No abstract

Delayed graft function (DGF) of kidney transplants increases risk of rejection. We aimed to assess the utility of weekly biopsies during DGF in the setting of currently used immunosuppression and identify variables associated with rejection during DGF. We reviewed all kidney transplants at our institution between January 2008 and December 2011. All patients received rabbit antithymocyte globulin/Thymoglobulin (ATG) or Basiliximab/Simulect induction with maintenance tacrolimus + mycophenolate + corticosteroid therapy. Patients undergoing at least one weekly biopsy during DGF comprised the study group. Eighty-three/420 (19.8%) recipients during this period experienced DGF lasting ≥1 week and underwent weekly biopsies until DGF resolved. Biopsy revealed significant rejection only in 4/83 patients (4.8%) (one Banff 1-A and two Banff 2-A cellular rejections, and one acute humoral rejection). Six other/83 patients (7.2%) had Banff-borderline rejection of uncertain clinical significance. Four variables (ATG versus Basiliximab induction, patient age, panel reactive anti-HLA antibody level at transplantation, and living versus deceased donor transplants) were statistically significantly different between patients with and without rejection, though the clinical significance of these differences is questionable given the low incidence of rejection. Conclusions. Under current immunosuppression regimens, rejection during DGF is uncommon and the utility of serial biopsies during DGF is limited.

No abstract

A database was constructed that facilitated the development of multiple interfaces for varying professionals. Content management is streamlined from a centralized location, also ensuring consistency of guidelines between medical practitioners and case managers and claims adjustors. DISCUSSION (CONCLUSION): This study demonstrates that delivery of treatment guideline recommendations in a decision support system is an effective dissemination strategy that can be tailored to the needs of users not necessarily trained in the interpretation and use of medical evidence. Combining this with an interface for physicians provides a mechanism that can improve the alignment between physician clinical decision-making and that of insurance professionals. TARGET AUDIENCE(S): 1. Guideline developer 2. Guideline implementer 3. Developer of guideline-based products 4. Health care policy analyst/policy-maker 5. Health insurance payers and purchasers

No abstract