#05#
Revisiones-Clínica-Diagnóstico
*** Reviews-Clinical-Diagnostics
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: - 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
----------------------------------------------------
[2]
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
----------------------------------------------------
[3]
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.
----------------------------------------------------
[4]
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
----------------------------------------------------
[5]
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.
----------------------------------------------------
[6]
TÍTULO / TITLE: - Postmenopausal
tubo-ovarian abscess due to Pseudomonas aeruginosa in a renal transplant
patient: a case report and review of the literature.
REVISTA
/ JOURNAL: - Transplantation 2001 Oct 15;72(7):1241-4.
AUTORES
/ AUTHORS: - El Khoury J; Stikkelbroeck MM; Goodman A;
Rubin RH; Cosimi AB; Fishman JA
INSTITUCIÓN
/ INSTITUTION: - Infectious Disease Division, GRJ 504,
Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
RESUMEN
/ SUMMARY: - BACKGROUND: Pseudomonas aeruginosa is an
uncommon cause of infection in the female genital tract. We report a case of
postmenopausal tubo-ovarian abscess (TOA) due to P. aeruginosa in a renal
transplant recipient. The presentation included mild abdominal symptoms with
rapid progression of peritonitis and surgical abscess drainage. This is the
first such case in an organ transplant recipient described in the English
literature. METHODS AND RESULTS: Published reports of 1040 cases of TOA were
reviewed. The most common features were a history of sexually transmitted
disease or pelvic inflammatory disease, and symptoms including abdominal pain
and fever. Escherichia coli, Bacteroides spp., and Klebsiella pneumoniae were
the most frequently encountered pathogens. Neisseria gonorrhoeae and Chlamydia
trachomatis, which are frequently isolated from cervical cultures, are
uncommonly isolated from tubo-ovarian abscesses. Forty percent of patients were
treated with antibiotics alone, 18.8% with abdominal surgery, and 32% with
surgery and antimicrobial therapy. CONCLUSION: This report illustrates the
muted presentation and atypical microbiology of gynecologic infection in an
organ transplant recipient. N.
Ref:: 59
----------------------------------------------------
[7]
- Castellano -
TÍTULO / TITLE:Polimorfismo del receptor de la
vitamina D y enfermedad osea postrasplante renal. Polymorphism of the vitamin D
receptor and bone disease after renal transplantation.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2001;21 Suppl 1:56-60.
AUTORES
/ AUTHORS: - Torres A; Barrios Y; Salido E
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia y, Hospital
Universitario de Canarias, Instituto Reina Sofia de Investigacion Nefrologica,
Tenerife, España. atorres@ull.es N. Ref:: 29
----------------------------------------------------
[8]
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.
----------------------------------------------------
[9]
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
----------------------------------------------------
[10]
TÍTULO / TITLE: - Ambulatory blood
pressure measurement in kidney transplantation: an overview.
REVISTA
/ JOURNAL: - Transplantation 2003 Dec 15;76(11):1643-4.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000091289.03300.1A
AUTORES
/ AUTHORS: - Tomson CR
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine, Southmead
Hospital, Bristol, UK. charlie.tomson@north-bristol.swest.nhs.uk
RESUMEN
/ SUMMARY: - Adequate control of hypertension is among
the most important aims of medical management of the kidney transplant
recipient, with the aim of reducing the risk of premature cardiovascular
disease and preserving graft function. Antihypertensive therapy should be
adjusted according to the best available estimates of usual resting blood
pressure. If clinic measurements are used, care should be taken to ensure that
these measurements are taken under optimal conditions. Home blood pressure
monitoring is a useful adjunct in many patients. Ambulatory blood pressure
monitoring gives valuable additional data; mean ambulatory blood pressure
correlates better with markers of target organ damage such as left ventricular
hypertrophy. However, current treatment thresholds and targets are based on
clinic measurements. Ambulatory blood pressure monitoring is certainly a useful
adjunct to clinic and home blood pressure measurement, but its role in routine
clinical practice in the transplant clinic remains to be defined. N. Ref:: 11
----------------------------------------------------
[11]
TÍTULO / TITLE: - Updated protocol for
the examination of specimens from patients with carcinoma of the urinary
bladder, ureter, and renal pelvis.
REVISTA
/ JOURNAL: - Arch Pathol Lab Med. Acceso gratuito al
texto completo.
●●
Enlace a la Editora de la Revista http://arpa.allenpress.com/
●●
Cita: Archives of Pathology & Laboratory Medicine: <> 2003
Oct;127(10):1263-79.
AUTORES
/ AUTHORS: - Amin MB; Srigley JR; Grignon DJ; Reuter
VE; Humphrey PA; Cohen MB; Hammond ME
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, Emory University
Hospital, Atlanta, Ga, USA.
----------------------------------------------------
[12]
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
----------------------------------------------------
[13]
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
----------------------------------------------------
[14]
TÍTULO / TITLE: - Current treatment
strategies in ANCA-positive renal vasculitis-lessons from European randomized
trials.
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 Jul;18 Suppl 5:v2-4.
AUTORES
/ AUTHORS: - Tesar V; Rihova Z; Jancova E; Rysava R;
Merta M
INSTITUCIÓN
/ INSTITUTION: - First Medical Department, First Medical
Faculty, Charles University, Prague, Czech Republic. tesar@beba.cesnet.cz
RESUMEN
/ SUMMARY: - Antineutrophil cytoplasmic antibody
(ANCA)-positive renal vasculitis is the most common cause of rapidly
progressive (crescentic) glomerulonephritis. Its life-threatening natural
course may be modified substantially by current treatment modalities. The
European Vasculitis Study Group (EUVAS) developed a subclassification of
ANCA-positive vasculitides based on the disease severity at presentation, and
have organized (so far) two waves of clinical trials. The first wave of randomized
clinical trials had the aim of optimizing the existing therapeutic regimens;
the second wave concentrated on testing some newer therapeutic approaches.
Here, the design and available results of the first wave and the design of some
second wave trials are reviewed briefly. The potential of the new targeted
approaches (e.g. anti-tumour necrosis factor therapy) is also briefly
mentioned. N. Ref:: 9
----------------------------------------------------
[15]
TÍTULO / TITLE: - How should the
immunosuppressive regimen be managed in patients with established chronic
allograft failure?
REVISTA
/ JOURNAL: - Kidney Int Suppl 2002 May;(80):68-72.
AUTORES
/ AUTHORS: - Danovitch GM
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, UCLA School of
Medicine, USA. gdanovitch@mednet.ucla.edu N. Ref:: 25
----------------------------------------------------
[16]
TÍTULO / TITLE: - Costs and consequences
of cytomegalovirus disease.
REVISTA
/ JOURNAL: - Am J Health Syst Pharm 2003 Dec 1;60(23
Suppl 8):S5-8.
AUTORES
/ AUTHORS: - Schnitzler MA
INSTITUCIÓN
/ INSTITUTION: - Washington University, 4547 Clayton
Avenue, Box 8084, St. Louis, MO 63110, USA. schnitz@wueconc.edu
RESUMEN
/ SUMMARY: - The impact of prophylactic oral
ganciclovir therapy on the incidence of cytomegalovirus (CMV) disease, patient
and graft survival, and costs in patients receiving kidney and liver
transplants is described. CMV disease is a common cause of morbidity and
mortality in solid organ transplant recipients unless prophylactic drug therapy
is used. Prophylactic oral ganciclovir therapy reduces the incidence of CMV
disease in kidney and liver transplant recipients. It is more effective for
recipients who are seronegative before the transplant and receive organs from
seronegative (D-/R-) donors than in seronegative recipients of organs from
seropositive (D+/R-) donors. CMV disease remains a problem in the latter. CMV
disease increases the risk of graft failure, which decreases the likelihood of
patient survival. The extent of matching of the DR subregion of the human
leukocyte antigen complex in the donor and recipient may affect graft survival
in patients with CMV disease. Graft failure is costly and should be considered
in economic analyses of CMV prophylaxis regimens because of the potential
impact of prophylaxis on CMV disease. The use of oral ganciclovir for CMV
prophylaxis has reduced the incidence of CMV disease in kidney and liver
transplant recipients. N.
Ref:: 10
----------------------------------------------------
[17]
TÍTULO / TITLE: - Protocol for the
examination of specimens from patients with Wilms tumor (nephroblastoma) or
other renal tumors of childhood.
REVISTA
/ JOURNAL: - Arch Pathol Lab Med. Acceso gratuito al
texto completo.
●●
Enlace a la Editora de la Revista http://arpa.allenpress.com/
●●
Cita: Archives of Pathology & Laboratory Medicine: <> 2003
Oct;127(10):1280-9.
AUTORES
/ AUTHORS: - Qualman SJ; Bowen J; Amin MB; Srigley JR;
Grundy PE; Perlman EJ
INSTITUCIÓN
/ INSTITUTION: - Department of Laboratory Medicine,
Children’s Hospital, Columbus, Ohio 43205, USA. qualmans@pediatrics.ohio-state.edu
----------------------------------------------------
[18]
TÍTULO / TITLE: - Protocol biopsy of the
stable renal transplant: a multicenter study of methods and complication rates.
REVISTA
/ JOURNAL: - Transplantation 2003 Sep 27;76(6):969-73.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000082542.99416.11
AUTORES
/ AUTHORS: - Furness PN; Philpott CM; Chorbadjian MT;
Nicholson ML; Bosmans JL; Corthouts BL; Bogers JJ; Schwarz A; Gwinner W; Haller
H; Mengel M; Seron D; Moreso F; Canas C
INSTITUCIÓN
/ INSTITUTION: - Clinical Sciences Laboratories, Leicester
General Hospital, Leicester, United Kingdom.
RESUMEN
/ SUMMARY: - BACKGROUND: Clinical trials in renal
transplantation must use surrogate markers of long-term graft survival if
conclusions are to be drawn at acceptable speed and cost. Morphologic changes
in transplant biopsies provide the earliest available evidence of damage, and
“protocol” biopsies from stable grafts can be used to reduce the number of
patients needed in clinical trials. This approach has been inhibited by
concerns over safety, but the risk of biopsy of a stable kidney, with no active
inflammation or acute functional impairment, has never been formally estimated.
METHODS: In accordance with a predefined set of questions, a retrospective
audit of a sequential series of protocol biopsies was performed in four major
transplant centers. RESULTS: A total of 2,127 biopsy events were assessed for
major complications, and 1,486 were assessed for minor ones. There were no
deaths. One graft was lost, under circumstances indicating that the loss should
have been prevented. Three episodes of hemorrhage required direct intervention.
Three further patients required transfusion. There were two episodes of
peritonitis, but one was arguably an unrelated event. All serious complications
presented within 4 hr of biopsy. CONCLUSIONS: The incidence of clinically
significant complications after protocol biopsy of a stable renal transplant is
low. Direct benefits to the patients concerned (irrespective of the benefit
that may accrue in clinical trials) were not formally assessed but seem likely
to outweigh the risk of the procedure. We believe that it is ethically
justifiable to ask renal transplant recipients to undergo protocol biopsies in
clinical trials and routine care.
----------------------------------------------------
[19]
TÍTULO / TITLE: - Steroid-resistant
kidney transplant rejection: diagnosis and treatment.
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: <> 2001 Feb;12 Suppl
17:S48-52.
AUTORES
/ AUTHORS: - Bock HA
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Kantonsspital,
Aarau, Switzerland. bock@ksa.ch
RESUMEN
/ SUMMARY: - Decreases in transplant function may be
attributable to a variety of conditions, including prerenal and postrenal
failure, cyclosporin A (CsA) toxicity, polyoma nephritis, recurrent
glomerulonephritis, and rejection. The diagnosis of rejection should therefore
be made on the basis of a transplant biopsy of adequate size, before the
initiation of any therapy. Pulse steroid treatment (three to five 0.25- to
1.0-g pulses of methylprednisolone, administered intravenously) is the usual
first-line therapy and has a 60 to 70% success rate, although orally
administered prednisone (0.25 g) may be just as efficacious. Even if reverted,
any rejection should trigger an at least temporary increase in basal
immunosuppression, consisting of an increase in CsA or tacrolimus target
levels, the addition of steroids or an increase in their dosage, the addition
of mycophenolate mofetil, or a switch from CsA to tacrolimus. The addition of
rapamycin or its RAD derivative may fulfill the same purpose. Steroid
resistance should not be assumed before the fifth day of pulse steroid
treatment, although histologic features of vascular rejection may indicate the
need for more aggressive treatment earlier. Steroid-resistant rejection is
traditionally treated with poly- or monoclonal antilymphocytic antibodies, with
success rates of 60 to 70%. Their potential benefit must be carefully balanced
against the risks of infection and lymphoma. More recently, mycophenolate
mofetil has been successfully used to treat steroid-resistant rejection, but
only of the interstitial (cellular) type. Switching from CsA to tacrolimus for
treating recurrent or antibody-resistant rejection is successful in
approximately 60% of cases. Plasmapheresis and intravenously administered Ig
have been used in some desperate cases, with surprising success. Because none
of the available drugs has a significantly better profile of therapeutic versus
adverse effects, the possible benefits of continued rejection therapy must be
continuously balanced with the potential for serious, sometimes fatal, side
effects. N. Ref:: 35
----------------------------------------------------
[20]
TÍTULO / TITLE: - Vitamin D as
immunomodulatory therapy for kidney transplantation.
REVISTA
/ JOURNAL: - Transplantation 2002 Oct 27;74(8):1204-6.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000031949.70610.BB
AUTORES
/ AUTHORS: - Becker BN; Hullett DA; O’Herrin JK; Malin
G; Sollinger HW; DeLuca H
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, B-3063 UW
Nephrology, University of Wisconsin, 2500 Overlook Terrace, Madison, WI 53705,
USA. bnb@medicine.wisc.edu
RESUMEN
/ SUMMARY: - Vitamin D (1alpha,25-dihydroxyvitamin D(3)
[1alpha,25-(OH)(2)D(3)]) has been studied in the past for its immunosuppressive
properties, and, in that context, it may also have potential utility as an
immunomodulatory agent for transplantation. A number of studies have
demonstrated that 1alpha,25-(OH)(2)D(3) or its analogs regulate immune cell
proliferation, differentiation, and responsiveness. A burgeoning number of
studies have also explored using 1alpha,25-(OH)(2)D(3) and its analogs directly
as therapy in animal models of kidney transplantation with success in
prolonging allograft function and preventing acute rejection. Some of these in
vivo effects may well be caused by alterations in immune cell function, but it
is also possible that exogenous 1alpha,25-(OH)(2)D(3) and its analogs are
altering the intragraft milieu as well, specifically through changes in the
TGF-beta signaling cascade. Such provocative data and the availability of newer
1alpha,25-(OH)(2)D(3) analogs that may limit side effects (e.g. hypercalcemia)
have created interest in examining this secosteroid clinically in kidney
transplantation. N.
Ref:: 34
----------------------------------------------------
[21]
TÍTULO / TITLE: - Pharmacokinetic,
pharmacodynamic, and outcome investigations as the basis for mycophenolic acid
therapeutic drug monitoring in renal and heart transplant patients.
REVISTA
/ JOURNAL: - Clin Biochem 2001 Feb;34(1):17-22.
AUTORES
/ AUTHORS: - Shaw LM; Korecka M; DeNofrio D; Brayman KL
INSTITUCIÓN
/ INSTITUTION: - Departments of Pathology & Laboratory
Medicine and Surgery, University of Pennsylvania Medical Center, Philadelphia,
PA, USA. shawlmj@mail.med.upenn.edu
RESUMEN
/ SUMMARY: - Mycophenolate mofetil is widely used in
combination with either cyclosporine or tacrolimus for rejection prophylaxis in
renal and heart transplant patients. Although not monitored routinely nearly to
the degree that other agents such as cyclosporine or tacrolimus, there is an
expanding body of experimental evidence for the utility of monitoring
mycophenolic acid, the primary active metabolite of mycophenolate mofetil,
plasma concentration as an index of risk for the development of acute
rejection. The following are important experimentally-based reasons for
recommending the incorporation of target therapeutic concentration monitoring
of mycophenolic acid: (1) the MPA dose-interval
area-under-the-concentration-time curve, and less precisely, MPA predose
concentrations predict the risk for development of acute rejection; (2) the
strong correlation between mycophenolic acid plasma concentrations and
expression of important cell surface activation antigens, whole blood
pharmacodynamic assays of lymphocyte proliferation and median graft rejection
scores in a heart transplant animal model; (3) the greater than 10-fold
interindividual variation of MPA area under the concentration time curve values
in heart and renal transplant patients receiving a fixed dose of the parent
drug; (4) drug-drug interactions involving other immunosuppressives are such
that when switching from one to another (eg, from cyclosporine to tacrolimus or
vice-versa) substantial changes in MPA concentrations can occur in patients
receiving a fixed dose of the parent drug; (5) significant effects of liver and
kidney diseases on the steady-state total and free mycophenolic acid area under
the concentration time curve values; (6) the need to closely monitor
mycophenolic acid when a major change in immunosuppression is planned such as
steroid withdrawal. Current investigations are focused on determination of the
most optimal sampling time and for mycophenolic acid target therapeutic
concentration monitoring. Further investigations are needed to evaluate the
pharmacologic activity of the newly described acyl glucuronide metabolite of
mycophenolic acid which has been shown to inhibit, in vitro, inosine
monophosphate dehydrogenase. N.
Ref:: 37
----------------------------------------------------
[22]
TÍTULO / TITLE: - Capillary C4d
deposition as a marker of humoral immunity in renal allograft rejection.
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
Sep;13(9):2420-3.
AUTORES
/ AUTHORS: - Watschinger B; Pascual M N. Ref:: 38
----------------------------------------------------
[23]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.1 Differential diagnosis of chronic graft
dysfunction.
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 4:4-8.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Any significant
deterioration in graft function should be investigated using the appropriate
diagnostic tools and, if possible, therapeutic interventions should be
initiated. The usual causes of a decline in glomerular filtration rate after
the first year include transplant-specific causes such as chronic allograft
nephropathy, acute rejection episodes, chronic calcineurin inhibitor
nephrotoxicity, transplant renal artery stenosis and ureteric obstruction, as
well as immunodeficiency-related causes and non-transplant-related causes, such
as recurrent or de novo renal diseases and bacterial infections. B. Any new
onset and persistent proteinuria of >0.5 g/24 h should be investigated and
therapeutic interventions should be initiated. The usual causes include chronic
allograft nephropathy and transplant glomerulopathy, and recurrent or de novo
glomerulonephritis.
----------------------------------------------------
[24]
- Castellano -
TÍTULO / TITLE:Reporte preliminar. Utilidad de la
angiotomografia renal en el protocolo del donador renal. Preliminary report.
Usefulness of computed tomographic angiography in the protocol of a kidney
donor.
REVISTA
/ JOURNAL: - Cir Cir. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.medigraphic.com/
●●
Cita: Cirugia y Cirujanos: <> 2003 Sep-Oct;71(5):379-82.
AUTORES
/ AUTHORS: - Ramirez-Bollas J; Hernandez-Dominguez M;
Arenas-Osuna J; Romero-Huesca A; Albores-Zuniga O
INSTITUCIÓN
/ INSTITUTION: - Cirujano General, Hospital de Especialidades
del Centro Medico Nacional “La Raza,” IMSS, Mexico D.F., Mexico. juliobollas@yahoo.com.mx
RESUMEN
/ SUMMARY: - OBJECTIVE: To determine clinical
correlation of reports of computed tomographic angiography renal (CT-AR) and
surgical findings of the kidney donor patient. MATERIAL AND METHODS: Patients
were submitted nephrectomy in the related live donor renal transplant program
between January and December 2002 as paut of life to which he is made as he
CT-AR study protocol. Statistical analysis was carried out by descriptive
statistics. RESULTS: Anatomical characteristics of 35 kidneys of the same
number of live donors (AD) submitted CT-AR were evaluated and comparison with
report of surgical technique was made. Incidence of accessory renal arteries
was 23%. As reported by CT-AR, the were 39 renal arteries (91%) compared with
43 arteries found during surgery. CT-AR identified four supernumerary renal
arteries (50%) of eight identified during surgical technique; 36 hiliar
arteries (90%) and three polar arteries were identified by CT-AR (100%). Only
one a case report of early bifurcation of renal artery (20%) by CT-AR was
recorded. Anatomical characteristics of veins were described in their totality.
CT-AR is a useful instrument to identify alterations in anatomical structure of
the renal vasculature, with results similar to other studies for description of
renal arteries and veins. We propose ATR as the initial study for evaluation of
the renal architecture of the live kidney (LKD).
----------------------------------------------------
[25]
TÍTULO / TITLE: - The impact of
cytomegalovirus infections and acute rejection episodes on the development of
vascular changes in 6-month protocol biopsy specimens of cadaveric kidney
allograft recipients.
REVISTA
/ JOURNAL: - Transplantation 2003 Jun
15;75(11):1858-64.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000064709.20841.E1
AUTORES
/ AUTHORS: - Helantera I; Koskinen P; Tornroth T;
Loginov R; Gronhagen-Riska C; Lautenschlager I
INSTITUCIÓN
/ INSTITUTION: - Department of Virology, Helsinki
University Central Hospital and University of Helsinki, Helsinki, Finland.
RESUMEN
/ SUMMARY: - BACKGROUND: The role of cytomegalovirus
(CMV) in chronic kidney allograft rejection remains controversial. The purpose
of this study was to examine the impact of CMV infection on histopathologic
changes in 6-month protocol biopsy specimens of kidney allografts. METHODS:
Altogether, 52 renal allograft recipients were studied. CMV infection was diagnosed
by CMV antigenemia test, viral cultures from blood and urine, or both. CMV was
demonstrated in the biopsy specimens by antigen detection and hybridization in
situ. Acute rejections were diagnosed by biopsy histology, and biopsy specimens
were graded according to the Banff ‘97 classification. RESULTS: CMV infection
was diagnosed in 41 patients. The 11 patients in whom CMV infection was not
detected were used as controls. Acute rejection was diagnosed in 22 of 41 CMV
patients and in 6 of 11 control patients. CMV was demonstrated in the biopsy
specimens of 19 of 41 CMV patients. CMV was not associated with increased
glomerular, tubular, or interstitial changes. However, the arteriosclerotic
changes in small arterioles were significantly increased in the subgroup of
patients where CMV was demonstrated in the graft as compared with controls
(P<0.01). Analysis of the impact of acute rejection on arteriolar thickening
showed that only a positive history of both acute rejection and CMV found in
the graft was associated with significantly increased vascular changes compared
with CMV-free recipients (P<0.05). CONCLUSIONS: Neither CMV nor acute
rejection alone was associated with increased vascular or other histopathologic
changes in 6-month protocol biopsy specimens of kidney allografts, but a
previous history of both acute rejection and the presence of CMV in the graft
was associated with increased vascular changes.
----------------------------------------------------
[26]
TÍTULO / TITLE: - Transplant
capillaropathy and transplant glomerulopathy: ultrastructural markers of
chronic renal allograft rejection.
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 Apr;18(4):655-60.
AUTORES
/ AUTHORS: - Ivanyi B
INSTITUCIÓN
/ INSTITUTION: - Department of Pathology, University of
Szeged, Szeged, Hungary. ivanyi@patho.szote.u-szeged.hu N. Ref:: 21
----------------------------------------------------
[27]
TÍTULO / TITLE: - Adenovirus
pyelonephritis in a pediatric renal transplant patient.
REVISTA
/ JOURNAL: - Pediatr Nephrol 2003 May;18(5):457-61.
Epub 2003 Mar 18.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00467-003-1080-x
AUTORES
/ AUTHORS: - Kim SS; Hicks J; Goldstein SL
INSTITUCIÓN
/ INSTITUTION: - Baylor College of Medicine, Texas, USA.
RESUMEN
/ SUMMARY: - Gross hematuria, graft pain, and rising
serum creatinine are classic signs of acute rejection, obstruction, or
bacterial pyelonephritis for patients with renal transplants. This presentation
often prompts percutaneous renal allograft biopsy. If subsequent evaluation
fails to show evidence of acute rejection, obstruction, or bacterial infection,
viral etiologies should be considered. We report a 14-year-old Hispanic female
with a living-related renal transplant who had gross hematuria, graft
tenderness, and increased serum creatinine, but did not have evidence of acute
rejection, obstruction, or bacterial pyelonephritis. To our knowledge, this is
the first report of adenovirus pyelonephritis in a transplanted kidney of a
pediatric patient, with isolation of adenovirus in the urine and in the
allograft using immunocytochemical techniques.
N. Ref:: 26
----------------------------------------------------
[28]
TÍTULO / TITLE: - Treatment of renal
transplant ureterovesical anastomotic strictures using antegrade balloon
dilation with or without holmium:YAG laser endoureterotomy.
REVISTA
/ JOURNAL: - Urology 2003 Nov;62(5):831-4.
AUTORES
/ AUTHORS: - Kristo B; Phelan MW; Gritsch HA; Schulam
PG
INSTITUCIÓN
/ INSTITUTION: - Department of Urology, University of
California, Los Angeles, School of Medicine, Los Angeles, Medical Center, Los
Angeles, California 90095, USA.
RESUMEN / SUMMARY: - OBJECTIVES: To report our results after antegrade endoscopic treatment of ureteral stenosis with balloon dilation with or without holmium laser endoureterotomy. Ureteral stenosis is the most common long-term urologic complication of renal transplantation. METHODS: From July 2000 to October 2002, 9 renal transplant patients with ureteral obstruction diagnosed by an increase in serum creatinine and radiologic evidence presented for endoscopic treatment. All patients were treated with nephrostomy tube drainage followed by antegrade flexible nephroureteroscopy and balloon dilation of the stricture. Three patients required holmium laser endoureterotomy during the same procedure because of fluoroscopic and endoscopic evidence of persistent stricture. All patients were treated with ureteral stents and nephrostomy tubes postoperatively. The median follow-up was 24 months (range 6 to 32). RESULTS: The site of stenosis was at the ureterovesical anastomosis in all patients, and the mean stricture length was 0.28 cm. Two patients had previously undergone ureteroneocystostomy for prior ureteral stenosis. Six patients (66%) required only balloon dilation, and 3 patients (33%) also required holmium laser endoureterotomy. The median ureteral stent and nephrostomy tube duration was 40 and 62 days, respectively. The mean serum creatinine level was 2.3 mg/dL at presentation and 1.7 mg/dL at the last follow-up visit. After a median follow-up of 24 months, the ureteral patency and graft function rates were both 100%. No perioperative complications occurred. CONCLUSIONS: Balloon dilation with or without holmium laser endoureterotomy was successful and safe in this group of renal transplant patients with short ure