1
|
Masset C, Branchereau J, Buron F, Karam G, Rabeyrin M, Renaudin K, Le Borgne F, Badet L, Matillon X, Legendre C, Glotz D, Antoine C, Giral M, Dantal J, Cantarovich D. The role of donor hypertension and angiotensin II in the occurrence of early pancreas allograft thrombosis. Front Immunol 2024; 15:1359381. [PMID: 38873595 PMCID: PMC11170105 DOI: 10.3389/fimmu.2024.1359381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/29/2024] [Indexed: 06/15/2024] Open
Abstract
Background About 10-20% of pancreas allografts are still lost in the early postoperative period despite the identification of numerous detrimental risk factors that correlate with graft thrombosis. Methods We conducted a multicenter study including 899 pancreas transplant recipients between 2000 and 2018. Early pancreas failure due to complete thrombosis, long-term pancreas, kidney and patient survivals were analyzed and adjusted to donor, recipient and perioperative variables using a multivariate cause-specific Cox model stratified to transplant centers. Results Pancreas from donors with history of hypertension (6.7%), as well as with high body mass index (BMI), were independently associated with an increased risk of pancreas failure within the first 30 post-operative days (respectively, HR= 2.57, 95% CI from 1.35 to 4.89 and HR= 1.11, 95% CI from 1.04 to 1.19). Interaction term between hypertension and BMI was negative. Donor hypertension also impacted long-term pancreas survival (HR= 1.88, 95% CI from 1.13 to 3.12). However, when pancreas survival was calculated after the postoperative day 30, donor hypertension was no longer a significant risk factor (HR= 1.22, 95% CI from 0.47 to 3.15). A lower pancreas survival was observed in patients receiving a pancreas from a hypertensive donor without RAAS (Renin Angiotensin Aldosterone System) blockers compared to others (50% vs 14%, p < 0.001). Pancreas survival was similar among non-hypertensive donors and hypertensive ones under RAAS blockers. Conclusion Donor hypertension was a significant and independent risk factor of pancreas failure. The well-known pathogenic role of renin-angiotensin-aldosterone system seems to be involved in the genesis of this immediate graft failure.
Collapse
Affiliation(s)
- Christophe Masset
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Julien Branchereau
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Fanny Buron
- Groupement Hospitalier Edouard Herriot Service d’urologie chirurgie de la transplantation, Lyon, France
| | - Georges Karam
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Maud Rabeyrin
- Groupement Hospitalier Edouard Herriot, Service d’anatomie et pathologie, Lyon, France
| | - Karine Renaudin
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
- Service d’anatomie et pathologie, CHU de Nantes, Nantes, France
| | | | - Lionel Badet
- Groupement Hospitalier Edouard Herriot Service d’urologie chirurgie de la transplantation, Lyon, France
| | - Xavier Matillon
- Groupement Hospitalier Edouard Herriot Service d’urologie chirurgie de la transplantation, Lyon, France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Denis Glotz
- Institut de Recherche Saint Louis, INSERM U976, Paris, France
| | - Corinne Antoine
- Institut de Recherche Saint Louis, INSERM U976, Paris, France
| | - Magali Giral
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Jacques Dantal
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Diego Cantarovich
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| |
Collapse
|
2
|
Modern indications for referral for kidney and pancreas transplantation. Curr Opin Nephrol Hypertens 2023; 32:4-12. [PMID: 36444661 DOI: 10.1097/mnh.0000000000000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Pancreas transplantation (PTx) is currently the only therapy that can predictably achieve sustained euglycemia independent of exogenous insulin administration in patients with insulin-dependent diabetes mellitus. This procedure involves a complex abdominal operation and lifetime dependence on immunosuppressive medications. Therefore, PTx is most frequently performed in combination with other organs, usually a kidney transplant for end stage diabetic nephropathy. Less frequently, solitary PTx may be indicated in patients with potentially life-threatening complications of diabetes mellitus. There remains confusion and misperceptions regarding indications and timing of patient referral for PTx. RECENT FINDINGS In this review, the referral, evaluation, and listing process for PTx is described, including a detailed discussion of candidate assessment, indications, contraindications, and outcomes. SUMMARY Because the progression of diabetic kidney disease may be less predictable than other forms of kidney failure, early referral for planning of renal and/or pancreas transplantation is paramount to optimize patient care and allow for possible preemptive transplantation.
Collapse
|
3
|
Pancreas Transplantation in Minorities including Patients with a Type 2 Diabetes Phenotype. URO 2022. [DOI: 10.3390/uro2040026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Prior to year 2000, the majority of pancreas transplants (PTx) were performed as simultaneous pancreas-kidney transplants (SPKTs) in Caucasian adults with end stage renal failure secondary to type 1 diabetes mellitus (T1DM) who were middle-aged. In the new millennium, improving outcomes have led to expanded recipient selection that includes patients with a type 2 diabetes mellitus (T2DM) phenotype, which excessively affects minority populations. Methods: Using PubMed® to identify appropriate citations, we performed a literature review of PTx in minorities and in patients with a T2DM phenotype. Results: Mid-term outcomes with SPKT in patients with uremia and circulating C-peptide levels (T2DMphenotype) are comparable to those patients with T1DM although there may exist a selection bias in the former group. Excellent outcomes with SPKT suggests that the pathophysiology of T2DM is heterogeneous with elements consisting of both insulin deficiency and resistance related to beta-cell failure. As a result, increasing endogenous insulin (Cp) production following PTx may lead to freedom checking blood sugars or taking insulin, better metabolic counter-regulation, and improvements in quality of life and life expectancy compared to other available treatment options. Experience with solitary PTx for T2DM or in minorities is limited but largely mirrors the trends reported in SPKT. Conclusions: PTx is a viable treatment option in patients with pancreas endocrine failure who are selected appropriately regardless of diabetes type or recipient race. This review will summarize data that unconventional patient populations with insulin-requiring diabetes may gain value from PTx with an emphasis on contemporary experiences and appropriate selection in minorities in the new millennium.
Collapse
|
4
|
Ventura-Aguiar P, Bayés-Genís B, Amor AJ, Cuatrecasas M, Diekmann F, Esmatjes E, Ferrer-Fàbrega J, García-Criado Á, Musquera M, Olivella S, Palou E, Paredes D, Perea S, Perez A, Poch E, Romano B, Escarrabill J. Patient Experience in Pancreas-Kidney Transplantation-A Methodological Approach Towards Innovation in an Established Program. Transpl Int 2022; 35:10223. [PMID: 35497883 PMCID: PMC9047730 DOI: 10.3389/ti.2022.10223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022]
Abstract
Simultaneous pancreas-kidney transplantation (SPKT) leads to increased survival and quality of life, and is an alternative treatment for insulin-dependent diabetes mellitus and end-stage kidney disease. Due to the particularities of this population (often with multiple comorbidities) and of the surgery (only performed in a few centers), a comprehensive analysis of patients' experience along the SPKT process is crucial to improve patient care and add value to this procedure. Therefore, we applied a systematic and iterative methodology with the participation of both patients and professional teams working together to explore and identify unmet needs and value-adding steps along the transplant patient journey at an established pancreas transplant program. Four main steps (to comprehend, to explore, to experiment and to assess) led to several interventions around three major areas: Administration and logistics, information and communication, and perceived quality of assistance. As a result, both displacements to the hospital for diagnostic purposes and the time delay involved in joining the patient waiting list for transplantation were reduced in parallel to the administrative procedures. In conclusion, the methodological implementation of key organizational changes has great impact on overall patient experience. Further quantitative analysis from the patient's perspective will consolidate our program and may add new prototype service design components.
Collapse
Affiliation(s)
- Pedro Ventura-Aguiar
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament, Fundació Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Beatriu Bayés-Genís
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament, Fundació Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Antonio J Amor
- Endocrinology Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Miriam Cuatrecasas
- Pathology Department, Center for Biomedical Diagnosis, Hospital Clinic Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament, Fundació Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Enric Esmatjes
- Endocrinology Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Joana Ferrer-Fàbrega
- Hepato-Bilio-Pancreatic Surgery and Digestive Transplant Unit, Hospital Clinic Barcelona, Barcelona, Spain
| | - Ángeles García-Criado
- Radiology Department, Center for Imaging Diagnosis, Hospital Clinic Barcelona, Barcelona, Spain
| | - Mireia Musquera
- Urology Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Silvia Olivella
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Eva Palou
- Patient Experience, Hospital Clinic Barcelona, Barcelona, Spain
| | - David Paredes
- Transplant Coordination Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Sonia Perea
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Anna Perez
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Esteban Poch
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Barbara Romano
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain
| | | |
Collapse
|
5
|
Naik M, Bhat T, Idrees M, Wani M, Wani I, Wani A, Wani M, Bhat M, Hamid A. A study comparing office blood pressure with ambulatory blood pressure in successful adult kidney-transplant recipients at a tertiary care center in North India. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_46_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
6
|
Masset C, Branchereau J, Karam G, Hourmant M, Dantal J, Giral M, Garandeau C, Meurette A, Kerleau C, Kervella D, Ville S, Blancho G, Cantarovich D. Clinical utility of C-peptide measurement after pancreas transplantation with especial focus on early graft thrombosis. Transpl Int 2021; 34:942-953. [PMID: 33733553 DOI: 10.1111/tri.13866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 11/26/2022]
Abstract
Since the beginning of our pancreas transplant programme, plasma C-peptide was routinely measured daily during the postoperative period. We aimed to evaluate the clinical interest of the C-peptide in the follow-up of pancreas transplantation with a particular look on early graft failure. From 2000 to 2016, 384 pancreas transplantations were evaluated. We collected and compared C-peptide, glycaemia and adjusted C-peptide (aCP; calculated based on C-peptide, glycaemia and creatininaemia) in patients with and without pancreas failure within 30 days after surgery. Variations of glycaemia, C-peptide and aCP between the day before and the day of failure were also recorded. The difference of aCP was significant during the first week after transplantation between patients with thrombosis and those with functional allograft: 63.2 vs. 26.7 on day 1, P = 0.0003; 61.4 vs. 26.7 on day 3, P < 0.0001; 64.8 vs. 5.7 on day 7, P < 0.0001, respectively. Glycaemia had a median increase of 8% on the day of failure, whereas C-peptide and aCP had, respectively, a median decrease of 88% and 83%. C-peptide monitoring after pancreas transplantation may help to identify graft function and early failure. This sensitive biomarker could allow pre-emptive diagnosis of an early thrombotic event allowing the possibility of rescue interventions.
Collapse
Affiliation(s)
- Christophe Masset
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Julien Branchereau
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Georges Karam
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Maryvonne Hourmant
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Jacques Dantal
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Magali Giral
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Claire Garandeau
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Aurélie Meurette
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Clarisse Kerleau
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Delphine Kervella
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Simon Ville
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Gilles Blancho
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Diego Cantarovich
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| |
Collapse
|
7
|
Gibbons A, Cinnirella M, Bayfield J, Watson CJE, Oniscu GC, Draper H, Tomson CRV, Ravanan R, Johnson RJ, Forsythe J, Dudley C, Metcalfe W, Bradley JA, Bradley C. Changes in quality of life, health status and other patient‐reported outcomes following simultaneous pancreas and kidney transplantation (SPKT): a quantitative and qualitative analysis within a UK‐wide programme. Transpl Int 2020; 33:1230-1243. [DOI: 10.1111/tri.13677] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/10/2020] [Accepted: 06/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Andrea Gibbons
- Health Psychology Research Unit Royal Holloway University of London London UK
- Department of Psychology University of Winchester Winchester UK
| | - Marco Cinnirella
- Psychology Department Royal Holloway University of London London UK
| | - Janet Bayfield
- Health Psychology Research Unit Royal Holloway University of London London UK
| | - Christopher J. E. Watson
- Department of Surgery NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation University of Cambridge and the NIHR Cambridge Biomedical Research CentreUniversity of CambridgeAddenbrooke’s Hospital Cambridge UK
| | - Gabriel C. Oniscu
- Edinburgh Transplant Centre Royal Infirmary of Edinburgh Edinburgh UK
| | - Heather Draper
- Health Sciences Warwick Medical School University of Warwick Coventry UK
| | | | - Rommel Ravanan
- Richard Bright Renal Unit Southmead HospitalNorth Bristol NHS Trust Bristol UK
| | | | - John Forsythe
- Transplant Unit Royal Infirmary of Edinburgh Edinburgh UK
- Organ Donation and Transplantation NHS Blood and Transplant Bristol UK
| | - Chris Dudley
- Richard Bright Renal Unit Southmead HospitalNorth Bristol NHS Trust Bristol UK
| | - Wendy Metcalfe
- Edinburgh Transplant Centre Royal Infirmary of Edinburgh Edinburgh UK
| | - J. Andrew Bradley
- Department of Surgery NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation University of Cambridge and the NIHR Cambridge Biomedical Research CentreUniversity of CambridgeAddenbrooke’s Hospital Cambridge UK
| | - Clare Bradley
- Health Psychology Research Unit Royal Holloway University of London London UK
- Health Psychology Research Ltd Egham UK
| |
Collapse
|
8
|
More Than 25 Years of Pancreas Graft Survival After Simultaneous Pancreas and Kidney Transplantation: Experience From the World's Largest Series of Long-term Survivors. Transplantation 2020; 104:1287-1293. [PMID: 31568218 DOI: 10.1097/tp.0000000000002960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
9
|
Takahi Y, Miyashita K, Takahara M, Katakami N, Kuroda A, Matsuoka TA, Matsuhisa M, Ito T, Shimomura I. Predictive factors of posttransplant glucose intolerance in Japanese patients with type 1 diabetes after pancreas transplantation. Endocr J 2019; 66:1101-1112. [PMID: 31495809 DOI: 10.1507/endocrj.ej19-0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pancreas transplantation (PTx) has been performed worldwide for patients with type 1 diabetes accompanied with end-stage renal disease or uncontrollable glycemic fluctuation. Nevertheless, risk factors of posttransplant glucose intolerance, which is responsible for progress of diabetic complications, remains unclear, especially in cases without pancreatic graft function loss. Therefore, this study was conducted to search for predictive factors of future glucose tolerance in PTx recipients without pancreatic graft function loss. Subjects were selected from among 41 Japanese patients with type 1 diabetes who received PTx between 2000 and 2016 in Osaka University Hospital, and 24 subjects free from rejections and thromboses were analyzed. Several examinations to evaluate insulin secretion and insulin sensitivity within 6 months after transplantation (initial examination) were performed. Glucose tolerance was evaluated by 120-minute post-load plasma glucose level during 75-g oral glucose tolerance tests (OGTT), referred to as PGOGTT120, at the initial examination and between 1 year and 2 years posttransplantation (maintenance period). The initial examination factors that were correlated with PGOGTT120 in the maintenance period were PGOGTT120 [r = 0.52 (p = 0.01)], insulinogenic index [r = -0.65 (p < 0.01)], and the ratio of incremental area under the curve of insulin to that of plasma glucose (iAUCR) calculated from data of OGTT [r = -0.65 (p < 0.01)]. Insulinogenic index [β = -0.28 (p = 0.02)] and iAUCR [β = -0.29 (p = 0.02)] were still significantly correlated with PGOGTT120 in the maintenance period after adjustment for PGOGTT120 at the initial examination. In conclusion, insulinogenic index and iAUCR from OGTT performed in the early posttransplantation period were predictive factors of future glucose intolerance.
Collapse
Affiliation(s)
- Yasumitsu Takahi
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Kazuyuki Miyashita
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Naoto Katakami
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
- Department of Metabolism and Atherosclerosis, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Akio Kuroda
- Diabetes Therapeutics and Research Center, Institute of Advance Medical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Taka-Aki Matsuoka
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute of Advance Medical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Toshinori Ito
- Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka 536-8588, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| |
Collapse
|
10
|
Nghiem DM, Gomez J, Gloston GF, Torres DS, Marek RJ. Psychological Assessment Instruments for Use in Liver and Kidney Transplant Evaluations: Scarcity of Evidence and Recommendations. J Pers Assess 2019; 102:183-195. [DOI: 10.1080/00223891.2019.1694527] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Duyen M. Nghiem
- Department of Clinical, Health, and Applied Sciences, University of Houston–Clear Lake, Houston, TX
| | - Jocelyn Gomez
- Department of Clinical, Health, and Applied Sciences, University of Houston–Clear Lake, Houston, TX
| | - Gabrielle F. Gloston
- Department of Clinical, Health, and Applied Sciences, University of Houston–Clear Lake, Houston, TX
| | - Debbie S. Torres
- Department of Clinical, Health, and Applied Sciences, University of Houston–Clear Lake, Houston, TX
| | - Ryan J. Marek
- Department of Clinical, Health, and Applied Sciences, University of Houston–Clear Lake, Houston, TX
| |
Collapse
|
11
|
Parajuli S, Arunachalam A, Swanson KJ, Aziz F, Garg N, Redfield RR, Kaufman D, Djamali A, Odorico J, Mandelbrot DA. Outcomes after simultaneous kidney‐pancreas versus pancreas after kidney transplantation in the current era. Clin Transplant 2019; 33:e13732. [PMID: 31628870 DOI: 10.1111/ctr.13732] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/28/2019] [Accepted: 10/14/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Sandesh Parajuli
- Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin
| | - Annamalai Arunachalam
- Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin
| | - Kurtis J. Swanson
- Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin
| | - Fahad Aziz
- Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin
| | - Neetika Garg
- Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin
| | - Robert R. Redfield
- Division of Transplant Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin
| | - Dixon Kaufman
- Division of Transplant Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin
| | - Arjang Djamali
- Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin
- Division of Transplant Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin
| | - Jon Odorico
- Division of Transplant Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin
| | - Didier A. Mandelbrot
- Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin
| |
Collapse
|
12
|
Pancreas Retransplant After Pancreas Graft Failure in Simultaneous Pancreas-kidney Transplants Is Associated With Better Kidney Graft Survival. Transplant Direct 2019; 5:e473. [PMID: 31576369 PMCID: PMC6708628 DOI: 10.1097/txd.0000000000000919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 11/30/2022] Open
Abstract
Background. Simultaneous pancreas-kidney (SPK) transplant is usually the best option for the diabetic end-stage renal disease patient. There is limited information about kidney graft outcomes in SPK recipients with isolated pancreas graft failure who do versus do not undergo pancreas retransplantation. Methods. Patients were divided into 2 groups based on whether they underwent pancreas retransplant (ReTx+) or not (ReTx−). Kidney graft function and survival were the primary endpoints. Results. One hundred and nine patients satisfied our selection criteria, 25 in ReTx+ and 84 in ReTx−. Mean interval from SPK to pancreas failure was significantly shorter in the ReTx+ compared with the ReTx− group, 19.3 ± 36.7 versus 45.7 ± 47.0 months (P = 0.01), respectively. There was no significant difference in kidney graft follow-up post SPK between 2 groups (P = 0.48). At last follow-up, 15 of the 25 (60%) of the repeat pancreas graft had failed, with a mean graft survival among these failed pancreas graft of 2.6 ± 2.7 years, ranging from 0 to 8.1 years. Uncensored kidney graft failure was significantly lower in the ReTx+ group compared with the ReTx− group, 44% versus 67% (P = 0.04). Death-censored kidney graft failure was also lower in the ReTx+ group, 24% versus 48% (P = 0.04). The difference in patient survival did not reach statistical significance. In adjusted Cox regression analysis, rejection as a cause of pancreas failure was associated with increased risk of death-censored kidney graft failure, and pancreas retransplantation was associated with decreased risk of kidney graft failure. A similar pattern was seen after 1:1 matching for the interval between SPK and pancreas graft failure. Conclusions. Even though ReTx+ patients accept the risks associated with repeat pancreas surgery, providers should consider this option in suitable otherwise healthy patients.
Collapse
|
13
|
|
14
|
Yadav P, Nunia S, Bansal A, Sureka SK, Jena R, Ansari MS, Srivastava A. Multidimensional assessment of quality of life of children and problems of parents in Indian society after pediatric renal transplant: Beyond the conventional thoughts. Pediatr Transplant 2017; 21. [PMID: 28718221 DOI: 10.1111/petr.13001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2017] [Indexed: 11/29/2022]
Abstract
This study evaluated multidimensional QoL after renal transplant to find the physical, psychosocial, and economic issues after pediatric transplant. Sixty-two patients under the age of 18 at the time of assessment were asked to complete WHOQOL questionnaires. Assessment of behavioral, emotional status of child, problems of parents, and SEC of family were also performed. The beneficial effect of transplantation was observed across all domains of QoL (physical, psychological, social, environmental, and overall QoL). The greatest change was observed in QoL domains that dealt with overall satisfaction (81.28±15.76 vs 45.32±10.98; P<.0001). The domain dealing with environmental factors showed the least variation after transplantation (65.58±17.45 vs 51.34±17.81; P<.0001). Feelings of happiness and peer group socialization were reported in 81% and 69% of patients, respectively. There was no marital disharmony in 52% of families. However, SEC deteriorated in 16% of families and 59% of the families availed financial assistance. Sixty-nine percent of children had not attended school after one year of transplantation, but return to school after transplant was reduced to 8% at 5 years. Pre- and post-transplant social and psychological support may help these patients and their families adjust in society and have a positive outlook for their future.
Collapse
Affiliation(s)
- Priyank Yadav
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sandeep Nunia
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ankur Bansal
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjoy K Sureka
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rahul Jena
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Mohd Sualeh Ansari
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Aneesh Srivastava
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
15
|
Brar A, Markell M, Stefanov DG, Timpo E, Jindal RM, Nee R, Sumrani N, John D, Tedla F, Salifu MO. Mortality after Renal Allograft Failure and Return to Dialysis. Am J Nephrol 2017; 45:180-186. [PMID: 28110327 DOI: 10.1159/000455015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 12/05/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The outcomes of patients who fail their kidney transplant and return to dialysis (RTD) has not been investigated in a nationally representative sample. We hypothesized that variations in management of transplant chronic kidney disease stage 5 leading to kidney allograft failure (KAF) and RTD, such as access, nutrition, timing of dialysis, and anemia management predict long-term survival. METHODS We used an incident cohort of patients from the United States Renal Data System who initiated hemodialysis between January 1, 2003 and December 31, 2008, after KAF. We used Cox regression analysis for statistical associations, with mortality as the primary outcome. RESULTS We identified 5,077 RTD patients and followed them for a mean of 30.9 ± 22.6 months. Adjusting for all possible confounders at the time of RTD, the adjusted hazards ratio (AHR) for death was increased with lack of arteriovenous fistula at initiation of dialysis (AHR 1.22, 95% CI 1.02-1.46, p = 0.03), albumin <3.5 g/dL (AHR 1.33, 95% CI 1.18-1.49, p = 0.0001), and being underweight (AHR 1.30, 95% CI 1.07-1.58, p = 0.006). Hemoglobin <10 g/dL (AHR 0.96, 95% CI 0.86-1.06, p = 0.46), type of insurance, and zip code-based median household income were not associated with higher mortality. Glomerular filtration rate <10 mL/min/1.73 m2 at time of dialysis initiation (AHR 0.83, 95% CI 0.75-0.93, p = 0.001) was associated with reduction in mortality. CONCLUSIONS Excess mortality risk observed in patients starting dialysis after KAF is multifactorial, including nutritional issues and vascular access. Adequate preparation of patients with failing kidney transplants prior to resuming dialysis may improve outcomes.
Collapse
Affiliation(s)
- Amarpali Brar
- Department of Medicine, SUNY Downstate School of Medicine, Brooklyn, NY, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Rosenthal MM, Molzahn AE, Chan CT, Cockfield SL, Kim SJ, Pauly RP. Why take the chance? A qualitative grounded theory study of nocturnal haemodialysis recipients who decline kidney transplantation. BMJ Open 2016; 6:e011951. [PMID: 27194322 PMCID: PMC4874163 DOI: 10.1136/bmjopen-2016-011951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The objective of this study was to examine the factors that influence decision-making to forgo transplantation in favour of remaining on nocturnal haemodialysis (NHD). DESIGN A grounded theory approach using in-depth telephone interviewing was used. SETTING Participants were identified from 2 tertiary care renal programmes in Canada. PARTICIPANTS The study participants were otherwise eligible patients with end-stage renal disease who have opted to remain off of the transplant list. A total of 7 eligible participants were interviewed. 5 were male. The mean age was 46 years. ANALYSIS A constant comparative method of analysis was used to identify a core category and factors influencing the decision-making process. RESULTS In this grounded theory study of people receiving NHD who refused kidney transplantation, the core category of 'why take a chance when things are going well?' was identified, along with 4 factors that influenced the decision including 'negative past experience', 'feeling well on NHD', 'gaining autonomy' and 'responsibility'. CONCLUSIONS This study provides insight into patients' thought processes surrounding an important treatment decision. Such insights might help the renal team to better understand, and thereby respect, patient choice in a patient-centred care paradigm. Findings may also be useful in the development of education programmes addressing the specific concerns of this population of patients.
Collapse
Affiliation(s)
- Meagen M Rosenthal
- Department of Pharmacy Administration, University of Mississippi, Oxford, Mississippi, USA
| | - Anita E Molzahn
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher T Chan
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sandra L Cockfield
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - S Joseph Kim
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert P Pauly
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
17
|
Rao S, Ghanta M, Moritz MJ, Constantinescu S. Long-Term Functional Recovery, Quality of Life, and Pregnancy After Solid Organ Transplantation. Med Clin North Am 2016; 100:613-29. [PMID: 27095649 DOI: 10.1016/j.mcna.2016.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article reviews the salient features of functional recovery, health-related quality of life (HR-QOL), and reproductive health, with special emphasis on pregnancy outcomes in kidney and liver recipients. Transplantation results in improved functional status and HR-QOL. Addressing factors that limit the optimal rehabilitation of transplant recipients can improve transplant outcomes. After successful transplantation, there is a rapid return of fertility, warranting counseling regarding contraception. Practitioners should be aware of the teratogenic potential of mycophenolic acid products. Posttransplant pregnancies are high risk, with increased incidences of hypertension, preeclampsia, and prematurity. Most pregnancies in kidney and liver recipients have successful maternal and newborn outcomes.
Collapse
Affiliation(s)
- Swati Rao
- Section of Nephrology, Hypertension and Kidney Transplantation, Temple University School of Medicine, 3440 North Broad Street, Kresge West, Suite 100, Philadelphia, PA 19140, USA
| | - Mythili Ghanta
- Pancreas Transplant Program, Section of Nephrology, Hypertension and Kidney Transplantation, Temple University School of Medicine, 3440 North Broad Street, Kresge West, Suite 100, Philadelphia, PA 19140, USA
| | - Michael J Moritz
- Transplant Services, Lehigh Valley Health Network, Allentown, PA 18103, USA; Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA; National Transplantation Pregnancy Registry, Gift of Life Institute, 401 North 3rd Street, Philadelphia, PA 19123, USA
| | - Serban Constantinescu
- National Transplantation Pregnancy Registry, Gift of Life Institute, 401 North 3rd Street, Philadelphia, PA 19123, USA; Kidney Transplant Program, Section of Nephrology, Hypertension and Kidney Transplantation, Temple University School of Medicine, 3440 North Broad Street, Kresge West, Suite 100, Philadelphia, PA 19140, USA.
| |
Collapse
|
18
|
Mortality on the Kidney Waiting List and After Transplantation in Patients With Peripheral Arterial Disease: An Analysis of the United States Renal Data System. Transplant Proc 2016; 48:15-20. [DOI: 10.1016/j.transproceed.2015.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 10/23/2015] [Accepted: 11/11/2015] [Indexed: 11/20/2022]
|
19
|
Sieverdes JC, Nemeth LS, Magwood GS, Baliga PK, Chavin KD, Brunner-Jackson B, Patel SK, Ruggiero KJ, Treiber FA. Patient-Centered mHealth Living Donor Transplant Education Program for African Americans: Development and Analysis. JMIR Res Protoc 2015; 4:e84. [PMID: 26265532 PMCID: PMC4705021 DOI: 10.2196/resprot.3715] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 02/23/2015] [Accepted: 04/27/2015] [Indexed: 11/13/2022] Open
Abstract
Background There is a critical need to expand the pool of available kidneys for African Americans who are on the transplant wait-list due to the disproportionally lower availability of deceased donor kidneys compared with other races/ethnic groups. Encouraging living donation is one method to fill this need. Incorporating mHealth strategies may be a way to deliver educational and supportive services to African American transplant-eligible patients and improve reach to those living in remote areas or unable to attend traditional group-session-based programs. Before program development, it is essential to perform formative research with target populations to determine acceptability and cultivate a patient-centered and culturally relevant approach to be used for program development. Objective The objectives of this study were to investigate African American kidney transplant recipients’ and kidney donors’/potential donors’ attitudes and perceptions toward mobile technology and its viability in an mHealth program aimed at educating patients about the process of living kidney donation. Methods Using frameworks from the technology acceptance model and self-determination theory, 9 focus groups (n=57) were administered to African Americans at a southeastern medical center, which included deceased/living donor kidney recipients and living donors/potential donors. After a demonstration of a tablet-based video education session and explanation of a group-based videoconferencing session, focus groups examined members’ perceptions about how educational messages should be presented on topics pertaining to the process of living kidney donation and the transplantation. Questionnaires were administered on technology use and perceptions of the potential program communication platform. Transcripts were coded and themes were examined using NVivo 10 software. Results Qualitative findings found 5 major themes common among all participants. These included the following: (1) strong support for mobile technology use; (2) different media formats were preferred; (3) willingness to engage in video chats, but face-to-face interaction sometimes preferred; (4) media needs to be user friendly; (5) high prevalence of technology access. Our results show that recipients were willing to spend more time on education than the donors group, they wanted to build conversation skills to approach others, and preferred getting information from many sources, whereas the donor group wanted to hear from other living donors. The questionnaires revealed 85% or more of the sample scored 4+ on a 5-point Likert scale, which indicates high degree of interest to use the proposed program, belief that other mHealth technologies would help with adherence to medical regimens, and doctors would make regimen adjustments quicker. In addition, high utilization of mobile technology was reported; 71.9% of the participants had a mobile phone and 43.9% had a tablet. Conclusions Our study supports the use of an mHealth education platform for African Americans to learn about living donation. However, potential recipients and potential donors have differing needs, and therefore, programs should be tailored to each target audience.
Collapse
Affiliation(s)
- John Christopher Sieverdes
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Jürgensen JS, Ikenberg R, Greiner RA, Hösel V. Cost-effectiveness of modern mTOR inhibitor based immunosuppression compared to the standard of care after renal transplantation in Germany. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2015; 16:377-390. [PMID: 24728542 DOI: 10.1007/s10198-014-0579-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 03/14/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Standards of immunosuppression in renal transplantation have changed dynamically in recent years. We here provide a refined advanced pharmacoeconomic model which uses state-of-the-art methods including a mixed treatment comparison (MTC) analysis. The aim was to assess the cost-effectiveness of current immunosuppressive therapy regimens (TR): "sirolimus + early withdrawal of cyclosporine + steroids" (TR1), "sirolimus-early transition" (TR2), "everolimus-early transition" (TR3) and "tacrolimus low dose + mycophenolate mofetil (MMF) + steroids" (TR4). METHODS An up-to-date Markov model with current source data was employed to assess the cost-effectiveness of modern immunosuppressive regimens over 12-month and 10-year time periods. Transition probabilities for the occurrence of events for the first year were based on an MTC analysis. The robustness of the model was tested in extensive sensitivity analyses. RESULTS Within the 12-month time period TR2 yields the highest life years (0.987 LY), generating costs of 17,500 <euro>. In terms of years with functioning graft (FG), TR4 yields the best efficacy over the 12-month model duration (0.970 years with FG). For the 10-year time period, TR2 yields the lowest costs (107,246 <euro>) and dominates both TR3 and TR1, as it is simultaneously more effective. Within the 10-year model duration, TR4 reaches slightly higher effects compared with TR2 (6.493 vs. 6.474 LY) resulting in an incremental cost-effectiveness ratio of 387,684 <euro> per LY gained. CONCLUSIONS The early transition to sirolimus provides long-term efficiency results comparable with a tacrolimus-based regimen, which represents a common treatment standard after kidney transplantation. Both are superior to other investigated immunosuppressive regimens.
Collapse
|
21
|
Martins LS, Outerelo C, Malheiro J, Fonseca IM, Henriques AC, Dias LS, Rodrigues AS, Cabrita AM, Noronha IL. Health-related quality of life may improve after transplantation in pancreas-kidney recipients. Clin Transplant 2015; 29:242-51. [PMID: 25581297 DOI: 10.1111/ctr.12511] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2015] [Indexed: 11/29/2022]
Abstract
Pancreas-kidney transplantation (PKT) may significantly improve quality of life (HRQOL) in patients with type 1 diabetes. We have assessed the changes felt by PKT patients, using the Gastrointestinal Quality of Life Index (GIQLI) and EuroQol-5D questionnaires. Patients were asked to compare how their HRQOL had changed from pre-transplantation to the last visit. The 60 men and 66 women enrolled had a mean follow-up of five yr; 84.1% with both grafts, 15.9% with one graft functioning. In all domains of EuroQol-5D scores improved after PKT, as well as the visual analogue scale health state (from 38% to 84%, p < 0.001; effect size 3.34). In GIQLI, physical function was felt better after PKT than before (14.83 ± 3.86 vs. 7.86 ± 4.43, p < 0.001; effect size 1.68); the same was observed for psychological status, social function, and GI complaints. Concerning the burden of medical treatment, the score significantly improved (from 1.31 to 3.63, p < 0.001, effect size 2.02). The rate of unemployed patients decreased after PKT (from 50.8% to 36.5%, p < 0.001). Multivariate analysis showed that having only one functioning graft was associated with worse HRQOL scores (B = -5.157, p = 0.015). In conclusion, for all assessed domains, patients reported a significant improvement in HRQOL after PKT. Maintenance of the two grafts functioning predicted higher improvement of HRQOL scores.
Collapse
Affiliation(s)
- La Salete Martins
- Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal; Transplantation Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar, University Hospital de Santo António, University of Porto, Porto, Portugal
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
High Rate of Unemployment After Kidney Transplantation: Analysis of the United Network for Organ Sharing Database. Transplant Proc 2014; 46:1290-4. [DOI: 10.1016/j.transproceed.2014.02.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 02/06/2014] [Indexed: 12/15/2022]
|
23
|
Salifu MO, Jindal RM. Mycophenolate mofetil dosage modifications following gastrointestinal complications in renal transplant patients. Expert Rev Pharmacoecon Outcomes Res 2014; 9:29-32. [DOI: 10.1586/14737167.9.1.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
24
|
Das RC, Srivastava K, Tudu J, Hooda AK. Crosssectional study of quality of life after renal transplant in end stage renal disease. Ind Psychiatry J 2014; 23:40-3. [PMID: 25535444 PMCID: PMC4261213 DOI: 10.4103/0972-6748.144955] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND End stage renal disease (ERD) is a psychologically debilitating illness with considerable emotional morbidity. There is variation in quality of life and mental health status among recipients and donor at different stages of kidney transplantation. MATERIALS AND METHODS The study is an observational analytic study. Sample for the study comprised of forty (40) consecutive patients including 20 recipients and 20 donors of 20 kidney transplantations, male and female, and who themselves/whose relatives provided written informed consent were included in the study. Both recipients and donors were followed-up from 2 weeks prior to transplant surgery to 6 months post-operatively by phone and when they came for review in Nephrology Out-Patient Department (OPD). Quality of life and mental health status was compared between the two groups. RESULTS Study groups were homogeneous on age, education, gender and marital status. After transplantation recipient's mean score in all parameters had increased and all changes were statistically significant (<0.05). CONCLUSION In this study significant changes in quality of life (QOL), and mental health status in recipients and donors before and after transplantation were noted. It is recommended to evaluate mental health related aspects of both donors and recipients.
Collapse
Affiliation(s)
- R C Das
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Kalpana Srivastava
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Jayadev Tudu
- Consultant Psychiatrist, Pune, Maharashtra, India
| | - A K Hooda
- Consultan Nephrology, Pune, Maharashtra, India
| |
Collapse
|
25
|
Rely K, Galindo-Suárez RM, Alexandre PK, García-García EG, Muciño-Ortega E, Salinas-Escudero G, Martínez-Valverde S. Cost Utility of Sirolimus versus Tacrolimus for the Primary Prevention of Graft Rejection in Renal Transplant Recipients in Mexico. Value Health Reg Issues 2012; 1:211-217. [PMID: 29702902 DOI: 10.1016/j.vhri.2012.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Therapies for end-stage renal disease improve quality of life, and survival. In Mexico, clinicians often must choose between different therapies without the availability of comparative outcomes evaluation. The present study evaluates the comparative cost-utility of sirolimus (SIR) versus tacrolimus (TAC) for the primary prevention of graft rejection in renal transplant recipients in Mexico. METHODS We used modeling techniques to estimate the cost-effectiveness of SIR versus TAC to prevent graft rejection in patients with end-stage renal disease in the Mexican setting. The model estimates the cost of quality-adjusted life-year (QALY) per patient. We applied a 20-year horizon (1-year Markov cycles). Cost-effectiveness was expressed in terms of cost per QALY. All costs are presented in 2011 US dollars. Probabilistic sensitivity analyses were conducted. RESULTS The total cost for the SIR treatment arm over the 20-year duration of the model is estimated to be $136,778. This compares with $142,624 for the TAC treatment arm, resulting in an incremental cost of SIR compared with that of TAC of-$5,846. Over 20 years, SIR was estimated to have 8.18 QALYs compared with 7.33 QALYs for TAC. The resulting incremental utility of SIR compared with that of TAC is 0.84 QALY gained. SIR is estimated to be both less costly and more effective than TAC, indicating that it is the dominant strategy. Notably, results suggest that SIR has a 78% probability of being dominant over the TAC strategy and a 100% probability of having an incremental cost-effectiveness ratio at or below $10,064 (1 GDP) per QALY. CONCLUSIONS These analyses suggest that in the Mexican setting, the use of SIR in place of TAC for the prevention of graft rejection in this population is likely to be cost saving.
Collapse
Affiliation(s)
| | | | - Pierre K Alexandre
- Department of Mental Health - Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | |
Collapse
|
26
|
|
27
|
Molnar-Varga M, Molnar MZ, Szeifert L, Kovacs AZ, Kelemen A, Becze A, Laszlo G, Szentkiralyi A, Czira ME, Mucsi I, Novak M. Health-Related Quality of Life and Clinical Outcomes in Kidney Transplant Recipients. Am J Kidney Dis 2011; 58:444-52. [DOI: 10.1053/j.ajkd.2011.03.028] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 03/29/2011] [Indexed: 11/11/2022]
|
28
|
Constantiner M, Cukor D. Barriers to immunosuppressive medication adherence in high-risk adult renal transplant recipients. ACTA ACUST UNITED AC 2011. [DOI: 10.1002/dat.20536] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
29
|
Evans RW, Applegate WH, Briscoe DM, Cohen DJ, Rorick CC, Murphy BT, Madsen JC. Cost-related immunosuppressive medication nonadherence among kidney transplant recipients. Clin J Am Soc Nephrol 2010; 5:2323-8. [PMID: 20847093 DOI: 10.2215/cjn.04220510] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Immunosuppressive medications are essential in preventing kidney transplant rejection. Continuous insurance coverage for outpatient immunosuppressive medications remains a major issue. The objective of this study was to establish the prevalence and consequences of cost-related immunosuppressive medication nonadherence. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A descriptive survey of all U.S. kidney transplant programs (n = 254) was conducted. The response rate for the survey exceeded 99%. The main outcome measures included the following: transplant recipient concerns related to medication costs, ability to pay for medications, medication nonadherence and its consequences, and failure of transplant centers to place patients on the transplant waiting list. RESULTS Continuous insurance coverage for outpatient immunosuppressive drugs is a problem having potentially grave consequences for the majority of kidney transplant recipients. More than 70% of kidney transplant programs report that their patients have an extremely or very serious problem paying for their medications. About 47% of the programs indicate that more than 40% of their patients are having difficulty paying for their immunosuppressive medications. In turn, 68% of the programs report deaths and graft losses attributable to cost-related immunosuppressive medication nonadherence. Some of the problems identified here are more significant for adult than pediatric patients. CONCLUSIONS The prevalence and consequences of cost-related immunosuppressive medication nonadherence among kidney transplant recipients have now been documented. The results presented here should serve as the necessary impetus for the development of health care policies supporting Medicare coverage of immunosuppressive medications for the life of the transplanted kidney.
Collapse
Affiliation(s)
- Roger W Evans
- United Network for the Recruitment of Transplantation Professionals, Rochester, MN 55902-1311, USA.
| | | | | | | | | | | | | |
Collapse
|
30
|
Depressive symptoms and mortality in patients after kidney transplantation: a prospective prevalent cohort study. Psychosom Med 2010; 72:527-34. [PMID: 20410250 DOI: 10.1097/psy.0b013e3181dbbb7d] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To analyze in a prospective cohort study if depressive symptoms are an independent predictor of mortality in kidney transplant recipients. METHODS Data from 840 transplanted patients followed at a single outpatient transplant center were analyzed. Sociodemographic parameters and clinical data were collected at enrollment (between August 2002 and February 2003). Participants completed the Center for Epidemiologic Studies-Depression (CES-D) scale. Depression was defined as CES-D score of > or = 18. Data on 5-year outcomes (death censored graft loss or mortality) were collected. RESULTS The prevalence of depression was 22%. Mortality was higher (21% versus 13%; p = .004) in patients with versus without depression. In a multivariate Cox proportional hazard model, both the baseline CES-D score (hazard ratio(for each 1-point increase) = 1.02; 95% confidence interval, 1.00-1.04) and the presence of depression at baseline (hazard ratio(presence) = 1.66; 95% confidence interval, 1.12-2.47) were significantly associated with mortality. The baseline CES-D score also significantly predicted death censored graft loss (hazard ratio(for each 1-point increase) = 1.03; 95% confidence interval, 1.01-1.05). CONCLUSION Depressive symptoms are an independent predictor of mortality in kidney transplanted patients.
Collapse
|
31
|
Smith GC, Trauer T, Kerr PG, Chadban SJ. Prospective quality-of-life monitoring of simultaneous pancreas and kidney transplant recipients using the 36-item short form health survey. Am J Kidney Dis 2010; 55:698-707. [PMID: 20176426 DOI: 10.1053/j.ajkd.2009.12.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 12/11/2009] [Indexed: 12/31/2022]
Abstract
BACKGROUND Few risk factors for quality-of-life outcomes of simultaneous pancreas and kidney transplant recipients are known because of a paucity of data from prospective studies. STUDY DESIGN Pretransplant assessment and prospective 3-year follow-up. SETTING & PARTICIPANTS Consecutive potential recipients at a university teaching hospital assessed by Liaison Psychiatry. PREDICTORS Demographic data; pretransplant Transplant Evaluation Rating Scale scores; current, past 12 months, and prior lifetime psychiatric disorder. OUTCOMES & MEASUREMENTS 36-Item Short Form Health Survey (SF-36) scores. RESULTS 37 simultaneous pancreas and kidney transplant recipients were assessed pretransplant and at 4 months posttransplant. Posttransplant at 1 year, 29 (81% of survivors); at 2 years, 26 (79% of survivors and those reaching 2 years); and at 3 years, 22 (92% of survivors and those reaching 3 years) patients were assessed. SF-36 Mental Component Summary (MCS) scores (mean pretransplant, 46.8 +/- 8.2 [SD]; 4 months, 51.7 +/- 8.5; 1 year, 50.1 +/- 9.7; 2 years, 51.8 +/- 8.9; and 3 years, 50.8 +/- 13.8) and Physical Component Summary (PCS) scores (pretransplant, 40.6 +/- 10.6; 4 months, 43.6 +/- 12.0; 1 year, 45.6 +/- 11.3; 2 years, 48.1 +/- 10.2; and 3 years, 46.8 +/- 9.1) showed sustained improvement posttransplant. MCS scores became similar to population norms. Functionally significant decreases in MCS and PCS scores were seen in 4%-21% and 8%-30% at times posttransplant. Male sex predicted higher scores at 4 months for the MCS (P = 0.003; regression coefficient, -8.28 [95% CI, -13.6 to -2.9]; effect size, 0.22) and PCS (P = 0.05; regression coefficient, -6.91 [95% CI, -13.9 to 0.9]; effect size, 0.08). Current psychiatric disorder at pretransplant evaluation predicted higher PCS scores at 4 months (P = 0.002; regression coefficient, -15.42 [95% CI, -24.6 to -6.2]; effect size, 0.22) and 1 year (P = 0.002; regression coefficient, -17.3 [95% CI, -27.9 to -6.7]; effect size, 0.29). Psychiatric disorder before the 12 months before the pretransplant evaluation predicted lower PCS scores at 4 months posttransplant (P < 0.001; regression coefficient, 14.98 [95% CI, 7.1-22.8]; effect size, 0.29). LIMITATIONS Cohort size. CONCLUSIONS Although half experienced sustained quality-of-life improvement, up to one-third experienced a decrease. Past psychiatric disorder is a risk factor. Patients should be educated and monitored appropriately.
Collapse
Affiliation(s)
- Graeme C Smith
- Monash University School of Psychology, Psychiatry and Psychological Medicine and Consultation-Liaison Psychiatry Service, Monash Medical Centre, Clayton, VIC, Australia.
| | | | | | | |
Collapse
|
32
|
Jürgensen JS, Arns W, Hass B. Cost-effectiveness of immunosuppressive regimens in renal transplant recipients in Germany: a model approach. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2010; 11:15-25. [PMID: 19296139 DOI: 10.1007/s10198-009-0148-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 02/26/2009] [Indexed: 05/15/2023]
Abstract
BACKGROUND The choice of immunosuppression regimen is of paramount importance for outcomes and cost of renal transplantation. We compared the cost-effectiveness of triple immunosuppressive regimens in Germany. METHODS A strong micro-simulation model was built comparing regimens based on cyclosporine, everolimus, sirolimus, and tacrolimus. Mean cost per patient, incremental cost per life year gained, and incremental cost per additional year with functioning graft were assessed from the perspective of the German statutory health insurance (SHI) after 2 and 10 years. RESULTS Over the 2-year period, the model predicted mean total costs per patient of 26,732, 29,352, 33,415, and 49,978 euro for sirolimus, cyclosporine, everolimus, and tacrolimus, respectively. Focusing on the cost per life year gained, the sirolimus-based regimen compared favorably with those based on everolimus and tacrolimus. The incremental cost-effectiveness ratio (ICER) of cyclosporine versus sirolimus is 524,000 euro per life year gained. Regarding the cost per year with functioning graft gained, sirolimus dominated cyclosporine and everolimus, while the ICER for tacrolimus compared to sirolimus amounts to 1,788,154 euro. Over the 10-year time frame, mean total costs per patient were 100,758, 108,300, 120,316, and 183,802 euro for sirolimus, cyclosporine, everolimus, and tacrolimus, respectively. With regard to life years gained, sirolimus dominated both cyclosporine and everolimus. The ICER of tacrolimus versus sirolimus was 1,766,894 euro. Considering the years with functioning graft gained, sirolimus dominated cyclosporine and everolimus, while the ICER for tacrolimus compared to sirolimus amounted to 1,339,419 euro. CONCLUSIONS Over both the 2-year and the 10-year time horizon, sirolimus-based immunosuppression represents a cost-effective option in renal transplantation in Germany.
Collapse
Affiliation(s)
- Jan Steffen Jürgensen
- Department of Nephrology and Medical Intensive Care, Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | | | | |
Collapse
|
33
|
Abstract
The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline on the monitoring, management, and treatment of kidney transplant recipients is intended to assist the practitioner caring for adults and children after kidney transplantation. The guideline development process followed an evidence-based approach, and management recommendations are based on systematic reviews of relevant treatment trials. Critical appraisal of the quality of the evidence and the strength of recommendations followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach. The guideline makes recommendations for immunosuppression, graft monitoring, as well as prevention and treatment of infection, cardiovascular disease, malignancy, and other complications that are common in kidney transplant recipients, including hematological and bone disorders. Limitations of the evidence, especially on the lack of definitive clinical outcome trials, are discussed and suggestions are provided for future research.
Collapse
|
34
|
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.
Collapse
Affiliation(s)
- Pilar Isla Pera
- Public Health Department, Nursing School, Universitat de Barcelona, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
35
|
Salifu MO, Norin AJ, O'Mahony C, Sumrani N, Apel A, Ikram M, Alam A, Hayat A, Jindal RM, Friedman EA, Distant DA. Long-term outcomes of dual kidney transplantation-a single center experience. Clin Transplant 2009; 23:400-6. [DOI: 10.1111/j.1399-0012.2009.00956.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
36
|
Hawksworth JS, Leeser D, Jindal RM, Falta E, Tadaki D, Elster EA. New directions for induction immunosuppression strategy in solid organ transplantation. Am J Surg 2009; 197:515-24. [PMID: 19249743 DOI: 10.1016/j.amjsurg.2008.04.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2008] [Accepted: 04/22/2008] [Indexed: 12/22/2022]
Abstract
BACKGROUND Solid organ transplant centers are increasingly using induction immunosuppression strategies. Induction immunosuppression involves the use of intense therapy at the time of transplantation with the goal of preventing acute rejection and ultimately inducing a tolerogenic state. The objective of this review is to examine specialized induction agents currently in clinical use and highlight novel therapeutics on the horizon for induction immunosuppression. METHODS A literature search using the PubMed and MEDLINE databases identified salient basic science and clinical research articles on induction immunosuppression for solid organ transplantation. CONCLUSIONS While current induction immunosuppression agents have reduced the incidence of acute rejection, the goal of transplant tolerance has not been realized. Furthermore, the long-term allograft survival rate is not clearly influenced by the practice of induction immunosuppression. New approaches to tolerance induction, such as costimulatory-based therapy, mixed chimerism, and adoptive cellular transfer, hold promise for more effective induction immunosuppression in solid organ transplantation.
Collapse
Affiliation(s)
- Jason S Hawksworth
- Department of Surgery, Walter Reed Army Medical Center, Washington, DC, USA
| | | | | | | | | | | |
Collapse
|
37
|
|
38
|
Muehrer RJ, Becker BN. PSYCHOSOCIAL FACTORS IN PATIENTS WITH CHRONIC KIDNEY DISEASE: Life After Transplantation: New Transitions in Quality of Life and Psychological Distress. Semin Dial 2008; 18:124-31. [PMID: 15771656 DOI: 10.1111/j.1525-139x.2005.18214.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Individuals with kidney failure often elect to undergo kidney transplantation because they believe that they will be more active and return a sense of normality to their lives with a functioning transplant. Therefore it is important to assess whether these objectives are being met. To do so, we can examine health-related quality of life (HRQOL) in transplant recipients. A number of tools have been used for this purpose, including general HRQOL instruments such as the 36-item short-form health survey (SF-36) and transplant-specific surveys such as the Kidney Transplant Questionnaire. In general, HRQOL assessments improve with transplantation in functional and physical domains. However, many factors actually influence HRQOL in a negative way, including comorbid conditions, kidney function per se, rejection episodes and hospitalizations, employment status, and adverse effects of medications. Perceived physical appearance, issues related to sexuality, stress, anxiety, and even guilt complicate the emotional and psychological landscape after transplantation. This constellation of factors may be predictive of posttransplant life events, such as resumption of employment. Posttransplant HRQOL may be exceedingly important in understanding the issues related to adherence with treatment regimens, especially in the pediatric and adolescent transplant populations. HRQOL is now established as an important issue after transplantation. Nonetheless, shortcomings still exist in our ability to address HRQOL after transplantation. In particular, more study of patient-centered interventions is needed. The use of standardized methodologies for patient assessment could improve our ability to identify if such patient-centered interventions actually succeed across populations, and help us further address the panoply of factors encompassed within posttransplant HRQOL.
Collapse
Affiliation(s)
- Rebecca J Muehrer
- Section of Nephrology, Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | | |
Collapse
|
39
|
Jürgensen J, Ulrich C, Hörstrup J, Brenner M, Frei U, Kahl A. Sexual Dysfunction After Simultaneous Pancreas–Kidney Transplantation. Transplant Proc 2008; 40:927-30. [DOI: 10.1016/j.transproceed.2008.03.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
40
|
Petersen E, Baird BC, Barenbaum LL, Leviatov A, Koford JK, Shihab F, Goldfarb-Rumyantzev AS. The impact of employment status on recipient and renal allograft survival. Clin Transplant 2008; 22:428-38. [DOI: 10.1111/j.1399-0012.2008.00803.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
41
|
|
42
|
Sajjad I, Baines LS, Salifu M, Jindal RM. The dynamics of recipient-donor relationships in living kidney transplantation. Am J Kidney Dis 2007; 50:834-54. [PMID: 17954298 DOI: 10.1053/j.ajkd.2007.07.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2007] [Accepted: 07/31/2007] [Indexed: 01/10/2023]
Abstract
Psychosocial issues in kidney transplant donors and recipients are a cause for concern. We reviewed studies that investigated psychosocial issues in donors and recipients of living kidney transplants. A variety of instruments were used for this purpose. However, there was a lack of consensus regarding the structure and method of psychosocial assessment in living kidney donors. We found that only a few centers currently carry out a systematic psychosocial follow-up of recipients and their donors. The majority of psychosocial studies were of living kidney donors, indicating a preference of researchers to study psychosocial issues in live kidney donors. We believe living kidney transplant recipients are also an important group, and more studies should be done to better understand the psychosocial issues in this group. The majority of studies were retrospective in nature. We also discuss relationships, interactions, and communication patterns that characterize living kidney donation. We place emphasis on understanding the relational history of donors and recipients to provide supportive intervention and enable the potential donor make an informed decision about surgery. We recommend comprehensive psychosocial screening before and after transplantation and donation. This may decrease psychological problems and increase satisfaction with the transplantation process. Furthermore, the transplant community will need to address the type of instruments, duration of follow-up, and funding sources to carry out our recommendations.
Collapse
Affiliation(s)
- Imran Sajjad
- Department of Medicine, University of Wisconsin, Madison, USA
| | | | | | | |
Collapse
|
43
|
Dobbels F, De Bleser L, De Geest S, Fine RN. Quality of life after kidney transplantation: the bright side of life? Adv Chronic Kidney Dis 2007; 14:370-8. [PMID: 17904505 DOI: 10.1053/j.ackd.2007.07.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This review describes the state-of-the-art on quality of life (QOL) in kidney transplant (KTx) recipients. More specifically, posttransplant QOL is compared with the pretransplant evaluation, with other chronically ill patient populations, and with healthy subjects. Determinants, consequences, and potential interventions to improve QOL are also summarized. However, because of the methodological diversity of published articles, this review starts with addressing some conceptual and methodological concerns surrounding research on QOL in general and in KTx recipients specifically. The ultimate goal of this review was to identify the gaps in the state-of-the-art evidence and to provide some guidelines for conduct of research in the future.
Collapse
Affiliation(s)
- Fabienne Dobbels
- Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium.
| | | | | | | |
Collapse
|
44
|
Kimmel PL, Cukor D, Cohen SD, Peterson RA. Depression in end-stage renal disease patients: a critical review. Adv Chronic Kidney Dis 2007; 14:328-34. [PMID: 17904499 DOI: 10.1053/j.ackd.2007.07.007] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Depression is the most common psychological disorder in end-stage renal disease (ESRD) patients with a prevalence rate as high as 20% to 25% by some contemporary estimates. There are several studies linking depression with mortality in ESRD, making early diagnosis and treatment essential. The mechanisms linking depression with survival in ESRD patients are unclear but may be related to treatment compliance, improvement in nutritional parameters, increased perception of social support, and modulation of the immune system. Although the best methods for depression screening remain controversial, recent research has validated cutoff values for some of the more common depression screening questionnaires for evaluation in ESRD hemodialysis (HD) patients. A cutoff score of 14 to 16 for the Beck Depression Inventory is believed to have the most sensitivity and specificity at making the psychiatric diagnosis of depression in ESRD HD patients. There are limited data regarding the treatment of depression in ESRD patients. Selective serotonin reuptake inhibitors, at initial low starting doses, may be used in close consultation with mental health providers if no active contraindication to their use exists. Data on the mechanisms linking depression and mortality and the optimal treatment of depression in ESRD patients await the performance of randomized controlled clinical trials.
Collapse
Affiliation(s)
- Paul L Kimmel
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC 20037, USA.
| | | | | | | |
Collapse
|
45
|
Cleemput I, Dobbels F. Measuring patient-reported outcomes in solid organ transplant recipients: an overview of instruments developed to date. PHARMACOECONOMICS 2007; 25:269-86. [PMID: 17402802 DOI: 10.2165/00019053-200725040-00002] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Improvements in organ preservation methods, immunosuppressive regimens and general post-transplant care have resulted in an increased life expectancy and a continually decreasing morbidity after solid organ transplantation. As attention gradually moves towards improving subjective patient outcomes, the use of patient-reported outcome measures (PROs) thus becomes increasingly important in post-transplant patient management. This paper provides a brief systematic overview of the transplant-specific PRO measures, and their psychometric properties, developed and used in solid organ transplant recipients to date. PRO measures may focus on or encompass different aspects of life relevant to organ transplant patients: overall quality of life (QOL), physical, psychological and social functioning, and adherence. Overall QOL can be measured using transplant-specific or generic QOL instruments, or a combination of both. In general, very little information is available on the psychometric properties of PRO measures, and there is no gold standard for PRO measurement. Transplant-specific and generic PRO instruments are complementary. Generic instruments will continue to be important for economic evaluations, but transplant-specific instruments may be more useful for patient management purposes, as they are generally more sensitive to small but clinically relevant changes in outcomes in transplant populations.
Collapse
Affiliation(s)
- Irina Cleemput
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium.
| | | |
Collapse
|
46
|
van der Mei SF, Krol B, van Son WJ, de Jong PE, Groothoff JW, van den Heuvel WJA. Social participation and employment status after kidney transplantation: a systematic review. Qual Life Res 2006; 15:979-94. [PMID: 16900279 DOI: 10.1007/s11136-006-0045-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2006] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To summarize and assess literature regarding social participation of recipients after successful kidney transplantation. METHODS A systematic review including a literature search in Medline (1980-2003) and five other databases, and assessment of methodological quality of selected studies by two reviewers applying a checklist of twelve criteria. RESULTS Seventeen studies out of 1443 identified references were selected. Quality scores for internal validity ranged from 0% to 50% (median 20%). Employment was the most used indicator of social participation and two studies briefly reported on vacation and recreation. Employment rate ranged from 18% to 82%, however differences in defining categories of employment or lack of description were present. Study populations were heterogeneous with regard to demographic and clinical characteristics. Three studies identified pre-transplant employment status as predictor of post-transplant employment. Other potential risk factors were not consistent across studies. CONCLUSION Measurement of social participation focuses mainly on employment status. Quality assessment revealed shortcomings in reporting and validity of studies, whereby valid conclusions regarding the degree of social participation after kidney transplantation cannot be drawn. Future research should supplement the focus on employment status by examining other aspects of social participation as well as potential risk factors.
Collapse
Affiliation(s)
- Sijrike F van der Mei
- Department of Health Sciences, Northern Centre for Healthcare Research (NCH), University Medical Centre Groningen (UMCG), University of Groningen, P.O. Box 196, 9700 AD, Groningen, The Netherlands.
| | | | | | | | | | | |
Collapse
|
47
|
Affiliation(s)
- S Bhagani
- Department of HIV Medicine, Royal Free Hospital, London, UK
| | | | | |
Collapse
|
48
|
Sureshkumar KK, Patel BM, Markatos A, Nghiem DD, Marcus RJ. Quality of life after organ transplantation in type 1 diabetics with end-stage renal disease. Clin Transplant 2006; 20:19-25. [PMID: 16556148 DOI: 10.1111/j.1399-0012.2005.00433.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Quality of life (QOL) should be an important consideration while choosing therapeutic options for patients with type 1 diabetes mellitus (DM) and end-stage renal disease (ESRD) including dialysis, cadaver (CKT) or living kidney transplant (LKT) or simultaneous pancreas-kidney (SPK) transplant. METHODS QOL was assessed in four groups of patients with history of type 1 DM and ESRD: recipients of SPK (n = 43), CKT (n = 43), LKT (n = 11) and wait listed (WL) patients (n = 23). Diabetes Quality of Life (DQOL), Short Form-36 (SF-36) and Quality of Well-Being (QWB) questionnaires were utilized. A subset of SPK (n = 19) and CKT (n = 12) recipients underwent longitudinal QOL evaluation. RESULTS On DQOL questionnaire, SPK group had better satisfaction subscore compared with CKT (1.8 +/- 0.5 vs. 2.2 +/- 0.6, p < 0.01) LKT (1.8 +/- 0.5 vs. 2.4 +/- 0.7, p < 0.05) and WL (1.8 +/- 0.5 vs. 2.6 +/- 0.6, p < 0.001) groups and better impact subscore compared with CKT (1.7 +/- 0.6 vs. 2.1 +/- 0.6, p < 0.05) and WL (1.7 +/- 0.6 vs. 2.3 +/- 0.6, p < 0.01) groups. There were no significant differences on physical/mental composite scores of SF-36. QWB score was better in SPK group vs. WL group (0.62 +/- 0.11 vs. 0.55 +/- 0.04, p < 0.05). Longitudinal decline in satisfaction (2.3 +/- 0.5 vs. 2.6 +/- 0.9, p = 0.058) and impact (2.0 +/- 0.5 vs. 2.2 +/- 0.5, p = 0.019) subscores of DQOL were noted in CKT group. There were no significant changes in the composite scores of SF-36 in both groups. QWB scores declined in the CKT group (0.67 +/- 0.10 vs. 0.61 +/- 0.05, p = 0.01). CONCLUSION QOL was better in type 1 diabetics with ESRD following transplantation when compared with remaining on WL. SPK transplantation had significant positive effect on diabetes-related QOL which was sustained longitudinally but it was difficult to show an overall improvement in general QOL.
Collapse
Affiliation(s)
- Kalathil K Sureshkumar
- Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
| | | | | | | | | |
Collapse
|
49
|
Franke GH, Yücetin L, Yaman H, Reimer J, Demirbas A. Disease-Specific Quality of Life in Turkish Patients After Successful Kidney Transplantation. Transplant Proc 2006; 38:457-9. [PMID: 16549146 DOI: 10.1016/j.transproceed.2005.12.110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To investigate disease-specific quality of life (QOL) in Turkish patients after successful kidney transplantation, the End-Stage Renal Disease Symptom Checklist Transplantation Module (ESRD-SCL-TM), a multidimensional questionnaire measuring disease-specific QOL, was translated and administered to a sample of successfully transplanted patients. Intercultural differences between Turkish and German patients as well as the influence of demographic (age, gender) and clinical (duration of graft function, living versus cadaver transplantation) data in the Turkish patients were evaluated by multivariate analyses of variance, and correlative techniques. The 152 investigated Turkish patients, including 106 (69.7%) men and 46 (30.3%) women, had a mean age of 34.8 years (SD = 10.8, range, 14 to 67 years). Time since successful kidney transplantation varied between 1 and 297 months (mean = 19.2 months; SD = 36.9). One hundred twelve patients (73.7%) received a kidney from a living donor, and 40 (26.3%) from a cadaver. The Turkish patients suffered statistically significantly more from disease-specific distress than the German patients (19% explanation of variance). They reported higher distress regarding four of six subscales. Turkish women suffered statistically significantly more from "Limited Physical Capacity," and "Side-effects of Corticosteroids" (10% explanation of variance) than men. The demonstrated higher disease-specific distress in successfully transplanted Turkish patients compared to the German samples may be the result of intercultural differences in reporting psychological and disease-specific distress. On the other hand, the higher distress of women compared to men is well known. Both results pointed out the necessity of psychological support.
Collapse
Affiliation(s)
- G H Franke
- Rehabilitation Psychology, University of Applied Sciences Magdeburg-Stendal, Stendal, Germany
| | | | | | | | | |
Collapse
|
50
|
Baines LS, Zawada ET, Jindal RM. Psychosocial profiling: a holistic management tool for non-compliance*. Clin Transplant 2005; 19:38-44. [PMID: 15659132 DOI: 10.1111/j.1399-0012.2004.00291.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We introduce a new concept of psychosocial profiling as a tool that provides the transplant team with a psychosocial framework for identification, intervention and management of non-compliance. This will also increase our understanding of emotional problems experienced by patients before transplant, as a result of living with the uncertainty and medical side effects of chronic illness. Psychosocial profiling is adaptable throughout the transplant process and gives every patient an opportunity of psychosocial support to help him or her into a position of emotional stability and compliance with their medications and postoperative care. Implementation of this strategy will move health care professionals from being gatekeepers to managers and facilitators of holistic care in recipients of transplants.
Collapse
|