Long-Term Quality of Life After Kidney Transplantation in Childhood

Morel, Philippe; Almond, P. S.; Matas, Art; Gillingham, Kristen J.; Chau, CH; Brown, Allison; Kashtan, Clifford E.; Mauer, S. Michael; Chavers, Blanche M.; Nevins, Thomas E.

doi:10.1097/00007890-199107000-00010

Cited by 91 publications

(56 citation statements)

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“…37 Nevertheless, favourable social and professional outcomes have been observed from a long-term follow-up (15.6 years ± 3 years) of people who had a kidney transplant as a child (aged 10 years ± 5 years). 38 Adherence to post-transplant immunosuppressive regimens is important for favourable clinical outcomes in children and adolescents 39 and has been suggested as a core strategy to improve clinical outcomes. 40 In addition, failing to follow treatment may result in an increase in medical costs.…”

Section: Significance For Patientsmentioning

confidence: 99%

Immunosuppressive therapy for kidney transplantation in children and adolescents: systematic review and economic evaluation

Haasova

Snowsill

Jones-Hughes

et al. 2016

Health Technol Assess

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BackgroundEnd-stage renal disease is a long-term irreversible decline in kidney function requiring kidney transplantation, haemodialysis or peritoneal dialysis. The preferred option is kidney transplantation followed by induction and maintenance immunosuppressive therapy to reduce the risk of kidney rejection and prolong graft survival.ObjectivesTo systematically review and update the evidence for the clinical effectiveness and cost-effectiveness of basiliximab (BAS) (Simulect,®Novartis Pharmaceuticals) and rabbit antihuman thymocyte immunoglobulin (Thymoglobuline,®Sanofi) as induction therapy and immediate-release tacrolimus [Adoport®(Sandoz); Capexion®(Mylan); Modigraf®(Astellas Pharma); Perixis®(Accord Healthcare); Prograf®(Astellas Pharma); Tacni®(Teva); Vivadex®(Dexcel Pharma)], prolonged-release tacrolimus (Advagraf,®Astellas Pharma); belatacept (BEL) (Nulojix,®Bristol-Myers Squibb), mycophenolate mofetil (MMF) [Arzip®(Zentiva), CellCept®(Roche Products), Myfenax®(Teva), generic MMF is manufactured by Accord Healthcare, Actavis, Arrow Pharmaceuticals, Dr Reddy’s Laboratories, Mylan, Sandoz and Wockhardt], mycophenolate sodium, sirolimus (Rapamune,®Pfizer) and everolimus (Certican,®Novartis Pharmaceuticals) as maintenance therapy in children and adolescents undergoing renal transplantation.Data sourcesClinical effectiveness searches were conducted to 7 January 2015 in MEDLINE (via Ovid), EMBASE (via Ovid), Cochrane Central Register of Controlled Trials (via Wiley Online Library) and Web of Science [via Institute for Scientific Information (ISI)], Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment (HTA) (The Cochrane Library via Wiley Online Library) and Health Management Information Consortium (via Ovid). Cost-effectiveness searches were conducted to 15 January 2015 using a costs or economic literature search filter in MEDLINE (via Ovid), EMBASE (via Ovid), NHS Economic Evaluation Databases (via Wiley Online Library), Web of Science (via ISI), Health Economic Evaluations Database (via Wiley Online Library) and EconLit (via EBSCOhost).Review methodsTitles and abstracts were screened according to predefined inclusion criteria, as were full texts of identified studies. Included studies were extracted and quality appraised. Data were meta-analysed when appropriate. A new discrete time state transition economic model (semi-Markov) was developed; graft function, and incidences of acute rejection and new-onset diabetes mellitus were used to extrapolate graft survival. Recipients were assumed to be in one of three health states: functioning graft, graft loss or death.ResultsThree randomised controlled trials (RCTs) and four non-RCTs were included. The RCTs only evaluated BAS and tacrolimus (TAC). No statistically significant differences in key outcomes were found between BAS and placebo/no induction. Statistically significantly higher graft function (p < 0.01) and less biopsy-proven acute rejection (odds ratio 0.29, 95% confidence interval 0.15 to 0.57) was found between TAC and ciclosporin (CSA). Only one cost-effectiveness study was identified, which informed NICE guidance TA99. BAS [with TAC and azathioprine (AZA)] was predicted to be cost-effective at £20,000–30,000 per quality-adjusted life year (QALY) versus no induction (BAS was dominant). BAS (with CSA and MMF) was not predicted to be cost-effective at £20,000–30,000 per QALY versus no induction (BAS was dominated). TAC (with AZA) was predicted to be cost-effective at £20,000–30,000 per QALY versus CSA (TAC was dominant). A model based on adult evidence suggests that at a cost-effectiveness threshold of £20,000–30,000 per QALY, BAS and TAC are cost-effective in all considered combinations; MMF was also cost-effective with CSA but not TAC.LimitationsThe RCT evidence is very limited; analyses comparing all interventions need to rely on adult evidence.ConclusionsTAC is likely to be cost-effective (vs. CSA, in combination with AZA) at £20,000–30,000 per QALY. Analysis based on one RCT found BAS to be dominant, but analysis based on another RCT found BAS to be dominated. BAS plus TAC and AZA was predicted to be cost-effective at £20,000–30,000 per QALY when all regimens were compared using extrapolated adult evidence. High-quality primary effectiveness research is needed. The UK Renal Registry could form the basis for a prospective primary study.Study registrationThis study is registered as PROSPERO CRD42014013544.FundingThe National Institute for Health Research HTA programme.

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Section: Significance For Patientsmentioning

confidence: 99%

Immunosuppressive therapy for kidney transplantation in children and adolescents: systematic review and economic evaluation

Haasova

Snowsill

Jones-Hughes

et al. 2016

Health Technol Assess

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“…/2015/ ТОМ 12/ № 5 АКТУАЛЬНОСТЬ Успешная трансплантация почки от живого родствен-ного донора (ЖРД) [1][2][3][4][5][6][7][8][9] является самым эффективным методом лечения детей с терминальной стадией хрони-ческой почечной недостаточности (ХПН): улучшаются рост и развитие детей, о чем свидетельствуют отдаленные результаты наблюдений многочисленных специализиро-ванных медицинских центров [3][4][5][6][7]. Ранее проведенные исследования были сосредоточены на изучении и анализе предпосылок, увеличивающих вероятность или реальность наступления неблагоприятных событий при пересадке органа [3][4][5]9].…”

Section: педиатрическая фармакологияunclassified

“…Ранее проведенные исследования были сосредоточены на изучении и анализе предпосылок, увеличивающих вероятность или реальность наступления неблагоприятных событий при пересадке органа [3][4][5]9]. В отделении трансплантации почки ФГБНУ «РНЦХ им.…”

Section: педиатрическая фармакологияunclassified

Predictors of Results of Living Relative Donor Kidney Transplantation in Children

Горяйнов¹,

Каабак²,

Бабенко³

et al. 2015

Pediatr. farmakol.

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“…A combined hormonal oral contraceptive pill, though very effective, might present serious complications such as thromboembolic and cardiovascular disease (Sucato & Murray, 2003). Cardiovascular disease among heart transplant recipients, which is found in 40% of patients 2 to 5 years following transplant, is a contraindication for the use of oral contraceptive pills (Morel et al, 1991). Hypertension, which is a side effect of immunosuppressant use, might represent another contraindication for the use of oral contraceptives.…”

Section: Physiological Outcomesmentioning

confidence: 99%

“…Barrier contraception provides the safest options for transplant patients (Winkler et al, 1993;Henning et al, 1988;Morel et al, 1991). Condoms decrease the risk of sexually transmitted disease, but are rarely used as the sole contraceptive option in adolescents due to the high failure rate (Sucato et al, 2003).…”

Section: Physiological Outcomesmentioning

confidence: 99%

The New Normal: A Bourdieusian Examination of Living Into Young Adulthood Being a Paediatric Heart Transplant Recipient

Mauthner

Angus

Gastaldo

et al. 2014

The Journal of Heart and Lung Transplantation

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Improved success of paediatric cardiac transplantation has resulted in increased survival of recipients into young adulthood (19 to 29 years of age). Young adults who received a heart transplant during childhood have experienced multiple life sustaining procedures. As survival and longevity increase, it is clear that transplant recipients experience negative physiological, psychological and social sequelae. With heart transplant offering individuals a chance to extend life into young adulthood, recipients need lifelong care and at age 18 they will transition from paediatric to adult healthcare facilities. The study addressed young adults circumstances of existence and their competing interests within various social environments. This research project applied Pierre Bourdieu's theoretical concepts of habitus, field and capital, to conceptualize and engage with empirical knowledge production about young adults who have received a heart transplant during childhood. Using visual methodology, focused open-ended interviews were conducted with 12 young adults who had a heart transplant during childhood. Bourdieu's work iii provided a theoretical framework to investigate transplant recipients' identities and social repositioning in relation to dominant discourses of organ transplant and shifting relationships with health services providers. This study involved an iterative process to identify recipients' encounters and new compositions in relation with others, in order to answer the research objective. These findings highlight that young adult transplant recipients struggle with relational dispositions that excludes them from various fields of social engagement; their struggle and exclusion from various fields is symbolic and is embedded in the structure of the dominant social order of the field from where they become excluded; the social order is taken up and embodied, leading young transplant recipients to practices of accommodation and "normalization". Changes

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Long-Term Quality of Life After Kidney Transplantation in Childhood

Cited by 91 publications

References 0 publications

Immunosuppressive therapy for kidney transplantation in children and adolescents: systematic review and economic evaluation

Immunosuppressive therapy for kidney transplantation in children and adolescents: systematic review and economic evaluation

Predictors of Results of Living Relative Donor Kidney Transplantation in Children

The New Normal: A Bourdieusian Examination of Living Into Young Adulthood Being a Paediatric Heart Transplant Recipient

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