Adriana Reginato Ribeiro

Non-invasive diagnosis of acute rejection in kidney transplants with delayed graft function.

Delayed graft function (DGF) often occurs in kidney transplants from deceased donors. We wanted to provide studies giving more accurate non-invasive tests for acute rejection (AR). Using real-time PCR, we examined the expression of cytolytic molecules such as perforin, granzyme B, and fas-ligand along with serpin proteinase inhibitor-9. We also measured the expression of FOXP3, a characteristic gene of T-regulatory cells known to be involved in AR. These studies were conducted on peripheral blood monocytes, urinary cells, and 48 surveillance kidney biopsies taken from a total of 35 patients with DGF. Of these patients, 20 had a histopathological diagnosis of AR, whereas other 28 had characteristics of acute tubular necrosis (ATN). Expression of cytolytic and apoptotic-associated genes in the biopsy tissue, peripheral blood leukocytes, and urinary cells was significantly higher in patients with AR than that in patients with ATN. Diagnostic parameters associated with FOXP3 gene expression were most accurate in peripheral blood leukocytes and urine cells with sensitivity, specificity, positive and negative predictive values, and accuracy between 94 and 100%. Our study shows that quantification of selected genes in peripheral blood leukocytes and urinary cells from renal transplant patients with DGF may provide a useful and accurate non-invasive diagnosis of AR.

Association Between the Presence of Anti-HLA Antibodies With Acute Rejection and Chronic Allograft Nephropathy in the First Year After Kidney Transplantation

The clinical relevance of anti-HLA antibodies following kidney transplantation has been a recent focus of research. Patients who present anti-HLA antibodies in the posttransplantation period have shown higher incidences of acute rejection episodes (ARE) and chronic allograft nephropathy (CAN). The objective of this study was to evaluate the presence of anti-HLA antibodies during the first year after kidney transplantation and their association with the occurrence of ARE and CAN. Eighty-eight kidney transplant recipients were evaluated for the presence of IgG anti-HLA antibodies using an enzyme-linked immunosorbent assay (LAT-M and LAT-1240, One Lambda Inc, Calif, United States). Protocol kidney biopsies were performed in consenting patients. ARE and CAN were diagnosed by clinical, laboratory, and histopathological criteria. Anti-HLA antibodies were observed in 20 (22.7%) patients. At 1 year follow-up, 26.1% presented ARE and 51.2% developed CAN. Nine patients (45%) with antibodies developed ARE as opposed to 20.6% without antibodies and 64.7% developed CAN as opposed to 47.8% of those without antibodies. In the histological analysis, the anti-HLA antibodies were associated with Banff IIA ARE (P = .001) and Banff grade II CAN (P = .012). Routine posttransplantation search for antibodies may identify cases at higher risk for acute and chronic rejection, and perhaps help to tailor the immunosuppressive regimen.

First Report of Human Pancreas Transplantation Using IGL-1 Preservation Solution: A Case Series.

I Georges Lopez preservation solution (IGL-1) is an extracellular type of preservation solution that has lesser viscosity and lower potassium concentration than the criterion of University of Wisconsin preservation solution (UW). Institute Georges Lopez-1 preservation solution has been used for preservation of human kidney and liver allografts, resulting in transplant outcomes that are similar to those obtained with UW. Although IGL-1 has been used successfully for preservation of human islet cells prior transplantation, and also for experimental pancreas transplantation, no previous report of human pancreas transplantation using IGL-1 was found in the medical literature. From February to October 2015, 5 consecutive simultaneous pancreas and kidney transplants were performed using IGL-1 preservation solution at our institution (Table 1). Procurement operations and pancreas transplantswere performed by a same surgeon (Chedid, M.F.). After cross clamping, 5 L of IGL-1 was infused through deceased donors aorta, and 1 Lwas infused through inferiormesenteric vein. Intravenous

Transplante renal em pacientes HIV positivos. Relato de dois casos da experiência inicial do Hospital de Clínicas de Porto Alegre

Recently kidney transplantation has become an accepted treatment modality for the treatment of HIV infected patients with end-stage renal diseases. For such treatment it is required stability of clinical and laboratory parameters related to HIV infection and the use of highly active antiretroviral therapy. In this report we present the first two cases in Brazil of patients with HIV infection transplanted with organs from deceased donors performed successfully in our institution. The interactions between immunosuppressive and antiretroviral drugs, the co-infections, cardiovascular risk profile and the high incidence of acute rejection remain the major problems to be dealt with in these patients.

Renal transplantation without maintenance immunosuppression. Identical twins and kidney transplantation following a successful bone marrow graft

Renal transplantation without maintenance immunosuppression has been sporadically reported in the literature. The cases include non-adherent patients who discontinued their immunosuppressive medications, transplantation between identical twins, kidney transplantation after a successful bone marrow graft from the same donor and simultaneous bone marrow and kidney transplantation for the treatment of multiple myeloma with associated renal failure. There are also ongoing clinical trials designed to induce donor specific transplant tolerance with infusion of hematopoietic cells from the same kidney donor. Here we describe two cases of renal transplantation without immunosuppression as examples of situations described above.

Outcomes of Kidney Transplantation from Expanded-Criteria Deceased Donors in a Single Center

Introduction Expanded donors criteria(ECDs) are a source of kidneys that increase the donor organ pool.The value of transplanting these kidneys is uncertain in our population because of concerns regarding diminished survival and predicted poorer outcomes. Our objective was to compare long-term outcomes of kidney from ECDs with those concurrent standard-criteria donors (SCDs). Materials and Methods We retrospectively reviewed our single-center experience with ECD kidney transplants (KT). Between January 2009 and December 2015 we performed 701 KTs from deceased donor. These patients were divided according to donor status into ECD ou SCD. Patients were followed untill 5 year after tansplantantation, death, graft failure, or loss to follow up. Results and Discussion During the period of study 470 patients (67%) were transplanted with SCDs kidneys and 231 (33%) with ECDs kidneys. Baselines characteristics (race, gender, cause of end stage renal disease, number of HLA antigen mismatches and imunossupression) were similar between the groups. DGF incidence was higher in ECDs group (76% vs 64,7%, p=0.033) which determined prolonged hospilalization time (p<0.02). Mean glomerular filtration rate was consistently lower in the ECD group at 1 month ( 34.4 ± 17.7 mL/min vs 45.5 ± 24.3mL/min), 3 months (40.7 ± 16.2mL/min vs 55.6 ± 27.3mL/min), 6 months (40.6 ± 16.1 mL/min vs 55.0 ± 23.7mL/min) and 12 months after transplantation(44.3 ± 18.3 mL/min vs 60.5 ± 24.3mL/min); p <0.01. Patient and graft survivals rates were between 2 groups. There were no significant differences at 1 year, 3 years and 5 years in graft survival (p=0,268) and 1 year, 3 years and 5 years in patient survival (p=0,264). Conclusion althoug renal function was better in SCD kidney recipientes, graft and patient survival of ECD kidney recipientes were comparable whith those of SCD kidney recipients. In conclusion, use of renal grafts from ECDs is a acceptable strategy for kidney transplantation.

EVALUATION OF TUBERCULIN SKIN TEST IN KIDNEY TRANSPLANT CANDIDATES: 2695

A.R. Ribeiro1, M.B. Gazzana2, A.R. Vicari3, P.D.T.R. Dalcin2, R.C. Manfro4, L.F.S. Gonçalves4 1Neprhology Department, Hospital de Clinicas de Porto Alegre, Porto Alegre /Rio Grande do Sul/BRAZIL, 2Pneumology, Hospital de Clinicas de Porto Alegre, Porto Alegre/BRAZIL, 3Neprhrology, Hospital de Clinicas de Porto Alegre, Porto Alegre/BRAZIL, 4Nephrology, Universidade Federal do Rio Grande do Sul Hospital de Clínicas de Porto Alegre, Porto Alegre/BRAZIL