DAISA SILVA RIBEIRO DAVID
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/16 - Laboratório de Fisiopatologia Renal, Hospital das Clínicas, Faculdade de Medicina
LIM/16 - Laboratório de Fisiopatologia Renal, Hospital das Clínicas, Faculdade de Medicina
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- The impact of pretransplant donor-specific antibodies on graft outcome in renal transplantation: a six-year follow-up study(2012) DAVID-NETO, Elias; SOUZA, Patricia Soares; PANAJOTOPOULOS, Nicolas; RODRIGUES, Helcio; VENTURA, Carlucci Gualberto; DAVID, Daisa Silva Ribeiro; LEMOS, Francine Brambate Carvalhinho; AGENA, Fabiana; NAHAS, William Carlos; KALIL, Jorge Elias; CASTRO, Maria Cristina RibeiroOBJECTIVE: The significance of pretransplant, donor-specific antibodies on long-term patient outcomes is a subject of debate. This study evaluated the impact and the presence or absence of donor-specific antibodies after kidney transplantation on short-and long-term graft outcomes. METHODS: We analyzed the frequency and dynamics of pretransplant donor-specific antibodies following renal transplantation from a randomized trial that was conducted from 2002 to 2004 and correlated these findings with patient outcomes through 2009. Transplants were performed against a complement-dependent T-and B-negative crossmatch. Pre- and posttransplant sera were available from 94 of the 118 patients (80%). Antibodies were detected using a solid-phase (Luminex (R)), single-bead assay, and all tests were performed simultaneously. RESULTS: Sixteen patients exhibited pretransplant donor-specific antibodies, but only 3 of these patients (19%) developed antibody-mediated rejection and 2 of them experienced early graft losses. Excluding these 2 losses, 6 of 14 patients exhibited donor-specific antibodies at the final follow-up exam, whereas 8 of these patients (57%) exhibited complete clearance of the donor-specific antibodies. Five other patients developed ""de novo'' posttransplant donor-specific antibodies. Death-censored graft survival was similar in patients with pretransplant donor-specific and non-donor-specific antibodies after a mean follow-up period of 70 months. CONCLUSION: Pretransplant donor-specific antibodies with a negative complement-dependent cytotoxicity crossmatch are associated with a risk for the development of antibody-mediated rejection, although survival rates are similar when patients transpose the first months after receiving the graft. Our data also suggest that early posttransplant donor-specific antibody monitoring should increase knowledge of antibody dynamics and their impact on long-term graft outcome.
conferenceObject Indication Biopsies Ten Years after Renal Transplant Frequently Show Antibody-Mediated Mechanisms of Allograft Injury(2012) DAVID, D. S. R.; BRINGHENTI, R. N.; VENTURA, C. G.; NAHAS, W. C.; DAVID-NETO, E.Long-term kidney allograft survival is greatly affected by chronic rejection that occurs through different pathways, mainly antibody-mediated and T cell-mediated. Previously, we demonstrated that 60% of the indication biopsies in patients clinically classified as chronic allograft nephropathy (CAN) were C4d-positive. Mechanistic classification of chronic allograft dysfunction (CAD) is available according to the Banff Classification. In order to evaluate the CAD biopsy findings in the very long-term follow-up, we retrieved indication biopsies obtained 10 or more years after kidney transplantation when C4d was routinely introduced at our center (06/2006) until 7/2011. 387 patients had 10 or more years of kidney transplant during this period. Among them, 43 patients (11.1%) had an indication biopsy after 10 years. The biopsies were blindly reviewed by two nephropathologists. Antibody-mediated rejection (AMR) was a very frequent finding (n=14, 32.5%), being 10 (23.2%) chronic active antibody-mediated rejection (CAMR) and 4 (9.3%) “late” acute antibody-mediated rejection (LAAMR). The LAAMR cases did not show any sign of chronicity, even when analyzed by electron microscopy. Tubular atrophy and interstitial fibrosis of undetermined origin (IFTA) was equally frequent (n=14, 32.5%), followed by de novo/relapsing glomerulopathies (n=5, 11.6%), C4d-negative transplant glomerulopathy (TG) (n=3, 7.0%), acute T cell-mediated rejection (n=1, 2.3%), borderline changes (n=1, 2.3%), chronic active T cell-mediated rejection (n=1, 2.3%), acute tubular necrosis (n=1, 2.3%), and other finding (n=3, 7.0%). The three TG C4d-negative cases were HCV-positive in the serum and one had also circulating donor-speci fi c antibodies (DSAs). This study is one of the rare available in literature that approaches a cohort of indication biopsies performed 10 or more years post-transplant and keeps showing the high frequency (one-third) of AM mechanism impacting in long-term graft survival.- Recipient of kidney from donor with asymptomatic infection by Paracoccidioides brasiliensis(2012) BATISTA, Marjorie V.; SATO, Paula K.; PIERROTTI, Ligia C.; PAULA, Flavio J. de; FERREIRA, Gustavo F.; RIBEIRO-DAVID, Daisa S.; NAHAS, William C.; DUARTE, Maria I. S.; SHIKANAI-YASUDA, Maria A.The increase in solid organ transplantations may soon create a rise in the occurrence of endemic fungal diseases, such as paracoccidioidomycosis, due to the lack of rigorous screening of donors from endemic areas. Here we present the first case of an immunocompetent and asymptomatic kidney donor who had Paracoccidioides brasiliensis infected-adrenal tissue but no glandular dysfunction.
conferenceObject Which Induction Therapy Should Be Used in Kidney Transplants with Prolonged Cold Ischemia Time?(2012) ARAUJO, M. J. C. L. N.; ONUSIC, V. L.; BATTAINI, L. C.; BARBOSA, E. A.; BOJIKIAN, R. T.; DAVID, D. R.; ANTONOPOULOS, I. M.; PAULA, F. Jota de; NAHAS, W. C.; NETO, E. D.; LEMOS, F. B. C.; CASTRO, M. C. Ribeiro de