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Article: Impact of Early Rejection Treatment on Infection Development in Kidney Transplant Recipients: A Propensity Analysis.

Gupta, Simran / Gea-Banacloche, Juan / Heilman, Raymond L / Yaman, Reena N / Me, Hay Me / Zhang, Nan / Vikram, Holenarasipur R / Kodali, Lavanya

Journal of transplantation

2024 Volume 2024, Page(s) 6663086

Abstract: Introduction: The impact of renal allograft rejection treatment on infection development has not been formally defined in the literature.: Methods: We conducted a retrospective cohort study of 185 rejection (case) and 185 nonrejection (control) ... ...

Abstract	Introduction: The impact of renal allograft rejection treatment on infection development has not been formally defined in the literature. Methods: We conducted a retrospective cohort study of 185 rejection (case) and 185 nonrejection (control) kidney transplant patients treated at our institution from 2014 to 2020 to understand the impact of rejection on infection development. Propensity scoring was used to match cohorts. We collected data for infections within 6 months of rejection for the cases and 18 months posttransplant for controls. Results: In 370 patients, we identified 466 infections, 297 in the controls, and 169 in the cases. Urinary tract infections (38.9%) and cytomegalovirus viremia (13.7%) were most common. Cumulative incidence of infection between the case and controls was 2.17 (CI 1.54-3.05); Conclusions: As previously understood, rejection treatment is a risk factor for subsequent infection development. Our data have defined this relationship more clearly. This study is unique, however, in that we found that infections, but not rejection, negatively impacted both overall patient survival and allograft survival, likely due to our institution's robust post-rejection protocols. Clinicians should monitor patients closely for infections in the post-rejection period and have a low threshold to treat these infections while also restarting appropriate prophylaxis.
Language	English
Publishing date	2024-03-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2503421-2
ISSN	2090-0015 ; 2090-0007
ISSN (online)	2090-0015
ISSN	2090-0007
DOI	10.1155/2024/6663086
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Article ; Online: The Problem With Predicting Uncommon Events: The Critical Effect of Prevalence in Test Performance.

Budhiraja, Pooja / Heilman, Raymond L / Edwards, Audrene S / Kaplan, Bruce

Transplantation proceedings

2022 Volume 54, Issue 7, Page(s) 1742–1744

Abstract: We used the Bayesian model to show the relationship between prevalence and the test's negative and positive predictive value. We used the above principle to understand the utility of biomarkers for acute rejection under different pretest probability of ... ...

Abstract	We used the Bayesian model to show the relationship between prevalence and the test's negative and positive predictive value. We used the above principle to understand the utility of biomarkers for acute rejection under different pretest probability of rejection. Given the test's sensitivity and specificity, the disease prevalence affects the predictive value of the test; the clinical decision to get any test should be considered while understanding the prevalence of disease and cost, risks, benefits of the tests, and available alternatives.
MeSH term(s)	Humans ; Prevalence ; Bayes Theorem ; Sensitivity and Specificity ; Predictive Value of Tests ; Probability
Language	English
Publishing date	2022-07-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	82046-5
ISSN	1873-2623 ; 0041-1345
ISSN (online)	1873-2623
ISSN	0041-1345
DOI	10.1016/j.transproceed.2022.03.066
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Article ; Online: Is Recipient HLA-B51 Status Protective for the Risk of BK Infection After Kidney Transplantation?

Heilman, Raymond L / Kaplan, Bruce

Transplantation

2018 Volume 103, Issue 3, Page(s) 461–462

MeSH term(s)	BK Virus ; HLA-B51 Antigen ; Humans ; Kidney ; Kidney Transplantation ; Polyomavirus Infections
Chemical Substances	HLA-B51 Antigen
Language	English
Publishing date	2018-12-17
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000002377
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Article ; Online: Favorable outcomes in Hispanic recipients receiving simultaneous pancreas kidney transplantation.

Budhiraja, Pooja / Reddy, Kunam S / Heilman, Raymond L / Jadlowiec, Caroline C / Khamash, Hassan / Reddy, Swetha / Katariya, Nitin / Chakkera, Harini A

Clinical transplantation

2023 Volume 37, Issue 10, Page(s) e15062

Abstract: The objective of this study was to compare the long-term outcomes of Hispanic versus white recipients who underwent simultaneous pancreas kidney transplantation (SPKT). This single-center study, conducted from 2003 to 2022, had a median follow-up of 7.5 ... ...

Abstract	The objective of this study was to compare the long-term outcomes of Hispanic versus white recipients who underwent simultaneous pancreas kidney transplantation (SPKT). This single-center study, conducted from 2003 to 2022, had a median follow-up of 7.5 years. The study included 91 Hispanic and 202 white SPKT recipients. The mean age (44 vs. 46 years), percentage of males (67% vs. 58%), and body mass index (BMI) (25.6 vs. 25.3 kg/m
MeSH term(s)	Humans ; Male ; Diabetes Mellitus, Type 2/surgery ; Diabetes Mellitus, Type 2/etiology ; Graft Survival ; Hispanic or Latino ; Kidney Transplantation ; Pancreas ; Pancreas Transplantation ; Female ; Adult ; Middle Aged
Language	English
Publishing date	2023-06-28
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.15062
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Article ; Online: Using the Virtual Crossmatch to Allow for Safer and More Efficient Kidney Transplantation of Highly Sensitized Patients.

Jaramillo, Andrés / Reddy, K Sudhakar / Heilman, Raymond L

Transplantation

2019 Volume 104, Issue 6, Page(s) 1121–1122

MeSH term(s)	Blood Grouping and Crossmatching ; Histocompatibility Testing ; Humans ; Kidney Transplantation
Language	English
Publishing date	2019-08-25
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000002925
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Article ; Online: Multiple abnormal peripheral blood gene expression assay results are correlated with subsequent graft loss after kidney transplantation.

Heilman, Raymond L / Fleming, James N / Mai, Martin / Smith, Byron / Park, Walter D / Holman, John / Stegall, Mark D

Clinical transplantation

2023 Volume 37, Issue 8, Page(s) e14987

Abstract: Background: The aim of this study was to correlate peripheral blood gene expression profile (GEP) results during the first post-transplant year with outcomes after kidney transplantation.: Methods: We conducted a prospective, multicenter ... ...

Abstract	Background: The aim of this study was to correlate peripheral blood gene expression profile (GEP) results during the first post-transplant year with outcomes after kidney transplantation. Methods: We conducted a prospective, multicenter observational study of obtaining peripheral blood at five timepoints during the first post-transplant year to perform a GEP assay. The cohort was stratified based on the pattern of the peripheral blood GEP results: Tx-all GEP results normal, 1 Not-TX had one GEP result abnormal and >1 Not-TX two or more abnormal GEP results. We correlated the GEP results with outcomes after transplantation. Results: We enrolled 240 kidney transplant recipients. The cohort was stratified into the three groups: TX n = 117 (47%), 1 Not-TX n = 59 (25%) and >1 Not-TX n = 64 (27%). Compared to the TX group, the >1 Not-TX group had lower eGFR (p < .001) and more chronic changes on 1-year surveillance biopsy (p = .007). Death censored graft survival showed inferior graft survival in the >1 Not-TX group (p < .001) but not in the 1 Not-TX group. All graft losses in the >1 Not-TX group occurred after 1-year post-transplant. Conclusions: We conclude that a pattern of persistently Not-TX GEP assay correlates with inferior graft survival.
MeSH term(s)	Humans ; Kidney Transplantation/adverse effects ; Prospective Studies ; Gene Expression ; Graft Survival ; Graft Rejection/etiology ; Graft Rejection/genetics
Language	English
Publishing date	2023-04-07
Publishing country	Denmark
Document type	Observational Study ; Multicenter Study ; Journal Article
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.14987
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Article ; Online: On Reporting of the Outcomes from Clinical Trials; a Call to Order.

Heilman, Raymond L / Srinivas, Titte R / Kaplan, Bruce

Transplantation

2018 Volume 102, Issue 12, Page(s) 1966–1967

MeSH term(s)	Data Collection ; Kidney ; Kidney Transplantation ; Randomized Controlled Trials as Topic ; Transplant Recipients
Language	English
Publishing date	2018-05-15
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000002279
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Article ; Online: Postoperative statin therapy is not associated with reduced incidence of venous thromboembolic events following kidney transplantation.

Frasco, Peter E / Rosenfeld, David M / Jadlowiec, Caroline C / Zhang, Nan / Heilman, Raymond L / Bauer, Isabel L / Alvord, Jeremy / Poterack, Karl A

Clinical transplantation

2022 , Page(s) e14805

Abstract: Background: The pleiotropic effects of statin therapy on inflammation and coagulation may reduce the risk of venous thromboembolism. This study evaluated whether statin therapy is associated with decreased venous thromboembolic (VTE) events following ... ...

Abstract	Background: The pleiotropic effects of statin therapy on inflammation and coagulation may reduce the risk of venous thromboembolism. This study evaluated whether statin therapy is associated with decreased venous thromboembolic (VTE) events following kidney transplantation. Methods: We performed a retrospective analysis of all primary kidney transplants performed between January 2014 and December 2019 at Mayo Clinic Arizona. Patients were divided into two groups depending on sustained statin therapy during the first year following transplantation. Recipient and donor clinical and demographic data were collected. The primary outcome was admission for symptomatic VTE events (deep vein thrombosis [DVT] or pulmonary embolism [PE]). Results: Sustained statin therapy in the first year following transplant was observed in 16.1% (n = 223) of 1384 kidney transplants. The overall incidence of VTE events in the year following kidney transplant was 3.8%. VTE occurred in 4.1% of recipients treated with statins and 3.8% of the controls - (hazard ratio [HR] .92, 95% confidence interval [95% CI] .39, 2.21, p = .86). However, there were significant differences between the groups in terms of age, sex, race/ethnicity, body mass index, indication for transplant, diagnosis of diabetes and discharge antiplatelet or anticoagulant therapy. Following sensitivity analysis in which cohort matching was performed to account for these differences, there was no difference in VTE event-free survival (HR .89, 95% CI .41, 1.96, p = .78) or overall survival (HR .54, 95% CI .15, 1.94, p = .35) between patients treated with statins compared to controls. Conclusion: Statin therapy in the year following successful kidney transplant was not associated with a reduction in risk of VTE.
Language	English
Publishing date	2022-09-06
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.14805
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Article ; Online: Outcomes of asymptomatic histologic pyelonephritis of kidney transplant.

Budhiraja, Pooja / Butterfield, Richard / Gea-Banacloche, Juan / Swaminathan, Sundararaman / Smith, Maxwell L / Khamash, Hassan A / Me, Hay Me / Kodali, Lavanya / Mour, Girish K / Nair, Sumi / Misra, Suman / Heilman, Raymond L

Clinical transplantation

2023 Volume 37, Issue 12, Page(s) e15125

Abstract: Background: Urinary Tract Infections are the most common post-transplant infection and can have varied presentations. This study aimed to describe the outcomes of kidney transplant recipients with asymptomatic histologic pyelonephritis on allograft ... ...

Abstract	Background: Urinary Tract Infections are the most common post-transplant infection and can have varied presentations. This study aimed to describe the outcomes of kidney transplant recipients with asymptomatic histologic pyelonephritis on allograft biopsy. Histologic Pyelonephritis was defined as neutrophil cast or neutrophilic tubulitis, interstitial infiltrates with predominant neutrophils, and no evidence of rejection or glomerulonephritis on biopsy. Methods: The study included 123 kidney transplant recipients, of whom 95 underwent protocol biopsies, and 28 had biopsies for elevated creatinine within the first 2 years of a kidney transplant. Results: The mean age of the cohort was 55.3 years, with 52% females and 78% deceased donor transplants. The risk factors for asymptomatic histologic pyelonephritis were recipient female sex (OR 1.89, 1.3-2.7, diabetes mellitus (OR 2.479, 1.687-3.645), and deceased donation (OR 1.69, 1.098-2.63). The incidence of asymptomatic pyelonephritis on protocol biopsy was 1.7%, with 52% having positive urine cultures and Escherichia coli being the most common bacteria. Subjects with asymptomatic pyelonephritis had inferior graft survival compared to the matched cohort HR 1.88 (1.06-3.35), p = .0281. In addition, of these 123 subjects, 68 (55%) subsequently developed pyelonephritis, and 34 subjects had pyelonephritis within 6 months after this episode. Subjects with recurrent infections exhibited lower survival HR 2.86 (1.36-6.02) and a trend toward higher rejection risk. Conclusion: Asymptomatic histologic pyelonephritis can occur in kidney transplant recipients and is associated with inferior graft survival.
MeSH term(s)	Humans ; Female ; Middle Aged ; Male ; Kidney Transplantation/adverse effects ; Pyelonephritis/etiology ; Pyelonephritis/pathology ; Urinary Tract Infections/etiology ; Transplantation, Homologous ; Bacteria ; Graft Rejection/diagnosis ; Graft Rejection/etiology ; Graft Rejection/epidemiology ; Graft Survival ; Kidney/pathology
Language	English
Publishing date	2023-09-13
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.15125
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Article ; Online: Duration of Dialysis in Acute Kidney Injury Donors and Transplant Outcomes.

Punukollu, Rachana / Ohara, Stephanie Y / Budhiraja, Pooja / Smith, Maxwell L / Kumm, Kayla / Ruch, Brianna / Misra, Suman / Reddy, Kunam S / Heilman, Raymond L / Jadlowiec, Caroline C

Journal of the American College of Surgeons

2023 Volume 238, Issue 1, Page(s) 61–69

Abstract: Background: Acute kidney injury (AKI) kidneys, including those from donors on dialysis, are often underutilized, although there is increasing data available demonstrating good transplant outcomes. To date, data on the duration of donor dialysis and ... ...

Abstract	Background: Acute kidney injury (AKI) kidneys, including those from donors on dialysis, are often underutilized, although there is increasing data available demonstrating good transplant outcomes. To date, data on the duration of donor dialysis and transplant outcomes are limited. Study design: This was a single-center study of deceased donor kidney transplants from 2010 to 2022. The study cohort consisted of recipients of deceased donor kidney transplants from donors with AKI and on dialysis. Three groups were identified based on the predetermined interquartile range of donor dialysis duration: 1 to 2 dialysis days, 3 to 4 dialysis days, and 5 or more dialysis days. Results: During this period, 765 AKI deceased donor transplants were performed, of which 230 were from donors on dialysis. The median dialysis duration was 2 days with a maximum of 13 days. Across the 3 groups, there were no differences in recipient age (p = 0.23) or dialysis vintage (p = 0.70). Donor age (p = 0.86) and kidney donor profile index (p = 0.57) were comparable between the groups. Recipients of deceased donor kidney transplants from donors on dialysis 5 or more days had lower terminal creatinine levels (p = 0.003) and longer cold ischemia times (p = 0.04). Posttransplant, the median length of hospital stay was 3 days for all groups (p = 0.75). There were no differences in delayed graft function occurrence (94.4% vs 86.8% vs 92.1%, p = 0.19), duration of delayed graft function (p = 0.56), or readmissions (p = 0.99). At 1 year posttransplant, the estimated glomerular filtration rate (p = 0.76), patient survival (p = 0.82), or death-censored graft survival (p = 0.28) were comparable. Conclusions: Excellent outcomes have been observed in AKI deceased donor kidney transplants, including those coming from donors on dialysis. In this small cohort, the duration of donor dialysis did not adversely affect outcomes. Cautious expansion of the donor pool, including donors on dialysis, should be considered given the ongoing organ shortage.
MeSH term(s)	Humans ; Delayed Graft Function/etiology ; Delayed Graft Function/epidemiology ; Kidney Transplantation ; Renal Dialysis ; Tissue Donors ; Acute Kidney Injury/etiology ; Acute Kidney Injury/therapy ; Graft Survival ; Kidney ; Retrospective Studies
Language	English
Publishing date	2023-10-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	1181115-8
ISSN	1879-1190 ; 1072-7515
ISSN (online)	1879-1190
ISSN	1072-7515
DOI	10.1097/XCS.0000000000000870
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