Successful Kidney Transplant from Donors with Sickle Cell Disease: A Case Series of Six Transplants.

People with sickle cell disease experience a high incidence of chronic kidney disease and end-stage kidney disease, secondary to tubular and glomerular effects of vaso-occlusion-induced hypoxia. Because of concerns of suboptimal kidney function, sickle cell donors are usually not considered for kidney donation, even if the rest of the parameters are acceptable for organ donation. A significant gap exists between the number of organ donors and the number of candidates waiting for a kidney transplant in the United States. To bridge the gap, we need to consider using nontraditional donors. We report kidney transplant outcomes in 6 recipients from 4 sickle cell kidney donors. Intracranial hemorrhage and sepsis were the causes of the death in donors, and no donor was in sickle cell crisis at the time of donation. None of the recipients experienced delayed graft function, and all recipients achieved excellent allograft function. The earliest allograft failure was at 27 months in a recipient who developed early acute rejection, while the longest follow-up was 10 years with adequate kidney function. In conclusion, given the shortage of kidneys for transplantation and demonstrated good outcomes, we propose that kidneys from sickle cell donors can be safely used.

Use and outcomes of kidneys from donors with renal angiomyolipoma: A systematic review.

BACKGROUND: Renal angiomyolipoma (AML) is the most frequent mesenchymal tumor of the kidney. Although there is a rare possibility of malignant transformation of AML, this risk has not been studied in immunosuppressed patients. The safety of donors with AML and their kidney transplant recipients has not been well established. METHODS: A literature search was conducted utilizing MEDLINE, EMBASE, and Cochrane databases from inception through May 15, 2018 (updated on October 2019). We included studies that reported the outcomes of kidney donors with AML or recipients of donor with AML. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42018095157). RESULTS: Fourteen studies with a total of 16 donors with AML were identified. None of the donors had a diagnosis of tuberous sclerosis complex (TSC), pulmonary lymphangioleiomyomatosis (LAM), or epithelioid variant of AML. Donor age ranged from 35 to 77 years, and recipient age ranged from 27 to 62 years. Ninety-two percent of the donors were female. Only 8% were deceased donor renal transplant. The majority underwent ex vivo resection (65%) before transplantation, followed by no resection (18%), and the remaining had in vivo resection. Tumor size varied from 0.4 cm to 7 cm, and the majority (87%) were localized in the right kidney. Follow-up time ranged from 1 to 107 months. Donor creatinine prenephrectomy ranged 0.89-1.1 mg/dL and postnephrectomy creatinine 1.0-1.17 mg/dL. In those who did not have resection of the AML, tumor size remained stable. None of the donors with AML had end-stage renal disease or died at last follow-up. None of the recipients had malignant transformation of AML. CONCLUSION: These findings are reassuring for the safety of donors with AML (without TSC or LAM) as well as their recipients without evidence of malignant transformation of AML. As such, this can also positively impact the donor pool by increasing the number of available kidneys.

Epidemiology of cannabis use and associated outcomes among kidney transplant recipients: A meta-analysis.

OBJECTIVE: Cannabis is the most commonly used recreational drug in the United States, and transplant acceptability for cannabis using candidates varies among transplant centers. However, the prevalence and impact of cannabis use on outcomes of kidney transplant recipients remain unclear. This study aimed to summarize the prevalence and impact of cannabis use on outcomes after kidney transplantation. METHODS: A literature search was performed using Ovid MEDLINE, EMBASE, and The Cochrane Library Databases from inception until September 2019 to identify studies assessing the prevalence of cannabis use among kidney transplant recipients, and reported adverse outcomes after kidney transplantation. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird. RESULTS: A total of four cohort studies with a total of 55 897 kidney transplant recipients were enrolled. Overall, the pooled estimated prevalence of cannabis use was 3.2% (95% CI 0.4%-20.5%). While the use of cannabis was not significantly associated with all-cause allograft failure (OR = 1.31, 95% CI 0.70-2.46) or mortality (OR = 1.52, 95% CI 0.59-3.92), the use of cannabis among kidney transplant recipients was significantly associated with increased death-censored graft failure with pooled OR of 1.72 (95% CI 1.13-2.60). CONCLUSIONS: The overall estimated prevalence of cannabis use among kidney transplant recipients is 3.2%. The use of cannabis is associated with increased death-censored graft failure, but not mortality after kidney transplantation.

Exploring the gender gap: Letters of recommendation to pediatric surgery fellowship.

BACKGROUND: Letters of recommendation (LoR) are considered one of the most important predictors of matching into a pediatric surgery fellowship. We determined if gendered differences exist in LoR written for resident candidates. METHODS: A retrospective review of blinded LoR to a fellowship program between 2015 and 2017 was performed. RESULTS: Of the 364 LoR reviewed for 49 female and 48 male applicants, male surgeons wrote 82.5% of letters. Male LoR contained more agentic terms (p = 0. 042), first name occurrences (p = 0.0082) and phrase "future success" (p = 0.015). Female letters included more socio-communal phrases (p = 0. 010) and 5% referenced a spouse's accomplishments vs. 0% of male letters. Male LoR contained more active possessive language (p-0. 027); ie: "he published", "he presented". We found no difference in an applicant's research experience (p = 0.06) or leadership qualities (p = 0. 067). CONCLUSION: Gender differences exist in LoR written for fellowship applicants applying to a highly competitive subspecialty.

Gendered Differences in Letters of Recommendation for Transplant Surgery Fellowship Applicants.

BACKGROUND: No published study has explored gender differences in letters of recommendation for applicants entering surgical subspecialty fellowships. METHODS: We conducted a retrospective review of letters of recommendation to a transplant surgery fellowship written for residents finishing general surgery residency programs. A dictionary of communal and agentic terms was used to explore differences of the letters based on applicant's gender as well as the academic rank and gender of the author. RESULTS: Of the 311 reviewed letters, 228 were letters of recommendation written for male applicants. Male surgeons wrote 92.4% of the letters. Male applicant letters were significantly more likely to contain agentic terms such as superb, intelligent, and exceptional (p = 0.00086). Additionally, male applicant letters were significantly more likely to contain "future leader" (p = 0.047). Letters written by full professors, division chiefs, and program directors were significantly more likely to describe female applicants using communal terms like compassionate, calm, and delightful (p = 0.0301, p = 0.036, p = 0.036, respectively). In letters written by assistant professors, female letters of recommendation had significantly more references to family (p = 0.036). CONCLUSIONS: Gendered differences exist in letters of recommendation for surgical fellowship applicants. This research may provide insight into the inherent gender bias that is revealed in letters supporting candidates entering the field.

Utility of Repeat Head Computed Tomography for Intracranial Hemorrhage After Trauma and Importance of Direct Patient Care.

At many institutions, it is common practice for trauma patients with traumatic intracranial hemorrhage (ICH) to receive routine repeat head computed tomographic (CT) scans after the initial CT scan, regardless of symptoms, to evaluate progression of the injury. The purpose of this study was to assess quantifiable risk factors (age, anticoagulation, gender) that could place patients at greater risk for progression of injury, thus requiring surgical intervention (craniotomy, craniectomy) for which serial CT scanning would be useful. From January 2014 to June 2015, a total of 211 patients presented with traumatic ICH and 198 were eligible for inclusion. Twenty-six patients required operative intervention for ICH. One of 26 patients went to the operating room as a result of repeat head CT scans without associated mental status change, change in neurological examination, or associated symptoms such as nausea or vomiting. Significant changes in patient management due to routine repeat CT scans were not observed. There were no statistically significant risk factors identified to place patients at higher risk for progression of disease. The data from this analysis emphasized the importance of nursing care in identifying and relaying changes in patient condition to the trauma team.