Refusal of transplant organs for non-medical reasons including COVID-19 status.

Transplant centers and physicians in the United States have limited guidance on the information which they can and cannot provide to transplant candidates regarding donors of potential organs. Patients may refuse organs for a variety of reasons ranging from pernicious requests including racism to misinformation about emerging medicine as with the COVID-19 vaccine and infection. Patient autonomy, organ stewardship, and equity are often at odds in these cases, but precedent indeed exists to help address these challenges.

Teaching Third-Year Medical Students to Address Patients' Spiritual Needs in the Surgery/Anesthesiology Clerkship.

Introduction: Despite many patients wanting physicians to inquire about their religious/spiritual beliefs, most physicians do not make such inquiries. Among physicians who do, surgeons are less likely than family and general practitioners and psychiatrists to do so.

Methods: To address this gap, we developed a 60-minute curriculum that follows the Kolb cycle of experiential learning for third-year medical students on their surgery/anesthesiology clerkship.

Trends in management of the small renal mass in renal transplant recipient candidates: A multi-institutional survey analysis.

Introduction: Patients with end-stage renal disease are under increased risk for renal cell carcinoma development, and radical nephrectomy is the preferred treatment in this setting. Owing to the increased surgical morbidity and mortality, active surveillance (AS) may be a valid option for treatment of small renal masses (SRM). As there is a lack of high-level evidence for treatment recommendations, we performed a survey analysis to analyze the treatment patterns of transplant surgeons.

Prostate-specific antigen screening and prostate cancer treatment in renal transplantation candidates: A survey of U.S. transplantation centers.

Introduction: Renal transplantation candidates are a highly screened population. There are currently no guidelines or consensus on prostate cancer (CaP) screening in these patients. In light of the recent United States Preventive Services Task Force recommendations against prostate-specific antigen (PSA) screening, we conducted a survey of transplantation surgeons to gain a better understanding of practice patterns among U.

Hepatitis C and renal transplantation.

Hepatitis C is a widespread problem, and the prevalence is higher in patients on hemodialysis than in the general population. In addition, hepatitis C reduces survival in dialysis patients and renal-transplant recipients. Kidney transplantation offers a survival advantage to those patients with chronic hepatitis C infection faced with the alternative of remaining on dialysis.

Curing diabetes with transplantation?

Type 1 diabetes affects >1 million people in the United States, where it accounts for up to 10% of all diabetes cases. Glycemic control via the use of exogenous insulin injections in diabetic patients is incomplete, resulting in multiple long-term complications such as retinopathy, neuropathy, vasculopathy, and nephropathy. The goal of beta-cell replacement by whole-pancreas or islet transplantation is to achieve long-term insulin independence, and the proposed benefits are improved quality of life, prevention of recurrent diabetic nephropathy, stabilization or improvement in secondary complications, and improved mortality.

Antibodies reactive to non-HLA antigens in transplant glomerulopathy.

Although T and B cell alloimmunity contribute to transplant injury, autoimmunity directed at kidney-expressed, non-HLA antigens may also participate. Because the specificity, prevalence, and importance of antibodies to non-HLA antigens in late allograft injury are poorly characterized, we used a protein microarray to compare antibody repertoires in pre- and post-transplant sera from several cohorts of patients with and without transplant glomerulopathy. Transplantation routinely induced changes in antibody repertoires, but we did not identify any de novo non-HLA antibodies common to patients with transplant glomerulopathy.

Tubular expression of KIM-1 does not predict delayed function after transplantation.

Injured epithelial cells of the proximal tubule upregulate the glycoprotein kidney injury molecule 1 (KIM-1), suggesting its potential as a biomarker of incipient kidney allograft injury. It is unknown whether KIM-1 expression changes in kidney allografts with delayed graft function (DGF), which often follows ischemia-reperfusion injury. Here, we prospectively measured KIM-1 RNA and protein expression in preperfusion biopsies of 30 living- and 85 deceased-donor kidneys and correlated the results with histologic and clinical outcomes after transplantation.

Donor Toll-like receptor 4 contributes to ischemia and reperfusion injury following human kidney transplantation.

While studies in animal models have linked Toll-like receptor (TLR) 4 signaling to kidney injury induced by ischemia and reperfusion, the relevance of TLR4 activation to allograft injury in human kidney transplants is unknown. Here we show that TLR4 is constitutively expressed within all donor kidneys but is significantly higher in deceased-, compared with living-donor organs. Tubules from deceased- but not living-donor kidneys also stained positively for high-mobility group box-1 (HMGB1), a known endogenous TLR4 ligand.

Kidney and pancreas transplantation in type 1 diabetes mellitus.

Type 1 diabetes mellitus is characterized by autoimmune destruction of pancreatic beta cells, leading to a state of absolute insulin deficiency. Glycemic control via the use of exogenous insulin injections is often imperfect, resulting in multiple long-term complications, such as retinopathy, neuropathy, vasculopathy, and nephropathy. The Diabetes Control and Complications Trial has provided conclusive evidence that better glycemic control by intensive insulin treatment effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with insulin-dependent diabetes mellitus.

Professionalism in medical education: the development and validation of a survey instrument to assess attitudes toward professionalism.

Background And Aim: This study examined attitudes toward professionalism in an academic medical center. The paper will describe the development and factorial validity of an instrument to measure attitudes toward professionalism in medical education among students, residents and faculty.

Methods: A factor analysis of the intercorrelations of responses to 36 items reflecting the American Board of Internal Medicine (ABIM) elements of professionalism for a sample of 765 medical students, residents and faculty was carried out.

Maturation of Thyriothecia of Schizothyrium pomi on the Reservoir Host Rubus allegheniensis.

Flyspeck disease caused by the Ascomycete fungus Schizothyrium pomi is a major component of a summer disease complex that has become an increasing problem on apple in the northeastern United States. This study describes the development of thyriothecia of S. pomi on one of its major reservoir hosts, wild blackberry, and suggests that temperature drives thyriothecium maturation.

Excellent outcome in infants and small children with thrombophilias undergoing kidney transplantation.

One of the most common causes of early graft failure in children undergoing renal transplantation is vascular thrombosis. Numerous risk factors for graft thrombosis have been previously described. Children with various types of thrombophilias such as protein C, protein S and factor V Leiden deficiencies are at an increased risk for vascular thrombosis.

Giant cavernous liver hemangiomas: effect of operative approach on outcome.

Hypothesis: The choice of operative technique for resection of giant cavernous hepatic hemangiomas has an effect on outcome.

Design: Case series.

Setting: Tertiary hepatobiliary surgery-liver transplantation service.

Dual-kidney transplants: long-term results.

Background: Dual-kidney transplantation, where two usually aged adult kidneys are placed into an adult recipient, is one way to help alleviate the continuing disparity between the number of patients on the kidney transplant waiting list and those who receive kidney transplants each year. The Dual Kidney Registry was developed to analyze donor and recipient data and outcomes at several centers.

Methods: Two hundred eighty-seven patients who have undergone transplantation since 1994 have been entered into the relational database.