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6.
Nephrology (Carlton) ; 23 Suppl 2: 45-51, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29968416

RESUMEN

The Banff histopathology classification system is the gold standard for assessing the causes of kidney allograft dysfunction triggered by antibody-mediated and T-cell-mediated immune reactions, thereby providing mechanistic insight and guiding therapeutic decisions. The original Banff classification (1993) consisted of four histological categories representing cell-mediated rejection: interstitial inflammation (i), tubulitis (t), endoarteritis (v), and transplant glomerulitis (g). The revised Banff 2007 classification added total inflammation score (ti) from both scarred and unscarred areas based on evolving interpretations of interstitial infiltrates. Further reappraisal of cell-mediated interstitial inflammation led to the introduction of a new inflammation score specific for areas of interstitial fibrosis and tubular atrophy, termed i-IF/TA, in the Banff 2015 scheme, establishment of a new Banff working group on T-cell-mediated rejection (TCMR), and revised criteria of chronic active TCMR in Banff 2017 classification. These Banff scheme updates reflect the general recognition that chronic interstitial inflammation is a common denominator of poor kidney allograft outcome. However, revised theories on the pathogenic importance of interstitial infiltrates have created difficulties in interpretation of chronic tubulointerstitial inflammation, as there are currently no histological criteria to discriminate immune-mediated tissue injury from 'non-specific' injury. Evolving theories on vascular lesions, both active and chronic, have also complicated histological assessment by obscuring the distinction between antibody-mediated and T-cell-mediated tissue injury. This review provides an overview of recent ideas on interstitial inflammation and vascular lesions based on emerging concepts of T-cell-mediated rejection.


Asunto(s)
Rechazo de Injerto/inmunología , Inmunidad Celular , Trasplante de Riñón/efectos adversos , Riñón/inmunología , Linfocitos T/inmunología , Aloinjertos , Biopsia , Difusión de Innovaciones , Predicción , Rechazo de Injerto/historia , Rechazo de Injerto/patología , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Riñón/patología , Trasplante de Riñón/historia , Trasplante de Riñón/tendencias , Valor Predictivo de las Pruebas , Factores de Riesgo , Linfocitos T/patología , Resultado del Tratamiento
7.
Transplantation ; 102(10): 1650-1665, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-29916987

RESUMEN

Robotic-assisted kidney transplantation (RAKT) represents the most recent innovation in the evolution of kidney transplantation surgery. Vascular techniques enabling kidney transplantation have existed since the early 20th century and contributed to the first successful open kidney transplant procedure in 1954. Technical advances have since facilitated minimally invasive laparoscopic and robotic techniques in live-donor surgery, and subsequently for the recipient procedure. This review follows the development of surgical techniques for kidney transplantation, with a special focus on the advent of robotic-assisted transplantation because of its potential to facilitate transplantation of those deemed previously too obese to transplant by standard means. The different techniques, indications, advantages, disadvantages, and future directions of this approach will be explored in detail. Robot-assisted kidney transplantation may become the preferred means of transplanting morbidly obese recipients, although its availability to such recipients remains extremely limited and strategies targeting weight loss pretransplantation should never be abandoned in favor of a "RAKT-first" approach.


Asunto(s)
Fallo Renal Crónico/cirugía , Trasplante de Riñón/métodos , Laparoscopía/métodos , Obesidad Mórbida/complicaciones , Procedimientos Quirúrgicos Robotizados/métodos , Comorbilidad , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Riñón/irrigación sanguínea , Riñón/cirugía , Fallo Renal Crónico/epidemiología , Trasplante de Riñón/historia , Trasplante de Riñón/tendencias , Laparoscopía/historia , Laparoscopía/tendencias , Obesidad Mórbida/epidemiología , Obesidad Mórbida/terapia , Arteria Renal/cirugía , Procedimientos Quirúrgicos Robotizados/historia , Procedimientos Quirúrgicos Robotizados/tendencias , Resultado del Tratamiento , Programas de Reducción de Peso
11.
Curr Urol Rep ; 19(3): 7, 2018 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-29399714

RESUMEN

PURPOSE OF REVIEW: The practice of kidney autotransplantation (KAT) has become an increasingly favorable approach in the treatment of certain renovascular, ureteral, and malignant pathologies. Current KAT literature describes conventional open procedures, which are associated with substantial risks. We sought to compare previously reported outcomes, evaluate common surgical indications, and assess associated risks and benefits of current KAT methods. A thorough evaluation and review of the literature was performed with the keywords "autologous transplantation" and "kidney." RECENT FINDINGS: Early outcomes of robotic KAT are encouraging and have been associated with fewer complications and shorter hospital stay, but require robotic technique proficiency. KAT is an important method to manage selected complex urological pathologies. Robotic KAT is promising. Nevertheless, future studies should utilize larger patient cohorts to better assess the risks and benefits of KAT and to further validate this approach.


Asunto(s)
Trasplante de Riñón/métodos , Riñón/cirugía , Trasplante Autólogo/métodos , Enfermedades Urológicas/cirugía , Predicción , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Riñón/irrigación sanguínea , Enfermedades Renales/historia , Enfermedades Renales/cirugía , Trasplante de Riñón/historia , Procedimientos Quirúrgicos Robotizados , Trasplante Autólogo/historia , Uréter/cirugía , Enfermedades Ureterales/historia , Enfermedades Ureterales/cirugía , Enfermedades Urológicas/historia
15.
G Ital Nefrol ; 35(Suppl 70): 84-86, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29482280
16.
Curr Opin Urol ; 28(2): 139-142, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29303915

RESUMEN

PURPOSE OF REVIEW: Kidney transplantation is the preferred modality for the treatment of patients with end-stage renal disease. Robot-assisted kidney transplantation (RAKT) has been in use since 2002 to reduce morbidity in open kidney transplantation. The aim of this review is to highlight the most relevant publications on this challenging surgical topic. RECENT FINDINGS: Recent publications suggest that minimally invasive techniques in kidney transplantation, including RAKT, have shown promising results particularly with regard to complications and recovery, reducing postoperative pain and analgesic requirement with a better cosmetic result. Regarding complications, RAKT seems to be a safe surgical alternative to open kidney transplantation. SUMMARY: When performed by surgeons with robotic and kidney transplantation experience, RAKT is safe and reproducible in selected cases while maintaining excellent graft function. The ideal indication of RAKT seems to be for morbidly obese patients ineligible for open kidney transplantation. Further investigations need to confirm this promising data.


Asunto(s)
Fallo Renal Crónico/cirugía , Trasplante de Riñón/métodos , Obesidad Mórbida/complicaciones , Procedimientos Quirúrgicos Robotizados/métodos , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Historia del Siglo XXI , Humanos , Hipotermia Inducida/métodos , Fallo Renal Crónico/complicaciones , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/historia , Tiempo de Internación/estadística & datos numéricos , Tempo Operativo , Selección de Paciente , Reproducibilidad de los Resultados , Procedimientos Quirúrgicos Robotizados/efectos adversos , Procedimientos Quirúrgicos Robotizados/historia , Isquemia Tibia
19.
Int J Artif Organs ; 40(7): 313-322, 2017 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-28685808

RESUMEN

From its introduction in 1943 and until the late 1970s, hemodialysis (HD) has been a lengthy and cumbersome treatment administered by a few skilled physicians and technicians to a very limited number of terminal kidney patients. The technological innovations introduced over the years made HD a treatment administered and supervised by nursing personnel to a very large numbers of kidney patients, hopefully until recovery of kidney functions or kidney transplantation. In 2013, it is estimated that 2.250.00 kidney patients were treated worldwide, and their number is steadily increasing. Shortage of transplant kidneys and quality of current treatments has contributed to increasing the survival of HD patients. Today, it is not unusual to find patients who have been on HD for longer than twenty years. All this generated the feeling that performance of membranes and dialysis technology has reached its limit. Recently, the increasing economic burden of healthcare caused by people ageing and the increasing incidence of degenerative diseases (e.g. diabetes and cardiovascular diseases), and the economic crisis has pushed many governments and health insurances to cut resources for healthcare. The main consequence is that investments in research and development in HD have been significantly reduced. The question is whether there is indeed no need for innovation in HD.In this paper, it is discussed how the paradigm of HD has changed and what possibly are now the drivers for innovation in HD. A few ideas are proposed that could be developed by adapting existing technologies to the future needs of HD.


Asunto(s)
Fallo Renal Crónico/historia , Trasplante de Riñón/historia , Diálisis Renal/historia , Aniversarios y Eventos Especiales , Predicción , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Fallo Renal Crónico/terapia , Trasplante de Riñón/tendencias , Diálisis Renal/tendencias
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