scholarly journals Economic Considerations in Using HCV and HIV Positive Donors for Kidney Transplant

2021 ◽  
Vol 05 (04) ◽  
pp. 1-1
Author(s):  
Aniruddha Bhattacharyya ◽  
◽  
Lee R. Friedman ◽  
Beje S. Thomas ◽  
Coleman I. Smith ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Hiv Infections ◽  
Deceased Donor ◽  
The United States ◽  
Opioid Use ◽  
Donor Pool ◽  
Socioeconomic Impacts ◽  
Novel Method ◽  
Stage Renal Disease ◽  
End Stage

End Stage Renal Disease is becoming more prevalent in the United States of America, with demand for kidney transplant exceeding the available organ supply. A novel method to increase the donor pool has been to consider transplanting organs from deceased patients who have had Hepatitis C Virus (HCV) or Human Immunodeficiency Virus (HIV) infections. Transplants with HCV infected kidneys are becoming more prevalent, due to increased organ supply due to increased mortality from injection opioid use. Similarly, deceased donor transplants using kidneys infected with HIV have become more common following the passage of the “HIV Organ Policy Equity (HOPE) Act” in 2013. These novel transplant strategies present distinct socioeconomic impacts which differ from those of prior transplant practices. Here, we have reviewed the costs and benefits of receiving a kidney transplant from deceased donors infected with HIV or HCV, compared to receiving a non-viremic kidney transplant.

scholarly journals Ureteric Trauma following Stent Removal in Kidney Transplant Recipient: A Unique Case of Prolonged Morbidity

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Ahmad Mirza ◽  
Imran Gani ◽  
Andy Shi Huang ◽  
Ravi Mallavarapu ◽  
Laura Mulloy ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Deceased Donor ◽  
Filling Defect ◽  
Percutaneous Nephrostomy ◽  
Distal Ureter ◽  
Noncontrast Ct ◽  
Deceased Donor Kidney Transplant ◽  
Stage Renal Disease ◽  
End Stage

A 52-year-old African-American male patient with end-stage renal disease due to hypertension underwent deceased donor kidney transplant procedure with no immediate complications. The postprocedure complications, interventions, and course were abstracted by chart review. The ureteric stent was removed with flexible cystoscopy on postoperative day (POD) 24. 24 hours later, the patient presented with abdominal pain and inability to urinate. An urgent ultrasound and noncontrast CT scan showed grade 4 hydronephrosis of the transplanted kidney. A percutaneous nephrostomy stent was placed for urinary diversion. A large ureteric hematoma filling the lumen of the mid to distal ureter was identified on the nephrostogram and was evacuated. A follow-up nephrostogram on POD 44 revealed a distal ureter stricture and persistent well-formed midureter filling defect. A repeat nephrostogram performed at POD 72 was done with stricture dilatation, internalization of stents, and removal of a percutaneous nephrostomy tube. The patient was maintained on antibiotics for UTI prophylaxis throughout the course.

Effect of the Opioid Crisis on the Donor Pool for Kidney Transplantation: An Analysis of National Kidney Deceased Donor Trends from 2010–2016

2018 ◽  
Vol 47 (2) ◽  
pp. 84-93 ◽  
Author(s):  
Donald F. Chute ◽  
Meghan E. Sise
Keyword(s):  
United States ◽  
Kidney Transplant ◽  
Drug Overdose ◽  
Organ Procurement ◽  
Deceased Donor ◽  
The United States ◽  
Hcv Infection ◽  
Kidney Donor ◽  
Donor Pool ◽  
Opioid Crisis

Background: The opioid crisis has led to a dramatic increase in the number of drug overdose deaths in the United States. Little is known about the effect of the opioid crisis on the kidney transplant donor pool, particularly on hepatitis C virus (HCV)-infected donors. Methods: This is a retrospective analysis of the data from the Organ Procurement and Transplantation Network from 2010 to 2016. We determined the changes in characteristics of kidney transplant donors and evaluated which changes may be directly related to the opioid crisis. Results: Between 2010 and 2016, we found a 26% increase in overall donors, including a 277% increase in the number of donors who died from drug overdose. Nineteen percent of donors who died of drug overdose had HCV infection. Donors who die from drug overdose and donors with HCV infection are younger, less likely to have diabetes or hypertension, and have favorable kidney donor profile index scores compared to average donors. Despite these favorable characteristics, HCV-infected donors appear to be notably underutilized, with substantially lower kidneys per donor being transplanted compared to HCV uninfected donors. Conclusion: The opioid crisis in the United States has substantially altered the kidney donor pool. Strategies to increase utilization of all potentially viable kidneys for transplant are needed, particularly in this era of new, highly effective, direct-acting antiviral therapy for HCV infection.

scholarly journals Hemodialysis Quality Metrics in the First Year Following a Failed Kidney Transplant

2019 ◽  
Vol 50 (3) ◽  
pp. 161-167 ◽  
Author(s):  
Anne M. Huml ◽  
Ashwini R. Sehgal
Keyword(s):  
United States ◽  
Kidney Transplant ◽  
The United States ◽  
Quality Metrics ◽  
First Year ◽  
Nephrology Care ◽  
Dialysis Outcomes ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: Failure of a previously transplanted kidney is a common cause of end-stage renal disease (ESRD) and represents 5% of incident dialysis patients in the United States. Patients with native kidney failure ESRD (Nat-ESRD) who receive predialysis care from a nephrologist have better outcomes in the first 12 months on dialysis than those who don’t. Because many patients with a failed kidney transplant ESRD (Tx-ESRD) receive care from nephrologists, they would also be expected to have good dialysis outcomes. We sought to compare the quality metrics of Tx-ESRD patients and Nat-ESRD patients during the first 12 months of hemodialysis. Methods: We used data from the United States Renal Data System to identify hemodialysis patients who began treatment between May 2012 and December 2013 and who received nephrology care prior to starting hemodialysis. Quality metrics by quarter for the first 12 months of treatment were dichotomized according to practice guidelines to determine the percentage of patients in each quarter who met quality of care goals. Results: Compared to Nat-ESRD (n = 96,063) patients, Tx-ESRD (n = 5,528) patients had 10–19% lower rates of at goal hemoglobin levels, 6–12% lower rates of at goal serum phosphorus, and 3–11% lower rates of at goal albumin levels. Compared to Nat-ESRD patients, ­Tx-ESRD patients had a 6% higher rate of fistula use in the first quarter but a 3–7% lower rate in subsequent quarters. Conclusions: Tx-ESRD patients have worse quality metrics related to anemia, phosphorus, albumin, and vascular access compared to Nat-ESRD patients. Nephrology care for patients with Tx-ESRD should be improved to address these quality metrics gaps.

scholarly journals The Magnitude of the Health and Economic Impact of Increased Organ Donation on Patients With End-Stage Renal Disease

2021 ◽  
Vol 6 (2) ◽  
pp. 238146832110634
Author(s):  
Huey-Fen Chen ◽  
Hayatt Ali ◽  
Wesley J. Marrero ◽  
Neehar D. Parikh ◽  
Mariel S. Lavieri ◽  
...  
Keyword(s):  
United States ◽  
Renal Disease ◽  
Economic Impact ◽  
End Stage Renal Disease ◽  
Deceased Donor ◽  
The United States ◽  
Kidney Donation ◽  
Life Years ◽  
Stage Renal Disease ◽  
End Stage

Objectives. There are several approaches such as presumed consent and compensation for deceased donor organs that could reduce the gap between supply and demand for kidneys. Our objective is to evaluate the magnitude of the economic impact of policies to increase deceased donor organ donation in the United States. Methods. We built a Markov model and simulate an open cohort of end-stage renal disease patients awaiting kidney transplantation in the United States over 20 years. Model inputs were derived from the United States Renal Data System and published literature. We evaluate the magnitude of the health and economic impact of policies to increase deceased donor kidney donation in the United States. Results. Increasing deceased kidney donation by 5% would save $4.7 billion, and gain 30,870 quality-adjusted life years over the lifetime of an open cohort of patients on dialysis on the waitlist for kidney transplantation. With an increase in donations of 25%, the cost saved was $21 billion, and 145,136 quality-adjusted life years were gained. Policies increasing deceased kidney donation by 5% could pay donor estates $8000 or incur a onetime cost of up to $4 billion and still be cost-saving. Conclusions. Increasing deceased kidney donation could significantly impact national spending and health for end-stage renal disease patients.

scholarly journals Study of prevalence of lymphoceles after kidney transplantation

2021 ◽  
Vol 6 (2) ◽  
pp. e28-e28
Author(s):  
Afshar Zomorodi ◽  
Farnood Salmani Milani ◽  
Mohsen Mohammad Rahimi
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Deceased Donor ◽  
Target Population ◽  
Transplant Recipients ◽  
Cross Sectional ◽  
Transplant Center ◽  
Male Patients ◽  
Stage Renal Disease ◽  
End Stage

Introduction: One of the complications of renal transplantation after surgery, which is frequently observed, is the symptomatic accumulation of fluid around the kidney, such as hematoma, lymphocele or lymphuria. Objectives: The incidence of lymphocele after kidney transplantation is widely different, therefore we decided to conduct a study to investigate the prevalence of lymphocytes in transplant recipients. Patients and Methods: The present study was a cross-sectional descriptive-analytical study. The target population in this study was adult and middle-aged men and women with end-stage renal disease (ESRD) who have undergone kidney transplant surgery at the kidney center of Imam Reza hospital in the last 5 years. Results: In all transplant recipients, symptomatic lymphoceles were observed in only 5 patients (3 female and 2 male patients with the mean age of 40.2±17.2 years) who occurred on average 48.4 ± 21.12 days after surgery between 24 days and 78 days. The results showed that 62% (156 cases) of patients were men and 211 patients (84.4%) were male transplant recipients. Also, 198 (79.2%) transplant donors were living donor and 52 (20.8%) were deceased donor/brain death. Conclusion: In the present study, we found the prevalence of lymphocele in transplant recipients in the kidney transplant center of Imam Reza in five years is 5 patients (2%) out of 250 patients with an average annual incidence of 1-2%.

Racial Differences in Access to the Kidney Transplant Waiting List for Children and Adolescents With End-Stage Renal Disease

PEDIATRICS ◽  
2000 ◽  
Vol 106 (4) ◽  
pp. 756-761 ◽  
Author(s):  
S. L. Furth ◽  
P. P. Garg ◽  
A. M. Neu ◽  
W. Hwang ◽  
B. A. Fivush ◽  
...  
Keyword(s):  
Renal Disease ◽  
Children And Adolescents ◽  
Kidney Transplant ◽  
Racial Differences ◽  
End Stage Renal Disease ◽  
Waiting List ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Coronary microvascular dysfunction is associated with degree of anaemia in end‐stage renal disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ashwin Radhakrishnan ◽  
Luke C. Pickup ◽  
Anna M. Price ◽  
Jonathan P. Law ◽  
Kirsty C. McGee ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Renal Disease ◽  
Kidney Transplant ◽  
End Stage Renal Disease ◽  
Microvascular Dysfunction ◽  
Left Ventricular ◽  
Coronary Microvascular Dysfunction ◽  
Transplant Candidates ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Coronary microvascular dysfunction (CMD) is common in end-stage renal disease (ESRD) and is an adverse prognostic marker. Coronary flow velocity reserve (CFVR) is a measure of coronary microvascular function and can be assessed using Doppler echocardiography. Reduced CFVR in ESRD has been attributed to factors such as diabetes, hypertension and left ventricular hypertrophy. The contributory role of other mediators important in the development of cardiovascular disease in ESRD has not been studied. The aim of this study was to examine the prevalence of CMD in a cohort of kidney transplant candidates and to look for associations of CMD with markers of anaemia, bone mineral metabolism and chronic inflammation. Methods Twenty-two kidney transplant candidates with ESRD were studied with myocardial contrast echocardiography, Doppler CFVR assessment and serum multiplex immunoassay analysis. Individuals with diabetes, uncontrolled hypertension or ischaemic heart disease were excluded. Results 7/22 subjects had CMD (defined as CFVR < 2). Demographic, laboratory and echocardiographic parameters and serum biomarkers were similar between subjects with and without CMD. Subjects with CMD had significantly lower haemoglobin than subjects without CMD (102 g/L ± 12 vs. 117 g/L ± 11, p = 0.008). There was a positive correlation between haemoglobin and CFVR (r = 0.7, p = 0.001). Similar results were seen for haematocrit. In regression analyses, haemoglobin was an independent predictor of CFVR (β = 0.041 95% confidence interval 0.012–0.071, p = 0.009) and of CFVR < 2 (odds ratio 0.85 95% confidence interval 0.74–0.98, p = 0.022). Conclusions Among kidney transplant candidates with ESRD, there is a high prevalence of CMD, despite the absence of traditional risk factors. Anaemia may be a potential driver of microvascular dysfunction in this population and requires further investigation.

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