29 results on '"Melexopoulou C"'
Search Results
2. Therapeutic options for recurrence of primary focal segmental glomerulonephritis (FSGS) in the renal allograft: Single-center experience
- Author
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Vallianou, K. Marinaki, S. Skalioti, C. Lionaki, S. Melexopoulou, C. Boletis, I. Darema, M.
- Subjects
urologic and male genital diseases - Abstract
Focal Segmental Glomerulosclerosis (FSGS) recurrence after kidney transplantation (KTx) is relatively frequent and is associated with poor graft survival. The aim of this study was to investigate which management strategies were associated with better outcomes in our cohort of KTx recipients with primary FSGS. We retrospectively collected data on patients with primary FSGS who received a KTx between 1993 and 2019. A history of biopsy proven FSGS in native kidneys and new onset of significant proteinuria early post-KTx led to the diagnosis of recurrence, which was confirmed by graft biopsy. From 1993 to 2019 we performed 46 KTxs in patients with primary FSGS. We identified 26 episodes of recurrence in 25 patients, 67% of them occurring in males. They were younger at the time of KTx (33.8 vs. 41.1 years old, p = 0.067) and had progressed to end stage renal disease (ESRD) faster after FSGS diagnosis (61.4 vs. 111.2 months, p = 0.038), while they were less likely to have received prophylactic plasmapheresis (61.5% vs. 90%, p = 0.029). 76.7% of recurrences were found early, after a median of 0.5 months (IQR 0.1–1) with a median proteinuria was 8.5 (IQR 4.9–11.9) g/day. All patients with recurrence were treated with plasmapheresis, while 8 (30.7%) additionally received rituximab, 1 (3.8%) abatacept, and 4 (15.4%) ACTH. 7 (27%) patients experienced complete and 11 (42.3%) partial remission after a mean time of 3 (±1.79) and 4.4 (±2.25) months, respectively. Prognosis was worse for patients who experienced a recurrence. Eleven (42.3%) patients lost their graft from FSGS in a median time of 33 (IQR 17.5–43.3) months. In this series of patients, primary FSGS recurred frequently after KTx. Prophylacic plasmapheresis was shown efficacious in avoiding FSGS recurrence, while timely diagnosis and plasmapheresis-based regimens induced remission in more than half of the patients. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
- Published
- 2021
3. PCSK9 and inflammatory biomarkers in the early post kidney transplantation period
- Author
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Melexopoulou, C. Marinaki, S. Oikonomou, E. Bonios, M.J. Theofilis, P. Miliou, A. Siasos, G. Tousoulis, D. Boletis, J.N.
- Abstract
OBJECTIVE: Various biomarkers have been studied in the early post-kidney transplantation (post-KTx) period in order to identify potential therapeutic targets for improving long-term graft survival. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a biomarker that has recently gained interest in cardiovascular disease but its role still remains to be defined post-KTx. PATIENTS AND METHODS: We prospectively evaluated the levels of PCSK9, interleukin (IL)-6, WBC and C-reactive protein in seventy-three hemodialysis patients undergoing KTx, at 3 time-points; pre-transplantation (day 0) and at 1 and 6-months post-KTx. All data were also analyzed according to donor-type (living or deceased) and compared with hemodialysis patients on transplant waiting list. RESULTS: At Day 0 there was no difference in WBC, CRP, IL-6 and PCSK9 levels between patients scheduled for transplantation and those who remained on hemodialysis. In transplanted patients WBC, CRP and IL-6 levels were significantly reduced early post-KTx [logIL-6 Day 0: 0.68 (0.33, 0.85) vs. 1-month: 0.57 (0.37, 0.75) vs. 6-months: 0.50 (0.32, 0.69) pg/ml, p=0.01], while PCSK9 levels were significantly increased (Day 0: 199.8±63.0 vs. 1-month: 276.2±79.4 vs. 6-months: 245.9±62.5 ng/ml, p
- Published
- 2021
4. Exploring the association of anorexia with frailty and sarcopenia in hemodialysis patients
- Author
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Poulia, K.A., primary, Kolovou, K., additional, Melexopoulou, C., additional, Kalaitzakis, E., additional, Gavalas, I., additional, Mavragani, D., additional, Morogianni, K., additional, Skalioti, C., additional, and Boletis, I.N., additional
- Published
- 2020
- Full Text
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5. The Role of Amiodarone in Recent-Onset Atrial Fibrillation after Ibutilide Has Failed to Restore Sinus Rhythm
- Author
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Sideris, S., Bonios, M., Melexopoulou, C., Exarchos, P., Tsatiris, K., and Kogias, J.
- Published
- 2007
- Full Text
- View/download PDF
6. PCSK9 and inflammatory biomarkers in the early post kidney transplantation period.
- Author
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MELEXOPOULOU, C., MARINAKI, S., OIKONOMOU, E., BONIOS, M. J., THEOFILIS, P., MILIOU, A., SIASOS, G., TOUSOULIS, D., and BOLETIS, J. N.
- Abstract
OBJECTIVE: Various biomarkers have been studied in the early post-kidney transplantation (post-KTx) period in order to identify potential therapeutic targets for improving long-term graft survival. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a biomarker that has recently gained interest in cardiovascular disease but its role still remains to be defined post-KTx. PATIENTS AND METHODS: We prospectively evaluated the levels of PCSK9, interleukin (IL)-6, WBC and C-reactive protein in seventy-three hemodialysis patients undergoing KTx, at 3 timepoints; pre-transplantation (day 0) and at 1 and 6-months post-KTx. All data were also analyzed according to donor-type (living or deceased) and compared with hemodialysis patients on transplant waiting list. RESULTS: At Day 0 there was no difference in WBC, CRP, IL-6 and PCSK9 levels between patients scheduled for transplantation and those who remained on hemodialysis. In transplanted patients WBC, CRP and IL-6 levels were significantly reduced early post-KTx [logIL-6 Day 0: 0.68 (0.33, 0.85) vs. 1-month: 0.57 (0.37, 0.75) vs. 6-months: 0.50 (0.32, 0.69) pg/ml, p=0.01], while PCSK9 levels were significantly increased (Day 0: 199.8±63.0 vs. 1-month: 276.2±79.4 vs. 6-months: 245.9±62.5 ng/ml, p<0.001). In contrast, no change of WBC, CRP, IL-6 and PCSK9 levels was observed in hemodialysis patients on follow-up (p=NS for all). Between living-donor and deceased-donor recipients, analysis showed reduced CRP and increased PCSK9 levels in both groups (p<0.05 for all), while IL-6 levels were reduced in living-donor and increased in deceased-donor recipients 1-month postKTx. PCSK9 levels were not correlated with renal function, delayed graft function, rejection episodes or inflammatory biomarkers. CONCLUSIONS: PCSK9 levels were increased post-KTx independently from renal function and inflammatory biomarkers, in both living and deceased-donor recipients. [ABSTRACT FROM AUTHOR]
- Published
- 2021
7. Celiac-like enteropathy associated with mycophenolate sodium in renal transplant recipients
- Author
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Filiopoulos, V. Sakellariou, S. Papaxoinis, K. Melexopoulou, C. Marinaki, S. Boletis, J.N. Delladetsima, I.
- Abstract
Background. Although colonic injury is a well-known complication of mycophenolic acid (MPA), the involvement of the upper gastrointestinal tract is less extensively documented. We present the occurrence of celiac-like duodenopathy manifested as a severe diarrhea syndrome in 2 renal transplant recipients on enteric-coated mycophenolate sodium. Methods. The patients belong to a setting of 16 renal transplant recipients under MPA suffering from chronic diarrhea in the absence of MPA-related colitis. Results. Both patients had a history of persistent diarrhea with significant weight loss. Colonic mucosa was unremarkable, whereas duodenal biopsies revealed celiac-like changes with increased epithelial cell apoptosis. Clinical symptoms completely resolved, and follow-up biopsies demonstrated normalization of histology after enteric-coated mycophenolate sodium withdrawal and switching to azathioprine. Conclusions. Celiac-like enteropathy seems to represent a rare side effect of MPA-associated immunosuppressive therapy and should be taken into account in the differential diagnosis of diarrhea in transplant recipients treated with MPA particularly in the absence of MPA-related colitis. As macroscopic lesions are usually missing, blind duodenal biopsies are necessary to establish the diagnosis. Copyright © 2018 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
- Published
- 2018
8. Frequent COL4 mutations in familial microhematuria accompanied by later-onset Alport nephropathy due to focal segmental glomerulosclerosis
- Author
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Papazachariou, L. Papagregoriou, G. Hadjipanagi, D. and Demosthenous, P. Voskarides, K. Koutsofti, C. Stylianou, K. and Ioannou, P. Xydakis, D. Tzanakis, I. Papadaki, A. and Kallivretakis, N. Nikolakakis, N. Perysinaki, G. Gale, D. P. and Diamantopoulos, A. Goudas, P. Goumenos, D. Soloukides, A. Boletis, I. Melexopoulou, C. Georgaki, E. Frysira, E. and Komianou, F. Grekas, D. Paliouras, C. Alivanis, P. and Vergoulas, G. Pierides, A. Daphnis, E. Deltas, C.
- Subjects
urologic and male genital diseases - Abstract
Familial microscopic hematuria (FMH) is associated with a genetically heterogeneous group of conditions including the collagen-IV nephropathies, the heritable C3/CFHR5 nephropathy and the glomerulopathy with fibronectin deposits. The clinical course varies widely, ranging from isolated benign familial hematuria to end-stage renal disease (ESRD) later in life. We investigated 24 families using next generation sequencing (NGS) for 5 genes: COL4A3, COL4A4, COL4A5, CFHR5 and FN1. In 17 families (71%), we found 15 pathogenic mutations in COL4A3/A4/A5, 9 of them novel. In 5 families patients inherited classical AS with hemizygous X-linked COL4A5 mutations. Even more patients developed later-onset Alport-related nephropathy having inherited heterozygous COL4A3/A4 mutations that cause thin basement membranes. Amongst 62 heterozygous or hemizygous patients, 8 (13%) reached ESRD, while 25% of patients with heterozygous COL4A3/A4 mutations, aged >50-years, reached ESRD. In conclusion, COL4A mutations comprise a frequent cause of FMH. Heterozygous COL4A3/A4 mutations predispose to renal function impairment, supporting that thin basement membrane nephropathy is not always benign. The molecular diagnosis is essential for differentiating the X-linked from the autosomal recessive and dominant inheritance. Finally, NGS technology is established as the gold standard for the diagnosis of FMH and associated collagen-IV glomerulopathies, frequently averting the need for invasive renal biopsies.
- Published
- 2017
9. The clinical course of IgA nephropathy after kidney transplantation and its management
- Author
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Lionaki, S. Panagiotellis, K. Melexopoulou, C. Boletis, J.N.
- Abstract
Immunoglobulin (Ig) A nephropathy is one of the most common primary glomerulonephritides worldwide causing end stage renal disease in up to 20–40% of affected patients, nearly two decades post diagnosis. Kidney transplantation is the treatment of choice for patients with renal failure, secondary to glomerular diseases. However, IgA nephropathy has a strong tendency to recur in the graft, and although initially thought to be a benign condition, several reports of graft loss, due to recurrent IgA nephropathy, there have been over the last three decades. Overall graft survival has been significantly improved in kidney transplantation, as a result of reduced incidence of acute rejection, as more potent and more specific immunosuppressive agents are now available in clinical practice. Thus, the rates of IgA nephropathy and other glomerulonephritides recurrence are expected to increase, since graft survival has been improved. However, the reported incidence of IgA nephropathy recurrence in the graft varies substantially across centers, as a consequence of different levels of interest, diverse biopsy policies and differing durations of follow up, of the published studies. Notably, recurrence rates of patients receiving graft biopsies by clinical indication only, ranges from 13% to 50% with graft loss being between 1.3% and 16%. The aim of this review is to underline important pathogenetic insights of IgA nephropathy, describe the clinical course of the disease after kidney transplantation, with emphasis on the incidence of recurrence and the associated risk factors, and finally provide all available options for its management in transplant recipients. © 2017 Elsevier Inc.
- Published
- 2017
10. Syndrome of Inappropriate Antidiuretic Hormone Secretion Complicating Systemic Nocardiosis in a Renal Transplant Recipient: A Case Report
- Author
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Melexopoulou, C. Pavlopoulou, I.D. Zormpala, A. Daikos, G.L. Boletis, J.N. Marinaki, S.
- Abstract
Background Infection by Nocardia species is an uncommon cause of severe clinical syndromes, particularly in immunocompromised patients, and solid-organ transplantation is the most common underlying condition. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) has been described thus far in lung and stem cell transplants with systemic nocardiosis. Case Report We report the first case of SIADH in a female elderly renal transplant recipient diagnosed with systemic nocardiosis 2 years after transplantation. The SIADH was managed appropriately, and her immunosuppressive regimen remained unchanged but was adjusted at a lower level. The systemic Nocardia infection was successfully treated with intravenous administration of trimethoprim-sulfamethoxazole and imipenem for 2 weeks followed by oral trimethoprim-sulfamethoxazole for a total of 12 months. Conclusions The SIADH syndrome is a recognizable complication of Nocardia infection in renal transplant recipients. Prompt identification along with proper management and prolonged antimicrobial treatment are essential to improve patients’ outcome. © 2017 Elsevier Inc.
- Published
- 2017
11. HYPERTENSIVE EMERGENCY IN A DIALYSIS PATIENT
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Zerva, K., primary, Papadopoulos, D., additional, Anastasiadis, G., additional, Sanidas, E., additional, Melexopoulou, C., additional, Boletis, J., additional, and Barbetseas, J., additional
- Published
- 2018
- Full Text
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12. Syndrome of Inappropriate Antidiuretic Hormone Secretion Complicating Systemic Nocardiosis in a Renal Transplant Recipient: A Case Report
- Author
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Melexopoulou, C., primary, Pavlopoulou, I.D., additional, Zormpala, A., additional, Daikos, G.L., additional, Boletis, J.N., additional, and Marinaki, S., additional
- Published
- 2017
- Full Text
- View/download PDF
13. FrequentCOL4mutations in familial microhematuria accompanied by later-onset Alport nephropathy due to focal segmental glomerulosclerosis
- Author
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Papazachariou, L., primary, Papagregoriou, G., additional, Hadjipanagi, D., additional, Demosthenous, P., additional, Voskarides, K., additional, Koutsofti, C., additional, Stylianou, K., additional, Ioannou, P., additional, Xydakis, D., additional, Tzanakis, I., additional, Papadaki, A., additional, Kallivretakis, N., additional, Nikolakakis, N., additional, Perysinaki, G., additional, Gale, D.P., additional, Diamantopoulos, A., additional, Goudas, P., additional, Goumenos, D., additional, Soloukides, A., additional, Boletis, I., additional, Melexopoulou, C., additional, Georgaki, E., additional, Frysira, E., additional, Komianou, F., additional, Grekas, D., additional, Paliouras, C., additional, Alivanis, P., additional, Vergoulas, G., additional, Pierides, A., additional, Daphnis, E., additional, and Deltas, C., additional
- Published
- 2017
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14. Incidence and risk factors of herpes zoster among adult renal transplant recipients receiving universal antiviral prophylaxis
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Pavlopoulou, I.D. Poulopoulou, S. Melexopoulou, C. Papazaharia, I. Zavos, G. Boletis, I.N.
- Abstract
Background: Herpes zoster (HZ) is a significant cause of morbidity and complications in adult renal transplant recipients. We determined the incidence, complications and risk factors for the development of HZ after renal transplantation in a setting using universal antiviral prophylaxis. Methods: The medical files of all adult renal transplants, performed between 2004 and 2008, were retrospectively reviewed to assess the clinical characteristics and risk factors of HZ. Incident cases of HZ were determined and the probability of developing post-transplant HZ for all subjects was calculated using the Kaplan Meier method. A multivariable Cox proportional hazards model was applied to assess the risk factors associated with the development of HZ. Results: A total of 450 patients were eligible with a median follow up of 38 months. Twenty nine subjects (6.4 %) developed HZ, the median time to onset was 18 months, only three of them (10.3 %) required hospitalization, and none developed disseminated or visceral disease and death directly attributed to zoster. However, high rates of post-herpetic neuralgia (48.7 %) were observed. Overall incidence was calculated at 20.6 cases per 1000 patient-years of follow-up. Following multivariate analysis, increased age ≥ 60 years old, positive pre-transplant history of varicella related disease and administration of rejection treatment conferred an increased risk of 4.00-fold (CI: 1.79- 8.92), 16.00-fold (CI: 4.62- 55.52), and 5.57-fold (CI: 1.56- 19.84) respectively, for the development of post-transplant zoster. Conclusions: HZ remains a common complication after renal transplantation in adults under current immunosuppession protocols and universal antiviral prophylaxis. © 2015 Pavlopoulou et al.
- Published
- 2015
15. 546 The role of amiodarone in recent onset atrial fibrillation after Ibutilide has failed to restore sinus rhythm
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Sideris, S., primary, Bonios, M., additional, Melexopoulou, C., additional, Anyfadis, S., additional, Dalabira, P., additional, Gontopoulos, K., additional, Sarafidou, A., additional, and Kogias, I., additional
- Published
- 2005
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16. Therapeutic apheresis in renal transplantation: An update.
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Melexopoulou C, Filiopoulos V, and Marinaki S
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- Humans, Graft Rejection therapy, Immunosuppressive Agents therapeutic use, ABO Blood-Group System, Blood Group Incompatibility, Kidney Transplantation methods, Blood Component Removal methods, Transplants
- Abstract
Therapeutic apheresis (TA) plays a significant role in various aspects of renal transplantation. It has been a necessary preconditioning component in ABO incompatible kidney transplants and an important modality in the removal of anti-human leukocyte antigen (HLA) antibodies both in the context of desensitization protocols that have been developed to allow highly sensitized kidney transplant candidates to be successfully transplanted and as treatment of antibody mediated rejection episodes post transplantation. In addition, TA has been used with various results for the management of recurrent focal segmental glomerulosclerosis. The purpose of this review is to examine the evidence supporting the application of TA as an adjunctive therapeutic option to immunosuppressive agents in protocols both before and after kidney transplantation., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2023 Elsevier Ltd. All rights reserved.)
- Published
- 2024
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17. WITHDRAWN:Therapeutic apheresis in renal transplantation: An update.
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Melexopoulou C, Filiopoulos V, and Marinaki S
- Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.transci.2023.103844 of original article. The duplicate article has therefore been withdrawn. This error bears no reflection on the article or its authors. The publisher apologizes to the authors and the readers for this unfortunate error. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal, Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2023 Elsevier Ltd. All rights reserved.)
- Published
- 2023
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18. Τhe Impact of Pre-Transplant Kidney Biopsy on the Evaluation of Prospective Living Kidney Donors.
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Marinaki S, Vallianou K, Darema M, Mantios E, Kapsia E, Melexopoulou C, Filiopoulos V, Liapis G, and Boletis IN
- Abstract
Living kidney donation contributes to increasing the donor pool. Since safety and excellent outcomes of living kidney donors (LKD) are essential, renal biopsy must be part of the pre-transplant evaluation in donors with isolated urine abnormalities or other risk factors. We retrospectively collected data on potential living donors evaluated in the pre-transplant outpatient clinic of Laiko General Hospital of Athens between 2007 and 2022, who underwent a pre-transplant biopsy. Biopsy indications included microscopic hematuria, borderline proteinuria and comorbidities suggestive of chronicity. Those with glomerular diseases or chronic lesions were excluded from donation. We identified 59 potential living donors who underwent renal biopsy. Of these, 10 (16.9%) were male. Median age was 58 (IQR 51-63) years, while 23 (39%) were older than 60 years. 49 out of 59 (83%) had glomerular hematuria, 10 (16.7%) had proteinuria (150-300 mg/d). Out of the 59 donors, 21 (35.6%) were hypertensive, three (5.1%) had impaired glucose tolerance and seven (11.9%) had a BMI > 30 kg/m
2 . A total of 32 (54.2%) potential donors were accepted for donation. Eight (13.6%) had IgA nephropathy, 10 (16.9%) TBMD and nine (15.3%) had increased chronicity including secondary FSGS. When compared with a control group of donors who did not need a pre-transplant biopsy, those 32 who donated were more frequently hypertensive ( p = 0.003), but had similar eGFR [61.3 (±10.4) vs. 61.9 (±13.8), p = 0.866] after a follow-up of 79 (36-114) months. Renal biopsy is a useful tool in the evaluation of prospective LKD. Thorough assessment of donors with isolated urine abnormalities and marginal donors is critical to ensure good post-donation outcomes.- Published
- 2023
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19. The Changing Landscape of Pneumocystis Jiroveci Infection in Kidney Transplant Recipients: Single-Center Experience of Late-Onset Pneumocystis Pneumonia.
- Author
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Marinaki S, Vallianou K, Melexopoulou C, Lionaki S, Darema M, Lambrou P, and Boletis I
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- Adult, Aged, Female, Humans, Immunosuppression Therapy methods, Male, Middle Aged, Pneumonia, Pneumocystis chemically induced, Pneumonia, Pneumocystis drug therapy, Postoperative Complications chemically induced, Postoperative Complications drug therapy, Retrospective Studies, Time Factors, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, Immunosuppression Therapy adverse effects, Kidney Transplantation adverse effects, Pneumocystis carinii, Pneumonia, Pneumocystis immunology, Postoperative Complications microbiology
- Abstract
Background: Pneumocystis jiroveci pneumonia (PCP) is a life-threatening pulmonary infection after kidney transplantation (KTx). Its onset in the current era of modern immunosuppression and of routine use of universal PCP prophylaxis seems to differ from its onset in previous decades in terms of late onset with subtle clinical presentation, indicating a need for increased vigilance., Methods: We retrospectively studied all KTx recipients from our center who underwent bronchoscopy and bronchoalveolar lavage (BAL) between 2009 and 2018. Of these, all cases with confirmed PCP any time after the first post-KTx year were included in the analysis., Results: Among 60 patients with KTx who had undergone bronchoscopy and BAL, 12 cases with late-onset PCP were identified. PCP appeared late at a median of 10.8 (interquartile range, 2.4-15.8) years after transplantation. Patients' mean age was 59 years, and all were receiving stable low-dose immunosuppression. Most of the patients (67%) had received PCP prophylaxis after KTx. Five out of 12 patients (42%) had concomitant cytomegalovirus (CMV) reactivation at the time of PCP. In almost all cases, clinical presentation was mild. Treatment consisted of trimethoprim-sulfamethoxazole (TMP-SMX) and intravenous corticosteroid administration, and concomitant immunosuppression was temporarily reduced or withdrawn. Outcome was generally good. None of the patients developed respiratory insufficiency or required mechanical ventilation. One patient died as a result of sepsis, and 3 more with preexisting advanced chronic kidney disease subsequently lost their grafts., Conclusion: Renal transplant recipients are at risk of late-onset PCP, even at a steady state of low-dose maintenance immunosuppression. Because of its subtle clinical presentation, high suspicion of the disease is warranted. Its early recognition and proper management are essential for a successful outcome., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
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20. Therapeutic Options for Recurrence of Primary Focal Segmental Glomerulonephritis (FSGS) in the Renal Allograft: Single-Center Experience.
- Author
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Vallianou K, Marinaki S, Skalioti C, Lionaki S, Darema M, Melexopoulou C, and Boletis I
- Abstract
Focal Segmental Glomerulosclerosis (FSGS) recurrence after kidney transplantation (KTx) is relatively frequent and is associated with poor graft survival. The aim of this study was to investigate which management strategies were associated with better outcomes in our cohort of KTx recipients with primary FSGS. We retrospectively collected data on patients with primary FSGS who received a KTx between 1993 and 2019. A history of biopsy proven FSGS in native kidneys and new onset of significant proteinuria early post-KTx led to the diagnosis of recurrence, which was confirmed by graft biopsy. From 1993 to 2019 we performed 46 KTxs in patients with primary FSGS. We identified 26 episodes of recurrence in 25 patients, 67% of them occurring in males. They were younger at the time of KTx (33.8 vs. 41.1 years old, p = 0.067) and had progressed to end stage renal disease (ESRD) faster after FSGS diagnosis (61.4 vs. 111.2 months, p = 0.038), while they were less likely to have received prophylactic plasmapheresis (61.5% vs. 90%, p = 0.029). 76.7% of recurrences were found early, after a median of 0.5 months (IQR 0.1-1) with a median proteinuria was 8.5 (IQR 4.9-11.9) g/day. All patients with recurrence were treated with plasmapheresis, while 8 (30.7%) additionally received rituximab, 1 (3.8%) abatacept, and 4 (15.4%) ACTH. 7 (27%) patients experienced complete and 11 (42.3%) partial remission after a mean time of 3 (±1.79) and 4.4 (±2.25) months, respectively. Prognosis was worse for patients who experienced a recurrence. Eleven (42.3%) patients lost their graft from FSGS in a median time of 33 (IQR 17.5-43.3) months. In this series of patients, primary FSGS recurred frequently after KTx. Prophylacic plasmapheresis was shown efficacious in avoiding FSGS recurrence, while timely diagnosis and plasmapheresis-based regimens induced remission in more than half of the patients.
- Published
- 2021
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21. Celiac-like Enteropathy Associated With Mycophenolate Sodium in Renal Transplant Recipients.
- Author
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Filiopoulos V, Sakellariou S, Papaxoinis K, Melexopoulou C, Marinaki S, Boletis JN, and Delladetsima I
- Abstract
Background: Although colonic injury is a well-known complication of mycophenolic acid (MPA), the involvement of the upper gastrointestinal tract is less extensively documented. We present the occurrence of celiac-like duodenopathy manifested as a severe diarrhea syndrome in 2 renal transplant recipients on enteric-coated mycophenolate sodium., Methods: The patients belong to a setting of 16 renal transplant recipients under MPA suffering from chronic diarrhea in the absence of MPA-related colitis., Results: Both patients had a history of persistent diarrhea with significant weight loss. Colonic mucosa was unremarkable, whereas duodenal biopsies revealed celiac-like changes with increased epithelial cell apoptosis. Clinical symptoms completely resolved, and follow-up biopsies demonstrated normalization of histology after enteric-coated mycophenolate sodium withdrawal and switching to azathioprine., Conclusions: Celiac-like enteropathy seems to represent a rare side effect of MPA-associated immunosuppressive therapy and should be taken into account in the differential diagnosis of diarrhea in transplant recipients treated with MPA particularly in the absence of MPA-related colitis. As macroscopic lesions are usually missing, blind duodenal biopsies are necessary to establish the diagnosis.
- Published
- 2018
- Full Text
- View/download PDF
22. Arteriovenous renal replacement therapy in end-stage left-sided heart failure patients has a detrimental effect on patients with impaired right ventricular function.
- Author
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Repasos E, Kaldara E, Pantsios C, Kapelios C, Nana E, Vernadakis S, Melexopoulou C, Malliaras K, Boletis J, and Nanas JN
- Subjects
- Aged, Cardio-Renal Syndrome therapy, Central Venous Catheters statistics & numerical data, Heart Failure mortality, Humans, Middle Aged, Mortality trends, Non-Randomized Controlled Trials as Topic methods, Patient Readmission statistics & numerical data, Retrospective Studies, Risk Factors, Survival Rate, Vascular Resistance physiology, Ventricular Dysfunction, Right complications, Central Venous Catheters standards, Heart Failure therapy, Hemofiltration methods, Renal Replacement Therapy adverse effects, Ventricular Dysfunction, Right physiopathology
- Abstract
Objective: Chronic intermittent renal replacement therapy(RRT) is an alternate method of decongestion for patients presenting with diuretic-resistant, end-stage heart failure(HF) and cardiorenal syndrome. The optimal method of vascular access has not been confirmed. This study investigated the 6-month outcomes of patients with end-stage HF after the creation of arteriovenous communications (AVC) compared with other means of RRT., Methods: We treated 40 patients with chronic, intermittent, ambulatory RRT, of whom 15 (37.5%; Group A) underwent creation of AVC, and 25 (62.5%; Group B) received intraperitoneal (n=6) or internal jugular catheters (n=19) with the goal of achieving body weight stabilization and relief from congestion., Results: The characteristics of the two groups were similar. According to Cox regression analysis, the 6-month rate of death or re-hospitalization for HF was significantly higher in Group A (73%) than in Group B (44%); hazard ratio (HR): 2.58; 95% confidence interval (CI) 1.2-6.2; P=0.02. Over a 6-month follow-up, the cumulative survival was significantly shorter (P=0.03) in Group A (13.8±10 weeks) than in Group B (20.7±7 weeks). In the 15 patients who received AVC, the only independent predictor of adverse outcome at 6 months was serum total bilirubin concentration (HR 2.5; 95% CI 1.1-5.7, p=0.02), whereas in the 25 patients who underwent other means of RRT, pulmonary vascular resistance (PVR) was identified as a risk factor for hospitalization or death at 1-year follow-up (HR 1.26; 95% CI 1.1-1.57, p=0.04)., Conclusion: In patients with end-stage HF, the creation of AVC for intermittent RRT was followed by a significant increase in morbidity and mortality in comparison to the safe and effective placement of permanent central venous catheters. Patients with elevated PVR seem to comprise a group at high risk for adverse outcomes after central catheter insertion., (Copyright © 2016 Hellenic Society of Cardiology. Published by Elsevier B.V. All rights reserved.)
- Published
- 2017
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23. The clinical course of IgA nephropathy after kidney transplantation and its management.
- Author
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Lionaki S, Panagiotellis K, Melexopoulou C, and Boletis JN
- Subjects
- Biopsy, Needle, Female, Glomerulonephritis, IGA diagnosis, Graft Rejection etiology, Graft Survival, Humans, Immunohistochemistry, Kidney Failure, Chronic physiopathology, Kidney Failure, Chronic surgery, Kidney Transplantation methods, Male, Prognosis, Recurrence, Treatment Outcome, Glomerulonephritis, IGA complications, Graft Rejection prevention & control, Immunosuppressive Agents administration & dosage, Kidney Failure, Chronic etiology, Kidney Transplantation adverse effects
- Abstract
Immunoglobulin (Ig) A nephropathy is one of the most common primary glomerulonephritides worldwide causing end stage renal disease in up to 20-40% of affected patients, nearly two decades post diagnosis. Kidney transplantation is the treatment of choice for patients with renal failure, secondary to glomerular diseases. However, IgA nephropathy has a strong tendency to recur in the graft, and although initially thought to be a benign condition, several reports of graft loss, due to recurrent IgA nephropathy, there have been over the last three decades. Overall graft survival has been significantly improved in kidney transplantation, as a result of reduced incidence of acute rejection, as more potent and more specific immunosuppressive agents are now available in clinical practice. Thus, the rates of IgA nephropathy and other glomerulonephritides recurrence are expected to increase, since graft survival has been improved. However, the reported incidence of IgA nephropathy recurrence in the graft varies substantially across centers, as a consequence of different levels of interest, diverse biopsy policies and differing durations of follow up, of the published studies. Notably, recurrence rates of patients receiving graft biopsies by clinical indication only, ranges from 13% to 50% with graft loss being between 1.3% and 16%. The aim of this review is to underline important pathogenetic insights of IgA nephropathy, describe the clinical course of the disease after kidney transplantation, with emphasis on the incidence of recurrence and the associated risk factors, and finally provide all available options for its management in transplant recipients., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
24. ESRD patients in Greece during the financial crisis.
- Author
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Naoum P, Kitsonis D, Topkaroglou I, Skroumpelos A, Athanasakis K, Melexopoulou C, Iatrou C, Boletis J, and Kyriopoulos J
- Subjects
- Adult, Female, Greece, Health Surveys, Humans, Life Style, Male, Middle Aged, Kidney Failure, Chronic therapy, Peritoneal Dialysis, Quality of Life, Renal Dialysis
- Published
- 2016
- Full Text
- View/download PDF
25. Excellent long term patient and renal allograft survival after ABO-incompatible kidney transplantation: Experience of one center.
- Author
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Melexopoulou C, Marinaki S, Liapis G, Skalioti C, Gavalaki M, Zavos G, and Boletis JN
- Abstract
Aim: To investigate the long-term results of ABO-incompatible (ABOi) kidney transplantation in a single center in Greece., Methods: Thirty consecutive ABOi kidney transplantations were performed from June 2005 to December 2013. All patients received rituximab one month prior to transplantation. Immunoadsorption therapy was performed for the removal of anti-A/B IgG antibodies until the titer was ≤ 1:16. Additional apheresis sessions were performed post-operatively. Intravenous immunoglobulin and oral immunosuppression consisting of tacrolimus (TAC) in combination with either everolimus or mycophenolate acid was administered. We compared the long term results of our ABOi group to those of a matched group of 30 ABO compatible (ABOc) living kidney recipients with similar baseline characteristics. The ABOc recipients received an immunosuppressive regimen consisting of TAC and mycophenolate acid. All patients in both groups received induction therapy with Basiliximab or Daclizumab, whereas corticosteroids were instituted on the day of surgery. During the follow-up period, indication biopsies were performed and interpreted by an experienced nephropathologist. The parameters we analyzed included the following: Donor/recipient age, gender, blood type, human leukocyte antigen mismatches, panel reactive antibodies, primary cause of renal failure, mean time on dialysis, immunosuppressive regimen, patient survival, graft outcome, incidence of rejections, surgical and infectious complications., Results: The mean follow-up period was 6 years (range 1 to 9 years). A mean of 5.0 ± 3.0 (range 0-14) pre-transplant immunoadsorptions were required in order to reach the target titer. Patient survival in ABOi group in comparison to ABOc group at 1, 3, 5 and 8 years did not differ significantly (100% vs 100%, 96% vs 100%, 92% vs 100% and 92% vs 100%, P = ns). Additionally, graft survival was similar in the two groups at the same time points (100% vs 100%, 96% vs 96%, 92% vs 96% and 81% vs 92%, P = ns). The mean serum creatinine and the estimated glomerular filtration rate by the modification of diet in renal disease formula at 1, 3, 5 and 8 years did not differ significantly between ABOi and ABOc group. None of the patients in the ABOi group developed acute or chronic antibody-mediated rejection evidenced by histological signs. Four patients (13.3%) in the ABOi group and 3 (10%) in the ABOc group experienced acute cellular rejection, which was treated successfully in all cases. Bacterial and viral infections were also similar between the two groups., Conclusion: ABOi kidney transplantation is a safe and effective alternative that enables kidney transplantation in countries with unacceptably long deceased-donor waiting lists.
- Published
- 2015
- Full Text
- View/download PDF
26. Incidence and risk factors of herpes zoster among adult renal transplant recipients receiving universal antiviral prophylaxis.
- Author
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Pavlopoulou ID, Poulopoulou S, Melexopoulou C, Papazaharia I, Zavos G, and Boletis IN
- Subjects
- Adolescent, Adult, Aged, Chickenpox complications, Chickenpox epidemiology, Female, Herpes Zoster prevention & control, Humans, Incidence, Male, Middle Aged, Neuralgia, Postherpetic epidemiology, Retrospective Studies, Risk Factors, Transplant Recipients statistics & numerical data, Virus Diseases epidemiology, Young Adult, Antiviral Agents therapeutic use, Chemoprevention statistics & numerical data, Herpes Zoster epidemiology, Kidney Transplantation adverse effects, Kidney Transplantation statistics & numerical data, Virus Diseases prevention & control
- Abstract
Background: Herpes zoster (HZ) is a significant cause of morbidity and complications in adult renal transplant recipients. We determined the incidence, complications and risk factors for the development of HZ after renal transplantation in a setting using universal antiviral prophylaxis., Methods: The medical files of all adult renal transplants, performed between 2004 and 2008, were retrospectively reviewed to assess the clinical characteristics and risk factors of HZ. Incident cases of HZ were determined and the probability of developing post-transplant HZ for all subjects was calculated using the Kaplan Meier method. A multivariable Cox proportional hazards model was applied to assess the risk factors associated with the development of HZ., Results: A total of 450 patients were eligible with a median follow up of 38 months. Twenty nine subjects (6.4%) developed HZ, the median time to onset was 18 months, only three of them (10.3%) required hospitalization, and none developed disseminated or visceral disease and death directly attributed to zoster. However, high rates of post-herpetic neuralgia (48.7%) were observed. Overall incidence was calculated at 20.6 cases per 1000 patient-years of follow-up. Following multivariate analysis, increased age ≥ 60 years old, positive pre-transplant history of varicella related disease and administration of rejection treatment conferred an increased risk of 4.00-fold (CI: 1.79-8.92), 16.00-fold (CI: 4.62-55.52), and 5.57-fold (CI: 1.56-19.84) respectively, for the development of post-transplant zoster., Conclusions: HZ remains a common complication after renal transplantation in adults under current immunosuppession protocols and universal antiviral prophylaxis.
- Published
- 2015
- Full Text
- View/download PDF
27. Valproate-induced hyperammonemic encephalopathy in a renal transplanted patient.
- Author
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Melexopoulou C, Marinaki S, Darema M, Skalioti C, Efthimiou A, Zavos G, and Boletis JN
- Subjects
- Adolescent, Female, Humans, Postoperative Complications chemically induced, Anticonvulsants adverse effects, Brain Diseases chemically induced, Hyperammonemia chemically induced, Kidney Transplantation, Valproic Acid adverse effects
- Abstract
Neurological complications after renal transplantation constitute an important cause of morbidity and mortality. Their differential diagnosis is difficult and essential for subsequent patient's management. Valproate-induced hyperammonemic encephalopathy is an uncommon but serious effect of valproate treatment. Here, we describe the case of a 15-year-old girl who was on a long-term therapy with valproate due to epilepsy and revealed impaired consciousness with hyperammonemia 12 days after renal transplantation. After withdraw of valproate, patients' symptoms resolved within 24 h. Clinicians should increase their awareness for potential complication of valproate, especially in transplanted patients.
- Published
- 2014
- Full Text
- View/download PDF
28. Cardiac resynchronization by cardiosphere-derived stem cell transplantation in an experimental model of myocardial infarction.
- Author
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Bonios M, Chang CY, Pinheiro A, Dimaano VL, Higuchi T, Melexopoulou C, Bengel F, Terrovitis J, Abraham TP, and Abraham MR
- Subjects
- Animals, Disease Models, Animal, Echocardiography, Male, Myocardial Infarction complications, Myocardial Infarction physiopathology, Myocardium pathology, Positron-Emission Tomography, Rats, Rats, Inbred WKY, Tissue Culture Techniques, Ventricular Dysfunction, Left diagnosis, Ventricular Dysfunction, Left etiology, Albumins, Cardiac Resynchronization Therapy methods, Myocardial Infarction surgery, Polyesters, Stem Cell Transplantation methods, Ventricular Dysfunction, Left surgery
- Abstract
Background: Cardiosphere-derived stem cell (CDC) transplantation can improve global left ventricular ejection fraction (LVEF) after myocardial infarction (MI). The aim of this study was to examine the effects of CDC transplantation on regional function and dyssynchrony after MI., Methods: Two million rat CDCs (n = 7) or phosphate-buffered saline (n = 7) was injected into the infarct regions of Wistar Kyoto rats. Infarct size and CDC localization were evaluated by positron emission tomography (n = 7). Two-dimensional and strain echocardiography were performed at 1 and 4 weeks after MI. LVEF, circumferential strain, and time to peak circumferential strain were measured in the basal and apical short-axis views. Dyssynchrony was defined as the maximal difference of time to peak circumferential strain of opposing segments in each short-axis view. Engraftment was measured by quantitative polymerase chain reaction., Results: Positron emission tomography revealed that infarct size was 15.4 ± 3.6% of the left ventricle and that CDCs were localized to the infarct and border zone. CDC transplantation improved mean LVEF (45 ± 8% to 52 ± 7%, P = .02), mean circumferential strain (-7 ± 2% to -10 ± 1%, P = .02), and mean dyssynchrony (45 ± 10 to 28 ± 11 m sec, P = .04) of the infarct/peri-infarct zone from 1 to 4 weeks after MI, despite CDC engraftment of only 2.4 ± 3%. In contrast, mean LVEF (48 ± 5% to 40 ± 4%, P = .03) and mean circumferential strain (-8 ± 2% to -7 ± 1%, P = .02) of the infarcted region deteriorated, with no significant change in dyssynchrony (42 ± 12 vs 46 ± 13 m sec, P = .60) in the saline group during the same time period. Change in LVEF was correlated with change in circumferential strain (r = -0.8, P = .002) and dyssynchrony (r = 0.6, P = .02) of the infarct/peri-infarct region at 4 weeks after MI., Conclusions: CDC therapy enhanced LVEF by improving circumferential strain and decreasing dyssynchrony of the infarct/peri-infarct region at 4 weeks, but not 1 week, after MI. Cellular resynchronization therapy using CDCs may be an alternative to traditional electrical cellular resynchronization therapy in post-MI dyssynchrony., (Copyright © 2011 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
29. Pulmonary Langerhans cell histiocytosis in a patient previously treated for germ cell tumor.
- Author
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Melexopoulou CA, Sgouros J, Argyriou P, Tsitsimelis D, Aravantinos G, and Samantas E
- Subjects
- Adult, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinoma, Embryonal therapy, Chemotherapy, Adjuvant, Histiocytosis, Langerhans-Cell diagnosis, Humans, Lung Neoplasms therapy, Male, Orchiectomy, Smoking Cessation, Testicular Neoplasms therapy, Treatment Outcome, Carcinoma, Embryonal secondary, Histiocytosis, Langerhans-Cell etiology, Lung Neoplasms secondary, Smoking adverse effects, Testicular Neoplasms pathology
- Published
- 2010
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