Severe intellectual disability does not preclude renal transplantation

Background. Intellectual disability (ID) in patients with chronic kidney disease is a relative contraindication for kidney transplantation.Methods. We analysed a retrospective cohort of 16 recipients of kidney transplantation with ID and 83 controls.Results. Graft survival at 5 years was similar between patients (81.2%) and controls (80.2%), P = 0.9. Patient survival at 5 years was lower among patients (81.2% versus 94.4%, P < 0.05). Patients had more infection episodes, but no risk factors were identified.Conclusion. Although recipients with ID have lower long-term patient survival, the equivalent graft survival rates support the indication of renal transplantation in such disability.Universidade Federal de São Paulo, Div Nephrol, Dept Med, Hosp Rim & Hipertensao, BR-04038002 São Paulo, BrazilUniversidade Federal de São Paulo, Div Nephrol, Dept Med, Hosp Rim & Hipertensao, BR-04038002 São Paulo, BrazilWeb of Scienc

Pregnancy after renal transplantation - a five-yr single-center experience

Background: There has been an increase in the number of pregnancies in renal transplant recipients. Our aim was to report our experience with a significant casuistic.Methods: Fifty-two pregnancies in 52 patients (January 2001 to December 2005), with two patients having a multiple pregnancy, were evaluated and patients were characterized and evaluated as clinical and obstetrical and perinatal outcomes.Results: Mean patient age was 26.5 yr (range 17-38) with live donors in 34 (65.4%) and cadaver donors in 18 (34.6%). the mean transplantation-pregnancy interval was 3.1 yr. Calcineurin inhibitors (cyclosporine or tacrolimus) comprised the immunosuppressive therapy in 49 pregnancies (94.2%). Pregnancy complications were chronic hypertension in 33 patients (63.5%), anemia in 31 (59.6%), urinary tract infection in 22 (42.3%) and diabetes in four (7.7%). Nine patients (17.3%) received blood transfusion. Preeclampsia was diagnosed in 16 cases (30.7%) and renal dysfunction in 23 (44.2%) with preeclampsia assumed to be the main cause. One patient (1.9%) had graft loss, as a result of hemorrhagic shock after preterm delivery at home. Premature rupture of membranes occurred in four cases (7.7%), and preterm delivery in 20 (38.4%). Sixteen (29.6%) newborn were small for gestational age. One case of neonatal death was registered as a result of excessive prematurity. Cesarean section was performed in 32 patients (61.5%), the main indications being related to hypertension syndromes and fetal distress.Conclusions: This group of patients is characterized by a wide range of antenatal and perinatal problems and must be managed in specialized tertiary units to achieve the very best results.Universidade Federal de São Paulo, Dept Obstet, São Paulo, BrazilUniversidade Federal de São Paulo, Nephrol Div Renal Transplant, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Obstet, São Paulo, BrazilUniversidade Federal de São Paulo, Nephrol Div Renal Transplant, São Paulo, BrazilWeb of Scienc

Risk factors for surgical site infection in kidney transplant recipients

We analyzed the epidemiologic characteristics and risk factors for surgical site infection (SSI) in kidney transplant recipients. From among 1,939 kidney transplant recipients, 120 with corresponding control subjects were evaluated in this study (1: 1 ratio). Reoperation, chronic glomerulonephritis, acute graft rejection, delayed graft function, diabetes, and high body mass index were identified in the analysis as risk factors for SSI.Hosp Rim & Hipertensao, Dept Internal Med, Div Infect Dis, São Paulo, BrazilHosp Rim & Hipertensao, Div Nephrol, São Paulo, BrazilUniversidade Federal de São Paulo, Div Stat, Dept Prevent Med, São Paulo, BrazilUniversidade Federal de São Paulo, Div Stat, Dept Prevent Med, São Paulo, BrazilWeb of Scienc

ANTI-HLA II ANTIBODIES and CHRONIC REJECTION.

Universidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Anti-HLA antibodies and chronic allograft nephropathy: Report of three-year follow-up of a prospective study

Universidade Federal de São Paulo, Hosp Rim & Hipertensao, São Paulo, BrazilUniversidade Federal de São Paulo, Hosp Rim & Hipertensao, São Paulo, BrazilWeb of Scienc

Pharmacokinetics and Long-TermSafety and Tolerability of Everolimus in Renal Transplant Recipients Converted From Cyclosporine

Background:Conversion from cyclosporine (CsA) to everolimus (EVR) in kidney transplant recipients receiving mycophenolate sodium (MPS) and corticosteroids has been used to reduce CsA associated toxicities. Nevertheless, exposures produced by the initial EVR dose, the steady state pharmacokinetic and long-term safety and tolerability have not been explored in detail.Methods:Twenty-four stable kidney transplant recipients receiving CSA, MPS, and corticosteroids were converted from CSA to EVR. The initial EVR dose was 3 mg BID. Weekly monitoring of EVR blood concentrations was followed by a full 12 hour pharmacokinetic profile 28 days after conversion. Therapeutic drug monitoring, safety, and tolerability were analyzed during 5 years of follow-up.Results:The study population was relatively young (mean of 42 years) with a predominance of males (62%) and White (67%) recipients of kidneys from living (54%) or deceased (46%) donors. Mean time of the conversion was 61 months after transplantation. In the first 7 patients, the initial EVR dose of 3 mg BID resulted in mean EVR trough blood concentration of 14.7 3.7 ng/mL at day 7. The initial EVR dose was then reduced to 2 mg BID for the following 17 patients. Four weeks after conversion, mean EVR dose was 1.7 +/- 0.5 mg BID (7 patients were receiving 1 mg BID and 17 were receiving 2 mg BID) resulting in mean EVR trough blood concentration of 4.0 +/- 1.4 ng/mL. Whereas mean maximum concentration (13.4 +/- 2.8 versus 22.9 +/- 7.4 ng/mL, P = 0.003) and mean apparent clearance (232 +/- 79 versus 366 +/- 173 mL/min, P = 0.016) were higher, mean area under the curve (78.2 +/- 22.1 versus 102.5 +/- 38.5 ng.h/mL, P = 0.067) and mean C-0 (3.7 +/- 1.3 versus 4.1 +/- 1.5 ng/mL, P = 0.852) were no different comparing patients receiving 1 mg and 2 mg EVR BID. Mean inter-subject variability of area under the curve, trough concentration, and maximum concentration was 38%, 36%, and 38%. EVR treatment was discontinued in 29% of patients due to proteinuria (N = 2), pneumonia (N = 2), dyslipidemia (N = 2), and anemia (N = 1) and MPS dose was reduced in 58% of patients.Conclusions:The initial 3 mg BID dose produced high EVR trough blood concentrations. The 2 mg BID dose appears to be the appropriate initial dose to provide therapeutic concentrations but still requires initial intensive therapeutic monitoring to achieve and maintain blood concentrations within the therapeutic target concentration. The combination of EVR and full dose MPS has limited long-term tolerability and safety.NovartisUniv Fed Sao Paulo, Div Nephrol, Hosp Rim, Rua Borges Lagoa,960 11 Andar, BR-04038002 Sao Paulo, BrazilUniv Fed Sao Paulo, Div Nephrol, Hosp Rim, Rua Borges Lagoa,960 11 Andar, BR-04038002 Sao Paulo, BrazilWeb of Scienc