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Item Adenovirus-Related Fulminant Liver Failure After Kidney Transplantation(International Scientific Information, 2022-08-06) Mihaylov, Plamen; Lutz, Andrew J.; Oppliger, Federico; Lin, Jingmei; Surgery, School of MedicineBACKGROUND: Human adenovirus is a well-known pathogen that can potentially lead to severe infection in immunocompromised patients. Adenovirus infections in solid-organ transplant recipients can range from asymptomatic to severe, prolonged, disseminated disease, and have a significant impact on morbidity, mortality, and graft survival. The clinical manifestations vary from asymptomatic and flu-like illness to severe life-threatening viremia with multi-organ failure. Post-transplant adenovirus infection is well described in kidney recipients, but in adult liver transplant recipients the impact of the virus is not well described. In this report, a case of disseminated adenovirus infection with subsequent fatal acute liver failure in a post-kidney transplant patient is presented. CASE REPORT: A 51-year-old man underwent a deceased kidney transplantation for focal segmental glomerulosclerosis. Shortly after the kidney transplantation, he received multiple plasmapheresis with additional steroid treatments for cellular rejection and reoccurrence of his primary kidney disease. Three weeks after the kidney transplant, he developed a disseminated adenovirus infection with subsequent acute liver failure. Despite the early diagnosis and aggressive treatment, the patient died. CONCLUSIONS: Patients with organ transplantation with autoimmune background etiology are usually over-immunosuppressed to avoid early rejection. In this population, opportunistic infections are not rare. Fever, general malaise, and transplant organ dysfunction are the first signs of bacterial or viral infection. Early infectious diseases work-up, including tissue biopsy, is fundamental to establish a diagnosis. Broad antibiotic and possible antiviral aggressive treatment are mandatory.Item Baseline Racial and Ethnic Differences in Access to Transplantation in Medicare’s ESRD Treatment Choices Payment Model(Elsevier, 2023-12-15) Drewry, Kelsey M.; Mora, Ariana N.; Kim, Daeho; Koukounas, Kalli; Wilk, Adam S.; Trivedi, Amal N.; Patzer, Rachel E.; Surgery, School of MedicineItem Effect of a Novel Multicomponent Intervention to Improve Patient Access to Kidney Transplant and Living Kidney Donation: The EnAKT LKD Cluster Randomized Clinical Trial(American Medical Association, 2023) Garg, Amit X.; Yohanna, Seychelle; Naylor, Kyla L.; McKenzie, Susan Q.; Mucsi, Istvan; Dixon, Stephanie N.; Luo, Bin; Sontrop, Jessica M.; Beaucage, Mary; Belenko, Dmitri; Coghlan, Candice; Cooper, Rebecca; Elliott, Lori; Getchell, Leah; Heale, Esti; Ki, Vincent; Nesrallah, Gihad; Patzer, Rachel E.; Presseau, Justin; Reich, Marian; Treleaven, Darin; Wang, Carol; Waterman, Amy D.; Zaltzman, Jeffrey; Blake, Peter G.; Surgery, School of MedicineImportance: Patients with advanced chronic kidney disease (CKD) have the best chance for a longer and healthier life if they receive a kidney transplant. However, many barriers prevent patients from receiving a transplant. Objectives: To evaluate the effect of a multicomponent intervention designed to target several barriers that prevent eligible patients from completing key steps toward receiving a kidney transplant. Design, setting, and participants: This pragmatic, 2-arm, parallel-group, open-label, registry-based, superiority, cluster randomized clinical trial included all 26 CKD programs in Ontario, Canada, from November 1, 2017, to December 31, 2021. These programs provide care for patients with advanced CKD (patients approaching the need for dialysis or receiving maintenance dialysis). Interventions: Using stratified, covariate-constrained randomization, allocation of the CKD programs at a 1:1 ratio was used to compare the multicomponent intervention vs usual care for 4.2 years. The intervention had 4 main components, (1) administrative support to establish local quality improvement teams; (2) transplant educational resources; (3) an initiative for transplant recipients and living donors to share stories and experiences; and (4) program-level performance reports and oversight by administrative leaders. Main outcomes and measures: The primary outcome was the rate of steps completed toward receiving a kidney transplant. Each patient could complete up to 4 steps: step 1, referred to a transplant center for evaluation; step 2, had a potential living donor contact a transplant center for evaluation; step 3, added to the deceased donor waitlist; and step 4, received a transplant from a living or deceased donor. Results: The 26 CKD programs (13 intervention, 13 usual care) during the trial period included 20 375 potentially transplant-eligible patients with advanced CKD (intervention group [n = 9780 patients], usual-care group [n = 10 595 patients]). Despite evidence of intervention uptake, the step completion rate did not significantly differ between the intervention vs usual-care groups: 5334 vs 5638 steps; 24.8 vs 24.1 steps per 100 patient-years; adjusted hazard ratio, 1.00 (95% CI, 0.87-1.15). Conclusions and relevance: This novel multicomponent intervention did not significantly increase the rate of completed steps toward receiving a kidney transplant. Improving access to transplantation remains a global priority that requires substantial effort.Item Epidemiology of parvovirus B19 and anemia among kidney transplant recipients: A meta-analysis(Wolters Kluwer, 2020-06-10) Thongprayoon, Charat; Khoury, Nadeen J.; Bathini, Tarun; Aeddula, Narothama Reddy; Boonpheng, Boonphiphop; Lertjitbanjong, Ploypin; Watthanasuntorn, Kanramon; Leeaphorn, Napat; Chesdachai, Supavit; Torres-Ortiz, Aldo; Kaewput, Wisit; Bruminhent, Jackrapong; Mao, Michael A.; Cheungpasitporn, Wisit; Medicine, School of MedicineBackground: Persistent anemia has been described in kidney transplant (KTx) recipients with parvovirus B19 virus infection. However, the epidemiology of parvovirus B19 and parvovirus B19-related anemia after KTx remains unclear. We conducted this systematic review (1) to investigate the incidence of parvovirus B19 infection after KTx and (2) to assess the incidence of parvovirus B19 among KTx patients with anemia. Materials and Methods: A systematic review was conducted in EMBASE, MEDLINE, and Cochrane databases from inception to March 2019 to identify studies that reported the incidence rate of parvovirus B19 infection and/or seroprevalence of parvovirus B19 in KTx recipients. Effect estimates from the individual studies were extracted and combined using random-effects, generic inverse variance method of DerSimonian and Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42019125716). Results: Nineteen observational studies with a total of 2108 KTx patients were enrolled. Overall, the pooled estimated seroprevalence of parvovirus B19 immunoglobulin G was 62.2% (95% confidence interval [CI]: 45.8%–76.1%). The pooled estimated incidence rate of positive parvovirus B19 DNA in the 1st year after KTx was 10.3% (95% CI: 5.5%–18.4%). After sensitivity analysis excluded a study that solely included KTx patients with anemia, the pooled estimated incidence rate of positive parvovirus B19 DNA after KTx was 7.6% (95% CI: 3.7%–15.0%). Among KTx with anemia, the pooled estimated incidence rate of positive parvovirus B19 DNA was 27.4% (95% CI: 16.6%–41.7%). Meta-regression analysis demonstrated no significant correlations between the year of study and the incidence rate of positive parvovirus B19 DNA (P = 0.33). Egger's regression asymmetry test was performed and demonstrated no publication bias in all analyses. Conclusion: The overall estimated incidence of positive parvovirus B19 DNA after KTX is 10.3%. Among KTx with anemia, the incidence rate of positive parvovirus B19 DNA is 27.4%. The incidence of positive parvovirus B19 DNA does not seem to decrease overtime.Item Existing Transplant Nephrology Compensation Models and Opportunities for Equitable Pay(Wolters Kluwer, 2022) Josephson, Michelle A.; Wiseman, Alexander C.; Tucker, J. Kevin; Segal, Mark S.; Schmidt, Rebecca J.; Mujtaba, Muhammad A.; Gurley, Susan B.; Gaston, Robert S.; Doshi, Mona D.; Brennan, Daniel C.; Moe, Sharon M.; Medicine, School of MedicineThe American Society of Nephrology (ASN) formed the ASN Task Force on Academic Nephrologist Compensation and Productivity in 2020 to understand how the subspecialty is evolving and where there are needs for alignment in compensation in US transplant centers. The task force's review of the roles and responsibilities of transplant nephrologists is in the companion perspective (1). Transplant nephrologists are required for successful kidney transplantation, the ideal treatment from a survival and quality-of-life perspective for patients with kidney failure (2,3). Unfortunately, work relative value unit (wRVU) requirements for compensation models vary tremendously across institutions and limit the ability to adequately staff programs. This article addresses transplant nephrology models of care, how different models affect funds flow and compensation, and opportunities to more equitably compensate transplant nephrologists.Item Gastrointestinal complications after kidney transplantation(Baishideng Publishing Group Inc., 2020-10-14) Gioco, Rossella; Corona, Daniela; Ekser, Burcin; Puzzo, Lidia; Inserra, Gaetano; Pinto, Flavia; Schipa, Chiara; Privitera, Francesca; Veroux, Pierfrancesco; Veroux, Massimiliano; Surgery, School of MedicineGastrointestinal complications are common after renal transplantation, and they have a wide clinical spectrum, varying from diarrhoea to post-transplant inflammatory bowel disease (IBD). Chronic immunosuppression may increase the risk of post-transplant infection and medication-related injury and may also be responsible for IBD in kidney transplant re-cipients despite immunosuppression. Differentiating the various forms of post-transplant colitis is challenging, since most have similar clinical and histological features. Drug-related colitis are the most frequently encountered colitis after kidney transplantation, particularly those related to the chronic use of mycophenolate mofetil, while de novo IBDs are quite rare. This review will explore colitis after kidney transplantation, with a particular focus on different clinical and histological features, attempting to clearly identify the right treatment, thereby improving the final outcome of patients.Item Geographic Differences in Racial Disparities in Access to Kidney Transplantation(Elsevier, 2023-08-11) McPherson, Laura J.; Di, Mengyu; Adams, Ayrenne A.; Plantinga, Laura; Pastan, Stephen O.; Patzer, Rachel E.; Surgery, School of MedicineItem Human papillomavirus infection-related cancer risk for kidney transplant recipients during adult life can be reduced by vaccination during childhood and adolescence(Frontiers Media, 2022-11-30) Nailescu, Corina; Shew, Marcia L.; Pediatrics, School of MedicineMalignancies are found between the first three reasons of mortality in pediatric and adult kidney transplant recipients, who overall have disproportionately higher rates of cancer compared to the general population, including human papillomavirus (HPV)-related genital, anal and oropharynx region cancers. Therefore, preventing HPV in this patient population is extremely important. HPV-vaccine was demonstrated to prevent HPV infection in individuals with intact immune systems. In addition, recent data reported less precancerous HPV lesions and cervical cancers with use of HPV vaccine. Since HPV is a sexually transmitted virus that is typically acquired shortly after the onset of sexual activity, it is best to administer the HPV vaccine immunization prior to the onset of sexual activity. This article reviews the epidemiology and pathophysiology of the HPV infection, as well as its role in the development of HPV-related pre-cancerous lesions and cancers in both general population and kidney transplant recipients. The focus is on the most effective primary prophylactic strategy, which is the HPV vaccination. The particularities of HPV vaccination strategies in kidney transplant recipients are compared to the general population. In addition, the article analyzes the various causes of suboptimal HPV immunization rates in kidney transplant candidates and recipients and discusses vaccination optimization strategies that can be applied during childhood and adolescence to reduce the burden of HPV-related disease states and cancer among adult kidney transplant recipients.Item Klotho in Kidney Transplantation: A New and Important Target?(Wolters Kluwer, 2023) Lim, Kenneth; Chen, Neal; Hato, Takashi; Medicine, School of MedicineItem Living kidney donor follow-up in a statewide health information exchange: health services utilization, health outcomes and policy implications(2016-05-24) Henderson, Macey Leigh; Stone, Cynthia L.; Dixon, Brian; Harle, Chris; Menachemi, Nir; Holmes, Ann; Fry-Revere, SigridLiving donors have contributed about 6,000 kidneys per year in the past 10 years, but more than 100,000 individuals are still waiting for a kidney transplant. Living kidney donors undergo a major surgical procedure without direct medical benefit to themselves, but comprehensive follow-up information on living donors’ health is unfortunately limited. Expert recommendations suggest capturing clinical information beyond traditional sources to improve surveillance of co-morbid conditions from living kidney donors. Currently the United Network for Organ Sharing is responsible for collecting and reporting follow-up data for all living donors from U.S. transplant centers. Under policy implemented in February of 2013, transplant centers must submit follow-up date for two years after donation, but current processes often yield to incomplete and untimely reporting. This dissertation uses a statewide Health Information Exchange as a new clinical data source to 1) retrospectively identify a cohort of living kidney donors, 2) understand their follow-up care patterns, and 3) observe selected clinical outcomes including hypertension, diabetes and post-donation renal function.