Severe intellectual disability does not preclude renal transplantation

Galante, Nelson Zocoler; Dib, Gustavo Antunes; Medina-Pestana, J.O.

doi:10.1093/ndt/gfq105

Cited by 28 publications

(29 citation statements)

References 15 publications

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“…In our survey, this included psychiatric diagnoses, cognitive disability, and citizenship. These are also characteristics that lack established clinical outcome data . The paucity of data, compounded by the ethical and emotional responses raised by these characteristics, likely contributes to a lack of consensus, policies, and consistency in decision making.…”

Section: Discussionmentioning

confidence: 99%

“…A 20‐item questionnaire was developed after a comprehensive literature review identified the most controversial medical and psychosocial characteristics relevant to liver transplant listing decisions . The survey took approximately 10 minutes to complete and queried providers about their personal opinions concerning the following patient characteristics: (1) advanced age, (2) HIV seropositivity, (3) obesity, (4) psychiatric diagnoses, (5) current incarceration, (6) marijuana use, (7) cognitive disability or mental retardation, and (8) citizenship/residency status.…”

Section: Methodsmentioning

confidence: 99%

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National survey of provider opinions on controversial characteristics of liver transplant candidates

et al. 2013

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Candidate selection for liver transplantation presents challenging ethical issues that require balancing the principles of justice and utility. The goal of this study was to assess the opinions of US transplant providers regarding the ways in which controversial medical and psychosocial characteristics influence patient eligibility for liver transplantation. An online, anonymous survey about adult patient characteristics was sent to providers (hepatologists, surgeons, psychiatrists, and social workers) at all 102 active adult liver transplant centers in the United States. A majority of the providers (251/444 or 56.5%) completed the survey. The providers were queried about 8 characteristics, and the 3 that were ranked most controversial were incarceration, marijuana use, and psychiatric diagnoses. Most providers identified a patient age 80 years (62.7%), a body mass index 45 kg/m 2 (56.6%), and current incarceration with a lifetime sentence (54.7%) as absolute contraindications to liver transplantation. In a multivariate analysis, the identification of absolute contraindications varied significantly with the provider type, the center volume, and the geographical region. Less than half of the providers reported that their centers had written policies regarding most of the characteristics examined. In conclusion, providers differ significantly in their opinions on controversial patient characteristics and transplant contraindications. Along with a paucity of literature data on outcomes, these provider differences may play a role in the fact that many centers do not have formal policies for selecting patients with these characteristics. Evidence-based data on the outcomes of such patients are needed to guide the formation of written policies to better standardize eligibility criteria.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

National survey of provider opinions on controversial characteristics of liver transplant candidates

et al. 2013

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“…Limited data from small case series suggest that children with ID, including those with an IQ <35, who receive a kidney transplant have comparable graft and recipient survival outcomes when compared to children without ID . Ohta et al.…”

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confidence: 99%

Prevalence and outcomes of renal transplantation in children with intellectual disability

Wightman

Young

Bradford

et al. 2014

Pediatric Transplantation

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Objective To describe the prevalence and outcomes of renal transplantation in children with intellectual disability (ID). Patients and Methods We performed a retrospective cohort analysis of all children receiving a first kidney alone transplant in the UNOS dataset from 2008 to 2011. Recipients with definite, probable, and without ID were compared using chi-square. Kaplan Meier curves were constructed for patient and graft survival. Cox proportional hazard models were used to estimate the association between ID and graft failure and patient survival. Results Over the study period, 332 children with definite (117) or probable (215) ID underwent first renal transplant, accounting for 16% of all first pediatric renal transplants (n=2076). Children with definite ID were not significantly different from children without ID with respect to sex, ethnicity, or prevalence of acute rejection. ID was associated with increased likelihood of deceased donor source. ID was not significantly associated with decreased graft or patient survival. Discussion In this first large-scale study, up to 16% of first pediatric renal transplants were performed in children with ID. Short-term graft and patient survival after transplant were equivalent between children with and without ID. Further research is needed to examine long-term outcomes of transplant in this population.

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“…In noncardiac areas of transplantation, there is no clear evidence that outcomes for intellectually disabled patients are poorer than outcomes for other patients [24–26]. A single case series examined five heart recipients spanning a range of intellectual disabilities and found positive outcomes in four of the five cases, with survival averaging 12 years [27].…”

Section: Emerging Issuesmentioning

confidence: 99%

Psychosocial factors and quality-of-life after heart transplantation and mechanical circulatory support

Rosenberger

Fox²,

DiMartini³

et al. 2012

Current Opinion in Organ Transplantation

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Purpose of review Psychosocial outcomes and quality-of-life (QOL) are important indicators of the success of heart transplantation and mechanical circulatory support (MCS). They warrant further research attention given the increasing frequency of these interventions and the diverse uses of MCS as destination therapy and bridge to transplant. Recent findings The literature has continued to identify correlates and predictors of psychosocial outcomes in five domains: physical functioning, psychological, behavioral, social functioning and global QOL. These issues in MCS patients, in particular, are receiving increased attention. Recent work also highlights the potential for psychosocial outcomes to predict transplant-related and MCS-related clinical outcomes, and also emphasizes issues involved in heart transplantation for older adults, heart transplantation for intellectually disabled individuals, and managing end-of-life planning in patients with MCS. Summary This field continues to be dominated by descriptive studies. Although recent work has provided a more complete picture of correlates of psychosocial outcomes, there is a need for intervention research to examine strategies to optimize these outcomes in both heart transplant and MCS populations. Clinicians should continue to monitor and address psychosocial issues with their patients in order to achieve posttransplant and postimplantation success that prolongs both quantity and QOL.

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Severe intellectual disability does not preclude renal transplantation

Abstract: Although recipients with ID have lower long-term patient survival, the equivalent graft survival rates support the indication of renal transplantation in such disability.

Cited by 28 publications

References 15 publications

National survey of provider opinions on controversial characteristics of liver transplant candidates

National survey of provider opinions on controversial characteristics of liver transplant candidates

Prevalence and outcomes of renal transplantation in children with intellectual disability

Psychosocial factors and quality-of-life after heart transplantation and mechanical circulatory support

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