Epidemiological Characteristics of the Largest Kidney Transplant Program in Mexico: Western National Medical Center, Mexican Institute of Social Security.

BACKGROUND: According to the National Transplant Center (CENATRA), in 2013, a total of 2707 transplantations were performed in Mexico; of them, 10% (270 transplantations) were done in our Tertiary Care Hospital (Western National Medical Center). This means that one in 10 transplant recipients undergoes transplantation at our medical center. The aim of our study was to describe the characteristics of and to compare changes in the kidney transplantation program over time. MATERIALS AND METHODS: This was a cross-sectional study. Data were collected from the hospital transplant registry from January 1994 to December 2014. RESULTS: During the study period, 3643 kidney transplantations were conducted; most were living donor 3236 (89%), and only 407 patients (11%) received a graft from a deceased donor. Of living donors, 2786 (87%) were related, and 450 (13%) were genetically unrelated. The average recipient age was 28 years, and the average age of the donor was 34 years. It was observed that siblings donated more frequently (51%), followed by parents (34%). Among unrelated donors, spouses donated the most (66%). In 80% of cases, the cause of end-stage renal disease (ESRD) was unknown (80%). The most frequent renal replacement therapy was peritoneal dialysis (54%), followed by hemodialysis (18%); only 5% of patients received preemptive kidney transplant. The most frequent immunosuppression scheme was tacrolimus, mycophenolate mofetil, and prednisone in 70% of patients. CONCLUSION: The Western National Medical Center is the largest kidney transplantation program in Mexico. The main activity is living donor transplantation. Recipients are relatively young persons with unknown etiology of ESRD.

Early Steroid Withdrawal in Recipients of a Kidney Transplant From a Living Donor: Experience of a Single Mexican Center.

BACKGROUND: Early steroid withdrawal (ESW) can improve lipid and hemodynamic profiles without severe acute rejection (AR) events in renal transplant patients. Our objective was to evaluate the effects of ESW on the frequency and severity of AR. METHODS: A randomized, open-label, controlled clinical trial was performed on renal transplant recipients with a follow-up of 12 months. In the ESW group, patients were selected for corticosteroid treatment withdrawal on the fifth day post transplantation. In the Control group, patients continued with steroid treatment. All patients were over 18 years of age with panel reactive antibody (PRA) class I and II HLA <20%. RESULTS: In total, 71 patients, 37 in the ESW group (52.1%) and 34 in the Control group (47.9%), had comparable AR incidences at the end of the follow-up (16% vs 15%) (NS) (RR = 1.20, 95% CI = 0.32-3.33). Although renal graft survival was similar between the ESW and Control groups (87% vs 94%), renal function was superior in the ESW group (85 vs 75 mL/min). Additionally, hypertension was less frequent in the ESW group (3% vs 35%), requiring the use of fewer antihypertensives (8% vs 50%). CONCLUSIONS: ESW was also associated with better blood pressure control and similar AR risk. The ESW group exhibited stable renal function.

El tipo de transporte peritoneal puede ser diferente en las distintas poblaciones de diálisis peritoneal de México / Transport and peritoneal dialysis

Introducción: La prueba de equilibrio peritoneal (PEP) esla más utilizada para clasificar el transporte peritoneal(TP). Los valores de referencia para población mexicanase establecieron en el Instituto Nacional de Nutrición SalvadorZubirán (INNSZ) hace más de 10 años. El objetivode este estudio fue evaluar el TP en población del occidentedel país, y comparar los resultados con los de Twardowskiy colaboradores y del INNSZ.Resultados: Se realizaron 159 pruebas; 48% pacienteseran diabéticos y 62% hombres. La edad fue 46±16años, peso 66.8±17.0 kg, y superficie corporal1.70±0.23 m2. No hubo diferencias entre grupos endiabetes ni peritonitis. El tiempo en diálisis fue menor ennuestro estudio que en del INNSZ (14.6±17.8 vs20.8±21.4 meses; p<0.05). Comparados con Twardowskie INNSZ, las D/P de creatinina 0, 2 y 4-h fueronmayores, y las D/D0 2 y 4-h, así como el volumen drenadofueron menores en el presente estudio. Utilizandovalores de referencia propios, el transporte alto (A) seobservó en 18%, promedio alto (PA) en 33%, promediobajo (PB) en 34% y bajo (B) en 15%, mientras que usandovalores del INNSZ el transporte A fue 23%, PA 36%,PB 33% y B 8%. Conclusión: Los pacientes de la población estudiada tuvieronvalores promedio de transporte peritoneal más altos que losde otros estudios, incluyendo población mexicana. En condicionesideales, es recomendable determinar valores de referenciaen cada centro, puesto que extrapolarlos de otrasregiones podría llevar a errores en el diagnóstico del tipo de TP

Introduction: Peritoneal equilibration test (PET) is the mostcommon test to classify peritoneal transport (PT). Referencevalues from Mexican population were established in the InstitutoNacional de la Nutrición Salvador Zubirán (INNSZ)more than 10 years ago. The aims of this study were to evaluatePT in a west of Mexico population (Hospital de Especialidades,Centro Médico Nacional de Occidente [HE,CMNO]), and to compare results with those obtained byTwardowski et al and in the INNSZ.Results: One-hundred fifty-nine PETs were performed; 48%patients were diabetics and 62% were male. Mean age was46±16 years, weight 66.8±17.0 kg and body surface area1.70±0.23 m2. There were no differences between groupsregarding diabetes or peritonitis frequency. Time on dialysis wasshorter in the present study than in the INNSZ (14.6±17.8 vs20.8±21.4 months; p<0.05). Compared to the Twardowskiand INNSZ studies, creatinine D/P ratio at 0, 2 and 4-h werehigher, and the D/D0 ratio at 2 and 4-h, and drained volumewere lower in our population. Using values obtained in the presentstudy, high transport (H) was present in 18%, high average(HA) in 33%, low average (LA) in 34% and low (L) in 15%,whereas employing the INNSZ reference values, H was presentin 23%, HA in 36%, LA in 33% and L in 8%. Conclusions: Patients from this studied population hadmean peritoneal transport values higher than those obtainedin other studies, including Mexican values. Ideally, it isrecommendable to determine reference values in every center,as extrapolating results from other regions may lead toerrors in diagnosing the peritoneal transport type