Evolução clínica pós-stent coronariano em pacientes submetidos a transplante de rim

Mota, Fábio Monteiro; Araújo, Juliana Pelissoni; Arruda, Jose A.; Júnior, Hélio Tedesco Silva; Pestana, José Osmar Medina; Sousa, José Marconi Almeida; Lima, Valter Correia de

doi:10.1590/s0066-782x2007000500004

Cited by 6 publications

(3 citation statements)

References 20 publications

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“…In the general population, intrastent restenosis (which results from excessive neointimal proliferation after BMS implantation)occurs in 20% to 30% of cases, determining higher rates of target vessel reintervention than those observed in the present study. [13][14][15] This result may be associated with a potential benefit of the immunosuppressive therapy, reaffirming what has been suggested in previous studies [7][8][9]16 During the follow-up period,in one-quarter of the patients, mortality from all causes was the major component of the high occurrence of MACE. This high death rate is expected in this population group, since, in addition to the high underlying cardiovascular risk, the impaired immune capacity (caused by the chronic kidney disease itself and the use of immunosuppressants) is associated with a higher risk of developing severe comorbidities, such as infections and malignancies, which are potentially life-threatening.…”

Section: Discussionsupporting

confidence: 83%

“…Research on this subject is of considerable interest, since it not only allows for the evaluation of the influence of classical risk factors for the development of coronary artery disease, but also for speculation on the impact of the characteristics of renal transplantation recipients, including the use of already tested immunosuppressive drugs to reduce intrastent restenosis. [7][8][9] This study aimed to describe the late evolution in patients with a history of renal transplantation submitted to PCI with stenting.…”

Section: Data Collectionmentioning

confidence: 99%

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Evolução clínica após intervenção coronária percutânea em indivíduos com transplante renal prévio

Trentin¹,

Melo²,

Santo³

et al. 2013

Rev. Bras. Cardiol. Invasiva

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Introdução: A doença arterial coronária é uma das principaiscausas de óbito em pacientes com doença renal crônica. Alémdisso, em decorrência da elevada prevalência de fatores de risco para aterosclerose, muitos desses pacientes necessitam de intervenção coronária percutânea (ICP) mesmo após o transplante renal. O objetivo deste estudo é descrever a evolução tardia de pacientes transplantados renais submetidos à ICP com stent. Métodos: Foram incluídos pacientes transplantados renais, com idade > 18 anos, tratados com ICP. O seguimento foi realizado por análise de prontuários e contato telefônico. O desfecho do estudo foi a incidência de eventos cardíacos adversos maiores (ECAM) durante o seguimento. Resultados: Foram incluídos 29 pacientes. A média de idade foi de 54,8 ± 8 anos, sendo a maioria do sexo masculino (72,4%). A prevalênciade hipertensão arterial sistêmica foi de 89,7%, de dislipidemia de 69%; e de diabetes, de 51,7%. A maior parte apresentava doença multiarterial (biarterial, 44,8%; triarterial, 41,4%). A complexidade das lesões foi elevada, sendo 84,3% dos tipos B2 ou C e 27,5% com lesões em bifurcação. A taxa de sucesso do procedimento foi de 100%. Stents convencionais foram utilizados em 96,6% dos casos. O tempo de seguimento foi de 1.378 ± 977 dias. A mortalidade foi de 25,1%, a taxa ABSTRACT Background: Coronary artery disease is a major cause of death in patients with chronic kidney disease. Moreover, due to the high prevalence of risk factors for atherosclerosis, many of these patients require percutaneous coronary intervention (PCI) even after renal transplantation. The aim of this study is to report the late follow-up of patients with renal transplantation treated with PCI and stenting. Methods: Patients > 18 years of age, with prior kidney transplantation, and treated with PCI were included. Clinical follow-up was evaluated by medical record analysis and telephone contact. The study endpoint was the incidence of major adverse cardiac events (MACE) during follow-up. Results: Twenty-nine patients were included. Mean age was 54.8 ± 8 years and the majority male (72.4%). The prevalence of hypertension was 89.7%, dyslipidemia 69% and diabetes 51.7%. Most of them had multivessel disease (2-vessel: 44.8%; 3-vessel: 41.4%). Lesion complexity was high, being 84.3% type B2 or C lesions and 27.5% bifurcation lesions. Procedural success rate was 100%. Bare metal stents were used in 96.6% of cases. The follow-up time was 1,378 ± 977 days. The mortality rate was 25.1%, target vessel revascularization rate was 15.9% and none of the patients presented nonfatal infarction. The incidence of MACE during follow-up was 34.5%. Conclusions: Late follow-up after PCI in renal transplantation patients demonstrated a high probability of

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Section: Discussionsupporting

confidence: 83%

Section: Data Collectionmentioning

confidence: 99%

Evolução clínica após intervenção coronária percutânea em indivíduos com transplante renal prévio

Trentin¹,

Melo²,

Santo³

et al. 2013

Rev. Bras. Cardiol. Invasiva

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“…In kidney transplant patients, everolimus may minimize or remove calcineurin inhibitors[76]. Interestingly, renal transplant patients with DES had a low rate of ST, probably related to the immunosuppressants given to prevent kidney rejection[77]. Everolimus has also been approved by the FDA for use in liver transplantation (LT), and is safe for use with tacrolimus within the first month after LT[78].…”

Section: Post Transplant Immunosuppressionmentioning

confidence: 99%

Organ transplantation and drug eluting stents: Perioperative challenges

Dalal¹

2016

WJT

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Patients listed for organ transplant frequently have severe coronary artery disease (CAD), which may be treated with drug eluting stents (DES). Everolimus and zotarolimus eluting stents are commonly used. Newer generation biolimus and novolimus eluting biodegradable stents are becoming increasingly popular. Patients undergoing transplant surgery soon after the placement of DES are at increased risk of stent thrombosis (ST) in the perioperative period. Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor such as clopidogrel, prasugrel and ticagrelor is instated post stenting to decrease the incident of ST. Cangrelor has recently been approved by Food and Drug Administration and can be used as a bridging antiplatelet drug. The risk of ischemia vs bleeding must be considered when discontinuing or continuing DAPT for surgery. Though living donor transplant surgery is an elective procedure and can be optimally timed, cadaveric organ availability is unpredictable, therefore, discontinuation of antiplatelet medication cannot be optimally timed. The type of stent and timing of transplant surgery can be of utmost importance. Many platelet function point of care tests such as Light Transmittance Aggregrometry, Thromboelastography Platelet Mapping, VerifyNow, Multiple Electrode Aggregrometry are used to assess bleeding risk and guide perioperative platelet transfusion. Response to allogenic platelet transfusion to control severe intraoperative bleeding may differ with the antiplatelet drug. In stent thrombosis is an emergency where management with either a drug eluting balloon or a DES has shown superior outcomes. Post-transplant complications often involved stenosis of an important vessel that may need revascularization. DES are now used for endovascular interventions for transplant orthotropic heart CAD, hepatic artery stenosis post liver transplantation, transplant renal artery stenosis following kidney transplantation, etc. Several antiproliferative drugs used in the DES are inhibitors of mammalian target of rapamycin. Thus they are used for post-transplant immunosuppression to prevent acute rejection in recipients with heart, liver, lung and kidney transplantation. This article describes in detail the various perioperative challenges encountered in organ transplantation surgery and patients with drug eluting stents.

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Presence of Cardiovascular Disease in Patients on a Waiting List for Renal Transplantation and in Patients After Kidney Transplantation in a Single Center

Ott

Busch

Steiner

et al. 2010

Transplantation Proceedings

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Evolução clínica pós-stent coronariano em pacientes submetidos a transplante de rim

Cited by 6 publications

References 20 publications

Evolução clínica após intervenção coronária percutânea em indivíduos com transplante renal prévio

Evolução clínica após intervenção coronária percutânea em indivíduos com transplante renal prévio

Organ transplantation and drug eluting stents: Perioperative challenges

Presence of Cardiovascular Disease in Patients on a Waiting List for Renal Transplantation and in Patients After Kidney Transplantation in a Single Center

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