J. McGillicuddy - Academia.edu (original) (raw)

Papers by J. McGillicuddy

American Journal of Transplantation

Progress in Transplantation, 2015

Background-Reasons underlying disparities in outcomes in liver resections between patients who ar... more Background-Reasons underlying disparities in outcomes in liver resections between patients who are African American and patients who are not are poorly understood. Methods-An observational longitudinal cohort study was performed. Clinical data were collected from medical records of 166 patients (59 African American, 107 not) undergoing partial hepatectomy between 2004 and 2012. Univariate and multivariate analyses were performed. Results-African Americans patients undergoing partial hepatectomy were more likely to be female, heavier, have hemangiomas or adenomas, and have hepatic steatosis on explant. Intraoperatively, African Americans had longer surgical times, higher estimated blood loss, and greater use of blood products. Major postoperative complications were significantly more common in African Americans. Multivariable modeling demonstrated that race, history of hepatitis C, and estimated blood loss were the only variables that were independently associated with a major complication; however, baseline serum creatinine level was the only variable that significantly modified the effect of race on complications. Conclusions-African Americans with normal serum creatinine levels had a similar rate of complication to patients who were not African American, but as the baseline serum level of creatinine increased, the odds ratio for a complication developing increased dramatically in the African American patients, suggesting that the disparities seen are predominantly driven by a subset of African American patients who have preexisting renal insufficiency.

Transplantation proceedings

Hepatic artery thrombosis (HAT) remains among the leading causes of early graft loss after liver ... more Hepatic artery thrombosis (HAT) remains among the leading causes of early graft loss after liver transplantation. Our transplant center began using universal aspirin prophylactic therapy immediately posttransplantation in 2007. The aim of this study was to determine the safety and efficacy of early aspirin therapy on clinical outcomes. This large-scale, cross-sectional analysis included all adult liver transplantations performed between 2000 and 2009. Pediatric and multiorgan transplants were excluded. Patients were grouped and compared based on whether they received early initiation of aspirin 325 mg PO daily posttransplantation. A total of 541 adult liver transplantations occurred during the study period; 439 had complete documentation and were analyzed. Clinical outcomes show aspirin patients had similar rates of early and late HAT, but had significantly lower early HAT, defined as HAT occurring within the first 30 days posttransplant, leading to graft loss. Other clinical outcom...

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2006

We appreciate Dr. Helling's very thoughtful letter (1) regarding our recently published descripti... more We appreciate Dr. Helling's very thoughtful letter (1) regarding our recently published description of a nearcatastrophic Endocatch-related injury to the kidney during laparoscopic donor nephrectomy. While we wholeheartedly agree with his conclusion that the single-surgeon Endocatch technique can, with appropriate care, be used very safely, we would like to take this opportunity to clarify a few salient points. First, our technique does not involve placing the kidney into the Endocatch bag prior to vessel transection, but only after both the vessels and ureter have been divided (2). Second, it is critical that care be taken to ensure that the entirety of the ureter is contained within the Endocatch bag to avoid the possibility of stripping the ureter. This has previously been described in the original series by Ratner et al. (3). Lastly, the injury described in our case report did not occur during retraction of the metal ring, but on attempted extraction of the bagged kidney with the ring still deployed. Our failure to retract the metal ring prior to bag extraction was likely the critical error. While in the vast majority of cases the extended ring and bagged kidney can be extracted without difficulty, in the very rare instance that problems arise, having the extended ring in the abdomen with the bagged kidney is a potential source of serious injury.

Journal of the South Carolina Medical Association (1975), 2008

Transplantation Proceedings, 2009

The aim of this study was to determine whether ethnicity impacts graft outcomes in kidney transpl... more The aim of this study was to determine whether ethnicity impacts graft outcomes in kidney transplant patients converted to sirolimus (SRL) and maintained on either calcineurin inhibitors (CI) or mycophenolate mofetil (MMF) with steroids. This study analyzed kidney transplants converted to SRL and transplanted between July 1991 and April 2007. Patients were divided into 4 groups: group 1: African-Americans converted to SRL + CI; group 2: non-African-Americans converted to SRL + CI; group 3: African-Americans converted to SRL + MMF; group 4: non-African-Americans converted to SRL + MMF. A total of 242 patients was included. Demographics, baseline immunosuppression, and reason for SRL conversion were similar among groups. Patients converted to SRL + CI regimens had significantly higher rates of acute rejection before SRL conversion, but equal rates after conversion. Development of proteinuria was similar across groups. African-American patients converted to SRL + MMF tended to have poorer outcomes compared with African-American patients converted to SRL + CI. Non-African-American patients converted to SRL + MMF tended to have better graft outcomes compared with non-African-American patients converted to SRL + CI. African-Americans converted to SRL may benefit from continued CI, whereas non-African-Americans converted to SRL seem to have better outcomes with MMF. Further prospective studies are warranted to confirm these findings.

Therapeutic Drug Monitoring, 2013

There is limited data analyzing the pharmacokinetic (PK) and pharmacodynamic (PD) properties of e... more There is limited data analyzing the pharmacokinetic (PK) and pharmacodynamic (PD) properties of everolimus (EVR) between African Americans and Caucasians. The purpose of this study was to determine and compare the EVR PKs and concentration-associated efficacy and toxicity in African American and Caucasian adult kidney transplant recipients. This was a retrospective PK and PD analysis of all patients who received EVR at the Medical University of South Carolina Transplant Center between 2006 and 2012. Forty-three patients received EVR (22 African Americans, 21 Caucasians). Baseline demographics, immunosuppression, and immunologic risk were similar between races, except for preexisting hypertension, deceased donor type, and cold ischemic time, which were higher in African American patients. PK analysis revealed that African American patients received higher initial EVR doses (2.1 ± 0.8 versus 1.6 ± 0.6 mg/d, P = 0.036), leading to higher early EVR concentrations (EVR &amp;amp;amp;amp;amp;amp;amp;gt;6 ng/mL during the first 60 days: 36% versus 10%, P = 0.037). Efficacy analysis demonstrated similar EVR effects on acute rejection rates (9% versus 10%, P = 0.961), chronic allograft changes (18% versus 14%, P = 0.729), and renal function, with both groups having improved creatinine clearance with EVR therapy (ΔeGFR: 27 versus 12 mL·min·1.73 m). Toxicity analysis demonstrated that African American patients had a trend toward higher rates of EVR discontinuation (46% versus 19%, P = 0.065) and significantly more diarrhea/gastrointestinal intolerance (73% versus 38%, P = 0.022). These results demonstrate EVR therapy is effective at preventing rejection and improving graft function in both African American and Caucasian adult renal transplant patients. Conflicting with previous mammalian target of rapamycin PK/PD analyses in African American patients, this study cohort demonstrated higher early EVR levels in the African American patients.

Journal of the American College of Surgeons, 2014

Public reporting of patient and graft outcomes in a national registry and close Centers for Medic... more Public reporting of patient and graft outcomes in a national registry and close Centers for Medicare and Medicaid Services oversight has resulted in transplantation being a highly regulated surgical discipline. Despite this, transplantation surgery lacks comprehensive tracking and reporting of perioperative quality measures. Therefore, the aim of this study was to determine the association between a kidney transplantation centers&amp;amp;amp;amp;amp;amp;amp;#39; perioperative quality benchmarking and graft and patient outcomes. This was an analysis of 2011 aggregate data compiled from 2 national datasets that track outcomes from member hospitals and transplantation centers. The transplantation centers included in this study were composed of accredited US kidney transplantation centers that report data through the national registry and are associate members of the University HealthSystem Consortium. A total of 16,811 kidney transplantations were performed at 236 centers in the United States in 2011, of which 10,241 (61%) from 93 centers were included in the analysis. Of the 6 perioperative quality indicators, 3 benchmarked metrics were significantly associated with a kidney transplantation center&amp;amp;amp;amp;amp;amp;amp;#39;s underperformance: mean ICU length of stay (C-statistic 0.731; p = 0.002), 30-day readmissions (C-statistic 0.697; p = 0.012) and in-hospital complications (C-statistic 0.785; p = 0.001). The composite quality index strongly correlated with inadequate center performance (C-statistic 0.854; p &amp;amp;amp;amp;amp;amp;amp;lt; 0.001, R(2) = 0.349). The centers in the lowest quartile of the quality index performed 2,400 kidney transplantations in 2011, which led to 2,640 more hospital days, 4,560 more ICU days, 120 more postoperative complications, and 144 more patients with 30-day readmissions, when compared with centers in the 3 higher-quality quartiles. An objective index of a transplantation center&amp;amp;amp;amp;amp;amp;amp;#39;s quality of perioperative care is significantly associated with patient and graft survival.

Journal of Surgical Research, 2014

Clinical Transplantation, 2010

African Americans (AA) have higher rejection rates and poorer graft outcomes compared to non-AAs.... more African Americans (AA) have higher rejection rates and poorer graft outcomes compared to non-AAs. Induction therapy is yet unproven in this high risk population. This retrospective study compared the efficacy of induction therapy [IL-2 receptor antibodies (IL2RA) or thymoglobulin] vs. no induction. One hundred and seventy-five AA patients were included in this analysis. Patients were well matched for demographic and immunologic characteristics in the non-induction and IL2RA induction groups; the Thymoglobulin induction group had significantly higher risk patients. Significantly fewer episodes of acute rejection occurred at one yr in patients treated with thymoglobulin and IL2RA vs. no induction (18% vs. 47%, p = 0.003, 26% vs. 47%, p = 0.02). Three yr graft survival was significantly improved in the IL2RA group compared to the non-induction group (85% vs. 68%, p = 0.032). Despite the thymoglobulin group being at high risk, they had similar graft survival rates compared to both the IL2RA group (76% vs. 85%, p = 0.18) and the non-induction group (76% vs. 68%, p = 0.48). Multivariate analysis demonstrated that induction therapy (combining IL2RA and thymoglobulin) independently reduced the risk of both acute rejection and graft loss. The use and type of induction therapy in AA patients significantly reduces acute rejection rates and may improve long-term graft outcomes in AA patients.

Clinical Journal of the American Society of Nephrology, 2012

BK virus is an infection in kidney transplantation patients jeopardizing graft survival. Unfortun... more BK virus is an infection in kidney transplantation patients jeopardizing graft survival. Unfortunately, there is no consensus on treatment of BK viremia and nephropathy. Leflunomide has been studied for the treatment of BK viremia and nephropathy, but there are limited data on the utility of leflunomide therapeutic drug monitoring. This study aimed to determine if a pharmacodynamic relationship exists between BK viral load reduction and leflunomide metabolite, A77 1726, serum concentrations. This study was a retrospective, single-center, longitudinal analysis of patients identified with BK viremia with or without nephropathy. Patients were grouped according to whether they received leflunomide. All BK viral PCR and A77 1726 concentrations were analyzed to determine pharmacodynamics, and were correlated with clinical outcomes. Of 76 patients identified, 52 received leflunomide therapy and 24 did not. Patients who received leflunomide were further analyzed according to A77 1726 concentrations and BK clearance; there was no difference in BK clearance. There was a lack of correlation between A77 1726 concentrations and log change in BK viral PCR concentration. Multivariate analysis demonstrated that mycophenolate mofetil discontinuation, BK viremia without nephropathy, and mean BK viral load were significantly associated with BK viral clearance; leflunomide use lacked this association. Pharmacodynamic analysis revealed no association between A77 1726 concentrations and BK viral PCR reductions. Multivariate analysis demonstrated that leflunomide therapy was not associated with BK viral clearance. Randomized studies are needed to determine the utility of leflunomide for BK viremia and nephropathy.

Transplant International, 2010