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Ostrowski P, Kargul M, Gurazda K, Skoryk A, Ostrowski M, Myślak M, Różański J, Skwirczyńska E. Immunosuppressant Adherence Factors Differentiating Compliant and Non-Compliant Kidney Transplant Recipients. J Clin Med 2023; 12:4081. [PMID: 37373774 DOI: 10.3390/jcm12124081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
The purpose of this study is to find out the psychological factor characteristic of non-adherence patients. The study population comprised kidney transplant recipients aged between 18 and 82 years at least 3 months post-transplant who voluntarily agreed to answer a couple of fully anonymous questionnaires that questions pertaining to basic data, type of immunosuppressive drugs taken, and standardized questionnaires. Participants were recruited using direct routine, free-of-charge visits to specialist doctors in transplant clinics. There was no significant difference in the percentage of men and women in both adherence and non-adherence groups. Non-adherence patients were significantly younger compared to adherence patients. There was also a significant difference in the patient's level of education. Adherence patients were better educated. No significant differences in criteria such as place of residence, having children or a partner, or way of living were observed. However, the emotion scale correlated negatively with the level of life orientation in both groups, but the level of the emotions scale and distractions subscale was negatively correlated with the level of self-esteem only for the adherence group. In future research, it would be worthwhile to focus on lifestyle and health-promoting behaviors in juxtaposition with the propensity for adherence.
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Affiliation(s)
- Piotr Ostrowski
- Department of General Surgery and Transplantation, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Michał Kargul
- Department of General Surgery and Transplantation, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Klaudia Gurazda
- Department of General Surgery and Transplantation, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Anastasiia Skoryk
- Department of General Surgery and Transplantation, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Marek Ostrowski
- Department of General Surgery and Transplantation, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Marek Myślak
- Department of Nephrology and Kidney Transplantation, Provincial Integrated Hospital, Arkońska 4, 71-455 Szczecin, Poland
| | - Jacek Różański
- Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Edyta Skwirczyńska
- Department of General Surgery and Transplantation, Pomeranian Medical University, 70-111 Szczecin, Poland
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Association of Postoperative Urinary Output in the First 24 Hours with Delayed Graft Function After Living and Deceased Donor Kidney Transplant: A Systematic Review. Nephrourol Mon 2021. [DOI: 10.5812/numonthly.119447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Context: Delayed graft function (DGF) is an important clinical outcome following renal transplantation; therefore, it is important to be correctly diagnosed. The DGF is thought to correlate with the first 24-hour urine output (UOP1), and this clinical sign is expected to predict DGF. Objectives: This study aimed to discover whether the UOP1 correlates significantly to the DGF incidence and can be a DGF predicting factor. Data Sources: This study compared the incidence of DGF with the UOP1 reported by studies obtained from the electronic databases, namely MEDLINE, Cochrane, and EBSCO. Studies that performed multivariate or bivariate analysis and/or reported sensitivity and specificity were included in this review. Results: A total of 1719 studies were obtained from the database search, and 2 studies were enrolled from other sources. Out of 1721 studies, 9 studies were recruited in this review, 5 of which reported sensitivity and specificity. Overall, nine of these studies had a low to moderate risk of bias. Almost all studies reported a significant relationship between the UOP1 and DGF. All studies agreed that the UOP1 is a sensitive predictive factor in predicting DGF. The specificity reported by the studies examined in this review varied greatly. The use of optimum cut-off in each study is considered to be the cause of this variability. Conclusions: The UOP1 is significantly related to the incidence of DGF and is a proper parameter for the prediction of DGF events.
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Association of Impaired Reactive Aldehyde Metabolism with Delayed Graft Function in Human Kidney Transplantation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2018:3704129. [PMID: 30671169 PMCID: PMC6323462 DOI: 10.1155/2018/3704129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 09/02/2018] [Accepted: 09/27/2018] [Indexed: 11/17/2022]
Abstract
Delayed graft function is an early complication following kidney transplantation with an unclear molecular mechanism. Here we determined whether impaired reactive aldehyde metabolism is associated with delayed graft function. Human kidney biopsies from grafts with delayed graft function were compared with grafts that did not develop delayed graft function by Ingenuity gene pathway analysis. A second series of grafts with delayed graft function (n = 10) were compared to grafts that did not develop delayed graft function (n = 10) by measuring reactive aldehyde metabolism, reactive aldehyde-induced protein adduct formation, and aldehyde dehydrogenase (ALDH) gene and protein expression. In the first series of kidney biopsies, several gene families known for metabolizing reactive aldehydes, such as aldehyde dehydrogenase (ALDH), aldo-keto reductase (AKR), and glutathione-S transferase (GSTA), were upregulated in kidneys that did not develop delayed graft function versus those that did. In the second series of kidney grafts, we focused on measuring aldehyde-induced protein adducts and ALDH enzymatic activity. The reactive aldehyde metabolism by ALDH enzymes was reduced in kidneys with delayed graft function compared to those that did not (37 ± 12∗ vs. 79 ± 5 μg/min/mg tissue, ∗P < 0.005, respectively). ALDH enzymatic activity was also negatively correlated with length of hospital stay after a kidney transplant. Together, our study identifies a reduced ALDH enzymatic activity with kidneys developing delayed graft function compared to those that did not. Measuring ALDH enzymatic activity and reactive aldehyde-induced protein adducts can potentially be further developed as a biomarker to assess for delayed graft function and recovery from a kidney transplant.
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Helfer MS, Pompeo JDC, Costa ORS, Vicari AR, Ribeiro AR, Manfro RC. Long-term effects of delayed graft function duration on function and survival of deceased donor kidney transplants. ACTA ACUST UNITED AC 2018; 41:231-241. [PMID: 30300438 PMCID: PMC6699432 DOI: 10.1590/2175-8239-jbn-2018-0065] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/13/2018] [Indexed: 11/22/2022]
Abstract
Introduction: Delayed graft function (DGF) is a frequent complication after deceased donor
kidney transplantation with an impact on the prognosis of the transplant.
Despite this, long-term impact of DGF on graft function after deceased donor
kidney transplantation has not been properly evaluated. Objective: The main objective of this study was to evaluate risk factors for DGF and the
impact of its occurrence and length on graft survival and function. Methods: A retrospective cohort study was performed in 517 kidney transplant
recipients who received a deceased donor organ between January 2008 and
December 2013. Results: The incidence of DGF was 69.3% and it was independently associated with
donor's final serum creatinine and age, cold ischemia time, use of antibody
induction therapy and recipient's diabetes mellitus. The occurrence of DGF
was also associated with a higher incidence of Banff ≥ 1A grade acute
rejection (P = 0.017), lower graft function up to six years after
transplantation and lower death-censored graft survival at 1 and 5 years (P
< 0.05). DGF period longer than 14 days was associated with higher
incidence of death-censored graft loss (P = 0.038) and poorer graft function
(P < 0.001). No differences were found in patient survival. Conclusions: The occurrence of DGF has a long-lasting detrimental impact on graft function
and survival and this impact is even more pronounced when DGF lasts longer
than two weeks.
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Affiliation(s)
| | | | | | | | | | - Roberto Ceratti Manfro
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.,Hospital de Clínicas de Porto Alegre, Nefrologia, Porto Alegre, RS, Brasil
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Ruppel P, Felipe CR, Medina-Pestana JO, Hiramoto LL, Viana L, Ferreira A, Aguiar W, Ivani M, Bessa A, Cristelli M, Gaspar M, Tedesco-Silva H. The influence of clinical, environmental, and socioeconomic factors on five-year patient survival after kidney transplantation. ACTA ACUST UNITED AC 2018; 40:151-161. [PMID: 29927458 PMCID: PMC6533991 DOI: 10.1590/2175-8239-jbn-3865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 09/04/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The risk of death after kidney transplant is associated with the age of the recipient, presence of comorbidities, socioeconomic status, local environmental characteristics and access to health care. OBJECTIVE To investigate the causes and risk factors associated with death during the first 5 years after kidney transplantation. METHODS This was a single-center, retrospective, matched case-control study. RESULTS Using a consecutive cohort of 1,873 kidney transplant recipients from January 1st 2007 to December 31st 2009, there were 162 deaths (case group), corresponding to 5-year patient survival of 91.4%. Of these deaths, 25% occurred during the first 3 months after transplant. The most prevalent cause of death was infectious (53%) followed by cardiovascular (24%). Risk factors associated with death were history of diabetes, dialysis type and time, unemployment, delayed graft function, number of visits to center, number of hospitalizations, and duration of hospital stay. After multivariate analysis, only time on dialysis, number of visits to center, and days in hospital were still associated with death. Patients who died had a non-significant higher number of treated acute rejection episodes (38% vs. 29%, p = 0.078), higher mean number of adverse events per patient (5.1 ± 3.8 vs. 3.8 ± 2.9, p = 0.194), and lower mean eGFR at 3 months (50.8 ± 25.1 vs. 56.7 ± 20.7, p = 0.137) and 48 months (45.9 ± 23.8 vs. 58.5 ± 20.2, p = 0.368). CONCLUSION This analysis confirmed that in this population, infection is the leading cause of mortality over the first 5 years after kidney transplantation. Several demographic and socioeconomic risk factors were associated with death, most of which are not readily modifiable.
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Affiliation(s)
| | | | | | | | - Laila Viana
- Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | - Wilson Aguiar
- Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Mayara Ivani
- Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Adrieli Bessa
- Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | - Melissa Gaspar
- Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Assessment of neutrophil gelatinase-associated lipocalin in the brain-dead organ donor to predict immediate graft function in kidney recipients: a prospective, multicenter study. Anesthesiology 2015; 122:96-105. [PMID: 25611655 DOI: 10.1097/aln.0000000000000497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Delayed graft function is a major determinant of long-term renal allograft survival. Despite considerable efforts to improve donor selection and matching, incidence of delayed graft function remains close to 25%. As neutrophil gelatinase-associated lipocalin (NGAL) has been shown to predict acute renal failure, the authors tested the hypothesis that NGAL measurement in brain-dead donors predicts delayed graft function in kidney recipients. METHODS In a prospective, multicenter, observational study, serum NGAL was measured in donors at the time of transfer to operating room. The primary endpoint was the delayed graft function, defined as the need for renal replacement therapy during the first week posttransplantation. RESULTS Among 159 included brain-dead donors, 146 were analyzable leading to 243 renal transplantations. Of these, 56 (23%) needed renal replacement therapy. Donors' NGAL values were similar in case of both delayed and normal graft function in recipients. The area under the receiver-operating curve for NGAL to predict the need for renal replacement therapy before day 8 was 0.50 (95% CI, 0.42 to 0.59). The area under curve for NGAL to predict failure to return to a normal graft function at day 8 was 0.51 (95% CI, 0.44 to 0.59). Using multivariate analysis, NGAL was not associated to the need for renal replacement therapy (odds ratio, 0.99; 95% CI, 0.98 to1.00) or failure to return to a normal graft function at day 8 (odds ratio, 1.00; 95% CI, 0.99 to 1.00). CONCLUSION NGAL measurement in brain-dead donors at the time of recovery failed to predict delayed or normal graft function in kidney recipients.
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Almeida F, Branco F, Cavadas V, Ribeiro S, Osório L, Rocha A, Ramos M, Martins L, Castro-Henriques A, Mota C, Reis A, Fraga A. Urological Complications After 134 Pediatric Kidney Transplants: A Single-center Study. Transplant Proc 2013; 45:1096-8. [DOI: 10.1016/j.transproceed.2013.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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