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 renal na Santa Casa de Porto Alegre: uma análise de 520 casos em 17 anos / Kidney transplants at the Santa Casa of Porto Alegre: a review of 520 transplants done in the last 17 years

Apresentamos os dados disponíveis relativos aos primeiros 520 transplantes renais na Santa Casa de Porto Alegre. A partir de 1989 foram realizados em média 75 transplantes por ano, sendo que em 1993 este número foi de 108, com 51,9 por cento provenientes de doadores cadavéricos. A sobrevida do enxerto no primeiro ano nos transplantes realizados após 1988 passou a ser de 89,8 por cento para doadores vivos e de 75 por cento para doadores cadavéricos. Durante o período de observaçäo (máximo de 17 anos e mínimo de 6 meses), 187 enxertos foram perdidos (36 por cento). Permanecem com enxerto funcionante 333 pacientes, com seguimento médio de 43.9 +/-31,7 meses. Em conclusäo, dois terços de nossos pacientes foram reabilitados e retornaram à uma vida produtiva, mostrando que o transplante renal näo pode ser encarado como uma terapêutica de elite, mas como uma forma de tratamento capaz de beneficiar a maioria dos pacientes com insuficiência renal crônica

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