scholarly journals Changes in quality of life (QoL) and other patient-reported outcome measures (PROMs) in living-donor and deceased-donor kidney transplant recipients and those awaiting transplantation in the UK ATTOM programme: a longitudinal cohort questionnaire survey with additional qualitative interviews

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e047263
Author(s):  
Andrea Gibbons ◽  
Janet Bayfield ◽  
Marco Cinnirella ◽  
Heather Draper ◽  
Rachel J Johnson ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Outcome Measures ◽  
Deceased Donor ◽  
Patient Reported Outcome Measures ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Post Transplant ◽  
Patient Reported

ObjectiveTo examine quality of life (QoL) and other patient-reported outcome measures (PROMs) in kidney transplant recipients and those awaiting transplantation.DesignLongitudinal cohort questionnaire surveys and qualitative semi-structured interviews using thematic analysis with a pragmatic approach.SettingCompletion of generic and disease-specific PROMs at two time points, and telephone interviews with participants UK-wide.Participants101 incident deceased-donor (DD) and 94 incident living-donor (LD) kidney transplant recipients, together with 165 patients on the waiting list (WL) from 18 UK centres recruited to the Access to Transplantation and Transplant Outcome Measures (ATTOM) programme completed PROMs at recruitment (November 2011 to March 2013) and 1 year follow-up. Forty-one of the 165 patients on the WL received a DD transplant and 26 received a LD transplant during the study period, completing PROMs initially as patients on the WL, and again 1 year post-transplant. A subsample of 10 LD and 10 DD recipients participated in qualitative semi-structured interviews.ResultsLD recipients were younger, had more educational qualifications and more often received a transplant before dialysis. Controlling for these and other factors, cross-sectional analyses at 12 months post-transplant suggested better QoL, renal-dependent QoL and treatment satisfaction for LD than DD recipients. Patients on the WL reported worse outcomes compared with both transplant groups. However, longitudinal analyses (controlling for pre-transplant differences) showed that LD and DD recipients reported similarly improved health status and renal-dependent QoL (p<0.01) pre-transplant to post-transplant. Patients on the WL had worsened health status but no change in QoL. Qualitative analyses revealed transplant recipients’ expectations influenced their recovery and satisfaction with transplant.ConclusionsWhile cross-sectional analyses suggested LD kidney transplantation leads to better QoL and treatment satisfaction, longitudinal assessment showed similar QoL improvements in PROMs for both transplant groups, with better outcomes than for those still wait-listed. Regardless of transplant type, clinicians need to be aware that managing expectations is important for facilitating patients’ adjustment post-transplant.

scholarly journals Validation of a survival benefit estimator tool in a cohort of European kidney transplant recipients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Armando Coca ◽  
Carlos Arias-Cabrales ◽  
Ana Lucía Valencia ◽  
Carla Burballa ◽  
Juan Bustamante-Munguira ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Survival Benefit ◽  
Patient Survival ◽  
Deceased Donor ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Donor Kidney ◽  
Transplant Survival ◽  
Post Transplant ◽  
Deceased Donor Kidney

Abstract Pre-transplant prognostic scores help to optimize donor/recipient allocation and to minimize organ discard rates. Since most of these scores come from the US, direct application in non-US populations is not advisable. The Survival Benefit Estimator (SBE), built upon the Estimated Post-Transplant Survival (EPTS) and the Kidney Donor Profile Index (KDPI), has not been externally validated. We aimed to examine SBE in a cohort of Spanish kidney transplant recipients. We designed a retrospective cohort-based study of deceased-donor kidney transplants carried out in two different Spanish hospitals. Unadjusted and adjusted Cox models were applied for patient survival. Predictive models were compared using Harrell’s C statistics. SBE, EPTS and KDPI were independently associated with patient survival (p ≤ 0.01 in all models). Model discrimination measured with Harrell’s C statistics ranged from 0.57 (KDPI) to 0.69 (SBE) and 0.71 (EPTS). After adjustment, SBE presented similar calibration and discrimination power to that of EPTS. SBE tended to underestimate actual survival, mainly among high EPTS recipients/high KDPI donors. SBE performed acceptably well at discriminating post-transplant survival in a cohort of Spanish deceased-donor kidney transplant recipients, although its use as the main allocation guide, especially for high KDPI donors or high EPTS recipients requires further testing.

Impact of Post-Transplant Dysglycemia on Renal Allogrfat Function in Kidney Transplant Recipients on Cyclosporine-Based Immunosuppression

2017 ◽  
Vol 71 (2) ◽  
pp. 91-98
Author(s):  
Lidija Petkovska ◽  
Goran Dimitrov ◽  
Julijana Brezovska Kavrakova ◽  
Zvezdana Petronijevic ◽  
Djulshen Selim ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Fasting Blood Glucose ◽  
Graft Function ◽  
Oral Glucose ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cross Sectional ◽  
Post Transplant ◽  
The Impact ◽  
Group 1

Abstract Introduction. Post-transplant diabetes (PTDM), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are common complications of immunosuppressive therapy (IT) and are associated with increased cardiovascular morbidity and impaired graft function (GF). Methods. Fifty-nine living donor kidney transplant recipients (KTR) were included in a combined cross-sectional and 8-month-observational prospective study about the impact of impaired glucose homeostasis (IGH) on GF. All patients were on standard IT including cyclosporine A (CsA), steroids and mycophenolate mofetil (MMF). In all patients a standard oral glucose tolerans test (OGTT) was performed. Results were classified according to the criteria of the American Diabetes Association: normal-with fasting blood glucose level (FGL) <5.6, IFG with FGL of 5.6-6.9, IGT with FGL of 7.8-11.1 and DM between > 6.9 FGL and >11 mmol/l. According to the results, all patients were divaded into two groups: Group 1 with impaired and Group 2 with normal GH. GF was estimated by GFR-Cockroft Gault (CG) and by degree of proteinuria in the beginning and end of the study. Results. Twenty of 59(33.9%) patients showed overt IGH after transplantation while the remaining 39(66.1) were normal. The principal dysglycemia in KTR were PTDM (2 patients-3.3%), IGT (18 patients-30.5%) and IFG (7 patients-11.8%). In Group 1, postprandial glucose was higher (8.1±2.3 vs 5.8±0.7), more KTR were male (70% vs 33.3%), higher CsA levels were observed (160.9±81.2 vs 115.1±59.9) and time after the surgery was shorter (24.5±21.3 vs 41.4±28.). After a follow-up period of approximately 18 months in Group 1 a significant decline in GFR (62.6-52.7 ml/min) was noted, with no significant change in proteinuria. The correlation analysis was positive between CsA level and IGH and the time after transplantation and IFG. Conclusion. Post-transplant dysglycemia and associated metabolic abnormalities are a significant factor for the deterioration of GF. CsA higher levels are associated with the occurrence of IGH and they affect the GF.

scholarly journals Current Pharmacological Intervention and Medical Management for Diabetic Kidney Transplant Recipients

Pharmaceutics ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 413
Author(s):  
Theerawut Klangjareonchai ◽  
Natsuki Eguchi ◽  
Ekamol Tantisattamo ◽  
Antoney J. Ferrey ◽  
Uttam Reddy ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Pharmacological Intervention ◽  
Diabetic Patients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Kidney Allograft ◽  
Post Transplant ◽  
Glucose Management

Hyperglycemia after kidney transplantation is common in both diabetic and non-diabetic patients. Both pretransplant and post-transplant diabetes mellitus are associated with increased kidney allograft failure and mortality. Glucose management may be challenging for kidney transplant recipients. The pathophysiology and pattern of hyperglycemia in patients following kidney transplantation is different from those with type 2 diabetes mellitus. In patients with pre-existing and post-transplant diabetes mellitus, there is limited data on the management of hyperglycemia after kidney transplantation. The following article discusses the nomenclature and diagnosis of pre- and post-transplant diabetes mellitus, the impact of transplant-related hyperglycemia on patient and kidney allograft outcomes, risk factors and potential pathogenic mechanisms of hyperglycemia after kidney transplantation, glucose management before and after transplantation, and modalities for prevention of post-transplant diabetes mellitus.

PRE- AND POST-TRANSPLANT BEHAVIOUR OF DSA IN KIDNEY TRANSPLANT RECIPIENTS WITH NEGATIVE CROSSMATCH TREATED BY PLAMAPHERESIS AND IVIG

2008 ◽  
Vol 86 (Supplement) ◽  
pp. 589
Author(s):  
L E. Morales-Buenrostro ◽  
C De Leo ◽  
M Arvizu ◽  
B Gabilondo ◽  
M Vilatoba ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplant
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