Advisor(s)
Abstract(s)
O transplante renal é hoje considerado como a melhor e mais eficaz alternativa terapêutica para
os doentes renais em estádio terminal. Apesar do seu elevado índice de sucesso, está sujeito a
prevalência elevada de complicações, sendo o maior limitador da sobrevida dos rins
transplantados o desenvolvimento da nefropatia crónica do enxerto que pode levar à perda de
função do enxerto. Esta, apresenta múltiplos factores de risco imunológicos tais como
compatibilidade dos antigénios do sistema HLA, ocorrência de episódios de rejeição aguda,
presença de anticorpos anti-HLA, transfusões de sangue, transplantes prévios e a resposta
imune subliminar continuada ao aloenxerto, e factores não imunológicos que incluem a idade e
o tipo de morte do dador, quantidade de nefrónios enxertada no receptor, agressão pela
isquemia/reperfusão e o uso de inibidores da calcineurina.
Os objetivos deste trabalho são: 1) caracterizar em termos demográficos uma população de
transplantados renais, avaliando diferentes variáveis referentes ao receptor, ao dador e ao
enxerto; 2) avaliar, diferentes variáveis imunológicas e não imunológicas, no receptor, dador e
enxerto; 3) identificar os possíveis factores de risco associados à rejeição/perda do enxerto.
Avaliamos retrospectivamente uma população de transplantados do Norte de Portugal, no
período de Janeiro de 1983 a Junho de 2010. Foram analisados possíveis factores
determinantes para a rejeição/perda do órgão no receptor, dador e enxerto; as variáveis
analisadas no receptor incluíram: sexo, idade, número de gestações, número de transfusões,
tempo de diálise, causa de insuficiência renal, presença de anticorpos anti- HLA, função renal
tardia e episódios de rejeição; as variáveis analisadas no dador incluíram: sexo, idade, causa de
morte e tipo de dador; compatibilidade no sistema HLA e tempo de isquemia fria foram os
factores referentes ao transplante. Os transplantados que perderam a função renal e
regressaram à diálise foram considerados como tendo rejeitado/perdido o enxerto.
Dos 3220 transplantados renais, 1022 (31,4%) perderam o enxerto e 2198 (68,3%) mantiveram
o enxerto funcionante. A duração média do transplante foi de 159 ± 166 meses. A principal
causa de perda do enxerto foi a rejeição crónica (30,0%). A análise multivariada revelou uma
forte associação entre a rejeição/perda do enxerto e a presença de anticorpos de novo
(RR=7.53; p <0.001), função tardia (RR=2.49; p <0.004) e pré sensibilização com anticorpos anti
HLA (RR=2.79; p <0.010). Neste trabalho identificamos factores de risco no receptor e no dador
de rim associados à falência do enxerto. Dado que o fenómeno da rejeição/perda do enxerto é
multifactorial, a determinação e prevenção dos seus factores de risco podem contribuir para um
significativo aumento da sobrevida do enxerto renal e melhorar a qualidade de vida do doente
transplantado renal.
Renal transplantation is now regarded as the best and most effective therapeutic alternative for kidney patients in terminal stage. Despite their high success rate, is subject to a high rate of complications, being the largest kidney transplant survival rate limiter the development of chronic graft nephropathy that can lead to loss of function of the graft. This presents multiple immunological risk factors such as compatibility of Antigen of the HLA system, occurrence of acute rejection episodes, presence of HLA Antibodies, blood transfusions, organ transplants and immune response continued to Allograft and subliminal non-immunological factors including age and the brain-dead donor type, amount of nephrons grafted on the receiver, aggression by ischemia, and the use of calcineurin inhibitors. The objectives of this work are: 1) characterize demographically a population of kidney transplanted, evaluating different variables related to the receiver, to the donor and graft; 2) evaluate, immunological and non-immunological different variables, on the receiver, donor and graft; 3) identify potential risk factors associated with graft rejection/loss. We evaluated retrospectively a transplanted population of Northern Portugal, from January 1983 to June 2010. Possible factors were analyzed for rejection/loss of the organ in the receiver, donor and graft; the variables analyzed in the receiver included: gender, age, number of pregnancies, number of transfusions, dialysis time, cause of kidney disease, the presence of anti-HLA Antibodies, late renal function and episodes of rejection; the variables analyzed in donor included: gender, age, cause of death and type of the donor; HLA system compatibility and cold ischemia time were the factors related to the transplant. Who have lost kidney function and returned to dialysis were considered as having rejected/lost the transplanted graft. Of 3220 renal transplant, 1022 (31.4%) lost the graft and 2198 (68.3%) kept functioning graft. The average length of the transplant was 166 ± 159 months. The main cause of graft loss was the chronic rejection (30.0).The main cause of graft loss was the chronic rejection (30.0). Multivariate analysis showed a strong association between graft rejection/loss and the presence of de novo antibodies (RR = 7.53; p< 0.001), late graft function (RR=2.49; p< 0.004) and pre sensitization with HLA Antibodies (RR = 2.79; p< 0.010) in this paper we identify risk factors in kidney donor and receiver associated with graft failure. Since the phenomenon of rejection/loss of the graft is multifactorial, the determination and prevention of its risk factors can contribute to a significant increase in renal graft survival and improve the quality of life in renal transplanted patients
Renal transplantation is now regarded as the best and most effective therapeutic alternative for kidney patients in terminal stage. Despite their high success rate, is subject to a high rate of complications, being the largest kidney transplant survival rate limiter the development of chronic graft nephropathy that can lead to loss of function of the graft. This presents multiple immunological risk factors such as compatibility of Antigen of the HLA system, occurrence of acute rejection episodes, presence of HLA Antibodies, blood transfusions, organ transplants and immune response continued to Allograft and subliminal non-immunological factors including age and the brain-dead donor type, amount of nephrons grafted on the receiver, aggression by ischemia, and the use of calcineurin inhibitors. The objectives of this work are: 1) characterize demographically a population of kidney transplanted, evaluating different variables related to the receiver, to the donor and graft; 2) evaluate, immunological and non-immunological different variables, on the receiver, donor and graft; 3) identify potential risk factors associated with graft rejection/loss. We evaluated retrospectively a transplanted population of Northern Portugal, from January 1983 to June 2010. Possible factors were analyzed for rejection/loss of the organ in the receiver, donor and graft; the variables analyzed in the receiver included: gender, age, number of pregnancies, number of transfusions, dialysis time, cause of kidney disease, the presence of anti-HLA Antibodies, late renal function and episodes of rejection; the variables analyzed in donor included: gender, age, cause of death and type of the donor; HLA system compatibility and cold ischemia time were the factors related to the transplant. Who have lost kidney function and returned to dialysis were considered as having rejected/lost the transplanted graft. Of 3220 renal transplant, 1022 (31.4%) lost the graft and 2198 (68.3%) kept functioning graft. The average length of the transplant was 166 ± 159 months. The main cause of graft loss was the chronic rejection (30.0).The main cause of graft loss was the chronic rejection (30.0). Multivariate analysis showed a strong association between graft rejection/loss and the presence of de novo antibodies (RR = 7.53; p< 0.001), late graft function (RR=2.49; p< 0.004) and pre sensitization with HLA Antibodies (RR = 2.79; p< 0.010) in this paper we identify risk factors in kidney donor and receiver associated with graft failure. Since the phenomenon of rejection/loss of the graft is multifactorial, the determination and prevention of its risk factors can contribute to a significant increase in renal graft survival and improve the quality of life in renal transplanted patients