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INTRODUCTION: The age for kidney transplantation (KT) is no longer a limitation and several studies have shown benefits in the survival of elderly patients. The aim of this study was to examine the relationship of the baseline Charlson comorbidity index (CCI) score to morbidity and mortality after transplantation. METHODS: In this multicentric observational retrospective cohort study, we included patients older than 60 years admitted on the waiting list (WL) for deceased donor KT from January 01, 2006, to December 31, 2016. The CCI score was calculated for each patient at inclusion on the WL. RESULTS: Data for analysis were available of 387 patients. The patients were divided in tertiles of CCI: group 1 (CCI: 1-2) n = 117, group 2 (CCI: 3-4) n = 158, and group 3 (CCI: ≥5) n = 112. Patient survival was significantly different between CCI groups at 1, 3, and 5 years, respectively: 90%, 88%, and 84% for group 1, 88%, 80%, and 72% for group 2, and 87%, 75%, and 63% for group 3 (p < 0.0001). Variables associated with mortality were CCI score (p < 0.0001), HLA mismatch (p = 0.014), length of hospital stay (p < 0.0001), surgical complications (p = 0.048). CONCLUSION: Individualized strategies to modify these variables may improve patient's morbidity and mortality after KT.
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Trasplante de Riñón , Humanos , Anciano , Estudios Retrospectivos , Comorbilidad , Hospitalización , Tiempo de InternaciónRESUMEN
BACKGROUND: The impact of renal transplantation (RT) in the elderly with many comorbid conditions is a matter of concern. The aim of our study was to assess the impact of RT on the survival of patients older than 60 years compared with those remaining on the waiting list (WL) according to their comorbidities. METHODS: In this multicentric observational retrospective cohort study, we included all patients older than 60 years old admitted on the WL from 01 January 2006 to 31 December 2016. The Charlson comorbidity index (CCI) score was calculated for each patient at inclusion on the WL. Kidney donor risk index was used to assess donor characteristics. RESULTS: One thousand and thirty-six patients were included on the WL of which 371 (36%) received an RT during a median follow-up period of 2.5 (1.4-4.1) years. Patient survival was higher after RT compared to patients remaining on the WL, 87%, 80%, and 72% versus 87%, 55%, and 30% at 1, 3, and 5 years, respectively. After RT survival at 5 years was 37% higher for patients with CCI ≥ 3, and 46% higher in those with CCI < 3, compared with patients remaining on the WL. On univariate and multivariate analysis, patient survival was independently associated with a CCI of ≥3 (hazard ratio 1.62; confidence interval 1.09-2.41; P < 0.02) and the use of calcineurin-based therapy maintenance therapy (hazard ratio 0.53; confidence interval 0.34-0.82; P < 0.004). CONCLUSIONS: Our study showed that RT improved survival in patients older than 60 years even those with high comorbidities. The survival after transplantation was also affected by comorbidities.
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Fallo Renal Crónico/terapia , Trasplante de Riñón/estadística & datos numéricos , Diálisis Renal/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Argentina/epidemiología , Causas de Muerte , Comorbilidad , Femenino , Estudios de Seguimiento , Humanos , Fallo Renal Crónico/mortalidad , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Listas de Espera/mortalidadRESUMEN
El síndrome urémico hemolítico se caracteriza por presentar anemia hemolítica microangiopática, trombocitopenia e insuficiencia renal aguda. Se clasifica en típico, diarrea positivo, inducido por Escherichia coli 0157-H7 (90%) y atípico, más comúnmente secundario a la desregulación de la vía alternativa del complemento (3-10%). La región cromosómica 1q32 contiene el sistema regulador de la activación del complemento humano (RCA). Se relaciona con mutaciones en factores reguladores de C3 como el factor H (FH, la más común), el factor I, el factor B y la proteína constitutiva de membrana (MCP). Presenta patrones de herencia autosómica tanto dominante como recesiva. El déficit de FH autosómico dominante generalmente ocurre en adultos y la mortalidad y el riesgo de enfermedad renal terminal oscila entre el 50%-90%. El objetivo de nuestro trabajo fue estudiar la función tubular y glomerular por técnicas de inmunohistoquímica para detectar mecanismos de transporte para agua (AQPs), urea (UT-A) y proteínas (nefrina, podocalixina y megalina) en un riñón transplantado de un paciente portador de SUH por déficit de FH que desarrolló una recidiva de SUH y lesiones por nefrotoxicidad. Detectamos un mecanismo de adaptación a la uremia por la expresión de novo de un UT-A2 en corteza renal y la disminución del UT-A1 en médula y alteraciones en el manejo proximal del agua por la disminución de la expresión de AQP1 en túbulo proximal. Las modificaciones a nivel de la expresión de la nefrina y la podocalixina podocitarias y de megalina en el túbulo proximal podrían explicar la presencia de proteinuria.