1
|
Fragale G, Laham G, Raffaele P, Fortunato M, Villamil S, Giordani MC, Taylor M, Ciappa J, Rodriguez M, Maldonado R, Trimarchi H, Pomeranz V, Ellena V, De La Fuente J, Bisigniano L, Antik A, Soler Pujol G. Renal Transplantation in the Elderly: Are They All the Same? A Multicenter, Comorbidity-Based Study. Nephron Clin Pract 2023; 147:550-559. [PMID: 37231956 DOI: 10.1159/000531178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION The age for kidney transplantation (KT) is no longer a limitation and several studies have shown benefits in the survival of elderly patients. The aim of this study was to examine the relationship of the baseline Charlson comorbidity index (CCI) score to morbidity and mortality after transplantation. METHODS In this multicentric observational retrospective cohort study, we included patients older than 60 years admitted on the waiting list (WL) for deceased donor KT from January 01, 2006, to December 31, 2016. The CCI score was calculated for each patient at inclusion on the WL. RESULTS Data for analysis were available of 387 patients. The patients were divided in tertiles of CCI: group 1 (CCI: 1-2) n = 117, group 2 (CCI: 3-4) n = 158, and group 3 (CCI: ≥5) n = 112. Patient survival was significantly different between CCI groups at 1, 3, and 5 years, respectively: 90%, 88%, and 84% for group 1, 88%, 80%, and 72% for group 2, and 87%, 75%, and 63% for group 3 (p < 0.0001). Variables associated with mortality were CCI score (p < 0.0001), HLA mismatch (p = 0.014), length of hospital stay (p < 0.0001), surgical complications (p = 0.048). CONCLUSION Individualized strategies to modify these variables may improve patient's morbidity and mortality after KT.
Collapse
Affiliation(s)
- Guillermo Fragale
- Nefrología y Trasplante renal, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Gustavo Laham
- Sección Nefrología, Centro de Educación Médica e Investigaciones Clínicas, "Norberto Quirno", Buenos Aires, Argentina
| | - Pablo Raffaele
- Unidad renal, Fundación Favaloro, Buenos Aires, Argentina
| | | | - Susana Villamil
- Trasplante renal, Hospital Italiano, Buenos Aires, Argentina
| | | | - Marcelo Taylor
- Centro Regional de Ablación e Implante Sur, Hospital San Martín, La Plata, Buenos Aires, Argentina
| | - Julio Ciappa
- Centro Regional de Ablación e Implante Sur, Hospital San Martín, La Plata, Buenos Aires, Argentina
| | - Marisol Rodriguez
- Nefrología y Trasplante renal, Clínica Vélez Sarsfield, Córdoba, Argentina
| | - Rafael Maldonado
- Nefrología y Trasplante renal, Clínica Vélez Sarsfield, Córdoba, Argentina
| | - Hernán Trimarchi
- Servicio de Nefrología, Hospital Británico, Buenos Aires, Argentina
| | - Vanesa Pomeranz
- Servicio de Nefrología, Hospital Británico, Buenos Aires, Argentina
| | - Virginia Ellena
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Cordoba, Argentina
| | - Jorge De La Fuente
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Cordoba, Argentina
| | - Liliana Bisigniano
- Dirección Científico Técnica, Instituto Nacional Central Único Coordinador de Ablación e Implante (INCUCAI), Buenos Aires, Argentina
| | - Ariel Antik
- Dirección Científico Técnica, Instituto Nacional Central Único Coordinador de Ablación e Implante (INCUCAI), Buenos Aires, Argentina
| | - Gervasio Soler Pujol
- Sección Nefrología, Centro de Educación Médica e Investigaciones Clínicas, "Norberto Quirno", Buenos Aires, Argentina
| |
Collapse
|
2
|
Fragale G, Mainetti L, Montal S, Beitía V, Lovisolo P, Karl A, Schnitzler E, Soler Pujol G, Tisi Baña M. [Strategic plan for reduction of hospital stay in renal transplantation]. J Healthc Qual Res 2018; 33:329-333. [PMID: 30497972 DOI: 10.1016/j.jhqr.2018.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/15/2018] [Accepted: 07/26/2018] [Indexed: 11/26/2022]
Abstract
Since January 2015 we have carried out a multiple-intervention strategic plan to reduce hospital stay in renal transplant recipients. The main objective of this study is to compare results of renal transplantation before and after putting into effect this plan in terms of graft and patient survival, readmissions and incidence of acute rejection during the first year post transplantation. In this retrospective analysis we included all patients 18 years of age or older who were transplanted at our institution. The strategic plan resulted in a significant reduction of hospital stay of renal recipients from 13.5 days in the pre-plan group (n=97) to 4.6 days in the post-plan group (n=62; p≤0.0001). The incidence of acute rejection during the first year was similar (pre-plan group=14.4% vs. post-plan group=16% [p=0.77]) as it was graft survival (88% vs. 90% [p=0.71]) and patient survival (95% vs. 98% [p=0.37]), respectively. The multiple-intervention strategic plan has significantly reduced the hospital stay of patients after renal transplantation without affecting graft or patient survival, which are comparable to those internationally published, and without jeopardizing patient's safety.
Collapse
Affiliation(s)
- G Fragale
- Servicio de Nefrología y Trasplante Renal, Hospital Universitario Austral, Buenos Aires, Argentina.
| | - L Mainetti
- Servicio de Nefrología y Trasplante Renal, Hospital Universitario Austral, Buenos Aires, Argentina
| | - S Montal
- Servicio de Nefrología y Trasplante Renal, Hospital Universitario Austral, Buenos Aires, Argentina
| | - V Beitía
- Servicio de Nefrología y Trasplante Renal, Hospital Universitario Austral, Buenos Aires, Argentina
| | - P Lovisolo
- Servicio de Nefrología y Trasplante Renal, Hospital Universitario Austral, Buenos Aires, Argentina
| | - A Karl
- Servicio de Nefrología y Trasplante Renal, Hospital Universitario Austral, Buenos Aires, Argentina
| | - E Schnitzler
- Departamento de Desarrollo Académico, Hospital Universitario Austral, Buenos Aires, Argentina
| | - G Soler Pujol
- Servicio de Nefrología y Trasplante Renal, Hospital Universitario Austral, Buenos Aires, Argentina
| | - M Tisi Baña
- Servicio de Clínica Médica, Hospital Universitario Austral, Buenos Aires, Argentina
| |
Collapse
|
3
|
Seclì L, Fusella F, Fragale G, Rubinetto C, Rocca S, Turco E, Brancaccio M. PO-237 Neutralising extracellular morgana impairs breast tumour growth and migration. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
4
|
Fragale G, Soler Pujol G, Mainetti L, San Román A, Durán Paredes V, Rizzo Manglio M. [Aggresive angiomyxoma after renal transplantation]. Medicina (B Aires) 2018; 78:440-442. [PMID: 30504112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
The condition of immunosuppressed increases the risk of cancer in kidney transplant patients, as compared to the general population. The best survival of inmunosupressed patients in recent years has turned both neoplasms and cardiovascular diseases into the main causes of morbidity and mortality. We present the case of a renal transplanted patient who developed an unusual form of mesenchymal tumor such as the aggressive angiomyxoma, four years after the implant and requiring wide surgical resection.
Collapse
Affiliation(s)
- Guillermo Fragale
- Servicio de Nefrología y Trasplante Renal, Hospital Universitario Austral, Pilar, Buenos aires, Argentina. E-mail:
| | - Gervasio Soler Pujol
- Servicio de Nefrología y Trasplante Renal, Hospital Universitario Austral, Pilar, Buenos aires, Argentina
| | - Luis Mainetti
- Servicio de Nefrología y Trasplante Renal, Hospital Universitario Austral, Pilar, Buenos aires, Argentina
| | - Alberto San Román
- Servicio de Anatomía Patológica, Hospital Universitario Austral, Pilar, Buenos aires, Argentina
| | - Victoria Durán Paredes
- Servicio de Anatomía Patológica, Hospital Universitario Austral, Pilar, Buenos aires, Argentina
| | - Miguel Rizzo Manglio
- Servicio de Oncología, Hospital Universitario Austral, Pilar, Buenos aires, Argentina
| |
Collapse
|
7
|
Tringali G, Scuderi G, Rosalia G, Massimino SD, Intonazzo V, Fragale G. [Separation and purification of Treponema pallidum by density gradient. Technical note]. Quad Sclavo Diagn 1985; 21:455-61. [PMID: 3915823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The reported possibility of obtaining purified suspension of Treponema pallidum through a Percoll density gradient is evaluated. The maintenance of motility and antigenicity of the purified T. pallidum allows further studies on antigenic structure of treponemes.
Collapse
|
8
|
Tringali G, La Rosa G, Intonazzo V, Perna AM, Fragale G. [Immunoenzyme reactions, immunofluorescence and complement fixation: evaluation in the study of anti-cytomegalovirus antibodies. Technical note]. Quad Sclavo Diagn 1985; 21:317-21. [PMID: 3012623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A comparative study of CF, IF and ELISA was carried out in order to comparatively evaluate the characteristics of sensitivity and specificity of the tests. The results seem to confirm the validity of both IF and ELISA in the laboratory diagnosis of CMV infections.
Collapse
|