Highly Sensitized Kidney Transplant Outcomes After the 2014 Kidney Allocation System Change.

Kidney Allocation System (KAS) was implemented by United Network for Organ Sharing in 2014 to reduce allocation disparities. Outcomes of highly sensitized patients (calculated panel reactive antibody (cPRA) ≥ 97%) before and after KAS were compared to low-risk recipients (cPRA <10%) in the post-KAS era were examined. The impact on racial disparities was determined.

Home Care Delivery and Remote Patient Monitoring of Kidney Transplant Recipients During COVID-19 Pandemic.

Telehealth plays a critical role in the response of healthcare organizations during the COVID-19 pandemic. While telemedicine offers a real-time patient-provider encounter, the inability to obtain vital signs during virtual visits is a potential limitation. Remote patient monitoring (RPM) uses portable devices in the patient's home to collect and electronically transmit physiological data to clinicians.

Association Between Donor-Recipient Biological Relationship and Allograft Outcomes After Living Donor Kidney Transplant.

Importance: The proportion of living donor kidney transplants from donors unrelated to their recipients is increasing in the US.

Objective: To examine the association between donor-recipient biological relationship and allograft survival after living donor kidney transplant.

Design, Setting, And Participants: This retrospective cohort study used Organ Procurement and Transplantation Network data on US adult living donor kidney transplants (n = 86 154) performed from January 1, 2000, to December 31, 2014, excluding cases in which recipients previously received a kidney transplant (n = 10 342) or key data were missing (n = 2832).

Impact of Deceased Donor Kidney Procurement Biopsy Technique on Histologic Accuracy.

Introduction: The factors that influence deceased donor kidney procurement biopsy reliability are not well established. We examined the impact of biopsy technique and pathologist training on procurement biopsy accuracy.

Methods: We retrospectively identified all deceased donor kidney-only transplants at our center from 2006 to 2016 with both procurement and reperfusion biopsies performed and information available on procurement biopsy technique and pathologist (n = 392).

Early Outcomes of Outpatient Management of Kidney Transplant Recipients with Coronavirus Disease 2019.

Background And Objectives: Outcomes of kidney transplant recipients diagnosed with coronavirus disease 2019 as outpatients have not been described.

Design, Setting, Participants, & Measurements: We obtained clinical data for 41 consecutive outpatient kidney transplant recipients with known or suspected coronavirus disease 2019. Chi-squared and Wilcoxon rank sum tests were used to compare characteristics of patients who required hospitalization versus those who did not.

Reproducibility of Deceased Donor Kidney Procurement Biopsies.

Background And Objectives: Unfavorable histology on procurement biopsies is the most common reason for deceased donor kidney discard. We sought to assess the reproducibility of procurement biopsy findings.

Design, Setting, Participants, & Measurements: We compiled a continuous cohort of deceased donor kidneys transplanted at our institution from 1/1/2006 to 12/31/2016 that had at least one procurement biopsy performed, and excluded cases with missing biopsy reports and those used in multiorgan transplants.

Procurement Biopsies in the Evaluation of Deceased Donor Kidneys.

Background And Objectives: Biopsies taken at deceased donor kidney procurement continue to be cited as a leading reason for discard; however, the reproducibility and prognostic capability of these biopsies are controversial.

Design, Setting, Participants, & Measurements: We compiled a retrospective, single-institution, continuous cohort of deceased donor kidney transplants performed from 2006 to 2009. Procurement biopsy information-percentage of glomerulosclerosis, interstitial fibrosis/tubular atrophy, and vascular disease-was obtained from the national transplant database.

Factors leading to the discard of deceased donor kidneys in the United States.

The proportion of deceased donor kidneys procured for transplant but subsequently discarded has been growing steadily in the United States, but factors contributing to the rising discard rate remain unclear. To assess the reasons for and probability of organ discard we assembled a cohort of 212,305 deceased donor kidneys recovered for transplant from 2000-2015 in the SRTR registry that included 36,700 kidneys that were discarded. 'Biopsy Findings' (38.

Association between Reperfusion Renal Allograft Biopsy Findings and Transplant Outcomes.

Biopsy findings at the time of procurement of deceased donor kidneys remain the most common reason cited for kidney discard. To determine the value of renal allograft histology in predicting outcomes, we evaluated the significance of histologic findings, read by experienced renal pathologists, in 975 postreperfusion biopsy specimens collected from 2005 to 2009 after living donor (=427) or deceased donor (=548) renal transplant. We evaluated specimens for the degree of glomerulosclerosis, interstitial fibrosis and tubular atrophy, and vascular disease; specimens with a score of 0 or 1 (scale, 0-3) for each parameter were considered optimal.

The weekend effect alters the procurement and discard rates of deceased donor kidneys in the United States.

Factors contributing to the high rate of discard among deceased donor kidneys remain poorly understood and the influence of resource limitations of weekends on kidney transplantation is unknown. To quantify this we used data from the Scientific Registry of Transplant Recipients and assembled a retrospective cohort of 181,799 deceased donor kidneys recovered for transplantation from 2000-2013. We identified the impact of the day of the week on the procurement and subsequent utilization or discard of deceased donor kidneys in the United States, as well as report the geographic variation of the impact of weekends on transplantation.

Flow-through Instillation of Hypochlorous Acid in the Treatment of Necrotizing Fasciitis.

Introduction: Necrotizing fasciitis (NF) is a rare and rapidly progressing bacterial infection of soft tissues. Bacterial toxins cause local tissue damage and necrosis, as well as blunt immune system responses. A self-propagating cycle of bacterial invasion, toxin release and tissue destruction can continue until substantial amounts of tissue become necrotic.

Preformed donor-specific antibodies and risk of antibody-mediated rejection in repeat renal transplantation.

Background: Allograft outcomes in patients undergoing repeat renal transplantation are inferior compared to first-time transplant recipient outcomes. Donor-specific antibodies detected by solid-phase assays (DSA-SPA) may contribute to the worse prognosis. The influence of DSA-SPA on repeat renal transplantation outcomes has not been previously studied in detail.

Treatment of Acute Necrotizing Fasciitis Using Negative Pressure Wound Therapy and Adjunctive NeutroPhase Irrigation Under the Foam.

Necrotizing fasciitis is a complication of a bacterial infection that activates the immune system in perifascial planes. This case report highlights initial diagnostic failures that delay early treatment, which causes profoundly negative consequences. Antimicrobial control with abolition of the inciting bacteria does not neutralize the subsequent endopathologic ravages.

Delay of adjuvant chemotherapy after elective mastectomy and immediate reconstruction in breast-conservation candidates: a matched-pair analysis.

Objectives: To analyze factors that influence the timing of adjuvant chemotherapy in patients who are candidates for breast-conservation therapy (BCT) but elect mastectomy with immediate reconstruction (M-IR).

Methods: We identified 35 consecutively treated patients with stage I or II breast cancer between 2004 and 2009 who underwent M-IR and adjuvant chemotherapy from the University of Louisville Cancer Registry. We matched these patients for age and AJCC stage to 35 controls who underwent BCT and adjuvant chemotherapy.

NeutroPhase(®) in chronic non-healing wounds.

Chronic non-healing wounds, such as venous stasis ulcers, diabetic ulcers, and pressure ulcers are serious unmet medical needs that affect a patient's morbidity and mortality. Common pathogens observed in chronic non-healing wounds are Staphylococcus including MRSA, Pseudomonas, Enterobacter, Stenotrophomonas, and Serratia spp. Topical and systemically administered antibiotics do not adequately decrease the level of bacteria or the associated biofilm in chronic granulating wounds and the use of sub-lethal concentrations of antibiotics can lead to resistant phenotypes.

Donor-specific antibodies adversely affect kidney allograft outcomes.

The effect of low titers of donor-specific antibodies (DSAs) detected only by sensitive solid-phase assays (SPAs) on renal transplant outcomes is unclear. We report the results of a systematic review and meta-analysis of rejection rates and graft outcomes for renal transplant recipients with such preformed DSAs, defined by positive results on SPA but negative complement-dependent cytotoxicity and flow cytometry crossmatch results. Our search identified seven retrospective cohort studies comprising a total of 1119 patients, including 145 with isolated DSA-SPA.

Impact of small variations in the delivered dose of rabbit antithymocyte induction therapy in kidney transplantation with early corticosteroid withdrawal.

Background: Optimal dosing of rabbit antithymocyte globulin (rATG) induction therapy in kidney transplantation is not well defined. The impact of dosing from variations in dose rounding or single dose limits has not been studied.

Methods: This retrospective study of 242 adult renal transplant recipients receiving rATG induction and steroid-sparing maintenance therapy evaluates the effect of small changes in rATG induction dosing.

One decade later: trends and disparities in the application of post-mastectomy radiotherapy since the release of the American Society of Clinical Oncology clinical practice guidelines.

Purpose: In 2001 ASCO published practice guidelines for post mastectomy radiotherapy (PMRT). We analyzed factors that influence the receipt of radiotherapy therapy and trends over time.

Methods And Materials: We analyzed 8889 women who underwent mastectomy as primary surgical treatment for stage II or III breast cancer between 1995 and 2008 using data from the Kentucky Cancer Registry.