RESUMEN
Renal transplantation is the best therapeutic option for end-stage chronic renal disease. Assuming that it is more advisable if performed early, we aimed to show the clinical, social, and economic advantages in 70% of our patients who were dialyzed only for a short period. For this purpose, we retrospectively collected data over 28 years in 142 kidney transplants performed in patients with <6 weeks on dialysis. 66% of our patients were 30-60 years old; 98% of the patients had living donors. At transplantation, 64% of our patients had no public support; however, 64% of them returned to work and got health insurance 2 months later. Full rehabilitation was achieved in all cases, including integration to the family, return to full-time work, school and university, sports, and reproduction. Immunosuppression consisted of 3 drugs, including steroids, cyclosporine, and azathioprine or mycophenolate. The cost in the 1st year, including patient and donor evaluation, surgery, immunosuppression, and follow-up, was $13,300 USD versus $22,320 for hemodialysis. We conclude that preemptive renal transplantation with <6 weeks on dialysis is the best therapeutic option for end-stage renal failure, especially in developing countries such as Bolivia, where until last year, full public support for renal replacement therapy was unavailable.
Asunto(s)
Fallo Renal Crónico/terapia , Trasplante de Riñón/estadística & datos numéricos , Adulto , Anciano , Azatioprina/economía , Azatioprina/uso terapéutico , Bolivia , Costos y Análisis de Costo , Ciclosporina/economía , Ciclosporina/uso terapéutico , Países en Desarrollo/economía , Países en Desarrollo/estadística & datos numéricos , Femenino , Humanos , Terapia de Inmunosupresión/economía , Terapia de Inmunosupresión/estadística & datos numéricos , Inmunosupresores/economía , Inmunosupresores/uso terapéutico , Fallo Renal Crónico/economía , Trasplante de Riñón/economía , Donadores Vivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Ácido Micofenólico/economía , Ácido Micofenólico/uso terapéutico , Diálisis Renal/economía , Diálisis Renal/estadística & datos numéricos , Terapia de Reemplazo Renal/estadística & datos numéricos , Estudios Retrospectivos , Trasplante Homólogo/economía , Trasplante Homólogo/estadística & datos numéricosRESUMEN
BACKGROUND: There is a gap between the number of patients requiring a renal allograft and the number of potential deceased donors (DD). One alternative is using allografts from non-related living donors (NRLD). AIM: To compare survival and complications of renal allograft recipients from DD, related living donors (RLD) and NRLD. MATERIAL AND METHODS: Observational study of a cohort of renal allograft recipients. Of 253 transplants performed in a Chilean region between 1981 and 2003, 20 patients received and allograft from a NRLD. Graft and patient survival of these patients were compared with those of 93 patients receiving an allograft from a related living donor and 140 receiving it from a DD. Patients were followed for 10 years or until death or dialysis requirement. RESULTS: No significant differences between groups in graft and patient survival, deaths with a functioning graft or return to dialysis were observed. Receptors of DD had more hospital admissions during the first years after receiving the graft, usually due to infections. Also a delayed graft function was more common among them. Glomerular filtration rate ten years after the graft was similar among the three groups. CONCLUSIONS: No differences in graft or patient survival was observed between patients receiving a renal allograft from NRLD, RLD or DD.
Asunto(s)
Aloinjertos/estadística & datos numéricos , Supervivencia de Injerto/fisiología , Trasplante de Riñón/mortalidad , Donadores Vivos , Donante no Emparentado/estadística & datos numéricos , Adulto , Causas de Muerte , Chile/epidemiología , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular/fisiología , Hospitalización/estadística & datos numéricos , Humanos , Terapia de Inmunosupresión/estadística & datos numéricos , Infecciones/complicaciones , Trasplante de Riñón/efectos adversos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Patients with high immunological risk have been relegated to the growing waiting list for an immunologically compatible donor. Our objective was to report the experience of a transplant center in desensitization of patients with high immunological risk. METHODS: We carried out a descriptive and retrospective study. Included were all the renal transplant patients from November 1999 to January 2008 in which we used plasmapheresis and standard dose of intravenous immunoglobulin (IVIG) as desensitization. RESULTS: Eight patients had history of alloimmunity (positive crossmatch or high panel-reactive antibodies (PRA >30%). Desensitization was accomplished with plasmapheresis and exchange of 1.5 plasma volume. Subsequent to each session we administered a standard dose of IVIG (5 g/dose). Immunosuppression began equal to the first plasmapheresis with calcineurin inhibitor (tacrolimus) plus six patients with mycophenolate mofetil and two patients with sirolimus. In seven cases, negative crossmatches were obtained before the transplantation, except in the eighth case in whom it was not done. Two patients received human antibodies against CD25 (basiliximab, 20 mg/dose). During their evolution, all patients maintained stable graft function. CONCLUSIONS: According to our experience, renal graft outcome in patients with high immunological risk after an adequate desensitization protocol is similar to that observed in nonsensitized patients, at least during the first year of transplantation.
Asunto(s)
Rechazo de Injerto/prevención & control , Antígenos HLA/inmunología , Inmunoglobulinas Intravenosas/uso terapéutico , Terapia de Inmunosupresión/métodos , Inmunosupresores/uso terapéutico , Trasplante de Riñón/inmunología , Plasmaféresis , Adulto , Anticuerpos Monoclonales/uso terapéutico , Basiliximab , Quimioterapia Combinada , Femenino , Supervivencia de Injerto , Prueba de Histocompatibilidad , Humanos , Terapia de Inmunosupresión/estadística & datos numéricos , Inmunosupresores/administración & dosificación , Isoanticuerpos/sangre , Masculino , Persona de Mediana Edad , Plasmaféresis/estadística & datos numéricos , Proteínas Recombinantes de Fusión/uso terapéutico , Reoperación , Estudios Retrospectivos , Riesgo , Adulto JovenAsunto(s)
Humanos , Femenino , Ciclosporina/efectos adversos , Trasplante de Riñón , Adolescente , Adulto , Anciano , Terapia Combinada , Ciclosporina/administración & dosificación , Ciclosporina/sangre , Interacciones Farmacológicas , Resumen en Inglés , Terapia de Inmunosupresión/métodos , Terapia de Inmunosupresión/estadística & datos numéricos , Fallo Renal Crónico/sangre , Fallo Renal Crónico/epidemiologíaAsunto(s)
Humanos , Femenino , Ciclosporina/efectos adversos , Trasplante de Riñón , Adolescente , Adulto , Anciano , Terapia Combinada , Ciclosporina/administración & dosificación , Ciclosporina/sangre , Interacciones Farmacológicas , Resumen en Inglés , Terapia de Inmunosupresión/métodos , Terapia de Inmunosupresión/estadística & datos numéricos , Fallo Renal Crónico/sangre , Fallo Renal Crónico/epidemiologíaRESUMEN
94 patients with renal allograft from a living related donor were studied in three different groups: 1 Patients with identical histocompatibility (n-32), treated with prednisone (PDN) and azathioprine (Aza); 2 Haploidentical patients (34) who received PDN, Aza and cyclosporine (CsA); 3 Haploidentical patients (28) who previous to the transplantation received specific donor blood transfusions and Aza/PDN after the transplantation. The survival for the patient and the graft after five years was 100% and 96% in group 1; 97% y 89% in group 2 and 82% and 72% in group 3. Five patients in group 1 received CsA also. There was no mortality in group 1, while there were one death in group 2 and two more in group 3. There was no significant difference between CsA and Blood transfusions in the patients and grafts survival.
Asunto(s)
Transfusión Sanguínea , Terapia de Inmunosupresión/métodos , Trasplante de Riñón/inmunología , Adolescente , Adulto , Azatioprina/administración & dosificación , Transfusión Sanguínea/estadística & datos numéricos , Intervalos de Confianza , Ciclosporina/administración & dosificación , Femenino , Supervivencia de Injerto , Humanos , Terapia de Inmunosupresión/estadística & datos numéricos , Trasplante de Riñón/mortalidad , Trasplante de Riñón/estadística & datos numéricos , Masculino , Oportunidad Relativa , Prednisona/administración & dosificación , Análisis de SupervivenciaRESUMEN
La población infantil inmunosuprimida se ha incrementado de manera considerable en los últimos años como consecuencia de la aparición de nuevos tipos de inmunodeficiencia determinados por el tratamiento relativamente exitoso de ciertas entidades neoplásicas y autoinmunes y, adicionalmente, debido a que el Síndrome de Inmunodeficiencia Adquirida (SIDA), golpea la población infantil con preocupante impacto. La mayor causa de morbilidad y mortalidad en todo este grupo de pacientes es la infección. El espectro de problemas asociados es amplio pero relativamente predecible si el enfoque diagnóstico y clínico del niño es adecuado. En consecuencia, los dos objetivos básicos en el enfoque de este tipo de paciente son: 1) la identificación de la inmunodeficiencia de base, y 2) el diagnóstico y prevención de las infecciones asociadas. Dentro de las situaciones clínicas que por su frecuencia o gravedad requieren de unas normas claras de evaluación están el manejo del paciente pediátrico con cáncer, febril y neutropénico y el del niño febril con infección por el virus de la inmunodeficiencia humana (VIH). Se discute la evaluación clínica y paraclínica, y la terapéutica, enfatizando las dificultades encontradas en cada uno de estos aspectos. Finalmente se analizan las nuevas técnicas en diagnóstico y tratamiento y, en particular, sus implicaciones para un cercano futuro.
Asunto(s)
Humanos , Niño , Terapia de Inmunosupresión/clasificación , Terapia de Inmunosupresión/enfermería , Terapia de Inmunosupresión/estadística & datos numéricos , Terapia de Inmunosupresión/mortalidadRESUMEN
Treatment with Cyclosporine has resulted in improved allograft survival. Cyclosporine metabolism occurs in the liver via hepatic cytochrome P-450IIIA microsomal enzyme. Pharmacokinetic drug interactions usually involve drugs which induce or inhibit the cytochrome P-450 system. We reviewed the Medical Charts of 53 renal transplant recipients immunosuppressed with Cyclosporine between 1985 and 1991. We analysed the relationship between Cyclosporine concentration, its dose and the change induced by concomitant administration of different drugs. Until December 1988, Cyclosporine was measured by solid-phase radioimmunoassay (RIA) using a polyclonal antibody. This method measures Cyclosporine and some of its metabolites. Since January 1989, Cyclosporine was measured in whole blood by radioimmunoassay (RIA-Kit Sandimmun, Sandoz), which used a specific monoclonal antibody which binds Cyclosporine and a non-specific monoclonal antibody which binds Cyclosporine and its metabolites. The therapeutic range recommended by Sandoz in whole blood using the specific monoclonal antibody is 100 to 400 ng/ml. We present 3 cases of probable pharmacokinetic drug interactions with Cyclosporine. The first patient received concomitantly isoniazide (150 mg/day). Cyclosporine levels were between 600 and 2085 ng/ml despite the dose reduction from 10 to 1.5 mg/kg/day (Fig. 1). The dose reduction of isoniazide to 100 mg/day resulted in reduction of Cyclosporine levels. Until December 1988 with the polyclonal antibody the median was 320 ng/ml (range: 185 to 760 ng/ml; n = 11).(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Ciclosporina/efectos adversos , Trasplante de Riñón , Adolescente , Adulto , Anciano , Terapia Combinada , Ciclosporina/administración & dosificación , Ciclosporina/sangre , Interacciones Farmacológicas , Femenino , Humanos , Terapia de Inmunosupresión/métodos , Terapia de Inmunosupresión/estadística & datos numéricos , Fallo Renal Crónico/sangre , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/terapia , Trasplante de Riñón/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Radioinmunoensayo , Estudios RetrospectivosRESUMEN
We studied the incidence of tuberculosis in 37 renal transplant patients. Mean age was 37 years and immune suppression therapy had been used for a mean of 37 months. Tuberculosis-free cases had received prednisone at a mean dose of 10 +/- 4 mg/day and azathioprine, 96 +/- 35 mg/day. 28% of patients had a positive tuberculin test, 24% a healed tuberculous lung lesion and 40% received chemoprophylaxis. Four patients developed tuberculosis, 10 times the incidence expected for the general population. Fever was present in all patients. Two patients had a disseminated form and one a laryngeal location. None of the patients had received chemoprophylaxis and the dose of prednisone was higher (18 +/- 9 mg/day) than that received by non-infected patients. Thus, chemoprophylaxis for tuberculosis appears warranted in all renal transplant recipients, regardless of tuberculin test results or chest X ray findings.