Contraceptive counseling and use among 197 female kidney transplant recipients

Background. There is growing interest about the quality of life of female transplant recipients, including their sexual and reproductive health. Although menstrual irregularity and infertility are common in women with advanced chronic diseases, most regain their reproductive function shortly after transplantation. Because an unplanned pregnancy soon after transplantation can expose both mother and fetus to considerable risk, it is recommended that these women should receive contraceptive counseling. However, the actual implementation and effectiveness of this recommendation has not been extensively studied.Methods. A total of 197 reproductive age, female, stable kidney graft recipients attending a large Brazilian transplantation clinic were interviewed. They were asked about menstrual pattern, sexual activity, counseling, and their use of contraceptive methods both before and after the transplant.Results. Before transplantation 70.6% reported menstrual irregularity, 91.9% of them were sexually active, 74.1% were counseled to use contraception and 86.3% used some contraceptive method. After the graft, 50.2% had menstrual irregularity, 79.7% were sexually active, 48.7% were advised to use contraceptives and 72.1% were actually using a method. After transplantation, there were 14 pregnancies in 11 women and 92.9% (13/14) of these were unplanned.Conclusions. Although most female kidney transplant recipients were sexually active both before and after transplantation, many were not counseled about the need for contraception and did not use any form of birth control. Health professionals involved in the management of these patients need to include contraceptive counseling as part of their routine care.Universidade Federal de São Paulo, Dept Obstet, Family Planning Sector Obstet & Nephrol Div, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Obstet, Family Planning Sector Obstet & Nephrol Div, São Paulo, BrazilWeb of Scienc

Pregnancy After Renal Transplantation-Setting Up a National Registry in Brazil

Universidade Federal de São Paulo, Dept Med, BR-04023900 São Paulo, BrazilUniv Estadual Campinas, Dept Med, São Paulo, BrazilComplexo Hosp Santa Casa Porto Alegre, Porto Alegre, RS, BrazilUniversidade Federal de São Paulo, Dept Med, BR-04023900 São Paulo, BrazilWeb of Scienc

Gingival Overgrowth Among Patients Medicated With Cyclosporin A and Tacrolimus Undergoing Renal Transplantation: A Prospective Study

Background: the aim of this study is to make a longitudinal evaluation of the incidence and severity of gingival overgrowth (GO) induced by immunosuppressive agents, such as tacrolimus (Tcr) and cyclosporin A (CsA), in the absence of calcium channel blockers in patients undergoing renal transplantation (RT).Methods: This longitudinal study is conducted in 49 patients with RT who were divided into a CsA group (n = 25) and Tcr group (n = 24). the individuals were assessed at four time intervals: before transplant and 30, 90, and 180 days after RTs. Demographic data and periodontal clinical parameters (plaque index, cemento-enamel junction to the gingival margin, probing depth, clinical attachment level, bleeding on probing [BOP], and GO) were collected at all time intervals.Results: the mean GO index was significantly lower in the Tcr group compared to the CsA group after 30 (P = 0.03), 90 (P = 0.004), and 180 (P = 0.01) days of immunosuppressive therapy. One hundred eighty days after RTs, a clinically significant GO was observed in 20.0% of individuals in the CsA group and 8.3% of individuals in the Tcr group. However, this difference was not statistically significant (P = 0.41). There was a reduction in periodontal clinical parameters regarding the time of immunosuppressive therapy for PI and BOP (P<0.001) in both groups.Conclusion: Although there was no statistical difference in the incidences of clinically significant GO after 180 days of immunosuppressive therapy, it was observed that GO occurred later in the Tcr group, and the severity of GO in this group was lower than in patients who used CsA. J Periodontol 2011;82:251-258.Foundations that Support Research in the State of São Paulo, São Paulo, S.P., BrazilUniv São Paulo, Sch Dent, Dept Stomatol, Div Periodont, BR-05508 São Paulo, BrazilUniversidade Federal de São Paulo, Paulista Med Sch, Div Nephrol, São Paulo, BrazilUniversidade Federal de São Paulo, Paulista Med Sch, Div Nephrol, São Paulo, BrazilFoundations that Support Research in the State of São Paulo, São Paulo, S.P., Brazil: 04/13167-1Web of Scienc

Monitoring for HHV-6 Infection After Renal Transplantation: Evaluation of Risk Factors for Sustained Viral Replication

Background. Human herpesvirus-6 (HHV-6) is known to reactivate after renal transplantation and has been associated with several clinical manifestations. Risk factors for sustained viral replication, however, remain unclear.Methods. Thirty consecutive kidney transplant patients were prospectively followed for HHV-6 replication between February 2007 and February 2008. Plasma samples for DNA detection were collected from the donor and the recipient before transplantation and from the recipient weekly for the first 2 months after transplantation and then every 2 weeks for 2 additional months. HHV-6 active infection was defined as detection of viral DNA in plasma, by polymerase chain reaction, in at least two consecutive samples over an interval of at least 1 week.Results. Active viral infection was detected in 25% of the recipients before transplantation and 27% (8 of 30) of the patients after transplantation. the mean time to onset of viral replication was 28.1 days after transplantation and 7 of 8 (87.5%) were asymptomatic. Risk factors associated with active HHV-6 infection were receiving an organ from a living donor (P=0.028), recipients with IgM antibodies detected before transplantation (P=0.005), and pretransplantation recipient HHV-6 viral load more than 10,000 copies/mL plasma (P=0.034).Conclusions. Active HHV-6 infection occurs early after renal transplantation and is mostly asymptomatic. Donor or recipient infection may occur at the time of transplantation and are related to higher rates of posttransplantation infections.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo UNIFESP, Dept Infect Dis, BR-05685090 São Paulo, BrazilUniv São Paulo, Inst Med Trop São Paulo, Virol Lab, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Infect Dis, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Med, Div Nephrol, BR-05685090 São Paulo, BrazilMassachusetts Gen Hosp, Div Infect Dis, Transplant Infect Dis & Compromised Host Serv, Boston, MA 02114 USAUniversidade Federal de São Paulo UNIFESP, Dept Infect Dis, BR-05685090 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Infect Dis, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Med, Div Nephrol, BR-05685090 São Paulo, BrazilWeb of Scienc

Charcot Neuroarthropathy After Simultaneous Pancreas-Kidney Transplant

Background. Immunosuppressive regimen is associated with several metabolic adverse effects. Bone loss and fractures are frequent after transplantation and involve multifactorial mechanisms.Methods. A retrospective analysis of 130 patients submitted to simultaneous pancreas-kidney transplantation (SPKT) and an identification of risk factors involved in de novo Charcot neuroarthropathy by multivariate analysis were used; P<0.05 was considered significant.Results. Charcot neuroarthropathy was diagnosed in 4.6% of SPKT recipients during the first year. Cumulative glucocorticoid doses (daily dose plus methylprednisolone pulse) during the first 6 months both adjusted to body weight (978 mg/kg) and not adjusted to body weight were associated with Charcot neuroarthropathy (P=0.001 and P<0.0001, respectively). Age, gender, race, time on dialysis, time of diabetes history, and posttransplantation hyperparathyroidism were not related to Charcot neuroarthropathy after SPKT.Conclusions. Glucocorticoids are the main risk factors for de novo Charcot neuroarthropathy after SPKT. Protocols including glucocorticoid avoidance or minimization should be considered.Universidade Federal de São Paulo, Div Nephrol, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Div Endocrinol, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Surg, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Div Nephrol, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Div Endocrinol, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Surg, BR-04023900 São Paulo, BrazilWeb of Scienc