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1.
Front Med (Lausanne) ; 8: 730156, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34790673

RESUMO

Background: Kidney transplant recipients appear to be at higher risk for critical COVID-19. Our analysis aimed to identify the possible risk factors for a severe course of the COVID-19 disease and to determine the influence of selected human leukocyte antigens (HLAs) on the course of the disease. Methods: This is a retrospective, multicenter analysis that included patients that were confirmed to be severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) positive after kidney transplantation (KT). The group of patients was divided into two subgroups according to the course of the infection, as follows: non-hospitalized and hospitalized. Results: A total of 186 patients (men, 69.4%) with confirmed SARS-CoV-2 positivity were included in the group. The following independent risk factors for the outcome of hospitalization were identified: the age at the time of infection [odds ratio (OR) = 1.19, P < 0.0001], a body mass index (BMI) >29.9 kg/m2 (OR = 7.21, P < 0.0001), <7.5-mg prednisone dose/day (OR = 2.29, P = 0.0008), and HLA-DQ2 with a protective nature (OR = 0.05, P = 0.0034). Conclusions: Higher doses of corticosteroids (>7.5 mg/kg) in standard immunosuppressive regimes and HLA-DQ2 appear to be protective factors in our analysis.

2.
Int Immunopharmacol ; 98: 107908, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34182244

RESUMO

INTRODUCTION: Infectious complications remain a common cause of mortality after kidney transplantation (KTx). Goal of effective immunosuppressive treatment (IS) must be balanced between decreasing incidence of acute kidney rejection (AKR) and avoiding the incidence of infections, at the same time. MATERIALS AND METHODS: The aim of our analysis was to identify the risk of fixed daily dose (DD) of mycophenolic acid (MPA) and levels of tacrolimus (TAC) in the development of a single, recurrent infection and AKR after KTx. RESULTS: Our analysis consisted of 100 patients after KTx (66 males, 34 females). MPA DD > 1080 mg was a risk factor (RF) for recurrent infection in general (OR 1.2964;P = 0.0277), for recurrent bacterial infection from 1st to 6th month (OR 1.2674;P = 0.0151), recurrent bacterial infection (OR 1.2574;P = 0.0436), single viral infection (OR 1.2640;P = 0.0398) from 6th-12th month after KTx. MPA DD > 1080 mg and levels of TAC above recommended levels were not independent RF for the incidence of the infection. CONCLUSION: MPA DD > 1080 mg as a RF for recurrent infection starting in the 1st month after KTx with significant association between the incidence of infections and MPA DD and TAC levels, without increased risk of AKR. In the centers with fixed dosing of IS, this can lead to lowering the risk of infections by decreasing MPA DD 1 month after KTx without increasing risk of infections.


Assuntos
Rejeição de Enxerto/prevenção & controle , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Reinfecção/epidemiologia , Adulto , Relação Dose-Resposta a Droga , Feminino , Rejeição de Enxerto/imunologia , Humanos , Imunossupressores/administração & dosagem , Incidência , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/administração & dosagem , Ácido Micofenólico/efeitos adversos , Complicações Pós-Operatórias/imunologia , Complicações Pós-Operatórias/microbiologia , Reinfecção/imunologia , Reinfecção/microbiologia , Estudos Retrospectivos , Tacrolimo/administração & dosagem , Tacrolimo/efeitos adversos
3.
Vnitr Lek ; 67(1): 4-8, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33752394

RESUMO

INTRODUCTION: For kidney transplantation is indicated any patient with chronic kidney disease in the terminal stage, unless it has a contraindication for this operation. The aim of this work is to evaluate the benefit of diagnostic hospitalizations of the patients before inclusion on the waiting list for kidney transplantation and to identify the most common differential diagnostic problems for the indication / contraindication for kidney transplantation. MATERIAL AND METHODS: This is a retrospective analysis, which included all potential recipients who underwent the examination process before inclusion on the waiting list and living donors in the form of diagnostic hospitalization at the Transplant Center at Martin University Hospital in 2016-2019. RESULTS: A total of 49 patients were included in the cohort, the average length of hospitalization was 5.6 days. Kidney trans plantation subsequently underwent 22 of these patients, 3 patients were clearly contraindicated.


Assuntos
Falência Renal Crônica , Transplante de Rim , Hospitalização , Humanos , Estudos Retrospectivos , Listas de Espera
4.
Nephron ; 144(11): 583-588, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32906116

RESUMO

Nephronophthisis (NPHP) is an autosomal recessive disease manifesting as tubulointerstitial nephritis uniformly progressing to ESRD in approximately 5-10% patients in childhood. Living donor transplantation is the most beneficial mean of renal replacement therapy compared to other methods. However, living kidney donation is contraindicated in potential donor with diseases of autosomal dominant mode of inheritance potentially leading to kidney failure in future. On the other hand, autosomal recessive genetic kidney diseases, such as NPHP, are not usually contraindication to living kidney donation. Herein, we are reporting related living kidney transplantation with a family history of NPHP form 46-year-old mother (heterozygote) to 17-year-old daughter with (autosomal recessive homozygote) with focus on donor follow-up after nephrectomy.


Assuntos
Doenças Renais Císticas/congênito , Transplante de Rim , Doadores Vivos , Adolescente , Feminino , Heterozigoto , Humanos , Doenças Renais Císticas/cirurgia , Pessoa de Meia-Idade
5.
Ann Transplant ; 25: e921117, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32675801

RESUMO

BACKGROUND The effect of a relative disproportion in the size of a transplanted kidney (KT) on graft function and survival is well documented. However, the importance of the H-Y antigen (male donor and female recipient) has not been unambiguously confirmed. MATERIAL AND METHODS Our retrospective analysis consists of 230 deceased donor/recipient pairs. The aim of the study was to determine the effect of sex mismatch between donors and recipients on the function of the graft and the graft and patient survival. RESULTS In the group of male donors, a statistically significantly lower value of the eGFR (estimated glomerular filtration rate) was recorded for female recipients in the fifth year after the KT (=0.0047). The male donor/female recipient group was an independent risk factor for: eGFR (<60 ml/min (CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration) in the third year after KT [HR 0.1618; (P=0.0004)], acute rejection in the first year after KT [HR 1.8992; (P=0.0387)], and the 5-year graft survival was significantly worse in this group. By adjusting the results for age and induction, this group was at significantly higher risk for decreased graft function (eGFR <30 ml/min) if the age of the donor was ≤50 years old and the recipient was >45 years old in the fifth year [HR 11.1676; (P=0.0139)], the age of the donor was ≤50 years old/recipient was ≤45 years old in the third year [HR 1.2500; (P=0.0050)], and also in the fifth year after KT [HR 8.1993; (P=0.0183)]. CONCLUSIONS Based on our analysis, the differences in the incidence of acute rejection episodes as well as in graft survival among the different groups of patients were confirmed. The group with the highest risk, in cases of an acute rejection episode, is a male donor/female recipient.


Assuntos
Função Retardada do Enxerto/imunologia , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto/imunologia , Antígeno H-Y/imunologia , Transplante de Rim/efeitos adversos , Insuficiência Renal Crônica/cirurgia , Doadores de Tecidos , Adulto , Função Retardada do Enxerto/etiologia , Feminino , Rejeição de Enxerto/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
6.
Transplant Proc ; 51(10): 3259-3264, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31732198

RESUMO

Practically all kidney allograft recipients require immunosuppressive therapy to prevent rejection and loss of the allograft. The aim of this study was to determine the occurrence of biopsy-proven acute rejection in low-immunologic risk kidney transplant recipients according to the type of induction (basiliximab vs low-dose of rabbit antithymocyte globulin [rATG], 3.5 mg/kg). MATERIALS AND METHODS: A total of 125 patients after primary kidney transplant were included in the retrospective analysis with 6-month follow-up. The immunosuppression regimen included tacrolimus, mycophenolic acid, and corticoids. RESULTS: We did not find any significant difference in the occurrence of acute rejection or difference in the occurrence of infection complications. Patients in the rATG group had a significantly longer period of cold ischemia, more frequently received kidney transplants from expanded criteria donors, and had significantly more mismatches in HLA-DR. Delayed graft function (DGF) was identified as an independent risk factor for biopsy-proven acute rejection (hazard ratio, 3.4859; P = .003). There was comparable incidence of DGF between the 2 groups despite that there were several factors that are more commonly associated with DGF in the rATG group. CONCLUSION: Patients with low immunologic risk and high risk of DGF benefit from the rATG induction in dose of 3.5 mg/kg without the increased risk of infection complications with the assumption of good graft function in long-term post-transplant period.


Assuntos
Soro Antilinfocitário/uso terapêutico , Basiliximab/uso terapêutico , Função Retardada do Enxerto/prevenção & controle , Rejeição de Enxerto/prevenção & controle , Imunossupressores/uso terapêutico , Transplante de Rim , Adulto , Soro Antilinfocitário/administração & dosagem , Soro Antilinfocitário/efeitos adversos , Biópsia , Feminino , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto , Humanos , Terapia de Imunossupressão , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Quimioterapia de Indução , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Tacrolimo/uso terapêutico
7.
J Diabetes Complications ; 33(4): 315-322, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30755355

RESUMO

INTRODUCTION: Sex differences are defined as biology-linked differences between women and men that occur through the sex chromosomes and their effects on organ systems. MATERIAL AND METHODS: The objective of this prospective study was to determine risk factors for post-transplant diabetes mellitus (PTDM) in men and women. RESULTS: A total of 417 patients (271 men and 146 women) were included in the monitored group. Age at the time of kidney transplantation (KT) >60 years and hypovitaminosis D at the time of KT (<20 µg/l) were identified as independent risk factors for PTDM in both men and women. It was further confirmed as an independent risk factor for men a waist circumference at the time of KT >94 cm, C-peptide at the time of KT >5 ng/ml, HOMA-IR >2 and triacylglycerols at the time of KT >1.7 mmol/l. In case of women, the dominant factor was BMI at the time of KT >30 kg/m2 and menopause at the time of KT. A significant decrease in C-peptide was recorded in women with PTDM. CONCLUSION: It was confirmed that there are gender differences with regard to the development of PTDM after KT. Women show pancreas ß cell dysfunction, whereas insulin resistance and metabolic syndrome are dominant in men.


Assuntos
Diabetes Mellitus/etiologia , Transplante de Rim/efeitos adversos , Caracteres Sexuais , Adulto , Estudos de Casos e Controles , Diabetes Mellitus/epidemiologia , Feminino , Seguimentos , Sobrevivência de Enxerto/fisiologia , Humanos , Transplante de Rim/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Eslováquia/epidemiologia
8.
J Diabetes Complications ; 32(9): 863-869, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30049444

RESUMO

INTRODUCTION: Obese patients have increased leptin production and selective resistance to its central anti-adipogenic effects, yet its pro-inflammatory immunostimulating effects persist. MATERIAL AND METHODS: In a group of 70 patients who underwent primary kidney transplantation (KT) we examined adiponectin and leptin levels at the time of KT and 6 months post-transplantation. Patients with diabetes mellitus type 1 or type 2 at the time of KT were excluded from the study. RESULTS: We found that leptin levels significantly increased during the post-transplant period (P = 0.0065). Overall, leptin levels were positively correlated with the level of triacylglycerols, post-transplant diabetes mellitus (PTDM) development and acute rejection (AR). We discovered that, in particular, high leptin levels were associated with AR [OR 2.1273; 95% CI 1.0130-4.4671 (P = 0.0461)] and PTDM development [OR 7.200; 95% CI 1.0310-50.2836 (P = 0.0465)], whereas, low adiponectin levels represent a risk factor for the development of insulin resistance [HR 38.6135; 95% CI 13.3844-67.7699 (P < 0.0001)] and obesity [HR 3.0821; 95% CI 0.8700-10.9192 (P = 0.0053)]. CONCLUSION: We found that a high serum concentration of leptin before KT is associated with both PTDM development and AR and merits further investigation in relation to KT.


Assuntos
Biomarcadores , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/etiologia , Transplante de Rim/efeitos adversos , Leptina/fisiologia , Complicações Pós-Operatórias/diagnóstico , Doença Aguda , Adiponectina/sangue , Adulto , Biomarcadores/sangue , Diabetes Mellitus/sangue , Feminino , Seguimentos , Rejeição de Enxerto/sangue , Rejeição de Enxerto/diagnóstico , Humanos , Resistência à Insulina/fisiologia , Leptina/sangue , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Valor Preditivo dos Testes , Sensibilidade e Especificidade
9.
Ann. hepatol ; 16(1): 149-156, Jan.-Feb. 2017. graf
Artigo em Inglês | LILACS | ID: biblio-838097

RESUMO

Abstract: Introduction and aims. Liver resection is the treatment of choice for many primary and secondary liver diseases. Most studies in the elderly have reported resection of primary and secondary liver tumors, especially hepatocellular carcinoma and colorectal metastatic cancer. However, over the last two decades, hepatectomy has become safe and is now performed in the older population, implying a paradigm shift in the approach to these patients. Material and methods. We retrospectively evaluated the risk factors for postoperative complications in patients over 65 years of age in comparison with those under 65 years of age after liver resection (n = 360). The set comprised 127 patients older than 65 years (35%) and 233 patients younger than 65 years (65%). Results. In patients younger than 65 years, there was a significantly higher incidence of benign liver tumors (P = 0.0073); in those older than 65 years, there was a significantly higher incidence of metastasis of colorectal carcinoma to the liver (0.0058). In patients older tan 65 years, there were significantly more postoperative cardiovascular complications (P = 0.0028). Applying multivariate analysis, we did not identify any independent risk factors for postoperative complications. The 12-month survival was not significantly different (younger versus older patients), and the 5-year survival was significantly worse in older patients (P = 0.0454). Conclusion. In the case of liver resection, age should not be a contraindication. An individualized approach to the patient and multidisciplinary postoperative care are the important issues.


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Complicações Pós-Operatórias/epidemiologia , Ablação por Cateter/efeitos adversos , Hepatectomia/efeitos adversos , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Fatores de Tempo , Distribuição de Qui-Quadrado , Modelos de Riscos Proporcionais , Incidência , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Fatores Etários , Resultado do Tratamento , Ablação por Cateter/mortalidade , Eslováquia , Medição de Risco , Seleção de Pacientes , Estimativa de Kaplan-Meier , Hepatectomia/métodos , Hepatectomia/mortalidade , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia
10.
Ann Hepatol ; 16(1): 149-156, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28051804

RESUMO

Introduction and aims. Liver resection is the treatment of choice for many primary and secondary liver diseases. Most studies in the elderly have reported resection of primary and secondary liver tumors, especially hepatocellular carcinoma and colorectal metastatic cancer. However, over the last two decades, hepatectomy has become safe and is now performed in the older population, implying a paradigm shift in the approach to these patients. MATERIAL AND METHODS: We retrospectively evaluated the risk factors for postoperative complications in patients over 65 years of age in comparison with those under 65 years of age after liver resection (n = 360). The set comprised 127 patients older than 65 years (35%) and 233 patients younger than 65 years (65%). RESULTS: In patients younger than 65 years, there was a significantly higher incidence of benign liver tumors (P = 0.0073); in those older than 65 years, there was a significantly higher incidence of metastasis of colorectal carcinoma to the liver (0.0058). In patients older than 65 years, there were significantly more postoperative cardiovascular complications (P = 0.0028). Applying multivariate analysis, we did not identify any independent risk factors for postoperative complications. The 12-month survival was not significantly different (younger versus older patients), and the 5-year survival was significantly worse in older patients (P = 0.0454). CONCLUSION: In the case of liver resection, age should not be a contraindication. An individualized approach to the patient and multidisciplinary postoperative care are the important issues.


Assuntos
Ablação por Cateter/efeitos adversos , Hepatectomia/efeitos adversos , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter/mortalidade , Distribuição de Qui-Quadrado , Feminino , Hepatectomia/métodos , Hepatectomia/mortalidade , Humanos , Incidência , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Seleção de Pacientes , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Eslováquia , Fatores de Tempo , Resultado do Tratamento
11.
Vnitr Lek ; 62(1): 48-51, 2016 Jan.
Artigo em Tcheco | MEDLINE | ID: mdl-26967237

RESUMO

INTRODUCTION: Infective endocarditis in a patient after kidney transplantation is a serious infective complication which increases the risk of loss of the graft and also the mortality of patients. The most important predisposing factor is the immunosuppressive therapy - mainly induction immunosuppression.Material and case description: 250 patients underwent kidney transplantation throughout the period of 12 years in the Transplant Center Martin. This set of patients included 5 patients (2 %) after heart valve replacement. We present the case of a patient after kidney transplantation with development of endocarditis of the bioprosthesis of the aortic valve one month after successful kidney transplantation. Diagnostics of endocarditis by standard procedures (examination by transthoracic echocardiogram, transesophageal echocardiography, hemocultures) was unsuccessful. We rarely diagnosed endocarditis only by PET-CT examination with a consequent change of the antibiotic treatment and successful managing of this post-transplant complication. CONCLUSION: Endocarditis after kidney transplantation is a serious complication which significantly worsens the mortality of patients. The risk of development of infective endocarditis after transplantation is also increased by induction, mainly by antithymocyte globulin. Diagnostics only by PET-CT examination is rare; however, in this case it fundamentally changed the approach to the patient and led to a successful treatment.


Assuntos
Valva Aórtica/diagnóstico por imagem , Bioprótese , Endocardite/diagnóstico , Rejeição de Enxerto/prevenção & controle , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Imunossupressores/efeitos adversos , Transplante de Rim , Complicações Pós-Operatórias/diagnóstico , Infecções Relacionadas à Prótese/diagnóstico , Valva Aórtica/cirurgia , Endocardite/imunologia , Humanos , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Complicações Pós-Operatórias/imunologia , Infecções Relacionadas à Prótese/imunologia , Tomografia Computadorizada por Raios X
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