Objective: To determine the prevalence and identify variables associated with renal dysfunction in long- term survivors of pediatric liver transplantation. Study design: Data from 117 patients who survived ≥ 3 years ...Objective: To determine the prevalence and identify variables associated with renal dysfunction in long- term survivors of pediatric liver transplantation. Study design: Data from 117 patients who survived ≥ 3 years after liver transplantation were analyzed. Demographic and clinical information was obtained from chart review and from a clinical care database. The dependent variable was renal function as determined by measured glomerular filtration rate (mGFR). Univariate and multivariate analyses were performed to identify independent variables associated with renal dysfunction (mGFR < 70 mL/min per 1.73 m2). Results: The average time since liver transplant was 7.6 ± 3.4 years (range, 3 to 14.6 years). When the last available mGFR for all patients was analyzed, renal dysfunction was present in 32% . In the univariate analysis, mGFR at 1 year after transplant, cyclosporine immunosuppression, and time since transplant were significant; the second two were strongly collinear. Using multiple logistic regression modeling excluding time since transplant, cyclosporine and mGFR at 1 year after transplant were strongly associated with renal dysfunction. Conclusions: Renal dysfunction is a common complication in children who survive liver transplantation. Our observations are of critical importance because children may live long enough to move from a stage of renal insufficiency characterized by asymptomatic decreased GFR to symptomatic end- stage renal disease.展开更多
Objective: To apply the principles of statistical process control (SPC) to manage calcineurin inhibitor (CNI) blood levels. We hypothesized that the use of SPC would increase the proportion of CNI blood levels in the ...Objective: To apply the principles of statistical process control (SPC) to manage calcineurin inhibitor (CNI) blood levels. We hypothesized that the use of SPC would increase the proportion of CNI blood levels in the target range. Study design: The study population consisted of 217 patients more than 3 months after liver transplantation. After demonstration of proof of concept using the rapid cycle improvement process, SPC was applied to the entire population. The change package included definition of target ranges for CNI, implementation of a web-based tool that displayed CNI blood levels on a control chart, and implementation of a protocol and a checklist for management of CNI blood levels. The principal outcome measure was the proportion of CNI blood levels in the target range. Results: In the pilot study, the proportion of CNI blood levels in the target range increased from 50% to 85% . When the protocol was spread to the entire population, the proportion of drug levels in the target range increased to 77% from 50% (P < .001),whereas the range of CNI levels decreased. The rate of allograft rejection did not change. Conclusions: Utilization of SPC increased the proportion of CNI blood levels in target range. These observations may be applicable to the care of other chronic health care problems.展开更多
文摘Objective: To determine the prevalence and identify variables associated with renal dysfunction in long- term survivors of pediatric liver transplantation. Study design: Data from 117 patients who survived ≥ 3 years after liver transplantation were analyzed. Demographic and clinical information was obtained from chart review and from a clinical care database. The dependent variable was renal function as determined by measured glomerular filtration rate (mGFR). Univariate and multivariate analyses were performed to identify independent variables associated with renal dysfunction (mGFR < 70 mL/min per 1.73 m2). Results: The average time since liver transplant was 7.6 ± 3.4 years (range, 3 to 14.6 years). When the last available mGFR for all patients was analyzed, renal dysfunction was present in 32% . In the univariate analysis, mGFR at 1 year after transplant, cyclosporine immunosuppression, and time since transplant were significant; the second two were strongly collinear. Using multiple logistic regression modeling excluding time since transplant, cyclosporine and mGFR at 1 year after transplant were strongly associated with renal dysfunction. Conclusions: Renal dysfunction is a common complication in children who survive liver transplantation. Our observations are of critical importance because children may live long enough to move from a stage of renal insufficiency characterized by asymptomatic decreased GFR to symptomatic end- stage renal disease.
文摘Objective: To apply the principles of statistical process control (SPC) to manage calcineurin inhibitor (CNI) blood levels. We hypothesized that the use of SPC would increase the proportion of CNI blood levels in the target range. Study design: The study population consisted of 217 patients more than 3 months after liver transplantation. After demonstration of proof of concept using the rapid cycle improvement process, SPC was applied to the entire population. The change package included definition of target ranges for CNI, implementation of a web-based tool that displayed CNI blood levels on a control chart, and implementation of a protocol and a checklist for management of CNI blood levels. The principal outcome measure was the proportion of CNI blood levels in the target range. Results: In the pilot study, the proportion of CNI blood levels in the target range increased from 50% to 85% . When the protocol was spread to the entire population, the proportion of drug levels in the target range increased to 77% from 50% (P < .001),whereas the range of CNI levels decreased. The rate of allograft rejection did not change. Conclusions: Utilization of SPC increased the proportion of CNI blood levels in target range. These observations may be applicable to the care of other chronic health care problems.
