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‣ Transplante renal em pacientes infectados pelo HIV; Kidney transplantation in HIV infected patients

MORENO, Carina Nilsen; SIQUEIRA, Raquel Cruzeiro de; NORONHA, Irene L
Fonte: Associação Médica Brasileira Publicador: Associação Médica Brasileira
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
67.782%
Este artigo de revisão tem como objetivo apresentar as principais considerações sobre o transplante renal em pacientes HIV positivos. Na última década, com o advento da terapia antirretroviral de alta atividade (Highly Active Antiretroviral Therapy - HAART), a evolução dos pacientes infectados pelo vírus da imunodeficiência humana (Human Immunodeficiency Virus - HIV) mudou significativamente, com uma acentuada diminuição das taxas de morbimortalidade nesta população. Neste contexto, o número de pacientes HIV positivos com doença renal crônica com necessidade de terapia dialítica vem aumentando progressivamente. Diante desta nova realidade, o transplante renal, antes considerado uma contraindicação absoluta para tais pacientes, passou a ser considerado uma alternativa de terapia substitutiva da função renal. Questões sobre o uso de imunossupressores neste grupo de pacientes e sua possível ação aumentando a replicação do HIV, além do risco de infecções oportunistas e de desenvolvimento de neoplasias, são amplamente discutidas. Porém, a experiência clínica nessa área mostra que a utilização dessas drogas para pacientes soropositivos parece ser segura, inclusive com relatos de ação antirretroviral de algumas das drogas imunossupressoras. Apesar disso...

‣ Factors associated with health-related quality of life after successful kidney transplantation: a population-based study

BOHLKE, Maristela; MARINI, Stela S.; ROCHA, Marcos; TERHORST, Lisoneide; GOMES, Rafael H.; BARCELLOS, Franklin C.; IRIGOYEN, Maria Claudia C.; SESSO, Ricardo
Fonte: SPRINGER Publicador: SPRINGER
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
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Kidney transplantation improves the quality of life of end-stage renal disease patients. The quality of life benefits, however, pertain to patients on average, not to all transplant recipients. The aim of this study was to identify factors associated with health-related quality of life after kidney transplantation. Population-based study with a cross-sectional design was carried out and quality of life was assessed by SF-36 Health Survey Version 1. A multivariate linear regression model was constructed with sociodemographic, clinical and laboratory data as independent variables. Two hundred and seventy-two kidney recipients with a functioning graft were analyzed. Hypertension, diabetes, higher serum creatinine and lower hematocrit were independently and significantly associated with lower scores for the SF-36 oblique physical component summary (PCSc). The final regression model explained 11% of the PCSc variance. The scores of oblique mental component summary (MCSc) were worse for females, patients with a lower income, unemployed and patients with a higher serum creatinine. The regression model explained 9% of the MCSc variance. Among the studied variables, comorbidity and graft function were the main factors associated with the PCSc...

‣ Biomarkers in Kidney Transplantation: Translating to clinical practice

Fonseca, I.
Fonte: Sociedade Portuguesa de Nefrologia Publicador: Sociedade Portuguesa de Nefrologia
Tipo: Artigo de Revista Científica
Publicado em //2013 Português
Relevância na Pesquisa
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Improving long-term graft survival is a major challenge in kidney transplantation. Ischaemia-reperfusion injury is a critical early allograft insult that enhances the risk of delayed graft function, which is common in deceased-donor transplantation. Delayed graft function complicates the post-transplant management and has a negative impact on both short and long-term outcomes. The development of effective interventions to prevent and attenuate the injury caused by ischaemia-reperfusion is constricted by the limited ability of early detection of kidney damage. In recent years, clinical and translational research has focused on improvements in the diagnosis of acute kidney injury and provided prognostic information that is helpful in the post-transplant care. Numerous biomarkers in kidney transplantation have been evaluated in the past decade, but, so far, evidence to support their use in routine practice is limited. The purpose of this review is to examine the current status of three biomarkers for early diagnosis and prognosis of delayed graft function, namely urinary neutrophil gelatinase-associated lipocalin, oxidative stress and cystatin C. In addition, the concept of a biomarker is addressed, as well as the existing challenges and perspectives for developing a biomarker. This review discusses current literature and reflects the author’s own interpretation and experience.

‣ Combined liver-kidney transplantation: experience at a brazilian university hospital

VERAS,Francisca Jovita de Oliveira; COELHO,Gustavo Rêgo; FEITOSA-NETO,Bartolomeu Alves; CERQUEIRA,João Batista Gadelha; GARCIA,Regina Célia F. Gomes; GARCIA,José Huygens Parente
Fonte: Colégio Brasileiro de Cirurgia Digestiva Publicador: Colégio Brasileiro de Cirurgia Digestiva
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/03/2014 Português
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Background: Combined liver-kidney transplant is a routine procedure in many transplant centers. The increase in its number coincided with the introduction in 2002 of the MELD (Model for End-stage Liver Disease) score for allocation of livers, prioritizing patients with renal dysfunction. Aim : To analyze the experience with combined liver-kidney transplantation in a liver transplant center in Brazil. Method : A retrospective review was conducted. All transplants were performed using grafts from deceased donors. Results : Sixteen combined liver-kidney transplantations were performed in the same period, which corresponds to 2.7% and 2.5% of the kidney and liver transplants, respectively. Fourteen patients were male (87.5 %) and two were female (12.5%). The average patients and donors age was 57.3±9.1 and 32.7±13.1, respectively. The MELD score mean was 23.6±3.67. The main cause of liver dysfunction were chronic hepatitis C virus (n=9). As for renal dysfunction, diabetic nephropathy (n=4) was the most frequent. There were six deaths, two of them by severe dysfunction of the liver graft and four by infectious causes. The 1, 3 and 5 years survival rate in patients undergoing liver-kidney transplantations was 68.8%...

‣ ABO-incompatible living-donor pediatric kidney transplantation in Japan

Aikawa,Atsushi; Kawamura,Takeshi; Shishido,Seichiro; Saito,Kazuhide; Takahashi,Kota
Fonte: Faculdade de Medicina / USP Publicador: Faculdade de Medicina / USP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2014 Português
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The Japanese ABO-Incompatible Transplantation Committee officially collected and analyzed data on pediatric ABO-incompatible living-donor kidney transplantation in July 2012. The age of a child was defined as <16 years, and 89 children who had undergone ABO-incompatible living-donor kidney transplantation from 1989 to 2011 were entered in a registry. These data were presented as the Japanese registry of pediatric ABO-incompatible living-donor kidney transplantation at the regional meetings of the International Pediatric Transplantation Association (IPTA) in Nagoya in September 2012 and in Sao Paulo in November 2012.

‣ Robotic-assisted Kidney Transplantation: Our Experience and Literature Review

Tzvetanov, Ivo; D’Amico, Giuseppe; Benedetti, Enrico
Fonte: Springer International Publishing Publicador: Springer International Publishing
Tipo: Artigo de Revista Científica
Português
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Kidney transplantation is the preferred treatment for patients with end-stage renal disease. While open surgery remains the gold standard, minimally invasive surgery has recently been introduced for the recipient undergoing kidney transplantation. Our team has employed the robotic surgical system to perform renal transplantation in obese recipients to minimize the risk of surgical site infections, with good results in terms of complications and graft and patient survival. However, others groups have performed kidney transplantation robotically in nonobese patients using different techniques. The da Vinci surgical system allows the performance of kidney transplantation under optimal operative conditions. Larger studies and long-term follow-up of recipients are required to determine the effectiveness of this approach. In this article, we describe our experience and review the development of the robotic-assisted kidney transplantation (RAKT).

‣ Donor Kidney Recovery Methods and the Incidence of Lymphatic Complications in Kidney Transplant Recipients

Saidi, R. F.; Wertheim, J. A.; Kennealey, P.; Ko, D. S. C.; Elias, N.; Yeh, H.; Hertl, M.; Kawai, T.
Fonte: Avicenna Organ Transplantation Institute Publicador: Avicenna Organ Transplantation Institute
Tipo: Artigo de Revista Científica
Português
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Background: Lymphatic leak and lymphocele are well-known complications after kidney transplantation. Objective: To determine the incidence of lymphatic complications in recipients of living donor kidneys. Methods: Among 642 kidney transplants performed between 1999 and 2007, the incidence of lymphatic complications was retrospectively analyzed in recipients of living donor kidneys procured by laparoscopic nephrectomy (LP, n=218) or by open nephrectomy (OP, n=127) and deceased donor kidneys (DD, n=297). A Jackson-Pratt drain was placed in the retroperitoneal space in all recipients and was maintained until the output became less than 30 mL/day. Results: Although the incidence of symptomatic lymphocele, which required therapeutic intervention, was comparable in all groups, the duration of mean±SD drain placement was significantly longer in the LP group—8.6±2.7 days compared to 5.6±1.2 days in the OP group and 5.4±0.7 days in the DD group (p<0.001). Higher output of lymphatic drainage in recipients of LP kidneys could lead to a higher incidence of lymphocele if wound drainage is not provided. Conclusion: More meticulous back table preparation may be required in LP kidneys to decrease lymphatic complications after kidney transplantation. These observations also support the suggestion that the major source of persistent lymphatic drainage following renal transplantation is severed lymphatics of the allograft rather than those of the recipient’s iliac space.

‣ Cancer incidence before and after kidney transplantation

Vajdic, C.; McDonald, S.; McCredie, M.; van Leeuwen, M.; Stewart, J.; Law, M.; Chapman, J.; Webster, A.; Kaldor, J.; Grulich, A.
Fonte: Amer Medical Assoc Publicador: Amer Medical Assoc
Tipo: Artigo de Revista Científica
Publicado em //2006 Português
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Context: Immune suppression after organ transplantation is associated with a markedly increased risk of nonmelanoma skin cancer and a few virus-associated cancers. Although it is generally accepted that other cancers do not occur at increased rates, there have been few long-term population-based cohort studies performed. Objective: To compare the incidence of cancer in patients receiving immune suppression after kidney transplantation with incidence in the same population in 2 periods before receipt of immune suppression: during dialysis and during end-stage kidney disease before renal replacement therapy (RRT). Design, Setting, and Participants: A population-based cohort study of 28 855 patients with end-stage kidney disease who received RRT, with 273 407 person-years of follow-up. Incident cancers (1982-2003) were ascertained by record linkage between the Australia and New Zealand Dialysis and Transplant Registry and the Australian National Cancer Statistics Clearing House. Main Outcome Measure: Standardized incidence ratios (SIRs) of cancer, using age-specific, sex-specific, calendar year–specific, and state/territory–specific population cancer incidence rates. Results:The overall incidence of cancer, excluding nonmelanoma skin cancer and those cancers known to frequently cause end-stage kidney disease...

‣ Increased incidence of squamous cell carcinoma of eye after kidney transplantation

Vajdic, C.; van Leeuwen, M.; McDonald, S.; McCredie, M.; Law, M.; Chapman, J.; Webster, A.; Kaldor, J.; Grulich, A.
Fonte: Oxford Univ Press Inc Publicador: Oxford Univ Press Inc
Tipo: Artigo de Revista Científica
Publicado em //2007 Português
Relevância na Pesquisa
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Squamous cell carcinoma (SCC) of the eye occurs at substantially increased rates in individuals with human immunodeficiency virus (HIV) infection, but it has not been reported in individuals with iatrogenic or congenital immune deficiency. In a national, population-based cohort of 10180 renal transplantation patients from Australia with 86898 person-years of follow-up, we ascertained primary incident cancers diagnosed in 1982–2003 by record linkage between the Australia and New Zealand Dialysis and Transplant Registry and the Australian National Cancer Statistics Clearing House. Standardized incidence ratios (SIRs) of cancer were calculated using age-, sex-, calendar year–, and state/territory–specific population cancer incidence rates. Statistical tests were two-sided. Five patients were diagnosed with ocular SCC after kidney transplantation (0.26 were expected), and the incidence was increased 20-fold (SIR = 19.5, 95% confidence interval [CI] = 6.3 to 45.5). Compared with the entire cohort, the five patients with ocular SCC after transplantation were more likely to have resided in the subtropical state of Queensland (60% versus 17%, P = .04), to have had end-stage kidney disease as a result of glomerulonephritis (100% versus 46%...

‣ Reduction in cardiovascular death after kidney transplantation

Pilmore, H.; Dent, H.; Chang, S.; McDonald, S.; Chadban, S.
Fonte: Lippincott Williams & Wilkins Publicador: Lippincott Williams & Wilkins
Tipo: Artigo de Revista Científica
Publicado em //2010 Português
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BACKGROUND: Cardiovascular (CVS) disease is the commonest cause of death after kidney transplantation. In the general population, CVS mortality has reduced significantly over the last two decades; however, this trend has not been specifically examined in the kidney transplant population. METHODS: We studied all patients in Australia and New Zealand with a functioning kidney transplant between 1980 and 2007 and examined trends in the cause and timing of all 2195 deaths recorded after kidney transplantation in the Australia and New Zealand Dialysis and Transplant registry. Poisson regression was used to compare death rates over the time periods. RESULTS: CVS events were the commonest cause of death throughout all the time points examined; however, CVS death rates significantly decreased with an adjusted risk ratio of 0.61 (95% confidence interval, 0.38-0.96; P=0.034) for 2005 to 2007 era. In comparison, death rates due to malignancy have increased significantly over this period. Decreased CVS death rates have occurred despite increasing comorbidity at the time of transplantation. Factors associated with CVS death were older recipient age, preexisting CVS disease, and diabetes mellitus. There was a significantly lower CVS death rate in patients with a glomerular filtration rate >48 mL/min compared with those with poor renal function (risk ratio...

‣ Theophyllin zur Prävention und Behandlung des Ischämie-/Reperfusionsschadens nach Nierentransplantation an der Ratte; Theophylline in prevention and treatment of ischemia-/reperfusioninjury in rat kidney transplantation

Baier, Hans-Detlef
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
Português
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Mehrere Studien konnten den positiven Effekt des Adenosinrezeptor (AdoR)-Antagonisten Theophyllin in verschiedenen Formen des akuten Nierenversagens bei Versuchstieren und Menschen nachweisen. Das Ziel dieser Studie war zu untersuchen, ob Theophyllin auch die beeinträchtigte Transplantatfunktion nach Ischämie-/Reperfusionsschaden bei experimenteller Nierentransplantation verbessern kann. Es wurde eine orthotope Transplantation der linken Niere von Fisher 344 auf Lewis-Ratten durchgeführt. Alle transplantierten Ratten erhielten täglich Cyclosporin (CsA 5 mg/kg). Der Effekt der Theophyllin-Behandlung (10 mg/kg) auf die Transplantatfunktion wurde mit der der entsprechenden Kontrollen fünf Tage nach Transplantation durch Messung der GFR (Inulin-Clearance) verglichen. Am fünften Tag war die GFR der Transplantatnieren in Kontroll-Ratten 0,23 +- 0,05 ml/min/g Nierengewicht (n=10) im Vergleich zu 0,50 +-0,09 ml/min/g Nierengewicht bei mit Theophyllin behandelten Ratten (n=9, p < 0,01), was einer um den Faktor 2 erhöhten GFR entspricht. Der Gehalt an renaler AdoR A1 Rezeptor mRNA war in beiden Transplantationsgruppen im Vergleich zu den entsprechenden Kontrollen signifikant erhöht, während AdoR A2A, A2B und A3 unverändert blieb. Theophyllin hatte keinen signifikanten Effekt auf die interstitielle Infiltration des Transplantats durch Monozyten/Makrophagen und T-Zellen. Serumzytokinkonzentrationen (IL-2...

‣ CD26 als prädiktiver Marker für die Abstoßung unter der immunsuppressiven Therapie mit Myfortic bei Patienten in der frühen Phase nach Nierentransplantation; CD26 as a predictive marker for rejection under immunosuppressive therapy with Myfortic in patients in the early phase after kidney transplantation

Leicht, Simone Adriana
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
Português
Relevância na Pesquisa
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In der Vorgängerstudie zeigte sich bei Patienten nach Nierentransplantation, dass eine hohe Expression des Oberflächenmarkers CD26 auf CD3+ Zellen in der ersten Woche nach Transplantation mit einem erhöhten Risiko assoziiert war, eine akute Abstoßung zu erleiden. Um das diagnostische Potential von CD26 genauer zu ermitteln, wurde in dieser Studie CD26 an einem größeren Patientenkollektiv untersucht. Die Patienten wurden hinsichtlich klinischer Ereignisse beobachtet und dementsprechend in Gruppen eingeteilt. Da die Zell-Isolation und Zell-Stimulation in der Vorgängerstudie sehr zeitaufwendig und arbeitsintensiv war, wurde in der Nachfolgestudie darauf verzichtet. Die Analysen erfolgten direkt auf EDTA-Vollblut. Die Studie beinhaltet 87 nierentransplantierte Patienten, welche als Immunsuppression Basiliximab, Tacrolimus, Mycophenolsäure (EC-MPS) und Steroide erhielten. Die Blutentnahmen erfolgten vor Transplantation (Tag 0), sowie am 3., 7. und 14. postoperativen Tag. Als Kontrollgruppe dienten 49 Blutspender. Sowohl bei Blutspendern als auch Patienten wurde die Expression der Oberflächenparameter CD3+/CD26+, CD4+/CD26+ und CD8+/CD26+ am FACS durchgeführt. Die Oberflächenmarker wurden in Abhängigkeit der Gesamtlymphozytenzahl in Prozent (%) bestimmt. Anschließend erfolgte die DPP IV-Aktivitätsmessung kinetisch mit Hilfe des Spektralphotometers...

‣ Measuring kidney transplantation activity

Lima, Bruno A.; Mendes, Miguel; Alves, Helena
Fonte: Sociedade Portuguesa de Nefrologia Publicador: Sociedade Portuguesa de Nefrologia
Tipo: Artigo de Revista Científica
Publicado em 06/06/2014 Português
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[ENG] Kidney allocation from cadaveric donors must balance two main principles: medical utility and justice. The principle of medical benefit is gauged by maximizing efficiency in the use of organs and the principle of justice by its effectiveness, ensuring that all patients have a reasonable opportunity of transplantation. In this paper we present some metrics that, when applied to candidates for kidney transplantation, will help in the best judgment defining kidney allocation systems. Knowing the prevalence and incidence (per year, per million inhabitants) of kidney transplant, candidates demographic factors, such as: sex, age groups, and socioeconomic status; as well as clinical and immunological characteristics: blood group, Panel Reactive Antibody values, Body Mass Index, type of dialysis, cause of renal failure, and comorbidities; allows for an objective comparison of allocation programmes. The waiting time for transplantation should be measured as the median time between the start of dialysis and transplantation of wait -listed patients each year. By using the Cox regression analysis, with time on dialysis for transplantation as a dependent variable and clinical, socio -demographic factors as independent variables, we will shed light on which characteristics affect the access to transplantation.; [PT] A distribuição de rins de dador cadáver deve equilibrar dois princípios fundamentais: a utilidade médica e a justiça. O principio do beneficio médico e aferido através da maximização da eficiência no uso dos órgãos...

‣ Measuring access to Kidney transplantation

Lima, Bruno A.; Mendes, Miguel; Alves, Helena
Fonte: John Wiley and Sons Publicador: John Wiley and Sons
Tipo: Conferência ou Objeto de Conferência
Publicado em /06/2014 Português
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ORAL SESSIONS - Best Abstracts; Kidney allocation from cadaveric donors must balance two main principles: medical utility and justice. The principle of medical benefit is gauged by maximizing efficiency in the use of organs, and the principle of justice by its effectiveness ensuring that all patients have a reasonable opportunity to be transplanted. The survival benefit of transplant patients when compared with dialyzed values is well described even after adjusting for age, comorbidities, albumin and Body Mass Index (BMI). This benefit is also observed in patients over the age of 60 years. Several factors are related to transplant efficiency: maximization of HLA matching for patients that are more relevant (children and youth), preference for children; minimization of ischemia time, and the relation of life expectancy of the graft with life expectancy of the receptor. The factors related to justice are: reduction of waiting times, and greater equity of access for patients regardless of their race, blood group, HLA homozygosity and geographic location. There are socio-demographic and immunological factors associated with longer waiting time for kidney transplantation, such as: age, blood group or sensitization against HLA antibodies.Knowing the prevalence and incidence (per year...

‣ Contributing factors to complications and surgical success in mouse kidney transplantation

Huang,Ling-Jin; Reese,Shannon; Djamali,Arjang
Fonte: Sociedade Brasileira de Urologia Publicador: Sociedade Brasileira de Urologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2012 Português
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PURPOSE: Mouse kidney transplantation is a challenging technique for novice microsurgeons. Factors that affect transplant outcomes for a clinical surgeon starting microsurgery have not yet been investigated. MATERIALS AND METHODS: 110 consecutive mouse kidney transplants were performed over a 9-month period. Data were recorded, and surgical results and complication were analyzed. RESULTS: Three and thirty day survival rates improved from 0 (0/6) to 92.3% (12/13) between months 1 and 9. Bleeding, arterial thrombosis, kidney failure and hydronephrosis were the most common causes of transplant failure. From month 1 to month 7, using the same surgical technique, practice significantly decreased the incidence of bleeding and increased the 3-day survival rate; however, it didn't significantly decrease the incidence of thrombosis, kidney failure, but improved the 30-day survival rate. From month 8, when surgical technique used on artery anastomosis switched from continuous suture to interrupted suture, surgical survival rate at 3 and 30 days improved significantly. Interestingly, ischemia time was not a significant factor determining the success of transplantation in this study. CONCLUSIONS: Practice is essential for novice microsurgeons...

‣ Kidney transplantation in children: a 50-case experience

Zerati Filho,Miguel; Furtado,Paulo S.; Barroso Jr,Ubirajara; Pugas,Cassio M.; D'avila,Cleverson; Souza,Geovanne F.
Fonte: Sociedade Brasileira de Urologia Publicador: Sociedade Brasileira de Urologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2005 Português
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OBJECTIVES: The aim of this article was to report our experience with kidney transplantation in children. MATERIALS AND METHODS: From June 1980 to December 2003, 690 kidney transplants were performed in our institution, among which 50 were in patients with less than 18 years old. Technical aspects as well as clinical and surgical evolution were reviewed in this study. RESULTS: Patient's mean age was 12 years (2-17 years). Twenty-nine patients were male and 21 female. Live related donors were responsible for 75% of the cases (38 patients) and 25% (12 patients) came from cadaver donors. The main complications were ureteral fistula in 6 patients (12%), arterial stenosis in 2 (4%), wall infection and dehiscence in 1 case (2%). The overall rate of surgical complication was 20%. No case of hyperacute rejection was reported. During the follow-up 20 grafts were lost due to chronic rejection and 2 patients died. No loss of graft due to surgical complications was reported. The graft survival rate was 71% in 1 year, 64% in 3 years and 57% in 5-year follow-up. CONCLUSIONS: Kidney transplantation in children is a viable treatment option for terminal kidney disease presenting success and surgical complication rate similar to kidney transplantation in adults.

‣ Contribuições à técnica cirúrgica em transplante renal - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; Contributions to the surgical techniques of kidney transplantation – Clinic Hospital of São Paulo University School of Medicine

Antonopoulos, Ioannis M.; Piovesan, Affonso C.; Falci Jr, Renato; Kanashiro, Hideki; Saito, Fernando J.; Nahas, William Carlos
Fonte: Universidade de São Paulo. Faculdade de Medicina Publicador: Universidade de São Paulo. Faculdade de Medicina
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; Formato: application/pdf
Publicado em 06/09/2009 Português
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Não é infreqüente ouvir que, em transplante renal, inovações de impacto no âmbito cirúrgico já não são mais prováveis. No entanto, soluções de alto impacto econômico ainda surgem com freqüência e muitas delas têm surgido no Brasil, contribuindo significativamente para a mudança de conduta cirúrgica em transplante renal a nível mundial. A técnica cirúrgica do transplante renal propriamente dita está bem estabelecida há anos, sendo muito parecida entre os diversos serviços de transplante. Já no que se refere ao tratamento cirúrgico das complicações do transplante e dos pacientes com doenças associadas à insuficiência renal crônica dialítica (IRCD), observamos considerável controvérsia e variação nas condutas. Este estudo pretende oferecer um panorama sobre as técnicas cirúrgicas utilizadas no transplante renal, as complicações decorrentes deste procedimento e os resultados obtidos pelo Serviço de Transplante Renal do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.; Is not rare to hear that, on kidney transplantation, improvements on surgical aspects are not probable anymore. Although, solutions with high economical impact arises frequently and, many of them, in Brazil...

‣ Preemptive kidney transplantation in elderly recipients with kidneys discarded of very old donors: a good alternative

Morales,Enrique; Gutiérrez,Eduardo; Hernández,Ana; Rojas-Rivera,Jorge; Gonzalez,Esther; Hernández,Eduardo; Polanco,Natalia; Praga,Manuel; Andrés,Amado
Fonte: Nefrología (Madrid) Publicador: Nefrología (Madrid)
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/01/2015 Português
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Background: The shortage of organs is a major hurdle in kidney transplantation, and one solution to the problem is to extend the age of the donor. However, organs from older donors are often discarded due to the macroscopic appearance of the parenchyma or major vessels. On the other hand, a large number of elderly patients are potential candidates for kidney transplantation, while many kidneys from elderly deceased donors are discarded due to a lack of age-matched recipients. In addition, a large number are often discarded due to the lack of compatible recipients among elderly patients undergoing chronic dialysis. A possible solution to avoid this wastage of kidneys potentially suitable for transplantation could be the performance of preemptive kidney transplantation (PKT) in carefully selected elderly patients. PKT improves graft and patient survival compared to other renal replacement therapy options. There is no information about PKT in elderly patients receiving kidneys from elderly deceased donors. Methods: From 2007 to 2012, we performed a prospective observational study comparing 26 elderly patients receiving PKT with a control group of 26 elderly patients receiving a first transplant after prior dialysis. Results: Mean age of recipients was 74.3 ± 2.9 years and mean age of donors was 73.8 ± 4.1 years. Induction immunosuppression was similar in both groups. Death-censored graft survival was 96% in the PKT group and 68% in the control group (p = 0.02)...

‣ Biomarkers in Kidney Transplantation: Translating to clinical practice

Fonseca,Isabel
Fonte: Sociedade Portuguesa de Nefrologia Publicador: Sociedade Portuguesa de Nefrologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/2013 Português
Relevância na Pesquisa
67.782%
Improving long-term graft survival is a major challenge in kidney transplantation. Ischaemia-reperfusion injury is a critical early allograft insult that enhances the risk of delayed graft function, which is common in deceased-donor transplantation. Delayed graft function complicates the post-transplant management and has a negative impact on both short and long-term outcomes. The development of effective interventions to prevent and attenuate the injury caused by ischaemia-reperfusion is constricted by the limited ability of early detection of kidney damage. In recent years, clinical and translational research has focused on improvements in the diagnosis of acute kidney injury and provided prognostic information that is helpful in the post-transplant care. Numerous biomarkers in kidney transplantation have been evaluated in the past decade, but, so far, evidence to support their use in routine practice is limited. The purpose of this review is to examine the current status of three biomarkers for early diagnosis and prognosis of delayed graft function, namely urinary neutrophil gelatinase-associated lipocalin, oxidative stress and cystatin C. In addition, the concept of a biomarker is addressed, as well as the existing challenges and perspectives for developing a biomarker. This review discusses current literature and reflects the author’s own interpretation and experience.

‣ Four decades of kidney transplantation in Cuba

Alfonzo,Jorge P.
Fonte: Medical Education Cooperation with Cuba Publicador: Medical Education Cooperation with Cuba
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2013 Português
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This article describes the background, beginnings, development, evolution and outcomes of kidney transplantation in Cuba. Nephrology as a medical specialty in Cuba began in 1962 and was formalized in 1966. Conditions were created to implement renal replacement therapy (including transplants), bring nephrology care to the entire country and train human resources who would assume this responsibility, making Cuba one of the first countries with a comprehensive program for renal patient care. After three unsuccessful cadaveric-donor kidney transplantations in 1968-69, the ensuing history of kidney transplantation can be summarized in the following three stages. 1970-1975: In January 1970, cadaveric-donor kidney transplantation began at the Nephrology Institute. That year, 17 kidney transplantations were performed; four of these patients lived with functional kidneys for 15-25 years; 10-year graft survival was 23.5% (Kaplan-Meier survival curve); HLA typing began in 1974. By December 1975, 170 grafts had been done in three hospitals. 1976-1985: Seven transplantation centers performed 893 grafts during this period. HLA-DR typing was introduced in 1976 and the National Histocompatibility Laboratory Network was founded in 1978. The first related living-donor kidney transplantation was done in 1979. 1986-2011: The National Kidney Transplantation Coordinating Center and the National Kidney Transplantation Program were created in 1986; the first combined kidney-pancreas transplantation was performed the same year. In 1990...