Luis Gustavo Modelli de Andrade

Objectives: To determine the incremental diagnostic yield of systematic template sampling during transperineal prostate biopsy (TPPB) in biopsy‐naïve men and to identify patient subgroups where systematic biopsy might be safely omitted. Patients and Methods: We retrospectively analysed 470 consecutive biopsy‐naïve men with PI‐RADS 3–5 lesions on multiparametric MRI who underwent combined MRI‐targeted and systematic template TPPB between January 2022 and May 2026 at a single institution. Clinically significant prostate cancer (csPCa) was defined as ISUP grade group 2 or higher. The primary outcome was csPCa detected on template biopsy in men with non‐significant disease (ISUP < 2) on targeted biopsy. Results: Overall, csPCa was detected in 356/470 men (75.7%). Systematic template biopsy identified csPCa missed by targeted biopsy in 10/470 men (2.1%, 95% CI 1.0%–3.9%), representing 2.8% of all csPCa diagnoses. Smaller index lesion size on MRI was the only statistically significant predictor of csPCa missed by targeted biopsy (OR 0.50 per 5 mm increase, 95% CI 0.28–0.90, p = 0.021). In subgroup analysis cross‐tabulating PI‐RADS category and PSA density (PSAD), template biopsy provided zero incremental yield in patients with PI‐RADS 5 lesions and a PSAD > 0.20 ng/mL ² (0.0%, one‐sided 95% upper bound 2.5%). The highest incremental yield was observed in men with PI‐RADS 4 lesions (3.7%, 95% CI 1.7%–7.0%). Conclusions: In this biopsy‐naïve cohort of men undergoing combined MRI‐targeted and template TPPB, systematic template biopsy provided a small incremental diagnostic yield for csPCa (2.1%) overall, with no added value in men with PI‐RADS 5 lesions and a PSAD > 0.20 ng/mL ² . A risk stratified approach to systemic sampling in these men may be considered. Validation in larger, multicentre cohorts is warranted before these findings can be incorporated into future guideline recommendations.

Objectives: To characterise patient‐reported pain, anxiety, satisfaction and willingness to undergo a repeat procedure, along with complication rate and diagnostic yield, in a large consecutive single‐centre cohort of freehand transperineal prostate biopsies (TPPB) performed under local anaesthesia (LA) alone. Patients and methods: Consecutive freehand TPPB cases entered into a single‐centre clinical registry between 27 April 2022 and 12 January 2026 were reviewed. Cases performed under general anaesthesia or under LA with intravenous sedation were excluded. The primary outcome was patient‐reported overall procedural pain on a 0–10 cm visual analogue scale (VAS), completed immediately after the procedure. Secondary outcomes were VAS scores for anxiety, distress, physical needs, emotional needs and satisfaction; association between pain and anxiety; procedural failure; complication rate; and detection of clinically significant prostate cancer (csPCa, ISUP grade group ≥2). The tertiary outcome was willingness to undergo a repeat biopsy if clinically indicated. Results: Of 800 consecutive cases, 777 (97.1%) performed under LA alone formed the analytic cohort. Median overall procedural pain was 2.0 (IQR 1.0–3.0), and severe pain (VAS ≥ 7) was reported by 45 of 760 patients (5.9%). Anxiety was moderately correlated with pain (Spearman ρ = 0.51, 95% CI 0.44–0.57), and severe pain was ten times more common above than below the median anxiety score (10.8% vs. 1.0%). Overall, 748 of 756 patients (98.9%, 95% CI 97.9–99.5%) would undergo the procedure again if clinically indicated, including 42 of the 45 (93%) who reported severe pain. Procedural failure occurred in 5 of 777 cases (0.6%) and a complication was noted in 26 of 776 (3.4%). CsPCa was identified in 477 of 769 patients (62.0%), rising stepwise with PI‐RADS score (1–2: 18.3%; 3: 22.6%; 4: 70.0%; 5: 88.4%). Conclusions: Freehand TPPB under LA alone is well tolerated in the outpatient setting. Pain is low overall, severe pain is uncommon, and almost all patients would undergo the procedure again as indicated. Patient‐reported anxiety is moderately associated with procedural pain and is a plausible modifiable target.

Objective: To compare the detection rates of clinically significant prostate cancer (csPCa) across 3 transperineal biopsy approaches: in-office local anesthetic cognitive fusion (CF), transperineal prostate biopsy (TPPB), general anesthetic CF TPPB using a brachytherapy grid, and general anesthetic software-assisted fusion (SAF) TPPB. Design, setting, and participants: We conducted a retrospective multicenter cohort study of men undergoing TPPB between April 2022 and March 2024 at 3 centers: Tauranga Hospital, New Zealand; St Andrews Hospital, Australia; and University Hospital Zurich, Switzerland. All patients underwent prebiopsy multiparametric MRI. Outcome measurements and statistical analysis: The primary outcome was the detection of csPCa (ISUP grade ≥ 2). Propensity score matching (1:1) was performed using age, body mass index (BMI), prostate-specific antigen (PSA) density, prostate volume, magnetic resonance report (PIRADS Score), and biopsy history. Logistic regression models incorporating matching weight-estimated odds ratios (ORs).The results of the matched analysis were supported by 2 sensitivity analyses: a multivariable regression in the full cohort and a matched-cohort analysis stratified by PI-RADS category (1-2, 3, and 4-5). Results: A total of 1272 patients were included (New Zealand, n = 505; Switzerland, n = 508; Australia, n = 259). After matching, csPCa detection was higher with local-anesthetic CF TPPB than with SAF TPPB (OR 0.48, 95% CI 0.34-0.69; P < .001) and general-anesthetic CF grid-based TPPB (OR 0.64, 95% CI, 0.44-0.92; P = .017). The results were consistent with those of the sensitivity analyses. Conclusions: In-office local-anesthetic cognitive-fusion TPPB was associated with higher csPCa detection than the comparator general-anesthetic cognitive-fusion and software-assisted fusion pathways in this multicenter cohort.

Kidney transplantation significantly improves outcomes in end-stage renal disease, however, long-term graft survival remains suboptimal. Traditional prognostic models often yield limited predictive power. Given the routine use of for-cause biopsies in clinical practice, we aimed to develop and compare ML models to predict graft survival using gene expression profiles from indication biopsies. Data from for-cause renal biopsies were collected from six cohorts in the Gene Expression Omnibus: GSE21374 (n = 282), GSE48581 (n = 306), GSE36059 (n = 411), GSE50058 (n = 101), GSE72925 (n = 168) and GSE25902 (n = 24). Differential expression and Cox regression analysis were applied to identify prognostic genes. These were used to train and validate 117 machine learning models. A total of 11 genes associated with graft loss were identified and used to train ML models. The Gradient Boosting Machine (GBM) achieved the highest C-index (> 0.85) and accurately stratified patients by graft survival. External validation in diagnostic tasks across four independent cohorts confirmed the model’s value of overall rejection (AUCs 0.760-0.826). Patients classified as High-risk showed reduced graft survival, enrichment of pro-inflammatory immune pathways and marked differences in immune cell composition. We developed and validated a transcriptome-based GBM model that accurately predicts graft survival using for-cause biopsy samples. The model demonstrated strong prognostic and diagnostic performance across multiple independent cohorts and reflects key immunological mechanisms of rejection. Its compact gene set offers practicality, supporting its potential integration into routine transplant care.

Background: Dengue fever poses a major public health threat in Brazil, particularly among individuals with comorbid conditions. Chronic kidney disease (CKD) is known to impair immune defenses and may predispose patients to worse infectious outcomes, but its impact on dengue has not been comprehensively evaluated at the national level. This study aimed to assess the association between CKD and adverse clinical outcomes of dengue fever. Methods: We conducted a population-based analysis using 2024 data from the Brazilian Information System for Notifiable Diseases (SINAN). Patients with a confirmed diagnosis of dengue, based on laboratory or clinical-epidemiological criteria, were included in the study. The cohort was stratified based on their CKD status. Clinical features and outcomes (hospitalization, severe dengue, and death) were compared. Multivariable logistic regression models weighted by inverse probability of treatment weighting (IPTW) were used to estimate adjusted odds ratios (ORs). Results: Among 5,837,904 confirmed dengue cases, 30,527 (0.5%) had CKD. Compared to patients without CKD, those with CKD had significantly higher rates of hospitalization (14% vs. 4%), severe dengue (1.6% vs. 0.1%), and death (2.2% vs. 0.1%) (all p < 0.001). In adjusted analyses, CKD was independently associated with increased odds of death (OR = 3.09, 95% CI: 2.66–3.59) and the composite outcome (OR = 1.62, 95% CI: 1.53–1.71). Hematologic and autoimmune comorbidities also conferred increased risk. Conclusion: CKD significantly worsens clinical outcomes in dengue fever. These findings highlight the need for early recognition, tailored care, and targeted public health strategies to protect this high-risk population during dengue outbreaks.

Emerging evidence suggests a bidirectional relationship between oral health and chronic kidney disease (CKD), yet population-based data from upper-middle-i

Objetivos: Descrever e analisar os dados do Registro Brasileiro de Transplantes (RBT) de 2024, comparando-os com anos anteriores e com as metas projetadas, além de avaliar a posição do Brasil no cenário mundial de transplantes. Métodos: Análise descritiva dos dados do RBT de 2024, publicado pela Associação Brasileira de Transplante de Órgãos (ABTO), com foco nas taxas de doação, transplantes realizados por tipo de órgão, distribuição regional e comparações internacionais. Resultados: Em 2024, o Brasil realizou 26.509 transplantes, incluindo 6.297 renais, 2.449 hepáticos, 440 cardíacos, 93 pulmonares, 141 de pâncreas e 17.089 de córneas. Houve aumento no número absoluto de todos os tipos de transplantes em relação a 2023, porém as taxas por milhão de população (pmp) ficaram abaixo das metas projetadas. A taxa de notificação de potenciais doadores (71,0 pmp) atingiu a meta prevista, mas a taxa de efetivação da doação (27%) ficou abaixo do esperado (30%), principalmente devido à elevada recusa familiar (46%). O Brasil ocupa o quarto lugar mundial em número absoluto de transplantes renais e hepáticos, mas posições intermediárias quando analisadas as taxas pmp. Persistem disparidades regionais significativas, com a região Sul liderando diversos indicadores. Conclusão: O sistema brasileiro de transplantes demonstra resiliência, mas ainda enfrenta desafios para atingir as metas projetadas. A elevada taxa de recusa familiar e as disparidades regionais representam os principais obstáculos a serem superados. Recomenda-se intensificar as campanhas de conscientização, aprimorar o processo de acolhimento familiar, fortalecer as Organizações de Procura de Órgãos e coordenações hospitalares de transplante, aumentar a taxa de utilização dos órgãos doados e implementar políticas específicas para redução das disparidades regionais.

Objectives: To describe and analyze data from the 2024 Brazilian Transplant Registry, comparing it with previous years and projected goals, as well as evaluating Brazil’s position in the global transplantation scenario. Methods: Descriptive analysis of data from the 2024 Brazilian Transplant Registry, published by the Brazilian Association of Organ Transplantation (ABTO), focusing on donation rates, transplants performed by organ type, regional distribution, and international comparisons. Results: In 2024, Brazil performed 26,509 transplants, including 6,297 kidney, 2,449 liver, 440 heart, 93 lung, 141 pancreas, and 17,089 cornea transplants. There was an increase in the absolute number of all types of transplants compared to 2023, but the rates per million population (pmp) were below the projected goals. The notification rate of potential donors (71.0 pmp) reached the expected target, but the donation effectiveness rate (27%) was below the expected rate (30%), mainly due to high family refusal (46%). Brazil ranks fourth worldwide in absolute number of kidney and liver transplants, but holds intermediate positions when analyzing pmp rates. Significant regional disparities persist, with the Southern region leading in various indicators. Conclusion: The Brazilian transplant system has demonstrated resilience and post-pandemic recovery capacity, but still faces challenges to achieve projected goals. The high family refusal rate and regional disparities represent the main obstacles to be overcome. It is recommended to intensify awareness campaigns, improve the family interview process, strengthen organ procurement organizations, and implement specific policies to reduce regional disparities.

Brazil ranks among the top five countries performing kidney transplants, operating the largest public transplantation system in the world. Nevertheless, the number of procedures performed represents less than 40% of demand, and there are significant regional disparities, with areas of the country reporting very low transplantation activity. Among the potential causes of this scenario are the low frequency of referrals for transplant evaluation and referrals made under inappropriate clinical conditions. In this document, the Brazilian Society of Nephrology aims to compile information supporting the selection of kidney transplantation as a renal replacement therapy. The document also details contraindications and patient care after listing and prioritization, in line with the national context. Our goal is to provide a document that serves as a national reference and contributes to streamlining the referral process for kidney transplantation, making it more frequent and effective, thereby expanding candidates՚ access to this treatment