Informe de un caso de infección por coronavirus en un trasplantado renal / Report of a case of coronavirus infection in a renal transplant recipient

INTRODUCCIÓN: La infección por coronavirus favorece el desarrollo de alteraciones respiratorias. En trasplantados renales el pronóstico de la neumonía por SARS-CoV-2 puede ser diferente al resto de la población. Muchos pacientes trasplantados tienen de base linfopenia inducida por fármacos, por lo que la detección y el tratamiento precoz son determinantes en este grupo de población. PRESENTACIÓN DEL CASO: Varón de 50 años con ERC no filiada, trasplantado renal en 2016 que acudió a urgencias por fiebre de 38ºC, tos, rinorrea, diarrea con pérdida de peso y molestia en injerto renal en fosa iliaca derecha. Se diagnosticó de COVID-19 positivo tras realización de placa de tórax y PCR SARS-CoV-2. Ingresó en nuestra unidad de trasplante renal. PLAN DE CUIDADOS: Se realizó una valoración inicial mediante los patrones funcionales de Gordon. Posteriormente identificamos Diagnósticos de Enfermería según la taxonomía NANDA con sus correspondientes criterios de resultados e intervenciones. EVALUACIÓN DEL PLAN: Tras la realización de las intervenciones y la evaluación de los indicadores de resultados observamos una disminución de la temperatura corporal y de la dificultad respiratoria con mejoría en el patrón respiratorio. En cuanto a la función renal, no se ha visto significativamente alterada a pesar de la retirada temporal de la inmunosupresión. CONCLUSIÓN: El paciente se fue de alta con una función renal similar a la previa y con la inmunosupresión reintroducida. Se lograron los objetivos planteados dejando patente que el papel de enfermería ha sido fundamental en el proceso de recuperación y afrontamiento de la enfermedad

INTRODUCTION: Coronavirus infection favours the development of respiratory disorders. In kidney transplant patients, the prognosis of SARS-CoV-2 pneumonia may be different from the rest of the population. Many transplant patients have drug-induced lymphopenia, so early detection and treatment are crucial in this population group. CASE DESCRIPTION: A 50-year-old man with unknown CKD and a kidney transplant in 2016 who came to the emergency room due to fever of 38ºC, cough, rhinorrhea, diarrhea with weight loss and discomfort in a kidney graft in the right iliac fossa. He was diagnosed with COVID-19 positive after performing a chest X-ray and SARS-CoV-2 PCR. He was admitted to our kidney transplant unit. DESCRIPTION OF THE CARE PLAN: An initial assessment was made using Gordon's functional patterns. Subsequently, we identify Nursing Diagnoses according to the NANDA taxonomy with their corresponding outcome and intervention criteria. EVALUATION OF THE CARE PLAN: After carrying out the interventions and evaluating the outcome indicators, we observed a decrease in body temperature and respiratory distress with improvement in the respiratory pattern. Regarding renal function, it has not been significantly altered despite the temporary withdrawal of immunosuppression. CONCLUSION: The patient is discharged with a renal function similar to the previous one and with reintroduced immunosuppression. The objectives set were achieved, making it clear that the role of nursing has been vital in the process of recovery and coping with the disease

Do outcomes after kidney transplantation differ for black patients in England versus New York State? A comparative, population-cohort analysis.

OBJECTIVES: Inferior outcomes for black kidney transplant recipients in the USA may not be generalisable elsewhere. In this population cohort analysis, we compared outcomes for black kidney transplant patients in England versus New York State. DESIGN: Retrospective, comparative, population cohort study utilising administrative data registries. SETTINGS AND PARTICIPANTS: English data were derived from Hospital Episode Statistics, while New York State data were derived from Statewide Planning and Research Cooperative System. All adults receiving their first kidney-alone allograft between 2003 and 2013 were eligible for inclusion. MEASURES: The primary outcome measure was mortality post kidney transplantation (including inhospital death, 30-day mortality and 1-year mortality). Secondary outcome measures included postoperative admission length of stay, risk of rehospitalisation, development of cardiac events, stroke, cancer or fracture and finally transplant rejection/failure. Cox proportional hazards regression was used to investigate relationship between ethnicity, country and outcome. RESULTS: Black patients comprised 6.5% of the English cohort (n=1215/18 493) and 23.0% of the New York State cohort (n=2660/11 602). Compared with New York State, black kidney transplant recipients in England were more likely younger, male, living-donor kidney recipients and had dissimilar medical comorbidities. Inpatient mortality was not statistically different, but death within 30 days, 1 year or kidney transplant rejection/failure was lower among black patients in England versus black patients in New York State. In adjusted regression analysis, with black ethnicity the reference group, white patients had reduced risk for 30-day mortality (OR 0.62 (95% CI 0.44 to 0.86)) and 1-year mortality (OR 0.79 (95% CI 0.63 to 0.99)) in New York State but no difference was observed in England. Compared with England, black kidney transplant patients in New York State had increased HR for kidney transplant rejection rejection/failure by median follow-up (HR 2.15, 95% CI 1.91 to 2.43). CONCLUSIONS: Outcomes after kidney transplantation for black patients may not be translatable between countries.

Maintaining the Gift of Life: Achieving Adherence in Adolescent Heart Transplant Recipients.

Since the beginning of United Network of Organ Sharing data collection in 1987, a total of 8,333 pediatric patients have received a heart transplant in the United States. Because these patients now have longer graft success with improved care and immunosuppression, many of them are entering adolescence and young adulthood. Primary care pediatric nurse practitioners need to be alert to the prevalence of noncompliance with treatment in heart transplant patients, which continues to be highest in adolescence. Low compliance in adolescence increases morbidity, contributes to decreasing quality of life, and is the leading reason for graft failure and mortality in this age group. This article will review common barriers to treatment adherence in the adolescent heart transplant patient, discuss the role of the primary care pediatric nurse practitioner in preventing noncompliance, and review strategies that the primary care pediatric nurse practitioner can implement to improve compliance in this patient population.

Elementos clinicos y epidemiologicos de entrevistas familiares para la donación de órganos y tejidos / Elementos clínico-epidemiológicos de entrevistas familiares para doação de órgãos e tecidos / Clinical-epidemiological elements of family interviews for donation of organs and tissues

Objetivos: Identificar los elementos clínicos y epidemiológicos de las entrevistass con las familias de potenciales donantes de órganos y tejidos. Métodos: Estudio cuantitativo, descriptivo, exploratorio y documental. La muestra consta de 93 registros de pacientes, cuyas familias fueron abordadas en los años 2012/2013. Se realizó un análisis de los datos mediante el paquete estadístico «R». Resultados: Se observó que el 62,4% de los enfoques se han realizado con familiares de los pacientes que se han convertido en potenciales donantes post-parada cardiorrespiratoria. Los padres fueron los miembros de la familia más entrevistados (40%). El porcentaje de donación de la familia fue del 51,6%. Globo del ojo/córneas fue el más consentido, llegando a representar 87,5%. Saber que el donante potencial era contrario (en vida) a la donación (46,7%) y desconocer su deseo en vida (33,4%) fueron las principales razones de la negativa de la familia. Conclusión: Identificar los elementos clínicos y epidemiológicos de entrevistas familiares para la donación es muy importante para evaluar la eficacia de las actividades realizadas en el proceso de donación de las instituiciones (AU)

Objetivos: Identificar os elementos clínico-epidemiológicos das entrevistas realizadas com familiares de potenciais doadores de órgãos e tecidos. Médotos: Estudo quantitativo, descritivo, exploratório e documental. A amostragem foi composta por prontuários de 93 pacientes, cujas famílias foram abordadas nos anos de 2012/2013. Realizou-se análise dos dados por meio do pacote estatístico «R». Resultados: Observou-se que 62,4% das abordagens foram realizadas com familiares de pacientes que se tornaram potenciais doadores pós-parada cardiorrespiratória. Os pais foram os familiares mais entrevistados, chegando a corresponder 40% das abordagens. O percentual de consentimento familiar para doação foi de 51,6%. Globo ocular/córneas foi o mais consentido, chegando a representar 87,5%. Saber que o potencial doador era contrário (em vida) a doação (46,7%) e desconhecer seu desejo em vida (33,4%) foram os principais motivos de recusa familiar. Conclusão: Identificar os elementos clínico-epidemiológicos das entrevistas familiares para doação é de suma importância para avaliar a eficácia das atividades desempenhadas no processo de doação das instituições (AU)

Objectives: To identify the clinical and epidemiological features of interviews with families of potential donors of organs and tissues. Methods: Quantitative research, descriptive, exploratory and documental. The sample was composed of medical records of 93 patients, whose families have been addressed in the years 2012/2013. It conducted data analysis using the statical package «R». Results: It was observed that 62.4% of approaches have ben performed with families of patients who have become potential cardiorespiratory arrest donor. Parents were the most interviewed family members coming to meet 40% of approaches. The family consent to donation percentage was 51.6%. Eye/corneas globe was the most spolied, coming to represent 87.5%. Knowing tha the potential donor was contrary (in life) donation (46.7%) and ignored his desire in life (33.4%) werw the main family groups for refusal. Conclusion: Identify the clinical and epidemiological elements of family interviews for donation is very important to evaluate the effectiveness of the activities performed in the donation process of the institutions (AU)

Medicine non-adherence in kidney transplantation.

BACKGROUND: The increasing prevalence of chronic kidney disease, the relative shortage of kidney donors and the economic- and health-related costs of kidney transplant rejection make the prevention of adverse outcomes following transplantation a healthcare imperative. Although strict adherence to immunosuppressant medicine regimens is key to preventing kidney rejection, evidence suggests that adherence is sub-optimal. Strategies need to be developed to help recipients of kidney transplants adhere to their prescribed medicines. FINDINGS: This review has found that a number of factors contribute to poor adherence, for example, attitudes towards medicine taking and forgetfulness. Few investigations have been conducted, however, on strategies to enhance medicine adherence in kidney transplant recipients. Strategies that may improve adherence include pharmacist-led interventions (incorporating counselling, medicine reviews and nephrologist liaison) and nurse-led interventions (involving collaboratively working with recipients to understand their routines and offering solutions to improve adherence). Strategies that have shown to have limited effectiveness include supplying medicines free of charge and providing feedback on a participant's medicine adherence without any educational or behavioural interventions. CONCLUSION: Transplantation is the preferred treatment option for people with end-stage kidney disease. Medicine non-adherence in kidney transplantation increases the risk of rejection, kidney loss and costly treatments. Interventions are needed to help the transplant recipient take all their medicines as prescribed to improve general well-being, medicine safety and reduce healthcare costs.

La adherencia terapéutica en el paciente trasplantado renal / Therapeutic adherence in kidney transplant patients

En los pacientes con enfermedad renal crónica portadores de un trasplante renal, la adherencia al tratamiento es crucial para prevenir el rechazo, pérdida del injerto, y la morbilidad adicional. Objetivo: conocer la producción científica actual de la adherencia al tratamiento de pacientes trasplantados de riñón y las variables que pueden influir. Método: Se realizó una búsqueda en las bases de datos de Scielo, PubMed, The Chocrane, Science Direct y Google académico. Se incluyeron artículos científicos escritos en inglés y español. Se analizaron los artículos que trataban la adherencia al tratamiento inmunosupresor de pacientes trasplantados de riñón, excluyendo los pacientes pediátricos. Resultados: La adherencia al tratamiento inmunosupresor por parte de estos pacientes es relativamente baja debido a la influencia de varios factores. La complejidad del tratamiento y el tiempo postrasplante, tienen una importante correlación negativa con la adherencia. El olvido u otras ocupaciones, se relaciona de forma significativa con la no adherencia no intencional por parte de los pacientes. Los grupos de edad con menos adherencia son los más jóvenes seguidos de los más mayores, y los más adherentes los adultos. En algunos países, la falta de adherencia se debe a que el elevado coste del tratamiento inmunosupresor corre por cuente del paciente. Por otro lado, las variables que no parecen influir de forma concluyente, son: el estado civil o modo de vida, efectos secundarios, nivel socioeconómico y educativo, situación laboral, raza, creencias en la necesidad y factores psicológicos. Por último, la variable de género es claramente la única que no influye sobre la falta de adherencia, ya que una mayoría de estudios demuestran que no influyen frente a solo dos que consideran que los varones son los menos adherentes. Conclusiones: los pacientes trasplantados de riñón presentan altos porcentajes de falta de adherencia al tratamiento, estando relacionados fundamentalmente la complejidad del tratamiento, el tiempo postrasplante, el olvido u otras ocupaciones y la edad (jóvenes y mayores) (AU)

In patients with chronic kidney disease who have a kidney transplant, adherence to treatment is crucial to prevent rejection, graft loss and additional morbility. Objective: to know current scientific production on adherence to treatment by kidney transplant patients and the variables that can affect it. Method: A search was conducted in the databases of Scielo, PubMed, The Chocrane, Science Direct and Google Scholar. Scientific articles written in English and Spanish were included. Articles that dealt with adherence to immunosuppressive treatment by kidney transplant patients were analysed, excluding paediatric patients. Results: Adherence to immunosuppressive treatment by these patients is relatively low due to the influence of several factors. The complexity of the treatment and time after the transplant have an important negative correlation to adherence. Forgetfulness or other occupations are related significantly to unintentional non-adherence by patients. The age groups with the lowest adherence are the youngest followed by the most elderly, while the most adherent are adults. In some countries, the lack of adherence is due to the fact that the high cost of the immunosuppressive treatment has to be paid by the patient. On the other hand, variables that do not appear to have a conclusive influence are: marital status or lifestyle, side effects, socio-economic and educational level, job situation, race, beliefs about their necessity and psychological factors. Finally, the variable of gender is clearly the only one that does not affect lack of adherence, as most studies show that gender does not influence adherence compared to only two that consider that men are less adherent. Conclusions: kidney transplant patients present higher percentages of lack of adherence to treatment, fundamentally related to the complexity of the treatment, the time since the transplant, forgetfulness, or other occupations and age (young and elderly) (AU)

Vascular access graft and native arterial branch fistulous formation.

This is the first reported case of an unusual complication of upper extremity swelling of the arm in a patient with an arteriovenous (AV) graft for haemodialysis. A graftogram demonstrated an aberrant fistula formation between the native arterial branch and the AV graft (aberrant arterio-graft fistula). Inadvertent back wall laceration of the AV graft during haemodialysis cannulation was postulated to be the aetiology. Aberrant arterio-graft fistula formation may be hard to diagnose because of the presence of thrill or bruit at the level of the anastomoses and rarity of the complication. Progression of extremity swelling with or without central venous occlusion should raise the suspicion and sought further investigation. Proper cannulation techniques prior to haemodialysis may prevent such complications.

Clinical observation and nursing care on the prevention of abdominal organ cluster transplantation rejection.

AIMS AND OBJECTIVES: To investigate the clinical characteristics of rejection after upper abdominal cluster transplantation. BACKGROUND: Abdominal organ cluster transplantation is used to treat multiple abdominal organ diseases. Delay in monitoring and treatment can lead to graft failure. DESIGN: A descriptive study. METHODS: Data collected from eight patients who underwent abdominal organ cluster transplantation from May 2004-March 2009 in our hospital were retrospectively assessed. The clinical manifestations of graft rejection and variations in characteristics associated with graft function were analysed. RESULTS: In all eight cases, graft function recovered successfully without rejection during the perioperative period. In one case, liver graft rejection occurred 1·5 months postoperatively, but dose adjustment of the anti-rejection drugs provided symptom relief. CONCLUSIONS: Rejection can be prevented and cured successfully through monitoring and early detection of rejection characteristics by the nursing staff. RELEVANCE TO CLINICAL PRACTICE: With the increase of awareness and knowledge on the clinical observation and nursing care, the rate of transplantation rejection decreased among abdominal cluster transplant patients.

Tratamiento del rechazo agudo hiperinmune con plasmaféresis y rituximab. Nuestra experiencia / No disponible

No disponible

[The changing life of caregiving mothers of children with chronic kidney disease--a single case study]. / Die veränderte Lebenswelt pflegender Mütter von Kindern mit chronischer Nierenerkrankung.

BACKGROUND: The scientific literature shows, that caring parents of children with chronic kidney disease experience profound changes of life-world in terms of their welfare and their health. The different experiences that by the child's illness influenced the life-world of the parents in the two stages of life "living with peritoneal dialysis" and "living after kidney transplantation" have not yet been described in the German literature. METHODOLOGY: To study the changing life-world in the two stages of life "living with peritoneal dialysis" and "living after kidney transplantation" of the child, a single case study was carried out. The mother was interviewed using a problem-centered-interview. The analysis of the interview was based on Mayring's technique of content analysis (2002). RESULTS: The category system shows that mother's life-world is influenced by different experiences in both stages of life. Subjectively, the mother saw her greatest challenge during the "life with peritoneal dialysis" in following the hygienic rules and the prevention of peritation" was her fear that the donor kidney would be rejected by her child. IMPLICATIONS: The results of this study correspond to the results of previous studies in the English literature. Healthcare professionals, including nurses can use the results of this study to build up a professional relationship, for empathic support and for improvement of parental well-being. Further qualitative research should focus on healthcare professionals' view regarding the experiences and needs of caring parents of children with chronic kidney disease in order to compare with parents' view.

Post-kidney transplant rejection and infection complications.

The care of a patient after kidney transplant is multifactorial and complex, often involving other organ systems. The clinical picture can frequently be complicated with symptoms that may be misleading, and hence, challenging to assess. The nephrology nurse caring for the recipient of a transplant should be able to assess the entire clinical situation, rather than focus only on renal function. When caring for recipients of transplants, nephrology nurses need to use their extensive knowledge base and employ critical thinking skills. Although all members of the multidisciplinary team are important for success, the patient remains the focal point of the team. Post-transplant management will be successful when patients actively participate in their care. Patient teaching plays a critical role in this success, and it starts when a transplant is anticipated and continues as long as the grafted kidney is functioning.

["What can I still do, what may I still do?"--ambivalent lived experiences and instruction need of patients in the early period after renal transplantation]. / "Was kann ich noch tun, was darf ich noch tun?"--Das ambivalente Erleben und der Schulungsbedarf von Patienten in der Frühphase nach einer Nierentransplantation.

With a share of approximately 27 % of renal replacement therapies renal transplantation (RTx) has by now become a well-established alternative to dialysis. However, little is known ab-out how patients experience their new situation shortly after the RTx and about their instruction and education needs. The purpose of this phenomenological study is to describe the patients' experiences after an RTx before being discharged from the inpatient ward or from hospital and to identify topics for patient instruction and education. The method included ten semi-structured interviews with patients after a first time allogenic renal transplantation, with stable transplant function, who still received in-patient treatment. Recorded, transcribed interviews were analyzed using Colaizzi's method. The essential structure of the experiences of patients after renal transplantation can be described as a "feeling of being torn". Within this overarching theme, six sub-themes were identified: 1) weighing dialysis against transplantation, 2) dealing with the organ, 3) the experience of positive changes, 4) the self-confidence resulting from it, 5) the experience of still existing impairments and worries, and finally 6) the ensuing need for support. As a conclusion for practice it is necessary to offer an actively approaching and realistic instruction and education in order to create everyday skills and a higher degree of self-determination in the patients.

Trasplante renal y rechazo vascular. Papel de enfermería en el tratamiento con plasmaféresis / Kidney transplant and vascular rejection. Role of nursing in treatment with plasmapheresis

La plasmaféresis (PF) es una técnica que se aplica en el servicio de trasplante renal (TR) de nuestro Hospital desde el año 1999, como tratamiento en el TR que presenta rechazo vascular. Este rechazo puede ser de dos tipos: mediado por anticuerpos o mediado por linfocitos T. El tratamiento con PF consigue eliminar los anticuerpos en sangre del paciente, y por tanto puede ser efectiva en el caso de que el rechazo vascular sea mediado por anticuerpos. La técnica es llevada a cabo por la enfermera dela unidad de trasplante. Esta debe conocer la técnica, los parámetros, sus indicaciones y las posibles complicaciones que puedan presentarse. El objetivo principal de nuestro estudio es ver la efectividad del tratamiento con PF y los cuidados de enfermería que se le proporcionan. Se realizó un estudio retrospectivo, observacional y descriptivo en una muestra de 15 pacientes. Los datos estudiados se han clasificado según el perfil del paciente, parámetros de la PF, evolución del TR, cuidados de enfermería y controles analíticos. Los resultados obtenidos demuestran que el tratamiento con PF es eficaz en el rechazo vascular mediado por anticuerpos ofreciéndose además cuidados integrales al paciente trasplantado, ya que la enfermera de la unidad de TR es la responsable de efectuar la técnica (AU)

Plasmapheresis (PPH) is a technique that has been applied in the kidney transplant service (KT)of our Hospital since 1999, as a treatment in KT that presents vascular rejection. This rejection can be of two types: caused by antibodies or caused by T lymphocytes. Treatment with PPH manages to eliminate the antibodies in the patient’s blood, and can therefore be effective when the vascular rejection is caused by antibodies. The technique is carried out by the nurse of the transplant unit. The nurse must be familiar with the technique, the parameters, its indications and the possible complications that may arise. The main purpose of our study is to see the effectiveness of treatment with PPH and the nursing care provided. A retrospective, observational and descriptive study was carried out of a sample of 15 patients. The data studied were classified according to the patient profile, PPH parameters, evolution of the KT, nursing care and analytical controls. The results obtained show that treatment with PPH is efficacious in vascular rejection caused by antibodies, also offering integral care to the transplant patient, since the nurse of the KT unit is responsible for carrying out the technique (AU)

Graft failure following allogeneic blood and marrow transplant: evidence-based nursing case study review.

Despite the advances made since the earliest days of transplant therapy, graft failure following allogeneic blood and marrow transplant is still a life-threatening complication. This article reviews the science of graft failure and uses a case study presentation to address how an oncology nursing staff was motivated by a patient's experience of graft failure. An evidence-based literature review was undertaken to answer three relevant clinical questions: (a) What factors contribute to graft failure in patients receiving allogeneic hematopoietic stem cell transplants? (b) What interventions are appropriate for these patients? and (c) How can this information assist nursing staff in providing improved care for these patients? An example of the table of evidence is provided.