Cuidados de enfermería al paciente trasplantado renal período pre-operatorio, pos trasplante inmediato y temprano en la Unidad de Trasplante Renal del Hospital de Especialidades Carlos Andrade Marín / Nursing care of the renal transplant patient pre-operative, immediate posttransplant and early post-transplant periods in the Renal Transplant Unit of the Carlos Andrade Marín Specialties Hospital

El trasplante renal es considerado como la mejor alternativa de tratamiento sustitutivo para la enfermedad renal crónica terminal (ERCT)1, es el procedimiento quirúrgico que consiste en reemplazar un riñón sano de un donante vivo o cadavérico a una persona con diagnóstico de ERCT, que ayuda a mejorar su calidad de vida, la reinserción a sus actividades sociales, físicas, emocionales, laborales y sexuales. La Organización Nacional de Trasplantes de España (ONT) en el año 2018, reportó que en la Unión Europea se realizaron 21 102 y en Latinoamérica 12 806 trasplantes renales2, en Ecuador el Ministerio de Salud Pública (MSP) en los años 2007-2020 reportó un total de 1 6153, le correspondió al Hospital de Especialidades Carlos Andrade Marín (HECAM) el 32% del total de trasplantes renales realizados entre el periodo 2007-20184. La evaluación del potencial receptor es realizada por un equipo multidisciplinario con formación académica, experiencia certificada en los diferentes procesos y acreditados por el Instituto Nacional de Donación y Trasplantes (INDOT)5. Los cuidados de enfermería enmarcados en esta ruta, son especializados e integrales, que incluyen los períodos pre operatorio, pos trasplante inmediato y temprano al incorporar además un proceso educativo entre enfermera, paciente y familia/ cuidador, con el fin de preservar la sobrevida del injerto.

Renal transplantation is considered the best alternative replacement treatment for end-stage chronic kidney disease (ESRD)1, it is the surgical procedure that consists of replacing a healthy kidney from a living or cadaveric donor to a person diagnosed with ESRD, which helps to improve their quality of life, reintegration to their social, physical, emotional, work and sexual activities. The National Transplant Organization of Spain (ONT) in 2018, reported that In the European Union 21 102 and in Latin America 12 806 renal transplants were performed2, in Ecuador the Ministry of Public Health (MSP) in the years 2007-2020 reported a total of 1 6153, corresponded to the Carlos Andrade Marín Specialties Hospital (HECAM) 32% of the total number of renal transplants performed between 2007-20184. The evaluation of the potential recipient is performed by a multidisciplinary team with academic training, certified experience in the different processes and accredited by the National Institute of Donation and Transplantation (INDOT)5. The nursing care framed in this route is specialized and comprehensive, including the pre-operative, immediate post-transplant and early post-transplant periods, incorporating an educational process between nurse, patient and family/caregiver, in order to preserve graft survival.

[Influence of the nursing professional over the quality of life in patients receiving kidney transplants.] / Influencia del profesional de enfermería en la calidad de vida de pacientes receptores de trasplante renal.

BACKGROUND: Kidney transplantation represents the treatment choice for most people with chronic kidney disease due to the benefits it provides compared to other renal replacement therapies. This population requires specific monitoring, where the nursing professional must attend to determining factors of health-related quality of life (HRQoL) in order to guarantee an effective approach to the difficulties that arise. This bibliographic review pretends to determine the altered physical, psychological, and social components of health-related quality of life maintained by kidney transplant recipients as a way to improve quality of care through the most appropriate nursing interventions. METHODS: The literature review was conducted in PubMed, Medes, LILACS, CINAHL, Dialnet and Scopus databases. From a total of 718 articles identified, 30 publications were selected in order to meet the aim of the review and the established inclusion, exclusion and PRISMA Statement criteria. RESULTS: The quality of the published studies was set at a mean score of 6.07 according to the PEDro scale, for clinical trials and 10.5, according to the Amstar scale, for bibliographic reviews. 50% of the total were published in the last two years (2018-2019) and 75% are between Q1 and Q2 of the JCR and SJR impact factors. CONCLUSIONS: An improvement in HRQoL has been identified in these patients compared to the previous period of dialysis, although it is not still comparable to the general population. The physical area seems to be the most affected. The nursing professional can develop health education, psychological counseling and self-management activities.

OBJETIVO: El trasplante renal representa el tratamiento de elección para la mayoría de personas con insuficiencia renal crónica debido a los beneficios que aporta frente a otras terapias renales sustitutivas. Esta población requiere de un seguimiento específico, en el cual el profesional de enfermería debe atender a los factores determinantes de la calidad de vida relacionada con la salud (CVRS). Esta revisión bibliográfica pretende determinar los componentes físicos, psicológicos y sociales alterados de la calidad de vida relacionada con la salud que mantienen los receptores de un trasplante renal para mejorar la actividad asistencial con las intervenciones enfermeras adecuadas. METODOS: Se realizó una búsqueda bibliográfica en las bases de datos de PubMed, Medes, LILACS, CINAHL, Dialnet y Scopus. De un total de 718 artículos identificados, se seleccionaron 18 publicaciones que cumplían con los criterios de inclusión, exclusión y de la Declaración PRISMA. RESULTADOS: La calidad de los estudios quedó fijada en una puntuación media de 6,07 según la escala PEDro, para los ensayos clínicos y en 10'5, según la escala Amstar, para las revisiones bibliográficas. El 50% del total fueron publicados en los dos últimos años (2018-2019) y el 75% se encuentra entre el Q1 y Q2 de los factores de impacto JCR y SJR. CONCLUSIONES: Se ha identificado la mejora de la CVRS en estos pacientes frente al período anterior de diálisis, aunque sigue siendo un nivel menor al de la población general. La esfera física es la más afectada. El profesional de enfermería desarrolla actividades de educación sanitaria y asesoramiento psicológico.

[The ANFIPA in practice: the example of the chronic kidney disease, dialysis, transplant college]. / L'Anfipa en pratique : exemple du collège Maladie rénale chronique, dialyse, transplantation.

The French association of advanced practice nurses (anfipa) is actively participating in setting up advanced practice across the country. Colleges are places of interaction and work for advanced practice nurses and students. Highlighting missions of this college enables us to create places of discussion and exchanges in the field, and to take part in the rollout of this new profession.

[SARS-CoV-2: recommendations on nursing care for dialyzed and transplanted patient].

Coronavirus disease 2019 is an infectious respiratory syndrome caused by the virus called SARS-CoV-2, belonging to the family of coronaviruses. The first ever cases were detected during the 2019-2020 pandemic. Coronaviruses can cause a common cold or more serious diseases such as Middle Eastern Respiratory Syndromes (MERS) and Severe Acute Respiratory Syndrome (SARS). They can cause respiratory, lung and gastrointestinal infections with a mild to severe course, sometimes causing the death of the infected person. This new strain has no previous identifiers and its epidemic potential is strongly associated with the absence of immune response/reactivity and immunological memory in the world population, which has never been in contact with this strain before. Most at risk are the elderly, people with pre-existing diseases and/or immunodepressed, dialyzed and transplanted patients, pregnant women, people with debilitating chronic diseases. They are advised to avoid contacts with other people, unless strictly necessary, and to stay away from crowded places, also observing scrupulously the recommendations of the Istituto Superiore di Sanità. In this article we detail the recommendations that must be followed by the nursing care staff when dealing with chronic kidney disease patients in dialysis or with kidney transplant patients. We delve into the procedures that are absolutely essential in this context: social distancing of at least one meter, use of PPI, proper dressing and undressing procedures, frequent hand washing and use of gloves, and finally the increase of dedicated and appropriately trained health personnel on ward.

Evaluation of a telehealth solution developed to improve follow-up after kidney Transplantation.

AIM: To explore patients' and healthcare professionals' experiences of using a telehealth solution developed to improve follow-up after kidney transplantation. BACKGROUND: Transplantation is the treatment of choice whenever feasible for patients with end-stage kidney disease. However, it implies lifelong adherence of self-monitoring, medicine and other restrictions to ensure successful outcomes. Based on user involvement, a telehealth solution was developed to support patients and healthcare professionals post-transplantation. DESIGN: An explorative qualitative study with a phenomenological-hermeneutic approach. METHODS: The developed app and workflow for follow-up were tested by patients and healthcare professionals and evaluated with interviews. In total, 16 patients and 20 healthcare professionals participated. Individual interviews were conducted with the patients, four nurses participated in two sets of interviews, and 16 doctors participated in a focus group. Data were analysed with inspiration from Ricoeur's theory of interpretation, on three levels: Naïve reading, structural analysis and critical interpretation and discussion. The COREQ checklist was applied in reporting the study. RESULTS: Three themes emerged: Challenging conditions for training sessions, telehealth improves patient reflection and collaboration, and telehealth gives patients a voice in consultations. In a challenging time, post-transplantation patients found the app easy to use; it facilitated support and reflection on how to manage. It also supported both patients and healthcare professionals at follow-up consultations in terms of enhanced preparation, improved dialogue and enabling consultations by phone. CONCLUSION: The study showed that patients and healthcare professionals found the app and workflow valuable and easy to use. The Patient Data feature in the app has potential as a communication tool. However, adjustments and further investigations are needed to develop the solution. RELEVANCE TO CLINICAL PRACTICE: The potential of telehealth brings new opportunities to provide treatment and care to newly transplanted patients. Telehealth can support both patients and health professionals by improving dialogue and collaboration.

Enfermagem no transplante renal: comparação da demanda de cuidado entre escalas / Enfermería en el trasplante renal: comparación de la demanda de cuidado entre turnos / Kidney transplant nursing: a comparison of care demand between scales

Resumo Objetivo Comparar o número de horas da demanda de cuidados de enfermagem ao paciente no pós-operatório de transplante renal, por meio dos instrumentos de Sistema de Classificação de Pacientes (SCP) e do Escore de Atividade de Enfermagem (NAS). Métodos Estudo de Coorte Prospectivo. A população foi composta pelos pacientes submetidos ao transplante renal com doador falecido no Hospital São Lucas da PUCRS, a avaliação ocorreu de 6 a 24 horas no pós-operatório imediato, nos dias subsequentes até a alta da UTI Cirúrgica e no 15º dia pós-operatório ou no dia da alta (o que tenha ocorrido primeiro). Resultados Completaram o estudo 73 pacientes, a média do SCP na primeira avaliação foi de 31,6 (cuidado intermediário), já no NAS a média foi de 86,5% (cuidado intensivo). Na última avaliação a pontuação encontrada no SCP foi de 15,5 (cuidado mínimo), no NAS a mediana foi de 50,1% (cuidado semi-intensivo). Não houve diferença significativa quando comparadas as pontuações obtidas na alta da UTI cirúrgica e na alta hospitalar. Conclusão Os achados deste estudo sugerem que há diferença entre o número de horas da demanda de cuidados ao transplantado renal no pós-operatório quando comparados os instrumentos SCP e NAS, e isso repercute também no tipo de cuidado.

Resumen Objetivo Comparar el número de horas de la demanda de cuidados de enfermería al paciente en posoperatorio de trasplante renal, por medio de los instrumentos de Sistema de Clasificación de Pacientes (SCP) y de la escala Nursing Activities Score (NAS). Métodos Estudio de cohorte prospectivo. La población fue formada por pacientes sometidos a trasplante renal con donante fallecido en el Hospital São Lucas de la universidad PUCRS. La evaluación se llevó a cabo de 6 a 24 horas en el posoperatorio inmediato, en los días subsiguientes hasta el alta de la UCI Quirúrgica y en el 15° día del posoperatorio o el día del alta (lo que haya sucedido primero). Resultados El estudio lo completaron 73 pacientes, el promedio del SCP en la primera evaluación fue 31,6 (cuidado intermedio) y en el NAS el promedio fue 86,5% (cuidado intensivo). En la última evaluación, la puntuación del SCP fue 15,5 (cuidado mínimo) y en el NAS la mediana fue 50,1% (cuidado semintensivo). No hubo diferencia significativa al comparar las valoraciones obtenidas en el alta de la UCI Quirúrgica y en el alta hospitalaria. Conclusión Los resultados de este estudio sugieren que hay diferencia entre el número de horas de la demanda de cuidados al trasplantado renal en el posoperatorio al comparar los instrumentos SCP y NAS, y eso repercute también en el tipo de cuidado.

Abstract Objective To compare the number of hours of nursing care demand for patients in the postoperative period after kidney transplantation, using the Patient Classification System (SCP) and Nursing Activity Score (NAS) tools. Methods a prospective cohort study. The population consisted of patients who underwent deceased donor kidney transplantation at PUCRS São Lucas Hospital. Assessment was carried out from 6 to 24 hours in the immediate postoperative period, on the days following discharge from the Surgical ICU and on the 15thpostoperative day or on the day of discharge (whichever occurred first). Results A total of 73 patients completed the study. The mean SCP in the first assessment was 31.6 (intermediate care), while in NAS the mean was 86.5% (intensive care). In the last assessment, the score found in the SCP was 15.5 (minimum care); In the NAS, the median was 50.1% (semi-intensive care). There were no significant differences when comparing the scores obtained at discharge from surgical ICU and discharge from hospital. Conclusion The findings of this study suggest that there is a difference between the number of hours of postoperative kidney transplant care demand when compared to the SCP and NAS tools, and this affects the type of care.

Transplante renal: enfermeiro da terapia intensiva no pós-operatório imediato / Renal transplantation: intensive therapeutic nurse in the immediate post-operative period / Transplante renal: enfermero terapéutico intensivo en el post-operatorio inmediato

Objetivo: Avaliar os saberes de enfermeiros no cuidado ao paciente no período pós-operatório imediato de transplante renal. Métodos: Estudo qualitativo, realizado no ano de 2015 em um hospital público de Santa Catarina. Participaram enfermeiros que atuavam na Unidade de Terapia Intensiva com experiência em cuidado no pós-operatório de transplante renal. Para a coleta de dados foi utilizado entrevista semiestruturada e a análise foi através do Discurso do Sujeito Coletivo. Resultados: O estudo deu origem a 5 discursos do sujeito coletivo: As primeiras horas requerem cuidados intensivos, checklist como potencialidade no cuidado de pacientes no pós operatório de transplante renal, qualificação profissional como ponto forte no cuidado, momento de expectativa e ansiedade para os pacientes e o acompanhante familiar no pósoperatório. Conclusão: O estudo evidenciou o fortalecimento de saberes dos enfermeiros, destacou o uso de checklist, a importância da educação continuada e de familiares como fonte de apoio aos pacientes

Objective: The study's main purpose has been to assess the nurses' understanding vis-à-vis patient care in the immediate postoperative period of renal transplantation. Methods: It is a descriptive-exploratory study with a qualitative approach, which was performed in a public hospital from the Santa Catarina State, in 2015. The participants were nurses who worked in the Intensive Care Unit with experience in postoperative renal transplant care. Data collection took place through semi-structured interviews, and the Collective Subject Discourse was used for data analysis. Results: This study resulted into five Collective Subject Discourses, as follows: the first hours require intensive care; checklist as potentiality in the care of patients undergoing postoperative period of renal transplantation; professional qualification as a strong support in caring; moment of expectation and anxiety for patients; and, the family companion during the postoperative period. Conclusion: This research evidenced the strengthening of nurses' knowledge concerning patient care and underlined the use of checklists, as well as the importance of continuing education and relatives as a source of support for patients

Objetivo: Evaluar y reflexionar sobre el conocimiento del enfermero en el cuidado de enfermería al paciente en el período post-operatorio inmediato de trasplante renal. Métodos: Estudio cualitativo descriptivo exploratorio, se utilizó la entrevista semiestructurada como forma de recolección de los datos con enfermeros actuantes de la unidad de terapia intensiva del local investigado. Resultados: se evidenció un respaldo teórico y práctico por parte de los enfermeros sobre el contexto del trasplante renal y la utilización del check-list como herramienta de trabajo. Se destacó la realización de capacitaciones en la institución hospitalaria. La familia fue identificada como relevante en la recuperación del paciente y la necesidad de un enfoque más amplio sobre la temática en la graduación. Conclusión: Los enfermeros identifican conocimientos y habilidades esenciales para el cuidado del paciente trasplantado, así como la institución hospitalaria, ya que ofrece oportunidad de perfeccionamiento técnico-científico a los profesionales

Nursing Diagnoses and Interventions in Kidney Transplant Recipients: A Retrospective Study.

PURPOSE: The aim of the study is to determine the nursing diagnoses and interventions applied to kidney transplant recipients. MATERIALS AND METHODS: A descriptive, retrospective study of nursing care plans of patients who underwent kidney transplantation from January 2008 through December 2016 was performed. Data were collected using a descriptive characteristics information form for patients and nursing care plans registered to the hospital's information-processing system. Data for nursing care plans of 100 kidney transplant recipients were analyzed. FINDINGS: It was determined that 59% of the kidney transplant recipients were male and the mean age ± SD was 42.56 ± 12.40 years; 81% of the patients had undergone kidney transplantation from living donors. The most commonly used nursing diagnoses in the care of kidney transplant recipients were (1) risk of infection (100%); (2) deficient knowledge (100%); (3) risk for bleeding (31%); (4) acute pain (26%); and (5) risk for falls (16%). The most common interventions were (1) examining the infection-related laboratory findings (69.0%); (2) limiting the number of visitors (64.0); and (3) setting aside time for patient questions and concerns (59.0%). CONCLUSIONS: Nursing diagnoses and interventions applied in the care of kidney transplant recipients seem to be limited. To provide holistic care to the kidney transplant recipients, the nursing care plans should include more extensive nursing diagnosis and interventions to maintain physical, psychological, and social well-being.

O enfermeiro e o modo de viver do usuário transplantado renal: buscando a qualidade de vida / The nurse and the model of living of the renal transplanted user: seeking the quality of life / El enfermero y el modo de vivir del usuario transplantado renal: buscando la calidad de vida

Objective:To know the scientific production about the way of life of the renal transplant user in their home environment and the educational actions of the nurse capable of promoting quality of life. Method: An exploratory and descriptive study, which follows the steps of the integrative review, which enables the researcher to problematize the subject by grouping and systematizing what has already been produced scientifically and incorporating them into the care practice. Outcome: The total of 58 studies included in the sample. After careful reading of the abstracts, 50 studies had no adherence to the subject matter and were excluded. Therefore, 08 articles were read in full and make up the sample. Conclusion: Knowing the way of life of the renal transplant user allows the focus of care, besides being individual, to be based on human relationships

Objetivo: Conocer la producción científica sobre el modo de vivir del usuario trasplantado renal en su ambiente domiciliar y las acciones educativas del enfermero capaces de promover la calidad de vida. Método: Estudio de carácter exploratorio y descriptivo, que sigue los pasos de la revisión integrativa, que posibilita al investigador problematizar la temática por medio de la agrupación y sistematización de lo que ya fue producido científicamente e incorporarlos a la práctica asistencial. Resultado: El total de 58 estudios incluidos en la muestra. Después de la lectura cuidadosa de los resúmenes 50 estudios no tenían adherencia con la temática en cuestión y fueron excluidos. Por lo tanto, 08 artículos fueron leídos en la integración y componen la muestra. Conclusión: Conocer el modo de vivir del usuario trasplantado renal permite que el foco del cuidado, además de individual, sea basado en relaciones humanas

Objetivo: Conhecer a produção científica sobre o modo de viver do usuário transplantado renal no seu ambiente domiciliar e as ações educativas do enfermeiro capazes de promover a qualidade de vida. Método: Estudo de caráter exploratório e descritivo, que segue os passos da revisão integrativa, que possibilita ao pesquisador problematizar a temática por meio do agrupamento e sistematização do que já foi produzido cientificamente e incorporá-los à prática assistencial. Resultado: O total de 58 estudos incluídos na amostra. Após a leitura criteriosa dos resumos, 50 estudos não possuíam aderência com a temática em questão e foram excluídos. Portanto, 8 artigos foram lidos na íntegra e compõem a amostra. Conclusão: Conhecer o modo de viver do usuário transplantado renal permite que o foco do cuidado, além de individual, seja baseado em relações humanas

A comunicação como ferramenta educativa no préoperatório mediato de transplante renal / The communication as an educational tool during kidney transplantation preoperative period / La comunicación como herramienta educativa en el período pre-operatorio mediato de trasplante renal

Objetivo: O objetivo do estudo é reconhecer a importância da comunicação como ferramenta utilizada pelo enfermeiro no pré-operatório mediato do paciente em terapia hemodialítica indicada para transplante renal. Métodos: Trata-se de um estudo descritivo, convergente, com abordagem qualitativa. Os dados foram coletados por meio de entrevista semiestruturada com 9 enfermeiras, utilizando um roteiro pré-estabelecido com questões subjetivas das quais emergiram 2 categorias: Responsabilidade do enfermeiro na comunicação com o paciente; e Importância da comunicação enfermeiro/ paciente. Resultados: Os resultados apontam a relevância de estudar o processo da comunicação, pois, ao praticá-lo, há aperfeiçoamento do modo que o enfermeiro se comunica, evitando interferências que possam comprometer as informações prestadas. Conclusão: Ressalta-se a importância da relação enfermeiro/paciente, que possibilita o entendimento das informações educativas e o modo como são prestadas, constituindo poderosa ferramenta no pré-operatório mediato de transplante renal

Objetivo: El objetivo es reconocer la importancia de la comunicación como herramienta utilizada por los enfermeros en el paciente preoperatorio mediato en hemodiálisis indicado para el trasplante de riñón. Método: Se trata de un estudio descriptivo, convergente, con un enfoque cualitativo. Los datos fueron recogidos a través de entrevista semi-estructurada con 9 enfermeras, utilizando un guión pre-establecido con preguntas subjetivas de las que emergieron 2 categorías: Responsabilidad del enfermero en la comunicación con el paciente; e Importancia de la comunicación enfermero/ paciente. Resultados: Los resultados señalan la relevancia de estudiar el proceso de la comunicación, pues, practicándola, hay una mejora en la forma en que el enfermero se comunica, evitando interferencias que puedan poner en peligro las informaciones ofrecidas. Conclusión: Se destaca la importancia de la relación enfermero/paciente, que permite la comprensión de las informaciones educativas y la forma en que se prestan, constituyendo poderosa herramienta en el período pre-operatorio mediato de trasplante renal

Objective: The study's aim has been to recognize the importance of the communication as a tool used by the nurse over the preoperative period of patients undergoing hemodialysis therapy and indicated for having renal transplantation. Methods: It is a descriptive and convergent study with a qualitative approach. Data were collected through a semi-structured interview with 9 female nurses and using a pre-established script with subjective questions. By using this approach, the following 2 categories emerged: the nurse's responsibility in communicating to the patient; and the significance of nurse/patient communication. Results: The results point out the relevance of studying the communication process, because, by putting it into practice, there is an improvement regarding the nurse's communication skills, and then avoiding any interference that may affect the information provided. Conclusion: The significance of the nurse/patient relationship stands out, which enables understanding the educational information and the way in which they are provided, then constituting a powerful tool during the preoperative period of a renal transplantation

Providing Culturally Sensitive Care for Islamic Patients and Families.

Nurses can expect to care for patients from different cultures and faith traditions and need to develop cultural competence. This article describes what is important in providing culturally and religiously sensitive care to Muslim and Middle Eastern patients. The Crescent of Care Model by Lovering is offered to aid understanding of five key areas of culturally competent care. Jesus' story of the Good Samaritan (Luke 10:25-37) offers guidance for Christian nurses caring for those in need.

A vivência do transplantado renal malsucedido que retornou para a hemodiálise / The living of the renal transplant failure patient who returned to hemodialysis

Objetivo: conhecer a experiência vivenciada por pessoas que induziram o transplantado renal a retornar ao tratamento dialítico por hemodiálise. Método: estudo descritivo, de abordagem qualitativa, utilizando como suporte teórico metodológico a fenomenologia existencial de Martin Heidegger, tendo como cenários de estudo os serviços de Nefrologia dos seguintes hospitais de Alagoas: Hospital Universitário Professor Alberto Antunes; Hospital Sanatório; Hospital do Açúcar; Hospital Chama; Hospital Santa Rita; Hospital Vida; Hospital Arthur Ramos e Hospital Santa Casa de Misericórdia de Maceió, e como participantes pós-transplantado renal mal-sucedido que retornou ao tratamento hemodialítico. Os dados serão produzidos por meio de entrevistas e analisados obedecendo a abordagem fenomenológica. Resultados esperados: discutir a adequação dos cuidados oferecidos aos transplantados renais, e assim, proporcionar subsídios para uma assistência de enfermagem e da equipe de saúde, mais direcionada e, consequentemente, aperfeiçoar a qualidade de vida destas pessoas.

Surgical Complications After Kidney Transplantation.

Since the first successful organ transplant conducted between twins in 1954, kidney transplant has evolved considerably over the past 50 years. Kidney transplant plays an important role in the treatment of end-stage kidney disease to improve the quality of life and prolong the life of patients. Despite significant advances, postoperative medical and surgical complications still represent important causes of morbidity and mortality. Many problems can be avoided through prophylactic correction of abnormalities detected during the preoperative evaluation; however, it is critical that technical mishaps at all stages of the transplant process (donor nephrectomy, benchwork preparation, and implant) be prevented and that careful postoperative monitoring be carried out, including thorough examination by attending physicians. However, despite these advances, surgical complications still present serious problems in kidney transplant recipients.

Low-Activity Kidney Transplant Center, A Single-Center Experience: Early Care as a Major Challenge.

OBJECTIVES: In many countries, some kidney transplants are performed in small centers, from which clinical data are rarely specifically reported. The aim of this study was to describe patient and graft survival rates and their correlates in a low-activity kidney transplant center. MATERIALS AND METHODS: We performed a retrospective cohort study of all patients who underwent transplant between January 2002 and May 2012 at a university hospital. Patient, graft, and death-censored graft survival rates were assessed with Kaplan-Meier analyses and compared by log-rank test, with associated factors analyzed by Cox proportional hazards modeling. RESULTS: Among a total of 162 patients, the mean age was 41.8 ± 13.5 years, and 92% received a living-donor graft. At 1, 3, and 5 years, patient survival was 88.6%, 86%, and 82.9%. Graft survival was 86.9%, 83%, and 77%, and death-censored graft survival was 98.1%, 96.6%, and 92.9% at the same time points. Most graft losses were due to patient death from infection and occurred within the first year after transplant. After adjustment, age over 42 years (hazard ratio of 3.94; 95% confidence interval, 1.39-11.13), deceased donor graft (hazard ratio of 11.41; 95% confidence interval, 1.2-108.35), and higher average education (hazard ratio of 4.96; 95% confidence interval, 1.01-24.32) were independently associated with graft loss. CONCLUSIONS: The observed patient and graft survival rates were similar to those described in large databases; however, early mortality remains a major challenge. Improving posttransplant care is a key issue to increasing survival in small transplant centers.

"We're not going to say it's suffering; we're going to say it's an experience": The lived experience of maternal caregivers in pediatric kidney transplantation.

Advances in the surgical and immunological aspects of pediatric kidney transplantation have resulted in significant improvements in long-term outcome and survival rates. However, there continues to be a negative impact reported on overall family functioning despite the reported good health and quality of life for the transplanted child. This research utilizes a phenomenological approach to examine the lived experiences of seven mothers of children who had undergone kidney transplantation. Findings of the study illuminate that the experience of mothering in the context of pediatric kidney transplantation is reflected in (1) the significance of relationships to the experience of self; (2) the lived experience of time; and (3) opportunities for growth and personal development. This research identifies that, while maternal caregiving in this context is fraught with challenges, there are opportunities for the development of skills and personal growth within the experience. By embracing a strength-based perspective, social work is well positioned to offer support for maternal meaning-making and adjustment during times of stress and uncertainty.

Estratégias implementadas pelo enfermeiro para aprendizagem do transplantado renal em imunossupressão / Estrategias implementadas por enfermeros para el aprendizaje en inmunosupresión para trasplantados renales / Strategies implemented by nurses for learning kidney transplant immunosuppression

RESUMO Descrever a vivência da enfermagem na implementação de estratégias de aprendizagem em imunossupressão para transplantados renais. Caracteriza-se como um estudo qualitativo, descritivo, que utiliza o referencial teórico da pesquisa convergente assistencial, realizado em uma unidade de transplante renal. Para a obtenção dos dados, utilizou-se de entrevistas e oficinas temáticas. Foram desenvolvidas estratégias de aprendizagem para três oficinas com grupos de transplantados renais: pacientes sem déficit cognitivo - estratégia discursiva, com recursos visuais; pacientes com déficit cognitivo - estratégia do discurso repetitivo com recursos visuais; pacientes com déficit visual - recursos auditivos e táteis. As estratégias adotadas para os transplantados na oficina com déficit cognitivo e visual requisitaram adaptações, mas na alta hospitalar os pacientes demonstraram capacidade para o autocuidado e a apreensão dos imunossupressores. A vivência possibilitou ao enfermeiro o planejamento, a implementação e a utilização de estratégias de aprendizagem que favoreceram a emancipação do autocuidado, influenciando na adesão ao tratamento e na qualidade de vida do transplantado.

RESUMEN Describir la experiencia de la enfermería en la implementación de estrategias de aprendizaje en inmunosupresión para trasplantados renales. Se caracteriza como un estudio cualitativo y descriptivo que utiliza el marco teórico de la investigación convergente asistencial, realizado en una unidad de trasplante de riñón. Para obtener los datos, se utilizaron entrevistas y talleres temáticos. Las estrategias de aprendizaje se desarrollaron en el transcurso de tres talleres con grupos de trasplantados renales: pacientes sin deterioro cognitivo - estrategia discursiva, con efectos visuales; pacientes con deterioro cognitivo - estrategia de discurso repetitivo, con efectos visuales; pacientes con deterioros visuales - recursos auditivos y táctiles. Las estrategias adoptadas para los trasplantados en el taller con deterioro cognitivo y visual requirieron adaptaciones, pero en el alta hospitalaria los pacientes demostraron capacidad para el autocuidado y la adquisición de los inmunosupresores. La experiencia permitió que el enfermo planifique, implemente y utilice estrategias de aprendizaje que favorecieron la emancipación del autocuidado, influyendo en la adhesión al tratamiento y en la calidad de vida del trasplantado.

ABSTRACT To describe an experience by nurses in the implementation of learning strategies in immunosuppression for kidney transplants. Characterized as a qualitative, descriptive study using the theoretical framework of convergent care research, performed in a kidney transplant unit. To obtain the data, we used interviews and thematic workshops. Learning strategies were developed for three workshops with groups of kidney transplant patients: patients without cognitive impairment - discursive strategy, with visuals; patients with cognitive impairment - repetitive speech strategy, with visuals; patients with visual deficits - auditory and tactile resources. The strategies adopted for the transplant with cognitive and visual impairment ordered adaptations, although at discharge patients demonstrated capacity for self-care and acquisition of immunosuppressive drugs. The experience made it possible for nurse planning, implementation and use of learning strategies that favored the emancipation of selfcare, influencing treatment adherence and quality of life of the transplant patient.

Descoberta da doença renal crônica e o cotidiano da hemodiálise / Discovery of chronic kidney disease and everyday of hemodialysis

O objetivo foi compreender o cotidiano da pessoa na vivência da hemodiálise. Pesquisa qualitativa com embasamento fenomenológico de Martin Heidegger. Participantes foram 14 pessoas cadastradas na lista de espera do transplante renal em tratamento hemodialítico em uma clínica de terapia renal substitutiva, sediada em um município Mineiro. Realizou a técnica de entrevista fenomenológica. Os resultados foram anunciados por um início abrupto e os sinais e sintomas da doença. Caracterizando sua descoberta, como o não conhecimento sobre a doença e sua terapêutica, expressando sentimento de tristeza, raiva, revolta, incomodo e ao mesmo tempo um dever a realização do tratamento. Relatam a necessidade da informação e divulgação sobre a doença renal crônica. A discussão possibilita a compreensão dos sentidos do ser-aí-hemodialítico mostrado pelo falatório, curiosidade e publicidade do cotidiano, como angústia imprópria guiando o ser a inautenticidade. Além da relação entre enfermeiro e ser cuidado que desvelou o cuidar com solicitude substitutiva. Conclui-se que a melhoria da atuação do enfermeiro pode ser pautada por abordagens teóricas e filosóficas dando suporte para um cuidar autentico buscando uma visão de saúde pela ótica do ser cuidado em interação com o cuidador embasando tanto nos aspectos objetivos como subjetivos.

The goal was to understand the person's daily life in hemodialysis experience. Qualitative research with phenomenological basis of Martin Heidegger. Participants were 14 people registered on the waiting list for kidney transplant hemodialysis treatment at a clinic of renal replacement therapy, based on a Collier county. He performed the phenomenological interview technique. The results were announced by an abrupt onset and symptoms and signs of the disease. Featuring its discovery,as no knowledge about the disease and its treatment, expressing feelings of sadness, anger, anger, discomfort and at the same time a duty to completion of treatment. Report the need for information and publicity about chronic kidney disease. The discussion provides an understanding of the way of being-there-hemodialysis shown by gossip, curiosity and daily advertising such as improper anguish guiding be inauthenticity. In addition to the relationship between nurse and be careful that unveiled the care withsubstitute care. We conclude that the improvement of nursing work can be guided by theoretical and philosophical approaches supporting care for authentic seeking a vision of health from the perspective of being careful interaction with the caregiver basing both objective aspects as subjective.

Adesão à terapia imunossupressora em receptores de transplante renal / Adherence to immunosuppressive therapy adherence in kidney transplant recipients

Kidney transplantation has advantages over other forms of kidney replacement therapies (hemodialysis and peritoneal dialysis) because it improves quality of life and increases the survival rate of recipients. However, adherence to immunosuppressive therapy after transplantation is an indispensable condition for the renal graft survival. Assessment of the adherence to immunosuppressive therapy in kidney transplant patients from a teaching hospital in São Luís -Maranhão, Brazil. Cross-sectional study of 151 kidney transplants with follow-up in the renal transplant clinic. Adherence to immunosuppressive was assessed by the self-report method Immunosuppressive Therapy Adherence Scale (ITAS): there was (60.3%) percentage of nonadherence of the transplant patients. The variables that were statistically significant with nonadherence were: being transplanted with a living donor (p=0.03), type of immunosuppressant used (p=0.04) and serum creatinine (p=0.04). We found a high rate of nonadherence to immunosuppressive therapy by the self-report method in renal transplant recipientsin an outpatient follow-up. This result becomes an important risk factor for adverse clinical outcomes, such as rejection and failure of the kidney graft

O transplante renal apresenta vantagens sobre as outras formas de terapias renais substitutivas (hemodiálise e diálise peritoneal), visto que melhora a qualidade de vida e aumenta a sobrevida dos receptores. Contudo, a adesão à terapia imunossupressora, após o transplante, é uma condição indispensável para a sobrevida do enxerto renal. Avaliar a adesão à terapia imunossupressora em transplantados renais de um hospital de ensino na cidade de São Luís ­Maranhão. Estudo transversal, cujos dados foram coletados no período de maio de 2012 a abril de 2013 com aplicação de instrumentos junto a 151 transplantadosrenais acompanhados no ambulatório de Transplante renal. A adesão aos imunossupressores foi avaliada pelo método autorrelato com a Escala de Aderência à Terapia Imunossupressora (ITAS). Encontrou-se um percentual de não adesão de (60,3%) dos transplantados. As variáveis que tiveram significância estatística com a não adesão foram: ter sido transplantado com doador vivo (p= 0,03), tipo de imunossupressor usado (p=0,04) e creatinina sérica (p=0,04). Houve uma taxa elevada de não adesão à terapia imunossupressora pelo autorrelato em receptores de transplante renal no seguimento ambulatorial. Tal resultado torna-se um importante fator de risco para desfechos clínicos negativos, como rejeição e falência do enxerto renal.