FABIANA AGENA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
18 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 18
conferenceObject Bone and Mineral Metabolism and Fibroblast Growth Factor 23 Levels After Kidney Donation(2014) FERREIRA, G.; GUERRA, G.; SCHIAVENATO, E.; AGENA, F.; MOYSES, R.; DAVID-NETO, E.; WOLF, M.- Seroconversion of 2009 pandemic influenza A (H1N1) vaccination in kidney transplant patients and the influence of different risk factors(2013) AZEVEDO, L. S.; GERHARD, J.; MIRAGLIA, J. L.; PRECIOSO, A. R.; TIMENETSKY, M. dC S. Tavares; AGENA, F.; GAMBA, C.; YASUDA, M. A. Shikanai; DAVID-NETO, E.; PIERROTTI, L.BackgroundInfluenza may present a high morbidity and mortality in solid organ transplanted patients (SOTP). Annual influenza virus vaccine is recommended for SOTP. However, low levels of seroconversion in SOTP have been reported. The aim of this study was to evaluate the immunogenicity of 2009 pandemic influenza A (H1N1) - A(H1N1)pdm09 - vaccine in kidney transplant patients and to analyze which features might affect seroconversion. MethodsThis study was conducted from March to August 2010 at the Renal Transplantation Unit of University of SAo Paulo, Brazil. A total of 85 renal transplant patients attending the outpatient unit received one 15-g intramuscular dose of A(H1N1)pdm09 influenza vaccine (reassortant vaccine virus A/California/7/2009 [NYMC X-179A]). Blood samples were collected immediately before and 21days after the vaccine was given. Antibody response was measured by the standard hemagglutination-inhibition (HI) assay. The primary immunogenicity endpoint for this study was seroconversion in previously seronegative patients (HI titers <1:40), and the secondary endpoint was the identification of features that could affect seroconversion in this population. ResultsFive (5.9%) patients presented HI titers prevaccination 1:40 and were excluded from further analysis. Seroconversion in previously negative patients occurred in 27 (34%) of 80 patients. Prevaccination HI titers geometrical mean was 5.8 and postvaccination 19.6 (ratio 3.4). Significant seroconversion rate factors were female gender, non-Caucasian ethnicity, and post-transplant time before vaccination. No impact was seen on seroconversion for age, donor type, tacrolimus and cyclosporine blood levels, renal function, or blood lymphocyte counts. Mycophenolate (MPA) showed a lower rate of seroconversion when compared with azathioprine. Tacrolimus and cyclosporine had similar seroconversion rates. Sirolimus use was associated with the highest rate of seroconversion, although these patient numbers were low. Immunosuppresssion containing MPA was considerably less effective in seroconversion than drug combinations with no MPA. Patients receiving sirolimus had more chance of seroconversion. HI titers geometric means pre/post vaccine were as follows: MPA (n=56): 5.8/12.8; tacrolimus (n=50): 5.9/16.2; cyclosporine (n=18): 5.4/24.2; azathioprine (n=19): 6.2/51.6; and sirolimus (n=6): 8/80. By univariate analysis, being female and non-White were variables associated with 3.3 times more chance of seroconversion than being male and White. In the multivariate analysis, the variables remaining in the model showed similar hazard ratios. ConclusionsIn this study, the monovalent A(H1N1)pdm09 influenza vaccine demonstrated low rates of seroconversion, particularly in patients on MPA, but with potentially higher response rates in patients on sirolimus.
- Cytomegalovirus prophylaxis in seropositive renal transplant recipients receiving thymoglobulin induction therapy: Outcome and risk factors for late CMV disease(2018) JR, Jose O. Reusing; FEITOSA, Emanoela B.; AGENA, Fabiana; PIERROTTI, Ligia C.; AZEVEDO, Luiz S. F.; KOTTON, Camille N.; DAVID-NETO, EliasBackgroundAnti-thymocyte globulin (ATG) therapy is a risk factor for cytomegalovirus (CMV) disease in renal transplant (RTx) recipients and therefore antiviral prophylaxis is commonly used. We evaluated the outcome of our current policy of 90days of CMV prophylaxis in seropositive recipients given ATG and the risk factors for the occurrence of CMV disease after prophylaxis. MethodsWe studied a retrospective cohort of 423 RTx (2010-2014) CMV-seropositive adults given ATG induction therapy. Results54 (13%) patients developed CMV disease at a median of 163days after transplant, of which 29 (54%) had viral syndrome and 25 (46%) had invasive disease. Median prophylaxis time (94days) and immunosuppressive drugs were similar between groups (CMV vs no-CMV). Those with CMV disease had more deceased donors and higher donor age, lower lymphocyte count, and lower median eGFR at day 90. Multivariable logistic regression analysis at day 90 and 180 found that eGFR 40ml/min/1.73m(2) (but not acute rejection) was associated with late CMV disease. In a separate validation cohort of 124 patients with 8% late CMV disease, eGFR 45 and lymphocyte count 800cells/mm(3) at the end of prophylaxis remained predictive of late CMV disease occurrence. ConclusionsThese data indicate that antiviral prophylaxis adequately prevented CMV in seropositive recipients given ATG, but late disease still occurred. Low eGFR and low lymphocyte count at the end of prophylaxis may help identify patients at higher risk of CMV disease.
conferenceObject Everolimus/low tacrolimus(TAC) compared to MPA/regularTAC for renal transplantation in the elderly recipient - preliminary analysis of the nEverOld trial(2016) DAVID-NETO, Elias; AGENA, Fabiana; RAMOS, Fernanda; TRIBONI, Ana H. K.; ALTONA, Marcelo; COELHO, Venceslau; GALANTE, Nelson Z.; LEMOS, Francine B. C.- An Open-label Randomized Controlled Parallel-group Pilot Study Comparing the Immunogenicity of a Standard-, Double-, and Booster-dose Regimens of the 2014 Seasonal Trivalent Inactivated Influenza Vaccine in Kidney Transplant Recipients(2022) ODONGO, Fatuma Catherine Atieno; BRAGA, Patricia Emilia; PALACIOS, Ricardo; MIRAGLIA, Joao Luiz; SARTORI, Ana Marli Christovam; IBRAHIM, Karim Yaqub; LOPES, Marta Heloisa; CAIAFFA-FILHO, Helio Hehl; TIMENETSKY, Maria do Carmo Sampaio Tavares; AGENA, Fabiana; AZEVEDO, Luiz Sergio Fonseca de; DAVID-NETO, Elias; PRECIOSO, Alexander Roberto; PIERROTTI, Ligia CameraBackground. Immunogenicity of influenza vaccine in transplant recipients is suboptimal and alternative vaccination regimens are necessary. Methods. We compared the immunogenicity of a standard-dose trivalent inactivated influenza vaccination (SDTIIV), double-dose trivalent inactivated influenza vaccination (DDTIIV), and booster-dose trivalent inactivated influenza vaccination (BDTIIV) of the 2014 seasonal trivalent inactivated influenza vaccine in kidney transplant recipients. We randomized 176 participants to SDTIIV (59), DDTIIV (59), and BDTIIV regimens (58). Antibody titers were determined by hemagglutination inhibition at enrollment and 21 d postvaccination. Seroprotection rates (SPRs), seroconversion rates (SCRs), and geometric mean ratios (GMRs) were analyzed separately for participants with low (<1:40) and high (>= 1:40) prevaccination antibody titers. Results. Vaccination was confirmed for 172 participants. Immunogenicity analysis was done for 149 participants who provided postvaccination blood samples. In the subgroup with high prevaccination antibody titers, all vaccination regimens induced SPR > 70% to all antigens, but SCR and GMR were below the recommendations. In the subgroup with low prevaccination antibody titers, DDTIIV and BDTIIV regimens induced adequate SCR > 40% and GMR > 2.5 for all antigens, whereas SDTIIV achieved the same outcomes only for influenza B. SPRs were >70% only after DDTIIV (A/H1N1-77.8%) and BDTIIV (A/H3N2-77.8%). BDTIIV regimen independently increased seroprotection to A/H1N1 (PR = 2.58; P = 0.021) and A/H3N2 (PR = 2.21; P = 0.004), whereas DDTIIV independently increased seroprotection to A/H1N1 (PR = 2.59; P = 0.021). Conclusions. Our results suggest that DDTIIV and BDTIIV regimens are more immunogenic than SDTIIV, indicating the need for head-to-head multicenter clinical trials to further evaluate their efficacy.
conferenceObject Is 90-days CMV prophylaxis effective in CMV-seropositive patients receiving thymoglobulin as induction therapy?(2016) DAVID-NETO, Elias; FEITOSA, Emanoela B.; AGENA, Fabiana; REUSING, Jose Otto; LEMOS, Francine B. C.conferenceObject Discovery of Peripheral Blood and Biopsy-Based Molecular Classifiers in Brazilian Kidney Transplant Patients.(2014) VENTURA, C.; KURIAN, S.; GELBART, T.; DAVID, D.; AGENA, F.; ABECASSIS, M.; FRIEDEWALD, J.; DAVID-NETO, E.; SALOMON, D.- Determination of viremia cut-off for risk to develop BKPyV-associated nephropathy among kidney transplant recipients(2018) BICALHO, Camila Silva; OLIVEIRA, Renato dos Reis; DAVID, Daisa Ribeiro; FINK, Maria Cristina Domingues Silva; AGENA, Fabiana; CASTRO, Maria Cristina; PANUTTI, Claudio; DAVID-NETO, Elias; PIERROTTI, Ligia CameraBackgroundBK polyomavirus (BKPyV)-associated nephropathy (BKPyVAN) is a consequence of BKPyV replication in the urinary tract in kidney transplant recipients (KTR). ObjectivesThe objectives were to determine the prevalence of BKPyV replication and BKPyVAN, risk factors associated to sustained viremia and BKPyVAN, and viremia cut-off that best predict the occurrence of sustained viremia and nephropathy in KTR of a single University Hospital Kidney Transplant Center. Patients and MethodsAll KTR undergoing transplantation from August 2010 to December 2011 were enrolled and monitored up to 2years posttransplantation for BKPyV viruria by decoy cells shedding or polymerase chain reaction (PCR) and viremia by PCR. Kidney biopsy was indicated if sustained viremia (two or more viremia above 10000copies/mL) to confirm BKPyVAN diagnosis. ResultsIn this study, 326 transplants were performed and 246 patients were included. Prevalence of viruria was 36.9%, viremia 22.3% and nephropathy 3.2%. Male gender was the only risk factor associated to sustained viremia or nephropathy. Cut-off value of viremia that best discriminates the progression to sustained viremia and to BKPyVAN was 37488 and 44956copies/mL, respectively. ConclusionsPrevalence of viruria, viremia, and nephropathy were similar to those reported in literature but the cut-off value of viremia that best discriminates the risk of progression to nephropathy was greater than the value usually reported, which is 10000copies/mL.
- Longitudinal Pharmacokinetics of Everolimus When Combined With Low-level of Tacrolimus in Elderly Renal Transplant Recipients(2017) DAVID-NETO, Elias; AGENA, Fabiana; RAMOS, Fernanda; TRIBONI, Ana Heloisa Kamada; ROMANO, Paschoalina; EBNER, Persio de Almeida Rezende; COELHO, Venceslau; GALANTE, Nelson Zocoler; LEMOS, Francine Brambate CarvalhinhoBackground Although the proportion of elderly patients among renal transplant recipients has increased, pharmacokinetic (PK) studies of immunosuppressants rarely include older patients. Methods We studied 12-hour everolimus (EVL) PK in 16 elderly renal transplant recipients (all whites; 10 men; mean age, 64 2 years (61-71 years), in 4 separate timepoints (at 7, 30, 60, and 150 days) after EVL introduction, corresponding to a mean postrenal transplantation day: PK1 (43 4 days), PK2 (65 +/- 7 days), PK3 (106 +/- 17 days), and PK4 (206 +/- 40 days). Patients received EVL (target trough level (C-trough, 3-8 ng/mL), prednisone, and tacrolimus (TCL) (target C-trough, 2-5 ng/mL). Results Mean TCL-C-trough was 7.2 +/- 3.8, 4.9 +/- 2.2, 4.9 +/- 2.2, and 4.5 +/- 1.2 ng/mL at PK1, PK2, PK3, and PK4, respectively. There were no differences among timepoints for mean EVL daily dose (data shown as PK3) (3.5 +/- 1.3 mg/d), C-trough (4.7 +/- 2.5 ng/mL), AUC(0-12h) (106 +/- 51 ng/h per mL), C-average (8.8 +/- 4.2 ng/mL), C-max (19.2 +/- 9.7 ng/mL), apparent Half-life (11.7 +/- 4.2 hours), estimated total body clearance (0.39 +/- 0.27 L/h), or fluctuation (166 +/- 65%). Also, none of those PK parameters differed statistically when adjusted for body weight. EVL-C-trough showed a very high correlation (r(2) = 0.849) with AUC(0-12h). Conclusions Our data indicate that elderly renal transplant recipients starting EVL 1 month after transplantation along with a steady-state TCL level, present stable EVL-PK parameters without significant changes in dose or exposure during the first 6 months after renal transplantation.
- Awareness of Inadvertent Use of Yellow Fever Vaccine Among Recipients of Renal Transplant(2020) MIRANDA, Lara Judith Cabral; AGENA, Fabiana; SARTORI, Ana Marli Christovam; DAVID-NETO, Elias; AZEVEDO, Luiz Sergio; PIERROTTI, Ligia Camera