[Prophylactic and pre-emptive therapy for cytomegalovirus infection in kidney transplant patients using oral valganciclovir]. / Tratamiento profiláctico y anticipado de la infección por citomegalovirus en pacientes trasplantados renales mediante valganciclovir oral.

UNLABELLED: Prophylactic and pre-emptive therapy with oral valganciclovir for cytomegalovirus infection in renal transplant recipients. BACKGROUND: Cytomegalovirus infection is a very important health problem in solid organ transplant recipients (SOT). Once-daily valganciclovir has been shown to be as clinically effective and well tolerated as oral ganciclovir tid in the prevention of CMV infection in high risk SOT recipients. METHODS: The aim of the present study was to evaluate the incidence and severity of CMV disease in 150 renal transplant recipients that received either prophylactic [high risk group (HR), N = 66] or pre-emptive [low risk group (LR), N = 84] therapy with oral valganciclovir (900 mg/day vo) for three months according to their basal risk. Patients were monitored for signs and symptoms of CMV disease and CMV plasma viral load was assessed weekly. RESULTS: A total of 31 patients (47%) of the HR and 26 patients (31%) of the LR presented a positive CMV PCR result. Twelve patients (14.3%) in the LR that had a high viral load (CMV PCR > 1,000 copies/mL) but remained asymptomatic received pre-emptive therapy. Four patients (4.7%) in the LR, after an average time of 35 days after transplant and two patients (4.5%) in the HR, after prophylactic treatment was completed, developed CMV disease. The disease was mild-moderate in most of the cases. Those patients that developed CMV disease responded to treatment with iv ganciclovir for 14 days followed by treatment with oral valganciclovir for up to three months. CONCLUSION: Prophylactic treatment with oral valganciclovir for CMV prevention is only required in high risk solid organ transplant recipients.

Tratamiento profiláctico y anticipado de la infección por citomegalovirus en pacientes trasplantados renales mediante vanglanciclovir oral / Prophylactic and pre-emptive therapy for cytomegalovirus infection in kidney transplant patients using oral valganciclovir

Antecedentes: La enfermedad por citomegalovirus (CMV) es un problema sanitario muy importante en receptores de trasplante de órgano sólido (TOS). Una dosis diaria de valganciclovirha demostrado ser tan clínicamente efectiva y bien tolerada como ganciclovir oral dos veces al día en la prevención de la infección por CMV en los receptores de TOS de alto riesgo. Métodos: El objetivo del presente estudio fue evaluar la incidencia y severidad de la enfermedad por CMV en 150 receptores de trasplante renal que recibieron tratamiento profiláctico(grupo de alto riesgo, N = 66) o anticipado (grupo de bajo riesgo, N = 84) con valganciclovir oral (900 mg/día)durante tres meses según el riesgo basal de sufrir la misma. Se hizo un seguimiento de los síntomas clínicos de la enfermedad por CMV en los pacientes y la carga viral de CMV en plasma fue monitorizada semanalmente. Resultados: Un total de 31 pacientes (47%) del grupo de alto riesgo y 26 pacientes (31%) del grupo de riesgo estándar presentaron un resultado de PCR-CMV positivo. Doce pacientes (14,3%) del grupo de riesgo estándard que presentaron una elevada carga viral (PCR-CMV > 1.000 copias/mL) pero que permanecieron asintomáticos recibieron tratamiento anticipado. Cuatro pacientes (4,7%) del grupo de alto riesgo, en un tiempo medio de 35 días después del trasplante y dos pacientes (4,5%) del grupo de alto riesgo, tras completar el tratamiento profiláctico, desarrollaron la enfermedad por CMV, que fue de intensidad media a moderada en la mayoría de los casos. Aquellos pacientes que desarrollaron la enfermedad respondieron al tratamiento con ganciclovir ev durante 14 días seguido de valganciclovir oral hasta tres meses. Conclusión: El tratamiento profiláctico con valgancicloviroral para la prevención de CMV sólo es requerida en receptores de TOS de alto riesgo (AU)

Prophylactic and pre-emptive therapy with oral valganciclovir for cytomegalovirus infection in renal transplant recipients. Background: Cytomegalovirus infection is a very important health problem in solid organ transplant recipients (SOT). Once daily valganciclovir has been shown to be as clinically effective and well tolerated as oral ganciclovir tid in the prevention of CMV infection in high risk SOT recipients. Methods: The aim of the present study was to evaluate the incidence and severity of CMV disease in 150 renal transplant recipients that received either prophylactic [high risk group (HR), N =66] or pre-emptive [low risk group (LR), N = 84] therapy with oral valganciclovir (900 mg/day vo) for three months according to their basal risk. Patients were monitored for signs and symptoms of CMV disease and CMV plasma viral load was assessed weekly. Results: A total of 31 patients (47%) of the HR and 26 patients(31%) of the LR presented a positive CMV PCR result. Twelve patients(14.3%) in the LR that had a high viral load (CMV PCR >1,000 copies/mL) but remained asymptomatic received pre-emptive therapy. Four patients (4.7%) in the LR, after an average time of 35 days after transplant and two patients (4.5%) in the HR, after prophylactic treatment was completed, developed CMV disease. The disease was mild-moderate in most of the cases. Those patients that developed CMV disease responded to treatment with iv ganciclovir for 14 days followed by treatment with oral valganciclovir for up to three months. Conclusion: Prophylactic treatment with oral valganciclovir for CMV prevention is only required in high risk solid organ transplant recipients (AU)

[Why renal transplant from living donors gives better results than cadaver renal transplant?]. / Por qué el trasplante renal de donante vivo da mejores resultados que el trasplante renalde donante cadáver?

BACKGROUND: According to literature, patient and graft survival is better in living donor renal transplants (LRT) than in cadaver renal transplants (CRT). OBJECTIVE: To study factors that determine the best results in LRT related to those of CRT, found in univariate studies. PATIENTS AND METHODS: Renal transplants (RT) done in Catalonia during the 1990-2004 period, performed in patients over 17 years (135 LRT and 3.831 CRT), have been analyzed (retransplants were not included). The data come from the Renal Patients Transplant Registry (RMRC). Student's t-test and chi2 test have been used for mean and for proportions comparisons, respectively. To analyze univariate and multivariate survival, actuarial method and Cox regression have been used, respectively. Estimated creatinine clearance has been studied and its data have been showed through Selwood modified Analysis. RESULTS: As it happens with other great RT patients series, the RMRC analysis, globally and without any adjustment, shows that patient and graft survival in LRT is better than that obtained with CRT. When we studied which variables explain these results, we found that main factors were smaller recipient age and the short time on dialysis. The great influence of both factors has been published in a large number of papers, explaining the differences obtained on the transplanted renal patient survival. CONCLUSIONS: Once adjusted the analysis by the different factors that influence the survival of the patient and the graft, there are no differences in the obtained results, since the best outcomes of the TRV are due to factors like the smaller recipient age and the advanced TR.

[Assessment of the living renal donor. Analysis of extra-renal pathology as a limitation for donation]. / Estudio del donante vivo renal. Análisis de la patologá extrarrenal como límite a la donación.

The goal of the donor evaluation is to ensure the suitability, safety and well being of the donor. In order to avoid important omissions, the evaluation of potential living kidney donors should be carried according to a protocol that includes a logical sequence of complementary explorations. Old age alone is not an absolute contraindication to donation but the evaluation should be more rigorous, because increased age may be associated with more post-operative complications after nephrectomy and renal function and long term graft survival could be shorter than the ones obtained from younger living donors. A body mass index of more than 35 kg/m2 should be an absolute contraindication to renal donation. Between 30 and 35 kg/m2 the donor evaluation should be more rigorous and it should be recommended to lose weight before nephrectomy. Hypertension is one of the most common reasons to declare a potential kidney donor unsuitable. Evidence of organ damage is an absolute contraindication to kidney donation. The donation is only reasonable when hypertension is well controlled with less than two drugs. To excluded diabetes mellitus all donors should have a fasting plasma glucose measurement. Diabetes mellitus is an absolute contraindication to living donation such as an impaired glucose tolerance or impaired fasting glucose with a family history of type 2 diabetes mellitus. Another contraindication to living donation is malignant disease, and the same standards should be adopted for cadaveric donors. The exceptions are low-grade non-melanoma skin cancer and carcinoma in situ of the uterine cervix. The presence of active infection usually precludes donation. It is very important to perform a routine test for viral infections. HIV, hepatitis B and C infection of the donor are usually a contraindication to living donor. CMV donor and recipient status should be taken into account before transplantation, and the recipients at risk for CMV disease should recieve prophylactic treatment according to the transplant unit policy.

Estudio del donante vivo renal. Análisis de la patología extrarrenal como límite a la donación / Assessment of the living renal donor. Analysis of extra-renal pathology as a limitation for donation

El objetivo de la evaluación de un potencial donante vivo renal es garantizarque su estado de salud sea óptimo, identificar las contraindicaciones absolutas ala donación y evaluar minuciosamente las posibles causas de contraindicación relativacon el fin de minimizar los riesgos a largo plazo.El protocolo de evaluación del donante debe incluir una secuencia lógica deexploraciones complementarias que aseguren los objetivos anteriormente expuestos.La edad avanzada no es una contraindicación absoluta a la donación renal perohay que tener en cuenta que el estudio debe ser más exhaustivo dado que estosdonantes tienen más complicaciones postoperatorias y que la supervivencia delinjerto a largo plazo es inferior a la de los injertos de donantes más jóvenes.La obesidad se considera una contraindicación relativa a la donación renal. Solamentepuede plantearse la donación cuando el IMC es menor de 35 kg/m2, realizandopreviamente estudios más rigurosos y aconsejando perder peso antes dela nefrectomía.La hipertensión arterial es una contraindicación a la donación renal cuando seasocia a lesión de órgano diana. Solamente sería razonable la donación cuandola presión arterial esté bien controlada con un máximo de un fármaco.La presencia de diabetes mellitus, de intolerancia a la glucosa o de glucemiabasal alterada con antecedentes familiares de diabetes tipo 2 contraindicaría ladonación renal. En el resto de situaciones relacionadas con alteraciones del metabolismohidrocarbonato no habría problemas para plantear la donación.Una historia de tumor maligno en un potencial donante contraindica la donación,con la excepción de cáncer de piel tipo no-melanoma o un carcinoma insitu de cervix.La evaluación del donante incluye una serie de test serológicos encaminados aidentificar determinadas infecciones transmisibles. La presencia de serología positivapara HIV, virus hepatitis B y C, contraindicarían habitualmente la donación.La serología positiva para citomegalovirus y virus Epstein-Barr no contraindicaríanla donación pero exigiría plantear un tratamiento profiláctico según la serologíadel receptor

The goal of the donor evaluation is to ensure the suitability, safety and wellbeing of the donor.In order to avoid important omissions, the evaluation of potential living kidneydonors should be carried according to a protocol that includes a logical sequenceof complementary explorations.Old age alone is not an absolute contraindication to donation but the evaluationshould be more rigorous, because increased age may be associated with morepost-operative complications after nephrectomy and renal function and long termgraft survival could be shorter than the ones obtained from younger living donors.A body mass index of more than 35 kg/m2 should be an absolute contraindicationto renal donation. Between 30 and 35 kg/m2 the donor evaluation should bemore rigorous and it should be recommended to lose weight before nephrectomy.Hypertension is one of the most common reasons to declare a potencial kidneydonor unsuitable. Evidence of organ damage is an absolute contraindicationto kidney donation. The donation is only reasonable when hypertension is wellcontroled with less than two drugs.To excluded diabetes mellitus all donors should have a fasting plasma glucosemeasurement. Diabetes mellitus is an absolute contraindication to living donationsuch as an impaired glucose tolerance or impaired fasting glucose with a familyhistory of tipe 2 diabetes mellitus.Another contraindication to living donation is malignant disease, and the samestandars should be adopted as for cadaveric donors. The exceptions are low-gradenon-melanoma skin cancer and carcinoma in situ of the uterine cervix.The presence of active infection usually precludes donation. It is very importantto perform a routine test for viral infections. HIV, hepatitis B and C infection ofthe donor are usually a contraindication to living donor. CMV donor and recipientstatus should be taken into account before transplantation, and the recipienst atrisk for CMV disease should recieve prophylactic treatment according to the transplantunit policy

Living donor renal transplantation in Catalonia: overall results and comparison of survival with cadaveric donor renal transplantation.

OBJECTIVES: To describe the general characteristics of living-donor renal transplantation (LRT) in Catalonia, and to compare results with those of the cadaveric donor renal transplant (CRT). RESULTS: Four hundred seventy-three LRTs have been performed in Catalonia since 1965. Transplantations carried out between 1980 and 2003, according to the RMRC data, were reviewed. The most frequent degrees of kinship are parents-children (48%), spouses (22%), and siblings (18%). Around 68% of the donors were women. Around 56% of recipients were men. The transplant was advanced in approximately 30% of the cases. The mean cold ischemia was 2 hours. Seven percent showed delayed graft function (DGF). Forty-nine percent of the patients had glomerular filtration >60 mL/min after 1 year. Patient survival at 1, 5, 10, and 20 years were 99%, 97%, 93%, and 82% in LRT; and 96%, 90%, 80%, and 62% in CRT (P < .00001). Graft survivals over the same periods were 91%, 76%, 58%, and 32% in LRT, and 85%, 69%, 49%, and 23% in CRT (P = .00008). The graft mean life was 12 years (LRT) and 10 years (CRT). Graft survivals, censoring deaths over the same periods, were 93%, 79%, 62%, and 39% in LRT, and 89%, 77%, 62%, and 37% in CRT (P = .3). Mean life was 14 years in both cases. The recipients mean age was 31 (LRT), and 44 years (CRT), whereas the donor mean age was 51 (LRT), and 42 years (CRT). CONCLUSIONS: LRT results were excellent both regarding DGF and patient and graft survivals. They were not comparable to CRT due to the different characteristics of the recipients. LRT is a good solution to reduce waiting lists.

Post-renal transplantation weight gain: its causes and its consequences.

OBJECTIVE: A tendency to increased body mass index (BMI) occurs after renal transplantation. The objective of this study was to analyze the causes and consequences of this weight gain. METHODS: Two hundred twelve renal transplant recipients were divided into 3 groups according to the evolution of their BMI: BMI loss (group 1); BMI increase <10% (group 2); and BMI increase >10% (group 3). RESULTS: The mean BMI gain was 6.2%, weight gain was 3.9 kg, and BMI gain was 1.4 kg/m(2). The patients in group 3 were younger, but there were no other significant differences in gender, preoperative diabetes, acute rejection, or prior BMI. Blood pressure was similar in all 3 groups, but more group 3 patients needed antihypertensive treatment. A progressive increase in total and low-density lipoprotein (LDL)-cholesterol was also observed as patients showed increased BMI. No differences were observed regarding carbohydrate metabolism. Groups 1 and 3 showed a more unfavorable micro-inflammatory profile. The creatinine clearance level was better in group 3 compared with group 1. We found no differences regarding the number of nonfatal postoperative cardiovascular events.

Síndrome antifosfolipídico / No disponible

El síndrome antifosfolipídico (SAFL) se caracteriza por la presencia de autoanticuerpos antifosfolípidicos (aFL) o de autoanticuerpos dirigidos contra proteínas de las membranas celulares. Sus manifestaciones clínicas consisten en trombosis arteriales o venosas y abortos de repetición. Puede manifestarse de forma aislada o asociada a enfermedades autoinmunes como el lupus eritematoso sistémico. A nivel renal, se observa trombosis de grandes vasos o de los capilares glomerulares (microangiopatía trombólica). En caso de afectación de 3 o más órganos, sistemas o tejidos se produce un SAFL catastrófico. El tratamiento consiste en una anticoagulación agresiva con heparina seguida de antivitamina K (AU)

The association of thrombotic events and/or pregnacy complications with circulating antiphospholipid antibodies defines antiphospholipid syndrome (APS). It can occur in patients without any disease. Beta 2 glycoprotein I-dependent anticardiolipin and lupus anticoagulant are the diagnostic tools. Renal involvement consists mainly of Thrombotic vascular complications involving large vessels or intrarenal small-sized vessels (thrombotic microangiopathy). A minority of patients may develop an acute catastrophic or devastating syndrome with multiple vascular occlusions. Treatment is based on IV beparin followed by warfarin (AU)