Bringing a Systems Approach to Living Donor Kidney Transplantation.

Introduction: Living donor kidney transplantation (LDKT) is the best treatment option for patients with kidney failure. Efforts to increase LDKT have focused on microlevel interventions and the need for systems thinking has been highlighted. We aimed to identify and compare health system-level attributes and processes that are facilitators and barriers to LDKT.

Health System-Level Barriers to Living Donor Kidney Transplantation: Protocol for a Comparative Case Study Analysis.

Background: Living donor kidney transplantation (LDKT) is the best treatment option for patients with kidney failure and offers significant medical and economic advantages for both patients and health systems. Despite this, rates of LDKT in Canada have stagnated and vary significantly across Canadian provinces, the reasons for which are not well understood. Our prior work has suggested that system-level factors may be contributing to these differences.

Identifying Modifiable System-Level Barriers to Living Donor Kidney Transplantation.

Introduction: Studying existing health systems with variable living donor kidney transplantation (LDKT) performance and understanding factors that drive these differences can inform comprehensive system-level approaches to improve LDKT. We aimed to quantify previously identified barriers and estimate their association with LDKT performance.

Methods: We conducted a cross-sectional survey of health professionals (HPs).

Health system barriers and facilitators to living donor kidney transplantation: a qualitative case study in British Columbia.

Background: In patients with kidney failure, living donor kidney transplantation (LDKT) is the best treatment option; yet, LDKT rates have stagnated in Canada and vary widely across provinces. We aimed to identify barriers and facilitators to LDKT in a high-performing health system.

Methods: This study was conducted using a qualitative exploratory case study of British Columbia.

Scurvy in the Intensive Care Unit.

Scurvy, caused by vitamin C deficiency, is a forgotten disease in the modern era of medicine. The prevalence of vitamin C deficiency in the United States is reported to be 7.1%.

An Alternative Cause of Encephalopathy: Valerian Root Overdose.

The interest in alternative therapeutics use has increased over the past few decades. Valerian, also known as "plant Valium," is a popular choice as a natural remedy for insomnia or anxiety. In order to ensure patient safety, clinicians need to be knowledgeable about commonly used alternative therapeutic products, their mechanisms of action, and potential pharmacological interactions.

Immunoglobulin G-4-Related Retroperitoneal Fibrosis.

Retroperitoneal fibrosis is caused by the replacement of normal retroperitoneal tissue with fibrosis. The majority of the cases are idiopathic, but some secondary causes include malignancy, infection, drugs, and radiotherapy. Immunoglobulin G-4 (IgG-4) related disease is a relatively newer disease and one of the rarer causes of retroperitoneal fibrosis.

Right Atrial Perforation Leading to Cardiac Tamponade Following Veno-Venous Extracorporeal Membrane Oxygenation Cannulation.

Extracorporeal membrane oxygenation (ECMO), as a supportive modality for cardiopulmonary failure, is increasing in its use due to improved advances in technology and experience lending to availability and ease of implementation. Complications with ECMO are quite common, and with increasing use, an increase in complications are a natural result. These complications can be from the underlying disease process or from the ECMO process itself, including cannula insertion.

Cardiopulmonary resuscitation-induced consciousness.

Cardiopulmonary resuscitation-induced consciousness (CPRIC) is a rare yet confusing event that can cause management issues during resuscitation. The reported incidence of CPRIC is increasing. Being aware of this phenomenon and developing a standardized approach for its management is important to prevent both delay and interruptions during resuscitation efforts.

Canadian Society of Transplantation and Canadian Society of Nephrology Commentary on the 2017 KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors.

Purpose Of Review: To review an international guideline on the evaluation and care of living kidney donors and provide a commentary on the applicability of the recommendations to the Canadian donor population.

Sources Of Information: We reviewed the 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors and compared this guideline to the Canadian 2014 Kidney Paired Donation (KPD) Protocol for Participating Donors.

Methods: A working group was formed consisting of members from the Canadian Society of Transplantation and the Canadian Society of Nephrology.

Bariatric Surgery Causing Hyperammonemia.

Bariatric surgery is recognized as a highly effective therapy for obesity but it does carry a risk of short term and long term complications since it results in a permanent alteration of the patient's anatomy. We present a case of 45-year-old female presented with a macular rash on extremities and facial rash from a rehabilitation center after having been discharged a month earlier from a revision surgery on her gastric bypass for anastomotic bleeding. She progressively became lethargic with Magnetic Resonance Imaging (MRI) of the brain showed symmetrically restricted diffusion concerning for hypoxic injury.

Common Questions and Misconceptions in the Management of Renal Transplant Patients: A Guide for Health Care Providers in the Posttransplant Setting.

Once renal transplant recipients are stabilized and require less frequent follow-up with their transplant team, health care providers outside of the transplant setting play an integral role in patients' ongoing medical care. Given renal transplant recipients' inherent complexity, these health care providers often seek consult regarding decisions that may affect transplant-related medications or outcomes. In this review, we discuss answers to 10 of the questions commonly posed to our renal transplant team by other health care providers.

A vexing case of bone pain in a renal transplant recipient: Voriconazole-induced periostitis.

Immunosuppression increases the risk of opportunistic infections including fungal infections in solid organ transplant recipients. Voriconazole is used to treat invasive aspergillus infections but prolonged usage may rarely lead to periostitis. Increased plasma fluoride concentration leading to osteoblastic upregulation is thought to be the catalyst, and symptom reversal occurs with discontinuation of the offending agent.

An Examination of the Application of the Kidney Donor Risk Index in British Columbia.

Background: The Kidney Donor Risk Index (KDRI) is a continuous measure of deceased donor kidney transplant failure risk that was derived in US patients based on 10 donor characteristics. In the United States, the KDRI is utilized to guide organ allocation and to inform clinical decisions regarding organ acceptance.

Objective: To examine the application of the US-derived KDRI in a large Canadian province.

The Change in Living Kidney Donation in Women and Men in the United States (2005-2015): A Population-Based Analysis.

The factors underlying the decline in living kidney donation in the United States since 2005 must be understood to inform strategies to ensure access to this option for future patients. Population-based estimates provide a better assessment of donation activity than do trends in the number of living donor transplants. Using data from the Scientific Registry of Transplant Recipients and the United States Census, we determined longitudinal changes in living kidney donation between 2005 and 2015, focusing on the effect of sex and income.

Variation in Dialysis Exposure Prior to Nonpreemptive Living Donor Kidney Transplantation in the United States and Its Association With Allograft Outcomes.

Background: The impact of dialysis exposure before nonpreemptive living donor kidney transplantation on allograft outcomes is uncertain.

Study Design: Retrospective cohort study.

Setting & Participants: Adult first-time recipients of kidney-only living donor transplants in the United States who were recorded within the Scientific Registry of Transplant Recipients for 2000 to 2016.

Reciprocity to Increase Participation of Compatible Living Donor and Recipient Pairs in Kidney Paired Donation.

Inclusion of compatible living donor and recipient pairs (CPs) in kidney paired donation (KPD) programs could increase living donor transplantation. We introduce the concept of a reciprocity-based strategy in which the recipient of a CP who participates in KPD receives priority for a repeat deceased donor transplant in the event their primary living donor KPD transplant fails, and then we review the practical and ethical considerations of this strategy. The strategy limits prioritization to CPs already committed to living donation, minimizing the risk of unduly influencing donor behavior.

Evaluation of Heparin Anticoagulation Protocols in Post-Renal Transplant Recipients (EHAP-PoRT Study).

Background: Disturbances in hemostasis are common among renal transplant recipients. Because of the risk of thromboembolism and graft loss after transplant, a prophylactic heparin protocol was implemented at St Paul's Hospital in Vancouver, British Columbia, in 2011. Therapeutic heparin is sometimes prescribed perioperatively for patients with preexisting prothrombotic conditions.

Management of the Potential Organ Donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement.

This document was developed through the collaborative efforts of the Society of Critical Care Medicine, the American College of Chest Physicians, and the Association of Organ Procurement Organizations. Under the auspices of these societies, a multidisciplinary, multi-institutional task force was convened, incorporating expertise in critical care medicine, organ donor management, and transplantation. Members of the task force were divided into 13 subcommittees, each focused on one of the following general or organ-specific areas: death determination using neurologic criteria, donation after circulatory death determination, authorization process, general contraindications to donation, hemodynamic management, endocrine dysfunction and hormone replacement therapy, pediatric donor management, cardiac donation, lung donation, liver donation, kidney donation, small bowel donation, and pancreas donation.