Papers by Federico Oppenheimer
Hip International, 2008
Osteoarticular complications are common in patients with chronic renal failure and they often req... more Osteoarticular complications are common in patients with chronic renal failure and they often require implantation of a hip arthroplasty (total or partial) due to osteoarthritis, femoral neck fracture or ischemic necrosis of multifactor aetiology. Between 1992 and 2005 we operated on eighteen patients (23 hips) with chronic renal failure who were receiving renal replacement therapy (ten haemodialysis and eight renal transplants), and in each case either a total or partial hip arthroplasty was implanted. This group comprised nine women and nine men, with a mean age of 56 years (range: 30-83). Five cases were bilateral. The clinical diagnoses were necrosis (fourteen cases), femoral neck fracture (five cases) and osteoarthritis (three cases). The main early complications were haemorrhage in seventeen cases (74%) and infection in six cases (33%) (two urinary infections and four of the surgical wound). The late complications involved eight cases (35%) of prosthetic loosening (five aseptic and three septic). The surgery-related mortality rate was 17% (three cases). Prosthetic hip surgery in patients receiving renal replacement therapy is associated with high morbidity and mortality, thus highlighting the importance of careful patient selection.
Revista clínica española, Jan 28, 1981
Transplantation proceedings, 1990
Transplantation proceedings, 1990
Transplantation proceedings, 1992
Holdaas H, Rostaing L, Serón D, Cole E, Chapman J, Fellstrøm B, Strom EH, Jardine A, Midtvedt K, Machein U, Ulbricht B, Karpov A, O'Connell PJ; ASCERTAIN Investigators. Conversion of long-term kidney transplant recipients from calcineurin inhibitor therapy to everolimus: a randomized, multicenter... Transplantation
Foot & ankle international, 2002
Uremic tumoral calcinosis is an uncommon, benign condition characterized by slow-growing calcifie... more Uremic tumoral calcinosis is an uncommon, benign condition characterized by slow-growing calcified periarticular soft tissue masses of varying size. We describe two patients with chronic renal failure on hemodialysis presenting uremic tumoral calcinosis, one in the fifth toe of the right foot and the other in the dorsum of the left foot between the first and second metatarsals. Excision of the calcic masses and parathyroidectomy were successfully performed in both patients. These cases are unusual in their rapid onset, mimicking acute infection. Differential diagnosis, radiological features and therapy are discussed.
Transplantation, 2011
R.U.P. conceived the study and participated in writing; H.S. provided critical input as a dermato... more R.U.P. conceived the study and participated in writing; H.S. provided critical input as a dermatologist and attending physician of Kaposi sarcoma patients; A.A.-V. and I.A.H. gave critical input as staff and attending physicians and participated in data collection and writing; E.H.S. critically reviewed the manuscript; and H.-G.K. critically reviewed the manuscript and participated in data collection.
Transplant International, 2012
Conflicts of interest Authors declare that they have had no involvements that might raise the que... more Conflicts of interest Authors declare that they have had no involvements that might raise the question of bias in the work reported or in the conclusions, implications, or opinions stated.
The Lancet, 1995
1. Lancet. 1995 May 6;345(8958):1174-5. HCV and organ transplantation. Morales JM, Campistol JM, ... more 1. Lancet. 1995 May 6;345(8958):1174-5. HCV and organ transplantation. Morales JM, Campistol JM, Bruguera M, Andrés A, Oppenheimer F, Rodicio JL. Comment on: Lancet. 1995 Feb 25;345(8948):484-7. PMID: 7723560 [PubMed - indexed for MEDLINE]. ...
Endocrine, 2014
Little is known about the effects of the administration of cinacalcet in dialytic patients who ar... more Little is known about the effects of the administration of cinacalcet in dialytic patients who are scheduled for kidney transplantation, and in particular about the changes in FGF23 and other mineral metabolism parameters after surgery compared with recipients not on cinacalcet at kidney transplantation. We performed a prospective observational cohort study with recruitment of consecutive kidney transplant recipients at our institution. Patients were classified according to whether they were under treatment with cinacalcet before transplantation. Bone mineral metabolism parameters, including C-terminal FGF23, were measured at baseline, on day 15, and at 1, 3, and 6 months after transplantation. In previously cinacalcet-treated patients, cinacalcet therapy was discontinued on the day of surgery and was not restarted after transplantation. A total of 48 kidney transplant recipients, 20 on cinacalcet at surgery and 28 cinacalcet non-treated patients, completed the follow-up. Serum phosphate declined significantly in the first 15 days after transplantation with no differences between the two groups, whereas cinacalcet-treated patients showed higher FGF23 levels, although not significant. After transplantation, PTH and serum calcium were significantly higher in cinacalcet-treated patients. We conclude that patients receiving cinacalcet on dialysis presented similar serum phosphate levels but higher PTH and serum calcium levels during the initial six months after kidney transplantation than cinacalcet non-treated patients. The group previously treated with cinacalcet before transplantation showed higher FGF23 levels without significant differences, so further studies should investigate its relevance in the management of these patients.
Open Access Journal of Clinical Trials, 2014
Two well defined, modifiable risk factors for kidney allograft failure are acute rejection and po... more Two well defined, modifiable risk factors for kidney allograft failure are acute rejection and poor graft function at one year post-transplant. Regulatory bodies and expert panels in the USA and Europe have recognized that both acute rejection and one-year graft function should be assessed when evaluating immunosuppressive regimens. TRANSFORM (Clinicaltrials.gov NCT01950819) is one of the first trials to adopt this approach and the first that applies a novel combined clinically meaningful endpoint to take the first step towards changing the paradigm for immunosuppression in kidney transplant patients. Everolimus with reduced-exposure calcineurin inhibitor (CNI) therapy is a strategy designed to reduce the risk of chronic nephrotoxicity and other dose-dependent complications associated with CNI therapy. In TRANSFORM, de novo kidney transplant patients are randomized to everolimus with reduced-exposure CNI, or mycophenolic acid with standard-exposure CNI, both with induction therapy and maintenance steroids. The primary endpoint is a composite of treated biopsy-proven acute rejection or estimated glomerular filtration rate ,50 mL/min/1.73 m 2 at month 12 post-transplant, which is expected to be sensitive both to the effects of acute and chronic allograft rejection and nephrotoxic side effects of immunosuppressive therapies. The construct of this endpoint allows the integration of a continuous outcome (graft function) with a logistic outcome (rejection). The trial uses a randomized, multicenter, open-label, two-arm design. After completion of a 2-year core study, patients enter a further 3-year prospective observational study. By capturing follow-up to 5 years, TRANSFORM will provide substantial data on the incidence of graft loss, graft dysfunction, cancer, cardiovascular events, and other patient-relevant outcomes. TRANSFORM will determine whether de novo CNI reduction with an everolimus-based regimen achieves short-term outcomes compared with standard CNI. As the largest clinical trial undertaken to date in kidney transplantation, recruiting more than 2,000 patients, and with extended follow-up to 5 years, TRANSFORM will provide critical data required to help maximize long-term outcomes.
Transplantation Reviews, 2012
Solid-organ transplant recipients are at increased risk of developing cancer compared with the ge... more Solid-organ transplant recipients are at increased risk of developing cancer compared with the general population. Tumours can arise de novo, as a recurrence of a preexisting malignancy, or from the donated organ. The ATOS (Aula sobre Trasplantes de Órganos Sólidos; the Solid-Organ Transplantation Working Group) group, integrated by Spanish transplant experts, meets annually to discuss current advances in the field. In 2011, the 11th edition covered a range of new topics on cancer and transplantation. In this review we have highlighted the new concepts and best practices for managing cancer in the pre-transplant and post-transplant settings that were presented at the ATOS meeting. Immunosuppression plays a major role in oncogenesis in the transplant recipient, both through impaired immunosurveillance and through direct oncogenic activity. It is possible to transplant organs obtained from donors with a history of cancer as long as an effective minimization of malignancy transmission strategy is followed. Tumour-specific wait-periods have been proposed for the increased number of transplantation candidates with a history of malignancy; however, the patient's individual risk of death from organ failure must be taken into consideration. It is important to actively prevent tumour recurrence, especially the recurrence of hepatocellular carcinoma in liver transplant recipients. To effectively manage post-transplant malignancies, it is essential to proactively monitor patients, with long-term intensive screening programs showing a reduced incidence of cancer post-transplantation. Proposed management strategies for post-transplantation malignancies include viral monitoring and prophylaxis to decrease infection-related cancer, immunosuppression modulation with lower doses of calcineurin inhibitors, and addition of or conversion to inhibitors of the mammalian target of rapamycin.
Transplantation Reviews, 2006
Acute antibody-mediated rejection (acute humoral rejection [AHR]) of organ allografts presents mo... more Acute antibody-mediated rejection (acute humoral rejection [AHR]) of organ allografts presents most of the time as severe dysfunction with a high risk of allograft loss. Peritubular capillary complement C4d deposition is diagnostic of AHR in kidney allografts and is associated with circulating ...
Transplantation Proceedings, 2003
Osteoporosis is a frequent complication after renal transplantation. Some workers have shown that... more Osteoporosis is a frequent complication after renal transplantation. Some workers have shown that bisphosphonates may be effective to prevent and treat corticosteroid-induced osteoporosis in these patients. In this study we report our experience with administration of the biphosphonate alendronate to treat renal transplanted patients with established osteoporosis. Material and Methods. Twelve to 24 months after transplantation (9 women, 5 men) 14 renal transplant patient were treated with alendronate and 12 patients (7 women, 5 men) were untreated. All patients displayed an iPTH Ͻ240 pg/mL and a bone mineral density (BMD) t-score ϽϪ2.5. All patients received cyclosporine and prednisone therapy. Biochemical measurements, BMD, and X-rays of the lumbar spine were measured during study. Patients in the treatment group received alendronate 10 mg/d (po) and vitamin D plus calcium (800 UI cholecalciferol and 2.5 g of CaCO 3) per day while those in the control group only received vitamin D plus calcium, at the same dose. Results. There was no difference in mean age, weight, time after transplantation, or immunosuppression between the treatment and control groups. There were no significant differences in the biochemical parameters during the study period. Over the 1-year study period, patients receiving alendronate displayed a greater increase in BMD. Lumbar spine BMD increased 4.3 Ϯ 6.1% in the treatment group versus 0.55 Ϯ 5.30% in controls. Femoral neck BMD increased 10.3 Ϯ 11.9% and 2.2 Ϯ 5.7%, respectively, in the treatment and control groups. Patients receiving alendronate frequently experienced intestinal disconfort. Conclusions. The bisphosphonate alendronate is effective to treat renal transplant patients suffering from established osteporosis.
Transplantation Journal, 2010
Thrombosis Research, 2001
Muromonab-CD3 is a murine monoclonal antibody (MoAb) that is used in the prophylaxis and treatmen... more Muromonab-CD3 is a murine monoclonal antibody (MoAb) that is used in the prophylaxis and treatment of acute graft rejection. Activation of coagulation and fibrinolysis following anti-CD3 administration have been reported in some patients to lead to irreversible intragraft thrombosis. We have studied the effect of muromonab-CD3 infusion on platelets using flow cytometry in six patients who received three daily doses of muromonab-CD3 as prophylaxis of rejection before receiving a living donor renal transplant. Samples were collected before, 15 and 60 min after muromonab-CD3 infusion. Immunolabeling of platelets was performed in whole blood using dual-color analysis. The following conjugated MoAb were used: anti-CD41a, -CD36, -CD42b, -CD62P, -CD63, -factor V/Va and nonspecific Ig. Samples were analyzed with a FACScan flow cytometer (Becton Dickinson, Mountain View, CA, USA). After muromonab-CD3 infusion, an increase in the binding of MoAb anti-factor V/Va to platelets was seen, which was only statistically significant (2.2% vs. 12.8%, P=.04) after 15 min of the second dose. No significant changes were seen in the other MoAbs studied. No thrombotic complications were observed after transplantation. In uremic patients receiving muromonab-CD3 infusion as prophylaxis of graft rejection, an increase in the binding of anti-factor V/Va, denoting an increased exposure of anionic phospholipids in platelets, was seen. This increase in platelet procoagulant activity might contribute to the appearance of thromboses within renal graft seen in some patients who received muromonab-CD3.
Therapeutic Drug Monitoring, 2001
Mycophenolate mofetil (MMF) in combination with cyclosporine (CsA) or Tacrolimus (TAC) has been s... more Mycophenolate mofetil (MMF) in combination with cyclosporine (CsA) or Tacrolimus (TAC) has been show to be a potent immunosuppressive agent. The authors assessed the mycophenolic acid (MPA) plasma levels achieved in clinical practice and evaluated the effect of concomitant administration of CsA and TAC. One hundred forty transplant patients (kidney: 120 and lung: 20) received a triple immunosuppression regimen of CsA or TAC, prednisone and MMF. Twenty-two renal transplant patients received double therapy with MMF and prednisone. There was no correlation between MMF dose and MPA trough concentrations (r ס-0.0657). The medians (range) of the MPA dose-to-concentration ratio (D/C) in the CsA and TAC groups were 0.90 (0.11-8.33) and 0.56 (0.11-14.3), respectively (p < 0.0001). According to the post transplant period (1-3, 4-6 and >6 months), D/C values were significantly lower in patients receiving MMF and TAC than those receiving MMF and CsA in all three periods. MPA levels in patients treated with MMF and CsA were significantly lower than those obtained in double therapy. The D/C ratio in CsA-treated patients, increased significantly (p ס 0.0005) when CsA level increased. There was no relationship between D/C ratio and TAC blood concentrations. These results suggest that CsA exerts an influence on MPA trough levels, although further work is required to characterize the mechanism of interaction.
Nephron Clinical Practice, 2004
Background/Aims: Chronic allograft nephropathy is the main cause of late graft loss and nonimmuno... more Background/Aims: Chronic allograft nephropathy is the main cause of late graft loss and nonimmunological factors, including hypertension and proteinuria, the principal etiological factors. In this context, blockage of the renin-angiotensin system could be helpful. The aim of the present study was to review the renoprotective efficacy of losartan in a large group of renal transplant patients undergoing long-term follow-up. Methods: A retrospective analysis of 276 renal transplant patients treated with losartan was performed. The indication for losartan was arterial hypertension in 163 patients, proteinuria in 37 patients and hypertension plus proteinuria in the remaining 76 patients. Clinical and biochemical parameters before starting losartan treatment (–6 months, –3 months and at baseline) and 3, 6, 9, 12, 18 and 24 months after the introduction of losartan were analyzed. Results: Arterial hypertension significantly decreased after the introduction of losartan (p = 0.000). Serum cr...
Uploads
Papers by Federico Oppenheimer