#12#
Revisiones-Ciencias
Básicas-Fisiología *** Reviews-Basic Sciences-Physiology
TRASPLANTE
RENAL *** RENAL TRANSPLANTATION
(Conceptos
/ Keywords: Renal-Kidney transplantation; Kidney donation-procurement; etc).
Enero /
January 2001 --- Marzo / March 2004
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[1]
TÍTULO / TITLE: - Interleukin-2 receptor
monoclonal antibodies in renal transplantation: meta-analysis of randomised
trials.
REVISTA
/ JOURNAL: - British Medical J (BMJ). Acceso gratuito
al texto completo.
●●
Enlace a la Editora de la Revista http://bmj.com/search.dtl
●●
Cita: British Medical J. (BMJ): <> 2003 Apr 12;326(7393):789.
●●
Enlace al texto completo (gratuito o de pago) 1136/bmj.326.7393.789
AUTORES
/ AUTHORS: - Adu D; Cockwell P; Ives NJ; Shaw J;
Wheatley K
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Queen Elizabeth
Hospital, Birmingham, B15 2TH. dwomoa.adu@uhb.nhs.uk
RESUMEN
/ SUMMARY: - OBJECTIVE: To study the effect of
interleukin-2 receptor monoclonal antibodies on acute rejection episodes, graft
loss, deaths, and rate of infection and malignancy in patients with renal
transplants. DESIGN: Meta-analysis of published data. DATA SOURCES: Medline,
Embase, and Cochrane library for years 1996-2003 plus search of medical
editors’ trial amnesty and contact with manufacturers of the antibodies.
SELECTION OF STUDIES: Randomised controlled trials comparing interleukin-2
receptor antibodies with placebo or no additional treatment in patients with
renal transplants receiving ciclosporin based immunosuppression. RESULTS: Eight
randomised controlled trials involving 1871 patients met the selection criteria
(although only 1858 patients were analysed). Interleukin-2 receptor antibodies
significantly reduced the risk of acute rejection (odds ratio 0.51, 95%
confidence interval 0.42 to 0.63). There were no significant differences in the
rate of graft loss (0.78, 0.58 to 1.04), mortality (0.75, 0.46 to 1.23),
overall incidence of infections (0.97, 0.77 to 1.24), incidence of
cytomegalovirus infections (0.81, 0.62 to 1.04), or risk of malignancies at one
year (0.82, 0.39 to 1.70). The different antibodies had a similar sized effect
on acute rejection (test for heterogeneity P=0.7): anti-Tac (0.37, 0.16 to
0.89), BT563 (0.37, 0.1 to 1.38), basiliximab (0.56, 0.44 to 0.72), and
daclizumab (0.46, 0.32 to 0.67). The reduction in acute rejections was similar
for all ciclosporin based immunosuppression regimens (test for heterogeneity
P=1.0). CONCLUSIONS: Adding interleukin-2 receptor antibodies to ciclosporin
based immunosuppression reduces episodes of acute rejection at six months by
49%. There is no evidence of an increased risk of infective complications.
Longer follow up studies are needed to confirm whether interleukin-2 receptor
antibodies improve long term graft and patient survival.
----------------------------------------------------
[2]
TÍTULO / TITLE: - Prognostic value of
myocardial perfusion studies in patients with end-stage renal disease assessed
for kidney or kidney-pancreas transplantation: a meta-analysis.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Feb;14(2):431-9.
AUTORES
/ AUTHORS: - Rabbat CG; Treleaven DJ; Russell JD;
Ludwin D; Cook DJ
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of
Nephrology, McMaster University, Hamilton, Ontario, Canada. rabbatc@mcmaster.ca
RESUMEN
/ SUMMARY: - The prognostic utility of myocardial perfusion
studies (MPS) such as thallium scintigraphy and dobutamine stress
echocardiography (DSE) for stratifying cardiac risk among candidates for kidney
or kidney-pancreas transplantation is uncertain. This study is a meta-analysis
to determine the prognostic significance of MPS results on future myocardial
infarction (MI) and cardiac death (CD) in patients with end-stage renal disease
(ESRD) assessed for kidney or kidney-pancreas transplantation. MEDLINE was
searched using combinations of MeSH headings and text words for
transplantation, coronary artery disease, prognosis, end-stage renal disease,
and noninvasive cardiac testing (nuclear scintigraphy and DSE) for primary
studies. Studies were included if they reported MPS results and cardiac events
in patients assessed for kidney or kidney-pancreas transplantation.
Methodologic study quality and outcome data were independently abstracted in
duplicate by two researchers. The relative risks (RR) of MI and CD were
calculated using a random effects model. Twelve articles met all inclusion
criteria; 12 studies reported CD, and 9 reported MI. In eight studies, thallium
scintigraphy was used (four with pharmacologic stress, four with exercise
stress), whereas four used DSE. When compared with negative tests, positive tests
had a significantly increased RR of MI (2.73 [95% CI, 1.25 to 5.97]; P = 0.01)
and CD (2.92 [95% CI, 1.66 to 5.12]; P < 0.001). Subgroup analyses of
studies of diabetic patients indicated that positive tests were associated with
a RR of CD 3.95 (95% CI, 1.48 to 10.5; P = 0.006) and a RR of MI 2.68 (95% CI,
0.95 to 7.57; P = 0.06) when compared with negative tests. In studies
evaluating mixed populations of diabetic and nondiabetic patients, positive
tests were associated with a RR of CD 2.52 (95% CI, 1.25 to 5.08; P = 0.01) and
with a RR of MI 2.79 (95% CI, 0.85 to 9.21; P = 0.09) when compared with a
negative test. The presence of reversible defects was associated with an
increased risk of MI in diabetic patients and of CD in both subgroups; fixed defects
were associated with an increased risk of CD but not MI. It is concluded that
positive MPS are useful in identifying patients with significantly increased
risk of future MI and CD in both diabetic and nondiabetic ESRD patients.
----------------------------------------------------
[3]
TÍTULO / TITLE: - Interleukin 2 receptor
antagonists for renal transplant recipients: a meta-analysis of randomized
trials.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):166-76.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000109643.32659.C4
AUTORES
/ AUTHORS: - Webster AC; Playford EG; Higgins G;
Chapman JR; Craig JC
INSTITUCIÓN
/ INSTITUTION: - Cochrane Renal Group, Centre for Kidney
Research, Children’s Hospital at Westmead, Westmead, NSW, Australia.
RESUMEN
/ SUMMARY: - BACKGROUND: Interleukin 2 receptor
antagonists (IL-2Ra) are increasingly used to treat renal transplant
recipients. This study aims to systematically identify and summarize the
effects of using IL-2Ra as induction immunosuppression, as an addition to
standard therapy, or as an alternative to other antibody therapy. METHODS:
Databases, reference lists, and abstracts of conference proceedings were
searched extensively to identify relevant randomized controlled trials in all
languages. Data were synthesized using the random effects model. Results are
expressed as relative risk (RR), with 95% confidence intervals (CI). RESULTS: A
total of 117 reports from 38 trials involving 4,893 participants were included.
When IL-2Ra were compared with placebo (17 trials; 2,786 patients), graft loss
was not significantly different at 1 year (14 trials: RR 0.84; CI 0.64-1.10) or
3 years (4 trials: RR 1.08; CI 0.71-1.64). Acute rejection was significantly
reduced at 6 months (12 trials: RR 0.66; CI 0.59-0.74) and at 1 year (10
trials: RR 0.67; CI 0.60-0.75). At 1 year, cytomegalovirus infection (7 trials:
RR 0.82; CI 0.65-1.03) and malignancy (9 trials: RR 0.67; CI 0.33-1.36) were
not significantly different. When IL-2Ra were compared with other antibody
therapy, no significant differences in treatment effects were demonstrated, but
IL-2Ra had significantly fewer side effects. CONCLUSIONS: Given a 40% risk of
rejection, seven patients would need treatment with IL-2Ra in addition to
standard therapy, to prevent one patient from undergoing rejection, with no
definite improvement in graft or patient survival. There is no apparent
difference between basiliximab and daclizumab.
----------------------------------------------------
[4]
TÍTULO / TITLE: - A randomized long-term
trial of tacrolimus/sirolimus versus tacrolimus/mycophenolate mofetil versus
cyclosporine (NEORAL)/sirolimus in renal transplantation. II. Survival,
function, and protocol compliance at 1 year.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):252-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000101495.22734.07
AUTORES
/ AUTHORS: - Ciancio G; Burke GW; Gaynor JJ; Mattiazzi
A; Roth D; Kupin W; Nicolas M; Ruiz P; Rosen A; Miller J
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, University of Miami School of Medicine, Miami, FL 33101, USA. gciancio@med.miami.edu
RESUMEN
/ SUMMARY: - BACKGROUND: In an attempt to reduce
chronic calcineurin inhibitor induced allograft nephropathy in first cadaver
and human leukocyte antigen non-identical living-donor renal transplantation,
sirolimus (Siro) or mycophenolate mofetil (MMF) was tested as adjunctive
therapy, with planned dose reductions of tacrolimus (Tacro) over the first year
postoperatively. Adjunctive Siro therapy with a similar dose reduction
algorithm for Neoral (Neo) was included for comparison. METHODS: The detailed
dose reduction plan (Tacro and Siro, group A; Tacro and MMF, group B; Neo and
Siro, group C) is described in our companion report in this issue of
Transplantation. The present report documents function, patient and graft
survival, protocol compliance, and adverse events. RESULTS: As mentioned (in
companion report), group demographics were similar. The present study shows no
significant differences in 1-year patient and graft survival but does show a
trend that points to more difficulties in group C by way of a rising slope of
serum creatinine concentration (P=0.02) and decreasing creatinine clearance
(P=0.04). There were more patients who discontinued the protocol plan in group
C. Thus far, no posttransplant lymphomas have appeared, and infectious
complications have not differed among the groups. However, a greater percentage
of patients in group C were placed on antihyperlipidemia therapy, with an
(unexpected) trend toward a higher incidence of posttransplant diabetes
mellitus in this group. Group A required fewer, and group B the fewest,
antihyperlipidemia therapeutic interventions (P<0.00001). CONCLUSIONS: This
1-year interim analysis of a long-term, prospective, randomized
renal-transplant study indicates that decreasing maintenance dosage of Tacro
with adjunctive Siro or MMF appears to point to improved long-term function,
with reasonably few adverse events.
----------------------------------------------------
[5]
TÍTULO / TITLE: - Routes to allograft
survival.
REVISTA
/ JOURNAL: - J Clin Invest. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jci.org/
●●
Cita: J Clinical Investigation: <> 2001 Apr;107(7):797-8.
AUTORES
/ AUTHORS: - Bromberg JS; Murphy B
INSTITUCIÓN
/ INSTITUTION: - Recanati/Miller Transplant Institute,
Mount Sinai School of Medicine, New York, New York 10029, USA. jon.bromberg@mountsinai.org N. Ref:: 21
----------------------------------------------------
[6]
TÍTULO / TITLE: - 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
----------------------------------------------------
[7]
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
----------------------------------------------------
[8]
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
----------------------------------------------------
[9]
TÍTULO / TITLE: - Renal transplantation:
can we reduce calcineurin inhibitor/stop steroids? Evidence based on protocol
biopsy findings.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003 Mar;14(3):755-66.
AUTORES
/ AUTHORS: - Gotti E; Perico N; Perna A; Gaspari F;
Cattaneo D; Caruso R; Ferrari S; Stucchi N; Marchetti G; Abbate M; Remuzzi G
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine and
Transplantation, Ospedali Riuniti di Bergamo, Mario Negri Institute for
Pharmacological Research, Italy.
RESUMEN
/ SUMMARY: - How to combine antirejection drugs and
which is the optimal dose of steroids and calcineurin inhibitors beyond the
first year after kidney transplantation to maintain adequate immunosuppression
without major side effects are far from clear. Kidney transplant patients on
steroid, cyclosporine (CsA), and azathioprine were randomized to per-protocol
biopsy (n = 30) or no-biopsy (n = 29) 1 to 2 yr posttransplant. Steroid or CsA
were discontinued or reduced on the basis of biopsy to establish effects on
drug-related complications, acute rejection, and graft function over 3 yr of
follow-up. Serum creatinine, GFR (plasma clearance of iohexol), RPF (renal
clearance of p-aminohippurate), CsA pharmacokinetics, and adverse events were
monitored yearly. At the end, patients underwent a second biopsy. Per-protocol
biopsy histology revealed no lesions (n = 5, steroid withdrawal), CsA
nephropathy (n = 13, CsA discontinuation/reduction), or chronic rejection (n =
12, standard therapy). Reducing the drug regimen led to overall fewer side
effects related to immunosuppression as compared with standard therapy or
no-biopsy. Steroids were safely stopped with no acute rejection or graft loss.
Complete CsA discontinuation was associated with acute rejection in the first
four patients. Lowering CsA to low target CsA trough (30 to 70 ng/ml) never led
to acute rejection or major renal function deterioration. Biopsy patients on
conventional regimen had no acute rejection, one graft loss, no significant
change in GFR, and significant RPF decline. No-biopsy controls: no acute
rejection, one graft loss, significant decline of GFR and RPF. By serial biopsy
analysis, severe lesions did not develop in patients with steroid
discontinuation in contrast to patients on standard therapy over follow-up. CsA
reduction did not adversely affect histology. Per-protocol biopsy more than 1
yr after kidney transplantation is a safe procedure to guide change of drug
regimen and to lower the risk of major side effects.
----------------------------------------------------
[10]
TÍTULO / TITLE: - 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
----------------------------------------------------
[11]
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
----------------------------------------------------
[12]
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
----------------------------------------------------
[13]
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
----------------------------------------------------
[14]
TÍTULO / TITLE: - Renal function as a
predictor of long-term graft survival in renal transplant patients.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 May;18 Suppl 1:i3-6.
AUTORES
/ AUTHORS: - First MR
INSTITUCIÓN
/ INSTITUTION: - Research and Development, Fujisawa
Healthcare, Inc., Deerfield, IL 60015, USA. roy_first@fujisawa.com
RESUMEN
/ SUMMARY: - Acute rejection is a major risk factor for
kidney graft failure. However, as acute rejection has been progressively
reduced by recent immunosuppressive regimens, other risk factors are becoming
increasingly important. Evidence is accumulating that early renal function
predicts long-term outcome. A recent registry survey of more than 100 000 kidney
transplants found that 6- and 12-month serum creatinine levels, as well as the
change between 6 and 12 months, are strongly associated with long-term graft
survival. A survey of paediatric renal transplant recipients showed that poor
creatinine clearance (<50 ml/min) as early as 30 days post-transplant
predicted an annual rate of graft loss of 13% compared with <3% in patients
with 30-day clearance >50 ml/min. This association between early renal
function and long-term outcome was confirmed in multicentre studies. Renal
transplant recipients (n=572) with 6-month serum creatinine levels >1.5
mg/dl suffered 3-year graft loss of 19.3% compared with only 8.5% in patients
with levels <1.6 mg/dl (P<0.001). Significantly fewer patients receiving
tacrolimus had 12-month serum creatinine levels >1.5 mg/dl compared with
cyclosporin (42 versus 54%, P<0.05). Interestingly, a single-centre study
(n=436) found that while glomerular filtration rate (GFR) at 6 months
post-transplant had remained stable over the last decade, the rate of loss of
renal function had decreased. A lower rate of GFR loss was associated with
absence of rejection, use of mycophenolate mofetil rather than azathioprine and
use of tacrolimus rather than cyclosporin (P<0.01). In conclusion, early measures
of renal function allow identification of those patients at highest risk of
graft failure and provide an invaluable tool for improving outcomes by tailored
immunosuppression. The choice of such immunosuppression should be guided not
only by its ability to prevent rejection, but also by its impact on renal
function. N. Ref:: 11
----------------------------------------------------
[15]
TÍTULO / TITLE: - Postmenopausal
tubo-ovarian abscess due to Pseudomonas aeruginosa in a renal transplant
patient: a case report and review of the literature.
REVISTA
/ JOURNAL: - Transplantation 2001 Oct 15;72(7):1241-4.
AUTORES
/ AUTHORS: - El Khoury J; Stikkelbroeck MM; Goodman A;
Rubin RH; Cosimi AB; Fishman JA
INSTITUCIÓN
/ INSTITUTION: - Infectious Disease Division, GRJ 504,
Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Pseudomonas aeruginosa is an
uncommon cause of infection in the female genital tract. We report a case of
postmenopausal tubo-ovarian abscess (TOA) due to P. aeruginosa in a renal
transplant recipient. The presentation included mild abdominal symptoms with
rapid progression of peritonitis and surgical abscess drainage. This is the
first such case in an organ transplant recipient described in the English
literature. METHODS AND RESULTS: Published reports of 1040 cases of TOA were
reviewed. The most common features were a history of sexually transmitted
disease or pelvic inflammatory disease, and symptoms including abdominal pain
and fever. Escherichia coli, Bacteroides spp., and Klebsiella pneumoniae were
the most frequently encountered pathogens. Neisseria gonorrhoeae and Chlamydia
trachomatis, which are frequently isolated from cervical cultures, are
uncommonly isolated from tubo-ovarian abscesses. Forty percent of patients were
treated with antibiotics alone, 18.8% with abdominal surgery, and 32% with
surgery and antimicrobial therapy. CONCLUSION: This report illustrates the
muted presentation and atypical microbiology of gynecologic infection in an
organ transplant recipient. N.
Ref:: 59
----------------------------------------------------
[16]
TÍTULO / TITLE: - Ambulatory blood
pressure measurement in kidney transplantation: an overview.
REVISTA
/ JOURNAL: - Transplantation 2003 Dec 15;76(11):1643-4.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000091289.03300.1A
AUTORES
/ AUTHORS: - Tomson CR
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine, Southmead
Hospital, Bristol, UK. charlie.tomson@north-bristol.swest.nhs.uk
RESUMEN
/ SUMMARY: - Adequate control of hypertension is among
the most important aims of medical management of the kidney transplant
recipient, with the aim of reducing the risk of premature cardiovascular
disease and preserving graft function. Antihypertensive therapy should be
adjusted according to the best available estimates of usual resting blood pressure.
If clinic measurements are used, care should be taken to ensure that these
measurements are taken under optimal conditions. Home blood pressure monitoring
is a useful adjunct in many patients. Ambulatory blood pressure monitoring
gives valuable additional data; mean ambulatory blood pressure correlates
better with markers of target organ damage such as left ventricular
hypertrophy. However, current treatment thresholds and targets are based on
clinic measurements. Ambulatory blood pressure monitoring is certainly a useful
adjunct to clinic and home blood pressure measurement, but its role in routine
clinical practice in the transplant clinic remains to be defined. N. Ref:: 11
----------------------------------------------------
[17]
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.
----------------------------------------------------
[18]
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
----------------------------------------------------
[19]
TÍTULO / TITLE: - Updated protocol for
the examination of specimens from patients with carcinoma of the urinary
bladder, ureter, and renal pelvis.
REVISTA
/ JOURNAL: - Arch Pathol Lab Med. Acceso gratuito al
texto completo.
●●
Enlace a la Editora de la Revista http://arpa.allenpress.com/
●●
Cita: Archives of Pathology & Laboratory Medicine: <> 2003
Oct;127(10):1263-79.
AUTORES
/ AUTHORS: - Amin MB; Srigley JR; Grignon DJ; Reuter
VE; Humphrey PA; Cohen MB; Hammond ME
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, Emory University
Hospital, Atlanta, Ga, USA.
----------------------------------------------------
[20]
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
----------------------------------------------------
[21]
- Castellano -
TÍTULO / TITLE:Aneurisma disecante de la arteria
renal en paciente trasplantado. Presentacion de un caso. Revision de la
literatura. Dissecting aneurysm of the renal artery in patient with
transplantation. Report of a case. Review of the literature.
REVISTA
/ JOURNAL: - Arch Esp Urol 2003 Nov;56(9):1059-62.
AUTORES
/ AUTHORS: - Canovas Ivorra J; Guardiola Mas A; Nicolas
Torralba JA; Jimeno Garcia L; Llorente Vinas S; Garcia Hernandez JA; Polo Perez
J; Banon Perez V
INSTITUCIÓN
/ INSTITUTION: - Servicio de Urologia, Hospital Universitario
Virgen de la Arrixaca, Murcia, España.
RESUMEN
/ SUMMARY: - OBJECTIVES: Aneurysmatic processes of the
renal artery after transplant are rare entities, generally secondary to
technical defects or infectious pictures. Among other presentations, dissecting
aneurysm are exceptional, having a particularly difficult diagnosis due to the
lack of specific clinical data which could differentiate them from other
processes such as graft rejection or acute tubular necrosis, as well as the
absence of characteristic representative images. METHODS: We report one case of
dissecting aneurysm after a kidney transplant resulting in graft loss. RESULTS:
We analyze the presentation form, diagnostic procedures, pathologic studies,
and possible therapeutic options. CONCLUSIONS: Dissecting aneurysm of the renal
artery is a rare entity of difficult diagnosis due to the poorness of
presenting symptoms and the difficulty of finding it in routine tests, being
necessary to think of it and to perform angiography as the only diagnostic
test. Treatment is carried out by hilar reconstruction or transplant
nephrectomy when the former is not possible.
N. Ref:: 10
----------------------------------------------------
[22]
TÍTULO / TITLE: - Clinicopathological
evaluation of renal allografts of four patients by 20-year protocol biopsies.
REVISTA
/ JOURNAL: - Clin Transplant 2003;17 Suppl 10:20-4.
AUTORES
/ AUTHORS: - Okamoto M; Nobori S; Higuchi A; Kadotani
Y; Ushigome H; Nakamura K; Akioka K; Omori Y; Yoshimura N
INSTITUCIÓN
/ INSTITUTION: - Department of Transplantation and
Endocrine Surgery, Kyoto Prefectural University of Medicine, Kyoto 602, Japan. amoto@koto.kpu-m.ac.jp
RESUMEN
/ SUMMARY: - Twenty-year protocol biopsies were
performed in four cases of renal transplant recipients with grafts that had
survived 20 years or more. All four recipients received transplants from their
parents, and never had episodes of acute rejection. They were maintained with
the conventional immunosuppressive protocol including azathioprine, mizoribine,
and prednisolone. Three of them had past history of malignant diseases such as
breast cancer and tongue cancer. In spite of fair graft function, the
microscopic findings of 20-year protocol biopsy showed various degrees of
histological damage; e.g. obsolescence of the glomeruli, glomerulosclerosis,
arteriole wall thickening, interstitial fibrosis and tubular atrophy. Although
two of the four grafts were functioning with low serum creatinine levels
(1.3-1.4 mg dL-1) at 24 years and 26 years following transplantation,
respectively, the function of the other two grafts had decreased more than 20
years after transplantation. In the two grafts with decreased function,
glomerulosclerosis and arteriole wall thickening tended to be more severe
(Banff classification of chronic allograft nephropathy [CAN] grade II and III)
at the 20-year protocol biopsy compared with the two well-functioning grafts
(CAN grade I and II). We conclude that the protocol biopsies even at 20 years
can contribute to predict the fate of renal allografts.
----------------------------------------------------
[23]
TÍTULO / TITLE: - Angiotensin II type 1
(AT1) receptor antagonists in the treatment of hypertension after renal
transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001;16 Suppl 1:117-20.
AUTORES
/ AUTHORS: - Holgado R; Anaya F; Del Castillo D
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Hospital Reina
Sofia, 14012 Cordoba, España.
RESUMEN
/ SUMMARY: - Hypertension is highly prevalent after
renal transplantation and has been associated with lower graft survival.
Optimum management of post-transplant hypertension remains to be defined.
Losartan, a potent, orally active and selective non-peptide blocker of the
angiotensin subtype 1 receptor, could represent a useful drug for treating
post-transplant hypertension. Recently, a prospective study of 12 weeks
treatment with losartan has showed a satisfactory control of arterial
hypertension associated with a decrease in proteinuria in this high-risk group
of renal transplant patients. A retrospective study was performed to review the
role of losartan as a renoprotective agent (evaluating blood pressure and
proteinuria) in renal transplant recipients in a long-term follow-up. A total
of 150 transplant recipients were included in the study. None of the patients
had a serum creatinine >3 mg/dl, or suspected renal artery stenosis, or
other severe concomitant diseases. The indication for losartan therapy was
hypertension, proteinuria and/or post-transplant erythrocytosis. The values of
blood pressure, results of fasting haematology, blood chemistry and total proteinuria
in 24-h urine samples were recorded at the time of initiation of losartan
therapy, 6 and 3 months before the start, and at 3, 6, 12, 18 and 24 months
thereafter. A tendency analysis by linear regression comparing two slopes
before and after treatment was realized. A decrease in mean blood pressure and
proteinuria, from 106.7+/-0.9 to 98.2+/-2.1 mmHg and from 1253.9+/-188 to
91.2+/-33.7 mg/24 h, P<0.05, respectively, was observed after introduction
of losartan. A progressive increase in creatinine clearance was observed after
the third month of losartan treatment. No significant changes were seen in
haematocrit or serum potassium levels. We can conclude that a progressive
decrease in mean arterial pressure associated with a decrease in proteinuria was
observed during long-term follow-up. Based on the capacity of losartan to
improve renal function, this drug could be decisive for the treatment and
prevention of chronic allograft nephropathy.
N. Ref:: 32
----------------------------------------------------
[24]
TÍTULO / TITLE: - Calcineurin-free
protocols with basiliximab induction allow patients included in “old to old”
programs achieve standard kidney transplant function.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Jun;35(4):1326-7.
AUTORES
/ AUTHORS: - Emparan C; Laukotter M; Wolters H; Dame C;
Heidenreich S; Senninger N
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, Uniklinikum Munster, Munster, Germany. cemparan@teleline.es
RESUMEN
/ SUMMARY: - INTRODUCTION: The EuroTransplant “old to
old” program establishes that patients older than 60 years can receive offers
of organs from donors older than 60 years. The compromised function of these
organs makes it a priority to preserve their initial kidney function.
HYPOTHESIS: Calcineurin-sparing protocols using anti-IL-2 receptor (IL-2R)
antibody induction (Simulect) may benefit initial kidney function in these
patients, as assessed by the rates of delayed graft function and of rejection
during the first month after transplant. PATIENTS AND METHODS: A cohort of 15
consecutive elderly patients were prospectively compared with 30 cadaveric
kidney transplants in younger recipients. Study patients were induced with
Simulect (20 mg, 30 minutes before reperfusion and 4 days after
transplantation) and steroids, delaying the introduction of CsA until the serum
creatinine was below 3 mg/dL. The other cohort of patients were
immunosuppressed with tacrolimus (trough 8 to 12), mycophenolats mofetil (MMF,
1 g/d), and an identical taper of steroids. The analysis compared donor and
recipient ages, mean cold ischemic time, incidence of initial kidney function
(diuresis in the first 24 h) serum creatinine levels, glomerular filtration
rate (GFR), number of dialysis sessions, and rejection rate in the two groups.
RESULTS: Except for the donor and recipient ages (72 vs 54 in donors, and 67
versus 52 years in recipients), no significant differences were observed
between the groups among the rates of acute rejection (6.6% vs 13.2%), delayed
graft function (13.2% required dialysis), or infection (6.6%). Within 1 month
all 45 grafts showed primary function with equal creatinine levels (mean 1.65).
CONCLUSIONS: Calcineurin-free protocols using IL-2 therapy as the initial
suppression allow patients in the “old to old” ET program to display equal
results to cadaveric kidney transplants with initial treatment with calcineurin
antagonists.
----------------------------------------------------
[25]
TÍTULO / TITLE: - Mycophenolate mofetil:
implications for the treatment of glomerular disease.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001 Sep;16(9):1752-6.
AUTORES
/ AUTHORS: - Badid C; Desmouliere A; Laville M
INSTITUCIÓN
/ INSTITUTION: - Departement de Nephrologie et EA645,
Universite Claude Bernard, Hopital Edouard Herriot, 5 place d’Arsonval, F-69437
Lyon Cedex 03, France. N.
Ref:: 44
----------------------------------------------------
[26]
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
----------------------------------------------------
[27]
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.
----------------------------------------------------
[28]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.3.1 Long-term immunosuppression. Late steroid or
cyclosporine withdrawal.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:19-20.
RESUMEN
/ SUMMARY: - GUIDELINES: A. In order to reduce or avoid
long-term serious adverse effects of corticosteroids, such as bone fractures,
diabetes mellitus, arterial hypertension, osteoporosis and eye complications,
steroid withdrawal should be considered. B. Steroid withdrawal is safe only in
a proportion of graft recipients and is recommended only in low-risk patients.
The efficacy of the remaining immunosuppression should be considered. C. After
steroid withdrawal, graft function has to be monitored very carefully because
of the risk of a delayed but continuous loss of function due to chronic graft
dysfunction. In the case of functional deterioration or dysfunction, steroids
should be re-administered. D. Cyclosporine withdrawal might be considered in
order to ameliorate nephrotoxicity, arterial hypertension, lipid disorders and
hypertrichosis. This can be carried out with no significant long-term risk of
progressive graft loss. The efficacy of the remaining immunosuppression should
be considered. After cyclosporine withdrawal, careful monitoring for acute
rejection is recommended.
----------------------------------------------------
[29]
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
----------------------------------------------------
[30]
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
----------------------------------------------------
[31]
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
----------------------------------------------------
[32]
TÍTULO / TITLE: - The impact of impaired
insulin release and insulin resistance on glucose intolerance after renal
transplantation.
REVISTA
/ JOURNAL: - Clin Transplant 2002 Dec;16(6):389-96.
AUTORES
/ AUTHORS: - Hjelmesaeth J; Hagen M; Hartmann A;
Midtvedt K; Egeland T; Jenssen T
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Section of
Nephrology, Oslo, Norway. joran@online.no
RESUMEN
/ SUMMARY: - The current knowledge of the pathogenesis
of post-transplant glucose intolerance is sparse. This study was undertaken to
assess the relative importance of insulin secretion (ISec) and insulin
sensitivity (IS) in the pathogenesis of post-transplant diabetes mellitus
(PTDM), impaired glucose tolerance (IGT) and impaired fasting glucose (IFG)
after renal transplantation. An oral glucose tolerance test (OGTT) was
performed in 167 non-diabetic recipients 10 wk after renal transplantation.
Fasting, 1-h and 2-h insulin and glucose levels were used to estimate the
insulin secretory response and IS. One year after transplantation 89 patients
were re-examined with an OGTT including measurements of fasting and 2 h
glucose. Ten weeks after transplantation the PTDM-patients had significantly
lower ISec and IS than patients with IGT/IFG, who again had lower ISec and IS
than those with normal glucose tolerance (NGT). One year later, a similar
difference in baseline ISec was observed between the three groups, whereas
baseline IS did not differ significantly. Patients who improved their glucose
tolerance during the first year, were mainly characterized by a significantly
greater baseline ISec, and they received a significantly higher median
prednisolone dose at baseline with a subsequent larger dose reduction during
the first year, than the patients who had their glucose tolerance unchanged or
worsened. In conclusion, both impaired ISec and IS characterize patients with
PTDM and IGT/IFG in the early course after renal transplantation. The presence
of defects in insulin release, rather than insulin action, indicates a poor
prognosis regarding later normalization of glucose tolerance. N. Ref:: 29
----------------------------------------------------
[33]
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
----------------------------------------------------
[34]
TÍTULO / TITLE: - Insulin resistance as
putative cause of chronic renal transplant dysfunction.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Apr;41(4):859-67.
AUTORES
/ AUTHORS: - de Vries AP; Bakker SJ; van Son WJ; Homan
van der Heide JJ; The TH; de Jong PE; Gans RO
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology Department of
Medicine, Groningen University Medical Center, Groningen, The Netherlands. a.p.j.de.vries@int.azg.nl
RESUMEN
/ SUMMARY: - Transplantation is the preferred organ
replacement therapy for most patients with end-stage renal disease. Despite
impressive improvements over recent years in the treatment of acute rejection,
approximately half of all grafts will loose function within 10 years after
transplantation. Chronic renal transplant dysfunction, also known as transplant
atherosclerosis, is a leading cause of late allograft loss. To date, no
specific treatment for chronic renal transplant dysfunction is available.
Although its precise pathophysiology remains unknown, it is believed that it
involves a multifactorial process of alloantigen-dependent and
alloantigen-independent risk factors. Obesity, posttransplant diabetes
mellitus, dyslipidemia, hypertension, and proteinuria have all been identified
as alloantigen-independent risk factors. Notably, these recipient-related risk
factors are well-known risk factors for cardiovascular disease, which cluster
within the insulin resistance syndrome in the general population. Insulin
resistance is considered the central pathophysiologic feature of this syndrome.
It is therefore tempting to speculate that it is insulin resistance that
underlies the recipient-related risk factors for chronic renal transplant
dysfunction. Recognition of insulin resistance as a central feature underlying
many, if not all, recipient-related risk factors would not only improve our
understanding of the pathophysiology of chronic renal transplant dysfunction,
but also stimulate development of new treatment and prevention strategies. N. Ref:: 99
----------------------------------------------------
[35]
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
----------------------------------------------------
[36]
TÍTULO / TITLE: - Bone remodeling after
renal transplantation.
REVISTA
/ JOURNAL: - Kidney Int Suppl 2003 Jun;(85):S125-8.
AUTORES
/ AUTHORS: - Bellorin-Font E; Rojas E; Carlini RG;
Suniaga O; Weisinger JR
INSTITUCIÓN
/ INSTITUTION: - Centro Nacional de Dialisis y Trasplante,
Division of Nephrology, Hospital Universitario de Caracas, Venezuela. ebellori@telcel.net.ve
RESUMEN
/ SUMMARY: - Several studies have indicated that bone
alterations after transplantation are heterogeneous. Short-term studies after
transplantation have shown that many patients exhibit a pattern consistent with
adynamic bone disease. In contrast, patients with long-term renal
transplantation show a more heterogeneous picture. Thus, while adynamic bone
disease has also been described in these patients, most studies show decreased
bone formation and prolonged mineralization lag-time faced with persisting bone
resorption, and even clear evidence of generalized or focal osteomalacia in
many patients. Thus, the main alterations in bone remodeling are a decrease in
bone formation and mineralization up against persistent bone resorption,
suggesting defective osteoblast function, decreased osteoblastogenesis, or
increased osteoblast death rates. Indeed, recent studies from our laboratory
have demonstrated that there is an early decrease in osteoblast number and surfaces,
as well as in reduced bone formation rate and delayed mineralization after
transplantation. These alterations are associated with an early increase in
osteoblast apoptosis that correlates with low levels of serum phosphorus. These
changes were more frequently observed in patients with low turnover bone
disease. In contrast, PTH seemed to preserve osteoblast survival. The
mechanisms of hypophosphatemia in these patients appear to be independent of
PTH, suggesting that other phosphaturic factors may play a role. However,
further studies are needed to determine the nature of a phosphaturic factor and
its relationship to the alterations of bone remodeling after
transplantation. N.
Ref:: 27
----------------------------------------------------
[37]
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.
----------------------------------------------------
[38]
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
----------------------------------------------------
[39]
TÍTULO / TITLE: - TGF-beta(1) gene
expression in protocol biopsies from patients with stable renal allograft
function.
REVISTA
/ JOURNAL: - Transplant Proc 2001
Feb-Mar;33(1-2):342-4.
AUTORES
/ AUTHORS: - Hueso M; Bover J; Espinosa L; Moreso F;
Seron D; Canas C; Raulf F; Blanco A; Gil-Vernet S; Carreras M; Castelao AM;
Grinyo JM; Alsina J
INSTITUCIÓN
/ INSTITUTION: - Nephrology Department, CSUB, L’Hospitalet
de Llobregat, Barcelona, España.
----------------------------------------------------
[40]
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
----------------------------------------------------
[41]
- Castellano -
TÍTULO / TITLE:Alteraciones del metabolismo oseo
tras el trasplante renal. Bone metabolism alterations after kidney
transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2003;23 Suppl 2:122-6.
AUTORES
/ AUTHORS: - Torres A; Garcia S; Barrios Y; Hernandez
D; Lorenzo V
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Unidad de
Investigacion, Hospital Universitario de Canarias, Instituto Reina Sofia de
Investigacion. atorres@ull.es
RESUMEN
/ SUMMARY: - Early after renal transplantation (RT) a
rapid decrease in bone mineral density at the lumbar spine, femoral neck, and
femoral shaft has been documented. In addition, an appreciable proportion of
patients still remain losing bone late after RT. As a consequence, RT patients
are at a high risk of bone fractures as compared to general population. Most
fractures involve appendicular skeleton, particularly the feet and ankles, and
the diabetic patient is at increased risk of fractures. Thus, early institution
of preventive measures and treatment of established osteoporosis are central.
The major cause of post-transplantation bone loss is corticosteroid treatment,
and this should be used at the lower dose compatible with graft survival.
Preexisting hyperparathyroidism also affects the early cancellous bone loss at
the spine, and post-transplantation bone loss reflects variable individual
susceptibility, resembling the polygenic determination of bone mineral density
in general. Clinical trials have demonstrated that bisphosphonates or vitamin D
plus calcium supplementation, prevent post-transplantation bone loss during the
first 6-12 months. However, their role in preventing bone fractures has not
been proven. Finally, recommendations for management, prevention and treatment,
are summarized. N.
Ref:: 24
----------------------------------------------------
[42]
TÍTULO / TITLE: - Lamivudine therapy for
severe acute hepatitis B virus infection after renal transplantation: case
report and literature review.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Sep;33(6):2948-9.
AUTORES
/ AUTHORS: - Nakhoul F; Gelman R; Green J; Khankin E;
Baruch Y
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Molecular
Medicine, Rambam Medical Center, Haifa, Israel. N. Ref:: 13
----------------------------------------------------
[43]
- Castellano -
TÍTULO / TITLE:Reporte preliminar. Utilidad de la
angiotomografia renal en el protocolo del donador renal. Preliminary report.
Usefulness of computed tomographic angiography in the protocol of a kidney
donor.
REVISTA
/ JOURNAL: - Cir Cir. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.medigraphic.com/
●●
Cita: Cirugia y Cirujanos: <> 2003 Sep-Oct;71(5):379-82.
AUTORES
/ AUTHORS: - Ramirez-Bollas J; Hernandez-Dominguez M;
Arenas-Osuna J; Romero-Huesca A; Albores-Zuniga O
INSTITUCIÓN
/ INSTITUTION: - Cirujano General, Hospital de
Especialidades del Centro Medico Nacional “La Raza,” IMSS, Mexico D.F., Mexico.
juliobollas@yahoo.com.mx
RESUMEN
/ SUMMARY: - OBJECTIVE: To determine clinical
correlation of reports of computed tomographic angiography renal (CT-AR) and
surgical findings of the kidney donor patient. MATERIAL AND METHODS: Patients
were submitted nephrectomy in the related live donor renal transplant program
between January and December 2002 as paut of life to which he is made as he
CT-AR study protocol. Statistical analysis was carried out by descriptive
statistics. RESULTS: Anatomical characteristics of 35 kidneys of the same
number of live donors (AD) submitted CT-AR were evaluated and comparison with
report of surgical technique was made. Incidence of accessory renal arteries
was 23%. As reported by CT-AR, the were 39 renal arteries (91%) compared with
43 arteries found during surgery. CT-AR identified four supernumerary renal
arteries (50%) of eight identified during surgical technique; 36 hiliar
arteries (90%) and three polar arteries were identified by CT-AR (100%). Only
one a case report of early bifurcation of renal artery (20%) by CT-AR was
recorded. Anatomical characteristics of veins were described in their totality.
CT-AR is a useful instrument to identify alterations in anatomical structure of
the renal vasculature, with results similar to other studies for description of
renal arteries and veins. We propose ATR as the initial study for evaluation of
the renal architecture of the live kidney (LKD).
----------------------------------------------------
[44]
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
----------------------------------------------------
[45]
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
----------------------------------------------------
[46]
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
----------------------------------------------------
[47]
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
----------------------------------------------------
[48]
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.
----------------------------------------------------
[49]
TÍTULO / TITLE: - Non-malignant skin
changes in transplant patients.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002 Aug;17(8):1380-3.
AUTORES
/ AUTHORS: - Avermaete A; Altmeyer P; Bacharach-Buhles
M
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Ruhr-University
Bochum, Bochum, Germany. N.
Ref:: 7
----------------------------------------------------
[50]
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
----------------------------------------------------
[51]
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
----------------------------------------------------
[52]
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
----------------------------------------------------
[53]
TÍTULO / TITLE: - Young age and the risk
for ifosfamide-induced nephrotoxicity: a critical review of two opposing
studies.
REVISTA
/ JOURNAL: - Pediatr Nephrol 2001 Dec;16(12):1153-8.
●●
Enlace al texto completo (gratuito o de pago) 1007/s004670100053
AUTORES
/ AUTHORS: - Aleksa K; Woodland C; Koren G
INSTITUCIÓN
/ INSTITUTION: - Division of Clinical Pharmacology and
Toxicology, Hospital for Sick Children, 555 University Avenue, Toronto, Canada.
RESUMEN
/ SUMMARY: - Ifosfamide has been in use as an effective
antineoplastic agent for solid tumors in both children and adults since the
late 1960s. Although some adverse effects (e.g. hemorrhagic cystitis) can be
overcome by the co-administration of 2-mercaptoethanesulfonate (MESNA), others
such as nephrotoxicity cannot. There is a consensus that factors such as the
cumulative dose of ifosfamide and concomitant cisplatin administration may
influence not only the incidence but also the severity of ifosfamide-induced
renal toxicity. Several preliminary studies suggested young age as a risk
factor for nephrotoxicity; however, there is little agreement on this. The
reasons for this uncertainty may include sample size, study design, dose and
differences in renal function assessment. In this review we examine the two
largest cohort studies conducted in pediatric patients. One study suggests that
ifosfamide-induced renal toxicity is age- related, whereas analysis of the
other failed to show age as an important predictor for ifosfamide-induced renal
toxicity. The studies differed in design, end-points of toxicity and concomitant
drug therapy. Due to the effectiveness of ifosfamide as an antineoplastic
agent, it is important that an understanding of the factors that predispose
pediatric patients to ifosfamide-induced nephrotoxicity be obtained. N. Ref:: 26
----------------------------------------------------
[54]
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
----------------------------------------------------
[55]
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.
----------------------------------------------------
[56]
TÍTULO / TITLE: - Renal transplantation
studies in genetic hypertension.
REVISTA
/ JOURNAL: - News Physiol Sci. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://nips.physiology.org/contents-by-date.0.shtml
●●
Cita: News in Physiological Sciences: <> 2001 Dec;16:262-5.
AUTORES
/ AUTHORS: - Grisk O; Rettig R
INSTITUCIÓN
/ INSTITUTION: - Department of Physiology, University of
Greifswald, D-17487 Greifswald, Germany.
N. Ref:: 17
----------------------------------------------------
[57]
TÍTULO / TITLE: - Renal artery aneurysm:
ex vivo repair and autotransplantation: case report and review of the
literature.
REVISTA
/ JOURNAL: - Int Surg 2003 Apr-Jun;88(2):61-3.
AUTORES
/ AUTHORS: - El Tayar AR; Labruzzo C; Haritopoulos K;
Hakim NS
INSTITUCIÓN
/ INSTITUTION: - Renal Transplant Unit, St. Mary’s
Hospital, London, United Kingdom.
RESUMEN
/ SUMMARY: - The incidence of renal artery aneurysm is
unknown, its natural history is unclear and unpredictable, and the clinical
symptoms are of little or no value in diagnosis. The risk of rupture is high in
pregnant women, as in splenic artery aneurysms and in aneurysms greater than 2
cm in size. Digital subtraction angiography is the best diagnostic test. When
an aneurysm is identified, surgery is the best treatment option to avoid
hypertension or rupture of the aneurysm. Because of advances in organ
preservation, nephrectomy, ex vivo repair, and autotransplantation is a safe
and successful procedure. We report the case of a 2-cm-wide neck aneurysm that
was treated by nephrectomy, ex vivo repair, and auto-transplantation. N. Ref:: 16
----------------------------------------------------
[58]
TÍTULO / TITLE: - MR imaging of renal
function.
REVISTA
/ JOURNAL: - Radiol Clin North Am 2003
Sep;41(5):1001-17.
AUTORES
/ AUTHORS: - Huang AJ; Lee VS; Rusinek H
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology-MRI, New York
University Medical Center, 530 First Avenue, HCC Basement, New York, NY 10016,
USA.
RESUMEN
/ SUMMARY: - MR imaging is the only single noninvasive
test that can potentially provide a complete picture of renal status with
minimal risk to the patient, simultaneously improving diagnosis while lowering
medical costs by virtue of its being a single test. The strengths of MR imaging
lie in its high spatial and temporal resolution and its lack of exposure to
ionizing radiation and nephrotoxic contrast agents. This article reviews the
use of MR imaging for quantification of renal functional parameters and its
application to clinical problems, such as RVD, hydronephrosis, and renal
transplantation. Although advances in both the technical and clinical aspects
of functional renal MR imaging have been made, much remains to be done. The
preliminary results reported in the many studies reviewed are exciting, but
these techniques need to be validated against accepted standards where such
standards exist. In addition, and perhaps more important, the effects of these
new diagnostic methods on patient outcomes must be studied. Finally, further
progress in image processing and analysis must be made to make functional renal
MR imaging truly practical. With these advances, one can expect functional
renal MR imaging to play an ever-expanding and influential role in the care and
management of the patient with renal disease.
N. Ref:: 57
----------------------------------------------------
[59]
TÍTULO / TITLE: - Ambulatory blood
pressure after renal transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001;16 Suppl 1:110-3.
AUTORES
/ AUTHORS: - Fernandez-Vega F; Tejada F; Baltar J;
Laures A; Gomez E; Alvarez J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia 1, Hospital Central
de Asturias, C/Celestino Villamil s/n, 33006 Oviedo, España.
RESUMEN
/ SUMMARY: - Renal transplantation has been a usual
medical practice in developed countries for several decades. A large number of
studies report the excellent results obtained with such a practice. The
survival of the graft, although able to be improved, is excellent and gives a
great deal of hope to patients with renal insufficiency. The high level of
investigation into immunosuppressor drugs offers, almost continuously, more
efficient and better tolerated products. Paradoxically, the usual problems of
patients with a renal transplant are not immunological but cardiovascular.
Elevated serum cholesterol levels, obesity, diabetes and other cardiovascular
risk factors (CVRFs) are usual in these patients, arterial hypertension (AHT)
being the most frequent. Nephrologists are increasingly using ambulatory blood
pressure monitoring (ABPM) on a daily basis. In the last 10 years, we have
obtained highly valuable and interesting results with this technique which have
allowed us to study and understand with greater precision the relationship of
AHT to the kidney. Here we analyse and review the most relevant aspects of ABPM
in the different stages of kidney disease, with special emphasis on renal
transplantation. N.
Ref:: 40
----------------------------------------------------
[60]
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.
----------------------------------------------------
[61]
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
----------------------------------------------------
[62]
TÍTULO / TITLE: - A prospective study of
rapid corticosteroid elimination in simultaneous pancreas-kidney
transplantation: comparison of two maintenance immunosuppression protocols:
tacrolimus/mycophenolate mofetil versus tacrolimus/sirolimus.
REVISTA
/ JOURNAL: - Transplantation 2002 Jan 27;73(2):169-77.
AUTORES
/ AUTHORS: - Kaufman DB; Leventhal JR; Koffron AJ;
Gallon LG; Parker MA; Fryer JP; Abecassis MM; Stuart FP
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, Northwestern University Medical School, 675 N. St. Clair
Street, Galter Pavilion, Suite 17-200, Chicago, IL 60611, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: We examined the feasibility of
rapid corticosteroid elimination in simultaneous pancreas kidney
transplantation. METHODS: Forty consecutive simultaneous pancreas-kidney (SPK)
transplant recipients were enrolled in a prospective study in which
antithymocyte globulin induction and 6 days of corticosteroids were administered
along with tacrolimus and MMF (n=20) or tacrolimus and sirolimus (n=20).
Mean+/-SD follow-up for recipients receiving tacrolimus/MMF and
tacrolimus/sirolimus were 12.7+/-3.9 and 13.4+/-2.9 months, respectively.
Patient and graft survival, and rejection rates were compared to an historical
control group (n=86; mean follow-up 41.5+/-15.4 months) of SPK recipients that
received induction and tacrolimus, MMF, and corticosteroids. RESULTS:
Demographic characteristics of recipient and donor variables were similar among
all groups. The 1-year actuarial patient, kidney, and pancreas survival rates
in the 40 SPK transplant recipients with rapid corticosteroid elimination were
100, 100, and 100%, respectively. In the historical control group the 1-year
actual patient, kidney, and pancreas survival rates were 96.5, 93.0, and 91.9%,
respectively. The 1-year rejection-free survival rate recipients in the rapid
steroid elimination group collectively was 97.5 vs 80.2% in the historical
control group (P=0.034). At 6 and 12 months posttransplant the serum creatinine
values remained stable in all groups. CONCLUSIONS: We conclude that chronic
corticosteroid exposure is not required in SPK transplant recipients receiving
antithymocyte globulin induction and maintenance immuno-suppression consisting
of either tacrolimus and mycophenolate mofetil or tacrolimus and sirolimus.
----------------------------------------------------
[63]
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
----------------------------------------------------
[64]
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
----------------------------------------------------
[65]
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
----------------------------------------------------
[66]
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
----------------------------------------------------
[67]
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
----------------------------------------------------
[68]
- Castellano -
TÍTULO / TITLE:Disfuncion endotelial en trasplante
renal. Endothelial dysfunction in renal transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2003;23 Suppl 4:52-8.
AUTORES
/ AUTHORS: - Crespo M; Campistol JM
INSTITUCIÓN
/ INSTITUTION: - Unidad de Trasplante Renal, Hospital
Clinic, IDIBAPS (Institut d’Investigacio Biomediques Agusti Pi i Sunyer),
Barcelona. N. Ref:: 55
----------------------------------------------------
[69]
TÍTULO / TITLE: - Tumour-like calcinosis
causing reversible tetraparesis in a patient on continuous ambulatory
peritoneal dialysis.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001 Sep;16(9):1958.
AUTORES
/ AUTHORS: - Ritz E; Hergesell O N. Ref:: 9
----------------------------------------------------
[70]
TÍTULO / TITLE: - Thymic microchimerism
correlates with the outcome of tolerance-inducing protocols for solid organ
transplantation.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2001
Dec;12(12):2815-26.
AUTORES
/ AUTHORS: - Noris M; Cugini D; Casiraghi F; Azzollini
N; De Deus Viera Moraes L; Mister M; Pezzotta A; Cavinato RA; Aiello S; Perico
N; Remuzzi G
INSTITUCIÓN
/ INSTITUTION: - Department of Immunology and Clinics of
Organ Transplantation, Mario Negri Institute for Pharmacological Research, via
Gavazzeni 11, 24125 Bergamo, Italy. noris@marionegri.it
RESUMEN
/ SUMMARY: - This study found that pretransplant
infusion of donor peripheral blood leukocytes, either total leukocytes
(peripheral blood leukocytes) or peripheral blood mononuclear cells (PBMC),
under appropriate immunomodulating conditions was more effective than donor
bone marrow (BM) in prolonging the survival of rats that received kidney
grafts. A higher percentage of MHCII(+) cells was found in donor PBMC than in BM
cells, and depletion of MHCII(+) cells from donor PBMC abolished their
tolerogenic potential. By the analysis of microchimerism in rats infused with
donor cells and killed at different time points thereafter, the better
tolerogenic potential of leukocyte infusion related to a higher capability of
these cells to engraft the recipient thymus. PCR analysis on OX6-immunopurified
cells revealed the presence of donor MHCII(+) cells in the thymus of these
animals. The role of intrathymic microchimerism was reinforced by findings that
thymectomy at the time of transplant prevented tolerance induction by donor
leukocytes. Donor DNA was found in the thymus of most long-term graft animals
that survived, but in none of those that rejected their grafts. The presence of
intrathymic microchimerism correlated with graft survival, and microchimerism
in other tissues was irrelevant. PCR analysis of DNA from thymic cell
subpopulations revealed the presence of donor MHCII(+) cells in the thymus of
long-term surviving animals. Thus, in rats, donor leukocyte infusion is better
than donor BM for inducing graft tolerance, defined by long-term graft
survival, donor-specific T cell hyporesponsiveness, and reduced interferon
gamma production. This effect appears to occur through migration of donor
MHCII(+) cells in the host thymus.
----------------------------------------------------
[71]
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
----------------------------------------------------
[72]
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
----------------------------------------------------
[73]
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
----------------------------------------------------
[74]
TÍTULO / TITLE: - Nutritional
considerations in renal transplant patients.
REVISTA
/ JOURNAL: - Blood Purif 2002;20(2):139-44.
AUTORES
/ AUTHORS: - van den Ham EC; Kooman JP; van Hooff JP
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine,
University Hospital Maastricht, The Netherlands. evha@sint.azm.nl
RESUMEN
/ SUMMARY: - In renal transplant patients, weight gain
generally increases after renal transplantation, which will be influenced by
improved appetite and a reversal of the uremic state. However, at least in the
early posttransplant period, the increase in body weight is mainly due to an
increase in body fat mass. This phenomenon may be partly due to relatively high
doses of steroids in the early period after renal transplantation, possibly
mediated by their inhibiting effect on lipid peroxidation, but also appears to
be related to physical inactivity. The increase in body fat mass may contribute
to posttransplant hyperlipidemia, which is improved but not completely
normalized by dietary intervention. Current dietary recommendations in stable
renal transplant patients do not generally differ from those of the general
population, although intense dietary counselling may be indicated in patients
with excessive posttransplant weight gain. The effect of supervised exercise
training on body composition is currently under investigation. N. Ref:: 57
----------------------------------------------------
[75]
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.
----------------------------------------------------
[76]
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
----------------------------------------------------
[77]
TÍTULO / TITLE: - Factors associated with
long-term renal allograft survival.
REVISTA
/ JOURNAL: - Ther Drug Monit 2002 Feb;24(1):36-9.
AUTORES
/ AUTHORS: - Kaplan B; Srinivas TR; Meier-Kriesche HU
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Shands University
Hospital, University of Florida, Gainesville, Florida 32610-0224, USA. kaplab@medicine.ufl.edu
RESUMEN
/ SUMMARY: - Major advances in immunosuppression and
reductions in the rates of acute rejection have led to increasing graft and
patient survival rates during the past two decades. Chronic dysfunction of the
renal allograft, however, remains a major clinical problem and probably
represents the end result of the complex interplay between donor and recipient
factors, immunologic injury, nonimmunologic insults, and drug-induced
nephrotoxicity. Optimal function of the renal allograft is obtained by
maintaining a balance between underimmunosuppression and acute rejection and
overimmunosuppression and drug-induced toxicities. To minimize side effects
while maintaining efficacy, immunosuppressive drugs are commonly used as
combination therapy. Pharmacokinetic and pharmacodynamic interactions between
these agents can affect graft survival and function. The evidence supporting
the role of therapeutic drug monitoring as applied to commonly used
immunosuppressants in modern transplantation is presented here, and the
increasing role of therapeutic drug monitoring in the optimization of graft and
patient survival rates in the modern era of renal transplantation is discussed. N. Ref:: 52
----------------------------------------------------
[78]
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
----------------------------------------------------
[79]
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
----------------------------------------------------
[80]
TÍTULO / TITLE: - Role of prostanoids and
endothelins in the prevention of cyclosporine-induced nephrotoxicity.
REVISTA
/ JOURNAL: - Prostaglandins Leukot Essent Fatty Acids
2001 Apr-May;64(4-5):231-9.
●●
Enlace al texto completo (gratuito o de pago) 1054/plef.2001.0265
AUTORES
/ AUTHORS: - Darlametsos IE; Varonos DD
INSTITUCIÓN
/ INSTITUTION: - Centre Franco-Hellenique de Recherches
Biomedicales, Nikolaos Papanikolaou, Corporation of the Municipality Agrinion,
Agrinion, 30100, Greece. darlamet@otenet.gr
RESUMEN
/ SUMMARY: - Cyclosporine A nephrotoxicity includes
both functional toxicity and histological changes, whose seriousness is
dependent upon the dose and the duration of the drug administration. Several
vasoactive agents have been found to be implicated in cyclosporine induced
nephrotoxicity, among which prostanoids and endothelins are the most important.
In previous studies we were able to prevent the early stage (7 days) of
cyclosporine (37.4 micromol [45 mg]/kg/day) induced nephrotoxicity in rats
either by the administration, i) of OKY-046, a thromboxane A(2)synthase
inhibitor, ii) of ketanserine, an antagonist of S(2)serotonergic,
a(1)adrenergic, and H(1)histaminergic receptors and iii) of nifedipine, a
calcium channel blocker, or by diet supplementation either with evening
primrose oil or fish oil. All these protective agents elevated ratios of
excreted renal prostanoid vasodilators (prostaglandins E(2), 6ketoF(1 alpha))
to vasoconstrictor (thromboxane B(2)), a ratio which was decreased by the
administration of cyclosporine alone. Nifedipine averted the cyclosporine
induced increase of urinary endothelin-1 release. All protections were
associated with the reinstatement of glomerular filtration rate forwards normal
levels whereas renal damage defence, consisting of a decrease of the
cyclosporine induced vacuolizations, was variable. Ketanserine and evening
primrose oil were the only agents which prevented the animal body weight loss.
These data suggest that prostanoids and endothelin-1 may mediate functional
toxicity while thromboxane A(2)is involved the morphological changes too,
provoked in the early stage of cyclosporine treatment. However, other
nephrotoxic factors and additional mechanisms could also be implicated in the
cyclosporine induced nephrotoxicity. N.
Ref:: 91
----------------------------------------------------
[81]
TÍTULO / TITLE: - Chronic allograft
failure: a disease we don’t understand and can’t cure?
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002 Aug;17(8):1384-90.
AUTORES
/ AUTHORS: - Schratzberger G; Mayer G
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Department of
Internal Medicine, Anichstrasse 35, A-6020 Innsbruck, Austria. N. Ref:: 58
----------------------------------------------------
[82]
TÍTULO / TITLE: - Inducible nitric oxide
synthase in renal transplantation.
REVISTA
/ JOURNAL: - Kidney Int 2002 Mar;61(3):872-5.
AUTORES
/ AUTHORS: - Joles JA; Vos IH; Grone HJ; Rabelink TJ
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Hypertension,
University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the
Netherlands.
RESUMEN
/ SUMMARY: - The importance of the endothelial isoform
of nitric oxide synthase (eNOS) has been well established. Endothelium-derived
nitric oxide has been shown to be essential for vascular homeostasis and
modulation of eNOS has thus become a target in prevention of cardiovascular
disease. The role of the inducible form of nitric oxide synthase (iNOS) in
vascular biology, however, is less clear. Classically, iNOS has been regarded
as an enzyme that produces nmolar amounts of the nitric oxide radical, thereby
leading to cellular damage. More recent data, however, have shown that the iNOS
can be a superoxide, peroxynitrite as well as a nitric oxide-producing enzyme,
while the biological effects of iNOS probably depend upon the sort of radical
species released by the enzyme as well as the anti-oxidant capacity of the
cellular microenvironment of the enzyme. This brief review discusses these
aspects in relation to renal transplantation.
N. Ref:: 40
----------------------------------------------------
[83]
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
----------------------------------------------------
[84]
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
----------------------------------------------------
[85]
TÍTULO / TITLE: - Renin system activation
and delayed function of the renal transplant.
REVISTA
/ JOURNAL: - Am J Hypertens 2001 Dec;14(12):1270-2.
AUTORES
/ AUTHORS: - Blumenfeld JD; Catanzaro DF; Kinkhabwala
M; Cheigh J; Hartono C; Serur D; Kapur S; Stubenbord WT; Haschemeyer R; Riggio
R
INSTITUCIÓN
/ INSTITUTION: - Rogosin Institute, Department of Surgery,
New York Presbyterian Hospital, Weill Medical College of Cornell University,
New York 10021, USA. blumenj@mail.rockefeller.edu
RESUMEN
/ SUMMARY: - Delayed graft function (DGF), defined as
persistent renal failure that requires dialysis within the first week after
kidney transplantation, occurs commonly after cadaveric renal transplantation
(CRT). This has important implications for long-term outcome because the 1-year
allograft survival rate is significantly reduced when DGF occurs. The
mechanisms contributing to the development of DGF are not well established.
However, several lines of evidence indicate that excess renin system activity,
in both the cadaver kidney donor and recipient, contributes importantly to the
pathogenesis of DGF. If this hypothesis can be verified in clinical studies,
then pharmacologic agents that interrupt the renin-angiotensin system (eg, type
1 angiotensin II receptor blockade, angiotensin converting enzyme inhibition,
and beta-adrenergic blockade) in the donor and recipient might significantly
improve the outcome of cadaveric renal transplants. N. Ref:: 22
----------------------------------------------------
[86]
TÍTULO / TITLE: - Glycaemic control and
graft loss following renal transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001 Oct;16(10):1978-82.
AUTORES
/ AUTHORS: - Thomas MC; Mathew TH; Russ GR N. Ref:: 32
----------------------------------------------------
[87]
TÍTULO / TITLE: - Tailoring
immunosuppressive therapy based on donor and recipient risk factors.
REVISTA
/ JOURNAL: - Transplant Proc 2001 May;33(3):2207-11.
AUTORES
/ AUTHORS: - First MR
INSTITUCIÓN
/ INSTITUTION: - University of Cincinnati Medical Center,
Cincinnati, Ohio 45267-0585, USA. N.
Ref:: 35
----------------------------------------------------
[88]
TÍTULO / TITLE: - Delayed graft function.
Influence on outcome and strategies for prevention.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):721-32.
AUTORES
/ AUTHORS: - Shoskes DA; Shahed AR; Kim S
INSTITUCIÓN
/ INSTITUTION: - Departments of Urology and Renal
Transplantation, Cleveland Clinic Florida, Weston, Florida, USA. dshoskes@urol.com
RESUMEN
/ SUMMARY: - Delayed graft function remains a prevalent
problem in cadaveric renal transplantation that increases rejection, decreases
graft and patient survival, increases the cost of transplantation, and
complicates patient management. Although current medical and surgical
strategies can reduce the incidence of DGF to 20% or less, newer therapies that
focus on nonimmune and immune forms of renal injury are needed to improve
outcomes further. N.
Ref:: 105
----------------------------------------------------
[89]
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
----------------------------------------------------
[90]
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
----------------------------------------------------
[91]
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
----------------------------------------------------
[92]
TÍTULO / TITLE: - Early experience using
calcineurin-free protocol in recipients of high-risk cadaver renal transplants.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Aug;34(5):1627-8.
AUTORES
/ AUTHORS: - El-Sabrout R; Delaney V; Butt F; Qadir M;
Rashid I; Hanson P; Butt K
INSTITUCIÓN
/ INSTITUTION: - Departments of Transplantation/Vascular
Surgery, New York Medical College, Valhalla, New York, USA.
----------------------------------------------------
[93]
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
----------------------------------------------------
[94]
TÍTULO / TITLE: - Ultrasonography in
renal transplantation.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2002 Apr;39(4):663-78.
AUTORES
/ AUTHORS: - O’neill WC; Baumgarten DA
INSTITUCIÓN
/ INSTITUTION: - Renal Division, Department of Medicine,
Emory University School of Medicine, Atlanta, GA 30322, USA. woneill@emory.edu
RESUMEN
/ SUMMARY: - Sonography is a simple, inexpensive, and
readily available imaging modality that has become an essential component of
the management of renal transplantation. It is indicated in almost all patients
with acute renal failure and also is useful in the evaluation of pain, infection,
and hematuria and the performance of percutaneous biopsy. Although many aspects
of sonography are similar in native and transplanted kidneys, there are
important differences and problems unique to the renal allograft, which form
the basis for this review. The anatomy of renal transplantation and changes
that accompany parenchymal disorders are discussed, but particular attention
focuses on problems related to the urinary tract, fluid collections, and
vascular disorders. By becoming more familiar with transplant sonography,
nephrologists will be better able to incorporate this indispensable tool into
the care of their patients. N.
Ref:: 66
----------------------------------------------------
[95]
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
----------------------------------------------------
[96]
TÍTULO / TITLE: - Xenotransplantation of
developing kidneys.
REVISTA
/ JOURNAL: - Am J Physiol Renal Physiol. Acceso
gratuito al texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ajprenal.physiology.org/
●●
Cita: American J. of Physiology. Renal Physiology: <> 2002
Oct;283(4):F601-6.
●●
Enlace al texto completo (gratuito o de pago) 1152/ajprenal.00126.2002
AUTORES
/ AUTHORS: - Hammerman MR
INSTITUCIÓN
/ INSTITUTION: - George M. O’Brien Kidney and Urological
Disease Center, Renal Division, Department of Medicine, Washington University
School of Medicine, St. Louis, Missouri 63110, USA. mhammerm@im.wustl.edu
RESUMEN
/ SUMMARY: - The number of kidney transplants performed
per year is limited by the availability of donor organs. One novel solution to
this shortage envisions “growing” new kidneys in situ via xenotransplantation
of renal anlagen. We have shown that developing metanephroi transplanted into
the omentum of animal hosts undergo differentiation and growth, become vascularized
by blood vessels of host origin, and exhibit excretory function. Metanephroi
can be stored for up to 3 days in vitro before transplantation with no
impairment in growth or function postimplantation. Metanephroi can be
transplanted across both concordant (rat --> mouse) and discordant/highly
disparate (pig --> rodent) xenogeneic barriers. This review summarizes
experimental data relating to the transplantation of developing kidneys. N. Ref:: 26
----------------------------------------------------
[97]
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
----------------------------------------------------
[98]
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.
----------------------------------------------------
[99]
TÍTULO / TITLE: - Sequential protocol
biopsies from renal transplant recipients show an increasing expression of
active TGF beta.
REVISTA
/ JOURNAL: - Transpl Int 2002 Dec;15(12):630-4. Epub
2002 Oct 19.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00147-002-0472-3
AUTORES
/ AUTHORS: - Jain S; Mohamed MA; Sandford R; Furness
PN; Nicholson ML; Talbot D
INSTITUCIÓN
/ INSTITUTION: - University Department of Surgery,
Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. sj34@le.ac.uk
RESUMEN
/ SUMMARY: - Chronic allograft nephropathy (CAN) is a
major cause of graft loss after renal transplantation. Implicated in the
pathogenesis of this complication is overproduction of the cytokine
transforming growth factor beta (TGF beta). In this study we measured changes
in CAN’s expression in stable patients early after transplantation, and studied
links with established risk factors for CAN, such as delayed graft function,
acute rejection, and cyclosporine exposure. We took biopsies from 40 renal
allografts at time of transplantation (pre-perfusion), and then, using
ultrasound guidance, at 1 week and 6 months after transplantation. An
immunofluorescence technique was used to stain sections for active TGF beta.
These were then assessed by semi-quantitative scanning laser confocal
microscopy. There was very little variation in active TGF-beta expression among
patients in their pre-perfusion biopsies. Expression had increased by 1 week
and then very significantly by 6 months ( P<0.0001). Patients who suffered
delayed graft function had increased TGF-beta expression at both time points.
There was no difference regarding donor type, acute rejection, and
immunosuppressive drug (cyclosporine or tacrolimus). There was no correlation
between the amount of TGF-beta expression at any time-point and isotope
glomerular filtration rate (GFR) at 12 months. This study demonstrated that in
a group of stable renal allograft recipients, TGF-beta expression in the kidney
increased after transplantation. As the study used protocol biopsies, this
increase is unlikely to be due to acute events, and probably represents a genuine
increase.
----------------------------------------------------
[100]
TÍTULO / TITLE: - Long-term outcome of
ABO-incompatible renal transplantation.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):769-80.
AUTORES
/ AUTHORS: - Toma H; Tanabe K; Tokumoto T
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, Tokyo Women’s
Medical University, Tokyo, Japan. toma@kc.twmu.ac.jp
RESUMEN
/ SUMMARY: - Based on the long-term experience with
ABO-incompatible kidney transplantation, the following can be concluded: 1.
Renal transplantation across ABO incompatibility is an acceptable treatment for
patients with end-stage renal failure. [table: see text] 2. Long-term patient
and graft survival in ABO-incompatible kidney transplantation is influenced
primarily by acute rejection episodes occurring within 1 year. 3. Despite the
removal of anti-ABO natural antibodies before transplantation, hyperacute
rejection crises may occur in some cases. 4. Humoral rejection is the most
prominent type of rejection in ABO-incompatible renal transplantation. Even
though most of this rejection is controllable with anti-rejection therapy, the
prognosis for a graft that undergoes humoral rejection is significantly poor.
5. The maximum IgG titers of anti-A/B antibody before transplantation may have
a harmful effect on graft acceptance in ABO-incompatible kidney
transplantation. 6. Renal transplantation across ABO incompatibility is
principally the most significant risk factor to affect long-term allograft
function in ABO-incompatible living kidney transplantation. N. Ref:: 24
----------------------------------------------------
[101]
TÍTULO / TITLE: - Sympathetic-vascular
interactions: further evidence in kidney transplantation.
REVISTA
/ JOURNAL: - J Hypertens 2002 Mar;20(3):379-81.
AUTORES
/ AUTHORS: - Grassi G; Calhoun DA N. Ref:: 26
----------------------------------------------------
[102]
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
----------------------------------------------------
[103]
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
----------------------------------------------------
[104]
TÍTULO / TITLE: - An analysis of early
renal transplant protocol biopsies—the high incidence of subclinical tubulitis.
REVISTA
/ JOURNAL: - Am J Transplant 2001 May;1(1):47-50.
AUTORES
/ AUTHORS: - Shapiro R; Randhawa P; Jordan ML;
Scantlebury VP; Vivas C; Jain A; Corry RJ; McCauley J; Johnston J; Donaldson J;
Gray EA; Dvorchik I; Hakala TR; Fung JJ; Starzl TE
INSTITUCIÓN
/ INSTITUTION: - University of Pittsburgh, Thomas E. Starzl
Transplantation Institute, PA 15213, USA. shapiror@msx.upmc.edu
RESUMEN
/ SUMMARY: - To investigate the possibility that we
have been underestimating the true incidence of acute rejection, we began to
perform protocol biopsies after kidney transplantation. This analysis looks at
the one-week biopsies. Between March 1 and October 1, 1999, 100 adult patients
undergoing cadaveric kidney or kidney/pancreas transplantation, or living donor
kidney transplantation, underwent 277 biopsies. We focused on the subset of
biopsies in patients without delayed graft function (DGF) and with stable or
improving renal function, who underwent a biopsy 8.2+/-2.6 d (range 3-18 d)
after transplantation (n = 28). Six (21%) patients with no DGF and with stable
or improving renal function had borderline histopathology, and 7 (25%) had
acute tubulitis on the one-week biopsy. Of the 277 kidney biopsies, there was one
(0.4%) serious hemorrhagic complication, in a patient receiving low molecular
weight heparin; she ultimately recovered and has normal renal function. Her
biopsy showed Banff 1B tubulitis. In patients with stable or improving renal
allograft function early after transplantation, subclinical tubulitis may be
present in a substantial number of patients. This suggests that the true
incidence of rejection may be higher than is clinically appreciated.
----------------------------------------------------
[105]
TÍTULO / TITLE: - Review. The resistive
index in renal Doppler sonography: where do we stand?
REVISTA
/ JOURNAL: - AJR Am J Roentgenol 2003
Apr;180(4):885-92.
AUTORES
/ AUTHORS: - Tublin ME; Bude RO; Platt JF
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, University of
Pittsburgh School of Medicine, 200 Lothrop St., Pittsburgh, PA 15213, USA. N. Ref:: 98
----------------------------------------------------
[106]
TÍTULO / TITLE: - Assessment of bone
mineralization following renal transplantation in children: limitations of DXA
and the confounding effects of delayed growth and development.
REVISTA
/ JOURNAL: - Am J Transplant 2001 Sep;1(3):193-6.
AUTORES
/ AUTHORS: - Leonard MB; Bachrach LK
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, The Children’s
Hospital of Philadelphia, University of Pennsylvania School of Medicine, USA. mleonard@cceb.med.upenn.edu
RESUMEN
/ SUMMARY: - Pediatric renal transplantation recipients
have numerous risk factors for decreased bone mass, including the underlying
renal disease, nutritional deficits, decreased physical activity, inflammation
and exposure to steroid therapy. The assessment of bone mineralization in
children following renal transplantation is fraught with difficulty. Dual
energy x-ray absorptiometry (DXA) is the most commonly employed tool to assess
bone mineralization. However, DXA has important limitations in children and in
individuals with renal disease. This brief review will examine the expected
gains in bone size and bone mass during growth and the mechanisms by which
renal failure and steroid therapy interrupt these process. In addition, the
limitations of DXA for detecting impaired bone mineralization in children with
renal disease are reviewed and alternative approaches explored. N. Ref:: 21
----------------------------------------------------
[107]
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
----------------------------------------------------
[108]
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
----------------------------------------------------
[109]
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.
----------------------------------------------------
[110]
TÍTULO / TITLE: - Influence of
cyclosporin, tacrolimus and rapamycin on renal function and arterial
hypertension after renal transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001;16 Suppl 1:121-4.
AUTORES
/ AUTHORS: - Morales JM; Andres A; Rengel M; Rodicio JL
INSTITUCIÓN
/ INSTITUTION: - Renal Transplant Unit, Nephrology
Department, Hospital 12 de Octubre, Madrid, España.
RESUMEN
/ SUMMARY: - Cyclosporin and tacrolimus have improved
survival figures in organ transplantation. However, both drugs are potentially
nephrotoxic. The immunosuppressive and nephrotoxic effects of both drugs appear
to depend on the inhibition of calcineurin. Cyclosporin and tacrolimus cause
acute (functional changes) and chronic nephrotoxicity (structural lesions in
the kidney). These last important lesions include arteriolar hyalinosis,
stripped interstitial fibrosis and tubular atrophy. It is possible that
repeated episodes of renal ischaemia contribute to the development of chronic
nephrotoxicity and then chronic allograft nephropathy. Cyclosporin and
tacrolimus also induce arterial hypertension. Therefore, the beneficial effects
of immunosuppression have been limited due to nephrotoxicity and arterial
hypertension. Rapamycin, a novel immunosuppressive agent, that does not inhibit
calcineurin, provides immunosuppression without nephrotoxicity. In fact, in the
trials performed in Europe, sirolimus-treated immunosuppression patients
exhibited a much better renal function than cyclosporin-treated patients.
However, sirolimus can potentiate the nephrotoxic effect of cyclosporin.
Therefore, when cyclosporin and sirolimus are used in combination, a reduction
of the cyclosporin dose is desirable. N.
Ref:: 28
----------------------------------------------------
[111]
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
----------------------------------------------------
[112]
TÍTULO / TITLE: - Role of transforming
growth factor-beta1 in the progression of chronic allograft nephropathy.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001;16 Suppl 1:114-6.
AUTORES
/ AUTHORS: - Campistol JM; Inigo P; Larios S; Bescos M;
Oppenheimer F
INSTITUCIÓN
/ INSTITUTION: - Renal Transplant Unit, Hospital Clinic,
Institut d’Investigacio Biomediques Agusti Pi i Sunyer, University of
Barcelona, Barcelona, España.
RESUMEN
/ SUMMARY: - Chronic allograft nephropathy is the
principal cause of late graft loss after the first year of renal
transplantation. Transforming growth factor-beta1 (TGF-beta1) is a key
fibrogenetic cytokine involved in the fibrosis of a number of chronic diseases
of the kidney and other organs, and recently evidence has shown that TGF-beta1
is involved in the pathogenesis of chronic renal allograft dysfunction.
Production of TGF-beta1 in these circumstances may be modulated by the
intrarenal renin-angiotensin system (angiotensin II induces TGF-beta1
production and secretion by the mesangial cells) and by a direct effect of
cyclosporin A, which stimulates the synthesis and expression of TGF-beta1. In a
prospective study of 14 renal transplant patients exhibiting chronic graft
nephropathy, we demonstrated that treatment with losartan significantly
decreased plasma levels of TGF-beta1 by >50%. There was a significant
correlation (P=0.04) between the increase in circulating angiotensin II after 2
weeks and the decrease in plasma TGF-beta(1) at the end of the study period,
suggesting that the degree of angiotensin II receptor blockade plays a decisive
role in the synthesis of TGF-beta1. A significant decrease in circulating
endothelin-1 (ET-1) levels also occurred during treatment with losartan,
together with a decrease in proteinuria. In a randomized 2x2 crossover study,
the effects of losartan and amlodipine on renal haemodynamics and on
profibrogenetic cytokines were analysed. Whereas amlodipine increased the
glomerular filtration rate (GFR) through an increase in the FF and P(G),
losartan slightly decreased the GFR, but with a significant decrease in FF and
P(G). With respect to the profibrogenetic cytokines, losartan decreased the
plasma levels of TGF-beta1 and ET-1, while amlodipine did not significantly
change TGF-beta1 and slightly increased ET-1.
N. Ref:: 16
----------------------------------------------------
[113]
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
----------------------------------------------------
[114]
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
----------------------------------------------------
[115]
TÍTULO / TITLE: - Cadaveric kidney
transplantation for the elderly.
REVISTA
/ JOURNAL: - Nephron 2002 Jul;91(3):361-78.
AUTORES
/ AUTHORS: - Pascual J; Marcen R; Liano F; Ortuno J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Hospital Ramon y
Cajal, C. Colmenar Km 9, 100, E-28034 Madrid, España. jpascual@hrc.insalud.es N. Ref:: 108
----------------------------------------------------
[116]
TÍTULO / TITLE: - Cost-effectiveness
analysis of basixilimab induction and calcineurin-sparing protocols in “old to
old” programs using Markov models.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Jun;35(4):1324-5.
AUTORES
/ AUTHORS: - Emparan C; Wolters H; Laukotter M; Dame C;
Senninger N
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, Uniklinikum, Munster, Germany. cemparan@teleline.es
RESUMEN
/ SUMMARY: - INTRODUCTION: Markov models are employed
in economic analyses to evaluate all possible expectations in a dilemna. The
introduction of a new clinical protocol (basiliximab induction with
calcineurin-sparing protocols) for a group of kidney transplant recipients
receiving organs from marginal donors was validated with a Markov simulation model.
HYPOTHESIS: Calcineurin-sparing protocols using anti-IL-2/antibody induction
(Simulect) show a beneficial effect on initial kidney function, reducing
transplantation costs reception based upon mean length of stay, mean admission
cost, and incidences of delayed graft function and complications during the
first month after transplant. PATIENTS AND METHODS: A Markov simulation model
was established following three different chains. A calcineurin-free regimen
with basiliximab induction (chain A), a calcineurin-sparing protocol with
basiliximab induction (chain B), and a conventional immunosuppressive regimen
(chain C). After designing the Markov chain and cohorts, 31 patients from the
“old to old” program were assigned to each chain eight to chain A, (eight to
chain B, and 15 to chain C). A month after transplantation a cost-benefit study
was performed guided by the three branches of the Markov model. RESULTS: The
Markov model showed a benefit of induction therapies in elderly patients. A
cost-benefit model showed that after a month there was a clear benefit from
Calcineurin=free plus basiliximab induction therapies, with a slight benefit
from calcineurin-sparing protocols. CONCLUSIONS: Markov models are extremely
useful when introducing new clinical therapies. In our transplant program, a
cost-effective analysis of outcomes in old patients using the Markov model
showed a clear benefit of calcineurin-sparing protocols with basixilimab
induction.
----------------------------------------------------
[117]
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
----------------------------------------------------
[118]
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
----------------------------------------------------
[119]
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
----------------------------------------------------
[120]
TÍTULO / TITLE: - Pregnancy after renal
transplantation: points to consider.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002 May;17(5):703-7.
AUTORES
/ AUTHORS: - Lessan-Pezeshki M N. Ref:: 30
----------------------------------------------------
[121]
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
----------------------------------------------------
[122]
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
----------------------------------------------------
[123]
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
----------------------------------------------------
[124]
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
----------------------------------------------------
[125]
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.
----------------------------------------------------
[126]
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
----------------------------------------------------
[127]
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.
----------------------------------------------------
[128]
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
----------------------------------------------------
[129]
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
----------------------------------------------------
[130]
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
----------------------------------------------------
[131]
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
----------------------------------------------------
[132]
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.
----------------------------------------------------
[133]
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
----------------------------------------------------
[134]
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
----------------------------------------------------
[135]
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
----------------------------------------------------
[136]
TÍTULO / TITLE: - A case of traumatic
renal graft rupture with salvage of renal function.
REVISTA
/ JOURNAL: - Clin Transplant 2001 Aug;15(4):289-92.
AUTORES
/ AUTHORS: - Akabane S; Ushiyama T; Hirano Y; Ishikawa
A; Suzuki K; Fujita K
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, Hamamatsu
University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka 431-3192,
Japan.
RESUMEN
/ SUMMARY: - An 18-yr-old man received a kidney graft
from a 60-yr-old female cadaver donor on February 8, 1996. Postoperative course
was uneventful and his serum creatinine level was stable at about 1.8 mg/dL. On
April 30, 1999, he collided with a truck while riding a motor cycle.
Macroscopic hematuria was observed and CT showed an extensive retroperitoneal
hematoma. Because his anemia and hypotension were becoming worse after
transfusion of 9 units of blood, he was operated on as an emergency case. A
large rupture reaching the pelvis and calyces was observed in the upper pole of
the grafted kidney. There were also numerous shallow lacerations, but the major
arteries and veins were not injured. The rupture was closed by suturing the
renal parenchyma with the peritoneum, and the other shallow lacerations were
closed by suturing the renal capsule. The kidney could be salvaged without
requiring hemodialysis. The serum creatinine was maintained at 2.1 mg/dL during
follow-up. A review of the literature showed that 6 cases of traumatic renal
graft rupture with salvage of the kidney have been reported. Our present case
was the seventh, and was the most severe graft rupture reported so far. N. Ref:: 7
----------------------------------------------------
[137]
TÍTULO / TITLE: - Applications of cell
therapy to whole kidney replacement.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2003 Jan;12(1):1-3.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000049810.98789.05
AUTORES
/ AUTHORS: - Hammerman MR N. Ref:: 13
----------------------------------------------------
[138]
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
----------------------------------------------------
[139]
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
----------------------------------------------------
[140]
TÍTULO / TITLE: - Intensive care and
immediate follow-up of children after renal transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Aug;33(5):2821-4.
AUTORES
/ AUTHORS: - Seikaly MG; Sanjad SA
INSTITUCIÓN
/ INSTITUTION: - Children’s Medical Center of Dallas,
Nephrology Office, Dallas, Texas, USA. N.
Ref:: 16
----------------------------------------------------
[141]
TÍTULO / TITLE: - Hyperlipidemia and
graft loss.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2423-5.
AUTORES
/ AUTHORS: - Stephan A; Barbari A; Karam A; Kilani H;
Kamel G; Masri A
INSTITUCIÓN
/ INSTITUTION: - Nephrology and Transplantation Unit, Rizk
Hospital, Beirut, Lebanon. lird@cyberia.net.lb N. Ref:: 30
----------------------------------------------------
[142]
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
----------------------------------------------------
[143]
TÍTULO / TITLE: - Thoracic radiology in
kidney and liver transplantation.
REVISTA
/ JOURNAL: - J Thorac Imaging 2002 Apr;17(2):122-31.
AUTORES
/ AUTHORS: - Fishman JE; Rabkin JM
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, University of
Miami School of Medicine, Jackson Memorial Hospital WW 279, 1611 N.W. 12th
Avenue, Miami, FL 33136, USA. jfishman@med.miami.edu
RESUMEN
/ SUMMARY: - Renal transplantation accounts for more
than half of all solid organ transplants performed in the U.S., and the liver
is the second most commonly transplanted solid organ. Although abdominal
imaging procedures are commonplace in these patients, there has been relatively
little attention paid to thoracic imaging applications. Preoperative imaging is
crucial to aid in the exclusion of infectious or malignant disease. In the
perioperative time period, thoracic imaging focuses both on standard intensive
care unit care, including monitoring devices and their complications, and on
the early infections that can occur. Postoperative management is divided into
three time periods, and the principles governing the occurrence of infections
and malignancies are reviewed. Anatomic and pathologic aspects unique to kidney
and liver transplantation patients are also discussed. N. Ref:: 35
----------------------------------------------------
[144]
TÍTULO / TITLE: - Glomerular
hypertension—an under-appreciated aspect of chronic rejection.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001 Feb;16(2):213-5.
AUTORES
/ AUTHORS: - Paul LC
N. Ref:: 20
----------------------------------------------------
[145]
TÍTULO / TITLE: - Nephron mass in kidney
transplantation.
REVISTA
/ JOURNAL: - Transplant Proc 2002 Sep;34(6):2401-2.
AUTORES
/ AUTHORS: - Barbari A; Stephan A; Masri MA; Kamel G;
Karam A; Kilani H; Abou Dayah I
INSTITUCIÓN
/ INSTITUTION: - Nephrology and Transplantation Unit, Rizk
Hospital, Beirut, Lebanon. lird@cyberia.net.lb N. Ref:: 29
----------------------------------------------------
[146]
TÍTULO / TITLE: - Homocysteine levels
among transplant recipients: effect of immunosuppressive protocols.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Sep;33(6):2945-6.
AUTORES
/ AUTHORS: - Mor E; Helfmann L; Lustig S; Bar-Nathan N;
Yussim A; Sela BA
INSTITUCIÓN
/ INSTITUTION: - Department of Transplantation, Rabin
Medical Center, Petach-Tikva, Israel.
----------------------------------------------------
[147]
TÍTULO / TITLE: - Routine
renin-angiotensin system blockade in renal transplantation?
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002
Jan;11(1):1-10.
AUTORES
/ AUTHORS: - Remuzzi G; Perico N
INSTITUCIÓN
/ INSTITUTION: - Department of Immunology and Clinic of
Organ Transplantation, Ospedali Riuniti di Bergamo and Mario Negri Institute
for Pharmacological Research, Bergamo, Italy. gremuzzi@marionegri.it
RESUMEN
/ SUMMARY: - There is ample evidence to support the
recommendation of renin-angiotensin system blockade therapy as the standard of
care for strategies aimed at preserving renal function in chronic renal
disease. Nevertheless, despite the well established antihypertensive effects of
these drugs, the use of renin-angiotensin system blockers in renal
transplantation has been quite limited so far, nephrologists being afraid of
the possibility of inducing renal insufficiency in patients with a single
kidney transplant. However, current knowledge of the ability of these agents to
control blood pressure and urinary protein excretion, as well as
post-transplant erythrocytosis, effectively in kidney transplant recipients
suggests that it is now time to apply renin-angiotensin system blockers to the
field of renal transplantation. N.
Ref:: 105
----------------------------------------------------
[148]
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.
----------------------------------------------------
[149]
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
----------------------------------------------------
[150]
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
----------------------------------------------------
[151]
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.
----------------------------------------------------
[152]
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
----------------------------------------------------
[153]
TÍTULO / TITLE: - Role of
ischemia-reperfusion injury in the development of chronic renal allograft
damage.
REVISTA
/ JOURNAL: - Transplant Proc 2001
Nov-Dec;33(7-8):3741-2.
AUTORES
/ AUTHORS: - Grinyo JM
INSTITUCIÓN
/ INSTITUTION: - Servei de Nefrologia, Hospital de
Bellvitge, University of Barcelona, Barcelona, España. jgrinyo@csub.scs.es N. Ref:: 15
----------------------------------------------------
[154]
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.
----------------------------------------------------
[155]
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
----------------------------------------------------
[156]
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
----------------------------------------------------
[157]
TÍTULO / TITLE: - High-resolution
magnetic resonance imaging to assess trabecular bone structure in patients
after transplantation: a review.
REVISTA
/ JOURNAL: - Top Magn Reson Imaging 2002
Oct;13(5):365-75.
AUTORES
/ AUTHORS: - Link TM
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, Technische
Universitat Munchen, Ismaninger Strasse 22, D-81675 Munich, Germany. tmlink@roe.med.uni-muenchen.de
RESUMEN
/ SUMMARY: - After organ transplantation patients have
a higher incidence of osteoporotic fractures. Bone mineral density (BMD)
measurements to assess fracture risk are of limited value in these patients. On
the other hand, structure-based techniques have shown promise. In this review,
the use of high-resolution magnetic resonance imaging in the analysis of the
trabecular bone structure in patients before and after renal and cardiac
transplantation cross-sectionally is presented. The analyses of calcaneal trabecular
structure were compared with BMD with regard to the prediction of
therapy-induced bone loss and osteoporotic fracture status. Sagittal and axial
T1-weighted spin-echo sequences with a voxel size of 0.2 x 0.2 x 1 mm were
performed at 1.5 T and structure measures analogous to bone histomorphometry
were calculated. In addition, fracture status of the spine and of the
peripheral skeleton was assessed. Structure measures showed significant
differences between healthy controls and patients before and after renal and
cardiac transplantation (p < 0.01). Osteoporotic fractures were found in
approximately 35% of the transplant patients; the percentage was higher in the
cardiac transplants. Structure measures and BMD were lower in patients with
fractures; differences were more significant in the cardiac transplant
patients. Using receiver operating characteristic analyses the diagnostic
performance in differentiating patients with and without fractures was highest
when BMD and structure measures were combined. Structure measures performed
better than BMD in the cardiac transplant patients, whereas results were
comparable in the renal transplant patients. In conclusion, structure measures
determined in high-resolution magnetic resonance images may be useful in assessing
changes of trabecular bone after organ transplantation and may improve the
prediction of fracture risk.
----------------------------------------------------
[158]
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
----------------------------------------------------
[159]
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
----------------------------------------------------
[160]
TÍTULO / TITLE: - Glomerular filtration
rate as a putative ‘surrogate end-point’ for renal transplant clinical trials
in children.
REVISTA
/ JOURNAL: - Pediatr Transplant 2003 Feb;7(1):18-24.
AUTORES
/ AUTHORS: - Filler G; Browne R; Seikaly MG
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, Children’s
Hospital of Eastern Ontario, Ottawa, Canada.
RESUMEN
/ SUMMARY: - Only with prospective randomized
controlled trials is it possible to evaluate the several immunosuppressive
regimens available to renal allograft recipients. Commonly used surrogate markers
of clinical outcome, such as patient and graft survival, are constantly
improving. Current immunosuppressive protocols have improved 1-yr graft
survival to over 90%. The small differences in graft survival among the various
immunosuppressive regimes require large patient cohorts in order to establish
statistical significance. Such studies are often difficult to conduct in a
timely manner, particularly in children. This necessitates the search for
better surrogate markers sensitive enough to detect differences in smaller
cohorts and in a shorter period of time. While the degree of fibrosis in
transplant biopsies might well predict long-term graft survival, protocol
biopsies are expensive, invasive, and unpopular among clinicians. In native
kidneys, glomerular filtration rate (GFR) closely correlates with disease
progression and interstitial fibrosis and appears to be well positioned as a
less invasive surrogate marker for long-term outcome. Nonetheless, the ideal
marker for GFR remains obscure. Serum creatinine has several major drawbacks,
making it a poor predictor of GFR. This review discusses the several methods
used to estimate or measure GFR with emphasis on 125I-iothalamate clearance and
serum cystatin C (cys-C). Of all the serum markers, cys-C is the most reliable
and the most promising. However, cys-C and other endogenous markers cannot
replace the diagnostic sensitivity and reliability of radiolabeled markers of
GFR such as 125I-iothalamate in renal transplant clinical trials.
Unfortunately, clearance of most radiolabeled markers of GFR including
125I-iothalamate remain costly and time consuming. N. Ref:: 70
----------------------------------------------------
[161]
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
----------------------------------------------------
[162]
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
----------------------------------------------------
[163]
TÍTULO / TITLE: - RAS blockade in
experimental renal transplantation. Benefits and limitations.
REVISTA
/ JOURNAL: - Curr Drug Targets Cardiovasc Haematol
Disord 2003 Mar;3(1):73-9.
AUTORES
/ AUTHORS: - Smit-van Oosten A; Stegeman CA; van Goor H
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology and Laboratory
Medicine, University Hospital Groningen, The Netherlands. a.smit-van.oosten@med.rug.nl
RESUMEN
/ SUMMARY: - In renal transplantation, chronic renal
transplant failure (CRTF) is the principal cause of late graft loss. Both
immunological and non-immunological factors play a role in the pathogenesis of
CRTF. However, CRTF is unresponsive to immunosuppressive therapy. In several
kidney diseases, inhibition of the renin-angiotensin system (RAS) has shown to
reduce the rate of progression of renal disease more effectively than
conventional antihypertensive drugs. Therefore, RAS blockade may be of benefit
in the treatment of CRTF. Several short-term studies in human renal transplant
recipients showed that RAS blockade had a beneficial effect on renal transplant
function, blood pressure and proteinuria. Despite these benefits physicians
remain reluctant to use ACE inhibition in these recipients, because of fear of
functional decrease in renal perfusion, especially in the setting of renal
transplant artery stenosis. To study the long-term effects of RAS blockade we
used the established Fisher to Lewis (F-L) model for CRTF, which mirrors the
progressive changes seen in humans. Studies in our lab and by others showed
that RAS blockade in the F-L model prevents proteinuria, glomerulosclerosis and
hypertension. However, when treated for 34 weeks with RAS blockade, renal
arteries developed severe intimal hyperplasia. This effect was specific for
Fisher rats. Syngrafted Fisher rats treated with ACE inhibition developed
intimal hyperplasia, but allografting significantly aggravated it. Fisher rats
have a four times higher renal ACE activity, compared with the Lewis rat. This
is comparable to the human DD/II genotype differences in ACE activity. Renal
transplant patients with the DD genotype may be more vulnerable for vascular
changes when treated with RAS blockade.
N. Ref:: 62
----------------------------------------------------
[164]
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
----------------------------------------------------
[165]
TÍTULO / TITLE: - Pulmonary-renal
vasculitic disorders: differential diagnosis and management.
REVISTA
/ JOURNAL: - Curr Rheumatol Rep 2003 Apr;5(2):107-15.
AUTORES
/ AUTHORS: - Jara LJ; Vera-Lastra O; Calleja MC
INSTITUCIÓN
/ INSTITUTION: - Clinical Research Unit and Rheumatology
Department, Hospital de Especialidades, Centro Medico La Raza, Mexico City, CP
02990, Mexico. luis_jara_quezada@hotmail.com
RESUMEN
/ SUMMARY: - Pulmonary-renal syndrome (PRS) is a
combination of diffuse pulmonary hemorrhage and glomerulonephritis.
Pulmonary-renal syndrome is not a single entity and is caused by a variety of
conditions, including Goodpastures syndrome associated with autoantibodies to
the glomerular and alveolar basement membranes, various forms of primary
systemic vasculitis associated with serum positivity for antineutrophil
cytoplasmic antibodies (ANCA), cryoglobulinemia, systemic lupus erythematosus,
systemic sclerosis, antiphospholipid syndrome, environmental factors, and
drugs. The majority of cases of PRS are associated with ANCAs. The antigen
target in Goodpastures syndrome is the alpha-3 chain of type IV collagen. The
antigen target in PRS associated with systemic vasculitis is proteinase-3 and
myeloperoxidase. Pulmonary-renal syndrome has been observed from the first to
the ninth decade of life. The widespread adoption of serologic testing
performed in an appropriate clinical context hopefully will limit diagnostic
delay. The goals of treatment in PRS are to remove the circulating antibodies,
to stop further production of autoantibodies, and to remove any antigen that
stimulates antibody production. Treatment is based on plasmapheresis, steroids,
and cyclophosphamide; however, infections are frequent contributors to death,
and less toxic alternatives may improve outcome and prognosis resulting in a
long-term survival. The degree of renal function and the percent of crescents
on renal biopsy are better predictors of outcome. Renal transplantation can be safely
carried out in PRS. N.
Ref:: 52
----------------------------------------------------
[166]
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
----------------------------------------------------
[167]
TÍTULO / TITLE: - The impact of delayed
graft function on the long-term outcome of renal transplantation.
REVISTA
/ JOURNAL: - J Nephrol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jnephrol.com/
●●
Cita: Journal of Nephrology: <> 2002 Jan-Feb;15(1):17-21.
AUTORES
/ AUTHORS: - Geddes CC; Woo YM; Jardine AG
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Western Infirmary, Glasgow,
UK. Colin.Geddes.WG@NorthGlasgow.NHS.UK
RESUMEN
/ SUMMARY: - Recent studies provide conflicting
conclusions regarding the impact of delayed graft function (DGF) on the
long-term outcome of renal transplantation. Some centres report DGF as an
independent risk factor for reduced long-term graft and patient survival, while
others report no impact on long-term outcome. Further scrutiny of data from
these studies reveals differences in the definition of DGF, definition of
long-term outcome, and statistical methods that may partly explain the
variability. The commonest definition of DGF is the need for dialysis in the
first week post-transplant, but this may be less informative than definitions
that consider DGF as a continuous variable such as time to achieving creatinine
clearance > 10ml/min. Acute rejection (AR) occurs more commonly in patients
with DGF and variability in the impact of DGF may also relate to strategies to
detect and treat AR during DGF. Centres with a vigilant strategy are likely to
note a lower impact of DGF because the associated long-term adverse impact of
AR is minimised. Furthermore, many centres reduce the dose of calcineurin
inhibiting drugs and/or use polyclonal antibody therapy during DGF but the
long-term impact of this strategy is unclear. Newer agents such as humanised
anti-IL2 monoclonal antibodies and rapamycin may have a role, but controlled
studies are required to define the optimal immunosuppressive regimen for
patients with DGF. In the meantime, measures to minimise ischaemic damage to
the transplant kidney and intensive surveillance for AR with weekly renal
biopsy in patients with DGF are recommended.
N. Ref:: 49
----------------------------------------------------
[168]
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
----------------------------------------------------
[169]
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
----------------------------------------------------
[170]
TÍTULO / TITLE: - Abnormal lipid
metabolism after renal transplantation.
REVISTA
/ JOURNAL: - Ann Transplant 2001;6(1):5-8.
AUTORES
/ AUTHORS: - Wanner C; Quaschning T
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of
Nephrology, University Hospital Wurzburg, Germany. c.wanner@medizin.uni-wuerzburg.de
RESUMEN
/ SUMMARY: - The evidence that lipid disorders in
patients following renal transplantation play a major role in the pathogenesis
of atherosclerosis and chronic renal allograft rejection is circumstantial. The
high rate of clinical vascular disease and cardiovascular complications in
renal transplant recipients, the high prevalence of an atherogenic dyslipidemia
and the evidence from the statin regression trials in the general population
suggest that lipid lowering treatment is beneficial in patients after renal
transplantation. In addition, animal models and observational studies in
patients have demonstrated correlations between plasma lipid levels and both
acute and chronic rejection. Animal transplant models and clinical trials in heart
transplant patients also suggest that statin treatment decreases the incidence
of chronic rejection. However, the mechanisms behind this protective effect
remain unsolved and no conclusive data exist proving that statins directly
inhibit the development of chronic rejection. However, sufficient evidence
exists to consider the use of these agents in the posttransplant setting for
their possible effects on cardiovascular complications. N. Ref:: 32
----------------------------------------------------
[171]
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
----------------------------------------------------
[172]
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
----------------------------------------------------
[173]
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
----------------------------------------------------
[174]
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
----------------------------------------------------
[175]
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
----------------------------------------------------
[176]
TÍTULO / TITLE: - Fibrinolysis in chronic
renal failure, dialysis and renal transplantation.
REVISTA
/ JOURNAL: - Ann Transplant 2002;7(1):34-43.
AUTORES
/ AUTHORS: - Opatrny K Jr; Zemanova P; Opatrna S; Vit L
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine I,
University Hospital and Charles University School of Medicine, Plzen, Czech
Republic. opatrny@fnplzen.cz
RESUMEN
/ SUMMARY: - The best known function of the
fibrinolytic system is its ability to dissolve blood clots. The key enzyme of
fibrinolysis, plasmin, is formed by conversion from plasminogen through the
action of activators, the most important of which is tissue type plasminogen
activator (tPA). Low levels of tPA or excessive levels of plasminogen activator
inhibitor-I (PAI-I) cause hypofibrinolysis, causally related to the development
of atherosclerosis and associated thrombotic complications, as well as with the
development of venous and arterial thrombosis. A chronic decrease in renal
function leads to hypofibrinolysis due primarily to low levels of tPA.
Hypofibrinolysis is present both in patients treated by long-term hemodialysis
and by peritoneal dialysis. The hemodialysis procedure acutely raises the
plasma levels of tPA, primarily as a result of the bioincompatibility of
materials in the extracorporeal circuit. In peritoneal dialysis, dialysis
solution dwell time is associated with an increase in PAI-I levels in the
abdominal cavity. Fibrinolysis defects occur also in renal transplant
recipients. In transplant patients, the main abnormality is also
hypofibrinolysis which, however, unlike the situation with the other methods of
renal replacement therapy, is secondary to a rise in PAI-I. A role in the
increase of the plasma levels of PAI-I in transplant patients is played by
steroid- and cyclosporine-based immunosuppression, most likely by metabolic
disorders such as insulin resistance or dyslipoproteinemia, and by genetic
factors. Animal experiments with chronic rejection have shown abnormalities in
local fibrinolysis in the graft, particularly increased PAI-I expression.
Fibrinolysis defects may contribute to an early and frequent development of
atherosclerosis in patients with chronic renal failure, to chronic dysfunction
of the renal transplant, or to peritoneal fibrosis and peritoneal catheter
obstruction in patients on peritoneal dialysis. The exact role of
hypofibrinolysis in the development of these complications, and the potential
for modulating it, warrant further research.
N. Ref:: 70
----------------------------------------------------
[177]
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
----------------------------------------------------
[178]
TÍTULO / TITLE: - Loss of bone mass after
renal transplantation.
REVISTA
/ JOURNAL: - Nephron Clin Pract 2003 Jan;93(1):C3-4.
AUTORES
/ AUTHORS: - Torres A
INSTITUCIÓN
/ INSTITUTION: - Nephrology Section, Hospital Universitario
de Canarias, Universidad de La Laguna, Tenerife, España. atores@ull.es
N. Ref:: 12
----------------------------------------------------
[179]
TÍTULO / TITLE: - Role of mesangial
expansion in the pathogenesis of diabetic nephropathy.
REVISTA
/ JOURNAL: - J Nephrol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jnephrol.com/
●●
Cita: Journal of Nephrology: <> 2001 Nov-Dec;14 Suppl 4:S51-7.
AUTORES
/ AUTHORS: - Dalla Vestra M; Saller A; Mauer M;
Fioretto P
INSTITUCIÓN
/ INSTITUTION: - Department of Medical and Surgical
Sciences, University of Padua, Italy.
RESUMEN
/ SUMMARY: - Glomerulopathy, characterized by
thickening of the glomerular basement membrane (GBM) and mesangial expansion,
is the most important renal structural change in type 1 diabetic patients with
diabetic nephropathy. Morphological lesions develop concomitantly in the
arterioles, tubules and interstitium. Mesangial fractional volume
[Vv(mes/glom)], an estimate of mesangial expansion, is the structural parameter
that best correlates with glomerular filtration rate (GFR) and it is also
closely related to the presence of proteinuria and hypertension. Diabetic
glomerulopathy has also been described in type 2 diabetic patients, but
glomerular lesions are milder than in type 1 diabetic patients. In type 2
diabetes glomerular structural parameters are, on average, altered. However,
despite persistent microalbuminuria or proteinuria, several patients have
normal glomerular structure. Renal structure is, in fact, heterogeneous in type
2 diabetic patients: only a subset has typical diabetic glomerulopathy, while a
substantial proportion has more advanced tubulo-interstitial and vascular
rather than glomerular lesions, or has normal or near normal renal structure. Also
in type 2 diabetes mesangial expansion is related to renal functional
parameters, but although significant, these structural-functional relationships
are less precise than in type 1 diabetes. Thus, both in type 1 and in type 2
diabetes, mesangial expansion is the most important structural change. Finally,
we have recently demonstrated that, the lesions of diabetic glomerulopathy can
be reversed in humans. This amelioration in glomerular structure was observed
after long-term normoglycemia obtained by pancreas transplantation. This is a
new concept in nephrology, and the understanding of the mechanisms involved in
the glomerular architectural remodelling might have important clinical and
therapeutic implications. N.
Ref:: 46
----------------------------------------------------
[180]
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
----------------------------------------------------
[181]
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.
----------------------------------------------------
[182]
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.
----------------------------------------------------
[183]
TÍTULO / TITLE: - Renin-angiotensin
system in chronic renal allograft dysfunction.
REVISTA
/ JOURNAL: - Contrib Nephrol 2001;(135):222-34.
AUTORES
/ AUTHORS: - Shihab FS
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, University of Utah
School of Medicine, Salt Lake City, Utah, USA. Fuad.Shihab@hsc.utah.edu N. Ref:: 44
----------------------------------------------------
[184]
TÍTULO / TITLE: - Intraoperative vascular
localization to facilitate endopyelotomy after renal transplantation.
REVISTA
/ JOURNAL: - ANZ J Surg 2001 Aug;71(8):485-6.
AUTORES
/ AUTHORS: - Siddins M; Kanchanabat B; Rao MM
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Transplantation, Queen
Elizabeth Hospital, Woodville, South Australia, Australia. siddinsmark@hotmail.com
RESUMEN
/ SUMMARY: - BACKGROUND: Pelviureteric junction (PUJ)
obstruction after renal transplantation is uncommon. Surgical correction can be
technically challenging due to dense perinephric adhesions and variable hilar
vascular anatomy. Endopyelotomy is well established in the treatment of PUJ
obstruction in native kidneys. METHODS: The present paper reports the first
experience of antegrade visual cold-knife endopyelotmy performed in a renal
allograft. In orientating the incision at the PUJ, preoperative imaging was
supplemented by intrarenal Doppler ultrasound, using a probe designed for
transoesophageal cardiac monitoring. To the authors’ knowledge this approach
has not previously been reported. RESULTS: Renal vascular relationships were
readily indentified by identifying arterial and venous waveforms. CONCLUSIONS:
For this uncommon procedure the use of intrarenal Doppler ultrasound provides
greater security in avoiding inadvertent vascular injury. N. Ref:: 5
----------------------------------------------------
[185]
TÍTULO / TITLE: - Transplanting a kidney
with a renal artery aneurysm—a case report and literature review.
REVISTA
/ JOURNAL: - Vasc Surg 2001 Jul-Aug;35(4):321-4.
AUTORES
/ AUTHORS: - Chiu B; Chiou AC; Leventhal JR; Stuart FP;
Pearce WH
INSTITUCIÓN
/ INSTITUTION: - Division of Vascular Surgery, Department
of Surgery, Northwestern University Medical School, Chicago, IL, USA.
RESUMEN
/ SUMMARY: - As a rare postoperative complication,
renal artery aneurysm has been reported in 0.95% of kidney transplants. A renal
artery aneurysm was repaired prior to transplantation of the kidney.
----------------------------------------------------
[186]
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
----------------------------------------------------
[187]
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
----------------------------------------------------
[188]
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
----------------------------------------------------
[189]
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
----------------------------------------------------
[190]
TÍTULO / TITLE: - Leptin and
transplantation: pieces are still missing in the puzzle.
REVISTA
/ JOURNAL: - Isr Med Assoc J 2002 Mar;4(3):207-8.
AUTORES
/ AUTHORS: - Modan-Moses D; Paret G N. Ref:: 24
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[191]
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
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