Fe-Ni porphyrin/mesoporous titania thin film electrodes: a bioinspired nanoarchitecture for photoelectrocatalysis.

Porphyrin and porphyrinoid derivatives have been extensively studied in the assembly of catalysts and sensors, seeking biomimetic and bioinspired activity. In particular, Fe and Ni porphyrins can be used for the hydrogen evolution reaction (HER) and oxygen evolution reaction (OER) by immobilization of these molecular catalysts on semiconductor materials. In this study, we designed a hybrid material containing a crystalline mesoporous TiO2 thin film in which the catalytic centres are Ni-porphyrin (NiP), Fe-porphyrin (FeP), and a NiP/FeP bimetallic system to assess whether the coexistence of both metalloporphyrins improves the OER activity. The obtained photoelectrodes were physicochemically and morphologically characterized through high-resolution FE-SEM images, UV-vis and Raman spectroscopies, cyclic voltammetry, and impedance measurements. The results show a differential behavior of the mono- and bimetallic porphyrin systems, where the Fe(iii) centre in FeP may increase the acidity and lower the reduction potential of the Ni2+/3+ couple when co-deposited with NiP leading to an improved photoelectrochemical water-oxidation performance. We have validated the cooperative effect of both metal complexes within this novel system, where the µ-peroxo-bridged interaction between Fe and Ni is integrated into a supramolecular heterometallic structure of porphyrins.

Sunlight-Driven Photocatalysis for a Set of 3D Metal-Porphyrin Frameworks Based on a Planar Tetracarboxylic Ligand and Lanthanide Ions.

Metal-porphyrin frameworks (MPFs) with trivalent lanthanide ions are the most sought-after materials in the past decade. Their porosities are usually complemented by optical properties imparted by the metal nodes, making them attractive multifunctional materials. Here, we report a novel family of 3D MPFs obtained through solvothermal reactions between tetrakis(4-carboxyphenyl) porphyrin (H4TCPP) and different lanthanide sources, yielding an isostructural family of compounds along the lanthanide series: [Ln2(DMF)(TCPP)1.5] for Ln = La, Ce, Nd, Pr, Er, Y, Tb, Dy, Sm, Eu, Gd, and Tm. Photoluminescent properties of selected phases were explored at room temperature. Also, the photocatalytic performance exhibited by these compounds under sunlight exposure is promising for its implementation in organic pollutant degradation. In order to study the photocatalytic activity of Ln-TCPPs in an aqueous medium, methylene blue (MB) was used as a contaminant model. The efficiency for MB degradation was Sm > Y > Yb > Gd > Er > Eu > either no catalyst or no light, obtaining more than 70% degradation at 120 min with Sm-TCPP. These results open the possibility of using these compounds in optical and optoelectronic devices for water remediation and sensing.

Elucidating the Role of the Metal Catalyst and Oxide Support in the Ru/CeO2-Catalyzed CO2 Methanation Mechanism.

This study addresses the yet unresolved CO2 methanation mechanism on a Ru/CeO2 catalyst by means of near-ambient-pressure X-ray photoelectron spectroscopy (NAP-XPS) and diffuse reflectance infrared Fourier transform spectroscopy (DRIFTS) complemented with periodic density functional theory (DFT) calculations. NAP-XPS results show that the switch from H2 to CO2 + H2 mixture oxidizes both the Ru and CeO2 phases at low temperatures, which is explained by the CO2 adsorption modes assessed by means of DFT on each representative surface. CO2 adsorption on Ru is dissociative and moderately endergonic, leading to polybonded Ru-carbonyl groups whose hydrogenation is the rate-determining step in the overall process. Unlike on Ru metal, CO2 can be strongly adsorbed as carbonates on ceria surface oxygen sites or on the reduced ceria at oxygen vacancies as carboxylates (CO2 -δ), resulting in the reoxidation of ceria. Carboxylates can then evolve as CO, which is released either via direct splitting at relatively low temperatures or through stable formate species at higher temperatures. DRIFTS confirm the great stability of formates, whose depletion relates with CO2 conversion in the reaction cell, while carbonates remain on the surface up to higher temperatures. CO generation on ceria serves as an additional reservoir of Ru-carbonyls, cooperating to the overall CO2 methanation process. Altogether, this study highlights the noninnocent role of the ceria support in the performance of Ru/CeO2 toward CO2 methanation.

Thermocatalytic CO2 Conversion over a Nickel-Loaded Ceria Nanostructured Catalyst: A NAP-XPS Study.

Despite the increasing economic incentives and environmental advantages associated to their substitution, carbon-rich fossil fuels are expected to remain as the dominant worldwide source of energy through at least the next two decades and perhaps later. Therefore, both the control and reduction of CO2 emissions have become environmental issues of major concern and big challenges for the international scientific community. Among the proposed strategies to achieve these goals, conversion of CO2 by its reduction into high added value products, such as methane or syngas, has been widely agreed to be the most attractive from the environmental and economic points of view. In the present work, thermocatalytic reduction of CO2 with H2 was studied over a nanostructured ceria-supported nickel catalyst. Ceria nanocubes were employed as support, while the nickel phase was supported by means a surfactant-free controlled chemical precipitation method. The resulting nanocatalyst was characterized in terms of its physicochemical properties, with special attention paid to both surface basicity and reducibility. The nanocatalyst was studied during CO2 reduction by means of Near Ambient Pressure X-ray Photoelectron Spectroscopy (NAP-XPS). Two different catalytic behaviors were observed depending on the reaction temperature. At low temperature, with both Ce and Ni in an oxidized state, CH4 formation was observed, whereas at high temperature above 500 °C, the reverse water gas shift reaction became dominant, with CO and H2O being the main products. NAP-XPS was revealed as a powerful tool to study the behavior of this nanostructured catalyst under reaction conditions.

Zinc porphyrin/mesoporous titania thin film electrodes: a hybrid material nanoarchitecture for photocatalytic reduction.

In this work, photocatalytic reduction of methyl viologen is achieved using zinc tetra(4-N-methylpyridyl)porphine (ZnP) functionalized mesoporous titania thin films (MTTF). Metalloporphyrins are the core of natural systems that harvest energy from the sun. Thus, a bioinspired approach is used, taking advantage of ZnP sensitizing capabilities and MTTF organized structure.

Unexpected Optical Blue Shift in Large Colloidal Quantum Dots by Anionic Migration and Exchange.

Compositional changes taking place during the synthesis of alloyed CdSeZnS nanocrystals (NCs) allow shifting of the optical features to higher energy as the NCs grow. Under certain synthetic conditions, the effect of those changes on the surface/interface chemistry competes with and dominates over the conventional quantum confinement effect in growing NCs. These changes, identified by means of complementary advanced spectroscopic techniques such as XPS (X-ray photoelectron spectroscopy) and XAS (X-ray absorption spectroscopy), are understood in the frame of an ion migration and exchange mechanism taking place during the synthesis. Control over the synthetic routes during NC growth represents an alternative tool to tune the optical properties of colloidal quantum dots, broadening the versatility of the wet chemical methods.

Understanding and Reducing Photothermal Forces for the Fabrication of Au Nanoparticle Dimers by Optical Printing.

Optical printing holds great potential to enable the use of the vast variety of colloidal nanoparticles (NPs) in nano- and microdevices and circuits. By means of optical forces, it enables the direct assembly of NPs, one by one, onto specific positions of solid surfaces with great flexibility of pattern design and no need of previous surface patterning. However, for unclear causes it was not possible to print identical NPs closer to each other than 300 nm. Here, we show that the repulsion restricting the optical printing of close by NPs arises from light absorption by the printed NPs and subsequent local heating. By optimizing heat dissipation, it is possible to reduce the minimum separation between NPs. Using a reduced graphene oxide layer on a sapphire substrate, we demonstrate for the first time the optical printing of Au-Au NP dimers. Modeling the experiments considering optical, thermophoretic, and thermo-osmotic forces we obtain a detailed understanding and a clear pathway for the optical printing fabrication of complex nano structures and circuits based on connected colloidal NPs.

Inorganically coated colloidal quantum dots in polar solvents using a microemulsion-assisted method.

The dielectric nature of organic ligands capping semiconductor colloidal nanocrystals (NCs) makes them incompatible with optoelectronic applications. For this reason, these ligands are regularly substituted through ligand-exchange processes by shorter (even atomic) or inorganic ones. In this work, an alternative path is proposed to obtain inorganically coated NCs. Differently to regular ligand exchange processes, the method reported here produces core-shell NCs and the removal of the original organic shell in a single step. This procedure leads to the formation of connected NCs resembling 1D worm-like networks with improved optical properties and polar solubility, in comparison with the initial CdSe NCs. The nature of the inorganic shell has been elucidated by X-ray Absorption Near Edge Structure (XANES), Extended X-ray Absorption Fine Structure (EXAFS) and X-ray Photoelectron Spectroscopy (XPS). The 1D morphology along with the lack of long insulating organic ligands and the higher solubility in polar media turns these structures very attractive for their further integration into optoelectronic devices.

Early Macrophage Infiltration and Sustained Inflammation in Kidneys From Deceased Donors Are Associated With Long-Term Renal Function.

Kidney transplants from living donors (LDs) have a better outcome than those from deceased donors (DDs). Different factors have been suggested to justify the different outcome. In this study, we analyzed the infiltration and phenotype of monocytes/macrophages and the expression of inflammatory and fibrotic markers in renal biopsy specimens from 94 kidney recipients (60 DDs and 34 LDs) at baseline and 4 months after transplantation. We evaluated their association with medium- and long-term renal function. At baseline, inflammatory gene expression was higher in DDs than in LDs. These results were confirmed by the high number of CD68-positive cells in DD kidneys, which correlated negatively with long-term renal function. Expression of the fibrotic markers vimentin, fibronectin, and α-smooth muscle actin was more elevated in biopsy specimens from DDs at 4 months than in those from LDs. Gene expression of inflammatory and fibrotic markers at 4 months and difference between 4 months and baseline correlated negatively with medium- and long-term renal function in DDs. Multivariate analysis point to transforming growth factor-ß1 as the best predictor of long-term renal function in DDs. We conclude that early macrophage infiltration, sustained inflammation, and transforming growth factor-ß1 expression, at least for the first 4 months, contribute significantly to the difference in DD and LD transplant outcome.

Monocyte implication in renal allograft dysfunction.

Macrophages are involved in the development and progression of kidney fibrosis. The aim of this study was to analyse the phenotype of circulating monocytes and their ability to predict kidney allograft dysfunction in living kidney transplant recipients. Whole blood samples from 25 kidney recipients and 17 donors were collected at five time-points. Monocyte phenotype was analysed by flow cytometry, and interleukin (IL)-10 and soluble CD163 by enzyme-linked immunosorbent assay. One week after transplantation, surface CD163 and IL-10 levels increased significantly from baseline [2·99 ± 1·38 mean fluorescence intensity (MFI) to 5·18 ± 2·42 MFI for CD163; 4·5 ± 1·46 pg/ml to 6·7 ± 2·5 pg/ml for IL-10]. This CD163 increase correlated with 4-month creatinine levels (r = 0·4394, P = 0·04). However, soluble CD163 decreased significantly from baseline at 1 week (797·11 ± 340·45 ng/ml to 576·50 ± 293·60 ng/ml). CD14(+) CD16(-) monocytes increased at 4 months and correlated positively with creatinine levels at 12 and 24 months (r = 0·6348, P = 0·002 and r = 0·467, P = 0·028, respectively) and negatively with Modification of Diet in Renal Disease (MDRD) at 12 months (r = 0·6056, P = 0·003). At 4 months, IL-10 decreased significantly (P = 0·008) and correlated positively with creatinine at 2 years (r = 0·68, P = 0·010) and with CD14(+) CD16(-) monocytes at 4 months (r = 0·732, P = 0·004). At 24 h, levels of human leucocyte antigen D-related declined from 12·12 ± 5·99 to 5·21 ± 3·84 and CD86 expression decreased from 2·76 ± 1·08 to 1·87 ± 0·95. Both markers recovered progressively until 12 months, when they decreased again. These results indicate that monitoring monocytes could be a promising new prognostic tool of graft dysfunction in renal transplant patients.

Trasplante renal de donante vivo en paciente VIH positivo / Living donor kidney transplatation in a HIV patient

La infección por el virus de la inmunodeficiencia humana (VIH) ha dejado de ser una contraindicación absoluta para el trasplante renal desde la introducción del tratamiento antirretroviral de gran actividad (TARGA). Se han establecido unos criterios consensuados para seleccionar a los pacientes VIH positivo candidatos a un trasplante: no haber sufrido enfermedades definitorias de SIDA (criptosporidiosis intestinal, leuco encefalopatía multifocal progresiva o sarcoma de Kaposi sistémico), tener una cifra de linfocitos CD4 mayor de 200 células/ µL, tener una carga viral indetectable y estar con tratamiento antirretroviral de gran actividad. Cumpliendo estos criterios, individualizando el tratamiento antirretroviral y con una pauta inmunosupresora óptima, la supervivencia del injerto renal al año es comparable a la de los pacientes VIH negativo. Presentamos el primer trasplante renal de donante vivo en un paciente VIH realizado en la Fundación Puigvert (AU)

Since the introduction of highly active antiretroviral therapy (HAART), human immunodeficiency virus (HIV) infection is no longer an absolute contraindication for renal transplantation. Selection criteria have been established for selecting HIV patients as a candidates for a transplant: not having suffered AIDS-defining disease (intestinal cryptosporidiosis, progressive multifocal leukoencephalopathy or systemic Kaposi sarcoma), to have a CD4 T-cell count greater than 200 cells/mL, undetectable viral load and being under treatment with highly active antiretroviral therapy. Fulfilling these criteria, individualizing antiretroviral therapy and with optimal immunosuppressive regimen, graft survival rates are similar to those reported for patients without HIV. We present the first Kidney transplantation from living donor in HIV patient performed at Fundació Puigvert (AU)

Prevalence evolution and impact of cardiovascular risk factors on allograft and renal transplant patient survival.

OBJECTIVE: The prevalence of traditional cardiovascular risk factors in renal transplantation is high. Studying the evolution of cardiovascular risk factors over time may help us to design better strategies to control them. The relative impact of traditional cardiovascular risk factors on allograft survival and mortality in transplant recipients is not clear. This study was performed to determine the incidence and risk factors for allograft survival and mortality among renal transplant patients. PATIENTS AND METHODS: We enrolled 250 patients who had undergone transplantation between 1980 and 2004. They were followed for various periods, and we analyzed the impact of traditional and nontraditional risk factors on renal allograft survival. RESULTS: The prevalence of hypertension was >80% during all the follow-up periods. Blood pressure diminished, antihypertensive drug prescription increased, and 15% of patients had adequate blood pressure control during follow-up. The prevalence of pretransplant diabetes mellitus was 6.8%; the incidence of posttransplant diabetes mellitus (PTDM) was 14.2%. The prevalence of PTDM increased over the course of patient evolution. The prevalence of dyslipidemia was in all cases >70%; total cholesterol and low-density lipoprotein (LDL)-cholesterol decreased; prescription of statins increased; and the percentage of patients with good lipid control also increased. The 25% prevalence of active smoking at the time of transplantation decreased to 13.6% at 10 years posttransplantation. The mean patient follow-up was 8 +/- 4.6 years. Sixty-five patients (26%) lost their grafts and 40 (16%) died during follow-up. Donor age, exercise, diastolic blood pressure, renal function, and albumin levels were independent risk factors for graft loss. Charlson comorbidity index at transplantation, recipient and donor ages, exercise, diastolic blood pressure, and LDL-cholesterol posttransplantation were independent risk factors for mortality among renal transplant recipients. CONCLUSION: Blood pressure and lipid control improved during follow-up, however, insufficiently among renal transplant patients. The prevalence of diabetes gradually increased, and the incidence of smoking cessation was low. Diastolic blood pressure, exercise, and albuminemia were the most significant modifiable cardiovascular risk factors for renal allograft survival. Diastolic blood pressure, LDL-cholesterol level, and exercise were the most relevant modifiable cardiovascular risk factors for the survival of renal transplant patients.

Evolución de los pacientes trasplantados con riñones procedentes de donantes en asistolia / Evolution of transplanted patients with kidneys form donors in asistolia

El objetivo del estudio fue analizar la evolución de los pacientes trasplantados con injertos procedentes de donantes en asistolia. La inmunosupresión fue cuádruple secuencial con Timoglobulina, micofenolato, esteroides y tacrolimus. Todos los pacientes presentaron una función retrasada del injerto y solamente un paciente tuvo un fallo primario. Durante el seguimiento, no se objetivó ningún rechazo agudo en el período precoz post-trasplante, la función renal mejoró progresivamente durante el primer año y no se observaron complicaciones importantes (AU)

The aim of this study was to analyze the evolution of renal transplant recipients from non-heart-beating donors. The immunosuppressive treatment was a quadruple sequential therapy with Thymoglobulin, mycophenolate, steroids and tacrolimus. All the patients bad delayed graft function and only one patient bad a nonviable kidney. The outcome didn´t show any early acute rejection or serious complications. We observed a good renal function (AU)

[Prophylactic and pre-emptive therapy for cytomegalovirus infection in kidney transplant patients using oral valganciclovir]. / Tratamiento profiláctico y anticipado de la infección por citomegalovirus en pacientes trasplantados renales mediante valganciclovir oral.

UNLABELLED: Prophylactic and pre-emptive therapy with oral valganciclovir for cytomegalovirus infection in renal transplant recipients. BACKGROUND: Cytomegalovirus infection is a very important health problem in solid organ transplant recipients (SOT). Once-daily valganciclovir has been shown to be as clinically effective and well tolerated as oral ganciclovir tid in the prevention of CMV infection in high risk SOT recipients. METHODS: The aim of the present study was to evaluate the incidence and severity of CMV disease in 150 renal transplant recipients that received either prophylactic [high risk group (HR), N = 66] or pre-emptive [low risk group (LR), N = 84] therapy with oral valganciclovir (900 mg/day vo) for three months according to their basal risk. Patients were monitored for signs and symptoms of CMV disease and CMV plasma viral load was assessed weekly. RESULTS: A total of 31 patients (47%) of the HR and 26 patients (31%) of the LR presented a positive CMV PCR result. Twelve patients (14.3%) in the LR that had a high viral load (CMV PCR > 1,000 copies/mL) but remained asymptomatic received pre-emptive therapy. Four patients (4.7%) in the LR, after an average time of 35 days after transplant and two patients (4.5%) in the HR, after prophylactic treatment was completed, developed CMV disease. The disease was mild-moderate in most of the cases. Those patients that developed CMV disease responded to treatment with iv ganciclovir for 14 days followed by treatment with oral valganciclovir for up to three months. CONCLUSION: Prophylactic treatment with oral valganciclovir for CMV prevention is only required in high risk solid organ transplant recipients.

Tratamiento profiláctico y anticipado de la infección por citomegalovirus en pacientes trasplantados renales mediante vanglanciclovir oral / Prophylactic and pre-emptive therapy for cytomegalovirus infection in kidney transplant patients using oral valganciclovir

Antecedentes: La enfermedad por citomegalovirus (CMV) es un problema sanitario muy importante en receptores de trasplante de órgano sólido (TOS). Una dosis diaria de valganciclovirha demostrado ser tan clínicamente efectiva y bien tolerada como ganciclovir oral dos veces al día en la prevención de la infección por CMV en los receptores de TOS de alto riesgo. Métodos: El objetivo del presente estudio fue evaluar la incidencia y severidad de la enfermedad por CMV en 150 receptores de trasplante renal que recibieron tratamiento profiláctico(grupo de alto riesgo, N = 66) o anticipado (grupo de bajo riesgo, N = 84) con valganciclovir oral (900 mg/día)durante tres meses según el riesgo basal de sufrir la misma. Se hizo un seguimiento de los síntomas clínicos de la enfermedad por CMV en los pacientes y la carga viral de CMV en plasma fue monitorizada semanalmente. Resultados: Un total de 31 pacientes (47%) del grupo de alto riesgo y 26 pacientes (31%) del grupo de riesgo estándar presentaron un resultado de PCR-CMV positivo. Doce pacientes (14,3%) del grupo de riesgo estándard que presentaron una elevada carga viral (PCR-CMV > 1.000 copias/mL) pero que permanecieron asintomáticos recibieron tratamiento anticipado. Cuatro pacientes (4,7%) del grupo de alto riesgo, en un tiempo medio de 35 días después del trasplante y dos pacientes (4,5%) del grupo de alto riesgo, tras completar el tratamiento profiláctico, desarrollaron la enfermedad por CMV, que fue de intensidad media a moderada en la mayoría de los casos. Aquellos pacientes que desarrollaron la enfermedad respondieron al tratamiento con ganciclovir ev durante 14 días seguido de valganciclovir oral hasta tres meses. Conclusión: El tratamiento profiláctico con valgancicloviroral para la prevención de CMV sólo es requerida en receptores de TOS de alto riesgo (AU)

Prophylactic and pre-emptive therapy with oral valganciclovir for cytomegalovirus infection in renal transplant recipients. Background: Cytomegalovirus infection is a very important health problem in solid organ transplant recipients (SOT). Once daily valganciclovir has been shown to be as clinically effective and well tolerated as oral ganciclovir tid in the prevention of CMV infection in high risk SOT recipients. Methods: The aim of the present study was to evaluate the incidence and severity of CMV disease in 150 renal transplant recipients that received either prophylactic [high risk group (HR), N =66] or pre-emptive [low risk group (LR), N = 84] therapy with oral valganciclovir (900 mg/day vo) for three months according to their basal risk. Patients were monitored for signs and symptoms of CMV disease and CMV plasma viral load was assessed weekly. Results: A total of 31 patients (47%) of the HR and 26 patients(31%) of the LR presented a positive CMV PCR result. Twelve patients(14.3%) in the LR that had a high viral load (CMV PCR >1,000 copies/mL) but remained asymptomatic received pre-emptive therapy. Four patients (4.7%) in the LR, after an average time of 35 days after transplant and two patients (4.5%) in the HR, after prophylactic treatment was completed, developed CMV disease. The disease was mild-moderate in most of the cases. Those patients that developed CMV disease responded to treatment with iv ganciclovir for 14 days followed by treatment with oral valganciclovir for up to three months. Conclusion: Prophylactic treatment with oral valganciclovir for CMV prevention is only required in high risk solid organ transplant recipients (AU)

[Why renal transplant from living donors gives better results than cadaver renal transplant?]. / Por qué el trasplante renal de donante vivo da mejores resultados que el trasplante renalde donante cadáver?

BACKGROUND: According to literature, patient and graft survival is better in living donor renal transplants (LRT) than in cadaver renal transplants (CRT). OBJECTIVE: To study factors that determine the best results in LRT related to those of CRT, found in univariate studies. PATIENTS AND METHODS: Renal transplants (RT) done in Catalonia during the 1990-2004 period, performed in patients over 17 years (135 LRT and 3.831 CRT), have been analyzed (retransplants were not included). The data come from the Renal Patients Transplant Registry (RMRC). Student's t-test and chi2 test have been used for mean and for proportions comparisons, respectively. To analyze univariate and multivariate survival, actuarial method and Cox regression have been used, respectively. Estimated creatinine clearance has been studied and its data have been showed through Selwood modified Analysis. RESULTS: As it happens with other great RT patients series, the RMRC analysis, globally and without any adjustment, shows that patient and graft survival in LRT is better than that obtained with CRT. When we studied which variables explain these results, we found that main factors were smaller recipient age and the short time on dialysis. The great influence of both factors has been published in a large number of papers, explaining the differences obtained on the transplanted renal patient survival. CONCLUSIONS: Once adjusted the analysis by the different factors that influence the survival of the patient and the graft, there are no differences in the obtained results, since the best outcomes of the TRV are due to factors like the smaller recipient age and the advanced TR.

[Pregnancy in recipients of kidney transplantation: effects on mother and child]. / Embarazo en receptoras de trasplante renal: efectos en la madre y en el niño.

When the field of transplantation was first developing, physicians worried about the teratogenicity of immunosuppressive medications and considered pregnancy ill-advised. The purpose of this study is to analyze pregnancy after kidney transplantation and their consequences on mother, graft and child. We review ten pregnant women with kidney transplantation, average of 29 years old and 44 months post-kidney transplantation. The mean glomerular filtration rate was 64 ml/min and the immunosuppression was with prednisone and tacrolimus. We analyze outcomes of different variables before and during pregnancy, and after labour. Pregnancy finished in nine of ten patients. Three patients needed cesarean section and only one patient had a miscarriage on the first term. Blood arterial pressure increased at the end of pregnancy and the creatinine level was stable with a few increase of proteinuria at the third term. We increased the tacrolimus dose to obtain the correct blood levels and any rejection was detected. We had only one patient with preeclampsia that we solved with a cesarean section. Labours were a mean of 37.2 weeks and the mean birth weight of infant was 2,809 grams. Two newborns had prematurity without structural malformations. Pregnancy after kidney transplantation is safe with prednisone and tacrolimus when the renal function is good, proteinuria doesn't exist and blood pressure is controlled.

Embarazo en receptoras de trasplante renal: efectos en la madre y en el niño / Pregnancy in recipients of kidney transplantation: effects on the mother and the child

El embarazo se contraindicaba en los inicios del trasplanterenal, pero actualmente la gestación es una parte más de los beneficios que aporta el mismo. El objetivo del estudio es analizar la viabilidad del embarazo post-trasplanterenal y sus consecuencias a nivel de la paciente, el injertorenal y el neonato. Se revisaron diez pacientes trasplantadas renales embarazadas con una edad media de 29 años y un tiempo medio post-trasplante de 44 meses. El filtrado glomerular estimado medio fue de 64 ml/min y la inmunosupresión fue con corticoides y tacrolimus. Se analizó la evolución de diferentes variables durante los meses de gestación y después del parto, inherentes a la madre, al injerto renal y al recién nacido. El embarazo llegó a término en nueve de las diez pacientes, seis por vía vaginal y tres con cesárea, con solo un aborto espontáneo en el primer trimestre. La presión arterial aumentó al final del embarazo y la creatinina se mantuvo estable durante los nueve meses con un incremento de la proteinuria a partir del tercer trimestre del embarazo. La dosis de tacrolimus se tuvo que aumentar en el tercer trimestre del embarazo para conseguir los niveles deseados y no se detectó ningún rechazo agudo durante el seguimiento, apareciendo como única complicación una pre-eclampsia que se resolvió con una cesárea. El parto tuvo lugar a las 37,2 semanas demedia y los recién nacidos presentaron un peso medio de2.809 g, destacando dos recién nacidos afectos de prematuridad/bajo peso al nacer sin surgir ninguna complicación de interés en los neonatos. El embarazo post- trasplante renal es seguro con una pauta inmunosupresora basada en esteroides y tacrolimus, con buenos resultados cuando antes del embarazo la función renal es correcta, no hay proteinuria y la presión arterial está controlada (AU)

When the field of transplantation was first developing, physicians worried about the teratogenicity of immunosuppressive medications and considered pregnancy ill-advised. The purpose of this study is to analyze pregnancy after kidney transplantation and their consequences on mother, graft and child. We rewiewten pregnant women with kidney transplantation, average of 29years old and 44 months post-kidney transplantation. The meanglomerular filtration rate was 64 ml/min and the immune suppression was with prednisone and tacrolimus. We analyze outcomes of differents variables before and during pregnancy, and after labour. Pregnancy finished in nine of ten patients. Three patients needed cesarean section and only one patient had a miscarriage on the first term. Blood arterial pressure increased at the end of pregnancy and the creatinine level was stable with a few increase of proteinuria at the third term. We increased the tacrolimus dose to obtain the correct blood levels and any rejection was detected. We had only one patient with preeclampsia that we solved with a cesarean section. Labours were a mean of37.2 weeks and the mean birth weight of infant was 2,809 g. Two newborns had prematurity without structural malformations. Pregnancy after kidney transplantation is safe with prednisone and tacrolimus when the renal function is good, proteinuria doesn’t exist and blood pressure is controlled (AU)

Living donor kidney transplantation in catalonia: comparison with cadaveric kidney donors.

INTRODUCTION: We studied the renal transplantation results of living donor compared with cadaveric donor kidney transplantations. PATIENTS AND METHODS: One hundred thirty-six living donor transplantations performed during the period of 1990 to 2003 (group 1) were compared with a control group of 4304 cadaveric donor transplantations (group 2), paired 1:1 with group 1 patients, according to the period of transplantation, the primary renal disease, the transplant number, as well as the recipient and donor ages. RESULTS: There were no differences regarding patient or graft survival during a 10-year follow-up. CONCLUSIONS: The benefit of performing living donor kidney transplantations is the possibility of having the donor available even before beginning dialysis treatment.