Sumit Mohan | Columbia University (original) (raw)

Papers by Sumit Mohan

Clinical Journal of the American Society of Nephrology

Background and objectivesActionable genetic findings have implications for care of patients with ... more Background and objectivesActionable genetic findings have implications for care of patients with kidney disease, and genetic testing is an emerging tool in nephrology practice. However, there are scarce data regarding best practices for return of results and clinical application of actionable genetic findings for kidney patients.Design, setting, participants, & measurementsWe developed a return of results workflow in collaborations with clinicians for the retrospective recontact of adult nephrology patients who had been recruited into a biobank research study for exome sequencing and were identified to have medically actionable genetic findings.ResultsUsing this workflow, we attempted to recontact a diverse pilot cohort of 104 nephrology research participants with actionable genetic findings, encompassing 34 different monogenic etiologies of nephropathy and five single-gene disorders recommended by the American College of Medical Genetics and Genomics for return as medically actiona...

PLOS ONE

Background Estimated glomerular filtration rate (eGFR) is routinely utilized as a measure of rena... more Background Estimated glomerular filtration rate (eGFR) is routinely utilized as a measure of renal function. While creatinine-based eGFR (eGFRcr) is widely used in clinical practice, the use of cystatin-C to estimate GFR (eGFRcys) has demonstrated superior risk prediction in various populations. Prior studies that derived eGFR formulas have infrequently included high proportions of elderly, African-Americans, and Hispanics. Objective Our objective as to compare mortality risk prediction using eGFRcr and eGFRcys in an elderly, race/ethnically diverse population. Design The Northern Manhattan Study (NOMAS) is a multiethnic prospective cohort of elderly stroke-free individuals consisting of a total of 3,298 participants recruited between 1993 and 2001, with a median follow-up of 18 years. Participants We included all Northern Manhattan Study (NOMAS) participants with concurrent measured creatinine and cystatin-C.

American Journal of Transplantation

Journal of the American College of Cardiology

The aim of this study was to examine the risk of contrast-induced nephropathy (CIN) and need for ... more The aim of this study was to examine the risk of contrast-induced nephropathy (CIN) and need for renal replacement therapy (RRT) in patients with advanced chronic kidney disease (CKD) who underwent ultra-low contrast angiography (ULCA) compared with conventional angiography (CA). This prospective

Hepatology

Over nearly 3 decades, organs from donors with hepatitis C virus (HCV) have been widely used for ... more Over nearly 3 decades, organs from donors with hepatitis C virus (HCV) have been widely used for recipients with HCV without detrimental impact on recurrence, graft survival, or the incidence of cholestatic hepatitis. The recent availability of highly effective antiviral therapy has dramatically decreased the number of HCV-viremic transplant candidates, contributing to underutilization of HCV-viremic donors in recent years. Combined with an increase in HCV-viremic donors due to opioid overdose death, experts have proposed the use of HCV-viremic donors in HCV-negative transplant recipients with post-transplant DAA therapy.

American Journal of Kidney Diseases

The presence of 2 apolipoprotein L1 gene (APOL1) risk variants is associated with increased risk ... more The presence of 2 apolipoprotein L1 gene (APOL1) risk variants is associated with increased risk for chronic kidney disease and end-stage kidney disease. Inferior allograft outcomes following transplantation with kidneys from donors with 2 risk variants have also been reported. These data, coupled with anecdotal case reports and a recent cohort study of living donors, raise important questions about the potential increased kidney disease risk for living donors with APOL1 risk variants and the need for testing as part of the standard living donor evaluation process. We identify a series of questions that are central to the development of clinical policy regarding APOL1 testing of potential living kidney donors given the current uncertainty over the clinical implications of having 2 risk variants. We explore the ethical challenges that arise when determining when and to whom APOL1 testing should be offered, what potential donors should be told about APOL1 testing, how test results should be used to determine suitability for donation, if and when recipients should have access to results, and how clinical policy regarding APOL1 testing should be established.

Transplant International

Asian Americans have the lowest organ donation registration rates in the United States, and the r... more Asian Americans have the lowest organ donation registration rates in the United States, and the reason for this is incompletely understood. Aiming to understand the reasons for low organ donation registration rate among Asian Americans, more specifically Chinese and Korean Americans, we conducted a systematic search of databases, websites, and gray literature. Altogether, 34 papers were retained after the assessment of relevance and quality. Commonly reported barriers to organ donation registration among Chinese and Koreans in the literature included lack of knowledge about organ donation, distrust of health‐care and allocation system, cultural avoidance of discussion of death‐related topics, and desire for intact body mainly stemming from the Confucian concept of filial piety. Strong family values coupled with a cultural reluctance to discuss death‐related topics among family members appear to underscore the reluctance to organ donation among Chinese and Koreans. Notably, improved knowledge negatively impacted organ donation intent and religion seemed to play a more important role when making decision about organ donation among Koreans, and the distrust of the allocation system is more prominent among Chinese. This information should be used to inform the development of culturally competent organ donation educational materials.

Transplant International

While deceased donor renal transplants (DDRT) from donors with either acute kidney injury (AKI) o... more While deceased donor renal transplants (DDRT) from donors with either acute kidney injury (AKI) or long cold ischemia time (CIT) are associated with increased risk of delayed graft function (DGF), recipients of these kidneys have good patient and allograft survival. There are limited data on whether kidneys with both AKI and long CIT have outcomes similar to kidneys with only one of these insults. Using data from the Scientific Registry of Transplant Recipients, we analyzed transplant outcomes in patients (2005-2015) receiving kidneys with AKI (terminal creatinine ≥2.0 mg/dl) and CIT 24-30 h (n = 1289), 30-36 h (n = 734), and >36 h (n = 614), using kidneys with AKI and CIT <24 h (n = 5434) as a reference. DGF was more common with increasing CIT up to 36 h, then decreased slightly (41.2% vs. 46.8% vs. 52.5% vs. 50.2%, P < 0.001). Death-censored graft survival (DCGS) at 3 years was better with CIT <24 h compared with other groups (92.5% vs. 90.8% vs. 92% vs. 89.2%, P = 0.018). On multivariable analysis, donor creatinine was predictive of DCGS, whereas only CIT >36 h was predictive of DCGS (aHR 1.27, P = 0.03). Recipients transplanted with kidneys with both AKI and long CIT have excellent intermediate-term outcomes.

Transplantation

TABLE S1. Description of livers available for adult, deceased brain dead donor, isolated liver tr... more TABLE S1. Description of livers available for adult, deceased brain dead donor, isolated liver transplants by procurement status and, if procured, transplanted vs. discarded (2003-2016) Livers not procured Livers procured for transplant Likelihood of Discard Likelihood of Nonprocurement Donor Characteristics Total (n=8370) Total Procured (n=65 316) Transplanted (n=58 862) Discarded (n=6454) Crude OR p value Crude OR p value Age (mean, [SD]) 47.80 (13.51) 44.37 (16.02) 43.56 (16.00) 51.83 (14.30) 1.034 (1.032-1.035) <0.001 1.014 (1.012-1.015) <0.001 Age > 60 (%) 1590 (19.00) 12 287 (18.81) 10 302 (17.50) 1985 (30.76) 2.09 (1.98-2.22) <0.001 1.01 (0.96-1.07) 0.684 Sex (%Female) 3685 (44.03) 27 372 (41.91) 24 496 (41.62) 2876 (44.56) 1.13 (1.07-1.19) <0.001 1.09 (1.04-1.14) <0.001 Race (%) White 5344 (63.85) 43 471 (65.56) 38 963 (66.19) 4508 (69.85) 1.18 (1.12-1.25) <0.001 0.89 (0.85-0.93) <0.001 African American 1039 (12.41) 11 352 (17.38) 10 492 (17.83) 860 (13.33) 0.71 (0.66-0.76) <0.001 0.67 (0.63-0.72) <0.001

Clinical Transplantation

Discard rate of Public Health Service Increased Risk (PHS-IR) organs is high despite the absence ... more Discard rate of Public Health Service Increased Risk (PHS-IR) organs is high despite the absence of worse kidney transplant outcomes. We conducted a retrospective, single-center study of PHS-IR kidney offers made to kidney transplant-only potential recipients from 6/2004 to 5/2015. Overall mortality and transplant outcomes between potential recipients were stratified by response to PHS-IR kidney offers. Cox regression and Kaplan-Meier analyses of mortality and allograft failure were performed. A total of 2423 potential recipients were offered a PHS-IR kidney, with 1502 transplanted, with or without a PHS-IR kidney. Predictors of accepting a PHS-IR kidney included higher Estimated Post Transplant Survival (EPTS) score, prior kidney transplant, and lower educational achievement on multivariable analysis (P = 0.025, P = 0.004, P = 0.023). A positive response to a PHS-IR kidney was associated with lower risk of mortality (3.63% vs 11.6%; aHR 0.467, P = 0.0008). PHS-IR kidney recipients had decreased risk of allograft loss compared to non-PHS-IR recipients (P = 0.007), though mortality outcomes were not significantly different based on PHS-IR status (P = 0.38). No transmission of HIV, HBV, or HCV occurred from PHS-IR kidney donors in this cohort. Efforts must be made to increase awareness of the beneficial outcomes of PHS-IR organs to maximize appropriate donor allocation.

Clinical transplantation, Jan 19, 2018

Studies have demonstrated the Timed Up and Go Test's (TUGT) ability to forecast post-operativ... more Studies have demonstrated the Timed Up and Go Test's (TUGT) ability to forecast post-operative outcomes for several surgical specialties. Evaluations of TUGT for waitlist and post-transplant outcomes has yet to be examined in kidney transplantation. To assess the prognostic utility of TUGT and its associations with waitlist and post-transplant outcomes for kidney transplant candidates. Single-center, prospective study of 518 patients who performed TUGT during their transplant evaluation between 9/1/2013-11/30/2014. TUGT times were evaluated as a continuous variable or 3-level discrete categorical variable with TUGT times categorized as long (>9s), average (8-9s), or short (5-8s). Transplanted individuals had shorter TUGT times than those who remained on the waitlist (8.99 vs. 9.79 seconds, p<0.001). Bivariable and multivariable logistic regression showed that after adjusting for age, there was no association between TUGT times and probability of waitlist removal (OR 0.997[...

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, Jan 9, 2018

The United Network of Organ Sharing (UNOS) is charged with the efficient and equitable allocation... more The United Network of Organ Sharing (UNOS) is charged with the efficient and equitable allocation of all deceased donor solid organs transplanted in the United States, including >10,000 deceased donor kidneys (DDKs) annually. In late 2011, regulatory changes led the Social Security Administration to stop including state death records in the Death Master File (DMF) used by UNOS, among others, for patient status verification. This change resulted in the removal of 4.2 million records from the DMF and 1 million fewer added records annually. This article is protected by copyright. All rights reserved.

Kidney international, Jul 5, 2018

The proportion of deceased donor kidneys procured for transplant but subsequently discarded has b... more The proportion of deceased donor kidneys procured for transplant but subsequently discarded has been growing steadily in the United States, but factors contributing to the rising discard rate remain unclear. To assess the reasons for and probability of organ discard we assembled a cohort of 212,305 deceased donor kidneys recovered for transplant from 2000-2015 in the SRTR registry that included 36,700 kidneys that were discarded. 'Biopsy Findings' (38.2%) was the most commonly reported reason for discard. The median Kidney Donor Risk Index of discarded kidneys was significantly higher than transplanted organs (1.78 vs 1.12), but a large overlap in the quality of discarded and transplanted kidneys was observed. Kidneys of donors who were older, female, Black, obese, diabetic, hypertensive or HCV-positive experienced a significantly increased odds of discard. Kidneys from donors with multiple unfavorable characteristics were more likely to be discarded, whereas unilaterally di...

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, Jan 30, 2018

The impact of a new national kidney allocation system (KAS) on access to the national deceased-do... more The impact of a new national kidney allocation system (KAS) on access to the national deceased-donor waiting list (waitlisting) and racial/ethnic disparities in waitlisting among US end-stage renal disease (ESRD) patients is unknown. We examined waitlisting pre- and post-KAS among incident (N = 1 253 100) and prevalent (N = 1 556 954) ESRD patients from the United States Renal Data System database (2005-2015) using multivariable time-dependent Cox and interrupted time-series models. The adjusted waitlisting rate among incident patients was 9% lower post-KAS (hazard ratio [HR]: 0.91; 95% confidence interval [CI], 0.90-0.93), although preemptive waitlisting increased from 30.2% to 35.1% (P < .0001). The waitlisting decrease is largely due to a decline in inactively waitlisted patients. Pre-KAS, blacks had a 19% lower waitlisting rate vs whites (HR: 0.81; 95% CI, 0.80-0.82); following KAS, disparity declined to 12% (HR: 0.88; 95% CI, 0.85-0.90). In adjusted time-series analyses of p...

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, Jan 24, 2018

The volume of solid organ transplant in the United States is increasing, providing improved quali... more The volume of solid organ transplant in the United States is increasing, providing improved quality of life and survival for patients with organ failure. The growth of transplantation requires a systematized management of transplant outcomes assessment, especially with the movement towards value-based care. However, there are several challenges to analyzing outcomes in the current registry-based, transplant reporting system: (1) longitudinal data points are difficult to capture in outcomes models; (2) data elements are restricted to those that already exist in the registry data; (3) there is a delay in the release of outcomes report. In this article, we propose an informatics approach to solve these problems by utilizing a 'common data model' to integrate disparate data sources, data elements, and temporal data points. Adopting such a framework can enable multi-center outcomes analyses among transplant centers, nationally and internationally. This article is protected by cop...

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, Jan 15, 2018

We previously developed a mobile- and web-based decision aid (iChoose Kidney) that displays indiv... more We previously developed a mobile- and web-based decision aid (iChoose Kidney) that displays individualized risk estimates of survival and mortality, for the treatment modalities of dialysis versus kidney transplantation. We examined the effect of iChoose Kidney on change in transplant knowledge and access to transplant in a randomized controlled trial among patients presenting for evaluation in three transplant centers. A total of 470 patients were randomized to standard transplantation education (control) or standard education plus iChoose Kidney (intervention). Change in transplant knowledge (primary outcome) among intervention vs. control patients was assessed using 9-items in pre- and post-evaluation surveys. Access to transplant (secondary outcome) was defined as a composite of waitlisting, living donor inquiries, or transplantation. Among 443 patients (n=226 intervention; n=216 control), the mean knowledge scores were 5.1 ± 2.1 pre- and 5.8 ± 1.9 post-evaluation. Change in kno...

Clinical Journal of the American Society of Nephrology

American Journal of Kidney Diseases, 2017

Transplantation, Jan 28, 2015

Despite a significant survival advantage of kidney transplantation compared with dialysis, nearly... more Despite a significant survival advantage of kidney transplantation compared with dialysis, nearly one third of end-stage renal disease (ESRD) patients are not educated about kidney transplantation as a treatment option at the time of ESRD diagnosis. Access to individualized, evidence-based prognostic information is needed to facilitate and encourage shared decision making about the clinical implications of whether to pursue transplantation or long-term dialysis. We used a national cohort of incident ESRD patients in the US Renal Data System surveillance registry from 2005 to 2011 to develop and validate prediction models for risk of 1- and 3-year mortality among dialysis versus kidney transplantation. Using these data, we developed a mobile clinical decision aid that provides estimates of risks of death and survival on dialysis compared with kidney transplantation patients. Factors included in the mortality risk prediction models for dialysis and transplantation included age, race/e...

Transplantation, Jan 28, 2015

Despite a significant survival advantage of kidney transplantation compared with dialysis, nearly... more Despite a significant survival advantage of kidney transplantation compared with dialysis, nearly one third of end-stage renal disease (ESRD) patients are not educated about kidney transplantation as a treatment option at the time of ESRD diagnosis. Access to individualized, evidence-based prognostic information is needed to facilitate and encourage shared decision making about the clinical implications of whether to pursue transplantation or long-term dialysis. We used a national cohort of incident ESRD patients in the US Renal Data System surveillance registry from 2005 to 2011 to develop and validate prediction models for risk of 1- and 3-year mortality among dialysis versus kidney transplantation. Using these data, we developed a mobile clinical decision aid that provides estimates of risks of death and survival on dialysis compared with kidney transplantation patients. Factors included in the mortality risk prediction models for dialysis and transplantation included age, race/e...

Clinical Journal of the American Society of Nephrology

Background and objectivesActionable genetic findings have implications for care of patients with ... more Background and objectivesActionable genetic findings have implications for care of patients with kidney disease, and genetic testing is an emerging tool in nephrology practice. However, there are scarce data regarding best practices for return of results and clinical application of actionable genetic findings for kidney patients.Design, setting, participants, & measurementsWe developed a return of results workflow in collaborations with clinicians for the retrospective recontact of adult nephrology patients who had been recruited into a biobank research study for exome sequencing and were identified to have medically actionable genetic findings.ResultsUsing this workflow, we attempted to recontact a diverse pilot cohort of 104 nephrology research participants with actionable genetic findings, encompassing 34 different monogenic etiologies of nephropathy and five single-gene disorders recommended by the American College of Medical Genetics and Genomics for return as medically actiona...

PLOS ONE

Background Estimated glomerular filtration rate (eGFR) is routinely utilized as a measure of rena... more Background Estimated glomerular filtration rate (eGFR) is routinely utilized as a measure of renal function. While creatinine-based eGFR (eGFRcr) is widely used in clinical practice, the use of cystatin-C to estimate GFR (eGFRcys) has demonstrated superior risk prediction in various populations. Prior studies that derived eGFR formulas have infrequently included high proportions of elderly, African-Americans, and Hispanics. Objective Our objective as to compare mortality risk prediction using eGFRcr and eGFRcys in an elderly, race/ethnically diverse population. Design The Northern Manhattan Study (NOMAS) is a multiethnic prospective cohort of elderly stroke-free individuals consisting of a total of 3,298 participants recruited between 1993 and 2001, with a median follow-up of 18 years. Participants We included all Northern Manhattan Study (NOMAS) participants with concurrent measured creatinine and cystatin-C.

American Journal of Transplantation

Journal of the American College of Cardiology

The aim of this study was to examine the risk of contrast-induced nephropathy (CIN) and need for ... more The aim of this study was to examine the risk of contrast-induced nephropathy (CIN) and need for renal replacement therapy (RRT) in patients with advanced chronic kidney disease (CKD) who underwent ultra-low contrast angiography (ULCA) compared with conventional angiography (CA). This prospective

Hepatology

Over nearly 3 decades, organs from donors with hepatitis C virus (HCV) have been widely used for ... more Over nearly 3 decades, organs from donors with hepatitis C virus (HCV) have been widely used for recipients with HCV without detrimental impact on recurrence, graft survival, or the incidence of cholestatic hepatitis. The recent availability of highly effective antiviral therapy has dramatically decreased the number of HCV-viremic transplant candidates, contributing to underutilization of HCV-viremic donors in recent years. Combined with an increase in HCV-viremic donors due to opioid overdose death, experts have proposed the use of HCV-viremic donors in HCV-negative transplant recipients with post-transplant DAA therapy.

American Journal of Kidney Diseases

The presence of 2 apolipoprotein L1 gene (APOL1) risk variants is associated with increased risk ... more The presence of 2 apolipoprotein L1 gene (APOL1) risk variants is associated with increased risk for chronic kidney disease and end-stage kidney disease. Inferior allograft outcomes following transplantation with kidneys from donors with 2 risk variants have also been reported. These data, coupled with anecdotal case reports and a recent cohort study of living donors, raise important questions about the potential increased kidney disease risk for living donors with APOL1 risk variants and the need for testing as part of the standard living donor evaluation process. We identify a series of questions that are central to the development of clinical policy regarding APOL1 testing of potential living kidney donors given the current uncertainty over the clinical implications of having 2 risk variants. We explore the ethical challenges that arise when determining when and to whom APOL1 testing should be offered, what potential donors should be told about APOL1 testing, how test results should be used to determine suitability for donation, if and when recipients should have access to results, and how clinical policy regarding APOL1 testing should be established.

Transplant International

Asian Americans have the lowest organ donation registration rates in the United States, and the r... more Asian Americans have the lowest organ donation registration rates in the United States, and the reason for this is incompletely understood. Aiming to understand the reasons for low organ donation registration rate among Asian Americans, more specifically Chinese and Korean Americans, we conducted a systematic search of databases, websites, and gray literature. Altogether, 34 papers were retained after the assessment of relevance and quality. Commonly reported barriers to organ donation registration among Chinese and Koreans in the literature included lack of knowledge about organ donation, distrust of health‐care and allocation system, cultural avoidance of discussion of death‐related topics, and desire for intact body mainly stemming from the Confucian concept of filial piety. Strong family values coupled with a cultural reluctance to discuss death‐related topics among family members appear to underscore the reluctance to organ donation among Chinese and Koreans. Notably, improved knowledge negatively impacted organ donation intent and religion seemed to play a more important role when making decision about organ donation among Koreans, and the distrust of the allocation system is more prominent among Chinese. This information should be used to inform the development of culturally competent organ donation educational materials.

Transplant International

While deceased donor renal transplants (DDRT) from donors with either acute kidney injury (AKI) o... more While deceased donor renal transplants (DDRT) from donors with either acute kidney injury (AKI) or long cold ischemia time (CIT) are associated with increased risk of delayed graft function (DGF), recipients of these kidneys have good patient and allograft survival. There are limited data on whether kidneys with both AKI and long CIT have outcomes similar to kidneys with only one of these insults. Using data from the Scientific Registry of Transplant Recipients, we analyzed transplant outcomes in patients (2005-2015) receiving kidneys with AKI (terminal creatinine ≥2.0 mg/dl) and CIT 24-30 h (n = 1289), 30-36 h (n = 734), and >36 h (n = 614), using kidneys with AKI and CIT <24 h (n = 5434) as a reference. DGF was more common with increasing CIT up to 36 h, then decreased slightly (41.2% vs. 46.8% vs. 52.5% vs. 50.2%, P < 0.001). Death-censored graft survival (DCGS) at 3 years was better with CIT <24 h compared with other groups (92.5% vs. 90.8% vs. 92% vs. 89.2%, P = 0.018). On multivariable analysis, donor creatinine was predictive of DCGS, whereas only CIT >36 h was predictive of DCGS (aHR 1.27, P = 0.03). Recipients transplanted with kidneys with both AKI and long CIT have excellent intermediate-term outcomes.

Transplantation

TABLE S1. Description of livers available for adult, deceased brain dead donor, isolated liver tr... more TABLE S1. Description of livers available for adult, deceased brain dead donor, isolated liver transplants by procurement status and, if procured, transplanted vs. discarded (2003-2016) Livers not procured Livers procured for transplant Likelihood of Discard Likelihood of Nonprocurement Donor Characteristics Total (n=8370) Total Procured (n=65 316) Transplanted (n=58 862) Discarded (n=6454) Crude OR p value Crude OR p value Age (mean, [SD]) 47.80 (13.51) 44.37 (16.02) 43.56 (16.00) 51.83 (14.30) 1.034 (1.032-1.035) <0.001 1.014 (1.012-1.015) <0.001 Age > 60 (%) 1590 (19.00) 12 287 (18.81) 10 302 (17.50) 1985 (30.76) 2.09 (1.98-2.22) <0.001 1.01 (0.96-1.07) 0.684 Sex (%Female) 3685 (44.03) 27 372 (41.91) 24 496 (41.62) 2876 (44.56) 1.13 (1.07-1.19) <0.001 1.09 (1.04-1.14) <0.001 Race (%) White 5344 (63.85) 43 471 (65.56) 38 963 (66.19) 4508 (69.85) 1.18 (1.12-1.25) <0.001 0.89 (0.85-0.93) <0.001 African American 1039 (12.41) 11 352 (17.38) 10 492 (17.83) 860 (13.33) 0.71 (0.66-0.76) <0.001 0.67 (0.63-0.72) <0.001

Clinical Transplantation

Discard rate of Public Health Service Increased Risk (PHS-IR) organs is high despite the absence ... more Discard rate of Public Health Service Increased Risk (PHS-IR) organs is high despite the absence of worse kidney transplant outcomes. We conducted a retrospective, single-center study of PHS-IR kidney offers made to kidney transplant-only potential recipients from 6/2004 to 5/2015. Overall mortality and transplant outcomes between potential recipients were stratified by response to PHS-IR kidney offers. Cox regression and Kaplan-Meier analyses of mortality and allograft failure were performed. A total of 2423 potential recipients were offered a PHS-IR kidney, with 1502 transplanted, with or without a PHS-IR kidney. Predictors of accepting a PHS-IR kidney included higher Estimated Post Transplant Survival (EPTS) score, prior kidney transplant, and lower educational achievement on multivariable analysis (P = 0.025, P = 0.004, P = 0.023). A positive response to a PHS-IR kidney was associated with lower risk of mortality (3.63% vs 11.6%; aHR 0.467, P = 0.0008). PHS-IR kidney recipients had decreased risk of allograft loss compared to non-PHS-IR recipients (P = 0.007), though mortality outcomes were not significantly different based on PHS-IR status (P = 0.38). No transmission of HIV, HBV, or HCV occurred from PHS-IR kidney donors in this cohort. Efforts must be made to increase awareness of the beneficial outcomes of PHS-IR organs to maximize appropriate donor allocation.

Clinical transplantation, Jan 19, 2018

Studies have demonstrated the Timed Up and Go Test's (TUGT) ability to forecast post-operativ... more Studies have demonstrated the Timed Up and Go Test's (TUGT) ability to forecast post-operative outcomes for several surgical specialties. Evaluations of TUGT for waitlist and post-transplant outcomes has yet to be examined in kidney transplantation. To assess the prognostic utility of TUGT and its associations with waitlist and post-transplant outcomes for kidney transplant candidates. Single-center, prospective study of 518 patients who performed TUGT during their transplant evaluation between 9/1/2013-11/30/2014. TUGT times were evaluated as a continuous variable or 3-level discrete categorical variable with TUGT times categorized as long (>9s), average (8-9s), or short (5-8s). Transplanted individuals had shorter TUGT times than those who remained on the waitlist (8.99 vs. 9.79 seconds, p<0.001). Bivariable and multivariable logistic regression showed that after adjusting for age, there was no association between TUGT times and probability of waitlist removal (OR 0.997[...

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, Jan 9, 2018

The United Network of Organ Sharing (UNOS) is charged with the efficient and equitable allocation... more The United Network of Organ Sharing (UNOS) is charged with the efficient and equitable allocation of all deceased donor solid organs transplanted in the United States, including >10,000 deceased donor kidneys (DDKs) annually. In late 2011, regulatory changes led the Social Security Administration to stop including state death records in the Death Master File (DMF) used by UNOS, among others, for patient status verification. This change resulted in the removal of 4.2 million records from the DMF and 1 million fewer added records annually. This article is protected by copyright. All rights reserved.

Kidney international, Jul 5, 2018

The proportion of deceased donor kidneys procured for transplant but subsequently discarded has b... more The proportion of deceased donor kidneys procured for transplant but subsequently discarded has been growing steadily in the United States, but factors contributing to the rising discard rate remain unclear. To assess the reasons for and probability of organ discard we assembled a cohort of 212,305 deceased donor kidneys recovered for transplant from 2000-2015 in the SRTR registry that included 36,700 kidneys that were discarded. 'Biopsy Findings' (38.2%) was the most commonly reported reason for discard. The median Kidney Donor Risk Index of discarded kidneys was significantly higher than transplanted organs (1.78 vs 1.12), but a large overlap in the quality of discarded and transplanted kidneys was observed. Kidneys of donors who were older, female, Black, obese, diabetic, hypertensive or HCV-positive experienced a significantly increased odds of discard. Kidneys from donors with multiple unfavorable characteristics were more likely to be discarded, whereas unilaterally di...

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, Jan 30, 2018

The impact of a new national kidney allocation system (KAS) on access to the national deceased-do... more The impact of a new national kidney allocation system (KAS) on access to the national deceased-donor waiting list (waitlisting) and racial/ethnic disparities in waitlisting among US end-stage renal disease (ESRD) patients is unknown. We examined waitlisting pre- and post-KAS among incident (N = 1 253 100) and prevalent (N = 1 556 954) ESRD patients from the United States Renal Data System database (2005-2015) using multivariable time-dependent Cox and interrupted time-series models. The adjusted waitlisting rate among incident patients was 9% lower post-KAS (hazard ratio [HR]: 0.91; 95% confidence interval [CI], 0.90-0.93), although preemptive waitlisting increased from 30.2% to 35.1% (P < .0001). The waitlisting decrease is largely due to a decline in inactively waitlisted patients. Pre-KAS, blacks had a 19% lower waitlisting rate vs whites (HR: 0.81; 95% CI, 0.80-0.82); following KAS, disparity declined to 12% (HR: 0.88; 95% CI, 0.85-0.90). In adjusted time-series analyses of p...

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, Jan 24, 2018

The volume of solid organ transplant in the United States is increasing, providing improved quali... more The volume of solid organ transplant in the United States is increasing, providing improved quality of life and survival for patients with organ failure. The growth of transplantation requires a systematized management of transplant outcomes assessment, especially with the movement towards value-based care. However, there are several challenges to analyzing outcomes in the current registry-based, transplant reporting system: (1) longitudinal data points are difficult to capture in outcomes models; (2) data elements are restricted to those that already exist in the registry data; (3) there is a delay in the release of outcomes report. In this article, we propose an informatics approach to solve these problems by utilizing a 'common data model' to integrate disparate data sources, data elements, and temporal data points. Adopting such a framework can enable multi-center outcomes analyses among transplant centers, nationally and internationally. This article is protected by cop...

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, Jan 15, 2018

We previously developed a mobile- and web-based decision aid (iChoose Kidney) that displays indiv... more We previously developed a mobile- and web-based decision aid (iChoose Kidney) that displays individualized risk estimates of survival and mortality, for the treatment modalities of dialysis versus kidney transplantation. We examined the effect of iChoose Kidney on change in transplant knowledge and access to transplant in a randomized controlled trial among patients presenting for evaluation in three transplant centers. A total of 470 patients were randomized to standard transplantation education (control) or standard education plus iChoose Kidney (intervention). Change in transplant knowledge (primary outcome) among intervention vs. control patients was assessed using 9-items in pre- and post-evaluation surveys. Access to transplant (secondary outcome) was defined as a composite of waitlisting, living donor inquiries, or transplantation. Among 443 patients (n=226 intervention; n=216 control), the mean knowledge scores were 5.1 ± 2.1 pre- and 5.8 ± 1.9 post-evaluation. Change in kno...

Clinical Journal of the American Society of Nephrology

American Journal of Kidney Diseases, 2017

Transplantation, Jan 28, 2015

Despite a significant survival advantage of kidney transplantation compared with dialysis, nearly... more Despite a significant survival advantage of kidney transplantation compared with dialysis, nearly one third of end-stage renal disease (ESRD) patients are not educated about kidney transplantation as a treatment option at the time of ESRD diagnosis. Access to individualized, evidence-based prognostic information is needed to facilitate and encourage shared decision making about the clinical implications of whether to pursue transplantation or long-term dialysis. We used a national cohort of incident ESRD patients in the US Renal Data System surveillance registry from 2005 to 2011 to develop and validate prediction models for risk of 1- and 3-year mortality among dialysis versus kidney transplantation. Using these data, we developed a mobile clinical decision aid that provides estimates of risks of death and survival on dialysis compared with kidney transplantation patients. Factors included in the mortality risk prediction models for dialysis and transplantation included age, race/e...

Transplantation, Jan 28, 2015

Despite a significant survival advantage of kidney transplantation compared with dialysis, nearly... more Despite a significant survival advantage of kidney transplantation compared with dialysis, nearly one third of end-stage renal disease (ESRD) patients are not educated about kidney transplantation as a treatment option at the time of ESRD diagnosis. Access to individualized, evidence-based prognostic information is needed to facilitate and encourage shared decision making about the clinical implications of whether to pursue transplantation or long-term dialysis. We used a national cohort of incident ESRD patients in the US Renal Data System surveillance registry from 2005 to 2011 to develop and validate prediction models for risk of 1- and 3-year mortality among dialysis versus kidney transplantation. Using these data, we developed a mobile clinical decision aid that provides estimates of risks of death and survival on dialysis compared with kidney transplantation patients. Factors included in the mortality risk prediction models for dialysis and transplantation included age, race/e...