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1.
Clinics ; 75: e1983, 2020. tab, graf
Article in English | LILACS | ID: biblio-1133389

ABSTRACT

Coronavirus disease (COVID-19) rapidly progresses to severe acute respiratory syndrome. This review aimed at collating available data on COVID-19 infection in solid organ transplantation (SOT) patients. We performed a systematic review of SOT patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The MEDLINE and PubMed databases were electronically searched and updated until April 20, 2020. The MeSH terms used were "COVID-19" AND "Transplant." Thirty-nine COVID-19 cases were reported among SOT patients. The median interval for developing SARS-CoV-2 infection was 4 years since transplantation, and the fatality rate was 25.64% (10/39). Sixteen cases were described in liver transplant (LT) patients, and the median interval since transplantation was 5 years. The fatality rate among LT patients was 37.5% (6/16), with death occurring more than 3 years after LT. The youngest patient who died was 59 years old; there were no deaths among children. Twenty-three cases were described in kidney transplant (KT) patients. The median interval since transplantation was 4 years, and the fatality rate was 17.4% (4/23). The youngest patient who died was 71 years old. Among all transplant patients, COVID-19 had the highest fatality rate in patients older than 60 years : LT, 62.5% vs 12.5% (p=0.006); KT 44.44% vs 0 (p=0.039); and SOT, 52.94% vs 4.54% (p=0.001). This study presents a novel description of COVID-19 in abdominal SOT recipients. Furthermore, we alert medical professionals to the higher fatality risk in patients older than 60 years. (PROSPERO, registration number=CRD42020181299)


Subject(s)
Humans , Male , Female , Infant , Child , Adult , Middle Aged , Aged , Pneumonia, Viral/mortality , Kidney Transplantation/adverse effects , Liver Transplantation/adverse effects , Coronavirus Infections/mortality , Betacoronavirus , Kidney Transplantation/mortality , Liver Transplantation/mortality , Pandemics , SARS-CoV-2 , COVID-19
2.
Rev. bras. ter. intensiva ; 30(2): 181-186, abr.-jun. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-959323

ABSTRACT

RESUMO Objetivos: Avaliar a calibração e a discriminação do APACHE IV no período pós-operatório de transplante renal. Métodos: Estudo clínico de coorte, que incluiu 986 pacientes adultos hospitalizados durante o período pós-operatório imediato de transplante renal em um único centro na Região Sul do Brasil. Resultados: Os pacientes de transplante renal que evoluíram para óbito no hospital tiveram APACHE IV significantemente mais elevado e maior mortalidade predita. O APACHE IV demonstrou calibração adequada (teste de Hosmer-Lemeshow: 11,24; p = 0,188) e boa discriminação, segundo a curva Característica de Operação do Receptor, que foi de 0,738 (IC95% 0,643 - 0,833; p < 0,001), embora tenha superestimado a taxa de mortalidade padronizada, que foi de 0,73 (IC95%: 0,24 - 1,42; p = 0,664). Conclusões: O APACHE IV demonstrou desempenho adequado para predizer o desfecho no hospital no período pós-operatório de pacientes submetidos à transplante renal.


ABSTRACT Objectives: To evaluate the calibration and discrimination of APACHE IV in the postoperative period after kidney transplantation. Methods: This clinical cohort study included 986 hospitalized adult patients in the immediate postoperative period after kidney transplantation, in a single center in southern Brazil. Results: Kidney transplant patients who died in hospital had significantly higher APACHE IV values and higher predicted mortality. The APACHE IV score showed adequate calibration (H-L 11.24 p = 0.188) and a good discrimination ROC curve of 0.738 (95%CI 0.643 - 0.833, p < 0.001), although SMR overestimated mortality (SMR = 0.73; 95%CI: 0.24 - 1.42, p = 0.664). Conclusions: The APACHE IV score showed adequate performance for predicting hospital outcomes in the postoperative period for kidney transplant recipients.


Subject(s)
Humans , Male , Female , Adult , Aged , Kidney Transplantation/methods , Hospital Mortality , APACHE , Postoperative Period , Prognosis , Brazil , Calibration , Predictive Value of Tests , Prospective Studies , ROC Curve , Cohort Studies , Kidney Transplantation/mortality , Middle Aged
3.
J. bras. nefrol ; 40(2): 151-161, Apr.-June 2018. tab, graf
Article in English | LILACS | ID: biblio-954536

ABSTRACT

ABSTRACT Introduction: The risk of death after kidney transplant is associated with the age of the recipient, presence of comorbidities, socioeconomic status, local environmental characteristics and access to health care. Objective: To investigate the causes and risk factors associated with death during the first 5 years after kidney transplantation. Methods: This was a single-center, retrospective, matched case-control study. Results: Using a consecutive cohort of 1,873 kidney transplant recipients from January 1st 2007 to December 31st 2009, there were 162 deaths (case group), corresponding to 5-year patient survival of 91.4%. Of these deaths, 25% occurred during the first 3 months after transplant. The most prevalent cause of death was infectious (53%) followed by cardiovascular (24%). Risk factors associated with death were history of diabetes, dialysis type and time, unemployment, delayed graft function, number of visits to center, number of hospitalizations, and duration of hospital stay. After multivariate analysis, only time on dialysis, number of visits to center, and days in hospital were still associated with death. Patients who died had a non-significant higher number of treated acute rejection episodes (38% vs. 29%, p = 0.078), higher mean number of adverse events per patient (5.1 ± 3.8 vs. 3.8 ± 2.9, p = 0.194), and lower mean eGFR at 3 months (50.8 ± 25.1 vs. 56.7 ± 20.7, p = 0.137) and 48 months (45.9 ± 23.8 vs. 58.5 ± 20.2, p = 0.368). Conclusion: This analysis confirmed that in this population, infection is the leading cause of mortality over the first 5 years after kidney transplantation. Several demographic and socioeconomic risk factors were associated with death, most of which are not readily modifiable.


RESUMO Introdução: O risco de óbito após transplante renal está associado à idade do receptor, presença de comorbidades, condição socioeconômica, às características ambientais locais e ao acesso a serviços de atenção à saúde. Objetivo: Investigar as causas e fatores de risco associados ao óbito nos primeiros cinco anos após o transplante renal. Métodos: Este é um estudo unicêntrico retrospectivo com pareamento dos grupos caso e controle. Resultados: Em uma coorte consecutiva de 1.873 receptores de transplante renal atendidos de 1/1/2007 a 31/12/2009 foram registrados 162 óbitos (grupo caso), correspondendo a uma taxa de sobrevida após cinco anos de 91,4%. Dos óbitos registrados, 25% ocorreram nos primeiros três meses após o transplante. A causa de óbito mais prevalente foi infecção (53%), seguida de doença cardiovascular (24%). Os fatores de risco associados a mortalidade foram histórico de diabetes, tipo e tempo em diálise, desemprego, função tardia do enxerto, número de consultas, número de hospitalizações e tempo de internação hospitalar. Após análise multivariada, apenas o tempo em diálise, o número de consultas e dias de internação permaneceram associados a mortalidade. Os pacientes que foram a óbito tiveram um número não significativamente maior de tratamentos de episódios de rejeição aguda (38% vs. 29%; p = 0,078), maior número médio de eventos adversos por paciente (5,1 ± 3,8 vs. 3,8 ± 2,9; p = 0,194) e TFGe média mais baixa aos três meses (50,8 ± 25,1 vs. 56,7 ± 20,7; p = 0,137) e 48 meses (45,9 ± 23,8 vs. 58,5 ± 20,2; p = 0,368). Conclusão: A presente análise confirmou que nessa população, a infecção foi a principal causa de mortalidade nos primeiros cinco anos após transplante renal. Vários fatores de risco demográficos e socioeconômicos foram associados a mortalidade, a maioria não prontamente modificável.


Subject(s)
Humans , Male , Female , Middle Aged , Kidney Transplantation/mortality , Socioeconomic Factors , Time Factors , Case-Control Studies , Survival Rate , Retrospective Studies , Risk Assessment , Environment
5.
J. bras. nefrol ; 39(3): 287-295, July-Sept. 2017. tab, graf
Article in English | LILACS | ID: biblio-893768

ABSTRACT

Abstract Introduction: Kidney transplantation is considered a cost-effective treatment compared to dialysis but accounts for a significant percentage of the public health care resources. Therefore, efficient systems capable of performing high number of procedures are attractive and sustainable. Objective: The aim of this study was to evaluate clinical outcomes of 11,436 kidney transplants regularly performed in a single transplant dedicated center over the last 18 years. Methods: This was a retrospective study performed in a single specialized transplant center. All consecutive patients who underwent transplantation between 08/18/1998 and 12/31/2015 were included in the analysis. Results: The annual number of transplants increased from 394 in 1999 to 886 in 2015, with a progressive reduction in the proportion of living donor kidney transplants (70% vs. 23%) and yielding over 8869 patients in regular follow up. Of 11,707 kidney transplants performed, 5348 (45.7%) were from living, 3614 (30.9%) standard and 1618 (13.8%) expanded criteria deceased donors, 856 (7.3%) pediatric and 271 (2.3%) simultaneous kidney-pancreas transplants. Comparing 1998-2002 and 2011-2014, five-years graft survival increased for kidney transplants performed with living donors (83.3% vs. 93.1%, p < 0.001), standard deceased donors (60.7% vs. 79.7%, p < 0.001), expanded criteria donors (46.5% vs. 71.5%, p < 0.001) and for the pediatric population (79.8% vs. 80.9%, p = 0.684). Conclusion: The implementation of a dynamic and efficacious health care system was associated with a progressive increase in the number of kidney transplants, in the cumulative number of patients in follow up and a shift from living related to deceased donor kidney transplants, with associated progressive increase in patient and graft survivals.


Resumo Introdução: Transplante renal é considerado um tratamento custo-efetivo comparado à diálise e representa uma porcentagem significativa dos recursos de saúde pública. Dessa forma, sistemas eficientes e capazes de realizar um elevado número de procedimentos, são atraentes e sustentáveis. Objetivo: O objetivo deste estudo foi avaliar os desfechos clínicos de 11.436 transplantes renais realizados em um centro único de transplante nos últimos 18 anos. Métodos: Trata-se de um estudo retrospectivo realizado em centro único e especializado em transplante renal. Todos os pacientes transplantados entre 18/08/1998 e 31/12/2015 foram incluídos nesta análise. Resultados: O número anual de transplantes aumentou de 394 em 1999 para 886 em 2015, com redução progressiva na proporção de transplantes realizados com doador vivo resultando em mais de 8869 pacientes em seguimento regular. De 11.707 transplantes renais realizados, 5348 (45,7%) foram de doador vivo, 3614 (30,9%) doador falecido padrão e 1618 (13,8%) de critério expandido, 856 (7,3%) pediátricos e 271 (2.3%) transplantes simultâneo rim-pâncreas. Comparando 1998-2002 e 2011-2014, a sobrevida do enxerto em 5 anos aumentou para os transplantes renais realizados com doador vivo (83,3% vs. 93,1%, p < 0,001), doador falecido padrão (60,7% vs. 79,7%, p < 0,001), falecido de critério expandido (46,5% vs. 71,5%, p < 0,001) e para a população pediátrica (79,8% vs. 80,9%, p = 0,684). Conclusão: A implementação de um sistema de saúde eficaz e dinâmico associou-se ao aumento progressivo no número de transplantes renais, no número cumulativo de pacientes em acompanhamento e na inversão do número de transplantes realizados com doador vivo para falecido. Houve um aumento progressivo na sobrevida do enxerto e do paciente, reforçando que este modelo pode ser aplicado em outras áreas terapêuticas.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Kidney Transplantation/statistics & numerical data , Outcome Assessment, Health Care , Time Factors , Survival Rate , Retrospective Studies , Kidney Transplantation/mortality , Treatment Outcome , Hospitals, Special
6.
Med. infant ; 23(2): 79-85, junio 2016. tab
Article in Spanish | LILACS | ID: biblio-882100

ABSTRACT

Introducción: Si bien la sobrevida de paciente e injerto en niños con trasplante renal (TxR) ha mejorado, algunos sugieren que la edad al TxR es predictora de malos resultados, y los mayores tendrían peor evolución. Objetivo: Definir sobrevida de paciente e injerto según edad al TxR, y factores pronósticos de fracaso en aquellos con peor evolución. Material y métodos: Cohorte retrospectivo de todos los pacientes con TxR en el Hospital Garrahan desde el 01-01-2002 hasta el 01-03-2016. Resultados: de 431 pacientes, 44, (10%) tenían < 6a, 179 (42%)> 6 y <12 y 208 (48%) ≥12 años. La sobrevida del paciente a 8 años fue 97%, 99% y 95% (p=0,2), y la del injerto de: 86%, 69% y 30% respectivamente (p=<0,001). En los ≥ de 12 años, con peor evolución, se incluyeron al análisis univariado como factores de riesgo de pérdida de injerto: GSFS como causa de IRC : HR: 9,4; (p<0,001), Rechazo Agudo (RA) temprano: HR: 8,1; (p<0,001), RA tardío: HR: 4,3; (p<0.001), DGF: HR: 4,1; (p<0,001), No adherencia: HR: 2,3; (p=0,02), Edad de DC > 35a: HR: 1,95 (p=0,1), Tiempo en diálisis: HR: 1,1 (p=0,1), Número de incompatibilidades HLAB y HLADR: HR: 0,8 (p=0,3), Tiempo de Isquemia : 0,9 (p=0,5), Sexo del receptor: HR:0,8 (p=0,6), Donante Cadavérico: HR: 1,2; (p=0,6), 2do TxR : HR: 1,2; (p=0,7). En análisis multivariado: RA tardío: HR: 12,9 (p<0,001), GSFS como causa de IRC: HR: 12,5 (p<0,001), RA temprano: HR: 9 (p<0,001), y DGF: HR: 4,9 (p<0,001). Conclusión: la sobrevida del injerto en adolescentes es inferior. Merecen atención, la prevención de la no adherencia asociada a rechazo, el paciente con GSFS y el retardo de la función pos TxR (AU)


Introduction: Although patient and graft survival of children with a kidney transplantation (KTx) has improved, it has been suggested that older age at KTx is a predictive factor of poor outcome. Aim: To evaluate patient and graft survival according to age at KTx and define predictive factors in those with a poor outcome. Material and methods: A retrospective cohort study was conducted in all patients who underwent KTx at Garrahan Hopital between 01-01-2002 and 01-03-2016. Results: Of 431 patients, 44 (10%) were <6yr, 179 (42%) >6yr, and <12yr, and 208 (48%) ≥12yr. Eight-year patient survival was 97%, 99%, and 95% (p=0.2) and graft survival was 86%, 69%, and 30% (p=<0.001), respectively. In children ≥12 yr, with a worse outcome, the following risk factors of graft loss were included in univariate analysis: FSGS-related CFR: HR: 9.4; (p<0.001), early acute rejection (AR): HR: 8.1; (p<0.001), late AR: HR: 4.3; (p<0.001), DGF: HR: 4.1; (p<0.001), non-adherence: HR: 2.3; (p=0.02), age of deceased donor >35yr: HR: 1.95 (p=0.1), time on dialysis: HR: 1.1 (p=0.1), number of HLA-B and HLA-DR mismatches: HR: 0.8 (p=0.3), cold ischemia time: 0.9 (p=0.5), recipient sex: HR:0.8 (p=0.6), deceased donor: HR: 1.2; (p=0.6), second KTx: HR: 1.2; (p=0.7; and in multivariate analysis: late AR: HR: 12.9 (p<0.001), FSGS-related CFR: HR: 12.5 (p<0.001), early AR: HR: 9 (p<0.001), and DGF: HR: 4.9 (p<0.001). Conclusion: Graft survival is lower in adolescents. Prevention of rejection associated with non-adherence, FSGS, and post-KTx DGF should be taken into account (AU)


Subject(s)
Humans , Child, Preschool , Child , Adolescent , Age Factors , Glomerulosclerosis, Focal Segmental , Graft Rejection , Kidney Transplantation/mortality , Postoperative Complications , Treatment Adherence and Compliance , Treatment Outcome , Adolescent , Cohort Studies , Retrospective Studies
7.
Med. infant ; 23(2): 108-116, junio 2016. tab
Article in Spanish | LILACS | ID: biblio-882252

ABSTRACT

En adultos y niños con trasplante renal (TxR) la sobrevida de paciente e injerto ha mejorado. En Argentina no existen datos de sobrevida en niños con TxR en diferentes décadas. El objeto de este trabajo fue valorar en niños con TxR sobrevida de paciente e injerto y analizar causas de muerte, perdida de injerto y factores de riesgo de pérdida. Dado que desde el año 2001 se unificaron prácticas de diagnóstico y tratamiento, se compararon dos periodos: 1988-2000 y 2001-2015. Se incluyeron 773 niños. A 1, 3, 5, 7 y 10 años, En TxR de DV (n=327), la sobrevida del paciente fue de 99%, 99%, 98%, 95%, 95% vs 100% y 96%, 96%, 96% y 96% (p=0.74); la del injerto de 97%, 91%, 85%, 78% y 67% vs 95%, 88%, 85%, 81% y 76% (p=0.81). En TxR de DC (n=446) la sobrevida de paciente fue de 97%, 93%, 90%, 89% y 87% en el 1er. periodo vs. 100%, 99% y 98% 98% y 98% en el 2do (p<0.001); la del injerto de 83%, 75%, 68%, 64% y 52% vs. 95%, 87%, 83%, 76% y 61% respectivamente (p<0. 001). El Rechazo Crónico fue la 1er causa de perdida (61% vs 62%); la 2da la muerte del paciente con injerto funcionante. La sepsis bacteriana fue la 1era causa de muerte (56% vs 67%). Ningún niño falleció por neoplasia entre el 2001 y 2015. En DV, fueron predictores de perdida de injerto: DGF (HR: 4.8; p<0.001), edad al TxR > 12 años (HR: 2.7; p=0.002) y RA tardío (HR: 2.1; p=0.009). En DC la necesidad de diálisis en la 1er semana post TxR (DGF): (HR: 4.4; p<0.001), el rechazo agudo (RA) tardío (HR: 3.7; p<0.001), GSFS como causa de IRC (HR: 2.5; p=0.01), y RA temprano (HR: 2.2; p=0.02). Conclusión: En el 2do periodo la sobrevida de paciente e injerto los TxR con DC mejoro, y en los TxR con DV no tuvo cambios. El rechazo crónico continúa siendo la 1era causa de perdida. Ningún paciente tuvo neoplasia (AU)


Patient and graft survival in kidney transplantation (KTx) has improved. In Argentina there are no data comparing transplant outcomes in children over different eras. The aim of this study was to evaluate patient and graft survival in children with KTx and to analyze cause of death, graft loss, and risk factors of graft loss. As diagnostic and treatment practices were unified in 2001, two periods were compared: 1988-2000 and 2001-2015. Overall, 773 children were included. Survival at 1, 3, 5, 7, and 10 years after a living-related donor (LRD) KTx was 99%, 99%, 98%, 95%, 95% vs 100% y 96%, 96%, 96% and 96% (p=0.74); graft survival was 97%, 91%, 85%, 78% y 67% vs 95%, 88%, 85%, 81%, and 76% (p=0.81). Patient survival after deceased donor (DD) KTx (n=446) was 97%, 93%, 90%, 89%, and 87% in the 1st period vs. 100%, 99% y 98% 98%, and 98% in the 2nd (p<0.001); graft survival was 83%, 75%, 68%, 64%, and 52% vs. 95%, 87%, 83%, 76%, and 61%, respectively (p<0. 001). Chronic rejection was the first cause of graft loss (61% vs 62%); the second was death of the patient with a functioning graft. Bacterial sepsis was the first cause of death (56% vs 67%). None of the patients died because of malignancies between 2001 and 2015. Among LRD transplants predicting factors of graft loss were: DGF (HR: 4.8; p<0.001), age at KTx >12 years (HR: 2.7; p=0.002), and late acute rejection (AR) (HR: 2.1; p=0.009). Among DD need for dialysis in the first week post-KTx (DGF): (HR: 4.4; p<0.001), late AR (HR: 3.7; p<0.001), FSGS-related CFR (HR: 2.5; p=0.01), and early AR (HR: 2.2; p=0.02). Conclusion: In the second period patient and graft survival after DD improved, while that of KTx with LRD remained unchanged. Chronic rejection continues being the first cause of graft loss. None of the patients developed malignancies.


Subject(s)
Humans , Infant , Child, Preschool , Child , Cause of Death , Graft Rejection/diagnosis , Graft Rejection/therapy , Graft Survival , Kidney Transplantation/adverse effects , Kidney Transplantation/mortality , Retrospective Studies
8.
Rev. méd. Chile ; 143(8): 961-970, ago. 2015. graf, tab
Article in Spanish | LILACS | ID: lil-762660

ABSTRACT

Background: After receiving a kidney allograft, patients tend to gain weight acquiring the risk associated with overweight and obesity. Aim: To compare the evolution during 10 years after transplantation of patients who gained more than 15% of their initial weight during the first year after receiving the graft with those who did not experience this increase. Material and Methods: Cohort study of 182 patients transplanted in a single hospital between 1981 and 2003. Demographic data, weight gain during the first year, drugs used, complications and evolution of patients and grafts were recorded. Results: Seventy two patients gained more than 15% of their weight during the first year. These were discharged after receiving the graft with a lower serum creatinine than their counterparts (1.46 ± 0.71 and 1.97 ± 1.74 mg/dl respectively, p = 0.02). Ten years mortality with a functioning kidney was higher among weight gainers (25 and 12.7% respectively, p = 0.03). No other differences were observed between groups. Conclusions: Patients who gained more than 15% of their initial weight during the first year after receiving a kidney graft have a higher 10 years mortality with a functioning kidney.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Graft Survival , Kidney Transplantation/mortality , Weight Gain , Cohort Studies , Creatinine/blood , Follow-Up Studies , Kidney Transplantation/adverse effects , Patient Readmission/statistics & numerical data , Survival Analysis , Time Factors
9.
Einstein (Säo Paulo) ; 13(2): 319-325, Apr-Jun/2015. graf
Article in English | LILACS | ID: lil-751435

ABSTRACT

ABSTRACT Given the shortage of organs transplantation, some strategies have been adopted by the transplant community to increase the supply of organs. One strategy is the use of expanded criteria for donors, that is, donors aged >60 years or 50 and 59 years, and meeting two or more of the following criteria: history of hypertension, terminal serum creatinine >1.5mg/dL, and stroke as the donor´s cause of death. In this review, emphasis was placed on the use of donors with acute renal failure, a condition considered by many as a contraindication for organ acceptance and therefore one of the main causes for kidney discard. Since these are well-selected donors and with no chronic diseases, such as hypertension, renal disease, or diabetes, many studies showed that the use of donors with acute renal failure should be encouraged, because, in general, acute renal dysfunction is reversible. Although most studies demonstrated these grafts have more delayed function, the results of graft and patient survival after transplant are very similar to those with the use of standard donors. Clinical and morphological findings of donors, the use of machine perfusion, and analysis of its parameters, especially intrarenal resistance, are important tools to support decision-making when considering the supply of organs with renal dysfunction.


RESUMO Diante da escassez de órgãos para transplante, algumas estratégias têm sido adotadas pela comunidade transplantadora, no sentido de ampliar a oferta de órgãos. Uma delas é a utilização de rins de doadores com critérios expandidos, ou seja, doadores com idade >60 anos ou entre 50 e 59 anos, e que atendem a dois ou mais dos seguintes critérios: história de hipertensão, creatinina sérica terminal >1,5mg/dL e acidente vascular cerebral como causa de morte do doador. Nesta revisão, foi dada ênfase à utilização de doadores com disfunção renal aguda, condição considerada por muitos uma contraindicação para a aceitação de órgãos e, portanto, uma das principais causas de descarte de órgãos. Desde que sejam doadores bem selecionados e que não tenham doença renal crônica, como hipertensão ou diabetes, muitos trabalhos mostraram que o uso de doadores com disfunção renal aguda deve ser encorajado, pois, em geral, a disfunção renal aguda é de caráter reversível. Embora, a maioria dos estudos tenha demonstrado que há uma maior taxa de função retardada do enxerto com a utilização desses órgãos, os resultados de sobrevida do enxerto e do paciente após o transplante são muito semelhantes aos resultados obtidos da utilização de doadores padrão. Os achados clínicos e morfológicos do doador, a utilização da máquina de perfusão e a análise de seus parâmetros, principalmente a resistência intrarrenal, são importantes ferramentas de apoio para tomada de decisão no momento da oferta de órgãos com disfunção renal.


Subject(s)
Aged , Humans , Middle Aged , Acute Kidney Injury/surgery , Graft Survival , Kidney Failure, Chronic/mortality , Kidney Transplantation/methods , Patient Selection , Tissue Donors/supply & distribution , Age Factors , Creatinine/blood , Delayed Graft Function/mortality , Donor Selection/organization & administration , Graft Survival/physiology , Kidney Failure, Chronic/surgery , Kidney Transplantation/mortality , Length of Stay/statistics & numerical data , Survival Rate
10.
Acta cir. bras ; 29(11): 748-751, 11/2014. tab, graf
Article in English | LILACS | ID: lil-728646

ABSTRACT

PURPOSE: To perform a cost analysis of simultaneous pancreas-kidney transplantation (SPKT) in a Brazilian hospital. METHODS: Between January 2008 and December 2011, 105 consecutive SPKTs at the Hospital of Kidney and Hypertension in Sao Paulo were evaluated. We evaluated the patient demographics, payment source (public health system or supplementary system), and the impact of each hospital cost component. The evaluated costs were corrected to December 2011 values and converted to US dollars. RESULTS: Of the 105 SPKT patients, 61.9% were men, and 38.1% were women. Eight patients died, and 97 were discharged (92.4%). Eighty-nine procedures were funded by the public health system. The cost for the patients who were discharged was $18.352.27; the cost for the deceased patients was $18.449.96 (p = 0.79). The FOR for SPKT during this period was positive at $5,620.65. The costs were distributed as follows: supplies, 36%; administrative costs, 20%; physician fees, 15%; intensive care unit, 10%; surgical center, 10%; ward, 9%. CONCLUSION: Mortality did not affect costs, and supplies were the largest cost component. .


Subject(s)
Female , Humans , Male , Costs and Cost Analysis , Kidney Transplantation/economics , Pancreas Transplantation/economics , Brazil , Hospitalization/economics , Intensive Care Units/economics , Kidney Transplantation/mortality , Pancreas Transplantation/mortality , Statistics, Nonparametric , Time Factors
11.
Medicina (B.Aires) ; 74(1): 1-8, ene.-feb. 2014. graf, tab
Article in Spanish | LILACS | ID: lil-708547

ABSTRACT

El trasplante renal (TR) presenta mejor supervivencia, calidad de vida y costos que la diálisis en la insuficiencia renal crónica (IRC). Estudiamos pacientes en diálisis que recibieron TR durante 2010, las causas de finalización del tratamiento y la supervivencia en diálisis. Evaluamos si criterios más amplios para la aceptación de trasplantes hubieran afectado los resultados del procedimiento en ese período. Incluimos 118 pacientes en diálisis, edad media 56.9 ± 18.4 años, tiempo en diálisis 45.5 ± 59.6 meses, 35 (30%) presentaban diabetes como causa de IRC, y 58 (49%) estaban en espera del TR. Treinta y cuatro finalizaron diálisis, 18 por TR y 12 por fallecimiento. Las principales causas de muerte fueron cardiovasculares, 6 (50%) e infecciones, 2 (17%). La supervivencia al año fue 85% para el grupo total, 98% para los pacientes inscriptos en lista de espera y 72% para no inscriptos. Durante 2010 se realizaron 88 TR (62 con donantes cadavéricos [DC], 18 donantes vivos y 8 dobles trasplantes páncreas-riñón). Los receptores de DC tenían en promedio 50.7 años, 67 meses en diálisis, 8 (13%) eran diabéticos, 12 (20%) con TR previos y 3 cross match contra panel de anticuerpos > 20%. Los donantes tenían edad media 45 años, 28 (45%) con criterios expandidos y 27.7 h de isquemia fría. A los 11.4 meses de seguimiento, 13 (21%) presentó rechazo agudo, la supervivencia para injerto fue de 88% y 93% para pacientes. La principal causa de finalización de diálisis fue TR, sin detectarse que el empleo de DC afectara la supervivencia del TR.


For patients with chronic renal failure (CRF), kidney transplant (KT) is a better alternative to dialysis in terms of survival, life quality and costs. We studied the general characteristics, causes and survival rate of the dialysis population in 2010. We evaluated broader criteria for acceptance of transplants has affected the results of the procedure in that period. A total of 118 dialysis patients were included; mean age 56.9 ± 18.4 years, dialysis duration 45.5 ± 59.6 months, main cause of CRF was diabetes in 35 (30%), and 58 (49%) were included in waiting list for KT. Of the 34 patients who finished dialysis in 2010, 18 (53%) were KT, while 12 (35%) died (cardiovascular 50%, infectious 17%). Survival at 12 months was 85% for the total group, 98% on waiting list and 72% those who were not enrolled. During 2010 there were 88 KT, 62 with cadaveric donors (CD), 18 with living donors and 8 with double pancreas-kidney transplants. Recipients of CD were 50.7 years old, with 67 months on dialysis, 8 (13%) diabetics, and 12 (20%) with previous KT. Donors had a mean age of 45 years, 28 (45%) expanded criteria, and 27.7 hours of cold ischemia time. During an approximate follow-up of 11.4 months, 13 (21%) suffered acute graft rejection, survival was 88% for graft and 93% for patients. We emphasize KT as the main cause of success as regards dialysis. No differences in risk factors were found to significantly affect graft or patient survival.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Kidney Transplantation/mortality , Renal Dialysis/mortality , Survival Rate , Argentina/epidemiology , Cadaver , Chronic Disease , Follow-Up Studies , Graft Rejection , Hemodialysis Units, Hospital/statistics & numerical data , Incidence , Kidney Transplantation/statistics & numerical data , Prevalence , Peritoneal Dialysis/mortality , Renal Dialysis/statistics & numerical data , Tissue Donors , Waiting Lists
12.
Clinics ; 69(supl.1): 22-27, 1/2014. graf
Article in English | LILACS | ID: lil-699023

ABSTRACT

The Japanese ABO-Incompatible Transplantation Committee officially collected and analyzed data on pediatric ABO-incompatible living-donor kidney transplantation in July 2012. The age of a child was defined as <16 years, and 89 children who had undergone ABO-incompatible living-donor kidney transplantation from 1989 to 2011 were entered in a registry. These data were presented as the Japanese registry of pediatric ABO-incompatible living-donor kidney transplantation at the regional meetings of the International Pediatric Transplantation Association (IPTA) in Nagoya in September 2012 and in Sao Paulo in November 2012.


Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , ABO Blood-Group System/blood , Blood Group Incompatibility/blood , Kidney Transplantation/mortality , Living Donors/statistics & numerical data , Blood Group Incompatibility/complications , Blood Group Incompatibility/mortality , Graft Rejection , Graft Survival , Japan/epidemiology , Kidney Transplantation/adverse effects , Kidney Transplantation/statistics & numerical data , Plasmapheresis , Retrospective Studies , Survival Rate
13.
Article in English | IMSEAR | ID: sea-159979

ABSTRACT

Summary: Extrapulmonary tuberculosis (TB) is more common than pulmonary TB in immuno-suppressed renal transplant recipients. Atypical presentation of TB and disseminated TB is known in transplant recipients. Usually intestinal TB presents with pain abdomen, intermittent subacute intestinal obstruction, diarrhoea and/or constitutional symptoms like fever and weight loss. Here we report a case of renal allograft recipient on regular hospital follow up, presented with acute abdomen with no previous symptoms of fever, weight loss or abdominal symptoms and was diagnosed to have tubercular ileal perforation on exploratory laporatomy and confirmed by histopathological examination. This patient succumbed to the illness due to sepsis despite timely surgery, broad spectrum antibiotics and antitubercular therapy.


Subject(s)
Adult , Fatal Outcome , Humans , Intestinal Perforation/etiology , Intestinal Perforation/mortality , Intestinal Perforation/surgery , Kidney Transplantation/adverse effects , Kidney Transplantation/mortality , Male , Sepsis/mortality , Tuberculosis/complications , Tuberculosis/epidemiology , Tuberculosis/mortality , Tuberculosis/surgery
14.
Medicina (B.Aires) ; 73(2): 136-140, abr. 2013. graf, tab
Article in Spanish | LILACS | ID: lil-694752

ABSTRACT

Un porcentaje considerable de pacientes presentan anemia post trasplante renal. Su origen es multifactorial y sus principales etiologías dependen de la etapa post trasplante que se considere. Estudiamos en un grupo de 134 pacientes los factores asociados con anemia tardía (6 meses post trasplante) y sus implicaciones clínicas a mediano plazo. En el análisis de regresión múltiple, la duración de la oliguria post trasplante y el número de episodios de rechazo fueron las variables significativamente asociadas con esta complicación. La supervivencia del órgano mostró una diferencia significativa a los 36 meses entre los grupos (83% en los anémicos versus 96% de los no anémicos p < 0.01). No observamos diferencias en mortalidad o eventos cardiovasculares. Concluimos que la presencia de anemia al sexto mes post trasplante renal está independiente y significativamente asociada con factores que condicionan la masa renal funcionante que explicarían además la menor supervivencia del injerto renal observada en estos pacientes.


A considerable percentage of patients exhibit anemia post kidney transplant. Its origin is multifactorial and the main causes involved depend on the post transplant period considered. We studied in a group of 134 consecutive patients the associated factors and the clinical implications of "late anemia" (6 months post transplant). Multiple regression analysis showed that post transplant oliguria and acute rejection episodes were significantly associated with anemia. Graft survival at 36 months was significantly reduced in the anemic group (83 % versus 96%, p < 0.01). No differences in patients survival or rate of cardiovascular events were observed. We concluded that anemia at 6 months post transplant is independently and significantly associated with events that reduced functioning renal mass and kidney survival.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Anemia/etiology , Delayed Graft Function/etiology , Kidney Transplantation/adverse effects , Anemia/mortality , Argentina/epidemiology , Graft Survival , Kidney Transplantation/mortality , Oliguria/etiology , Regression Analysis , Retrospective Studies , Survival Rate , Time Factors
15.
Clinics ; 68(2): 153-158, 2013. ilus, tab
Article in English | LILACS | ID: lil-668800

ABSTRACT

OBJECTIVES: This study compared the accuracy of the Simplified Acute Physiology Score 3 with that of Acute Physiology and Chronic Health Evaluation II at predicting hospital mortality in patients from a transplant intensive care unit. METHOD: A total of 501 patients were enrolled in the study (152 liver transplants, 271 kidney transplants, 54 lung transplants, 24 kidney-pancreas transplants) between May 2006 and January 2007. The Simplified Acute Physiology Score 3 was calculated using the global equation (customized for South America) and the Acute Physiology and Chronic Health Evaluation II score; the scores were calculated within 24 hours of admission. A receiver-operating characteristic curve was generated, and the area under the receiver-operating characteristic curve was calculated to identify the patients at the greatest risk of death according to Simplified Acute Physiology Score 3 and Acute Physiology and Chronic Health Evaluation II scores. The Hosmer-Lemeshow goodness-of-fit test was used for statistically significant results and indicated a difference in performance over deciles. The standardized mortality ratio was used to estimate the overall model performance. RESULTS: The ability of both scores to predict hospital mortality was poor in the liver and renal transplant groups and average in the lung transplant group (area under the receiver-operating characteristic curve = 0.696 for Simplified Acute Physiology Score 3 and 0.670 for Acute Physiology and Chronic Health Evaluation II). The calibration of both scores was poor, even after customizing the Simplified Acute Physiology Score 3 score for South America. CONCLUSIONS: The low predictive accuracy of the Simplified Acute Physiology Score 3 and Acute Physiology and Chronic Health Evaluation II scores does not warrant the use of these scores in critically ill transplant patients.


Subject(s)
Humans , Health Status Indicators , Hospital Mortality , Kidney Transplantation/mortality , Liver Transplantation/mortality , Lung Transplantation/mortality , Pancreas Transplantation/mortality , APACHE , Brazil , Critical Illness/mortality , Intensive Care Units , Prognosis , Risk Assessment , ROC Curve , Severity of Illness Index
16.
J. bras. nefrol ; 34(3): 216-225, jul.-set. 2012. ilus, tab
Article in Portuguese | LILACS | ID: lil-653538

ABSTRACT

INTRODUÇÃO: O transplante renal (TR) é considerado como a melhor terapia para a Doença Renal Crônica (DRC). Fatores associados à sobrevida dos receptores de TR devem ser avaliados tendo em vista a implementação de condutas adequadas no manejo desses pacientes. OBJETIVOS: Analisar a sobrevida de receptores de TR e fatores associados à sua mortalidade. MÉTODOS: Estudo observacional de coorte, retrospectivo, com todos os 215 pacientes submetidos a TR no Hospital Universitário da Universidade Federal do Maranhão-HUUFMA, entre 18 de março de 2000 e 18 de setembro de 2008, com seguimento mínimo de 12 e máximo de 101 meses. Características demográficas e clínicas dos pacientes foram observadas. Utilizou-se o método Kaplan-Meier para construção das curvas de sobrevida do paciente, sendo as mesmas comparadas pelo teste log-rank. O modelo de riscos proporcionais de Cox identificou fatores associados à mortalidade. RESULTADOS: A prevalência de óbito no período foi de 10,6%. A sobrevida de 1, 3 e 5 anos com doadores vivos foi de 97,8%, 94,1% e 92,9%, respectivamente, e com doadores falecidos, 95,6% e 95,6% para 1 e 3 anos, respectivamente. Foram fatores associados à menor sobrevida do paciente: idade > 40 anos (RR = 6,19; p = 0,001; IC 95% = 2,01-18,99) e intercorrência cirúrgica (RR = 4,98; p = 0,041; IC 95% = 1,07-23,27). CONCLUSÕES: As taxas de sobrevida do receptor de TR no HUUFMA foram semelhantes àquelas encontradas em outros trabalhos, nacionais e internacionais. Idade do receptor acima de 40 anos e intercorrências cirúrgicas foram significantemente associados à mortalidade do paciente neste estudo.


INTRODUCTION: Renal transplantation is regarded as the best treatment for patients with Chronic Kidney Disease. Factors associated to survival of renal transplant recipients must be evaluated in order to implement appropriate conducts in these patients. AIMS: To analyze the renal transplant patients survival and associated factors to their mortality. METHODS: Observational, retrospective cohort study, including all the 215 patients who underwent kidney transplantation in the Renal Transplant Service of the Hospital Universitário da Universidade Federal do Maranhão (HUUFMA), from March 18, 2000 to September 18, 2008, with a follow-up ranging from 12 to 101 months. Demographic and clinical characteristics were observed. The Kaplan-Meier method was used for construction of survival curves, and they were compared by log-rank test. The Cox proportional hazards model was used for identification of factors associated to mortality. RESULTS: The prevalence of deaths was 10,6%. The survival rates at 1, 3 and 5 years for living donors recipients were 97,8%, 94,1% and 92,9%, respectively and for deceased donors recipients, 95,6% and 95,6%, at 1 and 3 years, respectively. Factors statistically associated to a lower survival were: recipient age above 40 years (RR = 6.19; p = 0.001; 95% CI = 2.01-18.99) and surgery complications (RR = 4.98; p = 0.041; 95% CI = 1.07-23.27). CONCLUSIONS: Kidney recipients survival rates at HUUFMA were similar to the rates related in other, Brazilian and international studies. Recipient age above 40 years and surgery complications were significantly associated to mortality in this study.


Subject(s)
Adult , Female , Humans , Male , Kidney Transplantation/mortality , Brazil , Cohort Studies , Hospitals, University , Retrospective Studies , Risk Factors , Survival Analysis , Survival Rate
17.
Rev. méd. Chile ; 140(8): 990-998, ago. 2012. ilus
Article in Spanish | LILACS | ID: lil-660050

ABSTRACT

Background: Patients with autosomal dominant polycystic kidney disease (ADPKD) have a better survival in chronic dialysis than patients with other etiologies of renal failure. It has been suggested that extra-renal manifestations of ADPKD may increase the odds of complications and mortality, if these patients are transplanted. Aim: To determine whether survival and complications in transplanted patients with ADPKD are different from kidney graft recipients with other etiologies of renal failure. Subjects and Methods: Four hundred six patients with kidney transplantation were followed in three hospitals between 1976 and 2011 and 19 were carriers of ADPKD. The latter were matched by type of donor, gender, age and date of kidney transplant, with 38 graft recipients with other etiologies of renal failure. Results: Graft and patient 1, 5, 10 and 15 years survival were similar in both groups. Hospitalizations due to viral infections and sepsis were more common in patients with ADPKD. There were no differences in the rate of acute rejection, delayed graft function, cancer, gastrointestinal disorders and hospitalizations due to cardiovascular diseases. The frequency of graft loss due to death with a functioning kidney was similar between both groups. Conclusions: Patient and graft survival in transplanted patients with ADPKD were similar to patients with other etiologies of renal failure. The rate and type of complications were similar between groups with the exception of hospitalizations due to sepsis and viral infections, which were more common in ADPKD patients.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Kidney Transplantation/mortality , Polycystic Kidney, Autosomal Dominant/mortality , Graft Survival , Hospitalization , Immunosuppression/methods , Immunosuppressive Agents/administration & dosage , Kidney Transplantation/adverse effects , Postoperative Complications , Prevalence , Polycystic Kidney, Autosomal Dominant/surgery , Survival Rate , Treatment Outcome
18.
West Indian med. j ; 61(4): 422-428, July 2012. graf, tab
Article in English | LILACS | ID: lil-672929

ABSTRACT

OBJECTIVE: To assess patient and graft survival outcomes of renal transplant recipients from the National Organ Transplant Unit, Trinidad and Tobago. DESIGN AND METHODS: A retrospective descriptive analysis of renal transplants performed within five and half years (January 2006 - June 2011) at the National Organ Transplant Unit was conducted. The age, gender, ethnicity, cause of renal failure, donor type, outcome and complications were examined. The one, two and three-year patient and graft survival rates were analysed and factors affecting them were discussed. RESULTS: A total of 73 renal transplantations were done. Seventy (95.9%) were from live donors and 3 (4.1%) from deceased donors. Thirty-eight patients (52.1%) were males and 35 (47.9%) were females. The one-year, two-year and three-year patient survival rates were 91.46% (SE 0.04), 89.51 % (SE 0.04) and 86.31% (SE 0.05), respectively. The one-year graft survival rate was 94.34% (SE 0.03). The two-year and three-year graft survival rates were the same at 92.69% (SE 0.03). The most significant complications seen in the recipients were those related to infections and cardiovascular disease: 47.9% of patients had a urinary tract infection, with the majority occurring at twelve months and 32.5% developed dyslipidaemia for the first time at six months. Seven patients developed erythrocytosis. CONCLUSION: The patient and graft survival rates in this new transplant programme are acceptable. Complications which can occur in transplant recipients are common and have a significant impact on post-transplantation quality of life and survival. Thus, continuing assessment of comorbid factors pre and post-transplantation as well as the analysis of donor and recipient factors will lead to an increase in both patient and graft survival.


OBJETIVO: Evaluar los resultados de supervivencia de pacientes y transplantes en relación con recipientes de transplante renal en la Unidad Nacional de Trasplante de Órganos de Trinidad y Tobago. DISEÑO Y MÉTODOS: Se realizó un análisis descriptivo retrospectivo de trasplantes renales de cinco años y medio (enero de 2006 - junio de 2011) en la Unidad Nacional de Trasplantes de Órganos. Se examinó la edad, el género, la etnicidad, la causa de la insuficiencia renal, el tipo de donante, la evolución clínica del paciente, y las complicaciones. Se analizaron las tasas de supervivencia de pacientes y transplantes, de uno, dos y tres años, y se discutieron los factores que las afectan. RESULTADOS: Se realizaron un total de 73 trasplantes renales. Setenta (95.9%) fueron de donantes vivos, y tres (4.1%) de donantes muertos. Treinta y ocho pacientes (52.1%) eran varones y 35 (47.9%) eran hembras. Las tasas de supervivencias de uno, dos y tres años relativas a los pacientes, fueron 91.46% (SE 0.04), 89.51% (SE 0.04) y 86.31% (SE 0.05), respectivamente. La tasa de supervivencia de transplante de un año fue 94.34% (SE 0.03). Las tasas de supervivencia de transplante de dos y tres años fueron iguales, alcanzando un 92.69% (SE 0.03). Las complicaciones más significativas observadas en los recipientes fueron las relacionados con infecciones y la enfermedad cardiovascular: 47.9% de los pacientes tenían infección de las vías urinarias, teniendo lugar la mayoría de ellas a los doce meses, en tanto que el 32.5% desarrolló dislipidemia por primera vez a los seis meses. Siete pacientes desarrollaron eritrocitosis. CONCLUSIÓN: Las tasas de supervivencia de pacientes y transplantes en este nuevo programa de trasplante son aceptables. Las complicaciones que pueden ocurrir en los recipientes son comunes y tienen un impacto significativo en la calidad de vida postransplante. Por lo tanto, continua evaluación de los factores comórbidos pre- y postransplante, así como el análisis de donantes y recipientes conducirá a un aumento de la supervivencia, tanto de los pacientes como de los transplantes.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Kidney Transplantation/mortality , Cardiovascular Diseases/epidemiology , Dyslipidemias/epidemiology , Graft Survival , Retrospective Studies , Survival Analysis , Trinidad and Tobago
19.
Rev. méd. Chile ; 140(3): 295-304, mar. 2012. ilus, tab
Article in Spanish | LILACS | ID: lil-627641

ABSTRACT

Background: Death with a functioning graft (DWGF) is now one of the main causes of renal transplant (RTx) loss. Aim: To determine whether the causes of DWGF, characteristics of donors and recipients and complications of RTx have changed in the last two decades. Subjects and Methods: Cooperative study of a cohort of 418 kidney grafts performed between 1968 and 2010. Patients were divided into two groups according to whether their kidney transplants were performed between 1968 and 1992 (Group 1) or 1993 and 2010 (Group 2). Results: Sixty eight patients experienced DWGF. Infections were the leading cause of DWGF in both groups (38 and 41%, respectively), followed by cardiovascular diseases (24 and 23% respectively), gastrointestinal disorders (21 and 26% respectively) and cancer (17 and 10% respectively). There were no significant differences in causes of death between the two groups according to the time elapsed since the renal transplantation. In patients in Group 1, the interval between diagnosis of renal failure and dialysis (HD) and the interval between the start of HD and kidney transplantation were significantly lower than in Group 2. The former had also an increased number of acute rejections in the first five years of kidney transplantation (p < 0.001). In Group 2, patients more often received their kidneys from deceased donors, had previous kidney transplantation, higher rate of antibodies to a panel of lymphocytes and an increased incidence of cardiovascular disorders after five years of RTx. Conclusions: The proportion of graft loss due to DWGF has increased over the last 2 decades, but its causes have not changed significantly. Infections are the most common causes of DWGF followed by cardiovascular and digestive diseases.


Subject(s)
Adult , Female , Humans , Graft Survival , Kidney Transplantation/mortality , Kidney/surgery , Cause of Death , Graft Rejection/mortality , Immunosuppression/methods , Postoperative Complications/mortality , Survival Analysis , Survival Rate , Time Factors , Tissue Donors
20.
Rev. méd. Chile ; 139(1): 11-18, ene. 2011. ilus
Article in Spanish | LILACS | ID: lil-595260

ABSTRACT

Background: Simultaneous kidney and páncreas transplantation (SKPT) is the best alternative for end stage renal disease among patients with insulin dependent diabetes mellitus. Aim: To report our experience with SKPT. Material andMethods: Retrospective analysis ofl2 recipients of SKPT transplanted in one center starting in 1994, with a meanfollow-upperiod of6.8years (2-15). Results: Eleven ofl2 recipients were in chronic hemodialysis before SKPT. Mean A, B, DR and HLA mismatch was 4.3. Mean preformed anti HLA antibodies was 3.3 percent. Mean cold ischemia times for páncreas and kidney were 6 and 10 hours, respectively. In the first eight cases, the páncreas was drained to the bladder, and in the last four, an enteric drainage was performed. Eleven recipients were induced with antibodies, and maintenance immunosuppression consisted ofCyclosporine or Tacrolimusplus an antiproliferative agent. Ten year patient survival was 70 percent. Páncreas and kidney survival, defined by insulin and dialysis independence, were 72 and 73 percent respectively. Fifty percent of recipients experienced acute graft rejection (cellular or humoral), with good response to treatment except in one case. Conclusions: This experience shows that SKPT is associated with an excellent patient survival associated to insulin and dialysis independence in 70 percent of patients at 10 years.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Diabetes Mellitus, Type 1/surgery , Kidney Failure, Chronic/surgery , Kidney Transplantation/mortality , Pancreas Transplantation/mortality , Chile , Diabetes Mellitus, Type 1/physiopathology , Epidemiologic Methods , Kidney Failure, Chronic/physiopathology , Kidney Transplantation/adverse effects , Pancreas Transplantation/adverse effects , Treatment Outcome
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