Cardiac Remodeling in Structure and Function Six Months After Kidney Transplantation.

BACKGROUND: Cardiovascular disease accounts for 35% to 50% of the causes of mortality in chronic kidney disease. The majority of patients in substitution therapy in Mexico are subdialyzed owing to limited economic resources. This produces more cardiac deterioration than described in the statistics and has a direct impact on the prognosis of kidney transplantation. The aim of this work was to demonstrate and to quantify the improvement in the echocardiographic parameters 6 months after renal transplantation in patients with stable renal function. METHODS: This was an observational, analytic, prospective study of 23 patients with chronic kidney disease who received transplants in 2016 and had a glomerular filtration rate ≥80 mL/min (Chronic Kidney Disease-Epidemiology Collaboration) 6 months after transplantation. RESULTS: Echocardiographic results showed an increase in the left ventricular ejection fraction from 57.17 ± 10.46% to 64.09 ± 9.8%, an increase in the right ventricular ejection fraction from 0.56 ± 0.09% to 0.60 ± 0.08% and a reduction of the pulmonary arterial systolic pressure from 44.57 ± 13.88 mm Hg to 39.74 ± 11.04 mm Hg. There were also decreases in mitral regurgitation from 1.0 to 0.43, tricuspid insufficiency from 1.35 to 0.43, pulmonary insufficiency from 0.48 to 0.04, and aortic insufficiency from 0.35 to 0.04, all of these significant with P < .05. CONCLUSIONS: There was a significant improvement in cardiovascular function in our population 6 months after transplantation, despite the fact that renal transplantation is performed with greater cardiac deterioration than described in patients in other countries.

Specific Antigens by Federal Entity in Patients at the Transplant Unit of Specialities Hospital, National Medical Center Twenty-First Century, Mexico.

BACKGROUND: The study of the kidney transplant involves understanding the immunologic basis, such as histocompatibility and the genetic basis of a population. In Mexico, the study of the genetic basis has led to a genetic map by federal entities. METHODS: We performed an HLA study with 1,276 kidney transplant patients (recipients and donors) in the Hospital of the National Medical Center Twenty-First Century, determining HLA class I (A, B, and Cw) and class II (DRß1 and DQß1) antigens with the use of SSOP-PCR. A descriptive analysis was conducted with measures of central tendency (mean, SD). RESULTS: Of 1,276 HLA patients studied, we obtained 2,552 results for each class by the composition of the 2 haplotypes, and for HLA-Cw we processed 796 patients, for a total of 1,592 antigens for this class. We found antigens specific to each federal entity, and it was found that the Federal District had the highest number of specific antigens (10) followed by Morelos (7), Querétaro and Mexico State (3 each), and Tamaulipas, Aguascalientes, Michoacán, Guerrero, Puebla, and Oaxaca (1 each). CONCLUSIONS: The genetic map allows us to know proportions of antigens in every state in the center and south of Mexico owing to the diversity and area of influence of the National Medical Center XXIst Century, as well as the wide number of patients. Furthermore, there are still preserved proportionally distinct genetic roots in every entity.

Creation of a solid organ transplant program in an underdeveloped country: Mexico's General Hospital transplantation program.

BACKGROUND: With a population of >112 million persons, all Mexicans are entitled to receive medical care by the state and more than half have limited access to healthcare. From January 1985 to March 2009, 40 renal transplants were performed from living donors with a high percentage of complications. In April 2009, a new Solid Organ Transplantation Program was started; herein, we present this enterprise to the international community and briefly present a perspective on the Mexican transplant situation. MATERIALS AND METHODS: We performed a retrospective chart review of kidney and liver transplant recipients from April 2009 to November 2011, including demographic features, immunosuppression, complications as well as initial and 1 month function. RESULTS: We performed 68 kidney (59 living and 9 deceased donors) and 5 liver transplants (cadaveric donors). The kidney transplant recipients were 73.5% males and showed an overall mean age of 29.77 years (range, 18-60). The donor mean age was 34.08 years. Mean recipient creatinine pretransplant was 13.32 mg/dL, while at day 5 it was 2.33 and at month one, 1.32 mg/dL. Five grafts were lost (7.3%): 4 due to death with a functioning graft and 1 due to acute pyelonephritis. Five patients experienced delayed graft function Basiliximab induction was required in all but one who received thymoglobulin owing to a high panel reactive antibody. Maintenance therapy included a calcineurin inhibitor, mycophenolate mofetil (MMF), and prednisone. Liver transplant recipients were 83.6% women. The etiologies were alcoholic cirrhosis (n = 2), primary billiary cirrhosis (n = 1) and hepatitis C virus infection (n = 2). Complications included: reperfusion syndrome (n = 1), convulsive crisis (medication; n = 1), acute respiratory distress syndrome (n = 1), and death (n = 1). Their Model for End-Stage Liver Disease scopes were 10-21. After basiliximab induction, they had maintenance therapy with tacrolimus, MMF, and steroids. The donor mean age was 26.2 years. All survivors show normal liver function tests currently. CONCLUSIONS: From 1985 to 2009, 40 kidney transplants were performed, with multiple complications including donor deaths. Our current results were comparable to international standards, with <15% complication rate.

Parameters of Doppler ultrasound at five days posttransplantation as predictors of histology and renal function at one year.

INTRODUCTION: In our center, a Doppler ultrasound (DU) is performed at 5 days after transplantation. The normal upper limit of flow velocity (FV) in the renal artery is 200-250 cm/s. The resistance index (RI) is considered elevated when >0.8. Elevation of the RI can be shown in all the forms of graft dysfunction. OBJECTIVE: The objective of this study was to evaluate the capacity of the DU to predict the prognosis of graft function and histological damage at 1 year. METHODS: We examined a retrospective cohort of patients undergoing renal transplantation between January 2004 and May 2007. The renal function was evaluated with serum creatinine measurements and glomerular filtration rate (GFR) estimates by the quadratic Modification of Diet in Renal Disease study equation. The biopsy specimen was evaluated according to the Banff 1997 classification. RESULTS: The overall average age was 35 years, and 58% of the subjects were men. Eight cases (25.8%) showed abnormal DU. The Delta among those with normal DU was -0.94 versus 0.27 +/- 0.39 with abnormal DU (P < .005). There was no significance as far as the biopsy at 1 year. CONCLUSIONS: Renal DU allows physicians to suspect complications at the first posttransplantation year. It shows a tendency to elevated blood pressure, as well as increased deterioration of renal function over the first year.

[Hyperbaric oxygenation therapy, basic concepts]. / Terapia con oxigenación hiperbárica, conceptos básicos.

Hyperbaric oxygen therapy (HBO) is defined as a treatment in which a patient breathes 100% oxygen in a pressurized environment of at least 1.4 absolute atmospheres. The first written reports data from the 15th century, when it was used to treat respiratory diseases. For some time its applications lacked scientific support until the second half of this century when scientific publications were carried out using current methodology. This type of therapy is grounded basically in three gas laws: Henry's Law, Dalton's Law and Boyle's Law. The beneficial effects are: wound healing enhancement; increased neutrophil bactericidal capacity; direct toxic effect against some microorganisms; arteriolar vasoconstriction with subsequent edema reduction and decreased ischemia/reperfusion injury, among others. These are the result of increased environmental pressure and high oxygen tension in body tissues. Currently there are 13 accepted conditions to be treated with HBO and others are still under investigation. Following UHMS-accepted treatment protocols, complications and/or adverse effects are limited.