Mode of Obstetric Delivery in Kidney and Liver Transplant Recipients and Associated Maternal, Neonatal, and Graft Morbidity During 5 Decades of Clinical Practice

Abstract Background Most interventions for conditions with a small cohort size, such as transplantation, are unlikely to be part of a clinical trial. When condition-specific evidence is lacking, expert consensus can offer more precise guidance to improve care. Management of cardiovascular risk in liver-transplant recipients is one example for which clinicians have, to date, adapted evidence-based guidelines from studies in the general population. However, even when consensus is achieved, implementation of practice guidance is often inadequate and protracted. We report on a novel mixed-methods approach, the Northwestern Method©, for the development of clinical-practice guidance when condition-specific evidence is lacking. We illustrate the method through the development of practice guidance for managing cardiovascular risk in liver-transplant recipients. Methods The Northwestern Method© consists of (i) adaptation of relevant, existing, evidence-based clinical-practice guidelines for the target population; (ii) consensus by experts of the proposed practice guidance; (iii) identification of barriers to guidance adherence in current practice; and (iv) recommendation for implementation and dissemination of the practice guidance. The method is based on an iterative, user-centered approach in which the needs, wants, and limitations of all end users, including patients, are attended to at each stage of the design and development process. Conclusions The Northwestern Method© for clinical-practice-guidance development uses a mixed-methods approach to bring together broad representation from multiple disciplines and practice settings to develop consensus considering the unique needs and preferences of patients, caregivers, and practitioners who are directly impacted by clinical-practice-guidance recommendations. We hypothesize that a priori involvement of end users in the guidance-development process will lead to sustainable implementation of guidance statements into clinical practice.

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Clinical Practice of Unsedated Colonoscopy Among the Liver Transplant Recipients

10.21203/rs.2.19615/v1 ◽

2019 ◽

Author(s):

Man Xie ◽

Tao Mao ◽

Qun Zhang ◽

Zi-bin Tian ◽

Wei Rao

Keyword(s):

Liver Transplantation ◽

Clinical Practice ◽

Liver Transplant ◽

Tertiary Hospital ◽

Screening Colonoscopy ◽

Control Group ◽

Transplant Recipients ◽

Common People ◽

Patient’S Satisfaction ◽

Liver Transplant Recipients

Abstract Background: The incidence of colorectal cancer was increased in the liver transplant recipients and clinical practice of unsedated colonoscopy among the liver transplant recipients hasn't been fully studied. Our prospective and observational study was conducted in a tertiary hospital to investigate the clinical practice of unsedated colonoscopy among the liver transplant recipients. Methods: Between June 2017 and June 2018, clinical data of the 72 liver transplant recipients received the screening colonoscopy conducted by a same endoscopists was collected. And a group of asymptomatic health examiner of same age and same gender was chosen as control group at a ratio of 1:3. Data of the colonoscopy performance, patient satisfaction and colonoscopy finding were compared between the two groups. Results: No difference was observed between the two groups in the bowel clearance ( P =0.273) , however, cecal intubation time was longer ( P =0.024) and the auxiliary abdominal compression by nurses was more frequent ( P ＜0.01) in liver transplantation group. In term of patient’s satisfaction, postprocedural visual analog scale, the willingness of repeat the same procedure and the four-point Likert scale (no pain, slight pain, moderate pain, severe pain) on the second day were comparable between the two groups. Compared with control group, the incidence of polyps was higher in the liver transplantation group (50.00% (36/72) vs37.04% (80/216), P =0.036), and the incidence of adenomatous polyps(33.33%vs 24.07%, P =0.084) and advanced polyps (11.11%vs 5.56%, P =0.094) were also higher in the liver transplantation group, but no statistical difference was observed. Conclusions: Liver transplantation mildly increases the difficulty of colonoscopy with experienced practitioners, although the patient’s satisfaction was comparable with the common people. Key words: colonoscopy, liver transplantation, visual analogue scale, polyps

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Baseline evaluation of serum markers of inflammation and their utility in clinical practice in paediatric liver transplant recipients

Clinics and Research in Hepatology and Gastroenterology ◽

10.1016/j.clinre.2012.01.010 ◽

2012 ◽

Vol 36 (4) ◽

pp. 365-370 ◽

Cited By ~ 5

Author(s):

Tassos Grammatikopoulos ◽

Anil Dhawan ◽

Sanjay Bansal ◽

Jim Wade ◽

Roy Sherwood ◽

...

Keyword(s):

Clinical Practice ◽

Liver Transplant ◽

Serum Markers ◽

Transplant Recipients ◽

Markers Of Inflammation ◽

Baseline Evaluation ◽

Liver Transplant Recipients

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Adherence to, and patient convenience of, prolonged-release tacrolimus in stable kidney and liver transplant recipients after conversion from immediate-release tacrolimus in routine clinical practice in Switzerland

Swiss Medical Weekly ◽

10.4414/smw.2021.20453 ◽

2021 ◽

Author(s):

Marco Bonani ◽

Alexandre Balaphas ◽

Giulia Bedino ◽

Lo Bhler ◽

Philipp Dutkowski ◽

...

Keyword(s):

Clinical Practice ◽

Liver Transplant ◽

Immediate Release ◽

Routine Clinical Practice ◽

Prolonged Release ◽

Transplant Recipients ◽

Liver Transplant Recipients

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Immunosuppressive regimens for adult liver transplant recipients in real-life practice: consensus recommendations from an Italian Working Group

Hepatology International ◽

10.1007/s12072-020-10091-5 ◽

2020 ◽

Author(s):

Umberto Cillo ◽

Luciano De Carlis ◽

Massimo Del Gaudio ◽

Paolo De Simone ◽

Stefano Fagiuoli ◽

...

Keyword(s):

Liver Transplantation ◽

Clinical Practice ◽

Liver Transplant ◽

Working Group ◽

De Novo ◽

Real Life ◽

Transplant Recipients ◽

Adult Liver ◽

Consensus Statements ◽

Liver Transplant Recipients

AbstractIt is a well-recognized fact that implementing new guidelines in clinical practice may be difficult; therefore the Italian Society for Organ and Tissue Transplantation (SITO) set out to define practical immunosuppression tools for the management of liver transplantation patients. In 2017, an Italian Working Group of liver transplant experts and hepatologists issued a set of consensus statements along with evidence-based recommendations on the use of everolimus after liver transplantation. This article presents the evidence- and consensus-based algorithms developed within the Italian Working Group, which are aimed towards guiding clinicians in the selection of immunosuppressive regimens for the management of adult liver transplant recipients in real-life practice. The liver transplant recipient population, typically managed in clinical practice, was divided into the following categories: (1) standard patients; (2) critically ill patients; (3) patients with a specific etiology; (4) patients with hepatocellular carcinoma; (5) and patients with de novo malignancies. The algorithms are divided into two parts, according to the time from transplantation (0–3 months and > 3 months) and are discussed here along with relevant supporting literature, when available. Ultimately, it is hoped that the evidence- and consensus-based algorithms developed within the Italian Working Group, and presented here, contribute to simplify, personalize, and optimize immunosuppression of liver transplantation recipients in clinical practice.

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