One-year impact of COVID-19 pandemic on renal replacement therapy and kidney transplantation in a tertiary center in Southern Brazil / Impacto de um ano da Pandemia COVID 19 na terapia renal substitutiva e no transplante renal em centro terciário no Sul do Brasil

ABSTRACT Introduction: Patients on renal replacement therapy (RRT) and kidney transplant recipients (KTR) present multiple factors that may increase the risk of death from coronavirus disease 2019 (COVID-19). This study aimed to evaluate the incidence and impact of COVID-19 in RRT patients and KTRs. Methods: Between March 2020 and February 2021, we monitored the RRT population of thirteen dialysis facilities that refer patients for transplantation to our center, a tertiary hospital in Southern Brazil. In the same period, we also monitor COVID-19 incidence and mortality in our KTR population. Demographical, clinical, and COVID-19-related information were analyzed. Results: We evaluated 1545 patients in the dialysis centers, of which 267 (17.4%) were infected by COVID-19 and 53 (19.9%) died. Among 275 patients on the kidney transplant waiting list, 63 patients (22.9%) were infected and seven (11.1%) died. COVID-19 was the leading cause of death (29.2%) among patients on the waiting list. Within the population of 1360 KTR, 134 (9.85%) were diagnosed with COVID-19 and 20 (14.9%) died. The number of kidney transplants decreased by 56.7% compared with the same period in the previous twelve months. Conclusion: In the study period, patients on RRT and KTRs presented a high incidence of COVID-19 and high COVID-19-related lethality. The impact on the patients on the transplant waiting list was less pronounced. The lethality rate observed in both cohorts seems to be related to age, comorbidities, and disease severity.

Resumo Introdução: Pacientes em terapia renal substitutiva (TRS) e receptores de transplante renal (RTR) apresentam múltiplos fatores que podem aumentar o risco de óbito por doença do coronavírus 2019 (COVID-19). Este estudo teve como objetivo avaliar incidência e impacto da COVID-19 em pacientes em TRS e RTR. Métodos: Entre Março de 2020 e Fevereiro de 2021, monitoramos a população em TRS de treze unidades de diálise que encaminham pacientes para transplante ao nosso centro, um hospital terciário no Sul do Brasil. No mesmo período, também monitoramos a incidência e mortalidade da COVID-19 em nossa população de RTR. Foram analisadas informações demográficas, clínicas e relacionadas à COVID-19. Resultados: Avaliamos 1545 pacientes nos centros de diálise, dos quais 267 (17,4%) foram infectados pela COVID-19 e 53 (19,9%) foram a óbito. Entre 275 pacientes na lista de espera para transplante renal, 63 (22,9%) foram infectados e sete (11,1%) foram a óbito. COVID-19 foi a principal causa de óbito (29,2%) entre pacientes na lista de espera. Dentre a população de 1360 RTR, 134 (9,85%) foram diagnosticados com COVID-19 e 20 (14,9%) foram a óbito. O número de transplantes renais diminuiu em 56,7% comparado ao mesmo período nos doze meses anteriores. Conclusão: No período do estudo, pacientes em TRS e RTR apresentaram alta incidência de COVID-19 e alta letalidade relacionada à COVID-19. O impacto nos pacientes na lista de espera para transplante foi menos pronunciado. A taxa de letalidade observada em ambas as coortes parece estar relacionada à idade, comorbidades e gravidade da doença.

One-year impact of COVID-19 pandemic on renal replacement therapy and kidney transplantation in a tertiary center in Southern Brazil.

INTRODUCTION: Patients on renal replacement therapy (RRT) and kidney transplant recipients (KTR) present multiple factors that may increase the risk of death from coronavirus disease 2019 (COVID-19). This study aimed to evaluate the incidence and impact of COVID-19 in RRT patients and KTRs. METHODS: Between March 2020 and February 2021, we monitored the RRT population of thirteen dialysis facilities that refer patients for transplantation to our center, a tertiary hospital in Southern Brazil. In the same period, we also monitor COVID-19 incidence and mortality in our KTR population. Demographical, clinical, and COVID-19-related information were analyzed. RESULTS: We evaluated 1545 patients in the dialysis centers, of which 267 (17.4%) were infected by COVID-19 and 53 (19.9%) died. Among 275 patients on the kidney transplant waiting list, 63 patients (22.9%) were infected and seven (11.1%) died. COVID-19 was the leading cause of death (29.2%) among patients on the waiting list. Within the population of 1360 KTR, 134 (9.85%) were diagnosed with COVID-19 and 20 (14.9%) died. The number of kidney transplants decreased by 56.7% compared with the same period in the previous twelve months. CONCLUSION: In the study period, patients on RRT and KTRs presented a high incidence of COVID-19 and high COVID-19-related lethality. The impact on the patients on the transplant waiting list was less pronounced. The lethality rate observed in both cohorts seems to be related to age, comorbidities, and disease severity.

High mortality among kidney transplant recipients diagnosed with coronavirus disease 2019: Results from the Brazilian multicenter cohort study.

BACKGROUND: Kidney transplant (KT) recipients are considered a high-risk group for unfavorable outcomes in the course of coronavirus disease 2019 (COVID-19). AIM: To describe the clinical aspects and outcomes of COVID-19 among KT recipients. METHODS: This multicenter cohort study enrolled 1,680 KT recipients diagnosed with COVID-19 between March and November 2020, from 35 Brazilian centers. The main outcome was the 90-day cumulative incidence of death, for the entire cohort and according to acute kidney injury (AKI) and renal replacement therapy (RRT) requirement. Fatality rates were analyzed according to hospitalization, intensive care unit (ICU) admission, and mechanical ventilation (MV) requirement. Multivariable analysis was performed by logistic regression for the probability of hospitalization and death. RESULTS: The median age of the recipients was 51.3 years, 60.4% were men and 11.4% were Afro-Brazilian. Comorbidities were reported in 1,489 (88.6%), and the interval between transplantation and infection was 5.9 years. The most frequent symptoms were cough (54%), myalgia (40%), dyspnea (37%), and diarrhea (31%), whereas the clinical signs were fever (61%) and hypoxemia (13%). Hospitalization was required in 65.1%, and immunosuppressive drugs adjustments were made in 74.4% of in-hospital patients. ICU admission was required in 34.6% and MV in 24.9%. In the multivariable modeling, the variables related with the probability of hospitalization were age, hypertension, previous cardiovascular disease, recent use of high dose of steroid, and fever, dyspnea, diarrhea, and nausea or vomiting as COVID-19 symptoms. On the other hand, the variables that reduced the probability of hospitalization were time of COVID-19 symptoms, and nasal congestion, headache, arthralgia and anosmia as COVID-19 symptoms. The overall 90-day cumulative incidence of death was 21.0%. The fatality rates were 31.6%, 58.2%, and 75.5% in those who were hospitalized, admitted to the ICU, and required MV, respectively. At the time of infection, 23.2% had AKI and 23.4% required RRT in the follow-up. The cumulative incidence of death was significantly higher among recipients with AKI (36.0% vs. 19.1%, P < 0.0001) and in those who required RRT (70.8% vs. 10.1%, P < 0.0001). The variables related with the probability of death within 90 days after COVID-19 were age, time after transplantation, presence of hypertension, previous cardiovascular disease, use of tacrolimus and mycophenolate, recent use of high dose of steroids, and dyspnea as COVID-19 symptom. On the other hand, the variables that reduced the risk of death were time of symptoms, and headache and anosmia as COVID-19 symptoms. CONCLUSION: The patients diagnosed with COVID-19 were long-term KT recipients and most of them had some comorbidities. One in every five patients died, and the rate of death was significantly higher in those with AKI, mainly when RRT was required.

Exploring the causes of the high incidence of delayed graft function after kidney transplantation in Brazil: a multicenter study.

This retrospective multicenter (n = 18) cohort study evaluated the incidence, risk factors, and the impact of delayed graft function (DGF) on 1-year kidney transplant (KT) outcomes. Of 3992 deceased donor KT performed in 2014-2015, the incidence of DGF was 54%, ranging from 29.9% to 87.7% among centers. Risk factors (lower-bound-95%CI OR upper-bound-95%CI ) were male gender (1.066 1.2491.463 ), diabetic kidney disease (1.053 1.2961.595 ), time on dialysis (1.005 1.0071.009 ), retransplantation (1.035 1.3971.885 ), preformed anti-HLA antibodies (1.011 1.3831.892 ), HLA mismatches (1.006 1.0661.130 ), donor age (1.011 1.0171.023 ), donor final serum creatinine (sCr) (1.239 1.3171.399 ), cold ischemia time (CIT) (1.031 1.0431.056 ), machine perfusion (0.401 0.5420.733 ), and induction therapy with rabbit antithymocyte globulin (rATG) (0.658 0.8000.973 ). Duration of DGF > 4 days was associated with inferior renal function and DGF > 14 days with the higher incidences of acute rejection, graft loss, and death. In conclusion, the incidence and duration of DGF were high and associated with inferior graft outcomes. While late referral and poor donor maintenance account for the high overall incidence of DGF, variability in donor and recipient selection, organ preservation method, and type of induction agent may account for the wide variation observed among transplant centers.

Reutilização do dialisador e uso único: episódios de pirogenia e bacteremia / Reutilización del dializador y uso único: episodios de reacciones pirógenas y bacteriemias / Dialyzer reuse and single use: pyrogenesis and bacteremia episodes

Resumo Objetivos Comparar a reutilização do dialisador com o uso único deste material para marcadores bioquímicos, hematológicos, episódios de pirogenias e bacteremias. Métodos Estudo longitudinal com coleta de dados retrospectiva em prontuários de pacientes em hemodiálise, em hospital público universitário. A investigação foi conduzida seis meses com a reutilização do dialisador e seis meses com uso único. Os dados foram analisados no SPSS Versão 18.0. Para comparação das médias dos exames utilizou-se teste t pareado e Wilcoxon, episódios de pirogenia e bacteremia foram analisados pelo teste de Wilcoxon e Razão de Chances (RC) como medida de força de associação. Variáveis categóricas foram analisadas pelos testes de McNemar e Exato de Fisher. O estudo foi aprovado pelo Comitê de Ética e Pesquisa. Resultados Foram analisadas 5.508 sessões de hemodiálise de pacientes predominantemente masculinos 21(62%), média de idade 58(± 14) anos, hipertensos 14(41%), tempo médio de tratamento 6±3 anos. Durante uso único identificou-se redução da ureia pós diálise, creatinina, fósforo, ferritina, hematócrito e hemoglogina em relação ao reutilizado (p < 0,05) e 91% menos risco de pirogenia comparado a reutilização do dialisador (Razão de Chance= 0,091; IC 95%: 0,002-0,625). Não houve diferença significativa na ocorrência de bacteremias. Conclusão Os resultados sugerem maior remoção de biomarcadores bioquímicos e menos episódios de pirogenias quando o dialisador é uso único.ater removal of biochemical biomarkers and fewer pyrogenics episodes when the dialyzer is a single use.

Resumen Objetivos Comparar la reutilización del dializador con el uso único de este material en marcadores bioquímicos, hematológicos, episodios de reacciones pirógenas y bacteriemias. Métodos Estudio longitudinal con recolección de datos retrospectiva en historias clínicas de pacientes en hemodiálisis, en un hospital público universitario. La investigación fue conducida seis meses con la reutilización del dializador y seis meses con un único uso. Los datos fueron analizados en SPSS Versión 18.0. Para comparar los promedios de los análisis, se utilizó el Test-T pareado y prueba de Wilcoxon, los episodios de reacciones pirógenas y bacteriemia fueron analizados mediante la prueba de Wilcoxon y Razón de Momios (RM) como medida de fuerza de asociación. Las variables categóricas se analizaron con la prueba de McNemar y la prueba exacta de Fisher. El estudio fue aprobado por el Comité de Ética e Investigación. Resultados Se analizaron 5.508 sesiones de hemodiálisis de pacientes predominantemente masculinos 21 (62 %), promedio de edad 58 (±14) años, hipertensos 14 (41 %), tiempo promedio de tratamiento 6±3 años. Durante el uso único del dializador, se identificó una reducción de la urea posdiálisis, creatinina, fósforo, ferritina, hematocrito y hemoglobina respecto al dializador reutilizado (p < 0,05) y un 91 % menos de riesgo de reacción pirógena comparado con la reutilización del dializador (Razón de Momios = 0,091; IC 95 %: 0,002-0,625). No hubo diferencia significativa en episodios de bacteriemias. Conclusión Los resultados sugieren mayor eliminación de biomarcadores bioquímicos y menos episodios de reacciones pirógenas cuando el dializador se utiliza una única vez.

Abstract Objectives To compare dialyzer reuse with its single use for biochemical, hematological markers, pyrogenesis and bacteremia episodes. Methods A longitudinal study with retrospective data collection from medical records of patients on dialysis in a public university hospital. The investigation was conducted six months with dialyzer reuse and six months with single use. Data were analyzed using SPSS Version 18.0. To compare the tests means, paired t-test and Wilcoxon were used. Pyrogenesis and bacteremia episodes were analyzed using the Wilcoxon test and Odds Ratio (OR) as association strength measures. Categorical variables were analyzed using McNemar and Fisher's Exact tests. The study was approved by the hospital's Research Ethics Committee. Results Five thousand five hundred eight dialysis sessions of predominantly male patients were analyzed, 21 (62%), with mean age of 58 (± 14) years, hypertensive 14 (41%), with mean treatment time 6 ± 3 years. During single use, a reduction in urea after dialysis, creatinine, phosphorus, ferritin, hematocrit and hemoglogin was identified in relation to reuse (p<0.05) and 91% less risk of pyrogenesis compared to dialyzer reuse (Odds Ratio=0.091; 95% CI: 0.002-0.625). There was no significant difference in the occurrence of bacteremia. Conclusion The results suggest greater removal of biochemical biomarkers and fewer pyrogenics episodes when the dialyzer is a single use.

Long-term effects of delayed graft function duration on function and survival of deceased donor kidney transplants / Efeitos de longo prazo da duração da função tardia do enxerto sobre a função e sobrevida de transplantes renais com doadores falecidos

Abstract Introduction: Delayed graft function (DGF) is a frequent complication after deceased donor kidney transplantation with an impact on the prognosis of the transplant. Despite this, long-term impact of DGF on graft function after deceased donor kidney transplantation has not been properly evaluated. Objective: The main objective of this study was to evaluate risk factors for DGF and the impact of its occurrence and length on graft survival and function. Methods: A retrospective cohort study was performed in 517 kidney transplant recipients who received a deceased donor organ between January 2008 and December 2013. Results: The incidence of DGF was 69.3% and it was independently associated with donor's final serum creatinine and age, cold ischemia time, use of antibody induction therapy and recipient's diabetes mellitus. The occurrence of DGF was also associated with a higher incidence of Banff ≥ 1A grade acute rejection (P = 0.017), lower graft function up to six years after transplantation and lower death-censored graft survival at 1 and 5 years (P < 0.05). DGF period longer than 14 days was associated with higher incidence of death-censored graft loss (P = 0.038) and poorer graft function (P < 0.001). No differences were found in patient survival. Conclusions: The occurrence of DGF has a long-lasting detrimental impact on graft function and survival and this impact is even more pronounced when DGF lasts longer than two weeks.

Resumo Introdução: A função tardia do enxerto (FTE) é uma complicação frequente após transplantes renais com doadores falecidos com repercussões sobre o prognóstico do transplante. Contudo, o impacto a longo prazo da FTE sobre a função do enxerto após transplante renal com doador falecido não foi avaliado adequadamente. Objetivo: O principal objetivo do presente estudo foi avaliar os fatores de risco para FTE e o impacto de sua ocorrência e duração na sobrevida e função do enxerto. Métodos: O presente estudo observacional retrospectivo incluiu 517 receptores de transplante renal que receberam órgãos de doadores falecidos entre janeiro de 2008 e dezembro de 2013. Resultados: A incidência de FTE foi de 69,3%. Foi identificada associação independente entre FTE e creatinina sérica final e idade do doador, tempo de isquemia fria, uso de terapia de indução com anticorpos e diabetes mellitus do receptor. A ocorrência de FTE também foi associada a incidência mais elevada de rejeição aguda com classificação de Banff ≥ 1 A (P = 0,017), função reduzida do enxerto até seis anos após o transplante e menor sobrevida do enxerto censurada para óbito em 1 e 5 anos (P <0,05). Períodos de FTE superiores a 14 dias foram associados a maior incidência de perda do enxerto censurada para óbito (P = 0,038) e pior função do enxerto (P <0,001). Não foram identificadas diferenças de sobrevida nos pacientes. Conclusões: A ocorrência de FTE traz prejuízos de longa duração à função e sobrevida do enxerto. Tal impacto é ainda mais pronunciado quando a FTE persiste por mais de duas semanas.

Long-term effects of delayed graft function duration on function and survival of deceased donor kidney transplants.

INTRODUCTION: Delayed graft function (DGF) is a frequent complication after deceased donor kidney transplantation with an impact on the prognosis of the transplant. Despite this, long-term impact of DGF on graft function after deceased donor kidney transplantation has not been properly evaluated. OBJECTIVE: The main objective of this study was to evaluate risk factors for DGF and the impact of its occurrence and length on graft survival and function. METHODS: A retrospective cohort study was performed in 517 kidney transplant recipients who received a deceased donor organ between January 2008 and December 2013. RESULTS: The incidence of DGF was 69.3% and it was independently associated with donor's final serum creatinine and age, cold ischemia time, use of antibody induction therapy and recipient's diabetes mellitus. The occurrence of DGF was also associated with a higher incidence of Banff ≥ 1A grade acute rejection (P = 0.017), lower graft function up to six years after transplantation and lower death-censored graft survival at 1 and 5 years (P < 0.05). DGF period longer than 14 days was associated with higher incidence of death-censored graft loss (P = 0.038) and poorer graft function (P < 0.001). No differences were found in patient survival. CONCLUSIONS: The occurrence of DGF has a long-lasting detrimental impact on graft function and survival and this impact is even more pronounced when DGF lasts longer than two weeks.

Polyclonal anti T-lymphocyte antibody therapy monitoring in kidney transplant recipients: comparison of CD3+ T cell and total lymphocyte counts.

OBJECTIVE: To investigate the correlation between total lymphocyte and CD3+ T cell counts in peripheral blood in renal transplant patients treated with anti-thymocyte globulin, and discuss related outcomes. METHODS: A single-center, retrospective study involving 226 patients submitted to kidney transplant between 2008 and 2013, and treated with anti-thymocyte globulin for induction or treatment of cellular rejection. Doses were adjusted according to CD3+ T cell or total lymphocyte counts in peripheral blood. RESULTS: A total of 664 paired samples were analyzed. The Spearman's correlation coefficient was 0.416 (p<0.001) for all samples combined; the overall Kappa coefficient was 0.267 (p<0.001). Diagnostic parameters estimated based on total lymphocyte counts were also calculated using the number of CD3+ T cells (gold standard), with a cut off of >20 cells/mm3. CONCLUSION: Total lymphocyte and CD3+ T cell counts in peripheral blood are not equivalent monitoring strategies in anti-thymocyte globulin therapy.

Occupational hazards for nursing professionals related to the reuse and single use of the dialyzer. / Riscos ocupacionais para profissionais de enfermagem relacionados ao reúso e uso único do dialisador.

OBJECTIVE: To compare the reports of occupational events recorded by nursing professionals during the periods of reuse and single use of the dialyzer. METHOD: Retrospective longitudinal study with electronic medical records from nursing technicians of a hemodialysis service. Data were analyzed descriptively and Rate ratio. RESULTS: During the reuse of the dialyzer, there were seven events from five professionals reporting musculoskeletal disorders, ocular allergies and dermatosis. During single use, two professionals reported low back pain. The rate ratio of medication use was 6.7 days for every 1000 professionals during the reuse period and 1.52 days in the single use period (RR=4.4; 95% CI 2.182-9.805). Anti-inflammatory drugs were the most prescribed, and sick leaves were similar in both periods. CONCLUSION: Dialyzer reuse was associated with musculoskeletal disorders, ocular irritation, dermatosis and increased use of medications by professionals. Sick leaves were similar on the periods of dialyzer reuse and single use.

Riscos ocupacionais para profissionais de enfermagem relacionados ao reúso e uso único do dialisador / Occupational hazards for nursing professionals related to the reuse and single use of the dialyzer / Riesgos ocupacionales para profesionales enfermeros relacionados con el reúso y el uso único del dializador

RESUMO Objetivo: Comparar as ocorrências ocupacionais registradas pelos profissionais de Enfermagem durante a utilização do dialisador reutilizado e de uso único. Método: Estudo longitudinal, retrospectivo, realizado com prontuários de técnicos de Enfermagem de um serviço de hemodiálise. Os dados foram analisados descritivamente e calculados pela Razão de Densidade de Incidência. Resultados: Durante a reutilização do dialisador, foram registradas sete notificações de cinco profissionais relacionadas a distúrbios osteomusculares, a alergias oculares e à dermatose. Durante o uso único, dois profissionais registraram dor lombar. A taxa de exposição ao uso de medicamentos foi de 6,7 dias para cada 1.000 profissionais no período de reutilização do dialisador e de 1,52 dias no período de uso único (RDI=4,4; IC 95%: 2.182-9.805). Os anti-inflamatórios foram os mais prescritos, e os afastamentos do trabalho foram semelhantes nos dois períodos. Conclusão: O reúso do dialisador esteve associado a distúrbios osteomusculares, irritação ocular, dermatoses e maior uso de medicamentos pelos profissionais. Os afastamentos do trabalho foram semelhantes durante o uso do dialisador reutilizado e de uso único.

ABSTRACT Objective: To compare the reports of occupational events recorded by nursing professionals during the periods of reuse and single use of the dialyzer. Method: Retrospective longitudinal study with electronic medical records from nursing technicians of a hemodialysis service. Data were analyzed descriptively and Rate ratio. Results: During the reuse of the dialyzer, there were seven events from five professionals reporting musculoskeletal disorders, ocular allergies and dermatosis. During single use, two professionals reported low back pain. The rate ratio of medication use was 6.7 days for every 1000 professionals during the reuse period and 1.52 days in the single use period (RR=4.4; 95% CI 2.182-9.805). Anti-inflammatory drugs were the most prescribed, and sick leaves were similar in both periods. Conclusion: Dialyzer reuse was associated with musculoskeletal disorders, ocular irritation, dermatosis and increased use of medications by professionals. Sick leaves were similar on the periods of dialyzer reuse and single use.

RESUMEN Objetivo: Comparar las ocurrencias ocupacionales registradas por los profesionales enfermeros durante la utilización del dializador reutilizado y de uso único. Método: Estudio longitudinal, retrospectivo, realizado con fichas de técnicos de Enfermería de un servicio de hemodiálisis. Los datos fueron analizados descriptivamente y calculados por la Razón de Densidades de Incidencia. Resultados: Durante la reutilización del dializador, fueron registradas siete notificaciones de cinco profesionales relacionadas con disturbios osteomusculares, alergias oculares y dermatosis. Durante el uso único, dos profesionales registraron dolor lumbar. La tasa de exposición al uso de fármacos fue de 6,7 días para cada 1.000 profesionales en el período de reutilización del dializador y de 1,52 días en el período de uso único (RDI=4,4; IC 95%: 2.182-9.805). Los antiinflamatorios fueron los más prescritos, y las bajas laborales fueron semejantes en ambos períodos. Conclusión: El reúso del dializador estuvo asociado con disturbios osteomusculares, irritación ocular, dermatosis y mayor uso de fármacos por los profesionales. Las bajas laborales fueron semejantes durante el uso del dializador reutilizado y de uso único.

Polyclonal anti T-lymphocyte antibody therapy monitoring in kidney transplant recipients: comparison of CD3+ T cell and total lymphocyte counts / Monitoramento da terapia com anticorpo policlonal antilinfócitos T em transplantados renais: comparação da contagem de células T CD3+ e de linfócitos totais

ABSTRACT Objective: To investigate the correlation between total lymphocyte and CD3+ T cell counts in peripheral blood in renal transplant patients treated with anti-thymocyte globulin, and discuss related outcomes. Methods: A single-center, retrospective study involving 226 patients submitted to kidney transplant between 2008 and 2013, and treated with anti-thymocyte globulin for induction or treatment of cellular rejection. Doses were adjusted according to CD3+ T cell or total lymphocyte counts in peripheral blood. Results: A total of 664 paired samples were analyzed. The Spearman's correlation coefficient was 0.416 (p<0.001) for all samples combined; the overall Kappa coefficient was 0.267 (p<0.001). Diagnostic parameters estimated based on total lymphocyte counts were also calculated using the number of CD3+ T cells (gold standard), with a cut off of >20 cells/mm3. Conclusion: Total lymphocyte and CD3+ T cell counts in peripheral blood are not equivalent monitoring strategies in anti-thymocyte globulin therapy.

RESUMO Objetivo: Investigar a correlação entre a contagem de linfócitos totais e células T CD3+ no sangue periférico em receptores de transplante renal submetidos a tratamento com globulina antitimocitária, e discutir resultados relacionados. Métodos: Estudo retrospectivo de centro único envolvendo 226 pacientes submetidos a transplante renal entre 2008 e 2013 e tratados com globulina antitimocitária, para fins de indução ou tratamento de rejeição celular. As doses foram ajustadas de acordo com a contagem de células T CD3+ ou linfócitos totais no sangue periférico. Resultados: No total, 664 amostras pareadas foram analisadas. O coeficiente de correlação de Spearman para as amostras em geral foi de 0,416 (p<0,001) e o coeficiente Kappa, de 0,267 (p<0,001). Os parâmetros diagnósticos estimados com base na contagem de linfócitos totais foram recalculados, empregando-se o número de células T CD3+ (padrão-ouro) e adotando-se o ponto de corte >20 células/mm3. Conclusão: A contagem de linfócitos totais no sangue periférico não substitui a contagem de células T CD3+ enquanto estratégia de monitorização da terapia à base de globulina antitimocitária.

Evaluation of metabolic syndrome and associations with inflammation and graft function in renal transplant recipients / Avaliação da síndrome metabólica e suas associações com inflamação e função do enxerto em pacientes receptores de transplante renal

INTRODUCTION: Cardiovascular disease (CVD) is a major determinant of mortality in renal transplant recipients (RTR). Metabolic syndrome (MS) and chronic inflammation are currently considered non traditional risk factors for cardiovascular disease. This study evaluates the frequency of these conditions their associations with graft function. OBJECTIVE: To evaluate the prevalence of metabolic syndrome (MS) and inflammation and their associations with graft function in renal transplant recipients. METHODS: A cross-sectional study was carried out with 200 RTR. MS was defined by the NCEP-ATP III criteria. Inflammation was assessed by CRP levels. Renal function was assessed by GFR estimation using the MDRD equation. RESULTS: MS occurred in 71 patients (35.5%). Patients with MS had higher CPR and decreased GFR levels. Inflammation was present in 99 patients (49.5%). Mean waist perimeter, body mass index, triglycerides and serum total cholesterol were significantly higher in inflamed patients. An association between MS and inflammation was demonstrated, 48 (67.6%) patients with MS were inflamed and among those without MS the rate of inflamed patients was 39.5% (51 patients) (p < 0.001). A significantly higher percentage of patients with MS in the group of patients in chronic renal disease stages III and IV was observed. CONCLUSION: In RTR there is a significant association among MS and inflammation. MS is negatively associated with graft function. The clinical implications of these findings must be evaluated in longitudinal studies.

INTRODUÇÃO: A doença cardiovascular (DCV) é um dos principais determinantes da mortalidade em receptores de transplante renal (RTR). A síndrome metabólica (SM) e a inflamação crônica atualmente são considerados fatores de risco não tradicionais para doença cardiovascular. OBJETIVO: Avaliar a frequência da SM e da inflamação e suas associações com a função do enxerto em receptores de transplante renal. MÉTODOS: Foi realizado um estudo transversal com 200 RTR. A SM foi definida pelos critérios do NCEP-ATP III. A inflamação foi avaliada por meio dos níveis de PCR. A função renal foi avaliada pela estimativa da TFG por meio da equação MDRD. RESULTADOS: A SM ocorreu em 71 pacientes (35,5%). Pacientes com SM apresentaram maior PCR e diminuição dos níveis de TFG. A inflamação esteve presente em 99 pacientes (49,5%). A circunferência abdominal, índice de massa corporal, triglicérides e colesterol total foram significativamente maiores em pacientes com inflamação. Foi demonstrada associação entre MS e inflamação, 48 (67,6%) pacientes com SM estavam inflamados e entre aqueles sem SM a taxa de inflamados foi de 39,5% (51 pacientes) (p < 0,001). Uma porcentagem significativamente maior de pacientes com SM foi observada no grupo de pacientes de doença renal crônica estágios III e IV. CONCLUSÃO: Em RTR há associação significativa entre MS e inflamação. A SM está negativamente associada com a função do enxerto. As implicações clínicas destes achados devem ser avaliadas em estudos longitudinais.

Evaluation of metabolic syndrome and associations with inflammation and graft function in renal transplant recipients.

INTRODUCTION: Cardiovascular disease (CVD) is a major determinant of mortality in renal transplant recipients (RTR). Metabolic syndrome (MS) and chronic inflammation are currently considered non traditional risk factors for cardiovascular disease. This study evaluates the frequency of these conditions their associations with graft function. OBJECTIVE: To evaluate the prevalence of metabolic syndrome (MS) and inflammation and their associations with graft function in renal transplant recipients. METHODS: A cross-sectional study was carried out with 200 RTR. MS was defined by the NCEP-ATP III criteria. Inflammation was assessed by CRP levels. Renal function was assessed by GFR estimation using the MDRD equation. RESULTS: MS occurred in 71 patients (35.5%). Patients with MS had higher CPR and decreased GFR levels. Inflammation was present in 99 patients (49.5%). Mean waist perimeter, body mass index, triglycerides and serum total cholesterol were significantly higher in inflamed patients. An association between MS and inflammation was demonstrated, 48 (67.6%) patients with MS were inflamed and among those without MS the rate of inflamed patients was 39.5% (51 patients) (p < 0.001). A significantly higher percentage of patients with MS in the group of patients in chronic renal disease stages III and IV was observed. CONCLUSION: In RTR there is a significant association among MS and inflammation. MS is negatively associated with graft function. The clinical implications of these findings must be evaluated in longitudinal studies.

Transplante renal em pacientes HIV positivos: relato de dois casos da experiência inicial do Hospital de Clínicas de Porto Alegre / Kidney transplantation in HIV positive patients: two case reports from Hospital de Clínicas de Porto Alegre initial experience

Recentemente, o transplante renal passou a ser uma modalidade terapêutica aceita para o tratamento de pacientes renais crônicos terminais infectados pelo HIV. Para tal, há necessidade de estabilidade de parâmetros clínicos e laboratoriais relacionados à infecção pelo HIV e do uso de terapia antiretroviral de elevada eficiência. Neste relato, apresentamos os dois primeiros casos no Brasil de pacientes portadores de infecção pelo HIV transplantados com órgãos de doadores falecidos realizados com sucesso em nossa instituição. As interações entre os imunossupressores e as drogas antiretrovirais, as coinfecções, o perfil de risco cardiovascular e a elevada incidência de rejeição aguda permanecem os maiores problemas a serem equacionados nestes pacientes.

Recently kidney transplantation has become an accepted treatment modality for the treatment of HIV infected patients with end-stage renal diseases. For such treatment it is required stability of clinical and laboratory parameters related to HIV infection and the use of highly active antiretroviral therapy. In this report we present the first two cases in Brazil of patients with HIV infection transplanted with organs from deceased donors performed successfully in our institution. The interactions between immunosuppressive and antiretroviral drugs, the co-infections, cardiovascular risk profile and the high incidence of acute rejection remain the major problems to be dealt with in these patients.

[Kidney transplantation in HIV positive patients: two case reports from Hospital de Clínicas de Porto Alegre initial experience]. / Transplante renal em pacientes HIV positivos: relato de dois casos da experiência inicial do Hospital de Clínicas de Porto Alegre.

Recently kidney transplantation has become an accepted treatment modality for the treatment of HIV infected patients with end-stage renal diseases. For such treatment it is required stability of clinical and laboratory parameters related to HIV infection and the use of highly active antiretroviral therapy. In this report we present the first two cases in Brazil of patients with HIV infection transplanted with organs from deceased donors performed successfully in our institution. The interactions between immunosuppressive and antiretroviral drugs, the co-infections, cardiovascular risk profile and the high incidence of acute rejection remain the major problems to be dealt with in these patients.