APOL1 Gene Variants and Risk for Cardiovascular Disease.

INTRODUCTION: The association of APOL1 risk variants with cardiovascular risk and cardiovascular disease (CVD) in observational and clinical trials has had inconsistent results. We aim to assess the relationship between the presence of APOL1 risk variants and the CVD risk in Afro-descendant patients with end-stage renal disease (ESRD). METHODS: We performed an observational, cross-sectional study of Afro-descendant adult patients with ESRD who were on the waitlist for a kidney transplant. Associations of APOL1 genotypes (high-risk [HR] = 2 alleles; low-risk [LR] = 0 or 1 allele) with cardiovascular risk were the primary clinical endpoint. The relation was evaluated using univariate and multivariate analysis. RESULTS: We enrolled a total of 102 patients with ESRD; 37% (38 patients) had APOL1 HR status with two alleles in homozygous (G1/G1 = 21 and G2/G2 = 3) or compound heterozygote (G1/G2 = 14) form and 63% (64 patients) had APOL1 LR status. No significant association was found between HR APOL1 genotypes and high cardiovascular risk (in adjusted Colombia Framingham Risk Score). APOL1 HR versus LR variants were not independently associated with left ventricular hypertrophy or systolic dysfunction. No cardiovascular deaths occurred during the follow-up. CONCLUSION: In Afro-descendent patients with ESRD, APOL1 HR status is not associated with the increase in cardiovascular risk profile and metabolic disturbances.

COVID-19 en receptores de trasplante renal: la experiencia inicial en Colombia

Contexto: los pacientes con trasplante de riñón parecen tener un riesgo particularmente alto de enfermedad grave por COVID-19 debido a la inmunosupresión y la presencia de comorbilidades. Objetivo: describir las características clínicas, paraclínicas y desenlaces de los pacientes trasplantados renales que presentan infección por SARS-COV-2 en un hospital de cuarto nivel en Cali, Colombia. Metodología: realizamos un estudio observacional de receptores de trasplante renal con infección por SARS-CoV-2 ingresados ​​en la Fundación Valle del Lili, de junio a diciembre del 2020. Para ser elegibles en el estudio, los pacientes debían presentar síntomas compatibles, RT-PCR positiva y manejo hospitalario. Se excluyó a los pacientes asintomáticos. Resultados: inscribimos a un total de 50 pacientes, donde el 64 % eran hombres y la edad media fue de 53,5 años (rango 46-60). Las comorbilidades fueron: 36 (70 %) con hipertensión, 16 (32 %) con diabetes mellitus y 5 (10 %) con obesidad y los regímenes inmunosupresores más comunes fueron: tacrolimus, micofenolato y prednisona. La mediana de tiempo desde el inicio de los síntomas hasta la RT-PCR positiva fue de siete días. Los síntomas iniciales más comunes fueron fiebre (64 %), fatiga (58%), tos (44%) y disnea (36%). Los niveles basales de proteína C reactiva (PCR) fueron de 6,43 mg/dl (3,25-11,22), la mediana del recuento de linfocitos fue de 785 mm3/uL (550-1230), el dímero D basal fue de 0,767 ug/ml (0,484-1153,5) y el nivel medio de ferritina fue de 1011 ng/ml (670-2145). El 40 % desarrolló lesión renal aguda (20 pacientes), de los cuales 11 pacientes necesitaron terapia de remplazo renal, 6 de los pacientes fallecieron (12 %), 4/6 por insuficiencia multiorgánica relacionada con la sepsis y 2/6 por el síndrome de dificultad respiratoria agudo (SDRA). Conclusiones: las complicaciones mayores como la lesión renal aguda, el síndrome de dificultad respiratoria aguda y la mortalidad relacionada con la infección por COVID-19 observadas en nuestro estudio son significativas, pero menos frecuentes que las reportadas en otros países.

Background: Patients with kidney transplants seem to be at particularly high risk for severe COVID19 disease due to their impaired immune responses and comorbidities. Purpose: This study aims to describe kidney transplant patients' clinical characteristics and outcomes with SARSCOV-2 infection in a fourth-level hospital in Cali, Colombia. Methodology: We performed an observational study of kidney transplant recipients with SARS-CoV2 infection admitted at Fundación Valle del Lili from June to December 2020. To be eligible for this study, patients have symptoms compatible, a positive RT-PCR and inpatient management. Asymptomatic patients were excluded. Results: We enrolled a total of 50 patients. 64% were male, and the median age was 53.5 years (range 46-60). The comorbidities were 36 (70%) hypertension, 16 (32%) diabetes mellitus, 5 (10%) obesity. The most common immunosuppressive regimen was tacrolimus, mycophenolate and prednisone. The median time from symptoms onset to the positive RT-PCR was 7 days. The most common initial symptom was fever (64%), and fatigue (58%), cough (44%) and dyspnea (36%). Baseline levels of CRP was 6.43 mg/dL (3.25-11.22). The median lymphocyte count was 785 mm3/uL (550-1230). Baseline D-Dimer was 0.767 ug/ml (0.484-1153.5), ferritin median level was 1011ng/ml (670-2145). Six of the patients died (12%), 4/6 were by sepsis-related multi-organ failure and 2/6 were by ARDS. Conclusions: Major complications such as acute kidney injury, acute respiratory distress syndrome and mortality related to COVID-19 infection observed in our study are lower than those reported in other countries.

Corrigendum to "Prevalence of APOL1 Risk Variants in Afro-Descendant Patients with Chronic Kidney Disease in a Latin American Country".

[This corrects the article DOI: 10.1155/2019/7076326.].

Risk Factors Related to New-Onset Diabetes after Renal Transplantation in Patients of a High Complexity University Hospital in Colombia, 20 Years of Experience.

INTRODUCTION: New-onset diabetes after transplantation (NODAT) is associated with immunosuppression. Its complications can negatively influence patients' quality of life, which is why it is important to study the associated risk factors and expand the possible therapies in this particular group of patients. Materials and methods. Case-control study nested in a retrospective cohort. It included patients who received kidney transplantation at the high complexity University Hospital Fundación Valle del Lili in Cali, Colombia, between 1995 and 2014. Two controls were assigned for each case, depending on the type of donor and the date of the surgery. Information was collected from clinical records and the institutional TRENAL registry. We carried out a descriptive analysis of the selected variables and identified the risk factors with conditional logistic regression. RESULTS: 122 cases were identified to which 224 controls were assigned. The median age was 44 years (IQR: 34-55), and 54% were men. Having >50 years of age at the time of transplantation (OR: 3.18, 95% CI: 1.6-6.3, p = 0.001), body mass index >30 kg/m2 (OR: 3.6, 95% CI: 1.3-9.7, p = 0.010) and being afro-descendant (OR: 2.74, 95% CI: 1.1-6.5, p = 0.023) were identified as risk factors for the development of NODAT. Pretransplant fasting plasma glucose >100 mg/dl (OR: 2.9, 95% CI: 1.4-6.4, p = 0.005) and serum triglycerides >200 mg/dl (OR: 2.5, 95% CI: 1.4-4.4, p = 0.002) were also reported as independent risk factors. CONCLUSION: We ratify some risk factors for the development of this important disease, which include certain modifiable characteristics. Interventions aimed at changes in lifestyle could be established in a timely manner before transplant surgery.

Prevalence of APOL1 Risk Variants in Afro-Descendant Patients with Chronic Kidney Disease in a Latin American Country.

INTRODUCTION: In Colombia, the genetic background of the populations was shaped by different levels of admixture between Natives, European, and Africans. Approximately 35.363 patients have diagnosed chronic kidney disease and according to population studies, 10.4% of these patients are Afro-descendant. We aim to assess the frequency of APOL1 variants G1 and G2 in Afro-descendant patients with ESRD treated at la Fundacion Valle del Lili University Hospital in Cali, Colombia. METHODS: This is an observational cross-sectional study. Afro-descendant patients with ESRD in waitlist or recipients of kidney transplant were evaluated. Clinical data were collected from the electronic medical records. Genotyping was carried out by amplification of the exon 7 of the APOL1 gene. For the identification of risk genotypes, the bioinformatics tool BLAST was used. RESULTS: We enrolled 102 participants. The frequency of APOL1 risk variants was 67.2%, in which 24.5% (n = 25) were G1 heterozygous and 5.8% (n = 6) were G2 heterozygous and 37% of the patients had high-risk status with two alleles in homozygous (G1/G1 = 21 and G2/G2 = 3) or compound heterozygote (G1/G2 = 14) form.

Experiencia de trasplante renal de donantes y receptores mayores de 60 años en la Fundación Valle del Lili en Cali, Colombia, del año 2002 al 2016 / Kidney transplantation in donors and recipients over 60 at Fundación Valle del Lili in Cali, Colombia, from 2002 to 2016

INTRODUCCIÓN: El trasplante renal es el tratamiento de elección para los pacientes con insuficiencia renal terminal. Los pacientes mayores de sesenta años representan la población de mayor crecimiento con esta patología. Sin embargo, no se realizan los trasplantes de manera oportuna y la mayoría permanecen en diálisis con una menor sobrevida y calidad de vida. En este estudio se exponen los desenlaces de los trasplantes renales anciano-para-anciano realizados en una clínica de alta complejidad en Cali, Colombia. MATERIAL Y MÉTODOS: Estudio de cohorte, descriptivo de 31 trasplantes renales con donantes y receptores mayor de 60 años, realizados en la Fundación Valle del Lili en Cali, Colombia, desde enero del 2002 a marzo de 2016. RESULTADOS: De los 31 pacientes trasplantados renales, el 16% presentaron enfermedad cardiovascular post-trasplante, el 6,4% enfermedad cerebrovascular y el 22,6% malignidad. Se presentaron 12 (38,7%) infecciones oportunistas. Cinco pacientes (16%) presentaron disfunción crónica del injerto y tres (9,6%) pérdida del injerto. Nueve pacientes (29%) fallecieron con injerto funcionante. CONCLUSIÓN: La supervivencia de los pacientes trasplantados anciano para anciano en la Fundación Valle del Lili, es equiparable con los resultados en la literatura mundial. Las principales complicaciones asociadas a este tipo de trasplantes son malignidad, infecciones y patologías cardiovasculares. Debido a la alta complejidad y complicaciones de este tipo de trasplantes, los pacientes deben ser cuidadosamente seleccionados

INTRODUCTION: Kidney transplant is the first-line therapy for end-stage renal disease. Patients over 60 constitute a population which is increasingly affected by this disease. However, they do not receive timely transplantation and most of them stay on dialysis treatment with a reduction of their survival time and life quality. In this study we show the results of the kidney transplants between elderly patients performed at a private tertiary care hospital in Cali, Colombia. METHODS: This descriptive, cohort study includes 31 kidney transplants with donors and recipients over 60, which were carried out at Fundación Valle del Lili in Cali, Colombia, from January 2002 to March 2016. RESULTS: The average ages were 66 for recipients and 65 for donors. In most cases (90%) deceased donors were involved. The main cause of renal disease was diabetic nephropathy. CONCLUSION: The survival rate for the patients who underwent this procedure at the center mentioned above is similar to the results shown in the literature all over the world. The most common complications associated with this kind of operation are malignancy, infections and cardiovascular pathologies. Candidates for this transplantation should be carefully chosen given its complexity and related complications

En-Bloc Transplant of the Liver, Kidney and Pancreas: Experience from a Latin American Transplant Center.

BACKGROUND En-bloc transplantation is a surgical procedure in which multiple organs are transplanted simultaneously. It has some similarities with multi-organ transplantation but offers certain advantages. This report highlights the experience of our interdisciplinary group regarding the treatment and follow-up of patients who received en-bloc transplantation, with the aim of encouraging the development of this surgical technique. CASE REPORT The first case is a 38-year-old patient with type 1 diabetes mellitus, liver cirrhosis, and chronic kidney failure who received an en-bloc transplant of the liver, pancreas, and kidney with no intraoperative complications. He had a prolonged hospital stay due to anemia and systemic inflammatory response syndrome, which were resolved successfully. At follow-up, he had no requirement for insulin or for dialysis, or for new interventions. The second case describes a 48-year-old patient with type 2 diabetes mellitus, renal failure, and liver cirrhosis who received an en-bloc transplant of the liver, pancreas, and kidney with no complications. During the postoperative period, the patient suffered a possible episode of acute tubular necrosis, which evolved towards improvement, with a tendency to normal metabolic and renal functioning, with no additional events. The patient is currently in follow-up and is insulin-independent. CONCLUSIONS En-bloc transplantation is a safe procedure, which is technically simple and which achieves excellent results. This procedure is indicated in patients with end-stage renal disease, cirrhosis, and diabetes mellitus that is difficult to control.

Consenso Colombiano para la estratificación, diagnostico, Tratamiento y Prevención de la Infección por citomegalovirus en Pacientes Adultos con trasplante renal / Colombian consensus for stratification, diagnosis, treatment and prevention of cytomegalovirus infection in adults patients with renal transplant

El citomegalovirus es una de las principales causas de infección y enfermedad en receptores de trasplante renal, con un notorio impacto en términos de morbilidad, mortalidad y costos. Sin embargo, no existe en Colombia una práctica clínica estandarizada entre los centros de trasplante, por lo cual, es de suma importancia disponer de guías con el fin de orientar la estratificación, el diagnóstico de laboratorio, el tratamiento y la prevención de la infección y enfermedad por citomegalovirus en pacientes adultos con trasplante renal. A través de la metodología ADAPTE para la evaluación de calidad y transculturización de guías de práctica clínica a nuestro medio, un grupo multidisciplinario realizó una revisión sistemática de la literatura: se seleccionaron las guías internacionales, las cuales fueron evaluadas con el instrumento AGREE II en términos de calidad. Con la guía base seleccionada se buscó la evidencia existente para contestar a las preguntas, de acuerdo con el método de desarrollo de recomendaciones GRADE. Se realizaron recomendaciones para la estratificación, el diagnóstico, el tratamiento y la prevención de la infección y enfermedad por citomegalovirus en pacientes adultos con trasplante renal en Colombia.

Cytomegalovirus is a primary cause of infection and illness in patients who have had renal transplantation, with a significant impact on morbidity, mortality and economic costs. However, there is no standardized clinical practice in transplant centers in Colombia, and it is important to have guidelines to stratify, diagnose, treat and prevent cytomegalovirus infection and disease. Through ADAPTE's methodology for the quality evaluation and adaptation of clinical practice guidelines in our setting, a multidisciplinary group carried out a systematic review of the medical literature, selecting international guidelines that were evaluated with the AGREE-II instrument in terms of quality. With each selected guideline, an evidence table was constructed and the GRADE strategy was performed to develop recommendations. Recommendations related to stratification, laboratory diagnosis, treatment and prevention of infections and disease caused by cytomegalovirus in adult transplant patients were developed.

Trasplante renal con HLA idéntico de donante vivo y cadavérico: experiencia de la Fundación Valle de Lili, Cali, Colombia / Renal transplant with identical HLA with living and cadaver donor: Experience at Fundación Valle de Lili, Cali, Colombia

Introducción: En el trasplante renal con HLA idéntico los episodios de rechazo agudo son menores y tienen mejores tasas de supervivencia del injerto, comparado con los receptores con HLA no idéntico; a pesar de esto, persiste el dilema en cuanto al retiro o la disminución de la dosis de inmunosupresión. El objetivo de este trabajo es describir la experiencia de los trasplantes renales con HLA idéntico de donante vivo y cadavérico que se han realizado en la Fundación Valle del Lili desde 1995 hasta 2014. Material y métodos. De los 1.462 trasplantes renales realizados se incluyeron aquellos con HLA idéntico. Se hizo un análisis estadístico descriptivo para todas las variables consideradas y, para subgrupos seleccionados, el análisis de supervivencia y de rechazo agudo se hizo con el método de Kaplan-Meier. Para el análisis se usó Stata 12.0®. Resultados. Se practicaron 29 trasplantes renales con HLA idénticos. La mayoría fueron en hombres de raza mestiza y lo más frecuente fue una etiología desconocida de la enfermedad renal terminal. Dos pacientes presentaron rechazo agudo, y la supervivencia de los injertos a 1, 5, 10 y 15 años, fue de 100%, 93,7 %, 75 % y 75 %, respectivamente; la supervivencia de los pacientes a los 1, 5, 10 y 15 años, fue de 100%, 93,7 %, 84,3 % y 84,3 %, respectivamente. Conclusiones. Los receptores HLA idénticos poseen una supervivencia prolongada del injerto con menos tasas de rechazo agudo.

Introduction: Kidney transplantation is the treatment of choice for patients with end-stage renal disease (ESRD). Graft rejection is much lower in terms of acute rejection and improved graft survival in renal transplantation with HLA-identical compared to non-identical HLA receptors. The aim of this work is to describe the experience of HLA identical kidney transplantation from live and deceased donors that have been performed at Valle de Lili Foundation since 1995 to 2014. Material and methods. From the 1,462 kidney transplants performed those with HLA-identical were identified, a descriptive statistical analysis was performed for all variables considered in the analysis and for selected subgroups, the analysis of survival and acute rejection was made with the Kaplan-Meier method. Stata 12.0 was used for the analysis. Results: A total of 29 HLA-identical kidney transplants were performed. Most were men of mixed race; the main etiology of ESRD was unknown. Two patients had acute rejection and graft survival at five, ten and fifteen years was 93.7%, 75% and 75% respectively, patient survival at five, ten and fifteen years was 93.7%, 84.3% and 84.3% respectively. Conclusion: HLA-identical receptors have a prolonged survival of the graft with less acute rejection rates.

Derivación exocrina al duodeno en trasplante simultáneo de riñón y páncreas, experiencia en la Fundación Valle de Lili, Cali, Colombia / Exocrine bypass to the duodenum in simultaneous kidney and pancreas transplant, experience at Fundación Valle de Lili, Cali, Colombia

Introducción: El trasplante simultáneo de riñón y páncreas es reconocido como un tratamiento eficaz para el manejo de pacientes con diabetes mellitus, principalmente de tipo I, e insuficiencia renal crónica. Sin embargo, hoy en día aún existe dificultad para el seguimiento del injerto pancreático, ya que no existe un marcador serológico definitivo que lo permita y persiste la dificultad para la toma de biopsias. Se ha descrito una modificación en la técnica quirúrgica que permitiría el acceso endoscópico mediante una duodeno-duodenostomía. Material y métodos. Se seleccionaron los pacientes que recibieron un trasplante simultáneo de riñón y páncreas con derivación exocrina al duodeno, evaluando la seguridad del procedimiento, la evolución y las complicaciones médico-quirúrgicas. Resultados. Nueve pacientes fueron sometidos a trasplante simultáneo de riñón y páncreas con derivación exocrina al duodeno. La mediana de la edad fue de 36 años y la mayoría era del sexo masculino. El tiempo de isquemia en frío fue de 10 horas para el injerto pancreático y de 11 horas para el renal. El tiempo total de hospitalización fue de 21 días. Se presentó una pérdida del injerto pancreático y una pérdida del injerto renal. Hubo una sola muerte, causada por aspergilosis pulmonar. Conclusiones. La derivación exocrina duodenal permite y facilita la evaluación y el seguimiento endoscópico del injerto pancreático. No supone una mayor exigencia técnica en el trasplante simultáneo de riñón y páncreas, ni un incremento en el número de complicaciones en relación directa con la modificación del procedimiento quirúrgico.

Introduction: Despite its recognition as an effective therapy for the management of patients with Type I diabetes mellitus and chronic renal failure, simultaneous kidney and pancreas transplant encounters difficulties in monitoring the pancreatic graft, and there is no strong serologic marker coupled with the difficulties in taking biopsies. We describe a modification of a surgical technique that allows endoscopic access through a duodenostomy. Material and methods. Patients who received simultaneous kidney-pancreas transplantation with exocrine bypass to the duodenum were selected to evaluate the safety of the procedure, the clinical postoperative course, and the medical and surgical complications. Results: Nine patients were submitted to simultaneous kidney-pancreas transplantation with exocrine bypass to the duodenum. Median age was 36, most patients where male. Cold ischemia time was 10 hours for the pancreatic graft and 11 hours for the kidney graft. Total hospital stay was 21 days. There was one death caused by pulmonary aspergillosis. Conclusion: The duodenal exocrine derivation permits and facilitates the evaluation and endoscopy follow-up of the pancreatic graft. It neither imposes greater technical demands in simultaneous kidney-pancreas transplantation, nor an increase in the number of complications directly related to the modification of the surgical procedure.

Polyomavirus-associated nephropathy in renal and simultaneous pancreas-kidney transplant recipients: report of three cases.

Infection with polyomavirus (BK virus) is the cause of renal graft losses in more than 50% of the infected cases. There should be a high index of suspicion about this disease, although the incidence is only between 2% and 5% as the future of renal graft depends on the early and appropriate management of the same. Herein, we describe three clinical cases: Two were those of kidney transplant and the third, a combined kidney-pancreas transplant. In these cases, by reducing immunosuppression and, in one case, replacing the calcineurin inhibitor by MTOR (mammalian target of rapamycin) in addition, we were able to preserve of the normal function of the transplanted organs.

Trasplante simultáneo de riñón y páncreas en pacientes con diabetes mellitus de tipo 1, Clínica Fundación Valle del Lili, Cali, 2001-2013 / Simultaneous kidney and pancreas transplantation in patients with type 1 diabetes mellitus at Clínica Fundación Valle del Lily, Cali, Colombia

Los resultados clínicos obtenidos con el trasplante simultáneo de riñón y páncreas en pacientes con diabetes mellitus de tipo 1 e insuficiencia renal terminal, permiten afirmar que esta modalidad de trasplante constituye la mejor opción de control metabólico para este grupo de población. Objetivo. Presentar los resultados clínicos en pacientes con diabetes mellitus de tipo 1 e insuficiencia renal terminal, sometidos a trasplante simultáneo de riñón y páncreas. Materiales y métodos. Del registro institucional de trasplante renal (TRENAL), que incluye 1.300 pacientes, se seleccionaron los sometidos a trasplante simultáneo de riñón y páncreas. Se hizo un análisis con estadísticas no paramétricas y se estimó la supervivencia mediante el método de Kaplan-Meier. Resultados. Entre los años 2001 y 2012, se practicaron 27 trasplantes simultáneos de riñón y páncreas. La mayoría de los individuos era de sexo masculino (59 %), con edad –al momento del trasplante– de 34 años, y un tiempo transcurrido desde el diagnóstico de diabetes mellitus de tipo 1 de 22 años. El control glucémico se logró entre las 24 y las 48 horas después de la cirugía. La supervivencia fue de 92 % al año y de 87 % a los dos años, y la del injerto pancreático, de 88 % al año, valores equiparables a los mejores resultados esperados. Conclusión. El trasplante simultáneo de riñón y páncreas constituye una alternativa terapéutica eficaz para los pacientes con diabetes mellitus de tipo 1 e insuficiencia renal terminal. El reducido número de la muestra reflejó no sólo las dificultades existentes para la obtención de donantes, sino, también, la falta de difusión y reconocimiento de posibles candidatos; de ahí la importancia de la difusión de las experiencias existentes, con el fin de facilitar el acceso a esta opción de tratamiento.

Clinical outcomes in patients with Type 1 diabetes mellitus (DM 1) after simultaneous kidney-pancreas transplantation (SRP) and end stage renal disease have shown to be a therapeutic option with successful clinical results, making it the best metabolic control option for this population group. Objective. Clinical results show the short and medium term DM1 patients undergoing simultaneous kidney transplantation - Pancreas (SRP) in our institution. Material and method. Institutional registry of renal transplantation (Trenal), which includes 1300 patients, we selected patients undergoing simultaneous kidney pancreas transplantation. We performed a nonparametric statistical analysis and survival was estimated by Kaplan-Meier. Results. Between 2001 and 2012 there were a total of 27 simultaneous kidney - pancreas transplants , individuals mostly male (59%), with age at transplant of 34, a time from the diagnosis of DM I 22 years. The goal of achieving glycemic control was achieved in 24 to 48 hours post-op. The patient survival rate at one and two years is 92% and 87%, and of the pancreatic graft at one year was 88%, values comparable to the best expected results. Conclusion. The simultaneous kidney-pancreas transplantation is a therapeutic option with good clinical results in patients with DM1 and end stage renal disease. The small number of the sample reflects not only the difficulties in obtaining donors, but also the lack of diffusion and recognition of potential candidates, hence the importance of the diffusion of existing experience in order to facilitate access to the best treatment option.

Kidney transplantation and gastric bypass: a better control of comorbidities.

The database of patients who underwent laparoscopic gastric bypass at our institution from 2002 to 2008 was reviewed. Five patients with kidney transplants were found. The impact of the laparoscopic gastric bypass on their comorbidities and the grafts and patients' survival were studied. The five patients of the group are between 36 and 66 years old, three men and two women. Preoperative body mass index ranged between 35 and 42 kg/m(2). The first patient was operated on 4 years ago and presented an anastomotic leak at the gastrojejunal anastomosis that healed with medical treatment. The remaining four patients did not present postoperative complications. At the moment of analysis, the five patients were healthy and enjoying a good quality of life. All the patients had dyslipidemia which reached normal levels after surgery. Three of the patients had diabetes and achieved good control after the surgery. Most importantly, the absorption of immune suppressors was not altered; while some of the patients were even able to reduce their doses. Patients with renal terminal renal diseases and those with renal transplants with severe or morbid obesity are a group that can particularly benefit from a gastric bypass. The laparoscopic gastric bypass is feasible in severely or morbidly obese patients with kidney transplantation. The absorption of the immune-suppressive medication is not altered after a gastric bypass.

Predicción de sobrevida del injerto a corto y largo plazo mediante el uso de indices gamagráficos en receptores de trasplante renal / Graft's survival prediction at short and medium term using gamagraphic indexes in renal transplant receptors

En la sobrevida del injerto renal intervienen factores identificados desde la evaluación pre trasplante y las variables del posoperatorio temprano con las que se ha logrado establecer opciones de manejo médico que ayudan a mejorar la sobrevida a corto y largo plazo. En este trabajo se incluyen además dos índices gamagráficos como predictores de sobrevida, la escala de injuria tubular TISS (del inglés tubular injury severity scores) y el índice de extracción renal (R20/3). Objetivos: determinar la predicción del TISS y el R20/3 en la sobrevida del injerto a seis meses y un año Sitio: Fundación Clínica Valle del Lili, Cali, Colombia. Diseño estudio observacional analítico de cohorte retrospectiva. Material y métodos: se revisaron las gamagrafías renal 99mTc-Mag3 hechas a los receptores renales en la primera semana postrasplante. Se registraron los índices de TISS y el R20/3. Se revisaron las historias clínicas de estos pacientes obteniendo información demográfica, tiempo de isquemia del órgano, resultados de las biopsias, presencia de rechazo agudo y la evolución de los pacientes. Se realizó análisis estadístico univariado inicial y posteriormente se realizó análisis multivariado y análisis de sobrevida con el programa STATA 5.0...