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Fratila, Liana M. "Renal transplant outcome assessment /." free to MU campus, to others for purchase, 2004. http://wwwlib.umi.com/cr/mo/fullcit?p1421135.
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Wicht, Jonathan H. "Renal Transplant Survey: how standardised is a standard kidney transplant?" Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24507.
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Aim: The primary intention of the current study was to discover if there are international standards in renal transplantation. Method: A questionnaire was created using an online survey tool (Qualtrics ®), and distributed to a list of email addresses supplied by the unit's senior transplant surgeon. A literature review was performed on the questions and on the history of transplantation. Ethics was approved by FHS HREC number 193/2015. Results: A total of 30 surveys were completed from a total of 147 emails sent (20.4%). Two thirds of respondents work exclusively in the public sector and almost two-thirds (63.3%) of the respondents had been involved in transplantation for over 10 years. Two thirds of the surgeons estimate that their units perform more than 60 transplants per annum. Only 30% (9/30) use living donors in more than 50% of their surgeries. Most (53.3%) perfuse the kidneys both in the donor (in situ) and outside (ex situ or ex vivo). If no anatomic abnormalities were noted in open living donor nephrectomy, 63.3% would prefer to use the left kidney, and the recipient transplantation would be performed on the right side (76.7%). The majority (90%) of surgeons would preserve the vas deferens, but sacrifice the round ligament and inferior epigastric vessels (76.7% and 80% respectively). There is no marked difference for use of either the internal or external iliac artery for the arterial anastomosis, but most use the external iliac vein for venous anastomosis (86.7%). 80% use a ureteroneocystostomy with a tunnel, and 60% use a DJ stent or ureteric catheter and closed suction drain routinely. Two thirds would remove the transurethral catheter on day 4-7 post operatively. 80% routinely biopsy the kidney, and 63.3% would biopsy prior to treating for possible acute renal rejection. Discussion: These results compare with some of the studies found in the literature and operative textbooks. There do appear to be standards noted between most of the respondent's answers. Conclusion: There do appear to be standards for renal transplantation and these are appreciated globally.
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Moreno, Maria Fernanda Costa Henriques. "Adesão terapêutica em doentes submetidos a transplante hepático e renal." Master's thesis, Universidade Nova de Lisboa. Escola Nacional de Saúde Pública, 2012. http://hdl.handle.net/10362/9707.
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RESUMO - Introdução - A não adesão à terapêutica nos doentes transplantados foi identificada em diversos estudos e constitui um fator preditivo de morbilidade e mortalidade. Como em Portugal não existe um conhecimento aprofundado sobre os comportamentos de não adesão nos doentes transplantados, este estudo tem como objetivo a avaliação da adesão terapêutica nos doentes submetidos a transplante hepático e renal e a identificação de fatores associados à não adesão.
Metodologia - Foi elaborado e aplicado um questionário a uma amostra de doentes com mais de 18 anos submetidos a transplante renal ou hepático há mais de seis meses. Foi analisada a associação entre o comportamento de não adesão e fatores relacionados com o doente, condição, terapêutica e acesso aos serviços de saúde.
Resultados - Dos 75 inquiridos, 60% eram doentes transplantados de fígado e 40% transplantados renais, com uma média de 48 anos e maioritariamente do sexo masculino (65,3%). Entre os inquiridos, verificou-se que 44% admitiu ter tido um comportamento de não adesão aos medicamentos prescritos. Os doentes que reportaram comportamento de não adesão tinham uma média de idades de 44 anos, possuíam como escolaridade o ensino secundário ou curso profissional, trabalhavam ou estudavam, tomavam menos de oito comprimidos por dia e tinham sido transplantados há mais de 5 anos.
Adicionalmente, verificou-se que a dieta (28,8%), o exercício físico (33,3%) e o deixar de fumar (10,7%) são as indicações dadas pelos profissionais de saúde que os doentes referiram ter mais dificuldade em cumprir.
Conclusão - Com este estudo esperamos ter contribuído para aumentar o conhecimento sobre a adesão à terapêutica nos doentes transplantados, o qual deve ser aprofundado para permitir o desenvolvimento de estratégias efetivas de melhoria da adesão aos planos terapêuticos.ABSTRACT - Introduction - Treatment non adherence in transplant patients has been identified in numerous studies and is a predictive factor of morbidity and mortality in these patients. As the knowledge about the behaviors of non-adherence in transplant patients in Portugal is not very extensive this study aims to assess the treatment adherence in patients undergone liver and kidney transplantation as well as the identification of factors associated with non adherence. Methodology - A questionnaire was developed and applied to a sample of patients with more than 18 years who undergone kidney or liver transplantation, more than six months ago. It was also analyzed the association between non adherent behavior and patient-related factors, condition, treatment and access to healthcare services. Results - Out of 75 respondents, 60% were liver transplant patients and 40% were kidney transplant recipients, with an average age of 48 years and mostly male (65,3%). Amongst the respondents, 44% admitted having had already a non adherent behaviour to prescribed medications. Patients, who reported non adherent behaviour, had an average age of 44 years, secondary education or professional course, worked or studied, took less than eight pills a day and had been transplanted more than 5 years ago. Additionally it was found that the diet (28.8%), exercise (33.3%) and smoking cessation (10.7%) stand as the indications given by healthcare professionals that patients reported having more difficulty to adhere. Conclusion - With this study we hope to have contributed to increase knowledge about treatment adherence in transplant patients in Portugal, which must be deepened in order to allow the development of effective strategies to improve adherence to treatment plans in these patients.
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Gupta, Ajay. "Viral studies in renal transplant recipients." Thesis, University of Newcastle Upon Tyne, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.519564.
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Hopcraft, LucyAnn. "Neutrophil dysfunction in renal transplant patients." Thesis, University of Liverpool, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.539559.
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Rigatto, Claudio. "Cardiac disease in renal transplant recipients /." St. John's, NF : [s.n.], 2001.
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Farmer, Christopher Kenneth Trafford. "Corticosteroid withdrawal in renal transplant recipients." Thesis, King's College London (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.415155.
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Pereira, Ana Luísa Melo Dias. "Lesões orais em doentes transplantados." Master's thesis, [s.n.], 2015. http://hdl.handle.net/10284/5043.
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Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina DentáriaOs doentes transplantados são pacientes que cada vez mais nos surgem no consultório dentário e tal deve-se aos grandes avanços que se tem desenvolvido nesta última década quer nas técnicas cirúrgicas, quer nas terapêuticas medicamentosas usadas para evitar uma eventual rejeição do transplante. E é devido ao aumento da sua afluência, mas também por ser um tema pouco referido e no qual ainda é necessário realizar mais estudos, que neste trabalho se pretende retratar quais as lesões orais associadas aos transplantes realizados mais comummente, podendo eles ser do tipo cardíaco, hepático, renal ou de células hematopoiéticas. Tem ainda como objetivo descrever quais as manifestações clínicas das diferentes lesões, quais os sintomas que o paciente apresenta e como as tratar, mas também quais os melhores métodos para ajudar na prevenção destas mesmas. Contudo existe uma carência de protocolos definidos, por isso esta monografia pretende também sugerir alguns, com base em diferentes e variadas propostas feitas por vários autores ao longo desta última década. Este trabalho resume-se à ideia de que é necessário intervir na saúde oral dos pacientes com transplantes, não só para lhes melhorar o dia-a-dia e diminuir as suas comorbilidades, mas também para prevenir e evitar que se iniciem tais transtornos. Transplant patients are patients who increasingly emerge in the dental office and this is due to the great progress that has been developed over the last decade both in surgical techniques and in drug therapies used to prevent a possible rejection of the transplant. It is due to their increased affluence - and with this being a rarely mentioned issue still needing further studies - that this work is intended to portray what oral lesions associated with transplants performed more commonly, them being from the heart, liver, kidney or hematopoietic cells. It is also my goal to describe the clinical manifestations of different lesions and the symptoms of the patient and and how to treat them, but also what are the best methods to help prevent them. However, there is a lack of defined protocols, so this monograph also aims to suggest some, based on different proposals made by several authors over the last decade. This work comes down to the idea that it is necessary to interfere in the oral health of patients with transplants, not only for their everyday lives and decrease their comorbidities, but also to prevent and avoid the start of such disorders.
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Chapman, J. R. "Humoral sensitization of potential renal transplant recipients." Thesis, University of Cambridge, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.597471.
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Sharma, Rajan. "Cardiac risk stratification in renal transplant recipients." Thesis, St George's, University of London, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.423132.
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Alfonzo, Annette. "Donor specific hyporesponsiveness in renal transplant recipients." Thesis, University of Edinburgh, 2005. http://hdl.handle.net/1842/27068.
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A phenomenon called donor-specific hyporesponsiveness (DSH) has been described in some renal allograft recipients, in which there is progressive loss of responsiveness to donor tissues and this has been shown to be associated with a favourable long-term outcome. Despite its potential clinical importance, the mechanisms of DSH are unknown and there are no laboratory tests that accurately predict its development in individual patients which might allow the reduction of immunosuppressive therapy. Here I test the hypothesis that renal allograft recipients with DSH can be identified by analysis of the mixed lymphocyte reactivity in-vitro and that this state will be accompanied by the production of inhibitory cytokines such as IL-10 and TGF-β. The study comprised 78 patients from a single centre, 60 of whom were studied retrospectively and 18 prospectively over a one-year period. DSH was detected by donor specific mixed lymphocyte reactions and cytokine production was analysed by ELISA and PCR. Overall, DSH was found in 61% of cadaveric and 57% of livingrelated recipients in the retrospective cohort and in 36% of cadaveric and 25% of living-related recipients at one year post-transplant in the prospective cohort. DSH was associated with a lower incidence of late acute rejection in cadaveric and livingrelated recipients in both arms of the study. Chronic rejection was found in some patients, even in the presence of DSH, indicating that DSH is not exclusive to patients with a good allograft outcome. DSH correlated with a good graft outcome in long-term cadaveric recipients and was associated with low donor-specific IL-2 and high IL-4 production. Similarly, good graft outcome and DSH was associated with a trend towards low donor-specific IL-2 and high IL-4 production within the first year post-transplant. However, in long-term living-related recipients, DSH did not correlate with graft outcome and was associated only with low IL-2 production. A sub-group of cadaveric recipients with a de-novo solid organ malignancy shared many similar clinical and immunological features with their counterparts who did not have malignancy. This included good graft outcome, low acute rejection rate and a high incidence of DSH. Patients with malignancy produced low levels of IL-2, but also produced high levels of IL-10. However, there was no evidence of immune regulation mediated by IL-10 or TGF-β in any part of the study. My results suggest that it may be possible to select patients for tailoring of immunosuppression on the basis of detection of DSH, together with the production of a favourable cytokine profile at one year post-transplant. Potential candidates include cadaveric recipients with stable graft function who show DSH and produce four-fold higher levels of donor-specific IL-4 than IL-2, as well as HLA-ID living-related recipients with stable graft function who produce low levels of donor-specific IL-2.
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Blackhall, Melanie L. "Effects of antioxidant supplementation in renal transplant patients /." [St. Lucia, Qld.], 2005. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe19022.pdf.
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Willicombe, Michelle. "Donor specific HLA antibodies and renal transplant outcomes." Thesis, Imperial College London, 2012. http://hdl.handle.net/10044/1/10113.
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Despite the use of potent modern immunosuppressive agents chronic rejection remains the leading cause of allograft failure after renal transplant. Historically T cells were considered to be the main pivot of rejection mechanisms; however, over the past decade the key role of B cells in allograft rejection has been much more fully described. Antibody mediated rejection [AMR] was first classified as a distinct entity in the Banff histological classification of allograft pathology as late as 2001. This was a consequence of the demonstration of the complement split product C4d in renal allografts giving indirect evidence of humoral injury, along with the development of newer assays to detect circulating HLA donor specific antibodies [DSAs]; both of which were subsequently shown to be associated with reduced allograft survival. The development of solid phase technologies, in particular single antigen beads has introduced a readily available assay which can detect HLA DSA with high sensitivity and specificity. The benefit of routine application of such assays in renal transplantation is not known and is the principal question of this thesis; that is to establish if the detection of HLA DSAs will help in predicting rejection and allograft loss. Patients transplanted at Imperial College Renal and Transplant Centre were recruited into the studies. The underlying hypothesis is that donor specific antibodies identified by the more recently developed techniques are associated with inferior allograft survival, addressed in several related studies as follows: 1. Is C4d staining with no morphological features of rejection associated with risk of subsequent AMR and allograft loss? 2. Are preformed DSA detected by single antigen beads in the setting of a negative crossmatch associated with inferior allograft survival? 3. What is the relevance of de novo DSAs after renal transplantation? 4. What is the clinical significance of DQ DSA and should consideration be given to DQ mismatching in deceased organ allocation? 5. Do outcomes in patients with ACR with a humoral component differ when compared to those with pure ACR when treated in a uniform manner? A summary of the results is as follows: 1. C4d in the absence of histological features is not associated with AMR. However, patients with acute tubular injury who have DSA are at risk of subsequent AMR. 2. Patients with preformed DSA are at significant risk of AMR and allograft loss and as such antibodies detected by single antigen beads alone pre-transplant should be considered a relative contraindication to transplantation. 3. Patients who develop de novo DSA are at risk of AMR, transplant glomerulopathy [TG] and allograft failure. Routine testing for the detection of DSA may allow the potential to augment immunosuppression in order to improve outcomes. 4. DQ DSA are the most common DSA detected after transplant and are associated with inferior allograft outcomes. Patients mismatched at both DR and DQ alleles are at risk of developing DQ DSA. Algorithms incorporating the level of DQ mismatch might reduce DQ DSA formation and therefore improve long term allograft survival. 5. Patients with ACR with a humoral element are at risk of subsequent AMR, TG and graft failure. Such patients might benefit from more aggressive therapies than those targeted at ACR alone.
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Ramsay, Helen Mary. "Non-melanoma skin cancer in renal transplant recipients." Thesis, University of Birmingham, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.408971.
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Cranston, D. "Experimental renal transplantation in the rat : Studies on renal allograft survival by pretreatment with donor antigen." Thesis, University of Oxford, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.375225.
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Buijsch, Robert op den. "Pharmacokinetics and pharmacogenetics of tacrolimus in renal transplant patients." Maastricht : Maastricht : Universitaire Pers Maastricht ; University Library, Universiteit Maastricht [host], 2007. http://arno.unimaas.nl/show.cgi?fid=9445.
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Bordea, Cristina. "Skin cancers in renal transplant recipients : epidemiology and pathogenesis." Thesis, University of Oxford, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.270244.
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Saundh, Baljit Kaur. "The association between human polyomaviruses and renal transplant rejection." Thesis, University of Leeds, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.550340.
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Although much is known about human polyomaviruses, there is a paucity of knowledge of polyomavirus infections in renal transplant recipients (RTPs), particularly those given steroid sparing regimens and transmission of polyomaviruses. BK polyomavirus associated nephropathy (PVAN) is an uncommon complication causing graft failure post transplantation. The role of other polyomaviruses JC, Simian Virus 40, WU, KI and Merkel cell (MCV) is unclear. A prospective longitudinal study was carried out of 112 RTPs given steroid sparing regimens to investigate the presence of polyomaviruses. A second prospective study was undertaken of respiratory samples (n = 1640) submitted for the investigation of respiratory infection. The prevalence and dynamics of polyomavirus infections was studied using real-time multiplex PCR assays, antibody assays using recombinant virus-like particles and sequencing for virus typing and investigation of viral variation. There was no significant difference in prevalence for BKV and JCV infections in RTPs between the control and study treatment groups. Overall, 33% of RTPs were positive for BK viruria, of which 10.7% developed viraemia and 1.8% of these progressed to PVAN; 13.3% were positive for JCV infection and 2.7% for MCV. All samples were negative for SV40, WUV and KIV. No dual BKV and JCV infections were observed, although 8% of RTPs had dual BKV and CMV infection and 3.6% had dual JCV and CMV. There were no variations observed in the NCCR of RTPs with PVAN but duplications were observed during a BKV and JCV infection. Both BKV and JCV infections were acquired early post transplantation, molecular epidemiological studies suggested these were of donor origin. In the second study of children and adults with respiratory symptoms 3.6% were positive for WUV infection, 2.74% for KIV, 0.91 % for MCV and 0.18% for BKV infection. Epidemiology suggests a causative role for WUV but not KIV in respiratory disease.
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Robinson, Steven John. "New onset diabetes after transplantation in renal transplant recipients." Thesis, University of Bristol, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.559093.
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Background New Onset Diabetes After Transplantation (NODAT) is an important complication of renal transplantation associated with decreased graft and patient survival. This study aimed to validate established physiological measures of glucose homeostasis in the renal transplant population and use these techniques to establish the range of glucose handling in patients pre-transplant and the impact of transplantation on glucose handling. The main impact of NODAT is an increase in cardiovascular risk. Cardiovascular assessments were therefore performed in all patients in parallel with assessments of glucose homeostasis. Patients and Methods The study involved two distinct cohorts of patients: Patients identified retrospectively by an electronic database and a prospective cohort of patients on the live kidney donor waiting list whom were in the final stages of work-up for listing for a date for surgery. The retrospective cohort were analysed to establish epidemiological factors that predict NODAT and determine the natural history of NODAT in patients treated at our unit. A sub-group of this cohort was those who appeared to have recovered from NODAT on the basis of measurement of fasting plasma glucose, random plasma glucose or HbA1c. These patients underwent an oral glucose tolerance test (OGTT) to verify their diabetes status and perform the Homeostasis Model Assessment (HOMA) to estimate their beta cell function (%8) and insulin sensitivity (%S). The prospective cohort underwent an OGTT before transplant (n=18). 12 of the cohort also underwent a euglycaemic hyperinsulinaemic clamp study and 5 an arginine intravenous glucose tolerance test. Repeat testing was performed at 3 months. Finally cardiovascular assessment was performed in all patients by measurement of augmentation index and mean arterial blood pressure. Results The retrospective analysis of 306 consecutive renal transplants over 3 years demonstrated age at time of transplant and family history of diabetes to be predictors of development of NODA T. Also 10 of 12 individuals thought to have resolved from NODAT as judged by random and fasting glucose measurement and off hypoglycaemic and insulin treatment were shown to still have abnormal glucose handling, 8 were still diabetic as judged by a OGTT. Within the LKD cohort (n=18) the pre-transplant OGTT demonstrated 4 participants to have IGT and 2 participants to have diabetes. Glucose disposal rate (GDR) fell Significantly from pre to post transplant. Discussion This study has shown that insulin resistance is increased at three months post live donor kidney transplant. There was a trend also for pancreatic beta cell function to decline. Cardiovascular risk factors were shown to have not changed by three months. Our long-term objective is to create an algorithm that will enable clinicians to define the overall individual risk of developing NODAT. This will result in more rigorous surveillance of the individual and, with development of novel regimens, tailoring of post-transplant immunosuppression to ensure optimum protection from rejection and avoid the significant cardiovascular morbidity and mortality associated with developing diabetes. Resolution of NODAT should be based solely on an OGTT and long term surveillance offered as part of the graft follow-up. ii.
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Cairns, Jasmin. "Immunosuppressants and the renal transplant recipient : factors affecting adherence." Thesis, University of Manchester, 2012. https://www.research.manchester.ac.uk/portal/en/theses/immunosuppressants-and-the-renal-transplant-recipient-factors-affecting-adherence(c9be2ef8-6b8c-45ee-9061-057c93cbab49).html.
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In renal transplantation, immunosuppressants are prescribed to patients to prevent graft loss. Although the extent of adherence required for such treatment to prevent graft loss has not been determined, it is thought to be high. Despite this, research suggests adherence rates for renal transplant recipients to be only between 50% and 95%. Considering the impact of graft loss on the renal patient, the national healthcare budget and on the limited resource of donor organs, it is important to identify and understand factors that contribute to nonadherence, and thereafter to address those that are most influential. This thesis seeks to understand adherence of renal transplant recipients, and to identify the cognitive and behavioural factors influencing this behaviour. To achieve this, three main activities were performed, a literature review, an interview study and a questionnaire study, the methods and findings of which are presented following an overview of two social cognition models, used in two of the activities, and renal disease. The first activity, a comprehensive literature review, identified 55 research articles that explored factors influencing adherence of renal transplant recipients to immunosuppressant drug therapy. It included original research studies published between 1980 and 2009, and was updated in 2011. The findings were categorised into the five dimensional framework suggested by the World Health Organisation: patient- related factors; socio-economic factors; condition-related factors; therapy-related factors; and healthcare team and system-related factors. Secondly, a semi-structured interview study with 27 renal transplant recipients was conducted. The study explored their attitude towards and behaviours related to taking immunosuppressants. The interview schedule was informed by the health belief model, and framework analysis of the data identified five key themes. These were: satisfaction with renal replacement therapy; the importance of taking immunosuppressants; perception of side effects and risks; responding to side effects and risks; and 'compliance is routine'. Finally, a questionnaire was developed using the theory of planned behaviour and the findings of the previous two activities. Its purpose was to determine the predictors of renal transplant recipients' self-reported adherence and to explain their adherence. A logistic regression model of 528 survey responses suggested respondents were more likely to be highly adherent if they, in descending order of influence: had well- established habits; were unemployed; had a better prospective memory; were a shorter time post-transplantation; had higher levels of anticipated affect; and lower levels of perceived behavioural control. The thesis concludes with discussing the findings of the studies, their strengths and limitations, and their implications for practice and future research. The findings of this thesis suggest unintentional nonadherence to prevail and encourage the development of interventions which promote habit formation and maintenance.
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Morton, David. "Epstein-Barr virus infection in adult renal transplant recipients." Thesis, University of Manchester, 2013. https://www.research.manchester.ac.uk/portal/en/theses/epsteinbarr-virus-infection-in-adult-renal-transplant-recipients(bc856b34-7164-45e5-8a64-71693a104912).html.
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Aims: To explore the clinical significance of EBV infection in adult renal transplant recipients when detected in the late post-transplant period. Methods: (1) A prospective observational study recruiting 499 stable adult kidney transplant recipients with serial blood sampling for EBV DNAemia and assessment of clinical outcomes and associated factors. (2) A retrospective analysis of PTLD incidence, timing and outcomes in relation to EBV infection. Results: EBV DNAemia in stable kidney transplant recipients is common, found in 46% of recruited individuals screened over 1 year, with persistent DNAemia seen in 10%. DNAemia prevalence increased significantly with time from transplant (p<0.0001) from 16% within 1 year of transplant to 66% in those transplanted for 20-24 years. High baseline DNA levels predicted persistence of DNAemia. Time adjusted analyses showed significant association of DNAemia with EBV seronegative status and previous PTLD and low DNAemia rates with Mycophenolate Mofetil (MMF) use and lymphopenia. The mechanism did not appear to be directly linked to MMF induced B cell depletion. Chronic high viral load detection was significantly associated with time from transplant, EBV seronegative status at transplant, ciclosporin use and plasma detection of DNA. No significant differences in overall patient survival at 3 years, clinical symptoms or clinical findings such as anaemia, thrombocytopenia or rate of decline in renal function were seen between stable transplant recipients with and without EBV DNAemia. PTLD incidence also increases with time from transplant and was greatest during the 10th-14th post-transplant years. Disease was EBV positive in 68% cases. No statistically significant differences in overall patient survival, or overall disease complete response rates were seen in relation to recipient EBV serostatus or EBV status of PTLD histology. Conclusions: EBV DNAemia prevalence increases with time from transplant but was not associated with worse patient or graft survival or specific symptoms. PTLD incidence including EBV negative disease also increases with time from transplant but response rates and survival were not influenced by EBV serostatus or histological status.
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Galura, Sandra J. "Predictors of Immunosuppressant Adherence in Long-Term Renal Transplant Recipients." Doctoral diss., University of Central Florida, 2012. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/5215.
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To sustain the health and viability of renal transplants, adherence to immunosuppressant therapy (IST) medications is critical. Studies continue to identify decreased adherence rates as time from transplant increases (Chisholm-Burns, Kwong, Mulloy & Spivey, 2008; Chisholm, Lance, Mulloy, 2005; Chisholm, Mulloy, & DiPiro, 2005; Nivens & Thomas, 2009). While previous research has explored the effect of variables known to influence IST adherence in adult renal transplant recipients, limited studies have explored these variables in a population of renal transplant recipients with longer time posttransplant intervals. The purpose of this study was to examine demographic variables, time posttransplant, immunosuppressive agents, health beliefs, social support, and symptom experience and test their relationship to adherence in a population of long-term renal transplant recipients. A cross-sectional correlational design was used to collect data from a convenience sample of 98 adult renal transplant recipients who were three or more years from transplant. Participants completed five instruments: 1) demographic survey, 2) the Beliefs About Medicines Questionnaire (BMQ), 3) the Medical Outcomes Study (MOS) Modified Social Support Survey (MSSS), 4) the Basel Assessment of Adherence with Immunosuppressive Medication Scales (BAASIS), and 5) the Modified Transplant Symptom Occurrence and Symptom Distress Scale-59R (MTSOSD-59R). A composite adherence score (CAS) consisting of a self-report measure of adherence (BAASIS), nontherapeutic serum drug assay, and collateral report of adherence as provided by two transplant clinic professionals was used to determine final adherence group classification (adherent/nonadherent). Analysis of the relationship between all independent variables and adherence was conducted using Spearman's rho correlation coefficient. Mean scores for medication complexity, health beliefs, social support, and symptom experience were compared between age, gender, and time posttransplant groups using independent-samples t tests. A logistic regression prediction of probability was conducted to determine which of the variables that demonstrated a significant relationship to adherence were most predictive of adherence. Of the total sample population (N = 98), 39.8% (n = 39) were classified as adherent and 60.2% (n = 59) were nonadherent. Results demonstrated no significant relationship between age (continuous variable), time posttransplant, immunosuppressant medications (measured by a medication complexity index), health beliefs, symptom experience, and adherence. Weak, but significant relationships between age groups (r = -.213, p=.035), tangible social support (r = .215, p =.017), emotional informational social support (r = .274, p = .003), positive social interaction support (r = .199, p = .025), total overall social support (r = .274, p =.003) and composite adherence group classification were found. Older participants (> 55 yrs) were significantly less adherent than younger (< 54 yrs) participants. Mean scores for emotional / informational (EMI), positive social interaction (POS), and total social support (MSSS) were significantly lower in nonadherent participants. Regression results indicated the overall model of two predictors (age grouped [< 54 yrs; > 55 yrs] and EMI social support subscale) was statistically reliable in distinguishing between adherent and nonadherent participants (-2 Log Likelihood 116.244; Goodness-of-Fit x2 (2) = 13.664, p = .001), correctly classifying 69.1% of the cases. Findings from this study contribute to the body of research exploring predictors of immunosuppressant adherence in long-term renal transplant recipients. Data suggest both younger age (< 55) and categories of social support predict adherence in long-term renal transplant recipients. Healthcare providers caring for renal transplant recipients long-term should consider annually assessing older participants for adherence as well as for changes in social networks.ID: 031001498; System requirements: World Wide Web browser and PDF reader.; Mode of access: World Wide Web.; Adviser: Mary Lou Sole.; Title from PDF title page (viewed July 26, 2013).; Thesis (Ph.D.)--University of Central Florida, 2012.; Includes bibliographical references (p. 173-181).
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Bezerra, Ana Paula da Silva Azevedo Nora. "INCIDÊNCIA DE COMPLICAÇÕES VASCULARES EM TRANSPLANTE RENAL ENTRE 2013 E 2014 NA SANTA CASA DE MISERICÓRDIA DE GOIÂNIA." Pontifícia Universidade Católica de Goiás, 2016. http://tede2.pucgoias.edu.br:8080/handle/tede/3893.
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Introduction: Even though kidney transplant represents a new perspective to individuals with chronical kidney disease due to its correlation with a better quality of life results and morbimortality indexes, the procedure itself is not free of risks. Vascular complications rates around the world varies from 1 – 23% and it is are also associated with a high risk of kidney graft losses. Objective: To evaluate the incidence of vascular complications among patients submitted to kidney transplant at Santa Casa de Misericórdia de Goiânia on a period of time between January 2013 to December 2014. Material and Methods: It was analyzed 35 files from patients submitted to kidney transplant at Santa Casa de Misericórdia de Goiânia on a period of time between January 2013 and December 2014. It was analyzed the following variables: renal artery stenosis, renal artery thrombosis, renal vein stenosis, renal vein thrombosis, renal artery pseudoaneurysm, arteriovenous fistula, renal artery kinking, kidney graft torsion and kidney infarction. It was also collected data for: kidney graft side, donator´s aspects (alive or deceased), receptor´s age, receptor´s gender, necessity for reintervention and cold ischemia time. Results: It was included 32 patients, 34,38% females and 65,62% males, with median age of 46 years old. Among all surgical complications it was found 3 events of urinary leakage (9,3%), 2 events of retroperitoneal abscess (6,25%), 1 event of kidney graft torsion (3,12%) and 1 event of arterial stenosis (3,12%). All kidney grafts came from deceased donators (100%) and there were no graft losses. Conclusion: Even though the following study had shown a low incidence of vascular complications related with kidney transplant, the TIF more than 24 hours was the only independent risk factor associated with this event.
Introdução: Embora o transplante renal represente uma perspectiva ao indivíduo portador de doença renal crônica terminal por se correlacionar a melhores índices de qualidade de vida e de morbimortalidade, este procedimento não é isento de riscos. As taxas de complicações vasculares variam em todo mundo de 1 – 23% e guardam importância por estar associadas a elevado risco de perda do enxerto. Objetivo: Avaliar a incidência de complicação vascular em pacientes submetidos a transplante renal na Santa Casa de Misericórdia de Goiânia no período entre janeiro de 2013 a dezembro de 2014. Material e Métodos: Foram analisados 35 prontuários de pacientes submetidos a transplante renal na Santa Casa de Misericórdia de Goiânia no período de Janeiro de 2013 a Dezembro de 2014. Foram analisadas as seguintes variáveis: estenose de artéria renal, trombose de artéria renal, estenose de veia renal, trombose de veia renal, pseudoaneurisma de artéria renal, fístula arteriovenosa, kinking de artéria renal, torção de enxerto e infarto. Foi coletado em prontuário: rim transplantado, tipo de doador, idade do receptor, gênero do receptor, reinternação, tempo de isquemia fria. Resultados: A população estudada incluiu 32 pacientes, sendo 34,38% do sexo feminino e 65,62% do sexo masculino, com média de idade de 46 anos. Entre as complicações cirúrgicas, ocorreram 3 casos de fistula urinária (9,3%), 2 casos de coleção (6,25%), 1 caso de torção de enxerto (3,12%) e 1 caso de estenose arterial (3,12%). Todos os enxertos (100%) foram de doador falecido e não houve perda de enxerto em nenhum caso (0%). Conclusões: Embora o presente estudo tenha observado uma baixa incidência de complicação vascular relacionada a transplante renal, o TIF superior a 24hs foi o único fator de risco independente associado a tal evento (p=0,034).
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Taylor, Craig John. "Characterisation of antibody populations in renal dialysis patients : their role in renal transplant outcome." Thesis, Oxford Brookes University, 1991. https://radar.brookes.ac.uk/radar/items/a49a9281-0d74-4a58-8ffb-abca6cdcafd9/1.
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The relevance of a positive crossmatch in renal transplantation is controversial. Factors which may influence the relationship between recipient antibody sensitization and transplant outcome include; the antibody class and specificity, the time interval between the positive crossmatch and transplantation and whether the transplant is a first graft or a regraft. In highly sensitized patients the clinical relevance of a positive crossmatch against a particular donor is difficult to determine because it may be due to damaging (presumed antiHLA) and/or non-damaging (presumed non-HLA) antibodies. An in vitro assay has been developed which can reliably define the specificity of donor reactive antibodies even in complex mixtures. This technique was applied to define the immunoglobulin class and specificity of antibodies present in a series of positive crossmatch transplants. The clinical relevance of sensitization to HLA class I, DR, DQ and non-HLA was examined and a correlation sought with graft survival. The results showed good primary and regraft survival in the presence of peak positive and current positive crossmatches caused by IgM non-HLA antibodies. There was acceptable primary and regraft survival with peak positive-current negative crossmatches due to IgM HLA class I, but not with IgG antibodies. A positive B cell crossmatch caused by HLA antibodies was associated with good primary but poor regraft survival. These findings may be applied prospectively to select kidney donor and recipient pairs Who, despite a positive crossmatch, can be transplanted with a high probability of success. The target molecule of the commonest non-HLA antibody has remained a mystery for over 15 years. This question was investigated by the production and characterisation of human monoclonal antibodies from a renal dialysis patient by the generation of a mouse/human heterohybridoma. The resulting antibodies are of the IgM class with reaction profiles identical to those found in renal dialysis patients. Screening against panels of cells demonstrated that identical reactivity patterns could be generated at a different dilution for each MAb. This implies that the apparently different specificities are explained by differential target cell sensitivity. Reactivity profiles in fluorescence binding assays showed that this target cell sensitivity is dictated not by antigen density alone but also by antibody/antigen affinity. The results from enzyme treatment of target cells and from lectin inhibition studies show that the antibodies are polyreactive and capable of binding sialic acid dependent epitopes and other negatively charged cell surface molecules.
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Worthington, Judith Elizabeth. "HLA antibody production and its association with renal transplant outcome." Thesis, Manchester Metropolitan University, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.426459.
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Degiannis, Dimitrios. "Analysis of B lymphocyte function in prospective renal transplant patients." Thesis, University of Glasgow, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.329569.
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Minardi, Daniele. "The relationship between infection and rejection in renal transplant patients." Thesis, University College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.300926.
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Payne, Thomas. "Novel biomarkers of renal transplant failure/dysfunction via spectroscopic phenotyping." Thesis, Imperial College London, 2017. http://hdl.handle.net/10044/1/61777.
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Successful renal transplantation not only improves patients’ quality and duration of life, but also confers a substantial economic healthcare cost saving. With the growing burden of end-stage renal disease and the requirement for renal replacement therapy, strategies to augment transplant success and subsequent graft survival become more vital than ever. Herein, an objective means of characterising renal function across the transplant journey, and appropriately stratifying in accordance to individual contingencies/factors (including the early detection of renal dysfunction), based on metabolism is explored. Patient pairs, recipients and donors, were metabolically phenotyped prior to (24 h) and post (days 1–5) transplantation using a multi-platform analytical approach (i.e., Nuclear Magnetic Resonance Spectroscopy (NMR) and Mass Spectrometry (MS)) of urine and plasma (n = 50). Using advanced statistics, the resulting metabolic profiles were subsequently modelled, and related to multiple clinical phenotypes (and outcomes), to increase the understanding of molecular changes/signatures across transplantation, capturing valuable information pertinent to transplant type, cause, co-morbidity, modality, immunology and complication (p-value < 0.05) – over donors as well as recipients. An attempt to then develop predictive algorithms for the early detection of renal dysfunction was preliminary defined within the confines of the study design, where integrated NMR and MS metabolic data improved patient stratification for complications over clinical measures (receiver operator characteristic area under curve over 0.900) and potentially replace current measures. While prospective/multicentre studies are imperative for subsequent real-world adoption (qualification/validation), the work conducted herein encompassed much of the first stage of marker development – discovery – where metabolic phenotyping renal transplantation has provided a deeper characterisation of patient journeys with new insights into multiple contingencies/factors (including complication). Such findings infer the value of metabolic phenotyping to augment and potentially replace current measures and methods to better inform decision making in the clinic on the individual/precision level.
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Adair, Anya. "Macrophage mediated endothelial injury and proliferation in renal transplant rejection." Thesis, University of Edinburgh, 2008. http://hdl.handle.net/1842/4232.
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Macrophages (Mφ) have previously been implicated in both acute and chronic renal allograft rejection however the mechanisms remain unclear. In this thesis I set out to explore the effect of the Mφ on the endothelium in the context of renal graft rejection. Initial studies focussed upon human renal allograft tissue from transplant nephrectomies performed because of chronic allograft nephropathy (CAN). Immunostaining was carried out on these tissues (n=29) and control kidney tissue obtained from nephrectomies performed for renal cell carcinoma (n=19). An increased interstitial Mφ infiltrate was found compared to control tissue. Immunostaining for the T cell marker CD3 and the B cell marker CD20 demonstrated that both lymphocyte populations were present in the CAN tissue with almost negligible numbers seen in control tissue. Previous work in the group had demonstrated a reduced number of CD31 positive peritubular capillaries in the tissues used in these studies. In the work undertaken in this thesis, additional analysis was performed to study lymphatic vessels. Immunostaining of control tissue with the lymphatic endothelial cell (LEC) marker podoplanin demonstrated a normal distribution of lymphatic vessels around large interlobular arteries. CAN tissue, however, exhibited an increased lymphatic density with lymphatic vessels evident within the interstitium; a finding verified with two additional LEC markers (LYVE-1 and VEGFR-3). Further investigations examined possible mediators that could be responsible for the reduced microvascular peritubular capillary network and increased lymphatic vessels present in tissues affected by CAN. Previous work had implicated nitric oxide (NO) generated by the enzyme inducible nitric oxide synthase (iNOS) in cardiac allograft rejection. Double immunolabelling for iNOS and the Mφ marker CD68 revealed evidence of Mφ expression of iNOS. No obvious reduction in vascular endothelial growth factor (VEGF)-A was evident although marked expression of VEGF-A was found in CD20 positive B cells within CAN tissue. Occasional interstitial cells expressed the lymphangiogenic growth factor VEGF-C, with double labelling studies indicating occasional CD68 +ve Mø that were positive for VEGF-C. In vitro studies were undertaken to dissect the interaction between Mø and microvascular endothelial cells (MCEC-1) using well established in vitro co-culture techniques. Co-culture of cytokine activated bone marrow derived Mø with MCEC-1 cells (a murine cardiac microvascular endothelial cell line) resulted in increasing levels of MCEC-1 apoptosis and a reduced cell number over a 24-hour time course. Non-activated Mø or cytokines alone were not cytotoxic. Co-cultures were performed in the presence of L-Nimino- ethyl lysine (L-Nil), a specific inhibitor of iNOS (control D-N6- (1-iminoethyl)-lysine (D-Nil)). L-Nil significantly inhibited MCEC-1 apoptosis and preserved cell number implicating a major role for NO in Mø-mediated MCEC-1 death. Importantly, L-Nil treatment did not affect TNFα production by cytokines suggesting that TNFα is not involved in MCEC-1 death in this in vitro experimental system. Experiments were then undertaken involving the depletion of Mø in a murine model of acute renal allograft rejection. Renal transplants were performed between donor Balb/c mice and either FVB/N CD11b-DTR mice transgenic for the diphtheria toxin receptor (DTR) under the CD11b promoter or control non-transgenic FVB/N mice. Diphtheria toxin (DT) was administered on days 3 and 5 to induce Mø depletion and mice sacrificed at day 7. Isograft controls were also performed between FVB/N mice. Murine allografts exhibited marked interstitial F4/80 positive Mø infiltration with expression of iNOS in the allografts. There was significant loss of peritubular capillaries (PTC) in allografts compared to isografts, indicating microvascular injury. DT treated CD11b-DTR mice exhibited 75% reduction in Mø infiltration and this was associated with dramatic microvascular protection. B and T cells were not evident in the isograft but significant accumulation of B and T cells was present in the allograft and not affect by Mø depletion. Interestingly, there was an increase in the number of podoplanin positive lymphatic vessels in the allograft compared to the isograft, which was significantly inhibited following Mø depletion. The final area of study focussed upon attempts to isolate lymphatic endothelial cells in vitro. Two types of vascular cells (HUVECs and HDMECs) were analysed by flow cytometry for LEC markers and immunofluorescence to phenotype the cells. Magnetic bead sorting was then undertaken to isolate discrete populations of endothelial cells expressing LEC markers. The murine studies reinforce the cytotoxic potential of Mø and supports a role for Mø in the deleterious rarefaction of microvascular interstitial vessels with resultant tissue hypoxia and ischaemia. Furthermore, these data support the involvement of Mø in the interstitial lymphangiogenesis that may occur in renal allografts. Furthermore, the study of human allograft tissue indicates that microvascular rarefaction and an increase in intrarenal lymphatic vessels occurs in human disease. Lastly, Mø expression of iNOS and VEGF-C suggests that Mø are involved in key processes that may adversely affect graft outcome.
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Oliveira, Nilza Tavares Honorato de. "Expectativas do paciente renal crônico frente à espera do transplante." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/22/22131/tde-13032008-160458/.
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Este trabalho pretende lançar um novo olhar sobre o relacionamento entre as pessoas da equipe de saúde e pacientes com Insuficiência renal crônica. O trabalho com pacientes portadores de doença crônica geralmente contém uma carga mental muito densa para os trabalhadores, que lidam diariamente com questões existenciais, como a dor, o sofrimento e a morte, e questões profissionais, como os sentimentos de frustração e impotência diante da doença. Os pacientes também carregam uma carga psíquica, já que a IRC é uma doença que implica na convivência com a dor, o sofrimento e, às vezes, até a morte, que são questões geradoras de ansiedade e estresse. Por outro lado, a doença pode ser vista como uma oportunidade de crescimento pessoal, tanto do paciente como das pessoas que integram a equipe que o assiste. Assim, este trabalho teve como objetivo investigar as percepções e expectativas dos pacientes com IRC,enquanto aguardam, na fila de espera, por um transplante. Promover o máximo de crescimento e trocas na relação profissional-paciente, valorizando o trabalho como fonte de equilíbrio, satisfação e prazer, podem conduzir à realização pessoal, resgatando a doença como ponto de partida para o crescimento dos pacientes. Para isto, foi realizada uma pesquisa qualitativa, utilizando-se de entrevista e questionário, possibilitando a sugestão de medidas que podem contribuir para a qualidade de trabalho e de vida de profissionais e pacientes. Como resultado destas reflexões, emergem algumas sugestões a serem alcançadas; possibilitar os pacientes a realizarem suas escolhas; discutir amplamente com a sociedade a importância da doação de órgãos para que possa diminuir o número de pacientes na lista de espera e de medidas de suporte social ao mesmo; reivindicar a inserção, no ensino médico, de disciplinas que discutam sobre a doença crônica e oferecer um cuidado integral para os mesmos, isto é, atendendo às dimensões físicas, emocionais, espirituais, sociais e econômicas.The aim of this study was to look at the relationship between health teams and the patient with chronic kidney failure. Working with chronically sick patients often represents a heavy mental burden for health workers who have to handle existencial issues such as pain, suffering , and death as well as professional issues like frustation and helplessness in face of the disease. Patients also sustain a psychic burden once CKF is a condition that involves coping with pain, suffering, and sometimes death, which are issues that generate anxiety and stress.On the other hand, the disease can be regarded as an opportunity for personal growth both for the patient and the workers assisting them. Therefore, the goal of this study was to investigate CKF patients\' perceptions and expectations while waiting for a transplant. Promoting optimal personal growth and sharing in patient/health worker relationship as well as valueing work as a source satisfaction and pleasure can lead to self-realization, regarding disease as a way to foster the patient\'s growth Therefore, a qualitative study making use of interviews and a questionnaire was conducted. Such format allowed for suggesting measures that could improve the quality of working conditions and life both for patients and health workers. Some suggestions emmerged as a result of this study, such as enabling the patients to make their choices; raising public awareness by discussing the importance of organ donation in order to reduce the number of prospective recipients and actions to provide social support to them; requiring that Medical Schools include subjects that will discuss chronic diseases. Finally, patients should be able to receive thorough assistance targeting their physical, emotional, spiritual, social, and economic dimensions.
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Harmer, Andrea Wendy. "The significance of antibody production in human renal transplantation." Thesis, Open University, 1997. http://oro.open.ac.uk/57691/.
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Screening for HLA specific antibodies is an important part of laboratory testing for transplantation. The conventional technique for screening is complement dependent lymphocytotoxicity. The development and increasing use of the sensitive flow cytometric crossmatch technique has meant that this conventional screening method is often less sensitive than the final crossmatch. The aim of this study was the development of a flow cytometric screening technique which would be as sensitive as the flow cytometric crossmatch and the investigation of the newly developed ELISA screening method PRA-STAT. These methods were used to investigate antibody production in patients with failed transplants. Flow cytometric analysis of antibody binding to pooled cells was found to be a reliable and sensitive method for the detection of HLA class I and class II specific antibodies. PRA-STAT also detects both class I and class II specific antibodies. Both flow cytometric and PRA-STAT screening methods were shown to be more sensitive than conventional cytotoxic screening. Screening of patients with failed transplants by these sensitive methods showed that the majority of patients produce both HLA class I and class II donor specific antibodies following failure of a primary transplant. Flow cytometric and PRA-STAT screening detected antibody production earlier than cytotoxic screening in some patients. HLA matching was shown to be related to both graft survival and to the levels of antibody produced following graft failure with poorly matched grafts resulting in higher levels of sensitisation than well matched grafts. Patients with detectable post graft failure antibodies had a lower chance of receiving a second transplant and had significantly worse regraft survival than patients with no antibody. The results of the study suggest that HLA class II specific antibodies and repeat class II mismatches may be detrimental in regrafts and this requires further study.
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Salazar, Antony Brayan Campos. "Polimorfismos em genes envolvidos na farmacodinâmica de tacrolimo e everolimo e sua relação com a resposta ao tratamento imunossupressor, em receptores de transplante renal." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/9/9136/tde-23012018-170420/.
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O monitoramento de imunossupressores, como os inibidores de calcineurina ou de mTOR, é essencial para evitar desfechos clínicos desfavoráveis, em receptores de transplante renal. Polimorfismos em genes envolvidos na farmacocinética têm sido associados com variabilidade na resposta a imunossupressores, porém o papel de polimorfismos em genes envolvidos na farmacodinâmica é pouco conhecido. O objetivo deste estudo foi investigar a influência de polimorfismos de MTOR, PPP3CA, FKBP1A, FKBP2 e FOXP3, genes envolvidos na farmacodinâmica de imunossupressores, sobre a resposta clínica a tacrolimo e everolimo, em receptores de transplante renal. Foram incluídos 269 pacientes do ensaio clínico original (NCT01354301), realizado no Hospital do Rim e Hipertensão da UNIFESP, e randomizados em três esquemas imunossupressores: tacrolimo 0,05 mg/kg/dia com everolimo 1,5 mg/dia (TAC5/EVR); tacrolimo 0,1 mg/kg/dia com everolimo 1,5 mg/dia (TAC10/EVR); e tacrolimo 0,1 mg/kg/dia com micofenolato de sódio (TAC10/MFS). Foram coletados dados clínicos e laboratoriais, tais como o monitoramento de imunossupressores e desfechos de eficácia de segurança. Os polimorfismos nos genes MTOR (c.4731G>A, c.1437T>C, c.2997C>T); PPP3CA (c.249G>A); FKBP1A (n.259+243936T>C); FBKP2 (c.-2110G>T) e FOXP3 (c.-23+2882A>C, c.-22-902A>G) foram analisados por PCR em tempo real. As frequências alélicas dos polimorfismos estudados foram similares às da população global do projeto 1000genomes. O tratamento com everolimo e tacrolimo em maior dose (TAC10/EVR) foi associado com menor taxa de filtração glomerular estimada (TFGe) e maior creatinina sérica. Enquanto que o tratamento com tacrolimo e micofenolato de sódio (TAC10/MFS) foi associado com maior número de episódios de infecção por citomegalovirus, no 1° ano pós-transplante. Com relação aos desfechos de eficácia, os portadores do genótipo CC de MTOR c.1437T>C e FOXP3 c-23+2882A>C apresentaram maiores concentrações de creatinina sérica, no 12° mês (p<0,05). O polimorfismo FOXP3 c.-23+2882A>C foi associado com maior probabilidade de creatinina sérica aumentada (OR=1,75; IC95%=1,07-2,86; p=0,025). Os resultados da análise de regressão logística mostraram que o alelo MTOR c.4731G (genótipos AG+GG) foi associado com maior risco de rejeição aguda (OR=3,37; IC95%=1,10-10,30; p=0,033). Os portadores do alelo c.4731G apresentaram maior incidência cumulativa de episódios de rejeição, no 1° ano pós-transplante. Com relação aos desfechos de segurança, a variante FKBP2 c.-2110G>T (genótipo GG) foi associada com maior risco de leucopenia (OR=7,10; IC95%=1,81-27,87; p=0,025). O polimorfismo FKBP1A n.259+24936T>C (alelo C) foi associado com maior risco de constipação (OR=2,52; IC95%=1,13 - 5,61; p=0,024), enquanto que os polimorfismos FOXP3 c.-22-902A>G (alelo A) e c.-23+2882A>C (alelo A) foram associados, respectivamente, com maior risco de epigastralgia (OR=2,15; IC95%=1,01-4,56; p=0,047) e náuseas e/ou vômitos (OR=2,38; IC95%=1,05-5,38; p=0,038). O risco de apresentar dislipidemia foi maior nos portadores dos genótipos FKBP2 c.-21110GG (OR=1,92; IC95%=1,01-3,69; p=0,049) e FOXP3 c.-22-902GG (OR=2,06; IC95%=1,08-3,92; p=0,028). Em conclusão, os polimorfismos de genes MTOR, FKBP1A, FKBP2 e FOXP3 influenciam na função renal do enxerto e estão associados com risco de rejeição aguda e de eventos adversos, em receptores de transplante renal.The monitoring of immunosuppressive drugs, such as calcineurin and mTOR inhibitors, is essential to avoid undesirable kidney transplant outcomes. Polymorphisms in pharmacokinetics-related genes have been associated with variability in the response to immunosuppressive drugs, but the role of polymorphisms in pharmacodynamics-related genes is little known. The aim of this work was to investigate the influence of polymorphisms in MTOR, PPP3CA, FKBP1A, FKBP2 and FOXP3, genes involved in the pharmacodynamics of immunosuppressive drugs, on the clinical response to tacrolimus and everolimus in kidney transplant recipients. Two-hundred seventy-five kidney transplant recipients were included in this study, among the enrolled in the original clinical trial (NCT01354301) carried out at the Hospital do Rim e Hipertensão/UNIFESP, and randomized in three immunosuppressive treatments: tacrolimus 0.05 mg/kg/day with everolimus 1.5 mg/day (TAC5/EVR); tacrolimus 0.1 mg/kg/day with everolimus 1.5 mg/day (TAC10/EVR); and tacrolimus 0.1 mg/kg/day with sodium mycophenolate (TAC10/MFS). Clinical and laboratory data, including immunosuppressive drug monitoring, efficacy and safety outcomes, were recorded. Polymorphisms on the MTOR (c.4731G>A, c.1437T>C, c.2997C>T); PPP3CA (c.249G>A); FKBP1A (n.259+243936T>C); FBKP2 (c.-2110G>T) and FOXP3 (c.-23+2882A>C, c.-22-902A>G) genes were analyzed by real-time PCR. Allelic frequencies of the studied polymorphisms were similar to those of the global population reported by the 1000genomes project. Treatment with everolimus and high-dose tacrolimus (TAC10/EVR) was associated with lower estimated glomerular filtration rate (eGFR) and higher serum creatinine. Meanwhile treatment with tacrolimus and sodium mycophenolate (TAC10/MFS) was associated with higher number of cytomegalovirus infections, at 1-year post-transplantation. With regard to the kidney efficacy outcomes, the carriers of the CC genotype of MTOR c.1437T>C and FOXP3 c.-23+2882A>C had higher serum creatinine, at month 12 (p<0.05). The FOXP3 c.-23+2882A>C polymorphism was associated with high likelihood of increased serum creatinine (OR=1.75, 95%IC=1.07-2.86, p=0.025). The results of the logistic regression analysis showed that the allele MTOR c.4731G (AG+GG genotypes) was associated with higher risk of acute rejection (OR=3.37, 95%IC=1.10-10.30, p=0.033). The carriers of the c.4731G allele showed higher cumulative incidence of acute rejection episodes at 1-year post-transplantation. With regard to kidney safety outcomes, the FKBP2 c.-2110G>T variant (GG genotype) was associated with higher risk of leucopenia (OR=7.10, 95%IC=1.81-27.87, p=0.025). The FKBP1A n.259+24936T>C (C allele) polymorphism was associated with higher risk of constipation (OR=2.52, 95%IC=1.13-5.61, p=0.024), whilst FOXP3 c.-22 902A>G (A allele) and c.-23+2882A>C (A allele) were associated, respectively, with higher risk of epigastric pain (OR=2.15, 95%IC=1.01-4.56, p=0.047) and nausea and/or vomiting (OR=2.38, 95%IC=1.05-5.38, p=0.038). The risk of developing dyslipidemia was higher in carriers of the genotypes FKBP2 c.-21110GG (OR=1.92, 95%CI=1.01-3.69, p=0.049) and FOXP3 c.-22-902GG (OR=2.06, 95%CI=1.08-3.92, p=0.028). In conclusion, the polymorphisms in the MTOR, FKBP1A, FKBP2 and FOXP3 genes influence renal graft function and are associated with risk of acute rejection and adverse events in renal transplant recipients.
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Parker, Cornelle R. "Evaluation of renal bone disease in transplant recipients and related conditions." Thesis, University of Nottingham, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.342044.
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Onions, Louise. "Immunological monitoring of the B-cell compartment in renal transplant recipients." Thesis, Queen Mary, University of London, 2014. http://qmro.qmul.ac.uk/xmlui/handle/123456789/8969.
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B cells contribute to chronic allograft deterioration, negatively impacting graft survival, and curtailing the lifespan of a resource already in short supply. Given this, identifying alloreactive B cells could generate an important target in the battle against rejection. This study described an IgG-detecting ELISPOT used to determine if the risk of developing antibody-mediated rejection (AMR) could be predicted pretransplantation by in vitro analysis of allospecific B cells. This method failed to discriminate accurately B-cell responses to donor antigen. An alternative approach used was to detect peripheral HLA-specific B cells. Circulating HLA–A*0201 and – DQB1*0301 B cells were identified at higher frequency in sensitised patients, and this correlated with the level of serum alloantibody. Expression of HLA-DQB1*0301 B cells were at a higher frequency than HLA-A*0201 B cells in those with serum de novo donor-specific antibody (dnDSA). Next, levels of B-cell activating factor (BAFF) were investigated. Excess BAFF has been related to rejection and the development of DSA. Here elevated serum BAFF, low BAFF-receptor and DSA were all associated with deteriorating graft function. In addition intrarenal CD19+ cells, BAFF and BAFFreceptor identified with acute AMR. In contrast to a pathogenic role of B cells, a small population may be protective. The presence of regulatory B cells, defined by IL-10 production were higher in those with stable graft function, and identified with naïve B cells rather than memory B cells when compared to those with deteriorating grafts. The CD19+CD24highCD38high subset was also elevated in stable patients, and the ability to supress T-cell activation and secretion of the Th1 cell pro-inflammatory cytokine, IFN-γ was altered as a function of allograft stability. These data demonstrated characteristics within the B-cell compartment associated with stable graft function. The ability to monitor these cells may have clinical implications for predicating the risk of rejection, to dictate immunosuppressive therapy and promote allograft survival.
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Jham, Seema Hari. "Prognostic immune markers for chronic allograft injury in renal transplant recipients." Thesis, University of Birmingham, 2017. http://etheses.bham.ac.uk//id/eprint/7535/.
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Introduction: Alloimmunity is a major contributor to chronic allograft injury. There are currently no routine clinical cell-based assays that allow quantification of the recipients' alloimmune response towards a graft. Previous work from our group identified indirect alloimmune responses to non-polymorphic regions of HLA Class 1. The aim of this thesis was to assess the alloimmune response in renal transplant recipients (RTRs) by using synthetic peptides to nonpolymorphic regions ofHLA Class 2. Methods: Responses to newly synthesized HLA Class 2 peptides were tested in RTRs via any interferon ELISPOT assay. Cell surface staining techniques and Luminex technology were used to identify the T-cell subsets driving the immune responses and subsequent cytokine production respectively. Results: Increased responses to HLA Class 2 derived peptides were detected in renal transplant recipients compared to healthy controls. The activated effector memory subset ofT-cells was expanded in RTRs compared to healthy controls and generated these responses. T effector memory cell dependent TNF-a and IL-2 and T regulatory dependent IL-10 synthesis in the presence of specific peptide antigen was detected. Conclusion: A potential reproducible assay ofT cell alloreactivity has been identified to help stratify RTRs at risk of an ongoing alloimmune response but needs further testing in a larger multicentre study.
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Silva, Neto Manoel Lemes da. "Fatores de Risco para Infecções em Transplante Renal." Pontifícia Universidade Católica de Goiás, 2006. http://localhost:8080/tede/handle/tede/3051.
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Previous issue date: 2006-12-15Objectives: To investigate the prevalence of nosocomial infections (NIs) occurring up to 30 days following renal transplant at the Hospital Santa Casa de Misericórdia in Goiânia and to analyze risk factors for the development of surgical site infection (SSI) in renal transplant recipients and the consequences of the infections. Methods: A retrospective study was performed from January 2004 to June 2006, which determined hospital infections occurring during the first 30 days following renal transplant and the risk factors for the development of SSI and its consequences. A form was designed as an instrument for data collection containing the patients clinical and demographic information from hospital admission to discharge. Result: 108 renal transplants were analyzed, 49 (45.4%) of which were performed in female patients and 59 (54.6%) in male patients. Grafts from live donors totaled 67 (62%) and constituted the majority. Grafts from deceased donors totaled 41 (38%). The mean age was 38.1 years old and the average time of hospital stay was 16 days. The incident rate of bacterial nosocomial infection (NI) in recipients was 35.18% and occurred in 28 (25.9%) patients. Nine of the recipients presented two or more episodes of infection during the time of hospital stay. In this review, 38 episodes of bacterial nosocomial infection were diagnosed, 20 (18.5%) cases of urinary tract infection (UTI), 9 (8.33%) cases of SSI, 3 (2.77%) cases of pneumonias, 5 (4.62%) cases of bloodstream infection (septicemia) and 1 (0.92%) case of other infections. During the first 30 days, no loss of graft or death was observed. The number of infection episodes was directly proportional to the increase in the average and the median time of hospital stay (p< 0.001). UTI was the most prevalent and recipients of grafts from deceased donors were more prone to developing UTI than were recipients receiving grafts from live donors; in addition, the former group had twice as many more chances of developing UTI (p<0.046; OR=2.363). Fifty-four (50%) recipients presented graft dysfunction, thirteen of whom reestablished renal function without the need for dialytic treatment and 41 (38%) of whom underwent it through hemodialysis in the absolute majority of cases. Organs from deceased donors were more susceptible to the occurrence of graft dysfunction (p=0.001), in a ratio almost twenty times higher (OR=19.600). In the multivariate analysis, the following were regarded as risk factors for the development of SSI: time of pre-transplant dialytic treatment, presence of graft dysfunction, need for post-transplant dialytic treatment and number in units in the use of hemoderivatives. Conclusions: The low levels of effective organ donation accounted for a smaller number of grafts from deceased donors during the study. Bacterial nosocomial infections (NI) increased the time of hospital stay. The time of duration of dialysis treatment, graft dysfunction, the need for post-transplant dialytic treatment and an increase in the volume of associated hemoderived infusion represented higher risk of SSI. Graft dysfunction was higher in corpse donors. UTI was the most prevalent, which was regarded as risk for the development of SSI. Recipients of grafts from corpse donors were more susceptible to UTI. Re-operations, urological complications and hematomas of operative wound predisposed to SSI.
Objetivos: Verificar a prevalência de infecções hospitalares (IHs) ocorridas até 30 dias após o transplante renal no Hospital Santa Casa de Misericórdia de Goiânia e analisar os fatores de risco para aquisição de infecção de sítio cirúrgico (ISC) em pacientes submetidos a transplante renal(Txr) e as conseqüências das infecções. Métodos: Foi realizado um estudo retrospectivo no período que compreende janeiro de 2004 a junho de 2006, determinando as infecções hospitalares ocorridas nos primeiros 30 dias após o Txr, e os fatores de risco para a aquisição de ISC e suas conseqüências. Foi elaborada uma ficha como instrumento para a coleta de dados, contendo informações clínicas e demográficas dos pacientes desde a data da internação até a alta hospitalar. Resultados: Foram analisados 108 transplantados renais 49 (45,4%) do sexo feminino e 59 do sexo masculino (54,6%) e os enxertos de doador vivo foram a maioria, 67 (62%) e de doador cadáver 41 (38%). A média de idade foi de 38,1 anos e do período do tempo de internação hospitalar de 16 dias. A taxa de incidência de IH bacteriana nos receptores foi de 35,18% e ocorreu em 28 (25,9%) pacientes, e nove receptores tiveram dois ou mais episódios de infecção durante a internação. Nessa revisão diagnosticou-se 38 episódios de infecção hospitalar bacteriana, 20 (18,5%) casos de infecção do trato urinário (ITU), 9 (8,33 %) de ISC, 3 ( 2,77%) casos de pneumonias, 5 (4,62%) de infecção de corrente sanguínea (septicemia) e outras infecções 1 (0,92 %) caso. Nos primeiros 30 dias, não ocorreu perda de nenhum enxerto e não houve nenhum óbito. O número de episódios de infecção foi diretamente proporcional ao aumento da média e da mediana de internação (p< 0,001). ITU foi a infecção mais incidente e os receptores de enxerto de doador cadáver foram mais propensos á ITU do que os de doador vivo e tiveram mais do dobro de chance de contraí-la (p<0,046; OR=2,363). Cinqüenta e quatro receptores (50%) apresentaram disfunção do enxerto, treze recuperaram a função renal sem a necessidade do tratamento dialítico e 41 (38%) o realizaram fazendo hemodiálise na maioria absoluta dos casos. Órgãos de doador cadáver foram mais susceptíveis à ocorrência de disfunção de enxerto (p=0,001), numa razão de quase vinte vezes maior (OR= 19,600). Na análise multivariada, representaram risco a ISC; tempo de tratamento dialítico pré-tranplante, presença de disfunção de enxerto, necessidade de tratamento dialítico pós-transplante e quantidade em unidades no uso de hemoderivados. Conclusões: Os baixos índices na doação efetiva de órgãos significaram menor número de enxertos de doador cadáver no período de estudo. As IHs bacterianas prolongaram o período de tempo de internação hospitalar. Tempo de duração do tratamento dialítico, disfunção de enxerto, necessidade de tratamento dialítico pós-transplante e aumento no volume de infusão de hemoderivados associados, representaram maior risco a ISC. A disfunção de enxerto ocorreu em maior incidência nos enxertos de doador cadáver. A ITU foi a infecção mais incidente, significando risco para ocorrência de ISC. Receptores de enxerto de doador cadáver foram mais susceptíveis ITU. Reoperações, complicações urológicas e hematomas de ferida operatória, predispuseram à ISC.
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Wong, Kwok-kuen. "Evaluation on micro-AMS at early detection of acute renal transplant rejection." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40738243.
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Solomon, Daniel Aran. "Decision Making by Patients Awaiting Kidney Transplant." Yale University, 2010. http://ymtdl.med.yale.edu/theses/available/etd-03052010-141133/.
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Involving patients in medical decisions by acknowledging patients personal values and individual preferences has become an important goal of providing ethical medical care. Despite a general movement towards a model of shared decision-making, many patients do not fully meet their preferred role in practice. The decision whether or not to accept a kidney once it is offered to a patient awaiting transplant has historically been made predominantly by the transplant surgeon with little involvement from the patient. Because dialysis can provide long-term renal replacement, declining a kidney is a viable option. Patient changes over time and inherent heterogeneity of donor kidneys make this an authentic decision requiring careful analysis of costs and benefits from the patient perspective. The purpose of this study is to improve our understanding of how patients and transplant surgeons prioritize different factors when deciding whether or not to accept a kidney that has become available, in order to empower patients to become more involved in the decision-making process. Phase I: We developed a comprehensive list of factors that patients might consider important through qualitative interviews with patients, and deliberation with a transplant surgeon (SK) and a transplant nephrologists (RF). Phase II: We quantified the relative importance of each factor for patients on the transplant list and for transplant surgeons with a computerized survey using Maximum Differences Scaling. We developed relative importance scores using Heirarchical Bayes analysis, and tested for associations between patient characteristics and relative importance scores using Spearmans correlation coefficient and the Mann Whitney U test for continuous and categorical variables respectively. Of the factors evaluated, patients placed the greatest value on Kidney quality, How closely matched you are to the kidney, and How strongly your surgeon feels you should accept the kidney. Relative importance of different factors did not change based on patient demographic characteristics. Patients who are on the waiting list longer give less importance to kidney quality (standard beta estimate -0.23, p value 0.03) and more importance to How difficult it is for you to be matched to a donor (ie whether or not you are sensitized) (standard beta estimate 0.28, p value 0.01). Surgeons placed the greatest value on Kidney quality, How difficult it is for the patient to be matched to a kidney (ie whether or not the patient is sensitized), and The age of the donor. This pilot study suggests a role for standardized education tools to help empower patients to be involved in this difficult decision. Development of decision aids can be guided by the results of this project.
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黃國權 and Kwok-kuen Wong. "Evaluation on micro-AMS at early detection of acute renal transplant rejection." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40738243.
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Cassini, Marcelo Ferreira. "Correlação entre a espectroscopia de fluorescência induzida pelo laser e as alterações histológicas na isquemia e reperfusão renal em ratos." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/17/17137/tde-22092012-231314/.
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Introdução: O transplante renal é amplamente reconhecido como a melhor forma de tratamento para os pacientes que necessitam de terapia de substituição renal. Frequentemente a equipe transplantadora se depara com a difícil questão de determinar se órgãos, provenientes de doadores falecidos e limítrofes ou em parada cardíaca, estão aptos para serem transplantados. É difícil quantificar a intensidade do dano provocado pela isquemia no enxerto a ser utilizado, especialmente se o doador apresentou quadro de instabilidade hemodinâmica com queda significativa da perfusão tecidual e aumento do risco de diminuir a função do enxerto e afetar adversamente sua sobrevida. Desta forma torna-se justificável a utilização da técnica de espectroscopia de fluorescência induzida pelo laser, na tentativa de se avaliar a correlação entre os seus achados e o grau de lesão histológica renal experimental, uma vez que se trata de um método objetivo, não invasivo, rápido e em tempo real que, futuramente, pode ser aplicada nos transplantes renais em humanos. Objetivos: Avaliar a correlação entre os dados da espectroscopia de fluorescência induzida pelo laser e alterações histológicas na isquemia e reperfusão renal em ratos, e se existe diferença significativa na leitura da espectroscopia entre os polos superior, inferior e o terço médio. Materiais e Métodos: Foram utilizados 33 ratos (Rattus norvegicus) machos adultos da linhagem Wistar que, depois de anestesiados, tiveram seus rins esquerdos abordados. Inicialmente os rins foram submetidos à detecção da espectroscopia de fluorescência dos pólos superiores, inferiores e terços médios. As excitações foram geradas por lasers com comprimentos de onda de 408, 442 e 532 nm. Em seguida os pedículos renais esquerdos foram dissecados, isolados e clampeados com auxílio de mini-pinça vascular. Então, os animais foram divididos aleatoriamente em três grupos isquêmicos de 30, 60 e 120 minutos de isquemia quente. Em cada um dos grupos, os rins foram novamente analisados pela espectroscopia de fluorescência, bem como após 5 minutos de reperfusão, utilizando novamente feixes excitatórios com os mesmos comprimentos de onda, nas mesmas regiões renais. Posteriormente os rins esquerdos foram coletados e enviados para estudo histológico. Resultados: O tempo de isquemia mostrou forte influência com a graduação histológica. Com 30 minutos de isquemia, nenhum comprimento de onda (408, 442 e 532 nm) apresentou correlação com a graduação histológica (p = 0,81; p = 0,11; p = 0,21, respectivamente). Com 60 minutos de isquemia, o laser de excitação de 532 nm (na fase de reperfusão) apresentou coeficiente de correlação negativa significativa (r = - 0,61) com a graduação histológica. Na isquemia de 120 minutos, o laser com 442 nm de comprimento de onda (na fase de reperfusão) mostrou o coeficiente de correlação negativa significativa (r = - 0,73) com a graduação histológica. O terço médio renal apresentou média estatística superior à dos polos (p < 0,001) na leitura da espectroscopia de fluorescência. Conclusões: Há correlação entre os dados da espectroscopia de fluorescência induzida pelo laser e as alterações histológicas na isquemia renal em ratos, sendo necessário, durante a investigação, analisar apenas o terço médio renal.Introduction: Renal transplantation is widely recognized as the best form of treatment for patients who require renal replacement therapy. Often, the transplant team is faced with a difficult question, if organs from deceased marginal donors or non-heart beating donors are able to be transplanted. It is difficult to quantify the intensity of damage caused by ischemia in the graft to be used, especially if the donor had hemodynamic instability with a significant decrease of the tissue perfusion and an increased of the risk of diminishing the graft function which could affect adversely its survival. Thus it is justified to use the technique of laser-induced fluorescence spectroscopy, to assess the correlations between its results and the histological grade in experimental renal injury, since it is an objective, non-invasive, fast and in real-time analysis, which can be applied, in the future, in human kidney transplants. Objectives: To evaluate the correlation between the data of laser-induced fluorescence spectroscopy and histological changes in kidney ischemia and reperfusion in rats, and if there are significant differences of reading between the upper and lower poles and the middle area of such kidneys. Materials and Methods: We used 33 adults male rats (Rattus norvegicus) of Wistar strain, which after anesthetized, had their left kidney addressed. Initially such kidneys were submitted to detection of the fluorescence spectroscopy of the upper pole, lower pole and the middle area. Excitations were generated by lasers having wavelengths of 408, 442 and 532 nm. Then the left renal pedicles were dissected, isolated and clamped. Then the animals were randomized into three ischemic groups of 30, 60 and 120 minutes. In each group, the kidneys were analyzed by fluorescence spectroscopy for the second time, and again after 5 minutes of reperfusion, using excitatory beam with same wavelength, at the poles (upper and lower) and the middle area of the kidneys. Later, the left kidney were collected and sent for histological examination. Results: The ischemia time showed a strong influence on the histological grade. With 30 minutes of ischemia, no wavelength (408, 442 and 532 nm) was correlated with the histological lesions (p = 0.81, p = 0.11, p = 0.21, respectively). With 60 minutes of ischemia, the laser excitation of 532 nm (in the reperfusion phase) showed a significant negative correlation coefficient (r = - 0.61) with the histological grading. In 120 minutes of ischemia, laser with 442 nm wavelength (in the reperfusion phase) showed a significant negative correlation coefficient (r = - 0.73) with the histological grade. The middle area of the kidneys showed a higher average statistically (p< 0,001) than the poles in the reading of fluorescence spectroscopy. Conclusions: There is a strong correlation between the data of laser-induced fluorescence spectroscopy and the histological changes in rats renal ischemia, being necessary, during the investigation, to analyze only the middle area of the kidneys.
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Delaney, Michael Paul. "Immunosuppressive drug interactions and resistance in mononuclear cells from renal transplant patients." Thesis, University of Warwick, 2001. http://wrap.warwick.ac.uk/3703/.
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Existing anti-rejection drug regimes are inadequate since patients receive drugs despite serious side effects and poor response. New drugs are being developed which ultimately may allow for prescribing of rational, patient-specific immunosuppressive drug protocols. During this thesis the investigation of lymphocyte responses from renal transplant recipients to the immunosuppressant drugs Cyclosporin A (Cy A), FK506 and SDZ RAD were explored to understand the variation in sensitivity of lymphocytes to Cy A and FK506, the development of drug resistance, including resistance mechanisms, and the interactions between FK506 and SDZ RAD. Cy A and FK506 are substrates for P-glycoprotein (P-gp), the product of the multidrug-resistance (MDR1) gene in man. A hypothesis established during this thesis was that P-gp dependent mechanisms explain variations in lymphocyte sensitivities to Cy A and FK50. Lymphocytes from renal transplant recipients were assessed for their sensitivity to Cy A and FK506 and subsequently for P-gp expression and functional activity by flow cytometry. In further lymphocyte cultures the effect of the specific P-gp inhibitor, PSC 833 on sensitivity was investigated. Finally, the effects of the combination of FK506 and SDZ RAD in lymphocyte cultures were analysed. Results demonstrate a wide range in lymphocyte sensitivity to both Cy A and FK506, with the development of selective resistance to the drug used for treatment. All patients demonstrated P-gp functional activity but P-gp expression was not demonstrable. P-gp function did not account for the variation in lymphocyte sensitivity. There was no evidence of antagonism of effect of SDZ RAD in combination with FK506. In conclusion, these results suggest that non-P-gp mechanisms account for variations in lymphocyte sensitivity to Cy A and FK506. Combination therapy with SDZ RAD and FK506 is unlikely to be antagonistic in future treatment protocols.
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Crow, Leah. "Impact of Body Mass Index on Medicare Payments in Renal Transplant Recipients." University of Cincinnati / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1399276000.
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Cunnane, Bethan. "Renal transplant recipients’ adherence to immunosuppressant medication : an interpretative phenomenological analysis." Thesis, Cardiff University, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.437078.
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Dummett, Danielle Lisa. "Renal transplant failure : an exploration of patients' experiences from a psychological perspective." Thesis, Cardiff University, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.435961.
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Oliveira, Paula. "Transplante renal : desigualdades no acesso." Master's thesis, Universidade Nova de Lisboa. Escola Nacional de Saúde Pública, 2011. http://hdl.handle.net/10362/9419.
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RESUMO - Em Portugal estima-se que existam cerca de 14 mil insuficientes renais crónicos e estima-se que em 2025 sejam 24 mil. As alternativas de tratamento são: hemodiálise, diálise peritoneal ou o transplante renal. Das alternativas de tratamento, o transplante renal é considerado a melhor alternativa terapêutica proporcionando melhor qualidade de vida, aumentando a sobrevida dos doentes, caracterizando-se por ser menos oneroso e por apresentar melhor custo- efectivo, quando comparado com hemodiálise ou diálise peritoneal. Portugal situa-se entre os primeiros da Europa, relativo ao número de transplantes renais efectuados (56,1 por milhão de habitante), em 2010 efectuaram-se 573 transplantes renais. Apesar disso, muitos são os doentes que continuam em lista de espera a aguardar transplante, em média os doentes esperam cerca de dois a três anos por um transplante renal, quando o tempo ideal seria três a seis meses. Por outro lado, estudos internacionais demonstram que existem desigualdades no acesso ao transplante renal, assim à semelhança de outros países torna-se pertinente estudar a realidade portuguesa em relação à temática da desigualdade no acesso, dado o objectivo primordial do Serviço Nacional de Saúde de garantir a equidade nos cuidados de saúde.
Este trabalho tem como objectivo principal avaliar se factores como o sexo, idade a localização geográfica influenciam o acesso ao transplante renal, contribuindo para desigualdades no acesso.
Este trabalho baseou-se na base de dados dos doentes inscritos em lista de espera para transplante renal, respeitante à área de abrangência do Centro de Histocompatibilidade do Sul. Caracterizou-se a população quanto ao sexo, idade, concelho, região de saúde e unidade de transplantação. Determinou-se ainda, os tempos médios de espera para inscrição em lista activa e para transplante por sexo, idade, região de saúde e unidade de transplantação.Dos resultados obtidos salienta-se que as desigualdades encontradas no acesso ao transplante renal verificam-se entre o início do tratamento até à inscrição em lista activa para transplante. Depois dos doentes em lista activa, o tempo de espera médio não é influenciado significativamente pelo sexo, idade ou localização geográfica.ABSTRACT - In Portugal it is estimated that approximately 14,000 people suffer from chronic renal failure, and it is estimated that this number will increase 24,000 in 2025 Treatment alternatives are the following: hemodialysis, peritoneal dialysis and kidney transplantation. Among treatments, kidney transplantation is considered the best therapeutic alternative because it improves quality of life and increase patient’s survival. This technique is less costly and more cost-effective, when compared with hemodialysis or peritoneal dialysis. Portugal is among the first in Europe regarding the number of kidney transplants performed (56,1 per million inhabitants), in 2010 were carried out 573 kidney transplants. Nevertheless, many patients are still on the waiting list, awaiting for transplant. On average patients wait approximately two to three years for a kidney transplant, when the ideal time would be three to six months. On the other hand, international studies show that there are inequalities in access to kidney transplantation. Hence, it is relevant to analyze the Portuguese reality of unequal access to kidney transplantation, also so given the primary objective of the National Health Service to guarantee equity in health care delivery. In the present work we analyze whether factors such as sex, age or geographic location, contribute to inequalities in access to kidney transplantation. This work is based on a database of patients on waiting list for kidney transplantation; in the South Centre Histocompatibility catchment area. The population is characterized by gender, age, county, region and health unit transplantation. We analyze the average waiting time for being included in the active list for transplantation, and in waiting time for transplantation according to sex, age, health region and transplant unit. Results show that inequalities in access to kidney transplantation occur between the start of treatment and the inscription on the active list for transplantation. When patients are already in the active list, the average waiting time is not significantly influenced by gender, age or geographical location.
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Júnior, Valter Torezan Gouvêa. "Efeitos do pré-condicionamento isquêmico e suplementação de glutamina na isquemia e reperfusão renal - Estudo experimental em ratos." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/17/17137/tde-29082016-144206/.
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Introdução: A isquemia e reperfusão, que ocorre durante cirurgia renal, pode desencadear lesões que são mediadas por radicais livres produzidos na fase de reperfusão. A glutamina exerce propriedades positivas no sistema antioxidante por ação da glutationa. O pré- condicionamento isquêmico aumenta a tolerância a tecidos que sofrem isquemia. Objetivo: Avaliar a ação da glutamina associada ao pré-condicionamento isquêmico na isquemia e reperfusão renal em modelo animal. Métodos: Cinquenta ratos winstar machos foram submetidos à nefrectomia a direita. No oitavo dia de pós-operatório os animais foram randomizados em cinco grupos (n=10) que foram assim divididos: grupo I - grupo Sham, grupo II - grupo isquemia e reperfusão, grupo III - grupo pré-condicionamento isquêmico, grupo IV - grupo glutamina e grupo V- pré-condicionamento isquêmico associado a glutamina. Os grupos IV e V receberam glutamina através de gavagem por sete dias. Ao final do 14º dia da nefrectomia procedeu-se a isquemia renal esquerda por 45 minutos. Após 1 e 7 dias, cinco animais de cada subgrupo foram submetidos a nova cirurgia com coleta de sangue e retirada de tecido renal. Resultados: Após um dia de reperfusão o grupo V apresentou os níveis mais elevados de glutationa reduzida (2,55±0,34mmol/g tecido) quando comparado aos outros grupos. A atividade da enzima superóxido dismutase apresentou-se elevada no grupo V quando comparado ao grupo II (p=0.018). Já no sétimo dia de reperfusão o grupo V apresentou-se com a maior atividade da enzima glutationa peroxidase dentre todos os grupos (p=0.009), bem como a atividade da enzima glutationa reduzida (p=0,001). Neste mesmo dia a superóxido dismutase mostrou-se mais elevada no grupo V quando comparado aos grupos que sofreram intervenção isquêmica (p=0.02). No sétimo dia a caspase-3 e a proteína carbonilada do grupo V se mostraram com maiores valores quando comparados aos grupos restantes. A associação da glutamina ao pré-condicionamento isquêmico elevou a glutationa reduzida e superóxido dismutase no grupo no primeiro dia após a reperfusão. No sétimo dia após a reperfusão se observa uma persistente elevação da superóxido dismutase, enzimas glutationa peroxidase e glutationa redutase bem como os níveis de caspase-3 e proteína carbonilada. Conclusão: Neste modelo de isquemia renal por clampeamento de pedículo seguido de reperfusão se conclui que há uma potencialização do efeito antioxidante da associação da glutamina e pré-condicionamento isquêmico após 24 horas de reperfusão, entretanto tal efeito não é mantido até o sétimo dia após a reperfusão.Introduction: Ischemia and reperfusion injury that occurs during renal surgery can trigger injuries that are mediated by free radicals generated in the reperfusion phase. Glutamine exerts positive properties in the antioxidant system by the action of glutathione. Ischemic preconditioning increases tolerance to tissue suffering ischemia. Objective: To evaluate the action of glutamine associated with ischemic preconditioning in ischemia and reperfusion in animal models. Methods: Fifty rats Winstar males underwent nephrectomy right. On the eighth day after the operation the animals were randomized into five groups (n = 10) were divided as follows: Group I - sham group, II - ischemia and reperfusion group, III - ischemic preconditioning group, IV - glutamine group and group V- ischemic preconditioning group associated with glutamine. Groups IV and V received glutamine via gavage for seven days. At the end of 14 days nephrectomy proceeded to the left renal ischemia for 45 minutes. After 1 and 7 days, five animals in each subgroup underwent new surgery with blood collection and removal of kidney tissue. Results: After one day reperfusion group V showed higher levels of reduced glutathione (2.55 ± 0,34mmol / g tissue) compared to other groups. The enzyme activity superoxide dismutase showed up high in the V group compared to group II (p = 0.018). In the seventh day of reperfusion group V presented with the increased activity of glutathione peroxidase enzyme among all groups (p = 0.009) as well as the activity of reduced glutathione (p = 0.001). On the same day the superoxide dismutase was shown to be higher in the V group compared to groups who have suffered ischemic intervention (p = 0.02). On the seventh day caspase- 3 and protein carbonyl group V are shown with larger values when compared to the other groups. The association of glutamine to ischemic preconditioning increased the reduced glutathione and superoxide dismutase in the group on the first day after reperfusion. On the seventh day after reperfusion is observed a persistent elevation of superoxide dismutase, glutathione peroxidase enzymes and glutathione reductase and the levels of caspase-3 and protein carbonyl. Conclusion: In this model of renal ischemia by clamping the pedicle followed by reperfusion is concluded that there is a potentiation of the antioxidant effect of glutamine association and ischemic preconditioning after 24 hours of reperfusion, however this effect is not maintained until the seventh day after reperfusion.
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Marques, Bethânia Buzato. "Função sexual de mulheres com doença renal crônica." Faculdade de Medicina de São José do Rio Preto, 2018. http://hdl.handle.net/tede/449.
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
Chronic kidney disease (CKD) is highly prevalent and is currently a worldwide public health problem. It entails physical and psychological consequences and requires adaptation and change of lifestyle. Also, alterations in sexual function of men and women affected by such a disease, as well as decrease in libido are found in both sexes. Objective: to evaluate the performance and sexual satisfaction of women with chronic kidney disease and compare levels of performance and sexual satisfaction in the two main modalities of renal replacement therapy – hemodialysis and renal transplantation. Method: a descriptive cross-sectional study with 49 women enrolled in renal replacement therapy modalities (hemodialysis and renal transplantation) at Hospital de Base in the city of São José do Rio Preto - SP. For data collection, it was used data sheet containing socio-demographic information, scale for evaluation of sexual activity in women (SQ-F) and semi-structured interview. Results: 65,3% of collaborators have reported intense changes in body image after CKD, as well as decrease in libido and sexual performance. About 89,8% of collaborators present impairement in the SQ-F question regarding sexual desire. In the comparison between treatments, difference was significant in all SQ-F, except for question related to pain. When the total score of the instrument was evaluated, the group undergoing hemodialysis achieved a mean score of 39,0 (poor to unfavorable), and the kidney transplant group 70,0 (regular to good). Transplant collaborators has nine times greater chance (odds ratio – 9,2) of achieving better score in the instrument. Conclusion: the performance and sexual satisfaction of women with chronic kidney disease are impaired, which may be associated with different factors. In the comparison between groups, this study demonstrated significantly better sexual functioning in the transplant group.
A doença renal crônica apresenta elevada prevalência e constitui atualmente, um problema de saúde pública mundial. Acarreta consequências físicas, psicológicas e exige adaptação e mudança de estilo de vida. São também encontradas alterações na função sexual de homens e mulheres acometidos pela Doença Renal Crônica, assim como a diminuição da libido em ambos os sexos. Objetivo: avaliar o desempenho e a satisfação sexual de mulheres portadoras de Doença Renal Crônica e comparar os níveis desempenho e satisfação sexual nas duas principais modalidades de terapia renal substitutiva – hemodiálise e transplante renal. Método: estudo descritivo transversal, tendo como participantes 49 mulheres inseridas em modalidades de terapia renal substitutiva: Hemodiálise e Transplante Renal no Hospital de Base na cidade de São José do Rio Preto - SP. Foi utilizada para coleta de dados, ficha contendo informações sócio demográficas, escala para avaliação da atividade sexual na mulher (QS-F) e entrevista semiestruturada. Resultados: 65,3% das colaboradoras identificaram mudanças intensas na imagem corporal após a DRC. Assim como, diminuição na libido e no desempenho sexual. Cerca de 89,8% das colaboradoras apresentam prejuízo na questão do QS-F referente ao desejo sexual. Na comparação entre os tratamentos, a diferença foi significativa em todas as questões do QS-F, exceto na questão relacionada à dor. Quando avaliado pelo escore total do instrumento o grupo em tratamento hemodialítico alcançou a pontuação média de 39,0 (ruim a desfavorável), já o grupo de transplante renal 70,0 (de regular a bom). As colaboradoras em transplante apresentam probabilidade nove vezes maior (odds ratio – 9,2) de alcançarem melhor escore no instrumento. Conclusão: houve prejuízo clinicamente significativo no desempenho e satisfação sexual das mulheres portadoras de doença renal crônica, alterações que podem estar associadas a diferentes fatores. Na comparação de grupos, este estudo demonstrou um funcionamento sexual significativamente melhor no grupo transplante.
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Butler, Janet Ann. "Prevalence and psychosocial correlates of non-adherence to immunosuppressants in renal transplant recipients." Thesis, University of Southampton, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273830.
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Quigley, R. L. "Investigation of the mechanism of induction of immunologic unresponsiveness to renal allografts by blood transfusion." Thesis, University of Oxford, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.233514.
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Lima, Gilson José de. "Avaliação do desenvolvimento pondero-estatural em pacientes pediátricos submetidos a transplante renal no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/17/17137/tde-07012016-104855/.
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Introdução: A prevalência de doença renal crônica na faixa etária pediátrica ainda é desconhecida. O tratamento de escolha é o transplante renal, independente da idade. Os principais objetivos do tratamento são a manutenção do desenvolvimento físico, neurológico e esquelético, prevenção da doença do metabolismo mineral e ósseo (DMMO), adequada maturação sexual e da função endócrina. O déficit de crescimento está relacionado com a idade de surgimento da insuficiência renal e ocorre devido à má-nutrição energético-calórica, DMMO e uso de corticoide, além dos efeitos deletérios da anemia, uremia e resistência ao hormônio do crescimento. Causas relacionadas ao paciente como retardo de crescimento intra-uterino e malformações congênitas também estão relacionadas. Objetivos: avaliar o desenvolvimento pondero-estatural dos pacientes pediátricos submetidos a transplante renal no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HC FMRP-USP). Casuística: revisão dos prontuários dos pacientes pediátricos submetidos a transplante renal no HC FMRP-USP e análise do desenvolvimento pondero-estatural comparando os score-z altura para idade e índice de massa corporal (IMC) para idade durante o acompanhamento. As variáveis analisadas foram sexo, faixa etária, uso de Basiliximab, realização ou não de diálise, tipo de transplante realizado (doador falecido ou doador vivo relacionado), hipertensão arterial, dose de manutenção de prednisona. Resultados: foi possível avaliar os dados de 31 pacientes, 10 femininos e 21 masculinos. Ao longo do tempo houve ganho significativo em peso (p< 0,0001) e estatura (p< 0,0001) mas nenhuma das variáveis analisadas mostrou diferença estatisticamente significativa. Houve interação significativa do uso de Basiliximab e da faixa etária sobre o IMC e do uso de Basiliximab, faixa etária e dose de prednisona utilizada sobre a evolução da estatura. A estatura manteve abaixo da média padrão durante todo o acompanhamento e nenhum paciente atingiu a altura final esperada. O IMC estava abaixo da média padrão na ocasião do transplante mas a partir do primeiro ano recuperou e manteve estável em torno do percentil 0. Conclusões: a doença renal crônica na infância compromete o desenvolvimento ponderoestatural dos pacientes afetados.Introduction: The prevalence of chronic kidney disease in the pediatric age range is still unknown. The treatment of choice is a renal transplant, regardless of age. The main objectives of treatment are the maintenance of physical, neurological and skeletal development, the prevention of renal osteodystrophy, and appropriate sexual and endocrine function maturation. The growth deficit is related to the age at onset of renal failure and is due to energy-calorie malnutrition, to renal osteodystrophy and to corticoid use, in addition to the deleterious effects of anemia, uremia and of resistance to growth hormone. Additional patient-related causes are intrauterine growth retardation and congenital malformations. Objectives: to assess the weight-height development of pediatric patients submitted to renal transplantation at the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo (HC FMRP-USP). Patients: The medical records of pediatric patients submitted to renal transplantation at HC FMRP-USP were reviewed and weight-height development was analyzed by comparing the zscores for height for age and body mass index (BMI) for age during follow-up. The variables analyzed were: sex, age range, use of Basiliximab, having undergone dialysis or not, type of transplant performed (cadaver donor or related live donor), arterial hypertension, and maintenance dose of prednisone. Results: it was possible to assess the data of 31 patients, 10 girls and 21 boys. A significant weight gain (p<0.0001) and height (p<0.0001) occurred over time but none of the variables analyzed showed a statistically significant difference. There was a significant interaction between age range and BMI, between the use of Basiliximab and age range and between the prednisone dose used and height evolution. Height was below the standard mean value throughout follow-up and no patient reached the expected final height. BMI was below the standard mean value at the time of transplantation, but recovered after the first year and remained stable at a value of about 0. Conclusions: renal failure during childhood compromises the weight-height development of affected patients.