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Lapa JDS, Halpern M, Gouvêa ÉFD, de Lemos ADS, Gonçalves RT, Santoro-Lopes G. Lack of Impact of Acute Pyelonephritis on Kidney Graft Survival. Transplant Proc 2020; 52:1287-1290. [PMID: 32197868 DOI: 10.1016/j.transproceed.2020.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/23/2020] [Accepted: 02/05/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Urinary tract infection is the most common bacterial infection after kidney transplant. Some studies suggested that urinary tract infection could impair graft survival, but this issue remains debated. The objective of this study was to analyze the association between acute pyelonephritis (APN) and the risk of kidney graft failure. METHODS We performed a retrospective cohort study including patients who received a kidney transplant from 2001 to 2009 at a university hospital in Rio de Janeiro, Brazil. They were followed until December 2015. The primary outcome was graft failure. Follow-up of patients who died with a functioning graft was censored on the date of death. Cox proportional hazards method was used in multivariable analysis to assess risk factors for graft failure. The occurrence of the first episode of APN and acute rejection were modeled as time-dependent variables. RESULTS A total of 587 patients were included. Of these, 112 recipients (19%) developed 173 episodes of APN. Graft failure occurred in 150 patients (25%) after a median follow-up of 79 months. The factors associated with graft failure in the multivariate analyses were age of the transplant recipient (hazard ratio [HR], 0.97 per year; 95% confidence interval [CI], 0.96-0.99; P < .01), occurrence of delayed graft function (HR, 2.42; 95% CI, 1.72-3.40; P < .01), and acute rejection (HR, 2.71; 95% CI, 1.92-3.82; P < .01). There was no association between APN and graft failure (HR, 1.05; 95% CI, 0.65-1.68; P = .85). CONCLUSIONS Our results suggest that the occurrence of APN is not associated with a significant reduction in graft survival after kidney transplant.
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Affiliation(s)
| | - Márcia Halpern
- Serviço de Doenças Infecciosas e Parasitárias, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Érika Ferraz de Gouvêa
- Serviço de Doenças Infecciosas e Parasitárias, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alberto Dos Santos de Lemos
- Serviço de Doenças Infecciosas e Parasitárias, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renato Torres Gonçalves
- Serviço de Nefrologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Guilherme Santoro-Lopes
- Serviço de Doenças Infecciosas e Parasitárias, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Miglioli-Galvão L, Pestana JOM, Lopes-Santoro G, Torres Gonçalves R, Requião Moura LR, Pacheco Silva Á, Camera Pierrotti L, David Neto E, Santana Girão E, Costa de Oliveira CM, Saad Abboud C, Dias França JÍ, Devite Bittante C, Corrêa L, Aranha Camargo LF. Severe Strongyloides stercoralis infection in kidney transplant recipients: A multicenter case-control study. PLoS Negl Trop Dis 2020; 14:e0007998. [PMID: 32004346 PMCID: PMC7015428 DOI: 10.1371/journal.pntd.0007998] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 02/12/2020] [Accepted: 12/16/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Severe Strongyloides stercoralis infection in kidney transplant recipients is associated with considerable morbidity and mortality, although little is known about the risk factors for such infection. METHODOLOGY/PRINCIPAL FINDINGS This was a retrospective, multicenter, case-control study in which we assessed the risk factors for and clinical outcomes of severe S. stercoralis infections in kidney transplant recipients in Brazil. We included 138 kidney transplant recipients: 46 cases and 92 controls. Among the cases, the median number of days from transplantation to diagnosis was 117 (interquartile range [IQR], 73.5-965) and the most common clinical findings were gastrointestinal symptoms (in 78.3%) and respiratory symptoms (in 39.1%), whereas fever and eosinophilia were seen in only 32.6% and 43.5%, respectively. The 30-day all-cause mortality among the cases was 28.3% overall and was significantly higher among the cases of infection occurring within the first three months after transplantation (47% vs. 17.2%, P = 0.04). The independent risk factors were receiving a transplant from a deceased donor (odds ratio [OR] = 6.16, 95% confidence interval [CI] = 2.05-18.5), a history of bacterial infection (OR = 3.04, 95% CI = 1.2-7.5), and a cumulative corticosteroid dose (OR = 1.005, 95% CI = 1.001-1.009). The independent predictors of mortality were respiratory failure (OR = 98.33, 95% CI = 4.46-2169.77) and concomitant bacteremia (OR = 413.00, 95% CI = 4.83-35316.61). CONCLUSIONS/SIGNIFICANCE Severe S. stercoralis infections are associated with considerable morbidity and mortality after kidney transplantation. In endemic areas, such infection may occur late after transplantation, although it seems to be more severe when it occurs earlier after transplantation. Specific risk factors and clinical manifestations can identify patients at risk, who should receive prophylaxis or early treatment.
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Affiliation(s)
- Lísia Miglioli-Galvão
- Infectious Diseases Unit, Universidade Federal de São Paulo, São Paulo, Brazil
- * E-mail:
| | | | - Guilherme Lopes-Santoro
- Department of Preventive Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Álvaro Pacheco Silva
- Kidney Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Kidney Unit, Universidade Federal de São Paulo,São Paulo, Brazil
| | | | - Elias David Neto
- Kidney Transplant Unit, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Cely Saad Abboud
- Infectious Diseases Unit, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - João Ítalo Dias França
- Department of Epidemiology and Statistics, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | | | - Luci Corrêa
- Infectious Diseases Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luís Fernando Aranha Camargo
- Infectious Diseases Unit, Universidade Federal de São Paulo, São Paulo, Brazil
- Infectious Diseases Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Lapa Pedreira DA, Acacio GL, Gonçalves RT, Sá RAM, Brandt RA, Chmait RH, Kontopoulos EV, Quintero RA. Percutaneous fetoscopic closure of large open spina bifida using a bilaminar skin substitute. Ultrasound Obstet Gynecol 2018; 52:458-466. [PMID: 29314321 DOI: 10.1002/uog.19001] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/04/2017] [Accepted: 12/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We have described previously our percutaneous fetoscopic technique for the treatment of open spina bifida (OSB). However, approximately 20-30% of OSB defects are too large to allow primary skin closure. Here we describe a modification of our standard technique using a bilaminar skin substitute to allow closure of large spinal defects. The aim of this study was to report our clinical experience with the use of a bilaminar skin substitute and a percutaneous fetoscopic technique for the prenatal closure of large OSB defects. METHODS Surgery was performed between 24.0 and 28.9 gestational weeks with the woman under general anesthesia, using an entirely percutaneous fetoscopic approach with partial carbon dioxide insufflation of the uterine cavity, as described previously. If there was enough skin to be sutured in the midline, only a biocellulose patch was placed over the placode (single-patch group). In cases in which skin approximation was not possible, a bilaminar skin substitute (two layers: one silicone and one dermal matrix) was placed over the biocellulose patch and sutured to the skin edges (two-patch group). The surgical site was assessed at birth, and long-term follow-up was carried out. RESULTS Percutaneous fetoscopic OSB repair was attempted in 47 consecutive fetuses, but surgery could not be completed in two. Preterm prelabor rupture of membranes (PPROM) occurred in 36 of the 45 (80%) cases which formed the study group, and the mean gestational age at delivery was 32.8 ± 2.5 weeks. A bilaminar skin substitute was required in 13/45 (29%) cases; in the remaining 32 cases, direct skin-to-skin suture was feasible. There were 12 cases of myeloschisis, of which 10 were in the two-patch group. In all cases, the skin substitute was located at the surgical site at birth. In five of the 13 (38.5%) cases in the two-patch group, additional postnatal repair was needed. In the remaining cases, the silicone layer detached spontaneously from the dermal matrix (on average, 25 days after birth), and the lesion healed by secondary intention. The mean operating time was 193 (range, 83-450) min; it was significantly longer in cases requiring the bilaminar skin substitute (additional 42 min on average), although the two-patch group had similar PPROM rate and gestational age at delivery compared with the single-patch group. Complete reversal of hindbrain herniation occurred in 68% of the 28 single-patch cases and 33% of the 12 two-patch cases with this information available (P < 0.05). In four cases there was no reversal; half of these occurred in myeloschisis cases. CONCLUSIONS Large OSB defects may be treated successfully in utero using a bilaminar skin substitute over a biocellulose patch through an entirely percutaneous approach. Although the operating time is longer, surgical outcome is similar to that in cases closed primarily. Cases with myeloschisis seem to have a worse prognosis than do those with myelomeningocele. PPROM and preterm birth continue to be a challenge. Further experience is needed to assess the risks and benefits of this technique for the management of large OSB defects. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D A Lapa Pedreira
- Fetal Therapy Program, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - G L Acacio
- Obstetrics Department, University of Taubaté, Taubaté, Brazil
| | - R T Gonçalves
- Fetal Therapy Program, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - R A M Sá
- Fetal Medicine, Perinatal da Barra, Rio de Janeiro, Brazil
| | - R A Brandt
- Pediatric Neurosurgeon, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - R H Chmait
- The USFetus Research Consortium, Miami, Florida, USA
| | | | - R A Quintero
- The USFetus Research Consortium, Miami, Florida, USA
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Guimarães LFA, Halpern M, de Lemos AS, de Gouvêa EF, Gonçalves RT, da Rosa Santos MAA, Nucci M, Santoro-Lopes G. Invasive Fungal Disease in Renal Transplant Recipients at a Brazilian Center: Local Epidemiology Matters. Transplant Proc 2017; 48:2306-2309. [PMID: 27742285 DOI: 10.1016/j.transproceed.2016.06.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Invasive fungal disease (IFD) is an important complication after solid organ transplantation (SOT). A marked geographic variation in the epidemiology of IFD after kidney transplantation (KT) has been suggested by the results of previous studies. Nevertheless, data from Latin American centers are scarce. OBJECTIVE This study sought to describe the epidemiology of IFD at a Brazilian KT center. METHODS This study was a retrospective single-center cohort study that included patients who underwent KT between 1998 and 2009 and were followed up until July 2015. Cases of simultaneous kidney-pancreas transplantation were excluded. The primary study outcome was the occurrence of proven or probable IFD. RESULTS Among 908 KT recipients, 44 cases of IFD occurred in 42 patients (4.6%). Cryptococcus spp. infection, diagnosed in 16 cases (36.3%), was the leading cause of IFD, followed by histoplasmosis in 10 cases (22.7%) and invasive candidiasis in 10 (22.7%). Sporotrichosis, mucormycosis, invasive aspergillosis, pulmonary Cladophialophora sp. infection, trichosporonosis and Saccharomyces cerevisiae fungemia occurred in 1 recipient each (2.3%). Two additional (4.5%) cases of unspecified mold infections were identified by histopathological analysis. Most cases of IFD (67%) occurred later than 6 months after transplantation. Previous use of antilymphocyte antibodies (P = .008) and corticosteroid pulse therapy (P < .001) were more frequent among cases of IFD occurring within the first 6 months after transplantation. CONCLUSIONS The epidemiology of IFD in this Brazilian cohort was characterized by a large predominance of late infections and a high proportion of cases of cryptococcosis and histoplasmosis. These results highlight the considerable geographic variability of IFD epidemiology after KT.
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Affiliation(s)
- L F A Guimarães
- Department of Preventive Medicine, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil
| | - M Halpern
- Infectious Disease Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - A S de Lemos
- Infectious Disease Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - E F de Gouvêa
- Infectious Disease Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - R T Gonçalves
- Nephrology Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M A A da Rosa Santos
- Nephrology Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M Nucci
- Mycology Laboratory, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - G Santoro-Lopes
- Infectious Disease Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Franz C, Perez RDM, Zalis MG, Zalona ACJ, Rocha PTMDCEA, Gonçalves RT, Nabuco LC, Villela-Nogueira CA. Prevalence of occult hepatitis B virus infection in kidney transplant recipients. Mem Inst Oswaldo Cruz 2014; 108:657-60. [PMID: 23903984 PMCID: PMC3970606 DOI: 10.1590/0074-0276108052013019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 02/14/2013] [Indexed: 01/12/2023] Open
Abstract
In this cross-sectional study, 207 hepatitis B surface antigen (HBsAg)-negative kidney transplant recipients were evaluated based on demographic and epidemiological data and on the levels of serological markers of hepatitis B virus (HBV) and hepatitis C virus infection and liver enzymes. Patients with HBV or human immunodeficiency virus infection were excluded. Sera were analysed for the presence of HBV-DNA. HBV-DNA was detected in two patients (1%), indicating occult hepatitis B (OHB) infection (the HBV-DNA loads were 3.1 and 3.5 IU/mL in these patients). The results of the liver function tests were normal and no serological markers indicative of HBV infection were detected. The prevalence of OHB infection was low among kidney transplant recipients, most likely due to the low HBsAg endemicity in the general population of the study area.
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Affiliation(s)
- Cibele Franz
- Departamento de Clínica Médica, Serviço de Hepatologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
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de Lemos AS, Vieira MAMS, Halpern M, Quaresma RG, Borchardt AC, Santos MAAR, Gonçalves RT, Santoro-Lopes G. Results of implementation of preventive recommendations for tuberculosis after renal transplantation in an endemic area. Am J Transplant 2013; 13:3230-5. [PMID: 24119248 DOI: 10.1111/ajt.12470] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 03/05/2013] [Revised: 07/29/2013] [Accepted: 08/05/2013] [Indexed: 01/25/2023]
Abstract
This retrospective cohort study assessed the results of the implementation of preventive recommendations for tuberculosis (TB) among renal transplant recipients in an endemic area (Rio de Janeiro, Brazil). Subjects were defined as at high risk for TB if they had latent tuberculosis infection (LTBI), reported recent close contact with individuals with TB or received a graft from a donor with LTBI. A 6-month course of isoniazid preventive therapy (IPT) was targeted to high-risk subjects. The study end point was TB confirmed by culture. Altogether, 535 patients were included. Median follow-up was 59 months. The overall cumulative incidence of TB was 2.1% while among the 274 patients in whom the preventive protocol was fully implemented, the incidence was only 0.7%. The incidence of TB among 75 high-risk recipients not treated with isoniazid (7%) was significantly higher than that observed in 209 untreated low-risk patients (1%, p = 0.006) and in 65 high-risk subjects that received IPT (no case, p = 0.03). In conclusion, the implementation of preventive recommendations for TB in an endemic area allowed the appropriate discrimination between high- and low-risk renal transplant recipients and was associated with long-term reduction in the incidence of this complication among high-risk subjects.
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Affiliation(s)
- A S de Lemos
- Infectious Diseases Clinic, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil; Department of Preventive Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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de Gouvêa EF, Martins IS, Halpern M, Ferreira ALP, Basto ST, Gonçalves RT, Moreira BM, Santoro-Lopes G. The influence of carbapenem resistance on mortality in solid organ transplant recipients with Acinetobacter baumannii infection. BMC Infect Dis 2012; 12:351. [PMID: 23237530 PMCID: PMC3538523 DOI: 10.1186/1471-2334-12-351] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 12/10/2012] [Indexed: 01/12/2023] Open
Abstract
Background Infection with carbapenem-resistant Acinetobacter baumannii has been associated with high morbidity and mortality in solid organ transplant recipients. The main objective of this study was to assess the influence of carbapenem resistance and other potential risk factors on the outcome of A. baumannii infection after kidney and liver transplantation. Methods Retrospective study of a case series of A. baumannii infection among liver and renal transplant recipients. The primary outcome was death associated with A. baumannii infection. Multivariate logistic regression was used to assess the influence of carbapenem resistance and other covariates on the outcome. Results Forty-nine cases of A. baumannii infection affecting 24 kidney and 25 liver transplant recipients were studied. Eighteen cases (37%) were caused by carbapenem-resistant isolates. There were 17 (35%) deaths associated with A. baumannii infection. In unadjusted analysis, liver transplantation (p = 0.003), acquisition in intensive care unit (p = 0.001), extra-urinary site of infection (p < 0.001), mechanical ventilation (p = 0.001), use of central venous catheter (p = 0.008) and presentation with septic shock (p = 0.02) were significantly related to a higher risk of mortality associated with A. baumannii infection. The number of deaths associated with A. baumannii infection was higher among patients infected with carbapenem-resistant isolates, but the difference was not significant (p = 0.28). In multivariate analysis, the risk of A. baumannii-associated mortality was higher in patients with infection acquired in the intensive care unit (odds ratio [OR] = 34.8, p = 0.01) and on mechanical ventilation (OR = 15.2, p = 0.04). Appropriate empiric antimicrobial therapy was associated with significantly lower mortality (OR = 0.04, p = 0.03), but carbapenem resistance had no impact on it (OR = 0.73, p = 0.70). Conclusion These findings suggest that A. baumannii-associated mortality among liver and kidney transplant recipients is influenced by baseline clinical severity and by the early start of appropriate therapy, but not by carbapenem resistance.
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Affiliation(s)
- Erika Ferraz de Gouvêa
- Infectious Disease Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Justiniano da Rocha 201/302, Vila Isabel, CEP 20551-010, Rio de Janeiro, RJ, Brazil
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Zalona ACJ, Lopes GS, Schrago CG, Gonçalves RT, Zalis MG, Varella RB. Molecular characterization of BK polyomavirus subtypes in renal transplant recipients in Brazil. J Med Virol 2011; 83:1401-5. [PMID: 21678444 DOI: 10.1002/jmv.22117] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BK polyomavirus (BKV) is highly prevalent in the world population. Different reports indicate that BKV subtypes and subgroups present an uneven geographical distribution which might be correlated with human migration. However, there is a lack of data on the BKV subtype distribution in the South American population. The occurrence of BKV subtypes and subgroups detected in 51 kidney transplant recipients in Rio de Janeiro, Brazil is described. According to genetic studies, the population in this region descends mainly from European or African immigrants, with a relatively low genetic background from the Amerindians. By sequencing the VP1 region of BKV, subgroups Ib1 and Ia of subtype I were found in 34 (67%) and 15 (29%), respectively, of samples, while subtype II was present in 2 (4%) of the samples. Subtypes III and IV were not detected. Phylogenetic analysis indicated similarities between Brazilian BKV subgroup Ia and East African lineages; and subgroup Ib-1 with Asian and North American lineages, while subtype II samples were similar to sequences from Japan and the UK. This is the first report that describes distribution of BKV subtypes in South America. The high prevalence of BKV subgroup Ia probably reflects the high proportion of African descendants in this population. On the other hand, the predominance of subgroup Ib-1 and the absence of Ib-2 in an area with a high proportion of European ancestry was unexpected. Further studies in South American populations are needed to provide a better understanding of the epidemiology of BKV in this region.
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Affiliation(s)
- Ana Carolina Jonard Zalona
- Department of Preventive Medicine, Faculty of Medicine, Federal University of Rio de Janeiro, RJ, Brazil
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Santoro-Lopes G, de Lemos ADS, Halpern M, Gonçalves RT, Santos MAAR, Valiante PMN. Simultaneous cytomegalovirus and Mycobacterium tuberculosis infection presenting as hemorrhagic colitis 3 years after a kidney transplant. EXP CLIN TRANSPLANT 2011; 9:340-343. [PMID: 21967262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cytomegalovirus is an important cause of colonic disease in solid organ transplant recipients. Although several reports have shown that simultaneous infection with other pathogens may aggravate the course of cytomegalovirus colitis, to our knowledge, no case of colitis caused by simultaneous cytomegalovirus and Mycobacterium tuberculosis has been previously reported. We describe a case of hemorrhagic colitis associated with simultaneous cytomegalovirus/ Mycobacterium tuberculosis infection in a 26-year-old woman, 38 months after a kidney transplant. Initial results of histopathologic analyses of gastrointestinal biopsies showed that tuberculosis was the only cause of colitis, as no morphologic alteration suggestive of cytomegalovirus infection was observed on hematoxylin-eosin staining. However, further analysis with immunoperoxidase staining confirmed the clinical suspicion of cytomegalovirus infection. This report shows that cytomegalovirus/tuberculosis coinfection may be a cause of late-onset colitis among solid organ transplant recipients. It also illustrates that coinfection with other pathogens may pose an additional challenge for diagnosing gastrointestinal cytomegalovirus disease.
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Affiliation(s)
- Guilherme Santoro-Lopes
- Infectious Diseases Clinic, Hospital Universitario Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Tedesco-Silva H, Garcia VD, Contieri FLC, De Boni Monteiro de Carvalho D, Noronha IL, Gonçalves RT, de Paula FJ, Abbud-Filho M, Manfro RC, David-Neto E, Alfieri F, Ikehara E, Jiang Q, Tai SS, Medina-Pestana JO. Comparison of the safety and efficacy of cyclosporine minimization versus cyclosporine elimination in de novo renal allograft patients receiving sirolimus. Transplant Proc 2010; 42:1659-66. [PMID: 20620495 DOI: 10.1016/j.transproceed.2010.02.083] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 01/12/2010] [Accepted: 02/02/2010] [Indexed: 12/30/2022]
Abstract
The safety and efficacy of concentration-controlled use of sirolimus (SRL) and cyclosporine (CsA) followed by CsA minimization (CsAm) or elimination (CsAe) beginning at week 13 was compared in a phase 4, open-label, randomized (1:1) trial of renal transplant recipients enrolled between March 2004 and November 2005. The primary endpoint was renal function, measured at 12 months using the Nankivell formula, in patients remaining on therapy. Though a total enrollment of 140 patients in each group was planned to provide an 80% power to detect a difference in means, only 207 subjects were enrolled in this study. Demographic characteristics were similar between groups, with 98.1% recipients of first grafts, 69.1% from living donors, and 7.2% diabetics. At 12 months, there were no differences in renal function (61.08 vs 65.24 mL/min, P = .132); incidence of biopsy-confirmed acute rejection (14.3% vs 22.5%, P = .152); and patient (89.5% vs 92.2%, P = .632), graft (87.6% vs 88.2%, P = .999), and death-censored graft (98.1% vs 94.1%, P = .166) survivals between CsAm and CsAe groups, respectively. There were no differences in the overall rate of study-drug discontinuation (32.4% vs 36.3%, P = .562) but more patients discontinued because of lack of efficacy/graft loss in the CsAe group (4.8% vs 14.7%, P = .018). This study was underpowered to demonstrate the superiority of one regimen over the other. In summary, SRL immunotherapy combined with CsA minimization or elimination showed comparative safety and efficacy. Both regimens offer potential treatment options for de novo renal allograft recipients.
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Santos RL, De Farias MLF, De Mendonça LMC, Gonçalves RT, Martins MA, De Souza MMG. Effects of immunosuppressant FK-506 on tooth movement. Orthod Craniofac Res 2010; 13:153-61. [DOI: 10.1111/j.1601-6343.2010.01489.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Schettino CDS, Siqueira Filho AG, Domingues RC, Kuroki I, Deus FCCD, Gonçalves RT, Torres HM, Gasparetto E, Pacheco LC, Rocha E. Evaluation of atherosclerosis in renal transplanted patients by non-invasive methods. Arq Bras Cardiol 2009; 92:339-44, 356-61, 369-74. [PMID: 19629288 DOI: 10.1590/s0066-782x2009000500006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 06/03/2008] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Endothelial dysfunction can be considered an early atherogenic event. OBJECTIVE To assess atherosclerosis in renal transplanted patients through the coronary calcium score, carotid duplex scan and brachial reactivity through ultrasonography. METHODS We assessed 30 renal transplanted male patients with stable renal function, with a mean age of 41.3 years. RESULTS The detection of the atherosclerotic load in this population was very significant when the brachial reactivity technique was used (86.7%); it was less frequent when based on the presence of carotid plaque (33.3%) or the coronary calcium score (20%). The carotid plaque was considered when the thickness was > 12 mm. The coronary calcium score was abnormal when > 80 according to the Agatston scale, being observed in a low percentage of patients (21.7%), possibly due to the fact that the tomography is not the ideal method to detect atherosclerosis in renal patients, as it does not differentiates intimal calcifications of the medial layer. The adequate clinical control, the low age range and the factors related to the time of pre-transplant dialysis or the anti-inflammatory effect of the post-transplant drugs can delay the onset of the calcifications. CONCLUSION The evaluation of the atherosclerotic load through the carotid duplex scan (33,3%) and the coronary calcium score (20%) was not frequent; there was no correlation with the high rate of endothelial dysfunction detection observed with the brachial reactivity assessment (86.7%).
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Silva LFD, Marinho ACDO, Gonçalves RT, Ferreira FB. Pseudo-aneurisma arterial pós-transplante renal. Rev Col Bras Cir 2006. [DOI: 10.1590/s0100-69912006000600016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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15
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Azevedo LS, Castro MCR, Monteiro de Carvalho DB, d'Avila DO, Contieri F, Gonçalves RT, Manfro R, Ianhez LE. Incidence of delayed graft function in cadaveric kidney transplants in Brazil: a multicenter analysis. Transplant Proc 2006; 37:2746-7. [PMID: 16182798 DOI: 10.1016/j.transproceed.2005.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To evaluate the frequency of delayed graft function (DGF) in kidney transplant centers in Brazil, we sent a questionnaire requesting information on the number of cadaveric donor kidney transplants performed during the years 2000, 2001, and 2002, the number of early nonfunctioning grafts, and the number of patients on dialysis during the first posttransplant week with subsequent recovery. Among all centers performing more than 50 kidney transplants during the last year of evaluation, 6, performing 612 cadaveric kidney transplants during the study period, replied to the questionnaire. Sixty procedures (9.7%) resulted in nonfunctioning grafts, while 312 (55.6%) patients required dialysis during the first Ptx week: 216 (53.9%) in 2000, 189 (62.3%) in 2001, and 216 (51.6%) in 2002. The frequency of DGF during the study period was higher than that noted by several previous foreign studies. To better evaluate the possible causes of this finding, a more extensive and focused study is warranted.
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Affiliation(s)
- L S Azevedo
- Hospital das Clinicas da Faculdade de Medicina da USP
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16
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Santoro-Lopes G, Halpern M, Gonçalves RT. Perinephric abscess caused by Streptococcus agalactiae after renal transplantation. J Infect 2005; 51:e145-7. [PMID: 16230194 DOI: 10.1016/j.jinf.2004.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2004] [Accepted: 11/19/2004] [Indexed: 11/25/2022]
Abstract
We describe the case of a 37 year-old diabetic woman who presented with a multiloculated perinephric abscess caused by Streptococcus agalactiae 12 months after receiving a living-related kidney graft. Infection was successfully treated with surgical drainage and a four-week course of antibiotic therapy. To our knowledge, this is the first report of a perinephric abscess caused by this agent in a renal transplant recipient.
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Affiliation(s)
- Guilherme Santoro-Lopes
- Department of Preventive Medicine, Infectious Diseases Clinic, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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17
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Martins FPP, Souza SAL, Gonçalves RT, Fonseca LMB, Gutfilen B. Preliminary results of [99mTc]OKT3 scintigraphy to evaluate acute rejection in renal transplants. Transplant Proc 2005; 36:2664-7. [PMID: 15621118 DOI: 10.1016/j.transproceed.2004.09.085] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Allograft rejection can be classified as humoral or cellular mechanisms. Accurate diagnosis of acute rejection remains a formidable challenge in renal transplantation. The need to avoid unnecessary immunosuppressive therapy to treat this complication has led to a continued search for improved diagnostic methods to evaluate and identify postoperative episodes. Here we evaluated the use of [(99m)Tc]OKT3 scintigraphy to diagnose acute rejection in renal transplants. Among 22 patients undergoing renal transplant, we observed an increased [(99m)Tc]OKT3 kidney uptake with the passage of time in patients with rejecting allografts. These findings agreed with those of biopsies. We suggest the [(99m)Tc]OKT3 scans may be useful for the monitoring of renal transplants to detect acute rejection.
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Affiliation(s)
- F P P Martins
- Universidade Federal do Rio de Janeiro, 21941-590 Rio de Janeiro, Brazil
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18
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Souza SALD, Martins FPP, Gonçalves RT, Pontes DS, Carvalho ACP, Fonseca LMBD, Gutfilen B. Avaliação de transplantes renais utilizando-se 99mTc-leucócitos mononucleares. Radiol Bras 2004. [DOI: 10.1590/s0100-39842004000100005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A rejeição aguda do enxerto renal deve ser diagnosticada precocemente, uma vez que a reversibilidade da rejeição está relacionada com a rapidez na qual o tratamento é iniciado. Os objetivos deste estudo foram: 1) estabelecer um método quantitativo para avaliação da rejeição e necrose tubular aguda (NTA) do rim transplantado; 2) determinar o papel em potencial da cintilografia com leucócitos mononucleares marcados com tecnécio-99m no diagnóstico precoce da rejeição do rim transplantado e no diagnóstico diferencial da NTA. Cento e sessenta estudos cintilográficos foram realizados no primeiro e no quinto dia pós-operatório em 80 pacientes transplantados. Células autólogas foram utilizadas para marcação. Imagens foram obtidas 30 minutos, 3 horas e 24 horas após injeção de 444 MBq (12 mCi) das células marcadas. Houve captação anormal das células marcadas em 27 de 31 casos de rejeição e em seis de oito casos de NTA. Os resultados foram comparados com a clínica de cada paciente. Ultra-sonografias com Doppler detectaram 18 de 31 casos de rejeição. A sensibilidade e a especificidade para rejeição foram, respectivamente, de 87,1% e 100% para a cintilografia e 58,1% e 100% para a ultra-sonografia. Foram realizadas biópsias em oito pacientes, que mostraram sete rejeições e uma NTA. Os resultados sugerem que a cintilografia com leucócitos mononucleares marcados com tecnécio-99m pode ser útil no diagnóstico de rejeição e diagnóstico diferencial de NTA.
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Abstract
The fungus Fusarium sacchari was isolated repeatedly from the blood of an immunosuppressed host. The infection was treated successfully with a small dose of amphotericin B. The strain was resistant to this antifungal in vitro. MICs and minimum fungicidal concentrations of six antifungals for the clinical isolate are provided. To our knowledge, this is the first report involving this fungus in a case of fungemia.
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Affiliation(s)
- J Guarro
- Unitat de Microbiologia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201-Reus, Tarragona, Spain.
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Bruck I, Antoniuk SA, da Cunha FB, Gonçalves RT, Hamamoto GI, Scola RH, Werneck LC. [Idiopathic lumbosacral plexus neuropathy in child. Case report]. Arq Neuropsiquiatr 1996; 54:683-6. [PMID: 9201354 DOI: 10.1590/s0004-282x1996000400022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We describe a lumbosacral plexus neuropathy case in childhood in which detailed investigation, including electromyography and magnetic resonance imaging, was normal. Muscle biopsy showed mild denervation. No underlying condition was detected. The patient presented with pain, weakness and light atrophy in left lower limb, reduced reflex at the ankle, loss of the quadriceps reflex and paresthesy in involved limb. Recovery after one year was almost complete, with persistent slight weakness and atrophy.
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Affiliation(s)
- I Bruck
- Departamento de Pediatria e Neurologia (Serviço de Doenças Neuromusculares), Universidade Federal do Paraná, Curitiba, Brasil
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