Search

Objective: To describe the design, implementation, and evaluation of a two-week rotation intended to enhance junior surgical residents' preparation for their dedicated professional development time (PDT) and academic careers., Design: As part of a multifaceted effort to promote residents' academic development, we designed a two-week, nonclinical "Academic Development Block" (ADB) rotation for postgraduate year (PGY)-2 and -3 residents. During this rotation, residents meet with clinical, research, and peer mentors and work on academic activities, with relevant deliverables specific to each class year. We analyzed feedback from postrotation surveys and interviews, which were inductively coded and thematically analyzed, and data on resident grant applications and earnings before and after implementation., Setting: The general surgery residency program at a major urban, university-affiliated academic medical center. ADBs were first implemented in 2021., Participants: A total of 39 PGY-2 and PGY-3 residents rotated through the program with 51 ADBs over the first two years of implementation., Results: Surveys indicated overwhelmingly positive perceptions on the value of ADBs, including the amount of structure and resources available. Free-response and interview themes indicated appreciation for time to meet with mentors, develop ideas, and complete academic work. Residents believed the ADB rotation accelerated their transition into PDT and was a marker of institutional commitment. Areas for improvement pertained to the timing of ADBs and pairing of mentors. Both cohorts who participated in at least 1 ADB had higher proportions of residents who successfully applied for grants and a greater amount of total funding awarded compared to all 4 of the most recent cohorts prior to implementation., Conclusions: A short academic development rotation protected from clinical responsibilities is a well-regarded intervention to help residents refine their career goals and prepare for their PDT. Similar initiatives may be of interest to residency programs seeking to foster their residents' academic career development., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

The newest kidney allocation policy kidney allocation system 250 (KAS250) broadened geographic distribution while increasing allocation system complexity. We studied the volume of kidney offers received by transplant centers and the efficiency of kidney placement since KAS250. We identified deceased-donor kidney offers (N = 907,848; N = 36,226 donors) to 185 US transplant centers from January 1, 2019, to December 31, 2021 (policy implemented March 15, 2021). Each unique donor offered to a center was considered a single offer. We compared the monthly volume of offers received by centers and the number of centers offered before the first acceptance using an interrupted time series approach (pre-/post-KAS250). Post-KAS250, transplant centers received more kidney offers (level change: 32.5 offers/center/mo, P < .001; slope change: 3.9 offers/center/mo, P = .003). The median monthly offer volume post-/pre-KAS250 was 195 (interquartile range 137-253) vs. 115 (76-151). There was no significant increase in deceased-donor transplant volume at the center level after KAS250, and center-specific changes in offer volume did not correlate with changes in transplant volume (r = -0.001). Post-KAS250, the number of centers to whom a kidney was offered before acceptance increased significantly (level change: 1.7 centers/donor, P < .001; slope change: 0.1 centers/donor/mo, P = .014). These findings demonstrate the logistical burden of broader organ sharing, and future allocation policy changes will need to balance equity in transplant access with the operational efficiency of the allocation system., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Adler reports personal fees from Tegus and grants from AHRQ. Dr. Mohan reports personal fees for eGenesis and Kidney International Reports, grants from the NIH and Kidney Transplant Collaborative, serving as chair of the UNOS data advisory committee and as faculty cochair for the ESRD Treatment Choices Learning Collaborative outside of the submitted work. Dr. Husain reported receiving grants personal fees from Fresenius and grants from NIH outside of the submitted work., (Copyright © 2023 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)

Deceased donor kidney procurement biopsies findings are the most common reason for kidney discard. Retrospective studies have found inconsistent associations with post-transplant outcomes but may have been limited by selection bias because kidneys with advanced nephrosclerosis from high-risk donors are typically discarded. We conducted a retrospective cohort study of kidneys transplanted in the United States from 2015 to 2019 with complete biopsy data available, defining "suboptimal histology" as glomerulosclerosis ≥11%, IFTA ≥mild, and/or vascular disease ≥mild. We used time-to-event analyses to determine the association between suboptimal histology and death-censored graft failure after stratification by kidney donor profile index (KDPI) (≤35%, 36%-84%, ≥85%) and final creatinine (<1 mg/dl, 1-2 mg/dl, >2 mg/dl). Among 30 469 kidneys included, 36% had suboptimal histology. In adjusted analyses, suboptimal histology was associated with death-censored graft failure among kidneys with KDPI 36-84% (HR 1.22, 95% CI 1.09-1.36), but not KDPI≤35% (HR 1.24, 0.94-1.64) or ≥ 85% (HR 0.99, 0.81-1.22). Similarly, suboptimal histology was associated with death-censored graft failure among kidneys from donors with creatinine 1-2 mg/dl (HR 1.39, 95% CI 1.20-1.60) but not <1 mg/dl (HR 1.07, 0.93-1.23) or >2 mg/dl (HR 0.95, 0.75-1.20). The association of procurement histology with graft longevity among intermediate-quality kidneys that were likely to be both biopsied and transplanted suggests biopsies provide independent organ quality assessments., (© 2022 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Although there is a shortage of kidneys available for transplantation, many transplantable kidneys are not procured or are discarded after procurement. We investigated whether local market competition and/or organ availability impact kidney procurement/utilization. We calculated the Herfindahl-Hirschman Index (HHI) for deceased donor kidney transplants (2015-2019) for 58 US donation service areas (DSAs) and defined 4 groups: HHI ≤ 0.32 (high competition), HHI = 0.33-0.51 (medium), HHI = 0.53-0.99 (low), and HHI = 1 (monopoly). We calculated organ availability for each DSA as the number kidneys procured per incident waitlisted candidate, grouped as: <0.42, 0.42-0.69, >0.69. Characteristics of procured organs were similar across groups. In adjusted logistic regression, the HHI group was inconsistently associated with composite export/discard (reference: high competition; medium: OR 1.16, 95% CI 1.11-1.20; low 1.01, 0.96-1.06; monopoly 1.19, 1.13-1.26) and increasing organ availability was associated with export/discard (reference: availability <0.42; 0.42-0.69: OR 1.35, 95% CI 1.30-1.40; >0.69: OR 1.83, 95% CI 1.73-1.93). When analyzing each endpoint separately, lower competition was associated with higher export and only market monopoly was weakly associated with lower discard, whereas higher organ availability was associated with export and discard. These results indicate that local organ utilization is more strongly influenced by the relative intensity of the organ shortage than by market competition between centers., (© 2022 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Objective: We describe an innovative medical student surgery interest group and its influence on mentorship and career exploration., Design: SCRUBS, created to promote interest in academic surgery, is student-led, with continual surgical faculty and resident involvement. Its 3-component programming focuses on clinical skills, research, and mentorship opportunities for medical students to get involved in academic surgery early in medical education., Setting: The University of Michigan Medical School, Ann Arbor, MI., Participants: First through fourth year medical students, surgery residents, and attending surgeons., Results: SCRUBS is a multifaceted student organization providing longitudinal exposure to various aspects of surgery and academic medicine. The group grew annually from 2010 to 2014, with students and faculty expressing positive feedback. Over the time period reviewed, we had a greater percentage of students applying into surgical specialties compared with the national average (16.8 vs 12% in 2014). The group supported and facilitated mentorship, clinical skills development, and research opportunities for interested students., Conclusions: This innovative surgery interest group has been well received by students and surgeons, and our institution has seen above-average interest in surgical careers. Early, preclinical mentorship and exposure provided by SCRUBS may contribute to this higher surgical interest., (Copyright © 2018. Published by Elsevier Inc.)

Objective: The purpose of this study was to characterize the prevalence and natural history of aneurysms among abdominal transplant recipients., Methods: This article is a retrospective review of adult patients who underwent a kidney or liver transplant at a single center between February 23, 2000, and October 6, 2011. Data were obtained by searching electronic medical records for documentation of arterial aneurysm. Abdominal aortic aneurysms (AAAs) were included if they were ≥3.0 cm in diameter, and thoracic aortic aneurysms were included if they had a diameter ≥3.75 cm. Additional data collected included recipient demographics, transplant-specific data, and characteristics of the aneurysms., Results: There were 927 liver transplant recipients, 2133 kidney transplant recipients, 23 liver-kidney transplant recipients, and 133 kidney-pancreas transplant recipients included in our study; 127 of these patients were identified to have aneurysms (40 liver, 83 kidney, 3 liver-kidney, 1 kidney-pancreas). The overall prevalence of any aneurysm was similar for liver and kidney recipients, but the distribution of aneurysm types was different for the two groups. AAAs made up 29.6% of aneurysms in kidney transplant recipients and 11.4% of aneurysms in liver transplant recipients (P = .02). Visceral aneurysms were 10-fold as common in liver transplant recipients compared with kidney transplant recipients (47.7% of aneurysms vs 5.1% of aneurysms; P < .01). The majority of visceral artery aneurysms involved the hepatic and splenic artery. For both liver and kidney transplant recipients, most aneurysms occurred post-transplantation. All known aortic aneurysm ruptures occurred post-transplantation (25% of AAAs in liver transplant patients and 22.2% of thoracic aortic aneurysms in kidney transplant patients). There was a trend toward higher AAA expansion rates after transplantation (0.58 ± 0.48 cm/y compared with 0.41 ± 0.16 cm/y)., Conclusions: Compared with the general population, aneurysms may be more common and may have an aggressive natural history in abdominal transplant recipients. Furthermore, the types of aneurysms that affect liver and kidney transplant recipients differ. Care teams should be aware of these risks and surveillance programs should be tailored appropriately., (Copyright © 2014. Published by Mosby, Inc.)