1
|
von Ahrens D, Santeusanio AD, Weinberg AD, Moon J, Iyer KR. Risk factors for renal dysfunction after isolated intestinal transplantation. Clin Transplant 2024; 38:e15228. [PMID: 38289880 DOI: 10.1111/ctr.15228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 09/15/2023] [Accepted: 12/08/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Kidney dysfunction is a known complication of intestinal transplantation; however, the rate of development and risk factors for chronic kidney disease (CKD) remain poorly defined. METHODS This was a single-center retrospective review of isolated adult intestinal allograft recipients from 2011 to 2019. Patients who died or experienced graft loss within 1-year or had a prior transplant were excluded. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation at 0-, 6- and 12-months post-transplant, and multivariable linear regression was performed to identify variables associated with adjusted eGFR at 1-year. Independent variables included age, ethnicity, BMI, history of diabetes/hypertension, vasopressor use, TPN and stoma days, urinary or bloodstream infections, intravenous contrast exposure, rejection, concomitant immunosuppression, and time above the therapeutic range of tacrolimus. Variables with a p < .1 in univariate analysis were considered for multivariable modeling. RESULTS Thirty-three patients were included with a mean age of 43.9 ± 13.0. A mean 42.3% decline in eGFR was observed at 1-year post-transplant, with 15.2% of patients developing new stage 4/5 CKD. Factors associated with a greater decline in adjusted eGFR in the univariate model included increasing age, decreased BMI, stoma days, and vasopressor use. In the adjusted multivariable model patient age (β = -.77, p < .01) and stoma days (β = -.06, p < .01) remained significant. Tacrolimus and sirolimus exposure were not associated with decline in eGFR at 1 year. CONCLUSIONS Renal dysfunction is common following intestinal transplantation. The need for stoma creation should be carefully considered, and reversal should be performed when feasible for renal protection.
Collapse
Affiliation(s)
- Dagny von Ahrens
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA
| | - Andrew D Santeusanio
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA
- Department of Pharmacy, Mount Sinai Hospital, New York, New York, USA
| | - Alan D Weinberg
- Department of Population Health Science and Policy, Mount Sinai Hospital, New York, New York, USA
| | - Jang Moon
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA
| | - Kishore R Iyer
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA
| |
Collapse
|
2
|
Santeusanio AD, Carpenter GR, Crovetto B, Radparvar S. Delivery of sodium zirconium cyclosilicate through gastric and enteral feeding tubes. Am J Health Syst Pharm 2023; 80:804-805. [PMID: 37010876 DOI: 10.1093/ajhp/zxad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Indexed: 04/04/2023] Open
Affiliation(s)
| | | | - Brynna Crovetto
- Department of Pharmacy Mount Sinai Hospital New York, NY, USA
| | - Sara Radparvar
- Department of Pharmacy Mount Sinai Hospital New York, NY, USA
| |
Collapse
|
3
|
Petrosan A, Santeusanio AD, Khaim R, Delaney V. Comparison of Intensive Insulin Versus Oral Regimens on Early Glycemic Control Following Kidney Transplant. Prog Transplant 2022; 32:327-331. [PMID: 36114645 DOI: 10.1177/15269248221122869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Insulin is commonly prescribed to manage early post-kidney transplant hyperglycemia due to its flexibility. Studies comparing the effectiveness of oral therapies on glycemic outcomes remain limited. Project aims: The purpose of this program evaluation was to analyze our experience using oral antiglycemic agents immediately post-kidney transplant, compared to patients managed with insulin monotherapy. Design: This was a single-center, retrospective review of adult kidney transplant recipients with new or worsening hyperglycemia between 01/2014-05/2020. Patients were excluded if they had a prior or combined organ transplant, type 1 diabetes, or were previously on intensive insulin. Patients discharged on oral medications were 1:1 matched to patients receiving intensive insulin based on pre-specified clinical parameters. The primary endpoint was the number of diabetes-related readmissions within 6-months of transplant. Key secondary endpoints included mean serum glucose and hemoglobin A1c levels. Results: Thirty patients prescribed oral therapies were successfully matched to patients receiving intensive insulin. Baseline characteristics were similar between groups, except for more whites in the insulin group. There were no differences in diabetes-related (6.7% vs 3.3%; P = 1.00) or all-cause readmissions within 6-months. Mean serum glucose (P = .99) and hemoglobin A1c (P = .49) levels were also similar between patients receiving oral agents and insulin. However, 7 patients in the oral group were eventually converted to standing insulin. Conclusion: Our experience suggested that the early use of oral antiglycemics post-kidney transplant in select patients can result in similar outcomes relative to insulin. Meticulous follow-up is necessary as one-quarter of patients may require conversion to insulin within 1-month.
Collapse
Affiliation(s)
- Adina Petrosan
- Recanati-Miller Transplantation Institute, 5864Mount Sinai Hospital, New York, NY, USA
| | - Andrew D Santeusanio
- Recanati-Miller Transplantation Institute, 5864Mount Sinai Hospital, New York, NY, USA
| | - Rafael Khaim
- Recanati-Miller Transplantation Institute, 5864Mount Sinai Hospital, New York, NY, USA
| | - Veronica Delaney
- Recanati-Miller Transplantation Institute, 5864Mount Sinai Hospital, New York, NY, USA
| |
Collapse
|
4
|
Banu K, Lin Q, Basgen JM, Planoutene M, Wei C, Reghuvaran AC, Tian X, Shi H, Garzon F, Garzia A, Chun N, Cumpelik A, Santeusanio AD, Zhang W, Das B, Salem F, Li L, Ishibe S, Cantley LG, Kaufman L, Lemley KV, Ni Z, He JC, Murphy B, Menon MC. AMPK mediates regulation of glomerular volume and podocyte survival. JCI Insight 2021; 6:e150004. [PMID: 34473647 PMCID: PMC8525649 DOI: 10.1172/jci.insight.150004] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/01/2021] [Indexed: 12/20/2022] Open
Abstract
Herein, we report that Shroom3 knockdown, via Fyn inhibition, induced albuminuria with foot process effacement (FPE) without focal segmental glomerulosclerosis (FSGS) or podocytopenia. Interestingly, knockdown mice had reduced podocyte volumes. Human minimal change disease (MCD), where podocyte Fyn inactivation was reported, also showed lower glomerular volumes than FSGS. We hypothesized that lower glomerular volume prevented the progression to podocytopenia. To test this hypothesis, we utilized unilateral and 5/6th nephrectomy models in Shroom3-KD mice. Knockdown mice exhibited less glomerular and podocyte hypertrophy after nephrectomy. FYN-knockdown podocytes had similar reductions in podocyte volume, implying that Fyn was downstream of Shroom3. Using SHROOM3 or FYN knockdown, we confirmed reduced podocyte protein content, along with significantly increased phosphorylated AMPK, a negative regulator of anabolism. AMPK activation resulted from increased cytoplasmic redistribution of LKB1 in podocytes. Inhibition of AMPK abolished the reduction in glomerular volume and induced podocytopenia in mice with FPE, suggesting a protective role for AMPK activation. In agreement with this, treatment of glomerular injury models with AMPK activators restricted glomerular volume, podocytopenia, and progression to FSGS. Glomerular transcriptomes from MCD biopsies also showed significant enrichment of Fyn inactivation and Ampk activation versus FSGS glomeruli. In summary, we demonstrated the important role of AMPK in glomerular volume regulation and podocyte survival. Our data suggest that AMPK activation adaptively regulates glomerular volume to prevent podocytopenia in the context of podocyte injury.
Collapse
Affiliation(s)
- Khadija Banu
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Division of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Qisheng Lin
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - John M Basgen
- Morphometry and Stereology Laboratory, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Marina Planoutene
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Chengguo Wei
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anand C Reghuvaran
- Division of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Xuefei Tian
- Division of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Hongmei Shi
- Division of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Felipe Garzon
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aitor Garzia
- Laboratory of RNA Molecular Biology, The Rockefeller University, New York, New York, USA
| | - Nicholas Chun
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arun Cumpelik
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew D Santeusanio
- Division of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Weijia Zhang
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bhaskar Das
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fadi Salem
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Li Li
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shuta Ishibe
- Division of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lloyd G Cantley
- Division of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lewis Kaufman
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kevin V Lemley
- Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - John Cijiang He
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Barbara Murphy
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Madhav C Menon
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Division of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
5
|
Santeusanio AD, Gu A, Weinberg AD, Moon J, Iyer KR. Tacrolimus time-in-therapeutic range is associated with freedom from acute rejection and graft failure following intestinal transplantation. Clin Transplant 2021; 35:e14291. [PMID: 33740822 DOI: 10.1111/ctr.14291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 02/26/2021] [Accepted: 03/12/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Trough-adjusted tacrolimus is commonly prescribed following intestinal transplantation to prevent allograft rejection. Despite established practice, there remains limited direct evidence linking tacrolimus levels with improved clinical outcomes. METHODS This was a single-center review of all adult non-liver containing intestinal allograft recipients from 2011 to 2018. Patients received lymphocyte depleting induction and maintenance immunosuppression consisting of tacrolimus and a corticosteroid taper. Tacrolimus time-in-therapeutic range (TAC-TTR) was calculated for all patients from the date of transplant until 1-year post-transplant using Rosendaal's method. Cox-Proportional hazards modeling was utilized to assess freedom from acute rejection and graft failure stratified by TAC-TTR quartile. RESULTS 47 patients were included in the review. Mean TAC-TTR for the cohort was 30.2% ± 11.4. Fifteen episodes of acute rejection were observed, 8 of which were severe. Patients in the highest TAC-TTR quartile >36% had a lower incidence of acute rejection and graft failure relative to patients with a TAC-TTR <20%. Cox-Proportional hazards modeling found a 10% decrease in TAC-TTR was associated with an increased hazard for acute rejection (2.03), severe acute rejection (2.19), and graft loss (3.33). CONCLUSION The results of this study suggest that decreasing TAC-TTR is a risk factor for both acute rejection as well as intestinal allograft failure.
Collapse
Affiliation(s)
- Andrew D Santeusanio
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA.,Department of Pharmacy, Mount Sinai Hospital, New York, NY, USA
| | - Alan Gu
- Mount Sinai Hospital, New York, NY, USA
| | - Alan D Weinberg
- Department of Population Health Science and Policy, Mount Sinai Hospital, New York, NY, USA
| | - Jang Moon
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Kishore R Iyer
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| |
Collapse
|
6
|
Santeusanio AD, Bhansali A, Rana M, Lerner S, Shapiro R. Kidney transplantation in patients with prior coronavirus disease 2019 (COVID-19). Clin Transplant 2021; 35:e14288. [PMID: 33755252 PMCID: PMC8250112 DOI: 10.1111/ctr.14288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 12/23/2022]
Affiliation(s)
- Andrew D Santeusanio
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Arjun Bhansali
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Meenakshi Rana
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susan Lerner
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Ron Shapiro
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| |
Collapse
|
7
|
Santeusanio AD, Menon MC, Liu C, Bhansali A, Patel N, Mahir F, Rana M, Tedla F, Mahamid A, Fenig Y, Zendel A, Delaney V, De Boccardo G, Farouk SS, Sehgal V, Khaim R, Jacobs SE, Dunn D, Sullivan T, Taimur S, Baneman E, Florman S, Shapiro R. Influence of patient characteristics and immunosuppressant management on mortality in kidney transplant recipients hospitalized with coronavirus disease 2019 (COVID-19). Clin Transplant 2021; 35:e14221. [PMID: 33421213 PMCID: PMC7995120 DOI: 10.1111/ctr.14221] [Citation(s) in RCA: 13] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 01/08/2023]
Abstract
The influence of patient characteristics and immunosuppression management on COVID-19 outcomes in kidney transplant recipients (KTRs) remains uncertain. We performed a single-center, retrospective review of all adult KTRs admitted to the hospital with confirmed COVID-19 between 03/15/2020 and 05/15/2020. Patients were followed from the date of admission up to 1 month following hospital discharge or study conclusion (06/15/2020). Baseline characteristics, laboratory parameters, and immunosuppression were compared between survivors and patients who died to identify predictors of mortality. 38 KTRs with a mean baseline eGFR of 52.5 ml/min/1.73 m2 were hospitalized during the review period. Maintenance immunosuppression included tacrolimus (84.2%), mycophenolate (89.5%), and corticosteroids (81.6%) in the majority of patients. Eleven patients (28.9%) died during the hospitalization. Older age (OR = 2.05; 1.04-4.04), peak D-dimer (OR = 1.20; 1.04-1.39), and peak white blood cell count (OR = 1.11; 1.02-1.21) were all associated with mortality among KTRs hospitalized for COVID-19. Increased mortality was also observed among KTRs with concomitant HIV infection (87.5% vs. 36.1%; p < .01). Conversely, immunosuppression intensity and degree of reduction following COVID-19 diagnosis were not associated with either survival or acute allograft rejection. Our findings potentially support a strategy of individualization of immunosuppression targets based on patient-specific risk factors, rather than universal immunosuppression reduction for KTRs at risk from COVID-19.
Collapse
Affiliation(s)
- Andrew D Santeusanio
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Madhav C Menon
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Caroline Liu
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arjun Bhansali
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Niralee Patel
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Fahima Mahir
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Meenakshi Rana
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fasika Tedla
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Ahmad Mahamid
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Yaniv Fenig
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Alexey Zendel
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Veronica Delaney
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Graciela De Boccardo
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Samira S Farouk
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Vinita Sehgal
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Rafael Khaim
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Samantha E Jacobs
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dallas Dunn
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Timothy Sullivan
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah Taimur
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily Baneman
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sander Florman
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Ron Shapiro
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| |
Collapse
|
8
|
Santeusanio AD, Zendel A, Fenig Y, Mahamid A, Bhansali A, De Boccardo G, Delaney V, Farouk SS, Dunn D, Rana M, Florman S, Shapiro R. Kidney transplantation using lymphocyte depleting induction and standard maintenance immunosuppression at the height of the SARS-CoV-2 pandemic in New York City: A single-center experience. Clin Transplant 2020; 34:e14055. [PMID: 33439508 DOI: 10.1111/ctr.14055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 05/29/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Concerns have been raised regarding proceeding with kidney transplantation using standard immunosuppression in COVID-19 endemic areas. METHODS We performed a single-center review of all adult kidney transplants performed during the COVID-19 pandemic in New York City. Patients were managed with standard immunosuppression protocols, including lymphocyte depleting induction and trough-guided tacrolimus. Retrospective data were collected for 3 months from the date of transplantation or until study conclusion (5/7/2020). The primary outcomes assessed included patient and allograft survival as well as COVID-19 related hospital readmission. RESULTS 30 kidney transplants were performed during the height of the COVID-19 pandemic. After a median follow-up of 51.5 days, 93.3% of patients were alive with 100% death-censored allograft survival. 9 patients were readmitted to the hospital during the study period, 4 (13.3%) related to infection with COVID-19. Infections were mild in 3/4 patients, with one patient developing severe disease leading to respiratory failure. Patients readmitted with COVID-19 were numerically more likely to be African American, have a BMI > 30 kg/m2, have a lymphocyte count ≤ 300 cells/mL, and be on maintenance corticosteroids. CONCLUSIONS Kidney transplantation in areas endemic to COVID-19 using standard induction and maintenance immunosuppression appears to be associated with a modest risk for severe COVID-19 related disease.
Collapse
Affiliation(s)
- Andrew D Santeusanio
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Alexey Zendel
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Yaniv Fenig
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Ahmad Mahamid
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Arjun Bhansali
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Graciela De Boccardo
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Veronica Delaney
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Samira S Farouk
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Dallas Dunn
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meenakshi Rana
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sander Florman
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Ron Shapiro
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| |
Collapse
|
9
|
Santeusanio AD, Bhansali A, Weinberg A, Shapiro R, Delaney V, Florman S, De Boccardo G. Conversion to belatacept within 1‐year of renal transplantation in a diverse cohort including patients with donor‐specific antibodies. Clin Transplant 2020; 34:e13823. [DOI: 10.1111/ctr.13823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew D. Santeusanio
- Recanati‐Miller Transplantation Institute Mount Sinai Hospital New York NY USA
- Department of Pharmacy Mount Sinai Hospital New York NY USA
| | - Arjun Bhansali
- Recanati‐Miller Transplantation Institute Mount Sinai Hospital New York NY USA
| | - Alan Weinberg
- Department of Population Health Science and Policy Mount Sinai Hospital New York NY USA
| | - Ron Shapiro
- Recanati‐Miller Transplantation Institute Mount Sinai Hospital New York NY USA
| | - Veronica Delaney
- Recanati‐Miller Transplantation Institute Mount Sinai Hospital New York NY USA
| | - Sander Florman
- Recanati‐Miller Transplantation Institute Mount Sinai Hospital New York NY USA
| | | |
Collapse
|
10
|
Santeusanio AD, Weinberg AD, Florman SS, Schiano TD. Safety of direct-acting oral anticoagulants relative to warfarin in a matched cohort of liver transplant recipients. Clin Transplant 2019; 34:e13756. [PMID: 31738454 DOI: 10.1111/ctr.13756] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/22/2019] [Revised: 10/23/2019] [Accepted: 11/09/2019] [Indexed: 02/06/2023]
Abstract
Despite increasingly widespread utilization of direct-acting oral anticoagulants (DOACs), there remains limited experience with the use of these agents following liver transplantation. We performed a single-center, retrospective review of liver transplant recipients prescribed DOACs or warfarin between January 2014 and January 2018. Patients receiving DOACs were matched with warfarin-treated controls based on discrete clinical parameters and followed from the time of anticoagulant prescription, until treatment discontinuation or study conclusion. The primary endpoint for this review was the incidence of clinically relevant major or non-major bleeding among the treatment groups. Twenty-seven patients prescribed DOACs were identified for inclusion in the review, of which 20 could be matched with suitable warfarin controls. At the conclusion of the study, warfarin-treated patients had a significantly higher incidence of clinically relevant bleeding (45% vs 15%; P = .01). No statistically significant differences were found in the rate of new or recurrent thrombotic events. Multivariable logistic regression demonstrated that warfarin treatment was associated with a significantly higher odds of a bleeding event compared to treatment with a DOAC (OR = 6.9; 95% CI, 1.1-44.6). DOAC use appears relatively safe compared with warfarin in select liver transplant recipients. Patient-specific factors still bear consideration when selecting between the various anticoagulant options.
Collapse
Affiliation(s)
- Andrew D Santeusanio
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA.,Department of Pharmacy, Mount Sinai Hospital, New York, NY, USA
| | - Alan D Weinberg
- Department of Population Health Science and Policy, Mount Sinai Hospital, New York, NY, USA
| | - Sander S Florman
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Thomas D Schiano
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| |
Collapse
|
11
|
Abstract
Human leukocyte antigen allosensitization prior to transplant can increase the risk of early graft loss and prolong waitlist times for intestinal transplant candidates. Desensitization offers a potential therapeutic option to reduce the quantity of preformed antibodies prior to organ allocation and facilitate transplantation with a more immunologically compatible donor allograft. However, there remains a paucity of data to guide the use of desensitization in the setting of intestinal transplantation. As a result, in this review we evaluate the existing literature supporting the role of desensitization therapy in intestinal transplant, describe our own experience with the implementation of a risk-stratified desensitization protocol, and finally explore barriers and unanswered questions that continue to limit the widespread adoption of desensitization as a management strategy for highly sensitized intestinal transplant candidates.
Collapse
Affiliation(s)
- Andrew D. Santeusanio
- Department of Pharmacy, Mount Sinai Hospital, New York, NY, USA
- Recanati Miller Transplantation Institute, Intestinal Transplant Program, Mount Sinai Hospital, New York, NY, USA
| | - Jang Moon
- Recanati Miller Transplantation Institute, Intestinal Transplant Program, Mount Sinai Hospital, New York, NY, USA
- Department of Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Vinay Nair
- Department of Nephrology, North Shore University Hospital, Manhasset, NY, USA
| | - Kishore R. Iyer
- Recanati Miller Transplantation Institute, Intestinal Transplant Program, Mount Sinai Hospital, New York, NY, USA
- Department of Surgery, Mount Sinai Hospital, New York, NY, USA
| |
Collapse
|
12
|
Santeusanio AD, Bowen MM. Erratum: Short-Term Outcomes for Veterans Receiving Basal Insulin, Metformin, and a Sulfonylurea Who Are Started on a Third Noninsulin Agent Versus Prandial Insulin. Diabetes Spectrum 2018;31:261-266 (doi.org/10.2337/ds17-0068). Diabetes Spectr 2018; 31:367. [PMID: 30510394 PMCID: PMC6243227 DOI: 10.2337/ds18-er04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
[This corrects the article on p. 261 in vol. 31, PMID: 30140142.].
Collapse
|
13
|
Santeusanio AD, Bowen MM. Short-Term Outcomes for Veterans Receiving Basal Insulin, Metformin, and a Sulfonylurea Who Are Started on a Third Noninsulin Agent Versus Prandial Insulin. Diabetes Spectr 2018; 31:261-266. [PMID: 30140142 PMCID: PMC6092894 DOI: 10.2337/ds17-0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
AIMS Despite numerous recent advances in the management of patients with type 2 diabetes, there remains a paucity of data to guide sequential treatment intensification. METHODS This was a single-center, retrospective cohort study of patients receiving metformin, basal insulin, and a sulfonylurea who were started on a third noninsulin agent or prandial insulin. The primary outcome for this study was change in A1C at 6 months after treatment intensification. Secondary outcomes included change in weight at 6 months, change in A1C at 1 year, percentage of patients achieving an A1C <7.5% at 1 year, documented episodes of hypoglycemia, and time to progression to prandial insulin. RESULTS A total of 62 patients were identified for inclusion in the study: 28 receiving prandial insulin and 34 treated with a noninsulin agent. There was no significant difference in A1C change between the two treatment arms at either 6 months (-0.53 vs. -0.84%, P = 0.31) or 1 year (-0.67 vs. -0.86%, P = 0.61) after intervention. Patients receiving noninsulin agents gained significantly less weight at 6 months (-2.09 vs. 1.99 kg, P <0.01) and experienced fewer annual episodes of hypoglycemia (1.0 vs. 2.6, P = 0.01). Among patients treated with noninsulin agents, those receiving a glucagon-like peptide 1 receptor agonist were more likely to have an A1C <7.5% at 1 year than patients receiving a dipeptidyl peptidase 4 inhibitor (50 vs. 13%, P = 0.05). CONCLUSION These results highlight that, in select patients, noninsulin therapies can be added to a backbone of metformin, basal insulin, and a sulfonylurea with similar A1C reductions but improved metabolic parameters relative to intensive insulin therapy.
Collapse
Affiliation(s)
| | - Monica M. Bowen
- Department of Pharmacy, Lebanon VA Medical Center, Lebanon, PA
| |
Collapse
|
14
|
Affiliation(s)
| | - Benjamin E. Lukens
- Touro College of Pharmacy, New York, NY, and Mount Sinai Hospital, New York, NY
| | - Judy Eun
- Mount Sinai Hospital, New York, NY
| |
Collapse
|
15
|
Santeusanio AD, Dunsky KG, Pan S, Schiano TD. The Impact of Cirrhosis and Prescription Medications on QTc Interval Before and After Liver Transplantation. J Pharm Pract 2017; 32:48-53. [PMID: 29092657 DOI: 10.1177/0897190017737896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND: Higher rates of corrected QT (QTc) prolongation have been reported in patients with cirrhosis. The impact of liver transplantation and prescription medications on the natural history of QTc prolongation has yet to be well characterized. METHODS: This was a single-center review of patients receiving (group 1) or listed for (group 2) a liver transplant during 2014. Patients in group 1 were followed prospectively from the date of transplantation to assess rates of QTc normalization posttransplant. In group 2, patients were evaluated from the date of listing up until December 2015 to assess the prevalence of QTc prolongation among liver transplant candidates. RESULTS: In group 1, 22 (75.9%) patients with QTc intervals >460 milliseconds at the time of transplant established normal baseline QTc intervals following transplantation. The median time to this QTc normalization was 17 days. In group 2, 30 (16.9%) patients had at least 1 documented QTc interval >500 milliseconds with prevalence rates of 42.9%, 19.0%, and 10.2% in patients with natural model of end-stage liver disease scores of >30, 16 to 30, and <16, respectively ( P < .01). Overall, 49.4% of patients in group 1 and 47.5% of patients in group 2 were prescribed QTc prolonging medications. CONCLUSION: QTc prolongation will resolve following transplantation in the majority of patients and generally occurs within the first several weeks. Among the listed liver transplant candidates, higher rates of clinically significant QTc prolongation may be observed in patients with more severe underlying cirrhosis. QTc prolonging medications are commonly prescribed in this population and warrant monitoring following initiation.
Collapse
Affiliation(s)
| | - Kevin G Dunsky
- 2 Department of Cardiology, Mount Sinai Hospital, New York, NY, USA
| | - Stephanie Pan
- 3 Department of Population Health Science and Policy, Mount Sinai Hospital, New York, NY, USA
| | - Thomas D Schiano
- 4 Department of Hepatology, Mount Sinai Hospital, New York, NY, USA
| |
Collapse
|