ABSTRACT
Individualized prescription of bicarbonate solutions allows one to control metabolic acidosis. Low sodium solutions improve sodium removal and may become available in the future. Varying dwell time and fill volume when intermittent APD is prescribed improves the efficiency of dialysis. Continuous flow peritoneal dialysis can dramatically improves the efficiency of dialysis. Normalized haemoglobin values by epoietin-beta in renal transplant recipients are associated with a better graft survival at 2 years. Switch from calcineurins inhibitors to sirolimus after the first squamous-cell carcinoma lead to significantly longer survival free of cutaneous carcinoma at 2 years. Eculizumab allowed successful prevention and treatment of atypical haemolytic and uremic syndrome episodes.
Subject(s)
Kidney Transplantation , Peritoneal Dialysis , Dialysis Solutions , Graft Survival , HumansABSTRACT
Loss of the association between cuff number and peritonitis may be related to implementation of new strategies of prevention. Daily application of antibiotic prophylaxis at the peritoneal dialysis exit site is a very effective one. Update of peritoneal dialysis-related infections recommendations published by the international society of peritoneal dialysis presents some evolutions in diagnosis techniques and treatments. Renal transplant recipients under belatacept have significant better renal function and less cardio-vascular risk factors compared to patients under cyclosporine A. Six month administration of anti-CMV prophylaxis in seronegative recipients has shown less CMV disease at 12 month follow-up. The correction of anemia up to 13-15 g/dl was associated with a better quality of life and a better graft function at 2 years follow up.
Subject(s)
Kidney Transplantation/trends , Peritoneal Dialysis/trends , HumansABSTRACT
Chronic kidney disease (CKD) is complex to manage, especially when a substitutive treatment has to be implemented. Strict medical follow-up is mandatory but not sufficient to provide optimal care to the CKD patients. Educational intervention gives more skills to the patients to cope with this chronic disease. In this approach, physicians and nurses help patients to have a greater acceptance of their illness and make their treatment their own. Therapeutic education is part of this patient-centred approach. Peer counselling is also used in our program as well as an educative journal.
Subject(s)
Kidney Diseases/therapy , Patient Education as Topic , Chronic Disease , Humans , Renal DialysisABSTRACT
Results of islet of Langerhans transplantation have markedly improved in recent years, but most patients still lose insulin independence in the long-term. We report herein the longest (over 11 years) case of insulin independence after allogeneic islet transplantation. The subject had a 27-year history of type 1 diabetes and received a single islet-after-kidney graft of 8800 islet equivalents (IEQ)/kg, pooled from 2 donors. Insulin was discontinued by 3 months posttransplant and the patient has remained off insulin ever since. Yearly follow-up studies have revealed normal metabolic control, including normal oral glucose tolerance test (OGTT). Reasons for success may involve choice of immunosuppression, low metabolic demand and low immune responsiveness as suggested by an excellent HLA matching and a high count of circulating regulatory T cells. This observation is so far an exceptional case, but clearly demonstrates the validity of the concept that long-term insulin independence after allogeneic islet transplantation is an achievable target.
Subject(s)
Diabetes Mellitus, Type 1/surgery , Hypoglycemic Agents/blood , Insulin/blood , Islets of Langerhans Transplantation , Adult , Blood Glucose/metabolism , Female , Graft Survival , Humans , Immunosuppression Therapy , Postoperative Period , Time Factors , Transplantation, Homologous , Treatment OutcomeABSTRACT
There is a crucial need for noninvasive assessment tools after cell transplantation. This study investigates whether a magnetic resonance imaging (MRI) strategy could be clinically applied to islet transplantation. The purest fractions of seven human islet preparations were labeled with superparamagnetic iron oxide particles (SPIO, 280 microg/mL) and transplanted into four patients with type 1 diabetes. MRI studies (T2*) were performed prior to and at various time points after transplantation. Viability and in vitro and in vivo functions of labeled islets were similar to those of control islets. All patients could stop insulin after transplantation. The first patient had diffuse hypointense images on her baseline liver MRI, typical for spontaneous high iron content, and transplant-related modifications could not be observed. The other three patients had normal intensity on pretransplant images, and iron-loaded islets could be identified after transplantation as hypointense spots within the liver. In one of them, i.v. iron therapy prevented subsequent visualization of the spots because of diffuse hypointense liver background. Altogether, this study demonstrates the feasibility and safety of MRI-based islet graft monitoring in clinical practice. Iron overload (spontaneous or induced) represents the major obstacle to the technique.
Subject(s)
Contrast Media , Graft Rejection/diagnosis , Islets of Langerhans Transplantation , Islets of Langerhans , Magnetic Resonance Imaging/methods , Metal Nanoparticles , Adult , Female , Ferric Compounds/chemistry , Humans , Male , Metal Nanoparticles/chemistry , Middle Aged , Staining and LabelingABSTRACT
ABO incompatibility and positive cross match between the donor and the recipient are no longer considered absolute counter indications to renal transplantation. One-year and 5-years graft survival are similar to ABO compatible transplantation, although a higher incidence of acute humoral rejection is observed. Calcineurin inhibitors nephrotoxicity can be reduced since the introduction of new immunosuppressive drugs. Two forms of peritoneal dialysis are available: continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. In each situation the treatment must be tailored to the patient. Various clinical and biological parameters allow to judge the adequacy of the peritoneal dialysis. The last guidelines fixed the minimal target value of one of them, the Kt/V, at 1.7.
Subject(s)
Kidney Transplantation , Peritoneal Dialysis , HumansABSTRACT
Alternative to nephrotoxic calcineurin inhibitors regimens are feasible in renal transplantation. Sirolimus is an effective immunosuppressive drug with less drug-induced nephrotoxicity. Enteric-coated mycophenolate sodium provides a safety and efficacy alternative to mycophenolate mofetil. In peritoneal effluent, cancer antigen 125 (Ca 125) is a mesothelial cell marker and of in vivo biocompatibility of the new dialysis solutions. Longterm PD and peritoneal sclerosis are associated with a low number of mesothelial cells and a low concentration of dialysate Ca 125. Exposure to glucose and degradation products (GDPs) is important in the genesis of mesothelial damage. Short results of the more biocompatible solutions are promising (increasing of Ca 125). In the future, exposure to glucose can be reduced by using combinations of various osmotic agents, each in a low concentration (glycerol and amino acid solution).
