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- ItemSomente MetadadadosCorneal graft survival after therapeutic keratoplasty for Acanthamoeba keratitis(Wiley-Blackwell, 2008-09-01) Kashiwabuchi, Renata T. [UNIFESP]; Freitas, Denise de [UNIFESP]; Alvarenga, Lenio S. [UNIFESP]; Vieira, Luiz [UNIFESP]; Contarini, Patricia [UNIFESP]; Sato, Elcio [UNIFESP]; Foronda, Annette; Hofling-Lima, Ana Luisa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Purpose: To describe corneal graft survival and visual outcome after therapeutic penetrating keratoplasty in patients with Acanthamoeba keratitis (AK) that is unresponsive to clinical treatment.Methods: Retrospective study. Thirty-two patients with AK who underwent therapeutic penetrating keratoplasty (tPK) from August 1996 to August 2005 were included. Data relating to clinical features, visual acuity, surgical technique, graft survival and complications were collected. Graft survival was evaluated by the Kaplan-Meier method and comparisons were performed using the Log-rank test.Results: Most patients (62.5%) were female. Mean age [+/- standard deviation (SD)] was 35 (+/- 13) years (range 15-68 years). All patients were contact lens wearers. Eighteen patients (56%) presented paralytic mydriasis and glaucoma during the treatment. Thirteen patients (40%) developed glaucoma after surgery; eight of them (61%) required a second PK because of graft failure. of the 32 keratoplasty eyes, 56.2% presented graft failure at any follow-up point. Forty-five per cent of graft failures occurred before the 12 month follow-up, so 55% remained clear in the first year after surgery. Twelve patients underwent a second PK; seven of them failed and 45% were clear at 1 year. Two patients presented graft recurrence of amoebic infection. There was no significant difference in graft survival when eyes with or without mydriasis were compared (P = 0.40). Eyes with glaucoma presented a significantly shorter graft survival (P = 0.01).Conclusion: Penetrating keratoplasty is a treatment option for eyes that are unresponsive to clinical treatment infections. However, graft survival is poor; postoperative glaucoma is frequent and is associated with shorter graft survival.
- ItemSomente MetadadadosHigh expression of TIM-3 mRNA in urinary cells from kidney transplant recipients with acute rejection(Blackwell Publishing, 2007-06-01) Renesto, P. G.; Ponciano, V. C.; Cenedeze, Marcos Antonio [UNIFESP]; Camara, N. O. Saraiva; Pacheco-Silva, Alvaro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)TIM-3 is a recently described molecule specifically expressed on Th1 differentiated T cells. We explored the usefulness of urinary mRNA profiles in the diagnosis of renal acute rejection (AR). Sixty urinary samples from renal transplant recipients simultaneously collected to allograft biopsy, (AR = 30 and No-AR =30), and 12 urinary samples from stable renal transplants were analyzed. Urinary mRNA encoding for TIM-3 and IFN-gamma were quantified using real time RT-PCR. TIM-3 mRNA was highly expressed in AR (559.19 +/- 644.41) compared to No-AR (3.78 +/- 7.20), and stable transplants (0.54 +/- 0.76), p < 0.001. To a lesser degree, IFN-gamma mRNA transcripts were also increased in AR (50.40 +/- 38.71), compared with No-AR (4.69 +/- 12.62), and stable transplants (0.38 +/- 0.44) p < 0.001. the highest expression of TIM-3 in AR makes it a promising noninvasive test for its diagnosis.
- ItemSomente MetadadadosImproved renal function after kidney transplantation is associated with heme oxygenase-1 polymorphism(Wiley-Blackwell, 2008-09-01) Ozaki, K. S.; Marques, G. M.; Nogueira, E.; Feitoza, R. Q.; Cenedeze, M. A.; Franco, M. F. [UNIFESP]; Mazzali, M.; Soares, M. P.; Pacheco-Silva, A.; Camara, N. O. S. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Campinas (UNICAMP); Gulbenkian Inst Sci; Universidade de São Paulo (USP)Heme oxygenase-1 (HO-1) has a microsatellite polymorphism based on the number of guanosine-thymidine nucleotide repeats (GT) repeats that regulates expression levels and could have an impact on organ survival post-injury. We correlated HO-1 polymorphism with renal graft function. the HO-1 gene was sequenced (N = 181), and the allelic repeats were divided into subclasses: short repeats (S) (< 27 repeats) and long repeats (L) (>= 27 repeats). A total of 47.5% of the donors carried the S allele. the allograft function was statistically improved six months, two and three yr after transplantation in patients receiving kidneys from donors with an S allele. for the recipients carrying the S allele (50.3%), the allograft function was also better throughout the follow-up, but reached statistical significance only three yr after transplantation (p = 0.04). Considering only those patients who had chronic allograft nephropathy (CAN; 74 of 181), allograft function was also better in donors and in recipients carrying the S allele, two and three yr after transplantation (p = 0.03). Recipients of kidney transplantation from donors carrying the S allele presented better function even in the presence of CAN.
- ItemSomente MetadadadosPrognostic factors associated with poor graft outcomes in renal recipients with post-transplant glomerulonephritis(Blackwell Publishing, 2007-05-01) Requiao-Moura, Lucio R.; Moscoso-Solorzano, Grace T.; Franco, Marcello F.; Ozaki, Kikumi S.; Pacheco-Silva, Alvaro; Kirsztajn, Gianna Mastroianni; Camara, Niels O. S.; Universidade Federal de São Paulo (UNIFESP)Background: Little data are available concerning post-transplantation glomerulonephritis (PTx-GN) and its prognostic factors associated with graft outcomes.Methods: We retrospectively evaluated patients with de novo and recurrent PTx-GN to identify the factors associated with their negative impact on graft and patient outcomes. PTx-GN was diagnosed in 55 patients, wherein 17 (31%) had recurrent glomerulonephritis (GN) and 16 (29%) had de novo.Results: Our enrolled population consisted of 34 +/- 13.7-yr-old male patients (72%), on hemodialysis for a median of 18 months (0-204) and mainly grafted from living donors (76%). the median onset time of proteinuria and hematuria was 50 d (10-2160) and 30 d (4-1170), respectively. One-yr graft survival rates after PTx-GN diagnosis was 64%. the most frequent de novo GN was membranous GN (26%), while focal segmental glomerulosclerosis was the most frequent recurrent GN (41%), with a very early onset (median of three months). One-yr graft survival was better in the recurrent disease than in the de novo patients, 76% vs. 55% (p = 0.24). the best predictor factors that correlated with graft survival were: proteinuria < 3.5 g [relative risk (RR) = 0.24, p = 0.017], serum creatinine below 2.0 mg/dL (RR = 0.06, p = 0.016) at the time of biopsy and the use of angiotensin-converting enzyme inhibitors (ACEI) (RR = 0.12, p = 0.005). the use of ACEI markedly improved one-yr graft survival rates (92% vs. 47%, p < 0.001).Conclusion: PTx-GN has a strong negative impact on kidney graft survival. de novo GN appears to have a poorer prognosis than the recurrent type. Patients who used ACEI showed a better survival rate in the follow-up.
- ItemSomente MetadadadosRegional differences in the management and outcome of kidney transplantation in patients with human immunodeficiency virus infection: A 3-year retrospective cohort study(Wiley, 2017) Cristelli, Marina P. [UNIFESP]; Cofan, Federico; Tedesco-Silva, Helio [UNIFESP]; Trullas, Joan Carles; Santos, Daniel Wagner C. L. [UNIFESP]; Manzardo, Christian; Aguero, Fernando; Moreno, Asuncion; Oppenheimer, Federico; Diekmann, Fritz; Medina-Pestana, Jose O. [UNIFESP]; Miro, Jose MariaBackground: In the developed world, kidney transplantation (KT) in patients with human immunodeficiency virus (HIV) infection is well established. Developing countries concentrate 90% of the people living with HIV, but their experience is underreported. Regional differences may affect outcomes. Objectives: We compared the 3-year outcomes of patients with HIV infection receiving a KT in two different countries, in terms of incomes and development. Methods: This was an observational, retrospective, double-center study, including all HIV-infected patients >18years old undergoing KT. Results: Between 2005 and 2015, 54 KTs were performed (39 in a Brazilian center, and 15 in a Spanish center). Brazilians had less hepatitis C virus co-infection (5% vs 27%, P=.024). Median cold ischemia time was higher in Brazil (25 vs 18hours, P=.001). Biopsy-proven acute rejection (AR) was higher in Brazil (33% vs 13%, P=.187), as were the number of AR episodes (22 vs 4, P=.063). Patient survival at 3years was 91.3% in Brazil and 100% in Spain
- ItemSomente MetadadadosRenal transplantation in human immunodeficiency virus-infected recipients: a case-control study from the Brazilian experience(Wiley-Blackwell, 2016) Vicari, A. R.; Spuldaro, F.; Freitas, Tainá Veras de Sandes [UNIFESP]; Cristelli, Marina Pontello [UNIFESP]; Requiao-Moura, L. R.; Reusing, J. O.; Pierrotti, L. C.; Oliveira, M. L.; Girao, C. M.; Gadonski, G.; Kroth, L. V.; Deboni, L. M.; Ferreira, G. F.; Tedesco-Silva, Helio [UNIFESP]; Esmeraldo, R.; David-Neto, E.; Saitovitch, D.; Keitel, E.; Garcia, V. D.; Pacheco-Silva, A.; Pestana, Jose Osmar Medina [UNIFESP]; Manfro, R. C.BackgroundHighly active antiretroviral therapy has turned human immunodeficiency virus (HIV)-infected patients with end-stage renal disease into suitable candidates for renal transplantation. We present the Brazilian experience with kidney transplantation in HIV-infected recipients observed in a multicenter study. MethodsHIV-infected kidney transplant recipients and matched controls were evaluated for the incidence of delayed graft function (DGF), acute rejection (AR), infections, graft function, and survival of patients and renal grafts. ResultsFifty-three HIV-infected recipients and 106 controls were enrolled. Baseline characteristics were similar, but a higher frequency of pre-transplant positivity for hepatitis C virus and cytomegalovirus infections was found in the HIV group. Immunosuppressive regimens did not differ, but a trend was observed toward lower use of anti-thymocyte globulin in the group of HIV-infected recipients (P = 0.079). The HIV-positive recipient group presented a higher incidence of treated AR (P = 0.036) and DGF (P = 0.044). Chronic Kidney Disease Epidemiology Collaboration estimated that glomerular filtration rate was similar at 6 months (P = 0.374) and at 12 months (P = 0.957). The median number of infections per patient was higher in the HIV-infected group (P = 0.018). The 1-year patient survival (P < 0.001) and graft survival (P = 0.004) were lower, but acceptable, in the group of HIV-infected patients. ConclusionsIn the Brazilian experience, despite somewhat inferior outcomes, kidney transplantation is an adequate therapy for selected HIV-infected recipients.
- ItemSomente MetadadadosRenal transplantation outcomes: a comparative analysis between elderly and younger recipients(Blackwell Publishing, 2007-11-01) Mendonca, Helena Moises; Reis, Marlene Antonia dos; Sesso, Ricardo de Castro de Cintra; Camara, Niels Olsen Saraiva; Pacheco-Silva, Alvaro; Universidade Federal de São Paulo (UNIFESP); Univ Fed Triangulo Mineiro; Universidade de São Paulo (USP)Renal transplantation is presently the best treatment for end-stage renal disease, although considered contraindicated for elderly patients. However, more investigation is needed due to higher life expectancy rates of the general population and the increasing number of over 60-yr-old patients with chronic renal failure dependant upon dialysis. This study aims to determine graft and patient survival rates of renal transplant patients 60 yr and older compared to a younger group (50-59 yr old). Relevant pre- and post-transplant clinical data related to graft and patient survival in both groups were also investigated. Three-hundred and twenty consecutive renal transplant patients were enrolled in this study and grouped based on age at the time of the transplantation: one-hundred and ten patients at or over 60 yr old (elderly group) and 210 patients ranging from 50 to 59 yr old (younger group). There were no statistical differences in either group regarding clinical characteristics and immunological risk factors. the incidence of acute rejection was higher in the younger group (37.6%) than in the elderly (22.7%) (p = 0.01). Censored to death graft survivals at five yr were respectively 86.7% for patients >= 60 yr and 82.1% for patients 50-59 yr old (p = 0.49). Patient survival rates at five yr were respectively 76.2% for patients >= 60 yr and 81.6% for patients 50-59 yr old (p = 0.33). Our data show that renal transplantation for elderly patients has similar results to those found in younger individuals, which does not make age, in and of itself, a contraindication for transplantation.