Losa C; Rioja Sanz LA
INSTITUCIÓN
/ INSTITUTION: - Servicio de Urologia, Hospital
Universitario Miguel Servet, Zaragoza.
RESUMEN
/ SUMMARY: - Lymphoma involving the prostate is rare,
both as a primary and as a secondary presenting. Usually the prognosis remains
poor. The clinical presentation is similar to that of other lower urinary tract
obstructions, in fact prostatic lymphoma must be considered in patients with
these symptoms, particularly in patients with prior history of systemic lymphoma.
We report a case of a kidney transplantation in a male patient, diagnosis of
lymphoma non Hodgkin, with later recurrence in prostate. N. Ref:: 6
----------------------------------------------------
[27]
TÍTULO / TITLE: - Bone disease after
renal transplantation.
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 15;75(3):315-25.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000043926.74349.6D
AUTORES
/ AUTHORS: - Heaf JG
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology B, Copenhagen
University Hospital in Herlev, Denmark. heaf@dadlnet.dk
RESUMEN
/ SUMMARY: - Bone disease is common after renal
transplantation. The main syndromes are bone loss with a consequent fracture
rate of 3% per year, osteonecrosis of the hip, and bone pain. The causes of
disease include preexisting uremic osteodystrophy (hyperparathyroidism,
aluminum osteomalacia, beta2-associated amyloidosis, and diabetic osteopathy),
postoperative glucocorticoid therapy, poor renal function, and ongoing
hyperparathyroidism, as the result of either autonomous transformation of the
parathyroid gland or ongoing physiologic stimuli. Cyclosporine A treatment,
hyperphosphaturia, and a pathogenic vitamin D allele have also been implicated.
Bone loss is particularly pronounced during the first year after operation,
amounting to up to 9% of bone mass. The clinical and biochemical picture is
consistent with a high turnover bone disease, but histomorphometric studies do
not completely support this. Principal prophylactic options include
preoperative osteodystrophy prophylaxis; postoperative calcium, vitamin D, or
calcitriol therapy; estrogen therapy for postmenopausal women; and
parathyroidectomy for medically intractable hyperparathyroidism. Recently, prophylactic
biphosphonate treatment has shown promise, but the exact indications for
treatment remain to be determined. N.
Ref:: 221
----------------------------------------------------
[28]
- Castellano -
TÍTULO / TITLE:La influencia de los factores
geneticos en la patogenesis de dislipidemias posteriores al trasplante renal.
The effect of genetic factors on the pathogenesis of the dyslipidemias
following kidney transplantation.
REVISTA
/ JOURNAL: - Rev Invest Clin. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.imbiomed.com/
●●
Cita: Revista de Investigacion Clinica: <> 2002 Sep-Oct;54(5):472-3.
AUTORES
/ AUTHORS: - Lerman Garber I
INSTITUCIÓN
/ INSTITUTION: - Departamento de Endocrinologia y
Metabolismo, Instituto Nacional de Ciencias Medicas y Nutricion Salvador
Zubiran. lerman@netservice.com.mx N. Ref:: 11
----------------------------------------------------
[29]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.8. Bone disease.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:43-8.
RESUMEN
/ SUMMARY: - GUIDELINES: A. All kidney-transplanted
patients should undergo a systematic evaluation of their skeletal status,
including pre-transplant history of renal osteodystrophy, history of fractures
and plasma concentrations of calciotropic hormones and other parameters, and if
possible measurement of bone mineral density (BMD). B. Glucocorticoid therapy
should be given at the lowest possible dosage. As long as patients are
receiving steroids, vitamin D treatment (ergocalciferol or
1,25-dihydroxyvitamin D) is highly recommended. C. Optimal prevention of bone
disease by vitamin D treatment, sufficient calcium intake, sex hormone
substitution and appropriate use of thiazide diuretics should be considered in
all transplant patients. D. In established osteopenia, bisphosphonate treatment
should be considered despite limited information in transplant recipients. E.
Persistent tertiary hyperparathyroidism should be observed for 1 year after
transplantation whenever possible to allow for a spontaneous involution. F. In
patients with GFR <50 ml/min after transplantation, uraemic osteodystrophy
should be prevented.
----------------------------------------------------
[30]
TÍTULO / TITLE: - Solid organ
transplantation in patients with HIV infection.
REVISTA
/ JOURNAL: - Transplantation 2001 Jul 27;72(2):177-81.
AUTORES
/ AUTHORS: - Gow PJ; Pillay D; Mutimer D
INSTITUCIÓN
/ INSTITUTION: - Liver and Hepatobiliary Unit, Third Floor,
Nuffield House, Queen Elizabeth Hospital, Birmingham, England. N. Ref:: 43
----------------------------------------------------
[31]
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
----------------------------------------------------
[32]
TÍTULO / TITLE: - New immunosuppressive
agent: expectations and controversies.
REVISTA
/ JOURNAL: - Transplantation 2003 Mar 27;75(6):741-2.
AUTORES
/ AUTHORS: - Alsina J; Grinyo JM
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Bellvitge
Hospital, Barcelona, España. N.
Ref:: 5
----------------------------------------------------
[33]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.7.1 Late infections. Pneumocystis carinii pneumonia.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:36-9.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Approximately 5% of
patients develop Pneumocystis carinii pneumonia (PCP) after renal
transplantation if they do not receive prophylaxis. PCP is a severe disease,
with a very high fatality rate. Therefore, all renal transplant recipients
should receive PCP prophylaxis. The treatment of choice is
trimethoprim-sulfamethoxazole (TMP-SMX), at a dose of 80/400 mg/day or 160/800
mg every other day, for at least 4 months. Patients who are treated for
rejection should receive TMP-SMX prophylaxis for 3-4 months. B. In the case of
TMP-SMX intolerance, aerosolized pentamidine (300 mg once or twice per month)
is an alternative for prophylaxis. C. The first-line treatment of PCP is
high-dose TMP-SMX. Patients with a PaO2 of <70 mmHg initially should be
treated parenterally, and the administration of additional steroids should be
considered.
----------------------------------------------------
[34]
- Castellano -
TÍTULO / TITLE:Aneurisma disecante de la arteria
renal en paciente trasplantado. Presentacion de un caso. Revision de la
literatura. Dissecting aneurysm of the renal artery in patient with
transplantation. Report of a case. Review of the literature.
REVISTA
/ JOURNAL: - Arch Esp Urol 2003 Nov;56(9):1059-62.
AUTORES
/ AUTHORS: - Canovas Ivorra J; Guardiola Mas A; Nicolas
Torralba JA; Jimeno Garcia L; Llorente Vinas S; Garcia Hernandez JA; Polo Perez
J; Banon Perez V
INSTITUCIÓN
/ INSTITUTION: - Servicio de Urologia, Hospital
Universitario Virgen de la Arrixaca, Murcia, España.
RESUMEN
/ SUMMARY: - OBJECTIVES: Aneurysmatic processes of the
renal artery after transplant are rare entities, generally secondary to
technical defects or infectious pictures. Among other presentations, dissecting
aneurysm are exceptional, having a particularly difficult diagnosis due to the
lack of specific clinical data which could differentiate them from other
processes such as graft rejection or acute tubular necrosis, as well as the
absence of characteristic representative images. METHODS: We report one case of
dissecting aneurysm after a kidney transplant resulting in graft loss. RESULTS:
We analyze the presentation form, diagnostic procedures, pathologic studies,
and possible therapeutic options. CONCLUSIONS: Dissecting aneurysm of the renal
artery is a rare entity of difficult diagnosis due to the poorness of presenting
symptoms and the difficulty of finding it in routine tests, being necessary to
think of it and to perform angiography as the only diagnostic test. Treatment
is carried out by hilar reconstruction or transplant nephrectomy when the
former is not possible. N.
Ref:: 10
----------------------------------------------------
[35]
TÍTULO / TITLE: - De novo minimal change
disease associated with reversible post-transplant nephrotic syndrome. A report
of five cases and review of literature.
REVISTA
/ JOURNAL: - Clin Transplant 2002 Oct;16(5):350-61.
AUTORES
/ AUTHORS: - Zafarmand AA; Baranowska-Daca E; Ly PD;
Tsao CC; Choi YJ; Suki WN; Truong LD
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, Renal Section,
Baylor College of Medicine and the Methodist Hospital, Houston, TX 77030, USA.
RESUMEN
/ SUMMARY: - Nephrotic syndrome (NS) is frequent in
renal transplant recipients and may be related to a large variety of glomerular
lesions. In some of these cases, the transplant biopsy showed no significant
glomerular changes and the NS was reversible, but the primary renal disease was
not minimal change disease (MCD), suggesting that MCD may develop de novo in
renal transplant setting. Knowledge of this entity, however, is limited. Among
67 cases of post-transplant NS encountered in a 12-yr period, five were found
to be associated with de novo MCD. A critical review of the literature revealed
nine additional cases of de novo MCD. The data from these 14 cases show that
patients with de novo MCD had a large variety of primary renal diseases but MCD
or focal segmental glomerulosclerosis was not among them. Eight of the 14
transplanted kidneys (60%) were from living related donors, suggesting this as
a risk factor. Nephrotic range proteinuria (3-76 g/d) developed immediately or
shortly after transplantation (within 4 months for all reported cases, except
for one at 24 months). The serum creatinine when NS was first diagnosed was
normal or mildly elevated, but acute renal failure occurred in three patients.
On biopsy, the glomeruli were normal or, more frequently, displayed mild, focal
segmental mesangial sclerosis, hypercellularity, deposition of IgM/C3, or
accumulation of mononuclear inflammatory cells in some glomerular capillaries.
The tubulointerstitial compartment was normal in cases with normal renal
function; displayed mild acute and/or chronic rejection that correlated with a
mildly elevated serum creatinine; or showed acute changes including acute
rejection, acute tubular necrosis, or acute cyclosporin A toxicity, which
accounted for both acute renal failure at presentation and its subsequent
reversibility. Under various treatments, including increased steroids,
angiotensin converting enzyme inhibitors, calcium channel blockers and
angiotensin receptor blockers, sustained remission of NS was achieved in 13
cases, within a year (0.5-12 months) in 10 and later (24, 34 and 98 months,
respectively) in three. In the remaining case, the patient died of septic shock
2 months after transplantation. After remission of the NS, the grafts
functioned well without or with minimal proteinuria for several years. De novo
MCD has characteristic clinical and pathologic features. It represents an
important but hitherto underemphasized cause of post-transplant NS, which is
potentially reversible and does not adversely affect the renal
transplants. N.
Ref:: 37
----------------------------------------------------
[36]
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
----------------------------------------------------
[37]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.2. Cardiovascular risks. Arterial hypertension.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:25-6.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Arterial hypertension is
often present after renal transplantation and is of multifactorial origin.
Pre-transplant arterial hypertension, chronic allograft nephropathy and
immunosuppressive therapy are the most frequent causes of post-transplant
arterial hypertension. Careful monitoring and treatment of high blood pressure
are recommended following transplantation. B. Post-transplant arterial
hypertension is associated with an increased incidence of cardiovascular
disease in renal transplant patients and is an independent risk factor for
graft failure. Therefore, blood pressure control (<130/85 mmHg for renal
transplant recipients without proteinuria, and <125/75 mmHg for proteinuric
patients) is mandatory in these patients. General measures and pharmacological
intervention are necessary in many cases. In proteinuric patients,
anti-hypertensive and anti-proteinuric agents could be used, and stricter blood
pressure control is recommended. C. In patients with uncontrolled arterial
hypertension and/or renal function deterioration, underlying causes should be excluded,
especially transplant renal artery stenosis.
----------------------------------------------------
[38]
TÍTULO / TITLE: - Fragility fractures in
dialysis and transplant patients. Is it osteoporosis, and how should it be
treated?
REVISTA
/ JOURNAL: - Perit Dial Int 2001;21 Suppl 3:S247-55.
AUTORES
/ AUTHORS: - Hodsman AB
INSTITUCIÓN
/ INSTITUTION: - University of Western Ontario and Division
of Nephrology, London Health Sciences Centre, Canada. Anthony.hodsman@sjhc.london.on.ca
RESUMEN
/ SUMMARY: - The term “osteoporosis” must be applied
with caution to the uremic population, which has a complex range of metabolic
bone disease. Trials of therapeutic interventions to prevent fractures in non
uremic populations with osteoporosis cannot be generalized to uremic patients.
It is unclear what, if any, role systematic bone densitometry measurement can
play in the management of uremic patients who suffer “fragility”
fractures—either for diagnostic purposes or to determine the effectiveness of
therapy. Estrogen therapy—and perhaps SERMs (raloxifene)--appear to be a
reasonable addition to conventional management of secondary HPT with calcium
salts and vitamin D analogs. Using bisphosphonates to manage patients who have
pre-existing fractures should be considered experimental at best. In certain
circumstances, such treatment may be harmful. While the evidence is better that
early therapy with intravenous pamidronate in the peri-transplant interval may
mitigate the steroid-induced bone loss seen in those patients during the first
12 postoperative months, even that indication needs to be subjected to
systematic clinical studies to develop appropriate clinical practice
guidelines. N. Ref:: 48
----------------------------------------------------
[39]
TÍTULO / TITLE: - Clinicopathological
evaluation of renal allografts of four patients by 20-year protocol biopsies.
REVISTA
/ JOURNAL: - Clin Transplant 2003;17 Suppl 10:20-4.
AUTORES
/ AUTHORS: - Okamoto M; Nobori S; Higuchi A; Kadotani
Y; Ushigome H; Nakamura K; Akioka K; Omori Y; Yoshimura N
INSTITUCIÓN
/ INSTITUTION: - Department of Transplantation and
Endocrine Surgery, Kyoto Prefectural University of Medicine, Kyoto 602, Japan. amoto@koto.kpu-m.ac.jp
RESUMEN
/ SUMMARY: - Twenty-year protocol biopsies were
performed in four cases of renal transplant recipients with grafts that had
survived 20 years or more. All four recipients received transplants from their
parents, and never had episodes of acute rejection. They were maintained with
the conventional immunosuppressive protocol including azathioprine, mizoribine,
and prednisolone. Three of them had past history of malignant diseases such as
breast cancer and tongue cancer. In spite of fair graft function, the
microscopic findings of 20-year protocol biopsy showed various degrees of
histological damage; e.g. obsolescence of the glomeruli, glomerulosclerosis,
arteriole wall thickening, interstitial fibrosis and tubular atrophy. Although
two of the four grafts were functioning with low serum creatinine levels
(1.3-1.4 mg dL-1) at 24 years and 26 years following transplantation,
respectively, the function of the other two grafts had decreased more than 20
years after transplantation. In the two grafts with decreased function,
glomerulosclerosis and arteriole wall thickening tended to be more severe
(Banff classification of chronic allograft nephropathy [CAN] grade II and III)
at the 20-year protocol biopsy compared with the two well-functioning grafts
(CAN grade I and II). We conclude that the protocol biopsies even at 20 years
can contribute to predict the fate of renal allografts.
----------------------------------------------------
[40]
TÍTULO / TITLE: - How should the
immunosuppressive regimen be managed in patients with established chronic
allograft failure?
REVISTA
/ JOURNAL: - Kidney Int Suppl 2002 May;(80):68-72.
AUTORES
/ AUTHORS: - Danovitch GM
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, UCLA School of
Medicine, USA. gdanovitch@mednet.ucla.edu N. Ref:: 25
----------------------------------------------------
[41]
TÍTULO / TITLE: - ACE inhibitors and AII
receptor antagonists in the treatment and prevention of bone marrow transplant
nephropathy.
REVISTA
/ JOURNAL: - Curr Pharm Des 2003;9(9):737-49.
AUTORES
/ AUTHORS: - Moulder JE; Fish BL; Cohen EP
INSTITUCIÓN
/ INSTITUTION: - Department of Radiation Oncology, Medical
College of Wisconsin, Milwaukee, WI 53226, USA. jmoulder@its.mcw.edu
RESUMEN
/ SUMMARY: - Radiation nephropathy has emerged as a
major complication of bone marrow transplantation (BMT) when total body
irradiation (TBI) is used as part of the regimen. Classically, radiation
nephropathy has been assumed to be inevitable, progressive, and untreatable.
However, in the early 1990’s, it was demonstrated that experimental radiation
nephropathy could be treated with a thiol-containing ACE inhibitor, captopril.
Further studies showed that enalapril (a non-thiol ACE inhibitor) was also
effective in the treatment of experimental radiation nephropathy, as was an AII
receptor antagonist. Studies also showed that ACE inhibitors and AII receptor
antagonists were effective in the prophylaxis of radiation nephropathy.
Interestingly, other types of antihypertensive drugs were ineffective in
prophylaxis, but brief use of a high-salt diet in the immediate
post-irradiation period decreased renal injury. A placebo-controlled trial of
captopril to prevent BMT nephropathy in adults is now underway. Since excess
activity of the renin-angiotensin system (RAS) causes hypertension, and
hypertension is a major feature of radiation nephropathy; an explanation for the
efficacy of RAS antagonism in the prophylaxis of radiation nephropathy would be
that radiation leads to RAS activation. However, current studies favor an
alternative explanation, namely that the normal activity of the RAS is
deleterious in the presence of radiation injury. On-going studies suggest that
efficacy of RAS antagonists may involve interactions with a radiation-induced
decrease in renal nitric oxide activity or with radiation-induced tubular cell
proliferation. We hypothesize that while prevention (prophylaxis) of radiation
nephropathy with ACE inhibitors, AII receptor antagonists, or a high-salt diet
work by suppression of the RAS, the efficacy of ACE inhibitors and AII receptor
antagonists in treatment of established radiation nephropathy depends on blood
pressure control. N.
Ref:: 108
----------------------------------------------------
[42]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.7. Cardiovascular risks. Obesity and weight gain.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:29-30.
RESUMEN
/ SUMMARY: - GUIDELINE: Obesity (BMI >30 kg/m2) and
weight gain are associated with increased prevalence of cardiovascular disease
after transplantation. Appropriate dietary and lifestyle measures should be
recommended to these patients.
----------------------------------------------------
[43]
TÍTULO / TITLE: - Costs and consequences
of cytomegalovirus disease.
REVISTA
/ JOURNAL: - Am J Health Syst Pharm 2003 Dec 1;60(23
Suppl 8):S5-8.
AUTORES
/ AUTHORS: - Schnitzler MA
INSTITUCIÓN
/ INSTITUTION: - Washington University, 4547 Clayton
Avenue, Box 8084, St. Louis, MO 63110, USA. schnitz@wueconc.edu
RESUMEN
/ SUMMARY: - The impact of prophylactic oral
ganciclovir therapy on the incidence of cytomegalovirus (CMV) disease, patient
and graft survival, and costs in patients receiving kidney and liver
transplants is described. CMV disease is a common cause of morbidity and
mortality in solid organ transplant recipients unless prophylactic drug therapy
is used. Prophylactic oral ganciclovir therapy reduces the incidence of CMV disease
in kidney and liver transplant recipients. It is more effective for recipients
who are seronegative before the transplant and receive organs from seronegative
(D-/R-) donors than in seronegative recipients of organs from seropositive
(D+/R-) donors. CMV disease remains a problem in the latter. CMV disease
increases the risk of graft failure, which decreases the likelihood of patient
survival. The extent of matching of the DR subregion of the human leukocyte
antigen complex in the donor and recipient may affect graft survival in
patients with CMV disease. Graft failure is costly and should be considered in
economic analyses of CMV prophylaxis regimens because of the potential impact
of prophylaxis on CMV disease. The use of oral ganciclovir for CMV prophylaxis
has reduced the incidence of CMV disease in kidney and liver transplant
recipients. N. Ref:: 10
----------------------------------------------------
[44]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.4. Cardiovascular risks. Post-transplant diabetes
mellitus.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:28.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Post-transplant diabetes
mellitus (PTDM) should be identified by regular (every 3 months) fasting blood
glucose and/or glycated haemoglobin (HbA1c) measurements. PTDM should be
treated as appropriate to achieve normoglycaemia. B. Immunosuppressive therapy
should be adjusted to reverse or ameliorate PTDM.
----------------------------------------------------
[45]
TÍTULO / TITLE: - Protocol biopsy of the
stable renal transplant: a multicenter study of methods and complication rates.
REVISTA
/ JOURNAL: - Transplantation 2003 Sep 27;76(6):969-73.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000082542.99416.11
AUTORES
/ AUTHORS: - Furness PN; Philpott CM; Chorbadjian MT;
Nicholson ML; Bosmans JL; Corthouts BL; Bogers JJ; Schwarz A; Gwinner W; Haller
H; Mengel M; Seron D; Moreso F; Canas C
INSTITUCIÓN
/ INSTITUTION: - Clinical Sciences Laboratories, Leicester
General Hospital, Leicester, United Kingdom.
RESUMEN
/ SUMMARY: - BACKGROUND: Clinical trials in renal transplantation
must use surrogate markers of long-term graft survival if conclusions are to be
drawn at acceptable speed and cost. Morphologic changes in transplant biopsies
provide the earliest available evidence of damage, and “protocol” biopsies from
stable grafts can be used to reduce the number of patients needed in clinical
trials. This approach has been inhibited by concerns over safety, but the risk
of biopsy of a stable kidney, with no active inflammation or acute functional
impairment, has never been formally estimated. METHODS: In accordance with a
predefined set of questions, a retrospective audit of a sequential series of
protocol biopsies was performed in four major transplant centers. RESULTS: A
total of 2,127 biopsy events were assessed for major complications, and 1,486
were assessed for minor ones. There were no deaths. One graft was lost, under
circumstances indicating that the loss should have been prevented. Three
episodes of hemorrhage required direct intervention. Three further patients required
transfusion. There were two episodes of peritonitis, but one was arguably an
unrelated event. All serious complications presented within 4 hr of biopsy.
CONCLUSIONS: The incidence of clinically significant complications after
protocol biopsy of a stable renal transplant is low. Direct benefits to the
patients concerned (irrespective of the benefit that may accrue in clinical
trials) were not formally assessed but seem likely to outweigh the risk of the
procedure. We believe that it is ethically justifiable to ask renal transplant
recipients to undergo protocol biopsies in clinical trials and routine care.
----------------------------------------------------
[46]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.3. Cardiovascular risks. Hyperlipidaemia.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:26-8.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Hyperlipidaemia risk
profiles should be identified by regular screening (at least once a year) for
cholesterol, HDL-cholesterol, LDL-cholesterol and triglyceride blood levels in
renal transplant patients. B. In renal transplant patients, hyperlipidaemia
must be treated in order to keep the cholesterol/lipid levels within
recommended limits according to the number of risk factors. C. Management of
hyperlipidaemia after renal transplantation should be the same as for the
dialysis population, with, in addition, modification of the immunosuppressive
protocol when appropriate. D. Patients should be carefully monitored for
adverse effects of lipid-lowering agents or interactions with immunosuppressive
drugs.
----------------------------------------------------
[47]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.3.1 Long-term immunosuppression. Late steroid or
cyclosporine withdrawal.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:19-20.
RESUMEN
/ SUMMARY: - GUIDELINES: A. In order to reduce or avoid
long-term serious adverse effects of corticosteroids, such as bone fractures,
diabetes mellitus, arterial hypertension, osteoporosis and eye complications,
steroid withdrawal should be considered. B. Steroid withdrawal is safe only in
a proportion of graft recipients and is recommended only in low-risk patients.
The efficacy of the remaining immunosuppression should be considered. C. After
steroid withdrawal, graft function has to be monitored very carefully because
of the risk of a delayed but continuous loss of function due to chronic graft
dysfunction. In the case of functional deterioration or dysfunction, steroids
should be re-administered. D. Cyclosporine withdrawal might be considered in
order to ameliorate nephrotoxicity, arterial hypertension, lipid disorders and
hypertrichosis. This can be carried out with no significant long-term risk of
progressive graft loss. The efficacy of the remaining immunosuppression should
be considered. After cyclosporine withdrawal, careful monitoring for acute
rejection is recommended.
----------------------------------------------------
[48]
TÍTULO / TITLE: - Steroid-resistant
kidney transplant rejection: diagnosis and treatment.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2001 Feb;12 Suppl
17:S48-52.
AUTORES
/ AUTHORS: - Bock HA
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Kantonsspital,
Aarau, Switzerland. bock@ksa.ch
RESUMEN
/ SUMMARY: - Decreases in transplant function may be
attributable to a variety of conditions, including prerenal and postrenal
failure, cyclosporin A (CsA) toxicity, polyoma nephritis, recurrent
glomerulonephritis, and rejection. The diagnosis of rejection should therefore
be made on the basis of a transplant biopsy of adequate size, before the
initiation of any therapy. Pulse steroid treatment (three to five 0.25- to
1.0-g pulses of methylprednisolone, administered intravenously) is the usual
first-line therapy and has a 60 to 70% success rate, although orally
administered prednisone (0.25 g) may be just as efficacious. Even if reverted,
any rejection should trigger an at least temporary increase in basal
immunosuppression, consisting of an increase in CsA or tacrolimus target
levels, the addition of steroids or an increase in their dosage, the addition
of mycophenolate mofetil, or a switch from CsA to tacrolimus. The addition of
rapamycin or its RAD derivative may fulfill the same purpose. Steroid
resistance should not be assumed before the fifth day of pulse steroid
treatment, although histologic features of vascular rejection may indicate the
need for more aggressive treatment earlier. Steroid-resistant rejection is
traditionally treated with poly- or monoclonal antilymphocytic antibodies, with
success rates of 60 to 70%. Their potential benefit must be carefully balanced
against the risks of infection and lymphoma. More recently, mycophenolate
mofetil has been successfully used to treat steroid-resistant rejection, but
only of the interstitial (cellular) type. Switching from CsA to tacrolimus for
treating recurrent or antibody-resistant rejection is successful in
approximately 60% of cases. Plasmapheresis and intravenously administered Ig
have been used in some desperate cases, with surprising success. Because none
of the available drugs has a significantly better profile of therapeutic versus
adverse effects, the possible benefits of continued rejection therapy must be
continuously balanced with the potential for serious, sometimes fatal, side
effects. N. Ref:: 35
----------------------------------------------------
[49]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.6. Cardiovascular risks. Smoking.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:29.
RESUMEN
/ SUMMARY: - GUIDELINE: Cigarette smoking is associated
with a high frequency of post-transplant cardiovascular disease and may
adversely influence patient and graft survival. Active measures against tobacco
smoking are recommended.
----------------------------------------------------
[50]
TÍTULO / TITLE: - Cardiovascular disease
after renal transplantation.
REVISTA
/ JOURNAL: - Kidney Int Suppl 2002 May;(80):78-84.
AUTORES
/ AUTHORS: - Dimeny EM
INSTITUCIÓN
/ INSTITUTION: - Department of Public Health and Clinical
Medicine, Umea University, Sweden. emoke.dimeny@vll.se
RESUMEN
/ SUMMARY: - Cardiovascular disease is a major hazard
limiting the life expectancy of renal transplant recipients and the most
frequent cause of late allograft loss. Patients with renal disease have usually
been exposed for both traditional, and for them unique, risk factors over a
prolonged period of time and may carry the burden of advanced atherosclerotic
disease already at the time of transplantation. The observed survival benefit
of transplantation is probably from elimination of the numerous uremia-related
risk factors. However, immunosuppressive therapy and the chronic inflammatory
state, together with genetic susceptibility and not infrequently impaired renal
function, may bring about new potentially atherogenic conditions. Metabolic
risk factors may jeopardize both patient and graft survival. Several
observational studies provide evidence for the negative impact of preexisting
metabolic abnormalities on long-term outcomes. Identification of modifiable
cardiovascular risk factors may enable risk reduction also in renal transplant
recipients. Results of ongoing intervention trials are awaited. The observed
improvement of patient survival after renal transplantation during the past
decade may reflect the increasing awareness and more optimal care of patients
throughout the course of renal disease.
N. Ref:: 67
----------------------------------------------------
[51]
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.
----------------------------------------------------
[52]
- Castellano -
TÍTULO / TITLE:Prevencion del riesgo
cardiovascular en el trasplante renal. Documento de consenso. Prevention of
cardiovascular risk in renal transplantation. Consensus document.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22 Suppl 4:35-56.
AUTORES
/ AUTHORS: - Morales JM; Gonzalez Molina M; Campistol
JM; del Castillo D; Anaya F; Oppenheimer F; Gil Vernet JM; Grinyo JM; Capdevila
L; Lampreave I; Valdes F; Marcen R; Escuin F; Andres A; Arias M; Pallardo L
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia Hospital 12 de
Octubre Ctra, Andalucia km 5,400 28041 Madrid. jmorales@h12o.es N. Ref:: 122
----------------------------------------------------
[53]
- Castellano -
TÍTULO / TITLE:Riesgo cardiovascular en el
paciente trasplantado renal. Cardiovascular risk in patients with renal
transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22 Suppl 4:7-11.
AUTORES
/ AUTHORS: - Campistol JM
INSTITUCIÓN
/ INSTITUTION: - Unidad de Trasplante Renal, Hospital
Clinic, Universidad de Barcelona, Villarroel, 170 08036 Barcelona. jmcampis@clinic.ub.es N. Ref:: 10
----------------------------------------------------
[54]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.7.2. Late infections. Tuberculosis.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:39-43.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Tuberculosis (TB) is not
rare after renal transplantation, and can be life-threatening. Treatment of
active TB in renal transplant recipients should be the same as in the general
population, i.e. 2 months of quadruple therapy combining rifampin, isoniazid,
ethambutol and pyrazinamide, followed by a 4-months double therapy with
isoniazid and rifampin. The drug ethambutol should not be used initially if the
rate of resistance to isoniazid is less than 4% in the community. B. As
rifampin will reduce the plasma concentration of calcineurin antagonists and
rapamycin, the blood levels of these agents must be monitored closely.
Rifabutin may be used as an alternative to rifampin, as this drug is a less
potent inducer of the microsomal P450 enzymes. C. Renal transplant candidates
and renal transplant recipients should be screened for latent TB infection.
Patients considered to have latent TB infection are defined as: (i) those who
display a 5 mm (renal transplant recipients) or a 10 mm (dialysis patients)
induration after tuberculin skin testing; (ii) those with chest X-ray images
suggestive of past TB infection; (iii) those with a history of past TB
infection that was not treated adequately; and (iv) those who have been in
close contact with infectious patients. The preferred treatment of latent TB
infection is isoniazid 300 mg/day for 9 months.
----------------------------------------------------
[55]
TÍTULO / TITLE: - Renal replacement
therapy in the patient with acute brain injury.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Mar;37(3):457-66.
AUTORES
/ AUTHORS: - Davenport A
INSTITUCIÓN
/ INSTITUTION: - Royal Free and University College Hospital
Medical School, Centre for Nephrology, Royal Free Hospital, London, UK. andrew.davenport@rfh.nthames.nhs.uk
RESUMEN
/ SUMMARY: - The patient with an acute brain injury
requiring renal replacement therapy presents a major problem in that
conventional intermittent hemodialysis may exacerbate the injury by compromising
cerebral perfusion pressure, either after a reduction in cerebral perfusion or
because of increased cerebral edema. Compared with standard intermittent
hemodialysis, the continuous forms of renal replacement therapy (CRRT) provide
an effective therapy in terms of solute clearance, coupled with improved
cardiovascular and intracranial stability. The disadvantage of CRRT is that
anticoagulation may be required, and anticoagulants with systemic effects may
provoke intracerebral hemorrhage, either at the site of damage or around the
intracranial pressure monitoring device. Although peritoneal dialysis does not
require anticoagulation, the clearances achieved are often less than those of
CRRT, and sudden changes in intraperitoneal volume may provoke cardiovascular
and thus intracranial instability. N.
Ref:: 39
----------------------------------------------------
[56]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.5. Cardiovascular risks. Hyperhomocysteinaemia.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:28-9.
RESUMEN
/ SUMMARY: - GUIDELINE: Based on the present data, it
is not recommended to measure homocysteine levels.
----------------------------------------------------
[57]
TÍTULO / TITLE: - Calcium metabolism and
skeletal problems after transplantation.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2002
Feb;13(2):551-8.
AUTORES
/ AUTHORS: - Torres A; Lorenzo V; Salido E
INSTITUCIÓN
/ INSTITUTION: - Nephrology Section and Research Unit,
University Hospital of the Canary Islands, Instituto Reina Sofia de
Investigacion, Tenerife, España. atorres@ull.es N. Ref:: 59
----------------------------------------------------
[58]
TÍTULO / TITLE: - The impact of impaired
insulin release and insulin resistance on glucose intolerance after renal
transplantation.
REVISTA
/ JOURNAL: - Clin Transplant 2002 Dec;16(6):389-96.
AUTORES
/ AUTHORS: - Hjelmesaeth J; Hagen M; Hartmann A;
Midtvedt K; Egeland T; Jenssen T
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Section of
Nephrology, Oslo, Norway. joran@online.no
RESUMEN
/ SUMMARY: - The current knowledge of the pathogenesis
of post-transplant glucose intolerance is sparse. This study was undertaken to
assess the relative importance of insulin secretion (ISec) and insulin
sensitivity (IS) in the pathogenesis of post-transplant diabetes mellitus
(PTDM), impaired glucose tolerance (IGT) and impaired fasting glucose (IFG)
after renal transplantation. An oral glucose tolerance test (OGTT) was
performed in 167 non-diabetic recipients 10 wk after renal transplantation.
Fasting, 1-h and 2-h insulin and glucose levels were used to estimate the
insulin secretory response and IS. One year after transplantation 89 patients
were re-examined with an OGTT including measurements of fasting and 2 h
glucose. Ten weeks after transplantation the PTDM-patients had significantly
lower ISec and IS than patients with IGT/IFG, who again had lower ISec and IS
than those with normal glucose tolerance (NGT). One year later, a similar
difference in baseline ISec was observed between the three groups, whereas
baseline IS did not differ significantly. Patients who improved their glucose
tolerance during the first year, were mainly characterized by a significantly
greater baseline ISec, and they received a significantly higher median
prednisolone dose at baseline with a subsequent larger dose reduction during
the first year, than the patients who had their glucose tolerance unchanged or
worsened. In conclusion, both impaired ISec and IS characterize patients with
PTDM and IGT/IFG in the early course after renal transplantation. The presence
of defects in insulin release, rather than insulin action, indicates a poor
prognosis regarding later normalization of glucose tolerance. N. Ref:: 29
----------------------------------------------------
[59]
TÍTULO / TITLE: - Transplant Mac attack:
humor the macrophages.
REVISTA
/ JOURNAL: - Kidney Int 2003 May;63(5):1953-4.
AUTORES
/ AUTHORS: - Colvin RB
N. Ref:: 10
----------------------------------------------------
[60]
TÍTULO / TITLE: - Insulin resistance as
putative cause of chronic renal transplant dysfunction.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Apr;41(4):859-67.
AUTORES
/ AUTHORS: - de Vries AP; Bakker SJ; van Son WJ; Homan
van der Heide JJ; The TH; de Jong PE; Gans RO
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology Department of
Medicine, Groningen University Medical Center, Groningen, The Netherlands. a.p.j.de.vries@int.azg.nl
RESUMEN
/ SUMMARY: - Transplantation is the preferred organ
replacement therapy for most patients with end-stage renal disease. Despite
impressive improvements over recent years in the treatment of acute rejection,
approximately half of all grafts will loose function within 10 years after
transplantation. Chronic renal transplant dysfunction, also known as transplant
atherosclerosis, is a leading cause of late allograft loss. To date, no
specific treatment for chronic renal transplant dysfunction is available.
Although its precise pathophysiology remains unknown, it is believed that it
involves a multifactorial process of alloantigen-dependent and
alloantigen-independent risk factors. Obesity, posttransplant diabetes
mellitus, dyslipidemia, hypertension, and proteinuria have all been identified
as alloantigen-independent risk factors. Notably, these recipient-related risk
factors are well-known risk factors for cardiovascular disease, which cluster
within the insulin resistance syndrome in the general population. Insulin
resistance is considered the central pathophysiologic feature of this syndrome.
It is therefore tempting to speculate that it is insulin resistance that
underlies the recipient-related risk factors for chronic renal transplant
dysfunction. Recognition of insulin resistance as a central feature underlying
many, if not all, recipient-related risk factors would not only improve our understanding
of the pathophysiology of chronic renal transplant dysfunction, but also
stimulate development of new treatment and prevention strategies. N. Ref:: 99
----------------------------------------------------
[61]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.3.3. Long-term immunosuppression. Toxicity of
immunosuppression.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:21-3.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Careful long-term monitoring
of graft recipients is mandatory to discover signs of immunosuppressive drug
toxicity, in particular nephrotoxicity. B. In the case of a discrepancy between
the drug dose and signs of toxicity, then a thorough pharmacokinetic analysis
should be performed. C. Cardiovascular, renal and metabolic risks and the risk
of de novo malignancy must be considered in a long-term monitoring programme.
----------------------------------------------------
[62]
TÍTULO / TITLE: - Basiliximab: a review
of its use as induction therapy in renal transplantation.
REVISTA
/ JOURNAL: - Drugs 2003;63(24):2803-35.
AUTORES
/ AUTHORS: - Chapman TM; Keating GM
INSTITUCIÓN
/ INSTITUTION: - Adis International Limited, Auckland, New
Zealand. demail@adis.co.nz
RESUMEN
/ SUMMARY: - Basiliximab (Simulect), a chimeric
(human/murine) monoclonal antibody, is indicated for the prevention of acute
organ rejection in adult and paediatric renal transplant recipients in
combination with other immunosuppressive agents.Basiliximab significantly
reduced acute rejection compared with placebo in renal transplant recipients
receiving dual- (cyclosporin microemulsion and corticosteroids) or
triple-immunotherapy (azathioprine- or mycophenolate mofetil-based); graft and
patient survival rates at 12 months were similar. Significantly more
basiliximab than placebo recipients were free from the combined endpoint of
death, graft loss or acute rejection 3 years, but not 5 years, after
transplantation.The incidence of adverse events was similar in basiliximab and
placebo recipients, with no increase in the incidence of infection, including
cytomegalovirus (CMV) infection. Malignancies or post-transplant
lymphoproliferative disorders after treatment with basiliximab were rare, with
a similar incidence to that seen with placebo at 12 months or 5 years
post-transplantation. Rare cases of hypersensitivity reactions to basiliximab
have been reported.The efficacy of basiliximab was similar to that of equine
antithymocyte globulin (ATG) and daclizumab, and similar to or greater than
that of muromonab CD3. Basiliximab was as effective as rabbit antithymocyte
globulin (RATG) in patients at relatively low risk of acute rejection, but less
effective in high-risk patients. Numerically or significantly fewer patients
receiving basiliximab experienced adverse events considered to be related to
the study drug than ATG or RATG recipients. The incidence of infection,
including CMV infection, was similar with basiliximab and ATG or
RATG.Basiliximab plus baseline immunosuppression resulted in no significant
differences in acute rejection rates compared with baseline immunosuppression
with or without ATG or antilymphocyte globulin in retrospective analyses
conducted for small numbers of paediatric patients. Limited data from
paediatric renal transplant recipients suggest a similar tolerability profile
to that in adults. Basiliximab appears to allow the withdrawal of
corticosteroids or the use of corticosteroid-free or calcineurin
inhibitor-sparing regimens in renal transplant recipients.Basiliximab did not
increase the overall costs of therapy in pharmacoeconomic studies.CONCLUSION:
Basiliximab reduces acute rejection without increasing the incidence of adverse
events, including infection and malignancy, in renal transplant recipients when
combined with standard dual- or triple-immunotherapy. The overall incidence of
death, graft loss or acute rejection was significantly reduced at 3 years;
there was no significant difference for this endpoint 5 years after
transplantation. Malignancy was not increased at 5 years. The overall efficacy,
tolerability, ease of administration and cost effectiveness of basiliximab make
it an attractive option for the prophylaxis of acute renal transplant
rejection. N. Ref:: 85
----------------------------------------------------
[63]
TÍTULO / TITLE: - Hepatitis B and renal
transplantation: securing the sword of damocles.
REVISTA
/ JOURNAL: - Hepatology 2002 Nov;36(5):1041-5.
●●
Enlace al texto completo (gratuito o de pago) 1053/jhep.2002.36805
AUTORES
/ AUTHORS: - Perrillo RP N. Ref:: 37
----------------------------------------------------
[64]
TÍTULO / TITLE: - Successful treatment of
mucor infection after liver or pancreas-kidney transplantation.
REVISTA
/ JOURNAL: - Transplantation 2002 Feb 15;73(3):476-80.
AUTORES
/ AUTHORS: - Jimenez C; Lumbreras C; Aguado JM; Loinaz
C; Paseiro G; Andres A; Morales JM; Sanchez G; Garcia I; del Palacio A; Moreno
E
INSTITUCIÓN
/ INSTITUTION: - Department of General and Digestive
Surgery and Abdominal Organ Transplantation, Hospital Universitario Doce de
Octubre, 28041-Madrid, España. emorenog@hdoc.insalud.es
RESUMEN
/ SUMMARY: - BACKGROUND: Mucormycosis is a rare and
opportunistic infection usually associated with hematologic diseases, diabetes
mellitus, renal failure, solid tumors, and organ transplantation. METHODS: We
present five cases of mucor infection after transplantation (three after a
series of 750 orthotopic liver transplantation and two after a series of 13
simultaneous pancreas-kidney transplantation in patients with type 1 diabetes)
subjected to medical and surgical treatment and analyze the factors related to
the development of this infection. RESULTS: The clinical forms were two
cutaneous (laparotomy wound or prior surgical drain site), two rhino-maxillary,
and one pulmonary. As risk factors for mucormycosis all patients had pre- or
posttransplantation diabetes, and showed at least one episode of acute
rejection that required aggressive immunosuppression (2-7 g of
methylprednisolone; also three patients were treated with antithymocyte
globulin [ATG] monoclonal antibody [orthoclone and/or OKT3]). We also found
renal failure, acidosis, malnutrition, and Candida and cytomegalovirus
infections as factors related to mucor infection. Diagnosis of fungal infection
was confirmed by exudate or fluid culture in three cases and by biopsy in two.
All patients were treated with liposomal amphotericin B (from 3.5 to 5.6 g of
total dose) and resection until the surgical margins were free of infection.
All patients survived after this severe infection. CONCLUSIONS: With an early diagnosis
of mucormycosis by clinical findings, culture, or tissue biopsy, and aggressive
treatment consisting of administration of liposomal amphotericin B and surgical
resection of all infected tissue, excellent results are achieved. N. Ref:: 18
----------------------------------------------------
[65]
TÍTULO / TITLE: - De novo thrombotic
microangiopathy in renal transplant recipients: a comparison of hemolytic
uremic syndrome with localized renal thrombotic microangiopathy.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Feb;41(2):471-9.
●●
Enlace al texto completo (gratuito o de pago) 1053/ajkd.2003.50058
AUTORES
/ AUTHORS: - Schwimmer J; Nadasdy TA; Spitalnik PF;
Kaplan KL; Zand MS
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Nephrology Unit,
University of Rochester Medical Center, Rochester, NY, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Thrombotic microangiopathy
(TMA) is a well-recognized and serious complication of renal transplantation,
affecting 3% to 14% of patients administered calcineurin-inhibitor-based
immunosuppression. METHODS: We reviewed 1,219 biopsy reports of 742 kidney and
kidney-pancreas transplants performed during 15 years at our center and found
21 biopsy-confirmed cases of TMA. RESULTS: On presentation, the majority (62%)
had systemic TMA with manifest hemolysis and thrombocytopenia, whereas a subset
had TMA localized only to the graft (38%). There were no statistically
significant differences in sex, type of transplant, age, race, or type of
immunosuppression. Patients with systemic TMA were more likely to be treated
with plasma exchange (38% versus 13%; P < 0.05), more often required
dialysis therapy (54% versus 0%; P = 0.01), and had a greater rate of graft
loss (38% versus 0%; P < 0.05). No patient with the localized variant had
TMA-related graft loss. Patients with localized TMA often responded to
reduction, conversion, or temporary discontinuation of
calcineurin-inhibitor-based immunosuppression therapy and did not routinely
require plasma exchange for graft salvage. We compare our findings with the
literature regarding the prognosis of TMA. CONCLUSION: Classifying patients
with post-renal transplantation TMA into those with localized and systemic
disease is clinically useful because each group has distinct characteristics
and clinical courses. N.
Ref:: 37
----------------------------------------------------
[66]
TÍTULO / TITLE: - Hypertension after
kidney transplantation: are treatment guidelines emerging?
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002 Jul;17(7):1166-9.
AUTORES
/ AUTHORS: - Midtvedt K; Hartmann A N. Ref:: 31
----------------------------------------------------
[67]
TÍTULO / TITLE: - Hypertension after
kidney transplantation: impact, pathogenesis and therapy.
REVISTA
/ JOURNAL: - Am J Med Sci 2003 Apr;325(4):202-8.
AUTORES
/ AUTHORS: - Zhang R; Leslie B; Boudreaux JP; Frey D;
Reisin E
INSTITUCIÓN
/ INSTITUTION: - Section of Nephrology, Department of
Medicine, Louisianna State University Health Sciences Center, New Orleans
70112-2822, USA.
RESUMEN
/ SUMMARY: - Hypertension (HTN) contributes to the high
incidence of cardiovascular disease mortality as well as chronic allograft
nephropathy (CAN) and late graft failure in renal transplant recipients. The
mechanisms are complex and may involve pathogenic factors attributable to the
host, allograft, and immunosuppressive drugs. Calcium channel blockers should
be used to ameliorate the nephrotoxicity of calcineurin inhibitors in the early
years after transplantation. Angiotensin-converting enzyme inhibitors and
angiotensin-2 type-1 receptor blockers are safe and effective, have
antiproteinuric effects, slow the progression of CAN, and may provide survival
benefits. Diuretics and/or beta-adrenergic receptor blockers are frequently
added in combination regimen. Appropriate adjustment of the immunosuppressive
drugs should also be considered for the long-term care of kidney recipients
with HTN. N. Ref:: 53
----------------------------------------------------
[68]
- Castellano -
TÍTULO / TITLE:La enfermedad linfoproliferativa
difusa postrasplante renal y su relacion con el virus Epstein-Barr. Experiencia
de un centro. Diffuse lymphoproliferative disease after renal transplantation
and its relation with Epstein-Barr virus. Experience at one center.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22(5):463-9.
AUTORES
/ AUTHORS: - Franco A; Jimenez L; Aranda I; Alvarez L;
Gonzalez M; Rocamora N; Olivares J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia Hospital General
Alicante Maestro Alonso, 109 03010 Alicante. franco_ant@gva.es
RESUMEN
/ SUMMARY: - Post-transplant lymphoproliferative
disorders (PTLD) are a group of heterogeneous lymphoid proliferations in
chronic immunosuppressed recipients which appear to be related to Epstein Barr
Virus (EBV). Receptor EBV seronegativity, use of antilymphocyte antibodies and
CMV disease have been identified as risk factors that may tigger development of
PTLD. We have studied the incidence of PTLD and its relationship with EBV in
588 adult renal transplant recipients who were transplanted in our hospital
from 1988 to 2001. We have also evaluated the diagnostic and therapeutic
methods used, the risk factors and outcome of the patients who developed PTLD.
We identified 8 recipients (4 males and 4 females), range from 18 to 67 years
(mean age 45.6 years) with a median time between grafting and PTLD of 4.1 years
(0.1-7 years), who developed PTLD (1.3%). Only 1 patient received OKT3 and had
CMV disease, two of them (25%) had been treated with hight doses of
prednisolone, another was EBV seronegative, but the rest of them (50%) had no
risk factors. Two patients were diagnosed at autopsy, the diagnosis of 5 was
based on the histology of biopsy and the last one by CT scans of chest-abdomen
and cytology. The presence of EBV in the lymphoproliferative cells was assessed
in 5 out of the 7 studied patients (71.4%). The outcome of our recipients was
poor. Five out of 8 patients died shortly after diagnosis as a direct
consecuence of PTLD and another of an infectious complication of the treatment
(75%). The 2 patients alive started dialysis and 1 of them died 2 years later
of a non-related cause. In conclusion, PTLD is a relatively frequent disease
with a poor prognosis in renal transplant patients. It seems to have a close
relationship with EBV and can develop in the absence of the classical risk
factors. N. Ref:: 18
----------------------------------------------------
[69]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.2 Chronic graft dysfunction. Immunological factors
(alloimmunity).
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:8-11.
RESUMEN
/ SUMMARY: - GUIDELINE: All recipients of an allogeneic
kidney graft should take life-long maintenance immunosuppressive medication.
Whereas there is no immunological test to diagnose chronic allograft
dysfunction, circumstantial evidence suggests that immunological factors play
an important role in its pathogenesis. This evidence is based on experimental
data, the beneficial effect of sharing HLA antigens between donor and recipient
and post-transplantation immunological monitoring studies.
----------------------------------------------------
[70]
TÍTULO / TITLE: - Capillary C4d
deposition as a marker of humoral immunity in renal allograft rejection.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2002
Sep;13(9):2420-3.
AUTORES
/ AUTHORS: - Watschinger B; Pascual M N. Ref:: 38
----------------------------------------------------
[71]
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.
----------------------------------------------------
[72]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.1 Differential diagnosis of chronic graft
dysfunction.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:4-8.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Any significant
deterioration in graft function should be investigated using the appropriate
diagnostic tools and, if possible, therapeutic interventions should be
initiated. The usual causes of a decline in glomerular filtration rate after
the first year include transplant-specific causes such as chronic allograft
nephropathy, acute rejection episodes, chronic calcineurin inhibitor
nephrotoxicity, transplant renal artery stenosis and ureteric obstruction, as
well as immunodeficiency-related causes and non-transplant-related causes, such
as recurrent or de novo renal diseases and bacterial infections. B. Any new
onset and persistent proteinuria of >0.5 g/24 h should be investigated and
therapeutic interventions should be initiated. The usual causes include chronic
allograft nephropathy and transplant glomerulopathy, and recurrent or de novo
glomerulonephritis.
----------------------------------------------------
[73]
TÍTULO / TITLE: - Primary intestinal
posttransplant T-cell lymphoma.
REVISTA
/ JOURNAL: - Transplantation 2003 Jun 27;75(12):2131-2.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000060253.54333.F3
AUTORES
/ AUTHORS: - Michael J; Greenstein S; Schechner R;
Tellis V; Vasovic LV; Ratech H; Glicklich D
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Albert Einstein
College of Medicine, Montefiore Medical Center, Bronx, New York 10467, USA.
RESUMEN
/ SUMMARY: - There have been only five reported cases
of primary posttransplant T-cell lymphoma. We report the first case associated
with the use of sirolimus (Rapamycin, Wyeth-Ayerst, Philadelphia, PA). The
patient, receiving prednisone, cyclosporine, and sirolimus treatment, developed
ascites, diarrhea, and weight loss 7 months after his second renal transplant.
Tissue obtained at laparotomy established the diagnosis of primary T-cell
lymphoma. Latent membrane protein-1 for Epstein-Barr virus was negative, but
in-site hybridization test for Epstein-Barr-encoded RNA was positive. Despite
aggressive chemotherapy, the patient died 8 months posttransplant. This is the
sixth reported case of primary intestinal posttransplant T-cell lymphoma, but
it is the first case associated with the use of sirolimus. The incidence of
posttransplant lymphoproliferative disease in patients receiving sirolimus
should be studied. N.
Ref:: 6
----------------------------------------------------
[74]
- Castellano -
TÍTULO / TITLE:Alteraciones del metabolismo oseo
tras el trasplante renal. Bone metabolism alterations after kidney transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2003;23 Suppl 2:122-6.
AUTORES
/ AUTHORS: - Torres A; Garcia S; Barrios Y; Hernandez
D; Lorenzo V
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Unidad de
Investigacion, Hospital Universitario de Canarias, Instituto Reina Sofia de
Investigacion. atorres@ull.es
RESUMEN
/ SUMMARY: - Early after renal transplantation (RT) a
rapid decrease in bone mineral density at the lumbar spine, femoral neck, and
femoral shaft has been documented. In addition, an appreciable proportion of
patients still remain losing bone late after RT. As a consequence, RT patients
are at a high risk of bone fractures as compared to general population. Most
fractures involve appendicular skeleton, particularly the feet and ankles, and
the diabetic patient is at increased risk of fractures. Thus, early institution
of preventive measures and treatment of established osteoporosis are central.
The major cause of post-transplantation bone loss is corticosteroid treatment,
and this should be used at the lower dose compatible with graft survival.
Preexisting hyperparathyroidism also affects the early cancellous bone loss at
the spine, and post-transplantation bone loss reflects variable individual
susceptibility, resembling the polygenic determination of bone mineral density
in general. Clinical trials have demonstrated that bisphosphonates or vitamin D
plus calcium supplementation, prevent post-transplantation bone loss during the
first 6-12 months. However, their role in preventing bone fractures has not
been proven. Finally, recommendations for management, prevention and treatment,
are summarized. N.
Ref:: 24
----------------------------------------------------
[75]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.10. Pregnancy in renal transplant recipients.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:50-5.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Renal transplantation
restores fertility, and successful pregnancies have been reported in renal
transplant women. In women with normal graft function, pregnancy usually has no
adverse effect on graft function and survival. Therefore, women of childbearing
age who consider pregnancy should receive complete information and support from
the transplant team. B. Pregnancy could be considered safe about 2 years after
transplantation in women with good renal function, without proteinuria, without
arterial hypertension, with no evidence of ongoing rejection and with normal
allograft ultrasound. C. Pregnancy after transplantation should be considered a
high-risk pregnancy and should be monitored by both an obstetrician and the
transplant physician. Pregnancy should be diagnosed as early as possible. The
principal risks are infection, proteinuria, anaemia, arterial hypertension and
acute rejection for the mother, and prematurity and low birth weight for the
foetus. D. Pregnant women and transplanted patients are at increased risk of
infections, especially bacterial urinary tract infections and acute
pyelonephritis of the graft. Urine cultures should be performed monthly and all
asymptomatic infections should be treated. Monitoring of viral infections is
also recommended. (Evidence level B) E. Acute rejection episodes are uncommon
but may occur after delivery. Therefore, immunosuppression should be
re-adjusted immediately after delivery. F. Because pre-eclampsia develops in
30% of pregnant patients, especially those with prior arterial transplant hypertension,
blood pressure, renal function, proteinuria and weight should be monitored
every 2-4 weeks, with more attention during the third trimester.
Anti-hypertensive agents should be changed to those tolerated during pregnancy.
ACE inhibitors and angiotensin II receptor antagonists are absolutely
contra-indicated. G. Immunosuppressive therapy based on cyclosporine or
tacrolimus with or without steroids and azathioprine may be continued in renal
transplant women during pregnancy. Other drugs, such as mycophenolate mofetil
and sirolimus, are not recommended based on current information available.
Because of drug transfer into maternal milk, breastfeeding is not recommended.
H. Vaginal delivery is recommended, but caesarean section is required in at
least 50% of cases. Delivery should occur in a specialized centre. In the
puerperium, renal function, proteinuria, blood pressure,
cyclosporine/tacrolimus blood levels and fluid balance should be closely
monitored.
----------------------------------------------------
[76]
TÍTULO / TITLE: - Efficacy and toxicity
of a protocol using sirolimus, tacrolimus and daclizumab in a nonhuman primate
renal allotransplant model.
REVISTA
/ JOURNAL: - Am J Transplant 2002 Apr;2(4):381-5.
AUTORES
/ AUTHORS: - Montgomery SP; Mog SR; Xu H; Tadaki DK;
Hirshberg B; Berning JD; Leconte J; Harlan DM; Hale D; Kirk AD
INSTITUCIÓN
/ INSTITUTION: - NIDDK/Navy Transplantation and
Autoimmunity Branch, Naval Medical Research Center, Bethesda, Maryland 20892,
USA.
RESUMEN
/ SUMMARY: - A regimen combining sirolimus, tacrolimus,
and daclizumab has recently been shown to provide adequate immunosuppression
for allogeneic islet transplantation in humans, but remains unproven for
primarily vascularized allografts. We evaluated this regimen for renal allograft
transplantation in mismatched nonhuman primates. Dosages of sirolimus and
tacrolimus were adjusted for trough levels of 10-15 ng/mL and 4-6 ng/mL,
respectively. Treated monkeys (n = 5) had significantly prolonged allograft
survival, with a mean survival of 36 days vs. 7 days in untreated controls (n =
6, p = 0.008). Four of five treated animals, but none of the controls,
developed fibrinoid vascular necrosis of the small intestine. A review of gut
histology from animals on other immunosuppressive protocols performed by our
laboratory suggested that these lesions were a result of sirolimus exposure. In
summary, this regimen prolongs the survival of vascularized renal allografts,
but is limited by profound GI toxicity in rhesus macaques.
----------------------------------------------------
[77]
TÍTULO / TITLE: - Bone disease after
renal transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 May;18(5):874-7.
AUTORES
/ AUTHORS: - Sperschneider H; Stein G
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine IV,
Friedrich-Schiller-University, Jena, Germany. heide.sperschneider@kfh-dialyse.de N. Ref:: 36
----------------------------------------------------
[78]
TÍTULO / TITLE: - Does growth hormone
treatment affect the risk of post-transplant renal cancer?
REVISTA
/ JOURNAL: - Pediatr Nephrol 2002 Dec;17(12):984-9.
Epub 2002 Sep 11.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00467-002-0962-7
AUTORES
/ AUTHORS: - Mehls O; Wilton P; Lilien M; Berg U;
Broyer M; Rizzoni G; Waldherr R; Opelz G
RESUMEN
/ SUMMARY: - According to the analysis of the
Collaborative Transplant Study (CTS), the incidence of renal carcinoma in
patients with renal transplantation as well as with heart transplantation is
significantly increased at any given patient age. The cumulative incidence 10
years after kidney transplantation is 185 per 100,000 patients in children
below the age of 19 years at the time of transplantation. Age and
immunosuppressive treatment seem to be the major risk factors. The majority of
cancers develop within the native kidneys. Chronic transplant nephropathy and
accelerated senescence may be further risk factors for the development of
cancer within a kidney transplant. Growth hormone (GH) treatment could not be
identified as an additional risk factor.
N. Ref:: 26
----------------------------------------------------
[79]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.9.3. Haematological complications. Erythrocytosis.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:49-50.
RESUMEN
/ SUMMARY: - GUIDELINE: In the case of erythrocytosis,
the first-line treatment should be administration of ACE inhibitors or
angiotensin II receptor antagonists.
----------------------------------------------------
[80]
TÍTULO / TITLE: - Calcium channel
blockers as the treatment of choice for hypertension in renal transplant
recipients: fact or fiction.
REVISTA
/ JOURNAL: - Pharmacotherapy 2003 Jun;23(6):788-801.
AUTORES
/ AUTHORS: - Baroletti SA; Gabardi S; Magee CC; Milford
EL
INSTITUCIÓN
/ INSTITUTION: - Department of Pharmacy Services, Brigham
and Women’s Hospital, Boston, Massachusetts 02115, USA. Sbaroletti@partners.org
RESUMEN
/ SUMMARY: - Posttransplantation hypertension has been
identified as an independent risk factor for chronic allograft dysfunction and
loss. Based on available morbidity and mortality data, posttransplantation
hypertension must be identified and managed appropriately. During the past
decade, calcium channel blockers have been recommended by some as the
antihypertensive agents of choice in this population, because it was theorized
that their vasodilatory effects would counteract the vasoconstrictive effects
of the calcineurin inhibitors. With increasing data becoming available,
reexamining the use of traditional antihypertensive agents, including diuretics
and beta-blockers, or the newer agents, angiotensin-converting enzyme (ACE)
inhibitors and angiotensin II receptor blockers, may be beneficial. Transplant
clinicians must choose antihypertensive agents that will provide their patients
with maximum benefit, from both a renal and a cardiovascular perspective.
Beta-blockers, diuretics, and ACE inhibitors have all demonstrated significant
benefit on morbidity and mortality in patients with cardiovascular disease.
Calcium channel blockers have been shown to possess the ability to counteract
cyclosporine-induced nephrotoxicity. When compared with beta-blockers, diuretics,
and ACE inhibitors, however, the relative risk of cardiovascular events is
increased with calcium channel blockers. With the long-term benefits of calcium
channel blockers on the kidney unknown and a negative cardiovascular profile,
these agents are best reserved as adjunctive therapy to beta-blockers,
diuretics, and ACE inhibitors. N.
Ref:: 68
----------------------------------------------------
[81]
TÍTULO / TITLE: - Factors governing
cardiovascular risk in the patient with a failing renal transplant.
REVISTA
/ JOURNAL: - Perit Dial Int 2001;21 Suppl 3:S275-9.
AUTORES
/ AUTHORS: - Rigatto C; Parfrey P
INSTITUCIÓN
/ INSTITUTION: - Section of Nephrology, University of
Manitoba, St. Boniface General Hospital, Winnipeg, Canada. crigatto@sbgh.mb.ca
RESUMEN
/ SUMMARY: - Cardiomyopathy and IHD are important
morbid complications among renal transplant recipients. Age, diabetes, and sex
remain important markers of risk. Smoking, hyperlipidemia, and hypertension appear
to be the major reversible risk factors for IHD. Anemia and hypertension
predict CHF. Definitive evidence on optimal intervention is lacking.
Similarities in the renal transplant recipients to CRI patients with respect to
cardiomyopathy and to the general population with respect to IHD suggest that
extrapolation from those groups is reasonable in the interim. N. Ref:: 27
----------------------------------------------------
[82]
TÍTULO / TITLE: - Why study kidney
transplant risk factors?
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 15;75(3):266-7.
AUTORES
/ AUTHORS: - Matas AJ; Humar A
INSTITUCIÓN
/ INSTITUTION: - Medical School, University of Minnesota,
Minneapolis, MN, USA. N.
Ref:: 10
----------------------------------------------------
[83]
TÍTULO / TITLE: - The impact of
cytomegalovirus infections and acute rejection episodes on the development of
vascular changes in 6-month protocol biopsy specimens of cadaveric kidney
allograft recipients.
REVISTA
/ JOURNAL: - Transplantation 2003 Jun 15;75(11):1858-64.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000064709.20841.E1
AUTORES
/ AUTHORS: - Helantera I; Koskinen P; Tornroth T;
Loginov R; Gronhagen-Riska C; Lautenschlager I
INSTITUCIÓN
/ INSTITUTION: - Department of Virology, Helsinki
University Central Hospital and University of Helsinki, Helsinki, Finland.
RESUMEN
/ SUMMARY: - BACKGROUND: The role of cytomegalovirus
(CMV) in chronic kidney allograft rejection remains controversial. The purpose
of this study was to examine the impact of CMV infection on histopathologic
changes in 6-month protocol biopsy specimens of kidney allografts. METHODS:
Altogether, 52 renal allograft recipients were studied. CMV infection was
diagnosed by CMV antigenemia test, viral cultures from blood and urine, or
both. CMV was demonstrated in the biopsy specimens by antigen detection and
hybridization in situ. Acute rejections were diagnosed by biopsy histology, and
biopsy specimens were graded according to the Banff ‘97 classification.
RESULTS: CMV infection was diagnosed in 41 patients. The 11 patients in whom
CMV infection was not detected were used as controls. Acute rejection was
diagnosed in 22 of 41 CMV patients and in 6 of 11 control patients. CMV was
demonstrated in the biopsy specimens of 19 of 41 CMV patients. CMV was not
associated with increased glomerular, tubular, or interstitial changes.
However, the arteriosclerotic changes in small arterioles were significantly increased
in the subgroup of patients where CMV was demonstrated in the graft as compared
with controls (P<0.01). Analysis of the impact of acute rejection on
arteriolar thickening showed that only a positive history of both acute
rejection and CMV found in the graft was associated with significantly
increased vascular changes compared with CMV-free recipients (P<0.05).
CONCLUSIONS: Neither CMV nor acute rejection alone was associated with
increased vascular or other histopathologic changes in 6-month protocol biopsy
specimens of kidney allografts, but a previous history of both acute rejection
and the presence of CMV in the graft was associated with increased vascular
changes.
----------------------------------------------------
[84]
TÍTULO / TITLE: - Transplant
capillaropathy and transplant glomerulopathy: ultrastructural markers of
chronic renal allograft rejection.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Apr;18(4):655-60.
AUTORES
/ AUTHORS: - Ivanyi B
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, University of
Szeged, Szeged, Hungary. ivanyi@patho.szote.u-szeged.hu N. Ref:: 21
----------------------------------------------------
[85]
TÍTULO / TITLE: - Adenovirus
pyelonephritis in a pediatric renal transplant patient.
REVISTA
/ JOURNAL: - Pediatr Nephrol 2003 May;18(5):457-61.
Epub 2003 Mar 18.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00467-003-1080-x
AUTORES
/ AUTHORS: - Kim SS; Hicks J; Goldstein SL
INSTITUCIÓN
/ INSTITUTION: - Baylor College of Medicine, Texas, USA.
RESUMEN
/ SUMMARY: - Gross hematuria, graft pain, and rising
serum creatinine are classic signs of acute rejection, obstruction, or
bacterial pyelonephritis for patients with renal transplants. This presentation
often prompts percutaneous renal allograft biopsy. If subsequent evaluation
fails to show evidence of acute rejection, obstruction, or bacterial infection,
viral etiologies should be considered. We report a 14-year-old Hispanic female
with a living-related renal transplant who had gross hematuria, graft
tenderness, and increased serum creatinine, but did not have evidence of acute
rejection, obstruction, or bacterial pyelonephritis. To our knowledge, this is
the first report of adenovirus pyelonephritis in a transplanted kidney of a
pediatric patient, with isolation of adenovirus in the urine and in the
allograft using immunocytochemical techniques.
N. Ref:: 26
----------------------------------------------------
[86]
- Castellano -
TÍTULO / TITLE:Enfermedad coronaria en trasplante
renal. Coronary disease in renal transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22 Suppl 4:12-9.
AUTORES
/ AUTHORS: - Marcen R
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Hospital Ramon y
Cajal, Ctra. de Colmenar Viejo, km. 9,1 28034 Madrid. N. Ref:: 79
----------------------------------------------------
[87]
TÍTULO / TITLE: - Hepatitis C
virus-positive patients on the waiting list for transplantation.
REVISTA
/ JOURNAL: - Semin Nephrol 2002 Jul;22(4):361-4.
AUTORES
/ AUTHORS: - Campistol JM; Esforzado N; Morales JM
INSTITUCIÓN
/ INSTITUTION: - Renal Transplant Unit, Hospital Clinic,
University of Barcelona, Institut d’Investigacio Biomediques August Pi i Sunyer
(IDIBAPS), Barcelona, España. jmcampis@medicina.ub.es
RESUMEN
/ SUMMARY: - Hepatitis C virus (HCV) infection is a
common problem in renal transplant patients, associated with an increase in
morbidity and mortality. HCV infection is associated with a lower graft and
patient survival. The problem of HCV infection is the increase in viral load
and liver transaminases after renal transplantation secondary to
immunosuppressive therapy. After renal transplantation, interferon therapy is
not recommended because of the risk for acute rejection and acute nephritis. In
this context, it is absolutely necessary to consider the evaluation and
treatment of HCV infection during the dialysis period. Several studies have
defined the benefits of interferon therapy in dialysis patients, with rates of
maintenance response significantly higher than in the general population. The
difference in the pharmacokinetic profile of interferon in dialysis patients
could justify its higher efficacy. N.
Ref:: 17
----------------------------------------------------
[88]
TÍTULO / TITLE: - Obesity as a risk
factor in renal transplant patients.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001 Jan;16(1):14-7.
AUTORES
/ AUTHORS: - Pischon T; Sharma AM N. Ref:: 16
----------------------------------------------------
[89]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.5. Chronic graft dysfunction. Late recurrence of
primary glomerulonephritides.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:16-8.
RESUMEN
/ SUMMARY: - GUIDELINES: A. In the case of recurrent
focal and segmental glomerulosclerosis (FSGS), aggressive treatment with
high-dose cyclosporine in children, ACE inhibitors and/or Angiotensin II
antagonists, plasma exchange or immunoadsorption may result in remission in
some patients. B. In the case of recurrent membranous nephropathy (MN), there
is no specific treatment. However, control of risk factors, such as
hypertension, heavy proteinuria and hyperlipidaemia, and prevention of
thrombotic complications are recommended. C. In the case of recurrent
membranoproliferative glomerulonephritis (MPGN), there is no specific
treatment. However, control of risk factors, such as hypertension, heavy
proteinuria and hyperlipidaemia, and prevention of thrombotic complications are
recommended. D. In the case of recurrent IgA glomerulonephritis, use of
additional steroids is not yet a validated treatment. The control of risk
factors, such as hypertension, heavy proteinuria and hyperlipidaemia, is
recommended. E. In the rare case of recurrent anti-glomerular basement membrane
(anti-GBM) glomerulonephritis with reappearance of anti-GBM antibodies, it is
recommended to initiate plasma exchange and to treat with appropriate
immunosuppressive agents (e.g. cyclophosphamide).
----------------------------------------------------
[90]
TÍTULO / TITLE: - C4d and the fate of
organ allografts.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2002
Sep;13(9):2417-9.
AUTORES
/ AUTHORS: - Platt JL
N. Ref:: 16
----------------------------------------------------
[91]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.3 Chronic graft dysfunction. Non-alloimmune factors.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:11-5.
RESUMEN
/ SUMMARY: - GUIDELINES. A. Whereas immunological
mechanisms dominate in the initiation and propagation of the injury that leads
to chronic allograft dysfunction and nephropathy, there is circumstantial
evidence that non-immunological factors, such as advanced donor age,
hyperfiltration, overweight, delayed graft function, heavy proteinuria,
smoking, arterial hypertension, hypercholesterolaemia and
hypertriglyceridaemia, play a role as aggravating or progression factors. It is
recommended to prevent or, if possible, treat all these factors. B. As arterial
hypertension is very frequent among renal transplant patients and associated
with increased graft (and patient) loss, it is recommended to aim at a blood
pressure less than 130/85 mmHg in renal transplant patients and <125/75 mmHg
in recipients with proteinuria >1 g/day.
----------------------------------------------------
[92]
TÍTULO / TITLE: - Treatment of renal
transplant ureterovesical anastomotic strictures using antegrade balloon
dilation with or without holmium:YAG laser endoureterotomy.
REVISTA
/ JOURNAL: - Urology 2003 Nov;62(5):831-4.
AUTORES
/ AUTHORS: - Kristo B; Phelan MW; Gritsch HA; Schulam
PG
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, University of
California, Los Angeles, School of Medicine, Los Angeles, Medical Center, Los
Angeles, California 90095, USA.
RESUMEN
/ SUMMARY: - OBJECTIVES: To report our results after
antegrade endoscopic treatment of ureteral stenosis with balloon dilation with
or without holmium laser endoureterotomy. Ureteral stenosis is the most common
long-term urologic complication of renal transplantation. METHODS: From July
2000 to October 2002, 9 renal transplant patients with ureteral obstruction
diagnosed by an increase in serum creatinine and radiologic evidence presented
for endoscopic treatment. All patients were treated with nephrostomy tube
drainage followed by antegrade flexible nephroureteroscopy and balloon dilation
of the stricture. Three patients required holmium laser endoureterotomy during
the same procedure because of fluoroscopic and endoscopic evidence of
persistent stricture. All patients were treated with ureteral stents and
nephrostomy tubes postoperatively. The median follow-up was 24 months (range 6
to 32). RESULTS: The site of stenosis was at the ureterovesical anastomosis in
all patients, and the mean stricture length was 0.28 cm. Two patients had
previously undergone ureteroneocystostomy for prior ureteral stenosis. Six
patients (66%) required only balloon dilation, and 3 patients (33%) also
required holmium laser endoureterotomy. The median ureteral stent and
nephrostomy tube duration was 40 and 62 days, respectively. The mean serum
creatinine level was 2.3 mg/dL at presentation and 1.7 mg/dL at the last
follow-up visit. After a median follow-up of 24 months, the ureteral patency
and graft function rates were both 100%. No perioperative complications
occurred. CONCLUSIONS: Balloon dilation with or without holmium laser
endoureterotomy was successful and safe in this group of renal transplant
patients with short ureterovesical anastomotic strictures. N. Ref:: 19
----------------------------------------------------
[93]
TÍTULO / TITLE: - Hormone replacement
therapy in postmenopausal women with end-stage renal disease: a review of the
issues.
REVISTA
/ JOURNAL: - Semin Dial 2001 May-Jun;14(3):146-9.
AUTORES
/ AUTHORS: - Holley JL; Schmidt RJ
RESUMEN
/ SUMMARY: - Hormone replacement is an integral part of
therapies to prevent osteoporosis in postmenopausal women and may be considered
a component in the treatment of dyslipidemia, cardiovascular disease, and
possibly cognitive function. The indications for, and efficacy and prescription
of, hormone replacement therapy in postmenopausal women with ESRD have been
infrequently studied and less than 10% of postmenopausal women on dialysis are
receiving hormone replacement. Small studies suggest that hormone replacement
therapy is valuable in treating the dyslipidemia of women on dialysis, but
indicate that a reduction in the dosage of hormone replacement may be needed. A
potential role for hormone replacement therapy in the treatment and/or
prevention of osteoporosis and sexual dysfunction in postmenopausal women on
dialysis exists as well. N.
Ref:: 33
----------------------------------------------------
[94]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.9.1. Haematological complications. Anaemia.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:48-9.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Because anaemia is
relatively common after kidney transplantation, regular screening and careful
evaluation of its causes are recommended. In many cases, post-transplant
anaemia is caused by allograft dysfunction. The use of purine synthesis
inhibitors (azathioprine and MMF), ACE inhibitors and angiotensin II receptor
antagonists may frequently cause post-transplant anaemia. Anaemia is reversible
after withdrawing the offending agent. Haemolytic anaemia may develop in
transplant recipients. B. Treatment of anaemia should follow the European best
practice guidelines for treatment of anaemia in chronic renal failure.
----------------------------------------------------
[95]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.9.2. Haematological complications. Leukopenia.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:49.
RESUMEN
/ SUMMARY: - GUIDELINE: Because leukopenia is
relatively common after kidney transplantation, regular screening and careful
evaluation of its causes are recommended. Azathioprine and mycophenolate
mofetil may lead to leukopenia. The combination of allopurinol and azathioprine
should be avoided. Leukopenia is often associated with viral infections.
----------------------------------------------------
[96]
TÍTULO / TITLE: - Epstein-Barr
virus-associated pulmonary leiomyosarcoma arising twenty-nine years after renal
transplantation.
REVISTA
/ JOURNAL: - J Thorac Cardiovasc Surg 2003
Sep;126(3):877-9.
AUTORES
/ AUTHORS: - Ferri L; Fraser R; Gaboury L; Mulder D
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, McGill University
Health Centre, Montreal General Hospital, Room D10.168, 1650 Cedar Avenue,
Montreal, Quebec H3G 1A4, Canada. lferri@po-box.mcgill.ca N. Ref:: 5
----------------------------------------------------
[97]
TÍTULO / TITLE: - Cardiovascular disease
and the renal transplant recipient.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S36-43.
AUTORES
/ AUTHORS: - Kendrick E
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, University of
California—Los Angeles Medical Center, Los Angeles, CA 90095, USA. ekendrick@mednet.ucla.edu
RESUMEN
/ SUMMARY: - Cardiovascular complications contribute to
a significant proportion of the morbidity and mortality in renal transplant
patients. Underlying disease states such as diabetes and hypertension as well
as risk factors associated with chronic dialysis may cause many patients to
have established coronary artery and peripheral vascular disease at the time of
transplantation. Progression or new onset of disease can occur after
transplantation due to the continued presence of risk factors for
cardiovascular disease. The benefit of modification of these risk factors such
as hypertension and hyperlipidemia has been well established in the general
population and has more recently been explored in the renal transplant
population, although long-term studies documenting an improvement in morbidity
and mortality are not available. This article focuses on the potential benefit
of modification of risk factors in this setting. N. Ref:: 90
----------------------------------------------------
[98]
TÍTULO / TITLE: - Mechanisms and
consequences of arterial hypertension after renal transplantation.
REVISTA
/ JOURNAL: - Transplantation 2001 Sep 27;72(6
Suppl):S9-12.
AUTORES
/ AUTHORS: - Koomans HA; Ligtenberg G
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Hypertension,
University Hospital Utrecht, The Netherlands. h.a.koomans@digd.azu.nl
RESUMEN
/ SUMMARY: - The high incidence of hypertension after
renal transplantation contributes to the risk of cardiovascular morbidity and
mortality in renal transplant recipients. Although cyclosporine has been
influential in the improvement of transplant outcome, it has emerged as a major
cause of hypertension after organ transplantation. The underlying
pathophysiological mechanisms of cyclosporine-induced hypertension include
enhanced sympathetic nervous system activity, renal vasoconstriction, and
sodium/water retention. Hypertension is also significantly associated with reduced
graft survival and thereby requires aggressive treatment intervention. Calcium
channel blockers may offer some advantages over angiotensin-converting enzyme
inhibitors for the treatment of hypertension in stable renal transplant
recipients. Nevertheless, selection of the most appropriate antihypertensive
agent should take into account the possibility of pharmacokinetic interactions
with immunosuppressive agents. There is evidence to suggest that the use of
tacrolimus-based immunosuppression induces less hypertension compared with
cyclosporine. Not only do patients receiving tacrolimus tend to require less
antihypertensive therapy, but converting patients from cyclosporine to
tacrolimus has been shown to result in significant reductions in blood pressure.
Thus, tacrolimus may be associated with an improved cardiovascular risk profile
in renal transplant recipients. N.
Ref:: 26
----------------------------------------------------
[99]
TÍTULO / TITLE: - Apoptosis and
inflammation in renal reperfusion injury.
REVISTA
/ JOURNAL: - Transplantation 2002 Jun
15;73(11):1693-700.
AUTORES
/ AUTHORS: - Daemen MA; de Vries B; Buurman WA
INSTITUCIÓN
/ INSTITUTION: - Department of General Surgery, University
of Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands.
RESUMEN
/ SUMMARY: - Ischemia followed by reperfusion (I/R) has
cardinal implications in the pathogenesis of organ transplantation and
rejection. Apoptosis and inflammation are central mechanisms leading to organ
damage in the course of renal I/R. General aspects of apoptosis, morphology,
induction, and biochemistry are discussed. Activated caspases, the classical
effector enzymes of apoptosis, are able to induce not only apoptosis but also
inflammation after I/R in experimental models. This redefines the involvement
of apoptosis in I/R injury toward a central and functional role in the
development of organ damage. Our purpose is to assess aspects of apoptosis and
inflammation in terms of involvement in the pathogenesis of I/R-induced organ
damage. Moreover, the implications of recent experimental advances for
diagnosis and treatment of renal I/R injury in clinical practice will be
discussed. N. Ref:: 101
----------------------------------------------------
[100]
TÍTULO / TITLE: - Assessing cardiovascular
risk profile of immunosuppressive agents.
REVISTA
/ JOURNAL: - Transplantation 2001 Dec 27;72(12
Suppl):S81-8.
AUTORES
/ AUTHORS: - Jardine A
N. Ref:: 57
----------------------------------------------------
[101]
TÍTULO / TITLE: - Renal pathological
changes in Fabry disease.
REVISTA
/ JOURNAL: - J Inherit Metab Dis 2001;24 Suppl 2:66-70;
discussion 65.
AUTORES
/ AUTHORS: - Sessa A; Meroni M; Battini G; Maglio A;
Brambilla PL; Bertella M; Nebuloni M; Pallotti F; Giordano F; Bertagnolio B; Tosoni
A
INSTITUCIÓN
/ INSTITUTION: - Nefrologia e Dialisi, Ospedale di
Vimercate, Italia. adsess@tin.it
RESUMEN
/ SUMMARY: - Fabry disease is a rare X-linked disorder,
characterized by deficient activity of the lysosomal enzyme alpha-galactosidase
A. This leads to systemic accumulation of the glycosphingolipid
globotriaosylceramide (Gb3) in all body tissues and organs, including the
kidney. Renal manifestations are less evident in female heterozygotes than in
male hemizygotes, according to the Lyon hypothesis. Accumulation of Gb3 occurs
mainly in the epithelial cells of Henle’s loop and distal tubule, inducing
early impairment in renal concentrating ability; involvement of the proximal
tubule induces Fanconi syndrome. All types of glomerular cells are involved,
especially podocytes, and glomerular proteinuria may occur at a young age. The
evolution of renal Fabry disease is characterized by progressive deterioration
of renal function to end-stage renal failure (ESRF). Ultrastructural study of
kidney biopsies reveals typical bodies in the cytoplasm of all types of renal
cells, characterized by concentric lamellation of clear and dark layers with a
periodicity of 35-50 A. Management of progressive renal disease requires dietetic
and therapeutic strategies, usually indicated in developing chronic renal
failure, with dialysis and renal transplantation required for patients with
ESRF. The recent development of enzyme replacement therapy, however, should
make it possible to prevent or reverse the progressive renal dysfunction
associated with Fabry disease. N.
Ref:: 17
----------------------------------------------------
[102]
TÍTULO / TITLE: - The evolving role of
chemokines and their receptors in acute allograft rejection.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002 Aug;17(8):1374-9.
AUTORES
/ AUTHORS: - Inston NG; Cockwell P
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Renal
Transplantation, Queen Elizabeth Hospital, University Hospital Birmingham NHS
Trust, Birmingham, UK. N.
Ref:: 64
----------------------------------------------------
[103]
TÍTULO / TITLE: - A pilot protocol of a
calcineurin-inhibitor free regimen for kidney transplant recipients of marginal
donor kidneys or with delayed graft function.
REVISTA
/ JOURNAL: - Clin Transplant 2003;17 Suppl 9:31-4.
AUTORES
/ AUTHORS: - Shaffer D; Langone A; Nylander WA; Goral
S; Kizilisik AT; Helderman JH
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Vanderbilt
University Medical Center, Nashville, TN 37232, USA. david.schaffer@vanderbilt.edu
RESUMEN
/ SUMMARY: - The worsening shortage of cadaver donor
kidneys has prompted use of expanded or marginal donor kidneys (MDK), i.e.
older age or donor history of hypertension or diabetes. MDK may be especially
susceptible to calcineurin-inhibitor (CI) mediated vasoconstriction and nephrotoxicity.
Similarly, early use of CI in patients with delayed graft function may prolong
ischaemic injury. We developed a CI-free protocol of antibody induction,
sirolimus, mycophenolate mofetil, and prednisone in recipients with MDK or DGF.
METHODS: Adult renal transplant recipients who received MDK or had DGF were
treated with a CI-free protocol consisting of antibody induction (basiliximab
or thymoglobulin), sirolimus, mycophenolate mofetil, and prednisone. Serial
biopsies were performed for persistent DGF. Patients were followed
prospectively with the primary endpoints being patient and graft survival,
biopsy-proven acute rejection, and sirolimus-related toxicity. RESULTS:
Nineteen recipients were treated. Mean follow-up was 294 days. Actuarial 6- and
12-month patient survival was 100% and 100% and graft survival was 93% and 93%,
respectively. The only graft loss was due to primary non-function (PNF). The
incidence of AR was 16%. Mean serum creatinine at last follow-up was 1.6 mg/dL.
Sirolimus-related toxicity included lymphocele (1), wound infection (2),
thrombocytopenia (1). and interstitial pneumonitis (1). CONCLUSION: A CI-free
protocol with antibody induction and sirolimus results in low rates of AR and
PNF and excellent early patient and graft survival in patients with MDK and
DGF. CI-free protocols may allow expansion of the kidney donor pool by
encouraging utilization of MDK at high risk for DGF or CI-mediated
nephrotoxicity.
----------------------------------------------------
[104]
TÍTULO / TITLE: - De novo SLE after
cadaveric renal transplantation.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Sep;42(3):E24-7.
AUTORES
/ AUTHORS: - Laboi P; Dedi R; Campbell H; Hartley B;
Turney JH
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine and Histopathology,
Leeds General Infirmary, Leeds, United Kingdom. paullaboi396@hotmail.com
RESUMEN
/ SUMMARY: - De novo lupus nephritis in a renal
transplant recipient has not been previously reported. We present a transplant
recipient with long-standing insulin-dependent diabetes mellitus who presented
9 years posttransplant with hematoproteinuria and acute renal failure. New
findings of positive antinuclear antibody and double-stranded deoxyribonucleic
antibody and renal histology findings consistent with lupus nephritis suggest a
diagnosis of de novo systemic lupus erythematosis. N. Ref:: 8
----------------------------------------------------
[105]
TÍTULO / TITLE: - Chronic kidney disease
and the transplant recipient.
REVISTA
/ JOURNAL: - Blood Purif 2003;21(1):137-42.
AUTORES
/ AUTHORS: - Gill JS; Pereira BJ
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Tufts-New England
Medical Center, Boston, Mass 02111, USA.
RESUMEN
/ SUMMARY: - The recent Kidney Disease Outcomes Quality
Initiative (K/DOQI) classification of chronic kidney disease (CKD) includes
transplant recipients. Although there are important differences between kidney
transplant recipients (KTRs) and patients with native kidney disease, the
inclusion of KTRs along with other CKD patients is an important step to improve
long-term outcomes among transplant recipients. In this article we discuss the
applicability of the K/DOQI classification of CKD to transplant recipients and
the importance of premature patient death with graft function as a cause of
graft loss. The implementation of a comprehensive program of CKD care beginning
prior to transplantation and continuing after graft failure is discussed as a
strategy to improve patient outcomes and specific areas of concern for KTRs are
highlighted. N.
Ref:: 35
----------------------------------------------------
[106]
- Castellano -
TÍTULO / TITLE:Enfermedad cardiovascular en
transplante renal. Cardiovascular disease in kidney transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2001 Mar-Apr;21(2):104-14.
AUTORES
/ AUTHORS: - Marcen R; Pascual J N. Ref:: 143
----------------------------------------------------
[107]
TÍTULO / TITLE: - Extragonadal seminoma
after renal transplantation and immunosuppression; treatment in the presence of
renal dysfunction: a case report and literature review.
REVISTA
/ JOURNAL: - Med Oncol 2001;18(3):221-5.
AUTORES
/ AUTHORS: - Kosmas C; Tsavaris NB; Vadiaka M; Chiras
T; Boletis J; Kostakis A
INSTITUCIÓN
/ INSTITUTION: - Department of Pathophysiology, Athens
University School of Medicine, Laikon General Hospital, Greece. ckosm@ath.forthnet.gr
RESUMEN
/ SUMMARY: - A 37-yr-old man who had undergone renal
transplantation for end-stage renal failure presented with a large right pelvic
mass obstructing the transplanted kidney. Initially, this was diagnosed as an
anaplastic tumor while he had been on immunosuppressive treatment for kidney
allograft rejection after transplantation. Despite difficulties of classic
histopathology to reveal the origin of his tumor, FISH analysis revealed the
presence of chromosome 12p abnormalities, strongly indicative of a germ-cell
tumor-more likely seminoma-with extragonadal presentation. Because of renal
dysfunction, he was treated with carboplatin (dose adjusted according to renal
clearance) and etoposide, and when he experienced a rather atypical progression
with bone metastases, he was treated with single-agent paclitaxel, and died
almost 13 mo after initial presentation. The case adds further to the existing
small list of seminoma/GCTs developing in transplant recipients, points to the
unusual presentation patterns and diagnostic histopathology challenges, and
presents the difficulty in therapeutic options, as a result of frequent renal
dysfunction and intercurrent immunosuppressive therapy. All of these issues
together with an extensive literature review are discussed in detail.
----------------------------------------------------
[108]
TÍTULO / TITLE: - Non-malignant skin
changes in transplant patients.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002 Aug;17(8):1380-3.
AUTORES
/ AUTHORS: - Avermaete A; Altmeyer P; Bacharach-Buhles
M
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Ruhr-University
Bochum, Bochum, Germany. N.
Ref:: 7
----------------------------------------------------
[109]
- Castellano -
TÍTULO / TITLE:Trasplante renal en pacientes virus
de la hepatitis C positivos. Kidney transplantation in patients positive for
hepatitis C virus.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22 Suppl 5:62-6.
AUTORES
/ AUTHORS: - Campistol JM; Esforzado N; Morales JM;
Barrera JM
INSTITUCIÓN
/ INSTITUTION: - Unidad de Trasplante Renal, Hospital
Clinic, IDIBAPS (Institut d’Investigacio Biomedique Agusti Pi i Sunyer),
Universidad de Barcelona, Barcelona, Hospital 12 de Octubre, Madrid. N. Ref:: 11
----------------------------------------------------
[110]
TÍTULO / TITLE: - Posttransplant
erythrocytosis.
REVISTA
/ JOURNAL: - Kidney Int 2003 Apr;63(4):1187-94.
AUTORES
/ AUTHORS: - Vlahakos DV; Marathias KP; Agroyannis B;
Madias NE
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Aretaieion
University Hospital and Intensive Care Unit, Onassis Cardiac Surgery Center,
Athens, Greece. vlahakos@aretaieio.uoa.gr
RESUMEN
/ SUMMARY: - Posttransplant erythrocytosis (PTE) is
defined as a persistently elevated hematocrit to a level greater than 51% after
renal transplantation. It occurs in 10% to 15% of graft recipients and usually
develops 8 to 24 months after engraftment. Spontaneous remission of established
PTE is observed in one fourth of the patients within 2 years from onset,
whereas in the remaining three fourths it persists for several years, only to
remit after loss of renal function from rejection. Predisposing factors include
male gender, retention of native kidneys, smoking, transplant renal artery
stenosis, adequate erythropoiesis prior to transplantation, and rejection-free
course with well-functioning renal graft. Just as in other forms of
erythrocytosis, a substantial number (approximately 60%) of patients with PTE
experience malaise, headache, plethora, lethargy, and dizziness. Thromboembolic
events occur in 10% to 30% of the cases; 1% to 2% eventually die of associated
complications. Posttransplant erythrocytosis results from the combined trophic
effect of multiple and interrelated erythropoietic factors. Among them,
endogenous erythropoietin appears to play the central role. Persistent
erythropoietin secretion from the diseased and chronically ischemic native
kidneys does not conform to the normal feedback regulation, thereby establishing
a form of “tertiary hypererythropoietinemia.” However, erythropoietin levels in
most PTE patients still remain within the “normal range,” indicating that
erythrocytosis finally ensues by the contributory action of additional growth
factors on erythroid progenitors, such as angiotensin II, androgens, and
insulin-like growth factor 1 (IGF-1). Inactivation of the renin-angiotensin
system (RAS) by an angiotensin-converting enzyme (ACE) inhibitor, or an
angiotensin II type 1 AT1 receptor blocker represents the most effective, safe,
and well-tolerated therapeutic modality.
N. Ref:: 98
----------------------------------------------------
[111]
TÍTULO / TITLE: - HCV-associated renal
diseases after liver transplantation.
REVISTA
/ JOURNAL: - Int J Artif Organs 2003 Jun;26(6):452-60.
AUTORES
/ AUTHORS: - Fabrizi F; Aucella F; Lunghi G;
Bunnapradist S; Martin P
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and Dialysis,
Maggiore Hospital, IRCCS, Milano, Italy. fabrizi@policlinico.mi.it N. Ref:: 43
----------------------------------------------------
[112]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.12. Elderly (specific problems).
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:58-60.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Because renal
transplantation can extend the duration and quality of life in elderly patients
(age 60-70 years) with end-stage renal disease, transplantation should be
considered in all patients, particularly if special programmes and preparations
are applied. B. In elderly kidney transplant recipients, immunosuppression has
to be adapted to avoid both rejections and adverse effects. C. Accurate
diagnosis and aggressive treatment of cardiovascular disease in elderly
recipients are recommended because of the high number of deaths with functioning
grafts. D. The high risk of concomitant diseases, such as diabetes mellitus,
bone disease and malignancies, needs special consideration.
----------------------------------------------------
[113]
TÍTULO / TITLE: - Delayed renal allograft
dysfunction and cystitis associated with human polyomavirus (BK) infection in a
renal transplant recipient: a case report and review of literature.
REVISTA
/ JOURNAL: - Clin Nephrol 2003 Dec;60(6):405-14.
AUTORES
/ AUTHORS: - Gupta M; Miller F; Nord EP; Wadhwa NK
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Department of
Medicine, School of Medicine, State University of New York at Stony Brook, New
York 11794, USA.
RESUMEN
/ SUMMARY: - Human polyomavirus type BK (BKV)
associated nephritis (BKVAN) has recently emerged as an important cause of
renal allograft dysfunction and failure. Early recognition of this entity as a
cause of allograft dysfunction is extremely important since misdiagnosis can
accelerate graft loss. We report a case of BKVAN that presented with symptoms
related to cystitis, and review the risk factors, the diagnostic tools and the
approach to treatment of BK virus associated allograft nephropathy. N. Ref:: 32
----------------------------------------------------
[114]
TÍTULO / TITLE: - Early renal allograft
loss in a patient with crescentic glomerulonephritis in the native kidney.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Jan;37(1):202-209.
AUTORES
/ AUTHORS: - Gross M; Zand MS; Nadasdy T
INSTITUCIÓN
/ INSTITUTION: - Nephrology Unit, Department of Medicine,
University of Rochester Medical Center, Rochester, NY 14642, USA. N. Ref:: 29
----------------------------------------------------
[115]
TÍTULO / TITLE: - Post-transplant renal
tubulitis: the recruitment, differentiation and persistence of intra-epithelial
T cells.
REVISTA
/ JOURNAL: - Am J Transplant 2003 Jan;3(1):3-10.
AUTORES
/ AUTHORS: - Robertson H; Kirby JA
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, The Medical School,
University of Newcastle, Newcastle upon Tyne, UK.
RESUMEN
/ SUMMARY: - Tubulitis is used by the Banff protocol as
a major criterion to grade acute renal allograft rejection. This review
integrates results from in vitro and in vivo studies to develop a chronological
model to explain the development and functions of tubular inflammation during
the rejection process. Proteoglycan-immobilized chemokines are the primary
motivators for the vectorial recruitment of specific immune cell populations
from the blood, through the endothelium and interstitial tissues to the renal
tubules. After penetration of the basement membrane, T cells encounter TGF-beta
that can induce expression of the alphaEbeta7 integrin on proliferating cells.
This allows adhesion to E-cadherin on the baso-lateral surfaces of tubular epithelial
cells and provides an explanation for the epithelial-specific cytotoxicity
observed during acute rejection. Tubular epithelium is also a rich source of
IL-15 that can stimulate IL-15 receptor-expressing intratubular CD8+ T cells.
This anti-apoptotic microenvironment may explain the long-term persistence of
cycling T cells within intact tubules after episodes of acute rejection. These
memory-like T cells may have local immunoregulatory properties, including the
production of additional TGF-beta, but could also modify normal tubular
homeostasis resulting in epithelial to mesenchymal transdifferentiation,
tubulointerstitial fibrosis and, ultimately, graft failure. N. Ref:: 94
----------------------------------------------------
[116]
TÍTULO / TITLE: - Bisphosphonates in
dialysis and transplantation patients: efficacy and safety issues.
REVISTA
/ JOURNAL: - Perit Dial Int 2001;21 Suppl 3:S256-60.
AUTORES
/ AUTHORS: - Rodd C
INSTITUCIÓN
/ INSTITUTION: - Montreal Children’s Hospital, Quebec,
Canada. crodd@po-box.mcgill.ca
RESUMEN
/ SUMMARY: - Bisphosphonates are an old class of
compounds. They were used in the 1930s as antiscaling and anticorrosion agents
in washing powders and water to prevent the deposition of calcium crystals.
Those basic functions were later utilized in an attempt to prevent ectopic
calcifications in humans. The early studies demonstrated that bisphosphonates
had a strong affinity for bone. That property was first exploited when the compounds
were used for “bone scans.” Currently, the drugs are used for treatment of
hypercalcemic conditions, abnormal bone remodelling, Paget disease, malignancy,
and osteoporosis. Bisphosphonates have several important toxicities: acute
renal failure, worsening renal function, reduced bone mineralization, and
osteomalacia. For those reasons and others, this class of drugs has not yet
been approved for use in children or in patients with severe renal
insufficiency. The present review covers several aspects of bisphosphonates:
molecular structure, routes of administration, pharmacology, mechanisms of
action, toxicities, and exceptional uses in children with renal disease. N. Ref:: 18
----------------------------------------------------
[117]
TÍTULO / TITLE: - Long-term care of
pediatric renal transplant patients: from bench to bedside.
REVISTA
/ JOURNAL: - Curr Opin Pediatr 2002 Apr;14(2):205-10.
AUTORES
/ AUTHORS: - Samsonov D; Briscoe DM
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Department of
Medicine, Children’s Hospital and Harvard Medical School, Boston, Massachusetts
02115, USA.
RESUMEN
/ SUMMARY: - In this review, we discuss current and
future issues in the management of pediatric renal transplant recipients,
including the optimization of long-term graft function and the minimization of
complications caused by immunosuppression. Long-term management involves not
only the monitoring of graft function but also the identification of patients
at risk for the development of complications. The identification of patients
with immunoreactive or immunoregulatory responses can be performed molecular
monitoring of the immune response. Also, the use of frequent surveillance
kidney biopsies, surrogate markers of chronic rejection, and glomerular filtration
rate will be a part of future management. Identifying high-risk patients
enables the physician to optimize immunosuppression to limit acute rejection.
Short-and long-term management of pediatric transplant patients also includes
adequate monitoring of growth and the monitoring for post-transplant
lymphoproliferative disease. Ongoing clinical trials are underway that focus on
these novel approaches in caring for pediatric transplant recipients. N. Ref:: 41
----------------------------------------------------
[118]
- Castellano -
TÍTULO / TITLE:Aplicaciones de la biologia
molecular en el trasplante renal. Applications of molecular biology to renal
transplant.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2003;23(1):15-26.
AUTORES
/ AUTHORS: - Lario S; Bescos M; Campistol JM
INSTITUCIÓN
/ INSTITUTION: - Unidad de Trasplante Renal, Hospital
Clinic, de Barcelona Villarroel, 170 08036 Barcelona. jmcampis@medicina.ub.es N. Ref:: 35
----------------------------------------------------
[119]
TÍTULO / TITLE: - Intravascular volume
replacement therapy with synthetic colloids: is there an influence on renal
function?
REVISTA
/ JOURNAL: - Anesth Analg 2003 Feb;96(2):376-82, table
of contents.
AUTORES
/ AUTHORS: - Boldt J; Priebe HJ
INSTITUCIÓN
/ INSTITUTION: - Department of Anesthesiology and Intensive
Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany. Boldtj@gmx.net N. Ref:: 51
----------------------------------------------------
[120]
TÍTULO / TITLE: - Exploring treatment options
in renal transplantation: the problems of chronic allograft dysfunction and
drug-related nephrotoxicity.
REVISTA
/ JOURNAL: - Transplantation 2001 Jun 15;71(11
Suppl):SS42-51.
AUTORES
/ AUTHORS: - Campistol JM; Grinyo JM
INSTITUCIÓN
/ INSTITUTION: - University of Barcelona, España.
RESUMEN
/ SUMMARY: - The immunosuppressive benefits of
cyclosporine and tacrolimus in short-term and medium-term renal allograft
survival are well documented. It is becoming increasingly clear that the basis
of this immunosuppression, the inhibition of calcineurin, may be linked with
nephrotoxicity, hypertension, hyperlipidemia, and new-onset diabetes mellitus,
side effects that may lead to CRAD, death due to CVD, and late renal allograft
loss. This clinical picture presents a clear need for new strategies that
produce adequate immunosuppression to prevent acute rejection while
simultaneously reducing the side effects associated with CNI-related therapies.
Sirolimus combined with cyclosporine and tacrolimus has demonstrated an ability
to reduce incidences of early acute rejection and, used as base therapy, has
provided protection against acute rejection equivalent to that of cyclosporine,
without the consequent nephrotoxicity associated with CNIs. In preliminary
results from an ongoing clinical trial, sirolimus has been used to eliminate
cyclosporine during maintenance immunosuppression, with subsequent improvements
in measures of blood pressure and renal function. In addition, the
antiproliferative properties of sirolimus and its ability to prevent graft
vascular disease in animal studies make sirolimus a promising agent to decrease
incidences of CRAD and improve long-term renal allograft survival. These
findings point to a clear need to further explore both the efficacy of
sirolimus immunotherapy and its long-term effects. N. Ref:: 126
----------------------------------------------------
[121]
TÍTULO / TITLE: - Resolution of oral
non-Hodgkin’s lymphoma by reduction of immunosuppressive therapy in a renal
allograft recipient: a case report and review of the literature.
REVISTA
/ JOURNAL: - Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2002 Dec;94(6):697-701.
●●
Enlace al texto completo (gratuito o de pago) 1067/moe.2002.126889
AUTORES
/ AUTHORS: - Keogh PV; Fisher V; Flint SR
INSTITUCIÓN
/ INSTITUTION: - Department of Oral Surgery, Oral Medicine
and Oral Pathology, Dublin Dental School and Hospital, Trinity College,
Ireland. pakeogh@dental.tcd.ie
RESUMEN
/ SUMMARY: - A case of oral non-Hodgkin’s lymphoma
arising in a patient with insulin-dependent diabetes who had undergone renal
allograft transplantation is described. The resolution of the disease was
achieved by a reduction in her immunosuppressive therapy. The differential
diagnosis is discussed, and the management of posttransplantation lymphoproliferative
disorders is reviewed. N.
Ref:: 40
----------------------------------------------------
[122]
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
----------------------------------------------------
[123]
TÍTULO / TITLE: - Disseminated
acanthamebiasis in a renal transplant recipient with osteomyelitis and
cutaneous lesions: case report and literature review.
REVISTA
/ JOURNAL: - Clin Infect Dis 2002 Sep 1;35(5):e43-9.
Epub 2002 Aug 2.
AUTORES
/ AUTHORS: - Steinberg JP; Galindo RL; Kraus ES; Ghanem
KG
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, Johns Hopkins
Medical Institutions, Baltimore, MD 21209, USA.
RESUMEN
/ SUMMARY: - Disseminated acanthamebiasis is a rare
disease that occurs predominantly in patients with human immunodeficiency virus
(HIV) infection or acquired immunodeficiency syndrome but also in
immunosuppressed transplant recipients. Few reports have focused on
non-HIV-infected patients, in whom the disease is more likely to go unsuspected
and undiagnosed before death. We describe a renal transplant recipient with
Acanthamoeba infection and review the literature. The patient presented with
osteomyelitis and widespread cutaneous lesions. No causative organism was
identified before death, despite multiple biopsies with detailed histological
analysis and culture. Disseminated Acanthamoeba infection was diagnosed after
death, when cysts were observed in histological examination of sections of skin
from autopsy, and trophozoites were found in retrospectively reviewed skin
biopsy and surgical bone specimens. In any immunosuppressed patient, skin
and/or bone lesions that fail to show improvement with broad-spectrum
antibiotic therapy should raise the suspicion for disseminated acanthamebiasis.
Early recognition and treatment may improve clinical outcomes. N. Ref:: 32
----------------------------------------------------
[124]
TÍTULO / TITLE: - Histological evaluation
of renal allograft protocol biopsies in the early period and 1 year after
transplantation.
REVISTA
/ JOURNAL: - Clin Transplant 2003;17 Suppl 10:25-9.
AUTORES
/ AUTHORS: - Kanetsuna Y; Yamaguchi Y; Toma H; Tanabe K
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical Pathology, Jikei
University, Kashiwa Hospital, Japan.
RESUMEN
/ SUMMARY: - We histologically evaluated protocol
biopsy specimens of renal allografts obtained in the early period and 1 year
after transplantation. The patients were divided into those with at least one
history of acute rejection (AR group) and no history of rejection (NAR group),
and the histopathological features in the two groups were compared. A total of
45 early protocol biopsy specimens were obtained from 40 patients, and 31
1-year biopsy specimens were obtained from 30 patients. Acute rejection (AR) or
borderline change was observed in the early protocol biopsy specimens from 19
(45.2%) cases. AR or borderline change was observed in 12 of 19 (63.2%) in the
AR group, and in 7/26 cases (26.9%) in the NAR group. The incidence of AR or
borderline change in the AR group was higher than in the NAR group. Toxic
tubulopathy was found in the early protocol biopsy in 16 cases (35.6%). The
1-year biopsies tended to reveal more complicated findings. Chronic rejection
(CR) was seen in 8/16 cases (50.0%) in the AR group, and it was more frequent
than NAR group (two cases, 13.3%). In conclusion, the incidences of both AR and
CR were higher in the cases with a previous episode of AR. The early protocol
biopsy was useful in screening for subclinical AR and toxic tubulopathy. The
1-year biopsy was useful for evaluating various types of chronic graft damage.
We expect that adequate treatment based on protocol biopsy findings in each
patient will lead to better graft survival.
----------------------------------------------------
[125]
TÍTULO / TITLE: - Genetic variability and
transplantation.
REVISTA
/ JOURNAL: - Curr Opin Urol 2003 Mar;13(2):81-9.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mou.0000058635.64616.41
AUTORES
/ AUTHORS: - Marder B; Schroppel B; Murphy B
INSTITUCIÓN
/ INSTITUTION: - Mount Sinai School of Medicine, New York,
USA.
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: The purpose of this
review is to summarize recent advances within the area of genetic polymorphisms
with a specific emphasis on renal transplantation, and to discuss the potential
clinical applications. RECENT FINDINGS: Due to recent advances in molecular
techniques, there has been an abundance of publications describing genetic
variability in molecules relevant to transplant outcome. Many studies are now
demonstrating associations between polymorphisms in these candidate genes and
outcomes in organ transplantation. SUMMARY: These studies emphasize the
potential role of genetic variability in transplantation, and provide the
rationale for large prospective studies to clearly define the potential
benefits of genotyping in the risk stratification of transplant
recipients. N. Ref:: 91
----------------------------------------------------
[126]
TÍTULO / TITLE: - Hyperlipidemia: a risk
factor for chronic allograft dysfunction.
REVISTA
/ JOURNAL: - Kidney Int Suppl 2002 May;(80):73-7.
AUTORES
/ AUTHORS: - Castello IB
INSTITUCIÓN
/ INSTITUTION: - Department of Nephology and Renal
Transplantation, Hospital La Fe, Valencia, España. jorjav@ono.com
RESUMEN
/ SUMMARY: - While the early results of renal
transplantation have improved in the last years, but the long-term allograft
survival have not improved to the same extent. The major cause of these graft losses
is chronic allograft dysfunction (CAD). The pathogenesis of CAD is complex and
results from a interaction of immune and nonimmune factors. Between these
non-immunological related factors there are two cardiovascular risk factors,
hypertension and especially hyperlipidemia, that have been implicated in the
development and progression of CAD. Lipid profile abnormalities are very
prevalent in renal transplant patients. In last years several authors have
reported an association between different lipid profile alterations and CAD. We
conducted an observational study in our group to determine the relationship
between different lipid disturbances and CAD. The hypertriglyceridemia and the
Lp(a)>30 mg/dL before and after transplantation were, between the lipid
abnormalities, the two independent risk factors for CAD in a multivarite
analysis. N. Ref:: 43
----------------------------------------------------
[127]
TÍTULO / TITLE: - Identifying and
addressing potentially preventable causes of renal allograft loss.
REVISTA
/ JOURNAL: - Kidney Int 2002 Aug;62(2):718-9.
AUTORES
/ AUTHORS: - Langone AJ; Helderman JH N. Ref:: 9
----------------------------------------------------
[128]
TÍTULO / TITLE: - Rejection rate in
living donor kidney transplantation with and without basiliximab in
tacrolimus/mycophenolate mofetil-based protocol.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Mar;35(2):653-4.
AUTORES
/ AUTHORS: - Rahamimov R; Yussim A; After T; Lustig S;
Bar-Nathan N; Shaharabani E; Shapira Z; Shabthai E; Mor E
INSTITUCIÓN
/ INSTITUTION: - Department of Transplantation, Rabin
Medical Center, Beilinson Campus, Petah-Tiqwa, Israel. rutir@clalit.org.il
----------------------------------------------------
[129]
TÍTULO / TITLE: - B19 virus infection in
renal transplant recipients.
REVISTA
/ JOURNAL: - J Clin Virol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.elsevier.com/gej-ng/29/46/32/show/Products/VIRUSINT/index.htt
●●
Cita: J Clinical Virology: <> 2003 Apr;26(3):361-8.
AUTORES
/ AUTHORS: - Cavallo R; Merlino C; Re D; Bollero C;
Bergallo M; Lembo D; Musso T; Leonardi G; Segoloni GP; Ponzi AN
INSTITUCIÓN
/ INSTITUTION: - Virology Unit, Department of Public Health
and Microbiology, University of Turin, Via Santena 9, 10126, Turin, Italy. rossana.cavallo@unito.it
RESUMEN
/ SUMMARY: - BACKGROUND: B19 virus infection with
persistent anaemia has been reported in organ transplant recipients. Detection
of B19 virus DNA in serum is the best direct marker of active infection.
OBJECTIVE: The present study evaluated the incidence and clinical role of
active B19 virus infection in renal transplant recipients presenting with
anaemia. STUDY DESIGN: Forty-eight such recipients were investigated by nested
PCR on serum samples. The controls were 21 recipients without anaemia. Active
HCMV infection was also investigated as a marker of high immunosuppression.
RESULTS AND CONCLUSIONS: In 11/48 (23%) patients B19 virus DNA was demonstrated
in serum versus only 1/21 (5%) of the controls. Ten of these 11 patients had
already been seropositive at transplantation and active infection occurred in
eight of them during the first 3 months after transplantation. The remaining
patient experienced a primary infection 9 months after transplantation. Eight
(73%) of these 11 patients displayed a concomitant HCMV infection and four
(36%) showed increasing serum creatinine levels but none developed
glomerulopathy; 3/11 (27%) recovered spontaneously from anaemia whereas 8/11
(73%) needed therapy. In conclusion, the relatively high occurrence (23%) of
B19 virus infection in patients presenting with anaemia, suggests that it
should be considered in the differential diagnosis of persistent anaemia in
renal transplant recipients. Presence of the viral DNA should be assessed early
from transplantation and the viral load should be monitored to follow
persistent infection and better understand the relation between active
infection and occurrence of anaemia, and to assess the efficacy of IVIG therapy
and/or immunosuppression reduction in clearing the virus. N. Ref:: 56
----------------------------------------------------
[130]
TÍTULO / TITLE: - Utility of intravenous
immune globulin in kidney transplantation: efficacy, safety, and cost
implications.
REVISTA
/ JOURNAL: - Am J Transplant 2003 Jun;3(6):653-64.
AUTORES
/ AUTHORS: - Jordan S; Cunningham-Rundles C; McEwan R
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatric Nephrology &
Transplant Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. sjordan@cshs.org
RESUMEN
/ SUMMARY: - Intravenous immunoglobulin preparations
(IVIG) are known to be effective in the treatment of various autoimmune and
inflammatory disorders into their immunomodulatory, immunoregulatory, and
anti-inflammatory properties. Recently, IVIG has been utilized in the
management of highly sensitized patients awaiting renal transplantation. The
mechanisms of suppression of panel reactive antibodies (PRA) in patients
awaiting transplantation are currently under investigation and appear to be
related to anti-idiotypic antibodies present in IVIG preparations. In this
review, the various immunomodulatory mechanisms attributable to IVIG and their
efficacy in reducing PRAs will be described. In addition, the use of IVIG in
solid organ transplant recipients will be reviewed. The adverse events, safety
considerations, and economic impact of IVIG protocols for patients awaiting
solid organ transplantation will be discussed.
N. Ref:: 67
----------------------------------------------------
[131]
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.
----------------------------------------------------
[132]
TÍTULO / TITLE: - The effect of locally
synthesised complement on acute renal allograft rejection.
REVISTA
/ JOURNAL: - J Mol Med 2003 Jul;81(7):404-10. Epub 2003
Jun 25.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00109-003-0454-7
AUTORES
/ AUTHORS: - Sacks S; Zhou W
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and
Transplantation, Guy’s Hospital, King’s College London, University of London,
London, SE1 9RT, UK. steven.sacks@kcl.ac.uk
RESUMEN
/ SUMMARY: - The complement system of components and
receptors is one of the earliest forms of defence. Excessive or inappropriate
activation can result in tissue damage, classically illustrated in
immune-mediated nephritis. In addition, complement forms a bridge between
innate and adaptive immunity, helping to prepare and focus T and B lymphocyte
responses. More recent research in renal allograft models has shown that
complement-inhibited and complement-deficient animals have reduced inflammatory
injury and lowered antidonor immune responses. Furthermore, it is known that
the transplanted kidney is a significant site of local synthesis of C3,
although until recently the relative contribution of locally produced C3 to
transplant injury was unknown. Current evidence indicates that defective local
synthesis of C3 both reduces tissue injury and lowers the antidonor T cell
response, substantially increasing graft survival. Among various possible
explanations to account for these findings, the data favours a direct effect of
complement on alloreactive T cell stimulation. Study of complement gene
regulation by common immunosuppressive agents suggests that they do not
influence local complement synthesis. Alternative approaches are therefore
required to control the local effect of complement in the extravascular tissue
compartment of the graft. N.
Ref:: 88
----------------------------------------------------
[133]
TÍTULO / TITLE: - Renal problems after
lung transplantation of cystic fibrosis patients.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001 Jul;16(7):1324-8.
AUTORES
/ AUTHORS: - Schindler R; Radke C; Paul K; Frei U
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Internal
Intensive Care Medicine, Universitatsklinikum Charite, Campus Virchow Klinikum,
Berlin, Germany. N.
Ref:: 24
----------------------------------------------------
[134]
TÍTULO / TITLE: - Eradication of
parvovirus B19 infection after renal transplantation requires reduction of
immunosuppression and high-dose immunoglobulin therapy.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002 Oct;17(10):1840-2.
AUTORES
/ AUTHORS: - Liefeldt L; Buhl M; Schweickert B; Engelmann
E; Sezer O; Laschinski P; Preuschof L; Neumayer HH
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Charite,
Humboldt-University Berlin, Germany. lutz.liefeldt@charite.de N. Ref:: 17
----------------------------------------------------
[135]
TÍTULO / TITLE: - Skin cancers after
transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Jun;18(6):1052-8.
AUTORES
/ AUTHORS: - Dreno B
INSTITUCIÓN
/ INSTITUTION: - Centre Hospitalier Universitaire, Clinique
Dermatologique, Nantes, France. bdreno@wanadoo.fr N. Ref:: 32
----------------------------------------------------
[136]
TÍTULO / TITLE: - Limited dose monoclonal
IL-2R antibody induction protocol after primary kidney transplantation.
REVISTA
/ JOURNAL: - Am J Transplant 2002 Jul;2(6):568-73.
AUTORES
/ AUTHORS: - Ahsan N; Holman MJ; Jarowenko MV; Razzaque
MS; Yang HC
INSTITUCIÓN
/ INSTITUTION: - Nephrology and Transplant Division,
University of Medicine and Dentistry of New Jersey, New Brunswick 08904, USA. ahsanna@umdnj.edu
RESUMEN
/ SUMMARY: - This study prospectively compared
immunoprophylaxis with a single intraoperative dose (2 mg/kg) of monoclonal
interleukin-2 receptor (IL-2R) antibody vs. noninduction in kidney transplant
recipients treated with tacrolimus (FK 506), mycophenolate mofetil (MMF) and a
prednisone-based immunosuppression regimen. One hundred recipients of first-kidney
transplant were enrolled into the study to receive either anti-IL-2R monoclonal
antibody, daclizumab (2 mg/kg intraoperatively, limited anti-IL-2R) or no
induction (control). Each patient also received oral tacrolimus (dosed to
target trough level 10-15 ng/mL), MMF (500 mg bid) and prednisone. The primary
efficacy end-point was the incidence of biopsy proven acute rejection during
the first 6 months post-transplant. The patients were also followed for
12-month graft function, and graft and patient survival rates. Other than the
donor’s age being significantly lower in the control group, both groups were
comparable with respect to age, weight, gender, race, human leukocyte antigen
(HLA)-DR mismatch, panel reactive antibody (%PRA), cold ischemic time, cytomegalovirus
(CMV) status, causes of renal failure, and duration and modes of renal
replacement therapy (RRT). During the first 6 months, episodes of first biopsy
confirmed acute rejection was 3/50 (6%) in the limited anti-IL-2R group and
8/50 (16%) in the controls (p < 0.05). Twelve-month patient 100/98 (%) and
graft survival 100/96 (%) were not statistically different. The group receiving
limited anti-IL-2R did not have any adverse reactions. Our study demonstrates
that a limited (single) 2 mg/kg immunoprophylaxis dose with monoclonal IL-2R
antibody (daclizumab) when combined with tacrolimus/MMF/steroid allows
significant reduction in early renal allograft rejection to the single digit
level. The therapy with anti-IL-2R antibody is simple and is well tolerated.
----------------------------------------------------
[137]
TÍTULO / TITLE: - Preimplantation renal
biopsy: structure does predict function.
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 15;75(3):264-6.
AUTORES
/ AUTHORS: - D’Agati VD; Cohen DJ
INSTITUCIÓN
/ INSTITUTION: - Columbia University College of Physicians
and Surgeons, New York, NY, USA. N.
Ref:: 11
----------------------------------------------------
[138]
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
----------------------------------------------------
[139]
TÍTULO / TITLE: - Safety and efficacy of
TOR inhibitors in pediatric renal transplant recipients.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Oct;38(4 Suppl
2):S22-8.
AUTORES
/ AUTHORS: - Ettenger RB; Grimm EM
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, Mattel
Children’s Hospital at UCLA, Los Angeles, CA 90095-1752, USA. Rettenger@mednet.ucla.edu
RESUMEN
/ SUMMARY: - Information about the pharmacokinetics,
safety, and efficacy of target of rapamycin (TOR) inhibitors, such as sirolimus
and everolimus, in pediatric renal transplant recipients is limited. In an
ascending single-dose pharmacokinetic study of sirolimus in pediatric dialysis patients,
no clinically significant association was observed between patient age and
absorption of sirolimus from the gastrointestinal tract. However, young
pediatric patients (5 to 11 years of age) exhibited significantly greater
apparent oral clearances, suggesting that pediatric patients require slightly
higher doses than do adults when adjusted for body weight or surface area.
Similarly, in studies performed in pediatric renal transplant recipients, the
half-life of sirolimus was shorter and the clearance was greater in younger
patients. On the other hand, in single-dose pharmacokinetic studies of
everolimus, the apparent clearance was reduced in pediatric renal transplant
recipients compared with clearance in adults. This reduced clearance was
attributed to a smaller apparent volume of distribution in pediatric patients,
rather than to a difference in terminal half-life. This suggested that,
although the adult 12-hour dosing interval was appropriate for pediatric
patients, they would require reduced dosing based on body size compared with
adults. In a large trial (N = 719) of sirolimus versus azathioprine in
combination with cyclosporine microemulsion and prednisone, 6 pediatric
patients (13 to 18 years of age) received sirolimus at 2 mg/d, 3 received sirolimus
at 5 mg/d, and 3 received azathioprine. Seven of the nine patients who received
sirolimus experienced no rejection episodes. Six infectious episodes occurred
in the 6 patients receiving sirolimus at 2 mg/d, 10 episodes occurred in the 3
patients receiving sirolimus at 5 mg/d, and 8 episodes occurred in the 3
patients receiving azathioprine. At 6 months after transplantation, renal
function was similar in all 3 groups, although there was a statistically
nonsignificant increase in the group receiving sirolimus at 5 mg/d. The mean
cholesterol and triglyceride levels were generally comparable in all 3 groups.
TOR inhibitors are promising agents for the prevention of graft rejection in
pediatric renal transplant recipients, but more pharmacokinetic data are
required to assess the optimal dosing regimens in this population. In addition,
further data are needed on the efficacy and safety of TOR inhibitors in
combination with other agents in pediatric transplantation recipients to best
assess the role of TOR inhibition in corticosteroid and/or calcineurin
inhibitor-sparing regimens. N.
Ref:: 13
----------------------------------------------------
[140]
TÍTULO / TITLE: - Management of urinary
tract infections and lymphocele in renal transplant recipients.
REVISTA
/ JOURNAL: - Clin Infect Dis 2001 Jul 1;33 Suppl
1:S53-7.
AUTORES
/ AUTHORS: - Munoz P
INSTITUCIÓN
/ INSTITUTION: - Clinical Microbiology and Infectious
Diseases Department, Hospital General Universitario Gregorio Maranon, Madrid,
España. pmunoz@micro.hggm.es
RESUMEN
/ SUMMARY: - The most frequent infectious complication
after renal transplantation is urinary tract infection. This article deals with
antimicrobial prophylaxis, treatment of early and relapsing urinary tract
infections, and management of asymptomatic bacteriuria in renal transplant
patients. The incidence of lymphocele after renal transplantation varies, and
its treatment is still controversial. Management options are discussed. N. Ref:: 64
----------------------------------------------------
[141]
TÍTULO / TITLE: - Vascular and cellular
mechanisms of chronic renal allograft dysfunction.
REVISTA
/ JOURNAL: - Transplantation 2001 Jun 15;71(11
Suppl):SS37-41.
AUTORES
/ AUTHORS: - Morris RE
INSTITUCIÓN
/ INSTITUTION: - Stanford University School of Medicine,
California, United States. N.
Ref:: 29
----------------------------------------------------
[142]
- Castellano -
TÍTULO / TITLE:Riesgo cardiovascular y dislipemia
postrasplante renal. Cardiovascular risk and dyslipidemia after renal
transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22 Suppl 4:20-6.
AUTORES
/ AUTHORS: - Guijarro C; Massu ZA
INSTITUCIÓN
/ INSTITUTION: - Servicio de Medicina Interna, Hospital de
Alcorcon, Ayda. Villaviciosa, s/n. 28922 Alcorcon, Madrid. N. Ref:: 26
----------------------------------------------------
[143]
TÍTULO / TITLE: - Coadministration of
digoxin with itraconazole in renal transplant recipients.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Feb;37(2):E18.
AUTORES
/ AUTHORS: - Mathis AS; Friedman GS
INSTITUCIÓN
/ INSTITUTION: - Department of Pharmacy Practice and
Administration, College of Pharmacy, Rutgers, The State University of New
Jersey, College of Pharmacy, Piscataway, NJ, USA. smathis@sbhcs.com
RESUMEN
/ SUMMARY: - Digoxin toxicity is a major public health
issue in the United States. Often this is due to drug interactions, and renal
transplant recipients are at particularly high risk for drug-drug interactions.
We present cases of 2 renal transplant recipients who received itraconazole and
digoxin concomitantly and experienced digoxin toxicity. We have also reviewed
the relevant literature to elicit the mechanisms, signs, and symptoms of
digoxin toxicity in the presence of itraconazole. When clinicians know the
potential drug-drug interactions that may lead to digoxin toxicity, the
mechanisms of interaction, the signs and symptoms of digoxin toxicity, and
appropriate monitoring, digoxin toxicity is largely preventable. N. Ref:: 48
----------------------------------------------------
[144]
TÍTULO / TITLE: -
Trimethoprim-sulfamethoxazole induced aseptic meningitis in a renal transplant
patient.
REVISTA
/ JOURNAL: - Clin Nephrol 2001 Jan;55(1):80-4.
AUTORES
/ AUTHORS: - Muller MP; Richardson DC; Walmsley SL
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, The Toronto
General Hospital, University Health Network, Ontario, Canada.
RESUMEN
/ SUMMARY: - A 45-year-old man underwent renal
transplant for end-stage renal disease complicating systemic lupus erythematosis.
Within 24 hours of initiating Pneumocystis carinii pneumonia (PCP) prophylaxis
with trimethoprim-sulfamethoxazole (TMP-SMX) he developed fever and confusion.
Cerebrospinal fluid examination revealed a pleocytosis but cultures were
negative. The patient improved within three days after cessation of the TMP-SMX
but symptoms recurred rapidly upon drug rechallenge. Drug-induced aseptic
meningitis is an uncommon but well described clinical entity. This is the first
case described in a patient following renal transplantation. The literature is
reviewed and the clinical features, diagnostic challenges and possible
mechanisms of TMP-SMX-induced aseptic meningitis are discussed. This problem
may be more common in the transplant population than is recognized given the
difficulty of diagnosis combined with the widespread use of TMP-SMX as PCP
prophylaxis. N.
Ref:: 20
----------------------------------------------------
[145]
TÍTULO / TITLE: - Durable and high rates
of remission following chemotherapy in posttransplantation lymphoproliferative
disorders after renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Feb;35(1):256-7.
AUTORES
/ AUTHORS: - Gill D; Juffs HG; Herzig KA; Brown AM;
Hawley CM; Cobcroft RG; Petrie JJ; Marlton P; Kennedy G; Thomson DB; Campbell
SB; Nicol DL; Norris D; Johnson DW
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, Mater
Misericordiae Hospital, Brisbane, Australia.
N. Ref:: 18
----------------------------------------------------
[146]
TÍTULO / TITLE: - Hepatobiliary diseases
after kidney transplantation unrelated to classic hepatitis virus.
REVISTA
/ JOURNAL: - Semin Dial 2002 Sep-Oct;15(5):358-65.
AUTORES
/ AUTHORS: - Ahsan N; Rao KV
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and Transplatation,
Department of Medicine, University of Medicine and Dentistry of New Jersey,
Robert Wood Johnson Medical School, New Brunswick, USA. ahsanna@umdnj.edu
RESUMEN
/ SUMMARY: - Multiple studies during the past decades have
identified chronic liver disease as an important cause of morbidity and
mortality in kidney transplant recipients. It has been reported that up to 25%
of patients will have some degree of abnormal liver functions during the
immediate posttransplant period. In these patients, liver failure has been
implicated as the cause of death in approximately 30% of the long-term
survivors. While infections from hepatitis virus remain the main cause of
ongoing liver damage, many other opportunistic infections with various
potential to alter liver function have also been identified. In addition,
posttransplant patients are also exposed to hepatotoxic adverse effects of many
pharmacotherapeutics including immunosuppressive and nonimmunosuppressive
agents. Since there are numerous reports dealing with classic viral hepatitis
after kidney transplantation, this review primarily focuses on post-kidney
transplant liver diseases which are not due to classic hepatitis viruses. N. Ref:: 59
----------------------------------------------------
[147]
TÍTULO / TITLE: - Glycogen storage
disease type I: indications for liver and/or kidney transplantation.
REVISTA
/ JOURNAL: - Eur J Pediatr 2002 Oct;161 Suppl 1:S53-5.
Epub 2002 Jul 19.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00431-002-1004-y
AUTORES
/ AUTHORS: - Labrune P
INSTITUCIÓN
/ INSTITUTION: - Service de Pediatrie et Consultation de
Genetique, Hopital Antoine Beclere (AP-HP), BP 405, 92141 Clamart cedex,
France. philippe.labrune@abc.ap-hop-paris.fr
RESUMEN
/ SUMMARY: - Even though significant progress has been
achieved in the management of patients with glycogen storage disease type I,
hepatic (mainly adenomas) and renal (proteinuria, renal failure) complications
may still develop. Orthotopic liver transplantation has been reported in less
than 20 patients, and, in most cases, its indications were multiple hepatic
adenomas, sometimes combined with poor metabolic control and/or growth
retardation. Even though short-term outcome seems to be favourable, long-term
complications have been reported in several cases. Thus it appears that
improved metabolic control has to be attempted before performing liver
transplantation in such patients. As for renal transplantation, it has been
performed in patients with terminal renal failure. It is hoped that improving
long-term metabolic control will prevent renal involvement from evolving to
terminal renal failure. Finally, combined liver and kidney transplantation may
be indicated in a few patients. CONCLUSION: organ (liver/kidney)
transplantation in glycogen storage disease type I may be advantageous when long-term
metabolic control has been attempted. Nevertheless, post-transplantat long-term
complications may still develop. N.
Ref:: 24
----------------------------------------------------
[148]
TÍTULO / TITLE: - New strategies to
reduce nephrotoxicity.
REVISTA
/ JOURNAL: - Transplantation 2001 Dec 27;72(12
Suppl):S99-104.
AUTORES
/ AUTHORS: - Kreis H
RESUMEN
/ SUMMARY: - Since the introduction of cyclosporine,
CNIs have formed the basis of immunosuppressive therapy in renal
transplantation. The propensity of these agents to ultimately damage the very
organs they were intended to protect was always recognized, but largely ignored
due to their impressive ability to improve short-term outcomes. With the
availability of equally powerful new immunosuppressive agents devoid of major
nephrotoxicity, the irony of this situation has become all too apparent, and
investigators are beginning to reevaluate the role of CNIs in renal
transplantation. In this paper, we looked at strategies using MMF or sirolimus
to reduce, withdraw, or replace CNIs in renal transplantation. Although MMF has
proved effective in combination with CNIs, particularly in reducing acute
rejection rates, its use as base therapy to allow CNI therapy to be withdrawn
or eliminated is questionable. On the basis of initial trials, sirolimus holds
promise for use as base therapy. To date, it is probably the only agent used in
renal transplantation that provides immunosuppression comparable to
cyclosporine or tacrolimus, which may someday allow sirolimus to replace. CNIs
or allow early withdrawal of CNI therapy. Further study is needed to better
clarify the role of sirolimus in improving long-term renal transplantation
outcomes. N. Ref:: 61
----------------------------------------------------
[149]
TÍTULO / TITLE: - Glomerulonephritis
recurrence in the renal graft.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2001
Feb;12(2):394-402.
AUTORES
/ AUTHORS: - Chadban S
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Monash Medical
Centre, 246 Clayton Road, Clayton 3168, Australia. Steven.Chadban@med.monash.edu.au N. Ref:: 60
----------------------------------------------------
[150]
TÍTULO / TITLE: - Viral infections after
renal transplantation.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Apr;37(4):659-76.
AUTORES
/ AUTHORS: - Smith SR; Butterly DW; Alexander BD;
Greenberg A
INSTITUCIÓN
/ INSTITUTION: - Divisions of Nephrology and Infectious
Diseases, Duke University Medical Center, Durham, NC 27710, USA.
RESUMEN
/ SUMMARY: - Viral infections are a leading cause of
posttransplantation morbidity and mortality. A number of recent developments
have altered our understanding and management of these disorders. The
pathogenetic roles of several viruses, including human herpesviruses 6 and 8,
have been newly established. Molecular-based diagnostic tests now make more
rapid diagnosis possible. The licensing of new potent antiviral agents offers a
wider choice of drugs for viral prophylaxis and treatment. The use of more potent
immunosuppressive agents is responsible in part for the increasing incidence of
some viral infections, but this varies among drugs, and individual viruses
differ in their sensitivity to immunosuppressive agents. This review summarizes
the natural history, diagnosis, prevention, and treatment of many common viral
infections after renal transplantation.
N. Ref:: 103
----------------------------------------------------
[151]
TÍTULO / TITLE: - Special clinical
problems in geriatric patients.
REVISTA
/ JOURNAL: - Semin Dial 2002 Mar-Apr;15(2):116-20.
AUTORES
/ AUTHORS: - Winchester JF
INSTITUCIÓN
/ INSTITUTION: - RenalTech International, New York, NY
10021, USA. jamesw@renaltech.com
RESUMEN
/ SUMMARY: - The elderly dialysis patient presents
several challenges to the nephrologist. Concurrent illnesses may complicate
management, disabilities may interfere with mobility, hearing, and vision, and
depression and mental incompetence may be present. For these reasons the
physician and health care team should adopt a broad treatment plan, using
expert help if needed in managing the patient and involving family members,
clergy, and friends. While lifestyle changes are inevitable for the elderly
with initiation of dialysis, satisfactory outcomes are possible. In the event
of overwhelming illness and the patient’s perception of the futility of
continuation of dialysis, cessation of dialysis must be approached in a humane,
considerate, and compassionate manner. N.
Ref:: 78
----------------------------------------------------
[152]
TÍTULO / TITLE: - Renal transplant artery
stenosis.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Jul;18 Suppl 5:v74-7.
AUTORES
/ AUTHORS: - Buturovic-Ponikvar J
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, University
Medical Center, Ljubljana, Slovenia. jadranka.buturovic@mf.uni-lj.si
RESUMEN
/ SUMMARY: - Renal transplant artery stenosis is a
relatively frequent complication after transplantation, with an incidence of up
to 23% being reported. The gold standard for the diagnosis still remains renal
arteriography. Several imaging techniques are available to confirm the
diagnosis (duplex-Doppler, nuclear magnetic resonance, spiral computerized
tomography), and their use depends, in part, on the centre’s experience. The
treatment can either be conservative (providing graft perfusion is not
jeopardized) or by revascularization (surgical or percutaneous transluminal
angioplasty). There are several unresolved questions concerning
revascularization of the graft: whether and when to intervene? Is the stenosis
progressive in the long term? Is hypertension alone an indication for
angioplasty? How do we assess the haemodynamic significance of the stenosis?
What is a significant stenosis-50, 60, 80 or 90%? Is stenosis ‘good’ for
something? In Slovenia, since 1990, all renal transplant recipients are
screened regularly for the presence of stenosis by duplex-Doppler (performed by
nephrologists), and also in cases of deterioration of graft function or
hypertension. In the majority of patients with a diagnosed stenosis, the latter
was found to be stable over time (assessed by regular Doppler, graft function
and hypertension control). In some patients, spontaneous regression of the
stenosis was observed. Frequent Doppler assessment of these patients helps to
be more conservative with angioplasty and angiography. Deterioration of graft
function (with stenosis diagnosed by Doppler) is the main indication for
angiography (and angioplasty). Better definition of significant stenosis and
randomized studies comparing conservative treatment vs angioplasty are
warranted. Duplex-Doppler seems to be the ideal screening and follow-up test. N. Ref:: 19
----------------------------------------------------
[153]
- Castellano -
TÍTULO / TITLE:Insuficiencia renal en el
trasplante hepatico. Renal insufficiency in liver transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22 Suppl 5:69-71.
AUTORES
/ AUTHORS: - Rimola A
INSTITUCIÓN
/ INSTITUTION: - Servicio de Hepatologia, Hospital Clinic,
Barcelona. N. Ref:: 28
----------------------------------------------------
[154]
TÍTULO / TITLE: - Kidney transplantation:
graft monitoring and immunosuppression.
REVISTA
/ JOURNAL: - World J Surg 2002 Feb;26(2):185-93. Epub
2001 Dec 17.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00268-001-0206-1
AUTORES
/ AUTHORS: - Fisher JS; Woodle ES; Thistlethwaite JR Jr
INSTITUCIÓN
/ INSTITUTION: - Section of Transplantation, Department of
Surgery, University of Tennessee, Room A-202, Memphis,Tennessee 38103, USA.
RESUMEN
/ SUMMARY: - Renal transplantation has become the
preferred means of treating end-stage renal disease. Episodes of allograft
rejection have become the exception rather than the rule. The development of
real-time ultrasound-guided allograft biopsy and adoption of the Banff criteria
for histologic evaluation permit safe,accurate monitoring of graft histology.
New immunosuppressive agents have drastically reduced the number of episodes of
both primary and refractory rejection. Novel biologic agents in the form of
monoclonal antibodies and soluble receptor hybrid molecules may serve to reduce
the required doses of toxic chemical immunosuppressants and provide more specific
immune suppression directed at those elements of the immune system involved in
rejection of a given allograft. Development of assays to identify patients who
demonstrate donor antigen-specific hyporeactivity is now feasible. Hopefully,
these assays will serve as a guide for the reduction and possible removal of
immunosuppressive agents from stable renal allograft recipients. N. Ref:: 81
----------------------------------------------------
[155]
TÍTULO / TITLE: - Glycaemic control and
graft loss following renal transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001 Oct;16(10):1978-82.
AUTORES
/ AUTHORS: - Thomas MC; Mathew TH; Russ GR N. Ref:: 32
----------------------------------------------------
[156]
TÍTULO / TITLE: - Recurrent glomerulonephritis
following renal transplantation: an update.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Jul;18(7):1260-5.
AUTORES
/ AUTHORS: - Floege J
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and Immunology,
University of Aachen, Germany. juergen.floege@rwth-aachen.de N. Ref:: 56
----------------------------------------------------
[157]
TÍTULO / TITLE: - An update on herpes
virus infections in graft recipients.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Sep;18(9):1703-6.
AUTORES
/ AUTHORS: - Ketteler M; Kunter U; Floege J
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Clinical
Immunology, University Hospital Aachen, Germany. mketteler@ukaachen.de N. Ref:: 18
----------------------------------------------------
[158]
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
----------------------------------------------------
[159]
- Castellano -
TÍTULO / TITLE:Transplante renal. Tecnica y
complicaciones. Kidney transplantation. Technique and complications.
REVISTA
/ JOURNAL: - Actas Urol Esp. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aeu.es/actas/
●●
Cita: Actas Urológicas Españolas: <> 2003 Oct;27(9):662-77.
AUTORES
/ AUTHORS: - Garcia de Jalon Martinez A; Pascual
Regueiro D; Trivez Boned MA; Sancho Serrano C; Mallen Mateo E; Gil Martinez P;
Liedana Torres JM; Rioja Sanz LA
INSTITUCIÓN
/ INSTITUTION: - Servicio de Urologia, Hospital
Universitario Miguel Servet, Zaragoza.
RESUMEN
/ SUMMARY: - We want to make in this article, a deep
review of our experience in kidney transplantation since the moment we started
the technique in 1986 to the end of the year 2000. We also want to make a
compilation of the most important points of the surgical technique, patients
selection criteria, and the most common and uncommon complications that can
appear in kidney transplantation, analizing our results all along this time. N. Ref:: 21
----------------------------------------------------
[160]
TÍTULO / TITLE: - Acute renal failure and
multiple organ dysfunction in the ICU: from renal replacement therapy (RRT) to
multiple organ support therapy (MOST).
REVISTA
/ JOURNAL: - Int J Artif Organs 2002 Aug;25(8):733-47.
AUTORES
/ AUTHORS: - Ronco C; Bellomo R
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Dialysis and
Transplantation, St Bortolo Hospital, Vicenza, Italy. cronco@goldnet.it
RESUMEN
/ SUMMARY: - Renal replacement therapy (RRT) has
evolved from the concept that we need to treat the dysfunction of a single
organ (the kidney). As intensive care units have become more and more complex,
it has become clear that the majority of patients with acute renal failure
often have dysfunction of several other organs. In order to facilitate single
organ support in this setting, continuous renal replacement therapy (CRRT)
techniques have been developed. However, CRRT has opened the door to the
concept that targeting renal support as the only goal of extracorporeal blood
purification may be a simplistic view of our therapeutic aims. In this article
we argue that it is now time to move from the simple goal of achieving adequate
renal support. The proper goal of extracorporeal blood purification in ICU
should be multi-organ support therapy (MOST). We explain why MOST represents
the most logical future conceptual and practical evolution of CRRT and
illustrates the biological rationale, supplying animal and clinical evidence
that confirms the need to move rapidly in this direction theoretically,
practically and technologically. N.
Ref:: 104
----------------------------------------------------
[161]
TÍTULO / TITLE: - Tailoring
immunosuppressive therapy based on donor and recipient risk factors.
REVISTA
/ JOURNAL: - Transplant Proc 2001 May;33(3):2207-11.
AUTORES
/ AUTHORS: - First MR
INSTITUCIÓN
/ INSTITUTION: - University of Cincinnati Medical Center,
Cincinnati, Ohio 45267-0585, USA. N.
Ref:: 35
----------------------------------------------------
[162]
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
----------------------------------------------------
[163]
TÍTULO / TITLE: - Apheresis treatment of
recurrent focal segmental glomerulosclerosis after kidney transplantation:
re-analysis of published case-reports and case-series.
REVISTA
/ JOURNAL: - J Clin Apheresis 2001;16(4):175-8.
●●
Enlace al texto completo (gratuito o de pago) 1002/jca.10007 [pii]
AUTORES
/ AUTHORS: - Davenport RD
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, University of
Michigan, University Hospital 2G332/0054, Ann Arbor, MI 48109-0054, USA. rddvnprt@umich.edu
RESUMEN
/ SUMMARY: - A systematic re-analysis of published
cases was performed to better define the role of plasmapheresis in the
treatment recurrent focal segmental glomerulosclerosis after renal
transplantation. Forty-four cases were identified, of which 32 responded to
apheresis. The median number of treatments to response was 9. There was no
difference between responders and nonresponders in the total number of
treatments performed. The presence of sclerosis on biopsy predicted treatment
failure. Relapse after first successful treatment was reported in 10 cases. The
median number of treatments received was less and the time from diagnosis to
first treatment was greater for patients who relapsed than for patients in whom
relapse was not reported, but the differences were not statistically
significant. On the basis of this analysis, we recommend early treatment after
diagnosis with a regimen of three daily plasmapheresis treatments followed by 6
treatments on an every other day basis.
N. Ref:: 14
----------------------------------------------------
[164]
TÍTULO / TITLE: - Treatment of
hypertension in renal transplant recipients.
REVISTA
/ JOURNAL: - Curr Opin Urol 2003 Mar;13(2):91-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mou.0000058634.64616.08
AUTORES
/ AUTHORS: - Tylicki L; Habicht A; Watschinger B; Horl
WH
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine,
Nephrology and Transplantology, Medical University of Gdansk, Gdansk, Poland. leszek.tylicki@wp.pl
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: Hypertension is very
common in renal transplant recipients and is a significant risk factor for
mortality from cardiovascular diseases and for development of graft
dysfunction. RECENT FINDINGS: Recent guidelines for the treatment of
hypertension (Joint National Committee on Prevention, Detection, and Treatment
of High Blood Pressure VI Report and World Health Organization Guidelines) do
not directly address post-transplant hypertension. Specific recommendations for
the drug treatment of hypertension in renal allograft recipients have not been
given in the Clinical Practice Guidelines of the American Society of
Transplantation or those of the European Renal Association. SUMMARY: The
present paper summarizes some important aspects of post-transplant hypertension
and discusses potential treatment strategies aimed at reducing blood pressure
and thus improving patient and allograft survival. N. Ref:: 114
----------------------------------------------------
[165]
TÍTULO / TITLE: - Early experience using
calcineurin-free protocol in recipients of high-risk cadaver renal transplants.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Aug;34(5):1627-8.
AUTORES
/ AUTHORS: - El-Sabrout R; Delaney V; Butt F; Qadir M;
Rashid I; Hanson P; Butt K
INSTITUCIÓN
/ INSTITUTION: - Departments of Transplantation/Vascular
Surgery, New York Medical College, Valhalla, New York, USA.
----------------------------------------------------
[166]
TÍTULO / TITLE: - The role of newer
monoclonal antibodies in renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Feb-Mar;33(1-2):1000-1.
AUTORES
/ AUTHORS: - Vincenti F
INSTITUCIÓN
/ INSTITUTION: - University of California, San Francisco,
California, USA. N.
Ref:: 5
----------------------------------------------------
[167]
TÍTULO / TITLE: - Renal transplantation
after Streptococcus pneumoniae-associated hemolytic uremic syndrome.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Feb;37(2):E15.
AUTORES
/ AUTHORS: - Krysan DJ; Flynn JT
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics and Communicable
Diseases and the Division of Pediatric Nephrology, C.S. Mott Children’s
Hospital, University of Michigan, Ann Arbor, MI, USA.
RESUMEN
/ SUMMARY: - Of the several causes of nondiarrheal
hemolytic uremic syndrome (HUS), infection with Streptococcus pneumoniae is
infrequent, but important, because of its unique pathogenesis. A comprehensive
literature review found 37 well-documented cases of S pneumoniae-associated HUS
(SP-HUS), only 2 of which progressed to end-stage renal disease (ESRD). We
report the third such child, and the first to receive a renal transplant
following SP-HUS. Her course illustrates several unique characteristics of
SP-HUS common to previous patients reported in the literature, including a
greater duration of oligoanuria compared with cases not progressing to ESRD, the
significant adverse effect of unwashed blood products, and a possible influence
of female gender on outcome. Clinicians caring for children with SP-HUS should
be aware of these differences and modify therapy appropriately to avoid known
risk factors for poor outcome, specifically the use of unwashed blood
products. N. Ref:: 36
----------------------------------------------------
[168]
TÍTULO / TITLE: - Issues related to iron
replacement in chronic kidney disease.
REVISTA
/ JOURNAL: - Semin Nephrol 2002 Nov;22(6):479-87.
AUTORES
/ AUTHORS: - Agarwal R; Warnock D
INSTITUCIÓN
/ INSTITUTION: - Indiana University School of Medicine and
Richard L Roudebush VA Medical Center, Indianapolis, IN 46202, USA. ragarwal@iupui.edu
RESUMEN
/ SUMMARY: - Recent epidemiologic studies show that
iron deficiency occurs in the vast majority of patients with chronic kidney
disease (CKD). In patients with CKD, increased iron losses and, to a lesser
extent, poor oral absorption, can lead to iron-deficiency anemia. Correction of
iron-deficiency anemia is preferable by the oral route, however, data on oral
iron use are limited in this population. In CKD patients, parenteral iron
administered with recombinant human erythropoietin (rHuEpo), is the best
potential option for the correction of anemia. Nondextran iron preparations are
preferable because of a reduced incidence of serious adverse events. Parenteral
iron in CKD patients may not be entirely innocuous and, although commonly used,
have not received Food and Drug Administration approval for use in this patient
population. Exposure to intravenous (IV) iron may lead to oxidative stress,
renal injury, infection, cardiovascular disease, and osteomalacia. Studies are
needed to confirm the existence and magnitude of these complications. The
current data suggest that the overall risk-benefit ratio favors use of IV iron
when compared with untreated or partially treated iron-deficiency anemia. N. Ref:: 55
----------------------------------------------------
[169]
TÍTULO / TITLE: - Molecular mechanisms of
renal allograft fibrosis.
REVISTA
/ JOURNAL: - Br J Surg 2001 Nov;88(11):1429-41.
●●
Enlace al texto completo (gratuito o de pago) 1046/j.0007-1323.2001.01867.x
AUTORES
/ AUTHORS: - Waller JR; Nicholson ML
INSTITUCIÓN
/ INSTITUTION: - Division of Transplant Surgery, University
of Leicester, Leicester, UK. julian@waller79.fsnet.co.uk
RESUMEN
/ SUMMARY: - BACKGROUND: Chronic graft nephropathy
(CGN) remains the leading cause of renal allograft loss after the first year
following transplantation. Histologically it is characterized by
glomerulosclerosis, intimal hyperplasia and interstitial fibrosis. The
pathogenesis is unclear, but is likely to involve both immunological and
non-immunological factors. Despite improvements in short-term graft survival
rates, new immunosuppressive regimens have made no impact on CGN. METHODS: A
review of the current literature on renal transplantation, novel
immunosuppression regimens and advances in the molecular pathogenesis of renal
allograft fibrosis was performed. RESULTS AND CONCLUSION: Recent advances in
understanding of the underlying molecular mechanisms involved suggest autocrine
secretion of cytokines and growth factors, especially transforming growth
factor beta, are associated with a change in fibroblast phenotype leading to
the deposition of extracellular matrix. Repeated insults trigger upregulation
of the tissue inhibitors of matrix metalloproteinases, favouring accumulation
of extracellular matrix. To date, no drug has proved effective in inhibiting or
reducing allograft fibrosis. The deleterious consequences of chronic immunosuppression
on the development of such fibrosis are now recognized; newer immunosuppressive
drugs, including rapamycin and mycophenolate mofetil, reduce profibrotic gene
expression in both experimental and clinical settings, and offer potential
strategies for prolonging allograft survival.
N. Ref:: 155
----------------------------------------------------
[170]
TÍTULO / TITLE: - Immunologic risk
factors for chronic renal allograft dysfunction.
REVISTA
/ JOURNAL: - Transplantation 2001 Jun 15;71(11
Suppl):SS17-23.
AUTORES
/ AUTHORS: - Paul LC
INSTITUCIÓN
/ INSTITUTION: - Leiden University Medical School, The
Netherlands.
RESUMEN
/ SUMMARY: - Tissue injury is probably the central
feature leading to CRAD, whether that injury is produced by immunological or nonimmunological
factors. Tissue injury may expose cryptic antigens that, in an allogeneic
situation, stimulate immune responses that further increase tissue damage. With
acute rejection the immunological factor most strongly predictive of CRAD, HLA
mismatches may facilitate rejection or otherwise lead to CRAD. However,
clinical studies have not always demonstrated an increasing risk of CRAD with
increased numbers of HLA mismatches. Antibodies produced against HLA or other
donor-specific antigens may play a role in initiating the CRAD process or may
occur secondary to tissue damage. Several human transplant studies have
demonstrated an association between anti-HLA or anti-B cell antibodies and
CRAD. In animal models of CRAD, antibodies are produced against antigens
associated with glomerular and tubular basement membranes and mesangial cells,
as well as antigens associated with vascular endothelial cells. The
pathogenetic significance of these antibody responses is unclear at this time,
but these responses may interfere with repair processes that follow tissue
injury or otherwise facilitate mechanisms leading to CRAD. Whether similar
antibody responses against components of basement membrane and mesangial cells
occur in human renal transplant patients with CRAD is not yet known. The most
effective way to prevent CRAD is to prevent tissue damage, especially
immunity-related injury that involves maintaining appropriate
immunosuppression. When using calcineurin inhibitors for immunosuppression,
there is a risk of chronic calcineurin inhibitor-associated nephrotoxicity.
Nonnephrotoxic immunosuppressive agents, such as sirolimus and mycophenolate
mofetil, may be considered in therapeutic strategies designed to prevent acute
rejection and to minimize renal tissue damage due to nephrotoxic drugs. N. Ref:: 54
----------------------------------------------------
[171]
TÍTULO / TITLE: - The case against
protocol kidney biopsies.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Aug;34(5):1716-8.
AUTORES
/ AUTHORS: - Ponticelli C; Banfi G
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, IRCCS Ospedale
Maggiore di Milano, Via Commenda 15, 20122 Milan, Italy. ponticelli@policlinico.mi.it N. Ref:: 30
----------------------------------------------------
[172]
TÍTULO / TITLE: - Nonimmune risk factors
for chronic renal allograft disfunction.
REVISTA
/ JOURNAL: - Transplantation 2001 Jun 15;71(11
Suppl):SS10-6.
AUTORES
/ AUTHORS: - Fellstrom B
INSTITUCIÓN
/ INSTITUTION: - Uppsala University, Sweden. N. Ref:: 83
----------------------------------------------------
[173]
TÍTULO / TITLE: - Viral infections and
their impact on chronic renal allograft dysfunction.
REVISTA
/ JOURNAL: - Transplantation 2001 Jun 15;71(11 Suppl):SS24-30.
AUTORES
/ AUTHORS: - Soderberg-Naucler C; Emery VC
INSTITUCIÓN
/ INSTITUTION: - Karolinska Institute, Huddinge, Sweden.
RESUMEN
/ SUMMARY: - Viral infections, particularly those
involving HCMV, are an important complication of renal transplantation.
Transplantation protocols and treatment regimens that increase HCMV infection
and disease may promote the development of CRAD and impair long-term renal
allograft survival. Investigators are beginning to illuminate the mechanisms by
which HCMV infection may cause chronic rejection in general and transplant
vascular sclerosis in particular. Migration and proliferation of SMCs within
the intimal layer of blood vessels is an important component of transplant
vascular sclerosis, and HCMV appears to facilitate both of these processes.
Current management strategies for HCMV focus on prevention, either using a
focal preemptive therapeutic approach or by administering antiviral therapies
to all or at-risk patients. N.
Ref:: 74
----------------------------------------------------
[174]
TÍTULO / TITLE: - Nephrotoxicity of
selective COX-2 inhibitors.
REVISTA
/ JOURNAL: - J Rheumatol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jrheum.com/archive.html
●●
Cita: J of Rheumatology: <> 2001 Sep;28(9):2133-5.
AUTORES
/ AUTHORS: - Woywodt A; Schwarz A; Mengel M; Haller H;
Zeidler H; Kohler L
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
Hannover School of Medicine, Germany. Woywodt.Alexander@MH-Hannover.de
RESUMEN
/ SUMMARY: - We describe 2 male patients, a 49-year-old
with psoriatic arthritis and impaired renal function and a 43-year-old renal transplant
recipient, who both sustained a marked decline in glomerular filtration rate in
conjunction with a selective inhibitor of cyclooxygenase-2 (COX-2), rofecoxib.
In the second patient, acute renal failure necessitated hemodialysis. Both
patients made an uneventful recovery. Our report lends further support to the
assumption that COX-2 inhibitors, as a class, can be as nephrotoxic as their
nonselective predecessors. Therefore, COX-2 inhibitors should be used with
caution in renal transplant recipients and in patients with salt depletion and
renal insufficiency. N.
Ref:: 15
----------------------------------------------------
[175]
TÍTULO / TITLE: - Hypertension and renal
dysfunction in long-term liver transplant recipients.
REVISTA
/ JOURNAL: - Liver Transpl 2001 Nov;7(11 Suppl
1):S22-6.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2001.28511
AUTORES
/ AUTHORS: - Gonwa TA
INSTITUCIÓN
/ INSTITUTION: - Renal and Pancreas Transplant, Mayo Clinic
Transplant Center, Jacksonville, FL 32216, USA. gonwa.thomas@mayo.edu
RESUMEN
/ SUMMARY: - 1. A 10-year survival rate of 60% or
greater after orthotopic liver transplantation (OLT) is expected. 2. Renal
dysfunction is common after OLT. 3. Patients without early renal dysfunction
after OLT are at low risk for long-term renal dysfunction. 4. Hypertension
occurs in greater than 50% of long-term survivors. 5. Immunosuppressive
protocols must be adjusted early to avoid long-term complications. N. Ref:: 31
----------------------------------------------------
[176]
TÍTULO / TITLE: - Kidney transplantation
during the first trimester of pregnancy: immunosuppression with mycophenolate
mofetil, tacrolimus, and prednisone.
REVISTA
/ JOURNAL: - Transplantation 2001 Apr 15;71(7):994-7.
AUTORES
/ AUTHORS: - Pergola PE; Kancharla A; Riley DJ
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
Texas Health Science Center at San Antonio, 78229, USA.
RESUMEN
/ SUMMARY: - We present a case of living, related-donor
kidney transplantation during the first trimester of pregnancy. The patient
received mycophenolate mofetil (MMF), tacrolimus, and prednisone throughout the
entire pregnancy. This is the first reported case of use of MMF during
pregnancy. The mother did well, except for mild preeclampsia and mild renal
insufficiency at term. The baby girl was born prematurely at week 353/7. The
only possible teratogenic effects detected included hypoplastic nails and short
fifth fingers. No chromosomal abnormalities were found. The child is growing
and developing normally. Although we do not recommend the use of mycophenolate
mofetil during pregnancy based on this experience, it is reassuring to know that
a successful outcome can be expected in mothers treated with MMF during
pregnancy. N. Ref:: 10
----------------------------------------------------
[177]
TÍTULO / TITLE: - Renal function in
meningomyelocele: risk factors, chronic renal failure, renal replacement
therapy and transplantation.
REVISTA
/ JOURNAL: - Curr Opin Urol 2002 Nov;12(6):479-84.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mou.0000039446.39928.32
AUTORES
/ AUTHORS: - Muller T; Arbeiter K; Aufricht C
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatric Nephrology,
University Children’s Hospital, Vienna, Austria. thomas.mueller@akh-wien.ac.at
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: This review is on renal
function in patients with spina bifida. Risk factors for renal injury as well
specific issues concerning the treatment of chronic renal failure, renal
replacement therapy and kidney transplantation are discussed. Relevant work
published earlier than 2000 is also considered because of a lack of recent
literature. RECENT FINDINGS: Data from adult and paediatric surveys show renal
damage to be the single most prevalent cause of morbidity and mortality; even
in children, 30-40% exhibit evidence of renal damage. Additional factors such
as chronic infection and stone formation will then render the kidney more
vulnerable to progressive loss of renal mass and subsequent chronic renal
failure. As in other patients with renal insufficiency, the control of
hypertension, preferably with angiotensin-converting enzyme inhibitors, and
adequate nutrition are mainstays of nephrological care. The modality of
dialysis in these patients is complicated by ventriculoperitoneal shunts or
urinary stomata in peritoneal dialysis, or difficult vascular access in
haemodialysis. Renal transplantation is now considered the optimal treatment
for end-stage renal disease in all age groups. Although more prone to
complications, recent data on patients with meningomyelocele or severely
abnormal lower urinary tracts demonstrate excellent patient and graft
outcomes.SUMMARY: The common goal in caring for these patients must be the
prevention of progressive renal damage. However, once kidney failure has
occurred, good and safe techniques for renal replacement therapy are available
to bridge the time to transplantation, which is undoubtedly the best treatment
for these patients. N.
Ref:: 48
----------------------------------------------------
[178]
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
----------------------------------------------------
[179]
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.
----------------------------------------------------
[180]
TÍTULO / TITLE: - Hepatitis C virus
infection and renal transplantation.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Nov;38(5):919-34.
AUTORES
/ AUTHORS: - Fabrizi F; Martin P; Ponticelli C
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and Dialysis,
Maggiore Hospital, IRCCS, Milano, Italy.
RESUMEN
/ SUMMARY: - With the success of organ transplantation,
liver disease has emerged as an important cause of morbidity and mortality of
renal transplant (RT) recipients. Numerous studies performed during the 1990s
have shown that hepatitis C virus (HCV) infection is the leading cause of
chronic liver disease among RT recipients. The transmission of HCV by renal
transplantation of a kidney from an HCV-infected organ donor has been shown
unequivocally. Liver biopsy is essential in the evaluation of liver disease of
RT recipients, and histological studies have shown that HCV-related liver
disease after renal transplantation is progressive. The outcome of HCV-related
liver disease is probably more aggressive in RT recipients than immunocompetent
individuals. Various factors can affect the progression of HCV in the RT
population: coinfection with hepatitis B virus, time of HCV acquisition, type
of immunosuppressive treatment, and concomitant alcohol abuse. The role of
virological features of HCV remains unclear. The natural history of HCV
infection after renal transplantation is under evaluation; however, recent
surveys with long follow-ups have documented adverse effects of HCV infection
on patient and graft survival in RT recipients. Use of renal grafts from
HCV-infected donors in recipients with HCV infection does not appear to result
in a greater burden of liver disease, at least for a short period. The
association between HCV and de novo or recurrent glomerulonephritis after RT
has been hypothesized and is an area of avid research. Reported studies do not
support interferon (IFN) treatment for RT recipients with chronic hepatitis C
because of the frequent occurrence of graft failure, and information on the use
of other types of IFN or combined therapy (IFN plus ribavirin or amantadine) is
not yet available in the RT population.
N. Ref:: 134
----------------------------------------------------
[181]
TÍTULO / TITLE: - Diagnosis of acute
renal allograft rejection: evaluation of the Banff 97 Guidelines for Slide
Preparation.
REVISTA
/ JOURNAL: - Transplantation 2002 May 15;73(9):1518-21.
AUTORES
/ AUTHORS: - McCarthy GP; Roberts IS
INSTITUCIÓN
/ INSTITUTION: - Department of Histopathology, Manchester
Royal Infirmary, Manchester, United Kingdom.
RESUMEN
/ SUMMARY: - BACKGROUND: Arteritis and tubulitis, the
diagnostic features of acute renal allograft rejection, are typically focal
lesions. To avoid under-diagnosis, the Banff ‘97 schema recommends the
preparation of multiple slides, of which three should be stained with
hematoxylin and eosin (H&E) and three with periodic acid-Schiff (PAS) or
silver. In this study, we examine the validity of the Banff ‘97 recommendations
and determine how widely these recommendations are applied. METHODS: We
reviewed 52 consecutive renal transplant biopsy specimens showing both acute
tubulointerstitial and vascular rejection. Arteritis was graded for each
H&E slide, and tubulitis was graded for each H&E and PAS/silver. The
handling of renal allograft biopsy specimens in the U.K. was determined by
means of a questionnaire. RESULTS: When two, as opposed to three, H&E
slides were examined, arteritis was missed in 11.4% of cases; when only one
H&E slide was examined, arteritis was missed in 33.3% of cases. When only
one, as opposed to three, PAS/silver slide was examined, tubulitis was
under-graded in 33.3% of cases. In the U.K., 40% of laboratories stain at least
three slides with H&E, and 42% stain at least three slides with PAS/silver.
Only 30% of laboratories conform to all the Banff guidelines for slide
preparation. CONCLUSIONS: There is likely to be significant under-diagnosis and
under-grading of acute rejection if the Banff ‘97 guidelines for slide
preparation are not implemented. Most laboratories in the U.K. do not conform
to these guidelines.
----------------------------------------------------
[182]
TÍTULO / TITLE: - Tacrolimus: a further
update of its use in the management of organ transplantation.
REVISTA
/ JOURNAL: - Drugs 2003;63(12):1247-97.
AUTORES
/ AUTHORS: - Scott LJ; McKeage K; Keam SJ; Plosker GL
INSTITUCIÓN
/ INSTITUTION: - Adis International Limited, Auckland, New
Zealand. demail@adis.co.nz
RESUMEN
/ SUMMARY: - Extensive clinical use has confirmed that
tacrolimus (Prograf) is a key option for immunosuppression after
transplantation. In large, prospective, randomised, multicentre trials in
adults and children receiving solid organ transplants, tacrolimus was at least
as effective or provided better efficacy than cyclosporin microemulsion in
terms of patient and graft survival, treatment failure rates and the incidence
of biopsy-proven acute and corticosteroid-resistant rejection episodes.
Notably, the lower incidence of rejection episodes after renal transplantation
in tacrolimus recipients was reflected in improved cost effectiveness. In bone
marrow transplant (BMT) recipients, the incidence of tacrolimus grade II-IV
graft-versus-host disease was significantly lower with tacrolimus than
cyclosporin treatment. Efficacy was maintained in renal and liver transplant
recipients after total withdrawal of corticosteroid therapy from
tacrolimus-based immunosuppression, with the incidence of acute rejection
episodes at up to 2 years’ follow-up being similar with or without
corticosteroids. Tacrolimus provided effective rescue therapy in transplant
recipients with persistent acute or chronic allograft rejection or drug-related
toxicity associated with cyclosporin treatment. Typically, conversion to
tacrolimus reversed rejection episodes and/or improved the tolerability
profile, particularly in terms of reduced hyperlipidaemia. In lung transplant
recipients with obliterative bronchiolitis, conversion to tacrolimus reduced
the decline in and/or improved lung function in terms of forced expiratory
volume in 1 second. Tolerability issues may be a factor when choosing a
calcineurin inhibitor. Cyclosporin tends to be associated with a higher
incidence of significant hypertension, hyperlipidaemia, hirsutism, gingivitis
and gum hyperplasia, whereas the incidence of some types of neurotoxicity,
disturbances in glucose metabolism, diarrhoea, pruritus and alopecia may be
higher with tacrolimus treatment. Renal function, as assessed by serum
creatinine levels and glomerular filtration rates, was better in tacrolimus
than cyclosporin recipients at up to 5 years’ follow-up. CONCLUSION: Recent
well designed trials have consolidated the place of tacrolimus as an important
choice for primary immunosuppression in solid organ transplantation and in BMT.
Notably, in adults and children receiving transplants, tacrolimus-based primary
immunosuppression was at least as effective or provided better efficacy than
cyclosporin microemulsion treatment in terms of patient and graft survival,
treatment failure and the incidence of acute and corticosteroid-resistant
rejection episodes. The reduced incidence of rejection episodes in renal
transplant recipients receiving tacrolimus translated into a better cost
effectiveness relative to cyclosporin microemulsion treatment. The optimal
immunosuppression regimen is ultimately dependent on balancing such factors as
the efficacy of the individual drugs, their tolerability, potential for drug
interactions and pharmacoeconomic issues.
N. Ref:: 261
----------------------------------------------------
[183]
TÍTULO / TITLE: - New developments in the
management of cytomegalovirus infection and disease after renal
transplantation.
REVISTA
/ JOURNAL: - Curr Opin Urol 2001 Mar;11(2):153-8.
AUTORES
/ AUTHORS: - Kletzmayr J; Kreuzwieser E; Klauser R
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of
Nephrology and Dialysis, University of Vienna, Austria. josef.kletzmayr@nephro.imed3.akh-wien.ac.at
RESUMEN
/ SUMMARY: - The clinical management of cytomegalovirus
infection and disease in renal transplant recipients has recently been
significantly improved with the availability of data on prophylaxis with oral
ganciclovir and valacyclovir. In addition, significant progress in early
diagnosis and the quantitation of viral load has been achieved. The influence
of novel immunosuppressants on the clinical course of cytomegalovirus infection
has been clarified to some extent by recent clinical data. The identification
of risk factors for cytomegalovirus disease beyond seroconstellation and immunosuppression
is an ongoing process that might lead to a more targeted use of antiviral
agents, given the risk of ganciclovir resistance. The understanding of the
effects of cytomegalovirus on long-term graft outcome still needs to be
deepened in order to design cytomegalovirus-specific interventions to improve
graft survival. N.
Ref:: 50
----------------------------------------------------
[184]
TÍTULO / TITLE: - Assessment of bone
mineralization following renal transplantation in children: limitations of DXA
and the confounding effects of delayed growth and development.
REVISTA
/ JOURNAL: - Am J Transplant 2001 Sep;1(3):193-6.
AUTORES
/ AUTHORS: - Leonard MB; Bachrach LK
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, The Children’s
Hospital of Philadelphia, University of Pennsylvania School of Medicine, USA. mleonard@cceb.med.upenn.edu
RESUMEN
/ SUMMARY: - Pediatric renal transplantation recipients
have numerous risk factors for decreased bone mass, including the underlying
renal disease, nutritional deficits, decreased physical activity, inflammation
and exposure to steroid therapy. The assessment of bone mineralization in
children following renal transplantation is fraught with difficulty. Dual
energy x-ray absorptiometry (DXA) is the most commonly employed tool to assess
bone mineralization. However, DXA has important limitations in children and in
individuals with renal disease. This brief review will examine the expected
gains in bone size and bone mass during growth and the mechanisms by which
renal failure and steroid therapy interrupt these process. In addition, the
limitations of DXA for detecting impaired bone mineralization in children with
renal disease are reviewed and alternative approaches explored. N. Ref:: 21
----------------------------------------------------
[185]
TÍTULO / TITLE: - Hepatitis C and renal
disease.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2429-31.
AUTORES
/ AUTHORS: - Van Thiel D; Nadir A; Shah N
INSTITUCIÓN
/ INSTITUTION: - Division of Gastroenterology and
Hepatology, Stritch School of Medicine, Loyola University of Chicago, Loyola
University Medical Center, Maywood, IL 60153, USA. dvanthi@lumc.edu N. Ref:: 23
----------------------------------------------------
[186]
TÍTULO / TITLE: - Mycoplasma hominis
infection in renal transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002 Mar;17(3):495-6.
AUTORES
/ AUTHORS: - Pastural M; Audard V; Bralet MP; Remy P;
Salomon L; Tankovic J; Buisson CB; Lang P
INSTITUCIÓN
/ INSTITUTION: - Service de. Nephrologie, Universite Paris
XII, Creteil, France. N.
Ref:: 12
----------------------------------------------------
[187]
TÍTULO / TITLE: - Evolution of immunosuppression
and continued importance of acute rejection in renal transplantation.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S2-9.
AUTORES
/ AUTHORS: - Chan L; Gaston R; Hariharan S
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine, University
of Colorado Health Sciences Center, Denver, CO 80262, USA. Larry.Chan@uchsc.edu
RESUMEN
/ SUMMARY: - As steady improvement in short-term kidney
graft survival and long-term outcomes prolongs the lives of transplant
patients, responsibility for their care is shifting away from transplant
specialists and into the hands of community nephrologists. Therefore, community
nephrologists need to have a deeper understanding of immunosuppressive therapies
than ever before. Pharmacologic immunosuppression has been continuously
evolving over the past two decades. Azathioprine was introduced in the early
1960s. Introduction of cyclosporine (CsA) in 1983 revolutionized short-term
outcomes after renal transplantation. The first monoclonal antibody
immunosuppressant, OKT3, was introduced in 1986. The 1990s saw the introduction
of a number of important new agents, including mycophenolate mofetil (MMF),
tacrolimus, and a microemulsion CsA, as well as two new monoclonal antibodies.
Combinations of these new agents, along with improving clinical care, have
produced 1-year patient survival approaching 100% and graft survival exceeding
90%. The newest class of agents, the first of which is sirolimus, is called
target of rapamycin (TOR) inhibitors and is used with CsA for maintenance
therapy. Immunosuppressive drug therapy after kidney transplantation continues
to evolve. There is a variety of pharmacologic combinations from which to
choose, based on immunologic risk and side effect profiles. As new regimens are
developed, ongoing communications between the transplant center and community
nephrologists will be required to implement therapeutic changes and optimize
patient care successfully. N.
Ref:: 59
----------------------------------------------------
[188]
TÍTULO / TITLE: - Cutaneous neoplasms in
renal transplant recipients.
REVISTA
/ JOURNAL: - Eur J Dermatol 2002 Nov-Dec;12(6):532-5.
AUTORES
/ AUTHORS: - Rubel JR; Milford EL; Abdi R
INSTITUCIÓN
/ INSTITUTION: - Renal Division, MRB-4, Brigham and Women’s
Hospital, 75 Francis Street, Boston, MA 02115, USA. jrubel@massmed.org
RESUMEN
/ SUMMARY: - Cutaneous neoplasms are much more common
in renal transplant recipients than in the general population, and are the most
common malignancies in these patients. This is the case with basal cell
carcinoma, and even more so with squamous cell carcinoma. Many risk factors for
development of such malignancies are similar to those in the general
population. However, in the transplant population, such cancers appear at an
earlier age, behave more aggressively, and frequently appear at multiple sites.
Therefore, diligence on the part of the patient and on the part of his or her
health care providers is of utmost importance. Treatment options include
reduction in immunosuppression, but preventive maintenance remains the primary
focus of efforts to limit these malignancies.
N. Ref:: 37
----------------------------------------------------
[189]
TÍTULO / TITLE: - Decreasing side effects
of Neoral through three-times-a-day protocol in Chinese renal transplant
patients.
REVISTA
/ JOURNAL: - Transplant Proc 2001
Nov-Dec;33(7-8):3156-7.
AUTORES
/ AUTHORS: - Chen ZS; Zeng FJ; Lin ZB; Chen ZK; Sha B;
Wen ZX; Ming CS; Zhang WJ; Xia SS
INSTITUCIÓN
/ INSTITUTION: - Institute of Organ Transplantation, Tongji
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China.
----------------------------------------------------
[190]
TÍTULO / TITLE: - Influence of
cyclosporin, tacrolimus and rapamycin on renal function and arterial
hypertension after renal transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001;16 Suppl 1:121-4.
AUTORES
/ AUTHORS: - Morales JM; Andres A; Rengel M; Rodicio JL
INSTITUCIÓN
/ INSTITUTION: - Renal Transplant Unit, Nephrology
Department, Hospital 12 de Octubre, Madrid, España.
RESUMEN
/ SUMMARY: - Cyclosporin and tacrolimus have improved
survival figures in organ transplantation. However, both drugs are potentially
nephrotoxic. The immunosuppressive and nephrotoxic effects of both drugs appear
to depend on the inhibition of calcineurin. Cyclosporin and tacrolimus cause
acute (functional changes) and chronic nephrotoxicity (structural lesions in
the kidney). These last important lesions include arteriolar hyalinosis,
stripped interstitial fibrosis and tubular atrophy. It is possible that
repeated episodes of renal ischaemia contribute to the development of chronic
nephrotoxicity and then chronic allograft nephropathy. Cyclosporin and
tacrolimus also induce arterial hypertension. Therefore, the beneficial effects
of immunosuppression have been limited due to nephrotoxicity and arterial
hypertension. Rapamycin, a novel immunosuppressive agent, that does not inhibit
calcineurin, provides immunosuppression without nephrotoxicity. In fact, in the
trials performed in Europe, sirolimus-treated immunosuppression patients
exhibited a much better renal function than cyclosporin-treated patients.
However, sirolimus can potentiate the nephrotoxic effect of cyclosporin.
Therefore, when cyclosporin and sirolimus are used in combination, a reduction
of the cyclosporin dose is desirable. N.
Ref:: 28
----------------------------------------------------
[191]
TÍTULO / TITLE: - Fate of a renal
tubulopapillary adenoma transmitted by an organ donor.
REVISTA
/ JOURNAL: - Transplantation 2001 Aug 15;72(3):540-1.
AUTORES
/ AUTHORS: - Barrou B; Bitker MO; Delcourt A; Ourahma
S; Richard F
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, La Pitie
Salpetriere University Hospital, 83 bd. de l’Hopital, 75013 Paris, France. benoit.barrou@psl.ap-hop-paris.fr
RESUMEN
/ SUMMARY: - Organ transplantation from cadaveric
donors has a risk of cancer transmission. However, some reports indicate that
kidneys bearing small carcinomas can be safely transplanted, as can other
organs harvested from the same donor. We report herein the case of two
allograft recipients (left kidney and heart with no evidence of tumor) who
developed a renal carcinoma soon after transplantation. The initial tumor of
the donor was a 17-mm tubulopapillary adenoma found on the right kidney, which
was not transplanted. The left kidney recipient rejected all residual tumoral
cells after graft removal and immunosuppression discontinuation. The heart
recipient died 7 months after transplantation from metastasis of a renal
carcinoma. This strongly suggests that circulating carcinoma cells were present
at the time of organ retrieval and that they were not cleared by in situ
perfusion. In contrast with the literature data, this report indicates that
patients with small renal tubulopapillary tumors should not be considered for
organ donation. N.
Ref:: 10
----------------------------------------------------
[192]
TÍTULO / TITLE: - Immunosuppression
protocols for HLA identical renal transplant recipients.
REVISTA
/ JOURNAL: - Transplant Proc 2003 May;35(3):1074-5.
AUTORES
/ AUTHORS: - Keitel E; Santos AF; Alves MA; Neto JP;
Schaefer PG; Bittar AE; Goldani JC; Pozza R; Bruno RM; See D; Garcia CD; Garcia
VD
INSTITUCIÓN
/ INSTITUTION: - Renal Transplant Unit, Santa Casa
Hospital, Porto Alegre, RS, Brazil. keitel@terra.com.br
----------------------------------------------------
[193]
TÍTULO / TITLE: - Histopathology of
chronic renal allograft dysfunction.
REVISTA
/ JOURNAL: - Transplantation 2001 Jun 15;71(11
Suppl):SS31-6.
AUTORES
/ AUTHORS: - Furness PN
INSTITUCIÓN
/ INSTITUTION: - University of Leicester, United
Kingdom. N. Ref:: 44
----------------------------------------------------
[194]
TÍTULO / TITLE: - Candida fasciitis
following renal transplantation.
REVISTA
/ JOURNAL: - Transplantation 2001 Aug 15;72(3):477-9.
AUTORES
/ AUTHORS: - Wai PH; Ewing CA; Johnson LB; Lu AD;
Attinger C; Kuo PC
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Georgetown
University Medical Center, Washington, DC, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: We describe a rare case of
necrotizing fasciitis involving Candida albicans, an organism that has been
reported to have a minimal potential for invasive soft tissue infection. In
this case, immunosuppression, chronic renal failure, and a history of diabetes
mellitus were predisposing factors. METHODS: The medical record and
histopathologic material were examined. The clinical literature was reviewed
for previous cases of C albicans necrotizing fasciitis. RESULTS: A review of
the literature showed that in solid organ transplant recipients, localized
fungal soft tissue infection is infrequent, with only 35 cases reported between
1974 and 1992. Necrotizing fasciitis caused by C albicans is extremely rare in
the modern era of solid organ transplantation. CONCLUSIONS: The management of
transplant patients at risk for invasive fungal infection warrants a high index
of suspicion for fungal necrotizing fasciitis in the setting of wound infection
and merits a thorough investigation for atypical pathogens. N. Ref:: 8
----------------------------------------------------
[195]
TÍTULO / TITLE: - Contemporary
immunosuppression in renal transplantation.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):733-50.
AUTORES
/ AUTHORS: - Luke PP; Jordan ML
INSTITUCIÓN
/ INSTITUTION: - Departments of Surgery and Urology, University
of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
RESUMEN
/ SUMMARY: - Over the past 3 decades, renal allograft
survival has improved significantly as a result of the development of powerful
immunosuppressive agents. Nevertheless, the overall half-life of renal
allografts has increased marginally during that time period, owing to
drug-related nephrotoxicity and chronic rejection. New immunosuppressive agents
are being evaluated because of the need for a reduction in the dose of nephrotoxic
calcineurin inhibitors and corticosteroids. Additional agents have demonstrated
the ability to retard the onset of chronic rejection in preclinical transplant
models. In concert with these efforts, approaches are in development to
alleviate the ever increasing shortage of donor organs, including the as yet
unrealized goals of successful and practical xenotransplantation and the
bioartificial kidney. Further identification and development of novel agents
that target the specific components of the allograft response will provide the
key to the achievement of donor-specific tolerance, the “Holy Grail” of solid
organ transplantation. N.
Ref:: 165
----------------------------------------------------
[196]
TÍTULO / TITLE: - Call for revolution: a
new approach to describing allograft deterioration.
REVISTA
/ JOURNAL: - Am J Transplant 2002 Mar;2(3):195-200.
AUTORES
/ AUTHORS: - Halloran PF
RESUMEN
/ SUMMARY: - I propose a set of definable entities in
the renal transplant course, eliminating the need for the term ‘chronic
rejection’. The status of a renal transplant can be defined by the presence and
extent of rejection (T-cell-mediated or antibody-mediated); allograft
nephropathy (parenchymal atrophy, fibrosis, and fibrous intimal thickening in
arteries); transplant glomerulopathy; specific diseases; and factors which
could accelerate progression. The level of function and the slope of the loss
of function should be separately determined. This approach can be applied both
in research and in clinical practice, and can be adapted to other organ
transplants. N.
Ref:: 47
----------------------------------------------------
[197]
TÍTULO / TITLE: - The impact of late
acute rejection after cadaveric kidney transplantation.
REVISTA
/ JOURNAL: - Clin Transplant 2001 Aug;15(4):221-7.
AUTORES
/ AUTHORS: - Joseph JT; Kingsmore DB; Junor BJ; Briggs
JD; Mun Woo Y; Jaques BC; Hamilton DN; Jardine AG; Jindal RM
INSTITUCIÓN
/ INSTITUTION: - Department of Transplantation Surgery,
University of Glasgow and the Western Infirmary, Glasgow, UK.
RESUMEN
/ SUMMARY: - BACKGROUND: Acute graft rejection (AR)
following renal transplantation results in reduced graft survival. However,
there is uncertainty regarding the definition, aetiology and long-term graft
and patient outcome of AR occurring late in the post-transplant period. AIM: To
determine if rejection episodes can be classified by time from transplantation
by their impact on graft survival into early acute rejection (EAR) and late
acute rejection (LAR). MATERIALS AND METHODS: 687 consecutive adult renal
transplant recipients who received their first cadaveric renal transplant at a
single centre. All received cyclosporine (CyA)-based immunosuppression, from
1984 to 1996, with a median follow-up of 6.9 yr. Details were abstracted from
clinical records, with emphasis on age, sex, co-morbid conditions, HLA
matching, rejection episodes, patient and graft survival. ANALYSIS: Patients
were classified by the presence and time to AR from the date of
transplantation. Using those patients who had no AR (NAR) as a baseline, we
determined the relative risk of graft failure by time to rejection. The
characteristics of patients who had no rejection, EAR and LAR were compared.
RESULTS: Compared with NAR, the risk of graft failure was higher for those
patients who suffered a rejection episode. A much higher risk of graft failure
was seen when the first rejection episode occurred after 90 d. Thus, a period
of 90 d was taken to separate EAR and LAR (relative risk of 3.06 and 5.27
compared with NAR as baseline, p<0.001). Seventy-eight patients (11.4%) had
LAR, 271 (39.4%) had EAR and 338 (49.2%) had NAR. The mean age for each of
these groups differed (LAR 39.6 yr, EAR 40.8 yr compared with NAR 44 yr,
p<0.003). The 5-yr graft survival for those who had LAR was 45% and 10-yr
survival was 28%. HLA mismatches were more frequent in those with EAR vs. NAR
(zero mismatches in HLA-A: 36 vs. 24%, HLA-B: 35 vs. 23% and HLA-DR: 63 vs.
41%, p<0.003). There was no difference in mismatching frequency between NAR
and LAR. CONCLUSIONS: AR had a deleterious impact on graft survival,
particularly if occurring after 90 d. AR episodes should therefore be divided
into early and late phases. In view of the very poor graft survival associated
with LAR, it is important to gain further insight into the main aetiological
factors. Those such as suboptimal CyA blood levels and non-compliance with
medication should be further investigated with the aim of developing more
effective immunosuppressive regimens in order to reduce the incidence of
LAR. N. Ref:: 35
----------------------------------------------------
[198]
TÍTULO / TITLE: - Humoral rejection in
kidney transplantation: new concepts in diagnosis and treatment.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002 Nov;11(6):609-18.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000040046.33359.cf
AUTORES
/ AUTHORS: - Mauiyyedi S; Colvin RB
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, University of
Texas-Houston, Health Sciences Center, USA.
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: Evidence from several
transplant centers indicates that a substantial proportion of acute and chronic
renal allograft rejection is caused by antibodies to donor antigens.
Antibody-mediated injury arises despite potent anti-T cell pharmacological
agents, and probably requires different therapy. RECENT FINDINGS: Acute humoral
rejection occurs in 20-30% of acute rejection cases, has a poorer prognosis
than cellular rejection, and is refractory to conventional immunosuppressive
therapy. C4d deposition in peritubular capillaries of renal allografts has been
demonstrated to be a sensitive and diagnostic in-situ marker of acute humoral
rejection that correlates strongly with the presence of circulating
donor-specific antibodies. Biopsies with chronic allograft arteriopathy or
glomerulopathy also have a high frequency of C4d deposition and donor-specific
antibodies. The vessels of other organs, notably the heart, can also be targets
of humoral rejection. New polyclonal C4d antibodies work in paraffin sections.
Pitfalls in C4d staining have been identified and must be considered in the
valid interpretation of results. SUMMARY: As the histology is variable, the
current diagnosis of humoral rejection in biopsies relies on the demonstration
of C4d, a component of the classical complement pathway, in peritubular
capillaries. The new classification of renal allograft rejection incorporates
humoral and cellular mechanisms of injury, with the diagnostic criteria of
each. This should prove useful in guiding clinical treatment, and stratifying
drug trials, replacing obsolete terms such as ‘vascular rejection’. Specific
therapeutic strategies for humoral rejection with controlled trials targeting
the humoral limb of immunosuppression are needed. N. Ref:: 47
----------------------------------------------------
[199]
TÍTULO / TITLE: - A standardized protocol
for the treatment of severe pneumonia in kidney transplant recipients.
REVISTA
/ JOURNAL: - Clin Transplant 2002 Dec;16(6):450-4.
AUTORES
/ AUTHORS: - Sileri P; Pursell KJ; Coady NT; Giacomoni
A; Berliti S; Tzoracoleftherakis E; Testa G; Benedetti E
INSTITUCIÓN
/ INSTITUTION: - Division of Transplant Surgery, Infectious
Diseases, University of Illinois at Chicago Medical Center, USA.
RESUMEN
/ SUMMARY: - Although the incidence of pneumonia after
kidney transplantation is the lowest among all solid organ transplants, it is
associated with high mortality rate (40-50%). We evaluated the efficacy of a
protocol consisting of bronco-alveolar-lavage (BAL) for early microbiological
diagnosis, reduction of the immunosuppressive therapy, and prompt
administration of standardized antibiotic regimen in renal transplant
recipients with severe pneumonia. Between 6/1989 and 5/1999, 40 kidney
transplant recipients developed 46 episodes of severe pneumonia (hypoxia and/or
infiltrate on the chest X-ray). According to protocol, in all these cases, a
BAL was immediately performed and empirical antibiotic therapy was initiated
with erythromycin and trimethoprim-sulfamethoxazole i.v. Furthermore, the
immunosuppressive therapy was drastically reduced. Analyses of BAL fluid
included cell differential count, cytopathologic examination and cultures for
bacteria, fungi and viruses. Within 48 h, the therapy was switched to proper
i.v. antibiotics, if necessary, according to the results of sensitivity testing
of BAL specimens. The mortality rate was 12.5% (5 of 40). Mechanical
ventilation was required in 20 cases (34.5%) and four of the patients that
required intubation died. BAL alone established a diagnosis in 67.4% (31 of 46)
of the patients. Bacteria were responsible for 61% of the episodes, with fungi
responsible for 29% and viruses for 10%. Seven cases of Pneumocystis carinii
pneumonia were treated with the prolongation of the initial therapy. We
conclude that a combination of early detection of the responsible pathogen by
BAL, aggressive reduction of the immunosuppressive therapy and the immediate
empirical administration of erythromycin and trimethoprim-sulfamethoxazole is
an effective strategy to treat pneumonia kidney transplantation (KTX)
recipients.
----------------------------------------------------
[200]
TÍTULO / TITLE: - Renal transplantation
into the abnormal lower urinary tract.
REVISTA
/ JOURNAL: - Bju Int. Acceso gratuito al texto completo
a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.bjui.org/
●●
Cita: BJU International: <> 2003 Sep;92(5):510-5.
AUTORES
/ AUTHORS: - Sullivan ME; Reynard JM; Cranston DW
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, Churchill Hospital,
Oxford, UK. N. Ref:: 39
----------------------------------------------------