Rol de la oxitocina en patología psiquiátrica / Role of oxytocin in psychiatric pathology

Oxytocin is a neuropeptide that in mammals has important functions on different reproductive stages and socialization behaviors. In humans, its importance has been recognized in processes of social regulation such as social memory, affiliation, mentality and empathy. The objective of this work is to perform an updated review of the evidence about the role of oxytocin in psychiatric disorders. A bibliographic search was carried out on this topic through the Medline / PubMed and SciELO databases. The results show evidence on the possible etiopathogenic role of oxytocin in different clinical conditions. In addition, research has sought answers in this hormone to understand the different symptomatic profiles, such as emotional regulation, the recognition of emotions, the capacity for mentalization and the response to stress, which could operate as targets for possible therapeutic uses of oxytocin. Although the data are still incipient and inconclusive, oxytocin has been positioned as an important focus of neurobiological and therapeutic study in psychiatry for future research.

Identidad de género y salud mental / Gender identity and mental health

Resumen Este artículo tiene como objetivo revisar las implicaciones de la identidad de género en la construcción psíquica y la salud mental, sin pretender ser una revisión exhaustiva, dada la complejidad del tema. Se realiza un recorrido por las definiciones conceptuales de la identidad de género, pasando por algunos modelos explicativos de la misma, como una forma de comprender esta experiencia. Además, se abordará la realidad transgénero como factor de estrés psicosocial y, desde una perspectiva clínica, sus repercusiones psíquicas, enfatizando la diferenciación de las identidades trans con la entidad diagnóstica llamada disforia de género. Finalmente, se caracterizará la disforia de género, con énfasis en el malestar subjetivo secundario a la discordancia de género, sus relaciones con otros diagnósticos psiquiátricos, sus repercusiones psicosociales y las barreras de atención médica que este grupo de personas experimenta.

This article aims to review the implications of gender identity in psychic construction and mental health, without intending to be an exhaustive review, given the complexity of this issue. A tour of the conceptual definitions of gender identity is made, going through some explanatory models of it, as a way to understand this experience. Also, transgender reality as a psychosocial stress factor will be addressed and, from a clinical perspective, its psychic repercussions, emphasizing the differentiation of trans identities with the diagnostic entity called gender dysphoria. Finally, gender dysphoria will be characterized, focusing on the subjective disconfort secondary to gender discordance, its relationships with other psychiatric diagnoses, its psychosocial repercussions and the health care barriers that this group of people experiences.

[The renin-angiotensin system and the brain]. / El rol del sistema renina angiotensina a nivel cerebral.

The renin-angiotensin-aldosterone (RAAS) system and its effects on blood pressure and the regulation of water and electrolyte balance have been studied focusing on the cardiovascular and renal system. The activation of RAAS in other organs has local and systemic repercussions by modeling the macro- and microvasculture of peripheral organs. The brain RAAS influence on systemic blood pressure through the sympathetic nervous system. The angiotensin converting enzyme/angiotensin II/angiotensin 1 receptor axis (ACE/AngII/AT1), classical pathway, and angiotensin converting enzyme type 2/angiotensin (1-7)/Mas receptor (ACE2/Ang (1-7)/MasR), non-classical pathway, are involved in the modulation of the sympathetic response. The imbalance of these two axes with subsequently Ang II accumulation promote neurogenic hypertension and other vascular pathologies. The aminopeptidase/angiotensin IV/angiotensin 4 receptor (AMN/Ang IV/AT4) axis, which is exclusive of the brain, acts on cerebral microvasculature and participates in cognition, memory, and learning. The aim of this review is to decipher the major central RAAS mechanisms involved in blood pressure regulation. In addition, paracrine functions of brain RAAS and its role in neuroprotection and cognition are also described in this review.

Eosinofilia inducida por Olanzapina: A propósito de un caso / Olanzapine-induced eosinophilia: A case report

Resumen Se han descrito una serie de reacciones adversas asociadas a antipsicóticos, entre las que destacan las reacciones adversas hematológicas propias de algunos antipsicóticos atípicos. Las más renombradas han sido clásicamente las discrasias sanguíneas asociadas al uso de olanzapina. En este trabajo nos enfocamos en una reacción adversa poco común: eosinofilia en un paciente esquizofrénico paranoide usuario de olanzapina, situación documentada en contadas publicaciones a lo largo de la historia de uso de este medicamento. Se trata de una reacción adversa infrecuente, y por lo mismo poco conocida y estudiada.

Many adverse effects of antipsychotic drugs have been described, among which hematologic adverse effects stand out. Classically, blood discrasias have been associated to the use of olanzapine. On this paper we will focus on an uncommon adverse reaction: eosinophilia in a patient diagnosed with a paranoid schitzophrenia, who had been using olanzapine. There have been just a few reported cases of eosinophilia secondary to the use of olanzapine, which makes this an infrequent, rarely known and even less studied adverse reaction.

Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations.

Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate's phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection.

The Banff 2017 Kidney Meeting Report: Revised diagnostic criteria for chronic active T cell-mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials.

The kidney sessions of the 2017 Banff Conference focused on 2 areas: clinical implications of inflammation in areas of interstitial fibrosis and tubular atrophy (i-IFTA) and its relationship to T cell-mediated rejection (TCMR), and the continued evolution of molecular diagnostics, particularly in the diagnosis of antibody-mediated rejection (ABMR). In confirmation of previous studies, it was independently demonstrated by 2 groups that i-IFTA is associated with reduced graft survival. Furthermore, these groups presented that i-IFTA, particularly when involving >25% of sclerotic cortex in association with tubulitis, is often a sequela of acute TCMR in association with underimmunosuppression. The classification was thus revised to include moderate i-IFTA plus moderate or severe tubulitis as diagnostic of chronic active TCMR. Other studies demonstrated that certain molecular classifiers improve diagnosis of ABMR beyond what is possible with histology, C4d, and detection of donor-specific antibodies (DSAs) and that both C4d and validated molecular assays can serve as potential alternatives and/or complements to DSAs in the diagnosis of ABMR. The Banff ABMR criteria are thus updated to include these alternatives. Finally, the present report paves the way for the Banff scheme to be part of an integrative approach for defining surrogate endpoints in next-generation clinical trials.

Lorraine Racusen and Kim Solez Awarded the Gold Medal of the Catalan Transplant Society.

In March 2017, a joint meeting between The Catalan Society of Transplantation and the Banff Foundation was held at the University of Barcelona. This was an opportunity for the Catalan Society of Transplantation to recognize the crucial contributions to transplant pathology made by Lorraine Racusen and Kim Solez, who created and actively contributed to the development of the International Banff Classification System. The ceremony of the Gold Medal took place on March 31 at the University of Barcelona; it consisted of a presentation of the contributions of Lorraine Racusen and Kim Solez to the development of transplant pathology. In this article, the presentation of these awardees with the Gold Medal of the Catalan Society of Transplantation is summarized.

Trastorno por déficit atencional e hiperactividad (TDAH) y su relación con el síndrome de apnea obstructiva del sueño (SAOS) en pediatría / Attention deficit hyperactivity disorder (ADHD) and its relationship with obstructive sleep apnea syndrome (OSAS) in pediatrics

La importancia de la patología psiquiátrica en la infancia y la adolescencia ha ido en ascenso, debido al aumento en su diagnóstico y a sus implicancias socioculturales. El Trastorno por Déficit Atencional e Hiperactividad es el trastorno neurobiológico más diagnosticado en la práctica clínica infanto-juvenil, tanto así que debe ser conocido y manejado en la Atención Primaria por los médicos generales. Se ha descrito cierto grado de sobrediagnóstico influenciado, entre otros motivos, por las altas expectativas sociales respecto del rendimiento escolar/conductual de los niños, así como la presencia de otras patologías que se pueden manifestar con síntomas TDAH-like. En este sentido, la relación entre SAOS y TDAH, cobra gran relevancia, puesto que ambas patologías presentan una amplia prevalencia en nuestro país y un alto nivel de comorbilidad psiquiátrica/médica, además de relacionarse a través de una compleja y aún no muy bien conocida interacción neuropsicológica.

The importance of psychiatric disorders in childhood and adolescence has been increasing due to the increase in its diagnosis and its cultural implications. The Attention Deficit Hyperactivity Disorder is the neurobiological disorder most commonly diagnosed in the child-adolescent clinical practice, so much so that must be managed in primary care. It described some degree of overdiagnosis influenced by high school-social expectations and behavioral performance of children, and the presence of other conditions. In this sense, the relationship between OSA and ADHD, is very relevant, because both disorders share a wide prevalence in our country and a high level of psychiatric and medical comorbidity. In adittion, these interact through a complex and still not well known neuropsychological mechanism.

Real Time Central Assessment of Kidney Transplant Indication Biopsies by Microarrays: The INTERCOMEX Study.

The authors conducted a prospective trial to assess the feasibility of real time central molecular assessment of kidney transplant biopsy samples from 10 North American or European centers. Biopsy samples taken 1 day to 34 years posttransplantation were stabilized in RNAlater, sent via courier overnight at ambient temperature to the central laboratory, and processed (29 h workflow) using microarrays to assess T cell- and antibody-mediated rejection (TCMR and ABMR, respectively). Of 538 biopsy samples submitted, 519 (96%) were sufficient for microarray analysis (average length, 3 mm). Automated reports were generated without knowledge of histology and HLA antibody, with diagnoses assigned based on Molecular Microscope Diagnostic System (MMDx) classifier algorithms and signed out by one observer. Agreement between MMDx and histology (balanced accuracy) was 77% for TCMR, 77% for ABMR, and 76% for no rejection. A classification tree derived to provide automated sign-outs predicted the observer sign-outs with >90% accuracy. In 451 biopsy samples where feedback was obtained, clinicians indicated that MMDx more frequently agreed with clinical judgment (87%) than did histology (80%) (p = 0.0042). In 81% of feedback forms, clinicians reported that MMDx increased confidence in management compared with conventional assessment alone. The authors conclude that real time central molecular assessment is feasible and offers a useful new dimension in biopsy interpretation. ClinicalTrials.gov NCT#01299168.

Adherencia al tratamiento tras trasplante renal como indicador de calidad de la información recibida: estudio longitudinal con un seguimiento de 2 años / Adherence to treatment after kidney transplantation as quality indicator of the information received: longitudinal study of 2 years follow-up

Introducción. El trasplante es una modalidad de tratamiento óptima para la enfermedad renal crónica avanzada, que requiere de por vida la adherencia al tratamiento inmunosupresor. El objetivo de este estudio fue evaluar la adherencia al tratamiento después de un trasplante renal. Además de analizar el grado de información recibida al mes y 18 meses postrasplante y valorar su influencia en la adherencia al tratamiento. Material y métodos. El Cuestionario simplicado de adherencia a la medicación fue administrado al mes (T1), 6 meses (T2), 12 meses (T3), 18 meses (T4) y 24 meses (T5) postrasplante. La encuesta sobre aspectos del conocimiento y actitudes con respecto a la medicación se utilizó al mes y 18 meses postrasplante. Los datos se presentaron con medidas de tendencia central, y fueron comparados con pruebas no paramétricas. Resultados. Participaron 73 pacientes, con una mediana de edad de 57 años. El porcentaje de pacientes no-adherentes a la medicación fueron el 9,6% (T1), 22,5% (T2), 29,2% (T3), 29,8% (T4) y 28,1% (T5). Al mes del trasplante «no consultar con el médico al olvidarse alguna toma» (p=0,034) influyó significativamente en la no-adherencia farmacológica. A los 18 meses postrasplante ninguna de las cuestiones planteadas sobre el conocimiento de la medicación influyó en la no-adherencia al tratamiento farmacológico. Conclusiones. El mayor tiempo desde el trasplante incrementó la no-adherencia al tratamiento. Algunas cuestiones referidas a la información dada sobre el tratamiento influyeron en la no-adherencia en el trasplante inmediato, pero no en el seguimiento (AU)

Introduction. Transplantation is an optimal form of treatment for end-stage renal disease, but requires lifelong adherence to immunosuppressive therapy. The aim of this study was to longitudinally assess the adherence to treatment after kidney transplant, as well as to compare the amount of information about the treatment received at one month and 18 months post-transplantation, and its influence on adherence to treatment. Material and methods. The Self-Reported Measure of Medication Adherence was administered at month (T1), 6 months (T2), 12 months (T3), 18 months (T4), and 24 months (T5) post-transplantation. Survey about aspects of knowledge and attitudes about medication, was administered at one month and 18 months post-transplant. Measures of central tendency and non-parametric tests were used to compare the data. Results. The study included a total of 73 patients with a median age of 57 years. The percentage of patients non-adherent to medication was 9.6% (T1), 22.5% (T2), 29.2% (T3), 29.8% (T4), and 28.1% (T5). One month after transplantation “not consulting with the doctor on forgetting to take medication (P=.034) significantly influenced the non-adherence to treatment. At 18 months post- transplantation, none of the issues raised on medication knowledge had an influence on non-adherence to treatment. Conclusions. Longer times since transplantation increased the non-adherence to treatment. Some issues regarding the information of treatment influenced the non-adherence in the immediate transplant period, but not in the follow-up (AU)

[Adherence to treatment after kidney transplantation as quality indicator of the information received: Longitudinal study of 2 years follow-up]. / Adherencia al tratamiento tras trasplante renal como indicador de calidad de la información recibida: estudio longitudinal con un seguimiento de 2 años.

INTRODUCTION: Transplantation is an optimal form of treatment for end-stage renal disease, but requires lifelong adherence to immunosuppressive therapy. The aim of this study was to longitudinally assess the adherence to treatment after kidney transplant, as well as to compare the amount of information about the treatment received at one month and 18 months post-transplantation, and its influence on adherence to treatment. MATERIAL AND METHODS: The Self-Reported Measure of Medication Adherence was administered at month (T1), 6 months (T2), 12 months (T3), 18 months (T4), and 24 months (T5) post-transplantation. Survey about aspects of knowledge and attitudes about medication, was administered at one month and 18 months post-transplant. Measures of central tendency and non-parametric tests were used to compare the data. RESULTS: The study included a total of 73 patients with a median age of 57 years. The percentage of patients non-adherent to medication was 9.6% (T1), 22.5% (T2), 29.2% (T3), 29.8% (T4), and 28.1% (T5). One month after transplantation "not consulting with the doctor on forgetting to take medication (P=.034) significantly influenced the non-adherence to treatment. At 18 months post- transplantation, none of the issues raised on medication knowledge had an influence on non-adherence to treatment. CONCLUSIONS: Longer times since transplantation increased the non-adherence to treatment. Some issues regarding the information of treatment influenced the non-adherence in the immediate transplant period, but not in the follow-up.

The Banff 2015 Kidney Meeting Report: Current Challenges in Rejection Classification and Prospects for Adopting Molecular Pathology.

The XIII Banff meeting, held in conjunction the Canadian Society of Transplantation in Vancouver, Canada, reviewed the clinical impact of updates of C4d-negative antibody-mediated rejection (ABMR) from the 2013 meeting, reports from active Banff Working Groups, the relationships of donor-specific antibody tests (anti-HLA and non-HLA) with transplant histopathology, and questions of molecular transplant diagnostics. The use of transcriptome gene sets, their resultant diagnostic classifiers, or common key genes to supplement the diagnosis and classification of rejection requires further consensus agreement and validation in biopsies. Newly introduced concepts include the i-IFTA score, comprising inflammation within areas of fibrosis and atrophy and acceptance of transplant arteriolopathy within the descriptions of chronic active T cell-mediated rejection (TCMR) or chronic ABMR. The pattern of mixed TCMR and ABMR was increasingly recognized. This report also includes improved definitions of TCMR and ABMR in pancreas transplants with specification of vascular lesions and prospects for defining a vascularized composite allograft rejection classification. The goal of the Banff process is ongoing integration of advances in histologic, serologic, and molecular diagnostic techniques to produce a consensus-based reporting system that offers precise composite scores, accurate routine diagnostics, and applicability to next-generation clinical trials.

Biomarkers of Tolerance in Kidney Transplantation: Are We Predicting Tolerance or Response to Immunosuppressive Treatment?

We and others have previously described signatures of tolerance in kidney transplantation showing the differential expression of B cell-related genes and the relative expansions of B cell subsets. However, in all of these studies, the index group-namely, the tolerant recipients-were not receiving immunosuppression (IS) treatment, unlike the rest of the comparator groups. We aimed to assess the confounding effect of these regimens and develop a novel IS-independent signature of tolerance. Analyzing gene expression in three independent kidney transplant patient cohorts (232 recipients and 14 tolerant patients), we have established that the expression of the previously reported signature was biased by IS regimens, which also influenced transitional B cells. We have defined and validated a new gene expression signature that is independent of drug effects and also differentiates tolerant patients from healthy controls (cross-validated area under the receiver operating characteristic curve [AUC] = 0.81). In a prospective cohort, we have demonstrated that the new signature remained stable before and after steroid withdrawal. In addition, we report on a validated and highly accurate gene expression signature that can be reliably used to identify patients suitable for IS reduction (approximately 12% of stable patients), irrespective of the IS drugs they are receiving. Only a similar approach will make the conduct of pilot clinical trials for IS minimization safe and hence allow critical improvements in kidney posttransplant management.

Actualización en psicodermatología / Update in psychodermatology

Psychodermatology is an area of dermatology dedicated to the connection between this medical discipline and psychiatry. Its importance is based in that emotional factors can exacerbate skin diseases and psychiatric disorders may manifest as skin lesions. This relationship can be described as an intricate network involving psychological, social, neuroendocrine, immune and skin factors, as reflected in the complexity of the management of these patients. Is important to increase research and interest in this important issue, as an integrative and multidisciplinary approach allows for interventions in the vicious circle between psychiatric dysfunction and skin symptoms, improving significantly the quality of life of patients...

Ureteropielostomía con vía nativa en el tratamiento de la uropatía obstructiva en el trasplante renal adulto. Experiencia y posibilidades técnicas / Native ureteropyelostomy in the treatment of obstructive uropathy in adult renal transplant. Experience and technical alternatives

Objetivo: Analizar y evaluar nuestra experiencia en el tratamiento quirúrgico mediante abordaje abierto de las estenosis ureterales complejas postrasplante renal de adulto en un centro de tercer nivel en los últimos 7 años. Se revisan las diferentes alternativas quirúrgicas utilizadas. Pacientes y métodos: Desde enero de 2005 hasta diciembre de 2012 se han realizado un total de 589 trasplantes renales de adulto consecutivos. Un 1,1% del total presentaron algún grado de uropatía obstructiva sintomática que, tras derivación urinaria inicial, requirieron de abordaje quirúrgico abierto utilizando la vía urinaria nativa ipsilateral o contralateral. Se presentan las características de los pacientes, clínica, exploraciones realizadas así como técnica quirúrgica llevada a cabo y sus resultados. Resultados: Durante el periodo evaluado se llevaron a cabo un total de 7 cirugías reparativas en 5 varones y 2 mujeres que presentaban estenosis ureterales postrasplante renal mediante ureteropielostomía abierta utilizando uréter nativo ipsilateral en 6 casos y contralateral en el restante. En un caso de realizó anastomosis ureterocalicilar por retracción piélica extrema. No ha habido complicaciones relevantes ni se ha requerido de nefrectomía de riñón nativo por complicación posterior. La totalidad de los pacientes intervenidos presentaron cifras de creatinina plasmática óptimas con resolución de la dilatación previa. Conclusiones: La nefrostomía percutánea inicial seguida de la corrección quirúrgica abierta mediante la utilización de uréter nativo representa una alternativa definitiva, válida y óptima en términos de seguridad y preservación de la función renal

Objective: To analyze and evaluate our experience in surgical treatment with the open approach of the complex ureteral stenosis after adult kidney transplantation in a tertiary level hospital in the last seven years. We have reviewed the different surgical options used. Patients and methods: A total of 589 consecutive adult renal transplants were performed from January 2005 to December 2012. Of these, 1.1% showed some degree of symptomatic obstructive uropathy which after initial urinary diversion required open surgical approach using the ipsilateral or contralateral native urinary tract. Characteristics of the patient, clinical examinations performed and surgical technique performed as well as their results are presented. Results: During the period under review, in 5 men and 2 women who had ureteral stenoses after renal transplant, 7 reparative surgeries were performed by open ureteropyelostomy, using ipsilateral native ureter in 6 cases and contralateral ureter in the remaining case. In one case, uretero-calicial anastomosis was performed due to severe pyelic shrinkage. There were no significant complications. Native kidney nephrectomy was not required for further complications. All the patients operated on had optimum plasma creatinine levels with resolution of previous dilatation. Conclusions: The initial percutaneous nephrostomy followed by open surgical repair using native ureter represents a definitive, valid and optimal alternative in terms of safety and preservation of renal function

Low serum mannose-binding lectin levels are associated with inflammation and apoptosis in early surveillance allograft biopsies.

INTRODUCTION: Mannose-binding lectin (MBL) is a protein of the innate immune system that participates in host defense and the tissue injury/repair process, enhancing the clearance of apoptotic cells by macrophages. The aim is to characterize the relationship between pre-transplant MBL levels, histological lesions and number of apoptotic cells in early surveillance renal allograft biopsies. PATIENTS AND METHODS: Consecutive renal transplant recipients were recruited and MBL levels were classified into tertiles. The first tertile was considered the low MBL group. Surveillance biopsies were done during the first 6 months and were evaluated according to Banff criteria. Renal inflammatory infiltrates were studied by immunohistochemical techniques. Apoptosis was studied using morphological methods in renal tubular cells and was expressed as the number of apoptotic cells/mm(2). RESULTS: MBL was determined in 126 patients and a surveillance biopsy with sufficient tissue was obtained in 41 of them. Patients with low pre-transplant MBL levels showed a higher acute Banff index (3.14 ± 1.96 vs. 1.88 ± 1.56, p = 0.044) and an increased proportion of biopsies with tubular cell apoptosis The proportion of biopsies with tubular cell apoptosis was higher in patients with low pre-transplant MBL levels in comparison with patients with high MBL levels (4.3 ± 3.6 versus 0.2 ± 0.9 p = 0.012) and increased interstitial number of inflammatory cells and significantly the macrophages/mm(2) (109 ± 118 vs. 32 ± 46; p = 0.04). CONCLUSION: Low pre-transplant serum MBL levels are associated with more severe inflammation and increased apoptosis in early surveillance renal allograft biopsies suggesting that MBL modulates renal inflammation after transplantation.

Banff fibrosis study: multicenter visual assessment and computerized analysis of interstitial fibrosis in kidney biopsies.

Increasing interstitial fibrosis (IF) in native and kidney transplant biopsies is associated with functional decline and serves as a clinical trial end point. A Banff 2009 Conference survey revealed a range in IF assessment practices. Observers from multiple centers were asked to assess 30 renal biopsies with a range of IF and quantitate IF using two approaches on trichrome, Periodic acid-Schiff (PAS) and computer-assisted quantification of collagen III immunohistochemistry (C-IHC) slides, as well as assessing percent of cortical tubular atrophy% (TA%) and Banff total cortical inflammation score (ti-score). C-IHC using whole slide scans was performed. C-IHC assessment showed a higher correlation with organ function (r = -0.48) than did visual assessments (r = -0.32--0.42); computerized and visual C-IHC assessment also correlated (r = 0.64-0.66). Visual assessment of trichrome and C-IHC showed better correlations with organ function and C-IHC, than PAS, TA% and ti-score. However, visual assessment of IF, independent of approach, was variable among observers, and differences in correlations with organ function were not statistically significant among C-IHC image analysis and visual assessment methods. C-IHC image analysis correlated among three centers (r > 0.90, p < 0.0001, between all centers). Given the difficulty of visual IF assessment standardization, C-IHC image could potentially accomplish standardized IF assessment in multicenter settings.

Native ureteropyelostomy in the treatment of obstructive uropathy in adult renal transplant. Experience and technical alternatives.

OBJECTIVE: To analyze and evaluate our experience in surgical treatment with the open approach of the complex ureteral stenosis after adult kidney transplantation in a tertiary level hospital in the last seven years. We have reviewed the different surgical options used. PATIENTS AND METHODS: A total of 589 consecutive adult renal transplants were performed from January 2005 to December 2012. Of these, 1.1% showed some degree of symptomatic obstructive uropathy which after initial urinary diversion required open surgical approach using the ipsilateral or contralateral native urinary tract. Characteristics of the patient, clinical examinations performed and surgical technique performed as well as their results are presented. RESULTS: During the period under review, in 5 men and 2 women who had ureteral stenoses after renal transplant, 7 reparative surgeries were performed by open ureteropyelostomy, using ipsilateral native ureter in 6 cases and contralateral ureter in the remaining case. In one case, uretero-calicial anastomosis was performed due to severe pyelic shrinkage. There were no significant complications. Native kidney nephrectomy was not required for further complications. All the patients operated on had optimum plasma creatinine levels with resolution of previous dilatation. CONCLUSIONS: The initial percutaneous nephrostomy followed by open surgical repair using native ureter represents a definitive, valid and optimal alternative in terms of safety and preservation of renal function.

Microarray diagnosis of antibody-mediated rejection in kidney transplant biopsies: an international prospective study (INTERCOM).

In a reference set of 403 kidney transplant biopsies, we recently developed a microarray-based test that diagnoses antibody-mediated rejection (ABMR) by assigning an ABMR score. To validate the ABMR score and assess its potential impact on practice, we performed the present prospective INTERCOM study (clinicaltrials.gov NCT01299168) in 300 new biopsies (264 patients) from six centers: Baltimore, Barcelona, Edmonton, Hannover, Manchester and Minneapolis. We assigned ABMR scores using the classifier created in the reference set and compared it to conventional assessment as documented in the pathology reports. INTERCOM documented uncertainty in conventional assessment: In 41% of biopsies where ABMR features were noted, the recorded diagnoses did not mention ABMR. The ABMR score correlated with ABMR histologic lesions and donor-specific antibodies, but not with T cell-mediated rejection lesions. The agreement between ABMR scores and conventional assessment was identical to that in the reference set (accuracy 85%). The ABMR score was more strongly associated with failure than conventional assessment, and when the ABMR score and conventional assessment disagreed, only the ABMR score was associated with early progression to failure. INTERCOM confirms the need to reduce uncertainty in the diagnosis of ABMR, and demonstrates the potential of the ABMR score to impact practice.

Potential impact of microarray diagnosis of T cell-mediated rejection in kidney transplants: The INTERCOM study.

We previously developed a microarray-based test for T cell-mediated rejection (TCMR) in a reference set of 403 biopsies. To determine the potential impact of this test in clinical practice, we undertook INTERCOM, a prospective international study of 300 indication biopsies from 264 patients (ClinicalTrials.gov NCT01299168). Biopsies from six centers-Baltimore, Barcelona, Edmonton, Hannover, Manchester and Minneapolis-were analyzed by microarrays, assigning TCMR scores by an algorithm developed in the reference set and comparing TCMR scores to local histology assessment. The TCMR score correlated with histologic TCMR lesions-tubulitis and interstitial infiltration. The accuracy for primary histologic diagnoses (0.87) was similar to the reference set (0.89). The TCMR scores reclassified 77/300 biopsies (26%): 16 histologic TCMR were molecularly non-TCMR; 15 histologic non-TCMR were molecularly TCMR, including 6 with polyoma virus nephropathy; and all 46 "borderline" biopsies were reclassified as TCMR (8) or non-TCMR (38). Like the reference set, discrepancies were primarily in situations where histology has known limitations, for example, in biopsies with scarring and inflammation/tubulitis potentially from other diseases. Neither the TCMR score nor histologic TCMR was associated with graft loss. Thus the molecular TCMR score has potential to add new insight, particularly in situations where histology is ambiguous or potentially misleading.