340 research outputs found
mTOR inhibitors for medical treatment of post-transplantation encapsulating peritoneal sclerosis: a favourable single center experience
No full textBACKGROUND:
Encapsulating peritoneal sclerosis (EPS) is a serious complication in patients on peritoneal dialysis (PD) causing intestinal obstruction. Two different forms of EPS are reported: the classical one observed in patients on PD, and post-transplantation EPS (PostTx-EPS). The first-line therapy of classical and PostTx-EPS remains surgical treatment, but for both the complication rate and mortality are high. Recently, a few cases of EPS were successfully treated with inhibitors of mammalian target of rapamycin (mTORi). The aim of this study was to evaluate PostTx-EPS outcome in our patients, focusing on the potential benefit of mTORi treatment.
METHODS:
We performed a retrospective analysis on 1,048 kidney transplanted patients at our center between 11/2001 and 12/2011.
RESULTS:
In the 226 patients treated with PD at any time before grafting, we found 10 cases of PostTx-EPS (prevalence 4.4%). The mean age was 54.9 years (26-69), with a mean time on PD of 83.1 months (33-156). The interval between kidney transplant and EPS diagnosis was 10.5 months (4-18.9). Five of the ten patients were treated after the diagnosis with mTORi, with a favorable outcome in 4/5 cases. This result was substantially independent of surgical and steroid therapy, performed in 9/10 and 10/10 patients respectively.
CONCLUSION:
EPS is a serious complication but susceptible to improvement if early diagnosed. mTORi represent a useful option for EPS treatment. We too suggest adopting an immunosuppressive protocol based on mTORi, mycophenolate mofetil and steroids in order to prevent PostTx-EPS in transplanted patients at high risk
Rationale of mesenchymal stem cell therapy in kidney injury
No full textNumerous preclinical and clinical studies suggest that mesenchymal stem cells, also known as multipotent mesenchymal stromal cells (MSCs), may improve pathologic conditions involving different organs. These beneficial effects initially were ascribed to the differentiation of MSCs into organ parenchymal cells. However, at least in the kidney, this is a very rare event and the kidney-protective effects of MSCs have been attributed mainly to paracrine mechanisms. MSCs release a number of trophic, anti-inflammatory, and immune-modulatory factors that may limit kidney injury and favor recovery. In this article, we provide an overview of the biologic activities of MSCs that may be relevant for the treatment of kidney injury in the context of a case vignette concerning a patient at high immunologic risk who underwent a second kidney transplantation followed by the development of ischemia-reperfusion injury and acute allograft rejection. We discuss the possible beneficial effect of MSC treatment in the light of preclinical and clinical data supporting the regenerative and immunomodulatory potential of MSCs
Patologie dermatologie e rischio di neoplasia in pazienti portatori di trapianto di rene: revisione della casistica torinese
No full textL’insufficienza renale cronica determina la comparsa di specifiche alterazioni cutanee; cute e rene sono, infatti, complementari nella funzione emuntoria e nel mantenimento dell’omeostasi idro-elettrolitica, termica e della pressione arteriosa. Con il ripristino della funzionalità renale conseguente al trapianto, molte di queste condizioni patologiche vanno incontro a regressione. Tuttavia è noto dalla letteratura che altre patologie, quali le infezioni o le neoplasie della cute, si manifestano nei soggetti portatori di trapianto con frequenza maggiore rispetto alla popolazione non trapiantata.
Scopo di questo lavoro è valutare su una casistica di pazienti sottoposti a trapianto di rene presso il Centro Trapianti di Torino, l’effettiva incidenza di neoplasie cutanee e di altre patologie di competenza dermatologica e la correlazione tra queste, il tipo e la durata del trattamento immunosoppressivo e gli altri fattori di rischio endogeni ed esogeni; i dati sono stati elaborati mediante analisi univariata e multivariata.
Sono stati presi in considerazione complessivamente 283 pazienti (175 maschi e 108 femmine), sottoposti a trapianto di rene tra il 1974 e il 2009. L’età mediana al trapianto era di 50 anni (range 11-76). Al momento della visita dermatologica di controllo l’età mediana era di 58 anni (range 23-82), mentre il tempo mediano intercorso dalla data del trapianto era di 7,2 anni.
Per tutti i pazienti è stata valutata il tipo e la durata della terapia immunosoppressiva e la presenza di altri eventuali fattori di rischio endogeni (fototipo, familiarità...) o esogeni (esposizione solare o a fonti artificiali di UV professionale o ricreativa, pregresse ustioni...). In quattro pazienti all’anamnesi risultava l’exeresi di una neoplasia cutanea (3 epiteliomi, 1 melanoma) precedente il trapianto; altri 99 (34.5%) al momento della visita sono risultati affetti da una precancerosi (8) o una neoplasia (66 epiteliomi, 8 melanomi, 17 altre) insorta nel periodo successivo al trapianto. I melanomi erano prevalentemente “in situ” o sottili; tra gli epiteliomi, l’istotipo spinocellulare era rappresentato più frequentemente rispetto alla popolazione non trapiantata e costituiva il 33.3% delle diagnosi. Per entrambe le neoplasie, le sedi più colpite erano quelle fotoesposte e i soggetti con maggior rischio erano quelli di età più avanzata, con fototipo chiaro o anamnesi positiva per ustioni solari.
Nel 12.4% dei pazienti sono state diagnosticate infezioni cutanee; queste erano nella maggior parte dei casi rappresentate da patologie virali (verruche, molluschi contagiosi) o micotiche (onicomicosi) di scarsa rilevanza clinica e comunque non tali da rendere necessaria la modificazione del trattamento immunosoppressivo. Le patologie cutanee infiammatorie croniche e autoimmuni erano scarsamente rappresentate, probabilmente come conseguenza di un ruolo terapeutico indiretto svolto dalla terapia immunosoppressiva. Anche per quanto riguarda gli effetti secondari di competenza dermatologica conseguenti alla terapia antirigetto non sono state osservate manifestazioni di particolare rilievo; il farmaco più frequentemente implicato era il cortisone e l’effetto più comunemente osservato la follicolite.
In conclusione, la nostra esperienza conferma la necessità di un adeguato follow-up dermatologico per i pazienti sottoposti a trapianto di rene; i tempi e le modalità dei controlli devono però essere valutati prendendo in considerazione non solo la durata e il tipo di terapia immunosoppressiva ma anche le caratteristiche fenotipiche del paziente e la presenza di altri eventuali fattori di rischio
Persistently high-level polyomavirus BK replication in the absence of renal function abnormalities in a kidney transplant recipient
No full textPolyomavirus-associated nephropathy is an important cause of allograft dysfunction and graft loss after kidney transplantation. Even if histological evaluation is the gold standard for graft study and diagnosis of polyomavirus-associated nephropathy, K-DIGO guidelines suggest performing an indication biopsy in selected patient’s clinical conditions or laboratory parameters. The practice of protocol biopsy is still controversial. We report the management of a case of presumptive polyomavirus-associated nephropathy in a 53-year-old kidney transplant recipient affected by type 1 hyperoxaluria with persistent high levels of viruria and sustained levels of polyomavirus BK viremia. The presence of a presumptive polyomavirus-associated nephropathy, even if never confirmed by biopsy, never compromised his clinical condition and allograft function. As a result of an immunosuppression-sparing policy and use of mTOR inhibitor, the polyomavirus BK viremia was successfully controlled with an observation time >5 years. The decision to perform or not a graft biopsy was the main question in the management of this case. We opted for a non-invasive approach because of the high risk of biopsy with macrohematuria on earlier biopsy in a dual kidney transplant and patient’s unwillingness for the procedure. The replication level of polyomavirus BK was significantly reduced by the decrease of immunosuppression on the basis of a close nucleic acid testing monitoring. The strategy we adopted could be considered in cases when renal biopsy is contraindicated or considered to be high risk
The evolution of biocompatibility: from microinflammation to microvesiscles
No full textThe outlook of more biocompatible and physiological dialysis is today confronted with a older and sicker population in need of maintenance hemodialysis. The knowledge of biological mechanisms operating at the system level will be approached with the help of improved technologies hopefully able to reduce the deleterious effect of the repetitive contact with a foreign surface and to insure optimal performances for the elimination of small and middle molecule solutes. Advances in dialyzer membranes and geometries, as well as blood tubings The Evolution of Biocompatibility: From Microinflammation to Microvesiscles 107 together with new concepts in machine technology have already shown their great potential to improve survival and cardiovascular stability
Early cyclosporine withdrawal from a sirolimus-based regimen results in better renal allograft survival and renal function at 48 months after transplantation
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Early appearence of de novo anti-Hla antibodies following renal transplantation: preliminary results of a multicenter study
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