Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 6 de 6
Filtrar
1.
Transplantation ; 108(2): 545-555, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-37641175

RESUMO

BACKGROUND: There is no robust evidence-based data for ABO-incompatible kidney transplantation (ABOiKT) from emerging countries. METHODS: Data from 1759 living donor ABOiKT and 33 157 ABO-compatible kidney transplantations (ABOcKT) performed in India between March 5, 2011, and July 2, 2022, were included in this retrospective, multicenter (n = 25) study. The primary outcomes included management protocols, mortality, graft loss, and biopsy-proven acute rejection (BPAR). RESULTS: Protocol included rituximab 100 (232 [13.18%]), 200 (877 [49.85%]), and 500 mg (569 [32.34%]); immunoadsorption (IA) (145 [8.24%]), IVIG (663 [37.69%]), and no induction 200 (11.37%). Mortality, graft loss, and BPAR were reported in 167 (9.49%), 136 (7.73%), and 228 (12.96%) patients, respectively, over a median follow-up of 36.3 mo. In cox proportional hazard model, mortality was higher with IA (hazard ratio [HR]: 2.53 [1.62-3.97]; P < 0.001), BPAR (HR: 1.83 [1.25-2.69]; P = 0.0020), and graft loss (HR: 1.66 [1.05-2.64]; P = 0.0310); improved graft survival was associated with IVIG (HR: 0.44 [0.26-0.72]; P = 0.0010); higher BPAR was reported with conventional tube method (HR: 3.22 [1.9-5.46]; P < 0.0001) and IA use (HR: 2 [1.37-2.92]; P < 0.0001), whereas lower BPAR was reported in the prepandemic era (HR: 0.61 [0.43-0.88]; P = 0.008). Primary outcomes were not associated with rituximab dosing or high preconditioning/presurgery anti-A/anti-B titers. Incidence of overall infection 306 (17.39%), cytomegalovirus 66 (3.75%), and BK virus polyoma virus 20 (1.13%) was low. In unmatched univariate analysis, the outcomes between ABOiKT and ABOcKT were comparable. CONCLUSIONS: Our largest multicenter study on ABOiKT provides insights into various protocols and management strategies with results comparable to those of ABOcKT.


Assuntos
Transplante de Rim , Humanos , Transplante de Rim/métodos , Rituximab/uso terapêutico , Imunossupressores/uso terapêutico , Estudos Retrospectivos , Imunoglobulinas Intravenosas/uso terapêutico , Incompatibilidade de Grupos Sanguíneos , Sistema ABO de Grupos Sanguíneos , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto , Doadores Vivos , Estudos Multicêntricos como Assunto
2.
EClinicalMedicine ; 46: 101359, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35350707

RESUMO

Background: There is an enormous knowledge gap on management strategies, clinical outcomes, and follow-up after kidney transplantation (KT) in recipients that have recovered from coronavirus disease (COVID-19). Methods: We conducted a multi-center, retrospective analysis in 23 Indian transplant centres between June 26, 2020 to December 1, 2021 on KT recipients who recovered after COVID-19 infections. We analyzed clinical and biopsy-confirmed acute rejection (AR) incidence and used cox-proportional modeling to estimate multivariate-adjusted hazard ratios (HR) for predictors of AR. We also performed competing risk analysis. Additional outcome measures included graft loss, all-cause mortality, waiting time from a positive real-time polymerase test (RT-PCR) to KT, laboratory parameters, and quality of life in follow-up. Findings: Among 372 KT which included 38(10·21%) ABO-incompatible, 12(3·22%) sensitized, 64(17·20%) coexisting donors with COVID-19 history and 20 (5·37%) recipients with residual radiographic abnormalities, the incidence of AR was 34 (9·1%) with 1(0·26%) death censored graft loss, and 4(1·07%) all-cause mortality over a median (interquartile range) follow-up of 241 (106-350) days. In our cox hazard proportional analysis, absence of oxygen requirement during COVID-19 compared to oxygen need [HR = 0·14(0·03-0·59); p-value = 0·0071], and use of thymoglobulin use compared to other induction strategies [HR = 0·17(0·03-0.95); p-value = 0·044] had a lower risk for AR. Degree of Human leukocyte antigen (HLA) DR mismatch had the highest risk of AR [HR = 10.2(1·74-65·83); p-value = 0·011]. With competing risk analysis, with death as a competing event, HLA DR mismatch, and oxygen requirement continued to be associated with AR. Age, gender, obesity, inflammatory markers, dialysis vintage, steroid use, sensitization and ABO-incompatibility have not been associated with a higher risk of AR. The median duration between COVID-19 real time polymerase test negativity to transplant was 88(40-145) days (overall), and ranged from 88(40-137), 65(42-120), 110(49-190), and 127(64-161) days in World Health Organization ordinal scale ≤ 3, 4, 5, and 6-7, respectively. There was no difference in quality of life, tacrolimus levels, blood counts, and mean serum creatinine assessed in patients with a past COVID-19 infection independent of severity. Interpretation: Our findings support that the outcomes of KT after COVID-19 recovery are excellent with absence of COVID-19 sequelae during follow-up. Additionally, there does not seem to be a need for changes in the induction/immunosuppression regimen based on the severity of COVID-19. Funding: Sanofi.

3.
Saudi J Kidney Dis Transpl ; 25(4): 906-11, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24969215

RESUMO

Acute kidney injury (AKI) is one of the most challenging and serious complications of pregnancy. We present our experience on the clinical profile and outcome of 57 patients with pregnancy-related AKI, of a total of 580 patients with AKI seen during the study period. This is a prospective single-center study in a civil hospital conducted from January to December 2010. The most common age group of the study patients was 20-25 years; 43.8% of the patients had received antenatal care. AKI was observed in the puerperium (n = 34), early pregnancy (n = 10) and late pregnancy (n = 13). The cause of AKI included puerperal sepsis (63.1%), pregnancy-induced hypertension (PIH) (33.33%), post-abortion (22.80%), ante-partum hemorrhage (APH) (14%) and post-partum hemorrhage (PPH) (8%). Complete, partial and no renal recovery was observed in 52.64%, 21.05% and 26.31% of the patients, respectively. Low platelet count and plasma fibrinogen and high bilirubin, D-dimer and activated partial thromboplast in time were observed more commonly in patients with partial recovery. Of the 57 patients, 50 received hemodialysis, three received peritoneal dialysis and seven patients were managed conservatively. A total of 13 patients developed cortical necrosis that was associated with sepsis in six, PPH and pre-eclampsia/eclampsia in three patients each and APH in one. Nine patients died, and the cause of death was septicemia in four, pre-eclampsia in three and APH and PPH in one patient each. In our study, puerperal sepsis was the most common etiological factor for pregnancy-related AKI. Prolonged oliguria or anuria were bad prognostic factors for renal recovery. Sepsis, thrombocytopenia, disseminated intra-vascular coagulation and liver involvement were associated with increased mortality.


Assuntos
Países em Desenvolvimento , Complicações na Gravidez , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/fisiopatologia , Injúria Renal Aguda/terapia , Adulto , Causas de Morte , Progressão da Doença , Feminino , Humanos , Índia/epidemiologia , Rim/fisiopatologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/mortalidade , Complicações na Gravidez/fisiopatologia , Complicações na Gravidez/terapia , Estudos Prospectivos , Recuperação de Função Fisiológica , Indução de Remissão , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
4.
Saudi J Kidney Dis Transpl ; 23(1): 37-43, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22237216

RESUMO

Methanol is a cheap and potent adulterant of illicit liquors. Hemodialysis (HD) is the best method to rapidly remove both toxic acid metabolites and parent alcohols, and it plays a fundamental role in treating severely poisoned patients. This retrospective study was carried out on 91 patients with detectable serum methanol levels who underwent HD. Because toxic alcohol levels were not immediately available, the initial diagnosis and treatment was based on clinical history with evidence of toxic alcohol intake, presence of high anion metabolic acidosis and/or end organ damage. Patients received bicarbonate, ethanol, according to clinical features and blood gases. Patients underwent HD in the setting of known methanol ingestion with high anion gap metabolic acidosis, or evidence of end-organ damage, regardless of methanol level. HD prescription included large surface area dialyzer (≥ 1.5 m²), blood flow rate of 250-350 mL/min and dialysate flow rate of 500 mL/min for 4-6 h. Between 9 and 11 July 2009, 91 males with mean age 40 ± 8.5 years underwent HD, and 13 patients required a second HD session. Patients consumed 100-500 mL illicit liquors, and symptoms appeared six and 60 h later. Clinical features were gastro-intestinal symptoms (83.5%), visual disturbances (60.4%), central nervous system symptoms (59.3%) and dyspnea (43.9%). Before HD, mean pH was 7.11 ± 0.04 (range 6.70- 7.33) and mean bicarbonate levels were 8.5 ± 4.9 mmol/L (range 2-18). Three patients died due to methanol intoxication. Mortality was associated with severe metabolic acidosis (pH ≤ 6.90), ventilator requirement and coma/seizure on admission (P < 0.001). Timely HD, bicarbonate, ethanol and supportive therapy can be life-saving in methanol intoxication.


Assuntos
Bebidas Alcoólicas/intoxicação , Metanol/intoxicação , Diálise Renal , Acidose/induzido quimicamente , Acidose/terapia , Adulto , Bicarbonatos/administração & dosagem , Distribuição de Qui-Quadrado , Coma/induzido quimicamente , Coma/terapia , Terapia Combinada , Etanol/administração & dosagem , Humanos , Concentração de Íons de Hidrogênio , Índia , Masculino , Metanol/sangue , Pessoa de Meia-Idade , Intoxicação/etiologia , Intoxicação/mortalidade , Intoxicação/terapia , Respiração Artificial , Estudos Retrospectivos , Convulsões/induzido quimicamente , Convulsões/terapia , Fatores de Tempo , Resultado do Tratamento
5.
Int Urol Nephrol ; 44(1): 269-74, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21805084

RESUMO

BACKGROUND: Type 2 diabetes mellitus (DM) is the commonest cause of end-stage renal disease (ESRD) worldwide. Renal transplantation (RTx) is the best therapeutic modality for such patients. First-degree relatives of patients with type 2 DM have high risk of diabetes/pre-diabetes. Parents are often too old to be suitable donors, and siblings/children/spouse are either not suitable/acceptable or do not come forward for organ donation. This leaves deceased donation (DD) as only suitable donors. Data scarcity on DDRTx outcome in diabetic nephropathy (DN) prompted us to review our experience. This retrospective single-center 10-year study was undertaken to evaluate patient/graft survival, graft function, rejection episodes, and mortality in these patients. MATERIALS AND METHODS: Between January 2001 and March 2011, thirty-five DN-ESRD patients underwent DDRTx in our center following cardiac fitness assessment of recipients. All patients received single-dose rabbit-anti-thymocyte globulin for induction and steroids, calcineurin inhibitor, and mycophenolate mofetil/azathioprine for maintenance immunosuppression. Mean recipient age was 49.66 ± 6.76 years, and 25 were men. Mean donor age was 50 ± 16.45 years, 23 were men. RESULTS: Over a mean follow-up of 2.28 ± 2.59 years, patient and graft survival rates were 68.5% and 88.5%, respectively, with mean SCr of 1.9 ± 0.62 mg/dl. Delayed graft function was observed in 34.3% patients, and 25.7% had biopsy-proven acute rejection; 31.5% patients died, mainly because of infections (22.8%), coronary artery disease (2.86%), and cerebrovascular events (5.7%). CONCLUSION: DDRTx in patients with DN has acceptable graft function and patient/graft survival over 10-year follow-up in our center and, therefore, we believe it should be encouraged.


Assuntos
Nefropatias Diabéticas/cirurgia , Sobrevivência de Enxerto , Falência Renal Crônica/cirurgia , Transplante de Rim/imunologia , Adulto , Idoso , Soro Antilinfocitário/uso terapêutico , Azatioprina/uso terapêutico , Cadáver , Inibidores de Calcineurina , Creatinina/sangue , Função Retardada do Enxerto/sangue , Países em Desenvolvimento , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/etiologia , Feminino , Rejeição de Enxerto/patologia , Humanos , Terapia de Imunossupressão/efeitos adversos , Imunossupressores/uso terapêutico , Índia , Falência Renal Crônica/etiologia , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapêutico , Estudos Retrospectivos , Esteroides/uso terapêutico , Resultado do Tratamento
6.
Int Urol Nephrol ; 43(2): 535-41, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21107691

RESUMO

BACKGROUND: Type 2 diabetes mellitus (DM) is the commonest cause of end-stage renal disease (ESRD) worldwide. Data scarcity on renal transplantation (RTx) outcome in diabetic nephropathy (DN) prompted us to review our experience. This retrospective single-center, 5-year study was undertaken to evaluate patient and graft survival and function, evaluated by serum creatinine (SCr), rejection episodes, and mortality in patients. PATIENTS AND METHODS: One hundred type 2 DM-ESRD patients underwent RTx [80 living-related (LRD), 20 deceased donor (DD)] at our center following cardiac fitness of recipient. Post-transplant immunosuppression consisted of calcineurin inhibitor-based regimen. The mean donor age in the LRD group was 40.6 years and 52 years in the DD group. Male recipients constituted 95% in the LRD and 65% in the DD group. RESULTS: Over a mean follow-up of 2.47 years, 1- and 5-year patient/graft survival in LRDRTx was 85.1%/95.9% and 82.6%/95.9%, respectively, and mean SCr (in mg/dl) at 1 and 5 years was 1.38 and 1.58 mg/dl, respectively, with 20% of cases developing acute rejection (AR) episodes. Fifteen percent of patients died, mainly due to infections, and 1.3% died of coronary artery disease (CAD). In DDRTx, over a mean follow-up of 3.17 years, 1- and 4-year patient/graft survival was 72%/89.7% and 54%/89.7%, respectively; mean SCr at 1 and 4 years was 1.40 and 1.75 mg/dl, respectively, with 20% of cases developing AR episodes. Totally, 30% of patients were lost, mainly due to infections, and 10% of patients died from cerebrovascular events. CONCLUSION: In our center, in patients with RTx for type 2 DM diabetic nephropathy, the 4- and 5-year patient and graft survival rates and graft function can be considered acceptable. The results are better in LRDRTx than in DDRTx patients.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/cirurgia , Nefropatias Diabéticas/cirurgia , Falência Renal Crônica/etiologia , Falência Renal Crônica/cirurgia , Transplante de Rim , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA