144 results on '"C. Wiseman"'
Search Results
2. High levels of dd-cfDNA identify patients with TCMR 1A and borderline allograft rejection at elevated risk of graft injury
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Tarek Alhamad, Oyedolamu K. Olaitan, Dhiren Kumar, Irfan Agha, Nicolae Leca, Y. Qazi, Joseph K. Melancon, Hasan Fattah, Sidney J. Swanson, Erik Stites, Jonathan S. Bromberg, Gaurav Gupta, Alexander C. Wiseman, and Matthew R. Weir
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Graft Rejection ,medicine.medical_specialty ,Banff Classification ,rejection: T cell mediated (TCMR) ,Renal function ,kidney (allograft) function/dysfunction ,clinical research/practice ,Gastroenterology ,Interquartile range ,Internal medicine ,Biopsy ,medicine ,Humans ,Immunology and Allergy ,Pharmacology (medical) ,monitoring: immune ,Subclinical infection ,Transplantation ,medicine.diagnostic_test ,business.industry ,Clinical Science ,Allografts ,Kidney Transplantation ,Tissue Donors ,kidney failure/injury ,Allograft rejection ,biomarker ,Biomarker (medicine) ,Original Article ,ORIGINAL ARTICLES ,cellular transplantation (non‐islet) ,business ,Cell-Free Nucleic Acids ,Antibody formation - Abstract
The clinical importance of subclinical, early T cell–mediated rejection (Banff TCMR 1A and borderline lesions) remains unclear, due, in part to the fact that histologic lesions used to characterize early TCMR can be nonspecific. Donor‐derived cell‐free DNA (dd‐cfDNA) is an important molecular marker of active graft injury. Over a study period from June 2017 to May 2019, we assessed clinical outcomes in 79 patients diagnosed with TCMR 1A/borderline rejection across 11 US centers with a simultaneous measurement of dd‐cfDNA. Forty‐two patients had elevated dd‐cfDNA (≥0.5%) and 37 patients had low levels (, Among patients with borderline and 1A T cell–mediated rejection, a threshold of ≥ 0.5% of donor‐derived cell‐free DNA was associated with increased risk of renal function decline, donor‐specific antibody development, and future episodes of recurrent rejection.
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- 2020
3. Cardiovascular Disease and Kidney Transplantation
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John P. Vella and Alexander C. Wiseman
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medicine.medical_specialty ,business.industry ,Urology ,medicine ,Disease ,medicine.disease ,business ,Kidney transplantation - Published
- 2019
4. Access to Transplantation and Outcomes
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John P. Vella and Alexander C. Wiseman
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Transplantation ,medicine.medical_specialty ,business.industry ,medicine ,Intensive care medicine ,business - Published
- 2019
5. Malignancy After Kidney Transplantation
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Alexander C. Wiseman and John P. Vella
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medicine.medical_specialty ,business.industry ,Urology ,medicine ,medicine.disease ,Malignancy ,business ,Kidney transplantation - Published
- 2019
6. Infectious Complications of Kidney Transplantation
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Alexander C. Wiseman and John P. Vella
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medicine.medical_specialty ,business.industry ,medicine ,medicine.disease ,business ,Kidney transplantation ,Surgery - Published
- 2019
7. Emerging paradigm shift toward proactive topical treatment of psoriasis: A narrative review
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Jensen Yeung, Kim A. Papp, Melinda Gooderham, Gurbir Dhadwal, Lyn Guenther, Marni C. Wiseman, and Irina Turchin
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medicine.medical_specialty ,business.industry ,Administration, Topical ,Context (language use) ,Topical treatment ,Dermatology ,General Medicine ,medicine.disease ,Proactive maintenance ,Maintenance therapy ,Paradigm shift ,Psoriasis ,medicine ,Humans ,Narrative review ,Dermatologic Agents ,Intensive care medicine ,business ,Glucocorticoids ,Cholecalciferol ,Patient education - Abstract
Psoriasis (PsO) requires safe and effective long-term management to reduce the risk of recurrence and decrease the frequency of relapse. Topical PsO therapies are a cornerstone in the management of PsO though safety concerns limit the chronic, continuous use of topical corticosteroids and/or vitamin D3 analogues. Evidence-based guidelines on optimal treatment targets and maintenance therapy regimens are currently lacking. This review explores the evidence supporting approaches to maintenance topical therapy for PsO including continuous long-term therapy, chronic intermittent use, step-down therapy, sequential or pulse therapy regimens, and proactive maintenance therapy. Several unaddressed questions are discussed including how and when to transition from acute to maintenance therapy, strategies for monitoring long-term treatment, the role of topical maintenance therapy in the context of systemic and biologic therapies, risks of maintenance therapy, prescribing a topical preparation suitable for patients' preferences and skin type, and key concepts for patient education to maximize long-term outcomes. Overall, emerging evidence supports a paradigm shift towards proactive treatment once skin is completely clear as a strategy to enhance disease control without compromising safety.
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- 2021
8. Systematic Review on the Efficacy and Safety of Oral Janus Kinase Inhibitors for the Treatment of Atopic Dermatitis
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Michelle Le, Melissa Berman-Rosa, Feras M. Ghazawi, Marc Bourcier, Loretta Fiorillo, Melinda Gooderham, Lyn Guenther, Sameh Hanna, H. Chih-Ho Hong, Ian Landells, Perla Lansang, Danielle Marcoux, Marni C. Wiseman, Jensen Yeung, Charles Lynde, and Ivan V. Litvinov
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Medicine (General) ,medicine.medical_specialty ,gusacitinib ,Baricitinib ,medicine.medical_treatment ,MEDLINE ,Disease ,Targeted therapy ,R5-920 ,Internal medicine ,medicine ,baricitinib ,Limited evidence ,atopic dermatitis ,abrocitinib ,business.industry ,janus kinase ,General Medicine ,Atopic dermatitis ,medicine.disease ,upadacitinib ,Safety profile ,JAK inhibitor ,Medicine ,Systematic Review ,eczema ,business ,Janus kinase - Abstract
Background: Atopic dermatitis is a chronic, relapsing and remitting disease that can be difficult to treat despite a recently approved biologic therapy targeting IL-4/IL-13 receptor. Oral janus kinase inhibitors (JAKi) represent a novel therapeutic class of targeted therapy to treat moderate-to-severe atopic dermatitis (AD).Objective: To review the efficacy, safety, and pharmacokinetic characteristics of oral JAKi in the treatment of AD.Methods: A PRISMA systematic review was conducted using MEDLINE, EMBASE (Ovid), and PubMed databases for studies assessing the efficacy, safety, and/or pharmacokinetic properties of oral forms of JAKi in the treatment of AD in pediatric or adult populations from inception to June 2021.Results: 496 papers were reviewed. Of 28 articles that underwent full text screening, 11 met our inclusion criteria for final qualitative review. Four studies examined abrocitinib; three studies examined baricitinib; three examined upadacitinib and one examined gusacitinib (ASN002). Significant clinical efficacy and a reassuring safety profile was reported for all JAKi agents reviewed. Rapid symptom control was reported for abrocitinib, baricitinib and upadacitinib.Limitations: Given the relatively limited evidence for each JAKi and the differences in patient eligibility criteria between studies, the data was not deemed suitable for a meta-analysis at this time.Conclusion: Given their ability to achieve rapid symptom control with a reassuring safety profile, we recommend considering the use of JAKi as a reliable systemic treatment option for adult patients with moderate-to-severe AD, who are unresponsive to topical or skin directed treatments.
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- 2021
9. Developing simultaneous liver-kidney transplant medical eligibility criteria while providing a safety net: A 2-year review of the OPTN's allocation policy
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Sarah E Booker, Katrina Gauntt, Darren Stewart, Amber R. Wilk, David C. Mulligan, Richard N. Formica, and Alexander C. Wiseman
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Adult ,medicine.medical_specialty ,Tissue and Organ Procurement ,Safety net ,medicine.medical_treatment ,Kidney ,Risk Factors ,Internal medicine ,medicine ,Simultaneous liver kidney ,Immunology and Allergy ,Humans ,Pharmacology (medical) ,Dialysis ,Deceased donor kidney ,Transplantation ,business.industry ,Significant difference ,Graft Survival ,Kidney Transplantation ,Liver Transplantation ,Kidney allocation ,medicine.anatomical_structure ,Policy ,Liver ,Graft survival ,business - Abstract
The OPTN's simultaneous liver-kidney (SLK) allocation policy, implemented August 10, 2017, established medical eligibility criteria for adult SLK candidates and created Safety Net kidney allocation priority for liver-alone recipients with new/continued renal impairment. OPTN SLK and kidney after liver (KAL) data were analyzed (registrations as of December 31, 2019, transplants pre-policy [March 20, 2015-August 9, 2017] vs. post-policy [August 10, 2017-December 31, 2019]). Ninety-four percent of SLK registrations met eligibility criteria (99% CKD: 50% dialysis, 50% eGFR). SLK transplant volume decreased from a record 740 (2017) to 676 (2018, -9%), with a subsequent increase to 728 (2019, 1.6% below 2017 volume). For KAL listings within 1 year of liver transplant, waitlist mortality rates declined post-policy versus pre-policy (27 [95% CI = 20.6-34.7] vs. 16 [11.7-20.5]) while transplant rates increased fourfold (46 [32.2-60.0] vs. 197 [171.6-224.7]). There were 234 KAL transplants post-policy (94% Safety Net priority eligible), and no significant difference in 1-year patient/graft survival vs. kidney-alone (patient: 95.9% KAL, 97.0% kidney-alone [p = .39]; graft: 94.2% KAL, 94.6% kidney-alone [p = .81]). From pre- to post-policy, the proportion of all deceased donor kidney and liver transplants that were SLK decreased (kidney: 5.1% to 4.3%; liver: 9.7% to 8.7%). SLK policy implementation interrupted the longstanding rise in SLK transplants, while Safety Net priority directed kidneys to liver recipients in need with thus far minimal impact to posttransplant outcomes.
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- 2021
10. Proteinuria After Kidney Transplantation
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John P. Vella and Alexander C. Wiseman
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medicine.medical_specialty ,Proteinuria ,business.industry ,medicine ,Urology ,medicine.symptom ,medicine.disease ,business ,Kidney transplantation - Published
- 2019
11. Transplantation Tolerance and Biomarkers
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John P. Vella and Alexander C. Wiseman
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Transplantation ,Oncology ,medicine.medical_specialty ,business.industry ,Internal medicine ,Medicine ,business - Published
- 2019
12. Delayed Graft Function
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Alexander C. Wiseman and John P. Vella
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medicine.medical_specialty ,business.industry ,medicine ,business ,Delayed Graft Function ,Surgery - Published
- 2019
13. Chronic Kidney Disease and Coronary Artery Disease
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Mark J. Sarnak, Kerstin Amann, Sripal Bangalore, João L. Cavalcante, David M. Charytan, Jonathan C. Craig, John S. Gill, Mark A. Hlatky, Alan G. Jardine, Ulf Landmesser, L. Kristin Newby, Charles A. Herzog, Michael Cheung, David C. Wheeler, Wolfgang C. Winkelmayer, Thomas H. Marwick, Debasish Banerjee, Carlo Briguori, Tara I. Chang, Chien-Liang Chen, Christopher R. deFilippi, Xiaoqiang Ding, Charles J. Ferro, Jagbir Gill, Mario Gössl, Nicole M. Isbel, Hideki Ishii, Meg J. Jardine, Philip A. Kalra, Günther Laufer, Krista L. Lentine, Kevin Lobdell, Charmaine E. Lok, Gérard M. London, Jolanta Małyszko, Patrick B. Mark, Mohamed Marwan, Yuxin Nie, Patrick S. Parfrey, Roberto Pecoits-Filho, Helen Pilmore, Wajeh Y. Qunibi, Paolo Raggi, Marcello Rattazzi, Patrick Rossignol, Josiah Ruturi, Charumathi Sabanayagam, Catherine M. Shanahan, Gautam R. Shroff, Rukshana Shroff, Angela C. Webster, Daniel E. Weiner, Simon Winther, Alexander C. Wiseman, Anthony Yip, and Alexander Zarbock
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Psychological intervention ,CAD ,State of the art review ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Revascularization ,medicine.disease ,female genital diseases and pregnancy complications ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,cardiovascular diseases ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Prospective cohort study ,Very high risk ,Kidney disease - Abstract
Highlights •CKD is associated with very high risk of CAD. CAD management is complicated in CKD patients, due to comorbid conditions and potential side effects during interventions. •There are few trials related to CAD with focus on CKD patients, particularly in those with advanced CKD. •Additional prospective studies focusing on diagnosis, prevention, and treatment of CAD are needed in CKD.
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- 2019
14. Approach to the Assessment and Management of Adult Patients With Atopic Dermatitis: A Consensus Document. Section V: Consensus Statements on the Assessment and Management of Adult Patients With Moderate-to-Severe Atopic Dermatitis
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Robert Bissonnette, Parbeer Grewal, Gordon Sussman, Perla Lansang, Jensen Yeung, Mark G. Kirchhof, Kim A. Papp, C Lynde, Robert Gniadecki, Marni C. Wiseman, Lorne Albrecht, Ian Landells, Irina Turchin, Melinda Gooderham, Yves Poulin, Chih-Ho Hong, and Gurbir Dhadwal
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Adult ,Moderate to severe ,Document section ,medicine.medical_specialty ,Consensus ,Adult patients ,business.industry ,Treatment options ,Comorbidity ,Dermatology ,Atopic dermatitis ,medicine.disease ,Dermatitis, Atopic ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Health care ,medicine ,Humans ,Surgery ,business ,Intensive care medicine ,Adult atopic dermatitis - Abstract
This document is a concise, current, and practical guide for dermatologists and other health care providers managing adult patients with moderate-to-severe atopic dermatitis (AD). The recommendations made here are based on a consensus of specialists with extensive experience managing patients with AD. Topics reviewed in this publication include AD pathophysiology, assessment, comorbidities, and treatment options.
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- 2018
15. Approach to the Assessment and Management of Adult Patients With Atopic Dermatitis: A Consensus Document. Section III: Evaluation of Atopic Dermatitis Patients for Comorbidities
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Melinda Gooderham, Gordon Sussman, Chih-Ho Hong, Marni C. Wiseman, and Irina Turchin
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Adult ,medicine.medical_specialty ,Consensus ,Eye Diseases ,Comorbidity ,Dermatology ,Disease ,Anxiety ,Dermatitis, Atopic ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Prevalence ,medicine ,Humans ,Eosinophilic esophagitis ,Depression (differential diagnoses) ,Asthma ,Depression ,business.industry ,Atopic dermatitis ,medicine.disease ,body regions ,030228 respiratory system ,Eye disorder ,Surgery ,medicine.symptom ,business - Abstract
Atopic dermatitis (AD) is often associated with other atopic diseases, including asthma, allergic rhinitis, atopy-associated eye disorders, and eosinophilic esophagitis. Depression and anxiety are also comorbidities to AD that significantly affect quality of life and should be screened for in patients with AD. Links to other comorbidities such as cardiovascular disease and malignancy are considered inconclusive, but patient counselling and screening may be appropriate in some patients. This article highlights practical recommendations for the recognition and management of atopic and nonatopic comorbidities commonly associated with AD.
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- 2018
16. The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients
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Ekamol Tantisattamo, Ronald F. Parsons, Christopher D. Blosser, Miklos Z Molnar, Deborah Adey, Tarek Alhamad, Beatrice P. Concepcion, Krista L. Lentine, Arpita Basu, Neeraj Singh, Edward S. Kraus, John J. Friedewald, Martha Pavlakis, Leonardo V. Riella, Alexander C. Wiseman, Song Ong, Arman Faravardeh, Darshana Dadhania, Michelle Lubetzky, Gaurav Gupta, Amtul Aala, and Kenneth J. Woodside
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medicine.medical_specialty ,Allograft failure ,medicine.medical_treatment ,Kidney ,law.invention ,Randomized controlled trial ,law ,Renal Dialysis ,medicine ,Immunology and Allergy ,Humans ,Transplantation, Homologous ,Pharmacology (medical) ,Renal replacement therapy ,Patient group ,Intensive care medicine ,Dialysis ,Transplantation ,business.industry ,Immunosuppression ,Allografts ,Kidney Transplantation ,surgical procedures, operative ,medicine.anatomical_structure ,business ,Immunosuppressive Agents - Abstract
The return to dialysis after allograft failure is associated with increased morbidity and mortality. This transition is made more complex by the rising numbers of patients who seek repeat transplantation and therefore may have indications for remaining on low levels of immunosuppression, despite the potential increased morbidity. Management strategies vary across providers, driven by limited data on how to transition off immunosuppression as the allograft fails and a paucity of randomized controlled trials to support one approach over another. In this review, we summarize the current data available for management and care of the failing allograft. Additionally, we discuss a suggested plan for immunosuppression weaning based upon the availability of re-transplantation and residual allograft function. We propose a shared-care model in which there is improved coordination between transplant providers and general nephrologists so that immunosuppression management and preparation for renal replacement therapy and/or repeat transplantation can be conducted with the goal of improved outcomes and decreased morbidity in this vulnerable patient group.
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- 2021
17. Long-Term Immunosuppression Management: Opportunities and Uncertainties
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Alexander C. Wiseman and David Wojciechowski
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Oncology ,Graft Rejection ,medicine.medical_specialty ,Time Factors ,Epidemiology ,medicine.medical_treatment ,Calcineurin Inhibitors ,030230 surgery ,Critical Care and Intensive Care Medicine ,Belatacept ,Tacrolimus ,Maintenance Chemotherapy ,Abatacept ,03 medical and health sciences ,0302 clinical medicine ,Adrenal Cortex Hormones ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Adverse effect ,Immunosuppression Therapy ,Transplantation ,business.industry ,Alloimmunity ,Immunosuppression ,Squamous cell skin cancer ,MTOR Inhibitors ,Mycophenolic Acid ,Kidney Transplantation ,Kidney Transplantation Long-Term Management Challenges ,Discontinuation ,Calcineurin ,Nephrology ,Drug Therapy, Combination ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
The long-term management of maintenance immunosuppression in kidney transplant recipients remains complex. The vast majority of patients are treated with the calcineurin inhibitor tacrolimus as the primary agent in combination with mycophenolate, with or without corticosteroids. A tacrolimus trough target 5-8 ng/ml seems to be optimal for rejection prophylaxis, but long-term tacrolimus-related side effects and nephrotoxicity support the ongoing evaluation of noncalcineurin inhibitor-based regimens. Current alternatives include belatacept or mammalian target of rapamycin inhibitors. For the former, superior kidney function at 7 years post-transplant compared with cyclosporin generated initial enthusiasm, but utilization has been hampered by high initial rejection rates. Mammalian target of rapamycin inhibitors have yielded mixed results as well, with improved kidney function tempered by higher risk of rejection, proteinuria, and adverse effects leading to higher discontinuation rates. Mammalian target of rapamycin inhibitors may play a role in the secondary prevention of squamous cell skin cancer as conversion from a calcineurin inhibitor to an mammalian target of rapamycin inhibitor resulted in a reduction of new lesion development. Early withdrawal of corticosteroids remains an attractive strategy but also is associated with a higher risk of rejection despite no difference in 5-year patient or graft survival. A major barrier to long-term graft survival is chronic alloimmunity, and regardless of agent used, managing the toxicities of immunosuppression against the risk of chronic antibody-mediated rejection remains a fragile balance.
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- 2021
18. Transplant administration-A survey of the roles and responsibilities of kidney and pancreas medical directors of US transplant centers
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Darshana Dadhania, Gwen McNatt, Mona D. Doshi, Roy D. Bloom, Millie Samaniego, Y. Qazi, Neeraj Singh, Ronald F. Parsons, Todd E. Pesavento, Muhammad Saad Naseer, Alexander C. Wiseman, Bruce Kaplan, and John J. Friedewald
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United Network for Organ Sharing ,Adult ,Male ,medicine.medical_specialty ,Demographics ,education ,030230 surgery ,Kidney ,Physician Executives ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,medicine ,Humans ,Fellowships and Scholarships ,Pancreas ,health care economics and organizations ,Accreditation ,Transplantation ,business.industry ,Internship and Residency ,United States ,Education, Medical, Graduate ,Family medicine ,030211 gastroenterology & hepatology ,Job satisfaction ,business ,Administration (government) - Abstract
The current American Society of Transplantation (AST) accredited transplant fellowship programs in the United States provide no structured formal training in leadership and administration which is essential for successfully running a transplant program. We conducted a survey of medical directors of active adult kidney and kidney-pancreas transplant programs in the United States about their demographics, training pathways, and roles and responsibilities. The survey was emailed to 183 medical directors, and 123 (67.2%) completed the survey. A majority of respondents were older than 50 years (61%), males (80%), and holding that position for more than 10 years (47%). Only 51% of current medical directors had taken that position after completing a one-year transplant fellowship, and 58% took on the role with no prior administrative or leadership experience. The medical directors reported spending a median 50%-75% of time in clinical responsibilities, 25%-50% of time in administration, and 0%-25% time in research. The survey also captured various administrative roles of medical directors vis-a-vis other transplant leaders. The study, designed to be the starting point of an improvement initiative of the AST, provided important insight into the demographics, training pathways, roles and responsibilities, job satisfaction, education needs, and training gaps of current medical directors.
- Published
- 2021
19. Real-world effectiveness of adalimumab in patients with moderate-to-severe hidradenitis suppurativa: the 1-year SOLACE study
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Afsaneh Alavi, C Jean, Melinda Gooderham, Wayne Gulliver, Kim Papp, M S Alam, Jaggi Rao, Marni C. Wiseman, and O Desjardins
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medicine.medical_specialty ,Canada ,business.industry ,Adalimumab ,Nodule (medicine) ,Dermatology ,Disease ,medicine.disease ,Severity of Illness Index ,Hidradenitis Suppurativa ,Infectious Diseases ,Treatment Outcome ,Internal medicine ,Severity of illness ,Post-hoc analysis ,Medicine ,Humans ,Hidradenitis suppurativa ,Female ,medicine.symptom ,Stage (cooking) ,business ,Abscess ,medicine.drug - Abstract
Background Long-term, real-word data are needed to help manage patients with hidradenitis suppurativa (HS) through this recurrent, painful and debilitating disease. Objectives To primarily measure real-world effectiveness of adalimumab in HS and to secondarily observe clinical course of HS in the light of patients' response. Methods In SOLACE, adults with moderate-to-severe HS in need for change in ongoing therapy were treated with adalimumab for up to 52 weeks as per physician's medical practice. Treatment effectiveness was measured by Hidradenitis Suppurativa Clinical Response (HiSCR). Inflammatory nodules, abscesses and draining fistulas were counted, Hurley stage was assessed, and disease severity was rated using the International HS Severity Scoring System (IHS4). A post hoc analysis further explored the HiSCR response by abscess and inflammatory nodule (AN) count at baseline (low, medium and high) and gender. Spontaneously reported safety events were collected. Results From 23 Canadian centres, 69% of the 138 patients achieved HiSCR at week 24, which increased to 82% and 75% at week 52 in patients with medium and high AN counts, respectively. Gender (4 times the odds for female) and age at HS onset (5% decrease with each additional year) had an effect on achieving HiSCR. Treatment with adalimumab led to an important decrease in number of lesions in responders, with most gains observed in inflammatory nodules, more frequently in the lower body area of patients in the high AN count group. The IHS4 scores of responders were substantially lowered, with a larger decrease in patients of the high AN count group. No new safety signal was detected. Conclusions The effectiveness of adalimumab was maintained during this 1-year period, and an optimal gain was documented for patients with medium and high AN counts. These real-world data support a prompt treatment of HS patients and the use of IHS4 to monitor treatment.
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- 2021
20. Kidney recipients with allograft failure, transition of kidney care (KRAFT): A survey of contemporary practices of transplant providers
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John J. Friedewald, Michelle Lubetzky, Arpita Basu, Miklos Z Molnar, Beatrice P. Concepcion, Ekamol Tantisattamo, Ronald F. Parsons, Gaurav Gupta, Leonardo V. Riella, Arman Faravardeh, Deborah Adey, Emmanuel Edusei, Martha Pavlakis, James C. Rice, Krista L. Lentine, Alexander C. Wiseman, Kenneth J. Woodside, Tarek Alhamad, Song Ong, Darshana Dadhania, Edward S. Kraus, Christopher D. Blosser, Neeraj Singh, and Su-Hsin Chang
- Subjects
medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,MEDLINE ,030230 surgery ,Kidney ,Antimetabolite ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,medicine ,Immunology and Allergy ,Humans ,Transplantation, Homologous ,Pharmacology (medical) ,Transitional care ,Intensive care medicine ,Dialysis ,Transplantation ,business.industry ,Risk of infection ,Immunosuppression ,Allografts ,Kidney Transplantation ,Transplant Recipients ,Calcineurin ,medicine.anatomical_structure ,Kidney Failure, Chronic ,business - Abstract
Kidney allograft failure and return to dialysis carry a high risk of morbidity. A practice survey was developed by the AST Kidney Pancreas Community of Practice workgroup and distributed electronically to the AST members. There were 104 respondents who represented 92 kidney transplant centers. Most survey respondents were transplant nephrologists at academic centers. The most common approach to immunosuppression management was to withdraw the antimetabolite first (73%), while only 12% responded they would withdraw calcineurin inhibitor (CNI) first. More than 60% reported that the availability of a living donor is the most important factor in their decision to taper immunosuppression, followed by risk of infection, risk of sensitization, frailty, and side effects of medications. More than half of respondents reported that embolization was either not available or offered to less than 10% as an option for surgical intervention. Majority reported that ≤50% of failed allograft patients were re-listed before dialysis, and less than a quarter of transplant nephrologists performed frequent visits with their patients with failed kidney allograft after they return to dialysis. This survey demonstrates heterogeneity in the care of patients with a failing allograft and the need for more evidence to guide improvements in clinical practice related to transition of care.
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- 2021
21. Defining the roles and responsibilities of the kidney transplant medical director: A necessary step for future training, mentoring, and professional development
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Angelo M DeMattos, Millie Samaniego, Mona D. Doshi, Alexander C. Wiseman, Christina Klein, Todd E. Pesavento, John J. Friedewald, Kim Nicoll, Luke Preczewski, Nicolae Leca, Neeraj Singh, Enver Akalin, Roy D. Bloom, and Darshana Dadhania
- Subjects
Nephrology ,United Network for Organ Sharing ,medicine.medical_specialty ,Tissue and Organ Procurement ,Job description ,030230 surgery ,Kidney transplant ,Physician Executives ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Multidisciplinary approach ,Internal medicine ,Immunology and Allergy ,Medicine ,Humans ,Pharmacology (medical) ,Transplantation ,business.industry ,Professional development ,Mentoring ,medicine.disease ,Kidney Transplantation ,United States ,Kidney Failure, Chronic ,business ,Kidney disease - Abstract
The management of a kidney transplant program has evolved significantly in the last decades to become a highly specialized, multidisciplinary standard of care for end-stage kidney disease. Transplant center job descriptions have similarly morphed with increasing responsibilities to address a more complex patient mix, increasing medical and surgical therapeutic options, and increasing regulatory burden in the face of an ever-increasing organ shortage. Within this evolution, the role of the Kidney Transplant Medical Director (KTMD) has expanded beyond the basic requirements described in the United Network for Organ Sharing bylaws. Without a clear job description, transplant nephrology trainees may be inadequately trained and practicing transplant nephrologists may face opaque expectations for the roles and responsibilities of Medical Director. To address this gap and clarify the key areas in which the KTMD interfaces with the kidney transplant program, American Society of Transplantation (AST) formed a Task Force of 14 AST KTMDs to review and define the role of the KTMD in key aspects of administrative, regulatory, budgetary, and educational oversight of a kidney transplant program.
- Published
- 2020
22. Tacrolimus Intrapatient Variability, Time in Therapeutic Range, and Risk of De Novo Donor-Specific Antibodies
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James E. Cooper, Patrick Klem, Scott Davis, Alexander C. Wiseman, Jane Gralla, and Erik Stites
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Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Time Factors ,Coefficient of variation ,medicine.medical_treatment ,Calcineurin Inhibitors ,Time in therapeutic range ,chemical and pharmacologic phenomena ,030230 surgery ,Gastroenterology ,Risk Assessment ,Tacrolimus ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Therapeutic index ,HLA Antigens ,Isoantibodies ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Humans ,Retrospective Studies ,Transplantation ,biology ,business.industry ,Graft Survival ,nutritional and metabolic diseases ,Immunosuppression ,Middle Aged ,Kidney Transplantation ,stomatognathic diseases ,Transthyretin ,Treatment Outcome ,Cohort ,biology.protein ,030211 gastroenterology & hepatology ,Female ,Drug Monitoring ,business ,Biomarkers ,Immunosuppressive Agents - Abstract
Tacrolimus (TAC) is the most important agent for maintenance immunosuppression and prevention of immunologic injury to the renal allograft, yet there remains no consensus on how best to monitor drug therapy. Both high TAC intrapatient variability and low TAC time in therapeutic range (TTR) have been associated with risk of de novo donor-specific antibodies (dnDSA). In this study, we hypothesized that the risk associated with high TAC coefficient of variation (CV) is a result of low TAC TTR rather than the variability itself.We analyzed the risk of dnDSA, acute rejection, or death-censored graft loss by non-dosed-corrected TAC CV and TAC TTR during the first posttransplant year in a cohort of 538 patients with a median follow-up period of 4.1 years.Patients with CV44.2% and TTR40% (high intrapatient variability and low TTR) had a high risk of dnDSA (adjusted OR = 4.93, 95% confidence interval = 2.02-12.06, P0.001) and death-censored graft loss by 5 years (adjusted HR = 4.00, 95% confidence interval = 1.31-12.24, P = 0.015) when compared with patients with CV44.2% and TTR ≥40% (high intrapatient variability and optimal TTR), while the latter patients had similar risk to patients with CV44.2% (lower intrapatient variability).These data suggest that previously reported immunologic risk associated with high TAC intrapatient variability is due to time outside of therapeutic range rather than variability in and of itself when evaluating absolute non-dose-corrected TAC levels irrespective of reason or indication.
- Published
- 2020
23. The Transplant Nephrology Workforce in the United States: Current State and Future Directions
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Priyamvada Singh, Alexander C. Wiseman, Swee Ling Levea, Sami Alasfar, and Beatrice P. Concepcion
- Subjects
Nephrology ,medicine.medical_specialty ,Scope of practice ,Referral ,media_common.quotation_subject ,Population ,030232 urology & nephrology ,030204 cardiovascular system & hematology ,Nephrologists ,03 medical and health sciences ,0302 clinical medicine ,State (polity) ,Multidisciplinary approach ,Internal medicine ,Preoperative Care ,medicine ,Humans ,Health Workforce ,Fellowships and Scholarships ,education ,Referral and Consultation ,Kidney transplantation ,media_common ,Postoperative Care ,education.field_of_study ,business.industry ,Scope of Practice ,medicine.disease ,Kidney Transplantation ,United States ,surgical procedures, operative ,Family medicine ,Workforce ,Insurance, Health, Reimbursement ,business - Abstract
The population of patients with kidney transplants in the United States is growing. The delivery of transplant care is complex, involves a multidisciplinary transplant team, and care coordination between transplant and community providers. The transplant nephrologist is central to the delivery of this care and assumes a multitude of clinical and nonclinical roles and responsibilities. With a growing population of patients requiring transplant care that spans a continuum from pretransplant referral to long-term posttransplant management, an understanding of the current state of the transplant nephrology workforce in the United States and the future that it faces is important in ensuring that current and future needs of both patients and physicians are met. In this article, we (1) review the scope of practice of the transplant nephrologist, (2) discuss the state of training in the field of transplant nephrology, (3) review the role of the referring primary nephrologist in the care of patients undergoing kidney transplant, and (4) discuss challenges and opportunities facing the transplant nephrology workforce.
- Published
- 2020
24. To kidney or not to kidney: Applying lessons learned from the simultaneous liver-kidney transplant policy to simultaneous heart-kidney transplantation
- Author
-
Xingxing S. Cheng, Jeffrey J. Teuteberg, Kiran K. Khush, Jane C. Tan, and Alexander C. Wiseman
- Subjects
medicine.medical_specialty ,Economic shortage ,030230 surgery ,Kidney ,Kidney transplant ,03 medical and health sciences ,0302 clinical medicine ,Simultaneous liver kidney ,medicine ,Humans ,Intensive care medicine ,Kidney transplantation ,Transplantation ,business.industry ,medicine.disease ,Comorbidity ,Kidney Transplantation ,United States ,surgical procedures, operative ,medicine.anatomical_structure ,Policy ,Liver ,Heart Transplantation ,030211 gastroenterology & hepatology ,business - Abstract
As the medical community is increasingly offering transplantation to patients with increasing comorbidity burdens, the number of simultaneous heart-kidney (SHK) transplants is rising in the United States. How to determine eligibility for SHK transplant versus heart transplant alone is unknown. In this review, we situate this problem in the broader picture of organ shortage. We critically appraise available literature on outcomes in SHK versus heart transplant alone. We posit staged kidney-after-heart transplantation as a plausible alternative to SHK transplantation and review the pros and cons. Drawing lessons from the field of simultaneous liver-kidney transplant, we argue for an analogous policy for SHK transplant with standardized minimal eligibility criteria and a modified Safety Net provision. The new policy will serve as a starting point for comparing simultaneous versus staged approaches and refining the medical eligibility criteria for SHK.
- Published
- 2020
25. Low-dose subcutaneous immunoglobulin is an effective treatment for autoimmune bullous skin disorders: A case report
- Author
-
Erin Streu, James B. Johnston, and Marni C. Wiseman
- Subjects
medicine.medical_specialty ,lcsh:R5-920 ,JCMS Case Report ,biology ,business.industry ,Hospital setting ,Low dose ,immunoglobulins ,General Medicine ,030204 cardiovascular system & hematology ,Subcutaneous immunoglobulin ,Dermatology ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Bullous skin diseases ,biology.protein ,Medicine ,Effective treatment ,subcutaneous ,Antibody ,business ,lcsh:Medicine (General) - Abstract
Intravenous immunoglobulin is a recognized treatment in recalcitrant autoimmune bullous diseases. Infusions are administered monthly over 1–5 days in the hospital setting and associated with mild to severe infusion-related systemic effects, in part due to the high doses necessary to induce and achieve remission. We present a case series of four patients with bullous diseases treated successfully with low-dose subcutaneous IgG who achieved remission with maintenance therapy. Patient-administered smaller, more frequent doses of IgG into subcutaneous tissue more closely mimics the body’s own antibody production and produces a more stable serum trough level. Subcutaneous IgG is a novel treatment approach in bullous diseases which can induce a state remission.
- Published
- 2020
26. Nonprescription acne vulgaris treatments: Their role in our treatment armamentarium-An international panel discussion
- Author
-
Gabriella Fabbrocini, Sameer Zimmo, Marni C. Wiseman, Elena Araviiskaia, Delphine Kerob, Monika Arenbergerova, Maryna Anfilova, Elia Roo, Ziad Khamaysi, Olga L. Forero Barrios, Zrinka Bukvić Mokos, Anca Zbranca‐Toporas, Anneke Andriessen, Maja A. Hofmann, Aleksandra Lesiak, Brigitte Dréno, Marita Kosmadaki, Lucie Guerin, Merete Haedersdal, Dreno, B., Araviiskaia, E., Kerob, D., Andriessen, A., Anfilova, M., Arenbergerova, M., Forero Barrios, O. L., Bukvic Mokos, Z., Haedersdal, M., Hofmann, M. A., Khamaysi, Z., Kosmadaki, M., Lesiak, A., Roo, E., Zbranca-Toporas, A., Wiseman, M. C., Zimmo, S., Guerin, L., and Fabbrocini, G.
- Subjects
Adult ,Male ,medicine.medical_specialty ,Population ,Dermatology ,Review Article ,acne in adult women ,acne vulgari ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Acne Vulgaris ,acne in adult women, acne vulgaris, adjunctive treatment, dermocosmetics, monotherapy ,Medicine ,acne vulgaris ,Humans ,Medical prescription ,education ,Review Articles ,Acne ,Panel discussion ,Skin ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,adjunctive treatment ,Social environment ,medicine.disease ,Skin Aging ,Tolerability ,030220 oncology & carcinogenesis ,monotherapy ,Adjunctive treatment ,dermocosmetic ,Female ,Dermatologic Agents ,business ,dermocosmetics - Abstract
Background: Acne vulgaris (acne), a common inflammatory skin disorder, has its peak incidence between 14 and 19 years of age, with girls frequently developing acne earlier than boys. Over recent years, persistent acne is becoming more prevalent in adult women. ----- Objectives: This review and panel discussion addresses challenges in acne management, particularly in adult women. The role which nonprescription acne treatment can play is explored when used as monotherapy or as an adjunctive treatment for acne of all severity. ----- Methods: The best available evidence on nonprescription acne treatment was coupled with the opinion of an international expert panel of dermatologists to adopt statements and recommendations discussed in this review. ----- Results: All severity of acne has a significant burden on patients. Addressing environmental factors that are important for the individual with acne may help to educate, prevent, effectively manage, and maintain acne, as per the panel. They agreed that the adult female acne population has unique needs because of their aging skin and social environment. Nonprescription acne treatment products may help to balance the efficacy and tolerability of prescription acne treatment. Currently, there are no specific guidelines for how to use nonprescription acne treatment products in these patients. ----- Conclusion: The panel agreed that guidelines including nonprescription acne treatment either as monotherapy for mild acne or in combination with prescription treatments for more severe acne would address a significant unmet need.
- Published
- 2020
27. Preparing for Transplantation
- Author
-
Erik Stites, Scott Davis, James E. Cooper, and Alexander C. Wiseman
- Subjects
medicine.medical_specialty ,Referral ,business.industry ,Renal function ,Disease ,medicine.disease ,Transplantation ,surgical procedures, operative ,Inclusion and exclusion criteria ,medicine ,Stage (cooking) ,business ,Intensive care medicine ,Kidney transplantation ,Kidney disease - Abstract
Individuals with progressive advanced chronic kidney disease (CKD) have a number of treatment modalities to consider before reaching end-stage renal disease. As CKD reaches stage 4, and particularly as glomerular filtration rate approaches 20 mL/min, patients should be informed of kidney transplantation as a treatment option, provided education regarding the transplant process, and be referred to a transplant center unless there are clear contraindications or comorbidities that preclude consideration. There is an unfortunate and dramatic disparity between those who are eligible for transplantation and those who receive a transplant, due in part to referral biases, the comparative shortage of deceased donors, and a lack of acceptance or awareness of living kidney donation as an option. This chapter reviews the transplant landscape, discusses the procedural and pathophysiological considerations for kidney transplantation, and outlines the transplant evaluation process, including inclusion and exclusion criteria.
- Published
- 2020
28. Effect of Sirolimus on Native Total Kidney Volume After Transplantation in Patients with Autosomal Dominant Polycystic Kidney Disease: A Randomized Controlled Pilot Study
- Author
-
Charles L. Edelstein, Alexander C. Wiseman, Jane Gralla, Scott Davis, and Laurence Chan
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,Autosomal dominant polycystic kidney disease ,Urology ,Pilot Projects ,Kidney Volume ,030230 surgery ,Kidney ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Prospective Studies ,Kidney transplantation ,Sirolimus ,Transplantation ,urogenital system ,business.industry ,TOR Serine-Threonine Kinases ,Immunosuppression ,Middle Aged ,Polycystic Kidney, Autosomal Dominant ,medicine.disease ,Kidney Transplantation ,Tacrolimus ,surgical procedures, operative ,medicine.anatomical_structure ,Research Design ,Female ,Surgery ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
The mammalian target of rapamycin (mTOR) pathway has been shown to be central to cyst formation and growth in patients with autosomal dominant polycystic kidney disease (ADPKD). Drugs that suppress mTOR signaling are frequently used as antiproliferative agents for maintenance immunosuppression in patients who have undergone kidney transplantation. The aim of this study was to determine the effect of sirolimus, an mTOR inhibitor, on cyst volume regression in patients with ADPKD who have undergone renal transplantation.In this single-center, prospective, open-label, parallel-group, randomized trial, 23 adult patients with ADPKD who successfully underwent renal transplantation from 2008 to 2012 were subsequently randomized (on a 1:1 basis) to a maintenance immunosuppression regimen with either sirolimus (sirolimus, tacrolimus, prednisone) or mycophenolate (mycophenolate, tacrolimus, prednisone). Total kidney volumes were measured by means of high-resolution magnetic resonance imaging within 2 weeks after transplantation and at 1 year. The primary end point was change in total kidney volume at 1 year.Sixteen patients completed the 1-year study (8 patients in each group). There was a decrease in kidney volume in both the sirolimus group (percentage change from baseline, 20.5%; P .001) and mycophenolate group (percentage change from baseline, 17%; P = .048), but there was no significant difference in percentage change of total kidney volume between the groups (P = .665).In ADPKD patients at 1 year after kidney transplantation, there was a similar decrease in polycystic kidney volume in patients receiving an immunosuppression regimen containing sirolimus compared with patients receiving mycophenolate.
- Published
- 2018
29. 28186 Efficacy and safety of tralokinumab monotherapy in North American adult patients with moderate-to-severe atopic dermatitis: A subanalysis of the ECZTRA 2 trial
- Author
-
April W. Armstrong, Mark Lomaga, Kim A. Papp, Marni C. Wiseman, Jennifer Soung, and Lorne Albrecht
- Subjects
Moderate to severe ,medicine.medical_specialty ,Adult patients ,business.industry ,Medicine ,Dermatology ,Atopic dermatitis ,business ,medicine.disease ,Tralokinumab - Published
- 2021
30. Higher Fludarabine and Cyclophosphamide Exposures Lead to Worse Outcomes in Reduced-Intensity Conditioning Hematopoietic Cell Transplantation for Adult Hematologic Malignancy
- Author
-
Rachael A. Pearson, Pamala A. Jacobson, Qing Cao, Aileen Scheibner, Takuto Takahashi, Claudio G. Brunstein, John Rogosheske, Erica D. Warlick, Veronika Bachanova, Anthony C. Wiseman, Kinjal Sanghavi, and Daniel J. Weisdorf
- Subjects
Adult ,medicine.medical_specialty ,Adolescent ,Cyclophosphamide ,Gastroenterology ,Article ,Pharmacokinetics ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,Active metabolite ,Transplantation ,business.industry ,Hematopoietic Stem Cell Transplantation ,Area under the curve ,Cell Biology ,Hematology ,Total body irradiation ,Fludarabine ,Hematologic Neoplasms ,Pharmacodynamics ,Molecular Medicine ,business ,Vidarabine ,medicine.drug - Abstract
Reduced-intensity conditioning regimens using fludarabine (Flu) and cyclophosphamide (Cy) have been widely used in hematopoietic cell transplantation (HCT) recipients. The optimal exposure of these agents remains to be determined. We aimed to delineate the exposure-outcome associations of Flu and Cy separately and then both combined on HCT outcomes. This is a single-center, observational, pharmacokinetic (PK)-pharmacodynamic (PD) study of Flu and Cy in HCT recipients age ≥18 years who received Cy (50 mg/kg in a single dose), Flu (150 to 200 mg/m(2) given as 5 daily doses), and total body irradiation (TBI; 200 cGy). We measured trough concentrations of 9-β-D-arabinosyl-2-fluorade-nine (F-ara-A), an active metabolite of Flu, on days −5 and −4 (F-ara-A(Day-5) and F-ara-A(Day-4), respectively), and measured phosphoramide mustard (PM), the final active metabolite of Cy, and estimated the area under the curve (AUC). The 89 enrolled patients had a nonrelapse mortality (NRM) of 9% (95% confidence interval [CI], 3% to 15%) at day +100 and 15% (95% CI, 7% to 22%) at day +180, and an overall survival (OS) of 73% (95% CI, 63% to 81%) at day +180. In multivariate analysis, higher PM area under the curve (AUC) for 0 to 8 hours (PM AUC(0–8 hr)) was an independent predictor of worse NRM (P < .01 at both day +100 and day +180) and worse day +180 OS (P < .01), but no associations were identified for F-ara-A trough levels. We observed lower day +100 NRM in those with both high F-ara-A(Day-4) trough levels (≥40 ng/mL; >25th percentile) and low PM AUC(0–8 hr) (16-fold higher NRM. These results warrant further investigation to optimize reduced-intensity regimens based on better PK-PD understanding and possible adaptation to predictable factors influencing drug clearance.
- Published
- 2021
31. Management of Moderate to Severe Plaque Psoriasis: The Emerging Role of IL-17 Inhibition
- Author
-
Melinda Gooderham, Kim A. Papp, Robert Bissonnette, Ian Landells, Yves Poulin, Marni C. Wiseman, Chih-Ho Hong, Marc Bourcier, Ronald Vender, and Charles Lynde
- Subjects
0301 basic medicine ,Moderate to severe ,Plaque psoriasis ,medicine.medical_specialty ,business.industry ,Interleukin-17 ,Antibodies, Monoclonal ,Dermatology ,medicine.disease ,030207 dermatology & venereal diseases ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Psoriasis ,medicine ,Humans ,Surgery ,Interleukin 17 ,business - Published
- 2017
32. Current status of pancreas transplantation
- Author
-
Peter T. Kennealey, Alexander C. Wiseman, and Erik Stites
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,MEDLINE ,030230 surgery ,Pancreas transplantation ,Diabetes Complications ,03 medical and health sciences ,0302 clinical medicine ,Internal Medicine ,medicine ,Humans ,Survival rate ,Kidney transplantation ,Immunosuppression Therapy ,business.industry ,Patient Selection ,Graft Survival ,Patient survival ,Immunosuppression ,medicine.disease ,Kidney Transplantation ,Surgery ,Survival Rate ,medicine.anatomical_structure ,Nephrology ,Kidney Failure, Chronic ,Graft survival ,Pancreas Transplantation ,Pancreas ,business - Abstract
To review recent pancreas transplantation outcomes and indications and describe studies of the impact of pancreas transplant upon patient survival and secondary complications.A number of surgical advances have occurred that have improved the early success rate of transplant, and modern immunosuppressive strategies have improved the rate of longer term allograft survival. Pancreas transplant is associated with a mortality benefit when performed in patients with end-stage renal disease in combination with kidney transplant, but questions regarding the impact upon secondary diabetic complications together with the risk assumed by the surgical procedure and the attendant immunosuppression in the nonuremic patient may have tempered enthusiasm for broader expansion of transplantation. Thus, despite these advances, the number of pancreas transplants performed annually is falling consistently. Efforts to define optimal donor and recipient characteristics and understand the pathophysiological impact of pancreas transplant are active areas of research that may lead to greater expansion of pancreas transplant in the future.The review summarizes these advances, including the utilization patterns of pancreas transplant and current concepts of patient selection and graft monitoring, and places into perspective the current and future role of pancreas transplantation as a therapeutic option in diabetes.
- Published
- 2016
33. Chronic kidney disease and valvular heart disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies conference
- Author
-
Wajeh Y. Qunibi, Wolfgang C. Winkelmayer, Patrick Rossignol, Chien Liang Chen, Mark A. Hlatky, Paolo Raggi, Charles J. Ferro, Xiaoqiang Ding, Charles A. Herzog, Philip A. Kalra, Mark J. Sarnak, Alexander C. Wiseman, Yuxin Nie, Charumathi Sabanayagam, J. Cavalcante, Thomas H. Marwick, Simon Winther, Jonathan C. Craig, Günther Laufer, Marcello Rattazzi, David C. Wheeler, John S. Gill, Kevin W. Lobdell, Charmaine E. Lok, Alexander Zarbock, David M. Charytan, Jolanta Malyszko, Gautam R. Shroff, L. Kristin Newby, Hideki Ishii, Debasish Banerjee, Daniel E. Weiner, Ulf Landmesser, Michael Cheung, Patrick S. Parfrey, Helen Pilmore, Roberto Pecoits-Filho, Krista L. Lentine, Christopher DeFilippi, Tara I. Chang, Angela C Webster, Mohamed Marwan, Patrick B. Mark, Anthony Yip, Kerstin Amann, Sripal Bangalore, Meg Jardine, Gérard M. London, Rukshana Shroff, Nicole M. Isbel, Carlo Briguori, Alan G. Jardine, Josiah Ruturi, Catherine M. Shanahan, Jagbir Gill, and Mario Gössl
- Subjects
0301 basic medicine ,Aortic valve ,medicine.medical_specialty ,Population ,030232 urology & nephrology ,urologic and male genital diseases ,03 medical and health sciences ,aortic stenosis ,chronic kidney disease ,end-stage kidney disease ,mitral annular calcification ,valvular heart disease ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Epidemiology ,Prevalence ,medicine ,Humans ,Mitral Valve Stenosis ,Renal Insufficiency, Chronic ,Risk factor ,education ,education.field_of_study ,Mitral regurgitation ,Endocarditis ,business.industry ,Calcinosis ,Mitral Valve Insufficiency ,Aortic Valve Stenosis ,Congresses as Topic ,medicine.disease ,female genital diseases and pregnancy complications ,Stenosis ,030104 developmental biology ,medicine.anatomical_structure ,Nephrology ,Aortic Valve ,Cardiology ,cardiovascular system ,Mitral Valve ,business ,Kidney disease - Abstract
Chronic kidney disease (CKD) is a major risk factor for valvular heart disease (VHD). Mitral annular and aortic valve calcifications are highly prevalent in CKD patients and commonly lead to valvular stenosis and regurgitation, as well as complications including conduction system abnormalities and endocarditis. VHD, especially mitral regurgitation and aortic stenosis, is associated with significantly reduced survival among CKD patients. Knowledge related to VHD in the general population is not always applicable to CKD patients because the pathophysiology may be different, and CKD patients have a high prevalence of comorbid conditions and elevated risk for periprocedural complications and mortality. This Kidney Disease: Improving Global Outcomes (KDIGO) review of CKD and VHD seeks to improve understanding of the epidemiology, pathophysiology, diagnosis, and treatment of VHD in CKD by summarizing knowledge gaps, areas of controversy, and priorities for research.
- Published
- 2019
34. Belatacept-based immunosuppression with simultaneous calcineurin inhibitor avoidance and early corticosteroid withdrawal: A prospective, randomized multicenter trial
- Author
-
Alexander C. Wiseman, Eileen C. King, Rita R. Alloway, Patricia West-Thielke, John Leone, E. Steve Woodle, Arthur J. Matas, Ting Sa, Dixon B. Kaufman, and A. R. Shields
- Subjects
Graft Rejection ,medicine.medical_specialty ,medicine.medical_treatment ,Calcineurin Inhibitors ,Urology ,Belatacept ,Abatacept ,Adrenal Cortex Hormones ,Multicenter trial ,medicine ,Clinical endpoint ,Immunology and Allergy ,Humans ,Pharmacology (medical) ,Prospective Studies ,Immunosuppression Therapy ,Transplantation ,business.industry ,Graft Survival ,Immunosuppression ,Kidney Transplantation ,Tacrolimus ,Calcineurin ,Regimen ,Alemtuzumab ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
Simultaneous calcineurin inhibitor avoidance (CNIA) and early corticosteroid withdrawal (ESW) have not been achieved primarily due to excessive acute rejection. This trial compared 2 belatacept-based CNIA/ESW regimens with a tacrolimus-based ESW regimen. Kidney transplant recipients were randomized to receive alemtuzumab/belatacept, rabbit anti-thymocyte globulin (rATG)/belatacept, or rATG/tacrolimus. The combinatorial primary endpoint consisted of patient death, renal allograft loss, or a Modification of Diet in Renal Disease-calculated eGFR of
- Published
- 2019
35. Risk factors for skin cancer and solid tumors in newly diagnosed patients with chronic lymphocytic leukemia and the impact of skin surveillance on survival
- Author
-
James B. Johnston, Salah Mahmud, Sara Beiggi, Marni C. Wiseman, Erin Streu, Spencer B. Gibson, Dhali H.S. Dhaliwal, Aaron J. Marshall, Versha Banerji, Ganchimeg Ishdorj, and Zoann Nugent
- Subjects
Male ,Cancer Research ,medicine.medical_specialty ,Skin Neoplasms ,Chronic lymphocytic leukemia ,Newly diagnosed ,03 medical and health sciences ,0302 clinical medicine ,Sex Factors ,Risk Factors ,hemic and lymphatic diseases ,medicine ,Retrospective analysis ,Humans ,Referral and Consultation ,Early Detection of Cancer ,Aged ,Retrospective Studies ,integumentary system ,business.industry ,Incidence (epidemiology) ,Incidence ,Age Factors ,Neoplasms, Second Primary ,Hematology ,Middle Aged ,medicine.disease ,Dermatology ,Leukemia, Lymphocytic, Chronic, B-Cell ,humanities ,Oncology ,030220 oncology & carcinogenesis ,Skin surveillance ,Practice Guidelines as Topic ,Female ,Skin cancer ,business ,030215 immunology ,Follow-Up Studies - Abstract
A retrospective analysis on 587 patients with chronic lymphocytic leukemia (CLL) assessed risk factors for skin cancer and the influence of skin cancers on survival and incidence of solid tumors (STs). Patients underwent skin surveillance and were followed for a median of 6.65 years. The relative risk for skin cancer increased prior to CLL diagnosis rising 4-fold one-year post-diagnosis. Independent predictors for skin cancer were male gender (
- Published
- 2019
36. Three-month pancreas graft function significantly influences survival following simultaneous pancreas-kidney transplantation in type 2 diabetes patients
- Author
-
Veronica Hicks, Mark A. Schnitzler, Jason R. Wellen, Alexander C. Wiseman, Mei Wang, Kricia Ruano, Daniel C. Brennan, Krista L. Lentine, Ryan Kunjal, Su-Hsin Chang, and Tarek Alhamad
- Subjects
medicine.medical_specialty ,Urology ,Type 2 diabetes ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Immunology and Allergy ,Humans ,Pharmacology (medical) ,Pancreas ,Transplantation ,Kidney ,business.industry ,Hazard ratio ,Simultaneous pancreas kidney transplantation ,Graft Survival ,Type 2 Diabetes Mellitus ,medicine.disease ,Kidney Transplantation ,medicine.anatomical_structure ,Diabetes Mellitus, Type 1 ,Diabetes Mellitus, Type 2 ,Pancreas Transplantation ,business ,Kidney disease - Abstract
Successful simultaneous pancreas-kidney transplantation (SPK) improves quality-of-life and prolongs kidney allograft and patient survival in type-1 diabetic (T1DM) patients. However, the use of SPK in type-2 diabetic (T2DM) patients remains limited. We examined a national transplant registry for 35 849 T2DM kidney disease patients who received transplant between 2000 and 2016 and survived the first 3 months with a functioning kidney, and categorized as: deceased-donor kidney transplant alone (DD-KA, 68%), living-donor kidney transplant alone (LD-KA, 30%), or SPK (2%). Among SPK recipients, 6% had pancreas allograft failure within 3 months (SPK,P-) and 94% had a functional pancreas (SPK,P+). Associations of transplant type with kidney allograft failure and death (multivariable-adjusted hazard ratio, 95%LCL aHR95%UCL ), over follow-up through December 2018, were quantified by multivariable inverse probability of treatment weighted survival analyses. SPK recipients had better kidney graft and patient survival than LD-KA or DD-KA recipients. Compared to SPK,P+, DD-KA, or LD-KA recipients had significantly higher risk of kidney allograft failure (DD-KA: aHR 1.53 2.203.17 ; LD-KA: aHR 1.29 1.872.71 ) and death (DD-KA: aHR 2.12 3.255.00 ; LD-KA: aHR 1.54 2.353.59 ). SPK,P- recipients had significantly higher risk of death (aHR 1.68 3.306.50 ). Similar to T1DM, T2DM patients with SPK have a survival benefit compared to those with kidney transplant alone, but this benefit depends upon successful early pancreas function.
- Published
- 2019
37. Risk of ESKD in Older Live Kidney Donors with Hypertension
- Author
-
Jacqueline Garonzik-Wang, Richard C. Lindrooth, Josef Coresh, Madeleine M. Waldram, Dorry L. Segev, Mohamud A. Qadi, Jon J. Snyder, Abimereki D. Muzaale, Deidra C. Crews, Allan B. Massie, Macey L. Henderson, Fawaz Al Ammary, Alexander C. Wiseman, Xun Luo, and Daniel C. Brennan
- Subjects
Male ,Risk ,medicine.medical_specialty ,Epidemiology ,030204 cardiovascular system & hematology ,030230 surgery ,Kidney ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Internal medicine ,Living Donors ,Medicine ,Humans ,Systole ,Aged ,Aged, 80 and over ,Transplantation ,business.industry ,Hazard ratio ,Absolute risk reduction ,Editorials ,Original Articles ,Middle Aged ,Kidney Transplantation ,Confidence interval ,Blood pressure ,Nephrology ,Master file ,Cohort ,Hypertension ,Kidney Failure, Chronic ,Female ,business - Abstract
Background and objectives Hypertension in older kidney donor candidates is viewed as safe. However, hypertension guidelines have evolved and long-term outcomes have not been explored. We sought to quantify the 15-year risk of ESKD and mortality in older donors (≥50 years old) with versus those without hypertension. Design, setting, participants, & measurements A United States cohort of 24,533 older donors from 1999 to 2016, including 2265 with predonation hypertension, were linked to Centers for Medicare and Medicaid Services data and the Social Security Death Master File to ascertain ESKD development and mortality. The exposure of interest was predonation hypertension. From 2004 to 2016, hypertension was defined as documented predonation use of antihypertensive therapy, regardless of systolic BP or diastolic BP; from 1999 to 2003, when there was no documentation of antihypertensive therapy, hypertension was defined as predonation systolic BP ≥140 or diastolic BP ≥90 mm Hg. Results Older donors were 82% white, 6% black, 7% Hispanic, and 3% Asian. The median follow-up was 7.1 years (interquartile range, 3.4–11.1; maximum, 18). There were 24 ESKD and 252 death events during the study period. The 15-year risk of ESKD was 0.8% (95% confidence interval [95% CI], 0.4 to 1.6) for donors with hypertension (mean systolic BP, 138 mm Hg) versus 0.2% (95% CI, 0.1 to 0.4) for donors without hypertension (mean systolic BP, 123 mm Hg; adjusted hazard ratio, 3.04; 95% CI, 1.28 to 7.22; P=0.01). When predonation antihypertensive therapy was available, the risk of ESKD was 6.21-fold higher (95% CI, 1.20 to 32.17; P=0.03) for donors using antihypertensive therapy (mean systolic BP, 132 mm Hg) versus those not using antihypertensive therapy (mean systolic BP, 124 mm Hg). There was no significant association between donor hypertension and 15-year mortality (hazard ratio, 1.18; 95% CI, 0.84 to 1.66; P=0.34). Conclusions Compared with older donors without hypertension, older donors with hypertension had higher risk of ESKD, but not mortality, for 15 years postdonation. However, the absolute risk of ESKD was small.
- Published
- 2018
38. Approach to the Assessment and Management of Adult Patients With Atopic Dermatitis: A Consensus Document
- Author
-
Yves Poulin, Ian Landells, Jensen Yeung, Marni C. Wiseman, C Lynde, Gurbir Dhadwal, Irina Turchin, Robert Gniadecki, Chih-Ho Hong, Robert Bissonnette, Parbeer Grewal, Perla Lansang, Mark G. Kirchhof, Lorne Albrecht, Kim A. Papp, Gordon Sussman, and Melinda Gooderham
- Subjects
Adult ,medicine.medical_specialty ,Consensus ,Adult patients ,business.industry ,Inflammatory skin disease ,Inflammation ,Dermatology ,Atopic dermatitis ,medicine.disease ,Pathophysiology ,Dermatitis, Atopic ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,medicine ,Humans ,Surgery ,medicine.symptom ,business ,Adult atopic dermatitis - Abstract
Background: Atopic dermatitis (AD) is a chronic, relapsing, and remitting inflammatory skin disease with complex pathophysiology, primarily driven by type 2 inflammation. Existing guidelines often do not reflect all current therapeutic options and guidance on the practical management of patients with AD is lacking. Objectives: To develop practical, up-to-date guidance on the assessment and management of adult patients with AD. Methods: An expert panel of 17 Canadian experts, including 16 dermatologists and 1 allergist, with extensive clinical experience managing moderate-to-severe AD reviewed the available literature from the past 5 years using a defined list of key search terms. This literature, along with clinical expertise and opinion, was used to draft concise, clinically relevant reviews of the current literature. Based on these reviews, experts developed and voted on recommendations and statements to reflect the practical management of adult patients with AD as a guide for health care providers in Canada and across the globe, using a prespecified agreement cutoff of 75%. Results: Eleven consensus statements were approved by the expert panel and reflected 4 key domains: pathophysiology, assessment, comorbidities, and treatment. Conclusions: These statements aim to provide a framework for the assessment and management of adult patients with AD and to guide health care providers in practically relevant aspects of patient management.
- Published
- 2018
39. Simultaneous Liver-Kidney Transplant: Long-Term Management (Steroid Withdrawal and Safety Net Patients)
- Author
-
Alexander C. Wiseman
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Safety net ,Long term management ,Simultaneous liver kidney ,MEDLINE ,Urology ,Medicine ,Reviews ,business ,Steroid withdrawal - Published
- 2018
40. Protecting the Kidney in Liver Transplant Recipients: Practicee-Based Recommendations From the American Society of Transplantation Liver and Intestine Community of Practice
- Author
-
Jacqueline G. O'Leary, Pratima Sharma, Claus U. Niemann, Sumeet K. Asrani, Alexander C. Wiseman, Josh Levitsky, and John J. Fung
- Subjects
Nephrology ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Renal function ,030230 surgery ,Liver transplantation ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Internal medicine ,medicine ,Immunology and Allergy ,Pharmacology (medical) ,Intensive care medicine ,education ,Transplantation ,Kidney ,education.field_of_study ,business.industry ,medicine.disease ,medicine.anatomical_structure ,030211 gastroenterology & hepatology ,business ,Kidney disease - Abstract
Both acute and chronic kidney disease are common after liver transplantation and result in significant morbidity and mortality. The introduction of the Model for End-stage Liver Disease score has directly correlated with an increased prevalence of perioperative renal dysfunction and the number of simultaneous liver-kidney transplantations performed. Kidney dysfunction in this population is typically multifactorial and related to preexisting conditions, pretransplantation renal injury, perioperative events, and posttransplantation nephrotoxic immunosuppressive therapies. The management of kidney disease after liver transplantation is challenging, as by the time the serum creatinine level is significantly elevated, few interventions affect the course of progression. Also, immunological factors such as antibody-mediated kidney rejection have become of greater interest given the rising liver-kidney transplant population. Therefore, this review, assembled by experts in the field and endorsed by the American Society of Transplantation Liver and Intestine Community of Practice, provides a critical assessment of measures of renal function and interventions aimed at preserving renal function early and late after liver and simultaneous liver-kidney transplantation. Key points and practice-based recommendations for the prevention and management of kidney injury in this population are provided to offer guidance for clinicians and identify gaps in knowledge for future investigations.
- Published
- 2016
41. Predicting renal recovery after liver transplant with severe pretransplant subacute kidney injury: The impact of warm ischemia time
- Author
-
Hugo R. Rosen, Kenneth W. Hung, Alexander C. Wiseman, Nathan Schomaker, Linda Jennings, Jane Gralla, Scott W. Biggins, Trevor L. Nydam, Sumeet K. Asrani, and Heather L. Laskey
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Urology ,Renal function ,030230 surgery ,Liver transplantation ,Kidney ,Kidney Function Tests ,urologic and male genital diseases ,Severity of Illness Index ,End Stage Liver Disease ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,Warm Ischemia ,Renal replacement therapy ,Retrospective Studies ,Transplantation ,Creatinine ,Hepatology ,business.industry ,Acute kidney injury ,Recovery of Function ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,Liver Transplantation ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,chemistry ,Practice Guidelines as Topic ,Female ,030211 gastroenterology & hepatology ,business ,Kidney disease - Abstract
Identifying which liver transplantation (LT) candidates with severe kidney injury will have a full recovery of renal function after liver transplantation alone (LTA) is difficult. Avoiding unnecessary simultaneous liver-kidney transplantation (SLKT) can optimize the use of scarce kidney grafts. Incorrect predictions of spontaneous renal recovery after LTA can lead to increased morbidity and mortality. We retrospectively analyzed all LTA patients at our institution from February 2002 to February 2013 (n = 583) and identified a cohort with severe subacute renal injury (n = 40; creatinine
- Published
- 2016
42. APOL1 Polymorphisms in a Deceased Donor and Early Presentation of Collapsing Glomerulopathy and Focal Segmental Glomerulosclerosis in Two Recipients
- Author
-
Alexander C. Wiseman, C. P. Larsen, James E. Cooper, C. Boils, M. S. Lucia, and Pratik B. Shah
- Subjects
Transplantation ,medicine.medical_specialty ,business.industry ,Donor selection ,030232 urology & nephrology ,Glomerulosclerosis ,Renal function ,Disease ,030230 surgery ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Focal segmental glomerulosclerosis ,Internal medicine ,medicine ,Immunology and Allergy ,Pharmacology (medical) ,Risk factor ,business ,Kidney transplantation ,Kidney disease - Abstract
Two common polymorphisms in APOL1 (G1 and G2) are conserved in persons of African ancestry, and the presence of two polymorphisms (commonly referred to as risk variants) has been identified as a risk factor for chronic kidney disease and focal seg-mental glomerulosclerosis. In kidney transplantation, deceased donors with two APOL1 risk variants carry an increased risk of renal allograft failure in the recipient. An emerging question is whether these data should influence deceased donor assessment or be used to refine prediction of allograft survival. We present the first detailed report of two cases of recipient glomerular disease in the first year following transplant from a deceased donor later defined as carrying two APOL1 risk variants. A possible "second hit" predisposing to renal disease in these recipients is discussed, one with active cytomegalovirus infection concurrent with collapsing glomerulopathy and renal failure and the other with chronic, slowly healing wound infection and focal segmental glomeru-losclerosis but stable renal function. In retrospect, awareness of the donor APOL1 risk alleles would not have influenced donor selection and ultimately did not influence posttransplant management. These case reports inform further discussion of the value of APOL1 testing for deceased donors.
- Published
- 2016
43. Roflumilast Cream (ARQ-151) 0.15% and 0.3% Improved Burden of Signs and Symptoms in Adults With Chronic Plaque Psoriasis in a Phase 2b Study
- Author
-
Robert C. Higham, Howard Welgus, Melinda Gooderham, Marni C. Wiseman, Stephen K. Tyring, Kathleen Smith, Laura K. Ferris, Zoe Draelos, David R. Berk, Lorne Albrecht, Lynn Navale, Leon H Kircik, Kim Papp, Steven Kempers, Mark Lebwohl, and Linda Stein Gold
- Subjects
Plaque psoriasis ,medicine.medical_specialty ,business.industry ,Psoriasis ,medicine ,Signs and symptoms ,medicine.disease ,business ,Dermatology ,Roflumilast ,medicine.drug - Abstract
not available.
- Published
- 2020
44. Bandages will not fix a fractured system of chronic kidney disease care: Why the Dialysis PATIENTS Demonstration Act cannot be supported by the transplant community
- Author
-
Alexander C. Wiseman and John S. Gill
- Subjects
Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,030232 urology & nephrology ,030230 surgery ,Dialysis patients ,medicine.disease ,Bandages ,Law legislation ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,medicine ,Immunology and Allergy ,Humans ,Kidney Failure, Chronic ,Pharmacology (medical) ,Renal Insufficiency, Chronic ,business ,Intensive care medicine ,Dialysis ,Kidney disease - Published
- 2018
45. Defining kidney allograft benefit from successful pancreas transplant: separating fact from fiction
- Author
-
Alexander C. Wiseman, Erik Stites, and Peter T. Kennealey
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,Urology ,030230 surgery ,Pancreas transplantation ,Diabetic nephropathy ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Immunology and Allergy ,Medicine ,Humans ,Transplantation, Homologous ,Clinical significance ,Diabetic Nephropathies ,Kidney transplantation ,Transplantation ,Kidney ,business.industry ,Graft Survival ,medicine.disease ,Prognosis ,Kidney Transplantation ,surgical procedures, operative ,medicine.anatomical_structure ,Diabetes Mellitus, Type 1 ,Pancreas Transplantation ,business ,Pancreas - Abstract
Purpose of review To define the natural history of kidney allograft loss related to recurrent diabetes following transplant, and to understand the potential benefit of pancreas transplantation upon kidney allograft survival. Recent findings A postulated benefit of simultaneous pancreas kidney transplant is that, unlike kidney transplant alone, euglycemia from the added pancreas allograft may confer a nephroprotective benefit and prevent recurrent diabetic nephropathy in the renal allograft. Recent large database analyses and long-term histological assessments have been published that assist in quantifying the problem of recurrent diabetic nephropathy and answering the question of the potential benefits of euglycemia. Further data may be extrapolated from larger single-center series that follow the prognosis of early posttransplant diabetes mellitus as another barometer of risk from diabetic nephropathy and graft loss. Summary Recurrent diabetic nephropathy following kidney transplant is a relatively rare, late occurrence and its clinical significance is significantly diminished by the competing risks of death and chronic alloimmune injury. Although there are hints of a protective effect upon kidney graft survival with pancreas transplant, these improvements are small and may take decades to appreciate. Clinical decision-making regarding pancreas transplant solely based upon nephroprotective effects of the kidney allograft should be avoided.
- Published
- 2018
46. Lower Tacrolimus Exposure and Time in Therapeutic Range Increase the Risk of De Novo Donor-Specific Antibodies in the First Year of Kidney Transplantation
- Author
-
Scott Davis, Suhong Tong, Brian M. Freed, Patrick Klem, Gina Wedermyer, Alexander C. Wiseman, James E. Cooper, and Jane Gralla
- Subjects
Graft Rejection ,Male ,medicine.medical_specialty ,Adverse outcomes ,medicine.medical_treatment ,Urology ,Time in therapeutic range ,030204 cardiovascular system & hematology ,030230 surgery ,Kidney Function Tests ,Article ,Tacrolimus ,03 medical and health sciences ,0302 clinical medicine ,Therapeutic index ,Postoperative Complications ,HLA Antigens ,Isoantibodies ,Risk Factors ,Immunology and Allergy ,Medicine ,Humans ,Pharmacology (medical) ,Kidney transplantation ,Retrospective Studies ,Transplantation ,business.industry ,Donor specific antibodies ,Graft Survival ,Immunosuppression ,Middle Aged ,medicine.disease ,Prognosis ,Kidney Transplantation ,Tissue Donors ,Surgery ,Survival Rate ,Cohort ,Kidney Failure, Chronic ,Female ,business ,Immunosuppressive Agents ,Follow-Up Studies ,Glomerular Filtration Rate - Abstract
De novo donor-specific antibodies (dnDSA) have been associated with reduced graft survival. Tacrolimus (TAC)-based regimens are the most common immunosuppression used in in clinical practice today, yet an optimal therapeutic dose to prevent dnDSA has not been established. We evaluated mean TAC C0 and TAC time in therapeutic range for the risk of dnDSA in a cohort of 538 patients in the first year of kidney transplant. A mean TAC C0 < 8 ng/ml was associated with dnDSA by 6 months (OR 2.51, 95% CI 1.32-4.79, p=0.005) and by 12 months (OR 2.32, 95% CI 1.30-4.15, p=0.004) and there was a graded increase in risk with lower mean TAC C0. TAC time in therapeutic range of < 60% was associated with dnDSA (OR 2.05, 95% CI 1.28-3.30, p=0.003) and acute rejection (HR 4.18, 95% CI 2.31-7.58, p
- Published
- 2017
47. Live donor kidney - PAK versus SPK: how to decide?
- Author
-
Alexander C. Wiseman and Erik Stites
- Subjects
Male ,medicine.medical_specialty ,Live donor ,030232 urology & nephrology ,030230 surgery ,End stage renal disease ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Living Donors ,Immunology and Allergy ,Medicine ,Humans ,Intensive care medicine ,Survival analysis ,Transplantation ,Type 1 diabetes ,Kidney ,business.industry ,Graft Survival ,medicine.disease ,Kidney Transplantation ,Survival Analysis ,surgical procedures, operative ,medicine.anatomical_structure ,Diabetes Mellitus, Type 1 ,Relative risk ,Graft survival ,Female ,Pancreas Transplantation ,business - Abstract
Purpose of review Patients with type 1 diabetes and end stage renal disease face a complex choice when considering the relative risks and benefits of kidney transplant alone with or without subsequent pancreas after kidney transplant (PAK) or simultaneous kidney pancreas transplant (SPK). Recent findings SPK is considered the optimal treatment regarding long-term patient survival, but when also faced with the option of living donor kidney transplant with the potential for PAK later, the ideal option is less clear. Summary This review summarizes the current literature regarding SPK, living donor kidney transplant alone, and PAK transplant outcomes and examines the relative risks of pre- and posttransplant variables that impact patient and graft survival to help inform this complex treatment decision.
- Published
- 2017
48. A Consensus on Acne Management Focused on Specific Patient Features
- Author
-
Jack Toole, Jerry Tan, Ronald Vender, Catherine Zip, Chih-Ho Hong, Martin Gilbert, Richard Thomas, Charles Lynde, Marni C. Wiseman, Maha Dutil, Shannon Humphrey, Anneke Andriessen, Linda Rochette, and Benjamin Barankin
- Subjects
Adult ,Male ,Canada ,medicine.medical_specialty ,Consensus ,Adolescent ,Treatment adherence ,Alternative medicine ,Dermatology ,Skin sensitivity ,Young Adult ,Sex Factors ,Quality of life (healthcare) ,Pregnancy ,Acne Vulgaris ,medicine ,Humans ,Clinical severity ,Intensive care medicine ,Acne ,Prior treatment ,business.industry ,Patient Selection ,Age Factors ,Disease Management ,medicine.disease ,Pregnancy Complications ,Treatment Outcome ,Quality of Life ,Physical therapy ,Female ,Surgery ,Dermatologic Agents ,business ,Psychosocial - Abstract
Background: Most treatment guidelines for acne are based on clinical severity. Our objective was to expand that approach to one that also comprised individualized patient features: a case-based approach. Methods: An expert panel of Canadian dermatologists was established to develop demographic and clinical features considered to be particularly important in acne treatment selection. A nominal group consensus process was used for inclusion of features and corresponding appropriate treatments. Results: Consensus was achieved on the following statements: follicular epithelial dysfunction contributes to acne pathogenesis; inflammation from underlying disease(s) or prior treatment may impact further patient management; management focusing on specific patient features and on addressing psychosocial factors, including impact on quality of life, may improve treatment adherence and outcomes; and case-based scenarios are a practical approach to illustrate the effect of these factors. To address the latter, eight case profiles were developed. Conclusions: Management of acne should be based on multifactorial considerations beyond clinically determined acne severity and should include patient-reported impact, gender, skin sensitivity (including preexisting dermatoses), and phototype.
- Published
- 2014
49. Case Report of Patient With Erythropoietic Protoporphyria and Basal Cell Carcinoma Diagnoses
- Author
-
Marni C. Wiseman, Brent Schacter, and Shayne D. Reitmeier
- Subjects
Adult ,Male ,Pathology ,medicine.medical_specialty ,Skin Neoplasms ,Protoporphyria, Erythropoietic ,Dermatology ,Nose ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,medicine ,Humans ,Basal cell carcinoma ,030212 general & internal medicine ,skin and connective tissue diseases ,integumentary system ,business.industry ,medicine.disease ,Porphyria ,Carcinoma, Basal Cell ,Surgery ,Erythropoietic protoporphyria ,Skin cancer ,business - Abstract
Background: Basal cell carcinoma (BCC) is the most common nonmelanoma skin cancer. There is a clear association between BCC development and ultraviolet (UV) radiation. Erythropoietic protoporphyria (EPP) is an inherited porphyria disorder that is a result of protoporphyrin accumulation, typically manifesting with phototoxicity. Case Summary: We report a case of a 24 year-old man with both EPP and BCC diagnoses. At the age of 4 years, the patient was diagnosed with EPP. The patient presented with a BCC on his nose at age 24 years, despite sun avoidance as the primary treatment for his EPP diagnosis. Conclusion: Consider the diagnosis of BCC in a patient with EPP, despite sun avoidance.
- Published
- 2016
50. Wound events in kidney transplant patients receiving de novo everolimus: a pooled analysis of three randomized controlled trials
- Author
-
Kevin McCague, Y. Kim, Matthew Cooper, Bjoern Nashan, Gazi B. Zibari, Alexander C. Wiseman, and F Geissler
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Urology ,Kidney Function Tests ,Mycophenolic acid ,law.invention ,Lymphocele ,Randomized controlled trial ,Risk Factors ,law ,Humans ,Medicine ,Everolimus ,Prospective Studies ,Adverse effect ,Kidney transplantation ,Randomized Controlled Trials as Topic ,Retrospective Studies ,Sirolimus ,Wound Healing ,Transplantation ,business.industry ,Incidence (epidemiology) ,Graft Survival ,Middle Aged ,Mycophenolic Acid ,Prognosis ,medicine.disease ,Kidney Transplantation ,Surgery ,Cyclosporine ,Female ,business ,Wound healing ,Immunosuppressive Agents ,Follow-Up Studies ,Glomerular Filtration Rate ,medicine.drug - Abstract
Data were pooled from three prospective, multicenter trials in which 1996 de novo kidney transplant recipients were randomized to everolimus 1.5 or 3.0 mg or mycophenolic acid (MPA), with cyclosporine and steroids. Wound healing complications reported as adverse events were retrospectively reviewed in a blinded manner. The incidence of wound healing adverse events was 17.6% (351 of 1996) by day 90 and was similar for everolimus 1.5 mg (16.6% [110 of 661]) vs. MPA (14.3% [95 of 665]) (p = 0.255), but higher with everolimus 3.0 mg (21.8% [146 of 670]) (p0.001 vs. MPA). Similar results were observed for wound healing complications reported as serious adverse events. The 12-month incidence of lymphocele was 11.2% with everolimus 1.5 mg and 8.9% with MPA (p = 0.171), but lymphocele reported as a serious adverse event were more frequent with everolimus 1.5 mg (6.5% vs. 3.5%; p = 0.012). The hazard ratio (HR) for any wound healing complication vs. MPA was not significantly higher for everolimus3 ng/mL (HR 1.33; 95% CI 0.94-1.88; p = 0.104), but increased to 1.46 (95% CI 1.12-1.90; p = 0.005) for 3-8 ng/mL and 1.69 (95% CI 1.20-2.38; p = 0.002) for8 ng/mL. These results suggest that de novo kidney transplant patients receiving an initial everolimus dose of 1.5 mg do not appear to have a pronounced increased risk of wound healing complications vs. patients receiving MPA.
- Published
- 2013
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