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Kondrashkin AS, Storozhev RV, Oransky AV, Pinchuk AV, Balkarov AG, Dmitriyev IV, Yartsev PA, Khubutiya MS. [Preventive anterior abdominal wall repair in recipients of renal allograft]. Khirurgiia (Mosk) 2018:36-41. [PMID: 30307419 DOI: 10.17116/hirurgia2018090136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Retrospective analysis of safety and efficacy of preventive anterior abdominal wall repair in recipients of renal allograft. MATERIAL AND METHODS Kidney transplantation was performed in 396 patients with terminal renal failure within January 2015 - May 2017. Preventive endoprosthetics (PE) was applied in 28 (7.1%) patients. There were 7 women (26.9%) and 19 men (73.1%) aged 25-69 years (mean 44.5 (35, 56) years). Median of body mass index (BMI) was 27.5 (23.9, 29.9) kg/m2. RESULTS Postoperative morbidity was 42.3%. Complications were mild (type I and II) and did not require invasive treatment. Postoperative morbidity was similar regardless protocol of immunosuppressive therapy (IST). CONCLUSION Preventive abdominal wall repair after kidney transplantation is effective and safe to prevent postoperative hernia.
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Affiliation(s)
- A S Kondrashkin
- Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Departmenmt, Moscow, Russia
| | - R V Storozhev
- Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Departmenmt, Moscow, Russia
| | - A V Oransky
- Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Departmenmt, Moscow, Russia
| | - A V Pinchuk
- Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Departmenmt, Moscow, Russia; Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A G Balkarov
- Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Departmenmt, Moscow, Russia
| | - I V Dmitriyev
- Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Departmenmt, Moscow, Russia
| | - P A Yartsev
- Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Departmenmt, Moscow, Russia; Russian Medical Academy for Continuing Postgraduate Education of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - M Sh Khubutiya
- Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Departmenmt, Moscow, Russia; Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Mouelhi Y, Jouve E, Alessandrini M, Pedinielli N, Moal V, Meurette A, Cassuto E, Mourad G, Durrbach A, Dussol B, Gentile S. Factors associated with Health-Related Quality of Life in Kidney Transplant Recipients in France. BMC Nephrol 2018; 19:99. [PMID: 29703170 PMCID: PMC5921567 DOI: 10.1186/s12882-018-0893-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 04/11/2018] [Indexed: 02/07/2023] Open
Abstract
Background Health-Related Quality of Life (HRQoL) assessment after kidney transplantation has become an important tool in evaluating outcomes. This study aims to identify the associated factors with HRQoL among a representative sample size of Kidney Transplant Recipients (KTR) at the time of their inclusion in the study. Methods Data of this cross-sectional design is retrieved from a longitudinal study conducted in five French kidney transplant centers in 2011, and included KTR aged 18 years with a functioning graft for at least 1 year. Measures include demographic, psycho-social and clinical characteristics. To evaluate HRQoL, the Short Form-36 Health Survey (SF-36) and a HRQoL instrument for KTR (ReTransQol) were administered. Multivariate linear regression models were performed. Results A total of 1424 patients were included, with 61.4% males, and a mean age of 55.7 years (±13.1). Demographic and clinical characteristics were associated with low HRQoL scores for both questionnaires. New variables were found in our study: perceived poor social support and being treated by antidepressants were associated with low scores of Quality of Life (QoL), while internet access was associated with high QoL scores. Conclusion The originality of our study’s findings was that psycho-social variables, particularly KTR treated by antidepressants and having felt unmet needs for any social support, have a negative effect on their QoL. It may be useful to organize a psychological support specifically adapted for patients after kidney transplantation.
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Affiliation(s)
- Yosra Mouelhi
- Laboratoire de Santé Publique, Faculté de Médecine, Université Aix-Marseille, 3279, Marseille, EA, France.
| | - Elisabeth Jouve
- Service Santé Publique et Information Médicale, CHU Marseille, Marseille, France
| | - Marine Alessandrini
- Laboratoire de Santé Publique, Faculté de Médecine, Université Aix-Marseille, 3279, Marseille, EA, France
| | - Nathalie Pedinielli
- Service Santé Publique et Information Médicale, CHU Marseille, Marseille, France
| | - Valérie Moal
- Centre de Néphrologie et de Transplantation Rénale, CHU Marseille, Marseille, France
| | - Aurélie Meurette
- Transplantation, Urology and Nephrology Institute (ITUN), CHU Nantes, Nantes, France
| | | | - Georges Mourad
- Département de Néphrologie, Dialyse et Transplantation, CHU Montpellier, Montpellier, France
| | | | - Bertrand Dussol
- Centre de Néphrologie et de Transplantation Rénale, CHU Marseille, Marseille, France
| | - Stéphanie Gentile
- Laboratoire de Santé Publique, Faculté de Médecine, Université Aix-Marseille, 3279, Marseille, EA, France.,Service Santé Publique et Information Médicale, CHU Marseille, Marseille, France
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Sieverdes JC, Price M, Ruggiero KJ, Baliga PK, Chavin KD, Brunner-Jackson B, Patel S, Treiber FA. Design and approach of the Living Organ Video Educated Donors (LOVED) program to promote living kidney donation in African Americans. Contemp Clin Trials 2017; 61:55-62. [PMID: 28687348 DOI: 10.1016/j.cct.2017.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/03/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe the rationale, methodology, design, and interventional approach of a mobile health education program designed for African Americans with end stage renal disease (ESRD) to increase knowledge and self-efficacy to approach others about their need for a living donor kidney transplant (LDKT). METHODS The Living Organ Video Educated Donors (LOVED) program is a theory-guided iterative designed, mixed methods study incorporating three phases: 1) a formative evaluation using focus groups to develop program content and approach; 2) a 2-month proof of concept trial (n=27) to primarily investigate acceptability, tolerability and investigate increases of LDKT knowledge and self-efficacy; and 3) a 6-month, 2-arm, 60-person feasibility randomized control trial (RCT) to primarily investigate increases in LDKT knowledge and self-efficacy, and secondarily, to increase the number of living donor inquiries, medical evaluations, and LDKTs. The 8-week LOVED program includes an interactive web-based app delivered on 10″ tablet computer incorporating weekly interactive video education modules, weekly group video chat sessions with an African American navigator who has had LDKT and other group interactions for support and improve strategies to promote their need for a kidney. RESULTS Phase 1 and 2 have been completed and the program is currently enrolling for the feasibility RCT. Phase 2 experienced 100% retention rates with 91% adherence completing the video modules and 88% minimum adherence to the video chat sessions. CONCLUSIONS We are in the early stages of an RCT to evaluate the LOVED program; to date, we have found high tolerability reported from Phase 2.
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Affiliation(s)
- John C Sieverdes
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., Charleston, SC 29425-1600, USA.
| | - Matthew Price
- University of Vermont, College of Arts and Sciences, Department of Psychological Science, John Dewey Hall, Rm 248 2 Colchester Avenue, Burlington, VT 05405-0134, USA.
| | - Kenneth J Ruggiero
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., Charleston, SC 29425-1600, USA.
| | - Prabhakar K Baliga
- Medical University of South Carolina, College of Medicine, 96 Jonathan Lucas St., Charleston, SC 29425-1600, USA.
| | - Kenneth D Chavin
- Medical University of South Carolina, College of Medicine, 96 Jonathan Lucas St., Charleston, SC 29425-1600, USA; Case Western Reserve University School of Medicine, Department of Surgery-Transplant, 11100 Euclid Ave, Cleveland, OH 44106, USA.
| | - Brenda Brunner-Jackson
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., Charleston, SC 29425-1600, USA.
| | - Sachin Patel
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., Charleston, SC 29425-1600, USA.
| | - Frank A Treiber
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., Charleston, SC 29425-1600, USA; Medical University of South Carolina, College of Medicine, 96 Jonathan Lucas St., Charleston, SC 29425-1600, USA.
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Mazzoni D, Cicognani E, Mosconi G, Totti V, Roi GS, Trerotola M, Nanni Costa A. Sport activity and health-related quality of life after kidney transplantation. Transplant Proc 2015; 46:2231-4. [PMID: 25242758 DOI: 10.1016/j.transproceed.2014.07.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Considering the importance of sport activity for enhancing quality of life, the aim of this study was to investigate the effects of regular sport activity on quality of life of kidney transplant recipients. METHODS Health-related quality of life (HRQoL) was assessed with the use of the SF-36 questionnaire on a group of 118 active kidney transplant patients (AKTPs) practicing different sports at low to moderate intensity (5±4 h/wk). Scores were compared with those of 79 sedentary kidney transplant patients (SKTPs) and with 120 active healthy control subjects (AHCs). RESULTS AKTPs reported higher scores than SKTPs in the SF-36 scales of Physical Functioning (P<.05), Role Limitations due to Physical Problems (P<.05), General Health (P<.01), Vitality (P<.05), Social Functioning (P<.05), Role Limitations due to Emotional Problems (P<.05), and Mental Health (P<.01). AKTPs obtained higher scores than AHCs on the Mental Health (P<.01) and Social Functioning scales (P<.01) and similar scores (P>.05) on all the other scales. The effect of quantity of sport activity was significant on the General Health (P<.01; η2=0.05), and Role Physical scales (P=.04; η2=0.03), with higher sport activity associated with higher HRQoL. The effect of sex was significant for Bodily Pain (P=.05; η2=0.02), Vitality (P=.08; η2=0.06), Social Functioning (P=.08; η2=0.05), and Mental Health (P=.05; η2=0.02), with male participants scoring higher than female participants. CONCLUSIONS This study indicates that regular sport activity significantly improves different dimensions of HRQoL among kidney transplant recipients. The benefits of sport activity go beyond its impact on physical health to involve psychologic and social components of quality of life. Spontaneous and low to moderate sport activity may play an important role after kidney transplantation that has been largely underestimated in the literature.
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Affiliation(s)
- D Mazzoni
- Department of Psychology, University of Bologna, Bologna, Italy
| | - E Cicognani
- Department of Psychology, University of Bologna, Bologna, Italy
| | - G Mosconi
- Nephrology and Dialysis Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - V Totti
- Nonprofit Foundation for the Advancement of Organ and Tissue Transplantation, Padua, Italy
| | - G S Roi
- Education and Research Department, Isokinetic Medical Group, Bologna, Italy
| | - M Trerotola
- Italian National Transplant Center, Rome, Italy
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Roy R, Das MK, Pal BP, Ganesan S, Raman R, Sharma T. The effects of renal transplantation on diabetic retinopathy: clinical course and visual outcomes. Indian J Ophthalmol 2014; 61:552-6. [PMID: 24212305 PMCID: PMC3853450 DOI: 10.4103/0301-4738.121067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To elucidate the clinical course of diabetic retinopathy (DR) after renal transplantation (RT) in a hospital based cohort. DESIGN Retrospective study. MATERIALS AND METHODS A total of 56 eyes of 28 patients, who had DR and end stage renal disease (ESRD) due to diabetes and had undergone RT, were included in this study. Diagnosis and management of DR was carried out according to early treatment of diabetic retinopathy study (ETDRS) guidelines. DR outcome was defined as worsening if there was >2 step increase in the grade of DR or need for intervention such as laser (macular or pan retinal) or vitreoretinal surgery, improvement for <2 step change while stabilization was defined if DR remained within these two limits. RESULTS The mean age of the patients were 48.9 years. The mean duration of diabetes in the study group was 12.7 years. The patients were followed-up for a mean period of 52.2 ± 43.6 months. The pre-transplant mean Best corrected visual acuity (BCVA) was 0.4876 log MAR units and post-transplant mean BCVA was 0.4858 (P = 0.05). However, there was a significant visual improvement in first 20 months of renal transplant (P = 0.03). Worsening of DR was noted in 16 (32%) eyes whereas improvement was seen in 4 (8%). However, majority of eyes 30 (60%) had stable retinopathy at the final follow-up. CONCLUSIONS RT stabilized the retinopathy status in the majority of patients although in a minor subset the disease course was unpredictable.
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Affiliation(s)
- Rupak Roy
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Gentile S, Beauger D, Speyer E, Jouve E, Dussol B, Jacquelinet C, Briançon S. Factors associated with health-related quality of life in renal transplant recipients: results of a national survey in France. Health Qual Life Outcomes 2013; 11:88. [PMID: 23721430 PMCID: PMC3673846 DOI: 10.1186/1477-7525-11-88] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 05/15/2013] [Indexed: 12/22/2022] Open
Abstract
Background This study aims to identify factors associated with health related quality of life (HRQOL) through a comprehensive analysis of sociodemographic and clinical variables among a representative sample size of renal transplant recipients (RTR) in France. Methods A cross-sectional multicenter study was carried out in 2008. All RTR over 18 years old with a functioning graft for at least one year were included. Data included socio-demographic, health status, and treatment characteristics. To evaluate HRQOL, the Short Form-36 Health Survey (SF-36) and a HRQOL instrument for RTR (ReTransQol) were administered. Multivariate linear regression models were performed. Results A total of 1061 RTR were included, with a return rate of 72.5%. The variance explained in regression models of SF-36 ranges from 20% to 40% and from 9% to 33% for ReTransQol. The variables which decreased scores of both HRQOL questionnaires were: females, unemployment, lower education, living alone, high BMI, diabetes, recent critical illness and hospitalization, non-compliance, a long duration of dialysis and treatment side effects. Specific variables which decreased ReTransQol scores were dismissal and a recent surgery on the graft. These which decreased SF36 scores were being old and a recent infectious disease. The variables the most predictors of worse HRQOL were: side effects, infectious disease, recent hospitalization and female gender. Conclusions The originality of our study’s findings was that novel variables, particularly treatment side effects and unemployment, have a negative effect on quality of life of RTR. The French Biomedicine Agency and the National Health Institute for Public Health Surveillance conduct specific actions for professional reintegration and therapeutic education programs in the national plan to improve the HRQOL of people living with chronic diseases.
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Ephraim PL, Powe NR, Rabb H, Ameling J, Auguste P, Lewis-Boyer L, Greer RC, Crews DC, Purnell TS, Jaar BG, DePasquale N, Boulware LE. The providing resources to enhance African American patients' readiness to make decisions about kidney disease (PREPARED) study: protocol of a randomized controlled trial. BMC Nephrol 2012; 13:135. [PMID: 23057616 PMCID: PMC3489555 DOI: 10.1186/1471-2369-13-135] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 10/08/2012] [Indexed: 01/28/2023] Open
Abstract
Background Living related kidney transplantation (LRT) is underutilized, particularly among African Americans. The effectiveness of informational and financial interventions to enhance informed decision-making among African Americans with end stage renal disease (ESRD) and improve rates of LRT is unknown. Methods/design We report the protocol of the Providing Resources to Enhance African American Patients’ Readiness to Make Decisions about Kidney Disease (PREPARED) Study, a two-phase study utilizing qualitative and quantitative research methods to design and test the effectiveness of informational (focused on shared decision-making) and financial interventions to overcome barriers to pursuit of LRT among African American patients and their families. Study Phase I involved the evidence-based development of informational materials as well as a financial intervention to enhance African American patients’ and families’ proficiency in shared decision-making regarding LRT. In Study Phase 2, we are currently conducting a randomized controlled trial in which patients with new-onset ESRD receive 1) usual dialysis care by their nephrologists, 2) the informational intervention (educational video and handbook), or 3) the informational intervention in addition to the option of participating in a live kidney donor financial assistance program. The primary outcome of the randomized controlled trial will include patients’ self-reported rates of consideration of LRT (including family discussions of LRT, patient-physician discussions of LRT, and identification of a LRT donor). Discussion Results from the PREPARED study will provide needed evidence on ways to enhance the decision to pursue LRT among African American patients with ESRD. Trial registration ClinicalTrials.gov NCT01439516
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Affiliation(s)
- Patti L Ephraim
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, 2024 E. Monument Street, Suite 2-600, Baltimore, MD 21205, USA
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Page TF. Labor supply responses to government subsidized health insurance: evidence from kidney transplant patients. INTERNATIONAL JOURNAL OF HEALTH CARE FINANCE AND ECONOMICS 2011; 11:133-144. [PMID: 21567166 DOI: 10.1007/s10754-011-9092-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 04/26/2011] [Indexed: 05/30/2023]
Abstract
Between 1993 and 1995 Medicare increased the coverage of immunosuppression medication for kidney transplant recipients from 1 to 3 years following transplantation. The universal Medicare eligibility among kidney transplant patients provides a unique opportunity to explore labor supply responses to public insurance provision among a large number of men and women of prime working age and of all income levels. Although these patients are likely to be less healthy than the general population, upon receiving a kidney transplant, the main health problem of an individual with kidney failure, the lack of functioning kidneys, is removed. The income effects associated with the large transfer payment may discourage labor supply, while the potential health benefits of the coverage extension may promote labor supply. Results indicate that Medicare's increased medication coverage led to decreases in labor force participation among part time workers. These results suggest that potential labor supply reducing income effects should be taken into account when discussing the possibility of expanded public health insurance coverage, particularly for other groups of individuals with high expected medical expenditures, such as the elderly, or those with chronic conditions, such as diabetes. These results are useful considering the forthcoming expansion of government aid to purchase health insurance.
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Affiliation(s)
- Timothy F Page
- Department of Health Policy and Management, Robert Stempel College of Public Health and Social Work, Florida International University, HLS II 554, 11200 SW 8th Street, Miami, FL 33199, USA.
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Addressing racial and ethnic disparities in live donor kidney transplantation: priorities for research and intervention. Semin Nephrol 2010; 30:90-8. [PMID: 20116653 DOI: 10.1016/j.semnephrol.2009.10.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
One potential mechanism for reducing racial/ethnic disparities in the receipt of kidney transplants is to enhance minorities' pursuit of living donor kidney transplantation (LDKT). Pursuit of LDKT is influenced by patients' personal values, their extended social networks, the health care system, and the community at large. This review discusses research and interventions promoting LDKT, especially for minorities, including improving education for patients, donors, and providers, using LDKT kidneys more efficiently, and reducing surgical and financial barriers to transplant. Future directions to increase awareness of LDKT for more racial/ethnic minorities also are discussed including developing culturally tailored transplant education, clarifying transplant-eligibility practice guidelines, strengthening partnerships between community kidney providers and transplant centers, and conducting general media campaigns and community outreach.
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Liu H, Feurer ID, Dwyer K, Shaffer D, Pinson CW. Effects of clinical factors on psychosocial variables in renal transplant recipients. J Adv Nurs 2009; 65:2585-96. [DOI: 10.1111/j.1365-2648.2009.05111.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Isla Pera P, Moncho Vasallo J, Torras Rabasa A, Oppenheimer Salinas F, Fernández Cruz Pérez L, Ricart Brulles MJ. Quality of life in simultaneous pancreas-kidney transplant recipients. Clin Transplant 2009; 23:600-5. [PMID: 19674015 DOI: 10.1111/j.1399-0012.2009.01054.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Simultaneous pancreas-kidney transplantation (SPK Tx) allows dialysis and insulin therapy to be discontinued and improves the complications of diabetes mellitus type 1 (DM1). This study measure quality of life (QoL) in SPK transplant recipients and determine if there are differences in QoL between these patients and those with DM1 in renal replacement therapy (RRT). METHODS Short Form Health Survey 36-Item (SF-36) was administered to 69 SPK transplant recipients and 34 patients with DM1 under RRT. A descriptive analysis, multiple linear regression, ANOVA, and ordinal regression (PLUM) models were constructed. RESULTS QoL was higher in SPK transplant recipients than in patients receiving RRT. The best results were in the recently transplanted patients. Respect to Spanish population the men with SPK transplants scored higher on vitality and lower on general health, role limitations-physical and role limitations-emotional. Women with SPK transplants scored lower on general health. Among patients under RRT, men scored lower on the general health, physical functioning, vitality, and bodily pain while women scored lower on all dimensions. In both groups, greater age was associated with better mental health. CONCLUSION Positive predictive factors of QoL are SPK Tx and age while negative predictive factors are female sex and RRT.
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Affiliation(s)
- Pilar Isla Pera
- Public Health Department, Nursing School, Universitat de Barcelona, Barcelona, Spain.
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Orsenigo E, Socci C, Carlucci M, Zuber V, Fiorina P, Gavazzi F, Secchi A, Di Carlo V, Staudacher C. Multivariate Analysis of Factors Affecting Patient and Graft Survival After Renal Transplant. Transplant Proc 2005; 37:2461-3. [PMID: 16182709 DOI: 10.1016/j.transproceed.2005.06.099] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To evaluate factors affecting patient and kidney survival after renal transplant. PATIENT AND METHODS Among 361 patients undergoing renal transplant: 52% (n = 189) were simultaneous with pancreas transplant (SPKT group) and 48% (n = 172), a kidney transplant alone (KT group). Out of 361 patients, 75% (n = 270) were diabetics. The patients were 220 (61%) men and 141 (39%) women of mean age 41 +/- 9 years. The mean time of dialysis was 42 +/- 21 months (range 0 to 126), and the mean duration of diabetes 24 +/- 7 years (range 5 to 51). A Cox regression analysis was done. RESULTS The multivariate analysis revealed that in the final model diabetes and donor age were significant predictors of kidney graft survival; moreover, diabetes and recipient age were predictors of patient survival. Overall patient survival was significantly greater among nondiabetic patients (P = .002) or in diabetic patients who received SPKT, when compared with diabetics in whom only the kidney was transplanted (P = .001). CONCLUSIONS Diabetes and donor age were independent prognostic factors affecting kidney graft survival after renal transplant, and recipient age and diabetes were prognostic factors affecting patient survival. Combined pancreas and kidney transplantation should be offered to patients with end-stage diabetic nephropathy.
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Affiliation(s)
- E Orsenigo
- Department of Surgery, Vita e Salute University, San Raffaele Scientific Institute, Milan, Italy.
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Orsenigo E, Fiorina P, Cristallo M, Socci C, La Rocca E, Maffi P, Invernizzi L, Zuber V, Secchi A, Di Carlo V. Long-term survival after kidney and kidney-pancreas transplantation in diabetic patients. Transplant Proc 2005; 36:1072-5. [PMID: 15194372 DOI: 10.1016/j.transproceed.2004.04.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the influence of diabetes mellitus on patient and graft survival among renal versus renal-pancreatic recipients. METHODS Among 270 renal transplants performed from 1985 to 2002, a total of 204 (75%) were in diabetic patients and 66 (25%) in nondiabetic patients. Among the 204 diabetic patients 161 (60%) kidneys were transplanted simultaneously with a pancreatic graft (SKPT group). The overall group of patient included 164 (61%) men and 106 (39%) women with mean time on dialysis of 31 +/- 21 months (range 0 to 126 months). The mean duration of diabetes was 24 +/- 7 years (range 5 to 51 years). Ninety-nine percent of the patients were on renal replacement therapy (79% hemodialysis and 20% peritoneal dialysis). RESULTS The overall rejection rate was similar (NS). Both patient and kidney graft survival rates were worse in diabetics. Patient survival was 82% at 5 years among patients undergoing SKPT, 60% in diabetics receiving only a kidney, and 88% in nondiabetic transplanted patients. Kidney graft survival at 5 years was 77% in diabetics receiving SKPT, 68% in diabetics receiving a kidney alone, and 82% in nondiabetic patients. Overall patient survival was significantly greater among nondiabetics (P =.002) or in diabetics who received SKPT compared with diabetics who only had a kidney transplant (P =.001). CONCLUSIONS This retrospective clinical evaluation confirms that combined pancreas and kidney transplantation should be the first choice to insulin-dependent diabetes mellitus (IDDM) patients with end-stage diabetic nephropathy.
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Affiliation(s)
- E Orsenigo
- Department of Surgery, Vita e Salute University, San Raffaele Scientific Institute, Milan, Italy.
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