American Radium Society (ARS) Appropriate Use Criteria (AUC) for Extrahepatic Cholangiocarcinoma.

Although uncommon, extrahepatic cholangiocarcinoma (EHCC) is a deadly malignancy, and the treatment approaches remain controversial. While surgery remains the only cure, few patients are candidates for resection up front, and there are high rates of both local and distant failure following resection. Herein, we systematically review the available evidence regarding treatment approaches for patients with EHCC, including surgery, radiation, and chemotherapy. The evidence regarding treatment outcomes was assessed using the Population, Intervention, Comparator, Outcome, and Study design (PICOS) framework. A summary of recommendations based on the available literature is outlined for specific clinical scenarios encountered by providers in the clinic to guide the management of these patients.

An early experience on the effect of solid organ transplant status on hospitalized COVID-19 patients.

We compared the outcome of COVID-19 in immunosuppressed solid organ transplant (SOT) patients to a transplant naïve population. In total, 10 356 adult hospital admissions for COVID-19 from March 1, 2020 to April 27, 2020 were analyzed. Data were collected on demographics, baseline clinical conditions, medications, immunosuppression, and COVID-19 course. Primary outcome was combined death or mechanical ventilation. We assessed the association between primary outcome and prognostic variables using bivariate and multivariate regression models. We also compared the primary endpoint in SOT patients to an age, gender, and comorbidity-matched control group. Bivariate analysis found transplant status, age, gender, race/ethnicity, body mass index, diabetes, hypertension, cardiovascular disease, COPD, and GFR <60 mL/min/1.73 m2 to be significant predictors of combined death or mechanical ventilation. After multivariate logistic regression analysis, SOT status had a trend toward significance (odds ratio [OR] 1.29; 95% CI 0.99-1.69, p = .06). Compared to an age, gender, and comorbidity-matched control group, SOT patients had a higher combined risk of death or mechanical ventilation (OR 1.34; 95% CI 1.03-1.74, p = .027).

Infiltrating Kaposi sarcoma presenting as acute kidney injury: An unexpected consequence of deliberate hepatitis C-positive organ transplantation.

Kaposi sarcoma (KS) following kidney transplantation can result from recipient reactivation of latent human herpesvirus 8 (HHV-8) infection or activation of donor-acquired HHV-8 infection. Post-transplant KS typically manifests with cutaneous pathology, but rare cases of renal allograft involvement have been reported. We describe two cases of donor-derived HHV-8 infection in two hepatitis C (HCV) viremia-negative transplant recipients who each received a kidney from a donor with HCV viremia. One recipient did not develop KS while the other presented with acute kidney injury caused by extensive KS infiltration of the renal parenchyma and metastatic disease. This report reviews the literature for cases of KS involving the renal allograft and highlights an unexpected consequence of deliberate HCV-positive organ transplantation.

An unusual case of Kaposi sarcoma masquerading as cystitis in a kidney transplant recipient.

Human Herpes Virus-8 (HHV-8) may reactivate in immunocompromised patients including recipients of solid organ transplants. Reactivation of HHV-8 may result in Kaposi sarcoma (KS). KS typically occurs with dermatologic involvement but can affect virtually any other organ; most commonly the gastrointestinal tract. We present a diagnostically challenging case of KS in a South American woman 7 months after kidney transplant. She presented with recurrent urinary tract infection manifested by pelvic pain and dysuria. Imaging studies revealed bladder thickening with pelvic lymphadenopathy. Findings on tissue biopsied from the bladder and lymph nodes were consistent with KS. Her skin was not affected. This case illustrates that KS and other HHV-8-related diseases should be on the differential diagnosis as a cause of mass lesions as well as lymphadenopathy in transplant recipients. The case exemplifies the need to pursue a tissue diagnosis in immunocompromised patients when a diagnosis is uncertain.

Renal Transplantation as a Platform for Teaching Residents Open Vascular Surgical Techniques: Effects on Early Graft Function.

BACKGROUND: Over the past decade, increases in vascular fellowships and the use of endovascular technology have decreased the general surgery residents' exposure to open vascular surgery. We sought to elucidate whether renal transplant is a safe way to teach general surgery residents the essential tenants of vascular surgery without adversely affecting early patient outcomes. METHODS: All solitary, adult deceased donor kidney transplants performed at the University of Wisconsin from 2011 through 2016 were identified and divided into a resident-assist (RA) and fellow-assist cohorts (FA). DGF, defined by the requirement of dialysis within 1 week of transplant, was the primary outcome. Early graft survival and postoperative complications were considered the secondary endpoints. RESULTS: Of the 774 total cases, there were 228 (29.5%) in the RA cohort and 546 (70.5%) in the FA cohort. The RA and FA cohorts had comparable characteristics, except for a nonclinically significant difference in mean donor creatinine (0.96 vs 0.88mg/dL, p = 0.03). RA cases had a similar DGF rate compared to FA cases (25% vs 26%, p = 0.93). Additionally, there was no difference in 2-year graft survival (93.7% vs 95.5%, p = 0.38), nor the rates of graft thromboses (0.4% vs 0.7%, p = 0.65), incisional hernias (0.9% vs 1.8%, p = 0.35), and ureteral strictures (2.2% vs 1.6%, p = 0.55) between the 2 cohorts. CONCLUSIONS: Resident involvement in renal transplantation has no effect on DGF and early allograft function. Though the procedural involvement of each resident in a case is variable, it seems to be a safe way to teach retroperitoneal vascular exposure and anastomotic techniques.