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TRANSPLANTATION
PART 2 |
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Included
in this issue:
- Outcomes
- Transplantation
Cost
- Financing
a Transplant
- Cultural
Issues
- Research
- Resources
/ Links
NOTE:
Many of the articles below are from the Medscape
website. To view these acticles you must first register, however,
REGISTRATION IS FREE. Once registered, all articles are easily
accessible.
Mortality
from Time of Listing for Transplantation as an Indicator of Candidate
Outcomes
Survival after transplantation has traditionally been the statistic
most closely scrutinized as to the efficacy of the procedure and
a program's performance. We propose that mortality from
the time of listing is a more significant outcome measure
for potential transplant candidates.
Quality
of Life after Liver Transplantation
Liver transplantation has become an accepted treatment for end-stage
liver disease and acute liver failure. 87% of patients undergoing
liver transplant are expected to survive the 1st year and 80%
at the 3rd year after transplant. The improvement in outcomes
after transplant is a result of improvement in surgical techniques
and medical therapy.
Assessing
Quality-of-Life Outcomes in Organ Transplant Recipients: Progress
and Priorities
The goal of healthcare today is to improve the QOL of patients,
in addition to curing physical illness. Subjective well-being
and positive emotions and experiences (eg, happiness, life satisfaction)
are critically important to measure in patients because of their
adaptive significance.
Research has
repeatedly shown that people, including those with chronic physical
health problems, who are happy and who report an inner experience
of contentment, adapt more successfully to changes in health status,
have more satisfying interpersonal relationships, maintain perseverance
in the face of adversity, and consume fewer healthcare resources.
Therefore, developing interventions to enhance QOL are crucial
for patients confronting significant health changes (ie, chronic
illness and transplantation).
The
effects of clinical pathways for renal transplant on patient outcomes
and length-of-stay
RESULTS: Mean length of hospital stay decreased after development
and implementation of the cadaveric donor pathway (11.8 days after
implementation versus 17.5 days before development).
Why
Heart Transplant Patients Resume Smoking
Nearly half
of ex-smokers who receive heart transplants resume smoking at
some point after their life-saving operation, and now researchers
have good evidence to suggest who is at risk of relapse.
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Factors
Leading to Improved Outcomes in Bone Marrow Transplants
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In
1987, unrelated donor bone marrow transplantation was an
investigational therapy with uncertain benefits.
Since
then, morbidity and mortality have decreased and the indications
for stem cell transplantation have increased. Unrelated
donor stem cell transplantation is now an appropriate first
course of treatment for some patients. For some diseases
and disease stages, outcome of transplantation using an
unrelated donor is nearly equivalent to transplantation
using a comparably matched related donor.
Analyses
of these data identify factors that can improve a patient's
likelihood of a successful transplant.
1.
HLA Match Quality
2.
Patient Factors --
Analyses of stem cell transplant recipient data show that,
in general, the following patient-specific factors lead
to more favorable transplant outcomes:
- Transplant
performed during a stable disease period
- Transplant
performed on younger patients
-
Transplant performed during an earlier disease phase
- Cytomegalovirus
(CMV) sero-negative recipient
3.
Donor Factors
Outcome studies have shown that the only donor factor influencing
patient survival is donor age.
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Post-Renal Transplant Compliance: The Cognitions, Emotions
and Coping Behaviors
Post renal transplant noncompliance is currently the
3rd leading cause of renal graft loss -- chronic rejection
is the primary cause.
This study was
designed to provide specific data on the renal transplant
recipient's cognitions, emotions and behaviors following
a transplant. To understand the renal transplant compliance
process, multiple factors must be reviewed. These include
inquiry into the relationship between the individual and
his/her body, and the person-in-the-situation.
TRANSPLANT
REJECTION
Repeated
Transplant Rejection: Why Does it Happen?
All patients' immune systems are not alike.
Unfortunately,
our ability to measure the strength of the immune system
is very limited. This makes it difficult to determine the
right kind and number of medications that will effectively
stop transplant rejection without causing life-threatening
infections.
Immune
Tolerance: Improving Transplantation Success
In the past decade, discoveries made by NIAID-supported
scientists about the mechanisms that activate and regulate
the immune response have yielded a new approach to preventing
transplant rejection. Rather than suppressing the entire
immune system, this new approach uses a targeted strategy
designed to induce tolerance (the lack of an immune response)
by turning off the specific immune cells that attack the
transplant . . .
Advances
in tolerance induction will provide valuable new therapeutic
strategies in transplantation and in treating a wide range
of immune-mediated disorders.
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