JOSE OTTO REUSING JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
4 resultados
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- Chikungunya in kidney transplant recipients: A series of cases(2017) PIERROTTI, Ligia Camera; LOPES, Max Igor Banks Ferreira; NASCIMENTO, Ana Patricia do; CAIAFFA-FILHO, Helio; LEMOS, Francine Brambate Carvalhinho; REUSING JR., Jose Otto; SEJAS, Odeli Nicole Encinas; DAVID-NETO, Elias; AZEVEDO, Luiz SergioChikungunya (CHIK) is a mosquito-borne virus (CHIKV) infection that recently appeared in the Americas and thousands of confirmed cases have been reported in Brazil since the first autochthonous cases were reported in September 2014. We reported four cases of CHIK in kidney transplant recipients. The diagnosis was confirmed by positive CHIKV real-time polymerase chain reaction in two cases and positive CHIKV-IgM serology in two patients. The time between transplantation and CHIKV infection ranged from 2 to 11 years. All of them had arthralgia, and 3 of them had fever. Other symptoms were mild conjunctivitis, rash, and retro-orbital pain. Kidney function remained stable in all cases. In three patients prednisone doses were temporally increased and the symptoms disappeared concurrently with the increase of the dose. As for the fourth patient, the prednisone dose remained unchanged and yet she improved. Other immunosuppressive drugs were not changed for the four cases. As far as we know, there are only two previously reported cases of CHIK among solid organ transplant recipients besides the four cases reported here. Despite the small number of cases, we can speculate that the use of immunosuppression might have played a role in the paucity of symptoms and the gradual complete recovery with no complication. (C) 2017 The Authors.
- Association Between Total Cell Free DNA and SARS-CoV-2 In Kidney Transplant Patients: A Preliminary Study(2022) JR, Jose Otto Reusing; YOO, Jongwon; DESAI, Amishi; BROSSART, Katya; MCCORMICK, Sarah; MALASHEVICH, Allyson Koyen; BLOOM, Michelle S.; FEHRINGER, Gordon; WHITE, Roseann; BILLINGS, Paul R.; TABRIZIANI, Hossein; DEMKO, Zachary P.; GAUTHIER, Philippe; AKKINA, Sanjeev K.; DAVID-NETO, EliasBackground. Kidney transplant (KT) recipients are at high risk for developing severe COVID-19. Lowering immunosuppression levels in KT recipients with COVID-19 encourages native immune responses but can raise the risk of rejection. Donor-derived cell-free DNA (dd-cfDNA), reported as a fraction of total cfDNA, is a proven biomarker for KT rejection. Total cfDNA levels are elevated in patients with COVID-19, which may depress dd-cfDNA fractions, potentially leading to missed rejections.Methods. A retrospective analysis of 29 KT recipients hospitalized with COVID-19 between April and November 2020 examined total and dd-cfDNA levels. Blood samples were collected after onset of COVID-19, with follow-up samples collected from a subset of patients, when infection had likely subsided.Results. After COVID-19 diagnosis, the median total cfDNA level was elevated (7.9 multiples of median [MoM]). A significant decrease in total cfDNA levels was observed between the first and second time points (6.2 MoM, 1.0 MoM; P <001). A significant positive association was identified between total cfDNA levels and COVID-19 severity (P = .02; R2 = .19). Two patients with biopsy -proven acute cellular rejection had dd-cfDNA fractions below the 1% cutoff for rejection (0.20% and 0.78%), with elevated total cfDNA levels of 7.9 MoM and 41.8 MoM, respectively.Conclusions. In this preliminary study, total cfDNA levels were elevated in KT patients with COVID-19, subsiding after resolution of infection. High total cfDNA levels may confound dd-cfDNA results, leading to failure to identify rejection. Considering total cfDNA levels is impor-tant in interpretation of dd-cfDNA tests for assessment of rejection in KT patients with COVID-19 or other infection.
- 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.
- Interdialytic Blood Pressure and Risk of Cardiovascular Events and Death in Hemodialysis Patients(2023) LIMA, Jose Jayme G. De; GOWDAK, Luis Henrique W.; JR, Jose Otto Reusing; DAVID-NETO, Elias; BORTOLOTTO, Luiz A.IntroductionNormal (120-140 mm Hg) systolic peridialysis blood pressure (BP) is associated with higher mortality in hemodialysis (HD) patients.AimWe explored the relationship between hypertension and BP on outcomes using data collected at the interdialytic period.MethodsThis was a single-center observational cohort study with 2672 HD patients. BP was determined at inception, in mid-week, between 2 consecutive dialysis sessions. Hypertension was defined as systolic BP >= 140 mm Hg and/or diastolic BP >= 90 mm Hg. Endpoints were major CV events and all-cause mortality.ResultsDuring a median follow-up of 31 months, 761 patients (28%) experienced CV events and 1181 (44%) died. Hypertensive patients had lower survival free of CV than normotensive patients (P = 0.031). No difference occurred in the incidence of death between groups. Compared with the reference category of SBP >= 171 mmHg, the incidence of cardiovascular events was reduced in patients with SBP 101-110 (HR 0.647, 95% CI 0.455 to 0.920), 111-120 (HR 0.663, 95%CI 0.492 to 0.894), 121-130 (HR 0.747, 95%CI 0.569 to 0.981), and 131-140 (HR 0.757, 95%CI 0.596 to 0.962). On multivariate analysis, systolic and diastolic BP were not independent predictors of CV events or death. Normal interdialytic BP was not associated with mortality or CV events, and hypertension predicted an increased probability of CV complications.ConclusionsInterdialytic BP may be preferred to guide treatment decisions, and HD patients should be treated according to guidelines for the general population until specific BP targets for this population are identified.