Glennalmeida5191

Background Consider a theoretical situation in which 2 patients with similar baseline characteristics receive a kidney transplant on the same day 1 from a standard criteria deceased donor, the other from a living donor. Which kidney transplant will last longer? Methods We conducted a population-based cohort study using linked administrative healthcare databases from Ontario, Canada from January 1, 2005 to March 31, 2014 to evaluate several posttransplant outcomes in individuals who received a kidney transplant from a standard criteria deceased donor (n=1523) or from a living donor (n=1373). We used propensity-score weighting using overlap weights, a novel weighting method that emphasizes the population of recipients with the most overlap in baseline characteristics. Results Compared to recipients of a living donor, the rate of all-cause graft failure was not statistically higher for recipients of a standard criteria deceased donor (hazard ratio 1.1, 95% confidence interval [CI] 0.8, 1.6). Recipients of a standard criteria deceased donor, compared to recipients of a living donor had a higher rate of delayed graft function (23.6% vs. 18.7%, odds ratio 1.3, 95% CI 1.0, 1.6) and a longer length of stay for the kidney transplant surgery (mean difference 1.7 days, 95% CI 0.5, 3.0). Conclusion After accounting for many important donor and recipient factors, we failed to observe a large difference in the risk of all-cause graft failure for recipients of a standard criteria deceased versus living donor. Some estimates were imprecise which meant we could not rule out the presence of smaller clinically important effects.Background The novel coronavirus SARS-CoV-2 (COVID-19) poses unique challenges for immunosuppressed patients. Solid organ transplant recipients (SOT) comprise a large proportion of this group, yet there is limited knowledge about the presentation, clinical course and immunosuppression management of this novel infection among heart, lung, liver, pancreas and kidney transplant recipients. Methods We present 21 SOT diagnosed with COVID-19 between January 1, 2020 - April 22, 2020 at a US high-volume transplant center. Diagnostic workup, clinical course, immunosuppression/antiviral management and immediate outcomes are described. Results Twenty-one (15.9%) of 132 symptomatic patients tested were positive. Mean age at diagnosis was 54.8 ± 10.9 years. Median time from transplant was 5.58 years (IQR 2.25, 7.33). Median follow-up was 18 days (IQR 13, 30). Fourteen patients required inpatient management, with 7 (50%) placed in the intensive care unit (ICU). All transplant types were represented. Nearly 43% exhibited GI symptoms. Over half (56.2%) presented with elevated serum creatinine suggestive of acute kidney injury. The majority of patients (5/7) with concomitant infections at baseline required the ICU. Eighty-percent received hydroxychloroquine ± azithromycin. Ten received toclizumab and/or ribavirin; 1 received remdesivir. Antimetabolites ± calcineurin inhibitors were held or reduced. Ipatasertib cell line Over half of hospitalized patients (8/14) were discharged home. Only 1 mortality (4.8%) to date, in a critically-ill heart/kidney patient who had been in the ICU prior to diagnosis. Conclusion COVID-19 positive SOT at our institution had favorable short-term outcomes. Those with concomitant infections had more severe illness. More data will be available to evaluate long-term outcomes and disease impact on graft function.Background Mycophenolic acid (MPA) is a standard immunosuppressant in organ transplantation. A simple monitoring biomarker for MPA treatment has not been established so far. Here, we describe inosine 5'-monophosphate dehydrogenase (IMPDH) monitoring in erythrocytes and its application to kidney allograft recipients. Methods IMPDH activity measurements were performed using a high-performance liquid chromatography assay. Based on 4203 IMPDH measurements from 1021 patients we retrospectively explored the dynamics early after treatment start. In addition, we analyzed the influence of clinically relevant variables on IMPDH activity in a multivariate model using data from 711 stable patients. Associations between IMPDH activity and clinical events were evaluated in hospitalized patients. Results We found that IMPDH activity reflects MPA exposure after 8 weeks of constant dosing. In addition to dosage, body mass index, renal function and coimmunosuppression affected IMPDH activity. Significantly lower IMPDH activities were found in patients with biopsy-proven acute rejection as compared to patients without rejection (median [IQR] 696 [358-1484] versus 1265 [867-1618] pmol XMP/h/mg haemoglobin, P less then 0.001). The highest IMPDH activities were observed in hospitalized patients with clinically evident MPA toxicity as compared to patients with hospitalization not related to MPA treatment (1548 [1021-2270] vs. 1072 [707-1439] pmol XMP/h/mg haemoglobin; P less then 0.001). Receiver operating characteristic curve analyses underlined the usefulness of IMPDH to predict rejection episodes (area 0.662; CI 0.584-0.740; P less then 0.001) and MPA-associated adverse events (area 0.632; CI 0.581-0.683; P less then 0.001), respectively. Conclusion IMPDH measurement in erythrocytes is a novel and useful strategy for the longitudinal monitoring of MPA treatment.Purpose Being swamped is defined as "when you are so overwhelmed with what is occurring that you are unable to focus on the most important thing." The purpose of this study was to explore the experience of being swamped in the clinical setting among nurses who are members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the relationship of the level of being swamped to adherence to the AWHONN (2010) nurse staffing guidelines. Study design and methods A 25-item survey was sent to ~21,000 AWHONN members by email in the Fall of 2018. It was completed by 1,198 members, representing 49 states and the District of Columbia. Questions explored timing and causes of being swamped, its effect on health care team members and patients, what helps when a nurse feels swamped, and nurses' reports of their hospital following the AWHONN nurse staffing guidelines. Results Twenty-eight percent of nurses reported being swamped daily or multiple times per day. Situations that contribute to being swamped include assignments that are too heavy, interruptions, critical patient situations, and mistakes made by others that nurses are expected to catch and fix.