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Fouda A, Maallah MT, Kouyoumdjian A, Negi S, Paraskevas S, Tchervenkov J. RORγt inverse agonist TF-S14 inhibits Th17 cytokines and prolongs skin allograft survival in sensitized mice. Commun Biol 2024; 7:454. [PMID: 38609465 PMCID: PMC11014929 DOI: 10.1038/s42003-024-06144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
Chronic antibody mediated rejection (AMR) is the major cause of solid organ graft rejection. Th17 contributes to AMR through the secretion of IL17A, IL21 and IL22. These cytokines promote neutrophilic infiltration, B cell proliferation and donor specific antibodies (DSAs) production. In the current study we investigated the role of Th17 in transplant sensitization. Additionally, we investigated the therapeutic potential of novel inverse agonists of the retinoic acid receptor-related orphan receptor gamma t (RORγt) in the treatment of skin allograft rejection in sensitized mice. Our results show that RORγt inverse agonists reduce cytokine production in human Th17 cells in vitro. In mice, we demonstrate that the RORγt inverse agonist TF-S14 reduces Th17 signature cytokines in vitro and in vivo and leads to blocking neutrophilic infiltration to skin allografts, inhibition of the B-cell differentiation, and the reduction of de novo IgG3 DSAs production. Finally, we show that TF-S14 prolongs the survival of a total mismatch grafts in sensitized mice. In conclusion, RORγt inverse agonists offer a therapeutic intervention through a novel mechanism to treat rejection in highly sensitized patients.
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Affiliation(s)
- Ahmed Fouda
- Division of Surgical and Interventional Sciences, Department of Surgery, McGill University, Montréal, QC, H3G 1A4, Canada.
- Research Institute of the McGill University Health Centre, Montréal, QC, H3H 2R9, Canada.
- McGill University Health Centre, Montréal, QC, H4A 3J1, Canada.
| | - Mohamed Taoubane Maallah
- Division of Surgical and Interventional Sciences, Department of Surgery, McGill University, Montréal, QC, H3G 1A4, Canada
- Research Institute of the McGill University Health Centre, Montréal, QC, H3H 2R9, Canada
- McGill University Health Centre, Montréal, QC, H4A 3J1, Canada
| | - Araz Kouyoumdjian
- Research Institute of the McGill University Health Centre, Montréal, QC, H3H 2R9, Canada
- McGill University Health Centre, Montréal, QC, H4A 3J1, Canada
- Division of General Surgery, Department of Surgery, McGill University, Montréal, QC, H3G 1A4, Canada
| | - Sarita Negi
- Research Institute of the McGill University Health Centre, Montréal, QC, H3H 2R9, Canada
| | - Steven Paraskevas
- Division of Surgical and Interventional Sciences, Department of Surgery, McGill University, Montréal, QC, H3G 1A4, Canada
- Research Institute of the McGill University Health Centre, Montréal, QC, H3H 2R9, Canada
- McGill University Health Centre, Montréal, QC, H4A 3J1, Canada
- Division of General Surgery, Department of Surgery, McGill University, Montréal, QC, H3G 1A4, Canada
| | - Jean Tchervenkov
- Division of Surgical and Interventional Sciences, Department of Surgery, McGill University, Montréal, QC, H3G 1A4, Canada.
- Research Institute of the McGill University Health Centre, Montréal, QC, H3H 2R9, Canada.
- McGill University Health Centre, Montréal, QC, H4A 3J1, Canada.
- Division of General Surgery, Department of Surgery, McGill University, Montréal, QC, H3G 1A4, Canada.
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Davis SO, Zubair A, Igbokwe M, Abu M, Chiedozie CA, Sanni Q, Jesuyajolu D. A Scoping Review of Kidney Transplantation in Africa: How Far have We Come? World J Surg 2023; 47:2113-2123. [PMID: 37160654 DOI: 10.1007/s00268-023-07042-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Kidney transplantation is a life-saving treatment for end-stage kidney disease (ESKD) patients. However, access to this treatment in Africa lags behind other regions, leading to significant disparities in care. We aimed to analyse the indications, demographics, and outcomes of kidney transplantation in Africa. METHOD We conducted a systematic review of studies from PubMed, Google Scholar, and African Journal Online using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We pooled and analysed data on procedure type, graft outcomes, donor type, prophylaxis, post-operative complications, and survival from 33 eligible studies. RESULT The most common causes of ESKD requiring transplantation were glomerulonephritis and nephroangiosclerosis. Open nephrectomy was the predominant surgical approach (95%). Living donors accounted for 56.3% (4221) of all donors, with 68.5% being related to the recipient. Cadaveric donors accounted for 43.7% (3280) of transplants. Graft rejection was the most common surgical complication (39.44%), and 60.49% of patients developed hypertension in the follow-up period. CONCLUSION Our study highlights the potential of kidney transplantation to improve the lives of ESKD patients in Africa. However, further research and infrastructure development are necessary to make this treatment more widespread and successful.
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Affiliation(s)
| | | | - Martin Igbokwe
- Urology, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Moses Abu
- Urology, Surgery Interest Group of Africa, Lagos, Nigeria
| | | | - Quadri Sanni
- Urology, Surgery Interest Group of Africa, Lagos, Nigeria
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Navarro-González A, Arreola-Gutiérrez M, Barrera-De León JC, Calderón-Alvarado AB, Becerra-Moscoso MR. Why Do Not All Living Kidney Donor Candidates Are Accepted for Donation? A Pediatric Center Experience. Transplant Proc 2023; 55:1469-1472. [PMID: 36948962 DOI: 10.1016/j.transproceed.2023.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/07/2023] [Accepted: 02/20/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Living donor kidney transplantation is the best type of renal replacement therapy for patients with end-stage renal disease. Living kidney donors (LKDs) undergo an extensive evaluation before donating, and many potential LKDs are declined. This study aimed to define the reasons for the decline in LKD candidates referred to our center. METHODS We retrospectively analyzed clinical data of all potential LKDs evaluated between January 2001 and December 2021 at our institution,Western National Medical Center, Pediatric Hospital. Data were obtained by review of an electronic database. RESULTS A total of 1332 potential LKDs were evaluated, 796 (59.7%) successfully donated; 20 (1.5%) had a complete evaluation, were accepted for donation, and were on the waiting list for intervention; 56 (4.2%) continued in the evaluation process; 200 (15%) were discharged from the program due to administrative aspects, death (donor or receptor), or cadaveric renal transplantation in order of frequency; 56 (4.2%) withdraw by personal choice; and 204 (15.3%) were rejected for donation. Donor-related reasons included medical contraindications (n = 134, 65.7%), anatomic contraindications (n = 38, 18.6%), immunologic barriers (n = 18, 8.8%), and psychological reasons (n = 11, 5.4%). CONCLUSIONS Despite the large number of potential LKDs, a significant proportion did not proceed for donation for different reasons; in our description, it represents 40.3%. The largest proportion is because of donor-related causes, and most of the reasons result from the candidate's unnoticed chronic diseases.
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Affiliation(s)
- Alfonso Navarro-González
- Transplant - Urology and Nephrology Department, Pediatric Hospital, Western National Medical Center, Mexican Social Security Institute, Guadalajara, Mexico
| | - Monserrat Arreola-Gutiérrez
- Transplant - Urology and Nephrology Department, Pediatric Hospital, Western National Medical Center, Mexican Social Security Institute, Guadalajara, Mexico
| | - Juan Carlos Barrera-De León
- Research and Teaching Department, Pediatric Hospital, Western National Medical Center, Mexican Social Security Institute, Guadalajara, Mexico
| | - Ana B Calderón-Alvarado
- and Pediatric Surgery Department, Pediatric Hospital, Western National Medical Center, Mexican Social Security Institute, Guadalajara, Mexico.
| | - Mitzi R Becerra-Moscoso
- and Pediatric Surgery Department, Pediatric Hospital, Western National Medical Center, Mexican Social Security Institute, Guadalajara, Mexico
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Gunawardena T, Ridgway D. Transplant Nephrectomy: Current Concepts. Saudi J Kidney Dis Transpl 2022; 33:716-725. [PMID: 37955463 DOI: 10.4103/1319-2442.389431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
Kidney transplantation is the gold standard treatment option for patients with endstage kidney disease. As the number of waitlisted patients increases, the gap between supply and demand for suitable donor kidneys keeps widening. The adoption of novel strategies that expand the donor pool has attenuated this issue to a certain degree, and this has led to a progressive increase in the number of annual transplants performed. As transplanted kidneys have a finite lifespan, there is a reciprocal rise in the number of patients who return to dialysis once their allograft fails. The clinicians involved in the management of such patients are left with the problem of managing the nonfunctioning allograft. The decision to undertake transplant nephrectomy (TN) in these patients is not straightforward. Allograft nephrectomy is a procedure that is associated with significant morbidity and mortality. It will have implications for the outcomes of the subsequent transplant. In this review, we aimed to compressively discuss the indications, techniques, and outcomes of TN, which is an integral component of the management of a failing allograft.
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Affiliation(s)
- Thilina Gunawardena
- Department of Renal Transplant, Royal Liverpool University Hospital, Liverpool, United Kingdom
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5
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Abu S, Asaolu SO, Igbokwe MC, Olatise OO, Obiatuegwu K, Onwuasoanya UE, Adetunbi AR. Bacterial Colonization in Double J Stent and Bacteriuria in Post-Renal Transplant Patients. Cureus 2022; 14:e27508. [PMID: 36060333 PMCID: PMC9426638 DOI: 10.7759/cureus.27508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 11/08/2022] Open
Abstract
Background and objective Urinary tract infections (UTI) in kidney transplant recipients can cause significant morbidity and negatively impact both, graft and patient survival. Ureteric stenting in renal transplantation is aimed at reducing the risks of complications like ureteric leak and stenosis. Ureteric stents are not without their potential complications which may include UTI. We aimed to compare urine bacteriology and bacterial colonization of DJ stent following kidney transplantation, and to establish antimicrobial susceptibility to guide the choice of empirical antibiotics in the event of UTI in post-transplant patients with DJ stent. Materials and methods This was a prospective study carried out over a year period (February 2020 to January 2021). Eighty post-renal transplant patients with indwelling ureteral stents were recruited for the study. An early morning midstream urine sample was taken for analysis from consenting patients that met the inclusion criteria. All stents were removed via rigid cystoscopy and the distal end of the stent (4cm) was cut off and put in a sterile bottle for microbiological analysis. Sensitivity and resistance were tested against a panel of 19 antibiotics on all microbial isolates. Results were considered statistically significant when p < 0.05. Results The mean age of the patients was 47.9+ 12.1 years. Male patients were 60 (75%) while 20 (25%) were females. Fifty-one (52%) patients had hypertension while 25 (26%) had diabetes mellitus. Hypertension and diabetes were noted in 20 (21%) patients while only one patient (1%) had HCV. Prior to renal transplantation, patients had negative urine cultures. The majority of the patients (76, 95%) had their stent retrieved after 4 weeks, 2 (2.5%) of them had stents retrieved after 2 weeks, and 2 (2.5%) had stents retrieved after 8 weeks. There was a significant association between the duration of stent and stent colonization (p=0.031). No organism was cultured in both the urine and stent in 13 (14.4%) patients. Nine (10%) had positive stent culture with a negative urine culture while 5 (5.6%) had positive urine culture with a negative stent culture. The same organism was noted in both urine and stent in 58 (64.4%) of patients while different organisms were cultured in 5 (5.6%) of the patients. Escherichia coli was the most common organism cultured in the urine of 38 (65.5%) patients and 36 (58.1%) stents, respectively. The sensitivity pattern shows that the organisms were more susceptible to nitrofurantoin and gentamicin, and resistant to tetracycline and ceftriaxone. Tigecycline showed good susceptibility and poor resistance. Conclusion This study shows that stent colonization was slightly higher than urine bacteriology, with both demonstrating similar microbiological patterns. Selection of the initial empiric treatment should be based on local epidemiological data. Initial therapy should be de-escalated to the most narrow-spectrum antibiotics to complete the course of therapy once culture and sensitivity data is available. Antibiotics stewardship will help in reducing the trend of MDR pathogens.
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Wu M, Hu T, Zhu P, Nasser MI, Shen J, Sun F, He Q, Zhao M. Kidney organoids as a promising tool in nephrology. Genes Dis 2022; 9:585-597. [PMID: 35782972 PMCID: PMC9243316 DOI: 10.1016/j.gendis.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 11/29/2022] Open
Abstract
Kidney disease has become a global public health problem affecting over 750 million people worldwide and imposing a heavy economic burden on patients. The complex architecture of the human kidney makes it very difficult to study the pathophysiology of renal diseases in vitro and to develop effective therapeutic options for patients. Even though cell lines and animal models have enriched our understanding, they fail to recapitulate key aspects of human kidney development and renal disease at cellular and functional levels. Organoids can be derived from either pluripotent stem cells or adult stem cells by strictly regulating key signalling pathways. Today, these self-differentiated organoids represent a promising technology to further understand the human kidney, one of the most complex organs, in an unprecedented way. The newly established protocols improved by organ-on-chip and coculture with immune cells will push kidney organoids towards the next generation. Herein, we focus on recent achievements in the application of kidney organoids in disease modelling, nephrotoxic testing, precision medicine, biobanking, and regenerative therapy, followed by discussions of novel strategies to improve their utility for biomedical research. The applications we discuss may help to provide new ideas in clinical fields.
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Altheaby A, Almukhlifi A, Aldoukhi A, Alfaleh A, Aboalsamah G, Alshareef A, Alruwaymi M, Bin Saad K, Arabi Z. Why Living Kidney Donor Candidates Are Turned Down? A Single-Center Cohort Study. Cureus 2020; 12:e9877. [PMID: 32963917 PMCID: PMC7500709 DOI: 10.7759/cureus.9877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/19/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction Living donor kidney transplantation is the best replacement therapy for patients with end-stage renal disease. It offers more benefits than deceased donor transplantation. However, living kidney donors (LKDs) undergo an extensive evaluation to ensure their suitability for donation, and this can result in rejection of many potential donors. Aim The aim of this study was to recognize the reasons for declining LKDs in our Organ Transplant Center at King Abdulaziz Medical City. Settings and Design This was a retrospective study to determine the various reasons to reject an LKD at the Organ Transplant Center. Methods and Material All the LKDs from January 2016 to December 2019 were included. Declined donors were reviewed and data were obtained from the electronic database and transplant nephrology shared files. Statistical analysis We performed data analysis using SPSS version 24.0 (IBM Corp., Armonk, NY, USA). Data for continuous variables were presented as mean ± standard deviation and were compared using t-test. Categorical variables were presented as frequencies and percentages; chi-square test was used to test for main association and then Bonferroni adjustment was used for post-hoc testing. Statistical significance was considered if a two-tailed p-value of <0.05 was achieved. Results A total of 410 potential LKDs were evaluated, of whom 241 (58.8%) successfully underwent donor nephrectomy and 169 (41.2%) were unable to proceed for kidney donation. The most common reasons for rejection of LKDs were medical (47.9%) followed by immunological reasons mainly blood group incompatibility (19.5%). Other reasons were donor withdrawal (15.4%), recipient-related reasons (7.1%), surgically unfit to proceed for nephrectomy (4.7%), or psychological reasons (2.3%). Conclusions A significant proportion of potential LKDs did not complete the kidney donation process due to medical, immunological, and surgical reasons. In addition, a proportion of LKDs decided to withdraw at some point during the evaluation process. Investing in donors' educational programs and implementing a standardized evaluation process are essential to increase LKDs pool.
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Affiliation(s)
- Abdulrahman Altheaby
- Organ Transplant Center and Hepatobiliary Sciences Department, King Abdulaziz Medical City, Riyadh, SAU
| | - Ahmed Almukhlifi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | - Abdullah Alfaleh
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Ghaleb Aboalsamah
- Organ Transplant Center and Hepatobiliary Sciences Department, King Abdulaziz Medical City, Riyadh, SAU
| | - Ala Alshareef
- Organ Transplant Center and Hepatobiliary Sciences Department, King Abdulaziz Medical City, Riyadh, SAU
| | - Mohamed Alruwaymi
- Organ Transplant Center and Hepatobiliary Sciences Department, King Abdulaziz Medical City, Riyadh, SAU
| | - Khaled Bin Saad
- Organ Transplant Center and Hepatobiliary Sciences Department, King Abdulaziz Medical City, Riyadh, SAU
| | - Ziad Arabi
- Organ Transplant Center and Hepatobiliary Sciences Department, King Abulaziz Medical City, Riyadh, SAU
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Kim J, Chung SJ, Sinn DH, Lee KW, Park JB, Huh W, Lee JE, Jang HR, Kang W, Gwak GY, Paik YH, Choi MS, Lee JH, Koh KC, Paik SW. Hepatitis B reactivation after kidney transplantation in hepatitis B surface antigen-negative, core antibody-positive recipients. J Viral Hepat 2020; 27:739-746. [PMID: 32057171 DOI: 10.1111/jvh.13279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/18/2020] [Accepted: 01/27/2020] [Indexed: 12/11/2022]
Abstract
Nowadays, intensive immunosuppressive therapy including rituximab is commonly used prior to kidney transplantation (KT), raising concerns over hepatitis B virus (HBV) reactivation among hepatitis B surface antigen (HBsAg)-negative and anti-hepatitis B core (HBc)-positive KT recipients. Recent practice guidelines suggested watchful monitoring or antiviral prophylaxis for the first 6-12 months, the period of maximal immunosuppression. However, the actual risk for HBV reactivation, and whether short-term antiviral therapy in the early period is necessary, remains unclear. A total of 449 HBsAg-negative and anti-HBc-positive KT recipients were analysed for HBV reactivation. During a median follow-up of 6.7 (interquartile range: 4.2-9.4) years, HBV reactivation was observed in 9 patients (2.0%). The median time of HBV reactivation from KT was 2.8 years (range: 1.4-11.5 years), with cumulative incidence rates of 0%, 1% and 2% for 1, 3 and 5 years, respectively. There were no severe adverse outcomes, including liver transplantation or mortality related to HBV reactivation. The risk of HBV reactivation was not high, even in anti-HBs-negative patients (n = 60, 4% at 5 years), ABO mismatch (n = 92, 4% at 5 years), use of rituximab (n = 66, 3% at 5 years) or plasmapheresis (n = 17, 7% at 5 years), and acute rejection (n = 169, 3% at 5 years). In conclusion, the HBV reactivation risk was not high and the time of detection was not clustered in the early post-KT period. Our findings favour continued watchful monitoring over antiviral prophylaxis in the early period.
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Affiliation(s)
- Jihye Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Jin Chung
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyo Won Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Berm Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wooseong Huh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Eun Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Ryoun Jang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wonseok Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Geum-Youn Gwak
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Han Paik
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon Seok Choi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Hyeok Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Cheol Koh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woon Paik
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Gil APP, Lunardi AC, Santana FR, Bergamim JSSP, Sarmento LA, Cristelli MP, Chiavegato LD. Impact of Renal Transplantation and Immunosuppressive Therapy on Muscle Strength, Functional Capacity, and Quality of Life: A Longitudinal Study. Transplant Proc 2020; 52:1279-1283. [PMID: 32307144 DOI: 10.1016/j.transproceed.2020.02.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/07/2020] [Indexed: 12/24/2022]
Abstract
Renal transplantation is the best long-term treatment option compared with maintenance dialysis in patients with chronic kidney disease. This treatment should be combined with immunosuppressive drugs to obtain positive effects; however, the adverse effects of these medications in the respiratory and peripheral muscle strength, functional capacity, and quality of life of patients remain unknown. OBJECTIVE The objective of this study is to evaluate the respiratory and peripheral muscle strength, functional capacity, and quality of life of patients undergoing renal transplantation in the preoperative period and during the first 6 months of postoperative period. METHODS The respiratory and peripheral muscle strength, quality of life, and functional capacity of 40 patients were evaluated from the pretransplant period to 6 months post-renal transplantation. RESULTS Compared with the preoperative period, the patients experienced improvement of the respiratory and peripheral strength 6 months after transplant (maximal inspiratory pressure 44% and maximal expiratory pressure 28.96%, handgrip 13.81%, and lower limbs 26.95%) and also in the quality of life. CONCLUSION We conclude that 6 months after transplant, patients showed improvement in respiratory and peripheral muscle strength and quality of life, but even with the improvement, patients presented an unsatisfactory quality of life and muscle strength, regardless of immunosuppressive therapy.
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Affiliation(s)
- Ana Paula Pereira Gil
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Adriana Claudia Lunardi
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil; Department of Physical Therapy of School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda Ribeiro Santana
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Juliana Santi Sagin Pinto Bergamim
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil; Instituto Cuiabá de Ensino e Cultura - Cuiabá, Mato Grosso, Brazil
| | - Laís Azevedo Sarmento
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | | | - Luciana Dias Chiavegato
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil; Respiratory Division, Medicine Department, Federal University of São Paulo, São Paulo, São Paulo, Brazil.
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Roggeri DP, Roggeri A, Zocchetti C, Cozzolino M, Rossi C, Conte F. Real-world data on healthcare resource consumption and costs before and after kidney transplantation. Clin Transplant 2019; 33:e13728. [PMID: 31587354 DOI: 10.1111/ctr.13728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/15/2019] [Accepted: 09/30/2019] [Indexed: 11/26/2022]
Abstract
End-stage renal disease (ESRD) is increasing worldwide as a consequence of population aging and increasing chronic illness. Treatment consists mostly of dialysis and kidney transplantation (KTx), and KTx offers advantages for life expectancy and long-term cost reductions compared with dialysis. This study uses the administrative database of the Lombardy Region to analyze the costs of a cohort of patients with ESRD receiving KTx, covering a time period of 24 months before transplant to 12 months after. During 2011, 276 patients underwent kidney transplantation (8.7% preemptive and 91.3% non-preemptive). In the period before transplantation, the main cost driver was dialysis (66.6% for the period from -24 to -12 months and 73.8% for the period from -12 to 0 months), while in the 12 months after KTx, the most relevant cost was surgery. The total cost -24 to -12 months pre-KTx was 35 049.2€; the cost -12 to 0 months was 36 745.9€; and the cost 12 months after KTx was 43 805.8€. Non-preemptive patients showed much higher costs both pre- and post-KTx than preemptive patients. This study highlights how KTx modifies the resource consumption and costs composition of patients with ESRD vs those undergoing dialysis treatment and how KTx may be economically beneficial, especially preemptive intervention.
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Affiliation(s)
| | | | | | - Mario Cozzolino
- Renal Division, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | | | - Ferruccio Conte
- Renal Division, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
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11
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Muduma G, Aluvihare V, Clancy M, de Nigris E, Whitlock C, Landeira M, Nazir J. The Last Year Before Graft Failure Negatively Impacts Economic Outcomes and is Associated With Greater Healthcare Resource Utilization Compared With Previous Years in the United Kingdom: Results of a Retrospective Observational Study. Transplant Direct 2019; 5:e443. [PMID: 31165078 DOI: 10.1097/TXD.0000000000000884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/16/2019] [Accepted: 02/03/2019] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. Background. Kidney and liver transplantation is the standard of care for end-stage renal or liver disease. However, long-term survival of kidney and liver grafts remain suboptimal. Our study aimed to understand the healthcare resources utilized and their associated costs in the years before graft failure. Methods. Two noninterventional, retrospective, observational studies were conducted in cohorts of kidney or liver transplant patients. Once identified, patients were followed using the UK Clinical Practice Research Datalink linked to the Hospital Episode Statistics databases from the date of transplantation to the date of the first graft failure. Total healthcare costs in the year before graft failure (primary endpoint) and during years 2–5 before graft failure (secondary endpoint) were collected. Results. A total of 269 kidney and 81 liver transplant patients were analyzed. The mean total costs were highest for all resource components in the last year before graft failure, except for mean costs of immunosuppressive therapy per patient, which decreased slightly by index date (ie, graft failure). The mean total healthcare costs in the last year before graft failure were £8115 for kidney and £9988 for liver transplant patients and were significantly (P < 0.05) higher than years 2–5 before graft failure. Mean healthcare costs for years 2, 3, 4, and 5 before graft failure were £5925, £5575, £5469, and £5468, respectively, for kidney, and £6763, £7042, £6020, and £5651, respectively, for liver transplant patients. Conclusions. Total healthcare costs in the last year before graft failure are substantial and statistically significantly higher than years 2–5 before graft failure, in both kidney and liver transplant patients. Our findings show the economic burden placed on healthcare services in the years before graft failure.
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Nagarathnam M, Sivakumar V, Latheef SAA. Characteristics of Burden, Coping Strategies, and Quality of Life: The Effect of Age, Gender, and Social Variables in Caregivers of Renal Transplanted Patients from Southern Andhra Pradesh, India. Indian J Palliat Care 2019; 25:407-413. [PMID: 31413457 PMCID: PMC6659532 DOI: 10.4103/ijpc.ijpc_34_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Evaluation of burden, coping strategies, and quality of life (QOL) in caregivers may lead to specific interventions to reduce the burden among caregivers. Methods: In this prospective study, characteristics of burden, coping strategies, and QOL in caregivers was investigated and also studied the effect of age, gender, and social variables on these concepts. Results: Mean burden score of the caregivers was 28.66 ± 2.02. Thirty percent of caregivers had mild-to-moderate burden followed by moderate-to-severe burden (20%). Seeking social support was the dominant coping strategy used by the caregivers. Role limitations due to the physical health (RLDPH) and role limitations due to emotional problem (RLDEP) were compromised subscales of QOL. The mean score of RLDPH (P = 0.007) and RLDEP (P = 0.014) were found to be significantly higher in males than that of females. Marital status, education, type of relationship with the patient, religion, occupation, and duration of care giving showed significant effect on burden, coping strategies, and QOL. Lower emotional well-being (P = 0.003) and escape avoidance (P = 0.000) in males and lower physical component (PC) (P = 0.002) in females and lower PC (P = 0.000) and escape avoidance (P = 0.001) were found to be the significant predictors of burden in caregivers of renal transplanted patients. Conclusion: Predictors of burden and QOL subscales varies by gender. Social and clinical variables influence the QOL subscales. Gender- and social group-specific interventions rather than global interventions may reduce the burden of caregivers.
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Affiliation(s)
- M Nagarathnam
- Department of Medical and Surgical Nursing, Sri venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - V Sivakumar
- Department of Nephrology, Sri venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - S A A Latheef
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Hyderabad, Telangana, India
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Ferraz FHRP, Rodrigues CIS, Gatto GC, Sá NMD. Diferenças e desigualdades no acesso a terapia renal substitutiva nos países do BRICS. Ciênc saúde coletiva 2017; 22:2175-2185. [DOI: 10.1590/1413-81232017227.00662017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/28/2016] [Indexed: 02/04/2023] Open
Abstract
Resumo A doença renal terminal (DRT) é um importante problema de saúde pública, sobretudo nos países em desenvolvimento, em vista dos altos recursos econômicos necessários para manutenção dos pacientes nas diversas formas de terapias renais substitutivas (TRS) existentes. O objetivo deste artigo é analisar as diferenças e as desigualdades que envolvem o acesso a TRS nos países que compõem o BRICS (Brasil, Rússia, Índia, China e África do Sul). Estudo aplicado, descritivo, transversal, qualitativo e quantitativo, com análise documental e pesquisa bibliográfica, tendo como fonte de dados censos nacionais e publicações científicas envolvendo o acesso a TRS em tais países. Verificou-se evidências de iniquidade no acesso a TRS em todos os países do BRICS, ausência de censos de diálise e transplante nacionais (Índia), ausência de legislações efetivas que inibam a comercialização de órgãos (Índia e África do Sul) e uso de transplantes de doador falecido de prisioneiros (China). A construção de mecanismos que promovam compartilhamento de benefícios e de solidariedade no campo da cooperação internacional na área da saúde renal passa pelo reconhecimento das questões bioéticas que envolvem o acesso a TRS nos países do BRICS.
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Bavanandan S, Yap YC, Ahmad G, Wong HS, Azmi S, Goh A. The Cost and Utility of Renal Transplantation in Malaysia. Transplant Direct 2015; 1:e45. [PMID: 27500211 DOI: 10.1097/TXD.0000000000000553] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/15/2015] [Indexed: 02/02/2023] Open
Abstract
UNLABELLED Kidney transplantation is the optimal therapy for the majority of patients with end-stage renal disease. However, the cost and health outcomes of transplantation have not been assessed in a middle-income nation with a low volume of transplantation, such as Malaysia. AIM AND METHODS This study used microcosting methods to determine the cost and health outcomes of living and deceased donor kidney transplantation in adult and pediatric recipients. The perspective used was from the Ministry of Health Malaysia. Cost-effectiveness measures were cost per life year (LY) and cost per quality-adjusted LYs. The time horizon was the lifetime of the transplant recipient from transplant to death. RESULTS Records of 206 KT recipients (118 adults and 88 children) were obtained for microcosting. In adults, discounted cost per LY was US $8609(Malaysian Ringgit [RM]29 482) and US $13 209(RM45 234) for living-donor kidney transplant (LKT) and deceased donor kidney transplant (DKT), respectively, whereas in children, it was US $10 485(RM35 905) and US $14 985(RM51 317), respectively. Cost per quality-adjusted LY in adults was US $8826 (RM30 224) for LKT and US $13 592(RM46 546) for DKT. Total lifetime discounted costs of adult transplants were US $119 702 (RM409 921) for LKT, US $147 152 (RM503 922) for DKT. Total costs for pediatric transplants were US $154 841(RM530 252) and US $159 313(RM545 566) for the 2 categories respectively. CONCLUSIONS Both LKT and DKT are economically favorable for Malaysian adult and pediatric patients with ESRD and result in improvement in quality of life.
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NASRI H. World kidney day 2013: acute kidney injury; a public health aware. Iran J Public Health 2013; 42:338-40. [PMID: 23641413 PMCID: PMC3633806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 02/15/2013] [Indexed: 12/01/2022]
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