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Ju A, Cazzolli R, Howell M, Scholes-Robertson N, Wong G, Jaure A. Novel Endpoints in Solid Organ Transplantation: Targeting Patient-reported Outcome Measures. Transplantation 2023; 107:1895-1902. [PMID: 36749290 DOI: 10.1097/tp.0000000000004537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Although solid organ transplantation improves survival and quality of life in many patients with organ failure, treatment complications and side effects can have debilitating consequences for patients. Patient-reported outcome measures (PROMs) capture how patients feel and function, including quality of life, symptoms, and side effects that are assessed directly by patients. Yet, they remain infrequently reported in trials in solid organ transplantation. Barriers to implementing PROMs in trials include uncertainty in selecting appropriate PROMs, concerns about resources limitations, patient burden, and limited evidence to support the psychometric robustness of measures for use in transplant recipients. In recent years, there have been increasing efforts to include patient-reported outcomes that are important to patients in trials to ensure that trials provide patient-centered information for decision-making. This article will provide an overview of PROMs, discuss PROs that are important to solid organ transplant recipients and those that are used in trials in solid organ transplantation, and outline approaches for selecting PROMs for clinical trials.
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Affiliation(s)
- Angela Ju
- Centre for Kidney Research, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Sydney School of Public Health, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Rosanna Cazzolli
- Centre for Kidney Research, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Sydney School of Public Health, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Martin Howell
- Centre for Kidney Research, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Sydney School of Public Health, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Nicole Scholes-Robertson
- Centre for Kidney Research, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Sydney School of Public Health, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Germaine Wong
- Centre for Kidney Research, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Sydney School of Public Health, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Allison Jaure
- Centre for Kidney Research, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Sydney School of Public Health, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
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Fuochi E, Anastasio L, Lynch EN, Campani C, Dragoni G, Milani S, Galli A, Innocenti T. Main factors influencing long-term outcomes of liver transplantation in 2022. World J Hepatol 2023; 15:321-352. [PMID: 37034235 PMCID: PMC10075010 DOI: 10.4254/wjh.v15.i3.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/24/2022] [Accepted: 02/22/2023] [Indexed: 04/11/2023] Open
Abstract
Liver transplant (LT) outcomes have markedly improved in the recent decades, even if long-term morbidity and mortality are still considerable. Most of late deaths are independent from graft function and different comorbidities, including complications of metabolic syndrome and de novo neoplasms, seem to play a key role in determining long-term outcomes in LT recipients. This review discusses the main factors associated with late mortality and suggests possible strategies to improve long-term management and follow-up after liver transplantation. In particular, the reduction of drug toxicity, the use of tools to identify high-risk patients, and setting up a multidisciplinary team also for long-term management of LT recipients may further improve survival after liver transplantation.
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Affiliation(s)
- Elisa Fuochi
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Lorenzo Anastasio
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Erica Nicola Lynch
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Claudia Campani
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Gabriele Dragoni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
- Department of Medical Biotechnologies, University of Siena, Siena 53100, Italy
| | - Stefano Milani
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Andrea Galli
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Tommaso Innocenti
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
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3
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A Randomized Controlled Trial of a Pretransplant Educational Intervention in Kidney Patients. Transplant Direct 2021; 7:e753. [PMID: 34514108 PMCID: PMC8425830 DOI: 10.1097/txd.0000000000001202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/02/2021] [Accepted: 06/14/2021] [Indexed: 12/18/2022] Open
Abstract
Supplemental Digital Content is available in the text. Poor patient knowledge about transplantation is a significant problem following kidney transplant. A video-based educational intervention was developed to supplement standard education provided by transplant teams.
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Aljerian K. Uterine transplant: an ethical framework analysis from a Middle Eastern perspective. Curr Med Res Opin 2021; 37:1049-1060. [PMID: 33705236 DOI: 10.1080/03007995.2021.1902296] [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: 10/21/2022]
Abstract
BACKGROUND Significant advances in infertility treatment have been achieved over the past several decades, but women with uterine dysfunction, anomaly, or agenesis still need support to carry a pregnancy to term. Recently, advancements in surgical, anesthetic and immunosuppressive therapy have brought the idea of successful uterine transplant closer to reality, but many challenges must be overcome before uterine transplant can become more common, including ethical challenges related to the study and the conduct of this procedure. METHODS This was an updated ethical analysis of uterine transplant from a Middle Eastern perspective, using an established ethical framework that has been adapted for the analysis of research in non-Western cultures and developing countries. RESULTS Using the ethical framework, this analysis explored research developments in uterine transplant to date, using the following categories: collaborative partnership, social value, scientific validity, a fair selection of study population, favorable risk-benefit ratio, independent review, informed consent, and respect for recruited participants. The analysis revealed a significant need for region- and religion-specific ethical guidelines for uterine transplant procedures. CONCLUSIONS The horizons of research need to expand by addressing and researching the ethical issues related to uterine transplant trials and clinical procedures. LIMITATIONS Limitations included the challenges related to applying ethical analyses to work in developing countries, and the fact that this analysis was based on the views and interpretations of a single researcher.
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Affiliation(s)
- Khaldoon Aljerian
- Forensic and Legal Medicine Unit, Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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5
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Chen X, Zhang Y, Yu J. Symptom Experience and Related Predictors in Liver Transplantation Recipients. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 15:8-14. [PMID: 33188944 DOI: 10.1016/j.anr.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/25/2020] [Accepted: 11/08/2020] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Symptom experience after liver transplantation (LT) provides healthcare professionals with important information about the benefits and limitations of LT from patients' perspective. This study aims to explore the multidimensional symptom experience and analyze related predictive factors in LT recipients. METHODS This cross-sectional study evaluated the occurrence, frequency, intensity, and level of distress of 40 symptoms in 265 LT recipients. Stepwise multiple regression analysis was performed to analyze the influencing factors of symptom experience. RESULTS The analysis of patient-reported data indicated that the ten most common symptoms were fatigue (42.3%), frequent sleep interruptions (38.9%), difficulty falling asleep (35.9%), decreased memory (34.0%), dreaminess (29.8%), itch (28.7%), muscular weakness (26.4%), shortness of breath (25.3%), anxiety (24.5%), and hand tremor (21.9%). Patients were classified into four groups according to survival time (1-month, 2-6-month, 7-12-month, and >1-year groups) after LT, and the most common symptom was fatigue in the one-month and 2-6-month groups, difficulty falling asleep in the 7-12-month group, and decreased memory in the >1-year group. Type of the primary caregiver, complications, concerns about the decreased ability to perform household and outdoor activities, and concerns about being a burden to the family were predictors of symptoms burden. CONCLUSION LT recipients experienced complicated symptoms. In clinical practice, it is critical to integrate physicians, nurses, and social workers as a medical team to help LT recipients develop suitable coping strategies that can potentially address patients' concerns, increase the sense of confidence, and improve symptom outcomes.
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Affiliation(s)
- Xiao Chen
- Liver Disease Department, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yuxia Zhang
- Nursing Department, Zhongshan Hospital of Fudan University, Shanghai, China.
| | - Jingxian Yu
- Liver Disease Department, Zhongshan Hospital of Fudan University, Shanghai, China
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Åberg F. Quality of life after liver transplantation. Best Pract Res Clin Gastroenterol 2020; 46-47:101684. [PMID: 33158471 DOI: 10.1016/j.bpg.2020.101684] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/31/2020] [Indexed: 01/31/2023]
Abstract
Liver transplantation (LT) enables rapid transition from critical illness and poor prognosis back to health. After LT, health-related quality of life (HRQoL) generally becomes comparable to that of the general population, although some deficits in mainly physical domains are frequent. However, recipients continue to have symptoms related to immunosuppression, complications, and other things, which impact HRQoL and the recipient's ability to regain independence and re-establish function in everyday life. Less than half of LT recipients return to work. Reportedly, HRQoL seems to deteriorate slightly over the long-term, but still remains satisfactory. Physical fatigue is common, but recent studies show that structured exercise programs improve both fatigue and HRQoL. Emerging evidence also suggests that continued patient information, structured psychosocial support systems, and caregiver involvement might further help improve long-term HRQoL. More research is needed to gain better understanding of the factors affecting long-term HRQoL, and how to best improve HRQoL.
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Affiliation(s)
- Fredrik Åberg
- Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki University, Helsinki, Finland; The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Purnajo I, Beaumont JL, Polinsky M, Alemao E, Everly MJ. Trajectories of health-related quality of life among renal transplant patients associated with graft failure and symptom distress: Analysis of the BENEFIT and BENEFIT-EXT trials. Am J Transplant 2020; 20:1650-1658. [PMID: 31874117 DOI: 10.1111/ajt.15757] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/05/2019] [Accepted: 12/08/2019] [Indexed: 01/25/2023]
Abstract
Understanding the correlation between transplant symptoms, health-related quality of life (HRQoL), and graft outcomes is needed to support patient-focused drug development and posttransplant management. A post-hoc analysis of patient-reported outcomes from the Phase III belatacept trials was conducted in order to investigate the interrelationship between trajectories of HRQoL, symptom experience, and allograft outcomes. HRQoL and symptom experience were evaluated using Short-Form 36 Survey (SF-36) and Modified Transplant Symptom Occurrence and Distress Scale (MTSOSD-59R), respectively. HRQoL was captured in 831 eligible renal transplant patients at baseline, 12, 24, and 36 months posttransplant. Following transplantation, patients reported improvements in all SF-36 subscales compared to baseline. Latent class analysis revealed four trajectories in perceived general health, which were associated with graft failure after adjustment. Compared to patients with good perceived health, patients with fair and poor perceived health had 4.7 (95% confidence interval [CI] 1.5-14.8, P < .01) and 19.8 (95% CI 5.9-66.0, P < .01) times the risk of graft failure, respectively. Using multinomial logistic regression, different sets of symptoms were associated with perceived general health at baseline and 12 months posttransplant. The study supports monitoring HRQoL and symptom experience to capture each patient's health perspective, improve drug development, and optimize posttransplant management.
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Affiliation(s)
- Intan Purnajo
- Terasaki Research Institute, Los Angeles, California
| | | | | | - Evo Alemao
- Bristol Myers Squibb, Princeton, New Jersey
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Taber DJ, Posadas‐Salas A, Su Z, Rao V, Rohan V, Nadig S, McGillicuddy JW, Dubay D, Fleming JN. Preliminary assessment of safety and adherence to a once‐daily immunosuppression regimen in kidney transplantation: Results of a randomized controlled pilot study. Clin Transplant 2020; 34:e13844. [DOI: 10.1111/ctr.13844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 11/28/2022]
Affiliation(s)
- David J. Taber
- Division of Transplant Surgery College of Medicine Medical University of South Carolina Charleston SC USA
| | - Aurora Posadas‐Salas
- Division of Transplant Nephrology College of Medicine Medical University of South Carolina Charleston SC USA
| | - Zemin Su
- Division of General Internal Medicine College of Medicine Medical University of South Carolina Charleston SC USA
| | - Vinaya Rao
- Division of Transplant Nephrology College of Medicine Medical University of South Carolina Charleston SC USA
| | - Vinayak Rohan
- Division of Transplant Surgery College of Medicine Medical University of South Carolina Charleston SC USA
| | - Satish Nadig
- Division of Transplant Surgery College of Medicine Medical University of South Carolina Charleston SC USA
| | - John W. McGillicuddy
- Division of Transplant Surgery College of Medicine Medical University of South Carolina Charleston SC USA
| | - Derek Dubay
- Division of Transplant Surgery College of Medicine Medical University of South Carolina Charleston SC USA
| | - James N. Fleming
- Department of Pharmacy Services Medical University of South Carolina Charleston SC USA
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9
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Fleming JN, Posadas Salas MA, Taber DJ. Dosing Requirements of Extended-Release Tacrolimus (Astagraf XL) in African American Kidney Transplant Recipients Converted from Immediate-Release Tacrolimus (AAAKTRS). Ther Drug Monit 2020; 42:415-420. [PMID: 31913864 DOI: 10.1097/ftd.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The formal recommendation for converting twice-daily tacrolimus immediate release (IR) to once-daily tacrolimus extended release (ER) is a 1:1 dose conversion. However, more recent clinical analysis has shown that this may not be true; some patients may require a higher dose. In addition, de novo dosing tacrolimus ER has revealed that African Americans require approximately 20%-30% higher doses than Caucasians to achieve similar levels. As a result, this study sought to identify the appropriate dose conversion in the African American kidney transplant population, a population at high risk of rejection. METHODS This was a single-center, prospective, open-label study comparing the difference in dose-normalized trough and total daily dose necessary to reach steady-state therapeutic goal, after conversion from tacrolimus IR to tacrolimus ER, in 25 African American kidney transplant recipients. RESULTS After conversion to tacrolimus ER, there was a significant decrease in dose-normalized trough (C0) (0.44 versus 0.59, P = 0.03). Statistically significant differences were seen in both total daily and weight-based doses, when reported as actual values (15 versus 10 mg and 0.16 versus 0.11 mg/kg, respectively), as well as when standardized to achieve a target tacrolimus C0 of 8 ng/mL (18.1 versus 13.6 mg and 0.17 versus 0.15 mg/kg, respectively). The median standardized dose conversion required was 1.3 [1.0, 1.4], for the overall population. There were no instances of biopsy-proven acute rejection, allograft loss, or study drug discontinuation. CONCLUSIONS This single-center, open-label conversion study demonstrated that there was a statistically and clinically significant decrease in dose-normalized trough after conversion from tacrolimus IR to tacrolimus ER in an African American kidney transplant population and that a 1:1 dose conversion is unlikely to meet therapeutic goals.
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Affiliation(s)
- James N Fleming
- Department of Pharmacy Services, Medical University of South Carolina
| | - Maria A Posadas Salas
- Department of Medicine, Division of Nephrology and Hypertension, Medical University of South Carolina
| | - David J Taber
- Department of Pharmacy, Ralph H Johnson VAMC; and.,Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
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Mansell H, Rosaasen N, West-Thielke P, Wichart J, Daley C, Mainra R, Shoker A, Liu J, Blackburn D. Randomised controlled trial of a video intervention and behaviour contract to improve medication adherence after renal transplantation: the VECTOR study protocol. BMJ Open 2019; 9:e025495. [PMID: 30872550 PMCID: PMC6429879 DOI: 10.1136/bmjopen-2018-025495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Non-adherence after kidney transplantation contributes to increased rejections, hospitalisations and healthcare expenditures. Although effective adherence interventions are sorely needed, increasing education and support to transplant recipients demands greater use of care providers' time and resources in a healthcare system that is stretched. The objective of this clinical trial is to determine the effectiveness of an electronically delivered video series and adherence behaviour contract on improving medication adherence to immunosuppressant medications. METHODS AND ANALYSIS A multicentre, parallel arm, randomised controlled trial will be conducted with four sites across North America (Saskatoon, Calgary, Halifax, Chicago). Adult patients will be randomised (1:1) to either the intervention (ie, home-based video education +behaviour contract plus usual care) or usual care alone. De novo transplant recipients will be enrolled prior to their hospital discharge and will be provided with electronic access to the video intervention (immediately) and adherence contract (1 month post-transplant). Follow-up electronic surveys will be provided at 3 and 12 months postenrolment. The primary outcome will be adherence at 12 months post-transplant, as measured by self-report Basel Assessment of Adherence to Immunosuppressive medications and immunosuppressant levels. Secondary outcomes include the difference in knowledge score between the intervention and control in groups (measured by the Kidney Transplant Understanding Tool); differences in self-efficacy (Generalised Self-efficacy Scale), Beliefs of Medicine Questionnaire (BMQ), quality of life (Short Form-12), patient satisfaction and cost utilisation. The study aims to recruit at least 200 participants across participating sites. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Saskatchewan Behavioural Ethics Committee (Beh 18-63), and all patients provide informed consent prior to participating. This educational intervention aims to improve information retention and self-efficacy, leading to improved medication adherence after kidney transplantation, at low cost, with little impact to existing healthcare personnel. If proven beneficial, delivery can be easily implemented into standard of care. TRIAL REGISTRATION NUMBER NCT03540121; Pre-results.
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Affiliation(s)
- Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nicola Rosaasen
- Saskatchewan Transplant Program, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Patricia West-Thielke
- Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA
| | - Jenny Wichart
- Southern Alberta Transplant Program, Alberta Health Services, Calgary, Alberta, Canada
| | - Christopher Daley
- Multi-organ Transplant Program of Atlantic Canada, Halifax, Nova Scotia, Canada
| | - Rahul Mainra
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ahmed Shoker
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Juxin Liu
- College of Arts and Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - David Blackburn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Methods of olfactory ensheathing cell harvesting from the olfactory mucosa in dogs. PLoS One 2019; 14:e0213252. [PMID: 30840687 PMCID: PMC6402693 DOI: 10.1371/journal.pone.0213252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 02/18/2019] [Indexed: 11/19/2022] Open
Abstract
Olfactory ensheathing cells are thought to support regeneration and remyelination of damaged axons when transplanted into spinal cord injuries. Following transplantation, improved locomotion has been detected in many laboratory models and in dogs with naturally-occurring spinal cord injury; safety trials in humans have also been completed. For widespread clinical implementation, it will be necessary to derive large numbers of these cells from an accessible and, preferably, autologous, source making olfactory mucosa a good candidate. Here, we compared the yield of olfactory ensheathing cells from the olfactory mucosa using 3 different techniques: rhinotomy, frontal sinus keyhole approach and rhinoscopy. From canine clinical cases with spinal cord injury, 27 biopsies were obtained by rhinotomy, 7 by a keyhole approach and 1 with rhinoscopy. Biopsy via rhinoscopy was also tested in 13 cadavers and 7 living normal dogs. After 21 days of cell culture, the proportions and populations of p75-positive (presumed to be olfactory ensheathing) cells obtained by the keyhole approach and rhinoscopy were similar (~4.5 x 106 p75-positive cells; ~70% of the total cell population), but fewer were obtained by frontal sinus rhinotomy. Cerebrospinal fluid rhinorrhea was observed in one dog and emphysema in 3 dogs following rhinotomy. Blepharitis occurred in one dog after the keyhole approach. All three biopsy methods appear to be safe for harvesting a suitable number of olfactory ensheathing cells from the olfactory mucosa for transplantation within the spinal cord but each technique has specific advantages and drawbacks.
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12
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Incerti D, Summers N, Ton TGN, Boscoe A, Chandraker A, Stevens W. The Lifetime Health Burden of Delayed Graft Function in Kidney Transplant Recipients in the United States. MDM Policy Pract 2018; 3:2381468318781811. [PMID: 30288451 PMCID: PMC6124921 DOI: 10.1177/2381468318781811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/12/2018] [Indexed: 11/20/2022] Open
Abstract
Background. Although delayed graft function (DGF) is associated with
an increased risk of acute rejection and decreased graft survival, there are no
estimates of the long-term or lifetime health burden of DGF.
Objectives. To estimate the long-term and lifetime health
burden of DGF, defined as the need for at least one dialysis session within the
first week after transplantation, for a cohort representative of patients who
had their first kidney transplant in 2014. Methods. Data from the
United States Renal Data System (USRDS; 2001–2014) were used to estimate a
semi-Markov parametric multi-state model with three disease states. Maximum
length of follow-up was 13.7 years, and a microsimulation model was used to
extrapolate results over a lifetime. The impact of DGF was assessed by
simulating the model for each patient in the cohort with and without DGF.
Results. At the end of 13.7 years of follow-up, DGF reduces the
probability of having a functioning graft from 52% to 32%, increases the
probability of being on dialysis from 10% to 19%, and increases the probability
of death from 38% to 50% relative to transplant recipients who do not experience
DGF. A typical transplant recipient with DGF (median age = 53) is observed to
lose 0.87 quality-adjusted life-years (QALYs). Extrapolated over a lifetime, the
same 53-year-old DGF patient is projected to lose 3.01 (95% confidence interval:
2.33, 3.70) QALYs relative to a transplant recipient with the same
characteristics who does not experience DGF. Conclusions. The
lifetime health burden of DGF is substantial. Understanding these consequences
will help health care providers weigh kidney transplant decisions and inform
policies for patients in the context of varying risks of DGF.
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Affiliation(s)
| | | | | | - Audra Boscoe
- Alexion Pharmaceuticals Inc., New Haven, Connecticut
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13
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Cognitive Evaluation in Liver Transplant Patients Under Calcineurin Inhibitor Maintenance Therapy. Transplant Direct 2017; 3:e146. [PMID: 28405602 PMCID: PMC5381739 DOI: 10.1097/txd.0000000000000658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/19/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Neurological disorders due to calcineurin inhibitor (CNI) treatment pose a well-known problem after liver transplantation (LTx). In this study, the impact of CNIs on cognitive functioning during maintenance therapy was analyzed. A possible improvement of cognitive functioning, compliance and health-related quality of life (HRQoL) after conversion to a once-daily tacrolimus formulation was prospectively assessed. METHODS In a cross-section analysis cognitive functioning of living donors (LD), waiting list patients and LTx patients was tested using a 4 times trail making test (4-TTMT). In a further investigator-initiated trial a possible improvement of cognitive functioning, HRQoL and compliance after conversion to the once-daily tacrolimus formulation was prospectively assessed over 1 year. HRQoL was assessed using an EORTC-QLQ C30 questionnaire and patient's compliance was assessed by the Basel Assessment of Compliance with Immunosuppressive Medication Scales questionnaire. Correlated data were sex, age, time after surgery, liver disease, model of end-stage liver disease score, creatinine, CNI type, and CNI trough levels. RESULTS Two hundred eleven patients were included in this cross-section analysis. Twenty-seven patients agreed to participate in the investigator-initiated trial. LTx patients completed the 4-TTMT slower than living donor patients and faster than waiting list patients. Patients with twice daily cyclosporine A (CSA) formulation needed longer to finish the 4-TTMT than patients with the once-daily tacrolimus formulation. After drug conversion of a twice-daily CNI formulation to a once-daily tacrolimus formulation, CSA-treated patients needed longer to improve their cognitive functioning. HRQoL and compliance did not improve after drug conversion. CONCLUSIONS Patients with once-daily tacrolimus formulation had a better psychomotor speed than CSA-treated patients. The conversion to once-daily tacrolimus formulation significantly improved cognitive functioning, but had no impact on HRQoL or compliance.
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14
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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.
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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.
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Translational research in kidney transplantation and the role of patient engagement. Can J Kidney Health Dis 2015; 2:42. [PMID: 26543564 PMCID: PMC4634742 DOI: 10.1186/s40697-015-0077-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 09/02/2015] [Indexed: 12/25/2022] Open
Abstract
Background Translational research is an evolving discipline that is intended to bridge the gaps between basic science research, clinical research, and implementation in clinical practice. It is a fluid, multidirectional process that requires strong interdisciplinary collaboration to produce research that is relevant to end-users. Purpose of this review This review summarizes current perspectives on translational research and outlines its relevance and importance to kidney transplantation research. Sources of information Sources of information used for this review include published reports, articles, and research funding websites. Findings Tissue typing is used as an in-depth example of how translational research has been applied in the field of kidney transplant medicine, and how it has resulted in successful implementation of diagnostic and management options for sensitized individuals undergoing kidney transplantation. The value of actively involving kidney transplant stakeholders (patients, caregivers, and clinicians) in setting research priorities and determining relevant outcomes for future investigation is also discussed. Limitations This is a narrative review of the literature which has been partly influenced by the perspectives and experiences of its authors. Implications Translational and patient-oriented research practices should be incorporated into future research endeavours in the field of kidney transplantation in order to create beneficial change in clinical practice and improve patient outcomes. What was known before Translational research which engages patients in the investigative process can enhance the likelihood that medical discoveries will have a meaningful impact at the bedside. What this adds This article applies current perspectives on translational research and patient engagement to the field of kidney transplantation, illustrating how these approaches have led to significant advancements in the field. It provides further justification for deliberate, targeted efforts to cross-collaborate and incorporate the patient voice into kidney transplant research.
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16
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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]
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Perceived health after kidney transplantation: a cross-sectional comparison of long-term and short-term cohorts. Transplant Proc 2014; 45:2184-90. [PMID: 23953527 DOI: 10.1016/j.transproceed.2013.03.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 03/06/2013] [Indexed: 12/31/2022]
Abstract
Although increased longevity of grafts has led to a growing number of long-term kidney transplant recipients, knowledge about the perceived health of these patients remains limited. A cross-sectional sample of 609 patients (60% response) was stratified into a short-term (≤1 year), midterm (>1 and ≤8 years), and long-term cohort (>8 and ≤15 years posttransplantation). Cohorts were compared for perceived health (Visual Analogue Scale of the EQ-5D), number of symptoms, and number of comorbidities by analysis of variance/covariance and multivariate regression analyses. Long-term patients reported more symptoms, (F[2, 606] = 3.09, P = .046) and more comorbidities, (F[2, 588] = 4.75, P = .009) but similar levels of perceived health, (F[2, 550] = 2.37, P > .05). Furthermore, symptoms were less influential for perceived health among long- versus short-term (z = -2.08, P = .038) or midterm cohorts (z = -2.60, P = .009). Previously identified predictors of perceived health accounted for less variance in the long-term as opposed to short-term (z = 4.30, P < .001) and midterm cohort (z = 2.07, P = .039). Despite more symptoms and comorbidities, the perceived health of long-term kidney transplant recipients was comparable to the short- and midterm, possibly due to selective survival or patient adjustment. Because kidney function and symptoms were predominantly associated with short-term perceived health, there is an urgent need to identify variables associated with long-term perceived health.
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18
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Perlman RL, Rao PS. Quality of Life of Older Patients Undergoing Renal Transplantation: Finding the Right Immunosuppressive Treatment. Drugs Aging 2014; 31:103-9. [DOI: 10.1007/s40266-013-0149-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Ordin YS, Karayurt O, Cilengiroğlu OV. Validation and adaptation of the Modified Transplant Symptom Occurrence and Symptom Distress Scale-59 Items Revised into Turkish. Prog Transplant 2013; 23:392-400. [PMID: 24311405 DOI: 10.7182/pit2013743] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
CONTEXT The Modified Transplant Symptom Occurrence and Symptom Distress Scale-59 Items Revised (MTSOSD-59R) is a validated self-reported scale assessing patients' subjective experiences of adverse effects of immunosuppressants. It has been reported that the scale should be adapted and validated before it is used in patients of a different cultural (Brazilian, Dutch, German, French, Hindi, Italian, Spanish, and Swedish) background. OBJECTIVE To validate and adapt the MTSOSD-59R for use in Turkish transplant recipients. MATERIALS AND METHODS This cross-sectional study was performed between March 2010 and February 2011, and included 180 liver and kidney transplant recipients treated in 2 university hospitals in western Turkey. In addition, 180 healthy control participants were recruited from a community health service. Data were collected by using a demographic and clinical characteristics scale (MTSOSD-59R) and the Beck Depression Inventory. Items were translated in a culturally sensitive way by using forward-backward translation. Content validity was evaluated by using the content validity index. Ridit analysis and descriptive statistics helped to describe symptom experience in our population, and Mann Whitney U testing was used to compare patients versus healthy controls, depressed versus nondepressed patients, and male versus female patients for validity purposes. Split-half reliability analysis was used. RESULTS The content validity index was perfect (ie, value 1.0); the Turkish translation of the MTSOSD-59R had excellent known group validity. Split-half Spearman Brown corrected reliability coefficient was 0.991 for symptom occurrence and 0.992 for symptom distress. CONCLUSION The results suggest that the Turkish scale has appropriate language, content, and construct validity. This scale can now be used to assess the symptom experience related to immunosuppressive therapy in Turkish organ transplant recipients.
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Wang C, Wang G, Yi H, Tan J, Xu C, Fang X, Yang Y, Li H, Chen Q, Chen G. Symptom experienced three years after liver transplantation under immunosuppression in adults. PLoS One 2013; 8:e80584. [PMID: 24260427 PMCID: PMC3832465 DOI: 10.1371/journal.pone.0080584] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 10/04/2013] [Indexed: 01/12/2023] Open
Abstract
Background & Aims Immunosuppression-related symptom experience has not been covered thoroughly in long-term liver transplant recipients. The aim of this study was to assess the symptom experience of immunosuppressive therapy three years after liver transplantation and to correlate it with adherence to medications and sociodemographic or disease-related characteristics. Methods This study included 94 liver transplant recipients who had survived for more than 3 years after liver transplantation. Symptom experience was measured by the 59-Item Modified Transplant Symptom Occurrence and Symptom Distress Scale (MTSOSD-59R) at the outpatient visits. Adherence to immunosuppressive drugs was assessed using the Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS). Results Itching, concentration or memory problems, and fatigue were the three most frequent or most distressing symptoms. Factors significantly associated with a higher level of symptom frequency and distress were 3- to 5-year time cohort (i.e., time post-transplantation), and younger age. At the item level, concentration or memory problems were the most frequent and distressing symptoms in the 3- to 5-year time cohort. Itching was the most frequent and distressing symptom in the 5- to 9-year time cohort. Finally, relationship was found between symptom experience and nonadherence to immunosuppressive drugs. Conclusions Symptoms related to physical complaints or impairments were more often perceived and more distressing for liver transplant recipients 3 years after transplantation. Furthermore, the 3- to 5-year time cohort and younger age were associated with a higher degree of perceived symptom occurrence and symptom distress. Finally, recipients who perceived higher levels of symptom frequency and symptom distress reported higher levels of nonadherence.
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Affiliation(s)
- Chaoying Wang
- Nursing School, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Genshu Wang
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Huimin Yi
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jianling Tan
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Chi Xu
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaocui Fang
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yang Yang
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hua Li
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qier Chen
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- * E-mail: (QC); (GC)
| | - Guihua Chen
- School of Nursing, Sun Yat-sen University, Guangzhou, China
- * E-mail: (QC); (GC)
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21
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Stiefel P, Malehsa D, Bara C, Strueber M, Haverich A, Kugler C. Symptom experiences in patients after heart transplantation. J Health Psychol 2012; 18:680-92. [PMID: 22933576 DOI: 10.1177/1359105312454909] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patients' perceptions of immunosuppression-related symptom experience impact on quality of life and medication adherence. Using The Modified Transplant Symptom Occurrence and Symptom Distress Scale capturing items on symptom occurrence and symptom distress, 261 heart transplant recipients reported on their symptom experiences. Symptoms occurring with the highest prevalence were tiredness, lack of energy, and nervousness. Men showed erectile dysfunction causing the most distress. Women and younger patients reported significantly higher levels of symptom distress. Distress levels increased with time after transplant. Investigating responses to immunosuppression-related symptom experiences should help develop interventional methods to support long-term outcome.
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22
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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]
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23
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Prospective Changes in Health-Related Quality of Life and Emotional Outcomes in Kidney Transplantation over 6 Years. J Transplant 2011; 2011:671571. [PMID: 21822474 PMCID: PMC3142681 DOI: 10.1155/2011/671571] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 03/30/2011] [Accepted: 05/03/2011] [Indexed: 01/22/2023] Open
Abstract
Little is known on long-term outcomes in kidney transplantation. This study evaluated changes and predictors of generic and transplantation-specific health-related quality of life (HQoL) over six years in N = 102 kidney transplant survivors using the Short-form Health Survey-36 and the Transplant Effects questionnaire. Mixed models analysis was used to determine long-term outcomes. Emotional HQoL improved over time: Mental Component score, Mental Health, Energy (Ps = .000). Physical HQoL deteriorated: Physical Component Score (P = .001), Pain (P = .002). LRD transplant recipients had greater decline in physical functioning (P = .003) and PCS (P = .000) compared to cadaver recipients. Worry about the transplant (P = .036) and feelings of responsibility (P = .008) increased significantly over time. Worry about the transplant and perceived ability to work predicted 12.7% and 31.1% in variance in MCS and PCS, respectively. Efforts should be made to maintain HQoL and emotional outcomes with ongoing monitoring and support programs throughout the course of posttransplant care.
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Medikamentenbezogene Non-Adherence und Symptombelastungen nach Herztransplantation. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2011. [DOI: 10.1007/s00398-011-0834-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Impaired renal function is associated with worse self-reported outcomes after kidney transplantation. Qual Life Res 2011; 20:1689-98. [PMID: 21479956 DOI: 10.1007/s11136-011-9905-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2011] [Indexed: 01/05/2023]
Abstract
PURPOSE We sought to determine the association between health-related quality of life (HRQOL) and graft function in renal transplant recipients. DESIGN AND METHODS We enrolled 577 kidney transplant recipients aged 18-74 years (response rate 87%). Recipients with multiple or multi-organ transplantation, creatine kinase >200 U/L, acute renal failure or cellular rejection (n = 64), and without creatinine assessments in 3 months pre-enrollment (n = 127) were excluded. The questionnaire included Euro QOL 5 Dimensions (EQ-5D), Health Utility Index III (HUI-III), Kidney Disease Quality of Life-36 (KDQOL36) which include a generic section (RAND SF-12). Data on medical conditions, therapy regimens, and biochemistry results were extracted from clinical charts. We used general linear models adjusted for demographic, socioeconomic, and clinical characteristics to assess the association between HRQOL and severity of chronic kidney disease (CKD). RESULTS Patients with more advanced CKD were more likely to be African-American, covered by public insurance, more likely to have shorter time after transplantation, higher phosphorus and lower hemoglobin, serum albumin, and calcium levels. All HRQOL scales were inversely associated with CKD severity. All associations were robust to adjustment for possible confounders. CONCLUSIONS Several health-related quality of life dimensions may be affected by poor renal function after transplantation.
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26
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Majernikova M, Prihodova L, Rosenberger J, Nagyova I, Roland R, Groothoff JW, van Dijk JP. Factors associated with self-rated health after kidney transplantation: a prospective study. Am J Nephrol 2011; 33:364-9. [PMID: 21447943 DOI: 10.1159/000326336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 02/21/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND This prospective study explores and compares the relationship between patients' self-rated health (SRH) after kidney transplantation (KT) at different follow-up periods and its medical and nonmedical predictors over time. METHODS Patients (n = 128) who completed a questionnaire (the SRH question of the SF-36 and the End-Stage Renal Disease Symptom Checklist - Transplantation Module) were enrolled. Clinical data were retrieved from medical files. The sample was stratified into early (n = 89) and late (n = 39) cohorts according to time since KT at baseline. Linear regression was used to identify predictors of SRH at follow-up. RESULTS In both cohorts, a change in glomerular filtration rate (GFR) over time remained a predictor of SRH; in the early cohort, age was an additional predictor; in the late cohort, a change in transplantation-associated psychological distress over time and the number of late acute rejection episodes during the observation period were additional predictors. CONCLUSIONS Improvement in GFR over time predicted better SRH at each period after KT. Decreased transplantation-associated psychological distress and fewer late acute rejection episodes seemed to predict better SRH at a later follow-up period. Despite these observations, higher SRH was associated with better clinical outcomes.
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Affiliation(s)
- Maria Majernikova
- Nephrology and Dialysis Centre, Fresenius Medical Care, Kosice, Slovakia.
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Griva K, Jayasena D, Davenport A, Harrison M, Newman SP. Illness and treatment cognitions and health related quality of life in end stage renal disease. Br J Health Psychol 2011; 14:17-34. [DOI: 10.1348/135910708x292355] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Korb-Savoldelli V, Sabatier B, Gillaizeau F, Guillemain R, Prognon P, Bégué D, Durieux P. Non-adherence with drug treatment after heart or lung transplantation in adults: a systematic review. PATIENT EDUCATION AND COUNSELING 2010; 81:148-54. [PMID: 20627643 DOI: 10.1016/j.pec.2010.04.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 04/06/2010] [Accepted: 04/06/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Heart or lung transplantation is a complex intervention requiring medication adherence. The objective of this systematic review is to estimate the prevalence of non-adherence (NA) with post-transplantation medication in heart or lung recipients and to assess its clinical impact. We examined in the selected studies if the authors considered the patient's perspective in their evaluations. METHODS The electronic database MEDLINE, EMBASE and The Cochrane Central Register were searched. Only studies that reported the number of non-adhere subjects were eligible. The different methods of measurement, the ways in which authors defined NA and if authors had integrated patient's perspective in their secondary objectives were also assessed. RESULTS The range frequency of NA was 1-42.9% for all drugs. Non-adherent patients tend to experience worse outcomes compared to adherent patients. The patient's perception of drug side-effects is the most reported patient-related factor for impairing adherence. CONCLUSION NA after heart or lung transplantation is an important issue and concerns not only immunosuppressant treatments. The main striking point of the selected studies is the lack of patient perspective and the omission of patients-healthcare providers' relationship. PRACTICE IMPLICATIONS Future research must focus on patients' motivation for the medication-taking behaviour.
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Affiliation(s)
- V Korb-Savoldelli
- Pharmacy Department, AP-HP Georges Pompidou European Hospital, Paris, France.
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29
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Health-related quality of life of patients receiving low-toxicity immunosuppressive regimens: a substudy of the Symphony Study. Transplantation 2009; 87:1210-3. [PMID: 19384168 DOI: 10.1097/tp.0b013e31819ec41f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate health-related quality of life (HRQoL) in patients with different low-toxicity regimens posttransplantation. METHODS One hundred fifty-six patients were randomized to standard-dose cyclosporine A (CsA), mycophenolate mofetil, and corticosteroids or daclizumab induction, mycophenolate mofetil, and corticosteroids with a low dose of CsA, tacrolimus (Low-Tac), or sirolimus. SF-36 Health survey was completed at baseline, 3, 6, and 12 months. RESULTS There were no differences between groups in SF-36 at baseline or at month 12. Low-Tac showed higher scores at month 3 than standard-dose CsA and low dose of CsA. Patients with serum creatinine less than or equal to 1.5 mg/mL had better HRQoL at 6 and 12 months. Proportion of these patients was higher in Low-Tac at 6 months. Physical component summary of Patients increased during follow-up, but mental component summary did not. Patients with acute rejection showed lower mental component summary at 6 months. CONCLUSIONS No HRQoL differences were identified among groups, but the low-dose Tac group showed the fastest improvement.
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Kugler C, Geyer S, Gottlieb J, Simon A, Haverich A, Dracup K. Symptom experience after solid organ transplantation. J Psychosom Res 2009; 66:101-10. [PMID: 19154852 DOI: 10.1016/j.jpsychores.2008.07.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 07/08/2008] [Accepted: 07/29/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Understanding patients' perceptions and responses to immunosuppression-related symptom experiences following solid organ transplantation increases the likelihood that interventions can be designed to support long-term graft survival. METHODS This review summarizes and integrates evidence on transplant patients' symptom experiences related to immunosuppression side-effects in terms of symptom occurrence and symptom distress and other aspects of posttransplant treatment regimen. Empirical data of 18 reports on symptom experiences published between 1981 and April 2008 have been analyzed systematically. This report is organized to address the following areas of findings: (1) overview about instruments to assess symptom experiences, (2) descriptive information concerning symptom occurrence and related distress, (3) potential impact of symptom experiences on patient adherence, and (4) review of evidence between symptom experiences and health outcomes in terms of health-related quality of life (HRQoL). RESULTS Symptom experience scores remain high among all types of solid organ transplantation including kidney, liver, heart, and lung transplant, with no patterns related to symptom occurrence and distress. "Female gender" is consistently related to higher levels of symptom occurrence and symptom distress. Understanding the patients' appraisal of symptoms and side-effects related to the immunosuppressive therapy is a key to step forward by developing strategies to (1) reducing nonadherence triggered by symptom occurrence and distress, (2) decreasing non-adherence-related rejection, and (3) improving HRQoL by tailored symptom management. CONCLUSION As many side-effects are related to particular immunosuppressive drugs and dosages, a more in-depth understanding of the relationships among the concepts of symptom experience, nonadherence, and HRQoL may guide clinical decision making in the future.
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Affiliation(s)
- Christiane Kugler
- Department of Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
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31
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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.
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Affiliation(s)
- Rebecca J Muehrer
- Section of Nephrology, Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
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Abstract
BACKGROUND The determination of optimal tacrolimus (TAC) trough levels is needed to prevent adverse effects of calcineurin inhibitors. METHODS Stable transplant recipients currently receiving cyclosporine (CsA) were assigned randomly (1:1:1) to continue CsA (target trough level of 50-250 ng/mL); or convert to "reduced" TAC (target trough level 3.0-5.9 ng/mL) or "standard" TAC (target trough level 6.0-8.9 ng/mL). RESULTS At 12 months, there was a significant improvement in renal function in the reduced TAC versus CsA group with lower serum creatinine (P=0.004) and cystatin C (P<0.001), and higher estimated creatinine clearance (P=0.017). However, there were no statistically significant differences in any renal parameter in the standard TAC versus CsA group. Total and low-density lipoprotein cholesterol were significantly reduced in both TAC groups versus the CsA group (P<0.001). Patient and graft survival and episodes of biopsy-confirmed acute rejection were similar for all treatment groups, and no statistically significant differences were observed between groups in the incidence of new-onset diabetes or cardiac conditions, or in the prevalence of hyperglycemia, hypertension, or hyperlipidemia among patients who did not have these conditions at baseline. Alopecia developed more commonly among TAC-treated patients than CsA-treated patients (P<0.001). CONCLUSIONS Compared with CsA continuation, conversion to reduced TAC target trough concentrations resulted in significantly improved renal function without increasing the risk of rejection. Conversion to TAC, regardless of target concentration, resulted in improved serum lipid profiles in kidney transplant recipients at 12 months.
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Dobbels F, Moons P, Abraham I, Larsen CP, Dupont L, De Geest S. Measuring symptom experience of side-effects of immunosuppressive drugs: the Modified Transplant Symptom Occurrence and Distress Scale. Transpl Int 2008; 21:764-73. [PMID: 18435683 DOI: 10.1111/j.1432-2277.2008.00674.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Measurement of the patients' subjective experience of side-effects of immunosuppressants is a critical post-transplant outcome. This study aimed to update and validate the 45-item Modified Transplant Symptom Occurrence and Symptom Distress Scale (MTSOSD) for novel immunosuppressive regimens. We used four steps: (1) literature review to identify immunosuppressant-related symptoms; (2) screening of adverse event forms; (3) international experts' evaluation of the appropriateness of each symptom; and (4) a pilot study in 24 renal transplant patients to test the clarity of instructions and items, and a pilot study in 84 lung transplant patients, to determine content and discriminant validity. Steps 1 and 2 produced a list of 76 symptoms. Clinical experts deemed 59 symptoms as being relevant for assessing symptom experience (step 3). Based on the first pilot testing, items and instructions were adapted to improve clarity. The second pilot testing showed that the updated MTSOSD-59R was easy to complete, that items and instructions were understandable, and that symptom profiles differed between males and females, and between depressed and nondepressed patients (step 4). The MTSOSD-59R is an instrument with established content and discriminant validity for assessing transplant patients' symptom experience of side-effects stemming from currently available immunosuppressive regimens.
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Affiliation(s)
- Fabienne Dobbels
- Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium.
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Kugler C, Fischer S, Gottlieb J, Tegtbur U, Welte T, Goerler H, Simon A, Haverich A, Strueber M. Symptom experience after lung transplantation: impact on quality of life and adherence. Clin Transplant 2007; 21:590-6. [PMID: 17845632 DOI: 10.1111/j.1399-0012.2007.00693.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients' perceptions of immunosuppression- related symptom experience may impact on quality of life (QoL) and medication adherence. METHODS A total of 308 lung transplant recipients were screened for study inclusion. Two hundred eighty-seven patients (response rate 93%) completed a 91-item questionnaire consisting of subscales focusing on symptom experiences (frequency and distress), and adherence. QoL was assessed by a 40-item standardized instrument. Impact of symptom experiences on QoL and adherence were assessed. Potential determinants of immunosuppression induced symptom experiences were evaluated. RESULTS The most frequent reported symptoms were tremor (70%) and hirsutism (68.1%), whereas Cushingoid appearance (38.6%) and muscle weakness (31.9%) appeared to be the most distressing symptoms. Women (p < 0.001) and younger patients (<40 yr; p < 0.0001) reported a significantly higher level of symptom experience compared with their counterparts respectively. Symptom experiences negatively influenced QoL in all dimensions (p < 0.006). Those who described experiencing adverse effects reported significantly more "drug holidays" (p < or = 0.004) compared with those reporting minor frequent adverse effects. Patients' self-reported strategies to reduce adverse effects were to postpone medication intake (30%), to drop doses (8%), or to reduce doses (9%). CONCLUSIONS This study establishes a relationship between patients' perceptions of immunosuppression-related symptom experiences and the impact on QoL and adherence. Immunosuppression is accompanied by significant adverse effects in both symptom frequency and distress. Most frequently experienced symptoms do not necessarily have the greatest impact on perceived distress, and vice versa. High levels of adverse effects tend to negatively influence patients' QoL and adherence. Future research is required to understand the relationship of these complex variables.
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Affiliation(s)
- Christiane Kugler
- Hannover Thoracic Transplant Program, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
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Chisholm MA, Spivey CA, Mulloy LL. Effects of a medication assistance program with medication therapy management on the health of renal transplant recipients. Am J Health Syst Pharm 2007; 64:1506-12. [PMID: 17617501 DOI: 10.2146/ajhp060634] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The effects of a medication assistance program with medication therapy management (MTM) on the clinical outcomes and health-related quality of life (HQOL) of renal transplant recipients were studied. METHODS All renal transplant recipients who were enrolled in the Medication Access Program at the Medical College of Georgia for at least one year were included in the study. Patients' demographics, number of graft rejections (for one year pre-enrollment and one year post-enrollment), and diagnoses of hypertension, diabetes, and dyslipidemia were recorded and confirmed by medical and pharmacy records. The use of antihypertensive, antidiabetic, antilipemic, and immunosuppressant agents and laboratory values for fasting blood glucose, glycosylated hemoglobin (HbA(1c)), blood pressure, low-density-lipoprotein (LDL) cholesterol, total cholesterol, triglycerides, and serum immunosuppressant concentrations were identified for one year pre-enrollment and one year post-enrollment. HQOL was measured at the time of enrollment and one year post-enrollment. RESULTS Thirty-six adult renal transplant recipients were included in the study. All patients had hypertension, 72% had dyslipidemia, and 42% had diabetes. Patients received significantly more antihypertensive agents post-enrollment versus pre-enrollment (p < 0.001) and significantly more antidiabetic agents (p = 0.004) and antilipemics (p = 0.001). Measures of fasting blood glucose, glycosylated hemoglobin, LDL cholesterol, total cholesterol, triglycerides, blood pressure, and number of graft rejections decreased from pre-enrollment levels (p < 0.01). A significantly greater number of patients reached target serum cyclosporine levels post-enrollment versus pre-enrollment (p = 0.008). HQOL was significantly increased one year post-enrollment (p < 0.01). CONCLUSION A medication assistance program that included MTM services improved medication access, clinical outcomes, and HQOL in renal transplant recipients.
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Affiliation(s)
- Marie A Chisholm
- Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ 85750, USA.
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Ortega F, Valdés C, Ortega T. Quality of life after solid organ transplantation. Transplant Rev (Orlando) 2007. [DOI: 10.1016/j.trre.2007.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Ito D, Ibanez C, Ogawa H, Franklin RJM, Jeffery ND. Comparison of cell populations derived from canine olfactory bulb and olfactory mucosal cultures. Am J Vet Res 2007; 67:1050-6. [PMID: 16740101 DOI: 10.2460/ajvr.67.6.1050] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the numbers and proportions of olfactory ensheathing cells (OECs) in cell cultures derived from the olfactory bulb (OB) and olfactory mucosa of dogs. ANIMALS 7 dogs. PROCEDURES OB tissue and olfactory mucosa from the nasal cavity and frontal sinus were obtained from euthanatized dogs and prepared for cell culture. At 7, 14, and 21 days of culture in vitro, numbers and proportions of OECs, astrocytes, and fibroblasts were determined via immunocytochemistry. Antibody against the low-affinity nerve growth factor receptor p75 was used to identify OECs, antibody against glial fibrillary acidic protein was used to identify astrocytes, and antibody against fibronectin was used to identify fibroblasts. RESULTS Cultured OECs derived from the olfactory mucosa of the nasal cavity and frontal sinus had similar characteristics. However, whereas OECs in the OB cell cultures constituted approximately 50% of the cells at 7 days and approximately 75% at 21 days the proportion of OECs in cultures derived from both mucosal types was much lower, with approximately 40% OECs at 7 days and approximately 25% at 21 days. Analysis of OEC numbers revealed that these changes were accompanied by corresponding decreases and increases in the population of cells with fibronectin receptors. CONCLUSIONS AND CLINICAL RELEVANCE Although olfactory mucosal cell cultures yielded a sufficient number of OECs for spinal cord transplantation procedures in dogs, modification of culture conditions would be required to ensure that the derived cell population contained a sufficient proportion of OECs.
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Affiliation(s)
- Daisuke Ito
- Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK
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Chisholm MA, Spivey CA, Nus AV. Influence of economic and demographic factors on quality of life in renal transplant recipients. Clin Transplant 2007; 21:285-93. [PMID: 17425759 DOI: 10.1111/j.1399-0012.2007.00640.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The purpose of this study was to determine the influence of annual income, Medicare status, and demographic variables on the health-related quality of life (HQoL) of renal transplant recipients. METHODS A cross-sectional survey was mailed to 146 Georgia renal transplant recipients who had functional grafts. Data were collected using the SF-12 Health Survey (version 2), a demographics survey, and 2003 tax documents. One-way ANOVAs and Pearson's R correlations were used to examine relationships between annual income, Medicare status, demographic variables and SF-12 scores. Significant variables were included in stepwise multiple regression analyses. RESULTS Data from 130 participants (89% response rate) were collected. Recipients with no Medicare coverage had significantly higher scores on the Physical Functioning and Role Physical SF-12 scales (p = 0.005) compared to recipients with Medicare. Annual income was positively correlated with General Health (p < 0.05). Age and race were significant predictors of Vitality (p = 0.004) and Physical Component Summary (p < 0.001) scores. Age, race, and Medicare status were significant predictors of Physical Functioning and Role Physical scores (p < 0.001). Age, annual income, race, and years post-transplant were significant predictors of General Health score (p < 0.001). Age was the sole predictor of Bodily Pain score (p = 0.002), and marital status was the sole predictor of Social Functioning score (p = 0.005). CONCLUSIONS Interventions designed to offset financial barriers may be needed to bolster renal transplant recipients' HQoL.
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Affiliation(s)
- Marie A Chisholm
- Pharmacy Practice and Science, University of Arizona College of Pharmacy, USA.
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Affiliation(s)
- Matthew Jose
- Department of Nephrology, Royal Hobart Hospital, Hobart TAS 7000, Australia.
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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.
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Affiliation(s)
- Irina Cleemput
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium.
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Rosenberger J, van Dijk JP, Nagyova I, Zezula I, Geckova AM, Roland R, van den Heuvel WJA, Groothoff JW. Predictors of Perceived Health Status in Patients after Kidney Transplantation. Transplantation 2006; 81:1306-10. [PMID: 16699459 DOI: 10.1097/01.tp.0000209596.01164.c9] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients after kidney transplantation have decreased mortality, morbidity and better quality of life compared to people on dialysis. Major efforts are being directed towards research into graft and patient survival. Research into quality of life is less intensive. The aim of this study was to explore the predictors of perceived health status (PHS) in kidney transplant recipients. METHODS Out of 218 patients after kidney transplantation 138 participated in the study. Linear regression analysis was performed to predict PHS, measured with the SF-36 questionnaire, in three age categories (<40, 40-59, >or=60 years). Independent variables included social support (measured with the Social Support List Discrepancies questionnaire), sociodemographic and medical variables, side effects and compliance. RESULTS Predictors of better PHS in patients<40 years were better social support (P<or=0.001), lower creatinine (P<or=0.001) and lower stress from adverse effects (P<or=0.001). In the group of patients aged 40-59 years higher education (P<or=0.05), increased housekeeping activities (P<or=0.01) and lower stress from adverse effects (P<or=0.001) predicted better PHS. In the last age group predictors of better PHS were lower rate of dialysis (P<or=0.05) and posttransplant hospitalizations (P<or=0.01), absence of diabetes mellitus (P<or=0.01) and lower stress from adverse effects (P<or=0.05). CONCLUSIONS Major differences exist in PHS among kidney transplant recipients depending on their age. Side effects of therapy are the most important predictor of PHS for all age groups. PHS of young patients mostly depends on their renal function and their social support. Education and working activities are most important for middle-aged people whereas in older patients PHS is mostly affected by comorbidity.
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Affiliation(s)
- Jaroslav Rosenberger
- Nephrology and Dialysis Center, and Transplantation Department, University Hospital, Kosice, Slovak Republic.
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Habwe VQ. Posttransplantation Quality of Life: More Than Graft Function. Am J Kidney Dis 2006; 47:S98-110. [PMID: 16567244 DOI: 10.1053/j.ajkd.2005.12.041] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Accepted: 12/09/2005] [Indexed: 11/11/2022]
Abstract
Whereas newer immunosuppressive therapies have increased patient and graft survival, long-term treatment with these drugs has been linked to medical and physical complications that may impact on posttransplantation quality of life. Immunosuppression-related physical side effects that can alter appearance--including hirsutism, gingival hyperplasia, weight gain, cushingoid facies, hand tremors, alopecia, and skin disorders--are among the most bothersome to patients and may have serious psychosocial implications. In addition, physical side effects may influence patient adherence to their prescribed treatment regimens and result in more serious complications, such as acute rejection, graft loss, rehospitalization, and even mortality. Therefore, strategies for minimizing side effects of immunosuppressive therapy and improving medication adherence are integral to better long-term transplant recipient management.
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Affiliation(s)
- Violet Q Habwe
- Washington Nephrology Associates, Washington, DC 20037, USA.
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Jeffery ND, Smith PM, Lakatos A, Ibanez C, Ito D, Franklin RJM. Clinical canine spinal cord injury provides an opportunity to examine the issues in translating laboratory techniques into practical therapy. Spinal Cord 2006; 44:584-93. [PMID: 16520817 DOI: 10.1038/sj.sc.3101912] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
STUDY DESIGN Review. OBJECTIVES To highlight the value of investigating the effects of putative therapeutic interventions in clinical spinal cord injury (SCI) in domestic dogs. SETTING England, UK. METHODS Many experimental interventions in laboratory rodents have been shown to ameliorate the functional deficits caused by SCI; the challenge now is to determine whether they can be translated into useful clinical techniques. Important differences between clinical SCI in human patients and that in laboratory rodents are in the size of the spinal cord and heterogeneity of injury severity. A further key issue is whether the statistical difference in outcome in the laboratory will translate into a useful difference in clinical outcome. Here, we stress the value of investigating the effects of putative therapies in clinical SCI in domestic dogs. The causes of injury, ability to categorise the severity and methods available to measure outcome are very similar between canine and human patients. Furthermore, postmortem tissue more rapidly becomes available from dogs because of their short lifespan than from human patients. RESULTS The role that investigation of canine SCI might play is illustrated by our preliminary trials on intraspinal transplantation of olfactory glial cells for severe SCI. CONCLUSIONS This canine translational model provides a means of 'filtering' putative treatments before human application.
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Affiliation(s)
- N D Jeffery
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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Politi P, Piccinelli M, Fusar-Poli P, Poli PF, Klersy C, Campana C, Goggi C, Viganò M, Barale F. Ten years of "extended" life: quality of life among heart transplantation survivors. Transplantation 2004; 78:257-63. [PMID: 15280687 DOI: 10.1097/01.tp.0000133537.87951.f2] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Long-term quality of life (QOL) outcome in heart transplant recipients still remains uncertain. This study evaluates the health status and QOL of survivors with associated predictors 10 years after heart transplantation. PATIENTS AND METHODS A total of 276 patients who underwent heart transplantation in the Department of Cardiac Surgery, University of Pavia, between 1985 and 1992 were included in a cross-sectional study. Patients still alive 10 years after transplantation (n=122) were asked to complete the SF36 questionnaire and then received a full clinical examination. All QOL instruments that were used had acceptable reliability and validity. Descriptive statistics, Kaplan-Meier estimate, correlation coefficients, and general linear regression were used to analyze the data. RESULTS Survival rates 1, 5, and 10 years after transplantation were 87%, 77%, and 57%, respectively, and the average life expectancy was 9.16 years. The mental QOL of patients 10 years after heart transplantation was similar to that among the general population. The physical QOL was worse among patients when compared with the QOL of the general population, with predictors including older age, being married, the presence of complications, and impaired renal function. CONCLUSIONS Heart transplantation ensures a relatively high QOL even 10 years after surgery. Predictors of a poor QOL were determined, which may help to identify those patients for whom a poor outcome is likely so treatment can be tailored accordingly.
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Affiliation(s)
- Pierluigi Politi
- DSSAeP, Sezione di Psichiatria, Università di Pavia and Servizio Psichiatrico di Diagnosi e Cura, IRCCS Policlinico San Matteo-Pavia, 27100 Pavia, Italy.
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Streat S. Clinical review: moral assumptions and the process of organ donation in the intensive care unit. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2004; 8:382-8. [PMID: 15469581 PMCID: PMC1065007 DOI: 10.1186/cc2876] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of the present article is to review moral assumptions underlying organ donation in the intensive care unit. Data sources used include personal experience, and a Medline search and a non-Medline search of relevant English-language literature. The study selection included articles concerning organ donation. All data were extracted and analysed by the author. In terms of data synthesis, a rational, utilitarian moral perspective dominates, and has captured and circumscribed, the language and discourse of organ donation. Examples include "the problem is organ shortage", "moral or social duty or responsibility to donate", "moral responsibility to advocate for donation", "requesting organs" or "asking for organs", "trained requesters", "pro-donation support persons", "persuasion" and defining "maximising donor numbers" as the objective while impugning the moral validity of nonrational family objections to organ donation. Organ donation has recently been described by intensivists in a morally neutral way as an "option" that they should "offer", as "part of good end-of-life care", to families of appropriate patients. In conclusion, the review shows that a rational utilitarian framework does not adequately encompass interpersonal interactions during organ donation. A morally neutral position frees intensivists to ensure that clinical and interpersonal processes in organ donation are performed to exemplary standards, and should more robustly reflect societal acceptability of organ donation (although it may or may not "produce more donors").
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Affiliation(s)
- Stephen Streat
- Department of Critical Care Medicine, Auckland Hospital, New Zealand.
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Abstract
Despite a different molecular structure and biochemical properties, cyclosporine and tacrolimus--by inhibiting calcineurin activity--have been shown in the previous two decades of solid organ transplantation to be well tolerated and effective immunosuppressants. Initial randomized clinical trials showed a lower incidence of acute rejection in tacrolimus than in cyclosporine-treated patients, in combination with steroids and azathioprine. But in conjunction with mycophenolate mofetil, the difference in the incidence of acute rejection episodes is less clear. In general, short- and medium-term outcome variables (1-year serum creatinine, graft and patient survival) with cyclosporine and tacrolimus are excellent, and (almost) identical, with both substances having the same intrinsic nephrotoxic potential. On the other hand, cyclosporine and tacrolimus have a different impact on cardiovascular risk factors with tacrolimus having a better profile on arterial tension and lipid metabolism and cyclosporine on glucose metabolism. However, at present no data are available to discern that these differences in risk profile alter patient or graft survival or long-term cardiovascular morbidity/mortality. Therefore, prospective long-term trials are needed to study the quantitative impact of different immunosuppressive agents and concomitant cardiovascular risk factors on long-term patient and graft survival, before evidence-based (patient, graft, or cardiovascular) risk reduction can be firmly claimed by tailoring calcineurin inhibitors.
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Affiliation(s)
- B D Maes
- Department of Medicine, Division of Nephrology, University Hospital Gasthuisberg, Leuven, Belgium.
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