Publications by authors named "Luis A Evangelista-Carrillo"

3 Publications

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Cytomegalovirus in Renal Transplant Recipients from Living Donors with and without Valgancyclovir Prophylaxis and with Immunosuppression Based in Anti-thymocyte globulin or Basiliximab.

Int J Infect Dis 2021 Apr 13. Epub 2021 Apr 13.

Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Mexico.

Background: In our population, anti-thymocyte globulin (ATG) of 1 mg/Kg/day for 4 days is used; which permits not using valgancyclovir (VGC) prophylaxis in some renal transplant recipients (RTR) of moderate risk (R+), to reduce costs. Our objective was to determine the incidence and risk for the development of cytomegalovirus (CMV) with or without prophylaxis, when exposed to low doses of ATG or basiliximab (BSL).

Patients And Methods: A retrospective cohort included 265 RTRs with follow up of 12 months. Prophylaxis was used in R-/D + and only some R + . Tacrolimus (TAC), mycophenolate mofetil (MMF), and prednisone (PDN) were used in all patients. Logistic regression analysis was performed to estimate the risk of CMV in RTR with or without VGC.

Results: Cytomegalovirus was documented in 46 (17.3%) patients: twenty (43.5%) with CMV infection, and 26 (56.5%) with CMV disease. Anti-thymocyte globulin was used in 39 (85%): 32 "R+", 6 "D+/R-," and 1 "D-/R-". In 90% (27/30) of patients with CMV and without prophylaxis, ATG was used. The multivariate analysis showed an association of risk for CMV with the absence of prophylaxis (RR 2.29; CI 95%, 1,08-4.86), ATG use (RR 3.7; CI 95%, 1.50-9.13), TAC toxicity (RR 3,77; CI 95%, 1,41 -10,13), and lymphocytes at the sixth post-transplant month (RR 1,77; CI 95%, 1,0-3.16).

Conclusions: Low doses of ATG favor the development of CMV and a lower survival free of CMV compared with BSL. In scenarios where resources for employing VGC are limited, one acceptable strategy could be the use of BSL.
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http://dx.doi.org/10.1016/j.ijid.2021.04.032DOI Listing
April 2021

Donor-specific antibodies development in renal living-donor receptors: Effect of a single cohort.

Int J Immunopathol Pharmacol 2021 Jan-Dec;35:20587384211000545

Department of Physiology, University Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, México.

Minimization in immunosuppression could contribute to the appearance the donor-specific HLA antibodies (DSA) and graft failure. The objective was to compare the incidence of DSA in renal transplantation (RT) in recipients with immunosuppression with and without steroids. A prospective cohort from March 1st, 2013 to March 1st, 2014 and follow-up (1 year), ended in March 2015, was performed in living donor renal transplant (LDRT) recipients with immunosuppression and early steroid withdrawal (ESW) and compared with a control cohort (CC) of patients with steroid-sustained immunosuppression. All patients were negative cross-matched and for DSA pre-transplant. The regression model was used to associate the development of DSA antibodies and acute rejection (AR) in subjects with immunosuppressive regimens with and without steroids. Seventy-seven patients were included (30 ESW and 47 CC). The positivity of DSA class I (13% vs 2%;  < 0.05) and class II (17% vs 4%,  = 0.06) antibodies were higher in ESW versus CC. The ESW tended to predict DSA class II (RR 5.7; CI (0.93-34.5,  = 0.06). T-cell mediated rejection presented in 80% of patients with DSA class I ( = 0.07), and 86% with DSA II ( = 0.03), and was associated with DSA class II, (RR 7.23; CI (1.2-44),  = 0.03). ESW could favor the positivity of DSA. A most strictly monitoring the DSA is necessary for the early stages of the transplant to clarify the relationship between T-cell mediated rejection and DSA.
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http://dx.doi.org/10.1177/20587384211000545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020398PMC
March 2021

Early steroid withdrawal in a renal transplant cohort treated with tacrolimus, mycophenolate mofetil and basiliximab.

Nefrologia 2014 ;34(2):216-22

Background: Acute rejection and graft function have not been completely clarified in early-steroid-withdrawal (ESW) patients. The objective of this study was to compare the effect of early steroid withdrawal on GFR, graft survival/rejection in recipients in a cohort treated with tacrolimus/mycophenolate mofetil compared to a control cohort.

Material And Method: Retrospective cohort, in 60 low immunological risk recipients between December 2005 and July 2010. Study cohort (ESW-C N=32), steroid withdrawal was carried out after 5 days, while they were receiving tacrolimus/mycophenolate mofetil. The control cohort (C-C, N=28) received prednisone/tacrolimus/mycophenolate mofetil. Clinical, biochemical and histological variables were assessed at baseline and after 3, 6, and 12 months of follow-up. Kaplan-Meier and the Cox proportional hazards model were used to assess survival. Comparisons between cohorts were carried out by the Student's t and c2 tests.

Results: At follow-up, C-C displayed significantly higher systolic (125 ± 10 vs. 114 ± 8) and diastolic (81 ± 8 vs. 72 ± 7) blood pressure, serum glucose (96 ± 13 vs. 86 ± 10), triglycerides (177 ± 61 vs. 129 ± 34), total (183 ± 43 vs. 148 ± 34) and LDL-cholesterol (100 ± 22 vs. 87 ± 25). C-C had a higher proportion of antihypertensive (57 vs. 13%), and statins (27 vs. 9%) use. eGFR was better in ESW-C than in C-C (85.4 ± 20.6 vs. 70.6 ± 17.0, p=.004). AR frequency was lower in ESW-C.

Conclusions: Graft survival, GFR, AR rate and metabolic profile were better in the ESW-C than in C-C.
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http://dx.doi.org/10.3265/Nefrologia.pre2013.Dec.12028DOI Listing
July 2015