Incidence of Tuberculosis in Deceased-Organ Donors and Transmission Risk to Recipients in Spain

Transplantation - Published Ahead-of-Print Incidence of Tuberculosis in Deceased-Organ Donors and Transmission Risk to Recipients in Spain

Background: Globalization and migration patterns have increased the number of donors from countries with high incidence rates of tuberculosis (TB) in low incidence countries, with the subsequent increase in risk of TB transmission to the recipients. Methods: Retrospective cohort study, including all actual deceased donors in Spanish hospitals between January 1998 and June 2011 and all the recipients who had received an organ from donors identified as TB cases. Results: Six actual donors were identified as TB cases, representing an annual incidence of 30.6 cases/100,000 donors (95% CI, 4-58). Two cases did not become utilized donors, because TB was detected in the organ recovery and were therefore excluded. Annual incidence in utilized donors was 23 cases/100,000 donors (95% CI, 6-59). Annual incidence of the Spanish population in the same period was 17.5 cases/100,000 inhabitants (95% CI, 17-18). Annual incidence in actual donors belonging to the Romanian immigrant community was 2353 cases/100,000 donors (95% CI, 286-8242). Variations in the prophylactic strategy utilized in recipients were observed. TB was transmitted to three recipients (27.3% transmission), two of whom developed active TB. Conclusions: Incidence of TB in actual donors is greater than that of the general population (P<0.001). The risk of immigrant communities should be grouped according to the real incidence in donors. Transmissibility of TB is high; therefore, transplant teams should be immediately informed when TB donor transmission is suspected to prevent TB in the recipient. (C) 2013 Lippincott Williams & Wilkins, Inc.


http://pdfs.journals.lww.com/transplantjournal/9000/00000/Incidence_of_Tuberculosis_in_Deceased_Organ_Donors.98547.pdf

Sent with Reeder

Impact of Early Graft Function on 10-Year Graft Survival in Recipients of Kidneys From Standard- or Expanded-Criteria Donors

Transplantation - Published Ahead-of-Print Impact of Early Graft Function on 10-Year Graft Survival in Recipients of Kidneys From Standard- or Expanded-Criteria Donors

Background: The use of kidneys from expanded-criteria donors (ECD) is regarded with caution. Methods: We compared 279 kidney transplant recipients (KTxR) from standard-criteria donors (SCD) and 237 from ECD, transplanted between January 1990 and December 2006. We evaluated the impact of immediate graft function (IGF), slow graft function (SGF), and delayed graft function (DGF) and the drop in estimated glomerular filtration rate ([DELTA]eGFR) <=30% or >30% during the first year after transplantation on long-term patient and death-censored graft survival (DCGS). Results: Ten-year patient survival was similar in SCD- or ECD-KTxR (P=0.38). DCGS was better in SCD-KTxR versus ECD-KTxR (77.3% vs. 67.3%; P=0.01). DCGS did not differ in either group experiencing IGF (P=0.17) or DGF (P=0.12). However, DCGS was worse in ECD-KTxR experiencing SGF (84.9% vs. 73.7%; P=0.04). Predictors of DCGS were 1-year serum creatinine (hazard ratio, 1.03; P<0.0001) and [DELTA]eGFR >30% between 1 and 12 months ([DELTA]1-12eGFR) after transplantation (hazard ratio, 2.2; P=0.02). In ECD-KTxR with IGF and more than 1-year follow-up, 10-year DCGS was better in those with [DELTA]1-12eGFR <=30% versus those with [DELTA]1-12eGFR >30% (83.8% vs. 53.6%; P=0.01). Conclusion: Recipients of SCD or ECD kidneys with IGF or DGF had similar 10-year patient survival and DCGS. SGF had a worse impact on DCGS in ECD-KTxR. In addition to 1-year serum creatinine, [DELTA]1-12eGFR >30% is a negative predictor of DCGS. Larger studies should confirm if increasing the use of ECD, avoiding factors that contribute to SGF or DGF, and/or a decline in eGFR during the first year after transplantation may expand the donor pool and result in acceptable long-term outcomes. (C) 2013 Lippincott Williams & Wilkins, Inc.


http://pdfs.journals.lww.com/transplantjournal/9000/00000/Impact_of_Early_Graft_Function_on_10_Year_Graft.98552.pdf

Sent with Reeder

Comparison of Pharmacokinetics and Pathology for Low-Dose Tacrolimus Once-Daily and Twice-Daily in Living Kidney Transplantation: Prospective Trial in Once-Daily Versus Twice-Daily Tacrolimus

Transplantation - Published Ahead-of-Print Comparison of Pharmacokinetics and Pathology for Low-Dose Tacrolimus Once-Daily and Twice-Daily in Living Kidney Transplantation: Prospective Trial in Once-Daily Versus Twice-Daily Tacrolimus

Background: A prolonged-release formulation of tacrolimus (Tacrolimus QD) was developed to allow once-daily dosing and to have similar safety and efficacy profiles to twice-daily tacrolimus (Tacrolimus BID). This study compared the pharmacokinetics (PK) and renal pathology by protocol biopsy in de novo living kidney transplant recipients treated with either low-dose Tacrolimus QD or Tacrolimus BID. Methods: Between November 2009 and January 2011, 102 consecutive adult patients were randomized to receive either low-dose Tacrolimus QD or Tacrolimus BID. All patients underwent PK study and protocol biopsy on postoperative day 14. Additional protocol biopsies were performed between 6 and 12 months after renal transplantation. Results: During the 1-year follow up, the incidence of biopsy-proven acute rejection and toxic tubulopathy was low and similar in both groups. Twenty-four hours area under the curve (AUC0-24) was not different in both groups (285+/-78.7 and 281+/-62.4 ng hr/mL in Tacrolimus QD and Tacrolimus BID, respectively). C0 was well correlated with AUC0-24 in both groups and AUC0-24 between 260 and 280 in the Tacrolimus QD group was achieved by 6 to 8 ng/mL of C0. Acute nephrotoxicity was less than 10% in both groups without any clinical manifestation. Conclusion: Clinical efficacy, safety, and PK profile of Tacrolimus QD is same as those of Tacrolimus BID. (C) 2013 Lippincott Williams & Wilkins, Inc.


http://pdfs.journals.lww.com/transplantjournal/9000/00000/Comparison_of_Pharmacokinetics_and_Pathology_for.98539.pdf

Sent with Reeder

[Ureterostomy cytomegalovirus infection presenting as stoma ulceration in a kidney allograft receptor: a case report].

Abstract

Cytomegalovirus (CMV) is the most common viral infection affecting transplant patients, but urinary tract involvement has been rare. Only a few cases of symptomatic ureteritis have been reported in renal transplant recipients. In previous reports the presentation of CMV ureteritis is obstructive nephropathy, often in the absence of systemic illness, or rarely it may also mimic allograft rejection with minimal obstructive symptoms. We describe an additional case of CMV ureteritis in a patient with cutaneous ureterostomy. The unusual clinical presentation with urinary infection symptoms and ureterostomy stoma ulceration constitute a very particular presentation. The increasing report cases with CMV ureteritis suggest an increase of this post-transplant complication.

Links

Authors

Rico JE, Cardona X, Rodelo J, Reino A, Arias LF, Arbeláez M

Institution

Sección de Nefrología y Grupo de Trasplante Renal, Universidad de Antioquía, Hospital Universitario San Vicente de Paúl, Medillín, Colombia. jorgericof@yahoo.com

Source

Actas Urol Esp 2008 Jun; 32(6):649-52.

MeSH

• Adult
• Cytomegalovirus Infections
• Humans
• Inflammation
• Kidney Transplantation
• Male
• Skin Ulcer
• Ureteral Diseases
• Ureterostomy

Pub Type(s)

Case Reports; English Abstract; Journal Article

Language

spa

PubMed ID

18655351

Provided by

Unbound Medicine, Inc. www.unboundmedicine.com +1 610 627-9090

---

Survival of renal transplantation patients older than 60 years: a single-center experience.

Abstract

BACKGROUND

Elderly patients are the fastest growing population requiring renal replacement therapy. It has been stated that renal transplantation may be the best treatment option for these patients. However, it has been observed that older patients have a higher mortality rate than those who are younger. Yet the factors that determine post-transplantation outcomes in this population remain poorly defined. The aims of this study were to evaluate the graft and patient survival in kidney transplant recipients who are older than 60 years of age to identify relevant predictive factors.

METHODS

In this population-based retrospective cohort study of 201 kidney transplantations performed in elderly patients from January 2002 throughout June 2009, we estimated the 1-,3-,and 5-year patients and graft survival rates. We also evaluated the complications and the predictors of poor outcomes. Survival times were analyzed using the Kaplan-Meier method and survival differences assessed with Mantel-Cox log rank-test. We performed a Cox proportional hazards regression models to evaluate the impact of baseline and treatment characteristics on patient and graft survival.

RESULTS

Graft and patient survival rates at 1, 3, and 5 years were 76.4%, 71.3%, and 54.3%, and 78.2%, 73.8%, and 56.4%, respectively. Graft survival rates censored for patient death with a functioning graft were 93.1, 92.1, and 89%. Patient survival rates differed between diabetic and nondiabetic subjects at 1, 3 and 5 years (69.5% versus 83.6%; 59.8% versus 72.3%; 43.6% versus 65.7%; P = .008). On multivariate analysis, the factors associated with patients survival were diabetes mellitus (hazard ratio [HR] 2.058, 95% confidence interval [CI] 1.173-3.611, P = .012) and the 1-month serum creatinine value was > 1.6 mg/dL (HR 2.108 for each point increase, 95% CI 1.521-2.921, P = .000). Furthermore, there was an insignificant trend forward an association between active or past smoker and lower patient survival (HR 1.689, 95% CI 0.937-3.043, P = .08). The main causes of graft loss were patient death (79.5%). acute rejection (6.8%), and chronic allograft nephropathy (5.5%).

CONCLUSION

Renal transplantation can be performed safely and with acceptable outcomes in elderly patients after appropriate clinical evaluation. The grafts show excellent survival albeit that deaths with a functional graft continue to be an important issue.

Links

• Publisher Full Text

Authors

Rodelo JR, Nieto-Ríos JF, Serna-Higuita LM, Henao JE, García A, Reino AC, Tobón JC, Arbeláez M

Institution

Transplant Group, Nephrology Division, Universidad de Antioquia and Hospital Pablo Tobón Uribe, Medellin, Colombia. Electronic address: jrodelo@une.net.co.

Source

Transplant. Proc. 2013 May; 45(4):1402-9.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23726583

Provided by

Unbound Medicine, Inc. www.unboundmedicine.com +1 610 627-9090

---

1. Transplant Proc. 2011 Nov;43(9):3367-76. doi: 10.1016/j.transproceed.2011.09.092.

Cost-effectiveness analysis of the early conversion of tacrolimus to mammalian
target of rapamycin inhibitors in patients with renal transplantation.

Gamboa O, Montero C, Mesa L, Benavides C, Reino A, Torres RE, Castillo JS.

Fundaci�n Esensa, Bogot�, Colombia. oa_gamboa@yahoo.es

BACKGROUND: Renal replacement therapies which consist of renal transplantation
and dialysis are the only treatment options for patients with terminal renal
failure. These therapies have changed the outcome from being fatal to being a
chronic disease. Kidney transplantation involves the use of immunosuppressive
agents to prevent rejection. Currently, several immunosuppressive agents have
shown efficacy, safety, and different costs.
OBJECTIVE: The aim was to evaluate the cost-effectiveness of early conversion
from tacrolimus to mammalian target of rapamycin inhibitors sirolimus or
everolimus versus continuous treatment with tacrolimus among renal transplantat
patients in Colombia.
METHODS: We performed systematic literature review to extract data for clinical
effectiveness and safety of tacrolimus replacement schemes for immunosuppressive
therapy in renal transplantation in adults. A Markov model in TreeAge was
developed, simulating the patient's natural history with renal transplantation.
The perspective of the Colombian Health System was used, including only direct
costs. The cost-effectiveness ratio and incremental cost-effectiveness ratio were
estimated. Deterministic and probabilistic sensitivity analyses were performed. A
5% discount rate was applied in costs and health results.
RESULTS: Results for the replacement of tacrolimus to sirolimus are provided. The
cost per year of additional life gained for sirolimus was Col$2,441,171.43; the
cost for avoided loss was Col$4,014,152.84. The acceptability curve shows that a
strategy with sirolimus is the most cost-effective one.
CONCLUSIONS: This study suggested that the sirolimus strategy is cost-effective
in Colombia for patients with renal transplantation using as threshold less than
three times the gross domestic product (GDP) per capita of Colombia per life of
years gained.

Copyright � 2011 Elsevier Inc. All rights reserved.

PMID: 22099798 [PubMed - in process]

Cost-effectiveness analysis of the early conversion of tacrolimus to mammalian target of rapamycin inhibitors in patients with renal transplantation.

Abstract

BACKGROUND

Renal replacement therapies which consist of renal transplantation and dialysis are the only treatment options for patients with terminal renal failure. These therapies have changed the outcome from being fatal to being a chronic disease. Kidney transplantation involves the use of immunosuppressive agents to prevent rejection. Currently, several immunosuppressive agents have shown efficacy, safety, and different costs.

OBJECTIVE

The aim was to evaluate the cost-effectiveness of early conversion from tacrolimus to mammalian target of rapamycin inhibitors sirolimus or everolimus versus continuous treatment with tacrolimus among renal transplantat patients in Colombia.

METHODS

We performed systematic literature review to extract data for clinical effectiveness and safety of tacrolimus replacement schemes for immunosuppressive therapy in renal transplantation in adults. A Markov model in TreeAge was developed, simulating the patient's natural history with renal transplantation. The perspective of the Colombian Health System was used, including only direct costs. The cost-effectiveness ratio and incremental cost-effectiveness ratio were estimated. Deterministic and probabilistic sensitivity analyses were performed. A 5% discount rate was applied in costs and health results.

RESULTS

Results for the replacement of tacrolimus to sirolimus are provided. The cost per year of additional life gained for sirolimus was Col$2,441,171.43; the cost for avoided loss was Col$4,014,152.84. The acceptability curve shows that a strategy with sirolimus is the most cost-effective one.

CONCLUSIONS

This study suggested that the sirolimus strategy is cost-effective in Colombia for patients with renal transplantation using as threshold less than three times the gross domestic product (GDP) per capita of Colombia per life of years gained.

Links

• Publisher Full Text

Authors

Gamboa O, Montero C, Mesa L, Benavides C, Reino A, Torres RE, Castillo JS

Institution

Fundación Esensa, Bogotá, Colombia. oa_gamboa@yahoo.es

Source

Transplant. Proc. 2011 Nov; 43(9):3367-76.

Pub Type(s)

Journal Article; Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22099798

Provided by

Unbound Medicine, Inc. www.unboundmedicine.com +1 610 627-9090

---