IGOR DENIZARDE BACELAR MARQUES
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- EVALUATION OF BONE MICROARCHITECTURE BY HIGH-RESOLUTION PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY IN PATIENTS WITH CHRONIC KIDNEY DISEASE: COMPARISON WITH TRANSILIAC BONE BIOPSY(2015) MARQUES, Igor; ARAUJO, Maria Julia; GRACIOLLI, Fabiana; REIS, Luciene dos; CUSTODIO, Melani; PEREIRA, Rosa; JAMAL, Sophie; JORGETTI, Vanda; DAVID-NETO, Elias; MOYSES, Rosa
conferenceObject LOWER SERUM MAGNESIUM 1-YEAR POSTTRANPLANTATION IS ASSOCIATED WITH PROLONGED USE OF PROTON PUMP INHIBITORS AND DECREASED GRAFT SURVIVAL IN RENAL TRANSPLANT RECIPIENTS(2013) NIHEI, Camila; MARQUES, Igor Bacelar; SEGURO, Carlos Antonio; DAVID-NETO, EliasIntroduction and Aims: Hypomagnesaemia is a known side effect of immunosuppressive regimen, especially calcineurin inhibitors, and has been associated with new onset diabetes after transplantation (NODAT), decreased graft survival in chronic cyclosporine nephrotoxicity and vascular stiffness. Proton pump inhibitors-induced hypomagnesaemia has been described recently, although its relevance in renal transplant recipients is still unknown. Methods: We conducted a single center cross-sectional retrospective study of renal transplantations performed between 2006 and 2011 in order to evaluate the impact of low serum magnesium (Mg) levels in patient and graft outcomes. Serum Mg levels 1-year after renal transplantation were available for 316 patients. Results: The median follow-up was 1062 days (range, 284–2287). Patients were divided into four groups, based in quartiles of serum Mg levels, and no significant differences were found regarding sex, age, pretransplantation cholesterol, albumin, triglycerides, body mass index, donor age and type, immunosuppressive regimen, use of Mg supplements, delayed graft function, acute rejection, CMV and HCV infection, or NODAT development. Patients with Mg < 1.6 mg/dL (n=80) had a higher frequency of prolonged (> 1 year) proton pump inhibitors use (90% vs. 81%, p=0.04), when compared to patients with Mg > 2 mg/dL (n=81). Using Cox multivariate regression analyses, adjusted for recipient age, donor age and type, immunosuppressive regimen, diabetes, NODAT and presence of acute rejection, graft survival was significantly reduced in the low Mg group after 4.6 years posttransplantion (p=0.001). Conclusions: Hypomagnesaemia 1-year posttransplantation, possibly related to prolonged use (> 1 year) of proton pump inhibitors, is associated with decreased graft survival in renal transplant recipients.conferenceObject Screening for Inherited and Acquired Thrombophilia Prior to Renal Transplantation(2013) SILVA, R.; MORAES, C.; MARQUES, I.; PAULA, F. de; DAVID-NETO, E.All patients with a history of a thromboembolic event, early or recurrent vascular access thrombosis, family history of thrombosis, or multiple miscarriages underwent laboratory screening for thrombophilia. Since the introduction of the screening for hypercoagulable risk factors, 156 candidates for renal transplantation underwent laboratory evaluation. Eighty-eight patients (56%) exhibited at least one prothrombotic laboratory parameter, besides of isolated hyperhomocysteinemia, which confirmed a thrombophilic state. Lupus anticoagulant, anticardiolipin and beta-2-glycoprotein was present in 30%, 18% and 13%, and antithrombin III, protein C and protein S deficiencies in 11%, 8% and 10%, respectively. Factor V Leiden mutation was present in only one patient and prothrombin gene G20210 mutation was not found. Among the 156 patients, 30 underwent renal transplantation and were followed for a median of 199 days (range, 9 – 418). All patients were on triple immunosuppressive regimen compromising mycophenolate, tacrolimus and prednisone. Thrombophilia was identified in 16 (53%). Seventeen (57%) received perioperative anticoagulation with unfractionated heparin (9 patients with thrombophilia and 8 without laboratory confirmed thrombophilia). Five (30%) of these patients developed perinephric hematomas. Three patients with thrombophilia developed thrombotic complications (2 upper limbs deep-vein thrombosis and 1 allograft artery thrombosis) and 1 patient without thrombophilia developed allograft vein thrombosis, p=0.35. Nine patients developed acute rejection (5 in the group with thrombophilia and 4 in the group without thrombophilia, p=0.87). Mean glomerular filtration rate was similar between thrombophilic and non-thrombophilic patients in the last follow-up (54±27 vs. 47±22 mL/min/1.73m², p=0.35). One graft loss and 1 patient death were observed in each group. In conclusion, prothrombotic risk factors, especially antiphospholipid antibodies, are highly prevalent in patients awaiting renal transplantation with a clinical or familial history suggestive of thrombophilia, including early and recurrent vascular access failure. Despite pre-transplant screening and perioperative treatment and/or monitoring, thrombotic and bleeding complications are still frequent and severe.conferenceObject SCREENING FOR INHERITED AND ACQUIRED THROMBOPHILIA PRIOR TO RENAL TRANSPLANTATION(2013) MARQUES, Igor Bacelar; SILVA, Raquel de Melo; MORAES, Cinthia Esbrile; AZEVEDO, Luiz Sergio; NAHAS, William Carlos; DAVID-NETO, EliasIntroduction and Aims: Renal allograft recipients with thrombophilia are at higher risk for early allograft loss, microvascular occlusion and acute rejection with major consequences for allograft survival. The aim of the present study was to evaluate the prevalence of prothrombotic risk factors in patients awaiting renal transplantation and its contribution to patient and transplant outcomes. Methods: All patients with a history of a thromboembolic event, early or recurrent vascular access thrombosis, family history of thrombosis, or multiple miscarriages underwent laboratory screening for thrombophilia. Results:Since the introduction of the screening for hypercoagulable risk factors, 156 candidates for renal transplantation underwent laboratory evaluation. Eighty-eight patients (56%) exhibited at least one prothrombotic laboratory parameter, besides of isolated hyperhomocysteinemia, which confirmed a thrombophilic state. Lupus anticoagulant, anticardiolipin and beta-2-glycoprotein was present in 30%, 18% and 13%, and antithrombin III, protein C and protein S deficiencies in 11%, 8% and 10%, respectively. Factor V Leiden mutation was present in only one patient and prothrombin gene G20210 mutation was not found. Among the 156 patients, 30 underwent renal transplantation and were followed for a median of 199 days (range, 9–418). All patients were on triple immunosuppressive regimen compromising mycophenolate, tacrolimus and prednisone. Thrombophilia was identified in 16 (53%). Seventeen (57%) received perioperative anticoagulation with unfractionated heparin (9 patients with thrombophilia and 8 without laboratory confirmed thrombophilia). Five (30%) of these patients developed perinephric hematomas. Three patients with thrombophilia developed thrombotic complications (2 upper limbs deep-vein thrombosis and 1 allograft artery thrombosis) and 1 patient without thrombophilia developed allograft vein thrombosis, p=0.35. Nine patients developed acute rejection (5 in the group with thrombophilia and 4 in the group without thrombophilia, p=0.87). Mean glomerular filtration rate was similar between thrombophilic and non-thrombophilic patients in the last follow-up (54±27 vs. 47±22 mL/min/1.73m², p=0.35). One graft loss and 1 patient death were observed in each group. Conclusions: Prothrombotic risk factors, especially antiphospholipid antibodies, are highly prevalent in patients awaiting renal transplantation with a clinical or familial history suggestive of thrombophilia, including early and recurrent vascular access failure. Despite pre-transplant screening and perioperative treatment and/or monitoring, thrombotic and bleeding complications are still frequent and severe.- Lower Serum Magnesium 1-Year Posttranplantation Is Associated with Decreased Graft Survival in Renal Transplant Recipients(2013) NIHEI, C.; MARQUES, I.; LIMA, L.; MAIA, R.; SEGURO, A.; DAVID-NETO, E.Hypomagnesaemia is a known side effect of immunosuppressive regimen, especially calcineurin inhibitors, and has been associated with new onset diabetes after transplantation (NODAT), decreased graft survival in chronic cyclosporine nephrotoxicity and vascular stiffness. Proton pump inhibitors-induced hypomagnesaemia has been described recently, although its relevance in renal transplant recipients is still unknown. We conducted a single center cross-sectional retrospective study of renal transplantations performed between 2006 and 2011 in order to evaluate the impact of low serum magnesium (Mg) levels in patient and graft outcomes. Serum Mg levels 1-year after renal transplantation were available for 316 patients. The median follow-up was 1062 days (range, 284 – 2287). Patients were divided into four groups, based in quartiles of serum Mg levels, and no significant differences were found regarding sex, age, pretransplantation cholesterol, albumin, triglycerides, body mass index, donor age and type, immunosuppressive regimen, use of Mg supplements, delayed graft function, acute rejection, CMV and HCV infection, or NODAT development. Patients with Mg < 1.6 mg/dL (n=80) had a higher frequency of prolonged (> 1 year) proton pump inhibitors use (90% vs. 81%, p=0.04), when compared to patients with Mg > 2 mg/dL (n=81). Using Cox multivariate regression analyses, adjusted for recipient age, donor age and type, immunosuppressive regimen, diabetes, NODAT, and presence of acute rejection, graft survival was significantly reduced in the low Mg group after 4.6 years posttransplantion (p=0.001). In conclusion, hypomagnesaemia 1-year posttransplantation, possibly related to prolonged use (> 1 year) of proton pump inhibitors, is associated with decreased graft survival in renal transplant recipients.