1
|
Ammary FA, Yu Y, Ferzola A, Motter JD, Massie AB, Yu S, Thomas AG, Crews DC, Segev DL, Muzaale AD, Henderson ML. The first increase in live kidney donation in the United States in 15 years. Am J Transplant 2020; 20:3590-3598. [PMID: 32524764 PMCID: PMC8717834 DOI: 10.1111/ajt.16136] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 04/22/2020] [Revised: 05/26/2020] [Accepted: 06/01/2020] [Indexed: 01/25/2023]
Abstract
The first sustained increase in live kidney donation in the United States in 15 years was observed from 2017 to 2019. To help sustain this surge, we studied 35 900 donors (70.3% white, 14.5% Hispanic, 9.3% black, 4.4% Asian) to understand the increase in 2017-2019 vs 2014-2016 using Poisson regression. Among biologically related donors aged <35, 35-49, and ≥50 years, the number of donors did not change across race/ethnicity but increased by 38% and 29% for Hispanic and black ≥50. Among unrelated donors <35, 35-49, and ≥50, white donors increased by 18%, 14%, and 27%; Hispanic donors <35 did not change but increased by 22% and 35% for 35-49 and ≥50; black donors <35 declined by 23% and did not change for 35-49 and ≥50; Asian donors did not change. Among kidney paired donors <35, 35-49, and ≥50, white donors increased by 42%, 50%, and 68%; Hispanic donors <35 and 35-49 increased by 36% and 55% and did not change for ≥50; black donors did not change; Asian donors <35 did not change but increased by 107% and 82% for 35-49 and ≥50. The increase in donation was driven predominantly by unrelated and paired white donors. Donation among unrelated black individuals should be promoted.
Collapse
Affiliation(s)
- Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yifan Yu
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Alexander Ferzola
- 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
| | - Allan B. Massie
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sile Yu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alvin G. Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Deidra C. Crews
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Scientific Registry of Transplant Recipients, Minneapolis, MN
| | - Abimereki D. Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
2
|
Al Ammary F, Sidoti C, Segev DL, Henderson ML. Health Care Policy and Regulatory Challenges for Adoption of Telemedicine in Kidney Transplantation. Am J Kidney Dis 2020; 77:773-776. [PMID: 33171215 DOI: 10.1053/j.ajkd.2020.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/23/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Carolyn Sidoti
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Division of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD
| |
Collapse
|
3
|
Lentine KL, Motter JD, Henderson ML, Hays RE, Shukhman E, Hunt J, Al Ammary F, Kumar V, LaPointe Rudow D, Van Pilsum Rasmussen SE, Nishio-Lucar AG, Schaefer HM, Cooper M, Mandelbrot DA. Care of international living kidney donor candidates in the United States: A survey of contemporary experience, practice, and challenges. Clin Transplant 2020; 34:e14064. [PMID: 32808320 DOI: 10.1111/ctr.14064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/08/2020] [Revised: 08/08/2020] [Accepted: 08/13/2020] [Indexed: 12/25/2022]
Abstract
The evaluation and care of non-US citizen, non-US residents who wish to come to the United States to serve as international living kidney donors (ILKDs) can pose unique challenges. We surveyed US transplant programs to better understand practices related to ILKD care. We distributed the survey by email and professional society list-servs (Fall 2018, assessing 2017 experience). Eighty-five programs responded (36.8% program response rate), of which 80 considered ILKD candidates. Only 18 programs had written protocols for ILKD evaluation. Programs had a median of 3 (range: 0,75) ILKD candidates who initiated contact during the year, from origin countries spanning 6 continents. Fewer (median: 1, range: 0,25) were approved for donation. Program-reported reasons for not completing ILKD evaluations included visa barriers (58.6%), inability to complete evaluation (34.3%), concerns regarding follow-up (31.4%) or other healthcare access (28.6%), and financial impacts (21.4%). Programs that did not evaluate ILKDs reported similar concerns. Staff time required to evaluate ILKDs was estimated as 1.5-to-3-times (47.9%) or >3-times (32.9%) that needed for domestic candidates. Among programs accepting ILKDs, on average 55% reported successful completion of 1-year follow-up. ILKD evaluation is a resource-intensive process with variable outcomes. Planning and commitment are necessary to care for this unique candidate group.
Collapse
Affiliation(s)
- Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA
| | - Jennifer D Motter
- Johns Hopkins Comprehensive Transplant Center, Baltimore, Maryland, USA
| | - Macey L Henderson
- Johns Hopkins Comprehensive Transplant Center, Baltimore, Maryland, USA
| | - Rebecca E Hays
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Ellen Shukhman
- Cedars-Sinai Comprehensive Transplant Center, Los Angeles, California, USA
| | - Julia Hunt
- Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Fawaz Al Ammary
- Johns Hopkins Comprehensive Transplant Center, Baltimore, Maryland, USA
| | - Vineeta Kumar
- University of Alabama Comprehensive Transplant Center, Birmingham, Alabama, USA
| | | | | | | | | | - Matthew Cooper
- MedStar Georgetown Transplant Institute, Washington, District of Columbia, USA
| | | |
Collapse
|
4
|
Henderson ML, Herbst L, Love AD. Social Media and Kidney Transplant Donation in the United States: Clinical and Ethical Considerations When Seeking a Living Donor. Am J Kidney Dis 2020; 76:583-585. [DOI: 10.1053/j.ajkd.2020.03.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/24/2020] [Indexed: 11/11/2022]
|
5
|
Waldram MM, Thomas AG, Yu Y, Holscher CM, Nguyen AQ, Halpern SE, Ottman S, Muzaale AD, Henderson ML, Lentine KL, Al Ammary F, Brennan DC, Garonzik-Wang JM, Segev DL, Massie AB. Long-term renal function in living kidney donors with simple renal cysts: A retrospective cohort study. Clin Transplant 2020; 34:e13905. [PMID: 32399996 PMCID: PMC8720490 DOI: 10.1111/ctr.13905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/08/2020] [Revised: 04/17/2020] [Accepted: 05/06/2020] [Indexed: 01/25/2023]
Abstract
Simple (Bosniak I) renal cysts are considered acceptable in living kidney donor selection in terms of cancer risk. However, they tend to increase in number and size over time and might compromise renal function in donors. To clarify their implications for long-term renal function, we characterized the prevalence of renal cysts in 454 individuals who donated at our center from 2000 to 2007. We estimated the association between the presence of cysts in the kidney remaining after nephrectomy (ie, retained cysts) and postdonation eGFR trajectory using mixed-effects linear regression. Donors with retained cysts (N = 86) were older (P < .001) and had slightly lower predonation eGFR (median 94 vs 98 mL/min/1.73 m2 , P < .01) than those without cysts. Over a median 7.8 years, donors with retained cysts had lower baseline eGFR (-8.7 -5.6 -2.3 mL/min/1.73 m2 , P < .01) but similar yearly change in eGFR (-0.4 0.02 0.4 mL/min/1.73 m2 , P = .2) compared to those without retained cysts. Adjusting for predonation characteristics, there was no difference in baseline eGFR (P = .6) or yearly change in eGFR (P > .9). There continued to be no evidence of an association when we considered retained cyst(s) ≥10 mm or multiple retained cysts (all P > .05). These findings reaffirm current practices of accepting candidates with simple renal cysts for donor nephrectomy.
Collapse
Affiliation(s)
- Madeleine M. Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alvin G. Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yifan Yu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Courtenay M. Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anh Q. Nguyen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Samantha E. Halpern
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shane Ottman
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Abimereki D. Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Krista L. Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA
| | - Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel C. Brennan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
6
|
Van Pilsum Rasmussen SE, Uriarte J, Anderson N, Doby B, Ferzola A, Sung H, Cooney C, Brandacher G, Gordon E, Segev DL, Henderson ML. Public education materials about Vascular Composite Allotransplantation and donation in the United States: Current scope and limitations. Clin Transplant 2020; 34:e14066. [PMID: 32810365 DOI: 10.1111/ctr.14066] [Citation(s) in RCA: 3] [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: 04/20/2020] [Revised: 07/28/2020] [Accepted: 08/11/2020] [Indexed: 11/27/2022]
Abstract
As the field of Vascular Composite Allotransplantation (VCA) grows, demand for VCA donations will increase. The public should be made aware of this treatment option to support patients' informed decision-making and authorization for deceased donation. We assessed the availability and quality of existing VCA public education materials from organ procurement organizations (OPOs), transplant centers, the Organ Procurement and Transplant Network, Veterans Affairs, and the Department of Defense. A content analysis was performed to identify topics covered and important gaps. In total, 1314 public education materials were analyzed, including OPO Facebook posts (61.6%), OPO Twitter posts (29.9%), websites (6.4%), and written documents (eg, fact sheets, research reports) (2.1%). Upper extremity (34.7%) and face (34.5%) transplants were more commonly covered than reproductive (6.4%) or other VCA types (2.8%). Most materials (76.6%) referenced a specific VCA story. However, few materials described which patient population could benefit from VCA (eg, Veterans, amputees, burn victims, 16.4%), the authorization requirements for VCA donation (6.6%), or the appearance of transplanted VCA organs (1.2%). Current VCA public education materials do not adequately educate the public. More comprehensive education materials are needed to prepare the public to authorize VCA donation, become potential donors, or learn about transplant options.
Collapse
Affiliation(s)
| | - Jefferson Uriarte
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Naomi Anderson
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brianna Doby
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alexander Ferzola
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hannah Sung
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carisa Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elisa Gordon
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| |
Collapse
|
7
|
Purnell TS, Bae S, Luo X, Johnson M, Crews DC, Cooper LA, Henderson ML, Greer RC, Rosas SE, Boulware LE, Segev DL. National Trends in the Association of Race and Ethnicity With Predialysis Nephrology Care in the United States From 2005 to 2015. JAMA Netw Open 2020; 3:e2015003. [PMID: 32852554 PMCID: PMC7453308 DOI: 10.1001/jamanetworkopen.2020.15003] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 06/16/2020] [Indexed: 11/14/2022] Open
Abstract
Importance Predialysis nephrology care is associated with better survival among patients with end-stage kidney disease. Objective To examine national trends in racial/ethnic disparities in receipt of predialysis nephrology care at least 1 year before dialysis initiation in the United States from 2005 to 2015. Design, Setting, and Participants This national registry study assessed US registry data of 1 000 390 adults in the US Renal Data System who initiated maintenance dialysis treatment from January 1, 2005, to December 31, 2015, in multiple cross-sectional analyses. Multivariable logistic regression models were used to examine national trends in racial/ethnic disparities in receipt of predialysis nephrology care with adjustments for potential confounders. Data were analyzed April 17, 2020. Exposure Race/ethnicity of the patients. Main Outcomes and Measures Receipt of at least 12 months of predialysis nephrology care as determined by clinician-based documentation on the End Stage Renal Disease Medical Evidence Report Form CMS 2728. Results Among 1 000 390 adults (57.2% male; 54.6% White, 27.8% Black, 14.0% Hispanic, and 3.6% Asian; mean [SD] age, 62.4 [15.6] years) who initiated maintenance dialysis in the United States from 2005 to 2015, 310 743 (31.1%) received at least 12 months of predialysis nephrology care. In 2005 to 2007, compared with White adults, the adjusted odds ratio for receipt of at least 12 months of predialysis nephrology care was 0.82 (95% CI, 0.80-0.84) among Black adults, 0.67 (95% CI, 0.65-0.69) among Hispanic adults, and 0.84 (95% CI, 0.80-0.89) among Asian adults; in 2014 to 2015, the adjusted odds ratio was 0.76 (95% CI, 0.74-0.78) among Black adults, 0.61 (95% CI, 0.60-0.63) among Hispanic adults, and 0.90 (95% CI: 0.86-0.95) among Asian adults. Conclusions and Relevance In this cross-sectional study of more than 1 million US adults with end-stage kidney disease, racial and ethnic disparities in predialysis nephrology care did not substantially improve from 2005 to 2015. Study findings suggest that national strategies to address racial/ethnic disparities in predialysis nephrology care are needed.
Collapse
Affiliation(s)
- Tanjala S. Purnell
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, The Johns Hopkins University, Baltimore, Maryland
| | - Sunjae Bae
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Xun Luo
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Morgan Johnson
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, The Johns Hopkins University, Baltimore, Maryland
| | - Deidra C. Crews
- Johns Hopkins Center for Health Equity, The Johns Hopkins University, Baltimore, Maryland
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lisa A. Cooper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, The Johns Hopkins University, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Macey L. Henderson
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, The Johns Hopkins University, Baltimore, Maryland
| | - Raquel C. Greer
- Johns Hopkins Center for Health Equity, The Johns Hopkins University, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sylvia E. Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts
| | - L. Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Dorry L. Segev
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
8
|
Van Pilsum Rasmussen SE, Ferzola A, Cooney CM, Shores JT, Lee WA, Goldman E, Kaufman CL, Brandacher G, Segev DL, Henderson ML. Psychosocial factors and medication adherence among recipients of vascularized composite allografts. SAGE Open Med 2020; 8:2050312120940423. [PMID: 32695395 PMCID: PMC7350038 DOI: 10.1177/2050312120940423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/06/2020] [Accepted: 06/15/2020] [Indexed: 11/15/2022] Open
Abstract
Objectives Psychosocial factors are important predictors of medication adherence, and subsequently graft survival, in solid organ transplantation. Early experiences suggest this may also be the case in vascularized composite allotransplantation. Methods Using validated tools, we surveyed upper extremity transplant recipients at two centers to assess depression (Patient Health Questionnaire-9), personality (Ten-Item Personality Inventory), anxiety (Generalized Anxiety Disorder 7-Item Scale), post-traumatic stress disorder (Primary Care Post-Traumatic Stress Disorder Screen for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), and social support (Multidimensional Scale of Perceived Social Support). Medication adherence among vascularized composite allotransplantation recipients at two centers was assessed by a member of the clinical research team using the recipients' medical records. Results Medication adherence was reported for 12 vascularized composite allotransplantation recipients, and 9 vascularized composite allotransplantation recipients completed psychosocial assessments. Most recipients were believed to be adherent to their immunosuppression, however, three recipients were believed to be non-adherent and a member of the clinical team had discussed non-adherence at least once with five recipients. Results from the psychosocial assessment (n = 9) indicated that eight participants had high levels of social support, and eight demonstrated high levels of conscientiousness which have been associated with better medication adherence in solid organ transplantation. However, three participants demonstrated mild anxiety, two demonstrated minimal symptoms of depression, and one demonstrated post-traumatic stress disorder which have been associated with worse medication adherence in solid organ transplantation. Conclusion These findings lay the groundwork for future assessments of the role psychosocial factors play in facilitating medication adherence and broader transplant outcomes.
Collapse
Affiliation(s)
| | - Alexander Ferzola
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carisa M Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jaime T Shores
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wp Andrew Lee
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily Goldman
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
| | - Christina L Kaufman
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, USA
| |
Collapse
|
9
|
Van Pilsum Rasmussen SE, Eno A, Bowring MG, Lifshitz R, Garonzik-Wang JM, Al Ammary F, Brennan DC, Massie AB, Segev DL, Henderson ML. Kidney Dyads: Caregiver Burden and Relationship Strain Among Partners of Dialysis and Transplant Patients. Transplant Direct 2020; 6:e566. [PMID: 32766421 PMCID: PMC7339348 DOI: 10.1097/txd.0000000000000998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/18/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Caring for dialysis patients is difficult, and this burden often falls on a spouse or cohabiting partner (henceforth referred to as caregiver-partners). At the same time, these caregiver-partners often come forward as potential living kidney donors for their loved ones who are on dialysis (henceforth referred to as patient-partners). Caregiver-partners may experience tangible benefits to their well-being when their patient-partner undergoes transplantation, yet this is seldom formally considered when evaluating caregiver-partners as potential donors. METHODS To quantify these potential benefits, we surveyed caregiver-partners of dialysis patients and kidney transplant (KT) recipients (N = 99) at KT evaluation or post-KT. Using validated tools, we assessed relationship satisfaction and caregiver burden before or after their patient-partner's dialysis initiation and before or after their patient-partner's KT. RESULTS Caregiver-partners reported increases in specific measures of caregiver burden (P = 0.03) and stress (P = 0.01) and decreases in social life (P = 0.02) and sexual relations (P < 0.01) after their patient-partner initiated dialysis. However, after their patient-partner underwent KT, caregiver-partners reported improvements in specific measures of caregiver burden (P = 0.03), personal time (P < 0.01), social life (P = 0.01), stress (P = 0.02), sexual relations (P < 0.01), and overall quality of life (P = 0.03). These improvements were of sufficient impact that caregiver-partners reported similar levels of caregiver burden after their patient-partner's KT as before their patient-partner initiated dialysis (P = 0.3). CONCLUSIONS These benefits in caregiver burden and relationship quality support special consideration for spouses and partners in risk-assessment of potential kidney donors, particularly those with risk profiles slightly exceeding center thresholds.
Collapse
Affiliation(s)
| | - Ann Eno
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mary G. Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel C. Brennan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD
| | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD
| |
Collapse
|
10
|
Massie AB, Holscher CM, Henderson ML, Fahmy LM, Thomas AG, Al Ammary F, Getsin SN, Snyder JJ, Lentine KL, Garg AX, Segev DL. Association of Early Postdonation Renal Function With Subsequent Risk of End-Stage Renal Disease in Living Kidney Donors. JAMA Surg 2020; 155:e195472. [PMID: 31968070 DOI: 10.1001/jamasurg.2019.5472] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Importance Living kidney donation is associated with increased long-term risk of end-stage renal disease (ESRD). An early postdonation marker of ESRD risk could improve postdonation risk assessment and counseling for kidney donors and allow early intervention for donors at increased risk. Objective To determine the association between renal function in the first 6 months postdonation and subsequent risk of ESRD in kidney donors. Design, Setting, and Participants This secondary analysis of a prospective national cohort uses a population-based registry of all living kidney donors in the United States between October 26, 1999, and January 1, 2018, with follow-up through December 31, 2018. All kidney donors who had donated in the date range and had serum creatinine measured at 6 months (±3 months) postdonation were included. Exposures Renal function as measured by estimated glomerular filtration rate 6 months after donation (eGFR6). Main Outcomes and Measures End-stage renal disease, ascertained via linkage to Centers for Medicare & Medicaid Services data. Results A total of 71 468 living kidney donors were included (of 109 065 total donors over this period). Their median (interquartile range) eGFR6 was 63 (54-74) mL/min/1.73 m2. Cumulative incidence of ESRD at 15 years postdonation ranged from 11.7 donors per 10 000 donors with eGFR6 values greater than 70 mL/min/1.73 m2 to 33.1 donors per 10 000 donors with eGFR6 values of 50 mL/min/1.73 m2 or less. Adjusting for age, race, sex, body mass index, and biological relationship, every 10 mL/min/1.73 m2 reduction in eGFR6 was associated with a 28% increased risk of ESRD (adjusted hazard ratio, 1.28 [95% CI, 1.06-1.54]; P = .009). The association between predonation eGFR and ESRD was not significant and was fully mediated by eGFR6 (adjusted hazard ratio, 1.00 [95% CI, 0.86-1.17]; P = .97). The postdonation eGFR value was a better marker of ESRD than eGFR decline after donation or the ratio of eGFR6 to predonation eGFR, as determined by the Akaike information criterion (in which a lower value indicates a better model fit; eGFR6, 1495.61; predonation eGFR - eGFR6, 1503.58; eGFR6 / predonation eGFR, 1502.30). Conclusions and Relevance In this study, there was an independent association of eGFR6 with subsequent ESRD risk in living kidney donors, even after adjusting for predonation characteristics. The findings support measurement of early postdonation serum creatinine monitoring in living kidney donors, and the use of these data to help identify donors who might need more careful surveillance and early intervention.
Collapse
Affiliation(s)
- Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Courtenay M Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lara M Fahmy
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fawaz Al Ammary
- Department of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Samantha N Getsin
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jon J Snyder
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Krista L Lentine
- Center for Abdominal Transplantation, St Louis University, St Louis, Missouri
| | - Amit X Garg
- Department of Medicine, Western University, London, Ontario, Canada
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.,Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| |
Collapse
|
11
|
Shukhman E, Hunt J, LaPointe-Rudow D, Mandelbrot D, Hays R, Kumar V, Schaefer H, Ammary FA, Henderson ML, Nishio-Lucar A, Cooper M, Lentine KL. Evaluation and care of international living kidney donor candidates: Strategies for addressing common considerations and challenges. Clin Transplant 2020; 34:e13792. [PMID: 31991481 PMCID: PMC8761064 DOI: 10.1111/ctr.13792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/03/2019] [Revised: 12/28/2019] [Accepted: 01/19/2020] [Indexed: 12/24/2022]
Abstract
End-stage kidney disease patients in the United States may have family members or friends who are not US citizens or residents but are willing to serve as their living kidney donor in the United States ("international donors"). In July 2017, the American Society for Transplantation (AST) Live Donor Community of Practice (LDCOP) convened a multidisciplinary workgroup of experts in living donation care, including coordinators, social workers, donor advocates, administrators, and physicians, to evaluate educational gaps related to the evaluation and care of international donors. The evaluation of international living donor candidates is a resource-intensive process that raises key considerations for assessing risk of exploitation/inducement and addressing communication barriers, logistics barriers, and access to care in their home country. Through consensus-building discussions, we developed recommendations related to: (a) establishing program guidelines for international donor candidate evaluation and selection; (b) initial screening; (c) logistics planning; (d) comprehensive evaluation; and (e) postdonation care and follow-up. These recommendations are not intended to direct formal policy, but rather as guidance to help programs more efficiently and effectively structure and execute evaluations and care coordination. We also offer recommendations for research and advocacy to optimize the care of this unique group of living donors.
Collapse
Affiliation(s)
- Ellen Shukhman
- Cedars-Sinai Comprehensive Transplant Center, Los Angeles, CA
| | - Julia Hunt
- Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, NY
| | | | | | - Rebecca Hays
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - Vineeta Kumar
- University of Alabama Comprehensive Transplant Center, Birmingham, AL
| | | | - Fawaz Al Ammary
- Johns Hopkins Comprehensive Transplant Center, Baltimore, MD
| | | | | | | | - Krista L. Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO
| |
Collapse
|
12
|
Henderson ML, Hays R, Van Pilsum Rasmussen SE, Mandelbrot DA, Lentine KL, Maluf DG, Waldram MM, Cooper M. Living donor program crisis management plans: Current landscape and talking point recommendations. Am J Transplant 2020; 20:546-552. [PMID: 31552699 PMCID: PMC6984987 DOI: 10.1111/ajt.15618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/19/2019] [Revised: 08/18/2019] [Accepted: 09/03/2019] [Indexed: 01/25/2023]
Abstract
Although minimized by expert evaluation, operative technique, and postoperative care, the extremely low risk of perioperative mortality following living kidney or liver donation will never be eliminated. Furthermore, anticipation of poor donor outcome may simultaneously be a source of anxiety for physicians and programs and also be a circumstance for which they are unprepared. We conducted a national survey of US transplant surgeons to understand experiences with and systemic preparedness for the event of a living donor death. Respondents represented 87 unique transplant programs (71 kidney and 16 liver donor programs). Perioperative deaths were rare, as expected. Although most respondents (N = 57, 64% of total respondents; 88% of liver programs) reported being moderately to extremely concerned about a future living donor death at their institution, only 30 (33% of total program respondents) had a written plan available in the case of such an event; 63% of programs would find guidance and recommendations useful. To help address this gap, the American Society of Transplantation Live Donor Community of Practice (AST LDCOP) developed Living Donor Crisis Management Plan Talking Points suitable to guide crisis plan development at transplant programs.
Collapse
Affiliation(s)
- Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD
| | - Rebecca Hays
- Department of Coordinated Care, University of Wisconsin Hospital and Clinics, Madison, WI
| | | | - Didier A. Mandelbrot
- Department of Medicine, University of Wisconsin Hospitals and Clinics, Madison, WI
| | | | | | - Madeleine M. Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | |
Collapse
|
13
|
Muzaale AD, Massie AB, Al Ammary F, Henderson ML, Purnell TS, Holscher CM, Garonzik-Wang J, Locke JE, Snyder JJ, Lentine KL, Segev DL. Donor-Recipient Relationship and Risk of ESKD in Live Kidney Donors of Varied Racial Groups. Am J Kidney Dis 2019; 75:333-341. [PMID: 31732232 DOI: 10.1053/j.ajkd.2019.08.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 08/05/2018] [Accepted: 08/19/2019] [Indexed: 12/14/2022]
Abstract
RATIONALE & OBJECTIVE Risk factors for kidney failure are the basis of live kidney donor candidate evaluation. We quantified risk for end-stage kidney disease (ESKD) by the biological relationship of the donor to the recipient, a risk factor that is not addressed by current clinical practice guidelines. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS A cohort of 143,750 US kidney donors between 1987 and 2017. EXPOSURE Biological relationship of donor and recipient. OUTCOME ESKD. Donors' records were linked to national dialysis and transplantation registries to ascertain development of the outcome. ANALYTIC APPROACH Donors were observed over a median of 12 (interquartile range, 6-18; maximum, 30) years. Survival analysis methods that account for the competing risk for death were used. RESULTS Risk for ESKD varied by orders of magnitude across donor-recipient relationship categories. For Asian donors, risks compared with unrelated donors were 259.4-fold greater for identical twins (95% CI, 19.5-3445.6), 4.7-fold greater for full siblings (95% CI, 0.5-41.0), 3.5-fold greater for offspring (95% CI, 0.6-39.5), 1.0 for parents, and 1.0 for half-sibling or other biological relatives. For black donors, risks were 22.5-fold greater for identical twin donors (95% CI, 4.7-107.0), 4.1-fold for full siblings (95% CI, 2.1-7.8), 2.7-fold for offspring (95% CI, 1.4-5.4), 3.1-fold for parents (95% CI, 1.4-6.8), and 1.3-fold for half-sibling or other biological relatives (95% CI, 0.5-3.3). For white donors, risks were 3.5-fold greater for identical twin donors (95% CI, 0.5-25.3), 2.0-fold for full siblings (95% CI, 1.4-2.8), 1.4-fold for offspring (95% CI, 0.9-2.3), 2.9-fold for parents (95% CI, 2.0-4.1), and 0.8-fold for half-sibling or other biological relatives (95% CI, 0.3-1.6). LIMITATIONS Insufficient sample size in some race and relationship groups. Absence of data for family history of kidney disease for donors biologically unrelated to their recipients. CONCLUSIONS Marked differences in risk for ESKD across types of donor-recipient relationship were observed for Asian, black, and white donors. These findings warrant further validation with more robust data to better inform clinical practice guidelines.
Collapse
Affiliation(s)
- Abimereki D Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD
| | - Tanjala S Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Courtenay M Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Jayme E Locke
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jon J Snyder
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD; Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| |
Collapse
|
14
|
|
15
|
Lentine KL, Koraishy FM, Sarabu N, Naik AS, Lam NN, Garg AX, Axelrod D, Zhang Z, Hess GP, Kasiske BL, Segev DL, Henderson ML, Massie AB, Holscher CM, Schnitzler MA. Associations of obesity with antidiabetic medication use after living kidney donation: An analysis of linked national registry and pharmacy fill records. Clin Transplant 2019; 33:e13696. [PMID: 31421057 PMCID: PMC7153560 DOI: 10.1111/ctr.13696] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 03/27/2019] [Revised: 07/23/2019] [Accepted: 08/05/2019] [Indexed: 12/19/2022]
Abstract
We examined a novel linkage of national US donor registry data with records from a pharmacy claims warehouse (2007-2016) to examine associations (adjusted hazard ratio, LCL aHRUCL ) of post-donation fills of antidiabetic medications (ADM, insulin or non-insulin agents) with body mass index (BMI) at donation and other demographic and clinical factors. In 28 515 living kidney donors (LKDs), incidence of ADM use at 9 years rose in a graded manner with higher baseline BMI: underweight, 0.9%; normal weight, 2.1%; overweight, 3.5%; obese, 8.5%. Obesity was associated with higher risk of ADM use compared with normal BMI (aHR, 3.36 4.596.27 ). Metformin was the most commonly used ADM and was filled more often by obese than by normal weight donors (9-year incidence, 6.87% vs 1.85%, aHR, 3.55 5.007.04 ). Insulin use was uncommon and did not differ significantly by BMI. Among a subgroup with BMI data at the 1-year post-donation anniversary (n = 19 528), compared with stable BMI, BMI increase >0.5 kg/m2 by year 1 was associated with increased risk of subsequent ADM use (aHR, 1.03 1.482.14, P = .04). While this study did not assess the impact of donation on the development of obesity, these data support that among LKD, obesity is a strong correlate of ADM use.
Collapse
Affiliation(s)
- Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Farrukh M Koraishy
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Nagaraju Sarabu
- Division of Nephrology, Department of Medicine, University Hospitals Cleveland Medical center, Cleveland, OH, USA
| | - Abhijit S Naik
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ngan N Lam
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - David Axelrod
- University of Iowa Transplant Institute, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Zidong Zhang
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Gregory P Hess
- Drexel College of Medicine, Drexel University, Philadelphia, PA, USA
| | - Bertram L Kasiske
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Dorry L Segev
- Division of Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Macey L Henderson
- Division of Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Allan B Massie
- Division of Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Courtenay M Holscher
- Division of Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Mark A Schnitzler
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
16
|
Purnell TS, Luo X, Crews DC, Bae S, Ruck JM, Cooper LA, Grams ME, Henderson ML, Waldram MM, Johnson M, Segev DL. Neighborhood Poverty and Sex Differences in Live Donor Kidney Transplant Outcomes in the United States. Transplantation 2019; 103:2183-2189. [PMID: 30768570 DOI: 10.1097/tp.0000000000002654] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neighborhood poverty has been associated with worse outcomes after live donor kidney transplantation (LDKT), and prior work suggests that women with kidney disease may be more susceptible to the negative influence of poverty than men. As such, our goal was to examine whether poverty differentially affects women in influencing LDKT outcomes. METHODS Using data from the Scientific Registry of Transplant Recipients and US Census, we performed multivariable Cox regression to compare outcomes among 18 955 women and 30 887 men who received a first LDKT in 2005-2014 with follow-up through December 31, 2016. RESULTS Women living in poor (adjusted hazard ratio [aHR], 1.30; 95% confidence interval [CI], 1.13-1.50) and middle-income (aHR, 1.26; 95% CI, 1.14-1.40) neighborhoods had higher risk of graft loss than men, but there were no differences in wealthy areas (aHR, 1.07; 95% CI, 0.88-1.29). Women living in wealthy (aHR, 0.71; 95% CI, 0.59-0.87) and middle-income (aHR, 0.82; 95% CI, 0.74-0.92) neighborhoods incurred a survival advantage over men, but there were no statistically significant differences in mortality in poor areas (aHR, 0.85; 95% CI, 0.72-1.01). CONCLUSIONS Given our findings that poverty is more strongly associated with graft loss in women, targeted efforts are needed to specifically address mechanisms driving these disparities in LDKT outcomes.
Collapse
Affiliation(s)
- Tanjala S Purnell
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD
| | - Xun Luo
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Deidra C Crews
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Sunjae Bae
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jessica M Ruck
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Lisa A Cooper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Macey L Henderson
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD
| | - Madeleine M Waldram
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD
| | - Morgan Johnson
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD
| | - Dorry L Segev
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
17
|
Ammary FA, Bowring MG, Massie AB, Yu S, Waldram MM, Garonzik-Wang J, Thomas AG, Holscher CM, Qadi MA, Henderson ML, Wiseman A, Gralla J, Brennan DC, Segev DL, Muzaale AD. The changing landscape of live kidney donation in the United States from 2005 to 2017. Am J Transplant 2019; 19:2614-2621. [PMID: 30903733 PMCID: PMC6711793 DOI: 10.1111/ajt.15368] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 10/22/2018] [Revised: 03/12/2019] [Accepted: 03/15/2019] [Indexed: 01/25/2023]
Abstract
The number of live kidney donors has declined since 2005. This decline parallels the evolving knowledge of risk for biologically related, black, and younger donors. To responsibly promote donation, we sought to identify declining low-risk donor subgroups that might serve as targets for future interventions. We analyzed a national registry of 77 427 donors and quantified the change in number of donors per 5-year increment from 2005 to 2017 using Poisson regression stratified by donor-recipient relationship and race/ethnicity. Among related donors aged <35, 35 to 49, and ≥50 years, white donors declined by 21%, 29%, and 3%; black donors declined by 30%, 31%, and 12%; Hispanic donors aged <35 and 35 to 49 years declined by 18% and 15%, and those aged ≥50 increased by 10%. Conversely, among unrelated donors aged <35, 35 to 49, and ≥50 years, white donors increased by 12%, 4%, and 24%; black donors aged <35 and 35 to 49 years did not change but those aged ≥50 years increased by 34%; Hispanic donors increased by 16%, 21%, and 46%. Unlike unrelated donors, related donors were less likely to donate in recent years across race/ethnicity. Although this decline might be understandable for related younger donors, it is less understandable for lower-risk related older donors (≥50 years). Biologically related older individuals are potential targets for interventions to promote donation.
Collapse
Affiliation(s)
- Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Grace Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Sile Yu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Madeleine M. Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Alvin G. Thomas
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Courtenay M. Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mohamud A. Qadi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander Wiseman
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Jane Gralla
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel C. Brennan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Abimereki D. Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
18
|
Eno AK, Ruck JM, Van Pilsum Rasmussen SE, Waldram MM, Thomas AG, Purnell TS, Garonzik Wang JM, Massie AB, Al Almmary F, Cooper LM, Segev DL, Levan MA, Henderson ML. Perspectives on implementing mobile health technology for living kidney donor follow-up: In-depth interviews with transplant providers. Clin Transplant 2019; 33:e13637. [PMID: 31194892 PMCID: PMC6690770 DOI: 10.1111/ctr.13637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/09/2018] [Revised: 05/21/2019] [Accepted: 06/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND United States transplant centers are required to report follow-up data for living kidney donors for 2 years post-donation. However, living kidney donor (LKD) follow-up is often incomplete. Mobile health (mHealth) technologies could ease data collection burden but have not yet been explored in this context. METHODS We conducted semi-structured in-depth interviews with a convenience sample of 21 transplant providers and thought leaders about challenges in LKD follow-up, and the potential role of mHealth in overcoming these challenges. RESULTS Participants reported challenges conveying the importance of follow-up to LKDs, limited data from international/out-of-town LKDs, and inadequate staffing. They believed the 2-year requirement was insufficient, but expressed difficulty engaging LKDs for even this short time and inadequate resources for longer-term follow-up. Participants believed an mHealth system for post-donation follow-up could benefit LKDs (by simplifying communication/tasks and improving donor engagement) and transplant centers (by streamlining communication and decreasing workforce burden). Concerns included cost, learning curves, security/privacy, patient language/socioeconomic barriers, and older donor comfort with mHealth technology. CONCLUSIONS Transplant providers felt that mHealth technology could improve LKD follow-up and help centers meet reporting thresholds. However, designing a secure, easy to use, and cost-effective system remains challenging.
Collapse
Affiliation(s)
- Ann K Eno
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica M Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Madeleine M Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Tanjala S Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Department of Health Behavior and Society, Johns Hopkins School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
| | | | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Fawaz Al Almmary
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lisa M Cooper
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Department of Health Behavior and Society, Johns Hopkins School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland
| | | | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland
| |
Collapse
|
19
|
Al Ammary F, Thomas AG, Massie AB, Muzaale AD, Shaffer AA, Koons B, Qadi MA, Crews DC, Garonzik-Wang J, Fang H, Brennan DC, Lentine KL, Segev DL, Henderson ML. The landscape of international living kidney donation in the United States. Am J Transplant 2019; 19:2009-2019. [PMID: 30615253 PMCID: PMC6591087 DOI: 10.1111/ajt.15256] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 08/01/2018] [Revised: 12/31/2018] [Accepted: 01/01/2019] [Indexed: 01/25/2023]
Abstract
In the United States, kidney donation from international (noncitizen/nonresident) living kidney donors (LKDs) is permitted; however, given the heterogeneity of healthcare systems, concerns remain regarding the international LKD practice and recipient outcomes. We studied a US cohort of 102 315 LKD transplants from 2000-2016, including 2088 international LKDs, as reported to the Organ Procurement and Transplantation Network. International LKDs were more tightly clustered among a small number of centers than domestic LKDs (Gini coefficient 0.76 vs 0.58, P < .001). Compared with domestic LKDs, international LKDs were more often young, male, Hispanic or Asian, and biologically related to their recipient (P < .001). Policy-compliant donor follow-up was substantially lower for international LKDs at 6, 12, and 24 months postnephrectomy (2015 cohort: 45%, 33%, 36% vs 76%, 71%, 70% for domestic LKDs, P < .001). Among international LKDs, Hispanic (aOR = 0.23 0.360.56 , P < .001) and biologically related (aOR = 0.39 0.590.89 , P < .01) donors were more compliant in donor follow-up than white and unrelated donors. Recipients of international living donor kidney transplant (LDKT) had similar graft failure (aHR = 0.78 0.891.02 , P = .1) but lower mortality (aHR = 0.53 0.620.72 , P < .001) compared with the recipients of domestic LDKT after adjusting for recipient, transplant, and donor factors. International LKDs may provide an alternative opportunity for living donation. However, efforts to improve international LKD follow-up and engagement are warranted.
Collapse
Affiliation(s)
- Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Abimereki D Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ashton A Shaffer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Brittany Koons
- Department of Nursing, Villanova University, Villanova, Pennsylvania
| | - Mohamud A Qadi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deidra C Crews
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Hai Fang
- Department of Health Systems, Management and Policy, University of Colorado School of Public Health, Aurora, Colorado
| | - Daniel C Brennan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Krista L Lentine
- Department of Medicine, Saint Louis University, St. Louis, Missouri
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland
| |
Collapse
|
20
|
Al Ammary F, Luo X, Muzaale AD, Massie AB, Crews DC, Waldram MM, Qadi MA, Garonzik-Wang J, Henderson ML, Brennan DC, Wiseman AC, Lindrooth RC, Snyder JJ, Coresh J, Segev DL. Risk of ESKD in Older Live Kidney Donors with Hypertension. Clin J Am Soc Nephrol 2019; 14:1048-1055. [PMID: 31239252 PMCID: PMC6625624 DOI: 10.2215/cjn.14031118] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 11/29/2018] [Accepted: 04/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Hypertension in older kidney donor candidates is viewed as safe. However, hypertension guidelines have evolved and long-term outcomes have not been explored. We sought to quantify the 15-year risk of ESKD and mortality in older donors (≥50 years old) with versus those without hypertension. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A United States cohort of 24,533 older donors from 1999 to 2016, including 2265 with predonation hypertension, were linked to Centers for Medicare and Medicaid Services data and the Social Security Death Master File to ascertain ESKD development and mortality. The exposure of interest was predonation hypertension. From 2004 to 2016, hypertension was defined as documented predonation use of antihypertensive therapy, regardless of systolic BP or diastolic BP; from 1999 to 2003, when there was no documentation of antihypertensive therapy, hypertension was defined as predonation systolic BP ≥140 or diastolic BP ≥90 mm Hg. RESULTS Older donors were 82% white, 6% black, 7% Hispanic, and 3% Asian. The median follow-up was 7.1 years (interquartile range, 3.4-11.1; maximum, 18). There were 24 ESKD and 252 death events during the study period. The 15-year risk of ESKD was 0.8% (95% confidence interval [95% CI], 0.4 to 1.6) for donors with hypertension (mean systolic BP, 138 mm Hg) versus 0.2% (95% CI, 0.1 to 0.4) for donors without hypertension (mean systolic BP, 123 mm Hg; adjusted hazard ratio, 3.04; 95% CI, 1.28 to 7.22; P=0.01). When predonation antihypertensive therapy was available, the risk of ESKD was 6.21-fold higher (95% CI, 1.20 to 32.17; P=0.03) for donors using antihypertensive therapy (mean systolic BP, 132 mm Hg) versus those not using antihypertensive therapy (mean systolic BP, 124 mm Hg). There was no significant association between donor hypertension and 15-year mortality (hazard ratio, 1.18; 95% CI, 0.84 to 1.66; P=0.34). CONCLUSIONS Compared with older donors without hypertension, older donors with hypertension had higher risk of ESKD, but not mortality, for 15 years postdonation. However, the absolute risk of ESKD was small.
Collapse
Affiliation(s)
| | - Xun Luo
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Allan B Massie
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | | | - Madeleine M Waldram
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | | | | | - Macey L Henderson
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Alexander C Wiseman
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Richard C Lindrooth
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, Colorado
| | - Jon J Snyder
- Department of Epidemiology, University of Minnesota, Minneapolis, Minnesota; and.,Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Josef Coresh
- Departments of Medicine and.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Dorry L Segev
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.,Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| |
Collapse
|
21
|
Liyanage L, Muzaale AD, Henderson ML, Durand CM. Living kidney donation in individuals with hepatitis C and HIV infection: rationale and emerging evidence. Curr Transplant Rep 2019; 6:167-176. [PMID: 32855901 PMCID: PMC7449146 DOI: 10.1007/s40472-019-00242-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW HIV-infected (HIV+) and hepatitis C virus-infected (HCV+) individuals with end-stage renal disease (ESRD) have decreased access to kidney transplantation. With new opportunities provided by the HIV Organ Policy Equity (HOPE) Act and direct-acting antivirals (DAAs) for HCV, we explore the potential risks and benefits of living donor kidney transplantation from HIV+ or HCV+ donors, from the perspective of both donor health and recipient outcomes. RECENT FINDINGS The HOPE Act permits organ donation from both deceased and living HIV+ persons to HIV+ recipients; however, there is only clinical experience with HIV+ deceased donors to date. Empirical evidence demonstrates a low but acceptable risk of ESRD in potential HIV+ living donors without comorbidities who have well-controlled infection in the absence of donation. With the availability of potent DAAs for eradication of HCV infection, growing evidence shows good outcomes with HCV seropositive and/or viremic deceased kidney donors, providing rationale to consider HCV+ living donors. SUMMARY HIV+ and HCV+ living donor kidney transplantation may improve access to transplant for vulnerable ESRD populations. Careful evaluation and monitoring are warranted to mitigate potential risks to donors and recipients.
Collapse
Affiliation(s)
- Luckmini Liyanage
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Abimereki D. Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christine M. Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
22
|
Holscher CM, Bae S, Thomas AG, Henderson ML, Haugen CE, DiBrito SR, Muzaale AD, Garonzik Wang JM, Massie AB, Lentine KL, Segev DL. Early Hypertension and Diabetes After Living Kidney Donation: A National Cohort Study. Transplantation 2019; 103:1216-1223. [PMID: 30247449 PMCID: PMC6428622 DOI: 10.1097/tp.0000000000002411] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Living kidney donors have an increased risk of end-stage renal disease, with hypertension and diabetes as the predominant causes. In this study, we sought to better understand the timeline when these diseases occur, focusing on the early postdonation period. METHODS We studied 41 260 living kidney donors in the United States between 2008 and 2014 from the Scientific Registry of Transplant Recipients and modeled incidence rates and risk factors for hypertension and diabetes. RESULTS At 6 months, 1 year, and 2 years postdonation, there were 74, 162, and 310 cases, respectively, of hypertension per 10 000 donors. Donors who were older (per 10 y, adjusted incidence rate ratio [aIRR], 1.40; 95% confidence interval [CI], 1.29-1.51), male (aIRR, 1.31; 95% CI, 1.14-1.50), had higher body mass index (per 5 units, aIRR, 1.29; 95% CI, 1.17-1.43), and were related to their recipient (first-degree relative: aIRR, 1.28; 95% CI, 1.08-1.52; spouse: aIRR, 1.34; 95% CI, 1.08-1.66) were more likely to develop hypertension, whereas donors who were Hispanic/Latino were less likely (aIRR, 0.71; 95% CI, 0.55-0.93). At 6 months, 1 year, and 2 years, there were 2, 6, and 15 cases of diabetes per 10 000 donors. Donors who were older (per 10 y: aIRR, 1.42; 95% CI, 1.11-1.82), had higher body mass index (per 5 units: aIRR, 1.52; 95% CI, 1.04-2.21), and were Hispanic/Latino (aIRR, 2.45; 95% CI, 1.14-5.26) were more likely to develop diabetes. CONCLUSIONS In this national study, new-onset diabetes was rare, but 3% of donors developed hypertension within 2 years of nephrectomy. These findings reaffirm that disease pathways for kidney failure differ by donor phenotype and estimate the population most at-risk for later kidney failure.
Collapse
Affiliation(s)
- Courtenay M Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sunjae Bae
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christine E Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sandra R DiBrito
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Abimereki D Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
- Scientific Registry of Transplant Recipients, Minneapolis, MN
| |
Collapse
|
23
|
Henderson ML, Adler JT, Van Pilsum Rasmussen SE, Thomas AG, Herron PD, Waldram MM, Ruck JM, Purnell TS, DiBrito SR, Holscher CM, Haugen CE, Alimi Y, Konel JM, Eno AK, Garonzik Wang JM, Gordon EJ, Lentine KL, Schaffer RL, Cameron AM, Segev DL. How Should Social Media Be Used in Transplantation? A Survey of the American Society of Transplant Surgeons. Transplantation 2019; 103:573-580. [PMID: 29684002 PMCID: PMC6196114 DOI: 10.1097/tp.0000000000002243] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Social media platforms are increasingly used in surgery and have shown promise as effective tools to promote deceased donation and expand living donor transplantation. There is a growing need to understand how social media-driven communication is perceived by providers in the field of transplantation. METHODS We surveyed 299 members of the American Society of Transplant Surgeons about their use of, attitudes toward, and perceptions of social media and analyzed relationships between responses and participant characteristics. RESULTS Respondents used social media to communicate with: family and friends (76%), surgeons (59%), transplant professionals (57%), transplant recipients (21%), living donors (16%), and waitlisted candidates (15%). Most respondents (83%) reported using social media for at least 1 purpose. Although most (61%) supported sharing information with transplant recipients via social media, 42% believed it should not be used to facilitate living donor-recipient matching. Younger age (P = 0.02) and fewer years of experience in the field of transplantation (P = 0.03) were associated with stronger belief that social media can be influential in living organ donation. Respondents at transplant centers with higher reported use of social media had more favorable views about sharing information with transplant recipients (P < 0.01), increasing awareness about deceased organ donation (P < 0.01), and advertising for transplant centers (P < 0.01). Individual characteristics influence opinions about the role and clinical usefulness of social media. CONCLUSIONS Transplant center involvement and support for social media may influence clinician perceptions and practices. Increasing use of social media among transplant professionals may provide an opportunity to deliver high-quality information to patients.
Collapse
Affiliation(s)
- Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD
| | - Joel T. Adler
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Alvin G. Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Madeleine M. Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jessica M. Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tanjala S. Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Sandra R. DiBrito
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Christine E. Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yewande Alimi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonathan M. Konel
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ann K. Eno
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Elisa J. Gordon
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Krista L. Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | | | - Andrew M. Cameron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| |
Collapse
|
24
|
Ishaque T, Massie AB, Bowring MG, Haugen CE, Ruck JM, Halpern SE, Waldram MM, Henderson ML, Wang JG, Cameron AM, Philosophe B, Ottmann S, Rositch AF, Segev DL. Liver transplantation and waitlist mortality for HCC and non-HCC candidates following the 2015 HCC exception policy change. Am J Transplant 2019; 19:564-572. [PMID: 30312530 PMCID: PMC6349527 DOI: 10.1111/ajt.15144] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 04/05/2018] [Revised: 09/24/2018] [Accepted: 10/02/2018] [Indexed: 01/25/2023]
Abstract
Historically, exception points for hepatocellular carcinoma (HCC) led to higher transplant rates and lower waitlist mortality for HCC candidates compared to non-HCC candidates. As of October 2015, HCC candidates must wait 6 months after initial application to obtain exception points; the impact of this policy remains unstudied. Using 2013-2017 SRTR data, we identified 39 350 adult, first-time, active waitlist candidates and compared deceased donor liver transplant (DDLT) rates and waitlist mortality/dropout for HCC versus non-HCC candidates before (October 8, 2013-October 7, 2015, prepolicy) and after (October 8, 2015-October 7, 2017, postpolicy) the policy change using Cox and competing risks regression, respectively. Compared to non-HCC candidates with the same calculated MELD, HCC candidates had a 3.6-fold higher rate of DDLT prepolicy (aHR = 3.49 3.69 3.89 ) and a 2.2-fold higher rate of DDLT postpolicy (aHR = 2.09 2.21 2.34 ). Compared to non-HCC candidates with the same allocation priority, HCC candidates had a 37% lower risk of waitlist mortality/dropout prepolicy (asHR = 0.54 0.63 0.73 ) and a comparable risk of mortality/dropout postpolicy (asHR = 0.81 0.95 1.11 ). Following the policy change, the DDLT advantage for HCC candidates remained, albeit dramatically attenuated, without any substantial increase in waitlist mortality/dropout. In the context of sickest-first liver allocation, the revised policy seems to have established allocation equity for HCC and non-HCC candidates.
Collapse
Affiliation(s)
- Tanveen Ishaque
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mary G. Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christine E. Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jessica M. Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Samantha E. Halpern
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Madeleine M. Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Benjamin Philosophe
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shane Ottmann
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anne F. Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
25
|
Henderson ML, Thomas AG, Eno AK, Waldram MM, Bannon J, Massie AB, Levan MA, Segev DL, Bingaman AW. The Impact of the mKidney mHealth System on Live Donor Follow-Up Compliance: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e11000. [PMID: 30664485 PMCID: PMC6350092 DOI: 10.2196/11000] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 12/22/2022] Open
Abstract
Background Every year, more than 5500 healthy people in the United States donate a kidney for the medical benefit of another person. The Organ Procurement and Transplantation Network (OPTN) requires transplant hospitals to monitor living kidney donors (LKDs) for 2 years postdonation. However, the majority (115/202, 57%) of transplant hospitals in the United States continue to fail to meet nationally mandated requirements for LKD follow-up. A novel method for collecting LKD follow-up is needed to ease both the transplant hospital-level and patient-level burden. We built mKidney—a mobile health (mHealth) system designed specifically to facilitate the collection and reporting of OPTN-required LKD follow-up data. The mKidney mobile app was developed on the basis of input elicited from LKDs, transplant providers, and thought leaders. Objective The primary objective of this study is to evaluate the impact of the mKidney smartphone app on LKD follow-up rates. Methods We will conduct a two-arm randomized controlled trial (RCT) with LKDs who undergo LKD transplantation at Methodist Specialty and Transplant Hospital in San Antonio, Texas. Eligible participants will be recruited in-person by a study team member at their 1-week postdonation clinical visit and randomly assigned to the intervention or control arm (1:1). Participants in the intervention arm will receive the mHealth intervention (mKidney), and participants in the control arm will receive the current standard of follow-up care. Our primary outcome will be policy-defined complete (all components addressed) and timely (60 days before or after the expected visit date) submission of LKD follow-up data at required 6-month, 1-year, and 2-year visits. Our secondary outcome will be hospital-level compliance with OPTN reporting requirements at each visit. Data analysis will follow the intention-to-treat principle. Additionally, we will collect quantitative and qualitative process data regarding the implementation of the mKidney system. Results We began recruitment for this RCT in May 2018. We plan to enroll 400 LKDs over 2 years and follow participants for the 2-year mandated follow-up period. Conclusions This pilot RCT will evaluate the impact of the mKidney system on rates of LKD and hospital compliance with OPTN-mandated LKD follow-up at a large LKD transplant hospital. It will provide valuable information on strategies for implementing such a system in a clinical setting and inform effect sizes for future RCT sample size calculations. International Registered Report Identifier (IRRID) DERR1-10.2196/11000
Collapse
Affiliation(s)
- Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ann K Eno
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Madeleine M Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jaclyn Bannon
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Michael A Levan
- United Network for Organ Sharing, Richmond, VA, United States
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Adam W Bingaman
- The Texas Transplant Institute, Methodist Specialty and Transplant Hospital, San Antonio, TX, United States
| |
Collapse
|
26
|
Holscher CM, Luo X, Massie AB, Purnell TS, Garonzik Wang JM, Bae S, Henderson ML, Ammary FA, Ottman SE, Segev DL. Better graft outcomes from offspring donor kidneys among living donor kidney transplant recipients in the United States. Am J Transplant 2019; 19:269-276. [PMID: 30253051 PMCID: PMC6310629 DOI: 10.1111/ajt.15126] [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: 06/07/2018] [Revised: 09/06/2018] [Accepted: 09/19/2018] [Indexed: 01/25/2023]
Abstract
A recent study reported that kidney transplant recipients of offspring living donors had higher graft loss and mortality. This seemed counterintuitive, given the excellent HLA matching and younger age of offspring donors; we were concerned about residual confounding and other study design issues. We used Scientific Registry of Transplant Recipients data 2001-2016 to evaluate death-censored graft failure (DCGF) and mortality for recipients of offspring versus nonoffspring living donor kidneys, using Cox regression models with interaction terms. Recipients of offspring kidneys had lower DCGF than recipients of nonoffspring kidneys (15-year cumulative incidence 21.2% vs 26.1%, P < .001). This association remained after adjustment for recipient and transplant factors (adjusted hazard ratio [aHR] = 0.73 0.770.82 , P < .001), and was attenuated among African American donors (aHR 0.77 0.850.95 ; interaction: P = .01) and female recipients (aHR 0.77 0.840.91 , P < .001). Although offspring kidney recipients had higher mortality (15-year mortality 56.4% vs 37.2%, P < .001), this largely disappeared with adjustment for recipient age alone (aHR = 1.02 1.061.10 , P = .002) and was nonsignificant after further adjustment for other recipient characteristics (aHR = 0.93 0.971.01 , P = .1). Kidneys from offspring donors provided lower graft failure and comparable mortality. An otherwise eligible donor should not be dismissed because they are the offspring of the recipient, and we encourage continued individualized counseling for potential donors.
Collapse
Affiliation(s)
| | - Xun Luo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Tanjala S. Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | | | - Sunjae Bae
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shane E. Ottman
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.,Scientific Registry of Transplant Recipients, Minneapolis, MN
| |
Collapse
|
27
|
Ruck JM, Henderson ML, Eno AK, Van Pilsum Rasmussen SE, DiBrito SR, Thomas AG, Li R, Singer L, Massie I, Waldram MM, Konel JM, Helfer DR, Garonzik Wang JM, Purnell TS, Mogul DB, Lentine KL, Waterman AD, Segev DL. Use of Twitter in communicating living solid organ donation information to the public: An exploratory study of living donors and transplant professionals. Clin Transplant 2018; 33:e13447. [PMID: 30421841 DOI: 10.1111/ctr.13447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 05/08/2018] [Revised: 11/01/2018] [Accepted: 11/06/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND As transplant centers start leveraging Twitter for information dissemination and public engagement, it is important to understand current living solid organ donation-related Twitter use. METHODS We identified public Twitter profiles available in 01/2017 that referenced living organ donation and analyzed the use of donation-related Twitter handles, names, or profile information. Tweets were manually abstracted and qualitatively analyzed for common themes. Social media influence of those tweeting about living donation was evaluated using Klout score. RESULTS We identified 93 donors, 61 professionals, 12 hospitals, and 19 organizations that met eligibility criteria. Social media influence was similar across these groups (P = 0.4). Donors (16%) and organizations (23%) were more likely than professionals (7%) or hospitals (0%) to include transplant-related educational information in their profiles (P = 0.007). Living donation-related tweets were most commonly donation stories (33%), news reports (20%), reports about new transplant research (15%), and sharing transplant candidates' searches for donors (14%). CONCLUSIONS This exploratory study of living donors and transplant professionals, hospitals, and organizations on Twitter provides insight into how the social media platform may be used to communicate about and disseminate information about living donation.
Collapse
Affiliation(s)
- Jessica M Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Ann K Eno
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Sandra R DiBrito
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca Li
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lauren Singer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Indraneel Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Madeleine M Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan M Konel
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David R Helfer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Tanjala S Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Douglas B Mogul
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University, St. Louis, Missouri
| | - Amy D Waterman
- Department of Nephrology, University of California Los Angeles, Los Angeles, California
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| |
Collapse
|
28
|
Flechner SM, Thomas AG, Ronin M, Veale JL, Leeser DB, Kapur S, Peipert JD, Segev D, Henderson ML, Shaffer AA, Cooper M, Hil G, Waterman AD. The first 9 years of kidney paired donation through the National Kidney Registry: Characteristics of donors and recipients compared with National Live Donor Transplant Registries. Am J Transplant 2018; 18:2730-2738. [PMID: 29603640 PMCID: PMC6165704 DOI: 10.1111/ajt.14744] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [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: 02/16/2018] [Revised: 03/18/2018] [Accepted: 03/20/2018] [Indexed: 01/25/2023]
Abstract
The practice of kidney paired donation (KPD) is expanding annually, offering the opportunity for live donor kidney transplant to more patients. We sought to identify if voluntary KPD networks such as the National Kidney Registry (NKR) were selecting or attracting a narrower group of donors or recipients compared with national registries. For this purpose, we merged data from the NKR database with the Scientific Registry of Transplant Recipients (SRTR) database, from February 14, 2008, to February 14, 2017, encompassing the first 9 years of the NKR. Compared with all United Network for Organ Sharing (UNOS) live donor transplant patients (49 610), all UNOS living unrelated transplant patients (23 319), and all other KPD transplant patients (4236), the demographic and clinical characteristics of NKR transplant patients (2037) appear similar to contemporary national trends. In particular, among the NKR patients, there were a significantly (P < .001) greater number of retransplants (25.6% vs 11.5%), hyperimmunized recipients (22.7% vs 4.3% were cPRA >80%), female recipients (45.9% vs 37.6%), black recipients (18.2% vs 13%), and those on public insurance (49.7% vs 41.8%) compared with controls. These results support the need for greater sharing and larger pool sizes, perhaps enhanced by the entry of compatible pairs and even chains initiated by deceased donors, to unlock more opportunities for those harder-to-match pairs.
Collapse
Affiliation(s)
| | | | | | | | | | | | - John D Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | | | | | | | | | - Garet Hil
- National Kidney Registry, Babylon, NY
| | | |
Collapse
|
29
|
Holscher CM, Ishaque T, Garonzik Wang JM, Haugen CE, DiBrito SR, Jackson K, Muzaale AD, Massie AB, Al Ammary F, Ottman SE, Henderson ML, Segev DL. Living donor postnephrectomy kidney function and recipient graft loss: A dose-response relationship. Am J Transplant 2018; 18:2804-2810. [PMID: 30086198 PMCID: PMC6219620 DOI: 10.1111/ajt.15061] [Citation(s) in RCA: 5] [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: 04/10/2018] [Revised: 07/25/2018] [Accepted: 08/02/2018] [Indexed: 01/25/2023]
Abstract
Development of end-stage renal disease (ESRD) in living kidney donors is associated with increased graft loss in the recipients of their kidneys. Our goal was to investigate if this relationship was reflected at an earlier stage postdonation, possibly early enough for recipient risk prediction based on donor response to nephrectomy. Using national registry data, we studied 29 464 recipients and their donors from 2008-2016 to determine the association between donor 6-month postnephrectomy estimated GFR (eGFR) and recipient death-censored graft failure (DCGF). We explored donor BMI as an effect modifier, given the association between obesity and hyperfiltration. On average, risk of DCGF increased with each 10 mL/min decrement in postdonation eGFR (adjusted hazard ratio [aHR] 1.06, 95% confidence interval [CI] 1.02-1.10, P = .007). The association was attenuated with higher donor BMI (interaction P = .049): recipients from donors with BMI = 20 (aHR 1.12, 95% CI 1.04-1.19, P = .002) and BMI = 25 (aHR 1.07, 95% CI 1.03-1.12, P = .001) had a higher risk of DCGF with each 10 mL/min decrement in postdonation eGFR, whereas recipients from donors with BMI = 30 and BMI = 35 did not have a higher risk. The relationship between postdonation eGFR, donor BMI, and recipient graft loss can inform counseling and management of living donor kidney transplant recipients.
Collapse
Affiliation(s)
| | - Tanveen Ishaque
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Christine E. Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sandra R. DiBrito
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kyle Jackson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Abimereki D. Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shane E. Ottman
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.,Scientific Registry of Transplant Recipients, Minneapolis, MN
| |
Collapse
|
30
|
Eno AK, Thomas AG, Ruck JM, Van Pilsum Rasmussen SE, Halpern SE, Waldram MM, Muzaale AD, Purnell TS, Massie AB, Garonzik Wang JM, Lentine KL, Segev DL, Henderson ML. Assessing the Attitudes and Perceptions Regarding the Use of Mobile Health Technologies for Living Kidney Donor Follow-Up: Survey Study. JMIR Mhealth Uhealth 2018; 6:e11192. [PMID: 30305260 PMCID: PMC6231841 DOI: 10.2196/11192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 05/31/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In 2013, the Organ Procurement and Transplantation Network began requiring transplant centers in the United States to collect and report postdonation living kidney donor follow-up data at 6 months, 1 year, and 2 years. Despite this requirement, <50% of transplant centers have been able to collect and report the required data. Previous work identified a number of barriers to living kidney donor follow-up, including logistical and administrative barriers for transplant centers and cost and functional barriers for donors. Novel smartphone-based mobile health (mHealth) technologies might reduce the burden of living kidney donor follow-up for centers and donors. However, the attitudes and perceptions toward the incorporation of mHealth into postdonation care among living kidney donors are unknown. Understanding donor attitudes and perceptions will be vital to the creation of a patient-oriented mHealth system to improve living donor follow-up in the United States. OBJECTIVE The goal of this study was to assess living kidney donor attitudes and perceptions associated with the use of mHealth for follow-up. METHODS We developed and administered a cross-sectional 14-question survey to 100 living kidney donors at our transplant center. All participants were part of an ongoing longitudinal study of long-term outcomes in living kidney donors. The survey included questions on smartphone use, current health maintenance behaviors, accessibility to health information, and attitudes toward using mHealth for living kidney donor follow-up. RESULTS Of the 100 participants surveyed, 94 owned a smartphone (35 Android, 58 iPhone, 1 Blackberry), 37 had accessed their electronic medical record on their smartphone, and 38 had tracked their exercise and physical activity on their smartphone. While 77% (72/93) of participants who owned a smartphone and had asked a medical question in the last year placed the most trust with their doctors, nurses, or other health care professionals regarding answering a health-related question, 52% (48/93) most often accessed health information elsewhere. Overall, 79% (74/94) of smartphone-owning participants perceived accessing living kidney donor information and resources on their smartphone as useful. Additionally, 80% (75/94) perceived completing some living kidney donor follow-up via mHealth as useful. There were no significant differences in median age (60 vs 59 years; P=.65), median years since donation (10 vs 12 years; P=.45), gender (36/75, 36%, vs 37/75, 37%, male; P=.57), or race (70/75, 93%, vs 18/19, 95%, white; P=.34) between those who perceived mHealth as useful for living kidney donor follow-up and those who did not, respectively. CONCLUSIONS Overall, smartphone ownership was high (94/100, 94.0%), and 79% (74/94) of surveyed smartphone-owning donors felt that it would be useful to complete their required follow-up with an mHealth tool, with no significant differences by age, sex, or race. These results suggest that patients would benefit from an mHealth tool to perform living donor follow-up.
Collapse
Affiliation(s)
- Ann K Eno
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States
| | - Jessica M Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Samantha E Halpern
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Duke University School of Medicine, Durham, NC, United States
| | - Madeleine M Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Abimereki D Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Tanjala S Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States.,Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | | | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States.,Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, United States
| |
Collapse
|
31
|
Van Pilsum Rasmussen SE, Thomas AG, Garonzik-Wang J, Henderson ML, Stith SS, Segev DL, Nicholas LH. Reported effects of the Scientific Registry of Transplant Recipients 5-tier rating system on US transplant centers: results of a national survey. Transpl Int 2018; 31:1135-1143. [PMID: 29802802 PMCID: PMC6219856 DOI: 10.1111/tri.13282] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/17/2018] [Accepted: 05/17/2018] [Indexed: 11/30/2022]
Abstract
In the United States, the Scientific Registry of Transplant Recipients (SRTR) provides publicly available quality report cards. These reports have historically rated transplant programs using a 3-tier system. In 2016, the SRTR temporarily transitioned to a 5-tier system, which classified more programs as under-performing. As part of a larger survey about transplant quality metrics, we surveyed members of the American Society of Transplant Surgeons and American Society of Transplantation (N = 280 respondents) on transplant center experiences with patient and payer responses to the 5-tier SRTR ratings. Over half of respondents (n = 137, 52.1%) reported ≥1 negative effect of the new 5-tier ranking system, including losing patients, losing insurers, increased concern among patients, and increased concern among referring providers. Few respondents (n = 35, 13.7%) reported any positive effects of the 5-tier ranking system. Lower SRTR-reported scores on the 5-tier scale were associated with increased risk of reporting at least one negative effect in a logistic model (P < 0.01). The change to a more granular rating system provoked an immediate response in the transplant community that may have long-term implications for transplant hospital finances and patient options for transplantation.
Collapse
Affiliation(s)
| | - Alvin G. Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sarah S. Stith
- Department of Economics, University of New Mexico, Albuquerque, NM
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Lauren Hersch Nicholas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
32
|
Van Pilsum Rasmussen SE, Bowring MG, Shaffer AA, Henderson ML, Massie A, Tobian AAR, Segev DL, Durand CM. Knowledge, attitudes, and planned practice of HIV-positive to HIV-positive transplantation in US transplant centers. Clin Transplant 2018; 32:e13365. [PMID: 30074638 DOI: 10.1111/ctr.13365] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 06/07/2018] [Revised: 07/23/2018] [Accepted: 07/29/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND HIV+ donor organs can now be transplanted into HIV+ recipients (HIV D+/R+) following the HIV Organ Policy Equity (HOPE) Act. Implementation of the HOPE Act requires transplant center awareness and support of HIV D+/R+ transplants. METHODS To assess center-level barriers to implementation, we surveyed 209 transplant centers on knowledge, attitudes, and planned HIV D+/R+ protocols. RESULTS Responding centers (n = 114; 56%) represented all UNOS regions. Fifty centers (93 organ programs) planned HIV D+/R+ protocols (kidney n = 48, liver n = 34, pancreas n = 8, heart n = 2, lung = 1), primarily in the eastern United States (28/50). Most (91.2%) were aware that HIV D+/R+ transplantation is legal; 21.4% were unaware of research restrictions. Respondents generally agreed with HOPE research criteria except the required experience with ≥5 HIV+ transplants by organ type. Centers planning HIV D+/R+ protocols had higher transplant volume, HIV+ recipient volume, increased infectious risk donor utilization, and local HIV prevalence (P < 0.01). Centers not planning HIV D+/R+ protocols were more likely to believe their HIV+ candidates would not accept HIV+ donor organs (P < 0.001). Most centers (83.2%) supported HIV+ living donation. CONCLUSIONS Although many programs plan HIV D+/R+ transplantation, center-level barriers remain including geographic clustering of kidney/liver programs and concerns about HIV+ candidate willingness to accept HIV+ donor organs.
Collapse
Affiliation(s)
| | - Mary Grace Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ashton A Shaffer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Allan Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Aaron A R Tobian
- Transfusion Medicine Division, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Christine M Durand
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
33
|
Zhou JZ, Lemelman BT, Done N, Henderson ML, Macmillan A, Song DH, Dorafshar AH. Social Media and the Dissemination of Research: Insights from the Most Widely Circulated Articles in Plastic Surgery. Plast Reconstr Surg 2018; 142:555-561. [PMID: 30045187 DOI: 10.1097/prs.0000000000004598] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study is to quantify the relationship between social media use and the dissemination of research across nontraditional channels. METHODS Between June and August of 2016, the authors identified 10 plastic surgery journals with the highest impact factor and their 10 most widely circulated articles. Article age; journal impact factor; "distinguished" article designation; and social media metadata of the first authors, last authors, and journals were incorporated into a multivariate regression model to predict the Altmetric Attention Score, a quantitative measure of popularity across Web-based media platforms. RESULTS A total of 100 articles, 181 authors, and 10 journals were identified. Older articles tended to be less popular. The article's popularity was associated with the journal's audience size, but not with the author's social media activity. For each 1000 additional Twitter followers of the journal of publication, the Altmetric score is greater by a factor of 1.72 (95 percent CI, 1.076 to 2.749), which is the equivalent of 72 percent more Tweets. There is also a small but statistically significant negative association between the author's social media audience size and the popularity of his or her articles: for every 1000 additional followers, the Altmetric score is lower by a factor of 0.822 (95 percent CI, 0.725 to 0.932), which is the equivalent of 17.8 percent fewer Tweets. CONCLUSION The popularity of an article across social media platforms is associated with the journal's audience on social media, not with the magnitude of the author's social media activity.
Collapse
Affiliation(s)
- Joy Z Zhou
- From the Warren Alpert Medical School of Brown University; the Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center; the Center for Access Policy, Evaluation and Research, Boston University School of Medicine; the Departments of Surgery and Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; and the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| | - Benjamin T Lemelman
- From the Warren Alpert Medical School of Brown University; the Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center; the Center for Access Policy, Evaluation and Research, Boston University School of Medicine; the Departments of Surgery and Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; and the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| | - Nicolae Done
- From the Warren Alpert Medical School of Brown University; the Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center; the Center for Access Policy, Evaluation and Research, Boston University School of Medicine; the Departments of Surgery and Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; and the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| | - Macey L Henderson
- From the Warren Alpert Medical School of Brown University; the Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center; the Center for Access Policy, Evaluation and Research, Boston University School of Medicine; the Departments of Surgery and Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; and the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| | - Alexandra Macmillan
- From the Warren Alpert Medical School of Brown University; the Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center; the Center for Access Policy, Evaluation and Research, Boston University School of Medicine; the Departments of Surgery and Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; and the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| | - David H Song
- From the Warren Alpert Medical School of Brown University; the Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center; the Center for Access Policy, Evaluation and Research, Boston University School of Medicine; the Departments of Surgery and Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; and the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| | - Amir H Dorafshar
- From the Warren Alpert Medical School of Brown University; the Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center; the Center for Access Policy, Evaluation and Research, Boston University School of Medicine; the Departments of Surgery and Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; and the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| |
Collapse
|
34
|
Ruck JM, Van Pilsum Rasmussen SE, Henderson ML, Massie AB, Segev DL. Interviews of living kidney donors to assess donation-related concerns and information-gathering practices. BMC Nephrol 2018; 19:130. [PMID: 29884126 PMCID: PMC5994029 DOI: 10.1186/s12882-018-0935-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 09/12/2017] [Accepted: 05/29/2018] [Indexed: 11/18/2022] Open
Abstract
Background Efforts are underway to improve living kidney donor (LKD) education, but current LKD concerns and information-gathering preferences have not been ascertained to inform evidence-based resource development. As a result, prior studies have found that donors desire information that is not included in current informed consent and/or educational materials. Methods We conducted semi-structured interviews with 50 LKDs who donated at our center to assess (1) concerns about donation that they either had personally before or after donation or heard from family members or friends, (2) information that they had desired before donation, and (3) where they sought information about donation. We used thematic analysis of verbatim interview transcriptions to identify donation-related concerns. We compared the demographic characteristics of participants reporting specific concerns using Fisher’s exact test. Results We identified 19 unique concerns that participants had or heard about living kidney donation. 20% of participants reported having had no pre-donation concerns; 38% reported no post-donation concerns. The most common concern pre-donation was future kidney failure (22%), post-donation was the recovery process (24%), and from family was endangering their family unit (16%). 44% of participants reported being less concerned than family. 26% of participants wished they had had additional information prior to donating, including practical advice for recovery (10%) and information about specific complications (14%). Caucasian participants were more likely to hear at least one concern from family (76% vs. 33%, p = 0.02). The most commonly consulted educational resources were health care providers (100%) and websites (79% of donors since 2000). 26% of participants had had contact with other donors; an additional 20% desired contact with other LKDs. Conclusions Potential donors not only have personal donation-related concerns but frequently hear donation-related concerns from family members and friends. Current gaps in donor education include an absence of practical, peer-to-peer advice about donation from other prior donors and materials directed and potential donors’ family members and friends. These findings can inform the development of new educational practices and resources targeted not only at LKDs but at their social networks.
Collapse
Affiliation(s)
- Jessica M Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 34, Baltimore, MD, 21205, USA.
| | - Sarah E Van Pilsum Rasmussen
- Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 34, Baltimore, MD, 21205, USA
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 34, Baltimore, MD, 21205, USA
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 34, Baltimore, MD, 21205, USA.,Department of Epidemiology, Johns Hopkins School of Public Health, 720 Rutland Ave, Ross 34, Baltimore, MD, 21205, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 34, Baltimore, MD, 21205, USA.,Department of Epidemiology, Johns Hopkins School of Public Health, 720 Rutland Ave, Ross 34, Baltimore, MD, 21205, USA
| |
Collapse
|
35
|
Van Pilsum Rasmussen SE, Henderson ML, Bollinger J, Seaman S, Brown D, Durand CM, Segev DL, Sugarman J. Perceptions, motivations, and concerns about living organ donation among people living with HIV. AIDS Care 2018; 30:1595-1599. [PMID: 29724118 DOI: 10.1080/09540121.2018.1469724] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Recent changes to United States law now permit people living with HIV (PLWH) to donate organs to HIV-infected (HIV+) recipients under research protocols. PLWH may have unique motivations for and concerns about living donation and understanding them is critical to ensuring the integrity of this novel approach to organ transplantation. We conducted in-depth interviews with PLWH from an urban HIV clinic who had previously indicated their willingness to be a living donor. Interviews elicited information on their motivations, perceived benefits, and concerns regarding living donation. Codes were identified inductively and then organized into themes and subthemes. Two coders independently analyzed the interviews and reconciled differences in coding by consensus. Thematic saturation was reached after 20 interviews. Motivations for living donation among PLWH included an altruistic desire to help others as well as HIV-specific motivations including solidarity with potential recipients and a desire to overcome HIV-related stigma. Perceived benefits of living donation included gratification from saving or improving the recipient's life and conferring a sense of normalcy for the HIV+ donor. Concerns about donation included the possibility of a prolonged recovery period, organ failure, and transmission of another strain of the virus to the recipients. PLWH had unique motivations, perceived benefits, and concerns about living donation in addition to those previously identified in the general population. These unique factors should be addressed in research protocols, informed consent processes, and the education and training of independent living donor advocates so that these endeavors are ethically sound.
Collapse
Affiliation(s)
| | - Macey L Henderson
- a Department of Surgery , Johns Hopkins University , Baltimore , USA.,b School of Nursing , Johns Hopkins University , Baltimore , USA
| | - Juli Bollinger
- c Berman Institute of Bioethics , Johns Hopkins University , Baltimore , USA
| | - Shanti Seaman
- d Department of Medicine , Johns Hopkins School of Medicine , Baltimore , USA
| | - Diane Brown
- d Department of Medicine , Johns Hopkins School of Medicine , Baltimore , USA
| | - Christine M Durand
- d Department of Medicine , Johns Hopkins School of Medicine , Baltimore , USA
| | - Dorry L Segev
- a Department of Surgery , Johns Hopkins University , Baltimore , USA.,b School of Nursing , Johns Hopkins University , Baltimore , USA.,e Department of Epidemiology , Johns Hopkins University Bloomberg School of Public Health , Baltimore , USA
| | - Jeremy Sugarman
- c Berman Institute of Bioethics , Johns Hopkins University , Baltimore , USA.,d Department of Medicine , Johns Hopkins School of Medicine , Baltimore , USA
| |
Collapse
|
36
|
Abstract
Organ donation potential is not a motivator of care in the trauma bay, and it is ethically problematic to consider organ donor potential during the active resuscitation of a trauma patient. Despite organ donation being a public good, the role of the trauma physician is to maintain focus on the patient as an individual and to respect a patient's right to life and autonomy. This tenet of medicine is the foundation of the trust that a community and individuals must have in order for the health care system to function. Fortunately, there are guidelines and systems in place to allow physicians to care for the patient in front of them while simultaneously making morally sound decisions regarding donation in the setting of the current organ shortage.
Collapse
Affiliation(s)
- Sandra R DiBrito
- A general surgery resident at the Johns Hopkins Hospital and a PhD candidate in clinical investigations at the Johns Hopkins Bloomberg School of Public Health in Baltimore
| | - Macey L Henderson
- An assistant professor of surgery in the Department of Surgery in the Division of Transplantation at the Johns Hopkins School of Medicine in Baltimore, with a joint appointment in the Department of Acute and Chronic Care at the Johns Hopkins University School of Nursing, and a member of the board of directors for the Organ Procurement and Transplantation Network and the United Network for Organ Sharing
| |
Collapse
|
37
|
Henderson ML. Social Media in the Identification of Living Kidney Donors: Platforms, Tools, and Strategies. Curr Transplant Rep 2018; 5:19-26. [PMID: 29805956 PMCID: PMC5963285] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE OF REVIEW Living donor transplantation offers patients with end-stage renal disease faster access to transplant and better survival and quality of life than waiting for a deceased donor or remaining on dialysis. While many people state they would be willing to help someone in need through kidney donation, there are education and communication barriers to donor candidate identification. These barriers might be mitigated by technological innovations, including the use of social media. RECENT FINDINGS This article describes the state of contemporary evidence regarding use of social media tools and interventions to increase access to living donor transplantation, as reported in peer-reviewed medical literature, as well as programs that have not yet been formally evaluated. SUMMARY As social media platforms continue to grow and expand, a commitment to understanding and facilitating the use of social media by the transplant community may support patients who are interested in using social media as a tool to find a living kidney donor.
Collapse
Affiliation(s)
- Macey L. Henderson
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| |
Collapse
|
38
|
Ruck JM, Holscher CM, Purnell TS, Massie AB, Henderson ML, Segev DL. Factors associated with perceived donation-related financial burden among living kidney donors. Am J Transplant 2018; 18:715-719. [PMID: 29068176 PMCID: PMC5863761 DOI: 10.1111/ajt.14548] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 07/07/2017] [Revised: 09/18/2017] [Accepted: 10/12/2017] [Indexed: 01/25/2023]
Abstract
The perception of living kidney donation-related financial burden affects willingness to donate and the experience of donation, yet no existing tools identify donors who are at higher risk of perceived financial burden. We sought to identify characteristics that predicted higher risk of perceived financial burden. We surveyed 51 living kidney donors (LKDs) who donated from 01/2015 to 3/2016 about socioeconomic characteristics, predonation cost concerns, and perceived financial burden. We tested associations between both self-reported and ZIP code-level characteristics and perceived burden using Fisher's exact test and bivariate modified Poisson regression. Donors who perceived donation-related financial burden were less likely to have an income above their ZIP code median (14% vs. 72%, P = .006); however, they were more likely than donors who did not perceive burden to rent their home (57% vs. 16%, P = .03), have an income <$60 000 (86% vs. 20%, P = .002), or have had predonation cost concerns (43% vs. 7%, P = .03). Perceived financial burden was 3.6-fold as likely among those with predonation cost concerns and 10.6-fold as likely for those with incomes <$60 000. Collecting socioeconomic characteristics and asking about donation-related cost concerns prior to donation might allow transplant centers to target financial support interventions toward potential donors at higher risk of perceiving donation-related financial burden.
Collapse
Affiliation(s)
- Jessica M. Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Tanjala S. Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD,Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Johns Hopkins University School of Nursing, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD,Johns Hopkins University School of Nursing, Baltimore, MD
| |
Collapse
|
39
|
Hunt HF, Rodrigue JR, Dew MA, Schaffer RL, Henderson ML, Bloom R, Kacani P, Shim P, Bolton L, Sanchez W, Lentine KL. Strategies for Increasing Knowledge, Communication, and Access to Living Donor Transplantation: an Evidence Review to Inform Patient Education. Curr Transplant Rep 2018; 5:27-44. [PMID: 30873335 DOI: 10.1007/s40472-018-0181-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Purpose of review Inadequate knowledge of the benefits, risks and opportunities for living donation is an important, potentially modifiable barrier to living donor transplantation. We assessed the current state of the evidence regarding strategies to increase knowledge, communication and access to living donor transplantation, as reported in peer-reviewed medical literature. Recent Findings Nineteen studies were reviewed, categorized as programs evaluated in randomized controlled trials (8 studies) and programs supported by observational (non-randomized) studies (11 studies). Content extraction demonstrated that comprehensive education about living donation and living donor transplantation involves multiple learners - the transplant candidate, potential living donors, and social support networks - and requires communicating complex information about the risks and benefits of donation, transplantation and alternative therapies to these different audiences. Transplant centers can help transplant patients learn about living donor transplantation through a variety of formats and modalities, including center-based, home-based and remote technology-based education, outreach to dialysis centers, and social media. Evaluation of these strategies and program themes informed a new Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) public education brochure. Summary Increasing transplant candidate knowledge and comfort in talking about living donation and transplantation can reduce educational barriers to pursuit of living donor transplants. Ongoing efforts are needed to develop, refine and disseminate educational programs to help improve transplant access for more patients in need of organ donors.
Collapse
Affiliation(s)
- Heather F Hunt
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,LIVE ON Organ Donation, Inc., Longmeadow, MA
| | - James R Rodrigue
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Beth Israel Deaconess Transplant Institute, Boston, MA
| | - Mary Amanda Dew
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
| | - Randolph L Schaffer
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Scripps Clinic, La Jolla, CA
| | - Macey L Henderson
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Johns Hopkins University, Transplant Center & School of Nursing, Baltimore, MD
| | - Randee Bloom
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA
| | - Patrick Kacani
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA
| | - Pono Shim
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA
| | - Lee Bolton
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA
| | - William Sanchez
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Mayo Clinic, Rochester, MN
| | - Krista L Lentine
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Saint Louis University School of Medicine & Transplant Center, St. Louis, MO
| |
Collapse
|
40
|
Purnell TS, Luo X, Cooper LA, Massie AB, Kucirka LM, Henderson ML, Gordon EJ, Crews DC, Boulware LE, Segev DL. Association of Race and Ethnicity With Live Donor Kidney Transplantation in the United States From 1995 to 2014. JAMA 2018; 319:49-61. [PMID: 29297077 PMCID: PMC5833543 DOI: 10.1001/jama.2017.19152] [Citation(s) in RCA: 189] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
IMPORTANCE Over the past 2 decades, there has been increased attention and effort to reduce disparities in live donor kidney transplantation (LDKT) for black, Hispanic, and Asian patients with end-stage kidney disease. The goal of this study was to investigate whether these efforts have been successful. OBJECTIVE To estimate changes over time in racial/ethnic disparities in LDKT in the United States, accounting for differences in death and deceased donor kidney transplantation. DESIGN, SETTING, AND PARTICIPANTS A secondary analysis of a prospectively maintained cohort study conducted in the United States of 453 162 adult first-time kidney transplantation candidates included in the Scientific Registry of Transplant Recipients between January 1, 1995, and December 31, 2014, with follow-up through December 31, 2016. EXPOSURES Race/ethnicity. MAIN OUTCOMES AND MEASURES The primary study outcome was time to LDKT. Multivariable Cox proportional hazards and competing risk models were constructed to assess changes in racial/ethnic disparities in LDKT among adults on the deceased donor kidney transplantation waiting list and interaction terms were used to test the statistical significance of temporal changes in racial/ethnic differences in receipt of LDKT. The adjusted subhazard ratios are estimates derived from the multivariable competing risk models. Data were categorized into 5-year increments (1995-1999, 2000-2004, 2005-2009, 2010-2014) to allow for an adequate sample size in each analytical cell. RESULTS Among 453 162 adult kidney transplantation candidates (mean [SD] age, 50.9 [13.1] years; 39% were women; 48% were white; 30%, black; 16%, Hispanic; and 6%, Asian), 59 516 (13.1%) received LDKT. Overall, there were 39 509 LDKTs among white patients, 8926 among black patients, 8357 among Hispanic patients, and 2724 among Asian patients. In 1995, the cumulative incidence of LDKT at 2 years after appearing on the waiting list was 7.0% among white patients, 3.4% among black patients, 6.8% among Hispanic patients, and 5.1% among Asian patients. In 2014, the cumulative incidence of LDKT was 11.4% among white patients, 2.9% among black patients, 5.9% among Hispanic patients, and 5.6% among Asian patients. From 1995-1999 to 2010-2014, racial/ethnic disparities in the receipt of LDKT increased (P < .001 for all statistical interaction terms in adjusted models comparing white patients vs black, Hispanic, and Asian patients). In 1995-1999, compared with receipt of LDKT among white patients, the adjusted subhazard ratio was 0.45 (95% CI, 0.42-0.48) among black patients, 0.83 (95% CI, 0.77-0.88) among Hispanic patients, and 0.56 (95% CI, 0.50-0.63) among Asian patients. In 2010-2014, compared with receipt of LDKT among white patients, the adjusted subhazard ratio was 0.27 (95% CI, 0.26-0.28) among black patients, 0.52 (95% CI, 0.50-0.54) among Hispanic patients, and 0.42 (95% CI, 0.39-0.45) among Asian patients. CONCLUSIONS AND RELEVANCE Among adult first-time kidney transplantation candidates in the United States who were added to the deceased donor kidney transplantation waiting list between 1995 and 2014, disparities in the receipt of live donor kidney transplantation increased from 1995-1999 to 2010-2014. These findings suggest that national strategies for addressing disparities in receipt of live donor kidney transplantation should be revisited.
Collapse
Affiliation(s)
- Tanjala S. Purnell
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
| | - Xun Luo
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lisa A. Cooper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Allan B. Massie
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lauren M. Kucirka
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Macey L. Henderson
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Elisa J. Gordon
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Deidra C. Crews
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - L. Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Dorry L. Segev
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
41
|
Ruck JM, Zhou S, Thomas AG, Cramm SL, Massie AB, Montgomery JR, Berger JC, Henderson ML, Segev DL. Electronic messaging and communication with living kidney donors. Clin Transplant 2017; 32. [PMID: 29281129 DOI: 10.1111/ctr.13184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 12/18/2017] [Indexed: 01/16/2023]
Abstract
New regulations require living kidney donor (LKD) follow-up for 2 years, but donor retention remains poor. Electronic communication (eg, text messaging and e-mail) might improve donor retention. To explore the possible impact of electronic communication, we recruited LKDs to participate in an exploratory study of communication via telephone, e-mail, or text messaging postdonation; communication through this study was purely optional and did not replace standard follow-up. Of 69 LKDs recruited, 3% requested telephone call, 52% e-mail, and 45% text messaging. Telephone response rate was 0%; these LKDs were subsequently excluded from analysis. Overall response rates with e-mail or text messaging at 1 week, 1 month, 6 months, 1 year, and 2 years were 94%, 87%, 81%, 72%, and 72%. Lower response rates were seen in African Americans, even after adjusting for age, sex, and contact method (incidence rate ratio (IRR) nonresponse 2.07 5.8116.36 , P = .001). Text messaging had higher response rates than e-mail (IRR nonresponse 0.11 0.280.71 , P = .007). Rates of nonresponse were similar by sex (IRR 0.68, P = .4) and age (IRR 1.00, P > .9). In summary, LKDs strongly preferred electronic messaging over telephone and were highly responsive 2 years postdonation, even in this nonrequired, nonincentivized exploratory research study. These electronic communication tools can be automated and may improve regulatory compliance and postdonation care.
Collapse
Affiliation(s)
- Jessica M Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sheng Zhou
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shannon L Cramm
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - John R Montgomery
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan C Berger
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| |
Collapse
|
42
|
Henderson ML, Thomas AG, Shaffer A, Massie AB, Luo X, Holscher CM, Purnell TS, Lentine KL, Segev DL. The National Landscape of Living Kidney Donor Follow-Up in the United States. Am J Transplant 2017; 17:3131-3140. [PMID: 28510355 PMCID: PMC5690895 DOI: 10.1111/ajt.14356] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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: 10/19/2016] [Revised: 04/28/2017] [Accepted: 05/04/2017] [Indexed: 01/25/2023]
Abstract
In 2013, the Organ Procurement and Transplantation Network (OPTN)/ United Network for Organ Sharing (UNOS) mandated that transplant centers collect data on living kidney donors (LKDs) at 6 months, 1 year, and 2 years postdonation, with policy-defined thresholds for the proportion of complete living donor follow-up (LDF) data submitted in a timely manner (60 days before or after the expected visit date). While mandated, it was unclear how centers across the country would perform in meeting thresholds, given potential donor and center-level challenges of LDF. To better understand the impact of this policy, we studied Scientific Registry of Transplant Recipients data for 31,615 LKDs between January 2010 and June 2015, comparing proportions of complete and timely LDF form submissions before and after policy implementation. We also used multilevel logistic regression to assess donor- and center-level characteristics associated with complete and timely LDF submissions. Complete and timely 2-year LDF increased from 33% prepolicy (January 2010 through January 2013) to 54% postpolicy (February 2013 through June 2015) (p < 0.001). In an adjusted model, the odds of 2-year LDF increased by 22% per year prepolicy (p < 0.001) and 23% per year postpolicy (p < 0.001). Despite these annual increases in LDF, only 43% (87/202) of centers met the OPTN/UNOS-required 6-month, 1-year, and 2-year LDF thresholds for LKDs who donated in 2013. These findings motivate further evaluation of LDF barriers and the optimal approaches to capturing outcomes after living donation.
Collapse
Affiliation(s)
- M L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - A G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - A Shaffer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - A B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - X Luo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C M Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - T S Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - K L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - D L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| |
Collapse
|
43
|
Kasiske BL, Asrani SK, Dew MA, Henderson ML, Henrich C, Humar A, Israni AK, Lentine KL, Matas AJ, Newell KA, LaPointe Rudow D, Massie AB, Snyder JJ, Taler SJ, Trotter JF, Waterman AD. The Living Donor Collective: A Scientific Registry for Living Donors. Am J Transplant 2017; 17:3040-3048. [PMID: 28520316 DOI: 10.1111/ajt.14365] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 12/27/2016] [Revised: 04/20/2017] [Accepted: 05/07/2017] [Indexed: 01/25/2023]
Abstract
In the setting of an overall decline in living organ donation and new questions about long-term safety, a better understanding of outcomes after living donation has become imperative. Adequate information on outcomes important to donors may take many years to ascertain and may be evident only by comparing large numbers of donors with suitable controls. Previous studies have been unable to fully answer critical questions, primarily due to lack of appropriate controls, inadequate sample size, and/or follow-up duration that is too short to allow detection of important risks attributable to donation. The Organ Procurement and Transplantation Network does not follow donors long term and has no prospective control group with which to compare postdonation outcomes. There is a need to establish a national living donor registry and to prospectively follow donors over their lifetimes. In addition, there is a need to better understand the reasons many potential donors who volunteer to donate do not donate and whether the reasons are justified. Therefore, the US Health Resources and Services Administration asked the Scientific Registry of Transplant Recipients to establish a national registry to address these important questions. Here, we discuss the efforts, challenges, and opportunities inherent in establishing the Living Donor Collective.
Collapse
Affiliation(s)
- B L Kasiske
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - S K Asrani
- Transplant Hepatology, Baylor University Medical Center, Dallas, TX
| | - M A Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - M L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Henrich
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - A Humar
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - A K Israni
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - K L Lentine
- Department of Medicine, Saint Louis University, St. Louis, MO
| | - A J Matas
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | - K A Newell
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - D LaPointe Rudow
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York, NY
| | - A B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - J J Snyder
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - S J Taler
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - J F Trotter
- Transplant Hepatology, Baylor University Medical Center, Dallas, TX
| | - A D Waterman
- David Geffen School of Medicine at UCLA, Kidney Transplant Program, Los Angeles, CA
| | | |
Collapse
|
44
|
Henderson ML, Clayville KA, Fisher JS, Kuntz KK, Mysel H, Purnell TS, Schaffer RL, Sherman LA, Willock EP, Gordon EJ. Social media and organ donation: Ethically navigating the next frontier. Am J Transplant 2017; 17:2803-2809. [PMID: 28744966 DOI: 10.1111/ajt.14444] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 03/31/2017] [Revised: 06/30/2017] [Accepted: 07/17/2017] [Indexed: 01/25/2023]
Abstract
As the organ shortage continues to grow, the creation of social media communities by transplant hospitals and the public is rapidly expanding to increase the number of living donors. Social media communities are arranged in myriad ways and without standardization, raising concerns about transplant candidates' and potential donors' autonomy and quality of care. Social media communities magnify and modify extant ethical issues in deceased and living donation related to privacy, confidentiality, professionalism, and informed consent, and increase the potential for undue influence and coercion for potential donors and transplant candidates. Currently, no national ethical guidelines have been developed in the United States regarding the use of social media to foster organ transplantation. We provide an ethical framework to guide transplant stakeholders in using social media for public and patient communication about transplantation and living donation, and offer recommendations for transplant clinical practice and future research.
Collapse
Affiliation(s)
- M L Henderson
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - J S Fisher
- Scripps Clinic/Green Hospital, La Jolla, CA, USA
| | - K K Kuntz
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - H Mysel
- The Living Kidney Donors Network, Chicago, IL, USA
| | - T S Purnell
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - R L Schaffer
- Scripps Clinic/Green Hospital, La Jolla, CA, USA
| | - L A Sherman
- Medical College of Wisconsin Milwaukee, WI, USA
| | - E P Willock
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - E J Gordon
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
45
|
Holscher C, DiBrito S, Thomas AG, Massie AB, Wang JG, Lentine K, Segev DL, Henderson ML. Multiple Solid Organ Donations from Live Donors in the United States: What Do We Know? J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.989] [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: 10/18/2022]
|
46
|
Holscher C, Thomas AG, Wang JG, Massie AB, Segev DL, Henderson ML. Live Liver Donor Follow-Up: Fewer than Half of Centers Meet Nationally Mandated Follow-Up Requirements. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.986] [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: 10/18/2022]
|
47
|
Van Pilsum Rasmussen SE, Henderson ML, Kahn J, Segev D. Considering Tangible Benefit for Interdependent Donors: Extending a Risk-Benefit Framework in Donor Selection. Am J Transplant 2017; 17:2567-2571. [PMID: 28425206 PMCID: PMC6108434 DOI: 10.1111/ajt.14319] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 09/14/2016] [Revised: 04/06/2017] [Accepted: 04/12/2017] [Indexed: 01/25/2023]
Abstract
From its infancy, live donor transplantation has operated within a framework of acceptable risk to donors. Such a framework presumes that risks of living donation are experienced by the donor while all benefits are realized by the recipient, creating an inequitable distribution that demands minimization of donor risk. We suggest that this risk-tolerance framework ignores tangible benefits to the donor. A previously proposed framework more fully considers potential benefits to the donor and argues that risks and benefits must be balanced. We expand on this approach, and posit that donors sharing a household with and/or caring for a potential transplant patient may realize tangible benefits that are absent in a more distantly related donation (e.g. cousin, nondirected). We term these donors, whose well-being is closely tied to their recipient, "interdependent donors." A flexible risk-benefit model that combines risk assessment with benefits to interdependent donors will contribute to donor evaluation and selection that more accurately reflects what is at stake for donors. In so doing, a risk-benefit framework may allow some donors to accept greater risk in donation decisions.
Collapse
Affiliation(s)
| | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeffrey Kahn
- Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
| | - Dorry Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
48
|
Massie AB, Muzaale AD, Luo X, Chow EKH, Locke JE, Nguyen AQ, Henderson ML, Snyder JJ, Segev DL. Quantifying Postdonation Risk of ESRD in Living Kidney Donors. J Am Soc Nephrol 2017; 28:2749-2755. [PMID: 28450534 PMCID: PMC5576930 DOI: 10.1681/asn.2016101084] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [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: 10/10/2016] [Accepted: 03/05/2017] [Indexed: 11/03/2022] Open
Abstract
Studies have estimated the average risk of postdonation ESRD for living kidney donors in the United States, but personalized estimation on the basis of donor characteristics remains unavailable. We studied 133,824 living kidney donors from 1987 to 2015, as reported to the Organ Procurement and Transplantation Network, with ESRD ascertainment via Centers for Medicare and Medicaid Services linkage, using Cox regression with late entries. Black race (hazard ratio [HR], 2.96; 95% confidence interval [95% CI], 2.25 to 3.89; P<0.001) and male sex (HR, 1.88; 95% CI, 1.50 to 2.35; P<0.001) was associated with higher risk of ESRD in donors. Among nonblack donors, older age was associated with greater risk (HR per 10 years, 1.40; 95% CI, 1.23 to 1.59; P<0.001). Among black donors, older age was not significantly associated with risk (HR, 0.88; 95% CI, 0.72 to 1.09; P=0.3). Greater body mass index was associated with higher risk (HR per 5 kg/m2, 1.61; 95% CI, 1.29 to 2.00; P<0.001). Donors who had a first-degree biological relationship to the recipient had increased risk (HR, 1.70; 95% CI, 1.24 to 2.34; P<0.01). C-statistic of the model was 0.71. Predicted 20-year risk of ESRD for the median donor was only 34 cases per 10,000 donors, but 1% of donors had predicted risk exceeding 256 cases per 10,000 donors. Risk estimation is critical for appropriate informed consent and varies substantially across living kidney donors. Greater permissiveness may be warranted in older black candidate donors; young black candidates should be evaluated carefully.
Collapse
Affiliation(s)
- Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Abimereki D Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xun Luo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric K H Chow
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jayme E Locke
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Anh Q Nguyen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jon J Snyder
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| |
Collapse
|
49
|
Alejo JL, Luo X, Massie AB, Henderson ML, DiBrito SR, Locke JE, Purnell TS, Boyarsky BJ, Anjum S, Halpern SE, Segev DL. Patterns of primary care utilization before and after living kidney donation. Clin Transplant 2017; 31:10.1111/ctr.12992. [PMID: 28457016 PMCID: PMC5731477 DOI: 10.1111/ctr.12992] [Citation(s) in RCA: 7] [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] [Accepted: 04/25/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Annual visits with a primary care provider (PCP) are recommended for living kidney donors to monitor long-term health postdonation, yet adherence to this recommendation is unknown. METHODS We surveyed 1170 living donors from our center from 1970 to 2012 to ascertain frequency of PCP visits pre- and postdonation. Interviews occurred median (IQR) 6.6 (3.8-11.0) years post-transplant. We used multivariate logistic regression to examine associations between donor characteristics and PCP visit frequency. RESULTS Overall, only 18.6% had less-than-annual PCP follow-up postdonation. The strongest predictor of postdonation PCP visit frequency was predonation PCP visit frequency. Donors who had less-than-annual PCP visits before donation were substantially more likely to report less-than-annual PCP visits postdonation (OR=9.8 14.421.0, P<.001). Men were more likely to report less-than-annual PCP visits postdonation (adjusted OR=1.2 1.62.3, P<.01); this association was amplified in unmarried/noncohabiting men (aOR=2.4 3.96.3, P<.001). Donors without college education were also more likely to report less-than-annual PCP visits postdonation (aOR=1.3 1.82.5 , P=.001). CONCLUSIONS The importance of annual PCP visits should be emphasized to all living donors, especially those with less education, men (particularly single men), and donors who did not see their PCP annually before donation.
Collapse
Affiliation(s)
- Jennifer L Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xun Luo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sandra R DiBrito
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jayme E Locke
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tanjala S Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Brian J Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Saad Anjum
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Samantha E Halpern
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| |
Collapse
|
50
|
Abstract
About 6,000 individuals participate in the U.S. transplant system as a living organ donor each year. Organ donation (most commonly a kidney or part of liver) by living individuals is a unique procedure, where healthy patients undergo a major surgical operation without any direct functional benefit to themselves. In this article, the authors explore how the ideal of informed consent guides education and evaluation for living organ donation. The authors posit that informed consent for living organ donation is a process. Though the steps in this process are partially standardized through national health policy, they can be improved through institutional structures at the local, transplant center-level. Effective structures and practices aimed at supporting and promoting comprehensive informed consent provide more opportunities for candidates to ask questions about the risks and benefits of living donation and to opt out voluntarily Additionally, these practices could enable new ways of measuring knowledge and improving the consent process.
Collapse
Affiliation(s)
- Macey L Henderson
- Macey L. Henderson, J.D., Ph.D., is an Instructor of Surgery, Division of Transplant Surgery at Johns Hopkins School of Medicine in Baltimore, Maryland. She received her J.D. from the Indiana University Maurer School of Law-Bloomington, Indiana and Ph.D. in Health Policy and Management from the Indiana University Fairbanks School of Public Health in Indianapolis, Indiana. Jed Adam Gross, J.D., M.Phil., is a Bioethicist at Toronto General Hospital in Toronto, Ontario, a Ph.D. candidate in History at Yale University in New Haven, Connecticut, and a member of the Massachusetts bar. He earned his B.A. from the University of Pennsylvania in Philadelphia, Pennsylvania, and his postgraduate degrees from Yale University
| | - Jed Adam Gross
- Macey L. Henderson, J.D., Ph.D., is an Instructor of Surgery, Division of Transplant Surgery at Johns Hopkins School of Medicine in Baltimore, Maryland. She received her J.D. from the Indiana University Maurer School of Law-Bloomington, Indiana and Ph.D. in Health Policy and Management from the Indiana University Fairbanks School of Public Health in Indianapolis, Indiana. Jed Adam Gross, J.D., M.Phil., is a Bioethicist at Toronto General Hospital in Toronto, Ontario, a Ph.D. candidate in History at Yale University in New Haven, Connecticut, and a member of the Massachusetts bar. He earned his B.A. from the University of Pennsylvania in Philadelphia, Pennsylvania, and his postgraduate degrees from Yale University
| |
Collapse
|