International Journal of Organ Transplantation Medicine
Volume:10 Issue: 3, Summer 2019

Provider perceptions about patient candidacy for kidney transplant (KT) are potentially significant contributors to disparities in KT. To examine nephrologists’ perceptions about factors that are important in excluding patients from KT referral, and to analyze the association between these perceptions and nephrologists’ demographic and practice characteristics. Invitations were sent to 3180 nephrologists. Among those who consented, 822 fulfilled the inclusion criteria, and 250 were randomly invited to complete a questionnaire about perceptions of factors essential in deciding not to refer patients for KT. Responses from 216 participants with complete responses were analyzed. The 3 most common reasons for excluding patients were “patient’s inadequate social support” (44%), “limited understanding of the process due to patient’s inadequate education” (32%), and “patient’s age above 65” (26%). Nephrologists practicing in rural settings were more likely to consider inadequate support and limited education of patients as reasons not to refer for KT. In multivariate analysis, physicians with 2 or fewer transplant centers within 50 miles were more likely to report inadequate social support (OR: 3.15, 95% CI: 1.59–6.24) and age greater than 65 years (OR: 1.88, 95% CI: 1.01–3.49) as reasons to exclude patients from KT referral. Nephrologists whose practice included patients majority of whom had not completed high school were more likely to consider limited understanding due to inadequate education as an important reason to exclude patients from KT (OR: 3.31, 95% CI: 1.60–6.86). Patient’s social support, understanding, and age were the most common factors regarded by nephrologists as important in not referring patients for KT evaluation. Practice location, particularly rural setting, proximity to a transplant center, and the education level of a nephrologist’s patient population were important determinants of referral for KT.

Liver transplantation is the only treatment for end-stage and genetic liver diseases. The main burden of this treatment is the shortage of both living and cadaveric liver donors. An alternative treatment is using liver cell transplantation, which can be obtained from unused livers for transplantation. These hepatocytes should be kept ready in viable and functional situation in a frozen state to be instantly used when they would be needed. In our previous experience, we had isolated hepatocytes from unused livers. To find a preserving solution for increasing viability and function of the isolated hepatocytes that are stored to be transplanted. 9 cadaveric donor livers, which were not used for transplantation due to various causes such as severe steatosis, were selected to isolate hepatocytes. Various cold storage solutions were tried to find the best temperature for more viability and functionality for preservation of hepatocytes. University of Wisconsin (UW) solution and Williams E media were used as control media. 2 anti-apoptotic and antioxidative solutions, i.e., α-lipoic acid and ursodeoxycholic acid (UDCA), were used as cold preservatives solutions. The numbers of viable hepatocytes were estimated by trypan blue method; the functionality was assessed by the cells ability to produce urea. The highest number of viable and functional hepatocytes was obtained from freshly isolated cells. However, after preservation, the number of these viable hepatocytes and their functionality were not significantly different in cold storage solutions comparing to the control media used. Functionality of the isolated hepatocytes stored in UW with and without UCDA solution was similar to freshly isolated hepatocytes. Preservatives with anti-apoptotic and antioxidant activity could not increase the number of viable hepatocytes. Functionality of cold storing hepatocytes could be preserved similar to freshly isolated hepatocytes by UW solution with and without UCDA.

Non-adherence to medical care programs in transplant recipients is considered one of the life-threatening factors in transplant recipients, which can prevent achieving the desired levels of health care. To determine perceptions of liver transplant recipients about the barriers to their adherence to medical care programs. This study was conducted based on a qualitative content analysis method using semi-structured interviews with 23 liver transplant recipients, their families, and the transplant teams. A purposive sampling method was used in liver transplant clinics affiliated to Tehran University of Medical Sciences, Tehran, Iran, from May to November 2017. Three main categories including factors related to therapeutic problems (educational problems and medication challenges), personal factors (self-management disability), as well as social problems (cultural conditions and passive family) were identified as the barriers to adherence to medical care programs. Paying attention to barriers to adherence to medical care and planning for moderating them in a collaborative effort between transplant recipients and health care providers could increase the likelihood of survival and quality of life in these patients.

There is no treatment of choice for the management of acute antibody-mediated rejection (ABMR) in kidney transplant recipients. Plasmapheresis ± intravenous immunoglobulin (IVIg) ± rituximab has been used in different regimens with contradictory results. To compare three regimens of acute ABMR management including plasmapheresis + IVIg ± rituximab in two different rituximab regimens. In this prospective, observational study kidney transplant recipients with suspicious ABMR were categorized into three groups. Group 1 patients were treated with plasmapheresis + IVIg. Groups 2 and 3 received weekly rituximab at a dosage of 375 mg/m2 for either 4 doses (group 2 or high dose) or 2 doses (group 3 or low dose) in addition to plasmapheresis + IVIg. 8, 15, and 9 patients were categorized in groups 1, 2, and 3, respectively. There was no difference among the groups in terms of demographic and clinical characteristics of recipients and donors. Although, 1-year graft (37.5%, 60.0%, and 66.7% for groups 1, 2, and 3, respectively; p=0.308) and patients survival (75.0%, 86.7%, and 77.8% for groups 1, 2, and 3, respectively; p=0.730) were not significantly different among studied groups, graft survival was 22%–30% higher in rituximab-treated groups. Estimated glomerular filtration rate at 12th month of follow-up did not differ among groups (56.3±19.6, 57.3±20.6, 48.7±16.1 mL/min/1.73 m2 for groups 1, 2, and 3, respectively; p=0.683). However, kidney function steadily improved over time in rituximab-treated patients. Adding high or low doses of rituximab to plasmapheresis + IVIg comparably increased graft survival in suspicious acute ABMR kidney recipients and steadily improved kidney function among survived allografts over time.

New-onset diabetes after transplantation (NODAT) is a serious complication which runs the risk of infections, morbidity and mortality. To evaluate M235T and T174M polymorphisms of angiotensinogen gene along with some demographic and clinical factors including age; sex; body mass index (BMI); model for end-stage liver disease (MELD) score; prednisolone, mycophenolate mofetil and tacrolimus dose; and serum level in NODAT among liver recipients. In this study 115 patients (53 with and 62 without NODAT) who had no history of diabetes before the transplantation were investigated. Furthermore, 80 randomly selected apparently healthy people (no transplantation) were used as the control group. Two angiotensinogen polymorphisms (M235T and T174M) were studied using polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). Patients included 68 (59.1%) females and 47 (40.9%) males; they had a mean±SD age of 37.4±16.9 years. The M allele frequency was 55.7% (n=128) in M235T and 20.0% (n=46) in T174M polymorphisms. Binary logistic regression analysis confirmed that age (p=0.005), prednisolone dose (p<0.001) and mutated M235T polymorphism (p=0.003) were independent risk factors. Presence of M235T T allele may significantly (p<0.001) increase the NODAT risk, and increase the likelihood of developing end-stage liver disease (p=0.003). T174M T allele had a significantly (p=0.007) higher frequency in NODAT group.