Preemptive simultaneous pancreas kidney transplantation has survival benefit to patients

Several organ allocation protocols give priority to wait-listed simultaneous kidney-pancreas (SPK) transplant recipients to mitigate the higher cardiovascular risk of patients with diabetes mellitus on dialysis. The available information regarding the impact of preemptive simultaneous kidney-pancreas transplantation on recipient and graft outcomes is nonetheless controversial. To help resolve this, we explored the influence of preemptive simultaneous kidney-pancreas transplants on patient and graft survival through a retrospective analysis of the OPTN/UNOS database, encompassing 9690 simultaneous transplant recipients between 2000 and 2017. Statistical analysis was performed applying a propensity score analysis to minimize bias. Of these patients, 1796 (19%) were transplanted preemptively. At ten years, recipient survival was significantly superior in the preemptive group when compared to the non-preemptive group (78.9% vs 71.8%). Dialysis at simultaneous kidney-pancreas transplantation was an independent significant risk for patient survival (hazard ratio 1.66 [95% confidence interval 1.32-2.09]), especially if the dialysis duration was 12 months or longer. Preemptive transplantation was also associated with significant superior kidney graft survival compared to those on dialysis (death-censored: 84.3% vs 75.4%, respectively; estimated half-life of 38.57 [38.33 -38.81] vs 22.35 [22.17 - 22.53] years, respectively). No differences were observed between both groups neither for pancreas graft survival nor for post-transplant surgical complications. Thus, our results sustain the relevance of early referral for pancreas transplantation and the importance of pancreas allocation priority in reducing patient mortality after simultaneous kidney-pancreas transplantation

Incidence of severe breakthrough SARS-CoV-2 infections in vaccinated kidney transplant and haemodialysis patients

Introduction: Given the increased COVID-19 observed in kidney transplant recipients (KTRs) and haemodialysis patients, several studies have tried to establish the efficacy of mRNA vaccines in these populations by evaluating their humoral and cellular responses. However, there is currently no information on clinical protection (deaths and hospitalizations), a gap that this study aims to fill. Methods: Observational prospective study involving 1,336 KTRs and haemodialysis patients from three dialysis units affiliated to Hospital Clínic of Barcelona, Spain, vaccinated with two doses of mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 mRNA vaccines. The outcomes measured were SARS-CoV-2 infection diagnosed by a positive RT-PCR fourteen days after the second vaccine dose, hospital admissions derived from infection, and a severe COVID-19 composite outcome, defined as either ICU admission, invasive and non-invasive mechanical ventilation, or death. Results: Six per cent (18/302) of patients on haemodialysis were infected, of whom four required hospital admission (1.3%), only one (0.3%) had severe COVID-19, and none of them died. In contrast, 4.3% (44/1034) of KTRs were infected, and presented more hospital admissions (26 patients, 2.5%), severe COVID-19 (11 patients, 1.1%) or death (4 patients, 0.4%). KTRs had a significantly higher risk of hospital admission than HD patients, and this risk increased with age and male sex (HR 3.37 and 4.74, respectively). Conclusions: The study highlights the need for booster doses in KTRs. In contrast, the haemodialysis population appears to have an adequate clinical response to vaccination, at least up to four months from its administration

FUNDAMENTOS CONSTITUCIONALES DEL DERECHO PROBATORIO

El presente artículo se ocupa de desentrañar los soportes constitucionalesdel derecho probatorio y, por ende, de la prueba jurídica en sus diferentesespecies. Para el efecto comienza por sentar el principio de que laConstitución política es la fuente de todo nuestro derecho objetivo ypositivo.En seguida se precisan las nociones de derecho probatorio, pruebajurídica, prueba jurídica material y sus modalidades ad subtantiam actusy ad probationem, prueba administrativa y prueba judicial. Y con talesconceptos se emprende la búsqueda de las disposiciones constitucionalesque aluden a las mismas para conformar el respectivo inventario.The article concerns with disembowel the constitutional endures ofevidence law and, thus, the juridical evidence in its different species.For this matter the author starts standing the principle according towith the political constitution is the main source of all our objectiveand positive legislation.Subsequently, the author précis the notions of evidence law, thejuridical evidence and its species ad substantiam actus y adprobationem, administrative evidence, and judicial evidence. Withthose concepts the author initiate the search of the differentconstitutional dispositions which focus in the latter making therespective inventory

FUNDAMENTOS CONSTITUCIONALES DEL DERECHO PROBATORIO

El presente artículo se ocupa de desentrañar los soportes constitucionalesdel derecho probatorio y, por ende, de la prueba jurídica en sus diferentesespecies. Para el efecto comienza por sentar el principio de que laConstitución política es la fuente de todo nuestro derecho objetivo ypositivo.En seguida se precisan las nociones de derecho probatorio, pruebajurídica, prueba jurídica material y sus modalidades ad subtantiam actusy ad probationem, prueba administrativa y prueba judicial. Y con talesconceptos se emprende la búsqueda de las disposiciones constitucionalesque aluden a las mismas para conformar el respectivo inventario.The article concerns with disembowel the constitutional endures ofevidence law and, thus, the juridical evidence in its different species.For this matter the author starts standing the principle according towith the political constitution is the main source of all our objectiveand positive legislation.Subsequently, the author précis the notions of evidence law, thejuridical evidence and its species ad substantiam actus y adprobationem, administrative evidence, and judicial evidence. Withthose concepts the author initiate the search of the differentconstitutional dispositions which focus in the latter making therespective inventory