#06#
Revisiones-Clínica-Pronóstico
*** Reviews-Clinical-Prognosis
TRASPLANTE
RENAL *** RENAL TRANSPLANTATION
(Conceptos
/ Keywords: Renal-Kidney transplantation; Kidney donation-procurement; etc).
Enero /
January 2001 --- Marzo / March 2004
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[1]
TÍTULO / TITLE: - Strategies to improve
long-term outcomes after renal transplantation.
REVISTA
/ JOURNAL: - N Engl J Med. Acceso gratuito al texto
completo a partir de los 6 meses de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://content.nejm.org/
●●
Cita: New England J Medicine (NEJM): <> 2002 Feb 21;346(8):580-90.
●●
Enlace al texto completo (gratuito o de pago) 1056/NEJMra011295
AUTORES
/ AUTHORS: - Pascual M; Theruvath T; Kawai T;
Tolkoff-Rubin N; Cosimi AB
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Department of Medicine,
Massachusetts General Hospital, Boston, MA 02114, USA. mpascual@partners.org N. Ref:: 99
----------------------------------------------------
[2]
TÍTULO / TITLE: - Clinical practice guidelines
for managing dyslipidemias in kidney transplant patients: a report from the
Managing Dyslipidemias in Chronic Kidney Disease Work Group of the National
Kidney Foundation Kidney Disease Outcomes Quality Initiative.
REVISTA
/ JOURNAL: - Am J Transplant 2004;4 Suppl 7:13-53.
●●
Enlace al texto completo (gratuito o de pago) 1111/j.1600-6135.2004.0355.x
AUTORES
/ AUTHORS: - Kasiske B; Cosio FG; Beto J; Bolton K;
Chavers BM; Grimm R Jr; Levin A; Masri B; Parekh R; Wanner C; Wheeler DC;
Wilson PW
RESUMEN
/ SUMMARY: - The incidence of cardiovascular disease
(CVD) is very high in patients with chronic kidney (CKD) disease and in kidney
transplant recipients. Indeed, available evidence for these patients suggests
that the 10-year cumulative risk of coronary heart disease is at least 20%, or
roughly equivalent to the risk seen in patients with previous CVD. Recently,
the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative
(K/DOQI) published guidelines for the diagnosis and treatment of dyslipidemias
in patients with CKD, including transplant patients. It was the conclusion of
this Work Group that the National Cholesterol Education Program Guidelines are
generally applicable to patients with CKD, but that there are significant
differences in the approach and treatment of dyslipidemias in patients with CKD
compared with the general population. In the present document we present the
guidelines generated by this workgroup as they apply to kidney transplant
recipients. Evidence from the general population indicates that treatment of
dyslipidemias reduces CVD, and evidence in kidney transplant patients suggests
that judicious treatment can be safe and effective in improving dyslipidemias.
Dyslipidemias are very common in CKD and in transplant patients. However, until
recently there have been no adequately powered, randomized, controlled trials
examining the effects of dyslipidemia treatment on CVD in patients with CKD.
Since completion of the K/DOQI guidelines on dyslipidemia in CKD, the results
of the Assessment of Lescol in Renal Transplantation (ALERT) Study have been
presented and published. Based on information from randomized trials conducted
in the general population and the single study conducted in kidney transplant
patients, these guidelines, which are a modified version of the K/DOQI
dyslipidemia guidelines, were developed to aid clinicians in the management of
dyslipidemias in kidney transplant patients. These guidelines are divided into
four sections. The first section (Introduction) provides the rationale for the
guidelines, and describes the target population, scope, intended users, and
methods. The second section presents guidelines on the assessment of
dyslipidemias (guidelines 1-3), while the third section offers guidelines for
the treatment of dyslipidemias (guidelines 4-5). The key guideline statements
are supported mainly by data from studies in the general population, but there
is an urgent need for additional studies in CKD and in transplant patients.
Therefore, the last section outlines recommendations for research.
----------------------------------------------------
[3]
TÍTULO / TITLE: - Prognostic value of
myocardial perfusion studies in patients with end-stage renal disease assessed
for kidney or kidney-pancreas transplantation: a meta-analysis.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Feb;14(2):431-9.
AUTORES
/ AUTHORS: - Rabbat CG; Treleaven DJ; Russell JD;
Ludwin D; Cook DJ
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of
Nephrology, McMaster University, Hamilton, Ontario, Canada. rabbatc@mcmaster.ca
RESUMEN
/ SUMMARY: - The prognostic utility of myocardial perfusion
studies (MPS) such as thallium scintigraphy and dobutamine stress
echocardiography (DSE) for stratifying cardiac risk among candidates for kidney
or kidney-pancreas transplantation is uncertain. This study is a meta-analysis
to determine the prognostic significance of MPS results on future myocardial
infarction (MI) and cardiac death (CD) in patients with end-stage renal disease
(ESRD) assessed for kidney or kidney-pancreas transplantation. MEDLINE was
searched using combinations of MeSH headings and text words for
transplantation, coronary artery disease, prognosis, end-stage renal disease,
and noninvasive cardiac testing (nuclear scintigraphy and DSE) for primary
studies. Studies were included if they reported MPS results and cardiac events
in patients assessed for kidney or kidney-pancreas transplantation.
Methodologic study quality and outcome data were independently abstracted in
duplicate by two researchers. The relative risks (RR) of MI and CD were
calculated using a random effects model. Twelve articles met all inclusion
criteria; 12 studies reported CD, and 9 reported MI. In eight studies, thallium
scintigraphy was used (four with pharmacologic stress, four with exercise
stress), whereas four used DSE. When compared with negative tests, positive tests
had a significantly increased RR of MI (2.73 [95% CI, 1.25 to 5.97]; P = 0.01)
and CD (2.92 [95% CI, 1.66 to 5.12]; P < 0.001). Subgroup analyses of
studies of diabetic patients indicated that positive tests were associated with
a RR of CD 3.95 (95% CI, 1.48 to 10.5; P = 0.006) and a RR of MI 2.68 (95% CI,
0.95 to 7.57; P = 0.06) when compared with negative tests. In studies
evaluating mixed populations of diabetic and nondiabetic patients, positive
tests were associated with a RR of CD 2.52 (95% CI, 1.25 to 5.08; P = 0.01) and
with a RR of MI 2.79 (95% CI, 0.85 to 9.21; P = 0.09) when compared with a
negative test. The presence of reversible defects was associated with an
increased risk of MI in diabetic patients and of CD in both subgroups; fixed defects
were associated with an increased risk of CD but not MI. It is concluded that
positive MPS are useful in identifying patients with significantly increased
risk of future MI and CD in both diabetic and nondiabetic ESRD patients.
----------------------------------------------------
[4]
TÍTULO / TITLE: - A randomized long-term
trial of tacrolimus/sirolimus versus tacrolimus/mycophenolate mofetil versus
cyclosporine (NEORAL)/sirolimus in renal transplantation. II. Survival,
function, and protocol compliance at 1 year.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):252-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000101495.22734.07
AUTORES
/ AUTHORS: - Ciancio G; Burke GW; Gaynor JJ; Mattiazzi
A; Roth D; Kupin W; Nicolas M; Ruiz P; Rosen A; Miller J
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, Division of
Transplantation, University of Miami School of Medicine, Miami, FL 33101, USA. gciancio@med.miami.edu
RESUMEN
/ SUMMARY: - BACKGROUND: In an attempt to reduce
chronic calcineurin inhibitor induced allograft nephropathy in first cadaver
and human leukocyte antigen non-identical living-donor renal transplantation,
sirolimus (Siro) or mycophenolate mofetil (MMF) was tested as adjunctive
therapy, with planned dose reductions of tacrolimus (Tacro) over the first year
postoperatively. Adjunctive Siro therapy with a similar dose reduction
algorithm for Neoral (Neo) was included for comparison. METHODS: The detailed
dose reduction plan (Tacro and Siro, group A; Tacro and MMF, group B; Neo and
Siro, group C) is described in our companion report in this issue of
Transplantation. The present report documents function, patient and graft
survival, protocol compliance, and adverse events. RESULTS: As mentioned (in
companion report), group demographics were similar. The present study shows no
significant differences in 1-year patient and graft survival but does show a
trend that points to more difficulties in group C by way of a rising slope of
serum creatinine concentration (P=0.02) and decreasing creatinine clearance
(P=0.04). There were more patients who discontinued the protocol plan in group
C. Thus far, no posttransplant lymphomas have appeared, and infectious
complications have not differed among the groups. However, a greater percentage
of patients in group C were placed on antihyperlipidemia therapy, with an
(unexpected) trend toward a higher incidence of posttransplant diabetes
mellitus in this group. Group A required fewer, and group B the fewest,
antihyperlipidemia therapeutic interventions (P<0.00001). CONCLUSIONS: This
1-year interim analysis of a long-term, prospective, randomized
renal-transplant study indicates that decreasing maintenance dosage of Tacro
with adjunctive Siro or MMF appears to point to improved long-term function,
with reasonably few adverse events.
----------------------------------------------------
[5]
TÍTULO / TITLE: - Treatment and outcome
of invasive bladder cancer in patients after renal transplantation.
REVISTA
/ JOURNAL: - J Urol 2004 Mar;171(3):1085-8.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.ju.0000110612.42382.0a
AUTORES
/ AUTHORS: - Master VA; Meng MV; Grossfeld GD; Koppie
TM; Hirose R; Carroll PR
INSTITUCIÓN
/ INSTITUTION: - Departments of Urology and Surgery,
University of California, San Francisco, California 94143, USA. vmaster@urol.ucsf.edu
RESUMEN
/ SUMMARY: - PURPOSE: Optimal management and clinical
outcome of bladder cancer in renal transplant recipients are not well-defined.
We analyzed single institution treatment strategies and outcomes of these
patients. MATERIALS AND METHODS: We retrospectively reviewed the University of
California, San Francisco transplant database which contains information on
6,288 renal transplants performed between 1964 and 2002. The United Network for
Organ Sharing database and Israel Penn International Transplant Tumor Registry
were also queried to characterize the global nature of bladder cancer in renal
transplant recipients. RESULTS: The United Network for Organ Sharing database
(1986 to 2001) contained information on 31 patients who were found to have
bladder cancer (0.024% prevalence) and the Israel Penn International Transplant
Tumor Registry (1967 to 2001) contained information on 135 patients
representing 0.84% of all reported malignancies. We identified 7 renal
transplant recipients with bladder cancer at our institution. Invasive
transitional cell carcinoma developed in 5 patients at a median of 2.8 years
after transplant. Three patients underwent uncomplicated radical cystectomy and
preservation of the renal allograft. Overall survival at 48 months was 60%.
CONCLUSIONS: Bladder cancer after renal transplantation is not common. For
patients who present with invasive disease, traditional extirpative surgery
should be considered. Moreover, the allograft is rarely the source of
transitional cell carcinoma and can be preserved. In our experience the cancer
and urinary outcomes compare favorably with nontransplant patient outcomes
after treatment. N.
Ref:: 21
----------------------------------------------------
[6]
TÍTULO / TITLE: - Routes to allograft
survival.
REVISTA
/ JOURNAL: - J Clin Invest. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.jci.org/
●●
Cita: J Clinical Investigation: <> 2001 Apr;107(7):797-8.
AUTORES
/ AUTHORS: - Bromberg JS; Murphy B
INSTITUCIÓN
/ INSTITUTION: - Recanati/Miller Transplant Institute,
Mount Sinai School of Medicine, New York, New York 10029, USA. jon.bromberg@mountsinai.org N. Ref:: 21
----------------------------------------------------
[7]
TÍTULO / TITLE: - The CHORUS
(Cerivastatin in Heart Outcomes in Renal Disease: Understanding Survival)
protocol: a double-blind, placebo-controlled trial in patients with esrd.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Jan;37(1 Suppl
2):S48-53.
AUTORES
/ AUTHORS: - Keane WF; Brenner BM; Mazzu A; Agro A
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Hennepin County
Medical Center, University of Minnesota Medical School, Minneapolis, MN, USA. g.macgregor@sghms.ac.uk
RESUMEN
/ SUMMARY: - The 3-hydroxy-3-methylglutaryl coenzyme A
reductase inhibitor (statin)-mediated lowering of serum cholesterol has been
associated with a significant reduction in cardiovascular morbidity and
mortality. Recent studies suggest that additional non-lipid lowering effects
(eg, endothelial stabilization, anti-inflammatory, antithrombogenic) may be
important in modulating their effectiveness. Dyslipidemia is common in
end-stage renal disease (ESRD), and hemodialysis patients have increased
cardiovascular morbidity and mortality. Cerivastatin, a new statin with
powerful low-density lipoprotein-cholesterol (LDL-C) lowering capabilities,
possesses some unique non-LDL-C-mediated properties that may contribute to a
reduction of coronary events in the patient with ESRD. The primary objective of
this multicenter multinational study of 1,054 hemodialysis patients is to
compare 2 years of treatment with cerivastatin (0.4 mg/d) versus placebo on the
composite clinical event rate of myocardial infarction, sudden cardiac death,
ischemic stroke, and the need for coronary arterial bypass graft (CABG) or
percutaneous transluminal coronary angioplasty (PTCA) procedures in these
patients. Changes in lipids, inflammatory proteins including heat stable
C-reactive protein (hsCRP), interleukin-6 (IL-6), oncostatin-M, intracellular
adhesion molecule-1 (ICAM-1) and monocyte-chemoattractant protein-1 (MCP-1), as
well as markers of cardiac muscle pathology, such as troponin I and troponin T,
will be assessed in a subset of patients. This study is the first of its kind
to assess the effect of a statin on the reduction of cardiovascular morbidity
and mortality in an incident hemodialysis population. It will determine whether
treatment with cerivastatin can effectively reduce the significant
cardiovascular morbidity and mortality.
----------------------------------------------------
[8]
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.
----------------------------------------------------
[9]
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
----------------------------------------------------
[10]
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.
----------------------------------------------------
[11]
TÍTULO / TITLE: - Renal function as a
predictor of long-term graft survival in renal transplant patients.
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 May;18 Suppl 1:i3-6.
AUTORES
/ AUTHORS: - First MR
INSTITUCIÓN
/ INSTITUTION: - Research and Development, Fujisawa
Healthcare, Inc., Deerfield, IL 60015, USA. roy_first@fujisawa.com
RESUMEN
/ SUMMARY: - Acute rejection is a major risk factor for
kidney graft failure. However, as acute rejection has been progressively
reduced by recent immunosuppressive regimens, other risk factors are becoming
increasingly important. Evidence is accumulating that early renal function
predicts long-term outcome. A recent registry survey of more than 100 000
kidney transplants found that 6- and 12-month serum creatinine levels, as well
as the change between 6 and 12 months, are strongly associated with long-term
graft survival. A survey of paediatric renal transplant recipients showed that
poor creatinine clearance (<50 ml/min) as early as 30 days post-transplant
predicted an annual rate of graft loss of 13% compared with <3% in patients
with 30-day clearance >50 ml/min. This association between early renal
function and long-term outcome was confirmed in multicentre studies. Renal
transplant recipients (n=572) with 6-month serum creatinine levels >1.5
mg/dl suffered 3-year graft loss of 19.3% compared with only 8.5% in patients with
levels <1.6 mg/dl (P<0.001). Significantly fewer patients receiving
tacrolimus had 12-month serum creatinine levels >1.5 mg/dl compared with
cyclosporin (42 versus 54%, P<0.05). Interestingly, a single-centre study
(n=436) found that while glomerular filtration rate (GFR) at 6 months
post-transplant had remained stable over the last decade, the rate of loss of
renal function had decreased. A lower rate of GFR loss was associated with
absence of rejection, use of mycophenolate mofetil rather than azathioprine and
use of tacrolimus rather than cyclosporin (P<0.01). In conclusion, early
measures of renal function allow identification of those patients at highest
risk of graft failure and provide an invaluable tool for improving outcomes by
tailored immunosuppression. The choice of such immunosuppression should be
guided not only by its ability to prevent rejection, but also by its impact on
renal function. N.
Ref:: 11
----------------------------------------------------
[12]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.1. Organization of follow-up of transplant patients
after the first year.
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 4:3-4.
RESUMEN
/ SUMMARY: - GUIDELINES: A. All renal transplant
recipients should undergo regular laboratory check-ups (at least every 2 or 3
months) and regular medical visits as out-patients (at least every 4-6 months)
after the first year post-transplant. B. All renal transplant recipients should
be seen at least once a year in the transplant centre where the transplantation
has been performed or referred to a closer transplant centre for a complete
annual evaluation.
----------------------------------------------------
[13]
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
----------------------------------------------------
[14]
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
----------------------------------------------------
[15]
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
----------------------------------------------------
[16]
- 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
----------------------------------------------------
[17]
TÍTULO / TITLE: - Early prognosis of the
development of renal chronic allograft rejection by gene expression profiling
of human protocol biopsies.
REVISTA
/ JOURNAL: - Transplantation 2003 Apr 27;75(8):1323-30.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000068481.98801.10
AUTORES
/ AUTHORS: - Scherer A; Krause A; Walker JR; Korn A;
Niese D; Raulf F
INSTITUCIÓN
/ INSTITUTION: - Novartis Institutes for BioMedical
Research/Transplantation, Novartis Pharma AG, Basel, Switzerland.
RESUMEN
/ SUMMARY: - BACKGROUND: Chronic allograft rejection
(CR) is the major cause of failure of long-term graft survival and is so far
irreversible. Early prognosis of CR by molecular markers before overt
histologic manifestation would be a valuable aid for the optimization of
treatment regimens and the design of clinical CR trials. Oligonucleotide
microarray-based approaches have proven to be useful for the diagnosis and
prognosis of a variety of diseases and were chosen for the unbiased
identification of prognostic biomarkers. METHODS: Renal allograft biopsies were
taken at month 6 posttransplantation (PT) from two groups who were, at that
time, healthy recipients: one group developed CR at month-12 PT, the other
group remained healthy. Gene expression profiles from the two groups at month-6
PT biopsies were analyzed to identify differentially expressed genes with
prognostic value for CR development at month 12. RESULTS: A set of 10 genes was
identified that showed differential expression profiles between the two patient
groups and had a complete separation of the 15% to 85% quantile range for each
individual gene. This set of genes was sufficient to allow the correct
prediction of the occurrence or nonoccurrence of CR in 15 of 17 (88%) patients
using cross-validation (occurrence for a patient was predicted on the basis of
the other patients’ data only). In addition, a correct prediction could be made
that a recipient with a normal biopsy 12 months PT developed CR within the
following 6 months. CONCLUSIONS: Identified expression patterns seem to be
highly prognostic of the development of renal CR.
----------------------------------------------------
[18]
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
----------------------------------------------------
[19]
TÍTULO / TITLE: - Current status of renal
transplantation. Patient evaluations and outcomes.
REVISTA
/ JOURNAL: - Urol Clin North Am 2001 Nov;28(4):677-86.
AUTORES
/ AUTHORS: - Barry JM
INSTITUCIÓN
/ INSTITUTION: - Division of Urology and Renal
Transplantation, Department of Surgery, Oregon Health Sciences University,
Portland, Oregon, USA.
RESUMEN
/ SUMMARY: - A systematic team approach to the
assessment of renal transplant candidates is one of several factors that have
resulted in improved kidney transplant and recipient survival rates, rates that
were only imagined 4 decades ago. N.
Ref:: 47
----------------------------------------------------
[20]
TÍTULO / TITLE: - Effects of
catecholamine application to brain-dead donors on graft survival in solid organ
transplantation.
REVISTA
/ JOURNAL: - Transplantation 2001 Aug 15;72(3):455-63.
AUTORES
/ AUTHORS: - Schnuelle P; Berger S; de Boer J; Persijn
G; van der Woude FJ
INSTITUCIÓN
/ INSTITUTION: - University Hospital Mannheim, Theodor
Kutzer Ufer 1-3, 68167 Mannheim, Germany. schnuell@rumms.uni-mannheim.de
RESUMEN
/ SUMMARY: - BACKGROUND: In a recent single-center
study, donor use of catecholamines was identified to reduce kidney allograft
rejection. This study investigates the effects of donor employment of
adrenergic agents on graft survival in a large data base, including liver and
heart transplants. METHODS: The study was based on the registry of the
Eurotransplant International Foundation including 2415 kidney, 755 liver, and
720 heart transplants performed between January 1 and December 31, 1993. A
total of 1742 donor record forms referring to the cadaveric donor activities in
1993 were systematically reviewed with regard to employment of adrenergic
agents. Catecholamine use was simply coded dichotomously and divided into three
strata according to zero, single, and combined application. Multivariate Cox
regression including age, gender, cause of brain death, cold ischemia,
HLA-mismatching, number of previous transplants, and urgency in liver
transplants was applied for statistical analysis. RESULTS: Donor employment of
catecholamines was associated with increased 4-year graft survival after kidney
transplantation (hazard ratio [HR], 0.85; 95% confidence interval [95% CI],
0.74-0.98). The benefit is conferred in a dose-dependent manner and compares in
quantitative terms with prospective HLA matching on class I and class II
antigens (HR, 0.90; 95% CI, 0.84-0.97). Use of norepinephrine was predictive of
initial nonfunction after heart transplantation (HR, 1.66; 95% CI, 1.14-2.43),
but did not compromise liver grafts (HR, 0.94; 95% CI, 0.67-1.32). CONCLUSIONS:
Optimizing the management of brain-dead organ donors, including the possibility
of selective administration of adrenergic agents, may provide a major benefit
on graft survival without adverse side effects for the recipients. Further
investigation on best use of adrenergic drugs, optimum dosage, and duration is
warranted.
----------------------------------------------------
[21]
TÍTULO / TITLE: - Are peritoneal dialysis
patients with and without residual renal function equivalent for survival
study? Insight from a retrospective review of the cause of death.
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 May;18(5):977-82.
AUTORES
/ AUTHORS: - Szeto CC; Wong TY; Chow KM; Leung CB; Li
PK
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Prince of Wales
Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China. ccszeto@cuhk.edu.hk
RESUMEN
/ SUMMARY: - BACKGROUND: It remains unknown whether
results of survival studies in anuric patients can be extrapolated to those who
still have significant urine output. It is possible that after a prolonged
period on dialysis, anuric patients are qualitatively different from patients
with residual renal function. METHODS: We performed a retrospective review to
study the cause of death of 296 peritoneal dialysis patients of our centre over
a 7 year period, and compared the mortality and distribution of cause of death
between patients with and without residual renal function. RESULTS: One hundred
and forty-two cases (48.0%) died of vascular diseases, 82 cases (27.7%) died of
infections and 72 cases (24.3%) died of other causes. Anuric patients had a
higher overall mortality rate than non-anuric patients (14.9 vs 9.9%,
P=0.0005), and the difference was almost completely attributed to the
difference in mortality from vascular diseases (8.0 vs 4.1%, P<0.0001).
Vascular disease was a more common cause of death in anuric patients than those
with residual renal function (55.3 vs 40.8%, P=0.011). The difference was
largely explained by the higher prevalence of sudden cardiac death in anuric
patients (39 in 149 vs 19 in 147 cases). Patients without pre-existing
cardiovascular disease more commonly died of vascular disease after they became
anuric (47.4 vs 34.0%, P=0.017). The difference could not be explained by the
longer duration of dialysis in anuric patients because there was no significant
change in the distribution of cause of death with time on dialysis (chi-square
test, P=0.341). CONCLUSIONS: Our observation suggests that peritoneal dialysis
patients with and without residual renal function are qualitatively different.
Studies on peritoneal dialysis adequacy and survival in anuric patients should
only be extrapolated to the general dialysis population with caution.
----------------------------------------------------
[22]
TÍTULO / TITLE: - Kidney transplantation
from living-unrelated donors: comparison of outcome with living-related and
cadaveric transplants under current immunosuppressive protocols.
REVISTA
/ JOURNAL: - Urology 2003 Dec;62(6):1002-6.
AUTORES
/ AUTHORS: - Chkhotua AB; Klein T; Shabtai E; Yussim A;
Bar-Nathan N; Shaharabani E; Lustig S; Mor E
INSTITUCIÓN
/ INSTITUTION: - National Centre of Urology, Tbilisi,
Georgia.
RESUMEN
/ SUMMARY: - OBJECTIVES: Living-unrelated donors may
become an additional organ source for patients on the kidney waiting list. We
studied the impact of a combination of calcineurin inhibitors and
mycophenolate-mofetil together with steroids on the outcomes of living-related
(LRD), unrelated (LUR), and cadaver transplantation. METHODS: Between September
1997 and January 2000, 129 patients underwent LRD (n = 80) or LUR (n = 49)
kidney transplantation, and another 173 patients received a cadaveric kidney.
Immunosuppressive protocols consisted of mycophenolate-mofetil with
cyclosporine-Neoral (41%) or tacrolimus (59%) plus steroids. We compared the
patient and graft survival data, rejection rate, and graft functional parameters.
RESULTS: LRD recipients were younger (33.6 years) than LUR (47.8 years) and
cadaver (43.7 years) donor recipients (P <0.001). HLA matching was higher in
LRD patients (P <0.001). Acute rejection developed in 28.6% of LUR versus
27.5% of LRD transplants and 29.7% of cadaver kidney recipients (P = not
significant). The creatinine level at 1, 2, and 3 years after transplant was
1.63, 1.73, and 1.70 mg% for LRD patients; 1.48, 1.48, and 1.32 mg% for LUR
patients; and 1.75, 1.68, and 1.67 mg% for cadaver kidney recipients (P = not
significant), respectively. No difference in patient survival rates was found
among the groups. The 1, 2, and 3-year graft survival rates were significantly
better in recipients of LRD (91.3%, 90.0%, and 87.5%, respectively) and LUR
transplants (89.8%, 87.8%, and 87.8%, respectively) than in cadaver kidney
recipients (81.5%, 78.6%, 76.3%, respectively; P <0.01). CONCLUSIONS:
Despite HLA disparity, the rejection and survival rates of LUR transplants
under current immunosuppressive protocols are comparable to those of LRD and
better than those of cadaveric transplants.
----------------------------------------------------
[23]
TÍTULO / TITLE: - Ambulatory blood
pressure after renal transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2001;16 Suppl 1:110-3.
AUTORES
/ AUTHORS: - Fernandez-Vega F; Tejada F; Baltar J;
Laures A; Gomez E; Alvarez J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia 1, Hospital Central
de Asturias, C/Celestino Villamil s/n, 33006 Oviedo, España.
RESUMEN
/ SUMMARY: - Renal transplantation has been a usual
medical practice in developed countries for several decades. A large number of
studies report the excellent results obtained with such a practice. The
survival of the graft, although able to be improved, is excellent and gives a
great deal of hope to patients with renal insufficiency. The high level of
investigation into immunosuppressor drugs offers, almost continuously, more
efficient and better tolerated products. Paradoxically, the usual problems of
patients with a renal transplant are not immunological but cardiovascular.
Elevated serum cholesterol levels, obesity, diabetes and other cardiovascular
risk factors (CVRFs) are usual in these patients, arterial hypertension (AHT)
being the most frequent. Nephrologists are increasingly using ambulatory blood
pressure monitoring (ABPM) on a daily basis. In the last 10 years, we have
obtained highly valuable and interesting results with this technique which have
allowed us to study and understand with greater precision the relationship of
AHT to the kidney. Here we analyse and review the most relevant aspects of ABPM
in the different stages of kidney disease, with special emphasis on renal
transplantation. N.
Ref:: 40
----------------------------------------------------
[24]
TÍTULO / TITLE: - Preparing the patient
for renal replacement therapy. Teamwork optimizes outcomes.
REVISTA
/ JOURNAL: - Postgrad Med. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.postgradmed.com/journal.htm
●●
Cita: Postgraduate Medicine: <> 2002 Jun;111(6):97-8, 101-4, 107-8.
AUTORES
/ AUTHORS: - Bolton WK; Owen WF Jr
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, University of
Virginia School of Medicine, PO Box 800133, Charlottesville, VA 22908, USA. wkb5s@virginia.edu
RESUMEN
/ SUMMARY: - Proper preparation of a patient with CKD
for the development of ESRD and the need for RRT is essential to optimize the
patient’s quality and quantity of life and to help ensure positive economic and
societal outcomes. A collaborative team approach involving the primary care
physician team, the patient and his or her family and friends, and the nephrology
team should result in improved care of the CKD patient and improved outcomes.
It is not possible, feasible, or practical to attempt to provide the inclusive
care necessary to attain these goals in a system that does not take advantage
of the strengths of a team approach. Adopting this concept of care for patients
with kidney disease results in a win-win situation for all of the
participants—the patients, the physicians, and society. N. Ref:: 17
----------------------------------------------------
[25]
TÍTULO / TITLE: - Loss of living donor
renal allograft survival advantage in children with focal segmental
glomerulosclerosis.
REVISTA
/ JOURNAL: - Kidney Int 2001 Jan;59(1):328-33.
AUTORES
/ AUTHORS: - Baum MA; Stablein DM; Panzarino VM; Tejani
A; Harmon WE; Alexander SR
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Children’s
Hospital, Harvard Medical School, Boston, Massachusetts, USA.
RESUMEN / SUMMARY: - BACKGROUND: Because of concerns of increased risk of graft loss with recurrent disease, living donor (LD) transplantation in children with focal segmental glomerulosclerosis (FSGS) has been controversial. METHODS: The North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) database from January 1987 to January 2000 was examined to determine differences in demographics, treatment, and outcomes in children with FSGS compared with other renal diseases. RESULTS: Data on 6484 children, 752 (11.6%) with FSGS, demonstrated that FSGS patients were more likely to be older and black, and were less likely to receive either pre-emptive or LD transplant (P < 0.001). No differences existed in human lymphocyte antigen (HLA) matching or immunosuppression regimens. Acute tubular necrosis occurred in more FSGS patients following LD (11.8 vs. 4.6%) or cadaveric (CD; 27.9 vs. 16.3%) transplants (P < 0.001). Graf