RESUMO
The interplay of onco-immunology and kidney transplantation heralds a transformative era in medical science. This integration, while promising, presents significant challenges. Chief among these is the dichotomy of immunosuppression-boosting immunity against malignancies while suppressing it for graft survival. Additionally, limited clinical data on novel therapies, genetic variations influencing responses, economic concerns, and the narrow therapeutic window for post-transplant malignancies necessitate strategic addressal. Conversely, opportunities abound, including personalized immune monitoring, targeted therapies, minimized immunosuppression, and improved patient quality of life. Emphasizing collaborative research and interdisciplinary cooperation, the merging of these fields offers the potential for enhanced graft survival and reduced post-transplant malignancy risks. As we harness modern technology and promote patient-centric care, the vision for the future of kidney transplantation becomes increasingly hopeful, paving the way for more personalized and effective treatments. The article aims to elucidate the critical challenge of balancing immunosuppression to simultaneously combat malignancies and ensure graft survival. It addresses the scarcity of clinical data on novel therapies, the impact of genetic variations on treatment responses, and the economic and therapeutic concerns in managing post-transplant malignancies. Furthermore, it explores the opportunities precision medicine offers, such as personalized immune monitoring, targeted therapies, and reduced immunosuppression, which could significantly improve patient outcomes. Highlighting the importance of collaborative research and interdisciplinary efforts, the article seeks to demonstrate the potential for enhanced graft survival and reduced post-transplant malignancy risks. By leveraging modern technology and prioritizing patient-centric care, it envisions a future where kidney transplantation is more personalized and effective, offering hope for advancements in this field.
RESUMO
OBJECTIVE: Benign prostatic hyperplasia (BPH) is one of the most common diseases found among elderly men. Even though multiple risk factors of BPH have been identified in the past, the risk factors which have a direct impact on prostate volume have not been identified. In this study, we aim to determine the most significant contributing risk factors to prostate volume enlargement by analyzing possible associated risk factors previously studied. METHODS: This is a quantitative study with an analytical observational design, performed using a retrospective cohort approach. Total sampling was performed on 83 patients who underwent transurethral resection of the prostate (TURP) in Sanglah General Hospital from January to February 2019. Bivariate analysis is performed to examine each variable's association with prostate volume followed by a multivariate analysis. All variables were reassessed with path analysis to measure the direct effects, indirect effects, and total effects on prostate volume. RESULTS: Bivariate analysis shows that serum testosterone (R=0.208; p=0.059) and prostate-specific antigen (PSA) level (R=0.626; p=0.001) have a significant association with prostate volume. Multivariate analysis shows that serum PSA (B=1.4; p=0.001; 95% confidence interval [95% CI]=1.039-1.770) and testosterone (B=0.024; p=0.005; 95% CI=0.008-0.041) levels are significant among all the analyzed risk factors. There is a significant and strong effect of PSA to prostate volume (c=0.636; p=0.001) whereas testosterone has a significant albeit weak effect to prostate volume (c=0.246; p=0.009) based on the total effect of the path analysis. CONCLUSION: Serum testosterone and PSA levels are significantly associated with prostatic volume increase among BPH patients.
