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1.
J Korean Med Sci ; 34(40): e260, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31625292

RESUMO

BACKGROUND: The impact of institutional case volume to graft failure rate after adult kidney transplantation is relatively unclear compared to other solid organ transplantations. METHODS: A retrospective cohort study of 13,872 adult kidney transplantations in Korea was performed. Institutions were divided into low- (< 24 cases/year), medium- (24-60 cases/year), and high- (> 60 cases/year) volume centers depending on the annual case volume. One-year graft failure rate was defined as the proportion of patients who required dialysis or re-transplantation at one year after transplantation. Postoperative in-hospital mortality and long-term graft survival were also measured. RESULTS: After adjustment, one year graft failure was higher in low-volume centers significantly (adjusted odds ratio [aOR], 1.50; 95% confidence interval [CI], 1.26-1.78; P < 0.001) and medium-volume centers (aOR, 1.87; 95% CI, 1.57-2.23; P < 0.001) compared to high-volume centers. Low-volume centers had significantly higher mortality (aOR, 1.75; 95% CI, 1.15-2.66; P = 0.01) than that of high-volume centers after adjustment. Long-term graft survival of up to 9 years was superior in high-volume centers compared to low- and medium-volume centers (P < 0.001). CONCLUSION: Higher-case volume centers were associated with lower one-year graft failure rate, lower in-hospital mortality, and higher long-term graft survival after kidney transplantation.


Assuntos
Rejeição de Enxerto/etiologia , Transplante de Rim/efeitos adversos , Adulto , Bases de Dados Factuais , Feminino , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Adulto Jovem
2.
Transplant Proc ; 51(8): 2568-2574, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31563240

RESUMO

BACKGROUND: Various factors influence kidney transplant (KT) outcome. The impact of age difference between donor and recipient on long- and short-term graft and patient survival in living donor KT remains unclear. OBJECTIVE: We aim to determine whether age difference, sex matching, and body mass index (BMI) matching between donor and recipient affect the 12-month patient and graft survival in KT. METHOD: We studied a retrospective cohort of 804 patients 18 years or older with primary KT from January 2010 to December 2014. Patient renal function and patient survival were followed up for 12 months post KT. Repeated analysis of variance measurement determined if there was a significant difference in the mean creatinine levels when the sample was grouped according to the matching groups for sex, age difference, and BMI classification. Odds ratios were computed to ascertain graft loss and graft rejection. Results were considered statistically significant if P < .05. RESULTS: Male donor-female recipient had the lowest creatinine levels over time compared with male donor-male recipient (P < .001) and female donor-male recipient (P < .001). Older donor-younger recipient with age difference of ≥ 15 years had the highest overall creatinine (P < .001). For BMI matching, a normal donor and an underweight recipient combination resulted in the lowest mean creatinine levels over the course of 12 months (P < .001). In terms of graft rejection, odds ratio was highest for a female donor and a male recipient (P < .00a) compared with a male donor and a female recipient. For graft loss, older donors (≥ 15 years) had the highest risk (P < .001) vs those older by 11 to 15 years. CONCLUSION: There was significant difference in the 12-month graft function of patients when grouped according to their matching for age difference, sex, and BMI. The risk for graft rejection increases when the combination for donor-recipient is female donor-male recipient. For graft loss, this is most significant for donors who are older by ≥ 15 years than their recipients.


Assuntos
Fatores Etários , Índice de Massa Corporal , Transplante de Rim/métodos , Fatores Sexuais , Adulto , Estudos de Coortes , Feminino , Rejeição de Enxerto/mortalidade , Sobrevivência de Enxerto/fisiologia , Humanos , Transplante de Rim/mortalidade , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
3.
Transplant Proc ; 51(8): 2606-2610, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31439331

RESUMO

BACKGROUND: Antithymocyte globulin (ATG) is an induction therapy in kidney transplantation, but our knowledge about the relation between outcomes and ATG regimens is limited. We compared ATG effectiveness in kidney transplantation according to dosage and administration schedule. METHODS: Reports from 1970 until May 2018 in CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded were searched. We performed direct and indirect network meta-analysis using Bayesian models and generated rankings for ATG dosage and injection number variations by generation mixed treatment comparison.We compared ATG dose and schedule in kidney transplantation in relation to all-cause death, graft failure, antibody-mediated rejection, T-cell mediated rejection, biopsy-proven acute rejection, and bacterial and viral infection. RESULTS: Ten studies (N = 1065) were analyzed by forming 6 groups: ATG alternate doses, 9 mg/kg, 6 mg/kg, and 4.5 mg/kg; single dose, 6 mg/kg, and 4.5 mg/kg; and control. Compared to placebo, ATG regimen variations were not associated with significant differences in survival, viral infection, renal function, or graft survival. ATG regimens 9 and 4.5 mg alternate dosing tended to reduce biopsy-proven acute rejection but without statistical significance. According to the highest rank probability, the 9 mg alternate dosing group had the highest tendency for cytomegalovirus and bacterial infections but without statistical significance. CONCLUSIONS: The rejection frequency tended to be lower for the 9 and 4.5 mg alternate dosing groups. Infections occurred at a higher rate in the 9 mg alternate dosing group, but the differences in the risk of infection among the groups with different ATG regimens were not statistically significant.


Assuntos
Soro Antilinfocitário/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Imunossupressores/uso terapêutico , Transplante de Rim , Meta-Análise em Rede , Adulto , Feminino , Rejeição de Enxerto/mortalidade , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade
4.
Transplant Proc ; 51(7): 2308-2311, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31400977

RESUMO

BACKGROUND: This study aimed to determine whether de novo, prolonged-release tacrolimus- (PR-tacro) based immunosuppressive regimen affected graft and patient survival when compared to an immediate-release, twice-daily, tacrolimus- (IR-tacro) based regimen in kidney transplant recipients. We also aimed to determine the difference between the frequency of side effects, including diabetes control, in study groups. METHODS: A total of 115 standard risk kidney transplant recipients were enrolled in this single center, retrospective study. Fifty-two patients received PR-tacro and 63 patients received IR-tacro as a calcineurin inhibitor. The primary outcome measures included incidence of graft loss and delayed graft function (DGF), biopsy-proven acute rejection , graft and patient survival, and creatinine clearance. Secondary outcome measures included the incidence of non-adherence, drug-induced tremor; post-transplant diabetes mellitus diagnosis rate; and control of diabetes in pre-transplant diabetic patients. RESULTS: Baseline characteristics and mean tacrolimus trough levels were comparable between groups. Incidence of graft loss, DGF, and graft and patient survival were similar between groups (P > .05). Mean creatinine clearance level was also similar (P > .05). Mean serum levels of fasting glucose (P < .05) and A1C (P < .05) were lower in PR-tacro group when compared to IR-tacro group. Post-transplant diabetes mellitus diagnosis rate was also lower in PR-tacro group when compared to IR-tacro group (P = .040). CONCLUSION: This study suggests that there is no statistically significant difference between PR-tacro and IR-tacro in terms of patient and graft survival, DGF, and biopsy-proven acute rejection rates in kidney transplant recipients. Post-transplant diabetes mellitus frequency is lower in non-diabetic patients, and glucose metabolism control is better in diabetic patients.


Assuntos
Inibidores de Calcineurina/administração & dosagem , Rejeição de Enxerto/mortalidade , Imunossupressores/administração & dosagem , Transplante de Rim/mortalidade , Tacrolimo/administração & dosagem , Adulto , Função Retardada do Enxerto/etiologia , Feminino , Rejeição de Enxerto/tratamento farmacológico , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida
5.
Transplant Proc ; 51(8): 2633-2636, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31447192

RESUMO

INTRODUCTION: The most effective immunosuppressant protocol in kidney transplantation (KT) is the combination of a calcineurin inhibitor, steroid, and mycophenolate mofetil (MMF) until now. However, MMF withdrawal (MW) is performed for many reasons, and the clinical course of the KT recipients after MW is not clearly known. The purpose of this study was to investigate the clinical outcomes of KT after MW. MATERIALS AND METHODS: We retrospectively analyzed the medical records of 626 KT recipients between 2000 and 2016. We evaluated the incidence of biopsy-proven acute rejection (BPAR), graft and patient survival rates, and risk factors related with graft failure. RESULTS: The proportion of MW was 33.2% (208 of 626 patients). The median time between KT and MW was 6.4 months (range, 3.2-32.1 months). The common causes of MW were infection (70.7%), hematologic abnormalities (9.1%), and gastrointestinal trouble (7.7%). The incidence of BPAR was significantly higher in the MW group compared with the MMF continuation group (27.4% vs 8.9%, respectively, P < .001). Death-censored graft survival and patient survival rates were significantly lower in the MW group compared with the MMF continuation group (P < .001; P < .001, respectively). In the multivariate analysis, BPAR after MW was an independent risk factor for graft failure (hazard ratio 6.058, 95% confidence interval, 3.172-11.569, P < .001). CONCLUSIONS: The incidence of rejection, graft failure, and patient mortality in KT were high after MW. Therefore, MW should be considered carefully.


Assuntos
Rejeição de Enxerto/mortalidade , Imunossupressores/administração & dosagem , Transplante de Rim , Ácido Micofenólico/administração & dosagem , Síndrome de Abstinência a Substâncias/mortalidade , Suspensão de Tratamento , Adulto , Inibidores de Calcineurina/administração & dosagem , Quimioterapia Combinada , Feminino , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esteroides/administração & dosagem , Síndrome de Abstinência a Substâncias/etiologia , Resultado do Tratamento
7.
J Hepatobiliary Pancreat Sci ; 26(9): 393-400, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31211912

RESUMO

INTRODUCTION: Interferon (IFN) treatment for liver transplant (LT) recipients with hepatitis C virus (HCV) increases acute cellular rejection (ACR) and worsens graft and patient survival. It is unknown if direct-acting antivirals (DAAs) affect rejection rates or post-transplant survival. METHOD: The United Network for Organ Sharing STAR files of December 2017 (n = 25,916) were analyzed. RESULTS: Compared with non-HCV-LT, HCV-LT survival was worse in the IFN-era (2007-2008) and IFN+DAA-era (2011), but not in the DAA-era (2014-2015). ACR6m rate has been less frequent in newer eras and was lower in HCV-LT than in non-HCV-LT in both the DAA-era (6.9% vs. 9.3%, P < 0.001) and in the IFN+DAA-era (8.8% vs. 11.8%, P = 0.001), but not in the IFN-era (10.8% vs. 11.0%, P = 0.39). HCV-LT recipients who had ACR6m had worse 2-year survival than those without ACR6m, in the IFN-era (80.0% vs. 88.4%, P < 0.0001) and in the IFN+DAA-era (81.4% vs. 89.2%, P < 0.01) but not in the DAA-era (90.4% vs. 93.2%, P = 0.085). Cox proportional hazard model identified ACR6m as independent risk factor for mortality in HCV-LT in the IFN-era (HR = 1.88, P ≤ 0.001) and in the IFN+DAA-era (HR = 1.84, P = 0.005), but not in the DAA-era (P = n.s.). CONCLUSIONS: Two-year survival of HCV-LT recipients were significantly better in the DAA-era; these were associated with reduced rate and impact of ACR6m.


Assuntos
Antivirais/uso terapêutico , Rejeição de Enxerto/epidemiologia , Hepatite C Crônica/cirurgia , Transplante de Fígado , Feminino , Rejeição de Enxerto/mortalidade , Sobrevivência de Enxerto , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/mortalidade , Humanos , Interferons/uso terapêutico , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
8.
Saudi J Kidney Dis Transpl ; 30(3): 640-647, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31249228

RESUMO

The outcome of long-term kidney allograft is extremely important. The present study aimed to discern the factors affecting long-term kidney allograft survival, including the type of donation and the use of extended criteria donors. Seven hundred and thirty-seven kidney transplant alone patients entered this retrospective cross-sectional study. The impact of different factors on death-censored long-term kidney allograft survival was evaluated. The Cox proportional survival model was employed to identify these factors. A value of P < 0.05 was considered statistically significant. The data were analyzed using IBM Statistical Package for the Social Sciences version 19.0. The study was conducted at the Mashhad University of Medical Sciences, Mashhad, Iran. In comparison with living kidney donations, both nontraumatic and traumatic brain death cadaveric kidney donations showed statistically significant inferior graft survival. Furthermore, the Kaplan-Meier survival analysis showed better durability of living kidney donations in comparison with traumatic and nontraumatic deceased donors (Log-rank test value = 0.001). Patients with delayed graft function (DGF) had a significantly shorter long-term death censured long-term graft survival in comparison with those without this complication. The Cox proportional models showed that DGF occurrence and the type of donation play a statistically significant role in long-term kidney graft survival. In addition, regarding graft survival, there was no difference between standard criteria and extended criteria donors. The occurrence of DGF and living or deceased types of donations have a significant effect on long-term kidney allograft survival.


Assuntos
Função Retardada do Enxerto/etiologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Adulto , Idoso , Estudos Transversais , Função Retardada do Enxerto/mortalidade , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/mortalidade , Humanos , Imunossupressores/efeitos adversos , Transplante de Rim/mortalidade , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
9.
Saudi J Kidney Dis Transpl ; 30(3): 655-662, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31249230

RESUMO

Although the outcomes of ABO-incompatible (ABOi) kidney transplant recipients are quite favorable, these patients are at increased risk of early antibody-mediated rejection (AMR) and graft loss. Some studies have also shown high mortality in the ABOi group mainly due to increased risk of infections. The AMR rates have been reported anywhere from <10% to >50% in the literature. The outcomes of the ABOi kidney transplants in the Saudi population are not known. In this study, we aimed to determine the graft and patient survival in ABOi kidney transplant recipients in the Saudi population. We included all adult patients who underwent ABOi transplantation between 2007 and 2016. All patients received rituximab, therapeutic plasma exchange, thymoglobulin, intravenous antibiotics, and intravenous immunoglobulin. The maintenance immunosuppression was prednisone, mycophenolate mofetil, and tacrolimus. The data were collected from a prospectively maintained database. A total of 77 patients were included in the study. The most common blood group mismatch was A to O (44.2%), followed by B to O (26.0%) and A to B (16.9%). In the 1st year, 17% of patients developed acute cellular rejection and AMR occurred in 7.8% of patients. Two patients were diagnosed with BK nephropathy. In the 1st year, urinary tract infection occurred in 25 (32.5%) patients. No patient was diagnosed severe viral or fungal infection. In the 1st year, four grafts were lost (graft survival of 94.8%); all grafts were lost within two weeks, three due to AMR and one due to technical reason. One year patient survival was 100%. In this study of ABOi kidney transplant recipients, we observed low risks of infectious complications with excellent patient and graft survival. Our immunosuppressive protocol can be considered safe.


Assuntos
Sistema do Grupo Sanguíneo ABO/imunologia , Incompatibilidade de Grupos Sanguíneos/imunologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Histocompatibilidade , Imunossupressores/uso terapêutico , Transplante de Rim , Adulto , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/mortalidade , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Masculino , Infecções Oportunistas/imunologia , Fatores de Risco , Arábia Saudita , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
10.
Ann Thorac Surg ; 108(4): 1037-1044, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31121129

RESUMO

BACKGROUND: The median survival after lung retransplantation (ReLTx) reported to the International Society of Heart and Lung Transplantation is restricted to 2.5 years. We report the results after ReLTx from our center. METHODS: A retrospective data collection was performed for the 635 patients who underwent lung transplantation between 1991 and 2017 at our center. Recipient variables were compared between patients undergoing only primary lung transplantation (PLTx) and those undergoing PLTx and later ReLTx. Time to death was compared using the Kaplan-Meier method. The risk of ReLTx was analyzed in Cox regression models. Any interaction between type of transplantation, single/double, and PLTx/ReLTx was investigated. RESULTS: ReLTx was performed in 49 patients. Survival after ReLTx at 30 days and 1, 2, and 5 years was 90%, 76%, 71%, and 55%, respectively, and the corresponding survival after PLTx was 94%, 82%, 76%, and 61%, respectively. A hazard ratio of 1.73 for ReLTx was shown (95% confidence interval [CI], 1.14 to 2.63; P = .011). After adjustments for sex, age, diabetes, renal function, preoperative ventilator, and extracorporeal membrane oxygenation, the hazard ratio was 1.43 (95% CI, 0.90 to 2.26; P = .13). ReLTx was performed in 8 patients (16%) within the first year after PLTx. The 1-year survival for this group was 50% compared with 81% (P = .18) for patients who underwent ReLTx later than 1 year after the PLTx. One-year survival after double ReLTx was 60% (95% CI, 25% to 83%) compared with 79% (95% CI, 63% to 89%) for single ReLTx. CONCLUSIONS: ReLTx is a reasonable option for a selected group of patients. Ideally, a number of well-established risk factors are avoided and the ReLTx is performed more than 1 year after the PLTx.


Assuntos
Rejeição de Enxerto/mortalidade , Pneumopatias/cirurgia , Transplante de Pulmão/mortalidade , Transplantados , Adolescente , Adulto , Idoso , Criança , Feminino , Seguimentos , Rejeição de Enxerto/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Suécia/epidemiologia , Fatores de Tempo , Adulto Jovem
11.
Biomed Res Int ; 2019: 7105084, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31061825

RESUMO

Background: The results of kidney transplantation are impacted by the categories of events responsible for patient death and graft failure. The objective of this study was to evaluate the causes of death and graft failure and outcomes after graft failure among kidney transplant recipients. Methodology: A retrospective cohort study was conducted with 944 patients who underwent kidney transplantation. Outcomes were categorized in a managed and hierarchical manner. Results: The crude mortality rate was 10.8% (n=102): in 35.3% cause of death was infection, in 30.4% cardiovascular disease, and in 15.7% neoplasia and in 6.8%, it was not possible to determine the cause of death. The rate of graft loss was 10.6%. The main causes of graft failure were chronic rejection (40%), acute rejection (18.3%), thrombosis (17.3%), and recurrence of primary disease (16.5%). Failures due to an acute rejection occurred earlier than those due to chronic rejection and recurrence (p<0.0001). As late causes of graft loss, death with the functioning kidney occurred earlier than recurrence and chronic rejection (p=0.008). The outcomes after graft failure were retransplantation in 26.1% and death in 21.4%, at a mean of 25.5 and 21.4 months, respectively. Conclusion: It was possible to identify more than 90% of the events responsible for the deaths of transplanted patients, predominantly infectious and cardiovascular diseases. Among the causes of graft failure, chronic and acute rejections and recurrence were the main causes of graft failure which were followed more frequently by retransplantation than by death on dialysis.


Assuntos
Rejeição de Enxerto/mortalidade , Transplante de Rim/mortalidade , Trombose/mortalidade , Doença Aguda , Adulto , Idoso , Doença Crônica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Retratamento , Estudos Retrospectivos , Trombose/etiologia
12.
Exp Clin Transplant ; 17(2): 170-176, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30945629

RESUMO

OBJECTIVES: Kidney transplant is the optimal treatment for children with end-stage renal disease. Multiple factors affect patient and graft survival. We assessed determinants of long-term patient/graft survival in our center by a retrospective review of pediatric living donor (< 18 years) kidney transplants from February 2003 to December 2016. MATERIALS AND METHODS: Donor and recipient demo-graphic data and immunosuppression use were gathered for analyses. Transplant outcomes included patient/graft survival, acute rejection, and 1-year estimated glomerular filtration rate. Patient/graft survival results were analyzed by Kaplan-Meier, and Cox proportional hazards regression model was used for risk factors (univariate/multivariate). P ≤ .05 was statistically significant. RESULTS: Ninety-nine patients were included. Age was 13.4 ± 3.08 years, 64.6% were male, and 88.9% were on dialysis with time of 17.1 ± 12.6 months. Mean donor age was 36.6 ± 7.7 years, and most were females (63.6%). Donor estimated glomerular filtration rate was 89.4 ± 16.9 mL/min/1.73 m2. HLA match was 3.2 ± 1.05. Panel reactive antibody showed 8.6 ± 20.5%. Of total patients, 47.5% used induction, 88.9% used cyclo-sporine, and 100% used mycophenolate mofetil. Five- and 10-year patient survival rates were 93.2% and 93.2%. One-year acute rejection was 14.1%, with rate of 24.2% throughout follow-up. One-year estimated glomerular filtration rate was 76.4 ± 25.6 mL/min/1.73 m2. Five- and 10-year graft survival rates were 62.6% and 43.3%. Multivariate analysis confirmed donor age and acute rejection episodes throughout follow-up as risk factors for graft survival (P < .05). CONCLUSIONS: Acute rejection and donor age are important risk factors for 10-year graft survival in living-donor pediatric kidney transplant in our program.


Assuntos
Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Transplante de Rim/efeitos adversos , Doadores Vivos , Doença Aguda , Adolescente , Fatores Etários , Criança , Seleção do Doador , Feminino , Seguimentos , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/mortalidade , Humanos , Imunossupressores/uso terapêutico , Transplante de Rim/mortalidade , Masculino , México , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
Hum Immunol ; 80(8): 573-578, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31014826

RESUMO

High levels of angiotensin receptor antibodies (ATRab) are associated with acute cellular and humoral rejection, vascular occlusion, de novo human leucocyte antigen donor specific antibody (HLA DSA) and poor graft survival in kidney transplant recipients (KTR). Since 2015 we proactively managed patients "at risk" (AR) with ATRab >17 U/ml with perioperative plasma exchange (PLEX) and/or angiotensin receptor blockade (ARB). 44 patients were treated with this protocol. 265 KTR with ATRab ≤17 U/ml deemed "low risk" (LR) were transplanted under standard conditions. PLEX and ARB were not associated with increased risk of: delayed graft function requiring haemodialysis (HDx), hyperkalaemia >5.5 mmol/l requiring HDx, and the combined clinical end-point of severe hypotension, blood transfusion and re-operation for bleeding. Rejection rates were similar at 90 days: 8/44 (18%) in the AR group and 36/265 (14%) in the LR group (p = 0.350). Death censored graft survival was the same between the AR and LR groups with a 94% 48-month graft survival - hazard ratio (log-rank) 1.16 [95% CI 0.2-5.8] p = 0.844. Proactive treatment of ATRab >17 U/ml with PLEX and/or ARB is not associated with increased rates of perioperative complications and comparable rates of rejection and death censored graft survival at 4 years compared to KTR <17 U/ml ATRab.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Autoanticorpos/uso terapêutico , Benzimidazóis/uso terapêutico , Rejeição de Enxerto/imunologia , Transplante de Rim , Troca Plasmática/métodos , Receptores de Angiotensina/imunologia , Tetrazóis/uso terapêutico , Adulto , Idoso , Austrália , Autoanticorpos/metabolismo , Feminino , Seguimentos , Rejeição de Enxerto/mortalidade , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida
14.
Clin Exp Nephrol ; 23(8): 1076-1086, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31016431

RESUMO

BACKGROUND: There is little information about very long-term outcomes of kidney allograft recipients exposed to calcineurin inhibitors. METHODS: In this single-centre retrospective study with 20-year follow-up, we analyzed data from 644 patients who underwent primary renal transplantation between 1983 and 1993. Participants were treated with a cyclosporine-based immunosuppressive scheme and had allograft function at 1 year. RESULTS: After 20 years, 15.2% patients died, 39.7% experienced allograft loss, 26.8% were alive with a functioning transplant, and 18.2% were lost to follow-up. Cardiovascular disease (30.8%), malignancy (26.6%) and infection (17.0%) were the main causes of death. Age, new-onset proteinuria > 1 g/day, major acute cardiovascular event (MACE), and malignancy were independent predictors of mortality at time-dependent multivariate analysis. Chronic rejection (63.3%), recurrent glomerulonephritis (14.0%), and nonspecific interstitial fibrosis/tubular atrophy (13.2%) were the leading cause of allograft loss. Basal disease, hepatitis C, difference between 1 year and nadir serum creatinine, new-onset proteinuria > 1 g/day, and MACE were independent predictors of transplant failure. Among patients with 20-year allograft function, we recorded the following complications: hypertension (85%), malignancy (13%), diabetes (9%), and cardiovascular disease (9%). Median serum creatinine and proteinuria were 1.4 mg/dL and 0.6 g/day, respectively. CONCLUSIONS: Prolonged use of cyclosporine may expose to several dose-related adverse events and may contribute to the development of allograft dysfunction but it does not necessarily cause relentless, progressive transplant failure if patients are carefully and consistently monitored during the follow-up.


Assuntos
Inibidores de Calcineurina/efeitos adversos , Ciclosporina/efeitos adversos , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Adulto , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/mortalidade , Humanos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Falha de Tratamento
15.
Hepatobiliary Pancreat Dis Int ; 18(3): 206-213, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30952435

RESUMO

BACKGROUND: Small-for-size graft (SFSG) has emerged as one of the very contentions in adult-to-adult living donor liver transplantation (LDLT) as a certain graft size is related to recipients' prognosis. Graft-to-recipient weight ratio (GRWR) ≥0.8% was considered as a threshold to conduct LDLT. However, this also has been challenged over decades as a result of technique refinements. For a better understanding of SFSG in practice, we conducted this meta-analysis to compare the perioperative outcomes and long-term outcomes between patients adopting the grafts with a lower volume (GRWR < 0.8%, SFSG group) and sufficient volume (GRWR ≥ 0.8%, non-SFSG group) in adult-to-adult LDLT. DATA SOURCES: The studies comparing recipients adopting graft with a GRWR < 0.8% and ≥ 0.8% were searched by three authors independently in PubMed, Web of Science, Embase, the Cochrane Library, MEDLINE and Google Scholar databases until September 2018 and data were analyzed by RevMan 5.3.5. RESULTS: Sixteen studies with a total of 3272 subjects were included in this meta-analysis. In terms of small-for-size syndrome (SFSS), no significant difference was found in subjects enrolled after year 2010 (before 2010, OR=3.00, 95% CI: 1.69-5.35, P = 0.0002; after 2010, OR=1.23, 95% CI: 0.79-1.90, P = 0.36; P for interaction: 0.02). There was no significant difference in operative duration, blood loss, cold ischemia time, biliary complications, acute rejection, postoperative bleeding, hospitalization time, perioperative mortality, and 1-, 3- and 5-year overall survival rates between two groups. CONCLUSIONS: This meta-analysis suggested that adopting SFSG in adult LDLT has comparable outcomes to those with non-SFSG counterparts since 2010.


Assuntos
Seleção do Doador , Sobrevivência de Enxerto , Transplante de Fígado/métodos , Doadores Vivos , Adulto , Feminino , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/mortalidade , Humanos , Transplante de Fígado/efeitos adversos , Transplante de Fígado/mortalidade , Masculino , Tamanho do Órgão , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
16.
Ann Transplant ; 24: 147-154, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30872563

RESUMO

BACKGROUND Brain death initiates hemodynamic, immunological, and hormonal changes that potentially compromise organ quality for transplantation. Therefore, it is generally believed that organs should be procured as soon as possible after the declaration of brain death. However, conflicting data exist regarding the impact of brain death duration on long-term graft function and survival. MATERIAL AND METHODS The effect of duration of brain death on graft survival and function of 1869 adult transplant recipients receiving kidneys from deceased donors after brain death was analyzed, using relevant donor and recipient characteristics and allograft related factors. RESULTS Duration of brain death was a significant predictor for long-term graft survival, whilst there was no significant effect of duration of brain death on the incidence of delayed graft function or acute graft rejection after kidney transplantation. After dividing the study population into a "short durBD" (<10.6 hours) group and a "long durBD" (>10.6 hours) group, the 15-year graft survival estimates were significantly higher and the serum creatinine at 3 months after transplantation was significantly lower in the "long durBD" group. CONCLUSIONS Duration of brain death does not affect the incidence of delayed graft function or acute rejection after kidney transplantation. However, longer duration of brain death is associated with better kidney allograft function and survival.


Assuntos
Morte Encefálica , Rejeição de Enxerto/epidemiologia , Sobrevivência de Enxerto , Transplante de Rim/mortalidade , Coleta de Tecidos e Órgãos , Feminino , Seguimentos , Rejeição de Enxerto/mortalidade , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Doadores de Tecidos
17.
Transpl Immunol ; 55: 101204, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30904625

RESUMO

PURPOSE: We investigated the implications of early recurrent 1R rejections for long-term outcomes after heart transplantation (HT) and evaluated the prognostic significance of 1990 ISHLT grading 1B/2 versus 1A. METHODS: Data on all patients who underwent HT between 1992 and 2017 were reviewed. Patients with ≥2 endomyocardial biopsies graded 1R in the first 3 months were classified as "recurrent 1R." Those patients were further categorized according to 1A vs. 1B/2. Outcomes (>3 months) were long-term rejections and the combined endpoint of cardiac allograft vasculopathy (CAV) and cardiovascular (CV) mortality. RESULTS: Sixty-nine out of 228 patients were classified as recurrent grade 1R. In the recurrent 1R group, 2R rejection rate was significantly higher (2.6 ±â€¯0.6 vs 1.2 ±â€¯0.4, p = 0.03), while survival free of rejections was lower (5-year: 57.1% vs. 72.3%, p = 0.022). Multivariate analysis showed that early recurrent 1R rejection was associated with a 30% increased risk for subsequent major rejection. Among 28 patients classified as 1B/2 of the recurrent group, rejection scores were higher, while survival free of rejections was lower, compared to 37 patients of the recurrent group classified as 1A (5-year: 57.1% vs. 72.7%, p = 0.013). Kaplan-Meier analysis showed that CAV/CV mortality at 10 years of follow-up was significantly higher among the recurrent 1R group (38% vs. 18% p < 0.05). Multivariate analysis showed that early recurrent 1R rejections were associated with a 2.5-fold increased risk for CAV/CV mortality. CONCLUSION: Early recurrent grade 1R rejections negatively affect long-term outcomes. The adverse outcomes are experienced mainly by 1R patients subcategorized as1B/2 and not 1A.


Assuntos
Rejeição de Enxerto , Transplante de Coração , Miocárdio , Adulto , Biópsia , Intervalo Livre de Doença , Feminino , Seguimentos , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/mortalidade , Rejeição de Enxerto/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio/imunologia , Miocárdio/patologia , Estudos Prospectivos , Sistema de Registros , Taxa de Sobrevida , Transplante Homólogo
18.
Transpl Immunol ; 54: 47-51, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30743001

RESUMO

BACKGROUND: Risk factors for the development of anti-HLA antibodies include blood transfusion, organ transplantation, and pregnancy. Humoral rejection, mediated by donor-specific anti-HLA antibodies (DSA), has been studied in all kind of solid organ transplantations, and several studies have suggested that post-liver transplantation (LT) DSA may play a role in acute and chronic rejection. OBJECTIVE: The aim of the present study was to assess the impact of pregnancy on the occurrence of DSA and the impact of DSA in a large population of young female LT recipients. METHODS: This single center retrospective study included all female patients who underwent a first LT between January 1990 and December 2010 and who were of childbearing age during post-LT follow-up (i.e. 18 to 40 years old). RESULTS: The study population consisted in 73 patients, and the mean age at LT was 20.9 years (0.6-39.9); 32 patients were transplanted during childhood. The global incidence of de novo DSA was 42.5% (31/73), after a median delay of 15.5 years (1-25) of follow-up after LT. Most de novo DSA were anti-class II alone (90.3%), and included anti-DQ for 80.6%. From the 73 patients, 33 presented at least one pregnancy after LT (45.2%) and before DSA screening. Multivariate analysis disclosed that history of pregnancy (OR = 6.37; 95%CI, 2.17-18.63, p = 0.001) and younger age at LT (OR = 0.96; 95%CI:0.92-0.99, p = 0.033) were significantly associated with de novo DSA. Among the 31 patients who had de novo DSA, the diagnosis of antibody-mediated rejection was made in 8 patients (25.8%), after a median delay of 74 months after LT; 6/8 (75.0%) had history of pregnancy. During follow-up, 3 of these 8 patients lost their liver graft and died. CONCLUSION: The results of the present study suggest that close monitoring of DSA in young women with history of pregnancy should be recommended regarding the risk of DSA-mediated rejection.


Assuntos
Rejeição de Enxerto/diagnóstico , Isoanticorpos/metabolismo , Transplante de Fígado , Complicações na Gravidez/diagnóstico , Gravidez/imunologia , Adolescente , Adulto , Fatores Etários , Feminino , Seguimentos , Rejeição de Enxerto/mortalidade , Antígenos HLA/imunologia , Humanos , Imunidade Humoral , Monitorização Fisiológica , Complicações na Gravidez/mortalidade , Estudos Retrospectivos , Risco , Análise de Sobrevida , Adulto Jovem
19.
Transpl Immunol ; 54: 29-37, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30710628

RESUMO

Mannose binding lectin 2 (MBL2) is one of the pattern-recognition soluble receptors and is responsible for complement activation via the lectin pathway, so it plays an important role in kidney transplantation. The aim of the study was to examine the association between MBL2 gene polymorphisms and acute rejection of the kidney allograft. This study enrolled 266 Caucasian deceased-donor renal transplant recipients - 69 with diagnosed acute graft rejection, 197 with stable graft function. A 969 bp DNA fragment, from chromosome 10, including promoter region and exon 1 of MBL2 gene was sequenced. The DNA fragment obtained contained 122 SNPs accordingly to the NCBI dbSNP database. Of this number only nine showed variation within our population (rs36014597, rs5030737, rs1800450, rs7095891, rs11003123, rs7096206, rs7084554, rs11003124, rs11003125), and only these were subjected to further analysis. Among the studied polymorphisms in the MBL2 gene only rs1800450 polymorphism was statistically significantly associated with kidney allograft rejection. The AA genotype was significantly associated with an increased risk of acute kidney allograft rejection. (AA vs GA+GG: OR=9.29 (95%CI: 1.83-47.17), p=0.005). The results of our study indicate that MBL2 gene rs1800450 polymorphism may be associated with the risk of acute kidney allograft rejection. The AA genotype, associated with lower MBL2 expression, may be associated with an increased risk of acute kidney allograft rejection.


Assuntos
Genótipo , Rejeição de Enxerto/genética , Transplante de Rim , Lectina de Ligação a Manose/genética , Doença Aguda , Adulto , Feminino , Frequência do Gene , Predisposição Genética para Doença , Rejeição de Enxerto/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Análise de Sobrevida , Transplante Homólogo
20.
Transpl Int ; 32(6): 635-645, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30685880

RESUMO

The impact of the duration of delayed graft function (DGF) on graft survival is poorly characterized in controlled donation after circulatory death (DCD) donor kidney transplantation. A retrospective analysis was performed on 225 DCD donor kidney transplants between 2011 and 2016. When patients with primary nonfunction were excluded (n = 9), 141 recipients (65%) had DGF, with median (IQR) duration of dialysis dependency of 6 (2-11.75) days. Longer duration of dialysis dependency was associated with lower estimated glomerular filtration rate at 1 year, and a higher rate of acute rejection. On Kaplan-Meier analysis, the presence of DGF was associated with lower graft survival (log-rank test P = 0.034), though duration of DGF was not (P = 0.723). However, multivariable Cox regression analysis found that only acute rejection was independently associated with lower graft survival [HR (95% CI) 4.302 (1.617-11.450); P = 0.003], whereas the presence of DGF and DGF duration were not. In controlled DCD kidney transplantation, DGF duration itself may not be independently associated with graft survival; rather, it may be that acute rejection associated with prolonged DGF is the poor prognostic factor.


Assuntos
Função Retardada do Enxerto/fisiopatologia , Nefropatias/cirurgia , Transplante de Rim/métodos , Doadores de Tecidos , Adulto , Idoso , Feminino , Taxa de Filtração Glomerular , Rejeição de Enxerto/mortalidade , Sobrevivência de Enxerto , Humanos , Estimativa de Kaplan-Meier , Rim/fisiopatologia , Nefropatias/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Obtenção de Tecidos e Órgãos , Resultado do Tratamento
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