FRANCINE BRAMBATE CARVALHINHO LEMOS
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
16 resultados
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Agora exibindo 1 - 10 de 16
- 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.
- Preserving the B-Cell Compartment Favors Operational Tolerance in Human Renal Transplantation(2012) SILVA, Hernandez M.; TAKENAKA, Maisa C. S.; MORAES-VIEIRA, Pedro M. M.; MONTEIRO, Sandra M.; HERNANDEZ, Maristela O.; CHAARA, Wahiba; SIX, Adrien; AGENA, Fabiana; SESTERHEIM, Patricia; BARBE-TUANA, Florencia Maria; SAITOVITCH, David; LEMOS, Francine; KALIL, Jorge; COELHO, VeronicaTransplanted individuals in operational tolerance (OT) maintain long-term stable graft function after completely stopping immunosuppression. Understanding the mechanisms involved in OT can provide valuable information about pathways to human transplantation tolerance. Here we report that operationally tolerant individuals display quantitative and functional preservation of the B-c ell compartment in renal transplantation. OT exhibited normal numbers of circulating total B cells, naive, memory and regulatory B cells (Bregs) as well as preserved B-cell receptor repertoire, similar to healthy individuals. In addition, OT also displayed conserved capacity to activate the cluster of differentiation 40 (CD40)/signal transducer and activator of transcription 3 (STAT3) signaling pathway in Bregs, in contrast, with chronic rejection. Rather than expansion or higher activation, we show that the preservation of the B-cell compartment favors OT. Online address: http://www.molmed.org doi: 10.2119/molmed.2011.00281
- Aging and End Stage Renal Disease Cause A Decrease in Absolute Circulating Lymphocyte Counts with A Shift to A Memory Profile and Diverge in Treg Population(2019) FREITAS, Geraldo Rubens Ramos; FERNANDES, Maria da Luz; AGENA, Fabiana; JALUUL, Omar; SILVA, Sergio Colenci; LEMOS, Francine Brambate Carvalhinho; COELHO, Veronica; DAVID-NETO, Elias; GALANTE, Nelson ZocolerThere is a growing number of elderly kidney transplant (Ktx) recipients. Elderly recipients present lower acute rejection rates but higher incidence of infection and malignancies. Aging per se seems to result in a shift to memory profile and chronic kidney disease (CKD) in premature immunological aging. Understanding aging and CKD effects on the immune system can improve elderly Ktx immunosuppression. We analyzed the effects of aging and CKD in the immune system, comparing healthy adults (HAd) (n=14, 26 +/- 2y), healthy elderly (HEld) (n=15, 79 +/- 7y), end stage renal disease (ESRD) adults (EnAd) (n=18, 36 +/- 7y) and ESRD elderly (EnEld) (n=31, 65 +/- 3y) prior to Ktx regarding their naive, memory and regulatory T and B peripheral lymphocytes. Aging and ESRD presented additive effect decreasing absolute numbers of B and T-lymphocytes, affecting memory, naive and regulatory subsets without synergic effect. Both resulted in higher percentages of T memory subsets and opposing effects on regulatory T (TREG) subsets, higher percentage in aging and lower in ESRD. Combined effect of aging and ESRD also resulted in higher regulatory B cell percentages. In addition to global lymphopenia and TCD4(+) memory shift in both aging and ESRD, aging shifts to an immunoregulatory profile, inducing a increase in TREG percentages, contrasting with ESRD that decreases TREGs. Differential immunosuppression regimens for elderly Ktx may be required.
- Home blood pressure (BP) monitoring in kidney transplant recipients is more adequate to monitor BP than office BP(2011) AGENA, Fabiana; PRADO, Elisangela dos Santos; SOUZA, Patricia Soares; SILVA, Giovanio Vieira da; LEMOS, Francine Brambate Carvalhinho; MION JR., Decio; NAHAS, William Carlos; DAVID-NETO, EliasBackground. Hypertension is highly prevalent among kidney transplantation recipients and considered as an important cardiovascular risk factor influencing patient survival and kidney graft survival. Aim. Compare the blood pressure (BP) control in kidney transplant patients through the use of home blood pressure monitoring (HBPM) is more comparable with the results of ambulatory blood pressure monitoring compared to the measurement of office blood pressure. Methods. From March 2008 to April 2009 prospectively were evaluated 183 kidney transplant recipients with time after transplantation between 1 and 10 years. Patients underwent three methods for measuring BP: office blood pressure measurement (oBP), HBPM and ambulatory blood pressure monitoring (ABPM). Results. In total, 183 patients were evaluated, among them 94 were men (54%) and 89 women (46%). The average age was 50 6 11 years. The average time of transplant was 57 6 32 months. Ninety-nine patients received grafts from deceased donors (54%) and 84 were recipients of living donors (46%). When assessed using oBP, 56.3% presented with uncontrolled and 43.7% with adequate control of BP with an average of 138.9/82.3 +/- 17.8/12.1 mmHg. However, when measured by HBPM, 55.2% of subjects were controlled and 44.8% presented with uncontrolled BP with an average of 131.1/78.5 +/- 17.4/8.9 mmHg. Using the ABPM, we observed that 63.9% of subjects were controlled and 36.1% of patients presented uncontrolled BP with an average 128.8/80.5 +/- 12.5/8.1 mmHg. We found that the two methods (oBP and HBPM) have a significant agreement, but the HBPM has a higher agreement that oBP, confirmed P = 0.026. We found that there is no symmetry in the data for both methods with McNemar test. The correlation index of Pearson linear methods for the ABPM with the other two methods were 0.494 for office measurement and 0.768 for HBPM, best value of HBPM with ABPM. Comparing the errors of the two methods by paired t-test, we obtained the descriptive level of 0.837. Looking at the receiver operating characteristic curve for BP measurements in each method, we observed that oBP is lower than those obtained by HBPM in relation to ABPM. Conclusion. We conclude that the results obtained with HBPM were closer to the ABPM results than those obtained with BP obtained at oBP, being more sensitive to detect poor control of hypertension in renal transplant recipients.
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.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 EVALUATION OF MDRD4, CKD-EPI AND MODIFIED COCKCROFT-GAULT EQUATIONS TO ESTIMATE GLOMERULAR FILTRATION RATE IN THE ELDERLY RENAL TRANSPLANTED RECIPIENTS(2015) DAVID-NETO, Elias; KAMADA, Triboni Ana Heloisa; RAMOS, Fernanda; AGENA, Fabiana; BRAMBATE, Carvalhinho Lemos Francine; TATIT, Sapienza Marcelo; ALTONA, Marcelo; NAHAS, William Carlos- Longitudinal Pharmacokinetics of Mycophenolic Acid in Elderly Renal Transplant Recipients Compared to a Younger Control Group: Data from the nEverOld Trial(2019) ROMANO, Paschoalina; AGENA, Fabiana; EBNER, Persio de Almeida Rezende; SUMITA, Nairo Massakazu; TRIBONI, Ana Heloisa Kamada; RAMOS, Fernanda; GARCIA, Marcio dos Santos; DUARTE, Nilo Jose Coelho; LEMOS, Francine Brambate Carvalhinho; GALANTE, Nelson Zocoler; DAVID-NETO, EliasBackground and ObjectivesElderly patients are increasingly likely to be recipients of transplants. However, the pharmacokinetics of mycophenolic acid (MPA) in this population are yet to be studied in detail. The objective of this study was to assess whether there were differences in MPA pharmacokinetic parameter values between elderly recipients and younger-adult recipients during the 6months immediately following renal transplantation.MethodsIn this analysis, the longitudinal 12-h pharmacokinetics of MPA, administered as enteric-coated mycophenolate sodium (EC-MPS), were evaluated in 44 elderly renal transplant recipients and compared with the corresponding pharmacokinetics of MPA in 31 younger adult recipients. Measurements were performed at 7, 30, 60, 90, and 180days post-transplantation. All patients received tacrolimus and prednisone.ResultsThe elderly patients were 30years older than the younger controls, with a predominance of males and Caucasians. Elderly patients had lower serum albumin than the younger controls during the first 6months after transplantation. The mean estimated total body MPA clearance of the elderly recipients was not significantly different from that of the controls at any analyzed time point (the mean clearance across all time points was 0.310.17 vs 0.300.25L/h/kg). MPA exposure, as evaluated from the area under the 12-h time versus measured MPA concentration (adjusted for dose/body weight) curve, did not differ between the groups at any time point (mean exposure across all time points was 4.68 +/- 3.61 vs 5.95 +/- 4.29 mu gh/mL per mg/kg for the elderly recipients and the controls).ConclusionsThese data show that the pharmacokinetics of MPA in elderly renal transplant recipients were no different to those of younger-adult recipients in this study population.Clinicaltrials.govp id=""Par5000"">NCT 01631058.
- 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.
conferenceObject DEFINING PP65ENEMIA AND QPCR CUT-OFFS FOR PRE-EMPTIVE THERAPY OF CMV DISEASE IN LOW-RISK RENAL TRANSPLANTED RECIPIENTS(2013) DAVID-NETO, Elias; LEMOS, Angelica Dias; BOAS, Lucy Santos Vilas; LATIF, Acram Zahredine Abdul; AGENA, Fabiana; PAULA, Flavio Jota de; PIERROTI, Ligia; LEMOS, Francine; NAHAS, William Carlos; CAIAFFA FILHO, Helio; PANNUTI, Claudio Sergio