Long-term care and nursing management of a patient who is the recipient of a renal transplant.

This is the final article in a three-part education series on renal transplantation, which addresses the specialist knowledge required in the long-term management of the people undergoing renal transplantation. The first article in this series (Murphy F., Trevitt R., Chamney M. et al. (2011). Patient health and well-being while waiting for renal transplantation: Part 1. Journal of Renal Care 37(4), 224-231) addressed patient health and well being while waiting for a renal transplant. The second article (Trevitt R., Dunsmore V., Murphy F., Piso L., Perriss C., Englebright B. & Chamney M. (2012) Pre- and post-transplant care: nursing management of the renal transplant recipient: Part 2. Journal of Renal Care 38(2), 107-114) examined pre- and post-operative care and management.

Pre- and post-transplant care: nursing management of the renal transplant recipient: part 2.

This is the second article in a three part continuing education series on renal transplantation which addresses the specialised knowledge and skills required in order to prepare a patient admitted to hospital for renal transplantation and then how to care for that patient afterwards. The first article in this series addressed patient health and well-being while waiting for a renal transplant. The third article will look at the long-term care of kidney recipients.

Patient health and well-being while waiting for renal transplantation: part I.

This is the first article in a series of three articles concerning renal transplantation. This first article will address the patient's health and well-being while waiting for renal transplantation and the role of the multidisciplinary team in the promoting of this. The subsequent articles will address pre- and post-renal transplant care and the long-term complications of renal transplantation.

Living kidney donors: the need to minimise long term risk.

Living kidney donor (LKD) transplantation is an important option for people with established renal disease and their families. Outcome data for donors shows that it is a relatively safe procedure. Long-term studies do not take into account the wider acceptance criteria currently employed, or the increasing number of ethnic minority donors. A literature review was carried out to look for evidence that the risk to donors should be reassessed in order to be able to inform donors better about those risks and whether they are modifiable. Strong evidence was found that LKD has good short-term outcomes; long-term evidence is incomplete in view of the selection criteria currently used for donors and lack of studies. LKD remains a low risk procedure and should continue to be encouraged. However, evaluation of donors should be more thorough with particular respect to any long-term risk of diabetes mellitus and other cardiovascular risk factors related to family or ethnic disposition and lifestyle. Long-term surveillance is essential to modify risk factors, allow early intervention and to further develop evaluation criteria.

BK virus nephropathy in renal transplant patients in London.

BACKGROUND: BK nephropathy (BKN) is an important cause of renal transplant dysfunction, believed to be associated with higher levels of immunosuppression. We assessed the experience of BKN in renal transplant patients in the London region. METHODS: All six London transplant centers participated and case notes of patients with BKN in 2004 to 2005 were reviewed. RESULTS: There were 17 cases of BKN, giving an incidence of 2.1%. Median time to diagnosis was 9 months. Median baseline creatinine rose from 150 to 196 mumol/L. At diagnosis, 16 patients were on tacrolimus, 15 on mycophenolate mofetil, and 10 on triple therapy with tacrolimus, mycophenolate mofetil, and prednisolone. Management of BKN involved reducing immunosuppression; cidofovir was used in two patients and methylprednisolone in five for acute rejection. Median follow-up time was 29.2 months. Creatinine returned to baseline in four patients, remained elevated in 12 and one patient lost his graft. The new median baseline creatinine was 216 mumol/L. Eight patients underwent repeat biopsies of which four became negative for BKV and three subsequently cleared the virus on blood and urine polymerase chain reaction and urine decoy cells. Overall, eight patients cleared the virus. None of age, sex, viral load, or biopsy characteristics (Banff ct score, Drachenberg grade, and number of BKV positive cells) were associated with poorer outcome when patients with increase in creatinine of less than 30% (n=7) or more than 30% (n=10) from baseline were compared. CONCLUSION: The incidence of BKN in this study is comparable with previous studies, with more favorable outcomes. It supports the association of BKN with potent immunosuppression.

Pretransplantation levels of C-reactive protein predict all-cause and cardiovascular mortality, but not graft outcome, in kidney transplant recipients.

BACKGROUND: Chronic inflammation, the common pathway that leads to cardiovascular disease and chronic allograft nephropathy after transplantation, is prevalent in patients with end-stage renal failure. We set out to investigate the hypothesis that enhanced pretransplantation C-reactive protein (CRP) levels and Chlamydia seropositivity, both markers of an altered immune response, would predict graft failure and mortality in patients receiving renal replacement therapy. METHODS: A retrospective study of 115 patients, based on CRP levels in pretransplantation serum (group 1, 0 to 5 mg/L; group 2, 5 to 10 mg/L; group 3, >10 mg/L), were investigated for the following end points: transplant rejection, graft failure, and all-cause and cardiovascular mortality. RESULTS: There were no correlations between CRP levels or Chlamydia seropositivity with respect to rejection rates or graft failure. Furthermore, there was no relationship between Chlamydia seropositivity and survival. All-cause and cardiovascular mortality were significantly greater in patients with CRP levels greater than 10 mg/L and 5 to 10 mg/L compared with those with CRP levels less than 5 mg/L. All-cause mortality rates were 5% in the 0-to-5-mg/L group, 20% in the 5-to-10-mg/L group, and 44% in the greater-than-10-mg/L group. With regard to cardiovascular mortality, death rates were 0% in the 0-to-5-mg/L group, 10% in the 5-to-10-mg/L group, and 22% in the greater-than-10-mg/L group. Univariate analysis of cardiovascular mortality and covariates showed a significant relationship with age (relative risk [RR], 1.07; P < 0.05), diabetes (RR, 5.6; P < 0.05), aspirin intake (RR, 0.2; P < 0.05), antihypertensive therapy (RR, 0.02; P < 0.05), and CRP level (RR, 11; P < 0.05), but CRP level remained the only significant predictor (RR, 1.19; P < 0.05) on multivariate analysis. CONCLUSION: Pretransplantation CRP level is independently associated with all-cause and cardiovascular mortality in our cohort of transplant recipients and may be a useful predictive marker in the follow-up of posttransplantation patients.