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Davis RA, Branagan T, Schneck CD, Schold JD, Thant T, Kaplan B. Lithium and the living kidney donor: Science or stigma? Am J Transplant 2023; 23:1300-1306. [PMID: 37236400 DOI: 10.1016/j.ajt.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023]
Abstract
Nearly 10 000 people are removed from the kidney transplant waiting list each year either due to becoming too ill for transplant or due to death. Live donor kidney transplant (LDKT) provides superior outcomes and survival benefit relative to deceased donor transplant, but the number of LDKT has decreased over the past few years. Therefore, it is of paramount importance that transplant centers employ evaluation processes that safely maximize LDKT. Decisions about donor candidacy should be based on the best available data, rather than on processes prone to bias. Here, we examine the common practice of declining potential donors based solely on treatment with lithium. We conclude that the risk of end-stage renal disease related to lithium treatment is comparable to other generally accepted risks in LDKT. We present this viewpoint to specifically challenge the carte blanche exclusion of individuals taking lithium and highlight the importance of using the best available data relevant to any risk factor, rather than relying on biases, when evaluating potential living kidney donors.
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Affiliation(s)
- Rachel A Davis
- Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA.
| | - Tyler Branagan
- Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Christopher D Schneck
- Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Jesse D Schold
- Department of Surgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Thida Thant
- Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Bruce Kaplan
- Department of Surgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education, Aurora, Colorado, USA; Department of Medicine, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
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Jesse MT, Jackson WE, Liapakis A, Ganesh S, Humar A, Goldaracena N, Levitsky J, Mulligan D, Pomfret EA, Ladner DP, Roberts JP, Mavis A, Thiessen C, Trotter J, Winder GS, Griesemer AD, Pillai A, Kumar V, Verna EC, LaPointe Rudow D, Han HH. Living donor liver transplant candidate and donor selection and engagement: Meeting report from the living donor liver transplant consensus conference. Clin Transplant 2023:e14954. [PMID: 36892182 DOI: 10.1111/ctr.14954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/14/2023] [Accepted: 02/25/2023] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Living donor liver transplantation (LDLT) is a promising option for mitigating the deceased donor organ shortage and reducing waitlist mortality. Despite excellent outcomes and data supporting expanding candidate indications for LDLT, broader uptake throughout the United States has yet to occur. METHODS In response to this, the American Society of Transplantation hosted a virtual consensus conference (October 18-19, 2021), bringing together relevant experts with the aim of identifying barriers to broader implementation and making recommendations regarding strategies to address these barriers. In this report, we summarize the findings relevant to the selection and engagement of both the LDLT candidate and living donor. Utilizing a modified Delphi approach, barrier and strategy statements were developed, refined, and voted on for overall barrier importance and potential impact and feasibility of the strategy to address said barrier. RESULTS Barriers identified fell into three general categories: 1) awareness, acceptance, and engagement across patients (potential candidates and donors), providers, and institutions, 2) data gaps and lack of standardization in candidate and donor selection, and 3) data gaps regarding post-living liver donation outcomes and resource needs. CONCLUSIONS Strategies to address barriers included efforts toward education and engagement across populations, rigorous and collaborative research, and institutional commitment and resources.
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Affiliation(s)
- Michelle T Jesse
- Transplant Institute, Henry Ford Health System, Detroit, Michigan, USA
| | - Whitney E Jackson
- Division of Gastroenterology and Hepatology, University of Colorado, Aurora, Colorado, USA
| | - AnnMarie Liapakis
- Yale School of Medicine and Yale New Haven Transplant Center, New Haven, Connecticut, USA
| | - Swaytha Ganesh
- Thomas E Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Abhinav Humar
- Thomas E Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nicolas Goldaracena
- Division of Transplant Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Josh Levitsky
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David Mulligan
- Division of Transplant Surgery, Yale University, New Haven, Connecticut, USA
| | | | - Daniela P Ladner
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - John P Roberts
- UCSF Department of Surgery, San Francisco, California, USA
| | - Alisha Mavis
- Pediatric Gastroenterology, Hepatology, and Nutrition, Duke University Health, Durham, North Carolina, USA
| | - Carrie Thiessen
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - James Trotter
- Transplant Hepatology, Baylor University Medical Center, Dallas, Texas, USA
| | | | - Adam D Griesemer
- Department of Surgery, NYU Langone Heath, New York, New York, USA
| | - Anjana Pillai
- Department of Internal Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Vineeta Kumar
- Department of Medicine, Division of Nephrology/Transplant, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth C Verna
- Center for Liver Disease and Transplantation, Columbia University, New York, New York, USA
| | - Dianne LaPointe Rudow
- Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA
| | - Hyosun H Han
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Jackson WE, Kaplan A, Saben JL, Kriss MS, Cisek J, Samstein B, Liapakis A, Pillai AA, Brown RS, Pomfret EA. Practice patterns of the medical evaluation of living liver donors in the United States. Liver Transpl 2023; 29:164-171. [PMID: 37160068 DOI: 10.1002/lt.26571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/26/2022] [Accepted: 09/02/2022] [Indexed: 01/27/2023]
Abstract
Living donor liver transplantation (LDLT) can help address the growing organ shortage in the United States, yet little is known about the current practice patterns in the medical evaluation of living liver donors. We conducted a 131-question survey of all 53 active LDLT transplant programs in the United States to assess current LDLT practices. The response rate was 100%. Donor acceptance rate was 0.33 with an interquartile range of 0.33-0.54 across all centers. Areas of high intercenter agreement included minimum age cutoff of 18 years (73.6%) and the exclusion of those with greater than Class 1 obesity (body mass index, 30.0-34.9 m/kg 2 ) (88.4%). Diabetes mellitus was not an absolute exclusion at most centers (61.5%). Selective liver biopsies were performed for steatosis or iron overload on imaging (67.9% and 62.3%, respectively) or for elevated liver enzymes (60.4%). Steatohepatitis is considered an exclusion at most centers (84.9%). The most common hypercoagulable tests performed were factor V Leiden (FVL) (88.5%), protein C (73.1%), protein S (71.2%), antithrombin III (71.2%) and prothrombin gene mutation (65.4%). At 41.5% of centers, donors were allowed to proceed with donation with FVL heterozygote status. Most programs discontinue oral contraceptive pills at least 28 days prior to surgery. At most centers, the need for cardiovascular ischemic risk testing is based on age (73.6%) and the presence of one or more cardiac risk factors (68.0%). Defining areas of practice consensus and variation underscores the need for data generation to develop evidence-based guidance for the evaluation and risk assessment of living liver donors.
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Affiliation(s)
- Whitney E Jackson
- Division of Gastroenterology and Hepatology , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA.,Colorado Center for Transplantation Care , Research and Education , Aurora , Colorado , USA
| | - Alyson Kaplan
- Division of Gastroenterology and Hepatology , Weill Cornell Medicine , New York , New York , USA
| | - Jessica L Saben
- Colorado Center for Transplantation Care , Research and Education , Aurora , Colorado , USA.,Department of Surgery , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA
| | - Michael S Kriss
- Division of Gastroenterology and Hepatology , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA.,Colorado Center for Transplantation Care , Research and Education , Aurora , Colorado , USA
| | - Jaime Cisek
- Colorado Center for Transplantation Care , Research and Education , Aurora , Colorado , USA.,Department of Surgery , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA
| | - Benjamin Samstein
- Department of Surgery , Weill Cornell Medicine , New York , New York , USA
| | - AnnMarie Liapakis
- Yale University Division of Gastroenterology and Hepatology , Yale New Haven Transplantation Center , New Haven , Connecticut , USA
| | - Anjana A Pillai
- Division of Gastroenterology and Hepatology , University of Chicago Medicine , Chicago , Illinois , USA
| | - Robert S Brown
- Division of Gastroenterology and Hepatology , Weill Cornell Medicine , New York , New York , USA
| | - Elizabeth A Pomfret
- Colorado Center for Transplantation Care , Research and Education , Aurora , Colorado , USA.,Department of Surgery , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA
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Engels EA, Fraser GE, Kasiske BL, Snyder JJ, Utt J, Lynch CF, Li J, Pawlish KS, Brown S, Yu KJ, Pfeiffer RM. Cancer risk in living kidney donors. Am J Transplant 2022; 22:2006-2015. [PMID: 35510728 PMCID: PMC9357116 DOI: 10.1111/ajt.17082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/03/2022] [Accepted: 04/25/2022] [Indexed: 01/25/2023]
Abstract
Living kidney donors are screened for transmissible diseases including cancer. Outcomes following donation are excellent, but concern exists regarding development of chronic kidney disease, and cancer risk is unknown. We used linked transplant and cancer registry data to identify incident cancers among 84,357 kidney donors in the United States (1995-2017). We compared risk with the general population using standardized incidence ratios (SIRs). For selected cancers, we used Poisson regression to compare donors with 47,451 Adventist Health Study 2 (AHS-2) participants, who typically have healthy lifestyles. During follow-up, 2843 cancers were diagnosed in donors, representing an overall deficit (SIR 0.79, 95%CI 0.76-0.82). None of 46 specified cancer sites occurred in excess relative to the general population, and 15 showed significant deficits (SIR < 1.00). Compared with AHS-2 participants, donors had similar incidence of liver cancer, melanoma, breast cancer, and non-Hodgkin lymphoma but, starting 7 years after donation, elevated incidence of colorectal cancer (adjusted incidence rate ratio 2.07, 95%CI 1.54-2.79) and kidney cancer (2.97, 1.58-5.58, accounting for the presence of a single kidney in donors). Elevated kidney cancer incidence may reflect adverse processes in donors' remaining kidney. Nonetheless, cancer risk is lower than in the general population, suggesting that enhanced screening is unnecessary.
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Affiliation(s)
- Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Gary E Fraser
- School of Public Health, Loma Linda University, Loma Linda, California, USA
| | - Bertram L Kasiske
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota, USA
| | - Jon J Snyder
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota, USA
| | - Jason Utt
- Research Affairs, Loma Linda University, Loma Linda, California, USA
| | - Charles F Lynch
- Department of Epidemiology, The University of Iowa, Iowa City, Iowa, USA
| | - Jie Li
- Department of Health, Cancer Epidemiology Services, Trenton, New Jersey, USA
| | - Karen S Pawlish
- Department of Health, Cancer Epidemiology Services, Trenton, New Jersey, USA
| | - Sandra Brown
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Kelly J Yu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
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Lee CY, Lin MH, Lin HY, Ting YT, Wang HK, Wang CL, Tsai MK, Chen CC, Lee CY. Survey of factors associated with the willingness toward living kidney donation. J Formos Med Assoc 2022; 121:2300-2307. [DOI: 10.1016/j.jfma.2022.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/08/2022] [Accepted: 06/15/2022] [Indexed: 12/29/2022]
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