Glomeruloesclerose segmentar e focal pós transplante renal
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Repositório Institucional da UNIFESP |
dARK ID: | ark:/48912/001300000w3pz |
Texto Completo: | https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=9096857 https://repositorio.unifesp.br/handle/11600/60035 |
Resumo: | Background: FSGS recurs in 30% of adults and in 80% of pediatric kidney transplant recipients. There is no standard of care treatment. Aim: The purpose of this study was to evaluate clinical and laboratorial characteristics, response to treatment and renal outcomes of patients with post transplant FSGS. Methods: The study includes a retrospective and a prospective analysis of patients with post transplant FSGS. The single-center cohort study 1 analyzed patients treated with plasmapheresis (PP) and combinations of high dose steroids, cyclosporine and rituximab. The prospective single-center study 2 applied multitarget treatment consisting of cyclosporine, prednisone and PP to assess therapeutic response and adverse events. The study 3 evaluated retrospectively data from both previous studies together. Results: Among 61 patients with post transplant FSGS included in study 1 the median time to diagnosis was 19 days. The incidence of first biopsy-confirmed FSGSr was 18% reaching 52.4% with follow-up biopsies. During PP treatment 54% of the patients developed infectious complications. PP was discontinued in 37% of patients due to treatment failure (no remission or graft loss) and in 26% due to AE. All patients who discontinued PP due to AE did not show clinical response or lost the allograft. The incidence of acute rejection and borderline changes was 34.4%. The incidences of partial and complete remissions were 16.4% and 27.8%, respectively. Overall 6-years patient and graft survivals were 90.7% and 64.5%, respectively. Among 13 patients of study 2 submitted to the multitarget treatment the median time to diagnosis was 1 month. Mean proteinuria was 8,8g/g and mean serum creatinine was 4,2 mg/dL. The incidence of first biopsy-confirmed FSGSr was 27%. Treatment was started in 4 days. All patients discontinued treatment in a mean time of 27 days, 11 of them (84.6%) due to infectious intercurrences. The study 3 has not detected risk factors for graft loss or remission. Conclusion: This analysis confirms the low, variable and unpredictable rate of FSGSr remission, with treatment options showing variable efficacy and high rate of AE, ultimately leading to inferior graft survival. The main infectious intercurrence was cytomegalovirus (CMV). Multitarget treatment was not a therapeutic option in FSGSr patients of our center. |
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Glomeruloesclerose segmentar e focal pós transplante renalFocal Segmental GlomerulosclerosisPlasmapheresisProteinuriaChronic Renal FailureKidney Transplantation.Glomeruloesclerose Segmentar FocalPlasmaféreseProteinúriaInsuficiência Renal CrônicaBackground: FSGS recurs in 30% of adults and in 80% of pediatric kidney transplant recipients. There is no standard of care treatment. Aim: The purpose of this study was to evaluate clinical and laboratorial characteristics, response to treatment and renal outcomes of patients with post transplant FSGS. Methods: The study includes a retrospective and a prospective analysis of patients with post transplant FSGS. The single-center cohort study 1 analyzed patients treated with plasmapheresis (PP) and combinations of high dose steroids, cyclosporine and rituximab. The prospective single-center study 2 applied multitarget treatment consisting of cyclosporine, prednisone and PP to assess therapeutic response and adverse events. The study 3 evaluated retrospectively data from both previous studies together. Results: Among 61 patients with post transplant FSGS included in study 1 the median time to diagnosis was 19 days. The incidence of first biopsy-confirmed FSGSr was 18% reaching 52.4% with follow-up biopsies. During PP treatment 54% of the patients developed infectious complications. PP was discontinued in 37% of patients due to treatment failure (no remission or graft loss) and in 26% due to AE. All patients who discontinued PP due to AE did not show clinical response or lost the allograft. The incidence of acute rejection and borderline changes was 34.4%. The incidences of partial and complete remissions were 16.4% and 27.8%, respectively. Overall 6-years patient and graft survivals were 90.7% and 64.5%, respectively. Among 13 patients of study 2 submitted to the multitarget treatment the median time to diagnosis was 1 month. Mean proteinuria was 8,8g/g and mean serum creatinine was 4,2 mg/dL. The incidence of first biopsy-confirmed FSGSr was 27%. Treatment was started in 4 days. All patients discontinued treatment in a mean time of 27 days, 11 of them (84.6%) due to infectious intercurrences. The study 3 has not detected risk factors for graft loss or remission. Conclusion: This analysis confirms the low, variable and unpredictable rate of FSGSr remission, with treatment options showing variable efficacy and high rate of AE, ultimately leading to inferior graft survival. The main infectious intercurrence was cytomegalovirus (CMV). Multitarget treatment was not a therapeutic option in FSGSr patients of our center.Introdução: A recorrência de GESF (GESFr) ocorre em 30% dos adultos e em 80% das crianças receptores de transplante renal. Não existe até o momento tratamento bem definido. Objetivo: O objetivo deste estudo foi avaliar características clínicas e laboratoriais, resposta a diferentes opções de tratamento e desfechos renais em pacientes com GESF pós-transplante. Métodos: O estudo inclui análises retrospectiva e prospectiva em centro único de pacientes com GESF pós-transplante. O estudo 1 retrospectivo analisou pacientes tratados com plasmaférese (PF) e combinações de altas doses de esteroides, ciclosporina (CsA) e rituximabe. O estudo 2 prospectivo aplicou o tratamento multitarget composto por CsA, prednisona e PF para avaliar a resposta terapêutica e eventos adversos (EA). O estudo 3 analisou retrospectivamente os dados dos dois estudos anteriores em conjunto. Resultados: Dos 61 pacientes transplantados incluídos no estudo 1, a mediana do tempo para o diagnóstico de GESF foi de 19 dias. A incidência de GESFr confirmada por biópsia foi de 18%, alcançando 52,4% em biópsias de seguimento. Durante o tratamento com PF, 54% dos pacientes desenvolveram complicações infecciosas. A PF foi descontinuada em 37% dos casos devido à falha do tratamento (sem remissão ou perda do enxerto) e em 26% por EA. Todos os pacientes que descontinuaram a PF devido a EA não apresentaram remissão ou perderam o enxerto. A incidência de rejeição aguda e alterações borderline foi de 34,4%. As incidências de remissões parciais e completas foram de 16,4% e 27,8%, respectivamente. A sobrevida global de 6 anos do paciente e do enxerto foi de 90,7% e 64,5%, respectivamente. No estudo 2, os 13 pacientes tratados com o esquema multitarget tiveram mediana de tempo para o diagnóstico de 1 mês, proteinúria média de 8,8 g/g e creatinina sérica média de 4,2 mg/dL. A incidência de GESFr confirmada pela primeira biópsia foi de 27%. O tratamento foi iniciado em uma mediana de tempo de 4 dias. Todos os pacientes interromperam o tratamento em um tempo médio de 27 dias, 11 deles (84,6%) devido a infecção por citomegalovírus (CMV). No estudo 3, não foram detectados fatores de risco para perda do enxerto e remissão. Conclusão: Destaca-se a baixa taxa de remissão com a utilização de PF para tratamento de GESFr, a alta taxa de EA e o impacto negativo na sobrevida do enxerto. O tratamento multitarget para GESFr não foi adequado para a população atendida em nosso serviço e incluída no estudo devido aos EA sérios, com predomínio das complicações infecciosas (84,6%), destacando-se a infecção por CMV. Na avaliação dos 74 pacientes com GESF pós-transplante, não foram identificados por análise multivariada fatores de risco para perda do enxerto ou favorecedores de resposta aos tratamentos realizados.Dados abertos - Sucupira - Teses e dissertações (2019)Coordenação de Aperfeiçoamento Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo (UNIFESP)Kirsztajn, Gianna Mastroianni [UNIFESP]Silva Junior, Hélio Tedesco da [UNIFESP]http://lattes.cnpq.br/1621797721074970http://lattes.cnpq.br/5744106277657588http://lattes.cnpq.br/0083743222802856Universidade Federal de São Paulo (UNIFESP)Siliano, Juliana Mansur [UNIFESP]2021-01-19T16:37:48Z2021-01-19T16:37:48Z2019-10-08info:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=9096857SILIANO, Juliana Mansur. Glomeruloesclerose segmentar e focal pós-transplante. 2019. 76f. Tese (Doutorado em Nefrologia) – Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 2019.Tese Juliana Mansur-A.pdfhttps://repositorio.unifesp.br/handle/11600/60035ark:/48912/001300000w3pzporSão Pauloinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2024-08-01T08:32:58Zoai:repositorio.unifesp.br/:11600/60035Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652024-12-11T20:40:40.593094Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.none.fl_str_mv |
Glomeruloesclerose segmentar e focal pós transplante renal |
title |
Glomeruloesclerose segmentar e focal pós transplante renal |
spellingShingle |
Glomeruloesclerose segmentar e focal pós transplante renal Siliano, Juliana Mansur [UNIFESP] Focal Segmental Glomerulosclerosis Plasmapheresis Proteinuria Chronic Renal Failure Kidney Transplantation. Glomeruloesclerose Segmentar Focal Plasmaférese Proteinúria Insuficiência Renal Crônica |
title_short |
Glomeruloesclerose segmentar e focal pós transplante renal |
title_full |
Glomeruloesclerose segmentar e focal pós transplante renal |
title_fullStr |
Glomeruloesclerose segmentar e focal pós transplante renal |
title_full_unstemmed |
Glomeruloesclerose segmentar e focal pós transplante renal |
title_sort |
Glomeruloesclerose segmentar e focal pós transplante renal |
author |
Siliano, Juliana Mansur [UNIFESP] |
author_facet |
Siliano, Juliana Mansur [UNIFESP] |
author_role |
author |
dc.contributor.none.fl_str_mv |
Kirsztajn, Gianna Mastroianni [UNIFESP] Silva Junior, Hélio Tedesco da [UNIFESP] http://lattes.cnpq.br/1621797721074970 http://lattes.cnpq.br/5744106277657588 http://lattes.cnpq.br/0083743222802856 Universidade Federal de São Paulo (UNIFESP) |
dc.contributor.author.fl_str_mv |
Siliano, Juliana Mansur [UNIFESP] |
dc.subject.por.fl_str_mv |
Focal Segmental Glomerulosclerosis Plasmapheresis Proteinuria Chronic Renal Failure Kidney Transplantation. Glomeruloesclerose Segmentar Focal Plasmaférese Proteinúria Insuficiência Renal Crônica |
topic |
Focal Segmental Glomerulosclerosis Plasmapheresis Proteinuria Chronic Renal Failure Kidney Transplantation. Glomeruloesclerose Segmentar Focal Plasmaférese Proteinúria Insuficiência Renal Crônica |
description |
Background: FSGS recurs in 30% of adults and in 80% of pediatric kidney transplant recipients. There is no standard of care treatment. Aim: The purpose of this study was to evaluate clinical and laboratorial characteristics, response to treatment and renal outcomes of patients with post transplant FSGS. Methods: The study includes a retrospective and a prospective analysis of patients with post transplant FSGS. The single-center cohort study 1 analyzed patients treated with plasmapheresis (PP) and combinations of high dose steroids, cyclosporine and rituximab. The prospective single-center study 2 applied multitarget treatment consisting of cyclosporine, prednisone and PP to assess therapeutic response and adverse events. The study 3 evaluated retrospectively data from both previous studies together. Results: Among 61 patients with post transplant FSGS included in study 1 the median time to diagnosis was 19 days. The incidence of first biopsy-confirmed FSGSr was 18% reaching 52.4% with follow-up biopsies. During PP treatment 54% of the patients developed infectious complications. PP was discontinued in 37% of patients due to treatment failure (no remission or graft loss) and in 26% due to AE. All patients who discontinued PP due to AE did not show clinical response or lost the allograft. The incidence of acute rejection and borderline changes was 34.4%. The incidences of partial and complete remissions were 16.4% and 27.8%, respectively. Overall 6-years patient and graft survivals were 90.7% and 64.5%, respectively. Among 13 patients of study 2 submitted to the multitarget treatment the median time to diagnosis was 1 month. Mean proteinuria was 8,8g/g and mean serum creatinine was 4,2 mg/dL. The incidence of first biopsy-confirmed FSGSr was 27%. Treatment was started in 4 days. All patients discontinued treatment in a mean time of 27 days, 11 of them (84.6%) due to infectious intercurrences. The study 3 has not detected risk factors for graft loss or remission. Conclusion: This analysis confirms the low, variable and unpredictable rate of FSGSr remission, with treatment options showing variable efficacy and high rate of AE, ultimately leading to inferior graft survival. The main infectious intercurrence was cytomegalovirus (CMV). Multitarget treatment was not a therapeutic option in FSGSr patients of our center. |
publishDate |
2019 |
dc.date.none.fl_str_mv |
2019-10-08 2021-01-19T16:37:48Z 2021-01-19T16:37:48Z |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
doctoralThesis |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=9096857 SILIANO, Juliana Mansur. Glomeruloesclerose segmentar e focal pós-transplante. 2019. 76f. Tese (Doutorado em Nefrologia) – Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 2019. Tese Juliana Mansur-A.pdf https://repositorio.unifesp.br/handle/11600/60035 |
dc.identifier.dark.fl_str_mv |
ark:/48912/001300000w3pz |
url |
https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=9096857 https://repositorio.unifesp.br/handle/11600/60035 |
identifier_str_mv |
SILIANO, Juliana Mansur. Glomeruloesclerose segmentar e focal pós-transplante. 2019. 76f. Tese (Doutorado em Nefrologia) – Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 2019. Tese Juliana Mansur-A.pdf ark:/48912/001300000w3pz |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.coverage.none.fl_str_mv |
São Paulo |
dc.publisher.none.fl_str_mv |
Universidade Federal de São Paulo (UNIFESP) |
publisher.none.fl_str_mv |
Universidade Federal de São Paulo (UNIFESP) |
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reponame:Repositório Institucional da UNIFESP instname:Universidade Federal de São Paulo (UNIFESP) instacron:UNIFESP |
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Universidade Federal de São Paulo (UNIFESP) |
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UNIFESP |
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UNIFESP |
reponame_str |
Repositório Institucional da UNIFESP |
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Repositório Institucional da UNIFESP |
repository.name.fl_str_mv |
Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP) |
repository.mail.fl_str_mv |
biblioteca.csp@unifesp.br |
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1818602526494162944 |