{"id":24767,"date":"2023-12-18T12:35:13","date_gmt":"2023-12-18T11:35:13","guid":{"rendered":"https:\/\/idibell.cat\/?p=24767"},"modified":"2023-12-18T12:35:13","modified_gmt":"2023-12-18T11:35:13","slug":"lidibell-i-lhospital-de-bellvitge-fan-el-primer-pas-cap-a-la-medicina-personalitzada-en-trasplantament-renal","status":"publish","type":"post","link":"https:\/\/idibell.cat\/2023\/12\/lidibell-i-lhospital-de-bellvitge-fan-el-primer-pas-cap-a-la-medicina-personalitzada-en-trasplantament-renal\/","title":{"rendered":"L\u2019IDIBELL i l\u2019Hospital de Bellvitge fan el primer pas cap a la medicina personalitzada en trasplantament renal"},"content":{"rendered":"<p><span data-contrast=\"auto\">Un estudi d\u2019investigadors de l\u2019IDIBELL i l\u2019Hospital Universitari de Bellvitge, publicat a la revista <\/span><i><span data-contrast=\"auto\">Kidney International<\/span><\/i><span data-contrast=\"auto\">, ha significat el primer pas cap al desplegament de la medicina personalitzada i de precisi\u00f3 en trasplantament renal. Els investigadors han aconseguit demostrar els bons resultats d\u2019un algoritme que ajusta les dosis de l\u2019immunosupressor tacrolimus segons les caracter\u00edstiques de cada persona.<\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Molts dels pacients que reben un trasplantament renal s\u00f3n tractats amb tacrolimus per evitar el rebuig. Actualment, la dosi inicial d\u2019aquest f\u00e0rmac es decideix en funci\u00f3 nom\u00e9s del pes corporal de la persona. Si despr\u00e9s cal ajustar-la, com passa sovint, es fa nom\u00e9s segons l\u2019experi\u00e8ncia emp\u00edrica del metge, d\u2019acord amb el sistema d\u2019assaig i error.<\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">No es t\u00e9 en compte, doncs, el fet que el tacrolimus t\u00e9 efectes diferents en cada persona per molts motius, ni el risc immunol\u00f2gic personal, el risc d\u2019efectes adversos o la qualitat del rony\u00f3 del donant. Tampoc no es decideix la dosi segons els factors gen\u00e8tics, tot i que se sap que, segons la persona, de vegades cal una dosi fins al doble de gran que una altra per aconseguir els mateixos efectes.<\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Aquests investigadors van estudiar l\u2019efectivitat d\u2019un algoritme de dosificaci\u00f3 validat que inclou l\u2019edat, la proporci\u00f3 de gl\u00f2buls vermells a la sang (hematocrit) i la pres\u00e8ncia de determinats indicadors gen\u00e8tics en cada persona, a m\u00e9s del coneixement que es t\u00e9 de com influeixen aquests par\u00e0metres en el comportament del f\u00e0rmac.<\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">L\u2019estudi va analitzar un total de 90 pacients trasplantats de rony\u00f3 a l\u2019Hospital de Bellvitge entre el 2018 i el 2020. En concret, va comparar el comportament del f\u00e0rmac entre els que van rebre una dosificaci\u00f3 segons el nou algoritme i els que van rebre la dosificaci\u00f3 est\u00e0ndard tenint en compte nom\u00e9s el pes corporal.<\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">El resultat va ser que, cinc dies despr\u00e9s del trasplantament, un 55% de pacients del primer grup i nom\u00e9s un 21% del segon grup havien assolit la concentraci\u00f3 m\u00ednima necess\u00e0ria de tacrolimus. El primer grup va necessitar 5 dies i el grup de control 10 dies de mitjana per arribar al nivell terap\u00e8utic desitjat. Els pacients amb dosificaci\u00f3 individualitzada, a m\u00e9s, van requerir menys canvis en la dosi i van mostrar menys variabilitat entre ells pel que fa a la pres\u00e8ncia efectiva del f\u00e0rmac.<\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Despr\u00e9s d\u2019un trasplantament renal, el m\u00e9s habitual \u00e9s que els pacients tractats amb tacrolimus estiguin massa o massa poc exposats a aquest f\u00e0rmac durant els primers dies, cosa que augmenta el risc de complicacions. El fet de poder assolir abans els nivells adequats pot significat una reducci\u00f3 del risc de rebuig i dels casos de toxicitat causada pel f\u00e0rmac.<\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Segons destaca la Dra. N\u00faria Lloberas, investigadora principal del grup de recerca en nefrologia i transplantament renal de l\u2019IDIBELL i l\u2019Hospital de Bellvitge i autora principal de l\u2019estudi, \u201cseria desitjable que l\u2019estrat\u00e8gia que hem testejat fos adoptada a la majoria d\u2019unitats de trasplantament renal. Es tracta d\u2019una aproximaci\u00f3 relativament f\u00e0cil i barata, que requereix nom\u00e9s un estudi farmacogen\u00e8tic previ al trasplantament i la detecci\u00f3 d\u2019unes poques variables cl\u00edniques i anal\u00edtiques\u201d.<\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">En el mateix n\u00famero de la revista <\/span><i><span data-contrast=\"auto\">Kidney International<\/span><\/i><span data-contrast=\"auto\">, un comentari editorial elogia el disseny i l\u2019execuci\u00f3 del treball i subratlla que \u201cpot representar el comen\u00e7ament de la medicina de precisi\u00f3 en el trasplantament renal\u201d. Segons els autors de l\u2019article editorial, el treball fet a Bellvitge marca el cam\u00ed a seguir, que ha de passar, segons afirmen, per anar afegint a l\u2019algoritme nous par\u00e0metres que reforcin el seu paper de guia per a una ter\u00e0pia plenament personalitzada.<\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6}\">\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><em>L\u2019Institut d&#8217;Investigaci\u00f3 Biom\u00e8dica de Bellvitge (IDIBELL) \u00e9s un centre de recerca en biomedicina creat l\u2019any 2004. Est\u00e0 participat per l&#8217;Hospital Universitari de Bellvitge i l\u2019Hospital de Viladecans de l&#8217;Institut Catal\u00e0 de la Salut, l&#8217;Institut Catal\u00e0 d&#8217;Oncologia, la Universitat de Barcelona i l\u2019Ajuntament de l\u2019Hospitalet de Llobregat.\u00a0<\/em><\/p>\n<p><em>L\u2019IDIBELL \u00e9s membre del Campus d&#8217;Excel\u00b7l\u00e8ncia Internacional de la Universitat de Barcelona HUBc i forma part de la instituci\u00f3 CERCA de la Generalitat de Catalunya. L&#8217;any 2009 es va convertir en un dels cinc primers centres d\u2019investigaci\u00f3 espanyols acreditats com a institut d\u2019investigaci\u00f3 sanit\u00e0ria per l\u2019Instituto de Salud Carlos III. A m\u00e9s, forma part del programa \u201cHR Excellence in Research\u201d de la Uni\u00f3 Europea i \u00e9s membre de EATRIS i REGIC. Des de l\u2019any 2018, l\u2019IDIBELL \u00e9s un Centro Acreditado de la Fundaci\u00f3n Cient\u00edfica AECC (FCAECC).\u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Els investigadors han aconseguit demostrar els bons resultats d\u2019un algoritme que ajusta les dosis de l\u2019immunosupressor tacrolimus segons les caracter\u00edstiques de cada persona.\u00a0Els resultats s\u2019han publicat a la revista cient\u00edfica \u2018Kidney International\u2019.<\/p>\n","protected":false},"author":8,"featured_media":24779,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"default","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[334,339,479],"tags":[],"class_list":["post-24767","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicina-translacional","category-nefrologia-i-transplantament-renal","category-p-de-malalties-infeccioses-i-transplantaments"],"publishpress_future_action":{"enabled":false,"date":"2024-12-25 11:51:09","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category"},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"_links":{"self":[{"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/posts\/24767","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/comments?post=24767"}],"version-history":[{"count":3,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/posts\/24767\/revisions"}],"predecessor-version":[{"id":24780,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/posts\/24767\/revisions\/24780"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/media\/24779"}],"wp:attachment":[{"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/media?parent=24767"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/categories?post=24767"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/tags?post=24767"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}