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- Steroid Withdrawal in Simultaneous Pancreas-Kidney Transplantation:Publication . Malheiro, J.; Martins, La Salete; Fonseca, Isabel; Gomes, A.M.; Santos, J.; Dias, L.; Dores, J.; Oliveira, F.; Seca, R.; Almeida, R.; Henriques, A.; Cabrita, A.; Teixeira, M.ABSTRACT Simultaneous pancreas-kidney transplantation (SPK) is the treatment of choice for selected diabetic patients with end-stage renal disease. Maintenance steroid therapy is associated with significant morbidity and mortality among SPK transplant recipients. Steroid withdrawal regimens are becoming more common, albeit with reservations regarding its safety and efficacy. We performed retrospective review of 77 SPK transplant recipients from May 2000 to December 2007. The subjects received induction therapy with thymoglobulin followed by maintenance immunosuppression with tacrolimus and myco- phenolate mofetil. late steroid withdrawal protocol was adopted. The rates of acute rejection, graft and patient survival, and side effects were analyzed. One-year patient, kidney, and pancreas survivals were 93%91%and 86%respectively. Eleven patients experienced acute rejection. Mean follow-up time was 1155.5 776.1 days. Prednisolone withdrawal was carried out between and 12 months posttransplantation in 42 patients (77.8%with at least year follow-up; no case of acute rejection occurred. At present, 72 patients have functioning kidney graft, and 65 patients also have functioning pancreas graft. The mean serum creatinine is 1.12 0.49 mg/dL and the mean HbA1c concentration is 4.5% 0.4%The patients have low prevalence of hypertension, hyperlipidemia, and obesity. Steroid withdrawal was successful and safe in the majority of in-study patients and safe without an increase of immune events. Our patient and graft outcomes are within other international SPK transplant units standards.
- Pulmonary alveolar proteinosis: a rare pulmonary toxicity of sirolimus.Publication . PEDROSO, S.L.; Martins, La Salete; SOUSA, S.; REIS, A.; DIAS, L.; HENRIQUES, A.C.; SARMENTO, A.M.; CABRITA, A.Transpl Int. 2007 Mar;20(3):291-6. Pulmonary alveolar proteinosis: a rare pulmonary toxicity of sirolimus. Pedroso SL, Martins LS, Sousa S, Reis A, Dias L, Henriques AC, Sarmento AM, Cabrita A. Nephrology Department, Hospital Geral de Santo António, Porto, Portugal. sofiapedroso@sapo.pt Abstract The aim of our paper is to describe an unusual pulmonary toxicity of sirolimus (SRL) in a kidney transplant recipient. We present a 34-year-old woman with a second renal transplantation, complicated with steroid-resistant acute rejection and chronic allograft dysfunction. Two years after initiating SRL, she presented complaints of progressive dyspnoea, nonproductive cough, chest pain and low-grade fever of 1 month duration. She had chronic allograft nephropathy and slight elevation of lactic dehydrogenase levels. After exclusion of common reasons of this condition, a computed tomography (CT) of the thorax and bronchoscopy was performed, revealing ground-glass opacification with polygonal shapes on CT and an opaque appearance with numerous macrophages on bronchoalveolar lavage. The alveolar macrophages stained positive by Periodic acid-Schiff. Diagnosis of pulmonary alveolar proteinosis (PAP) was made and drug-induced toxicity was suspected. SRL was withdrawn with marked improvement in the patients' clinical and radiological status. PAP resolved within 3 months without further therapy. PAP is a very rare complication of SRL therapy with only a few cases described. Withdrawal of SRL with conversion to another immunosuppressant seems to be an appropriate procedure in this condition. PMID: 17291222 [PubMed - indexed for MEDLINE
- Renal transplantation in patients over 60 years of age: a single‐center experience.Publication . PEDROSO, S.; Martins, La Salete; Fonseca, Isabel; DIAS, L.; HENRIQUES, A.C.; SARMENTO, A.M.; CABRITA, A.Transplant Proc. 2006 Jul-Aug;38(6):1885-9. Renal transplantation in patients over 60 years of age: a single-center experience. Pedroso S, Martins L, Fonseca I, Dias L, Henriques AC, Sarmento AM, Cabrita A. Nephrology and Transplant Departments, Hospital Geral de Santo António, Largo Professor Abel Salazar, 4050-011 Porto, Portugal. sofiapedroso@sapo.pt Abstract The prevalence of end-stage renal disease (ESRD) increases with advancing age. In most countries renal transplant recipients are getting older, too. Transplantation must be considered for ESRD patients older than 60 years; however, there are few data regarding outcomes in this population. We retrospectively reviewed the clinical course of recipients aged > or =60 years (n = 43) who underwent primary or repeated grafts from August 1988 to December 2004. We then compared recipient and donor characteristics as well as graft and patient survivals with recipients aged 18 to 59 years (n = 1058) who were transplanted during the same time. Donor age tended to be higher among the oldest recipient group (P < .001). Mean follow-up was significantly shorter in the group aged > or =60 years (P < .001), as our institution only recently has frequently accepted patients > or =60 years. Older recipients showed more frequent delayed graft function (P = .007), longer initial hospitalization (P = .005), and a significantly lower incidence of posttransplant acute rejection episodes (P = .015). Patient (P = .057), graft (P = .407), and death-censored graft (P = .649) survivals were not different between the two groups. Seven recipients aged > or =60 years died; the main cause of which was cardiovascular in origin. The loss of organs (n = 11) in the older patients was mainly due to death with a functioning kidney (54.5%). Our results confirm that renal transplant must be considered in selected patients older than 60 years as patient and graft survivals are similar to those of younger patients. PMID: 16908313 [PubMed - indexed for MEDLINE
- Impact Assessment in Living Kidney Donation: Psychosocial AspectsPublication . Frade, I.C.; Fonseca, Isabel; Dias, L.; Henriques, A.C.; Martins, La Salete; Santos, J.; Sarmento, M.; Lopes, A.ABSTRACT Background. Living donor kidney transplantation has positive influence on graft survival and recipient quality of life (QoL)We assessed the psychosocial impact of donation to the donor. Methods. Before and after the procedure 32 living kidney donors (mean age 41 years) completed the Zung Self-Rating Anxiety and Depression Scales; Sociodemographic, Short-Form 36 Health Survey (SF-36)and Donation Perceptions Questionnaire. Results. Living kidney donors were siblings (62.5%)parents (34.4%)or daughter (3.1%)Transplantation was not successful in two cases: one recipient death and one graft failure. No significant changes were observed in donor QoL except for the SF-36 social functioning subscale that showed significant improvement after donation (.038) reduction in depression symptom frequency was verified after donation (from 65.6% to 46.9%)There was an almost significant decrease in depression scores (.077)which was in fact was significant when one considered only successful transplants (.021)There was no significant variation in anxiety scores among donors. Time since transplantation was inversely correlated with overall anxiety (.443, .011)and with somatic anxiety subscales (.357, .045)For most donors, the decision to donate was easy and spontaneous. Nearly all donors would donate again and strongly encourage others to donate. Conclusions. Except for the social functioning scale that improved, no significant changes were observed in QoL of living kidney donors after the procedure. Depression scores significantly decreased after donation, but anxiety scores remained stable. Donors, who were mostly siblings, showed positive perceptions about donation, did not regret their decision, and strongly recommend it to others.
- Impact of hepatitis C virus on renal transplantation: association with poor survival.Publication . Pedroso, S.; Martins, La Salete; Fonseca, Isabel; Dias, L.; Henriques, A.C.; Sarmento, A.M.; Cabrita, A.Transplant Proc. 2006 Jul-Aug;38(6):1890-4. Impact of hepatitis C virus on renal transplantation: association with poor survival. Pedroso S, Martins L, Fonseca I, Dias L, Henriques AC, Sarmento AM, Cabrita A. Nephrology and Transplant Departments, Hospital Geral de Santo António, Largo Professor Abel Salazar, 4050-011 Porto, Portugal. sofiapedroso@sapo.pt Abstract Data concerning the effect of hepatitis C virus (HCV) infection on the long-term outcome of patient and allograft survival are conflicting. We performed a retrospective study including all renal transplant recipients who underwent the procedure at our center between July 1983 and December 2004. We compared HCV-positive (n = 155) versus HCV-negative (n = 1044) recipients for the prevalence of anti-HCV, patient/donor characteristics, and graft/patient survival. The prevalence of HCV-positive patients was 12%. The anti-HCV positive recipients displayed a longer time on dialysis (P < .001), more blood transfusions prior to transplant (P < .001), and a higher number of previous transplants (P < .001). There were no differences in the incidence of acute rejection between the two groups. Patient (P = .006) and graft survival (P = .012) were significantly lower in the HCV-positive than the HCV-negative group. Graft survival censored for patient death with a functioning kidney did not differ significantly between HCV-positive and HCV-negative recipients (P = .083). Death from infectious causes was significantly higher among the HCV-positive group (P = .014). We concluded that HCV infection had a significant detrimental impact on patient and renal allograft prognosis. Death from infectious causes was significantly more frequent among HCV-positive than the non-HCV population. PMID: 16908314 [PubMed - indexed for MEDLINE
- Impact of Homocysteinemia on Long-Term Renal Transplant SurvivalPublication . Fonseca, Isabel; Martins, La Salete; Queirós, J.; Mendonça, D.; Dias, L.; Sarmento, A.M.; Henriques, A.C.; Cabrita, A.Impact of Homocysteinemia on Long-Term Renal Transplant Survival I. Fonseca, L. Martins, J. Queirós, D. Mendonça, L. Dias, A.M. Sarmento, A.C. Henriques, and A. Cabrita ABSTRACT Aim. We prospectively followed cohort of 202 renal transplant recipients for years to examine the impact of fasting homocysteinemia on long-term patient and renal allograft survival. Methods. Cox proportional hazards regression analysis was used to identify independent predictors of all-cause mortality and graft loss. Results. Hyperhomocysteinemia (tHcy 15 mol/L) was present in 48.7% of the 202 patients, predominantly among men (55.8%as opposed to women (37.1%)At the end of the follow-up period, 13 (6.4%patients had died including 10 from cardiovascular disease, and 23 had (11.4%had lost their grafts. Patient death with functioning allograft was the most prevalent cause of graft loss (13 recipients)Levels of tHcy were higher among patients who died than among survivors (median 23.9 vs 14.3 mol/L; .005)Median tHcy concentration was also higher among the patients who had lost their allografts than those who did not (median 19.0 vs 14.1 mol/L; .001)In Cox regression model including gender, serum creatinine concentration, transplant duration, traditional cardio- vascular risk factors, and associated conditions, such as past cardiovascular disease, only tHcy concentration (ln) (HR 5.50; 95% CI, 1.56 to 19.36; .008) and age at transplantation (HR 1.07; 95% CI, 1.02 to 1.13; .01) were independent predictors of patient survival. After censoring data for patient death, tHcy concentration was not risk factor for graft loss. Conclusions. This prospective study shows that tHcy concentration is significant predictor of mortality, but not of graft loss, after censoring data for patient death.