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1.
Pediatr Nephrol ; 33(12): 2343-2352, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30058047

RESUMO

BACKGROUND: JC polyomavirus (JCPyV)-associated nephropathy (JCPyVAN) is a severe, but rare complication in adult renal transplant (RTx) recipients. Related data in pediatric patients are scarce. METHODS: Based on the CERTAIN Registry, we therefore performed a multi-center, retrospective study on the JCPyV antibody status, prevalence of JCPyV replication, and its associated disease in 139 pediatric RTx recipients (mean age, 8.5 ± 5.3 years). JCPyV DNA in plasma and/or urine was measured by quantitative PCR at a median time of 3.2 (IQR, 0.3-8.1) years post-transplant. RESULTS: 53.2% of patients were JCPyV-seronegative prior to transplantation; younger age was associated with JCPyV seronegativity. 34/139 (24.5%) patients post-transplant showed active JCPyV replication in either urine (22.0%), plasma (13.4%), or both (7.6%). JCPyV viremia occurred significantly (p < 0.001) more often in patients with viruria (34.6%) than in those without (7.6%), but 7/118 (5.9%) had isolated viremia. High-level viruria (> 107 copies/mL) was found in 29.6% of viruric patients. A higher net state of immunosuppression constituted an independent risk factor for JCPyV replication both in urine and plasma (OR 1.2, p < 0.02). Male patients tended to have a higher risk of JCPyV viremia than females (OR 4.3, p = 0.057). There was one male patient (0.7%) with JCPyVAN 7 years post-transplant, which resolved after reduction of immunosuppressive therapy. No patient exhibited progressive multifocal leukoencephalopathy. CONCLUSIONS: This first multi-center study on JCPyV in pediatric renal transplant recipients shows that JCPyV replication is common (24.5%), with strong immunosuppression being a significant risk factor, but associated nephropathy is rare.


Assuntos
Vírus JC/isolamento & purificação , Nefropatias/epidemiologia , Transplante de Rim/efeitos adversos , Infecções por Polyomavirus/epidemiologia , Viremia/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Humanos , Terapia de Imunossupressão/efeitos adversos , Nefropatias/imunologia , Nefropatias/virologia , Masculino , Infecções por Polyomavirus/imunologia , Infecções por Polyomavirus/virologia , Prevalência , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Transplantados/estatística & dados numéricos , Viremia/imunologia , Viremia/virologia
2.
Pediatr Nephrol ; 33(6): 1057-1068, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29536257

RESUMO

BACKGROUND: Infants with a body weight of less than 10 kg are often not considered to be suitable candidates for renal transplantation (RTx). The objective of this study was to evaluate this arbitrary weight threshold for pediatric RTx. METHODS: We conducted a multicenter, retrospective, match-controlled cohort study on infants weighing less than 10 kg at time of engrafting (low-weight group [LWG], n = 38) compared to a matched control group (n = 76) with a body weight of 10-15 kg, using data from the first 2 years post-transplant derived from the CERTAIN Registry. RESULTS: Patient survival was 97 and 100% in the LWG and control groups, respectively (P = 0.33), and death-censored graft survival was 100 and 95% in the LWG and control groups, respectively (P = 0.30). Estimated glomerular filtration rate at 2 years post-transplant was excellent and comparable between the groups (LWG 77.6 ± 34.9 mL/min/1.73 m2; control 74.8 ± 29.1 mL/min/1.73 m2; P = 0.68). The overall incidences of surgery-related complications (LWG 11%, control 23%; P = 0.12) and medical outcome measures (LWG 23%, control 36%, P = 0.17) were not significantly different between the groups. The medical outcome measures included transplant-related viral diseases (LWG 10%, control 21%; P = 0.20), acute rejection episodes (LWG 14%, control 29%; P = 0.092), malignancies (LWG 3%, control 0%; P = 0.33) and arterial hypertension (LWG 73%, control 67%; P = 0.57). CONCLUSIONS: These data suggest that RTx in low-weight children is a feasible option, at least in selected centers with appropriate surgical and medical expertise.


Assuntos
Peso Corporal , Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Complicações Pós-Operatórias/etiologia , Magreza/complicações , Estudos de Casos e Controles , Pré-Escolar , Estudos de Coortes , Feminino , Sobrevivência de Enxerto , Humanos , Lactente , Transplante de Rim/efeitos adversos , Masculino , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
3.
BMJ Open ; 7(6): e015593, 2017 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-28606904

RESUMO

OBJECTIVES: It is known that transition, as a shift of care, marks a vulnerable phase in the adolescents' lives with an increased risk for non-adherence and allograft failure. Still, the transition process of adolescents and young adults living with a kidney transplant in Germany is not well defined. The present research aims to assess transition-relevant structures for this group of young people. Special attention is paid to the timing of the process. SETTING: In an observational study, we visited 21 departments of paediatric nephrology in Germany. Participants were doctors (n=19), nurses (n=14) and psychosocial staff (n=16) who were responsible for transition in the relevant centres. Structural elements were surveyed using a short questionnaire. The experiential viewpoint was collected by interviews which were transcribedverbatim before thematic analysis was performed. RESULTS: This study highlights that professionals working within paediatric nephrology in Germany are well aware of the importance of successful transition. Key elements of transitional care are well understood and mutually agreed on. Nonetheless, implementation within daily routine seems challenging, and the absence of written, structured procedures may hamper successful transition. CONCLUSIONS: While professionals aim for an individual timing of transfer based on medical, social, emotional and structural aspects, rigid regulations on transfer age as given by the relevant health authorities add on to the challenge. TRIAL REGISTRATION NUMBER: ISRCTN Registry no 22988897; results (phase I) and pre-results (phase II).


Assuntos
Transplante de Rim/psicologia , Transição para Assistência do Adulto/organização & administração , Transição para Assistência do Adulto/normas , Adolescente , Fatores Etários , Feminino , Alemanha , Humanos , Entrevistas como Assunto , Masculino , Pesquisa Qualitativa , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
4.
Transplantation ; 100(4): 862-70, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26736017

RESUMO

BACKGROUND: Cytomegalovirus (CMV) replication and disease, with its associated morbidity and poor transplant outcome, represents a serious threat to transplant recipients. The pediatric kidney transplant population is at a particularly increased risk of CMV infection. METHODS: We therefore analyzed CMV epidemiology in a large cohort of pediatric renal transplant recipients (n = 242) and assessed the impact of antiviral chemoprophylaxis with valganciclovir (VGCV) or ganciclovir (GCV) on CMV replication and morbidity. RESULTS: While antiviral chemoprophylaxis with VGCV or GCV in patients with a high (D+/R-) or intermediate (D+/R+) CMV risk (n = 82) compared to preemptive therapy (n = 47) had no significant effect on the incidence of CMV syndrome or tissue-invasive disease, chemoprophylaxis was associated with a better preservation of transplant function at 3 years posttransplant (loss of estimated glomerular filtration rate in the chemoprophylaxis cohort, 16.0 ± 3.4 vs. 30.1 ± 4.7 mL/min per 1.73 m(2) in the preemptive therapy cohort, P < 0.05).CMV replication was associated with a more pronounced decline of graft function (difference in estimated glomerular filtration rate of 9.6 mL/min per 1.73 m(2) at 3 years) compared to patients without CMV replication. However, patients undergoing VGCV or GCV chemoprophylaxis had more leukocytopenia. CONCLUSION: Antiviral chemoprophylaxis with VGCV or GCV in recipients with a high or moderate CMV risk is associated with a better preservation of transplant function. Hence, the prevention of CMV replication in this patient population has the potential to improve transplant outcome.


Assuntos
Antivirais/administração & dosagem , Infecções por Citomegalovirus/prevenção & controle , Citomegalovirus/efeitos dos fármacos , Ganciclovir/análogos & derivados , Transplante de Rim , Infecções Oportunistas/prevenção & controle , Adolescente , Fatores Etários , Antivirais/efeitos adversos , Criança , Pré-Escolar , Citomegalovirus/patogenicidade , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/imunologia , Infecções por Citomegalovirus/virologia , Esquema de Medicação , Europa (Continente)/epidemiologia , Feminino , Ganciclovir/administração & dosagem , Ganciclovir/efeitos adversos , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Incidência , Transplante de Rim/efeitos adversos , Masculino , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/imunologia , Infecções Oportunistas/virologia , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Valganciclovir
5.
Sensors (Basel) ; 10(12): 10778-802, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-22163498

RESUMO

The specific advantages of ultra-wideband electromagnetic remote sensing (UWB radar) make it a particularly attractive technique for biomedical applications. We partially review our activities in utilizing this novel approach for the benefit of high and ultra-high field magnetic resonance imaging (MRI) and other applications, e.g., for intensive care medicine and biomedical research. We could show that our approach is beneficial for applications like motion tracking for high resolution brain imaging due to the non-contact acquisition of involuntary head motions with high spatial resolution, navigation for cardiac MRI due to our interpretation of the detected physiological mechanical contraction of the heart muscle and for MR safety, since we have investigated the influence of high static magnetic fields on myocardial mechanics. From our findings we could conclude, that UWB radar can serve as a navigator technique for high and ultra-high field magnetic resonance imaging and can be beneficial preserving the high resolution capability of this imaging modality. Furthermore it can potentially be used to support standard ECG analysis by complementary information where sole ECG analysis fails. Further analytical investigations have proven the feasibility of this method for intracranial displacements detection and the rendition of a tumour's contrast agent based perfusion dynamic. Beside these analytical approaches we have carried out FDTD simulations of a complex arrangement mimicking the illumination of a human torso model incorporating the geometry of the antennas applied.


Assuntos
Técnicas Biossensoriais/instrumentação , Fenômenos Fisiológicos Cardiovasculares , Imageamento por Ressonância Magnética/instrumentação , Monitorização Fisiológica/instrumentação , Neoplasias/diagnóstico , Simulação por Computador , Estudos de Viabilidade , Humanos , Imageamento por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/normas , Monitorização Fisiológica/métodos , Miocárdio , Neoplasias/diagnóstico por imagem , Radar/instrumentação , Radar/estatística & dados numéricos , Intensificação de Imagem Radiográfica/métodos , Tronco
6.
Proc SPIE Int Soc Opt Eng ; 6919(69190K)2008 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-21603095

RESUMO

Increased complexity of scientific research poses new challenges to scientific data management. Meanwhile, scientific collaboration is becoming increasing important, which relies on integrating and sharing data from distributed institutions. We develop SciPort, a Web-based platform on supporting scientific data management and integration based on a central server based distributed architecture, where researchers can easily collect, publish, and share their complex scientific data across multi-institutions. SciPort provides an XML based general approach to model complex scientific data by representing them as XML documents. The documents capture not only hierarchical structured data, but also images and raw data through references. In addition, SciPort provides an XML based hierarchical organization of the overall data space to make it convenient for quick browsing. To provide generalization, schemas and hierarchies are customizable with XML-based definitions, thus it is possible to quickly adapt the system to different applications. While each institution can manage documents on a Local SciPort Server independently, selected documents can be published to a Central Server to form a global view of shared data across all sites. By storing documents in a native XML database, SciPort provides high schema extensibility and supports comprehensive queries through XQuery. By providing a unified and effective means for data modeling, data access and customization with XML, SciPort provides a flexible and powerful platform for sharing scientific data for scientific research communities, and has been successfully used in both biomedical research and clinical trials.

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