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Rahul M Jindal

Publications and source records attributed to Rahul M Jindal.

17 recordsLinked to original sources
PubMed2005

Kidney transplantation and gender disparity.

Gender inequity in access to hemodialysis and kidney transplantation has created a public health crisis in the US. Women have a lower chance of receiving hemodialysis and kidney transplant than men, but they constitute the majority of living kidney donors. Research has shown that economic factors such as greater income of men may encourage females to be donors; while gender-bias on part of physicians or institutions, lack of social support networks and differences in health-seeking behaviors compared to men are cited as reasons for this imbalance. We suggest various strategies to improve participation of women in the transplant process by education; raising awareness by publishing gender-specific data for dialysis and transplant centers; education and workshops to eliminate gender-bias within institutions and health-care providers and establishment of gender-specific support groups. Transplant teams that are more sensitive to the social complexities of women's lives may lead to increased understanding of the effects of renal disease and indicate measures that need to be in place in order to address this gender disparity in the treatment of renal failure. Research needs to be done to elucidate the underlying medical, societal or psychological processes that lead to gender bias in the field of kidney transplantation.

Female↗
PubMed2005

Psychosocial profiling: a holistic management tool for non-compliance.

We introduce a new concept of psychosocial profiling as a tool that provides the transplant team with a psychosocial framework for identification, intervention and management of non-compliance. This will also increase our understanding of emotional problems experienced by patients before transplant, as a result of living with the uncertainty and medical side effects of chronic illness. Psychosocial profiling is adaptable throughout the transplant process and gives every patient an opportunity of psychosocial support to help him or her into a position of emotional stability and compliance with their medications and postoperative care. Implementation of this strategy will move health care professionals from being gatekeepers to managers and facilitators of holistic care in recipients of transplants.

Holistic Health↗
PubMed2005

Minimization of immunosuppressive therapy after renal transplantation: results of a randomized controlled trial.

Modern immunosuppressive regimens reduce the acute rejection rate by combining a cornerstone immunosuppressant like tacrolimus or cyclosporine with adjunctive agents like corticosteroids, mycophenolate mofetil (MMF) or azathioprine, often associated with untoward side effects. A 6-month randomized study was conducted in 47 European centers. Triple therapy with tacrolimus (trough levels 5-15 ng/mL), corticosteroids (dosage 10 mg/day) and MMF (1 g/day) was administered for 3 months. From day 92, patients either continued with triple therapy (control, n = 277), or stopped steroids (n = 279), or stopped MMF (n = 277). Surrogate markers for long-term benefits were changes in lipid profiles and occurrence of hematological, gastrointestinal and infectious complications. The 6-month acute rejection incidence (biopsy-proven) was similar in all groups (17.0% vs. 15.1% vs. 14.8%, p = 0.744), although the incidence after month 3 was higher in the steroid stop group than in the two other groups. Mean reductions in total cholesterol (18.9 mg/dL [0.49 mmol/L]) and LDL-cholesterol (8.1 mg/dL [0.21 mmol/L]) between months 4 and 6 were greater in the steroid stop group (p < 0.001). Leukopenia (p = 0.0082), serious CMV infection (p = 0.024), anemia (p = NS) and diarrhea (p = NS) were less frequent in the MMF stop group. In a study population of immunologically low-risk patients' withdrawal of corticosteroids or MMF from a tacrolimus-based therapy at 3 months was feasible. A longer follow-up will be needed to confirm the expected advantages for the long-term outcome and to assess the long-term safety of this minimization of immunosuppressive therapy.

Adolescent↗
PubMed2004

Obesity and kidney transplantation.

There is a worldwide epidemic of obesity, and an increasing number of patients who are obese are presenting for solid-organ transplantation. Obesity increases the risk for delayed graft function and local wound complications after technically successful kidney transplantation. Obese patients are more likely to have comorbid factors leading to premature death with a functioning kidney transplant. We suggest the use of World Health Organization criteria when reporting the impact of obesity on recipients of solid-organ transplants. Prospective multicenter studies are indicated to evaluate long-term outcomes in obese patients who successfully receive a kidney transplant. Rigorous efforts should be made to optimize weight before and after solid-organ transplantation by a judicious combination of diet, exercise, minimization of steroid therapy, surgery, and psychological therapies.

Humans↗
PubMed2004

Prospective randomized study of individual and group psychotherapy versus controls in recipients of renal transplants.

BACKGROUND: Recipients of kidney transplant have been shown to develop emotional problems. These have been associated with medical noncompliance, compromised quality of life, and difficulty integrating the newly acquired transplant into their sense of self. In general, group psychotherapy has been shown to be more cost effective than individual therapy. We have compared the efficacy of two modalities of therapy in recipients of kidney transplants with control patients who did not receive therapy. METHODS: Recipients of first cadaver kidney transplants were randomized into two groups to receive a 12-week course of group or individual psychotherapy. The control arm of the study was composed of 37 consecutive patients who had received a first cadaver kidney. Recipients of live kidney transplants, and patients who received more than one kidney transplant, were excluded because these patients have different emotional issues. The Beck Depression Inventory (BDI) was used as a measure of change in emotional state, pretherapy, at 3, 6, 9, and 12 months. A higher score on BDI was suggestive of psychologic dysfunction. RESULTS: We recruited 89 recipients of first cadaver kidney transplants into the study. They were randomly allocated into the two study groups, 49 for individual therapy, and 40 for group therapy. Of these, 82 patients completed 12 weeks of therapy (45 patients from the individual treatment arm, and 37 from the group therapy arm). Fifty-five patients completed one-year follow-up (33 in individual therapy, and 32 in the group therapy). The mean score was 26.3 +/- 7.9 before and 18.9 +/- 9.0 after therapy in the individual treatment group (P= 0.001). This was in comparison with a mean score of 30.2 +/- 3.8 before and 26.0 +/- 4.2 after therapy for the group therapy arm (P= 0.01). Improvement appeared to be more significant in the individual therapy compared with group therapy (P= 0.01). Lowering of scores was progressive and sustained (P= 0.01). In the control arm, mean score was 9.4 +/- 5.4 before and 20.5 +/- 5.5 at the end of the first year (P= 0.005), suggesting a significant worsening of BDI scores. Multivariate analysis of age, gender, employment status, duration of dialysis, etiology of kidney failure, diabetes mellitus, and psychotherapy received at any time before transplantation did not affect results. CONCLUSION: We conclude that both individual and group psychotherapy were beneficial to our patients; however, individual therapy was found to result in lower BDI scores versus group therapy at the end of treatment period.

Adult↗
PubMed2004

Pancreas transplantation.

Over the last 15 years whole organ pancreas transplantation has emerged as the treatment of choice for selected patients with uremia and Type I Diabetes Mellitus. Improvements in surgical technique, better understanding of transplant related complications and advances in immunosuppressive therapy have encouraged the application of this procedure to an increasing number of patients. Pancreas transplantation occurs under three primary scenarios: simultaneous kidney pancreas transplantation, pancreas transplantation after kidney transplantation, and pancreas transplant alone. Overall results are excellent with 90%-95% one-year patient survival, and 85%-90% of patients achieving normal glycemic control. There also exists a significant long-term survival advantage among the simultaneous kidney pancreas transplant group.

Diabetes Mellitus, Type 1↗
PubMed2003

Reversal of diabetes in the rat by injection of hematopoietic stem cells infected with recombinant adeno-associated virus containing the preproinsulin II gene.

AIM: To study the effect of injecting hematopoietic stem cells containing the preproinsulin gene II (rI2) via recombinant adeno-associated virus (rAAV) into normal and streptozotocin-diabetic rats. METHODS: rI2 was transfected into rat hematopoietic stem cells using rAAV vector. Stem cells were injected by intravenous route into normal and STZ-induced diabetic rats to study blood sugar and expression of rI2 in various tissues. The pLP-1 recombinant plasmid containing rI2 (vLP-1) was engineered as previously described. Bone marrow from female Wistar-Furth rats was enriched for stem cells by using plastic adherence and monoclonal antirat CD3 and CD45 RA to deplete T and B cells. The remaining cells were exposed to vLP-1 (multiplicity of infection MOI =50:1 or 100:1) for 2 h. Approximately ten million exposed stem cells were injected by intravenous route into each animal; there were four groups: normal animals at MOI 50:1 (group 1) or MOI 100:1 (group 2); group 3 animals (n = 9) were streptozotocin-induced diabetic animals at MOI 100:1. Animals that showed reversal of diabetes from group 3 were sacrificed for study of gene expression at weeks 1, 2, and 6, respectively. Control diabetic animals did not receive stem cells or virus constituted group 4. Expression of rI2 was analyzed by RT-PCR and Southern analyses. RESULTS: Despite introduction of insulin gene, groups 1 and 2 had blood sugar concentrations that remained within normal levels, while 3 of 9 animals in group 3 showed reversal of diabetes; using RT-PCR,group 1 expressed rI2 in liver, spleen, thymus, brain, and heart at week 1 only. In group 2, rI2 was seen in the thymus up to 6 weeks; in diabetic animals (group 3) rI2 was seen in liver, bone marrow, spleen, thymus, and peripheral blood lymphocytes at week 2 and in thymus and lymphocytes at week 6. CONCLUSIONS: We have shown that (1) rAAV is a useful vector for transferring rI2 into rat hematopoietic stem cells; (2) normal animals remained euglycemic after injection of stem cells containing rI2 despite identification in various tissues suggesting autoregulation, and (3) short-term reversal of diabetes was achieved in some animals by injection of stem cells containing rI2.

Animals↗
PubMed2003

Quality of life after kidney and pancreas transplantation: a review.

There is an increasing amount of data on quality of life (QOL) in most chronic illnesses; some of the instruments used are generic, but recently, there is a tendency to use disease-specific instruments. We propose that recipients of organ transplants be assessed routinely for QOL by means of the 36-Item Short-Form Health Survey or a disease-specific instrument; for compliance, by means of the Long-Term Medication Behavior Self-Efficacy Scale; and for psychological status, by means of the Beck Depression Inventory Brief Symptom Inventory or the Symptom Checklist. The widespread use of QOL data in recipients of organ transplants will increase accountability of service providers and eventually increase patient satisfaction because these instruments are patient reported.

Adult↗
PubMed2003

Influence of hypercholesterolemia on patient and graft survival in recipients of kidney transplants.

AIM: The aim of this retrospective, single centre study, was to study the effect of pre- and post-transplant serum total cholesterol (TC) on patient and graft survival. We also sought to see whether patients who had very high TC (>8 mmol/L) had a higher incidence of graft failure and patient mortality compared with those whose cholesterol was only moderately elevated. METHODS: Records of 935 cadaver kidney transplants between 1984 and 1998 were examined. Patients were placed into three groups based on TC level: <5.5 mmol/L (group 1), 5.5-8 mmol/L (group 2) and >8 mmol/L (group 3). The mean TC value from the first five post-transplant years was taken to seek a correlation between TC and post-transplant events. RESULTS: The mean graft follow-up was 66.9 +/- 50.1 months, ranging from 0.1 to 191 months, while mean patient follow-up was 83.8 +/- 50.1 months, ranging from 0.5 to 191.6 months. Pre-transplant TC was available in 201 patients (21.5%), and post-transplant data was available (for first 5 yr) in 655 patients (70%). During the study period, 220 patients (23.5%) had died, 285 (30.5%) of the grafts had failed during the follow-up, while 129 (13.8%) of the patients died with a functioning graft. We found significantly longer survival of patients having a pre-transplant TC below 5.5 mmol/L vs. patients whose pre-transplant TC was above 5.6 mmol/L (p = 0.02). We also compared patients who had very high pre-transplant TC (>8 mmol/L) level with those whose TC was moderately elevated (5.5-8 mmol/L) and found that there was no higher incidence of graft failure (p = 0.77) nor patient mortality (p = 0.83). No difference could be found in graft survival based on pre-transplant TC. We also did not find a detrimental influence of post-transplant TC on the patient or graft survival. Diabetes mellitus (p = 0.006) and age over 50 yr (p = 0.007) affected patient survival, while low cyclosporine levels (p = 0.02) and acute rejection episodes (p = 0.009) affected graft survival. The mode of dialysis and time on dialysis prior to transplantation did not affect patient and graft survival. CONCLUSIONS: We found significantly greater survival of patients having a pre-transplant TC below 5.5 mmol/L. No difference could be found in graft survival based on pre-transplant TC. Post-transplant TC did not adversely affect patient or graft survival.

Adult↗
PubMed2003

Development of a questionnaire to assess attitudes and beliefs toward organ donation among Asians.

In the United Kingdom, people from the Indian subcontinent have a higher incidence of kidney failure, are less likely to receive a kidney transplant, and have a higher mortality rate from renal disease. In addition, Asians are reluctant donors; white people make up 95% of the donor pool. We developed a questionnaire to determine the knowledge and attitudes toward organ donation in the Asian communities. The setting was a public forum; the aims were (1) to study the attitudes of Asians toward organ donation, (2) to validate our questionnaire, and (3) to initiate a campaign of increasing awareness of organ donation and transplantation in the Asian community in the greater Glasgow area. Our survey suggested that Asians have an awareness of organ donation and transplantation, and they would donate an organ to a family member; however, they did not carry a donor card. Respondents unanimously agreed that lobbying by religious leaders was the best means to promote awareness.

Adult↗
PubMed2002

A public forum to promote organ donation amongst Asians: the Scottish initiative.

There is a chronic shortage of organs for transplantation in the UK. This problem is particularly acute amongst Asians living within the UK. The Transplant Unit, University of Glasgow, joined forces with local businessmen to initiate a public meeting to promote awareness of transplant issues affecting Asians in the greater Glasgow area. During the Forum, we conducted a survey to determine the level of knowledge about organ transplantation, donation and willingness to donate, in relationship to the age, gender, marital status and religious affiliation amongst the attendees. The Forum was conducted at a public hall after publicity in the local press and Asian shops. The meeting was attended by over 300 people of Asian origin. Of the 90 survey forms handed out, 80 were returned fully completed. There was almost no opposition to organ donation, and many of the respondents were aware that religious leaders in the UK had endorsed organ donation. However, favourable disposition to these issues was not accompanied by carrying of the organ donor card, despite an awareness of the National Donor Register. The majority of the respondents were willing to undergo live organ donation, but were undecided about cadaveric donation. The issue of presumed consent drew mixed responses. Asians in the Glasgow region are not sympathetic to the matter of organ transplantation and donation, despite their recognition of the issues of organ shortage. We suggest that the matter needs to be further integrated into Asian culture by religious leaders and business persons. Our findings indicate that women over the age of 30 and based in the home may be in a unique position of influence by virtue of their position of centrality within the social network. This approach may also be suitable in other areas of the UK and the world with a large number of ethnic minorities.

Adult↗
PubMed2002

Compliance and late acute rejection after kidney transplantation: a psycho-medical perspective.

INTRODUCTION: We examined the relationship between late acute rejection (LAR) after cadaveric kidney transplantation and medical compliance utilizing a modified version of the Long-term Medication Behaviour Self-efficacy Scale (LTMBS-scale), a validated patient self-report questionnaire. The original LTMBS-scale uses a five-point scale, however, our pilot study showed that patients found it difficult to discriminate between the five options. We therefore modified this to a three-point scale. PATIENTS AND METHODS: We carried out a retrospective analysis of all patients who received a kidney transplant in our unit in the cyclosporin (CyA) era. We divided rejections into early and late rejection based on the time interval after transplantation. Graft rejection was confirmed by biopsy; LAR was defined as acute rejection occurring after 90 d. We retrospectively administered the modified LTMBS-scale to determine individual patient confidence and self-efficacy in taking their medications in a variety of situations (home, work, leisure, psychological and physical). Individual patient confidence and self-efficacy was analysed in relationship to compliance behaviour. RESULTS: Twenty-four questionnaires were distributed, 22 (92%) were returned fully completed. The overall results suggested that our patients surveyed were not particularly confident (mean score 2.17 out of maximum possible 3) in taking their medications in a variety of contexts. They demonstrated significantly less confidence (mean score 1.0) when experiencing physical (brittle bones, feeling 'ill') and psychological ('sadness') side-effects of medication and emotional reactions to the experience of chronic illness. CONCLUSION: Negative physical and psychological states were related to low self-efficacy with the taking of immunosuppressive medication, non-compliance and subsequent LAR in our cohort of patients.

Adult↗
PubMed2002

Emotional issues after kidney transplantation: a prospective psychotherapeutic study.

BACKGROUND: Negative emotional states are the single most influential factor in determining quality of life after a successful kidney transplant. We designed a prospective study using psychotherapeutic principles to understand and intervene in emotional issues in adult recipients of first cadaver kidney transplants. METHODS: Forty-nine recipients of first cadaver kidney transplants were subjected to 12 sessions (at weekly intervals) of psychotherapy within 3 months of receiving their transplant. The Beck Depression Inventory (BDI) was utilized as a measure of change in emotional state, pretherapy, at 3, 6, 9 and 12 months. A higher score on BDI was suggestive of psychological dysfunction. In the first instance, data was analysed within a quantitative framework, by virtue of the BDI. In the second instance, data was considered in terms of recurring themes described by patients during psychotherapy and was analysed qualitatively. In the third instance, both qualitative and quantitative data was considered in terms of individual patient's ability to achieve some feeling of having implemented some social, relational and vocational equilibrium into their everyday life. Recipients of live kidneys, paediatric transplants and patients who received more than one transplant were excluded, as emotional issues are different in this cohort of patients. All patients have completed 1 yr of follow up. None of the patients were on antidepressant medication before or after therapy. RESULTS: This is an ongoing study in which we are comparing individual vs. group therapy vs. controls (who receive no therapy). The total number of patients recruited will be 120 and the final report will be available in 2003-04. The results reported in this paper form the 49 patients in the individual arm of the study. All the patients in our study happened to be white people. There was significant improvement in the BDI scores following therapy. The mean score was 26.3 +/- 7.9 before and 20.5 +/- 8.8 after therapy (p = 0.001); the lowering of the scores remained sustained at 12 months. Multivariate analysis of age, gender, employment status, duration of dialysis (if in dialysis for more than 3 yrs) and psychotherapy given before transplantation did not affect the results of our study. For the qualitative aspect of the study, we grouped the emotional problems as expressed by the patients into three recurring themes (i) fear of rejection, (ii) feelings of paradoxical loss post-transplant despite having received a successful transplant and (iii) the psychological integration of the newly acquired kidney. CONCLUSIONS: Psychotherapeutic intervention was an effective means of addressing emotional problems in recipients of kidney transplants. The recurring themes as identified above provided a baseline for psychotherapeutic exploration and resolution of these issues. Successful resolution of these issues was associated with lower BDI scores and the redefinition of normality in daily living post-transplant.

Adult↗
PubMed2002

Loss of the imagined past: an emotional obstacle to medical compliance in kidney transplant recipients.

Among kidney transplant recipients, the concepts of grief and bereavement have been considered in terms of graft rejection, side effects of drugs, or death of the donor. However, our research suggests that even after a successful kidney transplantation, patients may present with feelings of bereavement, grief, or low mood, which may appear paradoxical because they have just received a much desired transplant. This sense of bereavement should be considered in terms of an imagined past, which may help to understand the patient's current mood changes and medical noncompliance. In the case report presented here, we have used the concept of systemic integrative psychotherapy to analyze change in a patient's life. Based on our research, we suggest that feelings of bereavement and grief are generated as patients come to terms with their past, which has been irretrievably lost to chronic illness, and contemplate their future. Feelings of grief and bereavement in the posttransplant period may be due to the loss of an imagined past, and must be differentiated from the bereavement the patient feels for the donor and the donor family. These feeling of loss, if not resolved, may lead to social isolation and medical noncompliance.

Activities of Daily Living↗