Early Vascular Thrombosis After Kidney Transplantation: Can We Predict Patients at Risk?

BACKGROUND: Renal transplant is the therapy of choice for patients with chronic renal disease. In recent years, improvement in immunosuppressive drugs reduced early graft loss associated with acute rejection. However, vascular thrombosis, accounting for 5% of early graft loss, can sensitize the recipient for human leukocyte antibodies, reducing the chance for a second transplant. The aim of this study was to identify risk factors for vascular thrombosis in a single transplant center, to design specific prevention protocol. METHODS: This was a retrospective, case-control study. From the Renal Transplant Unit database, we identified 21 cases of vascular thrombosis in recipients of kidneys from deceased donors. Recipients from the contralateral kidney from the same donor, without vascular complications, were assigned to the control group. Data analyzed included donor, recipient, transplant surgery, and post-operative follow-up. The local ethics committee approved the protocol. RESULTS: Thrombosis and control groups were comparable for recipient characteristics, cold ischemia time, organ side (right or left), and site of arterial anastomosis. We observed an increased risk for vascular thrombosis in kidneys with multiple veins (odds ratio, 11.32; P = .03). Organ retrieval surgery complications, such as vascular lesions or heterogeneous perfusion, despite normal pre-implantation biopsy, were considered risk factors for vascular thrombosis within the first post-operative day (odds ratio, 7.1; P = .03). CONCLUSIONS: In this series, multiple renal vein and organ retrieval surgery complications were risk factors for early vascular thrombosis.

Excessive Pap smears due to opportunistic cervical cancer screening.

The study aimed to analyze the Pap smears carried out for cervical cancer screening according to Ministry of Health guidelines. All smear tests carried out within the public health system in Campinas in 2003 were analyzed. All tests that did not conform to the guidelines were considered excessive. The guidelines recommend screening once every three years for all women aged 25 to 59 after they have received two negative smears. This study showed that the majority of women initiated screening prior to 25 years of age and the periodicity was predominantly annual, followed by biannual tests. In conclusion, 63.4% of tests were excessive. The screening coverage was 14.76%, but if all the tests had been performed as recommended, the final coverage over three years could have reached 65.4%. Thus it is possible to increase the coverage with the available resources since the screening works like an organized program.