RESUMO
INTRODUCTION@#Data on malignancy after kidney transplantation (KTX) is limited in our region, leading to challenges in the care of renal allograft recipients. We aimed to examine the epidemiology, risk factors and outcomes of post-KTX patients.@*METHODS@#A retrospective cohort study was conducted of 491 patients who underwent KTX from 1 January 2000 to 31 December 2011. Data linkage analysis was done between our centre and the National Registry of Diseases Office to determine the standardised incidence ratio (SIR), standardised mortality ratio (SMR) and risk factors for malignancy after KTX.@*RESULTS@#31 patients (61.3% male) developed malignancy during this period, and their median age at diagnosis was 50 (range 18-65) years. Median time to malignancy diagnosis was 2.6 (range 0.3-7.9) years, with cumulative incidence of 1%, 4% and 10% at one, five and ten years, respectively. The commonest malignancy type was lymphoma, followed by kidney cancer, colorectal cancer and malignancy of the male genital organs. Multivariate analysis identified cyclosporine use as an independent risk factor for malignancy. Compared to the general population, KTX recipients had higher malignancy and mortality rates after malignancy diagnosis (SIR 3.36; SMR 9.45). Survival rates for KTX recipients with malignancy versus those without malignancy were 100%, 93% and 64% versus 97%, 93% and 83% at one, five and ten years, respectively.@*CONCLUSION@#KTX was associated with higher mortality and incidence of malignancy. Newer immunosuppressive agents and induction therapies were not found to be risk factors for malignancy, possibly due to our relatively small sample size.
RESUMO
Background: hypertriglyceridemia, in combination with low HDL cholesterol levels, is a risk factor for cardiovascular disease. Our objective was to evaluate the efficacy of Ciprofibrate for the treatment of this form of dyslipidemia and to identify factors associated with better treatment response
Methods: multicenter, international, open-label study. Four hundred and thirty seven patients were included. The plasma lipid levels at inclusion were fasting triglyceride concentrations between 1.6 - 3.9 mM/L and HDL cholesterol ?1.05 mM/L for women and ?0.9 mM/L for men. The LDL cholesterol was below 4.2 mM/L. All patients received Ciprofibrate 100 mg/d. Efficacy and safety parameters were assessed at baseline and at the end of the treatment. The primary efficacy parameter of the study was percentage change in triglycerides from baseline
Results: after 4 months, plasma triglyceride concentrations were decreased by 44% [p <0.001]. HDL cholesterol concentrations were increased by 10% [p < 0.001]. Non-HDL cholesterol was decreased by 19%. A greater HDL cholesterol response was observed in lean patients [body mass index <25 kg/m2] compared to the rest of the population [8.2 vs 19.7%, p <0.001]. In contrast, cases with excess body weight had a larger decrease in non-HDL cholesterol levels [-20.8 vs -10.8%, p <0.001]. There were no significant complications resulting from treatment with Ciprofibrate
Conclusions: ciprofibrate is efficacious for the correction of hypertriglyceridemia/low HDL cholesterol. A greater decrease in non-HDL cholesterol was found among cases with excess body weight. The mechanism of action of Ciprofibrate may be influenced by the pathophysiology of the disorder being treated