High chromosomal mobility of rDNA clusters in holocentric chromosomes of Triatominae, vectors of Chagas disease (Hemiptera-Reduviidae).

The subfamily Triatominae (Hemiptera-Reduviidae) includes more than 150 blood-sucking species, potential vectors of the protozoan Trypanosoma cruzi, causative agent of Chagas disease. A distinctive cytogenetic characteristic of this group is the presence of extremely stable chromosome numbers. Unexpectedly, the analyses of the chromosomal location of ribosomal gene clusters and other repetitive sequences place Triatominae as a significantly diverse hemipteran subfamily. Here, we advance the understanding of Triatominae chromosomal evolution through the analysis of the 45S rDNA cluster chromosomal location in 92 Triatominae species. We found the 45S rDNA clusters in one to four loci per haploid genome with different chromosomal patterns: On one or two autosomes, on one, two or three sex chromosomes, on the X chromosome plus one to three autosomes. The movement of 45S rDNA clusters is discussed in an evolutionary context. Our results illustrate that rDNA mobility has been relatively common in the past and in recent evolutionary history of the group. The high frequency of rDNA patterns involving autosomes and sex chromosomes among closely related species could affect genetic recombination and the viability of hybrid populations, which suggests that the mobility of rDNA clusters could be a driver of species diversification.

Short-term atorvastatin therapy improves arterial stiffness of middle-aged systemic lupus erythematosus patients with pathological pulse wave velocity.

Objectives Statins have been proposed as a potential treatment for systemic lupus erythematosus (SLE) due to their immunomodulatory properties, their role restoring endothelial function and preventing atherosclerosis. We evaluate the effect of a short period treatment with a low dose of atorvastatin and its withdrawal on early stage subclinical atherosclerosis. Methods Thirty-seven SLE females received 20 mg/day atorvastatin during eight weeks. At baseline, at the end of treatment and six months after atorvastatin withdrawal, disease activity, subclinical atherosclerosis -assessed by measuring carotid-femoral pulse wave velocity (PWV) - and quantification of circulating endothelial progenitor cells (EPC) - as a surrogate biological marker of subclinical atherosclerosis - were carried out. Results The group of SLE patients with baseline pathological arterial stiffness showed a significant decrease of PWV after atorvastatin therapy (8.43 ± 1.45 m/s vs 7.42 ± 1.06 m/s; p = 0.002) that is maintained six months after treatment finished. Only patients of the middle-aged group showed a nearly significant decrease in the PWV measured along the study (7.16 ± 1.23 m/s vs 6.76 ± 0.82 m/s; p = 0.05). Atorvastatin induced a significant decrease in the circulating EPC percentage (0.65 ± 0.67 vs 0.40 ± 0.31; p = 0.023) as well as a downward trend of disease activity that it is observed by a decrease in SLE disease activity index simultaneously with an increase in C3 complement and significant decrease in serum concentration of vascular endothelial grow factor (VEGF) and sVCAM-1. Conclusions Short-term atorvastatin therapy reduces arterial stiffness of SLE patients with baseline pathological PWV, who are mainly in the group of middle-aged patients. Further studies are needed to determine whether these patients would benefit from statin therapy in preventing cardiovascular events.

The use of ertapenem for the treatment of community-acquired pneumonia in routine hospital practice: a matched cohort study.

OBJECTIVE: The clinical response to ertapenem in community-acquired pneumonia (CAP) at the setting of routine hospital practice has been scarcely evaluated. METHODS: We retrospectively compared CAP cases treated with ertapenem or with other standard antimicrobials (controls) at a tertiary 1,434-bed center from 2005 to 2014. RESULTS: Out of 6,145 patients hospitalized with CAP, 64 (1%) ertapenem-treated and 128 controls were studied (PSI IV-V 72%, mean age 73 years.). A significant higher proportion of bedridden patients (41% vs. 21%), residence in nursing homes (19% vs. 7%), previous use of antibiotics (39% vs. 29%) and necrotizing (13% vs. 1%) or complicated (36% vs. 19%) pneumonia, was observed in the ertapenem vs. non-ertapenem patients. Initial treatment with ertapenem was independently associated with an earlier resolution of signs of infection. In patients aged 65 or older the independent risks factors for mortality were: PSI score (7.0, 95%CI 1.8-27.7), bedridden status (4.6, 95%CI 1.1-20.9) and Health Care Associated Pneumonia (HCAP) (4.6, 95%CI 1.3-16.5). First-line treatment with ertapenem was an independent protector factor in this subgroup of patients (0.1, 95%CI 0.1-0.7). CONCLUSIONS: Ertapenem showed a superior clinical response in frail elderly patients with complicated community-acquired pneumonia, and it may be considered as a first-line therapeutic regimen in this setting.

Metabolic syndrome is associated with decreased circulating endothelial progenitor cells and increased arterial stiffness in systemic lupus erythematosus.

OBJECTIVES: Metabolic syndrome (MetS) is highly prevalent in patients with systemic lupus erythematosus (SLE) and it has been associated with increased cardiovascular risk. We examined the contribution of MetS to inflammatory markers, arterial stiffness and circulating endothelial progenitor cells (EPCs) as surrogates of subclinical atherosclerosis. METHODS: Cardiovascular risk factors, SLE-specific factors and peripheral blood EPCs were assessed in 50 female SLE patients. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III. Simultaneously, atherosclerosis was assessed by measuring the carotid-femoral pulse wave velocity (PWV) by doppler velocimetry. RESULTS: Beyond the factors included in the definition, SLE patients with MetS have a significantly higher serum level of uric acid (6.88 ± 2.20 vs 4.45 ± 1.17, p < 0.001) and some inflammatory biomarkers such as homocysteine, IL-8, sICAM-1 or complement molecules. The presence of MetS in our patients was closely linked with a significantly increased patient organ damage score (3.20 ± 1.97 vs 1.60 ± 1.67, p = 0.008), a decreased percentage of circulating EPCs (0.53 ± 0.24 vs 0.85 ± 0.57, p = 0.007) and an increased arterial stiffness (9.89 ± 2.40 vs 7.13 ± 1.51, p < 0.001). CONCLUSIONS: MetS may contribute to the development of atherosclerosis by significantly increasing inflammation levels and arterial stiffness and decreasing circulating EPCs. This finding would justify close monitoring of these patients.

High dynamics of rDNA cluster location in kissing bug holocentric chromosomes (Triatominae, Heteroptera).

In this paper, we determine by fluorescent in situ hybridization the variability in the chromosomal location of 45S rDNA clusters in 38 species belonging to 7 genera of the Triatominae subfamily, using a triatomine-specific 18S rDNA probe. Our results show a striking variability at the inter- and intraspecific level, never reported so far in holocentric chromosomes, revealing the extraordinary genomic dynamics that occurred during the evolution in this group of insects. Our results also demonstrate that the chromosomal position of rDNA clusters is an important marker to disclose chromosomal differentiation in species karyotypically homogenous in their chromosome number.

Valoración de actividades básicas de la vida diaria y de deterioro cognitivo en centenarios: concordancia entre las escalas utilizadas / Assessment of basic activities of daily living and cognitive impairment in centenarians: correlation between the scales used

Objetivo. Analizar la concordancia entre escalas de actividades básicas de la vida diaria (ABVD) y de deterioro cognitivo en centenarios. Método. Entrevista domiciliaria a todos los centenarios de nuestra área, cumplimentándose tres escalas de ABVD (índice de Katz [IK], índice de Barthel [IB] e índice de incapacidad física de la Cruz Roja [IFCR]), y dos de valoración de deterioro cognitivo (miniexamen cognoscitivo [MEC], y el índice de incapacidad psíquica de la Cruz Roja [IPCR]). Se valoró la concordancia mediante el índice kappa. Resultados. Se entrevistó a 80 centenarios, 26 hombres y 64 mujeres, media de edad, 100,8±1,3 años. Más de la mitad de los centenarios presentaron independencia funcional o dependencia leve, siendo los hombres independientes con más frecuencia (IB 70±34,4 frente a 50,4±36,3; p=0,005). Al valorar deterioro cognitivo, los resultados fueron discordantes, aunque los hombres presentaron menos deterioro cognitivo que las mujeres (MEC, 16,5±9,1 vs. 11,6±8,1; p=0,008). Los tres cuestionarios que miden ABVD (IK, IB, IFCR) clasificaron uniformemente a los centenarios; el IK y el IB clasifican igual al 95% de los centenarios (kappa, 0,899), el IB y el IFCR al 97,5% (kappa, 0,95) y el IK e IFCR al 97,5% (kappa, 0,95). La concordancia en los cuestionarios de deterioro cognitivo fue muy baja; se clasificaron igual al 58,8% de los centenarios (kappa, 0,295). Conclusiones. Cualquiera de las tres escalas de ABVD es útil en pacientes centenarios. Sin embargo, está por definir cómo valorar el deterioro cognitivo(AU)

Objective. To analyse the concordance between different scales used to assess basic activities of daily living and cognitive impairment in centenarians. Method. A domiciliary interview was carried out with all centenarians in our area. Three scales of basic activities of daily living (Katz index [KI], Barthel index [BI], Red Cross physical impairment index [RCPI]), and two of cognitive impairment assessment(Mini cognoscitive test [MCT], Red Cross psychic impairment index [RCPI]) were completed. Results. A total of 80 centenarians were interviewed, 26 men and 64 women, mean age 100.8±1.3. More than half of centenarians had functional independence or slight dependence. Men were more frequently independent than women (BI 70±34.4 vs. 50.4±36.3; P=.005). The results of cognitive impairment tests were discordant, although men had less cognitive impairment than women (MCT 16.5±9.1 vs. 11.6±8.1; P=.008). The three scales of basic activities of daily living uniformly classified the centenarians, with a high level of concordance between them: KI and BI similarly classified up to 95% of the centenarians (Kappa 0.899), BI and RCPI to 97.5% (kappa 0.95), KI and RCPI to 97.5% (Kappa 0.95). Nevertheless, the concordance between the cognitive impairment measured by RCPI and MCT was low; only 58.8% of centenarians were equally classified (Kappa 0.295). Conclusions. Any of three scales analysed for assessment of basic activities of daily living is useful in centenarians. Nevertheless, the best way to assess cognitive impairment in these patients needs to be defined(AU)

[Assessment of basic activities of daily living and cognitive impairment in centenarians: correlation between the scales used]. / Valoración de actividades básicas de la vida diaria y de deterioro cognitivo en centenarios: concordancia entre las escalas utilizadas.

OBJECTIVE: To analyse the concordance between different scales used to assess basic activities of daily living and cognitive impairment in centenarians. METHOD: A domiciliary interview was carried out with all centenarians in our area. Three scales of basic activities of daily living (Katz index [KI], Barthel index [BI], Red Cross physical impairment index [RCPI]), and two of cognitive impairment assessment(Mini cognoscitive test [MCT], Red Cross psychic impairment index [RCPI]) were completed. RESULTS: A total of 80 centenarians were interviewed, 26 men and 64 women, mean age 100.8±1.3. More than half of centenarians had functional independence or slight dependence. Men were more frequently independent than women (BI 70±34.4 vs. 50.4±36.3; P=.005). The results of cognitive impairment tests were discordant, although men had less cognitive impairment than women (MCT 16.5±9.1 vs. 11.6±8.1; P=.008). The three scales of basic activities of daily living uniformly classified the centenarians, with a high level of concordance between them: KI and BI similarly classified up to 95% of the centenarians (Kappa 0.899), BI and RCPI to 97.5% (kappa 0.95), KI and RCPI to 97.5% (Kappa 0.95). Nevertheless, the concordance between the cognitive impairment measured by RCPI and MCT was low; only 58.8% of centenarians were equally classified (Kappa 0.295). CONCLUSIONS: Any of three scales analysed for assessment of basic activities of daily living is useful in centenarians. Nevertheless, the best way to assess cognitive impairment in these patients needs to be defined.

[25 years experience in cerebrospinal shunt. Are new systems better?]. / 25 años de experiencia en válvulas de derivación ventrículo-peritoneal. Son mejores los nuevos sistemas?

INTRODUCTION: Since the introduction of the first ventricular shunt in 1949, the cerebrospinal shunts are the most used choice for the management of hydrocephalus in children. With the technological advance, systems have been developing increasingly sophisticated. Our aim is to study the incidence of complications after the implantation of these shunts and the variables associated to it. MATERIAL AND METHODS: We perform a retrospective study between 1981 and 2006, gathering the patients between 0 and 15 years treated at our Hospital for the placement of a cerebrospinal shunt or as consequence of a problem of the device. We analyze the tipe of shunt (Hakim, Pudentz, Delta, Orbis-Sigma, Strata, Codman), etiology of hydrocephalus, age, immediate and late complications, permanence of the system, changes of the system and cerebrospinal fluid. The qualitative data were analyze by c2 test. We also estimate survival of shunts with Kaplan-Meier stimator and make a multivariant Cox regression analysis. RESULTS: A total of 75 patients. The main etiology for hydrocephalous was myelomeningocele, followed by congenital and posthemorrhagic. Most of the patients presented complications of the system in the follow-up. They were adjusted for age, sex, etiology, shunt and surgeon. The variable that had an independent effect for predicting the presence of a complication was the type of shunt, being the most ancient systems those with major survival. The most frequent complication in the immediate period (< 3 month) was the obstruction and infection of the proximal catheter or shunt. Distal catheter disconnection or break prevailed in the late one. We got few functional complications, these were not related with the type of shunt. CONCLUSIONS: In our experience, the shunts with the less short-term probability of complication (< 3 months) have been old simple systems like Hakim and Pudentz. The functional complications, that are those which presumably should be reduced by the new programmable systems, don,t seem do it, neither mean longer survival of the system.

25 años de experiencia en válvulas de derivación ventrículo-peritoneal. ¿Son mejores los nuevos sistemas? / 25 years experience in cerebrospinal shunt. Are new systems better?

Introducción. Desde la introducción del primer shunt ventricular en 1949, las válvulas de derivación ventrículo-peritoneal constituyen la forma de derivación más utilizada en niños y adultos con hidrocefalia. Con el avance tecnológico se han ido desarrollando sistemas cada vez más sofisticados. Nuestro objetivo es determinar la incidencia de complicaciones tras la implantación de válvulas ventrículo-peritoneales y las variables asociadas a las mismas. Material y métodos. Realizamos un estudio retrospectivo entre1981 y 2006, recogiendo a los pacientes entre 0 y 15 años ingresados en nuestro Hospital para colocación de válvula de derivación o como consecuencia de un problema del dispositivo. Realizamos una recogida de datos incluyendo tipo de válvula (Hakim®, Pudenz®, Delta®, Orbis-Sigma®, Strata®, Codman®), causas de la hidrocefalia, edad, complicaciones inmediatas y tardías, durabilidad de los sistemas, recambios,análisis de LCR. La asociación de variables cualitativas se realizó por medio del estadístico Chi cuadrado. Se hizo a su vez un análisis de supervivencia con la metología Kaplan-Marie y un análisis multivariado de regresión de Cox. Realizamos además una revisión bibliográfica al respecto. Resultados. Se recogieron 75 pacientes. La causa más frecuente de hidrocefalia ha sido la espina bífida, seguida de malformaciones congénitas y hemorragia intraventricular. La mayoría presentan complicaciones en el seguimiento. Ajustando por edad y por tipo de válvula la variable que tiene un efecto independiente para predecir la presencia de una complicación es el tipo de válvula, siendo los sistemas más antiguos los de mayor supervivencia. El sexo y la edad no modifican dicha probabilidad. La complicación más frecuente fue de tipo obstructivo e infeccioso en el período precoz y desconexión-rotura del catéter distal en el tardío. Las complicaciones funcionales fueron escasas y no dependieron del tipo de válvula. Conclusiones. Las válvulas con menos probabilidad a corto plazo de presentar complicaciones (< de 3 meses) han resultado ser los antiguos sistemas Hakim® y Pudenz®. Las complicaciones funcionales, que son las que presumiblemente evitarían los nuevos sistemas, no parecen mejorar con ellos y no conllevan una mayor supervivencia del sistema (AU)

Introduction. Since the introduction of the first ventricular shunt in 1949, the cerebrospinal shunts are the most used choice for the management of hydrocephalus in children. With the technological advance, systems have been developing increasingly sophisticated. Our aim is to study the incidence of complications after the implantation of these shunts and the variables associated to it. Material and methods. We perform a retrospective study between1981 and 2006, gathering the patients between 0 and 15 years treated at our Hospital for the placement of a cerebrospinal shunt or as consequence of a problem of the device. We analyze the type of shunt (Hakim®,Pudentz®, Delta®, Orbis-Sigma®, Strata®, Codman®), etiology of hydrocephalus, age, immediate and late complications, permanence of the system, changes of the system and cerebrospinal fluid. The qualitative data were analyze by c2 test. We also estimate survival of shunts with Kaplan-Meier stimator and make a multivariant Cox regression analysis. Results. A total of 75 patients. The main etiology for hydrocephalous was myelomeningocele, followed by congenital and posthemorrhagic. Most of the patients presented complications of the system in the follow-up. They were adjusted for age, sex, etiology, shunt and surgeon. The variable that had an independent effect for predicting the presence of a complication was the type of shunt, being the most ancient systems those with major survival. The most frequent complication in the immediate period (< 3 month) was the obstruction and infection of the proximal catheter or shunt. Distal catheter disconnection or break prevailed in the late one. We got few functional complications, these were not related with the type of shunt. Conclusions. In our experience, the shunts with the less short-term probability of complication (< 3 months) have been old simple systems like Hakim® and Pudentz® The functional complications, that are those which presumably should be reduced by the new programmable systems, don’t seem do it, neither mean longer survival of the system (AU)

Control of diabetes and cardiovascular risk factors in patients with type 2 diabetes in primary care. The gap between guidelines and reality in Spain.

To evaluate the level and factors affecting control of diabetes and cardiovascular risk factors in type 2 diabetes (TYPE 2 DM) patients. Multicentre cross-sectional study: a sample of 430 primary care practices across Spain selected 1907 type 2 diabetic patients. The first five consecutive ambulatory patients with TYPE 2 DM were eligible for the inclusion into the survey. Patients were free of known cardiovascular disease (CVD). Control criteria were defined based on 2002 American Diabetes Association (ADA) clinical practice recommendations. A total of 1907 patients (51% women) aged 63 +/- 9 years. Smoking prevalence was 22.6%, 50.6% had levels of A1c < 7%. Mean blood pressure (BP) was 148 +/- 17/86 +/- 10 mmHg. Only 7.8% have achieved the target of BP < 130/80 mmHg. Among the 1180 patients (65%) treated for hypertension, this target was attained in only 4.4% of patients. A measurement for low-density lipoprotein (LDL) cholesterol was available in 1669 patients (88%). Only 5.9% of patients achieved the target of LDL < 100 mg/dl. Among the 638 patients (41.6%) on drug treatment for dyslipidaemia, this target was attained in only 5.6% of patients. Among type 2 diabetic patients in Spain the prevalence of cardiovascular risk factors is high. Control of glycaemia, smoking, BP and LDL are far from optimal despite the widespread use of guidelines for the management of diabetes and CVD. The application of published recommendations needs to be reinforced.

[Renal transplantation in the northwest of Spain: analysis of the activity in the region of Galicia]. / Trasplante renal en el noroeste español. Análisis de la actividad en la Comunidad Autnoma de Galicia.

BACKGROUND: Spain is the world leader in organ transplant rates, and the national average is maintained in the northwestern Spanish region of Galicia. However, there is no official registry recording transplantation results in this region. In this paper we report a study of patient and graft survival and risk factors among kidney transplant patients in Galicia between January 1996 and December 2000. METHODS: Patients receiving kidney transplants in Galicia in the above period were monitored up to the end of 2001, deaths and graft losses were recorded and analysed by actuarial and Kaplan-Meier methods, and possible risk factors for death and graft loss were evaluated using Cox's proportional hazards model. RESULTS: In the study period, 672 kidneys were transplanted, all from deceased donors. Graft and patient survival rates were respectively 80% and 94% after 1 year, and 67% and 83%, after 5 years. Two-thirds of graft losses occurred within the first year and the most common cause was vascular thrombosis (44%). Independent risk factors for graft loss were donor asystole (relative risk [RR] = 3.41, 95% confidence interval [CI]: 1.73-6.73), donor age (RR = 1.54, CI: 1.05-2.27 for 40-60-year-olds, RR = 2.59, CI: 1.66-4.07 for over-60s, relative to under-40s), donation from outside the institution in which implant was performed (RR = 1.43, CI: 1.02-2.02), acute rejection (RR = 2.32, CI: 1.63-3.22), and retransplantation (RR = 1.56, CI: 1.03-2.37). The main causes of death were infections (38%), followed by cardiovascular pathologies (30%) and tumours (11%). CONCLUSIONS: The kidney transplant rate varies excessively within Galicia; the global rate is 50 per million inhabitants per year. Patient survival is similar to those recorded in national registers, but graft survival is deficient, apparently due to a high incidence of vascular thrombosis.

Trasplante renal en el noroeste español. Análisis de la actividad en la Comunidad Autónoma de Galicia / Renal transplantation in the northwest of spain: analysis of the activity in the region of Galicia

Introducción: España encabeza la actividad trasplantadora internacional y Galiciase sitúa en un nivel semejante; sin embargo, la ausencia de registros oficialesimpide tener conocimiento de los resultados en esta Comunidad Autónoma.Por ello, analizamos el trasplante renal en Galicia en los últimos años, para determinarsus resultados en cuanto a supervivencia y factores de riesgo.Metodología: Seguimiento, entre uno y seis años, de los trasplantes realizadosen Galicia entre enero-1996 y diciembre-2000, analizando pérdidas de injertos ypacientes en función de distintas variables relacionadas con receptor y donante.Para estudiar la supervivencia se utilizaron los métodos actuarial y de Kaplan-Meier, y para evaluar factores de riesgo, el modelo de riesgos proporcionales deCox.Resultados: Se realizaron 672 trasplantes, todos procedentes de donante cadáver,siendo la supervivencia del injerto del 80% y 67% después de uno y cincoaños; mientras que la del paciente fue del 94% y 83%. El 67% de las pérdidasde injerto se producen en los primeros doce meses, siendo la causa más frecuentela trombosis vascular (44%). Los factores de riesgo independientes para la pérdidadel injerto fueron donación en asistolia (riesgo relativo [HR] = 3,41; intervalode confianza al 95% [CI]: 1,73-6,73); edad del donante (RR = 1,54, IC: 1,05-2,27 entre 40-60 años; RR = 2,59, CI: 1,66-4,07 en mayores de 60; siempre enrelación a los menores de 40); injerto generado en hospital no trasplantador (RR= 1,43; CI: 1,02-2,02); rechazo agudo (RR = 2,32; CI: 1,63-3,22) y retrasplante(RR = 1,56; CI: 1,03-2,37). Las infecciones fueron la principal causa de muerte(38%), seguidas de patologías cardiovasculares (30%) y tumores (11%).Conclusiones: La tasa de trasplantes, aunque con significativas diferencias territoriales,es de 50 por millón de población y la supervivencia del paciente es comparablea la de cualquier registro internacional; sin embargo, la supervivencia delinjerto, posiblemente debido a elevada incidencia de trombosis vascular, es manifiestamentemejorable

Background: Spain is the world leader in organ transplant rates, and the nationalaverage is maintained in the northwestern Spanish region of Galicia. However,there is no official registry recording transplantation results in this region. In thispaper we report a study of patient and graft survival and risk factors among kidneytransplant patients in Galicia between january 1996 and december 2000.Methods: Patients receiving kidney transplants in Galicia in the above periodwere monitored up to the end of 2001, deaths and graft losses were recordedand analysed by actuarial and Kaplan-Meier methods, and possible risk factors fordeath and graft loss were evaluated using Cox’s proportional hazards model.Results: In the study period, 672 kidneys were transplanted, all from deceaseddonors. Graft and patient survival rates were respectively 80% and 94% after1 year, and 67% and 83% after 5 years. Two-thirds of graft losses occurred withinthe first year and the most common cause was vascular thrombosis (44%).Independent risk factors for graft loss were donor asystole (relative risk [RR] =3.41, 95% confidence interval [CI]: 1.73-6.73), donor age (RR = 1.54, CI: 1.05-2.27 for 40-60-year-olds, RR = 2.59, CI: 1.66-4.07 for over-60s, relative to under-40s), donation from outside the institution in which implant was performed (RR= 1.43, CI: 1.02-2.02), acute rejection (RR = 2.32, CI: 1.63-3.22), and retransplantation(RR = 1.56, CI: 1.03-2.37). The main causes of death were infections(38%), followed by cardiovascular pathologies (30%) and tumours (11%).Conclusions: The kidney transplant rate varies excessively within Galicia; the globalrate is 50 per million inhabitants per year. Patient survival is similar to thoserecorded in national registers, but graft survival is deficient, apparently due to ahigh incidence of vascular thrombosis

Trasplante renal en el noroeste español. Análisis de la actividad en la Comunidad Autónoma de Galicia / Renal transplantation in northwestern Spain

Introducción: España encabeza la actividad trasplantadora internacional y Galicia se sitúa en un nivel semejante; sin embargo, la ausencia de registros oficiales impide tener conocimiento de los resultados en esta Comunidad Autónoma. Por ello, analizamos el trasplante renal en Galicia en los últimos años, para determinar sus resultados en cuanto a supervivencia y factores de riesgo. Metodología: Seguimiento, entre uno y seis años, de los trasplantes realizados en Galicia entre enero-1996 y diciembre-2000, analizando pérdidas de injertos y pacientes en función de distintas variables relacionadas con receptor y donante. Para estudiar la supervivencia se utilizaron los métodos actuarial y de Kaplan- Meier, y para evaluar factores de riesgo, el modelo de riesgos proporcionales de Cox. Resultados: Se realizaron 672 trasplantes, todos procedentes de donante cadáver, siendo la supervivencia del injerto del 80% y 67% después de uno y cinco años; mientras que la del paciente fue del 94% y 83%. El 67% de las pérdidas de injerto se producen en los primeros doce meses, siendo la causa más frecuente la trombosis vascular (44%). Los factores de riesgo independientes para la pérdida del injerto fueron donación en asistolia (riesgo relativo [HR] = 3,41; intervalo de confianza al 95% [CI]: 1,73-6,73); edad del donante (RR = 1,54, IC: 1,05- 2,27 entre 40-60 años; RR = 2,59, CI: 1,66-4,07 en mayores de 60; siempre en relación a los menores de 40); injerto generado en hospital no trasplantador (RR = 1,43; CI: 1,02-2,02); rechazo agudo (RR = 2,32; CI: 1,63-3,22) y retrasplante (RR = 1,56; CI: 1,03-2,37). Las infecciones fueron la principal causa de muerte (38%), seguidas de patologías cardiovasculares (30%) y tumores (11%). Conclusiones: La tasa de trasplantes, aunque con significativas diferencias territoriales, es de 50 por millón de población y la supervivencia del paciente es comparable a la de cualquier registro internacional; sin embargo, la supervivencia del injerto, posiblemente debido a elevada incidencia de trombosis vascular, es manifiestamente mejorable

Background: Spain is the world leader in organ transplant rates, and the national average is maintained in the northwestern Spanish region of Galicia. However, there is no official registry recording transplantation results in this region. In this paper we report a study of patient and graft survival and risk factors among kidney transplant patients in Galicia between january 1996 and december 2000. Methods: Patients receiving kidney transplants in Galicia in the above period were monitored up to the end of 2001, deaths and graft losses were recorded and analysed by actuarial and Kaplan-Meier methods, and possible risk factors for death and graft loss were evaluated using Cox’s proportional hazards model. Results: In the study period, 672 kidneys were transplanted, all from deceased donors. Graft and patient survival rates were respectively 80% and 94% after 1 year, and 67% and 83% after 5 years. Two-thirds of graft losses occurred within the first year and the most common cause was vascular thrombosis (44%). Independent risk factors for graft loss were donor asystole (relative risk [RR] = 3.41, 95% confidence interval [CI]: 1.73-6.73), donor age (RR = 1.54, CI: 1.05- 2.27 for 40-60-year-olds, RR = 2.59, CI: 1.66-4.07 for over-60s, relative to under- 40s), donation from outside the institution in which implant was performed (RR = 1.43, CI: 1.02-2.02), acute rejection (RR = 2.32, CI: 1.63-3.22), and retransplantation (RR = 1.56, CI: 1.03-2.37). The main causes of death were infections (38%), followed by cardiovascular pathologies (30%) and tumours (11%). Conclusions: The kidney transplant rate varies excessively within Galicia; the global rate is 50 per million inhabitants per year. Patient survival is similar to those recorded in national registers, but graft survival is deficient, apparently due to a high incidence of vascular thrombosis

Varón de 25 años con debilidad muscular y alteraciones electrocardiográficas tras ejercicio físico / 25-year-old male with muscular weakness and electrocardiographic changes after exercise

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