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  1. Article ; Online: Continuation of immunosuppression vs. immunosuppression weaning in potential repeat kidney transplant candidates: a care management perspective.

    Hickey, Michelle J / Singh, Gurbir / Lum, Erik L

    Frontiers in nephrology

    2023  Volume 3, Page(s) 1163581

    Abstract: Management of immunosuppression in patients with a failing or failed kidney transplant requires a complete assessment of their clinical condition. One of the major considerations in determining immunosuppression is whether or not such an individual is ... ...

    Abstract Management of immunosuppression in patients with a failing or failed kidney transplant requires a complete assessment of their clinical condition. One of the major considerations in determining immunosuppression is whether or not such an individual is considered a candidate for re-transplantation. Withdrawal of immunosuppression in a re-transplant candidate can result in allosensitization and markedly reduce the chances of a repeat transplant. In this review, we summarize the effects of immunosuppression reduction on HLA sensitization, discuss the impacts of allosensitization in these patients, and explore reduction protocols and future directions. Risks of chronic immunosuppression, medical management of the failing allograft, and the effect of nephrectomy are covered elsewhere in this issue.
    Language English
    Publishing date 2023-06-07
    Publishing country Switzerland
    Document type Journal Article ; Review
    ISSN 2813-0626
    ISSN (online) 2813-0626
    DOI 10.3389/fneph.2023.1163581
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  2. Article ; Online: Pretransplant Treatment to Avoid Recurrent Membranous Nephropathy in a Kidney Transplant Recipient: A Case Report.

    Lum, Erik L / Zuckerman, Jonathan E / Abdelnour, Lama / Terenzini, Jennifer / Singh, Gurbir / Bunnapradist, Suphamai

    Kidney medicine

    2024  Volume 6, Issue 6, Page(s) 100822

    Abstract: Kidney transplant candidates with high anti-M-type phospholipase A2 receptor antibody activity may be at increased risk for early postkidney transplant recurrence and allograft loss. Pretransplant treatment to induce serological remission may be ... ...

    Abstract Kidney transplant candidates with high anti-M-type phospholipase A2 receptor antibody activity may be at increased risk for early postkidney transplant recurrence and allograft loss. Pretransplant treatment to induce serological remission may be warranted to improve allograft survival. In this case report, a patient seeking their third kidney transplant, who lost 2 prior living donor transplants from early recurrent membranous nephropathy, underwent pretransplant treatment for membranous nephropathy with serological remission and no evidence of recurrent disease.
    Language English
    Publishing date 2024-04-12
    Publishing country United States
    Document type Case Reports
    ISSN 2590-0595
    ISSN (online) 2590-0595
    DOI 10.1016/j.xkme.2024.100822
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  3. Article ; Online: Adenovirus in a Kidney Transplant Recipient.

    Lum, Erik L / Zuckerman, Jonathan / Gaynor, Pryce / Bunnapradist, Suphamai

    Kidney medicine

    2023  Volume 5, Issue 4, Page(s) 100605

    Language English
    Publishing date 2023-01-25
    Publishing country United States
    Document type Editorial
    ISSN 2590-0595
    ISSN (online) 2590-0595
    DOI 10.1016/j.xkme.2023.100605
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  4. Article: BK Viremia Exacerbation With Adalimumab Coadministration.

    Lum, Erik L / Bunnapradist, Suphamai

    Transplantation direct

    2020  Volume 6, Issue 6, Page(s) e557

    Language English
    Publishing date 2020-05-22
    Publishing country United States
    Document type Journal Article
    ISSN 2373-8731
    ISSN 2373-8731
    DOI 10.1097/TXD.0000000000001000
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  5. Article ; Online: Novel indications for referral and care for simultaneous liver kidney transplant recipients.

    Lum, Erik L / Bunnapradist, Suphamai / Wiseman, Alexander C / Gurakar, Ahmet / Ferrey, Antoney / Reddy, Uttam / Al Ammary, Fawaz

    Current opinion in nephrology and hypertension

    2024  Volume 33, Issue 3, Page(s) 354–360

    Abstract: Purpose of review: Kidney dysfunction is challenging in liver transplant candidates to determine whether it is reversible or not. This review focuses on the pertinent data on how to best approach liver transplant candidates with kidney dysfunction in ... ...

    Abstract Purpose of review: Kidney dysfunction is challenging in liver transplant candidates to determine whether it is reversible or not. This review focuses on the pertinent data on how to best approach liver transplant candidates with kidney dysfunction in the current era after implementing the simultaneous liver kidney (SLK) allocation policy and safety net.
    Recent findings: The implementation of the SLK policy inverted the steady rise in SLK transplants and improved the utilization of high-quality kidneys. Access to kidney transplantation following liver transplant alone (LTA) increased with favorable outcomes. Estimating GFR in liver transplant candidates remains challenging, and innovative methods are needed. SLK provided superior patient and graft survival compared to LTA only for patients with advanced CKD and dialysis at least 3 months. SLK can provide immunological protection against kidney rejection in highly sensitized candidates. Post-SLK transplant care is complex, with an increased risk of complications and hospitalization.
    Summary: The SLK policy improved kidney access and utilization. Transplant centers are encouraged, under the safety net, to reserve SLK for liver transplant candidates with advanced CKD or dialysis at least 3 months while allowing lower thresholds for highly sensitized patients. Herein, we propose a practical approach to liver transplant candidates with kidney dysfunction.
    MeSH term(s) Humans ; Kidney Transplantation/methods ; Renal Dialysis/adverse effects ; Risk Factors ; Kidney ; Renal Insufficiency ; Graft Survival ; Liver ; Referral and Consultation ; Renal Insufficiency, Chronic/diagnosis ; Renal Insufficiency, Chronic/surgery
    Language English
    Publishing date 2024-02-12
    Publishing country England
    Document type Review ; Journal Article
    ZDB-ID 1151092-4
    ISSN 1473-6543 ; 1535-3842 ; 1062-4813 ; 1062-4821
    ISSN (online) 1473-6543 ; 1535-3842
    ISSN 1062-4813 ; 1062-4821
    DOI 10.1097/MNH.0000000000000970
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    Zs.A 3686: Show issues Location:
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  6. Article ; Online: Current opinions in nephrology and hypertension: kidney transplantation in patients with plasma cell dyscrasias.

    Lum, Erik L / Bunnapradist, Suphamai

    Current opinion in nephrology and hypertension

    2019  Volume 28, Issue 6, Page(s) 573–580

    Abstract: Purpose of review: Plasma cell dyscrasias encompass a group of hematological disorders characterized by increased production of immunoglobulins by clonal B cells. Kidney involvement is common. Significant advances in the treatment of plasma cell ... ...

    Abstract Purpose of review: Plasma cell dyscrasias encompass a group of hematological disorders characterized by increased production of immunoglobulins by clonal B cells. Kidney involvement is common. Significant advances in the treatment of plasma cell dyscrasias have resulted in improved survival and may permit kidney transplantation in candidates previously denied transplantation. Treatments may also have effects on kidney transplant recipients who develop plasma cell dyscrasias post transplantation.
    Recent finding: The available evidence suggests that transplantation of candidates with nonmultiple myeloma plasma cell dyscrasias provides good outcome with low recurrence rates, so long as the disease has been treated with a complete or good partial response prior to transplantation. Candidates with a history untreated MGRS or a history of multiple myeloma have a high rate of recurrence posttransplant. Kidney transplant recipients who develop plasma cell dyscrasias post transplantation have an increased risk of death and thalidomide-based regimens may increase the risk of rejection.
    Summary: Transplant candidates with a history of plasma cell dyscrasia who are in remission should not be excluded from transplantation. Individuals with multiple myeloma have a high rate of recurrence and myeloma post kidney transplant must be managed carefully.
    MeSH term(s) Humans ; Kidney Transplantation/adverse effects ; Monoclonal Gammopathy of Undetermined Significance/complications ; Multiple Myeloma/complications ; Paraproteinemias/complications ; Paraproteinemias/therapy
    Language English
    Publishing date 2019-10-02
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1151092-4
    ISSN 1473-6543 ; 1535-3842 ; 1062-4813 ; 1062-4821
    ISSN (online) 1473-6543 ; 1535-3842
    ISSN 1062-4813 ; 1062-4821
    DOI 10.1097/MNH.0000000000000544
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  7. Article ; Online: Evaluation of Renal Disease in Patients With Cirrhosis.

    Lum, Erik L / Homkrailas, Piyavadee / Bunnapradist, Suphamai

    Journal of clinical gastroenterology

    2020  Volume 54, Issue 4, Page(s) 314–321

    Abstract: Renal dysfunction in cirrhosis is common and is associated with increased mortality. Identifying and treating reversible causes of renal disease can significantly improve outcomes. The etiology, approach, and evaluation of renal disease in this group of ... ...

    Abstract Renal dysfunction in cirrhosis is common and is associated with increased mortality. Identifying and treating reversible causes of renal disease can significantly improve outcomes. The etiology, approach, and evaluation of renal disease in this group of patients is similar to the noncirrhosis patient, with a few specific caveats. Renal disease may be unrelated to the cause of cirrhosis (eg, prerenal acute kidney injury, acute tubular necrosis), occur as a manifestation of the same systemic disease responsible for the liver disease (eg, chronic viral hepatitis B and C infection) or as a consequence of cirrhosis (hepatorenal syndrome). Kidney impairment may be underrecognized in patients with cirrhosis due to over-reliance on creatinine-based glomerular filtration rate equations used in clinical practice. The first steps of evaluation for the renal disease include a thorough medical history to identify the underlying cause of cirrhosis and any potential trigger for renal dysfunction, physical examination, and review of prior laboratory records for baseline renal function. Renal imaging and urinalysis should be performed on all cirrhotic patients with renal dysfunction to establish the presence of urinary obstruction, chronicity and intrinsic renal disease.
    MeSH term(s) Acute Kidney Injury/diagnosis ; Acute Kidney Injury/etiology ; Creatinine ; Hepatorenal Syndrome ; Humans ; Kidney ; Liver Cirrhosis/complications ; Liver Cirrhosis/diagnosis
    Chemical Substances Creatinine (AYI8EX34EU)
    Language English
    Publishing date 2020-02-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 448460-5
    ISSN 1539-2031 ; 0192-0790
    ISSN (online) 1539-2031
    ISSN 0192-0790
    DOI 10.1097/MCG.0000000000001325
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    Zs.A 1523: Show issues Location:
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  8. Article ; Online: Reduction in Maintenance Immunosuppression in Kidney Transplant Recipients With Stable Donor-Derived Cell-Free DNA Measurements: A Case Series.

    Lum, Erik L / Towns, Arta / Basuli, Debargha / Pham, Phuong-Thu / Sarkar, Mrinalini / Bunnapradist, Suphamai

    Transplantation proceedings

    2022  Volume 55, Issue 1, Page(s) 93–97

    Abstract: Personalization of maintenance immunosuppression in kidney transplant recipients has long remained a goal in the transplant community. The recent addition of donor-derived cell-free DNA assays to detect allograft rejection and monitor allograft health ... ...

    Abstract Personalization of maintenance immunosuppression in kidney transplant recipients has long remained a goal in the transplant community. The recent addition of donor-derived cell-free DNA assays to detect allograft rejection and monitor allograft health may permit for reductions in maintenance immunosuppression in recipients with stable levels. Herein, we described 5 patients with stable donor-derived cell-free DNA levels who underwent reduction in maintenance immunosuppression without precipitation of clinical rejection, proteinuria, or de novo donor specific antibody formation.
    MeSH term(s) Humans ; Immunosuppressive Agents ; Kidney Transplantation ; Immunosuppression Therapy ; Tissue Donors ; Transplantation, Homologous ; Graft Rejection ; Transplant Recipients
    Chemical Substances Immunosuppressive Agents
    Language English
    Publishing date 2022-12-29
    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.2022.12.003
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  9. Article ; Online: Listing Malignant Melanoma Patients for Renal Transplantation.

    Qaqish, Shaker / Datta, Nakul / Bunnapradist, Suphamai / Lum, Erik L

    Transplantation proceedings

    2020  Volume 52, Issue 10, Page(s) 3033–3037

    Abstract: Background: Melanoma is an immune responsive malignancy and the need for immunosuppression for successful transplantation may lead to recurrent disease. The recommended waiting time is unknown with various groups recommending anywhere from no wait to 5 ... ...

    Abstract Background: Melanoma is an immune responsive malignancy and the need for immunosuppression for successful transplantation may lead to recurrent disease. The recommended waiting time is unknown with various groups recommending anywhere from no wait to 5 years.
    Methods: In this single-center, retrospective observational study all kidney transplant recipients' charts from 1991 to 2015 were reviewed for a diagnosis of melanoma before transplantation. The charts were reviewed for the clinical characteristics of melanoma pre transplantation, induction immunosuppression, maintenance immunosuppression, graft function, death, and recurrence of melanoma.
    Results: Thirteen patients with a history of melanoma underwent kidney transplantation during this period. Recipients had been in remission for an average of 7.0 years (range, 10 months to 20 years, median 6 years). Approximately 61.5% received a living donor transplant, antithymocyte globulin was administered in 23.1% of recipients, and the remaining 76.9% received basiliximab. Melanoma recurred in 1 patient (7.7%). Maintenance immunosuppression varied, but only 2 patients remained on standard triple therapy with prednisone, calcineurin inhibitor, and antimetabolite therapy. Average follow-up time since transplant was 7.5 years, with 1 patient death 9 years post transplant from sepsis.
    Conclusion: In conclusion, with our center demonstrates safety of kidney transplantation in patients with a prior history of localized melanoma and shorter waiting time. In malignant melanoma stage 0 and 1, waiting the recommended 5 years from the time of remission to kidney transplantation should be reconsidered.
    MeSH term(s) Adult ; Aged ; Female ; Humans ; Immunocompromised Host ; Immunosuppressive Agents/therapeutic use ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/surgery ; Kidney Transplantation ; Male ; Melanoma/complications ; Melanoma/pathology ; Middle Aged ; Neoplasm Recurrence, Local/immunology ; Retrospective Studies ; Skin Neoplasms/complications ; Skin Neoplasms/pathology ; Melanoma, Cutaneous Malignant
    Chemical Substances Immunosuppressive Agents
    Language English
    Publishing date 2020-07-09
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 82046-5
    ISSN 1873-2623 ; 0041-1345
    ISSN (online) 1873-2623
    ISSN 0041-1345
    DOI 10.1016/j.transproceed.2020.04.1823
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  10. Article ; Online: Current Status of Simultaneous Liver-Kidney Transplantation in the United States.

    Lum, Erik L / Cárdenas, Andrés / Martin, Paul / Bunnapradist, Suphamai

    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

    2019  Volume 25, Issue 5, Page(s) 797–806

    Abstract: On August 10, 2017, a formal policy was enacted in the United States that defined listing criteria for simultaneous liver-kidney transplantation and priority for patients who received a liver transplantation (LT) and subsequently developed significant ... ...

    Abstract On August 10, 2017, a formal policy was enacted in the United States that defined listing criteria for simultaneous liver-kidney transplantation and priority for patients who received a liver transplantation (LT) and subsequently developed significant kidney disease after LT. This article reviews and summarizes the rationale for such policies, the policies themselves, and the potential impact on LT candidates.
    MeSH term(s) End Stage Liver Disease/complications ; End Stage Liver Disease/mortality ; End Stage Liver Disease/surgery ; Health Care Rationing/standards ; Health Care Rationing/statistics & numerical data ; Healthcare Disparities ; Humans ; Kidney Transplantation/methods ; Kidney Transplantation/standards ; Kidney Transplantation/statistics & numerical data ; Liver Transplantation/adverse effects ; Liver Transplantation/methods ; Liver Transplantation/standards ; Liver Transplantation/statistics & numerical data ; Patient Selection ; Policy ; Registries ; Renal Insufficiency/etiology ; Renal Insufficiency/surgery ; Risk Factors ; Time Factors ; Tissue and Organ Procurement/standards ; Tissue and Organ Procurement/statistics & numerical data ; United States/epidemiology ; Waiting Lists
    Language English
    Publishing date 2019-04-03
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2006866-9
    ISSN 1527-6473 ; 1527-6465
    ISSN (online) 1527-6473
    ISSN 1527-6465
    DOI 10.1002/lt.25444
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