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INTRODUCTION: Long-term kidney transplantation (KT) results in patients with familial Mediterranean fever (FMF)-related amyloidosis are not well studied. This study reviewed the long-term survival outcomes of FMF patients who underwent KT. METHODS: We compared the outcomes of 31 patients who underwent (KT) for biopsy-proven amyloidosis secondary to FMF with 31 control patients (five with diabetes mellitus and 26 with nondiabetic kidney disease) undergoing KT between 1994 and 2021 at Baskent University Hospital. All data were recorded retrospectively from patients' files. RESULTS: THE MEDIAN AGE (QUARTILE DEVIATION: QD) at the time of KT in the FMF and control group were 31 (6.7) and 33 (11), respectively. The median follow-up period (QD) after KT was 108 (57) months in the FMF and 132 (72) months in the control group. In the FMF group, graft and patient survivals were 71% and 84% at 5 years and 45% and 48% at 10 years, respectively. In the control group, graft and patient survivals were 79% and 100% at 5 years and 63% and 71% at 10 years, respectively. Patient survival in the FMF group at 5 years was significantly lower than in the control group (p = .045). There was no statistically significant difference between the FMF and control groups in terms of graft and patient survival, and serum creatinine levels at 10 years. All patients were given triple immunosuppressive treatment with cyclosporine, mycophenolate mofetil, and prednisolone. Three patients received anakinra and one received canakinumab in addition to colchicine treatment. One FMF patient also underwent heart transplantation due to AA amyloidosis. Of the FMF patients, 11 died during follow-up. CONCLUSION: We have found that the long-term outcome of KT in patients with FMF amyloidosis is numerically worse but not statistically different from the control group. However, short- and long-term complications still need to be resolved.
Assuntos
Amiloidose , Febre Familiar do Mediterrâneo , Falência Renal Crônica , Transplante de Rim , Humanos , Febre Familiar do Mediterrâneo/complicações , Febre Familiar do Mediterrâneo/tratamento farmacológico , Transplante de Rim/efeitos adversos , Estudos Retrospectivos , Falência Renal Crônica/etiologia , Amiloidose/etiologia , Amiloidose/cirurgia , Colchicina/uso terapêuticoRESUMO
BACKGROUND: When the blood pressure rises before awakening in the morning, it is called as morning blood pressure pulse (MBPS). MBPS is considered to be an independent risk factor for cardiovascular disease. The aim of this study was to investigate the associations between MBPS, graft function, arterial stiffness and echocardiographic indices in renal transplant recipients. METHODS: Among 600 renal transplant recipients, 122 patients who had a history of hypertension and were taking at least one antihypertensive medication were enrolled in the study. Arterial stiffness was measured by carotid-femoral pulse wave velocity (PWv), and echocardiographic indices were assessed. 24 h ambulatory blood pressure was monitored for all patients. MBPS was calculated by subtracting morning systolic blood pressure from minimal asleep systolic blood pressure. RESULTS: Mean morning, day time and asleep systolic blood pressure values were 171.2 ± 23.9, 137.9 ± 18.1, and 131.7 ± 18.9, respectively. Nondipper hypertension status was observed in 93 patients. Mean MBPS was 35.6 ± 19.5 mm Hg, means PWv was 6.5 ± 2.0 m/s. Patients with MBPS ≥ 35 mm Hg, had significantly lower eGFR and higher proteinuria, PWv. higher left atrium volume and LVMI. In regression analysis, day time systolic blood pressure, asleep systolic blood pressure, morning blood pressure surge, nondipper status and left ventricular mass index were detected as the predictors of graft function. CONCLUSIONS: Increased morning blood pressure surge is associated with graft dysfunction, increased arterial stiffness and LVMI that contribute to cardiovascular mortality and morbidity in renal transplant recipients.
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Hipertensão , Transplante de Rim , Rigidez Vascular , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão Arterial , Humanos , Hipertensão/etiologia , Transplante de Rim/efeitos adversos , Análise de Onda de PulsoRESUMO
OBJECTIVES: Dynapenia and sarcopenia are related to increased morbidity and mortality in the general population. Chronic kidney disease (CKD) causes sarcopenia and dynapenia with different mechanisms. The aim of this study is to compare the muscle parameters in renal transplant recipients to CKD patients and patients without kidney disease and assess their associations with serum insulin-like growth factor-1 (IGF-1) levels. METHOD: In total, 120 renal transplant recipients (mean age: 40.4 ± 10.5 years), 60 CKD patients (mean age: 41.9 ± 11.4 years), and 60 control subjects with normal kidney function (mean age: 38.8 ± 9.9 years) were enrolled. Body mass index, hand grip strength, bioelectrical impedance analysis, 6-minute walking test, and serum IGF-1 level were measured and compared between groups. Muscle parameters were evaluated according to The Foundation for the National Institutes of Health Biomarkers Consortium Sarcopenia Project criteria. RESULTS: IGF-1 levels were highest in the renal transplantation group and lowest in the control group (P = .029). In total, 12.5% of patients in the renal transplantation group (13.3% overweight, 20% obese), 11.6% in the CKD group, and 1.6% in the control group had dynapenia (P = .015). In addition, 8.3% of patients in the CKD group, 3.3% in the renal transplantation group (50% overweight), and none of the patients in the control group had sarcopenia (P = .054). In multivariate analyses, muscle strength was associated with IGF-1 levels in renal transplant recipients (beta = 2.314, t = 3.456, P = .001). CONCLUSIONS: Serum IGF-1 is closely associated with muscle strength in renal transplant recipients. The negative effects of CKD on muscle system cannot be completely resolved with renal transplantation. Sarcopenic obesity and dynapenic obesity need special attention and therefore body mass index cannot be used as the only parameter to evaluate frailty in renal transplant recipients.
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Transplante de Rim , Insuficiência Renal Crônica , Sarcopenia , Adulto , Feminino , Força da Mão , Humanos , Fator de Crescimento Insulin-Like I , Rim , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Obesidade/complicações , Sobrepeso/complicações , Insuficiência Renal Crônica/complicações , Sarcopenia/epidemiologiaRESUMO
OBJECTIVES: Tertiary hyperparathyroidism, characterized by autonomous overproduction of parathyroid hormone, can be seen in patients with long-standing secondary hyperparathyroidism (pretransplant) or after renal transplant (posttransplant). Parathyroid scintigraphy and ultrasonography are the most commonly used imaging procedures for the preoperative localization of abnormal parathyroid glands. We aimed to evaluate imaging findings in pretransplant and posttransplant tertiary hyperparathyroidism. MATERIALS AND METHODS: This study included 32 patients with pretransplant tertiary hyperparathyroidism and 20 patients with posttransplant tertiary hyperparathyroidism. On parathyroid scintigraphy with technetium-99m sestamibi, early-phase and latephase images were acquired. Images were evaluated for the presence and the number of active foci and the degree of uptake on the late-phase image. The existence of an autonomous gland was based on latephase retention and was scored from 0 to 2 (retention score). On ultrasonography, the criteria threshold for autonomy was the maximum length of the largest gland ≥10 mm (ultrasonography score). RESULTS: On parathyroid scintigraphy, the most commonly observed pattern in the pretransplant group was positivity in ≥3 glands, and in the posttransplant group the most commonly observed pattern was positivity in 1 to 2 glands. In pretransplant and posttransplant groups, the criteria threshold for the presence of an autonomous parathyroid gland on parathyroid scintigraphy (grade 2 retention) was met in 26 (81%) and 9 (45%) patients and on ultrasonography in 25 (78%) and 10 (50%) patients, respectively. In the whole group of patients (n = 52), correlation existed between ultrasonography score and retention score. Glandular weight was correlated with both retention score and ultrasonography score. CONCLUSIONS: Higher numbers of detectable glands and the presence of parathyroid autonomy were more common in the pretransplant group. This might be explained by parathyroid gland involution after transplant. The results may also suggest that factors other than autonomy are responsible for posttransplant tertiary hyperparathyroidism.
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Hiperparatireoidismo Secundário , Glândulas Paratireoides , Humanos , Glândulas Paratireoides/diagnóstico por imagem , Hiperparatireoidismo Secundário/diagnóstico por imagem , Hiperparatireoidismo Secundário/etiologia , Tecnécio Tc 99m Sestamibi , Cintilografia , Ultrassonografia/métodos , Compostos RadiofarmacêuticosRESUMO
BACKGROUND: Crush Syndrome is a major cause of morbidity and mortality following large-scale catastrophic earthquakes. Since there are no randomized controlled studies on Crush Syndrome, knowledge on this subject is limited to expert experience. The primary objective is to analyze the epidemiological and demographic characteristics, clinical outcomes, and mortality factors of earthquake victims after the Pazarcik and Elbistan earthquakes on February 6, 2023. METHODS: This cross-sectional and observational retrospective study evaluated 610 earthquake victims who presented to our center between February 6 and April 30, 2023. Among these patients, 128 with Crush Syndrome were included in the study. Patient information was gathered from hospital records during their stay and from national registries upon referral. The primary outcome was to identify risk factors for mortality. Demographic and laboratory data were analyzed by acute kidney injury (AKI) stages; mortality-affecting factors were identified through regression analysis. RESULTS: Of the 128 Crush Syndrome patients (100 adults, 28 children), 64 were female. The AKI rate was 32.8%. Among patients with AKI, the frequency of hemodialysis requirement was 69%, and the mortality rate was 14.2%. The overall mortality rate for patients with Crush Syndrome was 4.6%, compared to 3.9% (19/482) in earthquake victims without Crush Syndrome (p=0.705). Notably, low systolic blood pressure at admission was the only factor significantly affecting mortality in Crush Syndrome patients (Hazard Ratio [HR]: 1.088, p=0.021, 95% Confidence Interval [CI]). CONCLUSION: Our study highlights low systolic blood pressure upon admission as a significant risk factor for increased mortality in Crush Syndrome patients. This finding may contribute to the literature by emphasizing the importance of monitoring blood pressure under rubble and administering more aggressive fluid therapy to patients with low systolic blood pressure.
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Injúria Renal Aguda , Síndrome de Esmagamento , Terremotos , Adulto , Criança , Humanos , Feminino , Masculino , Síndrome de Esmagamento/epidemiologia , Síndrome de Esmagamento/etiologia , Estudos Retrospectivos , Estudos Transversais , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapiaRESUMO
OBJECTIVES: Secondary hyperparathyroidism (sHPT) is a compensatory complication of chronic kidney disease. The aim of this study was to compare PS findings in pediatric and adult patients with sHPT. METHODS: This study included 50 pediatric and 50 adult patients with sHPT. Parathyroid scintigraphy was performed with Tc-99m sestamibi. After radiopharmaceutical injection, early-phase (15 min) and late-phase (60-90 min) images were acquired. Planar images were interpreted visually for the presence / number of active foci compatible with a parathyroid lesion, the presence and degree of uptake in skeletal structures, and the degree of thyroid sestamibi uptake. Parathyroid surgery was performed in 21 pediatric and 28 adult patients. RESULTS: Serum PTH and ALP values were significantly higher in pediatric than in adult patients ( P < 0.05 for each). In operated patients, on a lesion-based analysis, the sensitivity of PS in pediatric and adult patients were 40% and 71%, respectively. A nonlocalizing scan was observed in 24% of pediatric patients. Pediatric patients had a higher incidence of reduced thyroid sestamibi uptake (42% versus 2%). Skeletal sestamibi uptake was detected in 40% of pediatric and 30% of adult patients and the degree of uptake was higher in pediatric patients. CONCLUSIONS: The results revealed more significant changes in the biochemical profile of pediatric compared with adult patients with sHPT. The sensitivity of PS was lower, and the likelihood of a nonlocalizing scan was higher in pediatric patients. The results may also suggest more severe skeletal findings in pediatric patients. Reduced thyroid sestamibi uptake in children needs further evaluation.
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Hiperparatireoidismo Secundário , Humanos , Adulto , Criança , Hiperparatireoidismo Secundário/diagnóstico por imagem , Hiperparatireoidismo Secundário/patologia , Hiperparatireoidismo Secundário/cirurgia , Cintilografia , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/patologia , Tecnécio Tc 99m Sestamibi , Compostos Radiofarmacêuticos , Compostos de Organotecnécio , Nitrilas , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Patients with end-stage renal disease have a lower quality of life compared to the general population. Oral health-related quality of life (OHRQoL) is of particular interest as good oral health could influence general health. This study aimed to compare dental and periodontal health status, OHRQoL, and general health perception of renal transplant (TX) and hemodialysis patients (HD) with that of healthy controls. METHODS: The study included 64 TX, 63 HD, and 61 healthy patients. TX patients were also grouped according to the time elapsed after transplantation and currently use of immunosuppressive agents. The numbers of decayed, missing, and filled teeth were recorded as DMFT, and periodontal health status was evaluated. Patients' general health perceptions and OHRQoL were assessed using Short Form-36, Oral Health Impact Profile-14, and OHRQoL-United Kingdom questionnaires. RESULTS: The HD groups presented significantly higher DMFT scores and periodontal scores than TX and control groups. OHRQoL-United Kingdom total scores of TX and HD groups were lower than controls (P < .05). Oral Health Impact Profile-14 total scores revealed that HD groups' OHRQoL was significantly lower than TX and control groups (P < .05). Perceptions of general health of TX patients were higher than in the HD group. CONCLUSIONS: Renal transplantation has shown to increase quality of life and OHRQoL compared to hemodialysis therapy. Neither the immunosuppressive agent nor the time elapsed after transplantation were observed to be significant factors affecting OHRQoL.
Assuntos
Transplante de Rim , Saúde Bucal , Qualidade de Vida , Diálise Renal , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Falência Renal Crônica , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Reino UnidoRESUMO
OBJECTIVES: Kidney transplant is the treatment of choice for patients with end-stage renal disease. Antibody-mediated rejection is associated with higher rates of graft loss in kidney transplant recipients. Determining the risk factors of antibody-mediated rejection is vital for its prevention, early diagnosis, and appropriate treatment, as these factors may be important in maintaining long-term graft survival in transplant recipients. In our study, we analyzed the risk factors of antibody-mediated rejection in kidney transplant recipients and the negative impact of antibody-mediated rejection on graft function. MATERIALS AND METHODS: We analyzed demographic and clinical data of 124 kidney transplant recipients (37 female [30%] and 87 male [70%] patients) who were diagnosed with antibody-mediated rejection at transplant biopsy. We compared graft outcomes of this patient cohort versus 75 kidney transplant recipients (24 female [32%] and 51 male [68%] patients) who were not diagnosed with antibody-mediated rejection. RESULTS: Mean ages of patients with and without antibody-mediated rejection were 38.2 ± 13.6 and 34.4 ± 13.0 years, respectively. Mean ages of donors for patients with antibody-mediated rejection was significantly higher (48.0 ± 13.2 y) than for donors of patients without antibody-mediated rejection (47.1 ± 11.4 y; P < .05). Rate of graft loss was 15.3% in patients with antibody-mediated rejection; patients without antibody-mediated rejection had no graft loss (P < .05). Positive panel reactive antibody levels and blood transfusion before transplant were found to be risk factors of antibody-mediated rejection in kidney transplant recipients. However, recipients who received tacrolimus had less antibody-mediated rejection episodes than recipients who received sirolimus or cyclophosphamide. CONCLUSIONS: Antibody-mediated rejection is associated with high rates of graft loss in kidney transplant recipients. Avoiding blood transfusion, lowering panel reactive antibody levels, choosing younger donors, and using tacrolimus in high-risk kidney transplant recipients may reduce antibody-mediated rejection rates and provide better graft survival.
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Rejeição de Enxerto/imunologia , Isoanticorpos/sangue , Transplante de Rim/efeitos adversos , Adulto , Biomarcadores/sangue , Feminino , Rejeição de Enxerto/sangue , Rejeição de Enxerto/diagnóstico , Sobrevivência de Enxerto , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVES: The introduction of direct-acting antiviral agents has allowed significant chances for treatment for difficult-to-treat populations. This study aimed to investigate the efficacy, tolerability, and safety of these therapies in both patients with end-stage renal disease and kidney transplant recipients with chronic hepatitis C virus infection. MATERIALS AND METHODS: This study was a retrospective analysis with prospective follow-up of patients. The antiviral combination of ombitasvir 25 mg, paritaprevir 75 mg, ritonavir 50 mg, and dasabuvir 50 mg was prescribed to patients with end-stage renal disease or kidney transplant recipients with noncirrhotic or compensated cirrhotic liver disease. The other antiviral combination consisted of sofosbuvir 400 mg and ledipasvir 90 mg, which was recommended to patients with decompensated cirrhosis or those who could not tolerate the first combination regimen. Ribavirin was given to all patients with genotype 1a hepatitis C virus infection. All clinical and laboratory data were recorded at week 4, at end of the treatment, and at 12 weeks after completion of treatment. RESULTS: In terms of efficacy, sustained virologic response at 12 weeks was achieved in 94% of patients in the end-stage renal disease group and 92% of patients in the kidney transplant group. In terms of tolerability, antiviral treatment was well tolerated in both groups. Cardiac arrest and cerebrovascular accident were seen in the end-stage renal disease group; severe mucositis and glossitis were seen in the kidney transplant group. Hospitalization was needed in 2 patients for treatment of drug interactions with tacrolimus and sirolimus. Renal allograft function worsened in 2 patients, with 1 patient having biopsyproven antibody-mediated rejection. CONCLUSIONS: We observed great efficacy and safety in both kidney transplant recipients and patients with end-stage renal disease with these agents in treatment of chronic hepatitis C. However, clinicians should remain aware of drug interactions and adverse events in this fragile patient population.
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Anilidas/uso terapêutico , Antivirais/uso terapêutico , Carbamatos/uso terapêutico , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/tratamento farmacológico , Falência Renal Crônica/complicações , Falência Renal Crônica/cirurgia , Transplante de Rim , Compostos Macrocíclicos/uso terapêutico , Ritonavir/uso terapêutico , Sulfonamidas/uso terapêutico , Uracila/análogos & derivados , 2-Naftilamina , Adulto , Idoso , Anilidas/efeitos adversos , Antivirais/efeitos adversos , Carbamatos/efeitos adversos , Ciclopropanos , Interações Medicamentosas , Quimioterapia Combinada , Feminino , Genótipo , Hepacivirus/genética , Hepatite C Crônica/complicações , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/virologia , Humanos , Imunossupressores/efeitos adversos , Falência Renal Crônica/diagnóstico , Transplante de Rim/efeitos adversos , Lactamas Macrocíclicas , Compostos Macrocíclicos/efeitos adversos , Masculino , Pessoa de Meia-Idade , Prolina/análogos & derivados , Estudos Prospectivos , Estudos Retrospectivos , Ribavirina/uso terapêutico , Fatores de Risco , Ritonavir/efeitos adversos , Sulfonamidas/efeitos adversos , Resposta Viral Sustentada , Fatores de Tempo , Resultado do Tratamento , Uracila/efeitos adversos , Uracila/uso terapêutico , ValinaRESUMO
OBJECTIVES: Neurologic complications are a significant cause of morbidity and mortality in patients who undergo transplants. We sought to evaluate the nature and incidence of neurologic complications in patients undergoing a renal transplant. PATIENTS AND METHODS: Between January 2005 and December 2007, 132 adults (35 women, 97 men; mean age, 34.32 -/+ 0.90 years) underwent a renal transplant at our institution. Associated comorbid medical conditions, presenting neurologic symptoms, and type of immunosuppression were obtained from patients' medical records. RESULTS: Major indications for renal transplant were hypertensive nephropathy (14.4%), vesicoureteral reflux (11.4%), and idiopathic causes (21.2%). Mean follow-up was 17.26 -/+ 0.89 months (range, 2 weeks to 40 months). Twenty neurologic complications were found in 18 patients (6 women, 12 men; mean age, 33.83 -/+ 2.37 years). Presenting symptoms included posterior leukoencephalopathy syndrome, 1 (5.6%); cephalgia, 10 (55.6%); cerebral infarcts, 2 (11.1%); seizure, 3 (16.7%); tremor, 2 (11.1%); encephalopathy, 1 (5.6%); and sinus thrombosis, 1 (5.6%). Immunosuppressive agents were the primary cause of 16 of the 20 neurologic complications. Effectiveness and complications of cyclosporinewere screened for a total of 1858.50 months, tacrolimus for 853.50 months, and sirolimus for 620 months; 50.2% of the neurologic complications appeared during the first 3 months after transplant; the blood level of immunosuppressive medications did not need to be higher than normal in every case. DISCUSSION: In addition to cyclosporine and tacrolimus, we suggest (for the first time) sirolimus as a cause of neurocomplications after renal transplant.
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Transplante de Rim/efeitos adversos , Doenças do Sistema Nervoso/etiologia , Adolescente , Adulto , Idoso , Cadáver , Feminino , Cefaleia/epidemiologia , Cefaleia/etiologia , Humanos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Convulsões/epidemiologia , Convulsões/etiologia , Doadores de Tecidos , Tremor/epidemiologia , Tremor/etiologia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia , Adulto JovemRESUMO
OBJECTIVES: In kidney transplant recipients, reduced muscle mass and hand-grip strength are associated with impaired nutritional status. Serum testosterone is highly associated with muscle strength in the general population. Here, we aimed to determine the associations among serum testosterone, hand-grip strength, and nutritional and inflammatory parameters, as well as graft function. MATERIALS AND METHODS: Our study included 144 stable male kidney transplant recipients from our renal transplant outpatient clinic. All patients were evaluated for clinical parameters (age, duration of hemodialysis, and posttransplant time), biochemical parameters (calcium, phosphorus, parathyroid hormone, C-reactive protein, albumin, creatinine), and serum testosterone levels. Body composition was analyzed with the bioimpedance spectroscopy analysis technique using a body composition monitor that estimates body mass index and percent fat. Hand-grip strength was analyzed by using a dynamometer (ProHealthcareProducts.com, Park City, UT, USA). We calculated estimated glomerular filtration rate using the Modification of Diet in Renal Disease-4 equation. RESULTS: Demographic characteristics, duration of dialysis before transplant, biochemical parameters, and estimated glomerular filtration rates were similar among study patients. Mean (standard deviation) serum testosterone was 588.0 (55.5) ng/dL, mean body mass index was 26.8 (0.6) kg/m2, and mean hand-grip strength was 42.2 (1.7) mm2. Serum testosterone levels were positively correlated with hand-grip strength (r = 0.445; P = .033) and serum albumin (r = 0.399; P = .05) and negatively correlated with serum C-reactive protein (r = -0.454; P = .05) and age. In linear multiple regression analysis, serum albumin (P = .033) and testosterone levels (P = .038) were shown to be predictors of hand-grip strength. However, we could not show a significant correlation between graft function and testosterone. CONCLUSIONS: Serum testosterone level is correlated with hand-grip strength and C-reactive protein and albumin levels, which may indicate that testosterone affects nutritional status and inflammation in male renal transplant recipients.
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Força da Mão , Inflamação/diagnóstico , Transplante de Rim , Desnutrição/diagnóstico , Debilidade Muscular/diagnóstico , Albumina Sérica Humana/análise , Testosterona/sangue , Transplantados , Adiposidade , Adulto , Biomarcadores/sangue , Índice de Massa Corporal , Estudos Transversais , Taxa de Filtração Glomerular , Humanos , Inflamação/sangue , Inflamação/etiologia , Inflamação/fisiopatologia , Mediadores da Inflamação/sangue , Transplante de Rim/efeitos adversos , Masculino , Desnutrição/sangue , Desnutrição/etiologia , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Debilidade Muscular/sangue , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Estado Nutricional , Fatores de Risco , Fatores Sexuais , Resultado do TratamentoRESUMO
OBJECTIVES: Although living kidney donors have a minimal lifetime risk of developing end-stage renal disease, long-term complications and physiologic and psychologic sequelae resulting from donation remain unclear because of lack of optimum follow-up after transplant. Here, we evaluated renal function, complications, and physical and mental performance of living kidney donors. MATERIALS AND METHODS: We evaluated 147 patients who donated living kidneys between 1981 and 2012 at Baskent University Hospital. We collected data on donor age, sex, body mass index, smoking status, hypertension before and after nephrectomy, proteinuria, estimated glomerular filtration rate according to the Modification of Diet in Renal Disease formula, and duration after donation. All donors answered the Medical Outcomes Study short-form general health survey; results were evaluated according to answers to 11 questions totaling 22 points. RESULTS: Body mass index of donors showed that 31 (21.1%) were in normal range, 66 (44.9%) had mild obesity (body mass index of 26-30 kg/m²), and 30 (34%) had moderate to high obesity (body mass index > 30 kg/m2). Results from the general health survey showed that 117 donors (80%) had no loss, 13 (9%) had mild loss, 12 (8%) had moderate loss, and 5 (3%) had high loss of ability. When we compared estimated glomerular filtration rates according to donor age, donors who were 18 to 34 years had a mean estimated glomerular filtration rate of 113.5 ± 40, donors 35 to 49 years had a mean rate of 95.01 ± 23.4, donors 50 to 64 years had a mean rate of 87.43 ± 25.4, and donors older than 65 years had a mean rate of 63.76 ± 11.35 mL/min/1.73 m², revealing a statistically significant loss of kidney function with aging (P = .001).. CONCLUSIONS: Careful evaluation of kidney donors before and after donation is essential for the most common risk factors, such as obesity, and for loss of kidney function, especially in older donors.
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Taxa de Filtração Glomerular , Nefropatias/epidemiologia , Transplante de Rim/efeitos adversos , Rim/fisiopatologia , Doadores Vivos , Nefrectomia/efeitos adversos , Obesidade/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Índice de Massa Corporal , Feminino , Nível de Saúde , Hospitais Universitários , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Incidência , Nefropatias/diagnóstico , Nefropatias/fisiopatologia , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/fisiopatologia , Prognóstico , Proteinúria/epidemiologia , Proteinúria/fisiopatologia , Fatores de Risco , Fatores de Tempo , Turquia/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: Chronic allograft dysfunction is a complex and multifactorial process characterized by progressive interstitial fibrosis and tubular atrophy. The finding of interstitial fibrosis and tubular atrophy is prevalent among kidney transplant patients receiving a calcineurin inhibitor-based immunosuppressive regimen and may be considered as a surrogate of allograft survival. Both immune (acute rejection episodes, sensitization, and HLA incompatibility) and nonimmune (donor age, delayed graft function, calcineurin inhibitor toxicity, infections, and hypertension) mechanisms play a role in chronic allograft dysfunction, and different causes all lead to similar histologic and clinical final pathways, with the end result of graft loss. In our study, we aimed to compare the outcomes of kidney transplant recipients with or without interstitial fibrosis and tubular atrophy in protocol biopsies to determine the conditions that may affect allograft survival. MATERIALS AND METHODS: We divided 192 kidney transplant recipients into 2 groups (96 patients with interstitial fibrosis and tubular atrophy; 96 patients without interstitial fibrosis and tubular atrophy) according to protocol biopsy at 6 months. Patient groups were compared according to their risk factors for chronic allograft dysfunction (cold ischemia time, delayed graft function, donor age, infections, mean blood calcineurin levels, and hypertension). RESULTS: Cold ischemia time, delayed graft function, high 24-hour proteinuria levels, and higher mean blood calcineurin levels were found to be major risk factors for poor graft function in kidney transplant recipients with interstitial fibrosis and tubular atrophy. Renin-angiotensin system blockage with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was found to be preventive for interstitial fibrosis and tubular atrophy after kidney transplant. CONCLUSIONS: Preventing prolongation of cold ischemia time, lowering blood cholesterol levels, angiotensin-converting enzyme inhibitors and angiotensin receptor blocker treatment even without existing proteinuria and avoiding higher doses of calcineurin inhibitors should be major approaches in kidney transplant recipients.
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Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Inibidores de Calcineurina/administração & dosagem , Sobrevivência de Enxerto/efeitos dos fármacos , Imunossupressores/administração & dosagem , Nefropatias/prevenção & controle , Transplante de Rim/efeitos adversos , Sistema Renina-Angiotensina/efeitos dos fármacos , Adulto , Aloenxertos , Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Atrofia , Biópsia , Inibidores de Calcineurina/efeitos adversos , Isquemia Fria/efeitos adversos , Função Retardada do Enxerto/etiologia , Feminino , Fibrose , Humanos , Hipercolesterolemia/complicações , Imunossupressores/efeitos adversos , Nefropatias/diagnóstico , Nefropatias/etiologia , Masculino , Proteinúria/etiologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVES: Leptin, the Ob gene product, centrally regulates weight control. Transplant recipients are exposed to many factors affecting body mass. Leptin has been reported to activate the peripheral immune system. In this study, we evaluated serum leptin levels and factors contributing to hyperleptinemia; the relationship between serum leptin levels and lymphoid stem and mature cells; and their role in the rejection process in renal transplant recipients. MATERIALS AND METHODS: Sixty-three renal transplant recipients were included in the study. Patients were grouped according to serum leptin percentiles as hypoleptinemic (n=17), normoleptinemic (n=32), and hyperleptinemic (n=14). We determined serum leptin levels by radioimmunoassay and absolute number of CD34(+), CD7(+), CD34(+)CD7(+) lymphoid stem cells, CD4(+) and CD8(+) lymphocytes in peripheral blood by flow cytometry. RESULTS: The hyperleptinemic patients constituted 22.3% of the transplant patient. The mean peripheral blood CD34(+)CD7(+) lymphocyte count was significantly higher in hyperleptinemic patients than in normo- or hypoleptinemic patients (6.9, 6.1, and 44.3 cells/mm(3), respectively, P<0.05). There were no significant differences in the mean CD34(+), CD7(+), CD8(+), and CD4(+) lymphocyte count and CD4/CD8 ratio among the groups with respect to serum leptin levels. CD34(+)CD7(+) lymphocyte count was positively correlated with serum leptin levels (r=0.416, P<0.05). CONCLUSIONS: Hyperleptinemia is not rare during the posttransplant period. Our data support the results of previous experimental studies that have demonstrated the effect of the leptin hormone on lymphoid stem cells. The central and peripheral effects of leptin may differ on lymphoid stem cells and a serum threshold level may apply for the central effects.
Assuntos
Antígenos CD34 , Antígenos CD7 , Transplante de Rim , Leptina/sangue , Células-Tronco , Adolescente , Adulto , Antígenos CD34/imunologia , Antígenos CD7/imunologia , Biomarcadores/sangue , Índice de Massa Corporal , Relação CD4-CD8 , Feminino , Humanos , Transplante de Rim/efeitos adversos , Transplante de Rim/imunologia , Leptina/imunologia , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/etiologia , Obesidade/imunologia , Células-Tronco/imunologiaRESUMO
A renal artery aneurysm in a stenotic renal artery is a rare clinical entity with an incidence of 0.015% to 1% in patients with renovascular hypertension. Interventional stent placement is the first line of treatment for simple aneurysms of the proximal renal artery. However, renal autotransplantation has been used as an alternative treatment for complex lesions and for lesions originating from the distal renal artery. We present a patient with a renal artery aneurysm, renal artery stenosis of the segmental branches of the left kidney, and occlusion of the right renal artery. The surgical strategy included renal explantation, ex vivo renal preservation, ex vivo reconstruction of the 2 renal artery branches, and renal heterotopic autotransplantation. We conclude that renal autotransplantation is a safe and effective surgical procedure for patients with complex renal arterial disease.
Assuntos
Transplante de Rim/métodos , Obstrução da Artéria Renal/cirurgia , Transplante Autólogo , Adulto , Humanos , Rim , Masculino , Preservação de Órgãos , Radiografia , Obstrução da Artéria Renal/diagnóstico por imagem , Resultado do TratamentoRESUMO
BACKGROUND: Cyclosporin A (CsA) is known to induce gingival overgrowth. Apoptosis plays a critical role in the regulation of inflammation and the host immune response. The aim of this study was to investigate apoptosis in CsA-induced gingival enlargement using electron microscopy examination of keratinocytes. METHODS: Gingiva specimens were collected from 12 CsA-treated renal transplant patients with gingival overgrowth and eight healthy controls with gingivitis. Clinical findings (probing depth, gingival index, and plaque index) were compared in the two groups. Histological and ultrastructural features of the specimens were also compared, and extent of keratinocyte apoptosis was scored on a three-tier scale: 0 = no apoptotic cells; 1 = one or two apoptotic cells; 2 = more than two cells. RESULTS: There were no significant differences between groups with respect to gingiva-related clinical findings or extent of keratinocyte apoptosis. CONCLUSIONS: The results indicate that the extent of keratinocyte apoptosis in the gingiva of kidney recipients with CsA-induced gingival overgrowth is similar to that observed in inflamed gingiva of healthy individuals. Further studies on apoptosis of different cell types in the presence of CsA should clarify this agent's role in the pathogenesis of drug-induced gingival enlargement.
Assuntos
Apoptose/fisiologia , Ciclosporina/efeitos adversos , Crescimento Excessivo da Gengiva/patologia , Imunossupressores/efeitos adversos , Adulto , Estudos de Casos e Controles , Feminino , Crescimento Excessivo da Gengiva/induzido quimicamente , Gengivite/patologia , Humanos , Queratinócitos/citologia , Queratinócitos/patologia , Transplante de Rim , Masculino , Microscopia EletrônicaRESUMO
OBJECTIVES: Chronic hepatitis C virus infection compromises hemodialysis patients and increases liver-related mortality. Interferon treatment is associated with improved sustained virological response rates and increased risk of graft loss after kidney transplant. This may be related to the development of antihuman leukocyte antigen antibodies, which may be a surrogate marker of potent immune response. We evaluated panel reactive antibody 1 and 2 levels for prediction of sustained viral response in patients with kidney transplant. MATERIALS AND METHODS: In this retrospective cohort study, we reviewed data from hepatitis C virusinfected hemodialysis patients who received interferon treatment before kidney transplant. Panel reactive antibody > 20% was considered positive. Sustained viral response rates for interferon treatment were obtained and compared with panel reactive antibody 1 and 2 values. RESULTS: There were 40 patients (16 female and 24 male patients; mean age, 41.5 y; range, 18-65 y). Sustained viral response rate was 18/40 (45%). Panel reactive antibody 1 was negative in 31 patients and positive in 9 patients. Sustained viral response ratio was not correlated with panel reactive antibody 1 positivity. Panel reactive antibody 2 was negative in 31 patients (sustained viral response: present, 11 patients; absent, 20 patients) and positive in 9 patients (sustained viral response: present, 7 patients; absent, 2 patients). Sustained viral response ratio was significantly correlated with panel reactive antibody 2 positivity. CONCLUSIONS: We showed a correlation between panel reactive antibody 2 positivity and sustained viral response rates that may be a predictive tool for hepatitis C virus treatment response. In patients with other complications that compromise hepatitis C virus treatment, panel reactive antibody 2 may be a surrogate marker for sustained viral response prediction. The induction of cellular immunity may cause clearance of hepatitis C virus infection and formation of high panel reactive antibody 2 levels.
Assuntos
Anticorpos/sangue , Antivirais/uso terapêutico , Antígenos HLA/imunologia , Hepatite C Crônica/tratamento farmacológico , Histocompatibilidade/efeitos dos fármacos , Interferons/uso terapêutico , Falência Renal Crônica/cirurgia , Transplante de Rim , Adolescente , Adulto , Idoso , Antivirais/efeitos adversos , Biomarcadores/sangue , Feminino , Anticorpos Anti-Hepatite C/sangue , Hepatite C Crônica/complicações , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/imunologia , Teste de Histocompatibilidade , Humanos , Imunidade Celular/efeitos dos fármacos , Interferons/efeitos adversos , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/imunologia , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Diálise Renal , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: New-onset diabetes after transplantation (NODAT) is associated with decreased graft survival and an increased risk for cardiovascular disease. The objective of this study was to evaluate the risk factors for development of NODAT and its' relationship with arterial stiffness and left ventricular mass index (LVMI) in kidney transplant recipients. METHODS: 159 kidney transplant recipients were selected from our transplantation center who underwent renal transplantation between years 2007 and 2010. RESULTS: Among 159 patients, 57 (32.2%) patients were with NODAT who were significantly older than patients without diabetes (P: 0.0001). Patients with NODAT had significantly higher pulse wave velocity (PWv) (P: 0.033) and left ventricular mass index LVMI (P: 0.001) compared to patients without NODAT. Further analysis was done according to LVMI as follows: LVMI > 130 g/m(2) (n: 57) and LVMI ≤ 130 g/m(2) (n: 102). We observed higher office systolic and diastolic BP, serum trygliceride, glucose, creatinine, age, and HbA1c (P: 0.0001) levels in patients with LVMI > 130 g/m(2). Linear regression analysis revealed that HbA1c was the major determinant of LVMI (P: 0.026, ß: 0.361). CONCLUSIONS: HbA1c is the major determinant of LVMI, so strict control of serum glucose levels is essential for preventing cardiovascular disease in patients with NODAT.
Assuntos
Glicemia/metabolismo , Diabetes Mellitus/diagnóstico , Hipertrofia Ventricular Esquerda/etiologia , Transplante de Rim , Rim/fisiopatologia , Adulto , Pressão Sanguínea/fisiologia , Diabetes Mellitus/sangue , Diabetes Mellitus/fisiopatologia , Feminino , Humanos , Hipertrofia Ventricular Esquerda/sangue , Hipertrofia Ventricular Esquerda/fisiopatologia , Masculino , Pessoa de Meia-Idade , Rigidez Vascular/fisiologiaRESUMO
OBJECTIVES: We investigated the effect of hepatitis B virus in kidney transplant patients in terms of patient care and survival. MATERIALS AND METHODS: We retrospectively analyzed kidney transplant patients from 1993 to 2013. A control group with negative serology was selected. The hepatitis B virus-positive group was divided into 2 subgroups based on serologic status, treatments, and treatment responses. Group A had viral suppression, and group B had hepatitis B virus DNA persistence. Overall and allograft survival rates were compared. RESULTS: We identified 32 hepatitis B virus-positive and 74 hepatitis B virus-negative patients. Positive group was treated with lamivudine (n = 23), lamivudine plus entecavir (n = 4), lamivudine plus tenofovir (n = 4), or lamivudine plus entecavir and tenofovir (n = 1). In group A (n = 15), antiviral treatment was given based on the presence of either hepatitis B surface antigen with negative hepatitis B virus DNA (n = 11) or hepatitis B virus DNA positivity (n = 4). Group B patients (n = 17) received antiviral treatment for persistence of hepatitis B virus DNA (n = 7) or for viral reactivation (ie, recurrence of hepatitis B virus DNA) (n = 10). Groups A and B did not differ significantly in terms of graft or overall survival. Liver biopsy was performed in 17 patients; 3 patients had high-grade fibrosis or cirrhosis, and 14 patients had normal histology or mild hepatitis. Median graft survival time was longer in positive group (69.5 mo vs 54 mo; P = .007). Five- and 10-year overall survival rates were comparable (89%-84% vs 96%-96%; P = .107). CONCLUSIONS: Hepatitis B virus-positive kidney transplant patients have increased liver transaminase levels, longer graft survival times, and similar median overall survival rates compared with hepatitis B virus-negative patients.
Assuntos
Sobrevivência de Enxerto , Vírus da Hepatite B/patogenicidade , Hepatite B/virologia , Falência Renal Crônica/cirurgia , Transplante de Rim , Adulto , Idoso , Antivirais/uso terapêutico , Feminino , Hepatite B/complicações , Hepatite B/diagnóstico , Hepatite B/tratamento farmacológico , Vírus da Hepatite B/efeitos dos fármacos , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVES: We aimed to investigate the colonoscopy findings in patients after kidney transplant. MATERIALS AND METHODS: We retrospectively analyzed kidney transplant patients who had colonoscopy examinations for various indications between 2011 and 2015. RESULTS: Eighty-one patients (25 women and 56 men) with a mean age of 39 years (range, 18-64 y) were identified. Mean follow-up after transplant was 9 years (range, 1-29 y). The most common indications for colonoscopy were diarrhea (41%), anemia (29%), gastrointestinal bleeding (12%), abdominal pain (12%), and unexplained weight loss (6%). Either colitis or ileitis or both were diagnosed in 20 patients (25%), whereas polyps were found in 9 patients (11%). One patient presented with hematochezia, which was diagnosed as cytomegalovirus colitis. The remaining cases of colitis or ileitis were diagnosed as nonspecific inflammation. Indications for colonoscopy were not correlated with age, duration after transplant, or use of immunosuppressive drugs. A subgroup analysis for mycophenolate-induced colitis found that 88% of patients used mycophenolate, but presence of colitis or ileitis had no statistical correlation with its use. In patients with poor gastrointestinal symptoms, the only significant predictor of presence of colitis or ileitis was a high C-reactive protein value (> 5 mg/dL; P = .02). CONCLUSIONS: Incidence of colitis and/or ileitis is a relatively common finding in patients after kidney transplant. Opportunistic infections, mycophenolate use, and mild degree of indeterminate colitis or ileitis disease may be the underlying condition. Cytomegalovirus infection should be screened in all recipients because it may cause serious complications or death in chronically immunocompromised patients.