Bakgrund: Mer än 10% av den västerländska befolkningen lever med kronisk njursvikt. Njurtransplantation är det effektivaste behandlingsalternativet vid svår kronisk njursvikt, och fler än 600 personer står på väntelistan för en ny njure i Sverige. Det är som sjuksköterska viktigt att se patienterna bakom sjukdomen och ha förståelse för deras individuella behov. Genom att få en uppfattning av patienternas livsvärld, har sjuksköterskan möjlighet att främja njurmottagarnas liv efter transplantationen. Syfte: Syftet med litteraturstudien var att belysa njurmottagares erfarenheter av livet efter en transplantation. Metod: En litteraturstudie baserad på 10 vetenskapliga studier med kvalitativ ansats. Studiernas kvalitet granskades med hjälp av SBU:s granskningsmall och analyserades med en innehållsanalys. Resultat: Resultatet presenterades i tre tema och nio undertema. De tema som framkom var: Utmaningar i det dagliga livet, Livsförändringar och Självständighet. Slutsats: Njurmottagarna upplevde många olika känslor efter transplantationen. De kände glädje och tacksamhet, för att de hade fått en ny chans i livet, men också för att de inte längre var beroende av dialysbehandling. De upplevde också känslor av rädsla och oro, som var associerade till risken för njuravstötning och fysiska komplikationer. Dessutom hade anhöriga höga förväntningar som mottagarna inte kunde leva upp till, vilket bidrog till känslor av besvikelse. Genom personcentrerad vård och mycket information från sjuksköterskor, var njurmottagarna mer redo för livet efter transplantationen. / Background: More than 10% of the western population are living with kidney failure. The most effective treatment for severe chronic kidney failure is a kidney transplant, and more than 600 people are waiting for a new kidney in Sweden. It is important as a nurse to see the patient behind the disease and have understanding for their individual needs. By gaining insight of the person’s life-world, can the nurse promote kidney recipients life after a transplant. Aim: The purpose was to explore kidney recipient’s experiences of life after a transplantation. Method: A literature review based on 10 scientific articles with qualitative approach. The quality of the articles was reviewed and analyzed by a content analysis. Results: The results were presented in three themes and nine sub-themes. The themes presented were Challenges in the daily life, Life changes and Independence. Conclusion: The kidney recipients experienced different emotions after the transplant. They felt joy and gratitude, because they had been given a new chance in life, but also because they were no longer dependent on dialysis treatment. They also experienced feelings of fear and anxiety, which were associated with the risk of kidney rejection and physical complications. In addition, relatives had high expectations that the recipients could not live up to, which contributed to feelings of disappointment. The obstacles that the recipients experienced in life after the transplant, could the nurse support them in. Through person centered care and a lot of information from the nurses, were the kidney recipients more ready for life after the transplant.

Die Nierentransplantation stellt aktuell die Therapie der Wahl für Patienten mit terminaler chronischer Niereninsuffizienz dar. Dabei ist die Lebendspende der postmortalen Transplantation vorzuziehen, sofern ein passender Organspender zur Verfügung steht. Welchen Stellenwert einzelne Einflussfaktoren und Aspekte für das körperliche und seelische Wohlbefinden einnehmen, soll in dieser Arbeit an den 1997 – 2014 ope- rierten Patienten des Transplantationszentrums Dresden untersucht werden. Zusammenfassend beschäftigt sich diese Studie mit der gesundheitsbezogenen Lebensqualität von Spendern und Empfängern nach einer Lebendnierentransplantation. Die Ergebnisse sollen dazu beitragen, die perioperative Therapie und Betreuung zu optimieren sowie dem persönlichen Umfeld Hinweise zur Unterstützung ihrer Angehörigen aufzuzeigen.:Inhaltsverzeichnis Abbildungs- und Tabellenverzeichnis Abkürzungsverzeichnis 1. Einleitung 1.1 Funktion der Niere 1.2 Die Niereninsuffizienz 1.3 Nierenersatzverfahren 1.4 Organtransplantation 1.5 Das Transplantationsgesetz 1.6 Lebendnierenspende 1.6.1 Modelle 1.6.2 Voraussetzungen 1.6.2.1 Medizinisch 1.6.2.2 Psychologisch 1.6.2.3 Rechtlich 1.6.3 Durchführung 1.6.4 Vorteile 1.6.5 Risiken 1.6.6 Gesundheitsbezogene Lebensqualität und Transplantation 1.6.6.1 Empfänger 1.6.6.2 Spender 1.7 Entscheidungsfindung 2 Material und Methoden 2.1 Ziele und Fragestellungen 2.2 Durchführung der Datenerhebung 2.3 Beschreibung der Instrumente 2.3.1 BSI-18 2.3.2 Morisky-Score 2.3.3 WHO-5 2.3.4 Beratungsbedarf 2.3.5 LOT-R 2.3.6 BFI-K 2.3.7 F-SozU-22 2.3.8 GBB-24 2.3.9 Item Bundesgesundheitssurvey 2.4 Datenaufbereitung und statistische Auswertung 3 Ergebnisse 3.1 Auswertung nach Spenderstatus 3.1.1 Soziodemographie 3.1.2 Komplikationen 3.1.3 Zufriedenheit 3.1.4 Veränderungen 3.1.5 Psychisches Befinden 3.1.6 Compliance 3.1.7 Lebensqualität 3.1.8 Beratungsbedarf 3.1.9 Persönlichkeit 3.1.10 Soziale Unterstützung 3.1.11 Körperliche Beschwerden 3.2 Auswertung nach Geschlecht 3.2.1 Soziodemographie 3.2.2 Komplikationen 3.2.3 Zufriedenheit 3.2.4 Veränderungen 3.2.5 Psychisches Befinden 3.2.6 Compliance 3.2.7 Lebensqualität 3.2.8 Beratungsbedarf 3.2.9 Persönlichkeit 3.2.10 Soziale Unterstützung 3.2.11 Körperliche Beschwerden 3.3 Auswertung nach Alter 3.3.1 Komplikationen 3.3.2 Zufriedenheit 3.3.3 Veränderungen 3.3.4 Psychisches Befinden 3.3.5 Compliance 3.3.6 Lebensqualität 3.3.7 Beratungsbedarf 3.3.8 Persönlichkeit 3.3.9 Soziale Unterstützung 3.3.10 Körperliche Beschwerden 3.4 Auswertung nach Bildungsstand 3.4.1 Soziodemographie 3.4.2 Komplikationen 3.4.3 Zufriedenheit 3.4.4 Veränderungen 3.4.5 Psychisches Befinden 3.4.6 Compliance 3.4.7 Lebensqualität 3.4.8 Beratungsbedarf 3.4.9 Persönlichkeit 3.4.10 Soziale Unterstützung 3.4.11 Körperliche Beschwerden 3.5 Auswertung nach postoperativem Zeitraum 3.5.1 Komplikationen 3.5.2 Zufriedenheit 3.5.3 Veränderungen 3.5.4 Psychisches Befinden 3.5.5 Compliance 3.5.6 Lebensqualität 3.5.7 Beratungsbedarf 3.5.8 Persönlichkeit 3.5.9 Soziale Unterstützung 3.5.10 Körperliche Beschwerden 3.6 Regressionsanalyse 3.6.1 Zusammenhänge psychische Belastung 3.6.2 Zusammenhänge körperliches Befinden/Beschwerdedruck 3.6.3 Zusammenhänge Lebensqualität 3.6.4 Zusammenhänge soziale Unterstützung 3.6.5 Zusammenhänge Zufriedenheit 3.7 Korrelationsanalyse 4 Diskussion der Studie 4.1 Spender und Empfänger 4.2 Frauen und Männer 4.3 Alter 4.4 Bildungsstand 4.5 Datum der Transplantation 4.6 Studienkritik 4.6.1 Auswahl der Patienten 4.6.2 Durchführung 4.6.3 Auswertung 5 Zusammenfassung 6 Literaturverzeichnis 7 Anhang 7.1 Tabellen 7.2 Fragebogen 7.3 Fragebogen „Nachbefragung“ 7.4 Votum der Ethikkommission 7.5 Anlage 1 7.6 Anlage 2 8 Danksagung

Bakgrund: Njurtransplantation ses som den främsta behandlingsmetoden vid terminal njursvikt, då den ökar både livskvalitet och livslängd för patienten jämfört med dialys. Prevalensen av njursvikt ökar i hela världen och efterfrågan av njurar möter inte behovet. Syfte: Syftet med studien var att belysa patientens upplevelse i väntan på en njurtransplantation. Metod: Studien genomfördes som en litteraturstudie med induktiv ansats, för att bilda en uppfattning om hur forskningsläget ser ut inom valt område. Resultat: Resultatet baseras på nio kvalitativa vetenskapliga artiklar från sju olika länder, där fyra kategorier framkom, Ett liv som begränsar, Förväntningar, Glädje och sorg samt Behov och betydelse av stöd. Gemensamt för samtliga artiklar var att livet begränsades i väntan på en njurtransplantation, vilket påverkade patienterna både emotionellt och fysiologiskt. Ju längre tid som patienterna befann sig på väntelistan minskade hoppet om en ny njure, och känslan av frustration samt oro ökade. Konklusion: Litteraturstudien visar på att behovet av information från sjuksköterskan till patienter som väntade på en njurtransplantation var stort. Information skapade en känsla av delaktighet i vården som i sin tur bevarade patientens hopp, samt minskade upplevelsen av oro. / Background: Kidney transplantation is seen as the main treatment method for terminal kidney failure as it increases both quality of life and longevity of the patient compared to dialysis. The prevalence of kidney failure is increasing worldwide and the demand for kidneys is not meeting the need. Aim: The aim of the study was to highlight the patient's experience while waiting for a kidney transplant. Method: The study was conducted as a literature study with an inductive approach to form an idea of what the research situation looks like in the chosen area. Result: The result is based on nine qualitative articles from seven different countries where four categories emerged: A life that limits, Expectations, Joy and sorrow and Need and importance of support. Common to all articles was that life was limited while waiting for a kidney transplant, which affected the patients both emotionally and physiologically. The longer the patients were on the waiting list, the less hope for a new kidney diminished and the feeling of frustration and anxiety increased. Conclusion: The literature study shows that the need for information from the nurse to patients waiting for a kidney transplant was great. Information created a sense of participation in care which in turn preserved the patient's hope and reduced the experience of anxiety.

Background: Simultaneous pancreas-kidney transplantation (SPKT) profoundly improves the health-related quality of life (HRQoL) of recipients. However, the influence of the pre-transplant dialysis modality on the success of the SPKT and post-transplant HRQoL remains unknown. Methods: We analyzed the surgical outcome, long-term survival, as well as HRQoL of 83 SPKTs that were performed in our hospital between 2000 and 2016. Prior to transplant, 64 patients received hemodialysis (HD) and nineteen patients received peritoneal dialysis (PD). Physical and mental quality of life results from eight basic scales and the physical and mental component summaries (PCS and MCS) were measured using the Short Form 36 (SF-36) survey. Results: Peri- and postoperative complications, as well as patient and graft survival were similar between the two groups. Both groups showed an improvement of HRQoL in all SF-36 domains after transplantation. Compared with patients who received HD before transplantation, PD patients showed significantly better results in four of the eight SF-36 domains: physical functioning (mean difference HD - PD: - 12.4 ± 4.9, P = < 0.01), bodily pain (- 14.2 ± 6.3, P < 0.01), general health (- 6.3 ± 2.8, P = 0.04), vitality (- 6.8 ± 2.6, P = 0.04), and PCS (- 5.2 ± 1.5, P < 0.01) after SPKT. In the overall study population, graft loss was associated with significant worsening of the HRQoL in all physical components (each P < 0.01). Conclusions: The results of this analysis show that pre-transplant dialysis modality has no influence on the outcome and survival rate after SPKT. Regarding HRQoL, patients receiving PD prior to SPKT seem to have a slight advantage compared with patients with HD before transplantation.

Objectives: Adequate organ perfusion, as well as appropriate blood pressure levels at the time of unclamping, is crucial for early and long-term graft function and outcome in simultaneous pancreas–kidney transplantation (SPKT). However, the optimal intraoperative mean arterial pressure (MAP) level has not well been defined. Methods: From a prospectively collected database, the medical data of 105 patients undergoing SPKT at our center were retrospectively analyzed. A receiver operating characteristic (ROC) analysis was preliminarily performed for optimal cut-off value for MAP at reperfusion, to predict early pancreatic graft function. Due to these results, we divided the patients according to their MAP values at reperfusion into <91 mmHg (n = 47 patients) and >91 mmHg (n = 58 patients) groups. Clinicopathological characteristics and outcomes, as well as early graft function and long-term survival, were retrospectively analyzed. Results: Donor and recipient characteristics were comparable between both groups. Rates of postoperative complications were significantly higher in the <91 mmHg group than those in the >91 mmHg group (vascular thrombosis of the pancreas: 7 (14%) versus 2 (3%); p = 0.03; pancreatitis/intraabdominal abscess: 10 (21%) versus 4 (7%); p = 0.03; renal delayed graft function (DGF): 11 (23%) versus 5 (9%); p = 0.03; postreperfusion urine output: 106 ± 50 mL versus 195 ± 45 mL; p = 0.04). There were no significant differences in intraoperative volume repletion, central venous pressure (CVP), use of vasoactive inotropic agents, and the metabolic outcome. Five-year pancreas graft survival was significantly higher in the >91 mmHg group (>91 mmHg: 82% versus <91 mmHg: 61%; p < 0.01). No significant differences were observed in patient and kidney graft survival at 5 years between both groups. Multivariate Cox regression analysis affirmed MAP < 91 mmHg as an independent prognostic predictor for renal DGF (HR 3.49, 1.1–10.8, p = 0.03) and pancreas allograft failure (HR 2.26, 1.0–4.8, p = 0.01). Conclusions: A MAP > 91 mmHg at the time point of reperfusion was associated with a reduced rate of postoperative complications, enhancing and recovering long-term graft function and outcome and thus increasing long-term survival in SPKT recipients.

Bakgrund: Organtransplantation ger nytt hopp och nytt liv till sjuka patienter. Njursvikt är en kronisk, försvagande sjukdom som påverkar många aspekter av patienternas liv. Den effektivaste behandlingen mot kronisk njursvikt är transplantation. Forskning visar hur patienterna upplever livet efter njurtransplantation.Syfte: Syftet är att sammanställa vetenskapliga artiklar som belyser patienters upplevelse av livet efter njurtransplantation.Metod: Litteraturstudie med tematisk analys av tio vetenskapliga artiklar med kvalitativ ansats.Resultat: Studiens resultat visade att en del av patienterna upplevde många positiva förändringar men det fanns också en del som upplevde ett antal begränsningar. Att leva med en ny njure ledde till en känsla av frihet, glädje, lycka och en möjlighet till att kunna planera mer långsiktigt. Rädsla och oro över att den nya njuren kunde stötas bort, skuld över att ta emot någon annans njure, livslångbehandling och för höga förväntningar ledde till ett begränsat liv. Resultatet visade inte på någon tydlig skillnad mellan kvinnor och mäns upplevelser av livet efter njurtransplantationen men vissa variationer kunde urskiljas.Konklusion: I studien framkom olika aspekter kring hur patienterna såg på livet efter en njurtransplantation. Före uppsatsen förväntade vi oss att patienterna skulle vara lättade då de tidigare varit på gränsen till döden. Men även om patienterna upplevde att de hade en högre livskvalitet efter transplantationen kom det ändå stunder då de misströstade och trodde att förbättringarna endast var tillfälliga. / Background: Organ transplantation gives new hope and new life to patients. Renal failure is a chronic, devastating disease that affects many aspects of the patients' lives. The most effective treatment for chronic kidney failure is transplantation. Research shows how patients experience life after kidney transplantationAim: The aim is to collect scientific articles that highlight the patient's experience of life after transplantation.Method: Literature study with thematic analysis of ten scientific articles with qualitative approach.Results: The study results showed that some of the patients experienced many positive changes, but there were also some who experienced a few limitations. Living with a new kidney led to a sense of freedom, joy, happiness, and opportunity to be able to plan more over a long term. The fear and concern that the new kidney could be rejected, guilt over receiving someone else's kidney, life-long treatment and high expectations led to a limited life. The results showed no significant difference between women’s and men's experiences of life after kidney transplantation, but certain variations could be discerned.Conclusion: The study revealed different aspects of the experience of life after renal transplantation. Before this study was expected only the good aspects and believed that it would only be a relief for patients as the previously lasted on the verge of death. Even if patients feel that they had a better life than before the transplant there are times when they despair, and think that the improvements they experience only temporary.

No description available.

Background/Objectives: The sequence of graft implantation in simultaneous pancreas-kidney transplantation (SPKT) warrants additional study and more targeted focus, since little is known about the short- and long-term effects on the outcome and graft survival after transplantation. Material and methods: 103 patients receiving SPKT in our department between 1999 and 2015 were included in the study. Patients were divided according to the sequence of graft implantation into pancreas-first (PF, n = 61) and kidney-first (KF, n = 42) groups. Clinicopathological characteristics, outcome and survival were reviewed retrospectively. Results: Donor and recipient characteristics were similar. Rates of post-operative complications and graft dysfunction were significantly higher in the PF group compared with the KF group (episodes of acute rejection within the first year after SPKT: 11 (18%) versus 2 (4.8%); graft pancreatitis: 18 (18%) versus 2 (4.8%), p = 0.04; vascular thrombosis of the pancreas: 9 (14.8%) versus 1 (2.4%), p = 0.03; and delayed graft function of the kidney: 12 (19.6%) versus 2 (4.8%), p = 0.019). The three-month pancreas graft survival was significantly higher in the KF group (PF: 77% versus KF: 92.1%; p = 0.037). No significant difference was observed in pancreas graft survival five years after transplantation (PF: 71.6% versus KF: 84.8%; p = 0.104). Kidney graft survival was similar between the two groups. Multivariate analysis revealed order of graft implantation as an independent prognostic factor for graft survival three months after SPKT (HR 2.6, 1.3–17.1, p = 0.026) and five years (HR 3.7, 2.1–23.4, p = 0.040). Conclusion: Our data indicates that implantation of the pancreas prior to the kidney during SPKT has an influence especially on the early-post-operative outcome and survival rate of pancreas grafts.

Accurately predicting graft failure following kidney transplantation is essential for identifying high-risk patients and tailoring treatment strategies. This thesis aims to forecast kidney graft failure by estimating and predicting the glomerular filtration rate (GFR) using real data related to pre-transplant and post-operative patients status, provided to us by Hannover Medical School. To achieve this, we implement three Bayesian filtering techniques: the Extended Kalman Filter (EKF), the Unscented Kalman Filter (UKF), and the Particle Filter (PF), on a discrete-time state-space stochastic Duffing oscillator model. We also conduct regression analysis between available GFR measurements and the filters' estimated and predicted values, followed by an error analysis using root mean square error. Our results demonstrate that Particle Filter, utilizing 10,000 particles, consistently produced accurate estimates compared to other filters in most patients. Furthermore, we observe that data interpolation yields more accurate results.

In dieser Arbeit sollen die Vermittelbarkeit der notwendigen methodischen Fähigkeiten zur Anwendung der EbM in der klinischen Entscheidungsfindung sowie die Qualität der dazu unverzichtbaren Publikationen klinischer Studien für das Gebiet der Nierentransplantation untersucht werden. Des Weiteren sollen angesichts der für viele Fragen nicht vorhandenen Studienergebnisse alternative Verfahren der Gewinnung von klinisch entscheidungsrelevanten Erkenntnissen in der Nierentransplantationsmedizin untersucht werden. Liegen in einer Entscheidungssituation relevante Ergebnisse qualitativ adäquater randomisierter Studien vor, sollte die Entscheidung auf diese Ergebnisse gestützt werden. Die klinische Entscheidungsfindung kann auf verschiedenen Wegen unterstützt werden. Der Königsweg ist die auf Erkenntnissen der Grundlagenforschung fußende randomisierte Studie. Deren Nutzung erfordert jedoch eine leitliniengemäße Publikation und auf Seiten des Lesers entsprechendes Methodenwissen zur Interpretation der Ergebnisse. Komplementäre Methoden, insbesondere Analysen klinischer Datenbanken können die aus randomisierten Studien stammenden Entscheidungsgrundlagen sinnvoll ergänzen und die Durchführung weiterer randomisierter Studien vorbereiten. Auf diesem Hintergrund erscheint es auch für den Bereich der Nierentransplantation sinnvoll, die bestehende Datenbasis konsequent weiter auszubauen. / This work aims to investigate the communicability of the necessary skills for the application of Evidence-based Medicine in everyday clinical decision making. In addition the publication quality and design of clinical trials in the field of kidney transplantation are observed. In this context and on the background of the lack of clinically relevant study data for many important aspects of transplantation medicine alternative methods of knowledge generation to support clinical decision making are assessed. Whenever results of adequate prospective randomized trials are available clinical decision making should take these into account. But clinical decision making can be supported in various ways. The best way is the conduction of randomized clinical trials based on the results of basic science investigations. Use of randomized trial results requires their guideline-conforming publication and on the reader’s side the corresponding methodological skills for the critical interpretation and assessment of the scientific medical literature. Complementary methods - especially analyses of clinical databases can achieve substantial enhancement of the foundation for clinical decision making. They can also help to prepare the conduct of further randomized studies. Thus, as in other fields it seems worthwile to expand the existing databases in the field of kidney transplantation.