Renal transplants using expanded cadaver donor criteria.

AIMS: to analyze the frequency of transplants using expanded donor criteria (EDC) and the incidence of delayed graft function, acute rejection and the patient and graft survival compared to ideal donors (ID). PATIENTS: retrospective analysis of the 582 cadaver renal transplants performed from Jun 1988 to Mar 2003 in adult recipients. The expanded donor criteria were considered as history of hypertension or evidence of atherosclerosis, diabetes, age less than 5 or more than 55 years old, serum creatinine higher than 2.0 mg/dL, shock and retrieval in cardiac arrest. The statistical analysis used was Student t test, Chi-square test, and Kaplan-Meier method as indicated. RESULTS: 25.4% of our transplants used expanded criteria donor. Comparing, respectively, the EDC and ID we found: the incidence of delayed graft function of 63.9% vs 50.4% (P: 0.007); incidence of acute rejection of 66.1% vs 72.3% (P: 0.203). The patient survival at 1 and 5 years was 87% vs 92% and 81% vs 79%, respectively (P: 0.6809). The graft survival at 1 and 5 year was 74% vs 82% and 57% vs 59% (P: 0.2072), respectively for EDC and ID. CONCLUSIONS: One fourth of our cadaver transplants fulfilled the extended donor criteria. The incidence of delayed graft function was higher in these transplants, but the prevalence of rejection episodes was similar to ideal donors. The patient and graft survival were not statistically different at 1 and 5 year.

Twenty-five year experience with renal transplantation at Santa Casa Hospital, Porto Alegre.

From 1977 to July 2002, 1,376 renal transplants were performed at Santa Casa of Porto Alegre. The number of transplants and the patient and graft survival rates have been rising each year since 1987. The overall one-year graft survival rates were 90% for living donor recipients and 80% for cadaver donor recipients, respectively; however, the patient and graft survival rates increased significantly between the early (1977-1995) and more recent (1996-2002) periods. Pediatric patients (less than 18 years old) accounted for 15.8% of the transplants that were performed, most of them from living related donors. The patient and graft survival rates did not differ statistically when we compared recipients of transplants from "ideal" and marginal cadaver donors, even when we considered only those risk factors that affected graft function in assigning a marginal donor. During the 25-year observation period, 537 grafts have been lost (39%), including those patients who died with functioning graft. We are currently following 834 patients with a functioning graft, with an average follow-up of 67+54 months.

Transplante simultâneo de rim e pâncreas: experiência com nove casos na Irmandade Santa Casa de Misericórdia de Porto Alegre / Simultaneous kidney and pancreas transplantation: experience with 9 cases in Irmandade Santa Casa de Misericórdia de Porto Alegre

É apresentada a experiência do Serviço de Nefrologia da Santa Casa de Porto Alegre com o Transplante Simultâneo de Rim e Pâncreas (TxSRP) em diabéticos insulino-dependentes urêmicos. Entre agosto de 1987 e fevereiro de 1996 foram realizados nove TxSRP. A sobrevida do paciente do rim e do pâncreas foi de 88,9 por cento, 77,8 por cento e 76,2 por cento no primeiro ano e de 63,4 por cento, 51,8 por cento e 50,7 por cento no terceiro ano. Ocorreram quatro óbitos. Foram perdidos um enxerto renal e um pancreático. Ao final da observaçäo, cinco pacientes estavam vivos com enxerto renal funcionante e quatro com funçäo pancreática normal. O TxSRP pode, em determinadas situaçöes, ser uma alternativa para o tratamento de diabéticos insulino-dependentes urêmicos necessitando de transplante renal.

Tuberculose em urêmicos / Tuberculosis in patients with chronic renal failure

A tuberculose ocorre com maior freqüência nos pacientes com insuficiência renal crônica em diálise. O diagnóstico é dificil, pois os sintomas säo inespecíficos e podem ser atribuídos à uremia. O teste tuberculínico é negativo na maioria dos pacientes (63,5%), e säo comuns as formas extra-pulmonares da doença *56%). Recomendamos a realizaçäo da reaçäo de Mantoux em todos os pacientes urêmicos; os que foram reatores ao teste, sem evidências de doença ativa, poderiam beneficiar-se da quimioprofilaxia com isoniazida pelo período de um ano. Considerando a eficácia, a facilidade de administraçäo e menores paraefeitos, propomos, como esquema terapêutico para tuberculose em pacientes em diálise, a associaçäo da pirazimida por 2 meses, isoniazida e rifampicina por 6 meses