#04#
Revisiones-Clínica-Epidemiología,
Higiene & Prevención *** Reviews-Clinical-Epidemiology, Hygiene &
Prevention
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: - 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.
----------------------------------------------------
[3]
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
----------------------------------------------------
[4]
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.
----------------------------------------------------
[5]
- 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
----------------------------------------------------
[6]
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.
----------------------------------------------------
[7]
TÍTULO / TITLE: - Calcium channel
blockers for preventing acute tubular necrosis in kidney transplant recipients.
REVISTA
/ JOURNAL: - Cochrane Database Syst Rev
2004;1:CD003421.
●●
Enlace al texto completo (gratuito o de pago) 1002/14651858.CD003421.pub2
AUTORES
/ AUTHORS: - Shilliday I; Sherif M
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Monklands Hospital, Monkscourt
Avenue, Airdrie, UK, ML6 0JS.
RESUMEN
/ SUMMARY: - BACKGROUND: The incidence of delayed graft
function in cadaveric grafts has increased over the last few years due in part
to the large demand for cadaveric kidneys necessitating the use of kidneys from
marginal donors. Calcium channel blockers have the potential to reduce the
incidence of post-transplant acute tubular necrosis (ATN) if given in the
peri-operative period. However, there is controversy surrounding their use in
this situation with no consensus as to their efficacy. OBJECTIVES: To evaluate
the benefits and harms of using calcium channel blockers in the peri-transplant
period in patients at risk of ATN following cadaveric kidney transplantation.
SEARCH STRATEGY: We searched the Cochrane Renal Group’s specialised register,
the Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane
Library issue 2, 2003) MEDLINE (1966 to January 2003) and EMBASE (1980 -
January 2003). The Trials Search Coordinator was contacted to develop the
search strategy. SELECTION CRITERIA: Randomised controlled trials comparing
calcium channel blockers given in the peri-transplant period with controls were
included. Quasi-randomised trials were excluded. DATA COLLECTION AND ANALYSIS:
Data was extracted and quality assessed independently by two reviewers, with
differences resolved by discussion. Dichotomous outcomes are reported as
relative risk (RR) and measurements on continuous scales are reported as
weighted mean differences (WMD) with 95% confidence intervals (CI). MAIN
RESULTS: Nine trials were suitable for inclusion. Treatment with calcium
channel blockers in the peri-transplant period was associated with a
significant decrease in the incidence of post transplant ATN (RR 0.57, 95%CI
0.40 to 0.82) and delayed graft function (RR 0.44, 95% CI 0.28 to 0.69). There
was no difference between control and treatment groups in graft loss,
mortality, requirement for haemodialysis. There was insufficent information to
comment on adverse events. REVIEWER’S CONCLUSIONS: These results suggest that
calcium channel blockers given in the peri-operative period may reduce the
incidence of ATN post-transplantation. The result should be treated with
caution due to the heterogeneity of the trials which made comparison of studies
and pooling of data difficult.
----------------------------------------------------
[8]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.2. Cancer risk after renal transplantation. Skin
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 4:31-6.
RESUMEN
/ SUMMARY: - GUIDELINES: D. Due to the high prevalence
of skin cancers after organ transplantation, it is highly recommended to inform
patients about self-awareness. E. Primary prevention should include the
avoidance of sun exposure, use of protective clothing and use of an effective
sunscreen (protection factor >15) for unclothed body parts (head, neck,
hands and arms) in order to prevent the occurrence of squamous-cell carcinoma.
This is the most frequent skin tumour in transplant recipients, and its
preferential location is the head. F. Recipients with pre-malignant skin
lesions (warts, epidermodysplasia verruciformis or actinic keratoses) should be
referred early to a dermatologist for active treatment and close follow-up. G.
All skin cancers should be completely removed by a dermatologist with
appropriate techniques, such as electro-desiccation with curettage, cryotherapy
or surgical excision. H. Secondary prevention for recipients should include
close follow-up by a dermatologist (at least every 6 months), the use of
topical retinoids to control actinic keratoses and to diminish squamous-cell
carcinoma recurrence, and reduction of immunosuppression whenever possible. I.
In recipients with multiple and/or recurrent skin cancers, the use of systemic
retinoids, such as low-dose acitretin, could be recommended for months/years,
if well tolerated, in addition to further reduction in immunosuppression
whenever possible.
----------------------------------------------------
[9]
TÍTULO / TITLE: - Mycophenolate mofetil
versus azathioprine therapy is associated with a significant protection against
long-term renal allograft function deterioration.
REVISTA
/ JOURNAL: - Transplantation 2003 Apr 27;75(8):1341-6.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000062833.14843.4B
AUTORES
/ AUTHORS: - Meier-Kriesche HU; Steffen BJ; Hochberg
AM; Gordon RD; Liebman MN; Morris JA; Kaplan B
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine,
University of Florida College of Medicine, Gainesville, FL 32610-0224, USA. meierhu@medicine.ufl.edu.
RESUMEN
/ SUMMARY: - BACKGROUND: To evaluate the association of
long-term continuous mycophenolate mofetil (MMF) versus azathioprine (AZA)
therapy and renal allograft function, as measured by the slope of reciprocal
creatinine, we analyzed 49,666 primary renal allograft recipients reported to
the United States Renal Data System between October 31, 1988 and June 30, 1998.
METHODS: The primary study endpoint was defined as a greater than 20% decrease
below a 6-month baseline of 1/serum creatinine (SCr) (slope of reciprocal
creatinine) at or beyond 1 year after transplantation. A secondary endpoint was
defined as reaching an SCr value greater than 1.6 mg/dL. Univariate
Kaplan-Meier analysis and multivariate Cox proportional hazard models were used
to investigate the risk of reaching the study endpoints. Multivariate analyses
were corrected for potential confounding covariates. RESULTS: According to the
Cox proportional hazard model, 12-month continued therapy of MMF versus AZA was
associated with a protective effect against declining renal function, as
measured by the slope of reciprocal creatinine (relative risk [RR]=0.84,
confidence interval 0.78-0.91, P<0.001). For 24-month continued therapy of
MMF versus AZA, MMF was associated with a further decreased risk for a decline
in renal function (RR=0.66, confidence interval=0.57-0.77, P<0.001).
Furthermore, MMF was associated with a protective effect against reaching the
SCr threshold of 1.6 mg/dL (RR=0.80, P<0.001) beyond 12 months
posttransplantation. CONCLUSIONS: Continuous use of MMF versus AZA was
associated with a protective effect against declining renal function beyond 1
year after transplantation. Further study is needed to confirm that continued
MMF therapy is protective against long-term deterioration in renal function.
----------------------------------------------------
[10]
TÍTULO / TITLE: - Protocol core needle
biopsy and histologic Chronic Allograft Damage Index (CADI) as surrogate end
point for long-term graft survival in multicenter studies.
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):773-9.
AUTORES
/ AUTHORS: - Yilmaz S; Tomlanovich S; Mathew T;
Taskinen E; Paavonen T; Navarro M; Ramos E; Hooftman L; Hayry P
INSTITUCIÓN
/ INSTITUTION: - Data Analysis Center, Division of
Transplantation, Department of Surgery, University of Calgary, Alberta, Canada.
RESUMEN
/ SUMMARY: - This study is an investigation of whether
a protocol biopsy may be used as surrogate to late graft survival in
multicenter renal transplantation trials. During two mycophenolate mofetil
trials, 621 representative protocol biopsies were obtained at baseline, 1 yr,
and 3 yr. The samples were coded and evaluated blindly by two pathologists, and
Chronic Allograft Damage Index (CADI) score was constructed. At 1 yr, only 20%
of patients had elevated (>l.5 mg/100 ml) serum creatinine, whereas 60% of
the biopsies demonstrated an elevated (>2.0) CADI score. The mean CADI score
at baseline, 1.3 +/- 1.1, increased to 3.3 +/- 1.8 at 1 yr and to 4.1 +/- 2.2
at 3 yr. The patients at 1 yr were divided into three groups, those with CADI
<2, between 2 and 3.9, and >4.0, the first two groups having normal (1.4 +/-
0.3 and 1.5 +/- 0.6 mg/dl) and the third group pathologic (1.9 +/- 0.8 mg/dl)
serum creatinine. At 3 yr, there were no lost grafts in the low CADI group, six
lost grafts (4.6%) in the in the elevated CADI group, and 17 lost grafts
(16.7%) in the high CADI group (P < 0.001). One-year histologic CADI score
predicts graft survival even when the graft function is still normal. This
observation makes it possible to use CADI as a surrogate end point in
prevention trials and to identify the patients at risk for intervention trials.
----------------------------------------------------
[11]
TÍTULO / TITLE: - Incidence of ESRD and
survival after renal replacement therapy in patients with type 1 diabetes: a
report from the Allegheny County Registry.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Jul;42(1):117-24.
AUTORES
/ AUTHORS: - Nishimura R; Dorman JS; Bosnyak Z; Tajima
N; Becker DJ; Orchard TJ
INSTITUCIÓN
/ INSTITUTION: - Department of Epidemiology, Graduate
School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. rimei@excite.co.jp
RESUMEN
/ SUMMARY: - BACKGROUND: Little information is
available regarding the long-term incidence of end-stage renal disease (ESRD)
and survival after the introduction of renal replacement therapy (RRT) in
patients with type 1 diabetes. METHODS: We studied 1,075 patients with type 1
diabetes (onset age < 18 years) diagnosed between 1965 and 1979, who
comprise the Allegheny County population-based registry. Onset of ESRD was defined
as the introduction of RRT (dialysis or transplantation). RESULTS: Of 1,075
registrants, the living status of 975 patients (90.7%) and complication status
of 798 patients (74.2%) were ascertained as of January 1, 1999. During the
observation period, 104 patients (13.0%) developed ESRD, for an incidence rate
of 521/100,000 person-years (95% confidence interval, 424 to 629). The
cumulative incidence of ESRD was 11.3% at 25 years of diabetes. A significant
decline was observed in 20-year cumulative incidence rates of ESRD for patients
diagnosed between 1965 and 1969, 1970 and 1974, and 1975 and 1979 (9.1%, 4.7%,
and 3.6%, respectively; P = 0.006). Of 104 patients with ESRD, 29 patients
(28%) received dialysis alone, 44 patients (42%) received dialysis followed by
kidney transplantation, 26 patients (25%) underwent successful transplantation
alone, and 5 patients (5%) underwent a failed kidney transplantation followed
by dialysis therapy. The cumulative survival rate 10 years after the
introduction of RRT was 51.2%. The cumulative survival rate of dialysis therapy
followed by kidney transplantation was significantly greater than that of
dialysis therapy alone (P < 0.001). No difference was detected in survival
between pancreas-kidney transplant recipients and kidney-alone transplant
recipients (P = 0.7). CONCLUSION: The incidence of ESRD observed in this cohort
has declined, probably reflecting the better glycemic and blood pressure
control available since the early 1980s.
N. Ref:: 35
----------------------------------------------------
[12]
TÍTULO / TITLE: - The economic value of
valacyclovir prophylaxis in transplantation.
REVISTA
/ JOURNAL: - J Infect Dis. Acceso gratuito al texto
completo a partir de los 2 años de la publicación; - http://www.journals.uchicago.edu/
●●
Cita: J. of Infectious Diseases: <> 2002 Oct 15;186 Suppl 1:S116-22.
AUTORES
/ AUTHORS: - Squifflet JP; Legendre C
INSTITUCIÓN
/ INSTITUTION: - University Clinic Saint Luc, 1200
Brussels, Belgium. Jean-Paul.Squifflet@chir.ucl.ac.be
RESUMEN
/ SUMMARY: - Cytomegalovirus (CMV) infection and
disease, with its extensive direct and indirect consequences, adds considerably
to the cost of patient management in both solid organ and bone marrow transplantation.
Antiviral prophylaxis for CMV infection can offer cost advantages over
preemptive therapy and “wait-and-treat” approaches. Valacyclovir has
demonstrated efficacy for CMV prophylaxis in renal, heart, and bone marrow
transplantation and is cost-effective when compared with placebo in renal
transplant recipients at high risk of CMV infection. In reducing CMV infection
and disease, valacyclovir prophylaxis appears to be associated with reductions
in indirect effects of CMV (acute graft rejection, other opportunistic
infections) and, if these effects are considered, the potential exists for even
greater savings to be made with valacyclovir therapy. Benefits of valacyclovir
in transplantation extend beyond CMV to other herpesviruses and may be increased
in some clinical situations by prolonging prophylaxis beyond 3 months. N. Ref:: 32
----------------------------------------------------
[13]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.13 Analysis of patient and graft survival.
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 4:60-7.
RESUMEN
/ SUMMARY: - GUIDELINES: A. It is important for a
transplant unit to follow-up on the results of their transplant activities. In
order to achieve correct reports on graft and patient outcome in all patients,
it is necessary to have sufficient resources, such as a computerized database,
and continuous updates of patient information. All data collected should be
subjected to validation procedures to ensure completeness and accuracy. B.
Improved outcomes following implementation of new protocols, based on
evaluation of clinical multi-centre trials, should be verified at local
transplant centres since centres often include a range of patients different
from those selected for the trial. C. The most widely accepted descriptor of
outcome is the Kaplan-Meier probability estimate of patient and graft survival.
Survival estimates should be calculated at intervals of time after
transplantation and should always be expressed with their 95% confidence
intervals. D. Kaplan-Meier survival estimates may be calculated in three ways.
(i) ‘Patient survival’ should be calculated from the date of transplantation to
the date of death or the date of the last follow-up. (ii) ‘Graft survival’
(non-censored for death) should be calculated from the date of transplantation
to the date of irreversible graft failure signified by return to long-term dialysis
(or retransplantation) or the date of the last follow-up during the period when
the transplant was still functioning or to the date of death. Here, death with
graft function is treated as graft failure. (iii) ‘Graft survival censored for
death with a functioning graft’ (death-censored graft survival) should be
calculated from the date of transplantation to the date of irreversible graft
failure signified by return to long-term dialysis (or retransplantation) or the
date of last follow-up during the period when the transplant was still
functioning. In the event of death with a functioning graft, the follow-up
period is censored at the date of death. E. The outcome of transplants carried
out at a centre should be compared with those achieved across a range of data
from centres collated by national and international multi-centre registries.
Interpretation of a centre’s performance should take into account the number of
transplants performed and the prevalence of major risk factors. F. Major risk
factors that influence transplant outcome are identifiable by applying
multivariate analytical methods to large multi-centre follow-up databases.
Although these major risk factors may not be identifiable in individual centre
data, they should nonetheless be taken into account in patient management. G.
When designing a clinical trial or evaluating data from a recent trial, the
expected improvement in graft survival resulting from a reduction in acute
rejection may be estimated from a knowledge of the rejection and graft survival
rates that existed prior to the introduction of the new therapeutic regimen. H.
When designing or evaluating a clinical trial, it is important to analyse the
power of the study to verify statistically the difference (in graft survival)
that might be expected and its statistical significance. A study resulting in
absence of statistically significant differences between two treatment groups
with insufficient statistical power to verify a difference at the expected
level should not be taken as evidence of absence of a true difference.
----------------------------------------------------
[14]
TÍTULO / TITLE: - Management of the
waiting list for cadaveric kidney transplants: report of a survey and
recommendations by the Clinical Practice Guidelines Committee of the American
Society of Transplantation.
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: <> 2002
Feb;13(2):528-35.
AUTORES
/ AUTHORS: - Danovitch GM; Hariharan S; Pirsch JD; Rush
D; Roth D; Ramos E; Starling RC; Cangro C; Weir MR
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, University of
California, Los Angeles, School of Medicine, Los Angeles, California 90025,
USA. gdanovitch@mednet.ucla.edu
RESUMEN
/ SUMMARY: - The Clinical Practice Guidelines Committee
of the American Society of Transplantation developed a survey to review the
policies of kidney transplant programs in the United States with respect to the
management of the steadily expanding waiting list for cadaveric kidneys. The
survey was sent to 287 centers, and 192 (67%) responded. The survey indicated
that regular follow-up monitoring, most frequently on an annual basis, is
required by the majority (71%) of programs. Patients considered to be at high
risk and candidates for combined kidney-pancreas transplantation may be
monitored more frequently. Annual screening for coronary artery disease is
typically required for asymptomatic patients considered to be at high risk for
covert disease. Noninvasive techniques are typically used, and a designated cardiologist
is usually available to the transplant program. The dialysis nephrologist or
the potential transplant recipient is expected to inform the transplant program
of intercurrent events that may affect transplant candidacy. Standard health
maintenance screening is required, together with the routine updating of
serologic and other blood tests that may be relevant to the posttransplant
course. Smaller transplant programs (<100 patients on the waiting list) are
more likely to maintain closer contact with the wait-listed patients and to
attempt to influence their treatment during dialysis and are less likely to
cancel transplants because of unanticipated pretransplant medical problems. The
work load necessitated by the follow-up monitoring of wait-listed patients was
assessed and, in the absence of specific evidence-based information, a series
of recommendations were developed to reflect current standards of practice and
to suggest future research initiatives.
----------------------------------------------------
[15]
TÍTULO / TITLE: - Nonmelanoma skin cancer
in organ transplant patients.
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 15;75(3):253-7.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000044135.92850.75
AUTORES
/ AUTHORS: - Jemec GB; Holm EA
INSTITUCIÓN
/ INSTITUTION: - Division of Dermatology, Department of
Medicine, Roskilde Hospital, 4000 Roskilde, Denmark. ccc2845@vip.cybercity.dk
RESUMEN
/ SUMMARY: - Nonmelanoma skin cancer (NMSC) is more
frequent in immunocompromised patients, for example, patients with organ
transplants. A number of studies have been published from different countries
that present a similar picture of tumors in transplant patients. In addition,
the behavior of these tumors is often more aggressive in this group of
high-risk patients. The multitude of NMSC and precancerous lesions presents a
clinical diagnostic and therapeutic challenge to the managing dermatologists.
Technology is being developed to cope with the clinical diagnosis and medical
adjunct treatment to broaden the therapeutic options. It is suggested that the
optimal use of these new developments occurs if patients are seen in specialized
clinics aimed at providing preventive measures, diagnosis, and treatment. N. Ref:: 50
----------------------------------------------------
[16]
TÍTULO / TITLE: - A benefit-risk
assessment of basiliximab in renal transplantation.
REVISTA
/ JOURNAL: - Drug Saf. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.csmwm.org/
●●
Cita: Drug Safety: <> 2004;27(2):91-106.
AUTORES
/ AUTHORS: - Boggi U; Danesi R; Vistoli F; Del Chiaro
M; Signori S; Marchetti P; Del Tacca M; Mosca F
INSTITUCIÓN
/ INSTITUTION: - Division of General Surgery and
Transplants, Department of Oncology, Transplants and Advanced Technologies in
Medicine, University of Pisa, Pisa, Italy. uboggi@med.unipi.it
RESUMEN
/ SUMMARY: - Interleukin-2 (IL-2) and its receptor
(IL-2R) play a central role in T lymphocyte activation and immune response
after transplantation. Research on the biology of IL-2R allowed the
identification of key signal transduction pathways involved in the generation
of proliferative and antiapoptotic signals in T cells. The alpha-chain of the
IL-2R is a specific peptide against which monoclonal antibodies have been
raised, with the aim of blunting the immune response by means of inhibiting
proliferation and inducing apoptosis in primed lymphocytes. Indeed,
basiliximab, one of such antibodies, has proved to be effective in reducing the
episodes of acute rejection after kidney and pancreas transplantation. The use
of basiliximab was associated with a significant reduction in the incidence of
any treated rejection episodes after kidney transplantation in the two major
randomised studies (placebo 52.2% vs basiliximab 34.2% at 6 months, European
study; placebo 54.9% vs basiliximab 37.6% at 1 year, US trial). Basiliximab and
equine antithymocyte globulin (ATG) administration resulted in a similar rate
of biopsy-proven acute rejection at 6 months (19% for both) and at 12 months
(19% and 20%, respectively). The use of basiliximab appears not to be
associated with an increased incidence of adverse events as compared with
placebo in immunosuppressive regimens, including calcineurin inhibitors,
mycophenolate mofetil or azathioprine and corticosteroids, and its safety
profile is superior to ATG. Moreover, a similar occurrence of infections is
noted in selected studies (65.5% after basiliximab vs 65.7% of controls),
including cytomegalovirus infection (17.3% vs 14.5%), and cytokine-release
syndrome is not observed. Finally, economic analysis demonstrated lower costs of
overall treatment in patients treated with basiliximab. Therefore, the use of
basiliximab entails a very low risk, allows safe reduction of corticosteroid
dosage and reduces the short- and mid-term rejection rates. However, the
improvement in the long-term survival of kidney grafts in patients treated
according to modern immunosuppressive protocols is still to be demonstrated.
These conclusions are based on a systematic review of the scientific
literature, indexed on Medline database, concerning the mechanism of action,
therapeutic activity, safety and pharmacoeconomic evaluation of basiliximab in
renal transplantation. N.
Ref:: 62
----------------------------------------------------
[17]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.7.1 Late infections. Pneumocystis carinii pneumonia.
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 4:36-9.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Approximately 5% of patients
develop Pneumocystis carinii pneumonia (PCP) after renal transplantation if
they do not receive prophylaxis. PCP is a severe disease, with a very high
fatality rate. Therefore, all renal transplant recipients should receive PCP
prophylaxis. The treatment of choice is trimethoprim-sulfamethoxazole
(TMP-SMX), at a dose of 80/400 mg/day or 160/800 mg every other day, for at
least 4 months. Patients who are treated for rejection should receive TMP-SMX
prophylaxis for 3-4 months. B. In the case of TMP-SMX intolerance, aerosolized
pentamidine (300 mg once or twice per month) is an alternative for prophylaxis.
C. The first-line treatment of PCP is high-dose TMP-SMX. Patients with a PaO2
of <70 mmHg initially should be treated parenterally, and the administration
of additional steroids should be considered.
----------------------------------------------------
[18]
TÍTULO / TITLE: - Renal transplantation
in HBsAg+ patients: is lamivudine your “final answer”?
REVISTA
/ JOURNAL: - J Clin Gastroenterol 2003 Jul;37(1):9-11.
AUTORES
/ AUTHORS: - Fontana RJ N. Ref:: 30
----------------------------------------------------
[19]
TÍTULO / TITLE: - Infectious disease
prophylaxis in renal transplant patients: a survey of US transplant centers.
REVISTA
/ JOURNAL: - Clin Transplant 2002 Feb;16(1):1-8.
AUTORES
/ AUTHORS: - Batiuk TD; Bodziak KA; Goldman M
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Indiana University
Medical Center, Indianapolis, USA. tbatiuk@iupui.edu
RESUMEN
/ SUMMARY: - Definitive approaches to most infectious
diseases following renal transplantation have not been established, leading to
different approaches at different transplant centers. To study the extent of
these differences, we conducted a survey of the practices surrounding specific
infectious diseases at US renal transplant centers. A survey containing 103
questions covering viral, bacterial, mycobacterial and protozoal infections was
developed. Surveys were sent to program directors at all U.S. renal transplant
centers. Responses were received from 147 of 245 (60%) transplant centers and
were proportionately represented all centers with respect to program size and
geographical location. Pre-transplant donor and recipient screening for
hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus
(HIV) and cytomegalovirus (CMV) is uniform, but great discrepancy exists in the
testing for other agents. HCV seropositive donors are used in 49% of centers.
HIV seropositivity remains a contraindication to transplantation, although 13%
of centers indicated they have experience with such patients. Post-transplant,
there is wide variety in approach to CMV and Pneumocystis carinii (PCP)
prophylaxis. Similarly divergent practices affect post-transplant vaccinations,
with 54% of centers routinely vaccinating all patients according to customary
guidelines in non-transplant populations. In contrast, 22% of centers indicated
they do not recommend vaccination in any patients. We believe an appreciation
of the differences in approaches to post-transplant infectious complications
may encourage individual centers to analyse the results of their own practices.
Such analysis may assist in the design of studies to answer widespread and
important questions regarding the care of patients following renal
transplantation. N.
Ref:: 38
----------------------------------------------------
[20]
TÍTULO / TITLE: - Graft function and
other risk factors as predictors of cardiovascular disease outcome.
REVISTA
/ JOURNAL: - Transplantation 2001 Sep 27;72(6
Suppl):S16-9.
AUTORES
/ AUTHORS: - Forsythe JL
INSTITUCIÓN
/ INSTITUTION: - Transplant Unit, The Royal Infirmary of
Edinburgh, UK. john.forsythe@luht.scot.nhs.uk
RESUMEN
/ SUMMARY: - The high incidence of cardiovascular
disease after renal transplantation is related to a high prevalence and
accumulation of risk factors before and after transplantation. Hypertension,
posttransplantation diabetes, and hyperlipidemia are well-recognized risk
factors for the development of cardiovascular events after renal
transplantation and are strongly associated with immunosuppressive therapy.
Hyperhomocysteinemia is a potential risk factor for cardiovascular disease in
renal transplant recipients, but although a growing matter of study, a direct
association with immunosuppressive agents is not yet proven. In addition to
treatment intervention, risk management should also involve tailoring the
immunosuppressive regimen to minimize the more indirect cardiovascular risk
factors such as renal dysfunction and acute rejection. N. Ref:: 41
----------------------------------------------------
[21]
TÍTULO / TITLE: - ACE inhibitors and AII
receptor antagonists in the treatment and prevention of bone marrow transplant
nephropathy.
REVISTA
/ JOURNAL: - Curr Pharm Des 2003;9(9):737-49.
AUTORES
/ AUTHORS: - Moulder JE; Fish BL; Cohen EP
INSTITUCIÓN
/ INSTITUTION: - Department of Radiation Oncology, Medical
College of Wisconsin, Milwaukee, WI 53226, USA. jmoulder@its.mcw.edu
RESUMEN
/ SUMMARY: - Radiation nephropathy has emerged as a
major complication of bone marrow transplantation (BMT) when total body
irradiation (TBI) is used as part of the regimen. Classically, radiation
nephropathy has been assumed to be inevitable, progressive, and untreatable.
However, in the early 1990’s, it was demonstrated that experimental radiation
nephropathy could be treated with a thiol-containing ACE inhibitor, captopril.
Further studies showed that enalapril (a non-thiol ACE inhibitor) was also
effective in the treatment of experimental radiation nephropathy, as was an AII
receptor antagonist. Studies also showed that ACE inhibitors and AII receptor
antagonists were effective in the prophylaxis of radiation nephropathy.
Interestingly, other types of antihypertensive drugs were ineffective in
prophylaxis, but brief use of a high-salt diet in the immediate
post-irradiation period decreased renal injury. A placebo-controlled trial of
captopril to prevent BMT nephropathy in adults is now underway. Since excess
activity of the renin-angiotensin system (RAS) causes hypertension, and
hypertension is a major feature of radiation nephropathy; an explanation for
the efficacy of RAS antagonism in the prophylaxis of radiation nephropathy
would be that radiation leads to RAS activation. However, current studies favor
an alternative explanation, namely that the normal activity of the RAS is
deleterious in the presence of radiation injury. On-going studies suggest that
efficacy of RAS antagonists may involve interactions with a radiation-induced
decrease in renal nitric oxide activity or with radiation-induced tubular cell
proliferation. We hypothesize that while prevention (prophylaxis) of radiation
nephropathy with ACE inhibitors, AII receptor antagonists, or a high-salt diet
work by suppression of the RAS, the efficacy of ACE inhibitors and AII receptor
antagonists in treatment of established radiation nephropathy depends on blood
pressure control. N.
Ref:: 108
----------------------------------------------------
[22]
TÍTULO / TITLE: - Clinical epidemiology
of cardiac disease in renal transplant recipients.
REVISTA
/ JOURNAL: - Semin Dial 2003 Mar-Apr;16(2):106-10.
AUTORES
/ AUTHORS: - Rigatto C
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Section of
Nephrology, St. Boniface General Hospital, University of Manitoba, Winnipeg,
Canada. crigatto@sbgh.mb.ca
RESUMEN
/ SUMMARY: - Cardiovascular disease (CVD) is the major
cause of death among renal transplant recipients (RTRs), accounting for 17-50%
of deaths. Both cardiomyopathy (congestive heart failure [CHF] and left
ventricular hypertrophy [LVH]) and ischemic heart disease (IHD) are important
complications of renal transplantation, although the morbid impact of
cardiomyopathy has been overlooked until recently. Echocardiographic disorders
and clinical CHF occur far more frequently in RTRs than in the general
population, suggesting that renal transplantation may be a state of accelerated
heart failure. In contrast, the incidence of IHD in RTRs is similar to that in
the Framingham cohort. Age, diabetes, and gender remain important markers of
risk for both disorders. Smoking, hyperlipidemia, and hypertension appear to be
the major reversible risk factors for IHD, while anemia and hypertension are
major reversible risk factors for cardiomyopathy. Definitive evidence on
optimal intervention is lacking. Clinical trials are needed to define optimum
targets for treatment of these risk factors, especially hypertension and
anemia. N. Ref:: 33
----------------------------------------------------
[23]
TÍTULO / TITLE: - The spectrum of kidney
disease in American Indians.
REVISTA
/ JOURNAL: - Kidney Int Suppl 2003 Feb;(83):S3-7.
AUTORES
/ AUTHORS: - Narva AS
INSTITUCIÓN
/ INSTITUTION: - Indian Health Service Kidney Disease
Program, Albuquerque, New Mexico, USA. anarva@abq.ihs.gov
RESUMEN
/ SUMMARY: - American Indians and Alaska Natives
(AI/AN) experience high rates of chronic kidney disease. Several studies have
demonstrated increased rates of early kidney disease among AI/AN, both in
diabetics and non-diabetics. Among some tribes of the American Southwest, high
rates of mesangiopathic glomerulonephritis have been documented. The epidemic
of diabetes among AI/AN, which began in the middle of the 20th
century, appears to be driving the increase in end-stage renal disease (ESRD).
At the end of 1999, AI/AN had a national prevalence rate of treated ESRD that
was 3.5 times greater than that of white Americans. There is significant
regional variation as well as differences among the approximately 550 tribes
that make up the American Indian community, with some tribes experiencing ESRD
rates over twenty times the rate of whites. Although graft survival is
excellent, AI/AN ESRD patients are less likely than whites to be placed on the
transplant waiting list, and those listed wait longer for a transplant. Despite
socioeconomic barriers and high rates of co-morbid illness, survival among
AI/AN ESRD patients is better than among whites. The burden of kidney disease,
particularly the multigenerational occurrence in some families, is perceived as
a major threat to the well-being of native communities. There is a sense of
urgency among tribal leaders to address this epidemic, and research that may
decrease its burden is likely to be welcomed.
N. Ref:: 13
----------------------------------------------------
[24]
- Castellano -
TÍTULO / TITLE:Analisis estadistico de la
incidencia de canceres “de novo” en pacientes trasplantados renales: una nueva
metodologia de estudio. Statistic analysis of “de novo” cancer incidence in
renal transplant patients: a new study methodology.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2003 Sep-Oct;23(5):395-8.
AUTORES
/ AUTHORS: - Virto J; Orbe J; Lampreabe I; Zarraga S;
Urbizu JM; Gainza FJ
INSTITUCIÓN
/ INSTITUTION: - Departamento de Econometria y Estadistica
de la Facultad de Ciencias Economicas y Empresariales, Servicio de Nefrologia,
Unidad docente, Hospital de Cruces, Baracaldo.
N. Ref:: 16
----------------------------------------------------
[25]
- Castellano -
TÍTULO / TITLE:Prevencion del riesgo
cardiovascular en el trasplante renal. Documento de consenso. Prevention of
cardiovascular risk in renal transplantation. Consensus document.
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 4:35-56.
AUTORES
/ AUTHORS: - Morales JM; Gonzalez Molina M; Campistol
JM; del Castillo D; Anaya F; Oppenheimer F; Gil Vernet JM; Grinyo JM; Capdevila
L; Lampreave I; Valdes F; Marcen R; Escuin F; Andres A; Arias M; Pallardo L
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia Hospital 12 de
Octubre Ctra, Andalucia km 5,400 28041 Madrid. jmorales@h12o.es N. Ref:: 122
----------------------------------------------------
[26]
TÍTULO / TITLE: - Basiliximab: a review
of its use as induction therapy in renal transplantation.
REVISTA
/ JOURNAL: - Drugs 2003;63(24):2803-35.
AUTORES
/ AUTHORS: - Chapman TM; Keating GM
INSTITUCIÓN
/ INSTITUTION: - Adis International Limited, Auckland, New
Zealand. demail@adis.co.nz
RESUMEN / SUMMARY: - Basiliximab (Simulect), a chimeric (human/murine) monoclonal antibody, is indicated for the prevention of acute organ rejectio