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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.
Oral Dis ; 26(1): 22-34, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30661274

RESUMO

OBJECTIVE: The aim of this systematic review was to identify clinical outcomes following kidney transplantation associated with periodontal status. MATERIAL AND METHODS: A systematic review was conducted and included cross-sectional, case-control, or cohort studies published until August 2018 from PubMed/MEDLINE, Scopus, Science Direct, and CENTRAL. The research was carried out using the following descriptors: "kidney transplantation," "chronic renal failure," "periodontal diseases," "periodontitis," "chronic periodontitis," "gingival hyperplasia," and "gingivitis." The outcomes comprised the clinical transplantation variables. Two independent reviewers extracted the data and assessed the quality of the studies using Newcastle-Ottawa scale. RESULTS: The electronic search revealed 1,063 potentially relevant studies. We selected 114 articles for reading the full text. Therefore, six studies met the inclusion criteria: one case-control, three cross-sectional, and two cohort studies. All studies showed low risk of bias. The findings suggest that the periodontal status may be associated with the largest left ventricular mass, greater carotid thickness, graft rejection, lower graft survival, and a higher mortality rate within 60 months among kidney transplant recipients. CONCLUSION: The findings of this systematic review indicate that there is an association between periodontal status and worsening of graft function and systemic health among kidney transplant recipients.


Assuntos
Gengivite/complicações , Rejeição de Enxerto , Transplante de Rim , Doenças Periodontais/complicações , Humanos , Transplante de Rim/mortalidade
3.
Transplant Proc ; 51(9): 2914-2916, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31711576

RESUMO

Native nephrectomy (NN) in patients with autosomal dominant polycystic kidney disease (ADPKD) is indicated in cases of recurrent urinary tract infections and hematuria, neoplastic degeneration, and encumbrance. Timing, indication, and surgical approach of NN depends on the symptoms or policy of the center. The aim of our study is to evaluate our experience. In our retrospective study, we included 130 patients with a diagnosis of ADPKD from 530 patients evaluated for renal transplantation from 2011 to 2017. We analyzed the etiologic indication, the timing, and the complications of NN. In our cohort, 53 patients underwent open NN, 85% pre-kidney transplantation (KT), 13% post-KT, and only 1 case simultaneous with KT. In the pre-KT group, indications included: major indication was encumbrance in the. In the post-KT group, the major indication was infection followed by encumbrance, which developed after KT. Complications were: 3 cases of bleeding (1 required relaparotomy, 2 evolved into hematoma and radiological derange); 1 iatrogenic iliac artery injury, which was contextually repaired, and 5 cases of incisional hernia. At 35 ± 7.2 months follow-up, patients' survival was 96%; 1 patient died at the induction of anesthesia and 1 patient from sepsis after double NN and removal of nonfunctional transplanted kidney. NN is not without complications and should be performed when clearly indicated. In our experience, we preferred to perform NN before KT.


Assuntos
Transplante de Rim , Nefrectomia , Rim Policístico Autossômico Dominante/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Nefrectomia/mortalidade , Rim Policístico Autossômico Dominante/mortalidade , Estudos Retrospectivos
5.
Transplant Proc ; 51(8): 2568-2574, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31563240

RESUMO

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


Assuntos
Fatores Etários , Índice de Massa Corporal , Transplante de Rim/métodos , Fatores Sexuais , Adulto , Estudos de Coortes , Feminino , Rejeição de Enxerto/mortalidade , Sobrevivência de Enxerto/fisiologia , Humanos , Transplante de Rim/mortalidade , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
6.
Transplant Proc ; 51(8): 2671-2675, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31477419

RESUMO

OBJECTIVE: Delta neutrophil index (DNI), representing an elevated fraction of circulating immature granulocyte in acute infection, has been reported as a useful, predictable marker for mortality in patients with sepsis. We have hypothesized that an increased recipient DNI is associated with poor prognosis in cadaver donor kidney transplantation. METHODS: We investigated patients undergoing kidney transplantation from cadaver donors from March 2013 to January 2018. Rejection was diagnosed by kidney biopsy with Banff classification and excluded subclinical rejection. RESULTS: In a total of 73 patients undergoing cadaver kidney transplantation, 25 (34.2%) patients were diagnosed with rejection based on the Banff classification. Among them, 11 patients were diagnosed with early rejection. The recipients' postoperative DNI (%) was different between patients with early rejection and patients without rejection (0.18 vs 1.21, P < .001). In the univariate logistic regression analysis, cold ischemic time, donor preoperative last creatinine level, postoperative DNI level, and perioperative infection were predictive of early rejection. However, in a multivariate adjusted logistic regression test, only a high level of DNI (odds ratio 12.307, 95% confidence interval [CI] 1.22-129.82) was associated with early rejection. The C-statistic was 0.777 (95% CI 0.604-0.951, P = .004) for DNI. In multivariate Cox regression analysis, the donor's last creatinine level (hazard ratio 2.25, 95% CI 1.26-4.13) and preoperative DNI (hazard ratio 14.02 95% CI 2.62-75.26) were predictors of renal survival. CONCLUSIONS: Increased DNI in cadaver donor kidney transplantation recipients might be one of the predictive values of early kidney rejection and prognosis.


Assuntos
Rejeição de Enxerto/sangue , Transplante de Rim , Neutrófilos/citologia , Neutrófilos/imunologia , Adulto , Cadáver , Feminino , Rejeição de Enxerto/imunologia , Humanos , Transplante de Rim/métodos , Transplante de Rim/mortalidade , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Doadores de Tecidos
7.
Transplant Proc ; 51(8): 2582-2586, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31474448

RESUMO

BACKGROUND: Advances in renal transplantation have improved graft survival. However, many patients experience graft failure due to chronic renal allograft nephropathy. Although renal retransplantation is increasingly performed, its outcome is controversial. The aim of this study was to evaluate outcomes of renal retransplantation compared with those of first renal transplantation. METHODS: From March 1969 to August 2018, there were 3000 cases of renal transplantation performed at Seoul St. Mary's Hospital, Korea. Because the number of third renal transplantation was too small, only first and second renal transplantation groups were compared using propensity score matching. Outcomes of the third renal transplantation were then added. Graft survival rates were determined using Kaplan-Meier survival curves and assessed for significance using log-rank test. RESULTS: Five- and 10-year patient-graft survival rates for the first renal transplantation were 82.6% and 72.8%, respectively. Those for the second renal transplantation were 78.4% and 73.9%, respectively (P = .588). Five- and 10-year patient survival rates were 91.2% and 85.1%, respectively, for the first renal transplantation. These were 87.8% and 85.5%, respectively, for the second renal transplantation (P = .684). Five- and 10-year death-censored graft survival rates were 88.8% and 80.6%, respectively, for the first renal transplantation. These were 84.6% and 80.5%, respectively, for the second renal transplantation (P = .564). CONCLUSIONS: This study showed that graft survival of second renal transplantation was not significantly different from that of first renal transplantation. Therefore, renal retransplantation might be a reasonable option for patients who lost the first renal graft.


Assuntos
Sobrevivência de Enxerto , Transplante de Rim , Reoperação , Adulto , Feminino , Humanos , Estimativa de Kaplan-Meier , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/cirurgia , Pontuação de Propensão , Reoperação/mortalidade , República da Coreia
8.
Transplant Proc ; 51(6): 1758-1762, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399163

RESUMO

BACKGROUND: Although tacrolimus is an effective immunosuppressive drug used for preventing biopsy proven acute rejection (BPAR) in kidney transplanted patients, its nephrotoxicity may compromise renal function and lead to delayed initiation because of its side effects. This study aimed to evaluate the safety of early initiation of tacrolimus in the occurrence of BPAR during the first 90 days post transplant. METHODS: We conducted a retrospective cohort study involving 315 patients who underwent kidney transplantation from 2015 to 2017. Comparisons were performed between 2 groups according to whether the start time of tacrolimus therapy was delayed or not delayed. Cox proportional hazards models were used to examine the association between variables and the occurrence of BPAR. RESULTS: The incidence of BPAR was 14.9% (n = 47) and it was significantly higher in the delayed group (19.4% vs 6.4%; P = .002). Delayed initiation tacrolimus group was significantly associated with the risk of BPAR (hazard ratio: 2.95; P < .036). The overall mortality rate was 2.5% (n = 8) and there was no association between delayed initiation therapy and death (P = .56). CONCLUSION: Our study confirmed that delayed initiation of tacrolimus in patients with delayed graft function is associated with a high risk of BPAR.


Assuntos
Rejeição de Enxerto/prevenção & controle , Imunossupressores/administração & dosagem , Tacrolimo/administração & dosagem , Tempo para o Tratamento , Adulto , Estudos de Coortes , Feminino , Rejeição de Enxerto/epidemiologia , Humanos , Incidência , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
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
10.
Transplant Proc ; 51(8): 2606-2610, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31439331

RESUMO

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


Assuntos
Soro Antilinfocitário/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Imunossupressores/uso terapêutico , Transplante de Rim , Meta-Análise em Rede , Adulto , Feminino , Rejeição de Enxerto/mortalidade , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade
11.
Transplant Proc ; 51(7): 2257-2261, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31400969

RESUMO

INTRODUCTION: and Aim. End-stage renal disease owing to structural urologic anomalies is frequent in the pediatric population. Impaired bladder function is thought to have a negative effect on graft function and survival. The aim of this study was to present our single-center experience and long-term follow-up results in pediatric patients who underwent renal transplantation for urologic reasons and to compare graft survival among patients who underwent transplantation for nonurologic reasons. METHOD: The paper records of renal transplanted children (<18 years of age) held by Ege University Medical Faculty between 1998 and 2018 were evaluated retrospectively. Patients with normal bladder function who underwent transplantation for urologic reasons were defined as group A, whereas patients who had impaired bladder function and underwent transplantation for urologic reasons were defined as group B; a control group was defined as group C. RESULTS: Eighty-three patients were included in the study. The creatinine values of the patients at their last visit were no different between groups (P = .930). One-, 5-, and 10-year graft survival rates were 97%, 89%, and 74%, respectively, in group A; 100% for all years in group B; and 97%, 94%, and 80%, respectively, in group C. There was no statistically significant difference in terms of graft survival between groups (P = .351). CONCLUSION: Children with end-stage renal disease owing to urologic abnormalities may be good candidates for kidney transplantation with a favorable prognosis for graft function and survival.


Assuntos
Falência Renal Crônica/cirurgia , Transplante de Rim/mortalidade , Sistema Urinário/anormalidades , Doenças Urológicas/cirurgia , Adolescente , Criança , Creatinina/análise , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/congênito , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Doenças Urológicas/sangue , Doenças Urológicas/congênito
12.
Transplant Proc ; 51(7): 2308-2311, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31400977

RESUMO

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


Assuntos
Inibidores de Calcineurina/administração & dosagem , Rejeição de Enxerto/mortalidade , Imunossupressores/administração & dosagem , Transplante de Rim/mortalidade , Tacrolimo/administração & dosagem , Adulto , Função Retardada do Enxerto/etiologia , Feminino , Rejeição de Enxerto/tratamento farmacológico , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida
13.
Transplant Proc ; 51(8): 2710-2713, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31447193

RESUMO

BACKGROUND: Hyperlipidemia and cardiovascular disease are risk factors for long-term renal transplant dysfunction. However, no meta-analyses of randomized controlled trials have investigated the effects of statin treatment on graft function in renal transplant recipients. The aim of the present study was to evaluate the effects of statin use on renal transplant patients using a meta-analysis approach. METHODS: We conducted a systematic review and meta-analysis using random effects modeling. We searched the following databases for all studies published through to June 15, 2018: Cochrane Central Register, OVID MEDLINE, Embase, and PubMed. We reviewed all relevant reviews, registered trials, and relevant conference proceedings to compare clinical outcomes and survival between fluvastatin recipients and controls. RESULTS: Five trials with a total of 3725 patients were included. Glomerular filtration rates, graft loss, tacrolimus level, antibody-mediated rejection, T cell-mediated rejection, proteinuria, fungal infection (candida), and patient survival rates did not differ between the fluvastatin and control groups. However, major adverse cardiovascular events were 1.547 times more common in the control group than in the fluvastatin group (P = .001). CONCLUSIONS: Fluvastatin use was associated with a reduction in major adverse cardiac events among kidney transplant patients.


Assuntos
Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/tratamento farmacológico , Fluvastatina/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Transplante de Rim , Rejeição de Enxerto/epidemiologia , Humanos , Transplante de Rim/mortalidade
14.
Transplant Proc ; 51(6): 1763-1772, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31255359

RESUMO

BACKGROUND: Despite advancements in the management of kidney transplantation (KT), kidney transplant recipients (KTRs) have a higher risk of mortality than the age-matched general population. Improvement of long-term graft and patient survival is a significant issue. Therefore we investigated the effects of postoperative nutritional status on graft and patient survival and explored the predictive factors involved in nutritional status. METHODS: Our retrospective study included 118 KTRs who underwent KT at our hospital. Clinical and laboratory data were obtained from medical charts. The prognostic nutritional index (PNI) was used to assess nutritional status. Changes in nutritional status after KT were monitored and the effect of nutritional status on graft and patient survival was investigated. The variables involved in nutritional status were also explored. RESULTS: The KTRs in this cohort comprised 66 men and 52 women with a median age of 47 years at KT. There were 16, 32, and 22 cases of cadaveric, preemptive, and ABO-incompatible KTs, respectively. Postoperative PNI gradually improved and was stable from 6 months after KT. Although graft survival was regulated by ABO-compatibility, independent predictors for patient survival were history of dialysis, PNI, and serum-corrected calcium levels. Preemptive KT and inflammatory status contributed to PNI. CONCLUSIONS: Nutritional status of KTRs improved over time after KT and could contribute to patient survival. Optimal nutritional educational programs and interventions can lead to better outcomes in KTRs. Further studies are needed to validate our results and develop appropriate nutritional educational programs, interventions, and exercise programs.


Assuntos
Sobrevivência de Enxerto , Transplante de Rim/mortalidade , Estado Nutricional , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos , Transplantados
15.
Transplant Proc ; 51(6): 1717-1726, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31301861

RESUMO

BACKGROUND: Cardiovascular complications are the leading causes of morbidity and mortality in patients with end-stage renal disease. The risk profile very often contributes to their death while on the waiting list. Most studies have been carried out in older patients with end-stage renal disease, reflecting the general dialysis population. The aim of this study was to analyze the risk profile in young patients with advanced chronic kidney disease on the kidney transplant waiting list. METHODS: This was a retrospective, single-center study of 748 patients on the kidney transplant waiting list at the University Hospital Essen, Germany. Clinical and laboratory parameters were collected between 2015 and 2016. RESULTS: Of 748 patients (62% male), the median age was 48 years. Hypertension, coronary heart disease, and diabetes mellitus were the leading comorbidities, and their frequency rose significantly with age. Their median laboratory values did not differ significantly depending on age except for albumin. Hyperuricemia was quite common in our population with a prevalence of about 75% in women and 50% in men throughout all age groups. A total of 26.6% of the patients between 18 and 35 years of age had advanced anemia (hemoglobin < 10 g/dL), and thus they were affected most frequently. Elevated C-reactive protein serum levels were observed in 37.2% of the patients. Regarding the lipid profile, we observed that HDL cholesterol was within the normal range in only among 51.9% of men and 44.3% of women. CONCLUSIONS: Cardiovascular risk factors are quite common in our cohort and affect young patients similarly.


Assuntos
Doenças Cardiovasculares/epidemiologia , Falência Renal Crônica/complicações , Falência Renal Crônica/mortalidade , Listas de Espera/mortalidade , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Alemanha , Humanos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
16.
Ann Transplant ; 24: 439-445, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31346153

RESUMO

BACKGROUND The pre-procurement pancreas suitability score (P-PASS) and the pancreas donor risk index (pDRI) are established predictive scores for graft survival and patient outcome following pancreatic transplantation. This retrospective study aimed to evaluate the predictive value of P-PASS and pDRI following simultaneous pancreas and kidney (SPK) transplantation, or pancreas after kidney (PAK) transplantation, and the clinical impact of donor-specific factors on the postoperative graft and recipient outcome at a single transplant center. MATERIAL AND METHODS The study included 105 patients who underwent SPK (n=104) or PAK (n=4) between 2000 and 2017. Donor-specific and recipient-specific parameters were recorded. Kaplan-Meier analysis and Cox regression analysis were used to assess the outcome after transplantation. RESULTS Overall, the mean 1-year and 5-year pancreas graft survival and patient survival rates were 78.7% and 93.2%, and 76.9% and 90.0%, respectively. The postoperative outcome in patients with a P-PASS score of <17 was not significantly different when compared with patients with a score of ≥17. A P-PASS score of ≥17 was significantly associated with early pancreas graft loss (p=0.04). There was no significant difference in postoperative outcome between patients with high pDRI and low pDRI. Smoking of donor (p=0.046) was a risk factor and coronary heart disease of recipient (p=0.003) had a significant effect on survival of pancreas graft. CONCLUSIONS This study showed that P-PASS and pDRI were not reliable predictors of outcome after pancreas transplantation and that specific characteristics of the donor and recipient must be evaluated when predicting the outcome of pancreas transplantation.


Assuntos
Sobrevivência de Enxerto , Transplante de Rim/mortalidade , Transplante de Pâncreas/mortalidade , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Doadores de Tecidos
17.
Transplant Proc ; 51(8): 2637-2642, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31349984

RESUMO

BACKGROUND: Mizoribine (MZR) has been developed as an immunosuppressant and is widely used in Asia. However, most studies on MZR have been performed in Japan, and there remains a lack of reports on long-term use in other countries. The purpose of this study is to evaluate the efficacy and safety of MZR's use in Korean kidney transplant recipients by observing their clinical courses and analyzing their long-term patent and graft survival rates. METHODS: We studied 129 subjects who had received MZR as a maintenance immunosuppressant since January 2000. Our analysis was based on the patients' medical records from January 2000 to December 2017. RESULTS: The overall survival rates of the kidney transplant recipients were 100% at 1 year, 99.1% at 5 years, 96.8% at 10 years, and 92.5% at 15 years. The graft survival rates were 100% at 1 year, 98.3% at 5 years, 93.2% at 10 years, and 82.2% at 15 years. There were differences in the recipient survival and graft survival rates according to the kidney donor and the use of renal replace therapy before transplant. There were no differences in the survival rates according to the MZR dose, the type of underlying disease, or other clinical factors. CONCLUSIONS: The use of low doses of MZR as a maintenance immunosuppressant could be an effective means of ensuring relatively good long-term patient and graft survival rates in cases of kidney transplant.


Assuntos
Sobrevivência de Enxerto/efeitos dos fármacos , Imunossupressores/administração & dosagem , Transplante de Rim/mortalidade , Ribonucleosídeos/administração & dosagem , Adulto , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Fatores de Tempo
18.
Saudi J Kidney Dis Transpl ; 30(3): 640-647, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31249228

RESUMO

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


Assuntos
Função Retardada do Enxerto/etiologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Adulto , Idoso , Estudos Transversais , Função Retardada do Enxerto/mortalidade , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/mortalidade , Humanos , Imunossupressores/efeitos adversos , Transplante de Rim/mortalidade , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
19.
Saudi J Kidney Dis Transpl ; 30(3): 655-662, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31249230

RESUMO

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


Assuntos
Sistema do Grupo Sanguíneo ABO/imunologia , Incompatibilidade de Grupos Sanguíneos/imunologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Histocompatibilidade , Imunossupressores/uso terapêutico , Transplante de Rim , Adulto , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/mortalidade , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Masculino , Infecções Oportunistas/imunologia , Fatores de Risco , Arábia Saudita , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
20.
Transplant Proc ; 51(5): 1575-1578, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31155195

RESUMO

BACKGROUND: Superior patient and graft survival rates have been attributed to living donor kidney transplant (LDKT) when compared to deceased donor transplantation. The aim of this study was to assess graft survival in a population of LDKT in the last 14 years and the potential impact of some clinical features. METHODS: A retrospective observational study was conducted, reviewing the records of all patients undergoing LDKT in one center from January 1, 2004, to December 31, 2017. Survival data were evaluated by Kaplan-Meier, log rank test, and Cox regression. RESULTS: Two hundred seventy-seven LDKT were performed. The median follow-up time was 4 (0-13) years. Graft loss was observed in 9% of patients; 4 patients died. The overall survival was 97% at year 1, 94% at year 5, and 83% at years 10 and 13. We found a significantly worse graft survival in patients with early vascular complications that required surgical intervention (P = .00) ≥3 HLA MM (P = .01), ≥1 HLA-DR MM (P = .04) and female recipients (P = .01). The negative impact of ≥1 HLA-B MM on survival was borderline (P = .05). After excluding early graft losses secondary to vascular events, ≥1 HLA-A MM and rejection have also implicated a negative impact on survival (P = .04 and .01, respectively). In the multivariate analysis, these variables were still related to inferior survival. CONCLUSIONS: We observed a good overall graft survival (>80% after 13 years). Possible factors related to poor outcomes suggested by this study were early vascular complications; HLA mismatches; rejection; and, with less certainty, female recipients.


Assuntos
Sobrevivência de Enxerto/fisiologia , Transplante de Rim/mortalidade , Doadores Vivos , Adulto , Feminino , Rejeição de Enxerto/epidemiologia , Antígenos HLA-DR , Teste de Histocompatibilidade , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo
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