1
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Frutos MÁ, Crespo M, Valentín MDLO, Alonso-Melgar Á, Alonso J, Fernández C, García-Erauzkin G, González E, González-Rinne AM, Guirado L, Gutiérrez-Dalmau A, Huguet J, Moral JLLD, Musquera M, Paredes D, Redondo D, Revuelta I, Hofstadt CJVD, Alcaraz A, Alonso-Hernández Á, Alonso M, Bernabeu P, Bernal G, Breda A, Cabello M, Caro-Oleas JL, Cid J, Diekmann F, Espinosa L, Facundo C, García M, Gil-Vernet S, Lozano M, Mahillo B, Martínez MJ, Miranda B, Oppenheimer F, Palou E, Pérez-Saez MJ, Peri L, Rodríguez O, Santiago C, Tabernero G, Hernández D, Domínguez-Gil B, Pascual J. Erratum to "Recommendations for living donor kidney transplantation". Nefrologia 2023:S2013-2514(23)00024-X. [PMID: 36842855 DOI: 10.1016/j.nefroe.2023.02.001] [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] [Received: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/28/2023] Open
Affiliation(s)
| | - Marta Crespo
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | | | | | - Juana Alonso
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | | | - Esther González
- Nephrology Department, Hospital Universitario 12 Octubre, Spain
| | | | - Lluis Guirado
- Nephrology Department, Fundacio Puigvert, Barcelona, Spain
| | | | - Jorge Huguet
- RT Surgical Team, Fundació Puigvert, Barcelona, Spain
| | | | - Mireia Musquera
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | - David Paredes
- Donation and Transplantation Coordination Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Ignacio Revuelta
- Nephrology and RT Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Antonio Alcaraz
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Manuel Alonso
- Regional Transplantation Coordination, Seville, Spain
| | | | - Gabriel Bernal
- Nephrology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Alberto Breda
- RT Surgical Team, Fundació Puigvert, Barcelona, Spain
| | - Mercedes Cabello
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | - Joan Cid
- Apheresis and Cell Therapy Unit, Haemotherapy and Haemostasis Department, Hospital Clinic Universitari, Barcelona, Spain
| | - Fritz Diekmann
- Nephrology and RT Department, Hospital Clinic Universitari, Barcelona, Spain
| | - Laura Espinosa
- Paediatric Nephrology Department, Hospital La Paz, Madrid, Spain
| | - Carme Facundo
- Nephrology Department, Fundacio Puigvert, Barcelona, Spain
| | | | | | - Miquel Lozano
- Apheresis and Cell Therapy Unit, Haemotherapy and Haemostasis Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | | | | | | | - Eduard Palou
- Immunology Department, Hospital Clinic i Universitari, Barcelona, Spain
| | | | - Lluis Peri
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | | | - Guadalupe Tabernero
- Nephrology Department, Servicio de Nefrología, Hospital Universitario de Salamanca, Spain
| | - Domingo Hernández
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | - Julio Pascual
- Nephrology Department, Hospital del Mar, Barcelona, Spain
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2
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Frutos MÁ, Crespo M, Valentín MDLO, Alonso-Melgar Á, Alonso J, Fernández C, García-Erauzkin G, González E, González-Rinne AM, Guirado L, Gutiérrez-Dalmau A, Huguet J, López del Moral JL, Musquera M, Paredes D, Redondo D, Revuelta I, Van-der Hofstadt CJ, Alcaraz A, Alonso-Hernández Á, Alonso M, Bernabeu P, Bernal G, Breda A, Cabello M, Caro-Oleas JL, Cid J, Diekmann F, Espinosa L, Facundo C, García M, Gil-Vernet S, Lozano M, Mahillo B, Martínez MJ, Miranda B, Oppenheimer F, Palou E, Pérez-Saez MJ, Peri L, Rodríguez O, Santiago C, Tabernero G, Hernández D, Domínguez-Gil B, Pascual J. Fe de errores de «Recomendaciones para el trasplante renal de donante vivo». Nefrologia 2023. [DOI: 10.1016/j.nefro.2023.01.012] [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: 02/06/2023] Open
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3
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Frutos MÁ, Crespo M, Valentín MDLO, Alonso-Melgar Á, Alonso J, Fernández C, García-Erauzkin G, González E, González-Rinne AM, Guirado L, Gutiérrez-Dalmau A, Huguet J, Moral JLLD, Musquera M, Paredes D, Redondo D, Revuelta I, Hofstadt CJVD, Alcaraz A, Alonso-Hernández Á, Alonso M, Bernabeu P, Bernal G, Breda A, Cabello M, Caro-Oleas JL, Cid J, Diekmann F, Espinosa L, Facundo C, García M, Gil-Vernet S, Lozano M, Mahillo B, Martínez MJ, Miranda B, Oppenheimer F, Palou E, Pérez-Saez MJ, Peri L, Rodríguez O, Santiago C, Tabernero G, Hernández D, Domínguez-Gil B, Pascual J. Recommendations for living donor kidney transplantation. Nefrologia 2022; 42 Suppl 2:5-132. [PMID: 36503720 DOI: 10.1016/j.nefroe.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 06/17/2023] Open
Abstract
This Guide for Living Donor Kidney Transplantation (LDKT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this Guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes. Moreover, the role of living donors in the current KT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDKT, offer additional ways to treat renal patients with an incompatible donor. Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations. This Guide does not forget that LDKT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able take them into account. Experience over recent years has led to progress in risk analysis, to protect donors' health. This aspect always has to be taken into account by LDKT programmes when evaluating potential donors. Finally, this Guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees.
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Affiliation(s)
| | - Marta Crespo
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | | | | | - Juana Alonso
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | | | - Esther González
- Nephrology Department, Hospital Universitario 12 Octubre, Spain
| | | | - Lluis Guirado
- Nephrology Department, Fundacio Puigvert, Barcelona, Spain
| | | | - Jorge Huguet
- RT Surgical Team, Fundació Puigvert, Barcelona, Spain
| | | | - Mireia Musquera
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | - David Paredes
- Donation and Transplantation Coordination Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Ignacio Revuelta
- Nephrology and RT Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Antonio Alcaraz
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Manuel Alonso
- Regional Transplantation Coordination, Seville, Spain
| | | | - Gabriel Bernal
- Nephrology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Alberto Breda
- RT Surgical Team, Fundació Puigvert, Barcelona, Spain
| | - Mercedes Cabello
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | - Joan Cid
- Apheresis and Cell Therapy Unit, Haemotherapy and Haemostasis Department, Hospital Clinic Universitari, Barcelona, Spain
| | - Fritz Diekmann
- Nephrology and RT Department, Hospital Clinic Universitari, Barcelona, Spain
| | - Laura Espinosa
- Paediatric Nephrology Department, Hospital La Paz, Madrid, Spain
| | - Carme Facundo
- Nephrology Department, Fundacio Puigvert, Barcelona, Spain
| | | | | | - Miquel Lozano
- Apheresis and Cell Therapy Unit, Haemotherapy and Haemostasis Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | | | | | | | - Eduard Palou
- Immunology Department, Hospital Clinic i Universitari, Barcelona, Spain
| | | | - Lluis Peri
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | | | | | - Domingo Hernández
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | - Julio Pascual
- Nephrology Department, Hospital del Mar, Barcelona, Spain.
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4
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Toapanta N, Jiménez S, Molina-Gómez M, Maruri-Kareaga N, Llinàs-Mallol L, Villanego F, Facundo C, Rodríguez-Ferrero M, Montero N, Vázquez-Sanchez T, Gutiérrez-Dalmau A, Beneyto I, Franco A, Vicente AH, Pérez-Tamajon ML, Martin P, Ramos-Verde AM, Castañeda Z, Bestard O, Moreso F. Induction immunosuppression and outcome in kidney transplant recipients with early COVID-19 after transplantation. Clin Kidney J 2022; 15:2039-2045. [PMCID: PMC9129170 DOI: 10.1093/ckj/sfac112] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
COVID-19 in kidney transplants has a high risk of complications and mortality, especially in older recipients diagnosed during the early period after transplantation. Management of immunosuppression has been challenging during the pandemic. We investigated the impact of induction immunosuppression, either basiliximab or thymoglobulin, on the clinical evolution of kidney transplants developing COVID-19 during the early period after transplantation. Kidney transplant recipients with less than 6 months with a functioning graft diagnosed of COVID-19 from the initial pandemic outbreak (March 2020) until July 31st, 2021 from different Spanish centers participating in a nationwide registry. A total of 127 patients from 17 Spanish centers developed COVID-19 during the first 6 months after transplantation, 73 (57.5%) received basiliximab and 54 (42.5%) thymoglobulin. Demographics were not different between groups but patients receiving thymoglobulin were more sensitized (cPRA of 32.7±40.8% vs. 5.6±18.5%) and were more frequently re-transplants (30% vs. 4%). Recipients older than 65 years treated with thymoglobulin showed the highest rate of acute respiratory distress syndrome (64.7% vs. 37.1% for older recipients receiving thymoglobulin and basiliximab [p<0.05], and 23.7% and 18.9% for young recipients receiving basiliximab and thymoglobulin [p>0.05]) and the poorest survival (mortality rate of 64.7% and 42.9% for older recipients treated with thymoglobulin and basiliximab, respectively [p<0.05], and 8.1% and 10.5% for young recipients treated with thymoglobulin and basiliximab [p>0.05]). Older recipients treated with thymoglobulin showed the poorest survival in the Cox's regression model adjusted for comorbidities. Thus, thymoglobulin should be used with caution in older recipients during the present pandemic era.
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Affiliation(s)
- Néstor Toapanta
- Kidney Transplant Unit, Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sara Jiménez
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - María Molina-Gómez
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - Naroa Maruri-Kareaga
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario de Cruces, Barakaldo, Spain
| | - Laura Llinàs-Mallol
- Kidney Transplant Unit, Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Florentino Villanego
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Carme Facundo
- Kidney Transplant Unit, Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Marisa Rodríguez-Ferrero
- Kidney Transplant Unit, Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Nuria Montero
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Teresa Vázquez-Sanchez
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario Regional de Malaga, Spain
| | - Alex Gutiérrez-Dalmau
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Isabel Beneyto
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario la Fe, Valencia, Spain
| | - Antonio Franco
- Kidney Transplant Unit, Nephrology Department, Hospital General Universitario de Alicante, Spain
| | - Ana Hernández Vicente
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Lourdes Pérez-Tamajon
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Paloma Martin
- Kidney Transplant Unit, Nephrology Department, Clínica Universitaria de Navarra, Spain
| | | | - Zaira Castañeda
- Kidney Transplant Unit, Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Bestard
- Kidney Transplant Unit, Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Moreso
- Kidney Transplant Unit, Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
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5
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Budde K, Rostaing L, Maggiore U, Piotti G, Surace D, Geraci S, Procaccianti C, Nicolini G, Witzke O, Kamar N, Albano L, Büchler M, Pascual J, Gutiérrez-Dalmau A, Kuypers D, Wekerle T, Głyda M, Carmellini M, Tisone G, Midtvedt K, Wennberg L, Grinyó JM. Prolonged-Release Once-Daily Formulation of Tacrolimus Versus Standard-of-Care Tacrolimus in de novo Kidney Transplant Patients Across Europe. Transpl Int 2022; 35:10225. [PMID: 36017158 PMCID: PMC9397503 DOI: 10.3389/ti.2021.10225] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 11/12/2021] [Accepted: 12/27/2021] [Indexed: 11/24/2022]
Abstract
Background: Tacrolimus is the calcineurin inhibitor of choice for preventing acute rejection episodes in kidney transplant patients. However, tacrolimus has a narrow therapeutic range that requires regular monitoring of blood concentrations to minimize toxicity. A new once-daily tacrolimus formulation, LCP-tacrolimus (LCPT), has been developed, which uses MeltDose™ drug-delivery technology to control drug release and enhance overall bioavailability. Our study compared dosing of LCPT with current standard-of-care tacrolimus [immediate-release tacrolimus (IR-Tac) or prolonged-release tacrolimus (PR-Tac)] during the 6 months following de novo kidney transplantation. Comparisons of graft function, clinical outcomes, safety, and tolerability for LCPT versus IR-Tac/PR-Tac were also performed. Methods: Standard immunological risk patients with end-stage renal disease who had received a de novo kidney transplant were randomized (1:1) to LCPT (N = 200) or IR-Tac/PR-Tac (N = 201). Results: Least squares (LS) mean tacrolimus total daily dose from Week 3 to Month 6 was significantly lower for LCPT than for IR-Tac/PR-Tac. Although LS mean tacrolimus trough levels were significantly higher for LCPT than IR-Tac/PR-Tac, tacrolimus trough levels remained within the standard reference range for most patients. There were no differences between the groups in treatment failure measures or safety profile. Conclusion: LCPT can achieve similar clinical outcomes to other tacrolimus formulations, with a lower daily dose. Clinical Trial Registration:https://clinicaltrials.gov/, identifier NCT02432833.
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Affiliation(s)
- Klemens Budde
- Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
- *Correspondence: Klemens Budde,
| | - Lionel Rostaing
- Service de Néphrologie, Dialyse, Aphérèses et Transplantation, CHU Grenoble Alpes, Grenoble, France
| | - Umberto Maggiore
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | | | | | | | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, Universitätsmedizin Essen, University of Duisburg-Essen, Essen, Germany
| | - Nassim Kamar
- Departments of Nephrology and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR–BMT, Université Paul Sabatier, Toulouse, France
| | - Laetitia Albano
- Unité de Transplantation Rénale, Hôpital Pasteur 2, CHU Nice, Nice, France
| | - Matthias Büchler
- Service de Néphrologie et Transplantation Rénale, CHRU de Tours, Tours, France
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Alex Gutiérrez-Dalmau
- Department of Nephrology, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
| | - Dirk Kuypers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Wekerle
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Maciej Głyda
- Department of Transplantology, Surgery and Urology, District Hospital, Poznan, Poland, and Nicolaus Copernicus University Collegium Medicum, Bydgoszcz, Poland
| | - Mario Carmellini
- Department of Surgery and Bioengineering, University of Siena, Siena, Italy
| | | | - Karsten Midtvedt
- Department of Transplant Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lars Wennberg
- Department of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Josep M. Grinyó
- Department of Nephrology, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
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6
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de la Oliva Valentín M, Hernández D, Crespo M, Mahillo B, Beneyto I, Martínez I, Kanter J, Calderari E, Gil-Vernet S, Sánchez S, Agüera ML, Bernal G, de Santiago C, Díaz-Corte C, Díaz C, Espinosa L, Facundo C, Fernández-Lucas M, Ferreiro T, García-Erauzkin G, García-Alvarez T, Fraile P, González-Rinne A, González-Soriano MJ, González E, Gutiérrez-Dalmau A, Jiménez C, Lauzurica R, Lorenzo I, Martín-Moreno PL, Moreso F, de Gracia MC, Pérez-Flores I, Ramos-Verde A, Revuelta I, Rodríguez-Ferrero ML, Ruiz JC, Sánchez-Sobrino B, Domínguez-Gil B. Live donor kidney transplantation. Situation analysis and roadmap. Nefrologia 2022; 42:85-93. [PMID: 36153903 DOI: 10.1016/j.nefroe.2022.02.002] [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: 03/08/2021] [Accepted: 03/17/2021] [Indexed: 06/16/2023] Open
Abstract
Living donor kidney transplantation (LDKT) is the best treatment option for end stage renal disease in terms of both patient and graft survival. However, figures on LDKT in Spain that had been continuously growing from 2005 to 2014, have experienced a continuous decrease in the last five years. One possible explanation for this decrease is that the significant increase in the number of deceased donors in Spain during the last years, both brain death and controlled circulatory death donors, might have generated the false idea that we have coped with the transplant needs. Moreover, a greater number of deceased donor kidney transplants have caused a heavy workload for the transplant teams. Furthermore, the transplant teams could have moved on to a more conservative approach to the information and assessment of patients and families considering the potential long-term risks for donors in recent papers. However, there is a significant variability in the LDKT rate among transplant centers and regions in Spain independent of their deceased donor rates. This fact and the fact that LDKT is usually a preemptive option for patients with advanced chronic renal failure, as time on dialysis is a negative independent factor for transplant outcomes, lead us to conclude that the decrease in LDKT depends on other factors. Thus, in the kidney transplant annual meeting held at ONT site in 2018, a working group was created to identify other causes for the decrease of LDKT in Spain and its relationship with the different steps of the process. The group was formed by transplant teams, a representative of the transplant group of the Spanish Society of Nephrology (SENTRA), a representative of the Spanish Society of Transplants (SET) and representatives of the Spanish National Transplant Organization (ONT). A self-evaluation survey that contains requests about the phases of the LDKT processes (information, donor work out, informed consent, surgeries, follow-up and human resources) were developed and sent to 33 LDKT teams. All the centers answered the questionnaire. The analysis of the answers has resulted in the creation of a national analysis of strengths, weaknesses, opportunities, threats (SWOT) of the LDKT program in Spain and the development of recommendations targeted to improve every step of the donation process. The work performed, the conclusions and recommendations provided, have been reflected in the following report: Spanish living donor kidney transplant program assessment: recommendations for optimization. This document has also been reviewed by a panel of experts, representatives of the scientific societies (Spanish Society of Urology (AEU), Spanish Society of Nephrology Nursery (SEDEN), Spanish Society of Immunology (SEI/GETH)) and the patient association ALCER. Finally, the report has been submitted to public consultation, reaching ample consensus. In addition, the transplant competent authorities of the different regions in Spainhave adopted the report at institutional level. The work done and the recommendations to optimize LDKT are summarized in the present manuscript, organized by the different phases of the donation process.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sara Sánchez
- Organización Nacional de Trasplantes, Madrid, Spain
| | | | | | | | | | - Cándido Díaz
- H. Clínico U. de Santiago, Santiago de Compostela, Spain
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7
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Valentín MDLO, Hernández D, Crespo M, Mahillo B, Beneyto I, Martínez I, Kanter J, Calderari E, Gil-Vernet S, Sánchez S, Agüera ML, Bernal G, de Santiago C, Díaz-Corte C, Díaz C, Espinosa L, Facundo C, Fernández-Lucas M, Ferreiro T, García-Erauzkin G, García-Alvarez T, Fraile P, González-Rinne A, González-Soriano MJ, González E, Gutiérrez-Dalmau A, Jiménez C, Lauzurica R, Lorenzo I, Martín-Moreno PL, Moreso F, de Gracia MC, Pérez-Flores I, Ramos-Verde A, Revuelta I, Rodríguez-Ferrero ML, Ruiz JC, Sánchez-Sobrino B, Domínguez-Gil B. Live donor kidney transplantation. Situation analysis and roadmap. Nefrologia 2021; 42:S0211-6995(21)00113-2. [PMID: 34294484 DOI: 10.1016/j.nefro.2021.03.008] [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: 03/08/2021] [Accepted: 03/17/2021] [Indexed: 10/20/2022] Open
Abstract
Living donor kidney transplantation (LDKT) is the best treatment option for end stage renal disease in terms of both patient and graft survival. However, figures on LDKT in Spain that had been continuously growing from 2005 to 2014, have experienced a continuous decrease in the last five years. One possible explanation for this decrease is that the significant increase in the number of deceased donors in Spain during the last years, both brain death and controlled circulatory death donors, might have generated the false idea that we have coped with the transplant needs. Moreover, a greater number of deceased donor kidney transplants have caused a heavy workload for the transplant teams. Furthermore, the transplant teams could have moved on to a more conservative approach to the information and assessment of patients and families considering the potential long-term risks for donors in recent papers. However, there is a significant variability in the LDKT rate among transplant centers and regions in Spain independent of their deceased donor rates. This fact and the fact that LDKT is usually a preemptive option for patients with advanced chronic renal failure, as time on dialysis is a negative independent factor for transplant outcomes, lead us to conclude that the decrease in LDKT depends on other factors. Thus, in the kidney transplant annual meeting held at ONT site in 2018, a working group was created to identify other causes for the decrease of LDKT in Spain and its relationship with the different steps of the process. The group was formed by transplant teams, a representative of the transplant group of the Spanish Society of Nephrology (SENTRA), a representative of the Spanish Society of Transplants (SET) and representatives of the Spanish National Transplant Organization (ONT). A self-evaluation survey that contains requests about the phases of the LDKT processes (information, donor work out, informed consent, surgeries, follow-up and human resources) were developed and sent to 33 LDKT teams. All the centers answered the questionnaire. The analysis of the answers has resulted in the creation of a national analysis of strengths, weaknesses, opportunities, threats (SWOT) of the LDKT program in Spain and the development of recommendations targeted to improve every step of the donation process. The work performed, the conclusions and recommendations provided, have been reflected in the following report: Spanish living donor kidney transplant program assessment: recommendations for optimization. This document has also been reviewed by a panel of experts, representatives of the scientific societies (Spanish Society of Urology (AEU), Spanish Society of Nephrology Nursery (SEDEN), Spanish Society of Immunology (SEI/GETH)) and the patient association ALCER. Finally, the report has been submitted to public consultation, reaching ample consensus. In addition, the transplant competent authorities of the different regions in Spain have adopted the report at institutional level. The work done and the recommendations to optimize LDKT are summarized in the present manuscript, organized by the different phases of the donation process.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sara Sánchez
- Organización Nacional de Trasplantes, Madrid, España
| | | | | | | | | | - Cándido Díaz
- H. Clínico U. de Santiago, Santiago de Compostela, España
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8
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Pérez-Sáez MJ, Blasco M, Redondo-Pachón D, Ventura-Aguiar P, Bada-Bosch T, Pérez-Flores I, Melilli E, Sánchez-Cámara LA, López-Oliva MO, Canal C, Shabaka A, Garra-Moncau N, Martín-Moreno PL, López V, Hernández-Gallego R, Siverio O, Galeano C, Espí-Reig J, Cabezas CJ, Rodrigo MT, Llinàs-Mallol L, Fernández-Reyes MJ, Cruzado-Vega L, Pérez-Tamajón L, Santana-Estupiñán R, Ruiz-Fuentes MC, Tabernero G, Zárraga S, Ruiz JC, Gutiérrez-Dalmau A, Mazuecos A, Sánchez-Álvarez E, Crespo M, Pascual J. Use of tocilizumab in kidney transplant recipients with COVID-19. Am J Transplant 2020; 20:3182-3190. [PMID: 32654422 PMCID: PMC7405397 DOI: 10.1111/ajt.16192] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/12/2020] [Accepted: 06/28/2020] [Indexed: 01/25/2023]
Abstract
Acute respiratory distress syndrome associated with coronavirus infection is related to a cytokine storm with large interleukin-6 (IL-6) release. The IL-6-receptor blocker tocilizumab may control the aberrant host immune response in patients with coronavirus disease 2019 (COVID-19) . In this pandemic, kidney transplant (KT) recipients are a high-risk population for severe infection and showed poor outcomes. We present a multicenter cohort study of 80 KT patients with severe COVID-19 treated with tocilizumab during hospital admission. High mortality rate was identified (32.5%), related with older age (hazard ratio [HR] 3.12 for those older than 60 years, P = .039). IL-6 and other inflammatory markers, including lactic acid dehydrogenase, ferritin, and D-dimer increased early after tocilizumab administration and their values were higher in nonsurvivors. Instead, C-reactive protein (CRP) levels decreased after tocilizumab, and this decrease positively correlated with survival (mean 12.3 mg/L in survivors vs. 33 mg/L in nonsurvivors). Each mg/L of CRP soon after tocilizumab increased the risk of death by 1% (HR 1.01 [confidence interval 1.004-1.024], P = .003). Although patients who died presented with worse respiratory situation at admission, this was not significantly different at tocilizumab administration and did not have an impact on outcome in the multivariate analysis. Tocilizumab may be effective in controlling cytokine storm in COVID-19 but randomized trials are needed.
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Affiliation(s)
- María J. Pérez-Sáez
- Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain,Correspondence María J. Pérez-Sáez
| | - Miquel Blasco
- Department of Nephrology and Kidney, Transplantation Hospital Clinic, Institute of Biomedical Research August Pi i Sunyer, REDinREN (RD16/0009/0023), Barcelona, Spain
| | - Dolores Redondo-Pachón
- Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain
| | - Pedro Ventura-Aguiar
- Department of Nephrology and Kidney, Transplantation Hospital Clinic, Institute of Biomedical Research August Pi i Sunyer, REDinREN (RD16/0009/0023), Barcelona, Spain
| | - Teresa Bada-Bosch
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Edoardo Melilli
- Department of Nephrology, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Luis A. Sánchez-Cámara
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | | | - Cristina Canal
- Department of Nephrology, Research Support Unit, Fundació Puigvert, Barcelona, Spain
| | - Amir Shabaka
- Department of Nephrology, Hospital Fundación Alcorcón, Alcorcón, Madrid, Spain
| | | | | | - Verónica López
- Department of Nephrology, Hospital Regional Universitario, Universidad de Málaga, IBIMA, REDinREN (RD16/0009/0006), Málaga, Spain
| | | | - Orlando Siverio
- Department of Nephrology, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | - Cristina Galeano
- Department of Nephrology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Jordi Espí-Reig
- Department of Nephrology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Carlos J. Cabezas
- Department of Nephrology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - María T. Rodrigo
- Department of Nephrology, Hospital Universitario Donostia, Donostia, Spain
| | - Laura Llinàs-Mallol
- Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain
| | | | | | - Lourdes Pérez-Tamajón
- Department of Nephrology, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
| | - Raquel Santana-Estupiñán
- Department of Nephrology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - María C Ruiz-Fuentes
- Department of Nephrology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Sofía Zárraga
- Department of Nephrology, Hospital de Cruces, Bilbao, Spain
| | - Juan C Ruiz
- Department of Nephrology, Hospital de Valdecilla, University of Cantabria, IDIAL, Santander, Spain
| | | | | | | | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain
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Pascual J, Melilli E, Jiménez-Martín C, González-Monte E, Zárraga S, Gutiérrez-Dalmau A, López-Jiménez V, Juega J, Muñoz-Cepeda M, Lorenzo I, Facundo C, Ruiz-Fuentes MDC, Mazuecos A, Sánchez-Álvarez E, Crespo M. COVID-19-related Mortality During the First 60 Days After Kidney Transplantation. Eur Urol 2020; 78:641-643. [PMID: 32624283 PMCID: PMC7303649 DOI: 10.1016/j.eururo.2020.06.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 06/12/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain.
| | - Edoardo Melilli
- Department of Nephrology, Hospital Universitari Bellvitge, Hospitalet del Llobregat, Barcelona, Spain
| | | | | | - Sofía Zárraga
- Department of Nephrology, Hospital de Cruces, Bilbao, Spain
| | | | | | - Javier Juega
- Department of Nephrology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | | | - Carme Facundo
- Department of Nephrology, Fundació Puigvert, Barcelona, Spain
| | | | | | | | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
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Rubio Rubio MV, Lou Arnal LM, Gimeno Orna JA, Munguía Navarro P, Gutiérrez-Dalmau A, Lambán Ibor E, Paúl Ramos J, Pernaute Lavilla R, Campos Gutiérrez B, San Juan Hernández-Franch A. Survival and quality of life in elderly patients in conservative management. Nefrologia 2019; 39:141-150. [PMID: 30827372 DOI: 10.1016/j.nefro.2018.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/09/2018] [Revised: 06/29/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Conservative Management (CM) has become a therapeutic option in Advanced Chronic Kidney Disease in the elderly. However, there is a lack of evidence about prognosis of these patients in terms of survival and health related quality of life (HRQoL). OBJECTIVE Establish predictive variables associated with mortality and analyse HRQoL in CM patients. PATIENTS AND METHODS Prospective cohort study. An assessment of renal function parameters and a comprehensive geriatric assessment were made, including: analysis of comorbidity, functional, cognitive, fragility, nutritional, social and HRQoL status. RESULTS 82 patients with a mean age of 84 years and significant pluripathology were studied: 56% had history of vascular event and Charlson >8. The mortality rate was 23/1,000 patients per month, with a homogeneous mortality rate after 6 months. Survival differed significantly depending on whether they presented with a previous vascular event (36.7 vs. 14.8; p=0.028), Charlson score ≥10 (42 vs. 17; p=0.002), functional status (48.4 vs. 19; p=0.002) and fragility (27 vs. 10; p=0.05). Mortality predictors included eGFR and proteinuria, the presence of previous vascular events, Charlson comorbidity score, malnutrition-inflammation parameters (albumin and MNA score), degree of dependency, physical HRQoL and increase of PTH level. The presence of previous vascular event, comorbidity, decreased albumin and elevated PTH were independent predictors of mortality. HRQoL remained stable over time and no significant worsening occurred during treatment. CONCLUSIONS Having knowledge of the factors associated with mortality and HRQoL assessment can be a useful tool to helping decision making during CM. Previous vascular events, comorbidity, decreased albumin and increased PTH were independent predictors of mortality.
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Affiliation(s)
| | | | | | | | | | - Elena Lambán Ibor
- Servicio de Medicina Interna, Hospital Ernest Lluch, Calatayud, Zaragoza, España
| | - Javier Paúl Ramos
- Servicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, España
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11
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Portolés JM, Pérez-Sáez MJ, López-Sánchez P, Lafuente-Covarrubias O, Juega J, Hernández D, Espí J, Navarro MD, Mazuecos MA, Rodríguez-Ferrero ML, Maruri-Kareaga N, Moreso F, Melilli E, de Souza E, Ruiz JC, Llamas F, Gutiérrez-Dalmau A, Guirado L, Martín-Moreno P, Pérez Flores I, Fernández-García A, Jiménez C, Gavela E, Ramos A, Pascual J. Kidney transplant from controlled donors following circulatory death: Results from the GEODAS-3 multicentre study. Nefrologia 2018; 39:151-159. [PMID: 30497696 DOI: 10.1016/j.nefro.2018.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 04/12/2018] [Revised: 07/16/2018] [Accepted: 07/31/2018] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Many European countries have transplant programmes with controlled donors after cardiac death (cDCD). Twenty-two centres are part of GEODAS group. We analysed clinical results from a nephrological perspective. METHODS Observational, retrospective and multicentre study with systematic inclusion of all kidney transplant recipients from cDCD, following local protocols regarding extraction and immunosuppression. RESULTS A total of 335 cDCD donors (mean age 57.2 years) whose deaths were mainly due to cardiovascular events were included. Finally, 566 recipients (mean age 56.5 years; 91.9% first kidney transplant) were analysed with a median of follow-up of 1.9 years. Induction therapy was almost universal (thymoglobulin 67.4%; simulect 32.8%) with maintenance with prednisone-MMF-tacrolimus (91.3%) or combinations with mTOR (6.5%). Mean cold ischaemia time (CIT) was 12.3h. Approximately 3.4% (n=19) of recipients experienced primary non-function, essentially associated with CIT (only CIT ≥ 14 h was associated with primary non-function). Delayed graft function (DGF) was 48.8%. DGF risk factors were CIT ≥ 14 h OR 1.6, previous haemodialysis (vs. peritoneal dialysis) OR 2.1 and donor age OR 1.01 (per year). Twenty-one patients (3.7%) died with a functioning graft, with a recipient and death-censored graft survival at 2-years of 95% and 95.1%, respectively. The estimated glomerular filtration rate at one year of follow-up was 60.9 ml/min. CONCLUSIONS CIT is a modifiable factor for improving the incidence of primary non-function in kidney transplant arising from cDCD. cDCD kidney transplant recipients have higher delayed graft function rate, but the same patient and graft survival compared to brain-dead donation in historical references. These results are convincing enough to continue fostering this type of donation.
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Affiliation(s)
| | | | | | | | - Javier Juega
- Hospital Universitario Germán Trías y Pujol, Barcelona, España
| | | | - Jordi Espí
- Hospital Universitario La Fe, Valencia, España
| | | | | | | | | | | | | | - Erika de Souza
- Hospital Universitario Clinic de Barcelona, Barcelona, España
| | | | | | | | | | | | | | | | | | - Eva Gavela
- Hospital Universitario Dr. Peset, Valencia, España
| | - Ana Ramos
- Fundación Jiménez Díaz, Madrid, España
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12
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Campistol JM, Gutiérrez-Dalmau A, Crespo J, Saval N, Grinyó JM. Clinical approach to kidney disease in kidney recipients in Spain. Nefrologia 2015; 35:256-63. [PMID: 26299168 DOI: 10.1016/j.nefro.2015.05.006] [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: 07/14/2014] [Accepted: 12/30/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In the present study, clinical criteria used by Spanish nephrologists when approaching chronic kidney disease (CKD) in kidney recipients, as well as their level of maintenance and control of renal function, were evaluated. METHODS An epidemiological, observational, multicenter, nation-wide, prospective study was carried out, with a 6-month follow-up period. Three hundred and sixty-eight adult patients with stage3 kidney disease after a 24-month or longer post-transplantation follow-up period were included. Visits schedule included a retrospective visit, a baseline visit, an optional mid-term visit, and a final visit at month6. RESULTS Mean time since kidney transplantation was 8.2±5.4years. Most common pre-transplant cardiovascular risk factors were high blood pressure (80.2%), followed by high cholesterol levels (61.7%). Serum creatinine levels showed a statistically significant decrease from baseline visit to 6-month visit (0.06±0.22; P<.0001), and glomerular filtration rate (GFR) reduction was -1.03±6.14 (P=0.0014). Significant independent prognostic factors for GFR worsening were: higher 24-hour proteinuria (OR=1.001 per mg; P=.020), longer time since transplantation (OR=1.009 per month; P=.017), and lower hemoglobin levels (OR=1.261 per g/dl; P=.038). Donor age also had some negative influence (OR=1.021 per year; P=.106). Biopsies were obtained in only 8% of kidney transplant recipients with stage 3 CKD with an intervention being carried out in 25.4% of cases. CONCLUSIONS Secondary markers and factors resulting in CKD progression, particularly anemia, are still frequently uncontrolled after kidney transplantation. Only about 2% of patients benefit from a therapeutic intervention based on a biopsy. Clinical perception differs from objective measures, which results in an obvious clinical inertia regarding risk factor control in such patients.
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Affiliation(s)
- Josep M Campistol
- Unidad de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España
| | | | - Josep Crespo
- Servicio de Nefrología, Hospital Universitario Dr. Peset, Valencia, España
| | - Núria Saval
- Novartis Farmacéutica S.A., Barcelona, España
| | - Josep Maria Grinyó
- Unidad de Nefrología y Trasplante Renal, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España.
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13
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Pascual J, Cruzado JM, Alonso A, Diekman F, Gallego RJ, Gutiérrez-Dalmau A, Hernández D, Morales JM, Rodrigo E, Zárraga S. Kidney Transplantation Group of the Spanish Society of Nephrology. Nefrologia 2013; 33:160-163. [PMID: 23511751 DOI: 10.3265/nefrologia.pre2013.feb.11902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2013] [Indexed: 06/01/2023] Open
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14
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Gutiérrez-Dalmau A, Revuelta I, Ferrer B, Mascaró JM, Oppenheimer F, Albanell J, Campistol JM. Distinct Immunohistochemical Phenotype of Nonmelanoma Skin Cancers Between Renal Transplant and Immunocompetent Populations. Transplantation 2010; 90:986-92. [DOI: 10.1097/tp.0b013e3181f6a0a1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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15
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Rovira J, Marcelo Arellano E, Burke JT, Brault Y, Moya-Rull D, Bañón-Maneus E, Ramírez-Bajo MJ, Gutiérrez-Dalmau A, Revuelta I, Quintana LF, Campistol JM, Diekmann F. Effect of mTOR inhibitor on body weight: from an experimental rat model to human transplant patients. Transpl Int 2008; 21:992-8. [PMID: 18657090 DOI: 10.1111/j.1432-2277.2008.00710.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED The aim was to study the influence of sirolimus (SRL) on body weight in a rat model and in kidney transplant patients. Wistar rats (15 weeks old) were either treated with vehicle (VEH; n = 8) or SRL (n = 7) 1.0 mg/kg three times per week for 12 weeks. Body mass and food intake were measured weekly. Adipocyte diameter was determined in hematoxylin-eosin stains. The body mass index (BMI) obtained from clinical kidney transplant trials comparing SRL-based with cyclosporine-based therapy was analyzed. ANIMALS SRL produced a decrease of the weight gain curve. At the end of the study, mean body weight in the SRL group was lower than in the VEH group (356 vs. 507 g, P < 0.01) in spite of comparable food intake normalized for body weight was not different. Mean adipocyte diameter was 36 mum in VEH and 25 mum in SRL rats (P = 0.009). Mean SRL blood trough concentration was 38 ng/ml. Kidney transplant patients: Two years after transplantation, BMI was significantly lower in the SRL-based treatment arm compared to cyclosporine (24.17 +/- 2.99 vs. 25.97 +/- 5.01 kg/m(2), P = 0.031). SRL treatment leads to less body mass. Adipocyte cell diameter was reduced in SRL-treated animals. A possible explanation may be the effects of SRL on metabolic regulation and cell growth.
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Affiliation(s)
- Jordi Rovira
- Department of Nephrology and Renal Transplantation, Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Hospital Clínic i Provincial de Barcelona, Barcelona, Spain.
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16
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Ramos-Cebrián M, Torregrosa JV, Gutiérrez-Dalmau A, Oppenheimer F, Campistol JM. Conversion from tacrolimus to cyclosporine could improve control of posttransplant diabetes mellitus after renal transplantation. Transplant Proc 2007; 39:2251-3. [PMID: 17889154 DOI: 10.1016/j.transproceed.2007.06.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 01/10/2023]
Abstract
Posttransplant diabetes mellitus (PTDM) occurs in approximately 15% to 20% of renal transplant patients. It has important clinical implications for graft function and survival. Anticalcineurin drugs are associated with an increased risk of developing PTDM. There is a little evidence that conversion from tacrolimus to cyclosporine (CsA)-based immunosuppression improves glucose metabolism and reverses diabetes. This prospective study included nine renal transplant patients (mean age of 34 +/- 20) with PTDM under immunosuppression with tacrolimus. Five were switched directly to CsA and the other four (glycemia > 250 mg/dL) required insulin and were simultaneously switched to CsA. Basal blood levels of tacrolimus were 7.9 +/- 1.9 ng/dL. Conversion was associated with an early, significant improvement of glycemia and HbA1c blood levels (P < .01). At the end of the follow-up, the glycemia (105 +/- 20 mg/dL) and Hb1Ac (5.1 +/- 0.4 mg/dL) were normal. Insulin was discontinued between 3 and 6 months in all patients who required it at the beginning. Cholesterol did not change significantly and triglycerides decreased significantly (basal 210 +/- 85 mg/dL, at 12 months 125 +/- 29, P < .01). Graft function was stable with a mean serum creatinine of 1.7 +/- 0.2 mg/dL. CsA blood levels remained stable during all follow-up periods (P = NS). There were neither episodes of acute rejection nor secondary effects related to the medication. In summary, renal transplant patients receiving tacrolimus who develop PTDM may display better control of hyperglycemia by a switch to CsA.
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Affiliation(s)
- M Ramos-Cebrián
- Nephrology and Renal Transplant Unit, Hospital Clinic, Barcelona, Spain
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17
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Diekmann F, Campistol JM, Saval N, Gutiérrez-Dalmau A, Arellano EM, Crespo M, Rossich E, Esforzado N, Cofán F, Ricart MJ, Torregrosa JV, Oppenheimer F. Sequential quadruple immunosuppression including sirolimus in extended criteria and nonheartbeating donor kidney transplantation. Transplantation 2007; 84:429-32. [PMID: 17700171 DOI: 10.1097/01.tp.0000269610.13590.52] [Citation(s) in RCA: 14] [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: 11/25/2022]
Abstract
The aim was to evaluate feasibility and safety of calcineurin inhibitor-free immunosuppression in high-risk donor kidney transplantation with sequential sirolimus introduction. Kidney transplant patients (n=76) with a donor aged >60 years, donor with acute renal failure, or a nonheartbeating donor were included. Immunosuppression consisted of antithymocyte globulin or basiliximab, mycophenolate mofetil, prednisone, and sequential introduction of sirolimus. One-year patient survival was 96.2% and 95.8%; graft survival was 94.2% and 91.7%; acute rejection rates were 21.2% and 12.4%; delayed graft function was 21.2% and 66.7%; and creatinine clearance was 58+/-20 mL/min and 56+/-21 mL/min for the brain-dead donor group and the nonheartbeating donor group, respectively. Most adverse events were infections, but also three lymphoceles, three urinary fistulas, three wound seromas. Sequential sirolimus introduction in high-risk donor kidney transplantation was found to lead to good patient and graft survival and incidence of acute rejection and delayed graft function.
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Affiliation(s)
- Fritz Diekmann
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Barcelona, Spain
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Diekmann F, Rovira J, Carreras J, Arellano EM, Bañón-Maneus E, Ramírez-Bajo MJ, Gutiérrez-Dalmau A, Brunet M, Campistol JM. Mammalian Target of Rapamycin Inhibition Halts the Progression of Proteinuria in a Rat Model of Reduced Renal Mass. J Am Soc Nephrol 2007; 18:2653-60. [PMID: 17804674 DOI: 10.1681/asn.2007010087] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [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: 11/03/2022] Open
Abstract
Many kidney transplant patients experience an increase in proteinuria when converted from a calcineurin inhibitor-based regimen to one based on a mammalian target of rapamycin (mTOR) inhibitor, and preexisting proteinuria and poor renal function have been identified as risk factors for this increase. Our aim was to evaluate the effect of sirolimus, an mTOR inhibitor, on renal function and histology in a proteinuric model of reduced renal mass. Sirolimus-treated animals had approximately half as much proteinuria as vehicle-treated animals (P < 0.05), and had less glomerulosclerosis, tubular atrophy, interstitial fibrosis, and inflammation. Immunohistochemistry showed that sirolimus attenuated the increased expression of renal vascular endothelial growth factor (VEGF), as well as the expression of VEGF receptors 1 and 2. In conclusion, sirolimus halted the progression of proteinuria and structural damage in a rat model of reduced renal mass, possibly through a reduction in renal VEGF activity.
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Affiliation(s)
- Fritz Diekmann
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Villarroel, 170, E-08036 Barcelona, Spain.
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19
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Diekmann F, Gutiérrez-Dalmau A, López S, Cofán F, Esforzado N, Ricart MJ, Rossich E, Saval N, Torregrosa JV, Oppenheimer F, Campistol JM. Influence of sirolimus on proteinuria in de novo kidney transplantation with expanded criteria donors: comparison of two CNI-free protocols. Nephrol Dial Transplant 2007; 22:2316-21. [PMID: 17452413 DOI: 10.1093/ndt/gfm181] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [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: 01/09/2023] Open
Abstract
BACKGROUND The contribution of mammalian target of rapamycin (mTOR) inhibitors to proteinuria is controversial. The aim was to analyse proteinuria in suboptimal kidney calcineurin inhibitor-(CNI) free de novo immunosuppression. METHODS All patients from our centre with donors >60 years and CNI-free treatment were included (n = 108). Patients were divided into two groups: (i) SRL group: sirolimus (SRL) + prednisone + mycophenolate mofetil (MMF) + antiCD25; (ii) MMF group: prednisone + MMF w/ or w/o antiCD25 (n = 75). Follow-up was 12 months. RESULTS Donors were slightly younger in the SRL group (68 vs 71 years; P < 0.05), receptor age (67 vs 65 years) was not significantly different. Patient survival in the MMF group was 88 vs 94% in the SRL group, however, these differences did not reach statistical significance. One-year graft survival censored for death was 83% in the MMF group and 94% in the SRL group. Acute rejection rate was 45% in the MMF and 15% in the SRL group (P < 0.01). The incidence of CNI introduction was higher in the MMF-group (35 vs 5; P < 0.05). The intention-to-treat analysis revealed significant differences of proteinuria [SRL vs MMF at 12 months: 461 (163-6988) vs 270 (53-3029) mg/day], which did not exist in the on-therapy (OT) analysis [SRL vs MMF at 12 months: 357 (199-1428) vs 279 (53-3029) mg/day]. New onset nephrotic range proteinuria seemed to occur slightly more frequently in SRL patients (3/33 vs 1/75; P = 0.049), however, all four cases occurred in a context of recurrent disease, or previous drug-independent damage or non-adherence. All of these patients were converted to CNI. CONCLUSION SRL-based compared with MMF-based treatment in kidney transplantation with advanced age donors is associated with an acceptable outcome, however, with increased proteinuria in the intention-to-treat analysis. A large subgroup of the patients in the MMF group experienced acute rejection and required conversion to CNI.
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Affiliation(s)
- Fritz Diekmann
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Villarroel, 170, E-08036 Barcelona, Spain.
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Abstract
The proliferation signal inhibitors [PSIs; mammalian target of rapamycin (mTOR) inhibitors] are widely used for immunosuppression in transplant recipients. Alongside their immunosuppressive properties, PSIs also have substantial anti-neoplastic activity, as a result of their inhibition of cellular signalling pathways involved in critical functions such as cell division, T-cell activation, invasion and growth factor production. In vitro and in vivo studies have shown that PSIs can prevent the growth of experimentally transformed cells and tumour-derived cell lines, and can also increase the sensitivity of cells to apoptosis-inducing agents. The mechanisms of anti-tumour activities of PSIs identified in pre-clinical studies include up-regulation of adhesion molecules with reversion to less invasive phenotypes, and inhibition of angiogenesis resulting from both decreased vascular endothelial growth factor production and decreased endothelial sensitivity to such growth factors. In clinical trials of PSIs in transplant recipients, results show that the incidence of malignancies is substantially lower in patients receiving PSIs than in those receiving calcineurin inhibitor (CNI)-based immunosuppression, with significantly longer times to the development of malignancy. This protective effect of the PSIs is also present in patients receiving combination therapy with a CNI and a PSI. There is also evidence to suggest a role for PSIs in the management of post-transplantation malignancy, with reports of complete resolution of primary and metastatic tumours after conversion from a CNI to a PSI. These beneficial effects have led to the investigation of everolimus and an analogue of sirolimus as a treatment for patients with advanced solid tumours.
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Affiliation(s)
- Alex Gutiérrez-Dalmau
- Department of Nephrology, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain
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Gutiérrez-Dalmau A, Sánchez-Fructuoso A, Sanz-Guajardo A, Mazuecos A, Franco A, Rial MC, Iranzo P, Torregrosa JV, Oppenheimer F, Campistol JM. Efficacy of Conversion to Sirolimus in Posttransplantation Kaposi’s Sarcoma. Transplant Proc 2005; 37:3836-8. [PMID: 16386556 DOI: 10.1016/j.transproceed.2005.10.076] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [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: 01/09/2023]
Abstract
UNLABELLED The increased incidence of Kaposi's sarcoma (KS) in organ transplantation has been related to the KS herpes virus and the permissive effect of immunosuppressive therapy. We postulated that conversion to SRL in renal recipients with KS favored regression of KS lesions without increasing the risk of graft rejection. METHODS In this study we performed a retrospective chart review of 7 caucasian renal transplant recipients affected by KS to determine demographic data, etiology of ESRD, immunologic risk factors, immunosuppressive treatment, KS disease follow-up, and renal function before and after SRL conversion. RESULTS All seven patients were under calcineurin inhibitor treatment at the onset of KS which was limited to the skin, without regression despite attempts to minimize immunosuppression. After conversion to SRL, six patients showed progressive regression of KS lesions, with only hyperpigmented atrophic cutaneous lesions remaining after a mean time of 8.1 months (2-18 months). The seventh patient has completed 9 months follow-up with a near complete regression of KS lesions. One patient returned to hemodialysis after 13 months following irreversible acute renal failure not directly related to SRL conversion; in the other six, renal function was stable. The mean serum creatinine was 1.87 +/- 0.64 versus 1.74 +/- 0.68 mg/dL, pre-conversion versus the end of follow up, respectively. Mean SRL blood level was 9.2 +/- 2.0 ng/mL. CONCLUSION After SRL conversion, patients with KS showed progressive regression without an increased risk of acute rejection. SRL offers a promising approach to the management of posttransplantation KS and probably other malignancies in organ transplant recipients.
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Affiliation(s)
- A Gutiérrez-Dalmau
- Department of Nephrology and Renal Transplant Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain.
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Abstract
Living donor kidney transplantation has become the option of preference for the treatment of endstage renal disease, whenever its performance is possible. The advantages of patient and graft survival should be balanced with risks associated with donation. Therefore, the evaluation of candidates for living donor kidney transplantation is mainly the comprehensive evaluation of these risks: medical, psychological, social and economic. Evaluating risks implies we are treating a controversial process, the medical progress, which is modifiable with time, even in the family and/or social environment of the donor-receptor couple. Short and long-term safety of living donor nephrectomy is directly engaged to the existence of a healthy donor. This he is the main objective of standard evaluation of candidates. Currently, with a growing demand of this option, minor abnormalities or risk factors detected during evaluation do not always become a formal contraindication, but we should try to establish a most objective threshold for the acceptance of donors in all evaluated spheres, for surgical risks and others directly related or not with renal mass reduction, and even for those engaged to the existence of a genetic link between donor and receptor, which might determine the presence of any future primary renal disease. As for other donation types, the process of evaluation should also ensure minimal risks for the receptor, with the same safety criteria applied to cadaver donors. We can conclude that careful evaluation of candidates for living kidney donation is the best guarantee for their safety and transplant success, and, in our opinion, it is the best instrument to offer an adequate informed consent.
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Gutiérrez-Dalmau A, Campistol JM. Kaposi's sarcoma after renal transplantation. N Engl J Med 2005; 353:846-7; author reply 846-7. [PMID: 16124128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Campistol JM, Romero R, Paul J, Gutiérrez-Dalmau A. Epidemiology of arterial hypertension in renal transplant patients: changes over the last decade. Nephrol Dial Transplant 2004; 19 Suppl 3:iii62-6. [PMID: 15192139 DOI: 10.1093/ndt/gfh1018] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Arterial hypertension is a common clinical problem in renal transplantation, with important consequences on graft and patient survival. PATIENTS AND METHODS A total of 3365 adult patients transplanted in 1990 (N = 824), 1994 (N = 1075) and 1998 (N = 1466) with a functioning graft after the first year were included. In this study, arterial hypertension was defined as systolic blood pressure (SBP) > or =140 mmHg and/or diastolic blood pressure (DBP) > or =90 mmHg and/or treatment with antihypertensive drugs. The use of angiotensin converting enzyme (ACE) inhibitors or angiotensin II (ATII) receptor blockers during the first year was recorded. RESULTS The prevalence of hypertension showed a progressive and significant increase during follow-up after renal transplantation in the three periods analysed, although SBP and DBP were lower in patients who underwent transplantation in 1998. The presence of arterial hypertension at 1 year was significantly associated with recipient gender (male), donor age (< 60 years), immunosuppressive therapy (cyclosporine), serum creatinine and year of transplantation. Arterial hypertension was not associated with graft survival and cardiovascular mortality. The prevalence and severity of hypertension was significantly lower in patients treated with tacrolimus vs cyclosporine. The use of ACE inhibitors or ATII receptor blockers has increased in the recent years. CONCLUSIONS Arterial hypertension remained a common problem in renal transplantation, although in recent years the intensity of the control seems satisfactory. The use of ACE inhibitors or ATII receptor blockers has increased significantly in the last years.
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Affiliation(s)
- Josep M Campistol
- Renal Transplant Unit, Hospital Clinic, University of Barcelona, 170, Villarroel, 08036, Barcelona, Spain.
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