Pancreas Kidney Research Articles

008. Massive Teratoma Attached to The Inferior Vena Cava and Abdominal Aorta in Pediatric Patient: A Case Report

Background: Massive teratomas are rare and complex tumors that can grow large and involve crucial structures, such as the inferior vena cava (IVC) and abdominal aorta. These tumors can be challenging to resect, especially in pediatric cases, due to their size and proximity to vital organs. Case: A 9-year-old boy was admitted with a history of an abdominal mass first detected at age 3. Over the years, the mass had progressively enlarged, initially the size of a grape and later the size of a tennis ball by age 6. Recent imaging, including CT scans, showed a retroperitoneal mass measuring approximately 20 x 10 cm with characteristics of a mature cystic teratoma. The mass was compressing surrounding structures, including the duodenum, pancreas, and left kidney, and was adherent to both the IVC and abdominal aorta. The surgical team performed a laparotomy with adhesiolysis, extensive tumor excision, and vascular repair. Vascular control was established, and the tumor was successfully removed, including sheared portions of the abdominal aorta, which required ligation and repair of the affected vessels. Conclusion: This case illustrates the complexity and challenges of managing massive retroperitoneal teratomas. Through a multidisciplinary approach, it was possible to achieve complete excision and ensure the patient’s recovery with no immediate complications.

Costs Analysis of Kidney Transplantation in Spain: Differences Between Regional Health Services

Background: For our society, chronic kidney disease is a major public health problem associated with high mortality, morbidity, reduced quality of life and a progressive increase in health costs. The aim of this study was to analyze and compare the current cost of kidney transplantation (KT) and kidney–pancreas transplantation (KPT) among the different Regional Health Services (RHS) in Spain. Methods: A descriptive comparative study analyzing the public prices of RHS in Spain. The Official Gazette of the different communities was consulted, where the latest available order on this type of cost was sought. A descriptive analysis was made of the stipulated cost of the KT and KPT, for each degree of severity, RHS, year of publication and cost calculation method. Mean cost and standard deviation were calculated. Results: KT prices were found for 15 of the 18 RHS (83.33%). The average cost of KT in Spain was €33,926.53 ± 6950.053 (range from €23,140.37 in the Canary Islands to €48,205.75 in Catalonia). For KPT, costs were found for 5 of the 18 RHS (27.8%). The mean cost of KPT was €65,792.38 ± 11,273.12 (ranging from €49,418.81 in Navarra to €78,363.20 in Andalusia). Conclusions: There is a large variability in KT and KPT costs in Spain between RHS. Our study underlines the importance of adopting standardized and updated costing methods for KT and KPT.

Tips for percutaneous nephrolithotomy for transplant kidney stone

IntroductionThe management of urinary tract stones, particularly de novo kidney allograft stones, presents unique challenges for kidney transplant recipients because of their prevalence and specific clinical considerations. Here, we describe a case in which percutaneous nephrolithotomy was successfully used to fragment a large kidney allograft stone ≥20 mm in size.Case presentationA 57‐year‐old woman who underwent ureteroureterostomy post simultaneous pancreas–kidney transplantation presented with gross hematuria after 15 years. Computed tomography revealed a 23‐mm stone in the transplanted kidney. Initial attempts at endoscopic combined intrarenal surgery were changed to percutaneous nephrolithotomy because of poor ureter mobility and tortuosity. Stone fragmentation was achieved using pneumatic and ultrasonic lithotripsy. A second procedure using Swiss LithoClast® Trilogy enabled complete stone clearance and ureteral stent placement.ConclusionBy understanding the peculiarities of the percutaneous approach, we demonstrated the safe and effective use of a pneumatic and ultrasonic lithotripter for kidney allograft stone fragmentation.

Adipose Tissue Can Have a Protective Effect on Outcome After Simultaneous Pancreas-Kidney Transplantation in Non-Obese Recipients.

BACKGROUND Obesity is suggested to impair the outcome after simultaneous pancreas-kidney transplantation, which affects survival, but the quantity and distribution of adipose tissue is not yet considered in obesity assessment. We aimed to evaluate the impact of body composition on outcome after simultaneous pancreas-kidney transplantation. MATERIAL AND METHODS We retrospectively analyzed data from 40 patients who underwent simultaneous pancreas-kidney transplantation due to type 1 diabetes mellitus with consecutive end-stage renal disease. Uni- and multivariate analyses, including donor's characteristics, were performed. RESULTS Only 6 (15%) recipients were obese. The incidence of postoperative complications was correlated with lower body fat proportion (p=0.03). This correlation remained significant in the multivariate analysis (p=0.015). Nevertheless, obesity was significantly associated with worse overall survival (p<0.001). Visceral tissue proportion was correlated with a higher level of glycated hemoglobin in long-term follow-up (p=0.003). CONCLUSIONS Fat quantity and distribution should be included in the assessment of obesity. A protective effect of adipose tissue was detected on outcome after simultaneous pancreas-kidney transplantation in normosthenic recipients, but obesity still appears to have a negative effect on outcome after transplantation. Visceral fat distribution can promote de novo diabetes mellitus.

Delayed peak antibody titers after the second dose of SARS-CoV-2 vaccine in solid organ transplant recipients: Prospective cohort study

Poor post-vaccination production of antibody against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a concern among solid organ transplant (SOT) recipients. Furthermore, the timing and kinetics of antibody titers after the second vaccine dose are unknown. We conducted a multicenter prospective observational study that included 614 SOT recipients: 460 kidney, 53 heart, 50 liver, 20 lung, and 31 simultaneous pancreas–kidney (SPK). The participants received two doses of the mRNA vaccine (Pfizer BNT162b2 or Moderna mRNA-1273), as indicated. Serum samples were collected before the first and second vaccinations and at 1, 3, and 6 months after the second vaccine dose, which were then assessed for SARS-CoV-2 antibodies. The overall seropositivity rate was 43% at 1 month after administration of the second vaccine dose; it gradually increased to 68% at 3 months after second dose administration and to 70% at 6 months. In addition, recipient of kidney, lung or SPK transplants had lower antibody titers at the 3- and 6-month time points than did the other recipients. SOT recipients acquired SARS-CoV-2 S-IgG antibodies slowly, and the peak titer differed significantly from that of the general population.

The Impact of Kidney/Pancreas Transplantation on Peripheral Arterial Disease.

It is unclear whether kidney/pancreas (KP) transplantation will prevent the progression of peripheral arterial disease (PAD) in patients with insulin dependent diabetes (IDDM) and end-stage renal disease. We sought to determine the pre- and posttransplant prevalence of symptomatic PAD and changes in carotid artery intima-media thickness (IMT) in KP recipients. In this single center study, outcomes were compared between KP recipients with and without a history of PAD. A subset of recipients underwent pre- and posttransplant IMT measurements. Among the study group (N = 107), 18 (17%) recipients admitted to a pretransplant history of symptomatic PAD, comprised 11 foot infections and 7 amputations (5 minor and 2 major). Baseline characteristics of age, gender, race, years of diabetes, dialysis history, smoking history, years of hypertension, and history of coronary artery disease (CAD) were equivalent between PAD and non-PAD cohorts. At a median follow-up of 60 months (IQR: 28, 110), 16 (15%) KP recipients had suffered a PAD event. In multivariate analysis, a pretransplant history of PAD (hazard ratio [HR] 9.66, p < 0.001) and CAD (HR 3.33, p = 0.04) were independent predictors of posttransplant PAD events. Among a subset of 20 recipients (3 with PAD), mean IMT measurements pretransplant and at a median of 24 (range 18-24) months posttransplant, showed no evidence of disease progression. Based on IMT measurements and clinical results, KP transplantation stabilized PAD in most patients, but did not alter outcomes of symptomatic PAD recipients. A pretransplant history of PAD and CAD was an independent predictor of posttransplant PAD events.

1092 Perioperative Practices and Early Post-Transplant Outcomes in Deceased Donor Simultaneous Kidney Pancreas Transplants (SPK): Results of a National Transplant Access to Theatre (NTACT) Audit

1092 Perioperative Practices and Early Post-Transplant Outcomes in Deceased Donor Simultaneous Kidney Pancreas Transplants (SPK): Results of a National Transplant Access to Theatre (NTACT) Audit

Free-breathing motion corrected magnetic resonance elastography of the abdomen.

Magnetic resonance elastography (MRE) is a non-invasive method to measure the viscoelastic properties of tissue and has been applied in multiple abdominal organs. However, abdominal MRE suffers from detrimental breathing motion causing misalignment of structures between repeated acquisitions for different MRE dimensions (e.g., motion encoding directions and wave phase offsets). This study investigated motion correction strategies to resolve all breathing motion on sagittal free-breathing MRE acquisitions in a phantom, in healthy volunteers and showed feasibility in patients. First, in silico experiments were performed on a static phantom dataset with simulated motion. Second, eight healthy volunteers underwent two sagittal MRE acquisitions in the pancreas and right kidney. The multi-frequency free-breathing spin-echo echo-planar-imaging (SE-EPI) MRE consisted of four frequencies (30, 40, 50, 60 Hz), eight wave-phase offsets, with 3 mm3 isotropic voxel size. Following data re-sorting in different number of motion states (4 till 12) based on respiratory waveform signal, three intensity-based registration methods (monomodal, multimodal, and phase correlation) and non-rigid local registration were compared. A ranking method was used to determine the best registration method, based on seven signal-to-noise and image quality measures. Repeatability was assessed for no motion correction (Original) and the best performing method (Best) using Bland-Altman analysis. Lastly, the best motion correction method was compared to no motion correction on patient MRE data [pancreatic ductal adenocarcinoma (PDAC, n=5) and metabolic dysfunction-associated steatotic liver disease (MASLD) (n=1)]. In silico experiments showed a deviation of shear wave speed (SWS) with simulated motion to the ground truth, which was (partially) resolved using motion correction. In healthy volunteers ranking resulted in the best motion correction method of monomodal registration using nine motion states, while no motion correction was ranked last. Limits of agreement were (-0.18, 0.14), and (-0.25, 0.18) m/s for Best and Original, respectively. Using motion correction in patients resulted in a significant increase in SWS in the pancreas (Original: 1.39±0.10 and Best: 1.50±0.17 m/s). After motion correction PDAC had a mean SWS of 1.56±0.27 m/s (Original: 1.42±0.25 m/s). The fibrotic liver mean SWS was 2.07±0.20 m/s (Original: 2.12±0.18 m/s). Motion correction in sagittal free-breathing abdominal MRE results in improved data quality, inversion precision, repeatability, and is feasible in patients.

Increase in lumbar spine but not distal radius bone mineral density in adults after pancreas kidney transplantation

Osteoporosis occurs in every third individual after simultaneous pancreas kidney transplantation (SPKT). Currently used bone measures insufficiently predict their fracture risk. Lumbar spine Trabecular bone score (TBS) and distal radius areal and volumetric bone mineral density (BMD) were monitored for the first time in patients with type 1 diabetes and chronic renal failure after SPKT with steroid-sparing protocol. In 33 subjects (mean age 43.4 ± 9.8 years), dual-energy X-ray absorptiometry and peripheral quantitative computed tomography were performed just after SPKT (baseline) and one and three years later. While TBS Z-scores increased (−1.1 ± 1.2 and −0.3 ± 1.0; p˂0.001, at baseline and year three, respectively), trabecular volumetric BMD Z-scores at distal radius metaphysis did not change during the study (−1.3 ± 1.3 and −1.3 ± 1.0; p = 0.38). Similarly, areal BMD Z-scores increased at lumbar spine, total hip and femoral neck (all p < 0.01), but not at the distal radius. SPKT induced bone measures' improvement at lumbar spine and hip but not at distal radius. Before suggesting changes in current clinical care, predictive value of individual bone measures or its combination for fracture risk assessment remains to be elucidated.

WCN24-332 Single Center Experience of Simultaneous Kidney Pancreas Transplants: Benefit for Type 2 Diabetic CKD Patients

WCN24-332 Single Center Experience of Simultaneous Kidney Pancreas Transplants: Benefit for Type 2 Diabetic CKD Patients

O172: Donor blood tests and pancreas outcome in simultaneous pancreas kidney transplantation, a national cohort study

Abstract Introduction Simultaneous pancreas-kidney (SPK) transplantation improves quality of life in people with diabetes and end-stage renal disease, and limits the progression of diabetes related complications. Many surgeons are reluctant to accept the pancreas of a donor with raised amylase, due to concern of potentially inferior outcomes. We aim to ascertain whether donor amylase and liver blood tests (a marker of visceral ischaemic injury) predict pancreas transplant outcome. Methods This retrospective cohort study used the NHS registry on adult SPK transplantation (2016-2021). Adjusted regressions models assessed the effect of donor amylase and liver blood tests on pancreas transplant outcome. Results 857 SPK recipients were included (619 following brainstem death, 238 following circulatory death). Peak donor amylase ranged from 8-3300U/L (median=70). Donor peak amylase had no significant impact on pancreas graft survival when adjusting for multiple confounders (aHR=0.944, 95% CI=0.754-1.81). Median peak alanine transaminase and aspartate transaminase was 67U/L and 72U/L (range 8-5930 and 0-7910U/L). Neither of these influenced pancreas graft survival in multivariable models (aHR=0.967, 95% CI=0.848-1.102 and aHR=0.908, 95% CI=0.771-1.070, respectively). Restricted cubic splines were used to assess the relationship between donor blood tests and pancreas graft survival without assuming linear relationships; these confirmed neither amylase, nor transaminases, significantly impact on pancreas transplant outcome. Conclusions Donor amylase and transaminases do not predict transplant outcomes. Therefore, raised donor amylase or transaminases should not be considered a barrier to organ utilisation. The use of pancreas grafts from donors with hyperamylasaemia is a safe, immediate, and simple approach to expand the donor pool.

Incidence, Risk Factors, and Outcomes of Posttransplant Erythrocytosis Among Simultaneous Pancreas-Kidney Transplant Recipients.

Posttransplant erythrocytosis (PTE) is a well-known complication of kidney transplantation. However, the risk and outcomes of PTE among simultaneous pancreas-kidney transplant (SPKT) recipients are poorly described. We analyzed all SPKT recipients at our center between 1998 and 2021. PTE was defined as at least 2 consecutive hematocrit levels of >51% within the first 2 y of transplant. Controls were selected at a ratio of 3:1 at the time of PTE occurrence using event density sampling. Risk factors for PTE and post-PTE graft survival were identified. Of 887 SPKT recipients, 108 (12%) developed PTE at a median of 273 d (interquartile range, 160-393) after transplantation. The incidence rate of PTE was 7.5 per 100 person-years. Multivariate analysis found pretransplant dialysis (hazard ratio [HR]: 3.15; 95% confidence interval [CI], 1.67-5.92; P < 0.001), non-White donor (HR: 2.14; 95% CI, 1.25-3.66; P = 0.01), female donor (HR: 1.50; 95% CI, 1.0-2.26; P = 0.05), and male recipient (HR: 2.33; 95% CI, 1.43-3.70; P = 0.001) to be associated with increased risk. The 108 cases of PTE were compared with 324 controls. PTE was not associated with subsequent pancreas graft failure (HR: 1.36; 95% CI, 0.51-3.68; P = 0.53) or kidney graft failure (HR: 1.16; 95% CI, 0.40-3.42; P = 0.78). PTE is a common complication among SPKT recipients, even in the modern era of immunosuppression. PTE among SPKT recipients was not associated with adverse graft outcomes, likely due to appropriate management.

Impact of removing donation service area and region from pancreas allocation

On March 15, 2021, the Organ Procurement and Transplantation Network (OPTN) replaced donation service area (DSA) and OPTN region as units of pancreas (PA) allocation with a 250 nautical mile (NM) circle with proximity points. We analyzed OPTN data for kidney-pancreas (KP) and PA candidates, transplants, and donors in the 2 years pre-policy (March 16, 2019, to March 14, 2021) and post-policy (March 15, 2021, to March 14, 2023). As expected, more transplants occurred at hospitals outside the recovering organ procurement organization’s DSA post-policy (KP: 32.1% vs 57.3%, P < .001; PA: 61.6% vs 69.3%, P = .09), but the majority stayed within 250 NM (KP: 79.7% vs 85.0%, P < .001; PA: 55.4% vs 61.5%, P = .19). Median preservation time increased from 9.5 to 10.3 hours for KP (P < .001); there was little change for PA (8.5 vs 8.6 hours; P = .99). There were no statistically significant differences in 1-year posttransplant patient mortality or graft failure after implementation for KP (mortality: 3.6% vs 3.2%, P = .60; kidney graft failure: 4.9% vs 5.0%, P = .95; PA graft failure: 9.5% vs 8.9%, P = .65) or PA (mortality: 1.7% vs 2.2%, P = .72; PA graft failure: 12.2% vs 12.6%, P = .88). The removal of DSA and OPTN region from PA allocation has resulted in broader distribution with minimal impact on preservation time or posttransplant outcomes.

Disparities Persist Among Hispanic Patients: Completing Evaluation, Waitlisting, and Receiving a Kidney Transplant.

Hispanic patients receive disproportionately fewer kidney transplants (KT) than non-Hispanic White (NHW) patients. In this observational study, we evaluated disparities in completing evaluation steps to KT among Hispanic patients. Using medical records of Hispanic and NHW patients initiating evaluation at 4 transplant centers from January 2011 to March 2020, we performed sequential Cox models to compare Hispanic versus NHW patients reaching each step of the evaluation process until receiving a KT. Among all 5197 patients (Hispanic n = 2473; NHW n = 2724) initiating evaluation, Hispanic patients had 8% lower risk to be approved by the kidney pancreas (KP) committee than NHW patients (adjusted hazard ratio [aHR], 0.92; 95% confidence intervals (CI), 0.86-0.98; P = 0.015). Among 3492 patients approved by the KP committee, Hispanic patients had 13% lower risk to be waitlisted than NHW patients (aHR, 0.87; 95% CI, 0.81-0.94; P = 0.004). Among 3382 patients who were waitlisted, Hispanic patients had 11% lower risk than NHW patients to receive KT (aHR, 0.89; 95% CI, 0.81-0.97; P = 0.011). Among all patients initiating evaluation, Hispanic patients had a 16% lower risk than NHW patients to reach KT (aHR, 0.84; 95% CI, 0.76-0.92; P = 0.0002). Our study found that disproportionately fewer Hispanic patients were approved by the KP committee, were waitlisted, and received a KT, particularly a living donor kidney transplant, than NHW patients. Closer oversight of the evaluation process may help patients overcome challenges in access to KT.

Should Transplant Nephrology Pursue Recognition from the Accreditation Council for Graduate Medical Education (ACGME)?

Kidney transplant is not only the best treatment for patients with advanced kidney disease but it also reduces health care expenditure. The management of transplant patients is complex as they require special care by transplant nephrologists who have expertise in assessing transplant candidates, understand immunology and organ rejection, have familiarity with perioperative complications, and have the ability to manage the long-term effects of chronic immunosuppression. This skill set at the intersection of multiple disciplines necessitates additional training in Transplant Nephrology. Currently, there are more than 250,000 patients with a functioning kidney allograft and over 100,000 waitlisted patients awaiting kidney transplant, with a burgeoning number added to the kidney transplant wait list every year. In 2022, more than 40,000 patients were added to the kidney wait list and more than 25,000 received a kidney transplant. The Advancing American Kidney Health Initiative, passed in 2019, is aiming to double the number of kidney transplants by 2030 creating a need for additional transplant nephrologists to help care for them. Over the past decade, there has been a decline in the Nephrology-as well Transplant Nephrology-workforce due to a multitude of reasons. The American Society of Transplantation Kidney Pancreas Community of Practice created a workgroup to discuss the Transplant Nephrology workforce shortage. In this article, we discuss the scope of the problem and how the Accreditation Council for Graduate Medical Education recognition of Transplant Nephrology Fellowship could at least partly mitigate the Transplant Nephrology work force crisis.

Effect of the Relationship between Respiratory Interval and Temporal Resolution on Image Quality in Free-breathing Abdominal MR Imaging.

To evaluate how the relationship between respiratory interval (RI) and temporal resolution (TR) impacts image quality in free-breathing abdominal MRI (FB-aMRI) using golden-angle radial sparse parallel (GRASP). Ten healthy volunteers (25.9 ± 2.5 years, four women) underwent 2 mins free-breathing fat-suppression T1-weighted imaging using GRASP at RIs of 3 and 5s (RI3 and RI5, respectively) and retrospectively reconstructed at TR of 1.8, 2.9, 4.8, and 7.7s (TR1.8, TR2.9, TR4.8, and TR7.7, respectively) in each patient. The standard deviation (SD) under the diaphragm was measured using SD maps showing the discrepancy for each horizontal section at all TRs. Two radiologists evaluated image quality (visualization of the right hepatic vein at the confluence of the inferior vena cava, posterior segment branch of portal vein, pancreas, left kidney, and artifacts) at all TRs using a 5-point scale. The SD was significantly higher at TR1.8 compared to TR4.8 (P < 0.01) and TR7.7 (P < 0.001), as well as at TR2.9 compared to TR7.7 (P < 0.01) for both RIs. The SD between TR4.8 and TR7.7 did not differ for both RIs. For all visual assessment metrics, the TR1.8 scores were significantly lower than the TR4.8 and TR7.7 scores for both RIs. The pancreas and left kidney scores at TR2.9 were significantly lower than those at TR7.7 (P < 0.05) for RI5. Additionally, the left kidney score at TR1.8 was lower than that at TR2.9 (P < 0.05) for RI3. All scores at TR2.9, TR4.8, and TR7.7 were similar for RI3, while those at TR4.8 and TR7.7 were similar for RI5. Prolonging the TRs compared to RIs enhances image quality in FB-aMRI using GRASP.

The influence of socioeconomic deprivation on outcomes in transplant patients infected with SARS-CoV-2 in Wales.

SARS-CoV-2 infection has had a significant impact on vulnerable individuals including transplant patients. Socioeconomic deprivation negatively affects outcomes of many health conditions. The aim of this study was to evaluate the effect of socioeconomic deprivation on the incidence and severity of SARS-CoV-2 infection among Welsh transplant patients. This study is a retrospective, cross-sectional study on the transplant population of Wales. The Welsh Index of Multiple Deprivation (WIMD) was used to assess the influence of socioeconomic deprivation on outcomes of Welsh transplant patients who developed SARS-CoV-2 infection. Outcome measures were the incidence of SARS-CoV-2 infection, rates of hospital and ICU admission, development of acute kidney injury (AKI) and mortality. A logistic binomial regression analysis was used to correlate the various risk factors with the incidence of SARS-CoV-2 infection. Two hundred and sixty-six (25%) of regular follow up patients had SARS-CoV-2 infection; of these 55 (20.7%) were admitted, 15 (5.6%) to ICU, 37 (13.9%) developed AKI, and 23 (8.6%) died. In a regression analysis, patients of younger age were associated with more (p=.001) and those with SPK (simultaneous pancreas kidney) transplant less chance of infection (p=.038), whereas social deprivation was not associated with the chance of infection (p=.14). In regression analysis increased social deprivation was associated with higher chance of AKI post SARS-CoV-2 (p=.049). Socioeconomic deprivation did not affect the rates or severity of SARS-CoV-2 infection apart from the degree of AKI in Welsh Transplant patients. Adherence to the preventive measures for this high-risk population must continue to remain a priority.

Structural Elucidation and Relative Quantification of Fatty Acid Double Bond Positional Isomers in Biological Tissues Enabled by Gas-Phase Charge Inversion Ion/Ion Reactions.

Fatty acids (FAs) contain a vast amount of structural diversity, and differences in fatty acid structure have been associated with various disease states. Accurate identification and characterization of fatty acids is critical to fully understand the biochemical roles these compounds play in disease progression. Conventional tandem mass spectrometry (MS/MS) workflows do not provide sufficient structural information, necessitating alternative dissociation methods. Gas-phase charge inversion ion/ion reactions can be used to alter the ion type subjected to activation to provide improved or complementary structural information. Herein, we have used an ion/ion reaction between fatty acid (FA) anions and magnesium tris-phenanthroline [Mg(Phen)3] dications to promote charge remote fragmentation of carbon-carbon bonds along the fatty acid chain, allowing for localization of carbon-carbon double bond (C=C) positions to successfully differentiate monounsaturated fatty acid isomers. Relative quantification was also performed to obtain the relative abundance of fatty acid isomers in different biological tissues. For example, the relative abundance of FA 18:1 (9) was determined to vary across regions of rat brain, rat kidney, and mouse pancreas, and FA 16:1 (9) was found to have a higher relative abundance in the dermis layer compared to the sebaceous glands in human skin tissue.

Increasing Access to Kidney Transplantation for Black and Asian Patients Through Modification of the Current A2 to B Allocation Policy.

The rate of A2 to B incompatible (ABO-i) kidney transplant continues to be low despite measures in the new Kidney Allocation System (KAS) to facilitate such transplants. This paper shows how the number of ABO-i transplants could increase if KAS policies were utilized to their fullest extent through a boost in ABO-i priority points. Predicting transplant outcomes using the Kidney Pancreas Simulated Allocation Model (KPSAM), preloaded with national data of 2010. We used this simulation to compare KAS to a new intervention in which priority equal to cPRA=100 has been given to blood type B candidate who are willing to accept an A blood type organ. The number of African American recipients increased by 375 (from 35% of recipient population to 38.7%), the number of blood type B African Americans increased by 65 (from 8% of recipient population to 9%), and the number of blood type B African Americans receiving blood type A kidneys increased by 49 (from 2% of recipient population to 2.5%). The same change occurred for Asians, particularly blood type B Asians (from 0.54% of the recipient population to 0.7%). Average wait time notably decreased by 27 days for blood type B African Americans. In the proposed scenario, 263 blood type B African Americans received blood type A organ (2.5% of recipient population) while only 181 (1.1%) of such transplants were performed in 2021. These results signify a considerable opportunity loss of ABO-i transplants for African American patients. If this policy was universally adopted, we would expect to see an overall increase of A2 to B transplantation, but in reality, not all centers perform ABOi transplantation. Thus, adopting this policy would incentivize other centers to perform more subtyping of A-type kidneys, and it would increase access to organs for blood type B Asian and African Americans in centers where ABOi transplantation already takes place.

Disseminated Intravascular Coagulation in the Immediate Postoperative Period After a Simultaneous Kidney Pancreas Transplant (SPK)

Disseminated Intravascular Coagulation in the Immediate Postoperative Period After a Simultaneous Kidney Pancreas Transplant (SPK)