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1.
J Coll Physicians Surg Pak ; 31(12): 1482-1486, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34794292

RESUMO

OBJECTIVE: To assess the frequency and time of onset of new-onset diabetes after transplant (NODAT) and its associated factors. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Nephrology, Bahria International Hospital, Lahore, Pakistan, from April 2016 to April 2018. METHODOLOGY: NODAT was diagnosed according to American Diabetes Association Criteria with fasting plasma glucose >126 mg/dl or random plasma glucose >200 mg/dl. Those with pre-existing diabetes and follow-up duration less than 12months, were excluded. Patients were divided in two groups: with and without NODAT, for statistical comparison. RESULTS: The study included 115 patients, 101 were males and the median age was 35.0 (29.0-46.0) years. During the one-year period of follow-up, 28 (24.3%) patients developed NODAT. The mean time of onset of NODAT was 5.3 ± 3.6 months. Family history of diabetes was positive in 46% patients in NODAT group, which was significantly higher as compared to 5.7% in non-NODAT group with p-value of <0.001, which is significant. All patients with more than three HLA mismatches developed NODAT. The mean fasting glucose levels (FPG) before transplant in NODAT group was 96.6 ± 15.4 mg/dl, which was significantly higher than FPG of non-NODAT group, where it was 80.5 ± 12.2 mg/dl. It was interesting to note that 35.7% of hepatitis patients developed NODAT as compared to 6 % in non-NODAT group with p =  0.001. CONCLUSION: NODAT was observed in 24.3% patients. The pre-transplant FPG, family history of diabetes, increased HLA mismatches, and hepatitis C infection were the major associated factors. Key Words: New onset diabetes after transplant, Fasting plasma glucose, Renal transplant.


Assuntos
Diabetes Mellitus , Transplante de Rim , Adulto , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etiologia , Jejum , Humanos , Transplante de Rim/efeitos adversos , Masculino , Paquistão/epidemiologia , Fatores de Risco
2.
New Microbiol ; 44(3): 184-186, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34783351

RESUMO

Coronavirus is a high-risk pathogen for kidney transplant recipients receiving immunosuppressive therapy; Coronavirus disease 2019 (COVID-19) is an infection causing severe acute respiratory syndrome (SARS-CoV2), and progressive withdrawal of immunosuppressive drugs has been suggested in transplanted patients. At IRCCS San Matteo Hospital in Pavia, Northern Italy, during the pandemic we performed a screening and all transplanted patients were evaluated for IgG anti SARS-CoV-2; 12 of 201 kidney transplant recipients (6%) screened for IgG anti SARS-CoV-2 (s) developed kidney transplant rejection; 10 (83%) were negative and 2 (17%) resulted positive for SARS-CoV-2 IgG, while among 189 patients without rejection, 162 (86%) resulted negative and 27 (14%) positive (P=0.69). COVID 19 course may be more severe in kidney transplant recipients but it does not significantly increase risk of kidney rejection.


Assuntos
COVID-19 , Transplante de Rim , Humanos , Transplante de Rim/efeitos adversos , Pandemias , RNA Viral , SARS-CoV-2 , Transplantados
4.
Bratisl Lek Listy ; 122(11): 771-777, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34672667

RESUMO

OBJECTIVES: The objective was to find out risk factors indicating the patients directly to selective coronarography (SCG) to avoid unnecessary non-invasive testing and in their absence to asses low cardiovascular risk and faster inclusion on the waiting list. BACKGROUND: Cardiovascular diseases (CVD) are the most frequent cause of death in dialysed patients. The aim of our retrospective analysis was to identify risk factors for coronary artery disease (CAD) before kidney transplantation (KTx). METHODS: Our retrospective analysis consisted of 55 dialysed patients (46 males, 9 females, p < 0.0001), undergoing SCG before KTx. We divided the patients according to SCG results (negative, n = 40, positive finding, n = 15). RESULTS: We confirmed a significantly lower incidence of diabetic nephropathy (p = 0.0484), ischaemic heart disease (p = 0.0174) and CAD (p = 0.0001) in patients without percutaneous coronary intervention (PCI; negative finding). Haemodynamically significant coronary stenosis correlated with the occurrence of stroke in a patient's history (p = 0.0104). We identified predictors for performing PCI (positive result): type 2 diabetes mellitus (DM) (p = 0.0472), high-density lipoprotein cholesterol ≤ 1.03 mmol/l (p = 0.0359), total calcium level ≤ 2 mmol/l (p = 0.0309), phosphate level ≥ 1.45 mmol/l (OR 0.2034; p = 0.0351). CONCLUSION: In our analysis, patients with DM and poorly managed chronic kidney disease/mineral bone disease were the riskiest subset of the patients with a positive SCG finding (Tab. 4, Fig. 2, Ref. 30). Text in PDF www.elis.sk Keywords: kidney transplantation, coronary artery disease, selective coronarography, cardiovascular risk.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Transplante de Rim , Intervenção Coronária Percutânea , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Transplante de Rim/efeitos adversos , Masculino , Estudos Retrospectivos , Fatores de Risco
5.
Int J Mol Sci ; 22(19)2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34638652

RESUMO

The combination of insulin resistance and ß-cells dysfunction leads to the onset of type-2 diabetes mellitus (T2DM). This process can last for decades, as ß-cells are able to compensate the demand for insulin and maintain normoglycemia. Understanding the adaptive capacity of ß-cells during this process and the causes of its failure is essential to the limit onset of diabetes. Post-transplant diabetes mellitus (PTDM) is a common and serious disease that affects 30% of renal transplant recipients. With the exception of immunosuppressive therapy, the risk factors for T2D are the same as for PTDM: obesity, dyslipidaemia, insulin resistance and metabolic syndrome. Tacrolimus (TAC) is the immunosuppressant of choice after renal transplantation but it has the highest rates of PTDM. Our group has shown that insulin resistance and glucolipotoxicity, without favouring the appearance of apoptosis, modify key nuclear factors for the maintenance of identity and functionality of ß-cells. In this context, TAC accelerates or enhances these changes. Our hypothesis is that the pathways that are affected in the progression from pre-diabetes to diabetes in the general population are the same pathways that are affected by TAC. So, TAC can be considered a tool to study the pathogenesis of T2DM. Here, we review the common pathways of ß-cells dysfunction on T2DM and TAC-induced diabetes.


Assuntos
Diabetes Mellitus Tipo 2/induzido quimicamente , Células Secretoras de Insulina/efeitos dos fármacos , Tacrolimo/efeitos adversos , Animais , Humanos , Resistência à Insulina/fisiologia , Transplante de Rim/efeitos adversos , Transplantados
6.
Biomed Res Int ; 2021: 9318725, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34692845

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic poses a special risk for both immunosuppressed patients, especially transplant recipients. Although the knowledge about this infection is growing, many uncertainties remain, particularly regarding the kidney. Kidney transplant recipients (KDRs) should be considered immunocompromised hosts since a potential risk for infection, comorbidity, and immunosuppression exposure exists. Additionally, the management of immunosuppressive agents in KDRs remains challenging. Potential drug interactions with immunosuppressive treatment escalated the risk of unwanted side effects. In this review, we aimed to attain an augmented awareness and improved management immunosuppressant for COVID-19 KDRs.


Assuntos
COVID-19/imunologia , Imunossupressores/uso terapêutico , Transplante de Rim , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/imunologia , Imunossupressores/farmacocinética , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , SARS-CoV-2/efeitos dos fármacos
7.
Am J Case Rep ; 22: e933168, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34620815

RESUMO

BACKGROUND Kidney transplantation is a treatment option for patients with end-stage renal disease. However, life-long immunosuppressive therapy, which is obligatory for renal transplant recipients, increases the risk of cancer recurrence and de novo tumor formation. Cancer is one of the leading causes of death in kidney transplant recipients. Renal cell carcinoma (RCC) of an allograft kidney is an extremely rare type of neoplasm and occurs in only about 0.22-0.25% of all kidney recipients. RCC is often asymptomatic and can be an incidental finding on routine examination. CASE REPORT In this case study, we describe a patient who developed chromophobe renal cell carcinoma 3 years after kidney transplantation from a living related donor. At the time of detection of the tumor, the graft function was impaired. A renal allograft biopsy was performed, and the pathological examination showed signs of chronic inflammation and chronic graft rejection. The graft biopsy failed to differentiate between oncocytoma and chromophobe carcinoma. Due to impaired graft function, presence of neoplasm in the graft, and morphologic chronic rejection, it was decided to perform a transplantectomy. The final histological examination showed the eosinophilic type of chromophobe carcinoma. CONCLUSIONS Chromophobe carcinoma in a kidney allograft is extremely rare in kidney transplant recipients. This clinical observation confirms the necessity and effectiveness of regular ultrasound and magnetic resonance imaging of the graft, not only for monitoring the functioning of the graft, but also for early detection of neoplasms in the transplanted kidney.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Transplante de Rim , Aloenxertos , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/cirurgia , Humanos , Rim , Neoplasias Renais/diagnóstico , Neoplasias Renais/etiologia , Neoplasias Renais/cirurgia , Transplante de Rim/efeitos adversos , Recidiva Local de Neoplasia
8.
BMC Oral Health ; 21(1): 547, 2021 10 24.
Artigo em Inglês | MEDLINE | ID: mdl-34689779

RESUMO

BACKGROUND: The oral health of organ transplanted patients before organ re-transplantation is largely unknown. This retrospective clinical study evaluates the necessity for intraoral surgical intervention and/or conservative treatment in candidates awaiting organ re-transplantation, both for graft failure and for reasons of another upcoming solid organ transplantation (renal or non-renal). METHODS: From January 2015 to March 2020 n = 19 transplant recipients in evaluation on the waiting list for solid organ re-transplantation could be included in the retrospective case series study. Using clinical and radiological examinations, necessity for oral surgical or conservative dental treatment was evaluated. On the basis of anamnesis data, current kidney function, renal replacement treatment (RRT), and medication, a risk profile for several patient subgroups was created. RESULTS: The clinical and radiological examinations showed a conservative and/or surgical treatment need in n = 13 cases (68.42%). In n = 7 cases (36.84%) surgical intervention was recommended due to residual root remnants (n = 5), unclear mucosal changes (n = 1), and periimplantitis (n = 1). In n = 16 recipients (84.2%) RRT (n = 15 hemodialysis; n = 1 peritoneal dialysis) had been performed. N = 14 recipients (73.68%) received immunosuppressants. In n = 1 patient (5.3%) displayed intraoral and n = 4 patients (21.1%) extraoral neoplasms due to drug-induced immunosuppression. CONCLUSIONS: Solid organ transplant recipients with renal failure present a complex treatment profile due to a double burden of uremia plus immunosuppressants. In cases of surgical treatment need a hospitalized setting is recommended, where potentially necessary follow-up care and close cooperation with disciplines of internal medicine is possible in order to avoid surgical and/or internal complications.


Assuntos
Falência Renal Crônica , Transplante de Rim , Transplante de Órgãos , Preparações Farmacêuticas , Humanos , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Saúde Bucal , Estudos Retrospectivos
9.
Sci Rep ; 11(1): 20073, 2021 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-34625642

RESUMO

Kidney transplantation recipients (KTR) with coronavirus disease 2019 (COVID-19) are at higher risk of death than general population. However, mortality risk factors in KTR are still not clearly identified. Our objective was to systematically analyze published evidence for risk factors associated with mortality in COVID-19 KTR. Electronic databases were searched for eligible studies on 1 August 2021. All prospective and retrospective studies of COVID-19 in KTR were considered eligible without language restriction. Since data in case reports and series could potentially be subsets of larger studies, only studies with ≥ 50 patients were included. Random-effects model meta-analysis was used to calculate weighted mean difference (WMD) and pooled odds ratio (OR) of factors associated with mortality. From a total 1,137 articles retrieved, 13 were included in the systematic review and meta-analysis comprising 4,440 KTR. Compared with survivors, non-survivors were significantly older (WMD 10.5 years, 95% CI 9.3-11.8). KTR of deceased donor were at higher risk of death (OR 1.73, 95% CI 1.10-2.74). Comorbidities including diabetes mellitus, cardiovascular disease, and active cancer significantly increased mortality risk. KTR with dyspnea (OR 5.68, 95% CI 2.11-15.33) and pneumonia (OR 10.64, 95% CI 3.37-33.55) at presentation were at higher mortality risk, while diarrhea decreased the risk (OR 0.61, 95% CI 0.47-0.78). Acute kidney injury was associated with mortality (OR 3.24, 95% CI 1.36-7.70). Inflammatory markers were significantly higher in the non-survivors, including C-reactive protein, procalcitonin, and interleukine-6. A number of COVID-19 mortality risk factors were identified from KTR patient characteristics, presenting symptoms, and laboratory investigations. KTR with these risk factors should receive more intensive monitoring and early therapeutic interventions to optimize health outcomes.


Assuntos
Injúria Renal Aguda/epidemiologia , COVID-19/epidemiologia , Transplante de Rim , Injúria Renal Aguda/mortalidade , COVID-19/mortalidade , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Comorbidade , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/mortalidade , Humanos , Transplante de Rim/efeitos adversos , Neoplasias/epidemiologia , Neoplasias/mortalidade , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Transplantados
10.
In Vivo ; 35(6): 3369-3375, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34697171

RESUMO

BACKGROUND/AIM: Patients after kidney transplants are at risk of cardiovascular morbidity. An elevated resistance index (RI) is associated with renal graft failure, while a decreased RI can be due to a renal artery stenosis. The RI can also be measured in the carotid artery. Whether a correlation between intrarenal RI after kidney transplant in adult patients and the RI of the internal carotid artery exists is still unclear. PATIENTS AND METHODS: In this prospective cross-sectional study, RI of kidney transplants and of the internal carotid artery were measured with duplex sonography. Carotid intima-media thickness as well as the Framingham risk score and the Augmentation index, all known markers of atherosclerosis, were assessed. Correlations between the RI in Carotid artery and the RI of the kidney transplant were based on Spearmen test with the level of significance set at p<0.05. RESULTS: Ninety-eight consecutive patients [60% male, mean age of 48.7 (±15.6)] were included. The mean interval after transplantation was 27.5 (±8.5) months and mean serum creatinine was 308 (±220.3) mmol/ml The RI of the internal carotid artery and the renal transplant were significantly correlated (p<0.05). A correlation between the RIs and the Augmentation Index was found. CONCLUSION: The RI of the kidney transplant is correlated with the RI of the carotid artery and to markers of general atherosclerosis. This observation may be helpful to identify patients after kidney transplant with higher risk for cardiovascular events and gain indirect information on transplant renal artery stenosis.


Assuntos
Aterosclerose , Transplante de Rim , Adulto , Aterosclerose/diagnóstico por imagem , Aterosclerose/etiologia , Espessura Intima-Media Carotídea , Estudos Transversais , Feminino , Humanos , Rim/diagnóstico por imagem , Transplante de Rim/efeitos adversos , Masculino , Estudos Prospectivos
15.
Medicine (Baltimore) ; 100(43): e27625, 2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34713851

RESUMO

ABSTRACT: Diarrhea is common in adults after solid organ transplantation (SOT) and bone marrow transplantation (BMT), but data in children are limited. Therefore, we aimed to determine the incidence and etiology of pediatric early-onset diarrhea in post SOT and BMT.We reviewed children aged 6 months to 18 years who underwent liver transplantation, kidney transplantation or BMT between January 2015 and December 2019 with duration of diarrhea > 72 hours within the first 6 months after transplantation. Clinical data and diarrheal course were collected. Regression analyses were performed to define factors associated with the interested outcomes.Among 252 transplanted patients, 168 patients (66.6%) had 289 documented episodes of diarrhea. A diagnosis of 68.2% of post-transplant diarrhea remained 'indefinite'. Enteric infection in SOT and gastrointestinal acute graft-versus-host disease (GI-aGVHD) in BMT were the commonly identified etiologies. Among 182 episodes among BMT children, skin rash was more pronounced when compared the ones with diarrhea > 7 days vs ≤ 7 days (odds ratio [OR] 13.9; 95% CI 1.8, 107.6). Males were more likely to develop GI-aGVHD as compared to females (OR 8.9). We found that GI-aGVHD was more common in the ones with skin rash and the presence of white blood cells in stool examination (OR 8.4 and 3.1, respectively). Deaths occurred in 7.7%.Two-thirds of post-transplant children experienced at least one episode of early-onset diarrhea, of which the etiology mainly remains undefined. Various clinical factors of prolonged/chronic diarrhea and GI-aGVHD may help clinicians when managing these children.


Assuntos
Transplante de Medula Óssea/efeitos adversos , Diarreia/etiologia , Transplante de Rim/efeitos adversos , Transplante de Fígado/efeitos adversos , Adolescente , Criança , Pré-Escolar , Fezes/citologia , Feminino , Doença Enxerto-Hospedeiro/patologia , Humanos , Lactente , Leucócitos/citologia , Masculino , Fatores Sexuais
16.
Am J Case Rep ; 22: e933267, 2021 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-34695070

RESUMO

BACKGROUND Leiomyosarcoma frequently occurs in patients who are on immunosuppressive therapy. It is the second most common sarcoma in this population and is often associated with Epstein-Barr virus (EBV) infection. We present a case of advanced leiomyosarcoma of the retroperitoneal space in a kidney transplant recipient and discuss additional risk factors for oncogenesis. CASE REPORT A 44-year-old woman with a history of peritoneal dialysis and kidney transplantation was diagnosed with multiple liver lesions. PET-CT scanning showed a metabolically active tumor in the left lumbar region with numerous liver focal lesions. The histological examination of the liver lesion biopsy identified advanced retroperitoneal leiomyosarcoma with a high proliferative index and liver involvement. Unexpectedly, the relation with EBV infection was not proven. The patient was treated with first-line doxorubicin, with the simultaneous reduction of immunosuppression. Owing to disease progression after 6 cycles, the patient received second-line chemotherapy based on gemcitabine and docetaxel, which was terminated owing to unacceptable toxicity, despite an observed response. Third-line trabectedin-based therapy with good tolerance and stabilization of disease after 20 months was being maintained at the time of this report. CONCLUSIONS The increased cancer mortality in solid-organ transplant recipients requires an individualized approach and increased post-transplantation screening according to additional specific cancer risk factors. A further consideration is the hypothetical relevance of long-term peritoneal membrane irritation in peritoneal dialysis patients.


Assuntos
Infecções por Vírus Epstein-Barr , Transplante de Rim , Leiomiossarcoma , Diálise Peritoneal , Adulto , Feminino , Herpesvirus Humano 4 , Humanos , Transplante de Rim/efeitos adversos , Leiomiossarcoma/complicações , Diálise Peritoneal/efeitos adversos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Espaço Retroperitoneal
18.
Front Immunol ; 12: 663602, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34539621

RESUMO

Background: A systematic review and meta-analysis were performed to investigate the efficacy and safety of conversion from calcineurin inhibitors (CNIs) to mammalian target of rapamycin inhibitors (mTORi) in kidney transplant recipients (KTRs). Methods: MEDLINE, EMBASE, PubMed, and Cochrane Library were searched to identify randomized controlled trials (RCTs) that compared the continuation of CNI with conversion to mTORi therapy. Results: Twenty-nine RCTs (5,747 KTRs) were included in our analysis. Meta-analysis of the glomerular filtration rate (SMD 0.20; 95%CI 0.10-0.31; P<0.01) and malignancy (RR 0.74; 95%CI 0.55-0.99; P=0.04) demonstrated a significant advantage of mTORi conversion over CNI continuation. However, the risk of acute rejection (RR 1.58; 95%CI 1.22-2.04; P<0.01), infection (RR 1.55; 95%CI 1.01-1.31; P=0.04), proteinuria (RR 1.87; 95%CI 1.34-2.59; P<0.01), leukopenia (RR 1.56; 95%CI 1.27-1.91; P<0.01), acne (RR 6.43; 95%CI 3.43-12.04; P<0.01), and mouth ulcer (RR 11.70; 95%CI 6.18-22.17; P<0.01) were higher in the mTORi group. More patients in the conversion group had to discontinue study medication (RR 2.52; 95%CI 1.75-3.63; P<0.01). There was no significant difference between the two groups with regard to death, graft loss, diabetes, chronic allograft nephropathy, and interstitial fibrosis/tubular atrophy. Conclusions: Posttransplant patients have a better graft function and lower incidence of malignancy after conversion from CNI to mTORi therapy. However, this conversion strategy may be prevented by the higher drug discontinuation rate due to mTORi-associated adverse events, such as more acute rejection, infection, proteinuria, leukopenia, acne, and mouth ulcer, indicating that conversion therapy may only be a treatment option in selected patients.


Assuntos
Inibidores de Calcineurina/uso terapêutico , Transplante de Rim , Inibidores de Proteínas Quinases/uso terapêutico , Serina-Treonina Quinases TOR/antagonistas & inibidores , Transplantados , Inibidores de Calcineurina/farmacologia , Substituição de Medicamentos , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto , Humanos , Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Razão de Chances , Avaliação de Resultados da Assistência ao Paciente , Inibidores de Proteínas Quinases/farmacologia , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Exp Clin Transplant ; 19(10): 1023-1031, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34498549

RESUMO

OBJECTIVES: There is scarcity of data on reoccurrence of SARS-CoV-2 infections in kidney transplant recipients. MATERIALS AND METHODS: We conducted a retrospective multicenter cohort study and identified 13 kidney transplant recipients (10 living and 3 deceased donors) with recurrent COVID-19, and here we report demographics, immunosuppression regimens, clinical profiles, treatments, and outcomes. RESULTS: COVID-19 second infection rate was 0.9% (13/1350) in kidney transplant recipients with a median age of 46 years; median time interval from transplant to first episode of COVID-19 diagnosis was 9.2 months (interquartile range, 2.2-46.5 months). The most common comorbidities were hypertension (84%) and diabetes (23%). Fever was significantly less common with recurrent COVID-19. COVID-19 severity ranged from asymptomatic (23%), mild (31%), and moderate (46%) during the first infection and asymptomatic (8%), mild (46%), and severe (46%) in the second infection. All 6 kidney transplant recipients with severe second infections died. The median interval between the 2 episodes based upon reverse transcriptase polymerase chain reaction COVID-19-positive tests was 135 days (interquartile range, 71-274 days) without symptoms. Statistically significant risk factors for mortality were dyspnea (P = .04), disease severity (P = .004), allograft dysfunction (P < .05), higher levels of neutrophil-to-lymphocyte ratio (P = .05), and intensive care unit/ventilator requirement (P = .004). Although our limited resources did not allow for molecular diagnostics and typing, we suggest that these second episodes were reinfections with SARS-CoV-2. CONCLUSIONS: To our knowledge, this is the largest study of kidney transplant recipients with reoccurring SARS-CoV-2 infection, and we observed 46% mortality.


Assuntos
COVID-19 , Transplante de Rim , Teste para COVID-19 , Pré-Escolar , Estudos de Coortes , Humanos , Lactente , Transplante de Rim/efeitos adversos , Estudos Retrospectivos , SARS-CoV-2 , Transplantados
20.
Transplant Proc ; 53(8): 2451-2467, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34465422

RESUMO

BACKGROUND: Kidney transplant recipients with coronavirus disease 2019 (COVID-19) are at increased risk for adverse outcomes, such as acute kidney injury (AKI), intensive care unit (ICU) admission, and death. The association of inflammatory biomarkers with outcomes and the impact of changes in immunosuppression on biomarker levels are unknown. METHODS: We investigated factors associated with a composite of AKI, ICU admission, or death, and whether immunosuppression changes correlated with changes in inflammatory biomarkers and outcomes in kidney transplant recipients with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction. RESULTS: Of 59 patients, 50% had estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Patients who discontinued calcineurin inhibitors (CNIs) had higher peak high-sensitivity C-reactive protein (hs-CRP) than those who maintained the same dose (median, 344; interquartile range [IQR], 145-374 vs median, 41; IQR, 22-116 mg/L, P = .03). Of the patients, 73% were hospitalized, 22% had admissions to the ICU, and 20% died. Of the 56% with AKI, 35% required dialysis. All patients with AKI but without pulmonary manifestations recovered to 10% of baseline creatinine levels. Factors associated with the composite outcome were eGFR <60 mL/min/1.73 m2 (odds ratio [OR], 5.833; 95% confidence interval [CI], 1.880-18.099; P = .002), hs-CRP (OR, 1.011/unit increase; 95% CI, 1.002-1.021; P = .019), white blood cell count (OR, 1.173/unit increase; 95% CI, 1.006-1.368; P = .041), and decreased or discontinued CNI (OR, 4.286; 95% CI, 1.353-13.572; P = .013). eGFR<60 mL/min/1.73 m2 (OR, 11.176; 95% CI, 1.581-79.001; P = .016), and peak hs-CRP (OR, 1.010/unit increase; 95% CI, 1.000-1.020; P = .049) remained associated with the composite in the multivariable model. CONCLUSIONS: Kidney transplant recipients with COVID-19 have high rates of ICU admissions, AKI, and death. Those with eGFR<60 mL/min/1.73 m2 are at highest risk. CNI reduction is associated with higher inflammatory biomarkers, correlating with worse outcomes. More studies are needed to determine if this association should drive clinical management.


Assuntos
COVID-19 , Imunossupressão , Transplante de Rim , Injúria Renal Aguda/virologia , Adulto , Idoso , Biomarcadores , COVID-19/complicações , Feminino , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplantados , Estados Unidos
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