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Santos AH, Mehta R, Alquadan K, Ibrahim H, Leghrouz MA, Belal A, Wen X. Age-modified risk factors for mortality of non-elderly adult kidney transplant recipients: a retrospective database analysis. Int Urol Nephrol 2024:10.1007/s11255-024-04132-3. [PMID: 38922533 DOI: 10.1007/s11255-024-04132-3] [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: 06/08/2024] [Accepted: 06/18/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE We aimed to investigate the role of the recipient's age strata in modifying the associations between risk factors and mortality in non-elderly adult kidney transplant (KT) recipients (KTR). METHODS We stratified 108,695 adult KTRs between 2000 and 2016 with conditional 1-year survival after KT into cohorts based on age at transplant: 18-49 years and 50-64 years. We excluded KTRs aged < 18 years or > / = 65 years. KTRs were observed for 5 years during the 2nd through 6th years post-KT for the outcome, all-cause mortality. RESULTS Increasing recipient age strata (18-49-year-old and 50-64-year-old) correlated with decreasing 6-year post-KT survival rates conditional on 1-year survival (79% and 57%, respectively, p < 0.0001). Middle adult age stratum was associated with a higher risk of all-cause mortality than young adult age stratum in KTRs of Hispanic/Latino and other races [HR = 1.23, 95% CI = 1.04-1.45 and HR = 1.51, 95% CI = 1.16-1.97, respectively] and with a primary native renal diagnosis of hypertension or glomerulonephritis [HR = 1.32, 95% CI = 1.12-1.55 and HR = 1.29, 95% CI = 1.10-151, respectively]. When compared with the young adult age stratum, the middle adult age stratum had a mitigating effect on the higher risk of mortality associated with sirolimus-mycophenolate or sirolimus-tacrolimus than the standard calcineurin inhibitor-mycophenolate regimen [HR = 0.75, 95% CI = 0.57-0.99 and HR = 0.71, 95% CI = 0.57-0.89, respectively]. CONCLUSION Among adult non-elderly KTRs, the age strata, 18-49 years, and 50-64 years, have varying modifying effects on the strength and direction of associations between some specific risk factors and all-cause mortality.
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Affiliation(s)
- Alfonso H Santos
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, 1600 SW Archer Road, Medical Science Bldg., Room NG-4, Gainesville, FL, 32610, USA.
| | - Rohan Mehta
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, 1600 SW Archer Road, Medical Science Bldg., Room NG-4, Gainesville, FL, 32610, USA
| | - Kawther Alquadan
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, 1600 SW Archer Road, Medical Science Bldg., Room NG-4, Gainesville, FL, 32610, USA
| | - Hisham Ibrahim
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, 1600 SW Archer Road, Medical Science Bldg., Room NG-4, Gainesville, FL, 32610, USA
| | - Muhannad A Leghrouz
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, 1600 SW Archer Road, Medical Science Bldg., Room NG-4, Gainesville, FL, 32610, USA
| | - Amer Belal
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, 1600 SW Archer Road, Medical Science Bldg., Room NG-4, Gainesville, FL, 32610, USA
| | - Xuerong Wen
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
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Chung MH, Park H. Development and Validation of the Resilience Scale for Kidney Transplantation (RS-KTPL). Asian Nurs Res (Korean Soc Nurs Sci) 2024; 18:167-177. [PMID: 38718894 DOI: 10.1016/j.anr.2024.04.011] [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: 12/27/2023] [Revised: 04/22/2024] [Accepted: 04/30/2024] [Indexed: 06/05/2024] Open
Abstract
PURPOSE This study developed a resilience scale for kidney transplantation (RS-KTPL) and assessed its reliability and validity. METHODS During the tool development phase, the concept of resilience in 10 patients who had undergone a kidney transplant was analyzed by integrating results from the theoretical and field research stages. Initial tool items were then derived. These items underwent content validity verification, item review, and a preliminary survey. The validation phase involved two main surveys, conducted using the preliminary 59 items derived from the development phase for data gathering. The first survey had 266 participants, and the second had 205 participants. Using the collected data, the structural validity, convergent validity, discriminant validity, criterion validity, and reliability of the tool items were verified, ultimately establishing the final items. RESULTS The RS-KTPL comprises six factors with 27 items confirmed through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) on a 4-point Likert scale: positive thought transition through recovery belief, supportive relationships with others, self-awareness of negative psychological reactions, physical health control, homeostasis control, and supportive relationships with medical staff. The cumulative explanation of the tool was 50.71%. The model fit of the RS-KTPL was represented as follows: GFI 0.88, CFI 0.93, TLI 0.91, RMSEA 0.04, and SRMRI 0.06. Convergent, discriminant, and criterion validity were also secured. The reliability of the tool, measured by Cronbach α was 0.87. CONCLUSIONS The RS-KTPL can be used to identify the level of resilience in patients who have undergone a kidney transplant, enabling them to recognize their strengths and areas of improvement for enhanced resilience. This tool can be applied in clinical nursing practices to comprehensively assess the resilience of patients with a kidney transplant, providing direction for nursing intervention plans to enhance patient resilience.
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Affiliation(s)
- Mi Ha Chung
- Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Hyojung Park
- College of Nursing, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, South Korea.
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Jaure A, Vastani RT, Teixeira-Pinto A, Ju A, Craig JC, Viecelli AK, Scholes-Robertson N, Josephson MA, Ahn C, Butt Z, Caskey FJ, Dobbels F, Fowler K, Jowsey-Gregoire S, Jha V, Tan JC, Sautenet B, Howell M. Validation of a Core Patient-Reported Outcome Measure for Life Participation in Kidney Transplant Recipients: the SONG Life Participation Instrument. Kidney Int Rep 2024; 9:87-95. [PMID: 38312789 PMCID: PMC10831350 DOI: 10.1016/j.ekir.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/04/2023] [Accepted: 10/23/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Life participation has been established as a critically important core for trials in kidney transplantation. We aimed to validate a patient-reported outcome measure for life participation in kidney transplant recipients. Methods A psychometric evaluation of the Standardized Outcomes in Nephrology life participation (SONG-LP) measure was conducted in adult kidney transplant recipients. The measure includes 4 items of life participation (leisure, family, work, and social) each with a 5-point Likert scale. Each item is scored from 0 (never) to 4 (always) and the summary measure score the average of each item. Results A total of 249 adult kidney transplant recipients from 20 countries participated. The SONG-LP instrument demonstrated internal consistency (Cronbach's α = 0.87; 95% confidence intervals [CI]: 0.83-0.90, baseline) and test-retest reliability over 1 week (intraclass correlation coefficient of 0.62; 95% CI: 0.54-0.70). There was moderate to high correlation (0.65; 95% CI: 0.57-0.72) with the PROMIS Ability to Participate in Social Roles and Activities Short Form 8a that assessed a similar construct, and moderate correlation with measures that assessed related concepts (i.e., EQ5D 0.57; 95% CI: 0.49-0.65), PROMIS Cognitive Functional Abilities Subset Short Form 4a (0.40; 95% CI: 0.29-0.50). Conclusion The SONG-LP instrument is a simple, internally consistent, reliable measure for kidney transplant recipients and correlates with similar measures. Routine incorporation in clinical trials will ensure consistent and appropriate assessment of life participation for informed patient-centered decision-making.
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Affiliation(s)
- Allison Jaure
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Rahim T. Vastani
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Angela Ju
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Jonathan C. Craig
- College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Andrea K. Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Michelle A. Josephson
- Department of Medicine (Section of Nephrology), The University of Chicago, Chicago, Illinois, USA
| | - Curie Ahn
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Zeeshan Butt
- Departments of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Phreesia, Inc., Wilmington, Delaware, USA
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Fabienne Dobbels
- Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Kevin Fowler
- The Voice of the Patient, Saint Louis, Missouri, USA
| | | | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Jane C. Tan
- Department of Medicine, Stanford University, Stanford, California, USA
| | | | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
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Weerasekera S, Reid N, Young A, Homes R, Sia A, Giddens F, Francis RS, Hubbard RE, Gordon EH. Putting Guidelines Into Practice: Is Frailty Measurement at the Time of Kidney Transplant Eligibility Assessment Valid, Feasible, and Acceptable to Patients? Transplant Direct 2023; 9:e1548. [PMID: 37854024 PMCID: PMC10581598 DOI: 10.1097/txd.0000000000001548] [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: 03/21/2023] [Revised: 08/22/2023] [Accepted: 09/08/2023] [Indexed: 10/20/2023] Open
Abstract
Background Clinical Practice Guidelines suggest that frailty be measured during kidney transplant eligibility assessments. Yet it is not known how frailty is best assessed in this setting or whether its assessment is acceptable to patients. We aimed to examine the construct validity and feasibility of Frailty Index (FI) assessment among patients attending a kidney transplant assessment clinic and to explore patients' perspectives on frailty and the acceptability of its routine assessment. Methods A 58-item FI was calculated for 147 clinic patients. Semistructured interviews were conducted with a subgroup of 29 patients. The FI was validated against normative FI characteristics (mean, distribution, limit), age, and the Estimated Post-Transplant Survival Score. Feasibility was assessed using descriptive statistics. Qualitative data were analyzed using reflexive thematic analysis. Results The mean FI was 0.23 (±0.10, normal distribution, limit 0.53). FI increased with age and Estimated Post-Transplant Survival score. The FI was completed for 62.8% of eligible patients (147/234). The median completion time was 10 min, and completion rate (with no missing data) was 100%. Four themes were identified: perceptions of frailty, acceptability, perceived benefits, and risks of frailty measurement. Patients linked frailty with age and adverse outcomes, and most did not consider themselves frail. Patients reported that the FI was quick, simple, and efficient. They felt that frailty assessment is relevant to transplant eligibility and should be used to address potentially reversible factors. Conclusions The FI demonstrated construct validity and was feasible and acceptable in this clinic setting. The challenge is ensuring that routine assessments lead to better care.
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Affiliation(s)
- Shavini Weerasekera
- Geriatrics and Rehabilitation Unit, Princess Alexandra Hospital, Metro South Hospital & Health Service, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Natasha Reid
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Adrienne Young
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Ryan Homes
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Aaron Sia
- Geriatrics and Rehabilitation Unit, Princess Alexandra Hospital, Metro South Hospital & Health Service, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Fiona Giddens
- Department of Nephrology, Princess Alexandra Hospital, Metro South Hospital & Health Service, Brisbane, Australia
| | - Ross S. Francis
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Metro South Hospital & Health Service, Brisbane, Australia
| | - Ruth E. Hubbard
- Geriatrics and Rehabilitation Unit, Princess Alexandra Hospital, Metro South Hospital & Health Service, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Emily H. Gordon
- Geriatrics and Rehabilitation Unit, Princess Alexandra Hospital, Metro South Hospital & Health Service, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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Li D, Ren Y, Chen R, Wu H, Zhuang S, Zhang M. Label-free MXene-assisted field effect transistor for the determination of IL-6 in patients with kidney transplantation infection. Mikrochim Acta 2023; 190:284. [PMID: 37417992 DOI: 10.1007/s00604-023-05814-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 04/23/2023] [Indexed: 07/08/2023]
Abstract
A spiral interdigitated MXene-assisted field effect transistor (SiMFETs) was proposed for determination of IL-6 in patients with kidney transplantation infection. Our SiMFETs demonstrated enhanced IL-6 detection range of 10 fg/mL-100 ng/mL due to the combination of optimized transistor's structure and semiconducting nanocomposites. Specifically, on one hand, MXene-based field effect transistor drastically amplified the amperometric signal for determination of IL-6; on the other hand, the multiple spiral structure of interdigitated drain-source architecture improved the transconductance of FET biosensor. The developed SiMFETs biosensor demonstrated satisfactory stability for 2 months, and favorable reproducibility and selectivity against other biochemical interferences. The SiMFETs biosensor exhibited acceptable correlation coefficient (R2=0.955) in quantification of clinical biosamples. The sensor successfully distinguished the infected patients from the health control with enhanced AUC of 0.939 (sensitivity of 91.7%, specificity of 86.7%). Those merits introduced here may pave an alternative strategy for transistor-based biosensor in point-of-care clinic applications.
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Affiliation(s)
- Dawei Li
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yaofei Ren
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ruoyang Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haoyu Wu
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shaoyong Zhuang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Zhang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Weimann A, Ahlert M, Seehofer D, Zieschang T, Schweda M. Old Age and Frailty in Deceased Organ Transplantation and Allocation-A Plea for Geriatric Assessment and Prehabilitation. Transpl Int 2023; 36:11296. [PMID: 37476294 PMCID: PMC10354295 DOI: 10.3389/ti.2023.11296] [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: 04/14/2023] [Accepted: 06/21/2023] [Indexed: 07/22/2023]
Abstract
Due to demographic ageing and medical progress, the number and proportion of older organ donors and recipients is increasing. At the same time, the medical and ethical significance of ageing and old age for organ transplantation needs clarification. Advanced age is associated with the frailty syndrome that has a negative impact on the success of organ transplantation. However, there is emerging evidence that frailty can be modified by suitable prehabilitation measures. Against this backdrop, we argue that decision making about access to the transplant waiting list and the allocation of donor organs should integrate geriatric expertise in order to assess and manage frailty and impairments in functional capacity. Prehabilitation should be implemented as a new strategy for pre-operative conditioning of older risk patients' functional capacity. From an ethical point of view, advanced chronological age per se should not preclude the indication for organ transplantation and the allocation of donor organs.
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Affiliation(s)
- Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany
| | - Marlies Ahlert
- Department of Economics, Martin-Luther-University of Halle, Halle, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Tania Zieschang
- Division of Geriatric Medicine, Department of Health Services Research, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
| | - Mark Schweda
- Division of Medical Ethics, Department of Health Services Research, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
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Thongprayoon C, Jadlowiec CC, Mao SA, Mao MA, Leeaphorn N, Kaewput W, Pattharanitima P, Nissaisorakarn P, Cooper M, Cheungpasitporn W. Distinct phenotypes of kidney transplant recipients aged 80 years or older in the USA by machine learning consensus clustering. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2023; 5:e000137. [PMID: 36843871 PMCID: PMC9944353 DOI: 10.1136/bmjsit-2022-000137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 02/05/2023] [Indexed: 02/22/2023] Open
Abstract
Objectives This study aimed to identify distinct clusters of very elderly kidney transplant recipients aged ≥80 and assess clinical outcomes among these unique clusters. Design Cohort study with machine learning (ML) consensus clustering approach. Setting and participants All very elderly (age ≥80 at time of transplant) kidney transplant recipients in the Organ Procurement and Transplantation Network/United Network for Organ Sharing database database from 2010 to 2019. Main outcome measures Distinct clusters of very elderly kidney transplant recipients and their post-transplant outcomes including death-censored graft failure, overall mortality and acute allograft rejection among the assigned clusters. Results Consensus cluster analysis was performed in 419 very elderly kidney transplant and identified three distinct clusters that best represented the clinical characteristics of very elderly kidney transplant recipients. Recipients in cluster 1 received standard Kidney Donor Profile Index (KDPI) non-extended criteria donor (ECD) kidneys from deceased donors. Recipients in cluster 2 received kidneys from older, hypertensive ECD deceased donors with a KDPI score ≥85%. Kidneys for cluster 2 patients had longer cold ischaemia time and the highest use of machine perfusion. Recipients in clusters 1 and 2 were more likely to be on dialysis at the time of transplant (88.3%, 89.4%). Recipients in cluster 3 were more likely to be preemptive (39%) or had a dialysis duration less than 1 year (24%). These recipients received living donor kidney transplants. Cluster 3 had the most favourable post-transplant outcomes. Compared with cluster 3, cluster 1 had comparable survival but higher death-censored graft failure, while cluster 2 had lower patient survival, higher death-censored graft failure and more acute rejection. Conclusions Our study used an unsupervised ML approach to cluster very elderly kidney transplant recipients into three clinically unique clusters with distinct post-transplant outcomes. These findings from an ML clustering approach provide additional understanding towards individualised medicine and opportunities to improve care for very elderly kidney transplant recipients.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Shennen A Mao
- Division of Transplant Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Napat Leeaphorn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA,Renal Transplant Program, Saint Luke's Health System, Kansas City, Missouri, USA
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | | | - Matthew Cooper
- Division of Transplant, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Courtney AE, Moorlock G, Van Assche K, Burnapp L, Mamode N, Lennerling A, Dor FJMF. Living Donor Kidney Transplantation in Older Individuals: An Ethical Legal and Psychological Aspects of Transplantation (ELPAT) View. Transpl Int 2023; 36:11139. [PMID: 37152615 PMCID: PMC10161899 DOI: 10.3389/ti.2023.11139] [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: 12/15/2022] [Accepted: 04/12/2023] [Indexed: 05/09/2023]
Abstract
Living donor transplantation is the optimal treatment for suitable patients with end-stage kidney disease. There are particular advantages for older individuals in terms of elective surgery, timely transplantation, and early graft function. Yet, despite the superiority of living donor transplantation especially for this cohort, older patients are significantly less likely to access this treatment modality than younger age groups. However, given the changing population demographic in recent decades, there are increasing numbers of older but otherwise healthy individuals with kidney disease who could benefit from living donor transplantation. The complex reasons for this inequity of access are explored, including conscious and unconscious age-related bias by healthcare professionals, concerns relating to older living donors, ethical anxieties related to younger adults donating to aging patients, unwillingness of potential older recipients to consider living donation, and the relevant legislation. There is a legal and moral duty to consider the inequity of access to living donor transplantation, recognising both the potential disparity between chronological and physiological age in older patients, and benefits of this treatment for individuals as well as society.
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Affiliation(s)
- Aisling E. Courtney
- Regional Nephrology and Transplant Unit, Belfast City Hospital, Belfast, United Kingdom
- *Correspondence: Aisling E. Courtney,
| | - Greg Moorlock
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Kristof Van Assche
- Research Group Personal Rights and Property Rights, University of Antwerp, Antwerp, Belgium
| | - Lisa Burnapp
- NHS Blood and Transplant, Bristol, United Kingdom
| | - Nizam Mamode
- Department of Surgery, King’s College London, London, United Kingdom
| | - Annette Lennerling
- The Transplant Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Frank J. M. F. Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
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9
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Structural and Functional Changes in Aging Kidneys. Int J Mol Sci 2022; 23:ijms232315435. [PMID: 36499760 PMCID: PMC9737118 DOI: 10.3390/ijms232315435] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/30/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022] Open
Abstract
The renal condition is one of the crucial predictors of longevity; therefore, early diagnosis of any dysfunction plays an important role. Kidneys are highly susceptible to the aging process. Unfavorable conditions may lead to a significant disturbance of the body's homeostasis. Apart from physiological changes, there are some conditions such as hypertension, diabetes or obesity which contribute to the acceleration of the aging process. A determination of macroscopic and microscopic changes is essential for assessing the progression of aging. With age, we observe a decrease in the volume of renal parenchyma and an increase in adipose tissue in the renal sinuses. Senescence may also be manifested by the roughness of the kidney surface or simple renal cysts. The main microscopic changes are a thickening of the glomerular basement membrane, nephrosclerosis, an accumulation of extracellular matrix, and mesangial widening. The principal aspect of stopping unfavorable changes is to maintain health. Studies have shown many useful ways to mitigate renal aging. This review is focused especially on medications such as renin-angiotensin-aldosterone system blockers or resveratrol, but even eating habits and lifestyle.
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10
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Antoun J, Brown DJ, Clarkson BG, Shepherd AI, Sangala NC, Lewis RJ, McNarry MA, Mackintosh KA, Corbett J, Saynor ZL. Experiences of adults living with a kidney transplant-Effects on physical activity, physical function, and quality of life: A descriptive phenomenological study. J Ren Care 2022. [PMID: 36250752 DOI: 10.1111/jorc.12443] [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: 04/06/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although kidney transplantation is the best treatment for kidney failure, scarce research has examined its effects on physical activity, physical function and quality of life. OBJECTIVES To investigate the experiences of a group of adults living with advanced kidney disease focusing on quality of life, physical activity and function and to see how findings differ in a group of kidney transplant recipients. APPROACH Individual semi-structured interviews were conducted with adults with advanced kidney disease (n = 10; 70.5 ± 8.9 years) and adults who had received a kidney transplant (n = 10; 50.7 ± 11.5 years; transplant age: 42.7 ± 20.9 months). Interviews were transcribed verbatim, thematically analysed and composite vignettes developed. FINDINGS Individuals with advanced kidney disease described a sense of loss and alteration to their life plans. Kidney transplant recipients reported increased freedom, independence and a return to near normality, with improved quality of life, physical activity and function compared with their pre-transplant lives. However, transplant recipients also described living with anxiety about the health of their transplant and fear it may fail. CONCLUSION Whilst adults living with advanced kidney disease often experience a reduced quality of life, physical activity and function, kidney transplantation can help facilitate a return to pre-disease levels of physical activity, physical function and quality of life. However, transplant recipients also reported living with anxiety around their new kidney failing. This study demonstrates the variability in the lived experiences of adults living with advanced kidney disease or a kidney transplant and highlights the need for patient-centred care.
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Affiliation(s)
- Joe Antoun
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK.,Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Daniel J Brown
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Beth G Clarkson
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Anthony I Shepherd
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK.,Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Nicholas C Sangala
- Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Robert J Lewis
- Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Melitta A McNarry
- Department of Sport and Exercise Sciences, Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Swansea, UK
| | - Kelly A Mackintosh
- Department of Sport and Exercise Sciences, Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Swansea, UK
| | - Jo Corbett
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Zoe L Saynor
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK.,Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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11
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Nash RP, Loiselle MM, Stahl JL, Conklin JL, Rose TL, Hutto A, Evon DM, Flythe JE, Burker EJ. Post-Traumatic Stress Disorder and Post-Traumatic Growth following Kidney Transplantation. KIDNEY360 2022; 3:1590-1598. [PMID: 36245667 PMCID: PMC9528379 DOI: 10.34067/kid.0008152021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/27/2022] [Indexed: 11/27/2022]
Abstract
Background Kidney transplantation (KT) is a life-saving therapy for kidney failure. However, KT recipients can suffer from debilitating depression, post-traumatic stress disorder (PTSD), and suicide. In contrast to PTSD, post-traumatic growth (PTG) is a positive psychologic change in response to a challenging situation. PTG has been studied in other chronic diseases, but less is known about its role in the setting of KT. We sought to elucidate the prevalence, predictors, and the effect of PTSD and PTG on post-KT outcomes. We also considered the roles of benefit finding and resilience. Methods In a literature review, we identified publications that examined PTSD, PTG, benefit finding, and/or resilience in KT recipients. We excluded case reports and first-person narratives. Publications meeting the specified criteria after full text review underwent data abstraction and descriptive analysis. Results Of the 1013 unique citations identified, 39 publications met our criteria. PTSD was the most common construct evaluated (16 publications). Resilience was studied in 11 publications, PTG in nine, and benefit finding in five. Up to 21% of adult and 42% of pediatric KT recipients may experience PTSD, which is associated with lower quality of life (QOL), impaired sleep, and other psychiatric comorbidity. PTG was associated with improved QOL, kidney function, and reduced risk of organ rejection. Although benefit finding tended to increase post KT, resilience remained stable post KT. Like PTG, resilience was associated with lower psychologic distress and increased treatment adherence and confidence in the health care team. Conclusions PTG, resilience, and benefit finding appear to reduce the risk of PTSD, promote well-being, and reduce risk of graft failure in KT recipients. Future research to understand these relationships better will allow clinicians and researchers to develop interventions to promote PTG, resilience, and benefit finding, and potentially improve post-transplant outcomes such as adherence and reducing risk of organ rejection.
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Affiliation(s)
- Rebekah P. Nash
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marci M. Loiselle
- Division of Behavioral Medicine, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Jessica L. Stahl
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jamie L. Conklin
- Health Science Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Terra L. Rose
- Division of Clinical Rehabilitation and Mental Health Counseling, Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Alissa Hutto
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Donna M. Evon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer E. Flythe
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
| | - Eileen J. Burker
- Division of Clinical Rehabilitation and Mental Health Counseling, Department of Psychiatry and Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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12
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Kim TY, Kim EY, Chang SO. Exploring post-transplant life in kidney transplant recipients taking immunosuppressive medication: A phenomenological study. Collegian 2022. [DOI: 10.1016/j.colegn.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Thind AK, Rule A, Goodall D, Levy S, Brice S, Dor FJMF, Evans N, Ospalla D, Thomas N, Wellsted D, Johansson L, Willicombe M, Brown EA. Prevalence of frailty and cognitive impairment in older transplant candidates - a preview to the Kidney Transplantation in Older People (KTOP): impact of frailty on outcomes study. BMC Nephrol 2022; 23:283. [PMID: 35963988 PMCID: PMC9375902 DOI: 10.1186/s12882-022-02900-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Kidney transplantation in older people has increased, however older transplant recipients experience mixed outcomes that invariably impacts on their quality of life. The increased vulnerability of older end stage kidney disease patients to frailty and cognitive impairment, may partially explain the differences in outcomes observed. The Kidney Transplantation in Older People (KTOP): impact of frailty on clinical outcomes study is an active clinical study aiming to explore the experience of older people waiting for and undergoing transplantation. In this manuscript we present the study protocol, the study cohort, and the prevalence of frailty and cognitive impairment identified at recruitment. METHODS The KTOP study is a single centre, prospective, mixed methods, observational study. Recruitment began in October 2019. All patients aged 60 or above either active on the deceased donor waitlist or undergoing live donor transplantation were eligible for recruitment. Recruited participants completed a series of questionnaires assessing frailty, cognition, and quality of life, which are repeated at defined time points whilst on the waitlist and post-transplant. Clinical data was concurrently collected. Any participants identified as frail or vulnerable were also eligible for enrolment into the qualitative sub-study. RESULTS Two hundred eight participants have been recruited (age 60-78). Baseline Montreal Cognitive Assessments were available for 173 participants, with 63 (36.4%) participants identified as having scores below normal (score < 26). Edmonton Frail Scale assessments were available for 184 participants, with 29 participants (15.8%) identified as frail (score ≥ 8), and a further 37 participants (20.1%) identified as being vulnerable (score 6-7). CONCLUSION In the KTOP study cohort we have identified a prevalence of 36.4% of participants with MoCA scores suggestive of cognitive impairment, and a prevalence of frailty of 15.8% at recruitment. A further 20.1% were vulnerable. As formal testing for cognition and frailty is not routinely incorporated into the work up of older people across many units, the presence and significance of these conditions is likely not known. Ultimately the KTOP study will report on how these parameters evolve over time and following a transplant, and describe their impact on quality of life and clinical outcomes.
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Affiliation(s)
- Amarpreet K. Thind
- grid.7445.20000 0001 2113 8111Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN UK ,grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
| | - Annabel Rule
- grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK ,grid.439764.b0000 0004 0449 9187Central London Community Healthcare NHS Trust, Ground Floor, 15 Marylebone Road, London, NW1 5JD UK
| | - Dawn Goodall
- grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
| | - Shuli Levy
- grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
| | - Sarah Brice
- grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
| | - Frank J. M. F. Dor
- grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK ,grid.7445.20000 0001 2113 8111Department of Surgery and Cancer, Imperial College London, South Kensington Campus, London, SW7 2AZ UK
| | - Nicola Evans
- grid.420545.20000 0004 0489 3985Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London, SE1 9RT UK
| | - David Ospalla
- grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
| | - Nicola Thomas
- grid.4756.00000 0001 2112 2291Institute of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA UK
| | - David Wellsted
- grid.5846.f0000 0001 2161 9644The Centre for Health Services and Clinical Research, The University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB UK
| | - Lina Johansson
- grid.7445.20000 0001 2113 8111Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN UK ,grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
| | - Michelle Willicombe
- grid.7445.20000 0001 2113 8111Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN UK ,grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
| | - Edwina A. Brown
- grid.7445.20000 0001 2113 8111Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN UK ,grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
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14
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Shrestha P, Van Pilsum Rasmussen SE, King EA, Gordon EJ, Faden RR, Segev DL, Humbyrd CJ, McAdams-DeMarco M. Defining the ethical considerations surrounding kidney transplantation for frail and cognitively impaired patients: a Delphi study of geriatric transplant experts. BMC Geriatr 2022; 22:566. [PMID: 35804289 PMCID: PMC9264705 DOI: 10.1186/s12877-022-03209-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/06/2022] [Indexed: 01/22/2023] Open
Abstract
Background Among adult kidney transplant (KT) candidates, 21% are frail and 55% have cognitive impairment, increasing the risk of pre- and post-KT mortality. Centers often assess frailty status and cognitive function during transplant evaluation to help identify appropriate candidate. Yet, there are no ethical guidelines regarding the use of frailty and cognitive function during this evaluation. We seek to develop a clinical consensus on balancing utility and justice in access to KT for frail and cognitively impaired patients. Methods Twenty-seven experts caring for ESRD patients completed a two-round Delphi panel designed to facilitate consensus (> 80% agreement). Results Experts believed that denying patients transplantation based solely on expected patient survival was inequitable to frail or cognitively impaired candidates; 100% agreed that frailty and cognitive impairment are important factors to consider during KT evaluation. There was consensus that health related quality of life and social support are important to consider before waitlisting frail or cognitively impaired patients. Experts identified important factors to consider before waitlisting frail (likely to benefit from KT, frailty reversibility, age, and medical contraindications) and cognitively impaired (degree of impairment and medication adherence) patients. Conclusions Clinical experts believed it was ethically unacceptable to allocate organs solely based on patients’ expected survival; frailty and cognitive impairment should be measured at evaluation when weighed against other clinical factors. Ethical guidelines regarding the use of frailty and cognitive function during KT evaluation ought to be developed. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03209-x.
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Affiliation(s)
- Prakriti Shrestha
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Elizabeth A King
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elisa J Gordon
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ruth R Faden
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA.,Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Casey Jo Humbyrd
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Mara McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Department of Surgery, New York University, New York, USA.
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15
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Schoot TS, Perry M, Hilbrands LB, van Marum RJ, Kerckhoffs APM. Kidney transplantation or dialysis in older adults-an interview study on the decision-making process. Age Ageing 2022; 51:6577232. [PMID: 35511744 DOI: 10.1093/ageing/afac111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In older patients with end-stage kidney disease (ESKD), the choice between kidney transplantation (KT) and dialysis may be more complex than in younger patients because of a higher prevalence of comorbidities and frailty. This study aims to provide greater insight into the current decision-making process by exploring the expectations, experiences and health outcome priorities of all stakeholders. METHODS We performed semi-structured interviews with patients ≥65 years with ESKD (eGFR <15 ml/min/1.73m2, KT recipient or treated with dialysis), patients' relatives and healthcare professionals (nephrologists, nurses and medical social workers). Interviews were conducted until data saturation and thematically analysed. RESULTS We performed 36 interviews (patients n = 18, relatives n = 5, healthcare professionals n = 13). Thematic analysis revealed five themes. Older patients' health outcome priorities were mostly related to quality of life (QOL). Individual older patients showed marked differences in the preferred level of engagement during the decision-making process (varying from 'wants to be in the lead' to 'follows the nephrologist') and in informational needs (varying from evidence-based to experience-based). On the contrary, healthcare professionals were quite unanimous on all aspects. They focused on determining eligibility for KT as start of the decision-making process, on clear and extensive information provision and on classical, medical outcomes. CONCLUSIONS The decision-making process could benefit from early identification of older patients' values, needs and health outcome priorities, in parallel with assessment of KT eligibility and before discussing the treatment options, and the explicit use of this information in further steps of the decision-making process.
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Affiliation(s)
- Tessa S Schoot
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud university medical center , Nijmegen , the Netherlands
- Department of Nephrology, ‘s-Hertogenbosch, Jeroen Bosch Hospital , the Netherlands
| | - Marieke Perry
- Department of Geriatric Medicine, Radboud university medical center , Nijmegen , the Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud university medical center , Nijmegen , the Netherlands
| | - Rob J van Marum
- Department of Geriatric Medicine, ‘s-Hertogenbosch, Jeroen Bosch Hospital , the Netherlands
- Department of Clinical Pharmacology, ‘s-Hertogenbosch, Jeroen Bosch Hospital , the Netherlands
- Department of Elderly Care Medicine, Amsterdam University Medical Center , the Netherlands
| | - Angèle P M Kerckhoffs
- Department of Nephrology, ‘s-Hertogenbosch, Jeroen Bosch Hospital , the Netherlands
- Department of Geriatric Medicine, ‘s-Hertogenbosch, Jeroen Bosch Hospital , the Netherlands
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16
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Sandal S, Ahn JB, Cantarovich M, Chu NM, Segev DL, McAdams-DeMarco MA. Evolving Trends in Risk Profiles and Outcomes in Older Adults Undergoing Kidney Retransplantation. Transplantation 2022; 106:1051-1060. [PMID: 34115459 PMCID: PMC8636546 DOI: 10.1097/tp.0000000000003842] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In older adults (≥65), access to and outcomes following kidney transplantation (KT) have improved over the past 3 decades. It is unknown if there were parallel trends in re-KT. We characterized the trends, changing landscape, and outcomes of re-KT in older adults. METHODS Among the 44,149 older kidney-only recipients (1995-2016) in the Scientific Registry of Transplant Recipients, we identified 1743 who underwent re-KT. We analyzed trends and outcomes (mortality, death-censored graft failure [DCGF]) by eras (1995-2002, 2003-2014, and 2015-2016) that were defined by changes to the expanded criteria donors and Kidney Donor Profile Index policies. RESULTS Among all older kidney-only recipients during 1995-2002, 2003-2014, 2015-2016 the proportion that were re-KTs increased from 2.7% to 4.2% to 5.7%, P < 0.001, respectively. Median age at re-KT (67-68-68, P = 0.04), years on dialysis after graft failure (1.4-1.5-2.2, P = 0.003), donor age (40.0-43.0-43.5, P = 0.04), proportion with panel reactive antibody 80-100 (22.0%-32.7%-48.7%, P < 0.001), and donation after circulatory death (1.1%-13.4%-19.5%, P < 0.001) have increased. Despite this, the 3-y cumulative incidence for mortality (22.3%-19.1%-11.5%, P = 0.002) and DCGF (13.3%-10.0%-5.1%, P = 0.01) decreased over time. Compared with deceased donor retransplant recipients during 1995-2002, those during 2003-2014 and 2015-2016 had lower mortality hazard (aHR = 0.78, 95% confidence interval, 0.63-0.86 and aHR = 0.55, 95% confidence interval, 0.35-0.86, respectively). These declines were noted but not significant for DCGF and in living donor re-KTs. CONCLUSIONS In older retransplant recipients, outcomes have improved significantly over time despite higher risk profiles; yet they represent a fraction of the KTs performed. Our results support increasing access to re-KT in older adults; however, approaches to guide the selection and management in those with graft failure need to be explored.
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Affiliation(s)
- Shaifali Sandal
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec
- Research Institute of the McGill University Health Centre, Montreal, Quebec
| | - JiYoon B. Ahn
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marcelo Cantarovich
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec
- Research Institute of the McGill University Health Centre, Montreal, Quebec
| | - Nadia M. Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mara A. McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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17
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Pardinhas C, Leal R, Figueiredo C, Rodrigues L, Guedes M, Santos L, Romãozinho C, Sá H, Alves R, Figueiredo A. Kidney Retransplant: Not Too Old for a Second Chance. Transplant Proc 2022; 54:1242-1246. [DOI: 10.1016/j.transproceed.2022.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/22/2022] [Accepted: 04/02/2022] [Indexed: 11/16/2022]
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18
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Memory KE, Wilkinson TJ, Smith AC, Lightfoot CJ. A qualitative exploration of the facilitators and barriers to self-management in kidney transplant recipients. J Nephrol 2022; 35:1863-1872. [PMID: 35467326 PMCID: PMC9035973 DOI: 10.1007/s40620-022-01325-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/27/2022] [Indexed: 11/26/2022]
Abstract
Background Understanding the behaviours that facilitate or impede one’s ability to self-manage is important to improve health-related outcomes in kidney transplant recipients (KTRs). Previous studies exploring the self-management experiences of KTRs have focused on specific tasks (e.g., medication adherence), age groups (e.g., adolescent or older recipients), or have been conducted outside of the UK where transferability of findings is unknown. Our study aimed to explore the perceptions and experiences of self-management in UK KTRs to identify facilitators and barriers associated with self-management tasks. Methods Semi-structured interviews were conducted with eleven KTRs. Topics explored included experiences of self-management tasks (diet, exercise, medications, stress management), perceived healthcare role, and future interventional approaches. Thematic analysis was used to identify and report themes. Results Eight themes were identified which were mapped onto the three self-management tasks described by Corbin and Strauss: medical, role and emotional management. Perceived facilitators to self-management were: gathering health-related knowledge, building relationships with healthcare professionals, creating routines within daily life, setting goals and identifying motivators, establishing support networks, and support from family and friends. Complexity of required treatment and adjusting to a new health status were perceived barriers to self-management. Conclusions Participants described the importance of collaborative consultations and continuity of care. Tailored interventions should identify individualised goals and motivators for participating in self-management. Education on effective strategies to manage symptoms and comorbidities could help alleviate KTRs’ perceived treatment burden. Family and peer support could emotionally support KTRs; however, managing the emotional burden of transplantation warrants more attention. Graphic abstract ![]()
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Affiliation(s)
- Katherine E Memory
- Leicester Medical School, University of Leicester, Leicester, UK
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Courtney J Lightfoot
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK.
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19
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Fazal MS, Gordon EJ, Humbyrd CJ. Current Bioethical Issues in Geriatric Organ Transplantation. CURRENT TRANSPLANTATION REPORTS 2022. [DOI: 10.1007/s40472-022-00364-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Beetz NL, Geisel D, Shnayien S, Auer TA, Globke B, Öllinger R, Trippel TD, Schachtner T, Fehrenbach U. Effects of Artificial Intelligence-Derived Body Composition on Kidney Graft and Patient Survival in the Eurotransplant Senior Program. Biomedicines 2022; 10:biomedicines10030554. [PMID: 35327356 PMCID: PMC8945723 DOI: 10.3390/biomedicines10030554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
The Eurotransplant Senior Program allocates kidneys to elderly transplant patients. The aim of this retrospective study is to investigate the use of computed tomography (CT) body composition using artificial intelligence (AI)-based tissue segmentation to predict patient and kidney transplant survival. Body composition at the third lumbar vertebra level was analyzed in 42 kidney transplant recipients. Cox regression analysis of 1-year, 3-year and 5-year patient survival, 1-year, 3-year and 5-year censored kidney transplant survival, and 1-year, 3-year and 5-year uncensored kidney transplant survival was performed. First, the body mass index (BMI), psoas muscle index (PMI), skeletal muscle index (SMI), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) served as independent variates. Second, the cut-off values for sarcopenia and obesity served as independent variates. The 1-year uncensored and censored kidney transplant survival was influenced by reduced PMI (p = 0.02 and p = 0.03, respectively) and reduced SMI (p = 0.01 and p = 0.03, respectively); 3-year uncensored kidney transplant survival was influenced by increased VAT (p = 0.04); and 3-year censored kidney transplant survival was influenced by reduced SMI (p = 0.05). Additionally, sarcopenia influenced 1-year uncensored kidney transplant survival (p = 0.05), whereas obesity influenced 3-year and 5-year uncensored kidney transplant survival. In summary, AI-based body composition analysis may aid in predicting short- and long-term kidney transplant survival.
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Affiliation(s)
- Nick Lasse Beetz
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany; (D.G.); (S.S.); (T.A.A.); (U.F.)
- DZHK (German Center for Cardiovascular Research), 10785 Berlin, Germany;
- Correspondence: ; Tel.: +49-30-45-065-7278
| | - Dominik Geisel
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany; (D.G.); (S.S.); (T.A.A.); (U.F.)
| | - Seyd Shnayien
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany; (D.G.); (S.S.); (T.A.A.); (U.F.)
| | - Timo Alexander Auer
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany; (D.G.); (S.S.); (T.A.A.); (U.F.)
- Berlin Institute of Health, 10178 Berlin, Germany;
| | - Brigitta Globke
- Berlin Institute of Health, 10178 Berlin, Germany;
- Department of Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany;
| | - Robert Öllinger
- Department of Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany;
| | - Tobias Daniel Trippel
- DZHK (German Center for Cardiovascular Research), 10785 Berlin, Germany;
- Department of Internal Medicine—Cardiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Thomas Schachtner
- Division of Nephrology, University Hospital Zurich, 8091 Zürich, Switzerland;
| | - Uli Fehrenbach
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany; (D.G.); (S.S.); (T.A.A.); (U.F.)
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21
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Organization of Post-Transplant Care and the 5-Year Outcomes of Kidney Transplantation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042010. [PMID: 35206198 PMCID: PMC8872049 DOI: 10.3390/ijerph19042010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 12/10/2022]
Abstract
The outcomes of kidney transplantation depend on numerous factors and vary between transplant centers. The aim of this study is to assess the relationship between selected organizational factors, comorbidities, and patient and graft survival. This is a retrospective analysis of 438 renal transplant recipients (RTR) followed for 5 years. Patient and graft survival were evaluated in relation to hospitalization length, distance from the patient's residence to the transplant center, the frequency of outpatient transplant visits, and the number and type of comorbidities. Five-year patient and graft survival rates were 93% and 90%, respectively. We found significant associations of patient survival with the prevalence of pre-transplant diabetes, cardiovascular diseases, malignancies, the number of comorbidities, and the first post-transplant hospitalization length. The incidence of infections, cardiovascular diseases, and transplanted kidney diseases was 60%, 40%, and 33%, respectively. As many as 41% of RTR had unknown etiology of primary kidney disease. In conclusion, the organization of post-transplant care needs to be adapted to the multi-morbidity of contemporary RTR and include multi-specialist care, especially in the context of current problems related to the COVID-19pandemic. The high proportion of patients with undetermined etiology of their primary renal disease carry the risk for additional complications during their long-term follow-up.
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22
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Long-term social outcome after pediatric kidney transplantation: a single-center experience. Clin Exp Nephrol 2022; 26:368-375. [PMID: 34988725 DOI: 10.1007/s10157-021-02158-w] [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: 12/30/2020] [Accepted: 11/05/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patient and graft survival rates after pediatric kidney transplantation have improved recently. Therefore, the quality of life or social outcome after kidney transplantation has become important for patients and their families. METHODS Patients who underwent kidney transplantation at < 18 years old and were observed for > 10 years were included in this study. The median age at first kidney transplantation was 9.2 (interquartile range [IQR] = 5.6-13.0) years; there were 56 males and 50 females. The median age at last follow-up was 29.9 (IQR = 22.2-36.0) years. We evaluated the patients' renal function, growth, professional status, and marital status at the last follow-up. RESULTS The percentage of functioning grafts at the last follow-up was 81.1%; 73 patients (68.9%) had a first graft. The mean estimated GFR was 51.0 ± 20.5 mL/min/1.73 m2. Twenty patients received dialysis for graft failure. The mean final heights of the males and females were 158.1 ± 9.2 cm (- 2.2 standard deviations) and 149.1 ± 6.4 cm (- 1.7 standard deviations), respectively. Excluding 23 students, 63 patients (75.9%) were employed. Office worker was the most common profession. Twelve patients (14.5%) were unemployed. Of patients > 20 years old, 14 (16.7%), three males and 11 females, were married. Five females had one child each. CONCLUSIONS The graft survival rate was favorable. The final height was short, particularly in male. The rate of employment was relatively high. The rate of marriage and having children were still low. Improving the social outcome is an important problem after pediatric kidney transplantation.
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23
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Fusfeld L, Menon S, Gupta G, Lawrence C, Masud SF, Goss TF. US payer budget impact of a microarray assay with machine learning to evaluate kidney transplant rejection in for-cause biopsies. J Med Econ 2022; 25:515-523. [PMID: 35345966 DOI: 10.1080/13696998.2022.2059221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM This study evaluates the economic impact to US commercial payers of MMDx-Kidney used in conjunction with histologic evaluation of for-cause kidney transplant biopsies. MATERIALS AND METHODS An Excel-based model was developed to assess the cost impact of histology plus MMDx-Kidney versus histology alone for the evaluation of potential rejection in kidney transplant patients who receive a for-cause biopsy. Different model time periods were assessed, ranging from 1 to 5 years post-biopsy. A targeted literature review was used to identify parameter estimates, validated by two external clinicians with expertise in managing kidney transplant rejection. A sensitivity analysis was conducted to evaluate the relative impact of key clinical and cost parameters. In particular, the model identified the magnitude of MMDx-Kidney's impact on graft failure from rejection that would be required for MMDx-Kidney to be cost-neutral. RESULTS By more accurately characterizing rejection, MMDx-Kidney is estimated to increase antirejection treatment costs by $1,126 per test. Nevertheless, a break-even analysis shows that the costs of MMDx-Kidney and anti-rejection medication, as well as the costs associated with an increase in the number of patients with functioning transplants, may be offset by reductions in costs associated with graft failure (i.e. costs of hospitalizations, dialysis, and repeat transplants) over 5 years, assuming MMDx-Kidney reduces annual graft failure from rejection by at least 5%. For the base case, with a 25% relative reduction in annual rate of graft failures from rejection, MMDx-Kidney increases overall costs incurred in the first year of the model but starts generating savings by the second year of the model. CONCLUSIONS Compared with histologic evaluation of for-cause kidney transplant biopsies alone, the use of MMDx-Kidney in conjunction with histologic evaluation improves the diagnoses of graft dysfunction and may have the potential to generate overall savings from reductions in rejection-related graft failure.
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Affiliation(s)
- Lauren Fusfeld
- Boston Healthcare Associates, Inc. (now a Veranex company), Boston, MA, USA
| | - Sreeranjani Menon
- Boston Healthcare Associates, Inc. (now a Veranex company), Boston, MA, USA
| | - Gaurav Gupta
- Division of Nephrology, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Salwa F Masud
- Boston Healthcare Associates, Inc. (now a Veranex company), Boston, MA, USA
| | - Thomas F Goss
- Boston Healthcare Associates, Inc. (now a Veranex company), Boston, MA, USA
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24
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Jankowska M, Bzoma B, Małyszko J, Małyszko J, Słupski M, Kobus G, Włodarczyk Z, Rutkowski B, Dębska-Ślizień A. Early outcomes and long-term survival after kidney transplantation in elderly versus younger recipients from the same donor in a matched-pairs analysis. Medicine (Baltimore) 2021; 100:e28159. [PMID: 34941068 PMCID: PMC8702131 DOI: 10.1097/md.0000000000028159] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 11/18/2021] [Indexed: 01/05/2023] Open
Abstract
The elderly are the fastest-growing population on waiting lists for kidney transplantation (KTx). Recognized barriers to KTx in the elderly is early post-transplant mortality and morbidity. To analyze the outcomes of KTx in recipients older than 60 years and, simultaneously, in their younger paired recipients, receiving a graft from the same donor.We included 328 kidney transplant recipients in the study. The elderly kidney transplant recipients (EKT) group included 164 patients aged 65 standard deviation (SD4) years. They were paired with younger kidney transplant recipients (YKT) aged 45 (SD12) years.The studied groups (EKT vs YKT) did not differ from the graft function estimated 1 year after the transplantation (50.7 mL/min vs 54.0 mL/min), while the estimated glomerular filtration rate decline was significantly faster in the YKT group. One-year patient survival (93.9% vs 97.0%), 1-year graft survival (90.4% vs 82.3%), and incidences of delayed graft function and acute rejection did not differ between the EKT and YKT groups. Significantly more cardiovascular complications and post-transplant diabetes mellitus were noticed in the EKT group. The long-term patient and graft survivals were poorer in the EKT group versus the YKT group, but death-censored graft survivals were the same. After having excluded donor-derived graft factors, there were no differences in the first-year outcome of KTx between recipients younger and older than 60 years. As life expectancy is lower in the EKT group, the probability of patient and graft survival was also significantly lower in this group. However, death-censored graft survival was not different in the EKT and YKT groups.
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Affiliation(s)
- Magdalena Jankowska
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland
| | - Beata Bzoma
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
- Ist Department of Nephrology and Transplantology with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| | - Jacek Małyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
- Ist Department of Nephrology and Transplantology with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| | - Maciej Słupski
- Department of General, Hepatobiliary and Transplant Surgery, Collegium Medicum Nicolaus Copernicus University Bydgoszcz, Bydgoszcz, Poland
| | - Grażyna Kobus
- Department of Clinical Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Zbigniew Włodarczyk
- Department of Transplantology and General Surgery, Collegium Medicum Nicolaus Copernicus University Bydgoszcz, Bydgoszcz, Poland
| | - Bolesław Rutkowski
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland
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25
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Cooper TE, Dalton A, Kieu A, Howell M, Jayanti S, Khalid R, Lim WH, Scholes-Robertson N, Craig JC, Teixeira-Pinto A, Bourke MJ, Tong A, Wong G. The CKD bowel health study: understanding the bowel health and gastrointestinal symptom management in patients with chronic kidney disease: a mixed-methods observational longitudinal study (protocol). BMC Nephrol 2021; 22:388. [PMID: 34802445 PMCID: PMC8606224 DOI: 10.1186/s12882-021-02600-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Gastro-intestinal (GI) intolerance is a frequently reported outcome in patients with kidney failure receiving maintenance dialysis and those who have received kidney transplants. Symptoms of GI intolerance (diarrhoea, constipation, bloating, abdominal pain, heart burn, and reflux) are associated with significant reduction in quality of life, morbidity, and increased used of healthcare resources. Having chronic kidney disease (CKD), together with related changes in diet and medication, may alter the gut microbiota and the microbial-derived uraemic metabolites that accumulate in kidney failure, and contribute to various complications including chronic diarrhoea, opportunistic infections, and drug-related colitis. Despite the high disease burden among patients with kidney replacement therapies, GI symptoms are often under-recognised and, consequently limited resources and strategies are devoted to the management of gastrointestinal complications in patients with CKD. METHODS The CKD Bowel Health Study is a multi-centre mixed-methods observational longitudinal study to better understand the bowel health and GI symptom management in patients with CKD. The program comprises of a longitudinal study that will assess the burden and risk factors of GI intolerance in patients treated with maintenance dialysis; a semi-structured interview study that will describe experiences of GI intolerance (including symptoms, treatment, self-management) in transplant candidates and recipients; and a discrete choice experience to elicit patient preferences regarding their experiences and perspectives of various intervention strategies for the management of GI symptoms after kidney transplantation. DISCUSSION This proposed program of work aims to define the burden the GI intolerance in patients with kidney failure and generate evidence on the patients' experiences of GI intolerance and their perspectives on their clinical and own management strategies of these symptoms, ensuring a patient-centred approach to guide clinical decision making and to inform the best study design for intervention trials. TRIAL REGISTRATION This study is registered on the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000548831 . This study has been approved by the Western Sydney Local Health District Human Research Ethics Committee of New South Wales Health (HREC ETH03007). This study is supported by a National Health and Medical Research Council (NHMRC) Australia Investigator Grant (APP1195414), and an NHMRC Australia Postgraduate Scholarship (APP2005244).
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Affiliation(s)
- Tess E Cooper
- Cochrane Kidney and Transplant, The Children's Hospital at Westmead, Westmead, Australia. .,Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia. .,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.
| | - Amy Dalton
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Anh Kieu
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | | | - Rabia Khalid
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Wai H Lim
- Sir Charles Gairdner Hospital, Nedlands, Australia.,School of Medicine, University of Western Australia, Perth, Australia
| | - Nicole Scholes-Robertson
- Cochrane Kidney and Transplant, The Children's Hospital at Westmead, Westmead, Australia.,Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Jonathan C Craig
- Cochrane Kidney and Transplant, The Children's Hospital at Westmead, Westmead, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Michael J Bourke
- Westmead Hospital, Westmead, Australia.,School of Medicine, The University of Sydney, Sydney, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.,Westmead Hospital, Westmead, Australia
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26
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Tang J, Kerklaan J, Wong G, Howell M, Scholes-Robertson N, Guha C, Kelly A, Tong A. Perspectives of solid organ transplant recipients on medicine-taking: Systematic review of qualitative studies. Am J Transplant 2021; 21:3369-3387. [PMID: 33866675 DOI: 10.1111/ajt.16613] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/16/2021] [Accepted: 04/02/2021] [Indexed: 01/25/2023]
Abstract
Medicine-taking among transplant recipients is a complex and ubiquitous task with significant impacts on outcomes. This study aimed to describe the perspectives and experiences of medicine-taking in adult solid organ transplant recipients. Electronic databases were searched to July 2020, and thematic synthesis was used to analyze the data. From 119 studies (n = 2901), we identified six themes: threats to identity and ambitions (impaired self-image, restricting goals and roles, loss of financial independence); navigating through uncertainty and distrust (lacking tangible/perceptible benefits, unprepared for side effects, isolation in decision-making); alleviating treatment burdens (establishing and mastering routines, counteracting side effects, preparing for the unexpected); gaining and seeking confidence (clarity with knowledge, reassurance through collective experiences, focusing on the future outlook); recalibrating to a new normal posttransplant (adjusting to ongoing dependence on medications, in both states of illness and health, unfulfilled expectations); and preserving graft survival (maintaining the ability to participate in life, avoiding rejection, enacting a social responsibility of giving back). Transplant recipients take medications to preserve graft function, but dependence on medications jeopardizes their sense of normality. Interventions supporting the adaptation to medicine-taking and addressing treatment burdens may improve patient satisfaction and capacities to take medications for improved outcomes.
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Affiliation(s)
- James Tang
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jasmijn Kerklaan
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Department of Pediatric Nephrology, Academic Medical Center, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Ayano Kelly
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
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27
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Peripheral Vascular Disease and Kidney Transplant Outcomes: Rethinking an Important Ongoing Complication. Transplantation 2021; 105:1188-1202. [PMID: 33148978 DOI: 10.1097/tp.0000000000003518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Peripheral vascular disease (PVD) is highly prevalent in patients on the waiting list for kidney transplantation (KT) and after transplantation and is associated with impaired transplant outcomes. Multiple traditional and nontraditional risk factors, as well as uremia- and transplant-related factors, affect 2 processes that can coexist, atherosclerosis and arteriosclerosis, leading to PVD. Some pathogenic mechanisms, such as inflammation-related endothelial dysfunction, mineral metabolism disorders, lipid alterations, or diabetic status, may contribute to the development and progression of PVD. Early detection of PVD before and after KT, better understanding of the mechanisms of vascular damage, and application of suitable therapeutic approaches could all minimize the impact of PVD on transplant outcomes. This review focuses on the following issues: (1) definition, epidemiological data, diagnosis, risk factors, and pathogenic mechanisms in KT candidates and recipients; (2) adverse clinical consequences and outcomes; and (3) classical and new therapeutic approaches.
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28
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Doucet BP, Cho Y, Campbell SB, Johnson DW, Hawley CM, Teixeira-Pinto ARM, Isbel NM. Kidney Transplant Outcomes in elderly Recipients: An Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry Study. Transplant Proc 2021; 53:1915-1926. [PMID: 34275599 DOI: 10.1016/j.transproceed.2021.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/14/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND There is an increase in elderly patients receiving kidney transplant internationally. This study describes elderly kidney transplant recipient outcomes in Australia and New Zealand. METHODS The study included all adult first kidney transplant recipients in Australia and New Zealand from 2000 to 2015. Survival and graft outcomes were compared between elderly (≥70 years) and younger (18-69 years) recipients using Cox proportional hazards regression. RESULTS Overall, 10651 kidney transplant recipients were included, of which 279 (2.6%) were elderly adults. The proportion of elderly recipients increased from 0.6 to 4.4% from 2000 to 2015. Compared with younger recipients, elderly recipients were more likely to receive kidneys from deceased donors, elderly donors, and expanded criteria donors. Elderly recipients experienced poorer patient survival with 1- and 5-year survival ranging from 96% to 97% and 79% to 81%, respectively, compared with 97% to 99% and 90% 95% in younger recipients, respectively. Elderly recipients experienced comparable rates of delayed graft function and, in living donor kidney recipients, lower rates of acute rejection. CONCLUSIONS Kidney transplantation in the elderly population is increasing. Although elderly recipients had inferior survival and graft outcomes, elderly recipients generally received poorer quality kidneys. The outcomes achieved in this cohort of elderly adults are encouraging, and improving elderly recipient outcomes should be an important focus for research.
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Affiliation(s)
- Brian Percy Doucet
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; Translational Research Institute, Brisbane, Queensland, Australia; Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Scott Bryan Campbell
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; Centre for Kidney Disease Research, The University of Queensland, Brisbane, Queensland, Australia
| | - David Wayne Johnson
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; Translational Research Institute, Brisbane, Queensland, Australia; Centre for Kidney Disease Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Carmel Mary Hawley
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia; Centre for Kidney Disease Research, The University of Queensland, Brisbane, Queensland, Australia; Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Armando Rogerió Martins Teixeira-Pinto
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nicole Maree Isbel
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; Translational Research Institute, Brisbane, Queensland, Australia; Centre for Kidney Disease Research, The University of Queensland, Brisbane, Queensland, Australia
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29
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Désy O, Vallin P, Béland S, Bouchard-Boivin F, Gama AP, De Serres SA. Longitudinal immune profile reveals reduced function of pro-inflammatory monocytes with age following kidney transplantation. Am J Transplant 2021; 21:1147-1159. [PMID: 32777159 DOI: 10.1111/ajt.16249] [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: 01/22/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 01/25/2023]
Abstract
Toxicity of immunosuppression, notably the risk of infection, increases with age. However, the dynamic changes in innate immune response following transplantation are unclear. Based on recent observations, we hypothesized that pro-inflammatory capacity would decrease with age. We analyzed approximately 300 PBMC samples collected longitudinally in 45 de novo, adult kidney recipients and performed detailed phenotypic and functional profiling of monocytes and T cell subsets. Inflammatory response to TLR4 stimulation and indirect allostimulation using mismatched HLA peptides were assessed. In patients aged ≥56 years, TNF-α production by intermediate monocytes was similar to that in younger patients early posttransplant, but diminished substantially later. Adjusted analyses suggested that this was not attributable to confounding factors. In contrast, the alloimmune response to HLA peptides measured by IFN-γ in CD4+ T cells and TNF-α in monocytes was stable over time, but was low in older recipients. Measurement of CD80-86 surface expression revealed no signal for a lower costimulation capacity of APCs. These results suggest that older recipients have a reduced function of their innate pro-inflammatory immune cells posttransplant while maintaining a stable, low alloimmune response over time. The effect of reduced immunosuppressant doses on preventing this phenomenon needs to be clarified.
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Affiliation(s)
- Olivier Désy
- Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Patrice Vallin
- Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Stéphanie Béland
- Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - François Bouchard-Boivin
- Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Alcino P Gama
- Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Sacha A De Serres
- Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada
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30
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Butler CR, Wightman A, Richards CA, Laundry RS, Taylor JS, Hebert PL, Liu CF, O'Hare AM. Thematic Analysis of the Health Records of a National Sample of US Veterans With Advanced Kidney Disease Evaluated for Transplant. JAMA Intern Med 2021; 181:212-219. [PMID: 33226419 PMCID: PMC7684522 DOI: 10.1001/jamainternmed.2020.6388] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE To be considered for a kidney transplant, patients with advanced kidney disease must participate in a formal evaluation and selection process. Little is known about how this process proceeds in real-world clinical settings. OBJECTIVE To characterize the transplant evaluation process among a representative national sample of US veterans with advanced kidney disease who were referred to a kidney transplant center. DESIGN, SETTING, AND PARTICIPANTS This qualitative study was a thematic analysis of clinician notes in the electronic health records of US veterans referred for kidney transplant evaluation. In a random sample of 4000 patients with advanced kidney disease between January 1, 2004, and December 31, 2014, cared for in the US Department of Veterans Affairs (VA) health care system, there were 211 patients who were referred to a transplant center during the follow-up period. This group was included in the qualitative analysis and was followed up until their date of death or the end of the follow-up period on October 8, 2019. MAIN OUTCOMES AND MEASURES Dominant themes pertaining to the kidney transplant evaluation and selection process identified through thematic analysis. RESULTS Among 211 study patients, the mean (SD) age was 57.9 (9.5) years, and 202 patients (95.7%) were male. The following 4 dominant themes regarding the transplant evaluation process emerged: (1) far-reaching and inflexible medical evaluation, in which patients were expected to complete an extensive evaluation that could have substantial physical and emotional consequences, made little accommodation for their personal values and needs, and impacted other aspects of their care; (2) psychosocial valuation, in which the psychosocial component of the transplant assessment could be subjective and intrusive and could place substantial demands on patients' family members; (3) surveillance over compliance, in which the patients' ability and willingness to follow medical recommendations was an important criterion for transplant candidacy and their adherence to a wide range of recommendations and treatments was closely monitored; and (4) disempowerment and lack of transparency, in which patients and their local clinicians were often unsure about what to expect during the evaluation process or about the rationale for selection decisions. For the evaluation process to proceed, local clinicians had to follow transplant center requirements even when they believed the requirements did not align with best practices or the patients' needs. CONCLUSIONS AND RELEVANCE In this qualitative study of US veterans with advanced kidney disease evaluated for transplant, clinician documentation in the medical record indicated that, to be considered for a kidney transplant, patients were required to participate in a rigid, demanding, and opaque evaluation and selection process over which they and their local clinicians had little control. These findings highlight the need for a more evidence-based, individualized, and collaborative approach to kidney transplant evaluation.
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Affiliation(s)
- Catherine R Butler
- Division of Nephrology, Department of Medicine, University of Washington, Seattle.,Hospital and Specialty Medicine, Geriatrics and Extended Care and Seattle-Denver Health Services Research and Development Center of Innovation, VA Puget Sound Health Care System, Seattle, Washington
| | - Aaron Wightman
- Department of Pediatrics, University of Washington School of Medicine, Seattle.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, Washington
| | - Claire A Richards
- Hospital and Specialty Medicine, Geriatrics and Extended Care and Seattle-Denver Health Services Research and Development Center of Innovation, VA Puget Sound Health Care System, Seattle, Washington.,School of Nursing, University of Washington, Seattle
| | - Ryan S Laundry
- Hospital and Specialty Medicine, Geriatrics and Extended Care and Seattle-Denver Health Services Research and Development Center of Innovation, VA Puget Sound Health Care System, Seattle, Washington
| | - Janelle S Taylor
- Department of Anthropology, University of Toronto, Toronto, Ontario, Canada
| | - Paul L Hebert
- Hospital and Specialty Medicine, Geriatrics and Extended Care and Seattle-Denver Health Services Research and Development Center of Innovation, VA Puget Sound Health Care System, Seattle, Washington.,Department of Health Services Research, University of Washington, Seattle
| | - Chuan-Fen Liu
- Hospital and Specialty Medicine, Geriatrics and Extended Care and Seattle-Denver Health Services Research and Development Center of Innovation, VA Puget Sound Health Care System, Seattle, Washington.,Department of Health Services Research, University of Washington, Seattle
| | - Ann M O'Hare
- Division of Nephrology, Department of Medicine, University of Washington, Seattle.,Hospital and Specialty Medicine, Geriatrics and Extended Care and Seattle-Denver Health Services Research and Development Center of Innovation, VA Puget Sound Health Care System, Seattle, Washington
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31
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O'Brien T, Russell CL, AlKahlout N, Rosenthal A, Meyer T, Tan A, Daloul R, Hathaway D. Recruitment of Older Kidney Transplant Recipients to a Longitudinal Study. Nurs Res 2020; 69:233-237. [PMID: 31688340 PMCID: PMC7313092 DOI: 10.1097/nnr.0000000000000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Currently, limited information is available regarding selection of the most successful strategies for recruitment of older adult kidney transplant recipients as research participants. OBJECTIVE The aim of this study was to explore multiple modes of recruitment strategies to enroll older kidney transplant recipients in a 1-year longitudinal study. METHODS We used a feasibility design to explore the following recruitment methods: face-to-face contact in the transplant clinic, paper flyers placed in the transplant clinic, Facebook, an online transplant newsletter, and a university website listing of research studies. RESULTS Enrollment was open for 9 months, during which time websites and the Facebook portal were active, 142 newsletters were e-mailed, and 424 patients were approached in the transplant clinic. Among patients approached in the clinic, 12 did not own a smartphone required for the study. The sample consisted of 60 participants (39 men, 21 women), with a mean age of 64.5 ± 4.7 years. Of the participants who enrolled in the study, the largest number (75%, n = 45) was recruited using the face-to-face method in the transplant clinic. The online transplant newsletter was the second-best recruitment source (18%, n = 11). DISCUSSION Recruitment strategies using face-to-face contact and the online newsletter associated with the transplant clinic organization appeared to be more effective than strategies not associated with the transplant clinic (Facebook and university website). Findings suggest that using a familiar organization communication method to recruit older chronic disease population may be the most beneficial.
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Affiliation(s)
- Tara O'Brien
- Tara O'Brien, PhD, RN, CNE, is an Assistant Professor; Noor AlKahlout, BS, Anna Rosenthal, SN, and Tess Meyer SN, are Research Team Members; and Alai Tan, PhD, is a Research Associate Professor at The Ohio State University College of Nursing, Columbus. Cynthia Russell PhD, RN, FAAN, is a Professor at the School of Nursing and Health Studies, University of Missouri-Kansas City. Reem Daloul, MD, is an Assistant Professor at The Ohio State University College of Medicine, Columbus. Donna Hathaway PhD, RN, FAAN, is a Distinguished Professor at the University of Tennessee Health Science Center, Memphis
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32
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Nolley E, Fleck J, Kavalieratos D, Dew MA, Dilling D, Colman R, Crespo MM, Goldberg H, Hays S, Hachem R, Lease E, Lee J, Reynolds J, Morrell M, Schenker Y. Lung Transplant Pulmonologists' Views of Specialty Palliative Care for Lung Transplant Recipients. J Palliat Med 2020; 23:619-626. [PMID: 31895634 PMCID: PMC7232634 DOI: 10.1089/jpm.2019.0222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Lung transplant recipients with serious illness may benefit from but rarely receive specialty palliative care (SPC) services. Transplant pulmonologists' views of SPC may be key to understanding SPC utilization but have not been well characterized. Objectives: (1) To understand how transplant pulmonologists view SPC and decide to refer transplant recipients and (2) to identify unique aspects of lung transplantation that may influence referral decisions. Design: We conducted semistructured interviews with transplant pulmonologists at nine geographically diverse high-volume North American transplant centers with SPC services. A multidisciplinary team analyzed interview transcripts using constant comparative methods to inductively develop and refine a coding framework related to SPC views and referral decisions. Results: We interviewed 38 transplant pulmonologists; most (36/38) had referred lung transplant recipients to SPC. Participants described SPC as a medical specialty that aims to improve quality of life and distinguished SPC from hospice care, which was considered end-of-life care. Participants who viewed transplant as a temporary solution (n = 17/38, 45%) described earlier utilization of SPC alongside disease-directed therapies, whereas those who viewed transplant as survival-focused (n = 21/38, 55%) described utilization of SPC after disease-directed therapies were exhausted. Concerns about one-year survival metrics and use of addicting medications for symptom palliation were barriers to referral. Conclusions: Transplant pulmonologists' SPC referral practices may be related to their views of lung transplantation. Optimizing use of SPC in lung transplantation will require improving communication between transplant pulmonology and SPC to ensure a collaborative effort toward patient-centered goals while addressing unique barriers to SPC referral.
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Affiliation(s)
- Eric Nolley
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jessica Fleck
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dio Kavalieratos
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel Dilling
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Loyola, Chicago, Illinois, USA
| | - Rebecca Colman
- Division of Respirology and Division of Palliative Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maria M. Crespo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hiliary Goldberg
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Steven Hays
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Ramsey Hachem
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in St Louis, St. Louis, Missouri, USA
| | - Erika Lease
- Department of Medicine, Division of Pulmonary Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - James Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Reynolds
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Matthew Morrell
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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33
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Renal transplantation in the elderly: Outcomes and recommendations. Transplant Rev (Orlando) 2020; 34:100530. [DOI: 10.1016/j.trre.2020.100530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/09/2019] [Accepted: 12/18/2019] [Indexed: 12/20/2022]
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34
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Shah VH, Rao MK. Changing Landscape of Solid Organ Transplantation for Older Adults: Trends and Post-Transplant Age-Related Outcomes. CURRENT TRANSPLANTATION REPORTS 2020. [DOI: 10.1007/s40472-020-00275-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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35
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Kayler LK, Majumder M, Bonner K, Ranahan M, Dolph B, Cadzow R, Feeley TH. Development and preliminary evaluation of an animation (simplifyKDPI) to improve kidney transplant candidate understanding of the Kidney Donor Profile Index. Clin Transplant 2020; 34:e13805. [PMID: 32003076 DOI: 10.1111/ctr.13805] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/27/2019] [Accepted: 01/23/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Transplant candidates are reluctant to accept kidneys from high Kidney Donor Profile Index (KDPI) donors. Incomplete understanding can lead to transplant delays for older transplant candidates. Patients need access to understandable information to make more informed decisions about KDPI. METHODS We developed a KDPI-specific animation with input from six stakeholder groups and conducted a one-group pre-post study with 60 kidney transplant candidates for feasibility and acceptability to improve participant KDPI knowledge, understanding, decisional self-efficacy, and willingness to accept a KDPI > 85% kidney. Data were compared using McNemar's test and Wilcoxon signed-rank test. RESULTS Compared with pre-animation scores, post-animation scores were significantly higher for KDPI knowledge for the entire cohort (4.6 vs 6.1, P < .001) and across different levels of age, educational attainment, health literacy, vintage, and technology access. The frequency of positive responses increased pre-post animation for KDPI understanding (55% vs 83%, P < .001) and decisional self-efficacy (47% vs 75%, P < .001). However, willingness to accept KDPI > 85% kidneys (32% vs 36%, P = .83) increased by 2%. After viewing simplifyKDPI, >90% indicated positive ratings on ease of watching, understanding, and engaging. CONCLUSION In collaboration with stakeholders, an educational animation about KDPI was developed that was well-received and is promising to impact knowledge.
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Affiliation(s)
- Liise K Kayler
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Surgery, State University of New York at Buffalo, Buffalo, New York.,Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, New York
| | - Monami Majumder
- Department of Surgery, State University of New York at Buffalo, Buffalo, New York
| | - Keisha Bonner
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Surgery, State University of New York at Buffalo, Buffalo, New York.,Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, New York
| | - Molly Ranahan
- Department of Family Medicine, Primary Care Research Institute, State University of New York at Buffalo, Buffalo, New York
| | - Beth Dolph
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Renee Cadzow
- Department of Health Services Administration, D'Youville College, Buffalo, New York
| | - Thomas H Feeley
- Department of Communication, State University of New York at Buffalo, Buffalo, New York
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36
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Psychosocial dimensions of hand transplantation: lessons learned from solid organ transplantation. Curr Opin Organ Transplant 2019; 24:705-713. [PMID: 31689261 DOI: 10.1097/mot.0000000000000712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The present review examines psychosocial factors emerging as predictive of clinical outcomes among solid organ transplant (SOT) recipients, with possible extensions to vascular composite allograft (VCA) and hand transplantation, in particular. The Chauvet Workgroup report and International Society of Heart and Lung Transplantation consensus guidelines are used to delineate areas of commonality between SOT and VCA, as well as unique features contributing to post-VCA psychosocial risk. RECENT FINDINGS Increasing evidence suggests that depression, cognitive function, and other posttransplant psychosocial factors consistently associate with clinical risk in SOT. However, the mechanisms precipitating these psychosocial risk factors are likely diverse in their cause, with large individual differences across SOT and VCA. Transdiagnostic dimensions may serve as mechanistic factors, increasing the risk of adverse clinical outcomes and suggesting potential treatment strategies for risk mitigation. Psychosocial dimensions including psychological flexibility, self-efficacy, and posttraumatic growth are discussed as potential contributory factors. SUMMARY Psychosocial factors hold importance in predicting posttransplant clinical outcomes. Emerging transdiagnostic factors may provide insight into mechanisms and potential treatments.
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37
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Ju A, Chow BY, Ralph AF, Howell M, Josephson MA, Ahn C, Butt Z, Dobbels F, Fowler K, Jowsey-Gregoire S, Jha V, Locke JE, Tan JC, Taylor Q, Rutherford C, Craig JC, Tong A. Patient-reported outcome measures for life participation in kidney transplantation: A systematic review. Am J Transplant 2019; 19:2306-2317. [PMID: 30664327 DOI: 10.1111/ajt.15267] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/07/2019] [Accepted: 01/13/2019] [Indexed: 01/25/2023]
Abstract
For many patients with end-stage kidney disease, transplantation improves survival and quality of life compared with dialysis. However, complications and side effects in kidney transplant recipients can limit their ability to participate in activities of daily living including work, study, and recreational activities. The aim of this study was to identify the characteristics, content, and psychometric properties of the outcome measures used to assess life participation in kidney transplant recipients. We searched MEDLINE, Embase, PsycINFO, and CINAHL from inception to July 2018 for all studies that reported life participation in kidney transplant recipients. Two authors identified instruments measuring life participation and reviewed for characteristics. In total, 230 studies were included: 19 (8%) randomized trials, 17 (7%) nonrandomized trials, and 194 (85%) observational studies. Across these studies, we identified 29 different measures that were used to assess life participation. Twelve (41%) measures specifically assessed aspects of life participation (eg, disability assessment, daily activities of living), while 17 (59%) assessed other constructs (eg, quality of life) that included questions on life participation. Validation data to support the use of these measures in kidney transplant recipients were available for only 7 measures. A wide range of measures have been used to assess life participation in kidney transplant recipients, but validation data supporting the use of these measures in this population are sparse. A content relevant and validated measure to improve the consistency and accuracy of measuring life participation in research may inform strategies for transplant recipients to be better able to engage in their life activities.
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Affiliation(s)
- Angela Ju
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Bi Yang Chow
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Angelique F Ralph
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | | | - Curie Ahn
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Zeeshan Butt
- Departments of Medical Social Sciences and Surgery (Division of Organ Transplantation), Northwestern University, Chicago, Illinois
| | | | - Kevin Fowler
- Kidney Health Initiative, Patient Family Partnership Council, The Voice of the Patient, Elmhurst, Illinois
| | | | | | - Jayme E Locke
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Jane C Tan
- Department of Medicine, Stanford University, Stanford, California
| | | | - Claudia Rutherford
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia.,Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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38
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Perceptions, Barriers, and Experiences With Successful Aging Before and After Kidney Transplantation: A Focus Group Study. Transplantation 2019; 104:603-612. [PMID: 31283666 DOI: 10.1097/tp.0000000000002848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND End-stage kidney disease (ESKD) patients are living longer, often into older age, and commonly pursue kidney transplantation. Successful aging, a multidimensional construct of physical and social wellbeing, has been expanded and adapted for patients with chronic disease. However, perceptions of, barriers to, and experiences with successful aging among adults with ESKD are unclear and likely differ based on whether they have received a kidney transplant. METHODS Ten focus groups were held with 39 total ESKD patients aged ≥50 years (19 transplant candidates, 20 transplant recipients). Transcriptions were analyzed thematically by 2 independent coders using an inductive, constant comparative approach. RESULTS The mean age was 64.8 (SD = 7.5); 51% were African American and 64% were males. Six themes were identified: familiarity with successful aging, perceptions of successful aging after ESKD diagnosis, barriers to successful aging, experiences with successful aging among transplant candidates, experiences with successful aging among transplant recipients, and suggested interventions. While all participants sought to achieve successful aging while living with ESKD, experiences with successful aging differed between candidates and recipients. Candidates struggled with the limitations of dialysis; some viewed transplantation as an opportunity to age successfully, while others were resigned to the drawbacks of dialysis. In contrast, transplant recipients were optimistic about their ability to age successfully, believing their transplant facilitated successful aging. Participants believed support groups for adults with ESKD and more thoughtful health care for aging adults would promote successful aging. CONCLUSIONS Adults with ESKD may benefit from discussions with their clinicians and caregivers about goals, barriers, and strategies regarding successful aging.
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39
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Lorenz EC, Egginton JS, Stegall MD, Cheville AL, Heilman RL, Nair SS, Mai ML, Eton DT. Patient experience after kidney transplant: a conceptual framework of treatment burden. J Patient Rep Outcomes 2019; 3:8. [PMID: 30701333 PMCID: PMC6353980 DOI: 10.1186/s41687-019-0095-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 01/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kidney transplant recipients face a lifelong regimen of medications, health monitoring and medical appointments. This work involved in managing one's health and its impact on well-being are referred to as treatment burden. Excessive treatment burden can adversely impact adherence and quality of life. The aim of this study was to develop a conceptual framework of treatment burden after kidney transplantation. Qualitative interviews were conducted with kidney transplant recipients (n = 27) from three Mayo Clinic transplant centers. A semi-structured interview guide originally developed in patients with chronic conditions and tailored to the context of kidney transplantation was utilized. Themes of treatment burden after kidney transplantation were confirmed in two focus groups (n = 16). RESULTS Analyses confirmed three main themes of treatment burden after kidney transplantation: 1) work patients must do to care for their health (e.g., attending medical appointments, taking medications), 2) challenges/stressors that exacerbate felt burden (e.g., financial concerns, health system obstacles) 3) impacts of burden (e.g., role/social activity limitations). CONCLUSIONS Patients describe a significant amount of work involved in caring for their kidney transplants. This work is exacerbated by individual, interpersonal and system-related factors. The framework will be used as a foundation for a patient-reported measure of treatment burden to promote better care after kidney transplantation.
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Affiliation(s)
- Elizabeth C Lorenz
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA. .,Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, USA.
| | - Jason S Egginton
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, USA
| | - Mark D Stegall
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Andrea L Cheville
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, USA
| | - Raymond L Heilman
- Mayo Clinic Arizona Transplant Center, Mayo Clinic, Phoenix, AZ, USA
| | | | - Martin L Mai
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - David T Eton
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, USA.,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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40
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Lønning K, Midtvedt K, Heldal K, Andersen MH. Older kidney transplantation candidates' expectations of improvement in life and health following kidney transplantation: semistructured interviews with enlisted dialysis patients aged 65 years and older. BMJ Open 2018; 8:e021275. [PMID: 29934388 PMCID: PMC6020985 DOI: 10.1136/bmjopen-2017-021275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The aim was to study the expectations of improvement in life and health following kidney transplantation (KTx) in a population of wait-listed patients ≥65 years with end-stage kidney disease. DESIGN Qualitative research with individual in-depth interviews. SETTING Patients on dialysis enlisted for a KTx from a deceased donor were included from an ongoing study of older patients' perspectives on KTx. Qualitative face-to-face interviews were conducted in a safe and familiar setting, and were analysed thematically using the theoretical framework of lifespan. INFORMANTS Fifteen patients (median age 70 years, range 65-82) from all parts of Norway were interviewed. Informants were included consecutively until no new information was gained. RESULTS Two main themes were evident: receiving a kidney is getting life back and grasp the chance. In addition, the themes 'hard to loose capacity and strength', 'reduced freedom' and 'life on hold' described the actual situation and thereby illuminated the informants' expectations. The informants tried to balance positive expectations and realism towards KTx, and they were hoping to become free from dialysis and to live a normal life. CONCLUSION This study shows that older KTx candidates comprise a heterogeneous group of patients who take individual approaches that allow them to maintain autonomy and control while waiting for a transplant. This study provides new knowledge about the older KTx candidates relevant for clinicians, patients and researchers.
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Affiliation(s)
- Kjersti Lønning
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Karsten Midtvedt
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Kristian Heldal
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Clinic of Internal Medicine, Telemark Hospital Trust, Skien, Norway
| | - Marit Helen Andersen
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Department of Health Sciences, University of Oslo, Oslo, Norway
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Hernández D, Alonso-Titos J, Armas-Padrón AM, Ruiz-Esteban P, Cabello M, López V, Fuentes L, Jironda C, Ros S, Jiménez T, Gutiérrez E, Sola E, Frutos MA, González-Molina M, Torres A. Mortality in Elderly Waiting-List Patients Versus Age-Matched Kidney Transplant Recipients: Where is the Risk? Kidney Blood Press Res 2018; 43:256-275. [PMID: 29490298 DOI: 10.1159/000487684] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/15/2018] [Indexed: 11/19/2022] Open
Abstract
The number of elderly patients on the waiting list (WL) for kidney transplantation (KT) has risen significantly in recent years. Because KT offers a better survival than dialysis therapy, even in the elderly, candidates for KT should be selected carefully, particularly in older waitlisted patients. Identification of risk factors for death in WL patients and prediction of both perioperative risk and long-term post-transplant mortality are crucial for the proper allocation of organs and the clinical management of these patients in order to decrease mortality, both while on the WL and after KT. In this review, we examine the clinical results in studies concerning: a) risk factors for mortality in WL patients and KT recipients; 2) the benefits and risks of performing KT in the elderly, comparing survival between patients on the WL and KT recipients; and 3) clinical tools that should be used to assess the perioperative risk of mortality and predict long-term post-transplant survival. The acknowledgment of these concerns could contribute to better management of high-risk patients and prophylactic interventions to prolong survival in this particular population, provided a higher mortality is assumed.
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Affiliation(s)
- Domingo Hernández
- Nephrology Department, Carlos Haya Regional University Hospital and University of Malaga, IBIMA, Málaga, Spain
| | - Juana Alonso-Titos
- Nephrology Department, Carlos Haya Regional University Hospital and University of Malaga, IBIMA, Málaga, Spain
| | | | - Pedro Ruiz-Esteban
- Nephrology Department, Carlos Haya Regional University Hospital and University of Malaga, IBIMA, Málaga, Spain
| | - Mercedes Cabello
- Nephrology Department, Carlos Haya Regional University Hospital and University of Malaga, IBIMA, Málaga, Spain
| | - Verónica López
- Nephrology Department, Carlos Haya Regional University Hospital and University of Malaga, IBIMA, Málaga, Spain
| | - Laura Fuentes
- Nephrology Department, Carlos Haya Regional University Hospital and University of Malaga, IBIMA, Málaga, Spain
| | - Cristina Jironda
- Nephrology Department, Carlos Haya Regional University Hospital and University of Malaga, IBIMA, Málaga, Spain
| | - Silvia Ros
- Nephrology Department, Carlos Haya Regional University Hospital and University of Malaga, IBIMA, Málaga, Spain
| | - Tamara Jiménez
- Nephrology Department, Carlos Haya Regional University Hospital and University of Malaga, IBIMA, Málaga, Spain
| | - Elena Gutiérrez
- Nephrology Department, Carlos Haya Regional University Hospital and University of Malaga, IBIMA, Málaga, Spain
| | - Eugenia Sola
- Nephrology Department, Carlos Haya Regional University Hospital and University of Malaga, IBIMA, Málaga, Spain
| | - Miguel Angel Frutos
- Nephrology Department, Carlos Haya Regional University Hospital and University of Malaga, IBIMA, Málaga, Spain
| | - Miguel González-Molina
- Nephrology Department, Carlos Haya Regional University Hospital and University of Malaga, IBIMA, Málaga, Spain
| | - Armando Torres
- Nephrology Department, Hospital Universitario de Canarias, CIBICAN, University of La Laguna, Tenerife and Instituto Reina Sofía de Investigación Renal, IRSIN, Tenerife, Spain
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42
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Cheng XS, Myers JN, Chertow GM, Rabkin R, Chan KN, Chen Y, Tan JC. Prehabilitation for kidney transplant candidates: Is it time? Clin Transplant 2017; 31. [DOI: 10.1111/ctr.13020] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Xingxing S. Cheng
- Division of Nephrology; Department of Medicine; Stanford University; Palo Alto CA USA
| | - Jonathan N. Myers
- Division of Cardiology; Veterans Affairs Palo Alto Health Care System; Palo Alto CA USA
- Research Service; Veterans Administration Health Care System; Palo Alto CA USA
| | - Glenn M. Chertow
- Division of Nephrology; Department of Medicine; Stanford University; Palo Alto CA USA
| | - Ralph Rabkin
- Division of Nephrology; Department of Medicine; Stanford University; Palo Alto CA USA
- Research Service; Veterans Administration Health Care System; Palo Alto CA USA
| | - Khin N. Chan
- Division of Cardiology; Veterans Affairs Palo Alto Health Care System; Palo Alto CA USA
| | - Yu Chen
- Research Service; Veterans Administration Health Care System; Palo Alto CA USA
| | - Jane C. Tan
- Division of Nephrology; Department of Medicine; Stanford University; Palo Alto CA USA
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