Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients: A Guidance Report and Clinical Checklist by the Consensus on Managing Modifiable Risk in Transplantation (COMMIT) Group.
In this article, the authors provide specific, practical recommendations, through the discussion of current evidence and best practice, for the management of modifiable risks in those kidney and liver transplant patients who have survived the first postoperative year.
Abstract:
Short-term patient and graft outcomes continue to improve after kidney and liver transplantation, with 1-year survival rates over 80%; however, improving longer-term outcomes remains a challenge. Improving the function of grafts and health of recipients would not only enhance quality and length of life, but would also reduce the need for retransplantation, and thus increase the number of organs available for transplant. The clinical transplant community needs to identify and manage those patient modifiable factors, to decrease the risk of graft failure, and improve longer-term outcomes.COMMIT was formed in 2015 and is composed of 20 leading kidney and liver transplant specialists from 9 countries across Europe. The group's remit is to provide expert guidance for the long-term management of kidney and liver transplant patients, with the aim of improving outcomes by minimizing modifiable risks associated with poor graft and patient survival posttransplant.The objective of this supplement is to provide specific, practical recommendations, through the discussion of current evidence and best practice, for the management of modifiable risks in those kidney and liver transplant patients who have survived the first postoperative year. In addition, the provision of a checklist increases the clinical utility and accessibility of these recommendations, by offering a systematic and efficient way to implement screening and monitoring of modifiable risks in the clinical setting.
TL;DR: An optimal care after kidney transplantation is crucial in order to maintain graft function as well as patient survival over the long term, and it is important to diagnose and treat infectious diseases particularly with opportunistic pathogens at an early time point.
TL;DR: In this paper , the authors analyzed the evolution of the causes of DWFG and the frequency of the types of cancer causing DWFG in kidney transplantation patients in Andalusia from 1984 to 2018.
TL;DR: Many efforts are being taken to overcome hurdles in the improvement in survival rates of long-term grafts, such as the development of new drugs, individualization of immunosuppression, and induction of immune tolerance.
TL;DR: Screening with the use of low-dose CT reduces mortality from lung cancer, as compared with the radiography group, and the rate of death from any cause was reduced.
TL;DR: In this paper, the authors investigated whether intensive therapy to target normal glycated hemoglobin levels would reduce cardiovascular events in patients with type 2 diabetes who had either established cardiovascular disease or additional cardiovascular risk factors.
TL;DR: A strategy of intensive glucose control, involving gliclazide (modified release) and other drugs as required, that lowered the glycated hemoglobin value to 6.5% yielded a 10% relative reduction in the combined outcome of major macrovascular and microvascular events, primarily as a consequence of a 21%relative reduction in nephropathy.
TL;DR: The use of intensive therapy to target normal glycated hemoglobin levels for 3.5 years increased mortality and did not significantly reduce major cardiovascular events and identify a previously unrecognized harm of intensive glucose lowering in high-risk patients with type 2 diabetes.
TL;DR: Two consensus methods commonly adopted in medical, nursing, and health services research--the Delphi process and the nominal group technique (also known as the expert panel)--are described, together with the most appropriate situations for using them.
Q1. What contributions have the authors mentioned in the paper "University of birmingham practical recommendations for long-term management of modifiable risks in kidney and liver transplant recipients" ?
The group ’ s remit is to provide expert guidance for the long-termmanagement of kidney and liver transplant patients, with the aim of improving outcomes by minimizing modifiable risks associated with poor graft and patient survival posttransplant. The objective of this supplement is to provide specific, practical recommendations, through the discussion of current evidence and best practice, for themanagement of modifiable risks in those kidney and liver transplant patients who have survived the first postoperative year.
Q2. What have the authors stated for future works in "University of birmingham practical recommendations for long-term management of modifiable risks in kidney and liver transplant recipients" ?
Although the future looks promising for the field of transplantation, recipients and HCPs must not lose sight of those factors that can be modified today, so leading to the best possible future outcomes for the recipients, and giving consolation to the donor family.
Q3. What are the factors that affect the long-term outcomes of a kidney transplant?
perioperative, and postoperative factorsmay impact long-term outcomes; these include donor and organ factors as well as logistic factors.
Q4. What is the risk factor for poor long-term graft survival?
Ischemia-reperfusion injury (IRI) is considered an unavoidable, but potentially modifiable, risk factor for poor long-term graft survival in solid organ transplantation.
Q5. What are the main factors that may interfere with the metabolism and elimination of tacrolimus?
In liver transplantation, graft dysfunction and/or biliary complications may interfere with metabolism and elimination of tacrolimus.
Q6. What is the effect of tacrolimus on trough concentrations?
The conversion from twice-daily to prolonged-release tacrolimus (capsules), both in kidney and liver transplant recipients, leads to lower blood trough concentrations and a reduced IPVof tacrolimus.
Q7. What are some of the risk factors that can be modified after a transplant?
8,9 However, some risk factors have the potential to be modified or mitigated posttransplantation to improve outcomes, including behavioral risk factors, such as medication adherence.
Q8. What is the cytolex ImmuKnow Cell Function Assay?
The Cylex ImmuKnow Cell Function Assay measures T-cell function by the release of adenosine triphosphate from CD4-positive lymphocytes in culture after a mitogenic stimulus.
Q9. What is the role of CNIs and steroids in the development of hypertension in kidney transplant?
CNIs and steroids play a major role in the development of hypertension in kidney transplant patients; therefore, modifications of immunosuppressive regimen may be considered for lowering BP in these patients.
Q10. What is the importance of maximizing long-term graft survival?
maximizing long-term graft survival and reducing the need for retransplantation is paramount, not only in improving outcomes for the recipients but also for those awaiting a graft.
Q11. What is the average blood concentration in the liver and kidney transplant recipients?
During subsequent maintenance therapy, blood concentrations have generally been in the range of 5-15 ng/mL in liver and kidney transplant recipients.
Q12. What is the reason for the large intrapatient and inter-subject exposure variability of tacrol?
the intrinsic pharmacokinetic and pharmacodynamic properties of tacrolimus, including erratic absorption, a variable first-pass effect, and unpredictable metabolism, may be responsible for its large intrapatient and inter-subject exposure variability.
Q13. What was considered to be the advantages of having a lower burden?
161 For liver transplantation, historically, it was considered that there might be advantages to having a lower immunosuppressive burden.
Q14. What is the reason for the increase in the use of CNI-based immunosuppressive?
Over the last 10 years, there has been a strong move in the renal transplant community to minimize CNI-based immunosuppressive regimens, largely based on reports of longterm nephrotoxicity.
Q15. What is the evidence to support the conclusion that generics are safe?
There appears to be insufficient evidence to provide reassurance that, in transplanted patients, generics are therapeutically equivalent to innovator immunosuppressants.