Virulence factors and antimicrobial resistance of Staphylococcus aureus isolated from the production process of Minas artisanal cheese from the region of Campo das Vertentes, Brazil.

Staphylococcus aureus is one of the main pathogens found in cheeses produced with raw milk, including Minas artisanal cheese from Brazil. However, information about S. aureus isolated from artisanal cheeses and its sources of production in small-scale dairies is very limited. We aimed to characterize the virulence factors of S. aureus isolated from raw milk, endogenous starter culture, Minas artisanal cheese, and cheese handlers from the region of Campo das Vertentes, Minas Gerais, Brazil. We identified the staphylococcal isolates by MALDI-TOF mass spectrometry. We evaluated biofilm production on Congo red agar and polystyrene plates. We used PCR to detect icaA, icaB, icaC, sea, seb, sec, sed, see, tsst-1, agr, and mecA. We evaluated the expression of staphylococcal toxin genes in PCR-positive staphylococcal isolates using quantitative reverse-transcription PCR, and we evaluated the production of these toxins and their hemolytic activity in vitro. We also evaluated the antimicrobial resistance profile of the staphylococcal isolates. For statistical analysis, we used cluster analysis, χ2 tests, and correspondence tests. We analyzed 76 staphylococcal isolates. According to PCR, 18.42, 18.42, 2.63, and 77.63% were positive for sea, tsst-1, sec, and agr, respectively. We found low expression of staphylococcal toxin genes according to quantitative reverse-transcription PCR, and only 2 staphylococcal isolates produced toxic shock syndrome toxins. A total of 43 staphylococcal isolates (56.58%) had hemolytic activity; 53 were biofilm-forming on Congo red agar (69.73%), and 62 on polystyrene plates (81.58%). None of the staphylococcal isolates expressed the mecA gene, and none presented a multi-drug resistance pattern. The highest resistance was observed for penicillin G (67.11%) in 51 isolates and for tetracycline (27.63%) in 21 isolates. The staphylococcal isolates we evaluated had toxigenic potential, with a higher prevalence of sea and tsst-1. Biofilm production was the main virulence factor of the studied bacteria. Six clusters were formed whose distribution frequencies differed for hemolytic activity, biofilm formation (qualitative and quantitative analyses), and resistance to penicillin, tetracycline, and erythromycin. These findings emphasize the need for effective measures to prevent staphylococcal food poisoning by limiting S. aureus growth and enterotoxin formation throughout the food production chain and the final product.

A Survival Analysis of Living Donor Kidney Transplant.

BACKGROUND: Superior patient and graft survival rates have been attributed to living donor kidney transplant (LDKT) when compared to deceased donor transplantation. The aim of this study was to assess graft survival in a population of LDKT in the last 14 years and the potential impact of some clinical features. METHODS: A retrospective observational study was conducted, reviewing the records of all patients undergoing LDKT in one center from January 1, 2004, to December 31, 2017. Survival data were evaluated by Kaplan-Meier, log rank test, and Cox regression. RESULTS: Two hundred seventy-seven LDKT were performed. The median follow-up time was 4 (0-13) years. Graft loss was observed in 9% of patients; 4 patients died. The overall survival was 97% at year 1, 94% at year 5, and 83% at years 10 and 13. We found a significantly worse graft survival in patients with early vascular complications that required surgical intervention (P = .00) ≥3 HLA MM (P = .01), ≥1 HLA-DR MM (P = .04) and female recipients (P = .01). The negative impact of ≥1 HLA-B MM on survival was borderline (P = .05). After excluding early graft losses secondary to vascular events, ≥1 HLA-A MM and rejection have also implicated a negative impact on survival (P = .04 and .01, respectively). In the multivariate analysis, these variables were still related to inferior survival. CONCLUSIONS: We observed a good overall graft survival (>80% after 13 years). Possible factors related to poor outcomes suggested by this study were early vascular complications; HLA mismatches; rejection; and, with less certainty, female recipients.

How does methylphenidate affect default mode network? A systematic review. / Como afecta el metilfenidato al circuito de activacion por defecto? Revision sistematica.

INTRODUCTION: Methylphenidate is a widely-used drug for the treatment of attention deficit/hyperactivity disorder (ADHD) and other neuropsychiatric disorders. Sustained-attention deficits and poorer task performance in these disorders have been associated with default mode network (DMN) dysfunction in fMRI studies. DMN is a set of brain areas more activated during the resting-state. Under the execution of external tasks, there is an attenuation of DMN activity. In healthy individuals, DMN and task-positive network are anticorrelated. It has been suggested that methylphenidate could normalize the attenuated task-related DMN deactivation in attention- and inhibitory control-related disorders and that such normalization could improve task performance. PATIENTS AND METHODS: To explore the hypothesis of DMN deactivation after methylphenidate administration, we conducted a systematic review of the literature. RESULTS: After a systematic search, 12 studies were included in this review. For eligibility, studies were required to measure the effects of methylphenidate administration on the DMN activity. Eleven studies showed evidence of MPH-induced improvements in brain areas related to DMN. The results suggest a normalization of brain circuits in individuals with DMN dysfunction. CONCLUSIONS: Our preliminary findings strongly suggest methylphenidate improves DMN dysfunction presented in ADHD and other neuropsychiatric disorders. Further studies are needed to better understand this effect and expand comprehension of methylphenidate action mechanisms.

TITLE: Como afecta el metilfenidato al circuito de activacion por defecto? Revision sistematica.Introduccion. El metilfenidato es un farmaco ampliamente usado como tratamiento del trastorno por deficit de atencion/hiperactividad (TDAH) y otros trastornos neuropsiquiatricos. La dificultad para mantener la atencion de forma prolongada y la deficiente ejecucion de tareas que caracterizan a tales trastornos se han vinculado a la disfuncion del circuito de activacion por defecto ­default mode network (DMN)­­, revelado en estudios de resonancia magnetica funcional. En los individuos sanos, el DMN y la red orientada a tareas (task-positive network) presentan una relacion inversa. Se ha planteado que el metilfenidato revertiria la escasa desactivacion del DMN durante la ejecucion de tareas que caracteriza a los trastornos de la atencion y del control inhibitorio, normalizacion que a su vez mejoraria la ejecucion de las tareas. Pacientes y metodos. Con objeto de examinar la hipotesis de que este farmaco propicia tal desactivacion, se llevo a cabo una revision sistematica de la bibliografia. Resultados. Doce estudios se incluyeron finalmente en la revision. Para ello, debian haber medido los efectos de la administracion del metilfenidato sobre la actividad del DMN. Once estudios mostraron indicios de mejora atribuible al metilfenidato en areas cerebrales vinculadas a dicho circuito. Los resultados indican la normalizacion de los circuitos cerebrales en los pacientes con disfuncion del DMN. Conclusiones. Los hallazgos preliminares ofrecen indicios solidos de que el metilfenidato mejora la disfuncion del DMN presente en el TDAH y otros trastornos neuropsiquiatricos. Se precisan nuevos estudios que diluciden los pormenores de este efecto y mejoren la comprension sobre los mecanismos de accion del metilfenidato.

Milk fermented by Lactobacillus species from Brazilian artisanal cheese protect germ-free-mice against Salmonella Typhimurium infection.

Ingestion of milks fermented by Lactobacillus strains showing probiotic properties is an important tool to maintain gastrointestinal health. In this study, Lactobacillus rhamnosus D1 and Lactobacillus plantarum B7, isolated from Brazilian artisanal cheese, were used as starters for the functional fermented milks to assess their probiotic properties in a gnotobiotic animal model. Male germ-free Swiss mice received a single oral dose of milk fermented by each sample, and were challenged with Salmonella Typhimurium five days afterwards. Milk fermented by both Lactobacillus strains maintained counts above 108 cfu/ml during cold storage. Lactobacillus strains colonised the gut of the germ-free-mice, maintaining their antagonistic effect. This colonisation led to a protective effect against Salmonella challenge, as demonstrated by reduced pathogen translocation and histological lesions, when compared to control group, especially for Lactobacillus rhamnosus D1. Additionally, mRNA expression of inflammatory (interferon gamma, interleukin (IL)-6, tumour necrosis factor alpha) and anti-inflammatory (transforming growth factor ß1) cytokines was augmented in animals previously colonised and then challenged, when compared to other experimental groups. Lactobacillus plantarum B7 colonisation also promoted higher expression of IL-17, showing a proper maturation of colonised germ-free-mice immune system. IL-5 was stimulated by both strains' colonisation and not by S. Typhimurium challenge.

Biofilm and toxin profile: A phenotypic and genotypic characterization of coagulase-negative staphylococci isolated from human bloodstream infections.

Coagulase-negative staphylococci (CNS) represent one of the most prevalent microorganisms in nosocomial infections worldwide, nevertheless little is known about their pathogenicity features. Thus, our aim was to characterize virulence aspects of CNS isolated from patients with bloodstream infections assisted in hospitals of Belo Horizonte, MG, Brazil. Strains were identified using bioMérieuxVitek® and for biofilm production evaluation, Congo Red Agar (CRA) and polystyrene plates were used. PCR was applied to detect icaA, icaB, icaC, atlE, sea, sec, sed, tsst-1 and agr. For statistical analyses were used hierarchical cluster, chi-square test and correspondence. 59 strains were analyzed, being S. haemolyticus the most prevalent. On CRA, 96.5% were biofilm producer, whereas on polystyrene plate, 100% showed adhesion at different times evaluated. Regarding genotypic analyses, 15.2%, 38.9%, 8.4%, 49.1%, 76.2%, 23.7%, 1.6%, 30.5% and 38.9% were positive for icaA, icaB, icaC, atlE, sea, sec, sed, tsst-1 and agr, respectively. Six clusters were formed and frequency distributions of agr, atlE, icaA, icaB, sea, sec, tsst-1 differed (P < 0.001). In conclusion, all strains were biofilm producer, with high prevalence of atlE, and had potential of toxin production, with high prevalence of sea. According to the group-analyses, icaB showed relationship with the strong adherence in samples.

Conversion From Twice-Daily to Once-Daily Tacrolimus in Stable Kidney Graft Recipients.

INTRODUCTION: Immunosuppression has a pivotal role in kidney transplantation. The new prolonged-release formulation of tacrolimus was developed to provide a more convenient once-daily dosing to improve patient adherence. METHODS: We selected 60 stable kidney transplant recipients who underwent tacrolimus conversion in our unit. Conversion was made on a 1 mg:1 mg basis in 66.7% of patients (n = 40) and on a 1 mg:1.1 mg basis in the remaining 33.3% (n = 20). Clinical and analytical data at conversion and postconversion was analyzed retrospectively to evaluate the efficacy and safety of conversion from tacrolimus twice-daily to once-daily formulation. RESULTS: A significant reduction in tacrolimus blood levels requiring an increase in tacrolimus daily dose was observed postconversion. Postconversion tacrolimus blood level reduction >25% was significantly higher in the conversion group 1 mg:1 mg basis (P = .004). In patients converted 1 mg:1 mg, female sex and higher tacrolimus level at conversion were significant risk factors for a reduction >25% in tacrolimus blood levels after conversion. No significant change was detected between mean glomerular filtration rate at conversion (57 mL/min) and at 3, 6, and 9 months postconversion. CONCLUSIONS: Once-daily tacrolimus at similar doses to the twice-daily formulation is an efficient and safe treatment option. Conversion made on 1 mg:1.1 mg basis seems advantageous at least in some patients.

Low transplantability of 0 blood group and highly sensitized candidates in the Portuguese kidney allocation algorithm: quantifying an old problem in search of new solutions.

The impact of patient's biological differences in waiting time for kidney transplantation is well known and has been a subject of extensive debate and struggle in transplantation community. Our purpose was to evaluate patient's access to kidney transplantation in Portugal, regarding their degree of allosensitization and blood type. A retrospective cohort study including 1020 candidates for kidney transplantation between 01 January 2010 and 31 December 2011 in transplant unit Centro Hospitalar do Porto was performed. The deceased donor organ offer by blood type decreased with the calculated panel reactive antibody (cPRA) increase for A and B blood groups candidates, while in 0 blood group candidates, a significant reduction in organ offer was only observable in hypersensitized (HS) ones. As a consequence, the median waiting time was also significantly higher in 0 blood group patients, when compared to the remaining groups. However, waiting time increased extensively with cPRA regardless blood type, especially HS patients with increases of 368%, 632%, 486%, and 140% for blood groups A, B, AB, and 0, respectively, when compared to each blood group global median waiting time. Our study shows that important measures need to be undertaken in order to mitigate the huge disadvantage that HS and 0 blood type patients naturally have.

Saccharomyces cerevisiae UFMG A-905 treatment reduces intestinal damage in a murine model of irinotecan-induced mucositis.

Indigenous microbiota plays a crucial role in the development of several intestinal diseases, including mucositis. Gastrointestinal mucositis is a major and serious side effect of cancer therapy, and there is no effective therapy for this clinical condition. However, some probiotics have been shown to attenuate such conditions. To evaluate the effects of Saccharomyces cerevisiae UFMG A-905 (Sc-905), a potential probiotic yeast, we investigated whether pre- or post-treatment with viable or inactivated Sc-905 could prevent weight loss and intestinal lesions, and maintain integrity of the mucosal barrier in a mucositis model induced by irinotecan in mice. Only post-treatment with viable Sc-905 was able to protect mice against the damage caused by chemotherapy, reducing the weight loss, increase of intestinal permeability and jejunal lesions (villous shortening). Besides, this treatment reduced oxidative stress, prevented the decrease of goblet cells and stimulated the replication of cells in the intestinal crypts of mice with experimental mucositis. In conclusion, Sc-905 protects animals against irinotecan-induced mucositis when administered as a post-treatment with viable cells, and this effect seems to be related with the reduction of oxidative stress and preservation of intestinal mucosa.

Effect of Different Sensitization Events on HLA Alloimmunization in Kidney Transplantation Candidates.

BACKGROUND: HLA alloimmunization is caused by sensitization events (SEs), such as transfusion, pregnancy, or previous organ transplantation, and the effects of particular SEs have not been thoroughly studied. Our aim was to evaluate how each SE affected HLA alloimmunization by considering Luminex assays. METHODS: Sera from 722 kidney transplantation candidates were screened per protocol by means of Luminex assays to determine the presence of anti-HLA class I/II antibodies; positive sera underwent single-antigen assay to determine the presence of specific antibodies against HLA A, B, C, DR, DQ, DP loci (positivity if median fluorescence intensity values were >1,000). The effect of each SE was analyzed considering only patients exposed to 1 kind of sensitization. RESULTS: In the 453 candidates with ≥1 SE, anti-HLA class I positivity rates were significantly higher in patients with previous transfusion (18.9%; P = .014), pregnancy (38.3%; P < .001) or transplant (75%; P < .001) compared with those with no SE (similar results for class II). The strength (median fluorescence intensity) of specific antibodies was significantly higher in patients with previous transplantation than in those with previous transfusion for HLA-A (8,017 vs 2,302; P = .02), HLA-B (7,765 vs 2,901; P = .018), and HLA-DR (9,835 vs 2,060; P = .003). Other anti-HLA antibody strengths were similar between patients with previous pregnancy or transplantation. CONCLUSIONS: Presence of any SE analyzed was associated with a higher prevalence of anti-HLA antibodies for class I ± II compared with nonsensitized patients. Transplantation had the strongest immunization effect on both classes, followed by pregnancy and then transfusion.

Kidney transplantation across a positive crossmatch: a single-center experience.

BACKGROUND: Kidney transplantation is the treatment of choice for end-stage renal disease, with improved mortality and quality of life compared with dialysis. Desensitization protocols have allowed kidney transplantation of highly sensitized patients, who have a lower probability to receive a matching kidney from a deceased or living donor. The aim of this work was to analyze the post-transplantation period of highly HLA-sensitized patients with positive flow cytometry crossmatch against donor cells. METHODS: Following an observational, retrospective design, we investigated 16 highly sensitized patients who underwent kidney or kidney-pancreas transplantation, assessing the impact of desensitization protocols and investigating treatment-related complications, graft function, antibody-mediated rejection (AMR) rate, and graft and patient survivals. RESULTS: We studied 16 patients with positive flow cytometry crossmatch, who were divided into 2 groups based on whether they were submitted to a desensitization protocol or not. Patients who were desensitized underwent transplantation in later years, had higher immunologic risk (panel reactive antibody peak 62% vs 33%; P = .038), higher percentage of 2nd kidney transplant (75% vs 25%; P = .066), and higher percentage of donor-specific anti-HLA antibodies identified (P = .028). A majority of patients were desensitized with high-dose intravenous immunoglobulin and plasmapheresis, and 5 patients received rituximab. Acute AMR rate was of 38%, and rituximab was associated with fewer episodes of AMR. Only 1 patient had graft failure, due to chronic humoral rejection, and the remaining maintained good graft function (mean serum creatinine value of 1.33 mg/dL). No patient died and few complications related to immunossupression were observed. CONCLUSIONS: Desensitization protocols were safe and allowed kidney transplantation in highly sensitized patients that probably would never undergo transplantation and gave the opportunity of living-donor transplant to patients with anti-HLA antibodies against the donor.

Kidney transplantation in type 2 diabetic patients: a matched survival analysis.

BACKGROUND: Diabetes mellitus (DM) is the most prevalent cause of kidney failure. Some concerns have been raised about the kidney transplantation (KT) results in diabetic patients. Therefore, we compared outcomes between diabetic and non-diabetic KT patients. METHODS: We included all KT performed in type 2 diabetic patients in our center from July 1983 to December 2009 with graft survivals beyond 3 months. Nondiabetic controls were individually matched with diabetic patients with respect to gender, age, year of transplantation, number of donor HLA mismatches, and dialysis vintage. The two groups were compared concerning patient and graft survivals, delayed graft function (DGF), and prevalence of acute rejection episodes (ARE). RESULTS: The 62 diabetic and 62 nondiabetic patients had a mean follow-up after KT of 102 ± 64 months. Diabetic patients and controls were similar for the matched variables. Death censored graft survivals of diabetics versus nondiabetics were 70% and 83% at 5 years and 54% and 71% at 10 years, respectively (P = .13). Patient survivals at 5 and 10 years were 69% and 50% for diabetic versus 96% and 84% for nondiabetic patients, respectively (P < .001). The prevalence of ARE and DGF did not differ (chi-squared test, P = .12). Multivariate Cox's proportional hazards analysis revealed DM (hazard ratio [HR] 7.72; P = .001) and viral hepatitis (HR = 4.18; P = .02) to correlate with reduced patient survival. CONCLUSION: Survival of diabetic patients after KT was reduced but death-censored graft outcomes were similar compared with matched nondiabetic patients. Concerns about graft survival should not prevent KT for diabetic patients with kidney failure.

A case series of de novo inflammatory bowel disease after kidney transplantation.

Diarrhea, which is common after transplantation, may be due to infections and immunosuppressive therapy. Inflammatory bowel disease (IBD) de novo or as an exacerbation of pre-existent disease is a rare complication after kidney transplantation with pre-existing disease having a less aggressive clinical course than the de novo disease. Cytomegalovirus mismatch, prescription of tacrolimus instead of cyclosporine or mycophenolate mofetil rather than azathioprine as well as low-dose corticosteroid treatments have been linked to an increased incidence of IBD. This series of renal transplant recipients with de novo IBD showed a higher incidence and more aggressive course than that previously described, possibly related to increased use of tacrolimus with minimization of steroids.

Noncutaneous neoplasms after kidney transplantation: analysis at single center.

Malignancy is the third most cause of death among kidney transplantation recipients after cardiovascular events and infection. The aim of this study was to investigate the types of and risk factors for cancer excluding skin lesions among kidney transplantation (KT) patients in Portugal. We studied retrospectively the 1695 patients who underwent KT between 1983 and 2009. Malignancies post-KT were considered if diagnosed at least 1 year after KT. The results were compared with a group of cancer free patients. During the follow-up period to June 2010, which included a median duration of 118.49 months (interquartile range 53.34 to 182.46), 60 patients (3.5%) developed 66 malignancies, which were the cause of death in 17. Compared with patients without cancer, the affected ones were older (P < .001), and had a longer duration of graft function (P = .002). There were no significant differences regarding gender, follow-up time, actue rejection episodes, donor type, number of KT, immunosuppressive regimen. The most frequent malignancy was colorectal cancer (21.2%), followed by malignant lymphoma (16.7%) and breast cancer (13.6%). The mean age of patients at diagnosis was 53.9 ± 11.5 years. The average time for development of a cancer was 8.3 ± 5.7 years with 42.4% detected between 1 and 5 years. In total, 16 patients were converted to sirolimus. Patient survival was significantly lower among subjects with cancer; censored graft survival was significantly higher in this group. A multivariate logistic regression analysis identified risk factors for malignancy post-KT to be recipient age and duration of follow-up. In conclusion, our data showed a significant number of tumors that generally not described to be higher lesions among KT. We achieved an early diagnosis and a lack of impact on death-censored graft survival.

Advantages of kidney transplant precocity in graft long-term survival.

BACKGROUND: Preemptive kidney transplantation (KT) or KT after a brief period on dialysis (<6 months) has been associated with better graft survival. Our study aimed to analyze the effect of an early KT on graft survival censored for patient death with functioning graft. METHODS: A total of 1,373 kidney-only transplantations, from both living and deceased donors, performed from 1983 to 2010 were retrospectively studied. We defined 2 groups: those with early KT (preemptive or within 6 months after dialysis initiation; n = 131) and non-early KT (n = 1,242). Survival curves for each group were calculated by Kaplan-Meier analysis and compared by log-rank test. The independent effect of early KT on censored graft survival was analyzed by a multivariate-adjusted Cox proportional regression model. RESULTS: The 5-, 10-, 15-, and 20-year censored graft survival rates were, respectively, 96%, 89%, 79%, and 79% among the early KT group, and 91%, 81%, 68%, and 49% among the non-early KT group (P = .024). Multivariate analysis showed the following to be independent predictors for censored graft failure: non-early KT (hazard ratio [HR] 2.58; P = .028), recipient age (HR 0.97; P < .001), donor age (HR 1.03; P < .001), recipient negative status for cytomegalovirus IgG (HR 1.44; P = .032), delayed graft function (HR 1.48; P = .013), and acute rejection event (HR 1.68; P = .002). CONCLUSIONS: Our results show that early KT can be an approach for the improvement of long-term graft survival.

A comparison between serum creatinine and cystatin C-based equations for estimation of graft function.

BACKGROUND: Accurate monitoring of estimated glomerular filtration rate (GFR) is essential for an optimal management of kidney transplant (KT) patients. We aimed to compare the predictive performance of creatinine- and cystatin C-based GFR with creatinine clearance (CCr) in a 24-hour urine collection as the reference test. METHODS: GFR was calculated using cystatin C-based equations (Le Bricon, Stevens) and two creatinine-based equations [Cockcroft-Gault (CG), modification of diet in renal disease (MDRD)]. We enrolled 173 KT recipients. Bias, precision, and accuracy of each equation were determined. Kappa statistics evaluated the concordance between the reference test and GFR formulas in classifying patients according graft function (CCr <60 or ≥60 mL/min/1.73 m2). RESULTS: Patients (108 males) had a mean age of 48.6 ± 12.2 years and a median posttransplant time of 6.8 years. Mean CCr was 69.3 ± 19.9 (range: 32.1-105.2) mL/min/1.73 m2. The cystatin C-based equations estimates (Le Bricon, Stevens) had the highest accuracy (83.8% and 87.9% within 30% of CCr result, respectively). Precision of Le Bricon, Stevens, and MDRD was similar (around 13.5 mL/min/1.73 m2)) and much better than CG (22.5 mL/min/1.73 m2). The lowest bias was seen in Le Bricon (-1.2 mL/min/1.73 m2), followed by CG, Stevens, and MDRD (-2.6, -9.5, -16.5 mL/min/1.73 m(2), respectively). Kappa coefficient was higher in cystatin C-based equations (0.53) in contrast with CG (0.48) and MDRD (0.40). Stevens had a high sensitivity (90.8%) and low specificity (66.7%) and, conversely, Le Bricon had 64.6% sensitivity and 87.0% specificity. CONCLUSIONS: Cystatin C-based equations showed a better predictive performance of graft function than creatinine-based equations. The role of cystatin C in graft function monitoring deserves further investigation.

Hyperuricemia in adult renal allograft recipients: prevalence and predictors.

BACKGROUND: Hyperuricemia is a common complication after kidney transplantation that may adversely affect graft survival. OBJECTIVE: Our aim was to determine the prevalence of hyperuricemia in a sample of adult kidney graft recipients and to investigate its predictors. METHODS: A total of 302 patients were included in the study. We used univariate analyses to compare clinical characteristics between the hyper-and normouricemic groups. We used multivariate adjusted logistic regression to detect independent predictors of hyperuricemia. Hyperuricemia was defined as serum uric acid ≥6.5 mg/dL in women and ≥7.0 mg/dL in men or allopurinol use. RESULTS: The patients had a mean age of 49.6 ± 13.4 years, a median posttransplantation time of 7.6 years, and a mean estimated glomerular filtration rate (eGFR) of 51.9 ± 18.46 mL/min. The prevalence of hyperuricemia was 42.1% (n = 127). Hyperuricemic patients were predominately male (P = .004), older (P = .038), and with lower eGFR (P < .001). They also had a higher prevalence of hypertension (P = .001), dyslipidemia (P = .004) and proteinuria (P = .001). Multivariate adjusted regression model showed as significant predictors of hyperuricemia: male gender (odds ratio [OR], 2.46; P = .002); impaired renal function (OR 1.33 for every 10 mL/min reduction in eGFR; P < .001), higher body weight (OR 1.09 for every 1 kg/m(2) increase of body mass index; P = .044), prednisolone use (OR 2.12; P = .035), and cyclosporine versus tacrolimus use (OR 2.44; P = .039). CONCLUSIONS: The prevalence of posttransplant hyperuricemia was high, particularly in patients with classical cardiovascular risk factors and lower eGFR. However, our findings suggest that modifiable immunosuppression options could play a role in its management.

New-onset lupus nephritis in a kidney transplant recipient with cystinosis-differential diagnosis with cysteamine-induced lupus: case report.

A case of lupus nephritis in an adult female kidney transplant recipient with cystinosis under cysteamine therapy is reported. Previous reports of new-onset lupus in cystinotic patients have focused in a possible relationship of lupus with cysteamine therapy, but no obvious pathophysiological association has been disclosed. The authors present a case of a 19-year-old female kidney transplant recipient with cystinosis admitted for acute allograft dysfunction, with clinical and immunologic manifestations of lupus nephritis. Cysteamine was considered as a potential cause of drug-induced lupus, and we temporarily interrupted this drug. The clinical picture, the negativity of antihistone antibodies, the nondisappearance of antinuclear antibodies after discontinuation of the drug, and the clinical stability after resuming cysteamine therapy suggested that the underlying mechanism of lupus was unrelated to the drug. This may be the first report of new-onset lupus in a kidney transplant recipient with cystinosis. Clinicians should be aware of the association of autoimmune abnormalities in patients with cystinosis.

Posttransplant outcomes of peritoneal dialysis versus hemodialysis patients.

The impact of dialysis modality on posttransplant outcomes remains controversial. The authors have compared primary failure, delayed graft function (DGF), acute rejection episodes as well as patient and allograft survivals among patients undergoing renal transplantation between 2004 and 2009, according to the modality of hemodialysis (HD) versus peritoneal dialysis (PD). We studied 306 patients (268 HD and 38 PD) with a mean follow-up of 29 ± 16 months. The PD cohort included a predominance of females (68.4% vs 36.2%; P = .001), lower age at transplantation (38 ± 14 vs 46 ± 12 years; P = .004), shorter time on dialysis (33 ± 49 vs 59 ± 157 months; P = .043), and higher rate of living donor grafts (PD 31.6% vs HD 13.1%; P = .003). Donor age (PD 43 ± 13 vs HD 45 ± 14 years; P = .30), human leukocyte antigen mismatch (P = .17), panel reactive antibody values (HD 11 ± 22 vs PD 13 ± 26; P = .55), and hyperimmunized patients (HD 3.73%; PD 7.89%; P = .23) were not different. Primary graft failure (3.4% vs 0%; P = .025) and DGF (37.1% vs 13.1%; P = .037) were more frequent among HD patients, but incidences of acute rejection episodes were similar (HD 10.5% vs PD 5.3%; P = 0.19). Neither recipient survival at 1 (97% in PD and HD) or 3 years (HD 90% vs PD 94%; P = .657) nor allograft survival at 1 year (HD 94% vs PD 95%; P = .80) or 3 years: (HD 70%, vs PD 81%; P = .73) were different. Graft function was similar at 1 (HD 64.2 ± 25 vs PD 56.4 ± 24 mL/min; P = .17) and 3 years (HD 62.3 ± 21 vs PD 46 ± 23 mL/min; P = .16). In our study, HD patients showed an higher incidence of DGF and primary allograft failure, but there was no difference in acute rejection episodes, long-term survivals, or renal function.

One hundred eleven simultaneous pancreas-kidney transplantations: 10-year experience from a single center in Portugal.

From May 2000 to May 2010, we performed 111 simultaneous pancreas-kidney transplants (SPKT) from cadaveric donors, by using enteric drainage and systemic vascular anastomosis. In 26 cases they showed 6 HLA mismatches. Immunosuppression included antithymocyte globulin, tacrolimus, mycophenolate mofetil, and steroids. The patients' mean age was 34 ± 6 years, and mean time from diabetes diagnosis was 23 ± 6 years; 107 patients had been on dialysis for 32 ± 24 months, and 4 had a preemptive status. Acute rejection episodes were detected in 20 patients (18%): in 3 cases they affected both organs, in 9 only the kidney, and in 8 only the pancreas. The incidence of complications needing reoperation was 28.8%. They were mostly pancreas graft-related, including bleeding, thrombosis, and infection. In more recent years, after a slight modification of surgical technique, we noted a decreased rate of complications. Six patients died from: 2 from cardiovascular or cerebrovascular disease, 3 from infection, and 1 from an unknown cause. Pancreas graft loss occurred in 26 and kidney graft loss in 12 patients. Four patients underwent a second pancreas and 5 a second kidney graft. Patients with surviving grafts showed good function: serum creatinine, 1.09 ± 0.23 mg/dL; fasting blood glucose, 79.7 ± 9.8 mg/dL; and HbA(1c), 4.88 ± 0.47%. Patient, kidney, and pancreas survival results were 96%, 96%, and 83% at 1; 94%, 91%, and 75% at 5; and 94%, 62%, and 69% at 10 years, respectively. These good results, compared with larger series and to recent pancreas transplant registry reports, are a strong motivation for the further development of this unique program in Portugal.

Late venous thrombosis of renal allograft: two cases with different treatment and outcome

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