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1,884 results on '"Smith, M.‐L."'

397. Increasing the Use of Kidneys From Unconventional and High‐Risk Deceased Donors

Author

Heilman, R. L., Mathur, A., Smith, M. L., Kaplan, B., and Reddy, K. S.

Abstract

In this paper, we have reviewed the literature and report on kidney donors that are currently used at relatively low rates. Kidneys from donors with acute kidney injury (AKI)seem to have outcomes equivalent to those from donors without AKI,provided one can rule out significant cortical necrosis. Kidneys from donors with preexisting diabetes or hypertension may have marginally lower aggregate survival but still provide patients with a significant benefit over remaining on the wait list. The Kidney Donor Profile Index derives only an aggregate association with survival with a very modest C statistic; therefore, the data indicated that this index should not be the sole reason to discard a kidney, except perhaps in patients with extremely low estimated posttransplant survivalscores. It is important to note that the Scientific Registry of Transplant Recipientsmodels of risk adjustment should allay concerns regarding regulatory issues for observed outcomes falling below expectations. The successful utilization of kidneys from donation after cardiac deathover the past decade shows how expanding our thinking can translate into more patients benefiting from transplantation. Given the growing number of patients on the wait list, broadening our approach to kidney acceptance could have an important impact on the population with end‐stage renal disease. Many lives could be prolonged by carefully considering use of kidneys that are often discarded. The authors summarize data from recent literature on clinical outcomes of increasing utilization of kidneys from unconventional and higher‐risk deceased donors.

Published
2016
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398. Fugitive emissions from the Bakken shale illustrate role of shale production in global ethane shift

Author

Kort, E. A., Smith, M. L., Murray, L. T., Gvakharia, A., Brandt, A. R., Peischl, J., Ryerson, T. B., Sweeney, C., and Travis, K.

Abstract

Ethane is the second most abundant atmospheric hydrocarbon, exerts a strong influence on tropospheric ozone, and reduces the atmosphere's oxidative capacity. Global observations showed declining ethane abundances from 1984 to 2010, while a regional measurement indicated increasing levels since 2009, with the reason for this subject to speculation. The Bakken shale is an oil and gas‐producing formation centered in North Dakota that experienced a rapid increase in production beginning in 2010. We use airborne data collected over the North Dakota portion of the Bakken shale in 2014 to calculate ethane emissions of 0.23 ± 0.07 (2σ) Tg/yr, equivalent to 1–3% of total global sources. Emissions of this magnitude impact air quality via concurrent increases in tropospheric ozone. This recently developed large ethane source from one location illustrates the key role of shale oil and gas production in rising global ethane levels. The Bakken shale in North Dakota accounted for 1–3% total global ethane emissions in 2014These findings highlight the importance of shale production in global atmospheric ethane shiftThese emissions impact air quality and influence interpretations of recent global methane changes

Published
2016
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399. Rapid Resolution of Donor‐Derived Glomerular Fibrin Thrombi After Deceased Donor Kidney Transplantation

Author

Batra, R. K., Heilman, R. L., Smith, M. L., Thomas, L. F., Khamash, H. A., Katariya, N. N., Hewitt, W. R., Singer, A. L., Mathur, A. K., Huskey, J., Chakkera, H. A., Moss, A., and Reddy, K. S.

Abstract

The aim of this study was to determine the clinical and histologic outcomes related to transplanting kidneys from deceased donors with glomerular fibrin thrombi (GFT). We included all cases transplanted between October 2003 and October 2014 that had either a preimplantation biopsy or an immediate postreperfusion biopsy showing GFT. The study cohort included 61 recipients (9.9%) with GFT and 557 in the control group without GFT. Delayed graft function occurred in 49% of the GFT group and 39% in the control group (p = 0.14). Serum creatinine at 1, 4, and 12 months and estimated GFR at 12 months were similar in the two groups. Estimated 1‐year graft survival was 93.2% in the GFT group and 95.1% in the control group (p = 0.22 by log‐rank). Fifty‐two of the 61 patients in the GFT group (85%) had a 1‐month protocol biopsy, and only two biopsies (4%) showed residual focal glomerular thrombi. At the 1‐year protocol biopsy, the prevalence of moderate to severe interstitial fibrosis and tubular atrophy was 24% in the GFT group and 30% in the control group (p = 0.42). We concluded that GFT resolves rapidly after transplantation and that transplanting selected kidneys from deceased donors with GFT is a safe practice. Deceased donor kidneys with glomerular fibrin thrombi can have excellent graft survival, as fibrin thrombi resolve by one month in most cases without any deleterious effect on renal function or biopsy findings at one year.

Published
2016
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