Navegando por Palavras-chave "Tratamento Preemptivo"

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    O impacto dos métodos de antigenemia pp65 e reação em cadeia da polimerase quantitativo para o diagnóstico de infecção por citomegalovírus em receptores de transplante renal em eras distintas
    (Universidade Federal de São Paulo (UNIFESP), 2020-12-18) Nakamura, Monica Rika [UNIFESP]; Bonato, Claudia Rosso Felipe [UNIFESP]; Universidade Federal de São Paulo
    Introduction: Cytomegalovirus (CMV) infection is one of the post- most common transplants (20 to 60%), with a possible negative impact on the survival of graft, increased morbidity, and occasionally mortality. Strategies for risk reduction should be adopted after kidney transplantation, such as prophylaxis pharmacological or preemptive treatment. The main laboratory methods for detection of CMV viremia after transplantation are the antigenemia for pp65 and the real-time polymerase chain reaction (PCR). In many Brazilian services, the strategy adopted is preemptive treatment, and the methodology for detecting viremia has varied between services and over time. Objective: To assess the impact of the pp65 (AgCMV) and PCR antigenemia methods used for the detection of viremia in the preemptive treatment of patients at high risk to develop CMV infection or disease, in different eras of transplantation renal. Methodology: This is a quasi-experimental, open, longitudinal study, observational, without intervention by the researchers, with historical control, center (Hospital do Rim - Fundação Oswaldo Ramos), designed to to compare two eras, in which different diagnostic methods of detection of CMV infection. Consecutive kidney transplants were analyzed, between 23/03/2016 to 13/08/2018: 193 patients in the AgCMV era and 198 patients in the AgCMV era PCRCMV. Incidence of infection and disease and duration of treatment were compared between the ages, in addition to an indirect measure of adherence for preemptive treatment. Multivariate analysis for the risk of infection and disease was performed in each of the ages. Results: The population selected for the study (391 patients) had an average of 48 years old, 55.5% male and 54.4% Caucasian, with a predominance of chronic kidney disease of undetermined etiology (43.2%). In the comparison between the two ages (AgCMV vs. PCRCMV), significant differences (P & lt; 0.05) were observed in the following variables: ethnicity of the recipient (45.6 vs. 63.1% Caucasians), time on dialysis pre-transplant (47 vs. 34 months), donor age (53 vs. 50 years), donor gender (47.2 vs. 58.6% male), frequency of KDPI & gt; 80% (49.7 vs. 36.9%) and PRA of class I & gt; 80% (11.4 vs. 4.5%), cold ischemia time (24.3 vs. 21.9 hours), frequency of late graft function (58.5 vs. 41.4%) and, consequently, renal function (CKD-EPI) in 30 days after transplantation (33.99 vs. 41.48 ml / min). There was no difference in the incidence of first episode of infection or disease in the two ages (52.2% vs. 47.8%, P = 0.30) or time to diagnosis (47 vs. 48 days, P = 0.92), however the treatment time was significantly shorter in the AGCMV era (20 vs. 28 days, P & lt; 0.001). There was no statistical difference in the incidence of CMV recurrence the two ages. In a multivariate analysis in the AgCMV era, renal function in 30 days was the only variable that interfered with the risk of developing infection or disease (HR = 0.98, CI- 95% 0.97-0.99, P & lt; 0.001). In the PCRCMV era, the variables related to this risk were donor age (HR = 1.02, 95% CI 1.00-1.03, P = 0.044), late graft function (HR = 1.65, 95% CI 1.07-2.54, P = 0.023) and acute rejection in the first 30 days (HR = 2.13, 95% CI 1.05-4.34, P = 0.037). Conclusion: there was no difference in the incidence of CMV infection and disease and nor in the time to detect viremia, between the two ages. Treatment time, however, it was superior in the PCRCMV era, with no difference in recurrence of infection or illness. Renal function at 30 days interfered with the risk of developing CMV infection or disease in the AgCMV era, as donor age, late function of the graft and acute rejection in the first 30 days were independent factors for the risk of infection or disease in the PCRCMV era.