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Me HM, Budhiraja P, Nair S, Kodali L, Ryan M, Khamash H, Heilman R, Wagler J, Ruch B, Jadlowiec CC, Moss A, Reddy KS. Utilizing kidneys from a donor with bile-cast nephropathy. Am J Transplant 2024; 24:141-144. [PMID: 37633448 DOI: 10.1016/j.ajt.2023.08.018] [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: 03/31/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
Here we discuss the successful utilization of a pair of deceased donor kidneys with bile-cast nephropathy. The donor had a kidney donor profile index of 48% and an acute kidney injury requiring continuous renal replacement therapy. Peak donor bilirubin was 40.5 mg/dL, and renal wedge biopsies showed bile-cast nephropathy. Both recipients had delayed graft function lasting up to 4 weeks. The 4-month biopsies showed mild interstitial fibrosis, tubular atrophy, and a resolution of bile casts. These kidney allografts showed the reversible course of cholemic nephropathy and the potential for increasing the utilization of previously discarded kidneys.
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Affiliation(s)
- Hay Me Me
- Division of Nephrology, Mayo Clinic, Phoenix, Arizona, USA.
| | | | - Sumi Nair
- Division of Nephrology, Mayo Clinic, Phoenix, Arizona, USA
| | - Lavanya Kodali
- Division of Nephrology, Mayo Clinic, Phoenix, Arizona, USA
| | - Margaret Ryan
- Division of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, Arizona, USA
| | - Hasan Khamash
- Division of Nephrology, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Josiah Wagler
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Brianna Ruch
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Caroline C Jadlowiec
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Adyr Moss
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Kunam S Reddy
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
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Jadlowiec CC, Ohara SY, Punukollu R, Wagler J, Ruch B, Kumm K, Budhiraja P, Me HM, Mathur AK, Reddy KS, Khamash H, Heilman R. Outcomes with transplanting kidneys offered through expedited allocation. Clin Transplant 2023; 37:e15094. [PMID: 37563488 DOI: 10.1111/ctr.15094] [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: 04/21/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Expedited out-of-sequence deceased donor kidney allocation is a strategy to avoid discards after early placement attempts have been unsuccessful. Our study aimed to assess outcomes and characteristics of these transplanted kidneys. METHODS KDPI matching was performed between expedited allocation (EA) and standard allocation (SA) deceased donor kidney transplants performed at our center. RESULTS Between 2018 and 2021, there were 225 EA offers, and 189 (84%) were transplanted. EA recipients were older (p = .007) and had shorter dialysis vintage (p < .0001). EA kidneys were likely to be nationally allocated (p < .001), have AKI (p < .0001) and longer CIT (p < .0001). There were no differences in EA and SA time-zero kidney biopsies (ci, p = .07; ct, p = .89; cv, p = .95; ah, p = .79). EA kidneys had more DGF (p = .0006), but there were no differences in DGF duration (p = .83), hospital length of stay (p = .43), 1- and 2-year eGFR (p = .16, p = .99), patient (p = .34), or death-censored graft (p = .66) survival. CONCLUSION During this study period, our center transplanted 189 kidneys through EA following local-regional declines. These kidneys often came from AKI donors and had more DGF but had similar outcomes to KDPI-matched SA kidneys. Although it has been suggested that EA has the potential to worsen transplant disparities, transplant center level decisions on organ acceptance contribute to these variations.
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Affiliation(s)
- Caroline C Jadlowiec
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Stephanie Y Ohara
- Division of Surgery, Valleywise Health Medical Center, Creighton University, Phoenix, Arizona, USA
| | - Rachana Punukollu
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Josiah Wagler
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Brianna Ruch
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Kayla Kumm
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Hay Me Me
- Division of Nephrology, Mayo Clinic, Phoenix, Arizona, USA
| | - Amit K Mathur
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Kunam S Reddy
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Hasan Khamash
- Division of Nephrology, Mayo Clinic, Phoenix, Arizona, USA
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Hydrick TC, Zhang C, Ruch B, Wagler J, Kumm K, Harbell JW, Hewitt WR, Jadlowiec CC, Katariya NN, Moss AA, Nguyen MC, Reddy KS, Singer AL, Mathur AK. Declining Medicare reimbursement in abdominal transplantation from 2000 to 2021. Surgery 2023; 173:1484-1490. [PMID: 36894411 DOI: 10.1016/j.surg.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND The Centers for Medicare and Medicaid Services is a major payer for abdominal transplant services. Reimbursement reductions could have a major impact on the transplant surgical workforce and hospitals. Yet government reimbursement trends in abdominal transplantation have not been fully characterized. METHODS We performed an economic analysis to characterize changes in inflation-adjusted trends in Medicare surgical reimbursement for abdominal transplant procedures. Using the Medicare Fee Schedule Look-Up Tool, we performed a procedure code-based surgical reimbursement rate analysis. Reimbursement rates were adjusted for inflation to calculate overall changes in reimbursement, overall year-over-year, 5-year year-over-year, and compound annual growth rate from 2000 to 2021. RESULTS We observed declines in adjusted reimbursement of common abdominal transplant procedures, including liver (-32.4%), kidney with and without nephrectomy (-24.2% and -24.1%, respectively), and pancreas transplant (-15.2%) (all, P < .05). Overall, the yearly average change for liver, kidney with and without nephrectomy, and pancreas transplant were -1.54%, -1.15%, -1.15%, and -0.72%. Five-year annual change averaged -2.69%, -2.35%, -2.64%, and -2.43%, respectively. The overall average compound annual growth rate was -1.27%. CONCLUSION This analysis depicts a worrisome reimbursement pattern for abdominal transplant procedures. Transplant surgeons, centers, and professional organizations should note these trends to advocate sustainable reimbursement policy and to preserve continued access to transplant services.
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Affiliation(s)
| | - Chi Zhang
- Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic, Rochester, MN. https://twitter.com/ChiZhang_MD
| | - Brianna Ruch
- Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ. https://twitter.com/BriannaCRuch
| | - Josiah Wagler
- Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Kayla Kumm
- Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Jack W Harbell
- Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Winston R Hewitt
- Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Caroline C Jadlowiec
- Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ. https://twitter.com/CarrieJadlowiec
| | - Nitin N Katariya
- Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Adyr A Moss
- Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | | | - Kunam S Reddy
- Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Andrew L Singer
- Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Amit K Mathur
- Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic, Rochester, MN.
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Jadlowiec CC, Frasco P, Macdonough E, Wagler J, Das D, Budhiraja P, Mathur AK, Katariya N, Reddy K, Khamash H, Heilman R. Association of DGF and Early Readmissions on Outcomes Following Kidney Transplantation. Transpl Int 2022; 35:10849. [PMID: 36620699 PMCID: PMC9817097 DOI: 10.3389/ti.2022.10849] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022]
Abstract
Concerns regarding outcomes and early resource utilization are potential deterrents to broader use of kidneys at risk for delayed graft function (DGF). We assessed outcomes specific to kidneys with DGF that required early readmission following transplant. Three groups were identified: 1) recipients with DGF not requiring readmission, 2) recipients with DGF having an isolated readmission, and 3) recipients with DGF requiring ≥2 readmissions. Most recipients either required a single readmission (26.8%, n = 247) or no readmission (56.1%, n = 517); 17.1% (n = 158), had ≥2 readmissions. Recipients requiring ≥2 readmissions were likely to be diabetic (53.8%, p = 0.04) and have longer dialysis vintage (p = 0.01). Duration of DGF was longer with increasing number of readmissions (p < 0.001). There were no differences in patient survival for those with DGF and 0, 1 and ≥2 readmissions (p = 0.13). Graft survival, however, was lower for those with ≥2 readmissions (p < 0.0001). This remained true when accounting for death-censored graft loss (p = 0.0012). Additional subgroup analysis was performed on mate kidneys with and without DGF and mate kidneys, both with DGF, with and without readmissions. For these subgroups, there were no differences in patient or graft survival. As a whole, patients with DGF have excellent outcomes, however, patients with DGF requiring ≥2 readmissions have lower graft survival. A better understanding of recipient variables contributing to multiple readmissions may allow for improvements in the utilization of DGF at-risk kidneys.
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Affiliation(s)
- Caroline C. Jadlowiec
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, United States,*Correspondence: Caroline C. Jadlowiec,
| | - Peter Frasco
- Division of Anesthesiology, Mayo Clinic, Phoenix, AZ, United States
| | - Elizabeth Macdonough
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, United States
| | - Josiah Wagler
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, United States
| | - Devika Das
- Division of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Pooja Budhiraja
- Division of Nephrology, Mayo Clinic, Phoenix, AZ, United States
| | - Amit K. Mathur
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, United States
| | - Nitin Katariya
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, United States
| | - Kunam Reddy
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, United States
| | - Hasan Khamash
- Division of Nephrology, Mayo Clinic, Phoenix, AZ, United States
| | - Raymond Heilman
- Division of Nephrology, Mayo Clinic, Phoenix, AZ, United States
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Das D, Wagler J, Ohara S, Nguyen M, Frasco PE, Smith M, Khamash H, Mathur AK, Budhiraja P, Reddy K, Heilman R, Jadlowiec C. Outcomes of Dual Kidney Transplants from High KDPI Kidneys are Superior Compared to Single Kidney High KDPI Transplants at One-Year. Clin Transplant 2022; 36:e14737. [PMID: 35633507 DOI: 10.1111/ctr.14737] [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] [Received: 02/11/2022] [Revised: 05/05/2022] [Accepted: 05/25/2022] [Indexed: 11/27/2022]
Abstract
Dual kidney transplantation (DKT), utilizing two adult kidneys from the same donor for one recipient, has been used as way to expand the available donor pool. These kidneys often come from high Kidney Donor Profile Index donors (KDPI >85%). Data comparing outcomes between high KDPI DKT and single kidney transplants (SKT) remain limited. We assessed outcomes of 336 high KDPI kidney transplants performed at our center; 11.0% (n = 37) were DKT. Recipients of DKT were older (p = 0.02) and donors had a higher KDPI score (median 96% vs. 91%, p<0.0001). DKT operative time was higher compared to SKT (+1.4 hours, p<0.0001). There were no differences in delayed graft function (54.1% vs. 51.5%, p = 0.77) and hospital length of stay (median 4.0 vs. 3.0 days, p = 0.21) between DKT and SKT. Grade I Clavien-Dindo complications occurred in 8.1% of DKT and 13.7% of SKT (p = 0.008). There were no grade IVa, IVb or V complications in either group. DKT had more glomerulosclerosis (p = 0.04), interstitial fibrosis (p = 0.02), tubular atrophy (p = 0.01), and arterial thickening (p = 0.03) on one-year protocol biopsies. Estimated glomerular filtration was higher for DKT at one- (p = 0.004) and two-years post-transplant (p = 0.01). There were no differences in patient (HR 1.3, 95% CI 0.5-3.3, p = 0.58) or graft (HR 1.1, 95% CI 0.5-2.3, p = 0.83) survival. Good outcomes can be achieved with DKT using high KDPI kidneys with moderate chronic changes. DKT is a good option to help further utilize high KDPI kidneys and minimize discard. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Devika Das
- Division of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Josiah Wagler
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Stephanie Ohara
- Division of Surgery, Valleywise Health Medical Center, Creighton University, Phoenix, Arizona, USA
| | - Michelle Nguyen
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Peter E Frasco
- Division of Anesthesiology, Mayo Clinic, Phoenix, Arizona, USA
| | - Maxwell Smith
- Division of Anatomic Pathology, Phoenix, Arizona, USA
| | - Hasan Khamash
- Division of Nephrology, Mayo Clinic, Phoenix, Arizona, USA
| | - Amit K Mathur
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Kunam Reddy
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Caroline Jadlowiec
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
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Jayasekera CR, Vikram HR, Rifat Z, Wagler J, Okubo K, Braaksma BR, Harbell JW, Jadlowiec CC, Katariya NN, Mathur AK, Moss A, Reddy KS, Singer A, Orenstein R, Saling CF, Seville MT, Mour GK, Vargas HE, Byrne TJ, Hewitt WR, Aqel BA. Solid Organ Transplantation From SARS-CoV-2-infected Donors to Uninfected Recipients: A Single-center Experience. Transplant Direct 2022; 8:e1286. [PMID: 35047665 PMCID: PMC8759616 DOI: 10.1097/txd.0000000000001286] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The risk of donor-derived severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in solid organ (heart, lung, liver, kidney, pancreas, and intestine) transplant recipients is poorly understood. Since hematogenous transmission of SARS-CoV-2 has not been documented to date, nonlung solid organs might be suitable for transplantation since they likely portend a low risk of viral transmission. METHODS Abdominal solid organs from SARS-CoV-2-infected donors were transplanted into uninfected recipients. RESULTS Between April 18, 2021, and October 30, 2021, we performed transplants of 2 livers, 1 simultaneous liver and kidney, 1 kidney, and 1 simultaneous kidney and pancreas from SARS-CoV-2-infected donors into 5 uninfected recipients. None of the recipients developed SARS-CoV-2 infection or coronavirus disease 2019, and when tested, allograft biopsies showed no evidence of SARS-CoV-2 RNA. CONCLUSIONS Transplanting nonlung organs from SARS-CoV-2-infected donors into uninfected recipients demonstrated no evidence of virus transmission.
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Affiliation(s)
- Channa R. Jayasekera
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ
| | | | - Zeeshan Rifat
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Josiah Wagler
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Keita Okubo
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Brandon R. Braaksma
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Jack W. Harbell
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Caroline C. Jadlowiec
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Nitin N. Katariya
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Amit K. Mathur
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Adyr Moss
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - K. Sudhakar Reddy
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Andrew Singer
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Robert Orenstein
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ
| | - Christopher F. Saling
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ
| | - Maria T. Seville
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ
| | - Girish K. Mour
- Division of Nephrology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ
| | - Hugo E. Vargas
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ
| | - Thomas J. Byrne
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ
| | - Winston R. Hewitt
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Bashar A. Aqel
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ
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Wilson T, Wagler J, LePorte A, Vijayakumar A, Kaya R, Metzler‐Wilson K, Walkowski S. Effect of sub‐occipital release on steady‐state and dynamic oscillatory features of the cardiovascular system (1170.7). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.1170.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Thad Wilson
- Marian University College of Osteopathic MedicineIndianapolisINUnited States
- Ohio University Heritage College of Osteopathic MedicineAthensOHUnited States
| | - Josiah Wagler
- Ohio University Heritage College of Osteopathic MedicineAthensOHUnited States
| | - Andrew LePorte
- Ohio University Heritage College of Osteopathic MedicineAthensOHUnited States
| | - Amirtha Vijayakumar
- Ohio University Heritage College of Osteopathic MedicineAthensOHUnited States
| | - Ryan Kaya
- Ohio University Heritage College of Osteopathic MedicineAthensOHUnited States
| | - Kristen Metzler‐Wilson
- Lebanon Valley CollegeAnnvillePAUnited States
- Marian University College of Osteopathic MedicineIndianapolisINUnited States
| | - Stevan Walkowski
- Ohio University Heritage College of Osteopathic MedicineAthensOHUnited States
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Gill DS, Singh R, Rana DS, Wagler J, Kroke E. Preparation, Characterization, X-Ray Structure Determination and Solution Properties of some Novel Copper(I) Bisulfate and Sulfate Salts and Their Stable Derivatives. Z Naturforsch B 2011. [DOI: 10.5560/znb.2011.66b1042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wagler J, Gerlach D, Roewer G. 8-oxyquinolinate and 8-oxyquinaldinate in silicon complex chemistry — a new face of old ligands. Chem Heterocycl Compd (N Y) 2006. [DOI: 10.1007/s10593-006-0279-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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