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Synchronous Central Nervous System Atypical Teratoid/ Rhabdoid Tumor and Malignant Rhabdoid Tumor of the Kidney: Case report of a Long-Term Survivor and Review of the Literature.

Mon, 12/11/2017 - 11:05

Synchronous Central Nervous System Atypical Teratoid/ Rhabdoid Tumor and Malignant Rhabdoid Tumor of the Kidney: Case report of a Long-Term Survivor and Review of the Literature.

World Neurosurg. 2017 Dec 06;:

Authors: Abu Arja MH, Patel P, Shah SH, Auletta JJ, Meyer EK, Conley SE, Aldrink JH, Pindrik JA, AbdelBaki MS

Abstract
BACKGROUND: Atypical teratoid/rhabdoid tumor (AT/RT) of the central nervous system (CNS) with synchronous or metachronous extra-CNS disease is a rare childhood malignancy with a dismal prognosis.
CASE DESCRIPTION: We report a seven-week-old female with metastatic AT/RT and synchronous malignant rhabdoid tumor of the kidney who received an intensive multimodal approach combining surgical resection, intrathecal chemotherapy, and high-dose chemotherapy with autologous peripheral blood stem cell transplant (PBSCT). She is currently 24 months of age without any evidence of disease. In addition, we completed an extensive literature review of cases with CNS AT/RT and synchronous or metachronous extra-CNS primary tumors. To date, a total of 31 pediatric cases have been reported, and the median overall-survival was six months post-diagnosis. The only three survivors received autologous PBSCT, and two of these patients had complete resection of their CNS tumor.
CONCLUSIONS: The rarity of CNS AT/RT with extra-CNS primary disease and the lack of standard treatment contribute to its reported dismal prognosis. We report a case of a long-term survivor with metastatic AT/RT and synchronous extra-CNS primary tumor. Maximal surgical resection, intrathecal chemotherapy, and consolidative autologous PBSCT may improve prognosis and avoid radiation.

PMID: 29223518 [PubMed - as supplied by publisher]

Frequency and Consequences of Right-Sided Heart Failure After Continuous-Flow Left Ventricular Assist Device Implantation.

Mon, 12/11/2017 - 11:05

Frequency and Consequences of Right-Sided Heart Failure After Continuous-Flow Left Ventricular Assist Device Implantation.

Am J Cardiol. 2017 Oct 31;:

Authors: Kurihara C, Critsinelis AC, Kawabori M, Sugiura T, Loor G, Civitello AB, Morgan JA

Abstract
Postoperative right-sided heart failure (RHF) is a common complication after continuous-flow left ventricular assist device implantation. Studies have examined RHF in the perioperative period, but few have assessed late-onset RHF. We analyzed the incidence of early and late RHF in patients with HeartMate II and HeartWare left ventricular assist devices and associated morbidity, mortality, and independent predictors of RHF. We retrospectively analyzed records of 526 patients with chronic heart failure who underwent continuous-flow left ventricular assist device implantation; 147 (27.9%) developed RHF (early RHF, n = 87, 16.5%; late RHF, n = 74, 14.4%). We examined demographics, postoperative complications, and long-term survival rate. Patients with RHF or late RHF had higher mortality (p <0.001) than those without RHF. Patients with RHF had a higher incidence of acute kidney injury (20.4% vs 11.9%, p = 0.01). Device type did not affect the incidence of early, late, or overall RHF. Patients with severe RHF requiring right ventricular assist device support had a low success of bridge to transplantation (11.1% vs 33.3%, p = 0.02). In Cox regression models, RHF was an independent predictor of mortality (hazard ratio = 1.69, 95% confidence interval = 1.28 to 2.22, p <0.001), but no predictive variables of RHF were identified. RHF was significantly associated with increased mortality and a higher incidence of postoperative acute kidney injury. RHF decreased the success rate of bridging patients to transplantation when a right ventricular assist device was required.

PMID: 29223289 [PubMed - as supplied by publisher]

The role of the kidney in combined liver-kidney transplantation.

Sun, 12/10/2017 - 13:45

The role of the kidney in combined liver-kidney transplantation.

Liver Transpl. 2017 Dec 09;:

Authors: Formica RN

PMID: 29222928 [PubMed - as supplied by publisher]

Survival of children after liver transplantation for hepatocellular carcinoma.

Sun, 12/10/2017 - 13:45

Survival of children after liver transplantation for hepatocellular carcinoma.

Liver Transpl. 2017 Dec 09;:

Authors: Baumann U, Adam R, Duvoux C, Mikolajczyk R, Karam V, D'Antiga L, Chardot C, Coker A, Colledan M, Erizon BG, Line PD, Hadzic N, Isoniemi H, Klempnauer JL, Reding R, McKiernan PJ, McLin V, Paul A, Salizzoni M, Furtado ESB, Schneeberger S, Karch A

Abstract
Hepatocellular carcinoma (HCC) in childhood differs from adult HCC as it is often associated with inherited liver disease. It is, however, unclear whether liver transplantation (LT) for HCC in childhood with or without associated inherited disease has a comparable outcome to adult HCC. Based on data from the European Liver Transplant Registry (ELTR) we aimed to investigate if there are differences in patient and graft survival after LT for HCC between children and adults and between patients with underlying inherited versus non inherited liver disease respectively. We included all 175 children who underwent LT for HCC and were enrolled in ELTR between 1985 and 2012; of these, 38 had an associated inherited liver disease. Adult HCC patients with (n=79) and without (n=316, matched by age, sex and LT date) inherited liver disease served as an adult comparison population. We used multivariable piecewise Cox regression models with shared frailty terms (for LT center) to compare patient and graft survival between the different HCC groups. Survival analyses demonstrated a superior long-term survival of children with inherited liver disease when compared to children with HCC without inherited liver disease (HR:0.29; 95%CI:0.10-0.90; p=0.03) and adults with HCC with inherited liver disease (HR:0.27; 95%CI:0.06-1.25;p=0.09). There was no survival difference between adults with and without inherited disease (HR:1.05; 95%CI:0.66-1.66; p=0.84).
CONCLUSION: The potential survival advantage of children with an HCC based on inherited disease should be acknowledged when considering transplantation and prioritization for these patients. Further prospective studies accounting for tumor size and extension at LT are necessary to fully interpret our findings. This article is protected by copyright. All rights reserved.

PMID: 29222922 [PubMed - as supplied by publisher]

Indoxyl Sulfate Upregulates Liver P-Glycoprotein Expression and Activity through Aryl Hydrocarbon Receptor Signaling.

Sun, 12/10/2017 - 13:45
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Indoxyl Sulfate Upregulates Liver P-Glycoprotein Expression and Activity through Aryl Hydrocarbon Receptor Signaling.

J Am Soc Nephrol. 2017 Dec 08;:

Authors: Santana Machado T, Poitevin S, Paul P, McKay N, Jourde-Chiche N, Legris T, Mouly-Bandini A, Dignat-George F, Brunet P, Masereeuw R, Burtey S, Cerini C

Abstract
In patients with CKD, not only renal but also, nonrenal clearance of drugs is altered. Uremic toxins could modify the expression and/or activity of drug transporters in the liver. We tested whether the uremic toxin indoxyl sulfate (IS), an endogenous ligand of the transcription factor aryl hydrocarbon receptor, could change the expression of the following liver transporters involved in drug clearance: SLC10A1, SLC22A1, SLC22A7, SLC47A1, SLCO1B1, SLCO1B3, SLCO2B1, ABCB1, ABCB11, ABCC2, ABCC3, ABCC4, ABCC6, and ABCG2 We showed that IS increases the expression and activity of the efflux transporter P-glycoprotein (P-gp) encoded by ABCB1 in human hepatoma cells (HepG2) without modifying the expression of the other transporters. This effect depended on the aryl hydrocarbon receptor pathway. Presence of human albumin at physiologic concentration in the culture medium did not abolish the effect of IS. In two mouse models of CKD, the decline in renal function associated with the accumulation of IS in serum and the specific upregulation of Abcb1a in the liver. Additionally, among 109 heart or kidney transplant recipients with CKD, those with higher serum levels of IS needed higher doses of cyclosporin, a P-gp substrate, to obtain the cyclosporin target blood concentration. This need associated with serum levels of IS independent of renal function. These findings suggest that increased activity of P-gp could be responsible for increased hepatic cyclosporin clearance. Altogether, these results suggest that uremic toxins, such as IS, through effects on drug transporters, may modify the nonrenal clearance of drugs in patients with CKD.

PMID: 29222397 [PubMed - as supplied by publisher]

Antiviral treatment of BK virus viremia after kidney transplantation.

Sun, 12/10/2017 - 13:45
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Antiviral treatment of BK virus viremia after kidney transplantation.

Am J Health Syst Pharm. 2017 Dec 15;74(24):2037-2045

Authors: Santeusanio AD, Lukens BE, Eun J

Abstract
PURPOSE: The various antiviral treatment options in the management of BK virus (BKV) viremia and BKV-associated nephropathy (BKVAN) are reviewed.
SUMMARY: Review of the PubMed database from 1990 to 2016 for all English language case series, cohort studies, and randomized controlled trials detailing antiviral treatment of BKV viremia or BKVAN in kidney transplant recipients returned only 16 published reports. The majority of these reports were based on small case series or protocol-based cohort studies, with no prospective head-to-head data and only modest benefit reported for cidofovir, leflunomide, i.v. immunoglobulin (IVIG), and fluoroquinolone therapy. Given the lack of comparative data, appropriate antiviral treatment of BKV viremia should be determined based on institutional immunosuppressive protocols and posttransplantation outcomes. In appropriate patients who are not immunologically sensitized, substituting leflunomide for mycophenolate as part of immunosuppression reduction is reasonable and may result in viral clearance in up to 43% of patients at 4 weeks. In patients with persistent viremia despite immunosuppression reduction, either IVIG 2 g/kg administered over 2-5 days or cidofovir 0.5 mg/kg per week until viral clearance is achieved is generally well tolerated. Otherwise, there is insufficient evidence to recommend the use of fluoroquinolone therapy in either the treatment or prophylaxis of BKV viremia at this time.
CONCLUSION: A review of the published literature revealed that certain populations of patients with BKV viremia or BKVAN can benefit from cidofovir, leflunomide, and IVIG therapy, but these data were derived from case series or protocol-driven cohort studies. Providers should treat patients on an individual basis to maximize clinical effectiveness while limiting adverse reactions.

PMID: 29222360 [PubMed - in process]

Chronic organ failure in adult sickle cell disease.

Sun, 12/10/2017 - 13:45
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Chronic organ failure in adult sickle cell disease.

Hematology Am Soc Hematol Educ Program. 2017 Dec 08;2017(1):435-439

Authors: Vichinsky E

Abstract
Sickle cell disease is now a chronic adult illness characterized by progressive multiorgan failure, particularly involving the brain and kidney. The etiology is multifactorial; it includes hemolysis and nitric oxide deficiency. As patients age, most experience neurologic insult. Twenty-five percent of older adults have had a clinical stroke and at least half of the population have had a silent infarct, cortical atrophy, and neurocognitive impairment. Periodic screening with neuroimaging and neurocognitive testing is recommended. Identification and correction of modifiable risk factors such as nocturnal hypoxemia, obstructive sleep apnea, and physical exercise programs should be implemented. Patients with neurocognitive impairment require cognitive remediation and educational accommodations. Chronic renal disease occurs in 25% of older adults and results in 50% of their deaths. Renal failure often develops insidiously. It can be prevented or minimized by early screening and treatment of modifiable risk factors including hypertension and microalbuminuria. There is an increasing number of therapeutic options, including inhibitors of the renin angiotensin system, angiotensin-II receptor blockers, endothelin-1 receptor antagonist, and haptoglobin therapy. Patients with sickle cell disease have increased mortality rates from renal failure compared with nonsickle cell patients, in part from a lack of access to early multidisciplinary care, including timely initiation of dialysis and renal transplantation.

PMID: 29222290 [PubMed - in process]

Fat embolism: a rare cause of perioperative renal transplant dysfunction.

Sun, 12/10/2017 - 13:45
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Fat embolism: a rare cause of perioperative renal transplant dysfunction.

BMJ Case Rep. 2017 Dec 07;2017:

Authors: Scott J, Collin N, Baker R, Ravanan R

Abstract
Fat embolism is a recognised complication of bony injury and orthopaedic surgery, commonly involving the long bones and pelvis. We report on the case of a 68-year-old renal transplant recipient who developed acute kidney injury following surgical stabilisation of metastatic carcinoma of the acetabulum and replacement of the proximal femur. A CT renal angiogram demonstrated a large fat embolus in the inferior vena cava (IVC) and left iliac veins below the level of IVC filter, with impaired renal perfusion. The risks of open or endovascular lipothrombectomy were felt to outweigh the potential benefits. The patient was managed with systemic anticoagulation and prepared for transplant failure. Subsequently, there was spontaneous improvement in urine output and 4 months postoperatively her transplant function had returned to her baseline level and this has remained stable at 1 year postsurgery.

PMID: 29222218 [PubMed - in process]

TERT rs2736098 (Ex2-659G>A) polymorphism and cancer susceptibility: evidence from a comprehensive meta-analysis.

Sun, 12/10/2017 - 13:45
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TERT rs2736098 (Ex2-659G>A) polymorphism and cancer susceptibility: evidence from a comprehensive meta-analysis.

Oncotarget. 2017 Nov 10;8(56):96433-96441

Authors: Pang T, Zhou M, Liu R, Luo J, Xia R

Abstract
Increasing researches have been performed regarding the relationship between TERT rs2736098 and cancer risk, but no consensus has been reached about the relationship. Here, we conducted this updated meta-analysis, aiming to comprehensively evaluate the role of TERT rs2736098 in cancer risk. We systematically searched potential relevant articles through PubMed, EMBASE, CNKI, and WanFang database before August 2017. A total of 33 studies with 18685 cases and 23820 controls were finally included in the current meta-analysis. We then adopted odds ratios (ORs) and 95% confidence intervals (CIs) to analyze the contributions of TERT rs2736098 to cancer risk. We found that the TERT rs2736098 polymorphism was associated with risk of cancer in overall analysis (AA vs. GG: OR = 1.26, 95% CI = 1.09-1.47; AA vs.
AG/GG: OR = 1.22, 95% CI = 1.09-1.36; AA/AG vs. GG: OR = 1.13, 95% CI = 1.02-1.24; A vs. G: OR = 1.11, 95% CI = 1.04-1.20). Furthermore, in analysis stratified by cancer type, ethnicity, control source, quality score, and Hardy-Weinberg equilibrium (HWE) in controls, we found increased risk of cancer among lung cancer, bladder cancer, breast cancer, colorectal cancer, other cancers, Asians, hospital-based subgroup, score > 9 group, as well as controls agreement with HWE group. Despite some limitations, the current meta-analysis represented the largest and the most comprehensive investigations, with the strongest conclusion than ever before. To further explicit the association between TERT rs2736098 and cancer risk, more well-design case-control studies with larger sample size are warranted in the future.

PMID: 29221218 [PubMed]

Pitfalls in Graft Survival Analysis.

Sat, 12/09/2017 - 13:45

Pitfalls in Graft Survival Analysis.

HLA. 2017 Dec 08;:

Authors: Unterrainer C, Döhler B, Süsal C

Abstract
The reliability of a scientific work depends on the accuracy of the analysis. Scientific publications in the field of kidney transplantation still contain methodical errors that may lead to wrong conclusions and result in severe consequences for the patients. Using the data from the Collaborative Transplant Study, we are presenting in this article six examples of the erroneous usage of statistical methods and demonstrate how these mistakes can be avoided.

PMID: 29220104 [PubMed - as supplied by publisher]

Benefits of multimodal enhanced recovery pathway in patients undergoing kidney transplantation.

Sat, 12/09/2017 - 13:45

Benefits of multimodal enhanced recovery pathway in patients undergoing kidney transplantation.

Clin Transplant. 2017 Dec 08;:

Authors: Espino KA, Narvaez JRF, Ott MC, Kayler LK

Abstract
BACKGROUND: Use of Enhanced recovery after surgery (ERAS) pathways to accelerate functional recovery and reduce length of stay (LOS) has rarely been investigated in kidney transplantation (KTX).
MATERIALS AND METHODS: Consecutive adult isolated KTXs between 7/2015-7/2016 (ERAS, n=139) were compared with a historical cohort between 1/2014-7/2015 (HISTORIC, n=95).
RESULTS: ERAS recipients were significantly more likely to receive kidneys that were non-local (56.1% vs. 4.2%), higher Kidney Donor Profile Index (36-85, 58.4% vs. 45.2%; >85, 15.2% vs. 10.7%), cold ischemia time ≥30h (62.4% vs. 4.7%), induced with antithymocyte globulin (97.1% vs. 87.4%), and to develop delayed graft function (46.4% vs. 25.0%). LOS was shorter by 1 day amongst ERAS (mean 4.59) compared to HISTORIC patients (mean 5.65) predominantly due to a shift in discharges within 3 days (32.4% vs. 4.2%). 30-day readmission to the hospital (27.3% vs. 27.4%) or emergency room visit (9.4% vs. 7.4%) were similar. There was one 30-day death in the ERAS group and none in the HISTORIC group. Return to bowel function and early meal consumption were significantly associated with ERAS; however, with somewhat higher diarrhea and emesis rates.
CONCLUSION: ERAS following KTX correlated with lower LOS without change in readmissions or ER visits despite higher delayed graft function rates. This article is protected by copyright. All rights reserved.

PMID: 29220082 [PubMed - as supplied by publisher]

Hepatitis C Virus Genotyping of Organ Donor Samples to Aid in Transplantation of HCV-positive Organs.

Sat, 12/09/2017 - 13:45

Hepatitis C Virus Genotyping of Organ Donor Samples to Aid in Transplantation of HCV-positive Organs.

Clin Transplant. 2017 Dec 08;:

Authors: Gentile C, Van Deerlin VM, Goldberg DS, Reese PP, Hasz RD, Abt P, Blumberg E, Farooqi MS

Abstract
Given the availability of new highly efficacious anti-HCV therapies, some clinicians have advocated for wider use of kidneys from hepatitis C virus-positive (HCV+) donors, including transplanting them into HCV-negative recipients. Since treatment regimens for HCV are commonly guided by genotype, pre-transplant HCV genotyping of tissue donors would be beneficial. To our knowledge, donor HCV genotyping has never been reported. We retrieved archived frozen plasma samples for 17 previous organ donors through a local organ procurement organization. We performed HCV genotyping using the eSensor HCVg Direct Test (GenMark Diagnostics) and also by Sanger sequencing, for confirmation (Retrogen). In addition, viral loads were measured using the COBAS AmpliPrep/TaqMan system (Roche Diagnostics). We found that most of the samples (n=14) were HCV Genotype 1a with the remainder being Genotype 2b (n=1) or Genotype 3 (n=2). All genotyping results were concordant with Sanger sequencing. The average HCV viral load in the sample group was ~ 1.6 million IU/mL (range: ~16,000 IU/mL to 7 million IU/mL). We demonstrate that viral RNA from organ donor plasma can be successfully genotyped for HCV. This ability suggests that transplantation of HCV+ kidneys into HCV-negative recipients, followed by genotype-guided antiviral therapy, could be feasible. This article is protected by copyright. All rights reserved.

PMID: 29220079 [PubMed - as supplied by publisher]

Female urothelial cell carcinoma in a failed kidney graft of a male recipient.

Sat, 12/09/2017 - 13:45

Female urothelial cell carcinoma in a failed kidney graft of a male recipient.

Neth J Med. 2017 Oct;75(8):354-356

Authors: de Jongh HJJ, van Duijnhoven EM, Rüland A, Abdul Hamid MMA, Speel EJM, van de Beek K

Abstract
We present a case of a male kidney transplant patient harbouring two kidney grafts of which one is functional. In the failed graft, he developed urothelial cell carcinoma with cells containing XX-chromosome, and female tumour cells were also found in the bladder. The patient underwent donor nephrectomy, was treated with epirubicin bladder instillations, and immunosuppression was tapered. Less than a year before re-transplantation a CT scan showed no abnormalities of the first graft. Transplantectomy before a second kidney transplantation is debated.

PMID: 29219831 [PubMed - in process]

[Platelet function tests: tailored antiplatelet therapy for vascular patients?]

Sat, 12/09/2017 - 13:45

[Platelet function tests: tailored antiplatelet therapy for vascular patients?]

Ned Tijdschr Geneeskd. 2017;161(0):D1700

Authors: Brand ART, Korporaal SJA, Urbanus RT, Pasterkamp G, de Borst GJ

Abstract
- Platelet aggregation inhibitors, also known as antiplatelet therapy (APT), are prescribed for the prevention of secondary cardiovascular events (CVE) after endovascular revascularization procedures.- Platelet aggregation inhibitors are not equally effective in all patients. The phenomenon of high residual platelet reactivity despite APT is called 'high on-treatment platelet reactivity' (HTPR); it bears an increased risk of secondary CVE.- Platelet function tests (PFT) can be used to diagnose HTPR. There are various tests available; of those, light transmission aggregometry (LTA) is considered the gold standard. Some tests are only suitable for determining the effect of a certain category of APT.- Research into the usefulness of PFTs to optimise treatment with APT has not yet produced an unambiguous conclusion.- Currently there is not yet an indication for routine use of PFT in clinical practice. However, for the treatment of certain categories of patients with thromboembolic disease - such as those with renal failure or a history of kidney transplant - PFT can be considered.

PMID: 29219795 [PubMed - in process]

Effects of the Vitamin D Analog 2AMD in Cyclosporine-Induced Nephrotoxicity: Dose-Response and Antifibrotic Activity.

Sat, 12/09/2017 - 13:45

Effects of the Vitamin D Analog 2AMD in Cyclosporine-Induced Nephrotoxicity: Dose-Response and Antifibrotic Activity.

Exp Clin Transplant. 2017 Dec;15(6):641-647

Authors: Tomasini-Johansson B, O'Brien C, Larson-Osborne A, Toraason I, Hullett D, Plum L, DeLuca H, Sollinger H

Abstract
OBJECTIVES: In this study, we aimed to ascertain the efficacy and determine the dose effects of a new analog of vitamin D, 2α-methyl-19-nor-(20S)-1α,25-dihydroxyvitamin D3 (2AMD), in decreasing fibrosis and improving renal function in a rat model of kidney disease.
MATERIALS AND METHODS: Using the cyclosporine model of chronic kidney disease, we tested 4 dose regimens (2.5, 5, 10, and 20 ng/kg) of 2AMD by subcutaneous administration. The 2AMD analog was compared with another analog, 2-methylene-19-nor-(20S)-1α,25-dihydroxyvitamin D3 (2MD), given at 5 ng/kg.
RESULTS: After 28 days of cyclosporine administration with 5 ng/kg 2AMD or 2MD, blood urea nitrogen levels were decreased by 20% and 30%, with no increase in serum calcium. This dose significantly decreased collagen levels by 50%, as determined by relative measurements of birefringence elicited under polarized light following picrosirius red staining of kidney tissues. The 20 ng/kg dose of 2AMD was hypercalcemic, with consequent deleterious effects on measured parameters; however, all doses of 2AMD tested decreased collagen as determined by picrosirius staining. In Western blot analysis of extracts from rat kidneys treated with cyclosporine and 5 ng/kg 2AMD, the fibrotic markers, fibronectin and vimentin, were decreased compared with animals treated only with cyclosporine.
CONCLUSIONS: We found that both vitamin D analogs are potent inhibitors of kidney fibrosis with potential renoprotective activity.

PMID: 29219791 [PubMed - in process]

Hepatitis C Virus Infection in Kidney Transplant Patients: Current Treatment Options.

Sat, 12/09/2017 - 13:45

Hepatitis C Virus Infection in Kidney Transplant Patients: Current Treatment Options.

Exp Clin Transplant. 2017 Dec;15(6):587-593

Authors: Dzekova-Vidimliski P, Sikole A

Abstract
Hepatitis C virus infection is highly prevalent among kidney transplant recipients, occurring consequently to their previous treatment with hemodialysis. Hepatitis C virus infection has been associated with lower graft and patient survival compared with that shown in patients without infection. The lower survival has been associated with the posttransplant progression of liver disease and increased risk for development of extrahepatic complications. The choice of immunosuppressive drugs could significantly affect the course of the infection with an accelerated viral replication after kidney transplant. Eradicating hepatitis C virus infection with antiviral treatment is imperative to increasing graft and patient survival after transplant. Antiviral treatment options include standard interferon-based therapy and new directacting antiviral agents. Interferon-based treatment is rarely used in kidney transplant recipients because it has been associated with high risk of interferoninduced acute graft rejection. Several novel studies have shown that the new direct-acting antiviral agents are highly efficacious for treatment of hepatitis C infection in kidney transplant patients.

PMID: 29219790 [PubMed - in process]

Organ donation in India: Scarcity in abundance.

Sat, 12/09/2017 - 13:45

Organ donation in India: Scarcity in abundance.

Indian J Public Health. 2017 Oct-Dec;61(4):299-301

Authors: Sachdeva S

Abstract
In modern era, India witnessed its first successful corneal, kidney and cardiac transplant in the year 1960, 1967 and 1994 though the reverberations for organ donation and transplantation (ODT) existed since time-memorial with roots existing in Hindu mythology along with vivid example of Guru Dadheech and lord Ganesha. No country in the world is able to meets its organ requirement. Government of India promulgated Transplantation of Human Organ and Tissues Act in 1994 and with the view to enlarge its scope and promote organ donation government has brought new amendments as of year 2014 and 2017. In the background of this journey many new developmental milestones have been achieved in the country however organ donation which has assumed public health significance has been consistently lower than expectations. This manuscript highlights the current status of ODT in the country; legislative environment, limitations, challenges, health education activities, and newer initiatives.

PMID: 29219138 [PubMed - in process]

The psychiatry-integrated nurse practitioner role in hemodialysis: An opportunity to provide nurse practitioner care between the interface of psychiatry and hemodialysis.

Sat, 12/09/2017 - 13:45

The psychiatry-integrated nurse practitioner role in hemodialysis: An opportunity to provide nurse practitioner care between the interface of psychiatry and hemodialysis.

CANNT J. 2017 Jan-Mar;27(1):13-8

Authors: Cooper B, Dang K, Jones A, Thomas A

Abstract
The mental health of patients living with end-stage kidney disease (ESKD) is an important aspect of their care. According to national survey data, depressive disorders affect about 9% of the North American population (Kessler, Chiu, Demler, Merikangas, & Walters, 2005). A review of psychological distress and depression across the spectrum of chronic kidney disease indicates that the prevalence of depression in ESKD is reported to be about four times that of the general population and it is associated with adverse outcomes including low quality-of-life ratings, graft failure, and death after renal transplantation (Zalai, Szeifert, & Novak, 2012). At St. Michael’s Hospital (SMH), patients on hemodialysis (HD) requiring psychiatry consultation had traditionally been referred to a dedicated outpatient psychiatrist. This presented challenges around access to psychiatry assessment and follow-up, as patients were reluctant to attend appointments outside of HD visits. The team recognized these challenges and addressed them through the introduction of the Medical Psychiatry NP (MP NP) role, as the point-of-care consultant in HD.

PMID: 29218968 [PubMed - in process]

A systematic review of immunosuppressant adherence interventions in transplant recipients: Decoding the streetlight effect.

Sat, 12/09/2017 - 13:45
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A systematic review of immunosuppressant adherence interventions in transplant recipients: Decoding the streetlight effect.

Pediatr Transplant. 2017 Dec 07;:

Authors: Duncan S, Annunziato RA, Dunphy C, LaPointe Rudow D, Shneider BL, Shemesh E

Abstract
Non-adherence to immunosuppressant medications is an important risk factor for graft dysfunction. To evaluate the effectiveness of adherence-enhancing interventions, we reviewed adherence intervention studies in solid organ transplant recipients (all ages). Using the following databases: PsycINFO, PubMed, Scopus, and ScienceDirect, we identified 41 eligible studies. Only three non-randomized trials showed a possible positive effect on objective indicators of transplant outcomes (such as rejection, liver enzyme levels, kidney function). None of the 21 RCTs showed an improvement in transplant outcomes. Three studies showed a higher rate of adverse events in the intervention group as compared with controls, although this may be related to ascertainment bias. Improvement in adherence as measured indirectly (eg, with electronic monitoring devices) was not aligned with effects on transplant outcomes. We conclude that adherence interventions, to date, have largely been ineffective in improving transplant outcomes. To improve this track record, intervention efforts may wish to concentrate on non-adherent patients (rather than use convenience sampling, which excludes many of the patients who need the intervention), use direct measures of adherence to guide the interventions, and employ strategies that are intensive and yet engaging enough to ensure that non-adherent patients are able to participate.

PMID: 29218760 [PubMed - as supplied by publisher]

Transition from laparoscopic to retroperitoneoscopic approach for live donor nephrectomy.

Sat, 12/09/2017 - 13:45
Related Articles

Transition from laparoscopic to retroperitoneoscopic approach for live donor nephrectomy.

Surg Endosc. 2017 Dec 07;:

Authors: Ng ZQ, Musk G, Rea A, He B

Abstract
BACKGROUND: Laparoscopic donor nephrectomy has become the standard of care due to multiple benefits. Currently, there are various techniques employed with two different approaches: transperitoneal (TLDN) or retroperitoneoscopic (RLDN) approach. There is a lack of data to determine which technique is superior, although the RLDN offers an anatomical advantage by avoidance of manipulation of the intraperitoneal organs. The aims of this study were to explore the merits of RLDN to TLDN and assess the learning curve of transition from TLDN to RLDN.
METHODS: From January 2010 to February 2017, 106 live donor nephrectomies were performed: 56 by TLDN and 50 by RLDN. Data on patient demographics, perioperative parameters, analgesic consumption, pain scores, and kidney graft function were collected and analysed. Data were compared with a Student's t test or Mann-Whitney test. A CUSUM analysis was performed to investigate the learning curve.
RESULTS: All live donor nephrectomies were successful with no conversion to open surgery. There was no blood transfusion, readmission, or mortality. No postoperative complications were graded over Clavien II. Kidney function was comparable in both groups. The follow-up period ranged from 3 to 78 months.
CONCLUSION: Retroperitoneoscopic live donor nephrectomy is a safe approach with comparable results to TLDN. RLDN has an anatomical advantage as it avoids manipulating the intraperitoneal organs and retains a virgin abdomen and hence translates to a lower perioperative complication risk.

PMID: 29218666 [PubMed - as supplied by publisher]

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