Arterial hypertension following renal transplantation in children - a short-term study

Systemic arterial hypertension is a common complication among transplanted patients. the objective of this study was to investigate the risk factors for arterial hypertension after kidney transplantation in children. A retrospective study was carried out of 70 kidney transplants performed on patients under 18 years of age at the Hospital do Rim and Hipertensao, from January 1998 to June 2001. At the end of 6 months post transplant, the patients were classified into either normotensive (n=31) or hypertensive (n=39) groups. the following potential risk factors for arterial hypertension were studied: (1) hypertension before transplantation; (2) the glomerular filtration rate (GFR) at 1, 3, and 6 months post transplant; (3) acute rejection episodes; (4) cumulative dose of corticosteroids; (5) the presence of native kidneys; (6) symptomatic renal artery stenosis; (7) cold ischemia time greater than 24 h; (8) age and sex of the donor; (9) age of the recipient; (10) transplant type (living related or cadaveric donor); (11) the body mass index of recipients at the end of the follow-up period; and (12) delayed graft function. the two groups were comparable in terms of the etiology of renal insufficiency, age, gender, and immunosuppressive drugs. Among the risk factors studied, the sole factor showing a statistically significant association with arterial hypertension was the GFR at 3 and 6 months after transplantation. in the group of normotensive patients, GFRs were 92+/-29 and 83+/-20 ml/min per 1.73 m(2) at 3 and 6 months, respectively, whereas in the hypertensive patients, GFRs were 74+/-23 and 70+/-21 ml/min per 1.73 m(2) respectively. Hence, only the lower GFR can be considered a risk factor for hypertension in children within our sample. However, arterial hypertension might be a risk factor for the early onset of chronic allograft nephropathy; in this case, hypertension should be considered the cause of lower glomerular filtration. Our data do not permit us to distinguish between these two hypotheses. the known risk factors for hypertension following renal transplantation in adults were not confirmed in the present study. It remains unclear to us as to whether this means the etiology of hypertension differs in children, or if this is the result of a bias in patient selection.Universidade Federal de São Paulo, Dept Pediat, São Paulo, BrazilUniversidade Federal de São Paulo, Hosp Rim & Hipertensao, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pediat, São Paulo, BrazilUniversidade Federal de São Paulo, Hosp Rim & Hipertensao, São Paulo, BrazilWeb of Scienc

Use of reduced dose of OKT3 (2.5 mg) after renal transplantation

UNIFESP, Escola Paulista Med, São Paulo, BrazilUNIFESP, Escola Paulista Med, São Paulo, BrazilWeb of Scienc

Cyclosporine from twice to single daily dosing: Impact on renal function, mortality, and graft loss

Unioversidadc Fed São Paulo, Hosp São Paulo, São Paulo, BrazilUnioversidadc Fed São Paulo, Hosp São Paulo, São Paulo, BrazilWeb of Scienc

Acute rejection is a risk factor for long-term survival in single-center analysis of 1544 renal transplants

Universidade Federal de São Paulo, Escola Paulista Med, Dept Med,Hosp Rim & Hipertensao, Div Nephrol,Fundacao Oswaldo Ramos, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Med,Hosp Rim & Hipertensao, Div Nephrol,Fundacao Oswaldo Ramos, São Paulo, BrazilWeb of Scienc

A single-center open label randomized trial of the safety and efficacy of the use of sirolimus versus azathioprine in one-haplotype living related kidney transplant recipients - Preliminary results

Universidade Federal de São Paulo, Hosp Rim & Hipertensao, BR-04038 São Paulo, BrazilUniversidade Federal de São Paulo, Hosp Rim & Hipertensao, BR-04038 São Paulo, BrazilWeb of Scienc

Interleukin-2 gene polymorphism is associated with renal but not cardiac transplant outcome

It was recently shown that IL-2 gene single nucleotide polymorphism (SNP) at position -330 (G-->T) is related to in vitro cytokine production levels, with the T/T and T/G genotypes being associated with low production and the G/G genotype associated with high production. the objective of this study was to investigate a possible influence of this polymorphism on renal and cardiac allograft outcomes. IL-2 SNP G-T (-330) was determined by PCR-RFLP in 67 recipients of heart allografts and in 63 recipients of renal grafts from HLA-haplo-identical, related donors. A higher frequency of the T/T genotype was observed in renal transplant patients who experienced at least one acute rejection episode during the first 3 months after transplantation than in those without rejection during this period (80% vs 49%, respectively, P < .05). Accordingly, the same genotype tended to be more frequent in renal recipients with a 6-month serum creatinine level above 1.5 mg/dL (median value for the whole group of kidney recipients) than in patients with lower creatinine levels (79% vs 45%, P < .08). Regarding cardiac transplant recipients, no associations were observed concerning acute rejection or graft survival. the finding of the association of T/T but not T/G genotype with acute kidney rejection was unexpected considering that both genotypes were shown to be associated with equal (low) IL-2 in vitro production. Further studies are necessary not only to dissect the nature of IL-2 T/T genotype association with kidney rejection, but also to explain why this genotype does not apparently influence cardiac allograft outcome.Universidade Federal de São Paulo, Div Immunogenet, Dept Pediat, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Div Nephrol, Dept Med, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Div Cardiol, Dept Med, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Div Immunogenet, Dept Pediat, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Div Nephrol, Dept Med, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Div Cardiol, Dept Med, São Paulo, SP, BrazilWeb of Scienc

Angioplasty with stent is the preferred therapy for posttransplant renal artery stenosis

UNIFESP, EPM, Hosp São Paulo, Hosp Rim & Hipertensao Hosp, São Paulo, BrazilUNIFESP, EPM, Hosp São Paulo, Hosp Rim & Hipertensao Hosp, São Paulo, BrazilWeb of Scienc

Predictive value of urinary retinol binding protein for graft dysfunction after kidney transplantation

High concentrations of retinol binding protein (RBP) are found in the urine of patients with tubulointerstitial injury. We evaluated the predictive value of urinary RBP (RBPu) for development graft dysfunction after kidney transplantation.Methods. Serum creatinine and RBPu were prospectively measured at months 3, 6, and 12 in 221 kidney transplant patients. Baseline graft function was defined as the lowest serum creatinine value during the first 3 months after transplantation. Graft dysfunction was assessed at 1 year as a >-20% or >-30% change in the inverse creatinine ((Delta) 1/Cr) compared to baseline value at month 3.Results. Among 183 patients with normal graft function (Cr less than or equal to 1.6 mg/dL) the mean (Delta)1/Cr from month 3 to 12 was -17 +/- 22% (-80% to + 44%). Using a receiver operating characteristic (ROC) analysis, concentrations higher than 0.6 mg/L showed the best Predictive value for diagnosis of graft dysfunction at 1 year. Mean (Delta)1/Cr from month 3 to 12 was -13 +/- 20% for those with RBP 0.6 mg/L (95% CI = -13% to -1.3%,P = .018). the percentage of patients with >-20% or >-30% (Delta)1/Cr was higher among patients with RBPu > 0.6 mg/L (34% vs 47%, P = .042; 21% vs 34%, P = .035). RBPu > 0.6 mg/L was the only variable independently associated with >-30% (Delta)1Cr at 1 year, with an odds ratio (OR) of 1.95 (95% CI 0.99 to 3.80, P = .05).Conclusion. RBPu may serve as a surrogate marker for graft dysfunction early after transplantation for patients with normal graft function, allowing early institution of intervention theraples to prolong allograft survival.UNIFESP, Hosp Rim & Hipertensao, Div Nephrol, BR-04038002 São Paulo, SP, BrazilUNIFESP, Hosp Rim & Hipertensao, Div Nephrol, BR-04038002 São Paulo, SP, BrazilWeb of Scienc