#01#
Revisiones
(todas) *** Reviews (all)
TRASPLANTE
RENAL *** RENAL TRANSPLANTATION
(Conceptos
/ Keywords: Renal-Kidney transplantation; Kidney donation-procurement; etc).
Enero /
January 2001 --- Marzo / March 2004
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[1]
TÍTULO / TITLE: - Strategies to improve
long-term outcomes after renal transplantation.
REVISTA
/ JOURNAL: - N Engl J Med. Acceso gratuito al texto
completo a partir de los 6 meses de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://content.nejm.org/
●●
Cita: New England J Medicine (NEJM): <> 2002 Feb 21;346(8):580-90.
●●
Enlace al texto completo (gratuito o de pago) 1056/NEJMra011295
AUTORES
/ AUTHORS: - Pascual M; Theruvath T; Kawai T;
Tolkoff-Rubin N; Cosimi AB
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Department of Medicine,
Massachusetts General Hospital, Boston, MA 02114, USA. mpascual@partners.org N. Ref:: 99
----------------------------------------------------
[2]
TÍTULO / TITLE: - Clinical practice
guidelines for managing dyslipidemias in kidney transplant patients: a report
from the Managing Dyslipidemias in Chronic Kidney Disease Work Group of the
National Kidney Foundation Kidney Disease Outcomes Quality Initiative.
REVISTA
/ JOURNAL: - Am J Transplant 2004;4 Suppl 7:13-53.
●●
Enlace al texto completo (gratuito o de pago) 1111/j.1600-6135.2004.0355.x
AUTORES
/ AUTHORS: - Kasiske B; Cosio FG; Beto J; Bolton K;
Chavers BM; Grimm R Jr; Levin A; Masri B; Parekh R; Wanner C; Wheeler DC;
Wilson PW
RESUMEN
/ SUMMARY: - The incidence of cardiovascular disease
(CVD) is very high in patients with chronic kidney (CKD) disease and in kidney
transplant recipients. Indeed, available evidence for these patients suggests
that the 10-year cumulative risk of coronary heart disease is at least 20%, or
roughly equivalent to the risk seen in patients with previous CVD. Recently,
the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative
(K/DOQI) published guidelines for the diagnosis and treatment of dyslipidemias
in patients with CKD, including transplant patients. It was the conclusion of
this Work Group that the National Cholesterol Education Program Guidelines are
generally applicable to patients with CKD, but that there are significant
differences in the approach and treatment of dyslipidemias in patients with CKD
compared with the general population. In the present document we present the
guidelines generated by this workgroup as they apply to kidney transplant
recipients. Evidence from the general population indicates that treatment of
dyslipidemias reduces CVD, and evidence in kidney transplant patients suggests
that judicious treatment can be safe and effective in improving dyslipidemias.
Dyslipidemias are very common in CKD and in transplant patients. However, until
recently there have been no adequately powered, randomized, controlled trials
examining the effects of dyslipidemia treatment on CVD in patients with CKD.
Since completion of the K/DOQI guidelines on dyslipidemia in CKD, the results
of the Assessment of Lescol in Renal Transplantation (ALERT) Study have been
presented and published. Based on information from randomized trials conducted
in the general population and the single study conducted in kidney transplant
patients, these guidelines, which are a modified version of the K/DOQI
dyslipidemia guidelines, were developed to aid clinicians in the management of
dyslipidemias in kidney transplant patients. These guidelines are divided into
four sections. The first section (Introduction) provides the rationale for the
guidelines, and describes the target population, scope, intended users, and
methods. The second section presents guidelines on the assessment of
dyslipidemias (guidelines 1-3), while the third section offers guidelines for
the treatment of dyslipidemias (guidelines 4-5). The key guideline statements
are supported mainly by data from studies in the general population, but there
is an urgent need for additional studies in CKD and in transplant patients.
Therefore, the last section outlines recommendations for research.
----------------------------------------------------
[3]
TÍTULO / TITLE: - Interleukin-2 receptor
monoclonal antibodies in renal transplantation: meta-analysis of randomised
trials.
REVISTA
/ JOURNAL: - British Medical J (BMJ). Acceso gratuito
al texto completo.
●●
Enlace a la Editora de la Revista http://bmj.com/search.dtl
●●
Cita: British Medical J. (BMJ): <> 2003 Apr 12;326(7393):789.
●●
Enlace al texto completo (gratuito o de pago) 1136/bmj.326.7393.789
AUTORES
/ AUTHORS: - Adu D; Cockwell P; Ives NJ; Shaw J;
Wheatley K
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Queen Elizabeth
Hospital, Birmingham, B15 2TH. dwomoa.adu@uhb.nhs.uk
RESUMEN
/ SUMMARY: - OBJECTIVE: To study the effect of
interleukin-2 receptor monoclonal antibodies on acute rejection episodes, graft
loss, deaths, and rate of infection and malignancy in patients with renal
transplants. DESIGN: Meta-analysis of published data. DATA SOURCES: Medline,
Embase, and Cochrane library for years 1996-2003 plus search of medical
editors’ trial amnesty and contact with manufacturers of the antibodies.
SELECTION OF STUDIES: Randomised controlled trials comparing interleukin-2
receptor antibodies with placebo or no additional treatment in patients with
renal transplants receiving ciclosporin based immunosuppression. RESULTS: Eight
randomised controlled trials involving 1871 patients met the selection criteria
(although only 1858 patients were analysed). Interleukin-2 receptor antibodies
significantly reduced the risk of acute rejection (odds ratio 0.51, 95%
confidence interval 0.42 to 0.63). There were no significant differences in the
rate of graft loss (0.78, 0.58 to 1.04), mortality (0.75, 0.46 to 1.23),
overall incidence of infections (0.97, 0.77 to 1.24), incidence of
cytomegalovirus infections (0.81, 0.62 to 1.04), or risk of malignancies at one
year (0.82, 0.39 to 1.70). The different antibodies had a similar sized effect
on acute rejection (test for heterogeneity P=0.7): anti-Tac (0.37, 0.16 to
0.89), BT563 (0.37, 0.1 to 1.38), basiliximab (0.56, 0.44 to 0.72), and
daclizumab (0.46, 0.32 to 0.67). The reduction in acute rejections was similar
for all ciclosporin based immunosuppression regimens (test for heterogeneity
P=1.0). CONCLUSIONS: Adding interleukin-2 receptor antibodies to ciclosporin
based immunosuppression reduces episodes of acute rejection at six months by
49%. There is no evidence of an increased risk of infective complications.
Longer follow up studies are needed to confirm whether interleukin-2 receptor
antibodies improve long term graft and patient survival.
----------------------------------------------------
[4]
TÍTULO / TITLE: - Prognostic value of
myocardial perfusion studies in patients with end-stage renal disease assessed
for kidney or kidney-pancreas transplantation: a meta-analysis.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Feb;14(2):431-9.
AUTORES
/ AUTHORS: - Rabbat CG; Treleaven DJ; Russell JD;
Ludwin D; Cook DJ
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of
Nephrology, McMaster University, Hamilton, Ontario, Canada. rabbatc@mcmaster.ca
RESUMEN
/ SUMMARY: - The prognostic utility of myocardial
perfusion studies (MPS) such as thallium scintigraphy and dobutamine stress
echocardiography (DSE) for stratifying cardiac risk among candidates for kidney
or kidney-pancreas transplantation is uncertain. This study is a meta-analysis
to determine the prognostic significance of MPS results on future myocardial
infarction (MI) and cardiac death (CD) in patients with end-stage renal disease
(ESRD) assessed for kidney or kidney-pancreas transplantation. MEDLINE was
searched using combinations of MeSH headings and text words for
transplantation, coronary artery disease, prognosis, end-stage renal disease,
and noninvasive cardiac testing (nuclear scintigraphy and DSE) for primary
studies. Studies were included if they reported MPS results and cardiac events
in patients assessed for kidney or kidney-pancreas transplantation.
Methodologic study quality and outcome data were independently abstracted in
duplicate by two researchers. The relative risks (RR) of MI and CD were
calculated using a random effects model. Twelve articles met all inclusion
criteria; 12 studies reported CD, and 9 reported MI. In eight studies, thallium
scintigraphy was used (four with pharmacologic stress, four with exercise
stress), whereas four used DSE. When compared with negative tests, positive
tests had a significantly increased RR of MI (2.73 [95% CI, 1.25 to 5.97]; P =
0.01) and CD (2.92 [95% CI, 1.66 to 5.12]; P < 0.001). Subgroup analyses of
studies of diabetic patients indicated that positive tests were associated with
a RR of CD 3.95 (95% CI, 1.48 to 10.5; P = 0.006) and a RR of MI 2.68 (95% CI,
0.95 to 7.57; P = 0.06) when compared with negative tests. In studies
evaluating mixed populations of diabetic and nondiabetic patients, positive
tests were associated with a RR of CD 2.52 (95% CI, 1.25 to 5.08; P = 0.01) and
with a RR of MI 2.79 (95% CI, 0.85 to 9.21; P = 0.09) when compared with a
negative test. The presence of reversible defects was associated with an
increased risk of MI in diabetic patients and of CD in both subgroups; fixed
defects were associated with an increased risk of CD but not MI. It is
concluded that positive MPS are useful in identifying patients with
significantly increased risk of future MI and CD in both diabetic and
nondiabetic ESRD patients.
----------------------------------------------------
[5]
TÍTULO / TITLE: - Interleukin 2 receptor
antagonists for renal transplant recipients: a meta-analysis of randomized
trials.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):166-76.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000109643.32659.C4
AUTORES
/ AUTHORS: - Webster AC; Playford EG; Higgins G;
Chapman JR; Craig JC
INSTITUCIÓN
/ INSTITUTION: - Cochrane Renal Group, Centre for Kidney
Research, Children’s Hospital at Westmead, Westmead, NSW, Australia.
RESUMEN
/ SUMMARY: - BACKGROUND: Interleukin 2 receptor
antagonists (IL-2Ra) are increasingly used to treat renal transplant
recipients. This study aims to systematically identify and summarize the
effects of using IL-2Ra as induction immunosuppression, as an addition to
standard therapy, or as an alternative to other antibody therapy. METHODS:
Databases, reference lists, and abstracts of conference proceedings were
searched extensively to identify relevant randomized controlled trials in all
languages. Data were synthesized using the random effects model. Results are
expressed as relative risk (RR), with 95% confidence intervals (CI). RESULTS: A
total of 117 reports from 38 trials involving 4,893 participants were included.
When IL-2Ra were compared with placebo (17 trials; 2,786 patients), graft loss
was not significantly different at 1 year (14 trials: RR 0.84; CI 0.64-1.10) or
3 years (4 trials: RR 1.08; CI 0.71-1.64). Acute rejection was significantly
reduced at 6 months (12 trials: RR 0.66; CI 0.59-0.74) and at 1 year (10
trials: RR 0.67; CI 0.60-0.75). At 1 year, cytomegalovirus infection (7 trials:
RR 0.82; CI 0.65-1.03) and malignancy (9 trials: RR 0.67; CI 0.33-1.36) were
not significantly different. When IL-2Ra were compared with other antibody
therapy, no significant differences in treatment effects were demonstrated, but
IL-2Ra had significantly fewer side effects. CONCLUSIONS: Given a 40% risk of
rejection, seven patients would need treatment with IL-2Ra in addition to
standard therapy, to prevent one patient from undergoing rejection, with no
definite improvement in graft or patient survival. There is no apparent
difference between basiliximab and daclizumab.
----------------------------------------------------
[6]
TÍTULO / TITLE: - A randomized long-term
trial of tacrolimus/sirolimus versus tacrolimus/mycophenolate mofetil versus
cyclosporine (NEORAL)/sirolimus in renal transplantation. II. Survival,
function, and protocol compliance at 1 year.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):252-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000101495.22734.07
AUTORES
/ AUTHORS: - Ciancio G; Burke GW; Gaynor JJ; Mattiazzi
A; Roth D; Kupin W; Nicolas M; Ruiz P; Rosen A; Miller J
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, University of Miami School of Medicine, Miami, FL 33101, USA. gciancio@med.miami.edu
RESUMEN
/ SUMMARY: - BACKGROUND: In an attempt to reduce
chronic calcineurin inhibitor induced allograft nephropathy in first cadaver
and human leukocyte antigen non-identical living-donor renal transplantation,
sirolimus (Siro) or mycophenolate mofetil (MMF) was tested as adjunctive
therapy, with planned dose reductions of tacrolimus (Tacro) over the first year
postoperatively. Adjunctive Siro therapy with a similar dose reduction
algorithm for Neoral (Neo) was included for comparison. METHODS: The detailed
dose reduction plan (Tacro and Siro, group A; Tacro and MMF, group B; Neo and
Siro, group C) is described in our companion report in this issue of Transplantation.
The present report documents function, patient and graft survival, protocol
compliance, and adverse events. RESULTS: As mentioned (in companion report),
group demographics were similar. The present study shows no significant
differences in 1-year patient and graft survival but does show a trend that
points to more difficulties in group C by way of a rising slope of serum
creatinine concentration (P=0.02) and decreasing creatinine clearance (P=0.04).
There were more patients who discontinued the protocol plan in group C. Thus
far, no posttransplant lymphomas have appeared, and infectious complications
have not differed among the groups. However, a greater percentage of patients
in group C were placed on antihyperlipidemia therapy, with an (unexpected)
trend toward a higher incidence of posttransplant diabetes mellitus in this
group. Group A required fewer, and group B the fewest, antihyperlipidemia
therapeutic interventions (P<0.00001). CONCLUSIONS: This 1-year interim
analysis of a long-term, prospective, randomized renal-transplant study
indicates that decreasing maintenance dosage of Tacro with adjunctive Siro or
MMF appears to point to improved long-term function, with reasonably few
adverse events.
----------------------------------------------------
[7]
TÍTULO / TITLE: - Renal physicians
association clinical practice guideline: appropriate patient preparation for
renal replacement therapy: guideline number 3.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
May;14(5):1406-10.
AUTORES
/ AUTHORS: - Bolton WK
INSTITUCIÓN
/ INSTITUTION: - University of Virginia School of Medicine,
Charlottesville, Virginia. rpa@renalmd.org
----------------------------------------------------
[8]
TÍTULO / TITLE: - Lamivudine for the
treatment of hepatitis B virus-related liver disease after renal
transplantation: meta-analysis of clinical trials.
REVISTA
/ JOURNAL: - Transplantation 2004 Mar 27;77(6):859-64.
AUTORES
/ AUTHORS: - Fabrizi F; Dulai G; Dixit V; Bunnapradist
S; Martin P
INSTITUCIÓN
/ INSTITUTION: - Center for Liver and Kidney Diseases and
Transplantation, Cedars-Sinai Medical Center, Los Angeles, CA, USA. fabrizi@policlinico.mi.it
RESUMEN
/ SUMMARY: - BACKGROUND: Numerous reports have appeared
on lamivudine use for the treatment of hepatitis B virus (HBV) infection after
renal transplantation (RT). However, the efficacy and safety of lamivudine
after RT remain unclear. METHODS: The authors evaluated the efficacy and safety
of initial lamivudine monotherapy in RT recipients with hepatitis B by
performing a systematic review of the literature with a meta-analysis of
clinical trials. The primary outcomes were hepatitis B (HB) e antigen (Ag) and
HBV-DNA clearance (as measures of efficacy); the secondary outcomes were
biochemical response (as measures of efficacy), dropout rate, and lamivudine
resistance (as measures of tolerability). The authors used the random effects
model of DerSimonian and Laird, and outcomes were analyzed on an intent-to-treat
basis. RESULTS: The authors identified 14 clinical trials (184 patients); all
of these were prospective cohort studies. The mean overall estimate for HBV-DNA
and HBeAg clearance, alanine aminotransferase normalization, and lamivudine
resistance was 91% (95% confidence interval [CI], 86%-96%), 27% (95% CI,
16%-39%), 81% (95% CI, 70%-92%), and 18% (95% CI, 10%-37%), respectively. HBeAg
seroconversion rate was assessed in four (28%) trials and ranged between 0% and
46%. The P value was greater than 0.05 for our test of study homogeneity. There
was no association between rate of patients who were male patients or had
cirrhosis, race, age, lamivudine dose, and HBV-DNA or HBeAg clearance.
Increased duration of lamivudine therapy was positively associated with
frequency of HBeAg loss (r =0.51, P =0.039) and lamivudine resistance (r
=0.620, P =0.019). Only 2 (14%) of 14 studies reported a dropout rate greater
than 0%. CONCLUSIONS: Our meta-analysis showed that the majority of RT
recipients with hepatitis B had high virologic and biochemical response with
lamivudine. Tolerance to lamivudine was good. However, lamivudine resistance
was frequent with prolonged therapy, potentially limiting its long-term
efficacy after RT.
----------------------------------------------------
[9]
TÍTULO / TITLE: - Treatment and outcome
of invasive bladder cancer in patients after renal transplantation.
REVISTA
/ JOURNAL: - J Urol 2004 Mar;171(3):1085-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.ju.0000110612.42382.0a
AUTORES
/ AUTHORS: - Master VA; Meng MV; Grossfeld GD; Koppie
TM; Hirose R; Carroll PR
INSTITUCIÓN
/ INSTITUTION: - Departments of Urology and Surgery,
University of California, San Francisco, California 94143, USA. vmaster@urol.ucsf.edu
RESUMEN
/ SUMMARY: - PURPOSE: Optimal management and clinical
outcome of bladder cancer in renal transplant recipients are not well-defined.
We analyzed single institution treatment strategies and outcomes of these
patients. MATERIALS AND METHODS: We retrospectively reviewed the University of
California, San Francisco transplant database which contains information on
6,288 renal transplants performed between 1964 and 2002. The United Network for
Organ Sharing database and Israel Penn International Transplant Tumor Registry
were also queried to characterize the global nature of bladder cancer in renal
transplant recipients. RESULTS: The United Network for Organ Sharing database
(1986 to 2001) contained information on 31 patients who were found to have
bladder cancer (0.024% prevalence) and the Israel Penn International Transplant
Tumor Registry (1967 to 2001) contained information on 135 patients
representing 0.84% of all reported malignancies. We identified 7 renal
transplant recipients with bladder cancer at our institution. Invasive
transitional cell carcinoma developed in 5 patients at a median of 2.8 years
after transplant. Three patients underwent uncomplicated radical cystectomy and
preservation of the renal allograft. Overall survival at 48 months was 60%.
CONCLUSIONS: Bladder cancer after renal transplantation is not common. For
patients who present with invasive disease, traditional extirpative surgery
should be considered. Moreover, the allograft is rarely the source of
transitional cell carcinoma and can be preserved. In our experience the cancer
and urinary outcomes compare favorably with nontransplant patient outcomes
after treatment. N.
Ref:: 21
----------------------------------------------------
[10]
TÍTULO / TITLE: - Routes to allograft
survival.
REVISTA
/ JOURNAL: - J Clin Invest. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jci.org/
●●
Cita: J Clinical Investigation: <> 2001 Apr;107(7):797-8.
AUTORES
/ AUTHORS: - Bromberg JS; Murphy B
INSTITUCIÓN
/ INSTITUTION: - Recanati/Miller Transplant Institute,
Mount Sinai School of Medicine, New York, New York 10029, USA. jon.bromberg@mountsinai.org N. Ref:: 21
----------------------------------------------------
[11]
TÍTULO / TITLE: - Diagnosis and therapy
of coronary artery disease in renal failure, end-stage renal disease, and renal
transplant populations.
REVISTA
/ JOURNAL: - Am J Med Sci 2003 Apr;325(4):214-27.
AUTORES
/ AUTHORS: - Logar CM; Herzog CA; Beddhu S
INSTITUCIÓN
/ INSTITUTION: - Renal Section, Salt Lake VA Healthcare
System, Department of Medicine, University of Utah School of Medicine, Salt
Lake City, USA.
RESUMEN
/ SUMMARY: - Even though cardiovascular disease is the
leading cause of death in patients with CRF and end-stage renal disease (ESRD),
ill-conceived notions have led to therapeutic nihilism as the predominant
strategy in the management of cardiovascular disease in these populations. The
recent data clearly support the application of proven interventions in the general
population, such as angiotensin-converting enzyme inhibitors and statins to
patients with CRF and ESRD. The advances in coronary stents and intracoronary
irradiation have decreased the restenosis rates in renal failure patients.
Coronary artery bypass with internal mammary graft might be the procedure of
choice for coronary revascularization in these patients. The role of screening
for asymptomatic coronary disease is established as a pretransplant procedure,
but it is unclear whether this will be applicable to all patients with ESRD.
Future studies need to focus on unraveling the mechanisms by which uremia leads
to increased cardiovascular events to design optimal therapies targeted toward
these mechanisms and improve cardiovascular outcomes. N. Ref:: 125
----------------------------------------------------
[12]
TÍTULO / TITLE: - Hemophagocytic syndrome
in renal transplant recipients: report of 17 cases and review of literature.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):238-43.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000107285.86939.37
AUTORES
/ AUTHORS: - Karras A; Thervet E; Legendre C
INSTITUCIÓN
/ INSTITUTION: - Service de Nephrologie et Transplantation
Renale, Hopital Saint-Louis, Paris, France.
RESUMEN
/ SUMMARY: - BACKGROUND: Hemophagocytic syndrome (HPS)
combines febrile hepatosplenomegaly, pancytopenia, hypofibrinemia, and liver
dysfunction. It is defined by bone marrow and organ infiltration by activated,
nonmalignant macrophages phagocytizing blood cells. HPS is often caused by an
infectious or neoplastic disease and has rarely been described in renal
transplant recipients. METHODS: We retrospectively analyzed 17 cases of HPS after
cadaveric renal transplantation (13 men and 4 women, age 41+/-8 years). The
median time between transplantation and hemophagocytosis was 52 days. Eleven
patients (64%) had received antilymphocyte globulins during the 3 months before
presentation. RESULTS: Fever was present in all patients, and
hepatosplenomegaly was present in 9 of 17 patients. Other nonspecific clinical
findings included abdominal, neurologic, and respiratory symptoms. Laboratory
tests showed anemia (hemoglobin 6.1+/-1.3 g/dL), thrombocytopenia
(34,000+/-32,000/mm3), and leukopenia (1,700+/-1,400/mm3). Elevated liver
enzymes were present in 12 of 17 patients, and cholestasis was present in 10 of
17 patients. Elevated triglycerides and ferritin were noted in 75% and 86% of
cases, respectively. HPS was related to viral infection in nine patients
(cytomegalovirus, Epstein-Barr virus, human herpesvirus 6, and human
herpesvirus 8), bacterial infection in three patients (tuberculosis and
Bartonella henselae), and other infections in two patients (toxoplasmosis and
Pneumocystis carinii pneumoniae). Posttransplant lymphoproliferative disease
was present in two patients. Despite large-spectrum anti-infectious treatment
and dramatic tapering of immunosuppression, death occurred in eight patients (47%).
Graft nephrectomy was performed in four of the nine surviving patients.
CONCLUSIONS: We report here the largest series of HPS after renal
transplantation. This rare disease is usually secondary to herpes viridae
infections, mostly cytomegalovirus and Epstein-Barr virus in severely
immunocompromised patients. Despite aggressive treatment, the prognosis remains
poor. N. Ref:: 22
----------------------------------------------------
[13]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.1. Cancer risk after renal transplantation.
Post-transplant lymphoproliferative disease (PTLD): prevention and treatment.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:31-3, 35-6.
RESUMEN
/ SUMMARY: - GUIDELINES: A. In the first year after
organ transplantation, recipients are at the greatest risk of developing
lymphoproliferative diseases (PTLDs), which are induced most often by
Epstein-Barr virus (EBV) infection, and patients should therefore be screened
prior to or at the time of transplantation for EBV antibodies. B. In the rare
cases (<5%) where the recipient is EBV seronegative, he or she has a 95%
likelihood of receiving an organ from an EBV-seropositive donor, which
translates into a high risk of primary EBV infection with seroconversion soon
after transplantation. In such cases, the recipient should receive a
prophylactic antiviral treatment with acyclovir, valacyclovir or ganciclovir,
starting at the time of transplant and lasting for at least 3 months. The
specific recommendations given for CMV prophylaxis could be applicable in this
situation. C. The treatment of PTLD should be based on accurate pathology with
extensive cell markers and phenotyping. The treatment modalities are as
follows. Reduction of basal immunosuppression in all cases (either maintain
only steroids, or decrease by at least 50% the anti-calcineurin drugs and stop
other immunosuppressive drugs). In the case of EBV-positive B-cell lymphoma, antiviral
treatment with acyclovir, valacyclovir or ganciclovir may be initiated for at
least 1 month or according to the blood level of EBV replication when
available. In the case of rare lymphomas from the mucosal-associated lymphoid
tissue (MALT) with positive Helicobacter pylori, full eradication of H. pylori
should be carried out with a validated protocol. Subsequent H. pylori
prophylaxis should be implemented to avoid relapse. In the case of
CD20-positive lymphomas, treatment with rituximab, a chimeric monoclonal
antibody directed against CD20, should be carried out with one i.v. injection
per week for 4 weeks. In the case of diffuse lymphomas or improper response to
previous treatment, CHOP chemotherapy should be used alone or in combination
with rituximab. The CHOP regimen is cyclophosphamide, doxorubicine, vincristine
and prednisone. Complete cessation of immunosuppression with or without graft
nephrectomy should also be considered.
----------------------------------------------------
[14]
TÍTULO / TITLE: - A meta-analysis from
the Cochrane Library reviewing interleukin 2 receptor antagonists in renal
transplantation.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):165.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000112919.54256.8D
AUTORES
/ AUTHORS: - Morris PJ; Monaco AP
----------------------------------------------------
[15]
TÍTULO / TITLE: - Dialysis, kidney
transplantation, or pancreas transplantation for patients with diabetes
mellitus and renal failure: a decision analysis of treatment options.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Feb;14(2):500-15.
AUTORES
/ AUTHORS: - Knoll GA; Nichol G
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Department of
Medicine, University of Ottawa, Canada. gknoll@ottawahospital.on.ca
RESUMEN
/ SUMMARY: - Patients with type 1 diabetes mellitus and
end-stage renal disease may remain on dialysis or undergo cadaveric kidney
transplantation, living kidney transplantation, sequential pancreas after
living kidney transplantation, or simultaneous pancreas-kidney transplantation.
It is unclear which of these options is most effective. The objective of this
study was to determine the optimal treatment strategy for type 1 diabetic
patients with renal failure using a decision analytic Markov model. Input data
were obtained from the published medical literature, the United Network for
Organ Sharing registry, and patient interviews. The outcome measures were life
expectancy (in life-years [LY]) and quality-adjusted life expectancy (in
quality-adjusted life-years [QALY]). Living kidney transplantation was
associated with 18.30 LY and 10.29 QALY; pancreas after kidney transplantation,
17.21 LY and 10.00 QALY; simultaneous pancreas-kidney transplantation, 15.74 LY
and 9.09 QALY; cadaveric kidney transplantation, 11.44 LY and 6.53 QALY;
dialysis, 7.82 LY and 4.52 QALY. The results were sensitive to the value of
several key variables. Simultaneous pancreas-kidney transplantation had the
greatest life expectancy and quality-adjusted life expectancy when living
kidney transplantation was excluded from the analysis. These data indicate that
living kidney transplantation is associated with the greatest life expectancy
and quality-adjusted life expectancy for type 1 diabetic patients with renal
failure. Treatment strategies involving pancreas transplantation should be
considered for patients with frequent metabolic complications of diabetes and
for those patients who favor kidney-pancreas transplantation over kidney
transplantation alone. For patients without a living donor, simultaneous
pancreas-kidney transplantation is associated with the greatest life expectancy.
----------------------------------------------------
[16]
TÍTULO / TITLE: - Treatment of hepatitis
B in special patient groups: hemodialysis, heart and renal transplant,
fulminant hepatitis, hepatitis B virus reactivation.
REVISTA
/ JOURNAL: - J Hepatol 2003;39 Suppl 1:S206-11.
AUTORES
/ AUTHORS: - Tillmann HL; Wedemeyer H; Manns MP
INSTITUCIÓN
/ INSTITUTION: - Department of Gastroenterology, Hepatology
and Endocrinology, Medizinische Hochschule Hannover, Carl-Neuberg-Strassel,
30623 Hannover, Germany. N.
Ref:: 81
----------------------------------------------------
[17]
TÍTULO / TITLE: - 4D imaging to assay
complex dynamics in live specimens.
REVISTA
/ JOURNAL: - Nat Cell Biol 2003 Sep;Suppl:S14-9.
AUTORES
/ AUTHORS: - Gerlich D; Ellenberg J
INSTITUCIÓN
/ INSTITUTION: - Gene Expression and Cell
Biology/Biophysics Programmes, European Molecular Biology Laboratory,
Heidelberg, Germany.
RESUMEN
/ SUMMARY: - A full understanding of cellular dynamics
is often difficult to obtain from time-lapse microscopy of single optical
sections. New microscopes and image-processing software are now making it
possible to rapidly record three-dimensional images over time. This
four-dimensional imaging allows precise quantitative analysis and enhances
visual exploration of data by allowing cellular structures to be interactively
displayed from many angles. It has become a key tool for understanding the
complex organization of biological processes in live specimens. N. Ref:: 55
----------------------------------------------------
[18]
TÍTULO / TITLE: - Pretransplant blood
transfusions revisited: a role for CD(4+) regulatory T cells?
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1
Suppl):S26-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000106469.12073.01
AUTORES
/ AUTHORS: - Roelen D; Brand A; Claas FH
INSTITUCIÓN
/ INSTITUTION: - Department of Immunohematology and
Bloodtransfusion, Leiden University Medical Center, Leiden, The Netherlands. d.l.roelen@lumc.nl.
RESUMEN
/ SUMMARY: - Pretransplant blood transfusions have been
shown to improve organ allograft survival. However, the immunologic mechanism
leading to this beneficial effect of blood transfusions is still unknown. The
observation that transfusions sharing at least one HLA-DR antigen (human
leukocyte antigen) with the recipient are more effective than HLA-mismatched
transfusions has led to the hypothesis that CD(4+) regulatory T cells are
induced that recognize allopeptides of the blood transfusion donor in the
context of the self-HLA-DR molecule on the donor cells. In vitro studies showed
that CD(4+) T cells recognizing an allopeptide in the context of self-HLA-DR
are indeed able to decrease the alloimmune response of autologous T cells by
affecting the activated T cells directly or indirectly by their modulatory
effect on dendritic cells. The first studies in a patient with a
well-functioning kidney graft after receiving an HLA-DR-matched pretransplant
blood transfusion showed that the low organ donor-specific cytotoxic
T-lymphocyte response after transplantation was indeed attributable to the
activity of regulatory CD(4+) T cells. N.
Ref:: 24
----------------------------------------------------
[19]
- Castellano -
TÍTULO / TITLE:Riesgo cardiovascular en pacientes
con insuficiencia renal cronica. Pacientes en tratamiento sustitutivo renal.
Cardiovascular risk in patients with chronic renal failure. Patients in renal
replacement therapy.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22 Suppl 1:68-74.
AUTORES
/ AUTHORS: - Cases A; Vera M; Lopez Gomez JM
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Unidad de
Hipertension Arterial, Hospital Clinic, IDIBAPS, Universidad de Barcelona,
Barcelona. acases@medicina.ub.es
RESUMEN
/ SUMMARY: - Dialysis patients constitute a high-risk
subset of patients for developing cardiovascular disease, which accounts for
nearly 50% of deaths. After stratification for age, race and gender,
cardiovascular mortality is 10-20 times higher in dialysis patients than in the
general population. Cardiovascular disease in this population cannot be fully
explained by the high prevalence of classical cardiovascular risk factors (age,
hypertension, diabetes, hyperlipidemia, smoking, etc.). Thus, the involvement
of “new” cardiovascular risk factors (hyperhomocysteinemia,
hyperfibrinogenemia, high lipoprotein (a) levels, oxidative stress,
inflammation, etc.), and uremia-related factors (anemia, impaired
calcium-phosphorus metabolism, hyperparathyroidism, accumulation of endogenous
inhibitors of nitric oxide synthesis, etc.) has been also invoked to play a
role in the increased cardiovascular risk in these patients. Endothelial
dysfunction is the initial event in the development of atherosclerosis. Uremic
patients exhibit an endothelial dysfunction, even before starting dialysis,
which persists o is even aggravated under dialysis treatment. Uremic patients
must be considered at high risk of developing cardiovascular disease. Thus
cardiovascular risk factors in these patients should be managed early,
aggressive and multifactorially in order to reduce their high cardiovascular
morbidity and mortality. N.
Ref:: 52
----------------------------------------------------
[20]
TÍTULO / TITLE: - The CHORUS
(Cerivastatin in Heart Outcomes in Renal Disease: Understanding Survival)
protocol: a double-blind, placebo-controlled trial in patients with esrd.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Jan;37(1 Suppl
2):S48-53.
AUTORES
/ AUTHORS: - Keane WF; Brenner BM; Mazzu A; Agro A
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Hennepin County
Medical Center, University of Minnesota Medical School, Minneapolis, MN, USA. g.macgregor@sghms.ac.uk
RESUMEN
/ SUMMARY: - The 3-hydroxy-3-methylglutaryl coenzyme A
reductase inhibitor (statin)-mediated lowering of serum cholesterol has been
associated with a significant reduction in cardiovascular morbidity and
mortality. Recent studies suggest that additional non-lipid lowering effects
(eg, endothelial stabilization, anti-inflammatory, antithrombogenic) may be
important in modulating their effectiveness. Dyslipidemia is common in
end-stage renal disease (ESRD), and hemodialysis patients have increased
cardiovascular morbidity and mortality. Cerivastatin, a new statin with
powerful low-density lipoprotein-cholesterol (LDL-C) lowering capabilities,
possesses some unique non-LDL-C-mediated properties that may contribute to a
reduction of coronary events in the patient with ESRD. The primary objective of
this multicenter multinational study of 1,054 hemodialysis patients is to
compare 2 years of treatment with cerivastatin (0.4 mg/d) versus placebo on the
composite clinical event rate of myocardial infarction, sudden cardiac death,
ischemic stroke, and the need for coronary arterial bypass graft (CABG) or
percutaneous transluminal coronary angioplasty (PTCA) procedures in these
patients. Changes in lipids, inflammatory proteins including heat stable
C-reactive protein (hsCRP), interleukin-6 (IL-6), oncostatin-M, intracellular
adhesion molecule-1 (ICAM-1) and monocyte-chemoattractant protein-1 (MCP-1), as
well as markers of cardiac muscle pathology, such as troponin I and troponin T,
will be assessed in a subset of patients. This study is the first of its kind
to assess the effect of a statin on the reduction of cardiovascular morbidity
and mortality in an incident hemodialysis population. It will determine whether
treatment with cerivastatin can effectively reduce the significant
cardiovascular morbidity and mortality.
----------------------------------------------------
[21]
TÍTULO / TITLE: - Dendritic cells and the
mode of action of anticalcineurinic drugs: an integrating hypothesis.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2003 Mar;18(3):467-8;
discussion 469-70.
AUTORES
/ AUTHORS: - Fierro A; Mora JR; Bono MR; Morales J;
Buckel E; Sauma D; Rosemblatt M
INSTITUCIÓN
/ INSTITUTION: - Clinica las Condes, Transplantation Unit,
Santiago, Chile. afierro@vtr.net N. Ref:: 16
----------------------------------------------------
[22]
TÍTULO / TITLE: - Renal transplantation:
can we reduce calcineurin inhibitor/stop steroids? Evidence based on protocol
biopsy findings.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Mar;14(3):755-66.
AUTORES
/ AUTHORS: - Gotti E; Perico N; Perna A; Gaspari F;
Cattaneo D; Caruso R; Ferrari S; Stucchi N; Marchetti G; Abbate M; Remuzzi G
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine and
Transplantation, Ospedali Riuniti di Bergamo, Mario Negri Institute for
Pharmacological Research, Italy.
RESUMEN
/ SUMMARY: - How to combine antirejection drugs and
which is the optimal dose of steroids and calcineurin inhibitors beyond the
first year after kidney transplantation to maintain adequate immunosuppression
without major side effects are far from clear. Kidney transplant patients on
steroid, cyclosporine (CsA), and azathioprine were randomized to per-protocol
biopsy (n = 30) or no-biopsy (n = 29) 1 to 2 yr posttransplant. Steroid or CsA
were discontinued or reduced on the basis of biopsy to establish effects on
drug-related complications, acute rejection, and graft function over 3 yr of
follow-up. Serum creatinine, GFR (plasma clearance of iohexol), RPF (renal
clearance of p-aminohippurate), CsA pharmacokinetics, and adverse events were
monitored yearly. At the end, patients underwent a second biopsy. Per-protocol
biopsy histology revealed no lesions (n = 5, steroid withdrawal), CsA
nephropathy (n = 13, CsA discontinuation/reduction), or chronic rejection (n =
12, standard therapy). Reducing the drug regimen led to overall fewer side
effects related to immunosuppression as compared with standard therapy or
no-biopsy. Steroids were safely stopped with no acute rejection or graft loss.
Complete CsA discontinuation was associated with acute rejection in the first
four patients. Lowering CsA to low target CsA trough (30 to 70 ng/ml) never led
to acute rejection or major renal function deterioration. Biopsy patients on
conventional regimen had no acute rejection, one graft loss, no significant
change in GFR, and significant RPF decline. No-biopsy controls: no acute
rejection, one graft loss, significant decline of GFR and RPF. By serial biopsy
analysis, severe lesions did not develop in patients with steroid
discontinuation in contrast to patients on standard therapy over follow-up. CsA
reduction did not adversely affect histology. Per-protocol biopsy more than 1
yr after kidney transplantation is a safe procedure to guide change of drug
regimen and to lower the risk of major side effects.
----------------------------------------------------
[23]
TÍTULO / TITLE: - Treatment of
posttransplant hypertension: too little, too late?
REVISTA
/ JOURNAL: - Transplantation 2003 Dec 15;76(11):1645-6.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000091290.30262.96
AUTORES
/ AUTHORS: - Paul LC
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Leiden
University Medical Center, Leiden, The Netherlands. lcpaul@lumc.nl N. Ref:: 12
----------------------------------------------------
[24]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.3. Cancer risk after renal transplantation. Solid
organ cancers: prevention and treatment.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:32, 34-6.
RESUMEN
/ SUMMARY: - GUIDELINES: J. All renal transplant
recipients should have regular ultrasonography of their native kidneys (when
applicable) for screening of renal cell carcinomas, which are observed at much
higher incidence in both dialysed and transplant patients. K. Guidelines
published for screening and prevention of solid organ cancers in the general
population should be strictly applied to transplant recipients, who are in
general at higher cancer risk, but would benefit equally or even greater. L.
All male renal transplant recipients aged 50 and over should have a yearly
prostate specific antigen (PSA) test prior to a regular digital rectal
examination. M. All female renal transplant recipients should have a yearly
cervical (PAP) smear together with regular pelvic examination and regular mammography,
according to national recommendations where available. N. All renal transplant
recipients should undergo a faecal occult-blood testing as a screening for
colorectal cancer and other (pre-malignant) lesions, according to national
recommendations where available. O. In all these conditions, it is recommended
to reduce immunosuppression whenever possible.
----------------------------------------------------
[25]
TÍTULO / TITLE: - End-stage renal disease
in India and Pakistan: burden of disease and management issues.
REVISTA
/ JOURNAL: - Kidney Int Suppl 2003 Feb;(83):S115-8.
AUTORES
/ AUTHORS: - Sakhuja V; Sud K
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Postgraduate
Institute of Medical Education and Research, Chandigarh, India. vasakhuja@glide.net.in
RESUMEN
/ SUMMARY: - In the absence of national registries, no
reliable data are available on the incidence and prevalence of end-stage renal
disease (ESRD) in India and Pakistan. The incidence of ESRD is likely to be
higher than that reported from the developed world, with chronic
glomerulonephritis being the most common cause, accounting for more than one
third of patients, while diabetic nephropathy accounts for about one fourth of
all patients in India. Patients are generally younger (mean age 42 years) at
the time of detection of ESRD and two-thirds first see a nephrologist after
they have reached end stage. Treatment of ESRD is a low priority for the
cash-strapped public hospitals and in the absence of health insurance plans,
less than 10% of all patients receive any kind of renal replacement therapy.
The vast majority of patients starting hemodialysis die or stop treatment
because of cost constraints within the first three months, and less than 2%
patients are started on ambulatory peritoneal dialysis. Although renal
transplantation is the cheapest option, only about 5% of all patients with ESRD
end up having a transplant. Living related donor transplants constitute 30 to
40% of all transplants in India, but there is a conspicuous gender bias with
female donors donating kidneys for their male relatives. Cadaveric
transplantation has yet to pick up and accounts for less than 2% of all
transplants. The enactment of legislation to regulate renal transplantation in
India has not been able to prevent unrelated (paid) donor transplants, which
constitute 60 to 70% of all renal transplants. Cyclosporine, azathioprine and
prednisolone continue to be the backbone of post-transplant immunosuppression,
with cyclosporine being stopped in a significant proportion at one year
post-transplant to cut down costs. Increasing awareness of renal disease
amongst the population and general practitioners could result in early
diagnosis of chronic renal failure and give opportunity for preventive
strategies to delay the onset of ESRD. Preemptive transplantation and use of
generic cyclosporine can help bring down the costs of treatment. Innovative and
affordable health insurance policies can also increase the number of patients
who receive effective treatment for ESRD in these two countries. N. Ref:: 10
----------------------------------------------------
[26]
TÍTULO / TITLE: - Regulatory T cells in
kidney transplant recipients: active players but to what extent?
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Jun;14(6):1706-8.
AUTORES
/ AUTHORS: - Zhai Y; Kupiec-Weglinski JW N. Ref:: 20
----------------------------------------------------
[27]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.1. Cardiovascular risks. Cardiovascular disease
after renal transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:24-5.
RESUMEN / SUMMARY: - GUIDELINES: A. Post-transplant cardiovascular disease is very common, an important cause of morbidity and the first cause of mortality in renal transplant recipients. Therefore, detection and early treatment of post-transplant cardiovascular disease are mandatory. B. Specific risk factors for developing post-transplant cardiovascular disease include pre-transplant cardiovascular disease, arterial hypertension, uraemia (graft dysfunction), hyperlipidaemia, diabetes mellitus, smoking and immunosuppressive treatment. These factors should be targeted for intervention. C. Pre-transplant cardiovascular disease is a major risk factor for post-transplant cardiovascular disease. Therefore, prior to transplantation, it is mandatory to detect and treat symptomatic coronary artery disease, heart failure due to valvular failure or cardiomyopathy, and pericardial constriction. This policy should also be followed in asymptomatic diabetic patients.