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Biomedical subjects

Lisa Daly

Publications and source records attributed to Lisa Daly.

6 recordsLinked to original sources

The impact of pancreas transplantation on patient employment opportunities.

BACKGROUND: A questionnaire study was designed to determine whether the quality of life benefit provided by receiving a kidney-pancreas (KP) transplant increased the incentive to return to work, compared with patients receiving a kidney alone (KA) transplant. METHODS: A confidential questionnaire was sent to 58 patients with insulin-dependent diabetes mellitus who had functioning grafts at least 6 months post-transplant. Thirty-eight patients had received a KP transplant and 20 patients, a KA transplant. RESULTS: Eighty-three percent of patients returned the questionnaire (87% of KP and 75% of KA patients [p: non-significant (ns)]. The pre-transplant demographic variables of age, gender, educational status, and need for dialysis, were equivalent between the KP and KA groups, respectively (p: ns). At the time of transplantation 39% of KP patients and 33% of KA patients were employed at least 20 h/wk (p: ns). However, post-transplant significantly more KP patients (73%) were working compared with KA patients (27%, p: 0.04). Additionally, pre-transplant employment was independently associated with post-transplant work status (p: 0.01). CONCLUSION: These data suggest that the improvement in quality of life associated with pancreas transplantation provide an added incentive for diabetics with renal insufficiency to seek employment.

Adult↗

Rapid steroid withdrawal in hepatitis C virus-positive kidney transplant recipients.

The effects of rapid steroid withdrawal (SW) on kidney transplantation (KT) outcome were investigated in 12 HCV+ patients in a prospective cohort study. These results were compared with 17 HCV+ patients who received KT in the prior 2 yr and treated with a standard prednisone taper protocol. SW patients received only 6 d of steroid treatment after transplantation. Eleven received Thymoglobulin and one Basiliximab induction treatment along with a calcineurin inhibitor and mycophenolate mofetil. Patient and graft survival was 92% in SW group (median follow-up 12 months, range 6-17), and 92 and 82% in the historic control group respectively (median follow-up 21 months, range 11-27). In the SW and control group, acute rejection rates were 9 and 18%, and mean creatinine levels at last follow-up 1.30 +/- 0.36 and 1.68 +/- 0.58 mg/dL respectively. Only two SW patients had an increase in liver function tests during follow-up (18%), compared with six patients in the control group (43%). This study demonstrates that rapid SW is safe for HCV+ KT recipients, without an increase in acute rejection episodes or liver function abnormalities in the short term.

Adult↗

Intravenous immunoglobulin and thymoglobulin facilitate kidney transplantation in complement-dependent cytotoxicity B-cell and flow cytometry T- or B-cell crossmatch-positive patients.

BACKGROUND: The aim of this study was to investigate the effect of Thymoglobulin and intravenous immunoglobulin (i.v.IG) therapy on the clinical outcome of a putatively high-risk group of kidney transplant recipients who have positive B-cell complement-dependent cytotoxicity (CDC) along with positive T- or B-cell flow cytometry (FC) crossmatch results. METHODS: We prospectively studied the effects of i.v.IG and Thymoglobulin induction treatment in B-cell CDC, and T- or B-cell FC crossmatch-positive kidney transplant recipients (seven women and one man; mean age, 43+/-12 years). RESULTS: Mean peak panel-reactive antibody (PRA) was 47+/-32. Three patients had donor-specific antibody by flow PRA (two anti-DR4 and one anti-A2). Each recipient received induction treatment with i.v.IG 100 mg/kg for 3 days and Thymoglobulin 1.5 mg/kg for 5 days after transplantation. No acute cellular rejections occurred during a median follow-up of 15 months (range, 12-17 months). Only one acute humoral rejection occurred 8 days after transplantation, which responded to plasmapheresis, i.v.IG, and rituximab. One allograft was lost because of polyoma nephritis. Patient survival was 100% and allograft survival was 88%. CONCLUSION: Our results indicate that i.v.IG and Thymoglobulin induction treatment may facilitate kidney transplantation in B-cell CDC and T- or B-cell FC crossmatch-positive patients.

Adult↗

Cytomegalovirus disease in high-risk transplant recipients despite ganciclovir or valganciclovir prophylaxis.

The clinical patterns and predictors of cytomegalovirus (CMV) disease in kidney and/or pancreas transplant patients on ganciclovir (1.0 g po t.i.d.) or valganciclovir (450 mg po q.d.) prophylaxis were studied. This is a retrospective analysis of 129 transplant recipients. Median follow up was 12 months (range, 6-18 months). The overall incidence of CMV disease at 1-year post-transplant was 14% (4% tissue-invasive, 10% noninvasive). Seventeen of 18 patients were diagnosed with CMV after completion of 3 months' prophylaxis (median 8 weeks, range, 2-28 weeks). Induction treatment with thymoglobulin, and Donor +/Recipient - CMV status were the strongest predictors for the development of CMV disease. Cytomegalovirus incidence was not different between patients treated with ganciclovir or valganciclovir (15 vs. 17%, respectively). Valganciclovir (450 mg q.d.) is as effective as oral ganciclovir in CMV prophylaxis. High-risk individuals might require higher doses or longer duration of valganciclovir treatment.

Antiviral Agents↗

An online communication tool alters the way patients find information.

Epilepsy Patients and users of an online educational and communication resource were polled about their information needs over time. Subjects appear to prefer to communicate with their specialist digitally rather than talk on the telephone or have a face-to-face visit. The longer the patients have access to the resource, the less likely they are to plan to make a face-to-face doctors office visit for information needs.

Communication↗

Anticonvulsants.

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Anticonvulsants↗