IntroductionThis study evaluated the effect of a surgical opioid-avoidance protocol (SOAP) on pos... more IntroductionThis study evaluated the effect of a surgical opioid-avoidance protocol (SOAP) on postoperative pain scores. The primary goal was to demonstrate that the SOAP was as effective as the pre-existing non-SOAP (without opioid restriction) protocol by measuring postoperative pain in a diverse, opioid-naive patient population undergoing inpatient surgery across multiple surgical services.MethodsThis prospective cohort study was divided into SOAP and non-SOAP groups based on surgery date. The non-SOAP group had no opioid restrictions (n=382), while the SOAP group (n=449) used a rigorous, opioid-avoidance order set with patient and staff education regarding multimodal analgesia. A non-inferiority analysis assessed the SOAP impact on postoperative pain scores.ResultsPostoperative pain scores in the SOAP group compared with the non-SOAP group were non-inferior (95% CI: −0.58, 0.10; non-inferiority margin=−1). The SOAP group consumed fewer postoperative opioids (median=0.67 (IQR=15)...
Solid organ transplantation is a lifesaving treatment option for patients with end-stage organ di... more Solid organ transplantation is a lifesaving treatment option for patients with end-stage organ disease. Postoperative management is complicated by lingering comorbidities of end-stage organ disease, the aggressive use of immunosuppressants, and toxicities associated with therapy. After
Purpose: Desensitization allows successful transplantation of patients with a positive crossmatch... more Purpose: Desensitization allows successful transplantation of patients with a positive crossmatch (PXM) against their living donor. The purpose of this investigation was to evaluate outcomes following PXM renal transplantation despite failure to convert to negative crossmatch (NXM) after desensitization. Methods: UIH records were retrospectively reviewed to identify subjects that underwent desensitization for a PXM renal transplant between 1/1/00 and 11/1/11. Patients who failed to convert to NXM after desensitization were identified as the non-converted subgroup. Patients who converted to NXM were identified as the converted control group. Results: A total of 108 PXM patients were transplanted with a desensitization protocol during the study period. Forty-two patients failed to convert to NXM prior to transplant comprising the PXM group. Sixty-six patients successfully converted after desensitization comprising the converted group. Mean GFR at 1 year was 47 in the PXM group and 57 ...
Induction therapy has reduced the incidence of acute rejection compared with historical standards... more Induction therapy has reduced the incidence of acute rejection compared with historical standards. The potency of currently available induction immunosuppression is not without risk and should be carefully considered. Induction with daclizumab, an IL-2 receptor antagonist, has been used safely and effectively for over 10 years across different transplant types. As a result of daclizumab use, transplant centers are able to implement steroid-sparing or calcineurin minimization protocols. Unfortunately, the manufacturing costs have resulted in withdrawal of this agent from the market reducing the options for patients undergoing transplantation. This review will update the reader on recently published daclizumab studies in adult solid organ transplant recipients, focusing on comparative studies with other induction agents. This paper will provide a summary of comparative studies between daclizumab and other induction therapies focusing on their efficacy and safety. Novel applications, such as long-term use in combination with calcineurin-inhibitor dose reduction and its value in the treatment of acute or chronic rejection have yet to be explored. Since daclizumab has been withdrawn from the market, future IL-2 receptor blockade will have to be achieved with basiliximab, which is a chimeric, monoclonal antibody directed against the same epitope.
Introduction: Early emergency department and hospital re-admissions are common in renal transplan... more Introduction: Early emergency department and hospital re-admissions are common in renal transplant recipients, but data are lacking in unique populations. Study Aim: The purpose of this study was to identify patient risk factors for multiple acute care utilization events within the first year of renal transplantation. Design: This was a single-center, retrospective cohort study of adult renal transplant recipients between 9/2013-9/2016. Patients were compared across number of emergency department visits and by hospital re-admissions. Diagnoses were categorized. Univariate and multivariate logistic regression was used to assess risk for multiple acute care utilization events within the first 12 months post-transplant. Results: A total of 216 patients were analyzed and were on average 50.5 (SD 13.9) years old, redominantly Black (49.77%) with an average body mass index of 33.33 (9.8) and were recipients of deceased donor renal transplants (61.11%). A total of 105 (48.6%) patients visi...
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
The pharmacokinetic profiles of medications are altered in overweight and underweight patients, b... more The pharmacokinetic profiles of medications are altered in overweight and underweight patients, but few studies have described these differences in patients with body mass index extremes. As solid organ transplant programs expand their candidate selection criteria to accommodate a growing population of patients with weight extremes, it has become imperative to understand and evaluate the impact weight extremes have on the pharmacokinetics of life‐sustaining immunosuppression in this population. This review will describe pharmacokinetic and dosing considerations for weight extremes in solid organ transplant recipients, including changes following bariatric surgeries, non‐pharmacologic and pharmacologic management strategies for weight loss and gain, and potential drug‐drug interactions with popular weight management products.
IntroductionThis study evaluated the effect of a surgical opioid-avoidance protocol (SOAP) on pos... more IntroductionThis study evaluated the effect of a surgical opioid-avoidance protocol (SOAP) on postoperative pain scores. The primary goal was to demonstrate that the SOAP was as effective as the pre-existing non-SOAP (without opioid restriction) protocol by measuring postoperative pain in a diverse, opioid-naive patient population undergoing inpatient surgery across multiple surgical services.MethodsThis prospective cohort study was divided into SOAP and non-SOAP groups based on surgery date. The non-SOAP group had no opioid restrictions (n=382), while the SOAP group (n=449) used a rigorous, opioid-avoidance order set with patient and staff education regarding multimodal analgesia. A non-inferiority analysis assessed the SOAP impact on postoperative pain scores.ResultsPostoperative pain scores in the SOAP group compared with the non-SOAP group were non-inferior (95% CI: −0.58, 0.10; non-inferiority margin=−1). The SOAP group consumed fewer postoperative opioids (median=0.67 (IQR=15)...
Solid organ transplantation is a lifesaving treatment option for patients with end-stage organ di... more Solid organ transplantation is a lifesaving treatment option for patients with end-stage organ disease. Postoperative management is complicated by lingering comorbidities of end-stage organ disease, the aggressive use of immunosuppressants, and toxicities associated with therapy. After
Purpose: Desensitization allows successful transplantation of patients with a positive crossmatch... more Purpose: Desensitization allows successful transplantation of patients with a positive crossmatch (PXM) against their living donor. The purpose of this investigation was to evaluate outcomes following PXM renal transplantation despite failure to convert to negative crossmatch (NXM) after desensitization. Methods: UIH records were retrospectively reviewed to identify subjects that underwent desensitization for a PXM renal transplant between 1/1/00 and 11/1/11. Patients who failed to convert to NXM after desensitization were identified as the non-converted subgroup. Patients who converted to NXM were identified as the converted control group. Results: A total of 108 PXM patients were transplanted with a desensitization protocol during the study period. Forty-two patients failed to convert to NXM prior to transplant comprising the PXM group. Sixty-six patients successfully converted after desensitization comprising the converted group. Mean GFR at 1 year was 47 in the PXM group and 57 ...
Induction therapy has reduced the incidence of acute rejection compared with historical standards... more Induction therapy has reduced the incidence of acute rejection compared with historical standards. The potency of currently available induction immunosuppression is not without risk and should be carefully considered. Induction with daclizumab, an IL-2 receptor antagonist, has been used safely and effectively for over 10 years across different transplant types. As a result of daclizumab use, transplant centers are able to implement steroid-sparing or calcineurin minimization protocols. Unfortunately, the manufacturing costs have resulted in withdrawal of this agent from the market reducing the options for patients undergoing transplantation. This review will update the reader on recently published daclizumab studies in adult solid organ transplant recipients, focusing on comparative studies with other induction agents. This paper will provide a summary of comparative studies between daclizumab and other induction therapies focusing on their efficacy and safety. Novel applications, such as long-term use in combination with calcineurin-inhibitor dose reduction and its value in the treatment of acute or chronic rejection have yet to be explored. Since daclizumab has been withdrawn from the market, future IL-2 receptor blockade will have to be achieved with basiliximab, which is a chimeric, monoclonal antibody directed against the same epitope.
Introduction: Early emergency department and hospital re-admissions are common in renal transplan... more Introduction: Early emergency department and hospital re-admissions are common in renal transplant recipients, but data are lacking in unique populations. Study Aim: The purpose of this study was to identify patient risk factors for multiple acute care utilization events within the first year of renal transplantation. Design: This was a single-center, retrospective cohort study of adult renal transplant recipients between 9/2013-9/2016. Patients were compared across number of emergency department visits and by hospital re-admissions. Diagnoses were categorized. Univariate and multivariate logistic regression was used to assess risk for multiple acute care utilization events within the first 12 months post-transplant. Results: A total of 216 patients were analyzed and were on average 50.5 (SD 13.9) years old, redominantly Black (49.77%) with an average body mass index of 33.33 (9.8) and were recipients of deceased donor renal transplants (61.11%). A total of 105 (48.6%) patients visi...
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
The pharmacokinetic profiles of medications are altered in overweight and underweight patients, b... more The pharmacokinetic profiles of medications are altered in overweight and underweight patients, but few studies have described these differences in patients with body mass index extremes. As solid organ transplant programs expand their candidate selection criteria to accommodate a growing population of patients with weight extremes, it has become imperative to understand and evaluate the impact weight extremes have on the pharmacokinetics of life‐sustaining immunosuppression in this population. This review will describe pharmacokinetic and dosing considerations for weight extremes in solid organ transplant recipients, including changes following bariatric surgeries, non‐pharmacologic and pharmacologic management strategies for weight loss and gain, and potential drug‐drug interactions with popular weight management products.
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Papers by Maya Campara