Epidemiological profile of the pancrêas-rim transplant and analysis of the immunological markers of rejection
Perfil epidemiológico do transplante pancrêas-rim e análise dos marcadores imunológicos de rejeição
Palavras-chave:
Immunological Markers, Pancreatic Transplantation, Kidney TransplantationResumo
INTRODUCTION: Pancreas-kidney transplantation is a therapy indicated for insulin-dependent patients and for end-stage chronic kidney disease secondary to Diabetes Mellitus (DM) and unstable DM, despite insulin treatment. The modalities established are: simultaneous pancreas-kidney; kidney followed by the pancreas and isolated pancreas. OBJECTIVE: To identify the epidemiological profile of pancreas-kidney transplantation in Brazil and analyze the immunological markers of rejection. MATERIAL AND METHODS: This is a descriptive, epidemiological study, with clinical analyses, carried out using the Brazilian Transplant Registry, as well as data from the National Transplant System. RESULTS: TSPR presents greater graft longevity and less rejection, when compared to TPAR and TIP. It is noted that the measurement of organ function by immunological monitoring, activated T cell expression and urinary/plasma assays are predictors of transplant viability. CONCLUSION: It was shown that transplants have greater graft longevity; acute rejection is better identified and life expectancy has increased among transplant recipients, providing improvements in independence and decent health conditions.
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Referências
Associação Brasileira de Transplante de Órgãos.Registro Brasileiro de Transplantes (RBT). São Paulo: Associação Brasileira de Transplante de Órgãos. Disponível em: https://site.abto.org.br/. Acesso em: 17 jun. 2021.
Brasil. Presidência da República. Lei nº 9.434, de 4 de fevereiro de 1997. Dispõe sobre a remoção de órgãos, tecidos e partes do corpo humano para fins de transplante e tratamento e dá outras providências [Internet]. Diário Oficial da União. Brasília, 5 fev. 1997. Disponível em: http://www.planalto.gov.br/ccivil_03/leis/L9434compilado.htm. Acesso em: 17 jun. 2021.
Brasil. Presidência da República. DECRETO Nº9.175, DE 18 DE OUTUBRO DE 2017. Dispõe sobre tratar da disposição de órgãos, tecidos, células e partes do corpo humano para fins de transplante e tratamento [Internet]. Diário Oficial da União. Brasília, 18 out. de 2017. Disponível em: D9175 (planalto.gov.br). Acesso em: 17 jun. 2021.
BRASIL. Ministério da Saúde. Departamento de Estatística do Sistema Único de Saúde (DATASUS). Sistema Nacional de Transplantes. Disponível em: http://www2.datasus.gov.br/DATASUS/index.php?area=061002. Acesso em: 17 jun. 2021.
DUFF, C. E.; SIMMONDS, M. J. Genetic predictors of long-term graft function in kidney and pancreas transplant patients. Briefings in Functional Genomics, [s. l.], v. 16, n. 4, p. 228–237, 2017.
DHOLAKIA, S. et al. “Advances in pancreas transplantation.” Journal of the Royal Society of Medicine, v. 109, n. 4, p. 141-6, 2016.
GUNASEKARAN, M. et al. “Development of immune response to tissue-restricted self-antigens in simultaneous kidney-pancreas transplant recipients with acute rejection.” Clinical Transplantation, v. 31, p. 8, 2017.
HAU, H. et al. “Short and long-term metabolic outcomes in patients with type 1 and type 2 diabetes receiving a simultaneous pancreas kidney allograft.” BMC endocrine disorders, v. 20, n. 1, p. 30. 27 Feb. 2020.
JIMENEZ VERA, E. et al. Standardisation of flow cytometry for whole blood immunophenotyping of islet transplant and transplant clinical trial recipients. PLoS ONE, [s. l.], v. 14, n. 5, p. 1–28, 2019.
KNIGHT, S. R. et al. “Donor-specific Cell-free DNA as a Biomarker in Solid Organ Transplantation. A Systematic Review.” Transplantation, v. 103, n. 2, p.273-283, 2019.
KHAMBALIA, H. A et al. “Links between a biomarker profile, cold ischaemic time and clinical outcome following simultaneous pancreas and kidney transplantation.” Cytokine, v. 105, p. 8-16, 2018.
LINDAHL, J. P. et al. “Cardiac Assessment of Patients With Type 1 Diabetes Median 10 Years After Successful Simultaneous Pancreas and Kidney Transplantation Compared With Living Donor Kidney Transplantation.” Transplantation, v. 101, n.6, p. 1261-1267, 2017.
MARÍN-CAÑAS, S. et al. Pancreatic ductal cells may have a negative effect on human islet transplantation. PLoS ONE, [s. l.], v. 14, n. 7, p. 1–16, 2019.
MEIRELLES JÚNIOR, R. F.; SALVALAGGIO, P.; PACHECO-SILVA, A. Transplante de pâncreas: revisão. Einstein (São Paulo), São Paulo, v. 13, n. 2, p. 305-309, Jun. 2015.
PONTRELLI, P. et al. “Interleukin-27 is a potential marker for the onset of post-transplant malignancies.” Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, v. 34, n.1, p. 157-166, 2019.
RODELO-HAAD, C. et al. “Pancreatic autoantibodies and CD14+CD16+ monocytes subset are associated with the impairment of ß-cell function after simultaneous pancreas-kidney transplantation.” PloS one, v. 14, n. 2 e0212547. 22 Feb. 2019
ROHAN, V. et al. “Impact of Type 1 and Type 2 Diabetes Mellitus on Pancreas Transplant Outcomes.” Experimental and Clinical Transplantation: Official Journal of the Middle East Society for Organ Transplantation, v. 17,n. 6, 2019.
SOARES, L. S. S. et al. Solid organ transplantation in Brazil: a descriptive study of distribution and access inequalities across the Brazilian territory, 2001-2017. Epidemiol. Serv. Saúde, Brasília, v. 29, n. 1, e2018512, Mar. 2020.
VAN DER TORREN, C. R. et al. Serum Cytokines as Biomarkers in Islet Cell Transplantation for Type 1 Diabetes. PLoS ONE, [s. l.], v. 11, n. 1, p. 1–13, 2016.
VALLABHAJOSYULA, P. et al. “Tissue-specific exosome biomarkers for noninvasively monitoring immunologic rejection of transplanted tissue.” The Journal of Clinical Investigation, v. 127, n. 4, p. 1375-1391, 2017.
VAIKUNTHANATHAN, T. et al. Regulatory T cells: tolerance induction in solid organ transplantation. Clinical & Experimental Immunology, [s. l.], v. 189, n. 2, p. 197–210, 2017.
XIE, W. Y et al. “Elevated C-peptide Levels Are Associated With Acute Rejection in Kidney Pancreas Transplantation.” Transplantation Proceedings, v. 52, n.3, p. 987-991, 2020.