ABSTRACT
Kidney transplantation is the renal replacement therapy of choice in patients with end-stag ekidney disease. Immunosuppressive drugs are the main pillar of treatment in solid organ transplantation as they reduce rejection rates and increase graft survival. However, they can also cause significant side effects that can complicate transplant progression. The objective of this chapter is to outline the main characteristics of immunosuppressantsagents, their mechanisms of action and the side effects.
El tratamiento de elección en los pacientes con enfermedad renal avanzada es el trasplante renal. Los fármacos inmunosupresores constituyen el pilar fundamental de la terapia en el trasplante de órgano sólido, ya que permiten disminuir las tasas de rechazo y aumentar la supervivencia del injerto. Sin embargo, también pueden provocar efectos adversos que pueden complicar la evolución del trasplante. El objetivo de este capítulo es exponer las características de los principales inmunosupresores, sus mecanismos de acción y principales efectos secundarios.
Subject(s)
Kidney Transplantation , Pharmaceutical Preparations , Graft Rejection/prevention & control , Graft Survival , Humans , Immunosuppressive AgentsABSTRACT
BACKGROUND: Kidney transplantation is the therapy of choice for end-stage kidney disease. Graft's life span is shorter than expected due in part to the delayed diagnosis of various complications, specifically those related to silent progression. It is recognized that serum creatinine levels and proteinuria are poor markers of mild kidney lesions, which results in delayed clinical information. There are many investigation looking for early markers of graft damage. Decreasing kidney graft cortical microcirculation has been related to poor prognosis in kidney transplantation. Cortical capillary blood flow (CCBF) can be measured by real-time contrast-enhanced sonography (RT-CES). Our aim was to describe the natural history of CCBF over time under diverse conditions of kidney transplantation, to explore the influence of donor conditions and recipient events, and to determine the capacity of CCBF for predicting renal function in medium term. PATIENTS AND METHODS: RT-CES was performed in 79 consecutive kidney transplant recipients during the first year under regular clinical practice. Cortical capillary blood flow was measured. Clinical variables were analyzed. The influence of CCBF has been determined by univariate and multivariate analysis using mixed regression models based on sequential measurements for each patient over time. We used a first-order autoregression model as the structure of the covariation between measures. The post-hoc comparisons were considered using the Bonferroni correction. RESULTS: The CCBF values varied significantly over the study periods and were significantly lower at 48 h and day 7. Brain-death donor age and CCBF levels showed an inverse relationship (r: -0.62, p<0.001). Living donors showed higher mean CCBF levels than brain-death donors at each point in the study. These significant differences persisted at month 12 (54.5 ± 28.2 vs 33.7 ± 30 dB/sec, living vs brain-death donor, respectively, p = 0.004) despite similar serum creatinine levels (1.5 ± 0.3 and 1.5 ± 0.5 mg/dL). A sole rejection episode was associated with lower overall CCBF values over the first year. CCBF defined better than level of serum creatinine the graft function status at medium-term. CONCLUSION: RT-CES is a non-invasive tool that can quantify and iteratively estimate cortical microcirculation. We have described the natural history of cortical capillary blood flow under regular clinical conditions.
