A Narrative Review of Qualitative Studies Describing Access to Kidney Transplantation.

BACKGROUND: This review used the Information-Motivation-Behavioral Skills (IMB) model of health behavior change to conceptualize the determinants of kidney transplant access behavior for adult patients with end-stage renal disease (ESRD). METHODS: A narrative review of qualitative studies of patient access to kidney transplantation was undertaken. Only articles in English were accessed. The existing literature was critically analyzed using theoretical constructs of the IMB model and thematic synthesis was performed. RESULTS: Results suggest patients having more information (greater transplant knowledge), more personal motivation (higher transplant outcomes expectations), more social motivation (more social and provider support), and more selfefficacy (confidence in navigating the transplant continuum) may be more likely to perform transplant access behaviors. CONCLUSION: Our findings provide a framework for considering patients' levels of knowledge, motivation, and self-efficacy in future educational and behavioral interventions for ESRD patients.

Cardiac stress test as a risk-stratification tool for posttransplant cardiac outcomes in diabetic kidney transplant recipients.

BACKGROUND: The utility of cardiac stress testing as a risk-stratification tool before kidney transplantation remains debatable owing to discordance with coronary angiography and outcome yields at different centers. METHODS: We conducted a retrospective study of 273 diabetic kidney transplant recipients from 2006 to 2010. By protocol, all diabetic patients underwent pharmacological radionucleotide stress test or dobutamine stress echocardiography before transplant. We compared the 1-year cardiac outcomes between those with negative stress test results and those with positive stress test results. RESULTS: Patients with a positive stress test result (n=67) underwent coronary angiogram, and significant coronary artery disease (≥70% coronary stenosis) was found in 35 (52.2%) patients. Of the latter, 32 (91.4%) underwent cardiac revascularization (24 underwent cardiac stenting and 8 underwent coronary artery bypass grafting). The rest (n=35) were treated medically. Within 1 year after transplant, the group with positive stress test results experienced more cardiac events (34.3% vs. 3.9%, P<0.001) including acute myocardial infarction (22.4% vs. 3.4%, P<0.001) and ventricular arrhythmias (8.9% vs. 0.05%, P=0.001), higher all-cause mortality (19.4% vs. 4.8%, P<0.001), and cardiac mortality (17.9% vs. 0.9%, P<0.001) compared with the group with negative stress test results. CONCLUSIONS: In this diabetic population, stress testing showed positive and negative predictive values of 34.3% and 96.1%, respectively. Pharmacological cardiac stress testing provided excellent risk stratification in diabetic kidney transplant recipients.