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Biomedical subjects

J H Helderman

Publications and source records attributed to J H Helderman.

At least 19 recordsLinked to original sources
PubMed2001

Life satisfaction in renal transplant recipients: preliminary results from the transplant learning center.

The Transplant Learning Center (TLC) was designed to improve quality of life (QOL) and preserve graft function in solid-organ transplant recipients. To meet the specific goals of the program, the Life Satisfaction Index and Transplant Care Index were designed to serve as composite measures for measuring transplant-specific QOL and the ability to care for a transplant, respectively. In this study, we analyzed self-reported health information to examine relationships between comorbidities and individual posttransplantation side effects, life satisfaction, and transplant care, defined by renal transplant recipients. Patients entered the TLC through self-referral or referral by a health professional. Included in the analysis were 3,676 TLC enrollees with a mean time since transplantation of 4.8 years. Comorbidities and adverse effects were common, with high blood pressure reported by 89% of respondents and unusual hair growth reported by 70%. Sexual dysfunction and headache had a greater impact on QOL than more common adverse effects, such as changes in body and facial shape, hirsutism, and tremor. Regression modeling was used to identify the most significant associations between QOL indices and structural (nonmedical), medical, and psychosocial factors. Greater life satisfaction was most strongly associated with being in control of one's health and living a normally active life with satisfying emotional relationships. Management of such clinical problems as adverse effects of medication and nonadherence should be informed by the patient's perspective. Clinicians should actively solicit information about physical activity, appearance concerns, side effects of medications, nonadherence, and sexual and relationship issues when evaluating renal transplant recipients.

Adult↗
PubMed2001

Renal transplantation.

Renal Transplantation has progressed from an experiment in surgery, nephrology, and immunology to the preferred means of renal replacement therapy for patients with end-stage renal disease. Patient and graft survival rates are spectacular in the short run and improving steadily in the long. The current state of the art reflects deepened understanding of the alloimmune response and the T lymphocyte activation cascade in part driving the discovery of ever more potent immunosuppressive agents. Important issues remain such as chronic allograft dysfunction, the organ shortage, and tolerance induction. In this review, we will look at the history, the expanding treatment options based on better understanding of the immunobiology of alloantigen response, and the persistent challenges awaiting.

Forecasting↗
PubMed2001

Prophylaxis and treatment of gastrointestinal complications following transplantation.

Most transplant recipients will experience some type of gastrointestinal (GI) complication. These effects often are caused by infectious damage induced by a variety of opportunistic organisms, but they also may be due to mechanical injury during surgery or to metabolic or organ toxicity associated with immunosuppressive regimens. Although some of these GI complications can substantially impair quality of life or even carry significant mortality risk, many of them can be prevented, and most of them can be treated medically without the need to stop immunosuppression and expose the patient to the risk of rejection. Limiting the use of steroids, giving prophylactic antiviral and antifungal agents (particularly to patients at risk) and adopting a low threshold for endoscopy are among the most important measures that can be used to avoid GI complications after transplantation.

Endoscopy, Gastrointestinal↗
PubMed2000

Transplantation for the millennium: attaining tolerance in our time--the Holy Grail.

Despite tremendous advances in organ transplantation over the past 40 years, life-long immunosuppression is still required to maintain the transplanted organ. The induction of human tolerance to defined foreign antigens while maintaining completely intact all the rest of the immune repertoire, in the absence of maintenance immunosuppression, continues to be the dream of the transplant scientist and clinician, the "Holy Grail," the quest which energizes much recent research. This article presents an overview on recent developments on transplantation tolerance.

Animals↗
PubMed1999

A puzzle solved.

Explore the source record for details and available documents.

Biopsy↗
PubMed1999

Drug substitution in transplantation: a National Kidney Foundation White Paper.

Specific safeguards to guide the approval process and substitution practices for generic immunosuppressive agents are necessary for the effective delivery of patient care. Currently, the Food and Drug Administration (FDA) requires the demonstration of bioequivalence of generic drugs to innovator drugs in normal healthy subjects, a criterion that may be insufficient for critical-dose drugs. For generic equivalents of critical-dose drugs and for innovator critical-dose drugs, there should be a requirement for replicate studies measuring intrasubject variability and subject-treatment interactions to establish that bioequivalence holds true. Extensive testing of generic drugs in all target patient types is impractical and should not be required. However, when evidence suggests that the bioavailability of a critical-dose drug may vary substantially in certain subgroups, the FDA should require a demonstration of bioequivalence of generic versions to innovator products in these representative target populations. Changes in the approval process for generics should be accompanied by more consistent substitution practices. Pharmacists should notify the prescribing physician and patient whenever a critical-dose drug (generic or brand name) is dispensed in a different formulation from the one the patient has been taking. Therapeutic substitution for such drugs should not be made unless the prescribing physician has granted approval. The health care provider should consider instituting appropriate monitoring whenever patients are switched between generic formulations or between innovator drugs and generic formulations. Patients should be well informed about generic substitutes so that they can participate in treatment choices.

Biological Availability↗
PubMed1998

Renal function in primary liver transplant recipients receiving neoral (cyclosporine) versus prograf (tacrolimus).

Immunosuppressive efficacy of Neoral and Prograf following primary hepatic transplantation was comparable. Incidence of rejection episodes, infectious complications, hypertension, and postoperative diabetes mellitus was comparable. Although clinical use of both immunosuppressants was associated with early compromise in renal function, no progressive renal dysfunction was observed.

Analysis of Variance↗
PubMed1998

Impact of Sandimmune, Neoral, and Prograf on rejection incidence and renal function in primary liver transplant recipients.

Following primary liver transplantation, immunosuppressive efficacy of Neoral and Prograf was similar and superior to that of Sandimmune. Rejection incidence was statistically increased with Sandimmune therapy. Incidence of hypertension, posttransplant diabetes mellitus, and infectious complications was not statistically different. Although early compromise in renal function was associated with Sandimmune, Neoral, and Prograf immunosuppression, no progressive renal dysfunction was identified.

Adult↗