Low median fluorescence intensity could be a nonsafety concept of immunologic risk evaluation in patients with shared molecular eplets in kidney transplantation.

Human leukocyte antigen (HLA) antibodies are usually "epitope" and not "antigen" specific. This work presents an interesting case concerning Luminex median fluorescence intensity (MFI) levels in antibodies considered low risk (<1,000), but producing humoral rejection. These low-titer antibodies could play an important role in transplantation. A 42-year-old woman was retransplanted with a deceased donor with negative complement-dependent cytotoxicity cross-matching. Our patient was pretransplant (PrT) sensitized to HLA antigens (single antigens (SA) = 31%) for 1 previous transplant. Thus, the formerly detected sensitized antigens were A32, A30, A31, cross-reacting group 5C, and DQ3 with a MFI(max) ≈ 4,127. In the posttransplantation period (PTP), the patient exhibited important instability in renal function and we detected an increased SA percentage (61%) with MFI(max) = 15,029 (A*32) with other antigens (detected with a low PrT MFI [<1,000]) as anti-A*03 (MFI(max) = 13,301) and anti-A*11 (MFI(max) = 13,714) specificities. Anti-A*03 was a donor-specific antibody (DSA). Renal biopsy was compatible with humoral rejection. The patient was pulsed with methylprednisolone, plasmapheresis, and intravenous immunoglobulin without improvement. Thus, we added anti-CD20 and the initial clinical response was highly favorable. Biopsies resulted in suggestive rejection reversion. MFI A*03 DSA decreased to 6,908 and later to MFI(max) = 5,505. After a 6-month PTP, the patient is well with MFI(max) = 3,124. It was possible to define exactly the potential immunizing epitope eplets whose recognition determined the specific antibody production. A*32:01, A*30:01, A*31:01 (detected PrT), A*11:01, and A*03:01 (detected PTP) alleles have several shared eplets (62QE, 70AQS, and 76VGT), with 62QE being the only eplet present on all alleles. In conclusion, low MFI levels in antibodies considered low risk could be important in posttransplant humoral rejection, although the patient's renal function can be restored. Thus, specific shared eplets should always be investigated with respect to previous transplant mismatches.

Cuidados de enfermería en la implantación, mantenimiento y retirada del balón de contrapulsación intraaórtica / Nursing care in the contrapulsation balloon implantation, maintenance and withdrawal

El balón de contrapulsación intraaórtica es utilizado como mecanismo de soporte circulatorio en pacientes con fallo cardíaco secundario a diversas causas. Al ser un dispositivo que requiere vigilancia continua, es utilizado principalmente en unidades de cuidados intensivos. Inflando y desinflando el balón intraaórtico se incrementa el riesgo coronario y mejora la función cardíaca. Es muy importante una buena sincronización entre la contrapulsación y el latido cardíaco del paciente. Los cuidados de enfermería durante todo el proceso se dirigen especialmente a la prevención de complicaciones originadas por el dispositivo: tromboembolismo, hemorragia, isquemia del miembro o de órganos vitales, riesgo de infección (AU)

[Nursing care in the contrapulsation balloon implantation, maintenance and withdrawal]. / Cuidados de enfermería en la implantación, mantenimiento y retirada del balón de contrapulsación intraaórtica.

Intraaortic pump is used as a mechanical circulatory support device for patients with heart failure by means of a lot of causes. Because it requires constant attention is used mainly in intensive care units. By inflating and deflating intraaortic balloon increases flow to coronary circulation and relieves some of the hearts workload. A good synchronization between counterpulsation and the patients heartbeat is very important. Nursing cares during this process tries to prevent complications originated by the device: blood clots, haemorrhage, visceral or limb ischemia, risk of infection.