Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)最新文献

{"title":"Compliance and Noncompliance in Kidney Transplant Patients: Cues for Transplant Coordinators","authors":"B. Siegal, S. Greenstein","doi":"10.1177/090591999900900207","DOIUrl":"https://doi.org/10.1177/090591999900900207","url":null,"abstract":"Journal of Transplant Coordination, Vol. 9, Number 2, June 1999 respondents reported noncompliance with immunosuppressants; lack of compliance was associated with being single, male, and less knowledgeable about medication administration, and having lower scores on several psychosocial scales. Using pill counts to assess medication noncompliance among 113 patients during the first 12 months posttranplantation, Hilbrands et al7 found that 23% of respondents were noncompliant with cyclosporine. Although these authors did not find a strong relationship between noncompliance and several demographic variables, compliance was noted to increase markedly following rejection episodes. Finally, in our recently reported analyses of data gathered by questionnaires for 519 renal allograft recipients and by chart review for a subset of 397 (76.5%), approximately 18% of patients reported that they forgot to take, decided not to take, or adjusted the dose or frequency of an immunosuppressive medication within the 4 weeks prior to data collection.8 Noncompliance was associated with demographic variables (younger age, male sex, nonwhite race), characteristics of the transplant (longer time since transplantation), and health beliefs (beliefs that posttransplant symptoms will persist and that medications are not effective). Research to date concerning levels and predictors of noncompliance has yielded results that are not easy to Compliance and noncompliance in kidney transplant patients: cues for transplant coordinators","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 1","pages":"104 - 108"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/090591999900900207","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65465883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generic drugs in transplantation: new responsibilities for clinical transplant coordinators.","authors":"L Ohler","doi":"10.7182/prtr.1.9.2.p4m54w71m24v3083","DOIUrl":"https://doi.org/10.7182/prtr.1.9.2.p4m54w71m24v3083","url":null,"abstract":"","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 2","pages":"71-2"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21555479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone densitometry should be included in the evaluation of candidates for lung transplantation.","authors":"V A Dodd,&nbsp;R B Staron,&nbsp;A Papadopoulos,&nbsp;L Evans,&nbsp;L L Schulman,&nbsp;B Jorgensen,&nbsp;R Gerow-Smith,&nbsp;E Shane","doi":"10.7182/prtr.1.9.2.c85777j256476504","DOIUrl":"https://doi.org/10.7182/prtr.1.9.2.c85777j256476504","url":null,"abstract":"<p><p>Bone loss and fractures are common complications of heart and liver transplantation, and are likely related to high-dose immunosuppressive therapy. We have previously demonstrated that many patients with end-stage lung disease already have osteoporosis and may be at even greater risk for fracture after lung transplantation. The purpose of this study is to determine the incidence of fracture in lung transplant recipients on osteoporosis prevention regimens, the relationship of fracture to pretransplant bone mineral density, and the impact of fracture on quality of life after lung transplantation. Twenty-one lung transplant candidates were prospectively evaluated with spine radiographs and bone mineral densitometry. Bone density was expressed as T scores, the number of standard deviations from the mean bone density of a young normal population of the same gender. Of 21 patients, 8 (38%) fractured during the first year. The mean pretransplant lumbar spine T score was significantly lower in the fracture patients (P = .03). Four of the 7 surviving fracture patients and 1 of the 10 patients who survived without fracture believed that chronic pain diminished their quality of life (X2 = 4.408; P = .04). These findings suggest that bone mineral density should be routinely included in the evaluation of lung transplant candidates. Patients with extremely low bone density or osteoporotic fracture should be counseled about the increased risk of fracture after transplantation.</p>","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 2","pages":"119-23"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21556008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of Kidney Transplantation under Tacrolimus-Based Immunosuppression in Elderly Patients","authors":"A. Soran, R. Shapiro, H. Başar, C. Vivas, V. Scantlebury, M. Jordan, H. Gritsch, J. Mccauley, P. Randhawa, T. Hakala, J. Fung","doi":"10.1177/090591999900900206","DOIUrl":"https://doi.org/10.1177/090591999900900206","url":null,"abstract":"Journal of Transplant Coordination, Vol. 9, Number 2, June 1999 went kidney transplantation between February 1990 and April 1997 at the University of Pittsburgh Medical Center. Of these 1227 kidney-only transplants, 230 (19%) were performed in patients aged 60 years or older at the time of transplantation (mean age, 65.2± 4.4 years; range, 60-84). The average donor age was 37.4±21.5 years (range, 1-76). Regarding sex distribution, 149 (65%) recipients were male and 81 (35%) were female. A total of 204 (89%) patients were white, 19 (8%) were black, and 7(3%) were in other ethnic groups. Cadaveric donors accounted for 223 (97%) of the cases, and living donors were used in 7 (3%) cases. The causes of end-stage renal disease were diabetes in 50 (22%) patients, hypertension in 33 (14%) patients, chronic glomerulonephritis in 30 (13%) patients, polycystic kidney disease in 23 (10%) patients, and other causes (renovascular disease, Outcome of kidney transplantation under tacrolimus-based immunosuppression in elderly patients","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 1","pages":"101 - 103"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/090591999900900206","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65465865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of kidney transplantation under tacrolimus-based immunosuppression in elderly patients.","authors":"A Soran,&nbsp;R Shapiro,&nbsp;H Basar,&nbsp;C Vivas,&nbsp;V P Scantlebury,&nbsp;M L Jordan,&nbsp;H A Gritsch,&nbsp;J McCauley,&nbsp;P Randhawa,&nbsp;T R Hakala,&nbsp;J J Fung","doi":"10.7182/prtr.1.9.2.2034366167382573","DOIUrl":"https://doi.org/10.7182/prtr.1.9.2.2034366167382573","url":null,"abstract":"<p><p>Kidney transplantation has become a reasonable treatment option for selected patients aged 60 years or older, and a number of different immunosuppressive drug protocols have been described. This article concerns 230 recipients who were aged 60 years or older and who were undergoing kidney-only transplantation at the University of Pittsburgh between January 1990 and April 1997. All recipients were treated with a tacrolimus-based immunosuppression regimen. The median follow-up was 31.5 months (range, 1-86). The 1-, 3-, and 5-year actuarial patient survival rates were 90%, 83%, and 76%, respectively. There were 42 (19%) deaths, cardiovascular disease (50%) and infection (38%) being the main causes. Death with a functioning kidney occurred in 28 (67%) patients. The 1-, 3-, and 5-year actuarial graft survival rates were 84%, 74%, and 64%, respectively. The delayed graft function rate was 33%. Rejection was seen in 57 (25%) elderly patients. The mean serum creatinine was 2.6 +/- 2.7 mg/dL and the serum urea nitrogen was 35 +/- 22 mg/dL. The mean tacrolimus level was 8.5 +/- 3.8 ng/mL. These results suggest that renal transplantation in older recipients under tacrolimus-based immunosuppression is associated with reasonable outcomes, and can be offered to appropriately selected patients.</p>","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 2","pages":"101-3"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21555484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New strategies using 'low-dose' mycophenolate mofetil to reduce acute rejection in patients following kidney transplantation.","authors":"P J Ulsh,&nbsp;H C Yang,&nbsp;M J Holman,&nbsp;N Ahsan","doi":"10.7182/prtr.1.9.2.t4l566l63m0g1126","DOIUrl":"https://doi.org/10.7182/prtr.1.9.2.t4l566l63m0g1126","url":null,"abstract":"<p><strong>Context: </strong>Tacrolimus, microemulsion cyclosporine (Neoral), and mycophenolate mofetil (MMF) at 2 and 3 grams daily have demonstrated superior immunosuppressive properties in several recent clinical trials involving solid-organ transplants. An effective immunosuppression may be maintained with lower doses of MMF administered with either tacrolimus or microemulsion cyclosporine.</p><p><strong>Objective: </strong>To compare tacrolimus plus \"low-dose\" MMF-based immunosuppressive regimen (TMBIR) with Neoral plus \"low-dose\" MMF-based immunosuppressive regimens (NMBIR) among kidney transplant recipients.</p><p><strong>Design: </strong>Prospective, randomized study.</p><p><strong>Patients: </strong>53 consecutive adult recipients of kidney transplant. Both groups (TMBIR and NMBIR) were equally matched on demographic characteristics.</p><p><strong>Interventions: </strong>Participants were randomized to receive orally either tacrolimus (0.08 mg/kg twice daily) (n = 27) or Neoral (4 mg/kg twice daily) (n = 26). Both regimens were started before surgery and continued when allograft demonstrated no postoperative acute tubular necrosis. Both groups received similar \"low-dose\" MMF (500 mg twice daily) and prednisone (2 mg/kg/day to taper off after 1 year). Switch from tacrolimus to Neoral or vice versa was allowed after refractory rejection or serious adverse events.</p><p><strong>Main outcome measure: </strong>Acute rejection and patient and graft survival 1 year following kidney transplant.</p><p><strong>Results: </strong>One-year patient survival rates were 88.9% for the TMBIR group and 100% for the NMBIR group; 1-year graft survival rates were 88.9% for the TMBIR group and 96.1% for the NMBIR group. No significant differences were found in the incidence of biopsy-confirmed acute rejection (14.8% TMBIR vs 23% NMBIR). Steroid-resistant rejections requiring cytolytic antibody therapy were higher in the NMBIR group (50% vs 25%). Three patients crossed over from NMBIR to TMBIR for refractory rejections and 1 patient crossed over from TMBIR to NMBIR for new onset seizure. Three episodes of cytomegalovirus infection were observed in the TMBIR group. Other adverse events were similar in both groups.</p><p><strong>Conclusions: </strong>Both tacrolimus and microemulsion cyclosporine combined with \"low-dose\" MMF and corticosteroids provide effective immunosuppression and have similar adverse events in kidney transplant recipients.</p>","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 2","pages":"114-8"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21556007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Model Organ Description Protocols for Completion by Transplant Surgeons Using Organs Procured from Medical Examiner Cases","authors":"F. Zugibe, J. Costello, M. Breithaupt, J. Segelbacher","doi":"10.1177/090591999900900202","DOIUrl":"https://doi.org/10.1177/090591999900900202","url":null,"abstract":"Journal of Transplant Coordination, Vol. 9, Number 2, June 1999 a lack of public education addressing misconceptions; cultural, racial, psychological, economic, and practical factors; a lack of staff education and administrative involvement2,5,12,17-20,25,26,30,32-36; and medical-legal problems in medical examiner and coroner offices.9,23,29,37-39 Positive effects with the Transplant Games and an interesting phenomenon called the “Island Effect,” which supports the concept of decentralization and close communication have been reported.25 The results of the Transplant Center Development Model, an interesting program that facilitates the donation process, specializes staff education, and promotes administrative involvement, show a 47% increase in organ referral, a 50% increase in the organ donation mean, and a 117% increase in tissue donation.7 In general, an eligible donor is one who has sustained an irreversible neurological insult, is declared brain dead while on a ventilator, and whose vital organs are free of infectious disease and malignancy except for primary brain tumors. Moreover, there must be an absence of any organic disease. A large portion of the donor pool currently comes from stroke victims, but a significant portion comes from medical examiner Model organ description protocols for completion by transplant surgeons using organs procured from medical examiner cases","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 1","pages":"73 - 80"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/090591999900900202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65465402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions in a Heart Transplant Recipient with a Histrionic Personality Disorder","authors":"C. Smith, A. Chakraburtty, D. Nelson, I. Paradis, S. Kesinger, K. Bak, A. Litsey, W. Paris","doi":"10.1177/090591999900900208","DOIUrl":"https://doi.org/10.1177/090591999900900208","url":null,"abstract":"Journal of Transplant Coordination, Vol. 9, Number 2, June 1999 fully oriented, had learned her medications, and was able to provide self-care. At home, the patient remained alert, oriented, and independent in her activities of daily living. Her psychological deterioration was first noted when she began to phone the transplant clinic every day. These conversations would last as long as 30 minutes and end only after the patient was repeatedly assured that she was not in the process of dying or was in need of additional medications. The patient often visited the clinic without a scheduled appointment and demanded to be seen. She self-medicated with over-the-counter and prescription medications, and concluded—without presenting symptoms—that she was allergic to some of her immunosuppressive medications. She also reported taking her medications intermittently. Upon being told that she could cause rejection of her transplanted heart by not complying with her immunosuppressant regimen, the patient accused the transplant team of issuing threats. She also complained of smelling food on the breath of a staff member while undergoing tests that required her to fast, and became agitated and verbally abusive. A psychiatric referral or psychotropic medications were recommended, both of which were refused by the patient. The patient was readmitted to the hospital on day 34 for treatment of mild rejection and evaluation of Interventions in a heart transplant recipient with a histrionic personality disorder","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 1","pages":"109 - 113"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/090591999900900208","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65465926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Book Reviews: Publishing Your Medical Research Paper: What They Don't Teach in Medical School","authors":"J. McCabe","doi":"10.1177/090591999900900211","DOIUrl":"https://doi.org/10.1177/090591999900900211","url":null,"abstract":"","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 1","pages":"124 - 124"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/090591999900900211","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65465640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of OPO Pulsatile Machine Preservation Practices and Results","authors":"J. Szust, L. Olson, L. Cravero","doi":"10.1177/090591999900900205","DOIUrl":"https://doi.org/10.1177/090591999900900205","url":null,"abstract":"Journal of Transplant Coordination, Vol. 9, Number 2, June 1999 proportions, it becomes apparent that the traditional brain-dead donor pool cannot supply enough organs to satisfy the need. Washington Hospital Center, as well as other transplant centers, has used non–heartbeating cadaver donors and the less than optimal brain-dead donors to answer this need.1,4 The major concern with these types of donors is organ quality.3,4 Physiologic damage sustained during warm ischemia time can cause an unacceptably high rate of delayed graft function.1,3-6 A UCLA multicenter study demonstrated that perfused kidneys had immediate function at a much greater rate than those preserved with ice storage.1 Furthermore, machine preservation appears to benefit those kidneys that have sustained substantial ischemic damage.2 Koyama et al1 concluded that pulsatile perfusion is cost-effective because it permits reliable kidney evaluation and dramatically increases immediate graft function, as well as graft survival rates. A comparison of OPO pulsatile machine preservation practices and results","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 1","pages":"100 - 97"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/090591999900900205","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65465731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}