Profilaxis combinada con inmunoglobulina intravenosa y plasmaféresis en pacientes altamente sensibilizados, receptores de trasplante renal o combinado hígado-riñón: experiencia en un centro médico colombiano / Combined prophylaxis with intravenous immunoglobulin and plasmapheresis in highly sensitized patients, recipients of kidney or combined liver-kidney transplant: experience in a Colombian medical center

El trasplante renal constituye la mejor opción de tratamiento para los pacientes con enfermedad renal crónica terminal. La supervivencia del injerto es de gran importancia y puede ser afectada por factores inmunológicos o no inmunológicos; esto unido al número de pacientes en las listas de espera, hace necesario definir estrategias de manejo que permitan tener mejores resultados a largo plazo. Objetivo. Determinar las características clínicas y humorales, y los desenlaces en receptores de trasplante renal o combinado hígado-riñón, altamente sensibilizados, que recibieron profilaxis combinada con inmunoglobulina intravenosa y plasmaféresis en el Hospital San Vicente Fundación, en Colombia. Materiales y métodos. Se realizó un estudio retrospectivo, observacional, descriptivo, que incluyó los pacientes trasplantados entre el 4 de julio de 2010 y el 19 de abril de 2017. Como variables se incluyeron, entre otras, la etiología de la enfermedad renal crónica, el tipo de terapia recibida, y el tiempo en lista de espera en días. Como desenlace se evaluó la presencia de rechazo, el tipo de rechazo, la pérdida del injerto, las complicaciones y la muerte. Resultados. Del total de 25 pacientes, el 100% recibió inmunoglobulina intravenosa y el 84% plasmaféresis. El 12% presentó rechazo del injerto, todos de tipo humoral, y el 20% perdió el injerto. Discusión. A pesar de la gran variedad de protocolos propuestos en la literatura, en esta población especial no se ha establecido un protocolo óptimo de inmunosupresión. El protocolo en nuestra pequeña cohorte no tuvo un impacto negativo en el porcentaje de infecciones postrasplante ni en la pérdida del injerto renal, pero sí redujo el tiempo en las listas de espera; por lo tanto, se requieren estudios adicionales para confirmar los hallazgos encontrados en este estudio

Kidney transplantation is the best treatment option for patients with terminal chronic kidney disease, regardless of the etiology, making graft survival an important feature, which may be affected by immunological or non-immunological factors. This, added to the increasing number of patients on waiting lists, makes it necessary to define management strategies for these patients that allow better long-term results. Objectives. To determine the clinical, humoral and outcome characteristics in highly sensitized recipients of kidney and simultaneous kidneyliver transplant who received combined prophylaxis with intravenous immunoglobulin and plasmapheresis therapy in a Colombian medical center. Materials and methods. A retrospective, observational, descriptive study was carried out that included the transplanted patients between July 4, 2010 and April 19, 2017. Variables included the etiology of chronic kidney disease, the type of therapy received, and waiting time in days, among others. As outcomes, the presence of rejection, type of rejection, graft loss, complications and death were evaluated. Results. From a total of 25 patients, 100% received intravenous immunoglobulin and 84% plasmapheresis. Twelve percent presented graft rejection, all humoral, and 20% lost the graft. Discussion. Despite the great variety of protocols proposed in the literature, an optimal immunosuppression protocol has not been established for this particular population. The protocol in our small cohort did not have a negative impact on the percentage of post-transplant infections nor in the loss of the renal graft, but it did reduce waiting time; therefore, additional studies are required to confirm the findings in this study

Peritoneal dialysis-related peritonitis: twenty-seven years of experience in a Colombian medical center

Peritonitis has been the most common complication of continues ambulatory peritoneal dialysis (CAPD) since it was first implemented, and it remains the leading cause of treatment failure and transfer to other renal replacement therapies. This study presents a Colombian series with a total of 2,469 episodes of peritonitis in 914 patients from a cohort of 1,497 patients on PD, who were followed for almost three decades at a single center. This is the largest Latin American series of patients with PD-related peritonitis. Objective: To describe the CAPD-related peritonitis in a cohort of patients followed for 27 years at a single center, and compare the results with those observed elsewhere in the world. Study Design: Prospective study of incident patients on CAPD from March 1981 to December 2008. Results: In our center, the rate of peritonitis has been steady between 0.8 and 0.9 since 1981 and no significant changes have been noticed in the 27 years of follow up. The rate remains similar to that described nowadays by other large dialysis centers in the world, which have reported significant improvements in recent decades. No significant differences were found in the isolates of gram-positive and gram-negative microorganisms or fungi with respect to those reported by other large series, or in the frequency of culture-negative peritonitis. Conclusion: This study presents the largest Latin American series of patients with CAPD-related peritonitis with a total of 2,469 patients. In this study, the rate of CAPD-related peritonitis remained almost the same during the three decades of observation despite having used three different CAPD systems. Our hypothesis is that the socio-economic conditions of the patients admitted for peritoneal dialysis influences the rate of peritonitis (AU)

Desde que se implementó por primera vez, la peritonitis ha sido la complicación más común de la diálisis peritoneal ambulatoria continua (DPAC) y sigue siendo la causa principal del fracaso del tratamiento y del cambio a otros tratamientos renales sustitutivos. En este estudio se presenta una serie colombiana de un total de 2469 episodios de peritonitis en 914 pacientes de una cohorte de 1497 pacientes en diálisis peritoneal (DP), que fueron sometidos a seguimiento durante casi tres décadas en un único centro. Se trata de la mayor serie de Latinoamérica de pacientes con peritonitis asociada con DP. Objetivo: Describir la peritonitis asociada con la DPAC en una cohorte de pacientes sometidos a seguimiento durante 27 años en un único centro y comparar los resultados con los observados en otras partes del mundo. Diseño del estudio: Estudio prospectivo de pacientes incidentes de DPAC desde marzo de 1981 hasta diciembre de 2008. Resultados: En nuestro centro, la tasa de peritonitis ha permanecido estable entre 0,8 y 0,9 desde 1981 y no se han observado cambios significativos en los 27 años de seguimiento. La tasa es similar a la descrita actualmente por otros grandes centros de diálisis del mundo, que han registrado importantes mejoras en las últimas décadas. No se detectaron diferencias significativas en las muestras aisladas de microorganismos gram positivos o gram negativos u hongos en lo que respecta a los registrados en otras grandes series ni en la frecuencia de peritonitis con cultivo negativo. Conclusión: En este estudio se presenta la mayor serie de Latinoamérica de pacientes con peritonitis asociada con DPAC con un total de 2469 pacientes. La tasa de peritonitis asociada con DPAC permaneció prácticamente inalterable durante las tres décadas de observación, a pesar de haber utilizado tres sistemas diferentes de DPAC. Nuestra hipótesis es que las condiciones socioeconómicas de los pacientes ingresados para diálisis peritoneal influyen en la tasa de peritonitis

Peritoneal dialysis-related peritonitis: twenty-seven years of experience in a Colombian medical center.

UNLABELLED: Peritonitis has been the most common complication of continues ambulatory peritoneal dialysis (CAPD) since it was first implemented, and it remains the leading cause of treatment failure and transfer to other renal replacement therapies. This study presents a Colombian series with a total of 2,469 episodes of peritonitis in 914 patients from a cohort of 1,497 patients on PD, who were followed for almost three decades at a single center. This is the largest Latin American series of patients with PD-related peritonitis. OBJECTIVE: To describe the CAPD-related peritonitis in a cohort of patients followed for 27 years at a single center, and compare the results with those observed elsewhere in the world. STUDY DESIGN: Prospective study of incident patients on CAPD from March 1981 to December 2008. RESULTS: In our center, the rate of peritonitis has been steady between 0.8 and 0.9 since 1981 and no significant changes have been noticed in the 27 years of follow up. The rate remains similar to that described nowadays by other large dialysis centers in the world, which have reported significant improvements in recent decades. No significant differences were found in the isolates of gram-positive and gram-negative microorganisms or fungi with respect to those reported by other large series, or in the frequency of culture-negative peritonitis. CONCLUSION: This study presents the largest Latin American series of patients with CAPD-related peritonitis with a total of 2,469 patients. In this study, the rate of CAPD-related peritonitis remained almost the same during the three decades of observation despite having used three different CAPD systems. Our hypothesis is that the socio-economic conditions of the patients admitted for peritoneal dialysis influences the rate of peritonitis.