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Non adherence + transplant

Kazuaki Tokodai, Shigehito Miyagi, Chikashi Nakanishi, Yasuyuki Hara, Wataru Nakanishi, Koji Miyazawa, Kenji Shimizu, Keigo Murakami, Hironobu Sasano, Masafumi Goto, Michiaki Unno, Takashi Kamei
The aim of this study was to evaluate the significance of post-transplant DSA as a predictor of liver fibrosis during long-term follow-up after pediatric LT. We evaluated the histological findings in 18 LT recipients who underwent liver biopsy after DSA screening. Liver fibrosis was scored based on the METAVIR fibrosis staging. Patients were divided into 2 groups based on histological findings, and clinical characteristics among patients with liver fibrosis were assessed. Of 18 patients, 7 were included in the fibrosis group...
March 14, 2018: Pediatric Transplantation
Jennifer Felicia Scheel, Katharina Schieber, Sandra Reber, Lisa Stoessel, Elisabeth Waldmann, Sabine Jank, Kai-Uwe Eckardt, Franziska Grundmann, Frank Vitinius, Martina de Zwaan, Anna Bertram, Yesim Erim
Introduction: Non-adherence to immunosuppressive medication is regarded as an important factor for graft rejection and loss after successful renal transplantation. Yet, results on prevalence and relationship with psychosocial parameters are heterogeneous. The main aim of this study was to investigate the association of immunosuppressive medication non-adherence and psychosocial factors. Methods: In 330 adult renal transplant recipients (≥12 months posttransplantation), health-related quality of life, depression, anxiety, social support, and subjective medication experiences were assessed, and their associations with patient-reported non-adherence was evaluated...
2018: Frontiers in Psychiatry
Anne I Dipchand
Pediatric heart transplantation is standard of care for children with end-stage heart failure. The diverse age range, diagnoses, and practice variations continue to challenge the development of evidence-based practices and new technologies. Outcomes in the most recent era are excellent, especially with the more widespread use of ventricular assist devices (VADs). Waitlist mortality remains high and knowledge of risk factors for death while waiting and following transplantation contributes to decision-making around transplant candidacy and timing of listing...
January 2018: Annals of Cardiothoracic Surgery
Helady Sanders-Pinheiro, Fernando Antonio Basile Colugnati, Elisa Oliveira Marsicano, Sabina De Geest, José Osmar Pestana Medina
BACKGROUND: Non-adherence to immunosuppressive therapy is a prevalent risk factor for poor clinical and after kidney transplantation (KT), and has contributed to the lack of improvement in long-term graft survival over the past decade. Understanding the multilevel correlates and risk factors of non-adherence is crucial to determine the optimal level for planning interventions, namely at the patient, health care provider, KT centre, and health care system level. Brazil, having the largest public transplantation program in the world and with regional differences regarding access to health services and service implementation, is in a unique position to study this multilevel approach...
February 20, 2018: BMC Nephrology
Lisa M Potter, Angela Q Maldonado, Krista L Lentine, Mark A Schnitzler, Zidong Zhang, Gregory P Hess, Edward Garrity, Bertram L Kasiske, David A Axelrod
Transplant immunosuppressants are often used off-label due to insufficient randomized prospective trial data to achieve organ-specific US Food and Drug Administration (FDA) approval. Transplant recipients who rely on Medicare Part D for immunosuppressant drug coverage are vulnerable to coverage denial for off-label prescriptions, unless use is supported by Centers for Medicare & Medicaid Services (CMS)-approved compendia. An integrated data set including national transplant registry data and 3 years of dispensed pharmacy records was used to identify the prevalence of immunosuppression use that is both off-label and not supported by CMS-approved compendia...
February 15, 2018: American Journal of Transplantation
Mariel Nöhre, Yesim Erim, Frank Vitinius, Felix Klewitz, Mario Schiffer, Martina de Zwaan
Organ transplantation is the best and to some extent only option for many patients with chronic organ failure. Usually after successful transplantation patients experience a significant improvement of their condition. Nevertheless, they are not cured but still chronically ill. Living with an organ transplant requires consequent immunosuppression intake, regular physician visits and following the recommendations regarding infection prevention. These factors are important to secure a long transplant survival...
February 13, 2018: Psychotherapie, Psychosomatik, Medizinische Psychologie
Bruna Lavezzo, Damiano Patrono, Francesco Tandoi, Silvia Martini, Fabrizio Fop, Valentina Ballerini, Chiara Stratta, Stefano Skurzak, Francesco Lupo, Paolo Strignano, Pier Paolo Donadio, Mauro Salizzoni, Renato Romagnoli, Francesco Giuseppe De Rosa
Invasive fungal infection (IFI) is a severe complication of liver transplantation burdened by high mortality. Guidelines recommend targeted rather than universal antifungal prophylaxis based on tiers of risk METHODS: We aimed to evaluate IFI incidence, risk factors and outcome after implementation of a simplified two-tiered targeted prophylaxis regimen based on a single broad-spectrum antifungal drug (amphotericin B). Patients presenting one or more risk factors according to literature were administered prophylaxis...
February 10, 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Miklos Z Molnar, James D Eason, Abduzhappar Gaipov, Manish Talwar, Praveen K Potukuchi, Kiran Joglekar, Adam Remport, Zoltan Mathe, Istvan Mucsi, Marta Novak, Kamyar Kalantar-Zadeh, Csaba P Kovesdy
History of psychosis or mania, if uncontrolled, both represent relative contraindications for kidney transplantation. We examined 3680 US veterans who underwent kidney transplantation. The diagnosis of history of psychosis/mania was based on a validated algorithm. Measured confounders were used to create a propensity score-matched cohort (n = 442). Associations between pretransplantation psychosis/mania and death with functioning graft, all-cause death, graft loss, and rejection were examined in survival models and logistic regression models...
February 6, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Marietta Nygaard, Niels Smedegaard Andersen, Claus Ernst Moser, Gitte Olesen, Ida Marie Schjødt, Carsten Heilmann, Henrik Sengeløv
Several immunosuppressive drugs have been proposed for second-line treatment of steroid-refractory acute graft versus host disease (aGvHD) after allogeneic hematopoietic stem cell transplantation. However, the studies on these drugs are small, retrospective, uncontrolled and use different endpoints. Therefore, it remains unknown which treatment is superior. We retrospectively evaluated 68 consecutive patients treated with infliximab for aGvHD. We adhered to recently proposed guidelines for aGvHD trials and thus evaluated response on day 7 and 28...
February 1, 2018: Bone Marrow Transplantation
Roni Bitterman, Noa Eliakim-Raz, Inbal Vinograd, Anca Zalmanovici Trestioreanu, Leonard Leibovici, Mical Paul
BACKGROUND: This is an update of the Cochrane review published in 2013, Issue 10.Immunosuppressed cancer patients are at increased risk of serious influenza-related complications. Guidelines, therefore, recommend influenza vaccination for these patients. However, data on vaccine effectiveness in this population are lacking, and the value of vaccination in this population remains unclear. OBJECTIVES: To assess the effectiveness of influenza vaccine in immunosuppressed adults with malignancies...
February 1, 2018: Cochrane Database of Systematic Reviews
Nora Drick, Benjamin Seeliger, Jan Fuge, Igor Tudorache, Mark Greer, Tobias Welte, Axel Haverich, Jens Gottlieb
BACKGROUND: Non-adherence to immunosuppressive treatment following solid organ transplantation is common and often associated with poorer outcomes. Non-adherence is difficult to assess and barriers to adherence in lung transplant (LTx) recipients remain to be elucidated. METHODS: A single center cross-sectional observational study of all LTx recipients attending our department between 07/2013 - 05/2014 was performed. Non-adherence was assessed using patient self-reporting, including Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS) along with health care worker (HCW) judgement and reasons for non-adherence by the Immunosuppressive Therapy Barriers Scale...
January 29, 2018: Clinical Transplantation
Olga Charnaya, Shamir Tuchman, Asha Moudgil
The development of dnDSA anti-HLA antibodies has been shown to be a significant risk factor for graft failure. In 2008, we instituted a routine protocol of standardized monitoring and treatment of dnDSA in pediatric kidney transplant recipients. Of 67 first-time pediatric kidney transplant recipients, 26 (38%) developed dnDSA after 1.36 (IQ 1-2.14) years. Coefficient of variance of tacrolimus, a surrogate marker of non-adherence, was found to be the single most important risk factor for dnDSA development. Overall, there was a significant reduction in dnDSA with treatment in 19 (76%) children...
March 2018: Pediatric Transplantation
Margot Den Hondt, Bart M Vanaudenaerde, Eric K Verbeken, Jan J Vranckx
OBJECTIVES: Prerequisites for successful trachea transplantation include the use of a biocompatible construct, submucosal vascularization and an epithelial covering. Implantation of non-epithelialized tracheal scaffolds may lead to stenosis. However, epithelial grafting or seeding can only be attempted onto a well-vascularized submucosal bed. Our aim was to investigate a method to prevent stenosis during prelamination of non-epithelialized, gently decellularized rabbit tracheae and to evaluate whether grafting of revascularized constructs with buccal mucosa is feasible...
January 15, 2018: Interactive Cardiovascular and Thoracic Surgery
Rupesh Raina, Joseph Wang, Vinod Krishnappa, Maria Ferris
The transition from pediatric to adult medical services is an important time in the life of an adolescent or young adult with a renal transplant. Failure of proper transition can lead to medical non-adherence and subsequent loss of graft and/or return to dialysis. The aim of this study was to conduct a systematic review and survey to assess the challenges and existing practices in transition of renal transplant recipient children to adult services, and to develop a transition protocol. We conducted a literature review and performed a survey of pediatric nephrologists across the United States to examine the current state of transition care...
January 16, 2018: Annals of Transplantation: Quarterly of the Polish Transplantation Society
Reem E Hamoda, Jennifer C Gander, Laura J McPherson, Kimberly J Arriola, Loren Cobb, Stephen O Pastan, Laura Plantinga, Teri Browne, Erica Hartmann, Laura Mulloy, Carlos Zayas, Jenna Krisher, Rachel E Patzer
BACKGROUND: The Reducing Disparities in Access to kidNey Transplantation Community Study (RaDIANT) was an End-Stage Renal Disease (ESRD) Network 6-developed, dialysis facility-level randomized trial testing the effectiveness of a 1-year multicomponent education and quality improvement intervention in increasing referral for kidney transplant evaluation among selected Georgia dialysis facilities. METHODS: To assess implementation of the RaDIANT intervention, we conducted a process evaluation at the conclusion of the intervention period (January-December 2014)...
January 15, 2018: BMC Nephrology
Franz Marie Gumabay, Marta Novak, Aarushi Bansal, Margot Mitchell, Olusegun Famure, S Joseph Kim, Istvan Mucsi
OBJECTIVE: The association between pre-transplant mental health concerns and non-adherence and post-transplant outcomes after kidney transplantation is not fully established. We examined the relationship between a pre-transplant history of mental health concerns and non-adherence and post-transplant outcomes among kidney transplant recipients. METHODS: In this retrospective single center cohort study of adult kidney transplant recipients (n=955) the associations between the history of mental health concerns or non-adherence and the time from kidney transplant to biopsy proven acute rejection; death-censored graft failure and total graft failure were examined using Cox proportional hazards models...
February 2018: Journal of Psychosomatic Research
Amelia R Cossart, Christine E Staatz, Scott B Campbell, Nicole M Isbel, W Neil Cottrell
BACKGROUND: Immunosuppressant medication non-adherence can result in allograft rejection and loss. The aim of this study was to investigate the prevalence of non-adherence and barriers to adherence with immunosuppressant medications, in an adult renal transplant cohort. METHODS: Kidney transplant recipients completed a self-report survey consisting of five validated questionnaires (Basel Assessment of Adherence Immunosuppression Scale (BAASIS), Beliefs about Medicines Questionnaire, Immunosuppressant Therapy Barrier Scale, Brief-Illness Perception Questionnaire, and Multidimensional Health Locus of Control Scale), and provided sociodemographic information...
December 26, 2017: Nephrology
Louisa Kühne, Bettina Jung, Helen Poth, Antonia Schuster, Simone Wurm, Petra Ruemmele, Bernhard Banas, Tobias Bergler
BACKGROUND: Non-adherence has been associated with reduced graft survival. The aim of this study was to investigate the immunological mechanisms underlying chronic renal allograft rejection using a model of non-adherence to immunosuppressive therapy. We used a MHC (major histocompatibility complex) -mismatched rat model of renal transplantation (Brown Norway to Lewis), in which rats received daily oral cyclosporine A. In analogy to non-adherence to therapy, one group received cyclosporine A on alternating days only...
December 19, 2017: BMC Immunology
Yuliya Senft, Monika Kirsch, Kris Denhaerynck, Fabienne Dobbels, Remon Helmy, Cynthia L Russell, Lut Berben, Sabina De Geest
BACKGROUND: As medication non-adherence is a major risk factor for poor post-transplant outcomes, we explored how adherence is assessed, enhanced and integrated across the transplant continuum. AIM: The aim of this study was to study practice patterns regarding pre- and post-transplant medication adherence assessment and interventions in international heart transplant centres. METHODS: We used data from the Building Research Initiative Group: chronic illness management and adherence in heart transplantation (BRIGHT) study, a cross-sectional study conducted in 36 heart transplant centres in 11 countries...
December 1, 2017: European Journal of Cardiovascular Nursing
S Duncan, R A Annunziato, C Dunphy, D LaPointe Rudow, B L Shneider, E Shemesh
Non-adherence to immunosuppressant medications is an important risk factor for graft dysfunction. To evaluate the effectiveness of adherence-enhancing interventions, we reviewed adherence intervention studies in solid organ transplant recipients (all ages). Using the following databases: PsycINFO, PubMed, Scopus, and ScienceDirect, we identified 41 eligible studies. Only three non-randomized trials showed a possible positive effect on objective indicators of transplant outcomes (such as rejection, liver enzyme levels, kidney function)...
February 2018: Pediatric Transplantation
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