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Franco A, Hernandez D, Zarraga S, Fructuoso AS, Crespo M, Mazuecos A, Corte CD, Benot AR, Ruiz JC, Beneyto I. Lymphoproliferative disorders after renal transplantation along 2 decades: a large longitudinal study of 21.546 recipients. Nefrologia 2023; 43:427-434. [PMID: 37813738 DOI: 10.1016/j.nefroe.2023.09.001] [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: 12/09/2021] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 10/11/2023] Open
Abstract
INTRODUCTION Post transplant lymphoproliferative disorders (PTLD) are heterogeneous lymphoid proliferations in recipients of solid organs which seem to be related to Epstein Barr Virus (EBV). The use of antilymphocyte antibodies, EBV seronegativity in the recipient,acute rejection and CMV infection have been identified as classical risk factors. MATERIAL Y METHODS We have studied in a retrospective observational study, the incidence of PTLD in a period of 22 years, its relationship with EBV, presence of classical risk factors and outcome in 21546 simple adult renal transplant recipients from cadaveric and living donors, transplanted in 21 hospitals from 1990 to 2009. RESULTS A total of 275 recipients developed PTLD (1,2%),195 males (70,9%), 80 females (29,1%) aged 59.2 (p25 44.7 p75 68)years. Two hundred forty-five (89.0%) were 1st transplant recipients and 269 (97,8%) from cadaveric donors. EBV in the tissue was reported in 94 out of the 155 studied recipients (60.6%) and 86.0% of the proliferations were due to B lymphocytes. PTLD median appearance after transplant were 42.months (p25, 75, 12, 77, 5). One hundred eighty-eight recipients out of 275 patients (68.3%) had any classical risk factor and the use of antilymphocyte antibodies was the most frequent. During the follow-up, 172 patients died (62,5%) and 103 (37,5%) had a complete remission. The main cause of death was PTLD progression (n = 91, 52,9%), followed by sepsis (n = 24, 13,9%). The follow-up period post-transplant of the recipients was between 3 and 22 years. The incidence was 0,14% during the first year post-trasplant and 0.98% the cumulative incidence at 10 years. Patient survival after diagnosis was 51%, 44% and 39% after 1, 2 and 5 years, respectively. Finally, overall graft survival was 48%, 39% and 33% at the same periods. CONCLUSION PTLD has a low incidence in renal transplant recipients. Most of the proliferations are due to B lymphocytes and seem to have a close relationship with EBV. PTLD can develop in the absence of classical risk factors. The prognosis is poor, mainly due to PTLD progression, but the survivors can even maintain their grafts.
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Affiliation(s)
- Antonio Franco
- Servicio de Nefrología, Hospital General de Alicante, Alicante, Spain.
| | | | - Sofia Zarraga
- Servicio de Nefrologia, Hospital de Cruces, Baracaldo, Vizcaya, Spain
| | | | - Marta Crespo
- Servicio de Nefrologia, Hospital del Mar, Barcelona, Spain
| | | | | | | | - Juan Carlos Ruiz
- Servicio de Nefrologia, Hospital Marque de Valdecilla, Santander, Cantabria, Spain
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Franco A, Mas-Serrano P, Gonzalez Y, Andres A, Zarraga S, Esforzado N, Alonso A, Gonzalez-Roncero F, Hernandez D, Beneyto I. There Are 33,784 Functioning Kidney Grafts in Spain: Who Monitors Them and How? Transplant Proc 2021; 53:2672-2674. [PMID: 34615600 DOI: 10.1016/j.transproceed.2021.07.057] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/16/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND As of December 31, 2018, Spain's National Transplant Organization estimated that there were 61,764 people under renal replacement therapy across the country. Of this population, 33,784 (54.7%) had a functioning kidney graft. METHODS Through the use of a survey to all Spanish hospitals involved in kidney transplantations, we studied the distribution of these recipients nationally, along with who was monitoring them and how. Data collected include the ratio of recipients to transplant nephrologists, median number of recipients followed in each center, and median number of transplant nephrologists per hospital. Of the 806 centers in the Spanish hospital network, 43 (5.3%) were involved in kidney transplants, including 39 transplant hospitals and 4 associated hospitals. The median number of transplants per center was 800 (interquartile range [IQR] = 510-1200). There were 3 nephrologists (IQR 2-5), and the ratio of recipients to transplant nephrologists was 270 (IQR = 190-323). RESULTS There were no significant differences in these data between autonomous communities, except in the case of the Canary Islands, which had a significantly lower ratio of recipients to transplant nephrologists (146; IQR = 100-185) compared with the rest of the country (ratio 277; IQR = 207-329; P < .001). Of the 39 hospitals, 29 (74.4%) referred patients to centers that did not perform transplants. CONCLUSIONS All in all, few Spanish hospitals perform kidney transplants. The ratio of recipients to transplant nephrologists is very high, compelling most hospitals to refer patients to nontransplant hospitals for follow-up. There are important differences in the distribution of recipients in hospitals in the Canary Islands vs the rest of the country, a difference that is undoubtedly attributable to its geographic peculiarities.
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Affiliation(s)
- Antonio Franco
- Department of Nephrology, Hospital General Universitario, Alicante, Spain.
| | | | - Yussel Gonzalez
- Department of Nephrology, Hospital General Universitario, Alicante, Spain
| | - Amado Andres
- Department of Nephrology, Hospital 12 Octubre, Madrid, Spain
| | - Sofia Zarraga
- Department of Nephrology, Hospital Cruces, Bilbao, Spain
| | | | - Angel Alonso
- Department of Nephrology, Hospital CUN, La Coruña, Spain
| | | | | | - Isabel Beneyto
- Department of Nephrology, Hospital La Fe, Valencia, Spain
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Gentil MA, González-Corvillo C, Perelló M, Zarraga S, Jiménez-Martín C, Lauzurica LR, Alonso A, Franco A, Hernández-Marrero D, Sánchez-Fructuoso A. Hepatitis C Treatment With Direct-Acting Antivirals in Kidney Transplant: Preliminary Results From a Multicenter Study. Transplant Proc 2017; 48:2944-2946. [PMID: 27932113 DOI: 10.1016/j.transproceed.2016.07.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/27/2016] [Indexed: 01/27/2023]
Abstract
Hepatitis C (HC) is a very relevant negative prognosis factor for graft and transplant recipient survival. New direct-acting antivirals (DAAs) allow us to solve this problem in an effective way. It is crucial to understand their real impact in our daily practice. We analyzed treatment results with DAA, free of interferon, in kidney transplant recipients (KTRs) from 15 Spanish hospitals (Grupo Español de Actualización en Trasplante), regarding effectiveness, tolerance, and impact on immunosuppression, renal function-proteinuria, and diabetes. One hundred nineteen KTRs were included (9 combined liver-kidney transplants). The main DAA used was sofobusvir (91%) combined with ledipasvir (55%), simeprevir (14%), or daclatasvir (13%); in 9 cases (7%), a paritaprevir-ritonavir-ombitasvir-dasabuvir combination (3D) was used; Ribavirin was used as a coadjuvant in 18%. Side effects were limited (23.5%) and without relevance in general, except in 7 patients for whom we needed to interrupt the treatment due to neurotoxicity (1) caused by drug interaction (3D and tacrolimus) or anemia (3) by Ribavirin or others. Ninety-four patients had completed the treatment when data were analyzed: virological response was seen in 97.8% % of cases. Liver function analysis improved: 84% normal versus 21% before starting the treatment (P < .001). Renal function and proteinuria did not change. Tacrolimus level at the end of DAA-treatment was significantly lower with respect to the beginning (5.8 ± 2.1 ng/mL vs. 7.4 ± 1.8 ng/mL, P = .03), despite a slight increase in the dose (2.6 mg/d vs. 2.3 mg/d, P = .17). DAA are highly effective in the treatment of hepatitis C in KTRs with good tolerance in general, making it possible to solve the problem and have a good chance to improve the prognosis in our transplantation patients. The use of these therapies in KTRs requires special control and coordination with digestive professionals, especially if 3D or Ribavirin is used.
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Affiliation(s)
- M A Gentil
- Department of Nephrology, Hospital Virgen Del Rocio, Sevilla, Spain
| | | | - M Perelló
- Department of Nephrology, Hospital Vall D'Hebron, Barcelona, Spain
| | - S Zarraga
- Department of Nephrology, Hospital De Cruces, Baracaldo, Spain
| | | | - L R Lauzurica
- Department of Nephrology, Hospital Germans Trias I Pujol, Badalona, Spain
| | - A Alonso
- Department of Nephrology, Complejo Hospitalario De A Coruña, A Coruña, Spain
| | - A Franco
- Department of Nephrology, Hospital San Juan, Alicante, Spain
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Gentil Govantes MA, Gonzalez Corvillo C, Sanchez Fructuoso A, Perello Carrascosa M, Zarraga S, Jimenez C, Beneyto I, Rodriguez Benot A, Alonso Hernandez A, Hernandez D, Franco A, Crespo M, Mazuecos MA. SP775DIRECT-ACTING ANTIVIRALS IN KIDNEY TRANSPLANT RECIPIENTS WITH HEPATITIS C VIRUS INFECTION: A SPANISH MULTICENTER STUDY. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx158.sp775] [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: 11/14/2022] Open
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Portolés Pérez J, Lafuente O, Sánchez-Sobrino B, Pérez Sáez M, Fernández García A, Llamas F, López-Sánchez P, Rodriguez-Ferrero M, Zarraga S, Ramos A, Pascual J. Kidney Transplantation With Organs From Donors After Circulatory Death Type 3: A Prospective Multicentric Spanish Study (GEODAS 3). Transplant Proc 2015; 47:27-9. [DOI: 10.1016/j.transproceed.2014.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mazuecos A, Fernandez A, Zarraga S, Andres A, Rodriguez-Benot A, Jimenez C, Gomez E, Paul J, Jimeno L, Fernandez C, Burgos D, Sanchez-Fructuoso A, Guirado L. High incidence of delayed graft function in HIV-infected kidney transplant recipients. Transpl Int 2013; 26:893-902. [DOI: 10.1111/tri.12147] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 05/08/2013] [Accepted: 06/14/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Ana Fernandez
- Renal Transplant Unit; Hospital Ramon y Cajal; Madrid; Spain
| | - Sofia Zarraga
- Renal Transplant Unit; Hospital de Cruces; Barakaldo; Spain
| | - Amado Andres
- Renal Transplant Unit; Hospital Doce de Octubre; Madrid; Spain
| | | | | | - Ernesto Gomez
- Renal Transplant Unit; Hospital Central de Asturias; Oviedo; Spain
| | - Javier Paul
- Renal Transplant Unit; Hospital Miguel Servet; Zaragoza; Spain
| | - Luisa Jimeno
- Renal Transplant Unit; Hospital Virgen de la Arrixaca; Murcia; Spain
| | | | - Dolores Burgos
- Renal Transplant Unit; Hospital Carlos Haya; Malaga; Spain
| | | | - Lluis Guirado
- Renal Transplant Unit; Fundacion Puigvert; Barcelona; Spain
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Olaverri J, Christian JM, Elorrieta P, Esnaola K, Rodríguez P, Marrón I, Uriarte I, Landa M, Zarraga S, Gainza F, Aranzabal J, Zabala J, Pertusa C. Utilization of Advanced-Age Donors in Renal Transplantation. Transplant Proc 2011; 43:3340-3. [DOI: 10.1016/j.transproceed.2011.09.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Mazuecos A, Fernandez A, Andres A, Gomez E, Zarraga S, Burgos D, Jimenez C, Paul J, Rodriguez-Benot A, Fernandez C. HIV infection and renal transplantation. Nephrol Dial Transplant 2010; 26:1401-7. [DOI: 10.1093/ndt/gfq592] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Urbizu JM, Amenabar JJ, Gomez-Ullate P, Zarraga S, Lampreabe I. Immunosuppression using tacrolimus/mycophenolate versus neoral/mycophenolate following kidney transplantation: a single-center experience. Transplant Proc 2002; 34:87-8. [PMID: 11959197 DOI: 10.1016/s0041-1345(01)02679-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J M Urbizu
- Department of Nephrology, Hospital de Cruces, Barakaldo, Bizkaia, Spain
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Garamendi I, Montejo M, Cancelo L, Lopez L, Aguirrebengoa K, Martín A, Zarraga S. Encephalitis caused by Epstein-Barr virus in a renal transplant recipient. Clin Infect Dis 2002; 34:287-8. [PMID: 11740719 DOI: 10.1086/323008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Zarraga S, Gainza FJ, Vallo A. Assessment of distal tubular function in Gitelman's syndrome. Pediatr Nephrol 1994; 8:262. [PMID: 8018511 DOI: 10.1007/bf00865498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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