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2. 420.3: The Use of mTOR Inhibitors Is Associated With Reduced Mortality Among Kidney Transplant Patients Developing COVID-19

Author

Requião-Moura, Lúcio, de Andrade, Luís Gustavo Modelli, Sandes-Freitas, Tainá V, Cristelli, Marina P, Viana, Laila A, Nakamura, Mônica R, Garcia, Valter D, Manfro, Roberto C, Simão, Denise R, Barros Almeida, Ricardo Augusto M, Ferreira, Gustavo F, Henrique Costa, Kellen Micheline A, Lima, Paula R, Pacheco-Silva, Alvaro, Fernandes Charpiot, Ida Maria M, Deboni, Luciane M, Ferreira, Teresa Cristina A, Mazzali, Marilda, Calazans, Carlos Alberto C, Oriá, Reinaldo B, Tedesco-Silva, Hélio, and Medina-Pestana, José

Published
2022
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4. Metastasis of skin squamous cell carcinoma in kidney transplant recipients.

Author

Alves, Felipe F. C., de Jesus, Laura C. B., Cristelli, Marina P., Enokihara, Milvia M. S. e S., Hirata, Sérgio H., Facina, Anamaria da Silva, and Tomimori, Jane

Subjects
SQUAMOUS cell carcinoma, KIDNEY transplantation, ISCHEMIC colitis, METASTASIS, PROGNOSIS, LYMPH nodes
Abstract

Cutaneous squamous cell carcinoma (cSCC) is the most common skin malignancy in kidney transplant recipients (KTRs) as a result of immunosuppression. A worldwide increase in kidney transplantation justifies the determination of prognostic biomarkers by collecting detailed patient data on metastasis development. This study aims to characterize the clinical, epidemiological, and histopathological profiles of KTRs who developed metastasis of cSCC. We conducted a retrospective single‐center study on 18 KTRs and 21 immunocompetent patients (ICs) with metastatic cSCC, using data from 2004 to 2021. ICs were older (median age 70.5 years) than KTRs (median age: 59.5 years). Both groups were predominantly male with Fitzpatrick skin phototype I/II. The primary tumor appeared around 83.5 months post‐transplant, usually in sun‐exposed areas (61.1%), though some non‐exposed areas in ICs (23.8%) contradicted literature findings. KTRs took longer to develop metastasis (median: 11.0 months) compared to ICs (median: 5.5 months). The mean size of the primary tumor was smaller in KTRs (2.50 cm2) compared to ICs (4.55 cm2). The main lymph node chain affected by metastasis was parotid lymph nodes in KTRs (27.8%) and cervical/axillar lymph nodes in ICs (both 19.0%). Both groups exhibited similar primary tumor grades and metastasis evolution, but KTRs had a higher prevalence of lymphovascular invasion. Metastasis of cSCC was more common in males with low skin phototype, in KTRs, particularly on the head and neck. The study suggests a possible link between lymphovascular invasion and metastasis development in KTRs. [ABSTRACT FROM AUTHOR]

Published
2024
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6. Donor-Derived Transmission of Cryptococcus gattii sensu lato in Kidney Transplant Recipients

Author

Santos, Daniel W.C.L., Hagen, Ferry, Meis, Jacques F., Cristelli, Marina P., Viana, Laila A., Bernardi, Fabiola D.C., Tedesco-Silva, Helio, Medina-Pestana, Jose O., and Colombo, Arnaldo L.

Subjects
Antithymocyte globulin, Highly active antiretroviral therapy, Mycoses -- Care and treatment, Kidney transplantation, Organ transplant recipients -- Care and treatment, Brain tumors -- Care and treatment, Health
Abstract

After antiretroviral therapy for HIV patients was introduced, solid organ transplant recipients became one of the major risk groups for developing cryptococcosis, possibly transmitted from donors (2,2). We describe 2 [...]

Published
2020

18. Lower seroprevalence for SARS‐CoV‐2‐specific antibodies among kidney transplant recipients compared to the general population in the city of Sao Paulo, Brazil

Author

Cristelli, Marina P., primary, Viana, Laila A., additional, Fortaleza, Carlos M., additional, Granato, Celso, additional, Nakamura, Monica R., additional, Santos, Daniel W.C.L., additional, Foresto, Renato Demarchi, additional, Tedesco‐Silva, Helio, additional, and Medina‐Pestana, Jose, additional

Published
2021
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19. Kidney transplantation in the time of COVID‐19: Dilemmas, experiences, and perspectives

Author

Cristelli, Marina P., primary, Viana, Laila A., additional, Fernandes, Ruan de A., additional, Nakamura, Monica R., additional, Foresto, Renato D., additional, Stopa Martins, Suelen B., additional, Alvarazi, Jacqueline F. L., additional, Leite, Valeria C., additional, Oliveira, Francisco R., additional, Carneiro, Vanessa A., additional, Santos, Daniel Wagner de C. L., additional, Aguiar, Wilson F., additional, Vaz, Maria Lucia dos S., additional, Tedesco‐Silva, Helio, additional, and Medina‐Pestana, José, additional

Published
2021
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20. The Full Spectrum of COVID-19 Development and Recovery Among Kidney Transplant Recipients

Author

Cristelli, Marina P., primary, Viana, Laila A., additional, Dantas, Marcus T.C., additional, Martins, Suelen B.S., additional, Fernandes, Ruan, additional, Nakamura, Monica R., additional, Santos, Daniel W.C.L., additional, Taddeo, Julia B., additional, Azevedo, Vega F., additional, Foresto, Renato D., additional, Tedesco-Silva, Helio, additional, and Medina-Pestana, Jose, additional

Published
2021
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21. High Prevalence of Long-COVID Among Kidney Transplant Recipients: A Longitudinal Cohort Study

Author

Amorim, Carlos Eduardo Neves, Gomes, Vinicius Lafico Teixeira, Cristelli, Marina Pontello, Viana, Laila Almeida, de Luca Correa, Hugo, Lima, Gierisson Brenno Borges, de Sousa Silva, Flaviana Santos, de Castro Lima, Gabriel Santos, Rosa, Thiago dos Santos, Nakamura, Monica Rika, Quintino, Priscilla Monteiro, Tedesco-Silva, Helio, and Medina-Pestana, José

Published
2022
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24. Immunogenicity After a Heterologous BNT262b2 Versus Homologous Booster in Kidney Transplant Recipients Receiving 2 Doses of CoronaVac Vaccine: A Prospective Cohort Study

Author

Medina-Pestana, José, Almeida Viana, Laila, Nakamura, Monica Rika, Lucena, Elizabeth França, Granato, Celso Francisco Hernandes, Dreige, Yasmim Cardoso, Amorim, Laysla Verhalen Pouzo, Chow, Charles Yea Zen, Demarchi Foresto, Renato, Roberto Requião-Moura, Lucio, Tedesco-Silva, Helio, and Cristelli, Marina Pontello

Published
2022
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25. The Mycophenolate-based Immunosuppressive Regimen Is Associated With Increased Mortality in Kidney Transplant Patients With COVID-19

Author

Requião-Moura, Lúcio R., Modelli de Andrade, Luís Gustavo, de Sandes-Freitas, Tainá Veras, Cristelli, Marina Pontello, Viana, Laila Almeida, Nakamura, Mônica Rika, Garcia, Valter Duro, Manfro, Roberto Ceratti, Simão, Denise Rodrigues, Almeida, Ricardo Augusto Monteiro de Barros, Ferreira, Gustavo Fernandes, Costa, Kellen Micheline Alves Henrique, de Lima, Paula Roberta, Pacheco-Silva, Alvaro, Charpiot, Ida Maria Maximina Fernandes, Deboni, Luciane Mônica, Ferreira, Teresa Cristina Alves, Mazzali, Marilda, Calazans, Carlos Alberto Chalabi, Oriá, Reinaldo Barreto, Tedesco-Silva, Hélio, Medina-Pestana, José, de Oliveira, Claudia Maria Costa, Esmeraldo, Ronaldo de Matos, Baptista, Maria Alice Sperto Ferreira, de Sousa, Marcos Vinícius, de Mello Santana, Viviane Brandão Bandeira, Romão, Elen Almeida, Zanocco, Juliana Aparecida, Bignelli, Alexandre Tortoza, de Carvalho, Deise De Boni Monteiro, Noronha, Irene de Lourdes, Saldanha, Anita Leme da Rocha, Romao, Joao Egídio, Arimatea, Gustavo Guilherme Queiroz, Lasmar, Marcus Faria, Rioja, Suzimar da Silveira, Kroth, Leonardo Viliano, Madeira, Rafael Lage, Miorin, Luiz Antônio, Malafronte, Patrícia, Pozzi, Carolina Maria, Pinheiro, Helady Sanders, Maciel, Rafael Fabio, Andrade, Larissa Guedes da Fonte, Filho, Lauro Monteiro Vasconcellos, Contieri, Fabiana Loss de Carvalho, Neves, Carolina Lara, Pereira, André Barreto, Silva, Amanda Maíra Damasceno, Palma, Lilian Monteiro Pereira, de Souza, Pedro Augusto Macedo, Machado, David José Barros, and Saber, Luciana Tanajura Santamaria

Published
2022
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26. Donor-Derived Transmission of Cryptococcus gattii sensu lato in Kidney Transplant Recipients

Author

Santos, Daniel W C L, Hagen, Ferry, Meis, Jacques F, Cristelli, Marina P, Viana, Laila A, Bernardi, Fabiola D C, Tedesco-Silva, Hélio, Medina-Pestana, José O, Colombo, Arnaldo L, Santos, Daniel W C L, Hagen, Ferry, Meis, Jacques F, Cristelli, Marina P, Viana, Laila A, Bernardi, Fabiola D C, Tedesco-Silva, Hélio, Medina-Pestana, José O, and Colombo, Arnaldo L

Abstract

We describe cases of donor-derived transmission of Cryptococcus deuterogattii in 2 kidney transplant recipients in Brazil and published information on other cases. Prompt reduction of immunosuppression and initiation of antifungal therapy was required to successfully control the fungal infections and preserve engraftment.

Published
2020

27. Clinical features and outcomes of kidney transplant recipients with focal segmental glomerulosclerosis recurrence

Author

Mansur, Juliana B, primary, Sandes‐Freitas, Tainá V, additional, Kirsztajn, Gianna M, additional, Cristelli, Marina P, additional, Mata, Gustavo F, additional, Paula, Mayara I, additional, Grenzi, Patricia C, additional, Martins, Suelen B S, additional, Felipe, Claudia R, additional, Tedesco‐Silva, Hélio, additional, and Pestana, José O M, additional

Published
2019
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29. Extractions in kidney transplant recipients

Author

Caliento, Rubens, Sá Fernandes, Karin, Andrade, Natália Silva, de Santana Sarmento, Dmitry José, Pontello Cristelli, Marina, L. Ortega, Karem, and Gallottini, Marina

Abstract

The authors undertook a prospective study to determine whether kidney transplant recipients had an increased risk of developing complications, such as local acute infection, alveolitis, increased bleeding, pain, and delayed healing, after tooth extraction.

Published
2022
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30. Long-term Efficacy and Safety of Everolimus Versus Mycophenolate in Kidney Transplant Recipients Receiving Tacrolimus

Author

Nunes Ficher, Klaus, Dreige, Yasmin, Gessolo Lins, Paulo Ricardo, Nicolau Ferreira, Alexandra, Toniato de Rezende Freschi, Juliana, Linhares, Kamilla, Stopa Martins, Suelen, Custodio, Luciana, Cristelli, Marina, Viana, Laila, Wagner Santos, Daniel, de Marco, Renato, Gerbase-DeLima, Maria, Proença, Henrique, Aguiar, Wilson, Nakamura, Monica, Rosso Felipe, Claudia, Medina Pestana, Jose, and Tedesco Silva, Helio

Abstract

Supplemental Digital Content is available in the text.

Published
2022
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31. Development and validation of a simple web‐based tool for early prediction of COVID‐19‐associated death in kidney transplant recipients

Author

Modelli de Andrade, Luis Gustavo, Sandes‐Freitas, Tainá Veras, Requião‐Moura, Lúcio R., Viana, Laila Almeida, Cristelli, Marina Pontello, Garcia, Valter Duro, Alcântara, Aline Lima Cunha, Esmeraldo, Ronaldo de Matos, Abbud Filho, Mario, Pacheco‐Silva, Alvaro, Lima Carneiro, Erika Cristina Ribeiro, Manfro, Roberto Ceratti, Costa, Kellen Micheline Alves Henrique, Simão, Denise Rodrigues, Sousa, Marcos Vinicius, Santana, Viviane Brandão Bandeira de Mello, Noronha, Irene L., Romão, Elen Almeida, Zanocco, Juliana Aparecida, Arimatea, Gustavo Guilherme Queiroz, De Boni Monteiro de Carvalho, Deise, Tedesco‐Silva, Helio, Medina‐Pestana, José, Keitel, Elizete, Costa de Oliveira, Claudia Maria, Neri, Beatriz de Oliveira, Fernandes Charpiot, Ida Maria Maximina, Ferreira, Teresa Cristina Alves, Vicari, Alessandra Rosa, Pereira, Tomás, Coelho, Maria Eduarda Heinzen de Almeida, Mazzali, Marilda, Ferreira, Gustavo Fernandes, Campos, Juliana Bastos, Rocha, Nicole Gomes Campos, Saldanha, Anita Leme da Rocha, Martinez, Tania Leme da Rocha, Romão, João Egídio, Teixeira Araújo, Maria Regina, Braga, Sibele Lessa, Deboni, Luciane Mônica, Krüger, Franco Silveira da Mota, Neto, Miguel Moysés, Claudino, Auro Buffani, Cláudio de Oliveira, Lívia, Matuck, Tereza Azevedo, Bignelli, Alexandre Tortoza, Hokazono, Silvia Regina, Suassuna, José Hermógenes Rocco, Rioja, Suzimar da Silveira, Madeira, Rafael Lage, Vilaça, Sandra Simone, Calazans, Carlos Alberto Chalabi, Calazans, Daniel Costa Chalabi, Malafronte, Patrícia, Miorin, Antonio, Aguiar, Filipe Carrilho, Andrade, Larissa Guedes da Fonte, Carvalho, Fabiana Loss, Martins, Karoline Sesiuk, Pinheiro, Hélady Sanders, Sertório, Emiliana Spadarotto, Pereira, André Barreto, Machado, David José Barros, Pozzi, Carolina Maria, Kroth, Leonardo Viliano, Filho, Lauro Monteiro Vasconcellos, Maciel, Rafael Fabio, Silva, Amanda Maíra Damasceno, Baptista, Ana Paula Maia, de Souza, Pedro Augusto Macedo, Lasmar, Marcus Faria, Saber, Luciana Tanajura Santamaria, Palma, Lilian Monteiro Pereira, and de Barros Almeida, Ricardo Augusto Monteiro

Abstract

This analysis, using data from the Brazilian kidney transplant (KT) COVID‐19 study, seeks to develop a prediction score to assist in COVID‐19 risk stratification in KT recipients. In this study, 1379 patients (35 sites) were enrolled, and a machine learning approach was used to fit models in a derivation cohort. A reduced Elastic Net model was selected, and the accuracy to predict the 28‐day fatality after the COVID‐19 diagnosis, assessed by the area under the ROC curve (AUC‐ROC), was confirmed in a validation cohort. The better calibration values were used to build the applicable ImAgeS score. The 28‐day fatality rate was 17% (n= 235), which was associated with increasing age, hypertension and cardiovascular disease, higher body mass index, dyspnea, and use of mycophenolate acid or azathioprine. Higher kidney graft function, longer time of symptoms until COVID‐19 diagnosis, presence of anosmia or coryza, and use of mTOR inhibitor were associated with reduced risk of death. The coefficients of the best model were used to build the predictive score, which achieved an AUC‐ROC of 0.767 (95% CI 0.698–0.834) in the validation cohort. In conclusion, the easily applicable predictive model could assist health care practitioners in identifying non‐hospitalized kidney transplant patients that may require more intensive monitoring. Trial registration:ClinicalTrials.gov NCT04494776. Machine learning applied to national registry data leads to the development and validatation of a web‐based model to predict COVID‐19‐associated death among kidney transplant recipients, identifying those who may may benefit from intensive monitoring.

Published
2022
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37. Clinical Outcome of 96 Post-Transplant Lymphoproliferative Disease Patients in a Renal Transplant Cohort

Author

Penna, Adriana M. Damasco, primary, Garibaldi Junior, Joao, additional, Perini, Guilherme Fleury, additional, Cavalcanti, Egyla M, additional, Cristelli, Marina P, additional, Bruscato, Adriana, additional, Pestana, Jose Osmar Medina, additional, Colleoni, Gisele W. B., additional, Zampieri Filho, Jose Pedro, additional, Vaez, Rodrigo, additional, Baiocchi, Otavio C. G., additional, and Bordin, Jose Orlando, additional

Published
2015
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38. Prognosis of Patients with Primary Central Nervous System Post-Transplant Lymphoproliferative Disorder (PTLD-CNS) Treated with Immunossupression Reduction, Intrathecal Chemotherapy and Whole-Brain Radiotherapy: An Analysis of 23 Patients in a Brazilian Cohort

Author

Perini, Guilherme Fleury, primary, Garibaldi Junior, Joao, additional, Penna, Adriana M. Damasco, additional, Cristelli, Marina P, additional, Bruscato, Adriana, additional, Cavalcanti, Egyla M, additional, Pestana, Jose Osmar Medina, additional, Colleoni, Gisele W. B., additional, Zampieri Filho, Jose Pedro, additional, Vaez, Rodrigo, additional, Baiocchi, Otavio C. G., additional, and Bordin, Jose Orlando, additional

Published
2015
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39. Immunogenicity, Safety, and Clinical Effectiveness After 2 Doses of BNT162b2 Vaccine Among Pediatric Kidney Transplant Recipients Versus Healthy Volunteers: A Prospective Nonrandomized Study

Author

Medina-Pestana, José, Martins, Suelen Bianca Stopa, Custódio, Luciana de Fatima Porini, Rissoni, Renata Aparecida Pimentel, Dreige, Yasmim Cardoso, Nakamura, Monica Rika, Amorim, Laysla Verhalen Pouzo, Chow, Charles Yea Zen, Tedesco-Silva, Helio, and Cristelli, Marina Pontello

Published
2023
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42. Cost-Effectiveness Analysis of Everolimus versus Mycophenolate in Kidney Transplant Recipients Receiving No Pharmacological Prophylaxis for Cytomegalovirus Infection: A Short-Term Pharmacoeconomic Evaluation (12 Months).

Author

Felipe, Claudia, Tedesco-Silva, Helio, Ferreira Brigido, Alexandra, Bessa, Adrieli, Ruppel, Priscila, Hiramoto, Liliane, de Paula, Mayara, Cristelli, Marina, Stopa, Suelen, Mansur, Juliana, Viana, Laila, Fahham, Lucas, Pepe, Camila, and Medina-Pestana, Jose

Abstract

Background Modern immunosuppressive regimens, although associated with improved 1-year graft survival, are associated with adverse effects, including opportunistic infections, diabetes mellitus after transplantation, cardiovascular complications, and de novo malignancies. Objectives To determine the short-term (12 months) cost-effectiveness of everolimus (EVR) versus mycophenolate sodium (MPS) in kidney transplant recipients receiving induction therapy, tacrolimus, prednisone, and no prophylaxis for cytomegalovirus infection. Methods A Markov state transition model was designed. Data from a single-center prospective trial were used along with data from the center’s medical bills database. The target population comprised adults with low immunological risk submitted to first ABO-compatible transplantation with kidneys recovered from living or deceased donors. The time horizon was 12 months. The interventions included tacrolimus and prednisone plus a single 3-mg/kg dose of rabbit antithymocyte globulin (ATG) and EVR or basiliximab (BAS) and EVR or BAS and MPS. The clinical outcomes considered for this analysis were cytomegalovirus infection/disease, acute rejection, graft dysfunction, surgical complications, graft loss, and life-years gained. Results ATG/EVR was cost-saving compared with BAS/MPS on all evaluated outcomes; BAS/EVR outperformed BAS/MPS on most of the evaluated outcomes. Results were confirmed by sensitivity analysis. Conclusions Compared with MPS, EVR is an alternative immunosuppressive agent that is able to provide resource-saving to the health care provider with effectiveness gains for the patient. [ABSTRACT FROM AUTHOR]

Published
2017
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43. Regional differences in the management and outcome of kidney transplantation in patients with human immunodeficiency virus infection: A 3-year retrospective cohort study.

Author

Cristelli, Marina P., Cofán, Federico, Tedesco‐Silva, Helio, Trullàs, Joan Carles, Santos, Daniel Wagner C. L., Manzardo, Christian, Agüero, Fernando, Moreno, Asunción, Oppenheimer, Federico, Diekmann, Fritz, Medina‐Pestana, Jose O., Miro, Jose Maria, Alcaraz, A., Ambrosioni, J., Bodro, M., Blanco, J.L., Brunet, M., Garcia, F., Paredes, D., and Esforzado, N.

Subjects
*KIDNEY transplantation, *HIV-positive persons, *HEPATITIS C virus, *BACTERIAL diseases, *REGIONAL differences
Abstract

Background In the developed world, kidney transplantation ( KT) in patients with human immunodeficiency virus ( HIV) infection is well established. Developing countries concentrate 90% of the people living with HIV, but their experience is underreported. Regional differences may affect outcomes. Objectives We compared the 3-year outcomes of patients with HIV infection receiving a KT in two different countries, in terms of incomes and development. Methods This was an observational, retrospective, double-center study, including all HIV-infected patients >18 years old undergoing KT. Results Between 2005 and 2015, 54 KTs were performed (39 in a Brazilian center, and 15 in a Spanish center). Brazilians had less hepatitis C virus co-infection (5% vs 27%, P=.024). Median cold ischemia time was higher in Brazil (25 vs 18 hours, P=.001). Biopsy-proven acute rejection ( AR) was higher in Brazil (33% vs 13%, P=.187), as were the number of AR episodes (22 vs 4, P=.063). Patient survival at 3 years was 91.3% in Brazil and 100% in Spain; P=.663. All three cases of death in Brazil were a result of bacterial infections within the first year post transplant. At 3 years, survival free from immunosuppressive changes was lower in Brazil (56% vs 90.9%, P=.036). Raltegravir-based treatment to avoid interaction with calcineurin inhibitor was more prevalent in Spain (80% vs 3%; P<.001). HIV infection remained under control in all patients, with undetectable viral load and no opportunistic infections. Conclusion Important regional differences exist in the demographics and management of immunosuppression and antiretroviral therapy. These details may influence AR and infectious complications. Non- AIDS infections leading to early mortality in Brazil deserve special attention. [ABSTRACT FROM AUTHOR]

Published
2017
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46. Prospective Randomized Trial Investigating the Influence of Pharmaceutical Care on the Intra-Individual Variability of Tacrolimus Concentrations Early After Kidney Transplant.

Author

Bessa, Adrieli B., Felipe, Claudia R., Hannun, Pedro, Sayuri, Priscila, Felix, Maria Julia, Ruppel, Priscila, Ferreira, Alexandra N., Cristelli, Marina P., Viana, Laila, Mansur, Juliana F., Basso, Geovana, Aguiar, Wilson Ferreira, Tedesco-Silva, Hélio, and Medina-Pestana, José

Published
2016
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48. Distinct Outcomes of Kidney Transplant Recipients With Recent COVID-19 According to the Timing of Infection

Author

Manfro, Arthur Gus, de Sandes-Freitas, Tainá Veras, Garcia, Valter Duro, Keitel, Elizete, Cristelli, Marina Pontello, Viana, Laila Almeida, Ferreira, Gustavo Fernandes, Campos, Juliana Bastos, Simão, Denise Rodrigues, Coelho, Maria Eduarda Heinzen de Almeida, Costa, Kellen Micheline Alves Henrique, Pereira Júnior, Tomás, Moschetta, Marina Oliboni, Baptista, Maria Alice Sperto Ferreira, Simões, Marcela Giraldes, Kroth, Leonardo Viliano, Deboni, Luciane Monica, Esmeraldo, Ronaldo de Matos, Medina-Pestana, Jose Osmar, Manfro, Roberto Ceratti, Fernandes Charpiot, Ida Maria Maximina, Aparecida Zanocco, Juliana, Sartori Giaretta, Débora, Alexandre Vieira, Marcos, de Mattos Brito Oliveira Sales, Maria Luiza, Alves Ferreira, Teresa Cristina, Cronenberge Sousa, Katia, Azevedo Matuck, Tereza, De Boni Monteiro de Carvalho, Deise, da Silveira Rioja, Suzimar, Hermógenes Rocco Suassuna, José, Lage Madeira, Rafael, Simone Vilaça, Sandra, de Lourdes Noronha, Irene, da Rocha Martinez, Tania Leme, Modelli de Andrade, Luís Gustavo, and de Barros Almeida, Ricardo Augusto Monteiro

Published
2022
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50. Infectious complications as the leading cause of death after kidney transplantation: analysis of more than 10,000 transplants from a single center

Author

Castro Rodrigues Ferreira, Flávio, Cristelli, Marina, Paula, Mayara, Proença, Henrique, Felipe, Claudia, Tedesco-Silva, Helio, and Medina-Pestana, José

Abstract

To identify specific causes of graft failure in a large sample of kidney transplant patients from a middle-income, developing country. Retrospective cohort study analyzing all consecutive single kidney transplants (KTs) performed at a single center in Brazil between January 1st 1998 and December 31st 2013. The database closing date was December 31st 2014. Out of 10,400 KTs, there were 1191 (11.45%) deaths with a functioning graft, 40 cases (0.38%) of primary non-function (PNF) and 1417 cases (13.62%) of graft loss excluding death and PNF as the cause. Infectious complications (404 cases, 34% of all deaths) were the major cause of death. Most deaths due to infection occurred within the first year after transplantation (157 deaths, 38.86%). Immunologic mechanisms, comprising acute rejection and immune-mediated interstitial fibrosis/tubular atrophy (IF/TA), were responsible for 52% of all cases of graft failure not involving recipient death. Half of the losses by acute rejection occurred late after transplantation. Contrary to what is observed in developed countries, infectious complications are the main challenge with kidney transplantation in Brazil. Non-adherence to treatment also appears to contribute significantly to long-term kidney graft loss. Strategies for improvement should focus on better compliance and a greater safety profile of immunosuppressive treatment.

Published
2017
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