Navegando por Autor "Pinto Filho, Valter Alves"

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Câncer em pacientes transplantados renais: evolução clínica e sobrevida do enxerto e do receptor
(Faculdade Ciências Médicas de Minas Gerais, 2020-10-19) Pinto Filho, Valter Alves; Nascimento, Evaldo; Oliveira, Raquel Aparecida Salustriano Fabreti de
Introduction. The end-stage renal disease (ESRD) has become an important public health problem in the world and kidney transplantation is considered the best treatment for ESRD in comparison with dialysis. In order to avoid graft rejection, the transplanted patient underwent continuous treatment with immunosuppressive drugs, whose side effects are associated with the development of different types of cancer (CA) with an important risk factor for mortality. The risk for malignant diseases can increase by two to 20 times in transplant patients. Despite this, cancer screening in the transplant population is inadequate and lacks specific guidelines. Objective. The aim of this study was to analyze the occurrence of cancer in kidney transplant patients, risk factors, clinical evolution and graft and patient survival. Material and methods. This case-control study included 100 patients who received a kidney transplant in the period of 2008 to 2018 at the Transplant Unit of the University Hospital Medical Sciences. Of these, 25 patients who developed CA were assigned to the case group and 75 patients without CA after transplantation were assigned to the control group. All patients were interviewed to survey risk factors such as smoking habit, family history among others before transplant and also screened for malignancies by laboratory and imaging exams. The immunosuppressive therapy was performed with induction immunotherapy in sensitized patients; maintenance triple immunosuppressive therapy using calcineurin inhibitor, methylprednisolone, and sodium mycophenolate. After transplantation, clinical suspicion associated with a positive history of malignancies motivated the initial screening for CA. If CA diagnosis was confirmed, the patient was underwent appropriate treatment. The logistic regression models to obtain the odds ratios and Kaplan-Meier method for survival curves were used in the analyzes. Results. An association of the risk factors as causes of ESRD, time in dialysis, smoking habit, family history of CA, rejection episodes, induction immunotherapy, and maintenance triple immunosuppression with CA development was not observed. Non-melanoma skin cancer was the most common, accounting for 60% of the cases, which was followed by stomach and prostate CA and lymphoproliferative diseases (4% each). The most frequent age range with CA diagnosis was 50–59 years and the highest number of diagnoses was noted from the fifth to seventh year after transplant (43.83%). Graft and patient survival was similar between the groups. Fifty per cent of the patients that died in the case group was due to CA. Conclusion. Association between CA development and the risk factors family history and smoking habit was not observed, and no differences in allograft and patient survival were found between the groups. However, CA can occur early after transplantation, significantly affecting the patient's quality of life. Due to the continuous use of immunosuppression in transplant patients and the high risk of CA, we suggest screening for oncological diseases.