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1.
Clin Exp Nephrol ; 26(2): 162-169, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34581898

RESUMO

BACKGROUND: The management of congenital nephrotic syndrome of the Finnish type (CNF) is challenging. It is difficult to withdraw intravenous albumin infusions, resulting in long-term hospitalization. In addition, fatal hypotension after bilateral nephrectomy has been reported. In our center, we have performed unilateral nephrectomy during early infancy. METHODS: Infants diagnosed with CNF between 2011 and 2020 in our institution were enrolled. We examined the clinical course before and after unilateral nephrectomy and evaluated the effectiveness of this strategy. RESULTS: Seven patients (all showing NPHS1 mutations) were enrolled. All required daily intravenous albumin infusion via central venous catheter (CVC). Unilateral nephrectomy was performed at a median of 76 days of age (59-208 days). Surgical complications did not occur in any of patients. The mean albumin dose was decreased after unilateral nephrectomy (2.0 vs 0.4 g/kg/day; p = 0.02). Intravenous albumin infusion could be withdrawn at a median of 17 days, the CVC removed at a median of 21 days, and they discharged at a median of 82 days after unilateral nephrectomy. Although bacterial infections were noted seven times before unilateral nephrectomy, only one episode occurred after surgery. Four patients initiated peritoneal dialysis at two to three years of age and all of them underwent kidney transplantation thereafter. CONCLUSIONS: Unilateral nephrectomy during early infancy may be an effective treatment allowing for withdrawal from albumin infusion, prevention of complications, withdrawal from CVCs and shortening hospital stay for patients with CNF.


Assuntos
Transplante de Rim , Síndrome Nefrótica , Diálise Peritoneal , Finlândia , Humanos , Lactente , Nefrectomia/efeitos adversos , Síndrome Nefrótica/diagnóstico
2.
Artif Organs ; 46(4): 597-605, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34951495

RESUMO

BACKGROUND: M101 is an extracellular hemoglobin isolated from a marine lugworm and is present in the medical device HEMO2 life®. The clinical investigation OXYOP was a paired kidney analysis (n = 60) designed to evaluate the safety and performance of HEMO2 life® used as an additive to preservation solution in renal transplantation. The secondary efficacy endpoints showed less delayed graft function (DGF) and better renal function in the HEMO2 life® group but due to the study design cold ischemia time (CIT) was longer in the contralateral kidneys. METHODS: An additional analysis was conducted including OXYOP patients and patients from the ASTRE database (n = 6584) to verify that the decrease in DGF rates observed in the HEMO2 life® group may not be due solely to the shorter CIT but also to HEMO2 life® performance. Kaplan-Meier estimate curves of cumulative probability of achieving a creatinine level below 250 µmol/L were generated and compared in both groups. A Cox model was used to test the effect of the explanatory variables (use of HEMO2 life® and CIT). Finally, a bootstrap strategy was used to randomly select smaller samples of patients and test them for statistical comparison in the ASTRE database. RESULTS: Kaplan-Meier estimate curves confirmed the existence of a relation between DGF and CIT and Cox analysis showed a benefit in the HEMO2 life® group regardless of the associated CIT. Boostrap analysis confirmed these results. CONCLUSIONS: The present study suggested that the better recovery of renal function observed among kidneys preserved with HEMO2 life® in the OXYOP study is a therapeutic benefit of this breakthrough innovative medical device.


Assuntos
Isquemia Fria , Transplante de Rim , Isquemia Fria/efeitos adversos , Isquemia Fria/métodos , Função Retardada do Enxerto , Sobrevivência de Enxerto , Hemoglobinas , Humanos , Rim/fisiologia , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Estudos Prospectivos , Fatores de Risco
7.
BMC Nephrol ; 23(1): 273, 2022 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-35927670

RESUMO

BACKGROUND: Waterlow scoring was introduced in the 1980s as a nursing tool to risk stratify for development of decubitus ulcers (pressure sores) and is commonly used in UK hospitals. Recent interest has focussed on its value as a pre-op surrogate marker for adverse surgical outcomes, but utility after kidney transplantation has never been explored. METHODS: In this single-centre observational study, data was extracted from hospital informatics systems for all kidney allograft recipients transplanted between 1st January 2007 and 30th June 2020. Waterlow scores were categorised as per national standards; 0-9 (low risk), 10-14 (at risk), 15-19 (high risk) and ≥ 20 (very high risk). Multiple imputation was used to replace missing data with substituted values. Primary outcomes of interest were post-operative length of stay, emergency re-admission within 90-days and mortality analysed by linear, logistic or Cox regression models respectively. RESULTS: Data was available for 2,041 kidney transplant patients, with baseline demographics significantly different across Waterlow categories. As a continuous variable, the median Waterlow score across the study cohort was 10 (interquartile range 8-13). As a categorical variable, Waterlow scores pre-operatively were classified as low risk (n = 557), at risk (n = 543), high risk (n = 120), very high risk (n = 27) and a large proportion of missing data (n = 794). Median length of stay in days varied significantly with pre-op Waterlow category scores, progressively getting longer with increasing severity of Waterlow category. However, no difference was observed in risk for emergency readmission within 90-days of surgery with severity of Waterlow category. Patients with 'very high risk' Waterlow scores had increased risk for mortality at 41.9% versus high risk (23.7%), at risk (17.4%) and low risk (13.4%). In adjusted analyses, 'very high risk' Waterlow group (as a categorical variable) or Waterlow score (as a continuous variable) had an independent association with increase length of stay after transplant surgery only. No association was observed between any Waterlow risk group/score with emergency 90-day readmission rates or post-transplant mortality after adjustment. CONCLUSIONS: Pre-operative Waterlow scoring is a poor surrogate marker to identify kidney transplant patients at risk of emergency readmission or death and should not be utilised outside its intended use.


Assuntos
Transplante de Rim , Biomarcadores , Estudos de Coortes , Humanos , Tempo de Internação , Medição de Risco , Fatores de Risco
8.
Front Immunol ; 13: 832924, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35935974

RESUMO

Vaccination against COVID-19 in patients with end-stage renal disease (ESRD) on replacement therapy and kidney transplant recipients (KTRs) is particularly important due to the high mortality rate. Here, we tested the local and systemic immunity to the novel Pfizer BioNTech (BNT162b2) messenger RNA (mRNA) in ESRD, KTR patients, and healthy individuals (150 subjects). The ESRD group was divided into: hemodialysis (HD) and peritoneal dialysis (PD). We investigated the local and systemic immunity based on anti-N (nucleoprotein) and anti-S (spike1/2) Immunoglobulin A (IgA) and Immunoglobulin G (IgG) antibodies, respectively. Additionally, we performed an Interferon gamma (IFN-γ) release test Interferon-gamma release assay (IGRA) to monitor the cellular component of vaccine response. The control group had the highest level of anti-S IgG antibodies (153/2,080 binding antibody units (BAU)/ml) among all analyzed patients after the 1st and 2nd dose, respectively. The HD group (48/926 BAU/ml) had a diminished antibody level compared to PD (93/1,607 BAU/ml). Moreover, the seroconversion rate after the 1st dose was lower in HD than PD (56% vs. 86%). KTRs had extremely low seroconversion (33%). IgA-mediated immunity was the most effective in the control group, while other patients had diminished IgA production. We observed a lower percentage of vaccine responders based on the IFN-γ level in all research participants (100% vs. 85% in control, 100% vs. 80% in PD, 97% vs. 64% in HD). 63% of seropositive KTRs had a positive IGRA, while 28% of seronegative patients produced IFN-γ. Collectively, PD patients had the strongest response among ESRD patients. Two doses of the Pfizer vaccine are ineffective, especially in HD and KTRs. A closer investigation of ESRD and KTRs is required to set the COVID-19 vaccine clinical guidance. Clinical Trial Registration Number: www.ClinicalTrials.gov, identifier: NCT04 905 862.


Assuntos
COVID-19 , Falência Renal Crônica , Transplante de Rim , Diálise Peritoneal , Vacina BNT162 , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Humanos , Imunoglobulina A , Imunoglobulina G , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Diálise Renal , SARS-CoV-2
9.
J Vis Exp ; (185)2022 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-35938826

RESUMO

Kidney transplantation in mice is a complicated and challenging surgery procedure. There are very few publications demonstrating the key steps of this operation. Therefore, this article introduces the technique and points out the surgical caveats associated with this operation. In addition, important modifications in comparison to the conventional procedure are demonstrated. Firstly, a patch of the abdominal aorta is cut and prepared so that the proximal bifurcations of the renal artery, including the ureteral artery are transected together with the donor kidney en bloc. This reduces the risk of a ureter necrosis and avoids the development of a urinary tract occlusion. Secondly, a new method of the vascular anastomosis is demonstrated that allows the operator to flexibly increase or decrease the size of the anastomosis after renal transplant reperfusion has already been initiated. This avoids the development of vessel strictures and intraabdominal bleeding. Thirdly, a technique that enables the anastomosis of the delicate donor ureter and the recipient bladder that does not cause a trauma is shown. Adopting this protocol can shorten the operation time and reduces the damage to the recipient's bladder, thereby significantly increasing the operation success rate for the recipient mice.


Assuntos
Transplante de Rim , Ureter , Anastomose Cirúrgica/métodos , Animais , Transplante de Rim/métodos , Camundongos , Artéria Renal/cirurgia , Ureter/cirurgia , Bexiga Urinária/cirurgia
10.
Virol J ; 19(1): 131, 2022 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-35941650

RESUMO

BACKGROUND AND AIMS: The John Cunningham virus (JCV) is the established etiological agent of the polyomavirus-associated nephropathy among renal transplant recipients. In the present study, we aimed to determine the probable predictive factors leading to JCV replication in renal transplant patients. MATERIAL AND METHODS: Urine and plasma samples were collected from a total of 120 consecutive renal-transplanted patients without preliminary screening from Jan 2018 to Mar 2019. After DNA extraction, the simultaneous detection and quantification of JCV and BK polyomavirus (BKV) were conducted using a Real-time quantitative PCR method. Moreover, statistical analyses were performed using the statistical software packages, SPSS version 21. RESULTS: The prevalence of JCV viruria and viremia among renal transplant recipients were 26 (21.67%) and 20 (16.67%), respectively. A significant association was observed between the JCV and two risk factors, diabetes mellitus (P = 0.002) and renal stones (P = 0.015). The prevalence of JCV viremia among recipients who were grafted near time to sampling was significantly higher (P = 0.02). There was a statistically significant coexistence between BK and JC viruses among our patients (P = 0.029). The frequency of JCV viruria in males was reported almost three times more than in females (P = 0.005). The JCV shedding in urine was significantly associated with the tropical steroids like prednisolone acetate, which have been the standard regimen (P = 0.039). Multivariable analysis revealed duration of post-transplantation (OR, 0.89; P = 0.038), diabetes mellitus (OR, 1.85; P = 0.034), and renal stone (OR 1.10; P = 0.04) as independent risk factors associated with JCV viremia post-renal transplantation. CONCLUSION: It seems that the discovery of potential risk factors, including immunological and non-immunological elements, may offer a possible preventive or therapeutic approach in the JCV disease episodes. The results of this study may also help clarify the probable clinical risk factors involving in progressive multifocal leukoencephalopathy development.


Assuntos
Vírus BK , Vírus JC , Nefropatias , Transplante de Rim , Infecções por Polyomavirus , Infecções Tumorais por Vírus , DNA Viral/genética , Feminino , Humanos , Vírus JC/genética , Transplante de Rim/efeitos adversos , Masculino , Transplantados , Viremia/epidemiologia
11.
Comput Intell Neurosci ; 2022: 5717068, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35909831

RESUMO

Background: Mizoribine (MZR) is widely used in Asia due to its high safety and low cost, and comparative studies of its safety and efficacy with the first-line drug mycophenolate mofetil (MMF) have been carried out. This paper aimed to compare the efficacy and safety of MZR and MMF in immunosuppressive therapy of renal transplantation by meta-analysis. Methods: We searched randomized controlled trials (RCTs) comparing MZR versus MMF for renal transplantation in PubMed, Excerpta Medica Database (EMBASE), Cochrane Library, Web of Science, WanFang Database, China National Knowledge Infrastructure (CNKI), and Chinese Biomedical Database (CBM). Articles were assessed for their risk of bias using the Cochrane Collaboration. Forest plots and funnel plots were also performed on the included articles. Results: A total of twelve studies with 1103 patients were selected in the analysis. No significant difference were observed between the MZR group and the MMF group for the rate of acute rejection (RR = 1.50, 95% CI 1.11 to 2.01, P = 0.008), patient survival (RR = 1.01, 95% CI 0.99 to 1.03, P = 0.56), graft survival (RR = 1.02, 95% CI 1.00 to 1.04, P = 0.12), leucopenia (RR = 0.69, 95% CI 0.44 to 1.10, P = 0.12), and liver damage (RR = 0.72, 95% CI 0.46 to 1.13, P = 0.15). The MZR group was associated with a lower risk of gastrointestinal disorder (RR = 0.28, 95% CI 0.13 to 0.62, P = 0.002) and cytomegalovirus infection (RR = 0.59, 95% CI 0.42 to 0.84, P = 0.003) but had a higher risk of hyperuricemia (RR 1.79, 95% CI 1.17 to 2.75, P = 0.007). No significant publication bias was observed among included studies. Discussion. MZR is similar to MMF in efficacy, and in terms of safety, MZR has a lower risk of gastrointestinal disorder and cytomegalovirus infection but a higher risk of hyperuricemia.


Assuntos
Infecções por Citomegalovirus , Gastroenteropatias , Hiperuricemia , Transplante de Rim , Infecções por Citomegalovirus/tratamento farmacológico , Gastroenteropatias/tratamento farmacológico , Humanos , Hiperuricemia/tratamento farmacológico , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Ácido Micofenólico/efeitos adversos , Ribonucleosídeos
12.
Eur Rev Med Pharmacol Sci ; 26(14): 4969-4978, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35916792

RESUMO

OBJECTIVE: Due to underlying allograft rejection and renal ischemia reperfusion injury (IRI) inducing renal injury, hyperuricemia (HUA) is one of the common complications after renal transplantation and may be a major contributor to reduced renal function. Currently, there are no uniform mechanisms of HUA after renal transplantation. This review aimed to figure out the immune mechanisms of HUA after renal transplantation and the molecular mechanisms of HUA-induced renal injury to provide new insights into renal function protection and prolonged survival time of grafts. MATERIALS AND METHODS: The search terms included 'Hyperuricemia', 'Renal transplantation', 'Urea acid', 'Gout' 'Graft Rejection', 'Graft Survival'. Databases including PubMed, Cochrane Library, Embase, Clinicaltrials.gov and China National Knowledge Infrastructure (CNKI) were searched for studies including mechanisms of hyperuricemia after renal transplantation from the beginning of databases to March 2022. RESULTS: Our study reviews the immune mechanisms of HUA after renal transplantation. HUA induces renal injury mainly by renal inflammation, oxidative stress, and endothelial dysfunction. IRI contributes to increased inflammation in renal grafts, mediates the recruitment of various inflammatory cell types. CONCLUSIONS: Due to underlying allograft rejection and IRI, renal transplant recipients are especially prone to HUA. HUA further reduces renal function and even graft loss. Treg targeting could be a novel therapeutic approach in renal transplantation.


Assuntos
Hiperuricemia , Transplante de Rim , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Hiperuricemia/complicações , Inflamação/complicações , Transplante de Rim/efeitos adversos
13.
Eur Rev Med Pharmacol Sci ; 26(14): 5063-5071, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35916802

RESUMO

OBJECTIVE: This study aims at evaluating the effects of ciprofol on the induction and maintenance of general anesthesia in patients undergoing kidney transplantation. PATIENTS AND METHODS: This prospective, randomized, single-blind study enrolled 120 patients aged 18-65 years who underwent general anesthesia for kidney transplantation. The patients were randomized into a ciprofol group (group C) and a propofol group (group P). Anesthesia induction: group C had injected IV with ciprofol 0.4 mg/kg, group P had injected IV with propofol 2.0 mg/kg, while both groups had injected IV with sufentanil 0.4-0.5 µg/kg and cisatracurium 0.2 mg/kg. Anesthesia maintenance: ciprofol was injected IV with 0.8-2.4 mg•kg-1•h-1 in group C, propofol was injected IV with 4-12 mg•kg-1•h-1 in group P, while remifentanil was injected IV with 8-15 µg•kg-1•h-1 and cisatracurium was injected IV with 0.1-0.2mg•kg-1•h-1, with the bispectral index (BIS) maintained at 40-60 during the operation. RESULTS: The success rate of sedation in both groups was 100%. Compared with the P group, in group C the time of disappearance of the eyelash reflex and a decline in the BIS to 60 was shorter (p<0.001); the time of awakening was prolonged (p<0.001); the number of sedative drugs administered was reduced (p<0.001); MAP fluctuated less five mins after transplantation (p<0.01); the incidence of injection pain during induction was reduced (p<0.001) and intraoperative hypotension was decreased(p<0.01). CONCLUSIONS: Ciprofol is safe and effective for anesthesia induction and maintenance in kidney transplantation and its sedative effect is better than that of propofol.


Assuntos
Transplante de Rim , Propofol , Anestesia Geral/efeitos adversos , Anestésicos Intravenosos , Método Duplo-Cego , Humanos , Estudos Prospectivos , Método Simples-Cego
14.
Am J Case Rep ; 23: e936564, 2022 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-35932113

RESUMO

BACKGROUND Human adenovirus is a well-known pathogen that can potentially lead to severe infection in immunocompromised patients. Adenovirus infections in solid-organ transplant recipients can range from asymptomatic to severe, prolonged, disseminated disease, and have a significant impact on morbidity, mortality, and graft survival. The clinical manifestations vary from asymptomatic and flu-like illness to severe life-threatening viremia with multi-organ failure. Post-transplant adenovirus infection is well described in kidney recipients, but in adult liver transplant recipients the impact of the virus is not well described. In this report, a case of disseminated adenovirus infection with subsequent fatal acute liver failure in a post-kidney transplant patient is presented. CASE REPORT A 51-year-old man underwent a deceased kidney transplantation for focal segmental glomerulosclerosis. Shortly after the kidney transplantation, he received multiple plasmapheresis with additional steroid treatments for cellular rejection and reoccurrence of his primary kidney disease. Three weeks after the kidney transplant, he developed a disseminated adenovirus infection with subsequent acute liver failure. Despite the early diagnosis and aggressive treatment, the patient died. CONCLUSIONS Patients with organ transplantation with autoimmune background etiology are usually over-immunosuppressed to avoid early rejection. In this population, opportunistic infections are not rare. Fever, general malaise, and transplant organ dysfunction are the first signs of bacterial or viral infection. Early infectious diseases work-up, including tissue biopsy, is fundamental to establish a diagnosis. Broad antibiotic and possible antiviral aggressive treatment are mandatory.


Assuntos
Infecções por Adenoviridae , Transplante de Rim , Falência Hepática Aguda , Adenoviridae , Infecções por Adenoviridae/diagnóstico , Infecções por Adenoviridae/tratamento farmacológico , Infecções por Adenoviridae/etiologia , Adulto , Humanos , Rim/patologia , Transplante de Rim/efeitos adversos , Falência Hepática Aguda/complicações , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/terapia
16.
Transpl Int ; 35: 10465, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35935272

RESUMO

For the past decades, complement activation and complement-mediated destruction of allograft cells were considered to play a central role in anti-HLA antibody-mediated rejection (AMR) of kidney transplants. However, also complement-independent mechanisms are relevant in the downstream immune activation induced by donor-specific antibodies, such as Fc-gamma receptor (FcγR)-mediated direct cellular activation. This article reviews the literature regarding FcγR involvement in AMR, and the potential contribution of FcγR gene polymorphisms to the risk for antibody mediated rejection of kidney transplants. There is large heterogeneity between the studies, both in the definition of the clinical phenotypes and in the technical aspects. The study populations were generally quite small, except for two larger study cohorts, which obviates drawing firm conclusions regarding the associations between AMR and specific FcγR polymorphisms. Although FcγR are central in the pathophysiology of AMR, it remains difficult to identify genetic risk factors for AMR in the recipient's genome, independent of clinical risk factors, independent of the donor-recipient genetic mismatch, and in the presence of powerful immunosuppressive agents. There is a need for larger, multi-center studies with standardised methods and endpoints to identify potentially relevant FcγR gene polymorphisms that represent an increased risk for AMR after kidney transplantation.


Assuntos
Transplante de Rim , Anticorpos , Rejeição de Enxerto , Imunossupressores , Transplante de Rim/efeitos adversos , Receptores de IgG
17.
Exp Clin Transplant ; 20(7): 657-662, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35924743

RESUMO

OBJECTIVES: Living donor transplant techniques must ensure donor safety and minimize complications. To achieve this goal, in 2003, we developed a new surgical procedure named video-assisted mini-laparotomy surgery for living donor nephrectomy. Video-assisted mini-laparotomy surgery standardizes the retroperitoneal mini-laparotomy technique as an alternative to open surgery. We have previously reported on video-assisted mini-laparotomy surgery techniques for use in kidney surgery. However, there are no reports of video-assisted mini-laparotomy surgery performed at other institutions. Therefore, we introduced video-assisted mini-laparotomy surgery at another institution, and here, we report on our experience. MATERIALS AND METHODS: We evaluated a consecutive series of 38 donors who underwent video-assisted mini-laparotomy living donor nephrectomy at National Health Insurance Service Ilsan Hospital from August 2016 to November 2019. All 38 patients were enrolled. Perioperative data and outcomes were retrospectively analyzed. We recorded perioperative and postoperative data, including operative time, estimated blood loss, and duration of hospital stay. RESULTS: The mean operative time was 144.35 ± 22.79 minutes, and the mean warm ischemia time was 184.35 ± 4.97 seconds. Mean estimated blood loss was 72.85 ± 60.81 mL. At 12 months after video-assisted mini-laparotomy surgery, the mean posttransplant serum creatinine level was 1.05 ± 0.18 mg/dL, and estimated glomerular filtration rate (according to the Modification of Diet in Renal Disease study equation) was 71.9 ± 10.34 mL/min/1.73 m2. There was no intraoperative or postoperative complication. CONCLUSIONS: Previous studies reported that video- assisted mini-laparotomy surgery has a steep learning curve and is difficult to reproduce. However, video- assisted mini-laparotomy surgery is a feasible and safe technique at our institution. Video-assisted mini- laparotomy surgery is a solo surgery that can be safely performed by any surgeon with prior kidney surgery experience.


Assuntos
Transplante de Rim , Laparoscopia , Humanos , Rim/cirurgia , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Laparoscopia/efeitos adversos , Laparotomia/efeitos adversos , Laparotomia/métodos , Curva de Aprendizado , Doadores Vivos , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
18.
Exp Clin Transplant ; 20(7): 663-667, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35924744

RESUMO

OBJECTIVES: Calcineurin inhibitors (cyclosporine and tacrolimus) are widely used in kidney transplant to prevent acute transplantrejection; however,the effects of these medications on graft sequelae after transplant remain unclear. We aimed to compare early complications, including graftrejectionandinfectionrates after kidney transplant, in childrenbetween the cyclosporine and tacrolimus immunomodulator regimens. MATERIALS AND METHODS: In this prospective cohort study, 105 pediatric patients who were candidates to receive kidney transplant in the age range of 4 to 18 years were included. There were 28 patients who received cyclosporine, and 77 patients who received tacrolimus. Participants were routinely tested for cytomegalovirus, BK virus, and bacterial infection on a monthly basis for the first 3 months and once every 3 months thereafter for the first year. The graft rejection rate was also assessed and compared between the 2 treatment regimens. RESULTS: There were no significant differences between the 2 groups receiving cyclosporine or tacrolimus in graft rejection rate (P = .719), cytomegalovirus viremia (P = .112), BK viremia (P = .278), and bacterial infection (P = .897). Graftfailure was significantly more frequent in male than in female patients (30.9% vs 8.2%; P = .004). The rates of graft failure in study patients with and without previous history of graftfailure were found to be statistically similar (16.7% vs 20.4%; P = .825). History of infection in donors did not affect the graft complications posttransplant in recipients. CONCLUSIONS: The use of either tacrolimus or cyclosporine leads to similar consequences in terms of graft rejection or posttransplant viral and bacterial infection, so either drug may be exchanged for the other if needed for tolerability.


Assuntos
Nefropatias , Transplante de Rim , Adolescente , Criança , Pré-Escolar , Ciclosporina/efeitos adversos , Feminino , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto , Humanos , Fatores Imunológicos , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Masculino , Estudos Prospectivos , Tacrolimo/efeitos adversos , Transplantados , Resultado do Tratamento , Viremia
19.
Exp Clin Transplant ; 20(7): 695-697, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35924746

RESUMO

Chronic active antibody-mediated rejection is the leading cause of kidney transplant failure. Although various immunosuppressive agents have been tested, rituximab included, presently there is no effective treatment. There are reports about the beneficial role of certain immunosuppressive protocols that include rituximab to reduce donor-specific antibodies, the cause of chronic active antibody-mediated rejection. If an immunosuppressive agent reduces donor-specific antibodies, its administration before the occurrence of chronic active antibody-mediated rejection may be beneficial. We describe a case of a renaltransplantrecipient with recurrent membranous nephropathy and recent development of donor-specific antibodies but without histological evidence of active antibody-mediated rejection. The patient received 3 weekly doses of rituximab for recurrent membranous nephropathy, and complete remission was achieved. One year after, he has preserved an excellentrenal function without proteinuria. However, repeated measurements of donor-specific antibodies revealed that rituximab only modestly reduced donor-specific antibodies. Donor-specific antibody levels remained considerably higher than the laboratory reference value. Thus,rituximab alone may not have a role to prevent chronic active antibody- mediated rejection in patients with donor-specific antibodies.


Assuntos
Glomerulonefrite Membranosa , Transplante de Rim , Anticorpos , Glomerulonefrite Membranosa/diagnóstico , Glomerulonefrite Membranosa/tratamento farmacológico , Glomerulonefrite Membranosa/patologia , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/prevenção & controle , Humanos , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Masculino , Rituximab/uso terapêutico , Resultado do Tratamento
20.
JAMA ; 328(5): 451-459, 2022 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-35916847

RESUMO

Importance: Care of adults at profit vs nonprofit dialysis facilities has been associated with lower access to transplant. Whether profit status is associated with transplant access for pediatric patients with end-stage kidney disease is unknown. Objective: To determine whether profit status of dialysis facilities is associated with placement on the kidney transplant waiting list or receipt of kidney transplant among pediatric patients receiving maintenance dialysis. Design, Setting, and Participants: This retrospective cohort study reviewed the US Renal Data System records of 13 333 patients younger than 18 years who started dialysis from 2000 through 2018 in US dialysis facilities (followed up through June 30, 2019). Exposures: Time-updated profit status of dialysis facilities. Main Outcomes and Measures: Cox models, adjusted for clinical and demographic factors, were used to examine time to wait-listing and receipt of kidney transplant by profit status of dialysis facilities. Results: A total of 13 333 pediatric patients who started receiving maintenance dialysis were included in the analysis (median age, 12 years [IQR, 3-15 years]; 6054 females [45%]; 3321 non-Hispanic Black patients [25%]; 3695 Hispanic patients [28%]). During a median follow-up of 0.87 years (IQR, 0.39-1.85 years), the incidence of wait-listing was lower at profit facilities than at nonprofit facilities, 36.2 vs 49.8 per 100 person-years, respectively (absolute risk difference, -13.6 (95% CI, -15.4 to -11.8 per 100 person-years; adjusted hazard ratio [HR] for wait-listing at profit vs nonprofit facilities, 0.79; 95% CI, 0.75-0.83). During a median follow-up of 1.52 years (IQR, 0.75-2.87 years), the incidence of kidney transplant (living or deceased donor) was also lower at profit facilities than at nonprofit facilities, 21.5 vs 31.3 per 100 person-years, respectively; absolute risk difference, -9.8 (95% CI, -10.9 to -8.6 per 100 person-years) adjusted HR for kidney transplant at profit vs nonprofit facilities, 0.71 (95% CI, 0.67-0.74). Conclusions and Relevance: Among a cohort of pediatric patients receiving dialysis in the US from 2000 through 2018, profit facility status was associated with longer time to wait-listing and longer time to kidney transplant.


Assuntos
Instituições de Assistência Ambulatorial , Acesso aos Serviços de Saúde , Falência Renal Crônica , Transplante de Rim , Diálise Renal , Listas de Espera , Adolescente , Instituições de Assistência Ambulatorial/economia , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Administração de Instituições de Saúde/economia , Administração de Instituições de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Falência Renal Crônica/economia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Transplante de Rim/economia , Transplante de Rim/estatística & dados numéricos , Masculino , Organizações sem Fins Lucrativos/economia , Organizações sem Fins Lucrativos/organização & administração , Organizações sem Fins Lucrativos/estatística & dados numéricos , Propriedade/economia , Propriedade/estatística & dados numéricos , Diálise Renal/economia , Diálise Renal/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo
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