Assuntos
Anticorpos Monoclonais/uso terapêutico , Glucocorticoides/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Imunoglobulina G/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Metilprednisolona/uso terapêutico , Ácido Micofenólico/uso terapêutico , Tacrolimo/uso terapêutico , Doença Aguda , Adolescente , Adulto , Idoso , Anticorpos Monoclonais Humanizados , Cadáver , Criança , Pré-Escolar , Daclizumabe , Quimioterapia Combinada , Feminino , Humanos , Terapia de Imunossupressão , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/análogos & derivadosRESUMO
Of the 1,679 renal allografts performed at the University of Miami between January 1, 1979 and October 31, 1999, 1,154 were from cadaver donors (CAD), 515 were from living-related donors (LRD), and 10 were from living-unrelated donors. The 3 ethnic groups: Black Caribbean-African-American, Hispanic, and others were almost equally represented among recipients. Recipient ages ranged between 1-83 years. In the CAD group, HLA matching was emphasized so that no patient received a kidney with less than one DR match, and for the entire series a mean of 2.59 of 6 HLA antigens were matched between donors and recipients. Overall actuarial 20-year patient and graft survival rates were 65.3% and 30.7%, respectively, with 69.2% patient and 38.5% graft survival rates for LRD, and 65.6% patient and 29.0% graft survival rates for CAD recipients. Several factors adversely affected long-term graft outcome. African-Americans had an overall 20-year graft survival rate of 13.6% compared with 34% for non African-Americans (p < 0.001) (not dependent on patient survival). Diabetic patients had an overall 20-year graft survival rate of 13.5% versus 34.2% for non-diabetics (primarily dependent on patient survival). In the category of non African-American, non-diabetic patients under age 36 (n = 412), the 20-year patient survival rates in the LRD and CAD groups were 85.0% and 79.3%, respectively, and the graft survival rates were 55.7% and 46.5%, respectively. This differed markedly from the results for the entire series.
Assuntos
Transplante de Rim/estatística & dados numéricos , Adolescente , Adulto , Negro ou Afro-Americano , Idoso , População Negra , Cadáver , Criança , Florida , Seguimentos , Sobrevivência de Enxerto , Hospitais Universitários , Humanos , Transplante de Rim/mortalidade , Transplante de Rim/fisiologia , Pessoa de Meia-Idade , Grupos Raciais , Estudos Retrospectivos , Taxa de Sobrevida , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/organização & administração , Resultado do Tratamento , Listas de Espera , População BrancaAssuntos
Antígenos CD/análise , Células da Medula Óssea/imunologia , Células-Tronco Hematopoéticas/imunologia , Imunidade Celular , Imunofenotipagem/métodos , Linfócitos T/imunologia , Anticorpos Monoclonais , Células da Medula Óssea/citologia , Cadáver , Divisão Celular , Células Cultivadas , Análise por Conglomerados , Técnicas de Cocultura , Células-Tronco Hematopoéticas/citologia , Humanos , Teste de Cultura Mista de Linfócitos , Baço/imunologia , Linfócitos T/citologia , Linfócitos T Citotóxicos/imunologia , Doadores de TecidosAssuntos
Antígenos de Histocompatibilidade Classe I/genética , Homozigoto , Subpopulações de Linfócitos T/imunologia , Anticorpos Monoclonais , Antígenos CD/análise , Citometria de Fluxo/métodos , Fluoresceína-5-Isotiocianato , Antígenos HLA-A/genética , Antígenos HLA-B/genética , Antígenos de Histocompatibilidade Classe I/análise , Valores de ReferênciaAssuntos
Hispânico ou Latino , Doadores de Tecidos , Cadáver , Florida , Humanos , Rim , Obtenção de Tecidos e Órgãos/tendênciasAssuntos
Sobrevivência de Enxerto/imunologia , Transplante de Rim/imunologia , Análise Atuarial , Adolescente , Adulto , Idoso , Criança , Nefropatias Diabéticas/cirurgia , Rejeição de Enxerto/patologia , Rejeição de Enxerto/terapia , Sobrevivência de Enxerto/fisiologia , Antígenos HLA-DR/análise , Teste de Histocompatibilidade , Humanos , Imunossupressores/uso terapêutico , Transplante de Rim/mortalidade , Transplante de Rim/patologia , Masculino , Pessoa de Meia-Idade , Transplante de Pâncreas/imunologia , Taxa de SobrevidaRESUMO
At the University of Miami liver transplantation for chronic liver disease in HCV-positive patients has shown good results, with a 92% patients survival rate (follow up 8 to 57 months, median 21). None the less, we found that a large number of patients are expected to develop serious histological graft damage and may need retransplantation, which may place a further strain on the already scarce donor resources. We have conducted a preliminary investigation on the importance of parameters which may correlate with the prognosis of HCV grafts. We found no impact of HLA match or typing. An interesting hypothesis, which deserves further investigation, is that some HCV strains could be more virulent than others and play a role as an independent risk factor. We have identified six strains among our patients and the BK serotype shows a trend to be associated with a worse outcome. We have found that patients developing and maintaining higher liver enzyme levels (ALT and GGT) after transplant and those with higher levels of viremia may be at risk to develop serious damage to their grafts.
Assuntos
Hepacivirus/classificação , Hepatite C/cirurgia , Transplante de Fígado/estatística & dados numéricos , Adolescente , Adulto , Idoso , Alanina Transaminase/sangue , População Negra , Criança , Feminino , Florida , Seguimentos , Hepacivirus/isolamento & purificação , Hepacivirus/patogenicidade , Teste de Histocompatibilidade , Hospitais Universitários , Humanos , Transplante de Fígado/mortalidade , Transplante de Fígado/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Viremia/epidemiologia , População Branca , gama-Glutamiltransferase/sangueRESUMO
Long-term (10-year) results of kidney transplantation have been analyzed from this center with respect to several variables. In this report the influence of viral disease was added in studying the effect of cadaver versus living-related donor, recipient race, and compliance. Over all, 10-year actuarial patient and graft survival were 68% and 48%, respectively. Cytomegalovirus, hepatitis B and C, and HIV-1 were studied for their effects, and survival curves analyzed statistically. Although cadaver and living-related donor, recipient race, and compliance were 3 main variables influencing graft survival, these 4 viruses were not selective in their effects on any of them. Hepatitis B surface antigen positivity and hepatitis C antibody positivity did not influence overall mortality or graft survival. Only cytomegalovirus seronegative status was important (as opposed to seropositive status, which was not). Of seronegative patients only those receiving a kidney from a seropositive donor were adversely affected. The presence of HIV-1 antibody had an adverse effect on graft survival, but the question remains as to whether overall mortality in HIV seropositive patients is any worse than those receiving dialysis therapy.
Assuntos
Transplante de Rim , Viroses/etiologia , Cadáver , Infecções por Citomegalovirus/etiologia , Seguimentos , Sobrevivência de Enxerto , Infecções por HIV/etiologia , Hepatite B/etiologia , Hepatite C/etiologia , Humanos , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Complicações Pós-Operatórias/etiologia , Taxa de Sobrevida , Transplante HomólogoAssuntos
População Negra , Hispânico ou Latino , Transplante de Rim , População Branca , Feminino , Florida , Rejeição de Enxerto , Antígenos HLA/imunologia , Antígenos HLA-DR/imunologia , Histocompatibilidade , Humanos , Masculino , Cooperação do Paciente , Análise de Sobrevida , Doadores de TecidosRESUMO
Of 631 renal allografts performed at our center between January 1, 1979 and June 30, 1989, 368 were from cadaver donors (CAD) and 263 were from living-related donors (LRD). The recipients were almost equally divided among 3 ethnic groups: Black, Hispanic, and non-Hispanic, non-Black (primarily of northern European background). Recipient ages ranged between 1 and 70 years. In the CAD group HLA matching was emphasized so that no patient received a kidney with less than a 1 DR match, and for the entire series there was a mean of 2.4 of 6 HLA antigens matched between donor and recipient. All patients (LRD and CAD) received at least 3 pretransplant blood transfusions. Overall actuarial 10-year patient and graft survival were 68% and 48% respectively, with 72% patient and 56% graft survival for LRD and 58% patient and 36% graft survival for CAD recipients. Factors adversely affecting long-term graft outcome were: a) Black race. Overall 10-year graft survival was 23% versus 55% for non-Blacks (p = 0.008); b) Type I Diabetes before transplant. Overall 10-year graft survival was 35% versus 51% for nondiabetics; and c) Compliance. This was the most significant factor influencing long-term survival, other than death due to cardiovascular disease. In a non-Black, nondiabetic category of less than 36 years of age at transplantation (n = 169), 10-year patient survival in LRD and CAD groups was 95% and 85%, respectively, and graft survival was 78% and 70%, respectively. This was markedly different from the entire series (p = 0.008). Even in this group, 4 of the 17 graft losses (including mortality) were due to documented prolonged noncompliance in teenagers. The 6 other deaths that occurred were due to hepatitis/cirrhosis (2), CMV (3), and AIDS (1). Among the factors not influencing graft survival in the CAD group was HLA matching after the minimum requirements were fulfilled, either by comparing 1 with 2 DR antigens, or total HLA (1-6) antigens matched.