Capitalizar el conocimiento es uno de los fundamentos que tiene colombiana de trasplantes para garantizar sólidos resultados y satisfacer así las necesidades no sólo de nuestros pacientes, nuestros clientes, sino también de nuestros colegas en trasplante a nivel mundial.
Es así, como el pasado 4 de noviembre de 2008 tuvimos oportunidad de compartir la sala de cirugía con el M.D. Ph D HELMUT PAUL ARBOGAST jefe de trasplantes de Ludwig Maximilians Universitat en Munich Alemania, quien participó en calidad de observador durante una nefrectomía por laparoscopia manoasistida en la Clínica Marly.
Al desarrollar con precisión las habilidades requeridas en cada uno de nuestros niveles de atención, podemos ofrecer unos valores diferenciales que nos permiten mostrar y compartir nuestra experiencia con profesionales de la calidad del Dr. Arbogast, y así competir en mercados retadores y de una exigencia de la más alta calidad.
La visita del Dr. HELMUT PAUL ARBOGAST Ph D. es muy importante para ofrecer un portafolio diferencial a nuestros clientes, ya que la innovación y capacitación nos da la capacidad de recopilar información clave y mejorar nuestras habilidades para brindar nuestra experiencia al beneficio de la salud pública en Colombia en el mundo.
Es así, como la experiencia compartida con el Dr. Arbogast, médico, científico e investigador con más de 45 publicaciones indexadas y con más de 25 años de experiencia en trasplantes, se convierten en todo un honor para los médicos de Colombiana de Trasplantes con quienes participó en la intervención quirúrgica de donante vivo.
F. Giron, Y. Baez, A. Niño-Murcia, J. Rodríguez, S. Salcedo
Two new diagnoses have been causing graft loss during long-term follow-up, namely, chronic nephropathy and anticalcineurinic toxicity. The advent of the mammalian target of rapamycin (m-TOR) obviates anticalcineurine toxicity and reduces posttransplant malignancy incidence with good inmunosuppressive potential. We examinated the renal and metabolic behavior in renal transplant recipients who required conversion from an anticalcineurinic (cyclosporine or tacrolimus) to an m-TOR inhibitor (everolimus) as part of their immunosuppressive maintenance therapy.
Materials and Methods
Twenty-one first renal transplant recipients had everolimus added to their inmunosuppressive therapy combined with an antimetabolite (mycophenolate mofetil or sodium mycophenolate). The mean age of the patients was 35 ± 17 years (range, 6 to 65). The prevalence of male recipients was 57%; the overall mean weight, 64 kg (range, 48 to 95). All patients were hispanic with 15 transplants from cadaveric donors (71%). The mean follow-up posttransplant was 18 months (range, 3 to 40) and the mean follow-up on everolimus, 10 months (range, 2 to 22).
There was no mortality or graft loss, but there were 3 (17%) biopsy-confirmed acute rejection episodes. There were no significant changes in metabolic function pre- or postconversion. Regarding renal function, the mean creatinine serum showed a trend to decline: preconversion 1.7 mg/dL; postconversion 1.5 mg/dL. In 10 patients, it was possible to discontinue at least one antihypertensive medication (48%).
Everolimus was an effective medication to manage renal transplant patients. It produced metabolic stability and low myelotoxicity, despite combination with an antimetabolite (mycophenolic acid). Also, reduction of antihypertensive medications was an additional benefits for many patients.
F. Giron, Y. Baez, A. Niño-Murcia, J. Rodríguez, S. Salcedo
Laparoscopic living donor nephrectomy for kidney transplantation is a technique that began in South America only recently. This procedure offers several advantages compared with open nephrectomy due to the minor pain, better cosmetic results, and shorter length of hospital stay. Herein we have described our experience with the use of nonabsorbable polymer ligaclip (NPL) to control the renal artery, vein, and ureter in hand-assisted laparoscopic donor nephrectomy (HALN).
We performed a review of 85 HALNs for renal transplantation at our institution between January 2004 and August 2007. We evaluated the preoperative characteristics of the donor, surgical parameters, and complications.
Fifty six percent of donors were men. Mean donor age was 34.4 years (range = 18 to 60). Left-sided nephrectomy was performed in 85%. Mean surgical time was 132 minute (range = 90 to 240) and among the last 35 nephrectomies, 120 minute (range = 90 to 180). Mean warm ischemia time was 240 seconds (range = 120 to 420). Conversion rate was 1.1%. Mortality was one case (1.1%) secondary to an episode of massive pulmonary thromboembolism. Mean length of hospital stay was 2.5 days (range 2 to 5) and mean blood loss, 125 mL. No complication related to the NPL was observed.
Laparoscopy living donor nephrectomy was a safe procedure for kidney transplantation. The training and experience of the surgeon was reflected in shorter times of surgery. The NPL was safe and cost-effective, not increasing morbidity of the procedure.
Y. Baez, F. Giron, A. Niño-Murcia, J. Rodríguez, S. Salcedo
The purpose of this study was to describe the initial experience with alemtuzumab as induction followed by steroid-free immunosuppression in kidney transplantation.
One hundred patients who received renal transplants from living and deceased donors were followed for a median period of 12 months (range = 1 to 12). A 30-mg intravenous dose of Alemtuzumab was administered on the transplant day, preceded by a 500-mg methylprednisolone dose. Maintenance immunosuppression consisted in the use of a calcineurin inhibitor in association with mycophenolic acid. Maintenance C2 levels of cyclosporine were between 400 and 600 ng/dL; or of tacrolimus, between 4 and 7 ng/dL. Prophylaxis included valgancyclovir, trimethoprim-sulfamethoxasole, and nystatin. All patients were evaluated for acute rejection episodes, adverse events, or death.
The cumulative incidences of acute rejection at 1, 3, 6, and 12 months were 0%, 4% (n = 4), 5% (n = 5), and 8% (n = 8), respectively. Most episodes were Banff 1 a or b (88%). The infectious complication rate was 23%. There was no case of cytomegalovirus infection or posttransplant lymphoproliferative disease. Three patients died: one due to tuberculosis; one, sepsis; and one, an acute coronary event. No patient was lost to follow-up.
This study suggested the safety and efficacy of Campath-1H as an induction agent in renal transplant recipients.