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1. Risk Factors for Early Post-transplant Weight Changes Among Simultaneous Pancreas-kidney Recipients and Impact on Outcomes

Author

Sandesh Parajuli, MD, Riccardo Tamburrini, MD, PhD, Fahad Aziz, MD, Ban Dodin, BS, MPhil, Brad C. Astor, PhD, Didier Mandelbrot, MD, Dixon Kaufman, MD, PhD, and Jon Odorico, MD

Subjects
Surgery, RD1-811
Abstract

Background. There are limited data about the risk factors for weight changes and the association of significant weight changes with graft and metabolic outcomes after simultaneous pancreas and kidney (SPK) transplantation. Methods. We included all SPK recipients with both allografts functioning for at least 6 mo post-transplant and categorized them based on the weight changes from baseline to 6 mo post-transplant. We analyzed risk factors for significant weight gain (SWG) and significant weight loss (SWL) over 6 mo post-transplant, as well as outcomes including pancreas uncensored graft failure, pancreas death-censored graft failure (DCGF), composite pancreas graft outcomes of DCGF, use of an antidiabetic agent, or hemoglobin A1C >6.5%, and kidney DCGF. Results. Of 280 SPK recipients, 153 (55%) experienced no significant weight change, 57 (20%) SWG, and 70 (25%) SWL. At 6 mo post-transplant, mean weight changes were 1.2% gain in the no significant weight change group, 13.4% gain in SWG, and 9.6% loss in the SWL groups. In multivariate analysis, the only factor associated with decreased risk for weight gain was older recipient age (aOR, 0.97; 95% confidence intervals, 0.95-0.99). Importantly, SWG or SWL were not associated with pancreas graft failure, P-DCGF, or K-DCGF. Interestingly in the adjusted model, SWG at 6 mo was associated with a lower risk for composite outcomes (HR, 0.35; 95% confidence intervals, 0.14-0.85). Conclusions. Forty-five percent of SPK recipients had significant weight changes by 6 mo post-transplant, but only 20% exhibited SWG. Likely because of proper management, weight changes were not associated with poor outcomes post-SPK transplant.

Published
2024
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2. Simultaneous Pancreas-Kidney Transplant Outcomes Stratified by Autoantibodies Status and Pretransplant Fasting C-peptide

Author

Sandesh Parajuli, MD, Riccardo Tamburrini, MD, PhD, Fahad Aziz, MD, Ban Dodin, BS, MPhil, Brad C. Astor, PhD, Didier Mandelbrot, MD, Dixon Kaufman, MD, PhD, and Jon Odorico, MD

Subjects
Surgery, RD1-811
Abstract

Backgrounds. Pancreatic beta cell function and islet autoantibodies classically distinguish types of diabetes (type 1 diabetes mellitus [DM] or type 2 DM). Here, we sought to evaluate simultaneous pancreas-kidney (SPK) transplant outcomes stratified by the presence or absence of beta cell function and autoantibodies. Methods. SPK recipients were eligible if pretransplant autoantibodies were measured against insulin, islet cell, or glutamic acid decarboxylase 65-kD isoform. Recipients were categorized as A+ or A– based on the detection of ≥1 autoantibodies. Recipients were similarly categorized on the basis of detectable pretransplant fasting C-peptide of ≥2 ng/mL (β+) or 6.5. Results. One hundred eighty-three SPK recipients were included: A+β– (n = 72), A–β– (n = 42), A–β+ (n = 49), and A+β+ (n = 20). We did not detect a statistical difference in non–death-censored pancreas graft failure for A+β– recipients compared with other groups: A–β– (adjusted hazard ratio [aHR]: 0.44; 95% confidence interval [CI], 0.14-1.42), A–β+ (aHR: 1.02; 95% CI, 0.37-2.85), and A+β+ (aHR: 0.67; 95% CI, 0.13-3.33) in adjusted analyses. Similar outcomes were observed for other outcomes. Conclusions. In SPK recipients, outcomes were similar among recipients with classic features of type 1 DM and various other types of DM.

Published
2024
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3. Analysis of individual components of frailty: Pre-transplant grip strength is the strongest predictor of post kidney transplant outcomes

Author

Sandesh Parajuli, Brad C. Astor, Heather M. Lorden, Kristan A. O'Toole, Rebecca E. Wallschlaeger, Isabel C. Breyer, Ban Dodin, Fahad Aziz, Jacqueline Garonzik‐Wang, and Didier A. Mandelbrot

Subjects
Transplantation
Abstract

Frailty is commonly assessed during kidney transplant recipient (KTR) evaluation. However, individual frailty components may have varying impact on post-transplant outcomes. In this single-center study of 825 KTRs, we determined the association between the individual components of a modified Fried frailty score and delayed graft function (DGF), early hospital readmission (EHR), cardiovascular (CV) events, acute rejection (AR), death censored graft failure (DCGF), and death. Sum frailty ≥3 was significantly associated with EHR (aOR = 3.62; 95% CI: 1.21-10.80). Among individual components, only grip strength was significantly associated with EHR (aOR = 1.54; 95% CI: 1.03-2.31). The addition of grip strength to a model with the other four components resulted in Net Reclassification Improvement (NRI) of 20.51% (p = .01). Similarly, only grip strength was significantly associated with CV events (aOR = 1.79; 95% CI: 1.12-2.86). The addition of grip strength to a model with the other four components resulted in NRI of 27.37% (p = .006). No other frailty components were associated with the outcomes of interest. Based on our findings, handgrip strength may be an important tool while assessing frailty, mainly predicting early readmission and cardiovascular events post-transplant.

Published
2022

5. Risk factors and outcomes of BK viremia among deceased donor kidney transplant recipients based on donor characteristics

Author

Margaret R. Jorgenson, Sandesh Parajuli, Isabel Breyer, Maha Mohamed, Fahad Aziz, Ban Dodin, Didier A. Mandelbrot, Arjang Djamali, and Neetika Garg

Subjects
Adult, medicine.medical_specialty, Graft failure, Multivariate analysis, Concordance, Viremia, medicine.disease_cause, Risk Factors, Internal medicine, medicine, Bk nephropathy, Humans, Deceased donor kidney, Polyomavirus Infections, Transplantation, Kidney, business.industry, medicine.disease, Kidney Transplantation, Transplant Recipients, BK virus, Tumor Virus Infections, Infectious Diseases, medicine.anatomical_structure, BK Virus, business
Abstract

BK polyomavirus (BKV) is a common infection among kidney transplant recipients (KTR). Risk factors and outcomes based on donor characteristics remain largely unknown.In this study, we aimed to analyze the impact of donor factors through a paired kidney analysis. We included 289 pairs of adult deceased donor transplants (578 KTRs total); each pair had received kidneys from the same donor. Recipient pairs were divided into three groups: "no BK group" if neither KTR developed BK viremia (n = 336), "discordant" if the only one did (n = 176), and "concordant" if both did (n = 66). Acute rejection (AR), graft failure, and BK nephropathy (BKN) were outcomes of interest.Donors in the concordant group were younger, had lower kidney donor profile index (KDPI), and were less likely to be donor after circulatory death (DCD). In multivariate analyses, KTRs who had a donor with a higher body mass index (BMI) (hazard ratio (HR): 0.97; 95% confidence interval (CI): 0.95-0.99; p = .009) were less likely to develop BKV. Concordance was not associated with AR (HR: 0.83; 95% CI: 0.51-1.34; p = .45), graft failure (HR: 1.77; 95% CI: 0.42-7.50; p = .43), or BKN (HR: 1.02; 95% CI: 0.51-2.03; p = .96).Our study suggests lower donor BMI is associated with BKV infection, and concordance or discordance between paired kidney recipients is not associated with poor outcomes.

Published
2021
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6. Kidney transplant outcomes among recipients with post-transplant hip or knee joint replacement surgery

Author

Ban Dodin, Isabel Breyer, Fauzia Osman, James Alstott, Fahad Aziz, Neetika Garg, Maha Mohamed, Didier Mandelbrot, Arjang Djamali, and Sandesh Parajuli

Subjects
Adult, Graft Rejection, Transplantation, Risk Factors, Graft Survival, Humans, Kidney Failure, Chronic, Transplants, Arthroplasty, Replacement, Kidney Transplantation, Transplant Recipients, Retrospective Studies
Abstract

Patients with end-stage renal disease (ESRD) are at a higher risk of needing hip or knee replacement (joint replacement) surgery due to the high prevalence of degenerative joint disease and other conditions. However, there remains a large debate about the timing of joint replacement surgery and whether it should be pre- vs post-transplant.We conducted a retrospective study analyzing all adult kidney transplant recipients (KTRs) at our university hospital who had undergone subsequent joint replacement between 2001 and 2017. Transplant-specific outcomes of acute rejection, death censored graft failure (DCGF), and patient death post-joint replacement surgery were outcomes of interest. Controls were selected at a 1:3 ratio based on the incidence density sampling of post-transplant interval.There were 101 KTRs in the joint replacement group and were compared with 281 controls. In the multivariate analysis, the need for joint replacement was not associated with acute rejection (HR: 1.59; 95% CI: 0.77-3.29; P = 0.21); DCGF (HR: 0.89; 95% CI: 0.49-1.60; P = 0.70) or patient death (HR: 0.84, 95% CI: 0.55-1.38, P = 0.42).In selected KTRs, joint replacement surgery was not associated with detrimental transplant-specific outcomes.

Published
2021

7. Staying Physically Active Is Associated with Better Mental Health and Sleep Health Outcomes during the Initial Period of COVID-19 Induced Nation-Wide Lockdown in Jordan

Author

Yazan A. Al-Ajlouni, Su Hyun Park, Jude Alawa, Ban Dodin, Ghaith Shamaileh, Nour Makarem, Katherine M. Keyes, and Dustin T. Duncan

Subjects
Jordan, Depression, SARS-CoV-2, Health, Toxicology and Mutagenesis, Public Health, Environmental and Occupational Health, COVID-19, physical activity, Article, lockdown, mental health, sleep health, Mental Health, Sleep Quality, Communicable Disease Control, Outcome Assessment, Health Care, Medicine, Humans, Sleep
Abstract

Jordan, a Middle Eastern country, initially responded to an outbreak of COVID-19 cases within its own borders by imposing a 7-week strict lockdown and closure of international and domestic travel. Such measures drastically influenced lifestyle behaviors of the population. This study aimed to investigate the prevalence of physical activity, and its association with mental and sleep health outcomes among Jordanians during a period of COVID-19 induced lockdown. Validated questionnaires were administered using a web-based platform to evaluate moderate-to-vigorous physical activity (MVPA), anxiety and depressive symptoms, sleep health, and sociodemographic characteristics. A modified Poisson regression model with robust error variance was used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Compared to participants who met the guidelines, those who did not had significantly higher prevalence of moderate or severe anxiety symptoms than that of minimal or mild anxiety symptoms and increased depressive symptoms. Insufficient MVPA was associated with higher prevalence of poor sleep quality, short sleep duration (

Published
2022
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