Brasil: the leading public kidney transplant program worldwide

Foresto, Renato Demarchi; Medina-Pestana, José; Silva, Hélio Tedesco

doi:10.1590/1806-9282.66.6.708

Cited by 6 publications

(5 citation statements)

References 2 publications

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“…The data of the large number of patients were extracted from the COVID‐19 KT Brazilian study. Brazil has the largest public transplant program in the world, 50 and the country has been dramatically affected by the pandemic since March 2020. Furthermore, the use of machine learning principles to fit different models, the internal validation in a cohort independent from those that were used to fit the model, validation in a second cohort, and the calibration 51 contributed to improving the robustness and quality of the ImAgeS Score.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a simple web-based tool for early prediction of COVID-19-associated death in kidney transplant recipients

Andrade

Sandes‐Freitas

Requião-Moura

et al. 2022

American Journal of Transplantation

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This analysis, using data from the Brazilian kidney transplant (KT) COVID‐19 study, seeks to develop a prediction score to assist in COVID‐19 risk stratification in KT recipients. In this study, 1379 patients (35 sites) were enrolled, and a machine learning approach was used to fit models in a derivation cohort. A reduced Elastic Net model was selected, and the accuracy to predict the 28‐day fatality after the COVID‐19 diagnosis, assessed by the area under the ROC curve (AUC‐ROC), was confirmed in a validation cohort. The better calibration values were used to build the applicable ImAgeS score. The 28‐day fatality rate was 17% ( n = 235), which was associated with increasing age, hypertension and cardiovascular disease, higher body mass index, dyspnea, and use of mycophenolate acid or azathioprine. Higher kidney graft function, longer time of symptoms until COVID‐19 diagnosis, presence of anosmia or coryza, and use of mTOR inhibitor were associated with reduced risk of death. The coefficients of the best model were used to build the predictive score, which achieved an AUC‐ROC of 0.767 (95% CI 0.698–0.834) in the validation cohort. In conclusion, the easily applicable predictive model could assist health care practitioners in identifying non‐hospitalized kidney transplant patients that may require more intensive monitoring. Trial registration: ClinicalTrials.gov NCT04494776.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a simple web-based tool for early prediction of COVID-19-associated death in kidney transplant recipients

Andrade

Sandes‐Freitas

Requião-Moura

et al. 2022

American Journal of Transplantation

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“…The Brazilian organ transplant system was the largest public program for kidney transplants worldwide. More than 95% of the transplants in Brazil were performed by SUS, including reimbursement of hospitalization and immunosuppressive medication [ 11 ]. In this study, we analyzed the DATASUS database, which captures information about most procedures (transplants and complications) in Brazil.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on Solid Organ Transplant and Rejection Episodes in Brazil’s Unified Healthcare System

Andrade

Barbosa

Rocha

et al. 2022

JCM

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Background: Brazil has the world’s largest public organ transplant program, which was severely affected by the COVID-19 pandemic. The primary aim of the study was to evaluate differences in solid organ transplants and rejection episodes during the COVID-19 pandemic compared to the five years before the pandemic in the country. Methods: A seven-year database was built by downloading data from the DATASUS server. The pandemic period was defined as March 2020 to December 2021. The pre-pandemic period was from January 2015 to March 2020. Results: During the pandemic, the number of solid organ transplants decreased by 19.3% in 2020 and 22.6% in 2021 compared to 2019. We found a decrease for each evaluated organ, which was more pronounced for lung, pancreas, and kidney transplants. The seasonal plot of rejection data indicated a high rejection rate between 2018 and 2021. There was also an 18% (IRR 1.18 (95% CI 1.01 to 1.37), p = 0.04) increase in the rejection rate during the COVID-19 pandemic. Conclusions: The total number of organ transplants performed in 2021 represents a setback of six years. Transplant procedures were concentrated in the Southeast region of the country, and a higher proportion of rejections occurred during the pandemic. Together, these findings could have an impact on transplant procedures and outcomes in Brazil.

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“…The impact of this information is relevant to Brazil, which is ranked at the first position in the number of transplants performed by the Brazilian public health system (SUS) [ 31 ] and reserves for this purpose an annual budget around R$1 billion [ 31 ]. In this context, the use of a high-cost medication such as eculizumab, which acquisition expenditure by the Brazilian government in the year 2016 was R$624,621,376.84 (60% of the annual budget destined for transplantation) may jeopardize the sustainability of the health program [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Thrombotic microangiopathy after kidney transplantation: Analysis of the Brazilian Atypical Hemolytic Uremic Syndrome cohort

et al. 2021

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Background Atypical Hemolytic Uremic Syndrome (aHUS) is an ultra-rare disease that potentially leads to kidney graft failure due to ongoing Thrombotic Microangiopathy (TMA). The aim was evaluating the frequency of TMA after kidney transplantation in patients with aHUS in a Brazilian cohort stratified by the use of the specific complement-inhibitor eculizumab. Methods This was a multicenter retrospective cohort study including kidney transplant patients diagnosed with aHUS. We collected data from 118 transplant centers in Brazil concerning aHUS transplanted patients between 01/01/2007 and 12/31/2019. Patients were stratified into three groups: no use of eculizumab (No Eculizumab Group), use of eculizumab for treatment of after transplantation TMA (Therapeutic Group), and use of eculizumab for prophylaxis of aHUS recurrence (Prophylactic Group). Results Thirty-eight patients with aHUS who received kidney transplantation were enrolled in the study. Patients’ mean age was 30 years (24–40), and the majority of participants was women (63% of cases). In the No Eculizumab Group (n = 11), there was a 91% graft loss due to the TMA. The hazard ratio of TMA graft loss was 0.07 [0.01–0.55], p = 0.012 in the eculizumab Prophylactic Group and 0.04 [0.00–0.28], p = 0.002 in the eculizumab Therapeutic Group. Conclusion The TMA graft loss in the absence of a specific complement-inhibitor was higher among the Brazilian cohort of kidney transplant patients. This finding reinforces the need of eculizumab use for treatment of aHUS kidney transplant patients. Cost optimization analysis and the early access to C5 inhibitors are suggested, especially in low-medium income countries.

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Brasil: the leading public kidney transplant program worldwide

Cited by 6 publications

References 2 publications

Development and validation of a simple web-based tool for early prediction of COVID-19-associated death in kidney transplant recipients

Development and validation of a simple web-based tool for early prediction of COVID-19-associated death in kidney transplant recipients

Impact of the COVID-19 Pandemic on Solid Organ Transplant and Rejection Episodes in Brazil’s Unified Healthcare System

Thrombotic microangiopathy after kidney transplantation: Analysis of the Brazilian Atypical Hemolytic Uremic Syndrome cohort

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