Navegando por Palavras-chave "Graft loss"

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    Clinicopathological 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.
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    Improved Rejection Prophylaxis With an Initially Intensified Dosing Regimen of Enteric-Coated Mycophenolate Sodium in de Novo Renal Transplant Recipients
    (Lippincott Williams & Wilkins, 2011-08-15) Budde, Klemens; Tedesco-Silva, Helio [UNIFESP]; Arns, Wolfgang; Shoker, Ahmed; Zeier, Martin; Klinger, Marian; Rosales, Beatriz; Walker, Rowan; Prestele, Hans; Vaidya, Soniya; Kuypers, Dirk; Charite; Universidade Federal de São Paulo (UNIFESP); Transplantat Zentrum; Univ Saskatchewan; Univ Heidelberg Hosp; Med Univ; Frente Rectorado LUZ; Royal Melbourne Hosp; Novartis Pharma AG; Novartis Inst BioMed Res; Univ Hosp Leuven
    Background. Approximately half of cyclosporine A-treated renal transplant recipients do not reach sufficient mycophenolic acid (MPA) exposure in the first weeks posttransplantation with standard MPA dosing regimens.Methods. Here, we present a prospectively planned meta-analysis of data from two 6-month parallel-run studies that evaluated the effect of an initially intensified versus standard dosing regimen of enteric-coated mycophenolate sodium (EC-MPS). Four hundred forty-one de novo renal transplant recipients were randomized (1:1) to intensified (2 weeks 2880 mg/d; subsequently 4 weeks 2160 mg/d; followed by 1440 mg/d) or standard (1440 mg/d) EC-MPS, with con-comitant cyclosporine A treatment and steroids with or without anti-IL-2R induction. Primary endpoint was treatment failure (biopsy-proven acute rejection [BPAR], graft loss, or death) at month 6 posttransplantation.Results. Treatment failure rates were 17.4% in intensified and 22.4% in standard groups (P=0.110). the incidence of BPAR was 13.8% (intensified) vs. 19.3% (standard; P=0.034). A total of 80.5% (intensified) versus 39.0% (standard) of patients achieved 12 hr MPA-area under the curve more than 30 mu g.hr/mL as early as day 3 posttransplant. Renal function, gastrointestinal symptom rating scores, and safety profiles were comparable between treatment groups.Conclusion. the initially intensified EC-MPS dosing regimen was associated with higher MPA exposure, significantly lower rate of BPAR, and comparable safety. However, the intensified regimen did not affect graft function or survival.
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    Infectious 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.