[The Argentine experience with human immune deficiency virus positive patients in the waiting list for liver transplantation: preliminary analysis]. / Experiencia argentina con pacientes positivos para el virus de la inmunodeficiencia humana en lista de espera para trasplante hepático: análisis preliminar.

UNLABELLED: After the introduction of high active antiretroviral therapy (HAART), the human immunodeficiency virus (HIV) was no longer considered a contraindication for transplantation. Yet, liver disease in this population is characterized by an accelerated course that may impact on the waiting list. OBJECTIVE: To evaluate the experience in Argentina with HIV positive patients listed for liver transplantation. PATIENTS AND METHODS: We analyzed 52 HIV positive patients listed between July 2005 and March 2010 (Group HIV positive). Results were compared with 462 HIV negative patients included during the same period (Group HIV negative). Data were obtained from INCUCAI, the Argentinian procurement organism and from the Transplantation Centers. RESULTS: The etiology of liver disease in the Group HIV positive was hepatitis C 40, HBV 3, fulminant hepatitis 3, alcohol 2, retrasplant 2 and others 2. The mean MELD at the time of listing was 1615 (lower than 19 in 40 cases, higher than 19 in 8, emergency in 3) in the group HIV positive and 16.64 in the group HIV negative (NS). The outcome in the waiting list for HIV positive and negative patients respectively was: death 14 (27%) vs 61 (18.7%) (P < 0.05), cadaveric donor transplant 10 (13%) vs 95 (29.4%) (P < 0.001), living donor transplant 0 (0%) vs 5 (1.1%) (NS), mean time from listing to death 270.70 298.11 days vs 267.29 266.53 days (NS), mean time from listing to transplant 70.26 74.05 vs 261 187.6 days (P < 0.01), mean MELD at the time of death 12.54 (13 cases lower than 15, 1 higher than 19) vs 19.6 9.7 (P < 0.05), mean MELD at the time of transplantation 24.33 vs 24.1 7.6 (NS). CONCLUSION: HIV positive patients have high mortality in the waiting list and low access to liver transplantation. MELD score underscores the severity of liver disease in this population when compared to HIV negative patients.

A new prognostic index for one-year survival in incident hemodialysis patients.

PURPOSE: Although scoring comorbidities for patients beginning chronic hemodialysis has proved significant and has led researchers to develop several indexes, none of them has been extensively accepted. The aim of this study was to: 1) develop a prognostic index for patients entering renal replacement therapy; and 2) identify which one of the available scores better predicts one-year survival. METHODS: Records from 5,360 incident dialysis-requiring ESRD individuals were studied and a novel comorbidity index (NI) was developed. The agreement of this NI with the Charlson age-comorbidity, Kahn-Wright, ACPI, and Hemmelgarn indexes was assessed to identify which one better predicts one-year survival. The Cox proportional hazard regression with time-dependent covariates was used to analyze survival and the area under the receiver operating characteristic (ROC) curve was calculated to assess the ability of this score to discriminate between prognoses and to compare this NI with indexes already in use. RESULTS: 16 of the original 19 predictor variables displayed hazard ratios =1.2. Although the area under the ROC curves for all the indexes compared were significantly different from 0.5, the NI showed better performance characteristics (0.74 vs. 0.70 for Charlson's, 0.68 for ACPI, 0.67 for Khan-Wright's and 0.63 for Hemmelgarn's). Compared with the Charlson score, the z statistic was 7.78 (p<0.001). One-year survival estimate for the high-risk group was 43% with the NI and ranged from 66% to 72% when assessed through other indexes. CONCLUSIONS: We recommend the use of this NI because it better predicts the one-year survival probability of incident hemodialysis-requiring ESRD individuals.

Experiencia argentina con pacientes positivos para el virus de la inmunodeficiencia humana en lista de espera para trasplante hepático: análisis preliminar / [The Argentine experience with human immune deficiency virus positive patients in the waiting list for liver transplantation: preliminary analysis].

UNLABELLED: After the introduction of high active antiretroviral therapy (HAART), the human immunodeficiency virus (HIV) was no longer considered a contraindication for transplantation. Yet, liver disease in this population is characterized by an accelerated course that may impact on the waiting list. OBJECTIVE: To evaluate the experience in Argentina with HIV positive patients listed for liver transplantation. PATIENTS AND METHODS: We analyzed 52 HIV positive patients listed between July 2005 and March 2010 (Group HIV positive). Results were compared with 462 HIV negative patients included during the same period (Group HIV negative). Data were obtained from INCUCAI, the Argentinian procurement organism and from the Transplantation Centers. RESULTS: The etiology of liver disease in the Group HIV positive was hepatitis C 40, HBV 3, fulminant hepatitis 3, alcohol 2, retrasplant 2 and others 2. The mean MELD at the time of listing was 1615 (lower than 19 in 40 cases, higher than 19 in 8, emergency in 3) in the group HIV positive and 16.64 in the group HIV negative (NS). The outcome in the waiting list for HIV positive and negative patients respectively was: death 14 (27

) (NS), mean time from listing to death 270.70 298.11 days vs 267.29 266.53 days (NS), mean time from listing to transplant 70.26 74.05 vs 261 187.6 days (P < 0.01), mean MELD at the time of death 12.54 (13 cases lower than 15, 1 higher than 19) vs 19.6 9.7 (P < 0.05), mean MELD at the time of transplantation 24.33 vs 24.1 7.6 (NS). CONCLUSION: HIV positive patients have high mortality in the waiting list and low access to liver transplantation. MELD score underscores the severity of liver disease in this population when compared to HIV negative patients.

Características de la población incidente en diálisis crónica en Argentina / Characteristics of the incident hemodialysis population in chronic hemodialysis in Argentina

Evaluamos las características de la población incidente en Diálisis Crónica (DC) en Argentina desde 2004 hasta 2008. La tasa de incidencia del total del país fue en 2008 de 143.1 pacientes por millón de habitantes-año (ppm), con cambios significativos entre los años 2006, 2007 y 2008. Existe una gran dispersión de tasas entre provincias de Argentina con un rango de 71-201 ppm. La edad de la población fue envejeciendo significativamente llegando en 2008 a 59.8 años de promedio y aumentando significativamente la población mayor a 64 años, especialmente en varones, cuyas tasas duplican a la de las mujeres a partir de los 70 años. La Nefropatía Diabética es la primer causa de Incidencia a DC representando el 35,5% del total en 2008, en aumento permanente desde 2004. Las comorbilidades cardiovasculares disminuyeron en el tiempo, no obstante se continúa con altos porcentajes. El 67% de los pacientes presentan Hematocrito menor al 30%. El 52% de los pacientes inician DC con Albuminemia menor a 3.5 gramos / decilitros. El 1.4-2.0% de la población ingresa con presencia del anticuerpo de la Hepatitis C. Llegan sin vacunarse contra la Hepatitis B el 61% de los pacientes, con aumento significativo en los años transcurridos. Aumentó la población que comienza Hemodiálisis Crónica (HD) con catéter transitorio, llegando a 2008 a representar el 66% del total. La población que declara no poseer ingresos económicos disminuyó al 22% en 2008. Concluimos que es de importancia fundamental el seguimiento o monitoreo anual de estas variables iniciales en pacientes incidentes en DC porque muchas de ellas demostraron estar directamente relacionadas con peor pronóstico vital.

Sobrevida en diálisis crónica en Argentina: período 2004-2008 / Survival in chronic dialysis in Argentina: period 2004-2008

Se presenta la sobrevida según método de Kaplan-Meier(KM) de pacientes incidentes (01/04/2004 al 31/12/2008) al Registro Argentino de Diálisis Crónica (DC). El seguimiento (N=27.224) tuvo un máximo de 2101 días o 69.07 meses, en ese período fallecieron 9747 pacientes y al 31/12/2009 estaban con vida 10319 pacientes. La mediana de sobrevida fue de 47,9 meses. Se recurrió al Modelo del riesgo proporcional de Cox multivariado para determinar riesgo relativo o Hazard Ratio (HR) entre cada variable independiente al ingreso a DC. Del total de variables tomamos 29 (siempre que no entren en conflicto entre ellas y con casos perdidos <25%). 19 variables se muestran como predictoras significativas : Edad al ingreso (4,1% de mayor riesgo de muerte por cada año), presencia de: Insuficiencia Cardíaca, Angina Persistente o Infartos de Miocardio previos, Enfermedad Cerebrovascular, Insuficiencia Vascular Periférica, Virus C de la Hepatitis+, Arritmia Cardíaca, haber recibido Transfusiones en los últimos 6 meses, Enfermedad Pulmonar Crónica, Neoplasia al ingreso y ser portador de SIDA.