Usefulness of Delayed Introduction of Tacrolimus in Kidney Transplants Using Type-III Donors After Circulatory Death.

INTRODUCTION: Our study compares 2 immunosuppressive strategies to reduce tacrolimus nephrotoxicity and its risk of acute tubular necrosis: delayed introduction of tacrolimus plus thymoglobulin vs initial tacrolimus plus basiliximab on the results of kidney transplant (KT) using type-III donation after circulatory death (III-DCD). MATERIAL AND METHODS: We analyzed all the transplants performed using type-III DCD in our hospital (42 cases). They were distributed in a first stage with delayed tacrolimus (3°-4° day) + thymoglobulin and a second one with initial tacrolimus + basiliximab, with a follow-up of 6 months. The rate of delayed graft function, the evolution of renal function, and the incidence of rejection were compared. RESULTS: 28 patients received thymoglobulin with delayed tacrolimus, and 13 patients received basiliximab and tacrolimus from day 0 (1 excluded). There were no significant differences in delayed graft function (27% group 1 and 23% group 2) or in rejection (10.7% and 15.4%), respectively. Serum creatinine at day 3, 7, 14, 30, and 180 showed no statistically significant differences. The levels of tacrolimus measured at 10, 30, 90, and 180 days after transplantation were similar, except for the first month: 10.10 ± 2.3 in group 1 and 12 ± 1.7 ng/mL in group 2 (P = .007). CONCLUSIONS: Delayed introduction of tacrolimus does not seem to suppose a benefit in KT using type-III DCD; therefore, the use of thymoglobulin, with its higher profile of adverse effects, seems unjustified in patients with normal immunological risk.

Ochrobactrum anthropiy peritonitis polimicrobiana en diálisis peritoneal: un predictor de resistencia / No disponible

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Proteinuria: a new marker of long-term graft and patient survival in kidney transplantation.

BACKGROUND: Proteinuria developing after renal transplantation is associated with increased renal failure. Moreover, proteinuria in the general population has been shown to be associated with morbidity and mortality due to cardiovascular disease, which is the main cause of death in renal transplant patients. The purpose of the present study was to investigate whether persistent proteinuria following renal transplantation was associated with a worse patient and graft survival. METHODS: We analysed kidney recipients included in the Spanish Chronic Allograft Nephropathy Study (n = 3365). Proteinuria at 1 year post-transplantation was analysed as a categorical variable (< 0.5, 0.5-1, > 1 g/day). RESULTS: Post-transplant proteinuria at 1 year was detected in 15.3% of patients. Graft survival in proteinuric patients was significantly lower as compared with patients without proteinuria and the survival was worse with increasing amounts of proteinuria. In the groups with proteinuria, renal graft function at the time of the analysis was worse than in the group without proteinuria. Patient survival was lower in patients with proteinuria although there was no difference between the two groups of proteinuric patients. The main cause of death was vascular disease in all groups of patients but especially in proteinuric patients. The relative risk of graft failure and patient death was higher in proteinuric patients: graft failure [0.5-1 g/day: 2.33 (1.79-3.01, P<0.0001); > 1 g/day: 3.46 (2.73-4.39, P<0.0001)], patient death [0.5-1 g/day: 2.05 (1.39-3.01, P = 0.0002); > 1 g/day: 2.3 (1.55-3.39, P<0.0001)]. CONCLUSIONS: Proteinuria, as in native kidney disease, is an excellent marker of poor long-term allograft prognosis and is an independent risk factor for total and cardiovascular mortality in the renal transplant population.

[Surgery of early gastric cancer. Twenty-five year experience]. / Cirugía del cáncer gástrico precoz. Experiencia en 25 años.

AIM: To study the influence of the depth of parietal invasion (mucosal-submucosal), the presence or absence of ganglionic invasion and type of gastrectomy performed (subtotal or total) on survival in patients with early gastric cancer. STUDY DESIGN: Longitudinal study. PATIENTS: A clinical-pathologic study of 101 patients who underwent surgery for early gastric cancer was performed. Probability of survival was estimated using the Kaplan-Meier and logrank tests and multivariate analysis was performed using the Cox test. RESULTS: Mucosal involvement was found in 46 patients (45.5%) and submucosal involvement in 55 patients (54.5%). The presence of ganglionic metastases was greater in tumors reaching the submucosa (14 [25.5%]) than in those limited to the mucosa (4 [8.7%]). Partial gastrectomy was performed according to tumor location in 84 patients (83.2%), total gastrectomy was performed in 16 patients (15.8%) and 1 wedge resection was performed. The mean postoperative follow-up was 84.04 55.89 months (range: 2-264). Comparison of survival in patients with tumors limited to the mucosal or submucosal layers revealed a p-value of 0.06 (NS). Comparison of survival in patients with metastases and in those without metastases revealed a p-value of < 0.0001. Comparison of survival between patients who underwent total gastrectomy and those who underwent partial gastrectomy showed a p-value of 0.38 (NS). Postoperative mortality was nil. Overall survival at 5 years was 79.24% and at 10 years was 68.14%. Multivariate analysis revealed that ganglionic involvement and depth of parietal invasion influenced survival. CONCLUSIONS: Survival is influenced by ganglionic involvement but not by submucosal invasion. Partial gastrectomy may be an appropriate procedure since survival is similar to that associated with total gastrectomy.