Multicentric study of immunological markers predictive of infection post-renal transplant

: 1.001_TEC Multicentric study of immunological markers predictive of infection post-renal transplant S. Adam, J. Perfetto, M.L. Hoyos; New York University School of Medicine, NYC, NY, USA, Hospital Universitario Marqués de Valdecilla: Instituto de Investigación Marqués de Valdecilla, Santander, Cantabria, Spain Background: Post solid organ transplant infections and rejections continue to be major causes of patient mortality despite advances in immunosuppression and anti-infectious prophylaxis. This is a multicentric investigation conducted in Santander, Spain to examine the use of markers of immunity to predict the development of infections in transplant patients. The research model was first developed in heart transplant patients, applied to lung and liver transplant patients, and is currently being used to analyze renal transplant patients. Our goals in this study are to define the IgG, IgA, IgM, C3, and C4 profiles of patients preand post-renal transplant, as well as to establish a relationship between the defined serum soluble immune markers and the development of infections post-renal transplant. Methods: We retrospectively analyzed clinical data collected using nephelometry from HUMV (Hospital Universitario Marqués de Valdecilla) patients (n 1⁄4 27) between the years of 2010-2014. Clinical data included pre-transplant comorbidities, etiology of underlying end-stage renal disease, pre-transplant renal replacement therapy, treated infections before transplantation, pre-transplant serology, vaccines before transplantation, donor serology, antimicrobial prophylaxis, post-transplant immunosuppressive therapy, posttransplant interventions, post-transplant complications, and total number of infectious episodes post-transplant. The data was analyzed using the statistical program SPSS (version 20.0). First, we looked at the total immunoglobulin and complement levels during the three time points (day 0, day 15, and day 30) to determine if a trend existed relative to transplantation. Next, we separately examined immunoglobulin and complement levels at day 0, day 15, and day 30 relative to number of infections developed post-transplant. Non-parametric statistical analysis was performed and the data was expressed as median and range values, as well as percentages. Statistical significance was considered when a p value <0.05 was obtained. Findings: Post-renal transplant immunosuppressive therapy lowered total immunoglobulin levels, especially IgG levels. We expected to find an inverse relationship between levels of serum immunoglobulins and number of post-transplant infections, but the data did not support this hypothesis. We did not see a change in C3 and C4 levels preand post-transplant. However, complement data was only included as a control to monitor patient renal function (a decrease in complement level would suggest protein or volume loss). Interpretation: We expected and found lower total immunoglobulin levels after transplant surgery. However, we also expected to find that patients with lower levels of serum immunoglobulins would have a higher number of post-transplant infections, but this A n n a l s o f G l o b a l H e a l t h , V O L . 8 2 , N O . 3 , 2 0 1 6 Technology and Innovation M a yeJ u n e 2 0 1 6 : 4 4 6 – 4 6 2 447 was not seen in the data analyzed. We believe this is due to, in part, the small sample size (n 1⁄4 27). Other confounding factors may have included clinical differences among the patients such as history of prior transplant, differences in induction therapy, infections within the six month period before renal transplantation, and number of rejections post-transplant. The lack of significant change between C3 and C4 complement levels preand post-transplant suggests that immunosuppressive therapy, which targets B and T cells, has no effect on complement. Funding: Travel funding was provided by the International Health Program of NYU School of Medicine, in collaboration with Santander Bank. Abstract #: 1.002_TEC: 1.002_TEC Building human capacity for optimal use of an electronic medical record system in Kenya: Results of a pilot evaluation of two elearning modules Jennifer Antilla, Leslie Wall, Charles Atelu, Veronica Muthee, Nzisa Liku, Nancy Puttkammer; International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA, Department of Global Health, University of Washington, Seattle, WA, USA, I-TECH Kenya, Nairobi Background: From 2012-15, the Kenyan Ministry of Health, its funders, and partners supported implementation of electronic medical record systems (EMRs) in more than 600 public-sector health facilities. Successful, sustained use of EMR data depends upon knowledge and skills of front-line health care workers to use such systems. High turnover of health workers and new EMR system features result in an ongoing need for and access to EMR training. In response to this need, the International Training and Education Center for Health (I-TECH) developed and piloted two interactive eLearning modules covering EMR data quality and using EMR data for decision-making. Method: I-TECH disseminated two asynchronous, offline modules to 6 facilities in Western Kenya via EMR system workstations. Facility management and on-site EMR mentors were oriented to the initiative; mentors supported other health workers to complete the modules. After 3 weeks, I-TECH collected questionnaires and conducted qualitative interviews on technical challenges when using the modules, relevance of the content, recommendations for dissemination, and suggestions for future topics. Results: Thirty seven health workers participated in small-group qualitative interviews and 28 completed questionaires. Key findings include: d Participants were highly motivated to complete the modules and obtain a certificate. d Modules took longer than expected to complete; 75% of respondents described the time required to complete each module as adequate. d Over 60% of participants strongly agreed that their motivation to action and confidence to use EMR data and improve data quality increased. d Over half of those interviewed recommended informal learning groups to discuss the modules. d Over 50% of participants indicated that content, organization, and navigation of the modules was good. Recommendations include: d Provide certificates or continuing education credits for learners who pass the post-test; d Integrate content on using EMR systems and clinical best practices d Strengthen the role of facility management in the orientations to the modules. Discussion and Conclusion: Facility staff were motivated to use EMR eLearning modules and apply what they learned. Participants found the content relevant to their jobs and cited an interest in additional scenarios and modules. Self-paced eLearning modules are a viable solution for standardizing sustainable training on EMR systems. Abstract #: 1.003_TEC: 1.003_TEC Establishing a process for the use of hydroxyurea in pediatric sickle cell patients in Angola R. Beaty, G. Airewele, D. Nirenberg, M.P. Noli, S. Kahan, E. Ishigami, M. Cubbage, W. Zhang, K. Wilson-Lewis; Department of Pharmacy, Texas Children’s Hospital, Texas Children’s Cancer and Hematology Centers, Baylor College of Medicine, Baylor International Pediatrics Aids Initiative Program and Project Abstracts: Texas Children’s Cancer and Hematology Centers and Baylor College of Medicine International Pediatric Aids Initiative (BIPAI) has partnered with Chevron to assist in the treatment of patients with Sickle Cell Disease (SCD) in Angola. The program called the Angolan Sickle Cell Initiative (ASCI), received a generous donation of the medication hydroxyurea (Hydrea ) from AmeriCares in partnership with Bristol-Myers Squibb. Hydroxyurea has been proven to be an important and effective treatment for individuals with SCD; it can minimize many of the significant symptoms patients develop, reduce the incidence of strokes, a major complication in patients with SCD, and can improve overall quality of life. Unfortunately, it is only available in the private healthcare sector and not yet available to the majority of the children affected by SCD treated in the public healthcare system. Structure/Method/Design: The goal of this project was 1to develop a process for storing, dispensing, and tracking hydroxyurea that complies with local legislation and donor requirements, 2to ensure maintenance of supply chain integrity, 3to track distribution and usage of hydroxyurea down to the patient level, and 4to create a Standard Operating Procedure (SOP) adapted to this middle-income country that mirrors other SOPs at Texas Children’s Hospital in order to provide a consistent standard of care. Outcome & Evaluation: We successfully implemented an electronic procedure for tracking, storing, handling, and dispensing hydroxyurea in Angola. We also designed a paper version that can be used as a back-up tracking method during power outages. We

Structure/Method/Design: The GCPM catalogs and geocodes cancer research and control projects on an interactive world map. Users can search projects by country, cancer type, institution, funding, and project dates, and view project details including abstracts, collaborators, and project website. The GCPM also provides map overlays of cancer-specific epidemiological measures and public health indicators, including cancer incidence, and the human development index.
Outcome & Evaluation: As of October 2015, the map contains over 1400 projects and 2270 collaboration sites across 119 countries. Of these collaboration sites, 54% are in the Americas, 28% are in Europe, 13% are in Asia and the Pacific, and 5% are in Africa and the Eastern Mediterranean. While the map currently includes research projects that primarily occur in high-income countries, efforts to expand the map to include research being performed in low and middle income countries is underway. Beginning in 2016, the GCPM will have been featured at 2 domestic conferences and 3 international conferences, and will feature additional project data from AORTIC, ASCO, and UICC partners.
Going Forward: In the next phase of the GCPM, we plan to expand search functionality, feature additional international projects, create an online data collection platform, and improve data usability. This is a multicentric investigation conducted in Santander, Spain to examine the use of markers of immunity to predict the development of infections in transplant patients. The research model was first developed in heart transplant patients, applied to lung and liver transplant patients, and is currently being used to analyze renal transplant patients. Our goals in this study are to define the IgG, IgA, IgM, C3, and C4 profiles of patients preand post-renal transplant, as well as to establish a relationship between the defined serum soluble immune markers and the development of infections post-renal transplant.
Clinical data included pre-transplant comorbidities, etiology of underlying end-stage renal disease, pre-transplant renal replacement therapy, treated infections before transplantation, pre-transplant serology, vaccines before transplantation, donor serology, antimicrobial prophylaxis, post-transplant immunosuppressive therapy, posttransplant interventions, post-transplant complications, and total number of infectious episodes post-transplant.
The data was analyzed using the statistical program SPSS (version 20.0). First, we looked at the total immunoglobulin and complement levels during the three time points (day 0, day 15, and day 30) to determine if a trend existed relative to transplantation. Next, we separately examined immunoglobulin and complement levels at day 0, day 15, and day 30 relative to number of infections developed post-transplant. Non-parametric statistical analysis was performed and the data was expressed as median and range values, as well as percentages. Statistical significance was considered when a p value <0.05 was obtained.
Findings: Post-renal transplant immunosuppressive therapy lowered total immunoglobulin levels, especially IgG levels. We expected to find an inverse relationship between levels of serum immunoglobulins and number of post-transplant infections, but the data did not support this hypothesis. We did not see a change in C3 and C4 levels pre-and post-transplant. However, complement data was only included as a control to monitor patient renal function (a decrease in complement level would suggest protein or volume loss).
Interpretation: We expected and found lower total immunoglobulin levels after transplant surgery. However, we also expected to find that patients with lower levels of serum immunoglobulins would have a higher number of post-transplant infections, but this I S S N 2 2 1 4 -9 9 9 6 / $ 3 6 . 0 0 was not seen in the data analyzed. We believe this is due to, in part, the small sample size (n ¼ 27). Other confounding factors may have included clinical differences among the patients such as history of prior transplant, differences in induction therapy, infections within the six month period before renal transplantation, and number of rejections post-transplant. The lack of significant change between C3 and C4 complement levels pre-and post-transplant suggests that immunosuppressive therapy, which targets B and T cells, has no effect on complement.
Funding: Travel funding was provided by the International Health Program of NYU School of Medicine, in collaboration with Santander Bank.
Abstract #: 1.002_TEC Building human capacity for optimal use of an electronic medical record system in Kenya: Results of a pilot evaluation of two elearning modules Jennifer Antilla 1 , Leslie Wall 2 , Charles Atelu 3 , Veronica Muthee 3 , Nzisa Liku 3 , Nancy Puttkammer 1 ; 1 International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA, 2 Department of Global Health, University of Washington, Seattle, WA, USA, 3 I-TECH Kenya, Nairobi Background: From 2012-15, the Kenyan Ministry of Health, its funders, and partners supported implementation of electronic medical record systems (EMRs) in more than 600 public-sector health facilities. Successful, sustained use of EMR data depends upon knowledge and skills of front-line health care workers to use such systems. High turnover of health workers and new EMR system features result in an ongoing need for and access to EMR training. In response to this need, the International Training and Education Center for Health (I-TECH) developed and piloted two interactive eLearning modules covering EMR data quality and using EMR data for decision-making.
Method: I-TECH disseminated two asynchronous, offline modules to 6 facilities in Western Kenya via EMR system workstations. Facility management and on-site EMR mentors were oriented to the initiative; mentors supported other health workers to complete the modules. After 3 weeks, I-TECH collected questionnaires and conducted qualitative interviews on technical challenges when using the modules, relevance of the content, recommendations for dissemination, and suggestions for future topics.
Results: Thirty seven health workers participated in small-group qualitative interviews and 28 completed questionaires. Key findings include: d Participants were highly motivated to complete the modules and obtain a certificate. d Modules took longer than expected to complete; 75% of respondents described the time required to complete each module as adequate. d Over 60% of participants strongly agreed that their motivation to action and confidence to use EMR data and improve data quality increased.
d Over half of those interviewed recommended informal learning groups to discuss the modules. d Over 50% of participants indicated that content, organization, and navigation of the modules was good.