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Axelrod D, Lentine KL, Schnitzler MA, Luo X, Xiao H, Orandi BJ, Massie A, Garonzik-Wang J, Stegall MD, Jordan SC, Oberholzer J, Dunn TB, Ratner LE, Kapur S, Pelletier RP, Roberts JP, Melcher ML, Singh P, Sudan DL, Posner MP, El-Amm JM, Shapiro R, Cooper M, Lipkowitz GS, Rees MA, Marsh CL, Sankari BR, Gerber DA, Nelson PW, Wellen J, Bozorgzadeh A, Osama Gaber A, Montgomery RA, Segev DL. The Incremental Cost of Incompatible Living Donor Kidney Transplantation: A National Cohort Analysis. Am J Transplant 2017; 17:3123-3130. [PMID: 28613436 DOI: 10.1111/ajt.14392] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 01/29/2017] [Revised: 05/04/2017] [Accepted: 05/22/2017] [Indexed: 01/25/2023]
Abstract
Incompatible living donor kidney transplantation (ILDKT) has been established as an effective option for end-stage renal disease patients with willing but HLA-incompatible living donors, reducing mortality and improving quality of life. Depending on antibody titer, ILDKT can require highly resource-intensive procedures, including intravenous immunoglobulin, plasma exchange, and/or cell-depleting antibody treatment, as well as protocol biopsies and donor-specific antibody testing. This study sought to compare the cost and Medicare reimbursement, exclusive of organ acquisition payment, for ILDKT (n = 926) with varying antibody titers to matched compatible transplants (n = 2762) performed between 2002 and 2011. Data were assembled from a national cohort study of ILDKT and a unique data set linking hospital cost accounting data and Medicare claims. ILDKT was more expensive than matched compatible transplantation, ranging from 20% higher adjusted costs for positive on Luminex assay but negative flow cytometric crossmatch, 26% higher for positive flow cytometric crossmatch but negative cytotoxic crossmatch, and 39% higher for positive cytotoxic crossmatch (p < 0.0001 for all). ILDKT was associated with longer median length of stay (12.9 vs. 7.8 days), higher Medicare payments ($91 330 vs. $63 782 p < 0.0001), and greater outlier payments. In conclusion, ILDKT increases the cost of and payments for kidney transplantation.
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Affiliation(s)
- D Axelrod
- Department of Transplantation, Lahey Hospital and Health System, Burlington, MA
| | - K L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - M A Schnitzler
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - X Luo
- Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - H Xiao
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - B J Orandi
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - A Massie
- Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - J Garonzik-Wang
- Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - M D Stegall
- Department of Surgery, Mayo Clinic, Rochester, MN
| | - S C Jordan
- Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles, CA
| | - J Oberholzer
- Department of Surgery, University of Illinois-Chicago, Chicago, IL
| | - T B Dunn
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | - L E Ratner
- Department of Surgery, Columbia University Medical Center, New York, NY
| | - S Kapur
- Department of Surgery, New York Presbyterian/Weill Cornell Medical Center, New York, NY
| | - R P Pelletier
- Department of Surgery, The Ohio State University, Columbus, OH
| | - J P Roberts
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - M L Melcher
- Department of Surgery, Stanford University, Palo Alto, CA
| | - P Singh
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - D L Sudan
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - M P Posner
- Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - J M El-Amm
- Integris Baptist Medical Center, Transplant Division, Oklahoma City, OK
| | - R Shapiro
- Department of Surgery, Mt. Sinai Medical Center, New York, NY
| | - M Cooper
- Medstar Georgetown Transplant Institute, Washington, DC
| | - G S Lipkowitz
- Department of Surgery, Baystate Medical Center, Springfield, MA
| | - M A Rees
- Department of Urology, University of Toledo Medical Center, Toledo, OH
| | - C L Marsh
- Division of Organ Transplantation, Scripps Center for Organ Transplantation, Department of Surgery, Scripps Clinic and Green Hospital, La Jolla, CA
| | - B R Sankari
- Department of Urology, Cleveland Clinic, Cleveland, OH
| | - D A Gerber
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - P W Nelson
- Department of Surgery, University of Nevada, Las Vegas, NV
| | - J Wellen
- Department of Surgery, Barnes-Jewish Hospital, St. Louis, MO
| | - A Bozorgzadeh
- Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA
| | - A Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - R A Montgomery
- Department of Surgery, New York University Langone Medical Center, New York, NY
| | - D L Segev
- Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD
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2
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Orandi BJ, Garonzik-Wang JM, Massie AB, Zachary AA, Montgomery JR, Van Arendonk KJ, Stegall MD, Jordan SC, Oberholzer J, Dunn TB, Ratner LE, Kapur S, Pelletier RP, Roberts JP, Melcher ML, Singh P, Sudan DL, Posner MP, El-Amm JM, Shapiro R, Cooper M, Lipkowitz GS, Rees MA, Marsh CL, Sankari BR, Gerber DA, Nelson PW, Wellen J, Bozorgzadeh A, Gaber AO, Montgomery RA, Segev DL. Quantifying the risk of incompatible kidney transplantation: a multicenter study. Am J Transplant 2014; 14:1573-80. [PMID: 24913913 DOI: 10.1111/ajt.12786] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [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: 01/28/2014] [Revised: 03/17/2014] [Accepted: 03/17/2014] [Indexed: 01/25/2023]
Abstract
Incompatible live donor kidney transplantation (ILDKT) offers a survival advantage over dialysis to patients with anti-HLA donor-specific antibody (DSA). Program-specific reports (PSRs) fail to account for ILDKT, placing this practice at regulatory risk. We collected DSA data, categorized as positive Luminex, negative flow crossmatch (PLNF) (n = 185), positive flow, negative cytotoxic crossmatch (PFNC) (n = 536) or positive cytotoxic crossmatch (PCC) (n = 304), from 22 centers. We tested associations between DSA, graft loss and mortality after adjusting for PSR model factors, using 9669 compatible patients as a comparison. PLNF patients had similar graft loss; however, PFNC (adjusted hazard ratio [aHR] = 1.64, 95% confidence interval [CI]: 1.15-2.23, p = 0.007) and PCC (aHR = 5.01, 95% CI: 3.71-6.77, p < 0.001) were associated with increased graft loss in the first year. PLNF patients had similar mortality; however, PFNC (aHR = 2.04; 95% CI: 1.28-3.26; p = 0.003) and PCC (aHR = 4.59; 95% CI: 2.98-7.07; p < 0.001) were associated with increased mortality. We simulated Centers for Medicare & Medicaid Services flagging to examine ILDKT's effect on the risk of being flagged. Compared to equal-quality centers performing no ILDKT, centers performing 5%, 10% or 20% PFNC had a 1.19-, 1.33- and 1.73-fold higher odds of being flagged. Centers performing 5%, 10% or 20% PCC had a 2.22-, 4.09- and 10.72-fold higher odds. Failure to account for ILDKT's increased risk places centers providing this life-saving treatment in jeopardy of regulatory intervention.
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Affiliation(s)
- B J Orandi
- Departments of Surgery and Medicine, Johns Hopkins Hospital, Baltimore, MD
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3
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Madden RL, Kurbanov A, Benedetto BJ, Lipkowitz GS. Early small bowel obstruction complicating hand-assisted laparoscopic donor nephrectomy: an uncommon etiology. Surg Endosc 2002; 16:1108. [PMID: 11984656 DOI: 10.1007/s00464-001-4142-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2001] [Accepted: 11/28/2001] [Indexed: 11/30/2022]
Abstract
Laparoscopic donor nephrectomy is gaining widespread acceptance as a minimally invasive technique for kidney donation. Although it has been associated with decreased patient morbidity and more rapid recovery, it exposes patients to possible complications inherent in its transperitoneal route. We report a case of a small bowel obstruction secondary to midjejunal intussusception occurring on the third postoperative day after a hand-assisted laparoscopic donor nephrectomy. The intussusception proved to be idiopathic since no lead point was identified. The patient recovered without significant sequela after reduction of the intussusceptum. Postoperative ideopathic intussusception is an uncommon cause of bowel obstruction in adults. Surgeons that perform laparoscopic donor nephrectomy will need to remain vigilant for complications that can be associated with the intraperitoneal route of this technique.
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Affiliation(s)
- R L Madden
- Department of Surgery, Baystate Medical Center, West Springfield, MA 01199, USA.
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4
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Abstract
Adenine phosphoribosyltransferase (APRT) deficiency is a rarely diagnosed cause of renal allograft dysfunction. We report the case of a 42-year-old man who presented in 1996 with idiopathic renal failure. Native kidney biopsy showed extensive microcrystalline interstitial nephritis. The patient subsequently underwent a living-related kidney transplant with excellent early graft function. During the next year, however, he had worsening allograft function, and allograft biopsy showed recurrent interstitial nephritis. Further chemical and spectroscopic analysis showed this lesion to be an annular microcrystalline nephritis consistent with APRT deficiency. This diagnosis was confirmed on erythrocyte assay. Treatment with allopurinol and a low-purine diet led to improvement and stabilization of renal function. APRT is a rare cause of renal allograft dysfunction requiring a high index of suspicion for early diagnosis and treatment. Increased physician awareness in the United States may hasten diagnosis and limit the morbidity associated with this disease.
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Affiliation(s)
- B Benedetto
- Departments of Surgery, Transplant Division, Medicine, Renal Division, and Pathology, Baystate Medical Center, Springfield, MA, USA.
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5
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Madden RL, Mulhern JG, Benedetto BJ, O'Shea MH, Germain MJ, Braden GL, O'Shaughnessy J, Lipkowitz GS. Completely reversed acute rejection is not a significant risk factor for the development of chronic rejection in renal allograft recipients. Transpl Int 2001; 13:344-50. [PMID: 11052270 DOI: 10.1007/s001470050712] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although acute rejection (AR) has been shown to correlate with decreased long-term renal allograft survival, we have noted AR in recipients who subsequently had stable function for more than 5 years. We reviewed 109 renal graft recipients with a minimum of 1 year graft survival and follow-up of 5-8 years. Post-transplant sodium iothalamate clearances (IoCI) measured at 3 months and yearly thereafter were used to separate recipients into 2 groups. In 61 patients (stable group), there was no significant decrease ( > 20 % reduction in IoCl over 2 consecutive years) in IoCl. Forty-eight patients had significant declines in IoCl (decline group). Groups were compared for incidence, severity, timing, and completeness of reversal of AR. Rejection was considered completely reversed if the post-AR serum creatinine (Scr) returned to or below the pre-AR nadir Scr after anti-rejection therapy. The incidence of AR was not significantly different between groups (47% vs 52%). A trend toward a lower mean number of AR episodes per patient was noted in the stable group (0.69 vs 1.04, P = 0.096), but the timing of AR was not different. Steroid-resistant AR occurred in approximately 25 % of both groups. A striking difference was seen in complete reversal of AR, with the stable group having 100% (42/42 episodes of AR in 29 patients) complete reversal whereas only 32 % (8/25) of the patients in the decline group had complete reversal (P < < 0.001). Of 8 declining patients with complete reversal, graft loss was due to chronic rejection (CR) in only 3. Seventeen declining patients had incomplete reversal of AR, and 82 % (14/17) lost their grafts to CR. Overall, only 8% (3/37) of the recipients with complete reversal of AR developed CR. No patients with incompletely reversed AR had stable long-term function as measured by IoCl. AR is not invariably deleterious to long-term renal graft function if each episode of AR can be completely reversed.
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Affiliation(s)
- R L Madden
- Department of Surgery, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA
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6
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Lipkowitz GS, Madden RL, Kurbanov A, Mulhern JG, O'Shea MH, Germain MJ, Freeman J, Braden GL. Transplantation and 2-year follow-up of kidneys procured from a cadaver donor with a history of lupus nephritis. Transplantation 2000; 69:1221-4. [PMID: 10762230 DOI: 10.1097/00007890-200003270-00030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Two patients underwent cadaver transplantation with kidneys from a donor with a history of World Health Organization Class IV/V lupus nephritis, and we report their clinical and pathological outcome. METHODS The donor had a diagnosis of lupus nephritis made by renal biopsy 5 years before donation. At the time of donation, a biopsy was performed on the donor and on one of the recipients at 2 months and 1 year after the transplant. RESULTS Both recipients underwent uneventful renal transplantation. On the first postoperative day, the donor's final pathological results became available. Although the frozen section seemed to be quite benign, the permanent sections revealed World Health Organization Class II/V lupus nephritis, with full house immunofluorescence and multiple electron dense deposits. Biopsies were performed on recipient #2 at 8 weeks and 1 year after the transplant. These revealed marked diminution followed by complete resolution of all tubular reticular structures and deposits as well as immunofluorescent activity. Both recipients remain with normal renal function and urinalysis at 3 years after the transplant. CONCLUSION Although a history of clinically significant renal disease has been considered an absolute contraindication to kidney donation, with appropriate workup and caution, select patients may still be considered, which would increase the potential donor pool.
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Affiliation(s)
- G S Lipkowitz
- Department of Surgery, Baystate Medical Center, Springfield, MA 01199, USA
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7
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Lipkowitz GS, Madden RL, Mulhern J, Braden G, O'Shea M, O'Shaughnessy J, Nash S, Kurbanov A, Freeman J, Rennke H, Germain M. Long-term maintenance of therapeutic cyclosporine levels leads to optimal graft survival without evidence of chronic nephrotoxicity. Transpl Int 1999; 12:202-7. [PMID: 10429958 DOI: 10.1007/s001470050211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Since the introduction of cyclosporine into clinical use, a major area of concern within the transplant community has been the fear of chronic nephrotoxicity. Although progressive renal damage does appear to occur in native kidneys of heart and liver transplant patients receiving cyclosporine, it has been our contention that its use is not a major cause of deterioration in renal allografts. We therefore undertook a study of 91 consecutive renal transplants performed over a three-year period with a minimum graft survival of 1 year and a follow-up of 7-9 years. Serial serum creatinine values, iothalamate clearances and cyclosporine levels were obtained at 3 months after transplantation and yearly thereafter. Biopsies were performed on all grafts that had failed as well as on the majority of patients with deteriorating renal function, and were interpreted by two nephropathologists. As measured by iothalamate clearances, 65% of the patients in this series exhibited absolutely stable renal function despite the maintenance of cyclosporine levels of more than 200 ng/ml for 7-9 years. Since these stable patients did not reveal any decline in renal function, it therefore follows that they did not experience chronic cyclosporine nephrotoxicity. Furthermore, none of the patients with declining renal function or with failed grafts showed any evidence of nephrotoxicity on biopsy. Chronic cyclosporine nephrotoxicity may be a cause of declining function or graft loss with renal transplant recipients, but if so, it is exceedingly rare.
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Affiliation(s)
- G S Lipkowitz
- Department of Surgery, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA
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8
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Abstract
Hypertension is a known complication after renal trauma. The cause of posttraumatic hypertension can be renal scarring, infarction, hydonephrosis, infection, vascular injury, and parenchymal compression. The authors report on the case of a 16-year-old boy who experienced hypertension after blunt renal trauma. He had a dense fibrous pseudocapsule causing renal parenchymal compression, which lead to hypertension, a Page kidney. Evaluation with computed tomographic (CT) scan, radioisotope renal scan, renal Doppler, and angiogram confirmed the diagnosis. Removal of the renal capsule and the constricting fibrous pseudocapsule was curative.
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Affiliation(s)
- K P Moriarty
- Division of Transplant, Tufts University School of Medicine, Baystate Medical Center, Springfield, MA, USA
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9
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Harro C, Braden GL, Morris AB, Lipkowitz GS, Madden RL. Failure to cure Mycobacterium gordonae peritonitis associated with continuous ambulatory peritoneal dialysis. Clin Infect Dis 1997; 24:955-7. [PMID: 9142800 DOI: 10.1093/clinids/24.5.955] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Nontuberculous mycobacteria are increasingly recognized as important pathogens in peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). Mycobacterium gordonae rarely causes human infection and is the least likely mycobacterium to produce clinical infection in CAPD patients. We describe a patient with persistent M. gordonae peritonitis acquired while undergoing CAPD. During 18 months of treatment, clinical improvement occurred but a microbiological cure could not be achieved. Principles of therapy for mycobacterial peritonitis developing during CAPD are reviewed, and potential explanations for our patient's failure to respond to therapy are discussed.
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Affiliation(s)
- C Harro
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts 01199, USA
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10
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Polk D, Madden RL, Lipkowitz GS, Braden GL, Germain MJ, Mulhern JG, O'Shea MH. Use of computerized tomography in the evaluation of a CAPD patient with a foramen of Morgagni hernia: a case report. Perit Dial Int 1996; 16:318-20. [PMID: 8761548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- D Polk
- Department of Surgery, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts, USA
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11
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Mulhern JG, Braden GL, O'Shea MH, Madden RL, Lipkowitz GS, Germain MJ. Trough serum vancomycin levels predict the relapse of gram-positive peritonitis in peritoneal dialysis patients. Am J Kidney Dis 1995; 25:611-5. [PMID: 7702059 DOI: 10.1016/0272-6386(95)90132-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We reviewed 31 episodes of gram-positive peritonitis that occurred in our peritoneal dialysis population between 1990 and 1993 in an attempt to identify the risk factor(s) for peritonitis relapse. All patients were treated with 4 weekly doses of intravenous vancomycin. Vancomycin doses no. 1 and 2 were based on body weight (15 mg/kg with a 1-g minimum); vancomycin doses no. 3 and 4 were adjusted in an attempt to maintain the trough serum vancomycin level at greater than 12 mg/L. Nine peritonitis episodes complicated by a relapse were identified. Peritonitis episodes preceding a relapse were similar to relapse-free episodes with respect to patient age, diabetes, peritoneal dialysis modality, duration of peritoneal dialysis treatment, residual urea clearance, peritoneal fluid cell count, causative organism, and weekly vancomycin dose. However, cumulative 4-week mean trough vancomycin levels were consistently lower during peritonitis episodes preceding a relapse (7.8 +/- 0.6 mg/L during relapse-prone episodes v 13.7 +/- 0.9 mg/L during relapse-free episodes; P = 0.0004). Furthermore, relapses developed during nine of 14 peritonitis episodes demonstrating a 4-week mean trough vancomycin level less than 12 mg/L compared with zero of 17 episodes with a 4-week trough level greater than 12 mg/L (P < 0.05). The detection of a low initial 7-day trough vancomycin level also was a useful marker for subsequent peritonitis relapse. In 13 peritonitis episodes associated with an initial trough level less than 9 mg/L, nine were complicated by a relapse.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J G Mulhern
- Department of Medicine, Baystate Medical Center, Springfield, MA 01199, USA
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12
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Mulhern JG, Lipkowitz GS, Braden GL, Madden RL, O'Shea MH, Harvilchuck H, Guarnera JM, Germain MJ. Association of post-renal transplant erythrocytosis and microalbuminuria: response to angiotensin-converting enzyme inhibition. Am J Nephrol 1995; 15:318-22. [PMID: 7573190 DOI: 10.1159/000168856] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Angiotensin-converting enzyme (ACE) inhibitor therapy has recently been shown to be effective in the treatment of post-renal transplant erythrocytosis (PTE). In an attempt to assess the effect of drug treatment on serum erythropoietin level, glomerular filtration rate, and urinary protein excretion, we prospectively evaluated 8 consecutive cadaveric renal transplant recipients with PTE treated with ACE inhibitor therapy for 3 months. In response to ACE inhibition, the mean hematocrit (HCT) value decreased from 53.7 +/- 0.6% before treatment to 42.7 +/- 2.2% at the conclusion of the study (p = 0.03). However, 1 patient failed to respond to ACE inhibition (HCT > 50%), and 2 patients with PTE developed anemia (HCT < 35%) while maintained on drug treatment. Although the mean serum erythropoietin level decreased during ACE inhibition (from 22.8 +/- 8.4 to 9.4 +/- 5.3 mU/ml; p = 0.06), a consistent change in individual erythropoietin levels was not identified. At the conclusion of the study, the serum erythropoietin levels were undetectable in 4 patients, decreased in 1, unchanged in 2, and increased in the only patient with PTE who failed to respond to drug treatment. All patients tolerated the ACE inhibitor therapy without developing cough or hyperkalemia. In addition, serum creatinine levels, 125I-iothalamate clearances, and mean arterial blood pressures were unchanged throughout the study. Microalbuminuria (spot urinary albumin/creatinine ratio between 30 and 200 mg/g) developed in 5 patients with PTE and coincided with the onset of erythrocytosis (25.2 +/- 7 mg/g before PTE and 76.3 +/- 36.7 mg/g at the time of PTE detection).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J G Mulhern
- Department of Medicine and Surgery, Baystate Medical Center, Springfield, Mass. 01199, USA
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13
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Lipkowitz GS, Madden RL. Transmission of Kaposi's sarcoma by solid organ donation. Transplant Sci 1994; 4:9-11. [PMID: 7804703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- G S Lipkowitz
- Baystate Medical Center, Division of Transplantation, Springfield, MA 01199
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14
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Germain MJ, Lipkowitz GS, Guarnera J, Fiorentino J. A comparison of different methods of estimating glomerular filtration rate in cyclosporine-treated renal transplant patients. Transplantation 1993; 55:203-5. [PMID: 8420049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- M J Germain
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts 01199
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15
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Germain MJ, Lipkowitz GS, Patel J, Hampf F. Predictive value of Doppler ultrasonography in renal transplantation. Clin Transplant 1992; 6:62-6. [PMID: 10147659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
During a 17-month period, 268 Doppler sonography studies were performed on 46 consecutive renal transplant patients. There were 35 episodes of acute rejection in 10 patients, 8 episodes of delayed function and 47 episodes of high cyclosporine levels (greater than 800 ng/dl by TDX method) in 21 patients. Defining an abnormal resistive index (RI) as greater than 0.8 or a 20% increase above baseline, the test has a specificity of 99% and a sensitivity of 94% in the 1st month post-transplant and had an overall predictive value of 99%. Episodes of high cyclosporine levels ranging from 800 to 1650 ng/dl did not correlate with a high RI except in one circumstance with concurrent acute rejection. Within the 1st month post-transplant, only 1 false-negative study occurred. An additional 8 false-negative studies occurred beyond 1 month post-transplant. Patients with delayed function are separated into three groups based on the Doppler ultrasounds: Group I, patients with an accelerated acute rejection with high RI (N = 2); Group II, patients with true ischemic acute tubular necrosis with normal RI (N = 2); and Group III, patients with possible immunologically-mediated delayed function with intermediate RI between 0.6 and 0.8 (N = 4). Doppler ultrasound is a useful ancillary test to confirm the clinical suspicion of acute rejection. Since high cyclosporine levels do not cause an increase in RI, Doppler ultrasound may help to avoid confusion between acute rejection and cyclosporine toxicity. Additionally, this test may offer insight into the cause of early post-transplant renal dysfunction.
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Affiliation(s)
- M J Germain
- Department of Medicine, Baystate Medical Center, Tufts University, School of Medicine, Springfield, MA
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16
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Warzynski MJ, Lipkowitz GS, Germain MJ, Johnson ML, Kuc EM, Blanchette JG, Guarnera JM. Lymphocyte activation antigens permit early detection and discrimination between rejection and infection episodes. Transplant Proc 1991; 23:180-2. [PMID: 1846712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- M J Warzynski
- Immunology Laboratory, Baystate Medical Center, Springfield, Massachusetts 01199
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17
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Galishoff ML, Lipkowitz GS, Germain MJ, Hong JH, Butt KM. The fate of paired kidneys: recipient immunologic risk factors profoundly influence immediate posttransplant renal function. Transplant Proc 1991; 23:1325-7. [PMID: 1989227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- M L Galishoff
- Department of Surgery, Baystate Medical Center, Springfield, MA 01199
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Sumrani N, Delaney V, Hong JH, Lipkowitz GS, Butt KM. Transplantation of organs from donors with Reye's syndrome: is it safe? Am J Nephrol 1990; 10:87-8. [PMID: 2343884 DOI: 10.1159/000168060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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19
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Zara CP, Lipkowitz GS, Perri N, Sumrani N, Hong JH, Friedman EA, Butt KM. Renal transplantation and end-stage lupus nephropathy in the cyclosporine and precyclosporine eras. Transplant Proc 1989; 21:1648-51. [PMID: 2652539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- C P Zara
- Department of Surgery, State University of New York Health Science Center, Brooklyn 11203-2098
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20
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Lipkowitz GS, Hong JH, Galishoff ML, McMillen M, Sumrani N, Hanson P, Tejani A, Butt KM. Immediate post-transplant renal failure: evidence for an immunologic pathogenesis. Transplant Proc 1989; 21:1256-7. [PMID: 2652413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- G S Lipkowitz
- Department of Surgery, SUNY Health Science Center, Brooklyn
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21
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Hong JH, Sumrani N, Lipkowitz GS, Pilkington BJ, Butt KM. Cyclosporine blood level and early transplant function of cadaver donor kidneys. Transplant Proc 1989; 21:1542-3. [PMID: 2652498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- J H Hong
- Department of Surgery, State University of New York, Brooklyn 11203
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22
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Sumrani NB, Lipkowitz GS, Hong JH, Hanson P, Butt KM. Complications of "one stitch" extravesical ureteric implantation in renal transplants in the cyclosporine and precyclosporine eras. Transplant Proc 1989; 21:1957-9. [PMID: 2652639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- N B Sumrani
- Department of Surgery, State University of New York Health Science Center, Brooklyn 11203-2098
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23
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Hong JH, Lipkowitz GS, Choi KS, Greenstein S, Chen CK, Butt KM. The effect of ex vivo irradiation of donor spleen on pancreas allograft rejection in the dog. Transplant Proc 1989; 21:1132-3. [PMID: 2650077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- J H Hong
- Department of Surgery, State University of New York, Brooklyn
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24
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Abstract
Twenty-nine percutaneous balloon dilations of the axillary and subclavian veins were performed in 19 patients. Stenoses occurred in typical locations of anatomic narrowing or at sites of previous trauma. The initial success rate was 76%, with a 1-year patency rate of 35% and a 2-year patency rate of 6%. Angioplasty can be performed on an outpatient basis with a very low rate of significant complications and can be repeated numerous times to keep a vein patent for many years. This procedure is especially valuable in dialysis patients who have limited access sites.
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Affiliation(s)
- S Glanz
- Department of Radiology, State University of New York, Health Science Center, Brooklyn 11203
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25
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Affiliation(s)
- P J Golueke
- Department of Surgery, SUNY-Health Science Center, Brooklyn 11203
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26
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Abstract
One hundred forty-one dilatations of stenotic lesions in dialysis access fistulas were performed. The initial success rate was 82%. The one-year patency rate was 45%, with a 2-year patency rate of 24%. Best results were obtained with a discrete stenosis at a graft-to-vein anastomosis. The procedure can be done on an outpatient basis and, although long-term results are poor, in appropriate patients multiple dilatations can be performed to keep a fistula functioning for many years.
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Affiliation(s)
- S Glanz
- Department of Radiology, Downstate Medical Center, Brooklyn, NY 11203
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27
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Yen CY, Greenstein SM, Lipkowitz GS, Hong JH, Nitta K, Friedman EA, Butt KM. Daily and alternate-day cyclosporine immunosuppressive regimens and synergism with azathioprine. Transplant Proc 1987; 19:1272-5. [PMID: 3547859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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28
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Hong JH, Lipkowitz GS, Yen CY, Greenstein SM, Manis T, Butt KM. Impact of immunosuppressive regimen on early posttransplant renal function. Transplant Proc 1987; 19:2106-10. [PMID: 3547914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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29
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Galishoff ML, Greenstein SM, Yen CY, Lipkowitz GS, Hanson P, Dunn E, Hong JH, Kaufman H, Solomon NA, Butt KM. Spleen-liver scintiscan: a new technique for distinguishing allograft rejection from cyclosporine nephrotoxicity. Transplant Proc 1987; 19:1795-800. [PMID: 3547885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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30
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Hinsdale JG, Lipkowitz GS, Pollock TW, Hoover EL, Jaffe BM. Prolonged enteral nutrition in malnourished patients with nonelemental feeding. Reappraisal of surgical technique, safety, and costs. Am J Surg 1985; 149:334-8. [PMID: 3919600 DOI: 10.1016/s0002-9610(85)80102-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In a 2 year period, 60 consecutive feeding enterostomies were placed in malnourished patients. The major complication rate was 1.6 percent. Total complications were 8 percent. Thirty day mortality was 13 percent. Nearly all patients were given isosmotic nonelemental diets. The incidence of diarrhea was 2 percent with this regimen. Four of five patients given elemental diets had diarrhea. Serum albumin levels increased significantly from a preoperative mean of 2.75 to 3.03 g/dl. Best overall results were achieved in patients undergoing upper gastrointestinal surgery or pancreatobilary procedures for nonmalignant lesions. More than $60,000 was saved in 2 years by substituting isosmotic formulas for elemental ones. It appears that many patients are given elemental formulas who do not actually require them. Since isosmotic solutions will not infuse through needle catheters, we advocate placing 12 F. catheters and have documented the safety of this change. By using these larger catheters, the surgeon will not lose the option of using isosmotic preparations. We have shown these preparations to be nutritionally effective with a marked lessening of diarrhea and a cost approximately a sixth of that of elemental products.
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Sclafani SJ, Goldstein AS, Lipkowitz GS. Radiologic management of a disrupted ureteral anastomosis and infected urinoma after gunshot wound. J Trauma 1984; 24:1060-2. [PMID: 6512899 DOI: 10.1097/00005373-198412000-00010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This report describes the successful utilization of interventional radiology to treat two complications of a gunshot wound to the ureter. A disrupted ureteral anastomosis was managed by a percutaneously placed antegrade nephrostomy with internal urinary drainage and ureteral stenting. The associated infected urinoma was also radiologically drained.
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Krantz A, Lipkowitz GS. Studies of mitochondrial monoamine oxidase. Inactivation of the enzyme by isomeric acetylenic and allenic amines yielding muturally exclusive products. J Am Chem Soc 1977; 99:4156-9. [PMID: 864109 DOI: 10.1021/ja00454a045] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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