Seguimiento por un año de la evolución del perfil cardiometabólico en pacientes trasplantados renales tratados con alemtuzumab, ciclosporina y esteroides en un hospital de referencia en Colombia
DOI:
https://doi.org/10.17533/udea.iatreia.v28n4a04Palabras clave:
enfermedad cardiovascular, factores de riesgo cardiovascular, trasplante renalResumen
Introducción: en los pacientes trasplantados renales los eventos cardiovasculares ocurren 50 veces más que en la población general y son la principal causa de muerte. El objetivo del estudio fue evaluar el comportamiento del perfil cardio-metabólico y determinar la frecuencia de eventos cardiovasculares mayores en el primer año del trasplante.
Métodos: estudio prospectivo en el que se evaluó el perfil cardio-metabólico en 67 pacientes adultos trasplantados durante el 2011.
Resultados: la edad promedio fue 44,3±12,05 años, 68,7 % eran hombres y 95,5 %, hipertensos. En el 89,6 % se empleó alemtuzumab-esteroides y ciclosporina e introducción tardía del antimetabolito. Se presentaron 3 diabetes mellitus postrasplante, 3 eventos cardiovasculares mayores y 12 rechazos agudos. Al año, la albúmina, la hemoglobina, el índice de masa corporal, el calcio y la HbA1C aumentaron con respecto al valor previo al trasplante (p<0,05), mientras que la paratohormona, el fósforo, la creatinina y el ácido úrico disminuyeron (p<0,05). La tasa de filtración glomerular (TFG) al año fue mayor en los pacientes sin rechazo (p 0,001).
Conclusión: la terapia inmunosupresora con alemtuzumab–ciclosporina- steroides mostró que al año del trasplante hubo mejoría significativa del metabolismo mineral óseo, el ácido úrico, la albúmina y la hemoglobina, pero empeoraron significativamente la HbA1c, el peso y el IMC, con una baja frecuencia de casos nuevos de diabetes mellitus y eventos cardiovasculares mayores.
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(1.) Ojo AO. Cardiovascular complications after renal transplantation and their prevention. Transplantation. 2006 Sep;82(5):603-11.
(2.) Wauters RP, Cosio FG, Suarez Fernandez ML, Kudva Y, Shah P, Torres VE. Cardiovascular consequences of new-onset hyperglycemia after kidney transplantation. Transplantation. 2012 Aug;94(4):377-82.
(3.) Cohen DJ, Vella JP. Nephrology Self-Assessment Program. Transplantation. Am Soc Nephrol. 2011 Nov;10(6):525-614.
(4.) Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999 Mar;130(6):461-70.
(5.) Pérez Rodriguez A, Leyva de la Torre C, Enamorado Casanova A, Pérez de Prado JC, Gutiérrez García F, Rodríguez Torres JC. Enfermedad Cardiovascular en Pacientes Con Trasplante Renal. Rev Cuba Med. 2014;53(1):37-49.
(6.) Rodelo JR, Nieto-Ríos JF, Serna-Higuita LM, Henao JE, García A, Reino AC, et al. Survival of renal transplantation patients older than 60 years: a single-center experience. Transplant Proc. 2013 May;45(4):1402-9.
(7.) Roberts L, Ramsaroop K, Seemungal T. Survival outcomes in renal transplantation in Trinidad and Tobago: SORTTT study. West Indian Med J. 2012 Jul;61(4):422-8.
(8.) Hanaway MJ, Woodle ES, Mulgaonkar S, Peddi VR, Kaufman DB, First MR, et al. Alemtuzumab induction in renal transplantation. N Engl J Med. 2011 May;364(20):1909-19.
(9.) Welberry Smith MP, Cherukuri A, Newstead CG, Lewington AJ, Ahmad N, Menon K, et al. Alemtuzumab induction in renal transplantation permits safe steroid avoidance with tacrolimus monotherapy: a randomized controlled trial. Transplantation. 2013 Dec;96(12):1082-8.
(10.) Brennan DC, Flavin K, Lowell JA, Howard TK, Shenoy S, Burgess S, et al. A randomized, double-blinded comparison of Thymoglobulin versus Atgam for induction immunosuppressive therapy in adult renal transplant recipients. Transplantation. 1999 Apr;67(7):1011-8. Erratum in: Transplantation 1999 May;67(10):1386.
(11.) Brennan DC, Daller JA, Lake KD, Cibrik D, Del Castillo D; Thymoglobulin Induction Study Group. Rabbit antithymocyte globulin versus basiliximab in renal transplantation. N Engl J Med. 2006 Nov;355(19):1967-77.
(12.) Ciancio G, Burke GW, Gaynor JJ, Roth D, Kupin W, Rosen A, et al. A randomized trial of thymoglobulin vs. alemtuzumab (with lower dose maintenance immunosuppression) vs. daclizumab in renal transplantation at 24 months of follow-up. Clin Transplant. 2008 Mar-Apr;22(2):200-10.
(13.) Ekberg H, Tedesco-Silva H, Demirbas A, Vítko S, Nashan B, Gürkan A, et al. Reduced exposure to calcineurin inhibitors in renal transplantation. N Engl J Med. 2007 Dec;357(25):2562-75.
(14.) Farney AC, Doares W, Rogers J, Singh R, Hartmann E, Hart L, et al. A randomized trial of alemtuzumab versus antithymocyte globulin induction in renal and pancreas transplantation. Transplantation. 2009 Sep;88(6):810-9.
(15.) Aakhus S, Dahl K, Widerøe TE. Cardiovascular disease in stable renal transplant patients in Norway: morbidity and mortality during a 5-yr follow-up. Clin Transplant. 2004 Oct;18(5):596-604.
(16.) Watson CJ, Bradley JA, Friend PJ, Firth J, Taylor CJ, Bradley JR, et al. Alemtuzumab (CAMPATH 1H) induction therapy in cadaveric kidney transplantation--efficacy and safety at five years. Am J Transplant. 2005 Jun;5(6):1347-53.
(17.) Ocampo C, Aristizabal A, Nieto J, Abadia H, Angel W, Guzman C, et al. Induction therapies in kidney transplantation: the experience of Hospital Pablo Tobon Uribe, Medellín, Colombia 2005-2010. Transplant Proc. 2011 Nov;43(9):3359-63.
(18.) Clatworthy MR, Friend PJ, Calne RY, Rebello PR, Hale G, Waldmann H, et al. Alemtuzumab (CAMPATH-1H) for the treatment of acute rejection in kidney trans-plant recipients: long-term follow-up. Transplantation. 2009 Apr;87(7):1092-5.
(19.) Resende L, Guerra J, Santana A, Mil-Homens C, Abreu F, da Costa AG. First year renal function as a predictor of kidney allograft outcome. Transplant Proc. 2009 Apr;41(3):846-8.
(20.) Fonseca I, Almeida M, Martins LS, Santos J, Dias L, Lobato L, et al. First-year renal function predicts long-term renal allograft loss. Transplant Proc. 2011 Jan-Feb;43(1):106-12.
(21.) Guerra J, Raimundo M, Teixeira C, Santana A, Cor-tesão A, Gomes da Costa A. Factors that may influence estimated glomerular filtration rate in patients with excellent graft function 10 years posttransplant. Transplant Proc. 2013 Apr;45(3):1060-2.
(22.) Kontodimopoulos N, Niakas D. An estimate of life-long costs and QALYs in renal replacement therapy based on patients’ life expectancy. Health Policy. 2008 Apr;86(1):85-96.
(23.) Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999 Dec;341(23):1725-30.
(24.) Rebollo P, Ortega F, Baltar JM, Díaz-Corte C, Navas-cués RA, Naves M, et al. Health-related quality of life (HRQOL) in end stage renal disease (ESRD) patients over 65 years. Geriatr Nephrol Urol. 1998;8(2):85-94.
(25.) Evenepoel P, Claes K, Kuypers D, Maes B, Bammens B, Vanrenterghem Y. Natural history of parathyroid function and calcium metabolism after kidney trans-plantation: a single-centre study. Nephrol Dial Transplant. 2004 May;19(5):1281-7.
(26.) Reinhardt W, Bartelworth H, Jockenhövel F, Schmidt-Gayk H, Witzke O, Wagner K, et al. Sequential changes of biochemical bone parameters after kid-ney transplantation. Nephrol Dial Transplant. 1998 Feb;13(2):436-42.
(27.) Jones H, Talwar M, Nogueira JM, Ugarte R, Cangro C, Rasheed H, et al. Anemia after kidney transplantation; its prevalence, risk factors, and independent association with graft and patient survival: a time-varying analysis. Transplantation. 2012 May;93(9):923-8.
(28.) Lofaro D, Greco R, Papalia T, Bonofiglio R. Increasing levels of hemoglobin improve renal transplantation outcomes. Transplant Proc. 2011 May;43(4):1036-8.
(29.) Chung BH, Kang SH, Hwang HS, Choi BS, Park CW, Kim YS, et al. Clinical significance of early-onset hyperuricemia in renal transplant recipients. Nephron Clin Pract. 2011;117(3):c276-83.
(30.) Rabbat CG, Thorpe KE, Russell JD, Churchill DN. Comparison of mortality risk for dialysis patients and cadaveric first renal transplant recipients in Ontario, Canada. J Am Soc Nephrol. 2000 May;11(5):917-22.
(31.) Oniscu GC, Brown H, Forsythe JL. Impact of cadaveric renal transplantation on survival in patients
IATREIA Vol 28(4) octubre-diciembre 2015399listed for transplantation. J Am Soc Nephrol. 2005 Jun;16(6):1859-65.
(32.) Port FK, Wolfe RA, Mauger EA, Berling DP, Jiang K. Comparison of survival probabilities for dialysis patients vs cadaveric renal transplant recipients. JAMA. 1993 Sep;270(11):1339-43.
(33.) United States Renal Data System. Annual Data Report 2014: an overview of the Epidemiology of Kidney Disease in the United States [Internet]. Bethesda: NIH; 2014 [consultado 2014 Feb 23]. Disponible en: http://www.usrds.org/adr.aspx
(34.) American Diabetes Association. Standards of medical care in diabetes--2014. Diabetes Care. 2014 Jan;37 Suppl 1:S14-80.
(35.) Heisel O, Heisel R, Balshaw R, Keown P. New onset diabetes mellitus in patients receiving calcineurin inhibitors: a systematic review and meta-analysis. Am J Transplant. 2004 Apr;4(4):583-95.
(36.) Vincenti F, Friman S, Scheuermann E, Rostaing L, Jenssen T, Campistol JM, et al. Results of an international, randomized trial comparing glucose metabolism disorders and outcome with cyclosporine versus tacrolimus. Am J Transplant. 2007 Jun;7(6):1506-14. Erratum in: Am J Transplant. 2008 Jan;8(1):1. Am J Transplant. 2008 Apr;8(4):908.
(37.) Burroughs TE, Lentine KL, Takemoto SK, Swindle J, Machnicki G, Hardinger K, et al. Influence of early posttransplantation prednisone and calcineurin inhibitor dosages on the incidence of new-onset diabetes. Clin J Am Soc Nephrol. 2007 May;2(3):517-23.
(38.) Inaba M, Okuno S, Kumeda Y, Yamada S, Imanishi Y, Tabata T, et al. Glycated albumin is a better glyce-mic indicator than glycated hemoglobin values in hemodialysis patients with diabetes: effect of anemia and erythropoietin injection. J Am Soc Nephrol. 2007 Mar;18(3):896-903.
(39.) Ng JM, Cooke M, Bhandari S, Atkin SL, Kilpatrick ES. The effect of iron and erythropoietin treatment on the A1C of patients with diabetes and chronic kidney disease. Diabetes Care. 2010 Nov;33(11):2310-3.
(40.) Shabir S, Jham S, Harper L, Ball S, Borrows R, Sharif A. Validity of glycated haemoglobin to diagnose new onset diabetes after transplantation. Transpl Int. 2013 Mar;26(3):315-21.
(41.) Kasiske BL, Snyder JJ, Gilbertson D, Matas AJ. Diabetes mellitus after kidney transplantation in the United States. Am J Transplant. 2003 Feb;3(2):178-85.
(42.) Bayer ND, Cochetti PT, Anil Kumar MS, Teal V, Huan Y, Doria C, et al. Association of metabolic syndrome with development of new-onset diabetes after transplantation. Transplantation. 2010 Oct;90(8):861-6.
(43.) Cosio FG, Kudva Y, van der Velde M, Larson TS, Textor SC, Griffin MD, et al. New onset hyperglycemia and diabetes are associated with increased cardiovascular risk after kidney transplantation. Kidney Int. 2005 Jun;67(6):2415-21.
(44.) Santos L, Rodrigo E, Piñera C, Quintella E, Ruiz JC, Fernández-Fresnedo G, et al. New-onset diabetes after transplantation: drug-related risk factors. Transplant Proc. 2012 Nov;44(9):2585-7.
(45.) Jardine AG, Gaston RS, Fellstrom BC, Holdaas H. Prevention of cardiovascular disease in adult recipients of kidney transplants. Lancet. 2011 Oct;378(9800):1419-27.
(46.) Holdaas H, Fellström B, Holme I, Nyberg G, Fauchald P, Jardine A, et al. Effects of fluvastatin on cardiac events in renal transplant patients: ALERT (Assessment of Lescol in Renal Transplantation) study design and baseline data. J Cardiovasc Risk. 2001 Apr;8(2):63-71.
(47.) Holdaas H, Fellström B, Jardine AG, Nyberg G, Grönhagen-Riska C, Madsen S, et al. Beneficial effect of early initiation of lipid-lowering therapy following renal transplantation. Nephrol Dial Transplant. 2005 May;20(5):974-80.
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