Clinical Impact of a Protocolized Kidney Donor Follow-up System

Kwon, Hyunwook; Jeon, Junseok; Kim, D.; Jang, Hye Ryoun; Sung, Hyun Hwan; Han, Deok Hyun; Park, J.B.; Lee, J.E.; Huh, Wooseong; Kim, Seung Ju; Kim, Y.G.; Kim, D.J.; Oh, Ha Young

doi:10.1016/j.transproceed.2018.10.026

Cited by 4 publications

(3 citation statements)

References 35 publications

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“…Although there was no evidence-based measure to improve renal adaptation, donors who are expected to show poor or insufficient renal adaptation should be more educated for lifestyle modification to reduce risk factors for CKD and actively followed-up by nephrologists. We established a donor clinic in our institution and applied systemized protocols for kidney donors, including post-donation follow-ups since 2013 (23). Poor renal adaptation was less frequent in the donor clinic period compared to the pre-donor clinic period.…”

Section: Discussionmentioning

confidence: 99%

Prediction tool for renal adaptation after living kidney donation using interpretable machine learning

Jeon

Song

et al. 2023

Front. Med.

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IntroductionPost-donation renal outcomes are a crucial issue for living kidney donors considering young donors’ high life expectancy and elderly donors’ comorbidities that affect kidney function. We developed a prediction model for renal adaptation after living kidney donation using interpretable machine learning.MethodsThe study included 823 living kidney donors who underwent nephrectomy in 2009–2020. AutoScore, a machine learning-based score generator, was used to develop a prediction model. Fair and good renal adaptation were defined as post-donation estimated glomerular filtration rate (eGFR) of ≥ 60 mL/min/1.73 m2 and ≥ 65% of the pre-donation values, respectively.ResultsThe mean age was 45.2 years; 51.6% were female. The model included pre-donation demographic and laboratory variables, GFR measured by diethylenetriamine pentaacetate scan, and computed tomography kidney volume/body weight of both kidneys and the remaining kidney. The areas under the receiver operating characteristic curve were 0.846 (95% confidence interval, 0.762–0.930) and 0.626 (0.541–0.712), while the areas under the precision-recall curve were 0.965 (0.944–0.978) and 0.709 (0.647–0.788) for fair and good renal adaptation, respectively. An interactive clinical decision support system was developed.1ConclusionThe prediction tool for post-donation renal adaptation showed good predictive capability and may help clinical decisions through an easy-to-use web-based application.

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Section: Discussionmentioning

confidence: 99%

Prediction tool for renal adaptation after living kidney donation using interpretable machine learning

Jeon

Song

et al. 2023

Front. Med.

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“…Patients should be monitored for the development of cardiovascular diseases, renal impairments, diabetes mellitus, malignancies, and osteoporosis for the best outcomes. Monitoring of dental health, mental health, sexual function, and immunization should also be provided [55].…”

Section: Strategies For Immune Suppression Withdrawal/minimizationmentioning

confidence: 99%

Strategies to Improve Immune Suppression Post-Liver Transplantation: A Review

2021

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Since the first liver transplantation operation (LT) in 1967 by Thomas Starzl, efforts to increase survival and prevent rejection have taken place. The development of calcineurin inhibitors (CNIs) in the 1980s led to a surge in survival post-transplantation, and since then, strategies to prevent graft loss and preserve long-term graft function have been prioritized. Allograft rejection is mediated by the host immune response to donor antigens. Prevention of rejection can be achieved through either immunosuppression or induction of tolerance. This leads to a clinical dilemma, as the choice of an immunosuppressive agent is not an easy task, with considerable patient and graft-related morbidities. On the other hand, the induction of graft tolerance remains a challenge. Despite the fact that the liver exhibits less rejection than any other transplanted organs, spontaneous graft tolerance is rare. Most immunosuppressive medications have been incriminated in renal, cardiovascular, and neurological complications, relapse of viral hepatitis, and recurrence of HCC and other cancers. Efforts to minimize immunosuppression are directed toward decreasing medication side effects, increasing cost effectiveness, and decreasing economic burden without increasing the risk of rejection. In this article, we will discuss recent advances in strategies for improving immunosuppression following liver transplantation.

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“…Areas that need to be considered, in addition to the graft health relate primarily to minimising the effect of immunosuppressive agents and preventing premature death by focussing on the causes of premature death or co-morbidity (see Table 4 ). The use of a protocolised approach may result in better patient and graft outcomes [ 33 ].…”

Section: Follow-up Of Transplant Recipientsmentioning

confidence: 99%

Follow-up of liver transplant recipients

Neuberger

2020

Best Practice & Research Clinical Gastroenterology

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The number of surviving liver allograft recipients is increasing almost exponentially. The quality and length of life is increasing but most recipients have reduced survival and quality of life compared with healthy matched individuals. Causes of premature death include cardio and cerebrovascular disease, renal failure, graft failure, de novo malignancy and recurrent disease. Follow-up is needed lifelong to ensure graft and patient health and ensure that complications are recognised and treated early. Immunosuppression is kept to the appropriate minimum and prophylactic interventions are given early, such as use of statins and tight control of blood pressure and blood sugar. Recipients will require life-long follow-up, and this is placing an increasing burden on transplant units. Follow-up is best done by close collaboration between the Liver Transplant Unit, the local hospital and primary care team. Involvement of other health care practitioners, such as recipient coordinators, pharmacists, dermatologists and addiction specialists may improve outcomes. Key to successful follow-up are agreed protocols and good communication between the recipients and all relevant health care providers. Use of IT allows for better communication and will support use of video and telephone consultations in selected instances. The most appropriate follow-up will depend on many factors, including logistic and geographic issues, local experience. The provision of well-funded and supported registries at local, national and international levels will allow for improvements in management.

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Clinical Impact of a Protocolized Kidney Donor Follow-up System

Cited by 4 publications

References 35 publications

Prediction tool for renal adaptation after living kidney donation using interpretable machine learning

Prediction tool for renal adaptation after living kidney donation using interpretable machine learning

Strategies to Improve Immune Suppression Post-Liver Transplantation: A Review

Follow-up of liver transplant recipients

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