Factors associated with the quality of life of living kidney donors in Korea: A cross-sectional study.

This study investigated the relationship between self-determination, physical health status, and Health related Quality of Life (=HRQoL) among living kidney donors. A descriptive survey was conducted between 2019 and 2020 and included 111 kidney donors. Data were collected using a self-report questionnaire on general and donation-related characteristics, self-determination, and HRQoL. The data also included medical records reflecting the physical health status at the time of the survey. Data were analyzed using a multiple regression model. Factors associated with HRQoL were perceived health recovery after donation (ß = 0.42, P < .001), up to 1 year since donation (ß = 0.33, P = .008), more than 1 up to 5 years since donation (ß = 0.52, P < .001), more than 5 up to 10 years since donation (ß = 0.53, P < .001), and competence of self-determination (ß = 0.23, P = .033). The explanatory power of these variables was 43.3%. HRQoL of living kidney donors can be affected by subjective and psychological factors. Therefore, health care providers should help living kidney donors have high self-determination during pre and post donation and concentrate on the subjective and psychological factors as well as objective health status.

Barriers to the donation of living kidneys for kidney transplantation.

Since the waiting time for deceased donor kidney transplantation continues to increase, living donor kidney transplantation is an important treatment for end stage kidney disease patients. Barriers to living kidney donation have been rarely investigated despite a growing interest in the utilization of living donor transplantation and the satisfaction of donor safety. Here, we retrospectively analyzed 1658 potential donors and 1273 potential recipients who visited the Seoul National University Hospital for living kidney transplantation between 2010 and 2017 to study the causes of donation discontinuation. Among 1658 potential donors, 902 (54.4%) failed to donate kidneys. The average number of potential donors that received work-up was 1.30 ± 0.66 per recipient. Among living donor kidney transplant patients, 75.1% received kidneys after work-up of the first donor and 24.9% needed work-up of two or more donors. Donor-related factors (49.2%) were the most common causes of donation discontinuation, followed by immunologic or size mismatches between donors and recipients (25.4%) and recipient-related factors (16.2%). Interestingly, withdrawal of donation consent along with refusal by recipients or family were the commonest causes, suggesting the importance of non-biomedical aspects. The elucidation of the barriers to living kidney donation could ensure more efficient and safer living kidney donation.

Tacrolimus trough levels in kidney transplant recipients.

BACKGROUND: It is very important that kidney transplant recipients (KTRs) take immunosuppressive drugs to prevent graft rejection. This study aimed to identify the tacrolimus trough levels (TTL)-mean, TTL-standard deviation (SD), and TTL- coefficient of variation (CV) as well as factors affecting these values over a 2-year period in clinically stable patients > 5 years after kidney transplantation (KT). METHODS: This retrospective study analyzed data from 248 adult outpatients > 5 years after KT. Medical chart data, including TTL, graft rejection, and tacrolimus dose change during a 2-year period, between January 2017 and December 2018, were collected. Multivariable regression analyses were conducted to determine the factors influencing the TTL-mean, TTL-SD, and TTL-CV. RESULTS: The TTL-mean, TTL-SD, and TTL-CV were 6.00 ± 1.07 ng/mL, 1.51 ± 1.09 ng/mL, and 0.25 ± 0.14, respectively. The TTL-mean, TTL-SD, and TTL-CV did not differ according to sex, type of donor, retransplant, pretransplant kidney disease, body mass index, or posttransplant time; hence, they are stable in kidney transplant recipients > 5 years after KT. The higher the TTL-mean, the higher the TTL-SD. Age and the TTL-SD significantly predicted the TTL-mean (p < .001). Tacrolimus dose change and the TTL-mean significantly predicted the TTL-SD (p < .001). Tacrolimus dose change significantly predicted the TTL-CV (p = .008). CONCLUSION: In clinically stable KTRs, TTL-SD and TTL-CV change sensitively in relation to tacrolimus dose changes. Therefore, changes in TTL-SD and TTL-CV in stable KTRs with no tacrolimus dose change require medical interest and attention.

The immediate effects of rib cage joint mobilization and chest wall stretch on muscle tone and stiffness of respiratory muscles and chest expansion ability in patients with chronic stroke.

[Purpose] The main purpose of this study was to identify the impact of rib cage joint mobilization and chest wall stretch on respiratory muscle tone and stiffness and chest expansion in stroke patients and to compare the effects of both interventions. [Subjects and Methods] Subjects were randomly assigned to a rib cage joint mobilization group (n=15) or a chest wall stretch group (n=15). Respiratory muscle tone and stiffness were measured using a myotonometer, and the chest expansion was gauged using a measuring tape. [Results] A significant difference was found on comparing the respiratory muscle tone and stiffness on the affected and sound side before intervention. Although both groups showed an increase in respiratory muscle tone and stiffness after intervention, no significant difference was found. A significant increase in chest expansion was observed; however, no significant difference was observed in the variations between the groups. [Conclusion] This study suggests that rib cage joint mobilization and chest wall stretch exercises can be used to increase chest expansion potential and respiratory muscle tone in patients with chronic stroke.

Comparison of the effects of core stabilization and chest mobilization exercises on lung function and chest wall expansion in stroke patients.

[Purpose] The main purpose of this study was to compare the effects of core stabilization and chest mobilization exercises on pulmonary function and chest expansion in chronic stroke patients. [Subjects and Methods] Thirty stroke patients were randomly divided into two groups: a core stabilization exercise group (n=15) and a chest mobilization exercise group (n=15). Each exercise was performed 3 times per week for 30 minutes for 4 weeks, and pulmonary function and chest expansion when breathing were measured for both groups. [Results] There were significant increases in both forced vital capacity and forced expiratory volume in 1 second before and after intervention. Core stabilization exercise resulted in a significant increase in peak expiratory flow, and significant increases in upper and lower chest expansion were detected with chest mobilization exercise. However, no significant difference was revealed between the two groups. [Conclusion] This study suggested that both exercises were effective in some aspects of pulmonary function while core stabilization can help increase peak expiratory flow and chest mobilization can assist with chest expansion.

Effect of eye movements and proprioceptive neuromuscular facilitation on balance and head alignment in stroke patients with neglect syndrome.

[Purpose] The purpose of this study was to assess the effect of eye movements and proprioceptive neuromuscular facilitation (PNF) on patients with neglect syndrome. [Subjects and Methods] The subjects were randomly allocated to 2 groups: the eye movements (EM) group; and the PNF with eye movements (PEM) group. The program was conducted five times each week for 6 weeks. Balance (both static and dynamic) and head alignment (craniovertebral angle and cranial rotation angle) were measured before and after testing. [Results] In measurements of static balance, the EM group showed significant improvement in sway length and sway area when examined in the eyes-open condition, but not when examined in the eyes-closed condition. The PEM group showed significant improvement when examined under both conditions. In the assessment of dynamic balance, both groups showed significant improvement in measurements of sway areas. With respect to head alignment, there were no significant differences pre- and post-testing in either the craniovertebral angle or the cranial rotation angle in the EM group, but the PEM group showed significant differences in both measurements. [Conclusion] These results suggest that in stroke patients with neglect syndrome, PNF with eye movements, rather than eye movements alone, has a greater positive effect on balance and head alignment.