scholarly journals Racial, Ethnic, and Socioeconomic Disparities in Web-Based Patient Portal Usage Among Kidney and Liver Transplant Recipients: Cross-Sectional Study (Preprint)

2018 ◽  
Author(s):  
Joel Wedd ◽  
Mohua Basu ◽  
Laura M Curtis ◽  
Kayla Smith ◽  
Denise J Lo ◽  
...  
Keyword(s):  
Higher Education ◽  
Liver Transplant ◽  
Kidney Transplant ◽  
Socioeconomic Disparities ◽  
Patient Portal ◽  
Transplant Recipients ◽  
Patient Portals ◽  
Web Based ◽  
Liver Transplant Recipients ◽  
Racial Ethnic

BACKGROUND Kidney and liver transplant recipients must manage a complex care regimen after kidney transplant. Although the use of Web-based patient portals is known to improve patient-provider communication and health outcomes in chronic disease populations by helping patients manage posttransplant care, disparities in access to and use of portals have been reported. Little is known about portal usage and disparities among kidney and liver transplant recipients. OBJECTIVE The aim of this study was to examine patient racial/ethnic, socioeconomic, and clinical characteristics associated with portal usage among kidney and liver transplant recipients. METHODS The study included all adult kidney and liver transplant recipients (n=710) at a large academic transplant center in the Southeastern United States between March 2014 and November 2016. Electronic medical record data were linked with Cerner portal usage data. Patient portal use was defined as any portal activity (vs no activity) recorded in the Cerner Web-based portal, including viewing of health records, lab results, medication lists, and the use of secure messaging. Multivariable log-binomial regression was used to determine the patient demographic, clinical, and socioeconomic characteristics associated with portal usage, stratified by organ. RESULTS Among 710 transplant recipients (n=455 kidney, n=255 liver), 55.4% (252/455) of kidney recipients and 48.2% (123/255) of liver recipients used the patient portal. Black patients were less likely to use the portal versus white patients among both kidney (57% black vs 74% white) and liver (28% black vs 55% white) transplant recipients. In adjusted multivariable analyses, kidney transplant recipients were more likely to use the portal if they had higher education; among liver recipients, patients who were white versus black and had higher education were more likely to use the portal. CONCLUSIONS Despite studies showing that patient portals have the potential to benefit transplant recipients as a tool for health management, racial and socioeconomic disparities should be considered before widespread implementation. Transplant centers should include portal training and support to all patients to encourage use, given its potential to improve outcomes.

eHealth literacy and web‐based patient portal usage among kidney and liver transplant recipients

2020 ◽  
Author(s):  
Kieran Maroney ◽  
Laura M. Curtis ◽  
Lauren Opsasnick ◽  
Kayla D. Smith ◽  
Morgan R. Eifler ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Patient Portal ◽  
Transplant Recipients ◽  
Web Based ◽  
Ehealth Literacy ◽  
Liver Transplant Recipients

Early-Onset Coronary Artery Disease after Pediatric Kidney Transplantation: Implicating the Angiogenesis Inhibitor, Endostatin

2011 ◽  
Vol 77 (6) ◽  
pp. 731-735 ◽  
Author(s):  
Corey W. Iqbal ◽  
Patrick G. Dean ◽  
Michael B. Ishitani
Keyword(s):  
Kidney Transplantation ◽  
Liver Transplant ◽  
Kidney Transplant ◽  
Angiogenesis Inhibitor ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Pediatric Kidney Transplantation ◽  
Control Subjects ◽  
Artery Disease ◽  
Liver Transplant Recipients

Pediatric kidney transplant recipients have a higher rate of coronary artery disease (CAD) as adults. The angiogenesis inhibitor, endostatin, has been implicated in the development of atherosclerosis. Endostatin levels will vary between adult patients who received a kidney transplant as a child. We conducted a study in young adult patients who had undergone pediatric kidney (n = 12) or liver transplantation (n = 8). Coronary arterial calcification was measured using electron beam CT. Values were compared with age-matched control subjects from an epidemiologic database. Serum endostatin levels were measured using enzyme-linked immunosorbent assay. Risk factors for atherosclerosis were assessed. Kidney transplant recipients had a higher rate of CAD compared with liver transplant recipients (33 vs 0%, P = 0.03). Mean (± standard error of mean) serum endostatin levels were higher in kidney transplant recipients compared with liver transplant recipients (26 ± 7 vs 14 ± 3 ng/mL, P = 0.04) and control subjects (26 ± 7 vs 11 ± 1 ng/ mL, P = 0.01). Pediatric kidney transplantation is associated with a higher rate of adult-onset CAD compared with liver transplantation. Endostatin levels were greater in kidney transplant recipients compared with liver transplant recipients and healthy control subjects. Endostatin may play a role in the development of atherosclerosis after kidney transplantation and may serve as a biomarker for atherosclerotic disease.

scholarly journals Dose-adjusted and dose/kg-adjusted concentrations of mycophenolic acid precursors reflect metabolic ratios of their metabolites in contrast with tacrolimus and cyclosporine

2019 ◽  
Vol 39 (9) ◽  
Author(s):  
Ewa Hryniewiecka ◽  
Jolanta Żegarska ◽  
Dorota Żochowska ◽  
Emilia Samborowska ◽  
Radosław Jaźwiec ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Kidney Transplant ◽  
Mycophenolic Acid ◽  
Parent Drug ◽  
Immunosuppressive Drug ◽  
Therapeutic Drug ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Liver And Kidney ◽  
Liver Transplant Recipients

Abstract Background and purpose: Therapeutic drug monitoring is a valuable tool supporting immunosuppressive therapy. Significant variation of immunosuppressive drug (ISD) concentrations during their use at similar doses is the basis of dose-normalization strategy. The strategy of dose-adjustment is proposed to identify variability in the rate of ISD metabolism. While the parent drug-to-metabolite ratio (metabolic ratio, MR) represents the rate of formation of individual metabolites. The present study was aimed at evaluation of associations between ISDs’ metabolism rate expressed as dose-adjusted concentrations (C/D) and dose/kg-adjusted concentrations (C/D/kg) and MRs of individual metabolites of tacrolimus, cyclosporine A and MPA precursors. Experimental approach: 506 patients have participated: 284 males (56.13%) and 222 females (43.87%); 318 after kidney (62.85%) and 188 after liver transplantation; median age was 51.34 (39.32-59.95) years and median time after transplantation 78.92 (33.87-138.4) months. Key results: Generally, we have not observed significant relationships between dose-adjusted and dose/kg-adjusted concentrations and MRs of cyclosporine and tacrolimus. Significant correlations were found for: AM9/CsA and dMC-CsA/CsA in kidney transplant recipients and MIII/Tac, AM1/CsA and AM4N/CsA in liver transplant recipients. In contrast, MRs of mycophenolic acid (MPA) metabolites correlated significantly with MPA C/D and C/D/kg both in kidney and liver transplant recipients. Conclusion and implications: In conclusion, easily available and easy to use in clinical practice C/D and C/D/kg ratios cannot be considered as parameters directly reflecting the rate of generation of major metabolites of cyclosporine and tacrolimus both in liver and kidney transplant recipients.

scholarly journals 1754. Pre-Transplant Vaccination Rates in Solid-Organ Transplant Recipients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S643-S644
Author(s):  
Daniel Friedman ◽  
Sara Belga ◽  
Catherine Burton ◽  
Jutta Preiksaitis ◽  
Dima Kabbani
Keyword(s):  
Hepatitis B ◽  
Liver Transplant ◽  
Kidney Transplant ◽  
Pneumococcal Vaccine ◽  
Hepatitis A ◽  
Solid Organ ◽  
Transplant Recipients ◽  
International Guidelines ◽  
Adult Kidney ◽  
Liver Transplant Recipients

Abstract Background Recipients of solid-organ transplants (SOT) are at increased risk of vaccine-preventable illnesses. Because of the immunosuppression administered following SOT, live vaccines are generally contraindicated post-SOT, and response to inactivated vaccines may be suboptimal. National and international guidelines recommend optimizing immunizations prior to SOT. We analyzed rates of vaccination for SOT candidates in a cohort of adult kidney and liver transplant recipients. Methods A retrospective chart review of adult kidney, kidney/pancreas (KP) and liver transplant recipients was conducted between 2014 and 2016. We calculated the rates of vaccinations of the following vaccines: pneumococcus, meningococcus, Hepatitis A and B, Haemophilus influenzae type B, measles, mumps, rubella, polio, tetanus, diphtheria and pertussis. Results 300 patients were included (147 kidney, 14 KP, 139 liver). Liver recipients were older (mean age 53 vs. 50; P = 0.028) and less likely to have had a previous transplant (5.8% vs. 21.1%; P < 0.001) or a living donor (15.8% vs. 32.3%, P = 0.01). Liver recipients were more likely to have been vaccinated against hepatitis A (106 [53.9%] vs. 28 [17.4%]; P < 0.001). Kidney and KP recipients were more likely to have received at least 1 dose of hepatitis B vaccine (138 [85.7%] vs. 91 [65.5%]; P < 0.001) or at least 1 dose of any of the pneumococcal vaccines (PSV23 94 [67.6%] vs. 92 [57.1%]; P = 0.062; PCV13 130 [80.7%] vs. 93 [66.9%]; P = 0.006; pneumococcal vaccine not clarified 47 [29.2%] vs. 14 [10.1%]; P < 0.001). No difference was observed with regards to other vaccines (Table 1). Being a kidney transplant recipient increased the odds of getting at least 1 dose of hepatitis B, tetanus/diphtheria/acellular pertussis (Tdap), measles, and pneumococcal vaccine (OR = 1.75, 95% CI [1.063–2.864]; P = 0.028) Conclusion In our cohort, kidney transplant recipients were more likely to have received pre-transplant vaccination. Despite the availability of local and international guidelines, vaccination in SOT candidates remains suboptimal and further study of barriers to implementation of these guidelines is warranted to inform future quality improvement initiatives. Disclosures All authors: No reported disclosures.

scholarly journals COVID-19 Severity and Mortality in Solid Organ Transplantation: Differences between Liver, Heart, and Kidney Recipients

2021 ◽  
Vol 2 (3) ◽  
pp. 296-303 ◽  
Author(s):  
Ricardo Wesley Alberca ◽  
Gabriela Gama Freire Alberca ◽  
Lucas Chaves Netto ◽  
Raquel Leão Orfali ◽  
Sarah Cristina Gozzi-Silva ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Kidney Transplant ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Control Group ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Solid Organ Transplant Recipients ◽  
Liver Transplant Recipients

The infection by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can generate a wide spectrum of clinical manifestations ranging from asymptomatic to severe respiratory and systemic disease with coagulation disorder named coronavirus disease 2019 (COVID-19). Patients with comorbidities have been identified as risk groups for severe COVID-19, also having a higher death risk. Previous reports have conflicting results regarding if solid organ transplant recipients present an increased risk for COVID-19. Nevertheless, previous investigations failed to distinguish between different organs received or made a longitudinal investigation on those patients. We recruited 39 solid organ transplant recipients: 25 kidney transplant recipients, 7 heart transplant recipients, and 7 liver transplant recipients and 25 age-matched non-transplant COVID-19 patients without comorbidities (control group) and compared daily laboratory data in addition to performing survival analysis. Heart and kidney transplant recipients presented an increase in several COVID-19 severity-associated biomarkers, such as neutrophil-to-lymphocyte ratio and thrombocytopenia, in comparison to the control group and liver transplant recipients. Heart and kidney transplant recipients also presented an increase in the need for intensive care and invasive mechanical ventilation during the disease’s course. Importantly, heart and kidney transplant recipients presented a higher mortality rate in comparison to liver transplant recipients and non-transplant recipients. In our cohort, heart and kidney transplant recipients presented a difference in clinical characteristics and survival rate in comparison to liver transplant recipients. Further investigation involving immune response to SARS-CoV-2 in solid organ recipients should consider and separate patients according to the organ grafted.

scholarly journals COVID-19 Vaccine Acceptance among Liver Transplant Recipients

Vaccines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1314
Author(s):  
Andrea Costantino ◽  
Federica Invernizzi ◽  
Erica Centorrino ◽  
Maurizio Vecchi ◽  
Pietro Lampertico ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Response Rate ◽  
Transplant Recipients ◽  
Vaccine Acceptance ◽  
Web Based ◽  
Entire Cohort ◽  
Baseline Characteristics ◽  
Vaccination Campaigns ◽  
Liver Transplant Recipients ◽  
Vaccination Hesitancy

(1) Background: COVID-19 vaccination hesitancy is a threat for fragile patients. We aimed to evaluate COVID-19 vaccination hesitancy and its reasons in a population of liver transplant (LT) recipients. (2) Methods: In February 2021, a questionnaire on COVID-19 vaccines was sent to LT patients followed at our liver transplant outpatient clinic in Milan, Italy. Sociodemographic and clinical characteristics were recorded. Patients were defined as willing, hesitant, or refusing and their reasons were investigated. Associations between baseline characteristics and willingness were evaluated. Since March 2021, when the COVID-19 vaccines became available for LT candidates and recipients in Italy, the entire cohort of LT recipients was contacted by phone and called for vaccination, and the rate of refusals recorded. (3) Results: The web-based survey was sent to 583 patients, of whom 190 responded (response rate of 32.6%). Among the respondents to the specific question about hesitancy (184), 157 (85.3%) were willing to be vaccinated against COVID-19, while 27 (14.7%) were hesitant. Among the hesitant, three were totally refusing, for a refusal rate of 1.6%. Thirteen hesitant patients (48.1%) answered that their COVID-19 vaccination hesitancy was influenced by being a transplant recipient. The fear of adverse effects was the main reason for refusal (81.5%). Of the 711 LT patients followed at our center, 668 got fully vaccinated, while 43 (6.1%) of them refused the scheduled vaccination. (4) Conclusions: Most patients accepted COVID-19 vaccines, although 6.1% refused the vaccine. Since it is crucial to achieve adequate vaccination of LT patients, it is very important to identify the reasons influencing COVID-19 vaccination hesitancy so that appropriate and targeted communication strategies can be established and specific vaccination campaigns further implemented.

Hyperhomocysteinemia in liver transplant recipients

2001 ◽  
Vol 120 (5) ◽  
pp. A562-A562
Author(s):  
A HABIB ◽  
B BACON ◽  
S RAMRAKHIANI
Keyword(s):  
Liver Transplant ◽  
Transplant Recipients ◽  
Liver Transplant Recipients
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