Friday, January 3, 2014
Friday, December 20, 2013
Clinical outcomes among renal transplant recipients with pre-transplant weakly reactive donor-specific antibodies
Abstract
Background
Alloantibody can lead to antibody-mediated rejection and graft loss in renal transplantation, necessitating an assessment of cross-match compatibility. Within the past decade, more specific solid phase assays of alloantibody have been widely adopted, allowing virtual cross-matching based on unacceptable antigens, the threshold of which is determined by individual centers.
Methods
We examined the clinical outcomes of 482 patients transplanted 2007–2009 in a single center, focusing on 30 patients with weakly reactive donor-specific antibody (DSA) determined prospectively prior to renal transplant.
Results
Compared with patients without DSA, patients with weakly reactive DSA do not have increased rates of antibody-mediated rejection, cellular rejection, or graft loss despite conventional immunosuppression utilization.
Conclusions
Using the screening methodology and immunosuppression regimen, we have applied to the patients with weak DSA allows them to be transplanted with equivalent outcomes as those without DSA, despite the overall higher risk characteristics of the patients in the weak DSA group.
http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fctr.12289
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Alberto Reino Buelvas
Médico Internista Nefrólogo
Hospital San Vicente de Paul
Grupo Trasplantes Renales
Director Médico Unidad Renal
Thursday, December 12, 2013
The role of mycophenolate mofetil in kidney transplantation revisited
Transplantation Reviews The role of mycophenolate mofetil in kidney transplantation revisited
Abstract: Since its regulatory approval in 1995, mycophenolate mofetil (MMF) has largely replaced azathioprine (AZA) as the anti-metabolite immunosuppressive of choice in kidney transplantation. While the initial industry-sponsored clinical trials suggested strong reductions in the incidence of acute rejection in the first six months post transplantation, long-term follow-up studies have failed to demonstrate a similar degree of benefit in overall graft and patient survival. In addition, several subsequent studies have raised questions on the potential attenuating effects of calcineurin inhibitor choice on MMF efficacy when compared to AZA. This review will revisit the question of whether the available evidence continues to support the superiority of MMF over AZA in kidney transplantation outcomes while comprehensively reviewing the available evidence from clinical trial data, systematic reviews, and registry studies.http://www.transplantationreviews.com/article/S0955-470X(13)00112-2/abstract?rss=yes
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Alberto Reino Buelvas
Médico Internista Nefrólogo
Hospital San Vicente de Paul
Grupo Trasplantes Renales
Director Médico Unidad Renal
Sunday, December 8, 2013
Desensitization for prevention of chronic antibody-mediated rejection after kidney transplantation
Abstract
Chronic antibody-mediated rejection (C-AMR) is the most important and leading cause of graft loss after kidney transplantation. Although it is well known that chronic renal allograft dysfunction or failure is caused by various immunological or non-immunological factors, donor-specific anti-human leukocyte antigen antibodies (DSAs) are considered to be the most detrimental to graft survival and could cause C-AMR. Despite the use of intensive treatment for C-AMR, outcomes have not always been promising. Recently, prevention, rather than treatment, of C-AMR has been attempted, and this approach appears to be a more effective option for reducing the incidence of C-AMR and, ultimately, improving long-term survival. To prevent C-AMR, removal of antibodies, inactivation of antibodies, and prevention of antibody production after kidney transplantation are essential. Preconditioning treatment including plasmapheresis, intravenous immunoglobulin, and rituximab injection seems the most effective of current desensitization protocols. In this minireview, we will focus on the prevention of C-AMR through desensitization and improving long-term graft survival.
http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fctr.12260
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Alberto Reino Buelvas
Médico Internista Nefrólogo
Hospital San Vicente de Paul
Grupo Trasplantes Renales
Director Médico Unidad Renal
Outcome of tonsillectomy for recurrent IgA nephropathy after kidney transplantation
Abstract
Since 2007, we have performed tonsillectomies for patients with recurrent immunoglobulin A nephropathy (IgAN) after kidney transplantation. Seven patients with primary IgAN showed biopsy-proven recurrent IgAN after living-donor kidney transplantation. They had persistent proteinuria or hematuria for an average of 40.3 months, and tonsillectomy was performed, on average, 75.6 months after kidney transplantation. In six patients with observation periods of more than one yr, good remission of urinary findings was observed after tonsillectomy. We classified the seven patients into three types of renal injury based on histological findings: severe, moderate, and mild. Two patients classified with severe renal injury at the time of tonsillectomy had other problems, such as refractory hypertension and bilateral sinusitis. They followed a rapidly progressive clinical course. One case already had moderate histological renal injury. He demonstrated prompt amelioration of urinary findings after tonsillectomy but immediate deviation from remission of proteinuria and hematuria. In the four cases presenting mild renal injury at tonsillectomy, the improved urinary findings and serum creatinine value after tonsillectomy have persisted. In conclusion, tonsillectomy may be a favorable treatment for cases of mild-grade IgAN. However, other treatments such as antihypertensive agents and diet therapy may be necessary in other grades.
http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fctr.12194
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Alberto Reino Buelvas
Médico Internista Nefrólogo
Hospital San Vicente de Paul
Grupo Trasplantes Renales
Director Médico Unidad Renal
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