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Non adherence + transplant

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
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
Margaret Bevans, Areej El-Jawahri, D Kathryn Tierney, Lori Wiener, William A Wood, Flora Hoodin, Erin E Kent, Paul B Jacobsen, Stephanie J Lee, Matt Hsieh, Ellen M Denzen, Karen L Syrjala
In 2016, the National Institutes of Health convened an expert consensus panel to address the research needs and best practices for patient-centered late effects of hematopoietic stem cell transplantation (HCT). The panel 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
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...
September 15, 2016: Journal of Renal Care
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 non-adherence (NA) and poorer health outcomes. This study aimed to describe the prevalence of anxiety and depression in YP post-liver transplant (LT), with autoimmune liver disease (AILD) 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...
September 6, 2016: Liver Transplantation
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
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
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
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
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
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
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 fibroblasts (CFU-F) assays, we have previously shown that BMSCs were highly enriched in the non-hematopoietic CD271<sup>pos</sup>/ CD140a<sup>low/neg</sup> fraction of normal adult human bone marrow...
August 15, 2016: Stem Cells and Development
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
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
Rachel E Patzer, Marina Serper, Peter P Reese, Kamila Przytula, Rachel Koval, Daniela P Ladner, Josh M Levitsky, Michael M Abecassis, Michael S Wolf
We sought to evaluate the prevalence of medication understanding and non-adherence of entire drug regimens among kidney transplantation (KT) recipients and to examine associations of these exposures with clinical outcomes. Structured, in-person interviews were conducted with 99 adult KT recipients between 2011 and 2012 at two transplant centers in Chicago, IL; and Atlanta, GA. Nearly, one-quarter (24%) of participants had limited literacy as measured by the Rapid Estimate of Adult Literacy in Medicine test; patients took a mean of 10 (SD=4) medications and 32% had a medication change within the last month...
October 2016: Clinical Transplantation
G Costa-Requena, M C Cantarell, F Moreso, G Parramon, D Seron
INTRODUCTION: Transplantation is an optimal form of treatment for end-stage renal disease, but requires lifelong adherence to immunosuppressive therapy. The aim of this study was to longitudinally assess the adherence to treatment after kidney transplant, as well as to compare the amount of information about the treatment received at one month and 18 months post-transplantation, and its influence on adherence to treatment. MATERIAL AND METHODS: The Self-Reported Measure of Medication Adherence was administered at month (T1), 6 months (T2), 12 months (T3), 18 months (T4), and 24 months (T5) post-transplantation...
July 14, 2016: Revista de Calidad Asistencial: Organo de la Sociedad Española de Calidad Asistencial
Cynthia L Russell, Shirley Moore, Donna Hathaway, An-Lin Cheng, Guoqing Chen, Kathy Goggin
BACKGROUND: Among adult kidney transplant recipients, non-adherence to immunosuppressive medications is the leading predictor of poor outcomes, including rejection, kidney loss, and death. An alarming one-third of kidney transplant patients experience medication non-adherence even though the problem is preventable. Existing adherence interventions have proven marginally effective for those with acute and chronic illnesses and ineffective for adult kidney transplant recipients. Our purpose is to describe the design and methods of the MAGIC (Medication Adherence Given Individual SystemCHANGE™) trial METHODS/DESIGN: We report the design of a randomized controlled trial with an attention-control group to test an innovative 6-month SystemCHANGE™ intervention designed to enhance immunosuppressive medication adherence in adult non-adherent kidney transplant recipients from two transplant centers...
2016: BMC Nephrology
David J Taber, Kelly J Hunt, Cory E Fominaya, Elizabeth H Payne, Mulugeta Gebregziabher, Titte R Srinivas, Prabhakar K Baliga, Leonard E Egede
Although outcome inequalities for non-Hispanic black (NHB) kidney transplant recipients are well documented, there is paucity in data assessing the impact of cardiovascular disease (CVD) risk factors on this disparity in kidney transplantation. This was a longitudinal study of a national cohort of veteran kidney recipients transplanted between January 2001 and December 2007. Data included baseline characteristics acquired through the United States Renal Data System linked to detailed clinical follow-up information acquired through the Veterans Affairs electronic health records...
September 2016: Hypertension
Jac Kee Low, Kimberley Crawford, Elizabeth Manias, Allison Williams
AIM: To understand the stressors related to life post-kidney transplantation, with a focus on medication adherence, and the coping resources people use to deal with these stressors. BACKGROUND: Although kidney transplantation offers enhanced quality and years of life for patients, the management of a kidney transplant post-surgery is a complex process. DESIGN: A descriptive exploratory study. METHOD: Participants were recruited from five kidney transplant units in Victoria, Australia...
June 20, 2016: Journal of Clinical Nursing
K Nishikawa, T Hasegawa, A Usami, A Urawa, S Watanabe, S Mizuno, S Isaji, Y Sugimura, M Okada
BACKGROUND: Past studies have indicated that psychological problems in both transplant recipients and donors increase during the pre-operative period. However, few studies have evaluated the pre-operative psychological status of both the recipient and the donor. METHODS: This study included the donors and recipients of 36 adult living donor kidney transplants (LDKT) and 12 adult living donor liver transplants (LDLT) between January 2012 and December 2014. Their personalities were assessed using the Tokyo University Egogram (TEG) and the Yatabe-Guilford Personality Inventory (Y-G), while their mood states just before transplantation were evaluated via the Profile of Mood States (POMS)...
May 2016: Transplantation Proceedings
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