Biomedical subjects

Ana Sánchez-Fructuoso

Publications and source records attributed to Ana Sánchez-Fructuoso.

3 recordsLinked to original sources

PubMed2006

Increase of proteinuria after conversion from calcineurin inhibitor to sirolimus-based treatment in kidney transplant patients with chronic allograft dysfunction.

BACKGROUND: Conversion from calcineurin inhibitor to sirolimus, rapamycin has become an option in patients with chronic allograft dysfunction (CAD). However, in many cases an increase of proteinuria has been observed. The aim was to characterize the course of this so far unexplained proteinuria after conversion. METHODS: In 149 renal transplant patients from various Spanish centres, proteinuria and renal function were analysed 6 months before until 6 months after conversion. Patients were divided into three groups according to mean proteinuria before conversion (1: 300-3500 mg/day; 3:>3.5 g/day). RESULTS: Generally patients showed an increase of proteinuria from 864+/-1441 (0-12125) to 1541+/-1878 (0-10976) mg/day after conversion; P<0.001. Group 1: 145+/-92 vs 669+/-868 mg/day, P<0.001; group 2: 1041+/-799 vs 1995+/-2021 mg/day, P<0.001; group 3: 6205+/-3184 vs 4859+/-2122 mg/day, P=NS. Patients with an increase of proteinuria of >500 mg/day (n=60; 40%) had a higher serum creatinine before conversion compared with patients with no or moderate increase (2.5+/-0.8 vs 2.15+/-0.72 mg/dl; P=0.002). The group that experienced an increase>500 mg/day had a higher serum creatinine after conversion compared with the patients with no or moderate increase (2.8+/-1.0 vs 2.1+/-1.2; P<0.001). Of 64 patients, 19 in group 1 showed an increase>500 mg/day. CONCLUSION: Conversion for CAD can be associated with an increase of proteinuria in patients with pre-existing renal damage; however, it preserves renal function in patients with better creatinine and proteinuria before conversion, and might not be of benefit if advanced loss of renal function and high proteinuria are already present before conversion.

Calcineurin Inhibitors↗

PubMed2005

Expression of adhesion molecules and RANTES in kidney transplant from nonheart-beating donors.

The main difference between cadaveric kidneys from donors with a heartbeat (HBD) and kidneys from nonheart-beating donors (NHBD) is related to warm ischemia/reperfusion time which constitutes an acute inflammatory process. On the contrary, brain death induces in HBD expression of pro-inflammatory adhesion molecules, making it important to evaluate this kind of molecules in both types of donors. Human renal biopsies from NHBD, HBD and normal kidneys (ischemia time = 0) were taken and frozen just before transplant. A semi-quantitative RT-PCR method was used to determine intracellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), lymphocyte function associated antigen (LFA-1), LFA-3, CD40, CD40 ligand (CD40L) and RANTES (regulated upon activation, normal T-cell expressed and secreted) gene expression. We have detected an elevated relative gene expression of ICAM-1, VCAM-1 and RANTES in NHBD biopsies compared with normal kidneys. In the case of RANTES, the gene expression from NHBD biopsies was higher than observed in HBD biopsies. The rest of genes were not augmented in any group. Preliminary data about early outcome of transplants indicates a correlation between pretransplant RANTES high gene expression levels and early post-transplant acute rejection. The gene expression of pro-inflammatory molecules like adhesion molecules and RANTES is augmented in kidneys from cadaveric NBD just before transplant. The expression is higher probably because of the prolonged warm ischemia period. A larger clinical study is necessary to clarify the effects of these variable expressions on the transplant outcome.

Adult↗

PubMed2004

Non-heart beating donors.

BACKGROUND: Several groups have demonstrated that non-heart beating donation is a viable source of organs for transplantation. However, the theoretically worse graft function and survival of the kidneys obtained from non-heart beating donors (NHBDs) is still a matter of debate that has led to consider them as marginal donors for kidney transplantation. METHODS: In this report, we compare the outcome and course of 83 kidney transplants from NHBDs with those corresponding to 3177 adult cadaveric heart beating donor (HBD) transplants performed over the same period in our country. Graft and patient survival were estimated by means of Kaplan-Meier analysis. In addition, groups were compared using Cox proportional regression. RESULTS: The delayed graft function (DGF) rate was higher on NHBD transplants than in HBD kidneys (58.8 vs 28.9%, P<0.0001). However, in 1998, where the highest number of NHBD transplants was performed, graft function estimated by serum creatinine levels at 3 months and 1 year, was significantly better in the NHBD transplant group (1.42+/-0.45 vs 1.66+/-0.66 and 1.45+/-0.59 vs 1.62+/-0.64, respectively, P = 0.01 and 0.07). Graft survival at 2 years was 97%, 95% at 4 years and 84% at 6 years for NHBDs and 97, 90 and 84%, respectively, for HBDs. Interestingly, DGF was a risk factor for worse graft survival in HBDs but not on NHBDs. CONCLUSIONS: We conclude that, in our study, both graft function and graft survival of NHBD kidney transplants are at least similar to those from HBD transplants. Therefore, NHBDs should be considered as a viable source of non-marginal kidneys for transplant.

Death↗