Patients' Expectations for Longevity of Kidney Transplant.

INTRODUCTION: Prior to transplantation, the transplant team is responsible for transplant education and posttransplant expectations. The majority of outcomes research focuses on 1- and 3-year graft survival, with a lack of literature focused upon whether patients have a realistic understanding of how many years deceased donor kidneys can be expected to function after transplant. OBJECTIVE: To determine whether potential kidney transplant patients' expectations for how long a deceased donor kidney will function after transplantation differs from transplant surgeons, using quantitative analysis. DESIGN: A cross-sectional survey was used with potential adult kidney transplant recipients and transplant surgeons. Patient surveys included demographics, quality-of-life questions, and questions of expectations of kidney function for deceased donor kidneys from the Kidney Donor Profile Index. The survey categorized donor organ risk as 0% to 20%, 21% to 85%, and 86% to 100%, and results were compared to responses from US Transplant Surgeons. Surgeons were contacted via e-mail using an online survey program. RESULTS: Responses included 154 transplant surgeons and 172 patients. Surgeon and patient responses were compared using Fisher exact test, showing a significant difference in each of the donor organ categories. We found that 47% of patient respondents did not correctly interpret the Kidney Donor Profile Index continuum. CONCLUSION: In every organ donor category, patients had a significantly different expectation for how long a transplanted kidney will last after transplant when compared to transplant surgeons. More study is required to determine why 47% of patients did not correctly interpret the Kidney Donor Profile continuum.

Posttransplant Lymphoproliferative Disorder Presenting as Testicular Lymphoma in a Kidney Transplant Recipient: A Case Report and Review of the Literature.

Posttransplant lymphoproliferative disorder (PTLD) is a malignancy caused by the immunosuppression that occurs after transplantation. It is primarily a nodal lesion but frequently it involves extranodal masses. Treatment is usually by reducing immunosuppressive therapy. Testicular lymphoma as PTLD is notably rare in documented literature and there is limited evidence of definitive treatment guidelines. This manuscript describes a patient who developed diffuse large B-cell lymphoma of his right testis one year following kidney transplantation. A diagnosis of PTLD was made and treatment with rituximab, locoregional radiotherapy, and intrathecal methotrexate in addition to the standard reduction of immunosuppression resulted in complete remission until now. We submit this case along with literature review of similar cases in the past and a review of specific peculiarities of our case with emphasis on our treatment plan to further the understanding of this diversiform disease.

Patients who leave before being seen in an urgent care setting.

OBJECTIVES: This study attempts to quantify and characterize the patients who leave before being seen (LBBS) by a physician in an urgent care setting. METHODS: A retrospective chart review was performed of visits between 1 May 2008 and 31 March 2010, at five urgent care centers (UCC). Variables extracted included sex, age, date and time of visit, and the chief complaint. A log of patient reports of the reasons for LBBS was reviewed. The relationship between waiting times and LBBS was analyzed for visits between 1 April 2012 and 30 June 2012. RESULTS: LBBS visits comprised 2.0% of the total of 378 332 visits. The left-before-being-seen group had a higher percentage of men (P<0.0001), and young and middle-aged patients (P<0.0001). The left-before-being-seen group had more visits in the overnight and daytime shifts and fewer visits on weekends (P<0.0001). Of those 10 409 patients who reported reasons at discharge, 43% cited a long wait time and 39% did not want to pay the copay. In the group for which wait times were available, 92.3% were triaged within 30 min and yet 60% of those who gave reasons stated that they were leaving because they had waited too long. CONCLUSION: The rates of leaving before being seen in urgent care were comparable with the lower end of those reported by emergency departments. Patients who left before being seen in UCC were most likely to be working-age adults during daytime hours. In UCC, LBBS is often related to perceived, rather than actual, long wait times.