ABSTRACT
OBJECTIVES: Poor adherence to immunosuppressive treatment is common in patients with systemic lupus erythematosus and may identify those with lupus nephritis (LN) who have a poorer prognosis. Non-adherence has also been reported to be a potential adverse outcome predictor in renal transplantation (rTp). We investigated whether non-adherence is associated with increased rTp graft rejection and/or failure in patients with LN. METHODS: Patients with LN undergoing rTp in two major London hospitals were retrospectively included. Medical and electronic records were reviewed for documented concerns of non-adherence as well as laboratory biochemical drug levels. The role of non-adherence and other potential predictors of graft rejection/failure including demographics, comorbidities, age at systemic lupus erythematosus and LN diagnosis, type of LN, time on dialysis prior to rTp and medication use were investigated using logistic regression. RESULTS: Out of 361 patients with LN, 40 had rTp. During a median follow-up of 8.7 years, 17/40 (42.5%) of these patients had evidence of non-adherence. A total of 12 (30.0%) patients experienced graft rejection or failure or both. In the adherent group 2/23 (8.7%) had graft rejection, whilst in the non-adherent this rose to 5/17 (29.4%, p = 0.11). Graft failure was seen in 5/23 (21.7%) patients from the adherent group and 4/17 (23.5%) in the non-adherent group ( p = 0.89). Non-adherent patients had a trend towards increased graft rejection, hazard ratio 4.38, 95% confidence interval = 0.73-26.12, p = 0.11. Patients who spent more time on dialysis prior to rTp were more likely to be adherent to medication, p = 0.01. CONCLUSION: Poor adherence to immunosuppressive therapy is common and has been shown to associate with a trend towards increased graft failure in patients with LN requiring rTp. This is the first paper to report that shorter periods on dialysis prior to transplantation might lead to increased non-adherence in lupus patients.
Subject(s)
Immunosuppressive Agents/therapeutic use , Kidney Failure, Chronic/surgery , Kidney Transplantation , Lupus Nephritis/therapy , Medication Adherence/statistics & numerical data , Adult , Disease Progression , Female , Graft Rejection , Graft Survival , Humans , Logistic Models , London , Lupus Erythematosus, Systemic , Male , Middle Aged , ROC Curve , Renal Dialysis , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
El edema pulmonar agudo por presión negativa es una causa importante de edema pulmonar que se desarrolla inmediatamente después de la extubación. Se expone el caso de una paciente con antecedentes importantes de alergia a múltiples medicamentos, programada para colecistectomía laparoscópica que, de manera inmediata, después de la extubación, desarrolló un laringoespasmo que evolucionó a edema agudo de pulmón con insuficiencia respiratoria aguda que requirió ventilación mecánica. El cuadro evolucionó favorablemente y se resolvió en las 72 horas posteriores a la cirugía (AU)
Negative presure pulmonary edema is an important cause of pulmonary edema that takes place inmediately after the extubation. We describe the case of a patient with history of multiple medications allergies. She was admitted outpatient laparoscopic colecystectomy and immediately after extubation she developed a laryngospasm wich envolved acute pulmonary edema with severe acute respiratory failure and she required mechanic ventilation. The patient was discharge after 72 hours (AU)
