RESUMO
INTRODUCTION: There are insufficient data regarding the efficacy and safety of vaccination in patients with auto-immune disease (AID) and/or drug-related immune deficiency (DRID). The objective of this study was to obtain professional agreement on vaccine practices in these patients. METHODS: A Delphi survey was carried out with physicians recognised for their expertise in vaccinology and/or the caring for adult patients with AID and/or DRID. For each proposed vaccination practice, the experts' opinion and level of agreement were evaluated. RESULTS: The proposals relating to patients with AID specified: the absence of risk of AID relapse following vaccination; the possibility of administering live virus vaccines (LVV) to patients not receiving immunosuppressants; the pertinence of determining protective antibody titre before vaccination; the absence of need for specific monitoring following the vaccination. The proposals relating to patients with DRID specified that a 3-6 month delay is needed between the end of these treatments and the vaccination with LVV. There is no contraindication to administering LVV in patients receiving systemic corticosteroids prescribed for less than two weeks, regardless of their dose, or at a daily dose not exceeding 10mg of prednisone, if this involves prolonged treatment. Out of 14 proposals, the level of agreement between the experts was "very good" for eleven, and "good" for the remaining three. CONCLUSION: Proposals for vaccine practices in patients with AID and/or DRID should aid with decision-making in daily medical practice and provide better vaccine coverage for these patients.
Assuntos
Doenças Autoimunes/imunologia , Doenças Autoimunes/terapia , Síndromes de Imunodeficiência/imunologia , Síndromes de Imunodeficiência/terapia , Vacinação/efeitos adversos , Vacinação/métodos , Corticosteroides/efeitos adversos , Adulto , Antineoplásicos/efeitos adversos , Prova Pericial , Humanos , Síndromes de Imunodeficiência/induzido quimicamente , Terapia de Imunossupressão/efeitos adversos , Imunossupressores/efeitos adversos , Inquéritos e Questionários , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Vacinação/estatística & dados numéricosAssuntos
Anticorpos/análise , Antígenos HLA/imunologia , Imunoglobulinas Intravenosas/uso terapêutico , Transplante de Rim/imunologia , Anticorpos/imunologia , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Humanos , ImunizaçãoAssuntos
Injúria Renal Aguda/induzido quimicamente , Glomerulosclerose Segmentar e Focal/induzido quimicamente , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/efeitos adversos , Injúria Renal Aguda/diagnóstico , Glomerulosclerose Segmentar e Focal/diagnóstico , Glomerulosclerose Segmentar e Focal/patologia , Humanos , Interferon-alfa/uso terapêutico , Masculino , Pessoa de Meia-IdadeRESUMO
Renal transplant vein thrombosis is an unusual event occurring in 0.3-3% of renal transplantations. Prognosis is uniformly poor with graft loss in nearly every case. We report here the first three cases of renal graft vein thrombosis successfully treated by percutaneous endoluminal thromboaspiration. After an initially uneventful course all recipients developed anuria and required hemodialysis. In two cases, an ultrasound examination suggested a diagnosis of venous thrombosis. Emergency arteriography and phlebography were performed, confirming the complete thrombosis of the graft veins. Thromboaspiration was carried out with full heparinization and led to renal function improvement in all cases. Grafts are still functioning 6 months after the procedure, with serum creatinine levels of 176 mumol/l, 120 mumol/l and 184 mumol/l, respectively. Thus, this procedure avoids surgical and anaesthetic risks and allows, if performed at an early stage, restoration of graft function. Great care must be taken to avoid vein wall damage, vascular suture line rupture, or pulmonary embolism.
Assuntos
Transplante de Rim , Complicações Pós-Operatórias , Veias Renais , Trombose Venosa/terapia , Adulto , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Sucção , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologiaAssuntos
Antivirais/uso terapêutico , Hepatite B Crônica/complicações , Hepatite B Crônica/tratamento farmacológico , Transplante de Rim , Lamivudina/uso terapêutico , Adulto , Antivirais/efeitos adversos , DNA Viral/sangue , Feminino , Vírus da Hepatite B/isolamento & purificação , Humanos , Lamivudina/efeitos adversos , Masculino , Pessoa de Meia-Idade , SegurançaRESUMO
OBJECTIVES: Ureteral necrosis is a rare complication of renal transplantation, and is seldom cured by endoscopic management alone. To avoid the potential hazard to the graft created by an open ureteral reconstruction in cases of renal transplant ureteral necrosis, we have appiled a new minimally invasive technique of total ureteral replacement, initially described for the palliative treatment of ureteral obstructions. The subcutaneous bypass technique is based on the use of a silicone-PTFE-bonded tube tunnelled underneath the skin. METHODS: Total ureteral replacement by subcutaneous pyelovesical bypass was performed in three renal transplant patients (two men and one woman; mean age 41 years, (range 23-58) years with ureteral necrosis after failure of primary endoscopic treatment. The ureteral lesion was distal necrosis in two patients, and a total necrosis in the other. Under general anaesthesia and fluoroscopic guidance, a percutaneous tract was created and progressively dilated. The ureteral prosthesis was introduced into the pyelocaliceal cavities through a 30 F Amplatz sheet, then subcutaneously tracked down to the suprapubic area, and introduced into the bladder via a short incision. RESULTS: There was no operative or postoperative morbidity. There was no obstruction, dislodgement or encrustation of the prosthesis. There were no bladder-related symptoms, or clinical reflux, and no abdominal wall complications. An asymptomatic episode of lower urinary tract infection (Staphylococcus epidermidis) was observed in the female patient. All the grafts were functioning with fine pyelocaliceal cavities, with a mean follow-up of 32 months (13-69 months). CONCLUSION: Total ureteral replacement by subcutaneous pyelovesical bypass is a simple and safe technique of ureteral reconstruction in renal transplantation. Late encrustation of the prosthesis may occur, and the prosthesis may need to be changed in such cases. Subcutaneous pyelovesical bypass can be regarded as an alternative to an open procedure to treat ureteral necrosis after renal transplantation.
Assuntos
Órgãos Artificiais , Transplante de Rim/efeitos adversos , Ureter , Doenças Ureterais/patologia , Doenças Ureterais/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Procedimentos Cirúrgicos Urológicos/métodosAssuntos
Hiperoxalúria Primária/cirurgia , Transplante de Rim , Transplante de Fígado , Calcinose/diagnóstico por imagem , Feminino , Humanos , Hiperoxalúria Primária/classificação , Hiperoxalúria Primária/diagnóstico por imagem , Pessoa de Meia-Idade , Nefrocalcinose/cirurgia , Radiografia , Recidiva , ReoperaçãoRESUMO
PURPOSE: We applied a new minimally invasive technique of artificial ureteral replacement for renal transplant ureteral necrosis. MATERIALS AND METHODS: Artificial ureteral replacement was performed in 3 renal transplant recipients with ureteral necrosis (complete in 1 and distal in 2) after failure of primary endoscopic treatment. Under fluoroscopic guidance a percutaneous tract is created and progressively dilated. The ureteral silicone polytetrafluoroethylene bonded tube is introduced into the pyelocaliceal renal graft cavities, tracked subcutaneously down to the suprapubic area and introduced into the bladder via a short incision. RESULTS: There were no immediate postoperative complications except for transient postoperative acute prostatitis in 1 patient. No secondary complications were observed with a mean followup of 2.5 years. All grafts have good late function and all tubes are patent with no evidence of encrustation or obstruction. The tubes are well tolerated underneath the skin. Reflux was present in all 3 cases with no clinical manifestation. An asymptomatic episode of lower urinary tract infection was observed in the female patient. CONCLUSIONS: In select cases of ureteral necrosis after renal transplantation artificial ureteral replacement by subcutaneous pyelovesical bypass offers a possible alternative to open ureteral reconstruction.
Assuntos
Transplante de Rim , Complicações Pós-Operatórias , Próteses e Implantes , Ureter/patologia , Adulto , Feminino , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Necrose , Ureter/cirurgiaAssuntos
Anticorpos Monoclonais/uso terapêutico , Herpesvirus Humano 4 , Transplante de Rim , Linfoma de Células B/terapia , Transtornos Linfoproliferativos/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Antígenos CD/análise , Feminino , Humanos , Terapia de Imunossupressão/métodos , Transplante de Rim/imunologia , Linfoma de Células B/diagnóstico por imagem , Linfoma de Células B/imunologia , Transtornos Linfoproliferativos/diagnóstico por imagem , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico por imagem , Leucemia-Linfoma Linfoblástico de Células Precursoras/imunologia , Tomografia Computadorizada por Raios XAssuntos
Antineoplásicos/uso terapêutico , Ciclofosfamida/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim , Neoplasias Ovarianas/tratamento farmacológico , Evolução Fatal , Feminino , Humanos , Falência Renal Crônica/cirurgia , Transplante de Rim/imunologia , Pessoa de Meia-Idade , Neoplasias Ovarianas/complicações , Doenças Renais Policísticas/cirurgiaRESUMO
Hematophagocytic histiocytosis is a clinicopathologic syndrome associating fever, liver dysfunction, blood cytopenia and coagulation abnormalities with hematophagocytosis in bone marrow and lymphoïd organs. This syndrome is found in immunocompromized patients and is triggered by infection. We describe herein the first 2 cases of HH in renal transplant recipients treated with ciclosporin. In our 1st case, H.H. was not recognized early and the patient died. In the 2nd case, prompt diagnosis associated to an anti-infectious treatment led to recovery. The clinician must thus be aware of the possibility of such a syndrome in renal transplant patients. Identification and treatment of the underlying infection is mandatory to avoid a fatal outcome.
Assuntos
Ciclosporina/uso terapêutico , Histiocitose de Células não Langerhans/etiologia , Transplante de Rim , Adulto , Medula Óssea/patologia , Evolução Fatal , Histiócitos/patologia , Histiocitose de Células não Langerhans/patologia , Humanos , Tecido Linfoide/patologia , Masculino , Pessoa de Meia-Idade , FagocitoseAssuntos
Epinefrina , Transplante de Rim/patologia , Transplante de Rim/fisiologia , Necrose Tubular Aguda/epidemiologia , Doadores de Tecidos , Creatinina/sangue , Diurese , Humanos , Necrose Tubular Aguda/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Terapia de Imunossupressão/efeitos adversos , Imunossupressores/efeitos adversos , Pneumatose Cistoide Intestinal/induzido quimicamente , Síndrome da Imunodeficiência Adquirida/complicações , Adulto , Quimioterapia Combinada , Humanos , Imunossupressores/uso terapêutico , Transplante de Rim , Masculino , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/etiologia , Radiografia , Linfócitos T/imunologiaAssuntos
Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/terapia , Imunoterapia , Neoplasias Renais/secundário , Neoplasias Renais/terapia , Transplante de Rim/imunologia , Adjuvantes Imunológicos/uso terapêutico , Carcinoma de Células Renais/cirurgia , Humanos , Imunossupressores/uso terapêutico , Falência Renal Crônica/cirurgia , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
Renal failure following transplantation can be classified in two groups: initial non function characterized by the absence of renal function after transplantation and delayed secondary non function after an initial improvement. In the first group, the most frequent etiology is an acute tubular necrosis (30 to 50% of the cases) which usually heals within three weeks. Arterial thrombosis are rare but of very bad prognosis. In the second group, the most frequent cases are acute rejection, urological complications, renal artery stenosis, urinary infections and cyclosporine, intoxication. Diagnostic imaging, and especially the color Doppler flow, is very effective in obtaining diagnosis. Vascular or urological complications are to be confirmed by contrasted opacifications. In the absence of vascular or urological obstruction renal failure must be related to a renal parenchymal disease. This may be acute tubular necrosis, a rejection, a pyelonephritis or a medicinal intoxication depending on clinical symptoms, the time of their apparition and the results of biological examinations.