Effect of Immigration Status on Outcomes in Pediatric Kidney Transplant Recipients.

Kidney transplantation is the optimal treatment for children with end-stage renal disease. For children with undocumented immigration status, access to kidney transplantation is limited, and data on transplant outcomes in this population are scarce. The goal of the present retrospective single-center study was to compare outcomes after kidney transplantation in undocumented children with those of US citizen children. Undocumented residency status was identified in 48 (17%) of 289 children who received a kidney transplant between 1998 and 2010. In undocumented recipients, graft survival at 1 and 5 years posttransplantation was similar, and mean estimated glomerular filtration rate at 1 year was higher than that in recipients who were citizens. The risk of allograft failure was lower in undocumented recipients relative to that in citizens at 5 years posttransplantation, after adjustment for patient age, donor age, donor type, and HLA mismatch (p < 0.04). In contrast, nearly one in five undocumented recipients who reached 21 years of age lost their graft, primarily because they were unable to pay for immunosuppressive medications once their state-funded insurance had ended. These findings support the ongoing need for immigration policies for the undocumented that facilitate access to work-permits and employment-related insurance for this disadvantaged group.

Combined pancreatic islet and kidney transplantation in a child with unstable type 1 diabetes and end-stage renal disease.

Islet transplantation after successful kidney transplantation is a recognized treatment for adults with diabetes and end-stage renal disease (ESRD), but has not been considered an option in the pediatric population. To our knowledge, we report the first combined islet and kidney transplant in a child. The patient was born with bilateral renal hypoplasia and was diagnosed with type 1 diabetes mellitus at age 13 months. He had erratic glycemic control and hypoglycemia unawareness. At 6 years of age, the child safely underwent simultaneous islet and live donor kidney transplantation. Although function of the islet graft was transient, the combined transplant provided significant benefits in terms of glucose control and overall growth and development. Such an approach represents a viable treatment option for pediatric patients with ESRD and unstable diabetes.

Establishing therapeutic boundaries as patient advocates.

Pediatric nurses often struggle to define their advocacy role with patients and their families. Nursing is based on the therapeutic use of self and caring. An unclear therapeutic relationship can undermine nurses' advocacy efforts. Nurses are encouraged but often not guided about staying within the parameters that define a professional and therapeutic relationship between the nurses and the patient/family. Examining the impact of unclear boundaries on the patient/family relationship and the nurse's ability to serve as an advocate provides the basis for suggested constructive strategies for addressing the related issues.

Utilizing volunteer research assistants in epidemiologic studies.

Utilizing volunteers in research-assistant roles can provide a new model for extending research dollars in epidemiologic studies of the elderly. This is increasingly important with a rapidly growing older population suffering from an increasing prevalence of disability, disease, and the related medical costs. During a two-year cross-sectional study of factors that predict health aging conducted by the Buck Center for Research in Aging in Marin County, California, 82 volunteers were recruited and trained to fill roles often held by paid research assistants. The key activities of telephone screening, interviewing, coding, and data entry were successfully completed by trained volunteers following standards and within a time frame comparable to similar studies. Volunteer research assistants contributed approximately 13,600 hours that resulted in a savings in personnel costs of over $100,000. Many of the people recruited and trained as volunteer research assistants were healthy older adults and retired workers. The project utilized their transferable skills and talents in an interesting and productive capacity.