RESUMO
There is still no consensus on the optimal management of COVID-19 within the general population due to the emerging evidence base. High-risk groups, including kidney transplant recipients living with HIV present unique additional challenges. Here we discuss two kidney transplant recipients living with HIV with SARS-CoV-2 infection and their clinical course, and review the existing literature for this subset of challenging patients.
Assuntos
Fármacos Anti-HIV/uso terapêutico , COVID-19/terapia , Glucocorticoides/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Infecções por HIV/tratamento farmacológico , Imunossupressores/uso terapêutico , Transplante de Rim , Adulto , Antibacterianos/uso terapêutico , Atovaquona/uso terapêutico , Contagem de Linfócito CD4 , Relação CD4-CD8 , COVID-19/complicações , COVID-19/imunologia , Didesoxinucleosídeos/uso terapêutico , Feminino , Infecções por HIV/complicações , Infecções por HIV/imunologia , HIV-1/genética , Humanos , Hospedeiro Imunocomprometido/imunologia , Lamivudina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/uso terapêutico , Pneumonia por Pneumocystis/prevenção & controle , Prednisolona/uso terapêutico , RNA Viral , Raltegravir Potássico/uso terapêutico , SARS-CoV-2 , Tacrolimo/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
BACKGROUND: An increasing number of patients are requiring multiple retransplants. We assessed outcomes of third and fourth kidney transplants, to aid decision making on the most suitable donor type. METHODS: Data were collected retrospectively for 2561 transplants, including 69 third and 8 fourth, performed from 2000 to 2017. Demographics and outcomes for the combined third/fourth group were compared to first and second transplants. Within the third/fourth kidney transplant group, comparisons were made between deceased donors (n = 39), live donor HLA-compatible (n = 23) and -incompatible (n = 13) transplants, as well as between standard (n = 25) and extended-criteria (n = 14) deceased donor transplants. RESULTS: Patient survival did not differ significantly by transplant number (P = 0.532), whereas death-censored graft survival declined progressively, from 89% at 5 years in first, 85% in second and 74% in the third/fourth transplant group (P < 0.001). Within the combined third/fourth transplant subgroup, 5-year graft survival was found to be 100% in recipients of HLA-compatible live donors, compared to 75% in deceased donors and 53% in HLA-incompatible live donors, although this difference did not reach statistical significance (P = 0.083). No significant difference in patient survival (P = 0.356) or complication rates (P = 0.757) were detected between these groups. For recipients of deceased donors in the third/fourth transplant group, there were no significant differences between standard versus extended-criteria donors for any of the outcomes considered. CONCLUSIONS: Despite variable functional outcomes, third and fourth kidney transplant recipients experience comparable patient survival rates to first and second transplants, regardless of the donor type. In selected patients, HLA-incompatible live donors and extended-criteria deceased donors should be considered.
Assuntos
Seleção do Doador , Histocompatibilidade , Transplante de Rim , Reoperação , Doadores de Tecidos , Sistema ABO de Grupos Sanguíneos , Adulto , Incompatibilidade de Grupos Sanguíneos/imunologia , Causas de Morte , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto , Antígenos HLA/imunologia , Humanos , Imunossupressores/uso terapêutico , Isoanticorpos/sangue , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Reoperação/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND/AIM: The Fistula Risk Score (FRS), as other risk scores, is a validated model predicting the development of a clinically relevant post-operative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD). We evaluated risk factors related with CR-POPF and correlated four predictive scores with the likelihood of developing CR-POPF in our cohort. PATIENTS AND METHODS: The records of 107 patients who underwent PD from 2007 to 2015 were obtained from a prospectively maintained database and reviewed. CR-POPFs were categorized by the International Study Group of Pancreatic Fistula (ISGPF) standards. Firstly, a univariate and multivariate analysis of risk factors related to CR-PPOPF was performed, and then the data were correlated with FRS, Wellner's, Robert's and Yamamoto's scores. RESULTS: In total, 30 patients developed a CR-POPF. On multivariate analysis, abdominal thickness (OR=1.02, p=0.010), Wirsung's duct diameter (OR=0.57, p=0.029), pancreatic consistency (OR=3.18, p=0.011) and histological diagnosis of the lesion (OR=1.65, p=0.012) represented independent predictive factors of CR-POPF. FRS (R2=0.596, p=0.001), Wellner's score (R2=0.285, p=0.005) and Roberts' score (R2=0.385, p=0.002) correlated with the likelihood of developing CR-POPF. CONCLUSION: Abdominal thickness, Wirsung's duct diameter, pancreatic consistency and histological diagnosis were independent predictive factors of CR-POPF. Predictive scores reflected the likelihood of CR-POPF, FRS being the score with the highest predictive value.
Assuntos
Pâncreas/cirurgia , Fístula Pancreática/fisiopatologia , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/fisiopatologia , Adulto , Idoso , Anastomose Cirúrgica/efeitos adversos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pâncreas/fisiopatologia , Ductos Pancreáticos/fisiopatologia , Ductos Pancreáticos/cirurgia , Fístula Pancreática/epidemiologia , Fístula Pancreática/cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de RiscoRESUMO
Renal transplantation confers improvement in quality of life and survival when compared to patients on dialysis. There is a universal shortage of organs, and efforts have been made to overcome this shortage by exploring new sources. One such area is the use of kidneys containing small tumours after resection of the neoplasm. This paper looks at the current evidence in the literature and reviews the feasibility of utilizing such a source.