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Ryan RJ, Bentall AJ, Issa N, Dean PG, Smith BH, Stegall MD, Riad SM. Outcomes of Older Primary Kidney Transplant Recipients by Induction Agent and High-risk Viral Discordance Status in the United States. Transplant Direct 2024; 10:e1698. [PMID: 39328252 PMCID: PMC11427033 DOI: 10.1097/txd.0000000000001698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 09/28/2024] Open
Abstract
Background The impact of induction type or high-risk viral discordance on older kidney transplant recipients is unclear. Herein, we analyzed the association between induction type, viral discordance, and outcomes for older recipients. Methods We analyzed the Scientific Registry of Transplant Recipients standard analysis file for all primary kidney transplant recipients older than 55 y who were transplanted between 2005 and 2022. All transplants were crossmatch negative and ABO-compatible. Recipients were discharged on tacrolimus and mycophenolate ± steroids. Recipients were categorized into 3 groups by induction received: rabbit antithymocyte globulin (r-ATG; N = 51 079), interleukin-2 receptor antagonist (IL-2RA; N = 22 752), and alemtuzumab (N = 13 465). Kaplan-Meier curves were generated for recipient and graft survival, and follow-up was censored at 10 y. Mixed-effect Cox proportional hazard models examined the association between induction type, high-risk viral discordance, and outcomes of interest. Models were adjusted for pertinent recipient and donor characteristics. Results Induction type did not predict recipient survival in the multivariable model, whereas Epstein-Barr virus high-risk discordance predicted 14% higher mortality (1.14 [1.07-1.21], P < 0.01). In the multivariable model for death-censored graft survival, alemtuzumab, but not IL-2RA, was associated with an increased risk of graft loss (1.18 [1.06-1.29], P < 0.01) compared with r-ATG. High-risk cytomegalovirus discordance predicted 10% lower death-censored graft survival (1.10 [1.01-1.19], P < 0.02). Live donor and preemptive transplantation were favorable predictors of survival. Conclusions In this large cohort of older transplant recipients, alemtuzumab, but not IL-2RA, induction was associated with an increased risk of graft loss compared with r-ATG. Cytomegalovirus and Epstein-Barr virus high-risk viral discordance portended poor graft and recipient survival, respectively.
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Affiliation(s)
- Randi J. Ryan
- Division of Transplant Surgery, Intermountain Health, Murray, UT
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Andrew J. Bentall
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Naim Issa
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Patrick G. Dean
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Byron H. Smith
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Mark D. Stegall
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Samy M. Riad
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
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Sertorio ES, Colugnati FAB, Denhaerynck K, De Smet S, Medina JOP, Reboredo MM, De Geest S, Sanders-Pinheiro H. Factors Associated With Physical Inactivity of Recipients of a Kidney Transplant: Results From the ADHERE BRAZIL Multicenter Study. Phys Ther 2024; 104:pzae058. [PMID: 38591795 DOI: 10.1093/ptj/pzae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 11/27/2023] [Accepted: 02/13/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Physical activity is recommended for recipients of a kidney transplant. However, ADHERE BRAZIL study found a high prevalence (69%) of physical inactivity in Brazilian recipients of a kidney transplant. To tackle this behavior, a broad analysis of barriers is needed. This study aimed to identify factors (patient and transplant center levels) associated with physical inactivity among recipients of a kidney transplant. METHODS This was a subproject of the ADHERE BRAZIL study, a cross-sectional, multicenter study of 1105 recipients of a kidney transplant from 20 kidney transplant centers. Using a multistage sampling method, patients were proportionally and randomly selected. Applying the Brief Physical Activity Assessment questionnaire, patients were classified as physically active (≥150 min/wk) or physically inactive (<150 min/wk). On the basis of an ecological model, 34 factors associated with physical inactivity were analyzed by sequential logistic regression. RESULTS At the patient level, physical inactivity was associated with smoking (odds ratio = 2.43; 95% CI = 0.97-6.06), obesity (odds ratio = 1.79; 95% CI = 1.26-2.55), peripheral vascular disease (odds ratio = 3.18; 95% CI = 1.20-8.42), >3 posttransplant hospitalizations (odds ratio = 1.58; 95% CI = 1.17-2.13), family income of >1 reference salary ($248.28 per month; odds ratio = 0.66; 95% CI = 0.48-0.90), and student status (odds ratio = 0.58; 95% CI = 0.37-0.92). At the center level, the correlates were having exercise physiologists in the clinical team (odds ratio = 0.54; 95% CI = 0.46-0.64) and being monitored in a teaching hospital (undergraduate students) (odds ratio = 1.47; 95% CI = 1.01-2.13). CONCLUSIONS This study identified factors associated with physical inactivity after kidney transplantation that may guide future multilevel behavioral change interventions for physical activity. IMPACT In a multicenter sample of recipients of a kidney transplant with a prevalence of physical inactivity of 69%, we found associations between this behavior and patient- and center-level factors. At the patient level, the chance of physical inactivity was positively associated with smoking, obesity, and patient morbidity (peripheral vascular disease and hospitalization events after kidney transplantation). Conversely, a high family income and a student status negatively correlated with physical inactivity. At the center level, the presence of a dedicated professional to motivate physical activity resulted in a reduced chance of physical inactivity. A broad knowledge of barriers associated with physical inactivity can allow us to identify patients at a high risk of not adhering to the recommended levels of physical activity.
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Affiliation(s)
- Emiliana S Sertorio
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil, and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
| | - Fernando A B Colugnati
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil, and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
| | - Kris Denhaerynck
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| | - Stefan De Smet
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Jose O P Medina
- Fundação Oswaldo Ramos, Disciplina de Nefrologia, Hospital do Rim e Hipertensão, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Maycon M Reboredo
- School of Medicine, Federal University of Juiz de Fora, Minas Gerais, Brazil, and Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Sabina De Geest
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Helady Sanders-Pinheiro
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil, and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
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Kohlmeier L, von der Born J, Lehmann E, Fröde K, Grabitz C, Greiner AS, Albrecht AA, Memaran N, Sugianto RI, Tegtbur U, Schmidt BMW, Kanzelmeyer N, Melk A. Physical activity and its impact on cardiovascular health in pediatric kidney transplant recipients. Pediatr Nephrol 2024; 39:1587-1598. [PMID: 38103064 PMCID: PMC10943152 DOI: 10.1007/s00467-023-06248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Cardiovascular (CV) morbidity after kidney transplantation (KTx) in childhood is of increasing importance. In light of a high prevalence of CV risk factors, protective measures such as physical activity (PA) come into focus. Our aim was to comprehensively assess PA in pediatric KTx recipients and evaluate its impact on CV health. METHODS Forty-eight patients were assessed for frequency, duration, intensity, and setting of PA using the "Motorik-Modul" PA questionnaire. Walking-based activity was measured by accelerometer in a subgroup (n = 23). CV risk factors and subclinical CV organ damage were determined. The impact of PA on CV parameters was analyzed using linear regression models. RESULTS Fifty-two percent of pediatric KTx recipients did not reach WHO recommended PA level; 54% did not engage in PA with vigorous intensity (VPA). Twenty-nine percent indicated an extremely inactive lifestyle (< 120 min/week of moderate to vigorous intensity PA, MVPA). Compared to the healthy German KiGGS cohort, KTx recipients specifically lacked engagement in sport activities (KTx: 129 min/week; 95%CI, 97-162 vs. KiGGS, 242 min/week; 95%CI, 230-253). VPA was associated with lower systolic blood pressure (p = 0.024) and resting heart rate (p = 0.005), MVPA with fewer components of the post-transplant metabolic syndrome (p = 0.037), and better left ventricular diastolic function (p = 0.006). CONCLUSIONS A considerable lack of PA, especially VPA, exists in young KTx recipients. PA was positively associated with important parameters of CV health. While long-term CV protection through PA seems promising in pediatric KTx recipients, specific educational approaches are most likely needed to increase patients' engagement in sport activities.
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Affiliation(s)
- Lena Kohlmeier
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jeannine von der Born
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Elena Lehmann
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Kerstin Fröde
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Carl Grabitz
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Anne-Sophie Greiner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | | | - Nima Memaran
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Rizky I Sugianto
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Uwe Tegtbur
- Institute of Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Bernhard M W Schmidt
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Nele Kanzelmeyer
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Yang H, Liu S, Chen J, Qiao Y, Wang C, Zhang W, Wei L, Chen R. Perceptions of barriers to and facilitators of exercise rehabilitation in adults with lung transplantation: a qualitative study in China. BMC Pulm Med 2024; 24:65. [PMID: 38297272 PMCID: PMC10832146 DOI: 10.1186/s12890-024-02882-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/24/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Exercise is crucial for pulmonary rehabilitation and improving the prognosis of lung transplantation (LTx) patients. However, many LTx patients in China have low exercise tolerance and compliance, and the reasons behind these challenges have not been fully elucidated. Therefore, this qualitative research aims to identify the barriers to and facilitators of exercise rehabilitation in LTx patients. METHODS From January to July 2023, 15 stable LTx patients were recruited and participated in in-depth, semi-structured, face-to-face interviews at Henan Provincial People's Hospital. The interview transcripts were analyzed using the COM-B model and the Theoretical Domains Framework (TDF). RESULTS Six general themes including 19 barriers and 14 facilitators for the exercise rehabilitation of LTx patients were identified based on the COM-B model and TDF. The barriers to exercise included physical limitations, insufficient exercise endurance, lack of knowledge, and lack of motivation. The facilitators of exercise included motivation, self-efficacy, perceived significance of exercise rehabilitation, and social support. CONCLUSION The study offers detailed insight into the development and implementation of exercise rehabilitation intervention strategies for LTx patients. By combining COM-B model and TDF, the study provides strong evidence that active behavior change strategies are required for LTx patients to promote their participation in exercise rehabilitation. Professional support, pulmonary rehabilitation training, behavior change technology, and digital health tools are essential for strengthening the evidence system for reporting exercise efficacy and effectiveness.
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Affiliation(s)
- Hui Yang
- Department of Thoracic surgery, Henan Key Laboratory for Nursing, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Saisai Liu
- Department of Thoracic surgery, Henan Key Laboratory for Nursing, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Jingru Chen
- Department of Thoracic surgery, Henan Key Laboratory for Nursing, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Yaxin Qiao
- Institute of Nursing and Health, Henan University, Kaifeng, 475004, Henan, China
| | - Chengcheng Wang
- Department of Thoracic surgery, Henan Key Laboratory for Nursing, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Wenping Zhang
- Department of Thoracic surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Li Wei
- Department of Thoracic surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Ruiyun Chen
- Department of Thoracic surgery, Henan Key Laboratory for Nursing, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan Province, People's Republic of China.
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Handler L, Jaloul P, Clancy J, Cuypers B, Muir J, Hemphill J, Janaudis-Ferreira T, Gottesman C, Wickerson L, Lovas M, Cafazzo JA, Mathur S. A Qualitative Study of the Perspectives of Healthcare Professionals on Features of Digital Health Interventions to Support Physical Activity in Solid Organ Transplant Recipients. Prog Transplant 2023; 33:43-49. [PMID: 36537126 PMCID: PMC9968994 DOI: 10.1177/15269248221145039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Digital health interventions may support physical activity among solid organ transplant recipients. These interventions should be designed with users in mind, including healthcare professionals who counsel transplant recipients on physical activity to ensure acceptance and to promote an optimal user experience. The purpose of this study was to explore the perspectives of health care providers on the features of digital health interventions that would be useful in the promotion, implementation, and maintenance of physical activity among solid organ transplant recipients. Methods: This qualitative, cross-sectional study used semistructured interviews that were conducted remotely, via videoconferencing software, with providers who worked with transplant recipients. Interviews were transcribed, and an iterative-inductive, thematic analysis was used to identify common themes. Data were coded using NVivo software. Findings: Thirteen providers participated in this study. Four main themes were identified: (a) physical activity and exercise features (eg, physical activity guidelines, and exercise instructions); (b) credibility; (c) self-management; and (d) user engagement. Potential barriers to using digital health interventions included staffing requirements, professional regulatory issues, cost, perceived low patient motivation to use, and lack of technological literacy or access. Discussion: Digital health interventions were perceived to be a potential adjunct to current physical activity counseling practices, and part of an innovative strategy to address identified barriers to physical activity participation in solid organ transplant recipients.
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Affiliation(s)
- Lauren Handler
- Department of Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada
| | - Paula Jaloul
- Department of Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada
| | - Jessica Clancy
- Department of Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada
| | - Brittany Cuypers
- Department of Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada
| | - Jayme Muir
- Department of Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada
| | - Julia Hemphill
- Department of Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada
| | - Tania Janaudis-Ferreira
- School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Canadian Donation and Transplantation Research Program, University of Alberta, Edmonton, Alberta, Canada.,Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Chaya Gottesman
- Toronto Lung Transplant Program, 33540Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada
| | - Lisa Wickerson
- Department of Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada.,Canadian Donation and Transplantation Research Program, University of Alberta, Edmonton, Alberta, Canada.,Toronto Lung Transplant Program, 33540Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada
| | - Mike Lovas
- Centre for Global eHealth Innovation, 7989University Health Network, Toronto, Ontario, Canada
| | - Joseph A Cafazzo
- Centre for Global eHealth Innovation, 7989University Health Network, Toronto, Ontario, Canada
| | - Sunita Mathur
- Department of Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada.,Canadian Donation and Transplantation Research Program, University of Alberta, Edmonton, Alberta, Canada.,School of Rehabilitation Therapy, 4257Queen's University, Kingston, Ontario, Canada
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6
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Hu S, Hu Y, Wang S, Jin Q, Wang W, Liu H, Li J, Liu H. Predicting physical activity in kidney transplant recipients: an application of the Health Action Process Approach model. PSYCHOL HEALTH MED 2023; 28:772-784. [PMID: 35468024 DOI: 10.1080/13548506.2022.2067576] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite numerous physical, psychological, and social benefits of physical activity (PA), few kidney transplant recipients (KTRs) positively participate in PA. It is essential to understand the influencing factors of PA in KTRs. This study aimed to apply the Health Action Process Approach (HAPA) model to explore the influencing factors of PA in KTRs. This was a prospective study involving 320 participants. Pre-actional self-efficacy, outcome expectancies, risk perception, social support, PA intention, and demographic and clinical data were measured at Time 1. Coping self-efficacy, planning, recovery self-efficacy, and PA behavior were assessed 3 months later. The hypothesized relationships were examined by structural equation modeling. Findings revealed significant direct effects of pre-actional self-efficacy, negative outcome expectancies, positive outcome expectancies, and social support on intention. Planning and recovery self-efficacy were significant predictors of PA. The HAPA model provided a validated and useful framework for predicting the factors influencing PA behavior in KTRs.
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Affiliation(s)
- Shujing Hu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Yue Hu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Shasha Wang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Qing Jin
- Department of Urological Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Urological Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hang Liu
- Department of Urological Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jiaqi Li
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Hongxia Liu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
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Li G, Guo QF, Zhao SP, Wang MW, Zhang X, Wang A, Gui CF, Tan QL, Gao Q. Investigation of preoperative physical activity level in kidney transplant recipients and its impact on early postoperative recovery: A retrospective cohort study. Front Surg 2023; 9:1062652. [PMID: 36684240 PMCID: PMC9852711 DOI: 10.3389/fsurg.2022.1062652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/21/2022] [Indexed: 01/07/2023] Open
Abstract
Objective To retrospectively investigate the preoperative physical activity (PA) level in kidney transplant recipients (KTRs) and its impact on early postoperative recovery. Methods A total of 113 patients who received kidney transplantation at West China Hospital of Sichuan University were enrolled in this retrospective cohort study. According to the PA level measured by the Chinese version of the International Physical Activity Questionnaire-Long Version, the patients were allocated into the low PA level group (Group L, n = 55) and medium to high PA level group (Group MH, n = 58). The kidney function recovery indicators, including estimated glomerular filtration rate (eGFR), postoperative complications, postoperative length of stay (LOS), and unscheduled readmission within three months of discharge, were evaluated and documented. A association analysis was applied to analyze and compare the association between indicators. Results The median PA levels of the KTRs were 1701.0 MTEs * min/week. Regarding the postoperative recovery indicators, the KTRs spent a mean time of 19.63 h to achieve transfer out of bed after the operation (Group L: 19.67 h; Group MH: 19.53 h; P = 0.952) and reached a mean distance of 183.10 m as the best ambulatory training score within two days after the operation (Group L: 134.91 m; Group MH: 228.79 m; P < 0.001). The preoperative PA level showed a moderate positive association with early postoperative ambulation distance (ρ = 0.497, P < 0.001). However, no significant between-group difference in eGFR on postoperative days 1, 3, and 5 (P = 0.913, 0.335, and 0.524) or postoperative complications, including DGF (P = 0.436), infection (P = 0.479), postoperative LOS (P = 0.103), and unscheduled readmission (P = 0.698), was found. Conclusions The preoperative PA level of KTRs is lower than that of the general population. KTRs with moderate or high preoperative PA levels showed higher ambulatory function in the early postoperative period than those with low preoperative PA levels, but no between-group differences in other early recovery indicators were observed.
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Affiliation(s)
- Guo Li
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People's Rublic of China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Qi-fan Guo
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People's Rublic of China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Shang-ping Zhao
- Centre of Kidney Transplantation, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Miao-wei Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People's Rublic of China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Xia Zhang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People's Rublic of China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Ao Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People's Rublic of China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Chen-fan Gui
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People's Rublic of China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Qi-ling Tan
- Centre of Kidney Transplantation, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Qiang Gao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People's Rublic of China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Correspondence: Qiang Gao
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8
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Poor Physical Function Trajectory Predicts Impaired Patient Survival in Older Recipients of Deceased Donor Kidneys: A Prospective Cohort Study. Transplant Direct 2022; 8:e1374. [PMID: 36245999 PMCID: PMC9553385 DOI: 10.1097/txd.0000000000001374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/02/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022] Open
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Cardiovascular Risk after Kidney Transplantation: Causes and Current Approaches to a Relevant Burden. J Pers Med 2022; 12:jpm12081200. [PMID: 35893294 PMCID: PMC9329988 DOI: 10.3390/jpm12081200] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Cardiovascular disease is a frequent complication after kidney transplantation and represents the leading cause of mortality in this population. Material and Methods. We searched for the relevant articles in the National Institutes of Health library of medicine, transplant, cardiologic and nephrological journals. Results. The pathogenesis of cardiovascular disease in kidney transplant is multifactorial. Apart from non-modifiable risk factors, such as age, gender, genetic predisposition and ethnicity, several traditional and non-traditional modifiable risk factors contribute to its development. Traditional factors, such as diabetes, hypertension and dyslipidemia, may be present before and may worsen after transplantation. Immunosuppressants and impaired graft function may strongly influence the exacerbation of these comorbidities. However, in the last years, several studies showed that many other cardiovascular risk factors may be involved in kidney transplantation, including hyperuricemia, inflammation, low klotho and elevated Fibroblast Growth Factor 23 levels, deficient levels of vitamin D, vascular calcifications, anemia and poor physical activity and quality of life. Conclusions. The timely and effective treatment of time-honored and recently discovered modifiable risk factors represent the basis of the prevention of cardiovascular complications in kidney transplantation. Reduction of cardiovascular risk can improve the life expectancy, the quality of life and the allograft function and survival.
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10
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O'Brien T, Tan A, Rose K, Focht B, Daloul R. Maintenance phase of a physical activity intervention in older kidney transplant recipients: A 12-month follow-up. Geriatr Nurs 2021; 42:1541-1546. [PMID: 34741827 DOI: 10.1016/j.gerinurse.2021.08.019] [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: 05/24/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Abstract
Daily walking activities are associated with improving cardiovascular outcomes in older kidney transplant recipients. However, little is known regarding physical activity adherence outcomes in older kidney recipients. The purpose of this randomized controlled trial 12-month follow-up study was to evaluate the feasibility of the intervention (SystemCHANGE™ + activity tracker) during the maintenance period (7-12 months), compared to an attention-control group (activity tracker only) in older kidney recipients (age 60 and older). The sample included 60 participants (n = 30 IG; n = 30 ACG). Adherence rates for wearing the activity tracker daily were 96.5% in the IG and 80.8% in the ACG. The IG demonstrated within-group improvements for blood pressure at 12 months. Overall, there was a decrease in the average daily steps observed in both groups. These data suggest this intervention is feasible and additional boosters should be considered during the maintenance period to encourage physical activity.
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Affiliation(s)
- Tara O'Brien
- The Ohio State University College of Nursing, Columbus, OH Columbus, OH, Newton Hall,1585 Neil Ave, Columbus, OH 43210, USA.
| | - Alai Tan
- The Ohio State University College of Nursing Newton Hall, 1585 Neil Ave, Columbus, OH, USA 43210
| | - Karen Rose
- The Ohio State University College of Nursing Newton Hall, 1585 Neil Ave, Columbus, OH, USA 43210
| | - Brian Focht
- The Ohio State University College of Education and Human Ecology, 152 PAES, 305 Annie and John Glenn Ave, Columbus, OH, USA, 43210
| | - Reem Daloul
- The Ohio State University College of Medicine, 300 West 10th Avenue Suite 1150, Columbus, USA, OH 43210
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11
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Ponticelli C, Favi E. Physical Inactivity: A Modifiable Risk Factor for Morbidity and Mortality in Kidney Transplantation. J Pers Med 2021; 11:927. [PMID: 34575704 PMCID: PMC8470604 DOI: 10.3390/jpm11090927] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/29/2021] [Accepted: 09/15/2021] [Indexed: 12/17/2022] Open
Abstract
In patients with chronic kidney disease, sedentary behavior is widely recognized as a significant risk factor for cardiovascular disease, diabetes, obesity, osteoporosis, cancer, and depression. Nevertheless, the real impact of physical inactivity on the health of kidney transplant (KT) recipients remains uncertain. Over the last decade, there has been a renewed interest in exploring the effects of regular physical exercise on transplant-related outcomes. There is now mounting evidence that physical activity may reduce the burden of cardiovascular risk factors, preserve allograft function, minimize immunosuppression requirement, and ameliorate the quality of life of KT recipients. Many positive feedbacks can be detected in the early stages of the interventions and with a minimal exercise load. Despite these encouraging results, the perceived role of physical activity in the management of KT candidates and recipients is often underrated. The majority of trials on exercise training are small, relatively short, and focused on surrogate outcomes. While waiting for larger studies with longer follow-up, these statistical limitations should not discourage patients and doctors from initiating exercise and progressively increasing intensity and duration. This narrative review summarizes current knowledge about the deleterious effects of physical inactivity after KT. The benefits of regular physical exercise are also outlined.
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Affiliation(s)
| | - Evaldo Favi
- Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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12
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Ponticelli C, Campise MR. The inflammatory state is a risk factor for cardiovascular disease and graft fibrosis in kidney transplantation. Kidney Int 2021; 100:536-545. [PMID: 33932457 DOI: 10.1016/j.kint.2021.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023]
Abstract
Several factors, such as donor brain death, ischemia-reperfusion injury, rejection, infection, and chronic allograft dysfunction, may induce an inflammatory state in kidney transplantation. Furthermore, inflammatory cells, cytokines, growth factors, complement and coagulation cascade create an unbalanced interaction with innate and adaptive immunity, which are both heavily involved in atherogenesis. The crosstalk between inflammation and thrombosis may lead to a prothrombotic state and impaired fibrinolysis in kidney transplant recipients increasing the risk of cardiovascular disease. Inflammation is also associated with elevated levels of fibroblast growth factor 23 and low levels of Klotho, which contribute to major adverse cardiovascular events. Hyperuricemia, glucose intolerance, arterial hypertension, dyslipidemia, and physical inactivity may create a condition called metaflammation that concurs in atherogenesis. Another major consequence of the inflammatory state is the development of chronic hypoxia that through the mediation of interleukins 1 and 6, angiotensin II, and transforming growth factor beta can result in excessive accumulation of extracellular matrix, which can disrupt and replace functional parenchyma, leading to interstitial fibrosis and chronic allograft dysfunction. Lifestyle and regular physical activity may reduce inflammation. Several drugs have been proposed to control the graft inflammatory state, including low-dose aspirin, statins, renin-angiotensin inhibitors, xanthine-oxidase inhibitors, vitamin D supplements, and interleukin-6 blockade. However, no prospective controlled trial with these measures has been conducted in kidney transplantation.
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Affiliation(s)
- Claudio Ponticelli
- Division of Nephrology, Ospedale Maggiore Policlinico, Milano, Italy (retired).
| | - Maria Rosaria Campise
- Division of Nephrology and Dialysis, Ca' Granda Foundation, Scientific Institute Ospedale Maggiore Policlinico di Milano, Milano, Italy
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13
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Oberbauer R. 2020 landmark papers in transplantation published in NDT: clinical research highlights in the area of kidney transplantation. Nephrol Dial Transplant 2021; 36:569-571. [PMID: 33508132 DOI: 10.1093/ndt/gfab011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rainer Oberbauer
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
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14
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Liu M, Sun Q, Cui L, Liu J, Liu L, Wu X, Wang Z, Zhou X, Xie J, Cheng AS. Fear of Movement and Physical Self-Efficacy Partially Mediate the Association Between Fatigue and Physical Activity Among Kidney Transplant Recipients. Clin Nurs Res 2021; 30:950-959. [PMID: 33511857 DOI: 10.1177/1054773821990263] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fatigue is one of the most distressing symptoms in renal transplant patients, causing functional impairment and worsening their quality of life. However, the mechanism by which fatigue affects physical activity is unclear. A cross-sectional study using a convenient sampling approach was utilized to investigate 665 kidney transplant recipients recruited from the transplantation centers of six general hospitals from July and September 2019. Structural equation modeling was used to examine the interaction among fatigue, fear of movement, physical self-efficacy, and physical activity. Our study found fatigue was directly negatively associated with physical activity and had an indirect impact on physical activity through the mediating effects of physical self-efficacy and fear of movement. These variables accounted for 44.4% of the variation in physical activity. Our findings alert healthcare providers for the importance of fatigue management for physical activity and focused attention on fear of movement and physical self-efficacy in renal transplant recipients.
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Affiliation(s)
- Min Liu
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qian Sun
- Xiangya Nursing School, Central South University, Changsha, China
| | - Lina Cui
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jia Liu
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lifang Liu
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoxia Wu
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhimin Wang
- Nursing Department of the Second Affiliated Hospital, Nanhua University, Hengyang, China
| | - Xin Zhou
- Transplantation Center of Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Jianfei Xie
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Andy Sk Cheng
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, China
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