Immunoprophylaxis with Simulect (basiliximab) in kidney transplantation: results from routine clinical practice at 18 kidney transplant units.

OBJECTIVE: The objective of this study is to assess a Simulect (basiliximab) regimen in routine clinical practice in the Spanish kidney transplantation units to evaluate efficacy and safety. METHODS: In this prospective, observational study, data on demographics, parameters of efficacy, and safety in patients who under with kidney transplantation treated with Simulect (basiliximab) were collected through an on-line collection system. RESULTS: One hundred sixty three patients at 18 kidney transplant units included 12 months follow-up. The patient mean age was 52 years (DS 13,67) including 96 (58.90%) men and 67 (41.10%) women. Cold ischemia time was 19 hours (DS 6,79). Only 2 patients presented with PRA >50%. For prophylactic immunosuppression, 67.13% of patients received triple therapy with CNI (cyclosporine 49.65% or tacrolimus 17.48%), MMF (66.43%) or AZA (10.49%), and steroids. Incidence of acute rejection (AR) at 12 months was 12.27% (1.84% steroid-resistant). In subgroup analysis, AR was 13.5% in nondiabetics and 4.5% in diabetics, including 3 steroid-resistant episodes (1.84%) in nondiabetics and none in diabetics. In relation to donor age, AR was incidence 10.3% in patients with kidneys from donors aged 50 years or younger and 10.6% when donors were older than 50 years, including 1 (1.73%) and 2 (1.93%) steroid-resistant episodes, respectively. The graft and patient survival rates at 12 months were 90% and 98%, respectively. CONCLUSIONS: Simulect (basiliximab) used in routine clinical practice provided good prophylaxis against acute rejection in several kidney transplant patient populations, similar to that observed in randomized clinical studies with excellent tolerability and safety.

Safety and efficacy of tacrolimus rescue therapy in 55 kidney transplant patients treated with cyclosporine.

To evaluate the efficacy and safety of conversion from cyclosporine to tacrolimus, we analyzed 55 kidney transplant patients who were converted due to cosmetic reasons in 42 patients, acute rejection in 2 patients, and other causes in 11 patients. At the doses and levels used, the development of diabetes mellitus was minimized. Disappearance of cosmetic side-effects and improvement of cardiovascular risk factors, together with conservation of renal function, encourage us to use tacrolimus as an efficacious and safe immunosuppressive therapy.

Presentación de cánceres en receptores trasplantados con órgano sólido / No disponible

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Valoración del tratamiento sustitutivo integrado en pacientes en insuficiencia renal terminal: selección versus elección / Assessment of integrated replacement therapy in patients with terminal renal insufficiency: selection vs election

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A randomized trial comparing cyclosporine and steroids with cyclosporine, azathioprine, and steroids in cadaveric renal transplantation.

BACKGROUND: In renal transplantation, triple-drug therapy (low-dose cyclosporine [CsA] combined with azathioprine plus steroids) has been replacing double-drug therapy (CsA plus steroids) in clinical practice without much evidence in favor of either therapy. Previous trials comparing the two immunosuppressive regimens gave conflicting results. We attempted to determine whether triple therapy is at least equivalent to double therapy. METHODS: A randomized trial was performed in 250 adult cadaveric renal transplant recipients, comparing double therapy (CsA [10 mg/kg/day] plus prednisone) with triple therapy (CsA [6 mg/kg/day] plus azathioprine plus prednisone). The median follow-up time was 930 days. RESULTS: The incidence of acute rejection episodes refractory to treatment was 11% in double therapy and 4% in triple therapy (relative risk reduction: 64%; 95% confidence interval: 5-100%; P=0.035). Patients in the double therapy group required more intensive antirejection treatment, and their pathologic lesions were more severe. The proportion of patients with acute rejection was similar (double therapy: 45% vs. triple therapy: 40%) as was the incidence of chronic renal dysfunction (double therapy: 17% vs. triple therapy: 15.5%), the 4-year graft survival (double therapy: 71% vs. triple therapy: 83%, P=0.089), and patient survival (double therapy: 94% vs. triple therapy: 93%). In 29 patients (23%), 35 episodes of azathioprine-induced leukopenia were recorded, and in 9 of them azathioprine had to be discontinued. The incidence of other adverse events did not differ between the groups. CONCLUSIONS: Triple therapy caused fewer episodes of refractory acute rejection episodes and was as efficacious and safe as double therapy.

[Renal tubular acidosis in the kidney transplant]. / Acidosis tubular renal en el trasplante renal.

UNLABELLED: Renal tubular acidosis is a syndrome of disordered renal acidification, we have studied a group of patients transplanted. Their cases clinic patients have been analyzed with no-present infectious disease, or tubulointerstitial diseases or urinary infection, immunosuppression with prednisone and azatioprine only, no have to ingest cyclosporine and period graft superior 3 months. We haven't neither patient with proximal renal tubular acidosis. We have been reported 7 cases of distal renal tubular acidosis. All the patients have make the furosemide test. Only one case hyperkalemia renal tubular acidosis. Histologic kidney had been chronic rejection. CONCLUSION: renal tubular acidosis is not infrequent of kidney transplantation and this syndrome connect with chronic rejection.

[Individualized supplementation of fluoride in primary pediatrics]. / Suplementación individualizada de flúor en pediatría primaria.

Problems found in the development of a program for individual supplementation of fluoride to infants and pre-school children in a primary pediatric outpatient unit are commented. Problems included knowledge of the level of fluoride in public water supply, in infant formulas and in mineral water used in their preparation and selection of a practical and regular method for supplying fluoride in the first year (having in mind other sources of fluoride) and in older children, and taking into account economic problems. Practical tables with the amount of fluoride in Spanish drinkable water, in commonly available infant formulas and mineral bottled waters, are shown.

[Absence of tuberculin reactivity after neonatal vaccination with BCG in Cantabria: analysis of 419 determinations]. / Ausencia de reactividad tuberculínica tras la vacunación neonatal con BCG en Cantabria: análisis de 419 determinaciones.

A prospective study is made of the tuberculin test sensitivity at 3 and 12 months after neonatal vaccination with BCG. From the results obtained in 419 tests the conclusion is that the percentage of positive tests is 3.8% and 1.6% at 3 and 12 months respectively, considering the threshold of positivity equal or superior to 10 mm (or 18.9 y 5.6% respectively with the threshold at 5 mm). These results are lower than the ones described previously, and therefore the conclusion is that in Cantabria the tuberculin tests should be valued without taken in consideration the antecedent of previous vaccination with BCG.