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The effect of race coefficients on preemptive listing for kidney transplantation

Abate, Mersema; Jandovitz, Nicholas; Hirsch, Jamie S; Breslin, Nadine; Lau, Lawrence; Fahmy, Ahmed E; Jhaveri, Kenar D; Richardson, Safiya; Alsalmay, Yaser; Baez, Anthony; Mishra, Akash; Bolourani, Siavash; Miyara, Santiago J; Winnick, Aaron; Nair, Gayatri; Bhaskaran, Madhu C; Grodstein, Elliot; Kressel, Adam M; Teperman, Lewis W; Molmenti, Ernesto P; Nair, Vinay
BACKGROUND/UNASSIGNED:Race coefficients of estimated glomerular filtration rate (eGFR) formulas may be partially responsible for racial inequality in preemptive listing for kidney transplantation. METHODS/UNASSIGNED:We used the Scientific Registry of Transplant Recipients database to evaluate differences in racial distribution of preemptive listing before and after application of the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) race coefficients to all preemptively listed non-Black kidney transplant candidates (eGFR modulation). Odds of preemptive listing were calculated by race, with Black as the reference before and after eGFR modulation. Variables known to influence preemptive listing were included in the model. RESULTS/UNASSIGNED:were removed. Compared with Black candidates, the adjusted odds of preemptive listing for White candidates decreased from 2.01 [95% confidence interval (95% CI) 1.78-2.26] before eGFR modulation to 1.18 (95% CI 1.0-1.39; P = 0.046) with the MDRD and 1.37 (95% CI 1.18-1.58) with the CKD-EPI equations after adjusting for race coefficients. CONCLUSIONS/UNASSIGNED:Removing race coefficients in GFR estimation formulas may result in a more equitable distribution of Black candidates listed earlier on a preemptive basis.
PMCID:9050544
PMID: 35498880
ISSN: 2048-8505
CID: 5394872

An early experience on the effect of solid organ transplant status on hospitalized COVID-19 patients

Nair, Vinay; Jandovitz, Nicholas; Hirsch, Jamie S; Abate, Mersema; Satapathy, Sanjaya K; Roth, Nitzan; Miyara, Santiago J; Guevara, Sara; Kressel, Adam M; Xiang, Alec; Wu, Grace; Butensky, Samuel D; Lin, David; Williams, Stephanie; Bhaskaran, Madhu C; Majure, David T; Grodstein, Elliot; Lau, Lawrence; Nair, Gayatri; Fahmy, Ahmed E; Winnick, Aaron; Breslin, Nadine; Berlinrut, Ilan; Molmenti, Christine; Becker, Lance B; Malhotra, Prashant; Gautam-Goyal, Pranisha; Lima, Brian; Maybaum, Simon; Shah, Samit K; Takegawa, Ryosuke; Hayashida, Kei; Shinozaki, Koichiro; Teperman, Lewis W; Molmenti, Ernesto P
We compared the outcome of COVID-19 in immunosuppressed solid organ transplant (SOT) patients to a transplant naïve population. In total, 10 356 adult hospital admissions for COVID-19 from March 1, 2020 to April 27, 2020 were analyzed. Data were collected on demographics, baseline clinical conditions, medications, immunosuppression, and COVID-19 course. Primary outcome was combined death or mechanical ventilation. We assessed the association between primary outcome and prognostic variables using bivariate and multivariate regression models. We also compared the primary endpoint in SOT patients to an age, gender, and comorbidity-matched control group. Bivariate analysis found transplant status, age, gender, race/ethnicity, body mass index, diabetes, hypertension, cardiovascular disease, COPD, and GFR <60 mL/min/1.73 m2 to be significant predictors of combined death or mechanical ventilation. After multivariate logistic regression analysis, SOT status had a trend toward significance (odds ratio [OR] 1.29; 95% CI 0.99-1.69, p = .06). Compared to an age, gender, and comorbidity-matched control group, SOT patients had a higher combined risk of death or mechanical ventilation (OR 1.34; 95% CI 1.03-1.74, p = .027).
PMID: 33443778
ISSN: 1600-6143
CID: 4747162

COVID-19 in kidney transplant recipients

Nair, Vinay; Jandovitz, Nicholas; Hirsch, Jamie S; Nair, Gayatri; Abate, Mersema; Bhaskaran, Madhu; Grodstein, Elliot; Berlinrut, Ilan; Hirschwerk, David; Cohen, Stuart L; Davidson, Karina W; Dominello, Andrew J; Osorio, Gabrielle A; Richardson, Safiya; Teperman, Lewis W; Molmenti, Ernesto P
There is minimal information on COVID-19 in immunocompromised individuals. We have studied 10 patients treated at 12 adult care hospitals. Ten kidney transplant recipients tested positive for SARS-CoV-2 by PCR, and 9 were admitted. The median age was 57 (IQR 47-67), 60% were male, 40% Caucasian, and 30% Black/African American. Median time from transplant to COVID-19 testing was 2822 days (IQR 1272-4592). The most common symptom was fever, followed by cough, myalgia, chills, and fatigue. The most common CXR and CT abnormality was multifocal patchy opacities. 3 patients had no abnormal findings. Leukopenia was seen in 20% of patients, and allograft function was stable in 50% of patients. 9 patients were on tacrolimus and a mycophenolic antimetabolite, and 70% were on prednisone. Hospitalized patients had their antimetabolite agent stopped. All hospitalized patients received hydroxychloroquine (HCQ) and azithromycin. 3 patients died (30%), five (50%) developed acute kidney injury. Kidney transplant recipients infected with COVID-19 should be monitored closely in the setting of lowered immunosuppression. Most individuals required hospitalization and presenting symptoms were similar to those of non-transplant individuals.
PMID: 32351040
ISSN: 1600-6143
CID: 4412622

Thromboelastography versus standard coagulation testing in the assessment and reversal of coagulopathy among cirrhotics: a systematic review and meta-analysis

Kovalic, Alexander J; Khan, Muhammad Ali; Malaver, Diego; Whitson, Matthew J; Teperman, Lewis W; Bernstein, David E; Singal, Ashwani; Satapathy, Sanjaya K
The utility of thromboelastography/thromboelastometry currently has unvalidated clinical benefit in the assessment and reversal of coagulopathy among cirrhotic patients as compared to standard coagulation testing. A novel systematic review and meta-analysis was conducted in order to assess pooled outcome data among patients receiving thromboelastography/thromboelastometry as compared to standard coagulation testing. As compared to standard coagulation testing, there was a significant reduction in the number of patients requiring pRBC, platelet, and fresh frozen plasma transfusions among thromboelastography/thromboelastometry group with pooled OR 0.53 (95% CI 0.32-0.85; P = 0.009), 0.29 (95% CI 0.12-0.74; P = 0.009), and 0.19 (95% CI 0.12-0.31; P < 0.00001), respectively. Similarly, there was a significant reduction in number of pRBC, platelet, and fresh frozen plasma units transfused in the thromboelastography/thromboelastometry group with pooled MD -1.53 (95% CI -2.86 to -0.21; P = 0.02), -0.57 (95% CI -1.06 to -0.09; P = 0.02), and -2.71 (95% CI -4.34 to -1.07; P = 0.001), respectively. There were significantly decreased total bleeding events with pooled OR 0.54 (95% CI 0.31-0.94; P = 0.03) and amount of intraoperative bleeding during liver transplantation with pooled MD -1.46 (95% CI -2.49 to -0.44; P = 0.005) in the thromboelastography/thromboelastometry group. Overall, there was no significant difference in mortality between groups with pooled OR 0.91 (95% CI 0.63-1.30; P = 0.60). As compared to standard coagulation testing, a thromboelastography/thromboelastometry-guided approach to the assessment and reversal of cirrhotic coagulopathy improves overall number of patients exposed to blood product transfusions, quantity of transfusions, and bleeding events.
PMID: 32012141
ISSN: 1473-5687
CID: 4299732

Post-transplant Outcome of Lean Compared to Obese Nonalcoholic Steatohepatitis in the United States: The Obesity Paradox

Satapathy, Sanjaya K; Jiang, Yu; Agbim, Uchenna; Wu, Cen; Bernstein, David E; Teperman, Lewis W; Kedia, Satish K; Aithal, Guruprasad P; Bhamidimarri, Kalyan Ram; Duseja, Ajay; Maiwall, Rakhi; Maliakkal, Benedict; Jalal, Prasun; Patel, Keyur; Puri, Puneet; Ravinuthala, Ravi; Wong, Vincent Wai-Sun; Abdelmalek, Manal F; Ahmed, Aijaz; Thuluvath, Paul J; Singal, Ashwani K
BACKGROUND AND AIM/OBJECTIVE:Morbid obesity is considered a relative contraindication for LT (Liver Transplant). We investigated if BMI (lean vs. obese) is a risk factor for post-LT graft and overall survival in NASH and non-NASH patients. METHODS:Using the UNOS database, LT recipients from 01/2002 to 06/2013 (age ≥18 yrs.) with follow up until 2017 were included. The association of BMI categories calculated at LT with graft and overall survival after LT were examined. RESULTS:After adjusting for confounders, all obesity cohorts (Overweight, Class I, Class II, and Class III obesity) among LT recipients for NASH had significantly reduced risk of graft and patient loss at 10 years follow up compared to the lean BMI cohort. In contrast, non-NASH group of LT recipients had no increased risk for graft and patient loss for overweight, Class I, Class II obesity groups, but had significantly increased the risk for graft (p<0.001) and patient loss (p=0.005) in the Class III obesity group. CONCLUSION/CONCLUSIONS:In this retrospective analysis of UNOS database, adult recipients selected for first LT, NASH patients with the lowest BMI have the worse long-term graft and patient survival as opposed to non-NASH patients where the survival was worse with higher BMI.
PMID: 31665561
ISSN: 1527-6473
CID: 4162332

Time-Effect of Donor and Recipient Characteristics on Graft Survival after Kidney Transplantation

Yang, Jingyan; Sardo Molmenti, Christine L; Cagliani, Joaquin; Datta, Harish; Grodstein, Elliot; Rasul, Rehana; Rilo, Horacio; Teperman, Lewis W; Molmenti, Ernesto P
The kidney allocation system (KAS) is based on quality-based "longevity matching" strategies that provide only a momentary snapshot of expected outcomes at the time of transplantation. The purpose of our study was to define on a continuous timeline the relative and mutual interactions of donor and recipient characteristics on graft survival. Total 39,108 subjects who underwent kidney transplant between October 25, 1999 and January 1, 2007 were identified in the United Network for Organ Sharing dataset. Our primary outcome was graft survival. Time-dependent receiver operating characteristic (ROC) curves and area under time-dependent ROC curve (AUC) were used to compare the predictive ability of the two allocation systems. During the first year after transplantation, both donor and recipient models showed identical relevance. From the first to the sixth years, although the two ROC curves were nearly identical, the donor model outweighed the recipient model. Both models intersected again at the sixth year. From that time onward, the ROC curve for recipient characteristics model predominated over the ROC curve for donor characteristics model. The predictive value of the recipient model (AUC = 0.752) was greater than that of the donor model (AUC = 0.673) We hope that this model will provide additional guidance and risk stratification to further optimize organ allocation based on the dynamic interaction of both donor and recipient characteristics over time.
PMCID:6882667
PMID: 31787824
ISSN: 1061-1711
CID: 4217852

Long-Term Impact of Live Liver Donation: A Self Report of the Donation Experience

Rudow, Dianne LaPointe; DeLair, Samantha; Feeley, Thomas; Florman, Sander; Guarrera, James; Kinkhabwala, Milan; Orloff, Mark; Teperman, Lewis; Morgan, Glyn
Outcomes for adult-to-adult living liver donors are largely based on short-term data drawn from single center studies. The aim of this study was to determine how living liver donation impacts self-reported Quality-of-Life up to 6 years post-donation in a sample of NYS residents.
PMID: 30589993
ISSN: 1527-6473
CID: 3560442

Directed organ donation and deceased donor-initiated kidney chains [Letter]

Molmenti, Ernesto P; Molmenti, Christine L Sardo; Grodstein, Elliot; Rilo, Horacio; Teperman, Lewis W
PMID: 30319104
ISSN: 1474-547x
CID: 3367932

Transjugular intrahepatic portosystemic shunt creation for cirrhotic portal hypertension is well tolerated among patients with portal vein thrombosis

Merola, Jonathan; Fortune, Brett E; Deng, Yanhong; Ciarleglio, Maria; Amirbekian, Smbat; Chaudhary, Noami; Shanbhogue, Alampady; Ayyagari, Rajasekhara; Rodriguez-Davalos, Manuel I; Teperman, Lewis; Charles, Hearns W; Sigal, Samuel H
BACKGROUND:Portal vein thrombosis (PVT) develops in cirrhotic patients because of stagnation of blood flow. Transjugular intrahepatic portosystemic shunt (TIPS) creates a low-resistance conduit that restores portal venous patency and blood flow. AIM/OBJECTIVE:The effect of PVT on transplant-free survival in cirrhotic patients undergoing TIPS creation was evaluated. PATIENTS AND METHODS/METHODS:A multicenter, retrospective cohort study of patients who underwent TIPS creation for cirrhotic portal hypertension was carried out. A Cox model with propensity score adjustment was developed to evaluate the effect of PVT on 90-day and 3-year transplant-free survival. A subgroup analysis examining mortality of those with superior and distal PVT was also carried out. RESULTS:A total of 252 consecutive TIPS creations were assessed, including 65 in patients with PVT. Survival of patients with high Model for End-stage Liver Disease scores (≥18) and PVT was not statistically different compared with patients with low Model for End-stage Liver Disease scores (<18) and no PVT at 90 days (P=0.46) and 3 years (P=0.42). Those with inferior PVT had improved 90-day and 3-year survival both compared with patients with a superior PVT and those without a PVT (P<0.01, all cases). CONCLUSION/CONCLUSIONS:The presence of PVT does not impair the prognosis of patients following TIPS creation, particularly in patients with distal portal occlusion.
PMID: 29462027
ISSN: 1473-5687
CID: 2963662

A Sustained Viral Response Achieved with Sofosbuvir/Ledipasvir May Increase the Incidence of Acute Cellular Rejection Post Liver Transplantation [Meeting Abstract]

Bortecen, K; Layman, R; Gelb, B; Winnick, A; Morgan, G; Tobias, H; Teperman, L
ISI:000383373902143
ISSN: 1600-6143
CID: 2386272