scholarly journals Burden of cytomegalovirus reactivation post kidney transplant with antithymocyte globulin use in Thailand: A retrospective cohort study

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1568 ◽  
Author(s):  
Maria N. Chitasombat ◽  
Siriorn P. Watcharananan
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Antithymocyte Globulin ◽  
Graft Loss ◽  
Infectious Complications ◽  
Inpatient Setting ◽  
Cost Of Treatment ◽  
Duration Of Hospitalization ◽  
Cmv Reactivation

Background: Cytomegalovirus (CMV) is an important cause of infectious complications after kidney transplantation (KT), especially among patients receiving antithymocyte globulin (ATG). CMV infection can result in organ dysfunction and indirect effects such as graft rejection, graft failure, and opportunistic infections. Prevention of CMV reactivation includes pre-emptive or prophylactic approaches. Access to valganciclovir prophylaxis is limited by high cost. Our objective is to determine the burden and cost of treatment for CMV reactivation/disease among KT recipients who received ATG in Thailand since its first use in our center. Methods: We conducted a single-center retrospective cohort study of KT patients who received ATG during 2010-2013. We reviewed patients’ characteristics, type of CMV prophylaxis, incidence of CMV reactivation, and outcome (co-infections, graft function and death). We compared the treatment cost between patients with and without CMV reactivation. Results: Thirty patients included in the study had CMV serostatus D+/R+. Twenty-nine patients received intravenous ganciclovir early after KT as inpatients. Only three received outpatient valganciclovir prophylaxis. Incidence of CMV reactivation was 43%, with a median onset of 91 (range 23-1007) days after KT. Three patients had CMV end-organ disease; enterocolitis or retinitis. Infectious complication rate among ATG-treated KT patients was up to 83%, with a trend toward a higher rate among those with CMV reactivation (P = 0.087). Patients with CMV reactivation/disease required longer duration of hospitalization (P = 0.018). The rate of graft loss was 17%. The survival rate was 97%. The cost of treatment among patients with CMV reactivation was significantly higher for both inpatient setting (P = 0.021) and total cost (P = 0.035) than in those without CMV reactivation. Conclusions: Burden of infectious complications among ATG-treated KT patients was high. CMV reactivation is common and associated with longer duration of hospitalization and higher cost.

The duration of hospitalization before review by the rapid response team: A retrospective cohort study

2015 ◽  
Vol 30 (4) ◽  
pp. 692-697 ◽  
Author(s):  
Roger J. Smith ◽  
John D. Santamaria ◽  
Espedito E. Faraone ◽  
Jennifer A. Holmes ◽  
David A. Reid ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Response Team ◽  
Duration Of Hospitalization

scholarly journals Associations with kidney transplant survival and eGFR decline in children and young adults in the United Kingdom: a retrospective cohort study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Alexander J. Hamilton ◽  
Lucy A. Plumb ◽  
Anna Casula ◽  
Manish D. Sinha
Keyword(s):  
Young Adults ◽  
Cohort Study ◽  
Young Adulthood ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Graft Loss ◽  
Glomerular Diseases ◽  
Children And Young Adults ◽  
Egfr Decline

Abstract Background Although young adulthood is associated with transplant loss, many studies do not examine eGFR decline. We aimed to establish clinical risk factors to identify where early intervention might prevent subsequent adverse transplant outcomes. Methods Retrospective cohort study using UK Renal Registry and UK Transplant Registry data, including patients aged < 30 years transplanted 1998–2014. Associations with death-censored graft failure were investigated with multivariable Cox proportional hazards. Multivariable linear regression was used to establish associations with eGFR slope gradients calculated over the last 5 years of observation per individual. Results The cohort (n = 5121, of whom n = 371 received another transplant) was 61% male, 80% White and 36% had structural disease. Live donation occurred in 48%. There were 1371 graft failures and 145 deaths with a functioning graft over a 39,541-year risk period. Median follow-up was 7 years. Fifteen-year graft survival was 60.2% (95% CI 58.1, 62.3). Risk associations observed in both graft loss and eGFR decline analyses included female sex, glomerular diseases, Black ethnicity and young adulthood (15–19-year and 20–24-year age groups, compared to 25–29 years). A higher initial eGFR was associated with less risk of graft loss but faster eGFR decline. For each additional 10 mL/min/1.73m2 initial eGFR, the hazard ratio for graft loss was 0.82 (95% CI 0.79, 0.86), p < 0.0001. However, compared to < 60 mL/min/1.73m2, higher initial eGFR was associated with faster eGFR decline (> 90 mL/min/1.73m2; − 3.55 mL/min/1.73m2/year (95% CI -4.37, − 2.72), p < 0.0001). Conclusions In conclusion, young adulthood is a key risk factor for transplant loss and eGFR decline for UK children and young adults. This study has an extended follow-up period and confirms common risk associations for graft loss and eGFR decline, including female sex, Black ethnicity and glomerular diseases. A higher initial eGFR was associated with less risk of graft loss but faster rate of eGFR decline. Identification of children at risk of faster rate of eGFR decline may enable early intervention to prolong graft survival.

A Retrospective Cohort Study of Falls in a Psychiatric Inpatient Setting

1991 ◽  
Vol 42 (7) ◽  
pp. 714-720 ◽  
Author(s):  
Elizabeth C. Poster ◽  
Luc R. Pelletier ◽  
Karen Kay
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Psychiatric Inpatient ◽  
Inpatient Setting
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