Renal transplantation in high cardiovascular risk patients

Current transplant success allows recipients with previous contraindications to transplant to have access to this procedure with more frequency and safety. The concept of high-risk patient has changed since the first stages of transplantation. In the first studies, the high-risk concept was based on...

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Autores principales: Bittar, Julio, Arenas, Paula Gabriela, Chiurchiu, Carlos, De La Fuente, Jorge, De Arteaga, Javier, Douthat, Walter Guillermo, Massari, Pablo U.
Formato: Artículo PeerReviewed
Lenguaje:Español
Publicado: W.B. Saunders 2009
Materias:
R Medicina (General)
Acceso en línea:http://pa.bibdigital.ucc.edu.ar/4956/1/A_Bittar.pdf
Aporte de:
Producción Académica Universidad Católica de Córdoba (UCCor) de Universidad Católica de Córdoba
id I38-R144-4956
record_format dspace
spelling I38-R144-49562025-10-28T14:32:06Z http://pa.bibdigital.ucc.edu.ar/4956/ Renal transplantation in high cardiovascular risk patients Bittar, Julio Arenas, Paula Gabriela Chiurchiu, Carlos De La Fuente, Jorge De Arteaga, Javier Douthat, Walter Guillermo Massari, Pablo U. R Medicina (General) Current transplant success allows recipients with previous contraindications to transplant to have access to this procedure with more frequency and safety. The concept of high-risk patient has changed since the first stages of transplantation. In the first studies, the high-risk concept was based on probability of early graft failure or on a patient's clinical condition to cope with high perioperatory morbimortality. Later on, this concept implied immunological factors that were crucial to ensure transplant success because hypersensitized or polytransfused patients experienced a higher risk of acute rejection and subsequent graft loss. Afterward, the presence of various comorbidities would redefine the high-risk concept for renal transplant mainly considering recipient's clinical aspects. Currently, the change in epidemiological characteristics of patients starting dialysis causes that we now deal with a greater increase of elderly patients, diabetic patients, and patients with history of cardiovascular disease. Today, high-risk patients are those with clinical features that predict an increase in the risk of perioperative morbimortality or death with functioning graft. In this review, we will attempted to analyze currents results of renal transplant outcomes in terms of patients and graft survival in elderly patients, diabe tic patients, and patients with previous cardiovascular disease from the most recent experiences in the literature and from experiences in our center. In any of the groups previously analyzed, survival offered by renal transplant is significantly higher compared to dialysis. Besides, these patients are the recipient group that benefit the most with the transplant because their mortality while remaining on dialysis is extremely high. Hence, renal transplantation should be offered more frequently to older patients, diabetic patients, and patients with pretransplant cardiac and peripheral vascular disease. A positive attitude toward renal transplantation is needed by physicians taking care of these patients from predialysis stages of chronic renal failure. W.B. Saunders 2009-12-31 info:eu-repo/semantics/closedAccess Artículo PeerReviewed application/pdf spa http://pa.bibdigital.ucc.edu.ar/4956/1/A_Bittar.pdf Bittar, Julio, Arenas, Paula Gabriela, Chiurchiu, Carlos, De La Fuente, Jorge, De Arteaga, Javier, Douthat, Walter Guillermo ORCID: https://orcid.org/0000-0002-4644-6003 <https://orcid.org/0000-0002-4644-6003> and Massari, Pablo U. (2009) Renal transplantation in high cardiovascular risk patients. Transplantation Reviews, 23 (4). pp. 224-234. info:eu-repo/semantics/altIdentifier/doi/10.1016/j.trre.2009.02.001
institution Universidad Católica de Córdoba
institution_str I-38
repository_str R-144
collection Producción Académica Universidad Católica de Córdoba (UCCor)
language Español
orig_language_str_mv spa
topic R Medicina (General)
spellingShingle R Medicina (General)
Bittar, Julio
Arenas, Paula Gabriela
Chiurchiu, Carlos
De La Fuente, Jorge
De Arteaga, Javier
Douthat, Walter Guillermo
Massari, Pablo U.
Renal transplantation in high cardiovascular risk patients
topic_facet R Medicina (General)
description Current transplant success allows recipients with previous contraindications to transplant to have access to this procedure with more frequency and safety. The concept of high-risk patient has changed since the first stages of transplantation. In the first studies, the high-risk concept was based on probability of early graft failure or on a patient's clinical condition to cope with high perioperatory morbimortality. Later on, this concept implied immunological factors that were crucial to ensure transplant success because hypersensitized or polytransfused patients experienced a higher risk of acute rejection and subsequent graft loss. Afterward, the presence of various comorbidities would redefine the high-risk concept for renal transplant mainly considering recipient's clinical aspects. Currently, the change in epidemiological characteristics of patients starting dialysis causes that we now deal with a greater increase of elderly patients, diabetic patients, and patients with history of cardiovascular disease. Today, high-risk patients are those with clinical features that predict an increase in the risk of perioperative morbimortality or death with functioning graft. In this review, we will attempted to analyze currents results of renal transplant outcomes in terms of patients and graft survival in elderly patients, diabe tic patients, and patients with previous cardiovascular disease from the most recent experiences in the literature and from experiences in our center. In any of the groups previously analyzed, survival offered by renal transplant is significantly higher compared to dialysis. Besides, these patients are the recipient group that benefit the most with the transplant because their mortality while remaining on dialysis is extremely high. Hence, renal transplantation should be offered more frequently to older patients, diabetic patients, and patients with pretransplant cardiac and peripheral vascular disease. A positive attitude toward renal transplantation is needed by physicians taking care of these patients from predialysis stages of chronic renal failure.
format Artículo
PeerReviewed
author Bittar, Julio
Arenas, Paula Gabriela
Chiurchiu, Carlos
De La Fuente, Jorge
De Arteaga, Javier
Douthat, Walter Guillermo
Massari, Pablo U.
author_facet Bittar, Julio
Arenas, Paula Gabriela
Chiurchiu, Carlos
De La Fuente, Jorge
De Arteaga, Javier
Douthat, Walter Guillermo
Massari, Pablo U.
author_sort Bittar, Julio
title Renal transplantation in high cardiovascular risk patients
title_short Renal transplantation in high cardiovascular risk patients
title_full Renal transplantation in high cardiovascular risk patients
title_fullStr Renal transplantation in high cardiovascular risk patients
title_full_unstemmed Renal transplantation in high cardiovascular risk patients
title_sort renal transplantation in high cardiovascular risk patients
publisher W.B. Saunders
publishDate 2009
url http://pa.bibdigital.ucc.edu.ar/4956/1/A_Bittar.pdf
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AT dearteagajavier renaltransplantationinhighcardiovascularriskpatients
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