Steroids in Pediatric Kidney Transplantation: A Balancing Act in Progress

Received 23 July 2009, revised 29 September 2009 and accepted for publication 02 October 2009Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78710/1/j.1600-6143.2009.02923.x.pd

Adolescents consider the future differently depending on the domain in question: results of an exploratory study in the United Kingdom

The study of Consideration of Future Consequences (CFC) construct has increased substantively in recent years. Underlying these developments is the presumption that consideration of the future is uniform across all domains, and not a domain-specific construct. Building on work undertaken previously, the present study used 30 researcher-derived items to assess the domain specificity of consideration of the future in three large samples of adolescents in the United Kingdom. A psychometrically valid and reliable 18-item scale measuring consideration of the future in four domains emerged. Domain specificity was supported on two levels: a good fitting multidimensional model of CFC; and low to moderate factor correlations for the four domains measured by the 18-item scale. The study suggests that adolescents are considerate of future outcomes to different degrees, depending on the domain, and the implications of this with regard to future research are discussed

Wow, that portal vein is small: Preventing portal vein thrombosis in liver transplantation for small children

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107365/1/lt23865.pd

Successful renal transplantation following prior bone marrow transplantation in pediatric patients

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72010/1/j.1399-3046.2004.00208.x.pd

Pediatric Transplantation in the United States, 1996–2005

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73448/1/j.1600-6143.2007.01780.x.pd

Human GUCY2C-Targeted Chimeric Antigen Receptor (CAR)-Expressing T Cells Eliminate Colorectal Cancer Metastases.

One major hurdle to the success of adoptive T-cell therapy is the identification of antigens that permit effective targeting of tumors in the absence of toxicities to essential organs. Previous work has demonstrated that T cells engineered to express chimeric antigen receptors (CAR-T cells) targeting the murine homolog of the colorectal cancer antigen GUCY2C treat established colorectal cancer metastases, without toxicity to the normal GUCY2C-expressing intestinal epithelium, reflecting structural compartmentalization of endogenous GUCY2C to apical membranes comprising the intestinal lumen. Here, we examined the utility of a human-specific, GUCY2C-directed single-chain variable fragment as the basis for a CAR construct targeting human GUCY2C-expressing metastases. Human GUCY2C-targeted murine CAR-T cells promoted antigen-dependent T-cell activation quantified by activation marker upregulation, cytokine production, and killing of GUCY2C-expressing, but not GUCY2C-deficient, cancer cells in vitro. GUCY2C CAR-T cells provided long-term protection against lung metastases of murine colorectal cancer cells engineered to express human GUCY2C in a syngeneic mouse model. GUCY2C murine CAR-T cells recognized and killed human colorectal cancer cells endogenously expressing GUCY2C, providing durable survival in a human xenograft model in immunodeficient mice. Thus, we have identified a human GUCY2C-specific CAR-T cell therapy approach that may be developed for the treatment of GUCY2C-expressing metastatic colorectal cancer

Pediatric Transplantation in the United States, 1997–2006

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73373/1/j.1600-6143.2008.02172.x.pd

A systematic review of parent and family functioning in pediatric solid organ transplant populations

The process of pediatric solid organ transplantation (SOT) places new and increased stressors on patients and family members. Measures of family functioning may predict psychological and health outcomes for pediatric patients and their families, and provide opportunity for targeted intervention. This systematic review investigated parent and family functioning and factors associated with poorer functioning in the pediatric SOT population. Thirty‐seven studies were identified and reviewed. Studies featured a range of organ populations (eg, heart, liver, kidney, lung, intestine) at various stages in the transplant process. Findings highlighted that parents of pediatric SOT populations commonly report increased stress and mental health symptoms, including posttraumatic stress disorder. Pediatric SOT is also associated with increased family stress and burden throughout the transplant process. Measures of parent and family functioning were associated with several important health‐related factors, such as medication adherence, readiness for discharge, and number of hospitalizations. Overall, findings suggest that family stress and burden persists post‐transplant, and parent and family functioning is associated with health‐related factors in SOT, highlighting family‐level functioning as an important target for future intervention.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136483/1/petr12900.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136483/2/petr12900_am.pd

Health literacy and its association with adherence in pediatric liver transplant recipients and their parents

ObjectiveNon- adherence to pediatric regimens is a common concern. Low health literacy is correlated with poor outcomes in adults but is understudied in pediatrics. The current project aimed to determine the relationship between health literacy, adherence, and outcomes in pediatric liver transplant recipients. Hypotheses included a) parent and patient health literacy would be positively correlated; and b) low patient and/or parent health literacy would be negatively correlated with adherence and health outcomes.Patients and MethodsEligible participants were recruited during routine follow- up visits in a pediatric liver transplant clinic. Parents and patients (>13 years old) completed 2 measures of health literacy. Patients - ¥18 years completed health literacy measures without corresponding parent surveys. Adherence variables and health outcomes were obtained from medical records.ResultsSeventy- nine patients across two sites completed the study. Variance in classification of health literacy between measures was observed; however, most parents (82%- 100%) scored within an - adequate literacy- range. More adolescents scored in lower health literacy ranges relative to the parents. Markers of SES were positively correlated with health literacy. Parent health literacy was negatively associated with biopsy- proven rejection episodes and the number of hospitalizations; however, it was not associated with measures of tacrolimus adherence. There were no relationships observed between parent and adolescent health literacy.ConclusionsHealth literacy is an important consideration in managing patient care; however, available measures demonstrate variability in capturing the skills of patients. Effective communication strategies may ameliorate admittedly small, but negative, impacts of limited health literacy on outcomes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156215/2/petr13726_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156215/1/petr13726.pd

The Art and Science of Immunosuppression: The Fifth Annual American Society of Transplant Surgeon's State-of-the-Art Winter Symposium

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72057/1/j.1600-6143.2005.01187.x.pd