RESUMO
BACKGROUND: Preemptive therapy reduces the risk of cytomegalovirus disease in high-risk kidney transplant patients. The advantage of this strategy is that only a fraction of patients receive antiviral drugs for a limited time, which decreases costs and toxicity but requires frequent monitoring and may not prevent complications of asymptomatic cytomegalovirus replication. MATERIAL AND METHODS: Long-term graft-function and patient survival of high-risk kidney transplant patients who received preemptive therapy guided by pp65 antigenemia was compared to those whose assay remained negative throughout the first post-transplant year. RESULTS: Between August 1997 and March 2005, 24 of 272 patients were CMV D+/R-. Thirteen of the 24 (54.2%) developed a positive CMV assay during follow-up; the time between transplant and first positive antigenemia was 66.7 +/- 58.3 days (range 29-251 days). Four patients developed symptoms associated with CMV, one of whom succumbed from complications of CMV neumonitis. Overall, no significant differences were observed in SCr, eGFR, delta SCr, and delta eGFR during a 60-month followup between patients who developed CMV infection or disease and those who remained pp65 antigenemia-negative throughout the first 12 post-transplant months. Additionally, no deaths or graft loss occurred during the long-term follow up of this cohort. CONCLUSIONS: Our results suggest that in this high risk group of kidney transplant recipients, treating CMV replication using a preemptive strategy during the first posttransplant year is associated with a low rate of CMV complications and probably interferes with the alleged long-term negative indirect effects of CMV on kidney function and survival.
Assuntos
Antivirais/uso terapêutico , Infecções por Citomegalovirus/prevenção & controle , Sobrevivência de Enxerto , Transplante de Rim , Complicações Pós-Operatórias/prevenção & controle , Pré-Medicação , Adulto , Antivirais/administração & dosagem , Estudos de Coortes , Creatinina/sangue , Citomegalovirus/imunologia , Citomegalovirus/fisiologia , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/epidemiologia , Feminino , Seguimentos , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Transplante de Rim/estatística & dados numéricos , Masculino , Fosfoproteínas/sangue , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Risco , Fatores de Tempo , Proteínas da Matriz Viral/sangue , Viremia/diagnóstico , Viremia/tratamento farmacológico , Replicação Viral , Adulto JovemRESUMO
Se realizó un estudio de los pacientes atendidos en el Hospital Escuela Oscar Danilo Rosales, en el período de Enero a Diciembre de 1998 con el objetivo de determinar cuáles son los síntomas y hallazgos encontrados por el laboratorio en las uropatías obstructivas. Los pacientes hospitalizados estudiados fueron el 62.9 por ciento masculinos y el 37.1 por ciento femeninos, los grupos de edad más afectados son los mayores de 50 años con un 64.2 por ciento y menores de 30 años un 10 por ciento. A todos los pacientes estudiados se les realizó exámen general de orina, creatinina, estudio radiológico, pielograma y ultrasonido