Development of Ureteral Stenosis/Obstruction in Kidney Transplant.

This retrospective study describes the incidence and prevalence of ureteral stenosis/obstruction (US/O) in a cohort of 334 renal transplants recipients in our center over the last 5 years and evaluates the risk factors that may influence the occurrence of US/O. The parameters studied included the following: history of prostate disease, smoking, urinary tract infection, renal lithiasis, ureterovesical reflux, presence and level of polar artery, type of ureterovesical anastomosis, delayed graft function, double J catheter, lymphocele, urinoma, acute rejection, prolonged catheterization, post-transplant infravesical obstruction and BK virus infection, age of the donor and recipient, and months on dialysis. Also evaluated were the nadir creatinine and instances of cold ischemia, asystole, reanastomosis, and double J catheter removal. The average incidence of US/O was 7.6% and was significantly correlated with factors of alteration of the uretero-bladder dynamics without finding a relation to vascular factors.

Cytomegalovirus Infection Monitoring Based on Interferon Gamma Release Assay in Kidney Transplantation.

BACKGROUND: Cytomegalovirus (CMV) is the most common viral infection after kidney transplantation and is associated with significant morbidity and mortality. Recent studies showed that CMV-specific CD8+ T cells play the crucial role in protection against CMV. The Quantiferon-CMV (QF-CMV) is an interferon gamma (IFN-γ) release assay (IGRA test) that measures the IFN-γ response to a range of T-cell epitopes of CMV. In the present study, we analyzed the clinical utility of QF-CMV assay to predict CMV infection in kidney transplant recipients and evaluated if reactive result in QF-CMV test could be predictor of the duration of treatment. METHODS: We studied 75 renal transplant recipients who had IGRA testing just before transplantation. The donor and recipient variables were reported from the clinical history. The variables related to transplantation were collected from transplantation process data and included CMV infection or disease, CMV treatment, and immunosuppressive treatment. Laboratory variables were C3-C4 complement fractions and DNA quantification of CMV. RESULTS: Fifty percent of patients had CMV infection, and 35.9% had CMV disease. The time of negativization of CMV DNA was 56.61 ± 23.5 days. Univariate analysis related to CMV infection only showed a statistically significant relation with thymoglobulin treatment (P = .001). Statistically significant variables in relation with CMV infection incidence were donor serology (P = .044) and thymoglobulin treatment (P = .004). The probability of CMV infection was lower with positive IGRA assay (P = .025). CONCLUSION: We found that IFN-γ response measured by QF-MV is a protective factor against CMV infection in post-transplantation kidney recipients.

Treatment With Darbepoetin During the First Year After Renal Transplantation: The Starting Point.

INTRODUCTION: Multiple factors are associated with post-transplantation anemia, and renal function is the main factor. The aims of this study were to compare the evolution of hemoglobin in the first year post-transplantation according to darbepoetin (DA) treatment, and factors related to it, to evaluate the difference between earlier versus delayed treatment, and to describe the dose change pattern. PATIENTS AND METHODS: We describe a retrospective study of cohorts in 462 transplant recipients (2004-2011). The variables reported were from donor, transplantation recipient, and DA treatment. RESULTS: In this study, 67.5% of patients were treated with DA, 32.5% were not. The comparison of hemoglobin in both groups during the first year showed a similar evolution with significant differences between consecutive measures until the second trimester. The hemoglobin of the treated group was significantly lower. The evolution of renal function was not different. Multivariate analysis related DA treatment to delayed graft function (DGF) and albuminuria in the first year. Patients with early versus delayed DA introduction did not show a difference regarding length of treatment, but the total dose in the delayed introduction was lower. The evolution of creatinine and hemoglobin was similar in both groups. CONCLUSION: The introduction of DA was related to DGF and albuminuria. The delayed introduction of DA meant the following: less total dose than earlier introduction, no difference in length of treatment, and a similar evolution in hemoglobin and renal function in both groups. The lack of guidelines about DA treatment in renal transplantation makes it difficult to establish a pattern of dose adjustment.

Treatment with N-acetylcysteine in stable renal transplantation.

The primary cause of morbidity and mortality in renal transplantation is cardiovascular disease. Increased oxidative stress implies a greater degree of atherogenesis in these patients. N-acetylcysteine (NAC) which has a thiol group that is the source of l-cysteine and reduced glutathione, acts against atherosclerosis via a decrease in apoptosis, vasoconstriction, and endothelial dysfunction. Experimental models have examined the antioxidant effects of NAC during and after ischemia-reperfusion, but few studies have shown an effect in renal transplantation in human beings. In 8 months, we studied the effect of NAC treatment on oxidative stress, lipids, and renal function in 25 patients with stable renal function and no diabetes after transplantation. Data were collected on oxidative parameters: malondialdehyde, glutathione peroxidase, catalase, superoxide dismutase, glutathione reductase, lipid profile, and renal function (creatinine concentration, Cockroft-Gault formula, and Modified Diet in Renal Disease study). There were no significant differences in oxidative profile before and after treatment with NAC. The mean serum high-density lipoprotein cholesterol fraction increased after treatment and showed a significant positive correlation with glutathione peroxidase (r = 0.495). Serum creatinine concentration decreased, and Cockroft-Gault and Modified Diet in Renal Disease study estimates of renal function increased in the treatment period. In conclusion, NAC treatment in patients with stable renal function after transplantation increased high-density lipoprotein cholesterol and antioxidant molecules in relation to glutathione peroxidase, with a positive influence on renal function.

Effect of allocated radiotherapy after breast surgeries over death risk in early breast cancer patients: a meta-analysis.

Meta-analysis is a widely used tool to synthesize the results of a set of primary studies leading to more powerful conclusions than those provided by isolated ones. To evaluate the effect of allocated radiotherapy, types of breast surgery and other risk factors over death risk in early breast cancer patients, we carried out a meta-analysis using logistic regression attending to the dichotomous character of the outcome. Our findings suggest that the type of breast surgery is an effect modifier of the risk factors over death in early breast cancer patients. The effect of allocated radiotherapy is associated with a less risk of death only for patients who had mastectomy plus axillary sampling. The effect of a systemic treatment is not associated with death risk for patients who had breast conservation, on the contrary it is associated for those patients with mastectomy alone and with mastectomy with axillary clearance.