Thesis (M.S.)--University of Michigan, 1987.

Thesis (M.S.)--University of Michigan, 1995. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1987.

Thesis (M.S.)--University of Michigan, 1995. / Includes bibliographical references.

Thesis (doctoral)--Rijksuniversiteit te Utrecht.

Thesis (doctoral)--Lund University, 1994. / Added t.p. with thesis statement inserted.

Thesis (doctoral)--Lund University, 1994. / Added t.p. with thesis statement inserted.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2008. / Härtill 4 uppsatser.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / As infecÃÃes relacionadas à assistÃncia à saÃde estÃo entre as principais complicaÃÃes em pacientes que se submetem a transplante de rim, em virtude, nÃo somente, dos regimes de imunossupressÃo a que estÃo submetidos, como a cuidados desempenhados pelas equipes de saÃde. O objetivo deste estudo foi analisar infecÃÃes relacionadas à assistÃncia à saÃde em pacientes transplantados renais em 2012, no MunicÃpio de Fortaleza, que possui serviÃos de transplante renal consolidados. Fez-se um estudo transversal onde foram analisadas as fichas ambulatoriais, prontuÃrios e fichas de notificaÃÃo e investigaÃÃo da CCIH de pacientes que realizaram transplante renal em 2012, no HUWC e HGF, instituiÃÃes com recordes sucessivos neste tipo de procedimento. Um total de 237 participantes, sendo, 101 (mÃdias de idade: 43,2 anos) pertencentes ao HUWC e 136 (mÃdias de idade: 45,4 anos) ao HGF, foi incluÃdo no estudo. Em ambas as instituiÃÃes, a maioria das pessoas era do sexo masculino, casada e residia na Capital do CearÃ. Grande parte delas tambÃm tinha o IMC normal, era hipertensa, tinha como principais causas de IRC: inderterminada, HAS e nefrites. A proporÃÃo de procedimentos invasivos realizados foi: biopsia do enxerto (HUWC: 45,54%; HGF: 26,47%), punÃÃo de cateter venoso central (HUWC: 98,01%; HGF: 97,06%), FAV (HUWC: 66,33%; HGF: 94,11%), e passagem de cateter duplo J (HUWC: 39,6%; HGF: 22,06%). A estimativa de prevalÃncia de IRAS nos 101 pacientes transplantados renais no HUWC foi de 50 (49,05%), e no HGF, 31 (22,79%). As IRAS mais comuns, tanto no HUWC, como no HGF, foram infecÃÃes do trato urinÃrio, e os principais agentes etiolÃgicos isolados, Klebsiella pneumoniae e Escherichia coli. No HUWC, os fatores sociodemogrÃficos, clÃnicos e epidemiolÃgicos que apresentaram associaÃÃo estatisticamente significante com o acometimento por IRAS foram: a classificaÃÃo do IMC (p<0,03), o tempo em diÃlise antes do transplante (p<0,05), o tempo de internaÃÃo total (p<0,0001), o tempo de cirurgia (p<0,001), o tempo de isquemia fria (p<0,01), a passagem de cateter duplo J (p<0,003), o tempo de uso do TOT (p<0,03) e o tempo de uso da SVD (p<0,04) no HUWC; no HGF, a classificaÃÃo do IMC (p<0,04), o LES como causa de IRC (p<0,01), a transfusÃo sanguÃnea antes do transplante (p<0,02), o tempo de internaÃÃo total (p<0,001) e o tempo de uso do CVC (p<0,04). Portanto, durante todo o perÃodo perioperatÃrio, hà necessidade de desenvolvimento de aÃÃes cautelosas por toda a equipe de saÃde, de forma a prevenir infecÃÃes e gastos desnecessÃrios do governo com internamentos e tratamentos prolongados, sustentando o crescimento da tÃcnica de transplantaÃÃo renal no Estado nos Ãltimos anos. / The healthcare-related infections are among the major complications in patients who undergo kidney transplant, by virtue not only of immunosuppression schemes to which they are subjected, as the care carried out by health teams. The aim of this study was to analyze healthcare-related infections in renal transplant recipients in 2012, in the city of Fortaleza, which has consolidated renal transplant services. A cross-sectional study where outpatient records were analyzed, charts and tokens for notification and investigation of patients who performed CCIH kidney transplant in 2012, in HUWC and HGF, institutions with successive records in this type of procedure. A total of 237 attendees, being, 101 (average age: 43.2 years) belonging to the HUWC and 136 (average age: 45.4 years) to the HGF, was included in the study. In both institutions, most people were male, married and resided in the Capital of CearÃ. Most of them also had the normal BMI was hypertensive, had as main causes of IRC: inderterminada, SAH and lupus nephritis. The proportion of invasive procedures performed were: graft biopsy (HUWC: 45.54%; HGF: 26.47%), central venous catheter puncture (HUWC: 98.01%; HGF: 97.06%), FAV (HUWC: 66.33%; HGF: 94.11%), and passage of double-J catheter (HUWC: 39.6%; HGF: 22.06%). The estimated prevalence of IRAS in 101 renal transplant recipients at HUWC was 50 (49.05%), and HGF, 31 (22.79%). The most common IRAS, both in HUWC, as in HGF, were urinary tract infections, and the main etiological agents isolated Klebsiella pneumoniae and Escherichia coli. In HUWC, the socio-demographic factors, clinicians and epidemiologists who presented statistically significant association with involvement by IRAS were: the classification of BMI (p<0.03) time on dialysis before transplantation (p<0.05), the total length of stay (p<0.0001), the time of surgery (p<0.001), cold ischemia time (p<0.01), the passage of double-J catheter (p<0.003), the speaking time of TOT (p<0.03) and time of use of the SVD (p<0.04) in HUWC; on HGF, classification of BMI (p<0.04), LES as a cause of IRC (p<0.01), blood transfusion before transplantation (p<0.02), the total length of stay (p<0.001) and time of use of the CVC (p<0.04). Therefore, throughout the perioperative period, there is a need for development of cautious actions throughout the health team, in order to prevent infections and unnecessary government spending with hospitalizations and prolonged treatments, supporting the growth of renal transplantation technique in the State in recent years.

Introduction: There is an increasing number of Canadians living with end stage renal disease (ESRD). Kidney transplantation is currently the best treatment for ESRD but long-term outcomes remain suboptimal. Identifying factors associated with better outcomes may lead to interventions or practice change that could improve patient survival or quality of life. The objectives of this thesis were to: i) systematically review the literature to examine centre variation in kidney transplantation outcomes and identify centre and provider level factors that may contribute to variation in outcomes; ii) describe differences that may exist at the patient, centre and provider level at the time of kidney transplantation across the six transplant centres in Ontario, Canada; iii) examine variation in graft and patient survival rates across transplant centres in Ontario; and iv) examine whether patient, centre and provider level characteristics contribute to variation in graft and survival rates across transplant centres. Methods: The first objective of this thesis was met by conducting a systematic review of the literature according to a predefined protocol. The last three objectives of the thesis were met by conducting a population based retrospective cohort study using administrative data from Ontario. Differences at the patient, centre and provider level were described at the time of kidney transplantation. Outcomes of interest included total graft loss; graft loss with follow-up censored at death; death with graft function; and total mortality. All outcomes were assessed at one year post transplantation and at the end of study follow up. Cox proportional hazards regression was used to obtain hazard ratios (HR) for each centre relative to the average across all centres. The independent effect of centre volume and provider characteristics on outcomes was also examined. Results: The systematic review identified 24 eligible studies. Outcomes included graft survival (n=24) and patient survival (n=9). The main characteristics evaluated were centre volume (n=17) and provider volume (n=2). Centre variation in graft survival was described in 80% (12/15) of studies, while less than half of studies (8/17) found a significant association between volume and graft survival. The population based retrospective cohort included 5092 adults (≥18 years) who received a primary solitary kidney transplant across 6 transplant centres in Ontario between January 1st 2000 and December 31st 2013. Variation in patient, centre and provider level factors existed across centres at the time of transplantation. At the end of study follow-up, case-mix adjusted HRs for total graft loss ranged from 0.84 (95% CI 0.53-1.33) to 1.16 (95% CI 1.00-1.34) across centres (p-value for between centre variation 0.46). After adjusting for centre and provider factors, differences across centres persisted. Centre volume, provider experience and provider type were not independently associated with either short or long-term outcomes (all p>0.05) with the exception of graft loss with follow-up censored at death. Discussion: This thesis suggests that there is variation in clinical outcomes across transplant centres in Ontario which is not explained by patient factors, centre volume or provider characteristics at the time of transplantation. Additionally centre volume, provider type and experience were not independently associated with outcomes. Future prospective studies with a larger sample size of transplant centres that examine follow-up care after discharge from hospital (e.g. frequency of visits) are required to better understand this phenomenon.