M Arbelaez

Hospital Universitario de San Vicente Fundación, Medellín, Antioquia, Colombia

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Publications (18)42.87 Total impact

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    ABSTRACT: Incidence and risk factors for cytomegalovirus (CMV) disease in a Colombian cohort of kidney transplant recipients. CMV infection and disease are important causes of morbidity and mortality in kidney transplant recipients, and its prevalence varies with economic, geographic, and ethnic factors. Among 1620 records from a Colombian reference center, CMV immunoglobulin (Ig)G seroprevalence was found to be 90.9% among recipients and 90.2% among donors. In 86% (n = 264) of the cases, CMV disease occurred during the first 6 months after the transplantation, and the most frequent clinical presentation was CMV syndrome, followed by gastrointestinal disease. The following parameters were independent predictors of CMV disease: serological status of D+/R+ (hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.03–2.63) and D+/R− (HR, 2.72; 95% CI, 1.49–4.93), age of the recipient (HR, 1.02; 95% CI, 1.01–1.03), and receiving more than 30 mg of prednisolone by the end of the first month after transplantation (HR, 1.59; 95% CI, 1.22–2.07). Acyclovir prophylaxis or other antiviral agents significantly decreased the risk of disease (HR, 0.41; 95% CI, 0.29–0.58 and HR, 0.34; 95% CI, 0.20–0.58, respectively). In conclusion, we found a high prevalence of CMV infection in a cohort of Latin American transplant recipients. In accord with findings from other regions, serological status is the main risk factor, prophylaxis with acyclovir is effective, and induction with alemtuzumab does not increase the risk of CMV disease.
    Transplantation Proceedings 01/2014; 46(1):160–166. · 0.95 Impact Factor
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    ABSTRACT: BACKGROUND: Elderly patients are the fastest growing population requiring renal replacement therapy. It has been stated that renal transplantation may be the best treatment option for these patients. However, it has been observed that older patients have a higher mortality rate than those who are younger. Yet the factors that determine post-transplantation outcomes in this population remain poorly defined. The aims of this study were to evaluate the graft and patient survival in kidney transplant recipients who are older than 60 years of age to identify relevant predictive factors. METHODS: In this population-based retrospective cohort study of 201 kidney transplantations performed in elderly patients from January 2002 throughout June 2009, we estimated the 1-,3-,and 5-year patients and graft survival rates. We also evaluated the complications and the predictors of poor outcomes. Survival times were analyzed using the Kaplan-Meier method and survival differences assessed with Mantel-Cox log rank-test. We performed a Cox proportional hazards regression models to evaluate the impact of baseline and treatment characteristics on patient and graft survival. RESULTS: Graft and patient survival rates at 1, 3, and 5 years were 76.4%, 71.3%, and 54.3%, and 78.2%, 73.8%, and 56.4%, respectively. Graft survival rates censored for patient death with a functioning graft were 93.1, 92.1, and 89%. Patient survival rates differed between diabetic and nondiabetic subjects at 1, 3 and 5 years (69.5% versus 83.6%; 59.8% versus 72.3%; 43.6% versus 65.7%; P = .008). On multivariate analysis, the factors associated with patients survival were diabetes mellitus (hazard ratio [HR] 2.058, 95% confidence interval [CI] 1.173-3.611, P = .012) and the 1-month serum creatinine value was > 1.6 mg/dL (HR 2.108 for each point increase, 95% CI 1.521-2.921, P = .000). Furthermore, there was an insignificant trend forward an association between active or past smoker and lower patient survival (HR 1.689, 95% CI 0.937-3.043, P = .08). The main causes of graft loss were patient death (79.5%). acute rejection (6.8%), and chronic allograft nephropathy (5.5%). CONCLUSION: Renal transplantation can be performed safely and with acceptable outcomes in elderly patients after appropriate clinical evaluation. The grafts show excellent survival albeit that deaths with a functional graft continue to be an important issue.
    Transplantation Proceedings 05/2013; 45(4):1402-1409. · 0.95 Impact Factor
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    ABSTRACT: Epidemiological data provide useful information for clinical practice and investigations. This study aimed to determine glomerular disease frequencies in a region of Colombia and it represents the basis for future studies. Single-center retrospective analysis at the University of Antioquia, Colombia. All native renal biopsies (July 1998 to December 2007) were reviewed, but only glomerular diseases were analyzed. The diagnosis of each case was based on histological, immunopathological and clinical features. A total of 1,040 biopsies were included. In 302 cases (29.0%), the patient's age was <or= 15 years. Primary glomerular diseases were diagnosed in 828 biopsies (79.6%) and secondary in 212 (20.4%). The most common primary diseases were focal and segmental glomerulosclerosis (FSGS) (34.8%), immunoglobulin A (IgA) nephropathy (IgAN) (11.8%), membranous glomerulonephritis (MGN) (10.6%), minimal change disease (MCD) (10.6%), crescentic glomerulonephritis (GN) (5.6%), and non-IgA mesangial proliferative GN (5.6%). Postinfectious GN represented 10.7% of the diagnoses if included as primary GN. Lupus nephritis corresponded to 17.8% of the entire series. In adults, the order of the most frequent primary diseases was: FSGS, IgAN, MGN, crescentic GN and MCD. In children (<or= 15 years), the most frequent were: FSGS, postinfectious GN, MCD, non-IgA mesangial proliferative GN, endocapillary diffuse GN and IgAN. As among Afro-Americans, FSGS is the most frequent type of glomerulopathy in our population, but in our group, there are more cases of IgAN. The reasons for these findings are unclear. This information is an important contribution towards understanding the prevalence of renal diseases in Latin America.
    São Paulo medical journal = Revista paulista de medicina 01/2009; 127(3):140-4. · 0.75 Impact Factor
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    ABSTRACT: Cytomegalovirus (CMV) is the most common viral infection affecting transplant patients, but urinary tract involvement has been rare. Only a few cases of symptomatic ureteritis have been reported in renal transplant recipients. In previous reports the presentation of CMV ureteritis is obstructive nephropathy, often in the absence of systemic illness, or rarely it may also mimic allograft rejection with minimal obstructive symptoms. We describe an additional case of CMV ureteritis in a patient with cutaneous ureterostomy. The unusual clinical presentation with urinary infection symptoms and ureterostomy stoma ulceration constitute a very particular presentation. The increasing report cases with CMV ureteritis suggest an increase of this post-transplant complication.
    Actas urologicas españolas 06/2008; 32(6):649-52. · 1.14 Impact Factor
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    ABSTRACT: Cytomegalovirus (CMV) is the most common viral infection affecting transplant patients, but urinary tract involvement has been rare. Only a few cases of symptomatic ureteritis have been reported in renal transplant recipients. In previous reports the presentation of CMV ureteritis is obstructive nephropathy, often in the absence of systemic illness, or rarely it may also mimic allograft rejection with minimal obstructive symptoms. We describe an additional case of CMV ureteritis in a patient with cutaneous ureterostomy. The unusual clinical presentation with urinary infection symptoms and ureterostomy stoma ulceration constitute a very particular presentation. The increasing report cases with CMV ureteritis suggest an increase of this post-transplant complication
    Actas urologicas españolas 01/2008; 32(6). · 1.14 Impact Factor
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    ABSTRACT: In the present study, we investigated whether pretransplantation HLA class I and class II antibodies and pretransplantation levels of soluble CD30 (sCD30) and IgA anti-Fab autoantibodies are predictive of kidney allograft survival. Pretransplantation sera of 504 deceased-donor kidney recipients were tested for IgG HLA class I and class II antibodies, sCD30, and IgA anti-Fab levels using the CTS 4 ELISA kit. Kidney graft survival was estimated by Kaplan-Meier method and multivariate Cox regression. Regardless of the presence of HLA class II antibodies, recipients with high HLA class I reactivity had lower 1-year graft survival than recipients with low reactivity (p < 0.01). Recipients with high sCD30 had lower 5-year graft survival rate than those with low sCD30 (p < 0.01). The sCD30 effect was observed in presensitized and nonsensitized recipients, demonstrated a synergistic effect with HLA class I antibodies (p < 0.001), and appeared to be neutralized in recipients with no HLA class II mismatches. IgA anti-Fab did not influence kidney graft survival. Our results indicate that high pretransplantation sCD30 levels and HLA class I positivity increase the risk of kidney graft loss regardless of other factors. Consequently, such determinations should be routinely performed to estimate recipients' risks of graft rejection before transplantation.
    Human Immunology 08/2007; 68(8):652-60. · 2.30 Impact Factor
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    ABSTRACT: Hepatitis C virus (HCV) infection is highly prevalent in renal transplant candidates; however, its effect on the transplant outcome is still controversial. The aim of the present study was to determine the effect of HCV infection in the outcome of kidney transplantation in a single transplant center. The study population 144 HCV- randomized selected patients and 64 HCV+ patients transplanted from 1973 to 2000, followed for up to 60 months post-transplantation. This retrospective study included the following variables: type of dialysis, time on renal replacement therapy, number of transfusions before and after transplantation, number of transplants, type of donor, immunosuppression, and rejection episodes. The Kaplan-Meier method was used to estimate graft and patient survival. Log-rank test was used to assess the difference in survival between HCV+ and HCV-. A multivariate Cox proportional hazards model was used to analyze the relation between graft and patient survival. HCV+ and HCV- patients had similar demographic and clinical characteristics; however, a higher number of HCV+ patients received blood transfusions after transplantation. Patient survival was not significantly different in 39 HCV+ and 96 HCV- patients transplanted with living-related donors (71% and 77% at five yr, respectively). Similarly, there was not significant difference in 25 HCV+ and 48 HCV- patients transplanted with kidneys from deceased donors, although there was a tendency to better outcome in HCV- patients (55% and 72% at five yr respectively). Regarding graft survival, there was also no differences in HCV+ and HCV- recipients of living-related grafts (61% and 66% at five yr post-transplant, respectively) and recipients of kidneys from deceased donors (44% and 41%, respectively). The results show that HCV+ patients can be transplanted with the same success than HCV- patients.
    Clinical Transplantation 01/2007; 22(1):16-9. · 1.63 Impact Factor
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    ABSTRACT: We described a case of allograft kidney dysfunction associated with renal parenchymal infection with amastigotes of Trypanosoma cruzi. The patient was diagnosed as being chronically infected prior to transplantation. The infection was probably acquired by blood transfusion. He could not complete antiparasitic treatment due to drug toxicity. He was transplanted from a cadaver who showed a negative test for Chagas' disease. One year after transplantation the serum creatinine progressively increased. Histological examination of renal biopsy revealed intracytoplasmic amastigotes of T cruzi. No evidence of other specific alterations in the graft was detected. It was unknown whether graft dysfunction was only due to parasitic infection. The present case confirmed that T cruzi can infect kidney grafts and that immunosuppression in kidney transplantation is potentially a cause of dissemination of Chagas' disease.
    Transplantation Proceedings 05/2006; 38(3):885-7. · 0.95 Impact Factor
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    ABSTRACT: The mechanisms underlying long-term acceptance of kidney allografts in humans under minimal or no maintenance immunosuppression are poorly understood. We analyzed the T-cell receptor (TCR) repertoires in circulating T cells of patients with long-term (> or = 9 years) renal allograft survival with (LTS-IS) and without immunosuppression (LTS-NoIS). T cells of LTS patients exhibited strongly altered TCR Vss usage, including an increased frequency of oligoclonality and a decreased frequency of polyclonality. All 3 LTS-NoIS and 12 of 16 LTS-IS patients demonstrated oligoclonality in at least three or more TCR V beta families, and the frequency of oligoclonality in these patients was significantly higher as compared to patients with well-functioning grafts at 3 years (p < 0.005 both), an uncomplicated course during the first year (p < 0.0001, both), acute rejection (p < 0.0001, both), chronic allograft nephropathy at 7 (p < 0.0001, both) or 13 years (p < 0.0001, both), dialysis patients (p < 0.0001, both) or healthy controls (p < 0.0001, both). In contrast to LTS patients, all other studied patient groups exhibited a polyclonal TCR repertoire. Our data indicate that TCR alteration is a common feature of long-term allograft outcome, which might be explained by clonal deletion, exhaustion of alloreactive T cells or predominant expression of particular T-cell subpopulations, such as regulatory T cells.
    American Journal of Transplantation 04/2005; 5(4 Pt 1):746-56. · 6.19 Impact Factor
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    ABSTRACT: Patients with long-term functioning organ allografts may have developed different mechanisms that explain the lack of graft rejection. However, it is not known how these mechanisms interplay or whether one of them predominates in such situations. The authors analyzed the expression of T-cell surface molecules involved in alloantigen recognition, signal transduction, co-stimulation, and activation markers on circulating T cells from patients with normal kidney function 10 or more years after transplantation, short-term survival (1-4 years), and chronic rejection and from healthy adults. The percentage and the median fluorescent intensity of each marker were determined by flow cytometry. Proliferative response against specific and third-party donors and mitogenic stimulation were also determined. Peripheral blood lymphocytes from patients with long-term surviving kidneys had decreased expression of T-cell receptor (TCR)-alphabeta (P < 0.01), CD3epsilon (P < 0.05), and CD3 zeta-chains (P < 0.001); diminished percentages of CD4(+)CD28(+) (P < 0.001) cells; and increased expression of CTLA-4(+) (P < 0.01) on CD3(+) cells. CD4(+)CD25(+)CD69(+) cells were also increased in long-term surviving patients. Long-term surviving patients had decreased donor-specific proliferative responses. The decreased expression of TCR-alphabeta and epsilon- and zeta-chains on circulating T cells of long-term surviving patients suggests that these cells may have defects in alloantigen recognition or signal transduction that may result in decreased numbers of T cells expressing co-stimulatory molecules and activation markers as well as a decreased specific proliferative response. The decrease in the percentage of CD28(+) cells and the increase in CD4(+)CD25(+)CD69(+) cells suggest that regulatory mechanisms of the immune response are still active in such patients.
    Transplantation 11/2004; 78(10):1541-7. · 3.78 Impact Factor
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    ABSTRACT: The purpose of our study was to evaluate short- and long-term results of transplants from cadaver donors who have died of poisoning by various substances. The actuarial survival rate of organs from intoxicated donors was calculated using the Kaplan-Meier method. Among the 507 donors between January 1998 and December 2002, 5 (0.98%) had a cause of brain death of poisoning, namely, organo-phosphates (n = 2), methanol (n = 1), cyanide (n = 1) and acetylsalicilic acid(n = 1), from whom were procured 10 kidneys, 1 liver, 2 corneas, and 1 set of bones. The follow up for patients receiving solid organs was 15.2 months (range, 0-48 months). At 3 months, 90% of kidneys had normal function. No delayed graft function rejection episodes or major complications were reported in any recipient. None showed evidence of acute or chronic poisoning. Two died, 1 early mortality was due to anesthetic complications and the other at 17 months to an unknown cause. Actuarial kidney survival rates were 90% and 80% at 12 and 24 months, respectively. The liver recipient was well at the end of follow up. Using organs of poisoned donors is feasible with comparable graft survival rates to other recipient.
    Transplantation Proceedings 01/2004; 36(6):1632-3. · 0.95 Impact Factor
  • Transplantation Proceedings 01/1993; 24(6):3096-7. · 0.95 Impact Factor
  • Transplantation Proceedings 05/1991; 23(2):1744-6. · 0.95 Impact Factor
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    ABSTRACT: One-year graft survival of 54 first cadaveric kidney transplants that received immunosuppressive treatment with CsA was analyzed with respect to the number of random pretransplant blood transfusions and the HLA class 1 and class 2 matching. Overall graft survival at 1 year was 80.7%. Patients with 3 to 20 pretransplant transfusions had a survival of 93.7% compared with 66.7% in those with less than three or more than 20 transfusions. All kidneys transplanted with two or less HLA-A + B mismatches survived at 1 year. With three mismatched antigens survival was of 88.9%. This value was reduced to 66.7% for four incompatibilities. A similar situation was found for HLA-DR matching since all kidneys with full compatibility survived at 1 year compared with 90.9% and 66.7% for one and two mismatches, respectively. HLA-B and HLA-DR exhibited an additive effect since again all grafts with two or less mismatches survived, whereas in the group with three different antigens this figure was 90% and only 1 of the three kidneys with completely different antigens survived.
    Transplantation Proceedings 09/1988; 20(4):715-9. · 0.95 Impact Factor
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    Annals of internal medicine 03/1986; 104(2):210-1. · 13.98 Impact Factor
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    ABSTRACT: Two renal allograft recipients who had received their organs from the same cadaver donor developed acute toxoplasmosis shortly after transplantation. Neither of the recipients had serologic evidence of previous exposure to Toxoplasma gondii at the time of surgery, but the donor had a positive indirect fluorescent antibody test. One of the recipients died during the fourth week, and multiorgan involvement with toxoplasmosis was demonstrated at autopsy. No evidence of the parasite could be found in the transplanted kidney. In the second recipient the disease was suspected, serologically demonstrated, and successfully treated. We concluded that toxoplasmosis was transmitted by the donor's kidneys, although this mode of transmission was not completely proven.
    American Journal of Kidney Diseases 06/1983; 2(6):615-7. · 5.29 Impact Factor
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    ABSTRACT: Se revisaron 159 pacientes de sexo femenino con trasplante renal en la Unidad Renal del Hospital U. San Vicente de Paúl, en un período que va desde agosto de 1973 hasta junio de 1987, con el fin de evaluar la frecuencia y el pronóstico del embarazo. Se presentaron siete embarazos en seis mujeres de 76 candidatas potenciales, cuyos resultados fueron así: tres operaciones cesáreas a causa de ruptura precoz de las membranas, un parto vaginal y tres abortos. Una paciente presentó rechazo del injerto durante el tercer trimestre del embarazo. La inmunoterapia no tuvo ningún efecto deletéreo sobre los fetos. Aunque el número de pacientes es pequeño para sacar conclusiones definitivas, se puede afirmar que no hubo aumento del riesgo sobre el injerto en aquellas pacientes embarazadas con función renal estable después de injerto renal. INTRODUCCION Se sabe que la falla renal crónica interfiere con la reproducción; sinembargo, cuando esta es co-rregida con el trasplante renal, la capacidad de reproducción mejora (1, 2). Este aumento en la capacidad reproductiva se presenta aun en pacien-tes con bajos niveles de estrógenos (3), las cuales al mismo tiempo tienen una alta incidencia de pre-maturidad (4). Dos situaciones contradictorias ocurren entre las mujeres con trasplante durante la edad repro-ductiva: sienten la necesidad de llegar a ser ma-Dr. Jorge Luis Arango: Profesor, Deparlamento de Medicina Interna, Sec-ción de Nefrología, Universidad de Antioquia; Dr. J.Caicedo: Profesor Aso-ciado; Dr. M. Arbeláez: Profesor; Dr. J.Henao, Profesor Asociado; Dr. G. Me-jía: Profesor; Dr. A. García: Profesor Asistente; Dr. M. Builes: Profesor Aso-ciado, Departamento de Medicina Interna, Universidad de Antioquia.

Publication Stats

99 Citations
42.87 Total Impact Points

Institutions

  • 2006–2014
    • Hospital Universitario de San Vicente Fundación
      Medellín, Antioquia, Colombia
  • 2013
    • Hospital Pablo Tobon Uribe
      Medellín, Antioquia, Colombia
  • 1988–2009
    • University of Antioquia
      • • Departamento de Patología
      • • Facultad de Medicina
      Antioquia, Departamento de Antioquia, Colombia