{"id":75,"date":"2019-10-23T15:00:22","date_gmt":"2019-10-23T13:00:22","guid":{"rendered":"http:\/\/td_uid_39_5db04ee67ba81"},"modified":"2019-11-14T15:06:38","modified_gmt":"2019-11-14T14:06:38","slug":"el-retrasplantament-renal-situacio-a-catalunya-i-reptes-plantejats","status":"publish","type":"post","link":"https:\/\/fjarno.org\/revista-renal\/el-retrasplantament-renal-situacio-a-catalunya-i-reptes-plantejats\/","title":{"rendered":"El Retrasplantament renal: situaci\u00f3 a Catalunya i REPTES plantejats"},"content":{"rendered":"

Anna Garcia Martinez<\/span>
\nCoordinadora M\u00e8dica<\/span>
\nTrasplantament d’\u00d2rgans<\/span><\/span><\/p>\n

Organitzaci\u00f3 Catalana de Trasplantaments (OCATT)<\/span><\/span><\/p>\n

Servei Catal\u00e0 de la Salut<\/span><\/span><\/p>\n

Malgrat les millores en la <\/i><\/b><\/span>cirurgia, en el tractament amb immunosupressors i en les <\/i><\/b><\/span>cures del malalt trasplantat, <\/i><\/b><\/span>el 19% dels receptors perden l\u2019empelt al cap de tres anys <\/i><\/b><\/span>de la intervenci\u00f3. <\/i><\/b><\/span>10 anys despr\u00e9s del trasplantament, el nombre de pacients que es troben en aquesta <\/i><\/b><\/span>situaci\u00f3 augmenta fins al 48%, gaireb\u00e9 la meitat.<\/i><\/b><\/span><\/h5>\n
El millor tractament de la Insufici\u00e8ncia Renal Cr\u00f2nica (IRC) en el cas dels malalts tributaris que han perdut un empelt \u00e9s el Retrasplantament. El percentatge de superviv\u00e8ncia en cas d\u2019un segon empelt s\u2019acosten als del primer.<\/i><\/b><\/span><\/h5>\n
A 31 de desembre de 2018, hi havia 1.055 persones en llista d\u2019espera d\u2019un \u00f2rgan i, d\u2019aquestes, 347 (33%) eren retrasplantaments.<\/i><\/b><\/span><\/h5>\n
\"\"<\/h5>\n

Dades a CATALUNYA<\/span><\/strong><\/span><\/h4>\n

A Catalunya, el 14% de pacients trasplantats l\u2019any 2018 ja havien estat trasplantats anteriorment. A 31 de desembre de 2018, hi havia 1.055 persones en llista d\u2019espera d\u2019un \u00f2rgan i, d\u2019aquestes, 347 (33%) eren retrasplantaments.<\/span><\/p>\n

Les dades de 2016 s\u00f3n les seg\u00fcents:<\/span><\/p>\n

El 95% dels malalts trasplantats sobreviuen el primer any, mentre que la superviv\u00e8ncia de l\u2019empelt (incloent-hi la mort com a causa de frac\u00e0s) \u00e9s del 86%. <\/span><\/p>\n

Passats 5 anys de trasplantament, l\u2019\u00edndex de superviv\u00e8ncia baixa al 87%; i el de l\u2019empelt al 69%.<\/span><\/p>\n

Aquestes dades s\u00f3n equiparables a les presentades per la majoria de pa\u00efsos europeus.<\/b><\/span><\/p>\n

\"\"<\/p>\n

La import\u00e0ncia de la COMPATIBILITAT<\/strong><\/span><\/h4>\n

El rebuig d\u2019un \u00f2rgan trasplantat es produeix quan, malgrat el tractament immunosupressor, el receptor reconeix com estrany l\u2019empelt i activa les defenses immunol\u00f2giques per eliminar-lo, de forma semblant a com passa amb els microorganismes pat\u00f2gens com bacteris i virus. \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span><\/span><\/p>\n

Una gran majoria dels pacients que han perdut l\u2019empelt tornen a la llista d\u2019espera \u201csensibilitzats\u201d, \u00e9s a dir, amb anticossos contra els ant\u00edgens d\u2019Histocompatibilitat HLA. Especialment en aquest cas, la compatibilitat entre donant i receptor \u00e9s un dels principals factors d\u2019\u00e8xit de qualsevol trasplantament renal.<\/span><\/p>\n

La compatibilitat es requereix tant pel que fa al grup sanguini com als Ant\u00edgens Leucocitaris Humans (HLA) relacionats amb les funcions del sistema immunitari. Sempre s\u2019intenta buscar el m\u00e0xim grau d\u2019histocompatibilitat entre donant i receptor per reduir la probabilitat de rebuig, analitzant els seus respectius grups sanguinis i prote\u00efnes HLA (\u00e9s el que coneix com a tipatge). <\/span><\/p>\n

Un pacient es pot sensibilitzar per diferents causes. Una de freq\u00fcent seria el reconeixement d\u2019algun dels ant\u00edgens del donant del trasplantament anterior. Pels pacients a qui els ha fracassat l\u2019empelt, buscar un nou donant compatible es far\u00e0 m\u00e9s dif\u00edcil. <\/span><\/p>\n

Diem que aquests pacients s\u00f3n pacients sensibilitzats o hiperimmunitzats. Si la seva taxa d\u2019anticossos \u00e9s del 90%, hem de pensar que rebutjarien el 90% dels donants. \u00c9s per aix\u00f2 que les seves perspectives de trasplantament s\u00f3n pitjors si els comparem amb els pacients que no tenen cap antic\u00f2s.<\/span><\/p>\n

\"\"<\/p>\n

REPTES plantejats<\/strong><\/span><\/h4>\n
1. Ampliar la possibilitat de trobar un donant compatible.<\/b><\/span><\/h5>\n

El juliol de 2015, es va implantar, en l\u2019\u00e0mbit de l\u2019Estat espanyol, un Programa per millorar l\u2019acc\u00e9s al trasplantament renal del receptor altament hiperimmunitzat o sensibilitzat, utilitzant la prova creuada virtual (PATHI). En l\u2019aplicaci\u00f3 d\u2019aquest Programa, si existeix un receptor a Espanya que tingui un valor de sensibilitzaci\u00f3 molt alt (es mesura en cPRA superior al 98%) ser\u00e0 prioritzat i qualsevol rony\u00f3 dels centres de l\u2019Estat que participen en el Programa, li ser\u00e0 ofert de forma priorit\u00e0ria.<\/span><\/p>\n

A Catalunya es prioritzen pacients amb una sensibilitzaci\u00f3 menor (cPRA superior a 90%) i tots els donants de Catalunya els poden oferir un rony\u00f3 si s\u00f3n compatibles.<\/span><\/p>\n

2. Millorar la qualitat (sensibilitat i especificitat) de les proves immunol\u00f2giques per disminuir el risc de rebuig.<\/b><\/span><\/h5>\n

A Catalunya s\u2019ha implantat una nova Guia d\u2019Estudis Immunol\u00f2gics en el Trasplantament Renal. Aquesta nova Guia pret\u00e9n donar suport a la sol\u00b7licitud i interpretaci\u00f3 del cat\u00e0leg de prestacions del Laboratori d\u2019Histocompatibilitat de Catalunya (LHC) als nefr\u00f2legs responsables del trasplantament, tant per facilitar el trasplantament d\u2019\u00f2rgans com per contribuir al diagn\u00f2stic diferencial del rebuig. <\/span><\/p>\n

Els principals canvis que incorpora la Guia s\u00f3n:<\/span><\/p>\n

\u2022 M\u00e9s precisi\u00f3 en el tipatge i en la identificaci\u00f3 dels anticossos per aconseguir que la prova creuada virtual, tamb\u00e9 anomenada Crossmatch virtual (confrontaci\u00f3 simulada donant\/receptor, previ al trasplantament) tingui un major valor predictiu i que el seguiment posttrasplantament sigui m\u00e9s acurat.<\/span><\/p>\n

\u2022 En el pretrasplantament les proves incloses en aquesta Guia faciliten un millor seguiment dels aloanticossos pretrasplantament, cosa que permet reduir el risc de rebuig i millorar la superviv\u00e8ncia de l\u2019empelt.<\/span><\/p>\n

\u2022 En el posttrasplantament es podr\u00e0 con\u00e8ixer quins s\u00f3n els pacients amb m\u00e9s risc de rebuig i, per tant, adequar la medicaci\u00f3 immunosupressora a les seves necessitats. Si ajustem la medicaci\u00f3, els efectes secundaris disminuiran en els pacients que la necessitin i millorar\u00e0 la superviv\u00e8ncia en aquells que tinguin m\u00e9s risc de rebuig.<\/span><\/p>\n

3. T\u00e8cniques de dessensibilitzaci\u00f3.<\/b><\/span><\/h5>\n

S\u2019est\u00e0 treballant en noves t\u00e8cniques de dessensibilitzaci\u00f3 que tenen per objectiu disminuir el grau de rebutjos dels pacients hiperimmunitzats en determinades situacions i un especial inter\u00e8s en el cas del trasplantament de donant viu.<\/span><\/p>\n

Totes les noves t\u00e8cniques del Laboratori d\u2019Histocompatibilitat de Catalunya i els tractaments de dessensibilitzaci\u00f3 estan coberts per l\u2019administraci\u00f3 sanit\u00e0ria catalana, la qual ha previst increments del suport econ\u00f2mic per aquestes proves i tractaments.<\/span><\/p>\n

\"\"<\/p>\n","protected":false},"excerpt":{"rendered":"

Anna Garcia Martinez Coordinadora M\u00e8dica Trasplantament d’\u00d2rgans Organitzaci\u00f3 Catalana de Trasplantaments (OCATT) Servei Catal\u00e0 de la Salut Malgrat les millores en la cirurgia, en el tractament amb immunosupressors i en les cures del malalt trasplantat, el 19% dels receptors perden l\u2019empelt al cap de tres anys de la intervenci\u00f3. 10 anys despr\u00e9s del trasplantament, el […]<\/p>\n","protected":false},"author":1,"featured_media":398,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,21],"tags":[19],"class_list":{"0":"post-75","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-featured","8":"category-ocatt","9":"tag-numero-1"},"yoast_head":"\nEl Retrasplantament renal: situaci\u00f3 a Catalunya i REPTES plantejats | Revista Renal<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, 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