Kidney Transplantation From Donors with Hepatitis B

The growing demand for organ donors to supply the increasing number of patients on kidney waiting lists has led most transplant centers to develop protocols that allow safe use of organs from donors with special clinical situations previously regarded as contraindications. Deceased donors with previous hepatitis B may be a safe resource to increase the donor pool even if there is still controversy among transplantation centers regarding the use of hepatitis B surface antigen-positive donors for renal transplantation. However, when allocated to serology-matched recipients, kidney transplantation from donors with hepatitis B may result in excellent short-term outcome. Many concerns may arise in the long-term outcome, and studies must address the evaluation of the progression of liver disease and the rate of reactivation of liver disease in the recipients. Accurate selection and matching of both donor and recipient and correct post-transplant management are needed to achieve satisfactory long-term outcomes

La transformación cultural como herramienta de creación de una organización de salud del conurbano bonaerense centrada en el marco normativo vigente

Fil: Zerbo, María Cecilia. Universidad de San Andrés. Escuela de Administración y Negocios.; Argentina.Aquino, Gustav

Estudio del enriquecimiento químico de galaxias masivas en simulaciones numéricas cosmológicas

Distintos estudios sugieren que las galaxias masivas (i.e., con masas estelares Μ★ ≳ 1010 Μ⊙) parecen seguir relaciones de escala asociadas a la metalicidad con características que difieren de aquellas correspondientes a sistemas menos masivos. En este trabajo, analizamos el origen del scatter de la relación masa-metalicidad (MZR, por sus siglas en inglés) de galaxias masivas mediante el uso de las simulaciones cosmológicas EAGLE (Evolution and Assembly of GaLaxies and their Environment'). Encontramos que, a M★ fija, la metalicidad de la fase gaseosa de las galaxias tiende a decrecer, en promedio, con la edad estelar de las mismas y la masa asociada a agujeros negros supermasivos. Además, en consistencia con trabajos previos, hallamos una clara dependencia del enriquecimiento químico de las galaxias con su morfo-cinemática. En particular, para galaxias de M★ similar, aquellas con menor soporte rotacional muestran componentes gaseosas de menor metalicidad, siendo esta tendencia más fuerte a medida que aumenta M★. De acuerdo a nuestros resultados preliminares, los principales procesos que determinarían la MZR de galaxias masivas serían el feedback de núcleos activos de galaxias y las fusiones entre galaxias.Different studies suggest that massive galaxies (i.e., with stellar masses Μ★ ≳ 1010 Μ⊙) seem to follow scaling relations associated with metallicity with characteristics that differ from those corresponding to less massive systems. In this work, we analyze the origin of the scatter of the mass-metallicity relation (MZR) of massive galaxies using the EAGLE (Evolution and Assembly of GaLaxies and their Environment) cosmological simulations. We find that, at a fixed M★, the gas-phase metallicity of galaxies tends to decrease, on average, with their stellar age and the mass associated with supermassive black holes. Furthermore, consistently with previous works, we find a clear dependence of the chemical enrichment of galaxies on their morpho-kinematics. In particular, for galaxies of similar M★, those with less rotational support show gas components with lower metallicities, this trend being stronger as M★ increases. According to our preliminary results, the main processes that would determine the MZR of massive galaxies would be the feedback of active galactic nuclei and galaxy mergers.Asociación Argentina de Astronomí

Simultaneous Native Nephrectomy and Kidney Transplantation in Patients With Autosomal Dominant Polycystic Kidney Disease.

INTRODUCTION:To evaluate the feasibility of simultaneous unilateral nephrectomy with kidney transplantation and to determine the effect of this procedure on perioperative morbidity and mortality and graft and patient survival. METHODS:Between January 2000 and May 2015, 145 patients with autosomal dominant polycystic kidney disease (ADPKD) underwent kidney transplantation. Of those, 40 (27.5%) underwent concurrent ipsilateral native nephrectomy (group NT). Patients in group NT were compared with patients with ADPKD not undergoing concurrent nephrectomy (group NT-) and asymptomatic patients undergoing pretransplant nephrectomy (group PNT). RESULTS:The average follow-up was 66 months. The graft survival rate at 1 and 5 years was 95% and 87.5% versus 93% and 76.2% in the NT and NT- groups, respectively (P = .903 and P = .544, respectively); 1-year patient survival was 100% for NT and 97% for NT- patients (P = .288), whereas 5-year patient survival was 100% and 92% for NT and NT- groups, respectively (P = .128). After propensity score matching (34 patients per group) no significant differences were observed in 1-year (97.1% in NT and 94.1%; P = 1) and 5-year (88.2% in NT and 91.2% in NT-; P = 1) graft survival, and in 1-year (100% for both groups; P = 1) and 5-year (100% in NT and 94.1% in NT-; P = 1) patient survival. Perioperative mortality was 0% among NT and 1.2% among NT- patients, whereas perioperative surgical complications were similar in both groups. One- and 5-year graft and patient survival were similar between the NT and PNT groups, but patients in the PNT group had significantly lower levels of hemoglobin and residual diuresis volumes at the time of transplant. Moreover, PNT patients had a longer pretransplant dialysis and a longer time on the waiting list. CONCLUSIONS:Simultaneous unilateral nephrectomy does not have a negative effect on patient and graft survival in patients with ADPKD and is associated with low morbidity. Pretransplant nephrectomy should be restricted only to highly symptomatic patients, whereas unilateral nephrectomy in asymptomatic patients should be performed during kidney transplantation only if massive kidney size precludes graft positioning

Change in kidney volume after kidney transplantation in patients with autosomal polycystic kidney disease.

BackgroundThe indication to bilateral nephrectomy in patients with autosomal dominant polycystic kidney scheduled for kidney transplantation is controversial. Indeed, the progressive enlargement of cysts may increase the risk of complications and the need for nephrectomy. However, very few studies investigated the change in kidney volume after kidney transplantation.Material and methodsIn this prospective cohort study, the change in native kidney volume in polycystic patients was evaluated with magnetic resonance imaging. Forty patients were included in the study. Kidney diameters and total kidney volume were evaluated with magnetic resonance imaging in patients who underwent simultaneous nephrectomy and kidney transplantation and in patients with kidney transplant alone, before transplantation and 1 year after transplantation.ResultsThere was a significant reduction of kidney volume after transplantation, with a mean degree of kidney diameters reduction varying from 12.24% to 14.43%. Mean total kidney volume of the 55 kidney considered in the analysis significantly reduced from 1617.94 ± 833.42 ml to 1381.42 ± 1005.73 ml (PConclusionsPolycystic kidneys volume significantly reduces after kidney transplantation, and this would reduce the need for prophylactic bilateral nephrectomy in asymptomatic patients

Clinical outcomes after propensity score matching.

<p>Clinical outcomes after propensity score matching.</p

Post-transplant outcomes of 40 kidney transplant recipients with autosomal dominant polycystic kidney disease with simultaneous ipsilateral nephrectomy (group NT) compared with 80 recipients with polycystic disease who did not receive adjuvant nephrectomy (group NT-).

<p>(A) Patient survival and (B) graft survival.</p

Surgical complications and clinical outcomes of 40 kidney transplant recipients with concomitant unilateral nephrectomy (NT).

<p>Patients of group NT were compared with 80 polycystic patients not undergoing simultaneous nephrectomy during kidney transplantation (NT-) and with 25 patients undergoing nephrectomy before transplantation (PNT).</p

Demographic and baseline characteristics after propensity score matching.

<p>Demographic and baseline characteristics after propensity score matching.</p