Follow-Up of Offspring Born to Parents With a Solid Organ Transplantation:A Systematic Review

Pregnancy after solid organ transplantation (SOT) has potential risks for the offspring. Most existing research focused on short-term pregnancy outcomes. The aim of this systematic review was to evaluate available data concerning longer term outcomes (>1 year) of these children. A systematic literature search, following PRISMA guidelines, of PubMed and Embase was performed from the earliest date of inception through to 6th April 2022. Publications on all types of (combined) SOT were eligible for inclusion. In total, 53 articles were included. The majority assessed offspring after kidney (78% of offspring) or liver transplantation (17% of offspring). 33 studies included offspring aged >4 years and five offspring aged >18 years. One study was included on fathers with SOT. The majority of the 1,664 included children after maternal SOT had normal intellectual, psychomotor, and behavioral development. Although prematurity and low birth weight were commonly present, regular growth after 1 year of age was described. No studies reported opportunistic or chronic infections or abnormal response to vaccinations. In general, pregnancy after SOT appears to have reassuring longer term outcomes for the offspring. However, existing information is predominantly limited to studies with young children. Longer prospective studies with follow-up into adulthood of these children are warranted

“It’s my life and it’s now or never”:Transplant recipients empowered from a service-dominant logic perspective

Patient well-being after an organ transplant is a major outcome determinant and survival ofthe graft is crucial. Before surgery, patients are already informed about how they caninfluence their prognosis, for example by adhering to treatment advice and remainingactive. Overall, effective selfmanagement of health-related issues is a major factor insuccessful long-term graft survival. As such, organ transplant recipients can be consideredas co-producers of their own health status. However, although keeping the graft in goodcondition is an important factor in the patient’s well-being, it is not enough. To have ameaningful life after a solid organ transplant, patients can use their improved health statusto once again enjoy time with family and friends, to travel and to return to work -in short toget back on track. Our assertion in this article is twofold. First, healthcare providers shouldlook beyond medical support in enhancing long-term well-being. Second, organ recipientsshould see themselves as creators of their own well-being. To justify our argument, we usethe theoretical perspective of service-dominant logic that states that patients are the truecreators of real value-in-use. Or as Bon Jovi sings, “It’s my life and it’s now or never.”<br/

Effect of Pregnancy on eGFR after Kidney Transplantation:A National Cohort Study

BACKGROUND: The effect of pregnancy on the course of estimated glomerular filtration rate (eGFR) is unknown in kidney transplant recipients (KTRs). METHODS: We conducted a nationwide multicenter cohort study in KTRs with pregnancy (>20 weeks) after kidney transplantation (KT). Annual eGFR's after KT until death or graft loss and additional eGFR's before each pregnancy were collected according to protocol. Changes in eGFR slope before and after each pregnancy were analyzed by generalized estimating equations (GEE) multilevel analysis adjusted for transplant vintage. RESULTS: We included 3194 eGFR measurements before and after pregnancy in 109 (55%) KTRs with 1, 78 (40%) with 2 and 10 (5%) with 3 pregnancies after KT. Median follow-up after first delivery post-KT was 14 years (IQR 18 years). Adjusted mean eGFR pre-pregnancy was 59 ml/min/1.73m2 (SEM 1.72; 95% CI 56-63), after first pregnancy 56 ml/min/1.73m2 (SEM 1.70; 95% CI 53-60), after second pregnancy 56 ml/min/1.73m2 (SEM 2.19; 95% CI 51-60) and after third pregnancy 55 ml/min/1.73m2 (SEM 8.63; 95% CI 38-72). Overall eGFR slope after first, second and third pregnancy was not significantly worse than pre-pregnancy (p = 0.28). However, adjusted mean eGFR after first pregnancy was 2.8 ml/min/1.73m (p = 0.08) lower than pre-pregnancy. CONCLUSIONS: First pregnancy has a small, but no significant, effect on eGFR slope in KTR. Midterm hyperfiltration, a marker for renal reserve capacity, was associated with better eGFR and death-censored graft survival. In this KTR cohort with long-term follow-up, no significant effect of pregnancy on kidney function was detected

European Studies and Europe: Twenty Years of Euroculture

In 1998, the Master’s programme Euroculture started with the aim to offer, amid the many existing programmes that focused on European institutional developments, a European studies curriculum that puts the interplay of culture, society and politics in Europe at the heart of the curriculum. Among other topics, the programme focused on how Europe and European integration could be contextualised and what these concepts meant to European citizens. In June 2018, Euroculture celebrated its twentieth anniversary with a conference to discuss not only the changes within the MA Euroculture itself, but also to reflect upon the changes in the field of European studies over the last two decades writ large. This volume brings together the main findings of this conference. Since its start, Euroculture has engaged with European studies by providing a space for cooperation between more mainstream-oriented research on the one hand and a variety of sociological, historiographical, post-structuralist, and post-colonial perspectives on Europe on the other. This has enabled Euroculture to contextualise the emergence and development of European institutions historically and in relation to broader socio-political and cultural processes. Its methodology, that treats theoretical and analytical work, classroom teaching and engaged practice as integral parts of critical inquiry, has significantly contributed to its ability to continuously enhance scholarly discussions. The volume is divided into two parts, which are intrinsically linked. The first part contains reflections on the field of European studies and on concepts, analytical perspectives and methodologies that have emerged through interdisciplinary dialogues in Euroculture/European studies. The second part contains contributions that reflect upon the Euroculture programme itself, discussing both changes and continuities in the curriculum and didactic methods, outlining possible venues for further developing the educational and research programme that is firmly embedded in a network of partners that have been closely cooperating over a span of no less than two decades

Facing the challenges of PROM implementation in Dutch dialysis care:Patients' and professionals' perspectives

BACKGROUND: Patient Reported Outcome Measures (PROMs) are increasingly used in routine clinical practice to facilitate patients in sharing and discussing health-related topics with their clinician. This study focuses on the implementation experiences of healthcare professionals and patients during the early implementation phase of the newly developed Dutch set of dialysis PROMs and aims to understand the process of early implementation of PROMs from the users' perspectives. METHODS: This is a qualitative study among healthcare professionals (physicians and nursing staff: n = 13) and patients (n = 14) of which 12 were receiving haemodialysis and 2 peritoneal dialysis. Semi-structured interviews were used to understand the barriers and facilitators that both professionals and patients encounter when starting to implement PROMs. RESULTS: The early PROM implementation process is influenced by a variety of factors that we divided into barriers and facilitators. We identified four barriers: patient´s indifference to PROMs, scepticism on the benefits of aggregated PROM data, the limited treatment options open to doctors and organizational issues such as mergers, organizational problems and renovations. We also describe four facilitators: professional involvement and patient support, a growing understanding of the use of PROMs during the implementation, quick gains from using PROMs such as receiving instant feedback and a clear ambition on patient care such as a shared view on patient involvement and management support. CONCLUSIONS: In this qualitative study carried out during the early implementation phase of the Dutch dialysis PROM set, we found that patients did not yet consider the PROM set to be a useful additional tool to share information with their doctor. This was despite the professionals' primary reason for using PROMs being to improve patient-doctor communication. Furthermore, the perceived lack of intervention options was frustrating for some of the professionals. We found that nurses could be important enablers of further implementation because of their intensive relationship with dialysis patients.</p

Pre-Transplant Plasma Potassium as a Potential Risk Factor for the Need of Early Hyperkalaemia Treatment after Kidney Transplantation:A Cohort Study

INTRODUCTION: Plasma potassium (K+) abnormalities are common among patients with chronic kidney disease and are associated with higher rates of death, major adverse cardiac events, and hospitalization in this population. Currently, no guidelines exist on how to handle pre-transplant plasma K+ in renal transplant recipients (RTR). OBJECTIVE: The aim of this study is to examine the relation between pre-transplant plasma K+ and interventions to resolve hyperkalaemia within 48 h after kidney transplantation. METHODS: In a single-centre cohort study, we addressed the association between the last available plasma K+ level before transplantation and the post-transplant need for dialysis or use of K+-lowering medication to resolve hyperkalaemia within 48 h after renal transplantation using multivariate logistic regression analysis. RESULTS: 151 RTR were included, of whom 51 (33.8%) patients received one or more K+ interventions within 48 h after transplantation. Multivariate regression analysis revealed that a higher pre-transplant plasma K+ was associated with an increased risk of post-transplant intervention (odds ratio 2.2 [95% CI: 1.1-4.4]), independent of donor type (deceased or living) and use of K+-lowering medication within 24 h prior to transplantation). CONCLUSIONS: This study indicates that a higher pre-transplant plasma K+ is associated with a higher risk of interventions necessary to resolve hyperkalaemia within 48 h after renal transplantation. Further research is recommended to determine a cutoff level for pre-transplant plasma K+ that can be used in practice