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Khaim R, Todd R, Rosowicz A, Shapiro R, Florman S, Kim-Schluger L, Tedla F. Impact of race-neutral eGFR calculations on African American kidney transplant candidate wait time: A single center retrospective analysis. Clin Transplant 2024; 38:e15267. [PMID: 38380716 DOI: 10.1111/ctr.15267] [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: 10/16/2023] [Revised: 01/10/2024] [Accepted: 02/02/2024] [Indexed: 02/22/2024]
Abstract
Race-inclusive estimated glomerular filtration rate (eGFR) could contribute to racial disparity in access to kidney transplantation. The Organ Procurement and Transplantation Network (OPTN) issued a policy allowing waiting time modification for candidates affected by race-inclusive eGFR calculations. Implementation of the new OPTN policy at the kidney transplant program of the Mount Sinai Hospital involved review of 921 African American candidates, of whom 240 (26%) candidates gained a median of 1 year and 10 months. The duration of time candidates gained varied from a minimum of 5 days to a maximum of 12 years and 3 months; 45.4% gained at least 2 years, and 12% gained at least 4 years of wait time. Among those who gained wait time, 20 (8.3%) candidates received deceased donor kidney transplants. Candidates who gained wait time had similar sociodemographic characteristics as those who did not, except that the median age for the former was higher by 3 years (59 vs. 56). Our early data suggest that the current policy on waiting time modification for candidates affected by race-inclusive estimation of GFR has the potential to improve racial disparity in access to kidney transplantation. However, the generalizability of our findings to other centers requires further study.
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Affiliation(s)
- Rafael Khaim
- Mount Sinai Recanati/Miller Transplantation Institute, Icahn School of Medicine, New York, New York, USA
| | - Rachel Todd
- Mount Sinai Recanati/Miller Transplantation Institute, Icahn School of Medicine, New York, New York, USA
| | - Andrew Rosowicz
- Mount Sinai Recanati/Miller Transplantation Institute, Icahn School of Medicine, New York, New York, USA
| | - Ron Shapiro
- Mount Sinai Recanati/Miller Transplantation Institute, Icahn School of Medicine, New York, New York, USA
| | - Sander Florman
- Mount Sinai Recanati/Miller Transplantation Institute, Icahn School of Medicine, New York, New York, USA
| | - Leona Kim-Schluger
- Mount Sinai Recanati/Miller Transplantation Institute, Icahn School of Medicine, New York, New York, USA
| | - Fasika Tedla
- Mount Sinai Recanati/Miller Transplantation Institute, Icahn School of Medicine, New York, New York, USA
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2
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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.
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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
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3
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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.
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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
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4
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Bane O, Said D, Weiss A, Stocker D, Kennedy P, Hectors SJ, Khaim R, Salem F, Delaney V, Menon MC, Markl M, Lewis S, Taouli B. 4D flow MRI for the assessment of renal transplant dysfunction: initial results. Eur Radiol 2020; 31:909-919. [PMID: 32870395 DOI: 10.1007/s00330-020-07208-7] [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: 01/28/2020] [Revised: 07/07/2020] [Accepted: 08/19/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES (1) Determine inter-observer reproducibility and test-retest repeatability of 4D flow parameters in renal allograft vessels; (2) determine if 4D flow measurements in the renal artery (RA) and renal vein (RV) can distinguish between functional and dysfunctional allografts; (3) correlate haemodynamic parameters with estimated glomerular filtration rate (eGFR), perfusion measured with dynamic contrast-enhanced MRI (DCE-MRI) and histopathology. METHODS Twenty-five prospectively recruited renal transplant patients (stable function/chronic renal allograft dysfunction, 12/13) underwent 4D flow MRI at 1.5 T. 4D flow coronal oblique acquisitions were performed in the transplant renal artery (RA) (velocity encoding parameter, VENC = 120 cm/s) and renal vein (RV) (VENC = 45 cm/s). Test-retest repeatability (n = 3) and inter-observer reproducibility (n = 10) were assessed by Cohen's kappa, coefficient of variation (CoV) and Bland-Altman statistics. Haemodynamic parameters were compared between patients and correlated to the estimated glomerular filtration rate, DCE-MRI parameters (n = 10) and histopathology from allograft biopsies (n = 15). RESULTS For inter-observer reproducibility, kappa was > 0.99 and 0.62 and CoV of flow was 12.6% and 7.8% for RA and RV, respectively. For test-retest repeatability, kappa was > 0.99 and 0.5 and CoV of flow was 27.3% and 59.4%, for RA and RV, respectively. RA (p = 0.039) and RV (p = 0.019) flow were both significantly reduced in dysfunctional allografts. Both identified chronic allograft dysfunction with good diagnostic performance (RA: AUC = 0.76, p = 0.036; RV: AUC = 0.8, p = 0.018). RA flow correlated negatively with histopathologic interstitial fibrosis score ci (ρ = - 0.6, p = 0.03). CONCLUSIONS 4D flow parameters had better repeatability in the RA than in the RV. RA and RV flow can identify chronic renal allograft dysfunction, with RA flow correlating with histopathologic interstitial fibrosis score. KEY POINTS • Inter-observer reproducibility of 4D flow measurements was acceptable in both the transplant renal artery and vein, but test-retest repeatability was better in the renal artery than in the renal vein. • Blood flow measurements obtained with 4D flow MRI in the renal artery and renal vein are significantly reduced in dysfunctional renal transplants. • Renal transplant artery flow correlated negatively with histopathologic interstitial fibrosis score.
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Affiliation(s)
- Octavia Bane
- Department of Radiology, Icahn School of Medicine at Mount Sinai (ISMMS), 1470 Madison Avenue, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, ISMMS, New York, NY, USA
| | - Daniela Said
- Department of Radiology, Icahn School of Medicine at Mount Sinai (ISMMS), 1470 Madison Avenue, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, ISMMS, New York, NY, USA
| | - Amanda Weiss
- Department of Radiology, Icahn School of Medicine at Mount Sinai (ISMMS), 1470 Madison Avenue, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, ISMMS, New York, NY, USA
| | - Daniel Stocker
- Department of Radiology, Icahn School of Medicine at Mount Sinai (ISMMS), 1470 Madison Avenue, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, ISMMS, New York, NY, USA
| | - Paul Kennedy
- Department of Radiology, Icahn School of Medicine at Mount Sinai (ISMMS), 1470 Madison Avenue, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, ISMMS, New York, NY, USA
| | - Stefanie J Hectors
- Department of Radiology, Icahn School of Medicine at Mount Sinai (ISMMS), 1470 Madison Avenue, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, ISMMS, New York, NY, USA.,Department of Radiology, Weill Cornell Medicine, New York, New York, NY, USA
| | - Rafael Khaim
- Division of Renal Medicine, Recanati Miller Transplantation Institute, ISMMS, New York, NY, USA
| | - Fadi Salem
- Department of Pathology, ISMMS, New York, NY, USA
| | - Veronica Delaney
- Division of Renal Medicine, Recanati Miller Transplantation Institute, ISMMS, New York, NY, USA
| | - Madhav C Menon
- Division of Renal Medicine, Recanati Miller Transplantation Institute, ISMMS, New York, NY, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai (ISMMS), 1470 Madison Avenue, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, ISMMS, New York, NY, USA
| | - Bachir Taouli
- Department of Radiology, Icahn School of Medicine at Mount Sinai (ISMMS), 1470 Madison Avenue, New York, NY, 10029, USA. .,BioMedical Engineering and Imaging Institute, ISMMS, New York, NY, USA.
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5
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Crismale JF, Khalid M, Bhansali A, De Boccardo G, Khaim R, Florman SS, Shapiro R, Schiano TD. Liver, simultaneous liver-kidney, and kidney transplantation from hepatitis C-positive donors in hepatitis C-negative recipients: A single-center study. Clin Transplant 2019; 34:e13761. [PMID: 31808193 DOI: 10.1111/ctr.13761] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 08/21/2019] [Revised: 11/02/2019] [Accepted: 12/03/2019] [Indexed: 02/06/2023]
Abstract
Transplantation of organs from hepatitis C virus (HCV)-antibody (Ab) and -nucleic acid test (NAT) positive donors into HCV-negative recipients has been proposed to expand the donor pool and shorten waiting times. Data on early single-center outcomes are lacking. Nineteen liver (LT, including seven simultaneous liver-kidney [SLKT]) and 17 kidney transplant (KT) recipients received organs from HCV (+) donors; of these, 13 were HCV NAT (+) in each group. All patients who received organs from HCV NAT (+) donors developed HCV viremia post-transplant except for 2 KT recipients. Patients were treated with a variety of direct-acting antiviral regimens, with high rates of sustained virologic response among those with at least 12 weeks of follow-up past the end of treatment: 12/13 (92%) and 8/8 (100%) among LT/SLKT, and KT recipients. Median time to treatment start was 42 days (interquartile range [IQR] 35-118 days) and 40 days (IQR 26-73) post-LT/SLKT and KT, respectively. One death occurred in a SLKT recipient unrelated to HCV or its treatment. There was no significant increase in rejection, proteinuria, or changes in immunosuppression in any group. Organs from HCV-viremic donors can be utilized for HCV-uninfected recipients with good short-term outcomes.
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Affiliation(s)
- James F Crismale
- Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, NY, USA
| | - Mian Khalid
- Department of Medicine, The Mount Sinai Hospital, New York, NY, USA
| | - Arjun Bhansali
- Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, NY, USA
| | - Graciela De Boccardo
- Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, NY, USA
| | - Rafael Khaim
- Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, NY, USA
| | - Sander S Florman
- Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, NY, USA
| | - Ron Shapiro
- Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, NY, USA
| | - Thomas D Schiano
- Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, NY, USA
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6
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Bane O, Hectors SJ, Gordic S, Kennedy P, Wagner M, Weiss A, Khaim R, Yi Z, Zhang W, Delaney V, Salem F, He C, Menon MC, Lewis S, Taouli B. Multiparametric magnetic resonance imaging shows promising results to assess renal transplant dysfunction with fibrosis. Kidney Int 2019; 97:414-420. [PMID: 31874802 DOI: 10.1016/j.kint.2019.09.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/31/2019] [Accepted: 09/26/2019] [Indexed: 12/28/2022]
Abstract
Here we assessed the diagnostic value of a quantitative multiparametric magnetic resonance imaging (mpMRI) protocol for evaluation of renal allograft dysfunction with fibrosis. Twenty-seven renal transplant patients, including 15 with stable functional allografts (eGFR mean 71.5 ml/min/1.73m2), and 12 with chronic dysfunction/established fibrosis (eGFR mean 30.1 ml/min/1.73m2), were enrolled in this prospective single-center study. Sixteen of the patients had renal biopsy (mean 150 days) before the MRI. All patients underwent mpMRI at 1.5T including intravoxel-incoherent motion diffusion-weighted imaging, diffusion tensor imaging, blood oxygen level dependent (BOLD R2*) and T1 quantification. True diffusion D, pseudodiffusion D*, perfusion fraction PF, apparent diffusion coefficient (ADC), fractional anisotropy (FA), R2* and T1 were calculated for cortex and medulla. ΔT1 was calculated as (100x(T1 Cortex-T1 Medulla)/T1 Cortex). Test-retest repeatability and inter-observer reproducibility were assessed in four and ten patients, respectively. mpMRI parameters had substantial test-retest and interobserver repeatability (coefficient of variation under 15%), except for medullary PF and D* (coefficient of variation over 25%). Cortical ADC, D, medullary ADC and ΔT1 were all significantly decreased, while cortical T1 was significantly elevated in fibrotic allografts. Cortical T1 showed positive correlation to the Banff fibrosis and tubular atrophy scores. The combination of ΔT1 and cortical ADC had excellent cross-validated diagnostic performance for detection of chronic dysfunction with fibrosis. Cortical ADC and T1 had good performance for predicting eGFR decline at 18 months (4 or more ml/min/1.73m2/year). Thus, the combination of cortical ADC and T1 measurements shows promising results for the non-invasive assessment of renal allograft histology and outcomes.
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Affiliation(s)
- Octavia Bane
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stefanie J Hectors
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Sonja Gordic
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Radiology, University Hospital Zürich, Zürich, Switzerland
| | - Paul Kennedy
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mathilde Wagner
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amanda Weiss
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rafael Khaim
- Division of Nephrology and Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zhengzi Yi
- Division of Nephrology and Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Mount Sinai Center for Bioinformatics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Weijia Zhang
- Division of Nephrology and Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Mount Sinai Center for Bioinformatics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Veronica Delaney
- Mount Sinai Center for Bioinformatics, 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
| | - Cijiang He
- Division of Nephrology and Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Madhav C Menon
- Division of Nephrology and Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bachir Taouli
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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7
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Hectors SJ, Bane O, Kennedy P, El Salem F, Menon M, Segall M, Khaim R, Delaney V, Lewis S, Taouli B. T 1ρ mapping for assessment of renal allograft fibrosis. J Magn Reson Imaging 2019; 50:1085-1091. [PMID: 30666744 DOI: 10.1002/jmri.26656] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is an unmet need for noninvasive methods to diagnose and stage renal allograft fibrosis. PURPOSE To investigate the utility of T1ρ measured with MRI for the assessment of fibrosis in renal allografts. STUDY TYPE Institutional Review Board (IRB)-approved prospective. SUBJECTS Fifteen patients with stable functional allograft (M/F 9/6, mean age 56 years) and 12 patients with allograft dysfunction and established fibrosis (M/F 6/6, mean age 51 years). FIELD STRENGTH/SEQUENCE T1ρ imaging at 1.5T using a custom-developed sequence. ASSESSMENT Average T1ρ in the cortex and medulla was quantified and T1ρ repeatability (expressed by the coefficient of variation [CV]) was measured in four patients. STATISTICAL TESTS Differences in T1ρ values between the 2 groups were assessed using Mann-Whitney U-tests. Diagnostic performance of T1ρ for differentiation between functional and fibrotic allografts was evaluated using receiver operating characteristic (ROC) analysis. Spearman correlations of T1ρ with Masson's trichrome-stained fractions and serum estimated glomerular filtration rate (eGFR) were assessed. RESULTS Higher T1ρ repeatability was found for cortex compared with medulla (mean CV T1ρ cortex 7.4%, medulla 13.3%). T1ρ values were significantly higher in the cortex of fibrotic vs. functional allografts (111.8 ± 17.2 msec vs. 99.0 ± 11.0 msec, P = 0.027), while there was no difference in medullary T1ρ values (122.6 ± 20.8 msec vs. 124.3 ± 20.8 msec, P = 0.789). Cortical T1ρ significantly correlated with Masson's trichrome-stained fractions (r = 0.515, P = 0.044) and eGFR (r = -0.546, P = 0.004), and demonstrated an area under the curve (AUC) of 0.77 for differentiating between functional and fibrotic allografts (sensitivity and specificity of 75.0% and 86.7%, using threshold of 106.9 msec). DATA CONCLUSION Our preliminary results suggest that T1ρ is a potential imaging biomarker of renal allograft fibrosis. These results should be verified in a larger study. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:1085-1091.
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Affiliation(s)
- Stefanie J Hectors
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Octavia Bane
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Paul Kennedy
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fadi El Salem
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Madhav Menon
- Division of Renal Medicine, Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maxwell Segall
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rafael Khaim
- Division of Renal Medicine, Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Veronica Delaney
- Division of Renal Medicine, Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sara Lewis
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bachir Taouli
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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LaPointe Rudow D, Geatrakas S, Armenti J, Tomback A, Khaim R, Porcello L, Pan S, Arvelakis A, Shapiro R. Increasing living donation by implementing the Kidney Coach Program. Clin Transplant 2019; 33:e13471. [PMID: 30588663 DOI: 10.1111/ctr.13471] [Citation(s) in RCA: 12] [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: 05/08/2018] [Revised: 12/07/2018] [Accepted: 12/18/2018] [Indexed: 12/27/2022]
Abstract
Candidates for living donor kidney transplantation (LDKT) find it difficult to discuss living donation with people in their social network, and there is a lack of useful interventions to train them. The Kidney Coach Program (KCP) was developed to equip individuals (advocates for candidates and candidate themselves) with the tools needed to find potential donors. The purpose of this pilot study is to evaluate the effects of the KCP on increasing the number of people considering living donation. METHODS Candidates for the KCP were recruited. Data were collected on the number of live donor inquiries in the coach group compared to listed patients (historical controls). RESULTS Over a 12-month period, 20 transplant candidates enrolled in the KCP were compared to 50 controls. Eighty percent of the participants in the KCP had at least one donor inquiry compared to 38% of controls (P = 0.001). Significantly, more Caucasian candidates participated in the KCP compared to other racial groups. CONCLUSIONS The KCP can be an effective method to increase awareness of a patient's need for LDKT. Existing clinical staff successfully implemented the program. Transplant programs should provide training to candidates and their supports on effective ways to find a living donor.
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Affiliation(s)
- Dianne LaPointe Rudow
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York City, New York.,Department of Population Health Science and Policy, Mount Sinai Hospital, New York City, New York
| | - Sara Geatrakas
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York City, New York
| | - Jonathan Armenti
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York City, New York
| | - Ariella Tomback
- Wurzweiler School of Social Work, Yeshiva University, New York City, New York
| | - Rafael Khaim
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York City, New York
| | - Lisa Porcello
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York City, New York
| | - Stephanie Pan
- Department of Population Health Science and Policy, Mount Sinai Hospital, New York City, New York
| | - Antonios Arvelakis
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York City, New York
| | - Ron Shapiro
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York City, New York
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9
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Nair V, Liriano-Ward L, Kent R, Huprikar S, Rana M, Florman SS, Delaney VB, Menon MC, Sehgal V, Miko L, Khaim R, Benvenisty A, Lerner S, Arvelakis A, Wadhera V, Ames S, Shapiro R. Early conversion to belatacept after renal transplantation. Clin Transplant 2017; 31. [PMID: 28267882 DOI: 10.1111/ctr.12951] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 01/20/2023]
Abstract
Belatacept is a non-nephrotoxic immunosuppressive agent, which may make it the ideal agent for patients with delayed or slow graft function on calcineurin inhibitors. There are limited data on conversion of patients to belatacept within 6 months of transplantation. Between January 2012 and December 2015, 16 patients were converted to belatacept for delayed or poor graft function (eGFR<30 mL/min/1.73 m2 , MDRD); three were HIV positive. Conversion protocols were analyzed in patients ≤4 months and 4-6 months post-transplantation. Mean serum creatinine levels after belatacept conversion were compared with preconversion levels. Patient survival was 100%, and graft survival was 88%. The mean creatinine fell from 3.9±1.82 mg/dL prebelatacept conversion to 2.1±1.1 mg/dL at 6 months and 1.9±0.47 mg/dL (median 1.8 mg/dL) at 12 months postconversion. There was no significant increased risk of rejection, infection, or malignancy. HIV parameters remained largely stable. Early conversion to belatacept in patients with DGF or slow graft function is safe and efficacious, in a single-center nonrandomized retrospective analysis.
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Affiliation(s)
- Vinay Nair
- Department of Medicine, Hofstra Northwell School of Medicine, Great Neck, NY, USA
| | - Luz Liriano-Ward
- Department of Medicine, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Rebecca Kent
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shirish Huprikar
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mena Rana
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sander S Florman
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY, USA
| | - Veronica B Delaney
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madhav C Menon
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vinita Sehgal
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leandra Miko
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY, USA
| | - Rafael Khaim
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY, USA
| | - Alan Benvenisty
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY, USA
| | - Susan Lerner
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY, USA
| | - Antonios Arvelakis
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY, USA
| | - Vikram Wadhera
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY, USA
| | - Scott Ames
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY, USA
| | - Ron Shapiro
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY, USA
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Nair V, Khaim R, El-Salem F, Kent R, Lerner S, Berger A, Miko L, Rollins B, Ebcioglu Z, Delaney V, Sehgal V, Menon M, Ames S, Benvenisty A, Wadhera V, Arvelakas A, Schiano T, Rana M, Huprikar S, Florman S, Shapiro R. Hepatitis C and Human Immunodeficiency Virus Kidney Transplantation: The Mount Sinai Experience. Clin Transpl 2015; 31:69-78. [PMID: 28514569] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Mount Sinai Hospital in New York has a long history in the field of organ transplantation. The first kidney transplant at Mount Sinai was performed in 1967 by the late Dr. Lewis Burrows and the first laparoscopic donor nephrectomy in New York was performed at Mount Sinai in 1996. Over 3000 kidney transplantations have been performed at Mount Sinai. In the early 1990s, the first hepatitis C virus (HCV) positive patient at Mount Sinai underwent a kidney transplant and the first kidney transplant in a patient with human immunodeficiency virus (HIV) in New York was performed at Mount Sinai in 2001. In general, these patients have done well after renal transplantation, with outcomes similar to those seen in non-infected patients. This chapter will describe the evolution of immunosuppressive regimens in HCV positive and HIV positive patients, and will describe the outcomes of kidney transplantation in these patients. Given the favorable outcomes, it is reasonable to continue to offer renal transplantation as a treatment for end stage renal disease patients with HCV and/or HIV.
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Affiliation(s)
- Vinay Nair
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY
| | - Rafael Khaim
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY
| | - Fadi El-Salem
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rebecca Kent
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY
| | - Susan Lerner
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY
| | - Amnon Berger
- Clinical Virology Unit and Department of Biochemistry and the Chanock Center for Virology, IMRIC, Hadassah Hebrew University Medical Center and Faculty of Medicine, Jerusalem, Israel
| | - Leandra Miko
- Pharmacy Department, The Mount Sinai Medical Center, New York, NY
| | - Brett Rollins
- Pharmacy Department, The Mount Sinai Medical Center, New York, NY
| | - Zeynep Ebcioglu
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY
| | - Veronica Delaney
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY
| | - Vinita Sehgal
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY
| | - Madhav Menon
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY
| | - Scott Ames
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY
| | - Alan Benvenisty
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY
| | - Vikram Wadhera
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY
| | - Antonious Arvelakas
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY
| | - Thomas Schiano
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY
| | - Meena Rana
- Department of Medicine, Infectious Disease Division, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shirish Huprikar
- Department of Medicine, Infectious Disease Division, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sander Florman
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY
| | - Ron Shapiro
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY
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Nair V, Sawinski D, Akalin E, Friedlander R, Ebcioglu Z, Sehgal V, Dinavahi R, Khaim R, Ames S, Lerner S, Murphy B, Bromberg JS, Heeger PS, Schröppel B. Effect of high-dose intravenous immunoglobulin on anti-HLA antibodies in sensitized kidney transplant candidates. Clin Transplant 2012; 26:E261-8. [PMID: 22686949 DOI: 10.1111/j.1399-0012.2012.01657.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Limited data exist on the effect of intravenous immunoglobulin (IVIg) on anti-HLA antibodies as determined by solid-phase assays. We reviewed our experience treating sensitized wait-listed kidney transplant recipients with IVIg as a method for desensitization and report our results utilizing Luminex single antigen (LSA) bead assay to quantify antibody reactivity (MFI). Fifteen patients with a cPRA > 40% received 2 g/kg IVIg per month for four months or until transplanted. LSA testing was performed before and after IVIg. Median MFI for anti-class I antibodies fell in 11 (73%) and increased in 4 (27%) patients after IVIg. Similar significant changes in MFI for anti-class II antibodies were observed in 10 patients (66%). Administration of IVIg was associated with a modest decrease in reactivity to both class I and II HLA antigens (median MFI change 493 and 1110, respectively; p < 0.0001) but did not significantly alter mean cPRA (85% before IVIg vs. 80% after IVIg; p = 0.1). Our data suggest a smaller effect of IVIg on HLA antibody reactivity than previously described, leading us to question how best to measure the efficacy of a desensitization protocol in current practice.
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Affiliation(s)
- Vinay Nair
- Division of Nephrology, Mount Sinai School of Medicine, New York, NY, USA.
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