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C Depasquale,
M L Pistorio,
D Corona,
A Mistretta,
D Zerbo,
N Sinagra,
A Giaquinta,
T Tallarita,
B Esker,
D Mociskyte,
A Leonardi,
R Gula, P Veroux,
M Veroux
[show abstract]
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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.
Transplantation Proceedings 09/2012; 44(7):1876-8. · 1.00 Impact Factor
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G Grosso,
D Corona,
A Mistretta,
D Zerbo,
N Sinagra,
A Giaquinta,
P Caglià,
C Amodeo,
A Leonardi,
R Gula, P Veroux,
M Veroux
[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.
Transplantation Proceedings 09/2012; 44(7):1864-8. · 1.00 Impact Factor
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G Grosso,
D Corona,
A Mistretta,
D Zerbo,
N Sinagra,
A Giaquinta,
S Cimino,
B Ekser,
G Giuffrida,
A Leonardi,
R Gula, P Veroux,
M Veroux
[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.
Transplantation Proceedings 09/2012; 44(7):1879-83. · 1.00 Impact Factor
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G Grosso,
D Corona,
A Mistretta,
D Zerbo,
N Sinagra,
A Giaquinta,
T Tallarita,
B Ekser,
A Leonardi,
R Gula, P Veroux,
M Veroux
[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.
Transplantation Proceedings 09/2012; 44(7):1859-63. · 1.00 Impact Factor
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[show abstract]
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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.
Transplantation Proceedings 09/2012; 44(7):1884-8. · 1.00 Impact Factor
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M Veroux,
D Corona,
B Ekser,
A Giaquinta,
T Tallarita,
C De Martino,
F Gentile,
C Virgilio,
M Gagliano, P Fiamingo,
P Veroux
[show abstract]
[hide abstract]
ABSTRACT: Hepatitis B virus core antibody (HBcAb)-positive organ donors have the potential to transmit infection to transplant recipients.
We investigated the use of a single dose of 2000 IU of hepatitis B immunoglobulin in 18 patients among a population of 54 kidney transplant recipients from HBcAb-positive deceased donors.
Twelve recipients were HBcAb-positive before transplantation. Among the other 42 patients, 5 (11.9%) seroconverted from HBcAb-negative to HBcAb-positive, whereas one HBcAb-positive recipient became hepatitis B virus surface antigen-positive with clinical signs of active hepatitis 6 years after transplantation. In the 18 patients who underwent prophylaxis, we did not find any seroconversion or hepatitis B virus (HBV) transmission. Graft and patient survival of HBcAb-positive kidney transplants did not differ significantly with a matched population of HBcAb-negative transplantation.
These results suggest that kidney transplantation from HBcAb-positive donors is safe with a low rate of HBV transmission. A prophylaxis with a single shot of hepatitis B immunoglobulin may be effective in reducing the risk of HBV seroconversion or reactivation and may be suggested in all naïve or HBcAb-positive transplant recipients.
Transplantation Proceedings 05/2011; 43(4):967-70. · 1.00 Impact Factor
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[show abstract]
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ABSTRACT: Enhancement of the subjective components, recognition of overall needs, and careful consideration of subjectively perceived quality of life among dialysis and/or transplanted patients appear to be key objectives to promote optimized adherence to treatment and active cooperation of the patient. This study explores the relationship between self-rated health among recipients of kidney transplantations from deceased marginal donors (age older than 55 years) in relation to gender, age, time on dialysis, years after transplantation, and donor age.
Posttransplant quality of life was assessed with the Complete Form Health Survey (SF-36) in 70 recipients of kidney transplantations from marginal deceased donors.
Donor age did not negatively influence health status perceived by the subjects. The vitality and mental health seemed to increase with greater donor ages, but the status of perceived health, vitality, social activities, and mental health were negatively influenced by the age of the transplant.
Our study shows that good general health and social well-functioning can be achieved also among recipients of organs from older donors. Thus, age alone should not be a barrier to organ donation, providing that the organ function is normal and that specific disease is absent in the organ.
Transplantation Proceedings 05/2011; 43(4):1045-7. · 1.00 Impact Factor
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[show abstract]
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ABSTRACT: The aim of this study was to compare values of apparent diffusion coefficient (ADC) and diffusion (D) with renal function indexes, in a population of kidney transplant recipients who underwent magnetic resonance with diffusion-weighted imaging (DWI) of the transplanted graft.
We studied 21 patients using a 1.5-Tesla magnetic resonance; DWI sequences were acquired with several b-values. Patients were divided into 3 groups by their creatinine clearance values: group A, clearance >60 mL/min; group B, clearance >30 and ≤60 mL/min; and group C, clearance ≤30 mL/min. ADCs values between groups were compared using the Mann-Whitney U test. Receiver operating characteristic (ROC) curves were created for prediction of normal renal function (group A) and renal failure (group C).
Comparing mean values of ADC between groups A and C, we observed a difference (P=0.0012), with higher values in group A. Regarding mean values of D, we observed a difference between groups A and C (P=0.022). In the comparison between contiguous groups, we observed no difference for ADC and D values. In the prediction of normal clearance values (group A), ROC curve showed an area under curve (AUC) of 0.861, with a sensitivity of 88.89% and specificity of 75% using a threshold ADC value ≥2.1 × 10(-3) mm(2)/sec. For prediction of normal clearance values (group A), ROC curve showed an AUC of 0.787, with a sensitivity of 77.8% and specificity of 83.3% using a threshold D value ≥2.3 × 10(-3) mm(2)/sec.
Although studies with a larger number of patients are needed, DWI represents a promising tool for noninvasive assessment of renal function. An ADC ≥ 2.1 × 10(-3) mm(2)/sec and a D ≥ 2.3 × 10(-3) mm(2)/sec may be used as a threshold for predicting normal clearance.
Transplantation Proceedings 05/2011; 43(4):960-6. · 1.00 Impact Factor
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Infection 01/2011; 39(1):83-5. · 2.66 Impact Factor
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[show abstract]
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ABSTRACT: To evaluate the incidence of sexual dysfunction and retrograde ejaculation after elective endovascular aneurysm repair (EVAR) and hand-assisted laparoscopic surgery (HALS) for abdominal aortic aneurysm (AAA).
A total of 100 patients eligible for elective repair of infrarenal AAAs were randomised in two groups: EVAR and HALS. The quality of sexual function was evaluated using the International Index of Erectile Function (IIEF), a 15-item questionnaire. Patients completed the IIEF preoperatively and at 12 months. The incidence of retrograde ejaculation was also evaluated.
One- and 12-month mortality rates were zero. Three patients in the EVAR group (6%) and two patients in the HALS group (4%) reported an erectile dysfunction (p = NS). The quality of sexual function at 1 year was similar in both groups: total score of 66 in the EVAR group versus 68 in the HALS group (p = 0.66). Retrograde ejaculation was detected in three cases in the HALS group versus no case in the EVAR group.
The HALS technique could be a minimally invasive alternative for sexually active males unsuitable for EVAR repair.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 07/2010; 40(1):71-5. · 2.92 Impact Factor
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ABSTRACT: N-acetyl-cysteine (NAC) is known to be a powerful antioxidant used to prevent renal damage. Our deceased-donor kidney transplantation protocol administered an NAC bolus at the time of declamping of the renal artery to reduce the potential oxidative damage with ischemia-reperfusion. The aim of injury this study was to compare the effects of NAC added to a continuous infusion of either fenoldopam or dopamine during kidney recipient anesthesia on mean arterial pressure (MAP) and end-tidal carbon dioxide (ECO(2)), which were assumed to be expressions of oxidative and acid-base status. One hundred forty patients undergoing deceased donor kidney transplantation were enrolled in the study. Using a standardized perioperative anesthesia protocol, the patients were divided into 4 groups: group N, receiving an NAC (50 mg/kg) bolus just before renal artery declamping (n = 40); group C, not receiving any NAC or other infusion (n = 20); group NF, same treatment as group N plus fenoldopam (0.1 microg/kg/min) continuous infusion (n = 40); and group ND, same treatment as group N plus dopamine (3 microg/kg/min) continuous infusion (n = 40). We recorded the duration of kidney cold and warm ischemia and EtCO(2) and MAP values before and after arterial declamping, as well as subjective evaluations of graft perfusion and the incidence of early or delayed graft function and adverse events. EtCO(2) was higher and MAP lower in group C compared with group N; comparing groups N, ND, and NF, the NF regimen resulted in lower EtCO(2) and higher MAP values and a greater incidence of early graft function. Subjective evaluation of graft perfusion was more favorable for groups N, ND, and NC, particularly for NF. No significant periprocedural adverse events were recorded in the groups. In our experience, the association of an NAC bolus at the time of renal artery declamping and continuous infusion of fenoldopam resulted in a minor, though non-significant, increase in EtCO(2) values, higher MAP, and greater incidence of early graft function during deceased-donor kidney transplantation compared with no NAC or NAC plus renal-dose dopamine. Further studies are necessary to better define the potential role of oxidative damage in renal ischemia- reperfusion injury, including implications for outcome, as well as the potential role of the combination of NAC plus fenoldopam as a nephroprotective and outcome-modulating regimen.
Transplantation Proceedings 05/2010; 42(4):1056-60. · 1.00 Impact Factor
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C De Pasquale,
M L Pistorio,
M Sorbello,
L Parrinello,
D Corona,
M Gagliano,
G Giuffrida,
A Giaquinta,
N Sinagra,
D Zerbo, P Veroux,
M Veroux
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ABSTRACT: INTRODUCTION: Psychologic disturbances are becoming more common in kidney transplantation, owing to effects of immunosuppressive therapy. In this study, we explored the incidence and specifity of psychopathology among kidney transplant patients. Twenty kidney transplant recipients underwent the Machover Draw-A-person test to detect significant variables (V1=V6) hypothetically related to chronologic age, education, years from transplantation, and gender differences. Emotional coarctation (V1) in the sense of "mental rigidity," "egocentrism," and "hypercontrol" were present in all transplant recipients (100%), followed by difficulty in interpersonal relationships (V3; 70%) and anxiety (V5; 70%). This research confirmed the hypothesis that transplantation can display a potential risk to the psychologic balance of the patient. Psychologic evaluation may be a fundamental step together with surgical aspects and management of immunosuppression to achieve well-being of kidney transplant recipients.
Transplantation Proceedings 05/2010; 42(4):1123-6. · 1.00 Impact Factor
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T Tallarita,
C Gurrieri,
A Cappellani,
D Corona,
M Gagliano,
G Giuffrida,
P Caglià,
P Fiamingo,
A Giaquinta,
N Sinagra,
D Zerbo,
G Virzì, P Veroux,
M Veroux
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ABSTRACT: Hemorrhoidal disease is a frequent cause of morbidity among the general population with a reported incidence of 4.4%, but little is known about its incidence and clinical features in kidney transplant recipients. Among 116 patients who had undergone kidney transplantation and were evaluated for hemorrhoidal disease, 82 had no hemorrhoids (70.6%), 28 (24%) had grade I hemorrhoids, and 6 (5.4%) had grade II hemorrhoids at the pretransplantation evaluation. Twenty-seven out of 116 recipients (22.4%) developed grade III or IV hemorrhoids after transplantation and underwent surgery. Hemorrhoidal disease was more frequent in patients with a pretransplantation history of hemorrhoids, with a rapid weight increase in the posttransplantation period, or who were aged between 30 and 50 years. Immunosuppressive therapy may play an important role in the worsening of hemorrhoidal disease among kidney transplant recipients. A prompt diagnosis and surgical treatment, whenever necessary, is mandatory for patients with clinical signs of worsening of hemorrhoids.
Transplantation Proceedings 05/2010; 42(4):1171-3. · 1.00 Impact Factor
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M Veroux,
D Corona,
V Scriffignano,
P Caglià,
M Gagliano,
G Giuffrida,
F Gona,
A Sciacca,
A Giaquinta,
S Oliveri,
N Sinagra,
T Tallarita,
D Zerbo,
M Sorbello,
L Parrinello, P Veroux
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ABSTRACT: Contamination of preservation fluid is common, with a reported incidence of 2.2% to 28.0%, and may be a major cause of early morbidity after transplantation. Herein, we report our experience with routine examination of preservation fluid collected just before implantation, focusing on the rate of contamination and the clinical consequences to recipients.
We analyzed 62 samples of preservation fluid for microbial and fungal contamination.
Twenty-four samples (38.7%) were contaminated with at least 1 organism. Bacterial contamination alone was observed in 18 samples; all patients received prophylactic treatment with intravenous piperacillin/tazobactam, 4.5 g/d for 10 days, without clinical sequelae. Six samples were contaminated with Candida species; all patients received prophylactic treatment with fluconazole, 100 mg/d for 3 months. One patient developed reversible acute renal failure due to ureteral obstruction by fungus balls at 30 days after transplantation.
Contamination of preservation fluid occurs frequently after kidney transplantation. Bacterial contamination evolved without symptoms in most patients treated with prophylactic antibiotic therapy. Fungal contamination may be potentially life-threatening. However, graft nephrectomy is not mandatory if the involved Candida species is identified correctly and appropriate antifungal therapy is rapidly prescribed.
Transplantation Proceedings 05/2010; 42(4):1043-5. · 1.00 Impact Factor
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Massimiliano Veroux,
D Corona,
G Giuffrida,
M Gagliano,
D Vizcarra,
T Tallarita,
D Zerbo,
A Giaquinta,
M Sorbello,
M Macarone, P Veroux
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ABSTRACT: Kidney transplantation is the best replacement therapy of type 2 diabetic patients and recently similar graft and patient survival between diabetic and nondiabetic recipients has been reported. However, standard immunosuppressive protocols are lacking. We present our experience with sirolimus-based immunosuppression in a population of 24 type 2 diabetic patients who underwent a kidney transplantation.
From January 2001 to December 2006, 396 kidney transplantations were performed. Twenty-four patients had type 2 diabetes mellitus as a cause of end-stage renal disease. They were randomized in two groups: thirteen patients (group A) received an immunosuppressive treatment with sirolimus, low-dose tacrolimus and steroids, while 11 patients (group B) received sirolimus, mycophenolate mofetil and steroids.
Clinical characteristics were similar between the two groups. A slightly better kidney functionality was observed in group B patients. There were neither acute rejection episodes nor severe infectious complications in both groups. One patient in each group underwent a foot amputation. Graft and patient survival was 100% for both groups at a median follow-up of 29 months.
Sirolimus-based immunosuppression is safe and efficacious in type 2 diabetic patients who underwent a kidney transplantation, allowing a better glucose metabolism control.
Urologia Internationalis 01/2010; 84(3):301-4. · 0.99 Impact Factor
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M Veroux,
G Giuffrida,
M Gagliano,
A Giaquinta,
T Tallarita,
M Sorbello,
D Corona,
D Zerbo,
D Vizcarra,
V Scriffignano,
M A Cannizzaro, P Veroux
[show abstract]
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ABSTRACT: Diagnosis of thyroid disease is fundamental in the evaluation of patients awaiting kidney transplantation. We analyzed the incidence of thyroid disease in patients with end-stage renal disease (ESRD) and evaluated its evolution before and after kidney transplantation.
Between January 2000 and May 2008, we evaluated 323 candidates for kidney transplantation. In all patients, serum concentrations of free triiodothyronine, free thyroxine, and thyroid-stimulating hormone were determined and a ultrasonography of the neck was performed. Patients with thyroid cancer were considered eligible for kidney transplantation after at least 2 years since treatment.
One-hundred-four patients with ESRD (44%) had functional or morphologic changes in the thyroid gland. Forty-one patients (17.4%) underwent fine-needle aspiration cytology; 3 demonstrated showed papillary carcinoma; 3, follicular adenomas; 8, uncertain cytologic lesions; and 27, a nodular goiter. Seventeen patients underwent surgery. Six of 11 patients with thyroid cancer underwent transplantation: two patients underwent laterocervical lymph node dissection because of local recurrence within 2 years after successful transplantation; the other 4 patients are alive with a functioning graft. Of the 184 transplant recipients, 10 underwent surgery to treat thyroid disease: 8 with multinodular goiter, 1 with micropapillary carcinoma, and 1 with follicular adenoma. All 10 patients are alive with a well-functioning graft and no signs of disease recurrence.
Thyroid diseases are common in patients with ESRD. Early diagnosis and treatment significantly decreased morbidity and mortality in patients awaiting transplantation.
Transplantation Proceedings 06/2009; 41(4):1142-4. · 1.00 Impact Factor
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ABSTRACT: Renal vein thrombosis (RVT) has an incidence of 0.55% to 3.4% and accounts for as many as one-third of early allograft losses. Rarely, RVT may be a consequence of an extension of ipsilateral iliac vein thrombosis. We present a rare case of iliocaval thrombosis as a consequence of inferior vena cava compression by a large-for-size kidney transplant.
A 20-year-old woman with spina bifida and kidney failure received a living donor kidney from her 52-year-old father. On postoperative day 8, the patient had right lower quadrant abdominal pain associated with oliguria. Graft duplex ultrasonography examination revealed venous thrombosis arising in the right femoral vein and extending to the iliac vein. An urgent second laparotomy was performed, and the kidney was finally placed in the peritoneal cavity.
The eventuality of an inferior vena cava compression by a transplanted kidney should be considered in any recipient with sudden leg swelling and acute graft dysfunction. An early diagnosis and prompt intervention may reduce the progression to RVT and subsequent graft nephrectomy. When planning a kidney transplantation with a supposed size discrepancy between donor and recipient, positioning the kidney on the left side or in the peritoneal cavity may be preferred.
Transplantation Proceedings 06/2009; 41(4):1405-6. · 1.00 Impact Factor
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A Mistretta,
M Veroux,
G Grosso,
F Contarino,
M Biondi,
G Giuffrida,
M Gagliano,
A Giaquinta,
D Zerbo,
T Tallarita,
D Corona, P Veroux
[show abstract]
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ABSTRACT: While deaths with a functioning graft have occurred more frequently in recent years, other nonimmunologic factors may have an important role in late allograft loss. These variables include socioeconomic and cultural status as risk factors for posttransplantation noncompliance with therapy. We examined the effect of socioeconomic and cultural status on graft and patient survival in a population of kidney transplant recipients.
This retrospective study included 223 kidney transplantations performed between September 2000 and December 2006.
A significant improvement in graft and recipient survival was observed with increased educational achievement level. Subjects with a high school diploma or college degree demonstrated significantly better outcome. Recipients who had attended intermediate or technical schools were also significantly more likely to have a better outcome than the lowest educational group. Using the lowest socioeconomic class as a reference, a proportional hazard model demonstrated statistically significant benefit for better outcome in patients with skilled occupations.
Results of the present study showed a significant difference in kidney transplantation outcome between different socioeconomic and educational classes. These results could help physicians to educate patients with end-stage renal disease to better understand long-term recovery after transplantation.
Transplantation Proceedings 06/2009; 41(4):1162-7. · 1.00 Impact Factor
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M Veroux,
D Corona,
G Scalia,
V Garozzo,
M Gagliano,
G Giuffrida,
C M Costanzo,
A Giaquinta,
I Palermo,
D Zappalà,
T Tallarita,
D Zerbo,
R Russo,
A Cappellani,
C Franchina,
V Scriffignano, P Veroux
[show abstract]
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ABSTRACT: Development of cancer after transplantation has rapidly became one of the leading causes of death in kidney transplant recipients with functioning grafts. Anogenital malignant neoplasms may occur with a 14-fold increased incidence, and human papilloma virus (HPV) infection has been recently identified as the leading cause of cervical carcinoma. We report the preliminary findings of a prospective study that evaluated the incidence of HPV infection and cervical carcinoma in a population of kidney transplant recipients.
The study included 35 female recipients of a deceased donor kidney with at least 6 months of follow-up. All patients underwent a cervicovaginal brushing, an HPV DNA test, and a Papanicolaou test.
Twenty-two patients (62.8%) were positive for HPV DNA. Thirteen of 22 HPV DNA-positive recipients (59%) demonstrated a high-risk HPV genotype. No cytologic anomalies were detected in Papanicolaou smears.
These preliminary data demonstrated a high incidence of HPV infection in renal transplant recipients. Most of our recipients exhibited a high-risk HPV genotype, which suggests higher aggressiveness of such infection in immunosuppressed patients. The HPV test is useful to monitor patients at higher risk of anogenital malignant neoplasms by identifying the cytologic anomalies at an earlier stage. This ongoing study will investigate the rate of progression of HPV infection and the clinical patterns of HPV-positive cytologic anomalies in renal transplant recipients.
Transplantation Proceedings 06/2009; 41(4):1191-4. · 1.00 Impact Factor
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M Sorbello,
A Paratore,
G Morello,
M Tindaro Sidoti,
D Rinzivillo,
C Molino,
C Di Tommaso,
L Parrinello, P Veroux,
D Corona,
G Giuffrida,
D Zerbo,
M Veroux
[show abstract]
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ABSTRACT: The objective of this study was to evaluate the efficacy of an analgesic regimen based on levobupivacaine continuous infusion into the surgical wound of living kidney donors (LKDs).
Fifty adult LKDs (mean age, 53.1 +/- 5.3 years; age range, 52-68 years) were retrospectively assigned to a no wound infusion (NWI) group (n = 25) or a wound infusion (WI) group (n = 25). At the end of surgery, patients in the WI group received 10 mg intramuscular morphine; a peridural catheter was placed 10 cm between the intercostal muscles fibers close to the lower rib extremity, and a solution of levobupivacaine, 150 mg/100 mL, was started at 5 ml/h(-1). Patients in the NWI group received intramuscular morphine, 10 mg, every 8 hours; intravenous tramadole, 100 mg, was planned as a rescue drug for incidental pain. Pain was measured using a visual analog scale (VAS) ranging from 1 (no pain) to 10 (maximum pain) in both the basal condition (VASb) and during coughing (VASc) at 1 hour after leaving the operating room and 6, 12, and 24 hours thereafter.
At 1, 6, 12, and 24 hours, VASb values in the NWI vs the WI group were 5.2 vs 3.1, 6.8 vs 4.1, 5.8 vs 4.9 (all p < .01), and 5.4 vs 5.1, respectively, and VASc values were 8.2 vs 6.3, 8.8 vs 5.9, 7.1 vs 5.3, and 6.8 vs 5.1 (all p < .01). Mean VAS score was significantly higher between 1 and 6 hours in the NWI group for all VASb measurements vs VASc values. Tramadole consumption was higher in the NWI group than in the WI group.
Continuous wound infusion with 5 mL/h(-1) levobupivacaine, 1.5 mg/mL(-1), resulted in a safe and effective analgesic protocol in LKDs both in the immediate postoperative period and in the first day after surgery, a result that was more effective than a morphine-tramadole regimen. No adverse effects were recorded, which confirmed the safety of the technique. It is probable that better results could be achieved with dedicated administration devices.
Transplantation Proceedings 05/2009; 41(4):1128-31. · 1.00 Impact Factor
