RESUMO
Whether influenza vaccination in solid-organ transplant recipients is efficacious remains a controversial issue. Furthermore, theoretical concerns have been raised regarding the safety of vaccination as it might trigger rejection of the allograft. The present prospective trial is aimed at investigating the antibody response and safety of influenza vaccination in renal transplant recipients (RTR). A total of 165 RTR and 41 healthy volunteers were vaccinated with a standard trivalent inactivated influenza vaccine. Hemagglutination-inhibiting (HI) antibodies were quantified before and 1 month after vaccination. Seroprotection (SP) and seroresponse (SR) were defined as a titer > or =40 and a 4-fold rise in HI titer, respectively. Similar SR rates were observed in both groups. Postvaccination SP rates in RTR amounted to 92.7%, 78.7% and 82.9% for A/H1N1, A/H3N2 and B, respectively. High baseline SP rates, most probably reflecting frequent preimmunizations, explain partly the high postvaccination SP rates. SR rate was independently and inversely associated with baseline SP rate. Mycophenolate mofetil (MMF) usage was associated with a 2.6-5-fold lower SR. Nonetheless, these patients showed good postvaccination SP rates. A booster dose did not enhance SP or SR rates. Influenza vaccination neither affected allograft function nor caused rejection episodes. In conclusion, influenza vaccination is efficacious and safe in renal transplantation.
Assuntos
Vírus da Influenza A Subtipo H1N1/imunologia , Vírus da Influenza A Subtipo H3N2/imunologia , Vírus da Influenza B/imunologia , Vacinas contra Influenza , Transplante de Rim/imunologia , Adulto , Formação de Anticorpos , Creatinina/sangue , Feminino , Humanos , Vacinas contra Influenza/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Valores de Referência , SegurançaRESUMO
The understanding of the molecular structure of the podocyte has increased considerabely in recent 5 years by genetic research in inherited glomerulopathies. Injury to the podocyte often leads to a reorganisation of the slit diaphragm and to foot process effacement, which can be noted in all forms of the nephrotic syndrome. Since the recent progress in our understanding of the molecular biology of the podocyte, it has become obvious that the podocyte is crucial in the pathogenesis of not only genetic but also of many acquired glomerulopathies such as focal segmental glomerulosclerosis, membranous glomerulopathy and diabetic nephropathy. In this review we provide a summary of the recent physiological and molecular insights into the podocyte and of its significance in different glomerulopathies.
