La terapia immunosoppressiva nel trapianto di rene

Immunosuppressive therapy in renal transplantation Immunosuppressive therapy in renal transplantation can be distinguished in induction therapy and maintenance therapy. Induction therapy is an intense immunosuppressive therapy administered at the time of kidney transplantation to reduce the risk of acute allograft rejection. In general, the induction immunosuppressive strategies used at kidney transplant centers fall into one of these two categories. One strategy relies upon high doses of conventional immunosuppressive agents, while the other utilizes antibodies directed against T-cell antigens in combination with lower doses of conventional agents. Maintenance immunosuppressive therapy is administered to almost all kidney transplant recipients to help prevent acute rejection and loss of the renal allograft. Although an adequate level of immunosuppression is required to dampen the immune response to the allograft, the level of chronic immunosuppression is decreased over time (as the risk of acute rejection decreases) to help lower the overall risk of infection and malignancy; these risks directly correlate with the degree of overall immunosuppression. The optimal maintenance immunosuppressive therapy in kidney transplantation is not established. The major immunosuppressive agents that are available in various combination regimens are glucocorticoids (primarily oral prednisone), azathioprine, mycophenolate mofetil (MMF), enteric-coated mycophenolate sodium (EC-MPS), cyclosporine (in non-modified or modified [microemulsion] form), Tacrolimus, everolimus, rapamycin (sirolimus), and Belatacept.

Prevenzione primaria della malattia cardiovascolare: c’è bisogno di un’aspirina?

The efficacy of antiplatelet treatment with aspirin in the primary prevention of major cardiovascular events was questioned during 2018, following a new series of trials that we summarize here in a quick synoptic overview. The three studies involved are the ASPREE trial, the ASCEND study and the ARRIVE trial. These studies all have a double-blind randomized design, and 100 mg/day aspirin was administered with an intention-to-treat approach and against placebo. Age of the enrolled patients, prevalence of diabetes mellitus and geographical location of other studies are just some of the elements analyzed here, in addition to the different problems of cardiovascular events. The ASPREE study observed a marginal reduction of cardiovascular events with the use of aspirin, by approximately 5% with a confidence interval at risk of insignificancy. On the other hand, the increased risk of a hemorrhagic event appeared to be rather robust, resulting between 18% and 62%. The ASCEND study observed a reduction in cardiovascular events of around 12%, offset by an increase in the risk of major bleeding between 9% and 52%. The ARRIVE study did not detect any incidence of major cardiovascular events, while the risk of major bleeding appeared to even double. The evidences of the current literature push us to review a widespread conviction among professionals who fight the war against cardiovascular disease every day: the prescription of aspirin in the primary prevention can no longer happen systematically, and every single prescription need care between benefits and dangers connected to the treatment.

Rene Policistico e trapianto di rene: accesso alla lista d’attesa e post trapianto: risultati della ricerca

Polycystic kidney disease and kidney transplantation: access to waiting list and post-transplant Autosomal-dominant polycystic kidney disease (ADPKD) is the leading genetic cause of end-stage renal disease (ESRD) worldwide. The number of ADPKD patients who are listed for transplantation or receive a kidney transplant is continuously increasing over time. AIRP conducted a survey to investigate the ADPKD patient journey, meaning the personal experience and expectations of people regarding kidney transplantation as therapeutic option of end-stage renal failure. The survey was conducted on 381 people with ADPKD, using computer-assisted web interviewing (CAWI). The results confirm that there are problems that need to be addressed before listing an ADPKD patient for a kidney transplantation, namely the patient’s comorbidities, the complexity of pre-transplant assessments and the shortage of organs. Pre-emptive transplantation from cadaver donor is a rare event in our country but it is a valid option, especially in case of living donation. Immunosuppression is well tolerated in a high percentage of subjects, but a follow-up is necessary to monitor negative side effects. Despite these problems, the outcome of kidney transplantation is optimal in these patients. Also, the relationship between patients and Nephrologists and/or Transplant Centers is important to ensure a positive outcome.

La terapia enzimatica sostitutiva nella malattia di Fabry

Enzyme Replacement Therapy for Fabry Disease Anderson-Fabry disease (FD) is a X-linked lysosomal storage disorder, which involves glycosphingolipids metabolism. Specific treatment for FD has been available in the last two decades, after the development and commercialization of recombinant human alfa-galactosidase A. Since then enzyme replacement therapy (ERT) has changed the natural history of the disease. Two different enzymatic formulations are available: agalsidase alfa and agalsidase beta at different dosages. The safety and efficacy profiles are similar. ERT induces Gb3 deposits reduction in renal and cardiac biopsies, improves quality of life, reduces pain and GI symptoms, decreases left ventricular mass and slows down renal function decline. In case of organ involvement, clinical evidence confirms the need to treat all patients with enzyme therapy, both male and female. In all other clinical settings, the decision to start ERT is controversial, because of the extremely variable clinical manifestations of FD. However, data suggest a greater response to ERT if started as early as possible in any patients. Timely treatment appears to be effective in stabilizing and possibly delaying FD progression. ERT infusion reactions due to allergic hypersensitivity or IgG antibody development could occur but can be easily managed. In-hospital and at home infusions are possible. The wide genetic and phenotypic heterogeneity observed in all FD patients requires a tailored approach to treatment options. Patients should be referred to an expert multidisciplinary team for the long term management of this challenging disease.

Metodi di campionamento negli studi epidemiologici

Sampling methods in epidemiological studies Sampling allows researchers to obtain information about a population through data obtained from a subset of the population, with a saving in terms of costs and workload compared to a study based on the entire population. Sampling allows the collecting of high quality information, provided that the sample size is large enough to detect a true association between exposure and outcome. There are two types of sampling methods: probability and non-probability sampling. In probability sampling the subset of the population is extracted randomly from all eligible individuals; this method, as all subjects have a chance of being chosen, allows researchers to generalize the findings of their study. In non-probability sampling, some individuals have no chance of being selected, because researchers do not extract the sample from all eligible subjects of a population; the sample is probably non-representative, the effect of sampling error cannot be estimated, so that the study produces non-generalizable results. Examples of probability sampling methods are: simple random sampling, systematic sampling, stratified sampling, and clustered sampling. Examples of non-probability sampling methods are: convenience sampling, judgement sampling.