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Becker SCDC, Medina-Pestana JO, Canziani MEF, Souza ALS, Amaral AC, Vieira GA, Ferraz ML. Performance of rapid test for antibodies to hepatitis C virus (anti-HCV) in hemodialysis patients and kidney transplant recipients. Int J Artif Organs 2022; 45:680-684. [PMID: 35751365 DOI: 10.1177/03913988221104834] [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] [Indexed: 11/17/2022]
Abstract
Rapid tests (RT) have been widely used for screening of hepatitis C virus (HCV) in general population, but its performance in hemodialysis (HD) patients and mainly in kidney-transplant recipients (RTx) is less known. The aim of this study was to evaluate the accuracy of RT for detection of anti-HCV in HD and RTx patients. Patients were prospectively included subdivided in four groups according to the positivity for anti-HCV detected by conventional serology: (1) HD patients anti-HCV +, (2) HD patients anti-HCV -, (3) RTx patients anti-HCV +, and (4) RTx patients anti-HCV -. All patients were retested for HCV using the commercial kit Alere HCV® Bioeasy Rapid Test (Bioeasy Diagnóstica LTDA-Minas Gerais, Brazil) in capillary whole blood samples. During the period of study were included 46 HD patients anti-HCV+, 62 HD patients anti-HCV -, 53 RTx patients anti-HCV + and 56 RTx patients anti-HCV -. In patients on HD, the RT showed sensitivity (S), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy of 100%. In RTx patients, S of 96%, SP of 100%, PPV of 100% and NPV of 97% were found (accuracy of 98%). In conclusion, in patients on HD there was 100% agreement between RT and the conventional immunoassay. In the RTx group, although the agreement was not 100%, the RT performed very well when compared to conventional serology. This study demonstrates that the RT can be an alternative to conventional serology in HCV screening of patients on HD and RTx.
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Affiliation(s)
| | | | | | | | - Ana Cristina Amaral
- Division of Gastroenterology, Federal University of São Paulo, Sao Paulo, Brazil
| | | | - Maria Lucia Ferraz
- Division of Gastroenterology, Federal University of São Paulo, Sao Paulo, Brazil
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Romano TM, Linhares MM, Posegger KR, Rangel ÉB, Gonzalez AM, Salzedas-Netto AA, Mucci S, Silva-Junior HT, Lopes Filho GDJ, Medina-Pestana JO. Evaluation of psychological symptoms in patients before and after simultaneous pancreas-kidney transplantation: a single-center cross-sectional study. Acta Cir Bras 2022; 37:e370202. [PMID: 35475809 PMCID: PMC9020788 DOI: 10.1590/acb370202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/09/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose: Simultaneous pancreas-kidney transplantation (SPKT) brings several benefits for insulin-dependent type-1 diabetic patients associated with end-stage renal disease (ESRD). However, data on psychological outcomes for the waiting list and the transplanted patients are still lacking. Methods: Using the psychological Beck inventories of anxiety (BAI) and depression (BDI), 39 patients on the waiting list were compared to 88 post-transplanted patients who had undergone SPKT. Results: Significant differences were found regarding depression (p = 0.003) but not anxiety (p = 0.161), being the pretransplant patients more vulnerable to psychological disorders. Remarkable differences were observed relative to the feeling of punishment (p < 0.001) and suicidal thoughts (p = 0.008) between the groups. It was observed that patients who waited a longer period for the transplant showed more post-transplant anxiety symptoms due to the long treatment burden (p = 0.002). Conclusions: These results demonstrated the positive impact of SPKT on psychological aspects related to depression when comparing the groups. The high number of stressors in the pretransplant stage impacts more severely the psychosocial condition of the patient.
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de Sandes-Freitas TV, de Andrade LGM, Moura LRR, Cristelli MP, Medina-Pestana JO, Lugon JR, Sesso R. Comparison of 30-day case-fatality rate between dialysis and transplant Covid-19 patients: a propensity score matched cohort study. J Nephrol 2022; 35:131-141. [PMID: 34677805 PMCID: PMC8532104 DOI: 10.1007/s40620-021-01172-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/17/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Patients undergoing kidney replacement therapies (KRTs) have a poor prognosis after Covid-19 infection. Few studies have compared the outcomes of such patients in the different KRT modalities. This study aimed to analyze the 30-day Covid-19-associated case-fatality rate of dialysis and kidney transplant patients. METHODS Retrospective cohort study analyzing data from patients with confirmed Covid-19 between Mar/20 and Jan/21 included in two multicenter studies, the Brazilian Covid-19 Dialysis Study (Dialysis group, n = 703) and the Covid-19-KT Brazilian Study (Transplant group, n = 1907). To assess the risk factors for death, adjusted Cox hazards models were used. A sensitivity analysis was performed using a propensity score analysis to match the groups (n = 587 patients in each group). RESULTS A higher percentage of transplant patients required hospitalization (68 vs. 51%, p < 0.001), intensive care (37 vs. 30%, p = 0.023), and invasive mechanical ventilation (28 vs. 22%, p = 0.035). Multivariate analysis of the before-matching sample showed that subjects in the transplant group were at a lower death risk at baseline (HR 0.380.560.85). However, they showed higher risk over time (HR 1.031.061.09). Kaplan-Meier analysis after propensity score matching confirmed the inferior 30-day cumulative survival in the transplant recipients (83 vs. 78%, p = 0.0014). CONCLUSION Both transplant and dialysis patients have high 30-day case-fatality rates after a Covid-19 diagnosis. Despite lower death risk at baseline, transplant patients have an increased death risk of 6% per day than dialysis patients.
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Affiliation(s)
- Tainá Veras de Sandes-Freitas
- Programa de Pós-Graduação Em Ciências Médicas, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Do Ceará, Fortaleza, CE, Brazil
- Hospital Universitário Walter Cantídio, Fortaleza, CE, Brazil
- Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | | | - Lucio Roberto Requião Moura
- Hospital Do Rim, Fundação Oswaldo Ramos, São Paulo, SP, Brazil.
- Departamento de Medicina, Disciplina de Nefrologia, Universidade Federal de São Paulo. Rua Botucatu, 740, São Paulo, SP, 04023-062, Brazil.
- Unidade de Transplante Renal, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | - José Osmar Medina-Pestana
- Hospital Do Rim, Fundação Oswaldo Ramos, São Paulo, SP, Brazil
- Departamento de Medicina, Disciplina de Nefrologia, Universidade Federal de São Paulo. Rua Botucatu, 740, São Paulo, SP, 04023-062, Brazil
| | - Jocemir Ronaldo Lugon
- Departamento de Medicina, Divisão de Nefrologia, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | - Ricardo Sesso
- Departamento de Medicina, Disciplina de Nefrologia, Universidade Federal de São Paulo. Rua Botucatu, 740, São Paulo, SP, 04023-062, Brazil
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Oliveira LCG, Cruz NAN, Ricelli B, Tedesco-Silva H, Medina-Pestana JO, Casarini DE. Interactions amongst inflammation, renin-angiotensin-aldosterone and kallikrein-kinin systems: suggestive approaches for COVID-19 therapy. J Venom Anim Toxins Incl Trop Dis 2021; 27:e20200181. [PMID: 34925477 PMCID: PMC8651214 DOI: 10.1590/1678-9199-jvatitd-2020-0181] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/24/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a rapid-spread infectious disease caused by the SARS-CoV-2 virus, which can culminate in the renin-angiotensin-aldosterone (RAAS) and kallikrein-kinin (KKS) systems imbalance, and in serious consequences for infected patients. This scoping review of published research exploring the RAAS and KKS was undertaken in order to trace the history of the discovery of both systems and their multiple interactions, discuss some aspects of the viral-cell interaction, including inflammation and the system imbalance triggered by SARS-CoV-2 infection, and their consequent disorders. Furthermore, we correlate the effects of continued use of the RAAS blockers in chronic diseases therapies with the virulence and physiopathology of COVID-19. We also approach the RAAS and KKS-related proposed potential therapies for treatment of COVID-19. In this way, we reinforce the importance of exploring both systems and the application of their components or their blockers in the treatment of coronavirus disease.
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Affiliation(s)
| | | | - Bruna Ricelli
- Nephrology Division, Department of Medicine, Universidade Federal de São Paulo (UNIFESP/EPM), São Paulo, SP, Brazil
| | - Helio Tedesco-Silva
- Nephrology Division, Department of Medicine, Universidade Federal de São Paulo (UNIFESP/EPM), São Paulo, SP, Brazil
| | - José Osmar Medina-Pestana
- Nephrology Division, Department of Medicine, Universidade Federal de São Paulo (UNIFESP/EPM), São Paulo, SP, Brazil
| | - Dulce Elena Casarini
- Nephrology Division, Department of Medicine, Universidade Federal de São Paulo (UNIFESP/EPM), São Paulo, SP, Brazil
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Freitas RCC, Bortolin RH, Genvigir FDV, Bonezi V, Hirata TDC, Felipe CR, Tedesco-Silva H, Medina-Pestana JO, Cerda A, Doi SQ, Hirata MH, Hirata RDC. Differentially expressed urinary exo-miRs and clinical outcomes in kidney recipients on short-term tacrolimus therapy: a pilot study. Epigenomics 2020; 12:2019-2034. [PMID: 33275448 DOI: 10.2217/epi-2020-0160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Indexed: 12/29/2022] Open
Abstract
Aim: To analyze the expression of urinary exosome-derived miRNAs (exo-miRs) in kidney recipients on tacrolimus-based therapy. Patients & methods: Clinical and drug monitoring data were recorded from 23 kidney recipients. Expression of 93 exo-miRs was measured by quantitative PCR array and mRNA targets were explored. Results: 16 exo-miRs were differentially expressed, including marked upregulation of miR-155-5p, and downregulation of miR-223-3p and miR-1228-3p. Expression of miR-155-5p and miR-223-3p correlated with tacrolimus dose (p < 0.05), miR-223-3p with serum creatinine (p < 0.05), and miR-223-3p and miR-1228-3p with blood leukocytes (p < 0.05). 12 miRNAs have predicted targets involved in cell proliferation, apoptosis, stress response, PIK3/AKT/mTOR and TGF-β signaling pathways. Conclusion: Differentially expressed urinary exo-miRs may be useful markers to monitor tacrolimus therapy and graft function in kidney transplantation.
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Affiliation(s)
- Renata Caroline Costa Freitas
- Department of Clinical & Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo 05508-000, Brazil
| | - Raul Hernandes Bortolin
- Department of Clinical & Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo 05508-000, Brazil
| | - Fabiana Dalla Vecchia Genvigir
- Department of Clinical & Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo 05508-000, Brazil
| | - Vivian Bonezi
- Department of Clinical & Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo 05508-000, Brazil
| | - Thiago Dominguez Crespo Hirata
- Department of Clinical & Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo 05508-000, Brazil
| | - Claudia Rosso Felipe
- Nephrology Division, Hospital do Rim, Federal University of Sao Paulo, Sao Paulo 04038-002, Brazil
| | - Helio Tedesco-Silva
- Nephrology Division, Hospital do Rim, Federal University of Sao Paulo, Sao Paulo 04038-002, Brazil
| | | | - Alvaro Cerda
- Department of Basic Sciences, Center of Excellence in Translational Medicine, BIOREN, Universidad de La Frontera, Temuco 4810296, Chile
| | - Sonia Quateli Doi
- School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Mario Hiroyuki Hirata
- Department of Clinical & Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo 05508-000, Brazil
| | - Rosario Dominguez Crespo Hirata
- Department of Clinical & Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo 05508-000, Brazil
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Genvigir FDV, Campos-Salazar AB, Felipe CR, Tedesco-Silva H, Medina-Pestana JO, Doi SDQ, Cerda A, Hirata MH, Herrero MJ, Aliño SF, Hirata RDC. CYP3A5*3 and CYP2C8*3 variants influence exposure and clinical outcomes of tacrolimus-based therapy. Pharmacogenomics 2020; 21:7-21. [PMID: 31849280 DOI: 10.2217/pgs-2019-0120] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: The influence of variants in pharmacokinetics-related genes on long-term exposure to tacrolimus (TAC)-based therapy and clinical outcomes was investigated. Patients & methods: Brazilian kidney recipients were treated with TAC combined with everolimus (n = 178) or mycophenolate sodium (n = 97). The variants in CYP2C8, CYP2J2, CYP3A4, CYP3A5, POR, ABCB1, ABCC2, ABCG2, SLCO1B1 and SLCO2B1 were analyzed. Main results: CYP3A5*3/*3 genotype influenced increase in TAC concentration from week 1 to month 6 post-transplantation (p < 0.05). The living donor and CYP2C8*3 variant were associated with reduced risk for delayed graft function (OR = 0.07; 95% CI = 0.03-0.18 and OR = 0.45; 95% CI = 0.20-0.99, respectively, p < 0.05). Conclusion: The CYP3A5*3 variant is associated with increased early exposure to TAC. Living donor and CYP2C8*3 variant seem to be protective factors for delayed graft function in kidney recipients.
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Affiliation(s)
- Fabiana Dalla Vecchia Genvigir
- Department of Clinical & Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Antony Brayan Campos-Salazar
- Department of Clinical & Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil.,Bioinformatics & Pharmacogenetics Laboratory, METOSMOD Research Group, School of Pharmacy & Biochemistry, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Claudia Rosso Felipe
- Nephrology Division, Hospital do Rim, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Helio Tedesco-Silva
- Nephrology Division, Hospital do Rim, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Sonia de Quateli Doi
- Nephrology Research Laboratory, School of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Alvaro Cerda
- Department of Basic Sciences, Center of Excellence in Translational Medicine, BIOREN, Universidad de La Frontera, Temuco, Chile
| | - Mario Hiroyuki Hirata
- Department of Clinical & Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - María José Herrero
- Department of Pharmacology, University of Valencia. Pharmacogenetics, Instituto Investigación Sanitaria y Hospital La Fe, Valencia, Spain
| | - Salvador Francisco Aliño
- Department of Pharmacology, University of Valencia. Pharmacogenetics, Instituto Investigación Sanitaria y Hospital La Fe, Valencia, Spain
| | - Rosario Dominguez Crespo Hirata
- Department of Clinical & Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
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Bonezi V, Genvigir FDV, Salgado PDC, Felipe CR, Tedesco-Silva H, Medina-Pestana JO, Cerda A, Doi SQ, Hirata MH, Hirata RDC. Differential expression of genes related to calcineurin and mTOR signaling and regulatory miRNAs in peripheral blood from kidney recipients under tacrolimus-based therapy. Ann Transl Med 2020; 8:1051. [PMID: 33145270 PMCID: PMC7575939 DOI: 10.21037/atm-20-1757] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Genetic and epigenetics factors have been implicated in drug response, graft function and rejection in solid organ transplantation. Differential expression of genes involved in calcineurin and mTOR signaling pathway and regulatory miRNAs was analyzed in the peripheral blood of kidney recipient cohort (n=36) under tacrolimus-based therapy. Methods PPP3CA, PPP3CB, MTOR, FKBP1A, FKBP1B and FKBP5 mRNA expression and polymorphisms in PPP3CA and MTOR were analyzed by qPCR. Expression of miRNAs targeting PPP3CA (miR-30a, miR-145), PPP3CB (miR-10b), MTOR (miR-99a, miR-100), and FKBP1A (miR-103a) was measured by qPCR array. Results PPP3CA and MTOR mRNA levels were reduced in the first three months of treatment compared to pre-transplant (P<0.05). PPP3CB, FKBP1A, FKBP1B, and FKBP5 expression was not changed. In the 3rd month of treatment, the expression of miR-99a, which targets MTOR, increased compared to pre-transplant (P<0.05). PPP3CA c.249G>A (GG genotype) and MTOR c.2997C>T (TT genotype) were associated with reduced expression of PPP3CA mRNA and MTOR, respectively. FKBP1B mRNA levels were higher in patients with acute rejection (P=0.026). Conclusions The expression of PPP3CA, MTOR and miR-99a in the peripheral blood of renal recipients is influenced by tacrolimus-based therapy and by PPP3CA and MTOR variants. These molecules can be potential biomarkers for pharmacotherapy monitoring.
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Affiliation(s)
- Vivian Bonezi
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Fabiana Dalla Vecchia Genvigir
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Patrícia de Cássia Salgado
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Claudia Rosso Felipe
- Nephrology Division, Hospital do Rim, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Helio Tedesco-Silva
- Nephrology Division, Hospital do Rim, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Alvaro Cerda
- Department of Basic Sciences, Center of Excellence in Translational Medicine, BIOREN, Universidad de La Frontera, Temuco, Chile
| | - Sonia Quateli Doi
- School of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Mario Hiroyuki Hirata
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Rosario Dominguez Crespo Hirata
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
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Ramos de Freitas GR, Benjamens S, Gonçalves PD, Cascelli de Azevedo ML, Reis da Silva Filho E, Medina-Pestana JO, Pol RA, Reis T. Kidney Allograft Cyst Infection. Kidney Int Rep 2020; 5:1114-1117. [PMID: 32647773 PMCID: PMC7335975 DOI: 10.1016/j.ekir.2020.04.013] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 10/29/2022] Open
Affiliation(s)
| | - Stan Benjamens
- Department of Surgery, Division of Transplantation Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Priscila Dias Gonçalves
- Department of Nephrology and Kidney Transplantation, Clínica de Doenças Renais de Brasília (CDRB), Brasília, Brazil.,Department of Nephrology, University Hospital of Brasilia (HUB), Brasília, Brazil
| | | | - Evandro Reis da Silva Filho
- Department of Nephrology and Kidney Transplantation, Clínica de Doenças Renais de Brasília (CDRB), Brasília, Brazil
| | - José Osmar Medina-Pestana
- Department of Nephrology, Hospital do Rim e Hipertensão, Federal University of São Paulo, São Paulo, Brazil
| | - Robert A Pol
- Department of Surgery, Division of Transplantation Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Thiago Reis
- Department of Nephrology and Kidney Transplantation, Clínica de Doenças Renais de Brasília (CDRB), Brasília, Brazil
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Emori CT, Uehara SNO, Amaral AC, Carvalho-Filho RJ, Moreira SR, Sandra de Souza E Silva I, Lanzoni VP, Silva-Souza AL, Gama RA, Soares Nunes EJ, Serra Leopércio AP, Appel F, Regina de Almeida Carvalho S, Benedito Silva AE, Medina-Pestana JO, Gomes Ferraz ML. Observational Study Evaluating the Outcome of Cirrhotic Hepatitis C Patients Submitted to Renal Transplantation. Transplant Proc 2020; 52:89-96. [PMID: 32000943 DOI: 10.1016/j.transproceed.2019.10.022] [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: 07/16/2019] [Accepted: 10/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND After renal transplantation (RTx) hepatitis C virus (HCV) is associated with higher morbidity and mortality resulting in lower patient and graft survival. Few studies have investigated the evolution of renal transplant patients with cirrhosis owing to HCV. The objectives were to evaluate the post-transplant evolution of cirrhotic patients and to compare them with noncirrhotic patients considering the outcomes, including hepatic decompensation, graft loss, and death. METHODS The retrospective-cohort study analyzed the data of patients undergoing RTx between 1993 and 2014, positive anti-HCV, HCV-RNA before RTx, and availability of data for assessment of cirrhosis. Demographic, clinical, and laboratory variables were compared between the groups according to the outcomes. The same were made between cirrhotic patients with and without portal hypertension (PH). Survival curves were constructed by the Kaplan-Meier test and compared by the log-rank test. Variables associated with the outcomes were analyzed using Cox regression. RESULTS This study included noncirrhotic (n = 201) and cirrhotic patients (n = 23). In cirrhotic patients, they were significantly older (49 vs 41.6 years) and mostly male (87% vs 65%), with a greater number of previous RTx (48% vs 18%), less frequent use of azathioprine (26% vs 54%), cyclosporine (13% vs 46.5%), more frequent use of tacrolimus (87% vs 55%), lower count of platelets × 1000 cells/mm3(110 vs 187), and higher pre-RTx international normalized ratio (1.20 vs 1.1).The Kaplan-Meier survival differed in cirrhotic vs noncirrhotic patients only in hepatic decompensation. Cox regression analysis identified pretransplant cirrhosis (hazard ratio 6.64, 95% confidence interval, 2.59-17.06) and tacrolimus (hazard ratio 3.17,95% confidence interval, 1.05-9.58) as variables independently associated with decompensation. CONCLUSIONS Patients with HCV and cirrhosis exhibit higher morbidity when submitted to RTx than noncirrhotic patients, with a higher risk of hepatic decompensation. However, no difference was observed in liver-related mortality, suggesting that RTx is a feasible option in cirrhotic patients without decompensation, even if they have PH.
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Affiliation(s)
| | | | - Ana Cristina Amaral
- Department of Gastroenterology, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | | | - Raimundo Araújo Gama
- Department of Gastroenterology, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Flávia Appel
- Department of Gastroenterology, Federal University of São Paulo, São Paulo, Brazil
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10
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Ponzio V, Chen Y, Rodrigues AM, Tenor JL, Toffaletti DL, Medina-Pestana JO, Colombo AL, Perfect JR. Genotypic diversity and clinical outcome of cryptococcosis in renal transplant recipients in Brazil. Emerg Microbes Infect 2019; 8:119-129. [PMID: 30866766 PMCID: PMC6455115 DOI: 10.1080/22221751.2018.1562849] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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] [Indexed: 12/14/2022]
Abstract
Genotypic diversity and fluconazole susceptibility of 82 Cryptococcus neoformans and Cryptococcus gattii isolates from 60 renal transplant recipients in Brazil were characterized. Clinical characteristics of the patients and prognostic factors were analysed. Seventy-two (87.8%) isolates were C. neoformans and 10 (12.2%) were C. gattii. VNI was the most common molecular type (40 cases; 66.7%), followed by VNII (9 cases; 15%), VGII (6 cases; 10%), VNB (4 cases; 6.7%) and VNI/II (1 case; 1.7%). The isolates showed a high genetic diversity in the haplotype network and six new sequence types were described, most of them for VNB. There was a bias towards skin involvement in the non-VNI population (P = .012). VGII isolates exhibited higher fluconazole minimum inhibitory concentrations compared to C. neoformans isolates (P = 0.008). The 30-day mortality rate was 38.3%, and it was significantly associated with fungemia and absence of headache. Patients infected with VGII had a high mortality rate at 90 days (66.7%). A variety of molecular types produce disease in renal transplant recipients in Brazil and highlighted by VGII and VNB. We report the clinical appearance and impact of the molecular type, fluconazole susceptibility of the isolates, and clinical characteristics on patient outcome in this population.
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Affiliation(s)
- Vinicius Ponzio
- a Department of Medicine, Division of Infectious Diseases, Escola Paulista de Medicina , Universidade Federal de São Paulo (UNIFESP) , São Paulo , Brazil
| | - Yuan Chen
- b Division of Infectious Disease, Department of Medicine , Duke University School of Medicine , Durham , NC , USA
| | - Anderson Messias Rodrigues
- c Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology and Parasitology , Universidade Federal de São Paulo (UNIFESP) , São Paulo , Brazil
| | - Jennifer L Tenor
- b Division of Infectious Disease, Department of Medicine , Duke University School of Medicine , Durham , NC , USA
| | - Dena L Toffaletti
- b Division of Infectious Disease, Department of Medicine , Duke University School of Medicine , Durham , NC , USA
| | - José Osmar Medina-Pestana
- d Hospital do Rim Oswaldo Ramos Foundation, Discipline of Nephrology , Universidade Federal de São Paulo (UNIFESP) , São Paulo , Brazil
| | - Arnaldo Lopes Colombo
- a Department of Medicine, Division of Infectious Diseases, Escola Paulista de Medicina , Universidade Federal de São Paulo (UNIFESP) , São Paulo , Brazil
| | - John R Perfect
- b Division of Infectious Disease, Department of Medicine , Duke University School of Medicine , Durham , NC , USA
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Carlotto JRM, Linhares MM, Salzedas Netto AA, Rangel ÉB, Medina-Pestana JO, Ferraro JR, Lopes Filho GJ, Oliva CAG, Gonzalez AM. Simultaneous pancreas-kidney transplantation and the impact of postoperative complications on hospitalization cost. Rev Col Bras Cir 2019; 46:e2096. [PMID: 30843947 DOI: 10.1590/0100-6991e-20192096] [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: 12/26/2018] [Accepted: 01/02/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE considering simultaneous pancreas-kidney transplantation cases, to evaluate the financial impact of postoperative complications on hospitalization cost. METHODS a retrospective study of hospitalization data from patients consecutively submitted to simultaneous pancreas-kidney transplantation (SPKT), from January 2008 to December 2014, at Kidney Hospital/Oswaldo Ramos Foundation (Sao Paulo, Brazil). The main studied variables were reoperation, graft pancreatectomy, death, postoperative complications (surgical, infectious, clinical, and immunological ones), and hospitalization financial data for transplantation. RESULTS the sample was composed of 179 transplanted patients. The characteristics of donors and recipients were similar in patients with and without complications. In data analysis, 58.7% of the patients presented some postoperative complication, 21.8% required reoperation, 12.3% demanded graft pancreatectomy, and 8.4% died. The need for reoperation or graft pancreatectomy increased hospitalization cost by 53.3% and 78.57%, respectively. The presence of postoperative complications significantly increased hospitalization cost. However, the presence of death, internal hernia, acute myocardial infarction, stroke, and pancreatic graft dysfunction did not present statistical significance in hospitalization cost (in average US$ 18,516.02). CONCLUSION considering patients who underwent SPKT, postoperative complications, reoperation, and graft pancreatectomy, as well as surgical, infectious, clinical, and immunological complications, significantly increased the mean cost of hospitalization. However, death, internal hernia, acute myocardial infarction, stroke, and pancreatic graft dysfunction did not statistically interfere in hospitalization cost.
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Affiliation(s)
| | - Marcelo Moura Linhares
- Universidade Federal de São Paulo, Disciplina de Gastroenterologia Cirúrgica, São Paulo, SP, Brasil
| | | | | | | | - José Roberto Ferraro
- Universidade Federal de São Paulo, Disciplina de Gastroenterologia Cirúrgica, São Paulo, SP, Brasil
| | - Gaspar Jesus Lopes Filho
- Universidade Federal de São Paulo, Disciplina de Gastroenterologia Cirúrgica, São Paulo, SP, Brasil
| | | | - Adriano Miziara Gonzalez
- Universidade Federal de São Paulo, Disciplina de Gastroenterologia Cirúrgica, São Paulo, SP, Brasil
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12
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Ricci G, Santos DW, Kovacs JA, Nishikaku AS, de Sandes-Freitas TV, Rodrigues AM, Kutty G, Affonso R, Silva HT, Medina-Pestana JO, de Franco MF, Colombo AL. Genetic diversity of Pneumocystis jirovecii from a cluster of cases of pneumonia in renal transplant patients: Cross-sectional study. Mycoses 2018; 61:845-852. [PMID: 29992629 DOI: 10.1111/myc.12823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 01/16/2018] [Revised: 06/11/2018] [Accepted: 07/01/2018] [Indexed: 12/25/2022]
Abstract
Pneumocystis jirovecii can cause severe potentially life-threatening pneumonia (PCP) in kidney transplant patients. Prophylaxis of patients against PCP in this setting is usually performed during 6 months after transplantation. The aim of this study is to describe the molecular epidemiology of a cluster of PCP in renal transplant recipients in Brazil. Renal transplant patients who developed PCP between May and December 2011 had their formalin-fixed paraffin-embedded (FFPE) lung biopsy samples analysed. Pneumocystis jirovecii 23S mitochondrial large subunit of ribosomal RNA (23S mtLSU-rRNA), 26S rRNA, and dihydropteroate synthase (DHPS) genes were amplified by polymerase chain reaction (PCR), sequenced, and analysed for genetic variation. During the study period, 17 patients developed PCP (only four infections were documented within the first year after transplantation) and six (35.3%) died. Thirty FFPE samples from 11 patients, including one external control HIV-infected patient, had fungal DNA successfully extracted for further amplification and sequencing for all three genes. A total of five genotypes were identified among the 10 infected patients. Of note, four patients were infected by more than one genotype and seven patients were infected by the same genotype. DNA extracted from FFPE samples can be used for genotyping; this approach allowed us to demonstrate that multiple P. jirovecii strains were responsible for this cluster, and one genotype was found infecting seven patients. The knowledge of the causative agents of PCP may help to develop new initiatives for control and prevention of PCP among patients undergoing renal transplant and improve routine PCP prophylaxis.
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Affiliation(s)
- Giannina Ricci
- Special Mycology Laboratory, Division of Infectious Diseases, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Daniel Wagner Santos
- Special Mycology Laboratory, Division of Infectious Diseases, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, SP, Brazil
| | - Joseph A Kovacs
- Critical Care Medicine Department, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Angela Satie Nishikaku
- Special Mycology Laboratory, Division of Infectious Diseases, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Anderson Messias Rodrigues
- Molecular Biology Division, Department of Microbiology, Immunology and Parasitology (DMIP), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Geetha Kutty
- Critical Care Medicine Department, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Regina Affonso
- Biotechnology Center, Nuclear and Energy Research Institute (IPEN), São Paulo, SP, Brazil
| | | | | | | | - Arnaldo Lopes Colombo
- Special Mycology Laboratory, Division of Infectious Diseases, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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13
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Cordeiro Cabral DB, de Sandes-Freitas TV, Medina-Pestana JO, Mastroianni-Kirsztajn G. Clinical Features, Treatment and Prognostic Factors of Post-Transplant Immunoglobulin A Nephropathy. Ann Transplant 2018. [PMID: 29519995 PMCID: PMC6248017 DOI: 10.12659/aot.907167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Initially described as a relatively benign condition, recent studies report graft loss in up to 50% of the patients with post-transplant IgA nephropathy. There is no evidence for the best therapeutic approach, and prognostic factors remain to be elucidated. Material/Methods Single center retrospective analysis of patients >12 years old, with clinically relevant post-transplant IgA nephropathy (proteinuria ≥1.0 g/g and/or graft dysfunction) and ≥6 months follow-up after diagnosis (n=47). Results Living donor transplants represented 85% of cases. Dysmorphic hematuria (100%), blood pressure elevation (95.7%), renal dysfunction (70.2%) and subnephrotic proteinuria (60.6%) predominated at presentation. Using the Oxford Classification, mesangial proliferation was the main histological lesion (91%). Treatment consisted mostly of blockade of the renin angiotensin system (89.4%) and modification of immunosuppression (85.1%), mainly by increasing oral steroids dose (83%), with venous pulse therapy in 63.8% of cases. Partial and complete remission occurred in 48.9% and 17% of cases, respectively. One patient died (sepsis) and 15 patients (31.9%) lost their grafts due to nephropathy. The percentage of decrease in glomerular filtration rate at diagnosis was independently associated with partial remission (HR 0.97, 95% CI 0.94–0.99, p=0.01) and graft loss (HR 1.13, 95% CI 1.06–1.20, p<0.001). Deceased donor (HR 28.04, 95% CI 4.41–178.39, p<0.001) and donor age (HR 1.1, 95% CI 1.04–1.16, p=0.001) were also risk factors for graft loss. Conclusions Despite treatment, most patients with post-transplant IgA nephropathy in this cohort study presented unfavorable outcomes, and graft dysfunction at diagnosis appeared to be the main prognostic marker.
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Affiliation(s)
| | - Tainá Veras de Sandes-Freitas
- Transplantation Section (Nephrology Division), Federal University of São Paulo (UNIFESP) and Hospital do Rim, São Paulo, SP, Brazil
| | - José Osmar Medina-Pestana
- Transplantation Section (Nephrology Division), Federal University of São Paulo (UNIFESP) and Hospital do Rim, São Paulo, Brazil
| | - Gianna Mastroianni-Kirsztajn
- Glomerulopathies Section (Nephrology Division), Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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14
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Freitas FGR, Lombardi F, Pacheco ES, Sandes-Freitas TVD, Viana LA, Junior HTS, Medina-Pestana JO, Bafi AT, Machado FR. Clinical Features of Kidney Transplant Recipients Admitted to the Intensive Care Unit. Prog Transplant 2017; 28:56-62. [PMID: 29258377 DOI: 10.1177/1526924817746685] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION There is a paucity of data regarding the complications in kidney transplant patients who may require intensive care unit (ICU) management, despite being the most common solid organ transplant worldwide. OBJECTIVE To identify the main reasons for ICU admission and to determine the factors associated with hospital mortality in kidney transplant recipients. DESIGN This single-center retrospective cohort study was conducted between September 2013 and June 2014, including all consecutive kidney transplant patients requiring ICU admission. We collected data on patient demographics, transplant characteristics, clinical data, and prognostic scores. The independent determinants of hospital mortality were identified by multiple logistic regression analysis. We also assessed the performance of Simplified Acute Physiology Score 3 (SAPS 3) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. RESULTS We analyzed data from 413 patients, the majority of whom were admitted late after renal transplantation (1169 days; 63-3003 days). The main reason for admission was sepsis (33.2%), followed by cardiovascular disease (16%). Age (odds ratio [OR] 1.05, confidence interval [CI], 1.01-1.09), SAPS 3 score (OR 1.04, CI, 1.01-1.08), the need for mechanical ventilation (OR 26.47, CI, 10.30-68.08), and vasopressor use (OR 3.34, CI, 1.37-8.13) were independently associated with hospital mortality. The performance of SAPS 3 and APACHE II scores was poor in this population and overestimated the mortality rates. CONCLUSION Sepsis was the main reason for ICU admission in kidney transplant recipients, followed by cardiovascular disease. Age and disease severity were associated with hospital mortality.
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Affiliation(s)
- Flávio Geraldo Rezende Freitas
- 1 Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, São Paulo, Brazil.,2 Unidade de Transplante, Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Fábio Lombardi
- 1 Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Eduardo Souza Pacheco
- 1 Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Laila Almeida Viana
- 2 Unidade de Transplante, Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Hélio Tedesco-Silva Junior
- 2 Unidade de Transplante, Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - José Osmar Medina-Pestana
- 2 Unidade de Transplante, Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Antônio Tonete Bafi
- 1 Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, São Paulo, Brazil.,2 Unidade de Transplante, Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Flavia Ribeiro Machado
- 1 Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, São Paulo, Brazil
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15
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Santos DW, Camargo LF, Gonçalves SS, Ogawa MM, Tomimori J, Enokihara MM, Medina-Pestana JO, Colombo AL. Melanized fungal infections in kidney transplant recipients: contributions to optimize clinical management. Clin Microbiol Infect 2017; 23:333.e9-333.e14. [PMID: 28062320 DOI: 10.1016/j.cmi.2016.12.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 09/25/2016] [Revised: 12/15/2016] [Accepted: 12/22/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This is a retrospective and observational study addressing clinical and therapeutic aspects of melanized fungal infections in kidney transplant recipients. METHODS We retrospectively reviewed medical records of all patients admitted between January 1996 and December 2013 in a single institution who developed infections by melanized fungi. RESULTS We reported on 56 patients aged between 30 and 74 years with phaeohyphomycosis or chromoblastomycosis (0.54 cases per 100 kidney transplants). The median time to diagnosis post-transplant was 31.2 months. Thirty-four (60.8%) infections were reported in deceased donor recipients. Fifty-one cases of phaeohyphomycosis were restricted to subcutaneous tissues, followed by two cases with pneumonia and one with brain involvement. Most dermatological lesions were represented by cysts (23/51; 45.1%) or nodules (9/51; 17.9%). Exophiala spp. (34.2%) followed by Alternaria spp. (7.9%) were the most frequent pathogens. Graft loss and death occurred in two patients and one patient, respectively. Regarding episodes of subcutaneous phaeohyphomycosis, a complete surgical excision without antifungal therapy was possible in 21 of 51 (41.2%) patients. Long periods of itraconazole were required to treat the other 30 (58.8%) episodes of subcutaneous disease. All four cases of chromoblastomycosis were treated only with antifungal therapy. CONCLUSIONS Melanized fungal infections should be considered in the differential diagnosis of all chronic skin lesions in transplant recipients. It is suggested that the impact of these infections on graft function and mortality is low. The reduction in immunosuppression should be limited to severely ill patients.
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Affiliation(s)
- D W Santos
- Special Mycology Laboratory-LEMI, Division of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, Brazil; Division of Infectious Diseases, Hospital do Rim, São Paulo, SP, Brazil
| | - L F Camargo
- Division of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, Brazil
| | - S S Gonçalves
- Special Mycology Laboratory-LEMI, Division of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, Brazil
| | - M M Ogawa
- Department of Dermatology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - J Tomimori
- Department of Dermatology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - M M Enokihara
- Department of Dermatology, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | - A L Colombo
- Special Mycology Laboratory-LEMI, Division of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, Brazil; Division of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, Brazil.
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16
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Vicari AR, Spuldaro F, Sandes-Freitas TV, Cristelli MP, Requião-Moura LR, Reusing JO, Pierrotti LC, Oliveira ML, Girão CM, Gadonski G, Kroth LV, Deboni LM, Ferreira GF, Tedesco-Silva H, Esmeraldo R, David-Neto E, Saitovitch D, Keitel E, Garcia VD, Pacheco-Silva A, Medina-Pestana JO, Manfro RC. Renal transplantation in human immunodeficiency virus-infected recipients: a case-control study from the Brazilian experience. Transpl Infect Dis 2016; 18:730-740. [PMID: 27503081 DOI: 10.1111/tid.12592] [Citation(s) in RCA: 5] [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: 03/05/2016] [Revised: 05/27/2016] [Accepted: 06/24/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Highly active antiretroviral therapy has turned human immunodeficiency virus (HIV)-infected patients with end-stage renal disease into suitable candidates for renal transplantation. We present the Brazilian experience with kidney transplantation in HIV-infected recipients observed in a multicenter study. METHODS HIV-infected kidney transplant recipients and matched controls were evaluated for the incidence of delayed graft function (DGF), acute rejection (AR), infections, graft function, and survival of patients and renal grafts. RESULTS Fifty-three HIV-infected recipients and 106 controls were enrolled. Baseline characteristics were similar, but a higher frequency of pre-transplant positivity for hepatitis C virus and cytomegalovirus infections was found in the HIV group. Immunosuppressive regimens did not differ, but a trend was observed toward lower use of anti-thymocyte globulin in the group of HIV-infected recipients (P = 0.079). The HIV-positive recipient group presented a higher incidence of treated AR (P = 0.036) and DGF (P = 0.044). Chronic Kidney Disease Epidemiology Collaboration estimated that glomerular filtration rate was similar at 6 months (P = 0.374) and at 12 months (P = 0.957). The median number of infections per patient was higher in the HIV-infected group (P = 0.018). The 1-year patient survival (P < 0.001) and graft survival (P = 0.004) were lower, but acceptable, in the group of HIV-infected patients. CONCLUSIONS In the Brazilian experience, despite somewhat inferior outcomes, kidney transplantation is an adequate therapy for selected HIV-infected recipients.
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Affiliation(s)
- A R Vicari
- Renal Transplant Unit, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - F Spuldaro
- Renal Transplant Unit, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - M P Cristelli
- Hospital do Rim, Federal University of São Paulo, São Paulo, SP, Brazil
| | - L R Requião-Moura
- Renal Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - J O Reusing
- Renal Transplant Unit, Hospital das Clínicas de São Paulo, University of São Paulo, São Paulo, SP, Brazil
| | - L C Pierrotti
- Renal Transplant Unit, Hospital das Clínicas de São Paulo, University of São Paulo, São Paulo, SP, Brazil
| | - M L Oliveira
- Renal Transplant Unit, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - C M Girão
- Renal Transplant Unit, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - G Gadonski
- Renal Transplant Unit, Hospital São Lucas, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - L V Kroth
- Renal Transplant Unit, Hospital São Lucas, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - L M Deboni
- Hospital Municipal São José e Fundação Pró-Rim, Joinville, SC, Brazil
| | - G F Ferreira
- Hospital Santa Casa de Misericórdia de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - H Tedesco-Silva
- Hospital do Rim, Federal University of São Paulo, São Paulo, SP, Brazil
| | - R Esmeraldo
- Renal Transplant Unit, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - E David-Neto
- Renal Transplant Unit, Hospital das Clínicas de São Paulo, University of São Paulo, São Paulo, SP, Brazil
| | - D Saitovitch
- Renal Transplant Unit, Hospital São Lucas, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - E Keitel
- Renal Transplant Unit, Hospital Santa Casa de Porto Alegre, Federal University of Medical Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - V D Garcia
- Renal Transplant Unit, Hospital Santa Casa de Porto Alegre, Federal University of Medical Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - A Pacheco-Silva
- Renal Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - R C Manfro
- Renal Transplant Unit, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
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17
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Felix MJP, Felipe CR, Tedesco-Silva H, Osmar Medina-Pestana J. Time-Dependent and Immunosuppressive Drug-Associated Adverse Event Profiles in De Novo Kidney Transplant Recipients Converted from Tacrolimus to Sirolimus Regimens. Pharmacotherapy 2016; 36:152-65. [PMID: 26799522 DOI: 10.1002/phar.1692] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
STUDY OBJECTIVE To evaluate the safety and tolerability of immunosuppressive drugs used in a planned randomized conversion from a calcineurin inhibitor, tacrolimus, to a mammalian target of rapamycin inhibitor, sirolimus, in de novo kidney transplant recipients. DESIGN Prospective safety analysis of data from a prospective, randomized, open-label, controlled study. PATIENTS A total of 119 adult kidney transplant recipients who received tacrolimus (TAC), mycophenolate sodium (MPS), and prednisone between February 2008 and May 2010; after 3 months of this regimen, 60 of these patients were randomized to conversion from TAC to sirolimus (SRL/MPS group), and 59 patients continued with the TAC regimen (TAC/MPS group). MEASUREMENTS AND MAIN RESULTS Both groups were followed for 24 months after transplantation for immunosuppressive regimen-associated and time-dependent occurrences of adverse events (AEs) and serious adverse events (SAEs). Before conversion from TAC to SRL, the cumulative incidence of AEs was 98%; 25% were SAEs. Gastrointestinal AEs (66%) and infections (58%) were the most frequent AEs. The incidences of TAC and MPS dose reductions due to AEs were 1.7% and 12%, respectively. After conversion, no significant differences were noted in the SRL/MPS group versus the TAC/MPS group in the cumulative incidences of AEs (100% vs. 98%) and SAEs (27% vs. 30%). The most common AEs were gastrointestinal (70% vs. 54%, p=0.23) and infection (77% vs. 73%, p=0.79) in the SRL/MPS versus TAC/MPS groups. The incidence of aphthous ulcer (28% vs. 0%, p=< 0.01), sinusitis (10% vs. 0%, p=0.01), dermatitis (15% vs. 3%, p=0.03), and dyslipidemia (35% vs. 14%, p=0.02) were higher in the SRL/MPS group compared with the TAC/MPS group. Cox proportion regression analysis showed a higher relative risk for gastrointestinal (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.2-3.01, p<0.05) and skin and subcutaneous tissue (HR 2.5, 95% CI 1.1-4.1, p<0.05) AEs in the SRL/MPS group compared with the TAC/MPS group. AE-related dose reductions occurred in 18.3% of patients receiving SRL and 3.3% of patients receiving TAC. MPS dose reductions due to AEs occurred in 11.7% of patients receiving SRL and 13.6% of patients receiving TAC. CONCLUSION SRL/MPS treatment was associated with a time-dependent higher incidence of gastrointestinal and skin and subcutaneous tissue AEs, which occurred mainly during the first 6 months after conversion from TAC/MPS. Although the treatments with SRL or TAC after 3 months of transplantation showed different safety profiles, both regimens demonstrated adequate tolerability, with low rates of early discontinuation related to AEs.
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Affiliation(s)
| | - Claudia Rosso Felipe
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Hélio Tedesco-Silva
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
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18
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Lemes-Canuto APPS, de Sandes-Freitas TV, Medina-Pestana JO, Mastroianni-Kirsztajn G. IgA NEPHROPATHY IN PATIENTS RECEIVING A RENAL TRANSPLANT. J Ren Care 2015; 41:222-30. [PMID: 25819382 DOI: 10.1111/jorc.12122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND IgA nephropathy (IgAN) is the third most frequent cause of renal graft loss among patients with primary glomerulonephritis. OBJECTIVES To assess clinical and laboratorial profile of patients with pre and/or post transplant IgAN, in addition to patient and graft survival in both groups. DESIGN Data from 146 patients who had received a renal transplant were retrospectively collected and were divided in two groups: group 1-patients with biopsy-documented IgAN as the underlying native kidney disease (n = 128); group 2-patients who developed post-transplant IgAN independent of the underlying disease (n = 18). PARTICIPANTS Patients submitted to renal transplantation (1998-2010) with pre and/or post transplant IgAN. MEASUREMENTS Clinical and laboratorial evaluation of renal function of 146 post transplant IgAN patients. RESULTS Recipients and deceased donors exhibited a higher degree of HLA compatibility (1.0 vs. 2.5 mismatches for groups 1 and 2, respectively). The main post-transplant IgAN presentation was haematuria associated with non-nephrotic proteinuria (44.4%). A histological pattern of focal segmental glomerulosclerosis was observed in 59.2% of biopsy samples. The 10-year patient survival was 93.5% in group 1 and 100% in group 2, and the graft survival rates were 58.5 and 87.2%, respectively. CONCLUSION The rate of post-transplant IgA diagnosis in our case series was 11%, and IgAN was diagnosed late in the course of transplantation. In most cases, IgAN manifested as haematuria and non-nephrotic proteinuria, without renal graft dysfunction, and this picture might explain late indication of graft biopsies. The 10-year patient survival rates were excellent.
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Affiliation(s)
| | | | - José Osmar Medina-Pestana
- Renal Transplant, Unit of the Division of Nephrology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Baxmann AC, Menon VB, Medina-Pestana JO, Carvalho AB, Heilberg IP. Overweight and body fat are predictors of hypovitaminosis D in renal transplant patients. Clin Kidney J 2014; 8:49-53. [PMID: 25713710 PMCID: PMC4310423 DOI: 10.1093/ckj/sfu120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/17/2014] [Indexed: 12/19/2022] Open
Abstract
Background Hypovitaminosis D has been frequently reported after renal transplantation, but the impact of obesity and other factors in the reduction of vitamin D levels is not well established. We aimed to evaluate risk factors contributing to hypovitaminosis D among nondiabetic renal transplant recipients (RTR) with serum creatinine <2.0 mg/dL, at least 6 months after transplantation. Methods One hundred RTR were subjected to anthropometric evaluation and body composition assessment through bioelectrical impedance analysis; blood samples were drawn for biochemical and hormonal determinations and clinical data were retrieved from the medical records. Results Hypovitaminosis D was observed in 65% and overweight (body mass index, BMI >25 kg/m2) in 59% of cases with a significant median weight gain after transplantation of 5.1 kg. An inadequate distribution of body fat was evidenced in 50% of males and in 58% of females. Patients with either vitamin D deficiency or insufficiency presented significantly higher median values of body fat and weight gain since transplantation, as well as lower lean mass compared with patients with normal vitamin D levels (P < 0.001). Moreover, median values of waist circumference, BMI, serum leptin and parathyroid hormone levels were significantly higher in the group with vitamin D deficiency. A multivariate linear regression analysis then revealed that body fat and leptin levels, but not skin color, gender, age, glucocorticoid use, renal function, microalbuminuria and other confounding factors, were independently associated with low levels of 25 hydroxyvitamin D3 even after adjustments for seasonal variations. Conclusion In conclusion, the present study showed body fat and serum leptin levels to be the only independent risk factors for hypovitaminosis D among RTR.
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Hering T, Passos AM, Perez RM, Bilar J, Fragano D, Granato C, Medina-Pestana JO, Ferraz MLG. Past and current hepatitis E virus infection in renal transplant patients. J Med Virol 2014; 86:948-53. [DOI: 10.1002/jmv.23915] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Tiago Hering
- Department of Gastroenterology; Federal University of Sao Paulo; Sao Paulo Brazil
| | - Ana Maria Passos
- Department of Infectious Diseases; Federal University of Sao Paulo; Sao Paulo Brazil
| | - Renata Mello Perez
- Department of Internal Medicine; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
| | - Juliana Bilar
- Department of Gastroenterology; Federal University of Sao Paulo; Sao Paulo Brazil
| | - Daniel Fragano
- Department of Gastroenterology; Federal University of Sao Paulo; Sao Paulo Brazil
| | - Celso Granato
- Department of Infectious Diseases; Federal University of Sao Paulo; Sao Paulo Brazil
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Oliveira N, Felipe CR, De Paula MI, Tamashiro EY, Tedesco-Siva H, Medina-Pestana JO. OHP-037 Benefits of clinical research in a single kidney transplant centre. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000436.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Felix M, Felipe CR, Tedesco-Silva H, Medina-Pestana JO, Spinelli GA. DI-033 Safety profile study of planned randomised conversion from tacrolimus to sirolimus-based immunosuppressive regimen in de novokidney transplant recipients. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000436.204] [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: 11/04/2022] Open
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Grenzi PC, Campos ÉF, Tedesco-Silva H, Felipe CR, Franco MF, Soares MF, Medina-Pestana JO, Gerbase-Delima M. Association of high post-transplant soluble CD30 serum levels with chronic allograft nephropathy. Transpl Immunol 2013; 29:34-8. [PMID: 23928467 DOI: 10.1016/j.trim.2013.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 06/17/2013] [Revised: 07/29/2013] [Accepted: 07/29/2013] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to evaluate the association of post-transplant soluble CD30 (sCD30) levels, isolated or in combination with of anti-HLA class II antibodies and of serum creatinine levels, with kidney graft loss due to chronic allograft nephropathy (CAN), and type of lesions in graft biopsies for cause. The study comprised 511 first kidney graft recipients, transplanted at a single center, with a graft functioning for at least 2.8 years. A single blood sample was collected from each patient. sCD30 levels were determined by ELISA, and HLA antibodies by Luminex assay. The minimum follow-up after testing was 9.3 years. High sCD30 levels, set at sCD30 ≥ 34.15 ng/mL, the presence of HLA class II antibodies, and serum creatinine ≥ 1.9 mg/dL were independently associated with CAN-graft loss (P values <0.0001, 0.05, <0.0001, respectively), and the combined hazard ratio for CAN-graft loss was 20.2. Analyses of 166 biopsies for cause showed that high sCD30 levels and creatinine were independently associated with interstitial lesions. Post-transplant sCD30 serum levels, especially in conjunction with information regarding HLA class II antibodies and serum creatinine levels, provide valuable information regarding graft outcome and could be useful for the management of kidney transplant recipients.
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Affiliation(s)
- Patricia C Grenzi
- Instituto de Imunogenética, AFIP, São Paulo, SP, Brazil; Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Passos AM, Heringer TP, Medina-Pestana JO, Ferraz MLG, Granato CFH. First report and molecular characterization of hepatitis E virus infection in renal transplant recipients in Brazil. J Med Virol 2013; 85:615-9. [DOI: 10.1002/jmv.23494] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2012] [Indexed: 11/10/2022]
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de Sandes-Freitas TV, Felipe CR, de Franco MF, Tedesco-Silva H, Medina-Pestana JO. Basiliximab induction in patients receiving tacrolimus-based immunosuppressive regimens. Int Urol Nephrol 2012; 45:537-46. [PMID: 23054318 DOI: 10.1007/s11255-012-0298-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 09/13/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE The use of basiliximab induction increased significantly in recent years based on its superior efficacy and excellent safety profile demonstrated in studies with cyclosporine-based immunosuppression. However, its clinical utility in patients receiving tacrolimus-based immunosuppressive regimens is still uncertain. METHODS We retrospectively reviewed data of 366 low immunological risk recipients of deceased donor kidney transplants. Of them, 134 received basiliximab and tacrolimus (TAC-IL2-RA), 100 received basiliximab and delayed tacrolimus(dTAC-IL2-RA), and 132 patients received tacrolimus without basiliximab(TAC-No). The endpoints were the incidence of acute rejection, graft function, and patient and graft survivals at 1 year. RESULTS The incidence of acute rejection was higher in dTAC-IL2-RA compared to TAC-IL-2RA and TAC-No Groups (33 vs.14.9 vs. 14.3 %, p < 0.001). Inferior creatinine clearance was observed in dTAC-IL2-RA Group compared to TAC-IL2-RA and TAC-No Groups at months 1 (41.6 vs. 49.9 vs. 44.8 mL/min, p = 0.004), 3 (49.8 vs. 57.2 vs. 53.5 mL/min, p = 0.017), and 6 (53.1 vs. 61.8 vs. 57.0 mL/min, p = 0.001). Patients who received basiliximab (TAC-IL2-RA and dTAC-IL2-RA Groups) had lower incidence of posttransplant diabetes (24 vs.18 vs. 39.3 %, p = 0.009). Patient and graft survivals were similar among the groups. CONCLUSIONS In low immunological risk kidney transplant recipients receiving tacrolimus, the use of basiliximab induction was not associated with lower rejection rates and did not allow delayed tacrolimus introduction.
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Affiliation(s)
- Tainá Veras de Sandes-Freitas
- Hospital do Rim e Hipertensão, Nephrology Division, Universidade Federal de São Paulo, Rua Borges Lagoa, 960, Vila Clementino, São Paulo, SP 04038-002, Brazil.
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Bastos DO, Perez RM, Silva IS, Lemos LB, Simonetti JP, Medina-Pestana JO, Silva AEB, Ferraz ML. Transcription-mediated amplification (TMA) for the assessment of viremia in hemodialysis patients with hepatitis C. J Med Virol 2012; 84:596-600. [PMID: 22337298 DOI: 10.1002/jmv.23216] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The diagnosis of hepatitis C virus (HCV) infection in hemodialysis patients is difficult particularly due to the presence of intermittent viremia. The aims of this study were: (a) to determine the prevalence of intermittent viremia in hemodialysis patients with anti-HCV antibodies who tested negative for HCV RNA by PCR at the first evaluation and (b) to evaluate the contribution of the transcription-mediated amplification method (TMA) to the diagnosis of viremia in the PCR-negative samples. One hundred and six patients with anti-HCV antibodies and an initial negative result for HCV RNA by PCR were included. An additional sample was collected for a second HCV RNA test by PCR after a minimum interval of 3 months and a positive result characterized intermittent viremia. HCV RNA was investigated by TMA in the PCR-negative sample of patients with intermittent viremia, and in the most recent sample from patients with PCR-negative results in both determinations. Intermittent viremia was observed in 60/106 (57%) patients (57% men; age: 45 ± 10 years). Fifty-one of the 60 negative samples from patients with intermittent viremia and 29/46 double-negative patients were tested by TMA. This assay detected viremia in 20/51 (39%) samples of intermittent viremia and in 2/29 (7%) of double-negative samples. The results showed that intermittent viremia is frequent in hemodialysis patients who tested negative for HCV RNA by PCR. Therefore, a second HCV RNA test is necessary for all HCV RNA-negative patients. The TMA assay appears to be the best first screening test for viremia in this population.
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Affiliation(s)
- Dauana O Bastos
- Division of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil
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Sekiguchi RT, Pannuti CM, Silva Jr. HT, Medina-Pestana JO, Romito GA. Decrease in oral health may be associated with length of time since beginning dialysis. Special Care in Dentistry 2012; 32:6-10. [DOI: 10.1111/j.1754-4505.2011.00223.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Brazil is a country with over 190 000 000 inhabitants and a health system composed of a large public, government managed system. Between 1999 and 2010 the number of deceased donors increased by 161%, from 3.8 to 9.9 pmp, and the number of solid organ transplants increased by 121%, from 2891 to 6402. This growth was a consequence of the creation of a well-organized national transplant program. Government funding, decentralization and educational investment in transplant coordinators and related professional were decisive. In 2009 Brazil was the second largest country in the absolute number of kidney transplants (n = 4259). There are significant region disparities in performance which are mainly due to the development status. Improvements in transplant and research regulations resulted in an increasing participation of Brazilian transplant centers in multicenter trials, reaching over 44 studies during the last 11 years. Brazilian centers have been involved in clinical trials using everolimus, sirolimus, fingolimod, mycophenolate mofetyl, mycophenolate sodium, tacrolimus modified-release, sotrastaurin, belatacept, JAK3 inhibitor CP690,550 and valganciclovir. The still increasing number of transplants performed every year along with more efficient regulatory and sanitary analysis, organized clinical research programs and reduction in region performance disparities will eventually increase even more the participation of Brazil in trials worldwide.
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Affiliation(s)
- H Tedesco Silva
- Hospital do Rim e Hipertensão-Universidade Federal de São Paulo-SP-Brazil.
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Freitas TVDS, Ono G, Corrêa L, Gomes PS, Galante NZ, Tedesco-Silva H, Camargo LFA, Medina-Pestana JO. Manifestações clínicas e evolução da infecção pelo vírus da influenza A (H1N1) em receptores de transplante renal. J Bras Nefrol 2011. [DOI: 10.1590/s0101-28002011000200004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Freitas TVDS, Ono G, Corrêa L, Gomes PS, Galante NZ, Tedesco-Silva H, Camargo LFA, Medina-Pestana JO. Clinical manifestations and evolution of infection by influenza A (H1N1) in kidney transplant recipients. J Bras Nefrol 2011; 33:136-141. [PMID: 21789426] [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] [Received: 08/11/2010] [Accepted: 09/21/2010] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION The emergence of the pandemic outbreak of influenza A (H1N1) in April, 2009, represented a logistic challenge for public health. Although most infected patients presented clinical and evolutionary manifestations which were very similar to seasonal influenza, a significant number of individuals developed pneumonia and severe acute respiratory failure. The impact of influenza A (H1N1) in immunocompromised patients is not well established yet. METHODS This study aimed to analyze the clinical presentations and evolution of influenza A (H1N1) in 19 kidney transplant recipients. Influenza A (H1N1) infection was confirmed by RT-PCR in all patients. Treatment included antiviral therapy with oseltamivir phosphate and antibiotics. RESULTS The studied population was compounded mostly of white people (63%), males (79%), at a mean age of 38.6 ± 17 years and patients with at least one comorbidity (53%). Influenza A (H1N1) infection was identified 41.6 ± 49.6 months after transplantation. Common symptoms included cough (100%), fever (84%), dyspnea (79%), and myalgia (42%). Acute allograft dysfunction was observed in 42% of the patients. Five patients (26%) were admitted to the Intensive Care Unit, two (10%) required invasive ventilation support, and two (10%) required vasoactive drugs. Mortality rate was 10%. CONCLUSIONS Acute renal allograft dysfunction was a common finding. Clinical, laboratory, and evolutionary characteristics were comparable to those in the general population.
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Rangel EB, Melaragno CS, Gonzalez AM, Linhares MM, de Sá JR, Salzedas A, Medina-Pestana JO. Delayed kidney allograft function after simultaneous pancreas-kidney transplantation. Transplant Proc 2011; 42:3655-9. [PMID: 21094834 DOI: 10.1016/j.transproceed.2010.06.030] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2009] [Revised: 03/28/2010] [Accepted: 06/10/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Simultaneous pancreas-kidney transplantation (SPKT) is one of the treatments for insulin-dependent chronic renal failure patients. METHODS One-year patient and kidney allograft survival rates of 150 patients undergoing SPKT were subjected to Cox regression and Kaplan-Meier analyses. Uni- and multivariate methods identified risk factors involved in allograft and patient survival. RESULTS One-year patient and kidney allograft survival rates were 82% and 80%, respectively. Delayed graft function (DGF) (P = .001; hazard ratio [HR]5.41) and acute kidney rejection episodes (P = .016; HR 3.36) were related to 1 year patient survival as well as intra-abdominal infection (IAI) rates. (IAI). One-year kidney allograft survival was related to DGF (P = .013; odds ratio [OR] 3.39), acute rejection (P = .001; OR 4.74), and IAI (P = .003, OR 6.29). DGF was related to a time on dialysis >27 months (P = .046; OR 2.59), cold kidney ischemia time >14 hours (P = .027; OR 2.94), donor age >25 years (P = .03; OR 2.82), and donor serum sodium concentration >155 mEq/L (P < .0001; OR 1.09). Female kidney to male recipient in 17% of the cases did not increase the risk of DGF. We observed an important correlation between donor serum sodium and creatinine (P < .0001), which suggested undertreatment of diabetes insipidus secondary to brain death. CONCLUSIONS DGF, acute rejection, and IAI were the main determinants of survival after SPKT. Improving the care of deceased donors may reduce DGF occurrence.
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Affiliation(s)
- E B Rangel
- Division of Nephrology, Universidade Federal de São Paulo, São Paulo, Brazil.
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Tedesco-Silva H, Claudia Rosso Felipe, Tainá Veras de Sandes Freitas, Marina Pontello Cristeli, Carolina Araújo Rodrigues, Medina-Pestana JO. Impact of everolimus: update on immunosuppressive therapy strategies and patient outcomes after renal transplantation. TRRM 2011. [DOI: 10.2147/trrm.s12217] [Citation(s) in RCA: 3] [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: 11/23/2022] Open
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Guimarães-Souza N, Dalboni MA, Canziani ME, Tedesco-Silva H, Batista MC, Sesso R, Câmara NO, Medina-Pestana JO, Pacheco-Silva A, Cendoroglo M. Clinical implications of initial renal function after deceased donor transplant. Transplant Proc 2010; 42:1084-9. [PMID: 20534229 DOI: 10.1016/j.transproceed.2010.03.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate whether slow graft function (SGF) after transplantation of deceased-donor kidneys affected the prevalence of anemia or the glomerular filtration rate (GFR). We retrospectively evaluated the records of 534 kidney transplant patients who were classified based on their initial renal function, namely, immediate graft function (IGF), slow graft function (SGF), or delayed graft function (DGF). Among the 534 kidney transplant patients studied, the occurrences of each condition were IGF 104, SGF 133, and DGF 297. Six months after transplantation, a greater percentage of DGF patients were anemic compared with the others (P = .028). However, at 12 months after transplantation, SGF patients showed more anemia than the IGF group. DGF and SGF patients displayed similar GFR values at 18 and 24 months after transplantation. However, IGF patients displayed higher GFRs, even when subjects who experienced acute rejection episodes were censored (P = .004). The incidence of acute rejection episodes was similar among SGF and DGF patients. Patients displaying SGF after deceased-donor transplantation showed a greater tendency to be anemic than those displaying IGF. This study also suggested that SGF patients were at risk for acute rejection episodes and/or significantly reduced kidney function as measured by GFR.
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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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Guimarães-Souza NK, Dalboni MA, Câmara NC, Medina-Pestana JO, Paheco-Silva A, Cendoroglo M. Infectious complications after deceased kidney donor transplantation. Transplant Proc 2010; 42:1137-41. [PMID: 20534244 DOI: 10.1016/j.transproceed.2010.03.074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Despite improvements in immunosuppressive therapy, infections remain a complication of renal transplantation that is associated with increased morbidity and graft rejection. The aim of this study was to evaluate the relationship between initial renal function after deceased donor transplantation and viral infections. METHODS We included patients 18 years and older who received a deceased donor transplantation between January 1995 and December 2004. They were divided into 2 groups: cases from 1994 to 1999, versus from 2000 to 2004. Initial renal function was classified as immediate (IGF), slow (SGF), or delayed (DGF). Infections were classified according to Centers for Disease Control and prevention standards. RESULTS Among 534 patients, SGF and DGF patients who underwent immunosuppression between 2000 and 2004 show a higher infection rate than IGF patients (P = .005). SGF patients showed a higher incidence of tissue-invasive cytomegalovirus disease (P < .001). Second episodes of viral infections were more common among all patients in this period. However, DGF patients were more susceptible to second episodes of viral infection. In the first group, OKT3 use (P = .013) and donor age (P = .012) were the major risk factors associated with viral infections whereas in the second group, thymoglobulin use (P = .002), acute rejection episode (P = .003), and anemia (P = .044) were the risk factors for viral infection. CONCLUSION Initial renal function after deceased donor transplantation was correlated with viral infection. DGF patients had a higher risk for second infection episodes. SGF patients had a higher risk for tissue-invasive cytomegalovirus infection.
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Aivazoglou L, Sass N, Sato J, Junior HS, Medina-Pestana JO, De Oliveira L. M10.5 Pregnancy after renal transplantation: a prospective evaluation of the graft function. Pregnancy Hypertens 2010. [DOI: 10.1016/s2210-7789(10)60044-x] [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: 11/27/2022]
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Siliano PR, Rocha LA, Medina-Pestana JO, Heilberg IP. The role of host factors and bacterial virulence genes in the development of pyelonephritis caused by Escherichia coli in renal transplant recipients. Clin J Am Soc Nephrol 2010; 5:1290-7. [PMID: 20448070 DOI: 10.2215/cjn.06740909] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to determine the role of host factors and bacterial virulence genes in the development of pyelonephritis caused by Escherichia coli in renal transplant (Tx) recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A total of 328 E. coli isolates from cases of cystitis (Cys; n=239) or pyelonephritis (PN; n=89), with 169 from renal Tx recipients, were subjected to molecular analyses to identify P-fimbria subunits (PapC, PapG II, and PapGIII), G- and M-fimbriae, and aerobactin. The presence of antibiotic resistance was also determined. Parameters such as gender, age, immunosuppression regimens, causes of ESRD, kidney donor, intraoperative anastomosis, use of double J stent, trimethoprim/sulfamethoxazole (TMP/SMZ) prophylaxis, and time after Tx were evaluated. RESULTS A multivariate analysis showed a significant association between PN and renal Tx. In renal Tx recipients, the risk of occurrence of PN was significantly higher among males and for those no longer receiving TMP/SMZ prophylaxis. E. coli strains isolated from PN presented a lower prevalence of papGIII and lower rates of resistance to pipemidic acid. Although papGII was more prevalent in PN than in Cys, it was not independently associated with PN. CONCLUSIONS These findings suggested that renal Tx increases the risk for PN, and the male sex represented a host factor independently associated with risk, whereas the prophylaxis with TMP/SMZ was protective. The lack of papGIII and low resistance to first-generation quinolones were bacterial-independent risk factors for PN in Tx.
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Rangel EB, Melaragno CS, Sá JR, Gonzalez AM, Linhares MM, Salzedas A, Medina-Pestana JO. Mycophenolate mofetil versus enteric-coated mycophenolate sodium after simultaneous pancreas-kidney transplantation. Transplant Proc 2010; 41:4265-9. [PMID: 20005381 DOI: 10.1016/j.transproceed.2009.09.060] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 08/15/2009] [Accepted: 09/02/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Adverse gastrointestinal events are frequent after mycophenolate use. The objectives of the present study were to report the incidence of acute noninfectious diarrhea, to determine the risk factors, and to compare the severity of reactions between mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS) after simultaneous pancreas kidney transplantation (SPKT). METHODS We included 165 SPKT patients from December 2000 to May 2007. Uni- and multivariate analyses were performed, using acute noninfectious diarrhea as the dependent variable. P < .05 was considered significant. RESULTS Mean age and duration of dialysis and of diabetes were 34.9 +/- 8.2 years, 27.3 +/- 18.3 months, and 21.9 +/- 16.2 years, respectively. Sixty-three percent used MMF, 36.4% used EC-MPS, and 0.6% used azathioprine. Multivariate analysis showed that the duration of diabetes (P = .049, confidence interval [CI] 1.0- 1.13) and MMF use (P = .013, 95% CI 0.2-0.82) were the main determinants of acute diarrhea after SPKT. MMF dose reduction (79.2% vs 62.3%, P = .024) and severity of diarrhea associated with orthostatic hypotension were more pronounced among MMF than EC-MPS patients (42.4% vs 15.1%, P = .001). There was no difference between MMF and EC-MPS after dose reduction in relation to the occurrence of acute kidney rejection (30.8% vs 26.7%, P = .53). CONCLUSIONS Acute noninfectious diarrhea after SPKT was related to the duration of diabetes and to prescription of MMF. Preferential use of EC-MPS was associated with a lower necessity of dose reduction and less severe episodes of acute diarrhea compared with MMF, although dose reduction was equally associated with acute episodes of kidney rejection.
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Affiliation(s)
- E B Rangel
- Nephrology Division, Universidade Federal de São Paulo, Rua Botucatu, 740 VilaClementino, 04023-900 São Paulo, Brazil.
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Ogawa MM, Galante NZ, Godoy P, Fischman-Gompertz O, Martelli F, Colombo AL, Tomimori J, Medina-Pestana JO. Treatment of subcutaneous phaeohyphomycosis and prospective follow-up of 17 kidney transplant recipients. J Am Acad Dermatol 2009; 61:977-85. [DOI: 10.1016/j.jaad.2009.03.037] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Revised: 03/03/2009] [Accepted: 03/03/2009] [Indexed: 10/20/2022]
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Schiavon LL, Narciso-Schiavon JL, Carvalho Filho RJ, Sampaio JP, Medina-Pestana JO, Lanzoni VP, Silva AEB, Ferraz MLG. Serum levels of YKL-40 and hyaluronic acid as noninvasive markers of liver fibrosis in haemodialysis patients with chronic hepatitis C virus infection. J Viral Hepat 2008; 15:666-74. [PMID: 18482283 DOI: 10.1111/j.1365-2893.2008.00992.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hepatitis C virus (HCV) infection is highly prevalent among end-stage renal disease (ESRD) patients undergoing haemodialysis and it is an important cause of morbidity and mortality in this population. The aim of this study was to evaluate the diagnostic value of YKL-40 and hyaluronic acid (HA) as noninvasive markers of liver fibrosis in 185 ESRD HCV-infected patients. Significant liver fibrosis was defined as METAVIR F2, F3 or F4 stages. Significant fibrosis was observed in 45 patients (24%). By univariate analysis, higher levels of YKL-40, HA, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) as well as reduced platelet count were associated with fibrosis. However, by multivariate analysis, only AST (P = 0.001), platelet count (P = 0.004) and HA (P = 0.042) were independently associated with significant fibrosis. For the prediction of significant fibrosis, the areas under receiver operating characterictic curve (AUROC) of the regression model (0.798) was significantly higher than the AUROC of YKL-40 (0.607) and HA (0.650). No difference was noted between the AUROC of the regression model and AST to platelet ratio index (APRI) (0.787). Values <8.38 of the regression model showed a negative predictive value of 94% and scores >or=9.6 exhibited a positive predictive value of 65%. If biopsy indication was restricted to scores in the intermediate range of the regression model, it could have been correctly avoided in 61% of the cases. In conclusion, APRI and a model based on AST, platelet count and HA showed better accuracy than YKL-40 and HA (when used solely) for the prediction of significant fibrosis in ESRD HCV-infected patients.
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Affiliation(s)
- L L Schiavon
- Division of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil.
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Garcia R, Machado PG, Felipe CR, Park SI, Spinelli GA, Franco MF, Tedesco-Silva H, Medina-Pestana JO. Exploratory calcineurin inhibitor-free regimens in living-related kidney transplant recipients. Braz J Med Biol Res 2008; 40:457-65. [PMID: 17401488 DOI: 10.1590/s0100-879x2007000400003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 03/28/2006] [Accepted: 01/19/2007] [Indexed: 11/21/2022] Open
Abstract
Chronic allograft nephropathy is among the major causes of graft loss even in low-risk kidney transplant recipients and correlates with acute nephrotoxic events during the first year post-transplant. Therefore, calcineurin inhibitor-free regimens may improve patient and graft survival among recipients of living-related kidney transplants. To confirm this hypothesis, we evaluated the efficacy and safety of two calcineurin inhibitor-free regimens in 92 low-risk recipients of one-haplotype living-related kidney transplants. Immunosuppression consisted of tacrolimus, azathioprine and prednisone (group I, GI, N = 38), 2 doses of daclizumab, mycophenolate mofetil (MMF), and prednisone (GII, N = 33) and 2 doses of daclizumab, MMF, sirolimus and prednisone (GIII, N = 21). At 12 months, treatment failure (biopsy-confirmed acute rejection, graft loss or death) was higher in GII compared to GIII and GI (54.5 vs 24.0 vs 13.1%, P < 0.01, respectively). In patients of black ethnicity the incidence of acute rejection was 25 vs 83.3 vs 20% (P = 0.055), respectively. Patient and graft survival was comparable. There were no differences in mean creatinine or calculated creatinine clearance at 12 months. Overall incidence of post-transplant diabetes mellitus (3.3%) and cytomegalovirus disease (4.3%) was similar in all groups. Further development of effective calcineurin inhibitor-free regimens should exclude patients of black ethnicity and may need full-induction therapy, perhaps with depleting agents, and concentration-controlled use of sirolimus and MMF.
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Affiliation(s)
- R Garcia
- Divisão de Nefrologia, Hospital do Rim e Hipertensão, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Vasconcelos VTD, Katayama RC, Ribeiro MFDL, Medina-Pestana JO, Baptista-Silva JCC. Kidney weight and volume among living donors in Brazil. SAO PAULO MED J 2007; 125:223-5. [PMID: 17992393 PMCID: PMC11020548 DOI: 10.1590/s1516-31802007000400006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Revised: 09/18/2006] [Accepted: 06/20/2007] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE The present study was performed to measure kidney weight and volume among living donors of both sexes in Brazil. DESIGN AND SETTING This was a cross-sectional survey carried out between December 2001 and August 2004. METHODS Kidney transplantations from 219 living donors were analyzed for this study. The kidneys were weighed in grams on a single-pan digital balance just after drainage of the perfusion fluid and removal of the perirenal fat. The kidney volume was determined in milliliters by water displacement. RESULTS The mean age at nephroureterectomy was 44 +/- 9.5. The donor organs came from the left side in 172 cases and from the right side in 47 cases. The weights and volumes of the right and left kidneys were, respectively, 169.83 +/- 29.91 g and 157.38 +/- 31.84 ml; and 173.00 +/- 33.52 g and 160.34 +/- 34.40 ml. The differences between the sides were not significant. CONCLUSIONS According to the present study, kidney weight cannot be the only factor determining the side on which nephroureterectomy is performed, because of the lack of statistical significance between the two sides. On average, females donate lower nephron doses than males do, which could in some transplants result in allograft damage.
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Affiliation(s)
| | | | | | | | - José Carlos Costa Baptista-Silva
- José Carlos Costa Baptista-Silva Departamento de Cirurgia da Universidade Federal de São Paulo Rua Borges Lagoa, 564 — Conjunto 124 São Paulo (SP) — Brasil — CEP 04038-000 Tel. (+55 11) 5571-8419 Fax. (+55 11) 5574-5253 E-mail:
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Clesca P, Dirlando M, Park SI, García R, Ferraz E, Pinheiro-Machado PG, Kushnaroff L, Tedesco-Silva H, Medina-Pestana JO. Thymoglobulin and rate of infectious complications after transplantation. Transplant Proc 2007; 39:463-4. [PMID: 17362760 DOI: 10.1016/j.transproceed.2007.01.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
UNLABELLED Thymoglobulin is used as an induction agent in kidney transplantation, but the optimal dose is not well established. However, its use may be associated with increased infectious complications after transplantation. METHODS This retrospective study of 61 high-risk renal recipients of transplants from deceased donors performed between June 2001 and April 2004 included patients treated with thymoglobulin. Patients were divided into two groups according to the total thymoglobulin dose (G1, n = 30, <7 mg/kg; G2, n = 31, >7 mg/kg) and followed for at least 1 year. RESULTS Mean recipient age was 43 +/- 14 years; 41% were males; 63% non-Whites. Mean cold ischemia time was 26.3 +/- 7 hours. Mean PRA was 23% (0-100%). Second transplantation was performed in 18 (29.5%) patients. Mean donor age was 42.1 +/- 16 years, and 59% had a cerebral vascular accident as the cause of death. Patient- and death-censored graft survival at 12 months were 86% and 88%, respectively. There were 149 infectious episodes among 47 (78%) patients. The incidence of infection was 1.7 +/- 0.24 infections per patient per year in G1 (lower dose) vs 3.12 +/- 0.23 in G2 (P < .001). Bacterial (0.66 +/- 1.0 vs 1.48 +/- 1.26 infections per patient per year, P = .009) and viral infections (0.9 +/- 0.71 vs 1.41 +/- 0.71; P = .006) were more frequent in the higher dose group. CONCLUSION This study suggested that a greater number of infectious episodes were present when the total dose of thymoglobulin was higher than 7 mg/kg.
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Affiliation(s)
- P Clesca
- Hospital do Rim e Hipertensao - Nephrology Division, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
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Carneiro-Roza F, Medina-Pestana JO, Moscoso-Solorzano G, Franco M, Ozaki K, Mastroianni-Kirsztajn G. Initial response to immunosuppressive and renoprotective treatment in posttransplant glomerulonephritis. Transplant Proc 2007; 38:3491-7. [PMID: 17175313 DOI: 10.1016/j.transproceed.2006.10.109] [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: 06/14/2006] [Indexed: 01/28/2023]
Abstract
UNLABELLED The current studies on posttransplant glomerulonephritis (PTxGN) do not establish when, how, or how long we must treat these patients. This study sought to compare the initial response to immunosuppressive treatment and renoprotection in PTxGN. PATIENTS AND METHODS This prospective study was performed in 23 patients with a histological diagnosis of PTxGN. RESULTS Mean follow-up was 12 months (3-18); 91% received immunosuppressants, and 56.5% just renoprotective drugs. The best results (reduction of serum creatinine [SCr] and proteinuria) with immunosuppression were observed in patients with recurrent membranous PTxGN using the scheme of Ponticelli (IV + PO corticosteroid [CS] + PO cyclophosphamide [CPP]). A similar response was also seen in subjects with recurrent or de novo focal glomerulosclerosis treated with PO CS or CPP, except when the initial SCr > 2.5 mg/dL. In de novo IgA nephropathy, reduction of proteinuria occurred with use of PO CS, with or without CPP, but without improvement in SCr. Patients with recurrent or de novo crescentic PTxGN used renoprotective drugs and always immunosuppressants. In this group, good results were seen with IV + PO CS, with or without CPP, when there was less than 50% of glomeruli with crescents, or more than 50% with crescents but an initial SCr < 2.5 mg/dL. CONCLUSION Immunosuppression seemed to give a better initial response than renoprotection in cases of membranous, IgA, and focal segmental glomulerulosclerosis PTxGN. Patients with an initial SCr > or = 2.5 mg/dL displayed worse outcomes.
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Affiliation(s)
- F Carneiro-Roza
- Glomerulopathy Section, Escola Paulista de Medicina- Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Abstract
METHODS We retrospectively analyzed the registry data from one organ procurement organization obtained between January 1 and December 31, 2005. RESULTS Among the 378 potential deceased donors, 182 (48.2%) were lost, mainly due to clinical conditions (27%) or cardiac arrest (19.3%). Of the remaining 196 (51.8%) potential donors, family consent was obtained in 94 cases (48%). Family refusal was higher for potential donors aged between 18 and 59 years (70%). Of the 94 donors, 72 (77%) had their organs harvested. Cardiac arrest before harvesting (56.5%) and positive viral serology (26%) were the main reasons for further losses. The mean donor age was 40 years and 51% were men. Causes of death were cerebral vascular accidents (55.5%), cranium encephalic traumas (29%), and gun shot wounds (8%). The rate of organ donation was 100% for kidneys and livers, 96% for hearts, 86% for pancreatas, 76% for lungs, and 74% for corneas. After assessment of organ viability, 94% of corneas, 91% of kidneys, and 88% of livers were transplanted, but only 52% of pancreata and 42% of hearts. The most frequent causes of discarded organs were age and concomitant donor infection. CONCLUSION Areas for potential improvements are: (1) earlier identification and adequate maintenance of potential donors; (2) campaigns for organ donation; and (3) careful evaluation of donated organs and selection of a suitable population to increase utilization of expanded criteria organs.
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Affiliation(s)
- J O Medina-Pestana
- Hospital do Rim e Hipertensao - Nephrology Division, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
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Medina-Pestana JO, Sampaio EM, Vaz MLS, Pinheiro-Machado PG, Tedesco-Silva H. Worse Renal Transplant Outcomes Observed Among Afro-Brazilian Patients on Prospective Registry Data of 2461 Renal Transplants at Least 1 Year Follow-up. Transplant Proc 2007; 39:435-6. [PMID: 17362750 DOI: 10.1016/j.transproceed.2007.01.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/25/2022]
Abstract
We present prospective registry data of 2461 (live donor = 1753 and deceased donor = 08) renal transplants performed between 1999 and 2003. All subjects were followed for more than 1 year after transplantation and most were treated with a calcineurin inhibitor and azathioprine. Afro-Brazilian, white, and mixed patients constituted 11% (272), 67.1% (1651), and 14.9% (367) of the population respectively. Mean dialysis time was 42.3 +/- 32.9 months and delayed graft function, occurred in more than 60%. Three-year patient survival rates were 96.3%, 92.8%, and 86.7% for living-related, living-unrelated, and deceased donors, respectively. Corresponding 3-year graft survival rates were 87.3%, 82.1%, and 71.3% and functional graft survival rates were 90.2%, 88.8%, and 81.5%. The poorer transplant outcome observed among Afro-Brazilian patients has been mainly attributed to differences in absorption of cyclosporine, tacrolimus, and mycophenolate mofetil.
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Affiliation(s)
- J O Medina-Pestana
- Hospital do Rim e Hipertensao - Nephrology Division, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
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Garcia R, Pinheiro-Machado PG, Felipe CR, Park SI, Silva LA, Franco MF, Tedesco-Silva H, Medina-Pestana JO. Conversion from azathioprine to mycophenolate mofetil followed by calcineurin inhibitor minimization or elimination in patients with chronic allograft dysfunction. Transplant Proc 2007; 38:2872-8. [PMID: 17112853 DOI: 10.1016/j.transproceed.2006.10.001] [Citation(s) in RCA: 6] [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: 12/22/2005] [Indexed: 11/29/2022]
Abstract
UNLABELLED The purpose of this study was to evaluate the effects of the conversion from azathioprine (AZA) to mycophenolate mofetil (MMF) followed by calcineurin inhibitor (CNI) elimination or minimization in patients with progressive chronic allograft dysfunction (CAD). METHODS Between November 6, 1999 and February 12, 2003, 169 patients receiving CNI/AZA/prednisone (153 CsA; 14 tacrolimus) were included in this study. Demographics, immunosuppression, graft function, hematology, and biochemistry were obtained before (-6, -3, and -1 month) and 1, 3, 6, 9 and 12 months after and at last follow-up visit after conversion. RESULTS Mean age was 34 +/- 12 years, 66% males, 51% Caucasian, and 72% living allograft recipients. Mean follow-up times before and after conversion were 32.4 and 19.4 months; 10 patients completed 3 years of follow-up. CNI elimination was performed in 39% and minimization in 61% of patients. Overall there was significantly improved graft function at 1 year after conversion (2.6 +/- 1.0 vs 2.1 +/- 0.6 mg/dL, P = .038). The slopes of the regression lines of 1/Cr vs time were significantly improved from preconversion to after conversion (-0.026 vs +0.007 mg(-1)/dL per day(-1), P = .001). There was a significant decrease in mean systolic (141 +/- 21 vs 135 +/- 22 mm Hg, P = .015) and diastolic (89 +/- 15 vs 84 +/- 14 mm Hg, P = .005) blood pressure values at 1 year. There were four episodes of acute rejection (Banff IA) treated with steroids. Three years after conversion, patient and graft survivals were 95% and 79%, respectively. One patient developed posttransplant lymphoproliferative disease. CONCLUSION Among patients with CAD, conversion from AZA to MMF followed by CNI minimization or elimination was a safe and effective strategy to preserve or improve graft function.
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Affiliation(s)
- R Garcia
- Nephrology Division, Hospital do Rim e Hipertensão, Universidade Federal de São Paulo, São Paulo, Brazil
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Campos EF, Tedesco-Silva H, Machado PG, Franco M, Medina-Pestana JO, Gerbase-DeLima M. Post-transplant anti-HLA class II antibodies as risk factor for late kidney allograft failure. Am J Transplant 2006; 6:2316-20. [PMID: 16925566 DOI: 10.1111/j.1600-6143.2006.01503.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [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: 01/25/2023]
Abstract
The purpose of this study was to prospectively analyze the relationship between the post-transplant anti-HLA class I and/or class II panel reactive antibodies and graft failure due to chronic allograft nephropathy (CAN). We studied 512 first kidney recipients transplanted at a single center, with a graft functioning for at least 3 years. A single blood sample was collected from each patient for antibody evaluation. The median posttransplant time after blood collection was 4.4 years and did not differ between patients with (n = 91) or without anti-HLA antibodies (n = 421). Female gender, pregnancies and blood transfusions were associated with the presence of anti-HLA class I antibodies. Graft function deterioration was associated with anti-HLA class II antibodies. Multivariate analysis showed independent association for creatinine levels (RR = 7.5), acute rejection (RR = 2.6), recipient male gender (RR = 3.6) and anti-HLA class II antibodies (RR = 2.9) and CAN-associated graft loss. In conclusion, the presence of anti-HLA class II antibodies conferred a risk for graft loss before a decline in renal function and increased the risk of graft failure in patients who already had a decline in graft function. Thus, anti-HLA class II antibody monitoring is a useful tool for the management of long-term kidney recipients.
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Affiliation(s)
- E F Campos
- Nephrology Division/Hospital do Rim e Hipertensão, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
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Galante NZ, Câmara NOS, Kallas EG, Salomão R, Pacheco-Silva A, Medina-Pestana JO. Noninvasive immune monitoring assessed by flow cytometry and real time RT-PCR in urine of renal transplantation recipients. Transpl Immunol 2006; 16:73-80. [PMID: 16860708 DOI: 10.1016/j.trim.2006.03.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [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: 11/02/2005] [Revised: 03/20/2006] [Accepted: 03/31/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Monitoring recipient's alloreactivity has shown to be critical for limiting overimmunosuppression besides allowing preemptive treatment of acute rejection (AR). METHODS Flow cytometry and real time RT-PCR were performed in urine of kidney transplant recipients with AR (n = 13) and compared with pyelonephritis (n = 10), chronic allograft nephropathy (n = 13), acute tubular necrosis (n = 13) and stable graft function (n = 11). Expression of CD3, CD4, CD8, HLA-DR, Fas-L, ICAM-1 and CD25 were assessed using flow cytometry. mRNA of perforin, granzyme B and Fas-L were quantified by real time RT-PCR. RESULTS Frequencies of CD3+, HLA-DR+, Fas-L+, ICAM-1+ and CD25+ cells were significantly higher in AR group (p < 0.05). ROC curves showed sensitivity from 70% to 91% and specificity from 30% to 100%, whereas the highest sensitivity and specificity was 91% and 100% respectively, for Fas-L+ cells. Levels of mRNA of perforin, granzyme B and Fas-L were significantly augmented in AR, while the sensitivity and specificity ranged from 85% to 88% and from 55% to 100%, respectively. CONCLUSIONS Analyses of immune activation markers by flow cytometry and real time RT-PCR are equally useful for noninvasive monitoring kidney allografts.
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Affiliation(s)
- Nelson Zocoler Galante
- Laboratório de Imunologia Clínica e Experimental. Departamento de Medicina, Disciplina de Nefrologia, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
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Medina-Pestana JO, Duro-Garcia V. Strategies for Establishing Organ Transplant Programs in Developing Countries: The Latin America and Caribbean Experience. Artif Organs 2006; 30:498-500. [PMID: 16836729 DOI: 10.1111/j.1525-1594.2006.00250.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 12/01/2022]
Abstract
The Latin America and Caribbean region is composed of 39 countries. It is remarkable the progress of transplantation in the region in despite of the low economic resources when compared to other regions. The criteria for brain death are well established and culturally accepted. The consent for retrieval is based on required family consent in most countries. The regulations for living donors are also well established, with restrictions to unrelated donors and prohibition of any kind of commerce. The access to transplant is limited by the model of public financing by each country, and those with public universal coverage have no financial restrictions to cover the costs for any citizen; in countries with restricted coverage, the access is restricted to the employment status. There is a progressive increment in the annual number of solid organ transplants in Latin America, reaching near 10,000 in 2004, accomplished by adequate legislation that is also concerned with the prohibition of organ commerce.
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Affiliation(s)
- José Osmar Medina-Pestana
- Nephrology Division, Hospital do Rim e Hipertensao, Universidade Federal de São Paulo, São Paulo, Brazil.
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