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Vu VA, Bhayana S, Sweiss H, Castro N, Hall R, Nelson J. Impact of Cumulative 6 mg/kg Antithymocyte Globulin on Early Posttransplant Outcomes in Kidney Transplant Recipients with Delayed Graft Function. Prog Transplant 2024; 34:47-52. [PMID: 38465633 DOI: 10.1177/15269248241237816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Introduction: Delayed graft function in kidney transplant is associated with an increased risk of rejection and graft loss. Use of rabbit antithymocyte globulin induction in delayed graft function has been correlated with less rejection compared to basiliximab, but optimal dosing remains unknown. Program Evaluation Aims: The purpose of this evaluation was to retrospectively assess the short-term effectiveness and tolerability of a clinical protocol that increased the net state of immunosuppression in delayed graft function kidney transplant recipients using cumulative 6 mg/kg rabbit antithymocyte globulin induction. Design: This retrospective cohort included 88 kidney transplant recipients with delayed graft function, transplanted between January 2017 and March 2021, who either received cumulative 4.5 mg/kg pre-protocol or 6 mg/kg post-protocol rabbit antithymocyte globulin. Outcomes evaluated were biopsy-proven acute rejection and incidence of graft loss, infection, and cytopenia at 6 months. Results: A significant reduction of biopsy-proven acute rejection incidence occurred post-protocol implementation (10/33, 30.3% vs 6/55, 10.9%; P = .04). Of those with rejection, significantly less post-protocol patients were classified as acute cellular rejection (9/10, 90.0% vs 2/6, 33.3%; P = .04). No death-censored graft loss was observed in either group. Rates of cytopenia and infection were similar pre- versus post-protocol implementation. Conclusion: Increasing the exposure to rabbit antithymocyte globulin and maintenance immunosuppression in delayed graft function kidney transplant recipients was tolerable and significantly reduced rejection occurrence at 6 months.
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Affiliation(s)
- Van Anh Vu
- Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, TX, USA
- College of Pharmacy, Pharmacotherapy Division, University of Texas at Austin, Austin, TX, USA
- Pharmacotherapy Education and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- University Health Transplant Institute, San Antonio, TX, USA
| | - Suverta Bhayana
- University Health Transplant Institute, San Antonio, TX, USA
- Department of Nephrology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Helen Sweiss
- Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, TX, USA
- College of Pharmacy, Pharmacotherapy Division, University of Texas at Austin, Austin, TX, USA
- Pharmacotherapy Education and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- University Health Transplant Institute, San Antonio, TX, USA
| | - Nohely Castro
- Pharmacy Services, Children's Health, Dallas, TX, USA
| | - Reed Hall
- Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, TX, USA
- College of Pharmacy, Pharmacotherapy Division, University of Texas at Austin, Austin, TX, USA
- Pharmacotherapy Education and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- University Health Transplant Institute, San Antonio, TX, USA
| | - Joelle Nelson
- Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, TX, USA
- College of Pharmacy, Pharmacotherapy Division, University of Texas at Austin, Austin, TX, USA
- Pharmacotherapy Education and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- University Health Transplant Institute, San Antonio, TX, USA
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Redwood L, Fox GJ, Nguyen TA, Bernarys S, Mason P, Vu VA, Nguyen VN, Mitchell EMH. Good citizens, perfect patients, and family reputation: Stigma and prolonged isolation in people with drug-resistant tuberculosis in Vietnam. PLOS Glob Public Health 2022; 2:e0000681. [PMID: 36962771 PMCID: PMC10021913 DOI: 10.1371/journal.pgph.0000681] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 06/01/2022] [Indexed: 11/19/2022]
Abstract
Stigma and isolation are common in people with tuberculosis (TB). Social isolation contributes to reduced health outcomes and TB treatment adherence. Stigma and the drivers of isolation in people with Drug-Resistant (DR)-TB may include modifiable advice and practices of family and Health Care Workers (HCW). This study aimed to understand the drivers of isolation and stigma from the perspective of people with DR-TB in Vietnam. A greater understanding of stigma and isolation is important to identify and balance patients' needs and disease transmission risk. In-depth interviews were conducted with 12 people with DR-TB and seven HCWs who care for people with DR-TB in two provinces in Vietnam. Interviews were audio-recorded, transcribed verbatim and translated to English. Data collection and analysis were conducted simultaneously. The data were then analysed using a thematic framework approach. Stigma and extended isolation were common experiences among people with DR-TB. To mitigate stigma, people with DR-TB used the local term 'lao lực' to describe their condition to others which is believed to be a less infectious and less stigmatising type of TB. This study identified that although HCW informed people with DR-TB of when they were no longer infectious and isolation was no longer required, their infection control advice was not always consistent. Despite knowing they were no longer infectious, most people with DR-TB continued to self-isolate to minimise the perceived repercussions of societal stigma, to protect their 'thể diện' (honour, prestige, reputation), and eliminate all risk of transmitting DR-TB to their family. This study identified three interconnected drivers of self-isolation in Vietnam, including fear of infecting others, fear of stigmatization, and to protect family reputation. TB control programmes need to better understand the social aspects of DR-TB to enable them to better support patients. Educating HCW to provide evidence-based infection control advice is vital.
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Affiliation(s)
- Lisa Redwood
- The Faculty of Medicine and Health, The University of Sydney, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
- The Woolcock Institute of Medical Research, Ba Dinh District, Hanoi, Vietnam
| | - Greg J Fox
- The Faculty of Medicine and Health, The University of Sydney, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
- The Woolcock Institute of Medical Research, Ba Dinh District, Hanoi, Vietnam
| | - Thu Anh Nguyen
- The Faculty of Medicine and Health, The University of Sydney, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
- The Woolcock Institute of Medical Research, Ba Dinh District, Hanoi, Vietnam
| | - Sarah Bernarys
- The University of Sydney, School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Paul Mason
- Taronga Conservation Society Australia, Sydney, Australia
- The University of Sydney, School of Education and Social Work, The University of Sydney, Camperdown New South Wales, Australia
| | - Van Anh Vu
- The Woolcock Institute of Medical Research, Ba Dinh District, Hanoi, Vietnam
| | | | - Ellen M H Mitchell
- Department of Public Health, Tropical Infectious Disease Group, Institute for Tropical Medicine, Antwerp, Belgium
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Perrin C, Vu VA, Matthijs N, Maftouh M, Massart DL, Vander HY. Screening approach for chiral separation of pharmaceuticals. Part I. Normal-phase liquid chromatography. J Chromatogr A 2002; 947:69-83. [PMID: 11873999 DOI: 10.1016/s0021-9673(01)01573-4] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A strategy for rapid screening for the separation of chiral molecules of pharmaceutical interest by normal-phase liquid chromatography using three cellulose/amylose stationary phases is proposed. In a first step, the most important parameters for the separations were determined and studied for their effects by means of experimental designs. Results showed that the cellulose tris-(3,5-dimethylphenylcarbamate), the amylose tris-(3,5-dimethylphenylcarbamate) and the cellulose tris-(4-methylbenzoate) stationary phases have very broad and complementary enantiorecognition properties. The type of organic modifier used in the mobile phase appeared to have a dramatic influence on the quality of the separation. Based on the results of the preliminary study, a screening strategy was developed and successfully applied to a set of 36 diverse drugs. Enantiomeric separation was observed in 89% of cases and the analysis times were usually shorter than 20 min.
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Affiliation(s)
- C Perrin
- Department of Pharmaceutical and Biomedical Analysis, Pharmaceutical Institute, Vrije Universiteit Brussels, Belgium
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