Hepatitis: Campistol JM

Barril G, González Parra E, Alcázar R, Arenas D, Campistol JM, Caramelo C, Carrasco M, Carreño V, Espinosa M, García Valdecasas J, Górriz JL, López MD, Martín L, Ruiz P, Terruel JL, Anonymous00170. · Nefrólogo Hosp. Universitario de La Princesa, Madrid. · Nefrologia. · Pubmed #15085792 No free full text.

Abstract: The viric infections influence morbi-mortality in Chronic kidney Disease patients in hemodialysis therapy and can affect to the Staff of the Units. The guides considered the most relevant virus at the present moment: C Virus, B Virus and HIV. To prevent horizontal nosocomial transmission is necessary the observance always the universal precautions in the HD units, although sometimes can appeared seroconversions and epidemic bud when exist a break of these. Is analyzed different situations with special focus in units for acute patients. The following steps under the suspicious of the epidemic bud appeared in one of the annexes together with legislation according to this case. Respect to the staff in every one of the virus is shown prevention patterns, serologic markers to perform when an accident with infected blood occur, also is considered when treatment is indicated. The guides considered too the conditions necessary for include these patients on waiting list for kidney transplantation.

Esforzado N, Morales JM, Campistol JM. · Unidad de Trasplante Renal, Hospital Clínic, IDIBAPS, Barcelona. · Gastroenterol Hepatol. · Pubmed #15324627 No free full text.

This publication has no abstract.

Morales JM, Campistol JM, Dominguez-Gil B. · Renal Transplant Unit, Nephrology Department, Hospital Universitario 12 de Octubre, Barcelona, Spain. · Semin Nephrol. · Pubmed #12118402 No free full text.

Abstract: Hepatitis C virus (HCV) infection is an important problem in the patient with end-stage renal disease. After transplantation, liver disease is more frequent in HCV-positive patients than in HCV-negative patients. In the long run, this leads to important liver complications. The patients have a higher risk for developing proteinuria and infections. Long-term patient and graft survival rates are lower in HCV-positive patients than in HCV-negative graft recipients. Mortality is higher, mainly as a result of liver disease and infections. Despite this, transplantation is the best option for the HCV-positive patient with end-stage renal disease. Transplantation of HCV-positive kidneys should be offered to HCV-positive recipients in whom HCV RNA is detected in the serum. Finally, several measures after transplantation minimize the consequences of HCV infection. Adjustment of immunosuppression and careful follow-up in the outpatient clinic for early detection of proteinuria, infection, or worsening of liver disease are mandatory.

Campistol JM, Esforzado N, Morales JM. · Renal Transplant Unit, Hospital Clinic, University of Barcelona, Institut d'Investigació Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. · Semin Nephrol. · Pubmed #12118401 No free full text.

Abstract: Hepatitis C virus (HCV) infection is a common problem in renal transplant patients, associated with an increase in morbidity and mortality. HCV infection is associated with a lower graft and patient survival. The problem of HCV infection is the increase in viral load and liver transaminases after renal transplantation secondary to immunosuppressive therapy. After renal transplantation, interferon therapy is not recommended because of the risk for acute rejection and acute nephritis. In this context, it is absolutely necessary to consider the evaluation and treatment of HCV infection during the dialysis period. Several studies have defined the benefits of interferon therapy in dialysis patients, with rates of maintenance response significantly higher than in the general population. The difference in the pharmacokinetic profile of interferon in dialysis patients could justify its higher efficacy.

Campistol JM, Esforzado N, Morales JM, Barrera JM. · Unidad de Trasplante Renal, Hospital Clínic, IDIBAPS (Institut d'Investigació Biomedique Agusti Pi i Sunyer), Universidad de Barcelona, Barcelona, Hospital 12 de Octubre, Madrid. · Nefrologia. · Pubmed #12107920 No free full text.

This publication has no abstract.

Morales JM, Campistol JM, Andrés A, Dominguez-Gil B, Esforzado N, Muñoz MA, Bruguera M, Oppenheimer F, Rodicio JL. · Nephrology Department, Hospital 12 de Octubre, Universidad Complutense, Madrid Spain. · Nephrol Dial Transplant. · Pubmed #11261711 links to  free full text

This publication has no abstract.

Morales JM, Campistol JM. · Renal Transplant Unit, Nephrology Department, Hospital Universitario Madrid, Spain. · J Am Soc Nephrol. · Pubmed #10864593 links to  free full text

This publication has no abstract.

Campistol JM, Esforzado N, Martínez J, Roselló L, Veciana L, Modol J, Casellas J, Pons M, de Las Cuevas X, Piera J, Oliva JA, Costa J, Barrera JM, Bruguera M. · Renal Transplant Unit, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain. · Nephrol Dial Transplant. · Pubmed #10534516 links to  free full text

Abstract: BACKGROUND: Hepatitis C virus (HCV) infection represents an important problem for the dialysis population due to its high prevalence and the long-term development of chronic liver disease, particularly following renal transplantation. METHODS: In order to assess the efficacy and tolerance of interferon (IFN) in the treatment of chronic hepatitis C in haemodialysis (HD) patients and their clinical course following renal transplantation, a multicentre, randomized, open-label study was conducted to compare IFN therapy vs a control group. RESULTS: Nineteen HCV RNA-positive patients received 3 x 10(6) U of IFN s.c., three times a week (post-HD), and 17 HCV RNA-positive patients were assigned to the control group. Tolerance to IFN therapy was good in nine patients, while treatment was discontinued in the other 10 due to the occurrence of side effects. HCV RNA was negative at the end of treatment in 14 out of 19 patients (74%) receiving IFN and in one patient (5%) in the control group. Six out of the 14 patients who initially responded to IFN therapy had a virological relapse (43%). Eight patients (42%) remained HCV RNA-negative, three of them until the day that renal transplantation (RT) was performed (7, 12 and 27 months, respectively), as did five patients on HD during the follow-up (27+/-5 months). Eight out of the nine patients (89%) who completed therapy were HCV RNA-negative at the end of treatment, and seven of them (78%) remained HCV RNA-negative during the follow-up on dialysis (21+/-8 months). Mean transaminase (ALT) values were significantly decreased following IFN therapy, while no changes were observed during the follow-up period in the control group. Fifteen patients (10 in the treatment group and five in the control group) underwent RT. Three patients in the treatment group were HCV RNA-negative at RT, and one of them had a virological relapse 20 months after RT, while the other two remained HCV RNA-negative at 3 months and 24 months after RT, respectively. In contrast to the control group, transaminase (ALT) remained within normal limits in all patients in the treatment group. Finally, during the post-RT follow-up, the transaminase mean values were significantly lower in treated patients vs patients in the control group (P<0.05). CONCLUSIONS: It is concluded that the biochemical and virological response to IFN therapy is good in HD patients. In addition, IFN therapy appears to exert a beneficial effect on the course of liver disease following RT, regardless of the virological response. Despite the fact that IFN therapy was discontinued in 10 out of the 19 patients due to the occurrence of side effects, these disappeared following discontinuation of therapy. Therefore, IFN therapy is advisable for HCV-infected dialysis patients who are candidates for RT.

Linares L, Cervera C, Cofán F, Ricart MJ, Esforzado N, Torregrosa V, Oppenheimer F, Campistol JM, Marco F, Moreno A. · Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain. · Transplant Proc. · Pubmed #17889144 No free full text.

Abstract: BACKGROUND: Mutiresistant bacterial infections are an emerging problem in the nosocomial setting. Our objectives were to describe the incidence, outcome, and risk factors for acquisition of multiresistant bacteria among renal transplant recipients. METHODS: We prospectively followed patients undergoing kidney transplantation over a 3-year period. We collected demographic features, underlying chronic diseases, and main transplant characteristics and complications. Multiple antibiotic resistance was defined for the most important bacteria: Enteric gram-negative bacilli resistant to betalactamics, cephalosporins, and quinolones; Staphylococcus aureus resistant to methicillin, cotrimoxazole, and clindamcin; Enterococcus spp resistant to ampicillin and quinolones; nonfermentator bacilli resistant to all antibiotics except aminoglycosides and collistin. RESULTS: Overall, 416 patients included 65 double transplants (62 kidney-pancreas and three kidney-liver) of mean age 48.5 years, and 57% men. Infection with multiresistant bacteria was observed in 58 patients (14%). Most frequent multiresistant bacteria were: Escherichia coli (n = 33), Klebsiella spp (n = 15), Citrobacter spp (n = 8), Enterobacter spp (n = 5), Morganella morganii (n = 2), Pseudomonas aeruginosa (n = 16), Acinetobacter baumanii (n = 2), Enterococcus spp (n = 9) and methicillin-resistant S. aureus (MRSA, n = 2). Age greater than 50 years, hepatitis C virus infection, double kidney-pancreas transplantation, requirement for posttransplant hemodialysis, surgical reoperation, and requirement for nephrostomy were independent variables associated with multiresistant bacterial infection. Most used antibiotics for treatment were: carbapenems (65%), amikacin (12%), linezolid, piperacillin-tazobactam, vancomycin, collistin, and fosfomycin. Infection with multiresistant bacteria was associated with a worse prognosis (graft loss or death, 19% vs 8%, P = .009). CONCLUSIONS: The incidence of infection with multiresistant bacteria in our renal transplant cohort was high, being most frequently cephalosporin-resistant enteric gram-negative bacilli and multiresistant P aeruginosa. Methicillin-resistant S. aureus incidence was low. Infection with multiresistant bacteria conferred a worse prognosis.

Arellano EM, Campistol JM, Oppenheimer F, Rovira J, Diekmann F. · Department of Nephrology and Renal Transplantation, Hospital Clinic, Barcelona, Spain. · Transplant Proc. · Pubmed #17889115 No free full text.

Abstract: INTRODUCTION: Chronic allograft nephropathy, cardiovascular mortality, and posttransplant malignancy are complications of conventional immunosuppression after kidney transplantation. We reported the feasibility of maintenance monotherapy with sirolimus (SRL) in a pilot experience. The aim was to study safety and feasibility of SRL maintenance monotherapy in 50 kidney transplant patients. METHODS: All patients from our center with at least 6 months follow-up on SRL monotherapy were included. During the first month after start of SRL monotherapy, follow-up visits were performed weekly, then each month for the following 2 months. Each follow-up visit included a physical exam and laboratory screening. RESULTS: Mean follow-up on SRL monotherapy was 34.7 +/- 14.9 months. The time between transplantation until start of monotherapy was 7.7 +/- 3.3 years. No rejections occurred. During follow-up, two patients died of cardiovascular disease (already diagnosed before monotherapy); one, of previously diagnosed posttransplant malignancy and one, of hepatitis C-related liver failure. Glomerular filtration rate (GFR) was 53 mL/min x 1.73 m2 at start of monotherapy and 50 mL/min x 1.73 m2 after 4 years. Proteinuria was 632 +/- 562 mg/24 hours at 4 years. During the follow-up, no significant changes in the lipid profile, glycemia, or hemoglobin occurred. CONCLUSIONS: Sirolimus monotherapy is safe in a selected group of immunological low-risk patients without increasing the risk of rejection.

Barrera J, Campistol JM. · Servicio de Hepatología. ICMDM. Hospital Clínic. IDIBAPS. España. · Gastroenterol Hepatol. · Pubmed #17298821 No free full text.

This publication has no abstract.

Serón D, Arias M, Campistol JM, Morales JM, Anonymous00277. · Nephrology Department, Hospital Universitario de Bellvitge, Barcelona, Spain. · Transplantation. · Pubmed #14702529 No free full text.

Abstract: BACKGROUND: Our aim was to study time-dependent modifications in the characteristics of renal transplants in Spain during the 1990s and risk factors associated with death-censored graft failure after the first year. METHODS: A total of 3,365 adult patients who underwent transplantation in 1990, 1994, and 1998 with a functioning graft after the first year were included. RESULTS: Ten-year patient and graft survival rates were 82% and 70%. Major modifications between 1990 and 1998 were increases in donor age (32 +/- 15 to 43 +/- 18 years, P<0.0001) and number of HLA mismatches (2.8 +/- 1.2 to 3.2 +/- 1.2, P<0.0001). Acute rejection decreased from 39% to 25% (P<0.0001), and the prevalence recipients with hepatitis C virus decreased from 29% to 10% (P<0.0001). The use of lipid-lowering agents during the first year increased from 6% to 41% (P<0.0001). Projected renal allograft half-life estimate was 15.4 (range, 14.1-16.8) years in 1990 and 17.7 (range, 14.0-21.4) in 1998 (P=0.007). Independent variables associated with graft survival were as follows: recipient age, last panel-reactive antibodies, acute rejection, hepatitis C virus antibodies in the recipient, triglycerides, serum creatinine and proteinuria at 3 months, and the increase of serum creatinine and proteinuria between the 3rd and 12th month. The use of statins during the first year was associated with a decreased risk for graft loss. CONCLUSION: Despite worsening of surrogate parameters of renal quality and poorer HLA matching, graft survival improved during the 1990s in Spain.

Domínguez-Gil B, Esforzado N, Muñoz MA, Andrés A, Rodicio JL, Bruguera M, Oppenheimer F, Campistol JM, Morales JM. · Hospital 12 de Octubre, Madrid. · Nefrologia. · Pubmed #11642168 No free full text.

This publication has no abstract.

Morales JM, Campistol JM, Andres A, Dominguez-Gil B, Esforzado N, Oppenheimer F, Rodicio JL. · Renal Transplant Unit, Nephrology Department, Hospital 12 de Octubre, Madrid, Spain. · Transplant Proc. · Pubmed #11267507 No free full text.

This publication has no abstract.

Campistol JM, Esforzdo N, Barrera JM, Morales JM, Oppenheimer F. · Renal Transplant Unit, Hospital Clinic, University of Barcelona, IDIBAPS, Spain. · Nephrol Dial Transplant. · Pubmed #11261710 links to  free full text

This publication has no abstract.