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Bisen SS, Zeiser LB, Getsin SN, Chiang PY, Stewart DE, Herrick-Reynolds K, Yu S, Desai NM, Al Ammary F, Jackson KR, Segev DL, Lonze BE, Massie AB. A2/A2B to B deceased donor kidney transplantation in the Kidney Allocation System era. Am J Transplant 2024; 24:606-618. [PMID: 38142955 DOI: 10.1016/j.ajt.2023.12.015] [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: 07/04/2023] [Revised: 11/20/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
Kidney transplantation from blood type A2/A2B donors to type B recipients (A2→B) has increased dramatically under the current Kidney Allocation System (KAS). Among living donor transplant recipients, A2-incompatible transplants are associated with an increased risk of all-cause and death-censored graft failure. In light of this, we used data from the Scientific Registry of Transplant Recipients from December 2014 until June 2022 to evaluate the association between A2→B listing and time to deceased donor kidney transplantation (DDKT) and post-DDKT outcomes for A2→B recipients. Among 53 409 type B waitlist registrants, only 12.6% were listed as eligible to accept A2→B offers ("A2-eligible"). The rates of DDKT at 1-, 3-, and 5-years were 32.1%, 61.4%, and 72.1% among A2-eligible candidates and 14.1%, 29.9%, and 44.1% among A2-ineligible candidates, with the former experiencing a 133% higher rate of DDKT (Cox weighted hazard ratio (wHR) = 2.192.332.47; P < .001). The 7-year adjusted mortality was comparable between A2→B and B-ABOc (type B/O donors to B recipients) recipients (wHR 0.780.941.13, P = .5). Moreover, there was no difference between A2→B vs B-ABOc DDKT recipients with regards to death-censored graft failure (wHR 0.771.001.29, P > .9) or all-cause graft loss (wHR 0.820.961.12, P = .6). Following its broader adoption since the implementation of the kidney allocation system, A2→B DDKT appears to be a safe and effective transplant modality for eligible candidates. As such, A2→B listing for eligible type B candidates should be expanded.
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Affiliation(s)
- Shivani S Bisen
- Grossman School of Medicine, New York University, New York, New York, USA
| | - Laura B Zeiser
- Grossman School of Medicine, New York University, New York, New York, USA
| | - Samantha N Getsin
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Po-Yu Chiang
- Grossman School of Medicine, New York University, New York, New York, USA
| | - Darren E Stewart
- Grossman School of Medicine, New York University, New York, New York, USA
| | | | - Sile Yu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Niraj M Desai
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fawaz Al Ammary
- Department of Medicine, University of California Irvine School of Medicine, Irvine, California, USA
| | - Kyle R Jackson
- Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - Dorry L Segev
- Grossman School of Medicine, New York University, New York, New York, USA; Scientific Registry of Transplant Recipients, Minneapolis, Minnesota, USA
| | - Bonnie E Lonze
- Grossman School of Medicine, New York University, New York, New York, USA
| | - Allan B Massie
- Grossman School of Medicine, New York University, New York, New York, USA.
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Gunasingha RMKD, Herrick-Reynolds K, Sanford JA, Radowsky J. Iatrogenic immunodeficiency-associated lymphoproliferative disorder presenting as small bowel perforation. BMJ Case Rep 2024; 17:e257148. [PMID: 38553024 PMCID: PMC10982773 DOI: 10.1136/bcr-2023-257148] [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] [Indexed: 04/02/2024] Open
Abstract
A woman in her late 50s on mycophenolate for limited systemic sclerosis presented with abdominal pain. Vital signs and investigative evaluations were normal. Cross-sectional imaging identified gastric and small bowel wall thickening, free fluid, and pneumoperitoneum. In the operating room, a small bowel perforation was found and resected. Postoperatively, immunosuppression was held and she completed a course of amoxicillin/clavulanate. She discharged home and re-presented on postoperative day 8 with seizures and was found to have a frontal brain mass which was biopsied. Pathology from both the resected bowel and brain biopsy demonstrated Epstein-Barr virus-positive B-cell lymphoproliferative disorder with polymorphic B-cell features. The patient's immunosuppression was discontinued, and she was enrolled in a clinical trial for chemotherapy. Lymphoproliferative disorder can present years after immunosuppression initiation with either spontaneous perforation or solid tumour. Pathological assessment determines treatment options. Heightened concern for atypical clinical presentations in immunosuppressed patients is always warranted.
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Affiliation(s)
| | | | - Jeffrey A Sanford
- Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jason Radowsky
- General Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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Mitchell J, Herrick-Reynolds K, Motter JD, Teles M, Kates O, Sung H, Chen PH, King E, Cameron A. Transplant Center Attitudes Toward Early Liver Transplant for Alcohol-associated Liver Disease. Transplant Direct 2023; 9:e1532. [PMID: 37649789 PMCID: PMC10465102 DOI: 10.1097/txd.0000000000001532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/29/2023] [Accepted: 07/14/2023] [Indexed: 09/01/2023] Open
Abstract
Background Many centers have removed 6-mo pretransplant alcohol abstinence requirements to provide early liver transplant (ELT) for individuals with severe alcohol-associated liver disease (ALD), but the practice remains controversial. Using data collected from a nationally distributed survey, this study examines the practices and attitudes of transplant centers in the United States regarding ELT. Methods A 20-item survey designed to assess center practices and provider attitudes was distributed to 225 medical and surgical directors from 143 liver transplant centers via email. Results Surveys were completed by 28.9% (n = 65) of directors and 39% (n = 56) of transplant centers. All responding centers reported evaluating patients for ELT. Circumstances for considering ELT included <6 mo of survival without a transplant (96.4%) and inability to participate in alcohol addiction therapy pretransplant (75%). Most (66%) directors indicated their center had established criteria for listing candidates with severe ALD for ELT. Regarding important factors for ELT candidate listing, 57.1% indicated patient survival, 37.5% indicated graft survival, and 55.4% indicated having a low risk of relapse. Only 12.7% of directors affirmed the statement, "Six months of pretransplant abstinence decreases the risk of relapse." Conclusions More centers are providing ELT for severe ALD. Inability to participate in alcohol addiction therapy and <6 mo of survival are commonly reported circumstances for considering ELT. Continued investigation of posttransplant outcomes in patients receiving ELT is essential to establishing a national consensus for distributing this valuable resource.
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Affiliation(s)
- Jonathan Mitchell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Jennifer D. Motter
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mayan Teles
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Olivia Kates
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hannah Sung
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Po-Hung Chen
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth King
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew Cameron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Herrick-Reynolds K, Patibandla A, Herbst L, Zeiser L, Love AD, Helfer DR, Segev DL, Cameron AM, Garonzik-Wang JM, King EA. Directed Potential Living Donors Interest in Kidney Paired and Nondirected Donation. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zheng S, Matthews AJ, Rahman N, Herrick-Reynolds K, Sible E, Choi JE, Wishnie A, Ng YK, Rhodes D, Elledge SJ, Vuong BQ. The uncharacterized SANT and BTB domain-containing protein SANBR inhibits class switch recombination. J Biol Chem 2021; 296:100625. [PMID: 33831416 PMCID: PMC8141524 DOI: 10.1016/j.jbc.2021.100625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 01/21/2023] Open
Abstract
Class switch recombination (CSR) is the process by which B cells switch production from IgM/IgD to other immunoglobulin isotypes, enabling them to mount an effective immune response against pathogens. Timely resolution of CSR prevents damage due to an uncontrolled and prolonged immune response. While many positive regulators of CSR have been described, negative regulators of CSR are relatively unknown. Using an shRNA library screen targeting more than 28,000 genes in a mouse B cell line, we have identified a novel, uncharacterized protein of 82kD (KIAA1841, NM_027860), which we have named SANBR (SANT and BTB domain regulator of CSR), as a negative regulator of CSR. The purified, recombinant BTB domain of SANBR exhibited characteristic properties such as homodimerization and interaction with corepressor proteins, including HDAC and SMRT. Overexpression of SANBR inhibited CSR in primary mouse splenic B cells, and inhibition of CSR is dependent on the BTB domain while the SANT domain is largely dispensable. Thus, we have identified a new member of the BTB family that serves as a negative regulator of CSR. Future investigations to identify transcriptional targets of SANBR in B cells will reveal further insights into the specific mechanisms by which SANBR regulates CSR as well as fundamental gene regulatory activities of this protein.
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Affiliation(s)
- Simin Zheng
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; NTU Institute of Structural Biology, Nanyang Technological University, Singapore, Singapore
| | - Allysia J Matthews
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA; Department of Biology, The Graduate Center and The City College of New York, New York, New York, USA
| | - Numa Rahman
- Immunology Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Emily Sible
- Department of Biology, The Graduate Center and The City College of New York, New York, New York, USA
| | - Jee Eun Choi
- Department of Biology, The Graduate Center and The City College of New York, New York, New York, USA
| | - Alec Wishnie
- Department of Biology, The Graduate Center and The City College of New York, New York, New York, USA
| | - Yan Kee Ng
- NTU Institute of Structural Biology, Nanyang Technological University, Singapore, Singapore
| | - Daniela Rhodes
- NTU Institute of Structural Biology, Nanyang Technological University, Singapore, Singapore
| | - Stephen J Elledge
- Department of Genetics, Program in Virology, Howard Hughes Medical Institute, Harvard Medical School, Boston, Massachusetts, USA; Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bao Q Vuong
- Department of Biology, The Graduate Center and The City College of New York, New York, New York, USA.
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Abstract
BACKGROUND Training in clinical medicine involves exposure to complex ethical and emotional situations. Reflection aids in the development of personal belief systems and improves self-awareness. Students may be reluctant to participate when reflection is mandatory and may be concerned about retaliation when the facilitator has a role in evaluations. Near-peers are institutional equals with more experience than the participants and may be well suited to facilitate reflection. METHODS A quarterly near-peer-facilitated reflective writing workshop (RWW) was implemented in the mandatory clinical curriculum at a single institution. Qualitative feedback forms were solicited and were analysed through an iterative and inductive consensus process. An end-of-year web-based survey was distributed to test the hypotheses generated from our analysis of the feedback forms. RESULTS There were 82 responses (80%) to the web-based survey and 266 (65%) feedback forms were collected. Although few students reported using writing as a coping mechanism, the RWW was viewed favourably, with 62% indicating that they would attend if optional. The structured prompts aided reflection. Students reported a higher likelihood of discussing difficult topics (doubts about medicine as a career, personal shortcomings, harassment and burnout) in sessions led by a near-peer than by a faculty member. The workshop created a safe space to reflect, increased a sense of camaraderie and helped normalise experiences. [The workshop] humanised the clinical experience, gave new perspective and reminded students of their positive personal accomplishments DISCUSSION: The near-peer-facilitated RWW is a novel intervention aimed at developing reflective practice and coping with the challenges of entering clinical medicine. It is highly structured and has been incorporated into the mandatory curriculum. It was well received by students, is generalisable and is easily implementable.
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Affiliation(s)
| | | | - Daniel J Zheng
- Boston Children's Hospital, Department of Pediatrics, Boston, MA, Boston Medical Center, Department of Pediatrics, Boston, MA
| | - Priscilla Wang
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA
| | | | - Andi Shahu
- Department of Internal Medicine, Johns Hopkins Hospital, Baltimore, MD
| | - Anna Reisman
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
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Herrick-Reynolds K, Brooks D, Wind G, Jackson P, Latham K. Military Medicine and the Academic Surgery Gender Gap. Mil Med 2019; 184:383-387. [DOI: 10.1093/milmed/usz083] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/02/2019] [Accepted: 03/21/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Gender disparity in academic medicine has been well described in the civilian sector. This has not yet been evaluated in the military health system where hundreds of female surgeons are practicing. Military service limits factors such as part time work and control over time spent away from family, which are often cited as contributors to the pay and promotion gap in civilian academic medicine. The military has explicit policies to limit discrimination based on gender. Pay between men and women is equal as it is based on rank and time in rank. One would expect to see less disparity in promotion through the academic ranks for military female surgeons given this otherwise equal treatment. This has not previously been objectively tracked or reported. It is beneficial to characterize the military academic medicine gender gap and benchmark against national data to define the academic gender gap and lay the groundwork for future work to identify factors contributing to the observed difference.
Material and Methods
This study was granted exemption from the Walter Reed National Military Medical Center (WRNMMC) Internal Review Board (IRB). The Uniformed Services University (USU) Department of Surgery academic appointment list was reviewed to assess female representation in the categories of Instructor, Assistant Professor, Associate Professor, Professor, and Other. Defense Manpower Data Center (DMDC) and the US Navy Bureau of Medicine and Surgery (BUMED) were assessed for total numbers of female surgeons on active duty, and numbers were compared with nationally published Association of American Medical Colleges (AAMC) data using a logistic regression model.
Results
There was a higher proportion of women in academic positions in the civilian cohort than in the military cohort (OR: 1.84; CI: 1.53–2.21, p < .0001). This difference was observed at every level of academic achievement. A higher percentage of women were observed at lower levels of professorship than at higher levels; instructors were more likely to be women than assistant professor (OR: 1.44, CI:1.16–1.79), associate professor (OR: 2.24, CI: 1.77–2.84), or full professor (OR:4.61, CI: 3.57–5.94).
Conclusions
Fewer female surgeons in military medicine hold academic appointment when compared with their counterparts in civilian medicine. Similar to the civilian sector, military academic surgery also demonstrates less likelihood of female representation in higher academic stations. This discrepancy in representation follows a linear trend over the different ranks. This discrepancy has not been previously documented. The military offers a unique opportunity to study the issue of gender imbalance in academic promotion practices given its otherwise equal treatment of males and females. Additional studies will be necessary to understand uniformed female surgeons’ barriers to academic advancement.
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Affiliation(s)
- Kayleigh Herrick-Reynolds
- Walter Reed National Military Medical Center, Department of General Surgery, 8901 Rockville Pike, Bldg 9, Bethesda, MD
| | - Daniel Brooks
- Uniformed Services University, 4301 Jones Bridge Rd. Bethesda, MD
| | - Gary Wind
- Walter Reed National Military Medical Center, Department of General Surgery, 8901 Rockville Pike, Bldg 9, Bethesda, MD
- Uniformed Services University, 4301 Jones Bridge Rd. Bethesda, MD
| | - Paula Jackson
- Uniformed Services University, 4301 Jones Bridge Rd. Bethesda, MD
- Walter Reed National Military Medical Center, Department of Otolaryngology, 8901 Rockville Pike, Bethesda, MD
| | - Kerry Latham
- Uniformed Services University, 4301 Jones Bridge Rd. Bethesda, MD
- Walter Reed National Military Medical Center, Department of Plastic Surgery, 8901 Rockville Pike, Bethesda, MD
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Rubinstein JC, Dinauer C, Herrick-Reynolds K, Morotti R, Callender GG, Christison-Lagay ER. Lymph node ratio predicts recurrence in pediatric papillary thyroid cancer. J Pediatr Surg 2019; 54:129-132. [PMID: 30361076 DOI: 10.1016/j.jpedsurg.2018.10.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 10/01/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Regional lymph node (LN) metastasis at the time of presentation plays a significant role in predicting recurrence in patients with papillary thyroid cancer (PTC). Multiple studies in the adult population have demonstrated that the lymph node ratio (LNR) in both the central and lateral neck can improve the accuracy of recurrence prediction, but this ratio has not been studied in the pediatric population. In this study, we sought to investigate the LNR in the central and lateral compartments as a prognostic predictor for recurrence in pediatric patients with PTC. METHODS A retrospective analysis of pediatric patients (≤21 years old) at a single institution between 2002 and 2014 who underwent total thyroidectomy with prophylactic central neck dissection (TTpCND) with at least 3 sampled nodes or total thyroidectomy with unilateral modified radical neck dissection (TTMRND) with at least 10 sampled nodes, and on whom at least 24 months of follow up data were available was performed. The LNR was defined as the ratio of metastatic LNs to total number of investigated LNs. Recurrence after TTpCND and TTMRND was examined separately as a function of LNR, using the value of 0.45 as a cutoff. RESULTS Forty-eight patients met inclusion criteria. Thirty-two underwent TTpCND, and sixteen underwent TTMRND. Median age at time of operation was 17 years (range 6-20), and median duration of follow-up was 53.5 months (range 24-183). In the TTpCND, LNR ranged from 0 to 1.0. There were two recurrences among the eight patients (25%) undergoing TTpCND in patients with LNRs >0.45 and a single recurrence among the 24 patients (4.2%) undergoing TTpCND with an LNR ≤0.45. In the TTMRND, LNR ranged from 0.1 to 1.0. There were 3 recurrences in 12 patients with LNR ≤0.45 (30.8%%) and 4 recurrences in 4 patients with LNR >0.45 (100%) (p = 0.03). CONCLUSIONS Although limited by small sample size, LNR may be a useful predictor to stratify the likelihood of recurrence in pediatric patients undergoing TTpCND or TTMRND for pathologic N1a or N1b PTC. TYPE OF STUDY Prognosis study / retrospective case series. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | | | | | - Raffaella Morotti
- Yale School of Medicine, Department of Pathology, New Haven, CT 06520
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