V. Gómez Dos Santos

Modelos experimentales para la investigación y el entrenamiento en trasplante renal

EXPERIMENTAL MODELS FOR RESEARCH AND TRAINING IN RENAL TRANSPLANT Introduction and objetives: An update on aspects and use of different experimental models applied in kid- ney transplant research is presented . This paper includes qualities, as long as similarities between most frequently used animal models and human clinical standards. Contributions of those models based on microsurgical or laparoscopic techniques are revised. The physiological consequences (hemodynamic, immunologic) of surgical technique (laparoscopy), applied in experimental models as long as non-heart bea- ting organ donor models and organ preservation methods are also reviewed. Finally, an update of those models applied in research in prothocols of either immunosupression or xenotransplant is done.

Functional Results of Renal Preservation in Hypothermic Pulsatile Machine Perfusion Versus Cold Preservation: Systematic Review and Meta-Analysis of Clinical Trials

BACKGROUND Hypothermic pulsatile machine perfusion (HPMP) decreases the rate of delayed graft function (DGF) in kidney grafts, compared with cold storage. However, it is not clear its use in the different subgroups of grafts. The objective was to review systematically all studies with better methodologic quality that compare HPMP versus cold storage. METHODS A systematic review was performed. The sources were Pubmed, Pubmed Central, Cochrane Library, Clinical Key, and Ovid. All randomized controlled trials that compared HPMP versus cold storage in renal grafts from human donors were considered. Outcomes analyzed were: percentage of DGF, primary nonfunction (PNF), and graft function in each group and for the different types of grafts, brain-death donors (DBDs), and different subgroups of donors after circulatory death (DCDs). RESULTS Twelve clinical trials, out of 9,867 titles, were included. HPMP improved DGF overall, as well as in DBDs and DCDs. The relative risks [RRs] were 0.79 (95% CI, 0.71-0.88), 0.85 (95% CI, 0.74-0.98), and 0.75 (95% CI, 0.61-0.92), respectively. There were no differences in PNF overall and for DBDs or DCDs. The RRs were 0.92 (95% CI, 0.73-1.16), 0.78 (95% CI, 0.22-2.73), and 1.13 (95% CI, 0.73-1.77), respectively. However, analysis with the better quality studies, overall RR for PNF was 0.62 (95% CI, 0.39-0.96). There were no differences between the graft function at 3 months after transplantation. CONCLUSIONS HPMP moderately improved the DGF results in grafts from cadaver donors of all types. HPMP could improve the PNF in grafts from DBDs, although more clinical trials are needed to prove that.

Trasplante experimental de islotes de páncreas en el tracto genitourinario asociado al trasplante renal

Resumen Conceptualmente el trasplante de pancreas (TP) asociado al trasplante renal (TR) puede resolver la insuficiencia renal cronica (IRC) y la diabetes (DM). Aunque el lugar de implantacion mas frecuentemente utilizado es la vena porta, el tracto genitourinario puede ser adecuado desde un punto de vista tecnico durante el TR. 20 animales con una edad media de 5,5 (SD 1,1) meses y una mediana de peso de 53 (30,102) kg se sometieron al siguiente protocolo experimental. El primer dia, se lleva a cabo la nefrectomia izquierda y el injerto es perfundido con solucion de Wisconsin, lo que se sigue de una pancreatectomia distal y el aislamiento de islotes por medio de la digestion enzimatica con Colagenasa. Los islotes son tenidos con el colorante vital Ditizona (DTZ) y cultivados durante 24 horas a 37o y 5% de Co2. El dia 2 se realiza la nefrectomia derecha y un TR ortotopico del injerto renal izquierdo preservado. Los islotes son trasplantados en 4 localizaciones diferentes en el tracto genitourinario: el espacio subcapsular del injerto renal, en la submucosa de vejiga, en el parenquima testicular y por via deferencial. El dia 7, los animales son sacrificados para estudio histopatologico. Se demostraron islotes viables en la submucosa vesical y en el testiculo tras infusion por via deferencial

Solitary Fibrous Tumor of the Kidney: A Wide Spectrum of an Uncommon Entity from Benignity to Malignant Metastatic Disease

Solitary fibrous tumour (SFT) is a spindle cell neoplasm that rarely occurs in the kidney. It has been reported mainly in the pleura, but it can also arise from almost every organ. Benign SFT of the kidney has been described in several cases, even with metastatic lesions, but only seven cases of malignant SFT including this case have been documented; and only three cases out of seven had distant metastasis. Clinical features are indistinguishable from other renal neoplasms. Diagnosis is based on inmunohistochemical analysis, showing positive staining for CD34, as a key for diagnosis. We report two different cases, with very different behaviour; showing the wide spectrum of malignancy of this entity; with a comprehensive review of the literature.

Relational database for urinary stone ambulatory consultation. Assessment of initial outcomes

OBJECTIVES To create a relational database for monitoring lithiasic patients. We describe the architectural details and the initial results of the statistical analysis. METHODS AND MATERIALS Microsoft Access 2002 was used as template. Four different tables were constructed to gather demographic data (table 1), clinical and laboratory findings (table 2), stone features (table 3) and therapeutic approach (table 4). For a reliability analysis of the database the number of correctly stored data was gathered. To evaluate the performance of the database, a prospective analysis was conducted, from May 2004 to August 2009, on 171 stone free patients after treatment (EWSL, surgery or medical) from a total of 511 patients stored in the database. Lithiasic status (stone free or stone relapse) was used as primary end point, while demographic factors (age, gender), lithiasic history, upper urinary tract alterations and characteristics of the stone (side, location, composition and size) were considered as predictive factors. An univariate analysis was conducted initially by chi square test and supplemented by Kaplan Meier estimates for time to stone recurrence. A multiple Cox proportional hazards regression model was generated to jointly assess the prognostic value of the demographic factors and the predictive value of stones characteristics. RESULTS For the reliability analysis 22,084 data were available corresponding to 702 consultations on 511 patients. Analysis of data showed a recurrence rate of 85.4% (146/171, median time to recurrence 608 days, range 70-1758). In the univariate and multivariate analysis, none of the factors under consideration had a significant effect on recurrence rate (p=ns). CONCLUSIONS The relational database is useful for monitoring patients with urolithiasis. It allows easy control and update, as well as data storage for later use. The analysis conducted for its evaluation showed no influence of demographic factors and stone features on stone recurrence.