• Refine Query
  • Source
  • Publication year
  • to
  • Language
  • 164
  • 69
  • 18
  • 17
  • 15
  • 8
  • 3
  • 2
  • 2
  • 1
  • 1
  • 1
  • 1
  • 1
  • 1
  • Tagged with
  • 314
  • 314
  • 159
  • 118
  • 93
  • 60
  • 45
  • 43
  • 43
  • 40
  • 27
  • 24
  • 24
  • 21
  • 21
  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
271

Analysis of Volatile Anesthetic-Induced Organ Protection in Simultaneous Pancreas–Kidney Transplantation

Jahn, Nora, Völker, Maria Theresa, Laudi, Sven, Stehr, Sebastian, Schneeberger, Stefan, Brandacher, Gerald, Sucher, Elisabeth, Rademacher, Sebastian, Seehofer, Daniel, Hau, Hans Michael, Sucher, Robert 26 October 2023 (has links)
Background: Despite recent advances in surgical procedures and immunosuppressive regimes, early pancreatic graft dysfunction, mainly specified as ischemia–reperfusion injury (IRI)— Remains a common cause of pancreas graft failure with potentially worse outcomes in simultaneous pancreas-kidney transplantation (SPKT). Anesthetic conditioning is a widely described strategy to attenuate IRI and facilitate graft protection. Here, we investigate the effects of different volatile anesthetics (VAs) on early IRI-associated posttransplant clinical outcomes as well as graft function and outcome in SPKT recipients. Methods: Medical data of 105 patients undergoing SPKT between 1998–2018 were retrospectively analyzed and stratified according to the used VAs. The primary study endpoint was the association and effect of VAs on pancreas allograft failure following SPKT; secondary endpoint analyses included “IRI- associated posttransplant clinical outcome” as well as long-term graft function and outcome. Additionally, peak serum levels of C-reactive protein (CRP) and lipase during the first 72 h after SPKT were determined and used as further markers for “pancreatic IRI” and graft injury. Typical clinicopathological characteristics and postoperative outcomes such as early graft outcome and long-term function were analyzed. Results: Of the 105 included patients in this study three VAs were used: isoflurane (n = 58 patients; 55%), sevoflurane (n = 22 patients; 21%), and desflurane (n = 25 patients, 24%). Donor and recipient characteristics were comparable between both groups. Early graft loss within 3 months (24% versus 5% versus 8%, p = 0.04) as well as IRI-associated postoperative clinical complications (pancreatitis: 21% versus 5% versus 5%, p = 0.04; vascular thrombosis: 13% versus 0% versus 5%; p = 0.09) occurred more frequently in the Isoflurane group compared with the sevoflurane and desflurane groups. Anesthesia with sevoflurane resulted in the lowest serum peak levels of lipase and CRP during the first 3 days after transplantation, followed by desflurane and isoflurane (p = 0.039 and p = 0.001, respectively). There was no difference with regard to 10-year pancreas graft survival as well as endocrine/metabolic function among all three VA groups. Multivariate analysis revealed the choice of VAs as an independent prognostic factor for graft failure three months after SPKT (HR 0.38, 95%CI: 0.17–0.84; p = 0.029). Conclusions: In our study, sevoflurane and desflurane were associated with significantly increased early graft survival as well as decreased IRI-associated post-transplant clinical outcomes when compared with the isoflurane group and should be the focus of future clinical studies evaluating the positive effects of different VA agents in patients receiving SPKT.
272

Njurdonatorers upplevelser av att frivilligt donera en njure / Experiences of kidney donors voluntarily donating a kidney.

Olsson, Kriss, Almaou, Alaa January 2024 (has links)
Bakgrund: Njurdonation är en omfattande process där en individ, efter eget beslut eller i samråd med andra, donerar en av sina friska njurar till en mottagare i behov av den för att förbättra sin överlevnad och hälsa. Som grundutbildad sjuksköterska har man tillgång till flera olika arbetsplatser, vilket innebär att man kommer möta olika patientgrupper i sitt yrke. I omvårdnaden av en njurdonator är den personcentrerade vården en viktig grundsten. Utöver denna princip är sjuksköterskans övriga kärnkompetenser avgörande. Det är nödvändigt att kunna samarbeta i team eftersom patienten inte bara behöver sjuksköterskans stöd utan även hjälp och kontakt med andra vårdpersonal såsom läkare, specialistsjuksköterska samt psykolog och kurator. Den grundutbildade sjuksköterskan spelar rollen som navet i samarbetet, med ansvar för att säkerställa att all samverkan fungerar samtidigt och ingen aspekt av vården försummas. Därför är det av vikt att den grundutbildade sjuksköterskan har kunskap om njurdonatorers upplevelser både pre- och postoperativt. Syfte: litteraturstudiens syfte var att belysa pre- och postoperativa donationsupplevelse för donatorer som frivilligt donerar en njure. Metod: Studien genomfördes som en systematisk litteraturgenomgång med en kvalitativ metod på en grund av tio vetenskapliga peer-reviewed artiklar. Analysen av artiklarna följde en specifik modell för innehållsanalys. Resultat: Tre huvudkategorier definierar donatorernas upplevelser av den pre-och postoperativa donationsprocessen; ”Donatorernas anledningar till att donera”, ”Betydelsefullt med emotionellt stöd och förståelse” och ”Stress och komplikationer”. Konklusion: Njurdonatorers erfarenheter är övervägande positiva men präglas av intensiva känslor såsom glädje och stolthet, samtidigt som de upplever nervositet och stress inför godkännandet som donator. Tillräckligt stöd och förståelse från vårdpersonal och närstående underlättar hanteringen av den emotionella påfrestningen. För sjuksköterskor är insikten om donatorers upplevelser avgörande för att erbjuda personcentrerad vård och förbereda både vårdpersonal och donator för potentiella konsekvenser, vilket främjar högre vård- och livskvalitet för donatorn. Nyckelord: Grundutbildad sjuksköterska, Njurdonation, Njurtransplantation, upplevelser, Personcentrerad vård / Background: Kidney donation is a medical process where an individual, by their own decision or in consultation with others, donates one of their healthy kidneys to a recipient in need, aiming to improve their survival and health. As a registered nurse, one has access to various workplaces and opportunities, meaning they will encounter different types of patients in their profession. In the care of kidney donors, person-centered care stands as a crucial cornerstone. Beyond this principle, the nurse´s other core competencies are paramount. Collaborating within a team is essential since the patient requires not only the nurse´s support but also assistance and interaction with other healthcare professionals such as physicians, specialized nurses, psychologists, and counselors. The bachelor's degree nurse plays a pivotal role in this collaboration, being responsible for ensuring seamless cooperation while no aspect of care is neglected. Therefore, it is crucial for the bachelor's degree nurse to have knowledge of kidney donors´experiences both pre- and post-operatively. Aim: The aim of the literature study was to illustrate the pre-and postoperative donation experience of donors who voluntarily donate a kidney. Method: The research was conducted as an approach to a qualitative systematic literature review, drawing from ten peer-reviewed original articles. The Articles underwent analysis following a specific model for content analysis. Result: Three main categories define the donors' experiences of the pre- and post-operative donation process; “Donors’ reasons for donating”, “Meaningful with emotional support and understanding” and “Stress and complications”. Conclusion: Kidney donors` experiences are predominantly positive but are characterized by intense emotions such as joy and pride, while at the same time they experience nervousness and stress before being accepted as a donor. Sufficient support and understanding from healthcare staff and relatives facilitates the handling of the emotional strain. For nurses, the insight into donors´experiences is essential to provide person-centered care and prepare both health care professionals and donors for potential consequences, promoting higher quality of care and quality of life for the donor. Keywords: Registered nurse, experiences. kidney donation, kidney transplantation, person-centred care.
273

Untersuchung von nierentransplantierten Patienten unter Berücksichtigung der HLA-Kompatibilität und der Dynamik der HLA-Antikörperbildung

Seeger, Wolf-Adam 28 April 2005 (has links)
In dieser Arbeit wurde die Überlebenszeit von Nierentransplantaten untersucht und deren Abhängigkeit von zwei Faktoren: der HLA-Kompatibilität und der Antikörperdynamik. Hierzu konnten Daten von 327 Patienten gesammelt werden, die zwischen 1991 und 1996 eine postmortale Spenderniere erhielten. Eine konventionelle Gewebetypisierung erfolgte mittels serologischer und molekularbiologischer Untersuchungen. Eine neue Matchingmethode wurde durchgeführt auf Ebene von Aminosäuren. Ein Antikörperscreening erfolgte vor und nach Transplantation mittels Lymphozytotoxtest und ELISA. Zur statistischen Bewertung benutzten wir die Kaplan-Meier-Methode zur Berechnung der Überlebenszeit und eine Cox Regression zur Berechnung des relativen Risikos. Bezüglich der Gewebeübereinstimmung konnten wir beim konventionellen Matching eine Tendenz feststellen, daß Patienten mit einer guten Übereinstimmung eine längere Transplantatüberlebenszeit zeigten, als Patienten mit einer schlechten Übereinstimmung. Beim Matching auf Aminosäureebene konnten keine Unterschiede in der Transplantatfunktion nachgewiesen werden. Bei Betrachtung des Antikörperverhaltens der Empfänger konnten wir signifikante Unterschiede nachweisen dahingehend, daß Nierentransplantierte mit einer Antikörperbildung eine schlechtere Transplantatüberlebenszeit besaßen als Patienten ohne Antikörpernachweis. Außerdem konnte gezeigt werden, daß Patienten mit vielen Transfusionen vor Transplantation eine signifikant kürzere Transplantatüberlebenszeit zeigten, als Patienten mit wenigen Transfusionen. Anhand unserer Ergebnisse empfehlen wir ein konventionelles Matching als Grundlage der Nierentransplantation. Ein Matching auf Ebene von Aminosäuren könnte zukünftig das konventionelle Match ergänzen oder ablösen. Außerdem empfehlen wir ein generelles Antikörperscreening der Empfänger vor und nach Transplantation, da Aussagen möglich werden zum Verlauf nach Transplantation und die immunsuppressive Therapie angepaßt werden kann. / In this study we examined the survival of kidney transplants and the influence of two factors: the hla-compatibility and the dynamics of antibodies. For this we collected full data of 327 Patients, who were transplanted with a postmortal kidney transplant between the years 1991-1996. A conventional tissue typing was done with serological and molecular biological tests. A new matching method was done at the level of amino acids. A screening for antibodies was done before and after transplantation using lymphocytotoxtest and ELISA. For statistical valuation we used the Kaplan-Meier-method for the calculation of the transplant survival time and a cox regression for the calculation of the relative risk. Regarding the tissue similarities at the conventional match we saw the trend of a longer transplant survival time at patients with a good match compared to patients with more missmatches. At matching at amino acid-level we couldn´t show any differences in the transplant survival time. By observing the dynamics of antibodies of the receiver we could show a significant difference: kidney transplant receivers developing antibodies show a shorter transplant survival time than patients, who didn´t develop antibodies. Additionally we could show that patients with many transfusions before transplantation have a significantly worser transplant function than patients with less transfusions. Resulting from our examinations we recommend a conventional matching as a basic for kidney transplantation. In future a matching at amino acid-level could supplement or replace the conventional match. Additionally we recommend an antibodyscreening of the transplant receivers before and after transplantation. A prediction for the posttransplant course will be possible and an individual adjustment of the immunsuppressive therapy.
274

Análise da sobrevida do paciente e do enxerto de diabéticos submetidos a diferentes modalidades de transplante / Analysis of patient and graft survival of diabetic patients undergoing different modalities of transplantation

Mesquita, Pablo Girardelli Mendonça 11 December 2013 (has links)
O diabetes mellitus (DM) é a principal causa de doença renal crônica (DRC) em vários países do mundo. Para pacientes diabéticos com DRC estágio 5 e indicação da terapia renal substitutiva, o transplante (Tx) renal representa uma modalidade terapêutica com técnica bem estabelecida e com excelentes resultados. O transplante simultâneo de rim-pâncreas (TSRP), uma alternativa mais recente praticada em um número mais restrito de centros, apresenta resultados positivos adicionais no controle metabólico, na qualidade de vida e nas complicações crônicas do diabetes. Entretanto, está associado a um risco maior de complicações pós-operatórias e maior número de internações. Tanto o transplante renal quanto o TSRP estão associados a melhor sobrevida do paciente em relação à diálise. A escolha da melhor modalidade de transplante para o paciente diabético com DRC ainda não está clara. O objetivo deste estudo foi analisar os resultados de diferentes modalidades de transplante em pacientes diabéticos com DRC estágio 5, realizados em 3 Centros Brasileiros de Transplante. Assim, analisar a sobrevida do paciente e do enxerto renal após 1, 5 e 8 anos em pacientes DM tipo 1 submetidos a TSRP comparados com transplante renal isolado com doador vivo (DM1-DV) ou transplante de renal isolado com doador falecido (DM1-DF) (Estudo de 3 modalidades de Tx em DM tipo1). Além disso, avaliar em pacientes DM tipo 2, os resultados do transplante renal realizado com doador vivo (DM2-DV) ou doador falecido (DM2-DF) comparados com pacientes DM tipo 1 submetidos ao transplante renal com doador vivo (DM1-DV) ou doador falecido (DM1-DF) (Estudo do Tx em DM tipo 2 vs DM tipo1). Os transplantes foram realizados em 3 Centros de Transplante (Hospital Beneficência Portuguesa, Hospital do Rim e Santa Casa de Porto Alegre). No \"Estudo de 3 modalidades de Tx em DM tipo 1\", foram incluídos 372 transplantes, sendo 262 TSRP, 78 DM1-DV e 32 DM1-DF. No \"Estudo do Tx em DM tipo 2 vs DM tipo 1\", foram incluídos 254 transplantes, sendo 78 DM1-DV, 32 DM1-DF, 61 DM2-DV, 83 DM2-DF. As curvas de sobrevida do paciente e do enxerto renal (Kaplan-Meyer) foram calculadas 1, 5 e 8 anos após o transplante. No \"Estudo de 3 modalidades de Tx em DM tipo 1\", a sobrevida do paciente de receptores de DM1-DV foi significativamente superior comparada com a sobrevida dos receptores de DM1-DF e TSRP no 1º ano (98,7%, 87,5% e 83,2%, respectivamente; p < 0,05) e no 5º ano pós-Tx (90,5%, 70% e 77%, respectivamente; p < 0,05). Não foi observada diferença entre a sobrevida dos pacientes do grupo DM1-DV e TSRP em 8 anos. A sobrevida do enxerto renal foi superior nos receptores DM1-DV no 1º ano pós-Tx, quando comparada com a sobrevida dos receptores DM1-DF e TSRP (96,1%, 84,4% e 80,2%, respectivamente; p < 0,05). Após 5 e 8 anos, a sobrevida do enxerto renal foi semelhante entre os grupos. Ocorreram 90 óbitos durante o período de estudo sendo as principais causas, a infecção (50%) e doença cardiovascular (22%). Óbito com enxerto funcionante e nefropatia crônica do enxerto foram as principais causas de perda do enxerto renal. No \"Estudo do Tx em DM tipo 2 vs DM tipo 1\", como esperado, os pacientes DM tipo 1 eram mais jovens em relação aos pacientes DM tipo 2 (mediana 37,5 e 55 anos, respectivamente; p < 0,0001). Os pacientes transplantados com doador falecido permaneceram maior tempo em tratamento dialítico pré-transplante (mediana 36 meses em DM1-DF e 36 meses em DM2-DF) comparados com pacientes transplantados com doador vivo (mediana 14 meses em DM1-DV e 18 meses em DM2-DV; p < 0,0001). Em pacientes com DM tipo 2, a sobrevida do paciente em 1, 5 e 8 anos nos pacientes DM2-DV foi 95,1%, 87,9% e 81,8%, respectivamente, significativamente maior do que nos pacientes DM2-DF (74,7%, 59,4% e 48,5%, respectivamente; p < 0,01). Em pacientes com DM tipo 1, a sobrevida do paciente em 1, 5 e 8 anos foi 98,7%, 90,5% e 82,1%, respectivamente, significativamente maior do que nos pacientes DM1-DV que nos pacientes DM1-DF (87,5%, 70% e 66,3%, respectivamente; p < 0,01). Comparando-se a sobrevida dos pacientes DM tipo 2 em relação aos DM tipo 1 submetidos a transplante com um mesmo tipo de doador, não foi observado diferença estatisticamente significante. Pacientes do grupo DM2-DV e pacientes DM1-DV apresentaram sobrevidas semelhantes. A sobrevida dos pacientes DM2-DF encontrada foi inferior em relação aos pacientes DM1-DF, porém sem diferença estatística. Em pacientes com DM tipo 2, a sobrevida do enxerto renal em 1, 5 e 8 anos nos pacientes DM2-DV foi 91,8%, 81,2% e 75,3%, respectivamente, significativamente maior do que nos pacientes DM2-DF (73,5%, 54,9% e 44.3%, respectivamente; p < 0,01). Em pacientes com DM tipo 1, a sobrevida do enxerto renal em 1, 5 e 8 anos nos pacientes DM1-DV foi 96,1%, 80,8% e 72,3%, respectivamente, significativamente maior do que nos pacientes DM1-DF (84,4%, 66,8% e 59,3%, respectivamente; p < 0,01) apenas no primeiro ano. Ocorreram 52 óbitos em pacientes DM tipo 2 sendo a infecção principal causa de óbito nos pacientes DM2-DF e a doença cardiovascular a principal causa de óbito nos DM2-DV. Ocorreram 23 óbitos no grupo de pacientes DM tipo 1 e a principal causa foi infecção nos pacientes DM1-DF e a doença cardiovascular nos DM1-DV. A principal causa de perda do enxerto renal foi óbito com enxerto funcionante (74%), seguido pela nefropatia crônica do enxerto (15%). Conclusão: Os resultados do \"Estudo de 3 modalidades de Tx em DM tipo1\" mostraram que em pacientes portadores de DM tipo 1 o transplante renal isolado realizado com doador vivo apresentou resultados superiores em relação às outras modalidades de transplante. Entretanto, em longo prazo, a sobrevida dos pacientes submetidos ao transplante renal com doador vivo não foi estatisticamente diferente do TSRP. Os resultados do \"Estudo do Tx em DM tipo 2 vs DM tipo1\" mostraram que o transplante renal com doador vivo é uma boa opção de terapia renal substitutiva para pacientes com DM tipo 2. Entretanto, os resultados observados nesta análise desencorajam a indicação de transplante renal com doador falecido para pacientes portadores de DM tipo 2, devendo ser indicado apenas em casos selecionados / Diabetes mellitus is the leading cause of chronic kidney disease (CKD) in several countries around the world. For diabetic patients with stage 5 CKD with an indication of renal replacement therapy, renal transplantation is a therapeutic modality with well-established technique and with excellent results. The simultaneous kidney-pancreas transplantation (SPK), a more recent modality of treatment, performed in a limited number of centers, presents additional positive results in metabolic control, quality of life, and chronic complications of diabetes mellitus (DM). However, it is associated with an increased risk of postoperative complications and a higher number of hospitalizations. Both renal and SPK transplantation are associated with better patient survival outcomes compared to dialysis. The choice of the best modality of transplantation for diabetic patients with CKD is not yet clear. The aim of this study was to analyze the results of different modalities of transplant for diabetic patients with CKD stage 5, performed in 3 Brazilian Transplant Centers. More specifically, the aim of this study was to analyze the patient and graft survival after 1, 5, and 8 years post-transplantation in type 1 DM patients submitted to SPK compared with diabetic patients submitted to isolated kidney transplant with living donor (DM1-LD) or deceased donor (DM1-DD) (Study of 3 Tx (transplant) modalities in type 1 DM). In addition, the aim of this study was also to evaluate the results of renal transplantation in type 2 DM performed with living donor (DM2-LD) or deceased donor (DM2-DD) compared with kidney transplantation in type 1 DM performed with living donor (DM2-LD) or deceased donor (DM2-DD) (Study of Tx in type 2 DM vs. type 1 DM). The transplants were performed in 3 Transplant Centers (Hospital Beneficência Portuguesa, Hospital do Rim, and Santa Casa de Porto Alegre). In the \"Study of 3 transplant modalities in type 1 DM\", 372 recipients were included, (262 SPK, 78 DM1-LD, and 32 DM1-DD). In the \"Study of Tx in type 2 DM vs. type 1 DM\", 254 transplants were included, 78 DM1-LD, 32 DM1-DD, 61 DM2-LD, 83 DM2-DD. Patient and graft survival distribution estimates were calculated using the Kaplan-Meier method in the 1, 5 and 8 years post-transplantation. In the \"Study of 3 transplant Tx modalities in type 1 DM\", the patient survival of DM1-LD recipients was significantly higher compared with the survival of DM1-DD and SPK at 1 year (98.7%, 87.5% and 83.2%, respectively; p < 0.05), and at 5 years post-transplantation (90.5%, 70% and 77%, respectively; p < 0.05). After 8 years, there was no significant difference between the survival of patients in group DM1-LD and SPK. The kidney graft survival was higher in DM1-LD, at 1 year, compared with survival of DM1-DD and SPK (96.2%, 84.4% and 80.8%, respectively; p < 0.05). After 5 and 8 years, the kidney graft survival was similar between the groups. There were 90 deaths during the study period and infection (50%) and cardiovascular disease (22%) were the major causes. Death with a functioning graft and chronic allograft nephropathy were the main causes of kidney graft loss. In the \"Study of Tx in type 2 DM vs. type 1 DM\", type 1 DM patients were younger compared to type 2 DM patients (median 37.5 and 55 years, respectively; p < 0.0001). Recipients of deceased donor remained longer time on dialysis before transplantation (median 36 months in DM1-DD, and 36 in DM2-DD) compared with patients transplanted with living donor (median 14 months in DM1-LD and 18 months in DM2-LD, p < 0.0001). In type 2 DM, patient survival at 1, 5 and 8 years in the group DM2-LD was 95.1%, 87.9%, and 81.8, respectively, significantly higher than patient survival in DM2-DD recipients (74.7, 59,4, and 48.5; respectively, p < 0.01). In type 1 DM, patient survival at 1, 5 and 8 years in the group DM1-LD was 98.7%, 90.5% and 82.1%, respectively, significantly higher than patient survival in DM1-DD recipients ( 87.5%, 70%, and 48.5%; respectively, p < 0.01). The comparison between patient survival with type 2 DM and type 1 DM undergoing kidney transplantation with the same type of donor, was not statistically different between the groups. Patient survival in group DM2-LD and DM1-LD was not different. Patient survival in the group DM2-DD was inferior to the group DM1-DD but without significant differences. In type 2 DM, kidney survival at 1, 5 and 8 years in the group DM2-LD was 91.8%, 81 2%, and 75.3%, respectively, significantly higher than patient survival in DM2-DD recipients (73.5%, 54.9%, and 44.3%, respectively, p < 0.01). In type 1 DM, kidney survival at 1, 5 and 8 years in the group DM1-LD was 96.1%, 80.8%, and 72.3%,, respectively, significantly higher than patient survival in DM1-DD recipients (84.4%, 66.8%, and 59.3%, respectively, p < 0.01) only in the first year. In these patients the kidney graft survival was superior in the group DM2-LD compared with DM2-DD. In type 1 DM patients kidney graft survival was 96.1%, 80.8% and 72.3% in patients DM1-LD; 84.4%, 66.8% and 59.3% in patients DM1-DD (p < 0.01); respectively. There were 52 deaths in the group of type 2 DM patients. Infection was the main cause of death in the group DM2-DD, and cardiovascular disease was the main cause in DM2-LD. There were 23 deaths in the group of type 1 DM patients and the main cause was infection in the group DM1-DD and cardiovascular disease in the group DM1-LD. The main cause of kidney graft loss was death with a functioning graft (74%), followed by chronic allograft nephropathy (15%). Patients in group DM2-LD showed good survival rates, particularly in the first year. Conclusion: The \"Study of 3 transplant modalities in type 1 DM\" showed better patient and graft survival with isolated kidney transplantation with living donor compared with others transplant modalities. However, at longer follow up (8 years), survival of patients undergoing living donor kidney transplantation was not statistically different to SPK. In the \"Study of Tx in type 2 DM vs. type 1 DM\", renal transplantation performed with living donor is a good option of renal replacement therapy for type 2 DM. The results observed in this analysis discourage the indication of kidney transplantation with deceased donor for patients with type 2 DM, which should be indicated in selected cases
275

Análise da sobrevida do paciente e do enxerto de diabéticos submetidos a diferentes modalidades de transplante / Analysis of patient and graft survival of diabetic patients undergoing different modalities of transplantation

Pablo Girardelli Mendonça Mesquita 11 December 2013 (has links)
O diabetes mellitus (DM) é a principal causa de doença renal crônica (DRC) em vários países do mundo. Para pacientes diabéticos com DRC estágio 5 e indicação da terapia renal substitutiva, o transplante (Tx) renal representa uma modalidade terapêutica com técnica bem estabelecida e com excelentes resultados. O transplante simultâneo de rim-pâncreas (TSRP), uma alternativa mais recente praticada em um número mais restrito de centros, apresenta resultados positivos adicionais no controle metabólico, na qualidade de vida e nas complicações crônicas do diabetes. Entretanto, está associado a um risco maior de complicações pós-operatórias e maior número de internações. Tanto o transplante renal quanto o TSRP estão associados a melhor sobrevida do paciente em relação à diálise. A escolha da melhor modalidade de transplante para o paciente diabético com DRC ainda não está clara. O objetivo deste estudo foi analisar os resultados de diferentes modalidades de transplante em pacientes diabéticos com DRC estágio 5, realizados em 3 Centros Brasileiros de Transplante. Assim, analisar a sobrevida do paciente e do enxerto renal após 1, 5 e 8 anos em pacientes DM tipo 1 submetidos a TSRP comparados com transplante renal isolado com doador vivo (DM1-DV) ou transplante de renal isolado com doador falecido (DM1-DF) (Estudo de 3 modalidades de Tx em DM tipo1). Além disso, avaliar em pacientes DM tipo 2, os resultados do transplante renal realizado com doador vivo (DM2-DV) ou doador falecido (DM2-DF) comparados com pacientes DM tipo 1 submetidos ao transplante renal com doador vivo (DM1-DV) ou doador falecido (DM1-DF) (Estudo do Tx em DM tipo 2 vs DM tipo1). Os transplantes foram realizados em 3 Centros de Transplante (Hospital Beneficência Portuguesa, Hospital do Rim e Santa Casa de Porto Alegre). No \"Estudo de 3 modalidades de Tx em DM tipo 1\", foram incluídos 372 transplantes, sendo 262 TSRP, 78 DM1-DV e 32 DM1-DF. No \"Estudo do Tx em DM tipo 2 vs DM tipo 1\", foram incluídos 254 transplantes, sendo 78 DM1-DV, 32 DM1-DF, 61 DM2-DV, 83 DM2-DF. As curvas de sobrevida do paciente e do enxerto renal (Kaplan-Meyer) foram calculadas 1, 5 e 8 anos após o transplante. No \"Estudo de 3 modalidades de Tx em DM tipo 1\", a sobrevida do paciente de receptores de DM1-DV foi significativamente superior comparada com a sobrevida dos receptores de DM1-DF e TSRP no 1º ano (98,7%, 87,5% e 83,2%, respectivamente; p < 0,05) e no 5º ano pós-Tx (90,5%, 70% e 77%, respectivamente; p < 0,05). Não foi observada diferença entre a sobrevida dos pacientes do grupo DM1-DV e TSRP em 8 anos. A sobrevida do enxerto renal foi superior nos receptores DM1-DV no 1º ano pós-Tx, quando comparada com a sobrevida dos receptores DM1-DF e TSRP (96,1%, 84,4% e 80,2%, respectivamente; p < 0,05). Após 5 e 8 anos, a sobrevida do enxerto renal foi semelhante entre os grupos. Ocorreram 90 óbitos durante o período de estudo sendo as principais causas, a infecção (50%) e doença cardiovascular (22%). Óbito com enxerto funcionante e nefropatia crônica do enxerto foram as principais causas de perda do enxerto renal. No \"Estudo do Tx em DM tipo 2 vs DM tipo 1\", como esperado, os pacientes DM tipo 1 eram mais jovens em relação aos pacientes DM tipo 2 (mediana 37,5 e 55 anos, respectivamente; p < 0,0001). Os pacientes transplantados com doador falecido permaneceram maior tempo em tratamento dialítico pré-transplante (mediana 36 meses em DM1-DF e 36 meses em DM2-DF) comparados com pacientes transplantados com doador vivo (mediana 14 meses em DM1-DV e 18 meses em DM2-DV; p < 0,0001). Em pacientes com DM tipo 2, a sobrevida do paciente em 1, 5 e 8 anos nos pacientes DM2-DV foi 95,1%, 87,9% e 81,8%, respectivamente, significativamente maior do que nos pacientes DM2-DF (74,7%, 59,4% e 48,5%, respectivamente; p < 0,01). Em pacientes com DM tipo 1, a sobrevida do paciente em 1, 5 e 8 anos foi 98,7%, 90,5% e 82,1%, respectivamente, significativamente maior do que nos pacientes DM1-DV que nos pacientes DM1-DF (87,5%, 70% e 66,3%, respectivamente; p < 0,01). Comparando-se a sobrevida dos pacientes DM tipo 2 em relação aos DM tipo 1 submetidos a transplante com um mesmo tipo de doador, não foi observado diferença estatisticamente significante. Pacientes do grupo DM2-DV e pacientes DM1-DV apresentaram sobrevidas semelhantes. A sobrevida dos pacientes DM2-DF encontrada foi inferior em relação aos pacientes DM1-DF, porém sem diferença estatística. Em pacientes com DM tipo 2, a sobrevida do enxerto renal em 1, 5 e 8 anos nos pacientes DM2-DV foi 91,8%, 81,2% e 75,3%, respectivamente, significativamente maior do que nos pacientes DM2-DF (73,5%, 54,9% e 44.3%, respectivamente; p < 0,01). Em pacientes com DM tipo 1, a sobrevida do enxerto renal em 1, 5 e 8 anos nos pacientes DM1-DV foi 96,1%, 80,8% e 72,3%, respectivamente, significativamente maior do que nos pacientes DM1-DF (84,4%, 66,8% e 59,3%, respectivamente; p < 0,01) apenas no primeiro ano. Ocorreram 52 óbitos em pacientes DM tipo 2 sendo a infecção principal causa de óbito nos pacientes DM2-DF e a doença cardiovascular a principal causa de óbito nos DM2-DV. Ocorreram 23 óbitos no grupo de pacientes DM tipo 1 e a principal causa foi infecção nos pacientes DM1-DF e a doença cardiovascular nos DM1-DV. A principal causa de perda do enxerto renal foi óbito com enxerto funcionante (74%), seguido pela nefropatia crônica do enxerto (15%). Conclusão: Os resultados do \"Estudo de 3 modalidades de Tx em DM tipo1\" mostraram que em pacientes portadores de DM tipo 1 o transplante renal isolado realizado com doador vivo apresentou resultados superiores em relação às outras modalidades de transplante. Entretanto, em longo prazo, a sobrevida dos pacientes submetidos ao transplante renal com doador vivo não foi estatisticamente diferente do TSRP. Os resultados do \"Estudo do Tx em DM tipo 2 vs DM tipo1\" mostraram que o transplante renal com doador vivo é uma boa opção de terapia renal substitutiva para pacientes com DM tipo 2. Entretanto, os resultados observados nesta análise desencorajam a indicação de transplante renal com doador falecido para pacientes portadores de DM tipo 2, devendo ser indicado apenas em casos selecionados / Diabetes mellitus is the leading cause of chronic kidney disease (CKD) in several countries around the world. For diabetic patients with stage 5 CKD with an indication of renal replacement therapy, renal transplantation is a therapeutic modality with well-established technique and with excellent results. The simultaneous kidney-pancreas transplantation (SPK), a more recent modality of treatment, performed in a limited number of centers, presents additional positive results in metabolic control, quality of life, and chronic complications of diabetes mellitus (DM). However, it is associated with an increased risk of postoperative complications and a higher number of hospitalizations. Both renal and SPK transplantation are associated with better patient survival outcomes compared to dialysis. The choice of the best modality of transplantation for diabetic patients with CKD is not yet clear. The aim of this study was to analyze the results of different modalities of transplant for diabetic patients with CKD stage 5, performed in 3 Brazilian Transplant Centers. More specifically, the aim of this study was to analyze the patient and graft survival after 1, 5, and 8 years post-transplantation in type 1 DM patients submitted to SPK compared with diabetic patients submitted to isolated kidney transplant with living donor (DM1-LD) or deceased donor (DM1-DD) (Study of 3 Tx (transplant) modalities in type 1 DM). In addition, the aim of this study was also to evaluate the results of renal transplantation in type 2 DM performed with living donor (DM2-LD) or deceased donor (DM2-DD) compared with kidney transplantation in type 1 DM performed with living donor (DM2-LD) or deceased donor (DM2-DD) (Study of Tx in type 2 DM vs. type 1 DM). The transplants were performed in 3 Transplant Centers (Hospital Beneficência Portuguesa, Hospital do Rim, and Santa Casa de Porto Alegre). In the \"Study of 3 transplant modalities in type 1 DM\", 372 recipients were included, (262 SPK, 78 DM1-LD, and 32 DM1-DD). In the \"Study of Tx in type 2 DM vs. type 1 DM\", 254 transplants were included, 78 DM1-LD, 32 DM1-DD, 61 DM2-LD, 83 DM2-DD. Patient and graft survival distribution estimates were calculated using the Kaplan-Meier method in the 1, 5 and 8 years post-transplantation. In the \"Study of 3 transplant Tx modalities in type 1 DM\", the patient survival of DM1-LD recipients was significantly higher compared with the survival of DM1-DD and SPK at 1 year (98.7%, 87.5% and 83.2%, respectively; p < 0.05), and at 5 years post-transplantation (90.5%, 70% and 77%, respectively; p < 0.05). After 8 years, there was no significant difference between the survival of patients in group DM1-LD and SPK. The kidney graft survival was higher in DM1-LD, at 1 year, compared with survival of DM1-DD and SPK (96.2%, 84.4% and 80.8%, respectively; p < 0.05). After 5 and 8 years, the kidney graft survival was similar between the groups. There were 90 deaths during the study period and infection (50%) and cardiovascular disease (22%) were the major causes. Death with a functioning graft and chronic allograft nephropathy were the main causes of kidney graft loss. In the \"Study of Tx in type 2 DM vs. type 1 DM\", type 1 DM patients were younger compared to type 2 DM patients (median 37.5 and 55 years, respectively; p < 0.0001). Recipients of deceased donor remained longer time on dialysis before transplantation (median 36 months in DM1-DD, and 36 in DM2-DD) compared with patients transplanted with living donor (median 14 months in DM1-LD and 18 months in DM2-LD, p < 0.0001). In type 2 DM, patient survival at 1, 5 and 8 years in the group DM2-LD was 95.1%, 87.9%, and 81.8, respectively, significantly higher than patient survival in DM2-DD recipients (74.7, 59,4, and 48.5; respectively, p < 0.01). In type 1 DM, patient survival at 1, 5 and 8 years in the group DM1-LD was 98.7%, 90.5% and 82.1%, respectively, significantly higher than patient survival in DM1-DD recipients ( 87.5%, 70%, and 48.5%; respectively, p < 0.01). The comparison between patient survival with type 2 DM and type 1 DM undergoing kidney transplantation with the same type of donor, was not statistically different between the groups. Patient survival in group DM2-LD and DM1-LD was not different. Patient survival in the group DM2-DD was inferior to the group DM1-DD but without significant differences. In type 2 DM, kidney survival at 1, 5 and 8 years in the group DM2-LD was 91.8%, 81 2%, and 75.3%, respectively, significantly higher than patient survival in DM2-DD recipients (73.5%, 54.9%, and 44.3%, respectively, p < 0.01). In type 1 DM, kidney survival at 1, 5 and 8 years in the group DM1-LD was 96.1%, 80.8%, and 72.3%,, respectively, significantly higher than patient survival in DM1-DD recipients (84.4%, 66.8%, and 59.3%, respectively, p < 0.01) only in the first year. In these patients the kidney graft survival was superior in the group DM2-LD compared with DM2-DD. In type 1 DM patients kidney graft survival was 96.1%, 80.8% and 72.3% in patients DM1-LD; 84.4%, 66.8% and 59.3% in patients DM1-DD (p < 0.01); respectively. There were 52 deaths in the group of type 2 DM patients. Infection was the main cause of death in the group DM2-DD, and cardiovascular disease was the main cause in DM2-LD. There were 23 deaths in the group of type 1 DM patients and the main cause was infection in the group DM1-DD and cardiovascular disease in the group DM1-LD. The main cause of kidney graft loss was death with a functioning graft (74%), followed by chronic allograft nephropathy (15%). Patients in group DM2-LD showed good survival rates, particularly in the first year. Conclusion: The \"Study of 3 transplant modalities in type 1 DM\" showed better patient and graft survival with isolated kidney transplantation with living donor compared with others transplant modalities. However, at longer follow up (8 years), survival of patients undergoing living donor kidney transplantation was not statistically different to SPK. In the \"Study of Tx in type 2 DM vs. type 1 DM\", renal transplantation performed with living donor is a good option of renal replacement therapy for type 2 DM. The results observed in this analysis discourage the indication of kidney transplantation with deceased donor for patients with type 2 DM, which should be indicated in selected cases
276

Étude qualitative sur l'expérience de la perte d'un greffon rénal

Ouellette, Amélie January 2009 (has links)
Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.
277

Avaliação de doença arterial coronária pela tomografia computadorizada combinada à perfusão miocárdica em pacientes com insuficiência renal crônica dialítica / Evaluation of coronary artery disease by computed tomography angiography combined with myocardial perfusion in patients with end-stage renal disease on dialysis

Adam, Eduardo Leal 28 May 2019 (has links)
Introdução: Pacientes com doença renal crônica terminal (DRCT) apresentam elevada prevalência de doença cardiovascular, sendo esta a principal causa de óbitos na população em diálise e após o transplante renal. Entretanto, a doença arterial coronária (DAC) é frequentemente assintomática em pacientes com DRCT e os exames não invasivos apresentam baixa acurácia diagnóstica nesses pacientes em relação à população geral. Objetivos: Determinar a performance diagnóstica da angiotomografia de artérias coronárias combinada à perfusão miocárdica pela tomografia (TC-AP) em pacientes com DRCT. Métodos: Estudo prospectivo, aberto, unicêntrico. Foram incluídos pacientes com DRCT em terapia de substituição renal, candidatos ao transplante renal com mais um fator de risco cardiovascular: idade >= 50 anos, diabetes ou história de doença cardiovascular. Todos os pacientes foram submetidos à coronariografia invasiva (CI) e à TC-AP. A aquisição das imagens tomográficas foi realizada durante estresse com dipiridamol e em repouso. Os resultados obtidos na TC-AP foram comparados aos da CI, considerada o padrão-ouro para diagnóstico de DAC. Foi realizada medida da reserva de fluxo fracionada (FFR) durante a CI em lesões obstrutivas classificadas visualmente como intermediárias. Baseado nos resultados da TC-AP e da CI (±FFR), os pacientes foram classificados como portadores ou não de DAC significativa e a análise foi feita por paciente. Os investigadores responsáveis pela análise da TC-AP não tiveram acesso aos resultados da CI (±FFR). Resultados: Entre julho de 2015 e janeiro de 2018, 64 pacientes (idade média 56,9 ± 9,2 anos; 67,2% do sexo masculino; 85,9% diabéticos) realizaram CI e TC-AP. A prevalência de DAC significativa na CI foi de 34,4%. Na comparação com a CI, os valores de sensibilidade e especificidade, valor preditivo positivo, valor preditivo negativo e a acurácia da TC-AP foram, respectivamente, 95,5%, 88,1%, 80,8%, 97,4% e 90,6%. As razões de verossimilhança positiva e negativa foram de 8,02 e 0,05, respectivamente. Conclusão: Um único exame baseado na tomografia computadorizada, associando angiografia coronária e perfusão miocárdica, apresentou elevada acurácia no diagnóstico de DAC obstrutiva significativa na população com DRCT candidata ao transplante renal. Essa estratégia poderá ser considerada na avaliação de DAC em pacientes com DRCT / Introduction: Patients with end-stage renal disease (ESRD) have a high prevalence of cardiovascular disease, which is the main cause of death in patients on dialysis or after kidney transplantation. However, coronary artery disease (CAD) is often asymptomatic in patients with ESRD, and noninvasive tests have a lower diagnostic accuracy in this scenario when compared to that in the general population. Objective: To determine the diagnostic performance of computed tomography (CT) angiography combined with myocardial perfusion (CT-AP) in the diagnosis of CAD in patients with ESRD. Methods: This was a prospective, single-center study. Patients with ESRD on renal replacement therapy, candidates for kidney transplantation, with at least one additional risk factor for cardiovascular disease (age >= 50 years, diabetes or previous cardiovascular disease) were included. All patients underwent invasive coronary angiography (ICA) and CT-AP. CT image acquisition was performed during dipyridamole-induced stress and at rest. Results of CT-AP were compared to those obtained on ICA, considered the gold standard for diagnosis of CAD. Fractional flow reserve (FFR) was measured during ICA for obstructive lesions visually graded as intermediate. Based on the results of CT-AP and ICA (±FFR), patients were classified as having significant or nonsignificant obstructive CAD, and analyses were performed at the patient level. Investigators responsible for the analysis of CT-AP were blinded to the findings of ICA (±FFR). Results: Between July 2015 and January 2018, 64 patients (mean age 56.9 ± 9.2 years; 67.2% male; 85.9% with diabetes) underwent ICA and CT-AP. Significant CAD was observed in 34.4% of patients on ICA. Compared to ICA, the sensitivity, specificity, positive and negative predictive values, and accuracy of CT-AP were 95.5%, 88.1%, 80.8%, 97.4%, and 90.6%, respectively. Positive and negative likelihood ratios were 8.02 and 0.05, respectively. Conclusion: A single test based on CT angiography and myocardial perfusion had a high accuracy for the diagnosis of significant obstructive CAD in patients with ESRD being evaluated for kidney transplantation. This strategy may be considered in the assessment of CAD in patients with ESRD
278

Prevalência de hipovitaminose D em pacientes transplantados renais / Prevalence of hypovitaminosis D in kidney transplant patients

Vilarta, Cristiane Flores 04 February 2011 (has links)
Inúmeros estudos têm demonstrado elevada prevalência de hipovitaminose D (deficiência/insuficiência de 25(OH)D) em indivíduos normais e em pacientes com e sem doença renal. Como os pacientes transplantados renais têm maior risco de desenvolver câncer de pele, são orientados a evitar exposição ao sol e usar filtro solar. A combinação de doença renal crônica (DRC) e menor exposição ao sol contribuem para que esses pacientes desenvolvam hipovitaminose D, o que pode piorar ou favorecer o desenvolvimento de doença óssea. O objetivo desse estudo foi avaliar a concentração sérica de 25(OH)D e a prevalência de hipovitaminose D em uma amostra representativa (N=149) de pacientes transplantados renais do Hospital das Clinicas da Universidade de São Paulo. Avaliamos ainda se a hipovitaminose poderia ser atribuída a menor exposição ao sol ou ingestão insuficiente de alimentos fontes. Comparamos os níveis séricos de 25(OH)D desses pacientes com o de indivíduos normais. Hipovitaminose D, definida pelos níveis séricos de 25(OH)D menores que 30 ng/ml, foi observada em 79% dos pacientes transplantados e o principal fator determinante foi a menor exposição ao sol.Os níveis séricos de creatinina e de paratormônio (PTH) foram significativamente mais elevados nos pacientes com hipovitaminose quando comparados aos com níveis normais de 25(OH)D. Observamos uma correlação inversa dos níveis séricos de 25(OH)D com os de paratormônio (r= -0,24; p<0,03). A prevalência de hipovitaminose D foi maior nos pacientes transplantados que nos indivíduos normais. Os níveis séricos de creatinina e PTH foram mais elevados nos transplantados, enquanto os de Ca, P e albumina menores que dos indivíduos normais. Em conclusão: A hipovitaminose D é freqüente nos pacientes transplantados renais e orientação dietética, exposição solar curta e regular ou mesmo a suplementação com vitamina D seriam medidas simples para assegurar níveis adequados dessa vitamina / Recent epidemiological studies have shown a high prevalence vitamin D deficiency in normal population and in patients with and without kidney diseases. In addition, kidney transplant patients are at higher risk for skin cancer, so they are advised to avoid sun and use sunscreen. Because of the combination of chronic kidney disease (CKD) and sun avoidance, kidney transplant patients are at high risk for developing hypovitaminosis D. We evaluated serum 25 vitamin D levels in a representative sample (N = 149) of kidney transplant patients from the University of São Paulo Transplant Unit. Our objectives were to determine the prevalence of hypovitaminosis D, comparing them to normal volunteers, as well as, to identify the factors that could be associated with this decrease in serum 25 vitamin D, such as sun exposure and dietary habits. Hypovitaminosis D, defined by serum levels < 30 ng/mL, was found in 79% of kidney transplant patients, and the main associated factor was low sun exposure. Patients that presented hypovitaminosis D had higher serum creatinine and parathormone (PTH) levels. Serum 25 vitamin D correlated with serum PTH (r= - 0.24; p=0.03). When compared to normal volunteers, renal transplant patients presented a higher prevalence of hypovitaminosis D, as well as low serum calcium, phosphate albumin, and higher creatinine, and PTH. Our results confirm a high prevalence of hypovitaminosis D in renal transplant patients. In conclusion, hypovitaminosis D is frequent in kidney transplant patients, therefore dietary orientation, short or regular sun exposure, and vitamin D supplementation are important determinants of vitamin D status
279

Impact de l'oxygénation active et d'un transporteur d'oxygène durant la conservation des greffons rénaux sur machine de perfusion avant transplantation / Impact of active oxygenation and oxygen carrier during the kidney transplant preservation in machine perfusion before transplantation

Kasil, Abdelsalam 10 December 2018 (has links)
Il est prouvé que la conservation des greffons rénaux marginaux en machine de perfusion (MP) est bénéfique. Cependant, cette méthode nécessite des améliorations afin de minimiser les lésions d’ischémie-reperfusion (I/R), par l’ajout d’oxygène et/ou d’un transporteur d’oxygène. Nous avons cherché à évaluer les effets de l’oxygénation et de l’ajout d’une hémoglobine de ver marin (HbAm, M101) durant la perfusion rénale hypothermique avant transplantation. Nos critères de jugement étaient basés sur la reprise de fonction du greffon et sur les lésions tardives de dysfonction rénale. Nous avons utilisé un modèle porcin : les reins ont été exposés à 1h d’ischémie chaude, puis perfusés dans une MP WAVES® pendant 23h à 4°C avant autotransplantation. Quatre groupes ont étudié : W (MP-21% O2), W-O2 (MP-100% O2), W-M101 (MP-21% O2 + 2g/L HbAm), W-O2+M101 (100% O2 + 2g/L HbAm), (n=6 per groupe). Les reins du groupe W-M101 ont montré un débit de perfusion plus élevé et une résistance rénale plus faible comparé aux autres groupes. Pendant la première semaine post-transplantation, les groupes W-O2 et W-M101 ont montré une créatininémie significativement plus faible et un meilleur taux de filtration glomérulaire (GFR). Les niveaux circulants de KIM-1 et IL-18 étaient plus faibles dans le groupe W-M101, tandis que les niveaux de NGAL et d’ASAT étaient plus faibles dans les groupes d’oxygénation active. Trois mois post-transplantation, la fraction excrétée de sodium et le ratio protéinurie/créatininurie étaient plus élevé dans le groupe W. La créatininémie était plus faible dans le groupe W-M101. La fibrose interstitielle a évalué à 3 mois post-transplantation étaient plus faible dans les groupes W-M101 et W-O2+M101. Nous avons révélé histologiquement que l’infiltration de mastocytes était significativement élevée dans le groupe W comparé aux autres groupes. Nous avons montré que la combinaison de 21% O2 + hémoglobine améliorent la reprise de fonction du greffon rénale. / Introduction: It is proved that preservation of marginal kidney graft in machine perfusion (MP) is beneficial. However, this method requires improvement to minimize the ischemia-reperfusion injuries (IRI), as addition of oxygen and/or an oxygen carrier. We aimed to evaluate the effects of oxygenation (100% or 21%) and the addition of marine worm hemoglobin (HbAm, M101) during hypothermic renal perfusion before transplantation. Our endpoints were based on graft function recovery and late renal dysfunction. Method and materials: We use a porcine model where kidneys were submitted to 1h warm ischemia, followed by WAVES® MP preservation for 23h before auto-transplantation. Four groups were studied: W (MP-21% O2), W-O2 (MP-100% O2), W-M101 (MP-21% O2 + 2g/L HbAm), W-O2+M101 (100% O2 + 2g/L HbAm), (n=6 per group). Results: Kidneys preserved in W-M101 group showed a higher perfusion flow and lower renal resistance, compared to other groups. During the first week post-transplantation, W-O2 or W-M101 groups showed lower blood creatinine and better glomerular filtration rate. Blood levels of KIM-1 and IL-18 were lower in W-M101 group, while blood levels of AST and NGAL were lower in groups with 100% O2. Three months after transplantation, the fractional excretion of sodium and the proteinuria/ creatininuria ratio were higher in W group. Blood creatinine was lower in W-M101 group. Interstitial fibrosis evaluated at 3 months was lower in groups W-M101 and W-O2+M101. We showed that the combination 21% O2 + hemoglobin improves the kidney graft outcome.Conclusion: We showed that the combination of 21% O2 + hemoglobin improved the kidney graft outcome.
280

Avaliação do potencial papel imunomodulador de células-tronco mesenquimais derivadas de tecido adiposo, no modelo experimental de transplante renal em ratos / Evaluation of the potential immunomodulatory role of mesenchymal stem cells derived from adipose tissue in the experimental kidney transplant model in rats

Pepineli, Rafael 19 January 2018 (has links)
Estudos com células tronco mesenquimais (CTm) têm despertado grande interesse devido a seu promissor potencial terapêutico e representam uma alternativa para o tratamento de diversas patologias em diferentes órgãos, inclusive em transplante renal. A rejeição crônica é um dos maiores desafios no transplante tardio e se caracteriza por perda progressiva da função renal causado pela intensa fibrogênese no aloenxerto. Os tratamentos convencionais com imunossupressores, apesar de reduzirem significativamente as crises de rejeição aguda, não interferem na sobrevida do enxerto a longo prazo. A compreensão dos processos fisiopatológicos da doença depende de seu estudo em modelos experimentais, que são de grande importância pois também propiciam uma melhor compreensão dos possíveis tratamentos. O presente estudo teve como objetivo analisar a terapia com células-tronco mesenquimais derivadas de tecido adiposo (CTmTA) no modelo experimental de transplante renal em ratos, para estudar seu efeito na rejeição crônica e avaliar seu potencial efeito imunomodulador. O modelo foi estabelecido com ratos das linhagens isogênicas Fisher (doador) e Lewis (receptor) e os animais transplantados foram divididos em três grupos: ISO (transplante isogênico de Lewis para Lewis, n=6), ALO (transplante alogênico de Fisher para Lewis, n=6) e ALO+CTmTA (transplante alogênico, tratado com CTmTA, n=6). As CTmTA foram caracterizadas por aderência ao plástico, diferenciação nas linhagens adipogênica, condrogênicas e osteogênicas e por citometria de fluxo. Foram inoculadas 1 x 106 células na região subcapsular renal no dia da realização da nefrectomia unilateral direita (10 dias pós-transplante). Após 6 meses foram realizadas análises dos parâmetros clínicos e laboratoriais, além de análise histológica, imunohistoquímica e PCR em tempo real. As CTmTA foram eficientes em prevenir significativamente a elevação da ureia e da creatinina séricas, manter clearence de creatinina em níveis normais, e prevenir a elevação da fração de excreção de Na+ e K+. Além disso, impediram o desenvolvimento de proteinúria e da hipertensão arterial. A análise histológica mostrou uma redução significativa do infiltrado inflamatório de macrófagos e linfócitos T, além de uma diminuição da fibrose intersticial no grupo ALO+CTmTA. O tratamento com CTmTA reduziu significativamente a expressão relativa dos fatores e citocinas pró-inflamatórios tais como INF-y, TNF-alfa, IL1beta e IL-6, além de aumento importante na expressão de IL-4 e IL-10, conhecidas por seu potencial antiinflamatório. Em conclusão, o tratamento com ADMSC em um modelo experimental de transplante renal pode trazer uma nova abordagem terapêutica para controle da rejeição crônica do enxerto. A aparente modulação da resposta imune observada neste trabalho, pode estar associada a uma possível polarização de macrófagos e células T. Outros estudos pré-clínicos e clínicos são necessários para confirmar nossos resultados / Studies involving mesenchymal stem cells (MSCs) have aroused great interest due to their promising therapeutic potential representing an alternative for the treatment of several pathologies in different organs, including renal transplantation. Chronic rejection is one of the major challenges in late transplantation and is characterized by progressive loss of renal function caused by intense fibrogenesis in the allograft. Conventional immunosuppressive treatments, while significantly reducing acute rejection crises, do not interfere with long-term graft survival. Animal model of kidney transplantation can provide a better understanding of the pathophysiological processes and bring a new path to treat chronic rejection. The aim of this project was to analyze the therapy with mesenchymal stem cells derived from adipose tissue (ADMSCs) in the experimental model of kidney transplantation in rats, focus on chronic rejection and evaluate its potential immunomodulatory effect. The model was established with rats of isogenic strains Fisher (donor) and Lewis (recipient), and the transplanted animals were divided into three groups: ISO (isogenic transplantation from Lewis to Lewis, n = 6), ALO (allogenic transplant from Fisher to Lewis, n = 6) and ALO + ADMSCs (allogenic transplantation, treated with ADMSCs, n = 6). ADMSCs were characterized by adhesion to plastic, differentiation in adipogenic, condrogenic and osteogenic lines and by flow cytometry. One million of cells were inoculated under the renal capsule on the day of the right unilateral nephrectomy (10 days after transplantation). After 6 months, clinical and laboratory parameters were analyzed, as well as histological analysis, immunohistochemistry and real-time PCR. ADMSCs were effective in preventing elevation of serum urea and creatinine, elevation of the Na + and K + excretion fraction as well as maintained creatinine clearence at normal levels. Furthermore, the treatment also prevented the development of proteinuria and preserved blood pressure. Histological analysis showed a significant reduction of macrophages and T cells infiltrate, associated to a decreased of interstitial fibrosis in the ALO + ADMSCs group. In the presence of ADMSCs, there was a significant decrease in the relative expression of INF-y, TNF-alpha, IL1beta and IL-6 factors and pro-inflammatory cytokines, as well as a significant increase in the relative expression of anti-inflammatory cytokines as IL-4 and IL-10. In conclusion, treatment with ADMSC in a transplantation model could open a new approach to control chronic rejection. This apparent modulation of the immune response may be associated with a possible polarization of macrophages and T cells. Further pre-clinical and clinical studies are needed to confirm our findings

Page generated in 0.1384 seconds