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Long-Term Outcomes among Kidney Transplant Recipients and after Graft Failure: A Single-Center Cohort Study in Brazil. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7105084. [PMID: 31061825 PMCID: PMC6466891 DOI: 10.1155/2019/7105084] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 12/29/2022]
Abstract
Background The results of kidney transplantation are impacted by the categories of events responsible for patient death and graft failure. The objective of this study was to evaluate the causes of death and graft failure and outcomes after graft failure among kidney transplant recipients. Methodology A retrospective cohort study was conducted with 944 patients who underwent kidney transplantation. Outcomes were categorized in a managed and hierarchical manner. Results The crude mortality rate was 10.8% (n=102): in 35.3% cause of death was infection, in 30.4% cardiovascular disease, and in 15.7% neoplasia and in 6.8%, it was not possible to determine the cause of death. The rate of graft loss was 10.6%. The main causes of graft failure were chronic rejection (40%), acute rejection (18.3%), thrombosis (17.3%), and recurrence of primary disease (16.5%). Failures due to an acute rejection occurred earlier than those due to chronic rejection and recurrence (p<0.0001). As late causes of graft loss, death with the functioning kidney occurred earlier than recurrence and chronic rejection (p=0.008). The outcomes after graft failure were retransplantation in 26.1% and death in 21.4%, at a mean of 25.5 and 21.4 months, respectively. Conclusion It was possible to identify more than 90% of the events responsible for the deaths of transplanted patients, predominantly infectious and cardiovascular diseases. Among the causes of graft failure, chronic and acute rejections and recurrence were the main causes of graft failure which were followed more frequently by retransplantation than by death on dialysis.
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Hakami L, Castle PM, Kiernan J, Choi K, Rahantamalala A, Rakotomalala E, Rakotoarison R, Wright P, Grandjean Lapierre S, Crnosija I, Small P, Vigan-Womas I, Marcos LA. Epidemiology of soil transmitted helminth and Strongyloides stercoralis infections in remote rural villages of Ranomafana National Park, Madagascar. Pathog Glob Health 2019; 113:94-100. [PMID: 30879406 DOI: 10.1080/20477724.2019.1589927] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Soil-transmitted helminth (STH) infections carry the highest number of disability adjusted life years among all neglected tropical diseases, disproportionately affecting low-income countries such as Madagascar. This study describes the epidemiology of STH and S. stercoralis infections in twelve remote villages surrounding Ranomafana National Park (RNP), Ifanadiana, Madagascar. Questionnaires and stool samples were collected from 574 subjects from random households. The Kato-Katz method and spontaneous sedimentation technique were used to examine stool samples for evidence of infection. Infection prevalence rates were 71.4% for Ascaris lumbricoides (95% CI: 67.7-75.1), 74.7% for Trichuris trichiura (95% CI: 71.1-78.2), 33.1% for hookworm (95% CI: 29.2-36.9), and 3.3% for Strongyloides stercoralis (95% CI: 1.84-4.77). Participants who were older in age (OR = 0.96; 95% CI: 0.95-0.99) and who had a high school education (OR = 0.17; 95% CI: 0.04-0.77) were less likely to be infected with a STH. Females were less likely to be infected with A. lumbricoides (OR = 0.52; 95% CI: 0.33-0.82). Participants living in villages further from the main road were more likely to be infected with a STH (F = 4.00, p = 0.02). Overall, this study found that 92.5% (95% CI: 90.3-94.6) of the people living in rural regions near RNP have at least one STH infection. This calls into question the current preventative chemotherapy (PC) program in place and suggests that further medical, socioeconomic, and infrastructural deveopments are needed to reduce STH prevalence rates among this underserved population.
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Affiliation(s)
- Lee Hakami
- a School of Medicine , Stony Brook University , Stony Brook , NY , USA
| | - Paul M Castle
- a School of Medicine , Stony Brook University , Stony Brook , NY , USA
| | - Jaydon Kiernan
- a School of Medicine , Stony Brook University , Stony Brook , NY , USA
| | - Koeun Choi
- a School of Medicine , Stony Brook University , Stony Brook , NY , USA
| | - Anjanirina Rahantamalala
- b Immunology of Infectious Diseases Unit , Institut Pasteur de Madagascar , Antananarivo , Madagascar
| | - Emma Rakotomalala
- b Immunology of Infectious Diseases Unit , Institut Pasteur de Madagascar , Antananarivo , Madagascar
| | - Rado Rakotoarison
- b Immunology of Infectious Diseases Unit , Institut Pasteur de Madagascar , Antananarivo , Madagascar
| | - Patricia Wright
- c Centre ValBio (nonprofit institute of Stony Brook University) , Ranomafana , Madagascar.,d Department of Anthropology , Stony Brook University , Stony Brook , NY , USA
| | | | - Ivan Crnosija
- f Department of Medicine , Stony Brook University , Stony Brook , NY , USA
| | - Peter Small
- e Global Health Institute , Stony Brook University , Stony Brook , NY , USA
| | - Ines Vigan-Womas
- b Immunology of Infectious Diseases Unit , Institut Pasteur de Madagascar , Antananarivo , Madagascar
| | - Luis A Marcos
- e Global Health Institute , Stony Brook University , Stony Brook , NY , USA.,g Division of Infectious Diseases, Department of Medicine, Department of Microbiology and Molecular Genetics , Stony Brook University , Stony Brook , NY , USA
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Infectious complications as the leading cause of death after kidney transplantation: analysis of more than 10,000 transplants from a single center. J Nephrol 2017; 30:601-606. [PMID: 28211034 DOI: 10.1007/s40620-017-0379-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/12/2017] [Indexed: 02/02/2023]
Abstract
AIM To identify specific causes of graft failure in a large sample of kidney transplant patients from a middle-income, developing country. METHODS Retrospective cohort study analyzing all consecutive single kidney transplants (KTs) performed at a single center in Brazil between January 1st 1998 and December 31st 2013. The database closing date was December 31st 2014. RESULTS Out of 10,400 KTs, there were 1191 (11.45%) deaths with a functioning graft, 40 cases (0.38%) of primary non-function (PNF) and 1417 cases (13.62%) of graft loss excluding death and PNF as the cause. Infectious complications (404 cases, 34% of all deaths) were the major cause of death. Most deaths due to infection occurred within the first year after transplantation (157 deaths, 38.86%). Immunologic mechanisms, comprising acute rejection and immune-mediated interstitial fibrosis/tubular atrophy (IF/TA), were responsible for 52% of all cases of graft failure not involving recipient death. Half of the losses by acute rejection occurred late after transplantation. CONCLUSION Contrary to what is observed in developed countries, infectious complications are the main challenge with kidney transplantation in Brazil. Non-adherence to treatment also appears to contribute significantly to long-term kidney graft loss. Strategies for improvement should focus on better compliance and a greater safety profile of immunosuppressive treatment.
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