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Górriz JL, Pallardó LM. [Early referral of patients to the nephrology unit: utopia or reality]. Nefrologia 2006; 26 Suppl 3:6-11. [PMID: 17469421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
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Sancho A, Gavela E, Crespo JF, Górriz JL, Avila A, Nuñez A, Molina P, García-Ramos JL, Montoro J, Pallardó LM. [Renal transplantation with positive crossmatch]. Nefrologia 2006; 26:261-6. [PMID: 16808265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Lymphocytotoxic antibodies reduce the expectancy of renal transplantation due to the increased risk of a positive crossmatch. MATERIAL AND METHODS We analyzed the evolution of eight kidney transplants performed in our unit in presence of a positive crossmatch with historical T and/or B lymphocyte positive crossmatches. RESULTS Mean panel reactivity was 76,6 +/- 25,7% (r: 22-100%), been higher than 75% in six patients. Six patients were recipients of a second or third transplant. Immunosuppression consisted of quadruple therapy including induction with thymoglobuline. Five patients had delayed graft function, and one had primary non-function of the graft. One patient lost her graft due to chronic allograft nephropathy in the second year postransplantation. Six patients maintained a good renal function (serum creatinine 1,2 +/- 0,5 mg/dl, proteinuria 0,20 +/- 0,34 g/day). CONCLUSION Renal transplantation in presence of a positive cross-match with historical serum and T lymphocytes and/or B lymphocytes, was followed by a satisfactory graft survival.
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Hernández D, Sánchez Fructuoso A, Serón D, Arias M, Campistol JM, Morales JM, Alonso A, Andrés A, del Castillo D, Gentil MA, González-Molina M, González Posada JM, Moreso F, Oppenheimer F, Pallardó LM, Solá R. [Chronic transplant nephropathy]. Nefrologia 2006; 26 Suppl 1:1-38. [PMID: 16808274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
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Nashan B, Bock A, Bosmans JL, Budde K, Fijter H, Jaques B, Johnston A, Lück R, Midtvedt K, Pallardó LM, Ready A, Salamé E, Salizzoni M, Suarez F, Thervet E. Use of Neoral C2 monitoring: a European consensus. Transpl Int 2005; 18:768-78. [PMID: 15948854 DOI: 10.1111/j.1432-2277.2005.00151.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Large-scale clinical trials using C(2) monitoring of cyclosporine (CsA) microemulsion (Neoral) in renal transplant recipients have demonstrated low acute rejection rates and good tolerability with a low adverse event profile in a variety of settings: with or without routine induction therapy; in combination with mycophenolate mofetil; with standard-exposure or low-exposure Neoral; and in patients with immediate or delayed graft function. In liver transplantation, C(2) monitoring significantly reduces the severity and incidence of acute rejection compared with C(0) monitoring, without adverse consequences in terms of renal function or tolerability. Different C(2) targets are appropriate depending on adjunctive immune suppression, level of immunologic risk, CsA tolerability, risk of renal toxicity and time since transplantation. CsA absorption may increase substantially in most patients during the first 1-2 weeks post-transplant, and this should be taken into account to avoid overshooting C(2) target range. A patient with a low C(2) value may be either a low or a delayed absorber of CsA, or be a normal absorber who is receiving too low a dose of Neoral. C(2) monitoring alone is insufficient to differentiate between these types of patients, and measurement of additional timepoints is recommended. Adopting C(2) monitoring in maintenance transplant patients identifies those who are overexposed to CsA. In summary, randomized, prospective, multicenter studies and single-center trials have evaluated Neoral C(2) monitoring within a range of regimens in different organ types, providing a robust evidence base for the benefits of this sensitive monitoring technique.
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Gavela E, Crespo JF, Sancho A, Avila A, Núñez A, Molina P, Pallardó LM. [Post-transplant diabetes mellitus associated with acute hepatitis C virus infection in a renal transplant recipient]. Nefrologia 2004; 24:75-8. [PMID: 15083962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
There are some controversial reports about the pathogenic role of hepatitis C virus infection on diabetes mellitus in renal graft recipients. We report a case of a renal transplanted who developed diabetes mellitus post-transplantation during an acute hepatitis C virus infection. We discuss the multifactorial etiology of post-transplant diabetes mellitus, and the possible interaction between tacrolimus and an acute virus C infection on its pathogenesis.
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Thervet E, Pfeffer P, Scolari MP, Toselli L, Pallardó LM, Chadban S, Pilmore H, Connolly J, Buchler M, Schena FP, Carreño CA, Dandavino R, Cole E. Clinical outcomes during the first three months posttransplant in renal allograft recipients managed by C2 monitoring of cyclosporine microemulsion. Transplantation 2003; 76:903-8. [PMID: 14508352 DOI: 10.1097/01.tp.0000089006.00653.64] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND MO2ART (monitoring of 2-hr absorption in renal transplantation) is the first prospective, multicenter trial of cyclosporine (CsA) blood level 2 hr postdose (C2) monitoring in de novo kidney recipients receiving CsA microemulsion (ME) (Neoral; Novartis, Basel, Switzerland). Efficacy and safety results from the first 3 months are presented here. METHODS MO2ART is a 12-month, open-label, randomized study involving 296 patients. In all patients, the dose of CsA-ME was adjusted to achieve protocol-defined C2 targets of 1.6 to 2.0 microg/mL for the first month, with subsequent tapering. Randomization into two target groups occurred at 3 months. All patients received steroids and mycophenolate mofetil (89%) or azathioprine. For patients with delayed graft function, the protocol permitted reduced C2 targets and prophylactic administration of antibodies. RESULTS At 3 months, overall incidence of biopsy-proven acute rejection was 11.5%. Median serum creatinine was 132 micromol/L. Patient and graft survival were 96.6% and 91.2%, respectively. C2 levels greater than 1.6 microg/mL were achieved within 5 days by 60.6% of patients with immediate graft function and 19.5% of patients with delayed graft function. Prophylactic antibodies were used in 15% of the total population. Twenty-four patients (8.1%) experienced serious adverse events with a suspected relation to CsA, and 26 patients (8.8%) discontinued the study because of adverse events (n=15) or after a switch in immunosuppression after rejection episodes (n=11). CONCLUSIONS Patient management by C2 monitoring resulted in a low incidence of biopsy-proven acute rejection in standard risk de novo kidney recipients, 85% of whom did not receive prophylactic antibodies. CsA-ME with C2 monitoring provides excellent short-term efficacy and safety among de novo renal transplant patients.
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Górriz JL, Sancho A, Pallardó LM, Amoedo ML, Martín M, Sanz P, Barril G, Selgas R, Salgueira M, Palma A, de la Torre M, Ferreras I. [Prognostic significance of programmed dialysis in patients who initiate renal substitutive treatment. Multicenter study in Spain]. Nefrologia 2002; 22:49-59. [PMID: 11987685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The aim of our study was to analyse patient characteristics, mortality and costs, all of them in relation to whether starting dialysis was planned or unplanned. METHODS A total of 362 patients (227 male and 135 female) from five hospitals of the National Health System, who were started on chronic renal replacement therapy (RRT) during 1996 and 1997 were included. Patients who were started on RRT after acute renal failure were excluded. We carried out a retrospective analysis of the demographic characteristics, patients' conditions at the time of initiating dialysis and outcome and costs at six and thirty-six months of treatment. Patients were classified as planned (PL-D) or unplanned dialysis (UNPL-D), depending on whether or not the patient had a vascular or peritoneal access ready to use for initiating RRT. RESULTS One hundred and eighty-six patients (51.4%) started on dialysis in the PL-D group whereas 176 (48.6%) did it as UNPL-D. In this latter group, 135 (37.3% of the total) had previously been monitored by a nephrologist, and 41 (11.3%) initiated dialysis without previous nephrological follow-up. UNPL-D was associated with older age (p < 0.001), non-nephrological follow-up (p < 0.001), diabetes (34.7% vs 22.6%) (p = 0.011), haemodialysis as a first mode of RRT (94.9 vs 81.7%) (p < 0.001), higher comorbidity risk (p < 0.001), dialysis initiation with uraemic symptoms or fluid overload (p < 0.001), increased blood transfusion requirement (p < 0.001) and lower serum albumin (p < 0.001), creatinine clearance (p < 0.001), haemoglobin concentration (p < 0.001), and weight (p = 0.002). In the PL-D group the main primary renal diseases were glomerular and polycystic disease, whereas interstitial and diabetic nephropathy were higher in UNPL-D group (p = 0.005). Multivariate analysis showed that previous non nephrological follow-up, uraemic symptoms, interstitial nephritis as primary renal disease correlated with UNPL-D initiation, and it was followed by choosing haemodialysis as first RRT. UNPL-D was also associated with increased number of days of hospitalization at the initiation of dialysis, and during the first 6 months (p < 0.001), increase of hospitalization days (p = 0.009), and increased 6-month-mortality (10.2% vs 3.2%) (p = 0.015, log rank test), and three-year mortality (24.2 vs 36.9%) (p = 0.006, log rank test). The costs of UNPL-D were fivefold that of the PL-D group. CONCLUSION UNPL-D has been associated with worse overall clinical conditions at the initiation of chronic replacement therapy, choosing haemodialysis as first RRT, increased morbi-mortality and subsequent increase of costs.
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Peñalver O, Camacho F, Pallardó LM. [Chronic renal insufficiency. VII: Therapeutic algorithm. Possible problems and their solution]. Nefrologia 2002; 21 Suppl 5:35-7. [PMID: 11881409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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Górriz JL, Sancho A, Pallardó LM, Amoedo ML, Barril G, Salgueira M, de la Torre M. Longer pre-dialysis nephrological care is associated with improved long-term survival of dialysis patients. More facts. Nephrol Dial Transplant 2002; 17:1354-5. [PMID: 12105266 DOI: 10.1093/ndt/17.7.1354-a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Crespo JF, Górriz JL, Avila A, Sancho A, Gavela E, Caño A, Zanón V, Pallardó LM. Prevalence of past varicella zoster virus infection in candidates for kidney transplantation: vaccination in seronegative patients. Transplant Proc 2002; 34:77. [PMID: 11959193 DOI: 10.1016/s0041-1345(01)02673-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sancho A, Crespo JF, Górriz JL, Avila A, Gavela E, Caño A, Pallardó LM. Age as a risk factor in renal transplantation. Transplant Proc 2002; 34:355. [PMID: 11959322 DOI: 10.1016/s0041-1345(01)02797-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Górriz JL, Martínez-Rodrigo J, Sancho A, Palmero J, Avila A, Blanes I, Lonjedo E, de la Cueva L, Crespo JF, Alcoy E, Caballero E, Pallardó LM. [Endoluminal percutaneous thrombectomy as a treatment for acute vascular access thrombosis: long-term results of 123 procedures]. Nefrologia 2001; 21:182-90. [PMID: 11464652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
UNLABELLED Percutaneous treatment of thrombosis of occluded vascular access (VA) for haemodialysis (HD) has been an alternative to surgical and pharmacological treatments, but long term results are not well defined. The aim of our study was to analyse the long term results of percutaneous thrombectomy as a treatment of occluded VA for HD. We conducted a prospective study from june 1995 to april 1999, including 123 consecutive thrombectomies in 64 VA in patients submitted to our hospital because of recent thrombosis of VA for HD. We used two different techniques, hydrodynamic catheter thrombectomy (Hydrolyser) in the 42 first procedures (34.1%), and since october 1996 we used mechanical balloon thrombolysis in the remaining 81 patients (65.9%). Underlying stenoses were evaluated by angiography, and treated by angioplasty. After the procedure, intravenous heparin was administered for 24 hours. The VA were 28 Brescia-Cimino arteriovenous fistulae (30.4%) and 64 PTFE grafts (69.6%). PATIENT CHARACTERISTICS mean age: 63 +/- 15 years (18-84), previous VA: 3.3 +/- 2.5 (0-9). The mean follow-up was 10.5 +/- 8.6 months (3-35). Percutaneous thrombectomy was able to remove the clots in 120 instances (technical success: 97.5%). After the thrombectomy 15 patients (16.3%) were immediately referred to the surgeon to perform a new VA due to vascular lesions in which percutaneous treatment was not indicated. Thirteen cases (14.1%) showed early thrombosis (< 72 hours). During the follow-up, 27 cases developed thrombosis (30%) and 26 VA were still patent (28.3%). In 23% of perfusion lung scans and in 2 of the 5 angiographies performed after thrombectomy, subsegmentary or segmentary perfusion defects were detected, without clinical significance. There were no relevant undesirable effects related to the technique and no symptomatic pulmonary embolism. In summary, percutaneous thrombectomy, whether hydrodynamic or mechanical, has shown to be an efficacious treatment of VA thrombosis for HD, preserving the VA with satisfactory long-term results.
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Crespo JF, Górriz JL, Sancho A, Avila A, Alcoy E, Pallardó LM. Triple therapy with mycophenolate mofetil, cyclosporine, and prednisone in renal transplantation. Transplant Proc 1999; 31:2261-2. [PMID: 10500568 DOI: 10.1016/s0041-1345(99)00329-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Górriz JL, Sancho A, Garcés R, Amorós F, Crespo JF, Pallardó LM. Recovery of renal function after renal failure due to cholesterol crystal embolism. Nephrol Dial Transplant 1999; 14:2261-2. [PMID: 10489252 DOI: 10.1093/ndt/14.9.2261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Porta B, Pérez-Ruixo JJ, Górriz JL, Crespo JF, Sancho A, Pallardó LM, Jiménez NV. Population pharmacokinetics of cyclosporine in kidney transplant patients. Transplant Proc 1999; 31:2246-7. [PMID: 10500561 DOI: 10.1016/s0041-1345(99)00322-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sancho A, Górriz JL, Crespo JF, Avila A, Alcaraz MJ, García Ramos JL, Pallardó LM. Prophylaxis of cytomegalovirus disease with intravenous ganciclovir in renal transplantation. Transplant Proc 1999; 31:2337-8. [PMID: 10500606 DOI: 10.1016/s0041-1345(99)00367-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Górriz JL, Rovira E, Sancho A, Ferrer R, Paricio A, Pallardó LM. IgA nephropathy associated with human immuno deficiency virus infection: antiproteinuric effect of captopril. Nephrol Dial Transplant 1997; 12:2796-7. [PMID: 9430904 DOI: 10.1093/ndt/12.12.2796] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Górriz JL, Sancho A, Ferrer R, Alcoy E, Crespo JF, Palmero J, Pallardó LM. Renal-limited polyarteritis nodosa presenting with loin pain and haematuria. Nephrol Dial Transplant 1997; 12:2737-9. [PMID: 9430885 DOI: 10.1093/ndt/12.12.2737] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Górriz JL, Sancho A, Lopez-Martin JM, Alcoy E, Catalán C, Pallardó LM. Rhabdomyolysis and acute renal failure associated with gemfibrozil therapy. Nephron Clin Pract 1996; 74:437-8. [PMID: 8893176 DOI: 10.1159/000189355] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Górriz JL, Sancho A, Alcoy E, García-Ramos JL, Pallardó LM. Rhabdomyolysis and acute renal failure associated with bezafibrate treatment. Nephrol Dial Transplant 1995; 10:2371-2. [PMID: 8808248 DOI: 10.1093/ndt/10.12.2371b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Puig N, Pallardó LM, Villalba JV, Sánchez J, Crespo J, Rodriguez R, Montoro JA. Donor-specific flow cytometric cross-match after kidney transplantation. Transplant Proc 1995; 27:2369-70. [PMID: 7652842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Górriz JL, Pallardó LM, Sarrión A, Sánchez J, Rochera A. Hepatitis C virus infection in renal transplant recipients: prognostic significance of chronic transaminase elevation. Transplant Proc 1995; 27:2250-1. [PMID: 7652794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Puig N, Pallardó LM, Carpio N, Sánchez P, Planelles D, Marín C, Montoro JA. Monocyte cross-match in renal transplantation. Transplant Proc 1995; 27:2412. [PMID: 7652856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Pallardó LM, Sánchez J, Puig N, Sánchez P, Beneyto I, Crespo J, Ros F, Rochera A. Chronic rejection in 500 kidney transplant patients treated with cyclosporine: incidence and risk factors. Transplant Proc 1995; 27:2215-6. [PMID: 7652778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Pallardó LM, Sánchez P, Sánchez J, García J, Beneyto I, Orero E, Rochera A. Analysis of the risk factors of late failure in renal transplantation under cyclosporine immunosuppression. Transplant Proc 1994; 26:2536-7. [PMID: 7940781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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