Evaluation of the use of a Renal Health application by kidney transplant recipients / Avaliação do uso do aplicativo Renal Health por transplantados renais / Evaluación del uso de la Aplicación Renal Health por parte de los receptores de trasplante renal

Abstract Objective: to evaluate the use of a renal health application by kidney transplant recipients. Method: a retrospective, observational study with a sample composed of individuals registered in the kidney transplant section of the application from July of 2018 to April of 2021. Demographic data, data entry, time of use, weight, blood pressure, blood glucose, creatinine, medication schedules, appointments, and tests were the variables collected. Descriptive analysis of the data was performed. Results: eight hundred and twenty-three downloads of the application were identified, and 12.3% of those were registered as kidney transplant recipients, the majority from southeastern Brazil (44.9%), 36±11 years old, and female (59.1%). Of the sample, 35.1% entered information such as creatinine (62%), weight (58.2%), and blood pressure (51.8%). Most used the application for one day (63.3%) and 13.9% for more than one hundred days. Those who used it for more than one day (36.7%) recorded weight (69%), medication intake (65.5%) and creatinine (62%), and scheduled appointments (69%). Conclusion: the kidney transplant recipient section of the Renal Health application generated interest in the young population, but showed low adherence throughout the assessed months. These results offer a relevant perspective on the implementation of mHealth technologies in kidney transplantation.

Resumo Objetivo: avaliar o uso do aplicativo Renal Health por transplantados renais. Método: estudo observacional retrospectivo com amostra composta por usuários que realizaram cadastro na seção para transplantados renais do aplicativo de julho de 2018 a abril de 2021. Foram coletadas as seguintes variáveis: dados demográficos, inserção de dados, tempo de uso, registros de peso, pressão arterial, glicemia, creatinina, horários das medicações, consultas e exames. Realizou-se análise descritiva dos dados. Resultados: houve 1.823 downloads do aplicativo e 12,3% cadastraram-se na seção para transplantados renais, a maioria do Sudeste do Brasil (44,9%), com 36±11 anos e do sexo feminino (59,1%). Da amostra, 35,1% inseriram informações como creatinina (62%), peso (58,2%) e pressão arterial (51,8%). A maioria utilizou o aplicativo por um dia (63,3%) e 13,9% por mais de cem dias. Os que utilizaram por mais de um dia (36,7%), inseriram peso (69%), agendaram consultas (69%), medicações (65,5%) e creatinina (62%). Conclusão: a seção para transplantados renais do aplicativo Renal Health despertou interesse na população jovem, mas apresentou baixa adesão ao longo dos meses avaliados. Esses resultados oferecem perspectiva relevante na implementação de tecnologias mHealth no transplante renal.

Resumen Objetivo: evaluar el uso de la aplicación Renal Health por parte de los receptores de trasplante renal. Método: estudio observacional retrospectivo con una muestra compuesta por usuarios que se registraron en la sección de trasplantados renales dentro de la aplicación desde julio de 2018 hasta abril de 2021. Se recolectaron las siguientes variables: datos demográficos, ingreso de datos, tiempo de uso, registros de peso, presión arterial, glucosa en sangre, creatinina, esquemas de medicación, consultas y exámenes. Se realizó un análisis descriptivo de los datos. Resultados: Ocurrieron 1.823 descargas de la aplicación y 12,3% se registró en la sección de trasplantados, la mayoría del sudeste de Brasil (44,9%), con edad de 36±11 años y del sexo femenino (59,1%). De la muestra, 35,1% ingresó información como: creatinina (62%), peso (58,2%) y presión arterial (51,8%). La mayoría utilizó la aplicación durante un día (63,3%) y el 13,9% más de cien días. Quienes lo usaron por más de un día (36,7%), agregaron peso (69%), programación de consultas (69%), medicación (65,5%) y creatinina (62%). Conclusión: la sección para trasplantados renales de la aplicación Renal Health despertó interés en la población joven, pero mostró baja adherencia en los meses evaluados. Estos resultados ofrecen una perspectiva relevante en la implementación de tecnologías mHealth en el trasplante renal.

Estatística geral de doação e transplantes de orgãos - Goiás - 2023 (Janeiro a setembro) / General statistics on organ donation and transplants - Goiás - 2023 (January to September)

Estatística geral de doação e transplantes de orgãos - Goiás que tem como objetivo transcrever em números os resultados de todo o trabalho executado pela Gerência de Transplantes em Goiás

General statistics on organ donation and transplants - Goiás which aims to transcribe into numbers the results of all the work carried out by the Transplant Management in Goiás

Nefrectomía totalmente laparoscópica para donante vivo de riñón: Características y desenlaces en una institución de alta complejidad en Colombia. Serie de casos / Total laparoscopic nephrectomy for a living kidney donor: Characteristics and outcomes in a single center from Colombia. Case series

Introducción. El trasplante es la mejor opción de tratamiento para los pacientes con enfermedad renal terminal, sin embargo, existe discrepancia entre las listas de espera y la disponibilidad de órganos a partir de la donación cadavérica. Buscando aumentar el número de órganos disponibles se implementó el trasplante con donante vivo. A partir de la introducción de técnicas mínimamente invasivas para la nefrectomía, el donante vivo ha logrado cifras cercanas al 50 % de los trasplantes realizados en muchas instituciones, debido a los beneficios propios del procedimiento. El objetivo de este estudio fue describir los resultados después de la incorporación del procedimiento totalmente laparoscópico en nuestra institución. Métodos. Se hizo un análisis retrospectivo de las características de los pacientes llevados a nefrectomía para obtención de injerto por técnica totalmente laparoscópica y los resultados en un solo centro en Cali, Colombia, desde noviembre de 2019 hasta octubre de 2022. Los datos fueron obtenidos mediante la revisión de las historias clínicas electrónicas. Resultados. Se realizaron 78 nefrectomías para obtención de injerto con técnica totalmente laparoscópica. El tiempo operatorio promedio fue de 152 minutos, el sangrado promedio fue de 12 ml, la estancia hospitalaria promedio del donante fue de 2,8 días. La tasa de complicaciones fue de 7,6 % (4 pacientes con complicación Clavien-Dindo I y 2 pacientes Clavien-Dindo IIIb). No se presentó ningún caso de mortalidad. Conclusiones. La técnica totalmente laparoscópica resulta ser una técnica segura con baja tasa de morbilidad y excelentes beneficios para los donantes.

Introduction. Kidney transplant is the best treatment option for end-stage renal disease. However, the discrepancy between waiting lists and the availability of organs from cadaveric donation is well known. Organ transplantation with a living donor was implemented to increase the number of organs available. Since the introduction of minimally invasive techniques for nephrectomy, living donors have achieved figures close to 50% of transplants performed in many institutions due to the procedure's benefits. In our country, the experiences described are from the hand-assisted technique. This is the first description after incorporating the laparoscopic procedure. Methods. A retrospective analysis of the characteristics and results of all patients undergoing nephrectomy to obtain a graft using a laparoscopic technique was carried at a single center in Cali, Colombia, from November 2019 to October 2022. The electronic medical records were reviewed to obtain the data. Results. Seventy-eight nephrectomies were performed to obtain a graft with a laparoscopic technique. The mean operating time was 152 minutes, the average bleeding was 12 cc, and the average hospital stay was 2.8 days. The complication rate was 7.6% (four patients with Clavien-Dindo I complication and two Clavien-Dindo IIIb patients). There were no cases of mortality. Conclusions. The laparoscopic technique is safe, with a low morbidity rate and excellent benefits.

Prevalencia de Complicaciones clínicas y quirúrgicas en el postrasplante renal inmediato y su impacto a corto plazo en la función renal / Prevalence of clinical and surgical complications in immediate post-renal transplantation and their short-term impact on renal function

INTRODUCCIÓN. La enfermedad renal crónica es definida como la pérdida progresiva, permanente e irreversible de la función renal, uno de los tratamientos es el trasplante renal el mismo que aumenta la calidad de vida de los pacientes que presentan esta patología, sin embargo, a pesar de ser uno de las mejores terapias no está exento de complicaciones especialmente las que se presentan posterior al acto quirúrgico ya que afectan al buen funcionamiento del injerto y afecta la supervivencia del mismo. OBJETIVO. Determinar la prevalencia de complicaciones clínicas y quirúrgicas en el postrasplante renal inmediato con el fin de identificar las principales complicaciones que ocasionan mayor deterioro en la función renal a corto plazo. MATERIAL Y MÉTODOS. Estudio Observacional descriptivo transversal, de pacientes trasplantados que se encuentran en seguimiento desde enero del 2015 hasta diciembre del 2018 en el servicio de Trasplante renal del Hospital de Especialidades Carlos Andrade Marín. La muestra será los 211 pacientes trasplantados de donante cadavérico. Los análisis se realizaron con el paquete estadístico IBM SPSS versión 25, para lo cual se empleó estadísticas descriptivas, utilizando tablas y representando los valores absolutos y relativos de las variables cualitativas, así como medidas de tendencia central y de variabilidad para las variables cuantitativas. RESULTADOS. Se estudiaron 193 pacientes trasplantados de los cuales el 49.66% tuvieron complicaciones, de los mismos el 33.16% fueron complicaciones clínicas y 16,5% complicaciones quirúrgicas; de las clínicas la infección de tracto urinario fueron las más prevalentes con 15%, seguida por el rechazo agudo 6,7%, las infecciones por virus poliomavirus BK fueron un porcentaje de 6,2%, la necrosis tubular aguda el 3,16% terminando con el rechazo hiperagudo en el 1,5% y la toxicidad por calcineurínicos 1,04%. Mientras tanto las complicaciones quirúrgicas las urológicas son las más prevalentes 8,8% seguida por las colecciones liquidas con el 6,74% finalmente la trombosis vascular con el 1,04%. CONCLUSIONES. Las complicaciones más prevalentes son las clínicas vs las quirúrgicas, afectando de igual forma la función renal al año sin diferencia estadísticamente significativa.

INTRODUCTION. Chronic kidney disease is defined as the progressive, permanent and irreversible loss of renal function, one of the treatments is renal transplantation, which increases the quality of life of patients with this pathology, however, despite being one of the best therapies, it is not free of complications, especially those that occur after surgery, since they affect the proper functioning of the graft and affect its survival. OBJECTIVE. To determine the prevalence of clinical and surgical complications in immediate post-renal transplantation in order to identify the main complications that cause greater deterioration in short-term renal function. MATERIAL AND METHODS. Cross-sectional descriptive observational study, of transplanted patients under follow-up from January 2015 to December 2018 in the Renal Transplant service of the Hospital de Especialidades Carlos Andrade Marín. The sample will be the 211 cadaveric donor transplanted patients. The analyses were performed with the IBM SPSS version 25 statistical package, for which descriptive statistics were used, using tables and representing the absolute and relative values of qualitative variables, as well as measures of central tendency and variability for quantitative variables. RESULTS. We studied 193 transplanted patients of whom 49.66% had complications, of which 33. Of the clinical complications, urinary tract infection was the most prevalent with 15%, followed by acute rejection 6.7%, polyomavirus BK infections were 6.2%, acute tubular necrosis 3.16%, ending with hyperacute rejection in 1.5% and calcineurin toxicity 1.04%. Meanwhile, urological surgical complications are the most prevalent 8.8% followed by liquid collections with 6.74% and finally vascular thrombosis with 1.04%. CONCLUSIONS. The most prevalent complications are clinical vs. surgical, affecting renal function at one year with no statistically significant difference.

Estatística geral de doação de orgãos - Goiás - 2023 (Janeiro a abril) / General organ donation statistics - Goiás - 2023 (January to April)

Esta Estatística Geral de Doação e Transplantes de Órgãos - Goiás tem como objetivo transcrever em números os resultados de todo o trabalho executado pela Gerência de Transplantes em Goiás de janeiro a abril de 2023

This General Statistics of Organ Donation and Transplantation - Goiás aims to transcribe in numbers the results of all the work carried out by the Transplant Management in Goiás from January to April 2023

Resultados en receptores de trasplante renal de donantes cadavéricos con infección por SARS-CoV-2: Una serie de casos en un centro de trasplante en Colombia / Results in kidney transplant recipients from cadaveric donors with SARS-CoV-2 infection: A case series in a transplant center in Colombia

Introducción. La pandemia por COVID-19 ha causado la muerte de 6,5 millones de personas en el mundo y la donación de órganos se ha visto ampliamente afectada, reflejándose en una disminución importante en el número de trasplantes. Colombia no ha sido ajena a dicha problemática. Ante este desafío, el Instituto Nacional de Salud ha permitido tomar donantes cadavéricos con reacción en cadena de la polimerasa con transcripción reversa (RT-PCR) positiva para Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), sin enfermedad activa. El objetivo de este estudio fue describir una serie de pacientes trasplantados de riñón con donantes cadavéricos con RT-PCR SARS-CoV-2 positivo y sus principales desenlaces clínicos. Métodos. Serie de casos de pacientes que fueron llevados a trasplante renal con donante cadavérico con SARS-CoV-2 positivo, sin enfermedad activa, entre mayo y agosto de 2022. Se recolectaron las variables demográficas y clínicas y se evaluó la infección y la mortalidad asociada a SARS-CoV-2 en un mes de seguimiento. Resultados. Un total de 5 receptores de trasplante renal con 5 donantes cadavéricos SARS-CoV-2 positivos fueron evaluados. No se presentó mortalidad ni pérdida del injerto renal. Se registraron dos casos de función retardada del injerto y un caso de rechazo agudo. Ninguno de los pacientes presentó RT-PCR SARS-CoV-2 positiva en el seguimiento posterior al trasplante. Conclusión. Con nuestra serie de casos mostramos que el trasplante de riñón proveniente de donante cadavérico con prueba positiva para RT-PCR SARS-CoV-2, sin evidencia de enfermedad COVID-19 activa, es un procedimiento seguro y una estrategia eficaz para aumentar el número de donantes en pandemia

Introduction. Coronavirus Disease-2019 (COVID-19) pandemic have caused the death of 6.5 million of people worldwide. The organ donation was extremely affected reflecting in the number of transplants. Colombia has not been immune to this problem. Facing this challenge, the National Institute of Health (Instituto Nacional de Salud, INS) allowed to assign cadaveric donors with reverse transcription-polymerase chain reaction (RT-PCR) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive without COVID-19. We aim to describe a case series of kidney transplant patients with RT-PCR SARS-CoV-2 positive cadaveric donors, and their main clinical outcomes. Methods. A case series of five patients who underwent kidney transplantation of cadaveric donors with positive RT-PCR SARS-CoV-2 during the study period from May to august of 2022. Demographics and clinical characteristics were collected from the institutional medical records, and we evaluated the mortality and infection associated with SARS-CoV-2. Results. A total of five kidney transplant recipients and five cadaveric donors with positive RT-PCR SARS-CoV-2 were described in the present study. There were not mortality reported and none of the patients had graft loss. Two cases of delayed graft function and one case of acute kidney rejection were documented. None of the patients had positive RT-PCR SARS-CoV-2 in the follow-up. Conclusion. Our series demonstrated that the kidney transplant of cadaveric donors with positive RT-PCR SARS-CoV-2 without clinical evidence of active COVID-19 disease is a safe procedure and an efficient strategy to increase donors during a pandemic

Medical and non-medical factors that influence the kidney transplantation technical registry: a cross-sectional study / Fatores clínicos e não clínicos que influenciam o cadastro técnico para transplante renal: estudo transversa

INTRODUCTION: Chronic kidney disease is a worldwide public health problem, because of its association with an elevated risk of mortality, low quality of life, and prohibitive cost to the health system. OBJECTIVE: To identify the factors that might influence the kidney transplantation technical registry. METHODS: Cross-sectional study of descriptive analysis conducted in six dialysis health care centers in the south of Rio Grande do Sul, Brazil. Patients over 18 years of age were included in this study in 2016 and 2017. The demographic and clinical variables were subjected to Pearson's chi-square test using Stata Software for statistical analysis. Research approved by the Ethics Committee 1386385. RESULTS: Of 314 participants, 228 (72.6%) were not on the kidney transplantation technical registry. The medical and non-medical factors with statistical significance were age (p<0.01), income (p<0.01), having children (p=0.01), time since diagnosis (p=0.01), and time on hemodialysis (p=0.01). CONCLUSION: There is a substantial proportion of 72.6% of hemodialysis patients not registered on the kidney transplantation technical registry. The identification of factors that influence the kidney transplantation technical registry contributes both theoretically and to healthcare management, by the health team and government who can direct strategies towards the most appropriate health care. Health professionals should be aware of the impact of these factors and how the factors might pose a risk of complications that make it impossible to register on the kidney transplantation waiting list.

INTRODUÇÃO: A doença renal crônica é um problema de saúde pública mundial, pois está associada ao alto risco de mortalidade, baixa qualidade de vida e elevado custo ao sistema de saúde. OBJETIVO: Identificar os possíveis fatores que podem influenciar o acesso ao cadastro técnico para transplante renal. MÉTODO: Estudo transversal de análise descritiva realizado em seis serviços de diálise da Metade Sul do Rio Grande do Sul, Brasil. Participaram desse estudo pacientes maiores de 18 anos nos anos de 2016 e 2017. As variáveis demográficas e clínicas foram submetidas ao teste qui-quadrado de Pearson utilizando o Software Stata para a análise estatística. Pesquisa aprovada pelo Comitê de Ética 1.386385. RESULTADOS: dos 314 pacientes em hemodiálise 228 (72,6%) não estavam no cadastro técnico para transplante renal. Os fatores clínicos e não clínicos que apresentaram significância estatística foram: idade (p<0,01), renda (p<0,01) possuir filhos (p=0,01), tempo de diagnóstico (p=0,01) e tempo em hemodiálise (p=0,01). CONCLUSÃO: Há uma proporção substancial de 72,6% pacientes em hemodiálise que não estão no cadastro técnico para transplante renal. A identificação dos fatores que influenciam no cadastro contribui tanto gerencial quanto teoricamente pois, possibilita que a equipe de saúde e os gestores possam direcionar estratégias para o cuidado em saúde mais adequado. Os profissionais de saúde devem estar cientes do impacto que esses fatores exercem e que podem oferecer risco de complicações que inviabilizem o cadastro técnico para transplante renal.

Protocolos de atención quirúrgica en el donante vivo y el receptor de trasplante renal / Surgical care protocols in the living donor and kidney transplant recipient

En El Salvador las enfermedades crónicas no transmisibles se han incrementado progresivamente en las últimas décadas, actualmente ocupan un lugar relevante en la ocurrencia de morbilidad y mortalidad en la población. El aparecimiento de nuevos casos, sumado a la alta cifra de los ya existentes, ha producido un incremento en la demanda de servicios de salud, tanto de atenciones ambulatorias, como de hospitalizaciones. Como parte esencial de este esfuerzo y con participación de especialistas del MINSAL y del ISSS, se han actualizado los protocolos médicos para el trasplante de riñón que fueron elaborados en el año 2019. EL presente documento contiene la inclusión de nuevos criterios, con los que se ha actualizado el contenido técnico, en relación con los procedimientos médicos que regirán la realización de los procesos de trasplante renal en la red de hospitales del SNIS, involucrados en la donación y trasplante con donantes vivos y que proporcionarán a pacientes que los reciban, la oportunidad de una mejor calidad de vida

In El Salvador, chronic noncommunicable diseases have increased progressively in recent decades, currently occupying a relevant place in the occurrence of morbidity and mortality in the population. The appearance of new cases, added to the high number of existing ones, has produced an increase in the demand for health services, both for outpatient care and hospitalizations. As an essential part of this effort and with the participation of MINSAL and ISSS specialists, the medical protocols for kidney transplantation that were prepared in 2019 have been updated. This document contains the inclusion of new criteria, with which has updated the technical content, in relation to the medical procedures that will govern the performance of kidney transplant processes in the SNIS network of hospitals, involved in donation and transplantation with living donors and that will provide patients who receive them, the opportunity of a better quality of life

Estado nutricional de pacientes submetidos ao transplante renal / Nutritional status of patients submitted to kidney transplantation

No período de pós Transplante Renal (TxR) o uso de imunossupressores é indicado. Seu uso crônico se associa a alterações endocrinometabólicas e do estado nutricional. Objetivo: Avaliar o estado nutricional de pacientes com Doenças Renais Crônicas (DRC) submetidos ao transplante renal. Método: Trata-se de um estudo transversal, realizado com pessoas que vivem com a DRC, submetidas ao TxR, no período mínimo de 6 (seis) meses. Coletou-se dados socioeconômicos, demográficos, antecedentes clínicos e antropométricos. Feita análise estatística dos dados e determinada a média e desvio padrão das variáveis numéricas. Verificou-se a normalidade dos dados pelo teste de Shapiro Wilk. Para variáveis não-paramétricas, foi aplicado teste de U-Mann-Whitney. Para variáveis categóricas, foi realizada análise descritiva. A comparação foi feita por Qui-quadrado de Pearson ou teste Exato de Fisher. Foi adotado p<0,05. Resultados: Ao avaliar 52 pacientes observou-se interação significativa entre o sexo feminino e o ganho de peso (p=0,02). A eutrofia foi prevalente segundo o Índice de massa corporal IMC (48,08%), entretanto, a adequação da CB, CMB e AMBC apontou relevantes percentuais de desnutrição. Aumento da incidência de diabetes (5,77% vs 30,77%) e de dislipidemia (3,85% vs 17,31%) no período pós TxR. Conclusão: O ganho de peso se associou significativamente ao sexo feminino. Verificou-se que mesmo diante da prevalência de eutrofia ao avaliar o IMC, a desnutrição foi presente ao se classificar as adequações das circunferências corporais

In the period after Renal Transplantation (KTx) the use of immunosuppressants is indicated, their chronic use is associated with endocrine-metabolic alterations and nutritional status. Objective: Evaluate the nutritional status of patients with Chronic Kidney Diseases (CKD) after kidney transplantation. Method: This is a cross-sectional study, carried out with people living with CKD, submitted to KTx, for a minimum period of 6 (six) months. Data on socioeconomic, demographic, clinical and anthropometric background were collected. Statistical analysis of the data was performed and the mean and standard deviation of numerical variables were determined. Data normality was verified by the Shapiro Wilk test. For non-parametric variables, U-Mann-Whitney´s test was applied. For categorical variables, descriptive analysis was performed. Comparison was performed using Pearson's chi-square or Fisher's test. The results were discussed at the 5% level of significance. Results: When assessing 52 patients, a significant interaction was observed between female gender and weight gain. (p=0,02). Eutrophy was prevalent according to BMI(48,08%) However, the adequacy of the MAC, MAMC and AMA presented relevant percentages of malnutrition. Increased incidence of diabetes (5,77% vs 30,77%) and dyslipidemia (3,85% vs 17,31%) in the period after KTx. Conclusion: The weight gain was significantly associated with female gender. It was found that even in the face of the prevalence of eutrophy when assessing BMI, malnutrition was present when classifying the adequacy of body circumferences

Prevalência de síndrome metabólica em pacientes pós-transplante renal / Prevalence of metabolic syndrome in post-kidney transplantation patients

O desenvolvimento da síndrome metabólica após o transplante renal (TxR) é evidenciado na literatura e se caracteriza por alterações que conferem a redução da função do enxerto. Objetivo: O objetivo deste trabalho é descrever a prevalência da síndrome metabólica e identificar variáveis que se associam à síndrome metabólica em receptores de TxR tardio. Metodologia: Trata-se de um estudo transversal analítico realizado com pacientes receptores de TxR. Foram incluídos participantes com idade superior ou igual a 18 anos, receptores de TxR tardio em acompanhamento superior a 6 meses. A análise descritiva dos dados foi expressa por médias, desvio padrão, medianas e percentuais. A normalidade dos dados foi verificada pelo teste de Shapiro-Wilk ao nível de 5% de significância. Aplicou-se o teste de comparação de médias para duas amostras independentes, teste t de Student. Foi utilizado o teste de correlação de Pearson para avaliar as possíveis relações existentes entre a variável tempo pós TxR com as outras variáveis de interesse. Resultados: Ao avaliar 43 pacientes com idade média de 50,9 ± 9,8 anos, notou-se que a síndrome metabólica esteve presente em 53,85% dos voluntários e que se associou ao peso prévio (p= 0,018), concentrações séricas de triglicerídeos (p= 0,001), menores médias de HDL (p= 0,053) e, também, foi verificada uma associação marginal com a circunferência da cintura (p= 0,051). A SM foi prevalente no período pós TxR. Ainda, as maiores médias de peso prévio ao TxR, de circunferência da cintura, de triglicerídeos e as menores médias de HDL se associaram à SM

The onset of metabolic syndrome (MS) after kidney transplantation (KTx) is evidenced in the literature and this is characterized by alterations that confer a reduction in the function of the transplantation. Objective: The aim of this research is to describe the prevalence of the metabolic syndrome and to identify the variables that are associated with the metabolic syndrome in recipients of belated KTx. Methods: This is an analytical cross-sectional study carried out with patients receiving KTx. Participants aged 18 years or older, recipients of late KTx with follow-up longer than 6 months, were included. The descriptive analysis of the data was expressed as means, standard deviation, medians and percentages. Data normality was verified using the Shapiro-Wilk test at a 5% significance level. The mean comparison test was applied for two independent samples, Student's t test. Pearson's correlation test was used to assess possible association between the variable time after KTx and the other variables of interest. Results: Forty-three patients with a mean age of 50.9 ± 9.8 years were evaluated and metabolic syndrome was present in 53.85% of the volunteers. There was an association with previous weight (p= 0.018), serum triglyceride concentrations (p= 0.001) and lower HDL means (p= 0.053) and and a marginal association with waist circumference (p=0,0051). MS was prevalent in the post-KTx period. Furthermore, the highest means of weight prior to KTx, waist circumference, TG and the lowest means of HDL were associated with MS

Resultados de la anestesia total intra venosa (TIVA) con perfusión controlada por objetivo (TCI) en pacientes sometidos a trasplante renal / Outcomes of Total Intravenous Anesthesia (TIVA) with Goal Controlled Perfusion (TCI) in Kidney Transplant Patients

Introducción: La anestesia total intravenosa (TIVA) con perfusión controlada por objetivo (TCI) es una técnica de anestesia general que usa una combinación de fármacos administrados exclusivamente por vía intravenosa sin usar fármacos por vía inhalatoria. Objetivos: Determinar los resultados del uso de TIVA TCI en los pacientes sometidos a trasplante renal, donantes y receptores, entre noviembre de 2014 y julio de 2018, en el Hospital de Clínicas. Pacientes y métodos: Estudio observacional, analítico transversal, con muestreo no probabilístico a criterio. La serie se agrupó en donantes y receptores. Los datos se expresan en medias y proporciones, se analizó el Odds Rattio y el R2. Se consideró una p< 0,05 como significativa. Resultados: se incluyeron a 198 intervenciones anestésicas, 131 (66,2%) fueron receptores. El rango de edad fue de entre 5 y 66 años (35,8±13 años) y 114 (57%) fueron masculinos. En el post operatorio inmediato, el tiempo en despertar, la PAS, PAD, PAM, frecuencia cardiaca y saturación de oxígeno no tuvieron diferencias significativas, en la comparación de los grupos (donante y receptor). Se observó cefalea en 3 (1,5%) del grupo de donantes y ninguna en los receptores. La diuresis fue tardía en 18 (9,1%) pacientes (p= 0,084 R2=29). Conclusión: La TIVA TCI demostró ser una técnica muy efectiva en el trasplante renal, con pronta recuperación y despertar inmediato tras la extubación, con lucidez absoluta en todos los pacientes.

Introduction: Total intravenous anesthesia (TIVA) with goal-controlled perfusion (TCI) is a general anesthesia technique that uses a combination of drugs administered exclusively intravenously without using inhalational drugs. Objectives: To determine the results of the use of TIVA TCI in kidney transplant patients, donors and recipients, between November 2014 and July 2018, at the Hospital de Clínicas. Patients and methods: Observational, cross-sectional analytical study, with non-probabilistic sampling at the discretion. The series was grouped into donors and recipients. The data is expressed in means and proportions, the Odds Rattio and the R2 were analyzed. A p<0.05 was considered significant. Results: 198 anesthetic interventions were included, 131 (66.2%) were recipients. The age range was between 5 and 66 years (35.8±13 years) and 114 (57%) were male. In the immediate postoperative period, time to awakening, SBP, DBP, MAP, heart rate and oxygen saturation did not show significant differences when comparing the groups (donor and recipient). Headache was observed in 3 (1.5%) of the donor group and none in the recipients. Diuresis was late in 18 (9.1%) patients (p= 0.084 R2=29). Conclusion: TIVA TCI proved to be a very effective technique in kidney transplantation, with prompt recovery and immediate awakening after extubation, with absolute clarity in all patients.

Fatores associados à adesão a terapia imunossupressora em indivíduos transplantados renais / Factors associated with adherence to immunosuppressive therapy in renal transplant recipients / Factores asociados a la adherencia a la terapia inmunosupresora en receptores de trasplante renal

Objetivo: Analisar os fatores associados à adesão a terapia imunossupressora em indivíduos transplantados renais. Métodos: Trata-se de estudo de corte transversal, com indivíduos transplantados renais em acompanhamento ambulatorial, na cidade do Recife, Nordeste do Brasil. Utilizou-se a Assessment of Adherence with Immunosuppressive Medication Scale para avaliar a adesão aos imunossupressores. Resultados: Em 147 transplantados renais, foi observada uma prevalência de mulheres (51,70%) com baixa escolaridade e baixo nível socioeconômico (60,54%). A amostra foi composta, em sua maioria, por receptores de enxerto renal proveniente de doador cadáver (50,34%), com tempo de espera para o transplante de até 48 meses (62,59%). A taxa de adesão dos participantes foi de 56,42%, e esteve associada ao tempo médio pós-transplante (p=0,033), com maior índice naqueles com menos de 5 anos de transplante renal. Os fatores associados a não adesão foram atrasos e esquecimentos. Conclusão: Considerando a necessidade de ampliar a taxa de adesão, é fundamental considerar o tempo de transplante renal no planejamento das ações. Além disso, é preciso utilizar estratégias que auxiliem na manutenção da tomada dos imunossupressores conforme prescrição médica a fim de contribuir para a manutenção do enxerto renal. (AU)

Objective: To analyze the factors associated with adherence to immunosuppressive therapy in kidney transplant patients. Methods: This is a cross-sectional study, with kidney transplant patients undergoing outpatient follow-up, in the city of Recife, Northeast Brazil. The Assessment of Adherence with Immunosuppressive Medication Scale was used to assess adherence to immunosuppressants. Results: In 147 kidney transplant recipients, there was a prevalence of women (51,70%), with low education and low socioeconomic status (60,54%). The sample consisted, mostly, of kidney graft recipients from cadaver donors (50,34%), with a waiting time for transplantation of up to 48 months (62,59%). The adherence rate of the participants was 56.42%, and was associated with the average post-transplant time (p = 0.033), with a higher rate in those with less than 5 years of kidney transplantation. The factors associated with non-adherence were delays and forgetfulness. Conclusion: Considering the need to increase the adherence rate, it is essential to consider the time of kidney transplantation when planning actions. In addition, it is necessary to use strategies that assist in maintaining the intake of immunosuppressants according to medical prescription in order to contribute to the maintenance of the renal graft. (AU)

Objetivo: Analizar los factores asociados a la adherencia a la terapia inmunosupresora en receptores de trasplante renal. Métodos: Se trata de un estudio transversal con pacientes con trasplante renal en seguimiento ambulatorio, en la ciudad de Recife, noreste de Brasil. Se utilizó la Assessment of Adherence with Immunosuppressive Medication Scale para evaluar la adherencia a los inmunosupresores. Resultados: En 147 receptores de trasplante renal, hubo una prevalencia de mujeres (51,70%), con bajo nivel educativo y nivel socioeconómico bajo (60,54%). La muestra estuvo compuesta, mayoritariamente, por receptores de injerto renal de donante cadáver (50,34%), con un tiempo de espera para el trasplante de hasta 48 meses (62,59%). La tasa de adherencia de los participantes fue del 56,42% y se asoció con el tiempo medio pos trasplante (p = 0,033), con una tasa mayor en aquellos con menos de 5 años de trasplante renal. Los factores asociados a la no adherencia fueron los retrasos y el olvido. Conclusión: Considerando la necesidad de incrementar la tasa de adherencia, es fundamental considerar el momento del trasplante renal a la hora de planificar acciones. Además, es necesario utilizar estrategias que ayuden a mantener la ingesta de inmunosupresores según prescripción médica para contribuir al mantenimiento del injerto renal. (AU)

Direct costs associated with lupus nephritis management in the Private Healthcare System in Brazil: an expert panel perspective / Custos diretos associados ao manejo da nefrite lúpica no Sistema de Saúde Privado no Brasil: uma perspectiva segundo painel de especialistas

Objective: To estimate direct medical costs of lupus nephritis (LN) in the Brazilian private healthcare system. Methods: An expert panel of five specialists were convened to discuss health resource usage in LN patient management. The discussion included diagnosis, treatment, and disease monitoring, including dialysis and kidney transplantation. Unit costs (in BRL) were obtained from public sources, and an estimation of 1-year costs was conducted. Results: Approximately 76.0% of patients with LN undergo kidney biopsy, of which 48.1% present with LN classes III­IV and 21.4% have class V. Around 67.5% of patients with LN classes III­IV experience an average of four renal flares annually. Overall, 20.3% of patients present refractory LN, and 10.3% have end-stage kidney disease (ESKD), requiring dialysis and kidney transplantation. Estimated total weighted annual costs per patient were BRL 115,824.81 for LN classes III­IV, BRL 85,684.79 for LN class V, BRL 115,594.98 for refractory LN; and BRL 325,712.88 for ESKD. The main annual cost driver for LN classes III­IV was renal flares (BRL 60,240.41; 52.0%) and dialysis for LN class V (BRL 31,128.38; 36.3%). Conclusions: Total direct costs increase when LN progresses to ESKD. Although it is challenging to improve the diagnosis, identification of the disease at an early stage, together with rapid initiation of treatment, are fundamental elements to optimize results, potentially reducing costs to the system and the impact of disease burden and quality of life on patients.

Objetivo: Estimar os custos médicos diretos da nefrite lúpica (NL) no sistema suplementar de saúde brasileiro. Métodos: Um painel de cinco especialistas foi estruturado para discutir o uso de recursos em saúde no manejo de pacientes com NL. Nesta discussão, incluíram-se o diagnóstico, o tratamento e o monitoramento da doença, contemplando também diálise e transplante renal. Os custos unitários foram obtidos de fontes públicas e os resultados expressos em custo anual. Resultados: Aproximadamente 76,0% dos pacientes com NL são submetidos à biópsia renal, sendo 48,1% com NL de classes III-IV e 21,4% de classe V. Cerca de 67,5% dos pacientes com classes III-IV apresentam, aproximadamente, quatro flares renais anuais. No geral, 20,3% dos pacientes apresentam NL refratária e 10,3% desenvolvem doença renal terminal (DRT), necessitando de diálise e transplante renal. O custo ponderado anual estimado por paciente foi de R$ 115.824,81 para NL de classes III-IV, R$ 85.684,79 para classe V, R$ 115.594,98 para NL refratária e R$ 325.712,88 para DRT. O principal fator para incremento dos custos anuais para NL de classes III-IV foram os flares renais (R$ 60.240,41; 52,0%) e, na classe V, a diálise (R$ 31.128,38; 36,3%). Conclusões: Há um incremento dos custos diretos da NL na progressão para DRT. Embora seja desafiador melhorar o diagnóstico, a identificação da doença em uma fase precoce, aliada ao tratamento iniciado de forma célere, são elementos fundamentais para otimizar os resultados, potencialmente reduzindo os custos ao sistema e o impacto da carga da doença e qualidade de vida dos pacientes.

Effects of Plasma-Lyte® and 0. 9% saline in renal function after deceased-donor kidney transplant: a randomized controlled trial

Abstract Background The influence of different crystalloid solutions infused during deceased-donor kidney transplant on the incidence of delayed graft function remains unclear. We investigated the influence of Plasma-Lyte® vs. 0.9% saline on the incidence of delayed graft function in deceased-donor kidney transplant recipients. Methods We conducted a single-blind randomized controlled trial of 104 patients aged 18 to 65 years who underwent deceased-donor kidney transplant under general anesthesia. Patients were randomly assigned to receive either Plasma-Lyte® (n = 52) or 0.9% saline (n = 52), at the same infusion volume, for intraoperative fluid replacement. The primary outcome was the occurrence of delayed graft function. Secondary outcomes included metabolic and electrolytic changes at the end of surgery. Results Two patients in the Plasma-Lyte® group and one in the 0.9% saline group died postoperatively and were not included for analysis. The incidence of delayed graft function in Plasma-Lyte® and 0.9% saline groups were 60.0% (95% Confidence Interval [95% CI 46.2-72.4]) and 74.5% (95% CI 61.1-84.4), respectively (p= 0.140). Mean (standard deviation) values of immediate postoperative pH and serum chloride levels in Plasma-Lyte® and 0.9% saline groups were 7.306 (0.071) and 7.273 (0.061) (p= 0.013), and 99.6 (4.2) mEq.L-1 and 103.3 (5.6) mEq.L-1, respectively (p< 0.001). All other postoperative metabolic and electrolyte variables were not statistically different at the immediate postoperative period (p> 0.05). Conclusion In deceased-donor kidney transplant recipients, the incidence of delayed graft function is not influenced by Plasma-Lyte® or 0.9% saline used for intraoperative fluid replacement.

Approach and anesthetic management for kidney transplantation in a patient with bilateral lung transplantation: case report

Abstract Lung transplantation is the last resort for end-stage lung disease treatment. Due to increased survival, lung recipients present an increased likelihood to be submitted to anesthesia and surgery. This case report describes a 23-year-old female patient with history of lung transplantation for cystic fibrosis, with multiple complications, and chronic kidney disease, and who underwent kidney transplantation under general anesthesia. Understanding the pathophysiology and changes related to immunosuppressive therapy is essential to anesthetic technique planning and safety, and for perioperative management. The success of both anesthesia and surgery requires a qualified multidisciplinary team due to the rarity of the clinical scenario and high incidence of associated morbidity and mortality.

Estatística geral de doação de orgãos - Goiás - 2022 (Janeiro a Outubro) / General organ donation statistics - Goiás - 2022 (january at october)

Esta Estatística Geral de Doação e Transplantes de Órgãos - Goiás tem como objetivo transcrever em números os resultados de todo o trabalho executado pela Gerência de Transplantes em Goiás de janeiro a outubro de 2022

This General Statistics of Organ Donation and Transplantation - Goiás aims to transcribe in numbers the results of all the work carried out by the Transplant Management in Goiás from January to October 2022

Aplicabilidade da teoria da incerteza da doença na lista de espera de transplante renal / Aplicabilidad de la teoría de la incertidumbre de la enfermedad en la lista de espera de trasplante renal / Applicability of the uncertainty in illness theory on patients on kidney transplant waiting lists

Objetivo: Apreender as experiências da vida cotidiana de pessoas em lista de espera de transplante renal e verificar a aplicabilidade da Teoria da Incerteza da Doença nesse contexto. Método: Pesquisa exploratória, descritiva de abordagem qualitativa, interpretada à luz da Teoria da Incerteza da Doença, de Merle Mishel. Resultados: Emergiram, da análise do conteúdo das entrevistas de oito pacientes, dois eixos significativos, denominados Aspectos internos do ajustamento à condição da doença e Aspectos externos do ajustamento à condição da doença que abrangem as categorias nomeadas de adaptação, enfrentamento, fornecedores de estrutura, quadro de estímulos e nova perspectiva de vida. Conclusão: O estudo possibilitou aprender os sentimentos preponderantes nas vivências das pessoas em lista de espera de transplante, as relações interpessoais com os familiares e equipe de saúde, o enfrentamento da doença e a esperança de um órgão compatível, assim como a aplicabilidade da Teoria no contexto do transplante renal.

Purpose: To understand the daily experiences of people on a kidney transplant waiting list and to verify the applicability of the Uncertainty in Illness Theory in this context. Method: An exploratory, descriptive, and qualitative research, based on Merle Mishel's Theory of Uncertainty in Illness. Results: From the analysis of interviews with eight patients, two significant axes emerged: a) Internal aspects of adjustment to the condition of the disease; and b) External aspects of adjustment to the condition of the disease. These axes cover the categories "adaptation", "coping", "structure providers", "stimulus board" and "new life perspectives". Conclusion: The study made it possible to understand the predominant feelings of people on a transplant waiting list, in addition to learning about their interpersonal relationships with family members and the health team, their coping with the disease, and their hope for a compatible organ. It was also possible to understand the applicability of the Theory in the context of a kidney transplant.

Objetivo: Conocer las vivencias de la vida diaria de las personas en lista de espera de trasplante renal y verificar la aplicabilidad de la Teoría de la Incertidumbre de la Enfermedad en este contexto. Método: Investigación cualitativa descriptiva exploratoria, interpretada a la luz de la Teoría de la Incertidumbre de la Enfermedad de Merle Mishel. Resultados: Del análisis del contenido de las entrevistas de ocho pacientes surgieron dos ejes significativos denominados Aspectos internos de ajuste a la condición de la enfermedad y Aspectos externos de ajuste a la condición de la enfermedad, que abarcan las categorías denominadas adaptación, afrontamiento, proveedores de estructura, relación de estímulos y nueva perspectiva de vida. Conclusión: El estudio permitió conocer los sentimientos predominantes en las vivencias de las personas en lista de espera de trasplante, las relaciones interpersonales con los familiares y el equipo médico, el afrontamiento de la enfermedad y la esperanza de un órgano compatible, así como la aplicabilidad de la Teoría en el contexto del trasplante de riñón.

Supervivencia de pacientes trasplantados en relación con la compatibilidad inmunológica / Survival of transplant patients in relation to immunological compatibility

Introducción: El trasplante renal es uno de los métodos de sustitución de la función renal y tiene como factor de mayor influencia en su supervivencia, la compatibilidad inmunológica del sistema mayor. Objetivos: Definir la supervivencia del trasplante y su relación con el grado de compatibilidad. Métodos: Se realizó un estudio retrospectivo sobre el tiempo de supervivencia con base hospitalaria de los 512 trasplantes en el período comprendido entre los años 1993 y 2010, ambos incluidos con seguimiento y corte al concluir el año 2019. Se empleó el Kaplan Meier para calcular las supervivencias, se utilizó el paquete estadístico Statiscal Package Social Science (Spss) versión 22.0. Resultados: 397 pacientes recibieron riñones cadavéricos al momento del corte, 11,3 por ciento de los injertos estaban funcionando, mientras que para los 115 que recibieron de vivo, el 45,2 por ciento, p=0,000. La mediana de supervivencia para el cadavérico fue de 3,1 años (SD 2,4-3,8) y dentro de ellos los que compartieron tres o más antígenos lograron el doble de sobrevida, p=0,033. Para el de donante vivo, la mediana fue de 16,0 años (SD 9,1-22,9) y dentro de este grupo 104 pacientes que compartían un haplotipo lograron 44,2 por ciento de función, los hermanos que eran idénticos un 66,0 por ciento. Por parentesco los que recibieron riñones de hermanos tienen mejor supervivencias que de padres a hijos, p=0,001. Conclusiones: Se definió que la compatibilidad inmunológica del sistema mayor entre donante y receptor propicia diferencias en la función de los injertos(AU)

Introduction: Renal transplantation is one of the methods of renal function substitution and the main factor influencing survival is the immunological compatibility of the major system. Objectives: To define transplant survival and the relationship with the degree of compatibility. Methods: A retrospective study was carried out on the hospital-based survival time of 512 transplants from 1993 to 2010, including follow-up and the cut at the end of 2019. The Kaplan-Meier estimator was used to calculate the survivals, the statistical package Statistical Package Social Science (Spss) version 22.0 was used. Results: Three hundred ninety seven (397) patients received cadaveric kidneys at the cut, 11.3percent of the grafts were functioning, 115 received living grafts, 45.2percent p=0.000. The median survival for the cadaveric kidneys was 3.1 years (SD 2.4-3.8) and among them those who shared three or more antigens achieved twice the survival, p=0.033. For the living donor, the median was 16.0 years (SD 9.1-22.9) and within this group, 104 patients, sharing a haplotype, achieved 44.2percent function, siblings, who were identical, achieved 66 .0percent. By kinship, those who received kidneys from siblings have better survival than for those who received it from parents, p=0.001. Conclusions: Immunological compatibility of the major system between donor and recipient was defined to favor differences in the function of the grafts(AU)

Análise de custo-efetividade do uso de inibidores da via de sinalização mTOR x micofenolato em receptores de transplante renal sem profilaxia para citomegalovírus s / Cost-effectiveness analysis of the use of mTOR signaling pathway inhibitors x mycophenolate in kidney transplantation recipients without cytomegalovirus prophylaxis

Objetivo: Avaliar a relação de custo-efetividade dos regimes imunossupressores utilizados em pacientes receptores de transplante renal, no Hospital Santa Casa de Misericórdia de Juiz de Fora, MG, basiliximabe, micofenolato de sódio, tacrolimo e prednisona (Grupo 1 = 93 pacientes), comparados com a associação de timoglobulina, everolimo, tacrolimo e prednisona (Grupo 2 = 91 pacientes). Métodos: Para a análise farmacoeconômica, foi utilizado o modelo de Árvore de Decisão, desenvolvido no software Treeage Suite 2011. Foi considerada uma coorte real de pacientes submetidos ao transplante renal entre janeiro de 2013 e março de 2017, os quais foram acompanhados por um período de um ano, sendo mensurados os benefícios clínicos, bem como os custos associados, na perspectiva do Sistema Único de Saúde. O método de custeio utilizado foi o botton-up. Foram adotados os limiares de custo-efetividade (LCEs) equivalentes a 1 PIB per capita e 1 a 3 PIB, considerando o ano de 2017. Resultados: No que diz respeito à sobrevida, a RCEI foi de cerca de R$ 214.234,12 para 1 ano de vida ganho. Em relação aos eventos adversos, a RCEI foi de cerca de R$ 43.682,98 para 1 ano sem incidência de eventos adversos. Conclusões: Ao avaliar a sobrevida e a incidência de eventos adversos, timoglobulina+everolimo não é considerado custo-efetivo em relação ao esquema contendo basiliximabe+micofenolato de sódio diante do LCE de 1 PIB per capita. No entanto, ao adotarmos o LCE até 3 PIB per capita, o regime contendo moglobulina+everolimo é custo-efetivo, ultrapassando cerca de 38% do PIB per capita.

Objective: Evaluate the cost-effectiveness of immunosuppressive regimens used in kidney transplant recipients at the Santa Casa de Misericórdia, Hospital in Juiz de Fora, MG, compared with basiliximab, mycophenolate sodium, tacrolimus and prednisone (Group 1 = 93 patients) with the association of thymoglobulin, everolimus, tacrolimus and prednisone (Group 2 = 91 patients). Methods: For the pharmacoeconomic analysis, the Decision Tree model was used, developed in the TreeAge Suite 2011 software. A real cohort of patients undergoing kidney transplantation between January 2013 and March 2017 was considered, they were followed up for a period of 1 year, where the clinical benefits were measured, as well as the associated costs, from the perspective

Management strategies for implementing a multicenter cross-sectional study: lessons from the ADHERE Brazil study

ABSTRACT BACKGROUND: Epidemiological studies involving large samples usually face financial and operational challenges. OBJECTIVES: To describe the planning and execution of ADHERE Brazil, an epidemiological study on 1,105 kidney transplant patients, and report on how the study was structured, difficulties faced and solutions found. DESIGN AND SETTING: Cross-sectional multicenter study in 20 Brazilian kidney transplantation centers. METHODS: Actions developed in each phase of implementation were described, with emphasis on innovations used within the logistics of this study, aimed at estimating the prevalence of nonadherence to treatment. RESULTS: Coordination of activities was divided into four areas: general, regulatory, data collection and statistics. Weekly meetings were held for action planning. The general coordination team was in charge of project elaboration, choice of participating centers, definition of publication policy and monitoring other coordination teams. The regulatory team provided support to centers for submitting the project to ethics committees. The data collection team prepared a manual on the electronic collection system, scheduled web meetings and was available to respond to queries. It also monitored the data quality and reported any inadequacies found. Communication with the centers was through monthly reports via e-mail and distribution of exclusive material. The statistical team acted in all phases of the study, especially in creating the data analysis plan and data bank, generation of randomization lists and data extraction. CONCLUSIONS: Through these logistics, we collected high-quality data and built a local research infrastructure for further studies. We present supporting alternatives for conducting similar studies. CLINICAL TRIAL ANNOTATION: http://clinicaltrials.gov/ on October 10, 2013; NCT02066935.