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[PMID]:29356887
[Au] Autor:Wang M; Zhang H; Zhou D; Qiao YC; Pan YH; Wang YC; Zhao HL
[Ad] Endereço:Center for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, Guangxi, China.
[Ti] Título:Risk for cancer in living kidney donors and recipients.
[So] Source:J Cancer Res Clin Oncol;144(3):543-550, 2018 Mar.
[Is] ISSN:1432-1335
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Malignancy following renal transplantation remains inconsistent with the reported safety of kidney donation during the long-term follow-up. METHODS: We conducted searches of the published literature which included healthy participants, recipients, living kidney donors (LKDs), and the availability of outcome data for malignancy. Eight from 938 potentially relevant studies were analyzed by means of fixed-effects model or random-effects model, as appropriately. RESULTS: In 48,950 participants, the follow-up range was 18 months to 20 years, and the mean age of the subjects was approximately 41 years. The incidence rate with 95% confidence interval (CI) for malignancy after kidney transplantation was 0.03 (0.01-0.05) in recipients and 0.03 (0.1-0.07) in LKDs, giving a pooled incidence rate of 0.03 (95% CI 0.02-0.04). LKDs contrasted nondonors by the overall odds ratio and 95% CI for total cancer of 2.80 (2.69-2.92). CONCLUSIONS: Kidney transplantation was associated with an increased risk of cancer during a long-term follow-up. Long-term risk for cancer in LKDs and kidney recipients should be monitored.
[Mh] Termos MeSH primário: Transplante de Rim/estatística & dados numéricos
Doadores Vivos/estatística & dados numéricos
Neoplasias/epidemiologia
Transplantados/estatística & dados numéricos
[Mh] Termos MeSH secundário: Seguimentos
Seres Humanos
Rim
Neoplasias/etiologia
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180123
[St] Status:MEDLINE
[do] DOI:10.1007/s00432-018-2590-z


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[PMID]:29184964
[Au] Autor:Costa C; Di Nauta A; Rittà M; Sinesi F; Bianco G; Sidoti F; Solidoro P; Cavallo R
[Ad] Endereço:Microbiology and Virology Unit, Laboratory of Virology.
[Ti] Título:Development of an EliSPOT assay for HSV-1 and clinical validation in lung transplant patients.
[So] Source:New Microbiol;40(4):251-257, 2017 Oct.
[Is] ISSN:1121-7138
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:Cellular immunity plays a major role in the control of HSV-1 infection/reactivation with a potential impact on the clinical-therapeutic management of immunocompromised patients, such as transplant recipients. Herein, we quantitatively evaluated T-cell response directed at HSV-1 by a newly developed IFN-γ EliSPOT assay in 53 patients (including 45 lung transplant recipients and eight subjects in waiting list). Overall, 62.2% of transplant patients and 62.5% of subjects on the waiting list showed a response to HSV-1 with no significant difference in the level of virus-specific cellular immunity. Response tended to be lower in the first three months posttransplantation with a progressive recovery of pretransplantation status by the second year and in the presence of HSV-1 DNA positivity in bronchoalveolar lavage. As expected, no response was found in seronegative patients. No significant difference in the level of response according to IgM and IgG status was found. Further studies are required to define the role of HSV-1 specific immune response for the clinical-therapeutic management of lung transplant patients and in other clinical settings and to define cut-off levels discriminating between absence/low and strong response to be related to the risk of viral infection/reactivation.
[Mh] Termos MeSH primário: ELISPOT/métodos
Herpes Simples/diagnóstico
Herpesvirus Humano 1/imunologia
Imunidade Celular
Transplante de Pulmão/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Feminino
Herpes Simples/virologia
Herpesvirus Humano 1/isolamento & purificação
Herpesvirus Humano 1/fisiologia
Seres Humanos
Masculino
Meia-Idade
Linfócitos T/imunologia
Transplantados
Ativação Viral
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171130
[St] Status:MEDLINE


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[PMID]:28452107
[Au] Autor:Hartmann CA; Vikram HR; Seville MT; Orenstein R; Kusne S; Blair JE; Grys TE; Patron RL
[Ad] Endereço:Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ.
[Ti] Título:Neuroinvasive St. Louis Encephalitis Virus Infection in Solid Organ Transplant Recipients.
[So] Source:Am J Transplant;17(8):2200-2206, 2017 Aug.
[Is] ISSN:1600-6143
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In summer 2015, three unrelated solid organ transplant recipients in Phoenix, Arizona, had meningoencephalitis suggestive of West Nile virus (WNV) infection. Testing was inconclusive but was later confirmed as St. Louis encephalitis (SLE). We retrospectively reviewed clinical manifestations, treatment, and outcomes of these transplant recipients. Common symptoms were fever, rigors, diarrhea, headache, and confusion. One patient died 3 days after hospitalization. Therapy for the other two patients was initiated with interferon α-2b (IFN) and intravenous IgG (IVIG; IFN plus IVIG in combination). Both patients tested positive for WNV by serologic assay, but SLE virus (SLEV) infection was later confirmed by plaque reduction neutralization test at a reference laboratory. Clinical improvement was observed within 72 h after initiation of IFN plus IVIG. SLEV has been an uncommon cause of neuroinvasive disease in the United States. Accurate, timely diagnosis is hindered because of clinical presentation similar to neuroinvasive WNV and SLE, serologic cross-reactivity, and lack of a commercially available serologic assay for SLEV. There is currently no approved therapy for flaviviral neuroinvasive disease. Anecdotal reports indicate varying success with IFN, IVIG, or IFN plus IVIG in WNV neuroinvasive disease. The same regimen might be of value for immunocompromised persons with neuroinvasive SLEV infection.
[Mh] Termos MeSH primário: Antivirais/uso terapêutico
Surtos de Doenças
Vírus da Encefalite de St. Louis/efeitos dos fármacos
Encefalite de St. Louis/epidemiologia
Sobrevivência de Enxerto/efeitos dos fármacos
Transplante de Órgãos
[Mh] Termos MeSH secundário: Idoso
Anticorpos Antivirais/sangue
Encefalite de St. Louis/tratamento farmacológico
Encefalite de St. Louis/virologia
Seguimentos
Seres Humanos
Imunoglobulinas Intravenosas/administração & dosagem
Interferon-alfa/uso terapêutico
Masculino
Meia-Idade
Prevalência
Prognóstico
Estudos Retrospectivos
Fatores de Risco
Transplantados
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Viral); 0 (Antiviral Agents); 0 (Immunoglobulins, Intravenous); 0 (Interferon-alpha)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1111/ajt.14336


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[PMID]:27779573
[Au] Autor:McAdams-DeMarco MA; Ying H; Olorundare I; King EA; Haugen C; Buta B; Gross AL; Kalyani R; Desai NM; Dagher NN; Lonze BE; Montgomery RA; Bandeen-Roche K; Walston JD; Segev DL
[Ad] Endereço:1 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. 2 Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD. 3 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 4 Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD.
[Ti] Título:Individual Frailty Components and Mortality in Kidney Transplant Recipients.
[So] Source:Transplantation;101(9):2126-2132, 2017 09.
[Is] ISSN:1534-6080
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Frailty increases early hospital readmission and mortality risk among kidney transplantation (KT) recipients. Although frailty represents a high-risk state for this population, the correlates of frailty, the patterns of the 5 frailty components, and the risk associated with these patterns are unclear. METHODS: Six hundred sixty-three KT recipients were enrolled in a cohort study of frailty in transplantation (12/2008-8/2015). Frailty, activities of daily living (ADL)/instrumental ADL (IADL) disability, Centers for Epidemiologic Studies Depression Scale depression, education, and health-related quality of life (HRQOL) were measured. We used multinomial regression to identify frailty correlates. We identified which patterns of the 5 components were associated with mortality using adjusted Cox proportional hazards models. RESULTS: Frailty prevalence was 19.5%. Older recipients (adjusted prevalence ratio [PR], 2.22; 95% confidence interval [CI], 1.21-4.07) were more likely to be frail. The only other factors that were independently associated with frailty were IADL disability (PR, 3.22; 95% CI, 1.72-6.06), depressive symptoms (PR, 11.31; 95% CI, 4.02-31.82), less than a high school education (PR, 3.10; 95% CI, 1.30-7.36), and low HRQOL (fair/poor: PR, 3.71; 95% CI, 1.48-9.31). The most common pattern was poor grip strength, low physical activity, and slowed walk speed (19.4%). Only 2 patterns of the 5 components emerged as having an association with post-KT mortality. KT recipients with exhaustion and slowed walking speed (hazards ratio = 2.43; 95% CI, 1.17-5.03) and poor grip strength, exhaustion, and slowed walking speed (hazard ratio, 2.61; 95% CI, 1.14-5.97) were at increased mortality risk. CONCLUSIONS: Age was the only conventional factor associated with frailty among KT recipients; however, factors rarely measured as part of clinical practice, namely, HRQOL, IADL disability, and depressive symptoms, were significant correlates of frailty. Redefining the frailty phenotype may be needed to improve risk stratification for KT recipients.
[Mh] Termos MeSH primário: Idoso Fragilizado/psicologia
Nível de Saúde
Falência Renal Crônica/cirurgia
Transplante de Rim/mortalidade
Transplantados/psicologia
[Mh] Termos MeSH secundário: Atividades Cotidianas
Adolescente
Adulto
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Baltimore/epidemiologia
Depressão/diagnóstico
Depressão/mortalidade
Depressão/psicologia
Avaliação da Deficiência
Escolaridade
Tolerância ao Exercício
Feminino
Avaliação Geriátrica
Força da Mão
Seres Humanos
Falência Renal Crônica/diagnóstico
Falência Renal Crônica/mortalidade
Transplante de Rim/efeitos adversos
Masculino
Saúde Mental
Meia-Idade
Fenótipo
Valor Preditivo dos Testes
Prevalência
Estudos Prospectivos
Qualidade de Vida
Fatores de Risco
Inquéritos e Questionários
Fatores de Tempo
Resultado do Tratamento
Caminhada
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1097/TP.0000000000001546


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[PMID]:29272850
[Au] Autor:Togsverd-Bo K; Philipsen PA; Hædersdal M; Wulf HCO
[Ad] Endereço:Department of Dermato-venerology, Bispebjerg University Hospital, 2400 Copenhagen, Denmark. Electronic address: ktogsverdbo@dadlnet.dk.
[Ti] Título:Skin autofluorescence reflects individual seasonal UV exposure, skin photodamage and skin cancer development in organ transplant recipients.
[So] Source:J Photochem Photobiol B;178:577-583, 2018 Jan.
[Is] ISSN:1873-2682
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:IMPORTANCE: Ultraviolet radiation (UVR)-induced skin cancers varies among organ transplant recipients (OTRs). To improve individual risk assessment of skin cancer, objectively quantified skin photodamage is needed. OBJECTIVES: We measured personal UVR-exposure dose in OTRs and assessed the relation between individual UVR exposure, skin cancer and objectively measured photodamage in terms of skin autofluorescence, pigmentation, and black light-evaluated solar lentigines. MATERIALS AND METHODS: Danish OTRs with (n=15) and without a history of skin cancer (n=15) kept sun diaries from May to September and wore personal dosimeters recording time-stamped UVR doses in standard erythema doses (SED). Photodamage was quantified as skin autofluorescence with excitation at 370nm (F370) and 430nm (F430), skin pigmentation (pigment protection factor, PPF), and black light-evaluated solar lentigines. RESULTS: OTRs with skin cancer received a higher UVR dose than OTRs without skin cancer (median 116 SED vs. 67 SED, p=0.07) and UVR exposure doses were correlated with increased PPF (p=0.052) and F370 on the shoulder (F370 ) (p=0.04). We found that skin cancer was associated with F370 (OR 10.53, CI 3.3-31,938; p=0.018) and time since transplantation (OR 1.34, CI 0.95-1.91, p=0.097). A cut-off at 7.2 arbitrary units, 89% of OTRs with skin cancer had F370 values above 7.2 arbitrary units and F370 was additionally related to patient age (p=0.09) and black light-evaluated solar lentigines (p=0.04). CONCLUSION: F370 autofluorescence indicates objectively measured photodamage and may be used for individual risk assessment of skin cancer development in OTRs.
[Mh] Termos MeSH primário: Neoplasias Cutâneas/etiologia
Pele/efeitos da radiação
Raios Ultravioleta
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seres Humanos
Lentigo/etiologia
Medições Luminescentes
Masculino
Meia-Idade
Razão de Chances
Transplante de Órgãos
Estações do Ano
Pele/química
Pigmentação da Pele/efeitos da radiação
Transplantados
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171223
[St] Status:MEDLINE


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[PMID]:29276997
[Au] Autor:Chae YK; Galvez C; Anker JF; Iams WT; Bhave M
[Ad] Endereço:Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA. Electronic address: young.chae@northwestern.edu.
[Ti] Título:Cancer immunotherapy in a neglected population: The current use and future of T-cell-mediated checkpoint inhibitors in organ transplant patients.
[So] Source:Cancer Treat Rev;63:116-121, 2018 Feb.
[Is] ISSN:1532-1967
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Although the indications for immune checkpoint inhibitors continue to grow, organ transplant recipients with advanced malignancies have been largely excluded from clinical trials testing the safety and efficacy of these therapies given their need for chronic immunosuppression and the risk of allograft rejection. With the rapid growth of transplant medicine and the increased risk of malignancy associated with chronic immunosuppression, it is critical that we systematically analyze the available data describing immune checkpoint blockade in the organ transplant population. Herein we provide a current and comprehensive review of cases in which immune checkpoint blockade was used on organ transplant recipients. Furthermore, we discuss the differences in efficacy and risk of allograft rejection between CTLA-4 and PD-1 inhibitors and make recommendations based on the limited available clinical data. We also discuss the future of immune checkpoint blockade in this subpopulation and explore the emerging data of promising combination therapies with mTOR, BRAF/MEK, and BTK/ITK inhibitors. Further clinical experience and larger clinical trials involving immune checkpoint inhibitors, whether as monotherapies or combinatorial therapies, will help develop regimens that optimize anti-tumor response and minimize the risk of allograft rejection in organ transplant patients.
[Mh] Termos MeSH primário: Neoplasias/imunologia
Neoplasias/terapia
Linfócitos T/imunologia
Transplantes/imunologia
[Mh] Termos MeSH secundário: Animais
Seres Humanos
Imunoterapia/métodos
Transplantados
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171226
[St] Status:MEDLINE


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Zalis, Mariano G
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[PMID]:29106916
[Au] Autor:Varella RB; Zalona ACJ; Diaz NC; Zalis MG; Santoro-Lopes G
[Ad] Endereço:Laboratory of Virology, Department of Microbiology and Parasitology, Universidade Federal Fluminense, Brazil. Electronic address: rvarella@id.uff.br.
[Ti] Título:BK polyomavirus genotypes Ia and Ib1 exhibit different biological properties in renal transplant recipients.
[So] Source:Virus Res;243:65-68, 2018 01 02.
[Is] ISSN:1872-7492
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BK polyomavirus (BKV) is an opportunist agent associated with nephropathy (BKVAN) in 1-10% of kidney transplant recipients. BKV is classified into genotypes or subgroups according to minor nucleotidic variations with unknown biological implications. Studies assessing the possible association between genotypes and the risk of BKVAN in kidney transplant patients have presented conflicting results. In these studies, genotype Ia, which is highly prevalent in Brazil, was less frequently found and, thus, comparative data on the biological properties of this genotype are lacking. In this study, BKV Ia and Ib1 genotypes were compared according to their viral load, genetic evolution (VP1 and NCCR) - in a cohort of renal transplant recipients. The patients infected with Ia (13/23; 56.5%) genotype exhibited higher viral loads in urine [>1.4 log over Ib1 (10/23; 43.5%); p=0.025]. In addition, genotype Ia was associated with diverse mutations at VP1 loops and sites under positive selection outside loops, which were totally absent in Ib1. Although the number of viremic patients was similar, the three patients who had BK nephropathy (BKVAN) were infected with Ia genotype. NCCR architecture (ww or rr) were not distinctive between Ia and Ib1 genotypes. Ia genotype, which is rare in other published BKV cohorts, presented some diverse biological properties in transplanted recipients in comparison to Ib1.
[Mh] Termos MeSH primário: Vírus BK/isolamento & purificação
Transplante de Rim/efeitos adversos
Infecções por Polyomavirus/virologia
Infecções Tumorais por Vírus/virologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Vírus BK/classificação
Vírus BK/genética
Vírus BK/fisiologia
Genótipo
Seres Humanos
Rim/cirurgia
Rim/virologia
Masculino
Meia-Idade
Filogenia
Infecções por Polyomavirus/etiologia
Transplantados/estatística & dados numéricos
Infecções Tumorais por Vírus/etiologia
Carga Viral
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171107
[St] Status:MEDLINE


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[PMID]:28466469
[Au] Autor:Zhao XY; Luo XY; Yu XX; Zhao XS; Han TT; Chang YJ; Huo MR; Xu LP; Zhang XH; Liu KY; Li D; Jiang ZF; Huang XJ
[Ad] Endereço:Peking University People's Hospital, Peking University Institute of Haematology, Beijing Key Laboratory of Haematopoietic Stem Cell Transplantation, Beijing, China.
[Ti] Título:Recipient-donor KIR ligand matching prevents CMV reactivation post-haploidentical T cell-replete transplantation.
[So] Source:Br J Haematol;177(5):766-781, 2017 06.
[Is] ISSN:1365-2141
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Licensed natural killer (NK) cells have been demonstrated to have anti-cytomegalovirus (CMV) activity. We prospectively analysed the human leucocyte antigen typing of donor-recipient pairs and the killer cell immunoglobulin-like receptor (KIR) typing of donors for 180 leukaemia patients to assess the predictive roles of licensed NK cells on CMV reactivation post-T-cell-replete haploidentical stem cell transplantation. Multivariate analysis showed that donor-recipient KIR ligand graft-versus-host or host-versus-graft direction mismatch was associated with increased refractory CMV infection (Hazard ratio = 2·556, 95% confidence interval, 1·377-4·744, P = 0·003) post-transplantation. Donor-recipient KIR ligand matching decreased CMV reactivation [51·65% (46·67, 56·62%) vs. 75·28% (70·87, 79·69%), P = 0·012], refractory CMV infection [17·58% (13·77, 21·40%) vs. 35·96% (31·09, 40·82%), P = 0·004] and CMV disease [3·30% (1·51, 5·08%) vs. 11·24% (8·04, 14·43%), P = 0·024] by day 100 post-transplantation. In addition, the percentage of γ-interferon expression on donor-derived NK cells was significantly higher in the recipients among the recipient-donor pairs with a KIR ligand match compared with that in the recipients among the pairs with a KIR ligand graft-versus-host or host-versus-graft direction mismatch on days 30 and 100 post-transplantation (P = 0·036 and 0·047, respectively). These findings have suggested that donor-recipient KIR ligand matching might promote the NK cell licensing process, thereby increasing NK cell-mediated protection against CMV reactivation.
[Mh] Termos MeSH primário: Infecções por Citomegalovirus/prevenção & controle
Linfócitos T/transplante
[Mh] Termos MeSH secundário: Adolescente
Adulto
Criança
Citomegalovirus/fisiologia
Feminino
Neoplasias Hematológicas/terapia
Teste de Histocompatibilidade/métodos
Seres Humanos
Células Matadoras Naturais/imunologia
Células Matadoras Naturais/fisiologia
Masculino
Meia-Idade
Estudos Prospectivos
Receptores KIR/genética
Receptores KIR/imunologia
Transplante de Células-Tronco/métodos
Transplantados
Condicionamento Pré-Transplante/métodos
Ativação Viral/genética
Ativação Viral/imunologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (KIR2DS2 protein, human); 0 (Receptors, KIR)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1111/bjh.14622


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[PMID]:28461684
[Au] Autor:Aguiar D; Martínez-Urbistondo D; Baroja-Mazo A; de la Mata M; Rodríguez-Perálvarez M; Rubín A; Puchades L; Serrano T; Montero J; Cuadrado A; Casafont F; Salcedo M; Rincón D; Pons JA; Herrero JI
[Ad] Endereço:Liver Unit, University Clinic of Navarra, Pamplona, Spain.
[Ti] Título:Real-World Multicenter Experience of Immunosuppression Minimization Among 661 Liver Transplant Recipients.
[So] Source:Ann Transplant;22:265-275, 2017 May 02.
[Is] ISSN:2329-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND Long-term morbidity and mortality in liver transplant recipients is frequently secondary to immunosuppression toxicity. However, data are scarce regarding immunosuppression minimization in clinical practice. MATERIAL AND METHODS In this cross-sectional, multicenter study, we reviewed the indications of immunosuppression minimization (defined as tacrolimus levels below 5 ng/mL or cyclosporine levels below 50 ng/mL) among 661 liver transplant recipients, as well as associated factors and the effect on renal function. RESULTS Fifty-three percent of the patients received minimized immunosuppression. The median time from transplantation to minimization was 32 months. The most frequent indications were renal insufficiency (49%), cardiovascular risk (19%), de novo malignancy (8%), and cardiovascular disease (7%). The factors associated with minimization were older age at transplantation, longer post-transplant follow-up, pre-transplant diabetes mellitus and renal dysfunction, and the hospital where the patients were being followed. The patients who were minimized because of renal insufficiency had a significant improvement in renal function (decrease of the median serum creatinine level, from 1.50 to 1.34 mg/dL; P=0.004). Renal function significantly improved in patients minimized for other indications, too. In the long term, glomerular filtration rate significantly decreased in non-minimized patients and remained stable in minimized patients. CONCLUSIONS Immunosuppression minimization is frequently undertaken in long-term liver transplant recipients, mainly for renal insufficiency. Substantial variability exists regarding the use of IS minimization among centers.
[Mh] Termos MeSH primário: Ciclosporina/administração & dosagem
Imunossupressores/administração & dosagem
Hepatopatias/cirurgia
Transplante de Fígado/métodos
Tacrolimo/administração & dosagem
[Mh] Termos MeSH secundário: Fatores Etários
Doenças Cardiovasculares/induzido quimicamente
Estudos Transversais
Ciclosporina/efeitos adversos
Ciclosporina/uso terapêutico
Feminino
Seres Humanos
Imunossupressores/efeitos adversos
Imunossupressores/uso terapêutico
Masculino
Meia-Idade
Fatores de Risco
Tacrolimo/efeitos adversos
Tacrolimo/uso terapêutico
Transplantados
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Immunosuppressive Agents); 83HN0GTJ6D (Cyclosporine); WM0HAQ4WNM (Tacrolimus)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:28466760
[Au] Autor:Patel SI; Chakkera HA; Wennberg PW; Liedl DA; Alrabadi F; Cha SS; Hooley DD; Amer H; Wadei HM; Shamoun FE
[Ad] Endereço:1 Department of Sleep Medicine, Mayo Clinic, Rochester, MN, USA.
[Ti] Título:Peripheral arterial disease preoperatively may predict graft failure and mortality in kidney transplant recipients.
[So] Source:Vasc Med;22(3):225-230, 2017 06.
[Is] ISSN:1477-0377
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Patients with end-stage renal disease undergoing kidney transplant often have diffuse atherosclerosis and high cardiovascular morbidity and mortality rates. We analyzed the correlation of peripheral arterial disease (PAD), here quantified by an abnormal ankle-brachial index (ABI) measured within the 5 years prior to kidney transplant, with graft failure and mortality rates (primary end points) after adjusting for known cardiovascular risk factors (age, sex, smoking history, hypertension, diabetes, stroke, known coronary artery disease or heart failure, years of dialysis). Of 1055 patients in our transplant population, 819 had arterial studies within the 5 years prior to transplant. Secondary end points included myocardial infarction; cerebrovascular accident; and limb ischemia, gangrene, or amputation. Low ABI was an independent and significant predictor of organ failure (OR, 2.77 (95% CI, 1.68-4.58), p<0.001), secondary end points (HR, 1.39 (95% CI, 0.97-1.99), p<0.076), and death (HR, 1.84 (95% CI, 1.26-2.68), p=0.002). PAD was common in this population: of 819 kidney transplant recipients, 46% had PAD. Low ABI was associated with a threefold greater risk of graft failure, a twofold greater risk of death after transplant, and a threefold greater risk of secondary end points. Screening for PAD is important in this patient population because of the potential impact on long-term outcomes.
[Mh] Termos MeSH primário: Falência Renal Crônica/cirurgia
Transplante de Rim/efeitos adversos
Doença Arterial Periférica/complicações
Complicações Pós-Operatórias/etiologia
Transplantados
[Mh] Termos MeSH secundário: Idoso
Índice Tornozelo-Braço
Distribuição de Qui-Quadrado
Feminino
Sobrevivência de Enxerto
Seres Humanos
Estimativa de Kaplan-Meier
Falência Renal Crônica/complicações
Falência Renal Crônica/diagnóstico
Falência Renal Crônica/mortalidade
Transplante de Rim/mortalidade
Masculino
Meia-Idade
Análise Multivariada
Razão de Chances
Doença Arterial Periférica/diagnóstico
Doença Arterial Periférica/mortalidade
Complicações Pós-Operatórias/diagnóstico
Complicações Pós-Operatórias/mortalidade
Valor Preditivo dos Testes
Modelos de Riscos Proporcionais
Estudos Retrospectivos
Fatores de Risco
Índice de Gravidade de Doença
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180118
[Lr] Data última revisão:
180118
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1177/1358863X16689830



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