Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 3 de 3
Filtrar
Más filtros










Base de datos
Intervalo de año de publicación
1.
Transplantation ; 103(7): 1468-1476, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-30335696

RESUMEN

BACKGROUND: Limited information exists about outcomes of HLA donor-specific antibody (DSA) negative (DSA-) microvascular inflammation (MVI). METHODS: We report our experience with 25 DSA- patients with MVI compared to 155 DSA+ patients who met Banff 2013 criteria for antibody-mediated rejection (AMR). We also compared outcomes to 228 DSA+ patients whose biopsies were negative for rejection and served as a negative control. RESULTS: There were no significant differences in the baseline characteristics between the DSA- MVI and DSA+ AMR groups. At the time of diagnosis, both groups had similar graft function. The DSA- group had higher MVI scores but lower C4d scores. At last follow-up, renal function was similar between the groups. There were 12 (48%) graft failures in the DSA- group and 59 (38%) graft failures in the DSA+ group, which was not statistically different. Similar results were found after matching for the MVI scores, C4d, and treatment between 2 groups. We also found similar outcomes between DSA- and DSA+ patients when only including those who would have met Banff 2017 criteria for AMR. In univariate Cox regression analyses, estimated glomerular filtration rate at time of biopsy, glomerulitis, rituximab, diabetes, v score, allograft glomerulopathy, fibrous intimal thickening, tubular atrophy, and interstitial fibrosis scores were associated with graft failure. In multivariate analysis, only estimated glomerular filtration rate was protective. Both groups had significantly worse outcomes than the DSA+-negative controls without AMR. CONCLUSIONS: Our findings suggest that outcomes and response to treatment with HLA DSA- MVI patients are similarly poor to those with DSA+ MVI patients, supporting a critical role for MVI in the diagnosis of AMR.


Asunto(s)
Rechazo de Injerto/inmunología , Antígenos HLA/inmunología , Histocompatibilidad , Isoanticuerpos/sangre , Trasplante de Riñón/efectos adversos , Microvasos/inmunología , Vasculitis/inmunología , Adulto , Bases de Datos Factuales , Femenino , Rechazo de Injerto/diagnóstico , Rechazo de Injerto/fisiopatología , Rechazo de Injerto/terapia , Supervivencia de Injerto , Humanos , Masculino , Microvasos/patología , Microvasos/fisiopatología , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Vasculitis/diagnóstico , Vasculitis/fisiopatología , Vasculitis/terapia
2.
Transplantation ; 103(8): 1722-1729, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-30507740

RESUMEN

BACKGROUND: Antibody-mediated rejection (AMR) is a leading cause of morbidity and mortality after kidney transplantation. Early diagnosis and treatment of subclinical AMR based on the donor-specific antibody (DSA) testing may result in better outcomes. METHODS: We tested this hypothesis in 220 kidney transplant recipients who underwent an indication or DSA-based surveillance protocol biopsies between March 1, 2013 and December 31, 2016. Patients were divided into 3 groups: clinical AMR (n = 118), subclinical AMR (n = 25), or no rejection on protocol biopsy (controls; n = 77). RESULTS: Both clinical and subclinical AMR groups underwent similar treatment including plasmapheresis, pulse steroids, IVIG, and rituximab (P = ns). Mean follow-up after AMR was 29.5 ± 16.8 months. There were 2 (3%), 2 (8%), and 54 (46%) death-censored graft failures in the control, subclinical, and clinical AMR groups, respectively (P < 0.001). Graft outcomes were similar in the subclinical rejection and control groups. In adjusted Cox regression analysis, only clinical rejection (hazards ratio [HR], 4.31; 95% confidence interval [CI], 1.01-18.94; P = 0.05) and sum chronicity scores (HR, 1.16; 95% CI, 1.01-1.35; P = 0.03) were associated with increased risk of graft failure, while estimated glomerular filtration rate at time of biopsy (HR, 0.98; 95% CI, 0.96-0.99; P = 0.01) was associated with decreased risk of graft failure. CONCLUSIONS: Our study suggests that early diagnosis and treatment of subclinical AMR using DSA monitoring may improve outcomes after kidney transplantation.


Asunto(s)
Glucocorticoides/uso terapéutico , Rechazo de Injerto/inmunología , Antígenos HLA/inmunología , Isoanticuerpos/inmunología , Trasplante de Riñón/efectos adversos , Plasmaféresis/métodos , Rituximab/uso terapéutico , Adulto , Aloinjertos , Biopsia , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Rechazo de Injerto/epidemiología , Rechazo de Injerto/terapia , Supervivencia de Injerto/inmunología , Humanos , Factores Inmunológicos/uso terapéutico , Riñón/patología , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Resultado del Tratamiento , Wisconsin/epidemiología
3.
WMJ ; 112(4): 177-80, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24734408

RESUMEN

Cases of kidney injury associated with the use of deferasirox chelation therapy during the course of treatment for iron overload have been reported infrequently. We present the case of a patient treated with deferasirox who had biopsy-proven tubular injury in the setting of clinical Fanconi syndrome. The patient required hospitalization for metabolic acidosis, electrolyte abnormalities, and associated symptoms. With supportive care and cessation of chelation therapy he improved, but has yet to fully recover. This is the first known case reporting biopsy-proven tubular damage in the setting of deferasirox use.


Asunto(s)
Benzoatos/efectos adversos , Síndrome de Fanconi/inducido químicamente , Quelantes del Hierro/efectos adversos , Sobrecarga de Hierro/tratamiento farmacológico , Insuficiencia Renal/inducido químicamente , Triazoles/efectos adversos , Deferasirox , Humanos , Masculino , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...