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Maenosono R, Unagami K, Oki R, Fujiwara Y, Banno T, Okada D, Yagisawa T, Kanzawa T, Hirai T, Omoto K, Hanafusa N, Azuma H, Takagi T, Ishida H. The medical cost and outcome of desensitization protocol in kidney transplantation recipients with high immunological risks. Int J Urol 2024; 31:422-429. [PMID: 38193573 DOI: 10.1111/iju.15383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/17/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Kidney transplantation is a well-established alternative in renal replacement therapy. Compared with hemodialysis, low-immunological-risk kidney transplantation can reduce the medical treatment costs associated with end-stage renal disease. However, there are few reports on whether high-immunological-risk kidney transplantation reduces the financial burden on governments. We investigated the medical costs of high-immunological-risk kidney transplantation in comparison with the cost of hemodialysis in Japan. METHODS We compared the medical costs of high-immunological-risk kidney transplantation with those of hemodialysis. 15 patients who underwent crossmatch-positive and/or donor-specific antibody-positive kidney transplantations between 2020 and 2021 were enrolled in this study. The patients received intravenous immunoglobulin, plasmapheresis, and rituximab as desensitizing therapy. RESULTS Acute antibody-mediated rejection was detected in nine (60%) recipients, while there were no indications of graft function deterioration during the follow-up. For each patient, the transplant hospitalization cost was 38 428 ± 8789 USD. However, the cumulative costs were 59 758 ± 10 006 USD and 79 781 ± 16 366 USD, at 12 and 24 months, respectively. Compared with hemodialysis (34 286 USD per year), high-immunological-risk kidney transplantation tends to be expensive in the first year, but the cost is likely to be lower than that of hemodialysis after 3 years. CONCLUSIONS Although kidney transplantation is initially expensive compared with hemodialysis, the medical cost becomes advantageous after 3 years even in kidney transplant recipients with high immunological risk.
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Affiliation(s)
- Ryoichi Maenosono
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
- Department of Urology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kohei Unagami
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
- Department of Organ Transplant Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Rikako Oki
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
- Department of Organ Transplant Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuya Fujiwara
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
- Department of Urology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Taro Banno
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Daigo Okada
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takafumi Yagisawa
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Taichi Kanzawa
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshihito Hirai
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuya Omoto
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Norio Hanafusa
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan
| | - Haruhito Azuma
- Department of Urology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideki Ishida
- Department of Organ Transplant Medicine, Tokyo Women's Medical University, Tokyo, Japan
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Singer P. Post-transplant education for kidney recipients and their caregivers. Pediatr Nephrol 2022:10.1007/s00467-022-05744-6. [PMID: 36227432 DOI: 10.1007/s00467-022-05744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022]
Abstract
Successful outcomes in pediatric kidney transplantation require the involvement of the transplant team as well as recipients and their caregivers. Enhancing patient and family understanding of the disease and of post-transplant care can result in improved adherence and outcomes. Educational strategies should aim to be broad, understandable, innovative, and inclusive while maintaining a tailored approach to individualized care. Teaching should not be viewed as a one-time event but rather as an ongoing conversation throughout the duration of care, emphasizing different aspects throughout the patient's various developmental stages. The following review article discusses the content and methods of post-transplant education.
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Affiliation(s)
- Pamela Singer
- Department of Pediatrics, Cohen Children's Medical Center-Long Island Jewish Medical Center, 269-01 76th Ave, New Hyde Park, NY, 11040, USA.
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Liu S, Wang G. Exploration of Sports Participation and Curriculum Resource Utilization in Primary Schools Before and After the “Double Reduction”. Front Psychol 2022; 13:898675. [PMID: 35911032 PMCID: PMC9336544 DOI: 10.3389/fpsyg.2022.898675] [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: 03/17/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022] Open
Abstract
In order to eliminate capital chaos in the Education And Training (EAT) industry and ease parents' and students' excessive attention to subject achievements over physical quality, China government has launched the “Double Reduction” (“DR”) policy which promotes students' Sports Participation (SP) in the Compulsory Education (CE) stage concerning students' physical and mental health. Firstly, based on the actual situation of students' SP before and after releasing the “DR” policy, this paper understands the exact needs of parents and children. Secondly, following empirical research and mathematical statistics, it analyzes the structure and characteristics of students' SP before and after the release of the “DR” policy. Mainly, the experiment focuses on the frequency, project types, and off-campus class expenditure. It also considers students' SP motivation in on-campus and off-campus sports classes before and after the “DR” policy proposal. Additionally the general curriculum resource utilization of PE teachers are surveyed in order to find out the current status of on-campus PE classes. Eventually, the strategies are put forward to optimize students' SP under the “DR” from the perspectives of family, school, and society. The results show that after the release of “DR”, parents and schools gradually pay attention to student's physical health and better understand students' physical exercise in school. The consumption expenditure on sports off-campus classes has increased significantly. Meanwhile, family income and the father's occupation significantly impact the children's SP frequency in off-campus sports classes. Overall, “DR” is a protracted war. The existing difficulties need to be solved by families, schools, and the government. The research provides a practical basis for extending and managing on-campus sports classes and training. It helps timely uncover the problems in policy implementation. It guides the formulation of PE policy in the next stage of CE.
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Affiliation(s)
- Shuhong Liu
- School of Physical Education, Liaoning Normal University, Dalian, China
- Graduate Students' Affairs Department, Shenyang Sport University, Shenyang, China
| | - Guihong Wang
- School of Social Sports, Shenyang Sport University, Shenyang, China
- *Correspondence: Guihong Wang
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Lui S, Hind T, Moon E, de Souza A, Broad K, Fairbairn J, Schreiber R, Armstrong K, Blydt-Hansen TD. Self-reported physical activity and lack of association with health-related quality of life in a pediatric solid-organ transplant population. Pediatr Transplant 2021; 25:e14093. [PMID: 34296505 DOI: 10.1111/petr.14093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/20/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Physical activity (PA) has been shown to have benefits, including improving health-related quality of life (HRQOL). However, there are few and conflicting studies assessing PA and its relationship with HRQOL in a pediatric solid-organ transplant (SOT) population. The aim of this study was to assess whether overall HRQOL was associated with PA and to determine whether that association was independent of other baseline and contemporaneous clinical and demographic indicators. METHODS A retrospective cross-sectional review was performed on 55 pediatric transplant patients (13 heart, 27 kidney, and 15 liver transplant). PA was measured by PAQ-C/PAQ-A, and HRQOL was measured using PedsQL. Demographics, baseline, and contemporaneous data were collected. RESULTS There were no significant differences in baseline and contemporaneous characteristics between heart, kidney, and liver transplant recipients. SOT recipients were 15.0 (11.0-18.0) years old at completion of surveys. Median PAQ score was 2.3 (1.6-3.2), PedsQL total score was 77 (65-91), and PedsQL physical functioning score was 88 (72-97). The PedsQL total score was not significantly associated with PAQ score. The PAQ score was significantly associated with physical functioning subscore of the PedsQL (r = 0.37, p < 0.01). Higher physical functioning score was associated with time since transplant (r = 0.29, p = 0.031). CONCLUSION Our SOT cohort has a HRQOL similar to other chronic conditions and higher than previous reported HRQOL in pediatric SOT populations. Higher levels of PA and longer time since transplant are associated with higher physical functioning scores.
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Affiliation(s)
- Samantha Lui
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tatsuma Hind
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Erin Moon
- Psychology, Pediatric Multi-Organ Transplant Program, BC Children's Hospital, Vancouver, BC, Canada
| | - Astrid de Souza
- Pediatric Cardiology, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Katherine Broad
- Social Work, Pediatric Multi-Organ Transplant Program, BC Children's Hospital, Vancouver, BC, Canada
| | - Julie Fairbairn
- Physiotherapy, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Richard Schreiber
- Pediatric Gastroenterology, Hepatology and Nutrition, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Kathryn Armstrong
- Pediatric Cardiology, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Tom D Blydt-Hansen
- Pediatric Nephrology, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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Moudgil A, Verghese P. Healthy living in pediatric transplant recipients: What does it take? Pediatr Transplant 2021; 25:e13784. [PMID: 33511761 DOI: 10.1111/petr.13784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Asha Moudgil
- Department of Nephrology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Priya Verghese
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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