#14#
Revisiones-Ciencias
Sociales (todas) *** Reviews-Social Sciences (all)
TRASPLANTE
RENAL *** RENAL TRANSPLANTATION
(Conceptos
/ Keywords: Renal-Kidney transplantation; Kidney donation-procurement; etc).
Enero /
January 2001 --- Marzo / March 2004
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[1]
TÍTULO / TITLE: - Renal physicians
association clinical practice guideline: appropriate patient preparation for
renal replacement therapy: guideline number 3.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
May;14(5):1406-10.
AUTORES
/ AUTHORS: - Bolton WK
INSTITUCIÓN
/ INSTITUTION: - University of Virginia School of Medicine,
Charlottesville, Virginia. rpa@renalmd.org
----------------------------------------------------
[2]
TÍTULO / TITLE: - Dialysis, kidney
transplantation, or pancreas transplantation for patients with diabetes
mellitus and renal failure: a decision analysis of treatment options.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Feb;14(2):500-15.
AUTORES
/ AUTHORS: - Knoll GA; Nichol G
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Department of
Medicine, University of Ottawa, Canada. gknoll@ottawahospital.on.ca
RESUMEN
/ SUMMARY: - Patients with type 1 diabetes mellitus and
end-stage renal disease may remain on dialysis or undergo cadaveric kidney
transplantation, living kidney transplantation, sequential pancreas after
living kidney transplantation, or simultaneous pancreas-kidney transplantation.
It is unclear which of these options is most effective. The objective of this
study was to determine the optimal treatment strategy for type 1 diabetic
patients with renal failure using a decision analytic Markov model. Input data
were obtained from the published medical literature, the United Network for
Organ Sharing registry, and patient interviews. The outcome measures were life
expectancy (in life-years [LY]) and quality-adjusted life expectancy (in
quality-adjusted life-years [QALY]). Living kidney transplantation was
associated with 18.30 LY and 10.29 QALY; pancreas after kidney transplantation,
17.21 LY and 10.00 QALY; simultaneous pancreas-kidney transplantation, 15.74 LY
and 9.09 QALY; cadaveric kidney transplantation, 11.44 LY and 6.53 QALY;
dialysis, 7.82 LY and 4.52 QALY. The results were sensitive to the value of
several key variables. Simultaneous pancreas-kidney transplantation had the
greatest life expectancy and quality-adjusted life expectancy when living
kidney transplantation was excluded from the analysis. These data indicate that
living kidney transplantation is associated with the greatest life expectancy
and quality-adjusted life expectancy for type 1 diabetic patients with renal
failure. Treatment strategies involving pancreas transplantation should be
considered for patients with frequent metabolic complications of diabetes and
for those patients who favor kidney-pancreas transplantation over kidney
transplantation alone. For patients without a living donor, simultaneous
pancreas-kidney transplantation is associated with the greatest life expectancy.
----------------------------------------------------
[3]
TÍTULO / TITLE: - Management of the
waiting list for cadaveric kidney transplants: report of a survey and
recommendations by the Clinical Practice Guidelines Committee of the American
Society of Transplantation.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2002
Feb;13(2):528-35.
AUTORES
/ AUTHORS: - Danovitch GM; Hariharan S; Pirsch JD; Rush
D; Roth D; Ramos E; Starling RC; Cangro C; Weir MR
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, University of
California, Los Angeles, School of Medicine, Los Angeles, California 90025,
USA. gdanovitch@mednet.ucla.edu
RESUMEN
/ SUMMARY: - The Clinical Practice Guidelines Committee
of the American Society of Transplantation developed a survey to review the
policies of kidney transplant programs in the United States with respect to the
management of the steadily expanding waiting list for cadaveric kidneys. The
survey was sent to 287 centers, and 192 (67%) responded. The survey indicated
that regular follow-up monitoring, most frequently on an annual basis, is
required by the majority (71%) of programs. Patients considered to be at high
risk and candidates for combined kidney-pancreas transplantation may be
monitored more frequently. Annual screening for coronary artery disease is
typically required for asymptomatic patients considered to be at high risk for
covert disease. Noninvasive techniques are typically used, and a designated
cardiologist is usually available to the transplant program. The dialysis
nephrologist or the potential transplant recipient is expected to inform the
transplant program of intercurrent events that may affect transplant candidacy.
Standard health maintenance screening is required, together with the routine
updating of serologic and other blood tests that may be relevant to the
posttransplant course. Smaller transplant programs (<100 patients on the
waiting list) are more likely to maintain closer contact with the wait-listed
patients and to attempt to influence their treatment during dialysis and are
less likely to cancel transplants because of unanticipated pretransplant
medical problems. The work load necessitated by the follow-up monitoring of
wait-listed patients was assessed and, in the absence of specific
evidence-based information, a series of recommendations were developed to
reflect current standards of practice and to suggest future research
initiatives.
----------------------------------------------------
[4]
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
----------------------------------------------------
[5]
TÍTULO / TITLE: - Costs and consequences
of cytomegalovirus disease.
REVISTA
/ JOURNAL: - Am J Health Syst Pharm 2003 Dec 1;60(23
Suppl 8):S5-8.
AUTORES
/ AUTHORS: - Schnitzler MA
INSTITUCIÓN
/ INSTITUTION: - Washington University, 4547 Clayton
Avenue, Box 8084, St. Louis, MO 63110, USA. schnitz@wueconc.edu
RESUMEN
/ SUMMARY: - The impact of prophylactic oral
ganciclovir therapy on the incidence of cytomegalovirus (CMV) disease, patient
and graft survival, and costs in patients receiving kidney and liver
transplants is described. CMV disease is a common cause of morbidity and
mortality in solid organ transplant recipients unless prophylactic drug therapy
is used. Prophylactic oral ganciclovir therapy reduces the incidence of CMV
disease in kidney and liver transplant recipients. It is more effective for
recipients who are seronegative before the transplant and receive organs from
seronegative (D-/R-) donors than in seronegative recipients of organs from
seropositive (D+/R-) donors. CMV disease remains a problem in the latter. CMV
disease increases the risk of graft failure, which decreases the likelihood of
patient survival. The extent of matching of the DR subregion of the human
leukocyte antigen complex in the donor and recipient may affect graft survival
in patients with CMV disease. Graft failure is costly and should be considered
in economic analyses of CMV prophylaxis regimens because of the potential
impact of prophylaxis on CMV disease. The use of oral ganciclovir for CMV
prophylaxis has reduced the incidence of CMV disease in kidney and liver
transplant recipients. N.
Ref:: 10
----------------------------------------------------
[6]
TÍTULO / TITLE: - Health economic
evaluations: the special case of end-stage renal disease treatment.
REVISTA
/ JOURNAL: - Med Decis Making 2002
Sep-Oct;22(5):417-30.
AUTORES
/ AUTHORS: - Winkelmayer WC; Weinstein MC; Mittleman
MA; Glynn RJ; Pliskin JS
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Brigham and
Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. wolfgang@post.harvard.edu
RESUMEN
/ SUMMARY: - This article synthesizes the evidence on
the cost-effectiveness of renal replacement therapy and discusses the findings
in light of the frequent practice of using the cost-effectiveness of
hemodialysis as a benchmark of societal willingness to pay. The authors
conducted a meta-analytic review of the medical and economic literature for
economic evaluations of hemodialysis, peritoneal dialysis, and kidney
transplantation. Cost-effectiveness ratios were translated into 2000 U.S.
dollars per life-year (LY) saved. Thirteen studies published between 1968 and
1998 provided such information. The cost effectiveness of center hemodialysis
remained within a narrow range of $55,000 to $80,000/LY in most studies despite
considerable variation in methodology and imputed costs. The cost-effectiveness
of home hemodialysis was found to be between $33,000 and $50,000/LY. Kidney
transplantation, however, has become more cost-effective over time, approaching
$10,000/LY. Estimates of the cost per life-year gained from hemodialysis have
been remarkably stable over the past 3 decades, after adjusting for price
levels. Uses of the cost-effectiveness ratio of $55,000/LY for center
hemodialysis as a lower boundary of society’s willingness to pay for an additional
life-year can be supported under certain assumptions.
----------------------------------------------------
[7]
TÍTULO / TITLE: - The spectrum of kidney
disease in American Indians.
REVISTA
/ JOURNAL: - Kidney Int Suppl 2003 Feb;(83):S3-7.
AUTORES
/ AUTHORS: - Narva AS
INSTITUCIÓN
/ INSTITUTION: - Indian Health Service Kidney Disease
Program, Albuquerque, New Mexico, USA. anarva@abq.ihs.gov
RESUMEN
/ SUMMARY: - American Indians and Alaska Natives (AI/AN)
experience high rates of chronic kidney disease. Several studies have
demonstrated increased rates of early kidney disease among AI/AN, both in
diabetics and non-diabetics. Among some tribes of the American Southwest, high
rates of mesangiopathic glomerulonephritis have been documented. The epidemic
of diabetes among AI/AN, which began in the middle of the 20th
century, appears to be driving the increase in end-stage renal disease (ESRD).
At the end of 1999, AI/AN had a national prevalence rate of treated ESRD that
was 3.5 times greater than that of white Americans. There is significant
regional variation as well as differences among the approximately 550 tribes
that make up the American Indian community, with some tribes experiencing ESRD
rates over twenty times the rate of whites. Although graft survival is
excellent, AI/AN ESRD patients are less likely than whites to be placed on the
transplant waiting list, and those listed wait longer for a transplant. Despite
socioeconomic barriers and high rates of co-morbid illness, survival among
AI/AN ESRD patients is better than among whites. The burden of kidney disease,
particularly the multigenerational occurrence in some families, is perceived as
a major threat to the well-being of native communities. There is a sense of
urgency among tribal leaders to address this epidemic, and research that may
decrease its burden is likely to be welcomed.
N. Ref:: 13
----------------------------------------------------
[8]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.5.6. Cardiovascular risks. Smoking.
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 4:29.
RESUMEN
/ SUMMARY: - GUIDELINE: Cigarette smoking is associated
with a high frequency of post-transplant cardiovascular disease and may
adversely influence patient and graft survival. Active measures against tobacco
smoking are recommended.
----------------------------------------------------
[9]
TÍTULO / TITLE: - Peritoneal dialysis
should be the first choice of initial renal replacement therapy for more
patients with end-stage renal disease.
REVISTA
/ JOURNAL: - ASAIO J 2001 Jul-Aug;47(4):309-11.
AUTORES
/ AUTHORS: - Mehrotra R; Nolph KD N. Ref:: 30
----------------------------------------------------
[10]
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.
----------------------------------------------------
[11]
TÍTULO / TITLE: - Why study kidney
transplant risk factors?
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 15;75(3):266-7.
AUTORES
/ AUTHORS: - Matas AJ; Humar A
INSTITUCIÓN
/ INSTITUTION: - Medical School, University of Minnesota,
Minneapolis, MN, USA. N.
Ref:: 10
----------------------------------------------------
[12]
TÍTULO / TITLE: - Quality of life after
kidney and pancreas transplantation: a review.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2003 Sep;42(3):431-45.
AUTORES
/ AUTHORS: - Joseph JT; Baines LS; Morris MC; Jindal RM
INSTITUCIÓN
/ INSTITUTION: - Royal Bournemouth Hospital, Bournemouth,
UK.
RESUMEN
/ SUMMARY: - There is an increasing amount of data on
quality of life (QOL) in most chronic illnesses; some of the instruments used
are generic, but recently, there is a tendency to use disease-specific
instruments. We propose that recipients of organ transplants be assessed
routinely for QOL by means of the 36-Item Short-Form Health Survey or a
disease-specific instrument; for compliance, by means of the Long-Term
Medication Behavior Self-Efficacy Scale; and for psychological status, by means
of the Beck Depression Inventory Brief Symptom Inventory or the Symptom
Checklist. The widespread use of QOL data in recipients of organ transplants
will increase accountability of service providers and eventually increase patient
satisfaction because these instruments are patient reported. N. Ref:: 92
----------------------------------------------------
[13]
TÍTULO / TITLE: - Hormone replacement
therapy in postmenopausal women with end-stage renal disease: a review of the issues.
REVISTA
/ JOURNAL: - Semin Dial 2001 May-Jun;14(3):146-9.
AUTORES
/ AUTHORS: - Holley JL; Schmidt RJ
RESUMEN
/ SUMMARY: - Hormone replacement is an integral part of
therapies to prevent osteoporosis in postmenopausal women and may be considered
a component in the treatment of dyslipidemia, cardiovascular disease, and
possibly cognitive function. The indications for, and efficacy and prescription
of, hormone replacement therapy in postmenopausal women with ESRD have been
infrequently studied and less than 10% of postmenopausal women on dialysis are
receiving hormone replacement. Small studies suggest that hormone replacement
therapy is valuable in treating the dyslipidemia of women on dialysis, but
indicate that a reduction in the dosage of hormone replacement may be needed. A
potential role for hormone replacement therapy in the treatment and/or
prevention of osteoporosis and sexual dysfunction in postmenopausal women on
dialysis exists as well. N.
Ref:: 33
----------------------------------------------------
[14]
TÍTULO / TITLE: - Nonheart-beating kidney
donation: current practice and future developments.
REVISTA
/ JOURNAL: - Kidney Int 2003 Apr;63(4):1516-29.
AUTORES
/ AUTHORS: - Brook NR; Waller JR; Nicholson ML
INSTITUCIÓN
/ INSTITUTION: - Division of Transplant Surgery, The
Department of Surgery, University of Leicester, Leicester General Hospital,
Leicester, United Kingdom. nicholasbrook@gfastmail.fm
RESUMEN
/ SUMMARY: - BACKGROUND: Nonheart-beating kidney
donation (NHBD) is gaining acceptance as a method of donor pool expansion.
However, a number of practitioners have concerns over rates of delayed graft
function, acute rejection, and long-term graft survival. The ethical issues
associated with NHBD are complex and may be a further disincentive. Tailored
strategies for preservation, viability prediction, and immunosuppression for
kidneys from this source have the potential to maximize the number of available
organs. This review article presents the current practice of NHBD kidney
transplantation, examines the results and draws comparisons with cadaveric
kidneys, and explores some areas of potential development. METHODS: A review of
the current literature on NHBD kidney donation was performed. RESULTS: The
renewed interest in NHBD kidneys is driven by a continuing shortfall in
available organs. Those centers involved in NHBD report an increase in kidney
transplants of the order of 16% to 40% and there is no evidence that the
financial costs are higher with NHBDs. The majority of experience comes from
Maastricht category 2 NHBDs, where an estimation of warm time is possible. This
is generally limited to 40 minutes. There are variations in the technique for
kidney preservation prior to retrieval, but most centers use an aortic balloon
catheter. Much work has looked at the ideal technique for kidney preservation
prior to implantation. Evidence suggests that machine perfusion produces the
best initial function rates, decreased use of adjuvant immunotherapy and fewer
haemodialysis sessions than static cold storage. CONCLUSION: Despite being
associated with poorer initial graft function, the long-term allograft survival
of NHBD kidneys does not differ from the results of transplantation from cadaveric
kidneys. Further, serum creatinine levels are generally equivalent. Constant
reassessment of the ethical issues is required for donation to be increased
while respecting public concerns. Use of viability assessment and tailoring of
immune suppression for NHBD kidneys may allow a further increase in donation
from this source. N.
Ref:: 132
----------------------------------------------------
[15]
TÍTULO / TITLE: - Proposed guidelines for
re-evaluation of patients on the waiting list for renal cadaver transplantation.
REVISTA
/ JOURNAL: - Transplantation 2002 Mar 15;73(5):811-2.
AUTORES
/ AUTHORS: - Matas AJ; Kasiske B; Miller L
INSTITUCIÓN
/ INSTITUTION: - Department of Surgery, University of
Minnesota, Minneapolis, MN 55455, USA.
RESUMEN
/ SUMMARY: - Transplant candidates are extensively
evaluated before being wait-listed for cadaver transplantation. Yet many wait a
number of years before being transplanted. We propose guidelines for regular
cardiac re-evaluation for patients on the waiting list.
----------------------------------------------------
[16]
TÍTULO / TITLE: - Random sample (DOPPS)
versus census-based (registry) approaches to kidney disease research.
REVISTA
/ JOURNAL: - Blood Purif 2003;21(1):85-8.
AUTORES
/ AUTHORS: - Port FK; Wolfe RA; Held PJ; Young EW
INSTITUCIÓN
/ INSTITUTION: - University of Renal Research and Education
Association (URREA), Ann Arbor, Mich, USA. fport@urrea.org
RESUMEN
/ SUMMARY: - This review describes advantages and limitations
of registries that base their analyses on the census of all patients.
Registries may utilize the random sample approach to enrich their data for more
detailed and informative research. The Dialysis Outcomes and Practice Pattern
Study (DOPPS) and its random sample approach is discussed here in detail, with
examples on the value of this method. The DOPPS is currently being expanded to
allow for even more valuable studies. This methodology can also be applied to
large countries that do not have an existing registry, as it is an effective
way of collecting detailed information at a relatively low cost that is
representative of the country or population as a whole. N. Ref:: 12
----------------------------------------------------
[17]
TÍTULO / TITLE: - Clinical audit and
long-term evaluation of renal transplant recipients.
REVISTA
/ JOURNAL: - Transplantation 2001 Dec 27;72(12
Suppl):S94-8.
AUTORES
/ AUTHORS: - Short CD; Russell S; Valentine A
RESUMEN
/ SUMMARY: - Renal transplant recipients now have an
increased life expectancy, and this has highlighted the need for increased
concern about the long-term complications associated with transplantation. To
better manage renal transplant recipients over the long term, it is essential
to schedule periodic clinic visits to detect problems and intervene in a timely
fashion. Besides enabling early detection and possible treatment, periodic
visits permit continuing patient education. Unfortunately, there is no
scientifically based consensus that indicates what the optimal frequency and
timing of such visits should be, although the AST has recently issued some
guidelines. At the MINT, an Annual Review Clinic has been implemented to
provide better service to renal transplant recipients over the long term. The
clinic offers a comprehensive medical assessment, identifies and quantifies
risk factors for CVD, and initiates referrals to appropriate specialists. The
Annual Review Clinic increases patient awareness in a number of areas specific
to transplantation, promotes a positive approach to healthcare, enables
collection of structured data for analysis, and, with hope, engenders a
significant degree of patient well-being and satisfaction. The medical
community needs to continue long-term patient evaluation and clinical audit as
means to improve long-term patient and graft survival, as well as patient
quality of life. N.
Ref:: 31
----------------------------------------------------
[18]
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.
----------------------------------------------------
[19]
TÍTULO / TITLE: - Complement activation
in early protocol kidney graft biopsies after living-donor transplantation.
REVISTA
/ JOURNAL: - Transplantation 2003 Apr 27;75(8):1204-13.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000062835.30165.2C
AUTORES
/ AUTHORS: - Sund S; Hovig T; Reisaeter AV; Scott H;
Bentdal O; Mollnes TE
INSTITUCIÓN
/ INSTITUTION: - Department/Institute of Pathology,
Rikshospitalet University Hospital, Oslo, Norway. stale.sund@helse-forde.no.
RESUMEN
/ SUMMARY: - BACKGROUND: To gain insight into
complement activation in kidney grafts, we studied the deposition of components
from all complement pathways in protocol biopsies from living-donor recipients
that were taken 1 week (median 7 days) after transplantation. METHODS: Graft
protocol biopsies (n=37) were taken consecutively and stained for two-color
immunofluorescence, with antibodies to C4d, C3, C1q, factor B, C6, terminal
C5b-9 complement complex, mannose-binding lectin (MBL), and MBL-associated
serine protease-1, combined with an endothelial marker. Light and electron
microscopy were performed in all cases. Clinical acute rejection (AR), graft
loss, and long-term kidney function were recorded. Baseline biopsies from 15 of
the patients served as controls. RESULTS: Endothelial C4d deposition was
demonstrated in peritubular capillaries in 11 of 37 cases (30%), of which 9 of
11 (82%) experienced clinical AR but only 6 of 11 (55%) experienced AR as
defined by histopathologic criteria. Biopsies from three patients, two with
early graft loss, showed diffuse global C4d in the glomerular endothelium with
codeposition of C3 in all patients and MBL-associated serine protease-1 in one
patient. Focal peritubular capillary C3 deposition was found in two additional
C4d-positive cases with AR. No posttransplant deposition was demonstrated for
the other components. CONCLUSIONS: Early diffuse C4d deposition in the kidney
graft capillaries is closely related to acute humoral rejection, whereas focal
staining may occur with mild AR or, rarely, without rejection. Codeposition of
C3 indicates early AR with a higher risk of graft loss. In most cases,
activation was limited to C4d, indicating efficient in situ regulation of complement
activation.
----------------------------------------------------
[20]
TÍTULO / TITLE: - Use of a pelvic kidney
for living transplantation: case report and review of the literature.
REVISTA
/ JOURNAL: - Am J Transplant 2003 Feb;3(2):235-8.
AUTORES
/ AUTHORS: - Luke PP; McAlister VC; Jevnikar AM; House
AA; Muirhead N; Cross J; Hollomby D; Chin JL
INSTITUCIÓN
/ INSTITUTION: - Departments of Surgery and Medicine,
London Health Sciences Center, the Multi-organ Transplant Program, The
University of Western Ontario, London, Ontario, Canada. patrick.luke@ihsc.on.ca
RESUMEN
/ SUMMARY: - Pelvic kidneys have anomalous vascular
supplies and collecting systems. Therefore, careful radiologic and functional
evaluation of these kidneys must be performed prior to procurement for
transplantation. We report the successful use of a pelvic kidney for
living-related transplantation. N.
Ref:: 7
----------------------------------------------------
[21]
TÍTULO / TITLE: - General health
management and long-term care of the renal transplant recipient.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S10-24.
AUTORES
/ AUTHORS: - Cohen D; Galbraith C
INSTITUCIÓN
/ INSTITUTION: - Columbia Presbyterian Hospital, New York,
NY 10032, USA. djc5@columbia.edu
RESUMEN
/ SUMMARY: - The steady improvement in short-term
success rates in renal transplant patients has translated into better long-term
success rates and a large number of patients with long-functioning renal
transplants. The necessity for the lifelong administration of immunosuppressive
medications to prevent rejection, coupled with the presence in many patients of
a variety of other medical problems dating from the period of renal
insufficiency prior to the time of renal transplantation, has created a large
group of patients with a unique and complex set of long-term medical care
needs. Due to the constraints of managed care, considerations of geography, or
patient preference, the long-term care of an increasing number of renal
transplant recipients has shifted away from the transplant center to the
community-based nephrologist or internist. For optimal care to be delivered, it
is important that the physicians managing these patients be cognizant of the
complex and interacting medical issues involved in their care. Appropriate
management can significantly prolong the life of the allograft as well as that
of the patient. Guidelines for understanding and managing some of the more
important and common general medical problems facing the long-term renal
transplant recipient (eg, infectious complications, cardiovascular disease,
hypertension, diabetes, hyperlipidemia, malignancy, pregnancy, bone disease,
dental care, preventive care) are addressed in this section. N. Ref:: 47
----------------------------------------------------
[22]
TÍTULO / TITLE: - Rejection rate in
living donor kidney transplantation with and without basiliximab in
tacrolimus/mycophenolate mofetil-based protocol.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Mar;35(2):653-4.
AUTORES
/ AUTHORS: - Rahamimov R; Yussim A; After T; Lustig S;
Bar-Nathan N; Shaharabani E; Shapira Z; Shabthai E; Mor E
INSTITUCIÓN
/ INSTITUTION: - Department of Transplantation, Rabin Medical
Center, Beilinson Campus, Petah-Tiqwa, Israel. rutir@clalit.org.il
----------------------------------------------------
[23]
TÍTULO / TITLE: - Clinical trials,
immunosuppression and renal transplantation: new trends in design and analysis.
REVISTA
/ JOURNAL: - Pediatr Nephrol 2002 Aug;17(8):573-84.
Epub 2002 Jun 13.
●●
Enlace al texto completo (gratuito o de pago) 1007/s00467-002-0909-z
AUTORES
/ AUTHORS: - Landais P; Daures JP
INSTITUCIÓN
/ INSTITUTION: - Laboratoire de Biostatistique et
d’Informatique Medicale, Hopital Necker Enfants Malades, Faculte Paris 5, 149
rue de Sevres, 75743 Paris Cedex 15, France. landais@necker.fr
RESUMEN
/ SUMMARY: - Clinical trials provide a framework to
search for more effective and less toxic immunosuppressive agents to control
renal transplant rejection. Some methodological aspects are presented. Patient
selection and the choice of study endpoints are discussed with emphasis on
standardized definitions and classification of histopathology, and on
qualification and quantification of chronic rejection. Choosing a Bayesian or a
frequentist approach and the afferent hypotheses is discussed together with the
interpretation of a P-value and a confidence interval. Strategies for limiting
the number of patients, increasing power and feasibility are reviewed,
including discussion of surrogate endpoints. New approaches to statistical
analysis are then presented, including intention-to-treat versus per-protocol
analysis, analysis of correlated data, dependent censoring, and meta-analysis
applied to renal transplantation. Pharmacoeconomics are finally introduced as
necessary for implementation of decision making regarding therapeutic
strategies. Reporting research increases its standards, and the CONSORT
(Consolidated Standards of Reporting Trials) and QOROM (Quality of Reporting of
Meta-analyses) criteria are to be integrated in the process of clinical trial
procedures. In conclusion, observational studies are presented as part of an
evidence-based approach in the hierarchy of evidence, keeping in mind that high
quality, randomized, controlled trials are still necessary to decrease uncertainty
in the field of renal transplantation. N.
Ref:: 100
----------------------------------------------------
[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: - Utility of intravenous
immune globulin in kidney transplantation: efficacy, safety, and cost
implications.
REVISTA
/ JOURNAL: - Am J Transplant 2003 Jun;3(6):653-64.
AUTORES
/ AUTHORS: - Jordan S; Cunningham-Rundles C; McEwan R
INSTITUCIÓN
/ INSTITUTION: - Department of Pediatric Nephrology &
Transplant Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. sjordan@cshs.org
RESUMEN
/ SUMMARY: - Intravenous immunoglobulin preparations
(IVIG) are known to be effective in the treatment of various autoimmune and
inflammatory disorders into their immunomodulatory, immunoregulatory, and anti-inflammatory
properties. Recently, IVIG has been utilized in the management of highly
sensitized patients awaiting renal transplantation. The mechanisms of
suppression of panel reactive antibodies (PRA) in patients awaiting
transplantation are currently under investigation and appear to be related to
anti-idiotypic antibodies present in IVIG preparations. In this review, the
various immunomodulatory mechanisms attributable to IVIG and their efficacy in
reducing PRAs will be described. In addition, the use of IVIG in solid organ
transplant recipients will be reviewed. The adverse events, safety
considerations, and economic impact of IVIG protocols for patients awaiting
solid organ transplantation will be discussed.
N. Ref:: 67
----------------------------------------------------
[26]
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). Graft survival was worse for LD FSGS
patients (5 years 69%) compared with no FSGS (82%, P < 0.001) and was not
significantly different than CD graft survival in the FSGS (60%) and No FSGS
groups (67%). The LD to CD ratios of relative risk of graft failure were higher
in FSGS patients (test for interaction, P = 0.01). Recurrence of original
disease was the only cause of graft failure that differed between groups (P <
0.001). A greater percentage of LD FSGS graft failures was attributed to
recurrence (P = 0.06). CONCLUSIONS: The impact of FSGS on graft survival in
children is greatest in LD transplants, resulting in loss of expected LD graft
survival advantage. The rationale for LD grafts in children with FSGS should be
based on factors other than better outcomes typically associated with LD
transplantation.
----------------------------------------------------
[27]
TÍTULO / TITLE: - Identification of
patients best suited for combined liver-kidney transplantation: part II.
REVISTA
/ JOURNAL: - Liver Transpl 2002 Mar;8(3):193-211.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2002.32504
AUTORES
/ AUTHORS: - Davis CL; Gonwa TA; Wilkinson AH
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of Nephrology,
University of Washington, Seattle, WA 98195, USA. cdavis@u.washington.edu
RESUMEN
/ SUMMARY: - Liver-kidney transplantation (LKT) should
be reserved for those recipients with primary disease affecting both organs.
However, increasing transplant list waiting times have increased the
development and duration of acute renal failure before liver transplantation.
Furthermore, the need for posttransplant calcineurin inhibitors can render
healing from acute renal failure difficult. Because of the increasing requests
for and controversy over the topic of a kidney with a liver transplant (OLT)
when complete failure of the kidney is not known, the following article will
review the impact of renal failure on liver transplant outcome, treatment of
peri-OLT renal failure, rejection rates after LKT, survival after LKT, and
information on renal histology and progression of disease into the beginnings
of an algorithm for making a decision about combined LKT. N. Ref:: 112
----------------------------------------------------
[28]
TÍTULO / TITLE: - The evaluation of renal
transplantation candidates: clinical practice guidelines.
REVISTA
/ JOURNAL: - Am J Transplant 2002;1 Suppl 2:1-95.
AUTORES
/ AUTHORS: - Kasiske BL; Cangro CB; Hariharan S; Hricik
DE; Kerman RH; Roth D; Rush DN; Vazquez MA; Weir MR
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Hennepin County
Medical Center, University of Minnesota, Minneapolis
----------------------------------------------------
[29]
TÍTULO / TITLE: - Preimplantation renal
biopsy: structure does predict function.
REVISTA
/ JOURNAL: - Transplantation 2003 Feb 15;75(3):264-6.
AUTORES
/ AUTHORS: - D’Agati VD; Cohen DJ
INSTITUCIÓN
/ INSTITUTION: - Columbia University College of Physicians
and Surgeons, New York, NY, USA. N.
Ref:: 11
----------------------------------------------------
[30]
TÍTULO / TITLE: - Using DAVE as a model
to go beyond treatment compliance with persons receiving renal replacement
therapy.
REVISTA
/ JOURNAL: - Soc Work Health Care 2002;36(2):35-48.
AUTORES
/ AUTHORS: - Bordelon TD
INSTITUCIÓN
/ INSTITUTION: - Social Work Department, University of
Southern Indiana, Evansville, IN, USA.
RESUMEN
/ SUMMARY: - DAVE is an acronym for Dialogue, Accept,
Validate, and Enact conceptualized for the purpose of helping nephrology social
workers assist persons with End-Stage Renal Disease take an active role in
making treatment decisions, especially the decision to comply with a treatment
regimen. As a model, DAVE is a summation of contemporary social work practice
including views on empowerment, the Strengths Perspective, and the
Problem-Solving Process. DAVE attunes the nephrology social worker and the
dialysis recipient to an attitude of mutual trust, respect, and collaboration
essential to helping dialysis recipients make important treatment
decisions. N. Ref:: 32
----------------------------------------------------
[31]