>Cirugía y Cirujanos
>Year 2009, Issue 5
Ruiz-George OM, Trujillo-Hernández B, Millán-Guerrero RO, Vásquez-Jiménez C
Isquemia fría prolongada, factor para rechazo agudo del injerto en trasplante renal cadavérico
Cir Cir 2009; 77 (5)
PDF: 73.50 Kb.
Background: Exposure of renal grafting to prolonged cold ischemia time (CIT) and the association with acute rejection (AR) are known. However, there is no evidence in Mexico about this topic. Thus, the objective of this study was to evaluate prolonged CIT as a risk factor for AR in renal grafting of cadaveric kidney transplantation in a Mexican population.
Methods: A cross-sectional study was carried out. Clinical files of patients undergoing renal grafting using cadaveric kidneys were reviewed from July 1994-June 2004. Prolonged CIT (≥12 h) as a risk factor for AR was evaluated. Other related variables were also examined.
Results: From 425 kidney transplantations, only 33 cases were cadaveric. Ten patients had AR. Prolonged CIT (OR 8.4; CI 1.5-44.2, p = 0.02) and azathioprine (AZA)-prednisone (PDN)-cyclosporine (CSA) combination (OR 9.1; CI 1.5-49.4, p = 0.02) were risk factors for AR. Anti-CD25 use (OR 0.6; CI 0.009-0.37, p = 0.001) and mycofenolate mofetil (MMF)-PDN-CSA combination (OR 0.1; CI 0.02-0.65, p = 0.02) were protective factors for AR.
Conclusions: In a Mexican population, prolonged CIT and AZAPDN-CSA combination were risk factors for AR. Meanwhile, anti-CD25 use and MMF-PDN-CSA combination were protective factors for AR in cadaveric kidney transplantations.
||Renal transplantation, graft, acute rejection.
Treviño-Becerra A. Insuficiencia renal crónica: enfermedad emergente, catastrófica y por ello primaria. Cir Cir 2004;72:3-4.
Ojo AO, Wolfe RA, Held PJ, Port FK, Schmouder RL. Delayed graft function: risk factors and implications for renal allograft survival. Transplantation 1997;63:968-974.
Bryan CF, Luger AM, Martínez J, Muruve N, Nelson PW, Pierce GE, et al. Cold ischemia time: an independent predictor of increased HLA class I antibody production after rejection of a primary cadaveric renal allograft. Transplantation 2001;71:875-879.
Mota A. Acute rejection in cadaveric renal transplantation under cyclosporine based therapy. Analysis of the risk factors and its influence on chronic dysfunction. Acta Med Port 2004;17:8-14.
Roodnat JI, Mulder PG, Van Riemsdijk IC, IJzermans JN, van Gelder T, Weimar W. Ischemia times and donor serum creatinine in relation to renal graft failure. Transplantation 2003;75:799-804.
Salahudeen AK, Haider N, May W. Cold ischemia and the reduced longterm survival of cadaveric renal allografts. Kidney Int 2004;65:713-718.
Gueler F, Gwinner W, Schwarz A, Haller H. Long-term effects of acute ischemia and reperfusion injury. Kidney Int 2004;66:523-527.
Asderakis A, Dyer P, Augustine T, Worthington J, Campbell B, Johnson RW. Effect of cold ischemic time and HLA matching in kidneys coming from “young” and “old” donors: do not leave for tomorrow what you can do tonight. Transplantation 2001;72:674-678.
Hwang AH, Cho YW, Cicciarelli J, Mentser M, Iwaki Y, Hardy BE. Risk factors for short- and long-term survival of primary cadaveric renal allografts in pediatric recipients: a UNOS analysis. Transplantation 2005;80:466-470.
Connolly JK, Dyer PA, Martin S, Parrott NR, Pearson RC, Johnson RW. Importance of minimizing HLA-DR mismatch and cold preservation time in cadaveric renal transplantation. Transplantation 1996;61:709-714.
Kunz R, Neumayer HH. Maintenance therapy with triple versus double immunosuppressive regimen in renal transplantation: a meta-analysis. Transplantation 1997;63:386-392.
Shapiro R, Scantlebury VP, Jordan ML, Vivas C, Ellis D, Lombardozzi-Lane S, et al. Pediatric renal transplantation under tacrolimus-based immunosuppression. Transplantation 1999;67:299-303.
Pascual M, Saidman S, Tolkoff-Rubin N, Williams WW, Mauiyyedi S, Duan JM, et al. Plasma exchange and tacrolimus-mycophenolate rescue for acute humoral rejection in kidney transplantation. Transplantation 1998;66:1460-1464.
The Tricontinental Mycophenolate Mofetil Renal Transplantation Study Group 2, 3. A blinded, randomized clinical trial of mycophenolate mofetil for the prevention of acute rejection in cadaveric renal transplantation 1. Transplantation 1996;61:1029-1037.
Ojo AO, Meier-Kriesche HU, Hanson JA, Leichtman AB, Cibrik D, Magee JC, et al. Mycophenolate mofetil reduces late renal allograft loss independent of acute rejection. Transplantation 2000;69:2405-2409.
Mota A. Sirolimus: a new option in transplantation. Expert Opin Pharmacother 2005;6:479-487.
>Cirugía y Cirujanos
>Year 2009, Issue 5