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Ralph O, Sullivan G, Chan E, Olaitan OK. Environmental Benefits of Electronic Table of Contents of Journals Over Print. Cureus 2023; 15:e47907. [PMID: 38034145 PMCID: PMC10683840 DOI: 10.7759/cureus.47907] [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] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
Recent discussion has driven debate on the best format for journals to deliver content to their readers. Traditional dogma necessitated a physical print copy, which was sent to subscribers automatically and came with the benefits of ease of use and familiarity. With the passage of time, electronic tables of contents, with or without the option for a print copy, have been used in lieu to save cost and environmental concerns and to allow content to be consumed in a more convenient, tidier way.
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Affiliation(s)
- Oliver Ralph
- General Surgery, Rush University Medical Center, Chicago, USA
| | | | - Edie Chan
- Transplantation, Rush University Medical Center, Chicago, USA
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2
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Chang J, Hejna EE, Terranella SL, Trawczynski MH, Hollinger EF, Jensik SC, Olaitan OK, Hertl M, Chan EY. Graft repair of arteriovenous fistula aneurysms is associated with decreased long-term patency. Am J Surg 2022; 224:136-140. [DOI: 10.1016/j.amjsurg.2022.04.009] [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] [Received: 07/01/2021] [Revised: 02/08/2022] [Accepted: 04/09/2022] [Indexed: 11/01/2022]
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3
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Williams MD, Thomas J, Paner A, Chan EY, Hollinger EF, Schadde E, Hertl M, Santos CAQ, Olaitan OK. Can Donor-Derived Cell-Free DNA Detect Graft-Versus-Host Disease in Solid Organ Transplantation: A Case Report. Transplant Proc 2021; 54:176-179. [PMID: 34961600 DOI: 10.1016/j.transproceed.2021.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/19/2021] [Indexed: 12/12/2022]
Abstract
Graft-versus-host disease (GVHD) is a rare complication after solid organ transplant. We present a case of GVHD after simultaneous pancreas kidney transplant. The patient was diagnosed with a cutaneous biopsy after developing the classic symptoms of maculopapular rash, diarrhea, and pancytopenia. However, this patient had unexplained elevations in donor-derived cell-free DNA (dd-cfDNA) for months before the onset of GVHD symptoms. We hypothesize that GVHD may be associated with elevated dd-cfDNA as a result of massive donor lymphocyte proliferation and turnover. Further investigation is warranted because earlier diagnosis and treatment could improve outcomes in an otherwise lethal disease.
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Affiliation(s)
- Michael D Williams
- Department of Surgery, Rush University Medical Center, Chicago, Illinois.
| | - Joshua Thomas
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Agne Paner
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Edie Y Chan
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Edward F Hollinger
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Erik Schadde
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Martin Hertl
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Carlos A Q Santos
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
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4
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Witkowski P, Anteby R, Olaitan OK, Forbes RC, Niederhaus S, Ricordi C, Fair JH, Harland RC. Pancreatic Islets Quality and Potency Cannot be Verified as Required for Drugs: Reflection on the FDA Review of a Biological License Application for Human Islets. Transplantation 2021; 105:e409-e410. [PMID: 34231527 DOI: 10.1097/tp.0000000000003880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Piotr Witkowski
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, IL
| | - Roi Anteby
- Harvard T.H. Chan School of Public Health, Boston, MA
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Racheal C Forbes
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Silke Niederhaus
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Camilo Ricordi
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, FL
| | - Jeffrey H Fair
- Department of Surgery, University of Texas Medical branch, Galveston, TX
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5
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Witkowski P, Odorico J, Pyda J, Anteby R, Stratta RJ, Schrope BA, Hardy MA, Buse J, Leventhal JR, Cui W, Hussein S, Niederhaus S, Gaglia J, Desai CS, Wijkstrom M, Kandeel F, Bachul PJ, Becker YT, Wang LJ, Robertson RP, Olaitan OK, Kozlowski T, Abrams PL, Josephson MA, Andreoni KA, Harland RC, Kandaswamy R, Posselt AM, Szot GL, Ricordi C. Arguments against the Requirement of a Biological License Application for Human Pancreatic Islets: The Position Statement of the Islets for US Collaborative Presented during the FDA Advisory Committee Meeting. J Clin Med 2021; 10:jcm10132878. [PMID: 34209541 PMCID: PMC8269003 DOI: 10.3390/jcm10132878] [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: 05/17/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 12/25/2022] Open
Abstract
The Food and Drug Administration (FDA) has been regulating human islets for allotransplantation as a biologic drug in the US. Consequently, the requirement of a biological license application (BLA) approval before clinical use of islet transplantation as a standard of care procedure has stalled the development of the field for the last 20 years. Herein, we provide our commentary to the multiple FDA’s position papers and guidance for industry arguing that BLA requirement has been inappropriately applied to allogeneic islets, which was delivered to the FDA Cellular, Tissue and Gene Therapies Advisory Committee on 15 April 2021. We provided evidence that BLA requirement and drug related regulations are inadequate in reassuring islet product quality and potency as well as patient safety and clinical outcomes. As leaders in the field of transplantation and endocrinology under the “Islets for US Collaborative” designation, we examined the current regulatory status of islet transplantation in the US and identified several anticipated negative consequences of the BLA approval. In our commentary we also offer an alternative pathway for islet transplantation under the regulatory framework for organ transplantation, which would address deficiencies of in current system.
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Affiliation(s)
- Piotr Witkowski
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (P.J.B.); (Y.T.B.); (L.-J.W.)
- Correspondence: ; Tel.: +1-773-834-3524
| | - Jon Odorico
- Division of Transplantation, Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53792, USA;
| | - Jordan Pyda
- Beth Israel Deaconess Medical Center, Department of Surgery, Harvard Medical School, Boston, MA 02115, USA;
| | - Roi Anteby
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Robert J. Stratta
- Section of Transplantation, Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
| | - Beth A. Schrope
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA; (B.A.S.); (M.A.H.)
| | - Mark A. Hardy
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA; (B.A.S.); (M.A.H.)
| | - John Buse
- Division of Endocrinology, Department of Medicine, University of NC, Chapel Hill, NC 27516, USA;
| | - Joseph R. Leventhal
- Department of Surgery, Northwestern University School of Medicine, Chicago, IL 60611, USA;
| | - Wanxing Cui
- Cell Therapy Manufacturing Facility, Georgetown University Hospital, Washington, DC 20007, USA;
| | - Shakir Hussein
- Detroit Medical Center, Department of Surgery, Wayne State School of Medicine, Detroit, MI 48201, USA;
| | - Silke Niederhaus
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Jason Gaglia
- Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA;
| | - Chirag S. Desai
- Department of Surgery, Section of Transplantation, University of NC, Chapel Hill, NC 27516, USA;
| | - Martin Wijkstrom
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Fouad Kandeel
- Department of Translational Research and Cellular Therapeutics, Diabetes and Metabolism Research Institute, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA;
| | - Piotr J. Bachul
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (P.J.B.); (Y.T.B.); (L.-J.W.)
| | - Yolanda Tai Becker
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (P.J.B.); (Y.T.B.); (L.-J.W.)
| | - Ling-Jia Wang
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (P.J.B.); (Y.T.B.); (L.-J.W.)
| | - R. Paul Robertson
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Washington, Seattle, WA 98133, USA;
| | | | - Tomasz Kozlowski
- Division of Transplantation, Department of Surgery, The University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA;
| | - Peter L. Abrams
- MedStar Georgetown Transplant Institute, Washington, DC 20007, USA;
| | | | - Kenneth A. Andreoni
- Department of Surgery, University of Florida, College of Medicine, Gainesville, FL 32610-0118, USA;
- Case Western Reserve University, Cleveland, OH 44106-5047, USA
| | - Robert C. Harland
- Department of Surgery, University of Arizona, Tucson, AZ 85711, USA;
| | - Raja Kandaswamy
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Andrew M. Posselt
- Division of Transplantation, Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA; (A.M.P.); (G.L.S.)
| | - Gregory L. Szot
- Division of Transplantation, Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA; (A.M.P.); (G.L.S.)
| | - Camillo Ricordi
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, FL 33136, USA;
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Santos CAQ, Rhee Y, Hollinger EF, Olaitan OK, Schadde E, Peev V, Saltzberg SN, Hertl M. Comparative incidence and outcomes of COVID-19 in kidney or kidney-pancreas transplant recipients versus kidney or kidney-pancreas waitlisted patients: A single-center study. Clin Transplant 2021; 35:e14362. [PMID: 33998716 PMCID: PMC8209946 DOI: 10.1111/ctr.14362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND COVID-19 epidemiologic studies comparing immunosuppressed and immunocompetent patients may provide insight into the impact of immunosuppressants on outcomes. METHODS In this retrospective cohort study, we assembled kidney or kidney-pancreas transplant recipients who underwent transplant from January 1, 2010, to June 30, 2020, and kidney or kidney-pancreas waitlisted patients who were ever on the waitlist from January 1, 2019, to June 30, 2020. We identified laboratory-confirmed COVID-19 until January 31, 2021, and tracked its outcomes by leveraging informatics infrastructure developed for an outcomes research network. RESULTS COVID-19 was identified in 62 of 887 kidney or kidney-pancreas transplant recipients and 20 of 434 kidney or kidney-pancreas waitlisted patients (7.0% vs. 4.6%, p = .092). Of these patients with COVID-19, hospitalization occurred in 48 of 62 transplant recipients and 8 of 20 waitlisted patients (77% vs. 40%, p = .002); intensive care unit admission occurred in 18 of 62 transplant recipients and 2 of 20 waitlisted patients (29% vs. 10%, p = .085); and 7 transplant recipients were mechanically ventilated and died, whereas no waitlisted patients were mechanically ventilated or died (11% vs. 0%, p = .116). CONCLUSIONS Our study provides single-center data and an informatics approach that can be used to inform the design of multicenter studies.
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Affiliation(s)
- Carlos A Q Santos
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Yoona Rhee
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Edward F Hollinger
- Division of Abdominal Transplantation, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Oyedolamu K Olaitan
- Division of Abdominal Transplantation, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Erik Schadde
- Division of Abdominal Transplantation, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Vasil Peev
- Division of Nephrology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Samuel N Saltzberg
- Division of Nephrology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Martin Hertl
- Division of Abdominal Transplantation, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
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Witkowski P, Philipson LH, Kaufman DB, Ratner LE, Abouljoud MS, Bellin MD, Buse JB, Kandeel F, Stock PG, Mulligan DC, Markmann JF, Kozlowski T, Andreoni KA, Alejandro R, Baidal DA, Hardy MA, Wickrema A, Mirmira RG, Fung J, Becker YT, Josephson MA, Bachul PJ, Pyda JS, Charlton M, Millis JM, Gaglia JL, Stratta RJ, Fridell JA, Niederhaus SV, Forbes RC, Jayant K, Robertson RP, Odorico JS, Levy MF, Harland RC, Abrams PL, Olaitan OK, Kandaswamy R, Wellen JR, Japour AJ, Desai CS, Naziruddin B, Balamurugan AN, Barth RN, Ricordi C. The demise of islet allotransplantation in the United States: A call for an urgent regulatory update. Am J Transplant 2021; 21:1365-1375. [PMID: 33251712 PMCID: PMC8016716 DOI: 10.1111/ajt.16397] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 07/17/2020] [Revised: 10/14/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023]
Abstract
Islet allotransplantation in the United States (US) is facing an imminent demise. Despite nearly three decades of progress in the field, an archaic regulatory framework has stymied US clinical practice. Current regulations do not reflect the state-of-the-art in clinical or technical practices. In the US, islets are considered biologic drugs and "more than minimally manipulated" human cell and tissue products (HCT/Ps). In contrast, across the world, human islets are appropriately defined as "minimally manipulated tissue" and not regulated as a drug, which has led to islet allotransplantation (allo-ITx) becoming a standard-of-care procedure for selected patients with type 1 diabetes mellitus. This regulatory distinction impedes patient access to islets for transplantation in the US. As a result only 11 patients underwent allo-ITx in the US between 2016 and 2019, and all as investigational procedures in the settings of a clinical trials. Herein, we describe the current regulations pertaining to islet transplantation in the United States. We explore the progress which has been made in the field and demonstrate why the regulatory framework must be updated to both better reflect our current clinical practice and to deal with upcoming challenges. We propose specific updates to current regulations which are required for the renaissance of ethical, safe, effective, and affordable allo-ITx in the United States.
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Affiliation(s)
- Piotr Witkowski
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | | | - Dixon B. Kaufman
- Division of Transplantation, Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lloyd E. Ratner
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Marwan S. Abouljoud
- Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Melena D. Bellin
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - John B. Buse
- Division of Endocrinology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Fouad Kandeel
- Department of Translational Research and Cellular Therapeutics, Diabetes and Metabolism Research Institute, Beckman Research Institute of City of Hope, Duarte, California, USA
| | - Peter G. Stock
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, California, USA
| | - David C. Mulligan
- Department of Surgery, Transplantation and Immunology, Yale University, New Haven, Connecticut, USA
| | - James F. Markmann
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tomasz Kozlowski
- Division of Transplantation, Department of Surgery, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Kenneth A. Andreoni
- Department of Surgery, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Rodolfo Alejandro
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, Florida, USA
| | - David A. Baidal
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, Florida, USA
| | - Mark A. Hardy
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Amittha Wickrema
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, Illinois, USA
| | - Raghavendra G. Mirmira
- Department of Medicine, Translational Research Center, University of Chicago, Chicago, Illinois, USA
| | - John Fung
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Yolanda T. Becker
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Michelle A. Josephson
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Piotr J. Bachul
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Jordan S. Pyda
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Charlton
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - J. Michael Millis
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Jason L. Gaglia
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert J. Stratta
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jonathan A. Fridell
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Silke V. Niederhaus
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Rachael C. Forbes
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kumar Jayant
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - R. Paul Robertson
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Jon S. Odorico
- Division of Transplantation, Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Marlon F. Levy
- Division of Transplantation, Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | | | - Peter L. Abrams
- MedStar Georgetown Transplant Institute, Washington, District of Columbia, USA
| | | | - Raja Kandaswamy
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jason R. Wellen
- Department of Surgery, Washington University, St Louis, Missouri, USA
| | - Anthony J. Japour
- Anthony Japour and Associates, Medical and Scientific Consulting Inc, Miami, FL, USA
| | - Chirag S. Desai
- Department of Surgery, Section of Transplantation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bashoo Naziruddin
- Transplantation Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Appakalai N. Balamurugan
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Rolf N. Barth
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Camillo Ricordi
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, Florida, USA
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Terranella SL, Poirier J, Chan EY, Hertl M, Olaitan OK. Should Pre-Transplant Hemoglobin A1c Be Used to Predict Post-Transplant Compliance in End-Stage Renal Disease Patients Undergoing Kidney Transplantation? Ann Transplant 2020; 25:e924061. [PMID: 32587234 PMCID: PMC7339972 DOI: 10.12659/aot.924061] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Patient compliance with immunosuppressive therapy after transplant has impacts on both graft and patient outcomes. For diabetic end-stage renal disease (ESRD) patients who are undergoing evaluation for kidney transplantation in our program, hemoglobin A1c (HbA1c) level of >10% is used as a flag that the patient may be at risk for noncompliance and that more comprehensive psychosocial screening is needed prior to transplant. We evaluated the association between pre-transplant HbA1c level and post-transplant compliance, as no study to date has looked at this in the transplant population. Material/Methods The charts of 392 patients who received a kidney transplant at a single institution between July 2008 and June 2012 were retrospectively reviewed. One hundred and sixty-five diabetic patients who received a kidney transplant alone were included in the final analysis. Our predictive variable was HbA1c level greater than 7.7% based on previous reports in the diabetic population. Outcome measures were graft survival, rejection episodes, unexplained low immunosuppressant levels, and documented noncompliance. Results There were no statistically significant differences between the HbA1c groups of ≤7.7% and >7.7% in outcomes of failed grafts (22.0% and 17.8%, p=0.2), rejection episodes (15.0% and 6.7%, p=0.3), unexplained low immunosuppressant level (46.6% and 37.9%, p=0.3), and documented noncompliance (25.0% and 16.7%, p=0.4). Conclusions In diabetic ESRD patients selected for renal transplantation, elevated pre-transplant HbA1c levels, defined as HbA1c >7.7%, are not predictive of post-transplant medication compliance. We advocate that this group of patients should not be denied transplant solely on their elevated pre-transplant HbA1c.
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Affiliation(s)
| | - Jennifer Poirier
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Edie Y Chan
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Martin Hertl
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
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9
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Niederhaus SV, Carrico RJ, Prentice MA, Fox AC, Mujtaba MA, Dunn TB, Olaitan OK, Fisher JS, Stratta RJ, Farney AC, Odorico JS, Fridell JA. C-peptide levels do not correlate with pancreas allograft failure: Multicenter retrospective analysis and discussion of the new OPT definition of pancreas allograft failure. Am J Transplant 2019; 19:1178-1186. [PMID: 30230218 DOI: 10.1111/ajt.15118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/17/2018] [Revised: 08/24/2018] [Accepted: 09/08/2018] [Indexed: 01/25/2023]
Abstract
The OPTN Pancreas Transplantation Committee performed a multicenter retrospective study to determine if undetectable serum C-peptide levels correspond to center-reported pancreas graft failures. C-peptide data from seven participating centers (n = 415 graft failures for transplants performed from 2002 to 2012) were analyzed pretransplant, at graft failure, and at return to insulin. One hundred forty-nine C-peptide values were submitted at pretransplant, 94 at return to insulin, and 233 at graft failure. There were 77 transplants with two available values (at pretransplant and at graft failure). For recipients in the study with pretransplant C-peptide <0.75 ng/mL who had a posttransplant C-peptide value available (n = 61), graft failure was declared at varying levels of C-peptide. High C-peptide values at graft failure were not explained by nonfasting testing or by individual center bias. Transplant centers declare pancreas graft failure at varying levels of C-peptide and do not consistently report C-peptide data. Until February 28, 2018, OPTN did not require reporting of posttransplant C-peptide levels and it appears that C-peptide levels are not consistently used for evaluating graft function. C-peptide levels should not be used as the sole criterion for the definition of pancreas graft failure.
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Affiliation(s)
- Silke V Niederhaus
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | | | | | - Abigail C Fox
- United Network for Organ Sharing, Richmond, Virginia
| | - Muhammad A Mujtaba
- Division of Nephrology and Transplant, Department of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Ty B Dunn
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnsota
| | - Oyedolamu K Olaitan
- Section of Abdominal Transplantation, Department of General Surgery, Rush Medical College, Chicago, Illinois
| | - Jonathan S Fisher
- Scripps Center for Organ Transplantation, Scripps Health, La Jolla, California
| | - Robert J Stratta
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Alan C Farney
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jon S Odorico
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Jonathan A Fridell
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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10
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Olaitan OK, Zimmermann JA, Shields WP, Rodriguez-Navas G, Awan A, Mohan P, Little DM, Hickey DP. Long-term outcome of intensive initial immunosuppression protocol in pediatric deceased donor renal transplantation. Pediatr Transplant 2010; 14:87-92. [PMID: 19309452 DOI: 10.1111/j.1399-3046.2009.01138.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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] [Indexed: 11/26/2022]
Abstract
To report the long-term outcome of deceased donor kidney transplantation in children with emphasis on the use of an intensive initial immunosuppression protocol using R-ATG as antibody induction. Between January 1991 and December 1997, 82 deceased donor kidney transplantations were performed in 75 pediatric recipients. Mean recipient age at transplantation was 12.9 yr and the mean follow-up period was 12.6 yr. All patients received quadruple immunosuppression with steroid, cyclosporine, azathioprine, and antibody induction using R-ATG-Fresenius. Actual one, five, and 10 yr patient survival rates were 99%, 97%, and 94%, respectively; only one patient (1.2%) developed PTLD. Actual one, five, and 10 yr overall graft survival rates were 84%, 71%, and 50%, respectively; there were five cases (6%) of graft thrombosis and the actual immunological graft survival rates were 91%, 78%, and 63% at one, five, and 10 yr, respectively. The use of an intensive initial immunosuppression protocol with R-ATG as antibody induction is safe and effective in pediatric recipients of deceased donor kidneys with excellent immunological graft survival without an increase in PTLD or other neoplasms over a minimum 10-yr follow up.
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Affiliation(s)
- Oyedolamu K Olaitan
- National Kidney and Pancreas Transplantation Centre, Beaumont Hospital, Dublin, Ireland.
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