{"id":114544,"date":"2018-03-11T10:42:36","date_gmt":"2018-03-11T10:42:36","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/factores-pronosticos-que-influyen-en-la-supervivencia-del-injerto-renal-a-largo-plazo-en-la-region-de-murcia\/"},"modified":"2018-03-11T10:42:36","modified_gmt":"2018-03-11T10:42:36","slug":"factores-pronosticos-que-influyen-en-la-supervivencia-del-injerto-renal-a-largo-plazo-en-la-region-de-murcia","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/nefrologia\/factores-pronosticos-que-influyen-en-la-supervivencia-del-injerto-renal-a-largo-plazo-en-la-region-de-murcia\/","title":{"rendered":"Factores pron\u00f3sticos que influyen en la supervivencia del injerto renal a largo plazo en la regi\u00f3n de murcia"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Florentina Rosique Lopez <\/strong><\/h2>\n<p>Objetivos 1.- Conocer la supervivencia del injerto renal de donante cad\u00e1ver a los 120 meses del trasplante y analizar las causas de p\u00e9rdida del injerto. 2.- Comparar la supervivencia del injerto renal y las causas de p\u00e9rdida del mismo a los 60 meses entre 2 d\u00e9cadas bien diferenciadas: 1985-1995\/1996-2005. 3.-Tras excluir aquellos injertos perdidos en los primeros 6 meses, valorar todos aquellos factores que podr\u00edan influir en la supervivencia a largo plazo del injerto.  4.- Valorar la evoluci\u00f3n de la funci\u00f3n renal a lo largo del tiempo comparando aquellos factores que hab\u00edan influido significativamente en la supervivencia del injerto a los 10 a\u00f1os.   material y m\u00e9todos todos los receptores con injertos de donante cad\u00e1ver, trasplantados en nuestro hospital desde julio\/1985 hasta 31\/diciembre\/2005 fueron incluidos. Supervivencia del injerto, causa de p\u00e9rdida del injerto y funci\u00f3n renal a los 60 y 120 meses fueron recogidos. Adem\u00e1s se compar\u00f3 la supervivencia del injerto y las causas de p\u00e9rdida a los 60 meses entre dos d\u00e9cadas. Finalmente, los siguientes factores fueron analizados: caracter\u00edsticas demogr\u00e1ficas del donante y receptor, causa de muerte, rechazo agudo precoz y tard\u00edo, retraso en la funci\u00f3n inicial del injerto, anticuerpos reactivos contra el panel, tiempo de isquemia fr\u00eda, enfermedad por citomegalovirus, pielonefritis aguda, n\u00famero de incompatibilidades hla, transfusiones pretrasplante, sexo del receptor, sexo del donante, edad del receptor, presencia del virus de la hepatitis c.  conclusiones 1.- La supervivencia global del injerto fue del 55,33% a los 120 meses, siendo el rechazo cr\u00f3nico responsable de la p\u00e9rdida en aproximadamente la mitad de los casos.  2.- Al comparar los 2 per\u00edodos se objetiv\u00f3 una  mejor\u00eda notable  de la supervivencia a los 60 meses, siendo en el segundo per\u00edodo de un 77,9% y en el primer per\u00edodo de un 61,3%.  3.- Al comparar las causas de p\u00e9rdida del injerto renal se observ\u00f3 en el segundo per\u00edodo una disminuci\u00f3n importante de las trombosis vasculares y complicaciones t\u00e9cnicas, as\u00ed como del rechazo cr\u00f3nico,  rechazo hiperagudo y rechazo agudo, sin embargo, aument\u00f3 en el segundo per\u00edodo el \u00e9xitus del paciente con ri\u00f1\u00f3n funcionante de causa neopl\u00e1sica, por sepsis y  causa cardiovascular. Esto parece deberse a la mayor potencia de los nuevos inmunosupresores disponibles.  4.- Aquellos injertos que eran funcionantes a los 6 meses del trasplante tuvieron una supervivencia del 95% a los 60 meses y del 82% a los 120 meses.  5.- Edad donante &gt; 60 a\u00f1os, retraso en la funci\u00f3n inicial del injerto, causa de muerte del donante de causa cerebrovascular, injertos enviados, rechazo agudo tard\u00edo, t\u00edtulo de anticuerpos citot\u00f3xicos &gt;10% tuvieron una influencia negativa en la supervivencia del injerto a largo plazo.  6.- El tiempo de isquemia fr\u00eda &gt; 12 horas solo fue un factor negativo significativo si donante &gt; 60 a\u00f1os.  7.- No influyeron en la supervivencia del injerto la enfermedad por cmv, pielonefritis aguda, virus hepatitis c, n\u00famero de incompatibilidades hla, pra m\u00e1ximo, transfusiones pre-trasplante, sexo del receptor, sexo del donante, edad del receptor, rechazo agudo precoz y tiempo de isquemia fr\u00eda.  8.- En lo referente a la funci\u00f3n renal fue peor al a\u00f1o del trasplante en aquellos injertos con factores que influyeron negativamente sobre la supervivencia del injerto a largo plazo, sin embargo, esta funci\u00f3n renal se mantuvo bastante estable a lo largo del tiempo al menos hasta el 7\u00c2\u00ba-8\u00c2\u00ba a\u00f1o, excepto los injertos que presentaron rechazo agudo tard\u00edo que sufrieron un deterioro r\u00e1pido de la funci\u00f3n renal durante la evoluci\u00f3n.  9.- A pesar del cambio del perfil del donante y el receptor, los nuevos inmunosupresores, la inducci\u00f3n de tolerancia y otros avances en el campo del trasplante renal nos ayudar\u00e1n sin duda alguna, a seguir mejorando nuestros resultados.   abstract aims:  1.- To know graft survival rate in cadaver donor renal transplantation at 120 months and analyze the causes of graft loss. 2.- To compare renal graft survival rate and causes of loss  at 60 months between two distinct decades: 1985-1995\/1996-2005. 3.- After excluding those grafts lost in the first six months, to assess all the factors which could influence graft survival in the long term. 4.-  To assess the evolution of renal function over time comparing those factors which had significantly influenced graft survival at 10 years.  materials and methods: all kidney-only recipients from deceased donors, transplanted in our hospital from 30 july 1985 to 31 december 2005 were included. Graft survival rate, cause of graft loss and renal function at 60 and 120 months were recorded. In addition, we compared the graft survival and causes of loss at 60 months between two decades. And finally, the following factors were analyzed: donor and receptor demographics, cause of death, early and late rejection, delayed graft function, panel reactive antibodies, hla compatibilities, cold ischemia time, cytomegalovirus disease, acute pyelonephritis, number of hla mismatches, pretransplant transfusions, recipient sex, donor sex, recipient age, hepatitis c virus.  conclusions: 1.\tThe overall survival of cadaveric renal grafts was 55.33% at 120 months, chronic rejection being responsible for the loss in about half of the cases. 2.\tWhen comparing the 2 periods, there was a significant improvement in survival at 60 months: 61.3% and 77.9% in the first and the second period respectively. 3.\tWhen comparing the causes of graft loss, a significant decrease of technical complications and chronic and acute rejection was observed in the second period. However, death with a functioning kidney because of neoplasias, sepsis and cardiovascular diseases increased in the second period.  4.\tThose grafts that were functional at 6 months after transplantation had a survival of 95% at 60 months and 82% at 120 months. 5.\tDonor age&gt; 60 years, delayed initial graft function, donor cause of death cerebrovascular cause, shipped grafts, late acute rejection, cytotoxic antibody titer&gt; 10% had a negative influence on graft survival long term. 6.\tThe cold ischemia time&gt; 12 hours was only a significant negative factor if donor&gt; 60 years 7.\tCytomegalovirus disease, acute pyelonephritis, hepatitis c virus, number of hla mismatches, panel reactive antibodies maximum pre-transplant transfusions, sex of the recipient, donor sex, recipient age, early acute rejection and cold ischemia time did not influence graft survival. 8.\tRenal function was worse a year after in those grafts with factors that negatively influenced graft survival in the long term. However, renal function remained steady over time at least until 7-8th year. Only grafts that suffered late acute rejection, underwent a rapid deterioration of renal function during evolution.  9.\tDespite the change in the characteristics of donor a recipient, new immunosuppressants, the induction of tolerance and other advances in the field of renal transplantation undoubtedly will help us to further improve our results.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Factores pron\u00f3sticos que influyen en la supervivencia del injerto renal a largo plazo en la regi\u00f3n de murcia<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Factores pron\u00f3sticos que influyen en la supervivencia del injerto renal a largo plazo en la regi\u00f3n de murcia <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Florentina Rosique Lopez <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 19\/07\/2013<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Luisa Jimeno Garcia<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: joaqu\u00edn G\u00f3mez g\u00f3mez <\/li>\n<li>M\u00aa asunci\u00f3n Sancho calabuig (vocal)<\/li>\n<li>Luis Pallard\u00f3 (vocal)<\/li>\n<li>bartolome Garcia perez (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Florentina Rosique Lopez Objetivos 1.- Conocer la supervivencia del injerto renal de donante cad\u00e1ver a los 120 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