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Background. Established in 2013, the Open Payments Program (OPP) mandated that medical device and pharmaceutical manufacturers submit record of any financial incentive given to physicians to the Centers for Medicare and Medicaid Services, which is in turn made publicly available. This study aims to characterize these payments to transplant surgeons over the first 6 y of OPP data. Methods. The study sample included all physicians who received at least one nonresearch payment as transplant surgeons to the OPP. To capture transplant surgeons who may be listed under their pipeline specialty, the American Society of Transplant Surgeons member directory as of January 2021 was queried. Payments were analyzed temporally, geographically, and by payment type, physician, and industry payer. Results. In total, payments totaling $15 661 536 were made to 1335 transplant surgeons over the study period. The mean payment was $436.90 (SD, $1760), and the median payment was $52.94 (interquartile range, $18.29–$159.80). The top contributing companies were Intuitive Surgical, Inc.; Gilead Sciences, Inc.; and Novartis Pharmaceuticals. Only 5.3% ($827 236) was paid toward faculty or as a speaker for a nonaccredited and noncertified continuing education program and honorarium. Educational payments came in at $1 233 141 (7.9%) over the study period. $13 750 828.60 (87.8%) of the payments were for other categories (consulting fees, food and beverages, etc). Organ transplant and procurement region 7 and 8 transplant surgeons received the highest median payments during the study period. Conclusions. This study is the first to characterize the payments made to transplant surgeons since the passage of the Sunshine Act. Further studies are needed to understand and interpret the relationship between industry and transplant surgeons, as the payments may or may not translate to influence in medical decisions or use of medical devices.

Metastatic breast cancer to the bladder is extraordinarily rare, with only 66 cases reported in the literature to date. Occasionally, metastatic breast cancer can first present itself with obstructive uropathy from a proposed retroperitoneal spread. We present a case of in which a 77 year old Caucasian female was found to have acute urinary obstruction from metastatic breast cancer to the bladder. Her breast biopsy came back invasive carcinoma with lobular features (Estrogen Receptor negative, Progesterone Receptor negative, and HER2 negative). She has symptoms of spontaneous urinary incontinence, but no gross hematuria. She had elevated Chromogranin A, Cancer Antigen (CA) 19-9, and CEA. She had a bladder biopsy which demonstrated metastatic breast carcinoma that stained GATA3, GCDFP15, BerEp4 positive and CK20 negative. 0% of tumor cells were positive for PD-L1 expression. The patient had renal deterioration despite bilateral ureteral stent placement, and thus required percutaneous nephrostomy tube placement. She died 4 months after her initial diagnosis.