Pre-Transplant Assessment of Vascular Calcification as a Risk Factor of Mortality, Graft Loss, and Cardiovascular Events in Renal Transplant Recipients.

BACKGROUND: Vascular calcification (VC) is known as an independent predictor of mortality in patients undergoing hemodialysis; nevertheless, there is a lack of studies about the impact of vascular calcification in renal transplant recipients, and none of them use the Kauppila Index (KI) as a predictor of patient and graft prognosis. METHODS: We conducted an observational, retrospective study of 119 renal transplants, evaluating abdominal aortic calcifications (L4-S1) with the KI. We established 2 categories: absence (KI = 0-2) and presence (KI = 3-24) of VCs before transplantation. We analyzed the impact of calcification in graft and patient survival, new-onset diabetes mellitus, hypertension, cardiovascular events, renal function, and mineral metabolism. RESULTS: VCs were observed in 50 patients (42%) before renal transplantation. Patients with VCs were older, but no statistical differences were found in the pre-transplant study between sex, diabetes, body mass index, and cardiovascular events. We found a major patient survival (limited to first 2 years after transplantation), graft survival, and death-censored graft survival in those without VCs (P = .037, P = .015, and P = .023, respectively). In line with results, a higher incidence of major cardiovascular events (MACE) and cardiovascular death was observed in the group with preexisting calcification (P = .016/P = .019). In the multivariable analysis, VCs were not an independent predictor for graft loss, death-censored graft loss, or major cardiovascular events. CONCLUSIONS: Simple evaluation of VCs with the use of the KI at the time of transplantation relates with graft and patient survival and with MACE after renal transplantation.

Gravidez heterotópica.A propósito de un caso clínico / Heterotopic pregnancy remains a difficult diagnosis and management problem

El embarazo heterotópico se define como la coexistencia de un embarazo intrauterino con un embarazo ectópico. Ocurre, aproximadamente, en 1,25 de cada 10.000 embarazos, siendo su incidencia mayor en mujeres con factores de riesgo para el embarazo ectópico. En este artículo se describe el caso clínico de un embarazo heterotópico en una mujer sin ningún factor de riesgo de embarazo ectópico, inicialmente interpretado y orientado como una situación de aborto diferido. Los clínicos deben considerar siempre la hipótesis de la existencia de un embarazo ectópico como causa de dolor abdominal, aun cuando se constate la presencia de un embarazo intrauterino. El embarazo heterotópico permanece como un problema de difícil diagnóstico y orientación clínica (AU)