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202. Toward Establishing Core Outcome Domains For Trials in Kidney Transplantation: Report of the Standardized Outcomes in Nephrology-Kidney Transplantation Consensus Workshops.

Author

Tong, Allison, Tong, Allison, Gill, John, Budde, Klemens, Marson, Lorna, Reese, Peter P, Rosenbloom, David, Rostaing, Lionel, Wong, Germaine, Josephson, Michelle A, Pruett, Timothy L, Warrens, Anthony N, Craig, Jonathan C, Sautenet, Benedicte, Evangelidis, Nicole, Ralph, Angelique F, Hanson, Camilla S, Shen, Jenny I, Howard, Kirsten, Meyer, Klemens, Perrone, Ronald D, Weiner, Daniel E, Fung, Samuel, Ma, Maggie KM, Rose, Caren, Ryan, Jessica, Chen, Ling-Xin, Howell, Martin, Larkins, Nicholas, Kim, Siah, Thangaraju, Sobhana, Ju, Angela, Chapman, Jeremy R, SONG-Tx Investigators, Tong, Allison, Tong, Allison, Gill, John, Budde, Klemens, Marson, Lorna, Reese, Peter P, Rosenbloom, David, Rostaing, Lionel, Wong, Germaine, Josephson, Michelle A, Pruett, Timothy L, Warrens, Anthony N, Craig, Jonathan C, Sautenet, Benedicte, Evangelidis, Nicole, Ralph, Angelique F, Hanson, Camilla S, Shen, Jenny I, Howard, Kirsten, Meyer, Klemens, Perrone, Ronald D, Weiner, Daniel E, Fung, Samuel, Ma, Maggie KM, Rose, Caren, Ryan, Jessica, Chen, Ling-Xin, Howell, Martin, Larkins, Nicholas, Kim, Siah, Thangaraju, Sobhana, Ju, Angela, Chapman, Jeremy R, and SONG-Tx Investigators

Abstract

BackgroundTreatment decisions in kidney transplantation requires patients and clinicians to weigh the benefits and harms of a broad range of medical and surgical interventions, but the heterogeneity and lack of patient-relevant outcomes across trials in transplantation makes these trade-offs uncertain, thus, the need for a core outcome set that reflects stakeholder priorities.MethodsWe convened 2 international Standardized Outcomes in Nephrology-Kidney Transplantation stakeholder consensus workshops in Boston (17 patients/caregivers; 52 health professionals) and Hong Kong (10 patients/caregivers; 45 health professionals). In facilitated breakout groups, participants discussed the development and implementation of core outcome domains for trials in kidney transplantation.ResultsSeven themes were identified. Reinforcing the paramount importance of graft outcomes encompassed the prevailing dread of dialysis, distilling the meaning of graft function, and acknowledging the terrifying and ambiguous terminology of rejection. Reflecting critical trade-offs between graft health and medical comorbidities was fundamental. Contextualizing mortality explained discrepancies in the prioritization of death among stakeholders-inevitability of death (patients), preventing premature death (clinicians), and ensuring safety (regulators). Imperative to capture patient-reported outcomes was driven by making explicit patient priorities, fulfilling regulatory requirements, and addressing life participation. Specificity to transplant; feasibility and pragmatism (long-term impacts and responsiveness to interventions); and recognizing gradients of severity within outcome domains were raised as considerations.ConclusionsStakeholders support the inclusion of graft health, mortality, cardiovascular disease, infection, cancer, and patient-reported outcomes (ie, life participation) in a core outcomes set. Addressing ambiguous terminology and feasibility is needed in establishing these core outcome

Published
2017

203. Developing Consensus-Based Priority Outcome Domains for Trials in Kidney Transplantation: A Multinational Delphi Survey With Patients, Caregivers, and Health Professionals.

Author

Sautenet, Bénédicte, Sautenet, Bénédicte, Tong, Allison, Manera, Karine E, Chapman, Jeremy R, Warrens, Anthony N, Rosenbloom, David, Wong, Germaine, Gill, John, Budde, Klemens, Rostaing, Lionel, Marson, Lorna, Josephson, Michelle A, Reese, Peter P, Pruett, Timothy L, Hanson, Camilla S, O'Donoghue, Donal, Tam-Tham, Helen, Halimi, Jean-Michel, Shen, Jenny I, Kanellis, John, Scandling, John D, Howard, Kirsten, Howell, Martin, Cross, Nick, Evangelidis, Nicole, Masson, Philip, Oberbauer, Rainer, Fung, Samuel, Jesudason, Shilpa, Knight, Simon, Mandayam, Sreedhar, McDonald, Stephen P, Chadban, Steve, Rajan, Tasleem, Craig, Jonathan C, Sautenet, Bénédicte, Sautenet, Bénédicte, Tong, Allison, Manera, Karine E, Chapman, Jeremy R, Warrens, Anthony N, Rosenbloom, David, Wong, Germaine, Gill, John, Budde, Klemens, Rostaing, Lionel, Marson, Lorna, Josephson, Michelle A, Reese, Peter P, Pruett, Timothy L, Hanson, Camilla S, O'Donoghue, Donal, Tam-Tham, Helen, Halimi, Jean-Michel, Shen, Jenny I, Kanellis, John, Scandling, John D, Howard, Kirsten, Howell, Martin, Cross, Nick, Evangelidis, Nicole, Masson, Philip, Oberbauer, Rainer, Fung, Samuel, Jesudason, Shilpa, Knight, Simon, Mandayam, Sreedhar, McDonald, Stephen P, Chadban, Steve, Rajan, Tasleem, and Craig, Jonathan C

Abstract

BackgroundInconsistencies in outcome reporting and frequent omission of patient-centered outcomes can diminish the value of trials in treatment decision making. We identified critically important outcome domains in kidney transplantation based on the shared priorities of patients/caregivers and health professionals.MethodsIn a 3-round Delphi survey, patients/caregivers and health professionals rated the importance of outcome domains for trials in kidney transplantation on a 9-point Likert scale and provided comments. During rounds 2 and 3, participants rerated the outcomes after reviewing their own score, the distribution of the respondents' scores, and comments. We calculated the median, mean, and proportion rating 7 to 9 (critically important), and analyzed comments thematically.ResultsOne thousand eighteen participants (461 [45%] patients/caregivers and 557 [55%] health professionals) from 79 countries completed round 1, and 779 (77%) completed round 3. The top 8 outcomes that met the consensus criteria in round 3 (mean, ≥7.5; median, ≥8; proportion, >85%) in both groups were graft loss, graft function, chronic rejection, acute rejection, mortality, infection, cancer (excluding skin), and cardiovascular disease. Compared with health professionals, patients/caregivers gave higher priority to 6 outcomes (mean difference of 0.5 or more): skin cancer, surgical complications, cognition, blood pressure, depression, and ability to work. We identified 5 themes: capacity to control and inevitability, personal relevance, debilitating repercussions, gaining awareness of risks, and addressing knowledge gaps.ConclusionsGraft complications and severe comorbidities were critically important for both stakeholder groups. These stakeholder-prioritized outcomes will inform the core outcome set to improve the consistency and relevance of trials in kidney transplantation.

Published
2017

204. Risk Factors for Developing Post-Transplant Malignancy in Children Who Receive a Kidney Transplant: Analysis of 1,055 Kidney Transplants between 1963 and 2015 at a Single Institution

Author

Serrano, Oscar K., primary, Bangdiwala, Ananta, additional, Vock, David, additional, Dunn, Ty B., additional, Chinnakotla, Srinath, additional, Finger, Erik, additional, Kandaswamy, Raja, additional, Pruett, Timothy L., additional, Matas, Arthur J., additional, and Chavers, Blanche, additional

Published
2016
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205. Microbial Contamination of Transplant Solutions during Islet Autotransplants Is Not Associated with Clinical Infection in a Pediatric Population

Author

Berger, Megan G., primary, Wilhelm, Joshua, additional, Bellin, Melena, additional, Schwarzenberg, Sarah J., additional, Dunn, Ty B., additional, Beilman, Greg, additional, Pruett, Timothy L., additional, Freeman, Martin, additional, Sutherland, David E., additional, and Chinnakotla, Srinath, additional

Published
2016
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206. Risk Factors for Developing Adult Cardiovascular Disease in Children Who Received a Kidney Transplant: Analysis of 1,055 Kidney Transplants between 1963-2015 at a Single Institution

Author

Serrano, Oscar K., primary, Bangdiwala, Ananta, additional, Vock, David, additional, Dunn, Ty B., additional, Chinnakotla, Srinath, additional, Finger, Erik, additional, Kandaswamy, Raja, additional, Pruett, Timothy L., additional, Matas, Arthur J., additional, and Chavers, Blanche, additional

Published
2016
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209. Total Pancreatectomy With Islet Autotransplantation Improves Quality of Life in Patients With Refractory Recurrent Acute Pancreatitis

Author

Bellin, Melena D., primary, Kerdsirichairat, Tossapol, additional, Beilman, Gregory J., additional, Dunn, Ty B., additional, Chinnakotla, Srinath, additional, Pruett, Timothy L., additional, Radosevich, David R., additional, Schwarzenberg, Sarah J., additional, Sutherland, David E.R., additional, Arain, Mustafa A., additional, and Freeman, Martin L., additional

Published
2016
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212. Microbial contamination of transplant solutions during pancreatic islet autotransplants is not associated with clinical infection in a pediatric population

Author

Berger, Megan G., primary, Majumder, Kaustav, additional, Hodges, James S., additional, Bellin, Melena D., additional, Schwarzenberg, Sarah Jane, additional, Gupta, Sameer, additional, Dunn, Ty B., additional, Beilman, Gregory J., additional, Pruett, Timothy L., additional, Freeman, Martin L., additional, Wilhelm, Joshua J., additional, Sutherland, David E.R., additional, and Chinnakotla, Srinath, additional

Published
2016
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213. Long-term Outcomes for Living Pancreas Donors in the Modern Era

Author

Kirchner, Varvara A., primary, Finger, Erik B., additional, Bellin, Melena D., additional, Dunn, Ty B., additional, Gruessner, Rainer W.G., additional, Hering, Bernhard J., additional, Humar, Abhinav, additional, Kukla, Aleksandra K., additional, Matas, Arthur J., additional, Pruett, Timothy L., additional, Sutherland, David E.R., additional, and Kandaswamy, Raja, additional

Published
2016
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214. Evolution of Living Donor Nephrectomy at a Single Center

Author

Serrano, Oscar Kenneth, primary, Kirchner, Varvara, additional, Bangdiwala, Ananta, additional, Vock, David M., additional, Dunn, Ty B., additional, Finger, Erik B., additional, Payne, William D., additional, Pruett, Timothy L., additional, Sutherland, David E. R., additional, Najarian, John S., additional, Matas, Arthur J., additional, and Kandaswamy, Raja, additional

Published
2016
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216. Standardized Outcomes in Nephrology-Transplantation: A Global Initiative to Develop a Core Outcome Set for Trials in Kidney Transplantation

Author

Tong, Allison, primary, Budde, Klemens, additional, Gill, John, additional, Josephson, Michelle A., additional, Marson, Lorna, additional, Pruett, Timothy L., additional, Reese, Peter P., additional, Rosenbloom, David, additional, Rostaing, Lionel, additional, Warrens, Anthony N., additional, Wong, Germaine, additional, Craig, Jonathan C., additional, Crowe, Sally, additional, Harris, Tess, additional, Hemmelgarn, Brenda, additional, Manns, Braden, additional, Tugwell, Peter, additional, Van Biesen, Wim, additional, Wheeler, David C., additional, Winkelmayer, Wolfgang C., additional, Evangelidis, Nicole, additional, Sautenet, Benedicte, additional, Howell, Martin, additional, and Chapman, Jeremy R., additional

Published
2016
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218. Tu1455 Comparable Rate of Long Term Insulin Independence between Adult Patients Undergoing Remote and Local TPIAT

Author

Kesseli, Samuel, primary, Wagar, Matthew, additional, Jung, Min Kyu, additional, Smith, Kerrington, additional, Lin, Yu, additional, Walsh, R Matthew, additional, Hatipoglu, Betul, additional, Freeman, Martin L., additional, Pruett, Timothy L., additional, Beilman, Gregory, additional, Sutherland, David, additional, Dunn, Ty, additional, Axelrod, David A., additional, Chaidarun, Sushela, additional, Stevens, Tyler, additional, Bellin, Melena, additional, and Gardner, Timothy, additional

Published
2016
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220. Implications of excess weight on kidney donation: Long-term consequences of donor nephrectomy in obese donors.

Author

Serrano, Oscar K., Sengupta, Bodhisatwa, Bangdiwala, Ananta, Vock, David M., Dunn, Ty B., Finger, Erik B., Pruett, Timothy L., Matas, Arthur J., and Kandaswamy, Raja

Abstract

Background An elevated body mass index (>30 kg/m2) has been a relative contraindication for living kidney donation; however, such donors have become more common. Given the association between obesity and development of diabetes, hypertension, and end-stage renal disease, there is concern about the long-term health of obese donors. Methods Donor and recipient demographics, intraoperative parameters, complications, and short- and long-term outcomes were compared between contemporaneous donors—obese donors (body mass index ≥30 kg/m2) versus nonobese donors (body mass index <30 kg/m2). Results Between the years 1975 and 2014, we performed 3,752 donor nephrectomies; 656 (17.5%) were obese donors. On univariate analysis, obese donors were more likely to be older (P <.01) and African American (P <.01) and were less likely to be a smoker at the time of donation (P =.01). Estimated glomerular filtration rate at donation was higher in obese donors (115 ± 36 mL/min/1.73m2) versus nonobese donors (97 ± 22 mL/min/1.73m2; P <.001). There was no difference between groups in intraoperative and postoperative complications; but intraoperative time was longer for obese donors (adjusted P <.001). Adjusted postoperative length of stay (LOS) was longer (adjusted P =.01), but after adjustment for donation year, incision type, age, sex, and race, there were no differences in short-term (<30 days) and long-term (>30 days) readmissions. Estimated glomerular filtration rate and rates of end-stage renal disease were not significantly different between donor groups >20 years after donation (P =.71). However, long-term development of diabetes mellitus (adjusted hazard ratio (HR) 3.14; P <.001) and hypertension (adjusted hazard ratio (HR) 1.75; P <.001) was greater among obese donors and both occurred earlier (diabetes mellitus: 12 vs 18 years postnephrectomy; hypertension: 11 vs 15 years). Conclusion Obese donors develop diabetes mellitus and hypertension more frequently and earlier than nonobese donors after donation, raising concerns about increased rates of end-stage renal disease. [ABSTRACT FROM AUTHOR]

Published
2018
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224. A multicenter study of total pancreatectomy with islet autotransplantation (TPIAT): POST (Prospective Observational Study of TPIAT).

Author

Bellin, Melena D., Abu-El-Haija, Maisam, Morgan, Katherine, Adams, David, Beilman, Gregory J., Chinnakotla, Srinath, Conwell, Darwin L., Dunn, Ty B., Freeman, Martin L., Gardner, Timothy, Kirchner, Varvara A., Lara, Luis F., Long-Simpson, Leslie, Nathan, Jaimie D., Naziruddin, Bashoo, Nyman, John A., Pruett, Timothy L., Schwarzenberg, Sarah J., Singh, Vikesh K., and Smith, Kerrington

Abstract

Background/objectives Total pancreatectomy with islet autotransplantation (TPIAT) is considered for managing chronic pancreatitis in selected patients when medical and endoscopic interventions have not provided adequate relief from debilitating pain. Although more centers are performing TPIAT, we lack large, multi-center studies to guide decisions about selecting candidates for and timing of TPIAT. Methods Multiple centers across the United States (9 to date) performing TPIAT are prospectively enrolling patients undergoing TPIAT for chronic pancreatitis into the Prospective Observational Study of TPIAT (POST), a NIDDK funded study with a goal of accruing 450 TPIAT recipients. Baseline data include participant phenotype, pancreatitis history, and medical/psychological comorbidities from medical records, participant interview, and participant self-report (Medical Outcomes Survey Short Form-12, EQ-5D, andPROMIS inventories for pain interference, depression, and anxiety). Outcome measures are collected to at least 1 year after TPIAT, including the same participant questionnaires, visual analog pain scale, pain interference scores, opioid requirements, insulin requirements, islet graft function, and hemoglobin A1c. Health resource utilization data are collected for a cost-effectiveness analysis. Biorepository specimens including urine, serum/plasma, genetic material (saliva and blood), and pancreas tissue are collected for future study. Conclusions This ongoing multicenter research study will enroll and follow TPIAT recipients, aiming to evaluate patient selection and timing for TPIAT to optimize pain relief, quality of life, and diabetes outcomes, and to measure the procedure's cost-effectiveness. A biorepository is also established for future ancillary studies. [ABSTRACT FROM AUTHOR]

Published
2018
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225. A Study on the Effect of Patient Characteristics, Geographical Utilization, and Patient Outcomes for Total Pancreatectomy Alone and Total Pancreatectomy With Islet Autotransplantation in Patients With Pancreatitis in the United States

Author

Lara, Luis F., Bellin, Melena D., Ugbarugba, Emmanuel, Nathan, Jaimie D., Witkowski, Piotr, Wijkstrom, Martin, Steel, Jennifer L., Smith, Kerrington D., Singh, Vikesh K., Schwarzenberg, Sarah J., Pruett, Timothy L., Naziruddin, Bashoo, Long-Simpson, Leslie, Kirchner, Varvara A., Gardner, Timothy B., Freeman, Martin L., Dunn, Ty B., Chinnakotla, Srinath, Beilman, Gregory J., Adams, David B., Morgan, Katherine A., Abu-El-Haija, Maisam A., Ahmad, Syed, Posselt, Andrew M., Hughes, Michael G., and Conwell, Darwin L.

Abstract

Supplemental digital content is available in the text.

Published
2019
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227. Quality Metrics in Kidney Transplantation: Current Landscape, Trials and Tribulations, Lessons Learned, and a Call for Reform

Author

Schold, Jesse D., Patzer, Rachel E., Pruett, Timothy L., and Mohan, Sumit

Abstract

Quality metrics have a long history in the field of kidney transplantation. These metrics are highly visible, with significant ramifications to transplantation centers based on their use in regulatory review and other stakeholders. In this perspective, we review the history of quality metrics in this field, discuss the perceptions and empirical evidence evaluating the impact of metrics on care delivery, and summarize the current landscape of quality oversight. Based on the research findings and opinions of the transplantation community, we suggest that significant reforms are needed for the evaluation of quality in the field based on more appropriately aligning metrics with optimizing patient outcomes. Moreover, there are vast potential uses of the current data that should be emphasized in a learning environment rather than a highly punitive system. In our view, these reforms would enhance care delivery, improve patient care, and better align incentives for providers of care that treat transplantation patients.

Published
2019
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228. Influence of the procurement surgeon on transplanted abdominal organ outcomes: An SRTR analysis to evaluate regional organ procurement collaboration

Author

Serrano, Oscar K., Vock, David M., Snyder, Jon J., Chinnakotla, Srinath, Kandaswamy, Raja, Pruett, Timothy L., Matas, Arthur J., and Finger, Erik B.

Abstract

Single-center studies have demonstrated regional organ procurement collaboration to reduce travel redundancy and improve procurement efficiency. We studied deceased donor kidney, liver, and pancreas transplants performed in the United States between 2002 and 2014 using the Scientific Registry of Transplant Recipients (SRTR). We compared graft failure (GF), death-censored graft failure (DCGF), and patient death (PD) between organs procured by surgeons from the recipient’s center (transplant procurement team [TPT]) versus surgeons from a different center (NTPT). Primary nonfunction (PNF) was assessed for liver and kidney and delayed graft function (DGF) for kidney using mixed-effects logistic modeling. There were 64 906 liver (61.6% TPT), 118 152 kidney (26.1% TPT), 10 832 simultaneous pancreas kidney (SPK; 56.6% TPT), and 4378 solitary pancreas (SP; 34.0% TPT) transplants. When compared to NTPT, DCGF for organs procured by TPT was significantly less for liver (adjusted HR: 0.93; 95% CI: 0.88-0.98) and marginally significant for kidney (0.97; 0.93-1.00) and SPK (0.90; 0.82-1.00), and not significant for SP (0.98; 0.86 -1.11). DGF for TPT kidney was significantly lower (adjusted OR 0.91; 0.87-0.95). Albeit modest, our findings demonstrate a difference between locally procured organs and those procured by the implanting team. Elucidating the etiology of these differences will enhance regional organ procurement collaboration.

Published
2019
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229. Time for reform in transplant program–specific reporting: AST/ASTStransplant metrics taskforce

Author

Chandraker, Anil, Andreoni, Kenneth A., Gaston, Robert S., Gill, John, Locke, Jayme E., Mathur, Amit K., Norman, Douglas J., Patzer, Rachel E., Rana, Abbas, Ratner, Lloyd E., Schold, Jesse D., and Pruett, Timothy L.

Abstract

In accordance with the National Organ Transplant Act and Department of Health and Human Services’ Final Rule, the Scientific Registry of Transplant Recipients (SRTR) publicly releases biannual program‐specific reports that include analyses of transplant centers’ risk‐adjusted waitlist mortality, organ acceptance ratios, transplant rates, and graft and patient survival.Since the inception of these center metrics, 1‐year posttransplant graft and patient survival have improved, and center variation has decreased, casting uncertainty on their clinical relevance. The SRTRhas recently modified center evaluations by ranking centers into 5 tiers rather than 3 tiers in an attempt to discriminate between programs performing within a tight range, further exacerbating this uncertainty. The American Society of Transplantation/American Society of Transplant Surgeons convened an expert taskforce to examine both the utility and unintended consequences of transplant center metrics. Estimates of center variation in outcomes in adjacent tiers are imprecise and fleeting, but can result in consequential changes in clinician and center behavior. The taskforce has concerns that current metrics, based principally on 1‐year graft and patient survival, provide minimal if any benefit in informing patient choice and access to transplantation, with the untoward effect of decreased utilization of organs and restriction of research and innovation. The AST/ASTS Transplant Metrics Taskforce examines the relevance of current program‐specific reporting for kidney transplantation in the modern era.

Published
2019
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230. Time for reform in transplant program–specific reporting: AST/ASTS transplant metrics taskforce

Author

Chandraker, Anil, Andreoni, Kenneth A., Gaston, Robert S., Gill, John, Locke, Jayme E., Mathur, Amit K., Norman, Douglas J., Patzer, Rachel E., Rana, Abbas, Ratner, Lloyd E., Schold, Jesse D., and Pruett, Timothy L.

Abstract

In accordance with the National Organ Transplant Act and Department of Health and Human Services’ Final Rule, the Scientific Registry of Transplant Recipients (SRTR) publicly releases biannual program-specific reports that include analyses of transplant centers’ risk-adjusted waitlist mortality, organ acceptance ratios, transplant rates, and graft and patient survival. Since the inception of these center metrics, 1-year posttransplant graft and patient survival have improved, and center variation has decreased, casting uncertainty on their clinical relevance. The SRTR has recently modified center evaluations by ranking centers into 5 tiers rather than 3 tiers in an attempt to discriminate between programs performing within a tight range, further exacerbating this uncertainty. The American Society of Transplantation/American Society of Transplant Surgeons convened an expert taskforce to examine both the utility and unintended consequences of transplant center metrics. Estimates of center variation in outcomes in adjacent tiers are imprecise and fleeting, but can result in consequential changes in clinician and center behavior. The taskforce has concerns that current metrics, based principally on 1-year graft and patient survival, provide minimal if any benefit in informing patient choice and access to transplantation, with the untoward effect of decreased utilization of organs and restriction of research and innovation.

Published
2019
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232. Governing new technologies that stop biological time: Preparing for prolonged biopreservation of human organs in transplantation

Author

Pruett, Timothy L., Wolf, Susan M., McVan, Claire Colby, Lyon, Peter, Capron, Alexander M., Childress, James F., Evans, Barbara J., Finger, Erik B., Hyun, Insoo, Isasi, Rosario, Marchant, Gary E., Maynard, Andrew D., Oye, Kenneth A., Toner, Mehmet, Uygun, Korkut, and Bischof, John C.

Abstract

Time limits on organ viability from retrieval to implantation shape the US system for human organ transplantation. Preclinical research has demonstrated that emerging biopreservation technologies can prolong organ viability, perhaps indefinitely. These technologies could transform transplantation into a scheduled procedure without geographic or time constraints, permitting organ assessment and potential preconditioning of the recipients. However, the safety and efficacy of advanced biopreservation with prolonged storage of vascularized organs followed by reanimation will require new regulatory oversight, as clinicians and transplant centers are not trained in the engineering techniques involved or equipped to assess the manipulated organs. Although the Food and Drug Administration is best situated to provide that process oversight, the agency has until now declined to oversee organ quality and has excluded vascularized organs from the oversight framework of human cells, tissues, and cellular-based and tissue-based products. Integration of advanced biopreservation technologies will require new facilities for organ preservation, storage, and reanimation plus ethical guidance on immediate organ use versus preservation, national allocation, and governance of centralized organ banks. Realization of the long-term benefit of advanced biopreservation requires anticipation of the necessary legal and ethical oversight tools and that process should begin now.

Published
2024
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236. Diagnostic Performance of Contrast-Enhanced MRI With Secretin-Stimulated MRCP for Non-Calcific Chronic Pancreatitis: A Comparison With Histopathology

Author

Trikudanathan, Guru, primary, Walker, Sidney P, additional, Munigala, Satish, additional, Spilseth, Ben, additional, Malli, Ahmad, additional, Han, Yusheng, additional, Bellin, Melena, additional, Chinnakotla, Srinath, additional, Dunn, Ty, additional, Pruett, Timothy L, additional, Beilman, Gregory J, additional, Peralta, Jose Vega, additional, Arain, Mustafa A, additional, Amateau, Stuart K, additional, Schwarzenberg, Sarah J, additional, Mallery, Shawn, additional, Attam, Rajeev, additional, and Freeman, Martin L, additional

Published
2015
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237. Factors Predicting Outcomes After a Total Pancreatectomy and Islet Autotransplantation Lessons Learned From Over 500 Cases

Author

Chinnakotla, Srinath, primary, Beilman, Gregory J., additional, Dunn, Ty B., additional, Bellin, Melena D., additional, Freeman, Martin L., additional, Radosevich, David M., additional, Arain, Mustafa, additional, Amateau, Stuart K., additional, Mallery, J. Shawn, additional, Schwarzenberg, Sarah J., additional, Clavel, Alfred, additional, Wilhelm, Joshua, additional, Robertson, R. Paul, additional, Berry, Louise, additional, Cook, Marie, additional, Hering, Bernhard J., additional, Sutherland, David E.R., additional, and Pruett, Timothy L., additional

Published
2015
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240. Positive Sterility Cultures of Transplant Solutions during Pancreatic Islet Autotransplantation Are Associated Infrequently with Clinical Infection

Author

Colling, Kristin P., primary, Blondet, Juan J., additional, Balamurugan, A.N., additional, Wilhelm, Joshua J., additional, Dunn, Ty, additional, Pruett, Timothy L., additional, Sutherland, David E.R., additional, Chinnakotla, Srinath, additional, Bellin, Melena, additional, and Beilman, Greg J., additional

Published
2015
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241. 362 Endoscopic Management of Biliary Complications After Living Donor Liver Transplantation: A Single Center Experience

Author

Elwir, Saleh, primary, Thompson, Julie, additional, Amateau, Stuart K., additional, Attam, Rajeev, additional, Hassan, Mohamed, additional, Kandaswamy, Raja, additional, Pruett, Timothy L., additional, Lake, John R., additional, Chinnakotla, Srinath, additional, Freeman, Martin L., additional, and Arain, Mustafa A., additional

Published
2015
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243. The liver recipient with acute renal dysfunction: A single institution evaluation of the simultaneous liver‐kidney transplant candidate.

Author

Yadav, Kunal, Serrano, Oscar K., Peterson, Kent J., Pruett, Timothy L., Kandaswamy, Raja, Bangdiwala, Ananta, Ibrahim, Hassan, Israni, Ajay, Lake, John, and Chinnakotla, Srinath

Subjects
LIVER transplantation, KIDNEY transplantation, KIDNEY disease treatments, PROCUREMENT of organs, tissues, etc., RETROSPECTIVE studies
Abstract

Abstract: The Organ Procurement Transplant Network (OPTN) listing criteria for simultaneous liver‐kidney transplant (SLK) are not well defined. Concerns remain about rising numbers of SLKs, which divert quality kidneys from candidates awaiting kidney transplants (KT). We performed a retrospective review of liver transplants (LTs) at our center from 2004 to 2014; 127 recipients (liver transplant alone; 102 LTA, 25 SLK) were identified with short‐term preoperative kidney dysfunction (creatinine >4 mg/dL or preoperative hemodialysis [HD] for <6 weeks). Both cohorts had comparable baseline demographic characteristics with the exception of higher model for end‐stage liver disease (MELD) score in the LTA group (41.4 vs 32.9, P < .0001) and higher incidence of pre‐LT diabetes in the SLK cohort (52% vs 26.5%, P = .0176). Duration of pre‐LT HD was higher in SLK recipients, but the difference was not statistically significant (P = .39). Renal nonrecovery (RNR) rate in LTA cohort was low (<5%). No significant difference was noted in 1‐year mortality, liver graft rejection/failure, or length of stay (LOS) between the cohorts. Thus, it appears that liver recipients with short‐term (<6 weeks) HD or AKI without HD have comparable outcomes between LTA and SLK. With provisions for a KT safety net, as proposed by OPTN, LTA may be the most adequate option for these patients. [ABSTRACT FROM AUTHOR]

Published
2018
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246. The impact of using an intraoperative goal directed fluid therapy protocol on clinical outcomes in patients undergoing total pancreatectomy and islet cell autotransplantation.

Author

Wagar, Matthew K., Magnuson, Josh, Liu, Patty T., Kirchner, Varvara, Wilhelm, Joshua J., Freeman, Martin L., Bellin, Melena D., Pruett, Timothy L., Beilman, Gregory J., and Dunn, Ty B.

Abstract

Background Patients undergoing total pancreatectomy and islet cell autotransplant (TPIAT) for treatment of pancreatitis are at risk for complications of over and under resuscitation. We hypothesized that using a goal directed fluid therapy (GDFT) protocol might impact clinical outcomes. Materials and methods A consecutive series of adult patients undergoing TPIAT were managed intraoperatively using either standard fluid therapy (SFT, n = 44) or GDFT (n = 23) as part of a pilot study between January 2013 and May 2015. Patient characteristics, intraoperative, and postoperative data were recorded prospectively, then retrospectively analyzed for differences between the groups. Results The GDFT group had lower total fluid resuscitation (3,240 cc vs 5,173 cc, p < 0.0001) and transfusion requirements (1.0 cc/kg vs 3.3 cc/kg, p = 0.050) compared to the SFT group. The pre to postop nadir hemoglobin change was significantly less for GDFT (4.2 vs 5.1 gm/dl, p = 0.021) despite less transfusion. Conclusions Compared to SFT, using an intraoperative GDFT protocol in TPIAT patients was associated with significantly decreased intraoperative fluid resuscitation, blood transfusion and less postoperative dilutional anemia, without any difference in complications of underresuscitation. This pilot study suggests that GDFT is likely safe and further investigation is warranted. [ABSTRACT FROM AUTHOR]

Published
2017
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249. Total Pancreatectomy and Islet Autotransplantation in Children for Chronic Pancreatitis

Author

Chinnakotla, Srinath, primary, Bellin, Melena D., additional, Schwarzenberg, Sarah J., additional, Radosevich, David M., additional, Cook, Marie, additional, Dunn, Ty B., additional, Beilman, Gregory J., additional, Freeman, Martin L., additional, Balamurugan, A. N., additional, Wilhelm, Josh, additional, Bland, Barbara, additional, Jimenez-Vega, Jose M., additional, Hering, Bernhard J., additional, Vickers, Selwyn M., additional, Pruett, Timothy L., additional, and Sutherland, David E. R., additional

Published
2014
Full Text
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250. Islet Size Index as a Predictor of Outcomes in Clinical Islet Autotransplantation

Author

Suszynski, Thomas M., primary, Wilhelm, Joshua J., additional, Radosevich, David M., additional, Balamurugan, A. N., additional, Sutherland, David E. R., additional, Beilman, Gregory J., additional, Dunn, Ty B., additional, Chinnakotla, Srinath, additional, Pruett, Timothy L., additional, Vickers, Selwyn M., additional, Hering, Bernhard J., additional, Papas, Klearchos K., additional, and Bellin, Melena D., additional

Published
2014
Full Text
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