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Kidney transplantation is the best renal replacement therapy for end-stage renal disease. Living donation constitutes the highest proportion of transplants in our country; donation nephrectomy requires assessment of renal function, which will influence the surgical planning of the kidney to donate. Methods We made a comparison between the evolutions of patients who underwent right nephrectomy versus left nephrectomy, for donation purposes in our center. Results Out of a total of 395 cases, 86 (21.7%) were right nephrectomies. With significant differences in the proportion of intraoperative complications, 2% for left nephrectomy and none for right nephrectomy; and more patients with postoperative complications (Clavien-Dindo II) for the left nephrectomy group, with a statistically significant difference (p = 0.02) Discussion and Conclusions Adequate surgical planning of the kidney to donate is required to ensure renal function after the donation event, as well as verification of the safety of the surgical act in the donor and the recipient, this must be collegiate and individualized for each transplant binomial.

To determine the evolution, associated factors and the outcomes of transplanted people one year after the evolution of a cohort in Mexico.Kidney transplant cohort from 2013 to 2017 in Mexico. 1118 patients were analyzed. Five outcomes were studied: overall survival, kidney graft, patient survival, delayed function, and acute dysfunction. Kaplan-Meier was used for kidney graft survival. For risk, bivariate and multivariate analyzes were performed with a significant value of p0.05.Of the 1118 kidney transplant patients, 57 (5.09%) had kidney graft loss, 52 (4.65%) died during the one-year follow-up; survival of the patient of 95.35% and of the graft 90.25%.The risk factors for the outcomes were transplantation from a deceased donor, recipient over 50 years of age and use of polyclonal agents. Infections and age are related to the death of the patient.Determinar la funcionalidad del injerto renal a 1 año en una cohorte retrospectiva en México.Cohorte de trasplante renal de 2013 a 2017 en México. Se analizaron 1118 pacientes. Se estudiaron cinco desenlaces: supervivencia global, supervivencia del injerto renal, supervivencia del paciente, función retardada y disfunción aguda. Para la supervivencia del injerto renal se usó Kaplan-Meier. Para el riesgo se realizó análisis bivariado y multivariado con valor significativo p0.05.De los 1118 pacientes con trasplante renal, 57 (5.09%) tuvieron pérdida del injerto, 52 (4.65 %) fallecieron durante el año de seguimiento; la supervivencia del paciente fue del 95.35% y la supervivencia del injerto fue del 90.25%.Los factores de riesgo para los desenlaces fueron trasplante de donante fallecido, receptor mayor de 50 años y uso de agentes policlonales. Las infecciones y la edad están relacionadas con la muerte del paciente.

Background General anesthesia is the conventional management of renal transplant, and its evolution has revolved around the development of new drugs; however, a group of patients meet conditions for neuraxial anesthesia, because of their comorbidities, who are at greater risk of complications with general anesthesia and are not favorable to grafting. Methods We conducted a controlled clinical trial of 109 renal transplant recipients where renal function was evaluated at 24, 48, and 72 hours and 3 months after transplant, and we compared regional, general anesthesia with inhaled anesthetic and total intravenous anesthesia. It was performed for 1 year, and serum creatinine, urea nitrogen, and electrolytes were evaluated. During the intraoperative period central venous pressure, mean arterial pressure, vasopressors, fluid therapy, diuretics, surgical time, anesthesia, hot and cold ischemia, immunosuppressants, and antihypertensives were evaluated. They were analyzed with χ2 independence and 1-way and 2-way repeated measures. Results The type of anesthesia was associated with hemodynamic stability (P = .018), the use of vasopressor (P = .005), and fluid therapy (P = .011). A value of P = .005 was found for central venous pressure at discharge from the operating room, and preincisional mean arterial pressure (P = .015) was among the types of anesthesia. Creatinine, blood urea nitrogen, sodium, and potassium were statistically significant over time (P Conclusion There is no difference between anesthetic techniques and clinical results over time. The personalized anesthetic technique will improve the neuroendocrine response and surgical stress, decrease the need for vasopressors and analgesics, and reduce complications.

Posttransplant anemia (PTA) in kidney recipients is a complication that has repercussions mainly of cardiovascular consequence. The objective of this study is to determine the prevalence of anemia, as well as the relationship between kidney recipient and donor sex, in the presence or absence of anemia at 12 months after kidney transplant (KT).Observational, longitudinal study of KTs made over a 5-year period, from 2013 to 2017, in a renal transplant unit from La Raza National Health Care Medical Center. Three hundred twenty-eight records were analyzed. Hemoglobin (Hb) and the presence or absence of anemia according to the definition by the World Health Organization were analyzed. The association between kidney recipient sex and donor type (living or deceased) was evaluated. Analysis of central tendency and dispersion were performed and the mean difference was established with χThe mean Hb (standard deviation) before KT was 10.38 (2.16) g/dL; Hb at 12 months was 14.47 (2.37) g/dL with an absolute increase of 4.09 g/dL. Before KT, male kidney recipients had a mean Hb of 10.54 (2.17) g/dL. At 12 months post-KT, mean Hb was 15.33 (2.25) with a change of 4.79 g/dL. Before KT, female kidney recipients had a mean Hb of 10.16 (2.13) g/dL. At 12 months post-KT, mean Hb was 13.31 (2.01) with a change of 3.15 g/dL. The difference between both sexes was 1.64 g/dL at the end of 12 months. Sixteen out of 152 (10.5%) patients had a serum creatinine (Cr) 1.2 mg/dL and anemia; 36 out of 176 (20.5%) patients had a Cr ≥ 1.2 mg/dL and anemia (P = .014). In the bivariate logistic regression with an odds ratio of 2.047 (95% confidence interval, 1027-4078; P = .042) for higher Cr levels and the presence of persistent anemia.There is a prevalence of anemia in female kidney recipients and recipients of kidneys from deceased donors. There is a higher risk of persistent anemia in the case of patients with some degree of graft failure at 12 months.

Objectives The biochemical conditions in which patients arrive before renal transplantation (RT) are rarely evaluated; examples of them are found in the Dialysis Outcomes and Practice Patterns Study (DOPPS). The objective of our study was to ascertain the fulfillment of biochemical goals for patients on renal replacement therapy before RT. Material and Methods Observational, retrospective study of patients who were on a RT protocol between 2012 and 2017 in 2 RT centers in Mexico. The records of 1188 patients with a history of RT and their lab results before transplantation were analyzed. Anthropometric values including hemoglobin, iron levels, calcium, phosphorus, parathyroid hormone, urea, creatinine, uric acid, and left ventricular ejection fraction were studied. All values were categorized as low, optimal, or high levels. Results The fulfillment of pretransplant biochemical objectives for elimination of azotemia (urea and creatinine) was achieved in 60% of the patients. Optimal values for calcium were found in 715 (64%) patients and optimal values for albumin were found in 690 (61.8%) patients. In the case of phosphorus, hemoglobin, uric acid, and parathyroid hormone, the optimal values were below 50%. Conclusions It is essential to improve compliance with biochemical and clinical objectives for patients on renal replacement therapy (dialysis, hemodialysis) before RT. Only half of the variables were within the optimal range before surgical intervention took place.

Choriocarcinoma is a malignant tumor, it is more frequent in the female sex, rarely reported in the male sex.A 19-year-old male patient who was admitted with hematochezia and melenic evacuations, panendoscopy and colonoscopy were performed without documenting the bleeding site, exploratory laparotomy was performed finding tumor lesion in the jejunum, the histopathological examination reported Choriocarcinoma.Gastrointestinal bleeding as a presentation of choriocarcinoma is sometimes the only symptom that the patient presents. Metastatic choriocarcinoma to the gastrointestinal tract is rare, which makes the suspected diagnosis poor.El coriocarcinoma es un tumor maligno, más frecuente en el sexo femenino, raramente reportado en el sexo masculino.Varón de 19 años que ingresa con hematoquecia y evacuaciones melénicas. Se realiza panendoscopia y colonoscopia, sin documentar el sitio de sangrado. Se realiza laparotomía exploradora y se encuentra una lesión tumoral en el yeyuno, cuyo examen histopatológico reportó coriocarcinoma.La hemorragia de tubo digestivo como presentación de un coriocarcinoma es en ocasiones el único síntoma que muestra un paciente. El coriocarcinoma metastásico al tracto gastrointestinal es raro, lo que hace que la sospecha diagnóstica sea pobre.

Introducción: El coriocarcinoma es un tumor maligno, más frecuente en el sexo femenino, raramente reportado en el sexo masculino. Caso clínico: Varón de 19 años que ingresa con hematoquecia y evacuaciones melénicas. Se realiza panendoscopia y colonoscopia, sin documentar el sitio de sangrado. Se realiza laparotomía exploradora y se encuentra una lesión tumoral en el yeyuno, cuyo examen histopatológico reportó coriocarcinoma. Conclusiones: La hemorragia de tubo digestivo como presentación de un coriocarcinoma es en ocasiones el único síntoma que muestra un paciente. El coriocarcinoma metastásico al tracto gastrointestinal es raro, lo que hace que la sospecha diagnóstica sea pobre.

Background Bone mineral disease after transplantation persists and is an issue that must be addressed owing to the cardiovascular impact it presents. The objective of this study is to present the behavior of calcium, phosphorus, and parathormone (PTH) before renal transplantation (RT) and throughout the 12 months after transplant surgery. Methods A longitudinal observational study of RT patients was performed from 2013 to 2017 in 2 renal transplant units in Mexico. In total, 1009 records of patients with RT were analyzed. Calcium, phosphorus, and PTH levels were studied before transplantation and for 12 months after. Central tendency and dispersion were measured, the difference of means was established with chi square or student t tests, and the significant value of P was set at Results Phosphorus had a median pre-RT of 5.73, which decreased to 2.8 in the first month post-transplant and then increased to 3.41 at 12 months post-RT. The median PTH, on the other hand, started at 420.60 and decreased to 67.45. Calcium began at 9.04 and hit a plateau of 9.58 during month 12 after the surgical event. Conclusions Of the 3 biochemical parameters evaluated, phosphorus was the one that most corrected itself after transplantation. Despite a tendency toward hypophosphatemia in the first month after transplantation, it began to normalize from month 6 on. Meanwhile, calcium was the biochemical value that changed the least after transplantation.

Introduction: The infection with SARS-CoV-2 that affects the entire world has been shown to be more severe in patients with comorbidities The object of this study was to know the survival of renal transplant patients infected with this coronavirus Material and methods: Eligible were renal transplant patients with SARS-CoV-2 infection requiring hospitalization (moderate and severe degree) from the start of the pandemic to September 28, 2020 Survival analysis was performed with Kaplan-Meier tables in days, using statistical package SPSSw v25 Results: Data was collected for 66 patients from 4 renal transplant facilities;the mean age was 39 5 years (IQR 30 0-49 5);global survival was 59 10% Difference of 67 50% vs 46 15% was observed between receivers from living and dead donors respectively (without Log Rank significance of 0 068);70 25% survival in patients with low immunological risk and 44 82% for high risk (Log Rank 0 034) Conclusions: Comorbidities and immunosuppression greatly influence mortality in renal transplant patients immunological risk presents an important determinant of patient survival [ABSTRACT FROM AUTHOR] Copyright of Trends in Transplantation is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

Introduction Renal transplantation (RT) has evolved to improve its functionality. Some factors have been little studied, one of which is hyperuricemia and its impact on renal graft function. The objective of this study is to determine the prevalence of complications of renal transplantation and its influence on hyperuricemia values in the first year of evolution. Material and Methods The authors completed a retrospective, observational study of 2 RT units in Mexico from January 2013 to December 2017. In total, 1009 files met the inclusion criteria; the levels of uric acid (UA) and creatinine (Cr) were determined before transplantation and in months 1, 3, 6, 9, and 12 after transplantation. Descriptive analysis was performed with measures of central tendency, measures of dispersion, difference of means with Student t test, and SPSS version 25 (IBM, Armonk, NY, United States). Results The mean pretransplant UA was 6.24 mg/dL (standard deviation [SD] 1.97); per month was 4.73 mg/dL (SD 1.49). There is a difference in means between categorized groups of UA in the 5 post-RT moments (1, 3, 6, 9, and 12 months). A positive correlation of 0.41 to 0.47 was found with Spearman’s test. The delayed function of the graft influenced in the first month after transplant in presenting hyperuricemia and acute dysfunction in month 6 showed that the rejection had no significance at any time. Conclusions The relationship between the values of UA and Cr in the RT represents a moderate positive correlation; delayed graft function in the first month impacts the presence of hyperuricemia, as well as acute dysfunction at month 6 after transplantation.

Background Dyslipidemia represents a trigger for cardiovascular complications, being in minimized renal transplantation (RT) or most of the occasions associated as something secondary to immunosuppression. The objective is to determine the pattern of cholesterol and triglyceride behavior in the first 12 months of post-transplant evolution and its relationship with age, sex of the recipient, and type of renal donor. Materials and Methods An observational, longitudinal study of RT carried out from 2013 to 2017 at the National Medical Center La Raza. In total, 328 records of patients with RT were analyzed. Cholesterol and triglyceride levels were studied over 12 months after renal transplantation; the association with sex, age of the renal recipient, and type of donor (live or deceased) was determined. Measures of central tendency and dispersion were made; the difference of means was established with a χ2 or Student t test. For risk, a bivariate analysis was performed with a significant value of P Results The mean pretransplant cholesterol was within normal values (176.32, standard deviation [SD] 40.15 mg/dL), but triglycerides were not (158.36, SD 36.60 mg/dL). The pattern in both cases increased the values the first month after transplant to reach similar pretransplant levels in month 12. Cholesterol showed differences for month 12 in the group over 50 years (P = .022); like triglycerides in the 9th and 12th months (P = .026 and .003, respectively), values were higher in those over 50 years. Discussion and Conclusions The pattern of cholesterol and triglyceride behavior is similar, even without understanding the reasons for the immediate post-transplant increase in month 1. There is no influence on the sex of the renal recipient nor on the type of donor. Only the age in recipients older than 50 years has a ratio of higher triglyceride values in months 9 and 12 and in cholesterol in the 12 months post-transplant.

Objetivo: analizar la proporción de casos con covid-19 con inmunosupresión, manejo intrahospitalario y trasplante renal en el país. Métodos: estudio descriptivo, se realizó un análisis de las bases de datos públicas acerca de los casos de covid-19 en México hasta el mes de septiembre, se analizó la proporción de pacientes con inmunosupresión hospitalizados que tuvieron un trasplante renal, así como su evolución. Resultados: los casos con covid-19 e inmunosupresión fueron 13 285, 30.8% de los cuales fueron atendidos de forma intrahospitalaria (4 104). La condición de inmunosupresión por el uso de inmunomoduladores en trasplante renal en este grupo de pacientes atendidos de manera intrahospitalaria fue de 4% (166); con una mortalidad para este grupo de pacientes de 41.5% (69). Conclusiones: la tasa de mortalidad en pacientes con covid-19 hospitalizados con inmunosupresión debido al uso de inmunomoduladores es cuatro veces más alta si se compara con la tasa de mortalidad nacional por covid-19.

While calcineurin inhibitors (CNIs) are effective for preventing acute rejection in kidney transplant recipients, long-term use may cause chronic kidney injury and is associated with increased risks of cardiovascular events, cancer, and infection-associated death. Immunosuppression strategies are needed to balance risks of acute and subclinical rejection with long-term benefits of improved kidney function. Sirolimus, an inhibitor of mammalian target of rapamycin, is used for immunosuppression in kidney transplantation. Its clinical utility has evolved, over more than 15 years, including de novo sirolimus with and without concomitant CNIs and conversion from CNI-based regimens to sirolimus. Sirolimus-containing regimens are associated with preservation of good renal function, with promising characteristics for improving long-term graft and patient survival, including antiviral and anticancer effects. Based on clinical evidence, use of low-dose sirolimus in a de novo approach with tacrolimus/steroids in the immediate posttransplantation period is appropriate. A feasible alternative is a long term, CNI-free combination with mycophenolate mofetil (following CNI-to-sirolimus conversion at 3-6 months). These strategies are appropriate for a broad range of patients with various levels of immunologic risk, including those receiving expanded criteria donor kidneys or at increased risk of delayed graft function, particular challenges in Latin America and other global regions.

The assessment of health-related quality of life is essential to renal replacement therapies. We conducted a study to evaluate the change in quality of life at 6 and 12 months after renal transplantation and compared with healthy population and general population.A prospective study in 278 renal transplant recipients using the SF-36 survey at 0, 6 and 12 months after transplantation. The results were compared with those obtained in healthy population (kidney donors) and general population. Student t test was employed for comparisons of means. A value of p0.05 was considered statistically significant.The quality of life before transplantation was lower than that observed in healthy population and the general population (p0.001). At 6 months of transplantation significant improvement over the baseline measurement (p0.001) in the 8 domains and the two composite scales was obtained, but at 12 months, an additional benefit was not observed. The quality of life of recipients at 12 months of transplant was lower only in the concept of general health (p=0.035) compared with healthy population. However, it was higher than general population in physical and mental composite scales (p=0.013 and p=0.001 respectively).The health related quality of life improved significantly at 6 and 12 months after renal transplantation, achieving equated healthy population and general population.Introducción: la evaluación de la calidad de vida relacionada con la salud es fundamental en las terapias de reemplazo renal. Realizamos un estudio para evaluar la modificación en la calidad de vida a los 6 y 12 meses del trasplante renal y compararla con población sana y población general. Métodos: se realizó un estudio prospectivo en 278 receptores renales aplicando la encuesta SF-36 a los 0, 6 y 12 meses del trasplante. Los resultados fueron comparados con los obtenidos en población sana (donantes renales) y población general. Se empleó prueba t de student para realizar las comparaciones de medias. Una plt; 0.05 fue considerada estadísticamente significativa.Resultados: la calidad de vida previa al trasplante fue inferior a la observada en población sana y población general (plt; 0.001). A los 6 meses de trasplante se obtuvo mejoría significativa con respecto a la medición basal (plt; 0.001) en los 8 dominios y las dos escalas compuestas, pero a los 12 meses no se observó un beneficio adicional. La calidad de vida de los receptores a los 12 meses de trasplante fue inferior solo en el concepto de salud general (p = 0.035) al compararse con la población sana. No obstante, fue superior a la población general en las escalas compuestas física y mental (p = 0.013 y p = 0.001 respectivamente).Conclusiones: la calidad de vida relacionada con la salud mejora significativamente a los 6 y 12 meses del trasplante renal, logrando equipararse con población sana y población general.