RESUMEN
OBJECTIVE: The objective of this study is to assess a Simulect (basiliximab) regimen in routine clinical practice in the Spanish kidney transplantation units to evaluate efficacy and safety. METHODS: In this prospective, observational study, data on demographics, parameters of efficacy, and safety in patients who under with kidney transplantation treated with Simulect (basiliximab) were collected through an on-line collection system. RESULTS: One hundred sixty three patients at 18 kidney transplant units included 12 months follow-up. The patient mean age was 52 years (DS 13,67) including 96 (58.90%) men and 67 (41.10%) women. Cold ischemia time was 19 hours (DS 6,79). Only 2 patients presented with PRA >50%. For prophylactic immunosuppression, 67.13% of patients received triple therapy with CNI (cyclosporine 49.65% or tacrolimus 17.48%), MMF (66.43%) or AZA (10.49%), and steroids. Incidence of acute rejection (AR) at 12 months was 12.27% (1.84% steroid-resistant). In subgroup analysis, AR was 13.5% in nondiabetics and 4.5% in diabetics, including 3 steroid-resistant episodes (1.84%) in nondiabetics and none in diabetics. In relation to donor age, AR was incidence 10.3% in patients with kidneys from donors aged 50 years or younger and 10.6% when donors were older than 50 years, including 1 (1.73%) and 2 (1.93%) steroid-resistant episodes, respectively. The graft and patient survival rates at 12 months were 90% and 98%, respectively. CONCLUSIONS: Simulect (basiliximab) used in routine clinical practice provided good prophylaxis against acute rejection in several kidney transplant patient populations, similar to that observed in randomized clinical studies with excellent tolerability and safety.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Trasplante de Riñón/inmunología , Proteínas Recombinantes de Fusión , Corticoesteroides/uso terapéutico , Factores de Edad , Basiliximab , Resistencia a Medicamentos , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Rechazo de Injerto/epidemiología , Humanos , Inmunosupresores/uso terapéutico , Trasplante de Riñón/mortalidad , Masculino , Persona de Mediana Edad , Estudios Prospectivos , España , Análisis de Supervivencia , Factores de TiempoRESUMEN
To evaluate the efficacy and safety of conversion from cyclosporine to tacrolimus, we analyzed 55 kidney transplant patients who were converted due to cosmetic reasons in 42 patients, acute rejection in 2 patients, and other causes in 11 patients. At the doses and levels used, the development of diabetes mellitus was minimized. Disappearance of cosmetic side-effects and improvement of cardiovascular risk factors, together with conservation of renal function, encourage us to use tacrolimus as an efficacious and safe immunosuppressive therapy.
Asunto(s)
Ciclosporina/efectos adversos , Trasplante de Riñón/inmunología , Tacrolimus/uso terapéutico , Adulto , Glucemia/metabolismo , Presión Sanguínea , Colesterol/sangre , Femenino , Estudios de Seguimiento , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Masculino , Estudios Retrospectivos , Seguridad , Factores de Tiempo , Ácido Úrico/sangreAsunto(s)
Ciclosporina/uso terapéutico , Supervivencia de Injerto/fisiología , Trasplante de Riñón/inmunología , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapéutico , Tacrolimus/uso terapéutico , Cadáver , Quimioterapia Combinada , Femenino , Rechazo de Injerto/epidemiología , Humanos , Fallo Renal Crónico/etiología , Fallo Renal Crónico/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/epidemiología , Terapia de Reemplazo Renal , Estudios Retrospectivos , Factores de Tiempo , Donantes de Tejidos , Insuficiencia del TratamientoAsunto(s)
Inmunosupresores/uso terapéutico , Enfermedades Renales/patología , Trasplante de Riñón/inmunología , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapéutico , Adulto , Biopsia , Creatinina/metabolismo , Femenino , Humanos , Enfermedades Renales/tratamiento farmacológico , Trasplante de Riñón/patología , Trasplante de Riñón/fisiología , Masculino , España , Trasplante Homólogo/inmunología , Trasplante Homólogo/patologíaRESUMEN
No disponible
Asunto(s)
Humanos , Trasplantes/efectos adversos , Neoplasias/epidemiología , Detección Precoz del Cáncer/métodos , Inmunología del Trasplante , Inmunosupresores/uso terapéutico , Selección de Donante/métodos , Recurrencia Local de Neoplasia/epidemiología , Virus Oncogénicos/patogenicidadAsunto(s)
Fallo Renal Crónico/terapia , Terapia de Reemplazo Renal , Adulto , Niño , Costos y Análisis de Costo , Complicaciones de la Diabetes , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/mortalidad , Trasplante de Riñón , Calidad de Vida , Diálisis Renal , Terapia de Reemplazo Renal/efectos adversos , Terapia de Reemplazo Renal/economíaAsunto(s)
Neoplasias/epidemiología , Complicaciones Posoperatorias/epidemiología , Trasplante , Carcinógenos/efectos adversos , Transformación Celular Neoplásica , Ciclosporina/efectos adversos , Predisposición Genética a la Enfermedad , Humanos , Huésped Inmunocomprometido , Terapia de Inmunosupresión/efectos adversos , Incidencia , Trasplante de Riñón , Trastornos Linfoproliferativos/tratamiento farmacológico , Trastornos Linfoproliferativos/etiología , Melanoma/epidemiología , Melanoma/etiología , Metástasis de la Neoplasia , Neoplasias/etiología , Neoplasias/cirugía , Neoplasias Inducidas por Radiación/epidemiología , Neoplasias Inducidas por Radiación/etiología , Neoplasias Primarias Secundarias/epidemiología , Neoplasias Primarias Secundarias/etiología , Células Madre Neoplásicas/trasplante , Oncogenes , Complicaciones Posoperatorias/etiología , Prevalencia , Recurrencia , Riesgo , Sarcoma de Kaposi/epidemiología , Sarcoma de Kaposi/etiología , Sarcoma de Kaposi/terapia , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/etiología , Neoplasias Cutáneas/terapia , Trasplante/efectos adversos , Infecciones Tumorales por Virus/epidemiología , Infecciones Tumorales por Virus/transmisión , Rayos UltravioletaRESUMEN
No disponible
No disponible
Asunto(s)
Humanos , Niño , Adulto , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/terapia , Terapia de Reemplazo Renal/efectos adversos , Terapia de Reemplazo Renal/economía , Costos y Análisis de Costo , Complicaciones de la Diabetes , Trasplante de Riñón , Calidad de Vida , Diálisis RenalAsunto(s)
Azatioprina/uso terapéutico , Ciclosporina/uso terapéutico , Inmunosupresores/uso terapéutico , Trasplante de Riñón/inmunología , Ácido Micofenólico/análogos & derivados , Adolescente , Adulto , Anciano , Causas de Muerte , Creatinina/sangre , Quimioterapia Combinada , Femenino , Rechazo de Injerto/epidemiología , Rechazo de Injerto/prevención & control , Humanos , Inmunosupresores/efectos adversos , Trasplante de Riñón/mortalidad , Trasplante de Riñón/fisiología , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Ácido Micofenólico/efectos adversos , Ácido Micofenólico/uso terapéutico , Prednisona/uso terapéutico , Análisis de SupervivenciaAsunto(s)
Ciclosporina/sangre , Ciclosporina/uso terapéutico , Inmunosupresores/sangre , Inmunosupresores/uso terapéutico , Trasplante de Riñón/inmunología , Administración Oral , Ciclosporina/administración & dosificación , Ciclosporina/farmacocinética , Emulsiones , Estudios de Seguimiento , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/farmacocinética , España , Factores de TiempoRESUMEN
BACKGROUND: In renal transplantation, triple-drug therapy (low-dose cyclosporine [CsA] combined with azathioprine plus steroids) has been replacing double-drug therapy (CsA plus steroids) in clinical practice without much evidence in favor of either therapy. Previous trials comparing the two immunosuppressive regimens gave conflicting results. We attempted to determine whether triple therapy is at least equivalent to double therapy. METHODS: A randomized trial was performed in 250 adult cadaveric renal transplant recipients, comparing double therapy (CsA [10 mg/kg/day] plus prednisone) with triple therapy (CsA [6 mg/kg/day] plus azathioprine plus prednisone). The median follow-up time was 930 days. RESULTS: The incidence of acute rejection episodes refractory to treatment was 11% in double therapy and 4% in triple therapy (relative risk reduction: 64%; 95% confidence interval: 5-100%; P=0.035). Patients in the double therapy group required more intensive antirejection treatment, and their pathologic lesions were more severe. The proportion of patients with acute rejection was similar (double therapy: 45% vs. triple therapy: 40%) as was the incidence of chronic renal dysfunction (double therapy: 17% vs. triple therapy: 15.5%), the 4-year graft survival (double therapy: 71% vs. triple therapy: 83%, P=0.089), and patient survival (double therapy: 94% vs. triple therapy: 93%). In 29 patients (23%), 35 episodes of azathioprine-induced leukopenia were recorded, and in 9 of them azathioprine had to be discontinued. The incidence of other adverse events did not differ between the groups. CONCLUSIONS: Triple therapy caused fewer episodes of refractory acute rejection episodes and was as efficacious and safe as double therapy.
Asunto(s)
Azatioprina/administración & dosificación , Ciclosporina/administración & dosificación , Inmunosupresores/administración & dosificación , Trasplante de Riñón/métodos , Prednisona/administración & dosificación , Enfermedad Aguda , Adolescente , Adulto , Ciclosporina/sangre , Supervivencia sin Enfermedad , Combinación de Medicamentos , Femenino , Estudios de Seguimiento , Rechazo de Injerto/prevención & control , Humanos , Inmunosupresores/efectos adversos , Riñón/fisiología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Análisis de Regresión , Factores de TiempoAsunto(s)
Etnicidad , Antígeno HLA-DR1/genética , Enfermedades Renales Poliquísticas/genética , Alelos , Frecuencia de los Genes , Ligamiento Genético , Antígenos HLA-A/genética , Antígenos HLA-B/genética , Antígenos HLA-DQ/genética , Cadenas beta de HLA-DQ , Antígenos HLA-DR/genética , Cadenas HLA-DRB1 , Humanos , Enfermedades Renales Poliquísticas/epidemiología , Enfermedades Renales Poliquísticas/inmunología , Reacción en Cadena de la Polimerasa , Polimorfismo Conformacional Retorcido-Simple , Riesgo , Factores de Riesgo , España/epidemiologíaRESUMEN
UNLABELLED: Renal tubular acidosis is a syndrome of disordered renal acidification, we have studied a group of patients transplanted. Their cases clinic patients have been analyzed with no-present infectious disease, or tubulointerstitial diseases or urinary infection, immunosuppression with prednisone and azatioprine only, no have to ingest cyclosporine and period graft superior 3 months. We haven't neither patient with proximal renal tubular acidosis. We have been reported 7 cases of distal renal tubular acidosis. All the patients have make the furosemide test. Only one case hyperkalemia renal tubular acidosis. Histologic kidney had been chronic rejection. CONCLUSION: renal tubular acidosis is not infrequent of kidney transplantation and this syndrome connect with chronic rejection.
Asunto(s)
Acidosis Tubular Renal/diagnóstico , Trasplante de Riñón/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Acidosis Tubular Renal/fisiopatología , Biopsia , Cadáver , Rechazo de Injerto/diagnóstico , Rechazo de Injerto/fisiopatología , Humanos , Riñón/patología , Trasplante de Riñón/fisiología , Complicaciones Posoperatorias/fisiopatologíaAsunto(s)
Hepacivirus/inmunología , Anticuerpos Antihepatitis/sangre , Hepatitis C/epidemiología , Diálisis Renal , Adolescente , Adulto , Ensayo de Inmunoadsorción Enzimática , Femenino , Hepatitis C/sangre , Hepatitis C/transmisión , Anticuerpos contra la Hepatitis C , Humanos , Masculino , Persona de Mediana Edad , Diálisis Renal/efectos adversos , Factores de Riesgo , Factores de TiempoRESUMEN
Problems found in the development of a program for individual supplementation of fluoride to infants and pre-school children in a primary pediatric outpatient unit are commented. Problems included knowledge of the level of fluoride in public water supply, in infant formulas and in mineral water used in their preparation and selection of a practical and regular method for supplying fluoride in the first year (having in mind other sources of fluoride) and in older children, and taking into account economic problems. Practical tables with the amount of fluoride in Spanish drinkable water, in commonly available infant formulas and mineral bottled waters, are shown.
Asunto(s)
Caries Dental/prevención & control , Fluoruros/administración & dosificación , Administración Oral , Factores de Edad , Niño , Preescolar , Fluoruración , Fluorosis Dental/prevención & control , Humanos , Lactante , Alimentos InfantilesRESUMEN
A prospective study is made of the tuberculin test sensitivity at 3 and 12 months after neonatal vaccination with BCG. From the results obtained in 419 tests the conclusion is that the percentage of positive tests is 3.8% and 1.6% at 3 and 12 months respectively, considering the threshold of positivity equal or superior to 10 mm (or 18.9 y 5.6% respectively with the threshold at 5 mm). These results are lower than the ones described previously, and therefore the conclusion is that in Cantabria the tuberculin tests should be valued without taken in consideration the antecedent of previous vaccination with BCG.