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      Future strategies to improve short- and long-term outcomes of renal transplantation in dogs Translated title: Estratégias futuras para melhorar os resultados de transplante renal em cães a curto e longo prazo

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          Abstract

          ABSTRACT: Transplants for cats with naturally occurring renal disease have been introduced into clinical practice, but canine renal transplantation represents a greater challenge because of the lack of a balanced immunosuppressive protocol, difficulty in selecting compatible canine kidney donors, and absence of transplantation monitoring protocols. This and other important factors will be discussed in this review to help improve short- and long-term outcomes for renal transplantation in dogs.

          Translated abstract

          RESUMO: O transplante renal em gatos com doença renal naturalmente adquirida está cada vez mais sendo introduzido na prática clínica. O transplante renal em cães, por sua vez, representa um desafio maior devido a falta da definição de um protocolo imunossupressor equilibrado, dificuldade na seleção de doadores compatíveis e ausência de protocolos de monitoramento de transplantes. Esses e outros fatores serão abordados nesta revisão afim de melhorar os resultados, tanto a curto quanto a longo prazo do transplante renal em cães.

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          Most cited references47

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          A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy

          Systemic corticosteroids play an integral role in the management of many inflammatory and immunologic conditions, but these agents are also associated with serious risks. Osteoporosis, adrenal suppression, hyperglycemia, dyslipidemia, cardiovascular disease, Cushing’s syndrome, psychiatric disturbances and immunosuppression are among the more serious side effects noted with systemic corticosteroid therapy, particularly when used at high doses for prolonged periods. This comprehensive article reviews these adverse events and provides practical recommendations for their prevention and management based on both current literature and the clinical experience of the authors.
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            Donor-derived mesenchymal stem cells combined with low-dose tacrolimus prevent acute rejection after renal transplantation: a clinical pilot study.

            The deleterious side effects of calcineurin inhibitors have impaired long-term survival after renal allograft. New immunotherapy regimens that minimize or even eliminate calcineurin inhibitors are required to improve transplantation outcome. Mesenchymal stem cells (MSCs) represent a unique cell population with immunosuppressive function and prolong allograft survival in experimental organ transplant models. In this pilot study, donor-derived bone marrow MSCs combined with a sparing dose of tacrolimus (50% of standard dose) were administered to six de novo living-related kidney transplant recipients. Six other patients who received a standard dose of tacrolimus were enrolled as a control. The safety of MSC infusion, acute rejection, graft function, and patient and graft survival within 12 months after kidney transplantation were observed. The immune profiles were analyzed at different time points after transplantation. None of the MSC recipients experienced immediate or long-term toxic side effects associated with MSC infusion. The tacrolimus dose (0.045±0.002 mg/kg) in the MSC group was significantly reduced compared with the control group (0.077±0.005 mg/kg). One acute rejection occurred only in the control group. All patients survived with stable renal function at month 12 and no chimerism was detectable at month 3. Patients in the MSC group showed significantly higher B-cell levels than the control group at month 3. These preliminary data suggest that the use of MSCs could provide potential benefits in renal transplantation by reducing the dosage of conventional immunosuppressive drug that is required to maintain long-term graft survival and function.
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              An inflammatory review of glucocorticoid actions in the CNS.

              In recent years, the classic view that glucocorticoids, the adrenal steroids secreted during stress, are universally anti-inflammatory has been challenged at a variety of levels. It was first observed that under some circumstances, acute GC exposure could have pro-inflammatory effects on the peripheral immune response. More recently, chronic exposure to GCs has been found to have pro-inflammatory effects on the specialized immune response to injury in the central nervous system. Here we review the evidence that in some cases, glucocorticoids can increase pro-inflammatory cell migration, cytokine production, and even transcription factor activity in the brain. We consider how these unexpected effects of glucocorticoids can co-exist with their well-established anti-inflammatory properties, as well as the considerable clinical implications of these findings.
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                Author and article information

                Journal
                cr
                Ciência Rural
                Cienc. Rural
                Universidade Federal de Santa Maria (Santa Maria, RS, Brazil )
                0103-8478
                1678-4596
                2021
                : 51
                : 1
                : e20200025
                Affiliations
                [3] Franca São Paulo orgnameUniversidade de Franca orgdiv1Programa de Pós-graduação em Ciência Animal Brazil
                [5] Uberlândia Minas Gerais orgnameUniversidade Federal de Uberlândia orgdiv1Programa de Pós-graduação em Ciências Veterinárias Brazil
                [2] Botucatu orgnameUniversidade Estadual Paulista orgdiv1Departamento de Clínica Veterinária Brazil
                [1] Jaboticabal orgnameUniversidade Estadual Paulista orgdiv1Departamento de Clínica e Cirurgia Veterinária Brazil
                [4] Belo Horizonte orgnamePontifícia Universidade Católica de Minas Gerais orgdiv1Departamento de Medicina Veterinária Brazil
                Article
                S0103-84782021000100602 S0103-8478(21)05100100602
                10.1590/0103-8478cr20200025
                f4e436a0-08e9-43e9-92ff-2169b8096ad8

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 13 January 2020
                : 03 August 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 47, Pages: 0
                Product

                SciELO Brazil

                Categories
                Clinic And Surgery

                veterinary medicine,immunosupression,renal replacement therapy,terapia de substituição renal,imunossupressão,medicina veterinária

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