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Related Concept Videos

Kidney Transplant I: Introduction01:28

Kidney Transplant I: Introduction

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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Kidney Transplant II: Surgical Procedure01:26

Kidney Transplant II: Surgical Procedure

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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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Kidney Transplant III: Nursing Management01:16

Kidney Transplant III: Nursing Management

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Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
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Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test01:22

Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test

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In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
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Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow01:26

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Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug...
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Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

78
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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Prescriptive Analytics Determining Which Patients Undergoing Simultaneous Liver-Kidney Transplant May Benefit From

Mohini Dasari1, James D Perkins, James B Hendele

  • 1From the Department of Surgery, UW Medicine Kidney and Pancreas Transplantation Program, University of Washington, Seattle, Washington, USA.

Experimental and Clinical Transplantation : Official Journal of the Middle East Society for Organ Transplantation
|December 24, 2021
PubMed
Summary

For simultaneous liver-kidney transplants, accepting high-risk organs may offer survival benefits for some patients. A new decision tool helps transplant programs advise candidates on high-risk organ acceptance versus waiting.

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Area of Science:

  • Transplantation Medicine
  • Medical Decision Making
  • Organ Procurement

Background:

  • Simultaneous liver-kidney transplant is a vital option for patients with end-stage liver disease and kidney failure.
  • Advising candidates on accepting high-risk grafts versus waiting presents a complex clinical challenge.

Purpose of the Study:

  • To develop a decision tool for transplant programs to guide patients on simultaneous liver-kidney transplant graft acceptance.
  • To identify critical factors influencing the decision to accept high-risk organs.

Main Methods:

  • Prescriptive analytic microsimulation was employed to analyze decision factors.
  • Organ Procurement and Transplantation Network data from 2002 to 2018 informed the simulation model's probabilities.

Main Results:

  • On average, accepting high-risk organs yielded 254.8 weeks of life, versus 285.6 weeks for waiting.
  • Individual program organ offer rates and candidate waitlist rank are critical decision factors.
  • High-risk candidates may benefit from accepting high-risk organs in programs with lower offer rates or for rare blood types.

Conclusions:

  • The developed model can determine when accepting high-risk organs for simultaneous liver-kidney transplant offers a survival advantage.
  • Program-specific probabilities are essential for personalized patient guidance.