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Article ; Online: Procurement Biopsies in Kidney Transplantation: More Information May Not Lead to Better Decisions.

Lentine, Krista L / Kasiske, Bertram / Axelrod, David A

Journal of the American Society of Nephrology : JASN

2021 Volume 32, Issue 8, Page(s) 1835–1837

MeSH term(s)	Biopsy ; Clinical Decision-Making ; Delayed Graft Function/pathology ; Frozen Sections ; Graft Survival ; Humans ; Kidney/pathology ; Kidney Transplantation ; Sclerosis ; Tissue Donors ; Tissue and Organ Procurement
Language	English
Publishing date	2021-05-27
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1085942-1
ISSN	1533-3450 ; 1046-6673
ISSN (online)	1533-3450
ISSN	1046-6673
DOI	10.1681/ASN.2021030403
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Article ; Online: OPTN/SRTR 2020 Annual Data Report: Living Donor Collective

Kasiske, B L / Lentine, K L / Ahn, Y / Skeans, M A / Eberhard, T / Folken, C / Wainright, J / Larkin, L / Nystedt, C

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

2022 Volume 22 Suppl 2, Page(s) 553–586

Abstract: The first successful solid organ transplant was a living donor kidney transplant in 1954. Since then, living donation has been an important source of organs for kidney and liver transplants in the United States. Unfortunately, the demand for organs has ... ...

Abstract	The first successful solid organ transplant was a living donor kidney transplant in 1954. Since then, living donation has been an important source of organs for kidney and liver transplants in the United States. Unfortunately, the demand for organs has not kept pace with the supply, and unlike deceased donor transplant, there has been little growth in the number of living donor transplants over the past decade. To better understand possible barriers to living donation and long-term risks attributable to donation, the Health Resources and Services Administration (HRSA) directed the Scientific Registry of Transplant Recipients (SRTR) to establish a national registry of all living donor candidates and donors evaluated at US transplant programs to acquire lifetime follow-up information. Other goals include understanding the factors associated with candidate approval and variation in approval practices across centers. A pilot program was conducted from June 2018 through September 2020 to inform baseline data collection and registration processes. In September 2020, the registry began recruiting additional sites evaluating candidates for living donation. Here, we describe candidates registered at participating living donor kidney and liver programs, from June 2018 through the end of 2020. Not all programs submitted data throughout the whole period. Data for kidney and liver living donor candidates are presented separately.
MeSH term(s)	Humans ; Kidney Transplantation ; Living Donors ; Organ Transplantation ; Registries ; Tissue Donors ; Tissue and Organ Procurement ; Transplant Recipients ; United States
Language	English
Publishing date	2022-03-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2060594-8
ISSN	1600-6143 ; 1600-6135
ISSN (online)	1600-6143
ISSN	1600-6135
DOI	10.1111/ajt.16983
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Article ; Online: Challenges in the management of the kidney allograft: from decline to failure: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.

Josephson, Michelle A / Becker, Yolanda / Budde, Klemens / Kasiske, Bertram L / Kiberd, Bryce A / Loupy, Alexandre / Małyszko, Jolanta / Mannon, Roslyn B / Tönshoff, Burkhard / Cheung, Michael / Jadoul, Michel / Winkelmayer, Wolfgang C / Zeier, Martin

Kidney international

2023 Volume 104, Issue 6, Page(s) 1076–1091

Abstract: In March 2022, Kidney Disease: Improving Global Outcomes (KDIGO) held a virtual Controversies Conference to address the important but rarely examined phase during which the kidney transplant is failing or has failed. In addition to discussing the ... ...

Abstract	In March 2022, Kidney Disease: Improving Global Outcomes (KDIGO) held a virtual Controversies Conference to address the important but rarely examined phase during which the kidney transplant is failing or has failed. In addition to discussing the definition of a failing allograft, 4 broad areas were considered in the context of a declining functioning graft: prognosis and kidney failure trajectory; immunosuppression strategies; management of medical and psychological complications, and patient factors; and choice of kidney replacement therapy or supportive care following graft loss. Identifying and paying special attention to individuals with failing allografts was felt to be important in order to prepare patients psychologically, manage immunosuppression, address complications, prepare for dialysis and/or retransplantation, and transition to supportive care. Accurate prognostication tools, although not yet widely available, were embraced as necessary to define allograft survival trajectories and the likelihood of allograft failure. The decision of whether to withdraw or continue immunosuppression after allograft failure was deemed to be based most appropriately on risk-benefit analysis and likelihood of retransplantation within a few months. Psychological preparation and support was identified as a critical factor in patient adjustment to graft failure, as was early communication. Several models of care were noted that enabled a medically supportive transition back to dialysis or retransplantation. Emphasis was placed on the importance of dialysis-access readiness before initiation of dialysis, in order to avoid use of central venous catheters. The centrality of the patient to all management decisions and discussions was deemed to be paramount. Patient "activation," which can be defined as engaged agency, was seen as the most effective way to achieve success. Unresolved controversies, gaps in knowledge, and areas for research were also stressed in the conference deliberations.
MeSH term(s)	Humans ; Kidney ; Kidney Diseases ; Transplantation, Homologous ; Renal Dialysis ; Allografts
Language	English
Publishing date	2023-05-24
Publishing country	United States
Document type	Practice Guideline ; Research Support, Non-U.S. Gov't ; Journal Article
ZDB-ID	120573-0
ISSN	1523-1755 ; 0085-2538
ISSN (online)	1523-1755
ISSN	0085-2538
DOI	10.1016/j.kint.2023.05.010
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Article ; Online: Incidence, risk factors, and long-term outcomes associated with antibody-mediated rejection - The long-term Deterioration of Kidney Allograft Function (DeKAF) prospective cohort study.

Hart, Allyson / Schladt, David P / Matas, Arthur J / Itzler, Robbin / Israni, Ajay K / Kasiske, Bertram L

Clinical transplantation

2021 Volume 35, Issue 7, Page(s) e14337

Abstract: ... recipient age, human leukocyte antigen DR mismatches, panel-reactive antibody >0%, positive T- or B-cell ...

Abstract	Major gaps remain in our understanding of antibody-mediated rejection (AMR) after kidney transplant. We examined the incidence, risk factors, response to treatment, and effects on outcomes of AMR at seven transplant programs in the long-term Deterioration of Kidney Allograft Function prospective study cohort. Among 3131 kidney recipients, there were 194 observed AMR cases (6.2%) during (mean ± SD) 4.85 ± 1.86 years of follow-up. Time to AMR was 0.97 ± 1.17 (median, 0.48) years. Risk factors for AMR included younger recipient age, human leukocyte antigen DR mismatches, panel-reactive antibody >0%, positive T- or B-cell cross-match, and delayed graft function. Compared with no AMR, the adjusted time-dependent hazard ratio for death-censored graft failure is 10.1 (95% confidence interval, 6.5-15.7) for all AMR patients, 4.0 (2.5, 9.1) for early AMR (<90 days after transplant), and 24.0 (14.0-41.1) for late AMR (≥90 days after transplant). Patients were treated with different therapeutic combinations. Of 194 kidney transplant recipients with AMR, 50 (25.8%) did not respond to treatment, defined as second AMR within 100 days or no improvement in estimated glomerular filtration rate by 42 days. Long-term outcomes after AMR are poor, regardless of the initial response to treatment. Better prevention and new therapeutic strategies are needed to improve long-term allograft survival.
MeSH term(s)	Allografts ; Cohort Studies ; Graft Rejection/epidemiology ; Graft Rejection/etiology ; Graft Survival ; Humans ; Incidence ; Kidney ; Prospective Studies ; Risk Factors
Language	English
Publishing date	2021-05-18
Publishing country	Denmark
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.14337
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Article ; Online: Factors enabling transplant program participation in the Scientific Registry of Transplant Recipients (SRTR) Living Donor Collective: A national survey.

Lentine, Krista L / Dew, Mary Amanda / Xiao, Huiling / Wisniewski, Addie / Levan, Macey L / Al Ammary, Fawaz / Sharfuddin, Asif / Axelrod, David A / Waterman, Amy D / Kasiske, Bertram

Clinical transplantation

2023 Volume 37, Issue 4, Page(s) e14908

Abstract: Background: The Scientific Registry of Transplant Recipients (SRTR) Living Donor Collective (LDC), the first effort to create a lifetime registry for living donor candidates in the United States, requires transplant programs to register donor candidates ...

Abstract	Background: The Scientific Registry of Transplant Recipients (SRTR) Living Donor Collective (LDC), the first effort to create a lifetime registry for living donor candidates in the United States, requires transplant programs to register donor candidates while the SRTR conducts follow-up. Methods: To better understand facilitators and barriers to program participation, we conducted a brief electronic survey of U.S. transplant program staff from October 26, 2021 to December 17, 2021. Results: We received 132 responses, with at least one response from 87 living donor programs (46 kidney programs, 33 kidney and liver programs, and eight liver programs alone). We found 86% of program representatives strongly agreed or agreed that funding adequate to cover the cost of data collection would facilitate LDC participation, 92% agreed or strongly agreed with importance of electronic data submission options, and 74% reported that elimination of requirements to submit duplicative pre-operative information to the Organ Procurement and Transplantation Network (OPTN) would be helpful. Other potentially enabling factors include reduction in duration of OPTN postdonation follow-up requirements, ease-of-use, protection from data use for regulation, adequate data security, and equity in data access. Conclusion: This survey identifies potential targets to strengthen participation in the effort to create a national living donor registry in the United States. Collaboration and investment to overcome barriers to LDC participation among transplant programs are vital to generate long-term data on living donation for donor candidates, donors, and patients in need of transplant.
MeSH term(s)	Humans ; United States ; Living Donors ; Transplant Recipients ; Organ Transplantation ; Registries ; Tissue and Organ Procurement ; Surveys and Questionnaires
Language	English
Publishing date	2023-02-05
Publishing country	Denmark
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.14908
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Article ; Online: OPTN/SRTR 2017 Annual Data Report: Deceased Organ Donation.

Israni, A K / Zaun, D / Rosendale, J D / Schaffhausen, C / Snyder, J J / Kasiske, B L

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

2019 Volume 19 Suppl 2, Page(s) 485–516

Abstract: SRTR uses data collected by OPTN to calculate metrics such as donation rate, organ yield, and rate of organs recovered for transplant but not transplanted. In 2017, 1,085,646 death and imminent death referrals were made to organ procurement organizations, ...

Abstract	SRTR uses data collected by OPTN to calculate metrics such as donation rate, organ yield, and rate of organs recovered for transplant but not transplanted. In 2017, 1,085,646 death and imminent death referrals were made to organ procurement organizations, of which 22,265 met the definition of eligible (11,673) or imminent neurological (10,592) deaths per OPTN policy. There were 10,286 deceased donors, and this number has been increasing since 2010. The number of organs authorized for recovery has also continued to increase since 2010. The recent increase may be in part due to the rising number of deaths of young individuals due to the opioid epidemic. In 2017, 4813 organs were discarded, including 3542 kidneys, 309 pancreata, 742 livers, 4 intestines, 33 hearts, and 272 lungs. These numbers suggest a need to reduce the number of organs discarded.
MeSH term(s)	Annual Reports as Topic ; Brain Death ; Graft Survival ; Humans ; Organ Transplantation/statistics & numerical data ; Organ Transplantation/trends ; Tissue Donors/statistics & numerical data ; Tissue Donors/supply & distribution ; Tissue and Organ Procurement/statistics & numerical data ; Tissue and Organ Procurement/trends ; United States
Language	English
Publishing date	2019-04-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2060594-8
ISSN	1600-6143 ; 1600-6135
ISSN (online)	1600-6143
ISSN	1600-6135
DOI	10.1111/ajt.15280
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Article ; Online: Response to Kalbfleish and Schaubel: "A Perspective on the Scientific Registry of Transplant Recipients Migration to Bayesian Methods".

Salkowski, N / Snyder, J J / Kasiske, B L

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

2015 Volume 15, Issue 8, Page(s) 2273–2274

MeSH term(s)	Humans ; Registries ; Transplantation
Language	English
Publishing date	2015-06-19
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2060594-8
ISSN	1600-6143 ; 1600-6135
ISSN (online)	1600-6143
ISSN	1600-6135
DOI	10.1111/ajt.13353
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Article ; Online: OPTN/SRTR 2020 Annual Data Report: Heart.

Colvin, M / Smith, J M / Ahn, Y / Skeans, M A / Messick, E / Bradbrook, K / Gauntt, K / Israni, A K / Snyder, J J / Kasiske, B L

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

2022 Volume 22 Suppl 2, Page(s) 350–437

Abstract: As we enter the third year of the new adult heart allocation policy, we are faced with the new challenges of the COVID-19 pandemic. In 2020, new listings (adult and pediatric) decreased slightly, with 4000 new listings in 2020, compared with 4087 in 2019; ...

Abstract	As we enter the third year of the new adult heart allocation policy, we are faced with the new challenges of the COVID-19 pandemic. In 2020, new listings (adult and pediatric) decreased slightly, with 4000 new listings in 2020, compared with 4087 in 2019; however, the number of adult heart transplants performed continued to increase, to 3715 in 2020. The number of pediatric heart transplants declined from 509 in 2019 to 465 in 2020. One-year and six-month posttransplant mortality rates in adult recipients have increased slightly since 2015 but have not significantly changed over the past decade. Overall, posttransplant mortality rates for adult recipients were 7.4% at six months and 9.4% at one year for transplants in 2019, 14.0% at three years for transplants in 2017, and 19.1% at five years for transplants in 2015. Although shorter-term posttransplant mortality rates have slightly increased, there has been a steady downward trend in longer-term mortality. Mortality rates for pediatric recipients were 5.7% at six months and 8.1% at one year for transplants in 2019, 11.6% at three years for transplants in 2017, and 15.2% at five years for transplants in 2015.
MeSH term(s)	Adult ; COVID-19/epidemiology ; Child ; Graft Survival ; Humans ; Pandemics ; Registries ; SARS-CoV-2 ; Tissue Donors ; Tissue and Organ Procurement ; United States/epidemiology ; Waiting Lists
Language	English
Publishing date	2022-03-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2060594-8
ISSN	1600-6143 ; 1600-6135
ISSN (online)	1600-6143
ISSN	1600-6135
DOI	10.1111/ajt.16977
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Article ; Online: OPTN/SRTR 2020 Annual Data Report: Liver.

Kwong, A J / Ebel, N H / Kim, W R / Lake, J R / Smith, J M / Schladt, D P / Skeans, M A / Foutz, J / Gauntt, K / Cafarella, M / Snyder, J J / Israni, A K / Kasiske, B L

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

2022 Volume 22 Suppl 2, Page(s) 204–309

Abstract: This year was marked by the COVID-19 pandemic, which altered transplant program activity and affected waitlist and transplant outcomes. Still, 8906 liver transplants were performed, an all-time high, across 142 centers in the United States, and ... ...

Abstract	This year was marked by the COVID-19 pandemic, which altered transplant program activity and affected waitlist and transplant outcomes. Still, 8906 liver transplants were performed, an all-time high, across 142 centers in the United States, and pretransplant as well as graft and patient survival metrics, continued to improve. Living donation activity decreased after several years of growth. As of June 30, 2020, 98989 liver transplant recipients were alive with a functioning graft, and in the context of increasing liver transplant volume, the size of both the adult and pediatric liver transplant waitlists have decreased. On February 4, 2020, shortly before the pandemic began, a new liver distribution policy based on acuity circles was implemented, replacing donor service area- and region-based boundaries. A policy change to direct pediatric livers to pediatric recipients led to an increase in deceased donor transplant rates and a decrease in pretransplant mortality rate among children, although the absolute number of pediatric transplants did not increase in 2020. Among adults, alcohol-associated liver disease became the predominant indication for liver transplant in 2020. After implementation of the National Liver Review Board and lower waitlist priority for most exception cases in 2019, fewer liver transplants were being performed via exception points, and the transplant rate between those with and without hepatocellular carcinoma has equalized. Women continue to experience higher pretransplant mortality and lower rates of liver transplant than men.
MeSH term(s)	Adult ; COVID-19/epidemiology ; Child ; Female ; Graft Survival ; Humans ; Liver ; Male ; Pandemics ; SARS-CoV-2 ; Tissue Donors ; Tissue and Organ Procurement ; United States/epidemiology ; Waiting Lists
Language	English
Publishing date	2022-03-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2060594-8
ISSN	1600-6143 ; 1600-6135
ISSN (online)	1600-6143
ISSN	1600-6135
DOI	10.1111/ajt.16978
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Article ; Online: OPTN/SRTR 2018 Annual Data Report: Deceased Organ Donation.

Israni, A K / Zaun, D / Hadley, N / Rosendale, J D / Schaffhausen, C / McKinney, W / Snyder, J J / Kasiske, B L

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

2020 Volume 20 Suppl s1, Page(s) 509–541

Abstract: SRTR uses data collected by OPTN to calculate metrics such as donation rate, organ yield, and rate of organs recovered for transplant but not transplanted. In 2018, there were 10,721 deceased donors, and this number has been increasing since 2010. The ... ...

Abstract	SRTR uses data collected by OPTN to calculate metrics such as donation rate, organ yield, and rate of organs recovered for transplant but not transplanted. In 2018, there were 10,721 deceased donors, and this number has been increasing since 2010. The number of deceased donor transplants increased to 29,676 in 2018 from 28,582 in 2017, and this number has been increasing since 2012. The recent increase may be due in part to the rising number of deaths of young people due to the opioid epidemic. In 2018, 4994 organs were discarded, slightly more than 4813 in 2017. In 2018, 3755 kidneys, 278 pancreata, 707 livers, 3 intestines, 23 hearts, and 317 lungs were discarded. These numbers suggest an opportunity to increase numbers of transplants by reducing discards.
MeSH term(s)	Graft Survival ; Humans ; Organ Transplantation/statistics & numerical data ; Tissue Donors/supply & distribution ; Tissue and Organ Procurement/statistics & numerical data ; United States
Language	English
Publishing date	2020-01-22
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2060594-8
ISSN	1600-6143 ; 1600-6135
ISSN (online)	1600-6143
ISSN	1600-6135
DOI	10.1111/ajt.15678
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