[show abstract][hide abstract] ABSTRACT: This study explored the personality characteristic traits within a sample of renal transplant patients, seeking to obtain predictive index for likely clinical impacts.
The personality study was performed using the Structured Clinical Interview Axis II Personality Disorders for Diagnostic and Statistical Manual of Mental Disorders fourth edition, text revision in 60 recipients of kidney transplantations from deceased donors.
The personality trait that prevailed in the female gender was borderline, while in the male gender it appeared to be predominantly obsessive-compulsive personality trait.
The personality study proved to be a good index to predict effects on the level of social adjustment. In this way, patients who have shown pathologic personality traits can be identified early to provide adequate psychologic-psychiatric support and follow-up.
[show abstract][hide abstract] ABSTRACT: The aim of our study was to analyze, from a psychological point of view, living kidney donor personality, examining a sample of 18 living kidney donors.
The personality study was performed using The Millon Clinical Multiaxial Inventory-III in 18 potential kidney donors, 6 of whom were genetically and 12 emotionally related individuals.
Our study showed the presence of narcissistic, histrionic, and obsessive-compulsive personality traits in living kidney donors.
It is necessary to explore the development of motivation for living donation in order to achieve and maintain a harmonious relationship with the recipient while respecting their individuality.
[show abstract][hide abstract] ABSTRACT: Organ transplantation has progressively established itself as the preferred therapy for many end-stage organ failures. However, many of these chronic diseases and their treatments can negatively affect nutritional status, leading to malnutrition and mineral deficiencies.
Nutritional status is an important determinant of the clinical outcome of kidney transplant recipients. Malnutrition and obesity may represent a contraindication to transplantation in many cases and may increase the risk of postoperative complications after the transplantation. Nutritional support in kidney transplant recipients is challenging, since it must take into account the pre-transplant nutritional status, the side effects of immunosuppression, the function of the transplanted graft, the presence of infection, and the general status of the patient at the time of the transplantation.
With these considerations in mind, we reviewed current literature on the impact of nutritional status on the outcome of kidney transplantation.
The International journal of artificial organs 08/2013; · 1.76 Impact Factor
[show abstract][hide abstract] ABSTRACT: New-onset diabetes mellitus after transplantation (NODAT) may complicate 2-50% of kidney transplantation, and it is associated with reduced graft and patient survivals. In this retrospective study, we applied a conversion protocol to sirolimus in a cohort of kidney transplant recipients with NODAT. Among 344 kidney transplant recipients, 29 patients developed a NODAT (6.6%) and continued with a reduced dose of calcineurin inhibitors (CNI) (8 patients, Group A) or were converted to sirolimus (SIR) (21 patients, Group B). NODAT resolved in 37.5% and in 80% patients in Group A and Group B, respectively. In Group A, patient and graft survivals were 100% and 75%, respectively, not significantly different from Group B (83.4% and 68%, resp., P = 0.847). Graft function improved after conversion to sirolimus therapy: serum creatinine was 1.8 ± 0.7 mg/dL at the time of conversion and 1.6 ± 0.4 mg/dL five years after conversion to sirolimus therapy (P < 0.05), while in the group of patients remaining with a reduced dose of CNI, serum creatinine was 1.7 ± 0.6 mg/dL at the time of conversion and 1.65 ± 0.6 mg/dL at five-year followup (P = 0.732). This study demonstrated that the conversion from CNI to SIR in patients could improve significantly the metabolic parameters of patients with NODAT, without increasing the risk of acute graft rejection.
Clinical and Developmental Immunology 01/2013; 2013:496974. · 3.06 Impact Factor
[show abstract][hide abstract] ABSTRACT: Evaluation of: Cohen EE, Wu K, Hartford C et al. Phase I studies of sirolimus alone or in combination with pharmacokinetic modulators in advanced cancer patients. Clin. Cancer. Res. 18(17), 4785-4793 (2012). The mTOR pathway mediates many biologic functions such as transcriptional and translational control, and is a target for anticancer drug development. mTOR inhibitors, such as sirolimus (SRL), display immunosuppressive and antiproliferative properties, and the use of SRL in kidney transplant recipients reduces the risk of post-transplant cancer. However, its use in advanced cancer patients has not been fully evaluated. The authors review the study by Cohen et al., evaluating the dose for oral, weekly SRL alone or in combination with grapefruit juice or ketoconazole to achieve the desired whole-blood concentration with antitumoral activity. This study demonstrates that SRL can be feasibly administered orally once weekly and displays a similar pharmacokinetic profile compared with other mTOR inhibitors. This study encouraged the use of SRL in advanced cancer patients and can stimulate clinical trials with a larger number of patients, evaluating the role of SRL as a new targeted therapy in cancer patients.
[show abstract][hide abstract] ABSTRACT: Multiple factors have been described among the causes of non-hereditary colorectal cancer. In Western countries, the most common risk factors include upper-middle socioeconomic status and dietary regimens rich in proteins and animal fats. High consumption of red meats, smoked foods, cold cuts, or canned foods is believed to contribute to carcinogenesis as they directly affect epithlial turnover and cause metabolism of biliary acids. Dietary fibers have protective effects in that they capture the fats and biliary acids, thereby inhibiting their activity. Tobacco smoking acts both locally and systemically on the colorectal mucosa through the production of carcinogenic agents. Finally, the action of alcohol, in association with nicotine addiction, also increases the risk of developing colorectal tumors. Knowledge of dietary and environmental factors is of paramount importance in implementing preventive strategies for colorectal cancer.
Frontiers in Bioscience 01/2013; 18:190-8. · 3.29 Impact Factor
[show abstract][hide abstract] ABSTRACT: Purpose
To investigate an examiner-independent catheter venography protocol that could be used to reliably diagnose venous outflow abnormalities in patients with multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency and to determine whether venous angioplasty is effective in the treatment of these abnormalities.
Materials and Methods
A total of 313 patients with MS and 12 patients with end-stage renal disease underwent echo-color Doppler sonography and catheter venography of the internal jugular veins (IJVs) to evaluate contrast medium clearance time. In patients with venous outflow anomalies, balloon angioplasty of the IJVs was performed.
A contrast medium clearance time cutoff value of 4 seconds or less provided the maximal combination of sensitivity and specificity for the right IJV (sensitivity, 73.4%; specificity, 100%) and left IJV (sensitivity, 91.4%; specificity, 100%). IJVs with a clearance time between 4.1 and 6 seconds had moderate delayed flow (MDF), and IJVs with a clearance time longer than 6 seconds had severe delayed flow (SDF); 89% of patients showed MDF/SDF through at least one IJV, 79% showed MDF/SDF through both IJVs, and only 5% showed normal flow in both IJVs. Balloon angioplasty was immediately able to improve flow in at least one IJV in 69% of patients, but venous flow was normalized in both veins in only 37% of patients; SDF persisted after angioplasty in 32% of patients.
There is a high prevalence of abnormal delayed flow through IJVs in patients with MS. Venous angioplasty was effective in only a minority of patients with SDF.
Journal of vascular and interventional radiology: JVIR 01/2013; 24(12):1790–1797. · 1.81 Impact Factor
[show abstract][hide abstract] ABSTRACT: PURPOSE: The purpose of this study was to evaluate the effect of primary balloon angioplasty (PBA) of cephalic veins with diameter ≤2 mm on patency and maturation time of autogenous radiocephalic arteriovenous fistulae (AVF) for hemodialysis. METHODS: Forty patients, all candidates for distal AVF, with a cephalic vein ≤2 mm, were randomized to two different surgical procedures: (1) PBA of a long segment of the cephalic vein from the wrist up to the elbow (n = 19); and (2) hydrostatic dilatation (HD) of a short venous segment (5 cm) at the level of the anastomosis (n = 21). PBA was performed using a standard balloon 4 × 150 mm. Primary end points were primary patency and reintervention rates. Secondary end points were maturation time and the rate of working AVF. Follow-up included physical and duplex ultrasound (DUS) examinations at 1,4, and 8 weeks, and every 3 months thereafter. RESULTS: Risk factors were homogeneously distributed between the two groups. Mean vein diameter was 1.8 ± 0.2 mm for the PBA group and 1.7 ± 0.2 mm for HD. Immediate success rate was 100% for PBA and 67% for HD groups (P = .04). Causes of failure in the HD group included early vein thrombosis in seven patients (33%). Mean fistula maturation time was 32 days in the PBA group and 55 days in the HD group (P = .04). During the mean follow-up of 7 months, three patients underwent drug-eluting balloon angioplasty for failure of AVF to mature due to stenosis (1 in the PBA group and 2 in the HD group). Six-month reintervention rate was significantly lower in the PBA group (5%) compared with the HD group (43%) (P = .02). At 6 months, primary patency rates were 95% in the PBA group and 57% in the HD group (P = .01). Working AVF rate was 100% in the PBA vs 90% in the HD group. CONCLUSIONS: PBA of very small cephalic veins during the creation of a distal AVF for hemodialysis is a safe and feasible procedure. This technique assures excellent primary patency, maturation time, and dramatically decreases reintervention rate.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 11/2012; · 3.52 Impact Factor
[show abstract][hide abstract] ABSTRACT: There are still many controversies about the impact of delayed graft function (DGF) on kidney transplantation outcome. The aims of this study were to define factors associated with DGF and to ascertain the relative impact of DGF on kidney transplantation outcome, both in the early postoperative period and in long-term follow-up.
Four hundred kidney transplant recipients were reviewed to assess the clinical impact of DGF on long-term outcome.
The overall prevalence of DGF was 24.3%. DGF was significantly associated with increasing recipient and donor age, duration of dialysis, and cold ischemia time. Patients with DGF displayed a significantly worse graft (P = .005) and patient (P < .001) survival compared with recipients with immediate function.
DGF is a frequent complication of renal transplantation and may be associated with a reduced graft and even patient survival. Strategies to prevent graft injury and, more specifically, DGF may be an important clue to provide a better long-term outcome in kidney transplantation.
[show abstract][hide abstract] ABSTRACT: We compared values of apparent diffusion coefficient (ADC) with renal function indices among a population of kidney transplant recipients who underwent magnetic resonance with diffusion-weighted imaging (DWI) of their grafts.
Thirty-five patients with right iliac transplanted kidneys were studied using 1.5-T magnetic resonance. Diffusion echo-planar sequences with several b-values were acquired to investigate transplanted grafts. Patients were divided into 3 groups according to their creatinine clearances; Group A, clearance >60 mL/min; Group B, clearance >30 and ≤60 mL/min; and Group C, clearance ≤30 mL/min. ADC values between groups were compared using Mann-Whitney U test. Receiver operating characteristic (ROC) curves were used to predict the normal function (Group A) versus renal failure cohorts (Group C).
Comparing mean values of ADC between Group A and Group C patients, we observed a significant difference (P = .0003) with higher ADC values among patients with a normal creatinine clearance (>60 mL/min). Comparing Groups B and C did not show a significant difference (P = .05); nor did Group A and Group B reveal a significant difference (P = .38). To predict normal clearance values, the Group A ROC curve showed an area under curve (AUC) of 0.780 with a sensitivity of 92.3% and a specificity of 68.2% at a threshold ADC value of ≥2.08 × 10(-3) mm(2)/sec. In the prediction of low clearance values, the Group C ROC curve showed an AUC of 0.846 with a sensitivity of 83.3% and a specificity of 82.6% using a threshold ADC value of ≤2.07 × 10(-3) mm(2)/sec.
Updating our experience among 35 patients, DWI was confirmed to be a promising noninvasive tool to assess renal function; an ADC ≥2.08 × 10(-3) mm(2)/sec may be used as a threshold to predict a normal clearance. However, an overlap of ADC values between groups is a limit.
[show abstract][hide abstract] ABSTRACT: The loss of renal function and urination with dialysis can produce a strong emotional crisis in a patient. This study explored the correlation between psychic symptoms and quality of life among hemodialysis patients who were older than 55 years of age in relation to demographic characteristics of age, time on dialysis, and education.
Twenty patients undergoing hemodialysis were included in the study. The psychic symptoms were studied using the Symptom Checklist-90. Revised (SCL-90 R) and the quality of life was studied using the Complete Form Health Survey (SF 36).
The high correlation between psychological sizes investigated through the SCL-90 R test and those for the SF-36 test confirmed the close relationship between physical disorders and mental suffering, and reduced vitality, and lack of socialization.
The psychiatrist and psychologist may help hemodialysis patients to improve their quality of life by providing new coping strategies for each of the family, occupational, and social network.
[show abstract][hide abstract] ABSTRACT: Nonimmunologic factors have been recently implicated in worse outcomes after kidney transplantation, producing a need to predict the operative risk among kidney recipients. We assessed the predictive value of the Charlson comorbidity index (CCI) among kidney transplant recipients.
A retrospective study of 223 first deceased-donor kidney transplantations performed from 2000 to 2007 evaluated the role of comorbidities.
About 50% of recipients displayed >1 comorbid condition before transplantation; the most frequently reported was diabetes mellitus. Increasing CCI scores significantly affected graft and patient survivals. Crude analysis showed a significant association between CCI >1 and risk of death (hazard ratio [HR], 3.87; 95% confidence interval [CI], 1.06-14.06; P = .04). After adjustment for several covariates, high CCI values remained significantly predictive of posttransplantation outcomes with a HR for death of (12.53; 95% CI, 1.9-82.68; P = .009).
Our predictive model showed a strong association of CCI and patient survival even after adjustment for several clinical covariates. CCI may be used to evaluate patients referred for kidney transplantation who display a significant burden of comorbid conditions that increase the risk of premature death or graft loss.
[show abstract][hide abstract] ABSTRACT: The number of obese kidney transplant candidates has been growing. However, there are conflicting results regarding to the effect of obesity on kidney transplantation outcome. The aim of this study was to investigate the association between the body mass index (BMI) and graft survival by using continuous versus categoric BMI values as an independent risk factor in renal transplantation.
We retrospectively reviewed 376 kidney transplant recipients to evaluate graft and patient survivals between normal-weight, overweight, and obese patients at the time of transplantation, considering BMI as a categoric variable.
Obese patients were more likely to be male and older than normal-weight recipients (P = .021; P = .002; respectively). Graft loss was significantly higher among obese compared with nonobese recipients. Obese patients displayed significantly lower survival compared with nonobese subjects at 1 year (76.9% vs 35.3%; P = .024) and 3 years (46.2% vs 11.8%; P = .035).
Obesity may represent an independent risk factor for graft loss and patient death. Careful patient selection with pretransplantation weight reduction is mandatory to reduce the rate of early posttransplantation complications and to improve long-term outcomes.
[show abstract][hide abstract] ABSTRACT: The increasing demand of organ donors to supply the increasing number of patients on kidney waiting list, has led most of the transplant centers to develop protocols that allow safe utilization from donors with special clinical situation, which heretofore were regarded as contraindication. Deceased donors with previous hepatitis may represent a safe resource to expand the donor pool. When allocated to serology-matched recipients, kidney transplantation from donors with hepatitis may result in excellent short term outcome. However, many concerns may arise in the long term outcome, and studies must be addressed to the evaluation of the progression of liver disease and to the rate of reactivation of liver disease in the recipients. An accurate selection of both donor and recipient is mandatory to achieve a satisfactory long term outcome.
[show abstract][hide abstract] ABSTRACT: Gastrointestinal (GI) complications may affect up to 64% of kidney transplant recipients, with a higher incidence of symptoms in patients receiving tacrolimus-based immunosuppression. Tacrolimus extended release once-daily (OD) formulation offers the benefit of OD administration over standard tacrolimus, with a similar rate of GI complications when compared with the standard tacrolimus. We hypothesized that patients with tacrolimus-based immunosuppressive regimen with posttransplant gastrointestinal symptoms may benefit from a conversion to a tacrolimus OD regimen.
In this pilot study, 27 kidney transplant recipients with tacrolimus-related GI complications were converted to a tacrolimus OD regimen (group 1). This group was compared with a historical cohort of 30 patients on standard tacrolimus therapy with GI symptoms (group 2). Patients were followed up for 1 year after initial enrollment.
Patients in group 1 reported a significant improvement in GI symptoms, as expressed by the change in the Gastrointestinal Symptom Rating Scale scores (1.7±0.3 vs. 1.2±0.2, P<0.001) and GI-specific health-related quality of life scores (87±26.3 vs. 97±24.6, P<0.05). After comparing changes in Gastrointestinal Symptom Rating Scale total scores and subscale scores at 12 months, patients in Group 1 scored better than patients in Group 2 in total scores (-0.5 vs. -0.12, P<0.0001), abdominal pain (P<0.001), diarrhea (P<0.001), and reflux (P=0.013).
Preliminary results from this study demonstrate that kidney transplant recipients experiencing tacrolimus-induced GI symptoms may benefit from a conversion to a tacrolimus OD regimen.
[show abstract][hide abstract] ABSTRACT: Chronic cerebrospinal venous insufficiency (CCSVI) has been associated to multiple sclerosis (MS).
To evaluate the possible association between CCSVI and MS, using a population-based control design.
A random cohort of 148 incident MS patients were enrolled in the study. We have also studied 20 patients with clinically isolated syndrome (CIS), 40 patients with other neurological diseases (OND), and 172 healthy controls. Transcranial (TCC) and Echo Color Doppler (ECD) were carried out in 380 subjects. A subject was considered CCSVI positive if ≥2 venous hemodynamic criteria were fulfilled.
CCSVI was present in 28 (18.9%) of the MS patients, in 2 (10%) of CIS patients, in 11 (6.4%) of the controls, and in 2 (5%) of the OND patients. A significant association between MS and CCSVI was found with an odds ratio of 3.41 (95% confidence interval 1.63-7.13; p = 0.001). CCSVI was significantly more frequent among MS subjects with a disease duration longer than 144 months (26.1% versus 12.6% of patients with duration shorter than 144 months; p = 0.03) and among patients with secondary progressive (SP) and primary progressive (PP) forms (30.2% and 29.4, respectively) than in patients with relapsing remitting (RR) MS (14.3%). A stronger association was found considering SP and PP forms (age adjusted OR = 4.7; 95% CI 1.83-12.0, p = 0.001); the association was weaker with the RR patients (age adjusted OR = 2.58; 95%CI 1.12-5.92; p = 0.02) or not significant in CIS group (age adjusted OR = 2.04; 95%CI 0.40-10.3; p = 0.4).
A higher frequency of CCSVI has been found in MS patients; it was more evident in patients with advanced MS, suggesting that CCSVI could be related to MS disability.
PLoS ONE 01/2012; 7(8):e41227. · 3.73 Impact Factor