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Säo Paulo med. j ; 140(3): 439-446, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1377376


ABSTRACT BACKGROUND: Epidemiological studies involving large samples usually face financial and operational challenges. OBJECTIVES: To describe the planning and execution of ADHERE Brazil, an epidemiological study on 1,105 kidney transplant patients, and report on how the study was structured, difficulties faced and solutions found. DESIGN AND SETTING: Cross-sectional multicenter study in 20 Brazilian kidney transplantation centers. METHODS: Actions developed in each phase of implementation were described, with emphasis on innovations used within the logistics of this study, aimed at estimating the prevalence of nonadherence to treatment. RESULTS: Coordination of activities was divided into four areas: general, regulatory, data collection and statistics. Weekly meetings were held for action planning. The general coordination team was in charge of project elaboration, choice of participating centers, definition of publication policy and monitoring other coordination teams. The regulatory team provided support to centers for submitting the project to ethics committees. The data collection team prepared a manual on the electronic collection system, scheduled web meetings and was available to respond to queries. It also monitored the data quality and reported any inadequacies found. Communication with the centers was through monthly reports via e-mail and distribution of exclusive material. The statistical team acted in all phases of the study, especially in creating the data analysis plan and data bank, generation of randomization lists and data extraction. CONCLUSIONS: Through these logistics, we collected high-quality data and built a local research infrastructure for further studies. We present supporting alternatives for conducting similar studies. CLINICAL TRIAL ANNOTATION: on October 10, 2013; NCT02066935.

Humans , Kidney Transplantation , Brazil/epidemiology , Prevalence , Cross-Sectional Studies , Communication
ABCS health sci ; 47: e022204, 06 abr. 2022. ilus, tab
Article in English | LILACS | ID: biblio-1363533


INTRODUCTION: Kidney transplantation (KT) is the renal replacement therapy (RRT) of choice for patients with chronic kidney disease (CKD). However, not every KT is successful and some patients persist on RRT. OBJECTIVE: To model a logistic regression with pre- and post-KT risk covariates capable of predicting secondary allograft dysfunction in need of RRT or reaching stage V of CKD until the first six months post-KT. METHODS: Cohort with KT recipients from Northeastern Brazil. Medical records of KT performed between 2011-2018 were analyzed. KT-recipients with insufficient data or who abandoned follow-up were excluded. The covariables analyzed were: demographic; infectious; pre- and post-KT comorbidities; panel reactive-antibodies; number of HLA mismatches; acute rejection episodes mediated by T-cell (ACR) or antibodies (AAR) six months after KT; and laboratory tests six months after KT. RESULTS: Covariates with higher risk for the analyzed outcomes six months after KT were: elderly KT recipients (OR:1.41; CI95%:1.01-1.99), time between onset of RRT and KT (ΔT-RRT&KT)>10years (OR:3.54; CI95%:1.27-9.87), diabetes mellitus (DM) pre-KT (OR:3.35; CI95%:1.51-7.46), pyelonephritis (OR:2.45; CI95%:1.24-4.84), polyomavirus nephropathy (OR:4.99; CI95%:1.87-13.3), AAS (OR:4.82; CI95%:1.35-17.2), 24h-proteinuria ≥300mg/24h (OR:5.05; CI95%:2.00-12.7) and serum calcium (Ca) <8.5mg/dL (OR:4.72; CI95%:2.00-11.1). The multivariate model presented an accuracy of 88.1% and the mean variance inflation factor is 1.81. CONCLUSION: Elderly-recipients, ΔT-RRT&KT>10 years, pre-KT DM, and post-KT aggressions until six months (pyelonephritis, polyomavirus nephropathy, ABMR, 24h-proteinuria≥300mg/24h, and Ca<8.5mg/dL) are associated with high predictive power for secondary allograft dysfunction in need of RRT or reaching CKD stage V until the first six months post-KT.

INTRODUÇÃO: Transplante renal (TR) é a terapia renal substitutiva (TRS) de escolha para pacientes com doença renal crônica (DRC). Entretanto, nem todo TR é bem-sucedido e alguns pacientes persistem em TRS. OBJETIVO: Modelar uma regressão logística com covariáveis de risco pré e pós-TR preditora da disfunção secundária do aloenxerto com necessidade de TRS ou alcance ao estágio V da DRC até os primeiros seis meses pós-TR. MÉTODOS: Coorte com receptores transplantados realizado em hospital no Nordeste brasileiro. Analisou-se registros médicos dos TR realizados entre 2011-2018. Receptores com dados insuficientes ou que abandonaram seguimento foram excluídos. Foram analisadas covariáveis: demográficas; infecciosas; comorbidades pré e pós-TR; painel de reatividade; incompatibilidades de HLA; episódios de rejeições agudas mediadas por células-T ou por anticorpos; exames laboratoriais seis meses pós-TR. RESULTADOS: Receptores idosos (OR:1,41; IC95%:1,01-1,99), tempo entre início da TRS e TR (∆T-TRS&TR)>10 anos (OR:3,54; IC95%:1,27-9,87), diabetes mellitus (DM) pré-TR (OR:3,35; IC95%:1,51-7,46), pielonefrite (OR:2,45; IC95%:1,24-4,84), nefropatia por poliomavírus (OR:4,99; IC95%:1,87-13,3), RAMA (OR:4,82; IC95%:1,35-17,2), proteinúria de 24h (Pt24h) ≥300mg/24h (OR:5,05; IC95%:2,00-12,7) e cálcio sérico (Ca)<8,5mg/dL (OR:4,72; IC95%:2,00-11,1) foram identificadas como covariáveis de maior risco para os desfechos analisados até seis meses pós-TR. O modelo multivariado apresentou acurácia de 88,1% e fator de inflação da variância médio de 1,81. CONCLUSÃO: Receptores idosos, ∆T-TRS&TR>10anos, DM pré-TR e agressões até seis meses pós-TR (pielonefrite, nefropatia por poliomavírus, RAMA, Pt24h≥300mg/24h e Ca<8,5mg/dL), apresentam alto poder preditivo para disfunção secundária do aloenxerto com necessidade de TRS ou alcance ao estágio V da DRC até os primeiros seis meses pós-TR.

Humans , Male , Female , Risk Factors , Kidney Transplantation , Renal Insufficiency, Chronic , Allografts , Proteinuria , Pyelonephritis , Logistic Models , Retrospective Studies , Renal Dialysis , Immunosuppression Therapy , BK Virus , Disease Progression , Hypocalcemia
San Salvador; MINSAL; feb. 02, 2022. 32 p. ilus, graf.
Non-conventional in Spanish | LILACS, BISSAL | ID: biblio-1361737


En los presentes lineamientos técnicos se describen los conceptos y procedimientos a realizar en la implementación del registro, además se presentan entre otros aspectos, los componentes relacionados con la obligatoriedad en el reporte, definición de caso registrable, las variables a registrar, las fuentes de información, metodología de la recolección, los centros de diálisis y trasplante, así como el reporte de resultados y la hoja de recolección de la información

These technical guidelines describe the concepts and procedures to be carried out in the implementation of the registry, in addition to presenting, among other aspects, the components related to the obligatory nature of the report, the definition of the registrable case, the variables to be registered, the sources of information, collection methodology, dialysis and transplant centers, as well as the results report and the information collection sheet

Records , Kidney Transplantation , Dialysis , Registries , Research Report
Rev. Méd. Inst. Mex. Seguro Soc ; 60(1): 52-58, 17-feb-2022. ilus, tab
Article in Spanish | LILACS | ID: biblio-1359848


Introducción: el conocimiento de la funcionalidad del injerto y la supervivencia del paciente es fundamental para valorar el éxito del trasplante renal. Objetivo: determinar la supervivencia de los pacientes trasplantados por tipo de donante y la funcionalidad de los injertos renales en una cohorte en México. Material y métodos: cohorte de trasplante renal de 2013 a 2017 en México. Se analizaron 790 pacientes seguidos por un año para valorar la supervivencia de los pacientes trasplantados por tipo de donante y la funcionalidad de los injertos renales. Para ello se usaron medidas de tendencia central y dispersión, así como tablas de supervivencia de Kaplan-Meier con SPSS, versión 25. Resultados: de los 790 pacientes, 518 fueron de donante vivo (65.56%) con supervivencia del paciente de 97.88% y de funcionalidad del injerto de 93.24% a 12 meses de seguimiento; 272 pacientes recibieron el injerto de donante fallecido con supervivencia del paciente de 91.18% y funcionalidad del injerto renal de 84.19%. Conclusiones: aún existe una diferencia de casi 5% en la supervivencia del paciente receptor de un donante vivo en referencia con un donante fallecido. Para la funcionalidad del injerto renal esta diferencia es > 7%. La donación cadavérica ha aumentado; sin embargo, incluso en cifras bajas es de aproximadamente el 35% en México

Background: Knowledge of the functionality of the graft and patient survival is essential to assess the success of kidney transplantation. Objective: To determine the survival of transplanted patients by type of donor and the functionality of kidney grafts in a cohort in Mexico. Material and methods: Kidney transplant cohort from 2013 to 2017 in Mexico. 790 patients followed up for one year were analyzed to assess the survival of transplanted patients by type of donor and the functionality of kidney grafts. For this, measures of central tendency and dispersion were used, as well as Kaplan-Meier survival tables with SPSS, version 25. Results: Out of the 790 patients, 518 were from living donors (65.56%) with patient survival of 97.88% and graft function of 93.24% at 12 months of follow-up; 272 patients received the graft from a deceased donor with patient survival of 91.18% and renal graft function of 84.19%. Conclusions: There is still a difference of almost 5% in the survival of the recipient patient from a living donor compared to a deceased donor. For the functionality of the kidney graft, this difference is > 7%. Cadaveric donation has increased; however, even at low figures is of approximately 35% in Mexico

Humans , Male , Female , Pregnancy , Adult , Middle Aged , Survival , Kidney Transplantation , Aftercare , Survivorship , Graft Survival , Cohort Studies , Mexico
Rev. eletrônica enferm ; 24: 1-9, 18 jan. 2022.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1367717


Objetivo: elaborar um modelo técnico-assistencial de enfermagem para pacientes de transplante renal. Método: desenvolvimento de modelo técnico-assistencial fundamentado nas teorias de Orem e Watson baseado na pesquisa convergente assistencial. O cenário foi um Centro Transplantador da região sul do Brasil. Coleta de dados - diagnóstico das atividades realizadas no serviço de transplante renal; entrevista semiestruturada com pacientes; e três grupos focais com enfermeiros. Participaram nove pacientes de transplante renal e dez enfermeiros que atuam nas fases do perioperatório. Utilizou-se análise de conteúdo. Resultados: categorias emergidas dos pacientes - expectativas do transplante renal; informação sobre o tratamento após transplante; mudança no estilo de vida após o adoecimento; importância do autocuidado; sentimentos envolvidos no transplante renal e melhorias do centro transplantador. Conclusão: o modelo desenvolvido foi fundamentado nas teorias de Watson e Orem contemplando integralidade, promoção do autocuidado e atuação do enfermeiro, bem como necessidades apontadas pelos pacientes.

Objective: to develop a model of nursing technical care for kidney transplant patients. Method: development of a technical care model based on the theories of Orem and Watson based on convergent care research. The setting was a Transplant Center in southern Brazil. Data collection - diagnosis of activities performed in the kidney transplant service; semi-structured interview with patients; and three focus groups with nurses. Nine kidney transplant patients and ten nurses who work in the perioperative period participated. Content analysis was performed. Results: categories emerged from patients - expectations of kidney transplantation; information about treatment after transplantation; lifestyle changes after illness; importance of self-care; feelings involved in kidney transplantation; and transplant center improvements. Conclusion: the developed model was based on Watson and Orem's theories and contemplated comprehensiveness, promotion of self-care and the role of nurses, as well as needs identified by patients.

Kidney Transplantation , Healthcare Models/trends , Perioperative Nursing
Rev. colomb. cir ; 37(2): 214-225, 20220316. tab, fig
Article in Spanish | LILACS | ID: biblio-1362926


Introducción. El trasplante renal es el tratamiento de elección para la enfermedad renal crónica. Debido a la brecha con la disponibilidad de donantes, el uso de criterios expandidos es una opción que busca mejorar la tasa de donación mundial. El objetivo de este estudio fue comparar la sobrevida del injerto y del paciente trasplantado con donante de criterios expandidos versus el donante estándar. Métodos. Cohorte retrospectiva de 1002 pacientes con trasplante renal donde se determinó la sobrevida del injerto renal y del receptor a 10 años después del trasplante. La sobrevida del injerto renal y el receptor fueron estimadas por el método de Kaplan-Meier. Una regresión de Cox fue realizada ajustando el modelo multivariado.Resultados. El análisis incluyó 1002 receptores, con un 18,8 % (n=189) que correspondían al uso de donante de criterios expandidos. El grupo de trasplante renal con donante de criterios expandidos tuvo menor sobrevida del paciente (48,1 % versus 63,8 %) y del injerto (63,3 % versus 74,7 %) en comparación con el grupo de trasplante renal con donantes con criterios estándar a los 10 años después del trasplante. La asociación de trasplante renal con donante de criterios expandidos y muerte o pérdida del injerto renal no fueron significativas cuando se ajustaron las variables en el modelo multivariado. Conclusión. El trasplante renal con donante de criterios expandidos tiene menor sobrevida del receptor y del injerto frente al grupo de trasplante renal con donante estándar. No hubo diferencias estadísticamente significativas en cuanto al trasplante renal con donante de criterios expandidos frente a la pérdida del injerto renal o muerte.

Introduction. Kidney transplantation is the treatment of choice for chronic kidney disease. Due to the gap with donor availability, the use of expanded criteria is an option that seeks to improve the global donation rate. The objective of this study was to compare the survival of the graft and the transplanted patient with an expanded criteria donor versus the standard donor. Methods. Retrospective cohort of 1002 kidney transplant patients where survival of the kidney graft and the recipient was determined at 10 years after transplantation. The survival of the kidney graft and the recipient were estimated by the Kaplan-Meier method. A Cox regression was performed by fitting the multivariate model. Results. The analysis included 1002 recipients with 18.8% (n=189) corresponding to the use of an expanded criteria donor. The expanded criteria donor kidney transplant group had lower patient (48.1% versus 63.8%) and graft (63.3% versus 74.7%) survival compared to the donor kidney transplant group with standard criteria at 10 years post-transplant. The association of kidney transplantation with expanded criteria donor and death or loss of the kidney graft were not significant when the variables were adjusted in the multivariate model. Conclusion. Kidney transplantation with an expanded criteria donor has a lower recipient and graft survival compared to the standard kidney transplant group. There were no statistically significant differences in expanded criteria donor kidney transplantation versus kidney graft loss or death.

Humans , Kidney Transplantation , Graft Survival , Tissue and Organ Procurement , Donor Selection , Transplant Donor Site , Graft Rejection
Rev. Col. Bras. Cir ; 49: e2022EDIT01, 2022.
Article in English | LILACS | ID: biblio-1365381


ABSTRACT Are presented results of experimental pig kidney xenotransplantation in Brazil, which aims to reduce the waiting list mortality due to shortage of organs. Recent clinical results obtained abroad are commented.

RESUMO Apresentam-se resultados de xenotransplante suíno de rim experimental no Brasil que visa reduzir as listas de espera nas quais falecem muitos inscritos à espera do transplante. Comentam-se os recentes resultados clínicos obtidos no exterior.

Animals , Kidney Transplantation , Swine , Transplantation, Heterologous/methods , Brazil , Waiting Lists , Kidney
An. Fac. Cienc. Méd. (Asunción) ; 54(3): 143-150, Dec. 2021.
Article in Spanish | LILACS | ID: biblio-1352977


El trasplante renal de órganos provenientes de donantes adultos implantados en una cavidad anatómica estrecha en pacientes pediátricos de bajo peso, ofrece importantes desafíos médicos y quirúrgicos a ser considerados. En esta publicación reportamos el primer caso en el Paraguay de un riñón con dos arterias renales injertado a la aorta y vena cava inferior, dentro de la cavidad abdominal de un paciente pediátrico de 12 kilogramos de peso, evaluando las dificultades médicas, anatómicas y quirúrgicas enfrentadas, así como las opciones de tratamiento instituidas para llevar a cabo este procedimiento de manera exitosa

Kidney transplantation of organs from adult donors implanted into a narrow anatomical cavity in underweight pediatric patients offers significant medical and surgical challenges to be considered. In this publication we report the first case in Paraguay of a kidney with two renal arteries, grafted to the aorta and inferior vena cava within the abdominal cavity, on a 12 kilogram pediatric patient, evaluating the medical, anatomical and surgical conditions faced, as well as the treatment options instituted to successfully carry out this procedure

Kidney Transplantation , Kidney , Arteries
Cambios rev. méd ; 20(2): 129-142, 30 Diciembre 2021. tabs.
Article in Spanish | LILACS | ID: biblio-1368491


El trasplante renal es considerado como la mejor alternativa de tratamiento sustitutivo para la enfermedad renal crónica terminal (ERCT)1, es el procedimiento quirúrgico que consiste en reemplazar un riñón sano de un donante vivo o cadavérico a una persona con diagnóstico de ERCT, que ayuda a mejorar su calidad de vida, la reinserción a sus actividades sociales, físicas, emocionales, laborales y sexuales. La Organización Nacional de Trasplantes de España (ONT) en el año 2018, reportó que en la Unión Europea se realizaron 21 102 y en Latinoamérica 12 806 trasplantes renales2, en Ecuador el Ministerio de Salud Pública (MSP) en los años 2007-2020 reportó un total de 1 6153, le correspondió al Hospital de Especialidades Carlos Andrade Marín (HECAM) el 32% del total de trasplantes renales realizados entre el periodo 2007-20184. La evaluación del potencial receptor es realizada por un equipo multidisciplinario con formación académica, experiencia certificada en los diferentes procesos y acreditados por el Instituto Nacional de Donación y Trasplantes (INDOT)5. Los cuidados de enfermería enmarcados en esta ruta, son especializados e integrales, que incluyen los períodos pre operatorio, pos trasplante inmediato y temprano al incorporar además un proceso educativo entre enfermera, paciente y familia/ cuidador, con el fin de preservar la sobrevida del injerto.

Renal transplantation is considered the best alternative replacement treatment for end-stage chronic kidney disease (ESRD)1, it is the surgical procedure that consists of replacing a healthy kidney from a living or cadaveric donor to a person diagnosed with ESRD, which helps to improve their quality of life, reintegration to their social, physical, emotional, work and sexual activities. The National Transplant Organization of Spain (ONT) in 2018, reported that In the European Union 21 102 and in Latin America 12 806 renal transplants were performed2, in Ecuador the Ministry of Public Health (MSP) in the years 2007-2020 reported a total of 1 6153, corresponded to the Carlos Andrade Marín Specialties Hospital (HECAM) 32% of the total number of renal transplants performed between 2007-20184. The evaluation of the potential recipient is performed by a multidisciplinary team with academic training, certified experience in the different processes and accredited by the National Institute of Donation and Transplantation (INDOT)5. The nursing care framed in this route is specialized and comprehensive, including the pre-operative, immediate post-transplant and early post-transplant periods, incorporating an educational process between nurse, patient and family/caregiver, in order to preserve graft survival.

Humans , Male , Female , Perioperative Nursing , Nursing Records , Kidney Transplantation/nursing , Patient-Centered Care , Nurse's Role , Nursing Care , Quality of Life , Tissue Donors , Preoperative Care , Renal Dialysis , Kidney Transplantation , Clinical Laboratory Techniques , Hospital Care , Renal Insufficiency, Chronic , Immunosuppressive Agents
J. bras. nefrol ; 43(4): 591-596, Dec. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1350916


Abstract Thrombotic microangiopathies are disorders characterized by nonimmune microangiopathic hemolytic anemia, thrombocytopenia, and multi-systemic failure. They are classified as thrombotic thrombocytopenic purpura, atypical hemolytic-uremic syndrome, and typical hemolytic uremic syndrome. The latter is associated with intestinal infections by Shiga toxin-producing bacteria. Typical hemolytic uremic syndrome in adults is an extremely rare condition, characterized by high morbidity and mortality. It has been seldom described in solid organ transplant recipients. Here is presented the case of a kidney transplant recipient who had typical hemolytic uremic syndrome with multisystem commitment, refractory to management and with a fatal outcome.

Resumo Microangiopatias trombóticas são distúrbios caracterizados por anemia hemolítica microangiopática não imune, trombocitopenia e insuficiência multissistêmica. Elas são classificadas como púrpura trombocitopênica trombótica, síndrome hemolítico-urêmica atípica e síndrome urêmica hemolítica típica. Essa última está associada a infecções intestinais por bactérias produtoras da toxina Shiga. A síndrome hemolítica urêmica típica em adultos é uma condição extremamente rara, caracterizada por alta morbimortalidade. Esta é raramente descrita em receptores de transplantes de órgãos sólidos. Apresentamos aqui o caso de um receptor de transplante renal que apresentava síndrome hemolítico-urêmica típica com comprometimento multissistêmico, refratário ao tratamento, e com desfecho fatal.

Humans , Adult , Purpura, Thrombotic Thrombocytopenic , Kidney Transplantation , Shiga-Toxigenic Escherichia coli , Atypical Hemolytic Uremic Syndrome , Anemia, Hemolytic
J. bras. nefrol ; 43(4): 520-529, Dec. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1350911


Abstract Background: Tuberculosis (TB) is a prevalent infection after kidney transplantation (KT) in high-burden countries. Latent tuberculosis infection (LTBI) screening includes previous TB history, chest radiograph findings, and tuberculin test (TST) and/or interferon-gamma release assays (IGRAs) results. We aimed to compare our routine LTBI screening of KT candidates and living donors (LD) with their IGRA results, and evaluate if this would improve isoniazid (INH) treatment referral. Methods: We evaluated adult KT candidates and LD with complete routine LTBI screening and QuantiFERON-TB® Gold In-Tube (QFT) testing. Blood samples were collected from April 4th, 2014 to October 31st, 2018, with follow-up until October 31st, 2019. Results: There were 116 KT recipients, with 30% QFT-positive results. Positive QFT was associated with past TB history (p=0.007), positive TST (p<0.0001), residual radiographic lesions (p=0.003), and diabetes (p=0.035). There were 25 LD, 40% had positive QFT. Positive QFT was associated with a positive TST (p=0.002). Positive QFT results increased INH referral in 80%. Post-transplant TB incidence was 2.6% in a median follow-up of 2 (1-33) months. No variables were associated with post-transplant TB. TB patients had inferior, although non-significant, 5-year graft survival (66.7% vs. 76.5%) (p = 0.402). Conclusion: In the present study, the association of QFT to our routine LTBI screening incremented INH treatment referral, but there was still a high incidence of post-transplant TB, possibly related to other forms of infection, such as new exposure and donor transmission.

Resumo Histórico: Tuberculose (TB) é uma infecção relativamente comum pós-transplante renal (TR) em países com alta prevalência da doença. O rastreamento de infecção latente por tuberculose (ILTB) inclui histórico prévio de TB, achados de radiografia do tórax, resultados do teste tuberculínico (TT) e/ou de ensaio de liberação de interferon-gama (IGRAs). Nosso objetivo foi comparar nossa avaliação de rotina de candidatos ao TR e doadores vivos (DV) com seus resultados de IGRA, avaliando se aumentaria o encaminhamento para tratamento com isoniazida (INH). Métodos: Avaliamos candidatos adultos ao TR e DV com rastreamento para ILTB de rotina completo e coleta de testes QuantiFERON-TB® Gold In-Tube (QFT). Coletamos amostras sanguíneas de 4 de Abril, 2014 - 31 de Outubro, 2018, com acompanhamento até 31 de Outubro, 2019. Resultados: Avaliamos 116 receptores de TR, 30% sendo QFT-positivo. QFT positivo foi associado ao histórico prévio de TB (p=0,007), TT positivo (p<0,0001), lesões radiográficas residuais (p=0,003), diabetes (p=0,035). Avaliamos 25 DV, 40% apresentaram QFT positivo. QFT positivo foi associado a TT positivo (p=0,002). Resultados positivos do QFT aumentaram o encaminhamento para INH em 80%. A incidência de TB pós-transplante foi 2,6% em uma mediana de acompanhamento de 2 (1-33) meses. Nenhuma variável foi associada à TB pós-transplante. Pacientes com TB tiveram sobrevida do enxerto em 5 anos inferior, embora não-significativa (66,7% vs. 76,5%) (p = 0,402). Conclusão: Neste estudo, a associação do QFT à nossa avaliação de ILTB de rotina aumentou o encaminhamento para tratamento com INH, mas ainda houve alta incidência de TB pós-transplante, possivelmente relacionada a outras formas de infecção, como nova exposição e transmissão pelos doadores.

Humans , Adult , Kidney Transplantation , Latent Tuberculosis/diagnosis , Latent Tuberculosis/epidemiology , Brazil , Tuberculin Test , Interferon-gamma Release Tests
J. bras. nefrol ; 43(4): 530-538, Dec. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1350900


Abstract Introduction: Cytomegalovirus (CMV) is one of the most common agents of infection in solid organ transplant patients, with significant morbidity and mortality. Objective: This study aimed to establish a threshold for initiation of preemptive treatment. In addition, the study compared the performance of antigenemia with qPCR results. Study design: This was a prospective cohort study conducted in 2017 in a single kidney transplant center in Brazil. Clinical validation was performed by comparing in-house qPCR results, against standard of care at that time (Pp65 CMV Antigenemia). ROC curve analysis was performed to determine the ideal threshold for initiation of preemptive therapy based on the qPCR test results. Results: Two hundred and thirty two samples from 30 patients were tested with both antigenemia and qPCR, from which 163 (70.26%) were concordant (Kappa coefficient: 0.435, p<0.001; Spearman correlation: 0.663). PCR allowed for early diagnoses. The median number of days for the first positive result was 50 (range, 24-105) for antigenemia and 42 (range, 24-74) for qPCR (p<0.001). ROC curve analysis revealed that at a threshold of 3,430 IU/mL (Log 3.54), qPCR had a sensitivity of 97.06% and a specificity of 74.24% (AUC 0.92617 ± 0.0185, p<0.001), in the prediction of 10 cells/105 leukocytes by antigenemia and physician's decision to treat. Conclusions: CMV Pp65 antigenemia and CMV qPCR showed fair agreement and a moderate correlation in this study. The in-house qPCR was revealed to be an accurate method to determine CMV DNAemia in kidney transplant patients, resulting in positive results weeks before antigenemia.

Resumo Introdução: Citomegalovírus (CMV) é um dos agentes infecciosos mais comuns em pacientes com transplante de órgãos sólidos, com morbidade e mortalidade significativas. Objetivo: Este estudo visou estabelecer um limite para o início do tratamento preemptivo. Além disso, comparou o desempenho da antigenemia com os resultados da qPCR in house. Desenho do estudo: Este foi um estudo de coorte prospectivo realizado em 2017 em um centro único de transplante renal no Brasil. A validação clínica foi realizada comparando resultados de qPCR in house, com o padrão de atendimento na época (Antigenemia para CMV Pp65). A análise da curva ROC foi realizada para determinar o limite ideal para o início da terapia preemptiva baseado nos resultados do teste qPCR in house. Resultados: 232 amostras de 30 pacientes foram testadas com antigenemia e qPCR, das quais 163 (70,26%) foram concordantes (Coeficiente Kappa: 0,435, p<0,001; Correlação Spearman: 0,663). PCR permitiu diagnósticos precoces. O número médio de dias para o primeiro resultado positivo foi 50 (intervalo, 24-105) para antigenemia e 42 (intervalo, 24-74) para qPCR (p<0,001). A análise da curva ROC revelou que em um limite de 3.430 UI/mL (Log 3,54), qPCR teve sensibilidade de 97,06% e especificidade de 74,24% (AUC 0,92617 ± 0,0185, p<0,001), na previsão de 10 células/10(5) leucócitos por antigenemia e na decisão do médico de tratar. Conclusões: Antigenemia para CMV Pp65 e qPCR para CMV mostraram uma concordância aceitável e uma correlação moderada neste estudo. qPCR in house revelou-se um método preciso para determinar DNAemia do CMV em pacientes transplantados renais, obtendo resultados positivos semanas antes da antigenemia.

Humans , Kidney Transplantation , Cytomegalovirus Infections/diagnosis , World Health Organization , DNA, Viral , Prospective Studies , Viral Load , Real-Time Polymerase Chain Reaction , Antigens, Viral
J. bras. nefrol ; 43(3): 375-382, July-Sept. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1340131


Abstract Introduction: The number of kidney transplants (KTx) is increasing in Brazil and, consequently, the costs of this procedure increase the country's health budget. We retrospectively evaluated the data of kidney transplant procedures until hospital discharge, according to kidney function recovery after the procedure. Methods: Retrospective analysis of the non-sensitized, 1st KTx from deceased donors performed between Jan/2010 to Dec/2017. Results: Out of the 1300 KTx from deceased donors performed in this period, 730 patients were studied and divided into 3 groups: Immediate Renal Function (IRF) - decrease in serum creatinine ≥ 10% on two consecutive days; Delayed Graft Function (DGF) - decrease in serum creatinine <10% on two consecutive days, without the need for dialysis, and Dialysis (D) - need for dialysis during the first week. Patients in group D stayed longer in the hospital compared to DGF and IRF (21, 11 and 8 days respectively, p < 0.001). More D patients (21%) were admitted to the ICU and performed a greater number of laboratory tests (p < 0.001) and renal biopsies (p < 0.001), in addition to receiving a higher amount of immunosuppressants. Total hospital costs were higher in group D and DGF compared to IRF (U$ 7.021,48; U$ 3.603,42 and U$ 2.642,37 respectively, p < 0.001). Conclusion: The costs of the transplant procedure is impacted by the recovery of kidney function after the transplant. The reimbursement for each of these different kidney function outcomes should be individualized in order to cover their real costs.

Resumo Introdução: O número de transplantes renais (KTx, do inglês kidney transplant) está aumentando no Brasil e, consequentemente, os custos deste procedimento aumentam o orçamento de saúde do país. Avaliamos retrospectivamente dados dos procedimentos de transplantes renais até a alta hospitalar, de acordo com a recuperação da função renal após o procedimento. Métodos: Análise retrospectiva dos 1º KTx de doadores falecidos, não sensibilizados, realizados entre Jan/2010 a Dez/2017. Resultados: Dos 1300 KTx de doadores falecidos realizados neste período, 730 pacientes foram estudados e divididos em 3 grupos: Função Renal Imediata (FRI) - diminuição na creatinina sérica ≥ 10% em dois dias consecutivos; Função Retardada do Enxerto (FRE) - diminuição na creatinina sérica <10% em dois dias consecutivos, sem necessidade de diálise, e Diálise (D) - necessidade de diálise durante a primeira semana. Pacientes no grupo D permaneceram mais tempo no hospital em comparação com FRE e FRI (21, 11 e 8 dias dias respectivamente, p < 0,001). Mais pacientes do grupo D (21%) foram admitidos na UTI e realizaram um maior número de testes laboratoriais (p < 0,001) e biópsias renais (p < 0,001), além de receberem uma quantidade maior de imunossupressores. Os custos hospitalares totais foram mais elevados nos grupos D e FRE em comparação com FRI (U$ 7.021,48; U$ 3.603,42 e U$ 2.642,37 respectivamente, p < 0,001). Conclusão: Os custos do procedimento de transplante são impactados pela recuperação da função renal após o transplante. O reembolso para cada um desses diferentes desfechos da função renal deve ser individualizado a fim de cobrir seus custos reais.

Humans , Kidney Transplantation , Tissue Donors , Retrospective Studies , Risk Factors , Renal Dialysis , Delayed Graft Function , Graft Survival , Kidney/physiology
J. bras. nefrol ; 43(3): 422-428, July-Sept. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1340127


Abstract The coronavirus (Sars-Cov-2) pandemic raised the need for social distance to reduce its spread. Chronic kidney disease patients on renal replacement therapy are especially susceptible to developing the most severe form of COVID-19, and, at the same time, require regular medical and multidisciplinary periodic follow-up. On an emergency basis, Brazil's professional regulatory bodies authorized telehealth assistance, which made possible to migrate from face-to-face to distance appointments in health services across the country, when necessary. This article's main objective is to describe the process of developing and implementing telehealth for monitoring renal transplant patients and patients on peritoneal dialysis during the COVID-19 pandemic.

Resumo A pandemia do coronavírus (Sars-CoV-2) trouxe a necessidade do isolamento social para a diminuição de sua propagação. Pacientes renais crônicos em terapia renal substitutiva são especialmente suscetíveis a desenvolverem a forma mais grave da covid-19, e, ao mesmo tempo, necessitam de acompanhamento médico e multidisciplinar regular com consultas periódicas. Em caráter emergencial, órgãos regulatórios profissionais brasileiros passaram a autorizar o atendimento da equipe de saúde por meio da teleconsulta, o que tornou possível a migração das consultas presenciais para consultas a distância nos serviços de saúde em todo o país, quando necessário. O principal objetivo deste artigo foi descrever o processo de desenvolvimento e implementação da teleorientação para acompanhamento de pacientes transplantados renais e em diálise peritoneal de um serviço de Joinville, SC, durante a pandemia de covid-19.

Humans , Kidney Transplantation , Peritoneal Dialysis , Telemedicine , COVID-19 , Pandemics , SARS-CoV-2
Aquichan ; 21(3): e2136, sept. 30, 2021.
Article in English, Portuguese | LILACS, BDENF, COLNAL | ID: biblio-1292401


Objectives: Mapping nursing care in kidney transplant patients. Materials and method: A scoping review was conducted according to the recommendations of the Joanna Briggs Institute Reviewers' Manual. Data were collected through 13 national and international databases from December 2020 to January 2021, following scientific rigor in the selection of the material. The pre-selection was made by reading the title, abstract and introductory text in advance; the materials included in this stage were read in full to define the content for the study. Results: Fifteen studies were included. Of these, 60% are articles; dissertations, manuals, protocols, guidelines and bulletins totaled 40% of the material studied. 86.6% of the material has a quantitative approach. Regarding the methodological design, 73.3% were descriptive/transversal character studies. Regarding the mapping of nursing care, it was possible to divide them into two categories: nursing care after kidney transplantation (immediate, mediated and late) and nursing care after kidney transplantation in primary health/extra-hospital care. Conclusions: It is concluded that the study allowed mapping nursing care to kidney transplant patients in the immediate, late and primary health care periods.

Objetivos: mapear los cuidados de enfermería en pacientes trasplantados renais. Materiales y método: scoping review conducida conforme las recomendaciones del Joanna Briggs Institute Reviewers' Manual. Se recolectaron los datos por medio de 13 bases de datos nacionales e internacionales de diciembre del 2020 a enero del 2021, siguiendo rigor científico en la selección del material. La preselección se dio mediante lectura previa de título, resumen y texto introductorio; los materiales incluidos en esta etapa se leyeron en la íntegra con el fin de definir el contenido para el estudio. Resultados: se incluyeron 15 estudios. De estos, el 60 % es artículo; tesis, manuales, protocolos, directrices y boletines suman 40 % del material estudiado. El 86,6 % del material presenta enfoque cuantitativo. En cuanto al diseño metodológico, el 73,3 % son estudios de tipo descriptivos/transversales. Con relación al mapeo de los cuidados de enfermería, se logró dividirlos en dos categorías: cuidados de enfermería post trasplante renal (inmediato, mediato y tardío) y cuidados de enfermería post trasplante renal en la atención primaria a la salud/extra hospitalaria. Conclusiones: se concluye que el estudio permitió mapear los cuidados de enfermería al paciente trasplantado renal en los posoperatorios inmediato, mediato, tardío y en la atención primaria a la salud.

Objetivos: mapear os cuidados de enfermagem em pacientes transplantados renais. Materiais e método: scoping review conduzida conforme as recomendações do Joanna Briggs Institute Reviewers' Manual. Os dados foram coletados por meio de 13 bases de dados nacionais e internacionais de dezembro de 2020 a janeiro de 2021, seguindo rigor científico na seleção do material. A pré-seleção se deu mediante a leitura prévia de título, resumo e texto introdutório; os materiais incluídos nessa etapa foram lidos na íntegra a fim de definir o conteúdo para o estudo. Resultados: foram incluídos 15 estudos. Destes, 60 % são artigos; dissertações, manuais, protocolos, diretrizes e boletins somaram 40 % do material estudado. 86,6 % do material apresenta abordagem quantitativa. Quanto ao desenho metodológico, 73,3 % eram estudos de tipo descritivos/transversais. Quanto ao mapeamento dos cuidados de enfermagem, pôde dividi-los em duas categorias: cuidados de enfermagem pós- transplante renal (imediato, mediato e tardio) e cuidados de enfermagem pós- transplante renal na atenção primária à saúde/extra-hospitalar. Conclusões: conclui-se que o estudo permitiu mapear os cuidados de enfermagem ao paciente transplantado renal nos pós-operatórios imediato, mediato, tardio e na atenção primária à saúde.

Postoperative Period , Review Literature as Topic , Kidney Transplantation , Nursing Care , Nursing
J. bras. nefrol ; 43(3): 301-302, July-Sept. 2021.
Article in English, Portuguese | LILACS | ID: biblio-1340122
Rev. ecuat. pediatr ; 22(2): 1-7, 31 de agosto del 2021.
Article in Spanish | LILACS | ID: biblio-1284504


Introducción: El trasplante renal en pediatría constituye el tratamiento de elección para la enfermedad renal crónica terminal (ERCT) con ventajas ampliamente comprobadas sobre los tratamientos dialíticos. El objetivo del presente estudio fue determinar los factores de riesgo relacionados con la sobrevida global y del injerto en un grupo de pacientes pediátricos con trasplante renal atendidos en un hospital de referencia nacional con observación de factores asociados al hiperparatiroidismo secundario. Métodos: En el presente estudio observacional, retrospectivo, se realizó en el Hospital Metropolitano de Quito - Ecuador desde el primero de enero del 2010 al treinta de junio del 2013. Se registró la mortalidad y la supervivencia del injerto, presencia de hiperparatiroidismo pre trasplante, variables demográficas, clínicas (compatibilidad). Se usa el método de Kaplan Meier para el análisis y se presentan riesgos relativos. Resultados: Ingresaron al estudio 33 pacientes, de edad 12±3.8 años. Donante cadavérico 21 casos (63.6%), donante vivo 12 pacientes 36.4%. 18 hombres (54.5%). La etiología de la ERCT fue indeterminada en 63.6%; nefropatías en 24.2% y uropatías en 12.1%. Rechazo agudo 1 paciente, rechazo tardío 10 pacientes. Las variables con significancia en la sobrevida del injerto fueron: hiperparatiroidismo RR= 6.0 (IC95%= 1.078-45.902) P=0.032. No recibir inmunosupresión completa RR=14.5 (IC95%= 3.807-55.225) P<0.001. La necesidad de diálisis pos trasplante la primera semana y biopsia temprana tuvieron RR=15 (IC95%= 3.9-57.2). Conclusiones: Este estudio demostró que el hiperparatiroidismo secundario es un factor de riesgo negativo para la sobrevida del injerto renal en pacientes pediátricos trasplantados

Introduction: Kidney transplantation in pediatrics is the treatment of choice for end-stage renal disease (ESRD) with widely proven advantages over dialysis treatments. The aim of the present study was to determine the risk factors related to global and graft survival in a group of pediatric kidney transplant patients treated at a national referral hospital with observation of factors associated with secondary hyperparathyroidism. Methods: In the present observational, retrospective study, it was carried out in the Hospital Metropolitano de Quito - Ecuador from January 1, 2010 to June 30, 2013. Mortality and graft survival, presence of hyperparathyroidism pre transplantation, demographic and clinical variables (compatibility). The Kaplan Meier method is used for analysis and relative risks are presented. Results: 33 patients, aged 12 ± 3.8 years, entered the study. Cadaveric donor 21 cases (63.6%), living donor 12 patients 36.4%. 18 men (54.5%). The etiology of ESRD was indeterminate in 63.6%; nephropathies in 24.2% and uropathies in 12.1%. Acute rejection 1 patient, late rejection 10 patients. Variables with significance in graft survival were: hyperparathyroidism RR = 6.0 (95% CI = 1.078-45.902) P = 0.032. Not receiving complete immunosuppression RR = 14.5 (95% CI = 3.807-55.225) P <0.001. The need for post-transplant dialysis the first week and early biopsy had RR = 15 (95% CI = 3.9-57.2). Conclusions: This study demonstrated that secondary hyperparathyroidism is a negative risk factor for kidney graft survival in pediatric transplant patients.

Humans , Child, Preschool , Child , Adolescent , Parathyroid Diseases , Prognosis , Kidney Transplantation , Child , Cause of Death , Critical Care
An. bras. dermatol ; 96(3): 346-348, May-June 2021. graf
Article in English | LILACS | ID: biblio-1285064


Abstract Paracoccidioidomycosis is an endemic systemic mycosis caused by Paracoccidioides brasiliensis complex and P. lutzii. It is a rare disease in non-HIV-induced immunosuppressed individuals. In organ transplant recipients, it is more frequently associated with immunosuppression after kidney transplantation. In a liver transplant patient, only one case has been published in the literature to date. The present report comprises the case of a 47-year-old female patient with disseminated skin lesions associated with signs and symptoms of systemic involvement of paracoccidioidomycosis that manifested one year after liver transplantation and under an immunosuppression regimen with tacrolimus and mycophenolate mofetil.

Humans , Female , Paracoccidioides , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/diagnostic imaging , Kidney Transplantation , Liver Transplantation/adverse effects , Transplant Recipients , Middle Aged