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Tratamiento del rechazo mediado por anticuerpos en pacientes trasplantados renales revisión sistemática

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dc.contributor.advisorMolina Castaño, Carlos Federico
dc.creatorRodriguez Rozo, Jorge Enrique
dc.creator.degreeMagíster en Epidemiología
dc.date.accessioned2016-10-21T13:14:30Z
dc.date.available2016-10-21T13:14:30Z
dc.date.created2016-09-20
dc.date.issued2016
dc.descriptionAntecedentes: El trasplante renal es la mejor alternativa terapéutica para la enfermedad renal crónica terminal. Los medicamentos inmunosupresores previenen el rechazo. El rechazo mediado por anticuerpos es frecuente y disminuye la función y duración del injerto. Objetivo: Evaluar sistemáticamente la evidencia disponible relacionada con la eficacia y seguridad del tratamiento para el rechazo mediado por anticuerpos en pacientes trasplantados renales. Metodologia: Revisión sistemática en bases de datos MEDLINE, EMBASE, Scopus y Biblioteca virtual de la salud. Literatura gris google scholar, google academico, www.clinicaltrialsregister.eu, and https://clinicaltrials.gov/. Búsqueda manual referencias artículos pre-seleccionados así como de revisiones previamente publicadas. Se siguieron las recomendacioes guia PRISMA para la identificacion de artículos potenciales, tamizaje y selección teniendo en cuenta los criterios de inclusion. Extracción datos de acuerdo a las variables, revisión calidad de los artículos elegidos utilizando evaluación riesgo de segos de Cochrane. Resultados: Se seleccionaron 9 ensayos clínicos publicados entre 1980 y 2016, incluyeron 222 pacientes (113 brazo de intervención y 109 en el control), seguimiento promedio 16 meses. Intervenciones evaluadas plasmaféresis, inmunoadsorción y rituximab. Hubo una amplia heterogeneidad en la definición de criterios de inclusión, criterios diagnósticos de rechazo y medidas de evaluación de eficacia de las intervenciones. Tres estudios encontraron diferencias estadísticamente significativas entre los grupos de tratamiento. Conclusiones: La evidencia sobre la eficacia de los tratamientos del rechazo mediado por anticuerpos en injertos renales es de baja calidad. Son necesarios ensayos clínicos controlados para poder definir el tratamiento óptimo de estos pacientes.spa
dc.description.abstractBackground: Kidney transplantation is the best therapeutic choice for end-stage chronic kidney disease (ES-CKD). Immunosuppressive drugs prevent rejection. Antibody mediated rejection is a frequent complication and implies a decrease in graft function and duration. This study is a systematic review to evaluate the evidence available regarding antibody mediated rejection treatment efficacy and safety in kidney transplant patients. Methods: Systematic review of databases MEDLINE, EMBASE, Scopus and Health Virtual Library (BVS in spanish). The grey literature sources were: google scholar, google academico, www.clinicaltrialsregister.eu, and https://clinicaltrials.gov/. There was a manual search of the references of every article pre-selected, as well as the review articles published previously. The PRISMA guidelines recommendations for identifying potential items, screening and selection were followed considering the inclusion criteria. Data according to variables were extracted and to asses the quality of the articles selected the evaluation of bias risk by Cochrane was used. Results: Nine clinical trials published 1980 and 2016 were selected, included 222 patients (113 at intervention arm, and 109 as control), with an average follow-up of 16 months. Interventions evaluated were plasmapheresis, immunoadsortion and rituximab. There was a wide heterogeneity in the definition of inclusion criteria, diagnostic criteria for rejection and assessment effectiveness of interventions. Three studies was able to demonstrate a statistical significance between treatment groups. Conclusion: The data describing the efficacy of treatments for antibody-mediated rejection in renal allografts are of low. Larger randomized controlled trials are required in order to define the optimal scheme of treatment for these patients.eng
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dc.identifier.doihttps://doi.org/10.48713/10336_12441
dc.identifier.urihttp://repository.urosario.edu.co/handle/10336/12441
dc.language.isospa
dc.publisherUniversidad del Rosariospa
dc.publisher.departmentFacultad de medicinaspa
dc.publisher.programMaestría en Epidemiologíaspa
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto completo)spa
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dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subjecttrasplante renalspa
dc.subjectrechazo mediado por anticuerposspa
dc.subjectInmunosupresiónspa
dc.subjectRechazo de trasplantespa
dc.subject.ddcIncidencia & prevención de la enfermedad
dc.subject.decsEpidemiologíaspa
dc.subject.decsEnfermedades renalesspa
dc.subject.decsInmunología del trasplantespa
dc.subject.keywordkidney transplantationeng
dc.subject.keywordantibody mediated rejectioneng
dc.subject.keywordgraft rejectioneng
dc.subject.keywordgraft survivaleng
dc.subject.lembEpidemiologíaspa
dc.titleTratamiento del rechazo mediado por anticuerpos en pacientes trasplantados renales revisión sistemáticaspa
dc.typemasterThesiseng
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTesis de maestríaspa
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TRATAMIENTO DEL RECHAZO MEDIADO POR ANTICUERPOS EN PACIENTES TRASPLANTADOS RENALES REVISIÓN SISTEMÁTICA
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Maestría en Epidemiología