Implications of Frailty for Peritransplant Outcomes in Kidney Transplant Recipients

AbstractPurpose of ReviewResearch over the past few decades points to the importance of frailty, or the lack of physiologic reserve, in the natural history of chronic diseases and in modifying the impact of potential interventions. End-stage kidney disease (ESKD) and the intervention of kidney transplantation are no exception. We review the recent epidemiologic and cohort-based evidence on the association between frailty and kidney transplant outcomes and provide a framework of questions with which to approach future research endeavors and clinical practice.Recent FindingsFrailty in kidney transplant candidates can be measured in numerous ways, including descriptive phenotype, description scores, functional testing, and surrogate measures. Regardless of the metric, the presence of frailty is strongly associated with inferior pre- and posttransplant outcomes compared with the absence of frailty. However, some frail patients with ESKD can benefit from transplant over chronic dialysis. Evidence-based approaches for identifying frail ESKD patients who can benefit from transplant over dialysis, with acceptable posttransplant outcomes, are lacking. Interventional trials to improve frailty and physical function before transplant (prehabilitation) and after transplant (rehabilitation) are also lacking.SummaryFrailty is increasingly recognized as highly relevant to peritransplant outcomes, but more work is needed to (1) tailor management to the unique needs of frail patients, both pre...
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research

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Sonia Mehrotra, Raj Kumar Sharma, Manas R PatelIndian Journal of Nephrology 2019 29(4):242-247 Vitamin-D has immuno-modulatory properties besides its role in mineral and bone disorder (MBD) and could have a role in allograft outcome. Fifty-two chronic kidney disease patients on dialysis going for transplantation were prospectively studied before and after renal transplantation. FGF23, 25(OH) vitamin D, 1,25-Dihydroxyvitamin D, PTH, serum Ca, serum PO4, and e-GFR status were evaluated. Vitamin D deficiency was seen in 25.0% of recipients before transplant (26.09 ± 12.19 ng/mL) and in 48.1% at 6 months post-tra...
Source: Indian Journal of Nephrology - Category: Urology & Nephrology Authors: Source Type: research
ConclusionThis study suggests that kidney transplantation is a better option over hemodialysis and peritoneal dialysis. We conclude that serious efforts ought to be made to foster potential brain-dead donors and altruistic kidney donation and promote peritoneal dialysis as a superior alternative to hemodialysis for eligible patients.
Source: Clinical Epidemiology and Global Health - Category: Epidemiology Source Type: research
This study developed a prediction tool for transition from PD to HD.Study DesignRetrospective cohort study.Setting &ParticipantsAdults initiating PD between January 2008 and December 2011, followed up through June 2015, for whom data were available in the US Renal Data System (USRDS).PredictorsClinical characteristics at PD initiation and peritonitis claims.OutcomesTransfer to HD, with the competing outcomes of death and kidney transplantation.Analytical ApproachOutcomes were ascertained from USRDS treatment history files. Subdistribution hazards (competing-risk) models were fit using clinical characteristics at PD ini...
Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Source Type: research
President Donald Trump on Wednesday signed an executive order aimed at streamlining the overburdened kidney care and transplantation system—a move meant to “bring new hope to millions of Americans suffering from kidney disease,” Trump said. The policy is intended to improve kidney care in three major ways: by emphasizing more effective and convenient treatments; making more kidneys available for transplant; and improving preventive care and education with the goal of reducing the number of people who develop end-stage renal disease by 25% by 2030. Kidney disease tends not to attract as much attention as o...
Source: TIME: Health - Category: Consumer Health News Authors: Tags: Uncategorized medicine onetime White House Source Type: news
Purpose of review The population of kidney transplant recipients with advanced chronic kidney disease is growing but their outcomes are poor and care is not standardized. There has been wide variety of research in recent years on different aspects of care in failing allografts, and these research findings may help the providers in optimizing care. The purpose of the review is to outline the challenges and opportunities in management of failing allograft, and provide tools for improvement. Recent findings This review summarizes the recent research in field of failing allograft including outcomes, immunosuppression, ris...
Source: Current Opinion in Organ Transplantation - Category: Surgery Tags: KIDNEY PANCREAS: Edited by Matthew Cooper Source Type: research
Pre-publication notice of proposed rule from the Centers for Medicare and Medicaid Services to implement two new mandatory Medicare payment models. The End-Stage Renal Disease (ESRD) Treatment Choices Model (ETC Model) is a mandatory payment model to encourage greater use of home dialysis and kidney transplants. The Radiation Oncology Model (RO Model) promotes quality and financial accountability for providers and suppliers of radiotherapy and tests whether making prospective episode payments to hospital outpatient departments and freestanding radiation therapy centers improves quality of care and reduces Medicare spending...
Source: Federal Register updates via the Rural Assistance Center - Category: Rural Health Source Type: news
GRAFTON (CBS) – President Donald Trump singed an executive order Wednesday, revamping the whole approach to treating kidney disease in this country. And a 19-year-old from Grafton is among the 30 million Americans who could benefit. “I just try to keep busy,” said Samantha Cleveland, “so I don’t focus on why I feel so terrible.” Samantha still battles through chronic fatigue to ride her horse, but is well aware that thousands of people die every year waiting for a kidney. “I try not to think about it,” she said, “because right now I’m doing OK.” Samantha Cle...
Source: WBZ-TV - Breaking News, Weather and Sports for Boston, Worcester and New Hampshire - Category: Consumer Health News Authors: Tags: Boston News Health Syndicated Local Donald Trump Grafton News Ken MacLeod kidney donor Source Type: news
by Craig Klugman, Ph.D. Few people would say that the system of payment and organ distribution is perfect. About 37 million Americans suffer from kidney disease and 94,831 are candidates (as of July 10, 2019) for kidney transplant. In 2018, 21,167 kidney transplants and 836 combined kidney/pancreas transplants were performed in the U.S. Many ESRD patients (468,000) receive dialysis treatment, usually in privately owned clinics, while 193,000 have received a transplant. The system of distribution of kidneys was changed a year ago, when the system sought to increase the number of successful transplants by decreasing the amou...
Source: blog.bioethics.net - Category: Medical Ethics Authors: Tags: Clinical Trials & Studies Featured Posts Health Care Health Regulation & Law HIV/AIDS Informed Consent Organ Transplant & Donation Privacy Public Health Source Type: blogs
At Massachusetts General Hospital, we pioneered simultaneous hematopoietic cell (HCT)/kidney transplantation from HLA-identical related donors for the treatment of hematological malignancies with end-stage renal failure. We have now extended this to HLA-haploidentical donors in a pilot trial. Six recipients, 5 of whom were conditioned with fludarabine, cyclophosphamide, and total-body irradiation, underwent combined HCT/kidney transplantation from haploidentical donors; graft-versus-host disease (GVHD) prophylaxis included post-HCT cyclophosphamide, tacrolimus, and mycophenolate mofetil. One patient died as a result of com...
Source: Blood - Category: Hematology Authors: Tags: Transplantation, Brief Reports Source Type: research
The administration set ambitious goals to move people out of traditional dialysis and to encourage organ donations.
Source: NYT - Category: American Health Authors: Tags: Kidneys Transplants Dialysis Presidential Election of 2020 Health and Human Services Department Azar, Alex M II Trump, Donald J your-feed-healthcare Source Type: news
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