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Vincenti F.,University of California at San Francisco | Larsen C.P.,Emory University | Alberu J.,Instituto Nacional Of Ciencias Medicas Y Nutricion Salvador Zubiran | Bresnahan B.,Medical College of Wisconsin | And 14 more authors.
American Journal of Transplantation | Year: 2012

The clinical profile of belatacept in kidney transplant recipients was evaluated to determine if earlier results in the BENEFIT study were sustained at 3 years. BENEFIT is a randomized 3 year, phase III study in adults receiving a kidney transplant from a living or standard criteria deceased donor. Patients were randomized to a more (MI) or less intensive (LI) regimen of belatacept, or cyclosporine. 471/666 patients completed ≥3 years of therapy. A total of 92% (MI), 92% (LI), and 89% (cyclosporine) of patients survived with a functioning graft. The mean calculated GFR (cGFR) was ∼21 mL/min/1.73 m 2 higher in the belatacept groups versus cyclosporine at year 3. From month 3 to month 36, the mean cGFR increased in the belatacept groups by +1.0 mL/min/1.73 m 2/year (MI) and +1.2 mL/min/1.73 m 2/year (LI) versus a decline of -2.0 mL/min/1.73 m 2/year (cyclosporine). One cyclosporine-treated patient experienced acute rejection between year 2 and year 3. There were no new safety signals and no new posttransplant lymphoproliferative disorder (PTLD) cases after month 18. Belatacept-treated patients maintained a high rate of patient and graft survival that was comparable to cyclosporine-treated patients, despite an early increased occurrence of acute rejection and PTLD. © Copyright 2011 The American Society of Transplantation and the American Society of Transplant Surgeons.


Fabian J.F.,Instituto Nacional Of Cardiologia Dr Ignacio Chavez | Mancilla E.,Instituto Nacional Of Cardiologia Dr Ignacio Chavez | Aburto J.S.,Instituto Nacional Of Cardiologia Dr Ignacio Chavez | Lopez J.O.,Instituto Nacional Of Cardiologia Dr Ignacio Chavez | And 3 more authors.
Transplantation Proceedings | Year: 2016

Introduction The live donor nephrectomy is an unusual surgical procedure as it is performed on healthy individuals. It is important to make the procedure as safe as possible without compromising the health of the donor and graft function. Justification In Mexico during 2014, 2610 kidney transplantations performed, and 1862 grafts were from living donors. Objective We describe our experience with hand-assisted laparoscopic nephrectomy on live donors for kidney transplantation. Materials and Methods We present a descriptive and observational study in which all living donors who completed the study protocol for renal transplantation are included. Results From September 2006 to July 2015, there were 238 hand-assisted laparoscopic nephrectomies with live donors; 227 (95.37%) were performed on the left side and 11 (4.63%) on the right side. Of donors, 54.1% were females. The average values for the variables analyzed were age 38.17 years, 25.94 BMI, creatinine 0.82-1.13 mg/dL pre- and postoperative month respectively, length of stay 4.95 (range 2-8), warm ischemia 5.07 (range 3-13) minutes, surgical time 168.85 minutes (range 90-306), and transsurgical bleeding 139 055 mL (range 25-650). One patient was reoperated for abdominal pain and bloating without evidence of pathology, attributing it to metabolic ileus. Two patients were converted to open surgery; 1 by technical problems with the laparoscopic equipment and the second by bleeding from the renal vein, both with good results. Discussion and Conclusions Laparoscopic nephrectomy is a safe method that allows kidney donors to have a speedy recovery without modifying the survivals of renal grafts. © 2016 Elsevier Inc.


PubMed | Instituto Nacional Of Cardiologia Dr Ignacio Chavez
Type: Journal Article | Journal: Transplantation proceedings | Year: 2016

The live donor nephrectomy is an unusual surgical procedure as it is performed on healthy individuals. It is important to make the procedure as safe as possible without compromising the health of the donor and graft function.In Mexico during 2014, 2610 kidney transplantations performed, and 1862 grafts were from living donors.We describe our experience with hand-assisted laparoscopic nephrectomy on live donors for kidney transplantation.We present a descriptive and observational study in which all living donors who completed the study protocol for renal transplantation are included.From September 2006 to July 2015, there were 238 hand-assisted laparoscopic nephrectomies with live donors; 227 (95.37%) were performed on the left side and 11 (4.63%) on the right side. Of donors, 54.1% were females. The average values for the variables analyzed were age 38.17 years, 25.94 BMI, creatinine 0.82-1.13mg/dL pre- and postoperative month respectively, length of stay 4.95 (range 2-8), warm ischemia 5.07 (range 3-13) minutes, surgical time 168.85 minutes (range 90-306), and transsurgical bleeding 139 055mL (range 25-650). One patient was reoperated for abdominal pain and bloating without evidence of pathology, attributing it to metabolic ileus. Two patients were converted to open surgery; 1 by technical problems with the laparoscopic equipment and the second by bleeding from the renal vein, both with good results.Laparoscopic nephrectomy is a safe method that allows kidney donors to have a speedy recovery without modifying the survivals of renal grafts.


Vanrenterghem Y.,University Hospital Leuven | Bresnahan B.,Medical College of Wisconsin | Campistol J.,University of Barcelona | Durrbach A.,University Paris - Sud | And 11 more authors.
Transplantation | Year: 2011

Background: Cardiovascular disease, the most common cause of death with a functioning graft among kidney transplant recipients, can be exacerbated by immunosuppressive drugs, particularly the calcineurin inhibitors. Belatacept, a selective co-stimulation blocker, may provide a better cardiovascular/metabolic risk profile than current immunosuppressants. Methods: Cardiovascular and metabolic endpoints from two Phase III studies (BENEFIT and BENEFIT-EXT) of belatacept-based regimens in kidney transplant recipients were assessed at month 12. Each study assessed belatacept in more intensive (MI) and less intensive (LI) regimens versus cyclosporine A (CsA). These secondary endpoints included changes in blood pressure, changes in serum lipids, and the incidence of new-onset diabetes after transplant (NODAT). RESULTS.: A total of 1209 patients were randomized and transplanted across the two studies. Mean systolic blood pressure was 6 to 9 mm Hg lower and mean diastolic blood pressure was 3 to 4 mm Hg lower in the MI and LI groups versus CsA (P≤0.002) across both studies at month 12. Non-HDL cholesterol was lower in the belatacept groups versus CsA (P<0.01 MI or LI vs. CsA in each study). Serum triglycerides were lower in the belatacept groups versus CsA (P<0.02 MI or LI vs. CsA in each study). NODAT occurred less often in the belatacept groups versus CsA in a prespecified pooled analysis (P<0.05 MI or LI vs. CsA). CONCLUSIONS.: At month 12, belatacept regimens were associated with better cardiovascular and metabolic risk profiles, with lower blood pressure and serum lipids and less NODAT versus CsA. The overall profile of belatacept will continue to be assessed over the 3-year trials. © 2011 by Lippincott Williams & Wilkins.


Zapata-Morales J.R.,Autonomous University of San Luis Potosi | Galicia-Cruz O.G.,Autonomous University of San Luis Potosi | Franco M.,Instituto Nacional Of Cardiologia Dr Ignacio Chavez | Morales F.M.,Autonomous University of San Luis Potosi
Journal of Biological Chemistry | Year: 2014

In this work, we demonstrated the regulation of glucose transporters by hypoxia inducible factor-1α (HIF-1α) activation in renal epithelial cells. LLC-PK1 monolayers were incubated for 1, 3, 6, or 12 h with 0% or 5% O2 or 300 μm cobalt (CoCl2). We evaluated the effects of hypoxia on the mRNA and protein expression of HIF-1α and of the glucose transporters SGLT1, SGLT2, and GLUT1. The data showed an increase in HIF-1α mRNA and protein expression under the three evaluated conditions (p < 0.05 versus t = 0). An increase in GLUT1 mRNA (12 h) and protein expression (at 3, 6, and 12 h) was observed (p < 0.05 versus t = 0). SGLT1 and SGLT2 mRNA and protein expression decreased under the three evaluated conditions (p < 0.05 versus t = 0). In conclusion, our results suggest a clear decrease in the expression of the glucose transporters SGLT1 and SGLT2 under hypoxic conditions which implies a possible correlation with increased expression of HIF-1α. © 2014 by The American Society for Biochemistry and Molecular Biology, Inc.


Ortiz-Vazquez M.,Instituto Nacional Of Cardiologia Dr Ignacio Chavez | Espinoza-Blanco O.,Instituto Nacional Of Cardiologia Dr Ignacio Chavez | Ramirez-Marroquin S.,Instituto Nacional Of Cardiologia Dr Ignacio Chavez | Calderon-Colmenero J.,Instituto Nacional Of Cardiologia Dr Ignacio Chavez | And 2 more authors.
Archivos de Cardiologia de Mexico | Year: 2016

Fontan operation is the final palliative stage of patients with univentricular hearts. Cardiopulmonary bypass (CPB) decreases ventricular performance and increases pulmonary artery pressures in the post operative recovery period. It seems that Fontan operation performed without CPB decreases short term morbidity and intra hospitalary length of stay. Objetive: Compare outcome in Fontan patients who have undergone surgery with or without CPB. Method: This is a retrospective review of patients undergoing Fontan operation from january 2009 to december 2012. Patients were grouped according to CPB use and comparative analyses were done. Results: Ten patients were operated without CPB use. There was a discrepancy between age in both groups, being younger in the no CPB group. Around 80% of patients in both groups had a staged procedure. A 18 mm graft was used in half of the cases; a fenestration was created in all cases. Length of stay was equal in both groups, there was less need of pharmacologic support and nitric oxide use in patients without CPB use. No deaths were reported also in this group. At folllow up, most patients had a class i functional status. Conclusions: In our experience, Fontan operation without CPB has similar outcomes compared with CPB use. © 2015 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.


Zeron H.M.,Mexico State University | Paez A.,Instituto Nacional Of Cardiologia Dr Ignacio Chavez | Zapata E.,Instituto Nacional Of Cardiologia Dr Ignacio Chavez | Masso F.,Instituto Nacional Of Cardiologia Dr Ignacio Chavez | Montano L.F.,National Autonomous University of Mexico
Diabetes and Metabolic Syndrome: Clinical Research and Reviews | Year: 2010

A family history of type 2 diabetes mellitus (DM) increases the probability to develop DM and endothelial dysfunction. Human umbilical vein endothelial cells (HUVECs) isolated from healthy newborns with familiar background of diverse diseases show early alterations such as less resistance to shear stress. The aim of this study was to evaluate the apoptosis by flow cytometry in HUVECs obtained from healthy newborns with (experimental) and without (control) a strong family history of DM, exposed to different glucose concentrations. Methods: HUVECs were incubated in M-199 culture media (containing a 5 mmol/L physiological glucose concentration) or supraphysiological glucose concentrations (15 or 30 mmol/L), for 48 h. Apoptosis was quantified by flow cytometry with annexin V and a polycaspase assay kit (FLICA, Immunochemistry Technologies LLC), and cell death was measurement by propidium iodide (PI, St Cruz Biotechnology Inc) positive stain. Results: Experimental HUVECs showed higher levels of apoptosis in the presence of increasing glucose concentration (p < 0.01), whereas control HUVECs showed low levels of apoptosis. Conclusions: Our results suggest that HUVECs, isolated from healthy newborns with a strong family history of DM, have an abnormal predisposition to apoptosis. © 2010 Diabetes India. Published by Elsevier Ltd. All rights reserved.


Mejia Dominguez A.M.,Instituto Nacional Of Cardiologia Dr Ignacio Chavez
Gaceta Medica de Mexico | Year: 2013

Transfusion-related acute lung injury (TRALI) is a syndrome characterized by acute respiratory distress following the transfusion of blood components. The pathophysiological hallmark of TRALI is increased pulmonary microvascular permeability. Several reports demonstrate that the majority of TRALI cases are precipitated by transfusion of donor antibodies directed against HLA (human leukocyte antigens) or HNA (human neutrophil antigens) expressed on the neutrophils' surface of the recipient. This antibody-antigen interaction is thought to directly cause neutrophils activation and release of cytotoxic agents, with subsequent endothelial damage and capillary leak. Following plasma transfusion is an important and underreported adverse event. Some blood centers have limited the collection of plasma from female donors due to their propensity for developing anti HLA antibodies after pregnancy.


PubMed | Hospital Eugenio Espejo and Instituto Nacional Of Cardiologia Dr Ignacio Chavez
Type: | Journal: Archivos de cardiologia de Mexico | Year: 2016

The best revascularization method of the unprotected left main is a current and evolving topic.Within 3 years, 2439 percutaneous coronary interventions (PCI) were registered. We included all the patients with PCI of the unprotected left main, n=48 and matched with patients who underwent coronary artery bypass graft (CABG), n=50. Mayor adverse cerebral-cardiac events (MACCE) were assessed in-hospital and out-hospital during a 16 months follow up.PCI showed higher risk profile that CABG group; logEuroSCORE 1621 vs. 56, p=0.001; clinical Syntax 7774 vs 5339, p=0.04. In-hospital MACCE (14% vs 18%, p= 0.64) were similar. The post-procedure ST myocardial infarction was less frequent in with PCI (0 vs 10%), p=0.03. The PCI group showed less MACCE (2.3% vs 18%, p=0.01) and a favorable trend in death (2.3% vs 12%, p=0.08) and cardiac death (2.3% vs. 8%, p=0.24) when patients presenting with cardiogenic shock were excluded. MACCE were comparable between PCI and CABG groups; (15 vs 12%, p=0.46) in the out-hospital phase. Survival without MACCE, death or cardiac death were comparable between groups (log rank, p=0.38, p=0.44 y p=0.16).Even though the clinical and peri-procedural risk profile of the PCI patients were higher, the in-hospital and out-hospital efficacy and safety were comparable with CABG.


PubMed | Instituto Nacional Of Cardiologia Dr Ignacio Chavez
Type: Journal Article | Journal: Archivos de cardiologia de Mexico | Year: 2016

Fontan operation is the final palliative stage of patients with univentricular hearts. Cardiopulmonary bypass (CPB) decreases ventricular performance and increases pulmonary artery pressures in the post operative recovery period. It seems that Fontan operation performed without CPB decreases short term morbidity and intra hospitalary length of stay.Compare outcome in Fontan patients who have undergone surgery with or without CPB.This is a retrospective review of patients undergoing Fontan operation from january 2009 to december 2012. Patients were grouped according to CPB use and comparative analyses were done.Ten patients were operated without CPB use. There was a discrepancy between age in both groups, being younger in the no CPB group. Around 80% of patients in both groups had a staged procedure. A 18mm graft was used in half of the cases; a fenestration was created in all cases. Length of stay was equal in both groups, there was less need of pharmacologic support and nitric oxide use in patients without CPB use. No deaths were reported also in this group. At folllow up, most patients had a class i functional status.In our experience, Fontan operation without CPB has similar outcomes compared with CPB use.

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