Navegando por Palavras-chave "Acute rejection"
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- ItemSomente MetadadadosClinicopathological Characteristics and Effect of Late Acute Rejection on Renal Transplant Outcomes(Lippincott Williams & Wilkins, 2014-10-27) Rodrigues, Carolina A.; Franco, Marcello F.; Cristelli, Marina P.; Pestana, Jose O. M.; Tedesco-Silva, Helio; Hosp Rim; Universidade Federal de São Paulo (UNIFESP)Background. Late acute rejection (LAR) has been associated with inferior kidney allograft outcomes.Methods. We retrospectively evaluated 355 episodes of biopsy-confirmed LAR in a cohort of 5758 kidney transplants performed between 1998 and 2008. Estimated glomerular filtration rate was obtained before, at, and after each LAR episode as well as histology and treatment. Associations of LAR with subsequent death or graft loss were estimated with Cox proportional regression analysis.Results. A total of 215 patients had 1 episode, 57 had 2 episodes, and 13 had 3 episodes of LAR. Rates of LAR-free survival were 97.4% at 1 year and 93.7% at 5 years. Estimated glomerular filtration rate decreased after each episode of LAR (56 +/- 21 vs. 44 +/- 18 vs. 36 +/- 11 mL/min/1.73 m(2), P<0.01). the majority of rejections were Banff IA or less, but the chronicity scores as well as plasma cell infiltrates increased after each LAR. All patients requiring dialysis lost their grafts. in a multivariable analysis, the severity of histological score (risk ratio [RR], 3.5; 95% confidence interval [CI], 1.58-7.87; P<0.001), the need for dialysis at LAR (RR, 3.31; 95% CI, 1.44-7.59; P<0.001), and treatment with methylprednisolone (RR, 2.31; 95% CI, 1.07-4.94; P=0.03) were independently associated with graft loss at 5 years, whereas tacrolimus and mycophenolate use was associated with reduced risk (RR, 0.46; 95% CI, 0.25-0.87; P<0.001).Conclusions. the prevalence and recurrence of LAR are considerable and associated with increased incidence of graft loss. Patients who need dialysis during LAR should be carefully evaluated owing to the high prevalence of graft failure.
- ItemSomente MetadadadosDetection of the Tim-3 ligand, galectin-9, inside the allograft during a rejection episode(Elsevier B.V., 2009-06-01) Naka, Erika Lamkowski [UNIFESP]; Ponciano, Viviane Campos [UNIFESP]; Cenedeze, Marcos Antonio [UNIFESP]; Pacheco-Silva, Alvaro [UNIFESP]; Saraiva Camara, Niels Olsen [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Hosp Israelita Albert EinsteinIntroduction: Tim-3 is a Th1 lymphocytes membrane protein with inhibitory function. Its ligand, galectin-9, was recently identified and it is expressed in some lymphocyte subpopulation. in addition, endothelial cells and fibroblasts can also express galectin-9 according to the local cytokine milieu. Both molecules can act as important regulatory tools in the immune system.Aim: Evaluate the expression of these immunoregulatory molecules inside kidney allografts during acute rejection episodes.Methods: By using a quantitative polymerase chain reaction assay, we measured the levels of messenger RNA (mRNA) for galectin-9 and Tim-3 in 21 samples obtained at allograft nephrectomy. Five samples received the histological diagnosis of acute non-vascular rejection (ANVR), twelve of acute vascular rejection (AVR), and five of loss of non-immune cause (LNIC; as control). As cytolytic response markers we measured mRNA levels of granzyme B, interferon-gamma and perforin. the statistic analysis was performed using one way analysis of variance (ANOVA) and Pearson correlation.Results: the mean levels of Tim-3 mRNA expression were 13.99 +/- 6.99 for LNIC, 48.13 +/- 54.47 for RACNV and 238.63 +/- 333.14 for RAV (p = 0.004). for galectin-9, the mean values were 0.57 +/- 0.49 for LNIC, 0.66 +/- 0.36 for RACNV and 2.34 +/- 1.62 for RAV (p = 0.006). Furthermore, there was a positive correlation between both molecules (r = 0.526, p = 0.016). Also. granzyme B, perforin and interferon-gamma mRNA expression were different among the three groups.Conclusion: Messenger RNA level expressions of all the studied molecules were higher inside allografts with more severe rejection. Moreover, there was a positive correlation between galectin-9 and Tim-3 mRNA levels. the simultaneous expression of galectin-9 and Tim-3 may indicate an immunoregulatory function, during the ongoing cytotoxic response. (C) 2008 Elsevier B.V. All rights reserved.
- ItemAcesso aberto (Open Access)Exploratory calcineurin inhibitor-free regimens in living-related kidney transplant recipients(Associação Brasileira de Divulgação Científica, 2007-04-01) Garcia, Riberto [UNIFESP]; Machado, Paula Goulart Pinheiro [UNIFESP]; Felipe, Claudia Rosso [UNIFESP]; Park, Sung In [UNIFESP]; Spinelli, Glaucio Amaral [UNIFESP]; Franco, Marcello Fabiano de [UNIFESP]; Tedesco-Silva Junior, Hélio [UNIFESP]; Pestana, Jose Osmar Medina [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Chronic allograft nephropathy is among the major causes of graft loss even in low-risk kidney transplant recipients and correlates with acute nephrotoxic events during the first year post-transplant. Therefore, calcineurin inhibitor-free regimens may improve patient and graft survival among recipients of living-related kidney transplants. To confirm this hypothesis, we evaluated the efficacy and safety of two calcineurin inhibitor-free regimens in 92 low-risk recipients of one-haplotype living-related kidney transplants. Immunosuppression consisted of tacrolimus, azathioprine and prednisone (group I, GI, N = 38), 2 doses of daclizumab, mycophenolate mofetil (MMF), and prednisone (GII, N = 33) and 2 doses of daclizumab, MMF, sirolimus and prednisone (GIII, N = 21). At 12 months, treatment failure (biopsy-confirmed acute rejection, graft loss or death) was higher in GII compared to GIII and GI (54.5 vs 24.0 vs 13.1%, P < 0.01, respectively). In patients of black ethnicity the incidence of acute rejection was 25 vs 83.3 vs 20% (P = 0.055), respectively. Patient and graft survival was comparable. There were no differences in mean creatinine or calculated creatinine clearance at 12 months. Overall incidence of post-transplant diabetes mellitus (3.3%) and cytomegalovirus disease (4.3%) was similar in all groups. Further development of effective calcineurin inhibitor-free regimens should exclude patients of black ethnicity and may need full-induction therapy, perhaps with depleting agents, and concentration-controlled use of sirolimus and MMF.
- ItemSomente MetadadadosInfectious complications as the leading cause of death after kidney transplantation: analysis of more than 10,000 transplants from a single center(Springer Heidelberg, 2017) Rodrigues Ferreira, Flavio de Castro [UNIFESP]; Cristelli, Marina Pontello [UNIFESP]; Paula, Mayara Ivani [UNIFESP]; Proenca, Henrique [UNIFESP]; Felipe, Claudia Rosso [UNIFESP]; Tedesco-Silva, Helio [UNIFESP]; Medina-Pestana, Jose Osmar [UNIFESP]Aim To identify specific causes of graft failure in a large sample of kidney transplant patients from a middle-income, developing country. Methods Retrospective cohort study analyzing all consecutive single kidney transplants (KTs) performed at a single center in Brazil between January 1st 1998 and December 31st 2013. The database closing date was December 31st 2014. Results Out of 10,400 KTs, there were 1191 (11.45%) deaths with a functioning graft, 40 cases (0.38%) of primary non-function (PNF) and 1417 cases (13.62%) of graft loss excluding death and PNF as the cause. Infectious complications (404 cases, 34% of all deaths) were the major cause of death. Most deaths due to infection occurred within the first year after transplantation (157 deaths, 38.86%). Immunologic mechanisms, comprising acute rejection and immune-mediated interstitial fibrosis/tubular atrophy (IF/TA), were responsible for 52% of all cases of graft failure not involving recipient death. Half of the losses by acute rejection occurred late after transplantation. Conclusion Contrary to what is observed in developed countries, infectious complications are the main challenge with kidney transplantation in Brazil. Non-adherence to treatment also appears to contribute significantly to longterm kidney graft loss. Strategies for improvement should focus on better compliance and a greater safety profile of immunosuppressive treatment.
- ItemAcesso aberto (Open Access)Patologia do transplante renal: achados morfológicos principais e como laudar as biópsias(Sociedade Brasileira de Patologia ClínicaSociedade Brasileira de PatologiaSociedade Brasileira de Citopatologia, 2008-08-01) Sementilli, Angelo; David, Daisa Ribeiro; Malheiros, Denise; Visona, Iria [UNIFESP]; Pegas, Karla Laís; Franco, Marcello Fabiano de [UNIFESP]; Soares, Maria Fernanda Sanches [UNIFESP]; Edelweiss, Maria Isabel Albano; Caldas, Maria Lúcia; Araújo, Sérgio [UNIFESP]; Universidade Metropolitana de Santos; Centro Universitário Lusíadas; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Irmandade da Santa Casa de Misericórdia de Porto Alegre; Salomão & Zoppi Medicina Diagnóstica; Universidade Federal do Rio Grande do Sul Faculdade de Medicina Departamento de Patologia; Universidade Federal Fluminense Faculdade de Medicina Centro de Ciências MédicasRenal transplant has reached remarkable and growing rates of success since its introduction; nowadays it is a widely used replacement therapy. Renal allograft biopsies are increasingly more frequent in the routine of pathology laboratories, whose histological findings are varied. This paper results from the expertise of the members of the Kidney Club of Sociedade Brasileira de Patologia, and presents a general overview of renal allograft pathology, focusing on the current Banff classification, its main categories and cases of difficult diagnosis.
- ItemSomente MetadadadosUrinary CD20 mRNA as a surrogate of CD20-positive cells infiltration during allograft dysfunction in renal transplant patients(Elsevier B.V., 2009-06-01) Ponciano, Viviane C. [UNIFESP]; Soares, Maria Fernanda Sanches [UNIFESP]; Naka, Erika L. [UNIFESP]; Arruda, Erika F. [UNIFESP]; Cenedeze, Marcos A. [UNIFESP]; Franco, Marcello F. [UNIFESP]; Pacheco-Silva, Alvaro [UNIFESP]; Camara, Niels O. S. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)B lymphocyte infiltration in renal acute allograft rejection has been associated with steroid resistance and poor outcomes. We aimed to measure CD20 mRNA in urine of renal transplant patients with graft dysfunction and correlate with the histological diagnosis and immunohistochemical (IH) staining for CD20. A total of 48 urine samples were analyzed (21 with acute rejection, 10 with chronic allograft nephropathy, 11 with unspecific tubular lesions, 3 with acute pyelonephritis and 3 with polyomavirus nephropathy), Higher urinary CD20 levels associated with a positive IH staining for CD20 (>50 positive cells/HPF) in renal tissue (p = 0.04), with a sensitivity of 83.3% and a specificity of 51.6%. Within the acute rejection group, a positive staining for CD20 was not associated with graft loss, steroid resistance or lack of return to basal creatinine after treatment, but was associated with higher serum creatinine at 3 and 6 months, I and 2 years after the acute episode (p < 0.05). in conclusion, we showed that urinary levels of CD20 detected by RT-PCR had a high sensitivity for CD20+ staining in the corresponding renal tissue, but with a low specificity. Patients with clusters of CD20+ cells > 50/HPF had higher serum creatinine after 2 years of follow up. (C) 2008 Elsevier B.V. All rights reserved.