RESUMO
PURPOSE: To report a single center experience with elective surgical patients as living kidney donors. METHODS: We retrospectively analyzed a prospective database of 458 living kidney donors from September 2005 to May 2011. Fifteen (3.2%) of them were elective surgical patients simultaneously undergoing living donor nephrectomy. We reviewed age, gender, operative time, intraoperative blood transfusion, intra- and postoperative complications, as well as length of hospital stay. Recipients were evaluated for delayed graft function. Four hundred forty-three patients undergoing living donor nephrectomy alone composed the control group. RESULTS: Among the elective surgical patients group, the mean (range) operative time was 155 (90 to 310) minutes and mean (range) length of hospital stay was 3 (2 to 9) days. One (6.7%) recipient displayed delayed graft function. Among the regular living kidney donors group, the mean (range) operative time was 100 (70 to 150) minutes, mean (range) length of hospital stay was 3 (2 to 5) days, and delayed graft function was observed in 5.6% of recipients. Only operative time (P = .03) was significantly different between the groups. CONCLUSIONS: Elective surgical patients are potential donors who may be treated at the same time as the living donor nephrectomy.
Assuntos
Adrenalectomia , Colecistectomia , Herniorrafia , Transplante de Rim/métodos , Doadores Vivos , Nefrectomia , Coleta de Tecidos e Órgãos/métodos , Adrenalectomia/efeitos adversos , Adulto , Idoso , Brasil , Distribuição de Qui-Quadrado , Colecistectomia/efeitos adversos , Função Retardada do Enxerto/etiologia , Procedimentos Cirúrgicos Eletivos , Feminino , Herniorrafia/efeitos adversos , Humanos , Transplante de Rim/efeitos adversos , Longevidade , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Coleta de Tecidos e Órgãos/efeitos adversos , Resultado do TratamentoRESUMO
OBJECTIVE: There are no data to support the suggestion that samples removed from one segment of the transplanted kidney are representative of the whole graft. The aim of this study was to compare the histological differences between biopsies obtained from different portions of the renal allograft and their impact on treatment recommendations. PATIENTS AND METHODS: Two hundred percutaneous biopsies were performed on kidney allografts and samples were collected from the upper and lower poles (100 kidneys). All samples were randomized and blindly reviewed. We obtained the discordance rates between the poles for the grading of acute rejection and for the diagnosis of nephrotoxicity due to immunosuppression. We also checked if the differences found were sufficient to call for different clinical recommendations. These values were compared with the intrapathologist variation rates. RESULTS: In 70 kidneys adequate sampling was obtained from both poles. The diagnosis of acute rejection were made in 17. The discordance rate between the upper and lower poles was 82.3% (kappa = 0.34), higher than the intrapathologist variation (P = .002). Nephrotoxicity was found in 14 kidneys. The discordance rate between the upper and lower poles was 28.6% (kappa = 0.88), with no difference compared with the intrapathologist variation. In 14 of the 70 kidneys (25.7%), discordances between poles had impact on clinical recommendations, most of these cases due to different gradings of acute rejection (78%). This number was higher than the intrapathologist variation (P = .04). CONCLUSIONS: The histopathological changes in the kidney allograft are not always homogeneous. This heterogeneity may affect the therapeutic recommendations.
Assuntos
Biópsia por Agulha/métodos , Rejeição de Enxerto/patologia , Transplante de Rim/patologia , Adolescente , Adulto , Automação , Pressão Sanguínea , Rejeição de Enxerto/induzido quimicamente , Humanos , Imunossupressores/toxicidade , Transplante de Rim/fisiologia , Túbulos Renais/patologia , Necrose , Variações Dependentes do Observador , Seleção de Pacientes , Distribuição Aleatória , Reprodutibilidade dos Testes , Estudos Retrospectivos , Transplante Homólogo/patologia , Transplante Homólogo/fisiologiaRESUMO
Exploratory research is proposed as a methodological procedure for a qualitative approach. The main purpose of this procedure is that of helping the researcher to develop a measurement tool which reflects reality. Both exploratory research conceptions, the traditional and the new one are discussed. The application of this methodological procedure to the study of human factors is recommended and the implementation stages are presented. Some applications for research in public health are suggested.