Trabalhos Acadêmicos
URI permanente desta comunidadehttps://repositorio.cmmg.edu.br/handle/123456789/5
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Item Glomerulopatias: evolução clínica, recorrência e sobrevida do enxerto em pacientes submetidos ao transplante renal(Faculdade Ciências Médicas de Minas Gerais, 2019-04-24) Figueiredo Júnior, Humberto Eustáquio; Nascimento, Evaldo; Oliveira, Raquel Aparecida Salustriano Fabreti deBackground: Glomerulopathies (GP) are a group of diseases that can lead to renal failure and need for dialysis, being the third cause of end stage renal disease (ESRD) in Brazil. Recurrent GP after kidney transplantation is a complication of kidney transplantation that could negatively affect kidney function and graft survival. Objectives: This study aimed to evaluate the outcome, graft survival and GP recurrence and its predictors in kidney-transplanted patients. Methods: The patients were divided into two groups: G1 (with GP; n=95) and G2 (with other causes of ESRD (n=373). Graft survival analyses were performed using the Kaplan-Meier for living donor (LD) and deceased donor (DD), for subtype of GP and for recurrence. Multivariate Cox regression analysis were used to investigate the predictors for graft loss and for GP recurrence. Pre-transplant diagnosis of GP in G1 was made based on clinical manifestation and/or biopsy. Post-transplant GP was classified in true recurrence or transplant GP (Tx-GP). Results: The proportion of rejection episodes and the mean serum creatinine levels in the first month after transplantation and in the following months were similar between G1 and G2 for LD and DD. Disease recurrence was observed in nine patients who received kidney from a LD, of which four lost their grafts. In patients who received kidney from a DD, recurrence was also observed in nine patients, of which three lost their grafts. No statistically significant differences in graft survival between G1 and G2 in relation to LD and DD were noted (P=0.299 and 0.434, respectively). However, differences in graft survival were found when GP subtypes and GP recurrence were analysed. The predictors of graft loss were delayed graft function (hazard ratio (HR)=2.226, P=0.002), rejection episodes (HR=1.904, P=0.017), and recurrence or Tx-GP (HR=3.243, P=0.006). The predictors of disease recurrence or Tx-GP were age (HR=0.945, P=0.028) and cold ischaemia time (HR=1.117, P=0.003). Conclusions: Kidney transplantation remains a reasonable treatment for GP with ESRD, although the possibility of disease recurrence. Loss of renal function due to IgA nephropaty was observed in the long term. For patients with focal segmental glomerulosclerosis, the decision on transplantation should be thoroughly discussed between the doctor and the patient because of the high rates of recurrence and allograft failure.