Stuck in the Sump: A Rare Complication of Biliary Surgery.

Sump syndrome is a rare complication of biliary surgery that is now rarely seen in the era of Endoscopic Retrograde Cholangiopancreatography (ERCP). It occurs when the distal common bile duct becomes obstructed between an anastomosis from a choledochoduodenostomy (CDD) and the ampulla of Vater, forming a sump that accumulates debris. Sump syndrome should be considered as a diagnosis in patients who present with cholangitis or pancreatitis and any history of biliary diversion, regardless of the time of presentation.

Body Size Remains the Major Source of Sex Disparity Despite Updated Liver Transplant Allocation Policies.

Background: Efforts to address US liver transplant (LT) access inequities continue, yet disparities linked to candidate traits persist.

Methods: Analyzing national registry data pre- and post-Acuity Circle (AC) policy, our study assessed the impact of low body surface area (BSA) on LT waitlist mortality. The outcomes of LT candidates listed in the pre-AC era (n = 39 227) and post-AC (n = 38 443) were compared for patients with low BSA (22.

Disparities in Access to Liver Transplant Referral and Evaluation among Patients with Hepatocellular Carcinoma in Georgia.

Unlabelled: Liver transplantation offers the best survival for patients with early-stage hepatocellular carcinoma (HCC). Prior studies have demonstrated disparities in transplant access; none have examined the early steps of the transplant process. We identified determinants of access to transplant referral and evaluation among patients with HCC with a single tumor either within Milan or meeting downstaging criteria in Georgia.

Geography, inequities, and the social determinants of health in transplantation.

Among the causes of inequity in organ transplantation, geography is oft-cited but rarely defined with precision. Traditionally, geographic inequity has been characterized by variation in distance to transplant centers, availability of deceased organ donors, or the consequences of allocation systems that are inherently geographically based. Recent research has begun to explore the use of measures at various geographic levels to better understand how characteristics of a patient's geographic surroundings contribute to a broad range of transplant inequities.

Defining the Need for Causal Inference to Understand the Impact of Social Determinants of Health: A Primer on Behalf of the Consortium for the Holistic Assessment of Risk in Transplantation (CHART).

Objective: This study aims to introduce key concepts and methods that inform the design of studies that seek to quantify the causal effect of social determinants of health (SDOH) on access to and outcomes following organ transplant.

Background: The causal pathways between SDOH and transplant outcomes are poorly understood. This is partially due to the unstandardized and incomplete capture of the complex interactions between patients, their neighborhood environments, the tertiary care system, and structural factors that impact access and outcomes.

What is visible is fixable: Visual dashboards for multi-domain assessment of organ procurement organization performance.

With stakeholder focus on the United States organ procurement system, there is a need for tools that permit comparative assessment of organ procurement providers. We developed a public-facing dashboard for organ procurement organizations (OPOs), using data from multiple sources, to create an online, readily accessible visualization of OPO practice conditions and performance for the period 2010-2020. With this tool, OPOs can be compared on the CMS metric of donors procured per 100 donation-consistent deaths, as well as donation after circulatory death procurement, procurement of older and minority patient populations, procurement in smaller hospitals, and procurement of patients without a significant drug history.

Identifying and understanding variation in population-based access to liver transplantation in the United States.

We aimed to identify variations in liver transplant access across transplant referral regions (TRRs), accounting for differences in population characteristics and practice environments. Adult end-stage liver disease (ESLD) deaths and liver waitlist additions from 2015 to 2019 were included. The primary outcome was listing-to-death ratio (LDR).

Racial and ethnic disparities in psychosocial evaluation and liver transplant waitlisting.

Health disparities have been well-described in all stages of the liver transplantation (LT) process. Using data from psychosocial evaluations and the Stanford Integrated Psychosocial Assessment, our objective was to investigate potential racial and ethnic inequities in overall LT waitlisting and not waitlisting for medical or psychosocial reasons. In a cohort of 2271 candidates evaluated for LT from 2014 to 2021 and with 1-8 years of follow-up, no significant associations were noted between race/ethnicity and overall waitlisting and not waitlisting for medical reasons.

Factors Associated With Geographic Disparities in Gastrointestinal Cancer Mortality in the United States.

Background & Aims: Significant geographic variability in gastrointestinal (GI) cancer-related death has been reported in the United States. We aimed to evaluate both modifiable and nonmodifiable factors associated with intercounty differences in mortality due to GI cancer.

Methods: Data from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research platform were used to calculate county-level mortality from esophageal, gastric, pancreatic, and colorectal cancers.

Time to Surgical Treatment and Facility Characteristics as Potential Drivers of Racial Disparities in Breast Cancer Mortality.

Background: Black women are more likely to die of breast cancer than White women. This study evaluated the contribution of time to primary surgical management and surgical facility characteristics to racial disparities in breast cancer mortality among both Black and White women.

Methods: The study identified 2224 Black and 3787 White women with a diagnosis with stages I to III breast cancer (2010-2014).

Listing at non-local transplant centers is associated with increased access to deceased donor kidney transplantation.

The ability of kidney transplant candidates to travel outside of their usual place of care varies by sociodemographic factors, potentially exacerbating disparities in access. We used Transplant Referral Regions (TRRs) to overcome previous methodological barriers of using geographic distance to assess the characteristics and outcomes of patients listed for kidney transplant at centers in neighboring TRR or beyond neighboring TRRs. Among listed kidney transplant candidates, 20.

A Population Health Approach to Transplant Access: Challenging the Status Quo.

Transplant referral and evaluation are critical steps to waitlisting yet remain an elusive part of the transplant process. Despite calls for more data collection on pre-waitlisting steps, there are currently no national surveillance data to aid in understanding the causes and potential solutions for the extreme variation in access to transplantation. As population health scientists, epidemiologists, clinicians, and ethicists we submit that the transplant community has an obligation to better understand disparities in transplant access as a first necessary step to effectively mitigating these inequities.

Understanding gastrointestinal cancer mortality disparities in a racially and geographically diverse population.

Background: Gastrointestinal (GI) cancers represent a diverse group of diseases. We assessed differences in geographic and racial disparities in cancer-specific mortality across subtypes, overall and by patient characteristics, in a geographically and racially diverse US population.

Methods: Clinical, sociodemographic, and treatment characteristics for patients diagnosed during 2009-2014 with colorectal cancer (CRC), pancreatic cancer, hepatocellular carcinoma (HCC), or gastric cancer in Georgia were obtained from the Surveillance, Epidemiology, and End Results Program database.

Examining utilization of kidneys as a function of procurement performance.

Questions have arisen around new metrics for organ procurement organizations (OPO) due to the perception that low-performing OPOs may be limited by local centers' acceptance of marginal organs. We reviewed 2013-2019 Organ Procurement and Transplantation Network (OTPN) and National Centers for Health Statistics (NCHS) data to explore the relationship between objectively measured OPO performance and utilization of deceased donor kidneys. We found that although donor recovery declined with rising age and kidney donor profile index (KDPI), OPO performance differences were evident within each age/KDPI group.

Biliary Complications Following Adult Deceased Donor Liver Transplantation: Risk Factors and Implications at a High-volume US Center.

Unlabelled: Biliary leaks and anastomotic strictures comprise the majority of biliary complications (BCs) following liver transplantation (LT). Currently, there are few large contemporary case series of BCs in adult deceased donor liver transplant (DDLT) recipients in the literature. The purpose of this study was to examine the pretransplant and intraoperative risk factors associated with BCs at a high-volume tertiary care center and determine the impact of these BCs on their posttransplant course and long-term transplant outcomes.

Racial and Ethnic Differences and Clinical Outcomes of Patients With Coronavirus Disease 2019 (COVID-19) Presenting to the Emergency Department.

Background: Since the introduction of remdesivir and dexamethasone for severe COVID-19 treatment, few large multi-hospital-system US studies have described clinical characteristics and outcomes of minority COVID-19 patients who present to the emergency department (ED).

Methods: This cohort study from the Cerner Real World Database (87 US health systems) from 1 December 2019 to 30 September 2020 included PCR-confirmed COVID-19 patients who self-identified as non-Hispanic Black (Black), Hispanic White (Hispanic), or non-Hispanic White (White). The main outcome was hospitalization among ED patients.