Amado Andres - Academia.edu (original) (raw)
Papers by Amado Andres
Nephrology Dialysis Transplantation, 1987
We have prospectively investigated the effect of desferrioxamine (DFO) administration (2 gi.v. af... more We have prospectively investigated the effect of desferrioxamine (DFO) administration (2 gi.v. after every haemodialysis session for 6 months) on the normocytic and normochromic anaemia of seven haemodialysis patients. None had either clinical or analytical data characteristic of chronic aluminium intoxication. At the end of DFO therapy, the haematocrit had increased from 20.5 +/- 2.7% to 30.4 +/- 7.7% (P less than 0.005), and the transfusional requirements decreased from 3.5 +/- 2.2 units (range 1-8 units) in the 6 months prior to DFO, to 0.7 +/- 0.9 units (range 0-2 units) during DFO administration (P less than 0.01). No transfusion was required during the second half of the DFO therapy period. Serum ferritin decreased from 105g +/- 532 nmol/l (2649 +/- 1331 ng/ml) to 507 +/- 403 nmol/l (1268 +/- 1008 ng/ml) (P less than 0.025). Two months after DFO withdrawal the haematocrit value fell significantly to 22.2 +/- 1.6% (P less than 0.01). DFO therapy was restarted in one patient at a lower dose (1 gi.v. after every haemodialysis session) and an increase of haematocrit from 23.8% to 40.2% was again observed after 3 months of treatment. The tolerance to DFO was excellent. We conclude that DFO therapy should be considered in haemodialysis patients with severe anaemia and increased blood transfusion requirements.
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Graft and patient survival in renal transplantation has increased with better immune suppression ... more Graft and patient survival in renal transplantation has increased with better immune suppression treatment, leading to the appearance of new complications such as posttransplant bone disease. After renal transplantation and the recovery of renal function, mineral metabolism disorders secondary to renal failure could be expected to normalize. However, both immediately after transplantation and later, and even with good renal graft function, we see bone disorders associated to renal osteodystrophy, a high incidence of osteopenia, persistent hyperparathyroidism, hypercalcemia, hypophosphoremia, and less commonly, aseptic bone necrosis. The causes potentially responsible for these disorders have basically been identified as different degrees of renal insufficiency in the graft, persistent posttransplant secondary hyperparathyroidism, and negative impact of immunosuppression treatment, particularly corticosteroids. The most important factor in the evolution of metabolic and bone disorder...
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Nephrology Dialysis Transplantation, 2015
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Journal of Transplantation, 2012
Information is lacking concerning concomitant administration of enteric-coated mycophenolate sodi... more Information is lacking concerning concomitant administration of enteric-coated mycophenolate sodium with tacrolimus (EC-MPS+Tac) in renal transplant recipients (RTxR). In this 6-month, prospective, open-label, multicenter study,de novoRTxR were randomized (1 : 1) to low-dose (LD) or standard-dose (SD) Tac with basiliximab, EC-MPS 720 mg bid, and steroids. Primary objective was to compare renal function at 6-month posttransplantation. Secondary objectives were to compare the incidences of biopsy-proven acute rejection (BPAR), graft loss and death, and new-onset diabetes mellitus (NODM). 292 patients (LDn=151, SDn=141) were included. Mean Tac levels were at the low end of the target range in standard-exposure patients (SD,n=141) and exceeded target range in low-exposure patients (LD = 151) throughout the study. There was no significant difference in mean glomerular filtration rate (GFR) between treatments (ITT-population: 63.6 versus 61.0 mL/min). Incidence of BPAR was similar (10.6% ...
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American Journal of Kidney Diseases, 1996
ABSTRACT
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Transplantation Proceedings, 2021
BACKGROUND As of December 31, 2018, Spain's National Transplant Organization estimated that t... more BACKGROUND As of December 31, 2018, Spain's National Transplant Organization estimated that there were 61,764 people under renal replacement therapy across the country. Of this population, 33,784 (54.7%) had a functioning kidney graft. METHODS Through the use of a survey to all Spanish hospitals involved in kidney transplantations, we studied the distribution of these recipients nationally, along with who was monitoring them and how. Data collected include the ratio of recipients to transplant nephrologists, median number of recipients followed in each center, and median number of transplant nephrologists per hospital. Of the 806 centers in the Spanish hospital network, 43 (5.3%) were involved in kidney transplants, including 39 transplant hospitals and 4 associated hospitals. The median number of transplants per center was 800 (interquartile range [IQR] = 510-1200). There were 3 nephrologists (IQR 2-5), and the ratio of recipients to transplant nephrologists was 270 (IQR = 190-323). RESULTS There were no significant differences in these data between autonomous communities, except in the case of the Canary Islands, which had a significantly lower ratio of recipients to transplant nephrologists (146; IQR = 100-185) compared with the rest of the country (ratio 277; IQR = 207-329; P < .001). Of the 39 hospitals, 29 (74.4%) referred patients to centers that did not perform transplants. CONCLUSIONS All in all, few Spanish hospitals perform kidney transplants. The ratio of recipients to transplant nephrologists is very high, compelling most hospitals to refer patients to nontransplant hospitals for follow-up. There are important differences in the distribution of recipients in hospitals in the Canary Islands vs the rest of the country, a difference that is undoubtedly attributable to its geographic peculiarities.
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Nephrology Dialysis Transplantation, May 1, 2018
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Nephrology Dialysis Transplantation, 2001
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Medicina Oral Patología Oral y Cirugia Bucal, 2013
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Immunology Letters, 1997
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Nephrology Dialysis Transplantation, 2017
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Nephrology Dialysis Transplantation
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Clinical Transplantation
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Clinical Transplantation
A potential benefit of immunomodulatory agents such as tocilizumab (TCZ) has been reported in pat... more A potential benefit of immunomodulatory agents such as tocilizumab (TCZ) has been reported in patients with coronavirus disease 2019 (COVID‐19) and severe pulmonary involvement. However, this therapy has been scarcely studied in kidney transplant (KT) recipients. Herein, we describe the clinical course and outcome of 10 KT patients with severe COVID‐19 that were treated with TCZ. Mean age of the study group was 54 ± 10 years (70% females), and 30% of the cases were within 6 months from transplant. Mycophenolate mofetil was discontinued in all cases upon admission, whereas baseline steroids were maintained and tacrolimus dose was reduced. Initial treatment included hydroxychloroquine, antibiotics, and prophylactic anticoagulation. Before treatment with TCZ, 3 patients were receiving high‐flow oxygen, 4 patients low‐flow oxygen and 1 case non‐invasive ventilation. All patients received a single dose of intravenous TCZ within a mean time of 7 ± 4 days since admission. During a median follow‐up of 16 days (IQR: 10‐29), 7 patients (70%) gradually improved and were finally discharged while three cases (30%) did not exhibited clinical improvement and ultimately died. In conclusion, although treatment with TCZ could be associated with improved clinical outcomes in a subset of KT recipients with COVID‐19, further studies are warranted before drawing firm conclusions.
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Transplantation
Background: A high frequency of regulatory B (Breg) cells, generally transitional B cells (Btrans... more Background: A high frequency of regulatory B (Breg) cells, generally transitional B cells (Btrans), has been associated with long-term kidney allograft survival and operational tolerance, while circulating follicular helper T cells (cTfh) correlate with graft rejection. We aimed to understand the interplay between these cell subsets and to determine their association with renal graft outcome. Methods: Btrans (CD19+CD24+CD38+) and IL10+Breg cells (CD19+ CD24highCD38high cells producing IL10 after CpG+CD40L ex vivo stimulation), as well as cTfh (CD4+CXCR5+T cells) have been analysed, preand post-transplantation, in a prospective cohort of 200 kidney transplant recipients and in healthy volunteers (HV). Results: End-stage renal disease patients had higher frequencies of Btrans and IL10+Breg cells compared to HV(20% vs 10% and 1.5% vs 0.8%, p<0.001 and p<0.01, respectively). Pretransplantation frequencies of Btrans and IL10+Breg cells were significantly higher in patients later rejecting than in patients remaining stable (26% vs 20%, p<0.05, and 2.3% vs 1.5%, p<0.01, respectively).In the multivariate analysis, pretransplantation %IL10+ Breg above the median predicted rejection and graft failure independently from age, de novoanti-HLA antibodies and delayed graft function (HR=3.98 and 13.46 respectively, both p=0.02). IL10+Breg decreased during the 1-year post-transplant follow-up, and a larger preto 7 days post-transplant reduction of %IL10+ Breg was also an independent predictor of rejection and graft failure (HR=3.63 and 5.86). Finally, IL10+ Breg correlated with cTfh pretransplantation (r=0.28, p<0.01). The cTfh/IL10+Breg ratio increased after transplantation, and this augmentation preceded and was significantly higher in rejectors vs stable recipients (p<0.05). Conclusions: Evaluation of pre-transplant IL10+Breg cells and the regular monitoring of the cTfh/IL10+ Breg ratio may be useful to assess posttransplant risk. Additionally, these observations suggest the need to develop therapeutic strategies aimed at depleting Tfh while preserving regulatory B cells in transplanted patients. ISCIII project 45/2013 and SMT 2017/082.
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Nephrology Dialysis Transplantation, May 1, 2018
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Transplantation
Background BK nephropathy (BKN) has increased its incidence in the last two decades. Moreover BKN... more Background BK nephropathy (BKN) has increased its incidence in the last two decades. Moreover BKN is a relevant cause of graft dysfunction in kidney transplantation. The mTOR inhibitors (mTORi) have a well-known antiviral action and have been suggested as the best immunosuppression in the BKN. However Tacrolimus-free therapy could increases the risk of both, acute and chronic rejection. Since 2009 in our center in patients with BKN we conducted a protocol discontinuing Mycophenolate and decreasing Tacrolimus (TAC) dose in association with mTORi, both with target levels of 5 ng/mL. Aim Analyze the efficacy and safety of a TAC-mTORi based-immunosuppression regimen in BKN in kidney transplantation. Methods From 2007 to 2013 we diagnosed 22 BKN. Patients diagnosed since 2009 (n= 14, group 1) were treated beginning mTORi and decreasing TAC dose plus Mycophenolate withdrawal. The others 8 patients suffered a significant reduction of immunosuppression (group 2). We analyze renal function, plasma quantitative BK PCR, antiHLA antibodies levels, acute or chronic rejections and dialysis or dead at final follow-up. Results 22 patients (16 men, 6 women; mean age 46±19 years) were identified. The BKN was diagnosed at 7th month after transplantation (range 2-55). The medium duration of follow-up was 53 months (6-85). Baseline characteristics and evolution of two groups are listed in Table 1. Although group 1 had a greater immunologic risk (43% had suffered a previous acute rejection and had antiHLA antibodies versus 25% of acute rejection and 12.5% with antiHLA antibodies in group 2) and a higher plasma BK viral load at diagnosis, the renal function during follow-up was more favorable than patients from group 2. Neither acute nor chronic rejection episodes were diagnosis in group 1. Only one patient in each group started chronic dialysis at the end of the follow-up (52 and 85 months after BKN diagnosis). Conclusion An immunosuppression regimen based in TAC and mTORi is an effective and safety treatment in patients with BKN. This treatment reduces viral load and increases graft survival without increases the rejection risk. Table. No title available.
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Nefrología (English Edition)
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Transplantation
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Kidney International
Donation after uncontrolled circulatory death (uDCD) refers to donation from persons who have die... more Donation after uncontrolled circulatory death (uDCD) refers to donation from persons who have died following cardiac arrest and unsuccessful attempt at resuscitation. We report the Spanish experience of uDCD kidney transplantation, and identify factors related to short-term post-transplant outcomes. The Spanish CORE system compiles data on all donation and transplant procedures in the country. Between 2012-2015, 517 kidney transplants from 288 uDCD donors were performed. The incidence of primary non-function was 10%, and the incidence of delayed graft function was 76%. One-year death-censored graft survival was 87%. In a Cox-Model, donor age ≥ 60 years (odds ratio [OR] 2.7; 95% confidence interval [CI] 1.2-6.1), in situ cooling of kidneys versus normothermic regional perfusion (OR 5.6; 95% CI 2.7-11.5) or hypothermic regional perfusion based on the use of extracorporeal membrane oxygenation devices (OR 4.3; 95% CI 2.1-8.6), and a recipient history of prior kidney transplant (OR 3.5; 95% CI 1.5-8.3) all significantly increased the risk of graft loss during the first year after transplantation. Kidney transplantation from uDCD donors provides acceptable 1-year outcomes, although there is room for improvement. Hypothermic and normothermic regional perfusion strategies are preferable to in situ cooling of kidneys from uDCD donors.
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Nephrology Dialysis Transplantation, 1987
We have prospectively investigated the effect of desferrioxamine (DFO) administration (2 gi.v. af... more We have prospectively investigated the effect of desferrioxamine (DFO) administration (2 gi.v. after every haemodialysis session for 6 months) on the normocytic and normochromic anaemia of seven haemodialysis patients. None had either clinical or analytical data characteristic of chronic aluminium intoxication. At the end of DFO therapy, the haematocrit had increased from 20.5 +/- 2.7% to 30.4 +/- 7.7% (P less than 0.005), and the transfusional requirements decreased from 3.5 +/- 2.2 units (range 1-8 units) in the 6 months prior to DFO, to 0.7 +/- 0.9 units (range 0-2 units) during DFO administration (P less than 0.01). No transfusion was required during the second half of the DFO therapy period. Serum ferritin decreased from 105g +/- 532 nmol/l (2649 +/- 1331 ng/ml) to 507 +/- 403 nmol/l (1268 +/- 1008 ng/ml) (P less than 0.025). Two months after DFO withdrawal the haematocrit value fell significantly to 22.2 +/- 1.6% (P less than 0.01). DFO therapy was restarted in one patient at a lower dose (1 gi.v. after every haemodialysis session) and an increase of haematocrit from 23.8% to 40.2% was again observed after 3 months of treatment. The tolerance to DFO was excellent. We conclude that DFO therapy should be considered in haemodialysis patients with severe anaemia and increased blood transfusion requirements.
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Graft and patient survival in renal transplantation has increased with better immune suppression ... more Graft and patient survival in renal transplantation has increased with better immune suppression treatment, leading to the appearance of new complications such as posttransplant bone disease. After renal transplantation and the recovery of renal function, mineral metabolism disorders secondary to renal failure could be expected to normalize. However, both immediately after transplantation and later, and even with good renal graft function, we see bone disorders associated to renal osteodystrophy, a high incidence of osteopenia, persistent hyperparathyroidism, hypercalcemia, hypophosphoremia, and less commonly, aseptic bone necrosis. The causes potentially responsible for these disorders have basically been identified as different degrees of renal insufficiency in the graft, persistent posttransplant secondary hyperparathyroidism, and negative impact of immunosuppression treatment, particularly corticosteroids. The most important factor in the evolution of metabolic and bone disorder...
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Nephrology Dialysis Transplantation, 2015
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Journal of Transplantation, 2012
Information is lacking concerning concomitant administration of enteric-coated mycophenolate sodi... more Information is lacking concerning concomitant administration of enteric-coated mycophenolate sodium with tacrolimus (EC-MPS+Tac) in renal transplant recipients (RTxR). In this 6-month, prospective, open-label, multicenter study,de novoRTxR were randomized (1 : 1) to low-dose (LD) or standard-dose (SD) Tac with basiliximab, EC-MPS 720 mg bid, and steroids. Primary objective was to compare renal function at 6-month posttransplantation. Secondary objectives were to compare the incidences of biopsy-proven acute rejection (BPAR), graft loss and death, and new-onset diabetes mellitus (NODM). 292 patients (LDn=151, SDn=141) were included. Mean Tac levels were at the low end of the target range in standard-exposure patients (SD,n=141) and exceeded target range in low-exposure patients (LD = 151) throughout the study. There was no significant difference in mean glomerular filtration rate (GFR) between treatments (ITT-population: 63.6 versus 61.0 mL/min). Incidence of BPAR was similar (10.6% ...
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American Journal of Kidney Diseases, 1996
ABSTRACT
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Transplantation Proceedings, 2021
BACKGROUND As of December 31, 2018, Spain's National Transplant Organization estimated that t... more BACKGROUND As of December 31, 2018, Spain's National Transplant Organization estimated that there were 61,764 people under renal replacement therapy across the country. Of this population, 33,784 (54.7%) had a functioning kidney graft. METHODS Through the use of a survey to all Spanish hospitals involved in kidney transplantations, we studied the distribution of these recipients nationally, along with who was monitoring them and how. Data collected include the ratio of recipients to transplant nephrologists, median number of recipients followed in each center, and median number of transplant nephrologists per hospital. Of the 806 centers in the Spanish hospital network, 43 (5.3%) were involved in kidney transplants, including 39 transplant hospitals and 4 associated hospitals. The median number of transplants per center was 800 (interquartile range [IQR] = 510-1200). There were 3 nephrologists (IQR 2-5), and the ratio of recipients to transplant nephrologists was 270 (IQR = 190-323). RESULTS There were no significant differences in these data between autonomous communities, except in the case of the Canary Islands, which had a significantly lower ratio of recipients to transplant nephrologists (146; IQR = 100-185) compared with the rest of the country (ratio 277; IQR = 207-329; P < .001). Of the 39 hospitals, 29 (74.4%) referred patients to centers that did not perform transplants. CONCLUSIONS All in all, few Spanish hospitals perform kidney transplants. The ratio of recipients to transplant nephrologists is very high, compelling most hospitals to refer patients to nontransplant hospitals for follow-up. There are important differences in the distribution of recipients in hospitals in the Canary Islands vs the rest of the country, a difference that is undoubtedly attributable to its geographic peculiarities.
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Nephrology Dialysis Transplantation, May 1, 2018
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Nephrology Dialysis Transplantation, 2001
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Medicina Oral Patología Oral y Cirugia Bucal, 2013
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Immunology Letters, 1997
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Nephrology Dialysis Transplantation, 2017
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Nephrology Dialysis Transplantation
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Clinical Transplantation
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Clinical Transplantation
A potential benefit of immunomodulatory agents such as tocilizumab (TCZ) has been reported in pat... more A potential benefit of immunomodulatory agents such as tocilizumab (TCZ) has been reported in patients with coronavirus disease 2019 (COVID‐19) and severe pulmonary involvement. However, this therapy has been scarcely studied in kidney transplant (KT) recipients. Herein, we describe the clinical course and outcome of 10 KT patients with severe COVID‐19 that were treated with TCZ. Mean age of the study group was 54 ± 10 years (70% females), and 30% of the cases were within 6 months from transplant. Mycophenolate mofetil was discontinued in all cases upon admission, whereas baseline steroids were maintained and tacrolimus dose was reduced. Initial treatment included hydroxychloroquine, antibiotics, and prophylactic anticoagulation. Before treatment with TCZ, 3 patients were receiving high‐flow oxygen, 4 patients low‐flow oxygen and 1 case non‐invasive ventilation. All patients received a single dose of intravenous TCZ within a mean time of 7 ± 4 days since admission. During a median follow‐up of 16 days (IQR: 10‐29), 7 patients (70%) gradually improved and were finally discharged while three cases (30%) did not exhibited clinical improvement and ultimately died. In conclusion, although treatment with TCZ could be associated with improved clinical outcomes in a subset of KT recipients with COVID‐19, further studies are warranted before drawing firm conclusions.
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Transplantation
Background: A high frequency of regulatory B (Breg) cells, generally transitional B cells (Btrans... more Background: A high frequency of regulatory B (Breg) cells, generally transitional B cells (Btrans), has been associated with long-term kidney allograft survival and operational tolerance, while circulating follicular helper T cells (cTfh) correlate with graft rejection. We aimed to understand the interplay between these cell subsets and to determine their association with renal graft outcome. Methods: Btrans (CD19+CD24+CD38+) and IL10+Breg cells (CD19+ CD24highCD38high cells producing IL10 after CpG+CD40L ex vivo stimulation), as well as cTfh (CD4+CXCR5+T cells) have been analysed, preand post-transplantation, in a prospective cohort of 200 kidney transplant recipients and in healthy volunteers (HV). Results: End-stage renal disease patients had higher frequencies of Btrans and IL10+Breg cells compared to HV(20% vs 10% and 1.5% vs 0.8%, p<0.001 and p<0.01, respectively). Pretransplantation frequencies of Btrans and IL10+Breg cells were significantly higher in patients later rejecting than in patients remaining stable (26% vs 20%, p<0.05, and 2.3% vs 1.5%, p<0.01, respectively).In the multivariate analysis, pretransplantation %IL10+ Breg above the median predicted rejection and graft failure independently from age, de novoanti-HLA antibodies and delayed graft function (HR=3.98 and 13.46 respectively, both p=0.02). IL10+Breg decreased during the 1-year post-transplant follow-up, and a larger preto 7 days post-transplant reduction of %IL10+ Breg was also an independent predictor of rejection and graft failure (HR=3.63 and 5.86). Finally, IL10+ Breg correlated with cTfh pretransplantation (r=0.28, p<0.01). The cTfh/IL10+Breg ratio increased after transplantation, and this augmentation preceded and was significantly higher in rejectors vs stable recipients (p<0.05). Conclusions: Evaluation of pre-transplant IL10+Breg cells and the regular monitoring of the cTfh/IL10+ Breg ratio may be useful to assess posttransplant risk. Additionally, these observations suggest the need to develop therapeutic strategies aimed at depleting Tfh while preserving regulatory B cells in transplanted patients. ISCIII project 45/2013 and SMT 2017/082.
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Nephrology Dialysis Transplantation, May 1, 2018
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Transplantation
Background BK nephropathy (BKN) has increased its incidence in the last two decades. Moreover BKN... more Background BK nephropathy (BKN) has increased its incidence in the last two decades. Moreover BKN is a relevant cause of graft dysfunction in kidney transplantation. The mTOR inhibitors (mTORi) have a well-known antiviral action and have been suggested as the best immunosuppression in the BKN. However Tacrolimus-free therapy could increases the risk of both, acute and chronic rejection. Since 2009 in our center in patients with BKN we conducted a protocol discontinuing Mycophenolate and decreasing Tacrolimus (TAC) dose in association with mTORi, both with target levels of 5 ng/mL. Aim Analyze the efficacy and safety of a TAC-mTORi based-immunosuppression regimen in BKN in kidney transplantation. Methods From 2007 to 2013 we diagnosed 22 BKN. Patients diagnosed since 2009 (n= 14, group 1) were treated beginning mTORi and decreasing TAC dose plus Mycophenolate withdrawal. The others 8 patients suffered a significant reduction of immunosuppression (group 2). We analyze renal function, plasma quantitative BK PCR, antiHLA antibodies levels, acute or chronic rejections and dialysis or dead at final follow-up. Results 22 patients (16 men, 6 women; mean age 46±19 years) were identified. The BKN was diagnosed at 7th month after transplantation (range 2-55). The medium duration of follow-up was 53 months (6-85). Baseline characteristics and evolution of two groups are listed in Table 1. Although group 1 had a greater immunologic risk (43% had suffered a previous acute rejection and had antiHLA antibodies versus 25% of acute rejection and 12.5% with antiHLA antibodies in group 2) and a higher plasma BK viral load at diagnosis, the renal function during follow-up was more favorable than patients from group 2. Neither acute nor chronic rejection episodes were diagnosis in group 1. Only one patient in each group started chronic dialysis at the end of the follow-up (52 and 85 months after BKN diagnosis). Conclusion An immunosuppression regimen based in TAC and mTORi is an effective and safety treatment in patients with BKN. This treatment reduces viral load and increases graft survival without increases the rejection risk. Table. No title available.
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Nefrología (English Edition)
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Transplantation
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Kidney International
Donation after uncontrolled circulatory death (uDCD) refers to donation from persons who have die... more Donation after uncontrolled circulatory death (uDCD) refers to donation from persons who have died following cardiac arrest and unsuccessful attempt at resuscitation. We report the Spanish experience of uDCD kidney transplantation, and identify factors related to short-term post-transplant outcomes. The Spanish CORE system compiles data on all donation and transplant procedures in the country. Between 2012-2015, 517 kidney transplants from 288 uDCD donors were performed. The incidence of primary non-function was 10%, and the incidence of delayed graft function was 76%. One-year death-censored graft survival was 87%. In a Cox-Model, donor age ≥ 60 years (odds ratio [OR] 2.7; 95% confidence interval [CI] 1.2-6.1), in situ cooling of kidneys versus normothermic regional perfusion (OR 5.6; 95% CI 2.7-11.5) or hypothermic regional perfusion based on the use of extracorporeal membrane oxygenation devices (OR 4.3; 95% CI 2.1-8.6), and a recipient history of prior kidney transplant (OR 3.5; 95% CI 1.5-8.3) all significantly increased the risk of graft loss during the first year after transplantation. Kidney transplantation from uDCD donors provides acceptable 1-year outcomes, although there is room for improvement. Hypothermic and normothermic regional perfusion strategies are preferable to in situ cooling of kidneys from uDCD donors.
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