RESUMO
BACKGROUND: Kidney transplantation is the treatment of choice for end-stage kidney disease, and a second transplantation becomes an opportunity for a better chance for long-term survival and quality of life. This study aimed to evaluate the outcomes and graft survival of patients transplanted a second time in comparison with single kidney transplant patients. METHODS: This retrospective observational study was conducted using a cohort of kidney transplant patients from 2008 to 2018. Fifty patients who underwent first transplant were randomly selected as group 1 (G1), and 31 patients who received a second kidney transplant as group 2 (G2). Outcomes, graft, and patient survival were assessed. RESULTS: G2 patients had higher proportions of rejection episodes and graft loss than G1. Fifteen (48.39%) patients from G2 maintained functioning grafts during follow-up, while 16 (51.61%) lost their grafts. The 10-year graft survival rate for patients with first transplant was 76.66%; it was 46.09% for retransplanted patients (P = 0.005). There was no statistically significant difference in patient survival between G1 and G2. CONCLUSIONS: Allograft survival rates of the first and second transplant with living donors had no statistically significant difference, but for deceased donors, poor graft survival was observed for the second allograft.
Assuntos
Transplante de Rim , Aloenxertos , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Transplante de Rim/efeitos adversos , Doadores Vivos , Qualidade de Vida , Estudos RetrospectivosRESUMO
Tacrolimus (TAC), a calcineurin inhibitor, and everolimus (EVL), an mTOR inhibitor, have been used as immunosuppressive (ISS) drugs in post-kidney transplantation therapy. The objective of this study was to compare the efficacy of EVL vs TAC in the ISS maintenance triple therapy. Ninety-seven kidney transplant patients, who received triple maintenance therapy with TAC, mycophenolate mofetil (MMF), and methyl prednisone (PRED), were evaluated. After four months of post-kidney transplant therapy, 30 patients enrolled in a randomized controlled clinical trial, in which 16 patients received TAC+MMF+PRED (cohort 1), and 14 patients switched to EVL+MMF+PRED (cohort 2). The patients were followed-up for 36 months. Two patients from cohort 1 lost their grafts after one year due to non-adherence. Two patients from cohort 2 had intolerance to mTOR inhibitors and were switched back to TAC from EVL. One case (6.25%) in cohort 1 and three cases (21.43%) in cohort 2 of acute T-cell-mediated rejection was observed. Antibody-mediated acute rejection (ABMAR) was observed in four patients (25.0%) in cohort 1, and antibody-mediated chronic rejection (ABMCR) was observed in two patients (12.50%). One patient from cohort 2 lost the graft after 15 months due to polyomavirus infection. The graft survival rate was 87.50% in cohort 1 and 92.86% in cohort 2. This clinical trial showed that the EVL+MMF+PRED triple maintenance therapy was efficacious compared with TAC during 32 months of follow-up. However, further studies are needed to confirm the efficacy of this regimen for long-term graft survival.
Assuntos
Transplante de Rim , Tacrolimo , Quimioterapia Combinada , Everolimo/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto , Humanos , Imunossupressores/uso terapêutico , Tacrolimo/uso terapêuticoRESUMO
Tacrolimus (TAC), a calcineurin inhibitor, and everolimus (EVL), an mTOR inhibitor, have been used as immunosuppressive (ISS) drugs in post-kidney transplantation therapy. The objective of this study was to compare the efficacy of EVL vs TAC in the ISS maintenance triple therapy. Ninety-seven kidney transplant patients, who received triple maintenance therapy with TAC, mycophenolate mofetil (MMF), and methyl prednisone (PRED), were evaluated. After four months of post-kidney transplant therapy, 30 patients enrolled in a randomized controlled clinical trial, in which 16 patients received TAC+MMF+PRED (cohort 1), and 14 patients switched to EVL+MMF+PRED (cohort 2). The patients were followed-up for 36 months. Two patients from cohort 1 lost their grafts after one year due to non-adherence. Two patients from cohort 2 had intolerance to mTOR inhibitors and were switched back to TAC from EVL. One case (6.25%) in cohort 1 and three cases (21.43%) in cohort 2 of acute T-cell-mediated rejection was observed. Antibody-mediated acute rejection (ABMAR) was observed in four patients (25.0%) in cohort 1, and antibody-mediated chronic rejection (ABMCR) was observed in two patients (12.50%). One patient from cohort 2 lost the graft after 15 months due to polyomavirus infection. The graft survival rate was 87.50% in cohort 1 and 92.86% in cohort 2. This clinical trial showed that the EVL+MMF+PRED triple maintenance therapy was efficacious compared with TAC during 32 months of follow-up. However, further studies are needed to confirm the efficacy of this regimen for long-term graft survival.
Assuntos
Humanos , Transplante de Rim , Tacrolimo/uso terapêutico , Quimioterapia Combinada , Everolimo/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto , Imunossupressores/uso terapêuticoRESUMO
The novel HLA alleles B*40:331, B*40:343, B*42:24, DRB1*01:74, DQB1*03:243, and DQB1*03:02:20 were identified in Brazilian individuals.
Assuntos
Alelos , Antígenos HLA-B/genética , Cadeias beta de HLA-DQ/genética , Cadeias HLA-DRB1/genética , Sequência de Bases , Brasil , Éxons/genética , Feminino , Teste de Histocompatibilidade , Humanos , Polimorfismo de Nucleotídeo Único/genéticaRESUMO
BACKGROUND: Delayed graft function (DGF) is the major post-transplant cause of deleterious effects to the allograft and is associated with poor allograft survival. The aim of this study was to report the outcomes of 236 kidney transplant recipients with different immunologic profiles. METHODS: All patients underwent transplantation (2008-2016) with a deceased donor at the University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil. Patients were classified into 3 groups according to immunologic profiles: nonsensitized (NS), sensitized without donor-specific antibody (SDSA-), or sensitized with donor-specific antibody (SDSA+). RESULTS: DGF was observed in 128 (54.24%), including 63 (49.22%) NS, 51 (39.84%) SDSA-, and 14 (10.94%) SDSA+ patients. The development of DGF was associated with dialysis for ≥49.25 months (odds ratio [OR] 2.30), donor age ≥42.25 years (OR 1.77), donor end creatinine level >1.22 mg/dL (OR 1.94), and cold ischemia time >12 hours (OR 2.45). Of the 55 patients with rejections, 37 (15.68%) had T-cell-mediated rejection (TCMR) and 18 (7.63%) had antibody-mediated rejection (AMR). Nine patients (16.36%) exhibited graft loss, 2 (0.85%) via TCMR in the SDSA- DGF+ group and 7 (2.97%) via AMR, including 2 NS DGF-, 2 SDSA- DGF-, 1 SDSA- DGF+, and 2 SDSA+ DGF+ patients. Graft survival significantly differed between the NSDGF- and SDSA- DGF+ groups (P = .014) and between the NS DGF- and SDSA+ DGF- groups (P = .036). CONCLUSION: In the 7-year period following transplantation, TCMR was more prevalent than AMR among patients with DGF. Graft loss was less prevalent among patients with TCMR than among those with AMR.
Assuntos
Isquemia Fria/efeitos adversos , Função Retardada do Enxerto/imunologia , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto/imunologia , Transplante de Rim/efeitos adversos , Adulto , Brasil , Feminino , Humanos , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Diálise Renal/efeitos adversos , Fatores de Risco , Fatores de Tempo , Doadores de Tecidos/estatística & dados numéricos , Resultado do TratamentoRESUMO
BACKGROUND: The HLA genes show high levels of diversity as indicated by the number of HLA alleles. There are almost 11,000 classical HLA-A, -B, -DRB1 alleles in populations around the world, making the search for compatible donors difficult. HLA diversity is generated by different genetic mechanisms, such as point mutations, which result in single nucleotide polymorphisms, insertion and deletion, and recombination. The aim of this study was to describe genetic mechanisms involved in the generation of HLA alleles in Brazilians. METHODS: Twenty-six alleles indentified in the Brazilian bone marrow donors were include in the study. Data regarding new HLA alleles by sequence-based typing were also used to elucidate what genetics mechanism was involved in the HLA variability. The new alleles were officially named by the World Health Organization Nomenclature Committee. RESULTS: The new alleles described were HLA-DRB1*11:04:14, HLA-A*33:117, and HLA-B*41:48. The DRB1*11:04:14 allele was generated by synonymous point mutation at codon 48. The A*33:117 allele was generated by nonsynonymous nucleotide mutation leading to amino acid substitution at codon 74. The B*41:48 allele was generated by an intralocus gene conversion between the HLA alleles from groups HLA-B*13, B*35, B*53, or B*58 and an allele from the HLA-B*41 group. CONCLUSIONS: Different genetic mechanisms introduce new mutant HLA alleles into the human population requiring attentive and rigorous specialists and the use of different methodologies to identify these mutations in HLA typing routine.
Assuntos
Alelos , Antígenos HLA-A/genética , Antígenos HLA-B/genética , Cadeias HLA-DRB1/genética , Mutação/genética , Brasil , Códon/genética , Conversão Gênica/genética , Teste de Histocompatibilidade , Humanos , Doadores de Tecidos/provisão & distribuiçãoRESUMO
Novel allele, HLA-B*14:56, generated by a gene conversion event was identified in a Brazilian individual.
Assuntos
Alelos , Antígenos HLA-B/genética , Sequência de Bases , Brasil , Éxons/genética , Teste de Histocompatibilidade , Humanos , Íntrons/genética , MasculinoRESUMO
Novel allele, HLA-B*51:220 generated by a gene conversion event was identified in a Brazilian individual.
Assuntos
Alelos , Antígenos HLA-B/genética , Regiões 5' não Traduzidas/genética , Sequência de Bases , Brasil , Éxons/genética , Humanos , Íntrons/genéticaRESUMO
Two novel alleles, HLA-A*02:643N and HLA-B*53:44, generated by different mechanisms, were identified in Brazilian individuals.
Assuntos
Alelos , Éxons , Antígenos HLA/genética , Antígeno HLA-A2/genética , Polimorfismo Genético , Doadores de Tecidos , Adulto , Sequência de Bases , Brasil , Códon/química , Feminino , Expressão Gênica , Genótipo , Antígenos HLA/imunologia , Antígeno HLA-A2/imunologia , Transplante de Células-Tronco Hematopoéticas , Teste de Histocompatibilidade , Humanos , Mutação com Perda de Função , Masculino , Reação em Cadeia da Polimerase , Alinhamento de Sequência , Análise de Sequência de DNARESUMO
The HLA-B*50:48 allele differs from HLA-B*50:01:01 by one nucleotide substitution at position 130.