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1.
Rev Esp Salud Publica ; 952021 Jul 07.
Artigo em Espanhol | MEDLINE | ID: mdl-34230448

RESUMO

BACKGROUND: Kidney transplantation represents the treatment choice for most people with chronic kidney disease due to the benefits it provides compared to other renal replacement therapies. This population requires specific monitoring, where the nursing professional must attend to determining factors of health-related quality of life (HRQoL) in order to guarantee an effective approach to the difficulties that arise. This bibliographic review pretends to determine the altered physical, psychological, and social components of health-related quality of life maintained by kidney transplant recipients as a way to improve quality of care through the most appropriate nursing interventions. METHODS: The literature review was conducted in PubMed, Medes, LILACS, CINAHL, Dialnet and Scopus databases. From a total of 718 articles identified, 30 publications were selected in order to meet the aim of the review and the established inclusion, exclusion and PRISMA Statement criteria. RESULTS: The quality of the published studies was set at a mean score of 6.07 according to the PEDro scale, for clinical trials and 10.5, according to the Amstar scale, for bibliographic reviews. 50% of the total were published in the last two years (2018-2019) and 75% are between Q1 and Q2 of the JCR and SJR impact factors. CONCLUSIONS: An improvement in HRQoL has been identified in these patients compared to the previous period of dialysis, although it is not still comparable to the general population. The physical area seems to be the most affected. The nursing professional can develop health education, psychological counseling and self-management activities.


Assuntos
Transplante de Rim/enfermagem , Qualidade de Vida , Humanos , Espanha
2.
BMJ Case Rep ; 14(7)2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34226250

RESUMO

A 44-year-old man with a history of renal transplantation presented with right lower abdominal wall swelling, redness and pain. A bacterial abscess was drained, and he was discharged home with oral antibiotics. After failing to improve, he returned to the hospital, where he was briefly treated with intravenous antibiotics and discharged home again. The patient returned 5 days later, reporting worsening right groin swelling that extended into the ipsilateral scrotum. Imaging revealed a persistent fluid collection in the region, and he was taken for surgical debridement. Tissue immunochemistry and histopathological evaluation identified cytomegalovirus infection. Plasma quantitative PCR for cytomegalovirus demonstrated high viraemia. The patient was successfully treated with intravenous ganciclovir, followed by oral valganciclovir, with resolution of the skin changes. Persistent hydrocele with epididymitis on imaging suggests that this process may have been the source of the cutaneous cytomegalovirus infection.


Assuntos
Infecções por Citomegalovirus , Transplante de Rim , Dermatopatias , Adulto , Antivirais/uso terapêutico , Citomegalovirus , Infecções por Citomegalovirus/tratamento farmacológico , Ganciclovir/uso terapêutico , Humanos , Transplante de Rim/efeitos adversos , Masculino , Dermatopatias/tratamento farmacológico
3.
BMJ Case Rep ; 14(7)2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34230047

RESUMO

Renal transplant recipients are at risk for opportunistic infections due to their immunosuppressed state. We describe the case of a 59-year-old renal transplant recipient who presented with sepsis and bilateral pulmonary emboli due to Candida parapsilosis She was treated with intravenous caspofungin and had a transoesophageal echocardiogram, which revealed vegetations on her pacemaker leads. She then underwent surgery to replace her pacemaker; however, her blood cultures remained positive for C. parapsilosis postoperatively. Her antifungal was switched to liposomal amphotericin B and flucytosine for 6 weeks, which yielded sterile blood cultures, and she was then initiated on lifelong fluconazole. Her recovery was complicated by tacrolimus toxicity 1 month after discharge due to fluconazole-induced CYP3A inhibition.


Assuntos
Fungemia , Transplante de Rim , Marca-Passo Artificial , Antifúngicos/uso terapêutico , Candida parapsilosis , Feminino , Fluconazol/uso terapêutico , Fungemia/tratamento farmacológico , Humanos , Transplante de Rim/efeitos adversos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade
4.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248334

RESUMO

Background/Objectives: Laparoscopic living donor nephrectomy (LLDN) of the right kidney is currently considered as part of standard of care; however, dealing with the renal hilum when performing ligation/division of its renal vessels is still a main concern. Here, we describe a simple-to-perform technique, i.e., flipping the fully mobilized right kidney to the midline so that the renal artery becomes anteriorly, which offers better visualization and easier dissection of the renal vessels (achieving maximized lengths) when performing hand-assisted LLDN of the right kidney. Methods: Living donors who underwent hand-assisted LLDN of the right kidney, along with their respective renal transplant recipients, were included in this report. Donor characteristics included renal artery and vein lengths; recipient characteristics included creatinine at months 12 - 36. Graft vein and arterial anastomosis data were also reported. Results: Nineteen living donors and 19 recipients, with median donor and recipient ages being 39 (24 - 60) and 53 (3 - 81) years, respectively, were included. None of the 38 patients had intra- or postoperative complications. Donor renal vein was anastomosed to the right external iliac vein (n = 16), right common iliac vein (n = 2), and inferior vena cava (n = 1). Gonadal vein (n = 1) and deceased donor iliac vein (n = 2) were used to increase the right renal vein length in 3 cases. Four donor kidneys had 2 arteries reconstructed side by side. None of the recipients developed any vascular or urological complications. Conclusions: The laparoscopic technique described is safe and allows better visualization of the right hilum, mainly the renal artery, and helps in stapling the renal vein and renal artery.


Assuntos
Laparoscopia Assistida com a Mão/métodos , Transplante de Rim/métodos , Rim/cirurgia , Nefrectomia/métodos , Coleta de Tecidos e Órgãos/métodos , Adulto , Feminino , Humanos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Artéria Renal/cirurgia , Veias Renais/cirurgia , Rotação , Resultado do Tratamento , Adulto Jovem
5.
BMC Infect Dis ; 21(1): 629, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210287

RESUMO

BACKGROUND: Along with the medical development, organ transplant patients increase dramatically. Since these transplant patients take immunosuppressants for a long term, their immune functions are in a suppressed state, prone to all kinds of opportunistic infections and cancer. However, it is rarely reported that the kidney transplant recipients (KTRs) have pulmonary tuberculosis and lung cancer simultaneously. CASE PRESENTATION: A 60-year-old male was admitted because of persistent lung shadow for 2 years without any obvious symptom 8 years after renal transplant. T-SPOT test was positive but other etiological examinations for Mycobacterium tuberculosis were negative. Chest CT scan revealed two pulmonary lesions in the right upper and lower lobe respectively. 18F-fluorodesoxyglucose positron-emission tomography (FDG-PET) CT found FDG intake increased in both pulmonary consolidation lesions. CT-guided percutaneous transthoracic needle biopsy revealed lung adenocarcinoma and tuberculosis. The video-assisted thoracoscopic surgery was operated to resect the malignancy lesions. The patient received specific anti-tuberculosis therapy and was discharged. At the follow-up of 6 months post drug withdrawal, the patient was recovered very well. CONCLUSIONS: We for the first time reported co-existence of smear-negative pulmonary TB and lung adenocarcinoma in a KTR, which highlighted the clinical awareness of co-occurrence of TB and malignancy after renal transplant and emphasized the value of biopsy and 18F-FDG-PET in early diagnosis of TB and cancer.


Assuntos
Adenocarcinoma/complicações , Transplante de Rim , Neoplasias Pulmonares/complicações , Tuberculose Pulmonar/complicações , Adenocarcinoma/cirurgia , China/epidemiologia , Etambutol/uso terapêutico , Fluordesoxiglucose F18 , Humanos , Biópsia Guiada por Imagem , Isoniazida/uso terapêutico , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Moxifloxacina/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificação , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Cirurgia Torácica Vídeoassistida , Resultado do Tratamento , Tuberculose Pulmonar/tratamento farmacológico
6.
Molecules ; 26(12)2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34207320

RESUMO

We evaluated mycophenolic acid (MPA) limited sampling strategies (LSSs) established using multiple linear regression (MLR) in children with nephrotic syndrome treated with mycophenolate mofetil (MMF). MLR-LSS is an easy-to-determine approach of therapeutic drug monitoring (TDM). We assessed the practicability of different LSSs for the estimation of MPA exposure as well as the optimal time points for MPA TDM. The literature search returned 29 studies dated 1998-2020. We applied 53 LSSs (n = 48 for MPA, n = 5 for free MPA [fMPA]) to predict the area under the time-concentration curve (AUCpred) in 24 children with nephrotic syndrome, for whom we previously determined MPA and fMPA concentrations, and compare the results with the determined AUC (AUCtotal). Nine equations met the requirements for bias and precision ±15%. The MPA AUC in children with nephrotic syndrome was predicted the best by four time-point LSSs developed for renal transplant recipients. Out of five LSSs evaluated for fMPA, none fulfilled the ±15% criteria for bias and precision probably due to very high percentage of bound MPA (99.64%). MPA LSS for children with nephrotic syndrome should include blood samples collected 1 h, 2 h and near the second MPA maximum concentration. MPA concentrations determined with the high performance liquid chromatography after multiplying by 1.175 may be used in LSSs based on MPA concentrations determined with the immunoassay technique. MPA LSS may facilitate TDM in the case of MMF, however, more studies on fMPA LSS are required for children with nephrotic syndrome.


Assuntos
Ácido Micofenólico/metabolismo , Síndrome Nefrótica/metabolismo , Adolescente , Coleta de Amostras Sanguíneas/métodos , Criança , Pré-Escolar , Cromatografia Líquida de Alta Pressão/métodos , Feminino , Humanos , Transplante de Rim/métodos , Modelos Lineares , Masculino , Análise Multivariada , Manejo de Espécimes/métodos
7.
Int J Mol Sci ; 22(12)2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34207555

RESUMO

Transplant glomerulopathy develops through multiple mechanisms, including donor-specific antibodies, T cells and innate immunity. This study investigates circulating small RNA profiles in serum samples of kidney transplant recipients with biopsy-proven transplant glomerulopathy. Among total small RNA population, miRNAs were the most abundant species in the serum of kidney transplant patients. In addition, fragments arising from mature tRNA and rRNA were detected. Most of the tRNA fragments were generated from 5' ends of mature tRNA and mainly from two parental tRNAs: tRNA-Gly and tRNA-Glu. Moreover, transplant patients with transplant glomerulopathy displayed a novel tRNA fragments signature. Gene expression analysis from allograft tissues demonstrated changes in canonical pathways related to immune activation such as iCos-iCosL signaling pathway in T helper cells, Th1 and Th2 activation pathway, and dendritic cell maturation. mRNA targets of down-regulated miRNAs such as miR-1224-5p, miR-4508, miR-320, miR-378a from serum were globally upregulated in tissue. Integration of serum miRNA profiles with tissue gene expression showed that changes in serum miRNAs support the role of T-cell mediated mechanisms in ongoing allograft injury.


Assuntos
Ácidos Nucleicos Livres/sangue , Rejeição de Enxerto/sangue , Nefropatias/sangue , Transplante de Rim , MicroRNAs/sangue , RNA de Transferência de Glicina/sangue , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Células Th1/metabolismo , Células Th2/metabolismo
8.
Medicine (Baltimore) ; 100(27): e26595, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232209

RESUMO

ABSTRACT: Increased neutrophil extracellular trap (NET) formation associates with high cardiovascular risk and mortality in patients with end-stage renal disease (ESRD). However, the effect of transplantation on NETs and its associated markers remains unclear. This study aimed to characterize circulating citrullinated Histone H3 (H3cit) and Peptidyl Arginase Deiminase 4 (PAD4) in ESRD patients undergoing transplantation and evaluate the ability of their neutrophils to release NETs.This prospective cohort study included 80 healthy donors and 105 ESRD patients, out of which 95 received a transplant. H3cit and PAD4 circulating concentration was determined by enzyme-linked immunosorbent assay in healthy donors and ESRD patients at the time of enrollment. An additional measurement was carried out within the first 6 months after transplant surgery. In vitro NET formation assays were performed in neutrophils isolated from healthy donors, ESRD patients, and transplant recipients.H3cit and PAD4 levels were significantly higher in ESRD patients (H3cit, 14.38 ng/mL [5.78-27.13]; PAD4, 3.22 ng/mL [1.21-6.82]) than healthy donors (H3cit, 6.45 ng/mL [3.30-11.65], P < .0001; PAD4, 2.0 ng/mL [0.90-3.18], P = .0076). H3cit, but not PAD4, increased after transplantation, with 44.2% of post-transplant patients exhibiting high levels (≥ 27.1 ng/mL). In contrast, NET release triggered by phorbol 12-myristate 13-acetate was higher in neutrophils from ESRD patients (70.0% [52.7-94.6]) than healthy donors (32.2% [24.9-54.9], P < .001) and transplant recipients (19.5% [3.5-65.7], P < .05).The restoration of renal function due to transplantation could not reduce circulating levels of H3cit and PAD4 in ESRD patients. Furthermore, circulating H3cit levels were significantly increased after transplantation. Neutrophils from transplant recipients exhibit a reduced ability to form NETs.


Assuntos
Armadilhas Extracelulares , Falência Renal Crônica/terapia , Transplante de Rim/métodos , Neutrófilos/patologia , Adulto , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Estudos Prospectivos
9.
Medicine (Baltimore) ; 100(28): e26656, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34260570

RESUMO

RATIONALE: Cryptococcal infection has been documented in immunocompromised patients. AIDS and renal transplant recipients account for majority of the cases. Most cases present with central nervous system or disseminated disease, with only few presenting soft tissue, bone, and joint manifestations. PATIENT CONCERNS: We present a case of soft tissue mass in a 66-year-old female renal transplant recipient and that of arthritis in a 64-year-old immunocompetent man who presented pseudogout arthropathy. Chest radiographies of both cases were negative. Biopsy revealed cryptococcal organisms. Blood culture or cerebrospinal fluid sampling indicated positive results for cryptococcal antigen. DIAGNOSIS: Cryptococcus neoformans was recovered in the wound culture. INTERVENTIONS: The patients received intravenous fluconazole and flucytosine, followed by oral fluconazole administration. OUTCOMES: Symptomatic improvements were achieved and no subsequent relapses were observed. LESSONS: The authors experienced 2 cases of cryptococcosis with very unusual clinical presentation. Early clinical suspicion and serum cryptococcal antigen testing can help in rapid appropriate diagnosis in immunocompetent as well as immunocompromised patients even in the absence of pulmonary involvement.


Assuntos
Abscesso/microbiologia , Criptococose/diagnóstico , Abscesso/diagnóstico , Abscesso/tratamento farmacológico , Idoso , Antifúngicos/uso terapêutico , Artrite/diagnóstico , Artrite/fisiopatologia , Criptococose/tratamento farmacológico , Criptococose/fisiopatologia , Cryptococcus neoformans , Diagnóstico Diferencial , Feminino , Fluconazol/uso terapêutico , Flucitosina/uso terapêutico , Humanos , Hospedeiro Imunocomprometido/fisiologia , Transplante de Rim , Masculino , Pessoa de Meia-Idade
10.
Int J Qual Health Care ; 33(3)2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34214155

RESUMO

BACKGROUND: The scholarship on the impact of the source of the donated kidney (living donor (LD) or deceased donor) and the ethnoreligious background on the quality of life post-transplantation have received little scientific attention. The purpose of the present research is to evaluate health-related quality of life and psychological feelings among kidney transplant (KT) recipients. OBJECTIVE: To compare the health related quality of life and psychological feelings between kidney transplant (KT) recipients who received a graft from a living versus a deceased donor, and between Muslim and Jewish patients. METHODS: Two hundred and sixty-two renal recipients completed the health-related quality of life (HRQOL; World Health Organization Quality of Life Brief Version (WHOQOL-BREF)) questionnaire and answered the Transplant Effects Questionnaire assessing their post-transplantation emotional and psychological responses. RESULTS: KT recipients reported medium levels of physical, psychological, social and environmental dimensions of HRQOL. Muslim recipients reported significantly higher levels of physical, psychological and social dimensions of HRQOL than Jews. Recipients of kidneys from LD reported higher levels of HRQOL and reported significantly higher levels of guilt and responsibility to be healthy. CONCLUSIONS: Our findings indicate that receiving a graft from an LD contributes to the HRQOL in the physical, psychological and environmental dimensions. Hence, donations from LD should be encouraged, by investing efforts in promoting public awareness of the importance of donating kidneys by LDs. Muslim KT recipients enjoy better physical, social and psychological HRQOL; this difference can be explained by the supportive and embracing familial and social networks characterizing traditional Arab communities. Post-transplantation support programs should be designed in order to provide further support and improve emotional and psychological responses to postoperative reality.


Assuntos
Transplante de Rim , Qualidade de Vida , Emoções , Humanos , Islamismo , Judeus
11.
Urologiia ; (3): 75-81, 2021 06.
Artigo em Russo | MEDLINE | ID: mdl-34251105

RESUMO

There are usually two main techniques of vessel anastomosis called as; end-to-end or end-to-side. The aim of this study was to investigate surgical vascular anastomotic and its correlation with early outcome after kidney transplantation. Data including gender, age, hospital stay, living or deceased donor, evidence of acute tubular necrosis, preference of artery or vein in addition to biochemical variables were noted analysed by SPSS. The study population was comprised of 84 females and 176 males (174 living versus 86 deceased donor). Surgical vascular anastomic techniques were based on; first artery second vein (FASV; n=209) or first vein second artery (FVSA; n=51). Vascular anastomic were performed as follow; group 1 (FASV with end-to-end; n= 52%), group 2 (FASV with end-to-side; n=29%), group 3 (FVSA with end-to-end; n=15%) and group 4 (FVSA with end-to-side; n= 5%). Comparison of groups showed that; deceased/living donor (group 1 versus group 3; p=0.02), ATN (group 1 versus group 2; p=0.002, group 1 versus group 4; p=0.03). Despite the higher use of deceased donors, those with vascular anastomic technique based on FASV (end-to-end) revealed a lower rate of ATN when compared to other techniques. Further studies in this direction recommended.


Assuntos
Transplante de Rim , Anastomose Cirúrgica , Feminino , Humanos , Doadores Vivos , Masculino , Fatores de Risco
12.
Arch Esp Urol ; 74(6): 623-627, 2021 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-34219066

RESUMO

OBJECTIVE: Calcification and atherosclerosis of the iliac arteries is very common in dialysis patients, making sometimes impossible the anastomosis of a kidney graft. The objective of this study is to present our kidney transplantation series using vascular prostheses for iliacartery reconstruction and to assess the results obtained in comparison to other published series. MATERIAL AND METHOD: In a single centre where 1090 kidney transplants were performed between January 2013 and December 2019, patients who required vascular reconstruction were identified for their descriptive analysis. RESULTS: In 9 patients (0.83%) arterial anastomosis was performed to a Gore-tex prosthesis (8) or using a bovine pericardium patch (1). Only in 1 case, the vascular bypass was prior to transplantation; in the other 8 the surgery was simultaneous. In 2 cases, an urgent transplantectomy was done because of acute rejection and prosthetic thrombosis. 6 patients had immediate graft function. 5 patients requireda new surgical or endovascular procedure to resolve complications. At 35 months of mean follow-up, 7 patients maintained renal graft function. CONCLUSION: Kidney transplantation with arterial anastomosis to a vascular prosthesis is very rare. Candidates should be carefully selected because of the high risk ofcomplications. Simultaneous vascular reconstruction is preferred.  The functional results are satisfactory.


Assuntos
Transplante de Rim , Animais , Prótese Vascular , Bovinos , Humanos , Artéria Ilíaca , Rim , Estudos Retrospectivos , Procedimentos Cirúrgicos Vasculares
13.
J Assoc Physicians India ; 69(1): 28-31, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34227772

RESUMO

Background: Renal transplantation is the treatment of choice for selected patients with end-stage renal disease. In this study, we present our experience and follow up data of renal transplantations done at this center with special emphasis on demographic characteristics, outcome and its complications. Materials and Methods: All those patients who underwent renal transplantations and had been followed up at this center were studied and their details were recorded. For living donor transplantation, donor and recipient were evaluated in detail. Graft loss was defined as the patient became dialysis-dependent or underwent second renal transplantation. Results: A total of 250 renal transplantations were done during the study period. 16.4% of total transplantations were cadaveric transplants. Recipients mean age was 38.5±11.64 yrs and donor mean age was 42.25 ±10.79 yrs. The majority of the recipients were male (72.4%) while female donors were predominant among living donors(59.3%). Mean graft survival time was 98.2 months (95% confidence interval [CI]:72.2-114.4). Mean patient survival time was 104.5 months (95% confidence interval [CI]:82.4-126.2). Conclusion: There is increasing no. of cadaveric renal transplants due to well established deceased donation programs in the state. Our patient and graft survival are comparable. Most of the immediate graft loss was due to acute rejection and late graft loss was due to chronic antibody-mediated rejection.


Assuntos
Transplante de Rim , Adulto , Feminino , Rejeição de Enxerto/epidemiologia , Sobrevivência de Enxerto , Humanos , Índia/epidemiologia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Centros de Atenção Terciária , Resultado do Tratamento
14.
BMC Nephrol ; 22(1): 251, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34229622

RESUMO

BACKGROUND: The ongoing coronavirus pandemic has major impacts on both patients and healthcare systems worldwide, thus creating new realities. Patients on maintenance dialysis listed for renal transplantation are a vulnerable subgroup with many comorbidities and recurring contacts with the healthcare system. Due to the COVID-19 pandemic transplant numbers have dropped considerably, further increasing waiting times in this high-risk population. On the other hand, knowledge of the severity of SARS-CoV-2 infection in immunocompromised patients, development and persistence of neutralising antibodies in such patients is just emerging. It is unclear how best to address the dilemma of postponing the life-saving transplantation. CASE PRESENTATION: We present a case report of a successful kidney transplantation only 65 days after the recipient was hospitalized for treatment of COVID-19 pneumonia. In a follow up of 9 months, we observed no signs of recurrent disease and transplant function is excellent. Monitoring SARS-CoV-2 antibody response demonstrates stable IgG levels. CONCLUSION: This reassuring case provides guidance to transplant centers how to proceed with kidney transplantation safely during the pandemic. Careful consideration of risks and benefits of the organ offer, full recovery from COVID-19 symptoms and the presence of a positive SARS-CoV-2 IgG antibody test, qualifies for kidney transplantation.


Assuntos
Anticorpos Antivirais/imunologia , COVID-19/imunologia , Falência Renal Crônica/cirurgia , Transplante de Rim , Idoso , COVID-19/complicações , Teste Sorológico para COVID-19 , Feminino , Rejeição de Enxerto/prevenção & controle , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Imunossupressores/uso terapêutico , Falência Renal Crônica/complicações , Diálise Renal , SARS-CoV-2
15.
BMC Med Res Methodol ; 21(1): 127, 2021 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-34154541

RESUMO

BACKGROUND: Kidney graft failure risk prediction models assist evidence-based medical decision-making in clinical practice. Our objective was to develop and validate statistical and machine learning predictive models to predict death-censored graft failure following deceased donor kidney transplant, using time-to-event (survival) data in a large national dataset from Australia. METHODS: Data included donor and recipient characteristics (n = 98) of 7,365 deceased donor transplants from January 1st, 2007 to December 31st, 2017 conducted in Australia. Seven variable selection methods were used to identify the most important independent variables included in the model. Predictive models were developed using: survival tree, random survival forest, survival support vector machine and Cox proportional regression. The models were trained using 70% of the data and validated using the rest of the data (30%). The model with best discriminatory power, assessed using concordance index (C-index) was chosen as the best model. RESULTS: Two models, developed using cox regression and random survival forest, had the highest C-index (0.67) in discriminating death-censored graft failure. The best fitting Cox model used seven independent variables and showed moderate level of prediction accuracy (calibration). CONCLUSION: This index displays sufficient robustness to be used in pre-transplant decision making and may perform better than currently available tools.


Assuntos
Transplante de Rim , Austrália , Sobrevivência de Enxerto , Humanos , Rim , Doadores de Tecidos
16.
Orv Hetil ; 162(26): 1029-1037, 2021 06 27.
Artigo em Húngaro | MEDLINE | ID: mdl-34175831

RESUMO

Összefoglaló. Bevezetés: Az antitest közvetítette kilökodés a graftvesztés gyakori oka a vesetranszplantáltak körében. Célkituzés: Célul tuztük ki, hogy ismertetjük a centrumunkban biopsziával igazolt humorális kilökodéssel rendelkezo betegeknek a kezelésre (standard kezelés: plazmaferézis, immunglobulin, rituximab) adott válaszát, valamint hogy vizsgáljuk a proteinuria grafttúlélésre kifejtett hatását és azt, hogy ezt a DSA-tól függetlenül teszi-e. Vizsgáltuk az eGFR-, a DSA-MFI-értéknek az antirejekciós terápia hatására bekövetkezo változásait is. Módszer: 85 beteg retrospektív analízisét végeztük el. A szövettani elemzésben a Banff-klasszifikációt vettük alapul. A csoportok összehasonlításához kategorikus változók esetén a Fisher-féle egzakt próbát, folyamatos változók esetén a Kruskal-Wallis-próbát használtuk. Eredmények: A biopsziával igazolt humorális rejekciós csoportba (ABMR-csoport) 19, a DSA-pozitív csoportba 14, a DSA-negatív csoportba 52 beteget választottunk be. A DSA-érték az ABMR-csoportban 61,16%-kal csökkent, a DSA-pozitív csoportban 42,86%-kal redukálódott (Fisher-féle egzakt: p = 0,1). Az ABMR-csoportban 9 betegnek a jelentos, 4-nek a nephroticus mértéku proteinuriája csökkentheto volt (az ABMR-csoport 68%-a). A legjobb grafttúlélés a legalacsonyabb fehérjeürítésnél adódott. Az antirejekciós terápiát követoen készült biopsziákban: a glomerulitis, az interstitialis gyulladás, az arteritis mértéke csökkent az antihumorális kezelés hatására, azonban krónikus elváltozások jelentek meg. Következtetés: Az ABMR-csoportban az antirejekciós terápiát követoen a fehérjeürítés monitorizálása javasolt, hiszen becsülheto vele a grafttúlélés. Orv Hetil. 2021; 162(26): 1029-1037. INTRODUCTION: Antibody-mediated rejection is a common cause of graft loss among kidney transplant recipients. OBJECTIVE: We aimed to describe the response of patients with biopsy-proven humoral rejection to treatment (standard treatment: plasmapheresis, immunoglobulin, rituximab) in our center. We also analyzed the effect of proteinuria on graft survival and whether this effect is independent of donor-specific antibodies (DSAs). Changes of eGFR and level of DSA following rejection treatment were examined. METHOD: In this study, laboratory data of 85 patients were analysed. Histological analysis was based on the Banff classification. Fisher's exact test was used for statistical analysis, and Kruskal-Wallis test was used to compare patient groups per variable. RESULTS: Data from 85 patients were processed retrospectively. 19 patients were selected for the biopsy-confirmed humoral rejection group (ABMR group), 14 for the DSA-positive group, and 52 for the DSA-negative group. DSA titer decreased by 61.16% in the ABMR group after treatment and by 42.86% in the DSA-positive group (Fisher's exact test: p = 0.1). In the ABMR group, significant nephrotic proteinuria in 4 patients and severe proteinuria in 9 patients were reduced (68% of ABMR group). The patients with the lowest protein excretion had the best graft survival. In biopsies performed after antirejection therapy, the extent of glomerulitis, interstitial inflammation, arteritis decreased with antihumoral treatment, but chronic lesions appeared. CONCLUSION: Following treatment of biopsy-proven ABMR, reduction of proteinuria predicts graft survival and should be monitored as an important factor-predicting prognosis. Orv Hetil. 2021; 162(26): 1029-1037.


Assuntos
Transplante de Rim , Humanos , Imunoglobulinas , Prognóstico , Estudos Retrospectivos
17.
Orv Hetil ; 162(26): 1052-1062, 2021 06 27.
Artigo em Húngaro | MEDLINE | ID: mdl-34175832

RESUMO

Összefoglaló. Bevezetés: Mind a dializált, mind a veseátültetett betegek körében vezeto haláloknak számít a cardiovascularis megbetegedés. E mögött foképp bal kamrai hypertrophia, volumenterheltség, következményes szívritmuszavar, szívbillentyu-elégtelenség, fokozott atherosclerosis állhat. Célkituzés: Célunk a vesetranszplantáció hatásának vizsgálata a bal kamra pumpafunkciójára, a szívritmuszavarokat kiváltó és meghatározó tényezokre és a vitiumokra nézve. Módszerek: A 2014. december 20. és 2018. június 21. közti idointervallumban, a Debreceni Egyetem Szervtranszplantációs Tanszékén felnott betegeken végzett veseátültetéseket vizsgáltuk retrospektív analízissel (n = 184). Vesetranszplantációt megelozoen, illetve azt követoen 6 és 12 hónappal az echokardiográfiás, a laboratóriumi és a gyógyszeres terápiás értékeket tanulmányoztuk. A statisztikai elemzéseket khi-négyzet-próbával, Fisher-féle egzakt teszttel és Kruskal-Wallis-féle varianciaanalízissel (ANOVA) végeztük (szignifikancia: p<0,05). Eredmények: A bal kamra végsystolés tágassága az átültetés elott 34,67 mm volt, míg a 6 hónapos eredmény 31,82 mm, a 12 hónapos 32,68 mm volt (p = 0,01). Átültetés elott a stroke prevalenciája 7,87% volt, míg a beavatkozás után nem fordult elo szélütés (p<0,001). Transzplantáció hatására a bal pitvari átméro (43,68 mm; 41,59 mm; 41,00 mm; p = 0,0417) és a káliumszint (4,98 mmol/l; 4,49 mmol/l; 4,49 mmol/l; p = 0,01) szignifikáns változást igazolt. Mutét elott II. fokú mitralis regurgitatiót észleltünk 10,7%-nál, mely 4,3%-ra, majd 2,1%-ra csökkent (p = 0,03). Transzplantációt megelozoen a billentyumeszesedés elofordulása diabetesesek között 45% (p = 0,20), 6 hónap múlva 46,7% (p = 0,018), 12 hónap múlva 60,0% (p = 0,024) volt. Következtetés: Transzplantáció után a bal pitvari átméro, a végsystolés bal kamrai átméro regrediál, csökken a pitvari ritmuszavarok kialakulásának gyakorisága. A mitralis regurgitatio közepesen súlyos fokainál szignifikáns javulást, a diabeteses populáción belül szignifikáns emelkedést tapasztaltunk a meszes billentyuk számát tekintve. Orv Hetil. 2021; 162(26): 1052-1062. INTRODUCTION: Among the population suffering from end-stage renal failure and the population after kidney transplantation, the leading reason of death is cardiovascular triggered by left ventricular hypertrophy, volume overload, consecutive arrhythmias, valvular insufficiency and increased artherosclerosis. OBJECTIVE: This study was aimed at examining the effect of kidney transplantation on pump function of the left ventricle, arrhythmic substrates and valvular heart diseases. METHODS: At the Division of Organ Transplantation, University of Debrecen, we carried out a retrospective data analysis of adult patients (n = 184) who had kidney transplantation in the period between December 2014 and June 2018. Preoperatively and, then, postoperatively (at 6 and 12 months) we studied the echocardiographic parameters, the laboratory results. Statistical analyses were performed using the chi-square/Fisher's exact test and Kruskal-Wallis analysis of variance (ANOVA) test. The results were regarded significant if p<0.05 was found. RESULTS: Preoperatively the end-systolic diameter of the left ventricle was 34.67 mm, whereas 6 and 12 months later these values were 31.82 mm and 32.68 mm (p = 0.01). The prevalence of stroke was 7.87% preoperatively; there was no stroke detected postoperatively (p<0.001). The impact of transplantation on the left atrial diameter (43.68 mm; 41.59 mm; 41.00 mm; p = 0.04) and seral potassium level (4.98 mmol/l; 4.49 mmol/l; 4.49 mmol/l; p<0.01) showed significant improvement. Before transplantation, grade 2 mitral regurgitation was observed in 10.7% of the patients, whereas it reduced to 4.3%, then to 2.1% 6 and 12 months postoperatively (p = 0.03). Preoperative valvular calcification was detected in 45% of the diabetic study population (p = 0.20), 6 and 12 months later, in 46.7% (p = 0.018) and 60.0% (p = 0.024). CONCLUSION: After transplantation, the left atrial and the end-systolic diameter of the left ventricle regrediated, decreasing the frequency of arrhythmic episodes. The number of the middle grade mitral valve regurgitation decreased and the calcification among diabetic population increased significantly. Orv Hetil. 2021; 162(26): 1052-1062.


Assuntos
Sistema Cardiovascular , Transplante de Rim , Adulto , Arritmias Cardíacas , Ecocardiografia , Humanos , Estudos Retrospectivos
18.
Orv Hetil ; 162(26): 1038-1051, 2021 06 27.
Artigo em Húngaro | MEDLINE | ID: mdl-34175833

RESUMO

Összefoglaló. Bevezetés: Veseátültetést követoen a graft és a beteg túlélésére hatással lehetnek a posztoperatív intervenciót igénylo szövodmények. Fontos szempont a mutéttechnikai eredményesség monitorozása. Többek között az irodalomban számos lehetoség ismert a veseátültetés sarokpontjának számító ureteranastomosis elkészítésére is, de az éranastomosisok technikája szintén dönto lehet. Célkituzés és módszer: Retrospektíven vizsgáltuk a 2010 és 2020 között végzett veseátültetéseket a Debreceni Egyetem Sebészeti Klinikáján. Célul tuztük ki a sebészeti szövodmények vizsgálatát, melyeket rendszereztünk, a módosított Clavien-féle beosztás alapján. A legnagyobb figyelmet az ureteranastomosisokra fordítottuk. Minden betegnél az adott kategóriában legsúlyosabb szövodményt vettük alapul a beosztáshoz. A minimális utánkövetési ido 1 év volt. Az adatokat az SPSS statisztikai program segítségével elemeztük. Eredmények: A vizsgált periódusban 406 veseátültetés történt, melybol 24,4% (n = 99) vesetranszplantáltnál alakult ki intervenciós (sebészeti, radiológiai, urológiai) szövodmény. A betegek átlagéletkora 49,5 ± 13,7 év, 60,8% férfi volt. A kumulatív mortalitás 10,1% volt. Grade 4-es szövodmény a betegek 6,9%-ánál (n = 28), Grade 3-as a 6,7%-ánál (n = 27), Grade 2-es a 3%-ánál (n = 12), Grade 1-es a 7,9%-ánál (n = 32) jelentkezett. A veseátültetés után 20,4%-ban (n = 83) alakult ki késon induló graftfunkció. Következtetés: A legenyhébb kategóriába (Grade 1.) került a legtöbb beteg, a szövodmények jelentos része sebészi, intervenciós radiológiai és urológiai közremuködéssel megoldható volt. Az ureteranastomosisok mutéti technikája és a releváns szövodmények kialakulása között nincs szignifikáns összefüggés. Megfelelo és idoben alkalmazott korrekciós kezelés mellett a graft- és betegtúlélést nem rontja szignifikánsan az enyhe és középsúlyos (Grade 1-3.) szövodmények kialakulása. Orv Hetil. 2021; 162(26): 1038-1051. INTRODUCTION: Complications associated with postoperative intervention may affect graft and patient survival after kidney transplantation. Monitoring the effectiveness of surgery is an important aspect. Ureter anastomosis can be the pivot of kidney transplant, the same as vascular anastomosis, so efficiency of the surgical technique is important to follow up. OBJECTIVE AND METHOD: We retrospectively examined kidney transplants performed between 2010 and 2020 at the Department of Surgery of the University of Debrecen. Data were analyzed by the SPSS statistical program. We aimed to investigate surgical complications, which were systematized based on the modified Clavien classification. In one patient, the most severe complication was used as the basis for the schedule. The minimum follow-up time was 1 year. RESULTS: 406 kidney transplants were performed in the examined period, of which 24.4% (n = 99) developed renal transplant complications (surgical, radiological, urological). The mean age of the patients was 49.5 ± 13.7 years, and 60.8% were male. The cumulative mortality was 10.1%. Grade 4 complication developed in 6.9% (n = 28) of the recipients, Grade 3 in 6.7% (n = 27), Grade 2 in 3% (n = 12), and Grade 1 in 7.9% (n = 32). 20.4% of the recipients had delayed graft function. CONCLUSION: The Grade 1 group had the biggest case number, so a significant part of the complications could be solved with the help of interventional radiology and urologists. There is no significant association between the surgical technique of ureteral anastomoses and the development of related complications. With appropriate therapy, graft and patient survival are not significantly impaired by the development of Grade 1-3 complications. Orv Hetil. 2021; 162(26): 1038-1051.


Assuntos
Transplante de Rim , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos
19.
Orv Hetil ; 162(26): 1012-1021, 2021 06 27.
Artigo em Húngaro | MEDLINE | ID: mdl-34175834

RESUMO

Összefoglaló. Bevezetés: A tudás mint potenciálisan módosítható faktor a megfelelo döntéshozatal elofeltétele. Célkituzés: Kutatásunk során a krónikus vesebetegek körében vizsgáltuk az egyes vesepótló kezelési módokkal kapcsolatos ismereteket, elemeztük a tudást befolyásoló tényezoket, annak érdekében, hogy feltérképezzük a betegismeretek e területen megfigyelheto hiányosságait. Egyúttal tájékoztatást és ismeretterjesztést adtunk a vesetranszplantációval kapcsolatosan. Módszer: A betegek ismereteit befolyásoló tényezoket tíz magyarázó változóra korrigált többváltozós lineáris regresszióval értékeltük, melynél a függo változó a tudáspontszám volt. Követéses vizsgálatunk elso adatfelvétele során az Eurotransplant-várólistán szereplo, vesetranszplantáció irányában kivizsgálás alatt álló, valamint a veseátültetést elutasító, 18 és 75 év közötti betegeket kerestük fel. Az elso körös (alaptudásszintet rögzíto) adatfelvétel összesen 254, az ismeretátadás utáni második pedig 115 vesebeteg bevonásával valósult meg. Eredmények: Eredményeink alapján elmondható, hogy a felsofokú (ß = 1,502, p<0,001) és a középfokú (ß = 2,346, p<0,001) iskolai végzettséggel rendelkezo betegek egyaránt magasabb tudáspontszámot értek el az alacsonyabb iskolai végzettséggel rendelkezokhöz képest. A korábban veseátültetésen már átesett betegek 2 ponttal magasabb pontszámot értek el a veseátültetésben még nem részesültekhez viszonyítva (ß = 2,024, p<0,001). Szignifikánsan magasabb pontszámot értek el azok a betegek is, akik megfelelo egészségmuveltségi szinttel rendelkeztek (ß = 1,344, p<0,001). Eredményeink bizonyítják programunk hatékonyságát, mert a részt vevo vesebetegek szignifikánsan magasabb pontszámot értek el a tudásszintfelméro teszten, több hónappal a betegedukációt követoen is (p<0,001). Következtetés: Az általunk azonosított hiányosságok segíthetnek az egészségügyi szakemberek számára abban, hogy melyek azok a területek, amelyekre a betegoktatási és önmegvalósító programok során hangsúlyt kell fektetni a beteg-együttmuködés és az eredmények javítása érdekében. Orv Hetil. 2021; 162(26): 1012-1021. INTRODUCTION: Knowledge as a potentially modifiable factor is a prerequisite for appropriate decision making. OBJECTIVE: In our study, we examined the knowledge level related to renal replacement therapies and its influencing factors among chronic kidney disease patients, in order to identify the patients' knowledge gaps. At the same time, we provided information, education on kidney transplantation. METHOD: Factors influencing the patients' knowledge were evaluated using a multivariate linear regression adjusted for ten factors, where the dependent variable was the knowledge score. During the first data collection of our follow-up study, we contacted patients on the Eurotransplant waiting list, patients undergoing medical evaluation, and patients who refuse a kidney transplant, between 18 and 75 years old. A total of 254 patients were involved in the first round of data collection (recording the basic level of knowledge), and 115 in the second one (after the education). RESULTS: Our results show that patients with both tertiary (ß = 1.502, p<0.001) and secondary (ß = 2.346, p<0.001) educational attainment achieved higher knowledge scores. Patients with previous kidney transplantation scored 2 points higher than those without (ß = 2.024, p<0.001). Moreover, patients with adequate health literacy level achieved significantly higher knowledge scores (ß = 1.344, p<0.001). Our results prove the effectiveness of our program since the participants achieved significantly higher scores on the knowledge test, even several months after the education (p<0.001). CONCLUSION: The gaps we have identified can help the healthcare professionals which areas need to be focused in patient education and self-management programs in order to improve patient collaboration and outcomes. Orv Hetil. 2021; 162(26): 1012-1021.


Assuntos
Transplante de Rim , Adolescente , Adulto , Idoso , Seguimentos , Pessoal de Saúde , Humanos , Hungria , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Adulto Jovem
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