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Kidney transplant candidate

W F Parker, L F Ross, J R Thistlethwaite, A E Gallo
The Kidney Allocation System (KAS) altered pediatric candidate prioritization. We determined KAS' impact on pediatric kidney recipients by examining delayed graft function (DGF) rates from 2010-2016. A propensity score matched pediatric recipients pre- and post-KAS. A semi-parametric decomposition analysis estimated the contributions of KAS-related changes in donor characteristics and dialysis time on DGF rate. The unadjusted odds of DGF was 69% higher post-KAS for young (<10 years at listing) recipients (N = 1,153, p=0...
February 19, 2018: Clinical Transplantation
Rachel E Patzer, Laura McPherson, Mohua Basu, Sumit Mohan, Michael Wolf, Mariana Chiles, Allison Russell, Jennifer C Gander, John J Friedewald, Daniela Ladner, Christian P Larsen, Thomas Pearson, Stephen Pastan
We previously developed a mobile- and web-based decision aid (iChoose Kidney) that displays individualized risk estimates of survival and mortality, for the treatment modalities of dialysis versus kidney transplantation. We examined the effect of iChoose Kidney on change in transplant knowledge and access to transplant in a randomized controlled trial among patients presenting for evaluation in three transplant centers. A total of 470 patients were randomized to standard transplantation education (control) or standard education plus iChoose Kidney (intervention)...
February 15, 2018: American Journal of Transplantation
Courtenay M Holscher, Kyle Jackson, Eric Kh Chow, Alvin G Thomas, Christine E Haugen, Sandra R DiBrito, Carlin Purcell, Matthew Ronin, Amy D Waterman, Jacqueline Garonzik Wang, Allan B Massie, Sommer E Gentry, Dorry L Segev
Kidney paired donation (KPD) can facilitate living donor transplantation for candidates with an incompatible donor, but requires waiting for a match while suffering the morbidity of dialysis. The balance between waiting for KPD versus desensitization or deceased donor transplantation relies on the ability to estimate KPD wait times. We studied donor/candidate pairs in the National Kidney Registry (NKR), a large multi-center KPD clearinghouse, between 10/2011-9/2015 using a competing risk framework. Among 1894 candidates, 52% were male, median age was 50 years, 66% were white, 59% had blood type O, 42% had PRA>80, and 50% obtained KPD through NKR...
February 13, 2018: American Journal of Transplantation
David D Lee, Hani M Wadei
On December 4, 2014, the new kidney allocation system (KAS) was implemented to reduce extreme longevity mismatches between kidney allograft and recipient life expectancy, increase the highly sensitized patients' access to transplantation through prioritization, broaden access for disadvantaged candidates by counting dialysis time towards wait-list time, and potentially increase the utilization of "marginal kidneys" through broader allocation at the local and regional level. In the first year after implementation, the early results of KAS suggested that the new policies were successful in meeting many of these goals 1 ...
February 12, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Brianna L Doby, Aaron A R Tobian, Dorry L Segev, Christine M Durand
PURPOSE OF REVIEW: The HIV Organ Policy Equity (HOPE) Act, signed in 2013, reversed the federal ban on HIV-to-HIV transplantation. In this review, we examine the progress in HOPE implementation, the current status of HIV-to-HIV transplantation, and remaining challenges. RECENT FINDINGS: Pursuant to the HOPE Act, the Department of Health and Human Services revised federal regulations to allow HIV-to-HIV transplants under research protocols adherent to criteria published by the National Institutes of Health...
February 9, 2018: Current Opinion in Organ Transplantation
T Yunhua, Z Qiang, J Lipeng, H Shanzhou, Z Zebin, J Fei, Z Zhiheng, W Linhe, J Weiqiang, W Dongping, G Zhiyong, H Xiaoshun
BACKGROUND: The incidence of end-stage renal disease (ESRD) after liver transplant (LT) has increased. The actual benefit of kidney transplantation (KT) is not completely understood in LT recipients with ESRD. METHODS: We analyzed Scientific Registry of Transplant Recipients data for all KT candidates with prior LT from 1998 to 2014; the benefits of KT relative to remaining on dialysis were compared by means of multivariate Cox proportional hazards regression analysis...
January 2018: Transplantation Proceedings
A A Rahnemai-Azar, J D Perkins, N Leca, C D Blosser, C K Johnson, S D Morrison, R Bakthavatsalam, A P Limaye, L Sibulesky
BACKGROUND: The new kidney allocation system (KAS) intends to allocate the top 20% of kidneys to younger recipients with longer life expectancy. We hypothesized that the new KAS would lead to greater allocation of Public Health Service (PHS) increased-risk donor organs to younger recipients. METHODS: Analyses of the Organ Procurement and Transplantation Network data of patients who underwent primary deceased kidney transplantation were performed in pre- and post-KAS periods...
January 2018: Transplantation Proceedings
H Meng, Y Liang, J Hao, J Lu
BACKGROUND: Although improved understanding and assessment of organ rejection significantly contribute to long-term allograft survival after kidney transplantation, reliable and predictive biomarkers that enable diagnoses of rejection state are lacking. Patient rejection of a kidney graft displays a specific blood and biopsy transcriptional pattern, raising the question of whether transcript biomarkers in blood could reflect events within the allograft. METHODS: Differential expression genes were screened on large-scale transcriptomic data from blood and allograft biopsies, which included recipients undergoing rejection and recipients with stable renal function...
January 2018: Transplantation Proceedings
Fernando Salvador, Adrián Sánchez-Montalvá, Elena Sulleiro, Francesc Moreso, Cristina Berastegui, Mireia Caralt, María-Jesús Pinazo, Zaira Moure, Ibai Los-Arcos, Oscar Len, Joan Gavaldà, Israel Molina
Reactivation of Chagas disease in the chronic phase may occur after solid organ transplantation, which may result in high parasitemia and severe clinical manifestations such as myocarditis and meningoencephalitis. The aim of the present study is to describe the prevalence of Chagas disease among solid organ-transplanted patients in a tertiary hospital from a nonendemic country. A cross-sectional study was performed at Vall d'Hebron University Hospital (Barcelona, Spain) from April to September 2016. Chagas disease screening was performed through serological tests in adult patients coming from endemic areas that had received solid organ transplantation and were being controlled in our hospital during the study period...
February 5, 2018: American Journal of Tropical Medicine and Hygiene
A Wey, S K Gustafson, N Salkowski, J Pyke, B L Kasiske, K Israni, J J Snyder
SRTR is considering more prominent reporting of program-specific adjusted transplant rate ratios (TRRs). To enable more useful reporting of TRRs, SRTR updated the transplant rate models to explicitly adjust for components of allocation priority. We evaluated potential associations between TRRs and components of allocation priority that could indicate programs' ability to manipulate TRRs by denying or delaying access to low-priority candidates. Despite a strong association with unadjusted TRRs, we found no candidate-level association between the components of allocation priority and adjusted TRRs...
February 3, 2018: American Journal of Transplantation
Wenqing Ye, Maurice D Voss, Sriharsha Athreya
PURPOSE: Symptomatically enlarged kidneys observed in autosomal dominant polycystic kidney disease (ADPKD) patients can lead to compression symptoms and contraindications to renal transplantation. Surgical nephrectomy can be utilized to increase space in the abdomen prior to renal transplantation; however, not all individuals are appropriate candidates for this procedure. Transcatheter arterial embolization (TAE) of the renal arteries can provide a noninvasive way to reduce renal volume in ADPKD...
January 31, 2018: Cardiovascular and Interventional Radiology
Ricardo Manuel de Oliveira Soares, Alexander Paul Glaser, Jason Evan Cohen, Obianuju Okocha, Robert Brewster Nadler
Background: Percutaneous nephrolithotomy (PCNL) is a procedure typically performed under general anesthesia (GA); however, many patients might be considered unfit for GA and locoregional anesthesia is their only chance to have the procedure done. Case Presentation: A 60-year-old Middle-Eastern female with end-stage lung disease underwent evaluation for lung transplant; she was found to have severe restrictive pattern on steroid and continuous oxygen therapy, pulmonary hypertension with dilated right ventricle, chronic anemia, and asthma...
2018: Journal of Endourology Case Reports
Sung Shin, Chang Hee Jung, Ji Yoon Choi, Hyun Wook Kwon, Joo Hee Jung, Young Hoon Kim, Duck Jong Han
BACKGROUND: Limited data are available regarding optimal selection criteria for pancreas transplant alone (PTA) to minimize aggravation of diabetic nephropathy. METHODS: A total of 87 type 1 diabetic patients were evaluated before and after PTA at a single center from January, 1999 to December, 2015, together with 87 matched non-transplanted type 1 diabetic subjects who were candidates for PTA to compare deterioration of native kidney function. A total of 163 patients (79 in the transplanted group and 84 in the nontransplanted group) were finally enrolled after excluding nine patients with estimated glomerular filtration rate less than 60 mL/min/1...
2018: PloS One
Bruno Alves Lima, Helena Alves
INTRODUCTION: Implemented in 2007 by Ordinance No. 6357, allocation rules of cadaveric donor kidneys seek to distribute equitably a scarce community resource to patients who can improve their survival and quality of life. As stated in the aforementioned ordinance these rules must be updated whenever the state of the art recommends it. The objective of this work is to evaluate and compare three cadaveric donor allocation models: scoring criteria of ordinance nº 6537/2007 (model 1); similar to the previous model but with a lower score for the dialysis time (model 2); and a model adapted from the previously proposed color allocation system (model 3)...
December 29, 2017: Acta Médica Portuguesa
Dongkyu Oh, Eun Suk Kang, Shinae Yu, Kyoungsuk Chun, Wooseong Huh, Hye Ryoun Jang, Chan Woo Cho, Nuri Lee, Kyo Won Lee, Hyojun Park, Jae Berm Park, Sung Joo Kim
As the need for the organ donation increases, strategies to increase kidney transplantation (KT) through expanded living donation have become essential. These include kidney paired donation (KPD) programs and desensitization in incompatible transplantations. KPD enables kidney transplant candidates with incompatible living donors to join a registry with other incompatible pairs in order to find potentially compatible living donor. Positive cross match and ABO incompatible transplantation has been successfully accomplished in selective cases with several pre-conditionings...
January 29, 2018: Journal of Korean Medical Science
Deirdre Sawinski, Jayme E Locke
Nearly 100,000 patients are waiting for a kidney transplant, yet each year only 11,000 undergo transplantation with a deceased donor kidney. Annual death rates among waitlist registrants range from 5% to 15%; many die before receiving a transplant. Not surprisingly, registrants turn to family and friends to become living kidney donors on their behalf. Living kidney donor selection practices aim to quantify lifetime risk for kidney failure based on a candidate's predonation demographic and health characteristics...
January 11, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Francis L Delmonico, Susan Gunderson, Kishore R Iyer, Gabriel M Danovitch, Timothy L Pruett, Jorge D Reyes, Nancy L Ascher
Since 2012, the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) has required transplant centers to record the citizenship and residency status of patients undergoing transplantation in the United States. This policy replaced the 5% threshold of the non-US citizen/non-U.S. residents (NC/NR) undergoing organ transplantation that could result in an audit of transplant center activity.We analyzed the frequency of NC/NR deceased donor organ transplants and wait list registrations at all US transplant centers using data provided by UNOS for that purpose to the UNOS Ad Hoc International Relations Committee...
January 11, 2018: Transplantation
Jesse D Schold, Kenneth A Andreoni, Anil K Chandraker, Robert S Gaston, Jayme E Locke, Amit K Mathur, Timothy L Pruett, Abbas Rana, Lloyd E Ratner, Laura D Buccini
Outcomes of patients receiving solid organ transplants in the United States are systematically aggregated into bi-annual Program-Specific Reports (PSRs) detailing risk-adjusted survival by transplant center. Recently, the Scientific Registry of Transplant Recipients (SRTR) issued 5-tier ratings evaluating centers based on risk-adjusted 1-year graft survival. Our primary aim was to examine the reliability of 5-tier ratings over time. Using 10 consecutive PSRs for adult kidney transplant centers from June 2012 to December 2016 (n = 208), we applied 5-tier ratings to center outcomes and evaluated ratings over time...
January 9, 2018: American Journal of Transplantation
Tanjala S Purnell, Xun Luo, Lisa A Cooper, Allan B Massie, Lauren M Kucirka, Macey L Henderson, Elisa J Gordon, Deidra C Crews, L Ebony Boulware, Dorry L Segev
Importance: Over the past 2 decades, there has been increased attention and effort to reduce disparities in live donor kidney transplantation (LDKT) for black, Hispanic, and Asian patients with end-stage kidney disease. The goal of this study was to investigate whether these efforts have been successful. Objective: To estimate changes over time in racial/ethnic disparities in LDKT in the United States, accounting for differences in death and deceased donor kidney transplantation...
January 2, 2018: JAMA: the Journal of the American Medical Association
Ayse L Mindikoglu, Antone R Opekun, Nagireddy Putluri, Sridevi Devaraj, David Sheikh-Hamad, John M Vierling, John A Goss, Abbas Rana, Gagan K Sood, Prasun K Jalal, Lesley A Inker, Robert P Mohney, Hocine Tighiouart, Robert H Christenson, Thomas C Dowling, Matthew R Weir, Stephen L Seliger, William R Hutson, Charles D Howell, Jean-Pierre Raufman, Laurence S Magder, Cristian Coarfa
The application of nontargeted metabolomic profiling has recently become a powerful noninvasive tool to discover new clinical biomarkers. This study aimed to identify metabolic pathways that could be exploited for prognostic and therapeutic purposes in hepatorenal dysfunction in cirrhosis. One hundred three subjects with cirrhosis had glomerular filtration rate (GFR) measured using iothalamate plasma clearance, and were followed until death, transplantation, or the last encounter. Concomitantly, plasma metabolomic profiling was performed using ultra-performance liquid chromatography-tandem mass spectrometry to identify preliminary metabolomic biomarker candidates...
December 12, 2017: Translational Research: the Journal of Laboratory and Clinical Medicine
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