Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)最新文献

Substantial improvements in short-term and long-term outcomes for kidney transplant recipients have resulted from better use of existing immunosuppressive agents and newer treatment options. Calcineurin inhibitors (e.g., cyclosporine and tacrolimus) remain the foundation of immunosuppressive therapy. These agents are considered critical-dose drugs because of their narrow therapeutic range, variable pharmacokinetics, formulation-dependent bioavailability, and negative clinical consequences of underdosing or overdosing. With the recent introduction of a new cyclosporine formulation, concern exists that current bioequivalence guidelines for generic approval may not provide adequate assessment of the safety and efficacy of critical-dose drugs. Transplant experts at 2 recent conferences recommended more rigorous criteria for bioequivalence testing of critical-dose drugs and adoption of consistent drug substitution practices. Additional recommendations included specifying the intended formulation and instituting appropriate monitoring whenever formulations are switched. A summary of the outcomes of these conferences and practice implications for transplant coordinators is discussed.

The question of patient nonadherence has always been an important factor in determining candidate suitability for organ transplantation. Data that explore the association of financial problems and posttransplant medication nonadherence are limited. Findings suggest that medication nonadherence was more likely to occur when recipients did not have insurance coverage and had to rely on Medicaid or indigent drug programs. Our center developed a formalized program within the outpatient pharmacy, including a full-time medication counselor who helped recipients secure resources to pay for pre- and posttransplant medications. To determine whether the availability of posttransplant medications could reduce medication nonadherence, we conducted a survey with 50 consecutive liver transplant recipients in the outpatient clinic. Nonadherence rates were significantly reduced from 25% to 10% (P < .01) compared with recipients who had been transplanted before the development of our drug program. These results suggest that optimum medication adherence can be obtained when recipients are provided guidance in securing their necessary medications without financial restriction.

Multiple reports of successful combined heart and kidney transplants adults suggest that this may be a viable option for a small subset of patients with coexisting end-stage heart and kidney failure. A review of the literature, however, reveals that few combined heart and kidney transplants have been reported in children. This article presents the case of a 13-year-old boy who underwent unsuccessful palliative surgery for a congenital heart defect. The patient developed heart failure with subsequent acute renal failure, and ultimately required a combined heart and kidney transplant. The combined procedure was successful in this patient and he is alive and well 27 months postoperatively.

Recent legislation in our service area has put restrictions on who is allowed to approach families about donation. Many hospitals have therefore requested training for designated requestors to speak with families. The organ procurement organization followed the consent rate of 2 hospitals to evaluate the effectiveness of the designated requestors in the consent process. This article compares the success of the hospital-based designated requestor program in obtaining consent with that of another hospital, which relies solely on the organ procurement coordinator to approach families. Thirteen staff members in hospital A received the 8-hour designated requestor training. A decrease in the consent rate at hospital A prompted the organ procurement organization to interview the 13 requestors. Possible reasons for the decline ranged from lack of experience to the lack of identification as donor family advocate. Both hospitals were encouraged to consider a multidisciplinary approach, which includes the organ procurement coordinator in the request process.