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Blessing and a curse of outpatient management of delayed graft function

机译:祝福和门诊治疗延迟移植功能的诅咒

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摘要

Delayed graft function (DGF) is a common complication occurring most often after deceased donor kidney transplant with several donor characteristics as well as immunologic factors that lead to its development post-transplant. These patients require dialysis and close kidney function monitoring until sufficient allograft function is achieved. This has resulted in limited options for DGF management, either prolonged hospitalization until graft function improves to the point where dialysis is no longer needed or discharge back to their home dialysis unit with periodic follow up in the transplant clinic. DGF is associated with a higher risk for acute rejection, premature graft failure, and 30-d readmission; therefore, these patients need close monitoring, immunosuppression management, and prompt allograft biopsy if prolonged DGF is observed. This may not occur if these patients are discharged back to their home dialysis unit. To address this issue, the University of Wisconsin-Madison created a clinic in 2011 specialized in outpatient DGF management. This clinic was able to successfully reduce hospital length of stay without an increase in 30-d readmission, graft loss, and patient death.
机译:延迟的移植物功能(DGF)是常见的并发症,死于具有多种供体特征的供体肾移植后死亡,以及导致移植后发育的免疫学因素。这些患者需要透析并密切监测肾功能,直到获得足够的同种异体移植功能。这导致DGF管理的选择有限,要么住院时间延长,直到移植物功能改善到不再需要透析的程度,要么在移植诊所进行定期随访,然后回到自己的家庭透析部门。 DGF与急性排斥反应,移植物过早衰竭和30 d再入院的风险较高有关;因此,如果观察到延长的DGF,这些患者需要密切监测,免疫抑制管理并立即进行同种异体移植活检。如果这些患者被送回家庭透析室,则可能不会发生这种情况。为了解决这个问题,威斯康星大学麦迪逊分校在2011年创建了一家专门从事门诊DGF管理的诊所。该诊所能够成功缩短住院时间,而不会增加30天再入院率,移植物丢失和患者死亡。

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