Avaliação dos 35 anos de transplante renal no Hospital São Lucas da PUCRS

• Autor(a) principal: Kroth, Leonardo Viliano
• Data de Publicação: 2015
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da PUC_RS
• Texto Completo: http://tede2.pucrs.br/tede2/handle/tede/6070
• topic: MEDICINA; RINS - TRANSPLANTE; INFECÇÕES URINÁRIAS; CIENCIAS DA SAUDE::MEDICINA

This is a retrospective study reporting 35 years of kidney transplantation at Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul. An historical approach of the origins and development of the Nephrology Unit over the years was performed. Data were separated into different eras, based on the type of immunosuppression, and the patient’s characteristics before, during and after transplantation were assessed. There were significant differences between each era, mainly on the characteristics of the recipients and donors, but also in the rates of complications and technical aspects of surgery. A total of 1231 transplants were performed until 2013, April 30. Of these, 55.8% were male, white (86.9%) and 76.6% from deceased donors. Most recipients aged between 19 and 59 years (77.5%), and 1.9% over 70 years. Significant differences were observed between the characteristics of each era, especially in relation to recipients and donors. Through the eras, an increased number of patients are being transplanted, with grafts from older donors (p<0.001) subjected to longer cold ischemia times (p<0.001) transplanted in an increasing proportion of elderly recipients (p<0.001), maintained in a longer period on the waiting list (p<0.001). Fewer episodes of rejection were observed (p<0.001), lower incidence of some clinical complications such as myocardial infarction (p<0.001), strokes (p=0.02) and post-­‐transplant diabetes (p<0.001), along of the time. In the present era, survival of patients at 1, 3 and 5 years were 98.3%, 94.6% and 90.5% for living donors and 92.4%, 87.2% and 80.7% for deceased donors, respectively. Survival of grafts were, for living donors, 92.2%, 88.7% and 82.4% and deceased donors 80.4%, 71.1% and 63.7%. Transplants with acute pyelonephritis in the first 30 days after transplantation, had significantly worse graft and patients survivals, compared to patients without pyelonephritis in the first 30 days. In addition, age, use of ureteral stents, thymoglobulin induction and longer hospital stays increased the risk of this infection. Recipients of expanded criteria donors transplants induced with thymoglobulin may be at a 25.75 fold increase in risk for death 24 hours after diagnosis of CRAB septicemia, a severe complication occurring in 10 recipients between January 2000 and April 2013, of 807 transplants patients. In recent years, our study showed a low incidence of cytomegalovirus (CMV) infection, despite the increased use of Thymoglobulin. We found that the use of low thymoglobulin doses reduces the risk of cytomegalovirus and, the use of oral ganciclovir had a protective effect on CMV, in the first year of transplantation. Finally, patients with a positive polyomavirus urinary cytology had worse renal function and graft survival in a seven years follow-­‐up period, compared with the patients without the presence of decoy cells in urine. The analysis of the 35 years of transplantation at the Renal Unit of Hospital São Lucas da PUCRS depicts the evolution and development of a program that is a reference in South Brazil, and the different management and results through the different eras. There were changes in donor and recipient’s characteristics, inclusion selection, compatibility assessment and immunosuppression protocols, among others.