Kidney organ donation: developing family practice initiatives to reverse inertia.

BACKGROUND: Kidney transplantation is associated with greater long term survival rates and improved quality of life compared with dialysis. Continuous growth in the number of patients with kidney failure has not been matched by an increase in the availability of kidneys for transplantation. This leads to long waiting lists, higher treatment costs and negative health outcomes. DISCUSSION: Misunderstandings, public uncertainty and issues of trust in the medical system, that limit willingness to be registered as a potential donor, could be addressed by community dissemination of information and new family practice initiatives that respond to individuals' personal beliefs and concerns regarding organ donation and transplantation. SUMMARY: Tackling both personal and public inertia on organ donation is important for any community oriented kidney donation campaign.

A multicenter, prospective study of C2-monitored cyclosporine microemulsion in a U.S. population of de novo renal transplant recipients.

BACKGROUND: Monitoring cyclosporine microemulsion (CsA-ME; Neoral) exposure 2 hours postdose (C2) has been reported to optimize the efficacy and safety of CsA-ME therapy. The addition of induction therapy to a maintenance regimen including CsA-ME C2 monitoring has not been evaluated. METHODS: In all, 123 adult renal transplant recipients were recruited at 14 U.S. centers for this 6-month study. CsA-ME dose was to be titrated to attain C2 targets of 1700 and 1500 ng/ml during posttransplant months 1 and 2, respectively. After 2 months, patients were randomized to one of two groups with different, decreasing C2 targets. Basiliximab, mycophenolate mofetil, and corticosteroids completed the study immunosuppression. RESULTS: Of the 119 evaluable patients, 76% were male, 22% African American, and 66% deceased donor recipients. Biopsy-proven acute rejection occurred in 10 patients (9.3%); there were two failed grafts and one death. Serum creatinine and calculated GFR values suggest good renal function, with month 6 medians of 1.5 ng/ml and 67 ml/min/1.73 m. Safety and tolerability assessments revealed no unexpected outcomes. Observed C2 levels were generally lower than protocol targets, particularly in the first weeks posttransplantation. CONCLUSIONS: The striking efficacy and outcomes may have been achieved in this study with lower C2 levels of CsA-ME because of the addition of basiliximab induction.

Dealing with the uncertain and the unexpected: a report on the first kidney transplantations in Aden, Republic of Yemen.

First kidney transplantations were performed in Aden, Jemen in 2003. A difficult medical environment and unrehearsed decision-making process in a country of scant resources were the background of this undertaking. A brief report is given on the medical situation, training and preparedness of the Yemeni medical community for transplant procedures. Initial impressions of psychological aspects of first-ever organ transplantation in this Islamic country are presented.

Disparities in care of patients with end-stage renal disease: review of literature and action plan.

Disparities in access to care for patients with end-stage renal disease (ESRD) and particularly to kidney transplantation, as well as discrepancies in follow-up and outcomes have been extensively documented as they relate to race, ethnicity, gender, socioeconomic factors, urban/rural residence, and geographic region. Furthermore, these inequalities seem to be increasing in various parts of the world and it is imperative to develop policies to address them among various population groups, identifying factors that might provide improved care for all patients with kidney disease. Numerous studies from various parts of the world have demonstrated racial, ethnic, and geographic differences regarding the delivery of healthcare to patients with ESRD. To the author's knowledge, although this issue has been studied at transplant centers in Iran on an individual basis, it has not been extensively studied on a national scale. In this paper, the current world literature will be reviewed, with the goal of emphasizing the need to initiate and expand full-scale studies to detect and remedy any existing inequalities in Iran, a vast country with an ethnically, culturally, and economically diverse population. The author proposes the designation, at the national level, of a task force to study disparities and to provide insight into the means of correcting them. As Iran continues to attain a position of regional leadership in the realm of organ transplantation, it seems prudent to invest in research aimed at detecting and remedying any inequalities in the provision of equivalent and just care for patients with ESRD.