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https://www.readbyqxmd.com/read/27907919/the-impact-of-health-care-appointment-non-adherence-on-graft-outcomes-in-kidney-transplantation
#1
David J Taber, James N Fleming, Cory E Fominaya, Mulugeta Gebregziabher, Kelly J Hunt, Titte R Srinivas, Prabhakar K Baliga, John W McGillicuddy, Leonard E Egede
BACKGROUND: Non-adherence to medication is a well-studied and known cause of late allograft loss, but it is difficult to measure and prospectively monitor. The aim of this study was to assess if appointment non-adherence was correlated with medication non-adherence and a predictor of graft outcomes. METHODS: This was a longitudinal cohort study that used the National United States Renal Data System and veterans affairs health records data with time-to-event analyses conducted to assess the impact on graft and patient survival...
December 2, 2016: American Journal of Nephrology
https://www.readbyqxmd.com/read/27886201/cryptococcal-meningitis-epidemiology-immunology-diagnosis-and-therapy
#2
REVIEW
Peter R Williamson, Joseph N Jarvis, Anil A Panackal, Matthew C Fisher, Síle F Molloy, Angela Loyse, Thomas S Harrison
HIV-associated cryptococcal meningitis is by far the most common cause of adult meningitis in many areas of the world that have high HIV seroprevalence. In most areas in Sub-Saharan Africa, the incidence of cryptococcal meningitis is not decreasing despite availability of antiretroviral therapy, because of issues of adherence and retention in HIV care. In addition, cryptococcal meningitis in HIV-seronegative individuals is a substantial problem: the risk of cryptococcal infection is increased in transplant recipients and other individuals with defects in cell-mediated immunity, and cryptococcosis is also reported in the apparently immunocompetent...
November 25, 2016: Nature Reviews. Neurology
https://www.readbyqxmd.com/read/27874250/immunosuppression-in-pediatric-liver-transplant-recipients-unique-aspects
#3
REVIEW
Miloh Tamir, Barton Andrea, Wheeler Justin, Pham Yen, Hewitt Winston, Keegan Tara, Sanchez Christine, Bulut Pinar, Goss John
Pediatric liver transplantation has experienced improved outcomes over the last 50 years. This can be attributed in part to establishing optimal use of immunosuppressive agents to achieve a balance between minimizing the risks of allograft rejection and infection. The management of immunosuppression in children is generally more complex and can be challenging when compared to the use of these agents in adult liver transplant patients. Physiologic differences in children alter the pharmacokinetics of immunosuppressive agents, which affects absorption, distribution, metabolism and drug excretion...
November 22, 2016: Liver Transplantation
https://www.readbyqxmd.com/read/27873477/telemedically-supported-case-management-of-living-donor-renal-transplant-recipients-to-optimize-routine-evidence-based-aftercare-a-single-center-randomized-controlled-trial
#4
A Schmid, S Hils, A Kramer-Zucker, L Bogatyreva, D Hauschke, S De Geest, P Pisarski
Improving mid-term and long-term outcomes after solid organ transplantation is imperative, and requires both state-of-the-art transplant surgery and optimization of routine, evidence-based aftercare. This randomized, controlled trial assessed the effectiveness of standard aftercare versus telemedically-supported case management, an innovative aftercare model, in 46 living-donor renal transplant recipients during the first post-transplant year. The model includes three components: (a) chronic care case management initiated after discharge, (b) case management initiated in emerging acute care situations, and (c) a telemedically-equipped team comprising a transplant nurse case manager and two senior transplant physicians (nephrologist, surgeon)...
November 22, 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27873464/hyalinosis-lesions-in-renal-transplant-biopsies-time-dependent-complexity-of-interpretation
#5
Gunilla Einecke, Jeff Reeve, Philip F Halloran
Because calcineurin inhibitor immunosuppressive drugs (CNIs) induce arteriolar hyalinosis (ah) in kidney transplants, ah lesions can potentially provide information about drug exposure. We studied the relationship of ah lesions to findings and outcomes in 562 indication biopsies taken 3 days to 35 years post-transplant. Prevalence of ah lesions increased with time post-transplant (TxBx). Ah-scores correlated with arterial intimal thickening and atrophy-fibrosis but, unlike atrophy-fibrosis, did not increase until after 500 days because of a background of ah1 lesions in early biopsies reflecting donor aging...
November 22, 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27830476/production-of-heterozygous-alpha-1-3-galactosyltransferase-ggta1-knock-out-transgenic-miniature-pigs-expressing-human-cd39
#6
Kimyung Choi, Joohyun Shim, Nayoung Ko, Heejong Eom, Jiho Kim, Jeong-Woong Lee, Dong-Il Jin, Hyunil Kim
Production of transgenic pigs for use as xenotransplant donors is a solution to the severe shortage of human organs for transplantation. The first barrier to successful xenotransplantation is hyperacute rejection, a rapid, massive humoral immune response directed against the pig carbohydrate GGTA1 epitope. Platelet activation, adherence, and clumping, all major features of thrombotic microangiopathy, are inevitable results of immune-mediated transplant rejection. Human CD39 rapidly hydrolyzes ATP and ADP to AMP; AMP is hydrolyzed by ecto-5'-nucleotidase (CD73) to adenosine, an anti-thrombotic and cardiovascular protective mediator...
November 9, 2016: Transgenic Research
https://www.readbyqxmd.com/read/27762479/transition-to-adult-care-for-pediatric-liver-transplant-recipients-the-western-australian-experience
#7
Tim Mitchell, Hannah Gooding, Cathy Mews, Leon Adams, Gerry MacQuillan, George Garas, Madhur Ravikumara, Ainslie Lopez, Megan Collins, Gary Jeffrey
Transition to adult care is a vulnerable period for pediatric transplant recipients and is associated with reduced medication compliance, graft loss, and increased mortality. Psychosocial outcomes in young adults differ between pediatric transplant recipients and their healthy peers. We conducted a single-center, retrospective cohort study of all pediatric liver transplant recipients who were transitioned through our center. This study aimed to assess the outcomes of transitioned pediatric liver transplant recipients at an Australian center, including mortality, adherence, and psychosocial morbidity...
October 20, 2016: Pediatric Transplantation
https://www.readbyqxmd.com/read/27682263/bioavailable-trace-metals-in-neurological-diseases
#8
REVIEW
Aurélia Poujois, Jean-Christophe Devedjian, Caroline Moreau, David Devos, Pascal Chaine, France Woimant, James A Duce
Medical treatment in Wilson's disease includes chelators (D-penicillamine and trientine) or zinc salts that have to be maintain all the lifelong. This pharmacological treatment is categorised into two phases; the first being a de-coppering phase and the second a maintenance one. The best therapeutic approach remains controversial, as only a few non-controlled trials have compared these treatments. During the initial phase, progressive increase of chelators' doses adjusted to exchangeable copper and urinary copper might help to avoid neurological deterioration...
October 2016: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/27660168/national-institutes-of-health-hematopoietic-cell-transplantation-late-effects-initiative-the-patient-centered-outcomes-working-group-report
#9
Margaret Bevans, Areej El-Jawahri, D Kathryn Tierney, Lori Wiener, William A Wood, Flora Hoodin, Erin E Kent, Paul B Jacobsen, Stephanie J Lee, Matthew M Hsieh, Ellen M Denzen, Karen L Syrjala
In 2015, the National Institutes of Health convened six working groups to address the research needs and best practices for late effects of hematopoietic stem cell transplantation survivors. The Patient-Centered Outcomes Working Group, charged with summarizing the HRQOL evidence base, used a scoping review approach to efficiently survey the large body of literature in adult and pediatric HCT survivors over 1 year after transplantation. The goals of this paper are to (1) summarize the current literature describing patient-centered outcomes in survivors, including the various dimensions of health-related quality of life affected by HCT, and describe interventions tested to improve these outcomes; (2) highlight areas with sufficient evidence allowing for integration into standard practice; (3) address methodological issues that restrict progress in this field; (4) identify major gaps to guide future research; and (5) specify priority research recommendations...
September 19, 2016: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/27629770/medication-adherence-after-renal-transplantation-a-review-of-the-literature
#10
Anne Rebafka
BACKGROUND: Whether or not patients follow the advice given by their healthcare professional is commonly referred to as adherence. In the case of kidney transplantation, transplant recipients need to take immunosuppressive drugs on a regular basis to prevent rejection of their transplant. However, medication adherence can be problematic for many patients. OBJECTIVES: This critical appraisal of evidence aimed to gain insights into factors contributing to adherence and non-adherence in recipients of kidney transplants, and to explore patients' perceptions regarding adherence to immunosuppression...
December 2016: Journal of Renal Care
https://www.readbyqxmd.com/read/27597423/liver-transplantation-and-adolescence-the-role-of-mental-health
#11
Anna Hames, Faith Matcham, Deepak Joshi, Michael A Heneghan, Anil Dhawan, Nigel Heaton, Marianne Samyn
Young people (YP) with chronic illness have higher rates of mental health problems than the general population, with psychosocial complexity associated with nonadherence and poorer health outcomes. This study aimed to describe the prevalence of anxiety and depression in YP after liver transplantation, with autoimmune liver disease and other chronic liver diseases, identify the factors YP attribute their distress to and the relationship between anxiety/depression, and describe YP's beliefs about their illness and treatment...
November 2016: Liver Transplantation
https://www.readbyqxmd.com/read/27594603/prevalence-and-modifiable-determinants-of-non-adherence-in-adult-kidney-transplant-recipients-in-a-german-sample
#12
Sandra Reber, Eva Morawa, Lisa Stößel, Sabine Jank, Frank Vitinius, Kai-Uwe Eckardt, Yesim Erim
OBJECTIVES: The aim of this cross-sectional study was to investigate the prevalence and the modifiable determinants of non-adherence in adult kidney transplant patients in follow-up care. METHODS: In 74 patients at least six months post-transplant, self-reported adherence (Basel Assessment of Adherence to ImmunosuppressiveMedications Scale, BAASIS©), subjective experience and attitudes after transplantation (Medication Experience Scale for Immunosuppressants, MESI), and depression and anxiety (Hospital Anxiety and Depression Scale,HADSD) were assessed...
September 2016: Zeitschrift Für Psychosomatische Medizin und Psychotherapie
https://www.readbyqxmd.com/read/27591329/moderator-s-view-the-use-of-calcineurin-inhibitors-in-the-treatment-of-lupus-nephritis
#13
Andreas Kronbichler, Irmgard Neumann, Gert Mayer
Lupus nephritis (LN) is one of the most severe manifestations of systemic lupus erythematosus (SLE), affecting ∼50% of patients, and both renal disease and treatment-related toxicity contribute to significant morbidity and mortality. Although our understanding of the aetiopathogenesis of LN is improving, treatment still remains a challenge, with the achievement of complete remission at 1 year in <50% of patients treated with current standard of care immunosuppressive therapy; this is associated with considerable short- and long-term side effects, some of which further contribute to non-adherence...
October 2016: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/27582080/can-best-interests-derail-the-trolley-examining-withdrawal-of-clinically-assisted-nutrition-and-hydration-in-patients-in-the-permanent-vegetative-state
#14
Zoe Fritz
In this paper, I explore under what circumstances it might be morally acceptable to transplant organs from a patient lacking capacity. I argue, with a developed hypothetical based around a mother and son, that (1) 'Best interests' should be interpreted broadly to include the interests that people have previously expressed in the well-being of others. It could, therefore, be in the 'best interests' of an unconscious patient to donate a non-vital organ to a family member. (2) Further expanding upon this case, and developing a variation on the 'trolley problems' I argue that where it is inevitable that an incapacitous patient is going to die-and specifically when it has been agreed through the courts that a patient in a permanent vegetative state is going to have clinically assisted nutrition and hydration withdrawn (with the inevitable consequence of death, and causing desiccation of the organs such that they are no longer able to be donated)-it could be in a patient's best interests to actively end their life with a drug that would stop the heart both to minimise potential suffering and in order to be able to have vital organs donated...
August 31, 2016: Journal of Medical Ethics
https://www.readbyqxmd.com/read/27579933/adherence-to-immunosuppressive-therapy-following-liver-transplantation-an-integrative-review
#15
Ramon Antônio Oliveira, Ruth Natália Teresa Turrini, Vanessa de Brito Poveda
OBJECTIVE: to investigate the evidence available in the literature on non-adherence to immunosuppressive therapy among patients undergoing liver transplantation. METHOD: integrative literature review, including research whose sample consisted of patients aged over 18 years undergoing liver transplantation. It excluded those containing patients undergoing multiple organ transplants. For the selection of articles, Medline / Pubmed, CINAHL, LILACS, Scopus and Embase were searched...
2016: Revista Latino-americana de Enfermagem
https://www.readbyqxmd.com/read/27548684/hypertension-in-the-kidney-transplant-recipient-overview-of-pathogenesis-clinical-assessment-and-treatment
#16
Daniel Glicklich, Rajat Lamba, Rahul Pawar
Cardiovascular disease is the leading cause of death in patients with chronic renal disease and the most common cause of death and allograft loss among kidney transplant recipients. Transplant patients often have multiple cardiovascular risk factors antedating transplantation. Among the most prominent is hypertension which affects at least 90% of transplant patients. Uncontrolled hypertension is an independent risk factor for allograft loss. The etiology of the hypertension in transplant recipients is complex and multifactorial, including the use of essential immuno-suppressive medications...
August 19, 2016: Cardiology in Review
https://www.readbyqxmd.com/read/27539748/evaluation-of-c1q-status-and-titer-of-de-novo-donor-specific-antibodies-as-predictors-of-allograft-survival
#17
C Wiebe, A J Gareau, D Pochinco, I W Gibson, J Ho, P E Birk, T Blydt-Hasen, M Karpinski, A Goldberg, L Storsley, D N Rush, P W Nickerson
De novo donor-specific antibodies (dnDSAs) that develop after renal transplantation are independent predictors of allograft loss. However, it is unknown if dnDSA C1q status or titer at the time of first detection can independently predict allograft loss. In a consecutive cohort of 508 renal transplant recipients, 70 developed dnDSAs. Histologic and clinical outcomes were correlated with the C1q assay or dnDSA titer. C1q positivity correlated with dnDSA titer (p < 0.01) and mean fluorescence intensity (p < 0...
August 19, 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27527928/human-non-hematopoietic-cd271-pos-cd140a-low-neg-bone-marrow-stroma-cells-fulfill-stringent-stem-cell-criteria-in-serial-transplantations
#18
Roshanak Ghazanfari, Hongzhe Li, Dimitra Zacharaki, Hooi Ching Lim, Stefan Scheding
Human bone marrow contains a population of non-hematopoietic stromal stem/progenitor cells (BMSCs), which play a central role for bone marrow stroma and the hematopoietic microenvironment. However, the precise characteristics and potential stem cell properties of defined BMSC populations have not yet been thoroughly investigated. Using standard adherent colony-forming unit fibroblast (CFU-F) assays, we have previously shown that BMSCs were highly enriched in the nonhematopoietic CD271(pos)/CD140a(low/neg) fraction of normal adult human bone marrow...
September 19, 2016: Stem Cells and Development
https://www.readbyqxmd.com/read/27496067/safety-adherence-and-efficacy-of-exercise-training-in-solid-organ-transplant-candidates-a-systematic-review
#19
REVIEW
Matthew P Wallen, Tina L Skinner, Toby G Pavey, Adrian Hall, Graeme A Macdonald, Jeff S Coombes
BACKGROUND: Patients awaiting solid-organ transplantation may be encouraged to undertake exercise training to improve pre- and post-transplant outcomes. However, the safety, adherence and efficacy of exercise training in this population remain unclear. METHODS: All randomized, non-randomized and non-controlled trials of exercise training interventions in solid-organ transplant candidates were included. The Cochrane risk of bias tool and a modified Newcastle-Ottawa scale were used to assess procedural quality...
October 2016: Transplantation Reviews
https://www.readbyqxmd.com/read/27467541/mental-health-and-behavioural-barriers-in-access-to-kidney-transplantation-a-canadian-cohort-study
#20
Istvan Mucsi, Aarushi Bansal, Michael Jeannette, Olusegun Famure, Yanhong Li, Marta Novak, S Joseph Kim
BACKGROUND: A history of mental health (MH) disorders or non-adherence (NA) may be barriers to completing the workup (WU) and/or undergoing kidney transplantation (KT) but this has not been well documented. In this work we analyzed the relationship between a history of MH disorders or NA and the likelihood of completing the WU or undergoing KT. METHODS: Patients referred for KT to the Toronto General Hospital from January 1, 2003 to December 31, 2012, and who completed a social work assessment, were included (n = 1769)...
July 27, 2016: Transplantation
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