Thesis (doctoral)--Lund University, 1994. / Added t.p. with thesis statement inserted.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2008. / Härtill 4 uppsatser.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / As infecÃÃes relacionadas à assistÃncia à saÃde estÃo entre as principais complicaÃÃes em pacientes que se submetem a transplante de rim, em virtude, nÃo somente, dos regimes de imunossupressÃo a que estÃo submetidos, como a cuidados desempenhados pelas equipes de saÃde. O objetivo deste estudo foi analisar infecÃÃes relacionadas à assistÃncia à saÃde em pacientes transplantados renais em 2012, no MunicÃpio de Fortaleza, que possui serviÃos de transplante renal consolidados. Fez-se um estudo transversal onde foram analisadas as fichas ambulatoriais, prontuÃrios e fichas de notificaÃÃo e investigaÃÃo da CCIH de pacientes que realizaram transplante renal em 2012, no HUWC e HGF, instituiÃÃes com recordes sucessivos neste tipo de procedimento. Um total de 237 participantes, sendo, 101 (mÃdias de idade: 43,2 anos) pertencentes ao HUWC e 136 (mÃdias de idade: 45,4 anos) ao HGF, foi incluÃdo no estudo. Em ambas as instituiÃÃes, a maioria das pessoas era do sexo masculino, casada e residia na Capital do CearÃ. Grande parte delas tambÃm tinha o IMC normal, era hipertensa, tinha como principais causas de IRC: inderterminada, HAS e nefrites. A proporÃÃo de procedimentos invasivos realizados foi: biopsia do enxerto (HUWC: 45,54%; HGF: 26,47%), punÃÃo de cateter venoso central (HUWC: 98,01%; HGF: 97,06%), FAV (HUWC: 66,33%; HGF: 94,11%), e passagem de cateter duplo J (HUWC: 39,6%; HGF: 22,06%). A estimativa de prevalÃncia de IRAS nos 101 pacientes transplantados renais no HUWC foi de 50 (49,05%), e no HGF, 31 (22,79%). As IRAS mais comuns, tanto no HUWC, como no HGF, foram infecÃÃes do trato urinÃrio, e os principais agentes etiolÃgicos isolados, Klebsiella pneumoniae e Escherichia coli. No HUWC, os fatores sociodemogrÃficos, clÃnicos e epidemiolÃgicos que apresentaram associaÃÃo estatisticamente significante com o acometimento por IRAS foram: a classificaÃÃo do IMC (p<0,03), o tempo em diÃlise antes do transplante (p<0,05), o tempo de internaÃÃo total (p<0,0001), o tempo de cirurgia (p<0,001), o tempo de isquemia fria (p<0,01), a passagem de cateter duplo J (p<0,003), o tempo de uso do TOT (p<0,03) e o tempo de uso da SVD (p<0,04) no HUWC; no HGF, a classificaÃÃo do IMC (p<0,04), o LES como causa de IRC (p<0,01), a transfusÃo sanguÃnea antes do transplante (p<0,02), o tempo de internaÃÃo total (p<0,001) e o tempo de uso do CVC (p<0,04). Portanto, durante todo o perÃodo perioperatÃrio, hà necessidade de desenvolvimento de aÃÃes cautelosas por toda a equipe de saÃde, de forma a prevenir infecÃÃes e gastos desnecessÃrios do governo com internamentos e tratamentos prolongados, sustentando o crescimento da tÃcnica de transplantaÃÃo renal no Estado nos Ãltimos anos. / The healthcare-related infections are among the major complications in patients who undergo kidney transplant, by virtue not only of immunosuppression schemes to which they are subjected, as the care carried out by health teams. The aim of this study was to analyze healthcare-related infections in renal transplant recipients in 2012, in the city of Fortaleza, which has consolidated renal transplant services. A cross-sectional study where outpatient records were analyzed, charts and tokens for notification and investigation of patients who performed CCIH kidney transplant in 2012, in HUWC and HGF, institutions with successive records in this type of procedure. A total of 237 attendees, being, 101 (average age: 43.2 years) belonging to the HUWC and 136 (average age: 45.4 years) to the HGF, was included in the study. In both institutions, most people were male, married and resided in the Capital of CearÃ. Most of them also had the normal BMI was hypertensive, had as main causes of IRC: inderterminada, SAH and lupus nephritis. The proportion of invasive procedures performed were: graft biopsy (HUWC: 45.54%; HGF: 26.47%), central venous catheter puncture (HUWC: 98.01%; HGF: 97.06%), FAV (HUWC: 66.33%; HGF: 94.11%), and passage of double-J catheter (HUWC: 39.6%; HGF: 22.06%). The estimated prevalence of IRAS in 101 renal transplant recipients at HUWC was 50 (49.05%), and HGF, 31 (22.79%). The most common IRAS, both in HUWC, as in HGF, were urinary tract infections, and the main etiological agents isolated Klebsiella pneumoniae and Escherichia coli. In HUWC, the socio-demographic factors, clinicians and epidemiologists who presented statistically significant association with involvement by IRAS were: the classification of BMI (p<0.03) time on dialysis before transplantation (p<0.05), the total length of stay (p<0.0001), the time of surgery (p<0.001), cold ischemia time (p<0.01), the passage of double-J catheter (p<0.003), the speaking time of TOT (p<0.03) and time of use of the SVD (p<0.04) in HUWC; on HGF, classification of BMI (p<0.04), LES as a cause of IRC (p<0.01), blood transfusion before transplantation (p<0.02), the total length of stay (p<0.001) and time of use of the CVC (p<0.04). Therefore, throughout the perioperative period, there is a need for development of cautious actions throughout the health team, in order to prevent infections and unnecessary government spending with hospitalizations and prolonged treatments, supporting the growth of renal transplantation technique in the State in recent years.

Thesis (Ph.D. )--University of Tennessee Health Science Center, 2008. / Title from title page screen (viewed on April 24, 2008 ). Research advisor: Shelly White-Means, Ph.D. Document formatted into pages (xi, 101 p. : ill.). Vita. Abstract. Includes bibliographical references (p. 94-100).

Crianças pequenas representam um grupo desafiador no transplante renal. O estudo analisa os resultados, do ponto de vista cirúrgico, do transplante renal em crianças com peso inferior a 15 kg utilizando o acesso cirúrgico extraperitoneal. Métodos: Foram revisados retrospectivamente os prontuários de 62 crianças com peso inferior a 15 kg submetidas a transplante renal entre 1998 e 2010, utilizando o acesso extraperitoneal e anastomose dos vasos renais dos doadores com a aorta ou artéria ilíaca comum e com a veia cava inferior ou ilíaca comum dos receptores. O ureter foi anastomosado à bexiga pela técnica extravesical de Lich- Grégoir. Resultados: Dos 62 transplantes, 32 enxertos (51,6%) eram provenientes de doadores vivos e 30 (48,4%) de doadores falecidos, sendo 28 deles pediátricos. A média de idade no transplante foi de 3,7 ± 2,2 anos (1 a 12), e o peso médio, de 12,3 ± 2,1 kg (5,6 a 14,9), sendo que 10 tinham peso inferior a 10 kg. Em 10 crianças (16,1%) o transplante foi preemptivo e em 5 (8,1%) havia trombose do sistema venoso prévio ao transplante. Em 1 e 5 anos, a sobrevida do paciente foi de 93,2% e 84,2% e a sobrevida do enxerto de 85,2% e 72,7%, respectivamente, sem diferença entre doadores vivos e falecidos. A função do enxerto com doador vivo foi melhor em 1 e 3 meses, mas a partir do 6o mês foi similar. Houve 6 complicações vasculares, sendo 4 tromboses vasculares, 1 laceração e 1 estenose de artéria renal e 2 coleções líquidas. Houve 17 perdas de enxerto, 6 por morte, sendo 5 com enxerto funcionante, 5 por complicações cirúrgicas, 3 por rejeição crônica e 3 por recorrência da doença de base. Conclusão: O acesso extraperitoneal é uma técnica válida no transplante renal de crianças com peso inferior a 15 kg, assegurando boa sobrevida do paciente e do enxerto e aceitável taxa de complicações, independentemente do tipo de doador, se vivo ou falecido, ou do tamanho do enxerto, se de adulto ou de criança. / Small children are a challenging group for kidney transplantation. This study analyzes the results of kidney transplantation in children weighing less than 15 kg using the extraperitoneal surgical access. Methods: A retrospective review of the records of 62 children weighting less than 15 kg was done. The kidney transplantation were performed between 1998 and 2010 using the extraperitoneal access and anastomosis of the renal vessels of donors to the aorta or common iliac artery and to the inferior vena cava or common iliac vein of the recipients. The ureter was anastomosed to the bladder using the Lich-Grégoir extravesical technique. Results: Thirty-two (51.6%) grafts of the 62 transplants were from living donors and 30 (48.4%) from deceased donors, 28 of them pediatric. The mean age at transplantion was 3.7 ± 2.2 years (1 to 12), and the mean weight, 12.3 ± 2.1 kg (5.6 to 14.9), and 10 of them weighed less than 10 kg. In 10 children (16.1%) the transplant was preemptive. Five 5 (8.1%) children presented previous thrombosis of the venous system. At 1 and 5 years, patient survival was 93.2% and 84.2% and graft survival was 85.2% and 72.7%, respectively, and there was no difference between living and deceased donors. The graft function of the living donor was better at 1 and 3 months, but was similar from the 6th month onward. There were 6 vascular complications (4 of them vascular thromboses, 1 laceration and 1 renal artery stenosis) and 2 perirenal collections. Seventeen grafts were lost, 6 due to death, 5 with a functioning graft, 5 due to surgical complications, 3 due to chronic rejection and 3 due to recurrence of the original disease. Conclusion: The extraperitoneal access is a valid kidney transplantantion technique in children weighing less than 15 kg, ensuring good patient and graft survival, and an acceptable rate of complications, independent of source of donor, living or deceased, or size of graft, whether from an adult or from a child.

Crianças pequenas representam um grupo desafiador no transplante renal. O estudo analisa os resultados, do ponto de vista cirúrgico, do transplante renal em crianças com peso inferior a 15 kg utilizando o acesso cirúrgico extraperitoneal. Métodos: Foram revisados retrospectivamente os prontuários de 62 crianças com peso inferior a 15 kg submetidas a transplante renal entre 1998 e 2010, utilizando o acesso extraperitoneal e anastomose dos vasos renais dos doadores com a aorta ou artéria ilíaca comum e com a veia cava inferior ou ilíaca comum dos receptores. O ureter foi anastomosado à bexiga pela técnica extravesical de Lich- Grégoir. Resultados: Dos 62 transplantes, 32 enxertos (51,6%) eram provenientes de doadores vivos e 30 (48,4%) de doadores falecidos, sendo 28 deles pediátricos. A média de idade no transplante foi de 3,7 ± 2,2 anos (1 a 12), e o peso médio, de 12,3 ± 2,1 kg (5,6 a 14,9), sendo que 10 tinham peso inferior a 10 kg. Em 10 crianças (16,1%) o transplante foi preemptivo e em 5 (8,1%) havia trombose do sistema venoso prévio ao transplante. Em 1 e 5 anos, a sobrevida do paciente foi de 93,2% e 84,2% e a sobrevida do enxerto de 85,2% e 72,7%, respectivamente, sem diferença entre doadores vivos e falecidos. A função do enxerto com doador vivo foi melhor em 1 e 3 meses, mas a partir do 6o mês foi similar. Houve 6 complicações vasculares, sendo 4 tromboses vasculares, 1 laceração e 1 estenose de artéria renal e 2 coleções líquidas. Houve 17 perdas de enxerto, 6 por morte, sendo 5 com enxerto funcionante, 5 por complicações cirúrgicas, 3 por rejeição crônica e 3 por recorrência da doença de base. Conclusão: O acesso extraperitoneal é uma técnica válida no transplante renal de crianças com peso inferior a 15 kg, assegurando boa sobrevida do paciente e do enxerto e aceitável taxa de complicações, independentemente do tipo de doador, se vivo ou falecido, ou do tamanho do enxerto, se de adulto ou de criança. / Small children are a challenging group for kidney transplantation. This study analyzes the results of kidney transplantation in children weighing less than 15 kg using the extraperitoneal surgical access. Methods: A retrospective review of the records of 62 children weighting less than 15 kg was done. The kidney transplantation were performed between 1998 and 2010 using the extraperitoneal access and anastomosis of the renal vessels of donors to the aorta or common iliac artery and to the inferior vena cava or common iliac vein of the recipients. The ureter was anastomosed to the bladder using the Lich-Grégoir extravesical technique. Results: Thirty-two (51.6%) grafts of the 62 transplants were from living donors and 30 (48.4%) from deceased donors, 28 of them pediatric. The mean age at transplantion was 3.7 ± 2.2 years (1 to 12), and the mean weight, 12.3 ± 2.1 kg (5.6 to 14.9), and 10 of them weighed less than 10 kg. In 10 children (16.1%) the transplant was preemptive. Five 5 (8.1%) children presented previous thrombosis of the venous system. At 1 and 5 years, patient survival was 93.2% and 84.2% and graft survival was 85.2% and 72.7%, respectively, and there was no difference between living and deceased donors. The graft function of the living donor was better at 1 and 3 months, but was similar from the 6th month onward. There were 6 vascular complications (4 of them vascular thromboses, 1 laceration and 1 renal artery stenosis) and 2 perirenal collections. Seventeen grafts were lost, 6 due to death, 5 with a functioning graft, 5 due to surgical complications, 3 due to chronic rejection and 3 due to recurrence of the original disease. Conclusion: The extraperitoneal access is a valid kidney transplantantion technique in children weighing less than 15 kg, ensuring good patient and graft survival, and an acceptable rate of complications, independent of source of donor, living or deceased, or size of graft, whether from an adult or from a child.

Crianças pequenas representam um grupo desafiador no transplante renal. O estudo analisa os resultados, do ponto de vista cirúrgico, do transplante renal em crianças com peso inferior a 15 kg utilizando o acesso cirúrgico extraperitoneal. Métodos: Foram revisados retrospectivamente os prontuários de 62 crianças com peso inferior a 15 kg submetidas a transplante renal entre 1998 e 2010, utilizando o acesso extraperitoneal e anastomose dos vasos renais dos doadores com a aorta ou artéria ilíaca comum e com a veia cava inferior ou ilíaca comum dos receptores. O ureter foi anastomosado à bexiga pela técnica extravesical de Lich- Grégoir. Resultados: Dos 62 transplantes, 32 enxertos (51,6%) eram provenientes de doadores vivos e 30 (48,4%) de doadores falecidos, sendo 28 deles pediátricos. A média de idade no transplante foi de 3,7 ± 2,2 anos (1 a 12), e o peso médio, de 12,3 ± 2,1 kg (5,6 a 14,9), sendo que 10 tinham peso inferior a 10 kg. Em 10 crianças (16,1%) o transplante foi preemptivo e em 5 (8,1%) havia trombose do sistema venoso prévio ao transplante. Em 1 e 5 anos, a sobrevida do paciente foi de 93,2% e 84,2% e a sobrevida do enxerto de 85,2% e 72,7%, respectivamente, sem diferença entre doadores vivos e falecidos. A função do enxerto com doador vivo foi melhor em 1 e 3 meses, mas a partir do 6o mês foi similar. Houve 6 complicações vasculares, sendo 4 tromboses vasculares, 1 laceração e 1 estenose de artéria renal e 2 coleções líquidas. Houve 17 perdas de enxerto, 6 por morte, sendo 5 com enxerto funcionante, 5 por complicações cirúrgicas, 3 por rejeição crônica e 3 por recorrência da doença de base. Conclusão: O acesso extraperitoneal é uma técnica válida no transplante renal de crianças com peso inferior a 15 kg, assegurando boa sobrevida do paciente e do enxerto e aceitável taxa de complicações, independentemente do tipo de doador, se vivo ou falecido, ou do tamanho do enxerto, se de adulto ou de criança. / Small children are a challenging group for kidney transplantation. This study analyzes the results of kidney transplantation in children weighing less than 15 kg using the extraperitoneal surgical access. Methods: A retrospective review of the records of 62 children weighting less than 15 kg was done. The kidney transplantation were performed between 1998 and 2010 using the extraperitoneal access and anastomosis of the renal vessels of donors to the aorta or common iliac artery and to the inferior vena cava or common iliac vein of the recipients. The ureter was anastomosed to the bladder using the Lich-Grégoir extravesical technique. Results: Thirty-two (51.6%) grafts of the 62 transplants were from living donors and 30 (48.4%) from deceased donors, 28 of them pediatric. The mean age at transplantion was 3.7 ± 2.2 years (1 to 12), and the mean weight, 12.3 ± 2.1 kg (5.6 to 14.9), and 10 of them weighed less than 10 kg. In 10 children (16.1%) the transplant was preemptive. Five 5 (8.1%) children presented previous thrombosis of the venous system. At 1 and 5 years, patient survival was 93.2% and 84.2% and graft survival was 85.2% and 72.7%, respectively, and there was no difference between living and deceased donors. The graft function of the living donor was better at 1 and 3 months, but was similar from the 6th month onward. There were 6 vascular complications (4 of them vascular thromboses, 1 laceration and 1 renal artery stenosis) and 2 perirenal collections. Seventeen grafts were lost, 6 due to death, 5 with a functioning graft, 5 due to surgical complications, 3 due to chronic rejection and 3 due to recurrence of the original disease. Conclusion: The extraperitoneal access is a valid kidney transplantantion technique in children weighing less than 15 kg, ensuring good patient and graft survival, and an acceptable rate of complications, independent of source of donor, living or deceased, or size of graft, whether from an adult or from a child.

Samples from 93 of 115 consecutive cadaveric renal transplants were selected to define polymorphisms in both IFN-γ and IL-10. A 12 CA repeat IFN-γ polymorphic allele was found in 73 patients (70 in patients analysed further). This polymorphism was associated with high IFN-γ production in vitro. According to the presence or not of the 12 CA repeat allele patients were separated in high and low producer genotype groups. The incidence of acute rejection was 54.3% in this high IFN-γ genotype group, contrasting with 44.4% in the low IFN-γ. Requirement for ATG therapy was greater in the high IFN-γ group (odds ratio [OR]=2.5). Among HLA-DR-mismatched patients, IFN-γ high producer genotype was more strongly associated with rejection (OR=1.6). In the cyclosporine monotherapy subgroup, 11 out of 14 patients with IFN-γ high genotype (78%) had acute rejection (OR=2.88, p=0.09). Graft survival was similar between the two IFN-γ groups. When the analysis was controlled for the presence of delayed graft function, 40.5% of the high IFN-γ genotype patients had serum creatinine levels above 200 micromoles/L contrasting with only 14.3% of the low IFN-γ genotype recipients at 5 years after transplantation (p=0.05). In a regression model of creatinine at 1 year the significant variables were the presence of DGF, donor age greater than 50, greater than two rejection episodes, DR mismatch, donor female to male recipient sex, IL-10 high genotype, and IFN-γ high genotype. Conclusion: The 12 CA repeat IFN-γ polymorphic allele is associated with high IFN-γ production. We have shown that this high producer genotype for IFN-γ influences acute rejection in kidney transplantation, particularly in high-risk groups; it is also associated with worse long-term graft function.

8 ABSTRACT Author: Bc. Lucie Moravcová Supervisor: MUDr. Vít Řeháček Charles University, Faculty of Pharmacy in Hradec Králové Title of master's thesis: Kidney transplantation: donor-recipient pairing in University Hospital Hradec Králové Background: The aim of this study was to determine HLA, blood group, age and sex match in donor-recipient pairing in kidney transplantation. HLA alleles of deceased donors were typed in Transfusion Department of the University Hospital Hradec Králové. Methods: Donor's HLA-A*, HLA-B* and HLA-DRB1* alleles were typed by PCR - SSP method. Complex data evaluating and processing was then performed. Results: 97 deceased donors were tested between 2013 and 2018. A total of 98 kidneys received from them were subsequently transplanted to 98 recipients in University Hospital Hradec Králové. 60,2 % of the donors were men, 63,3 % of the recipients were men. Most of the donors, as well as the recipients, were 51-70 years old (50,0 % and 59,2 %, respectively). The most common diagnoses in the group of deceased donors were associated with brain damage (66,3 %), the most common cause of renal failure in the group of recipients was chronic inflammatory kidney disease (41,8 %). All 98 transplantations (100,0 %) were AB0 compatible. 74 transplantations (75,5 %) were RhD compatible. 5...

O transplante de órgãos é hoje uma opção de tratamento de várias doenças terminais. Apesar de todos os progressos no campo do transplante, o principal problema enfrentado ainda é a rejeição. As principais moléculas responsáveis pela resposta alogeneica e subsequente rejeição ao enxerto, são os antígenos leucocitários humanos (HLA, do inglês Human Leucocyte Antigens). Porém, existem evidências que anticorpos dirigidos a antígenos não-HLA estão associados com rejeição de transplantes. Neste estudo, foi investigada a presença de anticorpos anti-célula endotelial (AACE) em 11 pacientes que perderam seus rins transplantados devido à rejeição humoral irreversível e em 2 com perda por trombose de veia renal. A ausência de anticorpos anti-HLA contra o doador foi verificada antes do transplante, da rejeição e antes e depois da transplantectomia, através da realização de provas cruzadas usando as técnicas mais sensíveis. Anticorpos não-HLA presentes em nove eluatos reagiram com EAHy.926. Eluatos positivos e negativos contra linhagem EAHy.926 foram testados contra cortes histológicos de 6 rins sadios para detecção de quais estruturas renais são reconhecidas por esses anticorpos. A reação foi avaliada pelo método de imunofluorescência indireta. Dos 13 eluatos testados, 4 (isotipo IgG) e 5 (isotipo IgM) reagiram com forte fluorescência nos glomérulos e endotélio arterial, mas não foi verificada reação na cápsula de Bowman e no epitélio tubular. Não foi observado polimorfismo na reatividade dos eluatos. Em onclusão, verificamos que os anticorpos não-HLA têm um importante papel na rejeição humoral. Estes estão reconhecendo antígenos de um sistema provavelmente não-polimórfico nas células de endoteliais presentes, principalmente, nos capilares glomerulares. / The transplant of organs is today an option of treatment to several terminal diseases. In spite of all the progress in the field of the transplants, the rejection remains a problem to be solved. The main target molecules for the allogenic response and subsequent allograft rejection are the human leukocyte antigens (HLA). However, there are growing evidences that non-HLA antibodies are associated with transplant rejection. In this study it was investigated the presence of anti-endothelial cell antibodies (AECA) in 11 patients who had early lost their transplanted kidney by irreversible humoral rejection and in 2 ones from renal venal thrombosis. The absence of anti-HLA antibodies against the donor was verified by the negativity of crossmatches performed using the most sensitive assays, at the transplant, at the rejection, and before and after the transplantectomy Antibodies from 9 eluates bound to EAHy.926. Positive and negatives eluates were tested against frozen sections from 6 normal kidneys in order to define the structures to which they were reactive. The reactivity was identified by indirect immunofluorescence method. From 13 eluates evaluated, 4 (isotipe IgG) and 5 (isotipe IgM) reacted to the glomerulus and renal arterial endothelium with intense fluorescence but they did not react to the Bowmans capsule and tubular epithelium. No polymorphism was observed in eluates reactivity. In conclusion, we have shown that non-HLA antibodies may represent a cause of the humoral rejection. These antibodies are probably recognizing antigens of a nonpolymorphic system in endothelial cells present, mainly, in the glomerular capillaries.