Early versus late acute antibody-mediated rejection in renal transplant recipients.

BACKGROUND: Over the last decade, the diagnostic precision for acute antibody-mediated rejection (aABMR) in kidney transplant recipients has improved significantly. The phenotypes of early and late aABMR may differ. We assessed the characteristics and outcomes of early versus late aABMR. METHODS: Between January 1, 2005 and December 31, 2010, aABMR was diagnosed in 67 grafts in 65 kidney recipients, with a median follow-up of 3.6 years (range, 61 days-7.3 years). Recipients were stratified by early aABMR (<3 months after transplantation; n=40) and late aABMR (>3 months after transplantation; n=27). The main outcome was kidney allograft loss. Outcome of aABMR was compared with recipients with acute early (n=276) or late (n=100) non-ABMR during the same period. RESULTS: Recipients with late aABMR had significantly reduced graft survival compared with recipients with early aABMR (P<0.001, log-rank test; 40% vs. 75% at 4 years; hazard ratio, 3.72; 95% confidence interval, 1.65-8.42). Graft survival in late aABMR was also inferior to late non-ABMR acute rejections (P=0.008). At transplantation, more patients were presensitized to human leukocyte antigens (22 [55%] vs. 4 [15%] in the early vs. late aABMR group). The late aABMR group was characterized by younger recipient age (37.9 ± 12.9 vs. 50.9 ± 11.6 years; P<0.001), increased occurrence of de novo donor-specific antibodies (52% vs. 13%; P=0.001), and nonadherence/suboptimal immunosuppression (56% vs. 0%; P<0.001). CONCLUSION: Compared with early aABMR, late aABMR had inferior graft survival and was characterized by young age, frequent nonadherence, or suboptimal immunosuppression and de novo donor-specific antibodies.

[Medical records of critically ill patients]. / Journaldokumentasjon for alvorlig syke.

BACKGROUND: Comprehensive, high-quality medical records are necessary for the communication between health care professionals. We wanted to assess the quality of records on critically ill patients in a teaching hospital in relation to statutory requirements and official guidelines. MATERIAL AND METHODS: We assessed the medical records on 119 patients who died in the hospital upon discharge from its intensive care unit over the 1999 to March 2002 period: the frequency of entries, entries about withdrawal or withholding of therapy, and the quality of the documentation. RESULTS AND INTERPRETATION: The records were of variable and frequently unacceptable quality. We found several violations of statutory requirements; in several wards this was standard practice. The records of four patients were missing. For 84 % of the patients, therapy had been withdrawn or withhold; 58 % of these cases were insufficiently documented. Eighteen patients had only one entry in their record; seven patients had none, in spite of the fact that they had had long stays in hospital. We find this lack of documentation disturbing, as this is a group of patients in whom even small fluctuations in medical status may have serious effects.