Abstract In this paper, we analyse and publish a yet unknown account of the revenues collected by the archbishop of Lisbon in 1465-1466 kept in the British Library. When combined with other sources, this document contains new information about the control and management solutions developed by Portuguese dioceses. Also, the quantitive information it contains provides a rare window into the structural changes that agrarian output underwent in Portugal after the Black Death.

Resumo O presente artigo analisa (e publica) uma até agora desconhecida lista das fontes de receita do arcebispo de Lisboa em 1465-1466 que esteve guardada no Museu Britânico. Combinada com outra documentação, este registo amplia os conhecimentos sobre a organização económica das dioceses portuguesas. A informação desta fonte oferece uma rara oportunidade de observar as alterações na agricultura portuguesa nos séculos XIV e XV.

Resumo O Museu Pedagógico Municipal de Lisboa, pensado para ser uma referência nacional, integrou um complexo educativo nos anos 80 do século XIX. Desse complexo fizeram parte instituições como o Jardim de Infância Froebel e a Escola Primária Superior, integradas numa rede de ensino municipal. Segundo o seu diretor, Adolfo Coelho, o Museu seria um instrumento na reforma da instrução popular. Este texto procura ligar o destino efémero do Museu à lógica de três documentos sobre a ação do Estado, quanto aos museus pensados para as classes populares. Nos documentos sobressai a grande prioridade: um museu para os tesouros artísticos nacionais e para contemplação do público, em vez de museus ao serviço da pedagogia e do ensino, para uso manual das suas coleções.

Abstract The Municipal Pedagogical Museum of Lisbon was part of an educational complex in the 1880s and was designed to be a national reference. Institutions such as the Froebel Kindergarten and the Superior Primary School were part of this complex, which belonged to a municipal education network. According to its director, Adolfo Coelho, the Museum would be an instrument in the reform of popular education. This paper seeks to link the Museum’s ephemeral fate to the rationale of three documents on the action of the State, concerning museums designed for popular classes. These documents highlight a main priority: a museum for national artistic treasures and for public contemplation, rather than pedagogical and teaching museums for manual use of their collections.

Resumo Introdução: Os receptores de transplante renal (TR) apresentam um alto risco para desfechos adversos de infecções, tais como a COVID-19. Métodos: Revisamos retrospectivamente todos os receptores de TR com COVID-19 documentada entre 1º de Março de 2020 e 15 de Março de 2021, e analisamos as características, curso clínico, tratamento e desfechos dos pacientes. Resultados: Identificamos 123 pacientes, 72% do sexo masculino, com uma média de idade de 54,5±13,0 anos. Vinte por cento eram assintomáticos, 7% apresentaram transmissão nosocomial, e 36% do restante necessitaram de internação. Quase todos os pacientes internados receberam oxigênio, 30% necessitaram de ventilação mecânica invasiva (VMI), mais da metade apresentou lesão renal aguda, com 10% necessitando de diálise, e 20% foram a óbito. A incidência foi comparável à da população portuguesa, mas a taxa de mortalidade foi quase quatro vezes superior (TMP de 3,768 (IC 95%: 1,723-7,154). Maior índice de massa corporal (OR 1,275; P=0,001), menor função do enxerto basal (OR 0,968; P=0,015), e transmissão nosocomial (OR 13,836; P=0,019) foram associados à demanda de oxigênio, enquanto sexo feminino (OR 3,801; P=0,031) e menor função do enxerto renal basal (OR 0,955; P=0,005), mas não índice de massa corporal, foram associados à VMI e/ou óbito. Conclusão: A taxa de mortalidade em pacientes com TR foi mais elevada do que na população em geral e a função renal basal mais baixa foi o marcador mais consistente para desfechos adversos. Introdução (TR infecções COVID19. COVID19 COVID 19. 19 Métodos COVID-1 º 202 1 2021 características clínico Resultados 12 72 masculino 545130 54 5 13 0 54,5±13, anos assintomáticos 7 36 internação oxigênio 30 VMI, , (VMI) aguda 10 diálise 20 óbito portuguesa TMP 3768 3 768 3,76 IC 95% 95 1,7237,154. 17237154 1,723 7,154 . 723 154 1,723-7,154) OR 1,275 1275 275 P=0,001, P0001 P P=0,001 001 P=0,001) 0,968 0968 968 P=0,015, P0015 P=0,015 015 P=0,015) 13,836 13836 836 P=0,019 P0019 019 3,801 3801 801 P=0,031 P0031 031 0,955 0955 955 P=0,005, P0005 P=0,005 005 P=0,005) eou ou Conclusão COVID1 COVID- 54513 54,5±13 (VMI 2 376 76 3,7 9 7237 1,7237,154 1723715 1723 1,72 7154 7,15 1,723-7,154 1,27 127 27 P000 P=0,00 00 0,96 096 96 P001 P=0,01 01 13,83 1383 83 3,80 380 80 P=0,03 P003 03 0,95 095 5451 54,5±1 37 3, 1,7237,15 172371 172 1,7 715 7,1 1,723-7,15 1,2 P00 P=0,0 0,9 09 13,8 138 8 3,8 38 545 54,5± 1,7237,1 17237 17 1, 71 7, 1,723-7,1 P0 P=0, 0, 13, 54,5 1,7237, 1,723-7, P=0 54, 1,7237 1,723-7 P= 1,723-

Abstract Introduction: Kidney transplant (KT) recipients have a high risk for adverse outcomes from infections, such as COVID-19. Methods: We have retrospectively reviewed all KT recipients with documented COVID-19 between March 1, 2020, and March 15, 2021, and analyzed patients’ characteristics, clinical course, treatment, and outcomes. Results: We identified 123 patients, 72% were male, with a mean age of 54.5±13.0 years. Twenty percent were asymptomatic, 7% had a nosocomial transmission, and 36% of the remainder required hospitalization. Almost all admitted patients received oxygen, 30% required invasive mechanical ventilation (IMV), more than a half had acute kidney injury, with 10% requiring dialysis, and 20% died. Incidence was comparable to that of the Portuguese population, but the mortality rate was almost four times higher (SMR of 3.768 (95% CI:1.723-7.154). Higher body mass index (OR 1.275, P=0.001), lower baseline graft function (OR 0.968, P=0.015), and nosocomial transmission (OR 13.836, P=0.019) were associated with oxygen demand, whereas female gender (OR 3.801, P=0.031) and lower baseline kidney graft function (OR 0.955, P=0.005), but not body mass index, were associated with IMV and/or death. Conclusion: Mortality rate in KT patients was higher than in the general population and lower baseline kidney function was the most consistent marker for adverse outcomes. Introduction (KT infections COVID19. COVID19 COVID 19. 19 Methods COVID-1 1 2020 15 2021 characteristics course treatment Results 12 72 male 545130 54 5 13 0 54.5±13. years asymptomatic 7 36 hospitalization 30 IMV, , (IMV) injury 10 dialysis 20 died SMR 3768 3 768 3.76 95% 95 (95 CI1.7237.154. CI17237154 CI 1.723 7.154 . 723 154 CI:1.723-7.154) OR 1275 275 1.275 P=0.001, P0001 P P=0.001 001 P=0.001) 0968 968 0.968 P=0.015, P0015 P=0.015 015 P=0.015) 13836 836 13.836 P=0.019 P0019 019 demand 3801 801 3.801 P=0.031 P0031 031 0955 955 0.955 P=0.005, P0005 P=0.005 005 P=0.005) andor or death Conclusion COVID1 COVID- 202 54513 54.5±13 (IMV 2 376 76 3.7 9 (9 CI1 7237 CI1.7237.154 CI1723715 1723 1.72 7154 7.15 CI:1.723-7.154 127 27 1.27 P000 P=0.00 00 096 96 0.96 P001 P=0.01 01 1383 83 13.83 380 80 3.80 P=0.03 P003 03 095 0.95 5451 54.5±1 37 3. ( CI1.7237.15 CI172371 172 1.7 715 7.1 CI:1.723-7.15 1.2 P00 P=0.0 09 0.9 138 8 13.8 38 3.8 545 54.5± CI1.7237.1 CI17237 17 1. 71 7. CI:1.723-7.1 P0 P=0. 0. 13. 54.5 CI1.7237. CI1723 CI:1.723-7. P=0 54. CI1.7237 CI172 CI:1.723-7 P= CI1.723 CI17 CI:1.723- CI1.72 CI:1.723 CI1.7 CI:1.72 CI1. CI:1.7 CI:1. CI:1 CI:

RESUMO A Revolução Liberal portuguesa (1820) e a Independência do Brasil (1822) instauraram governos monárquicos representativos e o parlamentarismo. Construídos na oposição ao Antigo Regime português e ao colonialismo luso, respetivamente, os novos regimes identificaram a instrução pública como causa para o progresso dos países e para a afirmação da administração política. Com base nos debates das Constituintes e de tratados e projetos de instrução dos anos 1820, seguimos o desenho do edifício educativo, que devia adaptar-se a uma vida exemplar e conforme. Iniciava-se, pela instrução de massas, a naturalização de um tipo secular de pastoral em ordem ao estabelecimento de um regime disciplinar-moral que enquadrasse os alunos nas sociedades liberais do século XIX. A história comparada é, neste texto, um instrumento de análise para tentar discutir as remotas origens dos dispositivos pedagógicos que, entretanto, “naturalizamos”.

ABSTRACT The Portuguese Liberal Revolution (1820) and the Independence of Brazil (1822) established representative monarchical governments and parliamentarism. Built in opposition to the Old Regime and Portuguese colonialism, respectively, the new regimes identified public education as a major cause for the development of the countries and the affirmation of political administration. Departing from the debates of the constituent assemblies, and from treaties and projects of instruction of the 1820s, we follow the design of the educational building, which should adapt to an exemplary and conforming life. Mass instruction began the naturalization of a secular type of pastoral to establish a disciplinary-moral system that would accommodate students to the 19th century liberal societies. In this text, comparative history is an instrument of analysis to discuss the remote origins of the pedagogical devices that we have “naturalized” in the meantime.

RESUMEN La revolución liberal portuguesa (1820) y la independencia de Brasil (1822) establecieron gobiernos monárquicos representativos y el parlamentarismo. Los nuevos regímenes, construidos en oposición al Antiguo Régimen y al colonialismo portugués, identificaron la instrucción pública como una de las principales causas del desarrollo de los países y de la afirmación de la administración política. A partir de los debates de las asambleas constituyentes y de los tratados y proyectos educativos de la década de 1820, vemos el diseño del edificio educativo que se está construyendo, que tuvo que adaptarse a una vida ejemplar y sumisa. La instrucción para las masas comenzó la naturalización de un tipo secular de pastoral, para el establecimiento de un régimen disciplinario-moral que enmarcaría a los estudiantes en las sociedades liberales del siglo XIX. La historia comparada es, en este texto, un instrumento de análisis para intentar discutir los orígenes remotos de los dispositivos pedagógicos que, con el tiempo, hemos “naturalizado”.

Rituximab (RTX) is a chimeric anti-CD20 monoclonal antibody that has been associated with delayed pulmonary toxicity. In patients receiving RTX, hypersensitivity pneumonitis, although rare, should be considered in the appropriate clinical and radiographic setting. The authors present a case of hypersensitivity pneumonitis associated with a single dose of RTX treatment in a kidney transplanted patient with acute antibody-mediated rejection.

Introduction: ABO incompatibility was considered a barrier to kidney transplant. However, the shortage of available organs for transplantation and the excellent long-term results further establish ABO-incompatible (ABOi) as a safe and effective therapeutic strategy. The aim of the present study was to evaluate the outcomes of ABOi transplantation in terms of graft survival and function, rejection episodes and infections complications. Methods: The authors present a single-center retrospective observational study in a unit with approximately 370 living donor kidney transplants registered. This study includes the analysis of 12 patients who underwent ABOi living donor kidney transplantation between November 2014 and July 2019. Desensitization protocol consisted of intravenous Rituximab 375mg/m2 single dose administration 2 weeks pretransplant. Tacrolimus and Mycophenolate Mofetil were started before transplantation one week and 48 hours respectively. Plasmapheresis was performed to remove anti-A or B antibodies until their titers were <1:8 during the first post-operative week and <1:16 at the second. All kidney recipients of both ABOi grafts received Basiliximab (20mg on days 0 and 4) as antibody induction therapy. Maintenance immunosuppression consisted of Tacrolimus, Mycophenolate Mofetil and corticosteroid. Results: A total of 12 patients were included in the study, 75% male; 43 years (IQR 31-50). The most common blood group mismatch was A to O (n=4; 33%). In the first year, 2 of patients (25%) developed acute rejection. The follow-up time was 17 months (IQR 7-36). Five patients (42%) developed infectious complications. None patients developed cytomegalovirus or BK polyomavirus infections. At the end graft and patient survival were 100%. Conclusion: ABOi kidney transplantation has become a routine procedure. With this approach, about 30% of living donors who were refused in the past can now donate their kidneys and thereby significantly expand the living donor pool. The immunosuppressive protocol of this unit can be considered safe.

Este artigo apresenta uma síntese crítica das 36 dissertações em história medieval defendidas nas universidades portuguesas entre 2010 e 2018. O seu número relativamente modesto (foram defendidas 825 teses em história) revela a reduzida produtividade dos programas doutorais em história medieval. Ainda que diminuto, este conjunto de dissertações pode ser considerado inovador. A maior parte dos doutorados não se limitou a replicar os modelos das décadas anteriores, antes contribuiu com temas de pesquisa que não eram prioritários para os historiadores da geração anterior. Do mesmo modo, os assuntos estudados estão bem alinhados com as tendências internacionais dentro do campo da história medieval.

The present paper provides a critical overview of the 36 medieval history dissertations concluded at Portuguese universities between 2010 and 2018. Their comparatively modest numbers (825 theses were completed in history) show the low productivity of the country’s PhD programs in medieval history. Their small numbers notwithstanding, this crop of dissertations can be considered innovative: they brought forth research issues that were not a priority for earlier historiographical generations. Also, the themes studied were well integrated with international research trends on medieval history.

Resumo A ocorrência de ascite no pós-Transplante Renal (TR) é infrequente, podendo ser consequência de complicações cirúrgicas ou médicas. Caso clínico: 61 anos, masculino, antecedentes de hipertensão arterial, carcinoma da língua e hábitos alcoólicos 12-20g/dia. Doença renal crônica secundária à doença renal poliquística autossômica dominante, sem poliquistose hepática. Submetido a TR de doador cadáver em setembro de 2017. Atraso na função de enxerto por estenose da artéria renal, corrigida cirurgicamente. Internado em janeiro de 2018 por ascite de novo, sem resposta a diuréticos. Circulação colateral abdominal visível. Disfunção do enxerto, tacrolinemia adequada. Sedimento urinário inocente. Anemia ligeira, sem trombocitopenia. Albumina sérica 4,0g/dL. Bioquímica hepática normal. Líquido peritoneal com características de transudado e gradiente sero-ascítico de albumina > 1,1. Ecografia com hepatomegalia, eixos vasculares permeáveis, sem esplenomegalia. Suspendeu micofenolato mofetil, reduziu restante imunossupressão. Manteve ascite refratária: excluídas etiologias infecciosas, metabólicas, autoimunes e neoplásicas. Sem proteinúria nefrótica e sem insuficiência cardíaca. RM: micronódulos compatíveis com quistos biliares. EDA sem varizes gastroesofágicas. Linfocintigrafia abdominal normal. Submetido a laparoscopia exploradora com biópsia hepática: cirrose septal incompleta de provável etiologia vascular, alguns ductos biliares dilatados. Manteve disfunção progressiva do TR, reiniciou hemodiálise. Proposta medição direta da pressão portal, protelada por resolução da ascite. Recuperação posterior da função de enxerto. Discussão: A cirrose septal incompleta é uma causa incomum de hipertensão portal não cirrótica. A sua definição é morfológica e a fisiopatologia, pouco conhecida. Não encontramos publicados casos de ascite pós-TR secundária a esta patologia, descrita como possivelmente associada a fármacos, alterações imunitárias, infecções, hipercoagulabilidade e predisposição genética.

Abstract The occurrence of ascites after Renal Transplant (RT) is infrequent, and may be a consequence of surgical or medical complications. Case report: 61 year-old, male, history of arterial hypertension, tongue carcinoma and alcoholic habits 12-20g/day. He had chronic kidney disease secondary to autosomal dominant polycystic kidney disease, without hepatic polycystic disease. He underwent cadaver donor RT in September 2017. He had delayed graft function by surgically corrected renal artery stenosis. He was admitted in January 2018 for ascites de novo, with no response to diuretics. HE had visible abdominal collateral circulation. Graft dysfunction, adequate tacrolinemia, Innocent urinary sediment, mild anemia, without thrombocytopenia. Serum albumin 4.0g / dL. Normal hepatic biochemistry. Peritoneal fluid with transudate characteristics and serum albumin gradient > 1.1. Ultrasound showed hepatomegaly, permeable vascular axes, without splenomegaly. Mycophenolate mofetil was suspended, with reduced remaining immunosuppression. He maintained refractory ascites: excluded infectious, metabolic, autoimmune and neoplastic etiologies. No nephrotic proteinuria and no heart failure. MRI: micronodules compatible with bile cysts. Upper Digestive Tract Endoscopy did not show gastroesophageal varicose veins. Normal abdominal lymphoscintigraphy. He underwent exploratory laparoscopy with liver biopsy: incomplete septal cirrhosis of probable vascular etiology some dilated bile ducts. He maintained progressive RT dysfunction and restarted hemodialysis. The proposed direct measurement of portal pressure was delayed by ascites resolution. There was further recovery of the graft function. Discussion: Incomplete septal cirrhosis is an uncommon cause of non-cirrhotic portal hypertension. Its definition is not well known, morphological and pathophysiological. We have not found published cases of post-RT ascites secondary to this pathology, described as possibly associated with drugs, immune alterations, infections, hypercoagulability and genetic predisposition.

Abstract This article shows that theCortesof Coimbra/1385, in which João I was acclaimed king, stand for a major break in Portuguese Constitutional History. While twentieth-century historiography considered that the vision of a limited monarchy formulated by the representatives in 1385 essentially failed, fiscal history shows that theseCortesdid indeed leave a clear and lasting break with the reign of Fernando I: extraordinary taxes could not be justified by the claim of the ‘necessity’ of the king and had to be consented by the representatives of the taxpayers. This achievement stands for a marked contrast with the wilful rule of Fernando I, who imposed taxes and debased coinages with little regard for parliament or constitutional limits.

Resumo Este artigo mostra como as Cortes de Coimbra/1385, nas quais João I foi aclamado rei, representam uma rutura na História Constitucional Portuguesa. Se a historiografia portuguesa do século XX considerou que a visão de uma monarquia formulada pelos procuradores em 1385 não teve consequências relevantes, na perspetiva oferecida pela História Fiscal estas Cortes marcam uma profunda transformação relativamente ao reinado de Fernando I: os impostos extraordinários deveriam ser aprovados pela assembleia representativa e não poderiam ser justificados pela simples ‘necessidade’ por parte do monarca. Estes princípios representam um contraste claro com a governação de Fernando I que ignorara asCortese limites constitucionais ao proceder a desvalorizações monetárias e a introduzir novos impostos

Resumo Ao longo de quase todo o século XIX, o Estado português acompanha o movimento internacional de organização de museus públicos de arte como lugares de instrução para artistas, operários, alunos e público. As principais iniciativas museológicas valorizam acima de tudo o desígnio do ensinamento e os museus vivificam como espaços de coleção e experimentação. Esta tendência secular, revisitada através dos regulamentos de cinco casos modelares, sofre uma inflexão a partir dos anos 1880, quando se anuncia uma concepção museológica que exalta a contemplação e a fruição como valores fundamentais e menoriza a instrução e a pesquisa experimental.

Abstract Throughout most of the nineteenth century, the Portuguese state follows the international movement for organizing public museums of art as places for the instruction of artists, workers, students and the public. The major museological initiatives value above all the purpose of teaching and the museums vivify as places of collection and experimentation. This secular tendency, revisited through the regulations of five model cases, suffered a reverse from the 1880s when a museological conception that exalts contemplation and enjoyment as fundamental values and mitigates instruction and experimental research is announced.

Resumen A lo largo de la mayor parte del siglo XIX, el Estado portugués sigue el movimiento internacional de la organización de los museos de arte públicos como lugares de educación para artistas, obreros, estudiantes y el público. Las principales iniciativas museológicas valoran por encima de todo la meta de la enseñanza y los museos vivifican como espacios de colección y experimentación. Esta tendencia secular, revisitada por medio de los reglamentos de cinco casos modelares, sufre una inflexión a partir de los años 1880, cuando se anuncia una concepción museológica que exalta la contemplación y la fruición como valores fundamentales y disminuye la instrucción y la investigación experimental.

Résumé Au cours de la majeure partie du XIXe siècle, l'État portugais a suivi le mouvement international consistant à organiser des musées d'art publics en tant que lieux d'enseignement pour les artistes, les ouvriers, les étudiants et le public. Les principales initiatives muséologiques valorisent tout d’ abord la conception de l'enseignement et les musées s'animent comme des espaces de collection et d'expérimentation. Cette tendance séculaire, revue à travers les réglementations de cinq cas modèles, s'est manifestée depuis les années 1880, à l'époque de l'annonce du succès de la conception muséologique qui exaltait la contemplation et la jouissance en tant que valeurs fondamentales et diminue l'enseignement et la recherche expérimentale.

Over the last 15 years, better immunosuppressive drugs have decreased acute rejection rates in kidney transplantation but have also led to an increase in the incidence and impact of BK virus nephropathy. The authors report the case of a 62--year-old man submitted to a renal transplant of a deceased donor with an immunosuppression regimen free of rabbit anti -thymocyte globulin and tacrolimus, in whom BK nephropathy was diagnosed at seven weeks post-transplant. Intravenous human immunoglobulin (IVIG) was administered after immunosuppression reduction. Instituted treatment was successful. This clinical case highlights the importance of a high index of suspicion for an atypical presentation of BK nephropathy in renal transplant recipients and strengthens the need for other therapeutic interventions beyond the reduction of immunosuppression. It was the starting point for a review of BK virus nephropathy in kidney transplantation with a focus on risk factors, diagnosis and treatment

Introduction: Malignancy management in renal transplant recipients is becoming a major factor affecting long-term patient survival. Thus, we intended to evaluate both incidence and prognosis of malignant diseases following renal transplantation at a single centre in Portugal. Methods: We studied retrospectively the 2,358 patients who underwent kidney transplantation (KT) between 1983 and 2014. Apart from descriptive analysis, both demographic and clinical characteristics of cancer and non-cancer cancer patients were compared. Results: During a median follow-up of 118 (IQR 57-179) months, 139 patients (5.8%) developed 158 de novo malignancies, with a median time from KT to diagnosis of 76..5 (IQR 21.0-132.0) months. When compared to non-cancer patients, they were older at KT date, had longer graft survival and a lower living donor recipients’ prevalence. As for post-transplant malignancies analysis, the most common were non-cutaneous non-lymphomatous cancers (49.4%, n=78), skin cancers (35.4%, n=56) and post-transplant lymphoproliferative disorders (9.5%, n=15). Considering specific diagnosis, squamous cell carcinoma and basal cell carcinoma with 17.1% and 16.5% respectively, and non-Hodgkin lymphomas with 7.6%, were the most frequent. Global mortality among cancer patients was 36.0%, with a median time of 9.7 (IQR 1.9-17.5) months from time of diagnosis to death. As for survival analysis, cancer patient survival was significantly lower while censored graft survival was significantly higher in this group. Conclusion: Incidence and characteristics of malignancy following renal transplantation in our unit are similar to those globally described, despite some traits probably a result of specific ethnic and environmental characteristics

Introduction: Kidney transplant improves survival even in highly-sensitized(HS) patients. To overcome their disadvantage in accessing transplantation, those with high Complement Dependent Cytotoxic PRA (CDC-PRA) receive additional points during allocation. Whether this strategy reaches all HS patients and how long they wait for a transplant is largely undetermined. Methods: Patients on our unit’s active wait-list for kidney transplantation in the year 2014 were analyzed. CDC-PRA and calculated PRA (cPRA) were recorded. To obtain cPRA, antibodies in the last serum available specific for HLA-A,-B or -DR with an intensity > 1000 MFI were considered. Results: The cPRA values in the population (N=551) were 0% (N=312), 1-79% (N=118) and ≥ 80% (22%; N=121). Among these groups, the proportion of women (29.5, 55.9 and 61.2%, P<0.001), prior sensitizing events (43.3, 80.5 and 96.7%, P<0.001) and time on dialysis (median of 3.9, 4.1 and 6.0 years, P<0.001) increased with cPRA, respectively. In most of those with a cPRA ≥ 80%, the CDC-PRA raised no suspicion of HS status (median 0%, P25-75 0-8%) and only 35 (28.9%) or 12 patients (9.9%) had a CDC-PRA in the peak serum higher than 50 or 80%, respectively (cut-offs needed to obtain additional points during allocation). HS patients by cPRA corresponded to 71% vs 15% of patients waiting for ≥ or <8 years, respectively (P<0.001). Even after exclusion of patients with a CDC-PRA above 50%, this disproportionate representation remained (58% versus 13%, P<0.001). Conclusion: HS patients as measured by cPRA remained longer on the wait-list, both in the primary analysis and when excluding those with a CDC-PRA> 50%. Moreover, only 30% of HS by cPRA patients received the extra points designed to improve their transplantability. We consider that both CDC-PRA and cPRA should be taken into account when defining HS status

Introdução: O efeito deletério dos anticorpos para antigénios MICA (major histocompatibility class I chainrelated A) na incidência de rejeição aguda e sobrevida do enxerto ainda não está consensualmente estabelecido. Metódos: Estudo retrospetivo de 554 transplantados renais. A análise comparativa entre doentes positivos e negativos para anticorpos anti-MICA pré-formados foi realizada para avaliar eventos sensibilizadores. A incidência de rejeição aguda no primeiro ano pós transplante renal e a sobrevida do enxerto renal foram determinadas consoante o resultado da citometria de fluxo pré-transplante para anticorpos anti-MICA e/ou anti- HLA (anti-human leukocyte antigen). Aplicou-se um modelo de análise multivariada para identificação de preditores independentes para rejeição aguda. Resultados: Foram identificados 41 doentes (7.4%) com anticorpos anti-MICA pré formados. A sensibilização para HLA, as transfusões sanguíneas e gestações prévias foram mais frequentes nos doentes MICA + mas apenas a presença de anticorpos anti-HLA classe I apresentou uma associação independente (OR 2.67, p = 0.02). Comparativamente ao grupo MICA-/HLA-, o grupo MICA-/HLA+ apresentou menor sobrevida livre de rejeição ao 1º ano (78.6% vs. 89.3%, p < 0.01), maioritariamente ocorrida nos primeiros seis meses, enquanto que nenhuma diferença foi encontrada com o grupo MICA+/HLA- (88.9% vs. 89.3%, p = ns). Apenas o status MICA-/HLA+ teve impacto independente na incidência de rejeição (OR 2.09, p = 0.03), ao contrário do status MICA+/HLA- (OR 1.08, p = ns). O grupo MICA-/HLA+ apresentou menor sobrevida do enxerto censurada para a morte aos 4 anos (85.8% vs. 95.3%, p = 0.03), não se verificando diferenças no grupo MICA+/HLA- (95.1% vs. 95.3%, p = ns). Conclusão: Os nossos resultados não suportam um efeito deletério dos anticorpos pré-formados para MICA, independente da sensibilização HLA, na incidência de rejeição aguda no 1º ano pós transplante e na sobrevida do enxerto

Background: Evidence supporting deleterious effect of preformed major histocompatibility class I chain-related A (MICA) antibodies in rejection incidence and graft survival is still unclear. Methods: Retrospective analysis of 554 kidney transplanted patients. Comparison between positive or negative for MICA antibodies patients was performed to characterize sensitizing triggers. Further classification according to pre-transplant flow cytometry-recorded anti-MICA and/or anti-human leukocyte antigen (HLA) antibodies was made to determine first year rejection incidence and graft survival. Multivariate analysis was applied to determine predictors for acute rejection. Results: Pre-formed anti-MICA antibodies were detected in 41 patients (7.4%). HLA sensitization, blood transfusions and pregnancies were frequently found in anti-MICA+ patients but only pre-formed anti-HLA class I antibodies showed independent association (OR 2.67, p = 0.02). Comparing to MICA-/HLA-, MICA-/HLA+ group presented significantly lower first year rejection-free survival (78.6% vs. 89.3%, p < 0.01), mostly occurred in the first six months, while no difference was found in MICA+/HLA- (88.9% vs. 89.3%, p = ns). MICA-/HLA+ showed independent impact in rejection (OR 2.09, p = 0.03), while no evidence was found in MICA+/HLA- (OR 1.08, p = ns). At 4 years, MICA-/HLA+ group presented lower graft survival (85.8% vs. 95.3%, p = 0.03). Again, no difference was found in MICA+/HLA- group (95.1% vs. 95.3%, p = ns). Conclusion: Our results do not support HLA-independent deleterious pathogenic role of pre-formed MICA antibodies on first year rejection incidence and graft survival