Outpatient Transplant Clinic Research Articles

Patient Quality of Life After Liver Transplantation in Terms of Emotional Problems and the Impact of Sociodemographic Factors

IntroductionLiver transplantation is recognized as an effective and necessary treatment of chronic as well as acute hepatic failure. The assessment of quality of life (QoL) after transplantation represents an ancillary tool to evaluate the efficacy of solid organ transplantation in addition to graft and patient survival rates and complications. The global assessment of QoL after transplantation usually confirms improvement compared to pretransplant conditions. PurposeAn attempt to evaluate the quality of life of patients after liver transplantation, with particular reference to sociodemographic factors and emotional problems. Materials and methodsThe study group included 121 patients (55 women and 66 men) at the age of 19 to 71 years who underwent surgery in the Central Teaching Hospital of the Medical University of Warsaw and the Infant Jesus Teaching Hospital in Warsaw, and were subsequently treated in an outpatient transplant clinic. The scoring procedure for the areas analyzed was based on the 36-Item Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). ResultsHigher patients age was correlated with lower quality of life of patients after liver transplantation, including physical functioning (patients >40 years of age declared lower physical performance, and patients <30 years of age indicated greatest limitations in their kind of work or other activities). The frequency of pain was also age-dependent (mostly patients >50 years of age). Women more often than men had worrying thoughts, were feeling tense or wound up, and had sudden feelings of anxiety or panic. By contrast, older people often declared that they felt to be slowed down. ConclusionsTo reduce pain and to improve physical performance of the study patients, rehabilitation procedures should be considered. Patients indicating symptoms associated with anxiety and depression should be referred to a clinical psychologist.

Health Needs Management Program and Compliance with Therapeutic Regimen among Postoperative Liver Transplant Recipients

Liver transplant recipients suffer from a chronic condition, which by itself entails risks and health problems, so they need to understand the transplantation process so as to change their living experience for better life post transplantation. The aim of this study was to The aim of this study was to assess the effect of health needs management program on liver transplant recipients' needs and their compliance to therapeutic regimen .Research design: A quasi experimental design was utilized to meet the aim of the study. Setting: The study was conducted in liver transplantation outpatient clinic at El Manial Cairo University hospital. Subjects: A purposive subjects of 40 patients post liver transplantation surgery from the liver transplantation outpatient clinic. Tools: A) Patient structured interviewing questionnaire to assess demographic characteristics among study subjects. B) Patients 'needs assessment tool to assess the following: 1. physical needs, 2. psychological needs, 3. social needs, 4. spiritual needs.5.educational needs C) Patients’ compliance questionnaire. Results: there were statistically significant differences among study subjects between pre and post program implementation regarding physical, psychological, social and educational needs. Furthermore, there were highly statistically significant differences between pre and post program implementation phases regarding all items of compliance among study group subjects. Conclusion: this study concluded that health needs management program had a positive effect in improvement of overall physical, psychological, social and educational needs of the recipient a well as their compliance to the therapeutic regime post program implementation. Recommendation: Health care providers specially nurses should develop time specific education programs based on liver transplant recipients’ educational needs at different post transplant times to maintain patients’ compliance .

Hand-Grip Strength Is Associated With Serum Testosterone and Albumin Levels in Male Kidney Transplant Recipients.

In kidney transplant recipients, reduced muscle mass and hand-grip strength are associated with impaired nutritional status. Serum testosterone is highly associated with muscle strength in the general population. Here, we aimed to determine the associations among serum testosterone, hand-grip strength, and nutritional and inflammatory parameters, as well as graft function. Our study included 144 stable male kidney transplant recipients from our renal transplant outpatient clinic. All patients were evaluated for clinical parameters (age, duration of hemodialysis, and posttransplant time), biochemical parameters (calcium, phosphorus, parathyroid hormone, C-reactive protein, albumin, creatinine), and serum testosterone levels. Body composition was analyzed with the bioimpedance spectroscopy analysis technique using a body composition monitor that estimates body mass index and percent fat. Hand-grip strength was analyzed by using a dynamometer (ProHealthcareProducts.com, Park City, UT, USA). We calculated estimated glomerular filtration rate using the Modification of Diet in Renal Disease-4 equation. Demographic characteristics, duration of dialysis before transplant, biochemical parameters, and estimated glomerular filtration rates were similar among study patients. Mean (standard deviation) serum testosterone was 588.0 (55.5) ng/dL, mean body mass index was 26.8 (0.6) kg/m2, and mean hand-grip strength was 42.2 (1.7) mm2. Serum testosterone levels were positively correlated with hand-grip strength (r = 0.445; P = .033) and serum albumin (r = 0.399; P = .05) and negatively correlated with serum C-reactive protein (r = -0.454; P = .05) and age. In linear multiple regression analysis, serum albumin (P = .033) and testosterone levels (P = .038) were shown to be predictors of hand-grip strength. However, we could not show a significant correlation between graft function and testosterone. Serum testosterone level is correlated with hand-grip strength and C-reactive protein and albumin levels, which may indicate that testosterone affects nutritional status and inflammation in male renal transplant recipients.

Prevalence and correlates of non-adherence to immunosuppressants and to health behaviours in patients after kidney transplantation in Brazil \u2013 the ADHERE BRAZIL multicentre study: a cross-sectional study protocol

BackgroundNon-adherence to immunosuppressive therapy is a prevalent risk factor for poor clinical and after kidney transplantation (KT), and has contributed to the lack of improvement in long-term graft survival over the past decade. Understanding the multilevel correlates and risk factors of non-adherence is crucial to determine the optimal level for planning interventions, namely at the patient, health care provider, KT centre, and health care system level. Brazil, having the largest public transplantation program in the world and with regional differences regarding access to health services and service implementation, is in a unique position to study this multilevel approach. Therefore, the Adhere Brazil Study (ADHERE BRAZIL) was designed to assess the prevalence and variability of non-adherence to immunosuppressants and to health behaviours among adult KT recipients in Brazil, and to assess the multilevel correlates of non-adherence to immunosuppressive medication. We describe the rationale, design, and methodology of the ADHERE BRAZIL study.Methods/DesignThis is an observational, cross-sectional, multicentre study that includes 20 Brazilian KT centres. A stratified sampling approach is used, based on strata, with the following characteristics considered: geographical region and transplant activity (number of KTs per year). A random sample of patients (proportional to the size of the centre within each stratum) is selected from each centre. The prevalence of different health behaviours is assessed through self-report. The assessment of multilevel correlates of non-adherence is guided by the ecological model that considers factors at the level of the patient, health-care professional, and transplant centre, using established instruments or instruments developed for this study. Data will be collected over an 18-month period, with information obtained during the regular follow-up visits to the transplant outpatient clinic and directly entered into the Research Electronic Data Capture (RedCap) system. Data entry is performed by a trained professional who is part of the transplant team. The data collection began in December 2015.DiscussionThis multicentre study is the first to evaluate multilevel correlates of non-adherence in KT patients and will provide a reliable estimate of non-adherence in Brazilian KT patients.Trial registrationClinicalTrials.gov on 10/10/2013, NCT02066935.

681 - Development and Implementation of Standardized Documentation Tools/“Smart Phrases” Within the Electronic Medical Record (EMR) of an Outpatient Transplant Clinic

Topic Significance & Study Purpose/Background/Rationale: Ambulatory transplant nursing is a rapidly evolving field of practice. Nurses working in this dynamic area are required to maintain accurate and concise documentation of all interventions they deliver in order to meet the standards outlined by medical and financial compliance. Without this accurate and timely record, nurses could place themselves and their patients at risk for financial, legal and medical penalties. It was hypothesized that there was an opportunity to improve the documentation of some nursing interventions within our outpatient clinic. Methods, Intervention, & Analysis: In the Spring of 2015, a nurse champion, with specific training related to charge reconciliation, leveraged the functionality of a newly implemented electronic medical record (EMR) to create compliance-approved documentation tools called “Smart Phrases” for fifteen high volume nursing interventions in our outpatient clinic. This same nurse champion developed educational materials to support Smart Phrase use, provided hands-on support, and initiated a daily internal audit procedure to ensure compliance and accuracy. Findings & Interpretation: With this mechanism in place to document nursing effort, it became apparent that the amount of time allotted to perform many of these interventions was being grossly underestimated. Armed with this data, nursing leadership was able to make a persuasive case for an additional five nursing positions to support the growing nursing workload, improve staff satisfaction, and optimize productivity. Discussion & Implications: Today and moving forward, nurses working in the ambulatory setting will be expected to refine and adjust their documentation to meet both medical and financial standards. It is essential that these nurses have a working understanding of charge reconciliation and reimbursement to document the high quality care they provide and accurately capture their productivity. The functionality of an EMR can often provide creative solutions to standardized data that could be used in unique ways to reflect both the obvious and discrete cost of delivering care.

698 - Maintaining Apheresis Competency in the Adult Blood and Marrow Transplant Outpatient Clinic

698 - Maintaining Apheresis Competency in the Adult Blood and Marrow Transplant Outpatient Clinic

Increased resistance of gram-negative urinary pathogens after kidney transplantation

BackgroundUrinary tract infection is the most common complication after kidney transplantation. It can cause severe sepsis and transplant loss. Emergence of drug resistance among gram-negative urinary pathogens is the current challenge for urinary tract infection treatment after kidney transplantation.MethodsThis study analyzes the antimicrobial susceptibility of gram-negative urinary pathogens after kidney transplantation from 2009 to 2012 at the Transplant Outpatient Clinic of the University Hospital Essen, Germany. Kidney transplant patients at the University Hospital Essen receive regular follow up examinations after transplantation. Midstream urines were examined for bacteriuria at each follow up visit.ResultsFrom 2009 to 2012 15.741 urine samples were obtained from 859 patients. In 2985 (19%) samples bacterial growth was detected. The most frequently detected gram-negative bacteria were E.coli 1109 (37%), Klebsiella spp. 242 (8%) and Pseudomonas aeruginosa 136 (4.5%). Klebsiella spp. showed a significant increase of resistance to trimethoprim-sulfamethoxazole by 19% (p = 0.02), ciprofloxacin by 15% (p = 0.01) and ceftazidime by 17% (p = 0.004). E.coli and P. aeruginosa isolates presented no significant differences of antimicrobial susceptibility to the analyzed antibiotics.ConclusionsAntimicrobial resistance of Klebsiella spp. increased significant to trimethoprim-sulfamethoxazole, ciprofloxacin and ceftazidime from 2009 to 2012.

Fatigue and its associated factors in liver transplant recipients in Beijing: a cross-sectional study

ObjectivesFatigue is a highly prevalent symptom experienced by patients who underwent the liver transplantation. However, the influencing factors of fatigue are poorly understood by healthcare professionals. The aim of this...

Evaluation of Direct Oral Anticoagulation Therapy in Heart and Lung Transplant Recipients.

Anticoagulation therapy is common in thoracic transplant recipients. Direct oral anticoagulants (DOACs) are alternatives to warfarin therapy, but characterization of their use in solid organ transplant is absent. The primary objective of this study was to describe a thoracic transplant patient population initiated on DOAC therapy. Secondary objectives were to assess adverse reactions, venous thromboembolism (VTE) recurrence, and drug-drug interactions during DOAC therapy. Single-center retrospective cohort study. A tertiary care medical center including inpatient hospitalization and outpatient transplant clinic visits. Thoracic transplant recipients who were initiated on DOACs between May 1, 2011, and March 1, 2015, at the University of Pittsburgh Medical Center were included. A total of 37 patients were included in the analysis. A majority of the patients were lung transplant recipients (86.4%) with a median age of 60.7 years. Twenty-eight patients had a history of VTE. The primary indication for DOAC initiation was VTE (86.5%). Rivaroxaban (78.4%) was the most commonly utilized agent. Dose reductions for major drug interactions (37.8%), renal insufficiency (10.8%), or both (8.1%) occurred within the study. Two patients had breakthrough VTE during DOAC therapy. Eight bleeding events were reported in the cohort, one of which was considered a major bleed. There was no difference in the incidence of bleeding in patients with drug-drug interactions and without drug-drug interactions during DOAC therapy (26.0% vs 7.1%, P = .154). Direct oral anticoagulant therapy was well tolerated by thoracic transplant recipients. Drug interactions and renal dose adjustments were common.

Psychological Predictors of Cooperation in the Chronic Treatment of Kidney Transplantation Patients

IntroductionA patient who complies with doctor recommendations is an indicator of proper cooperation in treatment. It is affected by environmental factors, soft competences of the doctors, and properties of the human personality. We investigated the psychological characteristics of patients that may facilitate human contact and promote healthy behaviors. The aim of the study was to analyze the importance of psychological factors for the occurrence of health-related behaviors necessary for cooperation in treatment. Material and MethodsThe study was conducted in a group of 105 patients (62 males and 43 females) aged from 25 years to 82 years old (mean, 50.4 years) after kidney transplantation who remained in follow-up at the Outpatient Transplant Clinic. We used two questionnaires: one for the patients and one for their doctors, including an assessment of healthy behaviors listed in 10 categories. The patients also completed the tests exploring the sense of self-efficacy (generalized self-efficacy scale), optimism (life orientation test – revised) and the control of emotions (Courtauld emotional control scale) in a Polish adaptation by Zygfryd Juczynski. In the statistical analysis, the Spearman rank correlation coefficient and the Kanonicza analysis were used, adopting the significance level of P < .05. ResultsWe found significant correlations between psychological factors and behaviors of the patients. The patients controlling the expression of anxiety often concentrated on cleanliness and hygiene (P = .013). The patients controlling the expression of anger (P = .008) and anxiety (P = .049) were less likely to perform self-observation, being of the opinion that the role of the physicians was to evaluate the development of the disease and advances in treatment. The patients with higher levels of optimism were perceived by the physicians as better cooperating in conducting self-observation (P = .024) and adherence to hygiene (P = .047); they were also less frequently struggling with ophthalmic problems (P = .004). The relationship between the factors associated with the disease and treatment (pressure, the efficiency of the transplanted kidney, and duration of treatment) and psychological factors (optimism, emotional control, and self-efficacy) has been confirmed. The emerged factors significantly affected each other, which indicated the matching of the model (P = .08). ConclusionsThe analysis of the results shows that psychological and somatic functioning of patients has a strong relationship with certain pro-health behaviors that determine the collaboration in treatment. This can serve as a basis for modifying the rules of managing the patients.

Cooperation in Treatment as an Indicator of Adaptation of Kidney Transplant Patients to Chronic Therapy

BackgroundCooperation between patients and physicians in chronic treatment is an important factor in the patients' adaptation to difficult circumstances. The search is ongoing for factors important to the physician–patient relationship, with the goal of identifying deficits and psychological resources of the patients and medical soft skills of the physicians that can affect the quality of cooperation. The aim of this study was to analyze the psychological mechanisms of patient cooperation with physicians in the area of treatment after kidney transplantation. MethodsThe study group consisted of 105 patients (62 male patients and 43 female patients) aged 25 to 82 years (mean age, 50.91 years) after kidney transplantation who remained in the follow-up protocol of the Outpatient Transplant Clinic. A questionnaire was used to examine the compatibility of ratings as expressed by the patients and their physicians in 10 areas of cooperation in treatment. The tests for a sense of self-efficacy (General Self-Efficacy Scale), optimism (Life Orientation Test–Revised), and the control of emotions (Courtauld Emotional Control Scale) in Juczyński's adaptation were used in the study of psychological factors. ResultsOnly 1 case reached total congruity by the patients and their physicians in all 10 areas of cooperation. In 3 areas, compliance was achieved in 70%, 72%, and 76%, respectively; in 6 areas, 50% to 66%; and in 1 sphere, 37%. We found no significant impact of psychological factors on patient compliance. A comparison was made of 2 groups of patients (1 of which was characterized by a high compatibility between the physician and patient assessments, and the second which was characterized by the lack of conformity). Moreover, assessment of the functioning of the transplanted kidneys was rated higher in those patients who achieved a high compliance with the opinions of medical cooperation in the treatment. ConclusionsThe quality of cooperation measured by using compliance assessments of the patients and physicians in health behaviors is satisfactory. This finding translated into a favorable assessment of the functioning of the transplanted kidney expressed by the patients. Qualitative information provides guidance for targeted increasing collaboration.

Challenges of Extracorporeal Photopheresis (ECP) in the Patient Population in the Adult Bone Marrow Transplant (ABMT) Outpatient Clinic

Challenges of Extracorporeal Photopheresis (ECP) in the Patient Population in the Adult Bone Marrow Transplant (ABMT) Outpatient Clinic

Evaluation of the Management of Hyperlipidemia and Hypertension in an Outpatient Cardiac Transplant Clinic

Background: Allograft coronary artery disease (ACAD) is a common cause of morbidity and mortality post-orthotopic heart transplantation (OHT). ACAD progression may be reduced by modifying cardiovascular risk factors, such as hyperlipidemia and hypertension. We sought to evaluate the management of hyperlipidemia and hypertension among OHT recipients followed in an outpatient cardiac transplant clinic. Objective: The primary objective was to assess the proportion of OHT patients achieving both the recommended LDL target of <2.0 mmol/L and BP targets of <140/90 mmHg (or <130/80 mmHg for diabetics) in an outpatient cardiac transplant clinic. Methods: A cross-sectional retrospective analysis of the medical records of all adult OHT recipients actively followed in our outpatient cardiac transplant between January-March 2009. Results: Of the 193 patients included, both the low-density lipoprotein (LDL) cholesterol and blood pressure (BP) targets were achieved in 111 (57.5%) patients. The LDL target alone was achieved by 140 (72.5%) patients and the BP target alone by 153 (79.3%) patients. Statins were prescribed in 183 (94.8%) patients with a mean LDL of 1.81 mmol/L (±0.55). Angiotensin converting enzyme-inhibitors [ACE-I] (or angiotensin receptor blockers [ARB]) were prescribed in 154 (79.8%) patients, diltiazem in 101 (52.3%) patients, and both in 85 (44.0%) patients, with a mean BP of 124.2/77.8 mmHg (±13.6/8.2). Adverse reactions related to statins, ACE-inhibitors or diltiazem were uncommon and rarely resulted in drug discontinuation. Conclusions: Guideline recommended that LDL and BP targets are achievable in a significant proportion of OHT recipients. The high utilization rates of statins for dyslipidemia and ACE-I (or ARB) and diltiazem for BP were consistent with guideline recommendations for the prevention of ACAD. Despite concerns regarding the potential for pharmacokinetic drug interactions in OHT patients, the reported rates of any drug intolerance to these medications were low in our population.

Tolerability of low-dose sulfamethoxazole/trimethoprim for Pneumocystis jirovecii pneumonia prophylaxis in kidney transplant recipients.

Background- Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection seen in immunosuppressed patients, including solid-organ transplant recipients. Sulfamethoxazole/trimethoprim (SMX/TMP) has long been considered first-line therapy for PCP prophylaxis. Optimal dosing regimens in solid-organ transplant recipients have not been fully defined. Objective-To examine the tolerability of a 1-year, 3-times weekly, prophylactic regimen of a single-strength SMX/TMP tablet. Study Design-Single-center, retrospective cohort study. Setting-A tertiary-care medical center, including inpatient hospitalizations and outpatient transplant clinic visits. Patients-Adult patients who received a kidney transplant between December 1, 2010, and November 30, 2012, at Hartford Hospital. Patients receiving a concurrent extrarenal transplant were excluded. Patients' charts were reviewed for up to 1 year after transplant. Results-A total of 88 patients were included in the analysis. Sixty-seven patients finished a full year of SMX/TMP after transplant, 10 patients discontinued SMX/TMP less than 1 year after transplant, and 11 patients started taking atovaquone instead of SMX/TMP after transplant. Documented reasons for discontinuation included hyperkalemia, leukopenia, diarrhea, and simplification of medication regimen. Patients without a documented reason for discontinuation did not have any obvious anomalies in laboratory values that would account for the discontinuation. Patients who received atovaquone for PCP prophylaxis had higher rates of recurrent urinary tract infections than did patients who received SMX/TMP for prophylaxis (33% vs 7%, P = .02). A longer postoperative stay (median [interquartile range, IQR] 13 [8.25-26] days vs 7 [6-9.5] days, P = .02), higher rates of delayed graft function (50% vs 10%, P = .004), as well as higher serum creatinine levels on postoperative day 7 (6.25 [2.4-10.1] mg/dL vs 1.8 [1.2-4.2] mg/dL, P= .01), postoperative month 1 (1.9 [0.8] mg/dL vs 1.4 [0.5] mg/dL, P = .002), and postoperative month 12 (1.6 [0.5] mg/dL vs 1.3 [0.3] mg/dL, P = .04) were associated with early SMX/TMP discontinuation. Conclusion-A low-dose prophylactic SMX/TMP regimen of 1 single-strength tablet 3 times weekly is well tolerated. Discontinuation rates were lower than other rates reported for higher-dose regimens.

Effect of active infection on cytochrome P450-mediated metabolism of cyclosporine in renal transplant patients.

Infections downregulate cytochrome-P activities and thus may alter drug disposition, especially for drugs with a narrow therapeutic index. Cyclosporine (CyA), still used for the prevention of allograft rejection in renal transplant recipients in Egypt, seems to be affected by these infectious changes, based on random clinical observations. In the present study, the effects of bacterial and fungal infection on CyA metabolism were studied in renal transplant patients and subsequent nephrotoxicity was monitored. Twenty renal transplant patients, diagnosed with fungal or bacterial infection, were recruited from the renal transplantation outpatient clinic in Alexandria University Hospitals. No dose adjustment in CyA was performed at least 1 week before the onset of infection. Exclusion criteria were patients with acute or chronic unstable liver disease, elderly patients, and patients on concomitant drugs affecting CyA metabolism. CyA trough levels and serum creatinine (SCR) concentrations were measured by fluorescence polarization immunoassay and enzymatic assay, respectively, pre-infection, during infection and in many cases, post infection. CyA trough levels and SCR concentrations increased significantly during the infection (P < 0.001, P = 0.002) respectively. Of the patients, 87% experienced a concomitant rise in CyA trough level and SCR concentrations. No significant difference between pre-infection and post-infection levels of CyA trough and SCR was found. CyA trough and SCR levels increased during bacterial and fungal infections and returned to pre-infection levels once the infection was resolved. The data generated stress the importance of monitoring CyA levels during episodes of infection. Our recommendations concerning CyA dose adjustment differ according to severity and duration of infection.

Simultaneous pancreas-kidney transplantation for diabetic end-stage renal disease under a hypertension status.

Sir, Diabetic kidney disease is one of the most devastating complications affecting diabetic patients’ survival. When suffering from both type 1 diabetes mellitus (DM) and end-stage renal disease (ESRD), simultaneous pancreas-kidney transplantation (SPKT) is the best therapeutic option and life-saving procedure.[1] Hypertension is known to be a common comorbidity associated with DM. The incidence of hypertension is above 60%, in some regions even exceeding 75%, among patients with DM.[2] Both hypertension and DM related closely to an increased risk of morbidity and mortality due to long-term macro- and microvascular pathological conditions, notably chronic kidney disease.[3] Furthermore, 80-90% of patients at stages IV and V chronic kidney disease suffer from resistant hypertension.[4] Therefore, hypertension may have a great impact on the long-term outcome after SPKT. Here, we present a case of SPKT patient who survived over 10 years without cardiovascular complications under effectively immunosuppressive and anti-hypertensive medication. A 43-year-old man diagnosed as hypertension and type 1 DM with ESRD underwent SPKT at our hospital in December 2004. The body weight, body height, and body mass index of the patient were 171 cm, 62 kg, and 21.2 kg/m2, respectively. He had been received hemodialysis therapy for 3 years. His blood glucose was unstable despite the treatment of oral drugs and insulin injection. His blood pressure was well-controlled under the combination of diuretic and calcium channel blockers. The systolic and diastolic blood pressure maintained <140/90 mmHg generally. No severe hypertension-related complications (e.g., heart failure, coronary artery disease, and aneurysm) or significant surgical contraindication was found before SPKT. Postoperative managements consisted of routine fluid replacement, infection prevention, and medication including somatostatin, low-dose heparin, acid inhibitor. Baseline immunosuppression consisted of a 3-day induction treatment with antithymocyte globulin with a delayed inception of tacrolimus, a steroid taper and mycophenolate mofetil. After the patient had been discharged, he continued to take a combination of diuretic and calcium channel blockers for antihypertension medication and self-examined daily blood pressure. The patient routinely followed up in the liver transplant outpatient clinic, and no complication was found during the 10 years. From what has been discussed above, strict pretransplant evaluation and selection criteria must be performed in SPKT candidates and effective management of hypertension is critical for improving recipients’ long-term outcome and quality of life. Financial support and sponsorship Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Lishui People's Hospital, Lishui, Zhejiang, P.R. China. Conflicts of interest There are no conflicts of interest.

The effect of Saccharomyces boulardii in patients eligible for liver transplantation.

The aim of this study was to evaluate the influence of Saccharomyces boulardii on the intestinal permeability, laboratory parameters and MELD and Child-Pugh severity scores in cirrhotic patients eligible for liver transplantation. Eighteen patients followed in a Transplant Outpatient Clinic were evaluated immediately before the beginning of treatment, after a 30-day period of treatment period with probiotics and at the end of the second study month (after a thirty-day period without probiotics). Fifteen healthy controls also underwent the intestinal permeability test (lactulose/mannitol). Before the probiotic, the median lactulose/ mannitol ratio was greater in the cirrhotic patients (0.0209, range 0.0012-0.1984) compared to the healthy controls (0.0030, range 0.0020-0.0013) (p < 0.05). Eight of fifteen patients, half of whom had ascites, showed increased intestinal permeability above the higher value observed in the controls. No significant association was found between the severity scores for liver disease, age, presence of ascites and intestinal permeability immediately before the beginning of study. After treatment with S. boulardii, there was no improvement in intestinal permeability or significant differences in the laboratory parameters for the three evaluations. Patients eligible for liver transplants presented with increased intestinal permeability compared to healthy controls. A thirty-day treatment with S. boulardii did not improve this intestinal permeability or the severity scores, nor did it impact the laboratory parameters.

Development and testing of a disease-specific health literacy measure in kidney transplant patients.

Health literacy affects a patient's ability to navigate through the system of care for late-stage kidney disease, including evaluation, waiting, and recovering from kidney transplant. To develop and provide a preliminary evaluation of a knowledge and decision-making capacity tool, which is a component of health literacy. Cross-sectional design with purposive sampling. Vascular access, dialysis, and outpatient transplant clinics. A Decision-Making Capacity Assessment Tool (DMCAT) was developed and administered to 127 adults at different stages in the kidney care process. The DMCAT tool is positively and significantly correlated to the other 2 previously validated instruments and accounts for more variance than the other 2 tools in the regression models. We found significant differences in patients' health literacy and decision-making capacity related to their stage of care. Decision-making capacity appeared to be an important component of health literacy and should be considered as health care providers tailor care to meet patients' needs.

Sagittal Abdominal Diameter as the Anthropometric Measure of Cardiovascular and Graft Loss Risk in Renal Transplant Recipients.

Purpose: Cardiovascular disease is the most common cause of death in renal transplant recipients. Arterial stiffness plays an important role in cardiovascular diseases and is an independent predictor for cardiovascular mortality in renal transplant recipients. Studies have demonstrated sagittal abdominal diameter (SAD) presented stronger prognostic value for all-cause and cardiovascular mortality in the general population. The aim of this study is to evaluate the association between the arterial stiffness and novel anthropometric indices in renal transplant recipients. Methods: One hundred eighty one renal transplant recipients from our renal transplant outpatient clinic were enrolled into the study. All patients were evaluated for their standard clinical (age, gender, duration of hemodialysis, post-transplant time), biochemical parameters. Anthropometric measurements (waist and hip circumference, abdominal sagittal diameter) were performed for all patients. PWv was determined from pressure tracing over carotid and femoral arteries using the SphygmoCor system. We calculated the estimated GFR (eGFR) using the MDRD4 equation. Results: Patients were divided into two group according to SAD measurements. Group 1 (n:127) was defined as the patients SAD < 24.3 cm and group 2 (n:54) was defined as the patients SAD ≥ 24.3 cm. Patients in group 2 had significantly higher triglyceride, C-reactive protein, uric acid, systolic blood pressure, PWv and body mass index measurements compared to Group 1 (p<0.05 for all). In group 2 eGFR was significantly lower than group 1 (p<0.022). SAD had positive correlation with PWv, Systolic and diastolic blood pressure, body mass index, triglyceride, fasting glucose, C-reactive protein and uric acid (p<0.05 for all). Conclusions: We showed both SAD was significantly associated with several components of metabolic syndrome, inflammation and arterial stiffness as well as graft loss. Considering the significant association of visceral fat with inflammation and cardiovascular disease, estimating visceral fat by SAD could be a useful tool to stratify cardiovascular risk as well as graft function in renal transplant recipients.

(597) - A Descriptive Study Examining Post Lung Transplantation: Patient Employment Status, Restricting Factors for Work, and Support Requirements

PurposeClinical outcomes for lung transplant recipients (LTR) are defined in terms of respiratory function tests. Little data regarding quality of life and employment status following LT has been published. The ability to work post LT may represent a good long term outcome of "health” in this population. We investigated patterns of employment within the current LT population in our centre to look at employment status, restricting factors, and support in order to better define the needs of this group.MethodsA questionnaire was provided to patients as they attended the Transplant Out-Patient clinic between 15th July and 13th September 2013. All data was collected anonymously. 154 questionnaires were given out and 126 were returned, giving a return rate of 82%. Descriptive statistics were used to analyse the numeric data.ResultsWorking status: Employed full time 9% (n=13); employed part time 12% (n=16); self employed 6% (n=8); volunteer 7% (n=9); student 7% (n=9); retired 25% (n=35); long term sick leave 14% (n=20); unemployed 20% (n=28). Restricting factors for work: See diagram. ‘Other’ factors limiting ability to work include health and functional issues, variability of health, and impact of transplant (appointments, medical regime, dialysis). Support requirements: Patients indicated that they required support in the first year post transplant, that individualised specialist advice was required and that liaison with their employer to educate about the impact of transplantation was essential.Conclusion PurposeClinical outcomes for lung transplant recipients (LTR) are defined in terms of respiratory function tests. Little data regarding quality of life and employment status following LT has been published. The ability to work post LT may represent a good long term outcome of "health” in this population. We investigated patterns of employment within the current LT population in our centre to look at employment status, restricting factors, and support in order to better define the needs of this group. Clinical outcomes for lung transplant recipients (LTR) are defined in terms of respiratory function tests. Little data regarding quality of life and employment status following LT has been published. The ability to work post LT may represent a good long term outcome of "health” in this population. We investigated patterns of employment within the current LT population in our centre to look at employment status, restricting factors, and support in order to better define the needs of this group. MethodsA questionnaire was provided to patients as they attended the Transplant Out-Patient clinic between 15th July and 13th September 2013. All data was collected anonymously. 154 questionnaires were given out and 126 were returned, giving a return rate of 82%. Descriptive statistics were used to analyse the numeric data. A questionnaire was provided to patients as they attended the Transplant Out-Patient clinic between 15th July and 13th September 2013. All data was collected anonymously. 154 questionnaires were given out and 126 were returned, giving a return rate of 82%. Descriptive statistics were used to analyse the numeric data. ResultsWorking status: Employed full time 9% (n=13); employed part time 12% (n=16); self employed 6% (n=8); volunteer 7% (n=9); student 7% (n=9); retired 25% (n=35); long term sick leave 14% (n=20); unemployed 20% (n=28). Restricting factors for work: See diagram. ‘Other’ factors limiting ability to work include health and functional issues, variability of health, and impact of transplant (appointments, medical regime, dialysis). Support requirements: Patients indicated that they required support in the first year post transplant, that individualised specialist advice was required and that liaison with their employer to educate about the impact of transplantation was essential. Working status: Employed full time 9% (n=13); employed part time 12% (n=16); self employed 6% (n=8); volunteer 7% (n=9); student 7% (n=9); retired 25% (n=35); long term sick leave 14% (n=20); unemployed 20% (n=28). Restricting factors for work: See diagram. ‘Other’ factors limiting ability to work include health and functional issues, variability of health, and impact of transplant (appointments, medical regime, dialysis). Support requirements: Patients indicated that they required support in the first year post transplant, that individualised specialist advice was required and that liaison with their employer to educate about the impact of transplantation was essential. Conclusion