Seasonal variation of cytomegalovirus disease in kidney transplant recipients.

PURPOSE: Studies conducted in the northern United States found cytomegalovirus (CMV) disease after liver transplantation follows a seasonal pattern, with increased incidence in fall and winter. This has not been evaluated in kidney transplant recipients. Improved understanding of CMV seasonality may help guide use of preventative therapies. METHODS: We evaluated adult patients receiving a kidney transplant at our center in Wisconsin from January 1, 1995 to December 31, 2018. CMV event was defined as quantifiable viral replication with clinical signs or symptoms suspicious for CMV per current consensus recommendations. Seasons were divided as follows: winter (December-February), spring (March-May), summer (June-August), and fall (September-November). The primary objective was to evaluate the annual distribution of CMV disease and determine whether this differed by season. RESULTS: There were 6151 kidney transplants in the study period. A total of 913 patients had 1492 episodes of CMV. Median time from transplant to first detection was 5.51 months (interquartile range [IQR] 2.87-11.7). The observed overall incidence exceeded the expected incidence in winter (+.7%), spring (+5.5%), and fall (+3.4%) and was less than expected in summer (-9.5%) (p = .18). The incidence of CMV during summer, however, was 21% less than expected (p = .001) in recipients who were CMV positive (R+) at the time of transplantation. No such difference was observed in CMV negative recipients (R-; p = .58). CONCLUSION: CMV after kidney transplant appears to be less common during the summer season in patients who were R+ at transplant but does not follow seasonal variation in R-. Reasons for this are unclear but are likely related to CMV-specific cell-mediated immunity. These findings may have clinical implications, particularly the use of non-pharmacologic strategies to improve response to antiviral therapy.

Fitness support group for organ transplant recipients: self-management, self-efficacy and health status.

TITLE: Fitness support group for organ transplant recipients: self-management, self-efficacy and health status. AIM: This paper is a report of a study conducted to describe postoperative self-management behaviours, perceived self-efficacy and health outcomes in adult organ transplant recipients who participated in a fitness support group. BACKGROUND: Self-management behaviours designed to promote patient autonomy contribute to positive health outcomes after therapeutic interventions. Despite an increase in organ transplantation, little is known about the impact of self-management on health outcomes after adult organ transplantation. Even less has been investigated regarding nursing interventions in the organ transplantation patient demographic to promote positive outcomes. METHOD: Using a cross-sectional descriptive design, 20 participants completed a questionnaire that included measures of self-management, self-efficacy and health status during the 2006 training season. FINDINGS: Participants were, on average, 55 years of age and 6 years since transplantation. Their results were compared to mean values as reported in the literature, and revealed consistently superior scores for the outcome variables. The mean amount of weekly aerobic exercise in the transplant group was 3.2 hours (sd 1.4). Participants demonstrated impressively high amounts of self-efficacy. Confidence was inversely related to extent of illness interference in activities of daily life (r = -0.772, P = 0.01). Health status scores also exceeded the norms, with all participants reporting at least 'good' health. Seventeen participants reported zero emergency department visits in the last 6 months. Nursing interventions geared toward maximizing patient self-efficacy may improve health outcomes for adults after solid organ transplantation. CONCLUSION: Group participation in a fitness programme may support achievement of self-management activities and feelings of self-efficacy in maintaining disease management.