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C Chamorro

Publications and source records attributed to C Chamorro.

At least 19 recordsLinked to original sources
PubMed2006

Does amiodarone influence early mortality in heart transplantation?

The use of amiodarone before transplantation has been linked to an increased number of complications, acute graft failures, and early mortality after a heart graft. We undertook a retrospective, descriptive, case-controlled study involving early mortality and acute graft failure. The 396 consecutive patients included 25 subjects who had been prescribed amiodarone for at least 30 days before transplantation. We excluded retransplantations, pediatric transplantations, and combined transplantations. The endpoints were early mortality and acute graft failure. No significant differences were observed in early mortality and acute graft failures. The multivariate analysis did not reveal any variable that correlated with early mortality. Our study did not support the idea that amiodarone constituted a negative predictor of early survival or acute graft failure.

Amiodarone↗
PubMed2006

Evolutional changes in maintenance immunosuppression following heart transplantation.

UNLABELLED: Patients with a heart transplant (HT) may require changes in their immunosuppressive maintenance medication. The basic treatment regimen in our patients consisted of an anticalcineurin agent, an antimetabolite, and a steroid. OBJECTIVE: We undertook a descriptive study to quantify the incidence and causes of these changes and determine how they occur. MATERIALS AND METHODS: We included the 432 HT performed at our center from November 1987 to October 2005. The baseline treatment was considered to be the treatment given following HT, and the maintenance treatment was that taken at the time of data collection. Kaplan-Meier survival curves were constructed for the analysis. RESULTS: The most significant change was the switch from azathioprine to mycophenolate mofetil. The survival rate after 17 years was 66%. CONCLUSIONS: As in the international registries, there has been an evident reduction in the use of cyclosporine and more particularly of azathioprine, in favor of tacrolimus and mycophenolate mofetil, respectively. No changes in the use of steroids have been observed. These data reflect an increasingly greater use of immunosuppressive agents with reduced side effect profiles.

Azathioprine↗
PubMed2006

Induction therapy with daclizumab in heart transplantation--how many doses?

UNLABELLED: Since their introduction onto the market, interleukin-2 antagonists have been increasingly used by a growing number of transplant units. Their benefits versus OKT3 appear evident, although the optimal dose remains to be established. Our objective was to establish possible differences related to the use of two versus five doses of daclizumab. MATERIALS AND METHODS: This study evaluated 81 consecutive patients treated with two bolus doses of daclizumab (1 mg/kg) on days 1 and 14 posttransplantation. We excluded retransplantations, pediatric transplantations, and combined transplantations. We compared our series to a previous trial involving the administration of a single bolus dose every 14 days (five boluses in total). Study variables included the number of graft rejections, the number of infections, and the mortality. Statistical analysis was performed using the chi square and Student's t tests. Significance was set at P < .05. RESULTS: There were no differences between groups in the baseline characteristics of the patients. The number of rejection episodes during the first year was significantly lower among the patients in our series treated with two bolus doses of daclizumab than in the series of patients treated with five bolus doses: 24 (30%) vs 17 (61%) episodes (P = .003). No significant differences were observed for mortality: the group receiving two boluses registered 10 deaths (12%) versus two (7%) in the group receiving five boluses (P = .4), or infection rate: 11 patients (40%) in the group receiving five bolus versus 31 patients (38%) in the group given two bolus doses (P = .9). CONCLUSIONS: Our results suggested that induction therapy with two doses of daclizumab was at least as effective in preventing rejection as five doses, with no negative effects on patient survival.

Antibodies, Monoclonal↗
PubMed2006

Multislice CT in graft vascular disease. A pilot study.

INTRODUCTION: Graft vessel disease (GVD) is one of the main long-term complications in heart transplant (HT) patients. At present, the diagnosis of this complication requires invasive procedures. Multislice CT is an emerging technique that allows visualization of the coronary anatomy, including the vascular lumen and wall thickness. Our objective was to establish the value of 16-detector multislice CT in the detection of GVD, compared with angiography and intravascular ultrasound (IVUS). PATIENTS AND METHODS: We studied 32 HT patients, who had a mean follow-up of 2016 days. CT was performed 24 hours prior to angiography, associated with IVUS if the latter proved normal. Comparisons were subsequently made using contingency tables to establish the sensitivity, specificity, and predictive values of the CT. RESULTS: Angiography was not performed on two patients, and eight were excluded from CT assessment due to serum creatinine values >1.5 mg/dL. Comparison of the CT findings with the invasive techniques yielded a sensitivity of 50%, a specificity of 81%, a negative predictive value of 81%, a positive predictive value of 50%, and a precision of 72%. CONCLUSIONS: Our results suggested good performance of the technique in screening for GVD because a high negative predictive value was recorded. We plan to increase the number of patients and use the 64-detector CT system to ensure greater time and spatial resolution.

Follow-Up Studies↗
PubMed2006

Influence of immunosuppression regimen on heart transplantation survival.

OBJECTIVE: To perform an analysis comparing long-term survival in heart transplant (HT) patients depending on the immunosuppressive regimen. MATERIALS AND METHODS: The study included 317 consecutive HT patients. We excluded pediatric cases, retransplants, combined transplants (lung and kidney), and immunosuppressive regimens with fewer than 10 cases. The six groups analyzed were: (1) OKT3 7 days + cyclosporine (CsA) + mycophenolate mofetil (MMF) + steroids (S); (2) OKT3 7 days + CsA + azathioprine (AZA) + S; (3) OKT3 10 days + CsA + MMF + S; (4) OKT3 10 days + CsA + AZA + S; (5) interleukin-2 (IL-2) antagonists + CsA + MMF + S; and (6) IL-2 antagonists + tacrolimus + MMF + S. Probability of survival was analyzed by Kaplan-Meier and log-rank methods. RESULTS: The groups were heterogeneous regarding the number of patients and follow-up. The baseline characteristics were similar, although there were differences in surgery times. The survivals by groups at the end of the follow-up period were: group 1: 75.8%; group 2: 51.2%; group 3: 63.6%; group 4: 25.3%; group 5: 91.2%; and group 6: 84.6%. A major reduction in survival was observed in the groups that were given induction with OKT3 monoclonal antibodies (groups 1, 2, 3, and 4), particularly when AZA was combined in the maintenance phase (groups 2 and 4) and when the induction dose was high (10-day therapy in groups 3 and 4). CONCLUSIONS: Our study suggested an association between the immunosuppressive regimen and the long-term survival of HT patients. The best results were obtained with an induction regimen based on IL-2 antagonists. On the basis of the survivals observed in this study, the maintenance combination we regard as "optimal" at this time is based on a combination of CsA, MMF, and steroids.

Adult↗
PubMed2006

Variations in the frequency and type of infections in heart transplantation according to the immunosuppression regimen.

OBJECTIVE: To evaluate the frequency of infection according to the immunosuppressive regimens used in our center. MATERIALS AND METHODS: From 259 consecutive heart transplants we excluded pediatric cases, retransplants, combined transplants (lung and kidney) and immunosuppressive regimens with fewer than 10 cases. The six groups analyzed were: (1) OKT3 (7 days) + cyclosporine (CsA) + mycophenolate mofetil (MMF) + steroids (S); (2) OKT3 (7 days) + CsA + azathioprine (AZA) + S; (3) OKT3 (10 days) + CsA + MMF + S; (4) OKT3 (10 days) + CsA + AZA + S; (5) interleukin-2 (IL-2) antagonists + CsA + MMF + S; (6) IL-2 antagonists + tacrolimus + MMF + S. Infection was considered significant when it causal hospital admission or prolonged hospitalization. RESULTS: With a total mean follow-up of 54 +/- 43 months, the total percentage of infection-free patients at the end of follow-up was 45.5%. Infection-free survival was lower among patients administered induction with OKT3 antibodies for 10 days, combined with cyclosporine, either with MMF (10%, group 3) or with azathioprine (27%, group 4), compared to those given IL-2 antagonists (particularly in combination with tacrolimus and MMF-69.2%, group 6). CONCLUSIONS: The results of this study showed that infection was frequent in heart transplantation. Furthermore, induction therapy with OKT3 monoclonal antibodies was associated with an important number of infections (particularly viral infections). Comparison of the treatment groups showed that the regimen associated with fever infections included an IL-2 receptor antagonist with tacrolimus, MMF, and S.

Drug Therapy, Combination↗
PubMed2006

[Monitoring pain: recommendations of the Analgesia and Sedation Work Group of SEMICYUC].

In critically ill patients, pain is frequently underestimated and so insufficiently managed. Psychological, haemodynamic and neuroendocrine responses, secondary to untreated pain, could produce morbidity and even increases in patient mortality. All members of the intensive care team must have abilities to assess and to manage pain. The evaluation of pain in the critically ill patient is very difficult but extremely important. Self-reported pain is the starting point for treatment. The pain scores recommended are, VAS (visual analogue scale) and NRS (numeric rating scale) in communicative patients and Campbell scale in uncommunicative patients. Adequate and regular patient assessment leads to improved pain control. Scores higher than 3 points should not be permitted. A pain-free Intensive Care Unit should be a quality standard healthcare aim.

Analgesics↗
PubMed2005

Human skin keratinocytes modified by a Friend-derived retroviral vector: a functional approach.

The goal of this study was to test the efficiency and possible functional effects of a Friend Leukemia derived retrovirus vector (FOCH29-NeoR) on cultured human keratinocytes, obtained from skin biopsy samples. The keratinocytes were grown and infected with filtered Friend vector supernatant. After one or two doses of infection, one duplicate of the culture was submitted to selection with G418; the other one was utilized for DNA extraction and PCR modification detection. Transduction efficiency was 46.66 percent and 47.22 percent for one and two doses of infection respectively (range 100 to 15 %). Colony Forming Efficiency (CFE) assays were done with Rodhamine-B staining in nonselected modified cultures and negative controls. There was no difference in CFE (% CFE= 10.74+/-6.53 negative control vs % CFE= 9.22+/-5.45 with one dose, and % CFE= 10.03+/-5.74 with two doses of infection). Nevertheless, the cell-cycle analysis done by Propidium Iodade (PI) incorporation and colchicine-arrest assays in nonselected transduced and nontransduced cells show that transduced keratinocytes have a longer time to enter G2. As far as we know, this is the first report of retroviral transduction-induced changes in the cell cycle done on human keratinocytes. This observation is very important because retroviral vectors of genes, such as platelet derived growth factor (PDGF) or vascular endothelial growth factor (VEGF), are expected to facilitate the implementation of these modified cultures for tissue grafting and skin substitute development and potentiate the effectiveness of the grafts.

Cells, Cultured↗
PubMed2005

Influence of induction therapy on rejection and survival in heart transplantation.

BACKGROUND AND AIMS: Immunosuppressive therapy has undergone great changes in recent years as a result of the introduction of new drugs, presumed a prior to be more effective and better tolerated. The greatest advance seems to have been the introduction of interleukin-2 (IL-2) receptor antagonists. The objective of this study was to determine whether the use of IL-2 receptor antagonists in induction therapy has implications for the development of rejection and survival. MATERIALS AND METHODS: Three hundred sixty-five consecutive cardiac transplant patients who received induction therapy were included. Heart-lung and transplants in children under 10 years were excluded. Three groups were compared according to the induction therapy (OKT3, 10 days; OKT3, 7 days; and IL-2R antagonists). Each treatment corresponded to a time period: OKT3 10 days from June 1989 to April 1994; OKT3 7 days from May 1994 to October 2002; and IL-2R antagonists from November 2002 to May 2004. Baseline characteristics of recipient and donor, surgical times, postsurgical complications, maintenance immunosuppression, number of rejections, time (days) to first rejection, and probability of survival at 1 year were recorded. We used analysis of variance, chi(2) test, Kaplan-Meier curves, and log-rank test as appropriate. A P-value < .05 was considered significant. RESULTS: There were significant differences in the characteristics of the transplanted patients in the various time periods. Thus, recipients in the OKT3 10 day group had worse status but better donors, whereas recipients in the IL-2R antagonists group had better status but older donors with longer duration of ischemia. The incidence of acute graft failure was similar in the three groups. The number of rejection episodes in the first year was higher among the OKT3 groups (OKT3 10 days, 1.7 +/- 1.3; OKT3 7 days, 1.2 +/- 1.2; IL-2R antagonists, 1.0 +/- 1.2; P = .02) and the probability of survival at 1 year was also lower (OKT3 10 days, 74%; OKT3 7 days, 77%; IL-2R antagonists, 94%; P = .0007). CONCLUSIONS: Induction therapy with IL-2 antagonists offers important advantages over treatment with OKT3 in terms of survival, with absolute and relative risk reductions of 20% and 27%. Furthermore, it did not increase the number of rejections, although this may have been due to the greater use of MMF versus azathioprine.

Adolescent↗
PubMed2005

Predictive factors for development of diabetes mellitus post-heart transplant.

INTRODUCTION: It is known that there is a high incidence of diabetes mellitus (DM) among heart transplant (HT) patients, which may be up to 30% at 5 years. The presence of DM has been associated with increased morbidity (infections, renal dysfunction, or graft vascular disease), and its development has been related primarily to immunosuppressive therapy. The objective of this study was to determine, in our experience, the presence of predictive variables for the development of DM following HT. METHODS: We studied 315 consecutive non-DM patients (88.6% men, mean age 51.5 years) who underwent HT in our hospital from November 1987 to May 2003, analyzing all variables that could be related to the development of DM during follow-up. Student t-test and chi(2) test were used for univariate statistical analysis and logistic regression for multivariate analysis. RESULTS: Of the 315 patients, 64 developed DM (20.3%) during a mean follow-up of 3.3 years. The univariate analysis showed that patients developing DM are older (54.9 +/- 8.7 versus 50.7 +/- 11.8 years, P = .008), have a higher body mass index (BMI) (27.3 +/- 3.8 versus 25.7 +/- 3.7, P = .003), a higher prevalence of HT (37.5% versus 23.5%, P = .023), a lower frequency of urgent HT (9.4% versus 26.2%, P = .004), are more often treated with steroids (85.9% versus 70.1%, P = .011) and tacrolimus (12.5% versus 4.4%, P = .015), and have a higher frequency of rejection episodes (71.2% versus 44.6%, P = .001). Multivariate analysis identified the following as predictive factors for the development of DM: age (OR = 1.04, P = .013), urgent HT (OR = 0.36, P = .031), treatment with tacrolimus (OR = 3.89, P = .012), and number of rejections (OR = 2.34, P = .002). CONCLUSION: In our population, age, urgent HT (which had a protective effect), treatment with tacrolimus, and number of rejections were independent predictive variables for the development of DM during follow-up.

Adult↗
PubMed2004

Successful bilateral lung transplantation from a methanol-poisoned donor.

The shortage of suitable organ donors is an important limiting factor that is making the evaluation of marginal donors necessary and, consequently, allowing expansion of standard donor criteria for organ removal. Lung procurement after methanol poisoning is anecdotal; in fact, there is only one published case in literature and that case showed a successful outcome. In this report, we describe a case of lung donation from a previously healthy individual who died from methanol poisoning. Both lungs were successfully implanted to a 20-year-old man who suffered from cystic fibrosis. This case report is new evidence that lung transplantation from methanol-poisoned donors may be safely performed with a good outcome.

Adult↗
PubMed2003

Cardiac donor management: another point of view.

The shortage of suitable donor hearts is an important limiting factor in heart transplantation and continues to produce discussion about adequate donor management with regard to graft quality. Recent recommendations, such as limiting the doses of catecholamines for maintenance therapy of cardiac donors, have causes up to two thirds of cardiovascular surgeons to refuse a heart graft from a donor treated with dopamine doses greater than 10 microg/kg/min although endogenous catecholamines may cardiac and pulmonary complications in organ donors, these conditions may be treated using similar agents. Perhaps it is the magnitude of the endogenous catecholamine surge that produces the pathology; thereafter, the levels, may quickly decrease to the point of catecholamine depletion at the receptor level so that exogenous administration is not deleterious and even can have beneficial effects. In the hemodynamic management of organ donors, administration of catecholamines with alpha and beta-1 effects may be needed in sufficient doses to reverse the loss of sympathetic tone at the vascular and cardiac level. Hemodynamic responses display a great individual variability; therefore, a maximal dose should not be set. Catecholamine administration increases coronary artery perfusion pressure, thus optimizing the cardiac performance. Furthermore, it is possible that immunomodulatory effects of catecholamines influence acute allograft rejection rates.

Catecholamines↗
PubMed2001

[Malposition of central venous catheters in hospitalized patients].

BACKGROUND: At the time of inserting a central catheter, it is recommended to check that its distal tip is positioned outside the heart cavities. Our objective was to determine the degree of fulfillment of this recommendation. PATIENTS AND METHOD: Cross-sectional study on patients carrying a central venous catheter who were admitted to conventional areas of a university hospital. We considered as "risk catheter" any catheter whose distal tip was located within the cardiac cavities. RESULTS: 34 out of 362 hospitalized patients had a central venous catheter. Fifty per cent of them were found to have a "risk catheter". In spite of its X-ray confirmation, no patient underwent a subsequent modification of the distal tip position. CONCLUSIONS: We have noticed a high percentage of patients with central venous catheters whose insertion supposed a cardiovascular risk. Unawareness of the serious complications that may arise from this fact probably justifies a high prevalence of misplacements.

Catheterization, Central Venous↗