Changes in quality of life after renal transplantation
Abstract
The objective of this study was to evaluate the modifications that renal transplantation produces on the quality of life (QOL) of patients with chronic renal failure (CRF) previously undergoing hemodialysis (HD) and to analyze the possible factors implicated. A multicenter study of QOL was performed on 1,023 patients undergoing dialysis, using as QOL indicators the Karnofsky Scale (KS) and the Sickness Impact Profile (SIP). Among this group, 93 patients received a renal transplant and QOL was re-studied in them; each subject, therefore, was his own control. In the 88 patients with a functioning graft, an improvement in QOL indices was globally observed; this improvement was much more marked in men than in women, for unclear reasons. Older age and greater prior comorbidity diminished the beneficial effects of transplantation. (Am J Kidney Dis 1998 Jul;32(1):93-100)
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Racialized and Immigrant Status and the Pursuit of Living Donor Kidney Transplant - a Canadian Cohort Study
2024, Kidney International ReportsBoth immigrant and racialized status may be associated with the pursuit of living donor kidney transplant (LDKT).
This study was a secondary analysis of a convenience cross-sectional sample of patients with kidney failure in Toronto, obtained from our “Comprehensive Psychosocial Research Data System” research database. The exposures included racialized, immigrant, and combined immigrant and racialized status (White nonimmigrant, racialized nonimmigrant, White immigrant and racialized immigrant). Outcomes include the following: (i) having spoken about LDKT with others, (ii) having a potential living donor (LD) identified, (iii) having allowed others to share the need for LDKT, (iv) having directly asked a potential donor to be tested, and (v) accept a hypothetical LDKT offer. We assessed the association between exposure and outcomes using univariable, and multivariable binary or multinominal logistic regression (reference: White or White nonimmigrant participants).
Of the 498 participants, 281 (56%) were immigrants; 142 (28%) were African, Caribbean, and Black (ACB); 123 (25%) were Asian; and 233 (47%) were White. Compared to White nonimmigrants, racialized immigrants (relative risk ratio [RRR]: 2.98; 95% confidence interval [CI]: 1.76–5.03) and racialized nonimmigrants (RRR: 2.84; 95% CI: 1.22–6.65) were more likely not to have spoken about LDKT with others (vs. having spoken or planning to do so). Both racialized immigrant (odds ratio [OR]: 4.07; 95% CI: 2.50–6.34), racialized nonimmigrants (OR: 2.68; 95% CI: 1.31–5.51) and White immigrants (OR: 2.68; 95% CI: 1.43–5.05) were more likely not to have a potential LD identified.
Both racialized and immigrant status are associated with less readiness to pursue LDKT. Supporting patients to communicate their need for LDKT may improve equitable access to LDKT.
A paired-kidney allocation study found superior survival with HLA-DR compatible kidney transplants in the Eurotransplant Senior Program
2023, Kidney InternationalThe Eurotransplant Senior Program (ESP) has expedited the chance for elderly patients with kidney failure to receive a timely transplant. This current study evaluated survival parameters of kidneys donated after brain death with or without matching for HLA-DR antigens. This cohort study evaluated the period within ESP with paired allocation of 675 kidneys from donors 65 years and older to transplant candidates 65 years and older, the first kidney to 341 patients within the Eurotransplant Senior DR-compatible Program and 334 contralateral kidneys without (ESP) HLA-DR antigen matching. We used Kaplan-Meier estimates and competing risk analysis to assess all cause mortality and kidney graft failure, respectively. The log-rank test and Cox proportional hazards regression were used for comparisons. Within ESP, matching for HLA-DR antigens was associated with a significantly lower five-year risk of mortality (hazard ratio 0.71; 95% confidence interval 0.53-0.95) and significantly lower cause-specific hazards for kidney graft failure and return to dialysis at one year (0.55; 0.35-0.87) and five years (0.73; 0.53-0.99) post-transplant. Allocation based on HLA-DR matching resulted in longer cold ischemia (mean difference 1.00 hours; 95% confidence interval: 0.32-1.68) and kidney offers with a significantly shorter median dialysis vintage of 2.4 versus 4.1 yrs. in ESP without matching. Thus, our allocation based on HLA-DR matching improved five-year patient and kidney allograft survival. Hence, our paired allocation study suggests a superior outcome of HLA-DR matching in the context of old-for-old kidney transplantation.
Association between controlled circulatory death donor waitlisting and waiting time before kidney transplantation in a French center
2022, Nephrologie et TherapeutiqueLa transplantation à partir de donneurs à cœur arrêté contrôlé (controlled Donation after Circulatory Death, cDCD) est une pratique nouvelle en France. Un consentement spécifique additionnel est nécessaire pour l’inscription sur liste d’attente cDCD. L’objectif de cette étude est d’estimer l’effet de l’inscription sur liste cDCD sur le temps d’attente avant transplantation rénale.
Les patients inscrits sur liste d’attente de transplantation rénale pour un donneur en état de mort encéphalique (Death Brain Donor, DBD) entre 2018 et 2019 dans le centre de Lille ont été inclus. Les patients candidats pour une seconde greffe rénale où ayant déjà reçu une transplantation d’organe n’ont pas été inclus. L’inscription sur liste d’attente cDCD était autorisée par un consentement signé du patient au jour de l’inscription sur liste DBD. Le critère de jugement principal est le délai avant transplantation.
Sur les 315 patients éligibles à un greffon cDCD lors de l’inscription sur liste de transplantation, 152 ont été inscrits sur la liste d’attente cDCD. La vitesse d’accès à la greffe de ces patients est multipliée par 1,42 (IC 95 % 1,07–1,87) par rapport à un patient inscrit uniquement pour un greffon DBD. Le délai avant transplantation était plus court de 2,59 mois (IC 95 % 0,49–4,69) pour un suivi de 2 ans pour les patients inscrits sur liste cDCD. Cela représente une transplantation supplémentaire à 6 mois toutes les 7 inscriptions sur liste d’attente cDCD.
L’inscription sur liste d’attente cDCD permet d’augmenter la vitesse d’accès à la transplantation rénale en France.
Transplantation from controlled donation after circulatory determination of death (cDCD) is a new practice in France. An additional specific consent is required for registration on the cDCD waiting list. The aim of this study is to evaluate the impact of cDCD acceptance on the waiting time for the registered patients on the transplant list.
Patients registered on the kidney transplant waiting list for a Death Brain Donor (DBD) kidney transplant between 2018 and 2019 in our center were included. Patients who were candidates for a second kidney transplant or who had already received an organ transplant were not included. The cDCD waiting list registration was authorized by a signed consent of the patient on the day of DBD registration. The primary endpoint was time to renal transplantation.
Of the 315 patients eligible for a cDCD graft at transplant list registration, 152 were registered on the cDCD waiting list. Time to transplantation for these patients was multiplied by 1.42 (95%CI 1.07–1.87) compared with patients not registered for a cDCD graft. The time to transplantation was 2.59 months (95%CI 0.49–4.69) shorter for a 2-year follow-up for cDCD-listed patients. This represents one additional transplant at 6 months for every seven registered patients.
cDCD waiting list registration reduced the time to kidney transplantation in France.
The Role of a Clinical Psychologist in Pediatric Nephrology
2022, Pediatric Clinics of North AmericaFood Literacy Is Associated With Adherence to a Mediterranean-Style Diet in Kidney Transplant Recipients
2021, Journal of Renal NutritionAdherence to a Mediterranean-style diet is associated with improved health outcomes in kidney transplant recipients (KTR). However, poor dietary habits, including excessive sodium intake, are common in KTR, indicating difficulties with incorporating a healthy diet into daily life. Food literacy is identified as potential facilitator of a healthy diet, but the precise relationship between food literacy and dietary intake in KTR has not been investigated. This study examined food literacy levels in KTR and its association with adherence to a Mediterranean-style diet and sodium intake.
This cross-sectional study is part of the TransplantLines Cohort and Biobank Study. Food literacy was measured with the Self-Perceived Food Literacy (SPFL) questionnaire. Dietary intake assessment with food frequency questionnaires was used to calculate the Mediterranean Diet Score. Sodium intake was based on the 24-hour urinary sodium excretion rate. Associations of SPFL with Mediterranean Diet Score and sodium intake were assessed with univariable and multivariable linear regression analyses.
In total, 148 KTR (age 56 [48-66]; 56% male) completed the SPFL questionnaire with a mean SPFL score of 3.63 ± 0.44. Higher SPFL was associated with a higher Mediterranean Diet Score in KTR (β = 1.51, 95% confidence interval 0.88-2.12, P ≤ .001). Although KTR with higher food literacy tended to have a lower sodium intake than those with lower food literacy (P = .08), the association of food literacy with sodium intake was not significant in a multivariable regression analysis (β = 0.52 per 10 mmol/24-hour increment, 95% confidence interval −1.79 to 2.83, P = .66).
Higher levels of food literacy are associated with better adherence to a Mediterranean-style diet in KTR. No association between food literacy and sodium intake was found. Further studies are needed to determine if interventions on improving food literacy contribute to a healthier diet and better long-term outcomes in KTR.
Malnutrition according to GLIM criteria in stable renal transplant recipients: Reduced muscle mass as predominant phenotypic criterion
2021, Clinical NutritionMalnutrition has a negative impact on quality of life and survival in renal transplant recipients (RTR). Therefore, malnutrition detection is important in RTR, but this may be hampered by concomitant presence of weight gain and overweight. Recently, the Global Leadership Initiative on Malnutrition (GLIM) developed a set of diagnostic criteria for malnutrition. We aimed to assess the prevalence of malnutrition according to the GLIM criteria and the distribution of phenotypic criteria in RTR. Additionally, we examined the potential value of 24-h urinary creatinine excretion rate (CER) as alternative measure for the criterion reduced muscle mass.
We used data from stable outpatient RTR included in the TransplantLines Cohort and Biobank Study (NCT02811835). Presence of weight loss and reduced intake or assimilation were derived from Patient-Generated Subjective Global Assessment (PG-SGA) item scores. Reduced muscle mass was assessed by multi-frequency bio-electrical impedance analysis (MF-BIA) and defined as an appendicular skeletal muscle mass index (ASMI) < 7 kg/m2 for men and <5.5 kg/m2 for women, and in additional analysis defined as creatinine-height index (CHI, based on 24 h urine CER) < 80%. Inflammation was present if C-reactive protein (CRP) was >5 mg/L. Malnutrition was defined as presence of at least one phenotypic (weight loss and/or low BMI and/or reduced muscle mass) and one etiologic criterion (reduced intake/assimilation and/or disease burden/inflammation).
We included 599 RTR (55 ± 13 years old, 62% male, BMI 27.2 ± 4.7 kg/m2) at a median of 3.1 years after transplantation. According to GLIM criteria, 14% was malnourished, of which 91% met the phenotypic criterion for reduced muscle mass. Similar results were found by using CHI as measure for muscle mass (13% malnutrition of which 79% with reduced muscle mass).
Malnutrition is present in one in 7 stable RTR, with reduced muscle mass as the predominant phenotypic criterion. Assessment of nutritional status, most importantly muscle status, is warranted in routine care, to prevent malnutrition in RTR from remaining undetected and untreated. The diagnostic value of 24-h urinary CER in this regard requires further investigation.