Navegando por Palavras-chave "Pancreas transplantation"
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- ItemAcesso aberto (Open Access)Aspectos bucais de pacientes candidatos a transplante de fígado e pâncreas-rim no Hospital São Paulo e Hospital do Rim(Universidade Federal de São Paulo (UNIFESP), 2018-07-26) Pereira, Andrea Helena Francisca Ramaglia [UNIFESP]; Gonzalez, Adriano Miziara [UNIFESP]; http://lattes.cnpq.br/6234829429056217; http://lattes.cnpq.br/9331976201359318; Universidade Federal de São Paulo (UNIFESP)As infecções bacterianas representam um risco elevado para o paciente candidato a transplante de órgão sólido. Este fato nos remete a importância de eliminar focos infecciosos da cavidade oral previamente ao transplante. Lesões periapicais, dentes em péssimas condições, doença periodontal e placa bacteriana são capazes de desencadear risco no pós-operatório. O objetivo deste trabalho foi avaliar as condições bucais dos pacientes candidatos a transplante de fígado e pâncreas – rim. Foi utilizado como método as condições bucais através de exame intra e extras orais, pacientes inscritos na fila do transplante de fígado e pâncreas – rim de agosto/2015 a fevereiro/2018, e correlacionamos estes achados com variáveis demográficas. Como resultados verificou-se que as variáveis demográficas nos candidatos a transplante de fígado (n=50) foram: sexo masculino 70%, idade média 44,5±12,92 anos. A média observada do valor do MELD foi de 22,5±9,2. Na avaliação da cirrose, a hepatite viral ocupou lugar de destaque acometendo 60% dos pacientes. As variáveis demográficas nos pacientes candidatos a transplante de pâncreas – rim (n=50) foram: sexo masculino 66%, idade média 39 ±7,0anos, tempo de diabetes a média foi de 25±7,3 anos, tempo de dialise a média foi 4±1,52 anos. A amaurose unilateral foi identificada em 22% dos pacientes e a amaurose bilateral em10% dos pacientes. O fio dental foi utilizado diariamente por 62% dos pacientes. As principais alterações nos candidatos de fígado e pâncreas foram: índice de CPOD (dentes cariados perdidos e obturados) com escore 5 (candidatos a transplante de fígado 100% versus candidatos a transplante de pâncreas – rim 83%, P<0,0001). No entanto a necessidade de tratamento odontológico foi igual nos 2 grupos: 70% versus 71% respectivamente (P=NS). Com base nestes dados conclui-se que os pacientes em fila de transplantes necessitam de cuidados odontológicos independente das características demográficas devido as condições bucais no momento do exame clínico). Na análise de fatores de risco, observamos que a necessidade de tratamento dentário nos pacientes candidatos a transplante de fígado teve correlação com idade (P=0,046), cor (P=0,046) e diagnóstico de hepatite viral (P=0,033). Não identificamos fatores de risco para os candidatos a transplante de pâncreas-rim.
- ItemAcesso aberto (Open Access)Avaliação da percepção da qualidade de vida em pacientes diabéticos urêmicos, pré e pós transplante simultâneo pâncreas-rim(Universidade Federal de São Paulo (UNIFESP), 2017-10-26) Posegger, Karin Romano [UNIFESP]; Linhares, Marcelo Moura [UNIFESP]; Mucci, Samantha [UNIFESP]; http://lattes.cnpq.br/2988710010245249; http://lattes.cnpq.br/0461653687573670; http://lattes.cnpq.br/7234204383309222; Universidade Federal de São Paulo (UNIFESP)Introduction: Diabetic patients with chronic renal failure are considered chronic sufferers, both physically and psychologically, because of the physical pain due to neuropathy and microangiopathy. Amputations, cardiovascular diseases, and retinopathy are also consequences of prolonged exposure to the deleterious effects of diabetes and dialysis. Pancreas-kidney transplantation is considered the gold standard treatment for diabetics with end-stage renal disease. This is a therapeutic intervention aimed at maintaining a healthier lifestyle, without the burden of dialysis and insulin therapy, as well as increasing the life expectancy of these patients. However, the gain of this therapy in terms of Quality of Life (QoL) is still little investigated. This study aims to measure the QoL gain with the simultaneous pancreas-kidney transplantation (SPKT), not only from the generic point of view, but most notably to the specific gain consequent to each transplanted organ and also analyzing the maintenance of QoL over time, in the post-transplant period. Methods: Using the KDQOL-SF 36 - Kidney Disease Quality of Life – Short Form Health Survey, generic and specific for chronic kidney disease (CKD) and PAID – Problems Areas in Diabetes (diabetes-specific) QoL evaluation in 160 patients - 57 on the waiting list versus 103 submitted to the SPKT. This study evaluated the perception of the patient regarding general and specific QoL gain, specific for the control of CKD and diabetes in the pre-transplant and post-transplant intervals, which were subdivided into three time intervals: <1 year, between 1 and 3 years, and > 3 years. Results: The results of the Mean scores regarding the QoL perception of pretransplant and post-transplant patients (<1 year, between 1 and 3 years, > 3 years) and p values were, respectively: General Symptoms - SF-36: Physical Functioning (62.8 x 73.3, 85.2 and 82.6; p<0.001), Physical Function (51.3 x 84.8, 71.0 and 82.3; p<0.001), General Health (45.1 x 86.1, 72.4 and 65.6; p<0.001), Emotional Function (62.0 x 91.3, 72.0 and 84.8; p=0.001), Social Function (64.5 x 91.8, 84.0 and 84.3; p<0.001), Health Changes (52.2 x 100.0, 87.0 and 77.3; p<0.001); Specific Domains Regarding to the CKD: Symptoms/Problems (81.2 x 92.2, 87.2 and 84.8; p=0.004), Effects of Kidney Disease (61.5 x 96.7, 94.3 and 93.6; p<0.001), Burden of Kidney Disease (45.7 x 87.8, 89.3 and 78.8; p<0.001), Dialysis Team Support (89.3 x 100.0, 100.0 and 99.3; p<0.001), Health Related to the CKD (56.5 x 91.7, 83.2 and 80.4; p<0.001); and Diabetes Specific Control - PAID: Stress Caused by Diabetes Mellitus (42.3 x 34.8, 29.5, and 27.8, p = 0.011). Conclusions: Patients receiving simultaneous pancreas-kidney transplants had a better perception of quality of life, either in the generic and in the specific questionnaires for kidney disease and diabetes, when compared to patients on the waiting list for SPKT. This positive perception remained practically stable over time.
- ItemAcesso aberto (Open Access)Avaliação dos sintomas psicológicos em pacientes pré e pós-transplante simultâneo pâncreas-rim.(Universidade Federal de São Paulo (UNIFESP), 2018-12-20) Romano, Thais Malta [UNIFESP]; Linhares, Marcelo Moura [UNIFESP]; Mucci, Samantha [UNIFESP]; http://lattes.cnpq.br/2988710010245249; http://lattes.cnpq.br/0461653687573670; http://lattes.cnpq.br/8868099518656795; Universidade Federal de São Paulo (UNIFESP)Introduction: The insulindependent diabetic patients associated with endstage renal disease (CRI) lead a life of intense suffering due to the dietary restrictions imposed by the incapacitating disease and chronic pain, and mainly by the dependence of the dialytic support. With the technical advances that have occurred in the last decade, simultaneous pancreaskidney transplantation (SPKT) has benefits for insulindependent diabetic patients with endstage renal disease. In addition to providing euglycemic status and normalization of renal function, SPKT has been shown to be important in the stabilization and even reversal of some chronic complications due to diabetes mellitus (DM), significantly improving the quality of life of these patients. The psychological aspects, especially anxiety and depression in simultaneous pancreaskidney transplantation and in chronic diseases in general are very frequent, leading to worsening of the evolution of both psychiatric and clinical disease. They may lead to low adherence to the therapeutic guidelines, in addition to greater morbidity and mortality. Psychic illnesses are often underdiagnosed and undertreated, mainly due to the presence of confounding clinical symptoms, which often occur in chronic diseases. Thus, the objective of this study was to establish and measure the most prevalent symptoms of depression and anxiety in patients with DM and with CRI waiting for SPKT, and to compare these symptoms with those found in patients already submitted to SPKT. Methods: Thirtyseven patients were studied, followed by the outpatient clinic of the Rim Hospital in São Paulo, 39 of whom were candidates for transplantation and in the waiting list, all patients with DM and CRI, and 88 patients who had undergone SPKT. Data from the Beck questionnaires were compared in the pre and post SPKT, which were divided into two groups: with symptoms anxiety/depression and no symptoms. Results: Significant differences were found between pre and post SPKT patients with regard to depression [18/39 (46.1%); 18/88 (20.4%); p = 0.003], respectively. Comparison of the symptoms of the BDI questionnaire between the groups revealed significant differences in relation to depression: feelings of punishment (p <0.001); suicidal thoughts (p = 0.008); irritation (p = 0.009); lack of energy / work / fatigue (p = 0.007); change in sleep pattern (p = 0.039); health concern (p = 0.004) and loss of interest by sex (p = 0.029). Regarding anxiety, there was no significant difference between the preand postSPKT groups [16/39 (41%); 25/88 (28.4%); p = 0.161)], respectively. However, the individual comparison of BAI items revealed significant differences in relation to anxiety: fear of the worst (p = 0.030); fear of dying (p = 0.005); frightening (p = 0.029); feeling of fainting (p = 0.015), all favoring posttransplantation. SPKT improves depressive symptoms both globally and specifically, and has a positive impact in terms of offering the patient greater interest and enthusiasm for life. Regarding anxiety, although there was no global improvement, SPKT seems to have a positive impact, offering greater feeling in relation to illness and life.
- ItemAcesso aberto (Open Access)Impacto da função retardada do enxerto pancreático no transplante simultâneo pâncreas-rim(Sociedade Brasileira de Nefrologia, 2011-06-01) Baitello, Marina [UNIFESP]; Galante, Nelson Zocoler [UNIFESP]; Coutinho, Luciano de Souza [UNIFESP]; Rangel, Erika Bevilaqua [UNIFESP]; Melaragno, Cláudio Santiago [UNIFESP]; Gonzalez, Adriano Miziara [UNIFESP]; Pestana, Jose Osmar Medina [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Simultaneous pancreas-kidney transplantation is an effective treatment for patients with type 1 diabetes melli>tus and end-stage chronic kidney disease. Delayed pancreatic graft function is a common and multifactor condition with significant impact in short-term outcome of simultaneous pancreas-kidney transplantations. The aim of this study was to analyze the impact of pancreatic delayed pancreatic graft function on simultaneous pancreas-kidney transplantation. METHODS: Donor and recipient's demographic data, percentage of panel reactivity, acute rejection incidence, and patient and grafts survivals were retrospectively analyzed in 180 SPKT performed between 2002 and 2007. RESULTS: The incidence of pancreatic delayed pancreatic graft function was 11%. Donors older than 45 years had significant risk of pancreatic delayed pancreatic graft function (OR 2.26; p < 0,05). Patients with pancreatic delayed pancreatic graft function had higher rates of acute renal rejection (47 versus 24%; p < 0.05), altered fasting plasma glucose (25 versus 5%; p < 0.05) and mean glycated hemoglobin (5.8 versus 5.4%; p < 0.05), than patients without pancreatic delayed pancreatic graft function at the end of the first year of follow up. There were no significant differences between patients with and without pancreatic delayed pancreatic graft function regarding patient survival (95 versus 88.7%; p = 0.38), pancreatic graft survival (90 versus 85.6%; p = 0.59) and renal graft survival (90 versus 87.2%; p = 0.70), respectively at the sample period of time. CONCLUSION: Pancreatic delayed pancreatic graft function had no significant impact in the short-term outcome of simultaneous pancreas-kidney transplantations. Although delayed pancreatic graft function had no impact on 1-year pancreas graft survival, it contributed to early pancreas graft dysfunction, as assessed by enhanced insulin and oral anti-diabetic drugs requirements.
- ItemAcesso aberto (Open Access)Impacto das complicações pós-transplante simultâneo pâncreas-rim sobre o custo da internação hospitalar(Universidade Federal de São Paulo (UNIFESP), 2018-10-25) Carlotto, Jorge Roberto Marcante [UNIFESP]; Gonzalez, Adriano Miziara [UNIFESP]; http://lattes.cnpq.br/6234829429056217; http://lattes.cnpq.br/2078645255414285; Universidade Federal de São Paulo (UNIFESP)Objective: To evaluate the financial impact of postoperative complications in the simultaneous pancreaskidney transplantation during hospitalization. Methods: In the study, were retrospectively analyzed the clinical and financial data of the hospitalization of patients submitted consecutively to the simultaneous pancreaskidney transplantation from January 2008 to December 2014 at Hospital Rim/Fundação Oswaldo Ramos. The main variables studied were reoperation, graft pancreatectomy, death, postoperative complications (surgical, infectious, clinical and immunological) and the financial data of hospitalization for transplantation. Results: The sample consisted of 179 transplants. In the analysis of the data, 58.7% of the patients had some postoperative complications and 21.8% required reoperation, 12.3% of graft pancreatectomy and 8.4% evolved to death. The characteristics of donors and recipients were similar in patients with and without complications. The average real cost of hospitalization was US$ 18,516.02. The need for reoperation or graft pancreatectomy increased hospitalization costs by 53,30% and 78,57%, respectively (p<0,001). The presence of postoperative complication or the severity of the complication significantly increased the cost (p<0,05). However, the presence of death, internal hernia, acute myocardial infarction, stroke and pancreatic graft dysfunction were not statistically significant in the final cost (p>0,05). Conclusions: In the sample studied, we observed that the presence of postoperative complications, reoperation and graft pancreatectomy increased the cost of simultaneous pancreaskidney transplantation. However, postoperative death, internal hernia, acute myocardial infarction, stroke, and pancreatic graft dysfunction do not interfere with this cost.
- ItemAcesso aberto (Open Access)Opções técnicas utilizadas no transplante pancreático em centros brasileiros(Colégio Brasileiro de Cirurgiões, 2005-02-01) Gonzalez, Adriano Miziara [UNIFESP]; Lopes Filho, Gaspar de Jesus [UNIFESP]; Triviño, Tarcísio [UNIFESP]; Messetti, Fabrízio [UNIFESP]; Rangel, Erika Bevilaqua [UNIFESP]; Melaragno, Claudio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)BACKGROUND: To analyze the profile of the most important Brazilian Transplant Centers regarding technical options in the pancreas transplant. METHODS: A query was sent by electronic mail for the 12 Brazilian Transplant Centers with at least one pancreas transplant performed. The query included ten questions approaching controversial and non-standard technical aspects. RESULTS: Midline abdominal incision is used in 90.9% of the Centers. The first organ to be implanted is the kidney in 63% of the Centers. Regarding the venous drainage, 90.9% perform systemic drainage. In 54.5% of the Centers the internal iliac vein is ligated. For combined pancreas-kidney transplant 90.9% of the teams perform enteric drainage. Five Centers answered about isolated pancreas transplant, two of them use enteric drainage and the other three prefer to utilize the bladder. 63% of the surgical teams use abdominal drain. 72.7% of the Centers adopt immunosupression induction for the combined pancreas-kidney transplant. The basic immunosuppression was an association between tacrolimus (FK506), and mofetil microfenolato (MMF), and corticoids. While antibiotic prophylaxis is performed in all the 12 Centers, fungus prophylaxis is routinely made in six of them. Eight Centers (72.7%) adopt vascular thrombosis prophylaxis by several different protocols. CONCLUSION: There are various technical medical protocols on how to conduct a pancreas transplant patient. The lack of homogeneity in the protocols makes it more difficult to analyze and compare the results. Nevertheless we can conclude that in combined pancreas-kidney transplant there is a preference towards midline abdominal incision, and vein systemic and enteric drainage, and vascular thrombosis prophylaxis.