127 results on '"António Castro Henriques"'
Search Results
2. A Receita do Arcebispo de Lisboa em 1465-1466
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António Castro Henriques
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receita ,arcebispo ,lisboa ,instituições eclesiásticas ,agricultura ,Social sciences (General) ,H1-99 ,Social history and conditions. Social problems. Social reform ,HN1-995 ,History (General) and history of Europe - Abstract
O presente artigo analisa (e publica) uma até agora desconhecida lista das fontes de receita do arcebispo de Lisboa em 1465-1466 que esteve guardada no Museu Britânico. Combinada com outra documentação, este registo amplia os conhecimentos sobre a organização económica das dioceses portuguesas. A informação desta fonte oferece uma rara oportunidade de observar as alterações na agricultura portuguesa nos séculos XIV e XV.
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- 2023
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3. Diagnostic challenge of recurrent macrophage activation syndrome before and after kidney transplant
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Joana Tavares, Filipa Silva, Ana Castro, Josefina Santos, Guilherme Rocha, Manuela Almeida, La Salete Martins, Leonídio Dias, António Castro Henriques, and António Cabrita
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2021
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4. COVID-19 in kidney transplant recipients: what have we learned one year later? A cohort study from a tertiary center
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Joana Tavares, João Pedro Oliveira, Pedro Reis, Bárbara Ribeiro, Filipa Silva, Jorge Malheiro, Manuela Almeida, La Salete Martins, António Cabrita, António Castro Henriques, and Leonídio Dias
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Acute Kidney Injury ,Renal Insufficiency, Chronic ,COVID-19 ,Immunosuppression ,Kidney Transplantation ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Abstract Introduction: Kidney transplant (KT) recipients have a high risk for adverse outcomes from infections, such as COVID-19. Methods: We have retrospectively reviewed all KT recipients with documented COVID-19 between March 1, 2020, and March 15, 2021, and analyzed patients’ characteristics, clinical course, treatment, and outcomes. Results: We identified 123 patients, 72% were male, with a mean age of 54.5±13.0 years. Twenty percent were asymptomatic, 7% had a nosocomial transmission, and 36% of the remainder required hospitalization. Almost all admitted patients received oxygen, 30% required invasive mechanical ventilation (IMV), more than a half had acute kidney injury, with 10% requiring dialysis, and 20% died. Incidence was comparable to that of the Portuguese population, but the mortality rate was almost four times higher (SMR of 3.768 (95% CI:1.723-7.154). Higher body mass index (OR 1.275, P=0.001), lower baseline graft function (OR 0.968, P=0.015), and nosocomial transmission (OR 13.836, P=0.019) were associated with oxygen demand, whereas female gender (OR 3.801, P=0.031) and lower baseline kidney graft function (OR 0.955, P=0.005), but not body mass index, were associated with IMV and/or death. Conclusion: Mortality rate in KT patients was higher than in the general population and lower baseline kidney function was the most consistent marker for adverse outcomes.
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- 2022
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5. Refractory ascites and graft dysfunction in early renal transplantation
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Catarina Pereira Eusébio, Sofia Correia, Filipa Silva, Manuela Almeida, Sofia Pedroso, La Salete Martins, Leonídio Diais, José Queirós, Helena Pessegueiro, Ramon Vizcaíno, and António Castro Henriques
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Transplante de Rim ,Ascite ,Fibrose ,Preparações Farmacêuticas. ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Abstract The occurrence of ascites after Renal Transplant (RT) is infrequent, and may be a consequence of surgical or medical complications. Case report: 61 year-old, male, history of arterial hypertension, tongue carcinoma and alcoholic habits 12-20g/day. He had chronic kidney disease secondary to autosomal dominant polycystic kidney disease, without hepatic polycystic disease. He underwent cadaver donor RT in September 2017. He had delayed graft function by surgically corrected renal artery stenosis. He was admitted in January 2018 for ascites de novo, with no response to diuretics. HE had visible abdominal collateral circulation. Graft dysfunction, adequate tacrolinemia, Innocent urinary sediment, mild anemia, without thrombocytopenia. Serum albumin 4.0g / dL. Normal hepatic biochemistry. Peritoneal fluid with transudate characteristics and serum albumin gradient > 1.1. Ultrasound showed hepatomegaly, permeable vascular axes, without splenomegaly. Mycophenolate mofetil was suspended, with reduced remaining immunosuppression. He maintained refractory ascites: excluded infectious, metabolic, autoimmune and neoplastic etiologies. No nephrotic proteinuria and no heart failure. MRI: micronodules compatible with bile cysts. Upper Digestive Tract Endoscopy did not show gastroesophageal varicose veins. Normal abdominal lymphoscintigraphy. He underwent exploratory laparoscopy with liver biopsy: incomplete septal cirrhosis of probable vascular etiology some dilated bile ducts. He maintained progressive RT dysfunction and restarted hemodialysis. The proposed direct measurement of portal pressure was delayed by ascites resolution. There was further recovery of the graft function. Discussion: Incomplete septal cirrhosis is an uncommon cause of non-cirrhotic portal hypertension. Its definition is not well known, morphological and pathophysiological. We have not found published cases of post-RT ascites secondary to this pathology, described as possibly associated with drugs, immune alterations, infections, hypercoagulability and genetic predisposition.
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- 2019
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6. TRANSPLANTE RENAL CRUZADO EM PORTUGAL – UM EXEMPLO DE SUCESSO
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Catarina Isabel Ribeiro, Nicole Pestana, Filipa Silva, Manuela Almeida, Leonídio Dias, Miguel Relvas, Susana Sampaio, João Godinho, Ana Gaspar, Domingos Machado, Catarina Teixeira, Lídia Santos, Sandra Tafulo, Fernando Nolasco, António Castro Henriques, and António Cabrita
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Insuficiência Renal ,Crónico ,Transplante de Rim ,Histocompatibilidade ,Portugal ,Specialties of internal medicine ,RC581-951 ,Special situations and conditions ,RC952-1245 ,Surgery ,RD1-811 - Abstract
Até 30% dos pares de dador vivo não são transplantados por incompatibilidade do grupo ABO e/ou do sistema Human Leukocyte Antigen (HLA). Os programas de doação renal cruzada surgiram como uma estratégia para tentar ultrapassar estas barreiras. Em Portugal o Programa Nacional de Doação Renal Cruzada (PNDRC) foi legislado em 2010 e o primeiro transplante renal cruzado ocorreu em 2013. Até ao momento foram efetuados 22 transplantes deste tipo. Objetivo: O presente trabalho visa avaliar as caraterísticas e perfil evolutivo dos doentes submetidos a transplante renal cruzado em Portugal. Métodos: Os autores apresentam um estudo observacional retrospetcivo com análise dos respetivos doentes. Resultados: Da amostra total, a maioria dos recetores era do sexo masculino (55%), com idade mediana 53 anos. A poliquistose renal foi a etiologia da doença renal mais comum (18%) e a maioria dos doentes encontrava-se previamente em programa crónico de hemodiálise (68%). Três doentes apresentaram Calculated Panel Reactive Antibody (PRAc) superior a 98% e 10 PRAc superior a 80%. Foi realizada indução de imunossupressão com Anti-Thymocyte Globulin (ATG) em 50% dos doentes e imunomodulação com Rituximab e/ou plasmaferese em 15%. Todos os recetores evoluíram com função imediata do enxerto. Não se registaram complicaçães major, com eventos minor em 15%. Num tempo mediano de follow-up de 2 7 [ 2-46] meses, não se verificou nenhum caso de rejeição celular aguda e a penas um de rejeição humoral. As sobrevidas do dador e recetor foram ambas 100%. Conclusão: A apresentação destes resultados preliminares excelentes visa estimular o aumento do número de pares a incluir no PNDRC e um maior número de transplantes efetuados no programa. Tal como uma parte significativa desta amostra, o transplante renal cruzado pode constituir uma possibilidade para doentes com incompatibilidade do sistema HLA e/ou do grupo ABO. A doação renal cruzada em muito engrandece a doação em vida, oferecendo a pares incompatíveis e selecionados, uma oportunidade de transplantação renal com sucesso.
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- 2019
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7. Histiocytic sarcoma; case report of a rare disease in a kidney transplant recipient
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Pedro Ventura Aguiar, Carla Dias, Pedro Azevedo, Hugo Neves Silva, Manuela Almeida, Sofia Pedroso, La Salete Martins, Leonídio Dias, Anabela Rodrigues, Ramón Viscaíño, António Cabrita, and António Castro Henriques
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histiocytic sarcoma ,post-transplant lymphoproliferative disease ,malignancy ,transplant ,chronic kidney disease ,Pathology ,RB1-214 ,Internal medicine ,RC31-1245 ,Other systems of medicine ,RZ201-999 - Abstract
Background: Histiocytic sarcoma (HS) is a rare hematologic neoplasm with a few hundred cases having been described to date. Case Presentation: We report the case of a 56-year-old woman with a history of hepatitis C infection and chronic kidney disease (CKD), submitted to a kidney transplant in 1984, under maintenance immunosuppression with prednisone and azathioprine. Patient presented with a relentlessly growing mass on her right front thorax. It was painless, smooth, and adherent to the deep muscle. Laboratory studies were unremarkable. Ultrasonography and computerized tomography (CT) scan revealed a highly vascularized heterogeneous mass (8×9 cm), with a necrotic centre. Positron emission tomography (PET) scan demonstrated multiple thoracic, abdominal, and pelvic nodules. Histology revealed a highly undifferentiated HS (vimentin, CD68, CD99, and CD4 positive). In spite of having started treatment with etoposide and thalidomide, no clinical response was achieved and the patient died three months later. Conclusions: To the authors’ knowledge, this is the first described case of HS in a solid organ transplant patient.
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- 2015
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8. Homozygosity for the E526V Mutation in Fibrinogen A Alpha-Chain Amyloidosis: The First Report
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Isabel Tavares, Luísa Lobato, Carlos Matos, Josefina Santos, Paul Moreira, Maria João Saraiva, and António Castro Henriques
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Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Systemic hereditary amyloidoses are autosomal dominant diseases associated with mutations in genes encoding ten different proteins. The clinical phenotype has implications on therapeutic approach, but it is commonly variable and largely dependent on the type of mutation. Except for rare cases involving gelsolin or transthyretin, patients are heterozygous for the amyloidogenic variants. Here we describe the first patient identified worldwide as homozygous for a nephropathic amyloidosis, involving the fibrinogen variant associated with the fibrinogen alpha-chain E526V (p.Glu545Val) mutation. In 1989, a 44-year-old woman presented with hypertension, hepatosplenomegaly, nephrotic syndrome, and renal failure. She started hemodialysis in 1990 and 6 years later underwent isolated kidney transplantation from a deceased donor. Graft function and clinical status were unremarkable for 16 years, despite progressively increased left ventricular mass on echocardiography. In 2012, 4 months before death, she deteriorated rapidly with severe heart failure, precipitated by Clostridium difficile colitis and urosepsis. Affected family members developed nephropathy, on average, nearly three decades later, which may be explained by the gene dosage effects on the phenotype of E526V (p.Glu545Val) fibrinogen A alpha-chain amyloidosis.
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- 2015
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9. Neutrophil Gelatinase-Associated Lipocalin in Kidney Transplantation Is an Early Marker of Graft Dysfunction and Is Associated with One-Year Renal Function
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Isabel Fonseca, José Carlos Oliveira, Manuela Almeida, Madalena Cruz, Anabela Malho, La Salete Martins, Leonídio Dias, Sofia Pedroso, Josefina Santos, Luísa Lobato, António Castro Henriques, and Denisa Mendonça
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Surgery ,RD1-811 - Abstract
Urinary neutrophil gelatinase-associated lipocalin (uNGAL) has been suggested as potential early marker of delayed graft function (DGF) following kidney transplantation (KTx). We conducted a prospective study in 40 consecutive KTx recipients to evaluate serial changes of uNGAL within the first week after KTx and assess its performance in predicting DGF (dialysis requirement during initial posttransplant week) and graft function throughout first year. Urine samples were collected on post-KTx days 0, 1, 2, 4, and 7. Linear mixed and multivariable regression models, receiver-operating characteristic (ROC), and areas under ROC curves were used. At all-time points, mean uNGAL levels were significantly higher in patients developing DGF (n=18). Shortly after KTx (3–6 h), uNGAL values were higher in DGF recipients (on average +242 ng/mL, considering mean dialysis time of 4.1 years) and rose further in following days, contrasting with prompt function recipients. Day-1 uNGAL levels accurately predicted DGF (AUC-ROC = 0.93), with a performance higher than serum creatinine (AUC-ROC = 0.76), and similar to cystatin C (AUC-ROC = 0.95). Multivariable analyses revealed that uNGAL levels at days 4 and 7 were strongly associated with one-year serum creatinine. Urinary NGAL is an early marker of graft injury and is independently associated with dialysis requirement within one week after KTx and one-year graft function.
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- 2013
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10. A Case Series of Gastrointestinal Tuberculosis in Renal Transplant Patients
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Pedro Azevedo, Cristina Freitas, Hugo Silva, Pedro Aguiar, Pedro Farrajota, Manuela Almeida, Sofia Pedroso, La Salete Martins, Leonídio Dias, José Ramón Vizcaíno, António Castro Henriques, and António Cabrita
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Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Tuberculosis is a disease relatively frequent in renal transplant patients, presenting a wide variety of clinical manifestations, often involving various organs and potentially fatal. Gastrointestinal tuberculosis, although rare in the general population, is about 50 times more frequent in renal transplant patients. Intestinal tuberculosis has a very difficult investigational approach, requiring a high clinical suspicion for its diagnosis. Therapeutic options may be a problem in the context of an immunosuppressed patient, requiring adjustment of maintenance therapy. The authors report two cases of isolated gastro-intestinal tuberculosis in renal transplant recipients that illustrates the difficulty of making this diagnosis and a brief review of the literature on its clinical presentation, diagnosis, and therapeutic approach.
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- 2013
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11. Over Ten-Year Kidney Graft Survival Determinants
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Anabela Malho Guedes, Jorge Malheiro, Isabel Fonseca, La Salete Martins, Sofia Pedroso, Manuela Almeida, Leonídio Dias, António Castro Henriques, and António Cabrita
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Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Kidney graft survival has been mainly evaluated using an up to 10-year threshold. Instead, in this study our aim was to evaluate predictive variables that impact long-term kidney graft survival (≥10 years). We enrolled 892 patients in our analysis: 638 patients with functioning graft at 10 years PT and 254 patients with graft failure at 10 years PT (considering patient death with a functioning graft
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- 2012
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12. COVID-19 em receptores de transplante renal: o que aprendemos um ano depois? Um estudo de coorte a partir de um centro terciário
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Joana Tavares, João Pedro Oliveira, Pedro Reis, Bárbara Ribeiro, Filipa Silva, Jorge Malheiro, Manuela Almeida, La Salete Martins, António Cabrita, António Castro Henriques, and Leonídio Dias
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Insuficiência Renal Crônica ,Injúria Renal Aguda ,COVID-19 ,Transplante Renal ,General Medicine ,Acute Kidney Injury ,Renal Insufficiency, Chronic ,Immunosuppression ,Kidney Transplantation ,Imunossupressão - Abstract
Introduction: Kidney transplant (KT) recipients have a high risk for adverse outcomes from infections, such as COVID-19. Methods: We have retrospectively reviewed all KT recipients with documented COVID-19 between March 1, 2020, and March 15, 2021, and analyzed patients’ characteristics, clinical course, treatment, and outcomes. Results: We identified 123 patients, 72% were male, with a mean age of 54.5±13.0 years. Twenty percent were asymptomatic, 7% had a nosocomial transmission, and 36% of the remainder required hospitalization. Almost all admitted patients received oxygen, 30% required invasive mechanical ventilation (IMV), more than a half had acute kidney injury, with 10% requiring dialysis, and 20% died. Incidence was comparable to that of the Portuguese population, but the mortality rate was almost four times higher (SMR of 3.768 (95% CI:1.723-7.154). Higher body mass index (OR 1.275, P=0.001), lower baseline graft function (OR 0.968, P=0.015), and nosocomial transmission (OR 13.836, P=0.019) were associated with oxygen demand, whereas female gender (OR 3.801, P=0.031) and lower baseline kidney graft function (OR 0.955, P=0.005), but not body mass index, were associated with IMV and/or death. Conclusion: Mortality rate in KT patients was higher than in the general population and lower baseline kidney function was the most consistent marker for adverse outcomes. Resumo Introdução: Os receptores de transplante renal (TR) apresentam um alto risco para desfechos adversos de infecções, tais como a COVID-19. Métodos: Revisamos retrospectivamente todos os receptores de TR com COVID-19 documentada entre 1º de Março de 2020 e 15 de Março de 2021, e analisamos as características, curso clínico, tratamento e desfechos dos pacientes. Resultados: Identificamos 123 pacientes, 72% do sexo masculino, com uma média de idade de 54,5±13,0 anos. Vinte por cento eram assintomáticos, 7% apresentaram transmissão nosocomial, e 36% do restante necessitaram de internação. Quase todos os pacientes internados receberam oxigênio, 30% necessitaram de ventilação mecânica invasiva (VMI), mais da metade apresentou lesão renal aguda, com 10% necessitando de diálise, e 20% foram a óbito. A incidência foi comparável à da população portuguesa, mas a taxa de mortalidade foi quase quatro vezes superior (TMP de 3,768 (IC 95%: 1,723-7,154). Maior índice de massa corporal (OR 1,275; P=0,001), menor função do enxerto basal (OR 0,968; P=0,015), e transmissão nosocomial (OR 13,836; P=0,019) foram associados à demanda de oxigênio, enquanto sexo feminino (OR 3,801; P=0,031) e menor função do enxerto renal basal (OR 0,955; P=0,005), mas não índice de massa corporal, foram associados à VMI e/ou óbito. Conclusão: A taxa de mortalidade em pacientes com TR foi mais elevada do que na população em geral e a função renal basal mais baixa foi o marcador mais consistente para desfechos adversos.
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- 2022
13. Is Erythrocytosis More Common After Simultaneous Pancreas Kidney Transplantation? A Single-Center Experience
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Marina Reis, Joana Tavares, Jorge Malheiro, Manuela Almeida, Sofia Pedroso, Leonidio Dias, António Castro Henriques, António Cabrita, and La Salete Martins
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Transplantation ,Surgery - Published
- 2023
14. Lower donated kidney volume is associated with increased risk of lower graft function and acute rejection at 1 year after living donor kidney—a retrospective study
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Filipa Silva, Jorge Malheiro, Diogo Nunes-Carneiro, Sofia Pedroso, Leonídeo Dias, Mariana Mandanelo, Nicole Pestana, Manuela Guedes de Almeida, Catarina Isabel Ribeiro, António Castro Henriques, La Salete Martins, Joana Tavares, and Miguel Silva-Ramos
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Graft Rejection ,medicine.medical_specialty ,Urology ,Renal function ,Kidney Volume ,Nephron ,030230 surgery ,Kidney ,03 medical and health sciences ,0302 clinical medicine ,Living Donors ,Humans ,Medicine ,Kidney transplantation ,Retrospective Studies ,Body surface area ,Transplantation ,business.industry ,Surrogate endpoint ,Incidence (epidemiology) ,Graft Survival ,medicine.disease ,Kidney Transplantation ,medicine.anatomical_structure ,030211 gastroenterology & hepatology ,business ,Glomerular Filtration Rate - Abstract
Kidney volume has been proven to be a surrogate marker of nephron mass and renal function. We studied 190 donor and recipient pairs undergoing living donor kidney transplantation at our institution during 9 years. Different metrics of donor kidney volume (DKV) were explored: alone or indexed to recipient's anthropometry, as body surface area (BSA). DKV/BSA (min. 49.7; P33rd 77.7; P67th 95.3; max. 176 cm3 /m2 ) was chosen given its higher correlation with eGFR at 1 year, and recipients were divided according to its tertiles (T). The eGFR at 1 year was lower in T1, when compared with T2 (P = 0.015) and T3 (P
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- 2020
15. Remaining kidney volume indexed to weight as a strong predictor of estimated glomerular filtration rate at 1 year and mid‐term renal function after living‐donor nephrectomy ‐ a retrospective observational study
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Miguel Silva-Ramos, Nicole Pestana, Avelino Fraga, Diogo Gil-Sousa, M.F. Almeida, Jorge Malheiro, Catarina Isabel Ribeiro, Diogo Nunes-Carneiro, Vítor Cavadas, La Salete Martins, Mariana Madanelo, Leonídio Dias, António Castro-Henriques, and Filipa Silva
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,living donor ,Renal function ,Kidney Volume ,030230 surgery ,Kidney ,Nephrectomy ,Living donor ,Living donor nephrectomy ,03 medical and health sciences ,0302 clinical medicine ,Bayesian multivariate linear regression ,kidney volume ,Living Donors ,nephrectomy ,medicine ,Humans ,Retrospective Studies ,Transplantation ,business.industry ,Retrospective cohort study ,Kidney Transplantation ,030211 gastroenterology & hepatology ,business ,Glomerular Filtration Rate ,transplantation - Abstract
The donors' estimated glomerular filtration rate (eGFR) after living nephrectomy has been a concern, particularly in donors with smaller kindeys. Therefore, we developed this retrospective observational study in 195 donors to determine the ability remaining kidney volume indexed to weight (RKV/W) to predict eGFR at 1 year through multivariate linear regression and to explore this relationship between annual eGFR change from 1 to 4 years postdonation evaluated by a linear mixed model. Comparing RKV/W tertiles (T1, T2, T3), RKV/W was a good predictor of 1-year eGFR which was significantly better in T3 donors. Gender, predonation eGFR, and RKV/W were independent predictors of eGFR at 1-year. In a subgroup with predonation eGFR < 90mL/min/1.73 m2 , a significant prediction of eGFR < 60mL/min/1.73 m2 was detected in males with RKV/W ≤ 2.51cm3 /kg. Annual eGFR (ml/min/year) change from 1 to 4 years was + 0.77. RKV/W divided by tertiles (T1-T3) was the only significant predictor: T2 and T3 donors had an annual eGFR improvement opposing to T1. RKV/W was a good predictor of eGFR at 1 year, independently from predonation eGFR. A higher RKV/W was associated with improved eGFR at 1 year. A decline in eGFR on the four years after surgery was only noticeable in donors with RKV/W ≤ 2.13cm3 /kg. info:eu-repo/semantics/publishedVersion
- Published
- 2020
16. Impact of Pancreatic Autoantibodies in Pancreas Graft Survival After Pancreas-Kidney Transplantation
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Manuela Guedes de Almeida, Filipa V.M. Silva, La Salete Martins, Leonídio Dias, António Castro Henriques, Sofia Pedroso, Jorge Malheiro, Catarina Ribeiro, Nicole Pestana, and Andreia Silva
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Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Pancreas transplantation ,Autoantigens ,Gastroenterology ,Pancreatic Autoantibodies ,Interquartile range ,Diabetes mellitus ,Internal medicine ,Humans ,Medicine ,Kidney transplantation ,Autoantibodies ,pancreas-kidney transplantation ,Transplantation ,Portugal ,biology ,Glutamate Decarboxylase ,business.industry ,Graft Survival ,Autoantibody ,Middle Aged ,Madeira Island ,medicine.disease ,Kidney Transplantation ,autoantibodies in Pancreas ,PG survival ,Diabetes Mellitus, Type 1 ,medicine.anatomical_structure ,biology.protein ,Female ,Surgery ,Pancreas Transplantation ,Antibody ,business ,Pancreas - Abstract
In simultaneous pancreas-kidney transplantation (SPKT), persistence or recurrence of pancreatic autoantibodies (PAs) has been associated with pancreas graft (PG) autoimmune-driven injury. Our aim was to analyze the impact of PAs on PG survival.Methods. Between January 1, 2000, and December 31, 2017, we studied 139 patients with post-SPKT antieglutamic acid decarboxylase (GAD) autoantibody. Alloimmune (ALI) events were defined as PG rejection and/or de novo donor-specific antibodies (DSA).Hence, 3 groups were defined: patients without ALI events or anti-GAD (n ¼ 42), those with ALI events (n ¼ 14), or those only with autoimmune events (positive for anti-GAD and no ALI events; n ¼ 83). Results. Male sex was predominant (n ¼ 72, 52%). Median age was 35 years (interquartile range: 31-39) and median follow-up was 6-7 years (interquartile range: 4.1-9.2). Regarding anti-GAD positivity post-SPKT (n ¼ 90, 65%), no differences were observed concerning age, sex, anti-HLA antibodies, HLA mismatch number and de novo DSA. ALI events were present in 10% (n ¼ 14). PG survival 15 years post-SPKT was better in patients without immune events (96%) followed by those with ALI (69%) and autoimmune events (63%) (P ¼ .025). Anti-GAD was associated to higher annualized mean Hb1AC (P ¼ .006) and lower mean C-peptide (P ¼ .013). According to pre- and post-SPKT anti-GAD status, conversion from negative to positive was associated to worse (63%) 10-year PG survival (P ¼ .044), compared to persistence of negative (100%) or positive anti-GAD (88%). Anti-islet cell and anti-insulin autoantibodies had no impact. Conclusion. Anti-GAD presence post-SPKT was associated to higher pâncreas disfunction and lower PG survival. De novo anti-GAD seems to offer a particular risk of PG failure. info:eu-repo/semantics/publishedVersion
- Published
- 2020
17. CAPITAL IN A FRONTIER ECONOMY: PORTUGAL, 1230–1500
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António Castro Henriques
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Economics and Econometrics ,History ,060106 history of social sciences ,media_common.quotation_subject ,05 social sciences ,06 humanities and the arts ,Interest rate ,Scarcity ,Frontier ,Economy ,Capital (economics) ,0502 economics and business ,Economics ,0601 history and archaeology ,050207 economics ,media_common - Abstract
In this paper we show that Portugal benefitted from comparatively low-interest rates from the 13thcentury onwards, well before the generalised drop in interest rates in Europe. Contrary to the thesis that frontier economies struggle with high-interest rates and scarcity of capital, we find that the country's low and stable interest rates can be explained by its wide availability of land, combined with monetary stability and a favourable institutional network. These conclusions are built upon an entirely new dataset of interest rates and returns on capital for Portugal in the period 1230–1500.
- Published
- 2019
18. Degree of HLA class II eplet mismatch load improves prediction of antibody-mediated rejection in living donor kidney transplantation
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Jorge Malheiro, Sofia Pedroso, M.F. Almeida, Sofia Santos, Sandra Tafulo, Cecília Mendes, Leonídio Dias, Luísa Lobato, António Castro-Henriques, and La Salete Martins
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Graft Rejection ,Risk ,0301 basic medicine ,Hla class ii ,Oncology ,medicine.medical_specialty ,Immunology ,Human leukocyte antigen ,Living donor ,03 medical and health sciences ,Risk model ,0302 clinical medicine ,Isoantibodies ,HLA-DQ Antigens ,Internal medicine ,Living Donors ,Humans ,Immunology and Allergy ,Medicine ,Precision Medicine ,Risk factor ,Kidney transplantation ,Aged ,Aged, 80 and over ,business.industry ,Histocompatibility Testing ,HLA-DR Antigens ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Kidney Transplantation ,Immunity, Humoral ,030104 developmental biology ,Histocompatibility ,Potential biomarkers ,Acute Disease ,Antibody mediated rejection ,business ,Follow-Up Studies ,030215 immunology - Abstract
Background HLA mismatching is a well known risk factor for worst outcomes in kidney transplantation. Methods In the present study, HLA antigen and eplet mismatches were determined in 151 living donor-recipient pairs transplanted between 2007 and 2014 and rejection episodes and graft survival were evaluated. Results We found that high HLA-II eplet mismatch load (EpMM ≥ 13, versus low EpMM ≤ 5), was an independent predictor of AMR (adjusted HR = 14.839; P = 0.011), while HLA-II AgMM was not. We also showed that HLA-II EpMM load was a significant better predictor of AMR than AgMM (c-statistic = 0.064; P = 0.023). After discriminating HLA-II into HLA-DR and HLA-DQ loci we demonstrated that high versus low eplet mismatch load for HLA-DR (T3 ≥ 6 versus T = 0–1, p = 0.013) and HLA-DQ (T3 ≥ 7 versus T = 0–1, p = 0.009) are independent predictors for AMR. HLA-II EpMM increased discrimination performance of the classical HLA-II AgMM risk model (IDI, 0.061, 95%CI: 0.005–0.195) for AMR. Compared with AgMM, HLA-II eplet model adequately reclassified 13 of 17 patients (76.5%) with AMR and 92 of 134 patients (68.7%) without AMR (cfNRI, 0.785, 95%CI: 0.300–1.426). Conclusions Our study evidences that eplet-based matching is a refinement of the classical HLA antigen mismatch analysis in LDKT and is a potential biomarker for personalized assessment of alloimmune risk.
- Published
- 2019
19. Mini-incision Living Donor Nephrectomy and Trans-peritoneal Laparoscopic Nephrectomy: Will There Be a Place for New Evidence?
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Vítor Cavadas, André Marques-Pinto, R. de Almeida, J. Cabral, António Castro-Henriques, Diogo Nunes-Carneiro, I. Braga, Avelino Fraga, Manuela Guedes de Almeida, and Miguel Silva-Ramos
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Nephrectomy ,Living donor nephrectomy ,Postoperative Complications ,Living Donors ,Humans ,Minimally Invasive Surgical Procedures ,Medicine ,Kidney transplantation ,Retrospective Studies ,Transplantation ,Surgical team ,Warm Ischemia Time ,business.industry ,Incidence ,Laparoscopic nephrectomy ,Retrospective cohort study ,Length of Stay ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Surgery ,Mini incision ,Tissue and Organ Harvesting ,Female ,Laparoscopy ,business - Abstract
To compare mini-incision donor nephrectomy (MDN) with laparoscopic donor nephrectomy (LDN) performed by the same surgical team, regarding short- and long-term outcomes.Three hundred and five patients, who underwent donor nephrectomy in our institution, through an MDN (n = 141) between January 1998-November 2011 and LDN (n = 164) since June 2010-December 2017, were compared.The mean operative time for MDN (120 ± 29 minutes) was not significantly different when compared to LDN (113 ± 34 minutes), but when comparing the first 50 LDN and the 50 most recent, we found a reduction in the duration of the procedure. Laparoscopic donors had a shorter warm ischemia time (229 seconds vs 310 seconds, P = .01), particularly the 50 most recent, hospital stay (4.3 days vs 5.9 days, P .001), and postoperative complications (P = .03). The incidence of graft acute tubular necrosis (ATN) was superior in the MDN (89% vs 25%, P .001), although there was no significant difference regarding first-year serum creatinine (SCr) and glomerular filtration rate (GFR) (SCr 1.38 mg/dL vs SCr 1.33 mg/dL and GFR 63.7 mL/min vs 63.1 mL/min) comparing the 2 groups. Long-term graft survival did not significantly differ between groups. There was also no relationship between postoperative ATN events and long-term graft function.With the growing experience of the high-volume centers and with specialized teams, LDN could be considered the most suitable technique for living donor nephrectomy with better results in short-term results (warm ischemia time, hospital stay, and postoperative complications), without difference in long-term outcomes.
- Published
- 2019
20. TRANSPLANTE RENAL CRUZADO EM PORTUGAL – UM EXEMPLO DE SUCESSO
- Author
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Leonídio Dias, Sandra Tafulo, Ana Gaspar, António M. Cabrita, Miguel Relvas, António Castro Henriques, Nicole Pestana, Catarina Isabel Ribeiro, Susana Sampaio, Fernando Nolasco, Catarina Teixeira, João Godinho, Manuela Guedes de Almeida, Domingos Machado, Lídia Santos, and Filipa Ferreira da Silva
- Subjects
medicine.medical_specialty ,Kidney ,business.industry ,medicine.medical_treatment ,Retrospective cohort study ,Immunosuppression ,medicine.disease ,medicine.anatomical_structure ,Internal medicine ,ABO blood group system ,medicine ,Rituximab ,Plasmapheresis ,business ,Kidney transplantation ,Kidney disease ,medicine.drug - Abstract
Até 30% dos pares de dador vivo não são transplantados por incompatibilidade do grupo ABO e/ou do sistema Human Leukocyte Antigen (HLA). Os programas de doação renal cruzada surgiram como uma estratégia para tentar ultrapassar estas barreiras. Em Portugal o Programa Nacional de Doação Renal Cruzada (PNDRC) foi legislado em 2010 e o primeiro transplante renal cruzado ocorreu em 2013. Até ao momento foram efetuados 22 transplantes deste tipo. Objetivo: O presente trabalho visa avaliar as caraterísticas e perfil evolutivo dos doentes submetidos a transplante renal cruzado em Portugal. Métodos: Os autores apresentam um estudo observacional retrospetcivo com análise dos respetivos doentes. Resultados: Da amostra total, a maioria dos recetores era do sexo masculino (55%), com idade mediana 53 anos. A poliquistose renal foi a etiologia da doença renal mais comum (18%) e a maioria dos doentes encontrava-se previamente em programa crónico de hemodiálise (68%). Três doentes apresentaram Calculated Panel Reactive Antibody (PRAc) superior a 98% e 10 PRAc superior a 80%. Foi realizada indução de imunossupressão com Anti-Thymocyte Globulin (ATG) em 50% dos doentes e imunomodulação com Rituximab e/ou plasmaferese em 15%. Todos os recetores evoluíram com função imediata do enxerto. Não se registaram complicaçães major, com eventos minor em 15%. Num tempo mediano de follow-up de 2 7 [ 2-46] meses, não se verificou nenhum caso de rejeição celular aguda e a penas um de rejeição humoral. As sobrevidas do dador e recetor foram ambas 100%. Conclusão: A apresentação destes resultados preliminares excelentes visa estimular o aumento do número de pares a incluir no PNDRC e um maior número de transplantes efetuados no programa. Tal como uma parte significativa desta amostra, o transplante renal cruzado pode constituir uma possibilidade para doentes com incompatibilidade do sistema HLA e/ou do grupo ABO. A doação renal cruzada em muito engrandece a doação em vida, oferecendo a pares incompatíveis e selecionados, uma oportunidade de transplantação renal com sucesso.
- Published
- 2019
21. A Thirteenth-Century Fiscal Constitution
- Author
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António Castro Henriques
- Subjects
Constitution ,media_common.quotation_subject ,Reining ,language.human_language ,Nominal interest rate ,State (polity) ,Political economy ,language ,Economics ,Middle Ages ,Portuguese ,Beneficial effects ,Capital market ,media_common - Abstract
The thirteenth century was an era of bold constitutional experiments in Europe. During this age, for the first time in history, fiscal constitutions, i.e., limits on the fiscal prerogatives of the state, emerged. In Portugal, this manifested itself as a monetary constitution that prevented the use of the kings’ minting rights and a hidden tax, namely the 1261 Instrumentum Super Facto Monete, which was presented as a contract. It was a genuine monetary constitution insofar as it had the credible commitment of the state and was enforced by the public, via the Cortes until 1369, when it likely outlived its utility for the markets. The beneficial effects of this constitution in reining potential monetary mischief can be observed in the comparatively low nominal interest rates prevalent in Portuguese capital markets.
- Published
- 2020
22. HLA class II eplet mismatch load improves prediction of dnDSA development after living donor kidney transplantation
- Author
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Sofia Santos, Luísa Lobato, Sandra Tafulo, Sofia Pedroso, Cecília Mendes, La Salete Martins, António Castro-Henriques, Manuela Guedes de Almeida, Jorge Malheiro, and Leonídio Dias
- Subjects
0301 basic medicine ,Hla class ii ,Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Multivariate analysis ,Immunology ,Urology ,Human leukocyte antigen ,Living donor ,03 medical and health sciences ,Epitopes ,0302 clinical medicine ,Antibody Specificity ,HLA Antigens ,Isoantibodies ,Genetics ,Living Donors ,Medicine ,Humans ,Molecular Biology ,Genetics (clinical) ,Kidney transplantation ,Retrospective Studies ,HLA-D Antigens ,business.industry ,Histocompatibility Testing ,General Medicine ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Histocompatibility ,Transplantation ,030104 developmental biology ,Cohort ,Female ,business ,Unrelated Donors ,Algorithms ,Immunosuppressive Agents ,030215 immunology ,Follow-Up Studies - Abstract
HLA donor-specific antibodies developed de novo after transplant remain a major cause of chronic allograft dysfunction. Our study main purpose was to determine whether HLA MM, assessed traditionally and by HLA total and AbVer eplet mismatch load (EptMM and EpvMM) assessed with HLAMatchMaker, had impact on dnDSA development after living donor kidney transplantation (LDKT). We retrospectively analysed a cohort of 96 LDKT between 2008 and 2017 performed in Hospital Santo Antonio. Seven patients developed dnDSA-II and EpvMM and EptMM were greater in dnDSA-II group compared to the no dnDSA-II (18.0 ± 8.7 versus 9.9 ± 7.9, p = .041 and 41.3 ± 18.9 versus 23.1 ± 16.7, p = .018), which is not observed for AgMM (2.29 versus 1.56; p = .09). In a multivariate analysis, we found that preformed DSA (HR = 7.983; p = .023), living unrelated donors (HR = 8.052; p = .024) and retransplantation (HR = 14.393; p = .009) were predictors for dnDSA-II (AUC = 0.801; 0.622-0.981). HLA-II EpvMM (HR = 1.105; p = .028; AUC = 0.856) showed to be a superior predictor of dnDSA-II, when compared to AgMM (HR = 1.740; p = .113; AUC = 0.783), when adjusted for these clinical variables. Graft survival was significantly lower within dnDSA-II patient group (36% versus 88%, p < .001). HLA molecular mismatch analysis is extremely important to minimize risk for HLA-II dnDSA development improving outcome and increasing chance of retransplant lowering allosensitization.
- Published
- 2020
23. SARS‐CoV‐2 infection in kidney transplant recipients: Early report of five cases
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Miguel Abreu, Ana Cipriano, Joana Fragoso, Leonídio Dias, António Castro Henriques, Sofia Pedroso, Joana Tavares, Filipa Silva, Jorge Malheiro, Hugo Cruz, Manuela Guedes de Almeida, and La Salete Martins
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,medicine.medical_treatment ,kidney transplantation ,Case Report ,Case Reports ,030230 surgery ,Kidney transplant ,Antimalarials ,03 medical and health sciences ,0302 clinical medicine ,Pandemic ,medicine ,Humans ,Lack of knowledge ,Kidney transplantation ,Transplantation ,SARS-CoV-2 ,business.industry ,COVID-19 ,Immunosuppression ,Middle Aged ,medicine.disease ,Transplant Recipients ,Anti-Bacterial Agents ,COVID-19 Drug Treatment ,Infectious Diseases ,Increased risk ,COVID‐19 infection ,Female ,Steroids ,030211 gastroenterology & hepatology ,business ,Hydroxychloroquine ,Kidney disease - Abstract
From December 2019 to March 2020, China was the epicenter of the SARS‐CoV‐2 infection pandemic, but from that moment on, Europe surpassed China in the number of new cases and deaths related to this novel viral respiratory infection. The emergence of this world pandemic is particularly important for solid organ transplant recipients, who might have an increased risk of mortality, not only due to their chronic immunosuppression status, but also to the cardiovascular risk that correlates with several years of chronic kidney disease. To the extent that there is still a lack of knowledge about the clinical characteristics, evolution, and prognosis of SARS‐CoV‐2 infection in kidney transplant recipients, we will report the first 5 cases diagnosed and followed in our transplant unit, as well as share the therapeutic strategies adopted.
- Published
- 2020
24. P1731ABO INCOMPATIBLE DONOR KIDNEY TRANSPLANTATION IN PORTUGAL
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La Salete Martins, António Castro Henriques, Sofia Pedroso, António Cabrita, Manuela Guedes de Almeida, Natália Silva, Leonídio Dias, Jorge Malheiro, and Catarina Isabel Ribeiro
- Subjects
Transplantation ,Kidney ,business.industry ,medicine.medical_treatment ,Congenital cytomegalovirus infection ,medicine.disease_cause ,medicine.disease ,Tacrolimus ,BK virus ,medicine.anatomical_structure ,Nephrology ,Immunology ,Prednisolone ,Medicine ,Plasmapheresis ,Rituximab ,business ,medicine.drug - Abstract
Background and Aims ABO incompatiblitity was considered a barrier to kidney transplant. However, the shortage of available organs for transplantation and the excellent long term results further establish ABO-incompatible (ABOi) as a safe and effective therapeutic strategy. The aim of the present study was to evaluate the outcomes of ABOi transplantation in terms of graft survival and function, rejection episodes and infections complications. Method The authors present a single center retrospective observational study, that include the analyse of 12 patients who underwent ABOi kidney transplantation between November 2014 and July 2019. All patients received Rituximab (375mg/m2) pre-operation and started Tacrolimus, Mycophenolate Mofetil and Prednisolone one week before surgery. Plasmapheresis was done to remove anti-A or B antibodies until their titles were Results : A total of 12 patients were included in the study, 75,0% male with 43 years (IQR 31-50) The most common blood group mismatch was A to O (n=4; 33%). In the first year, 2 of patients (17%) developed acute rejection. The follow-up time was 17 months (IQR 7-36). Five patients (42%) developed infectious complications. None patients developed cytomegalovirus or BK polyomavirus infections. At the end graft and patient survival were 100%. Conclusion ABOi kidney transplantation has become a routine procedure. By this approach, about 30% of living donors who were refused in the past can now donate their kidneys and thereby significantly expand the living donor pool. Immunosuppressive protocol of this Center can be considered safe.
- Published
- 2020
25. P1715CORRELATION OF DONATED KIDNEY MASS AND GRAFT FUNCTION IN RECIPIENTS OF LIVING DONOR KIDNEY TRANSPLANTATION
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Filipa Silva, La Salete Martins, Catarina Isabel Ribeiro, Leonídio Dias, António Castro Henriques, Diogo Carneiro, Joana Tavares, Miguel Ramos, Manuela Guedes de Almeida, Mariana Madanelo, Nicole Pestana, Sofia Pedroso, and Jorge Malheiro
- Subjects
Transplantation ,medicine.medical_specialty ,Kidney ,medicine.anatomical_structure ,Nephrology ,business.industry ,medicine ,business ,medicine.disease ,Living donor ,Graft function ,Kidney transplantation ,Surgery - Abstract
Background and Aims Kidney volume has been proven to be a surrogate marker of nephron mass and renal function in living donors. Although many studies correlate the kidney mass with renal donors’ function after donation, few studies have compared the donated kidney mass with estimated glomerular filtration rate (eGFR) in the kidneýs recipients. The purpose of this study is to examine the relationship between donor kidney volume and post-transplantation graft function by using computerized tomography to obtain renal volumes. Method Clinical data off all donor and recipient pairs undergoing live donor kidney transplantation (KT) at our institution between January 2008 and December 2017 (n=195) were reviewed. The volume of the kidney selected for transplant was determined using volume calculating software and correlate to transplant recipient eGFR. Results All metrics of donor kidney volume (DKV): DKV alone, ADK adjusted for weight, body mass index (BMI) or body surface area (BSA), correlated significantly with eGFR (all with p Significant risk factors for eGFR0% (OR=2.075, P=0.039); higher donor age (OR per unit=1.033, P=0.047); and peritoneal dialysis modality (in comparison with preemptive KT: OR=3.232, P=0.013). Higher (T3) DKV/BSA tercile (in comparison with T1: OR=0.306, P=0.004) was protective of this outcome. Patients that experienced AR at 1-year had significantly lower DKV/BSA, particularly those with acute cellular rejection (ACR). The median follow-up was 4,8 years (IQR: 3.2-7.5). The censored graft survival by DKV/BSA terciles at 10 years were 59,3% for group 1, 91.3% for group 2 and 91.1% for group 3 (figure 3). Conclusion Our study demonstrates that transplantation of donor-recipient pairs with lower DKV/BSA ratio were associated with significantly worse graft function and higher incidence of AR. This data suggests that a larger mass of nephrons remaining adjusted to recipient’s weight seems to predict a better long-term eGFR. This method can be useful in order to identify patients at risk for a low eGFR after KT and, in cases of multiple potential donors, optimize donor selection.
- Published
- 2020
26. ABO-incompatible living donor kidney transplantation in Portugal
- Author
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Serviço de Nefrologia – Centro Hospitalar de Vila Nova de Gaia, António Cabrita, Natália Silva, Serviço de Nefrologia, Jorge Malheiro, António Castro Henriques, Leonídio Dias, Manuela Guedes de Almeida, Espinho, Maria João Martins, Sofia Pedroso, and Catarina Ribeiro
- Subjects
business.industry ,ABO blood group system ,Immunology ,medicine ,medicine.disease ,business ,Living donor ,Kidney transplantation - Published
- 2020
27. Refractory ascites and graft dysfunction in early renal transplantation
- Author
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Filipa Silva, Ramon Vizcaíno, Manuela Guedes de Almeida, La Salete Martins, Sofia Correia, António Castro Henriques, Sofia Pedroso, Catarina Pereira Eusébio, Helena Pessegueiro, Leonídio Diais, and José Queirós
- Subjects
Liver Cirrhosis ,Male ,medicine.medical_specialty ,Portal venous pressure ,Pharmaceutical Preparations ,Autosomal dominant polycystic kidney disease ,Delayed Graft Function ,Fibrose ,Case Reports ,030230 surgery ,Renal artery stenosis ,lcsh:RC870-923 ,Gastroenterology ,Preparações Farmacêuticas ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,Internal medicine ,Transplante de Rim ,Hypertension, Portal ,Ascites ,medicine ,Humans ,Renal Insufficiency, Chronic ,business.industry ,General Medicine ,Middle Aged ,Polycystic Kidney, Autosomal Dominant ,medicine.disease ,lcsh:Diseases of the genitourinary system. Urology ,Kidney Transplantation ,Fibrosis ,Transplantation ,Heart failure ,Ascite ,Portal hypertension ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Kidney disease - Abstract
The occurrence of ascites after Renal Transplant (RT) is infrequent, and may be a consequence of surgical or medical complications. Case report: 61 year-old, male, history of arterial hypertension, tongue carcinoma and alcoholic habits 12-20g/day. He had chronic kidney disease secondary to autosomal dominant polycystic kidney disease, without hepatic polycystic disease. He underwent cadaver donor RT in September 2017. He had delayed graft function by surgically corrected renal artery stenosis. He was admitted in January 2018 for ascites de novo, with no response to diuretics. HE had visible abdominal collateral circulation. Graft dysfunction, adequate tacrolinemia, Innocent urinary sediment, mild anemia, without thrombocytopenia. Serum albumin 4.0g / dL. Normal hepatic biochemistry. Peritoneal fluid with transudate characteristics and serum albumin gradient > 1.1. Ultrasound showed hepatomegaly, permeable vascular axes, without splenomegaly. Mycophenolate mofetil was suspended, with reduced remaining immunosuppression. He maintained refractory ascites: excluded infectious, metabolic, autoimmune and neoplastic etiologies. No nephrotic proteinuria and no heart failure. MRI: micronodules compatible with bile cysts. Upper Digestive Tract Endoscopy did not show gastroesophageal varicose veins. Normal abdominal lymphoscintigraphy. He underwent exploratory laparoscopy with liver biopsy: incomplete septal cirrhosis of probable vascular etiology some dilated bile ducts. He maintained progressive RT dysfunction and restarted hemodialysis. The proposed direct measurement of portal pressure was delayed by ascites resolution. There was further recovery of the graft function. Discussion: Incomplete septal cirrhosis is an uncommon cause of non-cirrhotic portal hypertension. Its definition is not well known, morphological and pathophysiological. We have not found published cases of post-RT ascites secondary to this pathology, described as possibly associated with drugs, immune alterations, infections, hypercoagulability and genetic predisposition.
- Published
- 2019
28. Severe passenger lymphocyte syndrome associated to Rh antibodies after donor living renal transplantation
- Author
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Sofia Pedroso, Manuela Guedes de Almeida, Leonídio Dias, Marika Bini Antunes, Margarida Amil, António Castro Henriques, Jorge Malheiro, and La Salete Martins
- Subjects
Transplantation ,medicine.anatomical_structure ,business.industry ,Lymphocyte ,RH-antibodies ,Immunology ,Medicine ,business - Published
- 2019
29. A Survival Analysis of Living Donor Kidney Transplant
- Author
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António Cabrita, Leonídeo Dias, S. Rodrigues, Rachele Escoli, S. Pedroso, La Salete Martins, António Castro Henriques, C. Eusébio, and Manuela Guedes de Almeida
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Multivariate analysis ,Time Factors ,Population ,Histocompatibility Testing ,Living donor ,Internal medicine ,Living Donors ,Medicine ,Humans ,education ,Survival analysis ,Retrospective Studies ,Transplantation ,education.field_of_study ,business.industry ,Proportional hazards model ,Graft Survival ,Retrospective cohort study ,HLA-DR Antigens ,Middle Aged ,Kidney Transplantation ,Survival Analysis ,Log-rank test ,Multivariate Analysis ,Surgery ,Female ,business - Abstract
Background Superior patient and graft survival rates have been attributed to living donor kidney transplant (LDKT) when compared to deceased donor transplantation. The aim of this study was to assess graft survival in a population of LDKT in the last 14 years and the potential impact of some clinical features. Methods A retrospective observational study was conducted, reviewing the records of all patients undergoing LDKT in one center from January 1, 2004, to December 31, 2017. Survival data were evaluated by Kaplan-Meier, log rank test, and Cox regression. Results Two hundred seventy-seven LDKT were performed. The median follow-up time was 4 (0–13) years. Graft loss was observed in 9% of patients; 4 patients died. The overall survival was 97% at year 1, 94% at year 5, and 83% at years 10 and 13. We found a significantly worse graft survival in patients with early vascular complications that required surgical intervention (P = .00) ≥3 HLA MM (P = .01), ≥1 HLA-DR MM (P = .04) and female recipients (P = .01). The negative impact of ≥1 HLA-B MM on survival was borderline (P = .05). After excluding early graft losses secondary to vascular events, ≥1 HLA-A MM and rejection have also implicated a negative impact on survival (P = .04 and .01, respectively). In the multivariate analysis, these variables were still related to inferior survival. Conclusions We observed a good overall graft survival (>80% after 13 years). Possible factors related to poor outcomes suggested by this study were early vascular complications; HLA mismatches; rejection; and, with less certainty, female recipients.
- Published
- 2019
30. FP800THE BANFF I-IFTA LESION IN KIDNEY GRAFTS BIOPSIES WITH MICROVASCULAR INFLAMMATION: IMPACT AND INTERPRETATION
- Author
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Leonídio Dias, La Salete Martins, Sofia Pedroso, Sofia Santos, Jorge Malheiro, Manuela Guedes de Almeida, António Castro Henriques, and António Cabrita
- Subjects
Transplantation ,Kidney ,Pathology ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Lesion ,medicine.anatomical_structure ,Nephrology ,Biopsy ,medicine ,medicine.symptom ,business ,Microvascular inflammation - Published
- 2019
31. SP734CAN TRANSPLANT RENAL SCINTIGRAPHY PREDICT THE OCCURRENCE AND DURATION OF DELAYED GRAFT FUNCTION?
- Author
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Jorge Malheiro, Sofia Correia, La Salete Martins, António Cabrita, Leonídio Dias, Sofia Pedroso, Filipa Silva, Catarina Eusebio, Manuela Guedes de Almeida, and António Castro Henriques
- Subjects
Transplantation ,medicine.medical_specialty ,Nephrology ,business.industry ,Duration (music) ,medicine ,Radionuclide imaging ,Radiology ,business ,Renal scintigraphy ,Delayed Graft Function - Published
- 2019
32. Public or perish: the family archives of Beira Alta (Portugal)
- Author
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Manuel Ferros, António Castro Henriques, and Tiago de Sousa Mendes
- Published
- 2019
33. Post-Kidney Transplant Anemia as a Result of Passenger Lymphocyte Syndrome by Rhesus Antibodies - A Rare Etiology for a Common Finding
- Author
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da Silva Ad, La Salete Martins, Manuela Guedes de Almeida, António Cabrita, António Castro Henriques, Dias L, Malheiro J, and S. Pedroso
- Subjects
medicine.anatomical_structure ,biology ,business.industry ,Anemia ,Lymphocyte ,Immunology ,Etiology ,biology.protein ,Medicine ,Antibody ,business ,medicine.disease ,Kidney transplant - Published
- 2019
34. Eplet-based virtual PRA increases transplant probability in highly-sensitized patients
- Author
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Leonídio Dias, Manuela Guedes de Almeida, La Salete Martins, Sofia Pedroso, Ermelinda Osório, Luísa Lobato, Sandra Tafulo, Jorge Malheiro, and António Castro-Henriques
- Subjects
Waiting time ,Transplantation ,medicine.medical_specialty ,Deceased donor ,business.industry ,Histocompatibility Testing ,Graft Survival ,Immunology ,medicine.disease ,Kidney Transplantation ,Tissue Donors ,Highly sensitized ,HLA Antigens ,Renal Dialysis ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,business ,Kidney transplantation ,Probability - Abstract
The reduced access of highly-sensitized (HS) patients to kidney transplantation (KTx) is one of the major challenges for transplant community. Therefore, the aim of our study was to estimate the impact of three different vPRA calculations, assessed traditionally and using eplet-based analysis, in donor offers.At 01-01-2020, 157 HS patients are waitlisted for deceased donor KTx and were included in this study. Total vPRA (vPRAt) was calculated considering all patient allosensitization history, using 1 k MFI cut-off. Current vPRA (vPRAc) refers only to the last year SAB assays, using 1 k MFI cut-off. For eplet vPRA (vPRAe) every SAB assay was analyzed by HLAMatchmaker and HLAfusion software. Matching runs have been performed taking vPRA calculation as unacceptable antigens (UAs).All patients had at least one previous sensitizing event and patients with 100% vPRA were predominantly candidates for retransplantation (P 0.001), had higher PRA-CDC (P 0.001), and longer dialysis vintage waiting time (P 0.001). Inter-group movement analysis between vPRA measures showed that 70 (45%), 124 (79%) and 80 (51%) patients were reclassified to a lower group when considering vPRAt to vPRAc, vPRAt to vPRAe and vPRAc to vPRAe, respectively. The median percentage of change in estimated number of match runs needed for 95% probability of finding an acceptable donor was significantly more pronounced by increasing vPRAt intervals, when considering the reclassification from vPRAt to vPRAe (P 0.001) or vPRAc to vPRAe (P = 0.045), while from vPRAt to vPRAc it was not (P = 0.899).Our study demonstrated that the use of total or current vPRA calculations are impairing HS patients, by decreasing transplant probability, leading to dramatically longer waiting times, when compared to eplet based vPRA.
- Published
- 2021
35. Low transplantability of 0 blood group and highly sensitized candidates in the Portuguese kidney allocation algorithm: quantifying an old problem in search of new solutions
- Author
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Jorge Malheiro, E. Osório, Cecília Mendes, La Salete Martins, Josefina Santos, Manuela Guedes de Almeida, António Castro-Henriques, Leonídeo Dias, Sandra Tafulo, and S. Pedroso
- Subjects
Waiting time ,Blood type ,Deceased donor ,medicine.medical_specialty ,business.industry ,Immunology ,030232 urology & nephrology ,Retrospective cohort study ,030230 surgery ,medicine.disease ,Surgery ,Kidney allocation ,Transplantation ,03 medical and health sciences ,0302 clinical medicine ,Highly sensitized ,Internal medicine ,Genetics ,medicine ,Immunology and Allergy ,business ,Kidney transplantation - Abstract
The impact of patient's biological differences in waiting time for kidney transplantation is well known and has been a subject of extensive debate and struggle in transplantation community. Our purpose was to evaluate patient's access to kidney transplantation in Portugal, regarding their degree of allosensitization and blood type. A retrospective cohort study including 1020 candidates for kidney transplantation between 01 January 2010 and 31 December 2011 in transplant unit Centro Hospitalar do Porto was performed. The deceased donor organ offer by blood type decreased with the calculated panel reactive antibody (cPRA) increase for A and B blood groups candidates, while in 0 blood group candidates, a significant reduction in organ offer was only observable in hypersensitized (HS) ones. As a consequence, the median waiting time was also significantly higher in 0 blood group patients, when compared to the remaining groups. However, waiting time increased extensively with cPRA regardless blood type, especially HS patients with increases of 368%, 632%, 486%, and 140% for blood groups A, B, AB, and 0, respectively, when compared to each blood group global median waiting time. Our study shows that important measures need to be undertaken in order to mitigate the huge disadvantage that HS and 0 blood type patients naturally have.
- Published
- 2016
36. Conversion From Twice-Daily to Once-Daily Tacrolimus in Stable Kidney Graft Recipients
- Author
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Sofia Pedroso, António Castro Henriques, Pedro Vieira, Manuela Guedes de Almeida, Patrícia Barreto, La Salete Martins, António Cabrita, Jorge Malheiro, and Leonídeo Dias
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,Renal function ,chemical and pharmacologic phenomena ,030230 surgery ,Drug Administration Schedule ,Tacrolimus ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,In patient ,Dosing ,Kidney transplantation ,Retrospective Studies ,Transplantation ,Kidney ,business.industry ,Immunosuppression ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Transplant Recipients ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,Delayed-Action Preparations ,Patient Compliance ,Female ,030211 gastroenterology & hepatology ,Once daily ,business ,Immunosuppressive Agents - Abstract
Introduction Immunosuppression has a pivotal role in kidney transplantation. The new prolonged-release formulation of tacrolimus was developed to provide a more convenient once-daily dosing to improve patient adherence. Methods We selected 60 stable kidney transplant recipients who underwent tacrolimus conversion in our unit. Conversion was made on a 1 mg:1 mg basis in 66.7% of patients (n = 40) and on a 1 mg:1.1 mg basis in the remaining 33.3% (n = 20). Clinical and analytical data at conversion and postconversion was analyzed retrospectively to evaluate the efficacy and safety of conversion from tacrolimus twice-daily to once-daily formulation. Results A significant reduction in tacrolimus blood levels requiring an increase in tacrolimus daily dose was observed postconversion. Postconversion tacrolimus blood level reduction >25% was significantly higher in the conversion group 1 mg:1 mg basis ( P = .004). In patients converted 1 mg:1 mg, female sex and higher tacrolimus level at conversion were significant risk factors for a reduction >25% in tacrolimus blood levels after conversion. No significant change was detected between mean glomerular filtration rate at conversion (57 mL/min) and at 3, 6, and 9 months postconversion. Conclusions Once-daily tacrolimus at similar doses to the twice-daily formulation is an efficient and safe treatment option. Conversion made on 1 mg:1.1 mg basis seems advantageous at least in some patients.
- Published
- 2016
37. Detection of Complement-binding Donor-specific Antibodies, Not IgG-antibody Strength Nor C4d Status, at Antibody-mediated Rejection Diagnosis Is an Independent Predictor of Kidney Graft Failure
- Author
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António Cabrita, Jorge Malheiro, António Castro-Henriques, La Salete Martins, Sandra Tafulo, Sofia Santos, Leonídio Dias, Isabel Fonseca, Manuela Guedes de Almeida, Sofia Pedroso, and Idalina Beirão
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Graft failure ,Time Factors ,Biopsy ,030232 urology & nephrology ,030230 surgery ,Independent predictor ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Isoantibodies ,Risk Factors ,Internal medicine ,medicine ,Complement C4b ,Humans ,Retrospective Studies ,Transplantation ,Kidney ,biology ,business.industry ,Donor specific antibodies ,Complement C1q ,Hazard ratio ,Graft Survival ,Middle Aged ,Kidney Transplantation ,Peptide Fragments ,Complement system ,body regions ,medicine.anatomical_structure ,Treatment Outcome ,Immunoglobulin G ,Antibody mediated rejection ,biology.protein ,Female ,Antibody ,business ,Protein Binding - Abstract
BACKGROUND Antibody-mediated rejection (AMR) remains associated with reduced kidney graft survival and no clear prognostic marker is available. METHODS We investigated whether donor-specific antibodies (DSA) ability to bind C1q in comparison with AMR C4d status, both indirect signs of complement activation, improve risk stratification at time of AMR. Hence, among 467 patients in whom 1 or more graft biopsies were performed between 2008 and 2015, we included 56 with AMR according to Banff '15 criteria. Using concurrent sera, we prospectively identified DSA by single-antigen beads (IgG and C1q) assays. RESULTS Antibody-mediated rejection C4d (+) (n = 28) was associated with preformed DSA (P = 0.007), whereas DSA C1q (+) (n = 25) cases had stronger IgG-DSA (P < 0.001). At AMR, graft function was similar between DSA C1q groups, but in the first year after, it improved in DSA C1q (-), whereas a steady decline was observed in DSA C1q (+) cases, remaining significantly lower from 1 year until 4 years after AMR. DSA C1q (+) was significantly associated with reduced graft survival (P = 0.021), whereas AMR C4d (+) was not (P = 0.550). Importantly, a similar negative impact of DSA C1q (+) on graft survival was observed within AMR C4d (+) (P = 0.040) and (-) (P = 0.036), cases. In multivariable analysis, DSA C1q (+) (hazard ratio, 3.939, P = 0.005) and de novo DSA (hazard ratio, 4.409, P = 0.033) were independent predictors of graft failure, but stronger IgG-DSA was not. Similar results were obtained considering C1q-DSA and IgG-DSA strength as continuous variables. CONCLUSIONS C1q-DSA assessment at AMR can be a valuable tool in detecting patients with higher risk of graft failure.
- Published
- 2018
38. Correlations between donor-specific antibodies and non-adherence with chronic active antibody-mediated rejection phenotypes and their impact on kidney graft survival
- Author
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Leonídio Dias, Manuela Guedes de Almeida, Sandra Tafulo, Isabel Fonseca, Sofia Santos, La Salete Martins, António Cabrita, António Castro-Henriques, Sofia Pedroso, Idalina Beirão, and Jorge Malheiro
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Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Immunology ,030232 urology & nephrology ,030230 surgery ,Gastroenterology ,Medication Adherence ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Isoantibodies ,Internal medicine ,Biopsy ,medicine ,Immunology and Allergy ,Humans ,Kidney ,Proteinuria ,biology ,medicine.diagnostic_test ,Chronic Active ,business.industry ,Complement C1q ,Graft Survival ,Immunosuppression ,General Medicine ,Middle Aged ,Phenotype ,Kidney Transplantation ,Tissue Donors ,Immunity, Humoral ,body regions ,medicine.anatomical_structure ,Concomitant ,Chronic Disease ,biology.protein ,Female ,Antibody ,medicine.symptom ,business ,Immunosuppressive Agents - Abstract
Chronic-active antibody-mediated rejection (CAABMR) is associated with poor kidney graft survival and has no clear effective treatment. Forty-one cases of CAABMR were detected in indication graft biopsies and evaluated according to current Banff classification. We investigated the impact of concurrent donor-specific antibodies (DSA) and their characteristics, together with non-adherence regarding immunosuppression on CAABMR histopathological phenotypes and prognosis. Twenty-four (59%) patients had detectable DSA at biopsy, with 15 of them being considered non-adherent. Graft function at biopsy was similar in DSA (+) and (−) patients. DSA (+) patients had significantly higher tubulointerstitial inflammation (i and ti) and acute humoral (g+ptc+v+C4d) composite score than DSA (−). DSA (+)/non-adherent cases presented additionally with increased microvascular inflammation (ptc and v), besides having a distinctively lower ah score. C1q DSA strength was higher (P = .046) in non-adherent patients and correlated closely with C4d score (P = .002). Lower graft function and ah score, higher proteinuria and ci + ct score, and, separately per each model, DSA (+) (HR = 2.446, P = .034), DSA (+)/non-adherent (HR = 3.657, P = .005) and DSA (+)/C1q (+) (HR = 4.831, P = .003) status were independent predictors of graft failure. CAABMR with concomitant DSA pose a higher risk of graft failure. Adherence should be evaluated, and histopathological phenotyping and DSA characterization may add critical information.
- Published
- 2018
39. Adenovirus infection—A rare cause of interstitial nephritis in kidney transplant
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António Castro Henriques, Carla Moreira, Leonídio Dias, Manuela Guedes de Almeida, Sofia Pedroso, Joana Rocha, La Salete Martins, Ramon Vizcaíno, Joana Silva, António Cabrita, and Margarida Silva
- Subjects
Pathology ,medicine.medical_specialty ,Kidney ,medicine.anatomical_structure ,Nephrology ,business.industry ,Interstitial nephritis ,medicine ,Adenovirus infection ,medicine.disease ,business ,Nephritis ,Kidney transplant - Published
- 2019
40. Impact ofde novodonor-specific anti-HLA antibodies on grafts outcomes in simultaneous pancreas-kidney transplantation
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Sandra Tafulo, António Castro-Henriques, Idalina Beirão, António Cabrita, La Salete Martins, Leonídio Dias, Isabel Fonseca, and Jorge Malheiro
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,Human leukocyte antigen ,030230 surgery ,Pancreas transplantation ,Gastroenterology ,Isoantibodies ,03 medical and health sciences ,0302 clinical medicine ,HLA Antigens ,Internal medicine ,medicine ,Humans ,Kidney transplantation ,Transplantation ,Type 1 diabetes ,Kidney ,biology ,business.industry ,Histocompatibility Testing ,Graft Survival ,HLA-DR Antigens ,medicine.disease ,Kidney Transplantation ,Tissue Donors ,Logistic Models ,medicine.anatomical_structure ,Immunology ,biology.protein ,Female ,Pancreas Transplantation ,Antibody ,business - Abstract
De novo donor-specific antibodies (dDSA) relevance in simultaneous pancreas-kidney (SPK) transplantation has been scarcely investigated. We analyzed dDSA relationship with grafts outcomes in a long-term follow-up SPK-transplanted cohort. In 150 patients that received SPK transplant between 2000 and 2013, post-transplant anti-human leukocyte antigen (HLA) antibodies were screened and identified using Luminex-based assays in sera collected at 3, 6, and 12 months, then yearly. dDSA were detected in 22 (14.7%) patients at a median 3.1 years after transplant. Pretransplant anti-HLA sensitization (OR = 4.64), full HLA-DR mismatch (OR = 4.38), and previous acute cellular rejection (OR = 9.45) were significant risk factors for dDSA. dDSA were significantly associated with kidney (in association with acute rejection) and pancreas graft failure. In dDSA+ patients, those with at least one graft failure presented more frequently dDSA against class II or I + II (P = 0.011) and locusDQ (P = 0.043) and had a higher median dDSA number (P = 0.014) and strength (P = 0.030). Median time between dDSA emergence and pancreas and kidney graft failure was 5 and 12 months, respectively. Emergence of dDSA increased the risk of grafts failure in SPK-transplanted patients. Full HLA-DR mismatch was associated with dDSA emergence. dDSA characteristics might help identify patients at a higher risk of graft failure.
- Published
- 2015
41. CT-based renal volume and graft function after living-donor kidney transplantation: Is there a volume threshold to avoid?
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Leonídio Dias, António Castro-Henriques, Luís Xambre, La Salete Martins, Manuela Guedes de Almeida, Jorge Malheiro, Miguel Silva-Ramos, and Jorge Dias
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Adult ,Male ,Nephrology ,medicine.medical_specialty ,Tissue and Organ Procurement ,Urology ,Renal function ,Kidney Volume ,Kidney ,Young Adult ,Internal medicine ,Living Donors ,medicine ,Humans ,Kidney transplantation ,Retrospective Studies ,business.industry ,Graft Survival ,Retrospective cohort study ,Mathematical Concepts ,Organ Size ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Surgery ,Transplantation ,medicine.anatomical_structure ,Female ,Tomography, X-Ray Computed ,business ,Follow-Up Studies ,Glomerular Filtration Rate - Abstract
Donated kidney volume influences post-transplant outcomes and graft survival. We evaluated the relationship between living-donor kidney volume and recipient graft function at 12 months post-transplantation, exploring a volume threshold for a suboptimal graft function, and compared two different formulas of volume estimation. A retrospective analysis of 82 pairs of living-donor kidney transplants was conducted. Donor renal volumes were estimated from computerized tomography scans using the ellipsoid formula and the voxel counting technique. Linear and restricted cubic regression spline was used to analyze the association of volume with graft function. Additionally, we determined the correlation between the two volume estimation formulas and established a correction factor for the ellipsoid formula. Renal volume (adjusted to recipient BSA) had the strongest independent effect (B = 1.65 per 10 ml/m2 increase, p value
- Published
- 2015
42. Analysis of preformed donor-specific anti-HLA antibodies characteristics for prediction of antibody-mediated rejection in kidney transplantation
- Author
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Isabel Fonseca, Sandra Tafulo, Idalina Beirão, António Castro-Henriques, António Cabrita, La Salete Martins, Jorge Malheiro, and Leonídio Dias
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Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Globulin ,Basiliximab ,Immunology ,Human leukocyte antigen ,Gastroenterology ,Disease-Free Survival ,HLA Antigens ,Isoantibodies ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,Kidney transplantation ,Transplantation ,Kidney ,biology ,business.industry ,Donor specific antibodies ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Survival Rate ,body regions ,medicine.anatomical_structure ,Antibody mediated rejection ,biology.protein ,Female ,Antibody ,business ,medicine.drug - Abstract
Background The relevance of preformed donor specific antibodies (DSA) detected by Luminex assays, with a negative complement-dependent cytotoxicity (CDC) crossmatch, remains unsettled in kidney transplantation (KT). We aimed to analyze the impact of preformed DSA characteristics on kidney graft outcomes. Methods In 462 patients that received a kidney graft in our unit, between 2007 and 2012, pre-transplant sera were analyzed by Luminex screening assay to determine the presence of anti-human leukocyte antigen (HLA) antibodies and single-antigen bead assay [positive if mean fluorescence intensity (MFI) ≥ 1000] to assign anti-HLA specificities. Results Anti-HLA antibodies were present in 95 patients (20.6%), but only 40 (8.7%) had DSA. Antibody-mediated rejection (AMR) at 1-year was higher in patients with DSA (35.0%) than in those without them (0.9%) (P 3000 were significantly associated with AMR occurrence. Receiver operator curves revealed that a MFI of > 4900 in the highest DSA bead had a high sensitivity (85.7%) and that the sum of all DSA beads MFI > 11,000 had a high specificity (92.3%) for AMR prediction. Anti-thymocyte globulin versus basiliximab induction was more frequent in DSA + AMR − (65.4%) versus DSA + AMR + (34.6%) patients (P = 0.072). Five-year censored graft survival was lower in DSA + than in DSA − patients (respectively, 84.8% versus 94.9%, P = 0.006), although survival was only reduced in DSA + AMR + (68.8%) versus DSA + AMR − (96.0%) patients (P = 0.038). Conclusions Preformed DSA is associated with kidney graft loss, in relation with AMR occurrence. DSA strength may be used to improve immunological risk stratification of sensitized patients and their clinical management.
- Published
- 2015
43. Plenty of land, land of plenty: the agrarian output of Portugal (1311-20)
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António Castro Henriques and Repositório da Universidade de Lisboa
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History ,Internal migration ,Economics, Econometrics and Finance (miscellaneous) ,Subsistence agriculture ,Economic History, Agriculture, Living Standards, Frontier Economy ,Agriculture ,Standard of living ,jel:N53 ,Frontier ,Agrarian society ,Economy ,Agrarian output ,Development economics ,História de Portugal - séc. 14 ,Per capita ,Marginal product ,Economics ,Agrarian system - Abstract
This article presents a benchmark for Portuguese agrarian output for the 1311–20 decade. This benchmark is built from the supply side using the value of church tithes combined with contemporary parish accounts. Two main findings emerge: first, per capita agrarian output was similar in the recently conquered South and the North, hinting that internal migration after the Reconquista led to the equalization of marginal product across the country; second, that Portuguese real per capita agrarian output was above subsistence and higher than that of contemporary England and Wales. This result, which is robust to the assumptions used, confirms that by 1320 Portugal was a “frontier economy” with a high land/labor ratio and a high per capita output. This seems to reinforce the Malthusian theory that the amount of land per person was key in determining living standards. The article discusses the implication of these results for the inequality among nations.
- Published
- 2015
44. Transplantation - clinical II
- Author
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Handan Ozdemir, Himanshu V Patel, Tingli Wang, Izumi Yamamoto, Anna Perri, Eva Svobodova, Alberto Mella, Alexander Kildushevsky, Ole Øyen, Nicolas Congy-Jolivet, Sergio Luis-Lima, Yuangao Zou, Hideki Fuji, Tolga Yildirim, Norihiko Goto, Marian Klinger, Leonídio Dias, Won Seok Yang, Lanlan Wang, Tatjana Cvetkovic, Barbara Assenzio, Filiz Bakar, Samantha Mantovani, Halil Yazici, Vijay Thanaraj, Priyadarshini S Shah, Solbjørg Sagedal, Francesca Sidoti, Anupma Kaul, Giordano Zampi, Dharmendra Bhadauria, Moncef Mokni, Tatjana Jevtovic Stoimenov, Tine Thurison, Alessia Di Nauta, Christos S. Katsouras, Franca Sinesi, Denisa Mendonça, Jude Yagan, Atsushi Miki, Giorgos Spanos, F. Zalamea Jarrin, Maria Cristina Di Vico, Francesca Greco, Marco Ballestri, Veena R Shah, Takashi Yokoo, António Castro Henriques, Pranjal R Modi, Vito Fanelli, Andrey Vatazin, Jiri Fronek, Siren Sezer, Anna Teresa Mazzeo, Takayuki Yamamoto, Karen Stopper, Jerzy Chudek, Antonij Slavcev, Deepak Shankar Ray, Takaaki Kimura, Claudio Musetti, Christina Dörje, Lidija Orlić, Osman Ilhan, Rahmi Yilmaz, Francesca Damiano, Mehmet Gokhan Caglayan, Marcel Naik, Ken Kitamura, Maarten B. Rookmaaker, Arjan D. van Zuilen, Pablo Raffaele, Trond Jenssen, Yosu Luque, Masato Fujisawa, Katerina K. Naka, Giuseppe Paolo Segoloni, Ioannis Gkirdis, Leonardo Caroti, Maarten Naesens, Klemens Budde, Rossana Cavallo, Nanna von der Lippe, Ilaria Mastromauro, A. Azzebi, Rigas Kalaitzidis, Fredrik B. Brekke, António Cabrita, Sławomir Zmonarski, Flavio Vincenti, Alessandro De Vincenzi, Hela Ghezaiel, Vasilis Koutlas, Elena Cremaschi, Dorota Kamińska, Mark A. J. Devonald, Kostas C. Siamopoulos, Mahmut Altindal, Mehtap Ekmen Uyar, Dobrin Svinarov, Abdulrahman Housawi, Sanjin Rački, Wissal Sahtout, Ramazan Cetinkaya, Emre Tutal, Luísa Lobato, Mehmet Sukru Sever, Umberto Maggiore, Momir Mikov, Dorry L. Segev, Inés Beired Val, Stefania Bussolino, Fernando Gil Catalinas, Steffen Thiel, Anna Kotsia, Olesja Rissling, Halil Ermis, Borelli K. Zlatkov, Adam Varga, Efrat Harel, Eva Pokorna, P. Chudoba, Saliha Uyanık, Kostas Pappas, Maria Vittoria Mauro, Viktorija Dragojevic-Simic, Alexey Zulkarnaev, Vural Taner Yilmaz, Mikiko Yoshikawa, Luciana Mascia, Aureliusz Kolonko, Yasunaru Sakuma, Manoj R Gumber, Jens Bollerslev, Maria Boratyńska, Kathy Denesyk, Lionel Rostaing, Fabrizio Fop, Carlo Massimetti, Tak Mao Chan, Jamal Rizvi, Predrag Vlahovic, Anna Maria Degli Antoni, Yasuo Takeuchi, Bård Waldum, Pieter Evenepoel, Dai Kohguchi, Aurelio Rodríguez-Hernández, Marcin Protasiewicz, Yudo Tannno, Samira Ben Amor, Sofia Pedroso, Rusudana Kantaria, Nikola Stefanović, Renzo Bonofilgio, Kristin Godang, Hans-H. Neumayer, Aydin Turkmen, Bosiljka Devcic, Oktawia Mazanowska, Tomasz Dawiskiba, Zeynep Bal, Donatella Vizza, J. Portoles Perez, Maggie Ming Yee Mok, Veronika Fedulkina, Josefina Santos, Byung Ha Chung, Altagracia Bello Ovalle, Lampros Lakkas, Jean-Luc Taupin, Anis Belarbia, Anil Chandraker, Andrea Ranghino, Sharmas Vali, Yaeni Kim, Yong-Soo Kim, Dorota Bartoszek, Sakuma Yasunaru, Mirosław Banasik, Malgorzata Kaminska, Cheol Whee Park, Jonathan Visentin, Fulvia Giaretta, Nobuo Tsuboi, Nathan T. James, Tiziana Cena, Tri Q. Nquyen, Giovanni Piotti, Huseyin Kocak, Armando Torres, Milagros Sierra Carpio, Gabriela Pimentel Guzmán, O. Lafuente Covarrubias, B. Sanchez Sobrino, Yuliya V Smedbraaten, Morten W. Fagerland, Pankaj R Shah, Amin Amro, Maria Granito, Davide Diena, Hargovind L Trivedi, Kenan Keven, Hyuk Y Kwon, Bei Cai, Alena Parikova, Ercan Turkmen, Jean J. Filipov, Marc-Olivier Timsit, Alastair Ferraro, Nicoline M.H. Veldhuijzen, Ibrahim Aliosmanoglu, Koji Nanmoku, R K Sharma, Neven Vavic, Anders Hartmann, Nilgun Aysuna, Geir Mjøen, Barbara Sandor, Gianni Cappelli, Louise Moist, José-Carlos Oliveira, Salima Kejji, Alena Verflova, Haralampos Harisis, Babak J. Orandi, Cristina Izzo, Andras Toth, Ana González-Rinne, Ivana Mikolašević, Mehmet Haberal, Petra Reinke, Akimitsu Kobayashi, Marion Rabant, Agnieszka Sas, Giulia Ligabue, Soumava Gupta, Dmytro Khadzhynov, Soon Bae Kim, Fatih Yılmaz, Gunilla Høyer-Hansen, Fotios Zarzoulas, Semra Bozfakioglu, O. Guliyev, Mehtap Erkmen Uyar, Yasuyuki Nakada, Zeynep Kendi Celebi, Alejandro Jiménez-Sosa, Christophe Legendre, Haralampos Pappas, José Davide, Sandro Feriozzi, Keitaro Yokoyama, Mustafa Arici, Esteban Porrini, Niraj M. Desai, Dany Anglicheau, Enrico Eugenio Minetti, Shunji Narumi, Federica Civiletti, Bahar Gurlek Demirci, Pierre Merville, Pablo Klin, Natalia Negrín-Mena, Roberta Fenoglio, Pratik Das, Marco Quaglia, Abdelatif Achour, Martina Pavletic Persic, Turan Colak, Hallvard Holdaas, Hyun Seon Kim, Charlie Martinez, Nemanja Jacimovic, Sung H Son, Carlo Buzio, Francesco Fontana, Giorgos Tzeltzes, Anders Åsberg, Andrea Kantor, Sébastien Lepreux, Ana Aldea-Perona, Laure-Hélène Noël, Takafumi Yamakawa, Daniela Perugini, Magdalena Szotowska, Ichiro Ohkido, Antonio Gil Paraíso, Aruna V Vanikar, Nurhan Ozdemir Acar, Manuela Guedes de Almeida, Bo Ying Choy, Charles S. Craik, Antoine Bello, Andrzej Wiecek, Bang-Gee Hsu, Massimo Rittà, Cristina Giraldi, Björn Meijers, Gwendaline Guidicelli, Henri Kreis, Chul Woo Yang, Augusto Vaglio, Marit Elizabeth Von Düring, Kouji Nannmoku, Riccardo Magistroni, Yunus Erdem, Katrien De Vusser, Marta Artamendi Larrañaga, Hiroyasu Yamamoto, Luigi Biancone, Giorgos Nakas, Rita Marcela Fortunato, Enma Huarte Loza, Nemanja Rancic, Andrea Airoldi, Katarzyna Koscielska-Kasprzak, Francesca Leone, Kazunari Yoshida, R. Llopez Carratala, Miyeon Kim, Andrea Cossarizza, Gabriele Guglielmetti, G. Tognarelli, Burak Sayin, José Manuel González-Posada, Jin Kong, Bulent Altun, Ingrid Os, Anne Theakstone, Shantanu Bhattacharjya, Piotr Kuczera, Gian Domenico D Fabbri, Lionel Couzi, Yosra Guedri, Nurhan Ozdemir, Cristina Costa, Chung Hee Baek, Emil P. Dimitrov, Ester Gallo, Dirk Kuypers, Hermann Hernandez Vargas, Massimo Gai, Rohit Rungta, Jun-Seok Kim, Piero Stratta, Takashi Yagisawa, Cihat Burak Sayin, Antonio Amoroso, Faisal Rehman, Maria Zanazzi, P. Dominguez Apiñaniz, Teresa Papalia, Franco Brescia, Vesna Lukenda, Ruben Poesen, Gea Imperato, P. Carta, Davide Medica, Alessandra Palmisano, S. Karsten Alvarez, Rozenn Clément, Jelena Katic, F Ersoy, Vladimir Hanzal, Safa Nouira, Manisha Sahay, K. Kalmár-Nagy, Michele Battista, Eun J Whang, Kalman Toth, Andrew A. House, Anna Varberg Reisæter, Hyung Jin Cho, Evangelia Dounousi, Irini Tzalavra, Sabri Ferdaws, Gultekin Suleymanlar, Limei Luo, Ayhan Dinckan, Ilaria Deambrosis, Begum Erdemir, Akinori Nukui, Thomas Schachtner, Karsten Midtvedt, Cecilia Dall Anesse, Ewelina Sikora-Grabka, Domingo Marrero, Ming-Che Lee, Vivek B Kute, Lourdes Pérez-Tamajón, Ana Coloma Lopez, Maria Messina, Ozgur Akin Oto, Lorraine Kwan, Robert A. Montgomery, Aris Bechlioulis, Olga Balafa, Isabel Fonseca, Aida Larti, Magdalena Krajewska, Akira Kurosawa, Toshihisa Iwabuchi, Janka Slatinska, Teppei Ohyama, Agnieszka Hałoń, Daisuke Ishii, Dag Olav Dahle, Su-Kil Park, Soumaya Ben Abdelkrim, Won Y Choi, Fatma Nurhan Ozdemir Acar, Sanda Mrabet, Lorenzo Di Maria, Saliha Yildirim, Oliver Staeck, Aleksandra Kovacevic, Elisa Buti, Yasar Caliskan, Lampros K. Michalis, Makoto Tsujita, Paweł Madej, Michalis Mitsis, Eduardo Salido, Ondrej Viklicky, Kiranmai Ismal, Yoshihiko Watarai, Dimitris Evangelou, Hege Pihlstrøm, Dorsaf Zellama, Chul Soo Yoon, Radmila Veličković Radovanović, Thomas Bachelet, Duck Jong Han, Paolo Gigliotti, Shinichi Nishi, Danilo Lofaro, Nassim Kamar, Fabian Halleck, Charlotte Ng, Erik H. Strøm, Aki Mafune, Sara De Biasi, Selami Kocak Toprak, António Castro-Henriques, Fabiola Pagani, Alaattin Yildiz, Marcin Adamczak, Pablo Bridoux, Marina Colic, Anara Amanova, Kyeong Woo Nho, Anna V. Reisæter, Bum Soon Choi, Hugo Sanabria, Enrique Ramalle Gómara, Ayse Serra Artan, Walther H. Boer, Takahisa Hiramitsu, Narayan Prasad, Albane Sartorius, Juan De Francesco, Daniele Cagna, Jorge Malheiro, Himmet Bora Uslu, Alun Williams, Vincenzo Cantaluppi, Yunying Shi, La Salete Martins, Pål-Dag Line, Péter Szakály, and Takaaki Kobayashi
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Transplantation ,medicine.medical_specialty ,Nephrology ,business.industry ,Medicine ,business ,Surgery - Published
- 2012
45. A economia circular na indústria portuguesa de pasta, papel e cartão
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Fraga, Manuel António Castro Henriques de Castro, Remígio, Helena, and Duarte, Susana
- Subjects
Engenharia e Tecnologia::Engenharia Mecânica [Domínio/Área Científica] - Abstract
O elevado desenvolvimento industrial, os novos hábitos de consumo e o crescimento populacional tem levado a uma discussão nos vários setores da sociedade acerca da escassez de recursos, das emissões poluentes, e da produção de resíduos. Desta forma, e em contraposição com o modelo económico linear, no qual os produtos após produzidos e consumidos são eliminados, emerge um novo modelo de negócio: “A Economia Circular”. Este é um modelo baseado na reutilização, recuperação, reciclagem e reparação durante o ciclo de conceção e utilização de um produto. Este trabalho pretende fazer um estudo da economia circular na indústria de pasta, papel e cartão. Este foi o setor escolhido porque para além de representar cerca de 8% da produção industrial nacional, tem feito esforços significativos para promover o desenvolvimento ambientalmente sustentável. Assim a dissertação pretende dar a conhecer o ponto de situação do setor pasta, papel e cartão no âmbito da economia circular, fazendo uma comparação ibérica nos anos compreendidos entre 2011 e 2015 através do desenvolvimento de um índice comparativo baseado nos resultados de alguns indicadores ambientais. Também é feito um levantamento das atuais barreiras existentes, bem como a sua respetiva relevância na implementação plena da economia circular através da utilização do método Delphi. Segundo o estudo realizado o setor pasta, papel e cartão em Portugal apresenta um valor de cerca de 26% superior na implementação da economia circular face ao registado no setor em Espanha em 2015, com a peculiaridade que esta diferença tem vindo a diminuir nos últimos cinco anos. Quanto aos resultados do estudo relativo às atuais barreiras na implementação da economia circular no setor pasta, papel e cartão em Portugal, o estudo aponta que, entre outras, as três mais relevantes são a falta de regulamentação de flexibilização e promoção do intercâmbio de subprodutos, a demora no processo de classificação de substâncias como subprodutos e a perceção de que o produto final proveniente da utilização de subprodutos é de qualidade inferior quando comparado com um produto que use matéria prima virgem.
- Published
- 2017
46. Role of de novo donor-specific anti-HLA antibodies in kidney graft failure: A case-control study
- Author
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Leonídeo Dias, Idalina Beirão, Ana Castro, Sandra Tafulo, Isabel Fonseca, António Castro-Henriques, António Cabrita, Jorge Malheiro, and La Salete Martins
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Biopsy ,Immunology ,030230 surgery ,Kidney ,Gastroenterology ,Antibodies ,03 medical and health sciences ,0302 clinical medicine ,HLA Antigens ,Risk Factors ,Internal medicine ,Genetics ,medicine ,Immunology and Allergy ,Humans ,Kidney transplantation ,Dialysis ,Proteinuria ,medicine.diagnostic_test ,business.industry ,Proportional hazards model ,Hazard ratio ,Graft Survival ,Case-control study ,Odds ratio ,medicine.disease ,Kidney Transplantation ,Tissue Donors ,surgical procedures, operative ,Logistic Models ,Treatment Outcome ,Case-Control Studies ,Multivariate Analysis ,030211 gastroenterology & hepatology ,Female ,medicine.symptom ,business - Abstract
The role of de novo donor-specific anti-human leukocyte antigen (anti-HLA) antibodies (dnDSA) within the pathways leading to graft failure remains not fully understood. We investigated 56 patients who were transplanted between 2002 and 2014 with kidney graft failure (cases), for a possible association of development of dnDSA with graft failure. The 56 patients with failed transplants were matched with 56 patients with a functioning graft at present for the variables deceased or living donor, transplant number, transplant year, recipient age and gender, donor age and gender, dialysis vintage time, transplant induction therapy. All patients had at least one serum collected 1 year before failure (in cases) or end of follow-up (in controls). Cases and controls were very well-matched in several baseline characteristics. Post-transplant anti-HLA antibodies were found in 84% of cases and only 36% of controls (P < .001), with 54% of cases and 16% of controls (P < .001) having dnDSA at time of detection. Chronic active antibody-mediated rejection was significantly more common (P < .001) in patients with dnDSA (61% vs 12%), in 53 (47%) patients that had at least one graft biopsy performed during follow-up. dnDSA was a significant risk factor (odds ratio [OR] = 6.06; P = .003) for graft failure in a multivariable conditional logistic regression model. dnDSA as a time-dependent variable, was also an independent predictor [hazard ratio (HR) = 2.46; P = .002] of graft failure in a multivariable Cox regression analysis. In both statistical approaches, only dnDSA-II (OR = 11.90; P = .006) (HR = 2.30; P = .014) was significantly associated with graft failure. Post-transplant dnDSA was clearly associated with graft loss, particularly if against HLA class II antigens. dnDSA detection should be a tool for post-transplant monitoring of kidney graft recipients, allowing for the identification of those with a higher risk of graft failure.
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- 2017
47. Impact on mid-term kidney graft outcomes of pretransplant anti-HLA antibodies detected by solid-phase assays: Do donor-specific antibodies tell the whole story?
- Author
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António Cabrita, La Salete Martins, Idalina Beirão, Leonídio Dias, Isabel Fonseca, António Castro-Henriques, Jorge Malheiro, and Sandra Tafulo
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Immunology ,030232 urology & nephrology ,Human leukocyte antigen ,030230 surgery ,Gastroenterology ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,HLA Antigens ,Isoantibodies ,Internal medicine ,Immunology and Allergy ,Medicine ,Humans ,Transplantation, Homologous ,Hla antibodies ,Kidney transplantation ,Immunosorbent Techniques ,Retrospective Studies ,Kidney ,biology ,business.industry ,Incidence (epidemiology) ,Donor specific antibodies ,Histocompatibility Testing ,Graft Survival ,General Medicine ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Microspheres ,body regions ,medicine.anatomical_structure ,Treatment Outcome ,Immunoglobulin G ,Cohort ,biology.protein ,Female ,Antibody ,business - Abstract
The detrimental impact of preformed anti-HLA donor-specific antibodies (DSA) is well defined, contrarily to non-donor-specific antibodies (NDSA). We sought to evaluate their clinical impact in a cohort of 724 kidney graft recipients in whom anti-HLA antibodies were thoroughly screened and identified in pre-transplant sera by solid-phase assays. NDSA or DSA were detected in 100 (13.8%) and 47 (6.5%) recipients respectively, while 577 (79.7%) were non-allosensitized (NaS). Incidence of antibody-mediated rejection at 1-year was 0.7%, 4.0% and 25.5% in NaS, NDSA and DSA patients, respectively (NaS vs. NDSA P=0.004; NaS vs. DSA P0.001; NDSA vs. DSA P0.001). Graft survival was lowest in DSA (78.7%), followed by NDSA (88.0%) and NaS (93.8%) recipients (NaS vs. NDSA P=0.015; NaS vs. DSA P0.001; NDSA vs. DSA P=0.378). Multivariable competing risk analysis confirmed both NDSA (sHR=2.19; P=0.025) and DSA (sHR=2.87; P=0.012) as significant predictors of graft failure. The negative effect of NDSA and DSA on graft survival was significant in patients receiving no induction (P=0.019) or an anti-IL-2 receptor antibody (P0.001), but not in those receiving anti-thymocyte globulin (P=0.852). The recognition of the immunological risk associated with preformed DSA but also NDSA have important implications in patients' risk stratification, and may impact clinical decisions at transplant.
- Published
- 2017
48. Scaling Up Nutrition in Guinea-Bissau
- Author
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Jakub Kakietek, Edson Araujo, Fanceni Henriques Balde, Jonathan Kweku Akuoku, Julia Dayton Eberwein, António Castro Henriques, Meera Shekar, Linda Brooke Schultz, Michelle Ashwin Mehta, and Ivone Menezes Moreira
- Subjects
Marginal cost ,Economic growth ,education.field_of_study ,Cost–benefit analysis ,Public economics ,Behavior change ,Population ,Psychological intervention ,Internal rate of return ,Context (language use) ,Economics ,education ,health care economics and organizations ,Disease burden - Abstract
This paper builds on global experience and Guinea-Bissau's specific context to identify an effective nutrition approach along with costs and benefits of key nutrition interventions. It is intended to help guide the selection of the most cost-effective interventions as well as strategies for scaling these up. We estimate that the costs and benefits of implementing 10 nutrition-specific interventions in all regions of Guinea-Bissau would require a public investment of USD 17 million over five years (with about USD 3 million needed to maintain the current coverage of the interventions and USD 14 million needed to expand the coverage to reach 90 percent of the population). The two key conclusions of this paper are, first, that investing in nutrition in Guinea-Bissau is cost-effective based on international standards and, second, that investments in nutrition can generate very substantial health and economic benefits, with one dollar spent on nutrition interventions resulting in about 10 dollars of returns over the productive lives of children covered by high-impact nutrition interventions. Economic productivity could potentially increase by USD 120 million (discounted at 3 percent) over the productive lives of the beneficiaries, with an impressive internal rate of return of 9 percent annually. Theses findings point to a powerful set of nutrition-specific interventions that represent a high cost-effective approach to reducing child malnutrition and stunting in Guinea-Bissau.
- Published
- 2017
49. Predictive Factors of Graft-Censored Failure in Pediatric Kidney Transplantation
- Author
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António Castro Henriques, T. Tavares, Jorge Malheiro, Leonídeo Dias, Ana Rocha, Maria do Sameiro Faria, Liliana Rocha, Pedro Vieira de Azevedo, and Conceição Mota
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Graft Rejection ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Human leukocyte antigen ,Serology ,Young Adult ,Internal medicine ,medicine ,Humans ,Registries ,Child ,Kidney transplantation ,Dialysis ,Acute tubular necrosis ,Transplantation ,Univariate analysis ,business.industry ,Age Factors ,Odds ratio ,medicine.disease ,Kidney Transplantation ,Tissue Donors ,Surgery ,surgical procedures, operative ,Child, Preschool ,Multivariate Analysis ,Female ,business - Abstract
Kidney transplantation in children has shown steady improvement in graft survival outcome over the last decades. Using data obtained from the transplantation registry of our center between 1984 and 2012, we assessed the independent determinants of graft failure using the Cox proportional hazards regression. Altogether, 128 recipients younger than 18 years of age at the time of kidney transplantation and who had >3 months graft survival were studied. During 9.95 years of medium follow-up, 27 censored graft failures occurred. Censored graft survival rates at 5, 10, 15, and 20 years post-transplantation were 93%, 82%, 70%, and 63%, respectively. Studied factors included recipient and donor age, recipient gender, dialysis vintage, donor/recipient cytomegalovirus (CMV) serology, panel-reactive antibody percentage, human leukocyte antigen mismatching, previous transplantation number, donor type (deceased vs living donation), cold ischemia time, induction therapy with antithymocyte globulin, occurrence of acute tubular necrosis, and development of acute rejection. Using univariate analysis, the significant predictors for graft-censored failure were adult donor (P < .001), recipient age (P = .035), human leukocyte antigen mismatching (P = .025), antithymocyte globulin induction (P = .03), and development of acute rejection (P < .001). Two factors independently predicted graft-censored failure in multivariate analysis. The odds ratios for graft failure in patients with acute rejection and in children who received an organ of an adult were 3.744 and 4.962, respectively. Pediatric recipients should receive the first priority for allografts from pediatric donors and acute rejection should be meticulously prevented.
- Published
- 2014
50. Kidney Transplantation Across a Positive Crossmatch: A Single-Center Experience
- Author
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Sandra Tafulo, S. Pedroso, R. Costa, Jorge Malheiro, António Cabrita, Cledir Santos, Leonídeo Dias, Manuela Guedes de Almeida, La Salete Martins, and António Castro Henriques
- Subjects
Adult ,Graft Rejection ,Male ,Reoperation ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,Single Center ,Antibodies ,Antibodies, Monoclonal, Murine-Derived ,chemistry.chemical_compound ,HLA Antigens ,medicine ,Humans ,Immunologic Factors ,Kidney transplantation ,Retrospective Studies ,Transplantation ,Kidney ,Creatinine ,business.industry ,Histocompatibility Testing ,Panel reactive antibody ,Immunoglobulins, Intravenous ,Plasmapheresis ,Flow Cytometry ,medicine.disease ,Kidney Transplantation ,Surgery ,medicine.anatomical_structure ,chemistry ,Desensitization, Immunologic ,Female ,Rituximab ,business ,medicine.drug - Abstract
Background Kidney transplantation is the treatment of choice for end-stage renal disease, with improved mortality and quality of life compared with dialysis. Desensitization protocols have allowed kidney transplantation of highly sensitized patients, who have a lower probability to receive a matching kidney from a deceased or living donor. The aim of this work was to analyze the post-transplantation period of highly HLA-sensitized patients with positive flow cytometry crossmatch against donor cells. Methods Following an observational, retrospective design, we investigated 16 highly sensitized patients who underwent kidney or kidney-pancreas transplantation, assessing the impact of desensitization protocols and investigating treatment-related complications, graft function, antibody-mediated rejection (AMR) rate, and graft and patient survivals. Results We studied 16 patients with positive flow cytometry crossmatch, who were divided into 2 groups based on whether they were submitted to a desensitization protocol or not. Patients who were desensitized underwent transplantation in later years, had higher immunologic risk (panel reactive antibody peak 62% vs 33%; P = .038), higher percentage of 2nd kidney transplant (75% vs 25%; P = .066), and higher percentage of donor-specific anti-HLA antibodies identified (P = .028). A majority of patients were desensitized with high-dose intravenous immunoglobulin and plasmapheresis, and 5 patients received rituximab. Acute AMR rate was of 38%, and rituximab was associated with fewer episodes of AMR. Only 1 patient had graft failure, due to chronic humoral rejection, and the remaining maintained good graft function (mean serum creatinine value of 1.33 mg/dL). No patient died and few complications related to immunossupression were observed. Conclusions Desensitization protocols were safe and allowed kidney transplantation in highly sensitized patients that probably would never undergo transplantation and gave the opportunity of living-donor transplant to patients with anti-HLA antibodies against the donor.
- Published
- 2014
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