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Delayed graft function (DGF) after kidney transplantation heralds a worse prognosis. In patients with hyperoxaluria, the incidence of DGF is high. Oxalic acid is a waste product that accumulates when kidney function decreases. We hypothesize that residual diuresis and accumulated waste products influence the DGF incidence. Patients transplanted between 2018-2022 participated in the prospective cohort study. Pre-transplant concentrations of oxalic acid and its precursors were determined. Data on residual diuresis and other recipient, donor or transplant related variables were collected. 496 patients were included, 154 were not on dialysis. Oxalic acid, and glyoxylic acid, were above upper normal concentrations in 98.8%, and 100% of patients. Residual diuresis was ≤150 mL/min in 24% of patients. DGF occurred in 157 patients. Multivariable binary logistic regression analysis demonstrated a significant influence of dialysis type, recipient BMI, donor type, age, and serum creatinine on the DGF risk. Residual diuresis and glycolic acid concentration were inversely proportionally related to this risk, glyoxylic acid directly proportionally. Results in the dialysis population showed the same results, but glyoxylic acid lacked significance. In conclusion, low residual diuresis is associated with increased DGF incidence. Possibly accumulated waste products also play a role. Pre-emptive transplantation may decrease the incidence of DGF.
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Função Retardada do Enxerto , Diurese , Glioxilatos , Transplante de Rim , Ácido Oxálico , Humanos , Transplante de Rim/efeitos adversos , Feminino , Masculino , Pessoa de Meia-Idade , Função Retardada do Enxerto/etiologia , Função Retardada do Enxerto/epidemiologia , Adulto , Estudos Prospectivos , Idoso , Diálise Renal , Glicolatos , Hiperoxalúria/etiologia , Fatores de Risco , IncidênciaRESUMO
A minority of living kidney donors (between 5-25%) have poor psychological outcomes after donation. There is mixed evidence on the influence of medical complications on these outcomes. We examined whether medical complications among donors and recipients predicted changes in donors' mental health (psychological symptoms and well-being) between predonation and 1 year postdonation. One-hundred and forty-five donors completed questionnaires on mental health predonation and 3 and 12 months postdonation. Number of recipient rehospitalizations and donor complications (none; minor; or severe) were obtained from medical records at 3 and 12 months after surgery. Multilevel regression analyses were used to examine the association between medical complications and changes in donors' mental health over time after controlling for sociodemographic characteristics. We found that donor complications (P = 0.003) and recipient rehospitalizations (P = 0.001) predicted an increase in donors' psychological symptoms over time. Recipient rehospitalizations also predicted a decrease in well-being (P = 0.005) over time; however, this relationship became weaker over time. We conclude that medical complications experienced by either the donor or recipient is a risk factor for deterioration in donors' mental health after living kidney donation. Professionals should monitor donors who experience medical complications and offer additional psychological support when needed.
Assuntos
Transplante de Rim , Doadores Vivos/psicologia , Transtornos Mentais/complicações , Saúde Mental , Nefrectomia/psicologia , Insuficiência Renal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Qualidade de Vida , Análise de Regressão , Fatores de Risco , Autoimagem , Inquéritos e Questionários , Coleta de Tecidos e Órgãos , Resultado do Tratamento , Adulto JovemRESUMO
In deceased donor kidney transplantation donor age is known to influence graft survival. The influence of living donor age on graft survival is questioned. We compared the influence of living and deceased donor age on the outcome of renal transplantation. All 1821 transplants performed in our center between 1990 and 2009 were included in the analysis. Observation was until April 2012. A total of 941 patients received a deceased donor kidney and 880 a living donor kidney. In multivariate Cox analysis, recipient age, maximum and current panel reactive antibodies, transplant year, HLA-mismatches, donor age, donor gender, donor type, delayed graft function, and calcineurin inhibitor (CNI) and prednisone as initial immunosuppression were found to have a significant influence on death-censored graft failure. The influence of both living and deceased donor age followed a J-shaped curve, above 30 years the risk increased with increasing age. Donor type and donor age had an independent influence. The graft failure risk of deceased donor transplantation is almost twice that of living donor transplantation so that a 60-year-old living donor kidney has the same graft failure risk as a 20-year-old deceased donor kidney.
Assuntos
Transplante de Rim/imunologia , Doadores Vivos , Doadores de Tecidos , Adulto , Fatores Etários , Função Retardada do Enxerto/imunologia , Feminino , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto/imunologia , Humanos , Rim/imunologia , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Age criteria for kidney transplantation have been liberalized over the years resulting in more waitlisted elderly patients. What are the prospects of elderly patients on the waiting list? METHODS: Between 2000 and 2013, 2622 patients had been waitlisted. Waiting time was defined as the period between dialysis onset and being delisted. Patients were categorized according to age upon listing: <25; 25-44; 45-54; 55-64; and >64 years. Furthermore, the influence of ABO blood type and panel reactive antibodies on outflow patterns was studied. RESULTS: At the end of observation (November 2017), 1957 (75%) patients had been transplanted, 333 (13%) had been delisted without a transplantation, 271 (10%) had died, and 61 (2%) were still waiting. When comparing the age categories, outflow patterns were completely different. The percentage of patients transplanted decreased with increasing age, while the percentage of patients that had been delisted or had died increased with increasing age, especially in the population without living donor. Within 6 years, 93% of the population <25 years had received a (primarily living) donor kidney. In the populations >55 years, 39% received a living donor kidney, while >50% of patients without a living donor had been delisted/died. Multivariable analysis showed that the influence of age, ABO blood type, and panel reactive antibodies on outflow patterns was significant, but the magnitude of the influence of the latter 2 was only modest compared with that of age. CONCLUSIONS: "Elderly" (not only >64 y but even 55-64 y) received a living donor kidney transplantation less often. Moreover, they cannot bear the waiting time for a deceased donor kidney, resulting in delisting without a transplant in more than half the population of patients without a living donor. Promoting living donor kidney transplantation is the only modification that improves transplantation and decreases delisting/death on the waiting list in this population.
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BACKGROUND: Currently, potential kidney transplant patients more often suffer from comorbidities. The Charlson Comorbidity Index (CCI) was developed in 1987 and is the most used comorbidity score. We questioned to what extent number and severity of comorbidities interfere with graft and patient survival. Besides, we wondered whether the CCI was best to study the influence of comorbidity in kidney transplant patients. METHODS: In our center, 1728 transplants were performed between 2000 and 2013. There were 0.8% cases with missing values. Nine pretransplant comorbidity covariates were defined: cardiovascular disease, cerebrovascular accident, peripheral vascular disease, diabetes mellitus, liver disease, lung disease, malignancy, other organ transplantation, and human immunodeficiency virus positivity. The CCI used was unadjusted for recipient age. The Rotterdam Comorbidity in Kidney Transplantation score was developed, and its influence was compared to the CCI. Kaplan-Meier analysis and multivariable Cox proportional hazards analysis, corrected for variables with a known significant influence, were performed. RESULTS: We noted 325 graft failures and 215 deaths. The only comorbidity covariate that significantly influenced graft failure censored for death was peripheral vascular disease. Patient death was significantly influenced by cardiovascular disease, other organ transplantation, and the total comorbidity scores. Model fit was best with the Rotterdam Comorbidity in Kidney Transplantation score compared to separate comorbidity covariates and the CCI. In the population with the highest comorbidity score, 50% survived more than 10 years. CONCLUSIONS: Despite the negative influence of comorbidity, patient survival after transplantation is remarkably good. This means that even patients with extensive comorbidity should be considered for transplantation.
Assuntos
Técnicas de Apoio para a Decisão , Falência Renal Crônica/cirurgia , Transplante de Rim , Causas de Morte , Distribuição de Qui-Quadrado , Contraindicações , Sobrevivência de Enxerto , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Transplante de Rim/mortalidade , Análise Multivariada , Seleção de Pacientes , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVES: Living donor kidney transplantation offers advantages to the patient, however involves risks to the donor. To optimize donors' mental health after donation, we studied the influence of psychological factors on this outcome. Potential predictors were based on models of Lazarus () and Ursin and Eriksen () that describe predictors of mental health mediated by stress. DESIGN: Prospective design. METHODS: Living kidney donors (n = 151) were interviewed before donation and completed questionnaires 2.5 months before and 3 and 12 months post-donation. Using multilevel regression models, we examined whether appraisals, expectations, knowledge, social support, coping, life events, and sociodemographic characteristics predicted psychological symptoms and well-being and whether these relationships were mediated by stress. RESULTS: A greater increase in psychological symptoms over time was found among donors without a partner. Younger age, lack of social support, expectations of interpersonal benefit, lower appraisals of manageability, and an avoidant coping style were related to more psychological symptoms at all time points. The latter three were mediated by stress. No religious affiliation, unemployment, history of psychological problems, less social support, expectations of negative health consequences, and less positive appraisals were related to lower well-being at all time points. CONCLUSIONS: This study identified indicators of a lower mental health status among living kidney donors. Professionals should examine this profile before donation and the need for extra psychological support in relation to the number and magnitude of the identified indicators. Interventions should be focused on the changeable factors (e.g., expectations), decreasing stress/psychological symptoms, and/or increasing well-being. Statement of contribution What is already known on this subject? Until now, research on psychological outcomes after living kidney donation revealed that mental health remained the same for the majority of living kidney donors, while mental health improved or deteriorated for a minority after donation. In reaction to these findings, many psychosocial screening guidelines have been developed for potential donors; however, the components of these guidelines are based on professional opinions and experience rather than on longitudinal empirical data. There is a lack of research that identifies pre-donation donor characteristics that are related to a lower mental health among donors. Such studies are essential in order to tailor psychosocial support during the donation process. What does this study add? Components that are mostly included in psychosocial screening guidelines for potential living kidney donors are not predictive of deterioration, nor increase, in mental health after donation, except for the lack of a partner. Therefore, there is little evidence on the necessity of rejecting potential donors based on these psychological criteria. The following psychological risk factors are predictive of the absolute level of donors' mental health during the donation process: A history of psychological problems, expectations of interpersonal benefit and negative health outcomes, an avoidant coping style, lack of social support, appraisals of the donation process as an unmanageable and/or negative event, a younger age, no religious affiliation, and unemployment. We argue that potential donors should not be rejected for donation based on these factors, but the indicators should be used to identify donors who might be in need for more psychological support.
Assuntos
Transplante de Rim/psicologia , Doadores Vivos/psicologia , Saúde Mental/estatística & dados numéricos , Complicações Pós-Operatórias/psicologia , Estresse Psicológico/psicologia , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Transplante de Rim/estatística & dados numéricos , Doadores Vivos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Países Baixos , Estudos Prospectivos , Apoio Social , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Nonadherence to immunosuppressive medication after kidney transplantation is a behavioral issue and as such it is important to understand the psychological factors that influence this behavior. The aim of this study was to investigate the extent to which goal cognitions, illness perceptions, and treatment beliefs were related to changes in self-reported immunosuppressive medication adherence up to 18 months after transplantation. METHODS: Interviews were conducted with patients in the outpatient clinic 6 weeks (T1; n=113), 6 months (T2; n=106), and 18 months (T3; n=84) after transplantation. Self-reported adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale Interview. Psychological concepts were measured using the Brief Illness Perceptions Questionnaire, Beliefs about Medicines Questionnaire, and questions on the importance of adherence as a personal goal, conflict with other goals, and self-efficacy for goal attainment. RESULTS: Nonadherence significantly increased over time to 31% at T3. Perceived necessity of medication, perceived impact of transplant on life (consequences) and emotional response to transplantation significantly decreased over time. Participants who reported low importance of medication adherence as a personal goal were more likely to become nonadherent over time. CONCLUSIONS: Illness perceptions can be described as functional and supportive of adherence which is inconsistent with the pervasive and increasing nonadherence observed. There appears therefore to be a discrepancy between beliefs about adherence and actual behavior. Promoting (intrinsic) motivation for adherence goals and exploring the relative importance in comparison to other personal goals is a potential target for interventions.
Assuntos
Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Conhecimentos, Atitudes e Prática em Saúde , Imunossupressores/uso terapêutico , Transplante de Rim/psicologia , Adesão à Medicação/psicologia , Pacientes/psicologia , Adulto , Fatores Etários , Idoso , Cognição , Cultura , Emoções , Feminino , Objetivos , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/psicologia , Humanos , Imunossupressores/efeitos adversos , Entrevistas como Assunto , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Percepção , Estudos Prospectivos , Autoeficácia , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Donor-recipient ABO and/or HLA incompatibility used to lead to donor decline. Development of alternative transplantation programs enabled transplantation of incompatible couples. How did that influence couple characteristics? Between 2000 and 2014, 1232 living donor transplantations have been performed. In conventional and ABO-incompatible transplantation the willing donor becomes an actual donor for the intended recipient. In kidney-exchange and domino-donation the donor donates indirectly to the intended recipient. The relationship between the donor and intended recipient was studied. There were 935 conventional and 297 alternative program transplantations. There were 66 ABO-incompatible, 68 domino-paired, 62 kidney-exchange, and 104 altruistic donor transplantations. Waiting list recipients (n = 101) were excluded as they did not bring a living donor. 1131 couples remained of whom 196 participated in alternative programs. Genetically unrelated donors (486) were primarily partners. Genetically related donors (645) were siblings, parents, children, and others. Compared to genetically related couples, almost three times as many genetically unrelated couples were incompatible and participated in alternative programs (P < 0.001). 62% of couples were genetically related in the conventional donation program versus 32% in alternative programs (P < 0.001). Patient and graft survival were not significantly different between recipient programs. Alternative donation programs increase the number of transplantations by enabling genetically unrelated donors to donate.
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Background. Nonadherence to medication is a common problem after kidney transplantation. The aim of this study was to explore attitudes towards medication, adherence, and the relationship with clinical outcomes. Method. Kidney recipients participated in a Q-methodological study 6 weeks after transplantation. As a measure of medication adherence, respondents completed the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS(©)-interview). Moreover, the intrapatient variability in the pharmacokinetics of tacrolimus was calculated, which measures stability of drug intake. Data on graft survival was retrieved from patient records up to 2 years after transplantation. Results. 113 renal transplant recipients (19-75 years old) participated in the study. Results revealed three attitudes towards medication adherence-attitude 1: "confident and accurate," attitude 2: "concerned and vigilant," and attitude 3: "appearance oriented and assertive." We found association of attitudes with intrapatient variability in pharmacokinetics of tacrolimus, but not with self-reported nonadherence or graft survival. However, self-reported nonadherence immediately after transplantation was associated with lower two-year graft survival. Conclusion. These preliminary findings suggest that nonadherence shortly after kidney transplantation may be a risk factor for lower graft survival in the years to follow. The attitudes to medication were not a risk factor.
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BACKGROUND: Studies on the influence of socioeconomic factors and ethnicity on the results of kidney transplantation have led to various outcomes. In this study, we analyzed the influence of a combination of these factors on graft and patient survival in a population of kidney transplant recipients. METHODS: This retrospective study included all 1,338 patients who received a kidney transplant between 2000 and 2011 (825 living, 513 deceased donor transplantations). Both clinical and socioeconomic variables were studied. Clinical variables were recipient age, gender, ethnicity, original disease, maximum and current panel reactive antibodies, ABO blood type, retransplants, pretreatment, time on dialysis, comorbidity, transplant year, total number of HLA mismatches, donor type (living or deceased), age and gender, and calcineurin inhibitor treatment. Each recipient's postal code was linked to a postal code area information database to extract information on housing value, income, percentage non-Europeans in the area, and urbanization level. RESULTS: In multivariable analysis, graft survival censored for death was significantly influenced by recipient age, maximum panel reactive antibodies, HLA mismatches, donor type, donor age, and calcineurin inhibitor treatment. Patient survival was significantly influenced by recipient age, comorbidity, transplant year, and donor type. Socioeconomic factors and ethnicity did not have a significant influence on graft and patient survival. CONCLUSIONS: Though ethnicity and socioeconomic factors do not influence survival after kidney transplantation, the favorable influence of living donor type is of paramount importance. As non-Europeans and patients with unfavorable socioeconomic variables less often receive a living donor kidney transplant, their survival may be unfavorable after all.
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Sobrevivência de Enxerto , Transplante de Rim , Insuficiência Renal/economia , Insuficiência Renal/cirurgia , Sistema ABO de Grupos Sanguíneos , Adulto , Feminino , Seguimentos , Antígenos HLA/imunologia , Humanos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Diálise Renal , Insuficiência Renal/mortalidade , Estudos Retrospectivos , Classe Social , Fatores Socioeconômicos , Resultado do TratamentoRESUMO
BACKGROUND: Human leukocyte antigen (HLA) mismatches are known to influence graft survival in deceased-donor kidney transplantation. We studied the effect of HLA mismatches in a population of recipients of deceased-donor or living-donor kidney transplantations. METHODS: All 1998 transplantations performed in our center between 1990 and 2011 were included in this retrospective cohort study. Four different multivariable Cox proportional hazard analyses were performed with HLA mismatches as continuous variable, as categorical variable (total number of HLA mismatches), as binary variable (zero vs. nonzero HLA mismatches), and HLA-A, -B, and -DR mismatches included separately. RESULTS: Nine hundred ninety-one patients received a deceased-donor kidney and 1007 received a living-donor kidney. In multivariable Cox analysis, HLA mismatches, recipient age, current panel-reactive antibodies, transplant year, donor age, calcineurin inhibitor treatment, and donor type were found to have a significant and independent influence on the risk of graft failure, censored for death. Variables representing the total number of HLA-A, -B, and -DR mismatches had a significant and comparable influence in all analyses. CONCLUSIONS: The influence of HLA mismatches on death-censored graft survival holds true for both deceased- and living-donor kidney transplantation. However, the relative risk of death-censored graft failure of a 2-2-2 mismatched living-donor kidney is comparable with that of a 0-0-0 mismatched deceased-donor kidney.
Assuntos
Antígenos HLA/química , Histocompatibilidade/imunologia , Transplante de Rim/métodos , Transplante de Órgãos/métodos , Adulto , Algoritmos , Inibidores de Calcineurina , Estudos de Coortes , Feminino , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto , Teste de Histocompatibilidade/métodos , Humanos , Rim/imunologia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Risco , Doadores de Tecidos , Obtenção de Tecidos e Órgãos , Resultado do TratamentoRESUMO
OBJECTIVE: Nonadherence to immunosuppressive medication (IM) after kidney transplantation is related to poorer patient and graft outcomes; therefore research into modifiable factors associated with nonadherence is a priority. In this prospective cohort study we investigated whether changes in goal cognitions, illness perceptions, and treatment beliefs were related to self-reported medication adherence six months after kidney transplantation. METHODS: Interviews were conducted with patients in the out-patient clinic six weeks (T1: n=113) and six months (T2: n=106) after transplantation. Self-reported adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS© Interview). The Brief Illness Perceptions Questionnaire, Beliefs about Medicines Questionnaire and questions on goal cognitions were also administered at both time points. RESULTS: Self-reported nonadherence increased significantly between 6 weeks and 6 months after transplantation from 17% to 27%. Importance of medication adherence as a personal goal and self-efficacy to successfully carry out this goal decreased significantly over time. Perceived necessity of immunosuppressive medication was high but significantly decreased over time. Concerns about the medicines were low. There were no significant changes in illness perceptions or concerns over time. An increase in perceived graft longevity (timeline) was related to higher likelihood of nonadherence six months post-transplant. Furthermore, younger adult patients were more likely to be nonadherent six months after transplantation. CONCLUSION: The self-reported nonadherence levels found in this study so soon after transplantation demonstrate the need for early and continued intervention after kidney transplantation in order to maximise adherence and consequently clinical outcomes. Changes in (unrealistic) beliefs regarding the longevity of the graft may offer a potential target for intervention among nonadherent patients.
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Cognição , Objetivos , Conhecimentos, Atitudes e Prática em Saúde , Transplante de Rim/psicologia , Adesão à Medicação/psicologia , Percepção , Adulto , Idoso , Estudos de Coortes , Cultura , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Autocuidado , Autoeficácia , Autorrelato , Controles Informais da Sociedade , Inquéritos e QuestionáriosRESUMO
BACKGROUND: In the past 30 years, the number of living donor kidney transplantations has increased considerably and nowadays outnumbers the deceased donor transplantations in our center. We investigated which socioeconomic and clinical factors influence who undergoes living or deceased donor kidney transplantation. METHODS: This retrospective study included all 1338 patients who received a kidney transplant between 2000 and 2011 in the Erasmus MC Rotterdam. Clinical and socioeconomic variables were combined in our study. Clinical variables were recipient age, gender, ethnicity, original disease, retransplants, ABO blood type, panel-reactive antibody, previous treatment, and transplantation year. Each recipient's postcode was linked to a postcode area information data base, to extract demographic information on urbanization level, percentage non-Europeans in the area, income, and housing value. Chi-square, analysis of variance, and univariate and multivariate logistic regression analyses were performed. RESULTS: There were significant differences between the recipients of a living versus deceased donor kidney transplantation. In multivariate logistic regression analyses, 10 variables had a significant influence on the chance of receiving living donor kidney transplantation. Clinical and socioeconomic factors had an independent influence on this chance. Patients with ABO blood type O and B have smaller chances. Highly sensitized and elderly patients have smaller chances especially when combined with a collection of other unfavorable factors. Accumulation of unfavorable factors in non-Europeans prevents their participation in living donation programs. CONCLUSION: Both clinical and socioeconomic factors are associated with participation in living or deceased donor kidney transplantation. This study highlights the populations that would benefit from educational intervention regarding living donor transplantation.