Başkent Üniversitesi Yayınları
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Item Nephrologists Perceptions of Renal Transplant as Treatment of Choice for End-stage Renal Disease, Preemptive Transplant, and Transplanting Older Patients: An International Survey(Başkent Üniversitesi, 2011-08) Ghahramani, Nasrollah; Shrivastava, Pritika; Ghahramani, Mehrdad; Karparvar, Zahra YeganehObjectives: To explore the relation between nephrologists’ characteristics and their views of transplant as the treatment of choice for end-stage renal disease, preemptive transplant, and transplant of older patients. Materials and Methods: A comprehensive international Web-based survey explored the relation between nephrologists’ characteristics and their views of transplant as the treatment of choice for end-stage renal disease, preemptive transplant, and transplant of older patients. Results: A total of 1448 nephrologists completed the survey. The majority of respondents agreed with transplant as the treatment of choice for end-stage renal disease (75%), preemptive transplant (71%), and transplant for patients > 60 years of age (59%). The likelihood of agreement was higher among transplant and academic nephrologists, and practice at hospitals with ≥ 50 transplants per year. Urban location and ≤ 10 years in practice were associated with higher likelihood of viewing transplant as treatment of choice and favoring preemptive transplant. Conclusions: Demographic and practice characteristics influence nephrologists’ attitudes about transplant as the treatment of choice for end-stage renal disease, preemptive transplant, and transplant as an option for older patients. Detailed studies exploring the determinants of nephrologists’ attitudes are likely to identify sources of variations in perceptions of patient suitability for transplant. Our findings underscore the need for continuing educational programs addressing evolving aspects of transplant particularly targeting nephrologists practicing within nonacademic centers and in rural areas.Item Association Between Increased Body Mass Index, Calcineurin Inhibitor Use, and Renal Graft Survival(Başkent Üniversitesi, 2008-09) Ghahramani, Nasrollah; Hollenbeak, Christopher; Reeves, W. BrianObjectives: Using data from the US Renal Data System, we examined the relation between body mass index and graft survival as mediated through calcineurin inhibitor use. Materials and Methods: Adult patients who received a first kidney-only transplant, with at least 6 months’ survival were classified into 5 categories (underweight, normal, overweight, obese, and extremely obese) according to body mass index. Associations between calcineurin inhibitor use, body mass index categories, and outcomes were investigated. Results: Underweight and normal-weight recipients lived longer than the other 3 categories, regardless of calcineurin inhibitor use. Graft survival was significantly inferior among obese and extremely obese patients. Average graft survival was significantly higher for recipients with a normal body mass index than it was for overweight, obese, and extremely obese recipients. Risk ratio for graft failure was constant for the calcineurin inhibitor versus the noncalcineurin inhibitor group across all body mass index categories. Mean body mass index for the group with rejection episodes was similar to the group with no rejections; there was no correlation between body mass index and rejection risk. Conclusions: Increased body mass index is associated with inferior patient and graft survival, independent of calcineurin inhibitor use. Because we found no correlation between body mass index and risk of rejection, we assume that, at least after the initial 6 months, the adverse effect of obesity on graft outcome is partially mediated through nonimmunologic mechanisms. When analyzing graft and patient survival rates, we recommend that body mass index be considered a risk factor.