Subject(s)
Dietary Supplements , Gitelman Syndrome/diagnosis , Gitelman Syndrome/drug therapy , Adult , Blood Chemical Analysis , Drug Therapy, Combination , Female , Genetic Predisposition to Disease , Humans , Hypotension/diagnosis , Hypotension/drug therapy , Kidney Function Tests , Magnesium/therapeutic use , Magnesium Deficiency/diagnosis , Magnesium Deficiency/drug therapy , Male , Muscle Weakness/diagnosis , Muscle Weakness/drug therapy , Pedigree , Potassium/therapeutic use , Prognosis , Risk Assessment , Severity of Illness Index , Young AdultABSTRACT
BACKGROUND: Long-term survival after heart (HTx) or lung (LuTx) transplantation increases the risk for end-stage renal disease (ESRD). After HTx ESRD was reported to enhance mortality, and kidney transplantation (KTx) was shown to improve survival. However, prognostic factors in ESRD after HTx or LuTx are largely unknown. METHODS: Single-center observational study in HTx and LuTx patients who accessed the KTx waiting list; baseline characteristics were correlated with mortality. RESULTS: KTx was performed in 15 of 65 study patients. Survival was comparable on the KTx waiting list and in reference patients from the same center without ESRD. KTx significantly improved survival (5 years' survival 84.6% with KTx vs. 56.5% on the KTx waiting list, p = 0.030). None of the baseline parameters predicted mortality in the KTx group. Only on the KTx waiting list BMI (median 24.7 vs. 20.7; p < 0.05) and left ventricular ejection fraction (LVEF, median 63 vs. 53%, p < 0.008) significantly correlated with survival. CONCLUSIONS: The risk for mortality after HTx or LuTx is not increased by ESRD, provided that patients meet access criteria for the KTx waiting list. KTx improves survival in ESRD after HTx or LuTx. BMI and LVEF may predict outcome in HTx/LuTx patients on the KTx waiting list.
Subject(s)
Heart Transplantation/adverse effects , Heart Transplantation/mortality , Kidney Transplantation/adverse effects , Kidney Transplantation/mortality , Lung Transplantation/adverse effects , Lung Transplantation/mortality , Adult , Aged , Female , Heart Transplantation/trends , Humans , Kidney Transplantation/trends , Lung Transplantation/trends , Male , Middle Aged , Risk Factors , Survival Rate/trends , Time FactorsABSTRACT
Recent data suggest valganciclovir (VGC) to be as effective as ganciclovir for cytomegalovirus (CMV) prophylaxis. The objective of this study was to analyze the effect of oral valganciclovir in renal transplant patients with symptomatic CMV infection. Twenty-one patients with symptomatic CMV infection received VGC in doses adjusted to renal function until resolution of CMV antigenemia. The patients were followed for a mean of 5.5 months. During therapy, CMV antigenemia dropped in all patients from pretreatment positive levels of 5.2 +/- 3.7 to negative values of 0.25 +/- 0.2 positive cells/10,000 PBMC (P<0.001). After cessation of therapy, none of patients developed relapse of CMV antigenemia/symptoms within the follow-up. VGC therapy was well tolerated in all patients and no major adverse effects occurred. This pilot trial showed VGC to be safe and highly effective in antiviral therapy after renal transplantation. However, subsequent multicenter clinical trials for treatment of CMV disease are necessary.
