Medical Management of Transplant Patients

2018 ◽  
Author(s):  
Nidyanandh Vadivel ◽  
Nelson B Goes
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Viral Infection ◽  
Kidney Transplant ◽  
Medical Management ◽  
The United States ◽  
Long Term Outcome ◽  
Post Transplant

Kidney transplant is the best form of renal replacement therapy for most end-stage kidney disease patients due to improved quality of life and superior patient survival compared to chronic maintenance dialysis. Long-term outcome of kidney allograft recipients depends on the longevity of the allograft and optimal management of their comorbidities such as cardiovascular disease risk factors. According to organ procurement and transplant data in the United States, 14.5% of the deceased donor kidney wait list comprised patients who failed their first allograft and were awaiting second kidney transplant. Optimal immunosuppression management is key to both short- and long-term outcomes of allograft transplant by preventing rejection while avoiding or minimizing risk of over immunosuppression such as with infections and neoplasia. Cardiovascular disease is the leading cause of mortality after kidney transplant. It accounts for approximately 50% of deaths in the post transplant period and 30% of deaths among patients with preserved renal allograft function. Hence, it is crucial to optimally manage cardiovascular risk factors such as hypertension and diabetes post transplant. In this chapter, we review medical management of kidney transplant recipients, including commonly used induction therapies, maintenance immunosuppressive agents, and posttransplant medical complications such as posttransplant diabetes mellitus, hypertension, cardiovascular disease, bone disease, and BK viral infection. This review contains 1 table and 47 references Key Words: kidney transplantation, immunosuppression, rejection, post transplant diabetes mellitus (PTDM), BK viral infection,  calcineurin inhibitors,

Medical Management of Transplant Patients

2018 ◽  
Author(s):  
Nidyanandh Vadivel ◽  
Nelson B Goes
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Viral Infection ◽  
Kidney Transplant ◽  
Medical Management ◽  
The United States ◽  
Long Term Outcome ◽  
Post Transplant

Kidney transplant is the best form of renal replacement therapy for most end-stage kidney disease patients due to improved quality of life and superior patient survival compared to chronic maintenance dialysis. Long-term outcome of kidney allograft recipients depends on the longevity of the allograft and optimal management of their comorbidities such as cardiovascular disease risk factors. According to organ procurement and transplant data in the United States, 14.5% of the deceased donor kidney wait list comprised patients who failed their first allograft and were awaiting second kidney transplant. Optimal immunosuppression management is key to both short- and long-term outcomes of allograft transplant by preventing rejection while avoiding or minimizing risk of over immunosuppression such as with infections and neoplasia. Cardiovascular disease is the leading cause of mortality after kidney transplant. It accounts for approximately 50% of deaths in the post transplant period and 30% of deaths among patients with preserved renal allograft function. Hence, it is crucial to optimally manage cardiovascular risk factors such as hypertension and diabetes post transplant. In this chapter, we review medical management of kidney transplant recipients, including commonly used induction therapies, maintenance immunosuppressive agents, and posttransplant medical complications such as posttransplant diabetes mellitus, hypertension, cardiovascular disease, bone disease, and BK viral infection. This review contains 1 table and 47 references Key Words: kidney transplantation, immunosuppression, rejection, post transplant diabetes mellitus (PTDM), BK viral infection,  calcineurin inhibitors,

Medical Management of Atherosclerotic Risk Factors in Vascular Surgery Patients

2015 ◽  
Author(s):  
Jayer Chung
Keyword(s):  
United States ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Vascular Surgery ◽  
Medical Management ◽  
Antiplatelet Agents ◽  
The United States ◽  
Moderate Intensity ◽  
National Committee ◽  
Atherosclerotic Risk Factors

There is an epidemic of cardiovascular disease in the United States, which is responsible for approximately one death every 40 seconds in the United States. Whereas the overall mortality attributable to cardiovascular disease is decreasing, the overall prevalence of atherosclerotic risk factors is increasing. Optimal management of atherosclerotic risk factors can have profound effects on morbidity and mortality after vascular surgical procedures. This review covers risk factors for the development of atherosclerosis; the evaluation of patients with vascular disease; management of tobacco abuse, hypertension, hyperlipidemia, diabetes mellitus, and antiplatelet agents; and perioperative medical management concerns in vascular surgery. Tables highlight investigational biomarkers for atherosclerosis, behavioral modification recommendations to be used to improve smoking cessation, Eighth Joint National Committee guidelines for blood pressure management, definitions of high- and moderate-intensity statin therapy, and potential future areas of research. Algorithms lay out the effects of cigarette smoke, the proposed mechanism of statin pleiotropy as it pertains to the vasculature, and the proposed mechanisms of the role of hyperglycemia in atherogenesis. This review contains 3 figures, 6 tables, and 79 references.

Abstract 237: Prevalence of Cardiovascular Risk Factors and Cardiovascular Disease in Transgender Persons in The United States

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Aditi Malhotra ◽  
Hal A Skopicki ◽  
Smadar Kort ◽  
Noelle Mann ◽  
Puja Parikh
Keyword(s):  
Diabetes Mellitus ◽  
United States ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Chronic Obstructive Pulmonary Disease ◽  
Chronic Kidney Disease ◽  
The United States ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Transgender Persons

Background: There is a paucity of data regarding prevalence of cardiovascular disease (CVD) and corresponding cardiovascular (CV) risk factors in transgender individuals. We sought to assess the prevalence of CV risk factors and CVD in transgender persons in the United States. Methods: The 2018 Centers for Disease Control’s Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of 1,038 transgender individuals in the United States. Presence of CVD was noted with a single affirmative response to the following questions: “Has a health care professional ever told you that you had any of the following:” (1) a heart attack or myocardial infarction, (2) angina or coronary heart disease, (3) a stroke? Results: Among the 1,038 transgender individuals studied, a total of 145 (14.0%) had CVD while 893 (86.0%) did not. No differences in prevalence of CVD was noted in transgender individuals who transitioned from male-to-female (n=387), female-to-male (n=400), and gender nonconforming status (n=251) (15.0% vs 13.8% vs 12.7%, p=0.72). Transgender individuals with CVD were older, had lower annual income, higher rates of smoking (28.4% vs 18.1%, p=0.004), and higher rates of multiple co-morbidities including asthma (26.6% vs 17.4%, p = 0.009), skin cancer (21.8% vs 5.0%, p <0.001), non-skin cancers (16.8% vs 6.8%, p <0.001), chronic obstructive pulmonary disease (27.5% vs 7.0%, p <0.001), arthritis (65.3% vs 28.7%, p<0.001), depressive disorder (42.7% vs 31.0%, p= 0.006), chronic kidney disease (16.2% vs 3.3%, p< 0.001), and diabetes mellitus (42.0% vs 12.7%, p <0.001). No significant differences in race, health insurance status, or body mass index was noted between transgender individuals with CVD versus those without. In multivariable analysis, independent predictors of CVD in transgender individuals included older age, diabetes mellitus [odds ratio (OR) 2.82, 95% confidence interval (CI) 1.73 - 4.58], chronic kidney disease (OR 3.69, 95% CI 1.80 - 7.57), chronic obstructive pulmonary disease (OR 2.18, 95% CI 1.19 - 3.99), and depressive disorder (OR 1.82, 95% CI 1.09 - 3.03). Conclusions: In this observational contemporary study, CVD was prevalent in 14% of transgender individuals in the United States. Predictors of CVD in the transgender population exist and transgender persons should be appropriately screened for CV risk factors so as to minimize their risk of CVD.

scholarly journals Post-Transplant Cardiovascular Disease

2021 ◽  
pp. CJN.00520121
Author(s):  
Kelly A. Birdwell ◽  
Meyeon Park
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Kidney Transplant ◽  
Optimal Strategies ◽  
Future Research ◽  
Kidney Transplant Recipients ◽  
Post Transplant ◽  
Treatment And Prevention ◽  
Artery Disease

Cardiovascular disease remains a leading cause of death and morbidity in kidney transplant recipients and a common reason for post-transplant hospitalization. Several traditional and nontraditional cardiovascular risk factors exist, and many of them present pretransplant and worsened, in part, due to the addition of immunosuppression post-transplant. We discuss optimal strategies for identification and treatment of these risk factors, including the emerging role of sodium-glucose cotransporter 2 inhibitors in post-transplant diabetes and cardiovascular disease. We present common types of cardiovascular disease observed after kidney transplant, including coronary artery disease, heart failure, pulmonary hypertension, arrhythmia, and valvular disease. We also discuss screening, treatment, and prevention of post-transplant cardiac disease. We highlight areas of future research, including the need for goals and best medications for risk factors, the role of biomarkers, and the role of screening and intervention.

Post-transplant diabetes mellitus: risk factors, frequency of transplant rejections, and long-term prognosis

2005 ◽  
Vol 9 (2) ◽  
pp. 164-169 ◽  
Author(s):  
Ralf Schiel ◽  
Sebastian Heinrich ◽  
Thomas Steiner ◽  
Undine Ott ◽  
Günter Stein
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Post Transplant ◽  
Long Term Prognosis ◽  
Diabetes Mellitus Risk

Abstract 129: My Unlimited Potential: Multidimensional Workplace Life Style Modification Program Associated With Reduction in Cardiovascular Disease Risk Among Employees With Type 2 Diabetes

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Sankalp Das ◽  
Maribeth Rouseff ◽  
Henry Guzman ◽  
Thinh Tran ◽  
Doris Brown ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Dietary Habits ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
South Florida ◽  
Improvement Program ◽  
Short And Long Term

Background: Diabetes mellitus is one of the leading conditions resulting in high health costs and lost productivity. In recent year there is a growing interest for managing these chronic conditions through engagement of workplace wellness programs. In this study we examined the short and long term effects of an ongoing multicomponent lifestyle intervention improvement program (My Unlimited Potential (MyUP), among employees of Baptist Health South Florida (BHSF), a large not-for-profit health care system. Method: The present analysis focuses on the efficacy of an intensive lifestyle workplace intervention among individuals presenting with diabetes mellitus. The intervention provided tools to improve physical activity, stress and dietary habits. A multi-disciplinary team made up of an advanced nurse practitioner (ARNP), registered dietician (RD), exercise physiologist (EP), certified diabetic educator (CDE), and registered nurse (RN) met with participants to provide one-on-one counseling and training. Results: The current study assessed 33 (58 years +/- 8.8, 67% female) employees with diabetes mellitus enrolled in the MyUp wellness program who completed baseline, 12-weeks, 6 months and 1 year assessments. Significant short and long term improvements in cardio-metabolic risk factors were observed (Table1). Positive change in distribution of cardiovascular risk factors was noticed at 3, 6 and 12 months (Fig1). Conclusion: These results suggest that a multi component workplace lifestyle modification program results in both short and long term improvement in cardiovascular disease risk among employees with diabetes mellitus. Further large studies are needed to confirm our study findings.

scholarly journals Post-Transplant Diabetes Mellitus in Kidney Transplant Recipients: A Multi-Center Study

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0000862021
Author(s):  
Rubab F. Malik ◽  
Yaqi Jia ◽  
Sherry G. Mansour ◽  
Peter P. Reese ◽  
Isaac E. Hall ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Kidney Transplant ◽  
Graft Failure ◽  
De Novo ◽  
Kidney Transplant Recipients ◽  
Post Transplant ◽  
Kidney Recipients ◽  
Recipient Age

Background: De novo post-transplant diabetes mellitus (PTDM) is a common complication after kidney transplant (KT). Most recent studies are single-center with various approaches to outcome ascertainment. Methods: In a multi-center longitudinal cohort of 632 non-diabetic adult kidney recipients transplanted in 2010-2013, we ascertained outcomes through detailed chart review at 13 centers. We hypothesized that donor characteristics such as sex, HCV infection, and kidney donor profile index (KDPI) and recipient characteristics such as age, race, BMI, and increased HLA mismatches would affect the development of PTDM among KT recipients. We defined PTDM as hemoglobin A1c ≥6.5%, pharmacological treatment for diabetes, or documentation of diabetes in electronic medical records. We assessed PTDM risk factors and evaluated for an independent time-updated association between PTDM and graft failure using regression. Results: Mean recipient age was 52±14 years, 59% were male, 49% were Black. Cumulative PTDM incidence 5 years post-KT was 29% (186). Independent baseline PTDM risk factors included older recipient age (p<0.001) and higher BMI (p=0.006). PTDM was not associated with all-cause graft failure [adjusted Hazard Ratio (aHR) 1.10 (95% CI: 0.78-1.55)], death-censored graft failure [aHR 0.85 (0.53-1.37)], or death [aHR 1.31 (0.84-2.05)] at median follow-up of 6 (4.0,6.9) years post-KT. Induction and maintenance immunosuppression were not different between patients who did and did not develop PTDM. Conclusions: PTDM occurred commonly, and higher baseline BMI was associated with PTDM. PTDM was not associated with graft failure or mortality during the 6-year follow-up, perhaps due to short follow-up.

Incidence and Risk Factors of Post Transplant Diabetes Mellitus in Kidney Transplant Recipients in Qatar

2018 ◽  
Vol 102 ◽  
pp. S648
Author(s):  
Mohamad Alkadi ◽  
Shaefiq Thappy ◽  
Essa Abuhelaiqa ◽  
Jehan Mahmoud ◽  
Mona Jarman ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Kidney Transplant ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplant
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