Repositório Institucional - Unifesp :: Navegando por Palavras-chave "Kidney transplant"

Navegando por Palavras-chave "Kidney transplant"

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Acesso aberto (Open Access)
Avaliação do impacto de um programa de intervenções para prevenção de infecção do trato urinário associada ao uso de sonda vesical em pacientes transplantados renais
(Universidade Federal de São Paulo (UNIFESP), 2010-05-26) Regagnin, Dejanira Aparecida [UNIFESP]; Medeiros, Eduardo Alexandrino Servolo de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
The urinary tract infection is one of the most ordinary complications after a renal transplant and it may lead to rejection, donor kidney failure, long hospital stay period and increased cost. Although the use of a urinary catheter as its period of stay is considered a risk factor, little has been studied about the nursing staff knowledge to prevent urinary tract infection due to a urinary catheter. Objectives: Evaluate the nursing staff practice and knowledge related to the maintenance of a urinary catheter as the risks of its use, implement an intervention guide and measure its impact on the incidence of urinary tract infection and also on the nursing assistance to patients undergoing renal transplantation. Method: A prospective interventional study was performed in a hospital in São Paulo, from August first 2008 to July 31st 2009, and divided into two phases. In the first phase, which occurred from August 2008 to January 2009, the urinary catheter insertion and the procedures for its safe maintenance were observed and a questionnaire to access the nurses’ information about the subject was applied as well. In the second phase, from February first to July 31st 2009, a group of new actions based on data collected from the first round were implemented, the same questionnaire was applied once more followed by another period of observation which the main purpose was to verify the effect and changes caused by the new guide developed. Results: The nursing professionals’ theoretical knowledge assessment showed a meaningful statistical difference between the distinct study phases such as urethral meatus hygiene procedure (p=0,007), hygiene frequency urethral meatus (p<0.001), the cleaning product used in the hygiene of the urethral meatus (p<0,001), the catheter exchange frequency (p<0,001) and HRIM infection rates (p<0,001) awareness indicating an improvement after the intervention. The practice observation also showed a hand hygiene improvement among physicians: 9,1% of frequency before procedure and 68,2% after the procedure. Among the nursing staff members again positive results were noticed: 26,7% to 48% of hand washing before procedure and 76% to 86,7% after procedure. Better adherence to the use of personal protective equipment comparing 60 to 75% in the first round against 98% to 100% in the second. There were 44 (11,33%) cases of urinary tract infection in the first phase of the study, 26 deceaseddonor while 17 living-donor, which 37 (84,09%) due to urinary catheter presence. The average time between the urinary tract infection diagnosis and the kidney transplant was 13,5 days (5 to 30 days). In both phases, there was a bacterial infection predominance being the gram-negatives responsible for 97,7% of the infections in the first round against 82,25% in the second. E. coli itself was responsible for 34 (32%) cases of infection, followed by K. pneumoniae which caused 18 (16,9%) cases of infection. Conclusions: A meaningful practice and theoretical knowledge improvement can be noticed due to the educational program. Despite all the better results achieved in the second phase of this study, with reduction of urinary tract infection associated with vesical catheter (p=0,674), any impact on decreasing urinary tract infections could be demonstrated.
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Belatacept-Based Regimens Versus a Cyclosporine A-Based Regimen in Kidney Transplant Recipients: 2-Year Results From the BENEFIT and BENEFIT-EXT Studies
(Lippincott Williams & Wilkins, 2010-12-27) Larsen, Christian P.; Grinyo, Josep; Medina-Pestana, Jose [UNIFESP]; Vanrenterghem, Yves; Vincenti, Flavio; Breshahan, Barbara; Campistol, Josep M.; Florman, Sander; del Carmen Rial, Maria; Kamar, Nassim; Block, Alan; Di Russo, Gregory; Lin, Chen-Sheng; Garg, Pushkal; Charpentier, Bernard; Emory Univ; Univ Hosp Bellvitge; Universidade Federal de São Paulo (UNIFESP); Univ Hosp Leuven; Univ Calif San Francisco; Med Coll Wisconsin; Univ Barcelona; Mt Sinai Med Ctr; Inst Nefrol; CHU Rangueil; Bristol Myers Squibb Co; Univ Paris S 11
Background. At 1 year, belatacept was associated with similar patient/graft survival, better renal function, and an improved cardiovascular/metabolic risk profile versus cyclosporine A (CsA) in the Belatacept Evaluation of Nephroprotection and Efficacy as Firstline Immunosuppression Trial (BENEFIT) and Belatacept Evaluation of Nephroprotection and Efficacy as Firstline Immunosuppression Trial-EXTended criteria donors (BENEFIT-EXT) studies. Acute rejection was more frequent with belatacept in BENEFIT. Posttransplant lymphoproliferative disorder (PTLD)-specifically central nervous system PTLD-was observed more frequently in belatacept-treated patients. This analysis assesses outcomes from BENEFIT and BENEFIT-EXT after 2 years of treatment.Methods. Patients received a more intensive (MI) or a less intensive (LI) regimen of belatacept or a CsA-based regimen.Results. Four hundred ninety-three of 666 patients(74%) in BENEFIT and 347 of 543(64%) in BENEFIT-EXT completed 2 years of treatment. the proportion of patients who survived with a functioning graft was similar across groups (BENEFIT: 94% MI, 95% LI, and 91% CsA; BENEFIT-EXT: 83% MI, 84% LI, and 83% CsA). Belatacept's renal benefits were sustained, as evidenced by a 16 to 17 mL/min (BENEFIT) and an 8 to 10 mL/min (BENEFIT-EXT) higher calculated glomerular filtration rate in the belatacept groups versus CsA. There were few new acute rejection episodes in either study between years 1 and 2. Because PTLD risk was highest in Epstein-Barr virus(EBV)(-) patients, an efficacy analysis of EBV(+) patients was performed and was consistent with the overall population results. There were two previously reported cases of PTLD in each study between years 1 and 2 in the belatacept groups. the overall balance of safety and efficacy favored the LI over the MI regimen.Conclusions. At 2 years, belatacept-based regimens sustained better renal function, similar patient/graft survival, and an improved cardiovascular/metabolic risk profile versus CsA; outcomes that were maintained in EBV (+) patients. No new safety signals emerged.
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Bloodstream Infection After Kidney Transplantation: Epidemiology, Microbiology, Associated Risk Factors, and Outcome
(Lippincott Williams & Wilkins, 2010-09-15) Silva, Moacyr [UNIFESP]; Marra, Alexandre R. [UNIFESP]; Pereira, Carlos A. P. [UNIFESP]; Medina-Pestana, Jose O. [UNIFESP]; Camargo, Luis F. A. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Background. Bloodstream infection ( BSI) is associated with both relevant morbidity and mortality rates after kidney transplantation.Methods. From January 1, 2000 to January 31, 2006, all episodes of BSI were retrospectively assessed through the review of medical records in two tertiary teaching Hospitals in São Paulo, Brazil, where 3308 transplant procedures were performed during this period. Contaminants and polymicrobial infections were excluded. the main objectives of the study were to describe clinical and microbiologic aspects of BSI, as well as risk factors for both BSI and mortality from these infections in kidney transplant patients.Results. BSI was detected in 185 patients, with onset after a median of 235 days after transplantation; 62% occurred after 6 months. the primary source of infection was the urinary tract in 37.8%. the most prevalent pathogen overall was Escherichia coli (30.3%). Risk factors for early acquired BSI (first 6 months after transplantation) were acute rejection, ureteric stent placement, and receiving an organ from a deceased donor. for late BSI (after 6 months), associated risk factors were acute rejection, Charlson Comorbidity Score more than or equal to 3, and receiving an organ from a deceased donor. Risk factors related to 30-day mortality were Acute Physiology and Chronic Health Evaluation II Score more than or equal to 20, shock, and respiratory failure.Conclusions. BSI is most frequently a consequence of urinary tract infection, with a high prevalence of gram-negative bacilli. Severity of disease was the main determinant of 30-day mortality after BSI, and based on the knowledge of risk factors, some interventions are suggested for reducing the rate of BSI after transplantation.
Acesso aberto (Open Access)
Caracterização clínica e histopatológica e tipagem do papilomavírus humano das verrugas vulgares nos receptores de transplante renal
(Sociedade Brasileira de Dermatologia, 2010-10-01) Martelli-Marzagão, Flavia [UNIFESP]; Yamashiro, Alberto Shodi [UNIFESP]; Ogawa, Marilia Marufuji [UNIFESP]; Santos Jr, Gildo Francisco dos; Tomimori, Jane [UNIFESP]; Porro, Adriana Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Associação Fundo de Incentivo à Psicofarmacologia
The prevalence of skin lesions caused by the human papillomavirus (HPV) is high in kidney transplant patients. Twenty recipients of kidney transplants with a diagnosis of common warts were evaluated. HPV detection was performed by polymerase chain reaction (PCR) using the MY09/MY11 and RK91 primers. HPV typing was performed by restriction fragment length polymorphism analysis and direct sequencing. The presence of HPV was identified in 10 patients (50%) and the types identified were HPV-2, 27, 29, 34 and 57.
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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.
Acesso aberto (Open Access)
Complicações de ferida operatória em receptores de transplante renal recebendo everolimo
(Universidade Federal de São Paulo (UNIFESP), 2016-09-30) Ueno, Priscilla Sayuri [UNIFESP]; Pestana, Jose Osmar Medina de Abreu [UNIFESP]; http://lattes.cnpq.br/7250195328752808; http://lattes.cnpq.br/3096519505429509; Universidade Federal de São Paulo (UNIFESP)
Background: De novo use of mammalian target of rapamycin inhibitors after kidney transplantation is associated with a concentration-dependent incidence of wound healing adverse events (WHAE). The objective of this analysis was to compare the incidence of WHAE in patients receiving everolimus (EVR) or mycophenolate sodium (MPS). Methods: This was a predefined sub-analysis of a single center prospective randomized study in which 288 kidney transplant recipients receiving tacrolimus (TAC) and prednisone were randomized for three different regimens: antithymocyte globulin (r-ATG)/EVR(N=85); basiliximab (BAS)/EVR(N=102); BAS/MPS(N=101). Clinical WHAE were prospectively collected using a pre-specified case report form in all study visits. Abdominal ultrasound was performed at 30 days posttransplant to capture subclinical abnormalities. Surgeons were blinded to randomized treatment and no specific surgical procedures were implemented. Results: A higher proportion of patients in BAS/EVR showed at least one clinical WHAE (22.3 vs. 35.3 vs. 22.0%, p=0.03) and total clinical and subclinical WHAE (35 vs. 42 vs. 26%, p=0.014) compared to BAS/MPS, respectively. A higher proportion of patients in r-ATG/EVR showed subclinical WHAE (13 vs. 7 vs. 4%, p=0.025) compared to BAS/MPS, respectively. Patients receiving EVR showed a higher risk of developing clinical or subclinical WHAE (r-ATG/EVR vs. BAS/MPS hazard ratio 1.30 ; BAS/EVR vs. BAS/MPS hazard ratio 1.73,p=0.028).Conclusion: In this cohort of de novo kidney transplant recipients receiving TAC and prednisone, the use of EVR was associated with higher incidence of combined clinical and subclinical WHAE compared to MPS.
Acesso aberto (Open Access)
Cross-transmission of vancomycin-resistant Enterococcus in patients undergoing dialysis and kidney transplant
(Associação Brasileira de Divulgação Científica, 2010-01-01) Fram, Dayana Souza [UNIFESP]; Castrucci, Fernanda Marques [UNIFESP]; Taminato, Monica [UNIFESP]; Godoy-Martinez, Patricio [UNIFESP]; Freitas, Maria Cecília de Santos [UNIFESP]; Belasco, Angélica Gonçalves Silva [UNIFESP]; Sesso, Ricardo de Castro Cintra [UNIFESP]; Pacheco-Silva, Alvaro [UNIFESP]; Pignatari, Antonio Carlos Campos [UNIFESP]; Barbosa, Dulce Aparecida [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidad Austral de Chile Institute of Microbiology
The objective of this study was to investigate the occurrence of vancomycin-resistant Enterococcus (VRE) cross-transmission between two patient groups (long-term dialysis and kidney transplant patients). Molecular typing, by automated ribotyping with the RiboPrinter Microbial Characterization System (Qualicon, USA), was used to analyze VRE isolates from 31 fecal samples of 320 dialysis patients and 38 fecal samples of 280 kidney transplant patients. Clonal spread of E. faecalis and E. casseliflavus was observed intragroup, but not between the two groups of patients. In turn, transmission of E. gallinarum and E. faecium between the groups was suggested by the finding of vancomycin-resistant isolates belonging to the same ribogroup in both dialysis and transplant patients. The fact that these patients were colonized by VRE from the same ribogroup in the same health care facility provides evidence for cross-transmission and supports the adoption of stringent infection control measures to prevent dissemination of these bacteria.
Acesso aberto (Open Access)
Cystatin C and renal function in pediatric kidney transplant recipients
(Associação Brasileira de Divulgação Científica, 2009-12-01) Franco, Maria do Carmo Pinho [UNIFESP]; Nagasako, Samantha Santiago [UNIFESP]; Machado, Paula Goulart Pinheiro [UNIFESP]; Nogueira, Paulo Cesar Koch [UNIFESP]; Pestana, Jose Osmar Medina [UNIFESP]; Sesso, Ricardo de Castro Cintra [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
In clinical practice, the glomerular filtration rate (GFR) is often determined with serum creatinine. However, studies have shown cystatin C to be a better parameter for the diagnosis of impaired renal function. We compared GFR estimated by plasma cystatin C with GFR estimated by serum creatinine in a sample of 50 pediatric renal transplant recipients and 24 healthy children. The correlation between GFR estimated by serum creatinine and by cystatin C was significant (r = 0.75; P < 0.001, Person’s correlation); however, in pediatric kidney transplant recipients, the GFR was 6.7 mL/min lower when determined using cystatin C rather than serum creatinine. Moreover, using GFR estimated by cystatin C we found that 42% of the pediatric kidney transplant recipients had an estimated GFR <60 mL·min-1·1.73 (m²)-1, whereas when GFR was estimated by the serum creatinine formula only 16% of the children had values below this cutoff point indicative of chronic kidney disease (P < 0.001). We conclude that, in pediatric kidney transplant recipients, estimation of GFR yields lower values when cystatin C is used rather than serum creatinine.
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Expression of TLR-4 and -2 in peripheral mononuclear cells in renal transplant patients with TLR-4 gene polymorphism
(Elsevier B.V., 2010-12-01) Nogueira, Eliana [UNIFESP]; Salomao, Reinaldo [UNIFESP]; Collo Brunialti, Milena Karina [UNIFESP]; Ozaki, Kikumi S.; Marques, Georgia D. M.; Cenedeze, Marcos A.; Saraiva Camara, Niels Olsen; Pacheco-Silva, Alvaro; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
Introduction: TLR-4 has also been identified as a receptor for endogenous alarmins, which are increased post transplantation. TLR-4 has also been associated with a polymorphism that could impact graft outcome.Objective: To assess the expression of TLR-4 in kidney transplant patients carrying or not a polymorphism.Methods: TLR-4 polymorphism (A299G/T399I) was studied in 200 renal transplant patients. Healthy volunteers were also enrolled as control group. the polymorphism analysis was performed using restriction enzymes technique (RFLP). Functionality of TLR-4 polymorphism was assessed in samples from controls by quantification of TNF-alpha after LPS stimulus. TLR-4 and -2 expressions were also analyzed by flow cytometry.Results: TLR-4 polymorphism was present in 8.5% of renal transplant patients. This polymorphism was associated with impairment in TNF-alpha secretion. in general, in renal transplant patients, TLR-4 expression in monocytes and in neutrophils was lower than in health volunteers. TLR-2 and TLR-4 expressions in healthy volunteers with A299G/T399I TLR-4 polymorphism was higher than in wild-type genotype healthy volunteers (p<0.01 and p<0.05, respectively), and also higher than A299G/T399I TLR-4 polymorphism renal transplant patients (p<0.05). TLR-2 expression on neutrophils in wild-type genotype renal transplant patients was higher compared to wild-type genotype healthy volunteers, and was also higher in relation to A299G/T399I kidney transplanted patients (p<0.01).Conclusion: Stable renal transplant patients with TLR-4 polymorphism have a lower expression of TLR-4 and TLR-2 receptors in peripheral mononuclear cells, which ultimately indicate a less responsiveness for alarmins. (C) 2010 Elsevier B.V. All rights reserved.
Acesso aberto (Open Access)
Freqüência de estenose de artéria renal em 676 transplantes renais
(Associação Médica Brasileira, 1998-09-01) Lopes, J.a.m. [UNIFESP]; Almeida, C.j.r. De [UNIFESP]; Hachul, M. [UNIFESP]; Srougi, M. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Kidney transplantation is the permanent and safe treatment for patients with chronic renal failure, although surgical treatment is susceptible both to urological and many vascular complications, and post-transplantation, renal artery stenosis being the most important. OBJECTIVE: To verify the incidence of renal artery stenosis of 676 patients submitted to renal transplants, from living and cadaver donors, in the period of February of 1985 to December of 1994, when compared the end-to-end and end-to-side anastomosis with the external iliac artery of the recipient. METHODS: The data shown were obtained from charts of 676 patients submitted to renal transplants performed by the same surgery staff at the Hospital São Paulo -- Universidade Federal de São Paulo (UNIFESP) -- Escola Paulista de Medicina, between 1985 and 1994. RESULTS: Eleven cases (1.63%) of post-transplantation renal artery stenosis were found. CONCLUSION: 1) Frequency of post-transplantation renal artery stenosis was low and observed only in recipients of cadavers donors. 2) Frequency of post-transplantation renal artery stenosis with end-to-end artery anastomosis did not significantly differ from end-to-side anastomosis. 3) Age, sex and ethnic groups of patients did not interfere in the frequency of renal artery stenosis.
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An Integrated Safety Profile Analysis of Belatacept in Kidney Transplant Recipients
(Lippincott Williams & Wilkins, 2010-12-27) Grinyo, Josep; Charpentier, Bernard; Pestana, Jose Medina [UNIFESP]; Vanrenterghem, Yves; Vincenti, Flavio; Reyes-Acevedo, Rafael; Apanovitch, Anne Marie; Gujrathi, Sheila; Agarwal, Mamta; Thomas, Dolca; Larsen, Christian P.; Univ Barcelona; Hop Bicetre; Universidade Federal de São Paulo (UNIFESP); Univ Hosp Leuven; Univ Calif San Francisco; Hosp Miguel Hidalgo Aguascalientes; Bristol Myers Squibb Co; Emory Transplant Ctr; Univ Transplant Ctr
Background. Belatacept is associated with better renal function and an improved cardiovascular/metabolic risk profile versus cyclosporine in kidney transplant recipients. the current analysis examined pooled safety data for belatacept versus cyclosporine used in combination with basiliximab, mycophenolate mofetil, and steroids.Methods. Patients enrolled in three core studies in de novo kidney transplantation were randomized to a more intensive (MI) or less intensive (LI) regimen of belatacept or cyclosporine. the pooled analysis included 1425 patients (MI: 477; LI: 472; cyclosporine: 476). Median follow-up was approximately 2.4 years.Results. Belatacept was generally well tolerated. the frequency of deaths (MI: 7%; LI: 5%; cyclosporine: 7%) and serious infections (MI: 37%; LI: 32%; cyclosporine: 36%) were lower in the LI group versus cyclosporine. the frequency of malignancies was 10%, 6%, and 7% in the MI, LI, and cyclosporine groups, respectively. Sixteen cases of posttransplant lymphoproliferative disorder (PTLD) occurred (n = 8 MI; n = 6 LI; n = 2 cyclosporine), including nine cases involving the central nervous system (CNS) (n = 6 MI; n = 3 LI). the risk of CNS PTLD was highest in Epstein-Barr virus(-) recipients; more CNS PTLD cases occurred in the MI group. One case of progressive multifocal leukoenceph-alopathy was reported in the MI group.Conclusions. Treatment with belatacept-based regimens was generally safe for a period of at least 2 years. There was a greater risk of PTLD-specifically CNS PTLD-in the belatacept groups versus cyclosporine, especially in Epstein-Barr virus(-) patients and with the MI dose. the number of deaths and serious infections was lower in the LI regimen versus MI and cyclosporine. the overall safety profile favored the LI over the MI regimen.
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Investigation of Apoptosis-Related Gene Expression Levels in Preimplantation Biopsies as Predictors of Delayed Kidney Graft Function
(Lippincott Williams & Wilkins, 2014-06-27) Goncalves-Primo, Amador; Mourao, Tuila B. [UNIFESP]; Andrade-Oliveira, Vinicius [UNIFESP]; Campos, Erika F. [UNIFESP]; Medina-Pestana, Jose O. [UNIFESP]; Tedesco-Silva, Helio; Gerbase-DeLima, Maria [UNIFESP]; Inst Imunogenet AFIP; Universidade Federal de São Paulo (UNIFESP); Hosp Rim & Hipertensao
Background the purpose of this study was to investigate the expression of the gene coding for the antiapoptotic molecule Bcl-2, the proapoptotic molecule Bax, and the apoptosis executor enzyme caspase-3 in preimplantation renal biopsies (PIB) as markers for delayed graft function.Methods in this prospective single-center study, gene expression levels were evaluated using real-time TaqMan polymerase chain reaction in PIB of kidneys from 72 deceased donors (DDs) and 18 living donors (LDs).ResultsCASP3 and BAX expression levels were higher, whereas those of BCL2 were lower, in DD than in LD PIB. in biopsies from DD, BCL2 levels were lower in cases with DGF, whereas no differences were observed concerning CASP3 and BAX. the BAX/BCL2 gene expression ratio greater than 2.29 associated with DGF with an odds ratio of 2.00. A multiple regression analysis including data of TLR4 expression in the first day posttransplant PB from a previous study of our group conducted in the same patients revealed a very strong association of the combination of BAX/BCL2 greater than 2.3 in PIB and TLR4 of 0.95 uRE or lesser in PB with the occurrence of DGF, with OR of 120 and positive and negative predictive values of 91% and 92%, respectively.Conclusions the power to predict DGF of the combination of high BAX/BCL2 expression in PIB and low TLR4 expression in the first day posttransplant peripheral blood observed in the present study is extremely high, in comparison to any other marker or combinations of markers so far published in the literature.
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Predicting delayed kidney graft function with gene expression in preimplantation biopsies and first-day posttransplant blood
(Elsevier Science Inc, 2016) Mourao, Tuila Bittencourt [UNIFESP]; Mine, Karina Lumi [UNIFESP]; Campos, Erika Fernandes [UNIFESP]; Pestana, Jose Osmar Medina [UNIFESP]; Tedesco-Silva, Helio [UNIFESP]; Gerbase-Lima, Maria [UNIFESP]
The purpose of this study was to investigate possible markers for predicting delayed graft function (DGF). To this end we analyzed, in pre-implantation biopsies (PIB) and in first-day post-Tx peripheral blood mononuclear cells (PBMC), the expression of five genes (ACSL4, CUBN, DEFB1, FABP3, GK) through real-time TaqMan PCR assays. These genes were selected from a large scale gene expression study in PIB. DEFB1, FABP3 and GK expression levels in PIB were lower in cases with DGF and, in a multivariate analysis which included these genes and clinical variables, only FABP3 expression remained independently associated with DGF. FABP3 expression lower than-1.32 units of relative expression conferred an odds ratio for DGF of 41.1. Compared to the PBMC of recipients without DGF, recipients with prolonged DGF (pDGF) had lower ACSL4 and higher DEFB1 expression levels. In a multivariate analysis, including PBMC gene expression levels of ACSL4, DEFB1 and TLR4 (data from a previous study with the same patients) and clinical variables, only TLR4 remained independently associated with pDGF. In summary, this study revealed FABP3 expression in PIB as a marker for DGF and disclosed new genes possibly involved in the pathogenesis of DGF. (C) 2016 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.
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Pregnancy after renal transplantation: an evaluation of the graft function
(Elsevier B.V., 2011-04-01) Aivazoglou, Lais [UNIFESP]; Sass, Nelson [UNIFESP]; Tedesco-Silva, Helio [UNIFESP]; Sato, Jussara L. [UNIFESP]; Medina-Pestana, Jose O. [UNIFESP]; De Oliveira, Leandro G. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Objectives: To evaluate pregnancy outcomes and graft function in renal transplant recipients.Study design: Thirty-four pregnancies in 31 patients were evaluated. Graft dysfunction was defined as an increase of 0.3 mg/dL (215 mu mol/L) or more in serum creatinine (SCr) during pregnancy. Twenty-eight patients were also evaluated at one, six and twelve months after delivery to analyze the evolution of the graft function.Results: Fifteen patients experienced graft dysfunction during pregnancy, 10 related to preeclampsia, two related to rejection, one related to allograft obstruction and one related to urinary tract infection. One patient did not have an identified cause. in one patient, graft rejection ended in graft loss. the mean SCr level in the first trimester was 0.9 mg/dL (range: 0.5-2.1) among women who did not have graft dysfunction and 1.1 mg/dL (range: 0.5-1.9) among patients who had graft dysfunction (P = 0.66). the mean SCr level one year after delivery was 1.18 mg/dL in the first group and 1.21 mg/dL in the second group (P = 0.74). There was no difference in SCr level from the first trimester of pregnancy to one year after delivery in both groups evaluated (P = 0.35 and P = 0.13).Conclusions: Although graft dysfunction may occur during pregnancy, it seems to be temporary in the majority of the cases. It is important to emphasize that rejection is still a cause of graft loss during pregnancy. (C) 2010 Elsevier Ireland Ltd. All rights reserved.
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Toll-like receptors-related genes in kidney transplant patients with chronic allograft nephropathy and acute rejection
(Elsevier B.V., 2009-06-01) Nogueira, Eliana; Ponciano, Viviane Campos; Naka, Erika L.; Marques, Georgia D. M.; Cenedeze, Marcos A.; Saraiva Camara, Niels Olsen; Pacheco-Silva, Alvaro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
Introduction: Toll-like receptors (TLR) comprehend an emerging family of receptors that recognize pathogen-associated molecular patterns and promote the activation of leukocytes. Surgical trauma and ischemia-reperfusion injury are likely to provide exposure to endogenous ligands for TLR in virtually all kidney transplant recipients.Methods: Macroarray (GEArray OHS-018.2 Series-Superarray) analyses of 128 genes involved in TLR signaling pathway were performed in nephrectomy samples of patients with chronic allograft nephropathy (CAN) and acute rejection (AR, vascular and non vascular). the analysis of each membrane was performed by GEArray Expression Analysis Suite 2.0.Results: Macroarray profile identified a gene expression signature that could discriminate CAN and AR. Three genes were significantly expressed between CAN and vascular AR: Pellino 2; IL 8 and UBE2V1. in relation to vascular and non-vascular AR, there were only two genes with statistical significance: IL-6 and IRAK-3.Conclusion: Vascular and non-vascular AR and CAN showed different expression of a few genes in TLR pathway. the analysis of nephrectomy showed that activation of TLR pathway is present in AR and CAN. (C) 2008 Elsevier B.V. All rights reserved.

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