Relevant bibliographies by topics / Kidney transplant

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  1. Journal articles
  2. Dissertations / Theses
  3. Books
  4. Book chapters
  5. Conference papers
  6. Reports

Academic literature on the topic 'Kidney transplant'

Author: Grafiati
Published: 4 June 2021
Last updated: 25 January 2025

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Journal articles on the topic "Kidney transplant"

1

Husain, Syed Ali, Mariana C. Chiles, Samnang Lee, Stephen O. Pastan, Rachel E. Patzer, Bekir Tanriover, Lloyd E. Ratner, and Sumit Mohan. "Characteristics and Performance of Unilateral Kidney Transplants from Deceased Donors." Clinical Journal of the American Society of Nephrology 13, no. 1 (December 7, 2017): 118–27. http://dx.doi.org/10.2215/cjn.06550617.

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Background and objectivesThe fraction of kidneys procured for transplant that are discarded is rising in the United States. Identifying donors from whom only one kidney was discarded allows us to control for donor traits and better assess reasons for organ discard.Design, setting, participants, & measurementsWe conducted a retrospective cohort study using United Network for Organ Sharing Standard Transplant Analysis and Research file data to identify deceased donors from whom two kidneys were procured and at least one was transplanted. Unilateral pairs were defined as kidney pairs from a single donor from whom one kidney was discarded (“unilateral discard”) but the other was transplanted (“unilateral transplant”). Organ quality was estimated using the Kidney Donor Risk Index and Kidney Donor Profile Index (KDPI). We compared all-cause graft failure rates for unilateral transplants to those for bilateral transplant Kaplan–Meier methods, and life table methodology was used to evaluate 1-, 2-, 3-, and 5-year survival rates of transplants from bilateral and unilateral donors.ResultsCompared with bilateral donors (i.e., both kidneys transplanted) (n=80,584), unilateral donors (i.e., only one kidney transplanted) (n=7625) had higher mean terminal creatinine (1.3±2.1 mg/dl versus 1.1±0.9 mg/dl) and KDPI (67%±25% versus 42%±27%), were older, and were more likely to have hypertension, diabetes, hepatitis C, terminal stroke, or meet Centers for Disease Control and Prevention high-risk donor criteria. Unilateral discards were primarily attributed to factors expected to be similar in both kidneys from a donor: biopsy findings (22%), no interested recipient (13%), and donor history (7%). Anatomic abnormalities (14%), organ damage (11%), and extended ischemia (6%) accounted for about 30% of discards, but were the commonest reasons among low KDPI kidneys. Among kidneys with KDPI≥60%, there was an incremental difference in allograft survival over time (for unilateral versus bilateral transplants, 1-year survival: 83% versus 87%; 3-year survival: 69% versus 73%; 5-year survival: 51% versus 58%).ConclusionsA large number of discarded kidneys were procured from donors whose contralateral kidneys were transplanted with good post-transplant outcomes.
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Patrick, Grant, Brian Hickner, Karthik Goli, Liam D. Ferreira, John Goss, and Abbas Rana. "Trends in Survival for Adult Organ Transplantation." Annals of Surgery Open 5, no. 1 (February 22, 2024): e383. http://dx.doi.org/10.1097/as9.0000000000000383.

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Objective: Intent-to-treat analysis follows patients from listing to death, regardless of their transplant status, and aims to provide a more holistic scope of the progress made in adult solid-organ transplantation. Background: Many studies have shown progress in waitlist and post-transplant survival for adult kidney, liver, heart, and lung transplants, but there is a need to provide a more comprehensive perspective of transplant outcomes for patients and their families. Methods: Univariable and multivariable Cox regression analyses were used to analyze factors contributing to intent-to-treat survival in 813,862 adults listed for kidney, liver, heart, and lung transplants. The Kaplan–Meier method was used to examine changes in waitlist, post-transplant, and intent-to-treat survival. Transplantation rates were compared using χ2 tests. Results: Intent-to-treat survival has steadily increased for liver, heart, and lung transplants. The percentage of patients transplanted within 1 year significantly increased for heart (57.4% from 52.9%) and lung (73.5% from 33.2%). However, the percentage of patients transplanted within 1 year significantly decreased from 35.8% to 21.2% for kidney transplant. Notably, intent-to-treat survival has decreased for kidneys despite increases in waitlist and post-transplant survival, likely because of the decreased transplant rate. Conclusion: Intent-to-treat survival steadily improved for liver, heart, and lung transplant over the 30-year study period. Continued advancements in allocation policy, immunosuppression, and improved care of patients on the waitlist may contribute to further progress in outcomes of all organs, but the increasing discrepancy in supply and demand of donor kidneys is alarming and has impeded the progress of kidney intent-to-treat survival.
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Nghiem, Dai D. "The Deceased Transplant Recipients: A Forgotten Source of Organ Donors." Uro 3, no. 3 (July 3, 2023): 187–98. http://dx.doi.org/10.3390/uro3030020.

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Background: Organ transplantation is the most successful therapy for end-stage organ disease since it increases the quality of life and life expectancy. For these reasons, over 107,000 patients were on the waitlist in the United States for a transplant in 2022. Unfortunately, only 42,887 transplants were performed, and annually, over 7000 patients on the kidney list die or are too sick to transplant. To solve this severe organ shortage, the use of the deceased transplant recipients with functioning organs, whether transplanted or native, is explored as a new source of organ donors. Methods: To assess the feasibility of this option, first, we will review the rate of kidney transplant recipients dying with functioning grafts (DWGF), their re-use, the organ allocation system, the technical aspects of the organ procurement, and the transplantation of the DWGF kidneys. Then, we will consider the larger group of all deceased transplant recipients as potential donors for all functioning, native, or transplanted organs. Conclusions: (1). All functioning kidney transplants explanted from the deceased transplant recipients have excellent long-term function after re-transplantation. (2). The other functioning organs constitute a large unrecognized pool of transplantable organs. (3). The intensivists and the transplant community should be educated about these new options to improve the organ shortage.
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Ibrahim, Maria, George H. B. Greenhall, Dominic M. Summers, Lisa Mumford, Rachel Johnson, Richard J. Baker, John Forsythe, Gavin J. Pettigrew, Niaz Ahmad, and Chris J. Callaghan. "Utilization and Outcomes of Single and Dual Kidney Transplants from Older Deceased Donors in the United Kingdom." Clinical Journal of the American Society of Nephrology 15, no. 9 (July 20, 2020): 1320–29. http://dx.doi.org/10.2215/cjn.02060220.

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Background and objectivesKidneys from elderly deceased donors are often discarded after procurement if the expected outcomes from single kidney transplantation are considered unacceptable. An alternative is to consider them for dual kidney transplantation. We aimed to examine the utilization of kidneys from donors aged ≥60 years in the United Kingdom and compare clinical outcomes of dual versus single kidney transplant recipients.Design, setting, participants, & measurementsData from the United Kingdom Transplant Registry from 2005 to 2017 were analyzed. We examined utilization rates of kidneys retrieved from deceased donors aged ≥60 years, and 5-year patient and death-censored graft survival of recipients of dual and single kidney transplants. Secondary outcomes included eGFR. Multivariable analyses and propensity score analysis were used to correct for differences between the groups.ResultsDuring the study period, 7841 kidneys were procured from deceased donors aged ≥60 years, of which 1338 (17%) were discarded; 356 dual and 5032 single kidneys were transplanted. Donors of dual transplants were older (median, 73 versus 66 years; P<0.001) and had higher United States Kidney Donor Risk Indices (2.48 versus 1.98; P<0.001). Recipients of dual transplants were also older (64 versus 61 years; P<0.001) and had less favorable human leukocyte antigen matching (P<0.001). After adjusting for confounders, dual and single transplants had similar 5-year graft survival (hazard ratio, 0.81; 95% CI, 0.59 to 1.12). No difference in patient survival was demonstrated. Similar findings were observed in a matched cohort with a propensity score analysis method. Median 12-month eGFR was significantly higher in the dual kidney transplant group (40 versus 36 ml/min per 1.73 m2; P<0.001).ConclusionsRecipients of kidneys from donors aged ≥60 years have similar 5-year graft survival and better graft function at 12 months with dual compared with single deceased donor kidney transplants.
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Halperin, Rabbi Mordechai. "Organ Transplants from Living Donors." Israel Law Review 27, no. 4 (1993): 566–87. http://dx.doi.org/10.1017/s002122370001150x.

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I. Survey of Transplant TechniquesThe kidney is one of the few organs which today can be successfully transplanted from a living donor to an ailing recipient. A healthy donor can function satisfactorily with a single kidney; therefore the removal of one kidney for transplantation does not significantly endanger the donor's life. However, removal, or even partial removal, of other organs, such as the heart, lungs, or pancreas, will present a serious risk to the health and life of the donor.In addition to organs, skin, bone marrow, blood and other body parts can be transplanted from living donors.A. Kidney TransplantsThe kidneys function to regulate the body's electrolyte and water balance and eliminate various wastes. Severe kidney dysfunction endangers the patient's life, and requires treatment by dialysis or kidney transplant. Up until a decade ago, the life expectancy of patients treated by dialysis exceeded that of patients who underwent kidney transplants. Over the past decade, the life expectancy of patients who have undergone kidney transplants from deceased donors has increased to a point where it is now comparable with the life expectancy of patients on dialysis.
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Churchill, P. C., M. C. Churchill, and A. K. Bidani. "Kidney cross transplants in Dahl salt-sensitive and salt-resistant rats." American Journal of Physiology-Heart and Circulatory Physiology 262, no. 6 (June 1, 1992): H1809—H1817. http://dx.doi.org/10.1152/ajpheart.1992.262.6.h1809.

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Previous kidney cross-transplant studies have demonstrated that the genotype of the kidney plays a role in determining the blood pressure of the recipient in Dahl salt-sensitive (S) and salt-resistant (R) rats. The present studies were designed to elucidate this role. Kidney cross transplants were performed in unilaterally nephrectomized male recipients (John Rapp strains), such that each rat had a native kidney and a transplanted kidney of the opposite genotype. S and R rats with a native kidney and a transplanted kidney of the same genotype served as controls. After 4 wk on a 7.8% NaCl diet, rats were anesthetized and renal clearance studies were performed. S kidneys had lower glomerular filtration rate (GFR) and renal plasma flow (RPF) than R kidneys, and these differences were determined by the kidney's genotype rather than the recipient's, since S kidneys in R recipients tended to have lower GFR and RPF than R kidneys in S recipients. In contrast, independent of the kidney's genotype, the kidneys in S rats tended to have higher fractional excretion of H2O and Na (FEH2O and FENa) than the kidneys in R rats. Thus there were genetically determined differences in renal function between S and R rats; some (RPF and GFR) were intrinsic to the kidney, whereas others (FEH2O and FENa) were intrinsic to the host.(ABSTRACT TRUNCATED AT 250 WORDS)
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Salmanipour, Alireza, Mostafa Ghadamzadeh, Seyed Morteza Bagheri, Roja Hajipour, Pedram Sadeghi, and Farzan Vahedifard. "Comparison the Diagnostic Value of Doppler Ultrasonography to Biopsy, in Evaluation of Post-transplant Complications and Kidney Function." Journal of Organ Transplantation 1, no. 2 (October 13, 2022): 21–27. http://dx.doi.org/10.14302/issn.2576-9359.jot-22-4303.

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Background Doppler ultrasonography can evaluate vascular and renal parenchymal disorders. In this study, color Doppler patterns in transplanted kidneys were compared with histological diagnosis to develop diagnostic models for transplanted kidney failure. Method 45 kidney transplant patients participated in this prospective study (16 suffered acute tubular necrosis (ATN), and 29 had transplant rejection). All patients had color-Doppler ultrasonography to measure kidney parameters and Doppler indices. Serum creatinine levels also assessed the transplanted kidney's function. Result Ultrasound showed a significant difference between the two groups in iliac and interlobar PSV. The ROC analysis showed a high diagnostic value of the iliac artery PSV, in distinguishing ATN from kidney transplant rejection. Serum creatinine level correlated directly with transplanted kidney volume, renal cortical thickness, and transplanted kidney length, and inversely with interlobar artery PSV and EDV. In graft rejection patients, the only significant inverse correlation was found between serum creatinine level and PSV of the iliac artery and EDV of the intrelobar artery. Discussion and conclusion The iliac artery PSV can differentiate between ATN and rejection after renal transplantation. Evaluation of renal metric parameters along with PSV and EDV of the interlobar artery (in patients with ATN) and iliac artery and interlobar artery (in transplant rejection) help determine renal dysfunction.
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Parajuli, Sandesh, Jacqueline Garonzik-Wang, Brad C. Astor, Fahad Aziz, Neetika Garg, Bridget Welch, Jon Odorico, et al. "Twelve Thousand Kidney Transplants Over More Than 55 Y: A Single-center Experience." Transplantation Direct 10, no. 2 (January 19, 2024): e1575. http://dx.doi.org/10.1097/txd.0000000000001575.

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Background. Kidney transplant outcomes have dramatically improved since the first successful transplant in 1954. In its early years, kidney transplantation was viewed more skeptically. Today it is considered the treatment of choice among patients with end-stage kidney disease. Methods. Our program performed its first kidney transplant in 1966 and recently performed our 12 000th kidney transplant. Here, we review and describe our experience with these 12 000 transplants. Transplant recipients were analyzed by decade of date of transplant: 1966–1975, 1976–1985, 1986–1995, 1996–2005, 2006–2015, and 2016–2022. Death-censored graft failure and mortality were outcomes of interest. Results. Of 12 000 kidneys, 247 were transplanted from 1966 to 1975, 1147 from 1976 to 1985, 2194 from 1986 to 1995, 3147 from 1996 to 2005, 3046 from 2006 to 2015, and 2219 from 2016 to 2022 compared with 1966–1975, there were statistically significant and progressively lower risks of death-censored graft failure at 1 y, 5 y, and at last follow-up in all subsequent eras. Although mortality at 1 y was lower in all subsequent eras after 1986–1995, there was no difference in mortality at 5 y or the last follow-up between eras. Conclusions. In this large cohort of 12 000 kidneys from a single center, we observed significant improvement in outcomes over time. Kidney transplantation remains a robust and ever-growing and improving field.
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Goesch, Torsten R., Nancy A. Wilson, Weifeng Zeng, Bret M. Verhoven, Weixiong Zhong, Maya M. Coumbe Gitter, and William E. Fahl. "Suppression of Inflammation-Associated Kidney Damage Post-Transplant Using the New PrC-210 Free Radical Scavenger in Rats." Biomolecules 11, no. 7 (July 19, 2021): 1054. http://dx.doi.org/10.3390/biom11071054.

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Allograft kidney transplantation, which triggers host cellular- and antibody-mediated rejection of the kidney, is a major contributor to kidney damage during transplant. Here, we asked whether PrC-210 would suppress damage seen in allograft kidney transplant. Brown Norway (BN) rat kidneys were perfused in situ (UW Solution) with or without added 30 mM PrC-210, and then immediately transplanted into Lewis (LEW) rats. 20 h later, the transplanted BN kidneys and LEW rat plasma were analyzed. Kidney histology, and kidney/serum levels of several inflammation-associated cytokines, were measured to assess mismatch-related kidney pathology, and PrC-210 protective efficacy. Twenty hours after the allograft transplants: (i) significant histologic kidney tubule damage and mononuclear inflammatory cell infiltration were seen in allograft kidneys; (ii) kidney function metrics (creatinine and BUN) were significantly elevated; (iii) significant changes in key cytokines, i.e., TIMP-1, TNF-alpha and MIP-3A/CCL20, and kidney activated caspase levels were seen. In PrC-210-treated kidneys and recipient rats, (i) kidney histologic damage (Banff Scores) and mononuclear infiltration were reduced to untreated background levels; (ii) creatinine and BUN were significantly reduced; and (iii) activated caspase and cytokine changes were significantly reduced, some to background. In conclusion, the results suggest that PrC-210 could provide broadly applicable organ protection for many allograft transplantation conditions; it could protect transplanted kidneys during and after all stages of the transplantation process—from organ donation, through transportation, re-implantation and the post-operative inflammation—to minimize acute and chronic rejection.
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Gruessner, Rainer W. G., Arthur J. Matas, Goncal Lloveras, David S. Fryd, David L. Dunn, William D. Payne, David E. R. Sutherland, and John S. Najarian. "A comparison of single and double pediatric cadaver donor kidneys for transplantation." Clinical Transplantation 3, no. 4 (August 1989): 209–14. http://dx.doi.org/10.1111/j.1399-0012.1989.tb00184.x.

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Use of pediatric cadaver kidneys for transplantation is controversial; reports of outcome following pediatric donor transplantation have shown either similar results or worse results than when adult donors are used. Two techniques have been proposed for use of pediatric donor kidneys ‐ transplantation of a single kidney, or transplantation of both kidneys with a common aorta and cava to a single recipient. Single kidney transplants make optimum use of the donor pool; double transplants provide increased renal mass and therefore more functional reserve in the early posttransplant period. No study from a single institution has compared outcome after double versus single pediatric cadaver kidney transplantation. To investigate this issue, we reviewed our experience with 131 pediatric cadaver kidneys (donor age ≤ 10 years) transplanted between 1971 and 1988. We compared outcome of these transplants to outcome of adult donor kidney transplants. Of the group receiving pediatric kidneys, 33 (25%) received double and 98 (75%) received single pediatric kidney transplants. For double pediatric graft recipients, 5 and 10‐yr patient survival rates were 81% and 75%, respectively, whereas for single graft recipients, 5‐ and 10‐yr patient survival rates were 67% and 54% (NS). Graft survival was 78% (1 yr) and 48% (10 yr) in double kidney transplant recipients, but only 61% (1 yr) and 34% (10 yr) in single kidney transplant recipients (p = 0.07). When compared to adult cadaver kidney recipients, double graft recipients had similar short‐ and long‐term outcome (p = 0.6), whereas single pediatric kidney recipients had significantly decreased graft survival (p = 0.03). Pathogenesis for graft loss was similar in double and single pediatric kidney transplants. However, early graft loss (within first 3 months posttransplant) due to rejection was more frequent in single (16%) than in double (3%) pediatric allograft recipients (NS). We conclude that double pediatric cadaver kidneys provide an overall higher patient and graft survival. However, optimal use of the donor pool may be made by the use of single pediatric kidney transplants.
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Dissertations / Theses on the topic "Kidney transplant"

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Kubal, Chandrashekhar. "Comparative models of transplant and non-transplant human kidney disease." Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/3827/.

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Late kidney transplant losses along with chronic kidney disease in non-renal solid organ transplantation pose major problem in this field. To address this I compared ischaemia, interstitial scarring and inflammation on the renal biopsies from failing renal transplants and chronic kidney disease outside renal transplantation using native CKD as a control group. For matched renal function, a similar degree of interstitial scarring was observed across the three study groups. Ischaemia was predominant in failing renal transplants; conversely inflammation was predominant in native CKD. The relationship between macrophages and endothelial cells indicated that, despite a lower macrophage load, there may be an allogeneic impact of macrophages on endothelial cells. In the biopsies from CKD, mRNA levels for iNOS, arginase, CX3CL1, BCL-2, MCP-1/CCL2 and FSP-1 were increased in association with an increasing macrophage load. Macrophage load correlated positively with arginase/iNOS mRNA ratio, suggesting M2 phenotypic transformation of the macrophages. Co-localization studies, demonstrated an increased number of macrophages within 5 microns from endothelial cells in failing renal transplants when compared to chronic kidney disease. Further studies directed towards manipulating macrophage-endothelial cell interaction may be potentially beneficial in improving the longevity of renal transplants.
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Wicht, Jonathan H. "Renal Transplant Survey: how standardised is a standard kidney transplant?" Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24507.

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Aim: The primary intention of the current study was to discover if there are international standards in renal transplantation. Method: A questionnaire was created using an online survey tool (Qualtrics ®), and distributed to a list of email addresses supplied by the unit's senior transplant surgeon. A literature review was performed on the questions and on the history of transplantation. Ethics was approved by FHS HREC number 193/2015. Results: A total of 30 surveys were completed from a total of 147 emails sent (20.4%). Two thirds of respondents work exclusively in the public sector and almost two-thirds (63.3%) of the respondents had been involved in transplantation for over 10 years. Two thirds of the surgeons estimate that their units perform more than 60 transplants per annum. Only 30% (9/30) use living donors in more than 50% of their surgeries. Most (53.3%) perfuse the kidneys both in the donor (in situ) and outside (ex situ or ex vivo). If no anatomic abnormalities were noted in open living donor nephrectomy, 63.3% would prefer to use the left kidney, and the recipient transplantation would be performed on the right side (76.7%). The majority (90%) of surgeons would preserve the vas deferens, but sacrifice the round ligament and inferior epigastric vessels (76.7% and 80% respectively). There is no marked difference for use of either the internal or external iliac artery for the arterial anastomosis, but most use the external iliac vein for venous anastomosis (86.7%). 80% use a ureteroneocystostomy with a tunnel, and 60% use a DJ stent or ureteric catheter and closed suction drain routinely. Two thirds would remove the transurethral catheter on day 4-7 post operatively. 80% routinely biopsy the kidney, and 63.3% would biopsy prior to treating for possible acute renal rejection. Discussion: These results compare with some of the studies found in the literature and operative textbooks. There do appear to be standards noted between most of the respondent's answers. Conclusion: There do appear to be standards for renal transplantation and these are appreciated globally.
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O'Dair, Jonathan David. "Kidney transplant : graft and recipient profiling." Thesis, University of Nottingham, 2009. http://eprints.nottingham.ac.uk/10877/.

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Despite the recent introduction of a number of new and more potent anti-rejection drugs, the incidence of rejection and long-term graft survival remain unchanged. There remains a significant difference in long-term graft survival depending on the source of the donor. The purpose of this study was to examine gene expression in the transplanted kidney using microarray technology to identify potential biomarkers that could be used to predict and monitor graft function so that appropriate interventions could be made in the event of graft dysfunction. Over a 5 year period RNA was extracted from 144 donor kidneys that were transplanted. The initial attempts at probe preparation and hybridization were unsuccessful. This led to the development of a new strategy which involved the use of state-of-the-art microarray technology which embraced the advances realised with the completion of the human genome project. Microarray data was analysed using J-Express and Pathway studio. Significance analysis of microarray, hierachical clustering, gene ontology mapping and pathway analysis was performed. The identification of potential biomarkers that had previously been described by other authors validated this approach. In addition novel genes were identified that may have a role as biomarkers of graft function. Other potential biomarkers were identified that represented cellular processes that could be modified by therapeutic intervention thus possibly changing the clinical outcome or allowing monitoring of the success of therapy. Confirmation of previously described biomarkers and the identification of novel potential biomarkers has confirmed that gene expression profiling has a valuable role in identifying processes that are indicative of disease processes including those involved in kidney transplantation. Furthermore with the development of minimally invasive tests to measure these biomarkers, we can potentially change the natural history of the disease process, and hence, preserve graft function and possibly prolong life.
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Tabata, Masami. "Becoming a kidney transplant citizen: kidney transplantation, race and biological citizenship." Thesis, Boston University, 2013. https://hdl.handle.net/2144/21260.

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Thesis (M.A.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
I conducted a four-month ethnographic fieldwork study to document the stories of thirteen post-kidney-transplant minority patients and three nephrologists at Boston Medical Center. My research explores how patients’ interactions with health professionals, medical regimens, dialysis treatments, and adaptation to living with transplanted kidneys constantly shape their identities and perceptual worlds. Patients’ narratives highlighted the emotional struggles they encountered along the path of End-Stage Renal Disease, which unfolded as distinct experiences influenced by their varied backgrounds. The majority of my patient-participants lived on the verge of poverty, and in some cases, their insurance status caused delays in their being registered on the transplant waiting list, making them endure a long wait. Some patients were afraid of wearing short sleeves because they thought the scars on their arms from dialysis treatment would lead others to think they were gangsters. Instantiations of various theories emerged from the saturated data and narrative analysis, from Bourdieu’s concept of habitus with regard to the process of how patients alter their consciousness through interactions with medicine to Foucault’s ideas of power relations and technologies of the self that address the issues of agency and power that influence the formation of patients’ identities. The intersection of these theoretical frameworks led me to develop the critical medical anthropological-oriented concept of biological citizenship. This paper examines 1) the ways in which “race” interacts with the theoretical concept of biological citizenship and 2) the ways in which socioeconomic status and race tailor a kidney transplant patient’s illness experience, and related discourse.
2031-01-01
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Solomon, Daniel Aran. "Decision Making by Patients Awaiting Kidney Transplant." Yale University, 2010. http://ymtdl.med.yale.edu/theses/available/etd-03052010-141133/.

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Involving patients in medical decisions by acknowledging patients personal values and individual preferences has become an important goal of providing ethical medical care. Despite a general movement towards a model of shared decision-making, many patients do not fully meet their preferred role in practice. The decision whether or not to accept a kidney once it is offered to a patient awaiting transplant has historically been made predominantly by the transplant surgeon with little involvement from the patient. Because dialysis can provide long-term renal replacement, declining a kidney is a viable option. Patient changes over time and inherent heterogeneity of donor kidneys make this an authentic decision requiring careful analysis of costs and benefits from the patient perspective. The purpose of this study is to improve our understanding of how patients and transplant surgeons prioritize different factors when deciding whether or not to accept a kidney that has become available, in order to empower patients to become more involved in the decision-making process. Phase I: We developed a comprehensive list of factors that patients might consider important through qualitative interviews with patients, and deliberation with a transplant surgeon (SK) and a transplant nephrologists (RF). Phase II: We quantified the relative importance of each factor for patients on the transplant list and for transplant surgeons with a computerized survey using Maximum Differences Scaling. We developed relative importance scores using Heirarchical Bayes analysis, and tested for associations between patient characteristics and relative importance scores using Spearmans correlation coefficient and the Mann Whitney U test for continuous and categorical variables respectively. Of the factors evaluated, patients placed the greatest value on Kidney quality, How closely matched you are to the kidney, and How strongly your surgeon feels you should accept the kidney. Relative importance of different factors did not change based on patient demographic characteristics. Patients who are on the waiting list longer give less importance to kidney quality (standard beta estimate -0.23, p value 0.03) and more importance to How difficult it is for you to be matched to a donor (ie whether or not you are sensitized) (standard beta estimate 0.28, p value 0.01). Surgeons placed the greatest value on Kidney quality, How difficult it is for the patient to be matched to a kidney (ie whether or not the patient is sensitized), and The age of the donor. This pilot study suggests a role for standardized education tools to help empower patients to be involved in this difficult decision. Development of decision aids can be guided by the results of this project.
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Sankaran, David. "Cytokine gene polymorphism and kidney transplant outcome." Thesis, University of Manchester, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.488310.

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The pro-inflammatory cytokine TNF -a. and the immunoregulatory cytokine IL-IO have been implicated in acute rejection of kidney allografts. Similarly, the pro-fibrotic cytokine TGF-IJ 1 has been reported to be involved in the development of chronic rejection. It has also been shown that polymorphisms in the TNFA gene promoter (position -308) and in the TGF-IJI gene (at codon 25) correlate with differential production of these cytokines in vitro. Gene polymorphisms in the IL-IO promoter were also identified previously. However, their function had not been determined. Therefore, the initial part of this study was to investigate the effect of the three single base substitutions (G/A, CIT and CIA) in the IL-IO gene promoter on IL-IO gene expression. The results show that the G/A polymorphism at position -1117 of the a- 10 promoter was associated with differential production of IL-IO in vitro. Homozygous inheritance of a 'G' at this position correlated with a significant increase in the production of IL-IO by Con-A stimulated PBMCs. In addition, a-to gene reporter assays performed in the U937 monocytic cell line demonstrated that the activity of IL-l 0 promoter constructs containing the '0' was significantly higher than constructs containing the 'A' at position -1117 when co-transfected with an Ets-l transcription factor expression vector. Results from gel shift assays suggest that this difference in gene expression may be due to altered binding affinities of transcription factors to the IL-IO promoter. The second part of this study was to determine whether the IL-IO gene polymorphism, together with the TNF-a and TGF-pl gene polymorphisms, could influence the incidence and severity of acute rejection in the first 6 months following renal transplantation. Their effect on chronic transplant dysfunction was also assessed. The cytokine genotypes of 115 consecutive first cadaveric kidney allograft recipients and their corresponding donors were screened. Acute rejection episodes (RE) and the incidence of chronic transplant nephropathy (CTN) were defined clinically and confirmed histologically where possible. RE were further classified according to severity (RS), namely steroid resistant or responsive RE. The patients were categorised as high or low producers of the respective cytokines according to their genotypes and these were then correlated with the RE, RS and CTN. The recipient TNF-a high and IL-IO high producer genotype was significantly associated with multiple RE (~) in HLA-DR mismatched transplants (p=O.0047 and p=O.04S respectively) while only the TNF-a high producer genotype was associated with steroid resistant RE (p=O.02S). Donor cytokine genotypes did not correlate with RE or RS. When cytokine genotype combinations were analysed in context ofHLA-DR mismatching, the recipient T'NF-ahigh/donor TGF-Pl high producer genotype was associated with an increase in the incidence of RE. The recipiem TNF-a higML-lO high producer genotype was associated with an increase in the incidence of multiple RE in HLA-DR mismatched transplants and was also associated with steroid resistant RE. There was no significant association between cytokine genotypes and CTN. In conclusion, cytokine gene polymorphisms are determinants of RE and RS following kidney transplantation. Routine screening of these gene polymorphisms may have a clinical role in identifying patients at risk of multiple RE and severe rejections.
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Singer, Julian John. "The Gut-Kidney Axis in Kidney Transplantation." Thesis, The University of Sydney, 2022. https://hdl.handle.net/2123/29702.

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For the majority of patients with end-stage kidney disease, kidney transplantation remains the optimal treatment modality, offering superior survival and quality of life at a fraction of the cost of dialysis. However, the requirement for long-term immunosuppression increases the susceptibility of transplant recipients to metabolic complications, infection, cancer, and cardiovascular disease, meaning that a “normal” lifespan is rarely, if ever achieved. Innovative strategies are needed to reduce the burden of current immunosuppressive regimens and to maintain the balance between immunosuppression and the maintenance of protective immunity. The gut microbiome is a critical determinant of human health and modulates host immunity and metabolism through a number of recognised mechanisms, and likely others as yet unrecognised. In transplantation, the gut microbiome offers a novel target to alleviate the deleterious immune and metabolic responses that result from exposure to alloantigen and long-term immunosuppression. Herein, we show for the first time, that dietary modification of the gut microbiome can prevent allograft rejection in a murine model of kidney transplantation through signalling via GPR43 and mediated by the action of T regulatory cells. The aims of this thesis were to investigate the role of the gut microbiome in mediating immune responses in kidney transplantation, and to assess strategies to measure glycaemic risk (pre-transplant) and status (post-transplant). This thesis comprises a pre-clinical model of kidney transplantation and translational studies in the clinic, and is presented as a collection of published and submitted works.
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Huml, Anne M. "Outcomes of Deceased Donor Kidney Offers to Patients at the Top of the Waiting List." Case Western Reserve University School of Graduate Studies / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=case1512678441955104.

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Jha, Prakash Teknarayan. "Optimizing Paired Kidney Transplant by Applying Machine Learning." University of Toledo / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1301028157.

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Keung, Karen Lok Yee. "The Application of Transcriptomics in Kidney Transplant Injury." Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/21050.

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This research aimed to address two unmet clinical needs in renal transplantation. Firstly, novel therapeutics to improve allograft outcomes are required. Secondly, non-invasive prognostic biomarkers to predict adverse allograft outcomes are needed to provide an early treatment opportunity. The use of large-scale molecular profiling data coupled with advanced computational strategies to address these needs was the foundation for this research. In chapters 3 and 4, the aim was to describe for the first time the derivation of master regulatory genes, or key drivers, amongst the pathologic molecular pathways in acute rejection (AR) of the renal allograft, and demonstrate that these may serve as novel targets for therapeutic intervention. Using microarray gene expression datasets from human renal allograft biopsy tissue, an integrative network-based computational approach was employed to predict the key driver genes in AR, identifying 14 key drivers. Interrogation of a computational drug-repositioning resource identified drugs in current clinical use as candidates for repositioning in AR prevention. Minocycline was selected for validation in a murine cardiac allograft model of AR. Used alone, it attenuated the inflammatory profile of AR compared with controls, and prolonged graft survival when co-administered with immunosuppression. The aim of the work in chapter 5 was to facilitate the discovery of a whole blood, thus non-invasive, prognostic biomarker signature obtained early in the post-transplant course that could predict patients who will develop allograft fibrosis. Early identification of these patients could provide an opportunity to alter immunosuppression before fibrosis is established. Here, validation of an unpublished prognostic microRNA signature derived from whole blood obtained 3 months post-transplant, to predict those with allograft fibrosis 12 months post-transplant, was sought. This signature was derived from collaborators in the Genomics of Chronic Allograft Dysfunction (GoCAR) study, and validation sought using samples from the Australian Chronic Allograft Dysfunction (AUSCAD) study, a single-centre cohort of transplant patients with prospective collection of renal biopsy and biofluid samples with linked clinical data. The 4-miRNA signature was unable to accurately prognosticate patients that progressed to fibrosis at 12 months in the AUSCAD cohort. How future work could be modified to facilitate the identification and validation of a robust prognostic biomarker signature are addressed.
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Books on the topic "Kidney transplant"

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Parajuli, Sandesh, and Fahad Aziz, eds. Kidney Transplant Management. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-00132-2.

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1941-, Burdick James F., ed. Kidney transplant rejection: Diagnosis and treatment. 2nd ed. New York: Dekker, 1992.

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), Centers for Medicare &. Medicaid Services (U S. Medicare coverage of kidney dialysis and kidney transplant services. Baltimore, Md: U.S. Dept. of Health and Human Services, Centers for Medicare & Medicaid Services., 2001.

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United States. Health Care Financing Administration., ed. Medicare coverage of kidney dialysis and kidney transplant services. Baltimore, Md: U.S. Dept. of Health and Human Services, Health Care Financing Administration, 2000.

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1948-, Racusen Lorraine C., Solez Kim 1946-, and Burdick James F. 1941-, eds. Kidney transplant rejection: Diagnosis and treatment. 3rd ed. New York: M. Dekker, 1998.

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Melville, Williams G., Burdick James F. 1941-, and Solez Kim 1946-, eds. Kidney transplant rejection: Diagnosis and treatment. New York: M. Dekker, 1986.

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R, Castañeda-Zuñiga Wilfrido, ed. Radiologic diagnosis of renal transplant complications. Minneapolis: University of Minnesota Press, 1986.

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McKay, Dianne B., and Steven M. Steinberg, eds. Kidney Transplantation: A Guide to the Care of Kidney Transplant Recipients. Boston, MA: Springer US, 2010. http://dx.doi.org/10.1007/978-1-4419-1690-7.

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Chekesha. Fine thyme!: Vegetarian recipes from a kidney transplant recipient. Atlanta, Ga: Few Books, 2002.

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United States. Health Care Financing Administration, ed. Medicare coverage of kidney dialysis and kidney transplant services: A supplement to the Medicare handbook. [Baltimore, Md.]: U.S. Dept. of Health and Human Services, Health Care Financing Administration, 1991.

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Book chapters on the topic "Kidney transplant"

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Skolnick, M. Leon. "Kidney: Transplant." In Guide to the Ultrasound Examination of the Abdomen, 69–79. New York, NY: Springer New York, 1986. http://dx.doi.org/10.1007/978-1-4612-4878-1_6.

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Martinez-Cantarin, Maria P., and Jerry McCauley. "Transplant Immunosuppression." In Contemporary Kidney Transplantation, 1–14. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-14779-6_20-1.

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Cantarin, Maria P. Martinez, and Jerry McCauley. "Transplant Immunosuppression." In Contemporary Kidney Transplantation, 293–306. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-19617-6_20.

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Palma-Diaz, M. Fernando, and Jonathan E. Zuckerman. "Kidney Transplant Pathology." In Practical Atlas of Transplant Pathology, 79–110. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-23054-2_4.

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Sakhuja, Ankit, Neha Sehgal, Monica Vasudev, and Brahm Vasudev. "Kidney Transplant Outcomes." In Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation, 459–67. New York, NY: Springer New York, 2012. http://dx.doi.org/10.1007/978-1-4614-4454-1_38.

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Nahavandi, Firouzeh. "Transnational Kidney Transplant." In Commodification of Body Parts in the Global South, 59–74. London: Palgrave Macmillan UK, 2016. http://dx.doi.org/10.1057/978-1-137-50584-2_5.

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Baranski, Andrzej. "Kidney Transplant Surgery Techniques." In Kidney Transplantation, 271–397. Cham: Springer International Publishing, 2023. http://dx.doi.org/10.1007/978-3-030-75886-8_4.

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Zhang, Rubin, and Anil Paramesh. "Transplantation: Kidney, Kidney–Pancreas Transplant." In Diabetes and Kidney Disease, 175–201. New York, NY: Springer New York, 2014. http://dx.doi.org/10.1007/978-1-4939-0793-9_15.

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Moore, Catherine A. "Transplant and Pregnancy." In Kidney Transplant Management, 179–91. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-030-00132-2_14.

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Gong, Weihua. "Mouse Kidney Transplantation." In Rodent Transplant Medicine, 135–45. Dordrecht: Springer Netherlands, 2014. http://dx.doi.org/10.1007/978-94-017-9472-5_13.

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Conference papers on the topic "Kidney transplant"

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S. Pahl, Eric, W. Nick Street, Hans J. Johnson, and Alan I. Reed. "A Predictive Model for Kidney Transplant Graft Survival using Machine Learning." In 4th International Conference on Computer Science and Information Technology (COMIT 2020). AIRCC Publishing Corporation, 2020. http://dx.doi.org/10.5121/csit.2020.101609.

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Kidney transplantation is the best treatment for end-stage renal failure patients. The predominant method used for kidney quality assessment is the Cox regression-based, kidney donor risk index. A machine learning method may provide improved prediction of transplant outcomes and help decision-making. A popular tree-based machine learning method, random forest, was trained and evaluated with the same data originally used to develop the risk index (70,242 observations from 1995-2005). The random forest successfully predicted an additional 2,148 transplants than the risk index with equal type II error rates of 10%. Predicted results were analyzed with follow-up survival outcomes up to 240 months after transplant using Kaplan-Meier analysis and confirmed that the random forest performed significantly better than the risk index (p<0.05). The random forest predicted significantly more successful and longer-surviving transplants than the risk index. Random forests and other machine learning models may improve transplant decisions.
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Chu, Sauman, Allyson Hart, and Marilyn Bruin. "A patient-centered approach in designing a kidney transplant decision aid." In AHFE 2023 Hawaii Edition. AHFE International, 2023. http://dx.doi.org/10.54941/ahfe1004234.

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The kidney transplant decision aid tool (https://www.srtr.org/tools/kidney-transplant-decision-aid/) was designed, created, and included as part of the Scientific Registry of Transplant Recipients (SRTR) resource website. The decision aid tool was created with input from patients with kidney disease and the doctors who care for them. An extensive information gathering and testing process with user-centered approach was implemented. Ten interviews and 4 focus group discussion sessions were held with an average of 4.5 patients in each group to gather preliminary design and content directions. Two additional focus groups with a total of 12 kidney transplant providers and 4 additional national focus group discussions with a total of 19 patients were held afterward to discuss the created content and design approach. Finally, 15 individual patient testing sessions were conducted to refine the content, design, and navigation of the tool. The tool is intended to be used during patient’s visit with their doctor as the patient learns about kidney transplant. Our goal is to provide informative materials to empower patients by helping them understand treatment options and outcomes. The doctor will guide patient through the tool and explain the information to help them to make informed decisions.The decision aid tool contains concise information to compare the pros and cons of dialysis vs. transplant treatments, living donor vs. deceased donor transplant, accepting higher quality vs. lower quality deceased donor kidney offers, and increased infectious risk kidneys vs. standard infectious risk kidneys. We also created a calculator to estimate a patient’s likely outcomes on the kidney transplant wait list based on the transplant regions or center and the individual’s medical condition. Preliminary testing suggests that patients find the tool and the likely outcomes helpful in leading to informative decision making.
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Harvey, Christine. "The Kidney Transplant Process Model." In 2015 Winter Simulation Conference (WSC). IEEE, 2015. http://dx.doi.org/10.1109/wsc.2015.7408457.

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Afshar, Kourosh, B. Shadgan, and Baharak Tolouei. "Optical monitoring in kidney transplant." In Optical Interactions with Tissue and Cells XXXIII and Advanced Photonics in Urology, edited by Hyun Wook Kang, Ronald Sroka, Bennett L. Ibey, and Norbert Linz. SPIE, 2022. http://dx.doi.org/10.1117/12.2604261.

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Actor-Engel, Hannah. "Donor stem cells may reduce lifelong immunosuppressant use following transplant surgery." In ASN Kidney Week 2023, edited by Rachel Giles. Baarn, the Netherlands: Medicom Medical Publishers, 2023. http://dx.doi.org/10.55788/152e45ff.

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Brown, Fredericka, Robert Boehm, and Gary Shen. "2-D Axisymmetric Finite Difference Modeling of Thermistor Probe Heating on the Kidney." In ASME 2003 Heat Transfer Summer Conference. ASMEDC, 2003. http://dx.doi.org/10.1115/ht2003-47113.

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Developing a means of determining whether or not there is adequate perfusion in a newly transplanted kidney is the impetus for this study. The concept analyzed is that of a self-heating thermistor probe located between the kidney and the adjacent body tissue, inserted during the transplant procedure. When appropriate perfusion is present in the kidney, more heat will be dissipated in the organ tissue than when perfusion is insufficient for transplant success. If the heat dissipation for a given probe temperature above the bulk tissue is monitored, this might be able to be used as an indicator of procedural success or failure. To assess the sensitivity of this approach a numerical model has been developed and is reported here. An axisymmetric two-dimensional finite-difference formulation is used. Results are shown using typical values of properties for perfused and non-perfused tissue. The sensitivity of the approach to these properties indicates the type of accuracy that will be required in the clinical application of the technique.
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de Koning, Constance. "Modified donor blood cells seem a promising option in kidney transplant recipients." In ASN Kidney Week 2022, edited by Rachel Giles. Baarn, the Netherlands: Medicom Medical Publishers, 2022. http://dx.doi.org/10.55788/47c409cb.

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Barberà, Irene Carrión, Melissa Fajardo, Demetra Tsapepas, Hilda Fernandez, and Anca Askanase. "AB0461 BELATACEPT IN SLE KIDNEY TRANSPLANT PATIENTS." In Annual European Congress of Rheumatology, EULAR 2019, Madrid, 12–15 June 2019. BMJ Publishing Group Ltd and European League Against Rheumatism, 2019. http://dx.doi.org/10.1136/annrheumdis-2019-eular.626.

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Ghadermarzi, S., and O. Obi. "Tacrolimus Induced Diabetic Ketoacidosis Post Kidney Transplant." In American Thoracic Society 2020 International Conference, May 15-20, 2020 - Philadelphia, PA. American Thoracic Society, 2020. http://dx.doi.org/10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a5165.

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Fernandes Pedro, Inês, Dina Escaleira Fernandes, and Susana Moreira. "Pulmonary evaluation in potential kidney transplant candidates." In ERS Congress 2024 abstracts, PA3033. European Respiratory Society, 2024. http://dx.doi.org/10.1183/13993003.congress-2024.pa3033.

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Reports on the topic "Kidney transplant"

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Filipov, Jean, Tania Metodieva, Nikolay Hubanov, Emil Dimitiro, and Dobrin Svinarov. Cholecalciferol Supplementation and Its Effect on Proteinuria in Bulgarian Kidney Transplant Recipients. "Prof. Marin Drinov" Publishing House of Bulgarian Academy of Sciences, June 2021. http://dx.doi.org/10.7546/crabs.2021.06.15.

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Pereira, Lucas Carvalho, Igor Carvalho Pereira, Thamiris Dias Delfino Cabral, and Patricia Mendes Viana. Balanced crystalloids versus normal saline in kidney transplant: an updated systematic review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, July 2023. http://dx.doi.org/10.37766/inplasy2023.7.0047.

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Fang, Jiaxin, Fucong Peng, Luo Yang, Jingjing Li, Changyun Wei, Ruiting Wang, Shaobo Guo, Xiangru Li, and Hongxia Liu. Effect of illness perception, cognitive appraisal on coping in kidney transplant recipients: systematic review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, May 2023. http://dx.doi.org/10.37766/inplasy2023.5.0040.

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Cai, Peishan, Zhou Shu, Taotao Zhou, Jie Li, Wei Chen, Xianpeng Zeng, and Fang Zeng. Effects of vitamin D supplements on bone metabolism in kidney transplant recipients: a systematic review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, January 2024. http://dx.doi.org/10.37766/inplasy2024.1.0041.

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Rong, Jin, Dongming He, Die Hu, Xing Tao, Xiang Cai, Linlin Xiang, Silong Zhao, Peng Liu, and Qiong Liu. The impact of perioperative infusion of dexmedetomidine on postoperative renal function recovery in kidney transplant recipients： a systematic review and meta‑analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, July 2023. http://dx.doi.org/10.37766/inplasy2023.7.0068.

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Tipton, Kelley, Brian F. Leas, Emilia Flores, Christopher Jepson, Jaya Aysola, Jordana Cohen, Michael Harhay, et al. Impact of Healthcare Algorithms on Racial and Ethnic Disparities in Health and Healthcare. Agency for Healthcare Research and Quality (AHRQ), December 2023. http://dx.doi.org/10.23970/ahrqepccer268.

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Objectives. To examine the evidence on whether and how healthcare algorithms (including algorithm-informed decision tools) exacerbate, perpetuate, or reduce racial and ethnic disparities in access to healthcare, quality of care, and health outcomes, and examine strategies that mitigate racial and ethnic bias in the development and use of algorithms. Data sources. We searched published and grey literature for relevant studies published between January 2011 and February 2023. Based on expert guidance, we determined that earlier articles are unlikely to reflect current algorithms. We also hand-searched reference lists of relevant studies and reviewed suggestions from experts and stakeholders. Review methods. Searches identified 11,500 unique records. Using predefined criteria and dual review, we screened and selected studies to assess one or both Key Questions (KQs): (1) the effect of algorithms on racial and ethnic disparities in health and healthcare outcomes and (2) the effect of strategies or approaches to mitigate racial and ethnic bias in the development, validation, dissemination, and implementation of algorithms. Outcomes of interest included access to healthcare, quality of care, and health outcomes. We assessed studies’ methodologic risk of bias (ROB) using the ROBINS-I tool and piloted an appraisal supplement to assess racial and ethnic equity-related ROB. We completed a narrative synthesis and cataloged study characteristics and outcome data. We also examined four Contextual Questions (CQs) designed to explore the context and capture insights on practical aspects of potential algorithmic bias. CQ 1 examines the problem’s scope within healthcare. CQ 2 describes recently emerging standards and guidance on how racial and ethnic bias can be prevented or mitigated during algorithm development and deployment. CQ 3 explores stakeholder awareness and perspectives about the interaction of algorithms and racial and ethnic disparities in health and healthcare. We addressed these CQs through supplemental literature reviews and conversations with experts and key stakeholders. For CQ 4, we conducted an in-depth analysis of a sample of six algorithms that have not been widely evaluated before in the published literature to better understand how their design and implementation might contribute to disparities. Results. Fifty-eight studies met inclusion criteria, of which three were included for both KQs. One study was a randomized controlled trial, and all others used cohort, pre-post, or modeling approaches. The studies included numerous types of clinical assessments: need for intensive care or high-risk care management; measurement of kidney or lung function; suitability for kidney or lung transplant; risk of cardiovascular disease, stroke, lung cancer, prostate cancer, postpartum depression, or opioid misuse; and warfarin dosing. We found evidence suggesting that algorithms may: (a) reduce disparities (i.e., revised Kidney Allocation System, prostate cancer screening tools); (b) perpetuate or exacerbate disparities (e.g., estimated glomerular filtration rate [eGFR] for kidney function measurement, cardiovascular disease risk assessments); and/or (c) have no effect on racial or ethnic disparities. Algorithms for which mitigation strategies were identified are included in KQ 2. We identified six types of strategies often used to mitigate the potential of algorithms to contribute to disparities: removing an input variable; replacing a variable; adding one or more variables; changing or diversifying the racial and ethnic composition of the patient population used to train or validate a model; creating separate algorithms or thresholds for different populations; and modifying the statistical or analytic techniques used by an algorithm. Most mitigation efforts improved proximal outcomes (e.g., algorithmic calibration) for targeted populations, but it is more challenging to infer or extrapolate effects on longer term outcomes, such as racial and ethnic disparities. The scope of racial and ethnic bias related to algorithms and their application is difficult to quantify, but it clearly extends across the spectrum of medicine. Regulatory, professional, and corporate stakeholders are undertaking numerous efforts to develop standards for algorithms, often emphasizing the need for transparency, accountability, and representativeness. Conclusions. Algorithms have been shown to potentially perpetuate, exacerbate, and sometimes reduce racial and ethnic disparities. Disparities were reduced when race and ethnicity were incorporated into an algorithm to intentionally tackle known racial and ethnic disparities in resource allocation (e.g., kidney transplant allocation) or disparities in care (e.g., prostate cancer screening that historically led to Black men receiving more low-yield biopsies). It is important to note that in such cases the rationale for using race and ethnicity was clearly delineated and did not conflate race and ethnicity with ancestry and/or genetic predisposition. However, when algorithms include race and ethnicity without clear rationale, they may perpetuate the incorrect notion that race is a biologic construct and contribute to disparities. Finally, some algorithms may reduce or perpetuate disparities without containing race and ethnicity as an input. Several modeling studies showed that applying algorithms out of context of original development (e.g., illness severity scores used for crisis standards of care) could perpetuate or exacerbate disparities. On the other hand, algorithms may also reduce disparities by standardizing care and reducing opportunities for implicit bias (e.g., Lung Allocation Score for lung transplantation). Several mitigation strategies have been shown to potentially reduce the contribution of algorithms to racial and ethnic disparities. Results of mitigation efforts are highly context specific, relating to unique combinations of algorithm, clinical condition, population, setting, and outcomes. Important future steps include increasing transparency in algorithm development and implementation, increasing diversity of research and leadership teams, engaging diverse patient and community groups in the development to implementation lifecycle, promoting stakeholder awareness (including patients) of potential algorithmic risk, and investing in further research to assess the real-world effect of algorithms on racial and ethnic disparities before widespread implementation.
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Savedoff, William D., and Katherine Slack. Public Purchaser-Private Provider Contracting for Health Services: Examples from Latin America and the Caribbean. Inter-American Development Bank, January 2001. http://dx.doi.org/10.18235/0008783.

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The report presents examples to illustrate many of the key issues regarding health care contracting. This study discusses 27 examples of contracting with the private sector in Latin America and the Caribbean. The examples cover three types of services and target population: 11 are broadly-defined services for the entire population (e.g. outpatient services by private hospitals in Brazil); 8 are specific services for the entire population (e.g. high-tech services -heart surgery, kidney transplants, hip replacements, etc.- by private units in Uruguay); and 8 are specific services for a target population (e.g. a program to reduce child malnutrition in Honduras). In addition to its analysis of the cases, the study has generated a publicly available electronic database that can be corrected, updated, and expanded.
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Rodrigue, James, Aaron Fleishman, Jesse Schold, Kelli Collins Damron, Derek DuBay, Martha Pavlakis, Amy Evenson, and Prabhakar Baliga. Comparing Approaches to Improve Black Patients’ Chances of Getting Live Donor Kidney Transplants Sign Up for Updates. Patient-Centered Outcomes Research Institute (PCORI), May 2024. http://dx.doi.org/10.25302/05.2024.ad.160936589.

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Management of transplant kidney calculus obstruction. BJUI Knowledge, January 2016. http://dx.doi.org/10.18591/bjuik.0373.

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Techniques for managing transplant kidney RCC. BJUI Knowledge, December 2016. http://dx.doi.org/10.18591/bjuik.0376.

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