JOSE OTTO REUSING JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
7 resultados
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- Critical points and potential pitfalls of outbreak of IMP-1-producing carbapenem-resistant Pseudomonas aeruginosa among kidney transplant recipients: a case-control study(2021) FREIRE, M. P.; CAMARGO, C. H.; YAMADA, A. Y.; NAGAMORI, F. O.; JUNIOR, J. O. Reusing; SPADAO, F.; CURY, A. P.; ROSSI, F.; NAHAS, W. C.; DAVID-NETO, E.; PIERROTTI, L. C.Background: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) infection after kidney transplantation (KT) is associated with high mortality. Aim: To analyse an outbreak of infection/colonization with IMP-1-producing CRPA on a KT ward. Methods: A case-control study was conducted. Cases were identified through routine surveillance culture and real-time polymerase chain reaction for carbapenemase performed directly from rectal swab samples. Controls were randomly selected from patients hospitalized on the same ward during the same period, at a ratio of 3:1. Strain clonality was analysed through pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing was performed for additional strain characterization. Findings: CRPA was identified in 37 patients, in 51.4% through surveillance cultures and in 49.6% through clinical cultures. The median persistence of culture positivity was 42.5 days. Thirteen patients (35.1%) presented a total of 15 infections, of which seven (46.7%) were in the urinary tract; among those, 30-day mortality rate was 46.2%. PFGE analysis showed that all of the strains shared the same pulsotype. Multilocus sequence typing analysis identified the sequence type as ST446. Risk factors for CRPA acquisition were hospital stay >10 days, retransplantation, urological surgical reintervention after KT, use of carbapenem or ciprofloxacin in the last three months and low median lymphocyte count in the last three months.
- Prioritization Due to Dialysis Access Failure Impacts on Patient Survival after Kidney Transplantation(2013) REUSING JR., J.; SOUZA, P.; GALANTE, N.; AGENA, F.; PAULA, F. de; NAHAS, W.; DAVID-NETO, E.Dialysis vascular access failure, recipient of a non-renal solid organ transplantation and previous kidney donation are current indications of priority allocation (PA) for kidney transplant (KT) at our centre. Mortality among PA patients under dialysis is high and risk factors for long-term patient outcomes after transplantation remain largely elusive. In this study we analyzed a cohort of patients that received KT from Jan/2007 to Dec/2011. Long-term patient survival was compared between PA and non PA recipients transplanted in this period of time and clinical relevant data were analyzed. Data were recorded as of Aug/2012. Results: 948 KT were performed at our institution and 93 (9.8%) were included in our PA program. Most PA patients (n=86) had access failure. The mean follow up time was 32 (0 – 69) months. 5-year patient survival was lower in PA patients (76vs 86%, p=0.001). Twenty (21.5%) PA patients died and all deaths occurred in those with access failure, being 70% of them in the first 3 months. Causes of death were infection in 10 patients, bleeding complications (n=6), uremia (n=1), mesenteric ischemia (n=1) and unspecified shock (n=2). Considering this high mortality rate in the first 3 months after transplantation, we compared patients who died in this period of time (group A) vs. those who survived more than 3 months (group B). Age, gender, previous kidney transplants, sensitization, number of HLA mismatches, pre-transplant DSA, pre-transplant diabetes, induction therapy, DGF, rejection, use of heparin, IVIg and time from inscription in the PA program to transplantation were not statistically different between groups. Among 47 patients who were screened for thrombophilia, 83.3% from group A were positive vs. 31.7% from group B (p=0.01). Infection after transplantation and hemorrhagic complications were more frequent in group A. Groups were not different regarding causes of death. PA patients have a lower survival and this excessive death rate occur in the first three months after transplantation mainly due to infections and bleeding. Thrombophilia is very frequent in PA patients with HR....... for death.
- Renal transplantation in human immunodeficiency virus-infected recipients: a case-control study from the Brazilian experience(2016) VICARI, A. R.; SPULDARO, F.; SANDES-FREITAS, T. V.; CRISTELLI, M. P.; REQUIAO-MOURA, L. R.; REUSING, J. O.; PIERROTTI, L. C.; OLIVEIRA, M. L.; GIRAO, C. M.; GADONSKI, G.; KROTH, L. V.; DEBONI, L. M.; FERREIRA, G. F.; TEDESCO-SILVA, H.; ESMERALDO, R.; DAVID-NETO, E.; SAITOVITCH, D.; KEITEL, E.; GARCIA, V. D.; PACHECO-SILVA, A.; MEDINA-PESTANA, J. O.; MANFRO, R. C.BackgroundHighly active antiretroviral therapy has turned human immunodeficiency virus (HIV)-infected patients with end-stage renal disease into suitable candidates for renal transplantation. We present the Brazilian experience with kidney transplantation in HIV-infected recipients observed in a multicenter study. MethodsHIV-infected kidney transplant recipients and matched controls were evaluated for the incidence of delayed graft function (DGF), acute rejection (AR), infections, graft function, and survival of patients and renal grafts. ResultsFifty-three HIV-infected recipients and 106 controls were enrolled. Baseline characteristics were similar, but a higher frequency of pre-transplant positivity for hepatitis C virus and cytomegalovirus infections was found in the HIV group. Immunosuppressive regimens did not differ, but a trend was observed toward lower use of anti-thymocyte globulin in the group of HIV-infected recipients (P = 0.079). The HIV-positive recipient group presented a higher incidence of treated AR (P = 0.036) and DGF (P = 0.044). Chronic Kidney Disease Epidemiology Collaboration estimated that glomerular filtration rate was similar at 6 months (P = 0.374) and at 12 months (P = 0.957). The median number of infections per patient was higher in the HIV-infected group (P = 0.018). The 1-year patient survival (P < 0.001) and graft survival (P = 0.004) were lower, but acceptable, in the group of HIV-infected patients. ConclusionsIn the Brazilian experience, despite somewhat inferior outcomes, kidney transplantation is an adequate therapy for selected HIV-infected recipients.
conferenceObject Is CMV Prophylaxis Effective in CMV-Seropositive Patients Receiving Thymoglobulin as Induction Therapy?(2016) FEITOSA, E.; AGENA, F.; REUSING JR., J.; LEMOS, F.; DAVID-NETO, E.conferenceObject Thrombophilia Is Associated With Kidney Graft Loss But Not With Sensitization.(2014) REUSING JUNIOR, J.; SILVA, R.; EBAID, G.; D'AMICO, E.; DAVID-NETO, E.conferenceObject Thrombophilia Is Associated With Kidney Graft Loss But Not With Sensitization.(2014) REUSING JUNIOR, J.; SILVA, R.; EBAID, G.; D'AMICO, E.; DAVID-NETO, E.conferenceObject Original KDRI Predicts Kidney Graft Failure in a Brazilian Cohort.(2016) REUSING, J.; NIHEI, C.; SOUZA, A. Lino de; DAVID-NETO, E.; VENTURA, C.