Navegando por Palavras-chave "chronic allograft nephropathy"

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    Mycophenolate mofetil substitution for cyclosporine A in renal transplant recipients with chronic progressive allograft dysfunction: the creeping creatinine study
    (Lippincott Williams & Wilkins, 2005-02-27) Dudley, C.; Pohanka, E.; Riad, H.; Dedochova, J.; Wijngaard, P.; Sutter, C.; Silva, H. T.; Mycophenolate Mofetil Creep; Southmead Gen Hosp; Univ Vienna; Manchester Royal Infirm; Internal Clin FNsP; F Hoffman La Roche Ltd; Universidade Federal de São Paulo (UNIFESP)
    Background. This study determined whether cyclosporine A (CsA)-treated renal allograft recipients with deteriorating renal function (creeping creatinine) secondary to chronic allograft nephropathy (CAN) benefit from the addition of mycophenolate mofetil (MMF) to their immunosuppressive regimen, followed by withdrawal of CsA.Methods. in a controlled, open, multicenter study, CsA-treated renal allograft recipients with progressively deteriorating renal function were randomized to have their CsA discontinued with the concomitant addition of MMF to their regimen (group A) or to continue treatment with CsA (group B). the primary endpoint was the response rate over the 6-month period after withdrawal of CsA in group A or the equivalent time in group B. Response was defined as a stabilization or reduction of serum creatinine (SCr), as evidenced by a flattening or positive slope of the 1/SCr plot and no graft loss. Secondary endpoints included the incidence of acute rejection, graft and patient survival, and changes in selected metabolic parameters.Results. the response rate in the primary intent-to-treat population (n = 122) was 58% (36/62) in group A versus 32% (19/60) in group B (P= 0.0060). the corresponding percentages of responders in the per-protocol population (n = 107) were 60% (36/60) and 26% (12/47), respectively (P=0.0008). There were no acute rejections in group A during the study period. Patients in this group also experienced a significant decrease in total cholesterol.Conclusions. in patients with progressively deteriorating renal function secondary to CAN, addition of MMF followed by withdrawal of CsA results in a significant improvement in transplant function without the risk of acute rejection.
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    Post-transplant anti-HLA class II antibodies as risk factor for late kidney allograft failure
    (Blackwell Publishing, 2006-10-01) Campos, E. F.; Tedesco-Silva, H.; Machado, P. G.; Franco, M.; Medina-Pestana, J. O.; Gerbase-DeLima, Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The purpose of this study was to prospectively analyze the relationship between the post-transplant anti-HLA class I and/or class II panel reactive antibodies and graft failure due to chronic allograft nephropathy (CAN). We studied 512 first kidney recipients transplanted at a single center, with a graft functioning for at least 3 years. A single blood sample was collected from each patient for antibody evaluation. the median posttransplant time after blood collection was 4.4 years and did not differ between patients with (n = 91) or without anti-HLA antibodies (n = 421). Female gender, pregnancies and blood transfusions were associated with the presence of anti-HLA class I antibodies. Graft function deterioration was associated with anti-HLA class II antibodies. Multivariate analysis showed independent association for creatinine levels (RR = 7.5), acute rejection (RR = 2.6), recipient male gender (RR = 3.6) and anti-HLA class II antibodies (RR = 2.9) and CAN-associated graft loss. in conclusion, the presence of anti-HLA class II antibodies conferred a risk for graft loss before a decline in renal function and increased the risk of graft failure in patients who already had a decline in graft function. Thus, anti-HLA class II antibody monitoring is a useful tool for the management of long-term kidney recipients.
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    Presence of arteriolar hyalinosis in post-reperfusion biopsies represents an additional risk to ischaemic injury in renal transplant
    (Wiley-Blackwell, 2016) Matos, Ana Cristina; Câmara, Niels Olsen Saraiva [UNIFESP]; Requiao-Moura, Lucio R.; Tonato, Eduardo J.; Filiponi, Thiago C.; Souza-Durao, Marcelino, Jr.; Malheiros, Denise M.; Fregonesi, Mauricio; Borrelli, Milton; Pacheco-Silva, Alvaro [UNIFESP]
    Aim: The role of post-reperfusion biopsy findings as a predictor of early and long-term graft function and survival is still a target of research. Methods: We analyzed data from 136 post-reperfusion biopsies performed in deceased donor renal transplanted patients from November 2008 to May 2012. We analyzed the presence of acute tubular necrosis (ATN), arteriolar hyalinosis (AH), intimal thickness (IT), interstitial fibrosis (IF) and glomerulosclerosis (GS). We also analyzed the impact of donor features on the following outcomes: delayed graft function (DGF) and chronic allograft dysfunction defined as eGFR < 60mL/min at 1 year. Results: The mean donor age was 41 years, 26% of whom were extended criteria donors (ECD), 33% had hypertension and 50% had cerebral vascular accident (CVA) as the cause of death. ATN was present in 87% of these biopsies, AH in 31%, IF in 21%, IT in 27% and GS in 32%. DGF occurred in 80% and chronic allograft dysfunction was present in 53%. AHwas the only histological finding associated with DGF and chronic allograft dysfunction at 1 year. Patients with AH had a lower eGFR at 1 year than patients without it (49.8 mL/min x 64.5 mL/min, P= 0.02). In the multivariate analysis, risk variables for development of chronic graft dysfunction were male sex (odds ratio [OR] = 3.159 [CI: 1.22-8.16]