Incidencia de enfermedad renal crónica en los niños con trasplante hepático en La Cardio

La ERC en el trasplante hepático pediátrico está asociada con la exposición a nefrotóxicos e infecciones por gérmenes oportunistas. Evaluar la función renal en pacientes pediátricos es desafiante. Este estudio busca establecer la incidencia de ERC en pacientes menores de 18 años que recibieron un tr...

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Autores:
Arteaga Aya, Lucy Natalia
Valencia Morales, Victoria Eugenia
Tipo de recurso:
https://purl.org/coar/resource_type/c_7a1f
Fecha de publicación:
2024
Institución:
Universidad El Bosque
Repositorio:
Repositorio U. El Bosque
Idioma:
spa
OAI Identifier:
oai:repositorio.unbosque.edu.co:20.500.12495/12771
Acceso en línea:
https://hdl.handle.net/20.500.12495/12771
Palabra clave:
Trasplante hepatico pediatrico
Enfermedad renal cronica
Proteinuria
Hipertension arterial
Citomegalovirus
Infeccion
Paediatric liver transplantation
Chronic kidney disease
Proteinuria
Infection
Cytomegalovirus
Hypertension
WS 320
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openAccess
License
Atribución-NoComercial-CompartirIgual 4.0 Internacional
id UNBOSQUE2_db4ce154ced7aec380804171171f6439
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network_acronym_str UNBOSQUE2
network_name_str Repositorio U. El Bosque
repository_id_str
dc.title.none.fl_str_mv Incidencia de enfermedad renal crónica en los niños con trasplante hepático en La Cardio
dc.title.translated.none.fl_str_mv Incidence of chronic kidney disease in children with liver transplant in La Cardio
title Incidencia de enfermedad renal crónica en los niños con trasplante hepático en La Cardio
spellingShingle Incidencia de enfermedad renal crónica en los niños con trasplante hepático en La Cardio
Trasplante hepatico pediatrico
Enfermedad renal cronica
Proteinuria
Hipertension arterial
Citomegalovirus
Infeccion
Paediatric liver transplantation
Chronic kidney disease
Proteinuria
Infection
Cytomegalovirus
Hypertension
WS 320
title_short Incidencia de enfermedad renal crónica en los niños con trasplante hepático en La Cardio
title_full Incidencia de enfermedad renal crónica en los niños con trasplante hepático en La Cardio
title_fullStr Incidencia de enfermedad renal crónica en los niños con trasplante hepático en La Cardio
title_full_unstemmed Incidencia de enfermedad renal crónica en los niños con trasplante hepático en La Cardio
title_sort Incidencia de enfermedad renal crónica en los niños con trasplante hepático en La Cardio
dc.creator.fl_str_mv Arteaga Aya, Lucy Natalia
Valencia Morales, Victoria Eugenia
dc.contributor.advisor.none.fl_str_mv Baez, Martha
dc.contributor.author.none.fl_str_mv Arteaga Aya, Lucy Natalia
Valencia Morales, Victoria Eugenia
dc.subject.none.fl_str_mv Trasplante hepatico pediatrico
Enfermedad renal cronica
Proteinuria
Hipertension arterial
Citomegalovirus
Infeccion
topic Trasplante hepatico pediatrico
Enfermedad renal cronica
Proteinuria
Hipertension arterial
Citomegalovirus
Infeccion
Paediatric liver transplantation
Chronic kidney disease
Proteinuria
Infection
Cytomegalovirus
Hypertension
WS 320
dc.subject.keywords.none.fl_str_mv Paediatric liver transplantation
Chronic kidney disease
Proteinuria
Infection
Cytomegalovirus
Hypertension
dc.subject.nlm.none.fl_str_mv WS 320
description La ERC en el trasplante hepático pediátrico está asociada con la exposición a nefrotóxicos e infecciones por gérmenes oportunistas. Evaluar la función renal en pacientes pediátricos es desafiante. Este estudio busca establecer la incidencia de ERC en pacientes menores de 18 años que recibieron un trasplante hepático en La Cardio entre 2008 y 2020, y los factores asociados al desarrollo o progresión de esta complicación. Se realizó un estudio observacional de cohorte retrospectiva, incluyendo pacientes que fueron sometidos a trasplante hepático y/o retransplante desde el nacimiento hasta los 18 años. Se excluyeron pacientes con trasplante combinado hígado-riñón y aquellos fallecidos o con pérdida de seguimiento en los primeros seis meses posteriores al trasplante. Se analizaron variables cuantitativas y cualitativas.
publishDate 2024
dc.date.accessioned.none.fl_str_mv 2024-07-31T18:31:17Z
dc.date.available.none.fl_str_mv 2024-07-31T18:31:17Z
dc.date.issued.none.fl_str_mv 2024-07
dc.type.coar.fl_str_mv http://purl.org/coar/resource_type/c_7a1f
dc.type.local.spa.fl_str_mv Tesis/Trabajo de grado - Monografía - Especialización
dc.type.coar.none.fl_str_mv https://purl.org/coar/resource_type/c_7a1f
dc.type.driver.none.fl_str_mv info:eu-repo/semantics/bachelorThesis
dc.type.coarversion.none.fl_str_mv https://purl.org/coar/version/c_ab4af688f83e57aa
format https://purl.org/coar/resource_type/c_7a1f
dc.identifier.uri.none.fl_str_mv https://hdl.handle.net/20.500.12495/12771
dc.identifier.instname.spa.fl_str_mv instname:Universidad El Bosque
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional Universidad El Bosque
dc.identifier.repourl.none.fl_str_mv repourl:https://repositorio.unbosque.edu.co
url https://hdl.handle.net/20.500.12495/12771
identifier_str_mv instname:Universidad El Bosque
reponame:Repositorio Institucional Universidad El Bosque
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dc.language.iso.fl_str_mv spa
language spa
dc.relation.references.none.fl_str_mv 1. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Available from: www.publicationethics.org
2. Kivelä JM, Räisänen-Sokolowski A, Pakarinen MP, Mäkisalo H, Jalanko H, Holmberg C, et al. Long-term renal function in children after liver transplantation. Transplantation. 2011 Jan 15;91(1):115–20.
3. Kowalewski G, Kaliciński P, Stefanowicz M, Grenda R, Czubkowski P, Szymczak M. Long-term follow-up of renal function in children after liver transplantation-a single center retrospective study. Children. 2021 Aug 1;8(8).
4. Ojo AO, Held PJ, Port FK, Wolfe RA, Leichtman AB, Young EW, et al. Chronic Renal Failure after Transplantation of a Nonrenal Organ [Internet]. Vol. 10, n engl j med. 2003. Available from: www.nejm.org
5. Warady BA, Abraham AG, Schwartz GJ, Wong CS, Muñoz A, Betoko A, et al. Predictors of rapid progression of glomerular and nonglomerular kidney disease in children and adolescents: The chronic kidney disease in children (CKiD) cohort. American Journal of Kidney Diseases. 2015 Jun 1;65(6):878–88.
6. Porta G. Pediatric Liver Transplantation in South America: Incidence and Indications.
7. Feier F, Antunes E, D’agostino D, Varela-Fascinetto G, Jarufe N, Patillo JC, et al. Pediatric liver transplantation in Latin America: Where do we stand? Pediatr Transplant. 2016 May 1;20(3):408–16.
8. Solà E, Ginès P. Chronic kidney disease: A major concern in liver transplantation in the XXI century. Vol. 61, Journal of Hepatology. Elsevier; 2014. p. 196–7.
9. Kohli R, Cortes M, Heaton ND, Dhawan A. Liver transplantation in children: State of the art and future perspectives. Vol. 103, Archives of Disease in Childhood. BMJ Publishing Group; 2018. p. 192–8.
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14. Kohli R, Cortes M, Heaton ND, Dhawan A. Liver transplantation in children: State of the art and future perspectives. Vol. 103, Archives of Disease in Childhood. BMJ Publishing Group; 2018. p. 192–8.
15. Polat KY, Yazar, Aslan S, Kargı A, Selimoğlu A, Gürbulak B, et al. Comparing the Outcomes of Pediatric Liver Transplantation. Transplant Proc. 2023 Jun 1;55(5):1214–22.
16. Bourdeaux C, Darwish A, Jamart J, Tri TT, Janssen M, Lerut J, et al. Living-related versus deceased donor pediatric liver transplantation: A multivariate analysis of technical and immunological complications in 235 recipients. American Journal of Transplantation. 2007 Feb;7(2):440–7.
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18. Cerqueira DC, Soares CM, Silva VR, Magalhães JO, Barcelos IP, Duarte MG, et al. A predictive model of progression of CKD to ESRD in a predialysis pediatric interdisciplinary program. Clinical Journal of the American Society of Nephrology. 2014;9(4):728–35.
19. Fuhrman DY, Schneider MF, Dell KM, Blydt-Hansen TD, Mak R, Saland JM, et al. Albuminuria, proteinuria, and renal disease progression in children with CKD. Clinical Journal of the American Society of Nephrology. 2017;12(6):912–20.
20. Martinelli J, Habes D, Majed L, Guettier C, Gonzalès E, Linglart A, et al. Long-term outcome of liver transplantation in childhood: A study of 20-year survivors. American Journal of Transplantation. 2018 Jul 1;18(7):1680–9.
21. Burra P, Senzolo M, Masier A, Prestele H, Jones R, Samuel D, et al. Factors influencing renal function after liver transplantation. Results from the MOST, an international observational study. Digestive and Liver Disease. 2009 May;41(5):350–6.
22. Burra P, Senzolo M, Masier A, Prestele H, Jones R, Samuel D, et al. Factors influencing renal function after liver transplantation. Results from the MOST, an international observational study. Digestive and Liver Disease. 2009 May;41(5):350–6.
23. Kivelä JM, Räisänen-Sokolowski A, Pakarinen MP, Mäkisalo H, Jalanko H, Holmberg C, et al. Long-term renal function in children after liver transplantation. Transplantation. 2011 Jan 15;91(1):115–20.
24. Herlenius G, Hansson S, Krantz M, Olausson M, Kullberg-Lindh C, Friman S. Stable long-term renal function after pediatric liver transplantation. Pediatr Transplant. 2010 May;14(3):409–16.
25. Menon S, Kirkendall ES, Nguyen H, Goldstein SL. Acute kidney injury associated with high nephrotoxic medication exposure leads to chronic kidney disease after 6 months. Journal of Pediatrics. 2014;165(3):522-527.e2.
26. Bhatraju PK, Zelnick LR, Chinchilli VM, Moledina DG, Coca SG, Parikh CR, et al. Association Between Early Recovery of Kidney Function After Acute Kidney Injury and Long-term Clinical Outcomes. JAMA Netw Open. 2020 Apr 1;3(4):e202682.
27. Siew ED, Abdel-Kader K, Perkins AM, Greevy RA, Parr SK, Horner J, et al. Timing of Recovery From Moderate to Severe AKI and the Risk for Future Loss of Kidney Function. American Journal of Kidney Diseases. 2020 Feb 1;75(2):204–13.
28. Forni LG, Darmon M, Ostermann M, Oudemans-van Straaten HM, Pettilä V, Prowle JR, et al. Renal recovery after acute kidney injury. Intensive Care Med. 2017;43(6):855–66.
29. Kelly DA, Bucuvalas JC, Alonso EM, Karpen SJ, Allen U, Green M, et al. Long-term medical management of the pediatric patient after liver transplantation: 2013 practice guideline by the American association for the study of liver diseases and the American society of transplantation. Liver Transplantation. 2013 Aug;19(8):798–825.
30. Verma Y, Gupta E, Kumar N, Hasnain N, Bhadoria AS, Pamecha V, et al. Earlier and higher rates of cytomegalovirus infection in pediatric liver transplant recipients as compared to adults: An observational study. J Lab Physicians. 2018;10(02):221–5.
31. Abdullatif H, Dhawan A, Verma A. Epidemiology and Risk Factors for Viral Infections in Pediatric Liver Transplant Recipients and Impact on Outcome. Viruses. 2023;15(5).
32. Dulek DE. Update on Epidemiology and Outcomes of Infection in Pediatric Organ Transplant Recipients. Infect Dis Clin North Am. 2023;37(3):561–75.
33. Hayes M, Boge CLK, Sharova A, Vader D, Mitrou M, Galetaki DM, et al. Antiviral toxicities in pediatric solid organ transplant recipients. American Journal of Transplantation. 2022;22(12):3012–20.
34. Weiner C, Weintraub L, Wistinghausen B, Tomaino J, Arnon R, Kerkar N, et al. Graft rejection in pediatric liver transplant patients with Epstein-Barr viremia and post-transplant lymphoproliferative disease. Pediatr Transplant. 2012;16(5):458–64.
35. Alcamo AM, Alessi LJ, Vehovic SN, Bansal N, Bond GJ, Carcillo JA, et al. Severe Sepsis in Pediatric Liver Transplant Patients: The Emergence of Multidrug-Resistant Organisms. Pediatric Critical Care Medicine. 2019;20(7):e326–32.
36. Zarbock A, Nadim MK, Pickkers P, Gomez H, Bell S, Joannidis M, et al. Sepsis-associated acute kidney injury: consensus report of the 28th Acute Disease Quality Initiative workgroup. Nat Rev Nephrol. 2023;19(6):401–17.
37. Moffett BS, Goldstei SL. Acute kidney injury and increasing nephrotoxic-medication exposure in noncritically-Ill children. Clinical Journal of the American Society of Nephrology. 2011;6(4):856–63.
38. Mangus RS, Fridell JA, Vianna RM, Kwo PY, Chen J, Tector AJ. Immunosuppression induction with rabbit anti-thymocyte globulin with or without rituximab in 1000 liver transplant patients with long-term follow-up. Liver Transplantation. 2012 Jul;18(7):786–95.
39. Tchervenkov JI, Tzimas GN, Cantarovich M, Barkun JS, Metrakos P. The impact of thymoglobulin on renal function and calcineurin inhibitor initiation in recipients of orthotopic liver transplant: A retrospective analysis of 298 consecutive patients. Transplant Proc. 2004;36(6):1747–52.
40. Bajjoka I, Hsaiky L, Brown K, Abouljoud M. Preserving renal function in liver transplant recipients with rabbit anti-thymocyte globulin and delayed initiation of calcineurin inhibitors. Liver Transplantation. 2008 Jan;14(1):66–72.
41. Gras JM, Gerkens S, Beguin C, Janssen M, Smets F, Otte JB, et al. Steroid-free, tacrolimus-basiliximab immunosuppression in pediatric liver transplantation: Clinical and pharmacoeconomic study in 50 children. Liver Transplantation. 2008 Apr;14(4):469–77.
42. D’antiga L. Pediatric hepatology and liver transplantation. Pediatric Hepatology and Liver Transplantation. Springer International Publishing; 2019. 1–829 p.
43. Evrard V, Otte JB, Sokal E, Rochet JS, Haccourt F, Gennari F, et al. Impact of Surgical and Immunological Parameters in Pediatric Liver Transplantation: A Multivariate Analysis in 500 Consecutive Recipients of Primary Grafts. Ann Surg. 2004;239(2):272–80.
44. Miloh T, Barton A, Wheeler J, Pham Y, Hewitt W, Keegan T, et al. Immunosuppression in pediatric liver transplant recipients: Unique aspects. Vol. 23, Liver Transplantation. John Wiley and Sons Ltd; 2017. p. 244–56.
45. Arora-Gupta N, Davies P, McKiernan P, Kelly DA. The effect of long-term calcineurin inhibitor therapy on renal function in children after liver transplantation. Pediatr Transplant. 2004;8(2):145–50.
46. Anarat A, Testa S, Jankauskiene A, Caldas-Afonso A, Niaudet P, Mir S, et al. Strict Blood-Pressure Control and Progression of Renal Failure in Children. 2021;1639–50.
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48. Thangarajah D, O’Meara M, Dhawan A. Management of acute rejection in paediatric liver transplantation. Vol. 15, Pediatric Drugs. 2013. p. 459–71.
49. Lacquaniti A, Campo S, Casuscelli Di Tocco T, Rovito S, Bucca M, Ragusa A, et al. Acute and chronic kidney disease after pediatric liver transplantation: An underestimated problem. Vol. 34, Clinical Transplantation. Blackwell Publishing Ltd; 2020.
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52. Sethi A, Estrella MM, Ugarte R, Atta MG. Kidney function and mortality post-liver transplant in the Model for End-Stage Liver Disease ERA. Int J Nephrol Renovasc Dis. 2011;4:139–44.
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54. Ruan W, Galvan NTN, Dike P, Koci M, Faraone M, Fuller K, et al. The Multidisciplinary Pediatric Liver Transplant. Curr Probl Surg. 2023 Sep;101377.
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60. Daniel K, Said A. Early Biliary complications after liver transplantation. Vol. 10, Clinical Liver Disease. John Wiley and Sons Inc.; 2017. p. 63–7.
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spelling Baez, MarthaArteaga Aya, Lucy NataliaValencia Morales, Victoria Eugenia2024-07-31T18:31:17Z2024-07-31T18:31:17Z2024-07https://hdl.handle.net/20.500.12495/12771instname:Universidad El Bosquereponame:Repositorio Institucional Universidad El Bosquerepourl:https://repositorio.unbosque.edu.coLa ERC en el trasplante hepático pediátrico está asociada con la exposición a nefrotóxicos e infecciones por gérmenes oportunistas. Evaluar la función renal en pacientes pediátricos es desafiante. Este estudio busca establecer la incidencia de ERC en pacientes menores de 18 años que recibieron un trasplante hepático en La Cardio entre 2008 y 2020, y los factores asociados al desarrollo o progresión de esta complicación. Se realizó un estudio observacional de cohorte retrospectiva, incluyendo pacientes que fueron sometidos a trasplante hepático y/o retransplante desde el nacimiento hasta los 18 años. Se excluyeron pacientes con trasplante combinado hígado-riñón y aquellos fallecidos o con pérdida de seguimiento en los primeros seis meses posteriores al trasplante. Se analizaron variables cuantitativas y cualitativas.Especialista en Nefrología PediátricaEspecializaciónCKD in paediatric liver transplantation is associated with exposure to nephrotoxic drugs and opportunistic infections. Assessing renal function in paediatric patients is challenging. This study aims to establish the incidence of CKD in patients under 18 years of age who received a liver transplant at La Cardio between 2008 and 2020, and the factors associated with the development or progression of this complication. A retrospective observational cohort study was conducted, including patients who underwent liver transplantation and/or retransplantation from birth to 18 years of age. Patients with combined liver-kidney transplantation and those deceased or lost to follow-up in the first six months after transplantation were excluded. Quantitative and qualitative variables were analysed.application/pdfAtribución-NoComercial-CompartirIgual 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-sa/4.0/Acceso abiertoinfo:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Trasplante hepatico pediatricoEnfermedad renal cronicaProteinuriaHipertension arterialCitomegalovirusInfeccionPaediatric liver transplantationChronic kidney diseaseProteinuriaInfectionCytomegalovirusHypertensionWS 320Incidencia de enfermedad renal crónica en los niños con trasplante hepático en La CardioIncidence of chronic kidney disease in children with liver transplant in La CardioEspecialización en Nefrología PediátricaUniversidad El BosqueFacultad de MedicinaTesis/Trabajo de grado - Monografía - Especializaciónhttps://purl.org/coar/resource_type/c_7a1fhttp://purl.org/coar/resource_type/c_7a1finfo:eu-repo/semantics/bachelorThesishttps://purl.org/coar/version/c_ab4af688f83e57aa1. 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Ann Card Anaesth. 2019 Jan-Mar;22(1)spaORIGINALTrabajo de grado.pdfTrabajo de grado.pdfapplication/pdf638443https://repositorio.unbosque.edu.co/bitstreams/1103d647-5503-41b3-9789-b8421a72a972/download5ac9be0e4f78ae803a941723bcb5c506MD52CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-81154https://repositorio.unbosque.edu.co/bitstreams/29a2f1e1-e7a8-44d1-a4e9-68cb51247619/downloadadb7af3ef071a784ffe1b544b9a344abMD53LICENSElicense.txtlicense.txttext/plain; charset=utf-82000https://repositorio.unbosque.edu.co/bitstreams/231c559c-7fc0-4512-973a-4adf8954ce6a/download17cc15b951e7cc6b3728a574117320f9MD54Carta de autorización.pdfapplication/pdf158863https://repositorio.unbosque.edu.co/bitstreams/b324e935-4622-469b-b269-9f56bbf9c30b/downloade724d6c1aba4e2d4365c29528ca09f59MD55Acta de grado.pdfapplication/pdf242052https://repositorio.unbosque.edu.co/bitstreams/289d520f-ad2f-4fa9-a87e-84a8ce806d33/download33bfbb2cb2e2f9792bdddf5fd2ea7b9cMD58TEXTTrabajo de grado.pdf.txtTrabajo de grado.pdf.txtExtracted texttext/plain94270https://repositorio.unbosque.edu.co/bitstreams/de89cf45-692b-4ab3-881b-7a95a59f6137/downloada0afe3c720dc29725aee60957c9976c2MD56THUMBNAILTrabajo de grado.pdf.jpgTrabajo de grado.pdf.jpgGenerated Thumbnailimage/jpeg3072https://repositorio.unbosque.edu.co/bitstreams/1c20b0c4-5688-4aa2-b3c7-405b617a0c1f/download8dcbd188c66631d8f5e91907a0854d54MD5720.500.12495/12771oai:repositorio.unbosque.edu.co:20.500.12495/127712024-08-01 10:23:30.387http://creativecommons.org/licenses/by-nc-sa/4.0/Atribución-NoComercial-CompartirIgual 4.0 Internacionalembargo2026-07-30https://repositorio.unbosque.edu.coRepositorio Institucional Universidad El Bosquebibliotecas@biteca.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