RESUMEN
BACKGROUND: The long-term benefit of early treatment of subclinical disorders detected in kidney allografts by protocol biopsy is controversial. We collected 145 protocol biopsies from 113 recipients for comparison with 51 control patients in a single-center, prospective, randomized trial. METHODS: Ultrasound-guided biopsies were performed in recipients with stable renal function. Samples were taken at 3 (n=66) and/or 12 months (n=79) after transplantation. The biopsies were evaluated according to the Banff scheme, and patients were treated based on the diagnosis. Changes in glomerular filtration rate (GFR) were compared with 51 patients who were randomized as a control group. RESULTS: The findings on 38 samples (29%) were considered to be normal. Based on the pathology findings, such as subclinical acute rejection (n=23), calcineurin inhibitor toxicity (n=28), chronic rejection (n=6), and other specific pathologies (n=23), including polyoma virus nephropathy (n=2), induced treatment among 82 recipients (57%). Significantly better graft function was observed at 3-year follow-up among the biopsy group, compared with controls: GFR = 46.0 ± 13.8 vs 35 ± 15 mL/min (P=.002). The 5-year graft survival was significantly higher in the biopsy (81%) than in the control (55.6%) group (P=.0012). CONCLUSION: Early detection and treatment of subclinical pathologies improved graft function and long-term survival. Protocol biopsies were a valuable tool for posttransplantation management.
Asunto(s)
Rechazo de Injerto/terapia , Supervivencia de Injerto , Inmunosupresores/efectos adversos , Enfermedades Renales/terapia , Trasplante de Riñón/efectos adversos , Adulto , Enfermedades Asintomáticas , Biopsia , Distribución de Chi-Cuadrado , Diagnóstico Precoz , Femenino , Tasa de Filtración Glomerular , Rechazo de Injerto/diagnóstico , Rechazo de Injerto/etiología , Rechazo de Injerto/fisiopatología , Humanos , Hungría , Enfermedades Renales/diagnóstico , Enfermedades Renales/etiología , Enfermedades Renales/fisiopatología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Hiperlipoproteinemias/etiología , Fallo Renal Crónico/sangre , Diálisis Renal/efectos adversos , Adulto , Arteriosclerosis/etiología , Colesterol/sangre , Ácidos Grasos no Esterificados/sangre , Humanos , Hiperlipoproteinemias/sangre , Fallo Renal Crónico/terapia , Lipoproteínas HDL/sangre , Lipoproteínas VLDL/sangre , Riesgo , Triglicéridos/sangreRESUMEN
Changes of serum lipids and lipoproteins were determined quantitatively before and after haemodialysis in chronic uraemic patients. Serum beta-lipoprotein significantly decreased due to haemodialysis, while alpha-lipoprotein and the FFA level significantly increased. Slight correlations were observed between the applied transmembrane pressure and the serum concentration of FFA, HDL-cholesterol or total cholesterol levels. Hyper-beta-lipoproteinemia was found in 70.9 per cent and Frederickson-HLP in 33.3% of the haemodialyzed chronic uraemic patients.
