ABSTRACT
BACKGROUND: Calcineurin inhibitors play an important role in chronic allograft dysfunction. Sirolimus is an interesting alternative in renal transplant patients because it is less nephrotoxic than calcineurin inhibitors. METHODS: A chart review of the clinical outcome of kidney transplant patients converted to sirolimus with progressive allograft dysfunction is reported herein. Fifteen patients (average age: 32.3 years, 44 months mean time of conversion) were included. Indication for conversion was a >20% increase in serum creatinine over the last 6 months or progression to the range of 2-4.5 mg/dL. Patients underwent abrupt cessation of cyclosporine and sirolimus addition at 2-5 mg/day. RESULTS: Concomitant immunosuppression remained unchanged during conversion. Targeted sirolimus level was 8-12 ng/mL. Serum creatinine dropped from pre-conversion level of 2.75 +/- 0.83 to 2.14 +/- 0.67 and 1.97 +/- 0.66 mg/dL at 3 and 6 months (p <0.05). There was a significant decrease in blood urea nitrogen, hemoglobin and serum calcium at 3 months post-conversion as well as serum calcium and potassium at 6 months post-conversion (p <0.05). There were no rejection episodes. Patient and graft survival was 100% with three infectious complications. CONCLUSIONS: Monitored sirolimus conversion with sharp withdrawal of calcineurin inhibitor is an alternative for patients with deteriorating renal function and chronic allograft nephropathy.
Subject(s)
Graft Rejection/prevention & control , Graft Survival/drug effects , Immunosuppressive Agents/administration & dosage , Kidney Failure, Chronic/drug therapy , Kidney Transplantation , Sirolimus/administration & dosage , Adult , Calcineurin Inhibitors , Calcium/blood , Creatinine/blood , Cyclosporine/administration & dosage , Cyclosporine/adverse effects , Enzyme Inhibitors/administration & dosage , Enzyme Inhibitors/adverse effects , Enzyme Inhibitors/pharmacokinetics , Female , Graft Rejection/blood , Hemoglobins/analysis , Humans , Immunosuppressive Agents/pharmacokinetics , Kidney Failure, Chronic/blood , Kidney Failure, Chronic/etiology , Male , Monitoring, Physiologic , Potassium/blood , Retrospective Studies , Sirolimus/pharmacokinetics , Transplantation, Homologous , Treatment Outcome , Urea/bloodABSTRACT
Los feocromocitomas son tumores neuroendocrinospoco frecuentes, habitualmente sintomáticos y en la mayoría de los casos esporádicos, que se suelen localizar en la médula suprarrenal. Presentamos 2 casos de feocromocitoma extraadrenal no funcionan-te localizados en el retroperitoneo, aparentemente benignos, esporádicos y no asociados con otras neoplasias endocrinas ni enfermedades hereditarias. Empleamos ecografía, tomografía computarizada y resonancia magnética antes de la escisión completa del tumor por vía abdominal abierta, así como diversas técnicas inmunohistoquímicas para llegar al diagnóstico definitivo. Tras 8 y 14 meses de seguimiento no hay evidencia de recidiva de la enfermedad ni de aparición de otros síndromes. Como consecuencia de estos casos, llevamos a cabo una revisión bibliográfica centrándonos en los puntos más controvertidos (AU)
Pheochromocytomas are uncommon neuroendocrine tumors. They are usually symptomatic and sporadic and are generally located in the adrenal medulla. We present two cases of extra-adrenal nonfunctional pheochromocytomas located in the retro peritoneum. The tumors were apparently benign and sporadic and were not associated with other neoplasms or hereditary diseases. Ultrasonography, computed axial tomography and magnetic resonance imaging were performed before complete excision of the tumors using open abdominal surgery. Several immunohistochemical techniques were performed to reach the definitive diagnosis. After 8 and 14 months of follow-up, there is no evidence of recurrence or other syndromes. As a consequence of these two cases, we performed review of the literature on the topic, focussing on the most controversial areas (AU)
Subject(s)
Female , Adult , Middle Aged , Humans , Pheochromocytoma/diagnosis , Pheochromocytoma/surgery , Immunohistochemistry/methods , Paraganglioma/complications , Paraganglioma/diagnosis , Laparotomy/methods , Laparoscopy/methods , Abdomen/pathology , Abdomen , Sensitivity and Specificity , Paraganglioma/surgeryABSTRACT
Pheochromocytomas are uncommon neuroendocrine tumors. They are usually symptomatic and sporadic and are generally located in the adrenal medulla. We present two cases of extra-adrenal nonfunctional pheochromocytomas located in the retroperitoneum. The tumors were apparently benign and sporadic and were not associated with other neoplasms or hereditary diseases. Ultrasonography, computed axial tomography and magnetic resonance imaging were performed before complete excision of the tumors using open abdominal surgery. Several immunohistochemical techniques were performed to reach the definitive diagnosis. After 8 and 14 months of follow-up, there is no evidence of recurrence or other syndromes. As a consequence of these two cases, we performed a review of the literature on the topic, focussing on the most controversial areas.
