Prerenal Transplant Education and Evaluation Positively Impacts Outcomes.

Autor:	Jesse MT; Henry Ford Transplant Institute, Detroit, MI, USA.; Consultation-Liaison Psychiatry, Behavioral Health, 2971Henry Ford Health System, Detroit, MI, USA.; Center for Health Policy & Health Services Research, 2971Henry Ford Health System, Detroit, MI, USA.; Department of Psychiatry & Behavioral Neurosciences, Wayne State School of Medicine, Detroit, MI, USA., Clifton E; Department of Psychiatry, 1259University of Michigan, Ann Arbor, MI, USA., Kim DY; Henry Ford Transplant Institute, Detroit, MI, USA.; Transplant Services, Children's Hospital of Michigan, Detroit, MI, USA.; Department of Surgery, Wayne State School of Medicine, Detroit, MI, USA., Nicholson D; Henry Ford Transplant Institute, Detroit, MI, USA., Patil R; Henry Ford Transplant Institute, Detroit, MI, USA., Bhavsar S; Henry Ford Transplant Institute, Detroit, MI, USA., Desai S; Henry Ford Transplant Institute, Detroit, MI, USA., Gartrelle K; Henry Ford Transplant Institute, Detroit, MI, USA., Eshelman A; Henry Ford Transplant Institute, Detroit, MI, USA.; Consultation-Liaison Psychiatry, Behavioral Health, 2971Henry Ford Health System, Detroit, MI, USA., Fleagle E; Henry Ford Transplant Institute, Detroit, MI, USA.; Consultation-Liaison Psychiatry, Behavioral Health, 2971Henry Ford Health System, Detroit, MI, USA., Ahmedani B; Center for Health Policy & Health Services Research, 2971Henry Ford Health System, Detroit, MI, USA., Carlozzi NE; Department of Physical Medicine & Rehabilitation, 1259University of Michigan, Ann Arbor, MI, USA., Tang A; Public Health Sciences, 2971Henry Ford Health System, Detroit, MI, USA., Patel A; Henry Ford Transplant Institute, Detroit, MI, USA.; Nephrology, 2971Henry Ford Health System, Detroit, MI, USA.
Jazyk:	angličtina
Zdroj:	Progress in transplantation (Aliso Viejo, Calif.) [Prog Transplant] 2022 Mar; Vol. 32 (1), pp. 4-10. Date of Electronic Publication: 2021 Dec 03.
DOI:	10.1177/15269248211064888
Abstrakt:	Introduction: An outstanding question in kidney transplantation is how to prepare candidates and their social supports for optimal posttransplant outcomes. Project Aims: This program evaluation assessed whether a pretransplant quality improvement clinic improved clinical outcomes in the year posttransplant compared to recipients receiving standard of care. Design: The Countdown to Transplant Clinic was implemented with kidney transplant candidates expected to receive a transplant within the next few months. The clinic included an enhanced education session on posttransplant lifestyle management, confirmation of support (≥2 adults), and evaluations by transplant social work, psychology, and nephrology. Results: Seventy-five patients participated in the clinic and underwent a transplant. A retrospective chart review of posttransplant laboratory values, rehospitalizations (within 3-months posttransplant), biopsy-confirmed graft failure, and mortality (within 1-year posttransplant) were collected from both groups. Univariate and multivariate propensity score-weighted linear or logistic regression models were used to evaluate the association between clinic participation and outcomes. In models adjusting for relevant covariates, participation in The Countdown to Transplant Clinic (vs standard care) was associated with a lower coefficient of variation of serum tacrolimus (all values collected 3-12 months posttransplant), 30-day posttransplant white blood cell counts (but not 90-day), 90-day posttransplant potassium, and 30 and 31 to 90 days rehospitalizations. Clinic participation did not predict serum glucose levels at 30- or 90-days posttransplant. Due to low rates of rejection and mortality, meaningful comparisons were not possible. Conclusion: Participation in a pretransplant, multicomponent clinic may improve certain outcomes of interest posttransplantation. Pilot testing for feasibility for randomized controlled trials is a necessary next step.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu