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1.
Am Surg ; 86(2): 116-120, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167042

RESUMO

Unplanned readmission is often used as a surgical quality metric. A subset of kidney transplant recipients undergos multiple readmissions (MRs), although the incidence and risk factors are not well described. The aim of this study was to evaluate risk factors for MR after deceased donor kidney transplantation. All patients undergoing deceased donor kidney transplantation at a single center over a three-year period were analyzed via retrospective chart review for factors associated with MR. P values <0.05 were considered significant. Of 141 patients, the 30-day readmission rate was 26.2 per cent. MR occurred in 43 (30.5%) patients. Age, race, gender, initial organ function, and dialysis vintage were not associated with MR. Diabetic recipients, those who received basiliximab induction, those with acute rejection, and those with unplanned reoperations were at increased risk for MR. Infection was the most common reason for initial readmission in patients with MR (23.3%). One-year patient survival and death-censored graft survival were reduced for patients with MR. MRs are required for 30 per cent of kidney transplant recipients, primarily because of infection and immunologic causes. Recipients with diabetes and those who have acute rejection are at greatest risk.


Assuntos
Transplante de Rim/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Basiliximab/efeitos adversos , Diabetes Mellitus/epidemiologia , Feminino , Rejeição de Enxerto/epidemiologia , Sobrevivência de Enxerto , Humanos , Imunossupressores/efeitos adversos , Incidência , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Análise de Regressão , Reoperação/efeitos adversos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
2.
J. bras. nefrol ; 41(4): 534-538, Out.-Dec. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1056606

RESUMO

ABSTRACT Introduction: The number of incident and prevalent patients on dialysis has increased, as well as the number of candidates for renal transplantation in Brazil, without a proportional increase in the number of organ donors. The use of expanded kidneys, as to renal function, may be an alternative to increase the supply of organs. Objective: to discuss the feasibility of using expanded kidneys for renal function, which are in severe acute renal injury. Methods: All cases of renal transplantation of deceased donors performed at the Hospital das Clínicas de Botucatu of UNESP, from January 2010 to June 2018, totaling 732 cases were evaluated. Cases with final donor creatinine greater than 6 mg/dL were selected. Results: four patients were selected, of whom all donors were in severe acute kidney injury (AKI). These donors presented rhabdomyolysis as a probable cause of severe AKI, were young, with no comorbidities and had decreased urinary volume in the last 24 hours. The clinical evolution of all the recipients was satisfactory, with a glomerular filtration rate after transplantation ranging from 48 to 98 mL/min/1.73 m2. Conclusion: this series of cases shows the possibility of using renal donors in severe AKI, provided the following are respected: donor age, rhabdomyolysis as the cause of AKI, and implantation-favorable biopsy findings. Additional studies with better designs, larger numbers of patients and longer follow-up times are needed.


RESUMO Introdução: O número de pacientes incidentes e prevalentes em diálise tem aumentado, assim como o número de candidatos ao transplante renal no Brasil, sem um aumento proporcional do número de doadores de órgãos. O uso de rins expandidos, quanto à função renal, pode ser uma alternativa para aumentar a oferta de órgãos. Objetivo: discutir a viabilidade do uso de rins expandidos quanto à função renal, que estejam em lesão renal aguda severa. Métodos: foram avaliados todos os casos de transplante renal de doador falecido realizados no Hospital das Clínicas de Botucatu da UNESP, de janeiro de 2010 a junho de 2018, totalizando 732 casos. Selecionou-se os casos com creatinina final do doador maior do que 6 mg/dL. Resultados: quatro pacientes foram selecionados, dos quais todos os doadores estavam em lesão renal aguda (LRA) severa. Esses doadores apresentavam rabdomiólise como provável causa de LRA severa, eram jovens, sem comorbidades e apresentavam diminuição de volume urinário nas últimas 24 horas. A evolução clínica de todos os receptores foi satisfatória, com taxa de filtração glomerular após o transplante variando entre 48 a 98 mL/min/1,73m2. Conclusão: essa série de casos mostra a possibilidade de utilização de doadores renais em LRA severa, desde que respeitadas as condições seguintes: idade do doador, rabdomiólise como causa de LRA e achados de biópsia favoráveis à implantação. Estudos adicionais com melhores desenhos, maior número de pacientes e maiores tempos de seguimento são necessários.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Rabdomiólise/diagnóstico , Doadores de Tecidos/estatística & dados numéricos , Transplante de Rim/métodos , Função Retardada do Enxerto/diagnóstico , Lesão Renal Aguda/cirurgia , Projetos de Pesquisa , Brasil/epidemiologia , Cadáver , Estudos de Viabilidade , Estudos Retrospectivos , Diálise Renal/estatística & dados numéricos , Transplante de Rim/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Creatinina/sangue , Função Retardada do Enxerto/etiologia , Lesão Renal Aguda/etiologia , Taxa de Filtração Glomerular/fisiologia , Sobrevivência de Enxerto/fisiologia , Rim/fisiopatologia
3.
S Afr Med J ; 109(9): 665-667, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31635591

RESUMO

BACKGROUND: Hypertension in pregnancy is a risk factor for end-stage chronic kidney disease (ESKD) and is particularly common in South Africa (SA). There are no data for the risk of developing chronic kidney disease (CKD). OBJECTIVES: To conduct a study of all female patients who presented to the renal replacement programme at Groote Schuur Hospital, Cape Town, SA. METHODS: This was a retrospective study of female patients with ESKD who were presented to renal replacement meetings between 2007 and 2017. For each patient who was assessed, there was a comprehensive letter detailing patient demographics, as well as psychosocial and medical history, which served as the source data. Patients with a history of hypertension in pregnancy were identified as the case group and those without the condition were the control group. Patient demographics, causes of CKD, kidney function and outcome of the meeting were documented. RESULTS: Of the 415 female patients with ESKD, 70 (16.9%) had a history of hypertension in pregnancy. The ethnic breakdown was as follows: 132 (42.44%) black, 172 (55.3%) mixed ancestry and 7 (2.25%) white. Compared with the control group, the patients were younger, with a median age of 33 v. 41 years (p<0.001), higher serum creatinine 1 045 v. 751 µmol/L (p=0.017) and lower estimated glomerular filtration rate (eGFR) 4.0 v. 5.1 mL/min (p=0.029). Patients were more likely to abuse methamphetamine (5.7 v. 1.7%; p=0.049), and less likely to be diabetic (1.4 v. 20.9%; p<0.001) or HIV-positive (2.9 v. 12.5%; p=0.019). There were no ethnic differences between patients and controls. Underlying causes of renal disease showed significant differences, as patients were more likely to have hypertensive nephropathy (57.1 v. 22.9%; p<0.0001), and less likely to have diabetic kidney disease (1.4 v. 20.4%; p<0.001), HIV-associated nephropathy (HIVAN) (1.4 v. 6.4%) or polycystic kidney disease (1.4 v. 7.0%). There was no difference in acceptance to the dialysis and transplant programme (53 v. 47%). CONCLUSIONS: This study suggests an important link between hypertension in pregnancy and ESKD. The patients were significantly younger, presented later and were more likely to have hypertensive nephropathy. Methamphetamine abuse appears to be a risk factor. The study suggests that all women with hypertensive disorders during pregnancy need further evaluation and follow-up postpartum.


Assuntos
Hipertensão Induzida pela Gravidez/fisiopatologia , Falência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Terapia de Substituição Renal/métodos , Adulto , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Falência Renal Crônica/etiologia , Falência Renal Crônica/terapia , Transplante de Rim/estatística & dados numéricos , Pessoa de Meia-Idade , Gravidez , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos , Fatores de Risco , África do Sul/epidemiologia
4.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1202-1207, out.-dez. 2019. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1022269

RESUMO

Objetivo: Avaliar as características clínicas e imunológica dos receptores de transplante renal. Métodos: estudo documental e retrospectivo, realizado em um Ambulatório do Hospital Geral de Fortaleza, Fortaleza, Ceará, Brasil, com pacientes internados no período de junho de 2012 a junho de 2014. A amostra foi composta por 300 pacientes submetidos ao transplante renal. As variáveis preditoras de interesse, foram subdivididas em: características prétransplante, características pós-transplante e características imunológicas. Utilizou-se testes de Pearson e Spearman para avaliar correlação entre variáveis. Resultados: Houve predomínio de pacientes do sexo masculino (65%), com faixa etária entre 44 e 56 anos (31,4%). Demonstrou-se relação estatisticamente significante entre o DSA e a disfunção do enxerto (p<0,04), Rejeição celular o Painel Reativo classe I (p< 0,05), o tempo de internação e a disfunção do enxerto (p<0,001) e entre o entre o HLA e o MISMATCH. Conclusão: Aponta-se a necessidade de um acompanhamento crítico e individualizado do paciente transplantado por parte dos profissionais para garantir o sucesso do transplante a longo prazo


Objective: The study's purpose has been to assess both clinical and immunological characteristics of renal transplant recipients. Methods: It is a documentary and retrospective study that was performed at the renal transplantation ambulatory from the Hospital Geral de Fortaleza (HGF), Fortaleza city, Ceará State, with patients hospitalized from June 2012 to June 2014. The sample consisted of 300 patients submitted to renal transplantation. The predictive variables of interest were subdivided in the following categories: pre-transplant characteristics, post-transplant characteristics and immunological characteristics. Pearson and Spearman tests were used to evaluate the correlation between variables. Results: There was a predominance of male patients (65%), with ages ranging from 44 to 56 years (31.4%). A statistically significant relationship was found between the Donor-Specific Antibody and Delayed Graft Function (p<0.04), Cellular Rejection and PanelReactive Antibody class I (p<0.05), duration of hospitalization and Delayed Graft Function (p<0.001) and also between the Human Leukocyte Antigen and MISMATCH. Conclusion: It is pointed out the need for a critical and individualized follow-up of the transplanted patient by the professionals to guarantee the long-term transplantation success


Objetivo: Evaluar las características clínicas e inmunológicas de lós receptores de trasplante renal. Métodos: estudio documental y retrospectivo realizado en una clínica del Hospital General de Fortaleza, Fortaleza, Ceará, Brasil, con pacientes ingresados desde junio de 2012 a junio de 2014. La muestra fue de 300 pacientes sometidos a trasplante de riñón. Las variables predictoras de interés, fueron subdivididas en: características pretrasplante, características post-transplante y características inmunológicas. Se utilizaron pruebas de Pearson y Spearman para evaluar la correlación entre variables. Resultados: Hubo un predominio de pacientes del sexo masculino (65%), con edades comprendidas entre 44 y 56 años (31,4%). Se demostró una relación estadísticamente significativa entre el DSA y la disfunción del injerto (p <0,04), el rechazo celular del panel reactivo clase I (p <0,05), el tiempo de internación y la disfunción del injerto (p <0,001) y entre el HLA y el MISMATCH. Conclusión: Se apunta la necesidad de un acompañamiento crítico e individualizado del paciente trasplantado por parte de los profesionales para garantizar el éxito del trasplante a largo plazo


Assuntos
Humanos , Masculino , Feminino , Imunologia de Transplantes , Transplante de Rim/estatística & dados numéricos , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Brasil , Rejeição de Enxerto/epidemiologia
5.
Clin Nephrol ; 92(5): 221-225, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31496515

RESUMO

BACKGROUND: Multiple studies have revealed disparity in renal healthcare access and outcomes in racial/ethnic minorities with the socioeconomic status explaining the majority but not all of the disparity. We wanted to determine if racial/ethnic disparities existed at the first step toward renal transplantation, the renal transplant referral process. MATERIALS AND METHODS: A cohort of 200 adult end-stage renal disease patients was followed retrospectively for 2 years from January 2016 to February 2018. The study exposure was based on self-declared race/ethnicity of the patients, who were categorized as Black, White, and Hispanic. The study outcome was based on medical team patient evaluation and consisted of the patients who refused referral, who were not referred, and who were referred for transplant. Medical and demographic factors collected were age, gender, socioeconomic status, hemoglobin A1c ≥ 7, body mass index ≥ 40, left ventricular ejection fraction ≤ 40%, the presence of coronary or peripheral arterial disease, albumin level, history of smoking, cirrhosis, and cancer. The data were analyzed using univariate analyses and multinomial logistic regression. RESULTS: In the adjusted analysis, there was no difference in the likelihood of transplant referral between Black and White patients (OR = 0.71, 95% CI 0.22 - 2.3, p = 0.56). However, both Black (OR = 16, 95% CI 3.3 - 77, p = 0.0006) and White (OR = 22, 95% CI 3.4 - 150, p = 0.0013) patients were more likely to be referred for transplant when compared with Hispanic patients. Odds of transplant refusal were not different across race/ethnic groups. CONCLUSION: Hispanic patients are disadvantaged in the referral for renal transplant when compared to Black and White patients for reasons unclear at this time.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Transplante de Rim/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Estudos Retrospectivos
7.
Transplant Proc ; 51(7): 2283-2288, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31400976

RESUMO

Congenital nephrotic syndrome (CNS) is a genetic disease that is present in the antenatal period or during the first 3 months of life. In this study, we aimed to compare growth parameters of patients with CNS who received kidney transplants and either (1) had a normal glomerular filtration rate (GFR) at the time of transplant or (2) chronic kidney disease (CKD) at the time of transplant. Patients with a diagnosis of CNS who had a minimum follow-up period of 6 months were evaluated retrospectively. Children at stages 4 or 5 CKD or patients receiving dialysis during the pretransplant period were defined as group 1; patients with normal GFR at the time of transplantation were classified as group 2. Short stature and low weight were defined as less than -2 standard deviation scores (SDS) for height and weight according to their age. A total of 17 patients were included in the study. Thirteen of 17 patients had NPHS1 gene mutations. Group 1 and group 2 consisted of 8 and 9 patients, respectively. Mean height SDS and mean weight SDS in group 2 were higher than group 1 in the pretransplant period (-4.34 ± 1.74 vs -2.84 ± 1.56; P = .011 and -3.54 ± 0.93 vs -1.83 ± 1.13; P = .008). In the post-transplant period, the significant difference in height SDS continued in favor of group 2 (-3.16 ± 1.11 vs -1.16 ± 0.87; P = .002). The short stature rate was 83% in group 1 and 72% in group 2 in the pretransplant period (P = .62), and 83% in group 1 and 27% in group 2 in the post-transplant period (P = .02). Early renal transplantation seems to be effective for optimal height gain in children with CNS.


Assuntos
Transtornos do Crescimento/etiologia , Transplante de Rim/estatística & dados numéricos , Síndrome Nefrótica/cirurgia , Complicações Pós-Operatórias/etiologia , Insuficiência Renal Crônica/cirurgia , Fatores de Tempo , Adolescente , Estatura , Peso Corporal , Criança , Pré-Escolar , Feminino , Taxa de Filtração Glomerular , Humanos , Transplante de Rim/métodos , Masculino , Síndrome Nefrótica/fisiopatologia , Período Pós-Operatório , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/congênito , Insuficiência Renal Crônica/fisiopatologia , Estudos Retrospectivos
8.
Transplant Proc ; 51(8): 2559-2567, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31439328

RESUMO

BACKGROUND: This study aims to analyze the entire registry of kidney transplant over the past 50 years and understand the clinical significance. METHODS: From the data on 3012 kidney transplants performed at our center between March 1969 and September 2018, we analyzed retrospectively clinical variables. RESULTS: Until September 2018, there have been 3012 kidney transplants performed. The number of primary transplant cases was 2755 (91.8%), which included 16 cases of simultaneous liver-kidney transplant, and the number of repeated transplants was 245 (225 second transplants [7.5%] and 20 third transplants [0.7%]). There were 3 simultaneous pancreas kidney transplants, and 3 small bowel-kidney transplants, one of them being transplanted at the same time. There was a single simultaneous heart-kidney transplant. The viability rates of a transplanted kidney for 1, 5, 10, 20, and 30 years were 97%, 92%, 90%, 51%, and 36%, respectively, and the patient survival rates were 96%, 89%, 82%, 64%, and 52%, respectively. Five-year graft survival rate of the first 1000 cases was 64.6%; those of the 1001st to 2000th cases and 2001st to 3012th cases were 87.6% and 88.8%, respectively. There are statistically significant differences among the groups. CONCLUSION: This study has identified the appropriate selection or control of immunotherapy, based on the risk level of kidney transplant recipient, is needed to minimize chronic rejection, which is the key cause of transplanted kidney failure.


Assuntos
Transplante de Rim/estatística & dados numéricos , Adulto , Feminino , Rejeição de Enxerto/epidemiologia , Sobrevivência de Enxerto , Humanos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , República da Coreia , Estudos Retrospectivos
9.
Transplant Proc ; 51(8): 2555-2558, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31447191

RESUMO

BACKGROUND: Among foreigners undergoing kidney transplantation (KT) in Korea, Mongolians are the most common, and most of these cases are conducted at our center. We report the immunologic characteristics and clinical outcomes of these patients. METHODS: Consecutive Mongolian patients who underwent KT from September 2009 to August 2017 in our center were retrospectively analyzed. Pre- and post-transplant HLA antibody status and clinical data of the Mongolian patients were collected and compared with the Korean patients who underwent living donor KT during the same period. RESULTS: Sixty-two Mongolian and 85 Korean patients received KT and were followed up for 20.9 and 50.8 months (P = .01), respectively. Before transplantation, 17.7% of the Mongolian patients and 7.1% of the Korean patients were highly sensitized (P = .05). The patients were monitored consistently throughout the entire post-transplant period. Follow-up loss occurred in some cases. Of the patients, 32 Mongolian patients and 79 Korean patients were monitored for post-transplant HLA antibodies at any time point. Estimated glomerular filtration rates were comparable between Mongolian and Korean patients at 1 month (77.1 vs 71.5 mL/min/1.73m2, P = .21) and 1 year (64.6 vs 68.7 mL/min/1.73m2, P = .25) after transplantation but tended to be different at 3 years (57.2 vs 67.3 mL/min/1.73m2, P = .06) and 5 years (56.9 vs 73.1 mL/min/1.73m2, P = .04) post transplant. CONCLUSIONS: Mongolian patients undergoing KT in Korea were often highly sensitized. Mean follow-up time was short and follow-up loss was common in Mongolian patients compared with Korean patients. Cautious follow-up is needed for foreigner transplant recipients, especially for those at high-risk immunologically, to achieve better outcomes.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto/imunologia , Antígenos HLA/imunologia , Transplante de Rim/estatística & dados numéricos , Adulto , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Mongólia/etnologia , Período Pós-Operatório , Período Pré-Operatório , República da Coreia , Estudos Retrospectivos , Resultado do Tratamento
10.
G Ital Nefrol ; 36(4)2019 Jul 24.
Artigo em Italiano | MEDLINE | ID: mdl-31373472

RESUMO

Kidney transplant from donor after circulatory death (DCD) represents a valid choice to increase the incidence of renal transplantation, presenting recipients' and grafts' survival rates comparable to those from brain dead donors (DBD). In January 2016, the Transplant Referral Center in the Emilia Romagna region has started a DCD program. In the present study we report on the first 30 months of the program as far as our own Center in Bologna is concerned, and we provide a comparison with DBD transplants performed over the same period. From January 2016 to September 2018, 16 kidney transplants from 10 DCD donors (5 SCD-DCD and 5 ECD-DCD) have been performed, with two graft-loss at 12 months of follow-up, both due to renal artery rupture caused by infectious arteritis with consequent transplantectomy. Two patients died due to sepsis. Seven (44%) delay graft function (DGF) have been reported. No differences have been found between DCD and DBD in terms of kidney function (serum creatinine and eGFR evaluated at discharge, 12 and 24 months of follow-up). Kidney from marginal donors (ECD-DCD or KDPI >65%) were associated with a higher rate of DGF and worst graft function at discharge. All the predicting factors that have been analysed, including Karpinsky Score, failed to show an association with serum creatinine and eGFR at 12 and 24 months of follow up.


Assuntos
Parada Cardíaca , Transplante de Rim/estatística & dados numéricos , Doadores de Tecidos/estatística & dados numéricos , Morte Encefálica , Cadáver , Causas de Morte , Creatinina/sangue , Função Retardada do Enxerto/epidemiologia , Feminino , Taxa de Filtração Glomerular , Sobrevivência de Enxerto , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Desenvolvimento de Programas , Estudos Retrospectivos , Fatores de Tempo
11.
Transplant Proc ; 51(7): 2279-2282, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31358455

RESUMO

BACKGROUND: Approximately 6.3 million Syrian people migrated to other countries due to war since 2011. There are more than 3.5 million Syrian people living in Turkey under temporary protection. Syrian people receive free health care in Turkey, including kidney transplantation. Our institution started a kidney transplantation program about 3 years ago. It is the first institution performing living, related kidney transplantation for Syrian patients with end-stage renal failure. METHODS: All living, related kidney transplantations to Turkish and Syrian patients from the beginning of our transplantation program until September 2018 were enrolled in this study. Donor and recipient characteristics, induction and maintenance immunosuppression, length of hospital stay, creatinine values at first week and first month, treatment incompatibility, and graft survival were evaluated. RESULTS: Of the 25 living, related kidney transplantations 20% were Syrian. Three of 5 Syrian recipients were in the pediatric age group. None of the Syrian transplantations were preemptive, while half of the Turkish transplantations were preemptive (P = .005). Immunosuppression protocols, creatinine values, length of hospital stay, and graft survival rates were similar between groups. None of the Syrian recipients had treatment incompatibility (0%), unlike the Turkish recipients (15%). CONCLUSION: Outcomes of kidney transplantation for Syrian recipients are similar to those of Turkish recipients. Having this no-cost facility is great for Syrian kidney failure patients. The number of transplantations for Syrian patients under temporary protection in Turkey is expected to increase in the future, with these favorable results and easy to access, free health care facilities.


Assuntos
Falência Renal Crônica/etnologia , Falência Renal Crônica/cirurgia , Transplante de Rim/estatística & dados numéricos , Refugiados/estatística & dados numéricos , Adulto , Criança , Feminino , Sobrevivência de Enxerto , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Síria/etnologia , Resultado do Tratamento , Turquia
12.
Transplant Proc ; 51(7): 2205-2209, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31345596

RESUMO

PURPOSE: We evaluated potential kidney living donors and recipients for donation in our transplant center. MATERIALS AND METHODS: Candidates to be kidney living donors and kidney transplant recipients (KTxR) were retrospectively evaluated. All candidates were informed and assessed by transplant coordinator and nephrologists. All data were obtained from archive records. RESULTS: The mean ages of 194 kidney living donors and 182 KTxR were 45.7 ± 13.1 and 37.7 ± 14.6 years, respectively. Percentages of female candidates were 55.2% and 34.1% among kidney living donors and KTxR respectively. The kidney living donor candidates were the patients' mothers (27.3%), spouses (24.2%), siblings (21.6%), fathers (12.4%), and sons or daughters (6.2%) of KTxRs and others (8.2%). The numbers of donors with body mass index (BMI) > 30 kg/m2 and > 35kg/m2 were 56 (28.9%) and 17 (8.8%) respectively. Due to withdrawal from donation (21.2%) and renal problems (15.3%), 85/194 (43.8%) kidney living donors were excluded. Of the remaining 51/182 (28%) KTxR candidates, 26/182 (14.2%) were unsuitable because their panel-reactive antibody (PRA) > 20%. Sixty-six KTxR were performed in our center. Nine donor candidates were rejected due to obesity (BMI > 35 kg/m2). CONCLUSION: Most of our kidney living donors were mothers, housewives, and uneducated persons. Due to high percentages of suitability among candidates of KTxRs and kidney living donors as 72% and 56% may be an advantage for living kidney donation. However, PRA positivity in the recipients drew attention as a major barrier. The high incidence of obesity among the donor candidates suggests that societies must be more sensitive about this issue.


Assuntos
Transplante de Rim/estatística & dados numéricos , Doadores Vivos/estatística & dados numéricos , Transplantados/estatística & dados numéricos , Adulto , Índice de Massa Corporal , Família , Feminino , Humanos , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
13.
Prog Urol ; 29(6): 340-346, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31151914

RESUMO

INTRODUCTION: Kidney transplantation is championed as the gold standard treatment for patients with end-stage kidney disease. According to the biomedical agency, there is an increasing number of patients waiting for kidney transplantation. Faced with organ shortage, the use of marginal grafts may well increase the number of available kidney grafts. Occasionally, during dual kidney graft transplantation, the poor quality of one of the two grafts, or other specific circumstances, may lead to transplantation of only one of the two grafts. We have compared patient outcome concerning single kidney transplantation from an initial dual kidney graft with respect to dual kidney graft transplantation. MATERIAL: Among 67 patients enrolled for a dual kidney graft, 39 dual kidney grafts (group 1) were compared with 12 grafts performed with only one of the two kidneys of a dual kidney graft (group 2) as well as 15 grafts performed following a classic kidney graft protocol (group 3). RESULTS: The survival of grafts was respectively for groups 1, 2 and 3 of 100%, 72,5% and 75,4% (P=0.17). The survival of patients was respectively for groups 1, 2 and 3 of 78.3%, 89.9% and 87.8% (P=0.47). CONCLUSION: Our study suggests that transplantation of a single kidney, initially proposed as dual kidney graft candidate, has satisfying results in terms of graft survival and patient mortality at the expense of poorer renal function in comparison to dual kidney graft. Indeed, there was no significant difference in the survival of patients and grafts. This seems promising taking into consideration that the aim of transplantation in elderly recipients is primarily to avoid dialysis, rather than having optimal post-transplantation kidney function. LEVEL OF EVIDENCE: 4.


Assuntos
Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Sobrevivência de Enxerto , Humanos , Transplante de Rim/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
14.
Reumatol. clín. (Barc.) ; 15(3): 140-145, mayo-jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184365

RESUMO

Introducción: La enfermedad renal terminal (ERT) por nefritis lúpica (NL) se presenta en el 10-30% de los pacientes. Inicialmente, el lupus eritematoso sistémico (LES) fue una contraindicación para el trasplante renal (TR). En la actualidad, la supervivencia del injerto a largo plazo sigue siendo motivo de controversia. El objetivo del estudio fue comparar la supervivencia del TR en los sujetos con LES con otras causas de ERT. Métodos: Se incluyó a todos los pacientes con TR en sujetos con LES, de una cohorte retrospectiva en 2 centros de trasplante. Se realizó un grupo de comparación con otras etiologías de ERT en una relación 2:1 emparejados por edad, sexo y año del trasplante. La supervivencia se evaluó por el método de Kaplan-Meier y por el modelo de riesgos proporcionales de Cox. Resultados: Se incluyó a 25 sujetos con LES. La probabilidad de supervivencia en los sujetos con LES al año, 5 y 10 años fue del 92, el 66 y el 66%, respectivamente, la cual no difirió del grupo de comparación (p=0,39). En el análisis multivariante no existió una diferencia significativa en la supervivencia del injerto entre los 2 grupos (hazard ratio=1.95, IC del 95%, 0,57-6,61; p=0,28). La recurrencia de la NL fue del 8% y no se relacionó con la pérdida del injerto. El rechazo agudo fue la única variable asociada con la pérdida del injerto en los sujetos con LES (HR 16,5, IC del 95%, 1,94-140,1, p=0,01). Conclusiones: El riesgo de pérdida del injerto renal en los sujetos con LES fue similar al de los sujetos con otras causas de ERT


Introduction: End-stage renal disease (ESRD) due to lupus nephritis (LN) occurs in 10%-30% of patients. Initially systemic lupus erythematosus (SLE) was a contraindication for kidney transplantation (KT). Today, long-term graft survival remains controversial. Our objective was to compare the survival after KT in patients with SLE or other causes of ESRD. Methods: All SLE patients who had undergone KT in a retrospective cohort were included. Renal graft survival was compared with that of 50 controls, matched for age, sex, and year of transplantation. Survival was evaluated by the Kaplan-Meier test and the Cox proportional hazards model. Results: Twenty-five subjects with SLE were included. The estimated 1-year, 2- and 5-year survival rates for patients with SLE were 92%, 66% and 66%. Renal graft survival did not differ between patients with SLE and other causes of ESRD (P=.39). The multivariate analysis showed no significant difference in graft survival between the two groups (hazard ratio, HR=1.95, 95% confidence interval [CI] 0.57-6.61, P=.28). The recurrence rate of LN was 8% and was not associated with graft loss. Acute rejection was the only variable associated with graft loss in patients with SLE (HR=16.5, 95% CI 1.94-140.1, P=.01). Conclusions: Renal graft survival in SLE patients did not differ from that reported for other causes of ESRD


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Transplante de Rim/estatística & dados numéricos , Falência Renal Crônica/complicações , Lúpus Eritematoso Sistêmico/complicações , Rejeição de Enxerto/epidemiologia , Falência Renal Crônica/cirurgia , Fatores de Risco , Nefrite Lúpica/epidemiologia , Estudos Retrospectivos , Estudos de Casos e Controles
15.
Acta méd. costarric ; 61(2): 62-67, abr.-jun. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1001117

RESUMO

Resumen Objetivo: conocer la sobrevida del programa de trasplante renal en el Hospital Nacional de Niños, de enero 1978 a enero 2016. Métodos: estudio retrospectivo y descriptivo, en niños que recibieron un trasplante renal. Se recopiló la información de los expedientes clínicos. Se incluyeron pacientes menores de edad que tuvieran un injerto viable por al menos tres meses, pacientes con expediente pasivo completo y que brindaran el consentimiento informado. Resultados: se recopiló un total de 152 pacientes, y se incluyeron 143 en el estudio, ya que 9fueron excluidos. El 51 % (n= 73) fueron mujeres. Se realizó 167 trasplantes renales, el 63,5 % (n=105) fue de injertos provenientes de donante vivo relacionado. La sobrevida al primer año fue del 100 %, el 95 % a los 10 años y el 61% a los 20 años del trasplante. En cuanto a la sobrevida del injerto, se encontró una sobrevida al primer año del 95 %, del 76 % a los 3 años y del 73 % a los 5 años después del trasplante, con una incidencia de rechazo agudo del 28,7 %. Conclusión: el trasplante renal en niños es un procedimiento muy complejo donde la sobrevida depende de múltiples factores ambientales y adquiridos; sin embargo, sí es posible que centros pediátricos como el nuestro puedan llegar a alcanzar porcentajes de sobrevida acordes a los de centros de países desarrollados.


Abstract Objective: to know the survival of the renal transplant program at the National Children's Hospital, from January 1978 to January 2016. Methods: retrospective and descriptive study in children who received a kidney transplant. The information was compiled from the clinical files. We included children who had a viable graft for at least three months, patients with a complete passive file and who provided informed consent. Results: A total of 152 patients were collected, and 143 were included in the study, since 9 were excluded. 51% (n = 73) were women. A total of 167 kidney transplants were performed, 63.5% (n = 105) were grafts from a related living donor. Survival at the first year was 100%, 95% at 10 years and 61% at 20 years after transplantation. Regarding the survival of the graft, a survival rate of 95% was found in the first year, 76% at 3 years and 73% at 5 years after transplantation, with an incidence of acute rejection of 28.7%. Conclusions: Kidney transplantation in children is a very complex procedure where survival depends on multiple environmental factors and / or acquired, however it is possible that pediatric centers like ours can reach survival rates according to centers in developed countries.


Assuntos
Humanos , Masculino , Feminino , Transplante de Rim/estatística & dados numéricos , Costa Rica , Insuficiência Renal Crônica/mortalidade , Lesão Renal Aguda/complicações , Hospitais Pediátricos
16.
Int J Clin Pharm ; 41(4): 888-894, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31093938

RESUMO

Background Older kidney transplant recipients take a larger number of medications than younger patients, but there is currently no evidence that this affects health outcomes or that is it associated with potentia medicine-related problems. Objective To evaluate the prevalence and number of potentially inappropriate medications in older kidney transplant recipients and also the possible associated factors (sex, age, comorbidities, number of medications, etc.). Setting A renal post-transplant ambulatory outpatient clinic of a university hospital in Fortaleza, Brazil. Method PIMs were defined according to the Beers criteria, version 2015. Medications were classified following the Anatomical Therapeutic Chemical Classification System. Chi squared tests and analysis of variance were used for the analyses. Main outcome measure Prevalence of potentially inappropriate medications and medication groups with higher prevalence rates of PIMs, including associated factors. Results Among 143 kidney transplant recipients, 77.6% had at least one potentially inappropriate medication as part of their prescription regime. Medication groups that were most implicated in PIM are medicines that act on the alimentary tract and metabolism (55.9%), cardiovascular system (32.2%) and nervous system (21.7%). We detected a high prevalence (63.6%) of self-medication (use of OTC medicines without indication of a healthcare professional) among the population studied. There was a statistically significant association between the number of prescribed medications and the presence of potentially inappropriate medication in the prescription regime (P < 0.01). Conclusion Our data draw attention to the need of medicine therapy management by clinical pharmacists and clinicians in this group of patients and also assessing the real clinical impacts of these medications in the prescription regimes of elderly renal transplant patients.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Transplante de Rim/estatística & dados numéricos , Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco , Automedicação/estatística & dados numéricos
17.
S Afr Med J ; 109(4): 235-240, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-31084688

RESUMO

BACKGROUND: Kidney transplantation has been performed in South Africa (SA) since 1966. Transplants were initially limited to public hospitals, and the entry of the private sector heralded a new era in organ transplantation. OBJECTIVES: To document kidney transplantation in SA and compare numbers, rates, trends and sources of kidneys transplanted in the public and private sectors in SA over 25 years. METHODS: National kidney transplant data collected between 1991 and 2015 by the Organ Donor Foundation of South Africa were analysed. The total number of kidneys transplanted in the country was counted and rates were calculated. The numbers and rates in the private and public sectors were compared. The source of donor kidneys and sites where transplants were performed were documented. RESULTS: Over the 25-year period under review, 7 191 kidney transplants were performed in SA. The overall kidney transplant rate was 6.4 per million population (pmp), averaging 4.8 pmp in the public sector and 15.2 pmp in the private sector; 58.3% of the donor kidneys were derived from deceased donors. Cape Town and Johannesburg hospitals performed 75% of the country's kidney transplants. CONCLUSIONS: The overall transplant rate in SA is declining, especially in the public sector. Most kidney transplants in the country were performed in the public sector, and deceased-donor transplants predominated. Discrepancies exist in the allocation of kidneys. Recommendations are made on how the situation may be improved.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Falência Renal Crônica/cirurgia , Transplante de Rim/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Humanos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Estudos Retrospectivos , África do Sul
18.
Int Urol Nephrol ; 51(7): 1239-1247, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31089947

RESUMO

OBJECTIVE: Adverse outcomes in hemodialysis patients have been attributed, in part, to the pro-inflammatory state prevalent in this population. This study examines the relationship between blood neutrophil-to-lymphocyte ratio (NLR) with nutrition markers and health outcomes in hemodialysis (HD) patients. DESIGN: This is a 12-month prospective cohort study that recruited 77 participants from May to Jun 2017. SETTINGS AND SUBJECTS: Patients receiving maintenance hemodialysis. MAIN OUTCOMES: Hospitalization, transplants and mortality. RESULTS: Of the 77 participants, 63.8% were hospitalized, 10 (13%) died of cardiovascular diseases and 6 (7.8%) had a kidney transplant. Spearman correlations using baseline values showed an inverse significant correlation between the total number of hospitalizations and BMI kg/m2 (BMI rho = - 0.37, P <0.001); a significant inverse correlation between NLR and albumin (rho = - 0.22, P = 0.028); and a significant direct correlation between baseline NLR and BMI kg/m2 (rho = 0.22, P = 0.028). Participants were grouped by their NLR value into quartiles for outcomes analysis: quartile 1 (NLR ≤ 1.75), quartile 2 (NLR 1.76-2.6), quartile 3 (NLR 2.7-3.9) and quartile 4 (NLR ≥ 4). The percentage of patients with the lowest level of inflammation (NLR ≤ 1.75) was greater for not hospitalized patients than for hospitalized (39.3% vs 16.3%, P = 0.025) and not hospitalized participants had higher BMI kg/m2 (mean ± SD) at baseline compared to those hospitalized (29.11 ± 5.4 vs 26.22 ± 5.34, P = 0.026). In a multivariate cox regression analysis, participants in the lowest quartile (NLR ≤ 1.75) were compared to the rest on hospitalization, mortality and transplant. Years in dialysis, BMI kg/m2 and NLR ≤ 1.75 were significant predictors of hospitalization after adjustment (P = 0.021, P = 0.005, P = 0.039; respectively) and we observed an association of low NLR with a hazard ratio (HR 0.44, 95% CI 0.20-0.96, P = 0.039), BMI (HR 0.90, 95% CI 0.85-0.97, P = 0.005) and years in dialysis (HR 0.90, 95% CI 0.83-0.98, P = 0.021) for hospitalization in overall participants. In a further analysis comparing the effect of low NLR in the subgroup of diabetic vs non-diabetics, it was observed that BMI kg/m2 was a significant predictor for hospitalization in the non-diabetic subgroup (P = 0.040) but not significant in the case of diabetics (P = 0.128) after adjustments. Years in dialysis and NLR ≤ 1.75 were significant predictors of hospitalizations in the subgroup of diabetic before and after adjustment (P = 0.049, P = 0.044; respectively). Having a low NLR decreased 73% the risk for hospitalization (HR 0.27 95% CI 0.07-0.96, P = 0.044) in this subgroup. Survival and hospitalization curves were analyzed by comparing all participants and the diabetic subgroup, in the lowest inflammation quartile vs the rest (NLR ≤ 1.75 vs NLR > 1.75). Participants with NLR ≤ 1.75 had 100% survival rate (log-rank test, P = 0.059) and lower hospitalization rate (log-rank test, P = 0.025); participants with diabetes had lower hospitalization rate (log-rank test, P = 0.039). CONCLUSION: NLR at baseline was associated with nutritional markers (albumin, BMI). Low NLR at baseline was a predictor of lower risk for hospitalizations in HD patients with diabetes.


Assuntos
Falência Renal Crônica , Linfócitos , Neutrófilos , Estado Nutricional , Diálise Renal , Albumina Sérica/análise , Biomarcadores/sangue , Índice de Massa Corporal , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/metabolismo , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Transplante de Rim/estatística & dados numéricos , Contagem de Leucócitos/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Diálise Renal/efeitos adversos , Diálise Renal/métodos , Medição de Risco/métodos , Resultado do Tratamento , Estados Unidos/epidemiologia
19.
Int J Clin Pharm ; 41(4): 1047-1055, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31129889

RESUMO

Background The effects of mycophenolic acid exposure in the early period after transplantation on clinical outcomes have been reported; however, mycophenolic acid exposure in the early period after transplantation in Asian kidney transplant recipients who receive 1.5 g/d mycophenolate mofetil has never been investigated. Objective To determine mycophenolic acid exposure on day 3 post-transplantation in kidney transplant recipiens who receive 1.5 g/d mycophenolate mofetil. The effects of the reduced renal function on mycophenolic acid area under the concentration-time curve (AUC) and the achievement of the target AUC on the incidence of biopsy proven acute rejection during the first month post-transplantation were also evaluated. Setting A university hospital Method Blood samples and 24-h urine were collected on day 3 post-transplantation. Main outcome measures The mycophenolic acid AUC was calculated by linear trapezoidal rule and compared with the target of 45 mg*h/L. Results Of 42 Thai kidney transplant recipiens, the mean mycophenolic acid AUC of 45.1 mg*h/L (SD 14.7) was comparable to the AUC target (P = 0.962). Significant differences of the mycophenolic acid AUC were observed between patients with urine output of < 2400 mL and those with urine output ≥ 2400 mL (35.3 ± 6.6 and 47.4 ± 15.2, respectively; P = 0.002), and between patients with 24-h measured CrCl < 25 mL/min and those with CrCl ≥ 25 mL/min (38.0 (29.0, 42.2) and 49.2 ± 14.0, respectively; P = 0.017). Proportions of overall biopsy proven acute rejection among patients with mycophenolic acid AUC of < 45 and ≥ 45 mg*h/L were comparable (20.0% and 23.5%, respectively; P = 1.000). Conclusions After the starting dosage of 1.5 g/d mycophenolate mofetil, the mean mycophenolic acid AUC on day 3 post-kidney transplantation is comparable with the target of 45 mg*h/L. Severely reduced renal function significantly influences mycophenolic acid exposure.


Assuntos
Rejeição de Enxerto/epidemiologia , Transplante de Rim/estatística & dados numéricos , Ácido Micofenólico/farmacocinética , Transplantados/estatística & dados numéricos , Adolescente , Adulto , Inibidores Enzimáticos/sangue , Inibidores Enzimáticos/farmacocinética , Inibidores Enzimáticos/uso terapêutico , Feminino , Rejeição de Enxerto/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/sangue , Tailândia/epidemiologia , Adulto Jovem
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