Factors associated with patient and graft survival using kidneys from cadaveric donors in transplant patients under 18 years of age in Argentina.

BACKGROUND: Thanks to advances in surgical techniques and immune system suppression, the mortality rate in children with end-stage renal disease (ESRD) has dramatically declined. Kidney transplantation has become the primary method to treat ESRD in the pediatric population. MATERIALS AND METHODS: Information was obtained from SINTRA (National Information System of Orrgan Procurement and transplantation in Argentina) for the period 1998-2009. We used the Kaplan-Meier curve, survival was measured at 30 days, 1, 5, and 10 years. The Cox regression variables taken for patient and graft survival were gender and age of both donor and recipient, ischemia time (> or <24 hr), etiology of chronic renal failure, time on dialysis (> or <3 years) of the recipient, cause of donor's death (stroke, head trauma, anoxia, other causes of coma, tumor and others). We coded the value of mismatch. For each HLA, it was 0 when they shared the 2. Adding the 3 types of antigens, the possible mismatch values ranged between 0 and 6. However, all had values between 5 and 6. We used SPSS statistical software Medcalc 17. RESULTS: We analyzed 345 (54%) men and 290 (46%) women. The average age was 12.5 + 3.9 years. The median follow-up time was 4 years (maximum 13 years). Patient survival rates at 30 days were 99.4%, at 1 year 96.8%, at 5 years 91.1%, and at 10 years 82.5%. Cox regression for patient survival: being a female and receiving HR 1.88 (95% CI 1.09-3.25) P = .023 or donor HR 1.86 (95% CI 1.06-3.25) P = .030. Tumor HR 17.19 (95% CI 4.48-65.98) P = <.0001. For recipient's age compared with <12 years >12 years HR 1.99 (95% CI 1.11-3.65) P = <.024. Graft survival rate at 30 days was 97.2%, at 1 year was 91.9%, at 5 years was 79.3% and at 10 years was 61.8%. Compared with donor's age <18 years: 45-59 years HR 2.52 (95% CI 1.42-4.47) P = .002. Glomerulonephritis HR 1.71 (95% CI 1.10-2.77) P = .018. Tumor as the cause of donor's death HR 4.39 (95% CI 1.28-2.28) P = .012. Time on dialysis > 3 years HR 1.59 (95% CI 1.11-2.28) P = .012. CONCLUSIONS: Being a female, receiving a kidney from a woman and tumor as the cause of donor's death and age >12 years were associated with worse patient survival. Donor's age between 45 and 59, glomerulonephritis as the etiology of renal failure, tumor as the cause of death and time on dialysis >3 years were associated with lower graft survival.

Analysis of mortality while on waiting list for kidney transplant in adults in Argentina 2005-2009.

INTRODUCTION: Comparison of survival after renal transplant patients on the waiting list is an important factor to evaluate this therapy. OBJECTIVE: To measure the magnitude of deceased donor kidney transplant on patient survival compared to patients on dialysis and on waiting lists in over 18 years in Argentina. MATERIAL AND METHODS: The information was obtained from SINTRA for the period January 2003 to December 2009. The follow-up period ended in December 2010. Survival was considered as the time from the entrance to the waiting list until death, the end of the study (June 2009), or last follow-up available, whichever came first. The Kaplan-Meir method was used. The survival rate was recorded at 30 days, 1, 5 and 10 years. Log-rank was used to compare the curves and their statistical significance. The Cox regression model was used to consider the variables for both patient and graft survival, such as gender and age, time on dialysis, etiology of end-stage renal disease (ESRD), and presence of comorbidities. The MedCalc and SPSS 17 statistical packages were used. RESULTS: We analyzed 1682 patients transplanted average age 48.14 + 13.48 years and 3647 patients on waiting lists average age 47.88 + 14.32 years. For patients transplanted 30-day survival was 99.8% at 1 year 96.2% and 5 years of 79.9%. For patients on the waiting list survival at 30 days was 99.7% at 1 year and 5 years 94.6% 66.6%. Chi-square was 42.77, P = <.0001. HR 0.64 (95% CI 0.56 to 0.73). Cox regression for patients on waiting lists HR 1.40 (95% CI 1.20-1.63) P = <.0001. The time dependent Cox regression showed for patients transplanted at 30 days, <1 year >1 year showed HR 4.18 (95% CI 2.88-6.06) P = <.0001, HR 0.40 (95% CI 0.27 to 0.61) P = <.0001 and HR 0.19 (95% CI 1.12-0.29) P = <.0001, respectively. CONCLUSIONS: Survival, both at baseline and in the long term, is better in transplant patients as compared to patients on waiting list. In Cox time-dependant regression the risk of death during the first 30 days is 4 times higher in transplant patients. This reverses and at 1 year, transplant patients are 60% less likely to die, and after one year this probability is 81% lower (P =<.0001).

Factors associated with patient and graft survival using kidneys from cadaveric donors in transplanted patients over 18 years of age in Argentina.

BACKGROUND: With improvements in short-term kidney graft and patient survival, focus has shifted to understand patient and graft features that affect long-term survival. MATERIALS AND METHODS: This retrospective analysis from January 1998 to December 2009 employed Kaplan-Meier analysis to evaluate survival ratios at 30 days as well as 1, 5, and 10 years. A multivariable Cox regression model considered variables of donor and recipient, gender and age, cold ischemia time (CIT), chronic renal failure etiology, time on dialysis (TD) and cause of donor death. The mismatch (MM) value was coded according to the number of antigens shared by both the donor and the recipient for HLA-A, B, and DR. The MM values ranged between 0 and 6. Two groups were analyzed according the number of shared antigens: 0 to 3 versus 4 to 6. RESULTS: Among 3030 (55.85%) males and 2395 (44.15%) females, the overall mean age was 46.9 ± 13.9 years. Median follow-up was 4 years (max 13 years). Patient survival rate (SR) was 97.5% at 30 days, 87.5% at 1 year, 74.5% at 5 years, and 59.2% at 10 years. Using Cox analysis, patient SR was affected by: diabetic nephropathy (DN) hazard ratio (HR) 1.55 (95% confidence interval [CI 95%] 1.21-1.97) P = .0005; head trauma (HT) cause of donor death HR 0.83 (0.73-0.95) P = .0005 and donor age (DA) compared by 18 to 44 years: 45 to 59 years HR 1.44 (CI95% 1.00-1.30) P = .043, >60 years HR 1.41 (CI95% 1.17-1.70) P = .0004. In addition relevant factors were recipient age (RA) compared by 18 to 44 years: 45 to 59 HR 1.99 (CI95% 1.74-2.27) P < .0001, >60 years HR 3.24 (CI95% 2.79-3.75) P < .0001 and DT >7 years HR 1.33 (CI95% 1.19-1.48) P = .0001. MM HLA 0 to 3 level HR 0.78 (CI95% 0.69-0.88) P < .0001. Graft SR was 95% at 30 days, 81.6% at 1 year, 64.7% at 5 years, and 47.3% at 10 years. The relevant factors were: DN HR 1.26 (CI95% 1.01-1.57) P = .04; HT HR 0.82 (0.74-0.91) P = .0004; DA compared by 18 to 44 years: 45-59 years HR 1.19 (CI95% 1.07-1.32) P = .002, >60 years HR 1.53 (CI95% 1.30-1.80) P < .0001; RA compared by 18 to 44 years: 45-59 HR 1.33 (CI95% 1.19-1.47) P < .0001, >60 years HR 1.84 (CI95% 1.63-2.09) P < .0001; DT > 7 years HR 1.22 (CI95% 1.11-1.35) P = .0001; CIT >24 hours HR 1.13 (CI95% 1.03-1.23) P = .009 and MM HLA 0 to 3 HR 0.82 (CI95% 0.74-0.91) P = .0002. CONCLUSION: HT as the cause of donor death and MM between 0 and 3 were associated with better patient and graft SR, DN, TD over 7 years, DA and RA over 45 were associated with lower patient SR. CIT > 24 hours, DN, TD over 7 years, as well as donor and recipient ages over 45 yr were associated with a lower graft SR.

First evidence of azaspiracids (AZAs): A family of lipophilic polyether marine toxins in scallops (Argopecten purpuratus) and mussels (Mytilus chilensis) collected in two regions of Chile.

Azaspiracids are a family of lipophilic polyether marine biotoxins that have caused a number of human intoxication incidents in Europe since 1995 following the consumption by consumers of intoxicated shellfish (Mytilus edulis). These azaspiracids have now been identified in mussels (Mytilus chilensis) and scallops (Argopecten purpuratus) from two Chilean locations. This is the first report of the occurrence of azaspiracid toxins in these species (Mytilus chilensis and Argopecten purpuratus) from Chile. The areas studied were Bahía Inglesa (III Region, 27 degrees SL) and Chiloé Archipelago, both important scallop and mussels farming areas. Separation of azaspiracid (AZA1), azaspiracid isomer (AZA6) and its analogues, 8-methylazaspiracid (AZA2) and 22-demethylazaspiracid (AZA3), was achieved using reversed-phase LC and toxins were identified using a turbo electrospray ionisation (ESI) source, to a triple quadrupole mass spectrometer. In mussels, AZA1 was the predominant toxin in mussel hepatopancreas with AZA2, AZA3 and AZA6 present in approximate equivalent amounts in the remaining tissues, 20-30% of the AZA1 level. AZA2 predominated in the scallop samples with the toxin almost entirely present in the hepatopancreas (digestive gland). AZA1 was only observed in some of the scallop samples and was present at 12-15% of the AZA2 levels. Whilst the levels of AZAs in Chilean samples are below the EU regulatory limit of 160mug/kg, it is significant that this toxin is present in Pacific Ocean species. Consequently measures should be taken by regulatory authorities to implement regular seafood monitoring to ensure safety of harvested product.

Improved high-performance liquid chromatographic method for the determination of domoic acid and analogues in shellfish: effect of pH.

Domoic acid (DA) is a naturally-occurring amino acid that causes a form of human intoxication called amnesic shellfish poisoning (ASP) following the consumption of shellfish. A rapid and sensitive HPLC-UV method has been developed for analysis of DA and analogues in shellfish without the need for SPE clean-up. Isocratic chromatographic separation of DA and its isomers from shellfish matrix interferences and from the prevalent amino acid, tryptophan, was achieved by careful control of the mobile phase pH. The optimised pH was found to be 2.5 when using a Luna(2) C18 column. Sample extraction was verified with control extracts from shellfish spiked at 5.0 and 10.0 microg/g of DA and with certified reference material. The average extraction efficiency was 98.5%. The calibration, based on mussel tissue spiked with DA standard, was linear in the range 0.05-5.0 microg/ml (r = 0.9999) and the detection limit (signal:noise 3:1) was better than 25 ng/ml. The DA assay achieved good precision; %RSD = 1.63 (intra-day, n = 6) and %RSD = 3.7 (inter-day, n = 8). This method was successfully applied to a variety of shellfish species, allowing the rapid screening of a large number of samples per day (20-30), without the need for SPE clean-up. Quantitative data were obtained for shellfish samples containing domoic acid in the concentration range 0.25-330 microg/g. Using the same chromatographic conditions, LC-MS3 was used to determine DA and its isomers, isodomoic acid D and epi-domoic acid, in scallop tissues.