#09#
Revisiones-Ciencias
Básicas (todas) *** Reviews-Basic Sciences
TRASPLANTE
RENAL *** RENAL TRANSPLANTATION
(Conceptos
/ Keywords: Renal-Kidney transplantation; Kidney donation-procurement; etc).
Enero /
January 2001 --- Marzo / March 2004
La
biblioteca del conocimiento biomédico© es un servicio GRATUITO. Toda la
información ha sido obtenida de fuentes públicas, de portales de internet que
no requieren registro alguno para su uso, que no requieren estar de acuerdo con
sus Términos de uso, que son de libre acceso a todo el mundo, y son a su vez
gratuitos. La biblioteca (revisiones, guías, protocolos, medicina basada en la
evidencia, etc...) se recopila en base a una patente que permite a Effiloop la
catalogación de los artículos por campos de interés así como por el orden de su
importancia (se proveen las primeras 200 revisiones). Toda la informacion se
ampara en las leyes de libre pensamiento-expresión, y de uso justo. Este
documento sólo contiene artículos escritos en Castellano y/o Inglés.
The
biomedical library© is a FREE service. All the information has been obtained
from public sources, from web sites that do not require registration for their
use, that do not require an agreement with their Terms of use, that provide
free access for all, and are free of charge. The library (reviews, guides,
protocols, medicine based medicine, etc) is arranged according to a patent that
warrants Effiloop to catalogue the articles by fields of interest as well as to
sort articles by true relevance (the first 200 reviews are provided). All the
information is provided according to the freedom of speech and fair use laws.
Only articles written in Spanish and/or English are included.
[1]
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.
----------------------------------------------------
[2]
TÍTULO / TITLE: - Prognostic value of
myocardial perfusion studies in patients with end-stage renal disease assessed
for kidney or kidney-pancreas transplantation: a meta-analysis.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Feb;14(2):431-9.
AUTORES
/ AUTHORS: - Rabbat CG; Treleaven DJ; Russell JD;
Ludwin D; Cook DJ
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of
Nephrology, McMaster University, Hamilton, Ontario, Canada. rabbatc@mcmaster.ca
RESUMEN
/ SUMMARY: - The prognostic utility of myocardial perfusion
studies (MPS) such as thallium scintigraphy and dobutamine stress
echocardiography (DSE) for stratifying cardiac risk among candidates for kidney
or kidney-pancreas transplantation is uncertain. This study is a meta-analysis
to determine the prognostic significance of MPS results on future myocardial
infarction (MI) and cardiac death (CD) in patients with end-stage renal disease
(ESRD) assessed for kidney or kidney-pancreas transplantation. MEDLINE was
searched using combinations of MeSH headings and text words for
transplantation, coronary artery disease, prognosis, end-stage renal disease,
and noninvasive cardiac testing (nuclear scintigraphy and DSE) for primary
studies. Studies were included if they reported MPS results and cardiac events
in patients assessed for kidney or kidney-pancreas transplantation.
Methodologic study quality and outcome data were independently abstracted in
duplicate by two researchers. The relative risks (RR) of MI and CD were
calculated using a random effects model. Twelve articles met all inclusion
criteria; 12 studies reported CD, and 9 reported MI. In eight studies, thallium
scintigraphy was used (four with pharmacologic stress, four with exercise
stress), whereas four used DSE. When compared with negative tests, positive tests
had a significantly increased RR of MI (2.73 [95% CI, 1.25 to 5.97]; P = 0.01)
and CD (2.92 [95% CI, 1.66 to 5.12]; P < 0.001). Subgroup analyses of
studies of diabetic patients indicated that positive tests were associated with
a RR of CD 3.95 (95% CI, 1.48 to 10.5; P = 0.006) and a RR of MI 2.68 (95% CI,
0.95 to 7.57; P = 0.06) when compared with negative tests. In studies
evaluating mixed populations of diabetic and nondiabetic patients, positive
tests were associated with a RR of CD 2.52 (95% CI, 1.25 to 5.08; P = 0.01) and
with a RR of MI 2.79 (95% CI, 0.85 to 9.21; P = 0.09) when compared with a
negative test. The presence of reversible defects was associated with an
increased risk of MI in diabetic patients and of CD in both subgroups; fixed defects
were associated with an increased risk of CD but not MI. It is concluded that
positive MPS are useful in identifying patients with significantly increased
risk of future MI and CD in both diabetic and nondiabetic ESRD patients.
----------------------------------------------------
[3]
TÍTULO / TITLE: - Interleukin 2 receptor
antagonists for renal transplant recipients: a meta-analysis of randomized
trials.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):166-76.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000109643.32659.C4
AUTORES
/ AUTHORS: - Webster AC; Playford EG; Higgins G;
Chapman JR; Craig JC
INSTITUCIÓN
/ INSTITUTION: - Cochrane Renal Group, Centre for Kidney
Research, Children’s Hospital at Westmead, Westmead, NSW, Australia.
RESUMEN
/ SUMMARY: - BACKGROUND: Interleukin 2 receptor
antagonists (IL-2Ra) are increasingly used to treat renal transplant
recipients. This study aims to systematically identify and summarize the
effects of using IL-2Ra as induction immunosuppression, as an addition to
standard therapy, or as an alternative to other antibody therapy. METHODS:
Databases, reference lists, and abstracts of conference proceedings were
searched extensively to identify relevant randomized controlled trials in all
languages. Data were synthesized using the random effects model. Results are
expressed as relative risk (RR), with 95% confidence intervals (CI). RESULTS: A
total of 117 reports from 38 trials involving 4,893 participants were included.
When IL-2Ra were compared with placebo (17 trials; 2,786 patients), graft loss
was not significantly different at 1 year (14 trials: RR 0.84; CI 0.64-1.10) or
3 years (4 trials: RR 1.08; CI 0.71-1.64). Acute rejection was significantly
reduced at 6 months (12 trials: RR 0.66; CI 0.59-0.74) and at 1 year (10
trials: RR 0.67; CI 0.60-0.75). At 1 year, cytomegalovirus infection (7 trials:
RR 0.82; CI 0.65-1.03) and malignancy (9 trials: RR 0.67; CI 0.33-1.36) were
not significantly different. When IL-2Ra were compared with other antibody
therapy, no significant differences in treatment effects were demonstrated, but
IL-2Ra had significantly fewer side effects. CONCLUSIONS: Given a 40% risk of
rejection, seven patients would need treatment with IL-2Ra in addition to
standard therapy, to prevent one patient from undergoing rejection, with no
definite improvement in graft or patient survival. There is no apparent
difference between basiliximab and daclizumab.
----------------------------------------------------
[4]
TÍTULO / TITLE: - A randomized long-term
trial of tacrolimus/sirolimus versus tacrolimus/mycophenolate mofetil versus
cyclosporine (NEORAL)/sirolimus in renal transplantation. II. Survival,
function, and protocol compliance at 1 year.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):252-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000101495.22734.07
AUTORES
/ AUTHORS: - Ciancio G; Burke GW; Gaynor JJ; Mattiazzi
A; Roth D; Kupin W; Nicolas M; Ruiz P; Rosen A; Miller J
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, University of Miami School of Medicine, Miami, FL 33101, USA. gciancio@med.miami.edu
RESUMEN
/ SUMMARY: - BACKGROUND: In an attempt to reduce
chronic calcineurin inhibitor induced allograft nephropathy in first cadaver
and human leukocyte antigen non-identical living-donor renal transplantation,
sirolimus (Siro) or mycophenolate mofetil (MMF) was tested as adjunctive
therapy, with planned dose reductions of tacrolimus (Tacro) over the first year
postoperatively. Adjunctive Siro therapy with a similar dose reduction
algorithm for Neoral (Neo) was included for comparison. METHODS: The detailed
dose reduction plan (Tacro and Siro, group A; Tacro and MMF, group B; Neo and
Siro, group C) is described in our companion report in this issue of
Transplantation. The present report documents function, patient and graft
survival, protocol compliance, and adverse events. RESULTS: As mentioned (in
companion report), group demographics were similar. The present study shows no
significant differences in 1-year patient and graft survival but does show a
trend that points to more difficulties in group C by way of a rising slope of
serum creatinine concentration (P=0.02) and decreasing creatinine clearance
(P=0.04). There were more patients who discontinued the protocol plan in group
C. Thus far, no posttransplant lymphomas have appeared, and infectious
complications have not differed among the groups. However, a greater percentage
of patients in group C were placed on antihyperlipidemia therapy, with an
(unexpected) trend toward a higher incidence of posttransplant diabetes
mellitus in this group. Group A required fewer, and group B the fewest,
antihyperlipidemia therapeutic interventions (P<0.00001). CONCLUSIONS: This
1-year interim analysis of a long-term, prospective, randomized
renal-transplant study indicates that decreasing maintenance dosage of Tacro
with adjunctive Siro or MMF appears to point to improved long-term function,
with reasonably few adverse events.
----------------------------------------------------
[5]
TÍTULO / TITLE: - 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: - A meta-analysis from
the Cochrane Library reviewing interleukin 2 receptor antagonists in renal
transplantation.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):165.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000112919.54256.8D
AUTORES
/ AUTHORS: - Morris PJ; Monaco AP
----------------------------------------------------
[7]
TÍTULO / TITLE: - Treatment of hepatitis
B in special patient groups: hemodialysis, heart and renal transplant,
fulminant hepatitis, hepatitis B virus reactivation.
REVISTA
/ JOURNAL: - J Hepatol 2003;39 Suppl 1:S206-11.
AUTORES
/ AUTHORS: - Tillmann HL; Wedemeyer H; Manns MP
INSTITUCIÓN
/ INSTITUTION: - Department of Gastroenterology, Hepatology
and Endocrinology, Medizinische Hochschule Hannover, Carl-Neuberg-Strassel,
30623 Hannover, Germany. N.
Ref:: 81
----------------------------------------------------
[8]
TÍTULO / TITLE: - 4D imaging to assay
complex dynamics in live specimens.
REVISTA
/ JOURNAL: - Nat Cell Biol 2003 Sep;Suppl:S14-9.
AUTORES
/ AUTHORS: - Gerlich D; Ellenberg J
INSTITUCIÓN
/ INSTITUTION: - Gene Expression and Cell Biology/Biophysics
Programmes, European Molecular Biology Laboratory, Heidelberg, Germany.
RESUMEN
/ SUMMARY: - A full understanding of cellular dynamics
is often difficult to obtain from time-lapse microscopy of single optical
sections. New microscopes and image-processing software are now making it
possible to rapidly record three-dimensional images over time. This
four-dimensional imaging allows precise quantitative analysis and enhances
visual exploration of data by allowing cellular structures to be interactively displayed
from many angles. It has become a key tool for understanding the complex
organization of biological processes in live specimens. N. Ref:: 55
----------------------------------------------------
[9]
TÍTULO / TITLE: - Pretransplant blood
transfusions revisited: a role for CD(4+) regulatory T cells?
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1
Suppl):S26-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000106469.12073.01
AUTORES
/ AUTHORS: - Roelen D; Brand A; Claas FH
INSTITUCIÓN
/ INSTITUTION: - Department of Immunohematology and
Bloodtransfusion, Leiden University Medical Center, Leiden, The Netherlands. d.l.roelen@lumc.nl.
RESUMEN
/ SUMMARY: - Pretransplant blood transfusions have been
shown to improve organ allograft survival. However, the immunologic mechanism
leading to this beneficial effect of blood transfusions is still unknown. The
observation that transfusions sharing at least one HLA-DR antigen (human
leukocyte antigen) with the recipient are more effective than HLA-mismatched
transfusions has led to the hypothesis that CD(4+) regulatory T cells are
induced that recognize allopeptides of the blood transfusion donor in the
context of the self-HLA-DR molecule on the donor cells. In vitro studies showed
that CD(4+) T cells recognizing an allopeptide in the context of self-HLA-DR
are indeed able to decrease the alloimmune response of autologous T cells by affecting
the activated T cells directly or indirectly by their modulatory effect on
dendritic cells. The first studies in a patient with a well-functioning kidney
graft after receiving an HLA-DR-matched pretransplant blood transfusion showed
that the low organ donor-specific cytotoxic T-lymphocyte response after
transplantation was indeed attributable to the activity of regulatory CD(4+) T
cells. N. Ref:: 24
----------------------------------------------------
[10]
TÍTULO / TITLE: - Dendritic cells and the
mode of action of anticalcineurinic drugs: an integrating hypothesis.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Mar;18(3):467-8;
discussion 469-70.
AUTORES
/ AUTHORS: - Fierro A; Mora JR; Bono MR; Morales J;
Buckel E; Sauma D; Rosemblatt M
INSTITUCIÓN
/ INSTITUTION: - Clinica las Condes, Transplantation Unit,
Santiago, Chile. afierro@vtr.net N. Ref:: 16
----------------------------------------------------
[11]
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.
----------------------------------------------------
[12]
TÍTULO / TITLE: - Regulatory T cells in
kidney transplant recipients: active players but to what extent?
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Jun;14(6):1706-8.
AUTORES
/ AUTHORS: - Zhai Y; Kupiec-Weglinski JW N. Ref:: 20
----------------------------------------------------
[13]
TÍTULO / TITLE: - Interleukin 2 receptor
antagonists for kidney transplant recipients.
REVISTA
/ JOURNAL: - Cochrane Database Syst Rev
2004;1:CD003897.
●●
Enlace al texto completo (gratuito o de pago) 1002/14651858.CD003897.pub2
AUTORES
/ AUTHORS: - Webster A; Playford E; Higgins G; Chapman
J; Craig J
INSTITUCIÓN
/ INSTITUTION: - Centre for Kidney Research, The Children’s
Hospital at Westmead, Locked Bag 4001, Westmead, NSW, AUSTRALIA, 2145.
RESUMEN
/ SUMMARY: - BACKGROUND: Interleukin 2 receptor
antagonists (IL2Ra) are used as induction therapy for prophylaxis against acute
rejection in kidney transplant recipients. Use of IL2Ra has increased steadily,
with 38% of new kidney transplant recipients in the United States, and 23% in
Australasia receiving IL2Ra in 2002. OBJECTIVES: This study aims to
systematically identify and summarise the effects of using an IL2Ra, as an
addition to standard therapy, or as an alternative to other antibody therapy.
SEARCH STRATEGY: The Cochrane Renal Group’s specialised register (June 2003),
the Cochrane Controlled Trials Register (in The Cochrane Library issue 3,
2002), MEDLINE (1966-November 2002) and EMBASE (1980-November 2002). Reference
lists and abstracts of conference proceedings and scientific meetings were
hand-searched from 1998-2003. Trial groups, authors of included reports and
drug manufacturers were contacted. SELECTION CRITERIA: Randomised controlled
trials (RCTs) in all languages comparing IL2Ra to placebo, no treatment, other
IL2Ra or other antibody therapy. DATA COLLECTION AND ANALYSIS: Data was
extracted and quality assessed independently by two reviewers, with differences
resolved by discussion. Dichotomous outcomes are reported as relative risk (RR)
with 95% confidence intervals (CI). MAIN RESULTS: One hundred and seventeen
reports from 38 trials involving 4893 participants were included. Where IL2Ra
were compared with placebo (17 trials; 2786 patients), graft loss was not
significantly different at one (RR 0.83, 95% CI 0.66 to 1.04) or three years
(RR 0.88, 95% CI 0.64 to 1.22). Acute rejection (AR) was significantly reduced
at six months (RR 0.66, 95% CI 0.59 to 0.74) and at one year (RR 0.67, 95% CI
0.60 to 0.75). At one year, cytomegalovirus (CMV) infection (RR 0.82, 95% CI
0.65 to 1.03) and malignancy (RR 0.67, 95% CI 0.33 to 1.36) were not
significantly different. Where IL2Ra were compared with other antibody therapy
no significant differences in treatment effects were demonstrated, but adverse
effects strongly favoured IL2Ra. REVIEWER’S CONCLUSIONS: Given a 40% risk of
rejection, seven patients would need treatment with IL2Ra to prevent one
patient having rejection, with no definite improvement in graft or patient
survival. There is no apparent difference between basiliximab and daclizumab.
IL2Ra are as effective as other antibody therapies and with significantly fewer
side effects
----------------------------------------------------
[14]
TÍTULO / TITLE: - Potential role of major
histocompatibility complex class II peptides in regulatory tolerance to
vascularized grafts.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1
Suppl):S35-7.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000106472.91343.8D
AUTORES
/ AUTHORS: - LeGuern C
INSTITUCIÓN
/ INSTITUTION: - Transplantation Biology Research Center,
Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA. leguern@helix.mgh.harvard.edu
RESUMEN
/ SUMMARY: - The inactivation of persisting T
lymphocytes reactive to self- and non-self-antigens is a major arm of
operational immune tolerance in mammals. Silencing of such T cells proceeds
mostly by means of suppression, a process that is mediated by regulatory T-cell
subsets and especially by CD4(+)CD(25high) regulatory T cells (Treg). Although
Treg activation and ensuing suppressive activity appear to be major
histocompatibility complex class II dependent, the fine specificity of Treg
T-cell receptors has not yet been elucidated. Recent data from the author’s
laboratory on a class II gene therapy induction of tolerance to allogeneic
kidney grafts suggest that class II peptides are involved as generic signals
for Treg activation. A brief compilation of results that would support this
hypothesis is discussed in the present article. N. Ref:: 31
----------------------------------------------------
[15]
TÍTULO / TITLE: - Transcriptional
regulation of inflammatory genes before transplantation: a role for hypoxia
inducible factor-1alpha?
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 27;75(4):437-8.
AUTORES
/ AUTHORS: - Koo DD; Fuggle SV
INSTITUCIÓN
/ INSTITUTION: - Nuffield Department of Surgery, University
of Oxford, Oxford Transplant Centre, United Kingdom. N. Ref:: 5
----------------------------------------------------
[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: - Complement and the
kidney.
REVISTA
/ JOURNAL: - J Immunol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jimmunol.org/
●●
Cita: J. of Immunology: <> 2003 Oct 1;171(7):3319-24.
AUTORES
/ AUTHORS: - Quigg RJ
INSTITUCIÓN
/ INSTITUTION: - Section of Nephrology, University of
Chicago, Chicago, IL 60637, USA. rqigg@medicine.uchicago.edu N. Ref:: 94
----------------------------------------------------
[18]
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
----------------------------------------------------
[19]
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
----------------------------------------------------
[20]
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
----------------------------------------------------
[21]
- 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
----------------------------------------------------
[22]
TÍTULO / TITLE: - Ambulatory blood
pressure measurement in kidney transplantation: an overview.
REVISTA
/ JOURNAL: - Transplantation 2003 Dec 15;76(11):1643-4.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000091289.03300.1A
AUTORES
/ AUTHORS: - Tomson CR
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine, Southmead
Hospital, Bristol, UK. charlie.tomson@north-bristol.swest.nhs.uk
RESUMEN
/ SUMMARY: - Adequate control of hypertension is among
the most important aims of medical management of the kidney transplant
recipient, with the aim of reducing the risk of premature cardiovascular
disease and preserving graft function. Antihypertensive therapy should be
adjusted according to the best available estimates of usual resting blood
pressure. If clinic measurements are used, care should be taken to ensure that
these measurements are taken under optimal conditions. Home blood pressure
monitoring is a useful adjunct in many patients. Ambulatory blood pressure
monitoring gives valuable additional data; mean ambulatory blood pressure
correlates better with markers of target organ damage such as left ventricular
hypertrophy. However, current treatment thresholds and targets are based on
clinic measurements. Ambulatory blood pressure monitoring is certainly a useful
adjunct to clinic and home blood pressure measurement, but its role in routine
clinical practice in the transplant clinic remains to be defined. N. Ref:: 11
----------------------------------------------------
[23]
TÍTULO / TITLE: - European best practice guidelines
for renal transplantation. Section IV: Long-term management of the transplant
recipient. IV.3.2. Long-term immunosuppression. Therapy conversion.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:20-1.
RESUMEN
/ SUMMARY: - GUIDELINE: Conversion of immunosuppressive
drug therapy is recommended to avoid or reduce drug-specific adverse effects,
and is generally safe for long-term graft outcome.
----------------------------------------------------
[24]
TÍTULO / TITLE: - Disseminated ochroconis
gallopavum infection in a renal transplant recipient: the first reported case
and a review of the literature.
REVISTA
/ JOURNAL: - Clin Nephrol 2003 Dec;60(6):415-23.
AUTORES
/ AUTHORS: - Wang TK; Chiu W; Chim S; Chan TM; Wong SS;
Ho PL
INSTITUCIÓN
/ INSTITUTION: - Centre of Infection, Department of
Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR,
China.
RESUMEN
/ SUMMARY: - Ochroconis gallopavum is a potentially
fatal dematiaceous fungus causing opportunistic infections in immunocompromised
hosts. We report the first case of disseminated O. gallopavum infection in a
13-year-old renal transplant recipient, which involved the brain, lung and
spleen. He was treated with amphotericin B, itraconazole and voriconazole, a
new antifungal agent first used to treat such an infection. Besides antifungal
treatment, all immunosuppressive agents were stopped and automated peritoneal
dialysis was resumed. The initial infection was under control with both
clinical and radiological improvements after treatment. However, the patient
later acquired Acremonium spp. peritonitis; he failed to respond to high-dose
amphotericin B, and finally succumbed. A total of 13 reported O. gallopavum
human infections, including the one described here, are reviewed. The most
common site of involvement is the brain and the crude mortality rate is up to
46%. As the disease is potentially lethal in immunocompromised hosts, empirical
antifungal coverage should be considered in post-renal transplant recipients
with suspected brain abscess. Early biopsy of lesion for histopathological and
microbiological diagnosis would be essential in managing such cases. N. Ref:: 23
----------------------------------------------------
[25]
- 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
----------------------------------------------------
[26]
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
----------------------------------------------------
[27]
TÍTULO / TITLE: - Updated protocol for
the examination of specimens from patients with carcinoma of the urinary
bladder, ureter, and renal pelvis.
REVISTA
/ JOURNAL: - Arch Pathol Lab Med. Acceso gratuito al
texto completo.
●●
Enlace a la Editora de la Revista http://arpa.allenpress.com/
●●
Cita: Archives of Pathology & Laboratory Medicine: <> 2003
Oct;127(10):1263-79.
AUTORES
/ AUTHORS: - Amin MB; Srigley JR; Grignon DJ; Reuter
VE; Humphrey PA; Cohen MB; Hammond ME
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, Emory University
Hospital, Atlanta, Ga, USA.
----------------------------------------------------
[28]
TÍTULO / TITLE: - Renal transplantation
in HBsAg+ patients: is lamivudine your “final answer”?
REVISTA
/ JOURNAL: - J Clin Gastroenterol 2003 Jul;37(1):9-11.
AUTORES
/ AUTHORS: - Fontana RJ N. Ref:: 30
----------------------------------------------------
[29]
- 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
----------------------------------------------------
[30]
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.
----------------------------------------------------
[31]
TÍTULO / TITLE: - Current treatment
strategies in ANCA-positive renal vasculitis-lessons from European randomized
trials.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Jul;18 Suppl 5:v2-4.
AUTORES
/ AUTHORS: - Tesar V; Rihova Z; Jancova E; Rysava R;
Merta M
INSTITUCIÓN
/ INSTITUTION: - First Medical Department, First Medical
Faculty, Charles University, Prague, Czech Republic. tesar@beba.cesnet.cz
RESUMEN
/ SUMMARY: - Antineutrophil cytoplasmic antibody (ANCA)-positive
renal vasculitis is the most common cause of rapidly progressive (crescentic)
glomerulonephritis. Its life-threatening natural course may be modified
substantially by current treatment modalities. The European Vasculitis Study
Group (EUVAS) developed a subclassification of ANCA-positive vasculitides based
on the disease severity at presentation, and have organized (so far) two waves
of clinical trials. The first wave of randomized clinical trials had the aim of
optimizing the existing therapeutic regimens; the second wave concentrated on
testing some newer therapeutic approaches. Here, the design and available
results of the first wave and the design of some second wave trials are
reviewed briefly. The potential of the new targeted approaches (e.g.
anti-tumour necrosis factor therapy) is also briefly mentioned. N. Ref:: 9
----------------------------------------------------
[32]
TÍTULO / TITLE: - Angiotensin II type 1
(AT1) receptor antagonists in the treatment of hypertension after renal transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001;16 Suppl 1:117-20.
AUTORES
/ AUTHORS: - Holgado R; Anaya F; Del Castillo D
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Hospital Reina
Sofia, 14012 Cordoba, España.
RESUMEN
/ SUMMARY: - Hypertension is highly prevalent after
renal transplantation and has been associated with lower graft survival.
Optimum management of post-transplant hypertension remains to be defined.
Losartan, a potent, orally active and selective non-peptide blocker of the
angiotensin subtype 1 receptor, could represent a useful drug for treating
post-transplant hypertension. Recently, a prospective study of 12 weeks
treatment with losartan has showed a satisfactory control of arterial
hypertension associated with a decrease in proteinuria in this high-risk group
of renal transplant patients. A retrospective study was performed to review the
role of losartan as a renoprotective agent (evaluating blood pressure and
proteinuria) in renal transplant recipients in a long-term follow-up. A total
of 150 transplant recipients were included in the study. None of the patients
had a serum creatinine >3 mg/dl, or suspected renal artery stenosis, or
other severe concomitant diseases. The indication for losartan therapy was
hypertension, proteinuria and/or post-transplant erythrocytosis. The values of
blood pressure, results of fasting haematology, blood chemistry and total proteinuria
in 24-h urine samples were recorded at the time of initiation of losartan
therapy, 6 and 3 months before the start, and at 3, 6, 12, 18 and 24 months
thereafter. A tendency analysis by linear regression comparing two slopes
before and after treatment was realized. A decrease in mean blood pressure and
proteinuria, from 106.7+/-0.9 to 98.2+/-2.1 mmHg and from 1253.9+/-188 to
91.2+/-33.7 mg/24 h, P<0.05, respectively, was observed after introduction
of losartan. A progressive increase in creatinine clearance was observed after
the third month of losartan treatment. No significant changes were seen in
haematocrit or serum potassium levels. We can conclude that a progressive
decrease in mean arterial pressure associated with a decrease in proteinuria was
observed during long-term follow-up. Based on the capacity of losartan to
improve renal function, this drug could be decisive for the treatment and
prevention of chronic allograft nephropathy.
N. Ref:: 32
----------------------------------------------------
[33]
TÍTULO / TITLE: - Calcineurin-free
protocols with basiliximab induction allow patients included in “old to old”
programs achieve standard kidney transplant function.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Jun;35(4):1326-7.
AUTORES
/ AUTHORS: - Emparan C; Laukotter M; Wolters H; Dame C;
Heidenreich S; Senninger N
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, Uniklinikum Munster, Munster, Germany. cemparan@teleline.es
RESUMEN
/ SUMMARY: - INTRODUCTION: The EuroTransplant “old to
old” program establishes that patients older than 60 years can receive offers
of organs from donors older than 60 years. The compromised function of these
organs makes it a priority to preserve their initial kidney function.
HYPOTHESIS: Calcineurin-sparing protocols using anti-IL-2 receptor (IL-2R)
antibody induction (Simulect) may benefit initial kidney function in these
patients, as assessed by the rates of delayed graft function and of rejection
during the first month after transplant. PATIENTS AND METHODS: A cohort of 15
consecutive elderly patients were prospectively compared with 30 cadaveric
kidney transplants in younger recipients. Study patients were induced with
Simulect (20 mg, 30 minutes before reperfusion and 4 days after
transplantation) and steroids, delaying the introduction of CsA until the serum
creatinine was below 3 mg/dL. The other cohort of patients were
immunosuppressed with tacrolimus (trough 8 to 12), mycophenolats mofetil (MMF,
1 g/d), and an identical taper of steroids. The analysis compared donor and
recipient ages, mean cold ischemic time, incidence of initial kidney function
(diuresis in the first 24 h) serum creatinine levels, glomerular filtration
rate (GFR), number of dialysis sessions, and rejection rate in the two groups.
RESULTS: Except for the donor and recipient ages (72 vs 54 in donors, and 67
versus 52 years in recipients), no significant differences were observed
between the groups among the rates of acute rejection (6.6% vs 13.2%), delayed
graft function (13.2% required dialysis), or infection (6.6%). Within 1 month
all 45 grafts showed primary function with equal creatinine levels (mean 1.65).
CONCLUSIONS: Calcineurin-free protocols using IL-2 therapy as the initial
suppression allow patients in the “old to old” ET program to display equal
results to cadaveric kidney transplants with initial treatment with calcineurin
antagonists.
----------------------------------------------------
[34]
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
----------------------------------------------------
[35]
TÍTULO / TITLE: - Mycophenolate mofetil:
implications for the treatment of glomerular disease.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001 Sep;16(9):1752-6.
AUTORES
/ AUTHORS: - Badid C; Desmouliere A; Laville M
INSTITUCIÓN
/ INSTITUTION: - Departement de Nephrologie et EA645,
Universite Claude Bernard, Hopital Edouard Herriot, 5 place d’Arsonval, F-69437
Lyon Cedex 03, France. N.
Ref:: 44
----------------------------------------------------
[36]
TÍTULO / TITLE: - Renal dopaminergic
mechanisms in renal parenchymal diseases and hypertension.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001;16 Suppl 1:53-9.
AUTORES
/ AUTHORS: - Pestana M; Jardim H; Correia F;
Vieira-Coelho MA; Soares-da-Silva P
INSTITUCIÓN
/ INSTITUTION: - Departments of Nephrology, and Institute
of Pharmacology and Therapeutics, Faculty of Medicine, 4200 Porto, Portugal.
RESUMEN
/ SUMMARY: - The present report addresses the status of
the renal dopaminergic system activity in patients afflicted with different
renal disorders and in the remnant kidney of uninephrectomized (UNX) rats,
based on the urinary excretion of L-DOPA, dopamine and amine metabolites. In
renal transplant recipients with good recovery of graft function (group 1,
n=11), the daily urinary excretion of DOPAC, but not that of HVA, was found to
increase progressively throughout the first 12 days post-transplantation from
698+/-57 nmol in the first day to 3498+/-414 nmol on day 9, and then remained
constant until day 12. This resulted in a 6-fold increase in the urinary
DOPAC/dopamine ratios. In renal transplant recipients with acute tubular
necrosis (group 2, n=8), the urinary levels of dopamine, DOPAC and HVA were
approximately 30% of those in group 1. In a group of 28 patients with chronic
renal parenchymal disorders, the daily urinary excretion of L-DOPA, free
dopamine and dopamine metabolites (DOPAC and HVA) correlated positively with
the degree of deterioration of renal function (P<0.01). However, the
U(Dopamine/(L)-DOPA) and U(DOPAC/Dopamine) ratios in patients with chronic
renal insufficiency were found to be similar to those observed in patients with
normal renal function. In 14 IgA nephropathy (IgA-N) patients with near normal
renal function, the changes in 24 h mean blood pressure when going from 20 to
350 mmol/day sodium intake correlated negatively with the daily urinary
excretion of dopamine (r(2)=0.597, P<0.01). The urinary excretion of L-DOPA
and dopamine in IgA-N patients with salt-sensitive (SS) blood pressure was
lower than in salt-resistant (SR) patients (P<0.05), irrespective of their
daily sodium intake. However, the rise in urinary dopamine output during salt
loading (from 20 to 350 mmol/day) was greater (P<0.05) in IgA-N SS patients
(21.2+/-2.5% increase) than in SR patients (6.3+/-1.4% increase). Fifteen days
after the surgery, uninephrectomy (UNX) in the rat was accompanied by an
enhanced (P<0.05) urinary excretion of dopamine (36+/-3 vs 26+/-2), DOPAC
(124+/-11 vs 69+/-6) and HVA (611+/-42 vs 354+/-7) (nmol/g kidney/kg body
weight). This was accompanied by an increase in V(max) values for renal
aromatic L-amino acid decarboxylase in the remnant kidney of UNX rats
(P<0.05). Sch 23390, a D1 dopamine receptor antagonist, produced a marked
reduction in the urinary excretion of sodium in UNX rats, whereas in
sham-operated rats the decrease in urinary sodium did not attain a significant
difference. It is concluded that the study of the renal dopaminergic system in
patients afflicted with renal parenchymal disorders should address parameters
other than free urinary dopamine, namely the urinary excretion of L-DOPA and
dopamine metabolites (DOPAC and HVA). It is also suggested that in SS
hypertension of chronic renal parenchymal diseases, renal dopamine produced in
the residual tubular units may be enhanced during a sodium challenge, thus
behaving appropriately as a compensatory natriuretic hormone. N. Ref:: 25
----------------------------------------------------
[37]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.3.4. Long-term immunosuppression. Non-compliance.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:23-4.
RESUMEN
/ SUMMARY: - GUIDELINES: A. The detection of
non-compliers should be a permanent concern of the transplant team (doctors,
nurses and others). B. Because non-compliance is associated with late graft
dysfunction and graft loss, it is important to reduce the proportion of
non-compliers by implementing specific educational programmes addressing this
problem and the importance of immunosuppressive medications. C. Non-compliance
starts during the first year and may increase thereafter. Therefore, the
specific educational programme should be repeated and adapted to the need of
the transplant recipient, with delivery of few but clear messages.
----------------------------------------------------
[38]
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.
----------------------------------------------------
[39]
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.
----------------------------------------------------
[40]
TÍTULO / TITLE: - Angiopoietin growth
factors and Tie receptor tyrosine kinases in renal vascular development.
REVISTA
/ JOURNAL: - Pediatr Nephrol 2001 Feb;16(2):177-84.
AUTORES
/ AUTHORS: - Woolf AS; Yuan HT
INSTITUCIÓN
/ INSTITUTION: - Nephro-Urology Unit, Institute of Child
Health, University College London, UK. a.woolf@ich.ucl.ac.uk
RESUMEN
/ SUMMARY: - Angiopoietin-1 (Ang-1) is a secreted
growth factor which binds to and activates the Tie-2 receptor tyrosine kinase.
The factor enhances endothelial cell survival and capillary morphogenesis, and
also limits capillary permeability. Ang-2 binds the same receptor but fails to
activate it: hence, it is a natural inhibitor of Ang-1. Ang-2 destabilises
capillary integrity, facilitating sprouting when ambient vascular endothelial
growth factor (VEGF) levels are high, but causing vessel regression when VEGF
levels are low. Tie-1 is a Tie-2 homologue but its ligands are unknown.
Angiopoietin and Tie genes are expressed in the mammalian metanephros, the
precursor of the adult kidney, where they may play a role in endothelial
precursor growth. Tie-1-expressing cells can be detected in the metanephros
when it first forms and, based on transplantation experiments, these precursors
contribute to the generation of glomerular capillaries. During glomerular
maturation, podocyte-derived Ang-1 and mesangial-cell-derived Ang-2 may affect
growth of nascent capillaries. After birth, vasa rectae acquire their mature
configuration and Ang-2 expressed by descending limbs of loops of Henle would
be well placed to affect the growth of this medullary microcirculation.
Finally, preliminary data implicate angiopoietins in deregulated vessel growth
in Wilms’ kidney tumours and in vascular remodelling after nephrotoxicity. N. Ref:: 64
----------------------------------------------------
[41]
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.
----------------------------------------------------
[42]
TÍTULO / TITLE: - Vitamin D as
immunomodulatory therapy for kidney transplantation.
REVISTA
/ JOURNAL: - Transplantation 2002 Oct 27;74(8):1204-6.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000031949.70610.BB
AUTORES
/ AUTHORS: - Becker BN; Hullett DA; O’Herrin JK; Malin
G; Sollinger HW; DeLuca H
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, B-3063 UW
Nephrology, University of Wisconsin, 2500 Overlook Terrace, Madison, WI 53705,
USA. bnb@medicine.wisc.edu
RESUMEN
/ SUMMARY: - Vitamin D (1alpha,25-dihydroxyvitamin D(3)
[1alpha,25-(OH)(2)D(3)]) has been studied in the past for its immunosuppressive
properties, and, in that context, it may also have potential utility as an
immunomodulatory agent for transplantation. A number of studies have
demonstrated that 1alpha,25-(OH)(2)D(3) or its analogs regulate immune cell
proliferation, differentiation, and responsiveness. A burgeoning number of
studies have also explored using 1alpha,25-(OH)(2)D(3) and its analogs directly
as therapy in animal models of kidney transplantation with success in
prolonging allograft function and preventing acute rejection. Some of these in
vivo effects may well be caused by alterations in immune cell function, but it
is also possible that exogenous 1alpha,25-(OH)(2)D(3) and its analogs are
altering the intragraft milieu as well, specifically through changes in the
TGF-beta signaling cascade. Such provocative data and the availability of newer
1alpha,25-(OH)(2)D(3) analogs that may limit side effects (e.g. hypercalcemia)
have created interest in examining this secosteroid clinically in kidney
transplantation. N.
Ref:: 34
----------------------------------------------------
[43]
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
----------------------------------------------------
[44]
TÍTULO / TITLE: - Kidney and liver
transplantation in HIV-infected patients: case presentations and review.
REVISTA
/ JOURNAL: - AIDS Patient Care STDS 2003
Oct;17(10):501-7.
●●
Enlace al texto completo (gratuito o de pago) 1089/108729103322494294
AUTORES
/ AUTHORS: - Roland ME; Adey D; Carlson LL; Terrault NA
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
California, San Francisco, San Francisco, California, USA. mroland@php.ucsf.edu
RESUMEN
/ SUMMARY: - Until recently, HIV-infected patients have
been excluded from consideration for solid organ transplantation. The
relatively high mortality rates among HIV-infected transplant recipients
observed in the era prior to the use of highly active antiretroviral therapy
(HAART), coupled with long waiting times for cadaveric organs, made it
difficult to support organ transplantation in this patient group. However, in
response to the marked reductions in morbidity and mortality associated with
HIV infection, several transplant centers have developed pilot studies or
revised their clinical criteria to allow transplantation in this group of
patients. We describe two cases, one kidney and one liver transplant recipient,
and review the major clinical and research issues related to this topic.
Reports of transplantations in the pre-HAART era highlight two important
findings. First, some HIV-infected transplant recipients did very well with
long survival periods. However, overall progression to AIDS and death appeared
accelerated. We recently reported on our preliminary experience with 45
selected transplant recipients in the HAART era. One-year patient survival
rates were similar to unmatched survival data from the United Network for Organ
Sharing (UNOS) database. Median CD4+ T-cell counts remained stable in the follow-up
period compared to pretransplant. HIV-1 RNA nearly uniformly continued to be
suppressed below the limits of detection. Preliminary data are promising and
support the current efforts to evaluate patient and graft survival among
HIV-infected transplant recipients and to explore the mechanisms underlying the
many potential complications of transplantation in this population. N. Ref:: 21
----------------------------------------------------
[45]
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
----------------------------------------------------
[46]
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
----------------------------------------------------
[47]
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
----------------------------------------------------
[48]
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
----------------------------------------------------
[49]
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
----------------------------------------------------
[50]
TÍTULO / TITLE: - Pharmacokinetics of
tacrolimus-based combination therapies.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 May;18 Suppl 1:i12-5.
AUTORES
/ AUTHORS: - Undre NA
INSTITUCIÓN
/ INSTITUTION: - Fujisawa GmbH, Neumarkter Str. 61, D-81673
Munich, Germany. nas.undre@fujisawa.de
RESUMEN
/ SUMMARY: - This paper reviews the pharmacokinetics of
tacrolimus, with special reference to its combination with adjunctive
immunosuppressants. Oral bioavailability of tacrolimus, which is variable
between patients, averages approximately 25%. This is largely due to
extrahepatic metabolism of tacrolimus in the gastrointestinal epithelium.
Nevertheless, intra-patient variability is low, as evidenced by the small
number of dose changes required to maintain patients within the recommended
tacrolimus target levels. Tacrolimus is distributed extensively in the body
with most partitioned outside the blood compartment. Concentrations of
tacrolimus in blood are used as a surrogate marker of clinically relevant
concentration of the drug at the site(s) of action. Convenient whole-blood
sampling within a +/-2-h window around 12 h post-dose (C(min)) is highly
predictive of systemic exposure to tacrolimus and is thus used to optimise
therapy. Sampling at other time-points offers no advantage over C(min)
monitoring. The interactions of tacrolimus with other immunosuppressive agents
are well characterized. After cessation of concomitant corticosteroid
treatment, exposure to tacrolimus increases by approximately 25%. In contrast,
there is no pharmacokinetic interaction between mycophenolate mofetil (MMF) and
tacrolimus. Therefore, systemic exposure to the active metabolite of MMF,
mycophenolic acid, is higher with MMF-tacrolimus combination than with MMF-cyclosporin
combination. Therefore, 1 g/day MMF may be an adequate maintenance dose in
tacrolimus-based regimens. Co-administration of tacrolimus and sirolimus, while
having no effect on exposure to sirolimus, results in reduced exposure to
tacrolimus at sirolimus doses of 2 mg/day and above. In conclusion, tacrolimus
levels should be monitored when sirolimus is co-administered at doses >2
mg/day and after cessation of corticosteroid treatment. N. Ref:: 13
----------------------------------------------------
[51]
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
----------------------------------------------------
[52]
TÍTULO / TITLE: - Bone remodeling after
renal transplantation.
REVISTA
/ JOURNAL: - Kidney Int Suppl 2003 Jun;(85):S125-8.
AUTORES
/ AUTHORS: - Bellorin-Font E; Rojas E; Carlini RG;
Suniaga O; Weisinger JR
INSTITUCIÓN
/ INSTITUTION: - Centro Nacional de Dialisis y Trasplante,
Division of Nephrology, Hospital Universitario de Caracas, Venezuela. ebellori@telcel.net.ve
RESUMEN
/ SUMMARY: - Several studies have indicated that bone
alterations after transplantation are heterogeneous. Short-term studies after
transplantation have shown that many patients exhibit a pattern consistent with
adynamic bone disease. In contrast, patients with long-term renal
transplantation show a more heterogeneous picture. Thus, while adynamic bone
disease has also been described in these patients, most studies show decreased
bone formation and prolonged mineralization lag-time faced with persisting bone
resorption, and even clear evidence of generalized or focal osteomalacia in
many patients. Thus, the main alterations in bone remodeling are a decrease in
bone formation and mineralization up against persistent bone resorption,
suggesting defective osteoblast function, decreased osteoblastogenesis, or
increased osteoblast death rates. Indeed, recent studies from our laboratory
have demonstrated that there is an early decrease in osteoblast number and
surfaces, as well as in reduced bone formation rate and delayed mineralization
after transplantation. These alterations are associated with an early increase
in osteoblast apoptosis that correlates with low levels of serum phosphorus.
These changes were more frequently observed in patients with low turnover bone
disease. In contrast, PTH seemed to preserve osteoblast survival. The
mechanisms of hypophosphatemia in these patients appear to be independent of
PTH, suggesting that other phosphaturic factors may play a role. However,
further studies are needed to determine the nature of a phosphaturic factor and
its relationship to the alterations of bone remodeling after
transplantation. N.
Ref:: 27
----------------------------------------------------
[53]
- 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
----------------------------------------------------
[54]
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.
----------------------------------------------------
[55]
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
----------------------------------------------------
[56]
TÍTULO / TITLE: - TGF-beta(1) gene
expression in protocol biopsies from patients with stable renal allograft
function.
REVISTA
/ JOURNAL: - Transplant Proc 2001
Feb-Mar;33(1-2):342-4.
AUTORES
/ AUTHORS: - Hueso M; Bover J; Espinosa L; Moreso F;
Seron D; Canas C; Raulf F; Blanco A; Gil-Vernet S; Carreras M; Castelao AM;
Grinyo JM; Alsina J
INSTITUCIÓN
/ INSTITUTION: - Nephrology Department, CSUB, L’Hospitalet
de Llobregat, Barcelona, España.
----------------------------------------------------
[57]
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
----------------------------------------------------
[58]
- 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
----------------------------------------------------
[59]
TÍTULO / TITLE: - Lamivudine therapy for
severe acute hepatitis B virus infection after renal transplantation: case
report and literature review.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Sep;33(6):2948-9.
AUTORES
/ AUTHORS: - Nakhoul F; Gelman R; Green J; Khankin E;
Baruch Y
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Molecular
Medicine, Rambam Medical Center, Haifa, Israel. N. Ref:: 13
----------------------------------------------------
[60]
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.
----------------------------------------------------
[61]
- Castellano -
TÍTULO / TITLE:Reporte preliminar. Utilidad de la
angiotomografia renal en el protocolo del donador renal. Preliminary report.
Usefulness of computed tomographic angiography in the protocol of a kidney
donor.
REVISTA
/ JOURNAL: - Cir Cir. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.medigraphic.com/
●●
Cita: Cirugia y Cirujanos: <> 2003 Sep-Oct;71(5):379-82.
AUTORES
/ AUTHORS: - Ramirez-Bollas J; Hernandez-Dominguez M;
Arenas-Osuna J; Romero-Huesca A; Albores-Zuniga O
INSTITUCIÓN
/ INSTITUTION: - Cirujano General, Hospital de
Especialidades del Centro Medico Nacional “La Raza,” IMSS, Mexico D.F., Mexico.
juliobollas@yahoo.com.mx
RESUMEN
/ SUMMARY: - OBJECTIVE: To determine clinical
correlation of reports of computed tomographic angiography renal (CT-AR) and
surgical findings of the kidney donor patient. MATERIAL AND METHODS: Patients
were submitted nephrectomy in the related live donor renal transplant program
between January and December 2002 as paut of life to which he is made as he
CT-AR study protocol. Statistical analysis was carried out by descriptive
statistics. RESULTS: Anatomical characteristics of 35 kidneys of the same
number of live donors (AD) submitted CT-AR were evaluated and comparison with
report of surgical technique was made. Incidence of accessory renal arteries
was 23%. As reported by CT-AR, the were 39 renal arteries (91%) compared with
43 arteries found during surgery. CT-AR identified four supernumerary renal
arteries (50%) of eight identified during surgical technique; 36 hiliar
arteries (90%) and three polar arteries were identified by CT-AR (100%). Only
one a case report of early bifurcation of renal artery (20%) by CT-AR was
recorded. Anatomical characteristics of veins were described in their totality.
CT-AR is a useful instrument to identify alterations in anatomical structure of
the renal vasculature, with results similar to other studies for description of
renal arteries and veins. We propose ATR as the initial study for evaluation of
the renal architecture of the live kidney (LKD).
----------------------------------------------------
[62]
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.
----------------------------------------------------
[63]
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
----------------------------------------------------
[64]
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
----------------------------------------------------
[65]
TÍTULO / TITLE: - Interleukin 18 and
interleukin 18 binding protein: possible role in immunosuppression of chronic
renal failure.
REVISTA
/ JOURNAL: - Blood Purif 2003;21(3):258-70.
●●
Enlace al texto completo (gratuito o de pago) 1159/000070699
AUTORES
/ AUTHORS: - Dinarello CA; Novick D; Rubinstein M;
Lonnemann G
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
Colorado Health Sciences Center, Denver, Colo 80262, USA.
RESUMEN
/ SUMMARY: - Although interleukin (IL)-18 is a member
of the IL-1 family of ligands, IL-18 appears to have unique characteristics,
particularly in the regulation of the T helper type 1 (Th1) response. Th1
responses are required for tumor surveillance, killing intracellular organisms,
and to provide help for antibody production. In patients with chronic renal
failure, the well-known immunosuppression contributes to a failure to respond
to infectious challenges and vaccinations. The most salient biological property
of IL-18, linking this cytokine to the Th1 response, is its ability to induce
interferon gamma (IFN-gamma). In fact, IL-18 was originally identified as an
IFN-gamma-inducing factor, and IFN-gamma production is the hallmark of the Th1
response. Dysregulation of IFN-gamma production resulting from reduced activity
of IL-18 would explain one of the mechanisms of immunosuppression in patients
with chronic renal failure. The activity of IL-18 can be regulated by the
IL-18-binding protein (IL-18BP), a glycoprotein of 40,000 daltons, which is
constitutively expressed and appears to be the natural inhibitor of IL-18
activity. Unlike soluble receptors for IL-18, IL-18BP does not have a
transmembrane domain; IL-18BP is a secreted protein possessing a high-affinity
binding and ability to neutralize IL-18. IL-18BP was discovered in human urine
and is excreted in health following glomerular filtration. With decreasing
renal function, the concentrations of IL-18BP in the circulation are elevated
as compared with subjects with a normal renal function, and these elevated
levels may result in a decreased IL-18 activity. Because of the importance of
IL-18 and IFN-gamma in the Th1 response, the biology of IL-18 and IL-18BP is
reviewed here in the context of the immunosuppression of chronic renal
failure. N. Ref:: 81
----------------------------------------------------
[66]
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
----------------------------------------------------
[67]
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
----------------------------------------------------
[68]
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
----------------------------------------------------
[69]
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
----------------------------------------------------
[70]
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.
----------------------------------------------------
[71]
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
----------------------------------------------------
[72]
TÍTULO / TITLE: - Rapamycin in
combination with cyclosporine or tacrolimus in liver, pancreas, and kidney
transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2003 May;35(3
Suppl):201S-208S.
AUTORES
/ AUTHORS: - MacDonald AS
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Dalhousie
University, Halifax, Nova Scotia, Canada. Allan.macdonald@dal.ca
RESUMEN
/ SUMMARY: - A 10-year experience with the
immunosuppressive drug rapamycin that begins in the laboratory then extends
through multicentre trials in combination with cyclosporine in kidney
transplant recipients, exploration of its use as a single agent and in
combination with tacrolimus, and its potential in nonrenal organs is described.
Rapamycin is a potent inhibitor of endothelial injury in rat aortic allografts.
When added to full-dose cyclosporine it achieves low rejection rates, but it
augments the nephrotoxicity and hyperlipidemia of cyclosporine. On the other
hand, it allows discontinuation of calcineurin inhibitors in stable kidney and
liver patients suffering from nephrotoxicity late posttransplant. At least in
Caucasian patients, discontinuation of cyclosporine is possible as early as 3
months post-kidney transplant. In combination with low-dose tacrolimus,
exceptionally low rates of rejection were seen in recipients of kidney,
pancreas, and liver recipients with preservation of excellent renal function.
These pilot studies have been confirmed in several single-centre and, more
recently, multicentre trials in kidney and pancreas transplantation. The
side-effect profile of hyperlipidemia, lymphocoeles, delayed wound healing, and
possible liver effects are coming into focus, and ways of minimizing these
problems being introduced. The lessons learned include the need for early
adequate blood levels, the lack of correlation between dose and drug exposure,
and the potency that allows marked dose reductions in calcineurin inhibitors
and steroids. N.
Ref:: 36
----------------------------------------------------
[73]
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
----------------------------------------------------
[74]
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
----------------------------------------------------
[75]
TÍTULO / TITLE: - Sirolimus and
mycophenolate mofetil for calcineurin-free immunosuppression in renal
transplant recipients.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Oct;38(4 Suppl
2):S16-21.
AUTORES
/ AUTHORS: - Pescovitz MD; Govani M
INSTITUCIÓN
/ INSTITUTION: - Departments of Surgery,
Microbiology/Immunology, and Medicine, Indiana University, Indianapolis, IN
46202, USA. mpescov@iupui.edu
RESUMEN
/ SUMMARY: - Calcineurin inhibitors, such as
cyclosporine and tacrolimus, have been available for almost 20 years. Although
these drugs are highly effective and represent the mainstay of transplant
immunosuppression, they are associated with acute and chronic nephrotoxicity.
Acute nephrotoxicity, which occurs in the early period after transplantation,
leads to a higher rate of dialysis, and chronic nephrotoxicity may eventually
result in graft loss. Acute and chronic nephrotoxicity is becoming more common
as the use of marginal kidneys for transplantation increases. Two recently
available immunosuppressive agents, mycophenolate mofetil and sirolimus
(rapamycin), have no nephrotoxicity. The use of these drugs in combination with
other agents has led to the development of new paradigms of immunosuppressive
therapy. This paper reviews the results of clinical trials that have
investigated these new approaches to immunosuppression in renal transplant
recipients. N. Ref:: 9
----------------------------------------------------
[76]
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
----------------------------------------------------
[77]
TÍTULO / TITLE: - Young age and the risk
for ifosfamide-induced nephrotoxicity: a critical review of two opposing
studies.
REVISTA
/ JOURNAL: - Pediatr Nephrol 2001 Dec;16(12):1153-8.
●●
Enlace al texto completo (gratuito o de pago) 1007/s004670100053
AUTORES
/ AUTHORS: - Aleksa K; Woodland C; Koren G
INSTITUCIÓN
/ INSTITUTION: - Division of Clinical Pharmacology and
Toxicology, Hospital for Sick Children, 555 University Avenue, Toronto, Canada.
RESUMEN
/ SUMMARY: - Ifosfamide has been in use as an effective
antineoplastic agent for solid tumors in both children and adults since the
late 1960s. Although some adverse effects (e.g. hemorrhagic cystitis) can be
overcome by the co-administration of 2-mercaptoethanesulfonate (MESNA), others
such as nephrotoxicity cannot. There is a consensus that factors such as the
cumulative dose of ifosfamide and concomitant cisplatin administration may
influence not only the incidence but also the severity of ifosfamide-induced
renal toxicity. Several preliminary studies suggested young age as a risk
factor for nephrotoxicity; however, there is little agreement on this. The
reasons for this uncertainty may include sample size, study design, dose and
differences in renal function assessment. In this review we examine the two
largest cohort studies conducted in pediatric patients. One study suggests that
ifosfamide-induced renal toxicity is age- related, whereas analysis of the
other failed to show age as an important predictor for ifosfamide-induced renal
toxicity. The studies differed in design, end-points of toxicity and concomitant
drug therapy. Due to the effectiveness of ifosfamide as an antineoplastic
agent, it is important that an understanding of the factors that predispose
pediatric patients to ifosfamide-induced nephrotoxicity be obtained. N. Ref:: 26
----------------------------------------------------
[78]
TÍTULO / TITLE: - Minimizing calcineurin
inhibitor drugs in renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2003 May;35(3
Suppl):118S-121S.
AUTORES
/ AUTHORS: - Flechner SM
INSTITUCIÓN
/ INSTITUTION: - Section of Renal Transplantation,
Transplant Center A110, Cleveland Clinic Foundation, Cleveland, Ohio 44195,
USA.
RESUMEN
/ SUMMARY: - Calcineurin inhibitor drugs (CNI),
primarily cyclosporine then tacrolimus, have been the centerpieces of
maintenance immunosuppression for kidney transplantation since their
introduction in the 1980s. While these drugs have been responsible for improved
short-term outcomes and diminished rates of acute rejection, they are
nephrotoxic and can cause permanent renal injury in many patients. Indeed, some
have found that at 10 years after transplantation, the benefits of CNI drugs
have been lost compared to the previous generation of maintenance
immunosuppression. The use of these agents over many years contributes to the antigen-independent
decline in renal function referred to as chronic allograft nephropathy.
However, it remains unclear to what degree the use of CNI drugs contribute to
ultimate graft loss. For these reasons immunosuppressive alternatives to CNI
drugs have begun to emerge during the past few years. The recent introduction
of the potent immunosuppressive agent sirolimus has afforded an opportunity to
develop a regimen designed to maximize prophylaxis of early acute rejection,
absent drug-induced nephrotoxicity. It was our feeling that the combination of
antibody induction therapy combined with sirolimus substitution in a three-drug
maintenance regimen, would provide the best posttransplant renal function and
lowest rates of acute rejection. We have developed a CNI-free immunosuppressive
regimen consisting of basiliximab induction, followed by sirolimus, MMF and
steroids. Using this protocol we demonstrated comparable transplant outcomes
with improved renal function in adult recipients of primary renal transplants.
Limiting nephrotoxic immunosuppression should be considered an important goal;
but requires sufficient long-term follow-up to support the benefits suggested
from initial analysis of the data. N.
Ref:: 23
----------------------------------------------------
[79]
TÍTULO / TITLE: - Complement activation
in early protocol kidney graft biopsies after living-donor transplantation.
REVISTA
/ JOURNAL: - Transplantation 2003 Apr 27;75(8):1204-13.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000062835.30165.2C
AUTORES
/ AUTHORS: - Sund S; Hovig T; Reisaeter AV; Scott H;
Bentdal O; Mollnes TE
INSTITUCIÓN
/ INSTITUTION: - Department/Institute of Pathology,
Rikshospitalet University Hospital, Oslo, Norway. stale.sund@helse-forde.no.
RESUMEN
/ SUMMARY: - BACKGROUND: To gain insight into
complement activation in kidney grafts, we studied the deposition of components
from all complement pathways in protocol biopsies from living-donor recipients
that were taken 1 week (median 7 days) after transplantation. METHODS: Graft
protocol biopsies (n=37) were taken consecutively and stained for two-color
immunofluorescence, with antibodies to C4d, C3, C1q, factor B, C6, terminal
C5b-9 complement complex, mannose-binding lectin (MBL), and MBL-associated
serine protease-1, combined with an endothelial marker. Light and electron microscopy
were performed in all cases. Clinical acute rejection (AR), graft loss, and
long-term kidney function were recorded. Baseline biopsies from 15 of the
patients served as controls. RESULTS: Endothelial C4d deposition was
demonstrated in peritubular capillaries in 11 of 37 cases (30%), of which 9 of
11 (82%) experienced clinical AR but only 6 of 11 (55%) experienced AR as
defined by histopathologic criteria. Biopsies from three patients, two with
early graft loss, showed diffuse global C4d in the glomerular endothelium with
codeposition of C3 in all patients and MBL-associated serine protease-1 in one
patient. Focal peritubular capillary C3 deposition was found in two additional
C4d-positive cases with AR. No posttransplant deposition was demonstrated for
the other components. CONCLUSIONS: Early diffuse C4d deposition in the kidney
graft capillaries is closely related to acute humoral rejection, whereas focal
staining may occur with mild AR or, rarely, without rejection. Codeposition of
C3 indicates early AR with a higher risk of graft loss. In most cases,
activation was limited to C4d, indicating efficient in situ regulation of
complement activation.
----------------------------------------------------
[80]
TÍTULO / TITLE: - Renal transplantation
studies in genetic hypertension.
REVISTA
/ JOURNAL: - News Physiol Sci. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://nips.physiology.org/contents-by-date.0.shtml
●●
Cita: News in Physiological Sciences: <> 2001 Dec;16:262-5.
AUTORES
/ AUTHORS: - Grisk O; Rettig R
INSTITUCIÓN
/ INSTITUTION: - Department of Physiology, University of
Greifswald, D-17487 Greifswald, Germany.
N. Ref:: 17
----------------------------------------------------
[81]
TÍTULO / TITLE: - Renal artery aneurysm:
ex vivo repair and autotransplantation: case report and review of the
literature.
REVISTA
/ JOURNAL: - Int Surg 2003 Apr-Jun;88(2):61-3.
AUTORES
/ AUTHORS: - El Tayar AR; Labruzzo C; Haritopoulos K;
Hakim NS
INSTITUCIÓN
/ INSTITUTION: - Renal Transplant Unit, St. Mary’s
Hospital, London, United Kingdom.
RESUMEN
/ SUMMARY: - The incidence of renal artery aneurysm is
unknown, its natural history is unclear and unpredictable, and the clinical
symptoms are of little or no value in diagnosis. The risk of rupture is high in
pregnant women, as in splenic artery aneurysms and in aneurysms greater than 2
cm in size. Digital subtraction angiography is the best diagnostic test. When
an aneurysm is identified, surgery is the best treatment option to avoid
hypertension or rupture of the aneurysm. Because of advances in organ
preservation, nephrectomy, ex vivo repair, and autotransplantation is a safe
and successful procedure. We report the case of a 2-cm-wide neck aneurysm that
was treated by nephrectomy, ex vivo repair, and auto-transplantation. N. Ref:: 16
----------------------------------------------------
[82]
- 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
----------------------------------------------------
[83]
TÍTULO / TITLE: - MR imaging of renal
function.
REVISTA
/ JOURNAL: - Radiol Clin North Am 2003
Sep;41(5):1001-17.
AUTORES
/ AUTHORS: - Huang AJ; Lee VS; Rusinek H
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology-MRI, New York
University Medical Center, 530 First Avenue, HCC Basement, New York, NY 10016,
USA.
RESUMEN
/ SUMMARY: - MR imaging is the only single noninvasive
test that can potentially provide a complete picture of renal status with
minimal risk to the patient, simultaneously improving diagnosis while lowering
medical costs by virtue of its being a single test. The strengths of MR imaging
lie in its high spatial and temporal resolution and its lack of exposure to
ionizing radiation and nephrotoxic contrast agents. This article reviews the
use of MR imaging for quantification of renal functional parameters and its
application to clinical problems, such as RVD, hydronephrosis, and renal
transplantation. Although advances in both the technical and clinical aspects
of functional renal MR imaging have been made, much remains to be done. The
preliminary results reported in the many studies reviewed are exciting, but
these techniques need to be validated against accepted standards where such
standards exist. In addition, and perhaps more important, the effects of these
new diagnostic methods on patient outcomes must be studied. Finally, further
progress in image processing and analysis must be made to make functional renal
MR imaging truly practical. With these advances, one can expect functional
renal MR imaging to play an ever-expanding and influential role in the care and
management of the patient with renal disease.
N. Ref:: 57
----------------------------------------------------
[84]
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
----------------------------------------------------
[85]
TÍTULO / TITLE: - General health
management and long-term care of the renal transplant recipient.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S10-24.
AUTORES
/ AUTHORS: - Cohen D; Galbraith C
INSTITUCIÓN
/ INSTITUTION: - Columbia Presbyterian Hospital, New York,
NY 10032, USA. djc5@columbia.edu
RESUMEN
/ SUMMARY: - The steady improvement in short-term
success rates in renal transplant patients has translated into better long-term
success rates and a large number of patients with long-functioning renal
transplants. The necessity for the lifelong administration of immunosuppressive
medications to prevent rejection, coupled with the presence in many patients of
a variety of other medical problems dating from the period of renal
insufficiency prior to the time of renal transplantation, has created a large
group of patients with a unique and complex set of long-term medical care
needs. Due to the constraints of managed care, considerations of geography, or
patient preference, the long-term care of an increasing number of renal
transplant recipients has shifted away from the transplant center to the
community-based nephrologist or internist. For optimal care to be delivered, it
is important that the physicians managing these patients be cognizant of the
complex and interacting medical issues involved in their care. Appropriate
management can significantly prolong the life of the allograft as well as that of
the patient. Guidelines for understanding and managing some of the more
important and common general medical problems facing the long-term renal
transplant recipient (eg, infectious complications, cardiovascular disease,
hypertension, diabetes, hyperlipidemia, malignancy, pregnancy, bone disease,
dental care, preventive care) are addressed in this section. N. Ref:: 47
----------------------------------------------------
[86]
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
----------------------------------------------------
[87]
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.
----------------------------------------------------
[88]
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
----------------------------------------------------
[89]
TÍTULO / TITLE: - Anti-interleukin-2
receptor antibodies: basiliximab and daclizumab.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001 Sep;16(9):1756-60.
AUTORES
/ AUTHORS: - Pascual J; Marcen R; Ortuno J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Hospital Ramon y
Cajal, Universidad de Alcala, Carretera de Colmenar km 9, 100, E-28034 Madrid,
España. N. Ref:: 31
----------------------------------------------------
[90]
TÍTULO / TITLE: - A prospective study of
rapid corticosteroid elimination in simultaneous pancreas-kidney
transplantation: comparison of two maintenance immunosuppression protocols:
tacrolimus/mycophenolate mofetil versus tacrolimus/sirolimus.
REVISTA
/ JOURNAL: - Transplantation 2002 Jan 27;73(2):169-77.
AUTORES
/ AUTHORS: - Kaufman DB; Leventhal JR; Koffron AJ;
Gallon LG; Parker MA; Fryer JP; Abecassis MM; Stuart FP
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, Northwestern University Medical School, 675 N. St. Clair
Street, Galter Pavilion, Suite 17-200, Chicago, IL 60611, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: We examined the feasibility of
rapid corticosteroid elimination in simultaneous pancreas kidney
transplantation. METHODS: Forty consecutive simultaneous pancreas-kidney (SPK)
transplant recipients were enrolled in a prospective study in which
antithymocyte globulin induction and 6 days of corticosteroids were
administered along with tacrolimus and MMF (n=20) or tacrolimus and sirolimus
(n=20). Mean+/-SD follow-up for recipients receiving tacrolimus/MMF and
tacrolimus/sirolimus were 12.7+/-3.9 and 13.4+/-2.9 months, respectively.
Patient and graft survival, and rejection rates were compared to an historical
control group (n=86; mean follow-up 41.5+/-15.4 months) of SPK recipients that
received induction and tacrolimus, MMF, and corticosteroids. RESULTS:
Demographic characteristics of recipient and donor variables were similar among
all groups. The 1-year actuarial patient, kidney, and pancreas survival rates
in the 40 SPK transplant recipients with rapid corticosteroid elimination were
100, 100, and 100%, respectively. In the historical control group the 1-year
actual patient, kidney, and pancreas survival rates were 96.5, 93.0, and 91.9%,
respectively. The 1-year rejection-free survival rate recipients in the rapid
steroid elimination group collectively was 97.5 vs 80.2% in the historical
control group (P=0.034). At 6 and 12 months posttransplant the serum creatinine
values remained stable in all groups. CONCLUSIONS: We conclude that chronic
corticosteroid exposure is not required in SPK transplant recipients receiving
antithymocyte globulin induction and maintenance immuno-suppression consisting
of either tacrolimus and mycophenolate mofetil or tacrolimus and sirolimus.
----------------------------------------------------
[91]
TÍTULO / TITLE: - Membranous lupus
nephritis in a renal allograft: response to mycophenolate mofetil therapy.
REVISTA
/ JOURNAL: - Am J Transplant 2001 Sep;1(3):288-92.
AUTORES
/ AUTHORS: - Denton MD; Galvanek EG; Singh A; Sayegh MH
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA. dentonmd@gis.net
RESUMEN
/ SUMMARY: - Membranous lupus nephritis in a renal
allograft is considered rare. A 43-year-old man with quiescent systemic lupus
erythematosus (SLE) received a HLA identical transplant from his sister and 4
years later developed persistent nephrotic range proteinuria and morphological
features most compatible with membranous lupus nephritis on biopsy.
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor
antagonists, although successful in reducing proteinuria, were associated on
three occasions with acute allograft dysfunction. Sustained reduction of
proteinuria and stable graft function were achieved using mycophenolate mofetil
(MMF). MMF is emerging as a new therapy for primary renal disease in SLE. This
is the first report of successful treatment of membranous lupus nephritis in an
allograft using MMF. We review all cases of transplant-associated membranous
lupus nephritis in the English literature.
N. Ref:: 20
----------------------------------------------------
[92]
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
----------------------------------------------------
[93]
TÍTULO / TITLE: - Clinical trials, immunosuppression
and renal transplantation: new trends in design and analysis.
REVISTA
/ JOURNAL: - Pediatr Nephrol 2002 Aug;17(8):573-84.
Epub 2002 Jun 13.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00467-002-0909-z
AUTORES
/ AUTHORS: - Landais P; Daures JP
INSTITUCIÓN
/ INSTITUTION: - Laboratoire de Biostatistique et
d’Informatique Medicale, Hopital Necker Enfants Malades, Faculte Paris 5, 149
rue de Sevres, 75743 Paris Cedex 15, France. landais@necker.fr
RESUMEN
/ SUMMARY: - Clinical trials provide a framework to
search for more effective and less toxic immunosuppressive agents to control
renal transplant rejection. Some methodological aspects are presented. Patient
selection and the choice of study endpoints are discussed with emphasis on
standardized definitions and classification of histopathology, and on
qualification and quantification of chronic rejection. Choosing a Bayesian or a
frequentist approach and the afferent hypotheses is discussed together with the
interpretation of a P-value and a confidence interval. Strategies for limiting
the number of patients, increasing power and feasibility are reviewed,
including discussion of surrogate endpoints. New approaches to statistical
analysis are then presented, including intention-to-treat versus per-protocol
analysis, analysis of correlated data, dependent censoring, and meta-analysis
applied to renal transplantation. Pharmacoeconomics are finally introduced as
necessary for implementation of decision making regarding therapeutic
strategies. Reporting research increases its standards, and the CONSORT
(Consolidated Standards of Reporting Trials) and QOROM (Quality of Reporting of
Meta-analyses) criteria are to be integrated in the process of clinical trial
procedures. In conclusion, observational studies are presented as part of an
evidence-based approach in the hierarchy of evidence, keeping in mind that high
quality, randomized, controlled trials are still necessary to decrease
uncertainty in the field of renal transplantation. N. Ref:: 100
----------------------------------------------------
[94]
TÍTULO / TITLE: - Can bone marrow
differentiate into renal cells?
REVISTA
/ JOURNAL: - Pediatr Nephrol 2002 Oct;17(10):790-4.
Epub 2002 Aug 16.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00467-002-0949-4
AUTORES
/ AUTHORS: - Imai E; Ito T
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine and
Therapeutics, Division of Nephrology, Osaka University Graduate School of
Medicine, 2-2 Yamadaoka, Suita, 565-0871 Osaka, Japan. imai@medone.med.osaka-u.ac.jp
RESUMEN
/ SUMMARY: - A considerable plasticity of adult stem
cells has been confirmed in a wide variety of tissues. In particular, the
pluripotency of bone marrow-derived stem cells may influence the regeneration
of injured tissues and may provide novel avenues in regenerative medicine. Bone
marrow contains at least hematopoietic and mesenchymal stem cells, and both can
differentiate into a wide range of differentiated cells. Side population (SP)
cells, which are originally defined in bone marrow cells by high efflux of
DNA-binding dye, seem to be a new class of multipotent stem cells. Irrespective
of the approach used to obtain stem cells, the fates of marrow-derived cells
following bone marrow transplantation can be traced by labeling donor cells
with green fluorescence protein or by identifying donor Y chromosome in female
recipients. So far, bone marrow-derived cells have been reported to
differentiate into renal cells, including mesangial cells, endothelial cells,
podocytes, and tubular cells in the kidney, although controversy exists.
Further studies are required to address this issue. Cell therapy will be
promising when we learn to control stem cells such as bone marrow-derived stem
cells, embryonic stem cells, and resident stem cells in the kidney. Identification
of factors that support stem cells or promote their differentiation should
provide a relevant step towards cell therapy.
N. Ref:: 40
----------------------------------------------------
[95]
TÍTULO / TITLE: - Principles and clinical
application of assessing alterations in renal elimination pathways.
REVISTA
/ JOURNAL: - Clin Pharmacokinet 2003;42(14):1193-211.
AUTORES
/ AUTHORS: - Tett SE; Kirkpatrick CM; Gross AS;
McLachlan AJ
INSTITUCIÓN
/ INSTITUTION: - School of Pharmacy, University of Queensland,
Brisbane, Australia. s.tett@pharmacy.uq.edu.au
RESUMEN
/ SUMMARY: - Drugs and metabolites are eliminated from
the body by metabolism and excretion. The kidney makes the major contribution
to excretion of unchanged drug and also to excretion of metabolites. Net renal
excretion is a combination of three processes - glomerular filtration, tubular
secretion and tubular reabsorption. Renal function has traditionally been
determined by measuring plasma creatinine and estimating creatinine clearance.
However, estimated creatinine clearance measures only glomerular filtration
with a small contribution from active secretion. There is accumulating evidence
of poor correlation between estimated creatinine clearance and renal drug
clearance in different clinical settings, challenging the ‘intact nephron
hypothesis’ and suggesting that renal drug handling pathways may not decline in
parallel. Furthermore, it is evident that renal drug handling is altered to a
clinically significant extent in a number of disease states, necessitating
dosage adjustment not just based on filtration. These observations suggest that
a re-evaluation of markers of renal function is required. Methods that measure
all renal handling pathways would allow informed dosage individualisation using
an understanding of renal excretion pathways and patient characteristics.
Methodologies have been described to determine individually each of the renal
elimination pathways. However, their simultaneous assessment has only recently
been investigated. A cocktail of markers to measure simultaneously the
individual renal handling pathways have now been developed, and evaluated in
healthy volunteers. This review outlines the different renal elimination pathways
and the possible markers that can be used for their measurement. Diseases and
other physiological conditions causing altered renal drug elimination are
presented, and the potential application of a cocktail of markers for the
simultaneous measurement of drug handling is evaluated. Further investigation
of the effects of disease processes on renal drug handling should include
people with HIV infection, transplant recipients (renal and liver) and people
with rheumatoid arthritis. Furthermore, changes in renal function in the
elderly, the effect of sex on renal function, assessment of living kidney
donors prior to transplantation and the investigation of renal drug
interactions would also be potential applications. Once renal drug handling
pathways are characterised in a patient population, the implications for
accurate dosage individualisation can be assessed. The simultaneous measurement
of renal function elimination pathways of drugs and metabolites has the
potential to assist in understanding how renal function changes with different
disease states or physiological conditions. In addition, it will further our
understanding of fundamental aspects of the renal elimination of drugs. N. Ref:: 135
----------------------------------------------------
[96]
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
----------------------------------------------------
[97]
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
----------------------------------------------------
[98]
- Castellano -
TÍTULO / TITLE:Disfuncion endotelial en trasplante
renal. Endothelial dysfunction in renal transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2003;23 Suppl 4:52-8.
AUTORES
/ AUTHORS: - Crespo M; Campistol JM
INSTITUCIÓN
/ INSTITUTION: - Unidad de Trasplante Renal, Hospital
Clinic, IDIBAPS (Institut d’Investigacio Biomediques Agusti Pi i Sunyer),
Barcelona. N. Ref:: 55
----------------------------------------------------
[99]
TÍTULO / TITLE: - Tumour-like calcinosis
causing reversible tetraparesis in a patient on continuous ambulatory
peritoneal dialysis.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001 Sep;16(9):1958.
AUTORES
/ AUTHORS: - Ritz E; Hergesell O N. Ref:: 9
----------------------------------------------------
[100]
TÍTULO / TITLE: - Thymic microchimerism
correlates with the outcome of tolerance-inducing protocols for solid organ
transplantation.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2001
Dec;12(12):2815-26.
AUTORES
/ AUTHORS: - Noris M; Cugini D; Casiraghi F; Azzollini
N; De Deus Viera Moraes L; Mister M; Pezzotta A; Cavinato RA; Aiello S; Perico
N; Remuzzi G
INSTITUCIÓN
/ INSTITUTION: - Department of Immunology and Clinics of
Organ Transplantation, Mario Negri Institute for Pharmacological Research, via
Gavazzeni 11, 24125 Bergamo, Italy. noris@marionegri.it
RESUMEN
/ SUMMARY: - This study found that pretransplant
infusion of donor peripheral blood leukocytes, either total leukocytes
(peripheral blood leukocytes) or peripheral blood mononuclear cells (PBMC),
under appropriate immunomodulating conditions was more effective than donor
bone marrow (BM) in prolonging the survival of rats that received kidney
grafts. A higher percentage of MHCII(+) cells was found in donor PBMC than in BM
cells, and depletion of MHCII(+) cells from donor PBMC abolished their
tolerogenic potential. By the analysis of microchimerism in rats infused with
donor cells and killed at different time points thereafter, the better
tolerogenic potential of leukocyte infusion related to a higher capability of
these cells to engraft the recipient thymus. PCR analysis on OX6-immunopurified
cells revealed the presence of donor MHCII(+) cells in the thymus of these
animals. The role of intrathymic microchimerism was reinforced by findings that
thymectomy at the time of transplant prevented tolerance induction by donor
leukocytes. Donor DNA was found in the thymus of most long-term graft animals
that survived, but in none of those that rejected their grafts. The presence of
intrathymic microchimerism correlated with graft survival, and microchimerism
in other tissues was irrelevant. PCR analysis of DNA from thymic cell
subpopulations revealed the presence of donor MHCII(+) cells in the thymus of
long-term surviving animals. Thus, in rats, donor leukocyte infusion is better
than donor BM for inducing graft tolerance, defined by long-term graft
survival, donor-specific T cell hyporesponsiveness, and reduced interferon
gamma production. This effect appears to occur through migration of donor
MHCII(+) cells in the host thymus.
----------------------------------------------------
[101]
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
----------------------------------------------------
[102]
- Castellano -
TÍTULO / TITLE:Trasplante renal en receptores
mayores de 60 anos. Renal transplantation in donors over 60 years of age.
REVISTA
/ JOURNAL: - Arch Esp Urol 2003 Mar;56(2):151-9.
AUTORES
/ AUTHORS: - Gomez Vegas A; Blazquez Izquierdo J;
Bocardo Fajardo G; San Jose Manso L; Fernandez Perez C; Silmi Moyano A; Resel
Estevez L
INSTITUCIÓN
/ INSTITUTION: - Catedra y Servicio de Urologia, Hospital
Clinico San Carlos, Madrid, España.
RESUMEN
/ SUMMARY: - OBJECTIVES: To evaluate the impact of
receptor’s advanced age on kidney transplant outcomes. METHODS: We reviewed all
transplants performed between January 1990 and December 1999. Among 570
patients receiving grafts, 115 patients were 60 years or older at the time of
transplantation. We compared this group with receptors younger than 60 years.
We studied possible prognostic variables and compared patient and graft
outcomes. RESULTS: Mean age 63.81 (typical deviation (TD): 2.96). Mean
follow-up time for elderly receptors was 41.6 months (TD: 26.58). 55.7%
patients were males (p: 0.4). The most frequent cause for end stage renal
disease was unknown etiology in group 1 and glomerular in the younger group (p:
0.01). 42% patients older than 60 years presented initial graft dysfunction, in
comparison to 28.1% among younger than 60 (p: 0.006). Three-year graft survival
was 90.42% for receptors 60 years old or older compared to 88.72% for group 2,
without significant differences (p: 0.5). The most frequent graft loss etiology
was patient death. (67.7%). (p = 0.005). Patient survival was 81.01% in group 1
and 95.25% in group 2, being differences significant (p < 0.001).
CONCLUSIONS: Renal grafts in receptors over the age of 60 years show a greater
incidence of delayed graft function, although it doesn’t seem to influence
final graft survival. The most frequent cause for graft loss is receptor’s
death. Receptor’s age does not represent a contraindication for
transplant. N. Ref:: 17
----------------------------------------------------
[103]
TÍTULO / TITLE: - Interpreting the
mechanisms of continuous renal replacement therapy in sepsis: the peak
concentration hypothesis.
REVISTA
/ JOURNAL: - Artif Organs 2003 Sep;27(9):792-801.
AUTORES
/ AUTHORS: - Ronco C; Tetta C; Mariano F; Wratten ML;
Bonello M; Bordoni V; Cardona X; Inguaggiato P; Pilotto L; d’Intini V; Bellomo
R
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, St. Bortolo
Hospital, Vicenza, Italy. cronco@goldnet.it
RESUMEN
/ SUMMARY: - Severe sepsis and septic shock are the
primary causes of multiple organ dysfunction syndrome (MODS), which is the most
frequent cause of death in intensive care unit patients. Many water-soluble
mediators with pro- and anti-inflammatory action such as TNF, IL-6, IL-8, and
IL-10 play a strategic role in septic syndrome. In intensive care medicine,
blocking any one mediator has not led to a measurable outcome improvement in
patients with sepsis. CRRT is a continuously acting therapy, which removes in a
nonselective way pro- and anti-inflammatory mediators; “the peak concentration
hypothesis” is the concept of cutting peaks of soluble mediators through
continuous hemofiltration. Furthermore, there is evidence of increased efficacy
of high-volume hemofiltration compared to conventional CVVH, and other blood
purification techniques that utilize large-pore membranes or sorbent
plasmafiltration are conceptually interesting.
N. Ref:: 91
----------------------------------------------------
[104]
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
----------------------------------------------------
[105]
TÍTULO / TITLE: - Recent advances in
immunosuppressive therapy for renal transplantation.
REVISTA
/ JOURNAL: - Semin Dial 2001 May-Jun;14(3):218-22.
AUTORES
/ AUTHORS: - Peddi VR; First MR
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and Hypertension,
Department of Internal Medicine, University of Cincinnati College of Medicine,
Cincinnati, Ohio 45267-0585, USA. ram.peddi@uc.edu
RESUMEN
/ SUMMARY: - Recent advances in immunosuppression have
focused on more effective, safer, and targeted therapies that have resulted in
improved short- and intermediate-term renal allograft survival. During the past
decade there has been a marked decrease in acute rejection rates following
renal transplantation because of the use of newer immunosuppressive agents.
Recent data indicate that the average yearly reduction in the relative hazard
of graft failure beyond 1 year was 4.2% for all recipients (0.4% for those
recipients who had an acute rejection episode and 6.3% for those who did not
have an acute rejection). Despite these improvements the currently available
immunosuppressive agents are associated with significant cardiovascular risk
factors, an increased risk of infection, and the development of malignancies in
the long term. Predictive parameters of donor-specific hyporesponsiveness are
needed so as to allow identification of patients in whom immunosuppressive
therapy can be safely reduced. Immunosuppressive agents that have recently been
approved for use in the United States and those that are in clinical and
preclinical studies are discussed. N.
Ref:: 27
----------------------------------------------------
[106]
TÍTULO / TITLE: - Nutritional
considerations in renal transplant patients.
REVISTA
/ JOURNAL: - Blood Purif 2002;20(2):139-44.
AUTORES
/ AUTHORS: - van den Ham EC; Kooman JP; van Hooff JP
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine,
University Hospital Maastricht, The Netherlands. evha@sint.azm.nl
RESUMEN
/ SUMMARY: - In renal transplant patients, weight gain
generally increases after renal transplantation, which will be influenced by
improved appetite and a reversal of the uremic state. However, at least in the
early posttransplant period, the increase in body weight is mainly due to an
increase in body fat mass. This phenomenon may be partly due to relatively high
doses of steroids in the early period after renal transplantation, possibly
mediated by their inhibiting effect on lipid peroxidation, but also appears to
be related to physical inactivity. The increase in body fat mass may contribute
to posttransplant hyperlipidemia, which is improved but not completely
normalized by dietary intervention. Current dietary recommendations in stable
renal transplant patients do not generally differ from those of the general
population, although intense dietary counselling may be indicated in patients
with excessive posttransplant weight gain. The effect of supervised exercise
training on body composition is currently under investigation. N. Ref:: 57
----------------------------------------------------
[107]
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.
----------------------------------------------------
[108]
TÍTULO / TITLE: - The utility of
monoclonal antibody therapy in renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2002 May;34(3):797-800.
AUTORES
/ AUTHORS: - Loertscher R
INSTITUCIÓN
/ INSTITUTION: - Division of Transplantation, McGill
University Health Centre, Montreal, Quebec, Canada. rolf.loertscher@mcgill.ca N. Ref:: 37
----------------------------------------------------
[109]
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
----------------------------------------------------
[110]
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
----------------------------------------------------
[111]
TÍTULO / TITLE: - Epstein-Barr
virus-associated extranodal NK/T-cell lymphoma, nasal type of the hypopharynx,
in a renal allograft recipient: case report and review of literature.
REVISTA
/ JOURNAL: - Hum Pathol 2001 Nov;32(11):1264-8.
AUTORES
/ AUTHORS: - Stadlmann S; Fend F; Moser P; Obrist P;
Greil R; Dirnhofer S
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, University of
Innsbruck, Innsbruck, Austria.
RESUMEN
/ SUMMARY: - Posttransplant lymphoproliferative
disorders (PTLPDs) are predominantly B-cell lymphoproliferations, whereas a
T-cell origin is rarely observed. In contrast to B-cell PTLPD, T-cell PTLPDs
show an inconsistent association with Epstein-Barr virus (EBV). Until now, only
13 cases of EBV-associated T-cell PTLPDs have been reported. We describe a case
of an EBV-associated T-cell PTLPD in a renal allograft recipient 2 years after
transplantation. Histologic examination showed medium- to large-sized lymphoid
cells with an angiocentric growth pattern and necrosis. The atypical cells
showed a CD2+, CD3epsilon+, CD7+, CD43+, CD45R0+, CD56+, and CD4-, CD5-, CD8-
betaF1- phenotype with expression of the latent membrane protein (LMP)-1 of
EBV. In addition, EBV-specific RNAs (EBER ½) were identified by in situ
hybridization. Molecular analysis of the T-cell receptor (TCR) gamma chain by
polymerase chain reaction (PCR) showed a polyclonal pattern. The morphologic,
immunohistochemical, and molecular findings were consistent with a diagnosis of
an EBV-associated extranodal natural killer (NK)/T-cell non-Hodgkin lymphoma
(NHL) of nasal type. To our knowledge, this is the first reported case of this
rare entity in the posttransplant setting.
N. Ref:: 18
----------------------------------------------------
[112]
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
----------------------------------------------------
[113]
TÍTULO / TITLE: - Role of prostanoids and
endothelins in the prevention of cyclosporine-induced nephrotoxicity.
REVISTA
/ JOURNAL: - Prostaglandins Leukot Essent Fatty Acids
2001 Apr-May;64(4-5):231-9.
●●
Enlace al texto completo (gratuito o de pago) 1054/plef.2001.0265
AUTORES
/ AUTHORS: - Darlametsos IE; Varonos DD
INSTITUCIÓN
/ INSTITUTION: - Centre Franco-Hellenique de Recherches
Biomedicales, Nikolaos Papanikolaou, Corporation of the Municipality Agrinion,
Agrinion, 30100, Greece. darlamet@otenet.gr
RESUMEN
/ SUMMARY: - Cyclosporine A nephrotoxicity includes
both functional toxicity and histological changes, whose seriousness is
dependent upon the dose and the duration of the drug administration. Several
vasoactive agents have been found to be implicated in cyclosporine induced
nephrotoxicity, among which prostanoids and endothelins are the most important.
In previous studies we were able to prevent the early stage (7 days) of
cyclosporine (37.4 micromol [45 mg]/kg/day) induced nephrotoxicity in rats
either by the administration, i) of OKY-046, a thromboxane A(2)synthase
inhibitor, ii) of ketanserine, an antagonist of S(2)serotonergic, a(1)adrenergic,
and H(1)histaminergic receptors and iii) of nifedipine, a calcium channel
blocker, or by diet supplementation either with evening primrose oil or fish
oil. All these protective agents elevated ratios of excreted renal prostanoid
vasodilators (prostaglandins E(2), 6ketoF(1 alpha)) to vasoconstrictor
(thromboxane B(2)), a ratio which was decreased by the administration of
cyclosporine alone. Nifedipine averted the cyclosporine induced increase of
urinary endothelin-1 release. All protections were associated with the
reinstatement of glomerular filtration rate forwards normal levels whereas
renal damage defence, consisting of a decrease of the cyclosporine induced
vacuolizations, was variable. Ketanserine and evening primrose oil were the
only agents which prevented the animal body weight loss. These data suggest
that prostanoids and endothelin-1 may mediate functional toxicity while
thromboxane A(2)is involved the morphological changes too, provoked in the
early stage of cyclosporine treatment. However, other nephrotoxic factors and
additional mechanisms could also be implicated in the cyclosporine induced
nephrotoxicity. N.
Ref:: 91
----------------------------------------------------
[114]
TÍTULO / TITLE: - Chronic allograft
failure: a disease we don’t understand and can’t cure?
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002 Aug;17(8):1384-90.
AUTORES
/ AUTHORS: - Schratzberger G; Mayer G
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Department of
Internal Medicine, Anichstrasse 35, A-6020 Innsbruck, Austria. N. Ref:: 58
----------------------------------------------------
[115]
TÍTULO / TITLE: - Inducible nitric oxide
synthase in renal transplantation.
REVISTA
/ JOURNAL: - Kidney Int 2002 Mar;61(3):872-5.
AUTORES
/ AUTHORS: - Joles JA; Vos IH; Grone HJ; Rabelink TJ
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Hypertension,
University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the
Netherlands.
RESUMEN
/ SUMMARY: - The importance of the endothelial isoform
of nitric oxide synthase (eNOS) has been well established. Endothelium-derived
nitric oxide has been shown to be essential for vascular homeostasis and
modulation of eNOS has thus become a target in prevention of cardiovascular
disease. The role of the inducible form of nitric oxide synthase (iNOS) in
vascular biology, however, is less clear. Classically, iNOS has been regarded
as an enzyme that produces nmolar amounts of the nitric oxide radical, thereby
leading to cellular damage. More recent data, however, have shown that the iNOS
can be a superoxide, peroxynitrite as well as a nitric oxide-producing enzyme,
while the biological effects of iNOS probably depend upon the sort of radical
species released by the enzyme as well as the anti-oxidant capacity of the
cellular microenvironment of the enzyme. This brief review discusses these
aspects in relation to renal transplantation.
N. Ref:: 40
----------------------------------------------------
[116]
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
----------------------------------------------------
[117]
TÍTULO / TITLE: - Physiologic and
immunologic hurdles to xenotransplantation.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2001
Jan;12(1):182-93.
AUTORES
/ AUTHORS: - Samstein B; Platt JL
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Mayo Clinic,
Rochester, Minnesota, 55905, USA.
RESUMEN
/ SUMMARY: - The major problem in the field of renal
transplantation is currently the shortage of available kidneys. However, the
use of animals as a source of kidneys, i.e., xenotransplantation, is
increasingly being viewed as a potential solution to this problem. One
preeminent hurdle to xenotransplantation is the immune response of the
recipient against the graft; other hurdles include the physiologic limitations
of the transplant, infection, and ethical considerations. This review
summarizes what is currently known regarding the obstacles to
xenotransplantation and some potential solutions to those problems. N. Ref:: 111
----------------------------------------------------
[118]
TÍTULO / TITLE: - Renin system activation
and delayed function of the renal transplant.
REVISTA
/ JOURNAL: - Am J Hypertens 2001 Dec;14(12):1270-2.
AUTORES
/ AUTHORS: - Blumenfeld JD; Catanzaro DF; Kinkhabwala
M; Cheigh J; Hartono C; Serur D; Kapur S; Stubenbord WT; Haschemeyer R; Riggio
R
INSTITUCIÓN
/ INSTITUTION: - Rogosin Institute, Department of Surgery,
New York Presbyterian Hospital, Weill Medical College of Cornell University,
New York 10021, USA. blumenj@mail.rockefeller.edu
RESUMEN
/ SUMMARY: - Delayed graft function (DGF), defined as
persistent renal failure that requires dialysis within the first week after
kidney transplantation, occurs commonly after cadaveric renal transplantation (CRT).
This has important implications for long-term outcome because the 1-year
allograft survival rate is significantly reduced when DGF occurs. The
mechanisms contributing to the development of DGF are not well established.
However, several lines of evidence indicate that excess renin system activity,
in both the cadaver kidney donor and recipient, contributes importantly to the
pathogenesis of DGF. If this hypothesis can be verified in clinical studies,
then pharmacologic agents that interrupt the renin-angiotensin system (eg, type
1 angiotensin II receptor blockade, angiotensin converting enzyme inhibition,
and beta-adrenergic blockade) in the donor and recipient might significantly
improve the outcome of cadaveric renal transplants. N. Ref:: 22
----------------------------------------------------
[119]
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
----------------------------------------------------
[120]
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
----------------------------------------------------
[121]
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
----------------------------------------------------
[122]
TÍTULO / TITLE: - Maintenance
immunosuppression in the renal transplant recipient: an overview.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S25-35.
AUTORES
/ AUTHORS: - Gaston RS
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, University of
Alabama at Birmingham, Birmingham, AL 35294, USA. rgaston@nrtc.uab.edu
RESUMEN
/ SUMMARY: - Managing maintenance immunosuppressive
regimens after kidney transplantation is often challenging and confusing,
requiring careful attention to efficacy, dosing, adverse effects, and costs of
multiple medications. Most protocols combine a primary immunosuppressant
(cyclosporine or tacrolimus) with one or two adjunctive agents (azathioprine,
mycophenolate mofetil, sirolimus, corticosteroids). Avoiding drug-drug
interactions is a major part of effective immunosuppressant management, and
special situations (eg, pregnancy, intravenous dosing, caring for minority
patients) can prove especially daunting. This review summarizes available data
regarding current practices in maintenance immunosuppression, emphasizing
issues that arise in day-to-day management of renal transplant recipients. N. Ref:: 69
----------------------------------------------------
[123]
TÍTULO / TITLE: - Transplantation
tolerance: a journey from ignorance to memory.
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 Oct;18(10):1979-82.
●●
Enlace al texto completo (gratuito o de pago) 1093/ndt/gfg312
AUTORES
/ AUTHORS: - Lakkis FG
INSTITUCIÓN
/ INSTITUTION: - Yale University School of Medicine,
Section of Nephrology, 333 Cedar Street, PO Box 208029, New Haven, CT
06520-8029, USA. fadi.lakkis@yale.edu N. Ref:: 12
----------------------------------------------------
[124]
TÍTULO / TITLE: - Minimization of
immunosuppression in kidney transplantation. The need for immune monitoring.
REVISTA
/ JOURNAL: - Transplantation 2001 Oct 27;72(8
Suppl):S32-5.
AUTORES
/ AUTHORS: - Hricik DE; Heeger PS
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Case Western
Reserve University, Cleveland, Ohio, USA. deh5@po.cwru.edu N. Ref:: 16
----------------------------------------------------
[125]
TÍTULO / TITLE: - Developmental
approaches to kidney tissue engineering.
REVISTA
/ JOURNAL: - Am J Physiol Renal Physiol. Acceso
gratuito al texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ajprenal.physiology.org/
●●
Cita: American J. of Physiology. Renal Physiology: <> 2004
Jan;286(1):F1-7.
●●
Enlace al texto completo (gratuito o de pago) 1152/ajprenal.00167.2003
AUTORES
/ AUTHORS: - Steer DL; Nigam SK
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Pediatrics, and
Cellular Molecular Medicine, University of California, 9500 Gilman Drive, La
Jolla, CA 92093-0693, USA.
RESUMEN
/ SUMMARY: - Recent advances in our understanding of
the developmental biology of the kidney, as well as the establishment of novel
in vitro model systems, have potential implications for kidney tissue
engineering. These advances include delineation of the roles of a number of
growth factors in the developmental programs of branching morphogenesis and
mesenchymal differentiation, a new understanding of the roles of the
extracellular matrix, identification of potential “renal” stem cells, the ex
vivo propagation and subsequent recombination of isolated components of the
kidney, and successful transplantation of renal primordia into adult hosts.
This review will examine these advances in the context of approaches to tissue
engineering. Finally, novel approaches that synthesize advances in both
cell-based and organ-based approaches are proposed. N. Ref:: 46
----------------------------------------------------
[126]
TÍTULO / TITLE: - Atypical generalized
zoster with suspicious esophageal involvement and early relapse in an adult
renal transplant recepient.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Jun;34(4):1174-7.
AUTORES
/ AUTHORS: - Oh KH; Ahn C; Kim YS; Han JS; Kim S; Lee
JS; Kim EC; Oh MD; Chung JH
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine, Seoul
National University Hospital, Seoul, North Korea. N. Ref:: 18
----------------------------------------------------
[127]
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.
----------------------------------------------------
[128]
TÍTULO / TITLE: - Intrarenal synthesis of
complement.
REVISTA
/ JOURNAL: - Kidney Int 2001 Apr;59(4):1227-35.
AUTORES
/ AUTHORS: - Zhou W; Marsh JE; Sacks SH
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and
Transplantation, Guy’s Hospital, London, England, United Kingdom.
RESUMEN
/ SUMMARY: - During the past decade, research has shown
that the kidney has the capacity to synthesize most of the activation pathway
components of the complement cascade. As well as implying physiological roles
in local clearance of immune complexes and defense against invasive organisms,
an increasing amount of evidence indicates that the intrarenal synthesis of
complement makes an important contribution in the pathogenesis of renal injury.
Here we review this evidence and present a case for more definitive
investigation of these functions. N.
Ref:: 76
----------------------------------------------------
[129]
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
----------------------------------------------------
[130]
TÍTULO / TITLE: - Ultrasonography in
renal transplantation.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2002 Apr;39(4):663-78.
AUTORES
/ AUTHORS: - O’neill WC; Baumgarten DA
INSTITUCIÓN
/ INSTITUTION: - Renal Division, Department of Medicine,
Emory University School of Medicine, Atlanta, GA 30322, USA. woneill@emory.edu
RESUMEN
/ SUMMARY: - Sonography is a simple, inexpensive, and
readily available imaging modality that has become an essential component of
the management of renal transplantation. It is indicated in almost all patients
with acute renal failure and also is useful in the evaluation of pain,
infection, and hematuria and the performance of percutaneous biopsy. Although
many aspects of sonography are similar in native and transplanted kidneys,
there are important differences and problems unique to the renal allograft, which
form the basis for this review. The anatomy of renal transplantation and
changes that accompany parenchymal disorders are discussed, but particular
attention focuses on problems related to the urinary tract, fluid collections,
and vascular disorders. By becoming more familiar with transplant sonography,
nephrologists will be better able to incorporate this indispensable tool into
the care of their patients. N.
Ref:: 66
----------------------------------------------------
[131]
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
----------------------------------------------------
[132]
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
----------------------------------------------------
[133]
TÍTULO / TITLE: - Xenotransplantation of
developing kidneys.
REVISTA
/ JOURNAL: - Am J Physiol Renal Physiol. Acceso
gratuito al texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ajprenal.physiology.org/
●●
Cita: American J. of Physiology. Renal Physiology: <> 2002
Oct;283(4):F601-6.
●●
Enlace al texto completo (gratuito o de pago) 1152/ajprenal.00126.2002
AUTORES
/ AUTHORS: - Hammerman MR
INSTITUCIÓN
/ INSTITUTION: - George M. O’Brien Kidney and Urological
Disease Center, Renal Division, Department of Medicine, Washington University
School of Medicine, St. Louis, Missouri 63110, USA. mhammerm@im.wustl.edu
RESUMEN
/ SUMMARY: - The number of kidney transplants performed
per year is limited by the availability of donor organs. One novel solution to
this shortage envisions “growing” new kidneys in situ via xenotransplantation
of renal anlagen. We have shown that developing metanephroi transplanted into
the omentum of animal hosts undergo differentiation and growth, become
vascularized by blood vessels of host origin, and exhibit excretory function.
Metanephroi can be stored for up to 3 days in vitro before transplantation with
no impairment in growth or function postimplantation. Metanephroi can be
transplanted across both concordant (rat --> mouse) and discordant/highly
disparate (pig --> rodent) xenogeneic barriers. This review summarizes experimental
data relating to the transplantation of developing kidneys. N. Ref:: 26
----------------------------------------------------
[134]
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
----------------------------------------------------
[135]
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
----------------------------------------------------
[136]
TÍTULO / TITLE: - Donor specific
transfusion in kidney transplantation: effect of different immunosuppressive
protocols on graft outcome.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Aug;33(5):2787-8.
AUTORES
/ AUTHORS: - Barbari A; Stephan A; Masri MA; Joubran N;
Dagher O; Kamel G
INSTITUCIÓN
/ INSTITUTION: - Department ofNephrology and
Transplantation, Rizk Hospital, Beirut, Lebanon.
----------------------------------------------------
[137]
TÍTULO / TITLE: - Sequential protocol
biopsies from renal transplant recipients show an increasing expression of
active TGF beta.
REVISTA
/ JOURNAL: - Transpl Int 2002 Dec;15(12):630-4. Epub
2002 Oct 19.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00147-002-0472-3
AUTORES
/ AUTHORS: - Jain S; Mohamed MA; Sandford R; Furness
PN; Nicholson ML; Talbot D
INSTITUCIÓN
/ INSTITUTION: - University Department of Surgery,
Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. sj34@le.ac.uk
RESUMEN
/ SUMMARY: - Chronic allograft nephropathy (CAN) is a
major cause of graft loss after renal transplantation. Implicated in the
pathogenesis of this complication is overproduction of the cytokine
transforming growth factor beta (TGF beta). In this study we measured changes
in CAN’s expression in stable patients early after transplantation, and studied
links with established risk factors for CAN, such as delayed graft function,
acute rejection, and cyclosporine exposure. We took biopsies from 40 renal
allografts at time of transplantation (pre-perfusion), and then, using
ultrasound guidance, at 1 week and 6 months after transplantation. An
immunofluorescence technique was used to stain sections for active TGF beta.
These were then assessed by semi-quantitative scanning laser confocal
microscopy. There was very little variation in active TGF-beta expression among
patients in their pre-perfusion biopsies. Expression had increased by 1 week
and then very significantly by 6 months ( P<0.0001). Patients who suffered
delayed graft function had increased TGF-beta expression at both time points.
There was no difference regarding donor type, acute rejection, and
immunosuppressive drug (cyclosporine or tacrolimus). There was no correlation
between the amount of TGF-beta expression at any time-point and isotope
glomerular filtration rate (GFR) at 12 months. This study demonstrated that in
a group of stable renal allograft recipients, TGF-beta expression in the kidney
increased after transplantation. As the study used protocol biopsies, this
increase is unlikely to be due to acute events, and probably represents a genuine
increase.
----------------------------------------------------
[138]
TÍTULO / TITLE: - Kidney transplantation
in rats: an appraisal of surgical techniques and outcome.
REVISTA
/ JOURNAL: - Microsurgery 2003;23(4):387-94.
●●
Enlace al texto completo (gratuito o de pago) 1002/micr.10139
AUTORES
/ AUTHORS: - Schumacher M; Van Vliet BN; Ferrari P
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, Inselspital, Berne,
Switzerland. martin.schumacher@insel.ch
RESUMEN
/ SUMMARY: - Renal transplantation in rats is an
essential experimental tool in transplantation research. The surgical procedure
per se could affect the outcome of an experiment, independent of the hypothesis
addressed, therefore requiring a standardized method which should be comparable
across studies. To date, however, there is little information on the optimal
surgical technique. We performed a Medline search on original articles
published between 1965-2001 in order to evaluate whether specific technical
issues affecting the outcome of the procedure could be defined. Articles that
reported on a novel microsurgical procedure, or whose main purpose was the outcome
of a surgical technique itself, were included in the analysis. From 2,060
retrieved publications, 34 corresponded to the selection criteria (rats and
microsurgery and technique and kidney or renal transplantation). Among the
essential determining factors for a good outcome, body weight >200 g and
warm ischemic time <30 min were identified. Other important factors were the
techniques used for vascular (end-to-end and end-to-side procedure or sleeve
technique) and ureteral (bladder patch or end-to-end procedure) anastomosis.
Gender, animal strain, type of anesthesia, prophylactic administration of
antibiotics, and type of flushing solution did not affect the success of renal
allografts. In order to avoid a bias related to the surgical procedure in rat
renal transplantation, a warm ischemia time <30 min in animals with a body
weight >200 g seems to be essential. Also, end-to-end or end-to-side
vascular anastomoses are preferable to the sleeve technique. Other factors do
not influence the immediate function of the graft. N. Ref:: 40
----------------------------------------------------
[139]
TÍTULO / TITLE: - Long-term outcome of
ABO-incompatible renal transplantation.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):769-80.
AUTORES
/ AUTHORS: - Toma H; Tanabe K; Tokumoto T
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, Tokyo Women’s
Medical University, Tokyo, Japan. toma@kc.twmu.ac.jp
RESUMEN
/ SUMMARY: - Based on the long-term experience with
ABO-incompatible kidney transplantation, the following can be concluded: 1.
Renal transplantation across ABO incompatibility is an acceptable treatment for
patients with end-stage renal failure. [table: see text] 2. Long-term patient
and graft survival in ABO-incompatible kidney transplantation is influenced
primarily by acute rejection episodes occurring within 1 year. 3. Despite the
removal of anti-ABO natural antibodies before transplantation, hyperacute
rejection crises may occur in some cases. 4. Humoral rejection is the most
prominent type of rejection in ABO-incompatible renal transplantation. Even
though most of this rejection is controllable with anti-rejection therapy, the
prognosis for a graft that undergoes humoral rejection is significantly poor.
5. The maximum IgG titers of anti-A/B antibody before transplantation may have
a harmful effect on graft acceptance in ABO-incompatible kidney
transplantation. 6. Renal transplantation across ABO incompatibility is
principally the most significant risk factor to affect long-term allograft
function in ABO-incompatible living kidney transplantation. N. Ref:: 24
----------------------------------------------------
[140]
TÍTULO / TITLE: - Sympathetic-vascular
interactions: further evidence in kidney transplantation.
REVISTA
/ JOURNAL: - J Hypertens 2002 Mar;20(3):379-81.
AUTORES
/ AUTHORS: - Grassi G; Calhoun DA N. Ref:: 26
----------------------------------------------------
[141]
TÍTULO / TITLE: - Overview of clinical
trials with new agents.
REVISTA
/ JOURNAL: - Transplant Proc 2001 May;33(3):2201-3.
AUTORES
/ AUTHORS: - Charpentier B; Hiesse C; Durrbach A; Ammor
M; Von Ey F; Kechrid C; Kriaa F
INSTITUCIÓN
/ INSTITUTION: - Nephrology Department, University Hospital
of Bicetre, Kremlin Bicetre, France. N.
Ref:: 12
----------------------------------------------------
[142]
TÍTULO / TITLE: - Tailoring
immunosuppressive therapy in renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2478-9.
AUTORES
/ AUTHORS: - Vathsala A
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine, Singapore
General Hospital, Singapore. N.
Ref:: 13
----------------------------------------------------
[143]
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.
----------------------------------------------------
[144]
TÍTULO / TITLE: - Sirolimus: a new
promising immunosuppressive drug. Towards a rationale for its use 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: <> 2001 Jan;16(1):18-20.
AUTORES
/ AUTHORS: - Morelon E; Mamzer-Bruneel MF; Peraldi MN;
Kreis H N. Ref:: 19
----------------------------------------------------
[145]
TÍTULO / TITLE: - Review. The resistive
index in renal Doppler sonography: where do we stand?
REVISTA
/ JOURNAL: - AJR Am J Roentgenol 2003
Apr;180(4):885-92.
AUTORES
/ AUTHORS: - Tublin ME; Bude RO; Platt JF
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, University of
Pittsburgh School of Medicine, 200 Lothrop St., Pittsburgh, PA 15213, USA. N. Ref:: 98
----------------------------------------------------
[146]
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
----------------------------------------------------
[147]
TÍTULO / TITLE: - The role of HLA class I
and class II antibodies 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: <> 2001;16 Suppl 6:150-2.
AUTORES
/ AUTHORS: - Iniotaki-Theodoraki A
INSTITUCIÓN
/ INSTITUTION: - National Tissue Typing Center, General
Hospital of Athens G. Gennimatas, Athens, Greece. N. Ref:: 15
----------------------------------------------------
[148]
TÍTULO / TITLE: - Acid-base and
electrolyte management in continuous renal replacement therapy.
REVISTA
/ JOURNAL: - Blood Purif 2002;20(3):262-8.
AUTORES
/ AUTHORS: - Mehta RL
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Department of
Medicine, University of California San Diego Medical Center, San Diego, CA
92103-8342, USA. rmehta@ucsol.edu
RESUMEN
/ SUMMARY: - Continuous renal replacement techniques
are often utilized to manage acid-base and electrolyte problems in the
critically ill patient. These techniques have an inherent capacity to
manipulate the plasma composition and can be utilized efficiently to maintain
homeostasis and metabolic control. Unfortunately, the efficacy of these
techniques also permits wide variation in their use and can result in
complications if they are not used appropriately. In most instances
complications can be prevented by recognition of the operating principles and
careful attention to detail. This article provides an overview of the
principles of acid-base and electrolyte management with continuous renal
replacement therapy. N.
Ref:: 27
----------------------------------------------------
[149]
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
----------------------------------------------------
[150]
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
----------------------------------------------------
[151]
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.
----------------------------------------------------
[152]
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
----------------------------------------------------
[153]
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
----------------------------------------------------
[154]
TÍTULO / TITLE: - Role of transforming
growth factor-beta1 in the progression of chronic allograft nephropathy.
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 1:114-6.
AUTORES
/ AUTHORS: - Campistol JM; Inigo P; Larios S; Bescos M;
Oppenheimer F
INSTITUCIÓN
/ INSTITUTION: - Renal Transplant Unit, Hospital Clinic,
Institut d’Investigacio Biomediques Agusti Pi i Sunyer, University of
Barcelona, Barcelona, España.
RESUMEN
/ SUMMARY: - Chronic allograft nephropathy is the
principal cause of late graft loss after the first year of renal
transplantation. Transforming growth factor-beta1 (TGF-beta1) is a key
fibrogenetic cytokine involved in the fibrosis of a number of chronic diseases
of the kidney and other organs, and recently evidence has shown that TGF-beta1
is involved in the pathogenesis of chronic renal allograft dysfunction.
Production of TGF-beta1 in these circumstances may be modulated by the
intrarenal renin-angiotensin system (angiotensin II induces TGF-beta1
production and secretion by the mesangial cells) and by a direct effect of
cyclosporin A, which stimulates the synthesis and expression of TGF-beta1. In a
prospective study of 14 renal transplant patients exhibiting chronic graft
nephropathy, we demonstrated that treatment with losartan significantly
decreased plasma levels of TGF-beta1 by >50%. There was a significant
correlation (P=0.04) between the increase in circulating angiotensin II after 2
weeks and the decrease in plasma TGF-beta(1) at the end of the study period, suggesting
that the degree of angiotensin II receptor blockade plays a decisive role in
the synthesis of TGF-beta1. A significant decrease in circulating endothelin-1
(ET-1) levels also occurred during treatment with losartan, together with a
decrease in proteinuria. In a randomized 2x2 crossover study, the effects of
losartan and amlodipine on renal haemodynamics and on profibrogenetic cytokines
were analysed. Whereas amlodipine increased the glomerular filtration rate
(GFR) through an increase in the FF and P(G), losartan slightly decreased the
GFR, but with a significant decrease in FF and P(G). With respect to the
profibrogenetic cytokines, losartan decreased the plasma levels of TGF-beta1
and ET-1, while amlodipine did not significantly change TGF-beta1 and slightly
increased ET-1. N.
Ref:: 16
----------------------------------------------------
[155]
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
----------------------------------------------------
[156]
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
----------------------------------------------------
[157]
TÍTULO / TITLE: - Mycophenolate mofetil:
suggested guidelines for use in kidney transplantation.
REVISTA
/ JOURNAL: - BioDrugs 2001;15(1):37-53.
AUTORES
/ AUTHORS: - Behrend M
INSTITUCIÓN
/ INSTITUTION: - Abteilung fur Viszeral- und
Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany.
Behrend.Matthias@MH-Hannover.de
RESUMEN
/ SUMMARY: - Mycophenolate mofetil (MMF) is an
immunosuppressive drug designed to inhibit inosine monophosphate dehydrogenase
(IMPDH). IMPDH is a key enzyme in the de novo purine synthesis of lymphocytes.
It is crucially important for proliferative responses of human T and B
lymphocytes. The inhibition of IMPDH thus leads to selective lymphocyte
suppression. After successful use in various in vitro and animal models, MMF
was brought to clinical trial in patients undergoing transplantation. The drug
is rapidly and completely absorbed following oral administration. Pilot studies
of administration with cyclosporin and corticosteroids suggested a significant
reduction in the incidence of organ rejection at dosages of 1 to 3 g/day. As a
result of these studies, 3 pivotal randomised double-blind multicentre trials,
involving nearly 1500 patients, were designed to investigate the effects of
addition of MMF to different standard immunosuppressive protocols on the
prevention of acute renal allograft rejection. After 6 months, the rates of
biopsy-proven rejection were significantly reduced in patients receiving MMF.
In combination with cyclosporin and corticosteroids, the adverse effect profile
resembled that of azathioprine. Most adverse effects were associated with the
gastrointestinal tract, the blood system and opportunistic infections. MMF
offers improved immunosuppressive therapy following renal and probably other
solid organ transplantation. MMF has been licensed since 1995 for the
prevention of acute renal allograft rejection in most countries. It has been
used in different combinations of immunosuppressive drugs and in various
dosages and regimens. N.
Ref:: 124
----------------------------------------------------
[158]
TÍTULO / TITLE: - Cadaveric kidney
transplantation for the elderly.
REVISTA
/ JOURNAL: - Nephron 2002 Jul;91(3):361-78.
AUTORES
/ AUTHORS: - Pascual J; Marcen R; Liano F; Ortuno J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Hospital Ramon y
Cajal, C. Colmenar Km 9, 100, E-28034 Madrid, España. jpascual@hrc.insalud.es N. Ref:: 108
----------------------------------------------------
[159]
TÍTULO / TITLE: - Cost-effectiveness
analysis of basixilimab induction and calcineurin-sparing protocols in “old to
old” programs using Markov models.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Jun;35(4):1324-5.
AUTORES
/ AUTHORS: - Emparan C; Wolters H; Laukotter M; Dame C;
Senninger N
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, Uniklinikum, Munster, Germany. cemparan@teleline.es
RESUMEN
/ SUMMARY: - INTRODUCTION: Markov models are employed
in economic analyses to evaluate all possible expectations in a dilemna. The
introduction of a new clinical protocol (basiliximab induction with
calcineurin-sparing protocols) for a group of kidney transplant recipients
receiving organs from marginal donors was validated with a Markov simulation
model. HYPOTHESIS: Calcineurin-sparing protocols using anti-IL-2/antibody induction
(Simulect) show a beneficial effect on initial kidney function, reducing
transplantation costs reception based upon mean length of stay, mean admission
cost, and incidences of delayed graft function and complications during the
first month after transplant. PATIENTS AND METHODS: A Markov simulation model
was established following three different chains. A calcineurin-free regimen
with basiliximab induction (chain A), a calcineurin-sparing protocol with
basiliximab induction (chain B), and a conventional immunosuppressive regimen
(chain C). After designing the Markov chain and cohorts, 31 patients from the
“old to old” program were assigned to each chain eight to chain A, (eight to
chain B, and 15 to chain C). A month after transplantation a cost-benefit study
was performed guided by the three branches of the Markov model. RESULTS: The
Markov model showed a benefit of induction therapies in elderly patients. A
cost-benefit model showed that after a month there was a clear benefit from
Calcineurin=free plus basiliximab induction therapies, with a slight benefit
from calcineurin-sparing protocols. CONCLUSIONS: Markov models are extremely
useful when introducing new clinical therapies. In our transplant program, a
cost-effective analysis of outcomes in old patients using the Markov model
showed a clear benefit of calcineurin-sparing protocols with basixilimab
induction.
----------------------------------------------------
[160]
TÍTULO / TITLE: - Genitourinary
tuberculosis after renal transplantation: report of 3 cases and review.
REVISTA
/ JOURNAL: - Clin Infect Dis 2001 Feb 15;32(4):662-6.
Epub 2001 Feb 7.
AUTORES
/ AUTHORS: - Dowdy L; Ramgopal M; Hoffman T; Ciancio G;
Burke G; Roth D; Mies C; Jones B; Miller J
INSTITUCIÓN
/ INSTITUTION: - Division of Infectious Diseases,
Department of Medicine, University of Miami School of Medicine, Miami, FL
33136, USA. ldowdy@med.miami.edu
RESUMEN
/ SUMMARY: - Mycobacterium tuberculosis infection of
the genitourinary tract is an uncommon disease in renal transplant recipients
and presentation is atypical. Genitourinary tuberculosis is associated with
graft rejection, and this diagnosis should be considered for renal transplant
recipients with unexplained fever and constitutional symptoms. N. Ref:: 8
----------------------------------------------------
[161]
TÍTULO / TITLE: - Pregnancy in renal
transplantation: immunologic evaluation of neonates from mothers with
transplanted kidney.
REVISTA
/ JOURNAL: - Transpl Immunol 2002 May;9(2-4):161-4.
AUTORES
/ AUTHORS: - Schen FP; Stallone G; Schena A; Manfredi
G; Derosa C; Procino A; Di Paolo S
INSTITUCIÓN
/ INSTITUTION: - Department of Emergency and Organ
Transplantation, University of Bari, Italy. fp.schena@nephro.uniba.it
RESUMEN
/ SUMMARY: - The occurrence of pregnancy in young
female organ transplant recipients may sustain a high risk for prematurity and
low rate of malformations in neonates. Therefore, it is necessary to counsel
couples who want a child. In case of pregnancy, strict guidelines must be
observed. Continuous exposure to CsA in utero seems to impair T-, B- and
NK-cell development and function in neonates. This effect is prolonged
throughout the first year of life. In addition, low levels of serum
immunoglobulins occur at the same time. This leads to suggest a delayed
administration of classical vaccinations (after the first 6 months of life) in
view of the potential risks of both sub-optimal immunologic responses, and
adverse events after the administration of live, attenuated vaccines in infants
born from young female organ transplant recipients. N. Ref:: 13
----------------------------------------------------
[162]
TÍTULO / TITLE: - Steroid-free
immunosuppression in kidney transplantation: an editorial review.
REVISTA
/ JOURNAL: - Am J Transplant 2002 Jan;2(1):19-24.
AUTORES
/ AUTHORS: - Hricik DE
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Case Western
Reserve University School of Medicine, University Hospitals of Cleveland, Ohio
44106, USA. deh5@po.cwru.edu N. Ref:: 33
----------------------------------------------------
[163]
TÍTULO / TITLE: - Factor V Leiden
mutation: potential thrombogenic role in renal vein, dialysis graft and
transplant vascular thrombosis.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2001
May;10(3):409-14.
AUTORES
/ AUTHORS: - Wuthrich RP
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Department of
Medicine, Kantonsspital, St. Gallen, Switzerland. rpw@kssg.ch
RESUMEN
/ SUMMARY: - Factor V is an important blood coagulation
factor, the procoagulatory activity of which is inhibited by activated protein
C. The factor V Leiden mutation is due to a single base-pair change (G1691A),
which alters the initial cleavage site for activated protein C. The impaired
degradation of factor V by activated protein C yields a hypercoagulable state
that confers a lifelong increased risk of thrombosis in heterozygous and
homozygous individuals. The factor V Leiden mutation represents the most common
cause of inherited thrombophilia, and enhances the risk for venous thrombosis
by approximately sevenfold. In normal Western populations, heterozygosity for
the factor V Leiden mutation is present in 2-5%, whereas in patients with
venous thrombosis and a family history of thrombotic disease this figure may
reach 50-60%. The presence of the mutation markedly increases the risk for
renal vein thrombosis, particularly in neonates. Heterozygosity for factor V
Leiden mutation does not appear to be a major risk factor for dialysis access
clotting. The presence of factor V Leiden mutation is most devastating in
kidney transplant recipients. In these patients the mutation predisposes to
renal transplant vein thrombosis and early graft loss. The risk for acute
vascular rejection is also enhanced in transplant recipients who are
heterozygous for the mutation. Routine screening for factor V Leiden mutation
by polymerase chain reaction, and appropriate perioperative and postoperative
anticoagulation after renal transplantation might be a valuable strategy to
prevent thromboembolic complications in transplant recipients. N. Ref:: 47
----------------------------------------------------
[164]
TÍTULO / TITLE: - Do gastrostomies close
spontaneously? A review of the fate of gastrostomies following successful renal
transplantation in children.
REVISTA
/ JOURNAL: - Pediatr Surg Int 2001 May;17(4):326-8.
AUTORES
/ AUTHORS: - Davies BW; Watson AR; Coleman JE; Rance CH
INSTITUCIÓN
/ INSTITUTION: - Department of Paediatric Urology and
Nephrology, Nottingham City Hospital N.H.S. Trust, Nottingham, UK.
RESUMEN
/ SUMMARY: - Previous published data have shown the
benefit of nutritional support delivered via a gastrostomy button (GB) for
children on chronic dialysis. The use of the GB is suspended following renal
transplantation (RT) in most children and it is usually removed 2-3 months
later together with the chronic dialysis catheter when the child is on
alternate-day steroids. We reviewed the outcome of gastrostomies following
successful RT in children. The gastrostomies were created by an open technique
(Stamm) with the child under general anaesthesia, usually at the time of
insertion of a chronic dialysis catheter. Growth data and complications of the
GB were collected in a prospective registry. Following RT, the GB was removed
with the expectation that the tract would close spontaneously. Those in whom a
gastrocutaneous fistula persisted underwent formal surgical closure. A total of
18 children have had gastrostomy buttons removed: 11 gastrostomies (61%) closed
spontaneously, but 7 (39%) required operative closure at a median of 2 months
(range 3 weeks-4 years) post-removal. The need for formal closure was
significantly related to the duration that the gastrostomy had been in situ
pre-transplant (non-parametric statistics, 0.05 > p > 0.01). Although
nearly two-thirds of gastrostomies in this study closed spontaneously following
RT, less than one-half of those that had been in situ for more than 1 year did
so. We thus recommend formal closure of all gastrostomies that have been in
situ for more than 1 year. This can be done at the same operation as the
removal of the chronic dialysis catheter.
N. Ref:: 12
----------------------------------------------------
[165]
TÍTULO / TITLE: - Pregnancy after renal
transplantation: points to consider.
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 May;17(5):703-7.
AUTORES
/ AUTHORS: - Lessan-Pezeshki M N. Ref:: 30
----------------------------------------------------
[166]
TÍTULO / TITLE: - Pharmacological control
of the immune response in renal transplantation.
REVISTA
/ JOURNAL: - Bju Int. Acceso gratuito al texto completo
a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.bjui.org/
●●
Cita: BJU International: <> 2002 Nov;90(8):784-91.
AUTORES
/ AUTHORS: - Warrens AN
INSTITUCIÓN
/ INSTITUTION: - Imperial College, Faculty of Medicine, Hammersmith
Campus, London, UK. a.warrens@ic.ac.uk N. Ref:: 29
----------------------------------------------------
[167]
TÍTULO / TITLE: - Therapeutic drug
monitoring of immunosuppressive drugs in kidney transplantation.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002
Nov;11(6):657-63.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000040053.33359.26
AUTORES
/ AUTHORS: - Holt DW
INSTITUCIÓN
/ INSTITUTION: - Analytical Unit, St George’s Hospital
Medical School, London, UK. d.holt@sghms.ac.uk
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: Drug monitoring has
become an accepted adjunct to optimizing therapy with immunosuppressive drugs.
This review assesses publications that relate to the analytical techniques used
to measure cyclosporin, tacrolimus, mycophenolic acid, sirolimus and
everolimus, as well as the clinical data obtained for these drugs. For all of
these drugs there has been a substantial and continuing investment in assessing
the clinical value of drug monitoring. RECENT FINDINGS: Fundamental
controversies still persist regarding which time point to use for monitoring.
The most significant single development has been the move towards using a timed
blood sample 2 h after drug administration (C2) to monitor cyclosporin therapy
with the Neoral formulation. The favourable clinical results obtained with this
approach have had an impact on reevaluating monitoring data for some of the
other drugs. The newest drugs to reach clinical evaluation, sirolimus and
everolimus, have been studied in the context of concentration-controlled dosing
and there is a good rationale for their measurement. There have also been
developments in the analytical techniques used, mostly to improve the
selectivity of the assays or to adapt them to new monitoring strategies.
SUMMARY: Interpretation of drug concentration data is becoming ever more
complex in this field as the number of potential drug combinations expands. The
relatively narrow therapeutic index of these agents and the ever-present risk
of clinically significant pharmacokinetic drug interactions makes drug
monitoring an important aspect of their prescription. N. Ref:: 77
----------------------------------------------------
[168]
TÍTULO / TITLE: - Sirolimus (Rapamune) in
renal transplantation.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002
Nov;11(6):603-7.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000040045.55337.97
AUTORES
/ AUTHORS: - Johnson RW
INSTITUCIÓN
/ INSTITUTION: - Manchester Postgraduate Health Sciences Centre,
Manchester Royal Infirmary, Manchester.
RESUMEN
/ SUMMARY: - There has been a necessary change in
attitude to transplantation; there is much less concern with short-term outcome
and more concern with long-term kidney function, overall health and quality of
life. Nephrotoxicity is an invariable consequence of long-term treatment with
calcineurin antagonists and it is one of the most underestimated causes of late
graft loss; it has been reported as a serious threat to both patient and graft
survival following heart, liver and bone marrow transplantation. Sirolimus has
been shown in many recent studies to be of great value in allowing patients to
be weaned from cyclosporine with excellent patient and graft survival at 24
months a significant improvement in renal function with resolution of hirsutism
and gum hyperplasia. Patients maintained on the combined regime of cyclosporine
and sirolimus had significantly higher blood pressure, much more cyclosporine
nephrotoxicity and hyperuricaemia at 12 months. The experimental studies have
found cyclosporine and sirolimus potentiate with each other’s good and adverse
effects. Cyclosporine therefore augments hyperlipidaemia caused by sirolimus,
and sirolimus augments nephrotoxicity caused by cyclosporine. The results of
these studies indicate that sirolimus is a suitable replacement for
cyclosporine or tacrolimus for long-term maintenance therapy. By contrast the
use of sirolimus in combination with cyclosporine results in potentiation of
side effects. The principal disadvantages being increased cyclosporine
associated nephrotoxicity and sirolimus associated hyperlipidaemia N. Ref:: 32
----------------------------------------------------
[169]
TÍTULO / TITLE: - Bone marrow
transfusions in cadaver renal allografts: pilot trials with concurrent
controls.
REVISTA
/ JOURNAL: - Clin Transplant 2002 Oct;16(5):317-24.
AUTORES
/ AUTHORS: - Light J; Salomon DR; Diethelm AG;
Alexander JW; Hunsicker L; Thistlethwaite R; Reinsmoen N; Stablein DM
INSTITUCIÓN
/ INSTITUTION: - Transplant Services, Washington Hospital
Center, Washington, DC 20010, USA.jimmy.a.light@medstar.net
RESUMEN
/ SUMMARY: - BACKGROUND: The safety and immune
tolerance potential of donor marrow infusion with cadaveric source renal
transplants was evaluated in a series of non-randomized multicenter pilot
trials by the NIH Cooperative Clinical Trials in Transplantation (CCTT) Group.
PATIENTS AND METHODS: Three strategies were tested: (1) immunosuppression with
cyclosporin, azathioprine and prednisone with a single post-transplant day 1
infusion of 5 x 107 viable cells/kg, (2) OKT3 induction with triple drug
therapy and marrow transfusion on day 1, or (3) same therapy as (2) but with an
additional marrow transfusion on day 10-12. RESULTS: Thirty-eight marrow
recipients and 35 contemporaneous controls were entered with a mean follow-up
of over 5 yr. Graft survival was initially better in the marrow recipients than
the controls but was similar after 5 yr. Microchimerism rates were similar for
the marrow infusion and control groups throughout the follow-up period,
regardless of the immunosuppression strategies. DISCUSSION: Bone marrow
infusions were well tolerated by a group of cadaver renal allograft recipients.
There were no complications from the infusion(s), no episodes of graft-vs.-host
disease (GVHD) and no increase in infections or other complications. There was
a trend toward early improved graft survival in marrow recipients. Decreased
rejection rates were observed in black recipients. N. Ref:: 36
----------------------------------------------------
[170]
TÍTULO / TITLE: - An induction versus
no-induction protocol in anticalcineurin-based immunosuppression using very
low-dose steroids.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Jun;33(4
Suppl):3S-10S.
AUTORES
/ AUTHORS: - Charpentier B
INSTITUCIÓN
/ INSTITUTION: - University Hospital of Bicetre, Le
Kremlin-Bicetre, France.
----------------------------------------------------
[171]
TÍTULO / TITLE: - Polyomavirus BK
nephropathy: a (re-)emerging complication in renal transplantation.
REVISTA
/ JOURNAL: - Am J Transplant 2002 Jan;2(1):25-30.
AUTORES
/ AUTHORS: - Hirsch HH
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine,
University of Basel, Switzerland. hans.hirsch@unibas.ch
RESUMEN
/ SUMMARY: - Persisting polyomavirus replication is now
widely recognized as a (re-)emerging cause of renal allograft dysfunction. Up
to 5% of renal allograft recipients can be affected about 40weeks (range 6-150)
post-transplantation. Progression to irreversible failure of the allograft has
been observed in up to 45% of all cases. The BK virus strain is involved in the
majority of the cases. Risk factors may include treatment of rejection episodes
and increasing viral replication under potent immunosuppressive drugs such as
tacrolimus, sirolimus or mycophenolate. The diagnosis requires the histological
demonstration of nuclear polyomavirus inclusions in affected tubular epithelial
cells. Interstitial inflammatory infiltrates and fibrosis become more prominent
in the persisting disease and may be difficult to distinguish from (coexisting)
rejection. Detection of polyomavirus-inclusion bearing cells (‘decoy cells’) in
the urine and quantification of BK virus DNA in the plasma have been proposed
as surrogate markers for polyomavirus replication and allograft disease,
respectively. Antiviral treatment is not yet established; however, reports of
treatment with cidofovir are encouraging. Current management aims at the
judicious modification and/or reduction of immunosuppression which, in view of
preceding or concurrent rejection, is not without risk. N. Ref:: 51
----------------------------------------------------
[172]
TÍTULO / TITLE: - Cellular and molecular
parameters in human renal allograft rejection.
REVISTA
/ JOURNAL: - Clin Biochem 2001 Feb;34(1):29-34.
AUTORES
/ AUTHORS: - Kamoun M
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology and Laboratory
Medicine, University of Pennsylvania, School of Medicine, Philadelphia, PA
19104-4283, USA. malekkam@mail.med.upenn.edu
RESUMEN
/ SUMMARY: - Acute rejection of human renal allografts
is frequent postransplantation complication. In addition, it is a risk factor
for chronic rejection, the most common cause of failure of long-term
allografts. Renal allografts are rejected as a result of an immune response
directed against alloantigens on the graft that are absent from the host, and
the most important of these are the HLA antigens. The application of molecular
diagnostic methods has revealed a differential intra-renal gene expression of
cytokines, chemokines and their receptors, and cytotoxic attack molecules in
acute and chronic rejection processes. Differential expression of T cell
costimulatory molecules B7 and CD40/CD40L, and endothelium adhesion molecules
ICAM-1 and VCAM-1 has also been reported during acute rejection. These
molecules play an important role in mediating the recruitment of lymphocytes
into rejecting allografts and costimulation of T cell activation. Based on
experimental data, it seems that it is likely that the blockade of T cell
costimulatory pathways can be used in human in the future to selectively prevent
transplant rejection without generally suppressing the immune system. N. Ref:: 45
----------------------------------------------------
[173]
TÍTULO / TITLE: - Induction versus
non-induction protocols in anti-calcineurin-based immunosuppression.
REVISTA
/ JOURNAL: - Transplant Proc 2001
Nov-Dec;33(7-8):3334-6.
AUTORES
/ AUTHORS: - Charpentier B
INSTITUCIÓN
/ INSTITUTION: - Service de Nephrologie, University
Hospital of Bicetre, Bicetre, France.
----------------------------------------------------
[174]
TÍTULO / TITLE: - The case for protocol
kidney biopsies.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Aug;34(5):1713-5.
AUTORES
/ AUTHORS: - Isoniemi H
INSTITUCIÓN
/ INSTITUTION: - Transplantation and Liver Surgery Clinic,
Helsinki University Hospital, Kasarmik 11, FIN 00130 Helsinki, Finland. N. Ref:: 21
----------------------------------------------------
[175]
TÍTULO / TITLE: - HLA-specific
alloantibodies and renal graft outcome.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001 May;16(5):897-904.
AUTORES
/ AUTHORS: - Sumitran-Holgersson S
INSTITUCIÓN
/ INSTITUTION: - Division of Clinical Immunology,
Karolinska Institutet, Huddinge University Hospital, Huddinge, Sweden.
RESUMEN
/ SUMMARY: - HLA-specific humoral immunity, as a result
of recipient allosensitization, induces hyperacute rejection of allogenic
kidney grafts. Cross-match tests are performed to avoid this complication.
However, current techniques do not allow determination of HLA-specificity of
donor-reactive antibodies in the acute cadaver-donor situation. New methods are
described and discussed in this report as well as the alloantibody
specificities that are of clinical importance. Alloantibodies not only mediate
hyperacute rejection but may also participate in the acute rejection of organ
grafts. Clinical associations between early immunological complications, such
as acute rejection, in heart, liver and kidney allografted patients and
pre-transplantation humoral alloimmunity emphasize the need for proper
determination of donor-specific humoral immunity prior to transplantation. N. Ref:: 35
----------------------------------------------------
[176]
TÍTULO / TITLE: - Role of
anti-interleukin-2 receptor antibodies in kidney transplantation.
REVISTA
/ JOURNAL: - BioDrugs 2001;15(10):655-66.
AUTORES
/ AUTHORS: - Cibrik DM; Kaplan B; Meier-Kriesche HU
INSTITUCIÓN
/ INSTITUTION: - University of Michigan, Ann Arbor,
Michigan 48109-0704, USA. dcibrik@umich.edu
RESUMEN
/ SUMMARY: - From the early 1960s, the mainstay of
immunosuppression for kidney transplantation has been corticosteroids. Since
then, many new drugs have been developed to maintain the renal allograft.
Current maintenance immunosuppression commonly consists of corticosteroids,
antiproliferative agents and calcineurin inhibitors (e.g. cyclosporin). More
recently, antihuman antibodies, either monoclonal or polyclonal, have been
developed to use for induction at the time of transplantation or to treat
rejection. With the advances in molecular technology, a new class of antihuman
antibodies [the anti-interleukin-2 receptor (IL-2R) antibodies] has emerged
that incorporate a murine antigen-binding site on to a human immunoglobulin
backbone. Such methodology creates antihuman antibodies with high affinity for
the epitope and with prolonged serum antibody half-lives. Interleukin-2 and its
receptor are central to lymphocyte activation and are the main targets of
calcineurin inhibitors. In addition, the anti-IL-2R antibodies inhibit a key
target in immune activation. Daclizumab and basiliximab have been shown to significantly
reduce the incidence of acute rejection in kidney transplantation. Since these
anti-IL-2R antibodies are well tolerated and since calcineurin inhibitors are
intrinsically nephrotoxic, anti-IL-2R antibodies have been used in an attempt
to avoid cyclosporin after transplantation. Data from clinical trials seem to
indicate that the addition of an anti-IL-2R antibody is not sufficient to
warrant complete withdrawal of calcineurin inhibitors for more than a very
short period after transplantation. A more promising role for anti-IL-2R
antibodies may be in renal transplant recipients with delayed graft function
(DGF). Recent data on the use of either low-dose calcineurin inhibitors or
sirolimus (rapamycin) in conjunction with the anti-IL-2R antibodies for
patients with DGF showed no increased risk of acute rejection. Long-term graft
survival with use of these low-dose calcineurin inhibitor protocols has yet to
be established. N.
Ref:: 41
----------------------------------------------------
[177]
TÍTULO / TITLE: - Graft immunogenicity
revisited: relevance of tissue-specific immunity, brain death and donor
pretreatment.
REVISTA
/ JOURNAL: - Nephron 2002 Jun;91(2):181-7.
AUTORES
/ AUTHORS: - van der Woude FJ N. Ref:: 47
----------------------------------------------------
[178]
TÍTULO / TITLE: - Rejection-free protocol
using sirolimus-tacrolimus combination for pediatric renal transplant
recipients.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Aug;34(5):1942-3.
AUTORES
/ AUTHORS: - El-Sabrout R; Weiss R; Butt F; Delaney V;
Qadir M; Hanson P; Butt K
INSTITUCIÓN
/ INSTITUTION: - Departments of Transplantation/Vascular
Surgery, New York Medical College, Valhalla, New York, USA.
----------------------------------------------------
[179]
TÍTULO / TITLE: - Chromomycosis due to
Exophiala jeanselmei in a renal transplant recipient.
REVISTA
/ JOURNAL: - Eur J Dermatol 2003 May-Jun;13(3):305-7.
AUTORES
/ AUTHORS: - Pena-Penabad C; Duran MT; Yebra MT;
Rodriguez-Lozano J; Vieira V; Fonseca E
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Complejo
Hospitalario Juan Canalejo, Servicio de Dermatologia, Xubias de Arriba, 84,
15006. a Coruna, España.
RESUMEN
/ SUMMARY: - Chromomycosis is a rare mycotic infection
that is more frequent in tropical and subtropical regions. Dematiaceous fungi
are the causal agents of this mycosis. Several cases of chromomycosis in organ
transplant recipients have been reported. We present a case of chromomycosis by
Exophiala jeanselmei in a Spanish male who had received a renal transplant
several months previously, and was receiving treatment with tacrolimus,
prednisone and mycophenolate mofetil. Very few cases of chromomycosis due to
Exophiala have been reported, and this is, to our knowledge, the first European
case. N. Ref:: 16
----------------------------------------------------
[180]
TÍTULO / TITLE: - Transplantation of
embryonic kidneys.
REVISTA
/ JOURNAL: - Clin Sci (Lond) 2002 Dec;103(6):599-612.
●●
Enlace al texto completo (gratuito o de pago) 1042/
AUTORES
/ AUTHORS: - Hammerman MR
INSTITUCIÓN
/ INSTITUTION: - George M. O’Brien Kidney and Urological
Disease Center, Renal Division, Department of Medicine, Washington University
School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA. mhammerman@im.wustl.edu
RESUMEN
/ SUMMARY: - The number of kidney allotransplants
performed per year is limited by the availability of human donor organs.
Xenotransplantation of a vascularized organ, such as the kidney, as an
alternative to allotransplantation presents formidable immunological
challenges. One novel solution to this conundrum is to use embryonic kidneys
taken from animal donors early during organogenesis when metanephroi can be
transplanted in ‘cellular’ form. We and others have shown that developing
embryonic kidneys (metanephroi) transplanted into the omentum of animal hosts
undergo differentiation and growth in situ, become vascularized by blood
vessels of host origin and exhibit excretory function. Metanephroi can be
stored for up to 3 days in vitro prior to transplantation with no impairment in
growth or function post-implantation. Metanephroi can be transplanted across
both concordant (rat to mouse) and highly disparate/discordant (pig to rodent)
xenogeneic barriers. This review summarizes experimental data relating to the
transplantation of embryonic kidneys. N.
Ref:: 33
----------------------------------------------------
[181]
TÍTULO / TITLE: - Updating renal
transplantation therapies in developing countries.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2475-7.
AUTORES
/ AUTHORS: - Stephan A; Barbari A; Karam A; Kamel G;
Kilani H; Masri AM
INSTITUCIÓN
/ INSTITUTION: - Nephrology and Transplantation Unit, Rizk
Hospital, Beirut, Lebanon. lird@cyberia.net.lb N. Ref:: 33
----------------------------------------------------
[182]
TÍTULO / TITLE: - Postural renal
transplant obstruction: a case report and review of the literature.
REVISTA
/ JOURNAL: - Clin Nucl Med 2001 Aug;26(8):673-6.
AUTORES
/ AUTHORS: - Cohn DA; Gruenewald S
INSTITUCIÓN
/ INSTITUTION: - Department of Nuclear Medicine and Ultrasound,
Westmead Hospital, Westmead, New South Wales, Australia.
RESUMEN
/ SUMMARY: - A 48-year-old woman underwent cadaveric
renal transplantation for end-stage renal failure secondary to polycystic
kidney disease. Nine months after transplantation, intermittent renal
dysfunction and severe graft hydronephrosis developed despite the presence of a
ureteric stent. A Tc-99m MAG3 scan performed with the patient standing showed
complete transplant obstruction. Rapid tracer clearance with progressive bladder
filling was present when the patient was imaged in the supine position.
Ureteric obstruction is the most common urologic complication of renal
transplantation. However, postural ureteric obstruction has been described only
rarely. This case indicates that posture may affect ureteric patency and
highlights this potential pitfall in the evaluation of intermittent graft
dysfunction by diuretic renography. N.
Ref:: 10
----------------------------------------------------
[183]
TÍTULO / TITLE: - Immunosuppression in
elderly renal transplant recipients: are current regimens too aggressive?
REVISTA
/ JOURNAL: - Drugs Aging 2001;18(10):751-9.
AUTORES
/ AUTHORS: - Meier-Kriesche HU; Kaplan B
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of Florida,
Gainesville, Florida 32610-0024, USA.
RESUMEN
/ SUMMARY: - Renal transplantation is an accepted and
successful treatment modality in elderly patients with end-stage renal disease.
In comparison with maintenance dialysis, transplantation has been shown to
confer a mortality benefit as well as improvements in quality of life in older
individuals with end-stage renal disease. Despite this, overall outcomes of
renal transplantation in elderly individuals have, in general, been less
successful than those of younger renal transplant recipients. Largely, this has
been due to the particular vulnerability of elderly patients to the
immunosuppressive medications used in renal transplantation. This review
article covers these issues in some detail and briefly discusses some of the
pharmacokinetic, pharmacodynamic, physiological and immunological differences
between younger and older transplant recipients. Elderly renal transplant
recipients have both a higher rate of patient death and allograft loss censored
for death. Upon multivariate analysis, age of the recipient is strongly
associated with allograft loss independent of other known factors. Acute
rejections are less frequent in older individuals; however the consequence of a
rejection if it occurs is negative for long-term graft survival. On the other
hand, death by infection is vastly increased in older versus younger renal
transplant recipients. In general, the pharmacokinetics of the
immunosuppressive agents are little affected by age, but the tolerance to these
agents seems to decrease with increasing age. Elderly renal transplant
recipients present a very difficult clinical challenge. As the elderly become
an ever-increasing segment of the renal transplant population, new and
innovative immunosuppressive strategies will have to be considered and
applied. N. Ref:: 75
----------------------------------------------------
[184]
TÍTULO / TITLE: - A model for
reactivation of CMV from latency.
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: <> 2002 Aug;25 Suppl 2:S123-36.
AUTORES
/ AUTHORS: - Hummel M; Abecassis MM
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of Organ
Transplantation, Northwestern University Medical School, Chicago, IL 60611,
USA. m-hummel@northwestern.edu
RESUMEN
/ SUMMARY: - BACKGROUND: Reactivation of CMV from
latency results in serious morbidity and mortality in immunocompromised
transplant recipients. The mechanism by which CMV reactivates from latency has
not been well understood. OBJECTIVE: In this review we discuss three models for
reactivation from latency and present evidence in favor of the model that
reactivation is a multi-step process which is initiated by the allogeneic
response to the transplanted organ. Study design (J. Virol. 75 (2001) 4814).
Mice latently infected with murine cytomegalovirus (MCMV) were used as donors
for allogeneic or syngeneic kidney transplants into immunocompetent recipients.
The contralateral donor kidneys were used as controls. Transplanted kidneys
were removed at various times after transplant and analyzed for expression of
viral genes associated with productive infection and for expression of
inflammatory cytokines. Electrophoretic mobility shift assay was performed on
nuclear extracts of control and transplanted kidneys to examine activation of
AP-1 and NFkappaB. Latently infected mice were also injected with tumor
necrosis factor (TNF) to examine the effect of TNF alone on induction of MCMV
immediate-early (IE) gene expression. Transgenic major immediate early
promoter-lacZ mice carrying a beta-galactosidase reporter gene under the
control of the human cytomegalovirus (HCMV) IE promoter/enhancer were used as
donors for allogeneic kidney transplants to study the effect of allogeneic
transplantation on induction of HCMV IE gene expression. RESULTS: Allogeneic,
but not syngeneic transplantation induces MCMV IE-1 expression and expression
of inflammatory cytokines, including TNF. Allogeneic transplantation activates
transcription factors, including NFkappaB and AP-1. TNF alone can induce MCMV
IE-1 gene expression and activation of NFkappaB and AP-1 in some tissues.
CONCLUSIONS: We propose that induction of IE-1 gene expression is the first
step in reactivation of the virus in an immunocompromised transplant recipient,
and that it occurs as a result of the allogeneic response, which induces
expression of TNF and subsequent activation of NFkappaB, and
ischemia/reperfusion injury, which induces activation of AP-1. We speculate
that the natural stimulus for reactivation in an immunocompetent host is an
inflammatory immune response to infection and that allogeneic transplantation
mimics this process. N.
Ref:: 90
----------------------------------------------------
[185]
TÍTULO / TITLE: - A case of traumatic
renal graft rupture with salvage of renal function.
REVISTA
/ JOURNAL: - Clin Transplant 2001 Aug;15(4):289-92.
AUTORES
/ AUTHORS: - Akabane S; Ushiyama T; Hirano Y; Ishikawa
A; Suzuki K; Fujita K
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, Hamamatsu
University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka 431-3192,
Japan.
RESUMEN
/ SUMMARY: - An 18-yr-old man received a kidney graft
from a 60-yr-old female cadaver donor on February 8, 1996. Postoperative course
was uneventful and his serum creatinine level was stable at about 1.8 mg/dL. On
April 30, 1999, he collided with a truck while riding a motor cycle.
Macroscopic hematuria was observed and CT showed an extensive retroperitoneal
hematoma. Because his anemia and hypotension were becoming worse after
transfusion of 9 units of blood, he was operated on as an emergency case. A
large rupture reaching the pelvis and calyces was observed in the upper pole of
the grafted kidney. There were also numerous shallow lacerations, but the major
arteries and veins were not injured. The rupture was closed by suturing the
renal parenchyma with the peritoneum, and the other shallow lacerations were
closed by suturing the renal capsule. The kidney could be salvaged without
requiring hemodialysis. The serum creatinine was maintained at 2.1 mg/dL during
follow-up. A review of the literature showed that 6 cases of traumatic renal
graft rupture with salvage of the kidney have been reported. Our present case
was the seventh, and was the most severe graft rupture reported so far. N. Ref:: 7
----------------------------------------------------
[186]
TÍTULO / TITLE: - Molecular diagnosis of
viral infections in renal transplant recipients.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002 Nov;11(6):665-72.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000040054.33359.e8
AUTORES
/ AUTHORS: - Middeldorp JM
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, VU Medical
Center, Amsterdam, the Netherlands. j.middeldorp@vumc.nl
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: To discuss biological
and methodological aspects of virus infection monitoring in the renal
transplant setting. RECENT FINDINGS: New insights on the molecular pathogenesis
of acute and persistent virus infections and rapid developments in real-time
monitoring techniques are changing the current diagnostic routine. Accurate
risk-assessment prior to transplantation and quantitative monitoring of
parameters that reflect virus activity in the post-transplant period, including
genome load fluctuations and aberrant viral mRNA or protein expression, provide
early signs of undesired viral behaviour and allow pre-emptive therapeutic
intervention. As opposed to prophylactic administration of antiviral drugs, a
pre-emptive approach is more selective and will allow for antiviral immune
responses to build, which may have a long-term beneficial effect. In addition,
these virus-monitoring techniques allow for on-line assessment of therapeutic
efficacy and rapid identification of emerging resistant strains. The
combination of virus-monitoring techniques with rapid assessment of host immune
responses using FACS and ELISPOT techniques, will improve overall patient
management and long-term survival. SUMMARY: Viral infections continue to be a
significant complication in the transplant setting. Diagnostic monitoring
allows timely and accurate therapeutic intervention. Knowledge of pathogenic
mechanisms leading to disease is important for clinical decision making as well
as for the selection of appropriate molecular parameters discriminating normal
and disease-related activity of human pathogenic viruses. The increasing
availability of effective antiviral drugs permits pre-emptive intervention that
strongly depends on accurate viral monitoring procedures. N. Ref:: 57
----------------------------------------------------
[187]
TÍTULO / TITLE: - Replicative senescence
in organ transplantation-mechanisms and significance.
REVISTA
/ JOURNAL: - Transpl Immunol 2002 May;9(2-4):165-71.
AUTORES
/ AUTHORS: - Chkhotua A; Shohat M; Tobar A; Magal N;
Kaganovski E; Shapira Z; Yussim A
INSTITUCIÓN
/ INSTITUTION: - Institute of Urology, University of
Tbilisi, Georgia.
RESUMEN
/ SUMMARY: - In the past two decades, transplantation
has become a preferred modality of treatment of end-stage failure of vital
organs. Currently, with the significant improvement in short-term graft
survival rates, the main effort is concentrated on prolonging the functional
life span of transplanted organs. One of the theories which were put forward to
explain the progressive deterioration of transplant function was that of
replicative senescence. Senescence of an organ or tissue results from age
and/or environmental stress-dependant modification of cellular function. With
time, the accumulation of cellular alterations may lead to deleterious effects
in various organs and tissues and adversely affect transplants. In this article
we are reviewing the candidate mechanisms of senescence such as telomere
shortening, genetic regulation and environmental-‘toxic’ factors and are
examining the implications of the theory of replicative senescence for organ
allograft. We are also presenting our experiments with renal
ischemia/reperfusion in rat serving as a model of kidney transplantation, where
baseline kidney telomere length and novel marker of cellular
senescence—senescence associated beta-Galactosidase (SA-Gal) expression in tissue
served as markers. For the first time in vivo, we were able to show that with
aging of the animals the amount of senescent cells in kidney tissue was
increasing, while the average renal tissue telomere length was decreasing. The
degree of tissue senescence, as determined by amount of SA-Gal positively
stained cells, was inversely correlated with the recovery of the kidney
function after ischemia/reperfusion injury. These results confirm the theory of
replicative senescence in organ ischemia for the first time in vivo, and
quantitatively validate the direct correlation between the amount of senescent
cells in the organ and its susceptibility to ischemic injury. We conclude that
recent advances in study of the cellular basis of senescence, in vitro and especially
in vivo, may hold clues to the understanding of events which could be
implicated in the damage or protection of organ allografts. N. Ref:: 67
----------------------------------------------------
[188]
TÍTULO / TITLE: - TGF-beta1 expression
and chronic allograft nephropathy in protocol kidney graft biopsy.
REVISTA
/ JOURNAL: - Physiol Res. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.biomed.cas.cz/physiolres/
●●
Cita: Physiological Research: <> 2003;52(3):353-60.
AUTORES
/ AUTHORS: - Viklicky O; Matl I; Voska L; Bohmova R;
Jaresova M; Lacha J; Lodererova A; Striz I; Teplan V; Vitko S
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Transplant Center,
Institute for Clinical and Experimental Medicine, Prague, Czech Republic. ivo.matl@medicon.cz
RESUMEN
/ SUMMARY: - Chronic allograft nephropathy (CAN)
represents a frequent and irreversible cause of long-term renal graft loss.
TGF-beta1 is a key profibrogenic cytokine associated with CAN pathogenesis.
Because of clinical diagnostic inaccuracy, protocol biopsy has been suggested
to be a beneficial method for early CAN detection. Protocol core biopsy was
carried out in 67 consecutive cyclosporine-based immunosuppression-treated
kidney transplant recipients with stable renal function 12 months after renal
transplantation. Biopsy specimens were analyzed morphologically according to
Banff-97’ criteria and immunohistologically for TGF-beta1 staining. The data
obtained were correlated with plasma TGF-beta1 levels and clinical data. CAN
(grade I-III) was found in 51 patients (76 %). CAN grade I was found to be the
most frequent one (44 %). A normal finding within the graft was made in only 12
patients (18 %). Clinically silent acute rejection Banff IA was present in 4
patients (6 %). In 8 patients (12 %) with CAN, borderline changes were present.
We found a significant correlation between CAN grade and creatinine clearance,
as measured by the Cockroft-Gault formula (p<0.01) as well as body mass
index (p<0.01). There was a significant correlation between chronic
vasculopathy (Banff cv) and creatinine clearance, and between the degree of
TGF-beta1 staining and chronic vasculopathy (p<0.01). There were no
relations between morphological findings and TGF-beta1 plasma levels,
cyclosporine levels, plasma lipids, HLA-mismatches, panel reactive antibodies
(PRA), proteinuria, and the donor’s age. In conclusion, CAN is a frequent finding
in protocol kidney graft biopsies 12 months after transplantation. TGF-beta1
tissue expression is linked with chronic vasculopathy.
----------------------------------------------------
[189]
TÍTULO / TITLE: - Applications of cell
therapy to whole kidney replacement.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2003
Jan;12(1):1-3.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000049810.98789.05
AUTORES
/ AUTHORS: - Hammerman MR N. Ref:: 13
----------------------------------------------------
[190]
TÍTULO / TITLE: - Molecular mechanisms of
human embryogenesis: developmental pathogenesis of renal tract malformations.
REVISTA
/ JOURNAL: - Pediatr Dev Pathol 2002
Mar-Apr;5(2):108-29.
●●
Enlace al texto completo (gratuito o de pago) 1007/s10024-001-0141-z
AUTORES
/ AUTHORS: - Woolf AS; Winyard PJ
INSTITUCIÓN
/ INSTITUTION: - Nephro-Urology Unit, Institute of Child
Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.
RESUMEN
/ SUMMARY: - The focus of this review is the normal and
abnormal development of the kidney and lower urinary tract; for convenience, we
will refer to the whole system as the renal tract. The content represents a
convergence among the clinical disciplines of histopathology, nephrology, and
urology as well the basic sciences of developmental biology and molecular
genetics. The story has considerable clinical relevance since diverse renal
tract malformations are increasingly detected on fetal ultrasound screening and
constitute major causes of chronic renal failure necessitating dialysis and
kidney transplantation in children. Evidence is emerging that at least some of
these disorders have a defined genetic basis; in others, an abnormal embryonic,
or even maternal, environment may contribute to the pathogenesis. This field of
study is frequently updated, with new discoveries being made almost every week.
Hence this review can not be exhaustive or definitive, but instead highlights
some specific areas of interest. N.
Ref:: 235
----------------------------------------------------
[191]
TÍTULO / TITLE: - Of mice and men: the
road to tolerance.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002
Nov;11(6):579-81.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000040040.55337.cb
AUTORES
/ AUTHORS: - Tolkoff-Rubin NE N. Ref:: 12
----------------------------------------------------
[192]
TÍTULO / TITLE: - Intensive care and
immediate follow-up of children after renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Aug;33(5):2821-4.
AUTORES
/ AUTHORS: - Seikaly MG; Sanjad SA
INSTITUCIÓN
/ INSTITUTION: - Children’s Medical Center of Dallas,
Nephrology Office, Dallas, Texas, USA. N.
Ref:: 16
----------------------------------------------------
[193]
TÍTULO / TITLE: - Hepatitis C virus and
renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2433-5.
AUTORES
/ AUTHORS: - Van Thiel D; Nadir A; Shah N
INSTITUCIÓN
/ INSTITUTION: - Division of Gastroenterology and
Hepatology, Stritch School of Medicine, Loyola University of Chicago, Loyola
University Medical Center, Maywood, Illinois 60153, USA. dvanthi@lumc.edu N. Ref:: 22
----------------------------------------------------
[194]
TÍTULO / TITLE: - Hyperlipidemia and
graft loss.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2423-5.
AUTORES
/ AUTHORS: - Stephan A; Barbari A; Karam A; Kilani H;
Kamel G; Masri A
INSTITUCIÓN
/ INSTITUTION: - Nephrology and Transplantation Unit, Rizk
Hospital, Beirut, Lebanon. lird@cyberia.net.lb N. Ref:: 30
----------------------------------------------------
[195]
TÍTULO / TITLE: - Management of pediatric
postrenal transplantation infections.
REVISTA
/ JOURNAL: - Semin Nephrol 2001 Sep;21(5):521-31.
AUTORES
/ AUTHORS: - Dharnidharka VR; Harmon WE
INSTITUCIÓN
/ INSTITUTION: - Division of Pediatric Nephrology,
University of Florida College of Medicine, Gainesville, FL, USA. vikasmd@peds.ufl.edu
RESUMEN
/ SUMMARY: - Infections are the leading cause of
hospitalization and death after renal transplantation in children. Various
agents are implicated in posttransplantation infections. Viral infections due
to the cytomegalovirus and Epstein-Barr virus have assumed greater importance
as other infections such as pneumocystis pneumonia have come under control.
Multiple factors contribute to the difficulty in the prevention, diagnosis, and
treatment of pediatric postrenal transplantation infections. Prevention of
infections by adequate preparation before transplantation and the use of chemoprophylaxis
should be made a priority. An aggressive approach to diagnosis is required when
investigating fever in children. It is hoped that the use of more specific
immunosuppressive agents that block only the alloactivated T cells and leave
the rest of the immune response intact may result in a reduction in the number
and frequency of infections. N.
Ref:: 91
----------------------------------------------------
[196]
TÍTULO / TITLE: - Thoracic radiology in
kidney and liver transplantation.
REVISTA
/ JOURNAL: - J Thorac Imaging 2002 Apr;17(2):122-31.
AUTORES
/ AUTHORS: - Fishman JE; Rabkin JM
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, University of
Miami School of Medicine, Jackson Memorial Hospital WW 279, 1611 N.W. 12th
Avenue, Miami, FL 33136, USA. jfishman@med.miami.edu
RESUMEN
/ SUMMARY: - Renal transplantation accounts for more
than half of all solid organ transplants performed in the U.S., and the liver
is the second most commonly transplanted solid organ. Although abdominal
imaging procedures are commonplace in these patients, there has been relatively
little attention paid to thoracic imaging applications. Preoperative imaging is
crucial to aid in the exclusion of infectious or malignant disease. In the
perioperative time period, thoracic imaging focuses both on standard intensive
care unit care, including monitoring devices and their complications, and on
the early infections that can occur. Postoperative management is divided into
three time periods, and the principles governing the occurrence of infections
and malignancies are reviewed. Anatomic and pathologic aspects unique to kidney
and liver transplantation patients are also discussed. N. Ref:: 35
----------------------------------------------------
[197]
TÍTULO / TITLE: - Glomerular
hypertension—an under-appreciated aspect of chronic 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: <> 2001 Feb;16(2):213-5.
AUTORES
/ AUTHORS: - Paul LC
N. Ref:: 20
----------------------------------------------------
[198]
TÍTULO / TITLE: - Nephron mass in kidney
transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2401-2.
AUTORES
/ AUTHORS: - Barbari A; Stephan A; Masri MA; Kamel G;
Karam A; Kilani H; Abou Dayah I
INSTITUCIÓN
/ INSTITUTION: - Nephrology and Transplantation Unit, Rizk
Hospital, Beirut, Lebanon. lird@cyberia.net.lb N. Ref:: 29
----------------------------------------------------
[199]
TÍTULO / TITLE: - Homocysteine levels
among transplant recipients: effect of immunosuppressive protocols.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Sep;33(6):2945-6.
AUTORES
/ AUTHORS: - Mor E; Helfmann L; Lustig S; Bar-Nathan N;
Yussim A; Sela BA
INSTITUCIÓN
/ INSTITUTION: - Department of Transplantation, Rabin
Medical Center, Petach-Tikva, Israel.
----------------------------------------------------
[200]
TÍTULO / TITLE: - Routine
renin-angiotensin system blockade in renal transplantation?
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002
Jan;11(1):1-10.
AUTORES
/ AUTHORS: - Remuzzi G; Perico N
INSTITUCIÓN
/ INSTITUTION: - Department of Immunology and Clinic of
Organ Transplantation, Ospedali Riuniti di Bergamo and Mario Negri Institute
for Pharmacological Research, Bergamo, Italy. gremuzzi@marionegri.it
RESUMEN
/ SUMMARY: - There is ample evidence to support the
recommendation of renin-angiotensin system blockade therapy as the standard of
care for strategies aimed at preserving renal function in chronic renal
disease. Nevertheless, despite the well established antihypertensive effects of
these drugs, the use of renin-angiotensin system blockers in renal
transplantation has been quite limited so far, nephrologists being afraid of the
possibility of inducing renal insufficiency in patients with a single kidney
transplant. However, current knowledge of the ability of these agents to
control blood pressure and urinary protein excretion, as well as
post-transplant erythrocytosis, effectively in kidney transplant recipients
suggests that it is now time to apply renin-angiotensin system blockers to the
field of renal transplantation. N.
Ref:: 105
----------------------------------------------------