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- ItemAcesso aberto (Open Access)Feohifomicosis causada por Colletotrichum gloeosporioides y Alternaria infectoria en un paciente trasplantado renal(Soc Chilena Infectologia, 2014-08-01) Ogawa, Marilia Marufuji [UNIFESP]; Reis, Viviane [UNIFESP]; Godoy, Patricio [UNIFESP]; Menezes, Fernando Gatti de [UNIFESP]; Enokihara, Mílvia Maria Simões e Silva [UNIFESP]; Tomimori, Jane [UNIFESP]; Univ Austral Chile; Universidade Federal de São Paulo (UNIFESP); Dept MedSeveral species of black fungi have been reported as agents of subcutaneous phaeohyphomycosis. Although most of these fungi are considered opportunistic pathogens, they play an important role in phaeohyphomycosis, a disease considered an emergent mycosis among solid organ recipients. We report a case of phaeohyphomycosis caused by Alternaria infectoria of the left hand and the 4th finger of the right hand of a 68-year-old male who underwent a renal transplant 35 months before. The lesion was treated with surgical excision. One year later, the patient presented a new lesion on the 5th finger of the right hand, but this time caused by Colletotrichum gloeosporioides that was also removed surgically. Both lesions did not relapse after being removed. Antifungal susceptibility testing was performed against five antifungal drugs (amphotericin B, itraconazole, flucytosine, fluconazole and voriconazole). Alternaria infectoria was resistant to all five drugs and C. gloeosporioides was sensitive only to amphotericin B and voriconazole. We emphasize the need of histopathologic and microbiologic studies of new lesions of phaeohyphomycosis, since in this case the same patient was infected twice by two different fungi.
- ItemSomente MetadadadosMycophenolate 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.
- ItemSomente MetadadadosPharmacogenetics of calcineurin inhibitors in Brazilian renal transplant patients(Future Medicine Ltd, 2011-09-01) Santoro, Ana; Felipe, Claudia Rosso [UNIFESP]; Tedesco-Silva, Helio [UNIFESP]; Medina-Pestana, Jose O. [UNIFESP]; Struchiner, Claudio J.; Ojopi, Elida B.; Suarez-Kurtz, Guilherme; Inst Nacl Canc; Universidade Federal de São Paulo (UNIFESP); Fundacao Oswaldo Cruz; Universidade de São Paulo (USP)Aim: Polymorphisms in the CYP3A5 and ABCB1 genes have been investigated as modulators of the pharmacokinetics and clinical effects of cyclosporine (CSA) and tacrolimus (TAC) in European, North American and Asian populations, with controversial results. the extensive variation in worldwide frequency distribution of CYP3A5 and ABCB1 polymorphisms is a caveat against the extrapolation of these data to the heterogeneous and admixed Brazilian population. We investigated the effect of CYP3A5 and ABCB1 polymorphisms on CSA and TAC dose-adjusted trough concentration (C(0)/dose) in Brazilian renal transplant recipients, during the first 3 months post-transplantation. Materials & methods: Patients receiving CSA (n = 150) or TAC (n = 151) were genotyped for CYP3A5(star)3 (rs776746, 6986A>G), (star)6(rs10264272, 14690G>A) and (star) 7 (rs41303343, 27131-27132insT) and for ABCB1 1236C>T (rs1128503), 2677G>T/A (rs2032582) and 3435C>T (rs1045642) polymorphisms. We explored the effects of CYP3A5 and ABCB1 polymorphisms, clinical and demographical characteristics on CSA and TAC C(0)/dose under a two-step data ana-lysis strategy by fitting a longitudinal mixed-effects model to the data; first to select the important covariates under a univariate setting and then to fit the final multivariate model. Results: C(0)/dose of TAC was associated with the number of CYP3A5-defective alleles, in a gene-dose manner, throughout the observation period, whereas C0/dose of CSA was associated with body surface area and prednisone dosing. No other significant associations were detected. Conclusion: Individual adjustment of the initial TAC dose according to the CYP3A5 haplotypes comprising the CYP3A5(star)3, (star)6 and (star)7 defective alleles might prove beneficial to Brazilian renal transplant recipients and should be further investigated in prospective trials. Original submitted 5 April 2011; Revision submitted 4 May 2011
- ItemSomente MetadadadosPregnancy after renal transplantation - a five-yr single-center experience(Blackwell Publishing, 2007-05-01) Oliveira, Leandro G.; Sass, Nelson; Sato, Jussara L.; Ozaki, Kikumi S.; Medina Pestana, Jose O.; Universidade Federal de São Paulo (UNIFESP)Background: There has been an increase in the number of pregnancies in renal transplant recipients. Our aim was to report our experience with a significant casuistic.Methods: Fifty-two pregnancies in 52 patients (January 2001 to December 2005), with two patients having a multiple pregnancy, were evaluated and patients were characterized and evaluated as clinical and obstetrical and perinatal outcomes.Results: Mean patient age was 26.5 yr (range 17-38) with live donors in 34 (65.4%) and cadaver donors in 18 (34.6%). the mean transplantation-pregnancy interval was 3.1 yr. Calcineurin inhibitors (cyclosporine or tacrolimus) comprised the immunosuppressive therapy in 49 pregnancies (94.2%). Pregnancy complications were chronic hypertension in 33 patients (63.5%), anemia in 31 (59.6%), urinary tract infection in 22 (42.3%) and diabetes in four (7.7%). Nine patients (17.3%) received blood transfusion. Preeclampsia was diagnosed in 16 cases (30.7%) and renal dysfunction in 23 (44.2%) with preeclampsia assumed to be the main cause. One patient (1.9%) had graft loss, as a result of hemorrhagic shock after preterm delivery at home. Premature rupture of membranes occurred in four cases (7.7%), and preterm delivery in 20 (38.4%). Sixteen (29.6%) newborn were small for gestational age. One case of neonatal death was registered as a result of excessive prematurity. Cesarean section was performed in 32 patients (61.5%), the main indications being related to hypertension syndromes and fetal distress.Conclusions: This group of patients is characterized by a wide range of antenatal and perinatal problems and must be managed in specialized tertiary units to achieve the very best results.
- ItemSomente MetadadadosPrevalence of hepatitis delta virus among hemodialysis and renal transplant patients(Sage Publications Ltd, 2018) Pierre, Alessandra Maria Mont'Alverne [UNIFESP]; Feldner, Ana Cristina de Castro Amaral [UNIFESP]; Carvalho Filho, Roberto Jose de [UNIFESP]; Lopes, Edmundo Pessoa de Almeida; Gouvea, Michele Soares Gomes; Pinho, Joao Renato Rebello; Carvente, Claudia Teresa [UNIFESP]; Emori, Christini Takemi [UNIFESP]; Silva, Genimari Arruda da [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]Introduction: Hepatitis B virus infection is an important cause of liver disease in hemodialysis patients and renal transplant recipients. Hepatitis Delta virus is a defective virus transmitted by the same route of hepatitis B virus, which requires the helper function of hepatitis B virus. Data about hepatitis B virus/hepatitis delta virus coinfection are scarce and there are no studies regarding the coinfection among hemodialysis patients and renal transplant in our country. Objective: This study aimed to investigate the prevalence of hepatitis delta virus infection among hemodialysis patients and renal transplant recipients. Methods: Cross-sectional study analyzing virological markers of hepatitis B virus and hepatitis delta virus infection and biochemical and clinical features of liver disease of patients infected with hepatitis B virus in hemodialysis and renal transplant. Results: A total of 117 HBsAg-positive patients (46 hemodialysis and 71 renal transplant) were included. The mean age was 48.511.8years and 67% were males. Antiviral therapy was given to 74% of patients. Liver function tests were within the normal range. HBeAg-positive was found in 35% of patients and median hepatitis B virus DNA was 2.98log (IU/mL). Cirrhosis was detected in 26.5% of patients. The prevalence of anti-hepatitis delta virus total antibody (+) was 1.7% (2/117). None of the 2 patients had active hepatitis delta virus infection, since all samples tested negative for hepatitis delta virus-RNA. Conclusion: The results suggest a low prevalence rate of coinfection B and D in hemodialysis and renal transplant recipients in this population.
- ItemSomente MetadadadosSerum free light chains and post-transplant lymphoproliferative disorder in patients with renal transplant(Informa Healthcare, 2013-10-01) Fernando, Rodrigo C. [UNIFESP]; Rizzatti, Edgar G.; Braga, Walter M. T. [UNIFESP]; Santos, Melina G.; Oliveira, Mariana B. de [UNIFESP]; Pestana, Jose O. M. [UNIFESP]; Baiocchi, Otavio Carvalho Guimarães [UNIFESP]; Colleoni, Gisele W. B. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Grp FleuryThe aim of the present study was to determine whether there is an association between serum free light chains (sFLC) quantification and the development of post-transplant lymphoproliferative disorder (PTLD), using serum samples from a nested case control cohort of patients with renal transplant. Ten new cases of PTLD and 46 controls were enrolled. Additional comparison groups consisted of five human immunodeficiency virus (HIV)-infected individuals, five with untreated Hodgkin lymphoma and six normal individuals. Serum kappa and lambda FLC concentrations were measured by nephelometry and compared with reference ranges (normal and renal ranges). kappa and/or lambda were above the normal range in 90% of cases and in 65% of matched controls. There was no statistically significant difference between all groups, except for lambda FLC concentrations between cases of PTLD and normal individuals (p = 0.016). the kappa/lambda sFLC ratios of cases and controls were within the renal range and normal range. Our results suggest that sFLC are not useful to predict PTLD development in renal transplant recipients.
- ItemSomente MetadadadosSpecific sHLA in healthy donors and donor-specific sHLA in renal transplant patients(Elsevier B.V., 1999-05-01) Borelli, S. D.; Ferreira, E.; Oliveira, A. M.; Krishnaswamy, S.; Hiraki, D. D.; Grumet, F. C.; Universidade Estadual de Maringá (UEM); Universidade Federal de São Paulo (UNIFESP); Stanford UnivWe studied cadaver kidney transplant recipients to determine if their serum levels of donor-specific class I sHLA correlated with graft outcome. Testing of sHLA was performed by an ELISA sandwich assay using allospecific monoclonal trapping antibodies and anti-beta 2-mu detecting antibody. Sufficient sHLA sensitivity (<1 ng:ml) was achieved by using two synergistic trapping antibodies. Suitable antibodies were available for A2 and B7, and data were collected for these two antigens. Stability of these sHLA was determined in plasma and serum as were ranges of normal and background levels. Background levels varied substantially. Five AZ recipients of A2(+) grafts and 5 B7(-) recipients of B7(+) grafts were studied with appropriate sHLA levels measured pretransplant and at intervals post-transplant. Graft outcome was assessed by serum creatinines? renal biopsies and/or therapy for rejection. in the 5 patients (3 A2(-) and 2 B7(-)) whose post-transplant donor-specific sHLA never exceeded immunological complications (e.g., post-operative ATN, ureteral obstruction) did not affect the correlation. in the 5 patients with post-transplant levels exceeding pre-transplant levels, subsequent evidence of rejection was observed. Periodic measurement of donor-specific sHLA should be a useful instrument for monitoring renal allograft rejection. (C) American Society for Histocompatibility and Immunogenetics, 1999 Published by Elsevier Science Inc.