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1.
Exp Clin Transplant ; 17(Suppl 1): 83-91, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30777529

RESUMO

OBJECTIVES: The prevalence of BK-induced nephritis in renal transplant recipients is estimated to be 1% to 10%; the rate of graft loss within 1 year is 30% to 65%. We conducted this study to evaluate screening of BK virus in blood and/or urine among renal transplant recipients and to assess the effects of different therapeutic modalities in renal transplant recipients with BK nephropathy. MATERIALS AND METHODS: Kidney transplant recipients were screened at the time of transplant and then at 1, 2, 3, 6, 9, 12, 18, and 24 months posttransplant. Fiftynine patients were diagnosed with BK virus viremia. Patients were divided into 2 groups according to treatment: group 1 (n = 29) received an active treatment and group 2 (n = 30) received minimized immunosuppression. RESULTS: Most patients required graft biopsies to confirm diagnosis (86.2% in group 1 vs 50% in group 2; P = .03). Both groups were comparable regarding demographic data. Initial posttransplant graft function was significantly better in group 1 (P = .017); ultimately, there was no significant difference between both groups regarding graft survival (P= .51). Fifty percent of patients had biopsy-proven acute T-cell-mediated rejection before BK virus-associated nephropathy diagnosis (significantly higher in group 1). Serum creatinine levels were significantly better in group 2 at 3, 4, and 5 years after BK nephropathy (P = .001, .017, and .003, respectively). CONCLUSIONS: The prevalence of BK nephropathy in our renal transplant recipients was 5.9% with a rate of graft loss ranging from 43% to 51%. Regular screening, less intensive immunosuppressive therapy, and early intervention by reduction of immunosuppressive medications are advisable to obtain early diagnosis and to have better outcomes of BK virus-associated nephropathy with antiviral agents.


Assuntos
Antivirais/uso terapêutico , Vírus BK/efeitos dos fármacos , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Infecções Oportunistas/tratamento farmacológico , Infecções por Polyomavirus/tratamento farmacológico , Infecções Tumorais por Vírus/tratamento farmacológico , Antivirais/efeitos adversos , Vírus BK/imunologia , Vírus BK/patogenicidade , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Transplante de Rim/mortalidade , Kuweit/epidemiologia , Infecções Oportunistas/imunologia , Infecções Oportunistas/mortalidade , Infecções Oportunistas/virologia , Infecções por Polyomavirus/imunologia , Infecções por Polyomavirus/mortalidade , Infecções por Polyomavirus/virologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Infecções Tumorais por Vírus/imunologia , Infecções Tumorais por Vírus/mortalidade , Infecções Tumorais por Vírus/virologia
2.
Exp Clin Transplant ; 17(Suppl 1): 99-104, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30777531

RESUMO

OBJECTIVES: Pregnancy after kidney transplant has a high risk for maternal and fetal complications; however, it can be successful if patients are properly selected. Here, we studied outcomes and complications of pregnancies in kidney transplant recipients who received calcineurin inhibitor-based immunosuppression. MATERIALS AND METHODS: In this case control study, we reviewed patients who became pregnant between 2004 and 2017. For this analysis, each pregnancy was considered an event. We divided pregnancies into 2 groups according to calcineurin inhibitor-based maintenance immunosuppression: group 1 (49 pregnancies) received cyclosporine, and group 2 (33 pregnancies) received tacrolimus. Patients also received steroids and azathioprine. Patients had regular antenatal follow-up at the Hamed Alessa Organ Transplant Center (Kuwait) and in the maternity hospital (monthly until month 7 and then weekly until delivery). RESULTS: Of 750 female kidney transplant recipients within childbearing potential, there were 82 pregnancies (10.9%) in 49 recipients (6.5%). Seventy-eight pregnancies were planned, and 4 pregnancies occurred while women were using contraception. There was 1 triple pregnancy, 5 double, and 76 single pregnancies. Two women had preeclampsia as maternal complication, 2 had uncontrolled hypertension, and 7 developed graft dysfunction. Forty-seven women (57.3%) had caesarean section, and the remaining had vaginal deliveries. Of 89 babies, 86 were viable (1 intrauterine fetal death and 2 abortions). Eight babies were delivered prematurely with low birth weight, and 2 needed incubators. Mean serum creatinine levels were 97.9 ± 24, 109 ± 38, 100 ± 39, 120 ± 46, and 115 ± 57 µmol/L at baseline, first, second, and third trimesters, and postpartum, respectively. Twelve patients showed high panel reactive antibodies but without donor-specific antibodies. CONCLUSIONS: Posttransplant pregnancy can be successful in most renal allograft recipients, but the increased risk of fetal and maternal complications, including low birth weight, spontaneous abortus, and preeclampsia, should be considered.


Assuntos
Inibidores de Calcineurina/uso terapêutico , Ciclosporina/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim , Tacrolimo/uso terapêutico , Inibidores de Calcineurina/efeitos adversos , Estudos de Casos e Controles , Ciclosporina/efeitos adversos , Quimioterapia Combinada , Feminino , Sobrevivência de Enxerto , Humanos , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Kuweit , Nascimento Vivo , Gravidez , Complicações na Gravidez/etiologia , Resultado da Gravidez , Fatores de Risco , Tacrolimo/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
3.
Exp Clin Transplant ; 17(Suppl 1): 135-141, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30777539

RESUMO

OBJECTIVES: The number of renal transplants in elderly patients is increasing as age per se does not constitute a contraindication to transplant. We compared renal transplant outcomes in elderly recipients versus a group of middle-aged patients. MATERIALS AND METHODS: Our retrospective casecontrolled study compared elderly transplant recipients (n = 252; > 60 y old) with a matched cohort of younger adult recipients (n = 710; between 40 and 60 years old) who underwent renal transplant at the Hamed Al-Essa Organ Transplant Center of Kuwait between 2000 and 2014. Demographic characteristics, comorbidities, complications after transplant, and graft and patient outcomes were compared between groups. RESULTS: There were 252 elderly kidney transplant recipients (mean age of 65.5 ± 4.8 y; 59.52% males) and 710 younger adult patients (mean age of 49.3 ± 5.5 years; 61.4% males). Most donors were males in their thirties. Deceased donors predominated in the younger adult group, whereas living unrelated donors predominated in the elderly group (P < .05). Diabetes represented the most common cause of endstage kidney disease. Younger patients tended to receive heavier induction therapy but comparable maint enance immunosuppression. Posttransplant diabetes was higher in younger patients; however, there were more elderly patients with micro- and macroangiopathies (P < .05). No significant differences were shown between groups with regard to patient or graft survival (P > .05). This could be attributed to a significantly higher number of patients with cardiovascular risks, less rejection episodes, and higher number of malignancies in the elderly group (P < .05). CONCLUSIONS: Due to relatively less potent immunosuppression, elderly patients experienced lower rejection rates and better graft survival; however, patient survival was lower due to higher cardiovascular risk factors. Older patients should not be discouraged from living-donor renal transplant. Targeted research studies on protocols for the elderly are needed.


Assuntos
Seleção do Doador , Transplante de Rim/métodos , Transplantados , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Kuweit , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
4.
Exp Clin Transplant ; 17(3): 339-343, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30674240

RESUMO

OBJECTIVES: In a previous study, we evaluated 1-year outcomes of using low-dose valganciclovir prophylaxis for cytomegalovirus infection in intermediate-risk kidney transplant recipients. Whether this effect persists in the long term is unknown. We aimed to evaluate the 2-year follow up of such adopted prophylaxis. MATERIALS AND METHODS: We randomized 2 matched groups of kidney transplant recipients (1:1) to receive valganciclovir as 450 mg daily (group 1) or 900 mg daily (group 2) for the first 6 months after kidney transplant. The final analysis included 196 patients as intermediate-risk patients (98 in each treatment group) after exclusion of 5 high-risk patients. Serologically, all patients were at moderate risk for cytomegalovirus infection. Long-term outcomes including cytomegalovirus disease, acute rejection, new-onset diabetes after transplant, graft loss, and patient survival were assessed. RESULTS: Through year 2 of follow-up, cytomegalovirus infection was reported in only 1 patient in group 1 (at month 13) and 1 patient in group 2 (at month 19) (not significant). Biopsy-proven acute rejection episodes were not statistically different between the groups (2 episodes in group 1 and 6 in group 2; P = .431). New-onset diabetes posttransplant was reported in 8.1% in group 1 and 13.2% in group 2 (P = .535). Graft failure was equal in both groups (1 in each group) at 2 years of follow up (not significant). Patient survival was comparable in both groups (100% in group 1 versus 97.9% in group 2; P = .661). The total number of cytomegalovirus infections at 2 years was numerically less in group 1 (P = .128). CONCLUSIONS: Low-dose valganciclovir prophylaxis for 6 months was associated with sustained reduction of cytomegalovirus infection up to 2 years after kidney transplant without significant impact on the acute rejection, new-onset diabetes posttransplant, or patient and graft outcomes.

5.
Nephrourol Mon ; 8(3): e34770, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27570751

RESUMO

BACKGROUND: Renal transplantation is the ideal method for management of end-stage renal disease. The use of living donors for renal transplantation was critical for early development in the field and preceded the use of cadaveric donors. Most donors are related genetically to the recipients, like a parent, a child, or a sibling of the recipient, but there are an increasing percentage of cases where donors are genetically unrelated like spouses, friends, or altruistic individuals. Donor shortages constitute the major barrier for kidney transplantation, and much effort has been made to increase the supply of living donors. The impact of donor source on the outcome of renal transplantation is not adequately studied in our country. OBJECTIVES: The aim of the study was to evaluate the impact of donor source on the outcome of live donor kidney transplantation. PATIENTS AND METHODS: From March 1976 to December 2013, the number of patients that underwent living renal transplantation sharing at least one HLA haplotype with their donors was 2,485. We divided these patients into two groups: (1) 2,075 kidney transplant recipients (1,554 or 74.9% male and 521 or 25.1% female) for whom the donors were living related, (2) 410 kidney transplant recipients (297 or 72.4% male and 113 or 27.6% female) for whom the donors were living unrelated. All patients received immunosuppressive therapy, consisting of a calcineurin inhibitor, mycophenolate mofetil, or azathioprine and prednisolone. We compared acute rejection and complication rates, as well as long-term graft and patient survival of both groups. Demographic characteristics were compared using the chi-square test. Graft survival and patient survival were calculated using the Kaplan-Meier method. RESULTS: The percentages of patients with acute vascular rejection were significantly higher in the unrelated group, while percentages of patients with no rejection were significantly higher in the related group, but there were no significant differences regarding patient and graft survivals between both groups. CONCLUSIONS: Kidney transplant recipients who received their grafts either from live related donors or live unrelated donors had comparable patient and graft survival outcomes.

6.
Exp Clin Transplant ; 13 Suppl 1: 111-6, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25894138

RESUMO

OBJECTIVES: Kidney donors, similar to the general population, are at risk for development of type 2 diabetes mellitus. The course of donors who develop type 2 diabetes mellitus has not been well studied. This work is aimed at estimating the incidence of diabetes after kidney donation, and study some risk factors and some complications of diabetes mellitus after donation. MATERIALS AND METHODS: The material of this record based work comprised the records 2267 donors who donated 1 of their kidneys between 1976 and 2014 in the Urology and Nephrology Center, Mansoura University, Egypt, and regularly followed-up at its outpatient clinic. There were 388 donors included in the study and their medical records were revised. RESULTS: Postdonation weight gain and family history of diabetes mellitus were statistically significant on both the development of diabetes mellitus, high, very high albuminuria, and/or decreased creatinine clearance. Metformin and insulin use seemed to significantly reduce the protein excretion, and creatinine clearance decline in the studied group. CONCLUSIONS: There is a significant effect of the family history of diabetes mellitus on the development of high, very high albuminuria, and/or decreased creatinine clearance.


Assuntos
Albuminúria/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/epidemiologia , Transplante de Rim/efeitos adversos , Doadores Vivos , Nefrectomia/efeitos adversos , Adulto , Idoso , Albuminúria/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/fisiopatologia , Egito/epidemiologia , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Incidência , Testes de Função Renal , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Fatores de Tempo , Ganho de Peso
7.
Exp Clin Transplant ; 13(1): 26-34, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25654411

RESUMO

OBJECTIVES: New-onset diabetes mellitus after transplant is a common complication in renal allograft recipients. Recently, a high prevalence of diabetes mellitus has been reported in patients with chronic hepatitis C virus. The association between hepatitis C and diabetes mellitus is well demonstrated in the general population, but some controversy still exists. This work aimed to study the effect of pretransplant hepatitis C virus on the development of new-onset diabetes mellitus after transplant in Egyptian living-donor renal allotransplant recipients. MATERIALS AND METHODS: This retrospective single center study included 913 kidney transplant recipients who were transplanted at Mansoura Urology and Nephrology Center between 2000 and 2010. The patients were divided into 4 groups according to their hepatitis C virus serology and diabetic status. RESULTS: Pretransplant dialysis duration and number of blood transfusion units were statistically significant among both viremic and nonviremic groups. With respect to induction therapy, a highly statistical significance was observed between the 4 groups regarding presence and type of adjuvant therapy (P < .001). With respect to maintenance immunosuppression, high statistically significant results were observed regarding steroid and rapamycin between the 4 groups (P < .001) with lower significance regarding mycophenolate mofetil (P = .04) but no significance regarding azathioprine, cyclosporine, or tacrolimus therapy. Incidence of new-onset diabetes mellitus after transplant was statistically higher in the viremic than nonviremic group (P < .001). CONCLUSIONS: There was a positive correlation between incidence of new-onset diabetes mellitus after transplant and positive pretransplant hepatitis C virus status.


Assuntos
Diabetes Mellitus/etiologia , Hepacivirus/patogenicidade , Hepatite C/complicações , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Doadores Vivos , Adolescente , Adulto , Biomarcadores/sangue , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/virologia , Egito , Feminino , Sobrevivência de Enxerto , Hepatite C/sangue , Hepatite C/diagnóstico , Hepatite C/virologia , Humanos , Imunossupressores/uso terapêutico , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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