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Sawinski D, Rosenblatt RE, Morales JM. Renal transplantation using kidneys from hepatitis C-infected donors: A review of 30-years' experience. Nefrologia 2022:S2013-2514(22)00178-X. [PMID: 36564226 DOI: 10.1016/j.nefroe.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/18/2022] [Indexed: 06/17/2023] Open
Abstract
Kidney transplantation is the optimal therapy for end-stage kidney disease but limited by the available number of organs. Using HCV+ donors, both in HCV+ and HCV- recipients, is a rational response to the organ shortage. We review the historic experience using HCV+ donors in HCV+ recipients and assess long-term results. We also discuss contemporary practices, including the transplantation of HCV-viremic kidneys into HCV- recipients with different approaches to posttransplant HCV therapy.
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Affiliation(s)
- Deirdre Sawinski
- Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Russel E Rosenblatt
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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Sawinski D, Rosenblatt RE, Morales JM. Renal transplantation using kidneys from hepatitis C-infected donors: A review of 30-years’ experience. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Serrano M, Martinez-Flores JA, Norman GL, Naranjo L, Morales JM, Serrano A. The IgA Isotype of Anti-β2 Glycoprotein I Antibodies Recognizes Epitopes in Domains 3, 4, and 5 That Are Located in a Lateral Zone of the Molecule (L-Shaped). Front Immunol 2019; 10:1031. [PMID: 31134087 PMCID: PMC6515947 DOI: 10.3389/fimmu.2019.01031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/23/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Antiphospholipid syndrome (APS) is characterized by thrombosis and/or pregnancy morbidity with presence of anti-phospholipid antibodies (aPL). The APS classification criteria only consider the aPL of IgG/IgM isotype, however testing of aPL of IgA isotype is recommended when APS is suspected and consensus aPL are negative. IgA anti-βeta-2 glycoprotein-I (B2GP1) has been clearly related with occurrence of thrombotic events. Antibodies anti-B2GP1 of IgG/M isotypes recognize an epitope in Domain 1 (R39-G43), the epitopes that recognize IgA anti-B2GP1 antibodies are not well-identified. Aim: To determine the zones of B2GP1 recognized by antibodies of IgA isotype from patients with APS symptomatology and positive for IgA anti-B2GP1. Methods: IgA antibodies to Domain-1(D1) and Domain-4/5(D4/5) of B2GP1 (ELISA) and epitope mapping on oligopeptide arrays of B2GP1 were evaluated in sera from a group of 93 patients with at least one thrombotic and with isolated positivity for IgA anti-B2GP1 antibodies (negative for other aPL). Results: A total of 47 patients (50.5%) were positive for anti-D4/5 and 23(25%) were positive for anti-D1. When peptide arrays were analyzed, three zones of B2GP1 reactivity were identified for more than 50% of patients. The center of these zones corresponds to amino acids 140(D3), 204(D4), and 264(D5). The peptides recognized on D3 and D4 contain amino acid sequences sharing high homology with proteins of microorganism that were previously related with a possible APS infectious etiology. In the three-dimensional structure of B2GP1, the three peptides, as the R39-G43 epitope, are located on the right side of the molecule (L-shape). The left side (J-shape) does not bind the antibodies. Conclusions: Patients with thrombotic APS clinical-criteria, and isolated IgA anti-B2GP1 positivity appear to preferentially bind, not to the D1 or D4/5 domains of B2GP1, but rather to three sites in D3, D4, and D5. The sites on D3 and D4 were previously described as the target identified by human monoclonal antibodies derived from patients that were capable of inducing APS in animal models. The localization of these epitopes opens a new route to explore to increase understanding of the patholophysiology of the APS and to propose new alternatives and therapeutic targets.
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Affiliation(s)
- Manuel Serrano
- Healthcare Research Institute of Hospital 12 de Octubre, Madrid, Spain
| | | | | | - Laura Naranjo
- Healthcare Research Institute of Hospital 12 de Octubre, Madrid, Spain
| | | | - Antonio Serrano
- Healthcare Research Institute of Hospital 12 de Octubre, Madrid, Spain
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Serrano M, Cabrera-Marante O, Martínez-Flores JA, Morales P, Pérez D, Mora S, García F, González E, Paz-Artal E, Morales JM, Serrano A. Study of β 2-Glycoprotein I Polymorphisms in Patients With Chronic Renal Failure as a Predisposing Factor for the Development of Anti-β 2-Glycoprotein I Auto-Antibodies. Transplant Proc 2016; 48:2876-2879. [PMID: 27932096 DOI: 10.1016/j.transproceed.2016.07.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Immunoglobulin (Ig)A anti-β2-glycoprotein I (aB2GP1) antibodies are associated with thrombotic events, cardiovascular morbidity, and death in dialysis patients. About 30% of patients with chronic renal disease are positive for IgA aB2GP1; however, the origin of these antibodies is unknown. It has been speculated that dialysis membranes, age, or etiology of renal base disease are possible precipitating factors, although these factors do not appear to be the source of antibodies. B2GP1 is a protein of 326 amino acids grouped into five domains. Eight polymorphisms have been described; the most important are Val/Leu247, which appears to predispose aB2GP1 antibody production in patients with anti-phospholipid syndrome, and Trp/Ser316, which appears to have protective antibody production of aB2GP1. METHODS DNA samples from 92 patients with renal failure on hemodialysis were randomly collected with a 1:1 ratio for the positivity for IgA aB2GP1. Forty-six samples were positive for IgA aB2GP1 (group 1) and 46 negative for IgA aB2GP1 (group 2). All samples were anonymized to study polymorphism Val/Leu247 and polymorphism Trp/Ser316. RESULTS No significant differences were observed between those who were positive or negative for IgA aB2GP1 in patients with renal failure treated with hemodialysis and the polymorphism located in codons 247 and 316. CONCLUSIONS The two groups of patients have the same prevalence in polymorphisms 247 and 316, and therefore there appears not to be a genetic predisposition in our population. New trigger factors must be studied.
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Affiliation(s)
- M Serrano
- Department of Immunology, Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - O Cabrera-Marante
- Department of Immunology, Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J A Martínez-Flores
- Department of Immunology, Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Morales
- Department of Immunology, Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - D Pérez
- Department of Immunology, Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - S Mora
- Department of Immunology, Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F García
- Department of Nephrology, Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E González
- Department of Nephrology, Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Paz-Artal
- Department of Immunology, Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain; Immunology Section, Universidad San Pablo-CEU, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - J M Morales
- Department of Immunology, Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Serrano
- Department of Immunology, Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Spain.
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Pérez D, Martínez-Flores JA, Serrano M, Lora D, Paz-Artal E, Morales JM, Serrano A. Evaluation of three fully automated immunoassay systems for detection of IgA anti-beta 2-glycoprotein I antibodies. Int J Lab Hematol 2016; 38:560-8. [PMID: 27435259 DOI: 10.1111/ijlh.12543] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/20/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In recent years, we have been witnessing increased clinical interest in the determination of IgA anti-beta 2-glycoprotein I (aB2GPI) antibodies as well as increased demand for this test. Some ELISA-based diagnostic systems for IgA aB2GPI antibodies detection are suboptimal to detect it. The aim of our study was to determine whether the diagnostic yield of modern detection systems based on automatic platforms to measure IgA aB2GPI is equivalent to that of the well-optimized ELISA-based assays. METHODS In total, 130 patients were analyzed for IgA aB2GPI by three fully automated immunoassays using an ELISA-based assay as reference. The three systems were also analyzed for IgG aB2GPI with 58 patients. RESULTS System 1 was able to detect IgA aB2GPI with good sensitivity and kappa index (99% and 0.72, respectively). The other two systems had also poor sensitivity (20% and 15%) and kappa index (0.10 and 0.07), respectively. On the other hand, kappa index for IgG aB2GPI was >0.89 in the three systems. CONCLUSION Some analytical methods to detect IgA aB2GPI are suboptimal as well as some ELISA-based diagnostic systems. It is important that the scientific community work to standardize analytical methods to determine IgA aB2GPI antibodies.
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Affiliation(s)
- D Pérez
- Department of Immunology, Instituto de Investigación Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - J A Martínez-Flores
- Department of Immunology, Instituto de Investigación Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Serrano
- Department of Immunology, Instituto de Investigación Hospital Universitario 12 de Octubre, Madrid, Spain
| | - D Lora
- Epidemiology Section, Instituto de Investigación Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Paz-Artal
- Department of Immunology, Instituto de Investigación Hospital Universitario 12 de Octubre, Madrid, Spain.,Immunology Section, Universidad San Pablo-CEU, Madrid, Spain
| | - J M Morales
- Department of Immunology, Instituto de Investigación Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Serrano
- Department of Immunology, Instituto de Investigación Hospital Universitario 12 de Octubre, Madrid, Spain.,Immunology Section, Universidad San Pablo-CEU, Madrid, Spain
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Origüen J, Fernández-Ruiz M, López-Medrano F, Ruiz-Merlo T, González E, Morales JM, Fiorante S, San-Juan R, Villa J, Orellana MÁ, Andrés A, Aguado JM. Progressive increase of resistance in Enterobacteriaceae urinary isolates from kidney transplant recipients over the past decade: narrowing of the therapeutic options. Transpl Infect Dis 2016; 18:575-84. [PMID: 27373698 DOI: 10.1111/tid.12547] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/04/2016] [Accepted: 02/09/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Antibiotic resistance is an emerging phenomenon in kidney transplantation (KT). METHODS We compared species distribution and antimicrobial susceptibility patterns in 1052 isolates from urine cultures obtained in 2 different cohorts of kidney transplant recipients in a single center (Cohort A: 189 patients undergoing KT between January 2002 and December 2004 [336 isolates]; Cohort B: 115 patients undergoing KT between January 2011 and December 2013 [716 isolates]). RESULTS Asymptomatic bacteriuria accounted for most of the isolates (86.9% in Cohort A and 92.3% in Cohort B). Klebsiella pneumoniae (9.5% vs. 15.6%), Pseudomonas aeruginosa (1.8% vs. 7.9%), and Enterobacter cloacae (0.6% vs. 3.1%) were significantly more common in Cohort B. The isolation of K. pneumoniae in Cohort B was associated with the occurrence of acute pyelonephritis (9.8% of all K. pneumoniae isolates vs. 2.8% of the remaining uropathogens; P = 0.001). Non-susceptibility rates among Enterobacteriaceae in Cohort B were higher for every class of antibiotics (P ≤ 0.003) with the exception of fosfomycin. Compared to Cohort A, significant increases were seen in isolates from Cohort B for multidrug-resistant (MDR) (43.9% vs. 67.8%, respectively; P = 0.001), extended-spectrum beta-lactamase (ESBL)-producing (6.6% vs. 26.1%; P = 0.001), and carbapenemase-producing Enterobacteriaceae strains (0.0% vs. 5.0%; P = 0.001). Such differences were mostly attributable to K. pneumoniae (as 54.5% and 13.4% of isolates in Cohort B were ESBL-producing and carbapenemase-producing, respectively). MDR isolates were responsible for 69.1% of episodes of symptomatic urinary tract infection in Cohort B. CONCLUSION The increase in resistance rates among Enterobacteriaceae uropathogens is significant and may have an effect on KT programs.
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Affiliation(s)
- J Origüen
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - F López-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - T Ruiz-Merlo
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - E González
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - J M Morales
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - S Fiorante
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - R San-Juan
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - J Villa
- Department of Microbiology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - M Á Orellana
- Department of Microbiology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - A Andrés
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
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López-Medrano F, Silva JT, Fernández-Ruiz M, Carver PL, van Delden C, Merino E, Pérez-Saez MJ, Montero M, Coussement J, de Abreu Mazzolin M, Cervera C, Santos L, Sabé N, Scemla A, Cordero E, Cruzado-Vega L, Martín-Moreno PL, Len Ó, Rudas E, de León AP, Arriola M, Lauzurica R, David M, González-Rico C, Henríquez-Palop F, Fortún J, Nucci M, Manuel O, Paño-Pardo JR, Montejo M, Muñoz P, Sánchez-Sobrino B, Mazuecos A, Pascual J, Horcajada JP, Lecompte T, Lumbreras C, Moreno A, Carratalà J, Blanes M, Hernández D, Hernández-Méndez EA, Fariñas MC, Perelló-Carrascosa M, Morales JM, Andrés A, Aguado JM. Risk Factors Associated With Early Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: Results From a Multinational Matched Case-Control Study. Am J Transplant 2016; 16:2148-57. [PMID: 26813515 DOI: 10.1111/ajt.13735] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/13/2016] [Indexed: 01/25/2023]
Abstract
Risk factors for invasive pulmonary aspergillosis (IPA) after kidney transplantation have been poorly explored. We performed a multinational case-control study that included 51 kidney transplant (KT) recipients diagnosed with early (first 180 posttransplant days) IPA at 19 institutions between 2000 and 2013. Control recipients were matched (1:1 ratio) by center and date of transplantation. Overall mortality among cases was 60.8%, and 25.0% of living recipients experienced graft loss. Pretransplant diagnosis of chronic pulmonary obstructive disease (COPD; odds ratio [OR]: 9.96; 95% confidence interval [CI]: 1.09-90.58; p = 0.041) and delayed graft function (OR: 3.40; 95% CI: 1.08-10.73; p = 0.037) were identified as independent risk factors for IPA among those variables already available in the immediate peritransplant period. The development of bloodstream infection (OR: 18.76; 95% CI: 1.04-339.37; p = 0.047) and acute graft rejection (OR: 40.73, 95% CI: 3.63-456.98; p = 0.003) within the 3 mo prior to the diagnosis of IPA acted as risk factors during the subsequent period. In conclusion, pretransplant COPD, impaired graft function and the occurrence of serious posttransplant infections may be useful to identify KT recipients at the highest risk of early IPA. Future studies should explore the potential benefit of antimold prophylaxis in this group.
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Affiliation(s)
- F López-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J T Silva
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - P L Carver
- University of Michigan Health System, Ann Arbor, MI
| | - C van Delden
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - E Merino
- Unit of Infectious Diseases, Hospital Universitario General, Alicante, Spain
| | - M J Pérez-Saez
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - M Montero
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J Coussement
- Department of Nephrology, Dialysis and Kidney Transplantation, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M de Abreu Mazzolin
- Division of Nephology, Department of Medicine, Universidade Federal de São Paulo-UNIFESP and Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos, São Paulo, Brazil
| | - C Cervera
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - L Santos
- Unit of Renal Transplantation, Department of Urology and Kidney Transplantation, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - N Sabé
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - A Scemla
- Service de Néphrologie et Transplantation Adulte, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Paris, France
| | - E Cordero
- Unit of Infectious Diseases, Hospitales Universitarios "Vigen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - L Cruzado-Vega
- Department of Nephrology, Hospital Universitario "La Fe", Valencia, Spain
| | - P L Martín-Moreno
- Department of Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Ó Len
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - E Rudas
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - A Ponce de León
- Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, México
| | - M Arriola
- Clínica de Nefrología, Urología y Enfermedades Cardiovasculares, Santa Fe, Argentina
| | - R Lauzurica
- Department of Nephrology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - M David
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C González-Rico
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - F Henríquez-Palop
- Department of Nephrology, University Hospital "Doctor Negrín", Las Palmas de Gran Canaria, Spain
| | - J Fortún
- Department of Infectious Diseases, University Hospital "Ramón y Cajal", Madrid, Spain
| | - M Nucci
- Department of Internal Medicine, Hematology Service and Mycology Laboratory, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - O Manuel
- Department of Infectious Diseases and Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - J R Paño-Pardo
- Department of Internal Medicine, Hospital Universitario "La Paz", School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Montejo
- Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Bilbao, Spain
| | - P Muñoz
- Department of Microbiology and Infectious Diseases, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - B Sánchez-Sobrino
- Department of Nephrology, Hospital Universitario Puerta de Hierro-Majadahonda, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - A Mazuecos
- Department of Nephrology, Hospital Universitario "Puerta del Mar", Cádiz, Spain
| | - J Pascual
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J P Horcajada
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - T Lecompte
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - C Lumbreras
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - A Moreno
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - M Blanes
- Unit of Infectious Diseases, Hospital Universitario "La Fe", Valencia, Spain
| | - D Hernández
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - E A Hernández-Méndez
- Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, México
| | - M C Fariñas
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - M Perelló-Carrascosa
- Department of Nephrology, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - J M Morales
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - A Andrés
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
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Galindo I, Romero MC, Sánchez N, Morales JM. Quantitative volcanic susceptibility analysis of Lanzarote and Chinijo Islands based on kernel density estimation via a linear diffusion process. Sci Rep 2016; 6:27381. [PMID: 27265878 PMCID: PMC4893674 DOI: 10.1038/srep27381] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/10/2016] [Indexed: 11/23/2022] Open
Abstract
Risk management stakeholders in high-populated volcanic islands should be provided with the latest high-quality volcanic information. We present here the first volcanic susceptibility map of Lanzarote and Chinijo Islands and their submarine flanks based on updated chronostratigraphical and volcano structural data, as well as on the geomorphological analysis of the bathymetric data of the submarine flanks. The role of the structural elements in the volcanic susceptibility analysis has been reviewed: vents have been considered since they indicate where previous eruptions took place; eruptive fissures provide information about the stress field as they are the superficial expression of the dyke conduit; eroded dykes have been discarded since they are single non-feeder dykes intruded in deep parts of Miocene-Pliocene volcanic edifices; main faults have been taken into account only in those cases where they could modified the superficial movement of magma. The application of kernel density estimation via a linear diffusion process for the volcanic susceptibility assessment has been applied successfully to Lanzarote and could be applied to other fissure volcanic fields worldwide since the results provide information about the probable area where an eruption could take place but also about the main direction of the probable volcanic fissures.
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Affiliation(s)
- I Galindo
- Spanish Geological Survey, Unit of Canary Islands, Alonso Alvarado, 43, 2°A, 35003, Las Palmas de Gran Canaria, Spain
| | - M C Romero
- University of La Laguna, Department of Geography, 38207, La Laguna. Tenerife, Spain
| | - N Sánchez
- Spanish Geological Survey, Unit of Canary Islands, Alonso Alvarado, 43, 2°A, 35003, Las Palmas de Gran Canaria, Spain
| | - J M Morales
- University of Las Palmas de Gran Canaria, Faculty of Teacher Training, Special Didactics Department, 35004, Las Palmas de Gran Canaria, Spain
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9
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Polanco N, González Monte E, Folgueira MD, Morales E, Gutiérrez Martínez E, Bengoa I, Hernández A, Morales JM, Praga M, Andrés A. Everolimus-based immunosuppression therapy for BK virus nephropathy. Transplant Proc 2015; 47:57-61. [PMID: 25645770 DOI: 10.1016/j.transproceed.2014.11.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Mammalian target of rapamycin inhibitors (mTOR-i) have been proposed as possible immunosuppressants of choice in BK virus nephropathy (BKN) because of their antiviral capacity. On this basis, in 2007, our Service proposed a conversion to everolimus (EVE)-based therapy from calcineurin inhibitors with an anti-calcineurin-free therapy protocol in those patients diagnosed of BKN. METHODS A prospective, single-center case series study was performed. Fifteen cases of BKN were diagnosed from 2007 to the end of 2010. According to our protocol, immunosuppressant treatment was modified in 9 of these patients with suspension of mycophenolate and conversion from tacrolimus to EVE. RESULTS The renal function achieved by our patients after the transplantation was excellent. Mean serum creatinine (sCr) achieved was 1.16 ± 0.2 mg/dL. Evolution of the renal function after BKN diagnosis and conversion to mTOR-i was positive in all the patients. sCr on diagnosis was 1.85 ± 0.22 mg/dL, sCr at the point in time of conversion to EVE was 2 ± 0.21 mg/dL, and final sCr of the follow-up was 1.6 ± 0.39 mg/dL (P = .05). BK viremia became negative in 5 of our patients and decreased more than 95% in the remaining 4. None of the patients had an acute rejection episode after the change of immunosuppressant. CONCLUSIONS Conversion to mTOR-i-based therapy could provide an added benefit in BKN and could be an effective strategy for the decrease of the viremia and increase of graft survival in selected patients.
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Affiliation(s)
- N Polanco
- Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain.
| | | | - M D Folgueira
- Department of Microbiology, Hospital 12 de Octubre, Madrid, Spain
| | - E Morales
- Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
| | | | - I Bengoa
- Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
| | - A Hernández
- Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
| | - J M Morales
- Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
| | - M Praga
- Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
| | - A Andrés
- Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
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10
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Lledó-García E, Riera L, Passas J, Paredes D, Morales JM, Sánchez-Escuredo A, Burgos-Revilla FJ, de Andrés Belmonte A, Oppenheimer F, Rodríguez-Ferrero ML, Solé M, Matesanz R, Valentín M, Pascual J. Spanish consensus document for acceptance and rejection of kidneys from expanded criteria donors. Clin Transplant 2014; 28:1155-66. [PMID: 25109314 DOI: 10.1111/ctr.12434] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2014] [Indexed: 01/20/2023]
Abstract
In the recent years, more than 60% of available deceased donors are either older than 50 yr or have significant vascular comorbidities. This makes the acceptance and rejection criteria of renal allografts very rigorous, especially in cases of younger recipients, and at the same time encourages live donations. In our country, there is a lack of homogeneity in the percentages of use of expanded criteria donor (ECD) allografts between the different autonomous communities. Furthermore, the criteria vary greatly, and in some cases, great importance is given to the biopsy while in others very little. In this study, we present a unified and homogenous criteria agreed upon by consensus of a 10-member Panel representing major scientific societies related to renal transplantation in Spain. The criteria are to be used in accepting and/or rejecting kidneys from the so-called ECDs. The goal was to standardize the use of these organs, to optimize the results, and most importantly to provide for the maximum well being of our patients. Finally, we believe that after taking into account the Panel's thorough review of specific scientific literature, this document will be adaptable to other national renal transplant programmes.
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11
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Fernández-Ruiz M, López-Medrano F, Andrés A, Morales JM, Lumbreras C, San-Juan R, Polanco N, González E, Aguado JM. Serum iron parameters in the early post-transplant period and infection risk in kidney transplant recipients. Transpl Infect Dis 2013; 15:600-11. [PMID: 24011120 DOI: 10.1111/tid.12137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 03/05/2013] [Accepted: 04/11/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND The impact of iron metabolism on the risk of infectious complications has been demonstrated in various immunosuppressed populations. However, no previous studies have assessed this potential association in kidney transplant (KT) recipients. METHODS We prospectively analyzed 228 patients undergoing KT at our institution from November 2008 to February 2011. Serum iron parameters (iron level, ferritin, total iron-binding capacity, unsaturated iron-binding capacity, transferrin, and transferrin saturation) were assessed within the first 2 weeks after transplantation (median interval, 3 days; interquartile [Q1 -Q3 ] range, 1-6 days), and before the occurrence of the first infectious episode (median interval, 26 days; Q1 -Q3 range, 11-76 days). Primary outcome was the occurrence of any episode of infection during the first year. Multivariate-adjusted hazard ratios (aHRs) were estimated by Cox regression models. RESULTS Patients with ferritin level ≥ 500 ng/mL had higher incidence rates (per 1000 transplant-days) of overall infection (P = 0.017), bacterial infection (P = 0.002), and bloodstream infection (P = 0.011) during the first post-transplant year. One-year infection-free survival rate was lower in these recipients (26% vs. 41%; P = 0.004). On multivariate analysis, after adjusting for potential confounders, ferritin emerged as an independent predictor of overall infection (aHR [per unitary increment], 1.001; P = 0.006), and bacterial infection (aHR [per unitary increment], 1.001; P = 0.020). CONCLUSION Monitoring of serum iron parameters in the early post-transplant period may be useful in predicting the occurrence of infection in KT recipients, although further studies should be carried out to confirm this preliminary finding.
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Affiliation(s)
- M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
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12
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Fernández-Ruiz M, López-Medrano F, Varela-Peña P, Morales JM, García-Reyne A, San Juan R, Lumbreras C, Lora-Pablos D, Polanco N, Andrés A, Paz-Artal E, Aguado JM. Hypocomplementemia in kidney transplant recipients: impact on the risk of infectious complications. Am J Transplant 2013; 13:685-94. [PMID: 23311502 DOI: 10.1111/ajt.12055] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 10/31/2012] [Accepted: 11/12/2012] [Indexed: 01/25/2023]
Abstract
The usefulness of monitoring of complement levels in predicting the occurrence of infection in kidney transplant (KT) recipients remains largely unknown. We prospectively assessed serum complement levels (C3 and C4) at baseline and at months 1 and 6 in 270 patients undergoing KT. Adjusted hazard ratios (aHRs) for infection in each posttransplant period were estimated by Cox regression. The prevalence of C3 hypocomplementemia progressively decreased from 21.5% at baseline to 11.6% at month 6 (p = 0.017), whereas the prevalence of C4 hypocomplementemia rose from 3.7% at baseline to 9.2% at month 1 (p = 0.004). Patients with C3 hypocomplementemia at month 1 had higher incidences of overall (p = 0.002), bacterial (p = 0.004) and fungal infection (p = 0.019) in the intermediate period (months 1-6). On multivariate analysis C3 hypocomplementemia at month 1 emerged as a risk factor for overall (aHR 1.911; p = 0.009) and bacterial infection (aHR 2.130; p = 0.014) during the intermediate period, whereas C3 hypocomplementemia at month 6 predicted the occurrence of bacterial infection (aHR 3.347; p = 0.039) in the late period (>6 month). A simple monitoring strategy of serum C3 levels predicts the risk of posttransplant infectious complications in KT recipients.
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Affiliation(s)
- M Fernández-Ruiz
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), Hospital Universitario 12 de Octubre, School of Medicine, Universidad Complutense, Madrid, Spain.
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13
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San-Juan R, De Dios B, García-Reyne A, Fernández-Ruiz M, Lumbreras C, López-Medrano F, Morales JM, Hernando S, Folgueira D, Jiménez C, Aguado JM. Limited impact of cytomegalovirus infection in the long-term outcome of renal and liver transplant. J Clin Virol 2013; 56:316-22. [PMID: 23290883 DOI: 10.1016/j.jcv.2012.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 12/08/2012] [Accepted: 12/10/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND The strength of the assumed association of CMV and long term deleterious events in solid organ transplant recipients (SOT) is controversial. OBJECTIVES The aim of the present study was to evaluate whether viral replication dynamics during CMV infection or CMV disease may correlate not only with graft dysfunction and survival, but also with other potentially related late events in a long-term followed cohort of kidney (KT) and liver (LT) transplant recipients. STUDY DESIGN 162 SOT (104 kidney, 58 liver) at our institution (2003-2005) with survival over 180 days and a median follow-up of 71 months (9-86) were analyzed. Using a Cox proportional hazard model, CMV infection (including area under the curve of DNAemia[AUC]) and CMV disease in the first 180 days were evaluated as potential predictors of the following late events (>180 days): mortality, graft dysfunction (GD), graft loss (GL), cardiovascular events (CVE), malignant tumors (MT). RESULTS CMV infection occurred in 59% and CMV disease in 8%. Late death occurred in 17%, GD in 45.6%, GL in 14.2%, CVE in 10.5% and MT in 9.9%. We found no significant association between the intensity or duration of CMV viremia (AUC, persistent viremia or untreated CMV viremia) or CMV disease and the development of evaluated late events. According multivariate analysis neither CMV infection (hazard ratio [HR] 2.18 95% CI 0.949-5 p = 0.066) nor CMV disease (HR: 1.72; 95% CI 0.59-5 p = 0.31) were significantly correlated with late mortality. CONCLUSIONS Our data do not support that CMV infection or CMV disease contribute significantly to long-term deleterious events in SOT.
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Affiliation(s)
- R San-Juan
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain.
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14
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Morales JM, Marcén R, del Castillo D, Andres A, Gonzalez-Molina M, Oppenheimer F, Serón D, Gil-Vernet S, Lampreave I, Gainza FJ, Valdés F, Cabello M, Anaya F, Escuin F, Arias M, Pallardó L, Bustamante J. Risk factors for graft loss and mortality after renal transplantation according to recipient age: a prospective multicentre study. Nephrol Dial Transplant 2012; 27 Suppl 4:iv39-46. [PMID: 23258810 PMCID: PMC3526982 DOI: 10.1093/ndt/gfs544] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 10/18/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To describe the causes of graft loss, patient death and survival figures in kidney transplant patients in Spain based on the recipient's age. METHODS The results at 5 years of post-transplant cardiovascular disease (CVD) patients, taken from a database on CVD, were prospectively analysed, i.e. a total of 2600 transplanted patients during 2000-2002 in 14 Spanish renal transplant units, most of them receiving their organ from cadaver donors. Patients were grouped according to the recipient's age: Group A: <40 years, Group B: 40-60 years and Group C: >60 years. The most frequent immunosuppressive regimen included tacrolimus, mycophenolate mofetil and steroids. RESULTS Patients were distributed as follows: 25.85% in Group A (>40 years), 50.9% in Group B (40-60 years) and 23.19% in Group C (>60). The 5-year survival for the different age groups was 97.4, 90.8 and 77.7%, respectively. Death-censored graft survival was 88, 84.2 and 79.1%, respectively, and non death-censored graft survival was 82.1, 80.3 and 64.7%, respectively. Across all age groups, CVD and infections were the most frequent cause of death. The main causes of graft loss were chronic allograft dysfunction in patients <40 years old and death with functioning graft in the two remaining groups. In the multivariate analysis for graft survival, only elevated creatinine levels and proteinuria >1 g at 6 months post-transplantation were statistically significant in the three age groups. The patient survival multivariate analysis did not achieve a statistically significant common factor in the three age groups. CONCLUSIONS Five-year results show an excellent recipient survival and graft survival, especially in the youngest age group. Death with functioning graft is the leading cause of graft loss in patients >40 years. Early improvement of renal function and proteinuria together with strict control of cardiovascular risk factors are mandatory.
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Affiliation(s)
| | - Roberto Marcén
- Department of Nephrology, Hospital Ramon y Cajal, Madrid, Spain
| | | | - Amado Andres
- Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
| | | | | | - Daniel Serón
- Department of Nephrology, Hospital Vall d Hebron, Barcelona, Spain
| | | | | | | | - Francisco Valdés
- Department of Nephrology, Hospital Juan Canalejo, La Coruña, Spain
| | | | - Fernando Anaya
- Department of Nephrology, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Manuel Arias
- Department of Nephrology, Hospital Marqués de Valdecilla, Santander, Spain
| | - Luis Pallardó
- Department of Nephrology, Hospital Dr Peset, Valencia, Spain
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15
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Fernández-Ruiz M, López-Medrano F, Varela-Peña P, Lora-Pablos D, García-Reyne A, González E, Morales JM, San Juan R, Lumbreras C, Paz-Artal E, Andrés A, Aguado JM. Monitoring of immunoglobulin levels identifies kidney transplant recipients at high risk of infection. Am J Transplant 2012; 12:2763-73. [PMID: 22823002 DOI: 10.1111/j.1600-6143.2012.04192.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We aimed to analyze the incidence, risk factors and impact of hypogammaglobulinemia (HGG) in 226 kidney transplant (KT) recipients in which serum immunoglobulin (Ig) levels were prospectively assessed at baseline, month 1 (T(1) ), and month 6 (T(6) ). The prevalence of IgG HGG increased from 6.6% (baseline) to 52.0% (T(1) ) and subsequently decreased to 31.4% (T(6) ) (p < 0.001). The presence of IgG HGG at baseline (odds ratio [OR] 26.9; p = 0.012) and a positive anti-HCV status (OR 0.17; p = 0.023) emerged as risk factors for the occurrence of posttransplant IgG HGG. Patients with HGG of any class at T(1) had higher incidences of overall (p = 0.018) and bacterial infection (p = 0.004), bacteremia (p = 0.054) and acute pyelonephritis (p = 0.003) in the intermediate period (months 1-6). Patients with HGG at T(6) had higher incidences of overall (p = 0.004) and bacterial infection (p < 0.001) in the late period (>6 month). A complementary log-log model identified posttransplant HGG as an independent risk factor for overall (hazard ratio [HR] 2.03; p < 0.001) and bacterial infection (HR 2.68; p < 0.0001). Monitoring of humoral immunity identifies KT recipients at high risk of infection, offering the opportunity for preemptive immunoglobulin replacement therapy.
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Affiliation(s)
- M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre. Instituto de Investigación Hospital 12 de Octubre (i+12), School of Medicine, Universidad Complutense, Madrid, Spain.
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16
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Andrés A, Delgado-Arranz M, Morales E, Dipalma T, Polanco N, Gutierrez-Solis E, Morales JM, Praga M, Gutierrez E, Gonzalez E. Extended-release tacrolimus therapy in de novo kidney transplant recipients: single-center experience. Transplant Proc 2011; 42:3034-7. [PMID: 20970602 DOI: 10.1016/j.transproceed.2010.07.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Available data for extended-release tacrolimus (Tac) except in clinical trials are limited. OBJECTIVE To describe our initial experience with once-daily Tac in combination with corticosteroids and mycophenolate mofetil therapy in patients undergoing de novo renal transplantation. PATIENTS AND METHODS In this retrospective, observational, single-center study, data were obtained for 49 adult recipients treated with extended-release Tac and 30 patients treated with standard-release Tac (control group). Mean (SD) follow-up in the 2 groups was 3.5 (2.5) months and 4.0 (2.6) months, respectively. The primary characteristics were comparable between the groups. RESULTS The acute rejection rate in the extended-release group was 10%, and 13% in the standard-release group. Patient and graft survival rates were 98% and 96% vs 100% and 90%, respectively. Renal function in the 2 groups was comparable: serum creatinine concentration 1.3 (0.2) mg/dL vs 1.45 (0.4) mg/dL. At day 14 posttransplantation, Tac doses were 0.17 mg/kg/d vs 0.14 mg/kg/d, and blood concentrations were 9.0 ng/mL vs 14.0 ng/mL. In recipients older than 60 years, lower dosages of Tac resulted in blood concentrations similar to those in younger patients, with less variation in dosage. CONCLUSIONS Short-term experience with extended-release Tac therapy in de novo renal recipients confirms its efficacy and safety. Adjusting blood concentrations in the immediate posttransplantation period is less difficult with extended-release Tac compared with the twice-daily formulation.
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Affiliation(s)
- A Andrés
- Nephrology Department, Hospital 12 de Octubre, Madrid, Spain.
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17
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Cuellar-Baena S, Morales JM, Martinetto H, Calvar J, Sevlever G, Castellano G, Cerdá-Nicolás M, Celda B, Monleon D. Comparative metabolic profiling of paediatric ependymoma, medulloblastoma and pilocytic astrocytoma. Int J Mol Med 2011; 26:941-8. [PMID: 21042791 DOI: 10.3892/ijmm_00000546] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Brain tumours are the most common solid tumours in children and a major cause of childhood mortality. The most common paediatric brain tumours include ependymomas, cerebellar astrocytomas and medulloblastomas. These brain tumours are highly heterogeneous regarding their histology, prognosis and therapeutic response. Subtle biochemical changes can be detected in intact tissues by High-Resolution Proton Magnetic Angle Spinning Spectroscopy (HR-MAS) revealing the status of tumour microheterogeneity and metabolic alterations before they are morphologically detectable. In this study, we present metabolic profiles by HR-MAS of 20 intact tissue samples from paediatric brain tumours. Tumour types include ependymoma, medulloblastoma and pilocytic astrocytoma. The metabolic characterization of paediatric brain tumour tissue by HR-MAS spectroscopy provided differential patterns for these tumours. The metabolic composition of the tumour tissue was highly consistent with previous in vivo and ex vivo studies. Some resonances detected in this work and not previously observed by in vivo spectroscopy also show potential in determining tumour type and grade (fatty acids, phenylalanine, glutamate). Overall, this work suggests that the additional information obtained by NMR metabolic profiling applied to tissue from paediatric brain tumours may be useful for assessing tumour grade and determining optimum treatment strategies.
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Affiliation(s)
- S Cuellar-Baena
- Instituto de Física Gleb Wataghin, Universidade Estadual de Campinas, UNICAMP, Brazil
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18
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Morales JM, Campistol JM, Domínguez-Gil B, Andrés A, Esforzado N, Oppenheimer F, Castellano G, Fuertes A, Bruguera M, Praga M. Long-term experience with kidney transplantation from hepatitis C-positive donors into hepatitis C-positive recipients. Am J Transplant 2010; 10:2453-62. [PMID: 20977636 DOI: 10.1111/j.1600-6143.2010.03280.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Kidney transplantation from hepatitis C virus (HCV) antibody positive donors (HCVD+) into HCV antibody positive recipients (HCVR+) is controversial. We implemented this policy in our units in 1990. Herein, we report the long-term safety of this strategy. From March 1990 to March 2007, 162 HCVR+ received a kidney from HCVD+ (group 1) and 306 from HCVD- (group 2) in our units. Mean follow-up was 74.5 months. Five-and 10-year patient survival was 84.8% and 72.7% in group 1 vs. 86.6% and 76.5% in group 2 (p = 0.250). Three deaths in group 1 and two in group 2 were liver-disease related. Five- and 10-year graft survival was 58.9% and 34.4% versus 65.5% and 47.6% respectively (p = 0.006) while death-censored graft survival was 69% and 47% versus 72.7% and 58.5% (p = 0.055). Decompensated chronic liver disease was similar: 10.3% versus 6.2%. Cox-regression analysis could not identify the donor's HCV serology as a significant risk factor for death, graft failure and severe liver disease in HCVR+. In conclusion, long-term outcome of HCVR+ transplanted with kidneys from HCVD+ seems good in terms of patient survival, graft survival and liver disease. HCVD+ was not a significant risk factor for mortality, graft failure and liver disease among HCVR+. These data strongly suggest that the use of kidneys from HCVD+ in HCVR+ is a safe long-term strategy that helps to prevent kidney loss.
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Affiliation(s)
- J M Morales
- Nephrology Department, Hospital 12 de Octubre, Madrid, Spain.
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19
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Garcia-Reyne A, López-Medrano F, Morales JM, García Esteban C, Martín I, Eraña I, Meije Y, Lalueza A, Alastruey-Izquierdo A, Rodríguez-Tudela JL, Aguado JM. Cutaneous infection by Phomopsis longicolla in a renal transplant recipient from Guinea: first report of human infection by this fungus. Transpl Infect Dis 2010; 13:204-7. [PMID: 21457423 DOI: 10.1111/j.1399-3062.2010.00570.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report the case of a 72-year-old female renal transplant recipient with a nodular lesion in the distal phalange of the third left finger produced by a dematiaceous fungus that was identified as Phomopsis longicolla. She was treated with itraconazole and terbinafine and later with voriconazole, without response. The patient underwent a surgical resection with lesion-free edge and continued on voriconazole. One year later she was asymptomatic and had not developed new lesions.
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Affiliation(s)
- A Garcia-Reyne
- Infectious Disease Unit, University Hospital 12 Octubre, Madrid, Spain.
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20
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Ramírez E, Serrano A, García F, Alfaro FJ, Pérez V, Paz-Artal E, Morales JM. Prospective study on autoantibodies against apolipoprotein H (beta2GPI) in several clinical parameters from patients with terminal renal failure and functioning renal transplants. Transplant Proc 2010; 41:2370-2. [PMID: 19715922 DOI: 10.1016/j.transproceed.2009.06.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Renal transplantation is the best therapeutic option for patients with end-stage renal disease. However, long-term results have not been very encouraging because of patient deaths due to cardiovascular disease and chronic transplant nephropathy (CTN), which includes vascular damage similar to arteriosclerosis injury. Several autoantibodies have been related to vasculopathy in the transplant such as anti-beta2GPI IgA, IgG, and IgM autoantibodies. We analyzed the levels of these autoantibodies among a cohort of 176 transplant recipients and a control group of 80 healthy subjects using enzyme-linked immunosorbent assay (ELISA). We collected data concerning the cardiovascular status of the patients, such as age, sex, diabetes mellitus, biopsy-confirmed CTN, schemic cardiopathy, cholesterol, triglycerides, and renal status by Modification of Diet in Renal Disease (MDRD) clearance and proteinuria. We also selected other characteristics, including hepatitis C virus infection and systolic/diastolic arterial pressures. The proportion of patients with high levels of IgG and IgM anti-beta2GPI autoantibodies did not differ from that observed in the control group, whereas the difference became significant in the case of anti-beta2GPI IgA autoantibodies (19.88% vs 1%). These results for the presence of anti-beta2GPI IgA autoantibodies were related to clinical data through a multivariate analysis, where the only parameter influenced by the presence of these autoantibodies seemed to be proteinuria, which in most cases was due to CTN.
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Affiliation(s)
- E Ramírez
- Immunology and Nephrology Departments, Hospital Universitario 12 de Octubre, Madrid, Spain
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21
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Medina Polo J, Morales JM, Blanco M, Aguirre JF, Andrés A, Díaz R, Jiménez C, Leiva O, Meneu JC, Moreno E, Pamplona M, Passas J, Rodríguez A, de la Rosa F. Urological complications after simultaneous pancreas-kidney transplantation. Transplant Proc 2010; 41:2457-9. [PMID: 19715950 DOI: 10.1016/j.transproceed.2009.06.065] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We evaluated the incidence of urological complications after simultaneous renal and pancreatic transplantation. PATIENTS AND METHODS We retrospectively reviewed urological complications following 107 simultaneous kidney-pancreas transplantations performed at our institution between March 1995 and June 2008. The 46 women and 61 men were of mean age 37.8 years (range, 25-66). The mean duration of diabetes mellitus was 23.0 years (range, 9-48) and the mean duration of dialysis was 19.9 months (range, 0-70). The exocrine pancreatic secretions were drained to bladder in 58 cases, or enterically in 49 patients. The mean length of follow-up was 51.7 months. RESULTS The most frequent urological complication was urinary tract infection, reported in 63.8% of patients: 42 bladder-drained and 25 enteric-drained (P = .011). Hematuria occurred in 13 patients (12.5%): 12 bladder-drained and 1 enteric-drained (P = .002). Five bladder-drained patients developed bladder calculi. Among 58 bladder-drained patients, reflux pancreatitis occurred in 28 patients and urine leaks related to the pancreatic graft occurred in 7 patients. Conversion of exocrine secretions from bladder to enteric diversion was required in 6 patients. One- and 3-year patient survival rates were 92.7% and 89.1%, respectively. Moreover, 1 and 3-year kidney graft survival rates were 90.6% and 84.4%, and pancreas graft survival rates were 78.1 and 70.3%, respectively. CONCLUSION Simultaneous kidney-pancreas transplantation with bladder drainage is associated with a high frequency of urological complications. Appropriate treatment can resolve most complications. In our opinion, both enteric and bladder drainage seemed to be safe and effective alternatives to manage pancreatic exocrine secretions.
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Affiliation(s)
- J Medina Polo
- Department of Urology, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Blanco M, Medina J, Pamplona M, Miranda N, Gonzalez E, Aguirre JF, Andres A, Leiva O, Morales JM. Outcome of renal transplantation in adult patients with augmented bladders. Transplant Proc 2010; 41:2382-4. [PMID: 19715926 DOI: 10.1016/j.transproceed.2009.06.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We studied the long-term renal graft functions, survivals, and complications among patients with augmented bladders. PATIENTS AND METHODS Between 1976 and 2008, we performed 6/2600 renal transplantations in patients with augmented bladders. The mean patient age was 52 years. The cause of end-stage renal disease was chronic interstitial kidney disease in all patients, being secondary to lower urinary tract dysfunction. The etiology of bladder dysfunction was tuberculosis in 4 cases, bladder exstrophy in 1, and myelomeningocele in 1. Enterocystoplasty had been performed at a mean of 19 years prior to transplantation. The ureter was implanted into the native ureter in 5 cases and the bowel segment in 1 case. RESULTS With a mean follow-up of 56 months (range, 20-100 months), the overall graft survival was 50%. Three grafts were lost due to venous thrombosis (n = 1), and chronic allograft nephropathy (n = 2) at 37 and 100 months posttransplantation. No patient died during follow-up. Mean serum creatinine was 1.44 mg/dL with Modification of Diet in Renal Disease (MDRD) clearance of 76 mL/min/1.73 m(2). One fistula that caused obstructive uropathy and 2 cases of migration of a double J catheter were among the surgical complications. These patients showed a mean of 7 episodes of uncomplicated urinary infections. Only 1 patient was rehospitalized due to a complicated urinary tract infection. CONCLUSIONS Patients with enterocystoplasty and renal transplantation show a greater risk of urinary tract infections, albeit mostly uncomplicated. Despite this, the long-term results are acceptable.
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Affiliation(s)
- M Blanco
- Department of Urology, Doce de Octubre University Hospital, Madrid, Spain.
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Jiménez-Romero C, Manrique A, Meneu JC, Cambra F, Andrés A, Morales JM, González E, Hernández E, Morales E, Praga M, Gutierrez E, Moreno E. Compative study of bladder versus enteric drainage in pancreas transplantation. Transplant Proc 2010; 41:2466-8. [PMID: 19715953 DOI: 10.1016/j.transproceed.2009.06.164] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is some controversy concerning the choice of best technique for drainage of exocrine secretions in pancreas transplantation. We compared patients with bladder drainage (BD) versus those with enteric drainage (ED). PATIENTS AND METHODS From March 1995 to September 2008, 118 patients (68 men and 50 women) of overall mean age of 37.8 +/- 7.8 years underwent pancreas transplantation. There were 109 simultaneous pancreas-kidney, and 9 pancreas after kidney procedures. Recipients were divided in a BD (n = 66 patients) and an ED group (n = 52). RESULTS Donor characteristics were similar in both groups. Thirty-two patients (48.5%) of the BD group versus none in the ED group experienced urinary tract infections (UTI; P < .001), and 16 patients (24.2%) BD versus 15 (29.4%) ED developed intraabdominal infections (P = NS). The overall rate of relaparotomies was 33.9% (n = 40): 34.8% (n = 23) in the BD versus 32.7% (n = 17) in the ED group (P = NS). Thirty patients (25.4%) lost their pancreas grafts: 21 (31.8%) in the BD group versus 9 (17.3%) in the ED group (P = .055). The acute rejection rates were 12.7%; namely, 15.2% in the BD versus 9.8% in the ED (P = NS). Three-year patient and graft survivals were equivalent in both groups: 96.1% and 65.3% in the BD versus 89.0% and 74.0% in the ED group, respectively (P = NS). CONCLUSIONS ED is a good alternative to BD for drainage of pancreatic graft exocrine secretions because both techniques have the same patient and graft survival, but BD is associated with a significantly higher rate of UTI and urologic complications.
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Affiliation(s)
- C Jiménez-Romero
- Servicio de Cirugía General y Trasplante de Organos Abdominales, Hospital Doce de Octubre, Madrid, Spain.
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24
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Morales JM, Hartmann A, Walker R, Arns W, Senatorski G, Grinyó JM, Shoker A, Wilczek H, Jamieson NV, Lelong M, Brault Y, Burke JT, Scarola JA. Similar lipid profile but improved long-term outcomes with sirolimus after cyclosporine withdrawal compared to sirolimus with continuous cyclosporine. Transplant Proc 2010; 41:2339-44. [PMID: 19715914 DOI: 10.1016/j.transproceed.2009.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Renal transplant recipients show an increased risk of cardiovascular disease compared with a nontransplant population. Herein we have shown an analysis of a randomized controlled trial wherein 525 patients receiving a first or second (9.7%) renal allograft from a deceased (89.1%), a living-related (7.8%), or a living-unrelated donor (3.1%) received sirolimus (SRL), cyclosporine (CsA), and steroids (ST) at the time of transplantation with randomization at 3 months after transplantation of 430 eligible patients to continue on SRL-CsA-ST or to have CsA withdrawn with increased SRL trough targets (SRL-ST group). Graft survival, patient survival, and renal function at 5 years were analyzed by average fasting total cholesterol (<or=200 or >200 mg/dL) and triglyceride (<or=240 or >240 mg/dL) subgroups. At 5 years, total, high-density lipoprotein (HDL), and low-density lipoprotein [LDL] cholesterol and triglyceride values were similar between the groups. Statins ( approximately 80% of patients of both groups) were most effective to lower cholesterol ( approximately 50 mg/dL; P < .001; both groups), and fibrates ( approximately 25% of patients of both groups) were most effective to decrease triglycerides ( approximately 100 mg/dL; P < .001; both groups). Renal function and blood pressure were significantly better with SRL-ST. Hypercholesterolemia and hypertriglyceridemia were associated with reduced graft survival, patient survival, and calculated GFR, but the only significant difference was lower graft survival among SRL-CsA-ST patients with hypertriglyceridemia. Cardiovascular-related deaths were reported in 3.7% and 2.8% of patients in the SRL-CsA-ST and SRL-ST groups, respectively. In conclusion, when compared with continuous SRL-CsA-ST, CsA withdrawal at 3 months followed by SRL-ST significantly improved glomerular filtration rate (GFR) and blood pressure without a further increase in lipid parameters or an incidence of untoward effects from hyperlipidemia, despite a 2-fold higher SRL exposure.
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Blas-García A, Ballesteros D, Monleón D, Morales JM, Rocha M, Víctor VM, Apostolova N, Esplugues JV. Efavirenz induces alterations in lipid metabolism through AMPK activation. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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26
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Serón D, Anaya F, Marcén R, del Moral RG, Martul EV, Alarcón A, Andrés A, Burgos D, Capdevila L, Molina MG, Jiménez C, Morales JM, Oppenheimer F, Pallardó L, Fructuoso AS. [Guidelines for indicating, obtaining, processing and evaluating kidney biopsies]. Nefrologia 2008; 28:385-396. [PMID: 18662146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- D Serón
- Servei de Nefrología, Hospital Universitari de Bellvitge, Barcelona, España.
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Abstract
AIM To estimate the impact of infliximab (IFX) on hospital resources for patients with Crohn's disease. METHODS Resource use data for at least 1 year before (B-IFX) and after (A-IFX) infliximab administration were retrospectively collected for all patients treated with IFX at the Hospital Cabueñes (Spain). Direct costs calculated were: hospital-stays, surgeries, out-patient visits, diagnostic and laboratory tests, pharmacological treatments, and day-care hospitalization for IFX administration. RESULTS Patients (n = 34; mean age at treatment: 43.6 years) with 9.8 and 4.3 years (B-IFX and A-IFX, respectively) had their costs estimated. Partial or complete response was achieved in 82% of patients. Total annual B-IFX costs per patient were Euro 4,464, of which 62.4% was for hospitalization, 3.1% for surgery, 8.7% for consultation visits, 16.2% for diagnostic and laboratory tests, and 9.6% for other treatments. Total annual A-IFX costs per patient were Euro 10,594; of which 6.4% was for hospitalization, 0.8% for surgery, 4.2% for consultation visits, 7.6% for diagnostic and laboratory tests, 5.5% for other treatments, and 75.5% for IFX and its administration. The primary cost item was hospitalization (Euro 2,783) during the B-IFX period as opposed to IFX itself (Euro 7,996) during the subsequent A-IFX period. CONCLUSIONS In routine practice, IFX appears to be an effective treatment by reducing hospital-stays, but increases overall budgetary cost for patients with Crohn's disease.
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Affiliation(s)
- C Saro
- Department of Gastroenterology, Hospital de Cabueñes, Gijón, Spain
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28
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Gonzalez Molina M, Morales JM, Marcen R, Campistol JM, Oppenheimer F, Serón D, Gil-Vernet S, Capdevila L, Andrés A, Lampreave I, Del Castillo D, Cabello M, Burgos D, Valdés F, Anaya F, Escuín F, Arias M, Pallardó L, Bustamante J. Renal function in patients with cadaveric kidney transplants treated with tacrolimus or cyclosporine. Transplant Proc 2007; 39:2167-9. [PMID: 17889126 DOI: 10.1016/j.transproceed.2007.07.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Renal function predicts graft survival in kidney transplant patients. This study compared the 2-year evolution of renal function in patients treated with cyclosporine or tacrolimus in combination with mycophenolate mofetil (MMF) and prednisone. METHODS We studied 1558 cadaveric renal transplant recipients from 14 Spanish hospitals between January 2000 and December 2002. Of these, 1168 were treated with tacrolimus and 390 with cyclosporine. The primary efficacy endpoint was long-term renal function. Renal function was measured by serum creatinine and glomerular filtration rate (GFR) by creatinine clearance calculated from the Cockcroft-Gault formula. This report summarizes the 2-year results. RESULTS At 24 months the tacrolimus group showed significantly better serum creatinine (1.5 +/- 0.7 vs 1.8 +/- 0.8 mg/dL, P < .001) and GFR (60.5 +/- 20.9 mL/min vs 47.9 +/- 10.0, P < .001) than the cyclosporine group. Additionally, recipients with ideal graft donors (23.5 +/- 2.8 vs 24.0 +/- 2.9 years) had a better serum creatinine at 2 years (1.23 +/- 0.2 vs 1.5 +/- 0.4 mg/dL, P < .05). Multivariate analysis showed that tacrolimus was an independent factor associated with better renal function: odds ratio 1.6, 95% confidence interval (1.2 to 2.2), P < .001. CONCLUSIONS Patients with a renal transplant treated with tacrolimus in combination with MMF and prednisone displayed better renal function at 2 years than those who received cyclosporine.
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Affiliation(s)
- M Gonzalez Molina
- Department of Nephrology and the Kidney Transplantation Unit, Carlos Haya, Malaga, Spain.
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Ruiz JC, Campistol JM, Sanchez-Fructuoso A, Mota A, Grinyo JM, Paul J, Castro-Henriques A, Reimao-Pinto J, Garcia J, Morales JM, Granados E, Arias M. Early sirolimus use with cyclosporine elimination does not induce progressive proteinuria. Transplant Proc 2007; 39:2151-2. [PMID: 17889121 DOI: 10.1016/j.transproceed.2007.06.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Proteinuria has been reported in several papers after conversion from calcineurin inhibitors to Sirolimus (SRL), but this complication has not been analyzed in randomized clinical trials using de novo SRL. It is not known whether de novo use of SRL is a risk factor for proteinuria. We analyzed a series of patients included in a big multicenter randomized trial (RMR trial) corresponding to all patients in Spain and Portugal with respect to this issue. We retrospectively evaluated 24-hour proteinuria in all the patients during the study period (5 years postransplant) for comparison between treatment arms group A, continuous cyclosporine (CyA) + SRL and group B SRL with CyA elimination at 3 months postransplant. The elimination of CyA after the third month was not followed by significant changes in proteinuria. Nevertheless, during the last year of follow-up (between 48 and 60 months postransplant) an impressive increase in proteinuria was observed in group A. This surprising finding seemed to be a consequence of a protocol amendment that recommended CyA elimination in patients of group A, due to poorer results in the intermediate analysis of the trial. This fact suggests that the hemodynamic changes induced by elimination of the vasoconstrictor CyA might be responsible for the proteinuria but only in the long term probably when significant pathological lesions are already present. This finding argues for earlier conversion.
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Affiliation(s)
- J C Ruiz
- Nephrology Department, Valdecilla Hospital, University of Cantabria, Santander, Spain
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30
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Ruiz JC, Sánchez A, Rengel M, Beneyto I, Plaza JJ, Zárraga S, Errasti P, Andrés A, Morales JM, Torregrosa JV, Alarcón A, Morey A, Romero R, Fernández A, Díaz JM, Cantarell C. Use of the New Proliferation Signal Inhibitor Everolimus in Renal Transplant Patients in Spain: Preliminary Results of the EVERODATA Registry. Transplant Proc 2007; 39:2157-9. [PMID: 17889123 DOI: 10.1016/j.transproceed.2007.07.071] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Everolimus (Eve) has shown good efficacy and safety profiles in clinical trials in combination with low doses of cyclosporine but there is limited experience in other modes, especially with calcineurin inhibitor elimination. We developed a retrospective study to analyze its clinical use after approval in Europe in 2005. Herein we have presented the results of a series of 272 patients followed for the first 6 months after Eve introduction. In 93.8% of cases Eve was introduced after the first month posttransplantation (conversion use), and 6 months after introduction, the CNI had been eliminated in 75% of cases. The main indication for Eve introduction was the diagnosis of a malignant neoplasm (42%), whereas the combined indication of prevention and/or treatment of toxicity, especially nephrotoxicity, accounted for 46.3% of cases. Initial doses were low (1.37 mg/d), but were progressively increased up to 2 mg/d at 6 months. Renal function remained unchanged during the follow-up period, whereas proteinuria moderately increased. Only 5 cases (2%) of acute rejection episodes were observed with excellent patient and graft survivals at 6 months after conversion. Further analysis of this extensive series of patients with a longer follow-up is needed.
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Affiliation(s)
- J C Ruiz
- H.U. Marqués de Valdecilla, Santander, Spain.
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Marcén R, Morales JM, del Castillo D, Campistol JM, Serón D, Valdés F, Anaya F, Andrés A, Arias M, Bustamante J, Capdevila L, Escuin F, Gil-Vernet S, Gonzalez-Molina M, Lampreave I, Oppenheimer F, Pallardó L. Posttransplant diabetes mellitus in renal allograft recipients: A prospective multicenter study at 2 years. Transplant Proc 2007; 38:3530-2. [PMID: 17175323 DOI: 10.1016/j.transproceed.2006.10.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Indexed: 01/14/2023]
Abstract
The purpose of this study was to investigate the incidence and risk factors for the development of diabetes mellitus after kidney transplantation (PTDM). A total of 1783 nondiabetic renal allograft recipients transplanted from January 2000 to December 2002 were included. Diabetes was diagnosed following American Diabetes Association criteria. While 1276 patients were treated with tacrolimus (Tac), mycophenolate mofetil (MMF), and steroids, 507 patients received cyclosporine-ME (CsA), MMF, and steroids. PTDM incidence at 6, 12, and 24 months was 14.2%, 12.8%, and 13.3%, respectively. Cumulative incidence during the follow-up was 21.6%. Only 121 of the diabetic patients (47.6%) at 6 months remained diabetic at 24 months. Furthermore, 60 patients of 116 patients on insulin at 6 months (51.7%) remained on treatment at 24 months. The cumulative incidence of PTDM was similar in the two immunosuppressive treatments (19.7% on CsA-MMF vs 22.3% on Tac-MMF; P = NS). However, at 24 months, 14 of 50 diabetic patients on CsA-MMF (28%) and 74 of 161 patients on Tac-MMF (45.9%) were on insulin treatment (P < .05). By Cox regression analysis, age older than 60 years (RR 1.61; 95%CI 1.28-2.04; P < .001), body mass index (BMI) > 30 kg/m2 at transplantation (RR 1.66; 95%CI 1.27-2.16; P < .001), and immunosuppression with Tac (RR 1.30; 95%CI 1.02-1-66; P = .033) were associated with PTDM. In conclusions, the incidence of PTDM at 24 months in immunosuppressive protocols including MMF is about 22%, and it is associated with older age, increased BMI, and immnunosuppression with Tac.
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Affiliation(s)
- R Marcén
- Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, Spain.
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Manrique A, Jiménez C, Herrero ML, Meneu JC, Abradelo M, Moreno A, González E, Hernández E, Morales JM, Andrés A, Cortina J, Moreno E. Pancreas preservation with the University of Wisconsin versus Celsior solutions. Transplant Proc 2007; 38:2582-4. [PMID: 17098009 DOI: 10.1016/j.transproceed.2006.08.058] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The use of Celsior solution for organ preservation has not been thoroughly studied in pancreas transplantation. The aim of this study was to compare University of Wisconsin and Celsior solutions for preservation of pancreas grafts. PATIENTS AND METHODS From March 1995 to December 2005, 72 patients with type 1 diabetes underwent pancreas transplantation. There were 42 men and 30 women, with a mean age at transplantation of 38.1 +/- 7.5 years (range: 27 to 55 years), and a mean duration of diabetes of 22.5 +/- 6.6 years. Recipients were classified into two groups according to the preservation solution: (A) Celsior (n = 28, 38.9%) and (B) Wisconsin (n = 44, 61.1%). RESULTS The donor and recipient characteristics were similar in both groups. There were five cases of venous thrombosis in the Wisconsin group and two in the Celsior group (P = NS). The venous drainage technique in the former group was portocaval in 19 patients and portoiliac in 25; in the Celsior group, portocaval in 23 patients and portoiliac in five (P = .001). Enteric drainage was used in 19 patients from the Celsior group and 17 patients from the Wisconsin group (P = .01). Actuarial 2-year graft survival was 74.6% in the Wisconsin group and 77.4% in the Celsior group (P = NS). CONCLUSIONS No differences were observed in venous thrombosis between the two groups. The lower rate of venous thrombosis with the portocaval technique was related to the type of venous drainage rather than the type of preservation solution. Celsior solution may be considered as good as Wisconsin solution for pancreas transplantation.
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Affiliation(s)
- A Manrique
- Servicio de Cirugía General, Ap Digestivo y Trasplante de Organos Abdominales, Hospital Universitario Doce de Octubre, Madrid, Spain.
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Andrés A, Morales E, Morales JM, Bosch I, Campo C, Ruilope LM. Efficacy and Safety of Valsartan, an Angiotensin II Receptor Antagonist, in Hypertension After Renal Transplantation: A Randomized Multicenter Study. Transplant Proc 2006; 38:2419-23. [PMID: 17097955 DOI: 10.1016/j.transproceed.2006.08.066] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prevalence of posttransplant hypertension is high, and it appears to be a major risk factor for graft and patient survival. The aim of this study was to assess the efficacy and safety of valsartan, an angiotensin-receptor blocker (ARB), in the treatment of posttransplant hypertension. METHODS A multinational, multicenter, prospective, randomized, double-blind, placebo-controlled study was performed on the treatment of hypertension (systolic blood pressure [BP] >/= 140 and/or diastolic BP >/= 90 mm Hg) in adult cyclosporin-treated renal transplant recipients randomized to receive either valsartan (80 mg once daily) or a matching placebo for 8 weeks. After the first 4 weeks, furosemide 20 mg twice daily was added on a open basis if systolic BP remained >/= 130 mm Hg and/or diastolic BP remained >/= 85 mm Hg. RESULTS One hundred fifteen (valsartan = 57, placebo = 58) uncontrolled hypertensive patients despite monotherapy for hypertension, other than angiotensin-converting enzyme inhibitor or ARB, were randomized. In the valsartan group, significant decreases were seen in systolic BP (from 153 +/- 11 to 140.9 +/- 18.35 mm Hg at 4 weeks, and 136.5 +/- 15 mm Hg at 8 weeks) and diastolic BP (from 93 +/- 9 to 85.2 +/- 11.28 mm Hg at 4 weeks, and 83.8 +/- 9.2 mm Hg at 8 weeks). There was no significant change in the placebo group. In the valsartan group, a statistically but not clinically significant reduction was observed in the mean hemoglobin concentration (12.9 +/- 1.6 g/dL versus 13.8 +/- 1.6 g/dL at 4 weeks, P < .01; and 12.3 +/- 1.6 versus 13.8 +/- 1.7 at 8 weeks; P < .001) as well as a significant increase in serum potassium (4.4 +/- 0.5 mmol/L versus 4.1 +/- 0.4 mmol/L at 4 weeks, P < .01) vs placebo. CONCLUSIONS Valsartan is effective in the treatment of posttransplant hypertension and is well tolerated.
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Affiliation(s)
- A Andrés
- Hospital 12 de Octubre, Nephrology Department, Barcelona, Spain.
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Martínez-Castelao A, Hernández MD, Pascual J, Morales JM, Marcen R, Errasti P, Romero R, Oliver J, Jimeno L, Garcia Martinez J, Mendiluce A, Garcia Cosme P, Mazuecos A, Danz-Guajardo D, Alarcon A, Marrero D. Detection and treatment of post kidney transplant hyperglycemia: a Spanish multicenter cross-sectional study. Transplant Proc 2006; 37:3813-6. [PMID: 16386547 DOI: 10.1016/j.transproceed.2005.10.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The prevalence of diabetes mellitus (DM) is greater among patients with solid organ transplants than in the general population, although the factors associated with posttransplant DM (PTDM) are unknown. OBJECTIVES The objective of this study was to estimate the prevalence of and assess the risk factors for PTDM. PATIENTS AND METHODS We included outpatients with functioning isolated solid organ allografts (kidney, liver, heart, and lung). We collected demographic and posttransplant clinical data that included DM diagnostic ADA criteria, DM treatment, DM family history, presence of hepatitis C virus (HCV), immunosuppression treatment, hypertension, and dyslipidemia. RESULTS A total of 2178 patients included, 1410 kidney recipients, 489 liver transplants, 207 heart transplants, and 72 lung recipients. Seventeen and four-tenths percent of the patients who did not have DM prior to transplantation, developed PTDM (median time: 79 days). A greater prevalence was observed among patients with a family history, HCV, and tacrolimus treatment (with or without steroids P < .05). By logistic regression analyses, OR for these factors were 1.51, 1.65, and 1.38, respectively. Of those patients who did not suffer PTDM, 55.2% showed basal blood glucose values under 100 mg/dL; only 68% presented with a hemoglobin Alc under 6. CONCLUSIONS The prevalence of PTDM among kidney recipients was higher than that in the general population. DM family history, HCV positive, and tacrolimus were risk factors associated with this entity.
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Morales JM, Domínguez-Gil B, Gutiérrez MJ. [Impact of immunossuppression in the cardiovascular risk profile after renal transplantation I]. Nefrologia 2006; 26:181-94. [PMID: 16808256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Affiliation(s)
- J M Morales
- Unidad de Trasplante Renal, Servicio de Nefrología, Hospital Doce de Octubre, Madrid.
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Oppenheimer F, Alonso A, Arias M, Campistol JM, González Molina M, González Posada JM, Grinyo JM, Morales JM, Sánchez Fructuoso A, Sánchez-Plumed J, Ruiz JC. Handling sirolimus in clinical practice. Spanish Nephrology Society. Nefrologia 2006; 26 Suppl 2:64-93. [PMID: 17937635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
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Morales JM. Transplantation and tumors. Nefrologia 2006; 26 Suppl 2:12-20. [PMID: 17937631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Affiliation(s)
- J M Morales
- Servicio de Nefrología, Hospital Doce de Octubre, Madrid.
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Grinyo JM, Alonso A, Arias M, Campistol JM, González Molina M, González Posada JM, Morales JM, Oppenheimer F, Sánchez Fructuoso A, Sánchez-Plumed J, Ruiz JC. Sirolimus use in de "novo renal" transplantation. Nefrologia 2006; 26 Suppl 2:33-51. [PMID: 17937633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Affiliation(s)
- J M Grinyo
- Servicio de Nefrología, Hospital de Bellvitge, Barcelona.
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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] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
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40
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Ruiz JC, Alonso A, Arias M, Campistol JM, González Molina M, González Posada JM, Grinyo JM, Morales JM, Oppenheimer F, Sánchez Fructuoso A, Sánchez-Plumed J. Conversion to sirolimus. Nefrologia 2006; 26 Suppl 2:52-63. [PMID: 17937634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Affiliation(s)
- J C Ruiz
- Servicio de Nefrología, Hospital Marqués de Valdecilla, Santander.
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Morales JM. [Introduction: clinical relevance of graft-induced immunological injury after renal transplantation]. Nefrologia 2006; 26 Suppl 7:1-2. [PMID: 17768819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Affiliation(s)
- J M Morales
- Unidad de Trasplante Renal, Servicio de Nefrología, Hospital 12 de Octubre, Madrid.
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Nungaray N, Arriola M, Gutierrez MJ, Oliva E, Hernández E, Gonzalez E, Andres A, Morales JM. Rapamycin at Six Years Can Exhibit Normal Renal Function Without Proteinuria or Neoplasia After Renal Transplantation. A Single-Center Experience. Transplant Proc 2005; 37:3727-8. [PMID: 16386519 DOI: 10.1016/j.transproceed.2005.09.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Currently, long-term experience with Rapamune (RAPA) after renal transplantation is scarce. We present our experience with RAPA in patients who were included in clinical trials. Between 1996 and 1999, 27 renal transplant patients received RAPA alone or in combination with cyclosporine (CyA). We study 15 of them (9 males, 6 females; mean age 36 years) who are currently functioning with a mean follow-up of 6 years (range, 5.2-8 years). The presence of delayed graft function was 40% and acute rejection 26.6%, all of them controlled with steroids. Notably, no patients experienced an acute rejection episode after the first year. Among 15 patients, 12 received steroids, RAPA and CyA; and 3 received steroids, RAPA, azathioprine (AZA) or mycophenolate mofetil (MMF) for immunosuppression. At the end of follow-up, the situation was the opposite: 12 patients received steroids (2.5-5 mg/d) and RAPA associated with or without AZA/MMF, and 3 were maintained with steroids, RAPA and CyA. Renal function was excellent in the entire group: mean SCr 1.1 mg/dL (range, 0.7-1.8) with mean RAPA blood levels (HPLC) of 11 ng/dL (range 8-16). Hyperlipidemia was universal with all patients (100%) receiving statins maintaining acceptable levels of cholesterol (mean 209 +/- 28 mg/dL) and tryglycerides (mean 154 +/- 76 mg/dL). Arterial hypertension present in 12 of 15 (80%) patients was controlled with a mean of 1.5 drugs. Notably, no patient presented with proteinuria, neoplasia, posttransplant diabetes, or cardiovascular events. In conclusion, these single-center results suggest that Rapamune may be useful in the long-run after renal transplantation. The presence of normal renal function and the absence of proteinuria and neoplasia in these renal transplant patients may have important clinical implications.
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Affiliation(s)
- N Nungaray
- Renal Transplant Unit, Nephrology Department, Hospital 12 de Octubre, Madrid, Spain
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43
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Jiménez C, Manrique A, Herrero ML, Meneu JC, Abradelo M, Gutierrez E, Morales JM, Ortuño T, Praga M, Andrés A, Morales E, Moreno E. Incidence of Pancreas Graft Thrombosis in Portoiliac and Portocaval Venous Anastomosis. Transplant Proc 2005; 37:3977-8. [PMID: 16386602 DOI: 10.1016/j.transproceed.2005.10.081] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pancreas graft thromboses represent more than 70% of all technical failures; multiple risk factors have been implicated. We analyzed the thrombosis rates using portoiliac versus portocaval vein anastomoses. PATIENTS AND METHODS The series includes 53 patients who underwent pancreas transplantation: 49 simultaneous pancreas-kidney and 4 pancreas after kidney. There were 27 men and 26 women, of mean age of 37.2 +/- 7.0 years. We compared two groups of recipients that were classified according to venous anastomosis: (A) portoiliac (n = 30), and (B) portocaval (n = 23). RESULTS The recipients did not show significant differences in age, gender, or duration of diabetes mellitus, but body mass index was significantly higher among the portocaval group. A bladder-drained pancreas technique was more frequently performed in the portoiliac group (93% of patients) versus an enteric-drained pancreas in the portocaval group (81%; P < .001). Heparinization was performed in 12 recipients: 11 (36.6%) in the portoiliac group and 1 (4.3%) in the portocaval group (P < .01). Vascular graft thrombosis (venous in six and arterial in one) developed in seven patients (13.2%) all in the portoiliac group (23%) (P < .02). Two-year patient survival was 93% in the portoiliac group and 94% in portocaval group (P = NS). Two-year graft survival was 66.6% in the portoiliac group and 85.9% in portocaval group (P = .07). CONCLUSION There was no graft thrombosis among patients with a portocaval vein anastomosis.
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Affiliation(s)
- C Jiménez
- Servicio de Cirugía General, Ap. Digestivo y Trasplante de Organos Abdominales, Madrid, Spain.
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Morales JM, Andrés A, Dominguez-Gil B, Arriola M, Gutiérrez MJ, Hernández E, Ortuño T, Praga M. Ten Years of Treatment With Tacrolimus Is Related to an Excellent Renal Function, Allowing Monotherapy in a Large Proportion of Cases: Unicentric Results of the Tacrolimus Versus Cyclosporine A European Multicentric Study in Kidney Transplant Patients. Transplant Proc 2005; 37:3738-42. [PMID: 16386523 DOI: 10.1016/j.transproceed.2005.09.178] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Tacrolimus (Tac) is the most frequently used base inmunosuppressant for transplantation in Spain and the United States. However, long-term data on its use in renal transplant patients are lacking. The aim of this study was to analyze the 10-year outcome of patients from our institution treated with Tac or cyclosporine (CsA) who were included in the European Multicenter Study of kidney transplantation (1993 to 1994). This trial compared the efficacy and safety of steroids + Tac + azathioprine versus steroids + CsA + azathioprine at 1 year, showing a significantly lower acute rejection rate in Tac patients, with no differences in graft or patient survival. In our long-term analysis, we included patients with a functioning graft after the first year: 15 patients on Tac and 11 on CsA. In the "intent-to-treat" (ITT) analysis, patient survival was 14/15 (93%) versus 9/11 (82%) and death noncensored graft survival was 10/15 (67%) versus 8/11 (73%) in Tac and CsA, respectively. Analyzing patients "into treatment" (TT), death/noncensored graft survival was 11/16 (69%) versus 6/9 (67%), respectively. Serum creatinine tended to be lower in Tac group (ITT 1.26 +/- 0.42 vs 1.63 +/- 1.16 mg/dL, P = NS; TT 1.23 +/- 0.4 vs 1.86 +/- 1.28 mg/dL, P = NS). However, in the TT analysis, Tac patients exhibited a significantly better creatinine clearance (89.3 +/- 40 vs 46.8 +/- 21 mL/min, P = .037) and lower systolic blood pressure (125 +/- 5 vs 140 +/- 12 mm Hg, P = .007) at 10 years. No other significant differences were observed in blood pressure, lipid profile, or glucose metabolism. Outstandingly, Tac monotherapy was the most frequently used regimen after 10 years: ITT 6/9 (67%) versus 1/8 (12.5%), P = .05, TT 7/10 (70%) versus 0/6 (0%), P = .011. Patients under Tac monotherapy exhibited an excellent graft function (serum creatinine 1.08 +/- 0.14 mg/dL) and negative proteinuria, with Tac trough levels of 7.9 +/- 1.3 ng/mL. In summary, our results suggest that Tac-based immunosuppression provides an excellent kidney function 10 years after transplantation and allows monotherapy in a high percentage of kidney transplant patients.
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Affiliation(s)
- J M Morales
- Renal Transplant Unit, Nephrology Department, Doce de Octubre Hospital, Madrid, Spain.
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Moreno-Cuerda VJ, Aguado JM, Morales M, Andrés A, Morales JM, López-Medrano F, San Juan R, Lumbreras C. Is Double Renal Transplantation a Risk Factor for Cytomegalovirus Disease? Transplant Proc 2005; 37:3764-5. [PMID: 16386531 DOI: 10.1016/j.transproceed.2005.09.180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We performed a retrospective study to identify the risk factors for cytomegalovirus (CMV) disease among 570 renal transplant recipients. By means of a multivariate analysis we identified antilymphocyte antibody therapy (odds ratio [OR]: 4.6; 95% confidence interval [CI]: 2.0 to 10.6), high doses of corticosteroids (OR: 3.4; 95% CI: 1.2 to 10.1), and double renal transplant (OR: 4.1; 95% CI: 1.5 to 11.5). To the best of our knowledge, this is the first study to suggest that in addition to other well-known risk factors for CMV disease (ie, therapy with anti-lymphocyte antibodies or high doses of corticosteroids), the use of double renal transplantation appears to increase the risk of CMV disease in this population.
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Affiliation(s)
- V J Moreno-Cuerda
- Infectious Diseases Unit and Nephrology Department, University Hospital 12 de Octubre, Madrid, Spain
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46
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González E, Gutiérrez E, Hernández Y, Roselló G, Gutiérrez MJ, Martínez EG, Manzanera MJ, García JA, Praga M, Morales JM, Andrés A. Anti-CD25 Monoclonal Antibody Sequential Immunosuppressive Induction Therapy in Renal Transplants With High Risk of Delayed Graft Function. Transplant Proc 2005; 37:3736-7. [PMID: 16386522 DOI: 10.1016/j.transproceed.2005.09.176] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is little experience on the use of monoclonal antibodies that block the high-affinity interleukin-2 receptor (basiliximab and daclizumab) in sequential therapy in renal transplants with risk of delayed graft function. This study sougth to test the efficacy and safety of the substitution of anticalcineurins with two doses of basiliximab or daclizumab in the immediate posttransplant period for recipients at risk of delayed renal graft function. Immunosuppression consisted of steroids, mycophenolate mofetil, and two doses of basiliximab (20 mg/day) on days 0 and 4 posttransplant or daclizumab (1 mg/kg per day) on days 0 and 15 posttransplant. Anticalcineurins were not administered until the beginning of graft function. Among 49 recipients (mean age 63.5 +/- 10.5 years), 40 received a kidney from a donor over 60 years of age, three from a non-heart-beating donor, and six from donors with an acute elevation of serum creatinine to 2.4 +/- 0.86 (1.7-3.7). At a mean follow-up of 14.2 +/- 8.4 months, five patients experienced acute rejection episodes. Only 15 patients needed posttransplant dialysis (2.7 +/- 1.6). In 11 patients, cyclosporine (CsA) was introduced at 6 +/- 2.9 days posttransplant and in 37, tacrolimus on 8.6 +/- 3.6 days posttransplant. The incidence of kidney graft loss was 16.3%. Patient survival was 96%. Thirty-nine recipients are alive with functioning grafts, with mean serum creatinine of 1.4 mg/dL. In conclusion, substitution for anticalcineurins with interleukin-2-receptor blockade in the immediate posttransplant period for patients at risk of delayed graft function minimizes nephrotoxicity and reduces tubular necrosis, without increasing the risk of an acute rejection episode.
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Affiliation(s)
- E González
- Nephrology Department, Hospital 12 de Octubre, Madrid, Spain
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Garcia-Donaire JA, Acevedo M, Gutiérrez MJ, Manzanera MJ, Oliva E, Gutiérrez E, Andrés A, Morales JM. Tacrolimus as Basic Immunosuppression in Pregnancy After Renal Transplantation. A Single-Center Experience. Transplant Proc 2005; 37:3754-5. [PMID: 16386528 DOI: 10.1016/j.transproceed.2005.09.124] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Renal transplantation restores fertility within an average of 6 months, so women of childbearing age are able to consider pregnancy. Successful pregnancies have been reported in recent years under different immunosuppressive regimens, but the optimal treatment to achieve the maximum safety for both the mother and fetus remains unclear. Tacrolimus has been demonstrated to provide long-term immunosuppression and prevent rejection in most renal transplants. It seems safe, but experience is limited compared with cyclosporine. We report our experience highlighting the high rate of successful pregnancies attained in women treated with tacrolimus as the basic immunosuppressant and advised of recommendations to achieve a healthy newborn. Renal function was preserved during the pregnancy. The puerperal period and the rate of gestation-related difficulties appeared similar to that of the general population.
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Gutiérrez MJ, Acebedo-Ribó M, García-Donaire JA, Manzanera MJ, Molina A, González E, Nungaray N, Andrés A, Morales JM. Pregnancy in Renal Transplant Recipients. Transplant Proc 2005; 37:3721-2. [PMID: 16386517 DOI: 10.1016/j.transproceed.2005.09.175] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Fertility is restored after renal transplantation when good function is achieved. Our aim was to describe the gestations of our transplanted patients, analyzing outcomes and complications as well as long-term evolution of renal function. From 1976 to 2004, 43 gestations occurred in 35 renal transplanted women: their mean age was 31.7 +/- 4.06 years, with a mean time from the transplant to pregnancy of 4.32 years (0.4-13). At conception, all showed normal renal function (SCr 1.05 +/- 0.2 mg/dL). There were 19 abortions (43.8%), 9 of them spontaneous (21%) and 10 therapeutic (six cases for noncompliance with described criteria of European Best Practice Guidelines for Renal Transplantation, especially pregnancy less than 6 months after transplantation). Excluding these six cases of therapeutic abortions, 24 successful pregnancies occurred in 37 women (65.7%), although eight (29.1%) had premature delivery with live fetuses. Arterial hypertension was the most frequently complication (64%). Preeclampsia occurred in nine (37.5%) pregnancies, with proteinuria in five and only two with mild renal function deterioration. The majority of patients received cyclosporine (n = 20) or tacrolimus (n = 19). Since 1996, mycophenolate mofetil and sirolimus were stopped before conception. Birth weight was lower than 2500 g in 33.3% of pregnancies. Every newborn baby was healthy. Afterward, of the 24 patients with successfully pregnancy, 21 (87.5%) have functioning renal transplants at 53.2 months. After delivery, all currently show good renal function (SCr 1.16 +/- 0.35 mg/dL, CrCl 91 +/- 28.45 mL/m). In conclusion, pregnancy in our renal transplant women shows a success rate of 65.6%. However, complications related to arterial hypertension such as preeclampsia are frequent. The incidence of spontaneous abortions was similar to other series (21%). Long-term graft survival does not seem to be negatively affected by pregnancy.
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Affiliation(s)
- M J Gutiérrez
- Renal Transplant Unit, Nephrology Department, Hospital 12 Octubre, Madrid, Spain.
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Díaz-Pedroche C, Lumbreras C, Del Valle P, San Juan R, Hernando S, Folgueira D, Andrés A, Delgado J, Meneu JC, Morales JM, Moreno E, Aguado JM. Efficacy and Safety of Valgancyclovir as Preemptive Therapy for the Prevention of Cytomegalovirus Disease in Solid Organ Transplant Recipients. Transplant Proc 2005; 37:3766-7. [PMID: 16386532 DOI: 10.1016/j.transproceed.2005.10.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We prospectively followed 70 CMV-seropositive solid organ transplant recipients to evaluate the efficacy and safety of valganciclovir (VGCV) as preemptive therapy based on antigenemia test to prevent cytomegalovirus (CMV) disease. From December 2003 to May 2004, 12 of 70 (17%) asymptomatic patients who showed an antigenemia value > or =25 positive cells per 2 x 10(5) polymorphonuclear (PMN) were treated with VGCV (900 mg twice a day adjusted to renal function) until resolution of CMV antigenemia, a minimum of 14 days. No patient developed CMV disease during follow-up. Only one who showed an asymptomatic relapse of the antigenemia test > or =25 positive cells was successfully treated with a repeated course of VGCV. Mean duration of VGCV therapy was 18 days (range, 14 to 28). Antigenemia was negative in 7 of 12 (58%) patients after 14 days and negative in all patients 4 weeks after the administration of VGCV. No significant side effects were associated with the use of VGCV therapy. Preemptive VGCV therapy is safe and effective in the prevention of CMV disease in seropositive solid organ transplant recipients.
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Affiliation(s)
- C Díaz-Pedroche
- Infectious Diseases Unit, Department of Digestive Surgery and Abdominal Organs Transplantation, University Hospital 12 de Octubre, Madrid, Spain.
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Olazarán J, Alvarez-Linera J, de Santiago R, Escribano J, Benito-León J, Morales JM. [Regional correlations between MR imaging perfusion and SPECT in Alzheimer's disease]. Neurologia 2005; 20:240-4. [PMID: 15954033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
INTRODUCTION Dynamic susceptibility contrast (DSC) is a magnetic resonance (MR) technique that provides an estimation of cerebral blood flow (CBF) through the obtention of a cerebral blood volume map. As observed with nuclear medicine methods, DSC MR studies have demonstrated a temporoparietal hypoperfusion in Alzheimer's disease (AD). However, the concurrent validity of DSC and nuclear medicine techniques has not been sufficiently investigated. PATIENTS AND METHODS A single-photon emission computed tomography (SPECT) and a DSC MR perfusion study were performed consecutively in 14 AD patients. Expert based qualitative assessments of CBF were carried out in eight regions of interest (ROI). RESULTS Level of agreement in the studied ROI was highly variable. Presence of large blood vessels and patient head movement were possibly the main causes of this variability. Nevertheless, when interrater variability was eliminated, intraclass correlation coefficients became more uniform, ranging from 0.32 to 0.71. CONCLUSIONS DSC MR imaging was concordant with SPECT at the different cerebral lobes of AD patients. The positive findings should be confirmed under better technical and methodological conditions.
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Affiliation(s)
- J Olazarán
- CEP Hermanos Sangro, Area I de la Atención Especializada del Insalud, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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