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3 results on '"Matthew R. D’Costa, MD"'

1. Death With Function and Graft Failure After Kidney Transplantation: Risk Factors at Baseline Suggest New Approaches to Management

Author

Massini A. Merzkani, MD, Andrew J. Bentall, MD, Byron H. Smith, PhD, Xiomara Benavides Lopez, MD, Matthew R. D’Costa, MD, Walter D. Park, BS, Walter K. Kremers, PhD, Naim Issa, MD, Andrew D. Rule, MD, Harini Chakkera, MD, Kunam Reddy, MD, Hasan Khamash, MD, Hani M. Wadei, MD, Martin Mai, MD, Mariam P. Alexander, MD, Hatem Amer, MD, Aleksandra Kukla, MD, Mireille El Ters, MD, Carrie A. Schinstock, MD, Manish J. Gandhi, MD, Raymond Heilman, MD, and Mark D. Stegall, MD

Subjects
Surgery, RD1-811
Abstract

Background. Improving both patient and graft survival after kidney transplantation are major unmet needs. The goal of this study was to assess risk factors for specific causes of graft loss to determine to what extent patients who develop either death with a functioning graft (DWFG) or graft failure (GF) have similar baseline risk factors for graft loss. Methods. We retrospectively studied all solitary renal transplants performed between January 1, 2006, and December 31, 2018, at 3 centers and determined the specific causes of DWFG and GF. We examined outcomes in different subgroups using competing risk estimates and cause-specific Cox models. Results. Of the 5752 kidney transplants, graft loss occurred in 21.6% (1244) patients, including 12.0% (691) DWFG and 9.6% (553) GF. DWFG was most commonly due to malignancy (20.0%), infection (19.7%), cardiac disease (12.6%) with risk factors of older age and pretransplant dialysis, and diabetes as the cause of renal failure. For GF, alloimmunity (38.7%), glomerular diseases (18.6%), and tubular injury (13.9%) were the major causes. Competing risk incidence models identified diabetes and older recipients with higher rates of both DWFG and nonalloimmune GF. Conclusions. These data suggest that at baseline, 2 distinct populations can be identified who are at high risk for renal allograft loss: a younger, nondiabetic patient group who develops GF due to alloimmunity and an older, more commonly diabetic population who develops DWFG and GF due to a mixture of causes—many nonalloimmune. Individualized management is needed to improve long-term renal allograft survival in the latter group.

Published
2022
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2. Clinical and Kidney Structural Characteristics of Living Kidney Donors With Nephrolithiasis and Their Long-term Outcomes

Author

Matthew R. D’Costa, MD, Massini A. Merzkani, MD, Aleksandar Denic, MD, PhD, Aidan F. Mullan, MS, Joseph J. Larson, MS, Walter K. Kremers, PhD, Walter D. Park, BS, Mariam P. Alexander, MD, Harini A. Chakkera, MD, Sandra J. Taler, MD, Stephen B. Erickson, MD, Mark D. Stegall, MD, Naim Issa, MD, and Andrew D. Rule, MD

Subjects
Surgery, RD1-811
Abstract

Background. Nephrolithiasis in living kidney donors is concerning due to the potential impact on long-term postdonation kidney function. Methods. We performed a cohort study of living kidney donors from 2 centers with a baseline computed tomography scan and implantation renal biopsy. Donors (>5 y since donation) completed a follow-up survey or underwent chart review to assess eGFR and incident hypertension. Stone formers were classified as symptomatic if they had a past symptomatic episode or asymptomatic if only incidental radiographic kidney stones were identified during donor evaluation. We compared baseline clinical, imaging, and biopsy characteristics by stone former status including review of metabolic evaluations in stone formers. Long-term risks of renal complications (low eGFR and hypertension) by stone former status were evaluated. Results. There were 12 symptomatic and 76 asymptomatic stone formers among 866 donors. Overall, baseline clinical characteristics and implantation biopsy findings were similar between stone formers and non-stone formers. After a median follow-up of 10 y, stone former status was not associated with eGFR

Published
2022
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3. Clinical and Kidney Structural Characteristics of Living Kidney Donors With Nephrolithiasis and Their Long-term Outcomes

Author

Matthew R. D’Costa, MD, Massini A. Merzkani, MD, Aleksandar Denic, MD, PhD, Aidan F. Mullan, MS, Joseph J. Larson, MS, Walter K. Kremers, PhD, Walter D. Park, BS, Mariam P. Alexander, MD, Harini A. Chakkera, MD, Sandra J. Taler, MD, Stephen J. Erickson, MD, Mark D. Stegall, MD, Naim Issa, MD, and Andrew D. Rule, MD

Subjects
Transplantation, RD1-811, Surgery, Kidney Transplantation
Abstract

Background. Nephrolithiasis in living kidney donors is concerning due to the potential impact on long-term postdonation kidney function. Methods. We performed a cohort study of living kidney donors from 2 centers with a baseline computed tomography scan and implantation renal biopsy. Donors (>5 y since donation) completed a follow-up survey or underwent chart review to assess eGFR and incident hypertension. Stone formers were classified as symptomatic if they had a past symptomatic episode or asymptomatic if only incidental radiographic kidney stones were identified during donor evaluation. We compared baseline clinical, imaging, and biopsy characteristics by stone former status including review of metabolic evaluations in stone formers. Long-term risks of renal complications (low eGFR and hypertension) by stone former status were evaluated. Results. There were 12 symptomatic and 76 asymptomatic stone formers among 866 donors. Overall, baseline clinical characteristics and implantation biopsy findings were similar between stone formers and non-stone formers. After a median follow-up of 10 y, stone former status was not associated with eGFR

Published
2021

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