Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant Research Procurement: A Translational Simulation Model
Conclusions: Essential to clinical face transplant outcomes is the preparedness of the institution, multidisciplinary face transplant team, organ procurement organization, and solid organ transplant colleagues. A translational facial research procurement and solid organ recovery model serves as an educational experience to modify processes and address procedural, anatomical, and logistical concerns for institutions developing a clinical face transplantation program. This methodical approach best simulates the stressors and challenges that can be expected during clinical face transplantation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
CONCLUSION: Long-term survival following EPS managed conservatively with nutritional support is feasible, with the majority no longer requiring nutritional support and having a quality of life similar to other patients with ESKD. PMID: 32067553 [PubMed - as supplied by publisher]
CONCLUSIONS: In this randomized controlled trial, we were unable to demonstrate that regular, targeted testing and retraining of new PD patients increased the time to first peritonitis or reduced the rate of peritonitis, as the study comprised patients with a low risk of peritonitis, was underpowered, open to type 1 statistical error, and contamination between groups. PMID: 32063220 [PubMed - as supplied by publisher]
Authors: Blake PG, Brown EA Abstract Person-centered care has become a dominant paradigm in modern health care. It needs to be applied to people with end-stage kidney disease considering the initiation of dialysis and to peritoneal dialysis (PD) prescription and care delivery. It is relevant to their decisions about goals of care, transplantation, palliative care, and discontinuation of dialysis. It is also relevant to decisions about how PD is delivered, including options such as incremental PD. Shared decision-making is the essence of this process and needs to become a standard principle of care. It requires enga...
Authors: Rangaswamy D, Guddattu V, Webster AC, Borlace M, Boudville N, Clayton P, Badve S, Johnson DW, Sud K Abstract BACKGROUND: Icodextrin is a high molecular weight, starch-derived glucose polymer that is used as an osmotic agent in peritoneal dialysis (PD) to promote ultrafiltration. There has been wide variation in its use across Australia and the rest of the world, but it is unclear whether these differences are due to patient- or centre-related factors. METHODS: Using the Australia and New Zealand Dialysis and Transplant Registry, all adult patients (>18 years) who started PD in Australia between 1 Ja...
CONCLUSIONS: Care teams need to offer opportunities to elicit patients' knowledge and fears, dispel myths, forge connections with other patients, and visit the dialysis unit before transition to alleviate anxiety. Interventions that facilitate a sense of control should be grounded in the meaning that the disorder has for the person and how it impacts their sense of self. PMID: 32063183 [PubMed - as supplied by publisher]
The prevalence of chronic kidney disease and its risk factors is increasing worldwide, and the rapid rise in global need for end-stage kidney disease care is a major challenge for health systems, particularly in low- and middle-income countries. Countries are responding to the challenge of end-stage kidney disease in different ways, with variable provision of the components of a kidney care strategy, including effective prevention, detection, conservative care, kidney transplantation, and an appropriate mix of dialysis modalities.
This article outlines the steps necessary to establish a national kidney transplant program, starting with the requirement for effective legislation that provides the legal framework for transplantation whilst protecting organ donors, their families, recipients, and staff and is an essential requirement to combat organ trafficking.
Achievement of equity in health requires development of a health system in which everyone has a fair opportunity to attain their full health potential. The current, large country-level variation in the reported incidence and prevalence of treated end-stage kidney disease indicates the existence of system-level inequities. Equitable implementation of kidney replacement therapy (KRT) programs must address issues of availability, affordability, and acceptability. The major structural factors that impact equity in KRT in different countries are the organization of health systems, overall health care spending, funding and deliv...
The articles in this edition of Kidney International Supplements describe the background, rationale, and action plans for developing a strategic approach to increase access to integrated end-stage kidney disease (ESKD) care worldwide over the next decade. It is estimated that the number of people dying globally with ESKD for want of kidney replacement therapy is up to 3 times the number who receive it.1 Kidney transplantation meets only a small fraction of this therapeutic need. Many patients with advanced kidney disease, whether receiving kidney replacement therapy or not, suffer considerably because they have no access to supportive care.
A 66-year-old obese Hispanic female with IgA nephropathy and a previous failed kidney transplant received a left kidney transplant 4 months ago. She was hospitalized for recurrent pyelonephritis. Serial non –contrasted computed tomography over the prior 4 weeks reported a persistent hematoma and focal fluid collection of unclear etiology at the surgical site of the transplant kidney. Brightness-mode ultrasound showed mild hydronephrosis, initially thought to be secondary to pyelonephritis. A percutan eous nephrostomy tube was placed without improvement in urine output.