#14#
Revisiones-Ciencias
Sociales (todas) *** Reviews-Social Sciences (all)
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: - Renal physicians
association clinical practice guideline: appropriate patient preparation for
renal replacement therapy: guideline number 3.
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
May;14(5):1406-10.
AUTORES
/ AUTHORS: - Bolton WK
INSTITUCIÓN
/ INSTITUTION: - University of Virginia School of Medicine,
Charlottesville, Virginia. rpa@renalmd.org
----------------------------------------------------
[2]
TÍTULO / TITLE: - Dialysis, kidney
transplantation, or pancreas transplantation for patients with diabetes
mellitus and renal failure: a decision analysis of treatment options.
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):500-15.
AUTORES
/ AUTHORS: - Knoll GA; Nichol G
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Department of
Medicine, University of Ottawa, Canada. gknoll@ottawahospital.on.ca
RESUMEN
/ SUMMARY: - Patients with type 1 diabetes mellitus and
end-stage renal disease may remain on dialysis or undergo cadaveric kidney
transplantation, living kidney transplantation, sequential pancreas after
living kidney transplantation, or simultaneous pancreas-kidney transplantation.
It is unclear which of these options is most effective. The objective of this
study was to determine the optimal treatment strategy for type 1 diabetic
patients with renal failure using a decision analytic Markov model. Input data
were obtained from the published medical literature, the United Network for
Organ Sharing registry, and patient interviews. The outcome measures were life
expectancy (in life-years [LY]) and quality-adjusted life expectancy (in
quality-adjusted life-years [QALY]). Living kidney transplantation was
associated with 18.30 LY and 10.29 QALY; pancreas after kidney transplantation,
17.21 LY and 10.00 QALY; simultaneous pancreas-kidney transplantation, 15.74 LY
and 9.09 QALY; cadaveric kidney transplantation, 11.44 LY and 6.53 QALY;
dialysis, 7.82 LY and 4.52 QALY. The results were sensitive to the value of
several key variables. Simultaneous pancreas-kidney transplantation had the
greatest life expectancy and quality-adjusted life expectancy when living
kidney transplantation was excluded from the analysis. These data indicate that
living kidney transplantation is associated with the greatest life expectancy
and quality-adjusted life expectancy for type 1 diabetic patients with renal
failure. Treatment strategies involving pancreas transplantation should be
considered for patients with frequent metabolic complications of diabetes and
for those patients who favor kidney-pancreas transplantation over kidney
transplantation alone. For patients without a living donor, simultaneous
pancreas-kidney transplantation is associated with the greatest life expectancy.
----------------------------------------------------
[3]
TÍTULO / TITLE: - Management of the
waiting list for cadaveric kidney transplants: report of a survey and
recommendations by the Clinical Practice Guidelines Committee of the American
Society of Transplantation.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2002
Feb;13(2):528-35.
AUTORES
/ AUTHORS: - Danovitch GM; Hariharan S; Pirsch JD; Rush
D; Roth D; Ramos E; Starling RC; Cangro C; Weir MR
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, University of
California, Los Angeles, School of Medicine, Los Angeles, California 90025,
USA. gdanovitch@mednet.ucla.edu
RESUMEN
/ SUMMARY: - The Clinical Practice Guidelines Committee
of the American Society of Transplantation developed a survey to review the
policies of kidney transplant programs in the United States with respect to the
management of the steadily expanding waiting list for cadaveric kidneys. The
survey was sent to 287 centers, and 192 (67%) responded. The survey indicated
that regular follow-up monitoring, most frequently on an annual basis, is
required by the majority (71%) of programs. Patients considered to be at high
risk and candidates for combined kidney-pancreas transplantation may be
monitored more frequently. Annual screening for coronary artery disease is
typically required for asymptomatic patients considered to be at high risk for
covert disease. Noninvasive techniques are typically used, and a designated
cardiologist is usually available to the transplant program. The dialysis
nephrologist or the potential transplant recipient is expected to inform the
transplant program of intercurrent events that may affect transplant candidacy.
Standard health maintenance screening is required, together with the routine
updating of serologic and other blood tests that may be relevant to the
posttransplant course. Smaller transplant programs (<100 patients on the
waiting list) are more likely to maintain closer contact with the wait-listed
patients and to attempt to influence their treatment during dialysis and are
less likely to cancel transplants because of unanticipated pretransplant
medical problems. The work load necessitated by the follow-up monitoring of
wait-listed patients was assessed and, in the absence of specific
evidence-based information, a series of recommendations were developed to
reflect current standards of practice and to suggest future research
initiatives.
----------------------------------------------------
[4]
TÍTULO / TITLE: - Graft function and
other risk factors as predictors of cardiovascular disease outcome.
REVISTA
/ JOURNAL: - Transplantation 2001 Sep 27;72(6 Suppl):S16-9.
AUTORES
/ AUTHORS: - Forsythe JL
INSTITUCIÓN
/ INSTITUTION: - Transplant Unit, The Royal Infirmary of
Edinburgh, UK. john.forsythe@luht.scot.nhs.uk
RESUMEN
/ SUMMARY: - The high incidence of cardiovascular
disease after renal transplantation is related to a high prevalence and
accumulation of risk factors before and after transplantation. Hypertension,
posttransplantation diabetes, and hyperlipidemia are well-recognized risk
factors for the development of cardiovascular events after renal
transplantation and are strongly associated with immunosuppressive therapy.
Hyperhomocysteinemia is a potential risk factor for cardiovascular disease in
renal transplant recipients, but although a growing matter of study, a direct
association with immunosuppressive agents is not yet proven. In addition to
treatment intervention, risk management should also involve tailoring the
immunosuppressive regimen to minimize the more indirect cardiovascular risk
factors such as renal dysfunction and acute rejection. N. Ref:: 41
----------------------------------------------------
[5]
TÍTULO / TITLE: - Costs and consequences
of cytomegalovirus disease.
REVISTA
/ JOURNAL: - Am J Health Syst Pharm 2003 Dec 1;60(23
Suppl 8):S5-8.
AUTORES
/ AUTHORS: - Schnitzler MA
INSTITUCIÓN
/ INSTITUTION: - Washington University, 4547 Clayton
Avenue, Box 8084, St. Louis, MO 63110, USA. schnitz@wueconc.edu
RESUMEN
/ SUMMARY: - The impact of prophylactic oral
ganciclovir therapy on the incidence of cytomegalovirus (CMV) disease, patient
and graft survival, and costs in patients receiving kidney and liver
transplants is described. CMV disease is a common cause of morbidity and
mortality in solid organ transplant recipients unless prophylactic drug therapy
is used. Prophylactic oral ganciclovir therapy reduces the incidence of CMV
disease in kidney and liver transplant recipients. It is more effective for
recipients who are seronegative before the transplant and receive organs from
seronegative (D-/R-) donors than in seronegative recipients of organs from
seropositive (D+/R-) donors. CMV disease remains a problem in the latter. CMV
disease increases the risk of graft failure, which decreases the likelihood of
patient survival. The extent of matching of the DR subregion of the human
leukocyte antigen complex in the donor and recipient may affect graft survival
in patients with CMV disease. Graft failure is costly and should be considered
in economic analyses of CMV prophylaxis regimens because of the potential
impact of prophylaxis on CMV disease. The use of oral ganciclovir for CMV
prophylaxis has reduced the incidence of CMV disease in kidney and liver
transplant recipients. N.
Ref:: 10
----------------------------------------------------
[6]
TÍTULO / TITLE: - Health economic
evaluations: the special case of end-stage renal disease treatment.
REVISTA
/ JOURNAL: - Med Decis Making 2002
Sep-Oct;22(5):417-30.
AUTORES
/ AUTHORS: - Winkelmayer WC; Weinstein MC; Mittleman
MA; Glynn RJ; Pliskin JS
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Brigham and
Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. wolfgang@post.harvard.edu
RESUMEN
/ SUMMARY: - This article synthesizes the evidence on
the cost-effectiveness of renal replacement therapy and discusses the findings
in light of the frequent practice of using the cost-effectiveness of
hemodialysis as a benchmark of societal willingness to pay. The authors
conducted a meta-analytic review of the medical and economic literature for
economic evaluations of hemodialysis, peritoneal dialysis, and kidney
transplantation. Cost-effectiveness ratios were translated into 2000 U.S.
dollars per life-year (LY) saved. Thirteen studies published between 1968 and
1998 provided such information. The cost effectiveness of center hemodialysis
remained within a narrow range of $55,000 to $80,000/LY in most studies despite
considerable variation in methodology and imputed costs. The cost-effectiveness
of home hemodialysis was found to be between $33,000 and $50,000/LY. Kidney
transplantation, however, has become more cost-effective over time, approaching
$10,000/LY. Estimates of the cost per life-year gained from hemodialysis have
been remarkably stable over the past 3 decades, after adjusting for price
levels. Uses of the cost-effectiveness ratio of $55,000/LY for center
hemodialysis as a lower boundary of society’s willingness to pay for an additional
life-year can be supported under certain assumptions.
----------------------------------------------------
[7]
TÍTULO / TITLE: - The spectrum of kidney
disease in American Indians.
REVISTA
/ JOURNAL: - Kidney Int Suppl 2003 Feb;(83):S3-7.
AUTORES
/ AUTHORS: - Narva AS
INSTITUCIÓN
/ INSTITUTION: - Indian Health Service Kidney Disease
Program, Albuquerque, New Mexico, USA. anarva@abq.ihs.gov
RESUMEN
/ SUMMARY: - American Indians and Alaska Natives (AI/AN)
experience high rates of chronic kidney disease. Several studies have
demonstrated increased rates of early kidney disease among AI/AN, both in
diabetics and non-diabetics. Among some tribes of the American Southwest, high
rates of mesangiopathic glomerulonephritis have been documented. The epidemic
of diabetes among AI/AN, which began in the middle of the 20th
century, appears to be driving the increase in end-stage renal disease (ESRD).
At the end of 1999, AI/AN had a national prevalence rate of treated ESRD that
was 3.5 times greater than that of white Americans. There is significant
regional variation as well as differences among the approximately 550 tribes
that make up the American Indian community, with some tribes experiencing ESRD
rates over twenty times the rate of whites. Although graft survival is
excellent, AI/AN ESRD patients are less likely than whites to be placed on the
transplant waiting list, and those listed wait longer for a transplant. Despite
socioeconomic barriers and high rates of co-morbid illness, survival among
AI/AN ESRD patients is better than among whites. The burden of kidney disease,
particularly the multigenerational occurrence in some families, is perceived as
a major threat to the well-being of native communities. There is a sense of
urgency among tribal leaders to address this epidemic, and research that may
decrease its burden is likely to be welcomed.
N. Ref:: 13
----------------------------------------------------
[8]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.6. Cardiovascular risks. Smoking.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:29.
RESUMEN
/ SUMMARY: - GUIDELINE: Cigarette smoking is associated
with a high frequency of post-transplant cardiovascular disease and may
adversely influence patient and graft survival. Active measures against tobacco
smoking are recommended.
----------------------------------------------------
[9]
TÍTULO / TITLE: - Peritoneal dialysis
should be the first choice of initial renal replacement therapy for more
patients with end-stage renal disease.
REVISTA
/ JOURNAL: - ASAIO J 2001 Jul-Aug;47(4):309-11.
AUTORES
/ AUTHORS: - Mehrotra R; Nolph KD N. Ref:: 30
----------------------------------------------------
[10]
TÍTULO / TITLE: - Effects of
catecholamine application to brain-dead donors on graft survival in solid organ
transplantation.
REVISTA
/ JOURNAL: - Transplantation 2001 Aug 15;72(3):455-63.
AUTORES
/ AUTHORS: - Schnuelle P; Berger S; de Boer J; Persijn
G; van der Woude FJ
INSTITUCIÓN
/ INSTITUTION: - University Hospital Mannheim, Theodor
Kutzer Ufer 1-3, 68167 Mannheim, Germany. schnuell@rumms.uni-mannheim.de
RESUMEN
/ SUMMARY: - BACKGROUND: In a recent single-center
study, donor use of catecholamines was identified to reduce kidney allograft
rejection. This study investigates the effects of donor employment of
adrenergic agents on graft survival in a large data base, including liver and
heart transplants. METHODS: The study was based on the registry of the
Eurotransplant International Foundation including 2415 kidney, 755 liver, and
720 heart transplants performed between January 1 and December 31, 1993. A
total of 1742 donor record forms referring to the cadaveric donor activities in
1993 were systematically reviewed with regard to employment of adrenergic
agents. Catecholamine use was simply coded dichotomously and divided into three
strata according to zero, single, and combined application. Multivariate Cox
regression including age, gender, cause of brain death, cold ischemia,
HLA-mismatching, number of previous transplants, and urgency in liver
transplants was applied for statistical analysis. RESULTS: Donor employment of
catecholamines was associated with increased 4-year graft survival after kidney
transplantation (hazard ratio [HR], 0.85; 95% confidence interval [95% CI],
0.74-0.98). The benefit is conferred in a dose-dependent manner and compares in
quantitative terms with prospective HLA matching on class I and class II
antigens (HR, 0.90; 95% CI, 0.84-0.97). Use of norepinephrine was predictive of
initial nonfunction after heart transplantation (HR, 1.66; 95% CI, 1.14-2.43),
but did not compromise liver grafts (HR, 0.94; 95% CI, 0.67-1.32). CONCLUSIONS:
Optimizing the management of brain-dead organ donors, including the possibility
of selective administration of adrenergic agents, may provide a major benefit
on graft survival without adverse side effects for the recipients. Further
investigation on best use of adrenergic drugs, optimum dosage, and duration is
warranted.
----------------------------------------------------
[11]
TÍTULO / TITLE: - Why study kidney
transplant risk factors?
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 15;75(3):266-7.
AUTORES
/ AUTHORS: - Matas AJ; Humar A
INSTITUCIÓN
/ INSTITUTION: - Medical School, University of Minnesota,
Minneapolis, MN, USA. N.
Ref:: 10
----------------------------------------------------
[12]
TÍTULO / TITLE: - Quality of life after
kidney and pancreas transplantation: a review.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Sep;42(3):431-45.
AUTORES
/ AUTHORS: - Joseph JT; Baines LS; Morris MC; Jindal RM
INSTITUCIÓN
/ INSTITUTION: - Royal Bournemouth Hospital, Bournemouth,
UK.
RESUMEN
/ SUMMARY: - There is an increasing amount of data on
quality of life (QOL) in most chronic illnesses; some of the instruments used
are generic, but recently, there is a tendency to use disease-specific
instruments. We propose that recipients of organ transplants be assessed
routinely for QOL by means of the 36-Item Short-Form Health Survey or a
disease-specific instrument; for compliance, by means of the Long-Term
Medication Behavior Self-Efficacy Scale; and for psychological status, by means
of the Beck Depression Inventory Brief Symptom Inventory or the Symptom
Checklist. The widespread use of QOL data in recipients of organ transplants
will increase accountability of service providers and eventually increase patient
satisfaction because these instruments are patient reported. N. Ref:: 92
----------------------------------------------------
[13]
TÍTULO / TITLE: - Hormone replacement
therapy in postmenopausal women with end-stage renal disease: a review of the issues.
REVISTA
/ JOURNAL: - Semin Dial 2001 May-Jun;14(3):146-9.
AUTORES
/ AUTHORS: - Holley JL; Schmidt RJ
RESUMEN
/ SUMMARY: - Hormone replacement is an integral part of
therapies to prevent osteoporosis in postmenopausal women and may be considered
a component in the treatment of dyslipidemia, cardiovascular disease, and
possibly cognitive function. The indications for, and efficacy and prescription
of, hormone replacement therapy in postmenopausal women with ESRD have been
infrequently studied and less than 10% of postmenopausal women on dialysis are
receiving hormone replacement. Small studies suggest that hormone replacement
therapy is valuable in treating the dyslipidemia of women on dialysis, but
indicate that a reduction in the dosage of hormone replacement may be needed. A
potential role for hormone replacement therapy in the treatment and/or
prevention of osteoporosis and sexual dysfunction in postmenopausal women on
dialysis exists as well. N.
Ref:: 33
----------------------------------------------------
[14]
TÍTULO / TITLE: - Nonheart-beating kidney
donation: current practice and future developments.
REVISTA
/ JOURNAL: - Kidney Int 2003 Apr;63(4):1516-29.
AUTORES
/ AUTHORS: - Brook NR; Waller JR; Nicholson ML
INSTITUCIÓN
/ INSTITUTION: - Division of Transplant Surgery, The
Department of Surgery, University of Leicester, Leicester General Hospital,
Leicester, United Kingdom. nicholasbrook@gfastmail.fm
RESUMEN
/ SUMMARY: - BACKGROUND: Nonheart-beating kidney
donation (NHBD) is gaining acceptance as a method of donor pool expansion.
However, a number of practitioners have concerns over rates of delayed graft
function, acute rejection, and long-term graft survival. The ethical issues
associated with NHBD are complex and may be a further disincentive. Tailored
strategies for preservation, viability prediction, and immunosuppression for
kidneys from this source have the potential to maximize the number of available
organs. This review article presents the current practice of NHBD kidney
transplantation, examines the results and draws comparisons with cadaveric
kidneys, and explores some areas of potential development. METHODS: A review of
the current literature on NHBD kidney donation was performed. RESULTS: The
renewed interest in NHBD kidneys is driven by a continuing shortfall in
available organs. Those centers involved in NHBD report an increase in kidney
transplants of the order of 16% to 40% and there is no evidence that the
financial costs are higher with NHBDs. The majority of experience comes from
Maastricht category 2 NHBDs, where an estimation of warm time is possible. This
is generally limited to 40 minutes. There are variations in the technique for
kidney preservation prior to retrieval, but most centers use an aortic balloon
catheter. Much work has looked at the ideal technique for kidney preservation
prior to implantation. Evidence suggests that machine perfusion produces the
best initial function rates, decreased use of adjuvant immunotherapy and fewer
haemodialysis sessions than static cold storage. CONCLUSION: Despite being
associated with poorer initial graft function, the long-term allograft survival
of NHBD kidneys does not differ from the results of transplantation from cadaveric
kidneys. Further, serum creatinine levels are generally equivalent. Constant
reassessment of the ethical issues is required for donation to be increased
while respecting public concerns. Use of viability assessment and tailoring of
immune suppression for NHBD kidneys may allow a further increase in donation
from this source. N.
Ref:: 132
----------------------------------------------------
[15]
TÍTULO / TITLE: - Proposed guidelines for
re-evaluation of patients on the waiting list for renal cadaver transplantation.
REVISTA
/ JOURNAL: - Transplantation 2002 Mar 15;73(5):811-2.
AUTORES
/ AUTHORS: - Matas AJ; Kasiske B; Miller L
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, University of
Minnesota, Minneapolis, MN 55455, USA.
RESUMEN
/ SUMMARY: - Transplant candidates are extensively
evaluated before being wait-listed for cadaver transplantation. Yet many wait a
number of years before being transplanted. We propose guidelines for regular
cardiac re-evaluation for patients on the waiting list.
----------------------------------------------------
[16]
TÍTULO / TITLE: - Random sample (DOPPS)
versus census-based (registry) approaches to kidney disease research.
REVISTA
/ JOURNAL: - Blood Purif 2003;21(1):85-8.
AUTORES
/ AUTHORS: - Port FK; Wolfe RA; Held PJ; Young EW
INSTITUCIÓN
/ INSTITUTION: - University of Renal Research and Education
Association (URREA), Ann Arbor, Mich, USA. fport@urrea.org
RESUMEN
/ SUMMARY: - This review describes advantages and limitations
of registries that base their analyses on the census of all patients.
Registries may utilize the random sample approach to enrich their data for more
detailed and informative research. The Dialysis Outcomes and Practice Pattern
Study (DOPPS) and its random sample approach is discussed here in detail, with
examples on the value of this method. The DOPPS is currently being expanded to
allow for even more valuable studies. This methodology can also be applied to
large countries that do not have an existing registry, as it is an effective
way of collecting detailed information at a relatively low cost that is
representative of the country or population as a whole. N. Ref:: 12
----------------------------------------------------
[17]
TÍTULO / TITLE: - Clinical audit and
long-term evaluation of renal transplant recipients.
REVISTA
/ JOURNAL: - Transplantation 2001 Dec 27;72(12
Suppl):S94-8.
AUTORES
/ AUTHORS: - Short CD; Russell S; Valentine A
RESUMEN
/ SUMMARY: - Renal transplant recipients now have an
increased life expectancy, and this has highlighted the need for increased
concern about the long-term complications associated with transplantation. To
better manage renal transplant recipients over the long term, it is essential
to schedule periodic clinic visits to detect problems and intervene in a timely
fashion. Besides enabling early detection and possible treatment, periodic
visits permit continuing patient education. Unfortunately, there is no
scientifically based consensus that indicates what the optimal frequency and
timing of such visits should be, although the AST has recently issued some
guidelines. At the MINT, an Annual Review Clinic has been implemented to
provide better service to renal transplant recipients over the long term. The
clinic offers a comprehensive medical assessment, identifies and quantifies
risk factors for CVD, and initiates referrals to appropriate specialists. The
Annual Review Clinic increases patient awareness in a number of areas specific
to transplantation, promotes a positive approach to healthcare, enables
collection of structured data for analysis, and, with hope, engenders a
significant degree of patient well-being and satisfaction. The medical
community needs to continue long-term patient evaluation and clinical audit as
means to improve long-term patient and graft survival, as well as patient
quality of life. N.
Ref:: 31
----------------------------------------------------
[18]
TÍTULO / TITLE: - Kidney transplantation
from living-unrelated donors: comparison of outcome with living-related and
cadaveric transplants under current immunosuppressive protocols.
REVISTA
/ JOURNAL: - Urology 2003 Dec;62(6):1002-6.
AUTORES
/ AUTHORS: - Chkhotua AB; Klein T; Shabtai E; Yussim A;
Bar-Nathan N; Shaharabani E; Lustig S; Mor E
INSTITUCIÓN
/ INSTITUTION: - National Centre of Urology, Tbilisi,
Georgia.
RESUMEN
/ SUMMARY: - OBJECTIVES: Living-unrelated donors may
become an additional organ source for patients on the kidney waiting list. We
studied the impact of a combination of calcineurin inhibitors and
mycophenolate-mofetil together with steroids on the outcomes of living-related
(LRD), unrelated (LUR), and cadaver transplantation. METHODS: Between September
1997 and January 2000, 129 patients underwent LRD (n = 80) or LUR (n = 49)
kidney transplantation, and another 173 patients received a cadaveric kidney.
Immunosuppressive protocols consisted of mycophenolate-mofetil with
cyclosporine-Neoral (41%) or tacrolimus (59%) plus steroids. We compared the
patient and graft survival data, rejection rate, and graft functional
parameters. RESULTS: LRD recipients were younger (33.6 years) than LUR (47.8
years) and cadaver (43.7 years) donor recipients (P <0.001). HLA matching
was higher in LRD patients (P <0.001). Acute rejection developed in 28.6% of
LUR versus 27.5% of LRD transplants and 29.7% of cadaver kidney recipients (P =
not significant). The creatinine level at 1, 2, and 3 years after transplant
was 1.63, 1.73, and 1.70 mg% for LRD patients; 1.48, 1.48, and 1.32 mg% for LUR
patients; and 1.75, 1.68, and 1.67 mg% for cadaver kidney recipients (P = not
significant), respectively. No difference in patient survival rates was found
among the groups. The 1, 2, and 3-year graft survival rates were significantly
better in recipients of LRD (91.3%, 90.0%, and 87.5%, respectively) and LUR
transplants (89.8%, 87.8%, and 87.8%, respectively) than in cadaver kidney
recipients (81.5%, 78.6%, 76.3%, respectively; P <0.01). CONCLUSIONS:
Despite HLA disparity, the rejection and survival rates of LUR transplants
under current immunosuppressive protocols are comparable to those of LRD and
better than those of cadaveric transplants.
----------------------------------------------------
[19]
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.
----------------------------------------------------
[20]
TÍTULO / TITLE: - Use of a pelvic kidney
for living transplantation: case report and review of the literature.
REVISTA
/ JOURNAL: - Am J Transplant 2003 Feb;3(2):235-8.
AUTORES
/ AUTHORS: - Luke PP; McAlister VC; Jevnikar AM; House
AA; Muirhead N; Cross J; Hollomby D; Chin JL
INSTITUCIÓN
/ INSTITUTION: - Departments of Surgery and Medicine,
London Health Sciences Center, the Multi-organ Transplant Program, The
University of Western Ontario, London, Ontario, Canada. patrick.luke@ihsc.on.ca
RESUMEN
/ SUMMARY: - Pelvic kidneys have anomalous vascular
supplies and collecting systems. Therefore, careful radiologic and functional
evaluation of these kidneys must be performed prior to procurement for
transplantation. We report the successful use of a pelvic kidney for
living-related transplantation. N.
Ref:: 7
----------------------------------------------------
[21]
TÍTULO / TITLE: - General health
management and long-term care of the renal transplant recipient.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S10-24.
AUTORES
/ AUTHORS: - Cohen D; Galbraith C
INSTITUCIÓN
/ INSTITUTION: - Columbia Presbyterian Hospital, New York,
NY 10032, USA. djc5@columbia.edu
RESUMEN
/ SUMMARY: - The steady improvement in short-term
success rates in renal transplant patients has translated into better long-term
success rates and a large number of patients with long-functioning renal
transplants. The necessity for the lifelong administration of immunosuppressive
medications to prevent rejection, coupled with the presence in many patients of
a variety of other medical problems dating from the period of renal
insufficiency prior to the time of renal transplantation, has created a large
group of patients with a unique and complex set of long-term medical care
needs. Due to the constraints of managed care, considerations of geography, or
patient preference, the long-term care of an increasing number of renal
transplant recipients has shifted away from the transplant center to the
community-based nephrologist or internist. For optimal care to be delivered, it
is important that the physicians managing these patients be cognizant of the
complex and interacting medical issues involved in their care. Appropriate
management can significantly prolong the life of the allograft as well as that
of the patient. Guidelines for understanding and managing some of the more
important and common general medical problems facing the long-term renal
transplant recipient (eg, infectious complications, cardiovascular disease,
hypertension, diabetes, hyperlipidemia, malignancy, pregnancy, bone disease,
dental care, preventive care) are addressed in this section. N. Ref:: 47
----------------------------------------------------
[22]
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
----------------------------------------------------
[23]
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
----------------------------------------------------
[24]
TÍTULO / TITLE: - Preparing the patient
for renal replacement therapy. Teamwork optimizes outcomes.
REVISTA
/ JOURNAL: - Postgrad Med. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.postgradmed.com/journal.htm
●●
Cita: Postgraduate Medicine: <> 2002 Jun;111(6):97-8, 101-4, 107-8.
AUTORES
/ AUTHORS: - Bolton WK; Owen WF Jr
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, University of
Virginia School of Medicine, PO Box 800133, Charlottesville, VA 22908, USA. wkb5s@virginia.edu
RESUMEN
/ SUMMARY: - Proper preparation of a patient with CKD
for the development of ESRD and the need for RRT is essential to optimize the
patient’s quality and quantity of life and to help ensure positive economic and
societal outcomes. A collaborative team approach involving the primary care
physician team, the patient and his or her family and friends, and the
nephrology team should result in improved care of the CKD patient and improved
outcomes. It is not possible, feasible, or practical to attempt to provide the
inclusive care necessary to attain these goals in a system that does not take
advantage of the strengths of a team approach. Adopting this concept of care
for patients with kidney disease results in a win-win situation for all of the
participants—the patients, the physicians, and society. N. Ref:: 17
----------------------------------------------------
[25]
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
----------------------------------------------------
[26]
TÍTULO / TITLE: - Loss of living donor
renal allograft survival advantage in children with focal segmental
glomerulosclerosis.
REVISTA
/ JOURNAL: - Kidney Int 2001 Jan;59(1):328-33.
AUTORES
/ AUTHORS: - Baum MA; Stablein DM; Panzarino VM; Tejani
A; Harmon WE; Alexander SR
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Children’s
Hospital, Harvard Medical School, Boston, Massachusetts, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Because of concerns of
increased risk of graft loss with recurrent disease, living donor (LD)
transplantation in children with focal segmental glomerulosclerosis (FSGS) has
been controversial. METHODS: The North American Pediatric Renal Transplant
Cooperative Study (NAPRTCS) database from January 1987 to January 2000 was
examined to determine differences in demographics, treatment, and outcomes in
children with FSGS compared with other renal diseases. RESULTS: Data on 6484
children, 752 (11.6%) with FSGS, demonstrated that FSGS patients were more likely
to be older and black, and were less likely to receive either pre-emptive or LD
transplant (P < 0.001). No differences existed in human lymphocyte antigen
(HLA) matching or immunosuppression regimens. Acute tubular necrosis occurred
in more FSGS patients following LD (11.8 vs. 4.6%) or cadaveric (CD; 27.9 vs.
16.3%) transplants (P < 0.001). Graft survival was worse for LD FSGS
patients (5 years 69%) compared with no FSGS (82%, P < 0.001) and was not
significantly different than CD graft survival in the FSGS (60%) and No FSGS
groups (67%). The LD to CD ratios of relative risk of graft failure were higher
in FSGS patients (test for interaction, P = 0.01). Recurrence of original
disease was the only cause of graft failure that differed between groups (P <
0.001). A greater percentage of LD FSGS graft failures was attributed to
recurrence (P = 0.06). CONCLUSIONS: The impact of FSGS on graft survival in
children is greatest in LD transplants, resulting in loss of expected LD graft
survival advantage. The rationale for LD grafts in children with FSGS should be
based on factors other than better outcomes typically associated with LD
transplantation.
----------------------------------------------------
[27]
TÍTULO / TITLE: - Identification of
patients best suited for combined liver-kidney transplantation: part II.
REVISTA
/ JOURNAL: - Liver Transpl 2002 Mar;8(3):193-211.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2002.32504
AUTORES
/ AUTHORS: - Davis CL; Gonwa TA; Wilkinson AH
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of Nephrology,
University of Washington, Seattle, WA 98195, USA. cdavis@u.washington.edu
RESUMEN
/ SUMMARY: - Liver-kidney transplantation (LKT) should
be reserved for those recipients with primary disease affecting both organs.
However, increasing transplant list waiting times have increased the
development and duration of acute renal failure before liver transplantation.
Furthermore, the need for posttransplant calcineurin inhibitors can render
healing from acute renal failure difficult. Because of the increasing requests
for and controversy over the topic of a kidney with a liver transplant (OLT)
when complete failure of the kidney is not known, the following article will
review the impact of renal failure on liver transplant outcome, treatment of
peri-OLT renal failure, rejection rates after LKT, survival after LKT, and
information on renal histology and progression of disease into the beginnings
of an algorithm for making a decision about combined LKT. N. Ref:: 112
----------------------------------------------------
[28]
TÍTULO / TITLE: - The evaluation of renal
transplantation candidates: clinical practice guidelines.
REVISTA
/ JOURNAL: - Am J Transplant 2002;1 Suppl 2:1-95.
AUTORES
/ AUTHORS: - Kasiske BL; Cangro CB; Hariharan S; Hricik
DE; Kerman RH; Roth D; Rush DN; Vazquez MA; Weir MR
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Hennepin County
Medical Center, University of Minnesota, Minneapolis
----------------------------------------------------
[29]
TÍTULO / TITLE: - Preimplantation renal
biopsy: structure does predict function.
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 15;75(3):264-6.
AUTORES
/ AUTHORS: - D’Agati VD; Cohen DJ
INSTITUCIÓN
/ INSTITUTION: - Columbia University College of Physicians
and Surgeons, New York, NY, USA. N.
Ref:: 11
----------------------------------------------------
[30]
TÍTULO / TITLE: - Using DAVE as a model
to go beyond treatment compliance with persons receiving renal replacement
therapy.
REVISTA
/ JOURNAL: - Soc Work Health Care 2002;36(2):35-48.
AUTORES
/ AUTHORS: - Bordelon TD
INSTITUCIÓN
/ INSTITUTION: - Social Work Department, University of
Southern Indiana, Evansville, IN, USA.
RESUMEN
/ SUMMARY: - DAVE is an acronym for Dialogue, Accept,
Validate, and Enact conceptualized for the purpose of helping nephrology social
workers assist persons with End-Stage Renal Disease take an active role in
making treatment decisions, especially the decision to comply with a treatment
regimen. As a model, DAVE is a summation of contemporary social work practice
including views on empowerment, the Strengths Perspective, and the
Problem-Solving Process. DAVE attunes the nephrology social worker and the
dialysis recipient to an attitude of mutual trust, respect, and collaboration
essential to helping dialysis recipients make important treatment
decisions. N. Ref:: 32
----------------------------------------------------
[31]
TÍTULO / TITLE: - Is kidney donation in
the donor’s best interest?
REVISTA
/ JOURNAL: - Transplantation 2003 Sep 15;76(5):753-4.
AUTORES
/ AUTHORS: - Ross LF
INSTITUCIÓN
/ INSTITUTION: - MacLean Center for Clinical Medical
Ethics, University of Chicago, Illinois, USA.
N. Ref:: 9
----------------------------------------------------
[32]
TÍTULO / TITLE: - Effects of patient
compliance, parental education and race on nephrologists’ recommendations for
kidney transplantation in children.
REVISTA
/ JOURNAL: - Am J Transplant 2003 Jan;3(1):28-34.
AUTORES
/ AUTHORS: - Furth SL; Hwang W; Neu AM; Fivush BA; Powe
NR
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, The John Hopkins
Medical Institution, Baltimore, MD, USA. sfurth@jhmi.edu
RESUMEN
/ SUMMARY: - Transplantation is the treatment goal for
youth with kidney failure. To assess the effects of compliance, parental
education and race on nephrologists’ recommendations for transplantation in
children, we surveyed a national random sample of adult and pediatric
nephrologists. We elicited transplant recommendations for case vignettes
created from random combinations of patient age, gender, race, cause of renal
failure, family structure, parental education and compliance. Of 519 eligible
physicians, 316 (61%) responded. Nephrologists were more likely to recommend
transplantation for children of college-educated parents than children of
parents who did not finish high school, despite identical clinical and
demographic characteristics (adjusted OR 1.48, 95% CI 1.18, 1.86). Patient
noncompliance negatively influenced transplant recommendations (adjusted OR
0.1, 95% CI 0.08, 0.13). Additionally, compliance had a different effect on
transplant recommendations for white compared with black patients. The adjusted
OR of a white, compliant patient being referred for transplantation were twice
that of a black compliant patient (OR 2.06, 95% CI 1.17, 3.6). Education and
compliance with therapy independently influence nephrologists’ recommendations
for transplantation in youth with kidney failure. Among the most compliant
candidates, referral for transplantation may vary with patient race.
----------------------------------------------------
[33]
TÍTULO / TITLE: - Renal replacement
therapy in Hungary: the decade of transition.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Jun;18(6):1066-71.
AUTORES
/ AUTHORS: - Mogyorosy Z; Mucsi I; Rosivall L
INSTITUCIÓN
/ INSTITUTION: - International Programme, Centre for Health
Economics, University of York, UK. N.
Ref:: 20
----------------------------------------------------
[34]
TÍTULO / TITLE: - Kidney transplantation:
graft monitoring and immunosuppression.
REVISTA
/ JOURNAL: - World J Surg 2002 Feb;26(2):185-93. Epub
2001 Dec 17.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00268-001-0206-1
AUTORES
/ AUTHORS: - Fisher JS; Woodle ES; Thistlethwaite JR Jr
INSTITUCIÓN
/ INSTITUTION: - Section of Transplantation, Department of
Surgery, University of Tennessee, Room A-202, Memphis,Tennessee 38103, USA.
RESUMEN
/ SUMMARY: - Renal transplantation has become the
preferred means of treating end-stage renal disease. Episodes of allograft
rejection have become the exception rather than the rule. The development of
real-time ultrasound-guided allograft biopsy and adoption of the Banff criteria
for histologic evaluation permit safe,accurate monitoring of graft histology.
New immunosuppressive agents have drastically reduced the number of episodes of
both primary and refractory rejection. Novel biologic agents in the form of
monoclonal antibodies and soluble receptor hybrid molecules may serve to reduce
the required doses of toxic chemical immunosuppressants and provide more
specific immune suppression directed at those elements of the immune system
involved in rejection of a given allograft. Development of assays to identify
patients who demonstrate donor antigen-specific hyporeactivity is now feasible.
Hopefully, these assays will serve as a guide for the reduction and possible
removal of immunosuppressive agents from stable renal allograft
recipients. N. Ref:: 81
----------------------------------------------------
[35]
TÍTULO / TITLE: - Laparoscopic donor
nephrectomy.
REVISTA
/ JOURNAL: - Br J Surg 2003 Nov;90(11):1323-32.
●●
Enlace al texto completo (gratuito o de pago) 1002/bjs.4340
AUTORES
/ AUTHORS: - Handschin AE; Weber M; Demartines N;
Clavien PA
INSTITUCIÓN
/ INSTITUTION: - Department of Visceral and Transplant Surgery,
University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
RESUMEN
/ SUMMARY: - BACKGROUND: Living kidney donation
represents an important source of organs for patients with end-stage renal
failure. Over the past decade, laparoscopic donor nephrectomy has replaced the
conventional open procedure in many transplant centres. Using evidence-based
methods, this study examines the current status of laparoscopic donor
nephrectomy. METHOD: A Medline literature search (PubMed database, 1999-2002)
and manual cross-referencing were performed to identify all articles relating
to laparoscopic donor nephrectomy. Safety and efficacy criteria were analysed
systematically for each study. Studies included were categorized using an
evidence-based level grading system. RESULTS: Of 687 publications, 20 studies
with level I-II evidence and 12 with level III evidence were analysed. Only one
level I study could be identified. Level I and level II evidence suggests
superiority of the laparoscopic approach in regard to postoperative analgesic
consumption, hospital stay and return to work. Other safety and efficacy
criteria, including donor and recipient outcomes, were similar between the two
techniques. CONCLUSION: Laparoscopic donor nephrectomy has gained community
acceptance by physicians and patients over the past decade. Despite a lack of
strong evidence, such as large prospective randomized studies, laparoscopic
donor nephrectomy is likely to become the ‘gold standard’ for donor nephrectomy
in the near future. N.
Ref:: 78
----------------------------------------------------
[36]
TÍTULO / TITLE: - Successful kidney
transplantation using organs from a donor with disseminated intravascular
coagulation and impaired renal function: case report and review of the
literature.
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):412-5.
AUTORES
/ AUTHORS: - Pastural M; Barrou B; Delcourt A; Bitker
MO; Ourahma S; Richard F
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, Hopital La
Pitie-Salpetriere, Paris, France. N.
Ref:: 9
----------------------------------------------------
[37]
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
----------------------------------------------------
[38]
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
----------------------------------------------------
[39]
TÍTULO / TITLE: - Guidelines for
conducting a psychiatric evaluation of the unrelated kidney donor.
REVISTA
/ JOURNAL: - Psychosomatics 2003 Nov-Dec;44(6):452-60.
AUTORES
/ AUTHORS: - Leo RJ; Smith BA; Mori DL
INSTITUCIÓN
/ INSTITUTION: - Department of Psychiatry, School of
Medicine and Biomedical Sciences, State University of New York at Buffalo, NY
14215, USA.
RESUMEN
/ SUMMARY: - Living unrelated kidney donors have been
increasingly sought out as potential resources for patients with end-stage
renal disease. Several psychiatric issues must be factored into the presurgical
evaluation of prospective donors. This paper describes a proposed guideline
intended to assist clinicians in the psychiatric evaluation of prospective
kidney donors. Topics covered in the interview include the prospective donor’s
stability and ability to make an informed decision, the donor’s understanding
of the recipient’s illness and of the transplant surgery, and extenuating
factors that may influence the decision to donate. While efficient and
thorough, the guideline is intended to be flexible enough to address the
variety of issues that can affect the prospective donor’s decision to pursue
surgery. N. Ref:: 19
----------------------------------------------------
[40]
TÍTULO / TITLE: - Developmental
approaches to kidney tissue engineering.
REVISTA
/ JOURNAL: - Am J Physiol Renal Physiol. Acceso
gratuito al texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ajprenal.physiology.org/
●●
Cita: American J. of Physiology. Renal Physiology: <> 2004
Jan;286(1):F1-7.
●●
Enlace al texto completo (gratuito o de pago) 1152/ajprenal.00167.2003
AUTORES
/ AUTHORS: - Steer DL; Nigam SK
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Pediatrics, and
Cellular Molecular Medicine, University of California, 9500 Gilman Drive, La
Jolla, CA 92093-0693, USA.
RESUMEN
/ SUMMARY: - Recent advances in our understanding of
the developmental biology of the kidney, as well as the establishment of novel
in vitro model systems, have potential implications for kidney tissue
engineering. These advances include delineation of the roles of a number of
growth factors in the developmental programs of branching morphogenesis and
mesenchymal differentiation, a new understanding of the roles of the
extracellular matrix, identification of potential “renal” stem cells, the ex
vivo propagation and subsequent recombination of isolated components of the
kidney, and successful transplantation of renal primordia into adult hosts.
This review will examine these advances in the context of approaches to tissue
engineering. Finally, novel approaches that synthesize advances in both
cell-based and organ-based approaches are proposed. N. Ref:: 46
----------------------------------------------------
[41]
TÍTULO / TITLE: - Age and renal
transplantation: an interim analysis.
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):471-6.
AUTORES
/ AUTHORS: - Schratzberger G; Mayer G
INSTITUCIÓN
/ INSTITUTION: - University Hospital, Department of
Internal Medicine, Division of Nephrology, Innsbruck, Austria. gabriele.schratzberger@uibk.ac.at N. Ref:: 52
----------------------------------------------------
[42]
TÍTULO / TITLE: - Allocation of deceased
donor kidneys: past, present, and future.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Nov;42(5):882-90.
AUTORES
/ AUTHORS: - Danovitch GM; Cecka JM
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, David Geffen
School of Medicine at University of California at Los Angeles, Los Angeles, CA
90095-1689, USA. gdanovitch@mednet.ucla.edu
RESUMEN
/ SUMMARY: - The manner in which deceased donor kidneys
are allocated has broad relevance to the care of patients with end-stage renal
disease. An algorithm governing the allocation of deceased donor kidneys has
been applied in the United States since 1987. Adjustments were made to
facilitate the national sharing of highly matched kidneys, but the main
components of the algorithm remained largely unchanged. In ensuing years, the
number of patients on the waiting list has increased steadily while the supply
of kidneys has remained constant. The waiting time for an organ now is measured
in years, and the allocation of organs has become unpredictable. As of October
2002, several important changes have been made to the algorithm. These changes
are designed to increase the relative number of minority patients who undergo transplantation
and the use of extended-criteria donor kidneys. They also have practical
implications for the management of patients on the waiting list. The rationale
behind these changes is discussed in the context of the ethical underpinnings
of kidney allocation. N.
Ref:: 42
----------------------------------------------------
[43]
TÍTULO / TITLE: - The risk of living
kidney donation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 May;18(5):871-3.
AUTORES
/ AUTHORS: - Hartmann A; Fauchald P; Westlie L; Brekke
IB; Holdaas H N.
Ref:: 24
----------------------------------------------------
[44]
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.
----------------------------------------------------
[45]
TÍTULO / TITLE: - Role of donor kidney
biopsies in renal transplantation.
REVISTA
/ JOURNAL: - Transplantation 2001 May 27;71(10):1361-5.
AUTORES
/ AUTHORS: - Randhawa P
INSTITUCIÓN
/ INSTITUTION: - Division of Transplantation Pathology,
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh,
PA 15213, USA. N.
Ref:: 48
----------------------------------------------------
[46]
- Castellano -
TÍTULO / TITLE:Presente y futuro del trasplante
renal. Present and future of kidney transplantation.
REVISTA
/ JOURNAL: - Actas Urol Esp. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aeu.es/actas/
●●
Cita: Actas Urológicas Españolas: <> 2002 Nov-Dec;26(10):731-58.
AUTORES
/ AUTHORS: - Burgos FJ; Alcaraz A; Castillon I;
Gonzalez Martin M; Lledo E; Matesanz R; Marcen R; Montanes P; Pascual J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Urologia, Hospital Ramon y
Cajal, Universidad Alcala, Madrid.
RESUMEN
/ SUMMARY: - Renal transplant is the treatment of
choice for the patient with end stage renal disease. España is the country with
the highest donation rate (33 ppm). However, at present this figure is
stabilized. The development of non-beating heart programmes, living-donor
nephrectomy (specially laparoscopic nephrectomy) programmes, and may be
xenotransplantation in a non-immediate future could increase the
transplantation activity. The knowledge of preservation mechanisms, specially with
the use of perfusion machines allows to rescue for transplantation kidneys with
a long warm-ischemia time. Furthermore, these machines are useful for analyzing
viability markers. The new immunosuppressive drugs: Tacrolimus,
Mycophenolate-Mophetil, Rapamycin and monoclonal antibodies against alpha chain
of the interleukine-2 receptor (Basoliximab and Dazcizumab) have reduced the
incidence of acute rejection in the immediate renal transplant period. However,
its effect in the long-term follow-up period is still a matter of controversy.
The incidence of tumour in the renal transplant recipient is increased,
specially those of lymphoma, skin cancer and Kaposi sarcoma. Periodical exams
for detecting the development of tumours are mandatory in this population.
Finally, xenotransplantation is an attractive alternative, although
immunological, infective and ethical barriers should previously be
resolved. N. Ref:: 92
----------------------------------------------------
[47]
TÍTULO / TITLE: - Protocol biopsies should
be part of the routine management of kidney transplant recipients. Pro.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2002 Oct;40(4):671-3.
AUTORES
/ AUTHORS: - Rush D
INSTITUCIÓN
/ INSTITUTION: - Winnipeg Transplant Program Winnipeg,
Manitoba, Canada.
----------------------------------------------------
[48]
TÍTULO / TITLE: - Renal failure and renal
replacement therapy.
REVISTA
/ JOURNAL: - Crit Care Clin 2003 Jul;19(3):563-75.
AUTORES
/ AUTHORS: - Maxvold NJ; Bunchman TE
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatric Critical Care,
Children’s Hospital of Alabama, University of Alabama at Birmingham, 1600 7th
Avenue, Birmingham, AL 35233, USA.
RESUMEN
/ SUMMARY: - Continuous renal replacement therapy is an
effective means for fluid and solute management in ARF/MOSF. Prospective
studies have examined issues of anticoagulation, the impact of
replacement/dialysis, the effects of bicarbonate-versus lactate-based
solutions, and nutritional and medication clearance. Speculation and bias
exists concerning when and for what indications CRRT should be initiated. Many
clinicians, supported by data from Ronco and Goldstein, would contest that
early institution is better if the risks (eg, access, anticoagulation) are
minimal and the possible benefits are maximal. The authors, examining the
issues as an intensivist and as a nephrologist, believe that early institution,
aggressive replacement/dialysis, and use of citrate-based replacement fluids
provide substantive advantages. With the advent of Ronco’s recent data on
sepsis managed with filtration and plasma absorption, the indication for use of
CRRT in MOSF may become more evident regardless of the presence or absence of
ARF. N. Ref:: 56
----------------------------------------------------
[49]
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
----------------------------------------------------
[50]
TÍTULO / TITLE: - Prescription of
adequate renal replacement in critically ill patients.
REVISTA
/ JOURNAL: - Blood Purif 2001;19(2):238-44.
AUTORES
/ AUTHORS: - Paganini EP; Kanagasundaram NS; Larive B;
Greene T
INSTITUCIÓN
/ INSTITUTION: - Section of Dialysis & Extracorporeal
Therapy, Department of Nephrology/Hypertension, The Cleveland Clinic
Foundation, Cleveland, Ohio, USA. paganie@ccf.org N. Ref:: 47
----------------------------------------------------
[51]
TÍTULO / TITLE: - Expanded criteria
donors for kidney transplantation.
REVISTA
/ JOURNAL: - Am J Transplant 2003;3 Suppl 4:114-25.
AUTORES
/ AUTHORS: - Metzger RA; Delmonico FL; Feng S; Port FK;
Wynn JJ; Merion RM
INSTITUCIÓN
/ INSTITUTION: - TransLife-Florida Hospital Medical Center,
Orlando, FL, USA. N.
Ref:: 19
----------------------------------------------------
[52]
- Castellano -
TÍTULO / TITLE:Trasplante renal de donante vivo.
Living donor renal transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2001;21 Suppl 4:97-100.
AUTORES
/ AUTHORS: - Plaza JJ
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia Fundacion Jimenez
Diaz Avda. Reyes Catolicos, s/n. Madrid.
N. Ref:: 20
----------------------------------------------------
[53]
TÍTULO / TITLE: - A standardized protocol
for the treatment of severe pneumonia in kidney transplant recipients.
REVISTA
/ JOURNAL: - Clin Transplant 2002 Dec;16(6):450-4.
AUTORES
/ AUTHORS: - Sileri P; Pursell KJ; Coady NT; Giacomoni
A; Berliti S; Tzoracoleftherakis E; Testa G; Benedetti E
INSTITUCIÓN
/ INSTITUTION: - Division of Transplant Surgery, Infectious
Diseases, University of Illinois at Chicago Medical Center, USA.
RESUMEN
/ SUMMARY: - Although the incidence of pneumonia after
kidney transplantation is the lowest among all solid organ transplants, it is
associated with high mortality rate (40-50%). We evaluated the efficacy of a
protocol consisting of bronco-alveolar-lavage (BAL) for early microbiological
diagnosis, reduction of the immunosuppressive therapy, and prompt
administration of standardized antibiotic regimen in renal transplant
recipients with severe pneumonia. Between 6/1989 and 5/1999, 40 kidney
transplant recipients developed 46 episodes of severe pneumonia (hypoxia and/or
infiltrate on the chest X-ray). According to protocol, in all these cases, a
BAL was immediately performed and empirical antibiotic therapy was initiated
with erythromycin and trimethoprim-sulfamethoxazole i.v. Furthermore, the
immunosuppressive therapy was drastically reduced. Analyses of BAL fluid
included cell differential count, cytopathologic examination and cultures for
bacteria, fungi and viruses. Within 48 h, the therapy was switched to proper
i.v. antibiotics, if necessary, according to the results of sensitivity testing
of BAL specimens. The mortality rate was 12.5% (5 of 40). Mechanical
ventilation was required in 20 cases (34.5%) and four of the patients that
required intubation died. BAL alone established a diagnosis in 67.4% (31 of 46)
of the patients. Bacteria were responsible for 61% of the episodes, with fungi
responsible for 29% and viruses for 10%. Seven cases of Pneumocystis carinii
pneumonia were treated with the prolongation of the initial therapy. We
conclude that a combination of early detection of the responsible pathogen by
BAL, aggressive reduction of the immunosuppressive therapy and the immediate
empirical administration of erythromycin and trimethoprim-sulfamethoxazole is
an effective strategy to treat pneumonia kidney transplantation (KTX)
recipients.
----------------------------------------------------
[54]
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.
----------------------------------------------------
[55]
TÍTULO / TITLE: - Protocol biopsies
should be part of the routine management of kidney transplant recipients. Con.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2002 Oct;40(4):674-7.
AUTORES
/ AUTHORS: - Salomon DR
INSTITUCIÓN
/ INSTITUTION: - Department of Molecular and Experimental
Medicine, The Scripps Research Institute, and Center for Organ and Cell
Transplantation, Scripps Health, La Jolla, CA, USA.
----------------------------------------------------
[56]
TÍTULO / TITLE: - Laparoscopic live donor
nephrectomy. A review of the first 5 years.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):709-19.
AUTORES
/ AUTHORS: - Ratner LE; Montgomery RA; Kavoussi LR
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery and Pathology,
Thomas Jefferson University (LER), Philadelphia, Pennsylvania, USA. lloyd.ratner@mnil.tju.edu
RESUMEN
/ SUMMARY: - Laparoscopic live donor nephrectomy is
technically feasible. The operation has evolved over the last 5 years and is
greatly improved compared with the procedure originally described. Advantages
to the donor when compared with the standard open operation are decreased
postoperative pain, shorter hospitalization, a quicker recuperation, an earlier
return to driving, and an earlier return to employment. These improvements have
resulted in fewer lost wages and a lower financial burden for donors. Live
donor nephrectomy also provides improved cosmetic results. It successfully
removes many of the disincentives to live kidney donation and has resulted in
an increased willingness of individuals to donate their kidneys. The operative
risk seems to be equivalent to that of the open donor operation performed
through a flank approach. Although there is no financial advantage of the
laparoscopic operation in terms of hospital costs, the increase seen in live
donor transplantation may result in long-term cost savings overall. Kidneys
procured laparoscopically function well in recipents in the short and long
term. There is no increased risk for rejection or technical complications, and
the recipent’s length of hospitalization is unaffected. The laparoscopic donor
operation does not have any apparent deleterious effect on the recipient. The
procedure is being adopted rapidly by transplant centers around the world and
has been performed at more than 100 centers on five continents. The authors
believe that laparoscopic live donor nephrectomy will become the standard of
care in the not too distant future. N.
Ref:: 51
----------------------------------------------------
[57]
TÍTULO / TITLE: - Protocol for histologic
evaluation of marginal grafts in kidney transplants.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Mar;35(2):695-6.
AUTORES
/ AUTHORS: - Alferez MJ; Sola E; Garcia I; Mellado J;
Cabello M; Burgos D; Gonzalez Molina M
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Carlos Haya
University Hospital, Malaga, España.
----------------------------------------------------
[58]
TÍTULO / TITLE: - Strategies for
transplantation of cadaveric kidneys with congenital fusion anomalies.
REVISTA
/ JOURNAL: - J Urol 2001 Mar;165(3):761-5.
AUTORES
/ AUTHORS: - Uzzo RG; Hsu TH; Goldfarb DA; Taylor RJ;
Novick AC; Gill IS
INSTITUCIÓN
/ INSTITUTION: - Section of Renal Transplantation,
Department of Urology, Cleveland Clinic Foundation, Omaha, Nebraska,USA.
RESUMEN
/ SUMMARY: - PURPOSE: The dire shortage of cadaveric
kidneys has led to a gradual expansion of donor criteria in the transplant
community. The use of kidneys with anatomical fusion anomalies is uncommon and
has not been well defined in the literature. We evaluated the surgical
strategies and postoperative outcomes of transplanting cadaveric kidneys with
congenital fusion anomalies. MATERIALS AND METHODS: Three cadaveric kidneys
with congenital fusion anomalies were procured and transplanted between May
1994 and November 1999. None of the 3 donors had any significant urological
history. All fusion anomalies were identified during the organ procurement
process. RESULTS: Anomalies included 1 L-shaped cross-fused ectopic and 2
horseshoe kidneys. All 3 kidneys were procured en bloc. One horseshoe kidney
with a narrow isthmus was split and the 2 kidneys were transplanted into
separate recipients, while the other horseshoe kidney was transplanted en bloc
into a single recipient. The L-shaped kidney was transplanted en bloc into 1
patient. All transplants were successful with a serum creatinine of 1.1 to 1.9
mg/dl. CONCLUSIONS: To our knowledge we present the initial case of
transplantation of an L-shaped kidney. Cadaveric kidneys with congenital fusion
anomalies may be transplanted successfully using various individual technical
strategies based on the specific renal anatomy. As such, these kidneys may be
used to maximize the increasingly inadequate donor pool. N. Ref:: 21
----------------------------------------------------
[59]
TÍTULO / TITLE: - The nondirected
live-kidney donor: ethical considerations and practice guidelines: A National
Conference Report.
REVISTA
/ JOURNAL: - Transplantation 2002 Aug 27;74(4):582-9.
AUTORES
/ AUTHORS: - Adams PL; Cohen DJ; Danovitch GM; Edington
RM; Gaston RS; Jacobs CL; Luskin RS; Metzger RA; Peters TG; Siminoff LA; Veatch
RM; Rothberg-Wegman L; Bartlett ST; Brigham L; Burdick J; Gunderson S; Harmon
W; Matas AJ; Thistlethwaite JR; Delmonico FL
INSTITUCIÓN
/ INSTITUTION: - Wake Forest University School of Medicine,
USA.
RESUMEN
/ SUMMARY: - BACKGROUND: The success of kidney
transplantation from a genetically unrelated living spouse or friend has
influenced transplant physicians to consider the requests of individuals
wishing to volunteer to be a kidney donor who have no intended recipient specified.
Representatives of the transplant community gathered in Boston, MA, on May 31,
2001, to deliberate on the experience of live kidney donation from such
volunteers, currently termed nondirected donors (NDD). OBJECTIVE OF CONFERENCE
PARTICIPANTS: The objective of the conference was to recommend ethical and
practice guidelines for health care professionals considering the
transplantation of a kidney from a live NDD. CONFERENCE PARTICIPANTS: This
conference was convened under the sponsorship of The National Kidney
Foundation, with representation from The American Society of Transplantation
and The American Society of Transplant Surgeons, The American Society of
Nephrology, The United Resource Networks, The United Network for Organ Sharing,
The Association of Organ Procurement Organizations, The National Institutes of
Health, and The Division of Transplantation of the Health Resources and
Services Administration (see Appendix). CONFERENCE REPORT: The suggested
content of screening interviews, which provide information regarding the
donation process, elicits pertinent medical and psychosocial history, and
assesses NDD motivation are presented in this report. Approaches to identifying
the center that would evaluate the suitability of the NDD, to performing the kidney
recovery, and to selecting the NDD recipient are also proposed. Other ethical
issues such as the use of prisoners as an NDD, compensation for the NDD, media
involvement, and communication between the NDD and recipient are discussed.
CONCLUSION: The willingness of health care professionals to consider NDD
volunteers is driven by the compelling need to provide organs for an
ever-expanding list of patients awaiting a kidney transplant. However, the
psychological impact and emotional reward of donation has yet to be determined
for NDD who may not have any relationship to the recipient or knowledge of the
recipient’s outcome. Transplant centers that accept NDD should document an
informed consent process that details donor risks, assures donor safety, and determines
that the goals and expectations of the NDD and the recipient can be realized.
----------------------------------------------------
[60]
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
----------------------------------------------------
[61]
- Castellano -
TÍTULO / TITLE:Pielonefritis Xantogranulomatosa
asociada a embarazo, en rinon unico de antigua donante para trasplante.
Xanthogranulomatous pyelonephritis associated with pregnancy, in ex-transplant
donor with single kidney.
REVISTA
/ JOURNAL: - Actas Urol Esp. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aeu.es/actas/
●●
Cita: Actas Urológicas Españolas: <> 2002 Jan;26(1):20-3.
AUTORES
/ AUTHORS: - Ballesteros Sampol JJ; Ballesteros Monzo
C; Pares Puntas ME
INSTITUCIÓN
/ INSTITUTION: - Unidad Quirurgica de Trasplante Renal del
I.M.A.S. de Barcelona.
RESUMEN
/ SUMMARY: - We present the first case, up to our
knowledge, of XGP in pregnant woman, in solitary kidney (related living kidney
donor). Therapeutic abortion was not resolutive and nephron sparing surgery
(espeleostomy) was successfully performed. Fourteen years later the renal
function is still normal and 2/3 of renal parenchima are preserved. Literature
review is pointed out. N.
Ref:: 14
----------------------------------------------------
[62]
TÍTULO / TITLE: - Acute renal failure in
the ICU: assessing the utility of continuous renal replacement.
REVISTA
/ JOURNAL: - J Crit Care 2003 Mar;18(1):48-51.
●●
Enlace al texto completo (gratuito o de pago) 1053/jcrc.2003.YJCRC10
AUTORES
/ AUTHORS: - Hanson G; Moist L
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Department of
Medicine, London Health Sciences Centre, London, Ontario.
RESUMEN
/ SUMMARY: - Acute renal failure (ARF) in the ICU
patient still remains a common problem and is associated with increased
morbidity, mortality, and cost. Potential advantages of continuous renal
replacement (CRRT), compared with intermittent hemodialysis (IHD) include
enhanced hemodynamic stability, increased solute removal, and greater
ultrafiltration. Although it was hoped that CRRT would lead to improvement in
patient outcomes, there are few prospective, randomized clinical studies
comparing this modality with conventional hemodialysis in the treatment of
patients with ARF. The difficulties associated with designing such prospective
studies are the complex status of the medical patients and the ethical dilemma
of randomizing patients to a certain dialysis modality. At this time, there is
no evidence to support the assertion that CRRT improves clinical outcomes
compared with IHD. N.
Ref:: 34
----------------------------------------------------
[63]
TÍTULO / TITLE: - Open vs laparoscopic
donor nephrectomy 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 Jan;89(2):162-8.
AUTORES
/ AUTHORS: - Lind MY; Ijzermans JN; Bonjer HJ
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, University Hospital
Rotterdam-Dijkzigt, The Netherlands. N.
Ref:: 37
----------------------------------------------------
[64]
TÍTULO / TITLE: - Nephrology, dialysis
and transplantation in Turkey.
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 Dec;17(12):2087-93.
AUTORES
/ AUTHORS: - Erek E; Suleymanlar G; Serdengecti K
INSTITUCIÓN
/ INSTITUTION: - Nephrology Department, Istanbul
University, Cerrahpasa Medical Faculty, Istanbul, Turkey. e.erek@mail.com
RESUMEN
/ SUMMARY: - The establishment of the Turkish Society
of Nephrology (TSN) in 1970 coincided with that of many western European
nephrology societies. The TSN organized the 15th ERA-EDTA Congress
in Istanbul in 1978, earlier than many European Countries, and currently has
286 active members. At present, Turkey has 161 nephrologists, which equals 2.5
nephrologists per million population (p.m.p.). The number of original articles
submitted by Turkish authors to the journal Nephrology Dialysis Transplantation
ranks 7th-8th amongst total submissions to the journal.
Turkey also ranks 2nd-4th in the number of abstracts
submitted to recent ERA-EDTA Congresses. With 18 063 patients undergoing
intermittent haemodialysis treatment in 348 dialysis centres, Turkey has the 5th
largest chronic haemodialysis patient population among European countries. In
addition, 1903 patients are currently undergoing continuous ambulatory
peritoneal dialysis. However, with a total of 4693 renal transplants since
1975, of which only 21.3% were of cadaveric origin, Turkey lags considerably
behind other European countries in renal transplantation. In Turkey, the
prevalence and incidence of renal replacement therapy (RRT) are at present 358
and 52 p.m.p. respectively, and the expansion rate of the RRT stock is 17% (HD
18.5%, CAPD 6%, and transplantation 1.7%). The yearly gross mortality rate of
the total RRT population is 9.4%. The present priorities of the Turkish
nephrological community include high-standard research activity and long-term,
prospective clinical and epidemiological studies, an increase in the total
number and percentage of cadaveric transplants, further improvement of the
quality and cost-effectiveness of RRT, and finally the further development of
scientific and educational collaboration with the world nephrological
community. N. Ref:: 33
----------------------------------------------------
[65]
- Castellano -
TÍTULO / TITLE:El donante marginal en el
trasplante renal. The marginal donor 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: <> 2001;21 Suppl 4:104-10.
AUTORES
/ AUTHORS: - Andres A; Praga M; Ortuno T; Hernandez E;
Morales J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia Hospital 12 de
Octubre Ctra. de Andalucia, km. 5,400 28041 Madrid. N. Ref:: 47
----------------------------------------------------
[66]
TÍTULO / TITLE: - Evaluation, selection,
and follow-up of live kidney donors: a review of current practice in French
renal transplant centres.
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):2048-52.
AUTORES
/ AUTHORS: - Gabolde M; Herve C; Moulin AM
INSTITUCIÓN
/ INSTITUTION: - Laboratoire d’Ethique medicale et de Sante
publique, Faculte de Medecine Necker, Universite Paris V, France. martine.gabolde@bct.ap-hop-paris.fr
RESUMEN
/ SUMMARY: - BACKGROUND: A resurgence of interest in
the concept of live-donor renal transplantation has prompted a closer look at
methods of live donor evaluation, selection, and follow-up. The aim of this
study was to describe these methods in all 46 French renal transplant centres.
METHODS: Questionnaires were sent to all chief renal physicians. RESULTS: The
survey was completed by 78% of centres, which accounted for 95% of all
live-donor renal transplants carried out in France in 1995 and 1996. There was
a substantial variation in all three steps of live-donor management. For
example, we observed variations in the screening for specific short- or
long-term risk factors (especially cardiovascular or thrombotic risk factors
and diabetes). In addition the exclusion criteria differed, especially the
cut-off age for donation, which ranged from 45 to 75 years. The composition of
teams evaluating and selecting potential donors and the role of the potential
donors in the decision-making process varied greatly among centres. Finally, we
observed less variation in the methods of donor follow-up. CONCLUSIONS: The
current survey revealed a marked disparity in the management of live donors in
France. It raises the question of whether these practices should be codified
into a set of guidelines for live-donor transplantation.
----------------------------------------------------
[67]
TÍTULO / TITLE: - The use of expanded
criteria cadaver and live donor kidneys for transplantation.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):687-707.
AUTORES
/ AUTHORS: - Modlin CS; Goldfarb DA; Novick AC
INSTITUCIÓN
/ INSTITUTION: - Section of Renal Transplantation,
Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA. modlinc@ccf.org
RESUMEN
/ SUMMARY: - The use of expanded criteria donors
(non-traditional donors) can help lessen the current shortage of kidneys
available for transplantation. The use of older donors has accounted for a
large measure of the increase in the organ donation rate; however, the most
significant factors found to impact on transplant success negatively
traditionally have been shown to be extremes of donor age and last-hour urine
output. Less significant variables affecting success rates are average systolic
blood pressure, terminal serum creatinine, and days of hospitalization. With
the appropriate selection of organs from expanded donors, acceptable outcomes
can be obtained. When living donors are selected properly, kidneys with
anatomic variants without pathologic significance can be used safely. Kidneys
with a heightened potential for the development of progressive disease should
not be transplanted. Efforts to decrease the cold ischemia time by increasing
the use of kidneys from expanded criteria donors may improve the outcome of
transplantation further. Advances in surgical techniques, preservation
solutions, and methods for predicting eventual long-term renal function in
kidneys from expanded donors will be critical in allowing precise selection
criteria for kidneys for transplantation, resulting in the optimum use of a
scarce and precious resource. Until options such as xenotransplantation become
clinically feasible, the challenge will be to identify which donor organs
previously considered suboptimal can be used safely to expand the organ donor
pool. N. Ref:: 157
----------------------------------------------------
[68]
TÍTULO / TITLE: - Laparoscopic donor
nephrectomy: why not?
REVISTA
/ JOURNAL: - Arch Esp Urol 2002 Jul-Aug;55(6):714-20.
AUTORES
/ AUTHORS: - Jacobs SC; Cho E
INSTITUCIÓN
/ INSTITUTION: - Divisions of Urology and Videoscopic
Surgery, Department of Surgery, University of Maryland School of Medicine,
Baltimore, Maryland, USA. sjacobs@smail.umaryland.edu
RESUMEN
/ SUMMARY: - OBJECTIVES: Laparoscopic donor nephrectomy
has undergone explosive worldwide growth as the method of choice for removal of
living donor kidneys. However, the method does have some distinct disadvantages
as well. The objective is to define real and potential difficulties with the
generalized uncritical acceptance of this surgical technique. METHODS: The
literature and personal experience at the largest laparoscopic donor program
were reviewed and consolidated. Critical areas of technique and management were
analyzed. RESULTS: Laparoscopic living donor nephrectomy has increased the pool
of willing potential renal donors. In experienced has the recipient renal
function results are equivalent to open nephrectomy. CONCLUSIONS: There are
risks in performing the operation to the donor and to the allograft. These
risks are potentially catastrophic and mitigate against any casual attitudes
about embarking on a laparoscopic donor nephrectomy program. N. Ref:: 27
----------------------------------------------------
[69]
TÍTULO / TITLE: - Renal replacement
therapy at the time of the Taiwan Chi-Chi earthquake.
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 5:78-82.
AUTORES
/ AUTHORS: - Hwang SJ; Shu KH; Lain JD; Yang WC
INSTITUCIÓN
/ INSTITUTION: - Kaohsiung Municipal Hsio-Kang Hospital,
Kaohsiung Medical University, Taipei, Taiwan.
N. Ref:: 11
----------------------------------------------------
[70]
TÍTULO / TITLE: - Laparoscopic live donor
nephrectomy for transplantation: urgent need for standardising procedures.
REVISTA
/ JOURNAL: - Transpl Int 2001;14(1):52-4.
AUTORES
/ AUTHORS: - Mosimann F; Bettschart V; Schneider R N. Ref:: 23
----------------------------------------------------
[71]
TÍTULO / TITLE: - Tackling the shortage
of donor kidneys: how to use the best that we have.
REVISTA
/ JOURNAL: - Am J Nephrol 2003 Jul-Aug;23(4):245-59.
Epub 2003 Jul 1.
●●
Enlace al texto completo (gratuito o de pago) 1159/000072055
AUTORES
/ AUTHORS: - Perico N; Ruggenenti P; Scalamogna M;
Remuzzi G
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine and
Transplantation, Ospedali Riuniti Bergamo, Mario Negri Institute for
Pharmacological Research, Bergamo, Italy. perico@marionegri.it
RESUMEN
/ SUMMARY: - Shortage of kidney donor is still a major
limitation for renal transplantation programs. This review focuses on the
emerging practices, adopted to increase transplant activities, of expanding the
criteria for donor and recipient selection without exposing the recipient to
the drawbacks of a graft with inadequate nephron mass. Expanding the donor pool
inevitably led to consideration for kidney transplantation of organs from older
donors or from donors with hypertension, diabetes or other renal diseases. To
fit the reduced performance of these suboptimal organs with the renal
requirement of the recipient, selection of recipients with reduced metabolic
requirements or increase of nephron mass by simultaneous transplantation of two
suboptimal kidneys in the same recipient have been pursued. However, a critical
aspect of both approaches is to quantify functioning nephron mass provided to
the recipient by pre-transplant kidney biopsies. Morphological parameters
assessed on kidney biopsies at the time of donor evaluation may serve to
quantify the preserved tissue and to discriminate chronic irreversible lesions
from acute changes that may account for a transiently impaired renal function
in the donor, but that may recover after transplant. N. Ref:: 118
----------------------------------------------------
[72]
TÍTULO / TITLE: - Renal transplantation
dysfunction: the role of interventional radiology.
REVISTA
/ JOURNAL: - Clin Radiol 2002 Sep;57(9):772-83.
AUTORES
/ AUTHORS: - Sandhu C; Patel U
INSTITUCIÓN
/ INSTITUTION: - Department of Radiology, St George’s
Hospital, London, UK.
RESUMEN
/ SUMMARY: - The aim of this article is to review the
radiological management of complications following renal transplant. N. Ref:: 46
----------------------------------------------------
[73]
TÍTULO / TITLE: - The influence of organ
donor factors on early allograft function.
REVISTA
/ JOURNAL: - Curr Opin Urol 2003 Mar;13(2):99-104.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mou.0000058630.64616.1d
AUTORES
/ AUTHORS: - Schwarz C; Oberbauer R
INSTITUCIÓN
/ INSTITUTION: - Internal Medicine III, Department of
Nephrology, University of Vienna, Vienna, Austria.
RESUMEN
/ SUMMARY: - PURPOSE OF REVIEW: Postischaemic acute
renal allograft failure is among the main risk factors for reduced transplant
survival. Although new immunosuppressive protocols have reduced the number of
acute rejections, the incidence of acute renal failure remained unchanged. On
the basis of histomorphology it is not possible to predict donor kidneys at
risk of subsequent failure. Some factors are associated with failure, but even
combinations of these risk factors can not precisely predict the development of
acute renal failure. Studies have therefore evaluated the influence of
demographic donor and recipient factors on acute renal failure. New
biotechnology and data mining tools are currently being used to study and
identify the molecular predictors of acute renal failure. RECENT FINDINGS:
Recent studies showed that donor factors contributed to approximately 40% of
the variability in early allograft function. Deductive approaches identified
some isolated molecular targets, such as adhesion molecules, as risk factors.
Explorative analysis of the entire human genome, however, identified several
predictive clusters of genes, which can be functionally grouped into categories
such as cell death, stress response, cell adhesion, transcription factors,
inflammatory response or cell cycle-related genes. Based on this information,
preventative strategies using antisense oligonucleotides or antibodies were
adopted. Clinical studies identified the use of catecholamines in the organ
donor as beneficial. All these efforts aim to reduce renal tubular damage.
SUMMARY: A detailed analysis of the molecular events and pathways of renal gene
expression in the donor and after reperfusion, together with sophisticated data
analysis tools, will provide new insights into the pathophysiology of acute
renal failure. N.
Ref:: 53
----------------------------------------------------
[74]
TÍTULO / TITLE: - Increasing
African-American living kidney donors: the feasibility and potential role of nephrology
nurses and social workers.
REVISTA
/ JOURNAL: - Soc Work Health Care 2003;37(4):73-89.
AUTORES
/ AUTHORS: - Wolfe WA
INSTITUCIÓN
/ INSTITUTION: - Belmont Court Dialysis, Warminster
Hospital, 225 Newtown Road, Warminster, PA 18974, USA.
RESUMEN
/ SUMMARY: - This article endeavors to suggest that
there may be a better chance of attenuating the gap between the supply and
demand of kidney organs for African-American patients, by increasing the number
of living donors. Among the multiple issues focused on are the contrasting
dynamics between cadaver and living kidney donations with this population. The
dual importance of adequate information and providing it in a face-to-face
approach with African-American family members is also discussed. The final
focus is on the strategic position of nephrology nurses and social workers, in
potentially helping to increase the number of African-American living kidney
donors. N. Ref:: 69
----------------------------------------------------
[75]
TÍTULO / TITLE: - Outcomes in kidney
transplantation.
REVISTA
/ JOURNAL: - Semin Nephrol 2003 May;23(3):306-16.
AUTORES
/ AUTHORS: - Djamali A; Premasathian N; Pirsch JD
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine and Surgery,
University of Wisconsin Medical School, Madison, WI 53792, USA.
RESUMEN
/ SUMMARY: - It is estimated that there are greater
than 100000 kidney transplant recipients with a functioning graft in the United
States. Recent advances in immunosuppression have improved short-term graft
survival rates and decreased early mortality by decreasing the incidence and
therapy for acute rejection episodes. For those accepted on the waiting list,
transplant prolongs patient survival compared with remaining on dialysis.
During the 1990s, 3 new immunosuppressive drugs were introduced in clinical
kidney transplantation. All were approved for use by the Food and Drug
Administration after large, controlled, randomized trials. Mycophenolate
mofetil (MMF), when combined with cyclosporine (CSA) and prednisone, lowered
acute rejection rates by nearly 50% compared with control. Tacrolimus compared
with CSA also significantly reduced acute rejection rates in kidney transplant
recipients, but was associated with a significant increase in posttransplant
diabetes mellitus (PTDM) in the early trials. When evaluated in combination
with MMF, the incidence of PTDM was much lower. At the end of the decade,
sirolimus was shown in several randomized trials to lower acute rejection rates
and is believed to be less nephrotoxic compared with calcineurin inhibitors.
All of the randomized trials were not statistically powered to assess long-term
superiority. Registry analyses have been performed that appear to show some
long-term benefit of immunosuppressive therapy with MMF. Other outcome
assessments in kidney transplant recipients include risk factors for chronic
allograft nephropathy, hypertension, hyperlipidemia, and bone disease. Although
there are few randomized trials, understanding of the significance of these
common complications has progressed and strategies for therapy and intervention
have been developed. This article focuses on the randomized trials of
immunosuppressive therapy and complications associated with use of these drugs.
In addition, we review the current management and intervention for the
comorbidities associated with the long-term clinical management of the kidney
transplant recipient. N.
Ref:: 78
----------------------------------------------------
[76]
TÍTULO / TITLE: - Beyond the crossmatch:
successful renal transplantation after the elimination of anti-donor
antibodies.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2002
Nov;11(6):583-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.mnh.0000040041.55337.82
AUTORES
/ AUTHORS: - Cohen DJ
N. Ref:: 56
----------------------------------------------------
[77]
TÍTULO / TITLE: - Priorities in renal
replacement programs.
REVISTA
/ JOURNAL: - Int J Artif Organs 2002 May;25(5):397-400.
AUTORES
/ AUTHORS: - Bonomini V
INSTITUCIÓN
/ INSTITUTION: - Institute of Nephrology, Dialysis and
Transplantation, St Orsola University Hospital, Bologna, Italy. vbonomini@libero.it
RESUMEN
/ SUMMARY: - The various alternative programs in renal
replacement therapy have precise meritocratic ranking which unfortunately is
still largely ideal today. New directions and scientific plans (bioartificial
kidney, new immunomodulators, gene therapy) have to be followed to make today’s
ideal ranking become reality. N.
Ref:: 3
----------------------------------------------------
[78]
TÍTULO / TITLE: - Long-term allograft
surveillance: the role of protocol biopsies.
REVISTA
/ JOURNAL: - Curr Opin Urol 2001 Mar;11(2):133-7.
AUTORES
/ AUTHORS: - Nickerson P; Jeffery J; Rush D
INSTITUCIÓN
/ INSTITUTION: - Section of Nephrology, Department of
Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
RESUMEN
/ SUMMARY: - The safety of the renal allograft biopsy
and the standardization of allograft histopathology interpretation have renewed
interest in the performance of protocol (surveillance) biopsies. Recent
surveillance biopsy studies in the areas of pre-implantation and in the early
and late post-transplant periods are discussed. N. Ref:: 40
----------------------------------------------------
[79]
TÍTULO / TITLE: - Hand-assisted
urological laparoscopy.
REVISTA
/ JOURNAL: - Curr Opin Urol 2002 May;12(3):233-7.
AUTORES
/ AUTHORS: - Pietrow PK; Albala DM
INSTITUCIÓN
/ INSTITUTION: - Division of Urology, Department of
Surgery, Section of Endourology and Minimally Invasive Surgery, Duke University
Medical Center, Durham, North Carolina 27710, USA.
RESUMEN
/ SUMMARY: - Hand-assisted laparoscopy has been
successfully applied to various applications within the field of urology. Many
authors have proved the safety and efficacy of this technique, as well as
demonstrating improved patient recovery for such procedures as radical
nephrectomy, radical nephroureterectomy and donor nephrectomy. The recent
literature regarding this topic is reviewed and evaluated here. N. Ref:: 32
----------------------------------------------------
[80]
TÍTULO / TITLE: - Pretransplant
evaluation of renal transplant candidates.
REVISTA
/ JOURNAL: - Semin Nephrol 2002 Nov;22(6):515-25.
AUTORES
/ AUTHORS: - Gallon LG; Leventhal JR; Kaufman DB
INSTITUCIÓN
/ INSTITUTION: - Departments of Medicine and Surgery,
Feinberg School of Medicine of Northwestern University, Chicago, IL 60611, USA.
L-Gallon @nwu.edu
RESUMEN
/ SUMMARY: - Kidney transplantation should be strongly
considered for all medically suitable patients with chronic and end-stage renal
disease (ESRD). Improvements in outcomes after renal transplantation have
resulted in a more liberal selection of patients. High-risk category patients
including human immunodeficiency virus (HIV)-positive, highly sensitized patients,
T-cell positive cross-match, and ABO blood group-incompatible patients are now
considered potential renal transplant candidates. Unfortunately, the demand for
kidney transplants far exceeds the supply of available organs, causing a
persistent increase in the number of patients on the waiting list with a
parallel increase in the waiting time for a cadaveric kidney transplant. This
has 2 major consequences. First, patients on the waiting list are getting
sicker and older. Second, living donors have assumed increasing importance in
renal transplantation. Pre-existing morbidities including malignancies,
cardiovascular disease, infections, and coagulopathies should be extensively
evaluated before proceeding to transplantation. Special attention should be given
to cardiovascular risk factors because the leading cause of death after renal
transplant is cardiovascular disease. A full immunologic evaluation with ABO
blood group determination, human leukocyte antigen (HLA) typing, screening for
antibody to HLA phenotypes, and cross-matching need to be gathered before
transplantation to avoid antibody-mediated hyperacute rejection or to proceed
with specific protocols in highly sensitized or in positive T-cell cross-match
patients. With the increased rate of donation from living donors, regular
follow-up evaluation of kidney donors is recommended to detect hypertension or
proteinuria in those who may develop it.
N. Ref:: 72
----------------------------------------------------
[81]
TÍTULO / TITLE: - Laparoscopic live donor
nephrectomy.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Feb;28(1):127-35.
AUTORES
/ AUTHORS: - Novotny MJ
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, University of
California, Davis School of Medicine, Sacramento, California, USA.
RESUMEN
/ SUMMARY: - Laparoscopic donor nephrectomy offers
numerous advantages when compared with the traditional open approach. For the
donor, it has resulted in a shorter hospital stay, fewer postoperative
analgesic requirements, earlier return to activities of daily living and
employment, and decreased financial loss owing to absence from the workforce.
For the recipient, the procedure does not adversely impact on allograft
function, graft survival, or patient survival.
N. Ref:: 39
----------------------------------------------------
[82]
TÍTULO / TITLE: - Use of
non-heart-beating donors in renal transplantation.
REVISTA
/ JOURNAL: - Postgrad Med J 2001 Nov;77(913):681-5.
AUTORES
/ AUTHORS: - Kimber RM; Metcalfe MS; White SA;
Nicholson ML
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, University of
Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK. rkimber@doctors.org.uk
RESUMEN
/ SUMMARY: - The rate of renal transplantation has
plateaued and is now limited by the number of donor organs available. In the
past all donor kidneys came from living donors or controlled non-heart beating
donors. It was not until the introduction of brainstem death criteria that
cadaveric heart beating donors became the main source. Recently, there has been
renewed interest in non-heart beating donors, who have already suffered
cardiorespiratory arrest. Kidneys from these donors have a unique set of
problems associated with increased duration of warm ischaemia. To minimise
this, the kidneys are cooled in situ using an intra-aortic balloon catheter and
are perfused with cold hyperosmolar citrate. Retrieval can then proceed in the
normal fashion. Despite a higher level of delayed graft function, the results
from non-heart beating renal transplantation are good, with long term function
comparable to cadaveric organs. If used safely, they enable significant
expansion of the donor pool. Techniques in the future, such as machine
perfusion preservation, may further improve the results from non-heart beating
programmes. N. Ref:: 26
----------------------------------------------------
[83]
TÍTULO / TITLE: - Chronic graft
dysfunction: donor factors.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Aug;33(5):2695-8.
AUTORES
/ AUTHORS: - Barbari A; Stephan A; Masri MA; Kamel G;
Kilani H; Barakeh A
INSTITUCIÓN
/ INSTITUTION: - Nephrology and Transplantation Unit at
Rizk Hospital, Beirut, Lebanon. N.
Ref:: 68
----------------------------------------------------
[84]
TÍTULO / TITLE: - Trends and perspectives
in pancreas and simultaneous pancreas and kidney transplantation.
REVISTA
/ JOURNAL: - Curr Opin Urol 2001 Mar;11(2):165-74.
AUTORES
/ AUTHORS: - Kahl A; Bechstein WO; Frei U
INSTITUCIÓN
/ INSTITUTION: - Departments of Nephrology and Medical
Intensive Care, University Hospital Charite, Campus Virchow-Klinikum, Berlin,
Germany. andreas.kahl@charite.de
RESUMEN
/ SUMMARY: - Pancreas transplantation is still the best
option to achieve normoglycaemia and insulin independence in patients with type
I diabetes. As a result of improvements in surgical techniques,
immunosuppression and patient selection, one year survival rates of 95, 83, and
88% for patient, pancreas, and kidney survival, respectively, are reported for
patients with simultaneous pancreas and kidney transplantation. The main goals
for the future are to reduce postoperative morbidity, to identify the relevant
indications for single pancreas transplantation, to adopt the best surgical
technique for individual patients’ needs (bladder versus enteric drainage with
or without portal venous delivery of insulin), and to develop immunosuppressive
strategies with low nephrotoxic and diabetogenic potential. N. Ref:: 136
----------------------------------------------------
[85]
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
----------------------------------------------------
[86]
TÍTULO / TITLE: - Medication
noncompliance in patients with chronic disease: issues in dialysis and renal
transplantation.
REVISTA
/ JOURNAL: - Am J Manag Care 2003 Feb;9(2):155-71.
AUTORES
/ AUTHORS: - Loghman-Adham M
INSTITUCIÓN
/ INSTITUTION: - Pediatric Research Institute, Saint Louis
University School of Medicine, St Louis, MO, USA. mloghman@att.net
RESUMEN
/ SUMMARY: - For many chronic conditions, poor patient
compliance with prescribed medications and other aspects of medical treatment
can adversely affect the treatment outcome. Compliance with long-term treatment
for chronic asymptomatic conditions such as hypertension is on the order of
50%. Although drugs with a longer therapeutic half-life may ease the burden of
repeated daily dosing, the efficacy of any self-administered medication depends
to a large extent on patient compliance. This article addresses the compliance
issues in patients undergoing renal replacement therapy and in those with a
successful renal transplant. A focused discussion of compliance in dialysis and
renal transplant patients is followed by a general review of the literature on
patient compliance. Many factors associated with poor compliance in this
patient population are identified via a review of the recent literature. The
difficulties in monitoring medication compliance and the methods used are
discussed. Among factors associated with poor compliance, the following have
been identified in several studies: frequent dosing, patient’s perception of
treatment benefits, poor patient-physician communication, lack of motivation,
poor socioeconomic background, lack of family and social support, and younger
age. Many strategies have been suggested to improve medication compliance, most
without scientific validation. Strategies to improve compliance in dialysis and
transplant patients are similar to those described for other chronic conditions
and include simplifying the treatment regimen, establishing a partnership with
the patient, and increasing awareness through education and feedback. N. Ref:: 152
----------------------------------------------------
[87]
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
----------------------------------------------------
[88]
TÍTULO / TITLE: - Transplantation of
kidneys from HCV-positive donors: a safe strategy?
REVISTA
/ JOURNAL: - J Nephrol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jnephrol.com/
●●
Cita: Journal of Nephrology: <> 2003 Sep-Oct;16(5):617-25.
AUTORES
/ AUTHORS: - Fabrizi F; Bunnapradist S; Lunghi G;
Martin P
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Dialysis,
Transplantation, Maggiore Hospital, IRCCS, Milan, Italy. fabrizi@policlinico.mi.it
RESUMEN
/ SUMMARY: - Hepatitis C Virus (HCV) infection is the
most important cause of liver disease after renal transplantation (RT). The
impact of HCV on patient and graft survival after RT remains controversial;
however, the great majority of studies with large size and adequate follow-up
have shown the detrimental impact of HCV on long-term patient and graft
survival after RT. The use of kidneys from anti-HCV positive donors could help
decrease the continuing disparity between the number of patients on the
transplant waiting list and the number of patients receiving a transplant each
year. Single-center experiences have suggested transplanting kidneys from
anti-HCV positive donors only in anti-HCV positive dialysis patients. Such
practice has not demonstrated any adverse effect on the short-term patient
survival; the waiting times for RT were shortened. A better alternative seems
to be a policy of transplanting kidneys from anti-HCV positive donors only in
HCV RNA positive recipients. This requires HCV RNA testing of all anti-HCV
positive dialysis patients awaiting RT. Matching donors and recipients for HCV
genotype has been suggested; however, the assessment of donor HCV genotype is
currently hampered by time constraints. Recent evidence based on large data
base demonstrated that RT recipients of HCV-positive donors are at independent
increased risk of mortality; unadjusted 3-year patient survival was 85% versus
93% (P=0.01) in all recipients of donor HCV-positive and HCV-negative kidneys,
respectively. This was observed in all recipient subgroups including elderly
and HCV-positive recipients. In the near future, rapid nucleic acid testing
(NAT) of donors and recipients will allow the assessment of the HCV viremic
status in order to maximize organ use. With appropriate informed consent, use
of a renal graft from an HCV positive donor may be offered to an HCV infected
recipient. Additional studies are needed to clarify the link between donor
HCV-positive kidneys and patient mortality.
N. Ref:: 69
----------------------------------------------------
[89]
TÍTULO / TITLE: - Patient education in
renal transplantation.
REVISTA
/ JOURNAL: - EDTNA ERCA J 2002 Oct-Dec;28(4):176-9.
AUTORES
/ AUTHORS: - Akyolcu N
INSTITUCIÓN
/ INSTITUTION: - College of Nursing, Istanbul University,
Istanbul, Turkey. nakyolcu@yahoo.com
RESUMEN
/ SUMMARY: - Renal transplantation is the surgical
implantation of a human kidney from a compatible donor into a recipient. Renal
transplantation is a means of restoring renal function to normal in most
patients, thus allowing a return to a healthy lifestyle. Patients and their
families often ask nurses for health information. Professional nurses must
ensure that patients and families understand the transplantation and
therapeutic regimen and provide health education. It should be remembered that
certain physiological, psychosocial and pathological conditions might inhibit
the education process. Before renal transplantation the patient’s understanding
of the procedure and follow-up regimen and also the patient’s ability to cope
with a complex medication regimen are assessed. The nurse and the patient and
family should work together to set realistic, achievable goals, the aims of
which are mutually agreed. The agreed goals of health education should be
documented in a care plan, which will also provide reinforcement for both the
nurse and patient. N.
Ref:: 13
----------------------------------------------------
[90]
TÍTULO / TITLE: - Altruistic living 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: <> 2003 Nov-Dec;16 Suppl 7:S6-9.
AUTORES
/ AUTHORS: - Ponticelli C
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, IRCCS Maggiore
Hospital, Milan, Italy. ponticelli@policlinico.mi.it
RESUMEN
/ SUMMARY: - Living donor renal transplantation can not
only reduce the increasing gap between demand and supply of renal transplants,
but when compared with cadaveric renal transplants can also allow better
results, particularly in the long-term. With the exception of HLA-identical
siblings, there are no differences in long-term graft survival between
HLA-related and HLA-unrelated living donor transplants. The possibility of a
early transplantation, ideally before dialysis, can strongly improve patient
and graft survival. The post-operative mortality and morbidity of the donor are
minimal and may be furtherly reduced by an appropriate work-up. At present,
there is no evidence that mononephrectomy in healthy subjects can expose them
to an increased risk of renal failure, even in the long-term. N. Ref:: 28
----------------------------------------------------
[91]
TÍTULO / TITLE: - Pyogenic granuloma in a
renal transplant patient: case report.
REVISTA
/ JOURNAL: - Spec Care Dentist 2001
Sep-Oct;21(5):187-90.
AUTORES
/ AUTHORS: - al-Zayer M; da Fonseca M; Ship JA
INSTITUCIÓN
/ INSTITUTION: - Department of Orthodontics and Pediatric
Dentistry, University of Michigan School of Dentistry, 1011 N. University Ave.,
Ann Arbor, MI 48109, USA.
RESUMEN
/ SUMMARY: - This case report describes a 14-year-old
female referred to Pediatric Dentistry for evaluation and treatment of cyclosporine-induced
gingival hyperplasia. Examination of the anterior maxillary area showed a red,
vascular, exophytic, soft-tissue mass which had been excised a few months
earlier without a histopathologic examination being done. The mass did not
appear consistent with gingival overgrowth induced by long-term use of
medication, and thus an excisional biopsy was performed, which diagnosed the
lesion as a pyogenic granuloma. A review of the literature and management
recommendations are discussed. N.
Ref:: 20
----------------------------------------------------
[92]
TÍTULO / TITLE: - At-home self-care of
patients of long-term survival after renal transplantation: a survey of current
status.
REVISTA
/ JOURNAL: - Di Yi Jun Yi Da Xue Xue Bao 2002
Jan;22(1):86-7.
AUTORES
/ AUTHORS: - Wang JX; Shi HM
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Transplantation,
Nanfang Hospital, First Military Medical University, Guangzhou 510515.
RESUMEN
/ SUMMARY: - OBJECTIVE: To understand the current
status of at-home self-care implemented by patients with renal transplantation
of long-term survival, so as to provide the patients with adequate professional
advice and follow-up care after discharge from hospital. METHOD: A survey was
conducted in 248 patients who survived for over 3 years with functioning
transplanted kidneys by utilizing a self-designed questionnaire. RESULTS: The
at-home self-care was generally not well practiced by the patients with
apparent lack of self-care awareness and abilities. Though the current status
problematic, the survey showed that 96.32% of the patients wished to be
informed about self-care knowledge and skills. CONCLUSION: The patients
currently lack at-home self-care abilities and the medical staff should
carefully design self-care plans tailored to the needs of individual patient to
improve the survival of the patients and the transplanted kidneys as well.
----------------------------------------------------
[93]
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
----------------------------------------------------
[94]
TÍTULO / TITLE: - Legislation will
benefit dietitians, patients in pre-dialysis, post-transplant setting.
REVISTA
/ JOURNAL: - Nephrol News Issues 2001 Feb;15(3):11.
AUTORES
/ AUTHORS: - Lambert L
INSTITUCIÓN
/ INSTITUTION: - Dialysis Clinics Inc., Boston, Mass., USA.
N. Ref:: 2
----------------------------------------------------
[95]
TÍTULO / TITLE: - Annual trends and
triple therapy--1991-2000.
REVISTA
/ JOURNAL: - Clin Transpl 2001;:247-69.
AUTORES
/ AUTHORS: - Nishikawa K; Terasaki PI
INSTITUCIÓN
/ INSTITUTION: - Terasaki Foundation Laboratory, Los
Angeles, CA, USA.
RESUMEN
/ SUMMARY: - 1. Although the number of cadaver donor
transplants did not increase substantially over the past 10 years, unrelated
living donor grafts increased from 153 in 1991 to 1,661 through 2000. Use of
spousal and other unrelated donor organs contributed to this increase. There
was a modest increase in living-related donor transplants from 2,328 in 1991 to
3,451 in 2000. 2. Cadaver donor graft survival at one year improved from 84% in
1991 to 90% in 2000. In contrast, one-year graft survival of living donor
transplants only improved from 93% in 1991 to 95% in 2000. 3. Throughout the
10-year period, approximately 13% of transplants were repeat transplants from
cadaver donors and roughly 8% were regrafts from live donors. 4. Cadaver donor
transplants into White recipients declined from 68% in 1991 to 60% in 2000. For
living donors, the percentage of White patients remained constant at about 70%.
5. Graft survival in patients of all races was about equal at one year but
diverged at 3 years, with Asians having the highest and Blacks having the
lowest 3-year graft survival rates. 6. Average donor age increased from 31.7 in
1991 to 36 in 2000 for cadaveric donor transplants and 37.9 in 1991 to 40.4 in
2000 for living donor transplants. Cadaveric kidneys from donors older than 50
years of age yielded significantly lower 3-year graft survival. 7. Average
recipient age for cadaveric donor transplants increased from 42.1 in 1991 to
46.8 in 2000. The average recipient age for living donor transplants also
increased steadily from 33.7 in 1991 to 42.9 in 2000. There was relatively
little effect on graft survival rates for advanced age recipients. 8. The
percentage of sensitized recipients receiving cadaver donor grafts declined
from 27% in 1991 to 21% in 2000. Similarly, sensitized recipients receiving
living donor grafts decreased from 17% in 1991 to 13% in 2000. Graft survival
in patients with more than 50% PRA was lower at 3 years for patients receiving
cadaveric donor grafts. Highly sensitized patients receiving living donor
grafts had graft survival rates similar to those who were not sensitized. 9.
Cold ischemia times decreased from an average of 24.2 hours in 1991 to 18.9
hours in 2000. Improved graft survival rates over those 10 years were noted in
all groups, and even cold ischemia times more than 36 hours yielded 3-year
graft survivals comparable to those with lower cold ischemia times in 1998. 10.
The need for dialysis has remained constant at about 23% over the last 10 years
for patients receiving kidneys from cadaveric donors. The rate of dialysis for
patients receiving kidneys from living donors was about 5% for each of the 10
years examined. First day anuria increased from 11% in 1991 to 16% in 2000 for
cadaver donor transplants and 3% in 1999 to 5% in 2000 for living donor grafts.
11. Cadaveric donor patients requiring dialysis had a 3-year graft survival
rate of 63% if there was no first day anuria and 56% if they had first day
anuria. This is in contrast to 80% 3-year graft survival for those with
immediate diuresis and no need for dialysis. The 3-year graft survival rate for
those receiving living donor grafts and needing dialysis was 58% if they had
first day diuresis and 41% if they ware anuric on the first day. Conversely,
those who had first day function and did not require dialysis had 89% 3-year
graft survival. 12. Among the patients receiving cadaveric grafts with first
day diuresis there was a marked reduction in those with rejection, from 21% in
1991 to 5% in 2000. Similarly, for this type of patient receiving living donor
grafts, the reduction was 17% in 1991 to 5% in 2000. However, graft survival
among these patients did not change significantly. The greatest improvement was
noted in those with first day anuria and no rejection. 13. Patients who did not
require dialysis, and had rejection prior to discharge decreased markedly from
17% in 1991 to 3% in 2000 in those receiving cadaveric grafts and 15% in 1991
to 3.9% in 2000 for those receiving living donors. Graft survival of cadaveric
transplants in those needing dialysis, with and without rejection, improved the
most in the 10 year period. 14. Hospitalization days for cadaveric transplant
recipients were reduced from 19 days in 1991 to 10 days in 2000 and 16 days in
1991 to 8 days in 2000 for recipients of living donor grafts. There was an
increase in discharge serum creatinine values from 2.3 mg/dl in 1991 to 3.3
mg/dl in 2000 for cadaver donor grafts. 15. Double therapy was utilized for
about 15% of cadaveric and living donors. There was a sharp increase in
induction therapy, peaking at 51% in 1994 and decreasing to 5% by 2000 for
cadaveric donor transplants. Induction did not improve graft survival for
either cadaver or living donor transplant recipients. 16. Triple therapy
improved graft survival of White and Black patients, but did not affect the
half-lives in either race. 17. The lower graft survival from older donors was
not affected by triple therapy for cadaver donor transplants. Triple therapy
removed the donor age effect for recipients of living donor grafts. 18. Triple
therapy practically eliminated the effect of sensitization for cadaveric donor
grafts. Both double and triple therapy virtually eliminated the sensitization effect
for living donors. 19. Triple therapy significantly improved the survival of
kidneys with more than 36 hours cold ischemia time so that 3-year graft
survival was 76% at 3 years compared with 81% for kidneys stored 1-12 hours.
20. Triple therapy improved the 3-year graft survival of kidneys with first day
anuria from 50% for double therapy to 69% for triple therapy in cadaver donor
transplants. For living donor transplants, there was a similar improvement from
57% with double therapy to 72% with triple therapy. 21. Triple therapy improved
the 3-year cadaveric graft survival rate of kidneys requiring dialysis from 51%
with double therapy to 67% for triple therapy. There was a similar improvement
for living donors needing dialysis from 37% to 61% at 3 years.
----------------------------------------------------
[96]
TÍTULO / TITLE: - Ethical aspects of
living donor kidney transplantation and recipient adherence to treatment.
REVISTA
/ JOURNAL: - Prog Transplant 2003 Jun;13(2):105-9.
AUTORES
/ AUTHORS: - Wright L; Daar AS
INSTITUCIÓN
/ INSTITUTION: - University Health Network, Toronto,
Ontario.
RESUMEN
/ SUMMARY: - Living donor kidney transplantation
comprises approximately 30% of kidney transplantations in the United States and
is an effective form of renal replacement therapy, with low risk to the donor.
Twenty percent of living donors do not have a genetic relationship with their
recipients. In the selection of living donors, guiding ethical principles
include altruism, the absence of coercion or monetary reward, patient autonomy,
beneficence, and nonmaleficence. In order for the benefit of living donor
kidney transplantation to outweigh the risk, evidence that the proposed
recipient will care for the transplanted organ must exist. Nonadherence to treatment
has been identified as a major risk factor for graft rejection. When
nonadherence to treatment regimens leads to loss of the graft, the consequences
are felt by the recipient, donor, and the treatment team. The decision to
transplant an organ to a noncompliant patient from a cadaveric or a living
donor raises issues of patient autonomy, justice, paternalism, and benevolence
versus nonmaleficence. N.
Ref:: 31
----------------------------------------------------
[97]
TÍTULO / TITLE: - Appropriate preparation
for renal replacement therapy. Origins, rationale & implications for
practice improvement.
REVISTA
/ JOURNAL: - Nephrol News Issues 2003 Mar;17(4):14-8.
AUTORES
/ AUTHORS: - Haley WE
INSTITUCIÓN
/ INSTITUTION: - Division of Hypertension and Nephrology,
Mayo Clinic, Jacksonville, Fla., USA. N.
Ref:: 5
----------------------------------------------------
[98]
TÍTULO / TITLE: - Renal transplantation
from non-heart- beating donors: a review of the European experience.
REVISTA
/ JOURNAL: - J Nephrol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jnephrol.com/
●●
Cita: Journal of Nephrology: <> 2003 May-Jun;16(3):334-41.
AUTORES
/ AUTHORS: - Koffman G; Gambaro G
INSTITUCIÓN
/ INSTITUTION: - Renal Transplant Unit, Department of Renal
Medicine, Guy’s Hospital, London, UK. geoff.koffman@gstt.sthames.nhs.uk
RESUMEN
/ SUMMARY: - Shortage of organs for transplantation has
prompted a few centers in Europe to retrieve kidneys from non-heart-beating
donors (NHBD). Indeed, it has been suggested that NHBDs could bridge the gap
between supply and demand in renal transplantation. However, NHB donation still
has only limited diffusion. Reluctance to accept NHBDs as a source of kidneys
is due to medical, organizational and ethical reasons. The experiences,
protocols and results in Europe are described in this review. The analysis of
the European experience of kidney transplantation from NHBDs looks promising in
term of results. Long-term outcome is very similar in the two groups
notwithstanding worse short-term results. Actually, the primary non functioning
of grafts is significantly worse in NHBD kidneys. However, data suggest that
results could be improved by better patient selection and retrieval team
organization. Delayed graft function is also much more frequent in NHBD
kidneys; this poses problems in the short-term, but in the long-term does not
seem to influence the outcome. The risk that efforts in NHBD programs endanger
regular HBD programs because of limited organizational resources is not
supported by published data. Indeed, in the experiences analysed here it
appears that NHBD consistently increased the number of available kidneys and
has no effect on HB donations. N.
Ref:: 54
----------------------------------------------------
[99]
TÍTULO / TITLE: - Laparoscopic live donor
nephrectomy: a step forward in kidney transplantation?
REVISTA
/ JOURNAL: - JSLS 2003 Jul-Sep;7(3):197-206.
AUTORES
/ AUTHORS: - Skrekas G; Papalois VE; Mitsis M; Hakim NS
INSTITUCIÓN
/ INSTITUTION: - Transplant Unit, St. Mary’s Hospital,
London, UK.
RESUMEN
/ SUMMARY: - Open donor nephrectomy for live donor
kidney transplantation is a safe procedure that has been used for more than 30
years with excellent results. Laparoscopic donor nephrectomy is a relatively
new technique that has the potential of decreased postoperative pain, less
incisional morbidity, and shorter recovery time. Furthermore, it has been
reported that this potentially less traumatic approach increases the number of
potential live donors. This review article focuses on the currently used
laparoscopic techniques in live kidney donation as well as the controversy
regarding its efficacy, safety, and future.
N. Ref:: 64
----------------------------------------------------
[100]
TÍTULO / TITLE: - Medical waste
production and disposal arising from renal replacement therapy.
REVISTA
/ JOURNAL: - Adv Ren Replace Ther 2002 Jan;9(1):57-62.
AUTORES
/ AUTHORS: - Hoenich NA; Pearce C
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, School of
Clinical Medical Sciences, Medical School, University of Newcastle, Newcastle
upon Tyne, NE2 4HH, UK. nicholas.hoenich@ncl.ac.uk
RESUMEN
/ SUMMARY: - The treatment of end stage renal disease
(ESRD) makes extensive use of pre-sterilised disposable items that are
contaminated by blood or other body fluids following use. Commonly these items are
incinerated. Because they contain substantial amounts of polyvinylchloride
(PVC), their incineration releases polychlorinated dibenzo p dioxins (PCDD) and
polychlorinated di benzo p furans (PCF), as well as heavy metals. A consequence
of the release of these substances has been the introduction of legislation
controlling waste disposal. These issues are likely to impact on the management
of waste at the healthcare facility level. In parallel, new PVC-free materials
for use in renal replacement therapies have been developed whose incineration
is less controversial environmentally. N.
Ref:: 21
----------------------------------------------------
[101]
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
----------------------------------------------------
[102]
TÍTULO / TITLE: - Applications of
microarrays to renal transplantation: progress and possibilities.
REVISTA
/ JOURNAL: - Front Biosci 2003 Sep 1;8:s913-23.
AUTORES
/ AUTHORS: - Chua MS; Mansfield E; Sarwal M
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, Stanford
University School of Medicine, G320, 300 Pasteur Drive, Stanford, CA 94305, USA.
RESUMEN
/ SUMMARY: - By rapidly generating global views of gene
expression profiles, microarray technology offers a great advantage over
traditional methods of studying gene expression. This technology is gaining
rapid and widespread use in many areas of science and medicine because it can
be easily adapted to study many experimental questions. This article will
review the current applications of microarray technology in the field of renal
transplantation, and discuss the potential impact of this technology on
transplantation medicine. N.
Ref:: 49
----------------------------------------------------
[103]
TÍTULO / TITLE: - Transmission of viral
hepatitis by kidney transplantation: donor evaluation and transplant policies
(Part 1: hepatitis B virus).
REVISTA
/ JOURNAL: - Transpl Infect Dis 2002 Sep;4(3):124-31.
AUTORES
/ AUTHORS: - Natov SN
INSTITUCIÓN
/ INSTITUTION: - Tufts University School of Medicine,
Tufts-New England Medical Center, Boston, Massachusetts, USA.
RESUMEN
/ SUMMARY: - This two-part article discusses serologic
testing of prospective donors for viral hepatitis B and C as part of the
comprehensive donor evaluation and reviews of the current policies and
practices aimed at preventing donor-to-recipient transmission of hepatitis B
and C viruses (HBV, HBC). This second part of the review discusses HCV. Organs
procured from HCV-infected donors can transmit the virus to their recipients.
Because a number of studies have associated infections with HCV with increased
morbidity and mortality among renal transplant recipients, it is important to
prevent HCV transmission with renal transplantation. The majority of organ
procurement organizations (OPOs) perform routine screening of organ donors for
antibodies to HCV (anti-HCV). The prevalence of HCV infection among cadaver
organ donors, ascertained based on a positive anti-HCV test by ELISA2, varies
worldwide between 1.08% and 11.8%. The use of kidneys from donors negative for
anti-HCV by ELISA2 carries negligible or no risk of transmitting HCV infection.
The use of organs from anti-HCV-positive donors has been restricted to
life-saving transplants (heart, liver or lung) by the majority of OPOs
worldwide. However, discarding kidneys from all anti-HCV positive donors would
lead to unnecessary waste of organs because not all anti-HCV positive donors
are infectious. Recently, the policy of unconditional restriction on the use of
kidneys from anti-HCV positive donors has been challenged, and transplantation
of organs from anti-HCV-positive donors into anti-HCV-positive recipients has
been found to be safe. An even better alternative might be a policy of
transplanting kidneys from anti-HCV-positive donors only in HCV RNA-positive
recipients. However, until more data become available, these two strategies remain
experimental treatments. N.
Ref:: 51
----------------------------------------------------
[104]
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
----------------------------------------------------
[105]
TÍTULO / TITLE: - Ambulatory blood pressure
monitoring in pediatric renal transplantation.
REVISTA
/ JOURNAL: - Pediatr Transplant 2003 Apr;7(2):86-92.
AUTORES
/ AUTHORS: - Mitsnefes MM; Portman RJ
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, Division of
Nephrology and Hypertension, University of Cincinnati College of Medicine and
The Children’s Hospital Research Foundation, Cincinnati, OH, USA.
RESUMEN
/ SUMMARY: - Over last two decades ABPM has evolved
from a research device to an established and valuable clinical tool for BP evaluation.
More than 10 yrs ago ABPM was introduced to pediatrics and since that time, its
importance has been increasing in the management of hypertension in children
and adolescents. This review summarizes the information gathered from the
studies of ABPM in adult and pediatric patients with renal transplants. We will
review the importance of hypertension in this patient subset, discuss the
advantage of ABPM over CBP and focus on specific abnormalities and clinical
significance of ABPM in renal transplant recipients. N. Ref:: 57
----------------------------------------------------
[106]
TÍTULO / TITLE: - Vascular access for
extracorporeal renal replacement therapies in the intensive care unit in
clinical practice.
REVISTA
/ JOURNAL: - Contrib Nephrol 2001;(132):266-82.
AUTORES
/ AUTHORS: - Canaud B; Martin K; Nguessan C; Klouche K;
Leray-Loragues H; Beraud JJ
INSTITUCIÓN
/ INSTITUTION: - Nephrology Department, Metabolic Intensive
Care Unit and Renal Research and Training Institute, Lapeyronie University
Hospital, Montpellier, France. b-canaud@chu-montpellier.fr N. Ref:: 80
----------------------------------------------------
[107]
TÍTULO / TITLE: - Donor characteristics
can influence overall transplant activities: the Italian experience.
REVISTA
/ JOURNAL: - J Nephrol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jnephrol.com/
●●
Cita: Journal of Nephrology: <> 2003 May-Jun;16(3):342-9.
AUTORES
/ AUTHORS: - Rosati A; Salvadori M
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Careggi University Hospital,
Florence, Italy. nefrologia@ao-carreggi.toscana.it
RESUMEN
/ SUMMARY: - The notable increase in organ donations
and transplants in Italy in recent years, has led to the development of an
atypical approach to kidney transplantation. Regardless of the favorable
considerations of the organ donation rate, which has placed Italy among the
European leaders, a careful comparative evaluation of the data from Italian and
international registries demonstrates that renal transplantations in Italy have
not shared the same significant growth. The typology of donors has
significantly influenced not only the number of renal transplantations, but
also the access to transplants for some age groups and probably even the
quality and cost. The overall view that emerges is complex and somewhat
contradictory, but we believe that this perspective provides solid arguments
for choices that should not be delayed regarding living donor transplant, the
diffusion of a donation culture in the Italian population, and the criteria for
the organ allocation. N.
Ref:: 27
----------------------------------------------------
[108]
TÍTULO / TITLE: - Health related quality
of life (HRQOL) in the elderly on renal replacement therapy.
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 May-Jun;15(3):220-4.
AUTORES
/ AUTHORS: - Ortega F; Rebollo P
INSTITUCIÓN
/ INSTITUTION: - Institute Reina Sofia de Investigacion
Nefrologica, Renal Foundation Inigo Alvarez de Toledo Renal Unit, Asturias
Central Hospital, Oviedo, España. fortega@hca.es
RESUMEN
/ SUMMARY: - Various opinions have been presented about
the influence of age on the health-related quality of life (HRQOL) of patients
on renal replacement therapy (RRT). Some authors sustain that age worsens
HRQOL, while others show the opposite. It has been seen that a psychological
adjustment occurs with aging, even when chronic illness is also present. In
addition, elderly patients appear to adapt better to RRT than younger
ones. N. Ref:: 42
----------------------------------------------------
[109]
TÍTULO / TITLE: - Transmission of viral
hepatitis by kidney transplantation: donor evaluation and transplant policies
(Part 1: hepatitis B virus).
REVISTA
/ JOURNAL: - Transpl Infect Dis 2002 Sep;4(3):117-23.
AUTORES
/ AUTHORS: - Natov SN; Pereira BJ
INSTITUCIÓN
/ INSTITUTION: - Tufts University School of Medicine,
Tufts-New England Medical Center, Boston, Massachusetts, USA.
RESUMEN
/ SUMMARY: - This two-part article discusses serologic
testing of prospective donors for viral hepatitis B and C, as part of the
comprehensive donor evaluation, and reviews the current policies and practices
aimed at preventing donor-to-recipient transmission of hepatitis B and C
viruses (HBV, HBC). This first part of the review discusses HBV. Organs
procured from HBV-infected donors can transmit the virus to their recipients.
Because infections with HBV have been associated with increased morbidity and
mortality among renal transplant recipients, it is important to prevent HBV
transmission with renal transplantation. Routine serologic evaluation of
prospective organ donors for markers of HBV infection includes testing for
hepatitis B surface antigen (HBsAg), anti-hepatitis B surface antigen antibody
(HBsAb), and antibody to hepatitis B core antigen (anti-HBc). The risk of HBV
transmission with kidney transplantation is a function of the serologic status
of both donor and recipient. Knowledge of this risk is essential for the
rational use of kidney allografts. HBsAg-positive donors are at high risk of
transmitting HBV infection to their organ recipients, particularly if these
donors are concurrently positive for hepatitis B e antigen (HBeAg). Kidneys
from donors with isolated presence of HBsAb are unlikely to transmit HBV
infection to their recipients. The risk of HBV transmission with the use of
kidneys from IgG anti-HBc-positive, HBsAg-negative donors is low. Kidneys from
donors negative for both HBcAg and anti-HBc are at low-to-negligible or no risk
of transmitting HBV to their recipients. Under certain conditions, kidneys from
HBV-infected donors can be safely used and thus prevent unnecessary discarding
of organs. Kidneys from HBsAg-positive donors, who are negative for HBeAg,
carry no risk or only minimal risk of transmitting HBV infection to their
recipients if these recipients are immune to HBV or HBsAg-positive. However,
the safety of these policies deserves further evaluation. N. Ref:: 33
----------------------------------------------------
[110]
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
----------------------------------------------------
[111]
TÍTULO / TITLE: - The impact of dialysis
and transplantation on children.
REVISTA
/ JOURNAL: - Adv Ren Replace Ther 2001 Jul;8(3):206-13.
AUTORES
/ AUTHORS: - Furth SL; Gerson AC; Neu AM; Fivush BA
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatrics, Johns Hopkins
University School of Medicine, Baltimore, MD 21287-2535, USA. sfurth@jhmi.edu
RESUMEN
/ SUMMARY: - Effective methods to treat end stage renal
disease (ESRD) in children have become available in the United States during
the last 3 decades. Since the United States Congress created the Medicare ESRD
Program in 1972, most children with ESRD have the option of Medicare insurance.
Medicare expenditures for children with ESRD range from $14,000 for transplant
recipients to $43,000 for dialysis patients per year. The tremendous expense of
ESRD treatment has led to research to determine which treatment options are
associated with the best health outcomes and the best value (quality/cost) for
the money spent treating ESRD. The National Kidney Foundation’s Dialysis
Outcomes Quality Initiative recommends the use of quality of life and health
status measures to gauge the impact of renal replacement therapy on quality of
life in the ESRD population. In adult patients with renal failure, several
generic and disease-specific quality of life measures have been validated and
tested for reliability. In contrast, little research using validated and
reliable health status measures has been performed in pediatric patients to
measure the impact of ESRD. This article summarizes existing literature on how
we currently measure the impact of dialysis and transplantation on children,
discusses existing health status measures for children and adolescents, and
describes how these measures might be used to improve our care of patients and
long-term outcomes for children with kidney failure. N. Ref:: 43
----------------------------------------------------
[112]
TÍTULO / TITLE: - Center and other factor
effects in recipients of living-donor kidney transplants.
REVISTA
/ JOURNAL: - Clin Transpl 2001;:209-21.
AUTORES
/ AUTHORS: - Gjertson DW
RESUMEN
/ SUMMARY: - 1. LIVING DONOR KIDNEY TRANSPLANTS: Using
1996-2001 UNOS Registry data, we assessed the joint influence of center, 19
pre- and 5 posttransplant factors on renal allograft function in 21,830
patients transplanted with living donor kidneys. During an initial risk period,
21,033 recipients were projected to keep their grafts through one year (an
average 96.4% one-year graft survival), and, in a second risk period, 17,775
recipients were projected to keep their grafts through 5 years (84.5%
conditional 5-year graft survival after surviving one year posttransplant). 2.
CENTER EFFECTS: Following multivariate log-linear analysis, 57.5% and 26.5% of
assignable variation in one- and 5-year living-donor graft survival rates were
due to the variation across 234 transplant centers. Center effect dominated
other factors in influencing early outcomes among living kidney donor transplants.
A program’s size was associated with this center effect since all large centers
(400+ living donor kidneys) had better-than-average one-year graft survival
rates, whereas smaller centers (< or = 100 grafts) had wide ranges in
short-term outcomes (87-100%). Center size did not play a role in explaining
long-term variation, and the extent to which uniformity in care remains the
responsibility of the original center needs to be investigated. 3.
PRETRANSPLANT FACTOR EFFECTS: The impact of the 19 pretransplant cofactors on
short-term outcomes among living donor transplants was clinically
small—adjusted one-year graft survival rates across all categories exceeded
94%. However, their long-term effects were stronger and more typical of
cadaveric results. The following 4 factors, each explaining > 10% of the
assignable variation in conditional 5-year graft survival, were ranked and
independently yielded poor results: 1) kidneys from parental donors; 2) grafts
in male recipients; 3) teenage/adult recipients (> 12 years); and 4) black
recipients. Recipient’s original disease and body mass index, donor’s race and
age, and HLA matching were highly significant factors, but their impact on
long-term graft survival was less than those observed previously in cadaveric
renal transplants. 4. POSTTRANSPLANT FACTOR EFFECTS: Short- and long-term
outcomes were relatively stable regardless of the maintenance drug initiated at
hospital discharge. Living donor transplant outcomes were similar for Neoral
versus Tacrolimus and for MMF versus azathioprine. Kidney graft survival among
living donor transplants was strongly affected by delays in graft function or
acute rejection episodes. 5. CONCLUSIONS: During the first year posttransplant,
the benefits of receiving a living donor kidney (versus a cadaver kidney)
mitigate negative cofactor risks of graft failure. Beyond one-year, recipients
of living donor kidneys are subjected to the same deleterious effects from
cofactors and early posttransplant events that impact the long-term graft
survival following cadaveric transplantation.
----------------------------------------------------
[113]
TÍTULO / TITLE: - The UNOS renal
transplant registry.
REVISTA
/ JOURNAL: - Clin Transpl 2001;:1-18.
AUTORES
/ AUTHORS: - Cecka JM
INSTITUCIÓN
/ INSTITUTION: - UCLA Immunogenetics Center, Department of
Pathology, UCLA School of Medicine, Los Angeles, California, USA.
RESUMEN
/ SUMMARY: - The shortage of cadaver kidneys relative
to increasing demand for transplantation has lead to a remarkable rise in
transplantation from living donors. Based upon data reported to UNOS, the
number of living donor kidneys transplanted in 2000 (5,106) nearly equaled the
number of cadaver kidneys from preferred donors aged 6-50. HLA-mismatched
siblings, offspring, spouses and other genetically unrelated donors accounted
for nearly 80% of increased living donor transplantation during 1994-2000.
Despite the increased use of poorly HLA-matched living donor kidneys, the
actuarial 10-year graft survival rates for transplants between 1988-2000 were
clustered between 53-57% for HLA-mismatched living donor grafts, except for
offspring-to-parent transplants (49%) when the recipients were generally older.
The 10-year survival rate for 96,053 cadaver grafts was 38% during the same
period. The 5-year graft survival rates for more recent (1996-2000) cadaver
donor transplants were 66%, 62% and 56% for recipients of first, second and
multiple grafts, respectively (p < 0.001). The comparable results among
recipients of living donor kidneys were 67%, 66% and 59% (p = ns). The 5-year
graft survival rates for HLA-matched first grafts were 7% higher than those for
HLA-mismatched transplants when the kidney was from a living or cadaver donor.
HLA-identical sibling transplants provided the best long-term graft survival
(85% at 5 years and a 32 year half-life). Even with improved crossmatch tests
and stronger immunosuppression, sensitization was associated with 8% lower
graft survival at 5 years and with a higher rate of late graft loss among first
cadaver kidney recipients. Sensitization also was associated with an increase
in delayed graft function from 22% of unsensitized first transplant recipients
to as much as 36% among multiply retransplanted patients. Recipient race was a
key factor in long-term graft survival of both living and cadaver donor
kidneys. The rate of late graft loss was double among blacks compared with
recipients with other racial origins whether the kidney was from a living or
cadaver donor. Black recipients accounted for 29% of first cadaver transplants
during 1996-2000, but only 14% of living donor grafts. Thus an important
component of long-term differences in graft survival comparing living and
cadaver donor transplants is the disparate racial demographics. Both the recipient
and donor populations are aging. The proportion of cadaver kidney recipients
over age 50 increased from 26% to 45% and the proportion of living donor kidney
recipients over age 50 rose from 10% to 35% between 1988 and 2000. The aging
population affects the transplant outcome as 65% of graft losses among young
recipients (ages 10-15) were attributed to acute or chronic rejection compared
with only 25% of grafts lost among patients over age 60. More than half of
graft losses among older recipients were due to death with a functioning graft.
Kidneys from donors over age 60 comprised 9% of first cadaver transplants and
yielded a 50% 5-year graft survival rate compared with 70% when the donor was
aged 19-45. Kidneys from donors over age 60 accounted for only 3% of first
living donor transplants and their 84% 5-year graft survival rate was
comparable to that for younger donor kidneys. Despite declining immunological
graft losses with advancing recipient age, the effect of HLA matching was
similar among recipients of first cadaver transplants aged 50 or under and
those over age 50. Completely HLA-mismatched grafts had a 10% lower 5-year
graft survival rate than HLA-matched grafts when the recipient was over 50
compared with a 14% lower survival rate in younger recipients. The graft
half-lives were shorter by 5-7 years for HLA-mismatched kidneys transplanted to
older or younger recipients, respectively.
----------------------------------------------------
[114]
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.
----------------------------------------------------
[115]
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.
----------------------------------------------------
[116]
TÍTULO / TITLE: - Evaluation guidelines
for adult and pediatric kidney transplant programs: the Missouri experience.
REVISTA
/ JOURNAL: - Prog Transplant 2002 Mar;12(1):30-5.
AUTORES
/ AUTHORS: - Hillerman WL; Russell CL; Barry D; Brewer
B; Bianchi L; Cundiff W; Friedman B; Hoff J; Hood A; Mahon M; Olesky J; White M
INSTITUCIÓN
/ INSTITUTION: - University of Missouri-Columbia Hospital
and Clinics, Columbia, Mo., USA.
RESUMEN
/ SUMMARY: - CONTEXT: Rigorous candidate evaluation is
paramount for estimating risk and long-term success with transplantation. In
addition, because of increasing waiting times, patients are seeking listing at
multiple centers or transferring waiting time from one center to another.
Variations in center evaluation criteria are becoming increasingly important to
patients. OBJECTIVE: To describe the similarities and differences among the
evaluation guidelines for adult and pediatric kidney transplant programs in
Missouri. DESIGN: A descriptive design was used. SETTING AND PARTICIPANTS:
Kidney transplant nurse coordinators from 7 adult and 4 pediatric kidney
transplant programs from 10 centers in Missouri were invited to submit the
kidney transplant candidate evaluation guidelines from their programs. RESULTS:
Guidelines were submitted by nurse coordinators from all programs. Consults
with the kidney transplant team members, including surgeon, nephrologist,
social worker, and nurse coordinator, were included in all of the programs. For
the adult programs, 67% (20/30) of the tests and laboratory values were agreed
on by at least 70% of the program transplant team members. Similarly, for the
pediatric programs, 62% (16/26) of the age-appropriate tests and laboratory
values were agreed on by at least 75% of the program transplant team members.
CONCLUSIONS: Within the Missouri programs, testing is consistent whether the
center is large or small, adult or pediatric. Transplant teams should
periodically review their kidney transplant recipient evaluation criteria for
similarities to and differences from the current state-of-the-science and
surrounding programs.
----------------------------------------------------
[117]
TÍTULO / TITLE: - Renal transplantation
strengths and shortcomings.
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:S1-6.
AUTORES
/ AUTHORS: - Ponticelli C
INSTITUCIÓN
/ INSTITUTION: - Nephrology and Dialysis Division, IRCCS
Ospedale Maggiore, Milan, Italy.
RESUMEN
/ SUMMARY: - Although renal transplantation remains the
treatment of choice for many uremic patients there are still problems not
completely solved. The risk of acute rejection can be minimized by the modern
immunosuppression but many grafts fail in the long-term because of the
so-called chronic allograft nephropathy, which can be caused both by
alloantigen dependent and independent mechanisms. Recurrent renal disease is
another important cause of failure in the long-term. Death represents the
second cause of failure. Cardiovascular complications, infections, and cancer
are the most frequent causes of death. Careful selection of the candidate
tailored immunosuppression, aggressive diagnostic and therapeutic approaches
are needed to minimized mortality in transplant recipients. However, the main
limit for the success of transplantation is the shortage of donors. Use of
marginal donors, non-heart-beating donors, and living unrelated donors has been
recommended by many authorities to overcome the shortage of organs. N. Ref:: 50
----------------------------------------------------
[118]
TÍTULO / TITLE: - Renal replacement
therapy (RRT) in the ICU: criteria for initiating RRT.
REVISTA
/ JOURNAL: - Contrib Nephrol 2001;(132):171-80.
AUTORES
/ AUTHORS: - Burchardi H
INSTITUCIÓN
/ INSTITUTION: - Zentrum Anaesthesiologie, Rettungs- und
Intensivmedizin, Georg-August-Universitat, Gottingen, Deutschland. hburcha@gwdg.de N. Ref:: 41
----------------------------------------------------
[119]
TÍTULO / TITLE: - Gender imbalance in
living organ donation.
REVISTA
/ JOURNAL: - Med Health Care Philos 2002;5(2):199-204.
AUTORES
/ AUTHORS: - Biller-Andorno N
INSTITUCIÓN
/ INSTITUTION: - Department of Medical Ethics and History
of Medicine/Center for Psychosocial Medicine, University of Gottingen, Germany.
nbiller@gwdg.de
RESUMEN
/ SUMMARY: - Living organ donation has developed into
an important therapeutic option in transplantation medicine. However, there are
some medico-ethical problems that come along with the increasing reliance on
this organ source. One of these concerns is based on the observation that many
more women than men function as living organ donors. Whereas discrimination and
differential access have been extensively discussed in the context of cadaveric
transplantation and other areas of health care, the issue of gender imbalance
in living organ donation has received less attention. This paper presents
relevant data from the Eurotransplant and UNOS transplantation systems (1) and
discusses possible explanations for the documented gender discrepancies. The
conclusion calls for a review of existing practice guidelines in order to
secure effective protection of particularly vulnerable potential donors and an
equitable donor-recipient-ratio in living organ donation. N. Ref:: 45
----------------------------------------------------
[120]
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
----------------------------------------------------
[121]
TÍTULO / TITLE: - Kidney
transplantation—new developments.
REVISTA
/ JOURNAL: - Swiss Surg 2003;9(5):205-12.
AUTORES
/ AUTHORS: - Dahm F; Weber M
INSTITUCIÓN
/ INSTITUTION: - Division of Visceral and Transplantation
Surgery, University Hospital Zurich, Switzerland.
RESUMEN
/ SUMMARY: - The standard of care for patients with
end-stage renal disease is kidney transplantation, which not only confers a
survival benefit compared to hemodialysis, but is also cost-effective. The
indications, contraindications as well as the preoperative assessment of
recipients are discussed. The recurrence rate of the underlying renal disease
has to be taken into account, especially in living donation. Growing organ
shortage has lead transplant surgeons to accept older, less healthy, and even
non-heart-beating donors, with generally good results. Living-donation is safe
for the donor, outcome is excellent and plays an increasing role today. It has
surpassed the number of cadaveric kidney transplantations in some countries. Many
centres now apply laparoscopic donor nephrectomy with low morbidity. Matching
for ABO blood group and HLA is routinely performed, as well as pre-transplant
crossmatching. The surgical procedure has been standardized and the
complication rate is low. Immunosuppressive protocols have evolved over time,
and while the optimal regimen has not been defined, the availability of
numerous agents allows the regimen to be individualized. New agents are being
introduced into clinical practice. With increasing long-term graft survival and
thus life-long immunosuppression, cardiovascular disease, de-novo malignancies
and infectious complications are major causes of morbidity and mortality of
transplant recipients. Effective prophylactic measures are often available, and
surveillance protocols are warranted in these patients. Overall, the outcome of
renal transplantation is excellent and has improved over time. Future prospects
include induction of allograft tolerance, tissue engineering and
xenotransplantation. N.
Ref:: 97
----------------------------------------------------
[122]
TÍTULO / TITLE: - The next generation of
medications for kidney transplant patients.
REVISTA
/ JOURNAL: - Crit Care Nurs Clin North Am 2002
Mar;14(1):99-109.
AUTORES
/ AUTHORS: - Sims TW; Good EW
INSTITUCIÓN
/ INSTITUTION: - Digestive Health Center of Excellence and
Surgical Services, University of Virginia Health System, Charlottesville 22906,
USA. tws4m@virginia.edu
RESUMEN
/ SUMMARY: - Transplant pharmacotherapy evolves as new
agents are investigated and approved for use. Clinical immunosuppression has
been plagued with maintaining a balance between rejection of the transplanted
organ and complications of over-immunosuppression, including infection and
malignancy. Clinicians must understand current immunosuppressive regimens and
their associated effects when caring for transplant patients. While all
transplant patients receive some form of immunosuppressive therapy, the
combinations and choices increase as new drugs are developed. In the critical
and acute care settings, newly transplanted patients will likely receive
induction therapy. The goal of induction therapy is to increase long-term
patient and allograft survival while preventing or reducing rejection episodes.
Several agents are available for induction therapy, and each transplant center
designs its own protocol. The foundation for maintenance therapy rests on the
combining immunosuppressives to prevent rejection through a variety of pathways.
An understanding of the mechanism of action and additive effects of a drug
allows practitioners to optimize therapy while decreasing adverse effects.
Immunosuppressive therapy offers potential for reducing detrimental patient
outcomes and improving allograft survival. It is well established that repeated
rejection episodes correlate with poor long-term graft survival. Challenges
facing researchers and clinicians focus on improved patient outcomes and
options to address financial constraints of transplantation. N. Ref:: 33
----------------------------------------------------
[123]
TÍTULO / TITLE: - Live donor renal
transplantation.
REVISTA
/ JOURNAL: - Med Health R I 2002 Apr;85(4):128-30.
AUTORES
/ AUTHORS: - Morrissey P; Hopkins-Garcia B
INSTITUCIÓN
/ INSTITUTION: - Division of Organ Transplantation, Rhode
Island Hospital, Brown Medical School, Providence, RI, USA. Pmorrissey@lifespan.org N. Ref:: 6
----------------------------------------------------
[124]
TÍTULO / TITLE: - Nutritional assessment
and support of kidney transplant recipients.
REVISTA
/ JOURNAL: - J Infus Nurs 2004 Jan-Feb;27(1):45-51.
AUTORES
/ AUTHORS: - Tritt L
INSTITUCIÓN
/ INSTITUTION: - Kidney and Pancreas Transplant Program,
Indiana University Hospital, Indianapolis, USA.
RESUMEN
/ SUMMARY: - Kidney transplant has become a viable
option for patients with end-stage renal disease (ESRD). The number of kidney
transplants has steadily increased during the past 50 years. Advances in
surgical technique and immunosuppressive drugs have led to significant
improvements in survival rates. Many chronic diseases that lead to ESRD
negatively affect nutritional status. To minimize nutritional depletion and
optimize nutritional status, a complete and thorough evaluation by a registered
dietitian should be performed. The posttransplant nutritional goal is to
provide adequate nutrition to promote wound healing and anabolism, to prevent
infection, and to minimize side effects of medications. Providing adequate
nutrition and reducing the long-term side effects are essential for graft
survival in kidney transplant recipients
N. Ref:: 30
----------------------------------------------------
[125]
TÍTULO / TITLE: - Legalizing the sale of
kidneys for transplantation: suggested guidelines.
REVISTA
/ JOURNAL: - Isr Med Assoc J 2002 Dec;4(12):1132-4.
AUTORES
/ AUTHORS: - Rapoport J; Kagan A; Friedlaender MM
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology and Hypertension,
Kaplan Medical Center, Rehovot, Israel. jayson_r@clalit.org.il
----------------------------------------------------
[126]
TÍTULO / TITLE: - Kidney transplantation
from living donors: comparison of results between related and unrelated donor
transplants under new immunosuppressive protocols.
REVISTA
/ JOURNAL: - Isr Med Assoc J 2003 Sep;5(9):622-5.
AUTORES
/ AUTHORS: - Chkhotua AB; Klein T; Shabtai EL; Yussim
A; Bar-Nathan N; Shaharabani E; Lustig S; Mor E
INSTITUCIÓN
/ INSTITUTION: - National Center of Urology, Tbilisi,
Georgia.
RESUMEN
/ SUMMARY: - BACKGROUND: Recent advances in
immunosuppressive therapy have led to a substantial improvement in the outcome
of kidney transplantation. Living unrelated donors may become a source of
additional organs for patients on the kidney waiting list. OBJECTIVES: To study
the impact of the combination of calcineurin inhibitors and
mycophenolate-mofetile, together with steroids, on outcomes of living related
and unrelated transplants. METHODS: Between September 1997 and January 2000,
129 patients underwent living related (n = 80) or unrelated (n = 49) kidney
transplant. The mean follow-up was 28.2 months. Immunosuppressive protocols
consisted of MMF with cyclosporine (41%) or tacrolimus (59%), plus steroids.
Patient and graft survival data, rejection rate, and graft functional
parameters were compared between the groups. RESULTS: LUD recipients were older
(47.8 vs. 33.6 years) with a higher number of re-transplants (24.5% vs. 11.2%
in LRD recipients, P < 0.05). Human leukocyte antigen matching was higher in
LRD recipients (P < 0.001). Acute rejection developed in 28.6% of LUD and
27.5% of LRD transplants (P = NS). Creatinine levels at 1, 2 and 3 years
post-transplant were 1.6, 1.7 and 1.7 mg/dl for LRD patients and 1.5, 1.5 and
1.3 mg/dl for LUD recipients (P = NS). There was no difference in patient
survival rates between the groups. One, 2 and 3 years graft survival rates were
similar in LRD (91.3%, 90% and 87.5%) and LUD (89.8%, 87.8% and 87.8%)
recipients. CONCLUSIONS: Despite HLA disparity, rejection and survival rates of
living unrelated transplants under current immunosuppressive protocols are
comparable to those of living related transplants.
----------------------------------------------------
[127]
TÍTULO / TITLE: - The postanesthesia care
of an adult renal transplant recipient.
REVISTA
/ JOURNAL: - J Perianesth Nurs 2003 Feb;18(1):32-41.
●●
Enlace al texto completo (gratuito o de pago) 1053/jpan.2003.50002
AUTORES
/ AUTHORS: - Barone CP; Lightfoot ML; Barone GW
INSTITUCIÓN
/ INSTITUTION: - College of Nursing and an RNII, PRN Pool,
University Hospital PACU, CA, USA. baroneclaudiap@uams.edu
RESUMEN
/ SUMMARY: - Renal transplantation is the most common
type of solid organ transplant performed in this country. For the PACU nurse,
the immediate postoperative care of a renal transplant recipient can present a
very unique and interesting challenge. Like all patients arriving to the PACU,
the initial assessment of an immediate postoperative renal transplant recipient
should first address the routine postsurgical concerns of airway, respiration,
and hemodynamics. Most renal transplant programs have set protocols for the
care required during the immediate posttransplant stay in the PACU. The
postanesthesia nurse caring for these patients must become knowledgeable of
these protocols. The following is a review of the immediate postanesthesia care
for both the “fresh” renal transplant and the care of the long-term renal
transplant recipient who has had surgery.
N. Ref:: 16
----------------------------------------------------
[128]
TÍTULO / TITLE: - Ageism in renal
replacement therapy.
REVISTA
/ JOURNAL: - Nurs Older People 2003 Dec;15(9):14-6.
AUTORES
/ AUTHORS: - Munshi SK; Bell SL; Vijayakumar N; Warwick
G
INSTITUCIÓN
/ INSTITUTION: - Leicester General Hospital. N. Ref:: 26
----------------------------------------------------
[129]
TÍTULO / TITLE: - Nursing management of
patients for greater renal transplant success.
REVISTA
/ JOURNAL: - Prof Nurse 2002 Aug;17(12):725-8.
AUTORES
/ AUTHORS: - Shallcross J
INSTITUCIÓN
/ INSTITUTION: - Renal Transplant Unit, Royal Liverpool
University Hospital.
RESUMEN
/ SUMMARY: - There is now a greater choice of
immunosuppressive agents that can be used in the care of kidney transplant
patients. Concordance with treatment regimens is of prime importance and nurses
working with this patient group have a key role in encouraging adherence to
medication and helping patients to achieve a good quality of life. N. Ref:: 42
----------------------------------------------------
[130]
TÍTULO / TITLE: - What is new with renal
transplantation?
REVISTA
/ JOURNAL: - AORN J 2003 May;77(5):946-66; quiz 967-70.
AUTORES
/ AUTHORS: - Wallace MA
INSTITUCIÓN
/ INSTITUTION: - Valley View Medical Center, Cedar City,
Utah, USA.
RESUMEN
/ SUMMARY: - Dialysis and transplantation bring new
hope and life to thousands of patients with end-stage renal disease. Renal
transplantation restores reasonably normal health to patients whose kidneys no
longer function and frees them from the limitations imposed by dialysis.
Improved graft survival rates have further enhanced the desirability of
transplantation. Currently in the United States, more than 80,000 people are
living with a functioning renal transplant. The introduction of laparoscopic
and laparoscopy-assisted techniques has proven to be a major improvement to
living donation. This less invasive method of donating a kidney has more than
doubled the chance that a patient with kidney failure will receive a transplant
from a friend or loved one. New immunosuppressant medications, improved success
rates, and the proliferation of transplantation centers have made renal
transplantation a viable choice for many patients. The future will be dependent
upon a marked increase in organ donation, which in turn will bring about
earlier transplantation for patients with end-stage organ failure. N. Ref:: 46
----------------------------------------------------
[131]
TÍTULO / TITLE: - A protocol for paid
kidney donation in Israel.
REVISTA
/ JOURNAL: - Isr Med Assoc J 2003 Sep;5(9):611-4.
AUTORES
/ AUTHORS: - Friedlaender MM
INSTITUCIÓN
/ INSTITUTION: - Nephrology and Hypertension Service,
Hadassah University Hospital, Jerusalem, Israel. fried@cc.huji.ac.il
----------------------------------------------------
[132]
TÍTULO / TITLE: - Hoping and planning: a
multidisciplinary look at the pretransplant phase.
REVISTA
/ JOURNAL: - Nephrol Nurs J 2003 Jun;30(3):334-5.
AUTORES
/ AUTHORS: - Cochran CC; Callahan MB; Atkins CR
INSTITUCIÓN
/ INSTITUTION: - Medical City Hospital Dallas, Dallas, TX,
USA. N. Ref:: 7
----------------------------------------------------