#11#
Revisiones-Ciencias
Básicas-Eventos celulares *** Reviews-Basic Sciences-Cellular events
TRASPLANTE
RENAL *** RENAL TRANSPLANTATION
(Conceptos
/ Keywords: Renal-Kidney transplantation; Kidney donation-procurement; etc).
Enero /
January 2001 --- Marzo / March 2004
La
biblioteca del conocimiento biomédico© es un servicio GRATUITO. Toda la
información ha sido obtenida de fuentes públicas, de portales de internet que
no requieren registro alguno para su uso, que no requieren estar de acuerdo con
sus Términos de uso, que son de libre acceso a todo el mundo, y son a su vez
gratuitos. La biblioteca (revisiones, guías, protocolos, medicina basada en la
evidencia, etc...) se recopila en base a una patente que permite a Effiloop la
catalogación de los artículos por campos de interés así como por el orden de su
importancia (se proveen las primeras 200 revisiones). Toda la informacion se
ampara en las leyes de libre pensamiento-expresión, y de uso justo. Este
documento sólo contiene artículos escritos en Castellano y/o Inglés.
The
biomedical library© is a FREE service. All the information has been obtained
from public sources, from web sites that do not require registration for their
use, that do not require an agreement with their Terms of use, that provide
free access for all, and are free of charge. The library (reviews, guides,
protocols, medicine based medicine, etc) is arranged according to a patent that
warrants Effiloop to catalogue the articles by fields of interest as well as to
sort articles by true relevance (the first 200 reviews are provided). All the
information is provided according to the freedom of speech and fair use laws.
Only articles written in Spanish and/or English are included.
[1]
TÍTULO / TITLE: - Interleukin-2 receptor
monoclonal antibodies in renal transplantation: meta-analysis of randomised
trials.
REVISTA
/ JOURNAL: - British Medical J (BMJ). Acceso gratuito
al texto completo.
●●
Enlace a la Editora de la Revista http://bmj.com/search.dtl
●●
Cita: British Medical J. (BMJ): <> 2003 Apr 12;326(7393):789.
●●
Enlace al texto completo (gratuito o de pago) 1136/bmj.326.7393.789
AUTORES
/ AUTHORS: - Adu D; Cockwell P; Ives NJ; Shaw J;
Wheatley K
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Queen Elizabeth
Hospital, Birmingham, B15 2TH. dwomoa.adu@uhb.nhs.uk
RESUMEN
/ SUMMARY: - OBJECTIVE: To study the effect of
interleukin-2 receptor monoclonal antibodies on acute rejection episodes, graft
loss, deaths, and rate of infection and malignancy in patients with renal
transplants. DESIGN: Meta-analysis of published data. DATA SOURCES: Medline,
Embase, and Cochrane library for years 1996-2003 plus search of medical
editors’ trial amnesty and contact with manufacturers of the antibodies.
SELECTION OF STUDIES: Randomised controlled trials comparing interleukin-2
receptor antibodies with placebo or no additional treatment in patients with
renal transplants receiving ciclosporin based immunosuppression. RESULTS: Eight
randomised controlled trials involving 1871 patients met the selection criteria
(although only 1858 patients were analysed). Interleukin-2 receptor antibodies
significantly reduced the risk of acute rejection (odds ratio 0.51, 95%
confidence interval 0.42 to 0.63). There were no significant differences in the
rate of graft loss (0.78, 0.58 to 1.04), mortality (0.75, 0.46 to 1.23),
overall incidence of infections (0.97, 0.77 to 1.24), incidence of
cytomegalovirus infections (0.81, 0.62 to 1.04), or risk of malignancies at one
year (0.82, 0.39 to 1.70). The different antibodies had a similar sized effect
on acute rejection (test for heterogeneity P=0.7): anti-Tac (0.37, 0.16 to
0.89), BT563 (0.37, 0.1 to 1.38), basiliximab (0.56, 0.44 to 0.72), and
daclizumab (0.46, 0.32 to 0.67). The reduction in acute rejections was similar
for all ciclosporin based immunosuppression regimens (test for heterogeneity
P=1.0). CONCLUSIONS: Adding interleukin-2 receptor antibodies to ciclosporin
based immunosuppression reduces episodes of acute rejection at six months by
49%. There is no evidence of an increased risk of infective complications.
Longer follow up studies are needed to confirm whether interleukin-2 receptor
antibodies improve long term graft and patient survival.
----------------------------------------------------
[2]
TÍTULO / TITLE: - 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: - Routes to allograft
survival.
REVISTA
/ JOURNAL: - J Clin Invest. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jci.org/
●●
Cita: J Clinical Investigation: <> 2001 Apr;107(7):797-8.
AUTORES
/ AUTHORS: - Bromberg JS; Murphy B
INSTITUCIÓN
/ INSTITUTION: - Recanati/Miller Transplant Institute,
Mount Sinai School of Medicine, New York, New York 10029, USA. jon.bromberg@mountsinai.org N. Ref:: 21
----------------------------------------------------
[4]
TÍTULO / TITLE: - Treatment of hepatitis
B in special patient groups: hemodialysis, heart and renal transplant,
fulminant hepatitis, hepatitis B virus reactivation.
REVISTA
/ JOURNAL: - J Hepatol 2003;39 Suppl 1:S206-11.
AUTORES
/ AUTHORS: - Tillmann HL; Wedemeyer H; Manns MP
INSTITUCIÓN
/ INSTITUTION: - Department of Gastroenterology, Hepatology
and Endocrinology, Medizinische Hochschule Hannover, Carl-Neuberg-Strassel,
30623 Hannover, Germany. N.
Ref:: 81
----------------------------------------------------
[5]
TÍTULO / TITLE: - 4D imaging to assay
complex dynamics in live specimens.
REVISTA
/ JOURNAL: - Nat Cell Biol 2003 Sep;Suppl:S14-9.
AUTORES
/ AUTHORS: - Gerlich D; Ellenberg J
INSTITUCIÓN
/ INSTITUTION: - Gene Expression and Cell
Biology/Biophysics Programmes, European Molecular Biology Laboratory,
Heidelberg, Germany.
RESUMEN
/ SUMMARY: - A full understanding of cellular dynamics
is often difficult to obtain from time-lapse microscopy of single optical
sections. New microscopes and image-processing software are now making it
possible to rapidly record three-dimensional images over time. This
four-dimensional imaging allows precise quantitative analysis and enhances
visual exploration of data by allowing cellular structures to be interactively
displayed from many angles. It has become a key tool for understanding the
complex organization of biological processes in live specimens. N. Ref:: 55
----------------------------------------------------
[6]
TÍTULO / TITLE: - Pretransplant blood
transfusions revisited: a role for CD(4+) regulatory T cells?
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1
Suppl):S26-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000106469.12073.01
AUTORES
/ AUTHORS: - Roelen D; Brand A; Claas FH
INSTITUCIÓN
/ INSTITUTION: - Department of Immunohematology and
Bloodtransfusion, Leiden University Medical Center, Leiden, The Netherlands. d.l.roelen@lumc.nl.
RESUMEN
/ SUMMARY: - Pretransplant blood transfusions have been
shown to improve organ allograft survival. However, the immunologic mechanism
leading to this beneficial effect of blood transfusions is still unknown. The
observation that transfusions sharing at least one HLA-DR antigen (human
leukocyte antigen) with the recipient are more effective than HLA-mismatched
transfusions has led to the hypothesis that CD(4+) regulatory T cells are
induced that recognize allopeptides of the blood transfusion donor in the
context of the self-HLA-DR molecule on the donor cells. In vitro studies showed
that CD(4+) T cells recognizing an allopeptide in the context of self-HLA-DR
are indeed able to decrease the alloimmune response of autologous T cells by
affecting the activated T cells directly or indirectly by their modulatory
effect on dendritic cells. The first studies in a patient with a
well-functioning kidney graft after receiving an HLA-DR-matched pretransplant
blood transfusion showed that the low organ donor-specific cytotoxic
T-lymphocyte response after transplantation was indeed attributable to the
activity of regulatory CD(4+) T cells. N.
Ref:: 24
----------------------------------------------------
[7]
TÍTULO / TITLE: - Dendritic cells and the
mode of action of anticalcineurinic drugs: an integrating hypothesis.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Mar;18(3):467-8;
discussion 469-70.
AUTORES
/ AUTHORS: - Fierro A; Mora JR; Bono MR; Morales J;
Buckel E; Sauma D; Rosemblatt M
INSTITUCIÓN
/ INSTITUTION: - Clinica las Condes, Transplantation Unit,
Santiago, Chile. afierro@vtr.net N. Ref:: 16
----------------------------------------------------
[8]
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
----------------------------------------------------
[9]
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
----------------------------------------------------
[10]
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
----------------------------------------------------
[11]
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
----------------------------------------------------
[12]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.3.2. Long-term immunosuppression. Therapy conversion.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:20-1.
RESUMEN
/ SUMMARY: - GUIDELINE: Conversion of immunosuppressive
drug therapy is recommended to avoid or reduce drug-specific adverse effects,
and is generally safe for long-term graft outcome.
----------------------------------------------------
[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: - Renal dopaminergic
mechanisms in renal parenchymal diseases and hypertension.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001;16 Suppl 1:53-9.
AUTORES
/ AUTHORS: - Pestana M; Jardim H; Correia F;
Vieira-Coelho MA; Soares-da-Silva P
INSTITUCIÓN
/ INSTITUTION: - Departments of Nephrology, and Institute
of Pharmacology and Therapeutics, Faculty of Medicine, 4200 Porto, Portugal.
RESUMEN
/ SUMMARY: - The present report addresses the status of
the renal dopaminergic system activity in patients afflicted with different
renal disorders and in the remnant kidney of uninephrectomized (UNX) rats,
based on the urinary excretion of L-DOPA, dopamine and amine metabolites. In
renal transplant recipients with good recovery of graft function (group 1,
n=11), the daily urinary excretion of DOPAC, but not that of HVA, was found to
increase progressively throughout the first 12 days post-transplantation from
698+/-57 nmol in the first day to 3498+/-414 nmol on day 9, and then remained
constant until day 12. This resulted in a 6-fold increase in the urinary
DOPAC/dopamine ratios. In renal transplant recipients with acute tubular
necrosis (group 2, n=8), the urinary levels of dopamine, DOPAC and HVA were
approximately 30% of those in group 1. In a group of 28 patients with chronic
renal parenchymal disorders, the daily urinary excretion of L-DOPA, free
dopamine and dopamine metabolites (DOPAC and HVA) correlated positively with
the degree of deterioration of renal function (P<0.01). However, the
U(Dopamine/(L)-DOPA) and U(DOPAC/Dopamine) ratios in patients with chronic renal
insufficiency were found to be similar to those observed in patients with
normal renal function. In 14 IgA nephropathy (IgA-N) patients with near normal
renal function, the changes in 24 h mean blood pressure when going from 20 to
350 mmol/day sodium intake correlated negatively with the daily urinary
excretion of dopamine (r(2)=0.597, P<0.01). The urinary excretion of L-DOPA
and dopamine in IgA-N patients with salt-sensitive (SS) blood pressure was
lower than in salt-resistant (SR) patients (P<0.05), irrespective of their
daily sodium intake. However, the rise in urinary dopamine output during salt
loading (from 20 to 350 mmol/day) was greater (P<0.05) in IgA-N SS patients
(21.2+/-2.5% increase) than in SR patients (6.3+/-1.4% increase). Fifteen days
after the surgery, uninephrectomy (UNX) in the rat was accompanied by an
enhanced (P<0.05) urinary excretion of dopamine (36+/-3 vs 26+/-2), DOPAC
(124+/-11 vs 69+/-6) and HVA (611+/-42 vs 354+/-7) (nmol/g kidney/kg body
weight). This was accompanied by an increase in V(max) values for renal
aromatic L-amino acid decarboxylase in the remnant kidney of UNX rats
(P<0.05). Sch 23390, a D1 dopamine receptor antagonist, produced a marked
reduction in the urinary excretion of sodium in UNX rats, whereas in sham-operated
rats the decrease in urinary sodium did not attain a significant difference. It
is concluded that the study of the renal dopaminergic system in patients
afflicted with renal parenchymal disorders should address parameters other than
free urinary dopamine, namely the urinary excretion of L-DOPA and dopamine
metabolites (DOPAC and HVA). It is also suggested that in SS hypertension of
chronic renal parenchymal diseases, renal dopamine produced in the residual
tubular units may be enhanced during a sodium challenge, thus behaving
appropriately as a compensatory natriuretic hormone. N. Ref:: 25
----------------------------------------------------
[16]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.3.4. Long-term immunosuppression. Non-compliance.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:23-4.
RESUMEN
/ SUMMARY: - GUIDELINES: A. The detection of
non-compliers should be a permanent concern of the transplant team (doctors,
nurses and others). B. Because non-compliance is associated with late graft
dysfunction and graft loss, it is important to reduce the proportion of
non-compliers by implementing specific educational programmes addressing this
problem and the importance of immunosuppressive medications. C. Non-compliance
starts during the first year and may increase thereafter. Therefore, the
specific educational programme should be repeated and adapted to the need of
the transplant recipient, with delivery of few but clear messages.
----------------------------------------------------
[17]
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
----------------------------------------------------
[18]
TÍTULO / TITLE: - Vitamin D as
immunomodulatory therapy for kidney transplantation.
REVISTA
/ JOURNAL: - Transplantation 2002 Oct 27;74(8):1204-6.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000031949.70610.BB
AUTORES
/ AUTHORS: - Becker BN; Hullett DA; O’Herrin JK; Malin
G; Sollinger HW; DeLuca H
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, B-3063 UW
Nephrology, University of Wisconsin, 2500 Overlook Terrace, Madison, WI 53705, USA.
bnb@medicine.wisc.edu
RESUMEN
/ SUMMARY: - Vitamin D (1alpha,25-dihydroxyvitamin D(3)
[1alpha,25-(OH)(2)D(3)]) has been studied in the past for its immunosuppressive
properties, and, in that context, it may also have potential utility as an
immunomodulatory agent for transplantation. A number of studies have
demonstrated that 1alpha,25-(OH)(2)D(3) or its analogs regulate immune cell
proliferation, differentiation, and responsiveness. A burgeoning number of
studies have also explored using 1alpha,25-(OH)(2)D(3) and its analogs directly
as therapy in animal models of kidney transplantation with success in
prolonging allograft function and preventing acute rejection. Some of these in
vivo effects may well be caused by alterations in immune cell function, but it
is also possible that exogenous 1alpha,25-(OH)(2)D(3) and its analogs are
altering the intragraft milieu as well, specifically through changes in the
TGF-beta signaling cascade. Such provocative data and the availability of newer
1alpha,25-(OH)(2)D(3) analogs that may limit side effects (e.g. hypercalcemia)
have created interest in examining this secosteroid clinically in kidney
transplantation. N.
Ref:: 34
----------------------------------------------------
[19]
TÍTULO / TITLE: - Kidney and liver
transplantation in HIV-infected patients: case presentations and review.
REVISTA
/ JOURNAL: - AIDS Patient Care STDS 2003
Oct;17(10):501-7.
●●
Enlace al texto completo (gratuito o de pago) 1089/108729103322494294
AUTORES
/ AUTHORS: - Roland ME; Adey D; Carlson LL; Terrault NA
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
California, San Francisco, San Francisco, California, USA. mroland@php.ucsf.edu
RESUMEN
/ SUMMARY: - Until recently, HIV-infected patients have
been excluded from consideration for solid organ transplantation. The
relatively high mortality rates among HIV-infected transplant recipients
observed in the era prior to the use of highly active antiretroviral therapy
(HAART), coupled with long waiting times for cadaveric organs, made it
difficult to support organ transplantation in this patient group. However, in
response to the marked reductions in morbidity and mortality associated with
HIV infection, several transplant centers have developed pilot studies or
revised their clinical criteria to allow transplantation in this group of
patients. We describe two cases, one kidney and one liver transplant recipient,
and review the major clinical and research issues related to this topic.
Reports of transplantations in the pre-HAART era highlight two important
findings. First, some HIV-infected transplant recipients did very well with
long survival periods. However, overall progression to AIDS and death appeared
accelerated. We recently reported on our preliminary experience with 45
selected transplant recipients in the HAART era. One-year patient survival
rates were similar to unmatched survival data from the United Network for Organ
Sharing (UNOS) database. Median CD4+ T-cell counts remained stable in the
follow-up period compared to pretransplant. HIV-1 RNA nearly uniformly
continued to be suppressed below the limits of detection. Preliminary data are
promising and support the current efforts to evaluate patient and graft
survival among HIV-infected transplant recipients and to explore the mechanisms
underlying the many potential complications of transplantation in this population. N. Ref:: 21
----------------------------------------------------
[20]
TÍTULO / TITLE: - Transplant Mac attack:
humor the macrophages.
REVISTA
/ JOURNAL: - Kidney Int 2003 May;63(5):1953-4.
AUTORES
/ AUTHORS: - Colvin RB
N. Ref:: 10
----------------------------------------------------
[21]
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
----------------------------------------------------
[22]
TÍTULO / TITLE: - Hepatitis B and renal
transplantation: securing the sword of damocles.
REVISTA
/ JOURNAL: - Hepatology 2002 Nov;36(5):1041-5.
●●
Enlace al texto completo (gratuito o de pago) 1053/jhep.2002.36805
AUTORES
/ AUTHORS: - Perrillo RP N. Ref:: 37
----------------------------------------------------
[23]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.2 Chronic graft dysfunction. Immunological factors
(alloimmunity).
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:8-11.
RESUMEN
/ SUMMARY: - GUIDELINE: All recipients of an allogeneic
kidney graft should take life-long maintenance immunosuppressive medication.
Whereas there is no immunological test to diagnose chronic allograft
dysfunction, circumstantial evidence suggests that immunological factors play
an important role in its pathogenesis. This evidence is based on experimental
data, the beneficial effect of sharing HLA antigens between donor and recipient
and post-transplantation immunological monitoring studies.
----------------------------------------------------
[24]
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
----------------------------------------------------
[25]
TÍTULO / TITLE: - Primary intestinal
posttransplant T-cell lymphoma.
REVISTA
/ JOURNAL: - Transplantation 2003 Jun 27;75(12):2131-2.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000060253.54333.F3
AUTORES
/ AUTHORS: - Michael J; Greenstein S; Schechner R;
Tellis V; Vasovic LV; Ratech H; Glicklich D
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Albert Einstein
College of Medicine, Montefiore Medical Center, Bronx, New York 10467, USA.
RESUMEN
/ SUMMARY: - There have been only five reported cases
of primary posttransplant T-cell lymphoma. We report the first case associated
with the use of sirolimus (Rapamycin, Wyeth-Ayerst, Philadelphia, PA). The
patient, receiving prednisone, cyclosporine, and sirolimus treatment, developed
ascites, diarrhea, and weight loss 7 months after his second renal transplant.
Tissue obtained at laparotomy established the diagnosis of primary T-cell
lymphoma. Latent membrane protein-1 for Epstein-Barr virus was negative, but
in-site hybridization test for Epstein-Barr-encoded RNA was positive. Despite
aggressive chemotherapy, the patient died 8 months posttransplant. This is the
sixth reported case of primary intestinal posttransplant T-cell lymphoma, but
it is the first case associated with the use of sirolimus. The incidence of
posttransplant lymphoproliferative disease in patients receiving sirolimus
should be studied. N.
Ref:: 6
----------------------------------------------------
[26]
TÍTULO / TITLE: - The impact of
cytomegalovirus infections and acute rejection episodes on the development of
vascular changes in 6-month protocol biopsy specimens of cadaveric kidney
allograft recipients.
REVISTA
/ JOURNAL: - Transplantation 2003 Jun 15;75(11):1858-64.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000064709.20841.E1
AUTORES
/ AUTHORS: - Helantera I; Koskinen P; Tornroth T;
Loginov R; Gronhagen-Riska C; Lautenschlager I
INSTITUCIÓN
/ INSTITUTION: - Department of Virology, Helsinki
University Central Hospital and University of Helsinki, Helsinki, Finland.
RESUMEN
/ SUMMARY: - BACKGROUND: The role of cytomegalovirus
(CMV) in chronic kidney allograft rejection remains controversial. The purpose
of this study was to examine the impact of CMV infection on histopathologic
changes in 6-month protocol biopsy specimens of kidney allografts. METHODS:
Altogether, 52 renal allograft recipients were studied. CMV infection was
diagnosed by CMV antigenemia test, viral cultures from blood and urine, or
both. CMV was demonstrated in the biopsy specimens by antigen detection and
hybridization in situ. Acute rejections were diagnosed by biopsy histology, and
biopsy specimens were graded according to the Banff ‘97 classification.
RESULTS: CMV infection was diagnosed in 41 patients. The 11 patients in whom
CMV infection was not detected were used as controls. Acute rejection was
diagnosed in 22 of 41 CMV patients and in 6 of 11 control patients. CMV was
demonstrated in the biopsy specimens of 19 of 41 CMV patients. CMV was not
associated with increased glomerular, tubular, or interstitial changes.
However, the arteriosclerotic changes in small arterioles were significantly
increased in the subgroup of patients where CMV was demonstrated in the graft
as compared with controls (P<0.01). Analysis of the impact of acute
rejection on arteriolar thickening showed that only a positive history of both
acute rejection and CMV found in the graft was associated with significantly
increased vascular changes compared with CMV-free recipients (P<0.05).
CONCLUSIONS: Neither CMV nor acute rejection alone was associated with
increased vascular or other histopathologic changes in 6-month protocol biopsy
specimens of kidney allografts, but a previous history of both acute rejection
and the presence of CMV in the graft was associated with increased vascular
changes.
----------------------------------------------------
[27]
TÍTULO / TITLE: - Transplant
capillaropathy and transplant glomerulopathy: ultrastructural markers of
chronic renal allograft rejection.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Apr;18(4):655-60.
AUTORES
/ AUTHORS: - Ivanyi B
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, University of
Szeged, Szeged, Hungary. ivanyi@patho.szote.u-szeged.hu N. Ref:: 21
----------------------------------------------------
[28]
TÍTULO / TITLE: - Adenovirus
pyelonephritis in a pediatric renal transplant patient.
REVISTA
/ JOURNAL: - Pediatr Nephrol 2003 May;18(5):457-61.
Epub 2003 Mar 18.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00467-003-1080-x
AUTORES
/ AUTHORS: - Kim SS; Hicks J; Goldstein SL
INSTITUCIÓN
/ INSTITUTION: - Baylor College of Medicine, Texas, USA.
RESUMEN
/ SUMMARY: - Gross hematuria, graft pain, and rising
serum creatinine are classic signs of acute rejection, obstruction, or
bacterial pyelonephritis for patients with renal transplants. This presentation
often prompts percutaneous renal allograft biopsy. If subsequent evaluation
fails to show evidence of acute rejection, obstruction, or bacterial infection,
viral etiologies should be considered. We report a 14-year-old Hispanic female
with a living-related renal transplant who had gross hematuria, graft
tenderness, and increased serum creatinine, but did not have evidence of acute
rejection, obstruction, or bacterial pyelonephritis. To our knowledge, this is
the first report of adenovirus pyelonephritis in a transplanted kidney of a
pediatric patient, with isolation of adenovirus in the urine and in the
allograft using immunocytochemical techniques.
N. Ref:: 26
----------------------------------------------------
[29]
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
----------------------------------------------------
[30]
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
----------------------------------------------------
[31]
TÍTULO / TITLE: - Mechanisms and
consequences of arterial hypertension after renal transplantation.
REVISTA
/ JOURNAL: - Transplantation 2001 Sep 27;72(6
Suppl):S9-12.
AUTORES
/ AUTHORS: - Koomans HA; Ligtenberg G
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Hypertension,
University Hospital Utrecht, The Netherlands. h.a.koomans@digd.azu.nl
RESUMEN
/ SUMMARY: - The high incidence of hypertension after
renal transplantation contributes to the risk of cardiovascular morbidity and
mortality in renal transplant recipients. Although cyclosporine has been
influential in the improvement of transplant outcome, it has emerged as a major
cause of hypertension after organ transplantation. The underlying
pathophysiological mechanisms of cyclosporine-induced hypertension include
enhanced sympathetic nervous system activity, renal vasoconstriction, and
sodium/water retention. Hypertension is also significantly associated with
reduced graft survival and thereby requires aggressive treatment intervention.
Calcium channel blockers may offer some advantages over angiotensin-converting
enzyme inhibitors for the treatment of hypertension in stable renal transplant
recipients. Nevertheless, selection of the most appropriate antihypertensive agent
should take into account the possibility of pharmacokinetic interactions with
immunosuppressive agents. There is evidence to suggest that the use of
tacrolimus-based immunosuppression induces less hypertension compared with
cyclosporine. Not only do patients receiving tacrolimus tend to require less
antihypertensive therapy, but converting patients from cyclosporine to
tacrolimus has been shown to result in significant reductions in blood
pressure. Thus, tacrolimus may be associated with an improved cardiovascular
risk profile in renal transplant recipients.
N. Ref:: 26
----------------------------------------------------
[32]
TÍTULO / TITLE: - Apoptosis and
inflammation in renal reperfusion injury.
REVISTA
/ JOURNAL: - Transplantation 2002 Jun 15;73(11):1693-700.
AUTORES
/ AUTHORS: - Daemen MA; de Vries B; Buurman WA
INSTITUCIÓN
/ INSTITUTION: - Department of General Surgery, University
of Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands.
RESUMEN
/ SUMMARY: - Ischemia followed by reperfusion (I/R) has
cardinal implications in the pathogenesis of organ transplantation and
rejection. Apoptosis and inflammation are central mechanisms leading to organ
damage in the course of renal I/R. General aspects of apoptosis, morphology,
induction, and biochemistry are discussed. Activated caspases, the classical
effector enzymes of apoptosis, are able to induce not only apoptosis but also
inflammation after I/R in experimental models. This redefines the involvement
of apoptosis in I/R injury toward a central and functional role in the
development of organ damage. Our purpose is to assess aspects of apoptosis and
inflammation in terms of involvement in the pathogenesis of I/R-induced organ
damage. Moreover, the implications of recent experimental advances for
diagnosis and treatment of renal I/R injury in clinical practice will be
discussed. N. Ref:: 101
----------------------------------------------------
[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: - A pilot protocol of a
calcineurin-inhibitor free regimen for kidney transplant recipients of marginal
donor kidneys or with delayed graft function.
REVISTA
/ JOURNAL: - Clin Transplant 2003;17 Suppl 9:31-4.
AUTORES
/ AUTHORS: - Shaffer D; Langone A; Nylander WA; Goral
S; Kizilisik AT; Helderman JH
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Vanderbilt
University Medical Center, Nashville, TN 37232, USA. david.schaffer@vanderbilt.edu
RESUMEN
/ SUMMARY: - The worsening shortage of cadaver donor
kidneys has prompted use of expanded or marginal donor kidneys (MDK), i.e.
older age or donor history of hypertension or diabetes. MDK may be especially
susceptible to calcineurin-inhibitor (CI) mediated vasoconstriction and nephrotoxicity.
Similarly, early use of CI in patients with delayed graft function may prolong
ischaemic injury. We developed a CI-free protocol of antibody induction,
sirolimus, mycophenolate mofetil, and prednisone in recipients with MDK or DGF.
METHODS: Adult renal transplant recipients who received MDK or had DGF were
treated with a CI-free protocol consisting of antibody induction (basiliximab
or thymoglobulin), sirolimus, mycophenolate mofetil, and prednisone. Serial
biopsies were performed for persistent DGF. Patients were followed
prospectively with the primary endpoints being patient and graft survival,
biopsy-proven acute rejection, and sirolimus-related toxicity. RESULTS:
Nineteen recipients were treated. Mean follow-up was 294 days. Actuarial 6- and
12-month patient survival was 100% and 100% and graft survival was 93% and 93%,
respectively. The only graft loss was due to primary non-function (PNF). The
incidence of AR was 16%. Mean serum creatinine at last follow-up was 1.6 mg/dL.
Sirolimus-related toxicity included lymphocele (1), wound infection (2),
thrombocytopenia (1). and interstitial pneumonitis (1). CONCLUSION: A CI-free
protocol with antibody induction and sirolimus results in low rates of AR and
PNF and excellent early patient and graft survival in patients with MDK and
DGF. CI-free protocols may allow expansion of the kidney donor pool by
encouraging utilization of MDK at high risk for DGF or CI-mediated
nephrotoxicity.
----------------------------------------------------
[35]
TÍTULO / TITLE: - Rapamycin in
combination with cyclosporine or tacrolimus in liver, pancreas, and kidney
transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2003 May;35(3
Suppl):201S-208S.
AUTORES
/ AUTHORS: - MacDonald AS
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Dalhousie
University, Halifax, Nova Scotia, Canada. Allan.macdonald@dal.ca
RESUMEN
/ SUMMARY: - A 10-year experience with the
immunosuppressive drug rapamycin that begins in the laboratory then extends
through multicentre trials in combination with cyclosporine in kidney
transplant recipients, exploration of its use as a single agent and in
combination with tacrolimus, and its potential in nonrenal organs is described.
Rapamycin is a potent inhibitor of endothelial injury in rat aortic allografts.
When added to full-dose cyclosporine it achieves low rejection rates, but it
augments the nephrotoxicity and hyperlipidemia of cyclosporine. On the other
hand, it allows discontinuation of calcineurin inhibitors in stable kidney and
liver patients suffering from nephrotoxicity late posttransplant. At least in
Caucasian patients, discontinuation of cyclosporine is possible as early as 3
months post-kidney transplant. In combination with low-dose tacrolimus,
exceptionally low rates of rejection were seen in recipients of kidney,
pancreas, and liver recipients with preservation of excellent renal function.
These pilot studies have been confirmed in several single-centre and, more
recently, multicentre trials in kidney and pancreas transplantation. The
side-effect profile of hyperlipidemia, lymphocoeles, delayed wound healing, and
possible liver effects are coming into focus, and ways of minimizing these
problems being introduced. The lessons learned include the need for early
adequate blood levels, the lack of correlation between dose and drug exposure,
and the potency that allows marked dose reductions in calcineurin inhibitors
and steroids. N.
Ref:: 36
----------------------------------------------------
[36]
TÍTULO / TITLE: - HCV-associated renal
diseases after liver transplantation.
REVISTA
/ JOURNAL: - Int J Artif Organs 2003 Jun;26(6):452-60.
AUTORES
/ AUTHORS: - Fabrizi F; Aucella F; Lunghi G;
Bunnapradist S; Martin P
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and Dialysis,
Maggiore Hospital, IRCCS, Milano, Italy. fabrizi@policlinico.mi.it N. Ref:: 43
----------------------------------------------------
[37]
TÍTULO / TITLE: - Delayed renal allograft
dysfunction and cystitis associated with human polyomavirus (BK) infection in a
renal transplant recipient: a case report and review of literature.
REVISTA
/ JOURNAL: - Clin Nephrol 2003 Dec;60(6):405-14.
AUTORES
/ AUTHORS: - Gupta M; Miller F; Nord EP; Wadhwa NK
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Department of
Medicine, School of Medicine, State University of New York at Stony Brook, New
York 11794, USA.
RESUMEN
/ SUMMARY: - Human polyomavirus type BK (BKV)
associated nephritis (BKVAN) has recently emerged as an important cause of
renal allograft dysfunction and failure. Early recognition of this entity as a
cause of allograft dysfunction is extremely important since misdiagnosis can
accelerate graft loss. We report a case of BKVAN that presented with symptoms
related to cystitis, and review the risk factors, the diagnostic tools and the
approach to treatment of BK virus associated allograft nephropathy. N. Ref:: 32
----------------------------------------------------
[38]
TÍTULO / TITLE: - Sirolimus and
mycophenolate mofetil for calcineurin-free immunosuppression in renal
transplant recipients.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Oct;38(4 Suppl
2):S16-21.
AUTORES
/ AUTHORS: - Pescovitz MD; Govani M
INSTITUCIÓN
/ INSTITUTION: - Departments of Surgery,
Microbiology/Immunology, and Medicine, Indiana University, Indianapolis, IN
46202, USA. mpescov@iupui.edu
RESUMEN
/ SUMMARY: - Calcineurin inhibitors, such as
cyclosporine and tacrolimus, have been available for almost 20 years. Although
these drugs are highly effective and represent the mainstay of transplant
immunosuppression, they are associated with acute and chronic nephrotoxicity.
Acute nephrotoxicity, which occurs in the early period after transplantation,
leads to a higher rate of dialysis, and chronic nephrotoxicity may eventually
result in graft loss. Acute and chronic nephrotoxicity is becoming more common
as the use of marginal kidneys for transplantation increases. Two recently
available immunosuppressive agents, mycophenolate mofetil and sirolimus
(rapamycin), have no nephrotoxicity. The use of these drugs in combination with
other agents has led to the development of new paradigms of immunosuppressive
therapy. This paper reviews the results of clinical trials that have
investigated these new approaches to immunosuppression in renal transplant
recipients. N. Ref:: 9
----------------------------------------------------
[39]
TÍTULO / TITLE: - Post-transplant renal
tubulitis: the recruitment, differentiation and persistence of intra-epithelial
T cells.
REVISTA
/ JOURNAL: - Am J Transplant 2003 Jan;3(1):3-10.
AUTORES
/ AUTHORS: - Robertson H; Kirby JA
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, The Medical School,
University of Newcastle, Newcastle upon Tyne, UK.
RESUMEN
/ SUMMARY: - Tubulitis is used by the Banff protocol as
a major criterion to grade acute renal allograft rejection. This review
integrates results from in vitro and in vivo studies to develop a chronological
model to explain the development and functions of tubular inflammation during
the rejection process. Proteoglycan-immobilized chemokines are the primary
motivators for the vectorial recruitment of specific immune cell populations
from the blood, through the endothelium and interstitial tissues to the renal
tubules. After penetration of the basement membrane, T cells encounter TGF-beta
that can induce expression of the alphaEbeta7 integrin on proliferating cells.
This allows adhesion to E-cadherin on the baso-lateral surfaces of tubular
epithelial cells and provides an explanation for the epithelial-specific
cytotoxicity observed during acute rejection. Tubular epithelium is also a rich
source of IL-15 that can stimulate IL-15 receptor-expressing intratubular CD8+
T cells. This anti-apoptotic microenvironment may explain the long-term
persistence of cycling T cells within intact tubules after episodes of acute
rejection. These memory-like T cells may have local immunoregulatory
properties, including the production of additional TGF-beta, but could also
modify normal tubular homeostasis resulting in epithelial to mesenchymal
transdifferentiation, tubulointerstitial fibrosis and, ultimately, graft
failure. N. Ref:: 94
----------------------------------------------------
[40]
TÍTULO / TITLE: - Minimizing calcineurin
inhibitor drugs in renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2003 May;35(3
Suppl):118S-121S.
AUTORES
/ AUTHORS: - Flechner SM
INSTITUCIÓN
/ INSTITUTION: - Section of Renal Transplantation,
Transplant Center A110, Cleveland Clinic Foundation, Cleveland, Ohio 44195,
USA.
RESUMEN
/ SUMMARY: - Calcineurin inhibitor drugs (CNI),
primarily cyclosporine then tacrolimus, have been the centerpieces of
maintenance immunosuppression for kidney transplantation since their
introduction in the 1980s. While these drugs have been responsible for improved
short-term outcomes and diminished rates of acute rejection, they are
nephrotoxic and can cause permanent renal injury in many patients. Indeed, some
have found that at 10 years after transplantation, the benefits of CNI drugs
have been lost compared to the previous generation of maintenance
immunosuppression. The use of these agents over many years contributes to the
antigen-independent decline in renal function referred to as chronic allograft
nephropathy. However, it remains unclear to what degree the use of CNI drugs
contribute to ultimate graft loss. For these reasons immunosuppressive
alternatives to CNI drugs have begun to emerge during the past few years. The
recent introduction of the potent immunosuppressive agent sirolimus has
afforded an opportunity to develop a regimen designed to maximize prophylaxis
of early acute rejection, absent drug-induced nephrotoxicity. It was our
feeling that the combination of antibody induction therapy combined with
sirolimus substitution in a three-drug maintenance regimen, would provide the
best posttransplant renal function and lowest rates of acute rejection. We have
developed a CNI-free immunosuppressive regimen consisting of basiliximab
induction, followed by sirolimus, MMF and steroids. Using this protocol we
demonstrated comparable transplant outcomes with improved renal function in
adult recipients of primary renal transplants. Limiting nephrotoxic
immunosuppression should be considered an important goal; but requires
sufficient long-term follow-up to support the benefits suggested from initial
analysis of the data. N.
Ref:: 23
----------------------------------------------------
[41]
TÍTULO / TITLE: - Complement activation
in early protocol kidney graft biopsies after living-donor transplantation.
REVISTA
/ JOURNAL: - Transplantation 2003 Apr 27;75(8):1204-13.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000062835.30165.2C
AUTORES
/ AUTHORS: - Sund S; Hovig T; Reisaeter AV; Scott H;
Bentdal O; Mollnes TE
INSTITUCIÓN
/ INSTITUTION: - Department/Institute of Pathology,
Rikshospitalet University Hospital, Oslo, Norway. stale.sund@helse-forde.no.
RESUMEN
/ SUMMARY: - BACKGROUND: To gain insight into
complement activation in kidney grafts, we studied the deposition of components
from all complement pathways in protocol biopsies from living-donor recipients
that were taken 1 week (median 7 days) after transplantation. METHODS: Graft
protocol biopsies (n=37) were taken consecutively and stained for two-color
immunofluorescence, with antibodies to C4d, C3, C1q, factor B, C6, terminal
C5b-9 complement complex, mannose-binding lectin (MBL), and MBL-associated
serine protease-1, combined with an endothelial marker. Light and electron
microscopy were performed in all cases. Clinical acute rejection (AR), graft loss,
and long-term kidney function were recorded. Baseline biopsies from 15 of the
patients served as controls. RESULTS: Endothelial C4d deposition was
demonstrated in peritubular capillaries in 11 of 37 cases (30%), of which 9 of
11 (82%) experienced clinical AR but only 6 of 11 (55%) experienced AR as
defined by histopathologic criteria. Biopsies from three patients, two with
early graft loss, showed diffuse global C4d in the glomerular endothelium with
codeposition of C3 in all patients and MBL-associated serine protease-1 in one
patient. Focal peritubular capillary C3 deposition was found in two additional
C4d-positive cases with AR. No posttransplant deposition was demonstrated for
the other components. CONCLUSIONS: Early diffuse C4d deposition in the kidney
graft capillaries is closely related to acute humoral rejection, whereas focal
staining may occur with mild AR or, rarely, without rejection. Codeposition of
C3 indicates early AR with a higher risk of graft loss. In most cases,
activation was limited to C4d, indicating efficient in situ regulation of
complement activation.
----------------------------------------------------
[42]
TÍTULO / TITLE: - Histological evaluation
of renal allograft protocol biopsies in the early period and 1 year after transplantation.
REVISTA
/ JOURNAL: - Clin Transplant 2003;17 Suppl 10:25-9.
AUTORES
/ AUTHORS: - Kanetsuna Y; Yamaguchi Y; Toma H; Tanabe K
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical Pathology, Jikei
University, Kashiwa Hospital, Japan.
RESUMEN
/ SUMMARY: - We histologically evaluated protocol
biopsy specimens of renal allografts obtained in the early period and 1 year
after transplantation. The patients were divided into those with at least one
history of acute rejection (AR group) and no history of rejection (NAR group),
and the histopathological features in the two groups were compared. A total of
45 early protocol biopsy specimens were obtained from 40 patients, and 31
1-year biopsy specimens were obtained from 30 patients. Acute rejection (AR) or
borderline change was observed in the early protocol biopsy specimens from 19
(45.2%) cases. AR or borderline change was observed in 12 of 19 (63.2%) in the
AR group, and in 7/26 cases (26.9%) in the NAR group. The incidence of AR or
borderline change in the AR group was higher than in the NAR group. Toxic
tubulopathy was found in the early protocol biopsy in 16 cases (35.6%). The
1-year biopsies tended to reveal more complicated findings. Chronic rejection
(CR) was seen in 8/16 cases (50.0%) in the AR group, and it was more frequent
than NAR group (two cases, 13.3%). In conclusion, the incidences of both AR and
CR were higher in the cases with a previous episode of AR. The early protocol
biopsy was useful in screening for subclinical AR and toxic tubulopathy. The
1-year biopsy was useful for evaluating various types of chronic graft damage.
We expect that adequate treatment based on protocol biopsy findings in each
patient will lead to better graft survival.
----------------------------------------------------
[43]
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
----------------------------------------------------
[44]
TÍTULO / TITLE: - Membranous lupus
nephritis in a renal allograft: response to mycophenolate mofetil therapy.
REVISTA
/ JOURNAL: - Am J Transplant 2001 Sep;1(3):288-92.
AUTORES
/ AUTHORS: - Denton MD; Galvanek EG; Singh A; Sayegh MH
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA. dentonmd@gis.net
RESUMEN
/ SUMMARY: - Membranous lupus nephritis in a renal
allograft is considered rare. A 43-year-old man with quiescent systemic lupus
erythematosus (SLE) received a HLA identical transplant from his sister and 4
years later developed persistent nephrotic range proteinuria and morphological
features most compatible with membranous lupus nephritis on biopsy.
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor
antagonists, although successful in reducing proteinuria, were associated on
three occasions with acute allograft dysfunction. Sustained reduction of
proteinuria and stable graft function were achieved using mycophenolate mofetil
(MMF). MMF is emerging as a new therapy for primary renal disease in SLE. This
is the first report of successful treatment of membranous lupus nephritis in an
allograft using MMF. We review all cases of transplant-associated membranous
lupus nephritis in the English literature.
N. Ref:: 20
----------------------------------------------------
[45]
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
----------------------------------------------------
[46]
TÍTULO / TITLE: - Clinical trials,
immunosuppression and renal transplantation: new trends in design and analysis.
REVISTA
/ JOURNAL: - Pediatr Nephrol 2002 Aug;17(8):573-84.
Epub 2002 Jun 13.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00467-002-0909-z
AUTORES
/ AUTHORS: - Landais P; Daures JP
INSTITUCIÓN
/ INSTITUTION: - Laboratoire de Biostatistique et
d’Informatique Medicale, Hopital Necker Enfants Malades, Faculte Paris 5, 149
rue de Sevres, 75743 Paris Cedex 15, France. landais@necker.fr
RESUMEN
/ SUMMARY: - Clinical trials provide a framework to
search for more effective and less toxic immunosuppressive agents to control
renal transplant rejection. Some methodological aspects are presented. Patient
selection and the choice of study endpoints are discussed with emphasis on
standardized definitions and classification of histopathology, and on
qualification and quantification of chronic rejection. Choosing a Bayesian or a
frequentist approach and the afferent hypotheses is discussed together with the
interpretation of a P-value and a confidence interval. Strategies for limiting the
number of patients, increasing power and feasibility are reviewed, including
discussion of surrogate endpoints. New approaches to statistical analysis are
then presented, including intention-to-treat versus per-protocol analysis,
analysis of correlated data, dependent censoring, and meta-analysis applied to
renal transplantation. Pharmacoeconomics are finally introduced as necessary
for implementation of decision making regarding therapeutic strategies.
Reporting research increases its standards, and the CONSORT (Consolidated
Standards of Reporting Trials) and QOROM (Quality of Reporting of
Meta-analyses) criteria are to be integrated in the process of clinical trial
procedures. In conclusion, observational studies are presented as part of an
evidence-based approach in the hierarchy of evidence, keeping in mind that high
quality, randomized, controlled trials are still necessary to decrease
uncertainty in the field of renal transplantation. N. Ref:: 100
----------------------------------------------------
[47]
TÍTULO / TITLE: - Can bone marrow
differentiate into renal cells?
REVISTA
/ JOURNAL: - Pediatr Nephrol 2002 Oct;17(10):790-4.
Epub 2002 Aug 16.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00467-002-0949-4
AUTORES
/ AUTHORS: - Imai E; Ito T
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine and
Therapeutics, Division of Nephrology, Osaka University Graduate School of
Medicine, 2-2 Yamadaoka, Suita, 565-0871 Osaka, Japan. imai@medone.med.osaka-u.ac.jp
RESUMEN
/ SUMMARY: - A considerable plasticity of adult stem cells
has been confirmed in a wide variety of tissues. In particular, the
pluripotency of bone marrow-derived stem cells may influence the regeneration
of injured tissues and may provide novel avenues in regenerative medicine. Bone
marrow contains at least hematopoietic and mesenchymal stem cells, and both can
differentiate into a wide range of differentiated cells. Side population (SP)
cells, which are originally defined in bone marrow cells by high efflux of
DNA-binding dye, seem to be a new class of multipotent stem cells. Irrespective
of the approach used to obtain stem cells, the fates of marrow-derived cells
following bone marrow transplantation can be traced by labeling donor cells
with green fluorescence protein or by identifying donor Y chromosome in female
recipients. So far, bone marrow-derived cells have been reported to
differentiate into renal cells, including mesangial cells, endothelial cells,
podocytes, and tubular cells in the kidney, although controversy exists.
Further studies are required to address this issue. Cell therapy will be
promising when we learn to control stem cells such as bone marrow-derived stem
cells, embryonic stem cells, and resident stem cells in the kidney.
Identification of factors that support stem cells or promote their
differentiation should provide a relevant step towards cell therapy. N. Ref:: 40
----------------------------------------------------
[48]
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
----------------------------------------------------
[49]
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
----------------------------------------------------
[50]
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
----------------------------------------------------
[51]
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
----------------------------------------------------
[52]
TÍTULO / TITLE: - Recent advances in
immunosuppressive therapy for renal transplantation.
REVISTA
/ JOURNAL: - Semin Dial 2001 May-Jun;14(3):218-22.
AUTORES
/ AUTHORS: - Peddi VR; First MR
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and Hypertension,
Department of Internal Medicine, University of Cincinnati College of Medicine,
Cincinnati, Ohio 45267-0585, USA. ram.peddi@uc.edu
RESUMEN
/ SUMMARY: - Recent advances in immunosuppression have
focused on more effective, safer, and targeted therapies that have resulted in
improved short- and intermediate-term renal allograft survival. During the past
decade there has been a marked decrease in acute rejection rates following
renal transplantation because of the use of newer immunosuppressive agents.
Recent data indicate that the average yearly reduction in the relative hazard
of graft failure beyond 1 year was 4.2% for all recipients (0.4% for those
recipients who had an acute rejection episode and 6.3% for those who did not
have an acute rejection). Despite these improvements the currently available
immunosuppressive agents are associated with significant cardiovascular risk
factors, an increased risk of infection, and the development of malignancies in
the long term. Predictive parameters of donor-specific hyporesponsiveness are
needed so as to allow identification of patients in whom immunosuppressive
therapy can be safely reduced. Immunosuppressive agents that have recently been
approved for use in the United States and those that are in clinical and
preclinical studies are discussed. N.
Ref:: 27
----------------------------------------------------
[53]
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.
----------------------------------------------------
[54]
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
----------------------------------------------------
[55]
TÍTULO / TITLE: - Safety and efficacy of
TOR inhibitors in pediatric renal transplant recipients.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Oct;38(4 Suppl
2):S22-8.
AUTORES
/ AUTHORS: - Ettenger RB; Grimm EM
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, Mattel Children’s
Hospital at UCLA, Los Angeles, CA 90095-1752, USA. Rettenger@mednet.ucla.edu
RESUMEN
/ SUMMARY: - Information about the pharmacokinetics,
safety, and efficacy of target of rapamycin (TOR) inhibitors, such as sirolimus
and everolimus, in pediatric renal transplant recipients is limited. In an
ascending single-dose pharmacokinetic study of sirolimus in pediatric dialysis
patients, no clinically significant association was observed between patient age
and absorption of sirolimus from the gastrointestinal tract. However, young
pediatric patients (5 to 11 years of age) exhibited significantly greater
apparent oral clearances, suggesting that pediatric patients require slightly
higher doses than do adults when adjusted for body weight or surface area.
Similarly, in studies performed in pediatric renal transplant recipients, the
half-life of sirolimus was shorter and the clearance was greater in younger
patients. On the other hand, in single-dose pharmacokinetic studies of
everolimus, the apparent clearance was reduced in pediatric renal transplant
recipients compared with clearance in adults. This reduced clearance was
attributed to a smaller apparent volume of distribution in pediatric patients,
rather than to a difference in terminal half-life. This suggested that,
although the adult 12-hour dosing interval was appropriate for pediatric
patients, they would require reduced dosing based on body size compared with
adults. In a large trial (N = 719) of sirolimus versus azathioprine in
combination with cyclosporine microemulsion and prednisone, 6 pediatric
patients (13 to 18 years of age) received sirolimus at 2 mg/d, 3 received
sirolimus at 5 mg/d, and 3 received azathioprine. Seven of the nine patients
who received sirolimus experienced no rejection episodes. Six infectious
episodes occurred in the 6 patients receiving sirolimus at 2 mg/d, 10 episodes
occurred in the 3 patients receiving sirolimus at 5 mg/d, and 8 episodes
occurred in the 3 patients receiving azathioprine. At 6 months after
transplantation, renal function was similar in all 3 groups, although there was
a statistically nonsignificant increase in the group receiving sirolimus at 5
mg/d. The mean cholesterol and triglyceride levels were generally comparable in
all 3 groups. TOR inhibitors are promising agents for the prevention of graft
rejection in pediatric renal transplant recipients, but more pharmacokinetic
data are required to assess the optimal dosing regimens in this population. In
addition, further data are needed on the efficacy and safety of TOR inhibitors
in combination with other agents in pediatric transplantation recipients to
best assess the role of TOR inhibition in corticosteroid and/or calcineurin
inhibitor-sparing regimens. N.
Ref:: 13
----------------------------------------------------
[56]
TÍTULO / TITLE: - Epstein-Barr
virus-associated extranodal NK/T-cell lymphoma, nasal type of the hypopharynx,
in a renal allograft recipient: case report and review of literature.
REVISTA
/ JOURNAL: - Hum Pathol 2001 Nov;32(11):1264-8.
AUTORES
/ AUTHORS: - Stadlmann S; Fend F; Moser P; Obrist P;
Greil R; Dirnhofer S
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, University of
Innsbruck, Innsbruck, Austria.
RESUMEN
/ SUMMARY: - Posttransplant lymphoproliferative
disorders (PTLPDs) are predominantly B-cell lymphoproliferations, whereas a
T-cell origin is rarely observed. In contrast to B-cell PTLPD, T-cell PTLPDs
show an inconsistent association with Epstein-Barr virus (EBV). Until now, only
13 cases of EBV-associated T-cell PTLPDs have been reported. We describe a case
of an EBV-associated T-cell PTLPD in a renal allograft recipient 2 years after
transplantation. Histologic examination showed medium- to large-sized lymphoid
cells with an angiocentric growth pattern and necrosis. The atypical cells
showed a CD2+, CD3epsilon+, CD7+, CD43+, CD45R0+, CD56+, and CD4-, CD5-, CD8-
betaF1- phenotype with expression of the latent membrane protein (LMP)-1 of
EBV. In addition, EBV-specific RNAs (EBER ½) were identified by in situ
hybridization. Molecular analysis of the T-cell receptor (TCR) gamma chain by
polymerase chain reaction (PCR) showed a polyclonal pattern. The morphologic,
immunohistochemical, and molecular findings were consistent with a diagnosis of
an EBV-associated extranodal natural killer (NK)/T-cell non-Hodgkin lymphoma
(NHL) of nasal type. To our knowledge, this is the first reported case of this
rare entity in the posttransplant setting.
N. Ref:: 18
----------------------------------------------------
[57]
TÍTULO / TITLE: - Vascular and cellular
mechanisms of chronic renal allograft dysfunction.
REVISTA
/ JOURNAL: - Transplantation 2001 Jun 15;71(11
Suppl):SS37-41.
AUTORES
/ AUTHORS: - Morris RE
INSTITUCIÓN
/ INSTITUTION: - Stanford University School of Medicine,
California, United States. N.
Ref:: 29
----------------------------------------------------
[58]
TÍTULO / TITLE: - Durable and high rates
of remission following chemotherapy in posttransplantation lymphoproliferative
disorders after renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Feb;35(1):256-7.
AUTORES
/ AUTHORS: - Gill D; Juffs HG; Herzig KA; Brown AM;
Hawley CM; Cobcroft RG; Petrie JJ; Marlton P; Kennedy G; Thomson DB; Campbell
SB; Nicol DL; Norris D; Johnson DW
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, Mater
Misericordiae Hospital, Brisbane, Australia.
N. Ref:: 18
----------------------------------------------------
[59]
TÍTULO / TITLE: - Physiologic and
immunologic hurdles to xenotransplantation.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2001
Jan;12(1):182-93.
AUTORES
/ AUTHORS: - Samstein B; Platt JL
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Mayo Clinic,
Rochester, Minnesota, 55905, USA.
RESUMEN
/ SUMMARY: - The major problem in the field of renal
transplantation is currently the shortage of available kidneys. However, the
use of animals as a source of kidneys, i.e., xenotransplantation, is
increasingly being viewed as a potential solution to this problem. One
preeminent hurdle to xenotransplantation is the immune response of the
recipient against the graft; other hurdles include the physiologic limitations
of the transplant, infection, and ethical considerations. This review
summarizes what is currently known regarding the obstacles to
xenotransplantation and some potential solutions to those problems. N. Ref:: 111
----------------------------------------------------
[60]
TÍTULO / TITLE: - Maintenance
immunosuppression in the renal transplant recipient: an overview.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S25-35.
AUTORES
/ AUTHORS: - Gaston RS
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, University of
Alabama at Birmingham, Birmingham, AL 35294, USA. rgaston@nrtc.uab.edu
RESUMEN
/ SUMMARY: - Managing maintenance immunosuppressive
regimens after kidney transplantation is often challenging and confusing,
requiring careful attention to efficacy, dosing, adverse effects, and costs of
multiple medications. Most protocols combine a primary immunosuppressant
(cyclosporine or tacrolimus) with one or two adjunctive agents (azathioprine,
mycophenolate mofetil, sirolimus, corticosteroids). Avoiding drug-drug
interactions is a major part of effective immunosuppressant management, and
special situations (eg, pregnancy, intravenous dosing, caring for minority
patients) can prove especially daunting. This review summarizes available data
regarding current practices in maintenance immunosuppression, emphasizing
issues that arise in day-to-day management of renal transplant recipients. N. Ref:: 69
----------------------------------------------------
[61]
TÍTULO / TITLE: - Transplantation
tolerance: a journey from ignorance to memory.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Oct;18(10):1979-82.
●●
Enlace al texto completo (gratuito o de pago) 1093/ndt/gfg312
AUTORES
/ AUTHORS: - Lakkis FG
INSTITUCIÓN
/ INSTITUTION: - Yale University School of Medicine,
Section of Nephrology, 333 Cedar Street, PO Box 208029, New Haven, CT
06520-8029, USA. fadi.lakkis@yale.edu N. Ref:: 12
----------------------------------------------------
[62]
TÍTULO / TITLE: - Minimization of
immunosuppression in kidney transplantation. The need for immune monitoring.
REVISTA
/ JOURNAL: - Transplantation 2001 Oct 27;72(8
Suppl):S32-5.
AUTORES
/ AUTHORS: - Hricik DE; Heeger PS
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Case Western
Reserve University, Cleveland, Ohio, USA. deh5@po.cwru.edu N. Ref:: 16
----------------------------------------------------
[63]
TÍTULO / TITLE: - Developmental
approaches to kidney tissue engineering.
REVISTA
/ JOURNAL: - Am J Physiol Renal Physiol. Acceso
gratuito al texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ajprenal.physiology.org/
●●
Cita: American J. of Physiology. Renal Physiology: <> 2004
Jan;286(1):F1-7.
●●
Enlace al texto completo (gratuito o de pago) 1152/ajprenal.00167.2003
AUTORES
/ AUTHORS: - Steer DL; Nigam SK
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Pediatrics, and
Cellular Molecular Medicine, University of California, 9500 Gilman Drive, La
Jolla, CA 92093-0693, USA.
RESUMEN
/ SUMMARY: - Recent advances in our understanding of
the developmental biology of the kidney, as well as the establishment of novel
in vitro model systems, have potential implications for kidney tissue engineering.
These advances include delineation of the roles of a number of growth factors
in the developmental programs of branching morphogenesis and mesenchymal
differentiation, a new understanding of the roles of the extracellular matrix,
identification of potential “renal” stem cells, the ex vivo propagation and
subsequent recombination of isolated components of the kidney, and successful
transplantation of renal primordia into adult hosts. This review will examine
these advances in the context of approaches to tissue engineering. Finally,
novel approaches that synthesize advances in both cell-based and organ-based
approaches are proposed. N.
Ref:: 46
----------------------------------------------------
[64]
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
----------------------------------------------------
[65]
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
----------------------------------------------------
[66]
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
----------------------------------------------------
[67]
TÍTULO / TITLE: - Immunologic risk
factors for chronic renal allograft dysfunction.
REVISTA
/ JOURNAL: - Transplantation 2001 Jun 15;71(11
Suppl):SS17-23.
AUTORES
/ AUTHORS: - Paul LC
INSTITUCIÓN
/ INSTITUTION: - Leiden University Medical School, The
Netherlands.
RESUMEN
/ SUMMARY: - Tissue injury is probably the central
feature leading to CRAD, whether that injury is produced by immunological or
nonimmunological factors. Tissue injury may expose cryptic antigens that, in an
allogeneic situation, stimulate immune responses that further increase tissue
damage. With acute rejection the immunological factor most strongly predictive
of CRAD, HLA mismatches may facilitate rejection or otherwise lead to CRAD.
However, clinical studies have not always demonstrated an increasing risk of
CRAD with increased numbers of HLA mismatches. Antibodies produced against HLA
or other donor-specific antigens may play a role in initiating the CRAD process
or may occur secondary to tissue damage. Several human transplant studies have
demonstrated an association between anti-HLA or anti-B cell antibodies and
CRAD. In animal models of CRAD, antibodies are produced against antigens associated
with glomerular and tubular basement membranes and mesangial cells, as well as
antigens associated with vascular endothelial cells. The pathogenetic
significance of these antibody responses is unclear at this time, but these
responses may interfere with repair processes that follow tissue injury or
otherwise facilitate mechanisms leading to CRAD. Whether similar antibody
responses against components of basement membrane and mesangial cells occur in
human renal transplant patients with CRAD is not yet known. The most effective
way to prevent CRAD is to prevent tissue damage, especially immunity-related
injury that involves maintaining appropriate immunosuppression. When using
calcineurin inhibitors for immunosuppression, there is a risk of chronic calcineurin
inhibitor-associated nephrotoxicity. Nonnephrotoxic immunosuppressive agents,
such as sirolimus and mycophenolate mofetil, may be considered in therapeutic
strategies designed to prevent acute rejection and to minimize renal tissue
damage due to nephrotoxic drugs. N.
Ref:: 54
----------------------------------------------------
[68]
TÍTULO / TITLE: - The case against
protocol kidney biopsies.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Aug;34(5):1716-8.
AUTORES
/ AUTHORS: - Ponticelli C; Banfi G
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, IRCCS Ospedale
Maggiore di Milano, Via Commenda 15, 20122 Milan, Italy. ponticelli@policlinico.mi.it N. Ref:: 30
----------------------------------------------------
[69]
TÍTULO / TITLE: - Viral infections and
their impact on chronic renal allograft dysfunction.
REVISTA
/ JOURNAL: - Transplantation 2001 Jun 15;71(11
Suppl):SS24-30.
AUTORES
/ AUTHORS: - Soderberg-Naucler C; Emery VC
INSTITUCIÓN
/ INSTITUTION: - Karolinska Institute, Huddinge, Sweden.
RESUMEN
/ SUMMARY: - Viral infections, particularly those
involving HCMV, are an important complication of renal transplantation.
Transplantation protocols and treatment regimens that increase HCMV infection
and disease may promote the development of CRAD and impair long-term renal
allograft survival. Investigators are beginning to illuminate the mechanisms by
which HCMV infection may cause chronic rejection in general and transplant
vascular sclerosis in particular. Migration and proliferation of SMCs within
the intimal layer of blood vessels is an important component of transplant
vascular sclerosis, and HCMV appears to facilitate both of these processes.
Current management strategies for HCMV focus on prevention, either using a
focal preemptive therapeutic approach or by administering antiviral therapies
to all or at-risk patients. N.
Ref:: 74
----------------------------------------------------
[70]
TÍTULO / TITLE: - Donor specific
transfusion in kidney transplantation: effect of different immunosuppressive
protocols on graft outcome.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Aug;33(5):2787-8.
AUTORES
/ AUTHORS: - Barbari A; Stephan A; Masri MA; Joubran N;
Dagher O; Kamel G
INSTITUCIÓN
/ INSTITUTION: - Department ofNephrology and
Transplantation, Rizk Hospital, Beirut, Lebanon.
----------------------------------------------------
[71]
TÍTULO / TITLE: - Overview of clinical
trials with new agents.
REVISTA
/ JOURNAL: - Transplant Proc 2001 May;33(3):2201-3.
AUTORES
/ AUTHORS: - Charpentier B; Hiesse C; Durrbach A; Ammor
M; Von Ey F; Kechrid C; Kriaa F
INSTITUCIÓN
/ INSTITUTION: - Nephrology Department, University Hospital
of Bicetre, Kremlin Bicetre, France. N.
Ref:: 12
----------------------------------------------------
[72]
TÍTULO / TITLE: - Tailoring
immunosuppressive therapy in renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2478-9.
AUTORES
/ AUTHORS: - Vathsala A
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine, Singapore
General Hospital, Singapore. N.
Ref:: 13
----------------------------------------------------
[73]
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
----------------------------------------------------
[74]
TÍTULO / TITLE: - Evolution of
immunosuppression and continued importance of acute rejection in renal
transplantation.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S2-9.
AUTORES
/ AUTHORS: - Chan L; Gaston R; Hariharan S
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine, University
of Colorado Health Sciences Center, Denver, CO 80262, USA. Larry.Chan@uchsc.edu
RESUMEN
/ SUMMARY: - As steady improvement in short-term kidney
graft survival and long-term outcomes prolongs the lives of transplant
patients, responsibility for their care is shifting away from transplant
specialists and into the hands of community nephrologists. Therefore, community
nephrologists need to have a deeper understanding of immunosuppressive
therapies than ever before. Pharmacologic immunosuppression has been
continuously evolving over the past two decades. Azathioprine was introduced in
the early 1960s. Introduction of cyclosporine (CsA) in 1983 revolutionized
short-term outcomes after renal transplantation. The first monoclonal antibody
immunosuppressant, OKT3, was introduced in 1986. The 1990s saw the introduction
of a number of important new agents, including mycophenolate mofetil (MMF),
tacrolimus, and a microemulsion CsA, as well as two new monoclonal antibodies.
Combinations of these new agents, along with improving clinical care, have
produced 1-year patient survival approaching 100% and graft survival exceeding
90%. The newest class of agents, the first of which is sirolimus, is called
target of rapamycin (TOR) inhibitors and is used with CsA for maintenance
therapy. Immunosuppressive drug therapy after kidney transplantation continues
to evolve. There is a variety of pharmacologic combinations from which to
choose, based on immunologic risk and side effect profiles. As new regimens are
developed, ongoing communications between the transplant center and community
nephrologists will be required to implement therapeutic changes and optimize
patient care successfully. N.
Ref:: 59
----------------------------------------------------
[75]
TÍTULO / TITLE: - Decreasing side effects
of Neoral through three-times-a-day protocol in Chinese renal transplant
patients.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Nov-Dec;33(7-8):3156-7.
AUTORES
/ AUTHORS: - Chen ZS; Zeng FJ; Lin ZB; Chen ZK; Sha B;
Wen ZX; Ming CS; Zhang WJ; Xia SS
INSTITUCIÓN
/ INSTITUTION: - Institute of Organ Transplantation, Tongji
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China.
----------------------------------------------------
[76]
TÍTULO / TITLE: - Immunosuppression
protocols for HLA identical renal transplant recipients.
REVISTA
/ JOURNAL: - Transplant Proc 2003 May;35(3):1074-5.
AUTORES
/ AUTHORS: - Keitel E; Santos AF; Alves MA; Neto JP;
Schaefer PG; Bittar AE; Goldani JC; Pozza R; Bruno RM; See D; Garcia CD; Garcia
VD
INSTITUCIÓN
/ INSTITUTION: - Renal Transplant Unit, Santa Casa
Hospital, Porto Alegre, RS, Brazil. keitel@terra.com.br
----------------------------------------------------
[77]
TÍTULO / TITLE: - Candida fasciitis
following renal transplantation.
REVISTA
/ JOURNAL: - Transplantation 2001 Aug 15;72(3):477-9.
AUTORES
/ AUTHORS: - Wai PH; Ewing CA; Johnson LB; Lu AD;
Attinger C; Kuo PC
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Georgetown
University Medical Center, Washington, DC, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: We describe a rare case of
necrotizing fasciitis involving Candida albicans, an organism that has been
reported to have a minimal potential for invasive soft tissue infection. In
this case, immunosuppression, chronic renal failure, and a history of diabetes
mellitus were predisposing factors. METHODS: The medical record and
histopathologic material were examined. The clinical literature was reviewed
for previous cases of C albicans necrotizing fasciitis. RESULTS: A review of
the literature showed that in solid organ transplant recipients, localized
fungal soft tissue infection is infrequent, with only 35 cases reported between
1974 and 1992. Necrotizing fasciitis caused by C albicans is extremely rare in
the modern era of solid organ transplantation. CONCLUSIONS: The management of
transplant patients at risk for invasive fungal infection warrants a high index
of suspicion for fungal necrotizing fasciitis in the setting of wound infection
and merits a thorough investigation for atypical pathogens. N. Ref:: 8
----------------------------------------------------
[78]
TÍTULO / TITLE: - Humoral rejection in
kidney transplantation: new concepts in diagnosis and treatment.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002
Nov;11(6):609-18.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000040046.33359.cf
AUTORES
/ AUTHORS: - Mauiyyedi S; Colvin RB
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, University of
Texas-Houston, Health Sciences Center, USA.
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: Evidence from several
transplant centers indicates that a substantial proportion of acute and chronic
renal allograft rejection is caused by antibodies to donor antigens.
Antibody-mediated injury arises despite potent anti-T cell pharmacological
agents, and probably requires different therapy. RECENT FINDINGS: Acute humoral
rejection occurs in 20-30% of acute rejection cases, has a poorer prognosis
than cellular rejection, and is refractory to conventional immunosuppressive
therapy. C4d deposition in peritubular capillaries of renal allografts has been
demonstrated to be a sensitive and diagnostic in-situ marker of acute humoral
rejection that correlates strongly with the presence of circulating
donor-specific antibodies. Biopsies with chronic allograft arteriopathy or
glomerulopathy also have a high frequency of C4d deposition and donor-specific
antibodies. The vessels of other organs, notably the heart, can also be targets
of humoral rejection. New polyclonal C4d antibodies work in paraffin sections.
Pitfalls in C4d staining have been identified and must be considered in the
valid interpretation of results. SUMMARY: As the histology is variable, the
current diagnosis of humoral rejection in biopsies relies on the demonstration
of C4d, a component of the classical complement pathway, in peritubular
capillaries. The new classification of renal allograft rejection incorporates
humoral and cellular mechanisms of injury, with the diagnostic criteria of
each. This should prove useful in guiding clinical treatment, and stratifying
drug trials, replacing obsolete terms such as ‘vascular rejection’. Specific
therapeutic strategies for humoral rejection with controlled trials targeting
the humoral limb of immunosuppression are needed. N. Ref:: 47
----------------------------------------------------
[79]
TÍTULO / TITLE: - Mycophenolate mofetil:
suggested guidelines for use in kidney transplantation.
REVISTA
/ JOURNAL: - BioDrugs 2001;15(1):37-53.
AUTORES
/ AUTHORS: - Behrend M
INSTITUCIÓN
/ INSTITUTION: - Abteilung fur Viszeral- und
Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany.
Behrend.Matthias@MH-Hannover.de
RESUMEN
/ SUMMARY: - Mycophenolate mofetil (MMF) is an
immunosuppressive drug designed to inhibit inosine monophosphate dehydrogenase
(IMPDH). IMPDH is a key enzyme in the de novo purine synthesis of lymphocytes.
It is crucially important for proliferative responses of human T and B
lymphocytes. The inhibition of IMPDH thus leads to selective lymphocyte
suppression. After successful use in various in vitro and animal models, MMF
was brought to clinical trial in patients undergoing transplantation. The drug
is rapidly and completely absorbed following oral administration. Pilot studies
of administration with cyclosporin and corticosteroids suggested a significant
reduction in the incidence of organ rejection at dosages of 1 to 3 g/day. As a
result of these studies, 3 pivotal randomised double-blind multicentre trials,
involving nearly 1500 patients, were designed to investigate the effects of
addition of MMF to different standard immunosuppressive protocols on the
prevention of acute renal allograft rejection. After 6 months, the rates of
biopsy-proven rejection were significantly reduced in patients receiving MMF.
In combination with cyclosporin and corticosteroids, the adverse effect profile
resembled that of azathioprine. Most adverse effects were associated with the
gastrointestinal tract, the blood system and opportunistic infections. MMF
offers improved immunosuppressive therapy following renal and probably other
solid organ transplantation. MMF has been licensed since 1995 for the
prevention of acute renal allograft rejection in most countries. It has been
used in different combinations of immunosuppressive drugs and in various
dosages and regimens. N.
Ref:: 124
----------------------------------------------------
[80]
TÍTULO / TITLE: - Pregnancy in renal
transplantation: immunologic evaluation of neonates from mothers with
transplanted kidney.
REVISTA
/ JOURNAL: - Transpl Immunol 2002 May;9(2-4):161-4.
AUTORES
/ AUTHORS: - Schen FP; Stallone G; Schena A; Manfredi
G; Derosa C; Procino A; Di Paolo S
INSTITUCIÓN
/ INSTITUTION: - Department of Emergency and Organ
Transplantation, University of Bari, Italy. fp.schena@nephro.uniba.it
RESUMEN
/ SUMMARY: - The occurrence of pregnancy in young
female organ transplant recipients may sustain a high risk for prematurity and
low rate of malformations in neonates. Therefore, it is necessary to counsel
couples who want a child. In case of pregnancy, strict guidelines must be
observed. Continuous exposure to CsA in utero seems to impair T-, B- and
NK-cell development and function in neonates. This effect is prolonged
throughout the first year of life. In addition, low levels of serum
immunoglobulins occur at the same time. This leads to suggest a delayed
administration of classical vaccinations (after the first 6 months of life) in
view of the potential risks of both sub-optimal immunologic responses, and
adverse events after the administration of live, attenuated vaccines in infants
born from young female organ transplant recipients. N. Ref:: 13
----------------------------------------------------
[81]
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
----------------------------------------------------
[82]
TÍTULO / TITLE: - Do gastrostomies close
spontaneously? A review of the fate of gastrostomies following successful renal
transplantation in children.
REVISTA
/ JOURNAL: - Pediatr Surg Int 2001 May;17(4):326-8.
AUTORES
/ AUTHORS: - Davies BW; Watson AR; Coleman JE; Rance CH
INSTITUCIÓN
/ INSTITUTION: - Department of Paediatric Urology and
Nephrology, Nottingham City Hospital N.H.S. Trust, Nottingham, UK.
RESUMEN
/ SUMMARY: - Previous published data have shown the
benefit of nutritional support delivered via a gastrostomy button (GB) for
children on chronic dialysis. The use of the GB is suspended following renal
transplantation (RT) in most children and it is usually removed 2-3 months
later together with the chronic dialysis catheter when the child is on
alternate-day steroids. We reviewed the outcome of gastrostomies following
successful RT in children. The gastrostomies were created by an open technique
(Stamm) with the child under general anaesthesia, usually at the time of
insertion of a chronic dialysis catheter. Growth data and complications of the
GB were collected in a prospective registry. Following RT, the GB was removed
with the expectation that the tract would close spontaneously. Those in whom a
gastrocutaneous fistula persisted underwent formal surgical closure. A total of
18 children have had gastrostomy buttons removed: 11 gastrostomies (61%) closed
spontaneously, but 7 (39%) required operative closure at a median of 2 months
(range 3 weeks-4 years) post-removal. The need for formal closure was
significantly related to the duration that the gastrostomy had been in situ
pre-transplant (non-parametric statistics, 0.05 > p > 0.01). Although
nearly two-thirds of gastrostomies in this study closed spontaneously following
RT, less than one-half of those that had been in situ for more than 1 year did
so. We thus recommend formal closure of all gastrostomies that have been in
situ for more than 1 year. This can be done at the same operation as the
removal of the chronic dialysis catheter.
N. Ref:: 12
----------------------------------------------------
[83]
TÍTULO / TITLE: - Pharmacological control
of the immune response in renal transplantation.
REVISTA
/ JOURNAL: - Bju Int. Acceso gratuito al texto completo
a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.bjui.org/
●●
Cita: BJU International: <> 2002 Nov;90(8):784-91.
AUTORES
/ AUTHORS: - Warrens AN
INSTITUCIÓN
/ INSTITUTION: - Imperial College, Faculty of Medicine,
Hammersmith Campus, London, UK. a.warrens@ic.ac.uk N. Ref:: 29
----------------------------------------------------
[84]
TÍTULO / TITLE: - Therapeutic drug
monitoring of immunosuppressive drugs in kidney transplantation.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002
Nov;11(6):657-63.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000040053.33359.26
AUTORES
/ AUTHORS: - Holt DW
INSTITUCIÓN
/ INSTITUTION: - Analytical Unit, St George’s Hospital
Medical School, London, UK. d.holt@sghms.ac.uk
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: Drug monitoring has
become an accepted adjunct to optimizing therapy with immunosuppressive drugs.
This review assesses publications that relate to the analytical techniques used
to measure cyclosporin, tacrolimus, mycophenolic acid, sirolimus and
everolimus, as well as the clinical data obtained for these drugs. For all of
these drugs there has been a substantial and continuing investment in assessing
the clinical value of drug monitoring. RECENT FINDINGS: Fundamental
controversies still persist regarding which time point to use for monitoring.
The most significant single development has been the move towards using a timed
blood sample 2 h after drug administration (C2) to monitor cyclosporin therapy
with the Neoral formulation. The favourable clinical results obtained with this
approach have had an impact on reevaluating monitoring data for some of the
other drugs. The newest drugs to reach clinical evaluation, sirolimus and
everolimus, have been studied in the context of concentration-controlled dosing
and there is a good rationale for their measurement. There have also been
developments in the analytical techniques used, mostly to improve the
selectivity of the assays or to adapt them to new monitoring strategies.
SUMMARY: Interpretation of drug concentration data is becoming ever more
complex in this field as the number of potential drug combinations expands. The
relatively narrow therapeutic index of these agents and the ever-present risk
of clinically significant pharmacokinetic drug interactions makes drug
monitoring an important aspect of their prescription. N. Ref:: 77
----------------------------------------------------
[85]
TÍTULO / TITLE: - Sirolimus (Rapamune) in
renal transplantation.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002
Nov;11(6):603-7.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000040045.55337.97
AUTORES
/ AUTHORS: - Johnson RW
INSTITUCIÓN
/ INSTITUTION: - Manchester Postgraduate Health Sciences Centre,
Manchester Royal Infirmary, Manchester.
RESUMEN
/ SUMMARY: - There has been a necessary change in
attitude to transplantation; there is much less concern with short-term outcome
and more concern with long-term kidney function, overall health and quality of
life. Nephrotoxicity is an invariable consequence of long-term treatment with
calcineurin antagonists and it is one of the most underestimated causes of late
graft loss; it has been reported as a serious threat to both patient and graft
survival following heart, liver and bone marrow transplantation. Sirolimus has
been shown in many recent studies to be of great value in allowing patients to
be weaned from cyclosporine with excellent patient and graft survival at 24
months a significant improvement in renal function with resolution of hirsutism
and gum hyperplasia. Patients maintained on the combined regime of cyclosporine
and sirolimus had significantly higher blood pressure, much more cyclosporine
nephrotoxicity and hyperuricaemia at 12 months. The experimental studies have
found cyclosporine and sirolimus potentiate with each other’s good and adverse
effects. Cyclosporine therefore augments hyperlipidaemia caused by sirolimus,
and sirolimus augments nephrotoxicity caused by cyclosporine. The results of
these studies indicate that sirolimus is a suitable replacement for
cyclosporine or tacrolimus for long-term maintenance therapy. By contrast the
use of sirolimus in combination with cyclosporine results in potentiation of
side effects. The principal disadvantages being increased cyclosporine
associated nephrotoxicity and sirolimus associated hyperlipidaemia N. Ref:: 32
----------------------------------------------------
[86]
TÍTULO / TITLE: - Bone marrow
transfusions in cadaver renal allografts: pilot trials with concurrent
controls.
REVISTA
/ JOURNAL: - Clin Transplant 2002 Oct;16(5):317-24.
AUTORES
/ AUTHORS: - Light J; Salomon DR; Diethelm AG;
Alexander JW; Hunsicker L; Thistlethwaite R; Reinsmoen N; Stablein DM
INSTITUCIÓN
/ INSTITUTION: - Transplant Services, Washington Hospital
Center, Washington, DC 20010, USA.jimmy.a.light@medstar.net
RESUMEN
/ SUMMARY: - BACKGROUND: The safety and immune
tolerance potential of donor marrow infusion with cadaveric source renal
transplants was evaluated in a series of non-randomized multicenter pilot
trials by the NIH Cooperative Clinical Trials in Transplantation (CCTT) Group.
PATIENTS AND METHODS: Three strategies were tested: (1) immunosuppression with
cyclosporin, azathioprine and prednisone with a single post-transplant day 1
infusion of 5 x 107 viable cells/kg, (2) OKT3 induction with triple drug
therapy and marrow transfusion on day 1, or (3) same therapy as (2) but with an
additional marrow transfusion on day 10-12. RESULTS: Thirty-eight marrow
recipients and 35 contemporaneous controls were entered with a mean follow-up
of over 5 yr. Graft survival was initially better in the marrow recipients than
the controls but was similar after 5 yr. Microchimerism rates were similar for
the marrow infusion and control groups throughout the follow-up period,
regardless of the immunosuppression strategies. DISCUSSION: Bone marrow
infusions were well tolerated by a group of cadaver renal allograft recipients.
There were no complications from the infusion(s), no episodes of graft-vs.-host
disease (GVHD) and no increase in infections or other complications. There was
a trend toward early improved graft survival in marrow recipients. Decreased
rejection rates were observed in black recipients. N. Ref:: 36
----------------------------------------------------
[87]
TÍTULO / TITLE: - An induction versus
no-induction protocol in anticalcineurin-based immunosuppression using very
low-dose steroids.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Jun;33(4
Suppl):3S-10S.
AUTORES
/ AUTHORS: - Charpentier B
INSTITUCIÓN
/ INSTITUTION: - University Hospital of Bicetre, Le
Kremlin-Bicetre, France.
----------------------------------------------------
[88]
TÍTULO / TITLE: - Polyomavirus BK
nephropathy: a (re-)emerging complication in renal transplantation.
REVISTA
/ JOURNAL: - Am J Transplant 2002 Jan;2(1):25-30.
AUTORES
/ AUTHORS: - Hirsch HH
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine,
University of Basel, Switzerland. hans.hirsch@unibas.ch
RESUMEN
/ SUMMARY: - Persisting polyomavirus replication is now
widely recognized as a (re-)emerging cause of renal allograft dysfunction. Up
to 5% of renal allograft recipients can be affected about 40weeks (range 6-150)
post-transplantation. Progression to irreversible failure of the allograft has
been observed in up to 45% of all cases. The BK virus strain is involved in the
majority of the cases. Risk factors may include treatment of rejection episodes
and increasing viral replication under potent immunosuppressive drugs such as
tacrolimus, sirolimus or mycophenolate. The diagnosis requires the histological
demonstration of nuclear polyomavirus inclusions in affected tubular epithelial
cells. Interstitial inflammatory infiltrates and fibrosis become more prominent
in the persisting disease and may be difficult to distinguish from (coexisting)
rejection. Detection of polyomavirus-inclusion bearing cells (‘decoy cells’) in
the urine and quantification of BK virus DNA in the plasma have been proposed
as surrogate markers for polyomavirus replication and allograft disease,
respectively. Antiviral treatment is not yet established; however, reports of
treatment with cidofovir are encouraging. Current management aims at the
judicious modification and/or reduction of immunosuppression which, in view of
preceding or concurrent rejection, is not without risk. N. Ref:: 51
----------------------------------------------------
[89]
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
----------------------------------------------------
[90]
TÍTULO / TITLE: - Induction versus
non-induction protocols in anti-calcineurin-based immunosuppression.
REVISTA
/ JOURNAL: - Transplant Proc 2001
Nov-Dec;33(7-8):3334-6.
AUTORES
/ AUTHORS: - Charpentier B
INSTITUCIÓN
/ INSTITUTION: - Service de Nephrologie, University
Hospital of Bicetre, Bicetre, France.
----------------------------------------------------
[91]
TÍTULO / TITLE: - The case for protocol
kidney biopsies.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Aug;34(5):1713-5.
AUTORES
/ AUTHORS: - Isoniemi H
INSTITUCIÓN
/ INSTITUTION: - Transplantation and Liver Surgery Clinic,
Helsinki University Hospital, Kasarmik 11, FIN 00130 Helsinki, Finland. N. Ref:: 21
----------------------------------------------------
[92]
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
----------------------------------------------------
[93]
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
----------------------------------------------------
[94]
TÍTULO / TITLE: - Graft immunogenicity
revisited: relevance of tissue-specific immunity, brain death and donor
pretreatment.
REVISTA
/ JOURNAL: - Nephron 2002 Jun;91(2):181-7.
AUTORES
/ AUTHORS: - van der Woude FJ N. Ref:: 47
----------------------------------------------------
[95]
TÍTULO / TITLE: - Rejection-free protocol
using sirolimus-tacrolimus combination for pediatric renal transplant
recipients.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Aug;34(5):1942-3.
AUTORES
/ AUTHORS: - El-Sabrout R; Weiss R; Butt F; Delaney V;
Qadir M; Hanson P; Butt K
INSTITUCIÓN
/ INSTITUTION: - Departments of Transplantation/Vascular
Surgery, New York Medical College, Valhalla, New York, USA.
----------------------------------------------------
[96]
TÍTULO / TITLE: - Transplantation of
embryonic kidneys.
REVISTA
/ JOURNAL: - Clin Sci (Lond) 2002 Dec;103(6):599-612.
●●
Enlace al texto completo (gratuito o de pago) 1042/
AUTORES
/ AUTHORS: - Hammerman MR
INSTITUCIÓN
/ INSTITUTION: - George M. O’Brien Kidney and Urological
Disease Center, Renal Division, Department of Medicine, Washington University
School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA. mhammerman@im.wustl.edu
RESUMEN
/ SUMMARY: - The number of kidney allotransplants
performed per year is limited by the availability of human donor organs.
Xenotransplantation of a vascularized organ, such as the kidney, as an
alternative to allotransplantation presents formidable immunological
challenges. One novel solution to this conundrum is to use embryonic kidneys
taken from animal donors early during organogenesis when metanephroi can be
transplanted in ‘cellular’ form. We and others have shown that developing
embryonic kidneys (metanephroi) transplanted into the omentum of animal hosts
undergo differentiation and growth in situ, become vascularized by blood
vessels of host origin and exhibit excretory function. Metanephroi can be
stored for up to 3 days in vitro prior to transplantation with no impairment in
growth or function post-implantation. Metanephroi can be transplanted across
both concordant (rat to mouse) and highly disparate/discordant (pig to rodent)
xenogeneic barriers. This review summarizes experimental data relating to the
transplantation of embryonic kidneys. N.
Ref:: 33
----------------------------------------------------
[97]
TÍTULO / TITLE: - Updating renal
transplantation therapies in developing countries.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2475-7.
AUTORES
/ AUTHORS: - Stephan A; Barbari A; Karam A; Kamel G;
Kilani H; Masri AM
INSTITUCIÓN
/ INSTITUTION: - Nephrology and Transplantation Unit, Rizk
Hospital, Beirut, Lebanon. lird@cyberia.net.lb N. Ref:: 33
----------------------------------------------------
[98]
TÍTULO / TITLE: - Immunosuppression in
elderly renal transplant recipients: are current regimens too aggressive?
REVISTA
/ JOURNAL: - Drugs Aging 2001;18(10):751-9.
AUTORES
/ AUTHORS: - Meier-Kriesche HU; Kaplan B
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
Florida, Gainesville, Florida 32610-0024, USA.
RESUMEN
/ SUMMARY: - Renal transplantation is an accepted and
successful treatment modality in elderly patients with end-stage renal disease.
In comparison with maintenance dialysis, transplantation has been shown to
confer a mortality benefit as well as improvements in quality of life in older
individuals with end-stage renal disease. Despite this, overall outcomes of
renal transplantation in elderly individuals have, in general, been less successful
than those of younger renal transplant recipients. Largely, this has been due
to the particular vulnerability of elderly patients to the immunosuppressive
medications used in renal transplantation. This review article covers these
issues in some detail and briefly discusses some of the pharmacokinetic,
pharmacodynamic, physiological and immunological differences between younger
and older transplant recipients. Elderly renal transplant recipients have both
a higher rate of patient death and allograft loss censored for death. Upon
multivariate analysis, age of the recipient is strongly associated with
allograft loss independent of other known factors. Acute rejections are less
frequent in older individuals; however the consequence of a rejection if it occurs
is negative for long-term graft survival. On the other hand, death by infection
is vastly increased in older versus younger renal transplant recipients. In
general, the pharmacokinetics of the immunosuppressive agents are little
affected by age, but the tolerance to these agents seems to decrease with
increasing age. Elderly renal transplant recipients present a very difficult
clinical challenge. As the elderly become an ever-increasing segment of the
renal transplant population, new and innovative immunosuppressive strategies
will have to be considered and applied.
N. Ref:: 75
----------------------------------------------------
[99]
TÍTULO / TITLE: - A model for
reactivation of CMV from latency.
REVISTA
/ JOURNAL: - J Clin Virol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.elsevier.com/gej-ng/29/46/32/show/Products/VIRUSINT/index.htt
●●
Cita: J Clinical Virology: <> 2002 Aug;25 Suppl 2:S123-36.
AUTORES
/ AUTHORS: - Hummel M; Abecassis MM
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of Organ
Transplantation, Northwestern University Medical School, Chicago, IL 60611,
USA. m-hummel@northwestern.edu
RESUMEN
/ SUMMARY: - BACKGROUND: Reactivation of CMV from
latency results in serious morbidity and mortality in immunocompromised
transplant recipients. The mechanism by which CMV reactivates from latency has
not been well understood. OBJECTIVE: In this review we discuss three models for
reactivation from latency and present evidence in favor of the model that
reactivation is a multi-step process which is initiated by the allogeneic
response to the transplanted organ. Study design (J. Virol. 75 (2001) 4814).
Mice latently infected with murine cytomegalovirus (MCMV) were used as donors
for allogeneic or syngeneic kidney transplants into immunocompetent recipients.
The contralateral donor kidneys were used as controls. Transplanted kidneys
were removed at various times after transplant and analyzed for expression of
viral genes associated with productive infection and for expression of
inflammatory cytokines. Electrophoretic mobility shift assay was performed on
nuclear extracts of control and transplanted kidneys to examine activation of
AP-1 and NFkappaB. Latently infected mice were also injected with tumor
necrosis factor (TNF) to examine the effect of TNF alone on induction of MCMV
immediate-early (IE) gene expression. Transgenic major immediate early
promoter-lacZ mice carrying a beta-galactosidase reporter gene under the
control of the human cytomegalovirus (HCMV) IE promoter/enhancer were used as
donors for allogeneic kidney transplants to study the effect of allogeneic
transplantation on induction of HCMV IE gene expression. RESULTS: Allogeneic,
but not syngeneic transplantation induces MCMV IE-1 expression and expression
of inflammatory cytokines, including TNF. Allogeneic transplantation activates
transcription factors, including NFkappaB and AP-1. TNF alone can induce MCMV
IE-1 gene expression and activation of NFkappaB and AP-1 in some tissues.
CONCLUSIONS: We propose that induction of IE-1 gene expression is the first
step in reactivation of the virus in an immunocompromised transplant recipient,
and that it occurs as a result of the allogeneic response, which induces
expression of TNF and subsequent activation of NFkappaB, and
ischemia/reperfusion injury, which induces activation of AP-1. We speculate
that the natural stimulus for reactivation in an immunocompetent host is an
inflammatory immune response to infection and that allogeneic transplantation
mimics this process. N.
Ref:: 90
----------------------------------------------------
[100]
TÍTULO / TITLE: - Replicative senescence
in organ transplantation-mechanisms and significance.
REVISTA
/ JOURNAL: - Transpl Immunol 2002 May;9(2-4):165-71.
AUTORES
/ AUTHORS: - Chkhotua A; Shohat M; Tobar A; Magal N;
Kaganovski E; Shapira Z; Yussim A
INSTITUCIÓN
/ INSTITUTION: - Institute of Urology, University of
Tbilisi, Georgia.
RESUMEN
/ SUMMARY: - In the past two decades, transplantation
has become a preferred modality of treatment of end-stage failure of vital
organs. Currently, with the significant improvement in short-term graft
survival rates, the main effort is concentrated on prolonging the functional
life span of transplanted organs. One of the theories which were put forward to
explain the progressive deterioration of transplant function was that of replicative
senescence. Senescence of an organ or tissue results from age and/or
environmental stress-dependant modification of cellular function. With time,
the accumulation of cellular alterations may lead to deleterious effects in
various organs and tissues and adversely affect transplants. In this article we
are reviewing the candidate mechanisms of senescence such as telomere
shortening, genetic regulation and environmental-‘toxic’ factors and are
examining the implications of the theory of replicative senescence for organ
allograft. We are also presenting our experiments with renal
ischemia/reperfusion in rat serving as a model of kidney transplantation, where
baseline kidney telomere length and novel marker of cellular
senescence—senescence associated beta-Galactosidase (SA-Gal) expression in
tissue served as markers. For the first time in vivo, we were able to show that
with aging of the animals the amount of senescent cells in kidney tissue was
increasing, while the average renal tissue telomere length was decreasing. The
degree of tissue senescence, as determined by amount of SA-Gal positively
stained cells, was inversely correlated with the recovery of the kidney
function after ischemia/reperfusion injury. These results confirm the theory of
replicative senescence in organ ischemia for the first time in vivo, and
quantitatively validate the direct correlation between the amount of senescent
cells in the organ and its susceptibility to ischemic injury. We conclude that
recent advances in study of the cellular basis of senescence, in vitro and
especially in vivo, may hold clues to the understanding of events which could
be implicated in the damage or protection of organ allografts. N. Ref:: 67
----------------------------------------------------
[101]
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
----------------------------------------------------
[102]
TÍTULO / TITLE: - Of mice and men: the
road to tolerance.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002
Nov;11(6):579-81.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000040040.55337.cb
AUTORES
/ AUTHORS: - Tolkoff-Rubin NE N. Ref:: 12
----------------------------------------------------
[103]
TÍTULO / TITLE: - Hepatitis C virus and
renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2433-5.
AUTORES
/ AUTHORS: - Van Thiel D; Nadir A; Shah N
INSTITUCIÓN
/ INSTITUTION: - Division of Gastroenterology and Hepatology,
Stritch School of Medicine, Loyola University of Chicago, Loyola University
Medical Center, Maywood, Illinois 60153, USA. dvanthi@lumc.edu N. Ref:: 22
----------------------------------------------------
[104]
TÍTULO / TITLE: - Management of pediatric
postrenal transplantation infections.
REVISTA
/ JOURNAL: - Semin Nephrol 2001 Sep;21(5):521-31.
AUTORES
/ AUTHORS: - Dharnidharka VR; Harmon WE
INSTITUCIÓN
/ INSTITUTION: - Division of Pediatric Nephrology, University
of Florida College of Medicine, Gainesville, FL, USA. vikasmd@peds.ufl.edu
RESUMEN
/ SUMMARY: - Infections are the leading cause of
hospitalization and death after renal transplantation in children. Various
agents are implicated in posttransplantation infections. Viral infections due
to the cytomegalovirus and Epstein-Barr virus have assumed greater importance
as other infections such as pneumocystis pneumonia have come under control.
Multiple factors contribute to the difficulty in the prevention, diagnosis, and
treatment of pediatric postrenal transplantation infections. Prevention of
infections by adequate preparation before transplantation and the use of
chemoprophylaxis should be made a priority. An aggressive approach to diagnosis
is required when investigating fever in children. It is hoped that the use of
more specific immunosuppressive agents that block only the alloactivated T
cells and leave the rest of the immune response intact may result in a
reduction in the number and frequency of infections. N. Ref:: 91
----------------------------------------------------
[105]
TÍTULO / TITLE: - Polyomavirus in kidney
and kidney-pancreas transplantation: a defined protocol for immunosuppression
reduction and histologic monitoring.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Aug;34(5):1788-9.
AUTORES
/ AUTHORS: - Trofe J; Cavallo T; First MR; Weiskittel
P; Peddi VR; Roy-Chaudhury P; Alloway RR; Safdar S; Buell JF; Hanaway MJ;
Woodle ES
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, The University of Cincinnati, 231 Albert Sabin Way,
Cincinnati, OH 45267-0558, USA.
----------------------------------------------------
[106]
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
----------------------------------------------------
[107]
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
----------------------------------------------------
[108]
TÍTULO / TITLE: - Cyclosporine-associated
encephalopathy: a case report and literature review.
REVISTA
/ JOURNAL: - Transplant Proc 2001
Nov-Dec;33(7-8):3700-1.
AUTORES
/ AUTHORS: - Chang SH; Lim CS; Low TS; Chong HT; Tan SY
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Department of Medicine,
University of Malaya Medical Center, Kuala Lumpur, Malaysia.
----------------------------------------------------
[109]
TÍTULO / TITLE: - Tolerance and
near-tolerance strategies in monkeys and their application to human renal
transplantation.
REVISTA
/ JOURNAL: - Immunol Rev 2001 Oct;183:205-13.
AUTORES
/ AUTHORS: - Knechtle SJ; Hamawy MM; Hu H; Fechner JH
Jr; Cho CS
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, University of
Wisconsin Medical School, Madison, WI 53792-7375, USA. stuart@tx.surgery.wisc.edu
RESUMEN
/ SUMMARY: - Studies in non-human primates to evaluate
tolerance strategies in organ transplantation have led to innovation in human
transplantation. The two strategies we have studied in detail in non-human
primates are T-cell depletion by anti-CD3 immunotoxin and co-stimulation
blockade. Each of these strategies has been extended into early human trials in
renal transplantation. The results of these human and non-human primate studies
are summarized. Continued progress in better and safer immunosuppressive
methods remains closely linked to research using non-human primates. However,
there has not been a one-to-one correspondence between efficacy in the primate
and efficacy in humans. Rather, principles can be derived from non-human
primate studies that can be extended into human trials with the knowledge that
regimens will likely differ in humans compared to non-human primates. N. Ref:: 67
----------------------------------------------------
[110]
TÍTULO / TITLE: - Refining
immunosuppressive protocols in pediatric renal transplant recipients.
REVISTA
/ JOURNAL: - Transplant Proc 2001
Nov-Dec;33(7-8):3587-9.
AUTORES
/ AUTHORS: - Hoyer PF; Vester U
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatric Nephrology,
University Essen, Essen, Germany.
----------------------------------------------------
[111]
TÍTULO / TITLE: - Acute and chronic
rejection.
REVISTA
/ JOURNAL: - Semin Nephrol 2001 Sep;21(5):498-507.
AUTORES
/ AUTHORS: - Tejani A; Emmett L
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics and Surgery, New
York Medical College, Valhalla, NY, USA. Atejani@aol.com
RESUMEN
/ SUMMARY: - The major histocompatibility complex
molecules are the primary antigens responsible for causing graft rejection, and
T-cell recognition of alloantigens is the cardinal event initiating cellular
rejection. Current concepts suggest that direct allorecognition mediates acute
rejection, whereas indirect allorecognition mediates chronic rejection. In
biopsy tissue of rejecting human renal allografts, several cytotoxic
T-lymphocyte molecules are upregulated. The net result of cytokine release and
the acquisition of cell surface receptors is the emergence of antigen-specific
and graft-destructive T cells. Acute rejection is more frequent in children
than in adults. By the end of the first year posttransplantation, 45% of living
donor recipients and 60% of cadaver donor recipients will have an episode of
rejection. In recent years, with improved immunosuppressive therapy, the
incidence of acute rejection is decreasing at a rate of about 8% each year,
however, chronic rejection graft loss has increased to 41% of all graft losses
in the last 2 years. The mechanisms leading to chronic rejection and attempts
to reduce acute rejections should provide a better half-life to children
postrenal transplantation. N.
Ref:: 56
----------------------------------------------------
[112]
TÍTULO / TITLE: - Growing kidneys.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2001
Jan;10(1):13-7.
AUTORES
/ AUTHORS: - Hammerman MR
INSTITUCIÓN
/ INSTITUTION: - George M O’Brien Kidney and Urological
Disease Center, Department of Medicine, Washington University School of
Medicine, St Louis, Missouri 63110, USA. mhammerm@imgate.wustl.edu
RESUMEN
/ SUMMARY: - The number of kidney transplantations
performed per year is restricted by the limited availability of donor organs.
One possible solution to this shortage is the use of renal xenografts. However,
the transplantation of xenografts is complicated by hyperacute and acute
rejection. A second possible solution is to ‘grow a kidney’ from a transplanted
renal anlage. It has been postulated that the host immune response might be
attenuated after the transplantation of such an anlage (metanephros) instead of
a developed kidney. Transplanted metanephroi become chimeric organs in that
their blood supply originates, at least partly, from the host. It is possible
to transplant a developing metanephros, without the use of immunosuppression,
from one rat to another. Transplanted metanephroi grow, differentiate, become
vascularized, and function in host rats. ‘Growing kidneys’ via the
transplantation of metanephroi may hold promise as a novel therapeutic approach
to the treatment of chronic renal failure.
N. Ref:: 31
----------------------------------------------------
[113]
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
----------------------------------------------------
[114]
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
----------------------------------------------------
[115]
TÍTULO / TITLE: - The clinical and
cost-effectiveness of pulsatile machine perfusion versus cold storage of
kidneys for transplantation retrieved from heart-beating and non-heart-beating
donors.
REVISTA
/ JOURNAL: - Health Technol Assess 2003;7(25):1-94.
AUTORES
/ AUTHORS: - Wight J; Chilcott J; Holmes M; Brewer N
INSTITUCIÓN
/ INSTITUTION: - The School of Health and Related Research,
University of Sheffield, UK.
RESUMEN
/ SUMMARY: - OBJECTIVES: To evaluate the clinical and
cost-effectiveness of machine perfusion (MP) compared to cold storage (CS), as
a means of preserving kidneys prior to transplantation. Transplantation of
kidneys from both heart-beating donors (HBDs) and non-heart-beating donors
(NHBDs) is considered. Finally to review whether the use of MP can allow valid
testing of kidney viability prior to transplantation. DATA SOURCES: Fifteen
electronic bibliographic databases were searched. The reference lists of
relevant articles and sponsor submissions were hand searched and various health
service research-related resources were consulted via the Internet. REVIEW
METHODS: A literature search was undertaken to identify relevant studies and a
meta-analysis performed on the studies that had appropriate comparator groups
and reported sufficient data. A structured review examined tests of viability
of kidneys on MP. Economic modelling was used to determine the cost-effectiveness
and cost-utility of MP. RESULTS: The meta-analysis suggested that the use of
MP, as compared with CS, is associated with a relative risk of delayed graft
function (DGF) of 0.804 (95% confidence limits 0.672 to 0.961). There was no
evidence to suggest that this effect is different in kidneys taken from HBDs as
opposed to NHBDs. Meta-analysis of 1-year graft survival data showed no
significant effect, but the studies, even when aggregated, were severely
underpowered with respect to the likely impact on graft survival. The size of
effects demonstrated were in line with those predicted by an indirect model of
graft survival based on the association of DGF with graft loss. The economic
assessment indicated that it is unlikely that in the UK health setting complete
cost recovery will be obtained from a reduction in the incidence of DGF. The
probability that MP is cheaper and more effective than CS in the long term was
estimated at around 80% for NHBD recipients and 50-60% for HBD recipients. Flow
characteristics of the perfusate of kidneys undergoing MP may be an indicator
of kidney viability, but data were inadequate to calculate the sensitivity and
specificity of any test based on this. The concentration of
alpha-glutathione-S-transferase (a marker of cell damage) in the perfusate may
be the basis of a valid test. A threshold of 2800 micrograms/100 g gave a
sensitivity of 93% and specificity of 33% (and hence a likelihood ratio of
1.41). CONCLUSIONS: The baseline analysis indicated that in the long-term MP
would be expected to be cheaper and more effective than CS for both HBD and
NHBD recipients. A definitive study of the clinical benefit of MP in order to
establish its effect on DGF and longer term graft survival would be valuable,
together with an economic evaluation of the benefits. While direct evidence
relating to improvements in graft survival would be preferable, the small
predicted improvement indicates that a very large sample size would be
required. In addition to seeking direct evidence of the impact on DGF, research
quantifying the impact of DGF on graft survival in this technology is required.
Research is also needed to establish whether a valid test (or combination of
tests) of kidney viability can be developed.
N. Ref:: 123
----------------------------------------------------
[116]
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
----------------------------------------------------
[117]
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
----------------------------------------------------
[118]
TÍTULO / TITLE: - Therapeutic promise of
embryonic kidney transplantation.
REVISTA
/ JOURNAL: - Nephron Exp Nephrol 2003;93(2):e58.
●●
Enlace al texto completo (gratuito o de pago) 1159/000068516
AUTORES
/ AUTHORS: - Hammerman MR
INSTITUCIÓN
/ INSTITUTION: - George M. O’Brien Kidney and Urological
Disease Center, Renal Division, Department of Medicine, Washington University
School of Medicine, St. Louis, Mo 63110, USA. mhammerm@im.wustl.edu
RESUMEN
/ SUMMARY: - One novel solution to the shortage of
human kidneys available for transplantation envisions ‘growing’ new kidneys in
situ via xenotransplantation of renal anlagen. We and others have shown that
developing metanephroi transplanted into animal hosts undergo differentiation
and growth, become vascularized by blood vessels of host origin and exhibit
excretory function. Metanephroi can be stored for up to 3 days in vitro prior
to transplantation with no impairment in growth or function post-implantation.
Metanephroi can be transplanted across both concordant (rat to mouse) and
discordant/highly disparate (pig to rodent) xenogeneic barriers. Here we review
studies exploring the potential therapeutic use of embryonic kidney
transplantation. N.
Ref:: 21
----------------------------------------------------
[119]
TÍTULO / TITLE: - Pregnancy in renal
transplant recipients.
REVISTA
/ JOURNAL: - Adv Ren Replace Ther 2003 Jan;10(1):40-7.
●●
Enlace al texto completo (gratuito o de pago) 1053/jarr.2003.50002
AUTORES
/ AUTHORS: - Hou S
INSTITUCIÓN
/ INSTITUTION: - Section of Nephrology, Department of
Medicine, Loyola University Medical Center, Chicago, IL, USA. shou@lumc.edu
RESUMEN
/ SUMMARY: - Most women of childbearing age who receive
a renal transplant have a return of normal menses and have the ability to
become pregnant. Most studies indicate that pregnancy does not adversely affect
the transplant kidney’s survival as long as renal function is good and serum
creatinine is stable before pregnancy. The experience with immunosuppressive
drugs has been surprisingly reassuring with no increase in congenital anomalies
with cyclosporine, prednisone, and azathioprine. There is little experience
with newer drugs. Pregnant transplant recipients need to be monitored for
opportunistic infections, which may adversely affect the fetus, including
herpes, toxoplasmosis, and CMV. Hypertension, urinary tract infections, and
anemia are other common problems in pregnant transplant recipients. Despite a
high frequency of premature births, over 80% of pregnancies result in surviving
infants. N. Ref:: 38
----------------------------------------------------
[120]
TÍTULO / TITLE: - Renal transplantation
and polyomavirus infection: recent clinical facts and controversies.
REVISTA
/ JOURNAL: - Transpl Infect Dis 2003 Jun;5(2):65-71.
AUTORES
/ AUTHORS: - Kazory A; Ducloux D
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Renal
Transplantation, Saint-Jacques Hospital, 25000 Besancon, France. akazory@chu-besancon.fr
RESUMEN
/ SUMMARY: - Although many articles have been published
on polyomavirus-induced pathologies in transplant recipients, our knowledge
regarding their clinical aspects remains relatively limited. In fact, the
number of questions and controversies on the subject seems even to be
increasing as new publications continue to appear. This article presents some
of these controversies through a brief review of recent clinical facts about
the three polyomaviruses that infect humans—JC virus, simian virus 40, and BK
virus—as they relate to renal transplantation.
N. Ref:: 88
----------------------------------------------------
[121]
TÍTULO / TITLE: - On the horizon:
tailor-made immunosuppression in renal transplantation.
REVISTA
/ JOURNAL: - Nephron Clin Pract 2003;94(1):c5-10.
●●
Enlace al texto completo (gratuito o de pago) 1159/000070818
AUTORES
/ AUTHORS: - Warrens AN
INSTITUCIÓN
/ INSTITUTION: - Faculty of Medicine, Imperial College
London, Hammersmith Campus, London, UK. a.warrens@ic.ac.uk
RESUMEN
/ SUMMARY: - Immunosuppression for renal
transplantation has undergone more changes over the last 8 years than at any
other time in its history. It is now possible to be more selective in the
matching of drugs with a given patient. This brings with it the option of
improving graft outcome and also minimizing adverse effects. It is an ongoing
process that will utilize agents working at different points in the activation
cascade of the CD4+ ‘helper’ T lymphocyte. It may also be possible to
manipulate the immune system such that the organ-specific immune response may
be switched off, or rendered ‘tolerant’, thus removing the need for any
immunosuppressive drugs. In this brief review, we shall address each of these
approaches and discuss other therapeutic avenues being investigated. N. Ref:: 13
----------------------------------------------------
[122]
TÍTULO / TITLE: - Cat scratch disease and
acute rejection after pediatric renal transplantation.
REVISTA
/ JOURNAL: - Pediatr Transplant 2002 Aug;6(4):327-31.
AUTORES
/ AUTHORS: - Dharnidharka VR; Richard GA; Neiberger RE;
Fennell RS 3rd
INSTITUCIÓN
/ INSTITUTION: - The Division of Pediatric Nephrology,
Shands Children’s Hospital and University of Florida College of Medicine,
Gainesville, Florida 32610, USA. vikasmd@ufl.edu
RESUMEN
/ SUMMARY: - Cat scratch disease (CSD) can lead to
unexplained fever, generalized lymphadenopathy and organomegaly in immunocompetent
individuals. CSD has rarely been reported in immunocompromised transplant
recipients, where its clinical features would mimic the more common
post-transplant lymphoproliferative disease (PTLD). We report three cases of
CSD seen recently in children who had received prior kidney transplants. The
three children were between 7 and 9 yr old, and had received kidney transplants
2-4 yr prior, with stable renal function. In each case, there was unexplained
fever with either lymphadenopathy or organomegaly. The diagnosis of CSD was
suggested by a history of new cats being introduced into each household and
confirmed in all cases by the serological presence of a significant titer (>
1 : 64) of IgM antibodies to Bartonella henselae. Tests for other bacterial
infections, cytomegalovirus and Epstein-Barr virus infections were negative.
All the patients showed a clinical improvement with anti-microbial therapy. In
patients A and B, the CSD was associated with an acute rejection episode
shortly after diagnosis. The rejection episodes were reversed by intravenous
steroid pulse therapy. Only four cases of CSD have been previously reported
following solid organ transplantation. Acute rejection following CSD has not
been previously reported. CSD should be included in the differential diagnosis
of fever in the post-transplant setting, especially where PTLD is
suspected. N. Ref:: 12
----------------------------------------------------
[123]
TÍTULO / TITLE: - Sirolimus: a
comprehensive review.
REVISTA
/ JOURNAL: - Expert Opin Pharmacother 2001
Nov;2(11):1903-17.
AUTORES
/ AUTHORS: - Kahan BD
INSTITUCIÓN
/ INSTITUTION: - Division of Immunology and Organ
Transplantation, University of Texas-Houston, 6431 Fannin, Suite 6.240,
Houston, TX 77030, USA. barry.d.kahan@uth.tmc.edu
RESUMEN
/ SUMMARY: - Sirolimus (Rapamune), Wyeth-Ayerst,
Madison, NJ) is a new, potent, immunosuppressant that is emerging as a
foundation for long-term immunosuppressive therapy in renal transplantation.
The drug acts during both co-stimulatory activation and cytokine-driven
pathways via a unique mechanism: inhibition of a multifunctional
serine-threonine kinase, mammalian target of rapamycin (mTOR). Although there
is no a priori reason to assume it, sirolimus displays a synergistic
interaction to enhance the efficacy of cyclosporin A (CsA). In trials wherein
the concentrations of CsA and sirolimus were tightly controlled, rates of acute
rejection episodes were < 10%, despite markedly reduced exposures to each
agent. In pivotal multi-centre blinded dose-controlled trials, the rates of
acute rejection episodes within 12 months following administration of 2 or 5
mg/day sirolimus in combination with CsA and steroids were reduced to 19 and
14%, respectively. Since the inhibitory effect of sirolimus disables virtually
all responses to cytokine mediators due to the widespread involvement of mTOR
in multiple signalling pathways, the agent is likely also to retard
proliferation of endothelial and vascular smooth muscle cells, an important
component of the immuno-obliterative processes associated with chronic
rejection. The advantages of this unique therapeutic action combined with an
intrinsic lack of nephrotoxicity are counterbalanced by myelosuppressive and
hyperlipidaemic side effects. Ongoing studies are assessing whether the
long-term benefits of sirolimus to permit reduction in exposure to or
elimination of calcineurin inhibitors ameliorate the progression of chronic
nephropathy, the condition that erodes long-term renal transplant
survival. N. Ref:: 108
----------------------------------------------------
[124]
TÍTULO / TITLE: - New developments in
immunosuppressive therapy in renal transplantation.
REVISTA
/ JOURNAL: - Expert Opin Biol Ther 2002 Jun;2(5):483-501.
AUTORES
/ AUTHORS: - Gourishankar S; Turner P; Halloran P
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and Immunology,
University of Alberta, Edmonton, Canada. gsita@hotmail.com
RESUMEN
/ SUMMARY: - The introduction of new immunosuppressive
agents and protocols has improved outcomes for renal transplant recipients by
decreasing the risk of rejection and by increasing the function and lifespan of
the allograft. This article reviews the major changes in the combinations of
therapies used: calcineurin inhibitors, target of rapamycin inhibitors,
mycophenolate mofetil, non-depleting monoclonal versus depleting monoclonal and
polyclonal antibodies for induction and increasing emphasis on protocols for
reduction or avoidance of steroids and calcineurin inhibitors. The new agents
with novel immunological targets such as anti-CD40 ligand, LEA29Y, FTY720,
anti-CD20 (rituximab, Rituxan, Mabthera) and anti-CH52 (alemtuzumab, Campath),
which are under development but have yet to survive the rigors of clinical
trials are also discussed. In the presence of low early rejection rates,
immunosuppressive therapy is setting new goals such as better graft function
(glomerular filtration rates), reduction in adverse effects such as
hypertension, hyperlipidaemia and drug toxicity and, above all, the prevention
of late graft deterioration. N.
Ref:: 156
----------------------------------------------------
[125]
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
----------------------------------------------------
[126]
TÍTULO / TITLE: - Use of sirolimus in
kidney transplantation.
REVISTA
/ JOURNAL: - Prog Transplant 2001 Mar;11(1):29-32.
AUTORES
/ AUTHORS: - Podbielski J; Schoenberg L
INSTITUCIÓN
/ INSTITUTION: - University of Texas Medical School at
Houston, Houston, Tex., USA.
RESUMEN
/ SUMMARY: - Sirolimus, which has a distinctive
mechanism of action that inhibits cytokine-driven cell proliferation and
maturation, provides an exciting addition to the immunosuppressive regimen for
organ transplantation. A significant decrease in the number and severity of
rejection episodes has been noted when sirolimus is used; it also offers the
potential for patients to be withdrawn from steroids, making kidney
transplantation an option for many more potential recipients. Toxic conditions
such as hyperlipidemia, thrombocytopenia, and leukopenia become transient and
manageable with reduction of the sirolimus dose and/or countermeasure
therapy. N. Ref:: 9
----------------------------------------------------
[127]
TÍTULO / TITLE: - Management of hepatitis
B and C in renal failure and renal transplant recipients.
REVISTA
/ JOURNAL: - Trop Gastroenterol 2002
Apr-Jun;23(2):49-53.
AUTORES
/ AUTHORS: - Amarapurkar D; Das HS
INSTITUCIÓN
/ INSTITUTION: - Department of Gastroenterology and
Hepatology, Bombay Hospital And Medical Research Center, Mumbai. deepakn@bom3.vsnl.net.in N. Ref:: 79
----------------------------------------------------
[128]
TÍTULO / TITLE: - Renal senescence,
cellular senescence, and their relevance to nephrology and transplantation.
REVISTA
/ JOURNAL: - Adv Nephrol Necker Hosp 2001;31:273-83.
AUTORES
/ AUTHORS: - Halloran PF; Melk A
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology and Immunology,
University of Alberta, Edmonton, Canada.
N. Ref:: 27
----------------------------------------------------
[129]
TÍTULO / TITLE: - Varicella vaccination
in pediatric kidney transplant candidates.
REVISTA
/ JOURNAL: - Pediatr Transplant 2002 Apr;6(2):97-100.
AUTORES
/ AUTHORS: - Furth SL; Fivush BA
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, the Welch Center
for Prevention, Epidemiology and Clinical Research, The Johns Hopkins Medical
Institutions, Baltimore, Maryland, USA. sfurth@jhmi.edu
RESUMEN
/ SUMMARY: - Existing studies support the use of
varicella vaccine in a two-dose regimen in patients with renal disease prior to
transplantation. Levels of anti-varicella zoster virus antibody should be
monitored on a regular basis after immunization, and where a loss of a
previously protective antibody titer occurs, a third booster dose should be
considered pretransplant. Further data need to be collected regarding the use
of the vaccine in seronegative patients who have already undergone
transplantation. N.
Ref:: 22
----------------------------------------------------
[130]
TÍTULO / TITLE: - Tailoring
immunosuppressive therapy for renal transplant recipients.
REVISTA
/ JOURNAL: - Pediatr Transplant 2001 Dec;5(6):467-72.
AUTORES
/ AUTHORS: - Vanrenterghem YF
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, University
Hospital Gasthuisberg, Leuven, Belgium. yves.vanrenterghem@uz.kuleuven.ac.be
RESUMEN
/ SUMMARY: - During the past decade several new potent
immunosuppressive agents with different modes of action and different
side-effect profiles have become available. Nowadays immunosuppression after
renal transplantation is no longer one single regimen applicable to all
patients. In the selection of the optimal immunosuppressive protocol,
individual drug-related toxicity, recipient-related risk factors as well as
donor organ characteristics have to be taken into account. This article will
give an overview of the most recently developed immunosuppressive agents
available for clinical use. Their individual mode of action and their different
efficacy and safety profile will be described as basis for selection of each of
these drugs in an attempt to tailor the optimal therapeutic regimen for the
individual patient both in terms of short-term and long-term outcome. N. Ref:: 34
----------------------------------------------------
[131]
TÍTULO / TITLE: - Hypertensinogenic
mechanism of the calcineurin inhibitors.
REVISTA
/ JOURNAL: - Curr Hypertens Rep 2002 Oct;4(5):377-80.
AUTORES
/ AUTHORS: - Curtis JJ
INSTITUCIÓN
/ INSTITUTION: - University of Alabama at Birmingham,
Division of Nephrology, 35294-0006, USA. jcurtis@nrtc.uab.edu
RESUMEN
/ SUMMARY: - Kidney transplantation has seen a
remarkable improvement in allograft survival rates and patient survival rates,
and an equally remarkable reduction in acute rejection rates. Most attribute
these changes to the introduction and widespread use of calcineurin inhibitors
as part of the standard immunosuppressive regimen. Cyclosporine and tacrolimus
are ideal immunosuppressive agents, much more effective and safe than the
previous agents used. Especially ironic, however, for those caring for kidney
transplant patients has been the finding that these breakthrough agents are
toxic to the kidney and can cause hypertension. We can protect the transplanted
kidney from rejection, but still damage it paradoxically by the protecting
agent. Moreover, the prevalence of hypertension in transplant clinics has
increased (from 40%-50% to up to 90%-100%) as these newer agents have gained
widespread use. We remain uncertain of the mechanism whereby these agents cause
hypertension, and therefore remain uncertain of the ideal treatment; however,
the search for a mechanism has taken us from the organ level to intracellular
effects of the agents. The fact that both agents cause nephrotoxicity suggests
that a renal mechanism is at the heart of the hypertension. N. Ref:: 31
----------------------------------------------------
[132]
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
----------------------------------------------------
[133]
TÍTULO / TITLE: - Pediatric kidney transplantation:
growth, development, and nursing implications.
REVISTA
/ JOURNAL: - Prog Transplant 2002 Jun;12(2):129-35.
AUTORES
/ AUTHORS: - Pool R; Korus M
INSTITUCIÓN
/ INSTITUTION: - Hospital for Sick Children, Toronto,
Ontario.
RESUMEN
/ SUMMARY: - The complex issues related to the growth
and development of pediatric kidney transplant recipients are explored in this
paper. We divide the pediatric population into 3 age groups—toddlers and
preschoolers, school age children, and adolescents—and review the literature
describing growth and development in kidney transplant recipients and the
normal population briefly for each age group. Planning and delivery of nursing
care that is based on the implications of growth and development are discussed,
and have relevance for all allied healthcare professionals caring for pediatric
kidney transplant recipients and their parents. Allied healthcare professionals
in adult settings who provide care to recipients who received a transplant
before the age of 18 may also benefit from reviewing this article. N. Ref:: 31
----------------------------------------------------
[134]
TÍTULO / TITLE: - Eleven years
intraoperative ATG bolus. A list of successes.
REVISTA
/ JOURNAL: - Ann Transplant 2002;7(3):4-10.
AUTORES
/ AUTHORS: - Kaden J
INSTITUCIÓN
/ INSTITUTION: - Friedrichshain Hospital, Berlin, Germany.
RESUMEN
/ SUMMARY: - Induction therapy for organ
transplantation using monoclonal antibodies has been in recent years
reevaluated. Results from various centers indicate the value of such therapy,
especially in sensitized patients undergoing kidney transplantation as well as
in simultaneous kidney—pancreas transplant patients. Author presents the
experience of eleven years of intraoperative ATG bolus administration in the
Berlin—Friedrichshain Kidney Transplantation Center. N. Ref:: 43
----------------------------------------------------
[135]
TÍTULO / TITLE: - Crossmatch tests—an
analysis of UNOS data from 1991-2000.
REVISTA
/ JOURNAL: - Clin Transpl 2001;:237-46.
AUTORES
/ AUTHORS: - Cho YW; Cecka JM
RESUMEN
/ SUMMARY: - Based on more than 20,000 cadaver donor
transplants reported to UNOS between 1991-2000 with crossmatch results, the
following observations were made: 1. One-hundred sixty-nine transplants performed
despite a positive T-cell NIH crossmatch (usually with an historical serum
sample) were reported to UNOS and had 5%, 6%, 7%, and 11% lower graft survival
at one, 6, 12, and 24 months after transplantation compared with negative
crossmatch transplants, respectively. 2. Transplants with a positive T-cell
FCXM (n = 714) yielded 4%, 7%, and 9% lower graft survival at one, 6, and 12
months after transplantation compared with negative crossmatch transplants,
respectively. 3. Transplants with a positive B-cell crossmatch using NIH, Wash,
AHG or flow cytometry XM yielded statistically significantly lower (4-6%) graft
survival rates compared with B-cell negative crossmatch transplants. 4. The
differences in graft survival rates comparing recipients with a positive versus
a negative T-cell crossmatch test (NIH, AHG, and FCXM) were significant in
univariate analyses; however, only the NIH and FCXM showed a significant effect
on graft survival after adjustment of other factors in a multivariate analysis.
5. Regrafted patients with a positive T- and B-cell FCXM experienced a higher
incidence of primary nonfunction (12%) compared with those who had a negative
T- and B-cell FCXM (1%; P < 0.001). Flow cytometric or ELISA screening of
patient sera in addition to conventional cytotoxic crossmatch tests can provide
additional information to aid in the final decision of renal transplantation.
----------------------------------------------------
[136]
TÍTULO / TITLE: - Sensitization 2001.
REVISTA
/ JOURNAL: - Clin Transpl 2001;:271-8.
AUTORES
/ AUTHORS: - Hardy S; Lee SH; Terasaki PI
INSTITUCIÓN
/ INSTITUTION: - Terasaki Foundation Laboratory, Los
Angeles, California, USA.
RESUMEN
/ SUMMARY: - 1. The rate of transfusion decreased from
64% in 1992 to 36% in 2000. This need for transfusions continued despite the
introduction of erythropoetin. Females were transfused more frequently than
males. SLE patients were transfused more often than those with other diseases.
2. Transfusions no longer had a beneficial effect on the outcome of
transplantation, but rather with more transfusions, the graft outcome became
lower, as might be expected. 3. Rejection of a kidney transplant had the
strongest effect on sensitization, followed by transfusion and then
pregnancies. Females were more susceptible to sensitization than males.
Although non-transfused males should not have been sensitized, as many as 13%
were reported to have antibodies. As many as 20% of nulliparous females without
transfusions also were reported to have antibodies. 4. SLE patients were most
often sensitized among patients with various diseases. Females of all diseases
were more sensitized than males. 5. Unsensitized regraft patients had a 3%
lower 3-year graft survival than unsensitized first graft patients. Among
sensitized patients, regraft patients had a 4% lower graft survival than
sensitized first graft patients. 6. Patients with polycystic kidney disease had
the highest 3-year graft survival in both the sensitized and non-sensitized
patients. Sensitization to a PRA level of less than 50% was not detrimental to
patients with all the various diseases. 7. For cadaver donor regraft patients,
HLA-DR mismatch had a greater effect than AB mismatch. There was a 10
percentage point lower 3-year graft survival in cadaver donor regraft patients
mismatched for 2 DR antigens than mismatched for 0 DR antigens. 8. For living
donor transplants, regrafts from 0 AB or 0 DR mismatched transplants had the
same graft survival as first transplants.
----------------------------------------------------
[137]
TÍTULO / TITLE: - BK virus infection in
renal transplant recipients.
REVISTA
/ JOURNAL: - Pediatr Transplant 2001 Dec;5(6):398-405.
AUTORES
/ AUTHORS: - Lin PL; Vats AN; Green M
INSTITUCIÓN
/ INSTITUTION: - Departments of Pediatrics and Surgery,
Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh,
Pennsylvania 15213-2583, USA.
RESUMEN
/ SUMMARY: - BK virus (BKV) is increasingly being
recognized as an important pathogen among renal transplant recipients. To date,
only limited information is known about BKV infections in this population;
definitive data regarding the epidemiology, diagnosis, treatment, and outcome
of BKV infection are lacking. Therefore, further investigations are needed.
This article reviews our current understanding of BKV infections among renal
transplant patients. N.
Ref:: 43
----------------------------------------------------
[138]
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
----------------------------------------------------
[139]
TÍTULO / TITLE: - An update in transplant
immunosuppressive therapy.
REVISTA
/ JOURNAL: - Med Health R I 2002 Apr;85(4):131-3.
AUTORES
/ AUTHORS: - Thursby MA; Yango AF; Gohh RY
INSTITUCIÓN
/ INSTITUTION: - Rhode Island Hospital, Division of Renal
Diseases, 593 Eddy Street, Providence, RI 02903, USA. Mthursby@lifespan.org N. Ref:: 10
----------------------------------------------------
[140]
TÍTULO / TITLE: - Infections in the
transplant recipient.
REVISTA
/ JOURNAL: - Med Health R I 2002 Apr;85(4):125-7.
AUTORES
/ AUTHORS: - Fischer SA
INSTITUCIÓN
/ INSTITUTION: - Division of Infectious Diseases, Brown
Medical School, Providence, RI, USA. Sfischer@Lifespan.org N. Ref:: 22
----------------------------------------------------
[141]
TÍTULO / TITLE: - Herbal medicine and the
transplant patient.
REVISTA
/ JOURNAL: - Nephrol Nurs J 2002 Jun;29(3):269-74.
AUTORES
/ AUTHORS: - Allen D; Bell J
INSTITUCIÓN
/ INSTITUTION: - University Medical Center, Tucson, AZ,
USA.
RESUMEN
/ SUMMARY: - There has been a striking increase in
Americans’ awareness and use of herbal therapies over the past decade. Hundreds
of herbal products and homeopathic remedies are available to the consumer, but
most of these have not proved to be safe or effective. Moreover, the current
lax regulatory environment gives manufactures greater leeway in selling their
products. Scientists and researchers are studying how some herbs work, while
the complicated puzzle is how herbs interact with prescription drugs. The
importance of unrecognized interactions between herbs and immunosuppressants is
particularly relevant in the transplant recipient as serious consequences have
occurred. Transplant coordinators must become familiar with basic information
about herbs to carry out thorough assessments and educate patients about
harmful aspects. N.
Ref:: 17
----------------------------------------------------
[142]
TÍTULO / TITLE: - Update in
immunosuppression.
REVISTA
/ JOURNAL: - Nephrol Nurs J 2002 Jun;29(3):261-7.
AUTORES
/ AUTHORS: - Huizinga R
INSTITUCIÓN
/ INSTITUTION: - University of Alberta Hospital, Edmonton,
Alberta, Canada.
RESUMEN
/ SUMMARY: - This article briefly reviews the current
status of renal transplantation and the current focus of immunosuppression in
the prevention of chronic rejection. Four paradigms involved in the
understanding of the immune system and their role in rejection are discussed.
The paradigms are co-stimulation, quantifying immunosuppression, changing the
direction of lymphocytes, and inhibition of antibody. Examples of each of these
paradigms are given. N.
Ref:: 30
----------------------------------------------------
[143]
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
----------------------------------------------------