Comparación de la efectividad de los esquemas de tratamiento inmunosupresor en la sobrevida del injerto renal : experiencia de 5 años en sujetos trasplantados en Hospital Luis Vernaza
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2016
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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Objetivo: Ccomparar la efectividad de los esquemas de tratamiento inmunosupresor en la sobrevida del injerto renal. Materiales y Métodos: Estudio observacional, descriptivo, retro-prospectivo; no experimental. La población estudiada fue de 86 pacientes, a los cuales se los controlo un año post el trasplante en el Hospital Luis Vernaza, concluyendo en octubre 2015.Se hizo un seguimiento con pruebas bioquímicas a los 3,6 y 12 meses pos trasplante renal. Se diagnosticó rechazo agudo o crónico de acuerdo a la evolución clínica, valores de creatinina sérica mayores a 1.2 mg/dl, y/o por estudio Anatomo-Patológico por biopsia. Resultados: El rango promedio de edad fue 16-30 años, la relación de género fue masculino con 62% y femenino 38 %; la frecuencia de Donante Cadavérico fue de un 77%, el prestador fue el IESS con un 51%. De los Trasplante Renales realizados corresponde al HLV un 78%; la distribución por años, en 2014 correspondió el 25%(18 pacientes) y en el 2015, el 15% (11 pacientes). De los 24 pacientes a los que se les realizó biopsia renal, el 28% presentaron signos de rechazo con un diagnóstico patológico de rechazo agudo leve en el 58%. Los niveles basales de creatininemia el día 0 del trasplante estuvieron entre 5.6-10 mgdl (64%). Mientras que a depuración de creatinina y proteinuria de 24 horas encontramos que entre 61-90 ml/min/1.73, estuvieron el 55 % a los 3 y el 66 % a los 12 meses. La proteinuria entre 30-300 mg/24 horas fue de 65% a los 3 y de 67 % a los 12 meses. El esquema inmunosupresor estándar fue esteroides, micofenolato mofetilo y tacrolimus en un 35%de los trasplantados a los 3 meses; a los 6 meses se mantuvo el mismo esquema en el 23%y a los 12 meses en un 8%. Mientras que al cambio con el esquema esteroides-micofenolatomofetiloeverolimus/sirolimus a los 12 meses se observó un incremento al 27%. La sobrevida de los pacientes trasplantados fue de 98% y 2% fallecidos. Conclusiones: El esquema estándar con tacrolimus(ICN) constituye el esquema habitual pero se debió rotar o cambiar a los 3 o 6 meses por protocolo u observar signos de rechazo del injerto. El uso de esteroides-micofenolatomofetilo y Everolimus/Sirolimus (MTOR) fue el esquema con mejor sobrevida del injerto al año de seguimiento. La elevación de los niveles de creatinina y micro albuminuria fueron los parámetros indicadores de necesidad de biopsia renal. El grupo con un MTor presentó mayor proteinuria.
Objective: To compare the effectiveness of immunosuppressive therapy schemes in renal graft survival. Materials and Methods: Observational, descriptive, retro - prospective study; not experimental. The study population was 86 patients who received transplant and were controlled a year after it at the Luis Vernaza Hospital until October 2015. Were followed up with biochemical tests every 3, 6 and 12 months after renal transplantation. Diagnostic of acute or chronic rejection was done according to the clinical course, serum creatinine greater than 1.2 mg / dl , and/or pathologic study by biopsy. Results: The average age range was 16-30 years, male gender ratio was 62%, and 38% female; Deceased donor frequency was 77%, the lender was the IESS 51%. Kidney Transplant made at HLV corresponds to 78%; distribution through years: in 2014 accounted for 25% (18 patients) and in 2015, 15% (11 patients). Of the 24 patients who underwent renal biopsy, 28% showed signs of rejection with a pathological diagnosis of mild acute rejection in 58%. Baseline serum creatinine levels on day 0 of transplantation were among 5.6-10 mg-dl (64%). As to creatinine clearance and 24-hour proteinuria levels between 61-90 ml, were 55% at 3 and 66% at 12 months. Proteinuria between 30-300 mg / 24 hours was 65% at the 3rd month and 67% at 12 months. The standard immunosuppressive scheme withsteroid tacrolimus and micofenolatomofetilo was 35% at 3 months; at 6 months it remained the same in a 23% of the transplanted, and at 12 months 27%. As with a change to steroidmicofenolatomofetilo-everolimus / sirolimus we observed an increase to 27%. Survival of transplanted patients was 98%, only 2% died. Conclusions: Standard Scheme with tacrolimus is the usual pattern but had to be changed at 3 or 6 months after observing signs of graft rejection. Steroid use and Everolimus - micofenolatomofetilo / Sirolimus was with the better scheme forgraft survival at one year. Elevated levels of creatinine and microalbuminuria were indicators for renal biopsy. The mTor group presented a greater proteinuria.
Objective: To compare the effectiveness of immunosuppressive therapy schemes in renal graft survival. Materials and Methods: Observational, descriptive, retro - prospective study; not experimental. The study population was 86 patients who received transplant and were controlled a year after it at the Luis Vernaza Hospital until October 2015. Were followed up with biochemical tests every 3, 6 and 12 months after renal transplantation. Diagnostic of acute or chronic rejection was done according to the clinical course, serum creatinine greater than 1.2 mg / dl , and/or pathologic study by biopsy. Results: The average age range was 16-30 years, male gender ratio was 62%, and 38% female; Deceased donor frequency was 77%, the lender was the IESS 51%. Kidney Transplant made at HLV corresponds to 78%; distribution through years: in 2014 accounted for 25% (18 patients) and in 2015, 15% (11 patients). Of the 24 patients who underwent renal biopsy, 28% showed signs of rejection with a pathological diagnosis of mild acute rejection in 58%. Baseline serum creatinine levels on day 0 of transplantation were among 5.6-10 mg-dl (64%). As to creatinine clearance and 24-hour proteinuria levels between 61-90 ml, were 55% at 3 and 66% at 12 months. Proteinuria between 30-300 mg / 24 hours was 65% at the 3rd month and 67% at 12 months. The standard immunosuppressive scheme withsteroid tacrolimus and micofenolatomofetilo was 35% at 3 months; at 6 months it remained the same in a 23% of the transplanted, and at 12 months 27%. As with a change to steroidmicofenolatomofetilo-everolimus / sirolimus we observed an increase to 27%. Survival of transplanted patients was 98%, only 2% died. Conclusions: Standard Scheme with tacrolimus is the usual pattern but had to be changed at 3 or 6 months after observing signs of graft rejection. Steroid use and Everolimus - micofenolatomofetilo / Sirolimus was with the better scheme forgraft survival at one year. Elevated levels of creatinine and microalbuminuria were indicators for renal biopsy. The mTor group presented a greater proteinuria.
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Trasplante del riñón, Inmunosupresores, Epidemiología descriptiva, Estudios retrospectivos, Hospital Luis Vernaza, Cantón Guayaquil, Ecuador