#10#
Revisiones-Ciencias
Básicas-Molecular, Bioquímica, Metabolismo & Genética *** Reviews-Basic
Sciences-Molecular, Biochemistry, Metabolism & Genetics
TRASPLANTE
RENAL *** RENAL TRANSPLANTATION
(Conceptos
/ Keywords: Renal-Kidney transplantation; Kidney donation-procurement; etc).
Enero /
January 2001 --- Marzo / March 2004
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[1]
TÍTULO / TITLE: - 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: - 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.
----------------------------------------------------
[3]
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
----------------------------------------------------
[4]
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.
----------------------------------------------------
[5]
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
----------------------------------------------------
[6]
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
----------------------------------------------------
[7]
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
----------------------------------------------------
[8]
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
----------------------------------------------------
[9]
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
----------------------------------------------------
[10]
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
----------------------------------------------------
[11]
- 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
----------------------------------------------------
[12]
- 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
----------------------------------------------------
[13]
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
----------------------------------------------------
[14]
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
----------------------------------------------------
[15]
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
----------------------------------------------------
[16]
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
----------------------------------------------------
[17]
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.
----------------------------------------------------
[18]
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
----------------------------------------------------
[19]
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.
----------------------------------------------------
[20]
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
----------------------------------------------------
[21]
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.
----------------------------------------------------
[22]
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
----------------------------------------------------
[23]
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
----------------------------------------------------
[24]
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
----------------------------------------------------
[25]
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
----------------------------------------------------
[26]
- 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
----------------------------------------------------
[27]
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
----------------------------------------------------
[28]
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.
----------------------------------------------------
[29]
- 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
----------------------------------------------------
[30]
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.
----------------------------------------------------
[31]
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
----------------------------------------------------
[32]
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
----------------------------------------------------
[33]
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
----------------------------------------------------
[34]
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
----------------------------------------------------
[35]
- 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
----------------------------------------------------
[36]
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
----------------------------------------------------
[37]
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
----------------------------------------------------
[38]
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
----------------------------------------------------
[39]
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.
----------------------------------------------------
[40]
TÍTULO / TITLE: - Rejection rate in
living donor kidney transplantation with and without basiliximab in
tacrolimus/mycophenolate mofetil-based protocol.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Mar;35(2):653-4.
AUTORES
/ AUTHORS: - Rahamimov R; Yussim A; After T; Lustig S;
Bar-Nathan N; Shaharabani E; Shapira Z; Shabthai E; Mor E
INSTITUCIÓN
/ INSTITUTION: - Department of Transplantation, Rabin
Medical Center, Beilinson Campus, Petah-Tiqwa, Israel. rutir@clalit.org.il
----------------------------------------------------
[41]
TÍTULO / TITLE: - 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
----------------------------------------------------
[42]
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
----------------------------------------------------
[43]
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
----------------------------------------------------
[44]
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.
----------------------------------------------------
[45]
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
----------------------------------------------------
[46]
- 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
----------------------------------------------------
[47]
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
----------------------------------------------------
[48]
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
----------------------------------------------------
[49]
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.
----------------------------------------------------
[50]
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
----------------------------------------------------
[51]
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
----------------------------------------------------
[52]
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
----------------------------------------------------
[53]
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
----------------------------------------------------
[54]
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
----------------------------------------------------
[55]
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
----------------------------------------------------
[56]
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
----------------------------------------------------
[57]
TÍTULO / TITLE: - Sequential protocol
biopsies from renal transplant recipients show an increasing expression of
active TGF beta.
REVISTA
/ JOURNAL: - Transpl Int 2002 Dec;15(12):630-4. Epub
2002 Oct 19.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00147-002-0472-3
AUTORES
/ AUTHORS: - Jain S; Mohamed MA; Sandford R; Furness
PN; Nicholson ML; Talbot D
INSTITUCIÓN
/ INSTITUTION: - University Department of Surgery,
Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. sj34@le.ac.uk
RESUMEN
/ SUMMARY: - Chronic allograft nephropathy (CAN) is a
major cause of graft loss after renal transplantation. Implicated in the
pathogenesis of this complication is overproduction of the cytokine
transforming growth factor beta (TGF beta). In this study we measured changes
in CAN’s expression in stable patients early after transplantation, and studied
links with established risk factors for CAN, such as delayed graft function,
acute rejection, and cyclosporine exposure. We took biopsies from 40 renal
allografts at time of transplantation (pre-perfusion), and then, using
ultrasound guidance, at 1 week and 6 months after transplantation. An
immunofluorescence technique was used to stain sections for active TGF beta.
These were then assessed by semi-quantitative scanning laser confocal
microscopy. There was very little variation in active TGF-beta expression among
patients in their pre-perfusion biopsies. Expression had increased by 1 week
and then very significantly by 6 months ( P<0.0001). Patients who suffered
delayed graft function had increased TGF-beta expression at both time points.
There was no difference regarding donor type, acute rejection, and
immunosuppressive drug (cyclosporine or tacrolimus). There was no correlation
between the amount of TGF-beta expression at any time-point and isotope
glomerular filtration rate (GFR) at 12 months. This study demonstrated that in
a group of stable renal allograft recipients, TGF-beta expression in the kidney
increased after transplantation. As the study used protocol biopsies, this
increase is unlikely to be due to acute events, and probably represents a genuine
increase.
----------------------------------------------------
[58]
TÍTULO / TITLE: - 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
----------------------------------------------------
[59]
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
----------------------------------------------------
[60]
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
----------------------------------------------------
[61]
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.
----------------------------------------------------
[62]
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
----------------------------------------------------
[63]
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
----------------------------------------------------
[64]
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
----------------------------------------------------
[65]
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
----------------------------------------------------
[66]
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
----------------------------------------------------
[67]
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
----------------------------------------------------
[68]
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
----------------------------------------------------
[69]
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
----------------------------------------------------
[70]
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
----------------------------------------------------
[71]
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.
----------------------------------------------------
[72]
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
----------------------------------------------------
[73]
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.
----------------------------------------------------
[74]
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
----------------------------------------------------
[75]
TÍTULO / TITLE: - Kidney transplantation
and ANCA-associated vasculitis.
REVISTA
/ JOURNAL: - Cleve Clin J Med. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.ccjm.org/
●●
Cita: Cleveland Clinic J. of Medicine: <> 2002;69 Suppl 2:SII143-5.
AUTORES
/ AUTHORS: - van der Woude FJ
INSTITUCIÓN
/ INSTITUTION: - Vth Medical University Clinic, Klinikum
Mannheim, Heidelberg University, Mannheim, Germany. Fokko.van-der-Woude@med5.ma.uni-heidelberg.de N. Ref:: 26
----------------------------------------------------
[76]
TÍTULO / TITLE: - Beyond the crossmatch:
successful renal transplantation after the elimination of anti-donor
antibodies.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002
Nov;11(6):583-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000040041.55337.82
AUTORES
/ AUTHORS: - Cohen DJ
N. Ref:: 56
----------------------------------------------------
[77]
TÍTULO / TITLE: - Cell-free DNA in urine:
a marker for kidney graft rejection, but not for prenatal diagnosis?
REVISTA
/ JOURNAL: - Ann N Y Acad Sci 2001 Sep;945:250-7.
AUTORES
/ AUTHORS: - Zhong XY; Hahn D; Troeger C; Klemm A;
Stein G; Thomson P; Holzgreve W; Hahn S
INSTITUCIÓN
/ INSTITUTION: - Department of Obstetrics and Gynecology,
University of Basel, Switzerland.
RESUMEN
/ SUMMARY: - Intrigued by the rapid clearance of free
fetal DNA from the maternal circulation, we have investigated whether this
fetal genetic material could be cleared via the kidney. For this purpose, we
examined for the presence of Y chromosome-specific DNA sequences in urine
samples obtained from 8 women pregnant with male fetuses. No male-specific
sequences could be detected, despite the use of a very sensitive nested PCR
assay nor a highly reproducible real-time PCR assay. We did, however, detect
maternal DNA sequences. To determine if this cell-free DNA was derived from the
kidney or another source, we next examined urine from female kidney transplant
patients who had received male kidneys. Y chromosome-specific sequences were
indeed detectable by both nested and real-time PCR in these samples, thereby
confirming a recent report describing urinary DNA microchimerism. Quantitative
analysis of serially obtained samples furthermore suggests that
transplant-derived sequences are elevated during periods of graft rejection.
These results imply that the measurement of graft-derived urinary DNA may serve
as a new marker for kidney graft tolerance.
N. Ref:: 18
----------------------------------------------------
[78]
TÍTULO / TITLE: - Organ transplantation
in the vasculitides.
REVISTA
/ JOURNAL: - Curr Opin Rheumatol 2003 Jan;15(1):22-8.
AUTORES
/ AUTHORS: - Schmitt WH; van der Woude FJ
INSTITUCIÓN
/ INSTITUTION: - Vth Medical Clinic (Nephrology,
Endocrinology), University-Clinic Mannheim, Faculty of Clinical Medicine of The
University of Heidelberg, Germany. wilhelm.schmitt@med5.ma.uni-heidelberg.de
RESUMEN
/ SUMMARY: - Despite important therapeutic
improvements, permanent organ failure may develop in primary systemic
vasculitides and affect the heart, the lungs, and especially the kidneys. In
systemic vasculitides associated with antineutrophil cytoplasmic antibodies
(AASV), end-stage renal failure develops in 20% of cases. Renal transplantation
became a beneficial option in these patients, with a graft and patient survival
comparable to that in nondiabetic patients. This review summarizes the current
knowledge on indications and contraindications for renal transplantation in
AASV and discusses the impact of posttransplant immunosuppression on the course
of the patients. N.
Ref:: 57
----------------------------------------------------
[79]
TÍTULO / TITLE: - Anti-interleukin-2
receptor antibodies for the prevention of rejection in pediatric renal
transplant patients: current status.
REVISTA
/ JOURNAL: - Paediatr Drugs 2003;5(10):699-716.
AUTORES
/ AUTHORS: - Swiatecka-Urban A
INSTITUCIÓN
/ INSTITUTION: - Department of Physiology, Dartmouth
Medical School, Hanover, New Hampshire 03755, USA. Agnieszka.Swiatecka-Urban@Dartmouth.edu
RESUMEN
/ SUMMARY: - The anti-interleukin-2 receptor
(anti-IL-2R) antibody therapy is an exciting approach to the prevention of
acute rejection after renal allograft transplantation whereby immunosuppression
is exerted by a selective and competitive inhibition of IL-2-induced T cell
proliferation, a critical pathway of allorecognition. The anti-IL-2R antibodies
specifically block the alpha-subunit of the IL-2R on activated T cells, and
prevent T cell proliferation and activation of the effector arms of the immune
system. The anti-IL-2R antibodies are used as induction therapy, immediately
after renal transplantation, for prevention of acute cellular rejection in
children and adults. During acute rejection, the IL-2Ralpha chain is no longer
expressed on T cells; thus, the antibodies cannot be used to treat an existing
acute rejection. Two anti-IL-2R monoclonal antibodies are currently in clinical
use: daclizumab and basiliximab. In placebo-controlled phase III clinical
trials in adults, daclizumab and basiliximab in combination with calcineurin
inhibitor-based immunosuppression, significantly reduced the incidence of acute
rejection and corticosteroid-resistant acute rejection without increasing the
risk of infectious or malignant complications, and neither antibody was
associated with the cytokine-release syndrome. Children who receive calcineurin
inhibitors and corticosteroids for maintenance immunosuppression, as well as
children who receive augmented immunosuppression to treat acute rejection, are
at increased risk of growth impairment, hypertension, hyperlipidemia,
lymphoproliferative disorders, diabetes mellitus, and cosmetic changes. In
older children, the cosmetic adverse effects frequently reduce compliance with
the treatment, and subsequently increase the risk of allograft loss. Being
effective and well tolerated in children, the anti-IL-2R antibodies reduce the
need for calcineurin inhibitors while maintaining the overall efficacy of the
regimen; thus, the anti-IL-2R antibodies increase the safety margin (less
toxicity, fewer adverse effects) of the baseline immunosuppression. Secondly,
the anti-IL-2R antibodies decrease the need for corticosteroids and muromonab
CD3 (OKT3) in children as a result of decreased incidence of acute rejection.
The recommended pediatric dose of daclizumab is 1 mg/kg intravenously every 14
days for five doses, with the first dose administered within 24 hours
pre-transplantation. This administration regimen maintains daclizumab levels
necessary to completely saturate the IL-2Ralpha (5-10 microg/mL) in children
for at least 12 weeks.The recommended pediatric dose of basiliximab for
recipients <35 kg is 10 mg, and 20 mg for recipients > or =35 kg,
intravenously on days 0 and 4 post-transplantation. This administration regimen
maintains basiliximab levels necessary to completely saturate the IL-2Ralpha
(>0.2 microg/mL) in children for at least 3 weeks. N. Ref:: 88
----------------------------------------------------
[80]
TÍTULO / TITLE: - Lymphocyte
costimulatory receptors in renal disease and transplantation.
REVISTA
/ JOURNAL: - J Nephrol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jnephrol.com/
●●
Cita: Journal of Nephrology: <> 2002 Jan-Feb;15(1):7-16.
AUTORES
/ AUTHORS: - Biancone L; Deambrosis I; Camussi G
INSTITUCIÓN
/ INSTITUTION: - Chair of Nephrology, University of Turin,
Italy.
RESUMEN
/ SUMMARY: - Cell-to-cell signal exchange during
antigen presentation deeply influences the profile and extent of the immune
response. Together with the TCR/MHC-mediated signal, accessory signals are
provided to the T cell by the antigen-presenting cell (APC), through specific
receptor-ligand interactions that represent indispensable costimulation for
T-cell activation and survival. The main costimulatory pathways are the B7
family members and the CD40-CD154 receptor-ligand pair. B7-1 and B7-2
costimulate T-cells by binding to CD28. Their binding is prevented by the
neoexpression of CTLA4, a CD28 homologue that can deliver a negative signal.
Another CD28-like molecule, called ICOS (inducible costimulator), has been
described and binds B7RP-1, a third member of the B7 family, but not B7-1 and
B7-2. The CD40-CD154 interaction works as a two way costimulatory system by
triggering activation signals to both T-cell and APCs. Its importance is
highlighted by the discovery that mutations of the CD154 gene are responsible
for a severe human immunodeficiency. Disruption of the natural costimulatory
interaction was highly effective for prevention and treatment in several
experimental models of autoimmune disease and transplant rejection. This review
focuses on the most significant advances in understanding the
physiopathological events involving costimulatory molecules, and their impact
on renal diseases and transplantation. N.
Ref:: 65
----------------------------------------------------
[81]
TÍTULO / TITLE: - From renal amyloid
deposits to the identification of the culprit genes.
REVISTA
/ JOURNAL: - J Nephrol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jnephrol.com/
●●
Cita: Journal of Nephrology: <> 2003 May-Jun;16(3):427-30.
AUTORES
/ AUTHORS: - Pirson Y
INSTITUCIÓN
/ INSTITUTION: - Nephrology Department, Cliniques St Luc,
Universite Catholique de Louvain, Brussels, Belgium. pirson@nefr.ucl.ac.be
RESUMEN
/ SUMMARY: - Hereditary amyloidoses with renal
involvement are classified in two groups. The first group is a growing family
of autoinflammatory disorders characterized by recurrent fever attacks.
Amyloidosis is caused by the deposition of amyloid A (AA) protein, which is a
degradation product of a normal serum acute-phase protein: serum amyloid A
(SAA). The prototype is familial Mediterranean fever (FMF). TNF Receptor Associated
Periodic Syndrome (TRAPS) is a recently recognized periodic fever syndrome,
differing from FMF in several characteristics: autosomal-dominant transmission,
longer duration of attacks, and lack of response to colchicine prophylaxis. The
second group comprises a variety of disorders, each characterized by the
deposition of a specific mutant protein. The prototype is transthyretin
amyloidosis (TTR). Identification of the form of amyloidosis has clinical
implications. Therefore, in a patient with a history of recurrent fever attacks
and AA amyloidosis, a diagnosis of FMF or TRAPS dictates appropriate genetic
counseling and management. In patients with renal amyloidosis without a history
of fever, identification of the mutant protein is therapeutically crucial;
therefore, when the cell type that produces the precursor is (exclusively or
mainly) the hepatocyte, a liver transplantation is to be considered. N. Ref:: 24
----------------------------------------------------
[82]
TÍTULO / TITLE: - Management of selected
lipid abnormalities: hypertriglyceridemia, isolated low HDL-cholesterol,
lipoprotein(a), and lipid abnormalities in renal diseases and following solid
organ transplantation.
REVISTA
/ JOURNAL: - Cardiol Clin 2003 Aug;21(3):377-92.
AUTORES
/ AUTHORS: - Rosas S; Szapary P; Rader DJ
INSTITUCIÓN
/ INSTITUTION: - University of Pennsylvania Medical Center,
654 BRBII/III Labs, 421 Curie Boulevard, Philadelphia, PA 19104-6160, USA.
RESUMEN
/ SUMMARY: - Although the focus in treating lipid
disorders is on reducing LDL-C levels, additional lipid-related independent
risk factors, such as TG, HDL-C, and Lp(a) levels, should be used clinically to
assess cardiovascular risk. Decisions to initiate drug therapy for LDL-C
reduction may be influenced by levels of these other lipoprotein fractions.
Data supporting intervention to modify these factors are less abundant than for
LDL-C reduction, but in certain circumstances. drug therapy targeted at TGs or
HDL-C may be appropriate. Patients who have nephrotic syndrome and end-stage
renal disease are at particularly high risk for the development of CVD and
should be treated aggressively for their lipid disorders. Finally, solid organ
transplant recipients are almost always hyperlipidemic and appropriate therapy
could reduce cardiovascular events. N.
Ref:: 146
----------------------------------------------------
[83]
TÍTULO / TITLE: - Complement in renal
transplantation.
REVISTA
/ JOURNAL: - Nephron Clin Pract 2003;95(1):c3-8.
●●
Enlace al texto completo (gratuito o de pago) 1159/000073012
AUTORES
/ AUTHORS: - Chowdhury P; Zhou W; Sacks SH
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and
Transplantation, Guy’s Hospital, King’s College, University of London, London,
UK.
RESUMEN
/ SUMMARY: - Previous research and therapy in renal
transplantation largely focused on the cellular arm of the adaptive immune
response. Evidence is emerging that innate immune mechanisms, particularly
complement, play a greater role in inflammatory and immune responses against
the graft than has been previously recognized. Alternative complement pathway
activation appears to mediate renal ischaemia/reperfusion injury, and proximal
tubular cells may be both the source and the site of attack of complement
components in this setting. Locally produced complement also plays a role in
the development of both cellular and antibody-mediated immune responses against
the graft. C4d staining has emerged as a useful marker of humoral rejection
both in the acute and in the chronic setting and led to renewed interest in the
significance of anti-donor antibody formation. A number of therapies are in
development which inhibit complement or reduce local synthesis, and may lead to
an improved clinical outcome following renal transplantation. N. Ref:: 25
----------------------------------------------------
[84]
TÍTULO / TITLE: - Transplantation of
kidneys from HCV-positive donors: a safe strategy?
REVISTA
/ JOURNAL: - J Nephrol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jnephrol.com/
●●
Cita: Journal of Nephrology: <> 2003 Sep-Oct;16(5):617-25.
AUTORES
/ AUTHORS: - Fabrizi F; Bunnapradist S; Lunghi G;
Martin P
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Dialysis,
Transplantation, Maggiore Hospital, IRCCS, Milan, Italy. fabrizi@policlinico.mi.it
RESUMEN
/ SUMMARY: - Hepatitis C Virus (HCV) infection is the
most important cause of liver disease after renal transplantation (RT). The
impact of HCV on patient and graft survival after RT remains controversial;
however, the great majority of studies with large size and adequate follow-up
have shown the detrimental impact of HCV on long-term patient and graft
survival after RT. The use of kidneys from anti-HCV positive donors could help
decrease the continuing disparity between the number of patients on the
transplant waiting list and the number of patients receiving a transplant each
year. Single-center experiences have suggested transplanting kidneys from
anti-HCV positive donors only in anti-HCV positive dialysis patients. Such
practice has not demonstrated any adverse effect on the short-term patient
survival; the waiting times for RT were shortened. A better alternative seems
to be a policy of transplanting kidneys from anti-HCV positive donors only in
HCV RNA positive recipients. This requires HCV RNA testing of all anti-HCV
positive dialysis patients awaiting RT. Matching donors and recipients for HCV
genotype has been suggested; however, the assessment of donor HCV genotype is
currently hampered by time constraints. Recent evidence based on large data
base demonstrated that RT recipients of HCV-positive donors are at independent
increased risk of mortality; unadjusted 3-year patient survival was 85% versus
93% (P=0.01) in all recipients of donor HCV-positive and HCV-negative kidneys,
respectively. This was observed in all recipient subgroups including elderly
and HCV-positive recipients. In the near future, rapid nucleic acid testing
(NAT) of donors and recipients will allow the assessment of the HCV viremic
status in order to maximize organ use. With appropriate informed consent, use
of a renal graft from an HCV positive donor may be offered to an HCV infected
recipient. Additional studies are needed to clarify the link between donor
HCV-positive kidneys and patient mortality.
N. Ref:: 69
----------------------------------------------------
[85]
TÍTULO / TITLE: - Therapeutic apheresis
therapy for ABO-incompatible renal transplantations.
REVISTA
/ JOURNAL: - Therap Apher Dial 2003 Dec;7(6):520-8.
AUTORES
/ AUTHORS: - Ishida H; Tanabe K; Toma H; Akiba T
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, Division of Blood Purification,
Tokyo Women’s Medical University, Tokyo, Japan. tgphide@gol.com
RESUMEN
/ SUMMARY: - The most important transplantation antigen
system for organ transplantation is the ABO blood group system. Crossing the
blood barrier is usually not done except in emergency cases such as liver
transplantations for fulminant hepatitis. Early experiences of allograft
transplantations across the blood barriers were discouraging. In the 1970s,
clinical trials were started transplanting kidneys of subgroup A2 into blood
group O recipients because the tissues of the A2 subgroup express a lower
amount of A antigens compared with subgroup A1. The recipients required no
special treatment and received the standard immunosuppressive regimen as used
in blood group identical cases. Many early graft loses immediately after
transplantations were experienced, but these trials resulted in an excellent
graft survival rate. A few centers have adapted the concept of A2 kidneys to
non-A recipient transplantations with successful results by reducing anti-A
blood type titers prior to transplantations. In the early 1980s, the
possibility of bridging the ABO barrier was tested by several groups. A1 and B
kidneys from living donors were also successfully transplanted across the blood
barrier using quadruple immunosuppressive drugs and splenectomy. Since 1989,
the largest number of ABO-incompatible renal transplantations have been
performed in Japan because of the limited numbers of cadaveric donors.
Approximately 400 cases have been successfully transplanted across the blood
barrier at many centers in Japan. Owing to novel immunosuppressive drugs, the
ABO-incompatible allografts exhibited a level of function comparable with that
of ABO-matched allografts even though anti-A or anti-B antibodies had returned
to the circulation of the recipients. In this article, we describe the
historical background, the current therapeutic strategies including apheresis
therapy for the ABO-incompatible transplantations, and the experiences at our
institution. N.
Ref:: 26
----------------------------------------------------
[86]
TÍTULO / TITLE: - Management of hepatitis
B after renal transplantation: an update.
REVISTA
/ JOURNAL: - J Nephrol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jnephrol.com/
●●
Cita: Journal of Nephrology: <> 2002 Mar-Apr;15(2):113-22.
AUTORES
/ AUTHORS: - Fabrizi F; Lunghi G; Poordad FF; Martin P
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and Dialysis,
Institute of Hygiene and Preventive Medicine, Ospedale Maggiore Policlinico,
IRCCS, Milano, Italy. fabrizi@policlinico.mi.it
RESUMEN
/ SUMMARY: - Hepatitis B Virus (HBV) infection remains
an important cause of liver disease in renal transplant (RT) recipients and the
outcome of HBV infected RT recipients is less favorable than that of
noninfected RT recipients. The concern about graft loss induced by interferon (IFN)
therapy precludes its use; lamivudine, a second-generation analog, has been
recently approved for the treatment of hepatitis B and promises to be highly
effective in this setting. Several uncontrolled trials have reported a high
rate of biochemical (ranging between 80% and 100%) and virological (ranging
between 67% and 100%) response in RT recipients, comparable to immunocompetent
patients. Lamivudine has an excellent safety profile in RT recipients. However,
the emergence of viral mutations leading to resistance has been reported during
lamivudine therapy in RT recipients. In addition, numerous issues remain to be
clarified about lamivudine use after RT including the management of viral
resistance, the role of HBV genotypes in the response to lamivudine, and the
duration of therapy and response. The combination of newer nucleoside analogues
with lamivudine, analogous to HIV, may further improve the efficacy of
antiviral therapy against HBV after RT.
N. Ref:: 85
----------------------------------------------------
[87]
TÍTULO / TITLE: - Polyclonal antibodies
induction therapy in kidney transplantation: a single center experience.
REVISTA
/ JOURNAL: - Ann Transplant 2002;7(4):46-8.
AUTORES
/ AUTHORS: - Malaise J; De Meyer M; Mourad M; Squifflet
JP
INSTITUCIÓN
/ INSTITUTION: - Department of Renal and Pancreatic
Transplantation, Universite Catholique de Louvain Medical School, Brussels,
Belgium. Jacques.Malaise@chir.ucl.ac.be N. Ref:: 18
----------------------------------------------------
[88]
TÍTULO / TITLE: - Use of basiliximab and
daclizumab in kidney transplantation.
REVISTA
/ JOURNAL: - Prog Transplant 2001 Mar;11(1):33-7; quiz
38-9.
AUTORES
/ AUTHORS: - Olyaei AJ; Thi K; deMattos AM; Bennett WM
INSTITUCIÓN
/ INSTITUTION: - Oregon Health Sciences University,
Portland, Ore., USA.
RESUMEN
/ SUMMARY: - Kidney transplantation represents a major
medical victory in patients with whom dialysis and medical therapy have failed.
To increase survival rates and optimize the use of limited organs, both patient
care and immunosuppression therapy must be improved. Reduction in rejection
episodes or severity of rejection may ultimately improve long-term allograft
survival. Traditional engineered monoclonal antibodies have been associated
with severe cytokine release reactions and an increased risk of opportunistic
infections. Basiliximab and daclizumab are chimeric and humanized monoclonal
antibodies which inhibit thymus-dependent lymphocyte proliferation.
Interleukin-2 also affects the proliferation of natural killer cells,
macrophages and monocytes, bursa-equivalent lymphocytes, epidermal dendritic
cells, and lymphokine-activated killer cells. Interleukin-2 receptor
antagonists have been shown to reduce the incidence of acute rejection without
increasing the incidence of opportunistic infections or malignancy. Further
studies are needed to evaluate the overall effect of these agents on long-term
patient and allograft survival. N.
Ref:: 28
----------------------------------------------------
[89]
TÍTULO / TITLE: - RAS blockade in
experimental renal transplantation. Benefits and limitations.
REVISTA
/ JOURNAL: - Curr Drug Targets Cardiovasc Haematol
Disord 2003 Mar;3(1):73-9.
AUTORES
/ AUTHORS: - Smit-van Oosten A; Stegeman CA; van Goor H
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology and Laboratory
Medicine, University Hospital Groningen, The Netherlands. a.smit-van.oosten@med.rug.nl
RESUMEN
/ SUMMARY: - In renal transplantation, chronic renal
transplant failure (CRTF) is the principal cause of late graft loss. Both
immunological and non-immunological factors play a role in the pathogenesis of
CRTF. However, CRTF is unresponsive to immunosuppressive therapy. In several
kidney diseases, inhibition of the renin-angiotensin system (RAS) has shown to
reduce the rate of progression of renal disease more effectively than
conventional antihypertensive drugs. Therefore, RAS blockade may be of benefit
in the treatment of CRTF. Several short-term studies in human renal transplant
recipients showed that RAS blockade had a beneficial effect on renal transplant
function, blood pressure and proteinuria. Despite these benefits physicians
remain reluctant to use ACE inhibition in these recipients, because of fear of
functional decrease in renal perfusion, especially in the setting of renal
transplant artery stenosis. To study the long-term effects of RAS blockade we
used the established Fisher to Lewis (F-L) model for CRTF, which mirrors the
progressive changes seen in humans. Studies in our lab and by others showed
that RAS blockade in the F-L model prevents proteinuria, glomerulosclerosis and
hypertension. However, when treated for 34 weeks with RAS blockade, renal
arteries developed severe intimal hyperplasia. This effect was specific for
Fisher rats. Syngrafted Fisher rats treated with ACE inhibition developed
intimal hyperplasia, but allografting significantly aggravated it. Fisher rats
have a four times higher renal ACE activity, compared with the Lewis rat. This
is comparable to the human DD/II genotype differences in ACE activity. Renal
transplant patients with the DD genotype may be more vulnerable for vascular
changes when treated with RAS blockade.
N. Ref:: 62
----------------------------------------------------
[90]
TÍTULO / TITLE: - Immune profiling:
molecular monitoring in renal transplantation.
REVISTA
/ JOURNAL: - Front Biosci 2003 Sep 1;8:e444-62.
AUTORES
/ AUTHORS: - Hoffmann SC; Pearl JP; Blair PJ; Kirk AD
INSTITUCIÓN
/ INSTITUTION: - Transplantation Section, Transplantation
and Autoimmunity Branch, National Institute of Diabetes and Digestive and
Kidney Diseases, National Institutes of Health, Department of Health and Human
Services, Bethesda, Maryland 20889, USA.
RESUMEN
/ SUMMARY: - Molecular techniques have become a
mainstay for most biomedical research. In particular, sensitive methods for
gene transcript detection and advanced flow cytometry have been crucial in
fostering our understanding of the basic mechanisms promoting allosensitization
and adaptive immune regulation. These technologies have been validated in
vitro, and in pre-clinical settings, and as such their clinical application is
now clearly appropriate. It is becoming increasingly clear that these robust
techniques hold much promise to better elucidate human transplant biology, and
more importantly, guide clinical decision making with mechanistically-based
information. This article will discuss our laboratory’s use of several novel
technologies, including gene polymorphism analysis, real-time polymerase chain
reaction transcript quantification, and multi-color flow cytometry in clinical
human renal transplantation. Specific technical methodology will be presented
outlining keys for effective clinical application. Clinical correlations will
be presented as examples of how these techniques may have clinical relevance.
Suggestions for the adaptation of these methods for therapeutic intervention
will be given. We propose that clinical transplantation should proceed in close
step with modern molecular diagnostics.
N. Ref:: 84
----------------------------------------------------
[91]
TÍTULO / TITLE: - Pathogenesis and
molecular mechanisms of chronic allograft nephropathy.
REVISTA
/ JOURNAL: - Contrib Nephrol 2003;139:187-204.
AUTORES
/ AUTHORS: - Ahsan N; Cheung JY
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and
Transplantation, University of Medicine and Dentistry of New Jersey, Robert
Wood Johnson Medical School, One Robert Wood Johnson Place, MEB 412, New
Brunswick, NJ 08903, USA. ahsanna@umdnj.edu N. Ref:: 92
----------------------------------------------------
[92]
TÍTULO / TITLE: - Abnormal lipid
metabolism after renal transplantation.
REVISTA
/ JOURNAL: - Ann Transplant 2001;6(1):5-8.
AUTORES
/ AUTHORS: - Wanner C; Quaschning T
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of
Nephrology, University Hospital Wurzburg, Germany. c.wanner@medizin.uni-wuerzburg.de
RESUMEN
/ SUMMARY: - The evidence that lipid disorders in
patients following renal transplantation play a major role in the pathogenesis
of atherosclerosis and chronic renal allograft rejection is circumstantial. The
high rate of clinical vascular disease and cardiovascular complications in
renal transplant recipients, the high prevalence of an atherogenic dyslipidemia
and the evidence from the statin regression trials in the general population suggest
that lipid lowering treatment is beneficial in patients after renal
transplantation. In addition, animal models and observational studies in
patients have demonstrated correlations between plasma lipid levels and both
acute and chronic rejection. Animal transplant models and clinical trials in
heart transplant patients also suggest that statin treatment decreases the
incidence of chronic rejection. However, the mechanisms behind this protective
effect remain unsolved and no conclusive data exist proving that statins
directly inhibit the development of chronic rejection. However, sufficient
evidence exists to consider the use of these agents in the posttransplant
setting for their possible effects on cardiovascular complications. N. Ref:: 32
----------------------------------------------------
[93]
TÍTULO / TITLE: - Historical overview of
the use of cytomegalovirus hyperimmune globulin in organ transplantation.
REVISTA
/ JOURNAL: - Transpl Infect Dis 2001;3 Suppl 2:6-13.
AUTORES
/ AUTHORS: - Snydman DR
INSTITUCIÓN
/ INSTITUTION: - Division of Geographic Medicine and
Infectious Diseases, New England Medical Center, Boston, Massachusetts 02111,
USA. dsnydman@lifespan.org
RESUMEN
/ SUMMARY: - A historical review of the development of
cytomegalovirus hyperimmune globulin (CMV-IG, CytoGam) shows its increasing use
in solid organ transplant (SOT) recipients, either alone or in combination with
ganciclovir. A review of clinical trials of CytoGam in renal transplant
recipients shows reductions in CMV-associated syndromes and fungal and
parasitic superinfections, and increases in graft survival, while CytoGam
prophylaxis trials in orthotopic liver transplant (OLT) recipients have
produced reductions in severe CMV-associated disease and invasive fungal
disease. A combination of CytoGam plus ganciclovir in OLT recipients has
resulted in reductions in CMV hepatitis and infection, and CMV disease and
viremia, plus a trend in improved 1- and 2-year survival rates. N. Ref:: 18
----------------------------------------------------
[94]
TÍTULO / TITLE: - Applications of
microarrays to renal transplantation: progress and possibilities.
REVISTA
/ JOURNAL: - Front Biosci 2003 Sep 1;8:s913-23.
AUTORES
/ AUTHORS: - Chua MS; Mansfield E; Sarwal M
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, Stanford
University School of Medicine, G320, 300 Pasteur Drive, Stanford, CA 94305,
USA.
RESUMEN
/ SUMMARY: - By rapidly generating global views of gene
expression profiles, microarray technology offers a great advantage over
traditional methods of studying gene expression. This technology is gaining
rapid and widespread use in many areas of science and medicine because it can
be easily adapted to study many experimental questions. This article will
review the current applications of microarray technology in the field of renal
transplantation, and discuss the potential impact of this technology on
transplantation medicine. N.
Ref:: 49
----------------------------------------------------
[95]
TÍTULO / TITLE: - Transmission of viral
hepatitis by kidney transplantation: donor evaluation and transplant policies
(Part 1: hepatitis B virus).
REVISTA
/ JOURNAL: - Transpl Infect Dis 2002 Sep;4(3):124-31.
AUTORES
/ AUTHORS: - Natov SN
INSTITUCIÓN
/ INSTITUTION: - Tufts University School of Medicine,
Tufts-New England Medical Center, Boston, Massachusetts, USA.
RESUMEN
/ SUMMARY: - This two-part article discusses serologic
testing of prospective donors for viral hepatitis B and C as part of the
comprehensive donor evaluation and reviews of the current policies and
practices aimed at preventing donor-to-recipient transmission of hepatitis B
and C viruses (HBV, HBC). This second part of the review discusses HCV. Organs
procured from HCV-infected donors can transmit the virus to their recipients.
Because a number of studies have associated infections with HCV with increased
morbidity and mortality among renal transplant recipients, it is important to
prevent HCV transmission with renal transplantation. The majority of organ
procurement organizations (OPOs) perform routine screening of organ donors for
antibodies to HCV (anti-HCV). The prevalence of HCV infection among cadaver
organ donors, ascertained based on a positive anti-HCV test by ELISA2, varies
worldwide between 1.08% and 11.8%. The use of kidneys from donors negative for
anti-HCV by ELISA2 carries negligible or no risk of transmitting HCV infection.
The use of organs from anti-HCV-positive donors has been restricted to
life-saving transplants (heart, liver or lung) by the majority of OPOs
worldwide. However, discarding kidneys from all anti-HCV positive donors would
lead to unnecessary waste of organs because not all anti-HCV positive donors
are infectious. Recently, the policy of unconditional restriction on the use of
kidneys from anti-HCV positive donors has been challenged, and transplantation
of organs from anti-HCV-positive donors into anti-HCV-positive recipients has
been found to be safe. An even better alternative might be a policy of
transplanting kidneys from anti-HCV-positive donors only in HCV RNA-positive
recipients. However, until more data become available, these two strategies
remain experimental treatments. N.
Ref:: 51
----------------------------------------------------
[96]
TÍTULO / TITLE: - Transplanting kidneys
from donors with prior hepatitis B infection: one response to the organ
shortage.
REVISTA
/ JOURNAL: - J Nephrol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jnephrol.com/
●●
Cita: Journal of Nephrology: <> 2002 Nov-Dec;15(6):605-13.
AUTORES
/ AUTHORS: - Fabrizio F; Bunnapradist S; Martin P
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Dialysis and
Transplantation, Maggiore Hospital, Policlinico IRCCS, Milano, Italy. fabrizi@policlinico.mi.it
RESUMEN
/ SUMMARY: - While the number of cadaveric organ donors
remains relatively stable, the number of patients awaiting transplantation
continues to increase, creating a shortage of donor organs. To address this
imbalance, there is interest in transplanting organs formerly considered
marginal or undesirable. Thus, more organs are currently transplanted from
living donors, older donors, hemodynamically unstable donors, non-heart-beating
donors and donors with markers of prior hepatitis B virus (HBV) infection. A
large number (up to 93.8%) of liver transplant seronegative recipients from
anti-HBc antibody positive donors have acquired HBsAg after liver
transplantation in the absence of immunoprophylaxis. Based on experience in
liver transplantation programs, transmission of HBV from donors without HBsAg
but with antibody to HBV core antigen (anti-HBc), although conventionally
defined as evidence of resolved infection, can have adverse consequences on
both graft and recipient. On the contrary, HBV appears to be in-frequently
transmitted from HBsAg negative/anti-HBcAb positive kidney donors: the
incidence of de novo HBsAg seropositivity after renal transplantation ranges
between 0 and 5.2%. A significantly higher incidence of anti-HBc antibody
seroconversion (without developing HBsAg) after renal transplantation with
anti-HBc antibody positive donors was seen. However, anti-HBc antibody positive
renal allografts should be considered, especially for recipients who have been
successfully immunized with HBV vaccine. Prospective long-term studies are in
progress to assess the risk of de novo HBV infection (HBsAg seroconversion) in
renal transplant recipients who have not been successfully immunized with
vaccine against HBV. N.
Ref:: 58
----------------------------------------------------
[97]
TÍTULO / TITLE: - Daclizumab as induction
therapy in kidney and simultaneous pancreas-kidney transplantation.
REVISTA
/ JOURNAL: - Minerva Urol Nefrol 2003 Mar;55(1):43-56.
AUTORES
/ AUTHORS: - Ciancio G; Mattiazzi A; Miller J; Burke GW
INSTITUCIÓN
/ INSTITUTION: - Division of Transplantation, Department of
Surgery, University of Miami School of Medicine, Miami, FL 33101, USA. gciancio@med.miami.edu
RESUMEN
/ SUMMARY: - Acute rejection still remains a major
problem in organ transplantation and is a significant risk factor for chronic
rejection, and chronic rejection is one of the most important causes of late
graft loss. Current new immunosuppressive drugs such as tacrolimus, rapamycin
and mycophenolate mofetil have been developed to reduce acute rejection and to
improve renal allograft survival. More recently, antihuman antibodies, either
monoclonal or polyclonal, have been developed to use for induction therapy at
the time of transplantation or to treat rejection. Daclizumab, a new engineered
human immunoglobulin monoclonal antibody to the interleukin-2 receptor
a-subunit was approved to prevent acute rejection after solid organ
transplantation. Data from clinical trials show daclizumab to be well tolerated
in solid organ transplantation. It does not increase the incidence of
infection, including cytomegalovirus infection. N. Ref:: 72
----------------------------------------------------
[98]
TÍTULO / TITLE: - Update on drug sieving
coefficients and dosing adjustments during continuous renal replacement
therapies.
REVISTA
/ JOURNAL: - Contrib Nephrol 2001;(132):349-53.
AUTORES
/ AUTHORS: - Golper TA
INSTITUCIÓN
/ INSTITUTION: - Vanderbilt University Medical Center,
Nashville, Tenn., USA. N.
Ref:: 17
----------------------------------------------------
[99]
TÍTULO / TITLE: - Metabolic aspects of
tacrolimus in renal transplantation. Consequences for the choice of an
immunosuppressive regimen and for the management of post-transplant diabetes
mellitus.
REVISTA
/ JOURNAL: - Minerva Urol Nefrol 2003 Mar;55(1):33-42.
AUTORES
/ AUTHORS: - van Duijnhoven EM; Boots JM; Christiaans
MH; van Hooff JP
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine,University
Hospital Maastricht, Maastricht, The Netherlands. evd@sint.azm.nl
RESUMEN
/ SUMMARY: - The occurrence of post-transplant diabetes
mellitus (PTDM) is an important complication after renal transplantation
associated with an increased risk of chronic transplant dysfunction and of
cardiovascular morbidity and mortality. Both tacrolimus and cyclosporine have
been associated with PTDM. In the initial studies, PTDM seemed to occur more
often in tacrolimus treated patients than in cyclosporine treated patients. The
mechanism by which tacrolimus could cause PTDM was unknown and the relative
roles of tacrolimus and corticosteroids, which are often prescribed
concomitantly with tacrolimus, were unknown. In several studies we used fasting
glucose and insulin levels to assess (peripheral) insulin resistance, and
intravenous glucose tolerance tests to assess insulin secretion by the
pancreatic b-cells in response to a stimulus (glucose load). Thus, we evaluated
the mechanism by which tacrolimus causes glucose metabolic disorders, risk
factors for glucose metabolic disorders during tacrolimus treatment, the
relative roles of corticosteroids and tacrolimus trough levels in glucose
metabolic disorders, and also differences in glucose metabolism between
patients using tacrolimus versus patients using cyclosporine. Based on the
results of these studies and the available literature, the consequences for the
choice of a primary immunosuppressive agent and guidelines for the treatment of
PTDM during tacrolimus-based immunosuppression are discussed. N. Ref:: 40
----------------------------------------------------
[100]
TÍTULO / TITLE: - Renin-angiotensin
system in chronic renal allograft dysfunction.
REVISTA
/ JOURNAL: - Contrib Nephrol 2001;(135):222-34.
AUTORES
/ AUTHORS: - Shihab FS
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, University of Utah
School of Medicine, Salt Lake City, Utah, USA. Fuad.Shihab@hsc.utah.edu N. Ref:: 44
----------------------------------------------------
[101]
TÍTULO / TITLE: - Induction immunotherapy
with IL-2Ra monoclonal antibody in kidney transplantation.
REVISTA
/ JOURNAL: - Minerva Urol Nefrol 2003 Mar;55(1):67-79.
AUTORES
/ AUTHORS: - Ahsan N
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and
Transplantation, University of Medicine and Dentistry of New Jersey, Robert
Wood Johnson Medical School, New Brunswick, NJ 08903, USA. ahsanna@umdnj.edu
RESUMEN
/ SUMMARY: - The development of new immunosuppressive
agents is designed to reduce the incidence and severity of early acute
post-transplant rejection. One potential target for more specific
immunosuppressive therapy with monoclonal antibodies is the high affinity a
chain of interleukin-2 receptors (IL-2Ra). Clinical investigation of murine
IL-2Ra monoclonal antibodies (IL-2Ra mAb) in renal transplantation has
indicated that a complete blockade of IL-2Ra during the critical first
post-transplant months allows effective immunoprophylaxis, especially in the
early post-transplant period. Efficacy of these agents, however, is hampered by
their short disposition half-lives in humans and their immunogenicity in the
form of neutralizing human antimouse antibodies. These inherent problems can be
partially overcome by chi-meric, hyper-chimeric (humanized) products and
multiple dose regimens. Both IL-2Ra mAbs: daclizumab (humanized) and
basiliximab (chimeric) currently approved for clinical use have been found to
reduce the frequency of acute rejections in renal transplant recipients without
an apparent increase in short-term toxicities. In most transplant centers where
these agents are utilized, they are being routinely administered as induction
immunoprophylaxis in recommended multiple dose regimens to recipients of solid
organ transplants. Others have restricted their use to certain high-risk
patients such as those undergoing multi-organ transplantation, recipients with
high panel-reactive antibodies, African-Americans, patients at risk for
developing delayed graft function (DGF), and children. Recently some
investigators have successfully administered these antibodies co-administered
with newer immunosuppressive agents in limited dose protocols thus developing
cost effective and simplified regimens. Therefore, in the absence of a
favorable long-term efficacy, it is likely that these agents will be
administered in limited dose protocols along with one of the modulators of
IL-2, i.e. calcineurin inhibitors (CNI), to a selected group of patients in
whom additional immunosuppression in the early post-transplantation period is
desirable. N. Ref:: 59
----------------------------------------------------
[102]
TÍTULO / TITLE: - New monoclonal
antibodies in renal transplantation.
REVISTA
/ JOURNAL: - Minerva Urol Nefrol 2003 Mar;55(1):57-66.
AUTORES
/ AUTHORS: - Vincenti F
INSTITUCIÓN
/ INSTITUTION: - Kidney Transplant Service, University of
California, San Francisco, CA 94143-0780, USA. vincentif@surgery.ucsf.edu
RESUMEN
/ SUMMARY: - A decade of spectacular innovation in
maintenance immunosuppression drugs has resulted in dramatic reductions in
acute rejection and improvement in short and long term outcome after renal
transplantation. However the new drugs continue to lack specificity, many require
frequent therapeutic drug monitoring and all are associated with acute and
chronic toxicities. The new biologic agents, monoclonal antibodies (chimeric,
humanized, and fully human) and receptor-fusion proteins, lack immunogenicity,
have long half-life and prolonged biologic effects, require intermittent
administration and have minimal toxicity. The specificity and selectively of
the targets of the new biologic agents render them less toxic than the oral
maintenance drugs and thus could possibly replace the maintenance drugs most
associated with long-term toxicity such as the corticosteroids and the
calcineurin inhibitors. The recently introduced anti-interleukin 2 receptor
(IL-2R) monoclonal antibodies (mAbs) are the prototype of future biologic
agents; selective, safe, and inducing prolonged biologic effects. The IL-2R
mAbs have been used with a variety of maintenance immunosuppression regimens
double therapy with cyclosporine and prednisone, triple therapy with
cyclosporine, azathioprine and prednisone and with newer regimens such as
cyclosporine or tacrolimus, mycophenolate mofetil (MMF) and prednisone, and
most recently with sirolimus, MMF and prednisone. The major thrust of the new
biologics in clinical development is to block the co-stimulatory pathway. The
first attempt at blockade of the CD40-CD154 with anti-CD154 mAbs was
disappointing. Anti-CD 154 therapy was associated with thromboembolic events
and acute rejection. Attempts at blocking the CD28-B7s (CD80-CD86) pathway are
currently underway with the receptor fusion protein, LEA29Y a second generation
CTL4Aig, and humanized mAbs to CD 80 and CD86. LFA1, an adhesion molecule that
also participates in the co-stimulatory pathway, has also been targeted with a
mAb that binds to the CD11a chain of LFA1. Efalizumab, a humanized anti-CD11a
mAb, was shown in a phase I trial to be potentially effective in renal
transplantation. A humanized anti-CD45 RB mAb is currently in pre-clinical
studies and will likely be tested in a phase I trial of renal transplantation
within 1 year. While excellent results with anti-CD45 RB mAbs have been
published in experimental transplantation, the mechanism of action of anti-CD45
RB mAbs remains to be determined. Several antibodies that are currently
approved for non-transplant indications are currently used in single center
clinical trials in renal transplantation including Campath 1 H, a humanized
anti-CD52 mAb, Rituxamab, an anti-CD20 chimeric mAb, and Infliximab an
anti-TNFa chimeric mAb. In addition, several humanized mutagenized anti-CD3
mAbs, huOKT3g1, aglycosyl CD3 and HuM291 have been used in limited trials in
renal transplantation but have yet to have a formal clinical development.
Humanized mAbs and receptor fusion proteins offer the potential of providing
renal transplant recipients with a novel algorithm for immunosuppression that
relies on chronic intermittent intravenous administration of safe, non-toxic
agents replacing oral drug therapy maintenance. N. Ref:: 50
----------------------------------------------------
[103]
TÍTULO / TITLE: - The next generation of
medications for kidney transplant patients.
REVISTA
/ JOURNAL: - Crit Care Nurs Clin North Am 2002
Mar;14(1):99-109.
AUTORES
/ AUTHORS: - Sims TW; Good EW
INSTITUCIÓN
/ INSTITUTION: - Digestive Health Center of Excellence and
Surgical Services, University of Virginia Health System, Charlottesville 22906,
USA. tws4m@virginia.edu
RESUMEN
/ SUMMARY: - Transplant pharmacotherapy evolves as new
agents are investigated and approved for use. Clinical immunosuppression has
been plagued with maintaining a balance between rejection of the transplanted
organ and complications of over-immunosuppression, including infection and
malignancy. Clinicians must understand current immunosuppressive regimens and
their associated effects when caring for transplant patients. While all
transplant patients receive some form of immunosuppressive therapy, the
combinations and choices increase as new drugs are developed. In the critical
and acute care settings, newly transplanted patients will likely receive
induction therapy. The goal of induction therapy is to increase long-term
patient and allograft survival while preventing or reducing rejection episodes.
Several agents are available for induction therapy, and each transplant center
designs its own protocol. The foundation for maintenance therapy rests on the
combining immunosuppressives to prevent rejection through a variety of
pathways. An understanding of the mechanism of action and additive effects of a
drug allows practitioners to optimize therapy while decreasing adverse effects.
Immunosuppressive therapy offers potential for reducing detrimental patient
outcomes and improving allograft survival. It is well established that repeated
rejection episodes correlate with poor long-term graft survival. Challenges
facing researchers and clinicians focus on improved patient outcomes and
options to address financial constraints of transplantation. N. Ref:: 33
----------------------------------------------------
[104]
TÍTULO / TITLE: - Leptin and
transplantation: pieces are still missing in the puzzle.
REVISTA
/ JOURNAL: - Isr Med Assoc J 2002 Mar;4(3):207-8.
AUTORES
/ AUTHORS: - Modan-Moses D; Paret G N. Ref:: 24
----------------------------------------------------
[105]
TÍTULO / TITLE: - Polyoma virus in renal
transplant recipients.
REVISTA
/ JOURNAL: - Nephrol Nurs J 2002 Jun;29(3):247-50; quiz
251-2.
AUTORES
/ AUTHORS: - Weiskittel PD
INSTITUCIÓN
/ INSTITUTION: - University Hospital, Cincinnati, OH, USA.
RESUMEN
/ SUMMARY: - Infection and rejection have been the most
critical complications following renal transplantation. Rejection rates have
decreased recently with the advent of new and more powerful immunosuppressive
agents. However, infection continues to be a serious complication. The use of
broad-spectrum antibiotics and the development of antiviral agents have
provided effective tools to combat the infectious processes traditionally seen
in renal transplant recipients. Recently, a new viral illness has been
identified in this population. Polyoma virus infection has been identified as
the cause of allograft dysfunction and graft loss. This paper reviews the
current prevalence and outcome of renal transplant patients infected with polyoma
virus. N. Ref:: 16
----------------------------------------------------