New intervention aims to improve treatment adherence among teen kidney transplant recipients

Innovative trial combines digital technology and coaching to improve adherence to treatment among young kidney transplant patients.

Learning to become self-sufficient and responsible is part of life's journey through the teen and young adult years. Mistakes are often made, and lessons are learned. However, for young kidney-graft patients, any mistake or failure in keeping to their strict immunosuppressive therapy can lead to tragic results. In fact, low-adherence to medication remains a major contributor to the high level of organ rejection in this age group.

Transplant specialists and researchers from eight leading pediatric medical centers have united to help make a difference. Led by a pediatric nephrologist and scientist,  the team conducted a clinical trial named TAKE-IT aimed at testing a new intervention to improve adherence to treatment among adolescent kidney transplant recipients.

"Missing your anti-rejection medicine, even only a few times, can lead to graft failure," says corresponding author of the study, who is also a researcher and a professor of Medicine. "Given the shortage of organs available for transplant, every failure is not only a loss for the patient but also a loss for the transplant community."

Medication non-adherence is a major problem in the 15 to 30 per cent of children in North America who have a chronic illness, resulting in significant morbidity and mortality. It is also believed to be responsible for millions of dollars in potentially avoidable healthcare costs.

TAKE-IT: Multiplying tactics to help young patients follow treatment

The TAKE-IT intervention used a combination of electronic medication monitoring and meetings with a personal coach every three months to encourage and develop adherence behaviour. The researchers followed 169 adolescent and young adult kidney transplant recipients (aged 11 to 24) for a year. Participants used the electronic pillbox,  to monitor their medication-taking. The cohort of patients was divided into two groups. The first group (81 patients) could customize the monitoring system to send them digital nudges like emails or text messages if they did not take their medicine on time. They also received coaching from people who were not part of or did not interact with the clinical team. Members of the second group, known as the control group (88 patients), didn't receive electronic messaging or adherence coaching.

Results of the trial show that the young kidney transplant recipients who used the digital health medication management and adherence solution in combination with coaching had a 66 per cent higher adherence to the anti-rejection medicine. Better adherence is likely to lead to better graft survival.

Reactions to the intervention program varied. "Some people loved it and didn't want to give the pillbox back, but others hated it and stopped using it for reasons such as the pillbox being unwieldy. Based on this feedback, the device is being re-designed," the Dr. says. "Most teens, however, liked meeting with the coach."

"These results are exciting because they show that a multidisciplinary approach can really help teens and young adults stick to their treatment plan, which is so important for their continued well-being," adds study co-author. "The coaching has a big impact as it does in sports and other activities - the encouragement and personal connection is important, because it's not easy to be a teen or young adult with a chronic health condition."

The Dr. also emphasizes that remembering to take meds can be difficult when a lot of other things are happening in the lives of these young patients, and points out the benefit of text message and email reminders for a population who grew up using cellphones.

"This is one of the largest clinical trials on adherence to daily medication ever conducted in the kidney transplant population. Identifying an approach that is effective in promoting adherence in patients with chronic conditions is a major advance," says the Dr. "Better adherence will lead to healthier patients and is likely to save healthcare dollars by preventing serious complications that would need treatment or hospitalization."

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Kidney transplant performed with the assistance of robots

  Kidney transplant procedures involve a deep cut on the patient's belly button, which helps in placing the new organ in the body. However, the surgery can be performed by inflicting little more than a small keyhole size cut, with the assistance of robot during the procedure. A Bengaluru-based hospital has successfully performed two kidney transplants through this procedure.

Failure of her kidneys saw 35-year-old lady lose a lot of weight, besides a rapid deterioration in her overall health condition. When it seemed as if regular dialysis was the only option left for her, her mother-in-law volunteered to donate a kidney, which gave her a new lease of life.

A 29 year old man, from Odisha too was diagnosed with complete renal failure. His 50-year-old mother came forward to donate one of her kidneys, and saved her son from a difficult life. 

Neither of the two patients had to undergo the complicated surgeries that kidney transplant procedures are commonly associated with, advanced robotic technology ensured that they suffered very little; they also had to endure very short stays at the hospital following the surgery.

'Robotic instruments have 360 degree rotational capacity, compared with the human wrist, which is just 270 degrees. Also, they provide us a three dimensional view of the human anatomy The images are high definition and magnified," said Dr Deepak Dubey, consultant urologist and renal transplant surgeon at Manipal Hospital, where the procedure was performed. 

 He added that the surgical team had rehearsed the procedure thoroughly the previous day, and the patients and family members were provided with all the necessary formation.

Chairman of Manipal Hospitals, Dr H Sudarshan Ballal said that heightened awareness, the modest cost of procedures and the promise of a speedy recovery had helped put India on the global map, as far as robot-assisted surgeries were concerned. "Such procedures have started to cover a wide spectrum of procedures - cardiac, urology, general surgery, thoracic, gynaecology, et al," he added. 

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Scientists develop prototype of implantable artificial kidney

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Scientists have developed a coffee-cup-sized prototype of a surgically implantable artificial kidney that uses a silicon nanofilter to remove toxins, salts and other molecules from the blood.

The advance could be a promising alternative to kidney transplantation or dialysis for people with end stage renal disease (ESRD), researchers said. "We aim to conduct clinical trials on an implantable, engineered organ in this decade, and we are coordinating our efforts with both the NIH (US National Institutes of Health) and the US Food and Drug Administration," said Shuvo Roy, from University of California, San Francisco in US.

Researchers prototyped and tested key components of the coffee-cup-sized device, which mimics functions of the human kidney. One component of the new artificial kidney is a silicon nanofilter to remove toxins, salts, some small molecules, and water from the blood.

Bangladesh born Roy's research team designed the device based on manufacturing methods used in the production of semiconductor electronics and microelectromechanical systems. The new silicon nanofilters offer several advantages - including more uniform pore size - over filters now used in dialysis machines, according to Roy, who led the research together with William Fissell, a professor at the Vanderbilt University in US.
The silicon nanofilter is designed to function on blood pressure alone and without a pump or electrical power. Fissell said the project's goal is to create a permanent solution to the scarcity problem in organ transplantation. "We are increasing the options for people with chronic kidney disease who would otherwise be forced onto dialysis," Fissell added.

The artificial kidney being developed by Roy and Fissell is designed to be connected internally to the patient's blood supply and bladder and implanted near the patient's own kidneys, which are not removed. The research was presented at the American Society of Nephrology Kidney Week in US. 

http://www.dnaindia.com/health/report-scientists-develop-prototype-of-implantable-artificial-kidney-2145537

from this site, you can watch the video-Watch: Scientists explain the development