Grinyo J.,University of Barcelona |
Alberu J.,Instituto Nacional Of Ciencias Medicas Y Nutricion Salvador Zubiran |
Contieri F.L.C.,Hospital University Evangelico Of Curitiba |
Manfro R.C.,Hospital de Clinicas de Porto Alegre |
And 8 more authors.
Kidney transplant recipients who switched from a calcineurin inhibitor (CNI) to belatacept demonstrated higher calculated glomerular filtration rates (cGFRs) at 1 year in a Phase II study. This report addresses whether improvement was sustained at 2 years in the long-term extension (LTE). Patients receiving cyclosporine or tacrolimus were randomized to switch to belatacept or continue CNI. Of 173 randomized patients, 162 completed the 12-month main study and entered the LTE. Two patients (n = 1 each group) had graft loss between Years 1-2. At Year 2, mean cGFR was 62.0 ml/min (belatacept) vs. 55.4 ml/min (CNI). The mean change in cGFR from baseline was +8.8 ml/min (belatacept) and +0.3 ml/min (CNI). Higher cGFR was observed in patients switched from either cyclosporine (+7.8 ml/min) or tacrolimus (+8.9 ml/min). The frequency of acute rejection in the LTE cohort was comparable between the belatacept and CNI groups by Year 2. All acute rejection episodes occurred during Year 1 in the belatacept patients and during Year 2 in the CNI group. There were more non-serious mucocutaneous fungal infections in the belatacept group. Switching to a belatacept-based regimen from a CNI-based regimen resulted in a continued trend toward improved renal function at 2 years after switching. © 2012 The Authors. Transplant International © 2012 European Society for Organ Transplantation. Source
Cura C.I.,CONICET |
Lattes R.,Institute Nefrologia |
Nagel C.,Hospital Universitario Fundacion Favaloro |
Gimenez M.J.,Polytechnic University of Valencia |
And 6 more authors.
American Journal of Transplantation
Organ transplantation (TX) is a novel transmission modality of Chagas disease. The results of molecular diagnosis and characterization of Trypanosoma cruzi acute infection in naïve TX recipients transplanted with organs from infected deceased donors are reported. Peripheral blood and cerebrospinal fluid samples from the TX recipients of organs from infected donors were prospectively and sequentially studied for detection of T. cruzi by means of kinetoplastid DNA polymerase chain reaction (kDNA-PCR). In positive blood samples, a PCR algorithm for identification of T. cruzi Discrete Typing Units (DTUs) and quantitative real-time PCR (qPCR) to quantify parasitic loads were performed. Minicircle signatures of T. cruzi infecting populations were also analyzed using restriction fragment length polymorphism (RFLP)-PCR. Eight seronegative TX recipients from four infected donors were studied. In five, the infection was detected at 68.4 days post-TX (36-98 days). In one case, it was transmitted to two of three TX recipients. The comparison of the minicircle signatures revealed nearly identical RFLP-PCR profiles, confirming a common source of infection. The five cases were infected by DTU TcV. This report reveals the relevance of systematic monitoring of TX recipients using PCR strategies in order to provide an early diagnosis allowing timely anti-trypanosomal treatment. Polymerase chain reaction strategies allow for the early diagnosis of acute Chagas disease in naïve recipients transplanted with organs from Trypanosoma cruzi-infected donors. See editorial by Machado on page 3065. © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons. Source
Sun H.-Y.,National Taiwan University Hospital |
Munoz P.,Complutense University of Madrid |
Torre-Cisneros J.,University of Cordoba, Spain |
Aguado J.M.,Hospital 12 de Octubre |
And 9 more authors.
BACKGROUND: Incidence, characteristics, and risk factors for tuberculosis (TB)-associated immune reconstitution inflammatory syndrome (IRS) in solid-organ transplant (SOT) recipients are not known. METHODS: Patients are composed of 64 consecutive SOT recipients with TB followed for 12 months. IRS was defined based on previously proposed criteria. RESULTS: IRS developed in 14% (9/64) of the patients, a median of 47 days after the use of anti-TB therapy. Liver versus other types of organ transplant recipients (adjusted odds ratio [OR], 6.11; 95% confidence interval [CI], 1.08-34.86), prior cytomegalovirus infection (adjusted OR, 5.65; 95% CI, 0.93-34.47), and rifampin use (adjusted OR, 4.56; 95% CI, 0.74-27) were associated with a higher risk of IRS. The presence of more than one factor (liver transplantation, cytomegalovirus infection, and rifampin use) when compared with none of these factors conferred a 19-fold increase in the risk of IRS (P=0.01). Mortality at 1 year after diagnosis was 33.3% in patients with IRS and 17.2% in those without IRS (P=0.31). CONCLUSIONS: IRS was documented in 14% of the SOT recipients with TB. We determined clinically identifiable factors that may be useful in assessing the risk of tuberculosis-associated posttransplantation IRS. Copyright © 2013 Lippincott Williams & Wilkins. Source
Dominguez M.,Centro Iberoamericano Of Biodiversidad Cibio |
Sanz A.,University of Habana |
Chavez J.,Institute Nefrologia |
Almaguer N.,University of Habana
We describe the gonadal and fat-body cycles and their relationship to environmental factors for Cuban female Anolis lucius (Polychrotidae). We obtained monthly samples of lizards from the karstic caves at Boca de Jaruco, Havana, Cuba. The lizards reached sexual maturity at 45.0 mm snoutvent length and at approximately 7 mo of age. Female A. lucius showed seasonal reproduction from March to August. The nonreproductive season occurred from September to February, as identified by the absence of active ovogenesis. Vitellogenic ovaries, and almost all females having one or two oviductal eggs, characterized the peak reproductive interval from May to August. In contrast, fat-body mass diminished from May to July and reached its highest values from September to January. The clutch size is one egg per oviposition, and oviposition events occurred from July to September. Increased photoperiod and environmental temperature induced ovarian activity. © 2010 by the Herpetologists' League, Inc. Source
Rostaing L.,French Institute of Health and Medical Research |
Massari P.,Hospital Privado Centro Medico Of Cordoba |
Garcia V.D.,Hospital Dom Vicente Scherer |
Mancilla-Urrea E.,Instituto Nacional Of Cardiologia Ignacio |
And 8 more authors.
Clinical Journal of the American Society of Nephrology
Background and objectives: Prolonged use of calcineurin inhibitors (CNIs) in kidney transplant recipients is associated with renal and nonrenal toxicity and an increase in cardiovascular risk factors. Belatacept-based regimens may provide a treatment option for patients who switch from CNI-based maintenance immunosuppression. Design, setting, participants, & measurements: This is a randomized, open-label Phase II trial in renal transplant patients with stable graft function and receiving a CNI-based regimen. Patients who were ≥6 months but ≤36 months after transplantation were randomized to either switch to belatacept or continue CNI treatment. All patients received background maintenance immunosuppression. The primary end point was the change in calculated GFR (cGFR) from baseline to month 12. Results: Patients were randomized either to switch to belatacept (n = 84) or to remain on a CNI-based regimen (n = 89). At month 12, the mean (SD) change from baseline in cGFR was higher in the belatacept group versus the CNI group. Six patients in the belatacept group had acute rejection episodes, all within the first 6 months; all resolved with no allograft loss. By month 12, one patient in the CNI group died with a functioning graft, whereas no patients in the belatacept group had graft loss. The overall safety profile was similar between groups. Conclusions: The study identifies a potentially safe and feasible method for switching stable renal transplant patients from a cyclosporine- or tacrolimus-based regimen to a belatacept-based regimen, which may allow improved renal function in patients currently treated with CNIs. Copyright © 2011 by the American Society of Nephrology. Source