RESUMEN
A self-assessment instrument for use at home by transplant recipients was developed to help foster partnership between patients and their healthcare provider. Self-monitoring at home has not replaced the need for close follow-up but does allow patients to provide concrete data to their healthcare provider in order to promote earlier detection of and response to adverse events. Patients are taught the essentials of self-monitoring while they are in the hospital for their transplant. Patients who perform routine self-assessment would be able to detect and provide information about problems early in the course of events. Thus, early intervention could potentially decrease the severity of the problem and prevent repeated hospitalizations. The concern that patients would not be able to perform a reliable self-assessment was unfounded; patients exceeded expectations and embraced the opportunity to communicate physical signs and symptoms effectively.
Asunto(s)
Trasplante de Órganos , Educación del Paciente como Asunto , Autoevaluación (Psicología) , Humanos , Cooperación del Paciente , Relaciones Médico-Paciente , Calidad de VidaAsunto(s)
Difusión de Innovaciones , Trasplante de Riñón , Investigación en Enfermería/organización & administración , Calidad de Vida , Promoción de la Salud , Humanos , Trasplante de Riñón/enfermería , Trasplante de Riñón/psicología , Trasplante de Riñón/rehabilitación , Educación del Paciente como Asunto , Apoyo Social , TennesseeRESUMEN
Transplantation has enhanced the quality of life of all transplant recipients, but concern remains regarding the side effects of immunosuppressant drugs. In order to respond to these concerns, a survey to ascertain the side effect profile of transplant recipients was undertaken to identify the impact of chronic immunosuppression on quality of life. A nationwide survey of solid organ transplant recipients was carried out using a newly developed immunosuppressant side effect survey. Kidney, kidney-pancreas, liver and heart recipients responded to the survey (n = 505) and reflect the national distribution based on the UNOS data for organ type, recipient race and gender. The survey had four subscales: emotional burden, life/role responsibilities, mobility and GI distress. A fifth subscale included miscellaneous side effects that are more prevalent during the first 2 years post-transplant. Frequency and severity of each side effect were coded on a scale of 0-4 from 'no problem' to 'always' a problem. The entire range of possible scores (0-160) was reported, reflecting adequate variability in the responses. The sample consisted of 51% males, 77% Caucasians, 15% African Americans, with the remaining 8% other races. There were 225 (44.5%) kidney, 147 (29.1%) liver, 101 (20%) heart and 32 (6.4%) pancreas included. Age ranged from 18-71 years with time since transplant 1-21 years. Overall frequency (12.1 +/- 6.08), severity (10.5 +/- 6.96) and weighted scores (25.4 +/- 19.9) were low suggesting that, as a whole, immunosuppressant side effects, while present, were not severe or troublesome for most patients. Side effect profiles appeared similar among organ types. Differences were detected in the GI distress subscale with the heart recipients reporting significantly less GI distress than liver recipients (13.8 vs. 19.2; P<0.05). Side effect impact on mobility tended to increase between time eras; however, no statistical significance was detected. Side effects are a concern among health-care professionals; however, based on the results of this study, immunosuppressant-related side effects are not detrimental to quality of life and show no differences between types of organ transplanted.
Asunto(s)
Inmunosupresores/efectos adversos , Trasplante de Órganos , Adulto , Anciano , Análisis Factorial , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Estados UnidosRESUMEN
The return to work after transplantation has been actively discussed in the transplant community for years. However, despite the desire for transplant practitioners to have recipients return to being healthy, contributing members of society as well as return to work, practitioners often passively support the sick role. We discovered that patients who are returning to work after transplantation may have been out of the work force for several years, and require assistance that we as health care providers were unable or untrained to provide. An employment specialist was added to the transplant staff and became a vital part of our attempts to create a proactive employment atmosphere and enhance our patients' quality of life. Adding an advocate for employment in our center has also facilitated the shift in our thinking and approach to care from the sick role to one of rehabilitation and from reactive to proactive. This change in attitude has assisted in empowering our recipients to feel as if they can truly resume a normal life.
Asunto(s)
Personas con Discapacidad , Empleo , Trasplante de Órganos/rehabilitación , Orientación Vocacional , Adulto , Enfermedad Crónica , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Desarrollo de Programa , Desarrollo de PersonalRESUMEN
The Internet is a global communication network used by more than 17.6 million adults as a major source of current health information. Both the number of health-related Web sites and the number of Web users are increasing exponentially as well as reports indicating a growth in the number of persons who access the Internet specifically to retrieve information about organ transplantation. However, few are using this medium for posttransplant educational or psychosocial purposes. Armed with this information, as well as a commitment from the transplant team, we chose to develop a Web-based educational program to facilitate posttransplant care for our transplant recipients. The purpose of this article is to describe the planning, development, and implementation of a Web-based education program for transplant recipients.
Asunto(s)
Internet , Trasplante de Órganos , Educación del Paciente como Asunto/métodos , Implementación de Plan de Salud/métodos , HumanosRESUMEN
The return to work after transplantation has been actively discussed in the transplant community for years. However, despite the desire for transplant practitioners to have recipients return to being healthy, contributing members of society as well as return to work, practitioners often passively support the sick role. We discovered that patients who are returning to work after transplantation may have been out of the work force for several years, and require assistance that we as healthcare providers were unable or untrained to provide. An employment specialist was added to the transplant staff and became a vital part of our attempts to create a proactive employment atmosphere and enhance our patients' quality of life. Adding an advocate for employment in our center has also facilitated the shift in our thinking and approach to care from the sick role to one of rehabilitation and from reactive to proactive. This change in attitude has assisted in empowering our recipients to feel as if they can truly resume a normal life.
Asunto(s)
Empleo/organización & administración , Trasplante de Riñón/rehabilitación , Trasplante de Páncreas/rehabilitación , Adulto , Humanos , Trasplante de Riñón/psicología , Masculino , Trasplante de Páncreas/psicología , Evaluación de Programas y Proyectos de Salud , Calidad de Vida , Rol del Enfermo , Orientación Vocacional/organización & administraciónRESUMEN
Social support can have great influence on health, well-being, and general quality of life To promote awareness of the social network that surrounds each transplant recipient, transplant social workers are now using the Social Network Map as an intervention. Because perceptions of availability and accessibility of support are key elements in the use of social network resources, awakening an individual's awareness of available resources is a significant first step in enhancing social support and, ultimately, quality of life. The Social Network Map is used to establish dialogue regarding individuals' needs and sources of support, and then how the support system can meet those needs. Transplant social workers thus foster active use of those people in transplant recipients' networks who can meet the particular needs recipients identify.
Asunto(s)
Redes Comunitarias , Trasplante de Riñón/psicología , Trasplante de Riñón/rehabilitación , Apoyo Social , Servicio Social/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Previous research in quality of life (QoL) in renal transplant recipients has identified three factors predictive of improved QoL: reduction in adverse events, facilitation of employment, and enhancement of social support. After a decade of QoL outcome research, the researchers have proposed a multidisciplinary approach to posttransplant care by developing a clinical pathway using the three predictive factors. Putting into practice the research outcome, this pathway systematically addresses and evaluates each of the study arms and the impact on QoL. A clinical team has been instrumental in developing a model of practice that incorporates the research outcomes.
Asunto(s)
Vías Clínicas/organización & administración , Trasplante de Riñón/psicología , Evaluación de Resultado en la Atención de Salud/organización & administración , Grupo de Atención al Paciente/organización & administración , Calidad de Vida , Empleo , Conocimientos, Actitudes y Práctica en Salud , Humanos , Fallo Renal Crónico/psicología , Fallo Renal Crónico/cirugía , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/enfermería , Trasplante de Riñón/rehabilitación , Modelos Psicológicos , Investigación en Enfermería , Valor Predictivo de las Pruebas , Apoyo SocialRESUMEN
Sudden cardiac death occurring in patients with end-stage renal disease (ESRD) may be related to poor autonomic function (AF). It is not known whether patients having a sudden death can be identified by commonly used AF evoked tests or if a newer test evaluating heart rate variability (HRV) with power spectral analysis can better distinguish at-risk patients. This study sought to characterize AF in patients awaiting kidney transplantation, to identify factors associated with poor AF and sudden death, and to compare evoked versus 24-hour measures of cardiac AF. All patients underwent evoked cardiac AF tests, which included changes in heart rate with deep breathing (deltaBPM) and valsalva (VR). In addition, 24-hour HRV was assessed with time domain measurements of interbeat variability (pNN50, SDANN, and SDNN), which are associated with vagal function, circadian function, and sudden cardiac death (SDNN < 50), respectively. Frequency domain measures obtained by power spectral analysis (total, low, and high hertz) quantify total neural, sympathetic, and parasympathetic activity of the heart, respectively. Data were collected on 184 nondiabetic patients, 60 type 1 diabetic patients, and 34 type 2 diabetic patients with ESRD referred for transplantation. Five patients, all receiving peritoneal dialysis, experienced nontraumatic sudden cardiac death during the study. Evoked and 24-hour HRV control data were obtained from 67 and 48 healthy adults, respectively. Data show that regardless of subgroup, there was significant AF dysregulation in the 278 patients with ESRD, particularly for those with diabetes and those receiving peritoneal dialysis. Frequency domain measurements (three in each group: nondiabetic patients, type 1 diabetic patients, type 2 diabetic patients, deceased patients, hemodialysis patients, peritoneal dialysis, and nondialysis patients [n = 21]) were most sensitive to dysregulation, with 16 of 21 (76%) measurements more than 2 SD from the mean of the control group. This is in contrast to the time domain measurements (one of 21 [0.04%] > 2 SD from the mean of the control group) and evoked measurements (eight of 14 [57%] outside of the established norms). Of the five deceased patients, only one displayed normal values for all eight AF measurements reported; three (60%) had SDNNs less than 50. Of the 248 surviving patients, 42 (17%) had an SDNN less than 50. When analyzed, the ability of the SDNN to identify an at-risk group was found to have a sensitivity of 60%, a specificity of 83%, a positive predictive value of 7%, a negative predictive value of 99%, and an accuracy of 83%. While AF and time on dialysis were not found to be correlated, the length of diabetes was inversely related to all AF measures (r = -0.27 to -0.48; P < 0.0001), except pNN50. These data suggest that all groups of ESRD patients have severely compromised AF and, regardless of the type of diabetes, those with diabetes have the greatest degree of dysregulation. In addition, individuals receiving peritoneal dialysis were more prone to dysregulation, and the SDNN, a time domain measurement of 24-hour HRV, holds the promise of identifying patients at increased risk for early death in this population.
Asunto(s)
Muerte Súbita Cardíaca/etiología , Frecuencia Cardíaca , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/fisiopatología , Trasplante de Riñón , Adulto , Estudios de Casos y Controles , Complicaciones de la Diabetes , Electrocardiografía Ambulatoria , Femenino , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Diálisis Renal , Riesgo , Sensibilidad y Especificidad , Factores de TiempoRESUMEN
UNLABELLED: Quality of life (QoL) is generally found to improve for renal transplant recipients, although some patients continue to experience health-related problems. It was within this context that we undertook our investigation which focused on identifying the factors predictive of QoL following kidney transplantation. METHODS: The sample included 91 non-diabetic patients of which 69 provided 6-month data and 68 provided 12-month data. Three QoL questionnaires were administered to capture as many QoL dimensions as possible. Repeated measure analyses of variance with multiple post hoc comparisons of LS means was conducted to determine how QoL outcomes differed over time. Correlational analyses were performed on the 12-month dataset to determine which variables to include in the modeling process. Multiple stepwise regression with forward and backward entry were used in the prediction modeling. RESULTS: Essentially all patients experienced a significant improvement in QoL and the improvement occurred early and appeared to be sustained. Five separate prediction models were constructed, each including number of hospital days in first 6 months, employment, and social support. CONCLUSIONS: The similarity of the five models is of note. It is not necessarily these specific variables per se that predict QoL outcomes, but rather what they conceptually represent. These findings provide direction for interventions designed to enhance post-transplant QoL.
Asunto(s)
Trasplante de Riñón/psicología , Calidad de Vida , Adulto , Anciano , Análisis de Varianza , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Análisis de Regresión , Autoevaluación (Psicología) , Perfil de Impacto de Enfermedad , Apoyo Social , Encuestas y CuestionariosRESUMEN
The UT-Memphis Group has made a number of important contributions to the field of PTX including: 1. Pioneering studies on the effects of PTX on autonomic neuropathy;(15, 16) 2. Comprehensive reports dealing with quality of life after PTX;(17, 18, 38) 3. Seminal studies on the metabolic effects of PTX with portal venous delivery of insulin;(33,34) 4. Refining and perfecting a novel technique of PTX with portal venous drainage of insulin and primary enteric drainage of the exocrine secretions;(2,6,11,19) 5. Describing a percutaneous technique of pancreas biopsy;(20) and 6. Pioneering the use of glucose tolerance for rejection surveillance.(24) The P-E technique has the potential to become the standard of care in the near future because it is more physiologic, normalizes carbohydrate and lipid metabolism, and minimizes complications attributed to the transplant procedure. In addition, we have been actively involved in studying new immunosuppressive regimens in order to improve and simplify the care of the PTX recipient. We believe that PTX will remain an important option in the treatment of IDDM until other strategies are developed that can provide equal glycemic control with less or no immunosuppression or less overall morbidity.
Asunto(s)
Trasplante de Páncreas/métodos , Trasplante de Páncreas/estadística & datos numéricos , Adulto , Arterias/cirugía , Femenino , Rechazo de Injerto/epidemiología , Supervivencia de Injerto , Prueba de Histocompatibilidad , Hospitales Universitarios/estadística & datos numéricos , Humanos , Inmunosupresores/uso terapéutico , Masculino , Arteria Mesentérica Superior/cirugía , Trasplante de Páncreas/mortalidad , Trasplante de Páncreas/fisiología , Vena Porta/cirugía , Estudios Retrospectivos , Bazo/irrigación sanguínea , Tasa de Supervivencia , TennesseeRESUMEN
Following 10 years of descriptive quality-of-life studies, an innovative approach to outpatient care has been developed to decrease adverse events, increase employment, and enhance social support among renal transplant recipients. These 3 variables were found in the authors' previous studies to be predictive of increased quality of life following transplantation. With funding from the National Institute of Nursing Research, a multidisciplinary team has been assembled to implement the interventions identified. This article reviews the previous work that led to the development of the intervention study and demonstrates how research can guide practice.
Asunto(s)
Adaptación Psicológica , Trasplante de Órganos/psicología , Satisfacción del Paciente , Calidad de Vida , Humanos , Investigación en Enfermería , Grupo de Atención al Paciente , Apoyo a la Investigación como AsuntoRESUMEN
Prednisone tapering has become more common in the management of transplant recipients. Benefits of this practice, however, must be weighed against the risks. This study identified outcomes associated with variable low dose prednisone protocols. The study sample included 98 kidney and kidney-pancreas transplant recipients 1 year after transplant. Graft function, side effects of steroid therapy, and quality of life were recorded on patients receiving 0 (n = 5), 1 to 5 (n = 4), 5 to 7.5 (n = 5), 7.5 to 10 (n = 21), and greater than 10 mg/d prednisone (n = 63). Despite the fact that patients were assigned to the low dose groups because they were at risk for or already experiencing steroid induced side effects, the low dose groups presented side effect and quality of life profiles similar to or better than those of the standard dose group.
Asunto(s)
Antiinflamatorios/uso terapéutico , Trasplante de Riñón/psicología , Prednisona/uso terapéutico , Calidad de Vida , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación Metodológica en Enfermería , Trasplante de Páncreas/psicología , Encuestas y CuestionariosRESUMEN
We have previously shown that both kidney-alone and combined kidney-pancreas transplantation lower VLDL and IDL apoB while increasing LDL apoB, apoA-I, and HDL free cholesterol (FC). In this report, we analyze the lipoproteins of 31 patients who have undergone combined kidney-pancreas transplantation. Systemic venous drainage of the pancreas was utilized in 20 of these patients while 11 had portal venous drainage. Six lipoprotein subfractions (VLDL, IDL, LDL, HDL-L, HDL-M, HDL-D) were isolated by rapid gradient ultracentrifugation using a fixed-angle rotor. The apolipoprotein (by reverse-phase HPLC) and lipid (by enzymatic assays) composition of each subfraction was determined. After three months, there were few group differences. However, the portal group had substantial reductions in VLDL apoB at both six (-50% vs. +1%) and twelve months (-57% vs. +149%, P = .042) while the systemic group had increases in VLDL apoB. Similar differences were seen in IDL apoB (six months: -38% vs. +13%; twelve months: -61% vs. +56%, P = .008). LDL apoB increased in both groups at six months (portal: +7%; systemic: +30%) but fell in the portal group at twelve months (-17% vs. +41%, P = .0007). IDL triglyceride, cholesterol ester, phospholipids, and free cholesterol also fell by 19% to 47% in the portal group while they rose by 8% to 44% in the systemic patients, six and twelve months after surgery (P < .05). In addition, the VLDL and LDL free cholesterol to phospholipid ratios (FC/PL) fell (improved) by 16% to 26% in the portal patients while they rose by 9% to 28% in the systemic subjects during this time (P < .04). Finally, there were substantial improvements in the LDL composition of the portal patients compared to the systemic patients at six (PL/apoB: +23% vs. -16%, P = .005; CE/apoB: +14% vs. -14%, P = .037) and twelve months (PL/apoB: +39% vs. -13%, P = .011; CE/apoB: +41% vs. -15%, P = .011). These data indicate that portal drainage of the transplanted pancreas reduced the number of VLDL, IDL, and LDL particles, reduced the total mass of IDL (by 35%), and normalized the VLDL and LDL particle composition. These improvements were not seen in the patients who received systemic drainage of their pancreas. HDL-M also improved in the portal patients (TG: -29% vs. +12%, P = .025) (PL: +22% vs. -5%, P = .014) (total mass: +16% vs. +0.2%, P = .044) but not in the systemic patients six months after surgery. These results suggest that portal venous drainage of the pancreas leads to greater improvements in the lipoprotein composition of IDDM patients than does systemic drainage.
Asunto(s)
Diabetes Mellitus/terapia , Trasplante de Riñón , Lipoproteínas/sangre , Trasplante de Páncreas , Adolescente , Adulto , Drenaje/métodos , Femenino , Humanos , Trasplante de Riñón/métodos , Masculino , Trasplante de Páncreas/métodosRESUMEN
Anemia does not correct in many kidney transplant recipients, probably due to iron deficiency or inadequate erythropoietin (Epo) production. We evaluated effects of iron (Fe) availability on correction of anemia in renal transplant recipients and sought to characterize patterns of early Epo production by transplanted kidneys as related to peritransplant factors. In a prospective randomized trial, 51 consecutive renal transplant patients were followed for 6 months. Epo was measured on days 0, 3, 14, 48 and 168 posttransplantation. Fe status was monitored on days 14, 48 and 168. Pts were randomized at day 14 based on Fe status. Iron-deficient (FeD) patients (n = 24) were randomized to receive daily Fe supplementation (FeDs, n = 12) or no supplementation (FeDns, n = 12). Those with normal Fe status (FeN, n = 27) were followed as controls. No differences were found between groups at day 0 for Hct, Cr, Epo, age, dialysis history, or type of donor. Day 3 Creatinine and Hct were similar among groups, while Epo was significantly higher in FeD groups vs FeN (p < 0.004), and continued higher at 6 months. Though each pt improved Hct, most FeDns and FeN were anemic and Fe deficient at 6 months while all FeDs patients had corrected their anemia (p < or = 0.009) and Fe status. Four FeDs patients developed polycythemia. Epo production correlated inversely to cold ischemia time in cadaver renal allografts (p < 0.008).(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Anemia Ferropénica/prevención & control , Eritropoyetina/biosíntesis , Compuestos Ferrosos/uso terapéutico , Trasplante de Riñón/fisiología , Adulto , Anemia Ferropénica/etiología , Creatinina/sangre , Femenino , Ferritinas/sangre , Estudios de Seguimiento , Humanos , Inmunosupresores/uso terapéutico , Hierro/sangre , Masculino , Estudios Prospectivos , Factores de Tiempo , Transferrina/metabolismoAsunto(s)
Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/cirugía , Nefropatías Diabéticas/sangre , Fallo Renal Crónico/sangre , Trasplante de Riñón/fisiología , Lipoproteínas/sangre , Trasplante de Páncreas/fisiología , Nefropatías Diabéticas/cirugía , Humanos , Fallo Renal Crónico/cirugíaRESUMEN
Chronic renal failure (CRF) in nondiabetics is associated with a number of lipoprotein abnormalities that place these patients at high risk for atherosclerosis. This study compared the lipoprotein composition of nondiabetic controls (n = 68) with that of patients with insulin-dependent diabetes mellitus ([IDDM] n = 13) and of patients with IDDM and CRF ([IDDM + CRF] n = 74). Six lipoprotein subfractions (very-low-density lipoprotein [VLDL], intermediate-density lipoprotein [IDL], low-density lipoprotein [LDL], high-density lipoprotein-light [HDL-L], HDL-medium [HDL-M], and HDL-dense [HDL-D]) were isolated by rapid gradient ultracentrifugation using a fixed-angle rotor. The apolipoprotein (by reverse-phase high-performance liquid chromatography [HPLC]) and lipid (by enzymatic assays) composition of each subfraction was determined. The only abnormalities found in IDDM patients were increases in IDL and HDL-L triglyceride (TG) levels and an increase in the HDL-L free cholesterol (FC) level. The IDDM + CRF group had multiple abnormalities including (1) elevated TG, apolipoprotein (apo) C-II, and apo C-III levels in all lipid subfractions; (2) elevated VLDL and IDL apo B, TG, FC, cholesterol ester (CE), and phospholipid (PL) levels (with an increased CE/TG ratio in VLDL only); (3) decreased HDL-M apo A-I, apo A-II, CE, and PL levels, but an increased HDL-D apo A-I level; and (4) decreased lecithin:cholesterol acyltransferase (LCAT) activity. Twenty-five of the IDDM + CRF patients underwent combined pancreas and kidney (P + K) transplantation, and 12 patients received only a kidney transplant. Lipoprotein composition was determined at 3, 6, and 12 months posttransplant. Both types of transplantation resulted in similar alterations in lipoprotein composition, even though there was essential normalization of blood glucose levels in most of the patients who received a pancreas transplant (hemoglobin A1C [HbA1C], 9.1% +/- 1.1% v 5.7% +/- 0.3% at 12 months, P < .01). These posttransplant changes included (1) no improvement in the elevated TG level in any lipid subfraction even though there was some reduction in apo C-III levels in VLDL; (2) reductions in levels of VLDL and IDL apo B but increases in LDL apo B; (3) increases in HDL apo C-III and FC concentrations despite an increase in LCAT activity; and (4) increases in apo A-I levels in HDL-L and HDL-M. The addition of a pancreas to a kidney transplant had no obvious impact on the lipoproteins.(ABSTRACT TRUNCATED AT 400 WORDS)
Asunto(s)
Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/cirugía , Nefropatías Diabéticas/sangre , Nefropatías Diabéticas/cirugía , Fallo Renal Crónico/sangre , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Lipoproteínas/sangre , Trasplante de Páncreas , Adulto , Anciano , Apolipoproteínas/análisis , Glucemia/análisis , Ésteres del Colesterol/sangre , Cromatografía Líquida de Alta Presión , Diabetes Mellitus Tipo 1/complicaciones , Nefropatías Diabéticas/etiología , Femenino , Humanos , Fallo Renal Crónico/etiología , Lipoproteínas HDL/sangre , Lipoproteínas LDL/sangre , Masculino , Persona de Mediana Edad , Fosfatidilcolina-Esterol O-Aciltransferasa/análisis , Fosfatidilcolina-Esterol O-Aciltransferasa/metabolismo , Factores de Tiempo , Triglicéridos/sangreRESUMEN
The objectives of this study were to (1) identify risk factors and develop a prediction index for posttransplant diabetes mellitus (PTDM), (2) validate the risk factors and assess the index's predictive ability, and (3) modify the index to enhance its predictive accuracy. Preoperative variables included gender, race, age at transplantation, donor source, number of previous transplants, percentage of ideal body weight, family history of diabetes, and HLA type. Postoperative variables were glucose intolerance on postoperative days 0-3 and 4-7. Age, family history, glucose intolerance during postoperative d 4-7, and specific HLA types were significant independent risk factors for PTDM. No independent effects of race, gender, or donor source were detected. The four independent risk factors produced an equation that accurately predicted PTDM in 77% of the patients. Specificity and negative predictive values reached 75% and 97%, respectively, for the population of men.