RESUMEN
AIM: Accumulating literature indicates that late acute rejection (LAR) after kidney transplantation portends an unfavourable prognosis. There are no data on the incidence of LAR in Asian subjects, or its risk factors and associated clinical outcomes. METHODS: We conducted a retrospective single-centre case-+control study to investigate the incidence, risk factors and prognosis of LAR in Chinese kidney transplant recipients. Subjects with or without LAR were matched for age, gender, era of transplantation, allograft type, and maintenance immunosuppression regimen. RESULTS: Thirty-two episodes of LAR occurred within an observation period of 12 years giving an incidence rate of 0.46 episodes per 1000 patient-years. Acute rejection within the first year after transplantation was associated with an increased risk of LAR (OR 3.59, P = 0.041). In patients receiving maintenance immunosuppression regimen with steroid, cyclosporin A (CsA) and mycophenolate or an m-TOR inhibitor, patients with LAR showed lower trough CsA levels prior to and at the time of rejection compared to Controls (86.0 ± 26.1 vs. 105.6 ± 13.3 µg/L, P = 0.049; and 75.7 ± 35.7 vs. 106.0 ± 20.5 µg/L, P = 0.032, respectively). Trough CsA level below 80 µg/L was associated with the development of LAR (OR 10.82, P = 0.032). Patients with LAR showed an inferior allograft survival (P < 0.001) while patient survival rates were similar (P = 0.122). CONCLUSIONS: Late acute rejection is uncommon in Chinese kidney transplant recipients but is associated with reduced allograft survival. Risk factors include acute rejection in the first post-transplant year and trough CsA level below 80 µg/L in patients on CsA-based maintenance immunosuppression. Minimization of immunosuppression in apparently stable kidney transplant recipients must be exercised with caution.
Asunto(s)
Rechazo de Injerto/etiología , Trasplante de Riñón/efectos adversos , Enfermedad Aguda , Adulto , Femenino , Supervivencia de Injerto , Humanos , Trasplante de Riñón/mortalidad , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pronóstico , Factores de RiesgoAsunto(s)
Aspergilosis/complicaciones , Parálisis de Bell/etiología , Rinitis/microbiología , Sinusitis/microbiología , Anciano , Antifúngicos/uso terapéutico , Aspergilosis/terapia , Aspergillus , Desbridamiento , Humanos , Trasplante de Riñón , Trasplante de Hígado , Imagen por Resonancia Magnética , Masculino , Rinitis/diagnóstico por imagen , Rinitis/terapia , Sinusitis/diagnóstico por imagen , Sinusitis/cirugíaAsunto(s)
Funcionamiento Retardado del Injerto , Hipofosfatemia , Fallo Renal Crónico/cirugía , Trasplante de Riñón/efectos adversos , Riñón , Fosfatos/efectos adversos , Adulto , Biopsia , Funcionamiento Retardado del Injerto/inducido químicamente , Funcionamiento Retardado del Injerto/patología , Funcionamiento Retardado del Injerto/fisiopatología , Funcionamiento Retardado del Injerto/terapia , Femenino , Humanos , Hipofosfatemia/diagnóstico , Hipofosfatemia/tratamiento farmacológico , Hipofosfatemia/etiología , Inmunosupresores/administración & dosificación , Inmunosupresores/efectos adversos , Riñón/patología , Riñón/fisiopatología , Fallo Renal Crónico/etiología , Trasplante de Riñón/métodos , Nefritis Lúpica/complicaciones , Fosfatos/administración & dosificación , Tacrolimus/administración & dosificación , Tacrolimus/efectos adversos , Resultado del TratamientoAsunto(s)
Aminas/efectos adversos , Ácidos Ciclohexanocarboxílicos/efectos adversos , Fallo Renal Crónico/complicaciones , Mioclonía/inducido químicamente , Ácido gamma-Aminobutírico/efectos adversos , Anciano , Antiparkinsonianos/efectos adversos , Femenino , Gabapentina , Humanos , Mioclonía/complicacionesRESUMEN
Patients with influenza infection most commonly present with upper and occasionally lower respiratory tract symptoms. However, extrapulmonary presentations such as hepatitis are infrequently observed. We report a case of a hemodialysis patient with influenza A infection who presented with severe hepatitis and liver failure, while his respiratory symptoms were mild. It is important to recognize influenza infection as an unexplained cause of hepatitis and liver failure. In our case, liver failure resolved with supportive treatment.
Asunto(s)
Gripe Humana/complicaciones , Fallo Renal Crónico/terapia , Fallo Hepático/etiología , Diálisis Renal/métodos , Anciano , Humanos , Fallo Renal Crónico/complicaciones , MasculinoRESUMEN
BACKGROUND: Chronotropic incompetence (CI) is an independent predictor of cardiovascular events and overall mortality. The prevalence and significance of CI in renal transplant patient has not been examined. METHODS: 38 non-heart failure renal transplant recipients were recruited for a transthoracic echocardiogram and treadmill stress test using the modified Bruce protocol. RESULTS: 15 patients (39.5%) had CI (defined as failure to reach 85% of the maximum age-predicted heart rate, or <8 0% of predicted heart rate reserve). CI patients had higher left ventricular (LV) mass (216.5 ± 56.1 vs. 183.1 ± 40.0 g, p = 0.04), increased septal wall thickness (11.7 ± 1.4 vs. 10.7 ± 1.1 mm, p = 0.03) and posterior wall thickness (10.9 ± 1.9 vs. 9.5 ± 1.7 mm, p = 0.02). At multivariate analysis, CI was associated with elevated serum creatinine [odds ratio (OR) 1.04, p = 0.03] and increased LV mass (OR 1.03, p = 0.03). CI was associated with shorter exercise duration (3.53 ± 2.20 vs. 8.08 ± 2.34 min, p < 0.01) and lower metabolic equivalents (5.40 ± 2.05 vs. 9.82 ± 2.39, p < 0.01). At multivariate analysis, exercise duration was negatively associated with CI (ß = -0.54, p < 0.01). CONCLUSIONS: CI is present in approximately 40% of asymptomatic renal transplant recipients and is associated with reduced exercise tolerance, left ventricular hypertrophy, and worse allograft function .
Asunto(s)
Tolerancia al Ejercicio/fisiología , Frecuencia Cardíaca/fisiología , Hipertrofia Ventricular Izquierda/fisiopatología , Trasplante de Riñón , Adulto , Creatinina/sangre , Ecocardiografía , Prueba de Esfuerzo , Femenino , Humanos , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Riñón/fisiopatología , Masculino , Equivalente Metabólico , Persona de Mediana EdadRESUMEN
We report a case with severe electrolyte disturbance after the use of oral sodium phosphate solution (OSPS). A 69-year-old patient on haemodialysis received 45 mL of OSPS for bowel preparation. He had symptomatic hypocalcaemia with a serum calcium level of 0.95 mmol/L and serum phosphate level of 4.73 mmol/L. He was treated with haemodialysis and intravenous calcium supplementation. This patient had total parathyroidectomy recently leading to the absence of parathyroid hormone response. OSPS has been reported to cause life-threatening electrolyte disturbance especially in patients with renal failure. We suggest the use of safer alternatives for bowel preparations in renal failure patients.