Wednesday, July 29, 2015

Neoplastic and Non-Neoplastic Complications of Solid Organ Transplantation in Patients with Preexisting Monoclonal Gammopathy of Undetermined Significance (MGUS)

Clinical Transplantation Neoplastic and Non-Neoplastic Complications of Solid Organ Transplantation in Patients with Preexisting Monoclonal Gammopathy of Undetermined Significance (MGUS)

Abstract

Monoclonal gammopathy of undetermined significance (MGUS) occurs in 3-7% of the elderly population, with higher prevalence in renal failure patients, and is associated with a 25-fold increased lifetime risk for plasma cell myeloma (PCM), also known as multiple myeloma. Using the California State Inpatient, Emergency Department, and Ambulatory Surgery Databases components of the Healthcare Cost and Utilization Project (HCUP), we sought to determine if patients with MGUS who undergo solid organ allograft (n=22,062) are at increased adjusted relative risk (aRR) for hematological malignancy and other complications. Among solid organ transplant patients, patients with preexisting MGUS had higher aRR of PCM (aRR 19.46; 95%CI 7.05, 53.73; p<0.001), venous thromboembolic events (aRR 1.66; 95%CI 1.15, 2.41; p=0.007), and infection (aRR 1.24; 95%CI 1.06, 1.45; p=0.007). However, when comparing MGUS patients with and without solid organ transplant, there was decreased aRR for PCM with transplant (aRR 0.34; 95%CI 0.13, 0.88; p=0.027), and increased venous thromboembolic events (aRR 2.33; 95%CI 1.58, 3.44; p<0.001) and infectious risks, (aRR 1.44; 95%CI 1.23, 1.70; p<0.001). While MGUS increased the risk of PCM overall following solid organ transplantation, there was lower risk of PCM development compared to MGUS patients who did not receive a transplant. MGUS should not preclude solid organ transplant.

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http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fctr.12595

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Alberto Reino Buelvas 
Médico Internista Nefrólogo


You Are What You Eat: Metabolites of Gut Microbiota Provide Novel Insights into Diagnosis and Development of Chronic Kidney Disease



Alberto Reino Buelvas 
Médico Internista Nefrólogo


Thursday, July 23, 2015

Atlas of Renal Pathology: Minimal Change Disease

American Journal of Kidney Diseases Atlas of Renal Pathology: Minimal Change Disease

Minimal change disease (MCD) is characterized by nephrotic syndrome. It is the most common cause of nephrotic syndrome in children aged 1 to 7 years and remains a cause of nephrotic syndrome in adults.


http://www.ajkd.org/article/S0272-6386(15)00634-4/abstract?rss=yes

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Alberto Reino Buelvas 
Médico Internista Nefrólogo


Wednesday, July 8, 2015

Evaluation of Low- Versus High-dose Valganciclovir for Prevention of Cytomegalovirus Disease in High-risk Renal Transplant Recipients

Transplantation - Most Popular Articles Evaluation of Low- Versus High-dose Valganciclovir for Prevention of Cytomegalovirus Disease in High-risk Renal Transplant Recipients

imageBackground: Despite proven efficacy of prolonged cytomegalovirus (CMV) prophylaxis using valganciclovir 900 mg/day, some centers use 450 mg/day due to reported success and cost savings. This multicenter, retrospective study compared the efficacy and safety of 6 months of low-dose versus high-dose valganciclovir prophylaxis in high-risk, donor-positive/recipient-negative, renal transplant recipients (RTR). Methods: Two hundred thirty-seven high-risk RTR (low-dose group = valganciclovir 450 mg/day [n = 130]; high-dose group = valganciclovir 900 mg/day [n = s7]) were evaluated for 1-year CMV disease prevalence. Breakthrough CMV, resistant CMV, biopsy-proven acute rejection (BPAR), graft loss, opportunistic infections (OI), new-onset diabetes after transplantation (NODAT), premature valganciclovir discontinuation, renal function and myelosuppression were also assessed. Results: Patient demographics and transplant characteristics were comparable. Induction and maintenance immunosuppression were similar, except for more early steroid withdrawal in the high-dose group. Similar proportions of patients developed CMV disease (14.6% vs 24.3%; P = 0.068); however, controlling CMV risk factor differences through multivariate logistic regression revealed significantly lower CMV disease in the low-dose group (P = 0.02; odds ratio, 0.432, 95% confidence interval, 0.211–0.887). Breakthrough and resistant CMV occurred at similar frequencies. There was no difference in renal function or rates of biopsy-proven acute rejection, graft loss, opportunistic infections, or new-onset diabetes after transplantation. The high-dose group had significantly lower mean white blood cell counts at months 5 and 6; however, premature valganciclovir discontinuation rates were similar. Conclusions: Low-dose and high-dose valganciclovir regimens provide similar efficacy in preventing CMV disease in high-risk RTR, with a reduced incidence of leukopenia associated with the low-dose regimen and no difference in resistant CMV. Low-dose valganciclovir may provide a significant cost avoidance benefit.


http://journals.lww.com/transplantjournal/Fulltext/2015/07000/Evaluation_of_Low__Versus_High_dose_Valganciclovir.34.aspx

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Alberto Reino Buelvas 
Médico Internista Nefrólogo