| 1. |
- Frei, Ulrich, et al.
(författare)
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Acute rejection in low-toxicity regimens: clinical impact and risk factors in the Symphony study
- 2010
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Ingår i: Clinical Transplantation. - : Wiley. - 1399-0012 .- 0902-0063. ; 24:4, s. 500-509
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Tidskriftsartikel (refereegranskat)abstract
- The Symphony study assessed whether mycophenolate mofetil (MMF)-based regimens containing reduced doses of adjunct immunosuppressants could reduce toxicity while maintaining efficacy. Here, we examined the impact of acute rejection and associated risk factors. The incidence of biopsy-proven acute rejection in the low-dose tacrolimus group was approximately half that of the standard-dose cyclosporine and low-dose cyclosporine groups, and a third of that in the low-dose sirolimus group. The low-dose cyclosporine group had more severe rejection episodes (>= grade II) compared with other groups. Acute rejection was associated with a 10 mL/min glomerular filtration rate (GFR) reduction and a 5.3% absolute increase in graft loss at 12 months. Overall, the highest GFR was found in both rejecters and non-rejecters receiving low-dose tacrolimus, both in an intent-to-treat analysis and in patients successfully treated according to the protocol. In Cox regression models, human leukocyte antigen (HLA) mismatches and expanded criteria donors increased the acute rejection risk, while recipient age, living related donor, and MMF dose were associated with a reduced risk. Acute rejection was associated with worse outcome but did not entirely explain the differences among the treatment groups. The 2 g MMF plus low-dose tacrolimus combination appears to be the most efficient of all regimens examined regardless of acute rejection.
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| 2. |
- Ivarsson, Bodil, et al.
(författare)
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Recently accepted for the waiting list for heart or lung transplantation - patients' experiences of information and support.
- 2011
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Ingår i: Clinical Transplantation. - : Wiley. - 1399-0012 .- 0902-0063. ; 25, s. 664-671
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to describe the patients' experiences of the information and support they received after being placed on the waiting list for a heart or lung transplant. The design was qualitative, and the critical incident technique was used. Incidents were collected via interviews with 21 patients. A total of 357 important events, both positive and negative, were identified and divided into two main groups: Body and mind and Information and support. The following subgroups emerged: chronic illness affects the patients, attitudes towards the future, impact of information, support from public organizations, and support from the private sphere. The patients showed knowledge of and involvement in the upcoming transplantation, which indicates that healthcare professionals managed to convey information and support effectively. By identifying the importance of factors such as body and mind and information and support for patients recently accepted for heart or lung transplantation, healthcare professionals are able to make specific improvements in the information and support that they provide. An important implication is to enhance the knowledge regarding transplant patients in other institutions and improve cooperation. Specific support programs to assist patients who have dependent children should be developed. Society needs to become more enlightened about organ donation and transplantation patients.
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| 3. |
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| 4. |
- Fellström, Bengt, et al.
(författare)
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No detrimental effect on renal function during long-term use of fluvastatin in renal transplant recipients in the Assessment of Lescol in Renal Transplantation (ALERT) study
- 2006
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Ingår i: Clinical Transplantation. - : Wiley. - 0902-0063 .- 1399-0012. ; 20:6, s. 732-739
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Tidskriftsartikel (refereegranskat)abstract
- Background: Concerns have recently been raised regarding a potential harmful effect of statins on renal function. This study investigated the effect of fluvastatin treatment on renal function in renal transplant recipients enrolled in the Assessment of Lescol in Renal Transplantation (ALERT) trial. Methods: ALERT was a randomized, double-blind, placebo-controlled study of the effect of fluvastatin, 40-80 mg daily (n = 1050) or placebo (n = 1052) on cardiac and renal outcomes in renal transplant recipients over a follow-up period of five to six years. The incidence of graft loss, changes in serum creatinine, calculated creatinine clearance and proteinuria, and the incidence of renal adverse events (AEs) were assessed in both treatment groups. Results: Fluvastatin treatment in ALERT had no significant effect compared with placebo on renal function, assessed by serum creatinine (overall adjusted mean +/- SEM: fluvastatin, 175.4 +/- 2.20 mu mol/L; placebo, 172.7 +/- 2.20 mu mol/L; p = 0.39), creatinine clearance (fluvastatin, 55.3 +/- 0.30 mL/min; placebo, 55.8 +/- 0.30 mL/min; p = 0.26) or proteinuria (fluvastatin, 0.58 +/- 0.03 g/24 h; placebo, 0.53 +/- 0.03 g/24 h; p = 0.31). There were no significant differences between treatment groups when the 283 patients suffering graft loss were excluded from the analysis. Fluvastatin also had no detrimental effect on creatinine clearance or proteinuria in the subgroup of 340 diabetic patients without graft loss in ALERT. No notable differences in the rate of renal or musculoskeletal AEs were observed between fluvastatin and placebo groups. Conclusions: Fluvastatin had no detrimental effect on renal function, or the risk of renal AEs, in renal transplant recipients with or without diabetes enrolled in ALERT. Fluvastatin treatment for the prevention of cardiac events may therefore be used without fear of jeopardizing renal function.
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| 5. |
- Franzen, L., et al.
(författare)
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Letter to the editor (multiple letter)
- 2005
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Ingår i: Clinical Transplantation. - : Wiley. - 0902-0063 .- 1399-0012. ; 19:4, s. 571-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 6. |
- Hagelin, Joakim, et al.
(författare)
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Religious beliefs and opinions on clinical xenotransplantation : a survey of university students from Kenya, Sweden and Texas
- 2001
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Ingår i: Clinical Transplantation. - : Wiley. - 0902-0063 .- 1399-0012. ; 15:6, s. 421-425
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Tidskriftsartikel (refereegranskat)abstract
- This study investigated the association between religious beliefs and opinions on xenotransplantation among students from three different countries. A lower proportion of religious students accepted xenotransplantation than did non-religious students. A higher proportion of Protestant students seemed to accept xenotransplantation than did Muslim and Roman Catholic students. A higher proportion of the religious respondents had not formed an opinion on xenotransplantation compared to non-religious students. There was no difference according to gender on views on xenotransplantation, but a higher proportion of older students seemed to accept xenotransplantation than did younger students. A higher proportion of non-vegetarians reported acceptance of xenotransplantation than did vegetarians. Acceptance of xenotransplantation was higher in Sweden compared to the two other regions, and the proportion of students who had formed an opinion was higher as well.
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| 7. |
- Hagelin, Joakim, et al.
(författare)
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Students' acceptance of clinical xenotransplantation
- 2000
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Ingår i: Clinical Transplantation. - : Wiley. - 0902-0063 .- 1399-0012. ; 14:3, s. 252-256
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to elucidate undergraduate university students' views on clinical xenotransplantation. A total of 1875 students From eight faculties at Uppsala University and the Swedish University of Agricultural Sciences answered a questionnaire. Three out of four respondents would be prepared to receive a transplant from an animal on medical grounds if necessary. Forty percent had signed an organ donation card. There was no difference in attitude between those who had signed an allotransplantation card and those who had not. According to gender, age, length of university program, and faculty, results showed that a higher proportion of those who approved were male, young, and studying on programs longer than three years; also, they were more likely to study programs in the Faculties of Agriculture and Pharmacy. At the Medical Faculty, nursing studentsseemed to be less approving, compared to future biomedical analysts, biomedical scientists, and physicians. The acceptance of xenotransplantation also tended to be positively associated with morally accepting and understanding the use of animals in biomedical research, the approval of euthanasia, the approval of early abortion, and the use of human fetuses in research, as well as clinical testing of humans.
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| 8. |
- Haljamäe, Ulla, et al.
(författare)
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Remaining experiences of living kidney donors more than 3 yr after early recipient graft loss
- 2003
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Ingår i: Clinical Transplantation. - : John Wiley & Sons. - 0902-0063 .- 1399-0012. ; 17:6, s. 503-510
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Tidskriftsartikel (refereegranskat)abstract
- Living kidney donor programs, based on willingness among family members and close relatives to donate, have made it possible to perform a satisfactory number of kidney transplantations. Early graft loss in the recipient may occur and it is not known if such an event will result mainly in acute, rather transient, emotional reactions or if long-lasting reactions may be evoked in the living kidney donor. The aim of the present study was to assess and describe the remaining experiences of donors (n = 10) more than 3 yr after early recipient graft loss or death of the recipient. A phenomenographic, interview-based research approach was used. Five different fields or domains were identified: (i) the decision to donate; (ii) the information provided; (iii) care received at the time of donation; (iv) responses at graft failure; and (v) concerns remaining at the time of the interview. All donors expressed that they had volunteered to donate and that no stress had been put on them. The information given prior to and in connection with the donation procedure was deemed insufficient but all donors were satisfied with the medical care provided in connection with the nephrectomy and in the immediate post-operative period. Graft failure was immediately accepted on the intellectual level by nine of 10 donors but still evoked emotional reactions and responses included a wish that continuing contact with the transplant staff had been provided. The present interview-based study shows that it is of importance that the donor is thoroughly informed about all donor as well as recipient-related factors including the potential risk of recipient graft failure. In case of graft failure, or the death of the recipient, the transplant unit staff members should offer contact for discussions of medical matters as well as for psychosocial support. In individual cases it may be necessary to maintain such a supportive contact channel for a prolonged period of time.
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