#07#
Revisiones-Clínica-Complicaciones
*** Reviews-Clinical-Complications
TRASPLANTE
RENAL *** RENAL TRANSPLANTATION
(Conceptos
/ Keywords: Renal-Kidney transplantation; Kidney donation-procurement; etc).
Enero /
January 2001 --- Marzo / March 2004
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[1]
TÍTULO / TITLE: - Strategies to improve
long-term outcomes after renal transplantation.
REVISTA
/ JOURNAL: - N Engl J Med. Acceso gratuito al texto
completo a partir de los 6 meses de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://content.nejm.org/
●●
Cita: New England J Medicine (NEJM): <> 2002 Feb 21;346(8):580-90.
●●
Enlace al texto completo (gratuito o de pago) 1056/NEJMra011295
AUTORES
/ AUTHORS: - Pascual M; Theruvath T; Kawai T;
Tolkoff-Rubin N; Cosimi AB
INSTITUCIÓN
/ INSTITUTION: - Renal Unit, Department of Medicine,
Massachusetts General Hospital, Boston, MA 02114, USA. mpascual@partners.org N. Ref:: 99
----------------------------------------------------
[2]
TÍTULO / TITLE: - Interleukin-2 receptor
monoclonal antibodies in renal transplantation: meta-analysis of randomised
trials.
REVISTA
/ JOURNAL: - British Medical J (BMJ). Acceso gratuito
al texto completo.
●●
Enlace a la Editora de la Revista http://bmj.com/search.dtl
●●
Cita: British Medical J. (BMJ): <> 2003 Apr 12;326(7393):789.
●●
Enlace al texto completo (gratuito o de pago) 1136/bmj.326.7393.789
AUTORES
/ AUTHORS: - Adu D; Cockwell P; Ives NJ; Shaw J;
Wheatley K
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Queen Elizabeth
Hospital, Birmingham, B15 2TH. dwomoa.adu@uhb.nhs.uk
RESUMEN
/ SUMMARY: - OBJECTIVE: To study the effect of
interleukin-2 receptor monoclonal antibodies on acute rejection episodes, graft
loss, deaths, and rate of infection and malignancy in patients with renal
transplants. DESIGN: Meta-analysis of published data. DATA SOURCES: Medline,
Embase, and Cochrane library for years 1996-2003 plus search of medical
editors’ trial amnesty and contact with manufacturers of the antibodies.
SELECTION OF STUDIES: Randomised controlled trials comparing interleukin-2
receptor antibodies with placebo or no additional treatment in patients with
renal transplants receiving ciclosporin based immunosuppression. RESULTS: Eight
randomised controlled trials involving 1871 patients met the selection criteria
(although only 1858 patients were analysed). Interleukin-2 receptor antibodies
significantly reduced the risk of acute rejection (odds ratio 0.51, 95%
confidence interval 0.42 to 0.63). There were no significant differences in the
rate of graft loss (0.78, 0.58 to 1.04), mortality (0.75, 0.46 to 1.23),
overall incidence of infections (0.97, 0.77 to 1.24), incidence of
cytomegalovirus infections (0.81, 0.62 to 1.04), or risk of malignancies at one
year (0.82, 0.39 to 1.70). The different antibodies had a similar sized effect
on acute rejection (test for heterogeneity P=0.7): anti-Tac (0.37, 0.16 to
0.89), BT563 (0.37, 0.1 to 1.38), basiliximab (0.56, 0.44 to 0.72), and
daclizumab (0.46, 0.32 to 0.67). The reduction in acute rejections was similar
for all ciclosporin based immunosuppression regimens (test for heterogeneity
P=1.0). CONCLUSIONS: Adding interleukin-2 receptor antibodies to ciclosporin
based immunosuppression reduces episodes of acute rejection at six months by
49%. There is no evidence of an increased risk of infective complications.
Longer follow up studies are needed to confirm whether interleukin-2 receptor
antibodies improve long term graft and patient survival.
----------------------------------------------------
[3]
TÍTULO / TITLE: - 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.
----------------------------------------------------
[4]
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
----------------------------------------------------
[5]
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
----------------------------------------------------
[6]
TÍTULO / TITLE: - Hemophagocytic syndrome
in renal transplant recipients: report of 17 cases and review of literature.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 27;77(2):238-43.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000107285.86939.37
AUTORES
/ AUTHORS: - Karras A; Thervet E; Legendre C
INSTITUCIÓN
/ INSTITUTION: - Service de Nephrologie et Transplantation
Renale, Hopital Saint-Louis, Paris, France.
RESUMEN
/ SUMMARY: - BACKGROUND: Hemophagocytic syndrome (HPS)
combines febrile hepatosplenomegaly, pancytopenia, hypofibrinemia, and liver
dysfunction. It is defined by bone marrow and organ infiltration by activated,
nonmalignant macrophages phagocytizing blood cells. HPS is often caused by an
infectious or neoplastic disease and has rarely been described in renal
transplant recipients. METHODS: We retrospectively analyzed 17 cases of HPS after
cadaveric renal transplantation (13 men and 4 women, age 41+/-8 years). The
median time between transplantation and hemophagocytosis was 52 days. Eleven
patients (64%) had received antilymphocyte globulins during the 3 months before
presentation. RESULTS: Fever was present in all patients, and
hepatosplenomegaly was present in 9 of 17 patients. Other nonspecific clinical
findings included abdominal, neurologic, and respiratory symptoms. Laboratory
tests showed anemia (hemoglobin 6.1+/-1.3 g/dL), thrombocytopenia
(34,000+/-32,000/mm3), and leukopenia (1,700+/-1,400/mm3). Elevated liver
enzymes were present in 12 of 17 patients, and cholestasis was present in 10 of
17 patients. Elevated triglycerides and ferritin were noted in 75% and 86% of
cases, respectively. HPS was related to viral infection in nine patients
(cytomegalovirus, Epstein-Barr virus, human herpesvirus 6, and human
herpesvirus 8), bacterial infection in three patients (tuberculosis and
Bartonella henselae), and other infections in two patients (toxoplasmosis and
Pneumocystis carinii pneumoniae). Posttransplant lymphoproliferative disease
was present in two patients. Despite large-spectrum anti-infectious treatment
and dramatic tapering of immunosuppression, death occurred in eight patients (47%).
Graft nephrectomy was performed in four of the nine surviving patients.
CONCLUSIONS: We report here the largest series of HPS after renal
transplantation. This rare disease is usually secondary to herpes viridae
infections, mostly cytomegalovirus and Epstein-Barr virus in severely
immunocompromised patients. Despite aggressive treatment, the prognosis remains
poor. N. Ref:: 22
----------------------------------------------------
[7]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.1. Cancer risk after renal transplantation.
Post-transplant lymphoproliferative disease (PTLD): prevention and treatment.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:31-3, 35-6.
RESUMEN
/ SUMMARY: - GUIDELINES: A. In the first year after
organ transplantation, recipients are at the greatest risk of developing
lymphoproliferative diseases (PTLDs), which are induced most often by
Epstein-Barr virus (EBV) infection, and patients should therefore be screened
prior to or at the time of transplantation for EBV antibodies. B. In the rare
cases (<5%) where the recipient is EBV seronegative, he or she has a 95%
likelihood of receiving an organ from an EBV-seropositive donor, which
translates into a high risk of primary EBV infection with seroconversion soon
after transplantation. In such cases, the recipient should receive a
prophylactic antiviral treatment with acyclovir, valacyclovir or ganciclovir,
starting at the time of transplant and lasting for at least 3 months. The
specific recommendations given for CMV prophylaxis could be applicable in this
situation. C. The treatment of PTLD should be based on accurate pathology with
extensive cell markers and phenotyping. The treatment modalities are as
follows. Reduction of basal immunosuppression in all cases (either maintain
only steroids, or decrease by at least 50% the anti-calcineurin drugs and stop
other immunosuppressive drugs). In the case of EBV-positive B-cell lymphoma, antiviral
treatment with acyclovir, valacyclovir or ganciclovir may be initiated for at
least 1 month or according to the blood level of EBV replication when
available. In the case of rare lymphomas from the mucosal-associated lymphoid
tissue (MALT) with positive Helicobacter pylori, full eradication of H. pylori
should be carried out with a validated protocol. Subsequent H. pylori
prophylaxis should be implemented to avoid relapse. In the case of
CD20-positive lymphomas, treatment with rituximab, a chimeric monoclonal
antibody directed against CD20, should be carried out with one i.v. injection
per week for 4 weeks. In the case of diffuse lymphomas or improper response to
previous treatment, CHOP chemotherapy should be used alone or in combination
with rituximab. The CHOP regimen is cyclophosphamide, doxorubicine, vincristine
and prednisone. Complete cessation of immunosuppression with or without graft
nephrectomy should also be considered.
----------------------------------------------------
[8]
- Castellano -
TÍTULO / TITLE:Riesgo cardiovascular en pacientes
con insuficiencia renal cronica. Pacientes en tratamiento sustitutivo renal.
Cardiovascular risk in patients with chronic renal failure. Patients in renal
replacement therapy.
REVISTA
/ JOURNAL: - Nefrologia. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/
●●
Cita: Nefrologia: <> 2002;22 Suppl 1:68-74.
AUTORES
/ AUTHORS: - Cases A; Vera M; Lopez Gomez JM
INSTITUCIÓN
/ INSTITUTION: - Servicio de Nefrologia, Unidad de
Hipertension Arterial, Hospital Clinic, IDIBAPS, Universidad de Barcelona,
Barcelona. acases@medicina.ub.es
RESUMEN
/ SUMMARY: - Dialysis patients constitute a high-risk
subset of patients for developing cardiovascular disease, which accounts for
nearly 50% of deaths. After stratification for age, race and gender,
cardiovascular mortality is 10-20 times higher in dialysis patients than in the
general population. Cardiovascular disease in this population cannot be fully
explained by the high prevalence of classical cardiovascular risk factors (age,
hypertension, diabetes, hyperlipidemia, smoking, etc.). Thus, the involvement
of “new” cardiovascular risk factors (hyperhomocysteinemia,
hyperfibrinogenemia, high lipoprotein (a) levels, oxidative stress,
inflammation, etc.), and uremia-related factors (anemia, impaired
calcium-phosphorus metabolism, hyperparathyroidism, accumulation of endogenous
inhibitors of nitric oxide synthesis, etc.) has been also invoked to play a
role in the increased cardiovascular risk in these patients. Endothelial
dysfunction is the initial event in the development of atherosclerosis. Uremic
patients exhibit an endothelial dysfunction, even before starting dialysis,
which persists o is even aggravated under dialysis treatment. Uremic patients
must be considered at high risk of developing cardiovascular disease. Thus
cardiovascular risk factors in these patients should be managed early,
aggressive and multifactorially in order to reduce their high cardiovascular
morbidity and mortality. N.
Ref:: 52
----------------------------------------------------
[9]
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.
----------------------------------------------------
[10]
TÍTULO / TITLE: - Treatment of
posttransplant hypertension: too little, too late?
REVISTA
/ JOURNAL: - Transplantation 2003 Dec 15;76(11):1645-6.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000091290.30262.96
AUTORES
/ AUTHORS: - Paul LC
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology, Leiden
University Medical Center, Leiden, The Netherlands. lcpaul@lumc.nl N. Ref:: 12
----------------------------------------------------
[11]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.3. Cancer risk after renal transplantation. Solid
organ cancers: prevention and treatment.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:32, 34-6.
RESUMEN
/ SUMMARY: - GUIDELINES: J. All renal transplant
recipients should have regular ultrasonography of their native kidneys (when
applicable) for screening of renal cell carcinomas, which are observed at much
higher incidence in both dialysed and transplant patients. K. Guidelines
published for screening and prevention of solid organ cancers in the general
population should be strictly applied to transplant recipients, who are in
general at higher cancer risk, but would benefit equally or even greater. L.
All male renal transplant recipients aged 50 and over should have a yearly
prostate specific antigen (PSA) test prior to a regular digital rectal
examination. M. All female renal transplant recipients should have a yearly
cervical (PAP) smear together with regular pelvic examination and regular mammography,
according to national recommendations where available. N. All renal transplant
recipients should undergo a faecal occult-blood testing as a screening for
colorectal cancer and other (pre-malignant) lesions, according to national
recommendations where available. O. In all these conditions, it is recommended
to reduce immunosuppression whenever possible.
----------------------------------------------------
[12]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.1. Cardiovascular risks. Cardiovascular disease
after renal transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:24-5.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Post-transplant cardiovascular
disease is very common, an important cause of morbidity and the first cause of
mortality in renal transplant recipients. Therefore, detection and early
treatment of post-transplant cardiovascular disease are mandatory. B. Specific
risk factors for developing post-transplant cardiovascular disease include
pre-transplant cardiovascular disease, arterial hypertension, uraemia (graft
dysfunction), hyperlipidaemia, diabetes mellitus, smoking and immunosuppressive
treatment. These factors should be targeted for intervention. C. Pre-transplant
cardiovascular disease is a major risk factor for post-transplant
cardiovascular disease. Therefore, prior to transplantation, it is mandatory to
detect and treat symptomatic coronary artery disease, heart failure due to
valvular failure or cardiomyopathy, and pericardial constriction. This policy
should also be followed in asymptomatic diabetic patients.
----------------------------------------------------
[13]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.6.2. Cancer risk after renal transplantation. Skin
cancers: prevention and treatment.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:31-6.
RESUMEN
/ SUMMARY: - GUIDELINES: D. Due to the high prevalence
of skin cancers after organ transplantation, it is highly recommended to inform
patients about self-awareness. E. Primary prevention should include the
avoidance of sun exposure, use of protective clothing and use of an effective
sunscreen (protection factor >15) for unclothed body parts (head, neck,
hands and arms) in order to prevent the occurrence of squamous-cell carcinoma.
This is the most frequent skin tumour in transplant recipients, and its
preferential location is the head. F. Recipients with pre-malignant skin
lesions (warts, epidermodysplasia verruciformis or actinic keratoses) should be
referred early to a dermatologist for active treatment and close follow-up. G.
All skin cancers should be completely removed by a dermatologist with
appropriate techniques, such as electro-desiccation with curettage, cryotherapy
or surgical excision. H. Secondary prevention for recipients should include
close follow-up by a dermatologist (at least every 6 months), the use of
topical retinoids to control actinic keratoses and to diminish squamous-cell
carcinoma recurrence, and reduction of immunosuppression whenever possible. I.
In recipients with multiple and/or recurrent skin cancers, the use of systemic
retinoids, such as low-dose acitretin, could be recommended for months/years,
if well tolerated, in addition to further reduction in immunosuppression
whenever possible.
----------------------------------------------------
[14]
TÍTULO / TITLE: - Multicentric papillary
renal carcinoma in renal allograft.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Aug;42(2):381-4.
AUTORES
/ AUTHORS: - DeLong MJ; Schmitt D; Scott KM; Ramakumar
S; Lien YH
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
Arizona Health Sciences Center, Tucson, AZ 85724, USA.
RESUMEN
/ SUMMARY: - A renal transplant recipient with 13 years
of excellent allograft function was found incidentally to have a malignant mass
in his transplanted kidney. After resection, pathological analysis showed 29
separate lesions of renal cell carcinoma. All tumors were confined within the
renal capsule. The majority of tumors (21 of 29 tumors) were chromophil
basophilic carcinoma with papillary architecture, 5 tumors were clear cell, 2
tumors were mixed cell type, and 1 tumor was chromophil eosinophilic papillary
carcinoma. These histological findings are similar to those reported in
hereditary papillary renal carcinoma. To our knowledge, this is the first case
of multicentric papillary renal carcinoma occurring in the renal allograft. We
speculate that the allograft in this case is predisposed to malignant changes
because of preexisting genetic mutations, as well as prolonged
immunosuppression. N.
Ref:: 13
----------------------------------------------------
[15]
TÍTULO / TITLE: - Review of solid-organ
transplantation in HIV-infected patients.
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 27;75(4):425-9.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000046943.35335.18
AUTORES
/ AUTHORS: - Roland ME; Stock PG
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, University of
California, San Francisco, California, USA. mroland@php.ucsf.edu N. Ref:: 47
----------------------------------------------------
[16]
TÍTULO / TITLE: - Subcutaneous black
fungus (phaeohyphomycosis) infection in renal transplant recipients:three
cases.
REVISTA
/ JOURNAL: - Transplantation 2004 Jan 15;77(1):140-2.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000107287.70512.E7
AUTORES
/ AUTHORS: - Yehia M; Thomas M; Pilmore H; Van Der
Merwe W; Dittmer I
INSTITUCIÓN
/ INSTITUTION: - Auckland Renal Transplant Group, Auckland
Hospital, Auckland, New Zealand. mahay@adhb.govt.nz
RESUMEN
/ SUMMARY: - We describe three cases of subcutaneous
phaeohyphomycosis developing in the lower limbs of renal transplant recipients
shortly after transplantation. Each case presented with dark-colored nodules
that subsequently ulcerated. Histopathologic examination revealed dematiaceous
fungal hyphae with a surrounding granulomatous reaction. The fungi were subsequently
identified as Alternaria alternatum in two cases and Phialophora richardsiae in
one case. In one case, the lesions resolved during a prolonged (6-month) course
of itraconazole without the requirement for surgical excision. In the other two
cases, combined medical and surgical treatment resulted in cure. A review of
the literature on phaeohyphomycosis is presented. N. Ref:: 11
----------------------------------------------------
[17]
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.
----------------------------------------------------
[18]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.4. Chronic graft dysfunction. De novo renal disease
after transplantation.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:15-6.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Acute pyelonephritis is
relatively frequent in the transplanted kidney and carries a risk of
septicaemia. The condition should be recognized and the patient should be
treated promptly in the hospital. B. After initiation of any drugs known to
induce the development of interstitial nephritis in the transplant patient, it
is recommended to monitor renal function and abnormalities in order to detect
any side effects rapidly. If interstitial nephritis is observed, it is
recommended to stop the offending drug, and to initiate appropriate treatment.
C. De novo membranous nephropathy should be considered in cases of proteinuria
and nephrotic syndrome after transplantation. Viral infection, such as HCV,
should be excluded. D. In the case of the development of graft dysfunction in a
transplant patient with Alport’s syndrome, one should consider additionally the
possibility of de novo anti-glomerular basement membrane (anti-GBM)
glomerulonephritis.
----------------------------------------------------
[19]
TÍTULO / TITLE: - The economic value of
valacyclovir prophylaxis in transplantation.
REVISTA
/ JOURNAL: - J Infect Dis. Acceso gratuito al texto
completo a partir de los 2 años de la publicación; - http://www.journals.uchicago.edu/
●●
Cita: J. of Infectious Diseases: <> 2002 Oct 15;186 Suppl 1:S116-22.
AUTORES
/ AUTHORS: - Squifflet JP; Legendre C
INSTITUCIÓN
/ INSTITUTION: - University Clinic Saint Luc, 1200
Brussels, Belgium. Jean-Paul.Squifflet@chir.ucl.ac.be
RESUMEN
/ SUMMARY: - Cytomegalovirus (CMV) infection and
disease, with its extensive direct and indirect consequences, adds considerably
to the cost of patient management in both solid organ and bone marrow
transplantation. Antiviral prophylaxis for CMV infection can offer cost
advantages over preemptive therapy and “wait-and-treat” approaches.
Valacyclovir has demonstrated efficacy for CMV prophylaxis in renal, heart, and
bone marrow transplantation and is cost-effective when compared with placebo in
renal transplant recipients at high risk of CMV infection. In reducing CMV
infection and disease, valacyclovir prophylaxis appears to be associated with
reductions in indirect effects of CMV (acute graft rejection, other opportunistic
infections) and, if these effects are considered, the potential exists for even
greater savings to be made with valacyclovir therapy. Benefits of valacyclovir
in transplantation extend beyond CMV to other herpesviruses and may be
increased in some clinical situations by prolonging prophylaxis beyond 3
months. N. Ref:: 32
----------------------------------------------------
[20]
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.
----------------------------------------------------
[21]
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
----------------------------------------------------
[22]
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
----------------------------------------------------
[23]
- 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
----------------------------------------------------
[24]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.8. Cardiovascular risks. Immunosuppressive therapy.
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 4:30-1.
RESUMEN
/ SUMMARY: - GUIDELINE: Immunosuppressive therapies,
especially corticosteroids and anticalcineurin inhibitors; contribute to the
prevalence of cardiovascular risk factors, such as arterial hypertension,
hyperlipidaemia and hyperglycaemia, and this effect is dose dependent.
Reduction of the dose, withdrawal and/or switching to another drug could be
useful to control these risk factors.
----------------------------------------------------
[25]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.6. Chronic graft dysfunction. Late recurrence of
other diseases.
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 4:18-9.
RESUMEN
/ SUMMARY: - GUIDELINES: A. In the rare case of
recurrent lupus nephritis, no particular treatment is recommended. Only in the
few patients with clinically evident flare up is a reinforcement of
immunosuppression recommended. B. Recurrence of Henoch-Schonlein purpura may
occur even in the absence of clinical signs and symptoms. The prognosis for the
graft may be severe, particularly in adults. C. In the case of recurrent
ANCA-associated renal or systemic vasculitis, it is recommended to reinforce
the immunosuppression with appropriate agents. D. Since diabetic nephropathy
recurs almost invariably after transplantation, strict control of diabetes and
hypertension, and the use of ACE inhibitors and/or angiotensin II receptor
antagonists are recommended in order to prevent or slow the risk of recurrence.
----------------------------------------------------
[26]
- Castellano -
TÍTULO / TITLE:Linfoma de prostata secundario en
paciente trasplantado renal. Secondary prostatic lymphoma in a kidney
transplant patient.
REVISTA
/ JOURNAL: - Actas Urol Esp. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aeu.es/actas/
●●
Cita: Actas Urológicas Españolas: <> 2002 Jun;26(6):429-31.
AUTORES
/ AUTHORS: - Mallen Mateo E; Trivez Boned MA; Garcia
Garcia MA; Sancho Serrano C; Allepuz Losa C; Rioja Sanz LA
INSTITUCIÓN
/ INSTITUTION: - Servicio de Urologia, Hospital
Universitario Miguel Servet, Zaragoza.
RESUMEN
/ SUMMARY: - Lymphoma involving the prostate is rare,
both as a primary and as a secondary presenting. Usually the prognosis remains
poor. The clinical presentation is similar to that of other lower urinary tract
obstructions, in fact prostatic lymphoma must be considered in patients with
these symptoms, particularly in patients with prior history of systemic lymphoma.
We report a case of a kidney transplantation in a male patient, diagnosis of
lymphoma non Hodgkin, with later recurrence in prostate. N. Ref:: 6
----------------------------------------------------
[27]
TÍTULO / TITLE: - Bone disease after
renal transplantation.
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 15;75(3):315-25.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000043926.74349.6D
AUTORES
/ AUTHORS: - Heaf JG
INSTITUCIÓN
/ INSTITUTION: - Department of Nephrology B, Copenhagen
University Hospital in Herlev, Denmark. heaf@dadlnet.dk
RESUMEN / SUMMARY: - Bone disease is common after renal transplantation. The main syndromes are bone loss with a consequent fracture rate of 3% per year, osteonecrosis of the hip, and bone pain. The causes of disease include preexisting uremic osteodystrophy (hyperparathyroidism, aluminum osteomalacia, beta2-associated amyloidosis, and diabetic osteopathy), postoperative glucocorticoid therapy, poor renal function, and ongoing hyperparathyroidism, as the result of either aut