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Background: Graft loss increases the risk of patient death after simultaneous pancreas‐kidney (SPK) transplantation. The relative risk of each graft failure is complex due to the influence of several competing events. Methods: This retrospective, single‐center study compared 4‐year patient survival according to the graft status using Kaplan‐Meier (KM) and Competing Risk Analysis (CRA). Patient survival was also assessed according to five eras (Era 1: 2001–2003; Era 2: 2004–2006; Era 3: 2007–2009; Era 4: 2010–2012; Era 5: 2012–2015). Results: Between 2000 and 2015, 432 SPK transplants were performed. Using KM, patient survival was 86.5% for patients without graft loss (n = 333), 93.4% for patients with pancreas graft loss (n = 46), 43.7% for patients with kidney graft loss (n = 16), and 25.4% for patients with pancreas and kidney graft loss (n = 37). Patient survival was underestimated using KM versus CRA methods in patients with pancreas and kidney graft losses (25.4% vs. 36.2%), respectively. Induction with lymphocyte depleting antibodies was associated with 81% reduced risk (HR.19, 95% CI.38–.98, p =.0048), while delayed kidney function (HR 2.94, 95% CI 1.09–7.95, p =.033) and surgical complications (HR 2.94, 95% CI 1.22–7.08, p =.016) were associated with higher risk of death. Four‐year patient survival increased from Era 1 to Era 5 (79% vs. 87.9%, p =.047). Conclusion: In this cohort of patients, kidney graft loss, with or without pancreas graft loss, was associated with higher mortality after SPK transplantation. Compared to CRA, the KM model underestimated survival only among patients with pancreas and kidney graft losses. Patient survival increased over time. [ABSTRACT FROM AUTHOR]

Procrastination is a delay in an intended course of action and, thus, a self‐regulation failure hindering growth and well‐being. Contrarily, self‐regulation is a set of cognitive and metacognitive skills and strategies supporting goal‐directed behavior. There is ongoing discussion regarding the extent to which (and the ways in which) promoting self‐regulation may counteract procrastination. On the one hand, it is argued that procrastination is linked with stable personal dispositions; on the other hand, it is said that this problematic behavior is associated with contextual influences. To deepen the understanding of these relationships, we used structural equation modeling (SEM) to test a theory‐driven model integrating four self‐regulation factors (goal setting, decision making, persevering, and learning from mistakes) and two measures of procrastination (irrational and academic). We hypothesized that goal setting, decision making, and perseverance would sequentially mediate between learning from mistakes and procrastination outcomes, thus, suggesting that cognitive‐motivational (learning from mistakes, goal setting), strategic (decision making), and volitional (perseverance) factors may all be necessary for successful self‐regulation, which could potentially be promoted by contextual influences. Participants of the present study were 433 Chilean university students (304 women, 129 men, M = 20.74 years, SD = 2.86) who completed measures for procrastination and self‐regulation. Findings support the important roles of goal setting and perseverance for successful self‐regulation and suggest that goal setting may mediate the effects of learning from mistakes on perseverance and decision making; whereas perseverance may mediate the effects of goal setting and decision making on procrastination variations. These results suggest that the negative effects of motivational and strategic factors of self‐regulation on procrastination may depend at least partly on the abilities to improve goals and persevere. Taking into account these critical roles in dealing with procrastination, it seems appropriate to support college students' self‐regulation skills and strategies, raising awareness about the indispensability of adequate goal setting and persistence in following through with intended courses of action. Practitioner Points: Student procrastination reflects failed behavioral self‐regulation.Motivation, strategy, and implementation are required to avoid procrastination.Teachers must provide ongoing support for goals, decisions, and perseverance. [ABSTRACT FROM AUTHOR]

Background: Because COVID‐19 has been associated with high lethality rates among kidney transplant recipients (KTR), but also with a severe disruption and delays in overall healthcare, this study aims to evaluate the excess mortality in the pandemic era among KTR in a high‐volume Brazilian transplant center. Methods: This study used data from a single center that provides follow‐up on all its transplant recipients. The population of interest included all the patients who were transplanted between August 31, 1983 and December 31, 2022 and who were live from January 1, 2014. Using the "AutoRegressive Integrated Moving Average" forecasting algorithm, the expected mortality for the pandemic era (2020–2022) was modeled from the pre‐pandemic era (2014–2019). Results: There were 12 077 KTRs at risk of dying in the entire observation period. In the pre‐pandemic era, there were 21 deaths per 1000 patients at risk. In the pandemic era, there were 1429 observed deaths (rate of 47 deaths per 1000 patients at risk) versus the expected 587 deaths, resulting in an absolute number of 842 excess deaths, or an observed‐to‐expected ratio of 2.4, or an absolute rate of 26 deaths in excess per 1000 patients at risk. The excess deaths exhibited a temporal pattern mirroring that of the surges in new cases and lethality rates of COVID‐19. COVID‐19‐related deaths drove 94% of excess mortality in the pandemic era. Conclusion: In this large cohort of KTR under centralized follow‐up, more than twofold excess mortality was primarily driven by COVID‐19‐related deaths, highlighting the vulnerability of this population to the most severe presentation of SARS‐CoV‐2 infection. [ABSTRACT FROM AUTHOR]

Background: The relationship between serum concentration of uric acid (UA) and chronic kidney disease is complex due to many confounding variables. There is currently debate over whether hyperuricemia acts as a marker of kidney disease or as an independent risk factor. Objectives: To test the impact of serum UA concentration on the estimated glomerular filtration rate (GFR) of children undergoing kidney transplantation. Patients and Methods: Prospective longitudinal study of children and adolescents after kidney transplantation. We analyzed clinical, anthropometric, and laboratory data at pre‐transplant and 1, 3, and 6 months after transplant. We developed models of repeated measures analysis, using the generalized estimating equations technique for the outcome evolution of the estimated GFR at 1, 3 and 6 months. High serum UA concentration at 1 and 3 months was modeled as the main exposure variable. Results: We included 103 transplant patients. In a model adjusted for time, recipient sex and age, the occurrence of acute rejection episodes, and the estimated glomerular filtration at baseline, the trajectory of GFR exhibited an inverse relationship with UA (β = −7.1, 95% CI: −11.5 to −2.6, p <.01). Conclusion: Serum UA increase was associated with lower graft function over time. [ABSTRACT FROM AUTHOR]

Background: In children with kidney failure, the longer the duration of dialysis the greater the impact on growth deficit, quality of life, and life expectancy. The aim of this research is to test whether there was a shortening of treatment time from kidney failure to transplantation in pediatric patients and whether this time interval impacted height. Methods: Observational retrospective cohort study from 2005 to 2018. The first outcome variable was time to transplantation in years, while the second was height/age standard deviation score (SDS) at transplantation. Cox regression models were used to analyze time from disease to transplantation and linear regression was employed to test the association of the year of kidney failure onset with height. Results: A total of 780 children were evaluated and 517 underwent kidney transplantation after a median time of 1.9 years (IQR = 1.0–4.0). The variables significantly associated with time to transplant were: year of kidney failure onset (HR = 1.07; 95% CI: 1.05–1.10; p <.001), age at kidney failure onset <12 years (HR = 0.59; 95% CI: 0.49–0.71; p <.001), living in different state as transplant center (HR = 0.63; 95% CI: 0.53–0.77; p <.001), and undergoing blood transfusion before transplantation (HR = 0.63; 95% CI: 0.53–0.75; p <.001). Regarding growth, for each 1‐year increase in the epoch of kidney failure onset, a 0.05 SDS raise in height/age is expected (p <.001). Conclusion: Children with recent kidney failure onset had significantly lower time to the outcome and this reduction was associated with a less severe growth deficit. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the impact of HLA‐DPB1 allelic and molecular mismatches on the occurrence of acute rejection (AR) and low 5‐year graft function (5Y‐GF) in first kidney transplant (KT) recipients. This is a single center retrospective study of 130 deceased donor KT recipients transplanted between 2014 and 2016. HLA‐DPB1 allelic MM and the following molecular MM (mMM) were analyzed: expression MM with the high expression G allele in the donor; T cell epitope MM (TCE MM); epitope MM (EMM), considering all six hypervariable regions (EMM‐ABCDEF HVR), or only ABEF regions (EMM‐ABEF HVR); eplet MM (EpMM); antibody‐verified eplet MM (AbVer EpMM); and solvent accessible amino acid MM (SAMM). There was no association of allelic MM with AR or 5Y‐GF. The variables independently associated (Cox regression analyses) with AR were high donor final creatinine, nonpermissive TCE MM, ABCDEF EMM load ≥6, EpMM load ≥6; SAMM load ≥5, and AbVer EpMM load ≥3. No association between any HLA‐DPB1 mMM and 5Y‐GF was observed when all 130 transplant recipients were considered. However, when transplants from expanded criteria donors were excluded, independent associations were detected (logistic regression analyses) with AbVerEpMM load ≥2, SAMM load ≥7, cerebro‐vascular death, donor age, and AR. To our knowledge, this is the first study that shows that some HLA‐DPB1 mMM are associated with AR and low 5Y‐GF in a population of exclusively first kidney transplant recipients. [ABSTRACT FROM AUTHOR]

Background: Children and adolescents undergoing kidney transplantation may present oral conditions after the procedure, but a few studies have recently described them. Aim: To describe the oral conditions of post‐renal transplant children and adolescents. Design: Two calibrated dentists examined all the participants by assessing caries experience, enamel defects, periodontal condition and soft tissue lesions. Results: A total of 120 participants were included in the study, in which 63 (52.5%) were male and 57 (47.5%) were female, with a mean age of 12.78 ± 3.9 years. Among the participants, 104 (86.7%) showed at least one oral change directly related to kidney disease. The most frequent oral findings were enamel defect (49/120; 40.8%) and drug‐induced gingival overgrowth (DIGO) (20/120; 16.7%). Gingival bleeding was observed on probing in 115 (95.8%) participants, whereas 69 (57.5%) presented dental calculus and 51 (42.5%) had caries experience. Conclusion: Gingival bleeding, enamel defects and DIGO were the most frequent oral findings in kidney transplant children and adolescents. The use of amlodipine and anticonvulsants was associated with DIGO, and there was a positive correlation between oral ulcers and use of everolimus. [ABSTRACT FROM AUTHOR]

HLA‐DQB2 is a gene of limited polymorphism, with unknown function that presents at least two transcript variants: v1, which encodes the full‐length beta‐chain, and v2, which lacks exon 4 and could give rise to a soluble protein. We previously showed a strong correlation between high v2 expression in preimplantation biopsies (PIB) of kidneys from young (18‐ to 49‐year olds) but not from old, deceased donors and 1‐year posttransplant low (estimated glomerular filtration rate < 45 ml/min/1.73 m2) graft function (GF). In this study, we aimed to investigate the impact of posttransplant soluble HLA‐DQB2 (sDQB2) serum levels, v1 expression in PIB, and recipient HLA‐DQB2 rs7453920 A/G polymorphism on GF. sDQB2 was evaluated by enzyme‐linked immunosorbent assay in sera from 114 recipients, collected at least 1 year (median 2.1 years) after transplantation. Higher sDQB2 levels were observed in recipients of kidneys from young, but not from old, donors that had a ≥30% decline in GF within 1 year after blood collection for sDQB2 determination. Among the 15 recipients of kidneys from young donors with sDQB2 ≥ 1.52 ng/ml, 40% presented a ≥30% decline in GF, whereas this occurred in none of the 43 recipients with lower sDQB2 levels (p = 0.007; OR: 36.5). Expression of HLA‐DQB2 variant 1, measured by reverse transcription‐polymerase chain reaction (RT‐PCR) in 92 PIB from young or old donors, did not significantly differ between transplants with high or low 4‐year GF. HLA‐DQB2 rs7453920 single nucleotide polymorphism (SNP) frequencies did not significantly differ between recipients with low or high 4‐year GF. We conclude that HLA‐DQB2 variant 1 expression in PIB and recipient rs7453920 SNP polymorphism are not associated with graft outcome. On the other hand, the association, in transplants of kidneys from young donors, between high posttransplant serum sDQB2 levels and decline in GF is a very interesting finding that deserves a validation study in a larger cohort. [ABSTRACT FROM AUTHOR]

The purpose of this single center retrospective study was to investigate the relationship between HLA and ABO polymorphisms and COVID‐19 susceptibility and severity in kidney transplant recipients. It included 720 recipients who had COVID‐19 and 1680 controls composed by recipients in follow‐up who did not contact the transplantation center for COVID‐19 symptoms, up to the moment of their inclusion in the study. HLA‐A, ‐B, and ‐DRB1 allele groups and ABO frequencies were compared between recipients with COVID‐19 (all cases, or separately mild/moderate and severe disease) and controls. The HLA association study was conducted in two case–control series and only associations that showed a p‐value <0.05 in both series were considered. No HLA association regarding COVID‐19 occurrence or severity met this criterion. Homozygosity at HLA‐A locus was associated with COVID‐19 susceptibility (odds ratio 1.4) but not severity. Blood groups A and O were associated with susceptibility and resistance to COVID‐19, respectively. COVID‐19 severity was associated only with older age and cardiac disease, in a multivariate analysis. We conclude that an influence of HLA on COVID‐19 susceptibility is supported by the association with homozygosity at HLA‐A locus but that there is no evidence for a role of any particular HLA‐A, ‐B, or ‐DRB1 polymorphism. Thus, we suggest that what matters is the overall capability of an individual's HLA molecules to present SARS‐CoV‐2 peptides to T cells, a factor that might have a great influence on the breadth of the immune response. [ABSTRACT FROM AUTHOR]

Introduction: Hospital do Rim is a high‐volume kidney transplant (KT) center located in São Paulo, a city with 12.2 million inhabitants. Over the last 18 years, we performed 11 436 KT, 70% of which from deceased donors. To mitigate the effects of reduction in the number of transplants on the waiting list, sequential measures were implemented when COVID‐19 was declared pandemic. Methods: The first step was to provide SARS‐COV‐2 RT‐PCR testing for all symptomatic employees and patients and the compulsory use of personal protective equipment in the hospital facilities. Living donor KT were postponed, and all deceased donors and recipients were tested before the transplantation. The immunosuppressive protocols were maintained, and telehealth strategies were developed. Results: Among the 1013 employees, there were 214 cases of COVID‐19, nine required ward hospitalization, and no deaths occurred. In 26%, the probable source of contamination was occupational. From the first patient diagnosed with COVID‐19 in 03/20/2020 till 10/21/2020, 523 deceased KT were performed, a 21% increase compared with 2019, with no confirmed donor‐derived SARS‐CoV‐2 infection. Four patients were transplanted with a positive pretransplant SARS‐CoV‐2 test, but none of them developed the disease. Overall, of 11 875 KT followed in our center, 674 developed COVID‐19. Among the hospitalized, 53% required mechanical ventilation, and 45% required hemodialysis. Their overall mortality rate was 27.5%. Conclusion: This experience shows the challenges that transplant centers faced as the pandemic unfolded and illustrates the effectiveness of the sequential measures implemented to provide a safe environment for transplantation. [ABSTRACT FROM AUTHOR]

Aims: This study aims to know whether poor oral health increases the risk of acute rejection and hospitalization in kidney allograft recipients. Methods and results: This is a prospective cohort study. The same dentist followed participants for 2 months after renal transplant for monitoring oral health (clinical evaluation, DTMF index, and CPITN index), signs of graft rejection, infection, and hospitalization. We compiled rates and reasons for hospital readmission or extended hospital stay. The CPITN had a mean score of 0.38 ± 0.71, increasing to 0.90 ± 0.84, 60 days after transplant (P <.001). No one rejected the graft in the period of study. Patients with older age (P =.009; OR: 1.07; CI 95% 1.01–1.12) were at higher risk of hospitalization at each year of age and patients presenting pretransplant dental focus (P =.001; OR: 7.23; CI 95% 2.13–24.56) had 7.23 times more chance to be hospitalized in the first 2 months after the transplant. One participant was hospitalized due to acute foci of dental infection. Conclusion: There was an association between dental focus and hospital readmission/stay. However, our methods do not provide conclusive proof of causality. Hospitalization due to acute dental infection was rare. [ABSTRACT FROM AUTHOR]

Background: The objective was to assess the oral shedding and viremia of human herpesviruses in renal transplant recipients. Methods: This is a cohort study in which the participants were examined in three different periods: the first within 24 hours before renal transplantation and the second and third ones 15‐20 and 45‐60 days after the transplantation. Mouthwash and blood samples were collected in each period and then submitted to screening for the presence of eight types of human herpesviruses by using multiplex PCR. Results: HSV‐1 and EBV were more frequent in the saliva after renal transplantation, 15‐ to 20‐day period after the transplant. EBV was found in the saliva of 26 (35.6%) patients before renal transplantation and in 56.2% and 46.6% of them, in the 15‐ to 20‐day and 45‐ to 60‐day periods after the transplant, respectively. High detection rates (75.3%‐78.1%) were found for HHV‐7 despite the lack of significant variations between the study periods. There was no concordance between herpesviruses oral shedding and viremia. Conclusion: We concluded that the pattern of excretion of HSV‐1 and EBV in saliva is changed immediately after renal transplantation, increasing in the 15‐ to 20‐day period after the transplant surgery. No concordance between herpesviruses oral shedding and viremia was observed. [ABSTRACT FROM AUTHOR]

Aim: Focal segmental glomerulosclerosis recurs in up to 30% and up to 80% of adult and pediatric kidney transplant recipients, respectively. There is no standard of care treatment. The purpose of this study was to evaluate clinical characteristics, treatments and outcomes of patients with focal segmental glomerulosclerosis recurrence (FSGSr). Methods: This was a retrospective single‐center cohort study including FSGSr patients treated with plasmapheresis (PP) and combinations of high dose steroids, cyclosporine and rituximab. Results: Among 61 patients included in this analysis the median time to diagnosis was 19 days. The incidence of first biopsy‐confirmed FSGSr was 18% reaching 52.4% with follow‐up biopsies. During PP treatment 54% of the patients developed infectious complications. PP was discontinued in 37% of patients due to treatment failure (no remission or graft loss) and in 26% due to an adverse event. All patients who discontinued PP due to adverse event did not show clinical response or lost the allograft. The incidence of acute rejection was 34.4%. The incidences of partial and complete remissions were 16.4% and 27.8%, respectively. Overall 6‐years patient and graft survivals were 90.7% and 64.5%, respectively. Conclusion: This analysis confirms the low, variable and unpredictable rate of FSGSr remission, inconsistencies among available therapeutic options and its high rate of adverse events, and the negative impact on graft survival. SUMMARY AT A GLANCE: A retrospective single centre study describing the characteristics, outcomes and response to treatment of patients with recurrent Focal segmental glomerulosclerosis. Less than 30% achieved complete remission with aggressive therapy, often complicated by adverse events and premature allograft loss. [ABSTRACT FROM AUTHOR]

Aim: To investigate if calcification and intimal media thickness (IMT) of arteries are present in children and adolescents with end‐stage renal disease and to describe the risk factors associated with these alterations. Methods: In an observational, cross‐sectional prospective study, 68 patients were evaluated at the time of renal transplantation. A fragment of the inferior epigastric artery was removed during surgery for histopathological analysis to verify the presence or not of arterial calcification. Two outcomes were considered: the presence of calcium deposition and the measurement of the IMT of the artery. The potential exposure variables were: age, chronic kidney disease aetiology, diagnosis time, systolic blood pressure (SBP), use of oral active vitamin D, homocysteine and C‐reactive protein. Results: No arterial calcification was observed in the studied sample. The median value of the IMT of the inferior epigastric artery was 166 μm (interquartile range = 130–208). SBP standard deviation score and age were the only factors associated with this outcome. There was no statistical interaction between SBP and age with the IMT (P = 0.280). Conclusion: Arterial calcification is rare in children and adolescents with end‐stage renal disease. The factors associated with IMT were age and SBP. Summary at a Glance: This is an observational study of vascular calcification and intimal media thickness in a young end‐stage renal disease population. An inferior epigastric artery fragment was taken at the time of kidney transplant surgery. With median age of 15 years and median dialysis time of 1.2 years, calcification was not seen. Thicker intimal media thickness was associated with higher systolic blood pressure and older age. [ABSTRACT FROM AUTHOR]

Summary: Pneumocystis jirovecii can cause severe potentially life‐threatening pneumonia (PCP) in kidney transplant patients. Prophylaxis of patients against PCP in this setting is usually performed during 6 months after transplantation. The aim of this study is to describe the molecular epidemiology of a cluster of PCP in renal transplant recipients in Brazil. Renal transplant patients who developed PCP between May and December 2011 had their formalin‐fixed paraffin‐embedded (FFPE) lung biopsy samples analysed. Pneumocystis jirovecii 23S mitochondrial large subunit of ribosomal RNA (23S mtLSU‐rRNA), 26S rRNA, and dihydropteroate synthase (DHPS) genes were amplified by polymerase chain reaction (PCR), sequenced, and analysed for genetic variation. During the study period, 17 patients developed PCP (only four infections were documented within the first year after transplantation) and six (35.3%) died. Thirty FFPE samples from 11 patients, including one external control HIV‐infected patient, had fungal DNA successfully extracted for further amplification and sequencing for all three genes. A total of five genotypes were identified among the 10 infected patients. Of note, four patients were infected by more than one genotype and seven patients were infected by the same genotype. DNA extracted from FFPE samples can be used for genotyping; this approach allowed us to demonstrate that multiple P. jirovecii strains were responsible for this cluster, and one genotype was found infecting seven patients. The knowledge of the causative agents of PCP may help to develop new initiatives for control and prevention of PCP among patients undergoing renal transplant and improve routine PCP prophylaxis. [ABSTRACT FROM AUTHOR]

Abstract: Background: Cryptococcosis is the second most common cause of invasive fungal infections in renal transplant recipients in many countries, and data on graft outcome after treatment for this infection is lacking in less‐resourced health care settings. Methods: Data from 47 renal transplant recipients were retrospectively collected at a single institution during a period of 13 years. Graft dysfunction, graft loss, and mortality rates were evaluated. Predictors of mortality and graft loss were estimated. Results: A total of 38 (97.4%) patients treated with amphotericin B deoxycholate (AMBd) showed graft dysfunction after antifungal initiation and 8 (18.2%) had kidney graft loss. Graft loss within 30 days after cryptococcosis onset was significantly associated with disseminated infection, greater baseline creatinine levels, and graft dysfunction concomitant to AMBd therapy and an additional nephrotoxic condition. The 30‐day mortality rate was 19.2% and it was significantly associated with disseminated and pulmonary infections, somnolence at admission, high CSF opening pressure, positive CSF India ink, creatinine levels greater than 2.0 mg/dL at admission, graft dysfunction in patients treated with AMBd and an additional nephrotoxic condition and graft loss within 30 days. Conclusion: Graft dysfunction was common in renal transplant recipients with cryptococcosis treated with AMBd. The rate of graft loss rate was high, most frequently in patients with concomitant nephrotoxic conditions. Therefore, the clinical focus should be on the use of less nephrotoxic lipid formulations of amphotericin B in this specific population requiring a polyene induction regimen for treatment of severe cryptococcosis in all health care systems caring for transplantation recipients. [ABSTRACT FROM AUTHOR]

Study Objective To evaluate the safety and tolerability of immunosuppressive drugs used in a planned randomized conversion from a calcineurin inhibitor, tacrolimus, to a mammalian target of rapamycin inhibitor, sirolimus, in de novo kidney transplant recipients. Design Prospective safety analysis of data from a prospective, randomized, open-label, controlled study. Patients A total of 119 adult kidney transplant recipients who received tacrolimus ( TAC), mycophenolate sodium ( MPS), and prednisone between February 2008 and May 2010; after 3 months of this regimen, 60 of these patients were randomized to conversion from TAC to sirolimus ( SRL/ MPS group), and 59 patients continued with the TAC regimen ( TAC/ MPS group). Measurements and Main Results Both groups were followed for 24 months after transplantation for immunosuppressive regimen-associated and time-dependent occurrences of adverse events ( AEs) and serious adverse events ( SAEs). Before conversion from TAC to SRL, the cumulative incidence of AEs was 98%; 25% were SAEs. Gastrointestinal AEs (66%) and infections (58%) were the most frequent AEs. The incidences of TAC and MPS dose reductions due to AEs were 1.7% and 12%, respectively. After conversion, no significant differences were noted in the SRL/ MPS group versus the TAC/ MPS group in the cumulative incidences of AEs (100% vs 98%) and SAEs (27% vs 30%). The most common AEs were gastrointestinal (70% vs 54%, p=0.23) and infection (77% vs 73%, p=0.79) in the SRL/ MPS versus TAC/ MPS groups. The incidence of aphthous ulcer (28% vs 0%, p=< 0.01), sinusitis (10% vs 0%, p=0.01), dermatitis (15% vs 3%, p=0.03), and dyslipidemia (35% vs 14%, p=0.02) were higher in the SRL/ MPS group compared with the TAC/ MPS group. Cox proportion regression analysis showed a higher relative risk for gastrointestinal (hazard ratio [ HR] 1.9, 95% confidence interval [ CI] 1.2-3.01, p<0.05) and skin and subcutaneous tissue ( HR 2.5, 95% CI 1.1-4.1, p<0.05) AEs in the SRL/ MPS group compared with the TAC/ MPS group. AE-related dose reductions occurred in 18.3% of patients receiving SRL and 3.3% of patients receiving TAC. MPS dose reductions due to AEs occurred in 11.7% of patients receiving SRL and 13.6% of patients receiving TAC. Conclusion SRL/ MPS treatment was associated with a time-dependent higher incidence of gastrointestinal and skin and subcutaneous tissue AEs, which occurred mainly during the first 6 months after conversion from TAC/ MPS. Although the treatments with SRL or TAC after 3 months of transplantation showed different safety profiles, both regimens demonstrated adequate tolerability, with low rates of early discontinuation related to AEs. [ABSTRACT FROM AUTHOR]

Background: IgA nephropathy (IgAN) is the third most frequent cause of renal graft loss among patients with primary glomerulonephritis. Objectives: To assess clinical and laboratorial profile of patients with pre and/or post transplant IgAN, in addition to patient and graft survival in both groups. Design: Data from 146 patients who had received a renal transplant were retrospectively collected and were divided in two groups: group 1-patients with biopsy-documented IgAN as the underlying native kidney disease (n=128); group 2-patients who developed post-transplant IgAN independent of the underlying disease (n=18). Participants: Patients submitted to renal transplantation (1998-2010) with pre and/or post transplant IgAN. Measurements: Clinical and laboratorial evaluation of renal function of 146 post transplant IgAN patients. Results: Recipients and deceased donors exhibited a higher degree of HLA compatibility (1.0 vs. 2.5 mismatches for groups 1 and 2, respectively). The main post-transplant IgAN presentation was haematuria associated with non-nephrotic proteinuria (44.4%). A histological pattern of focal segmental glomerulosclerosis was observed in 59.2% of biopsy samples. The 10-year patient survival was 93.5% in group 1 and 100% in group 2, and the graft survival rates were 58.5 and 87.2%, respectively. Conclusion: The rate of post-transplant IgA diagnosis in our case series was 11%, and IgAN was diagnosed late in the course of transplantation. In most cases, IgAN manifested as haematuria and non-nephrotic proteinuria, without renal graft dysfunction, and this picture might explain late indication of graft biopsies. The 10-year patient survival rates were excellent. [ABSTRACT FROM AUTHOR]

The present paper describes the characterization and comparative study carried out on the 16th century murals of Casas Pintadas of the so-called Vasco da Gama House in the town of Évora, Southern Portugal. Even today, the two existing paintings in the porch vaulted cloister raise many questions about the pictorial techniques and materials that were used. The most adopted theory is that the upper register inspired in medieval bestiary was made with a secco technique, while the lower grotteschi frieze was achieved with a fresco technique. A multianalytical research was carried out in situ and in laboratory in order to attest this hypothesis and to characterize the paintings materials. Surface examination was made with normal and racking light complemented with in situ spectrophotometry in the visible, with stratigraphic and analytical study of microsamples by optical microscopy (OM) and scanning electron microscopy coupled with energy dispersive X-ray spectrometry (SEM-EDS). The results show similarities in the structure and elemental composition of both paintings mortars and pigments. The mortars' inner layers (the intonaci) were made with siliceous sands mixed with a dolomitic lime-based plaster (CaMg(CO3)2). On top of it, one to three thin layers of lime wash were applied. In SEM-EDS elemental maps, all the pigments at the cross-sections are embedded in a calcium carbonate matrice, and several nails marks are visible in situ with racking light in both paintings indicating a fresco technique. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The chronic course of hepatitis E virus infection in immunosuppressed patients has been recently documented; however, clinical features and factors associated with this occurrence are not well known. The aim of this study was to evaluate the prevalence of previous or current HEV infection in renal transplant patients. One hundred ninety-two kidney transplant patients were studied and classified in three groups: G1-infected with hepatitis B and/or C virus; G2-patients with elevated ALT; G3-patients with normal ALT and no hepatotropic virus infection. Demographic, epidemiologic and clinical characteristics were compared between the groups. Patients with HEV infection (previous or current) were also compared to those who tested negative for HEV. HEV infection was detected using serologic (anti-HEV IgG) and molecular (HEV RNA) methods. Anti-HEV IgG was positive in 28 (15%) while HEV RNA was positive in 20 (10%). When both markers were considered, 44 (23%) patients showed evidence of previous or current HEV infection. However, both markers were concomitantly positive in only four cases (2%). In the comparative analysis, patients infected with HBV and/or HCV showed lower frequency of anti-HEV IgG ( P = 0.009). There was no difference regarding demographic, epidemiologic and laboratory variable between viremic and non-viremic patients. In conclusion, past and current infection with HEV was a frequent finding among renal transplant recipients. Actively infected patients (HEV RNA positive) did not present distinct demographic and epidemiological characteristics or laboratory alterations suggestive of underlying liver damage. Therefore, infection with HEV can only be detected in immunosuppressed patients by systematic investigation of HEV RNA. J. Med. Virol. 86:948-953, 2014. © 2017 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

The Notch pathway is an important intercellular signaling pathway that plays a major role in controlling cell fate. Accumulating evidence indicates that Notch and its ligands present on antigen-presenting cells might be important mediators of T helper cell differentiation. In this study, we investigated the role of Jagged2 in murine cardiac transplantation by using a signaling Jagged2 m Ab ( Jag2) that activates recombinant signal-binding protein-Jκ. While administration of Jag2 m Ab had little effect on graft survival in the fully allogeneic mismatched model BALB/c→ B6, it hastened rejection in CD28-deficient recipients. Similarly, Jag2 precipitated rejection in the bm12→ B6 model. In this MHC class II-mismatched model, allografts spontaneously survive for >56 days due to the emergence of Treg cells that inhibit the expansion of alloreactive T cells. The accelerated rejection was associated with upregulation of Th2 cytokines and proinflammatory cytokine IL-6, despite expansion of Treg cells. Incubation of Treg cells with recombinant IL-6 abrogated their inhibitory effects in vitro. Furthermore, neutralization of IL-6 in vivo protected Jag2-treated recipients from rejection and Jagged2 signaling was unable to further accelerate rejection in the absence of Treg cells. Our findings therefore suggest that Jagged2 signaling can affect graft acceptance by upregulation of IL-6 and consequent resistance to Treg-cell suppression. [ABSTRACT FROM AUTHOR]

Hepatitis E virus (HEV) causes acute and chronic hepatitis in organ transplant recipients. Serological evidence for HEV infection has been discovered in various population groups in Brazil, and a single acute case has been confirmed. To date, however, no cases of HEV infection in immunocompromised patients have been reported in Brazil. This study aimed to identify and characterize hepatitis E cases in renal transplant recipients in Brazil. A retrospective study was performed on 96 serum samples from renal transplant recipients with unexplained liver enzymes elevation. Three confirmed cases of HEV infection were identified that lacked seroconversion to HEV IgG antibodies. The prevalence of HEV in these patients was 3.1%. Using a sequence analysis of a 304-nucleotide fragment within ORF2, the strains were classified as genotype 3 with a low percent identity to previously characterized strains. This is the first report of hepatitis E infection in renal transplant recipients in Brazil, and the data indicate that a novel genotype 3 subvariant may be present and that further investigation is necessary to characterize the circulating HEV strains. In this setting, HEV infection should be considered as a potential cause of abnormal liver tests of unknown origin. J. Med. Virol. 85:615-619, 2013. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

To determine the prevalence and risk factors for (i) overweight/obesity and (ii) weight gain six months after transplantation and to study the effect of weight excess on graft function and survival. We performed a retrospective study of kidney transplanted children. Endpoints: (i) prevalence of overweight/obesity at sixth month, (ii) gaining 1.0 BMI SDS from one to six months. To study the effects of weight excess, graft function and survival at 36 months were the endpoints. The study included 197 individuals. At sixth month, 57/197 (29%) presented overweight/obesity, and the factors associated to this outcome were: (i) age at transplantation ( OR = 3.04) and (ii) overweight/obesity in the first month ( OR = 22.16). Groups presented no difference on graft function and survival at 36 months. From one to six months, 90/197 (46%) patients gained >1.0 BMI SDS. This outcome was associated with (i) female sex ( OR = 2.50), (ii) steroids' pulses ( OR = 2.98), (iii) steroids exposure ( OR = 1.04), and (iv) living donor ( OR = 2.69). The group that gained BMI presented a lower 36 months graft survival (86% vs. 98%, p < 0.001). Weight excess and gain after transplantation are frequent, particularly in younger female recipients and in those receiving high steroids exposure. The lower graft survival in patients with rapid weight gain deserves investigation. [ABSTRACT FROM AUTHOR]

Background information regarding histological progression of hepatitis C after renal transplant ( RTx) is scarce. Aims To analyze clinical and laboratory evolution and histological progression of hepatitis C in patients evaluated before and after RTx. Methods Twenty-two HCV-infected patients submitted to liver biopsy pre- and post- RTx were included. A semiquantitative analysis of necroinflammatory activity and fibrosis staging was performed and the two biopsies were compared. Results Patients were mostly men (73%) with mean age of 36 ± 9 yr. Time post-transplant was 4 ± 2 yr and time between biopsies was 5 ± 2 yr. An elevation of alanine aminotransferase (p = 0.041) and aspartate aminotransferase (p = 0.004) levels was observed in the post-transplant period. Fibrosis progression after renal transplantation was observed in 11 (50%) of the patients, and necroinflammatory activity worsening was observed in 7 (32%) of the patients. The histological progression occurred even among those without significant histological lesions in pre-transplant biopsy. Conclusion The findings of this study suggest that the practice of indicating treatment in the pre-transplant phase based mainly on histological disease should be revised, because a high proportion of patients present disease progression. Because interferon cannot be used safely after RTx, treatment should be indicated for all ESRD patients with hepatitis C. [ABSTRACT FROM AUTHOR]

BACKGROUND: Consumer awareness regarding the intake of beef of organic origin is strongly associated with the beneficial outcomes to human health, the environment and animal welfare. In this paper the effects of slaughter season and muscle type on the fatty acid composition, conjugated linoleic acid (CLA) isomeric profile, total cholesterol, α-tocopherol and β-carotene contents and nutritional quality of intramuscular fat in organic beef ( n = 30) are reported for the first time. RESULTS: Organic beef showed a very low total lipid content, with seasonal changes in the levels of some fatty acids, CLA isomers, n-6/n-3 polyunsaturated fatty acid (PUFA) ratio, total cholesterol and β-carotene. In addition, differences between longissimus lumborum (relatively red) and semitendinosus (relatively white) muscles were found for many fatty acids, specific CLA contents, many CLA isomers and both PUFA/saturated fatty acid (SFA) and n-6/n-3 ratios. However, in spite of the seasonal and carcass variations, all organic meats analysed had values of beef similar to pasture-fed cattle. CONCLUSION: From a nutritional perspective, organic meat from both slaughter seasons seems to have high CLA contents, PUFA/SFA and n-6/n-3 indices within the recommended values for the human diet. The data indicate that intramuscular fat in organic meat has a high nutritional value throughout the year. Copyright © 2012 Society of Chemical Industry [ABSTRACT FROM AUTHOR]

The diagnosis of hepatitis C virus (HCV) infection in hemodialysis patients is difficult particularly due to the presence of intermittent viremia. The aims of this study were: (a) to determine the prevalence of intermittent viremia in hemodialysis patients with anti-HCV antibodies who tested negative for HCV RNA by PCR at the first evaluation and (b) to evaluate the contribution of the transcription-mediated amplification method (TMA) to the diagnosis of viremia in the PCR-negative samples. One hundred and six patients with anti-HCV antibodies and an initial negative result for HCV RNA by PCR were included. An additional sample was collected for a second HCV RNA test by PCR after a minimum interval of 3 months and a positive result characterized intermittent viremia. HCV RNA was investigated by TMA in the PCR-negative sample of patients with intermittent viremia, and in the most recent sample from patients with PCR-negative results in both determinations. Intermittent viremia was observed in 60/106 (57%) patients (57% men; age: 45 ± 10 years). Fifty-one of the 60 negative samples from patients with intermittent viremia and 29/46 double-negative patients were tested by TMA. This assay detected viremia in 20/51 (39%) samples of intermittent viremia and in 2/29 (7%) of double-negative samples. The results showed that intermittent viremia is frequent in hemodialysis patients who tested negative for HCV RNA by PCR. Therefore, a second HCV RNA test is necessary for all HCV RNA-negative patients. The TMA assay appears to be the best first screening test for viremia in this population. J. Med. Virol. 84:596-600, 2012. © 2011 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

ABSTRACT The aim of this study was to evaluate how oral health is affected by the length of time a patient has been receiving hemodialysis (HD) treatment. Ninety-four subjects participated in this study. Demographic, periodontal parameters, and decayed missing and filled teeth (DMFT) index were recorded by a trained and calibrated examiner. The subjects were divided into two groups: Group L (subjects who had been on HD for less than 36 months), and Group M (those who had been on HD for more than 37 months). In Group M, the mean probing depth was deeper ( p= 0.01) and clinical attachment loss was significantly higher ( p= 0.02) than subjects in Group L. The DMFT index score was also significantly higher in Group M ( p= 0.03). A moderate correlation between length of time on HD and DMFT index, probing depth, and clinical attachment loss was observed. The group of subjects who had been on HD for more than 37 months had more periodontal disease and higher DMFT index scores, suggesting that the length of time on HD could negatively impact oral health. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hemolysis may occur in 9% to 40% of patients after solid organ transplantation and be caused by the passenger lymphocyte syndrome (PLS). STUDY DESIGN AND METHODS: We have prospectively examined 217 kidney transplant recipients before (Day −1) and after (up to Days +10, +20, and +30) surgery. ABO-identical transplant was performed in 180 (82.9%) patients, while 37 (17.1%) individuals received ABO-compatible nonidentical grafts. Direct antiglobulin tests (DATs) were performed by tube technique (polyspecific anti-human globulin [IgG + C3d]), positive DAT samples were further tested by gel agglutination (monospecific anti-IgG, -IgM, -IgA, or -C3), and eluates were prepared from DAT-positive red blood cells (RBCs) by the dichloromethane elution test. RESULTS: We observed that 34 of 217 (15.7%) patients developed a positive DAT up to Day +30. The percentage of patients with positive DATs was significantly higher in those having ABO-compatible nonidentical transplants compared to those that received ABO-identical grafts (10/37 = 27.0% vs. 24/180 = 13.3%; p = 0.037). Specific RBC antibodies (anti-A or anti-B) were found in only 5 of 37 (13.5%) patients having ABO-compatible nonidentical transplants who presented with clinical hemolysis. We found only three reactive eluates from 24 patients with positive DATs who received ABO-identical transplants but had no hemolysis. CONCLUSIONS: Our data collected prospectively demonstrated that: 1) positive DATs occurred in 15.7% of all patients up to Day +30 after a kidney transplant; 2) the DAT positivity occurred up to Day +10 in 9.7% of all transplanted patients; 3) the majority of the transplant recipients with a positive DAT had a nonreactive RBC eluate; and 4) PLS was the cause of a positive DAT in 13.5% of patients submitted to ABO-compatible nonidentical kidney transplants. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to make a longitudinal evaluation of the incidence and severity of gingival overgrowth (GO) induced by immunosuppressive agents, such as tacrolimus (Tcr) and cyclosporin A (CsA), in the absence of calcium channel blockers in patients undergoing renal transplantation (RT). Methods: This longitudinal study is conducted in 49 patients with RT who were divided into a CsA group (n = 25) and Tcr group (n = 24). The individuals were assessed at four time intervals: before transplant and 30, 90, and 180 days after RTs. Demographic data and periodontal clinical parameters (plaque index, cemento-enamel junction to the gingival margin, probing depth, clinical attachment level, bleeding on probing [BOP], and GO) were collected at all time intervals. Results: The mean GO index was significantly lower in the Tcr group compared to the CsA group after 30 (P = 0.03), 90 (P = 0.004), and 180 (P = 0.01) days of immunosuppressive therapy. One hundred eighty days after RTs, a clinically significant GO was observed in 20.0% of individuals in the CsA group and 8.3% of individuals in the Tcr group. However, this difference was not statistically significant (P = 0.41). There was a reduction in periodontal clinical parameters regarding the time of immunosuppressive therapy for PI and BOP (P<0.001) in both groups. Conclusion: Although there was no statistical difference in the incidences of clinically significant GO after 180 days of immunosuppressive therapy, it was observed that GO occurred later in the Tcr group, and the severity of GO in this group was lower than in patients who used CsA. [ABSTRACT FROM AUTHOR]

Thrombotic microangiopathy (TMA) is rare after transplantation and is associated with a high incidence of kidney graft dysfunction. Between December 2000 and March 2006, 136 simultaneous pancreas–kidney transplantations were performed with an incidence of TMA of 5.1% (71.4% localized to kidney allograft). All cases were diagnosed during the first three months and were attributed to tacrolimus; 74% were women. Systemic TMA presented higher values of lactate dehydrogenase (2658 ± 659 U/L vs. 1331 ± 473 U/L, p = 0.04) and a greater decrease in hematocrit (45.8 ± 17.7% vs. 19.2 ± 6%, p = 0.02) than in localized TMA. Acute kidney rejection complicated almost 90% of the cases with 43% of kidney graft lost. Tacrolimus was switched to sirolimus and fresh-frozen plasma was administered. Creatinine clearance after a mean follow-up of two yr was 100.7 mL/min/1.73 m2 and 57.9 mL/min/1.73 m2 in patients with systemic and localized TMA, respectively. In conclusion, sirolimus is an alternative to TMA associated with tacrolimus. [ABSTRACT FROM AUTHOR]

Patients with end-stage renal disease (ESRD) show a high prevalence of hepatitis C, with a negative impact on the survival on hemodialysis and after renal transplantation. We evaluated the efficacy and tolerance of interferon-α (IFN-α) in HCV-infected ESRD patients on dialysis. Methods: Forty-six HCV-RNA-positive ESRD patients were studied. IFN-α regimen consisted of 3 million units three times a week for 12 months, and the patients were followed up for 6 months. End-of-treatment, and sustained biochemical and virological responses were evaluated and tolerance was assessed monthly. Results: A sustained virological response (SVR) was observed in 10/46 patients (22%) and in 10/29 who completed the treatment (34%). Alanine aminotransferase was elevated in 63% of the patients at the beginning of the study and returned to normal levels within the first month in all patients with SVR. Treatment was discontinued because of side effects in 11/46 patients (24%) and six patients (13%) were lost to follow-up. Conclusions: IFN-α monotherapy for hepatitis C in dialysis patients shows a high frequency of adverse effects. However, the SVR is high (34%) in patients who complete treatment, emphasizing the importance of careful selection and close follow-up in order to minimize and control possible side effects. [ABSTRACT FROM AUTHOR]

The behavior of hepatitis C in states of immunodeficiency is poorly understood and it is still unclear whether the characteristics of hepatitis C virus (HCV) infection in renal transplant patients differ from those observed in immunocompetent subjects. The aim of this study was to compare the biochemical and histologic characteristics of chronic HCV infection between renal transplant and immunocompetent patients. Forty-one HCV-RNA-positive renal transplant patients and 41 immunocompetent controls matched for gender, age at infection and time of infection were included in the study. The groups were compared regarding laboratory and histologic variables. Renal transplant patients showed lower alanine aminotransferase (ALT) levels (p = 0.005) and higher levels of γ-glutamyltransferase (p = 0.003), alkaline phosphatase (p < 0.001), and direct bilirubin (p < 0.001) when compared with controls. Histologic analysis revealed less intense portal (p < 0.001) and periportal (p = 0.046) inflammatory infiltrate in renal transplant patients but a larger proportion of cases with confluent necrosis (p = 0.043). No difference in the presence of septal fibrosis, hepatic steatosis, bile duct injury and siderosis was observed. However, there was a difference in the presence of lymphoid aggregates, which were less frequent in the renal transplant group (p < 0.001). In conclusion, the characteristics of hepatitis C in renal transplant patients differ from that observed in immunocompetent patients. In renal transplant patients, HCV infection is biochemically characterized by lower ALT levels and higher frequency of cholestasis. Regarding histology, despite lower frequency of lymphoid aggregates and less intense portal/periportal inflammatory infiltrate, a greater lobular damage was observed. The impact of these differences on the progression of fibrosis remains to be established. [ABSTRACT FROM AUTHOR]

Aim: This study was designed to identify optimal therapeutic sirolimus (SRL) concentrations in black kidney transplant recipients on reduced cyclosporine (CsA) exposure and prednisone. Methods: Seventy patients (64 living/six deceased) received CsA (8–10 mg/kg/d), prednisone, and 15 mg loading dose followed by 5-mg fixed doses of SRL till day 7 when they were randomized to maintain SRL trough concentrations (high-performance liquid chromatography) of 8–12 (GI = 34) or 15–20 (GII = 36) ng/mL. Results: Mean CsA concentrations were 109 ± 53 vs. 89 ± 41 ng/mL and 75 ± 54 vs. 60 ± 35 ng/mL (ns) at 2 and 6 months. Accordingly, mean SRL trough concentrations were 12.4 ± 6.1 vs. 20.0 ± 9.5 ng/mL (p < 0.001) and 10.8 ± 5.8 vs. 18.0 ± 6.1 ng/mL (p < 0.001). The incidence of biopsy-proven acute rejection [13% (GI: 18% vs. GII: 8%, ns)], graft loss or death was 16% (GI: 21% vs. GII: 11%, ns]. There were no deaths and three graft losses (GI = 1; GII = 2). Creatinine clearance was higher in GI (64.5 ± 17 vs. 54.4 ± 14.7 mL/min, p = 0.011). The incidence of post-transplant diabetes mellitus was 13% and no CMV disease was observed. Conclusion: In black recipients of primarily living renal allograft donors reduced CsA exposure and SRL concentration-controlled regimens produced low incidences of acute rejection, post-transplant diabetes mellitus and CMV disease, with no significant impairment in graft function. [ABSTRACT FROM AUTHOR]

Introduction: Renal transplant (RTx) patients with hepatitis C frequently show normal levels of alanine aminotransferase (ALT) and the significance of ALT in this group has not been established. Aim: To determine the value of ALT as a marker of histologic hepatic damage in RTx patients with hepatitis C virus (HCV) infection. Materials and methods: HCV-RNA-positive RTx patients with a liver biopsy were analyzed regarding staging and the grading of periportal and lobular necroinflammatory activity. Spearman's correlation coefficient was used to determine the correlation between ALT and histologic variables. Sensitivity, specificity and positive and negative predictive values (PPV and NPV) of ALT in the detection of septal fibrosis and interface hepatitis, and/or confluent necrosis were calculated. Results: Fifty-three patients (32 men, 60%), with a mean age of 42 ± 10 yr and time since transplant of 5 ± 4 yr were included. Only 27 (51%) patients showed elevated ALT levels, which were associated with septal fibrosis (p = 0.001), interface hepatitis (p < 0.001) and confluent necrosis (p = 0.05). A correlation was observed between ALT and staging ( r = 0.50, p < 0.001), periportal necroinflammatory activity ( r = 0.59, p < 0.001) and lobular necroinflammatory activity ( r = 0.50, p < 0.001). The sensitivity, specificity, PPV and NPV of ALT were 92, 61, 41 and 96%, respectively, for the detection of septal fibrosis, and 87, 77, 74 and 88% for the detection of interface hepatitis and/or confluent necrosis. Conclusion: ALT is a good marker of histologic hepatic lesion in HCV-infected RTx patients and, therefore, liver biopsy can be avoided in patients with persistently normal ALT. [ABSTRACT FROM AUTHOR]

Machado PGP, Felipe CR, Hanzawa NM, Park SI, Garcia R, Alfieri F, Franco M, Silva HT Jr, Medina-Pestana JO. An open-label randomized trial of the safety and efficacy of sirolimus vs. azathioprine in living related renal allograft recipients receiving cyclosporine and prednisone combination. Clin Transplant 2004: 18: 28–38. © Blackwell Munksgaard, 2004 The ability of sirolimus (SRL), in combination with reduced exposure of cyclosporine, was investigated to prevent acute rejection and associated side effects. Between June 1999 and February 2000, 70 recipients of primary one-haplotype living-related donor renal allografts were randomized to receive SRL (2 mg/d) or azathioprine (AZA) (2 mg/kg/d) combined with cyclosporine and prednisone. The primary end-point was a composite of first occurrence of biopsy-confirmed acute rejection, graft loss, or death during the first 3 months after transplantation. From week 4 to month 12, SRL patients received lower cyclosporine (week 4: 364 mg/d vs. 455 mg/d, p = 0.004; month 12: 195 mg/d vs. 255 mg/d, p = 0.038) doses and showed lower cyclosporine concentrations (week 4: 247 ng/mL vs. 309 ng/mL, p = 0.04; month 12: 143 ng/mL vs. 188 ng/mL, p = 0.045). Compared with AZA, SRL patients showed reduced 3-month primary end point (0% vs. 17.1%, p = 0.025), and reduced incidence of biopsy-confirmed acute rejection at 3 months (0% vs. 14.3%, p = 0.01) but not at 12 months (11.4% vs. 14.3%, NS). Mean creatinine at 12 months were not different (1.8 ± 0.6 vs. 1.6 ± 0.6, p = 0.23). Hyperlipidemia was the only adverse event more frequent among SRL patients (49% vs. 17%, p = 0.01). There were no differences in infections and no malignancies in both groups. The combination of 2 mg fixed doses of SRL, reduced cyclosporine exposure and prednisone was associated with a low incidence of acute rejection and did not result in significantly impaired graft function compared with patients receiving AZA, standard doses of cyclosporine and prednisone. [ABSTRACT FROM AUTHOR]

The impact of ethnic miscegenation on tacrolimus clinical pharmacokinetics and therapeutic drug monitoring. We sought to determine the influence of ethnic miscegenation on tacrolimus pharmacokinetics and trough concentrations during the first 6 months after transplantation. Methods: Tacrolimus concentrations were measured in blood samples obtained from 22 transplant recipients during the first week of transplant, within pharmacokinetic profiles, and throughout the first 6 months post-transplant, using the Pro Tac II ELISA method. Pharmacokinetic parameters and between- and within-subject blood concentration variability were compared stratifying the total population in two distinct ethnic groups of white (W) and non-white (NW) patients, according to a stringent criterion. Results: Between-subject variability in dose-adjusted concentrations during dosing interval varied from 38.8 to 69.5%. Compared with W patients, NW patients showed higher variability in blood tacrolimus concentrations during dosing interval (37.40 ± 5.64 vs. 56.95 ± 11.49, p < 0.001) and lower drug exposures (AUC: 229.4 ± 55.5 vs. 66.9 ± 67.1 ng × h/mL, p=0.036). The correlation coefficients (r 2 ) between C 0 , C 12 or C max and AUC were 0.83, 0.91 and 0.5, respectively. An equation derived from early time concentrations (C 0 , C 1.5 and C 4 ) accounted for 94% of the variability observed in AUC. Compared with W patients, a higher proportion of tacrolimus blood determinations during the first week were below 10 νg/mL in NW patients (24% vs. 62%, p=0.028). Tacrolimus absorption increased from week 1–4 (1.1 ± 0.53 vs. 1.73 ± 0.97 νg/mL/mg, p < 0.0001) but was still showed high between- (41.6–70.4%) and within-subject (18.2–32.5%) variability, regardless of ethnicity, after stabilization. Conclusion: Non-white patients show higher tacrolimus variability and... [ABSTRACT FROM AUTHOR]

The Latin America and Caribbean region is composed of 39 countries. It is remarkable the progress of transplantation in the region in despite of the low economic resources when compared to other regions. The criteria for brain death are well established and culturally accepted. The consent for retrieval is based on required family consent in most countries. The regulations for living donors are also well established, with restrictions to unrelated donors and prohibition of any kind of commerce. The access to transplant is limited by the model of public financing by each country, and those with public universal coverage have no financial restrictions to cover the costs for any citizen; in countries with restricted coverage, the access is restricted to the employment status. There is a progressive increment in the annual number of solid organ transplants in Latin America, reaching near 10 000 in 2004, accomplished by adequate legislation that is also concerned with the prohibition of organ commerce. [ABSTRACT FROM AUTHOR]

Background: Late cytomegalovirus infections (LCMV) after the cessation of prophylaxis are well described. We aimed to assess clinical and epidemiological data on late‐occurring cytomegalovirus (CMV) infections in the absence of CMV prophylaxis in a cohort of kidney transplant patients. Methods: In a cohort of kidney transplant recipients not employing CMV‐specific prophylaxis, patients with CMV infections occurring after 6 months of transplantation were compared to patients with CMV infections diagnosed within the first 6 months (early infections). The main objectives were to compare clinical outcomes and evaluate risk factors for late CMV infection. Results: A total of 556 patients were evaluated. Forty‐three patients with LCMV infections were compared to 513 patients with early CMV infections. LCMV infections occurred after a median of 473 days of transplantation and had a more severe course, with a statistically significant higher rate of invasive disease and graft loss (60.5% vs 21.6% and 11.6% vs 3.1% respectively). Thirty‐day mortality was twice as high for patients with LCMV, but did not reach statistical significance (9.3% vs 4.3%). By multivariate analysis, employment of antilymphocyte therapy early after transplantation and tacrolimus as initial immunosuppressive therapy were significantly protective for the occurrence of LCMV infections. Conclusion: Late CMV infections in the absence of specific prophylaxis after kidney transplantation have a more severe outcome when compared to early infections and occur in patients less immunosuppressed early after transplantation. Some studies suggest greater severity of late CMV infections (LCMV) after kidney transplantation. This study aims to evaluate late infections in a cohort of kidney transplantation in the absence of antiviral prophylaxis, focusing on risk factors and clinical aspects. [ABSTRACT FROM AUTHOR]

The aim of this study is to examine the effects of having personal experience and information about hypnosis over the beliefs and attitudes toward hypnosis, using a sample of students from Spain, United States, Portugal and Romania. The factor structure of the Revised Valencia Scale of Attitudes and Beliefs toward Hypnosis-Client Version, as well as its psychometric properties are also analyzed. An exploratory factor analysis of the scale was conducted and an 8-factor model solution similar to the one found in other versions of this scale was obtained: Help, Personal Control, Magical Solution, Interest, Collaboration, Fear, Memory/Trance and Marginal. Results also indicated that participants who had previously experienced hypnosis and/or based their knowledge of hypnosis on scientific sources scored, in general, higher in factors indicating positive attitudes and correct beliefs about hypnosis. Copyright © 2008 British Society of Experimental & Clinical Hypnosis. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Patients with end-stage renal disease (ESRD) show a high prevalence of hepatitis C, with a negative impact on the survival on hemodialysis and after renal transplantation. We evaluated the efficacy and tolerance of interferon-alpha (IFN-alpha) in HCV-infected ESRD patients on dialysis., Methods: Forty-six HCV-RNA-positive ESRD patients were studied. IFN-alpha regimen consisted of 3 million units three times a week for 12 months, and the patients were followed up for 6 months. End-of-treatment, and sustained biochemical and virological responses were evaluated and tolerance was assessed monthly., Results: A sustained virological response (SVR) was observed in 10/46 patients (22%) and in 10/29 who completed the treatment (34%). Alanine aminotransferase was elevated in 63% of the patients at the beginning of the study and returned to normal levels within the first month in all patients with SVR. Treatment was discontinued because of side effects in 11/46 patients (24%) and six patients (13%) were lost to follow-up., Conclusions: IFN-alpha monotherapy for hepatitis C in dialysis patients shows a high frequency of adverse effects. However, the SVR is high (34%) in patients who complete treatment, emphasizing the importance of careful selection and close follow-up in order to minimize and control possible side effects.