Estimated glomerular filtration rate in clinical practice: Consensus positioning of the Brazilian Society of Nephrology (SBN) and Brazilian Society of Clinical Pathology and Laboratory Medicine (SBPC/ML).

Chronic kidney disease (CKD) represents one of today's main public health problems. Serum creatinine measurement and estimation of the glomerular filtration rate (GFR) are the main tools for evaluating renal function. There are several equations to estimate GFR, and CKD-EPI equation (Chronic Kidney Disease - Epidemiology) is the most recommended one. There are still some controversies regarding serum creatinine measurement and GFR estimation, since several factors can interfere in this process. An important recent change was the removal of the correction for race from the equations for estimating GFR, which overestimated kidney function, and consequently delayed the implementation of treatments such as dialysis and kidney transplantation. In this consensus document from the Brazilian Societies of Nephrology and Clinical Pathology and Laboratory Medicine, the main concepts related to the assessment of renal function are reviewed, as well as possible existing controversies and recommendations for estimating GFR in clinical practice.

Organ Transplant From SARS-CoV-2-Positive Donors: A Brazilian Experience.

Since March 2022, donors with detectable SARS-CoV-2 RNA have been accepted for extrapulmonary organ transplants in Brazil. In this report, we described 11 successful organ transplants (6 kidney, 5 liver) from 5 asymptomatic infected donors.

Migratory pattern of the coronavirus disease 2019 and high fatality rates among kidney transplant recipients: report from the Brazilian Multicenter Cohort Study / Padrão migratório da doença coronavírus 2019 e altas taxas de mortalidade entre receptores de transplante renal: relatório do Estudo de Coorte Multicêntrico Brasileiro

Abstract Introduction: The unprecedented coronavirus disease 2019 (COVID-19) pandemic has affected kidney transplant (KT) recipients, with worldwide fatality rates around 25%. Considering the well-known Brazilian socio-demographic disparities, this report describes for the first time the main outcomes of COVID-19 in KT recipients according to Brazilian geographic regions. Methods: This multicenter national retrospective analysis included data from KT recipients with confirmed COVID-19 between March and November 2020. Results: Thirty-five of the 81 centers (57% of KT activity in Brazil) reported 1,680 patients with COVID-19. The Northeast was the first to reach the peak in the number of infections. The Southeast, due to its population density, contributed with the largest number of patients. Patients had a median age of 52 years, 76% had hypertension and 34% diabetes, 75% were recipients of a deceased donor, and the time interval between diagnosis and transplantation was 5.9 years. In 53% of patients, immunosuppression was adjusted, and clinical support varied according to geographic region. Hospitalization was required for 65% of the patients, 35% of them needed intensive care, 25% mechanical ventilation, and 23% renal replacement therapy. The 90-day overall fatality was 21%, being 23% in the Southeast, 16% in the Northeast, and 19% in the Central-west and South regions. Conclusion: The migratory pattern of the pandemic among KT recipients followed that of the general population and the outcomes were influenced by regional features. COVID-19 in KT recipients was associated with high utilization of health-care resources and higher fatality rates than those reported in the general population.

Resumo Introdução: A pandemia da COVID-19 afetou receptores de transplante renal (TR), com taxas de mortalidade mundial em torno de 25%. Considerando as notórias disparidades sócio-demográficas brasileiras, este relatório descreve pela primeira vez principais características e desfechos da doença em receptores de TR, segundo as regiões geográficas. Métodos: Esta análise retrospectiva multicêntrica nacional incluiu dados de receptores de TR com COVID-19 confirmada entre Março/Novembro de 2020. Resultados: Trinta e cinco dos 81 centros (57% da atividade de transplante renal brasileira) relataram 1.680 pacientes com COVID-19. O Nordeste foi o primeiro a atingir o pico no número de infecções. O Sudeste, por sua densidade populacional, contribuiu com maior número de pacientes. Pacientes tinham em média 52 anos, 76% apresentavam hipertensão e 34% diabetes, 75% receptores de doador falecido e o tempo entre diagnóstico e transplante foi de 5,9 anos. Em 53% dos pacientes, os imunossupressores foram ajustados, e o tratamento variou segundo a região. Hospitalização foi necessária para 65% dos pacientes, 35% necessitaram de cuidados intensivos, 25% ventilação mecânica, e 23% terapia renal substitutiva. A mortalidade geral em 90 dias foi 21%, sendo 23% no Sudeste, 16% no Nordeste, e 19% nas regiões Centro-Oeste e Sul. Conclusão: O padrão migratório da pandemia entre os receptores de TR seguiu o da população em geral e os desfechos foram influenciados por características regionais. A COVID-19 em receptores de TR foi associada à alta utilização de recursos de saúde e taxas de mortalidade mais altas do que as relatadas na população em geral.

Migratory pattern of the coronavirus disease 2019 and high fatality rates among kidney transplant recipients: report from the Brazilian Multicenter Cohort Study.

INTRODUCTION: The unprecedented coronavirus disease 2019 (COVID-19) pandemic has affected kidney transplant (KT) recipients, with worldwide fatality rates around 25%. Considering the well-known Brazilian socio-demographic disparities, this report describes for the first time the main outcomes of COVID-19 in KT recipients according to Brazilian geographic regions. METHODS: This multicenter national retrospective analysis included data from KT recipients with confirmed COVID-19 between March and November 2020. RESULTS: Thirty-five of the 81 centers (57% of KT activity in Brazil) reported 1,680 patients with COVID-19. The Northeast was the first to reach the peak in the number of infections. The Southeast, due to its population density, contributed with the largest number of patients. Patients had a median age of 52 years, 76% had hypertension and 34% diabetes, 75% were recipients of a deceased donor, and the time interval between diagnosis and transplantation was 5.9 years. In 53% of patients, immunosuppression was adjusted, and clinical support varied according to geographic region. Hospitalization was required for 65% of the patients, 35% of them needed intensive care, 25% mechanical ventilation, and 23% renal replacement therapy. The 90-day overall fatality was 21%, being 23% in the Southeast, 16% in the Northeast, and 19% in the Central-west and South regions. CONCLUSION: The migratory pattern of the pandemic among KT recipients followed that of the general population and the outcomes were influenced by regional features. COVID-19 in KT recipients was associated with high utilization of health-care resources and higher fatality rates than those reported in the general population.

Post Transplant Lymphoproliferative Disease Isolated to Kidney Allograft / Doença Linfo Proliferativa Pós-Transplante Isolada ao Enxerto Renal

ABSTRACT Post-transplantation lymphoproliferative disease (PTLD) comprises a heterogeneous group of hematolymphoid proliferations resulting from a monoclonal or polyclonal proliferation of lymphoid cells. The clinical presentation varies according to the affected sites. The gastrointestinal tract and the central nervous system are the most common, and constitutional symptoms are frequent. Isolated allograft involvement is rare. We report a case of polyclonal PTLD isolated in the kidney allograft in a patient who received an HLA-identical living donor seven years before. Noteworthy, this patient did not present constitutional symptoms, and his only clinical manifestation was graft dysfunction, expressed by an increase in serum creatinine and mild proteinuria. The diagnosis was performed through renal biopsy, which showed dense lymphoid interstitial infiltrate. The PTLD was polyclonal, unrelated to Epstein-Bar virus (EBV), and it was successfully treated with chemotherapy, reduced immunosuppression, and sirolimus.

RESUMO A doença linfoproliferativa pós-transplante (DLPT) é formada por um grupo heterogêneo de proliferações hematolinfóides resultantes da proliferação mono ou policlonal das células linfoides. O quadro clínico é variado e dependente dos sítios envolvidos, sendo o trato gastrintestinal e o sistema nervoso central os mais comuns, e sintomas constitucionais são frequentes. O envolvimento isolado do enxerto é raro. Relatamos aqui um caso de DLPT policlonal isolada do enxerto em um receptor de transplante renal com doador vivo HLA idêntico, ocorrido sete anos após o transplante. Digno de nota, o paciente não apresentou sintomas constitucionais e sua única manifestação clínica foi disfunção do enxerto, expressa através da elevação da creatinina e discreta proteinuria, sendo o diagnóstico realizado através de biópsia renal, que evidenciou infiltrado intersticial linfoide denso. Tratava-se de DLPT policlonal não relacionada ao vírus Epstein-Bar (EBV) e foi tratado com sucesso com quimioterapia, redução da imunossupressão e sirolimo.

High mortality among kidney transplant recipients diagnosed with coronavirus disease 2019: Results from the Brazilian multicenter cohort study.

BACKGROUND: Kidney transplant (KT) recipients are considered a high-risk group for unfavorable outcomes in the course of coronavirus disease 2019 (COVID-19). AIM: To describe the clinical aspects and outcomes of COVID-19 among KT recipients. METHODS: This multicenter cohort study enrolled 1,680 KT recipients diagnosed with COVID-19 between March and November 2020, from 35 Brazilian centers. The main outcome was the 90-day cumulative incidence of death, for the entire cohort and according to acute kidney injury (AKI) and renal replacement therapy (RRT) requirement. Fatality rates were analyzed according to hospitalization, intensive care unit (ICU) admission, and mechanical ventilation (MV) requirement. Multivariable analysis was performed by logistic regression for the probability of hospitalization and death. RESULTS: The median age of the recipients was 51.3 years, 60.4% were men and 11.4% were Afro-Brazilian. Comorbidities were reported in 1,489 (88.6%), and the interval between transplantation and infection was 5.9 years. The most frequent symptoms were cough (54%), myalgia (40%), dyspnea (37%), and diarrhea (31%), whereas the clinical signs were fever (61%) and hypoxemia (13%). Hospitalization was required in 65.1%, and immunosuppressive drugs adjustments were made in 74.4% of in-hospital patients. ICU admission was required in 34.6% and MV in 24.9%. In the multivariable modeling, the variables related with the probability of hospitalization were age, hypertension, previous cardiovascular disease, recent use of high dose of steroid, and fever, dyspnea, diarrhea, and nausea or vomiting as COVID-19 symptoms. On the other hand, the variables that reduced the probability of hospitalization were time of COVID-19 symptoms, and nasal congestion, headache, arthralgia and anosmia as COVID-19 symptoms. The overall 90-day cumulative incidence of death was 21.0%. The fatality rates were 31.6%, 58.2%, and 75.5% in those who were hospitalized, admitted to the ICU, and required MV, respectively. At the time of infection, 23.2% had AKI and 23.4% required RRT in the follow-up. The cumulative incidence of death was significantly higher among recipients with AKI (36.0% vs. 19.1%, P < 0.0001) and in those who required RRT (70.8% vs. 10.1%, P < 0.0001). The variables related with the probability of death within 90 days after COVID-19 were age, time after transplantation, presence of hypertension, previous cardiovascular disease, use of tacrolimus and mycophenolate, recent use of high dose of steroids, and dyspnea as COVID-19 symptom. On the other hand, the variables that reduced the risk of death were time of symptoms, and headache and anosmia as COVID-19 symptoms. CONCLUSION: The patients diagnosed with COVID-19 were long-term KT recipients and most of them had some comorbidities. One in every five patients died, and the rate of death was significantly higher in those with AKI, mainly when RRT was required.

[Prevalence and factors associated with non-enrollment for kidney transplant]. / Prevalência e fatores associados a não inscrição para transplante renal.

This study evaluated the prevalence and factors associated with lack of enrollment for kidney transplant among patients in chronic dialysis in Greater Metropolitan Fortaleza, Ceará, Brazil. The sample excluded patients with insufficient clinical status and those already in pre-kidney transplant evaluation. A semi-structured questionnaire was applied, including options for the question, "What is the main reason why you are not enrolled for kidney transplant?" Prevalence of patients considered fit but not enrolled or in pre- kidney transplant evaluation was 50.7%. The main reasons were fear of failure/loss of grafting (32.5%), difficulty with transportation or access to tests (20.9%), and temporary personal or family problems (13.7%). In the multivariate analysis, the variables associated with fear of failure or loss of graft were female sex (OR = 1.763; 95%CI: 1.224-2.540) and end-stage renal disease (ESRD) due to hypertension (OR = 1.732; 95%CI: 1.178-2.547), while monthly income (number of minimum wages) showed a protective association (OR = 0.882; 95%CI: 0.785-0.991). Time on dialysis (months) was a risk factor for difficulty with transportation and access to tests (OR = 1.004; 95%CI: 1.001-1.007), and female sex showed a protective association (OR = 0.576; 95%CI: 0.368-0.901). These results show high prevalence of patients in dialysis not enrolled on the kidney transplant waitlist. The main causes were lack of information and lack of access. Female sex, low income, and ESRD due to hypertension were risk factors for lack of enrollment on the kidney transplant waitlist due to fear of loss of graft, resulting from lack of information on this treatment modality. Male sex and longer time on dialysis were risk factors for difficulty in access to kidney transplant.

Este estudo avaliou a prevalência e os fatores associados a não procura por transplante renal entre pacientes em diálise crônica na Região Metropolitana de Fortaleza, Ceará, Brasil. Foram excluídos os pacientes sem condições clínicas e aqueles em avaliação pré-transplante renal. Um questionário semiestruturado foi aplicado, incluindo opções para a pergunta "Qual o principal motivo pelo qual o senhor/senhora não está inscrito(a) para o transplante renal?". A prevalência de pacientes considerados aptos, mas não inscritos e nem em avaliação pré-transplante renal foi de 50,7%. As principais causas foram: receio de insucesso/perda do enxerto (32,5%), dificuldade de transporte e acesso aos exames (20,9%) e problemas pessoais ou familiares temporários (13,7%). Em análise múltipla, as variáveis associadas a risco de receio do insucesso/perda do enxerto foram: sexo feminino (OR = 1,763; IC95%: 1,224-2,540) e doença renal dialítica (DRC 5-D) por hipertensão (OR = 1,732; IC95%: 1,178-2,547), tendo a renda mensal (salários mínimos) uma associação de proteção (OR = 0,882; IC95%: 0,785-0,991). O tempo em diálise (meses) foi um fator de risco para a dificuldade de transporte e acesso aos exames (OR = 1,004; IC95%: 1,001-1,007) e o sexo feminino apresentou uma associação de proteção (OR = 0,576; IC95%: 0,368-0,901). Esses resultados mostram elevada prevalência de pacientes em diálise fora de lista para transplante renal. As principais causas são reflexo da desinformação e falta de acesso. Sexo feminino, baixa renda e DRC 5-D por hipertensão foram os fatores de risco para a não procura por transplante renal por receio de perda do enxerto, reflexo da carência de informações sobre a modalidade. Sexo masculino e maior tempo em diálise foram os fatores de risco para a dificuldade de acesso à terapia.

Este estudio evalúo la prevalencia y los factores asociados a la no búsqueda de un trasplante renal entre pacientes con diálisis crónica en la Región Metropolitana de Fortaleza, Ceará, Brasil. Se excluyeron a pacientes sin condiciones clínicas y aquellos en evaluación pre-trasplante renal . Se aplicó un cuestionario semiestructurado, incluyendo opciones a la pregunta "¿cuál es el principal motivo por el cual usted no está inscrito(a) para un trasplante renal?" La prevalencia de pacientes considerados aptos, pero no inscritos y ni en evaluación pre-trasplante renal fue de un 50,7%. Las principales causas fueron: recelo al fracaso/pérdida del injerto (32,5%), dificultad de transporte y acceso a los exámenes (20,9%), así como problemas personales o familiares temporales (13,7%). En el análisis múltiple, las variables asociadas al riesgo del recelo al fracaso/pérdida del injerto fueron de sexo femenino (OR = 1,763; IC95%: 1,224-2,540) y enfermedad renal dialítica (DRC 5-D) por hipertensión (OR = 1,732; IC95%: 1,178-2,547), teniendo la renta mensual (salarios mínimos) una asociación de protección (OR = 0,882; IC95%: 0,785-0,991). El tiempo en diálisis (meses) fue un factor de riesgo para la dificultad en el transporte y acceso a los exámenes (OR = 1,004; IC95%: 1,001-1,007), y el sexo femenino tuvo una asociación de protección (OR = 0,576; IC95%: 0,368-0,901). Estos resultados muestran la elevada prevalencia de pacientes en diálisis fuera de la lista para transplante renal. Las principales causas son reflejo de la desinformación y falta de acceso. Sexo femenino, baja renta y DRC 5-D por hipertensión fueron factores de riesgo para la no búsqueda de trasplante renal por recelo a la pérdida del injerto, reflejo de la carencia de información sobre la modalidad. Sexo masculino y mayor tiempo en diálisis fueron factores de riesgo para la dificultad de acceso a la terapia. izará la atención a las vulnerabilidades individuales desde la perspectiva de la salud integral.

Declínio nas doações e transplantes de órgãos no Ceará durante a pandemia da COVID-19: estudo descritivo, abril a junho de 2020 / Disminución de donaciones y trasplantes de órganos en Ceará durante la pandemia COVID-19: un estudio descriptivo, abril - junio de 2020 / Fall in organ donations and transplants in Ceará in the COVID-19 pandemic: a descriptive study, April - June 2020

Objetivo Descrever as doações e os transplantes de órgãos no Ceará, Brasil, após a declaração da pandemia da COVID-19. Métodos Estudo descritivo, com dados da Associação Brasileira de Transplantes de Órgãos. O número de doadores e transplantes do período de abril a junho de 2020 foi comparado ao mesmo período de 2019 e ao primeiro trimestre de 2020. Resultados No primeiro semestre de 2020, o estado registrou 72 doadores efetivos. Destes, 17 (23,6%) no segundo trimestre. Dos 352 transplantes do primeiro semestre de 2020, 37 (10,7%) foram realizados no segundo trimestre. Em comparação ao período de abril a junho de 2019, houve redução de 67,9% e 89,3% no número de doadores e transplantes, respectivamente, no mesmo período de 2020. Conclusão Os números de doadores e transplantes do Ceará apresentaram importante declínio nos três meses seguintes ao decreto da pandemia da COVID-19, especialmente os das modalidades de rim, coração e córneas.

Objetivo Describir las donaciones y trasplantes de órganos en Ceará, Brasil, después de la declaración de la pandemia COVID-19. Métodos estudio descriptivo con datos de la Asociación Brasileña de Trasplantes de Órganos. Se comparó el número de donantes y trasplantes de abril a junio de 2020 con el mismo período de 2019 y el primer trimestre de 2020. Resultados El primer semestre de 2020, Ceará registró 72 donantes efectivos. De estos, 17 (23,6%) en el segundo trimestre. De 352 trasplantes realizados en el primer semestre de 2020, 37 (10.7%) fueron realizados en el segundo trimestre. En comparación al período de abril a junio de 2019, hubo reducción de 67,9% y 89,3% en el número de donantes y trasplantes, respectivamente, en el mismo período de 2020. Conclusión El número de donantes y trasplantes en Ceará mostró importante disminución en los tres meses siguientes al decreto pandémico COVID-19, especialmente las modalidades renal, cardíaca y córneas.

Objective To describe organ donations and transplants in Ceará state, Brazil, following the declaration of the COVID-19 pandemic. Methods This was a descriptive study using data from the Brazilian Organ Transplantation Association. The number of donors and transplants from April to June 2020 was compared to the same period in 2019 and to the first quarter of 2020. Results In the first half of 2020, the state registered 72 effective donors, just 17 (23.6%) of whom related to the second quarter. Of the 352 transplants in the first half of 2020, 37 (10.7%) were performed in the second quarter. Compared with the period from April to June 2019, there was a reduction of 67.9% and 89.3% in the number of donors and transplants, respectively, in the same period of 2020. Conclusion The number of donors and transplants in Ceará showed an important fall in the three months following the declaration of the COVID-19 pandemic, especially for kidney, heart and cornea transplants.

Prevalência e fatores associados a não inscrição para transplante renal / Prevalence and factors associated with non-enrollment for kidney transplant / Prevalencia y factores asociados a la no inscripción para un trasplante renal

Resumo: Este estudo avaliou a prevalência e os fatores associados a não procura por transplante renal entre pacientes em diálise crônica na Região Metropolitana de Fortaleza, Ceará, Brasil. Foram excluídos os pacientes sem condições clínicas e aqueles em avaliação pré-transplante renal. Um questionário semiestruturado foi aplicado, incluindo opções para a pergunta "Qual o principal motivo pelo qual o senhor/senhora não está inscrito(a) para o transplante renal?". A prevalência de pacientes considerados aptos, mas não inscritos e nem em avaliação pré-transplante renal foi de 50,7%. As principais causas foram: receio de insucesso/perda do enxerto (32,5%), dificuldade de transporte e acesso aos exames (20,9%) e problemas pessoais ou familiares temporários (13,7%). Em análise múltipla, as variáveis associadas a risco de receio do insucesso/perda do enxerto foram: sexo feminino (OR = 1,763; IC95%: 1,224-2,540) e doença renal dialítica (DRC 5-D) por hipertensão (OR = 1,732; IC95%: 1,178-2,547), tendo a renda mensal (salários mínimos) uma associação de proteção (OR = 0,882; IC95%: 0,785-0,991). O tempo em diálise (meses) foi um fator de risco para a dificuldade de transporte e acesso aos exames (OR = 1,004; IC95%: 1,001-1,007) e o sexo feminino apresentou uma associação de proteção (OR = 0,576; IC95%: 0,368-0,901). Esses resultados mostram elevada prevalência de pacientes em diálise fora de lista para transplante renal. As principais causas são reflexo da desinformação e falta de acesso. Sexo feminino, baixa renda e DRC 5-D por hipertensão foram os fatores de risco para a não procura por transplante renal por receio de perda do enxerto, reflexo da carência de informações sobre a modalidade. Sexo masculino e maior tempo em diálise foram os fatores de risco para a dificuldade de acesso à terapia.

Abstract: This study evaluated the prevalence and factors associated with lack of enrollment for kidney transplant among patients in chronic dialysis in Greater Metropolitan Fortaleza, Ceará, Brazil. The sample excluded patients with insufficient clinical status and those already in pre-kidney transplant evaluation. A semi-structured questionnaire was applied, including options for the question, "What is the main reason why you are not enrolled for kidney transplant?" Prevalence of patients considered fit but not enrolled or in pre- kidney transplant evaluation was 50.7%. The main reasons were fear of failure/loss of grafting (32.5%), difficulty with transportation or access to tests (20.9%), and temporary personal or family problems (13.7%). In the multivariate analysis, the variables associated with fear of failure or loss of graft were female sex (OR = 1.763; 95%CI: 1.224-2.540) and end-stage renal disease (ESRD) due to hypertension (OR = 1.732; 95%CI: 1.178-2.547), while monthly income (number of minimum wages) showed a protective association (OR = 0.882; 95%CI: 0.785-0.991). Time on dialysis (months) was a risk factor for difficulty with transportation and access to tests (OR = 1.004; 95%CI: 1.001-1.007), and female sex showed a protective association (OR = 0.576; 95%CI: 0.368-0.901). These results show high prevalence of patients in dialysis not enrolled on the kidney transplant waitlist. The main causes were lack of information and lack of access. Female sex, low income, and ESRD due to hypertension were risk factors for lack of enrollment on the kidney transplant waitlist due to fear of loss of graft, resulting from lack of information on this treatment modality. Male sex and longer time on dialysis were risk factors for difficulty in access to kidney transplant.

Resumen: Este estudio evalúo la prevalencia y los factores asociados a la no búsqueda de un trasplante renal entre pacientes con diálisis crónica en la Región Metropolitana de Fortaleza, Ceará, Brasil. Se excluyeron a pacientes sin condiciones clínicas y aquellos en evaluación pre-trasplante renal . Se aplicó un cuestionario semiestructurado, incluyendo opciones a la pregunta "¿cuál es el principal motivo por el cual usted no está inscrito(a) para un trasplante renal?" La prevalencia de pacientes considerados aptos, pero no inscritos y ni en evaluación pre-trasplante renal fue de un 50,7%. Las principales causas fueron: recelo al fracaso/pérdida del injerto (32,5%), dificultad de transporte y acceso a los exámenes (20,9%), así como problemas personales o familiares temporales (13,7%). En el análisis múltiple, las variables asociadas al riesgo del recelo al fracaso/pérdida del injerto fueron de sexo femenino (OR = 1,763; IC95%: 1,224-2,540) y enfermedad renal dialítica (DRC 5-D) por hipertensión (OR = 1,732; IC95%: 1,178-2,547), teniendo la renta mensual (salarios mínimos) una asociación de protección (OR = 0,882; IC95%: 0,785-0,991). El tiempo en diálisis (meses) fue un factor de riesgo para la dificultad en el transporte y acceso a los exámenes (OR = 1,004; IC95%: 1,001-1,007), y el sexo femenino tuvo una asociación de protección (OR = 0,576; IC95%: 0,368-0,901). Estos resultados muestran la elevada prevalencia de pacientes en diálisis fuera de la lista para transplante renal. Las principales causas son reflejo de la desinformación y falta de acceso. Sexo femenino, baja renta y DRC 5-D por hipertensión fueron factores de riesgo para la no búsqueda de trasplante renal por recelo a la pérdida del injerto, reflejo de la carencia de información sobre la modalidad. Sexo masculino y mayor tiempo en diálisis fueron factores de riesgo para la dificultad de acceso a la terapia. izará la atención a las vulnerabilidades individuales desde la perspectiva de la salud integral.

Fall in organ donations and transplants in Ceará in the COVID-19 pandemic: a descriptive study, April - June 2020. / Declínio nas doações e transplantes de órgãos no Ceará durante a pandemia da COVID-19: estudo descritivo, abril a junho de 2020.

OBJECTIVE: To describe organ donations and transplants in Ceará state, Brazil, following the declaration of the COVID-19 pandemic. METHODS: This was a descriptive study using data from the Brazilian Organ Transplantation Association. The number of donors and transplants from April to June 2020 was compared to the same period in 2019 and to the first quarter of 2020. RESULTS: In the first half of 2020, the state registered 72 effective donors, just 17 (23.6%) of whom related to the second quarter. Of the 352 transplants in the first half of 2020, 37 (10.7%) were performed in the second quarter. Compared with the period from April to June 2019, there was a reduction of 67.9% and 89.3% in the number of donors and transplants, respectively, in the same period of 2020. CONCLUSION: The number of donors and transplants in Ceará showed an important fall in the three months following the declaration of the COVID-19 pandemic, especially for kidney, heart and cornea transplants.

Decline in organ donations and transplants in Ceará in the COVID-19 pandemic: a descriptive study, April ­ June 2020 / Disminución de donaciones y trasplantes de órganos en Ceará en la pandemia COVID-19: un estudio descriptivo, abril ­ junio de 2020 / Declínio nas doações e transplantes de órgãos no Ceará durante a pandemia da COVID-19: estudo descritivo, abril ­ junho de 2020

Objective: To describe organ donations and transplants in Ceará, Brazil, after the COVID-19 pandemic decree. Methods: Descriptive study using data from the Brazilian Organ Transplantation Association. The number of donors and transplants from April to June 2020 was compared to the same period in 2019 and the first quarter of 2020. Results: In the first half of 2020, the state registered 72 effective donors. Of these, 17 (23.6%) in the second quarter. Of the 352 transplants in the first half of 2020, 37 (10.7%) occurred in the second quarter. Compared the period from April to June 2019, there was a reduction of 67.9% and 89.3% in the number of donors and transplants, respectively, in the same period of 2020. Conclusion: The number of donors and transplants in Ceará showed an important decline in the three months following the COVID-19 pandemic decree, especially for kidney, heart and corneal transplants.

Objetivo: Descrever as doações e os transplantes de órgãos no Ceará, Brasil, após a declaração da pandemia da COVID-19. Métodos: Estudo descritivo, com dados da Associação Brasileira de Transplantes de Órgãos. O número de doadores e transplantes do período de abril a junho de 2020 foi comparado ao mesmo período de 2019 e ao primeiro trimestre de 2020. Resultados: No primeiro semestre de 2020, o estado registrou 72 doadores efetivos. Destes, 17 (23,6%) no segundo trimestre. Dos 352 transplantes do primeiro semestre de 2020, 37 (10,7%) foram realizados no segundo trimestre. Em comparação ao período de abril a junho de 2019, houve redução de 67,9% e 89,3% no número de doadores e transplantes, respectivamente, no mesmo período de 2020. Conclusão: Os números de doadores e transplantes do Ceará apresentaram importante declínio nos três meses seguintes ao decreto da pandemia da COVID-19, especialmente os das modalidades de rim, coração e córneas.

The impact of deceased donor maintenance on delayed kidney allograft function: A machine learning analysis.

BACKGROUND: This study evaluated the risk factors for delayed graft function (DGF) in a country where its incidence is high, detailing donor maintenance-related (DMR) variables and using machine learning (ML) methods beyond the traditional regression-based models. METHODS: A total of 443 brain dead deceased donor kidney transplants (KT) from two Brazilian centers were retrospectively analyzed and the following DMR were evaluated using predictive modeling: arterial blood gas pH, serum sodium, blood glucose, urine output, mean arterial pressure, vasopressors use, and reversed cardiac arrest. RESULTS: Most patients (95.7%) received kidneys from standard criteria donors. The incidence of DGF was 53%. In multivariable logistic regression analysis, DMR variables did not impact on DGF occurrence. In post-hoc analysis including only KT with cold ischemia time<21h (n = 220), urine output in 24h prior to recovery surgery (OR = 0.639, 95%CI 0.444-0.919) and serum sodium (OR = 1.030, 95%CI 1.052-1.379) were risk factors for DGF. Using elastic net regularized regression model and ML analysis (decision tree, neural network and support vector machine), urine output and other DMR variables emerged as DGF predictors: mean arterial pressure, ≥ 1 or high dose vasopressors and blood glucose. CONCLUSIONS: Some DMR variables were associated with DGF, suggesting a potential impact of variables reflecting poor clinical and hemodynamic status on the incidence of DGF.

Clinical Features of Kidney Transplant Recipients Admitted to the Intensive Care Unit.

INTRODUCTION: There is a paucity of data regarding the complications in kidney transplant patients who may require intensive care unit (ICU) management, despite being the most common solid organ transplant worldwide. OBJECTIVE: To identify the main reasons for ICU admission and to determine the factors associated with hospital mortality in kidney transplant recipients. DESIGN: This single-center retrospective cohort study was conducted between September 2013 and June 2014, including all consecutive kidney transplant patients requiring ICU admission. We collected data on patient demographics, transplant characteristics, clinical data, and prognostic scores. The independent determinants of hospital mortality were identified by multiple logistic regression analysis. We also assessed the performance of Simplified Acute Physiology Score 3 (SAPS 3) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. RESULTS: We analyzed data from 413 patients, the majority of whom were admitted late after renal transplantation (1169 days; 63-3003 days). The main reason for admission was sepsis (33.2%), followed by cardiovascular disease (16%). Age (odds ratio [OR] 1.05, confidence interval [CI], 1.01-1.09), SAPS 3 score (OR 1.04, CI, 1.01-1.08), the need for mechanical ventilation (OR 26.47, CI, 10.30-68.08), and vasopressor use (OR 3.34, CI, 1.37-8.13) were independently associated with hospital mortality. The performance of SAPS 3 and APACHE II scores was poor in this population and overestimated the mortality rates. CONCLUSION: Sepsis was the main reason for ICU admission in kidney transplant recipients, followed by cardiovascular disease. Age and disease severity were associated with hospital mortality.

Effect of induction therapy in kidney transplantation in sensitive patients: analysis of risks and benefits.

INTRODUCTION: Sensitization is associated with worse clinical outcomes after kidney transplantation (KT), including increased incidence of delayed graft function, acute rejection (AR) and graft loss. OBJECTIVES: To evaluate 1-year efficacy and safety outcomes in sensitized KT recipients receiving antithymocyte globulin (ATG) induction and compare them to non-sensitized patients. METHODS: Deceased donors KT recipients transplanted between January 1998 and December 2009 were divided into 5 groups: control group 1 -n = 89, PRA negative, without induction therapy; control group 2 - n = 94, PRA negative, basiliximab induction; control group 3 - n = 81, PRA negative, ATG induction; test group 4 - n = 64, PRA 1-49%, ATG induction; test group 5 -n = 118, PRA ≥ 50%, ATG induction. RESULTS: There was no difference in the incidence of AR among patients sensitized and non-sensitized, except for group 1, with highest incidence of AR (20.2%,p = 0.006 vs. Group 4 and p = 0.001 vs. group 5). Sensitized patients induced with ATG had higher incidence of citomegalovirus infection when compared with group 2 (26.6% and 14.4% vs. 2.1%). There were no differences in graft and patient survivals. In multivariable analysis, PRA > 50% and ATG induction were not associated with graft loss, death or death-censored graft loss. CONCLUSION: Sensitized patients induced with ATG presented similar or lower incidence of AR when compared with non-sensitized patients not induced. Besides, these patients had similar safety profile and graft and patient survivals at 1 year.

Efeito da terapia de indução em pacientes sensibilizados: análise dos riscos e benefícios / Effect of induction therapy in kidney transplantation in sensitive patients: analysis of risks and benefits

Resumo Introdução: A sensibilização está associada a piores desfechos clínicos após o transplante renal (TxR), incluindo maior incidência de função tardia, rejeição aguda e perda do enxerto. Objetivos: Avaliar os desfechos de eficácia e segurança de 1 ano de receptores de TxR com doador falecido sensibilizados induzidos com globulina antitimócito (ATG) e compará-las aos de pacientes não sensibilizados. Métodos: Receptores de TxR com doador falecido entre janeiro de 1998 e dezembro de 2009 foram divididos em 5 grupos: grupo controle 1 - n = 89, PRA negativo, sem indução; grupo controle 2 - n = 94, PRA negativo, indução com basiliximabe; grupo controle 3 - n = 81, PRA negativo, indução com ATG; grupo teste 4 - n = 64, PRA 1-49%, indução com ATG; grupo teste 5 - n = 118, PRA ≥ 50%, indução com ATG. Resultados: Não houve diferença na incidência de rejeição entre pacientes sensibilizados e não sensibilizados, exceto pelo grupo 1, que apresentou a maior incidência de rejeição aguda comprovada por biópsia (20,2%, p = 0,006 vs. grupo 4 ep = 0,001 vs. grupo 5). Os pacientes sensibilizados induzidos com ATG apresentaram maior incidência de infecção por citomegalovírus quando comparados aos pacientes do grupo 2 (26,6% e 14,4% vs. 2,1%). Não houve diferença nas sobrevidas do enxerto e do paciente. Na análise multivariada, PRA > 50% e uso de ATG não foram associados à perda, perda com óbito censorado ou óbito. Conclusão: Os pacientes sensibilizados induzidos com ATG apresentaram incidência de rejeição semelhante ou inferior à de pacientes não sensibilizados não induzidos. Estes pacientes apresentaram sobrevidas do enxerto e do paciente semelhantes em 1 ano e comparável perfil de segurança.

Abstract Introduction: Sensitization is associated with worse clinical outcomes after kidney transplantation (KT), including increased incidence of delayed graft function, acute rejection (AR) and graft loss. Objectives: To evaluate 1-year efficacy and safety outcomes in sensitized KT recipients receiving antithymocyte globulin (ATG) induction and compare them to non-sensitized patients. Methods: Deceased donors KT recipients transplanted between January 1998 and December 2009 were divided into 5 groups: control group 1 -n = 89, PRA negative, without induction therapy; control group 2 - n = 94, PRA negative, basiliximab induction; control group 3 - n = 81, PRA negative, ATG induction; test group 4 - n = 64, PRA 1-49%, ATG induction; test group 5 -n = 118, PRA ≥ 50%, ATG induction. Results: There was no difference in the incidence of AR among patients sensitized and non-sensitized, except for group 1, with highest incidence of AR (20.2%,p = 0.006 vs. Group 4 andp = 0.001 vs. group 5). Sensitized patients induced with ATG had higher incidence of citomegalovirus infection when compared with group 2 (26.6% and 14.4% vs. 2.1%). There were no differences in graft and patient survivals. In multivariable analysis, PRA > 50% and ATG induction were not associated with graft loss, death or death-censored graft loss. Conclusion: Sensitized patients induced with ATG presented similar or lower incidence of AR when compared with non-sensitized patients not induced. Besides, these patients had similar safety profile and graft and patient survivals at 1 year.