RESUMEN
Systemic-enteric drainage is currently the most common technique for pancreas transplantation (PT). A novel alternative technique, portal-duodenal drainage (PDD), has potential physiological benefits and provides improved monitoring of the pancreatic graft. The current study describes 53 solitary PT procedures (43 pancreas after kidney and 10 pancreas transplant alone) using the PDD technique over the last three yr. This method resulted in one-yr patient survival at 96% and 83% graft survival. There were five cases (9.4%) of thrombosis, in which transplantectomy and two-layer closure of the native duodenum were performed. No fistulas were observed. Here, we demonstrate that the PDD technique in PT was as safe and effective as current techniques in clinical use.
Asunto(s)
Drenaje , Duodeno/cirugía , Supervivencia de Injerto , Trasplante de Riñón , Trasplante de Páncreas , Enfermedades Pancreáticas/cirugía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Pancreáticas/mortalidad , Pancreaticoduodenectomía/mortalidad , Complicaciones Posoperatorias , Pronóstico , Tasa de Supervivencia , Adulto JovenRESUMEN
Transmission of urothelial carcinoma via solid organ transplant has never been reported in the literature to our knowledge. We report a case of transmission of this tumour to a kidney recipient. The donor was a 37-year-old woman, victim of a subarachnoid haemorrhage. The recipient was a 21-year-old girl, with a history of chronic kidney disease secondary to neurogenic bladder. This fatality has been rarely described in literature, but never with this histological type of cancer. Nowadays, with the expanded criteria for donation, older people are accepted as donor because of the shortage of organs. However, this may increase the likelihood of the number of cancer transmission.
Asunto(s)
Carcinoma de Células Transicionales/etiología , Neoplasias Renales/etiología , Trasplante de Riñón/efectos adversos , Carcinoma de Células Transicionales/secundario , Femenino , Humanos , Neoplasias Renales/patología , Neoplasias Pulmonares/secundario , Adulto JovenRESUMEN
INTRODUCTION: The delay in the diagnosis of infections can be deleterious in renal transplant recipients. Thus, laboratory tests leading to an earlier diagnosis are very useful for these patients. PURPOSE: To assess the behavior of C-reactive protein (CRP) in renal transplant recipients with a diagnosis of cytomegalovirus (CMV) infection, tuberculosis (TB) and bacterial infection (BI). METHODS: A retrospective analysis of 129 patients admitted at our hospital, from 2006 to 2008 because of CMV, TB or BI, was carried out. Appropriate statistical analysis was done and values were expressed as medians, range. RESULTS: When CRP levels were compared among the groups with CMV disease, TB or BI, the group with CMV disease presented lower levels of CRP (18.4 mg/L, 0.28-44 mg/L) than the TB and BI (p < 0.05) groups. The area under the receiver-operating characteristics curve, distinguishing CMV disease from TB/BI, was 0.96 (p < 0.0001), resulting in 100% sensitivity and 90.63% specificity to detect CMV disease when CRP < 44.5 mg/L. The subgroup analysis of CMV infection showed increasing levels of CRP (0.28, 16 and 29.5 mg/L) in the asymptomatic, symptomatic and invasive disease subgroups, respectively (p < 0.05). CONCLUSION: The measurement of CRP levels may be a useful tool for differentiating CMV infection from the other types (bacterial or TB) of infection in kidney transplant recipients.
Asunto(s)
Infecciones Bacterianas/diagnóstico , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , Infecciones por Citomegalovirus/diagnóstico , Trasplante de Riñón , Tuberculosis/diagnóstico , Adolescente , Adulto , Anciano , Bacterias/patogenicidad , Infecciones Bacterianas/sangre , Niño , Preescolar , Citomegalovirus/patogenicidad , Infecciones por Citomegalovirus/sangre , Humanos , Persona de Mediana Edad , Mycobacterium/patogenicidad , Pronóstico , Estudios Retrospectivos , Resultado del Tratamiento , Tuberculosis/sangre , Adulto JovenRESUMEN
PURPOSE: We examined the development of urological abnormalities in a group of pediatric renal transplant recipients. MATERIALS AND METHODS: We reviewed 211 patients younger than 19 years who underwent 226 renal transplants. Three groups of patients were studied-136 children with end stage renal disease due to a nonurological cause (group 1), 56 children with a urological disorder but with an adequate bladder (group 2a) and 19 children with lower urinary tract dysfunction and/or inadequate bladder drainage (group 2b). A total of 15 children in group 2b underwent bladder augmentation (ureterocystoplasty in 6, enterocystoplasty in 9), 2 underwent continent urinary diversion, 1 underwent autoaugmentation and 1 underwent a Mitrofanoff procedure at the bladder for easier drainage. Kidney transplantation was performed in the classic manner by extraperitoneal access, and whenever possible the ureter was reimplanted using an antireflux procedure. RESULTS: At a mean followup of 75 months 13 children had died, 59 grafts were lost and 15 children had received a second transplant. Two patients in group 2a required a complementary urological procedure to preserve renal function (1 enterocystoplasty, 1 vesicostomy). A total of 12 major surgical complications occurred in 226 kidney transplants (5.3%), with a similar incidence in all groups. The overall graft survival at 5 years was 75%, 74% and 84%, respectively, in groups 1, 2a and 2b. CONCLUSIONS: With individualized treatment children with severely inferior lower urinary tract function may undergo renal transplantation with a safe and adequate outcome.
Asunto(s)
Fallo Renal Crónico/etiología , Fallo Renal Crónico/cirugía , Trasplante de Riñón/métodos , Enfermedades de la Vejiga Urinaria/complicaciones , Adolescente , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Resultado del Tratamiento , Enfermedades de la Vejiga Urinaria/cirugía , Trastornos Urinarios/etiología , Trastornos Urinarios/cirugía , Procedimientos Quirúrgicos UrológicosRESUMEN
We reviewed the impact of dengue in 27 renal transplant recipients (9 females and 18 males) at a mean of 63 (6-287) months after transplantation. Their mean age was 37+/-14 years and all were first transplantations (21 live donors, 6 deceased donors). Twenty-six were dengue fever cases and one had dengue hemorrhagic fever. Symptoms were: fever (100%), muscular pain (90%), malaise (75%), and headache (68%). Eight (29%) patients were admitted to hospital with one death. All other cases had full recovery. Mean serum creatinine before dengue was 1.4+/-0.6 mg/dL, increased to a mean peak of 1.9+/-1.2 mg/dL (P<0.001), and returned to baseline after recovery (1.6+/-0.82 mg/dL, P=NS). After a mean follow-up of 39+/-18 months, four patients lost their grafts due to chronic allograft nephropathy and four died, due to infectious causes not related to dengue. The first episode of dengue in transplanted patients resembled a flu-like syndrome, as in the general population. It did not cause long-term damage to either the patient or the graft.
Asunto(s)
Dengue/epidemiología , Trasplante de Riñón/mortalidad , Adulto , Brasil/epidemiología , Dengue/diagnóstico , Femenino , Rechazo de Injerto/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: The incidence of glucose metabolism disturbances after transplantation often is based on the use of hypoglycemic agents and not on the results of glucose tolerance tests (GTTs), which may camouflage the real incidence. A lack of information also exists regarding the profile of glucose metabolism during the first year after transplant. METHODS: Oral GTT along with insulin measurements and drugs pharmacokinetics were prospectively performed at days 30, 60, 180, and 360 after transplant to diagnose disturbances of glucose metabolism after renal transplantation, in nonobese patients receiving either tacrolimus (n=55) or cyclosporine (n=29), along with mycophenolate mofetil and steroids. RESULTS: The incidence of impaired glucose tolerance or diabetes mellitus reached a peak at 60 days and decreased at 1 year. It could not be adequately diagnosed using fasting plasma glucose in a decreased abnormal (>99 ng/mL) range. In both groups, insulin secretion, evaluated by the Homeostasis Model Assesment (HoMA-beta), decreased (P<0.005) from the condition of normal GTT (101+/-56%) to impaired glucose tolerance (72+/-35%) and diabetes mellitus (54+/-25%). In the cyclosporine group, insulin secretion was normal and stable throughout the study period, but in the tacrolimus group, insulin secretion recovered over time and was inversely correlated with tacrolimus exposure. Insulin resistance (HoMA-IR) did not change. CONCLUSIONS: This study shows the need to perform an oral GTT at 60 days and at the end of the first year of renal transplantation to adequately diagnose impaired glucose metabolism.
Asunto(s)
Glucemia/metabolismo , Inhibidores de la Calcineurina , Inmunosupresores/uso terapéutico , Trasplante de Riñón , Adulto , Ciclosporina/uso terapéutico , Ayuno/sangre , Femenino , Prueba de Tolerancia a la Glucosa , Homeostasis , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/farmacocinética , Insulina/metabolismo , Resistencia a la Insulina , Secreción de Insulina , Trasplante de Riñón/efectos adversos , Masculino , Enfermedades Metabólicas/inducido químicamente , Enfermedades Metabólicas/etiología , Persona de Mediana Edad , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapéutico , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Estudios Prospectivos , Esteroides/uso terapéutico , Tacrolimus/uso terapéutico , Factores de TiempoRESUMEN
OBJECTIVE: Little information is available on glomerular function changes after surgical treatment of primary hyperparathyroidism. The acute effects of some head and neck operations on renal function were studied. MATERIAL AND METHODS: Retrospective analysis of changes in creatinine levels and estimated glomerular filtration rate (eGFR) after surgery. Preoperative values were compared with values available until 72 hours after the operation. RESULTS: In tertiary hyperparathyroidism, mean preoperative and postoperative eGFR values were 57.7 mL/min and 40.8 mL/min (p < 0.0001), respectively. A similar decrease was observed after parathyroidectomy for primary hyperparathyroidism, from 85.4 mL/min to 64.3 mL/min (p < 0.0001). After major head and neck procedures, there was a slight increase in eGFR (from 94.3 mL/min to 105.4 mL/min, p = 0.002). CONCLUSION: Parathyroidectomy may be followed by a transient decrease in eGFR that is not often observed in other head and neck operations.
Asunto(s)
Creatinina/sangre , Tasa de Filtración Glomerular/fisiología , Hiperparatiroidismo Primario/cirugía , Paratiroidectomía/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Niño , Métodos Epidemiológicos , Femenino , Humanos , Hiperparatiroidismo Primario/sangre , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/sangre , Factores de Tiempo , Adulto JovenAsunto(s)
Hiperglucemia , Inmunoglobulinas Intravenosas/efectos adversos , Sistema del Grupo Sanguíneo ABO , Adulto , Incompatibilidad de Grupos Sanguíneos/sangre , Incompatibilidad de Grupos Sanguíneos/terapia , Diagnóstico Diferencial , Reacciones Falso Positivas , Femenino , Humanos , Hiperglucemia/inducido químicamente , Hiperglucemia/diagnóstico , Reacción a la TransfusiónRESUMEN
Plasma clearance of (51)Cr-EDTA ((51)Cr-EDTA-Cl) is an alternative method to evaluate glomerular filtration rate (GFR). This study aimed to investigate the concordance between (51)Cr-EDTA-Cl and renal inulin clearance (In-Cl) in renal transplant recipients as well to determine the repeatability of (51)Cr-EDTA-Cl in kidney donors. Forty four kidney recipients and 22 kidney donors were enrolled. Simultaneous measurements of (51)Cr-EDTA-Cl and In-Cl were performed. A single dose of 3.7MBq of (51)Cr-EDTA was injected and the plasma disappearance curve was created by taking blood samples at 2, 4, 6 and 8 h after injection. Bland and Altman statistical approach was used to quantify the agreement between In-Cl and (51)Cr-EDTA-Cl and to determine the better concordance between all possibilities of measure for the (51)Cr-EDTA-Cl. The mean of In-Cl was 44.5 +/- 17.9 ml/min/1.73 m(2). There was a positive correlation between In-Cl and all possible measurements of (51)Cr-EDTA-Cl. (51)Cr-EDTA-Cl with two samples taken at 4 and 8 h or at 4 and 6 h presenting the narrow limits of agreement and a difference (bias) of 2.8 and 2.7 ml/min, respectively. Two plasma sampling for (51)Cr-EDTA-Cl was a reliable method to measure GFR compared with In-Cl and comprises a suitable method to be used in kidney transplanted patients.
Asunto(s)
Anticoagulantes , Ácido Edético , Pruebas de Función Renal/métodos , Pruebas de Función Renal/normas , Trasplante de Riñón , Adulto , Anticoagulantes/farmacocinética , Radioisótopos de Cromo , Ácido Edético/farmacocinética , Femenino , Tasa de Filtración Glomerular , Humanos , Hipoglucemiantes/farmacocinética , Insulina/farmacocinética , Masculino , Persona de Mediana Edad , Modelos BiológicosRESUMEN
OBJECTIVE: Little information is available on glomerular function changes after surgical treatment of primary hyperparathyroidism. The acute effects of some head and neck operations on renal function were studied. MATERIAL AND MATHODS: Retrospective analysis of changes in creatinine levels and estimated glomerular filtration rate (eGFR) after surgery. Preoperative values were compared with values available until 72 hours after the operation. RESULTS: In tertiary hyperparathyroidism, mean preoperative and postoperative eGFR values were 57.7 mL/min and 40.8 mL/min (p < 0.0001), respectively. A similar decrease was observed after parathyroidectomy for primary hyperparathyroidism, from 85.4 mL/min to 64.3 mL/min (p < 0.0001). After major head and neck procedures, there was a slight increase in eGFR (from 94.3 mL/min to 105.4 mL/min, p = 0.002). CONCLUSION: Parathyroidectomy may be followed by a transient decrease in eGFR that is not often observed in other head and neck operations.
OBJETIVO: Há pouca informação sobre alterações da função glomerular após o tratamento cirúrgico do hiperparatireoidismo primário. O efeito agudo sobre a função renal foi estudado após algumas operações em cirurgia de cabeça e pescoço. MATERIAIS E MÉTODOS: Análise retrospectiva dos níveis de creatinina e da taxa de filtração glomerular estimada (eGFR). Os valores pré-operatórios foram comparados aos valores disponíveis até 72 horas após a operação. RESULTADOS: No hiperparatireoidismo terciário, os valores médios pré e pós-operatórios da eGFR foram 57,7 mL/min e 40,8 mL/min (p < 0,0001), respectivamente. O decréscimo após paratireoidectomia por hiperparatireoidismo primário foi de 85,4 mL/min para 64,3 mL/min (p < 0,0001). Após operações maiores de cabeça e pescoço, houve leve elevação da eGFR (de 94,3 mL/min para 105,4 mL/min, p = 0,002). CONCLUSÕES: A paratireoidectomia pode ser seguida de uma redução transitória na eGFR que não é frequentemente observada após outras operações em cabeça e pescoço.
Asunto(s)
Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Creatinina/sangre , Tasa de Filtración Glomerular/fisiología , Hiperparatiroidismo Primario/cirugía , Paratiroidectomía/efectos adversos , Biomarcadores/sangre , Métodos Epidemiológicos , Hiperparatiroidismo Primario/sangre , Complicaciones Posoperatorias/sangre , Factores de TiempoRESUMEN
BACKGROUND: Renal transplanted recipients have an increased incidence of actinic keratosis and skin cancer. METHODS: In order to examine the chemoprophylatic effects of low-dose acitretin on keratosis and skin cancer development we submitted 13 renal transplanted patients who presented actinic keratosis to acitretin therapy (20 mg/d) for 12 months. The patients were assessed at monthly intervals during the first 6 months and every 2 months until the 12th month for new skin lesions and for acitretin toxicity. Normal skin biopsies of sun exposed and sun protected areas were taken for histopathological examination and submitted to immunohistochemistry technique to demonstrate CD4+ and CD8+ T lymphocytes, natural killer (NK) cells and Langerhans' cells which were counted and compared before, after 6 and 12 months of the treatment. RESULTS: There was an improvement of actinic keratosis in all patients. Only one patient developed new skin cancer. Side-effects were well tolerated and no significant biochemical effects were observed. There were no differences in the microscopic aspects of the skin and in the number of CD4+ and CD8+ T lymphocytes and NK cells. There was a significant increase in the number of epidermal Langerhans' cells after 12 months of acitretin therapy. CONCLUSIONS: The data obtained permit us to conclude that low dose acitretin therapy is safe, well tolerated and partially effective in chemoprophylaxis of skin cancer in renal transplant recipients. The increase in epidermal Langerhans' cells observed may be an expression of the immunomodulatory effect of acitretin.
Asunto(s)
Acitretina/uso terapéutico , Queratolíticos/uso terapéutico , Queratosis/tratamiento farmacológico , Trasplante de Riñón/efectos adversos , Neoplasias Cutáneas/prevención & control , Acitretina/inmunología , Adulto , Anciano , Femenino , Humanos , Queratolíticos/inmunología , Queratosis/patología , Trasplante de Riñón/inmunología , Células Asesinas Naturales/inmunología , Células de Langerhans/inmunología , Linfocitos/inmunología , Masculino , Persona de Mediana Edad , Neoplasias Cutáneas/etiología , Neoplasias Cutáneas/patología , Luz Solar/efectos adversos , Rayos Ultravioleta/efectos adversosRESUMEN
BACKGROUND: There is little information regarding the 12-h mycophenolic acid (MPA) pharmacokinetics (PK), a way to monitor the drug and the need of frequent monitoring, in stable patients. METHODS: A cohort of 35 adults, under long-term mycophenolate mofetil (MMF) therapy plus cyclosporin A (n = 12), TACimus (n = 12) or MMF only (n = 11); all with prednisone had a 12-h MPA-PK performed to ascertain the percentage of them within a defined therapeutic window. In 13 other patients, two PK studies undergone 1 wk apart were performed to evaluate the need for frequent measurements. RESULTS: Fourteen (40%) patients were within the defined therapeutic window (36-60 microg h/mL). Nine patients (26%) were overexposed while 12 (34%) were underexposed. A Cmax> or =10 microg/mL was seen in 20 (57%) of the patients. These percentages were equally distributed between the treatment groups both for AUC0-12 and Cmax. The equations using C0, C2 or both predict exposure, although the use of C2 seems to be more adequate in clinical practice. There were no differences in MPA exposure in patients with a repeated PK evaluated 1 wk later. CONCLUSION: The use of MMF without monitoring MPA blood levels may cause over-/underexposure to the drug in stable recipients. However, in patients under MMF for more than 1 yr, MPA levels are stable and there is no need for frequent measurements.
Asunto(s)
Monitoreo de Drogas , Inmunosupresores/uso terapéutico , Trasplante de Riñón/inmunología , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapéutico , Adulto , Estudios de Cohortes , Femenino , Humanos , Inmunosupresores/inmunología , Masculino , Persona de Mediana Edad , Ácido Micofenólico/inmunologíaRESUMEN
PURPOSE: We assessed clinical and surgical results in renal transplantation candidates with voiding dysfunction and end stage renal disease who underwent bladder augmentation. MATERIALS AND METHODS: We analyzed 8 patients 3 to 30 years old with dilated ureters, voiding dysfunction and end stage renal disease who underwent renal transplantation following bladder augmentation from 1995 to 2003. The etiology of bladder dysfunction was neurogenic bladder in 3 patients, posterior urethral valves in 3 and vesicoureteral reflux in 2. All cases were assessed by ultrasonography, voiding cystourethrography and urodynamic studies. RESULTS: Mean followup was 50 months (range 4 to 93). Previous urodynamic evaluation revealed a bladder capacity of 75 to 294 ml (mean +/- SD 167.38 +/- 77.32) and an intravesical pressure of 28 to 100 mm H2O (mean 51.25 +/- 22.17). Urodynamic study after augmentation and kidney transplantation showed a bladder capacity of 191 to 400 ml (mean 335.25 +/- 99.01) and an intravesical pressure of 15 to 35 mm H2O (mean 28 +/- 9.45). Mean serum creatinine was 1.65 mg/dl (range 0.8 to 2.5). All patients remained continent. Three patients with neurogenic bladder empty the bladder by clean intermittent catheterization and the others empty by the Valsalva maneuver. None of the grafts were lost and the most common complication was asymptomatic urinary tract infection. CONCLUSIONS: Bladder augmentation is a well-known procedure for low capacity and poorly compliant bladders even in candidates for a renal transplant. Ureterocystoplasty combines the benefits common to all enterocystoplasties without adding to complications or risks.
Asunto(s)
Fallo Renal Crónico/cirugía , Trasplante de Riñón/fisiología , Uréter/cirugía , Vejiga Urinaria/cirugía , Urodinámica , Adolescente , Adulto , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Fallo Renal Crónico/complicaciones , MasculinoRESUMEN
The complete area under the time-concentration curve (AUC) is considered to be the gold standard for cyclosporin-A (CyA) monitoring. However, complete AUC is time- and cost-consuming. For this reason, we reviewed 259 4-h AUC (AUC0-4) performed in 74 renal transplanted patients in order to construct an equation to calculate AUC0-4. All samples were drawn from one adult population 13 days following transplantation, in order to allow the cyclosporin metabolism to stabilize. Regression analysis was done either with each or with a combination of two variables. Cyclosporin-A blood concentration at the second hour after the oral dose (C2) was the best predictor of AUC0-4, where AUC0-4 = 451 +(2.73 x C2), R2 = 0.87, p<0.001. The combination of C1 and C2 only, offered a better mathematical improvement to the C2 equation. This equation was further validated in 33 other CyA pharmacokinetic profiles performed in eight patients who had not participated in the equation development. In this new population, the C2 equation excellently predicted the trapezoidal AUC0-4 (R2 = 0.81). Our data shows that C2 can be safely used to estimate AUC0-4. The C2 equation simplifies CyA monitoring because of its high-predictive value and clinical feasibility.
Asunto(s)
Área Bajo la Curva , Ciclosporina/farmacocinética , Inmunosupresores/farmacocinética , Adulto , Estudios de Cohortes , Interpretación Estadística de Datos , Humanos , Trasplante de Riñón , Estudios RetrospectivosRESUMEN
Analisamos 105 neoplasias malignas em 94 pacientes (6,2 porcento) - 11 deles com 2 tipos diferentes de neoplasias - observados em um grupo de 1.511 pacientes transplantados renais, entrre janeiro de 1965 a dezembro de 1990. Dos 105 casos de neoplasias malignas observadas 85 casos eram da linhagem epitelial e 20 casos de linhagem mesenquimal. Das neoplasias da linhagem epitelial, 33 casos (31.41 porcento) eram de pele - 19 casos espinocelulares, (CEC) 12 casos basocelulares (CBC) e 2 casos espino-basocelulares - , 14 casos (13,3 porcento) eram de língua, lábio ou períneo e 38 casos (36,2 porcento) eram de outros tipos: Fígado (8), intestino (5), rim primitivo (5), tireóide(3), colo uterino(5),endométrtio(3), melanoma(3), mama(2), pulmäo(2) e indiferenciados(2). Das neoplasias de linhagem mesenquimal, a mais frequente foi o sarcoma de Kaposi (9 casos), seguido de linfoma (4), leucemis(3) e outros tipos(4). A incidência de neoplasia aumentou com o tempo pós-transplante: de 0 a 12 meses, 1,05 porcento; de 13 a 60 meses, 2,83 porcento; de 61 a 120 meses,3,91 porcento; de 121 a 180 meses, 6,64 porcento; e de 181 a 240 meses, 7,46 porcento. Quanto à tipagem HLA,A,B, a incidencia de CEC e CBC foi mais frequente em portadores de antígenos A3, B7 e B27. Nenhum caso desse tipo de tumor ocorreu em pacientes HLA B17 e B35 positivos. Portadores de antígenos A3, B7 e B17 estiveram associados a presença de outras neoplasias epiteliais. Os portadores de neoplasia da linhagem mesenquimal tinham mais frequentemente antígenos A9, A28 e B12. O prognóstico foi pior nos casos das neoplasias de linhagem mesenquimal, onde a mortalidade foi de 60 porcento. Concluímos que as neoplasias malignas säo um tipo de complicaçäo importante no pós-transplante renal, sendo as mais frequentes aquelas da linhagem epitelial (81 porcento).(au)