[Recurrence of post-kidney transplant glomerulonephritis: clinicopathological characteristics]. / Recurrencia de glomerulonefritis postrasplante renal: características clínico-patológicas.

INTRODUCTION: Glomerulonephritis (GN) is one of the main causes of end-stage renal disease worldwide and therefore a frequent cause of kidney transplantation, with the possibility of recurrence of GN (Recurrent Glomerulonephritis [GNR]) in the transplanted kidney. The purpose of this study was to identify the clinic and pathological characteristics of GNR in a population of transplant patients. MATERIALS AND METHODS: A descriptive, retrospective study was carried out in 109 patients in whom GNR was documented in the transplanted kidney demonstrated by biopsy during the period between 1998-2021. RESULTS: Of 109 patients, the most frequent GNR was GNIgA, in 38.5% (42), followed by FSGS with 31.2% (34); These same entities were the ones that presented the greatest graft dysfunction, with 50% (21) and 26.2% (11) respectively. The ranges of proteinuria indicated by the biopsy were 31.2% (34) with a range of 500 to 3500mg/24h and 34.9% (38) with proteinuria >3500mg/24h. In relation to the time elapsed between the transplant and the diagnosis of GNR, 33% (36) of the cases were >5 years, followed by 1 to 5 years in 26.6% (29). Recurrence in patients with GNIgA occurred mostly after 5 years post-transplant with 45.2% (19) and for FSGS it was between 1 and 6 months. CONCLUSION: We found a general frequency of GNR presentation similar to those reported by other centers where biopsies are performed for clinical indication, finding that the GN that recurred most frequently are GNIgA and FSGS.

Update of the recommendations on the management of the SARS-CoV-2 coronavirus pandemic (COVID-19) in kidney transplant patients.

SARS-CoV-2 infection (COVID-19) has had a significant impact on transplant activity in our country. Mortality and the risk of complications associated with COVID-19 in kidney transplant recipients (KT) were expected to be higher due to their immunosuppressed condition and the frequent associated comorbidities. Since the beginning of the pandemic in March 2020 we have rapidly improved our knowledge about the epidemiology, clinical features and management of COVID-19 post-transplant, resulting in a better prognosis for our patients. KT units have been able to adapt their programs to this new reality, normalizing both donation and transplantation activity in our country. This manuscript presents a proposal to update the general recommendations for the prevention and treatment of infection in this highly vulnerable population such as KT.

Vitamin D status and biomarkers of renal graft function after kidney transplantation: a longitudinal study.

Introduction: Introduction: Low 25-hydroxyvitamin D [25(OH)D] levels occur after kidney transplantation (KTx), and can be associated with increase the risk of graft loss. This longitudinal study aimed to evaluate the vitamin D status and association with biomarkers of the renal graft function after KTx. Methods: this longitudinal study included 42 patients evaluated at baseline, 3 and 6 months after KTx. Biodemographic, clinical, and biochemical parameters such as 25(OH)D and parathyroid hormone (PTH), and biomarkers of renal graft function, such as creatinine, estimated glomerular filtration rate (eGFR), and albumin/creatinine ratio (ACR), were assessed. Sun exposure was also evaluated. Patients were categorized according to their 25(OH)D levels. Results: at baseline, 25(OH)D levels < 30 ng/mL were found in 43 % patients, and 38 % of these patients failed to improve their 25(OH)D levels by 6 months after KTx. Low 25(OH)D levels occurred regardless of sun exposure. Further, 44 % patients developed albuminuria at 6 months. An increased ACR was observed in patients with 25(OH)D levels < 30 ng/mL (p = 0.002) compared to that in patients with 25(OH)D > 30 ng/mL. Additionally, 25(OH)D levels were negatively correlated with ACR at 6 months post-KTx (r = -0.444; p = 0.003). Twelve (28.6 %) patients with 25(OH)D levels < 30 ng/mL showed no eGFR recovery until 6 months after KTx. Conclusion: low vitamin D levels and increased albuminuria were observed at 6 months after KTx, even in a region with high sun exposure. The association between vitamin D status and biomarkers of renal graft function after KTx should be explored in further studies.

Introducción: Introducción: los bajos niveles de 25-hidroxivitamina D [25(OH)D] ocurren después del procedimiento de trasplante de riñón (KTx) y pueden estar asociados con un aumento del riesgo de pérdida del injerto. Este estudio longitudinal tuvo como objetivo evaluar el estado de la vitamina D y la asociación con los biomarcadores de función del injerto renal después del KTx. Métodos: este estudio longitudinal incluyó a 42 pacientes que fueron evaluados al inicio del estudio y, 3 y 6 meses después del KTx. Se evaluaron los parámetros biodemográficos, clínicos y bioquímicos, como 25(OH)D y hormona paratiroidea (PTH), y los biomarcadores de función del injerto renal, como creatinina, tasa de filtración glomerular estimada (eGFR) y relación albúmina/creatinina (ACR). También se evaluó la exposición al sol. Los pacientes se clasificaron según sus niveles de 25(OH)D. Resultados: al inicio del estudio se encontraron niveles de 25(OH)D < 30 ng/ml en el 43 % de los pacientes, mientras que el 38 % de estos pacientes no lograron mejorar sus niveles de 25(OH)D a los 6 meses después del KTx. También se produjeron niveles bajos de 25(OH)D independientemente de la exposición al sol. Asimismo, el 44 % de los pacientes desarrollaron albuminuria a los 6 meses. Se observó un aumento de la ACR en los pacientes con niveles de 25(OH)D < 30 ng/mL (p = 0,002) en comparación con los pacientes con 25(OH)D > 30 ng/mL. Además, los niveles de 25(OH)D se correlacionaron negativamente con la ACR a los 6 meses después del KTx (r = -0,444; p = 0,003). Doce (28,6 %) pacientes con niveles de 25(OH)D < 30 ng/ml no mostraron recuperación de la TFGe hasta 6 meses después del KTx. Conclusión: se observaron niveles bajos de vitamina D y un aumento de la albuminuria a los 6 meses después del KTx, incluso en una región con alta exposición solar. La asociación entre el estado de la vitamina D y los biomarcadores de función del injerto renal después del KTx debe explorarse en estudios adicionales.

Patient and graft survival in pancreas transplant recipients: The EFISPAN study.

INTRODUCTION AND OBJECTIVES: Graft outcomes in pancreas transplantation have improved in recent decades, but data are mainly derived from registries or prospective single-centre studies. This large epidemiological study was undertaken to investigate the impact of clinical and demographic factors on graft and patient survival in pancreas transplant recipients in Spain, and to provide robust, country-wide, practice-based data to complement registry findings. PATIENTS AND METHODS: We conducted a retrospective, longitudinal, epidemiological study to assess risk factors impacting patient and graft survival in pancreas transplant recipients in eight centres in Spain. All patients transplanted between 1 January 2008 and 31 December 2012 were included; data were collected until 31 December 2015. The Kaplan-Meier method was used for all time-to-event analyses, including patient survival, graft survival, acute rejection, and BPAR. For graft survival analysis, in cases of death with functioning graft, patients were censored without any event on the date of death. For acute rejection and BPAR, patients were censored without any event on the date of death or graft loss. Univariable and multivariable analyses (Cox proportional hazards model) were conducted to assess the association between baseline clinical and demographic characteristics and patient/graft survival. RESULTS: Data were included for 241 (80.1%) simultaneous pancreas-kidney transplants, 56 (18.6%) pancreas-after-kidney transplants and 4 (1.3%) pancreas transplants alone. Mean±standard deviation time from diagnosis until transplantation was 26.1±7.5 years. Nineteen patients died, mainly due to infections (n=10); the remaining 282 patients (93.7%) survived from transplantation until the end of the study. Among 55 patients (18.3%) with pancreas graft loss, the main reasons were vascular thrombosis (n=19), chronic rejection (n=10), acute rejection (n=6) and death with a functioning graft (n=5). The overall rate of vascular-related death was 1.3% at 5 years post transplant. Univariable analysis showed that patient age and weight, donor age, previous kidney transplantation, previous cardiovascular events and need for insulin more than 48h post transplantation were significantly associated with pancreas graft survival. Of these, in multivariable analyses pancreas graft survival was inferior in patients who had received a previous kidney transplant prior to pancreas transplantation (log-rank test, p=0.0002). Glucose metabolism, renal function and cardiovascular risk factors were generally stable following transplantation. CONCLUSIONS: The results of this multicentre study highlight the excellent patient and graft outcomes following pancreas transplantation, with a notably low incidence of cardiovascular events.

Could thymoglobulin increase hemorrhagic risk in the perioperative transplantation period of sensitized kidney recipients?

OBJECTIVE: It has been described that thymoglobulin could increase the risk of infections and malignancies, in comparison to basiliximab. Leukopenia and thrombocytopenia are also more common within the first days after transplantation among thymoglobulin patients. Our objective was to analyze bleeding complications in this subset of patients. MATERIAL AND METHODS: Bleeding complications were evaluated among 515 renal transplants carried out at our institution between 2012 and 2018. We compared patients treated with thymoglobulin (Group 1, N=91) with those treated with basiliximab (Group 2, N=424). RESULTS: We found differences in platelet decrease: 95,142.2 (55,339.6) in Group 1 and 52,364.3 (69,116.6) in Group 2 (P=0.001), number of patients with severe thrombocytopenia (<75,000/mm3) (20.8% vs. 3.7%, P=0.001), number of blood units transfused (3.25 (0.572) vs. 2.2 (0.191, P=0.028) and percentage of patients that required surgery due to bleeding (18.2% vs. 7.7%, P=0.046). In a multiple lineal regression multivariable analysis (dependent variable was number of blood units transfused), only age [OR 0.037, 95% CI (0.003-0.070)] and type of immunosuppression [OR 1.592, 95% CI (1.38-2.84)] showed statistical significance. CONCLUSIONS: The use of thymoglobulin in the perioperative transplantation period could increase bleeding complications. In our series, in the group of patients with thymoglobulin, severe thrombocytopenia was 6 times more frequent, and active bleeding that required surgery was also 2.5 times more frequent. One way to continue with the use of this immunosuppression agent, might be to adjust the dose instead of discontinuing it. The use of thymoglobulin should be a factor to consider in the postoperative period of these patients.

Mortality after kidney transplantation: 10-year outcomes.

OBJECTIVES: In the past decade, advances in immunological therapy have increased the survival of kidney recipients and their grafts. However, it has not achieved the desired level of improvement. This study aims to reveal the mortality among kidney recipients. METHODS: Medical data of the patients, who had undergone kidney transplantation (KT) between November 2010 and December 2020, were retrospectively reviewed. Inclusion criteria were adult kidney recipients, who had died. Exclusion criteria were pediatric recipients, recipients of en bloc and dual KT, recipients with missing data, and recipients with a primary non-functioning graft. The recipients were grouped according to their donor type; Group 1 (from a living donor) and Group 2 (from a deceased donor). Subgroup analyses were done for mortality by time-period post-transplant and for infectious causes of mortality. RESULTS: Of 314 recipients, 35 (11.14%) died. Twenty-nine recipients were included in the study (Group 1: 17 and Group 2: 12). The most common cause of mortality was infection (58.6%), and the second was cardiovascular disease (CVD) (24.1%). Sepsis developed in 29.4% of infection-related deaths, while COVID-19 constituted 23.5% of infection-related deaths. CONCLUSION: Early diagnosis and treatment of infectious and CVD are important to improve survival in kidney recipients.

OBJETIVOS: En la última década, los avances en la terapia inmunológica han aumentado la supervivencia de los receptores de riñón y sus injertos. Sin embargo, no se pudo lograr el nivel de mejora deseado. Este estudio tiene como objetivo revelar la mortalidad entre los receptores de riñón. MATERIALES Y MÉTODOS: Se revisaron retrospectivamente los datos médicos de los pacientes, que se habían sometido a un trasplante de riñón entre Noviembre de 2010 y Diciembre de 2020. Los criterios de inclusión fueron los receptores de riñón adultos, que habían fallecido. Los criterios de exclusión fueron los receptores pediátricos, los receptores de trasplantes de riñón dual y en bloque, los receptores con datos faltantes y los receptores con un injerto primario no funcionante. Los receptores se agruparon según su tipo de donante; Grupo 1 (de un donante vivo) y Grupo 2 (de un donante fallecido). Se realizaron análisis de subgrupos para la mortalidad por período de tiempo posterior al trasplante y para las causas infecciosas de mortalidad. RESULTADOS: De 314 beneficiarios, 35 (11,14%) fallecieron. Se incluyeron 29 receptores en el estudio (Grupo 1:17; Grupo 2:12). La causa más común de mortalidad fue la infección (58,6%) y la segunda fue la enfermedad cardiovascular (24,1%). La sepsis se desarrolló en el 29,4% de las muertes relacionadas con la infección, mientras que el COVID-19 constituyó el 23,5% de las muertes relacionadas con la infección. CONCLUSIÓN: El diagnóstico y tratamiento tempranos de enfermedades infecciosas y cardiovasculares es importante para mejorar la supervivencia de los receptores de riñón.

[Kidney transplantation into the urological training in Colombia.] / Trasplante renal en el entrenamiento urológico colombiano.

Kidney transplantation (KTx) is the best therapeutic modality for end stage renal disease. Currently in Colombia there are approximately 2800 patients waiting for KTx. Historically, urologists have beenin close contact with KTx, however in Colombia the interaction between urology and KT is scarce. OBJECTIVES: To determine the perceptions and KTx training level into colombian urology residents. MATERIAL AND METHODS: We conducted a retrospective and descriptive study through 14 items survey applied to colombian urology residents. Data are summarizedas means and Pearson Chi2 test was used to evaluate differences between qualitative variables.RESULTS: The study included 76 participants. More than half of the programs of urology residency in Colombia includes KTx training into their academic programs, 36.84% of participants have received formal training (lectures, rounds, clinical rotation, seminars) on KTx, 28.95% have participated into KTx procedure, 97.37% considered the KTx as a urological field, KTx is the urological area with least academic interest for the residents, 76.32% consider their training in KTx as insufficient. The main barrier identified to increase training in KTx during urology residency is the non-availability of a formal rotation. CONCLUSIONS: KTx is not an area of primary interest for the colombian urology residents. Although most residents identify the KTx as an area related to urology and that exposure to some phases of the KTx is acceptable, 76% of residents consider their transplant training as insufficient. The main barriers identified for the urology resident's approach to KTx are modifiable.

El trasplante renal (TxR) es el mejor tratamiento para la enfermedad renal crónica terminal. En Colombia hay más de 2800 personas en lista de espera para este proceso. Históricamente el urólogo ha estado vinculado con el TxR, sin embargo, en Colombia son pocos los urólogos que ejercen su práctica clínico-quirúrgica en este ámbito. OBJETIVOS: Determinar las percepciones y el nivel de entrenamiento que reciben los médicos residentes d e urología en Colombia con relación al TxR. MATERIALES Y MÉTODOS: Se realizó un estudio descriptivo de corte transversal. Se practicó una encuesta con 14 ítems a los médicos residentes de urología de Colombia para valorar sus percepciones sobre el entrenamiento recibido en TxR. El análisis de datos incluye estadística descriptiva y las diferencias entre variables cualitativas se analizaron con la prueba de Pearson Chi2. RESULTADOS: Se incluyeron 76 participantes. 59,21% manifestó que su programa incluye formación en TxR, 36,84% ha recibido entrenamiento formal en TxR, 28,95% ha participado en un TxR, 97,37% considera el TxR como un área concerniente a la urología, el TxR fue el área de menor interés en la formación y perspectiva laboral entre los participantes, 76,32% considera que su formación en TxR es insuficiente, la principal barrera identificada para aumentar el entrenamiento en TxR durante la residencia es la no disponibilidad de una rotación formal. CONCLUSIONES: El TxR no es un área de interés principal para el residente de urología colombiano; a pesar de que la mayoría de los residentes identifica al TxR cómo un área urológica y que la exposición a algunas fases del trasplante es aceptable, el 76% de residentes considera insuficiente su formación en TxR. Las principales barreras identificadas para la aproximación der esidente de urología al TxR son modificables.

History of urological malignancies before kidney transplantation, oncological outcome on the long term. / Antecedentes de neoplasias urológicas previos al trasplante renal. Resultados oncológicos a largo plazo.

INTRODUCTION: We aimed to report the oncological outcomes of ESRD patients with histories of urological malignancies who were subsequently submitted to kidney transplantation (KT). MATERIAL AND METHOD: Retrospective study lead in the Puigvert Foundation (Barcelona) registry of 1,200 KT performed from 1988 to 2018. Eighty-five urological malignancies that were treated before KT in 81 patients were identified: 15 (18%) prostate cancers, 49 (58%) RCC, 19 (22%) urothelial carcinomas and 2 (2%) testicular cancers. Baseline characteristics, cancer staging, treatment and follow-up were registered as well as the chronology of the start of dialysis, inscription on the waiting list and kidney transplantation. Endpoints included were cancer recurrence, metastatic progression, cancer-specific death and overall survival. RESULTS: In a median follow-up of 13.1 years (2.2-32), 16/85 (19%) cancer recurrences were reported, with 3 (4%) who progressed to metastasis and died of cancer. Median overall survival after cancer treatment was 25.3 years and cancer-specific survival was 95% at 25 years. Median time from cancer treatment to kidney transplantation was 4.8 years: 3.7 years in prostate cancer, 3.9 years in RCC and 8.8 years in bladder cancer. The median time from start of dialysis to kidney transplantation was 1.8 years in patients with histories of urological malignancy versus 0.5 year in the total cohort of 1,200 renal transplanted over the same period. CONCLUSIONS: Well-selected patients with histories of urological malignancies greatly benefit from kidney transplantation with infrequent and late cancer recurrence. Waiting time could be optimized in low-risk prostate cancer and RCC, but more robust data are needed.

History of urological malignancies before kidney transplantation, oncological outcome on the long term.

INTRODUCTION: We aimed to report the oncological outcomes of ESRD patients with histories of urological malignancies who were subsequently submitted to kidney transplantation (KT). MATERIAL AND METHOD: Retrospective study lead in the Puigvert Foundation (Barcelona) registry of 1,200 KT performed from 1988 to 2018. Eighty-five urological malignancies that were treated before KT in 81 patients were identified: 15 (18%) prostate cancers, 49 (58%) RCC, 19 (22%) urothelial carcinomas and 2 (2%) testicular cancers. Baseline characteristics, cancer staging, treatment and follow-up were registered as well as the chronology of the start of dialysis, inscription on the waiting list and kidney transplantation. Endpoints included were cancer recurrence, metastatic progression, cancer-specific death and overall survival. RESULTS: In a median follow-up of 13.1 years (2.2-32), 16/85 (19%) cancer recurrences were reported, with 3 (4%) who progressed to metastasis and died of cancer. Median overall survival after cancer treatment was 25.3 years and cancer-specific survival was 95% at 25 years. Median time from cancer treatment to kidney transplantation was 4.8 years: 3.7 years in prostate cancer, 3.9 years in RCC and 8.8 years in bladder cancer. The median time from start of dialysis to kidney transplantation was 1.8 years in patients with histories of urological malignancy versus 0.5 year in the total cohort of 1,200 renal transplanted over the same period. CONCLUSIONS: Well-selected patients with histories of urological malignancies greatly benefit from kidney transplantation with infrequent and late cancer recurrence. Waiting time could be optimized in low-risk prostate cancer and RCC, but more robust data are needed.

Manifestaciones clínicas y factores asociados a mortalidad por COVID-19 en receptores de trasplante renal en un centro colombiano / Clinical manifestations and factors associated with mortality from COVID-19 in kidney transplant recipients in a Colombian center

Objetivo: Los pacientes receptores de trasplante renal (TxR) tienen alta carga de comorbilidades y un riesgo aumentado de muerte por COVID-19. Nuestro objetivo es describir las manifestaciones y los desenlaces clínicos en un grupo de receptores de TxR con enfermedad por coronavirus 2019 (COVID-19) y definir factores asociados a mortalidad. Métodos: Estudio de corte transversal que incluyó la revisión retrospectiva de registros clínicos de pacientes receptores de TxR y diagnóstico de COVID-19 entre marzo de 2020 y febrero de 2022 en un centro de alta complejidad en Bogotá (Colombia). Se ejecutó un análisis bivariante y multivariante para establecer asociaciones entre las variables de interés y el desenlace en mortalidad. Resultados: Se incluyeron un total de 94 casos. El 71,28% tenía un TxR, principalmente de donante cadavérico. Las manifestaciones clínicas incluyeron la tos en el 79,7%, fiebre en el 50% y disnea en el 42,55% de los casos. La tasa de mortalidad global fue del 18,09%. En el 54,9% se realizó un ajuste inmunosupresor, con interrupción completa del esquema hasta en el 74% de estos casos. Conclusiones: La tasa de mortalidad evidenciada en receptores de TxR con COVID-19 es mayor que la descrita en la población general. La severidad de la COVID-19 en este grupo poblacional implica de forma frecuente la necesidad de ajustes a la terapia inmunosupresora. Los factores asociados a mortalidad fueron la disnea, la necesidad de intubación orotraqueal y de estancia en unidad de cuidados intensivos

Objective: Kidney transplant (KTx) recipients have a high burden of comorbidities and are at increased risk of death from coronavirus disease 2019 (COVID-19). Our objective is to describe the clinical manifestations and outcomes in a group of KTx recipients with COVID-19 and to define factors associated with mortality. Methods: Cross-sectional study that included the retrospective review of clinical records of KTx recipients diagnosed with COVID-19 between March 2020 and February 2022 in a transplant center in Bogotá (Colombia). A bivariate and multivariate analysis was performed to establish associations between the variables of interest and the primary outcome (mortality). Results: Ninety-four cases were included. 71.28% had a KTx, mainly from a cadaveric donor. Clinical manifestations included cough in 79.7%, fever in 50%, and dyspnea in 42.55% of cases. The overall mortality rate was 18.09%. In 54.9% an immunosuppressive adjustment was made, with complete interruption of the scheme in up to 74% of these cases. Conclusions: The mortality rate evidenced in KTx recipients with COVID-19 is higher than in general population. The severity of the COVID-19 in this group frequently requires adjustments to immunosuppressive therapy. The factors associated with mortality were dyspnea, the need for orotracheal intubation and intensive care unit sta

Kidney transplantation epidemiology in Brazil.

BACKGROUND: In 2015, were celebrated in Brazil 50 years of kidney transplants, whose activities have been registered since 1995 by the Brazilian Association of Organ Transplantation (ABTO). PURPOSE: To evaluate the quantitative evolution of renal transplants that occurred in Brazil during the period from 1995 to 2015 and to classify the country's position in the international scenario. METHODS: Ecological and retrospective study, based on data records published by ABTO and the International Registry in Organ Donation and Transplantation (IRODaT). RESULTS: During the period evaluated, there were 75,479 kidney transplants in Brazil, 43,771 (58%) of deceased donors. The southeastern region had the highest absolute number (n=44,746; 59.3%) and, the north, the lowest (n=1159; 1.6%). The cumulative percentage variation of transplants was 121%, and the annual variation was negative on six occasions (1996, 1997, 2002, 2005, 2006, 2015). The number of effective transplantation teams had a weak relation with the number of procedures performed (r=0.45, p: 0.03). Brazil was the second country with the highest absolute number of transplants in the period of analysis, considering a world ranking with 30 nations. CONCLUSION: The number of renal transplants in Brazil increased significantly over the years. However, the efforts of those involved in the different phases of the donation-transplant process should be continuous.

Relación entre la compatibilidad del HLA y la pérdida del injerto en trasplante renal de donante cadavérico: Un análisis por propensity score matching en Colombia / Relationship between HLA compatibility and graft loss in renal transplant from a deceased donor: An analysis by propensity score matching in Colombia

Introducción. En Colombia, solo un 24 % de los pacientes en lista recibieron un trasplante renal, la mayoría de donante cadavérico. Para la asignación de órganos se considera el HLA A-B-DR, pero la evidencia reciente sugiere que el HLA A-B no está asociado con los desenlaces del trasplante. El objetivo de este estudio fue evaluar la relevancia del HLA A-B-DR en la sobrevida del injerto de los receptores de trasplante renal. Métodos. Estudio de cohorte retrospectivo que incluyó pacientes trasplantados renales con donante cadavérico en Colombiana de Trasplantes, desde 2008 a 2023. Se aplicó un propensity score matching (PSM) para ajustar las covariables en grupos de comparación por compatibilidad y se evaluó la relación del HLA A-B-DR con la sobrevida del injerto renal por medio de la prueba de log rank y la regresión de Cox. Resultados. Se identificaron 1337 pacientes transplantados renales, de los cuales fueron mujeres un 38,7 %, con mediana de edad de 47 años y de índice de masa corporal de 23,8 kg/m2. Tras ajustar por PSM las covariables para los grupos de comparación, la compatibilidad del HLA A-B no se relacionó significativamente con la pérdida del injerto, con HR de 0,99 (IC95% 0,71-1,37) para HLA A y 0,75 (IC95% 0,55-1,02) para HLA B. Solo la compatibilidad por HLA DR fue significativa para pérdida del injerto con un HR de 0,67 (IC95% 0,46-0,98). Conclusión. Este estudio sugiere que la compatibilidad del HLA A-B no influye significativamente en la pérdida del injerto, mientras que la compatibilidad del HLA DR sí mejora la sobrevida del injerto en trasplante renal con donante cadavérico

Introduction. In Colombia, only 24% of patients on the waiting list received a renal transplant, most of them from cadaveric donors. HLA A-B-DR is considered for organ allocation, but recent evidence suggests that HLA A-B is not associated with transplant outcomes. The objective of this study was to evaluate the relevance of HLA A-B-DR on graft survival in kidney transplant recipients. Methods. Retrospective cohort study that included kidney transplant recipients with a cadaveric donor in Colombiana de Trasplantes from 2008 to 2023. A propensity score matching (PSM) was applied to adjust the covariates in comparison groups for compatibility, and the relationship of HLA A-B-DR with kidney graft survival was evaluated using the log rank test and Cox regression. Results. A total of 1337 kidney transplant patients were identified; of those, 38.7% were female, with median age of 47 years, and BMI 23.8 kg/m2. After adjusting the covariates with PSM for the comparison groups, HLA A-B matching was not significantly related to graft loss, with HR of 0.99 (95% CI 0.71-1.37) and 0.75 (95% CI 0.55-1.02), respectively. Only HLA DR matching was significant for graft loss with an HR of 0.67 (95% CI 0.46-0.98). Conclusions. This study suggests that HLA A-B matching does not significantly influence graft loss, whereas HLA DR matching does improve graft survival in renal transplantation with a cadaveric donor.

Calidad de vida y características clínicas de pacientes con trasplante renal con y sin rinosinusitis crónica / Quality of life and clinical characteristics of renal transplant patients with and without chronic rhinosinusitis

RESUMEN Introducción: El trasplante es el tratamiento de elección en pacientes con enfermedad renal crónica (ERC). Requiere inmunosupresión, que predispone al desarrollo de complicaciones; la rinosinusitis crónica (RSC) es una de las más importantes. Objetivo: Comparar las características de pacientes con ERC con y sin RSC en protocolo de trasplante en un hospital de concentración en Puebla, en México. Métodos: Estudio comparativo, transversal, retrospectivo, en pacientes de un hospital de tercer nivel de atención, con ERC y en protocolo de trasplante renal. Se aplicaron las escalas SNOT-22 y Lund-Mackay. Se utilizó estadística descriptiva y pruebas U de Mann-Whitney, exacta de Fisher y coeficiente de Phi; p<0.05, por lo que se consideró significativa. Resultados: Se reclutaron 360 pacientes: 49 presentaron RSC; prevalencia, 13.61 %; medias edad, 39.22 ±12.09 años y tiempo de evolución, 17.73 ±5.91 semanas. Presentaron poliposis nasosinusal 14.3 %; obstrucción nasal, 95.9 %; algia facial, 67.3%; rinorrea, 49 % e hiposmia/anosmia, 40.8 %. Factores de riesgo asociados: alergia a ácido acetilsalicílico (p=0.014) y atopia (p=0.000). Variantes anatómicas en pacientes con y sin RSC, respectivamente: Celdilla Agger-Nasi 95 % y 15.4 %; desviación septal, 50 % y 6.4 %; hipertrofia de cornetes, 50 % y 1.3 %; concha bullosa, 30 % y 4.2 % y cornete paradójico, 10 % y 1.6 %. La afectación de calidad de vida predominante en pacientes con y sin RSC fue moderada con un 53.1 % y leve, 97.1 % (p=0.000). Conclusión: La prevalencia de RSC fue 13.61 %; los factores de riesgo asociados, alergia al ácido acetilsalicílico y atopia y la variante anatómica predominante, Agger-nasal. La severidad tomográfica fue leve y la afectación de la calidad de vida, moderada.

ABSTRACT Introduction: Transplantation is the treatment of choice for patients with chronic kidney disease (CKD). It requires immunosuppression, which predisposes to the development of complications; chronic rhinosinusitis (CRS) is one of the most significant. Objetive: To compare the characteristics of patients with CKD and without CRS in a renal transplant protocol at a specialized hospital in Puebla, Mexico. Methods: A comparative, cross-sectional, retrospective study in patients with CKD and in renal transplant protocol at a third-level care hospital. The SNOT-22 and Lund-Mackay scales were applied. Descriptive statistics, Mann-Whitney U tests, Fisher's exact test, and Phi coefficient were used; p<0.05 was considered significant. Results: 360 patients were recruited: 49 presented with CRS; prevalence: 13.61%; mean age: 39.22 ± 12.09 years and duration of progression: 17.73 ± 5.91 weeks. Naso-sinusal polyposis was present in 14.3%; nasal obstruction in 95.9%; facial pain in 67.3%; rhinorrhea in 49% and hyposmia/anosmia in 40.8%. Associated risk factors: allergy to acetylsalicylic acid (p=0.014) and atopy (p=0.000). Anatomical variants in patients with and without CRS, respectively: Agger nasi cell 95% and 15.4%; septal deviation, 50% and 6.4%; turbinate hypertrophy, 50% and 1.3%; concha bullosa, 30% and 4.2%; and paradoxical turbinate, 10% and 1.6%. The predominant quality of life impact in patients with and without CRS was moderate at 53.1% and mild at 97.1% (p=0.000). Conclusion: The prevalence of CRS was 13.61%; the associated risk factors were allergy to acetylsalicylic acid and atopy, and the predominant anatomical variant was Agger nasi. The tomographic severity was mild, and the impact on quality of life was moderate.

Identificación de infección por el virus de la inmunodeficiencia humana en dos receptores de órgano sólido tres años después del trasplante / Identification of HIV infection in two solid organ recipients three years after transplantation

Resumen El examen de rutina de los donantes de órganos para detectar la infección por el virus de la inmunodeficiencia humana (HIV) ha hecho que la transmisión del virus mediante el trasplante de órganos sea poco común. Sin embargo, a pesar de las pruebas de detección de rutina, la transmisión del HIV continúa siendo un riesgo del trasplante de órganos ya que, a diferencia de los tejidos, los órganos sólidos no se pueden procesar, desinfectar, ni modificar para inactivar patógenos infecciosos. A continuación, se describe un caso de posible transmisión de HIV por trasplante de órganos de un donante previamente seronegativo a dos de sus receptores.

Abstract Routine screening of organ donors to detect human immunodeficiency virus (HIV) infection has detected the rare transmission of the virus through organ transplantation. However, despite routine screening, HIV transmission remains a risk in organ transplantation since, unlike tissues, solid organs cannot be processed, disinfected, or modified to inactivate infectious pathogens. A case of possible transmission of HIV by organ transplant is described below, from a previously seronegative donor to two recipients.

Litiasis urinaria en el donante cadavérico: respuestas a la penumbra urológica desde un análisis bibliométrico / Urolithiasis in the brain-dead donor: responses to the urological penumbra from a bibliometric analysis

La literatura disponible sobre las implicaciones de la urolitiasis en la donación y trasplante renal (TxR) con injertos de donante cadavérico es limitada; la información disponible tiene especial énfasis en el donante vivo. Objetivo: Exponer la producción bibliográfica y las implicaciones clínicas de la urolitiasis en el proceso de donación y TxR incluyendo la perspectiva con injertos de donante cadavérico. Métodos: Análisis bibliométrico ejecutado mediante una búsqueda sistemática de la literatura en Medline, Embase, SciELO, Cochrane Central, Google Académico y Web of Science utilizando combinaciones de los términos MesH "urolithiasis", "kidney calculi", "ureteral calculi", "tissue and organ procurement", "brain death", "living donors" y "kidney transplantation". Se limitó la búsqueda a artículos publicados entre los años 2000-2022. Resultados: Se analizaron 23 artículos. El 95.6% de ellos fueron publicados en inglés, el 26% se publicaron en revistas del cuartil 1, solo un tercio de ellos tienen relación con el donante cadavérico. La urolitiasis en el injerto renal no es una contraindicación absoluta para el trasplante, se puede ofrecer manejo quirúrgico activo ex vivo durante la cirugía de banco para cálculos > 4 mm y el trasplante con observación para injertos renales con cálculos < 4 mm. Conclusiones: La producción científica en términos de litiasis urinaria y donación/TxR es limitada. El hallazgo incidental de urolitiasis en el donante vivo o cadavérico de riñón no es una contraindic

The clinical literature about the implications of urolithiasis in the process of kidney donation/transplantation (KTx) from deceased donors is scarce. Objectives: To expose the current state of bibliographic production and the clinical implications of urolithiasis in the process of kidney donation/transplantation focus on cadaveric donor grafts. Methods: We performed a bibliometric analysis based on a systematic review of the literature in Medline, Embase, SciELO, Cochrane Central, Google Scholar and Web of Science using combinations (OR, AND) of MesH terms: "urolithiasis", "kidney calculi", "ureteral calculi", "tissue and organ procurement", "brain death", "living donors" and "kidney transplantation". The search was limited to primary articles, systematic reviews or meta-analyses performed in humans published between 2000-2022. Results: Twenty-three articles were included for analysis; 95.6% of the bibliographic production was published in English, 26% were published into quartile 1 journals. One third of the references were focused on cadaveric donors. The information obtained concludes that presence of urolithiasis in the kidney graft is not an absolute contraindication for KTx and proposes the ex vivo surgical management of urolithiasis during the bench surgery for stones > 4 mm and to proceed with KTx and then follow-up for kidney grafts with stones < 4 mm. Conclusions: The scientific production related to urolithiasis and kidney donation/transplantation is limited. The literature available concludes that incidental kidney stones in kidney grafts should not be considered an absolute contraindication for KTx. Ex vivo surgical management of urolithiasis is a feasible and safe prior to KTx

Actualización de las recomendaciones en el manejo de la pandemia por coronavirus SARS-CoV-2 (COVID-19) en pacientes con trasplante renal / Update of the recommendations on the management of the SARS-CoV-2 coronavirus pandemic (COVID-19) in kidney transplant patients

La infección por el SARS-CoV-2 (COVID-19) ha supuesto un importante impacto en la actividad trasplantadora en nuestro país. Era esperable que la mortalidad y el riesgo de complicaciones asociadas a la COVID-19 en el receptor de trasplante renal (TR) fueran mayores debido a su condición de inmunosupresión y a las frecuentes comorbilidades asociadas. Desde el inicio de la pandemia en marzo del 2020 hemos mejorado rápidamente nuestro conocimiento acerca de la epidemiología, características clínicas y manejo de la COVID-19 postrasplante, redundando en un mejor pronóstico para nuestros pacientes. Las unidades de TR han sabido adaptar sus programas a esta nueva realidad, normalizándose la actividad tanto de donación como de trasplante en nuestro país. Este manuscrito presenta una propuesta de actualización de las recomendaciones generales para la prevención y el tratamiento de la infección en esta población tan vulnerable como son los receptores de un trasplante renal. (AU)

SARS-CoV-2 infection (COVID-19) has had a significant impact on transplant activity in our country. Mortality and the risk of complications associated with COVID-19 in kidney transplant (KT) recipients were expected to be higher due to their immunosuppressed condition and the frequent associated comorbidities. Since the beginning of the pandemic in March 2020 we have rapidly improved our knowledge about the epidemiology, clinical features and management of COVID-19 post-transplant, resulting in a better prognosis for our patients. KT units have been able to adapt their programs to this new reality, normalizing both donation and transplantation activity in our country. This manuscript presents a proposal to update the general recommendations for the prevention and treatment of infection in this highly vulnerable population such as KT. (AU)

Costo-efectividad de dos esquemas de prevención de la infección por citomegalovirus en pacientes con trasplante renal y riesgo intermedio en Colombia.

Introducción. El citomegalovirus es la causa más frecuente de infección en pacientes con trasplante renal. Existen dos estrategias de similar efectividad para prevenirlo: la profilaxis universal con valganciclovir durante 90 días o el tratamiento anticipado verificando la carga viral semanal y aplicándolo solo si esta es positiva.Objetivo. Determinar cuál de estas dos estrategias sería más costo-efectiva en pacientes de riesgo intermedio en Colombia.Materiales y métodos. Se diseñó un árbol de decisiones bajo la perspectiva del tercer pagador considerando únicamente los costos médicos directos en pesos colombianos (COP) del 2014 durante un periodo de un año en una población de pacientes con riesgo intermedio para citomegalovirus (donante positivo y receptor positivo, o donante negativo y receptor positivo). Las probabilidades de transición se extrajeron de los estudios clínicos y se validaron con expertos mediante el método Delphi.Los costos de los procedimientos se basaron en el manual tarifario ISS 2001, con un incremento del 33 % a partir del índice de precios al consumidor (IPC) en salud de 2014, en tanto que los de los medicamentos se extrajeron de las circulares del Ministerio de Salud y del Sistema de Información de Medicamentos (Sismed).Resultados. La profilaxis universal con valganciclovir resultó ser menos costosa y se asoció con una menor probabilidad de infección. El costo promedio del primer año de tratamiento anticipado sería de COP$ 30'961.290, mientras que el universal sería de COP$ 29'967.834, es decir, un costo 'incremental' de COP$ 993.456.Conclusiones. Para los pacientes de riesgo intermedio con trasplante renal en Colombia, la profilaxis universal es la mejor estrategia por ser menos costosa y reducir el riesgo de infección.

Successful kidney transplant with eculizumab, thymoglobulin and belatacept therapy in a highly-sensitised patient with atypical haemolytic uraemic syndrome due to factor H mutation. / Trasplante renal exitoso con protocolo de eculizumab, timoglobulina y belatacept en paciente altamente sensibilizada con síndrome hemolítico urémico atípico por mutación del factor H.

Atypical haemolytic uremic syndrome is a disease caused by complement regulation abnormalities that generally progresses to chronic end-stage renal disease with a high rate of recurrence in kidney transplantation and a high risk of graft loss. Anti-complement therapy has improved the prognosis of these patients, achieving disease remission in most cases, increasing the likelihood of a successful kidney transplant and increasing patient and graft survival. Drugs with low risk of induction of thrombotic microangiopathies such as belatacept and mycophenolate have also been used with satisfactory results. We present the case of a young patient at high immunological risk, with atypical haemolytic uraemic syndrome due to factor H mutation, who underwent a successful kidney transplantation with eculizumab, thymoglobulin, belatacept, mycophenolate and steroids, to date preserving excellent graft function without disease recurrence.

Detección de ansiedad y depresión en el binomio receptor-donador durante el protocolo de trasplante renal / Anxiety and depression in the recipient-donor binomial during the kidney transplant protocol

ABSTRACT Introduction: Detection of anxiety and depression in the recipient-donor pair (BinRD) during the kidney transplant protocol (KT) is important to establish psychoeducational interventions that help achieve success during and after KT. Objective: To determine the presence of anxiety and depression symptoms in the BinRD during the RT protocol and to identify characteristics and associated factors. Methods: Cross-sectional study, including 174 binomials being evaluated for TR. The Beck Depression Scale (BDI-II) and the Hospital Anxiety and Depression Scale (HADS) were applied at the beginning of the RT protocol. Results: Anxiety and depression symptoms were more frequent in recipient candidates than in donors ([anxiety 39% vs 21%] [depression 46% vs 15%]) (p<0.0001). The recipients presented a higher risk of depression (OR=4.770, 95% CI 2.854-7.974, p<0.0001) and anxiety (OR=2.383, 95% CI 1.478-3.841, p<0.001). Undertaking hemodialysis in private units (OR 0.264, 95%CI 0.106-0.662, p=0.004) or being on automated peritoneal dialysis (OR 0.386, 95%CI 0.173-0.862, p=0.020 was associated with less anxiety in recipients. Conclusions: a high frequency of anxiety and depression symptoms in the BinRD, so it is important to offer effective psychological interventions focused especially on the recipient during the donation evaluation process.

RESUMEN Introducción: La detección de ansiedad y depresión en el binomio receptor-donador (BinRD) durante el protocolo de trasplante renal (TR) es importante, para establecer intervenciones psicoeducativas que ayuden a lograr el éxito durante y después del TR. Objetivo: Determinar presencia de síntomas de ansiedad y depresión en el BinRD durante el protocolo de TR e identificar características y factores asociados. Métodos: Estudio transversal, incluye 174 binomios en evaluación para TR. Se aplicó la Escala de Depresión de Beck (BDI-II) y la Escala de Ansiedad y Depresión Hospitalaria (HADS) al inicio del protocolo de TR. Resultados: Síntomas de ansiedad y depresión fueron más frecuentes en candidatos a receptores que en donadores ([ansiedad 39% vs 21%] [depresión 46% vs 15%]) (p<0.0001). Los receptores, presentaron mayor riesgo de depresión (OR=4.770, IC 95% 2.854-7.974, p<0.0001) y ansiedad (OR=2.383, IC 95% 1.478-3.841, p<0.001). Realizarse hemodiálisis en unidades privadas (OR 0.264, IC95% 0.106-0.662, p=0.004) o estar en diálisis peritoneal automatizada (OR 0.386, IC95% 0.173-0.862, p=0.020 se asoció a menor ansiedad en receptores. Conclusiones: Se evidenció una alta frecuencia de síntomas de ansiedad y depresión en el BinRD, por lo que es importante ofrecer intervenciones psicológicas eficaces enfocadas especialmente al receptor durante el proceso de evaluación para la donación.

Causas de exclusión de donantes renales vivos en el servicio de trasplante de un hospital de tercer nivel del noroeste de México

Objetivo: Identificar las causas de exclusión de los donantes renales vivos en un centro hospitalario de tercer nivel en el noroeste de México. Materiales y métodos: Estudio de tipo observacional, transversal, descriptivo, retrospectivo. Se realizó la evaluación de los expedientes clínicos de los candidatos vivos para donación renal, que abarcó el periodo comprendido entre el 1 de enero de 2019 y el 31 de diciembre de 2021. Resultados: De los 30 expedientes seleccionados, solo se eligieron 2 (6,6 %) donadores, es decir, existió un índice de rechazo de 28 (93,3 %) de los potenciales candidatos. La edad promedio fue de 40,7 años; al dividirlos en grupos de edad, se observó que el 7,44 % fueron ≤39 años; el 5,31 %, ≥50 años; y el 4,25 %, de 40 a 49 años. Dentro de las principales patologías que originaron el rechazo del donador vivo se encuentran las enfermedades crónicas, como afección renal desconocida, obesidad, diabetes mellitus, hipertensión arterial sistémica y cardiopatías, que representaron el 60,7 %. El deseo de donar es más frecuente entre consanguíneos que en no consanguíneos. En el caso de los consanguíneos, es decir, hermanos, padres, hijos, tíos, etc., el 64,2 % fue rechazado; en los no consanguíneos, el 34,7 %, que incluía a esposos y amigos. Conclusiones: Los resultados obtenidos sobre el índice de masa corporal (IMC) mostraron que el sobrepeso y la obesidad fueron las principales causas de exclusión, circunstancia que es particular en nuestro país respecto a su perfil epidemiológico. La cantidad de donantes vivos en nuestro centro se redujo porque la mayor parte de la población no es sana, padece obesidad y ello repercute al momento de presentarse como candidato a donante.

Objective: To identify the causes for exclusion of living kidney donors at a third-level hospital in northwestern Mexico. Materials and methods: An observational, cross-sectional, descriptive and retrospective study, in which the medical records of candidates for living kidney donation were evaluated from January 1, 2019 to December 31, 2021. Results: Out of the 30 selected records, only 6.6 % (2) were chosen as donors, i.e., the rejection rate of the potential candidates was 93.3 % (28). The average age was 40.7 years; when divided into age groups, it was observed that 7.44 % were ≤ 39 years, 5.31 % were ≥ 50 years and 4.25 % were in the 40-49 age range. The main pathologies that caused the rejection of living donors were chronic diseases such as unknown renal disease, obesity, diabetes mellitus, systemic hypertension and heart diseases, which accounted for 60.7 %. The desire to donate was more frequent among blood relatives than non-blood relatives. In the case of blood relatives, i.e., siblings, parents, children, uncles, aunts, etc., 64.2 % were rejected, while 34.7 % of non-blood relatives, including spouses and friends, were rejected. Conclusions: Based on the body mass index (BMI), the results showed that overweight and obesity were the main causes of exclusion, a situation that is consistent with the Mexican epidemiological profile. The number of living donors at our center has been reduced because most of the population is not healthy and has obesity, which affects the willingness to be a candidate for living kidney donation.