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1.
Rev. bras. oftalmol ; 81: e0021, 2022. graf
Article in Portuguese | LILACS | ID: biblio-1365728

ABSTRACT

RESUMO Este artigo descreve dois casos de reação imunológica de rejeição de transplante penetrante após a aplicação de dois tipos de vacina contra a COVID-19 - CoronaVac (Sinopharm/Butantan) e MRNA BNT162&2 (Pfizer-BioNTech) - com intervalo de 1 e 10 dias, respectivamente. A rejeição se manifestou com hiperemia, edema corneano e embaçamento da visão, que responderam rapidamente ao uso de corticoide tópico e subconjuntival. Até onde sabemos, este é o primeiro relato de rejeição de transplante penetrante de córnea pós-vacina anti-COVID-19. Recomendamos, presentemente, como prevenção, colírio de prednisolona a 1% 4 dias antes e durante 2 semanas após receber qualquer tipo de vacina para a COVID-19.


ABSTRACT This paper describes two cases of allograft corneal transplant rejection after the application of two types of COVID-19 vaccines - Coronavac (Sinopharm/Butantan) and MRNA BNT162&2 (Pfizer-BioNTech) vaccines - with an interval of 1 to 10 days, respectively. The rejection manifested in the form of corneal edema, hyperemia and blurred vision, which responded rapidly to the use of topical and subconjunctival corticosteroid. As far as we know, this is the first published report of immunological rejection of penetrating corneal transplant after COVID-19 vaccination. As a preventative measure, we now recommend the use of 1% prednisolone eye drop 4 days before and during 2 weeks after having received any type of COVID-19 vaccine.


Subject(s)
Male , Female , Adult , Middle Aged , Keratoplasty, Penetrating/adverse effects , Vaccination/adverse effects , COVID-19 Vaccines/adverse effects , Graft Rejection/etiology , Ophthalmic Solutions , Prednisolone/administration & dosage , Visual Acuity , Corneal Transplantation/adverse effects , Slit Lamp Microscopy , COVID-19 , Graft Rejection/diagnosis , Graft Rejection/prevention & control , Graft Rejection/drug therapy
2.
Clinics ; 76: e2597, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153997

ABSTRACT

A combination of immunosuppressants may improve outcomes due to the synergistic effect of their different action mechanisms. Currently, there is no consensus regarding the best immunosuppressive protocol after liver transplantation. This review aimed to evaluate the effectiveness and safety of tacrolimus associated with mycophenolate mofetil (MMF) in patients undergoing liver transplantation. We performed a systematic review and meta-analysis of randomized clinical trials. Eight randomized trials were included. The proportion of patients with at least one adverse event related to the immunosuppression scheme with tacrolimus associated with MMF was 39.9%. The tacrolimus with MMF immunosuppression regimen was superior in preventing acute cellular rejection compared with that of tacrolimus alone (risk difference [RD]=-0.11; p =0.001). The tacrolimus plus MMF regimen showed no difference in the risk of adverse events compared to that of tacrolimus alone (RD=0.7; p=0.66) and cyclosporine plus MMF (RD=-0.7; p=0.37). Patients undergoing liver transplantation who received tacrolimus plus MMF had similar adverse events when compared to patients receiving other evaluated immunosuppressive regimens and had a lower risk of acute rejection than those receiving in the monodrug tacrolimus regimen.


Subject(s)
Humans , Kidney Transplantation , Liver Transplantation , Randomized Controlled Trials as Topic , Immunosuppression , Tacrolimus/adverse effects , Drug Therapy, Combination , Graft Rejection/prevention & control , Immunosuppressive Agents/adverse effects , Mycophenolic Acid/adverse effects
3.
Braz. j. med. biol. res ; 54(4): e9369, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153534

ABSTRACT

Tacrolimus (TAC), a calcineurin inhibitor, and everolimus (EVL), an mTOR inhibitor, have been used as immunosuppressive (ISS) drugs in post-kidney transplantation therapy. The objective of this study was to compare the efficacy of EVL vs TAC in the ISS maintenance triple therapy. Ninety-seven kidney transplant patients, who received triple maintenance therapy with TAC, mycophenolate mofetil (MMF), and methyl prednisone (PRED), were evaluated. After four months of post-kidney transplant therapy, 30 patients enrolled in a randomized controlled clinical trial, in which 16 patients received TAC+MMF+PRED (cohort 1), and 14 patients switched to EVL+MMF+PRED (cohort 2). The patients were followed-up for 36 months. Two patients from cohort 1 lost their grafts after one year due to non-adherence. Two patients from cohort 2 had intolerance to mTOR inhibitors and were switched back to TAC from EVL. One case (6.25%) in cohort 1 and three cases (21.43%) in cohort 2 of acute T-cell-mediated rejection was observed. Antibody-mediated acute rejection (ABMAR) was observed in four patients (25.0%) in cohort 1, and antibody-mediated chronic rejection (ABMCR) was observed in two patients (12.50%). One patient from cohort 2 lost the graft after 15 months due to polyomavirus infection. The graft survival rate was 87.50% in cohort 1 and 92.86% in cohort 2. This clinical trial showed that the EVL+MMF+PRED triple maintenance therapy was efficacious compared with TAC during 32 months of follow-up. However, further studies are needed to confirm the efficacy of this regimen for long-term graft survival.


Subject(s)
Humans , Kidney Transplantation , Tacrolimus/therapeutic use , Drug Therapy, Combination , Everolimus/therapeutic use , Graft Rejection/prevention & control , Graft Survival , Immunosuppressive Agents/therapeutic use
4.
Rev. Assoc. Med. Bras. (1992) ; 66(3): 353-358, Mar. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136204

ABSTRACT

SUMMARY Melatonin has anti-inflammatory and antioxidant properties that can influence tissue growth and apoptosis. This aspect may influence the success of organ transplantation. OBJECTIVE To evaluate the relationship between melatonin and organ transplantation. METHODS A systematic review was performed in PubMed databases using the search terms: "melatonin physiology" or "melatonin therapy" and "transplant pharmacology" or "transplant physiology" or "transplant therapy" or "Transplant therapy". Experiments on the organs of the reproductive system were not included. After analysis, five articles were selected after reading the title and abstract of 50 manuscripts. The works were divided into two aspects: a) analysis of the influence of the organ transplantation procedure on melatonin production; b) action of melatonin on organ transplantation. RESULTS The cardiac transplantation surgical procedure, immunosuppression, and graft did not influence melatonin secretion in rodents, but there was a significant reduction of melatonin in the renal transplantation procedure in patients with renal insufficiency. Melatonin administration in experimental models decreased rejection and improved transplant success. CONCLUSION Studies show that melatonin can reduce organ and species dependence, and the use of melatonin decreases graft rejection.


RESUMO A melatonina tem propriedades anti-inflamatórias e antioxidantes que podem influenciar o crescimento e a apoptose dos tecidos. Esse aspecto pode influenciar o sucesso do transplante de órgãos. OBJETIVO Avaliar a relação entre a melatonina e o transplante de órgãos. MÉTODO A revisão sistemática foi realizada nas bases de dados do PubMed, usando os termos de pesquisa: "fisiologia da melatonina" ou "terapêutica da melatonina" e "farmacologia do transplante" ou "fisiologia do transplante" ou "terapêutica do transplante" ou "terapia do transplante". Não foram incluídos os experimentos sobre os órgãos do sistema reprodutivo. Após análise, cinco artigos foram selecionados após a leitura do título e do resumo de 50 manuscritos. Os trabalhos foram divididos em duas vertentes: a) análise da influência do procedimento de transplante de órgão na produção de melatonina; b) ação da melatonina sobre o transplante de órgãos. RESULTADOS O procedimento cirúrgico do transplante cardíaco, a imunossupressão e o enxerto não influenciaram a secreção de melatonina em roedores, mas houve redução significante da melatonina nos casos do procedimento de transplante renal em pacientes com insuficiência renal. A ministração de melatonina em modelos experimentais diminuiu a rejeição e melhorou o sucesso de transplante. CONCLUSÃO Os estudos mostram que a melatonina pode reduzir a dependência da espécie e do órgão e que o emprego da melatonina diminui a rejeição do órgão.


Subject(s)
Humans , Animals , Rats , Organ Transplantation , Graft Rejection/prevention & control , Melatonin/administration & dosage , Antioxidants/administration & dosage , Heart Transplantation , Immunosuppression , Kidney Transplantation , Graft Survival/drug effects , Melatonin/physiology
5.
Electron. j. biotechnol ; 32: 63-68, Mar. 2018. tab, graf
Article in English | LILACS | ID: biblio-1022642

ABSTRACT

Background: Although immunosuppressive therapies have made organ transplantation a common medical procedure worldwide, chronic toxicity has a major issue for long-term treatment. One method to improve therapies and methods is the application of immunomodulatory agents from parasites such as Hypoderma lineatum. Hypodermin A (HA) is a serine esterase secreted by the larvae of Hypoderma lineatum, several studies demonstrated its immunosuppressive mechanism in vitro, and recently we discovered that HA inhibits the expression of interferon (IFN)-γ and interleukin (IL)-2 and activates IL-10 expression. Therefore, we hypothesized that it might be a potential agent used to block allograft rejections. However, most studies of the immunosuppressive mechanisms associated with HA were undertaken at the cellular level. In order to augment these studies, we evaluated the immunosuppressive effects of HA in vivo using an HA transgenic mouse model. Result: Our results revealed similar findings to those reported by in vitro studies, specifically that HA induced prostaglandin E2 expression, downregulated IFN-γ and IL-2 expression, and promoted IL-10 secretion via E-type prostanoid receptor 4. Additionally, we observed that HA overexpression inhibited lipopolysaccharide-induced TLR4 activation. These findings provide insight into a new potential agent capable of blocking graft rejection. Conclusion: Our founding suggested that HA-related treatment could be a promising option to improve the viability of grafts in human.


Subject(s)
Animals , Mice , Serine Endopeptidases/immunology , Diptera/enzymology , Diptera/immunology , Graft Rejection/immunology , Enzyme-Linked Immunosorbent Assay , Serine Endopeptidases/metabolism , Blotting, Western , Cytokines , Immunosuppression , Interleukins/antagonists & inhibitors , Interferons/antagonists & inhibitors , Interleukin-10/metabolism , Reverse Transcriptase Polymerase Chain Reaction , Toll-Like Receptor 4 , Real-Time Polymerase Chain Reaction , Graft Rejection/enzymology , Graft Rejection/prevention & control
6.
Ann. hepatol ; 16(1): 94-106, Jan.-Feb. 2017. graf
Article in English | LILACS | ID: biblio-838091

ABSTRACT

Abstract: The use of calcineurin inhibitors (CNI) after liver transplantation is associated with post-transplant nephrotoxicity. Conversion to mycophenolate mofetil (MMF) monotherapy improves renal function, but is related to graft rejection in some recipients. Our aim was to identify variables associated with rejection after conversion to MMF monotherapy. Conversion was attempted in 40 liver transplant recipients. Clinical variables were determined and peripheral mononuclear blood cells were immunophenotyped during a 12-month follow- up. Conversion was classified as successful (SC) if rejection did not occur during the follow-up. MMF conversion was successful with 28 patients (70%) and was associated with higher glomerular filtration rates at the end of study. It also correlated with increased time elapsed since transplantation, low baseline CNI levels (Tacrolimus ≤ 6.5 ng/mL or Cyclosporine ≤ 635 ng/mL) and lower frequency of tacrolimus use. The only clinical variable independently related to SC in multivariate analysis was low baseline CNI levels (p = 0.02, OR: 6.93, 95%, CI: 1.3-29.7). Mean baseline fluorescent intensity of FOXP3+ T cells was significantly higher among recipients with SC. In conclusion, this study suggests that baseline CNI levels can be used to identify recipients with higher probability of SC to MMF monotherapy. Clinicaltrials.gov identification: NCT01321112.


Subject(s)
Humans , Male , Middle Aged , Aged , Liver Transplantation , Tacrolimus/administration & dosage , Cyclosporine/administration & dosage , Calcineurin Inhibitors/administration & dosage , Graft Rejection/prevention & control , Graft Survival/drug effects , Immunosuppressive Agents/administration & dosage , Mycophenolic Acid/administration & dosage , Time Factors , Transcription Factors/immunology , Drug Administration Schedule , T-Lymphocytes/immunology , Chi-Square Distribution , Odds Ratio , Multivariate Analysis , Prospective Studies , Risk Factors , Liver Transplantation/adverse effects , Treatment Outcome , Tacrolimus/adverse effects , Drug Monitoring/methods , Cyclosporine/adverse effects , Drug Therapy, Combination , Calcineurin Inhibitors , Graft Rejection/immunology , Immunosuppressive Agents/adverse effects , Kidney/drug effects , Kidney/physiopathology , Mycophenolic Acid/adverse effects
7.
Yonsei Medical Journal ; : 217-225, 2017.
Article in English | WPRIM | ID: wpr-126254

ABSTRACT

PURPOSE: The increased tolerability of enteric-coated mycophenolate sodium (EC-MPS), compared to mycophenolate mofetil, among kidney transplant recipients has the potential to facilitate cyclosporine (CsA) minimization. Therefore, a prospective trial to determine the optimum EC-MPS dose in CsA-based immunosuppression regimens is necessary. MATERIALS AND METHODS: A comparative, parallel, randomized, open-label study was performed for 140 patients from four centers to compare the efficacy and tolerability of low dose CsA with standard dose EC-MPS (the investigational group) versus standard dose CsA with low dose EC-MPS (the control group) for six months in de novo kidney transplant recipients. Graft function, the incidence of efficacy failure [biopsy-confirmed acute rejection (BCAR), death, graft loss, loss to follow-up], and adverse events were compared. RESULTS: The mean estimated glomerular filtration rate (eGFR) of the investigational group at six months post-transplantation was non-inferior to that of the control group (confidence interval between 57.3 mL/min/1.73m² and 67.4 mL/min/1.73 m², p0.05) in the incidence of discontinuations and serious adverse events (SAE) between the groups. CONCLUSION: CsA minimization using a standard dose of EC-MPS kept the incidence of acute rejection and additional risks as low as conventional immunosuppression and provided therapeutic equivalence in terms of renal graft function and safety issues.


Subject(s)
Adult , Aged , Cyclosporine/administration & dosage , Female , Graft Rejection/prevention & control , Humans , Immunosuppressive Agents/administration & dosage , Incidence , Kidney Transplantation , Male , Middle Aged , Mycophenolic Acid/administration & dosage , Prospective Studies , Tablets, Enteric-Coated , Time Factors
8.
Braz. j. med. biol. res ; 50(10): e6225, 2017. tab, graf
Article in English | LILACS | ID: biblio-888940

ABSTRACT

Coronary allograft vasculopathy is an inflammatory-proliferative process that compromises the long-term success of heart transplantation and has no effective treatment. A lipid nanoemulsion (LDE) can carry chemotherapeutic agents in the circulation and concentrates them in the heart graft. The aim of the study was to investigate the effects of methotrexate (MTX) associated to LDE. Rabbits fed a 0.5% cholesterol diet and submitted to heterotopic heart transplantation were treated with cyclosporine A (10 mg·kg-1·day-1 orally) and allocated to treatment with intravenous LDE-MTX (4 mg/kg, weekly, n=10) or with weekly intravenous saline solution (control group, n=10), beginning on the day of surgery. Animals were euthanized 6 weeks later. Compared to controls, grafts of LDE-MTX treated rabbits showed 20% reduction of coronary stenosis, with a four-fold increase in vessel lumen and 80% reduction of macrophage staining in grafts. Necrosis was attenuated by LDE-MTX. Native hearts of both LDE-MTX and Control groups were apparently normal. Gene expression of lipoprotein receptors was significantly greater in grafts compared to native hearts. In LDE-MTX group, gene expression of the pro-inflammatory factors tumor necrosis factor-α, monocyte chemoattractant protein-1, interleukin-18, vascular cell adhesion molecule-1, and matrix metalloproteinase-12 was strongly diminished whereas expression of anti-inflammatory interleukin-10 increased. LDE-MTX promoted improvement of the cardiac allograft vasculopathy and diminished inflammation in heart grafts.


Subject(s)
Animals , Rabbits , Graft Rejection/prevention & control , Heart Transplantation/adverse effects , Immunosuppressive Agents/administration & dosage , Lipids/administration & dosage , Methotrexate/administration & dosage , Nanoparticles/administration & dosage , Allografts , Immunosuppressive Agents/pharmacology , Methotrexate/pharmacology , Nanoparticles/chemistry
9.
Acta cir. bras ; 31(10): 675-679, Oct. 2016. graf
Article in English | LILACS | ID: biblio-827651

ABSTRACT

ABSTRACT PURPOSE: To evaluate the effect of remote ischemic preconditioning (IPC-R) in the fetal small bowel transplantation model. METHODS: Two groups were constituted: The Isogenic transplant (ISO, C57BL/6 mice, n=24) and the allogenic transplant (ALO, BALB/c mice, n=24). In each group, the animals were distributed with and without IPC-R. It was obtained the following subgroups: Tx, IPC-R, Fk, IPC-Fk, in both strains. Intestinal grafts were stained with hematoxylin and eosin and immunohistochemically. RESULTS: The graft development evaluation in ISO group showed that IPC-R reduced the development compared with ISO-Tx (5.2±0.4 vs 9.0±0.8) and IPC-R-Fk increased the graft development compared with IPC-R (11.2±0.7 and 10.2±0.8). In ALO group, IPC-Fk increased the development compared with ALO-Tx and ALO with IPC-R (6.0±0.8, 9.0±1.2, 0.0±0.0, 0.5±0.3). The PCNA expression was increased in ISO group treated with Fk and IPC-R compared to other groups (12.2±0.8 vs Tx: 8.8±0.9, IPC-R: 8.0±0.4 and Fk: 9.0±0.6). The graft rejection was lower in groups treated with IPC-R (-18%), Fk (-68%) or both (-61%) compared with ALO-Tx. CONCLUSION: Remote ischemic preconditioning showed benefic effect even associate with Tacrolimus on the development and acute rejection of the fetal small bowel graft in the Isogenic and Allogenic transplants.


Subject(s)
Animals , Male , Female , Mice , Fetal Tissue Transplantation/methods , Tacrolimus/therapeutic use , Ischemic Preconditioning/methods , Immunosuppressive Agents/therapeutic use , Intestine, Small/blood supply , Intestine, Small/transplantation , Time Factors , Transplantation, Isogeneic , Immunohistochemistry , Reproducibility of Results , Treatment Outcome , Cell Proliferation/drug effects , Graft Rejection/prevention & control , Mice, Inbred BALB C , Mice, Inbred C57BL
11.
Arq. bras. cardiol ; 105(2): 176-183, Aug. 2015. tab, graf, ilus
Article in English | LILACS | ID: lil-758005

ABSTRACT

AbstractIntroduction:Cardiac allograft vasculopathy (CAV) is a major limitation for long-term survival of patients undergoing heart transplantation (HT). Some immunosuppressants can reduce the risk of CAV.Objectives:The primary objective was to evaluate the variation in the volumetric growth of the intimal layer measured by intracoronary ultrasound (IVUS) after 1 year in patients who received basiliximab compared with that in a control group.Methods:Thirteen patients treated at a single center between 2007 and 2009 were analyzed retrospectively. Evaluations were performed with IVUS, measuring the volume of a coronary segment within the first 30 days and 1 year after HT. Vasculopathy was characterized by the volume of the intima of the vessel.Results:Thirteen patients included (7 in the basiliximab group and 6 in the control group). On IVUS assessment, the control group was found to have greater vessel volume (120–185.43 mm3 vs. 127.77–131.32 mm3; p = 0.051). Intimal layer growth (i.e., CAV) was also higher in the control group (27.30–49.15 mm3 [∆80%] vs. 20.23–26.69 mm3[∆33%]; p = 0.015). Univariate regression analysis revealed that plaque volume and prior atherosclerosis of the donor were not related to intima growth (r = 0.15, p = 0.96), whereas positive remodeling was directly proportional to the volumetric growth of the intima (r = 0.85, p < 0.001).Conclusion:Routine induction therapy with basiliximab was associated with reduced growth of the intima of the vessel during the first year after HT.


ResumoFundamento:A doença vascular do enxerto (DVE) constitui uma grande limitação de sobrevida a longo prazo de pacientes submetidos a transplante cardíaco (TxC). Alguns imunossupressores diminuem o aparecimento da DVE.Objetivos:O principal objetivo foi avaliar, através de ultrassonografia intracoronária (USIC), a variação do crescimento volumétrico da camada íntima e comparar, após um ano, o grupo que recebeu basiliximab com um grupo de controle.Métodos:Treze pacientes de um único centro foram analisados retrospectivamente de 2007 a 2009. As análises foram feitas através de USIC, medindo-se o volume de um segmento coronariano nos primeiros 30 dias e um ano após o TxC. A vasculopatia foi caracterizada pelo volume da camada íntima do vaso.Resultados:O estudo incluiu 13 pacientes (7 no grupo com o basiliximab e 6 no grupo de controle). A análise por USIC revelou que o grupo de controle apresentou maior crescimento volumétrico do vaso (131,32 a 127,77 mm3 x 120 a 185,43 mm3 p = 0,051). O crescimento da camada íntima (CCI) também foi maior no grupo de controle [Basiliximab: 20,23 a 26,69 mm3 (∆ 33%); Controle: 27,30 a 49,15 mm3(∆ 80% p = 0,015)]. De acordo com a regressão univariada, o volume da placa aterosclerótica prévia do doador não teve relação com o crescimento da íntima (r = 0,15, p = 0,96), enquanto que o remodelamento positivo do vaso foi diretamente proporcional ao crescimento da íntima (r = 0,85, p < 0,001).Conclusão:A terapia de indução de rotina com basiliximab está associada à redução do crescimento da camada íntima do vaso no primeiro ano após o transplante cardíaco.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Antibodies, Monoclonal/therapeutic use , Coronary Artery Disease/drug therapy , Graft Rejection/drug therapy , Heart Transplantation/adverse effects , Immunosuppressive Agents/therapeutic use , Recombinant Fusion Proteins/therapeutic use , Allografts/drug effects , Allografts/pathology , Biopsy , Case-Control Studies , Coronary Artery Disease/pathology , Coronary Artery Disease/prevention & control , Coronary Artery Disease , Disease Progression , Graft Rejection/pathology , Graft Rejection/prevention & control , Graft Rejection , /antagonists & inhibitors , Plaque, Atherosclerotic/drug therapy , Plaque, Atherosclerotic/pathology , Retrospective Studies , Risk Factors , Statistics, Nonparametric , Time Factors , Treatment Outcome , Tunica Intima/drug effects , Tunica Intima/pathology
12.
Rev. latinoam. enferm. (Online) ; 23(4): 603-610, July-Aug. 2015. tab, ilus
Article in English | LILACS, BDENF | ID: lil-761705

ABSTRACT

AbstractObjective: to evaluate the effect of foot reflexology on feet impairment of people with type 2 diabetes mellitus.Method: this is a randomized, controlled and blind clinical trial. The sample was comprised by people with type 2 diabetes mellitus who, after being randomized into Treated group (n = 21) and Control group (n = 24), received guidelines on foot self-care. To the Treated Group it was also provided 12 sessions of foot reflexology. The scores of impairment indicators related to skin and hair, blood circulation, tissue sensitivity and temperature were measured by means of the instrument for assessing tissue integrity of the feet of people with diabetes mellitus. Chi-square test, Fisher exact test, Mann-Whitney test and regression analyzes were applied to the data, considering a significance level of 5% (P value <0.05).Results: participants who received the therapy showed better scores in some impairment indicators related to skin and hair (hair growth, elasticity/turgor, hydration, perspiration, texture and integrity of the skin/ skin peeling).Conclusion: the foot reflexology had a beneficial effect on feet impairment of people with type 2 diabetes mellitus, which makes it a viable therapy, deserving investment. This study was registered in the Brazilian Registry of Clinical Trials - RBR-8zk8sz.


ResumoObjetivo:avaliar o efeito da reflexologia podal no comprometimento dos pés de pessoas com diabetes mellitus tipo 2.Método:trata-se de um ensaio clínico, randomizado, controlado e mascarado. A amostra foi composta por pessoas com diabetes mellitus tipo 2 que, após serem randomizadas em grupo Tratado (n=21) e Controle (n=24), receberam orientações de autocuidado com os pés. Ao Grupo Tratado também foram fornecidas 12 sessões de reflexologia podal. Foram mensurados os escores de comprometimento de indicadores relacionados à pele e pelos, circulação sanguínea, sensibilidade e temperatura tissular por meio do Instrumento para avaliação da integridade tissular dos pés de pessoas com diabetes mellitus. Aos dados foram aplicados os testes Qui-Quadrado, Exato de Fisher, Mann-Whitney e Análises de regressão, considerando-se nível de significância de 5% (Valor P<0,05).Resultados:os participantes que receberam a terapia apresentaram melhores escores de comprometimento em alguns indicadores relacionados à pele e pelos (crescimento de pelos, elasticidade/tugor, hidratação, transpiração, textura e integridade da pele/descamação cutânea).Conclusão:a reflexologia podal apresentou efeito benéfico sobre o comprometimento dos pés de pessoas com diabetes mellitus tipo 2, o que a torna uma terapia viável e que merece investimento. Este estudo foi registrado no Registro Brasileiro de Ensaios Clínicos - RBR-8zk8sz.


ResumenObjetivo:evaluar el efecto de la reflexología podal en el comprometimiento de los pies de personas con diabetes mellitus tipo 2.Método:se trata de un ensayo clínico, aleatorio, controlado y enmascarado. La muestra estuvo compuesta por personas con diabetes mellitus tipo 2 que, después de ser tratadas aleatoriamente en los grupos Tratado (n=21) y Control (n=24), recibieron orientaciones de autocuidado de los pies. También, al Grupo Tratado se le suministraron 12 sesiones de reflexología podal. Fueron medidos los puntajes de comprometimiento de indicadores relacionados a la piel y pelos, circulación sanguínea, sensibilidad y temperatura tisular por medio de instrumento para evaluación de la integridad del tejido de los pies de personas con diabetes mellitus. Los datos fueron sometidos a las pruebas Chi-cuadrado, Exacta de Fisher, Mann-Whitney y Análisis de regresión, considerando un nivel de significación de 5% (Valor p<0,05).Resultados:los participantes que recibieron la terapia presentaron mejores puntajes de comprometimiento en algunos indicadores relacionados a la piel y pelos (crecimiento de pelos, elasticidad/turgencia, hidratación, transpiración, textura e integridad de la piel/descamación cutánea).Conclusión:la reflexología podal presentó efecto benéfico sobre el comprometimiento de los pies de personas con diabetes mellitus tipo 2, lo que la torna una terapia viable y que merece inversiones. Este estudio fue registrado en el Registro Brasileño de Ensayos Clínicos - RBR-8zk8sz.


Subject(s)
Animals , Female , Mice , Antibodies, Monoclonal, Murine-Derived/pharmacology , /immunology , /immunology , Graft Survival/drug effects , Heart Transplantation , Lymphocyte Function-Associated Antigen-1/immunology , Membrane Glycoproteins/immunology , Tumor Necrosis Factors/immunology , Allografts , Graft Rejection/immunology , Graft Rejection/pathology , Graft Rejection/prevention & control , Graft Survival/immunology , Intercellular Adhesion Molecule-1/immunology , Mice, Inbred BALB C , Skin Transplantation , Time Factors
13.
Einstein (Säo Paulo) ; 13(2): 297-304, Apr-Jun/2015. tab, graf
Article in English | LILACS | ID: lil-751417

ABSTRACT

ABSTRACT Lung transplantation is a globally accepted treatment for some advanced lung diseases, giving the recipients longer survival and better quality of life. Since the first transplant successfully performed in 1983, more than 40 thousand transplants have been performed worldwide. Of these, about seven hundred were in Brazil. However, survival of the transplant is less than desired, with a high mortality rate related to primary graft dysfunction, infection, and chronic graft dysfunction, particularly in the form of bronchiolitis obliterans syndrome. New technologies have been developed to improve the various stages of lung transplant. To increase the supply of lungs, ex vivo lung reconditioning has been used in some countries, including Brazil. For advanced life support in the perioperative period, extracorporeal membrane oxygenation and hemodynamic support equipment have been used as a bridge to transplant in critically ill patients on the waiting list, and to keep patients alive until resolution of the primary dysfunction after graft transplant. There are patients requiring lung transplant in Brazil who do not even come to the point of being referred to a transplant center because there are only seven such centers active in the country. It is urgent to create new centers capable of performing lung transplantation to provide patients with some advanced forms of lung disease a chance to live longer and with better quality of life.


RESUMO O transplante pulmonar é um tratamento mundialmente aceito para alguma pneumopatias avançadas, conferindo aos receptores maior sobrevida e melhor qualidade de vida. Desde o primeiro transplante realizado com sucesso em 1983, mais de 40 mil transplantes foram feitos em todo mundo. Destes, cerca de 700 foram no Brasil. No entanto, a sobrevida do transplante é menor do que a desejada, com altos índices de mortalidade relacionados à disfunção primária do enxerto, infecções e disfunção crônica do enxerto, principalmente sob a forma da síndrome da bronquiolite obliterante. Novas tecnologias têm sido desenvolvidas para aprimoramento das diversas etapas do transplante pulmonar. Para aumentar a oferta de pulmões, o recondicionamento pulmonar ex vivo vem sendo utilizado em alguns países, inclusive no Brasil. Para suporte avançado de vida no período perioperatório, equipamentos de oxigenação extracorpórea e de suporte hemodinâmico vêm sendo utilizado como ponte para o transplante em pacientes gravemente doentes em lista de espera e para manter pacientes vivos até a resolução da disfunção primária do enxerto pós-transplante. Existe uma demanda reprimida de pacientes que necessitam de transplante pulmonar no Brasil e que nem sequer chegam a ser encaminhados a um centro transplantador, pois só existem sete deles ativos no país. É urgente a criação de novos centros capazes de realizar transplante pulmonar para oferecer a pacientes com algumas pneumopatias avançadas uma chance de viver mais e com melhor qualidade de vida.


Subject(s)
Humans , Lung Transplantation/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/surgery , Idiopathic Pulmonary Fibrosis/surgery , Brazil , Survival Analysis , Cause of Death , Waiting Lists , Age Factors , Lung Transplantation/methods , Lung Transplantation/mortality , Risk Assessment , Donor Selection , Perioperative Period , Contraindications , Graft Rejection/prevention & control
15.
J. bras. nefrol ; 37(2): 228-240, Apr-Jun/2015. tab, graf
Article in Portuguese | LILACS | ID: lil-751448

ABSTRACT

Resumo A combinação de imunossupressores faz parte do protocolo de tratamento de pacientes submetidos a um transplante renal (TR). A Thymoglobuline®, imunoglobulina policlonal de coelho dirigida contra timócitos humanos, é o agente mais usado como terapia de indução no TR nos Estados Unidos. No Brasil, a Thymoglobuline® está aprovada para uso em pacientes que foram submetidos a transplante e, apesar de ser amplamente utilizada, ainda existem controvérsias em relação ao seu modo de uso. Realizamos uma revisão sistemática da literatura avaliando os estudos que utilizaram a Thymoglobuline® na indução e no tratamento de rejeição em pacientes submetidos ao TR. A revisão utilizou os bancos de dados computadorizados da EMBASE, LILACS e MedLine e dos trabalhos selecionados foram extraídas informações sobre os dados gerais dos pacientes, as características metodológicas e as variáveis analisadas em cada estudo. Dos resultados obtidos, desenvolvemos um guia prático sobre o uso de Thymoglobuline® em pacientes transplantados renais.


Abstract The combination of immunosuppressive drugs is part of the treatment regimen of patients undergoing kidney transplantation (RT). Thymoglobulin®, a rabbit immunoglobulin directed against human thymocytes, is the most commonly agent used for induction therapy in RT in the US. In Brazil, Thymoglobulin® is approved by ANVISA for the use in patients who underwent kidney transplantation and despite being widely used, there are controversies regarding the drug administration. We prepared a systematic review of the literature, evaluating studies that used Thymoglobulin® for induction and for acute rejection treatment in patients undergoing RT. The review used the computadorized databases of EMBASE, LILACS and MedLine. Data were extracted from the studies concerning general features, methodological characteristics and variables analyzed in each study. From the results, a practical guide was prepared analyzing various aspects on the use of Thymoglobulin® in patients submitted to RT.


Subject(s)
Humans , Antilymphocyte Serum/therapeutic use , Graft Rejection/drug therapy , Graft Rejection/prevention & control , Immunosuppressive Agents/therapeutic use , Kidney Transplantation , Practice Guidelines as Topic
16.
Clinics ; 69(11): 745-749, 11/2014. tab, graf
Article in English | LILACS | ID: lil-731110

ABSTRACT

OBJECTIVES: Orthotopic liver transplantation has improved survival in patients with end-stage liver disease; however, therapeutic strategies that achieve ideal immunosuppression and avoid early complications are lacking. To correlate the dose and level of Tacrolimus with early complications, e.g., rejection, infection and renal impairment, after liver transplantation. From November 2011 to May 2013, 44 adult liver transplant recipients were studied in this retrospective comparative study. RESULTS: The most frequent indication for liver transplantation was hepatitis C cirrhosis (47.7%), with a higher prevalence observed in male patients (68.18%). The ages of the subjects ranged from 19-71 and the median age was 55.5 years. The mean length of the hospital stay was 16.1±9.32 days and the mean Model for End-stage Liver Disease score was 26.18±4.28. There were five cases of acute cellular rejection (11.37%) and 16 cases of infection (36.37%). The blood samples that were collected and analyzed over time showed a significant correlation between the Tacrolimus blood level and the deterioration of glomerular filtration rate and serum creatinine (p<0.05). Patients with infections had a higher serum level of Tacrolimus (p = 0.012). The dose and presence of rejection were significantly different (p = 0.048) and the mean glomerular filtration rate was impaired in patients who underwent rejection compared with patients who did not undergo rejection (p = 0.0084). CONCLUSION: Blood Tacrolimus levels greater than 10 ng/ml were correlated with impaired renal function. Doses greater than 0.15 mg/kg/day were associated with the prevention of acute cellular rejection but predisposed patients to infectious disease. .


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Immunosuppression/adverse effects , Immunosuppressive Agents/adverse effects , Liver Transplantation , Tacrolimus/adverse effects , Creatinine/blood , Dose-Response Relationship, Drug , Glomerular Filtration Rate , Graft Rejection/etiology , Graft Rejection/prevention & control , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/blood , Length of Stay , Renal Insufficiency/etiology , Renal Insufficiency/prevention & control , Statistics, Nonparametric , Time Factors , Treatment Outcome , Tacrolimus/administration & dosage , Tacrolimus/blood
17.
Medicina (B.Aires) ; 74(5): 400-403, oct. 2014. tab
Article in Spanish | LILACS | ID: lil-734408

ABSTRACT

En trasplante renal, los anticuerpos donante-específicos por ensayos de fase sólida predicen el rechazo temprano mediado por anticuerpos, incluso con resultados negativos de citometría de flujo o citotoxicidad dependiente del complemento. Aquí se describen los protocolos de inmunosupresión y los resultados a diez meses de cuatro pacientes en los que se detectó anticuerpos donante-específicos anti-antígenos leucocitarios humanos (HLA) por Luminex®, pero no detectados por el método de citotoxicidad dependiente de complemento (CDC) ni por citometría de flujo. Los cuatro pacientes recibieron tratamiento de inducción con 5 dosis de timoglobulina de 1.25 mg/kg y 5 dosis de inmunoglobulina intravenosa (IVIG) de 400 mg/kg. Además, uno recibió 20 mg de basiliximab el mismo día del trasplante y el día 4 postrasplante; otro recibió 3 sesiones de plasmaféresis en los días -5, -3, y -1 y eculizumab en dosis de 1200 mg antes del trasplante, 900 mg el día 1, and 600 mg por semana durante un mes. En todos los casos, la inmunosupresión de mantenimiento consistió en tacrolimus, micofenolato y deltisona. Todos presentaron buenos resultados en el corto plazo. Nuestra experiencia sugiere que los pacientes con anticuerpos donante-específicos anti-HLA detectados solo por Luminex® deben recibir un seguimiento estricto y que en esta población se pueden obtener buenos resultados a partir del uso de terapia de inducción con timoglobulina e IVIG.


In renal transplantation, donor specific antibodies (DSAs) detected by sensitive solid-phase assay foresee early antibody-mediated rejections, even with negative complement-dependent cytotoxicity or flow cytometry results. We describe the immunosuppression protocols and outcomes at 10 months of four renal transplant patients in whom anti-HLA DSAs were detected by Luminex® but not by CDC and flow cytometry. The four patients underwent induction treatment with five doses of thymoglobulin at 1.25 mg/kg and 5 doses of intravenous immunoglobulin (IVIG) at 400 mg/kg. In addition, one patient received 20 mg basiliximab on the day of transplant and on post-operative day 4; another patient underwent three sessions of plasmapheresis on days -5, -3, and -1 and also received 1200 mg eculizumab prior to transplant, 900 mg on day 1, and 600 mg each week during one month. In all of them, the maintenance immunosuppressive regimen consisted of tacrolimus, mycophenolate acid and deltisone. All patients had good short-term outcomes. Our findings suggest that patients with anti-HLA DSAs detected only by Luminex® should be monitored closely and can be treated successfully with induction therapy based on thymoglobulin and IVIG.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Antibodies/immunology , Graft Rejection/immunology , Graft Rejection/prevention & control , HLA Antigens/immunology , Immunosuppression/methods , Kidney Transplantation , Antibodies, Monoclonal, Humanized/administration & dosage , Immunoglobulins, Intravenous/administration & dosage , Immunosuppressive Agents/administration & dosage , Kidney Transplantation/methods , Mycophenolic Acid/administration & dosage , Tissue Donors , Treatment Outcome
18.
Bol. Hosp. Viña del Mar ; 70(3): 104-110, sept.2014. tab
Article in Spanish | LILACS | ID: lil-779200

ABSTRACT

Historia de los trasplantes renales efectuados en niños y adolescentes en el Hospital Dr. Gustavo Fricke de Viña del Mar: Una narración pormenorizada de cada trasplante. En este artículo se narra la historia de los trasplantes renales pediátricos efectuados en el hospital Dr. Gustavo Fricke entre 1984 y 2000. Durante el período se efectuaron 19 trasplantes en niños y adolescentes. De ellos, 42 por ciento se efectuó en niños menores de 15 años y 58 por ciento en adolescentes entre 15 y 18 años. El tiempo que permanecieron en diálisis crónica fue de 26 y 13 meses, respectivamente. Los niños recibieron un riñón más frecuentemente desde un donante fallecido (75 por ciento) y los adolescentes de un donante vivo (91 por ciento). El esquema inmunosupresor más utilizado fue la combinación de azatioprina, ciclosporina y corticoides. Los niños presentaron con mayor frecuencia un rechazo agudo y la necesidad de una reintervención quirúrgica en el postoperatorio que los adolescentes. A la fecha de corte de esta historia, transcurridos 30 años del primer trasplante pediátrico, 43 por ciento de los injertos renales efectuados en niños y 36 por ciento en adolescentes está funcionando, con un rango de duración entre 16 y 20 años...


History of kidney transplants performed in children and teenagers in Hospital Dr. Gustavo Fricke, Viña del Mar, Chile: A detailed narration of each kidney transplant This article told the history of pediatric renal transplants performed in Hospital Dr. Gustavo Fricke between 1984 and 2000. During this period 19 kidney transplants were performed in children and adolescents. Of these, 42 percent were performed in children under 15 years (range: 3-14) and 58 percent in adolescents (15-18 years). The time that patients remain in chronicdialysis was 26 months and 13 months, respectively. Children received a kidney more frequently from a deceased donor(75 percent) and adolescents from a living donor (91 percent). The immunosuppressive regimen most often used was the combination of azathioprine, cyclosporine and corticosteroids. Children had more often acute rejection in the postoperative period and the need of a reoperation. After 30 years of the first pediatric transplant, 43 percent of the renal grafts performed in children and 36 percent in adolescents are functioning, with a length between 16 and 20 years...


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Azathioprine/therapeutic use , Cyclosporins/therapeutic use , Immunosuppressive Agents/therapeutic use , Renal Insufficiency, Chronic/therapy , Kidney Transplantation/statistics & numerical data , Age Distribution , Age Factors , Graft Rejection/prevention & control , Treatment Outcome
19.
Rev. cuba. med ; 53(2): 165-177, abr.-jun. 2014.
Article in Spanish | LILACS | ID: lil-722968

ABSTRACT

Introducción: el retrasplante constituye la mejor opción terapéutica para los enfermos que pierden un primer trasplante renal y vuelven a diálisis, existen disímiles criterios en cuanto a sus resultados al compararlos con los trasplantes renales primarios. Objetivo: analizar el porcentaje de retrasplantes, revisar la supervivencia del injerto y del enfermo, el comportamiento de variables que pueden incidir en los resultados y compararlos con los de los enfermos que reciben un primer trasplante renal. Métodos: se realizó un estudio analítico, descriptivo, retrospectivo, de los trasplante renales realizados en el Hospital Hermanos Ameijeiras desde 1984 hasta diciembre de 2012; quedaron excluidos, los terceros trasplante, dobles (2 riñones a un mismo receptor), combinados (páncreas-riñón e hígado-riñón) y aquellos en los que no fue posible obtener la información requerida para la investigación. Se compararon (entre los grupos retrasplantes y primeros trasplantes) variables de índole general: edad de los receptores y donantes, sexo del receptor, enfermedad que ocasionó la insuficiencia renal, porcentaje de reactividad ante un panel de linfocito (PRA), compatibilidades HLA, tipo de donante (vivo o cadáver), tiempos de isquemia, presencia y duración de necrosis tubular aguda (donante cadáver), rechazo y supervivencia del injerto y el paciente. Resultados: los retrasplantes constituyeron el 5,4 por ciento de la muestra. No existieron diferencias entre edades, sexo, PRA, compatibilidades ni tipo de donante entre los segundos y primeros injertos. Los enfermos que llegaron a la insuficiencia renal por riñones poliquísticos nunca han recibido en nuestro centro un segundo trasplante. Resultó significativamente estadístico el uso de terapia cuádruple secuencial como inmunosupresión de inducción en los retrasplantes (55,9 por ciento vs. 9,7 por ciento de los primarios...


Introduction: retransplant constitutes the best therapeutic choice for patients who lose a first renal transplant and return to dialysis, existing dissimilar criteria as to its results when ranking them with renal primary transplant. Objective: to analyze the percentage of retransplantation, to revise graft and patient survival, to review the behavior of variables that can affect the results and to compare them with patients receiving a first renal transplant. Methods: an analytic, descriptive, retrospective study was accomplished, including all renal transplant performed at the Hermanos Ameijeiras Hospital from 1984 to December of 2012. Third transplants, double transplants (two kidneys to the same receptor), combined transplants (pancreas-kidney and liver-kidney) and those where it was not possible to obtain the information required for this research were excluded. Variables of general nature were compared between retransplantation groups and first transplants, such as: age of recipient and donor, sex of the recipient, a disease that caused kidney failure, percentage of reactivity to a lymphocyte panel (PRA), HLA compatibility, donor type (living or dead), ischemia time, presence and duration of acute tubular necrosis (dead donor), rejection and graft and patient survival. Results:rRetransplant constituted only 5.4 percent of the sample (34 patients). There were no differences in age, sex, PRA, donor type or compatibilities between the second and first grafts. Patients who reached the renal failure due to polycystic kidneys have never had a second transplant in our institution. The use of sequential quadruple therapy as induction immunosuppression, retransplantation (55.9 percent vs. 9.7 percent of primary) was statistically significant...


Subject(s)
Immunosuppression/methods , Graft Rejection/diagnosis , Graft Rejection/prevention & control , Transplantation Tolerance/physiology , Kidney Transplantation/methods , Epidemiology, Descriptive , Retrospective Studies , Survival Analysis , Graft Survival/physiology , Survival Rate/trends
20.
Clinics ; 69(supl.1): 39-41, 1/2014.
Article in English | LILACS | ID: lil-699021

ABSTRACT

The number of pediatric kidney transplants has been increasing in many centers worldwide, as the procedure provides long-lasting and favorable outcomes; however, few papers have addressed the immediate postoperative care of this unique population. Herein, we describe the management of these patients in the early postoperative phase. After the surgical procedure, children should ideally be managed in a pediatric intensive care unit, and special attention should be given to fluid balance, electrolyte disturbances and blood pressure control. Antibiotic and antiviral prophylaxes are usually performed and are based on the recipient and donor characteristics. Thrombotic prophylaxis is recommended for children at high risk for thrombosis, although consensus on the optimum therapy is lacking. Image exams are essential for good graft control, and Doppler ultrasound must be routinely performed on the first operative day and promptly repeated if there is any suspicion of kidney dysfunction. Abdominal drains can be helpful for surveillance in patients with increased risk of surgical complications, such as urinary fistula or bleeding, but are not routinely required. The immunosuppressive regimen starts before or at the time of kidney transplantation and is usually based on induction with monoclonal or polyclonal antibodies, depending on the immunological risk, and maintenance with a calcineurin inhibitor (tacrolimus or ciclosporin), an anti-proliferative agent (mycophenolate or azathioprine) and steroids.


Subject(s)
Child , Humans , Kidney Transplantation , Postoperative Care/methods , Early Medical Intervention , Graft Rejection/prevention & control , Immunosuppressive Agents/therapeutic use
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