RESUMEN
Delayed graft function (DGF) is defined as the need for dialysis within the first week after renal transplantation, and slow graft function as persistence of serum creatinine concentration of at least 3 mg/dL on day 5 after the procedure. In the present study, we analyzed the incidence and risk factors for DGF at our center. This retrospective study included 106 patients who underwent renal transplantation between January 2000 and June 2008. Of these, 11 patients were excluded. Two of the remaining 95 patients received organs from living donors, and 93 received cadaver organs. Variables analyzed included donor age, cause of death, cause of chronic renal failure, recipient age, method and time of long-term renal replacement therapy, residual diuresis, panel of reactive antibodies (PRA), HLA mismatch, sex compatibility, cold and warm ischemia times, biopsy-confirmed episodes of acute rejection, urine output in the operating room and in the first 24 hours after the procedure, and intraoperative induction therapy. Data were analyzed using the chi(2) and Fisher exact tests and analysis of variance, and are given as mean (SD) and frequency. Variables associated with DGF at univariate analysis (P < .05) were divided between risk factors and predictors of DGF for inclusion in logistic regression models. The incidence of DGF was 32.6%; slow graft function, 16.8%; and immediate graft function, 50.5%. Cold ischemia time longer than 20 hours (P = .02) and donor age (P = .008) were directly associated with DGF. Twenty-four-hour urine output was a strong predictor of DGF. Patients with DGF demonstrated a 25% incidence of an episode of acute rejection before discharge from the hospital. No difference in DGF was observed for use of intraoperative induction therapy.
Asunto(s)
Funcionamiento Retardado del Injerto/epidemiología , Trasplante de Riñón/fisiología , Trasplante de Riñón/estadística & datos numéricos , Biopsia , Chile , Funcionamiento Retardado del Injerto/fisiopatología , Rechazo de Injerto/epidemiología , Rechazo de Injerto/patología , Supervivencia de Injerto/fisiología , Humanos , Fallo Renal Crónico/etiología , Fallo Renal Crónico/cirugía , Selección de Paciente , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/fisiopatología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Renal failure generally accompanies an alteration in reproduction function. Even though a renal transplantation does in fact improve this function, there are few cases described in medical literature of multiple pregnancies in transplant patients that ended in a successful manner. In addition, there is a greater incidence of complications such as hypertension, preeclampsia, and premature delivery. This article describes a 31-year-old patient who became pregnant with triplets at 3 years and 6 months after receiving a renal transplant from a cadaver. The patient received treatment with cyclosporine, azathioprine, and prednisolone. During the pregnancy, there was a increase in hypertension, proteinuria, cholestasia gravidic symptoms, and premature delivery. Pregnancy control included evaluation of the fetoplacental unit together with hypertensive management and adjustment of immunosuppressant treatment, especially the cyclosporine dose, seeking to facilitate greater fetal maturity. Three newborns of 840, 860, and 1020 were delivered by cesarean section. The newborns spent 6 to 8 weeks in the neonatal unit and were released without complications. The newborns have presented adequate psychomotor and physical development to date. The triplets are now 4 years old. The transplant recipient has a creatinine clearance of 81 mL/min at 7 years after transplantation.
Asunto(s)
Glomeruloesclerosis Focal y Segmentaria/cirugía , Inmunosupresores/uso terapéutico , Trasplante de Riñón/inmunología , Embarazo Múltiple/fisiología , Trillizos , Adulto , Cadáver , Femenino , Glomeruloesclerosis Focal y Segmentaria/diagnóstico por imagen , Humanos , Hipertensión/tratamiento farmacológico , Recién Nacido , Riñón/diagnóstico por imagen , Nifedipino/uso terapéutico , Inducción de la Ovulación , Complicaciones Posoperatorias/tratamiento farmacológico , Embarazo , Donantes de Tejidos , UltrasonografíaRESUMEN
BACKGROUND: Renal transplant is the best therapeutic alternative for chronic renal failure, although it is not exempt of risks. AIM: To report the survival of renal transplant recipients and grafts and the main complications at a public hospital in Chile. PATIENTS AND METHODS: This is a non experimental, open historical cohort study, with reposition of the first 100 transplants in 94 patients, performed at the Carlos van Buren Hospital between 1984 and 1998. Seventy grafts came from cadaveric donors and 30 from live donors. As immunosuppressive therapy, prednisone + azathioprine was used in 48 transplants and the same regimen plus cyclosporine in 52. RESULTS: Mean age of recipients was 36 +/- 23 years old. Ten years actuarial survival of patients was 80.5% in transplants from cadaveric donors and 86% in transplants from live donors. Ten years graft survival was 57.5% in transplants from cadaveric donors and 42% in transplants from live donors. The period in which the transplant was performed (first or second half of the observation period), type of donor, HLA B-DR compatibility and sensitization (% PRA) had no effect on survival. Twenty five subjects lost their graft, 12 due to acute steroid resistant rejection, 10 due to chronic graft nephropathy and three due to renal artery thrombosis. Fifteen subjects died with a functioning graft, 10 due to infections, two due to an acute myocardial infarction, two due to an acute pancreatitis and one due to a brain tumor. CONCLUSIONS: Survival of grafts and renal transplant recipients was not influenced by the type of donor, period of transplantation and immune variables. Main causes of recipient death were infections and the main cause of graft failure was acute rejection.
Asunto(s)
Supervivencia de Injerto , Trasplante de Riñón , Adolescente , Adulto , Anciano , Azatioprina/uso terapéutico , Chile/epidemiología , Estudios de Cohortes , Ciclosporina/uso terapéutico , Supervivencia sin Enfermedad , Femenino , Rechazo de Injerto/prevención & control , Humanos , Inmunosupresores/uso terapéutico , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/mortalidad , Masculino , Persona de Mediana Edad , Prednisona/uso terapéuticoRESUMEN
We report a unilateral pulmonary nocardiosis in a 51 years old male that received a renal allograft. The clinical picture appeared 68 days after transplantation and the culture of a bronchoalveolar lavage showed the presence of Nocardia asteroides. Cyclos-porine and azathioprine were discontinued and trimethoprim-sulphamethoxazole was started with a good clinical response. Afterwards, azathioprine was restarted and the patient is asymptomatic at the present moment.