Browsing by Author "Moreira, P"
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- Artérias renais múltiplas na transplantação renal: será um problema atualmente?Publication . Carvalho, J; Nunes, P; Dinis, P; Tavares da Silva, E; Marques, V; Parada, B; Marconi, L; Moreira, P; Roseiro, A; Bastos, C; Rolo, F; Dias, V; Figueiredo, A
- Estudos urodinâmicos em idade pediátricaPublication . Bastos, S; Costa, J; Moreira, P; Veiros, I
- Isquémia fria de 18h: será que os nossos resultados desafiam as Guidelines?Publication . Carvalho, J; Nunes, P; Dinis, P; Antunes, H; Lourenço, M; Tavares da Silva, E; Parada, B; Marconi, L; Moreira, P; Roseiro, A; Bastos, C; Rolo, F; Dias, V; Figueiredo, A
- Pretransplant biopsy in expanded criteria donors: do we really need it?Publication . Tavares da Silva, E; Oliveira, R; Castelo, D; Marques, V; Sousa, V; Moreira, P; Simões, P; Bastos, C; Figueiredo, A; Mota, AAbstract INTRODUCTION: Renal transplantation is the best treatment for end-stage renal disease, including when using expanded criteria donors (ECD) kidneys. However, these suboptimal kidneys should be evaluated rigorously to meet their usefulness. Opinions differ about the best way to evaluate them. MATERIALS AND METHODS: We retrospectively reviewed kidneys from ECD harvested by a single academic institution between January 2008 and September 2013. Needle biopsies were performed at the time of the harvest when considered relevant by the transplant team. Two pathologists where responsible for their analysis; the Remuzzi classification has been used in all cases. RESULTS: We evaluated 560 ECD kidneys. Biopsies were made in 197 (35.2%) organs, 20 of which were considered not usable and 36 good only for double transplantation. Sixty-three kidneys (11.3%) were discarded by the transplant team based on the biopsy result and clinical criteria. Donors who underwent a biopsy were older (P < .001) and had a worse glomerular filtration rate (GFR; P = .001). Comparing donors approved and rejected by the biopsy, the rejected donors were heavier (P = .003) and had a lower GFR (P = .002). Cold ischemia time was longer for the biopsy group (P < .001). Regarding graft function, the biopsy overall score correlated with the transplant outcome in the short and long term. Separately, glomeruli and interstitium scores were correlated with recipient's GFR in the earlier periods (3 months; P = .025 and .037), and the arteries and tubules correlated with GFR in the longer term (at 3 years P = .004 and .010). CONCLUSION: The decision on the usability of ECD grafts is complex. At our center, we chose a mixed approach based on donor risk. Low-risk ECD do not require biopsy. In more complex situations, especially older donors or those with a lower GFR, prompted a pretransplant biopsy. The biopsy results proved to be useful as they relate to subsequent transplant outcomes, thereby allowing us to exclude grafts whose function would most probably be less than optimal.
- Risk factors for delayed renal graft function and their impact on renal transplantation outcomePublication . Figueiredo, A; Moreira, P; Parada, B; Nunes, P; Macário, F; Bastos, C; Mota, AOBJECTIVE: The objective of this study was to evaluate the risk factors for delayed graft function (DGF) and their influence on renal graft outcome. PATIENTS AND METHODS: We reviewed 1462 consecutive renal transplantation and identified 245 patients (17.1%) with delayed graft function and 1120 patients with immediate graft function. Forty-one cases were excluded because of a nonfunctioning graft as well as 26 other cases because of insufficient data. We compared the incidence, donor and recipient risk factors, and impact on graft outcomes, as well as patient and graft survival of delayed graft function. RESULTS: Donor weight and age, recipient weight, age, length of dialysis, and cold ischemia time were significantly higher in the delayed graft function group. Higher rates of acute rejection and chronic graft dysfunction were observed in this group of patients; we also observed worse graft function and survival. CONCLUSIONS: Multiple risk factors are associated with delayed graft function, which contribute decisively to a worse outcome.
- Será a obesidade um pesadelo na transplantação renal?Publication . Carvalho, J; Nunes, P; Dinis, P; Lourenço, M; Tavares da Silva, E; Parada, B; Marconi, L; Moreira, P; Roseiro, A; Bastos, C; Rolo, F; Dias, V; Figueiredo, A
- Surgical complications in 2000 renal transplantsPublication . Eufrásio, P; Parada, B; Moreira, P; Nunes, P; Bollini, S; Figueiredo, A; Mota, AINTRODUCTION: Renal transplantation is the best treatment for end-stage renal disease. In the last years, we have seen improvements in immunosuppressive treatment, which have allowed patients to experience a better quality of life and graft survival. Nevertheless, surgical complications remain important problems that increase morbidity, mortality, costs, and hospitalization. Our purpose was to evaluate surgical complications among a large series of 2000 renal transplantations. PATIENTS AND METHODS: We retrospectively analyzed all surgical complications among 2000 renal transplants performed between June 1980 and March 2010 in our department. RESULTS: Among 318 (15.9%) surgical complications, 4.8% of patients had urologic problems. Ureteral stenosis and fistula, stent obstruction, and ureteral necrosis occurred in 2.7%, 1.8%, 0.1%, and 0.2% of patients, respectively. Vascular complications reported in 2.7% of patients included arterial or venous thrombosis (1.0% or 0.4%), both arterial and venous thrombosis (0.1%), renal infarction (0.1%), renal artery aneurysm (0.1%) as well as arterial stenosis (0.5%), kinking (0.4%), or dissection (0.1%). Other complications, not specifically related with transplantation surgery, occurred in 4.4% of patients. CONCLUSION: Renal transplantation is a safe surgery by experienced teams. Our rates of surgical complications were within those reported by other series. A meticulous surgical technique is mandatory to prevent them. Prompt diagnosis and management are required to prevent graft damage and patient morbidity.
- Urinary Stones After Renal Transplantation – Incidence, Management and OutcomesPublication . Antunes, H; Parada, B; Tavares da Silva, E; Carvalho, J; Rodrigues, L; Simões, P; Moreira, P; Ferreira, C; Macário, F; Figueiredo, A