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SCD Kidney Transplantation vs Dialysis Ups Survival in Older Patients

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“Patients aged 65 years or older on a waiting list for a kidney transplant may be better off waiting for a kidney from a standard criteria donor (SCD) than accepting one from an expanded criteria donor (ECD), according to recent study.

“The acceptance of an ECD transplant should be carefully balanced against the risks of continued dialysis while waiting for a better donor offer,” investigators Rachel Hellemans, MD, of Antwerp University Hospital in Edegem, Belgium, and colleagues wrote in Nephrology Dialysis Transplantation.

The study included 3808 adult Belgian patients, of whom 3382 received a kidney transplant and 426 were waitlisted and remained on dialysis. The investigators divided patients into 3 age groups: 22 to 44 (1006 patients), 45 to 64 (2213 patients), and 65 years or older (589 patients). The median waiting time on the active waiting list for transplantation while on dialysis was longest for patients aged 22 to 44 years (22.4 months, followed by 18 months for those aged 45 to 64 years, and 11.7 months for those aged 65 years or older.”

Read the full article, here.

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‘Amazing’ recovery of donations, transplant rate seen during pandemic

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Organ donation and kidney transplants have made an “amazing” recovery from the worst days of the pandemic, a speaker said here, with more than 33,000 kidney transplants performed in 2020.

“There were some parts of the Northeast where there were zero living donor transplants done for weeks,” Matthew Cooper, MD, director of Kidney and Pancreas Transplantation at Medstar Georgetown Transplant Institute and professor of surgery at Georgetown University School of Medicine, said during a presentation at the virtual National Kidney Foundation Spring Clinical Meetings. “It was amazing how the country regained … the key was getting organs to areas where transplants could happen.”

Read the full article, here.

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‘Heart in a Box’ Expands Transplant Opportunities

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The Smidt Heart Institute, Home of the Nation’s No. 1 Adult Heart Transplant Program, Uses Transmedics Organ Care System (OCS) to Grow Geographic Area of Service, Enabling More Lifesaving Organ Transplants

Dominic Emerson, MD, and Pedro Catarino, MD, both transplant surgeons with the Smidt Heart Institute, know how to be spontaneous. At any given moment, they can get the call that a donor heart or lungs are available, requiring them to quickly board a private aircraft to procure the vital organs.

Until recently, those flights were quick jaunts lasting no more than four hours—the time a donor heart can survive on ice. Now that is all changing, thanks to a medical device called the OCS Heart, or “Heart in a Box,” which enables transplant surgeons to travel to much farther destinations to procure lifesaving organs by acting as a miniature intensive care unit that keeps the heart alive.

“Cedars-Sinai has the biggest adult heart transplant program in the world and takes on some of the most complex surgical cases,” said Emerson, associate surgical director of heart transplant and mechanical circulatory support and surgical co-director of the Cardiac Surgery Intensive Care Unit at Cedars-Sinai. “The Heart in a Box technology is helping break down a major barrier of transplantation, ultimately offering many patients a second chance at life.”

Read more, here.

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Coronavirus (COVID-19) Information and Updates

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“Johns Hopkins Medicine researchers are working tirelessly to find ways to better understand, treat and eventually eliminate COVID-19 and the illness that results from infection. New discoveries and observations from Johns Hopkins that we share here, especially those related to clinical therapies, are almost uniformly early in concept. They will require rigorous research, testing and peer review before solid conclusions for clinical care and disease prevention can be made.

In addition, Johns Hopkins researchers are conducting a variety of clinical trials to find new ways to detect, prevent and treat COVID-19. These trials include studies involving Johns Hopkins employees, people who have COVID-19 and analysis of collected data about the illness. Results of these clinical trials will be available when data is analyzed, peer-reviewed and published.”

You can stay up to date on information and resources, here.

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Coronavirus antibody tests have had plenty of problems. Hopkins is developing a better, at-home version

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Plenty of people want to know whether they ever had COVID-19, and public officials need to know. But existing antibody tests that look for markers of the disease caused by the coronavirus have not met the challenge, with accuracy, cost and convenience problems.

Scientists at the Johns Hopkins University and elsewhere, however, are working on the next generation of these tests that can be done at home.

“We wanted to develop something you could use on your kids,” said Netz Arroyo, a Hopkins assistant professor of pharmacology and molecular sciences who joined with a biomedical engineer and a biophysicist to repurpose a common medical device to look for the virus.

“It would be easy and you may not even have to poke their finger every time,” he said. “Now you have to go to a lab and have a blood draw.”

Read the full article, here.

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New kidney and pancreas transplant allocation policies in effect

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“UNOS has implemented a new system for matching kidney and pancreas transplant candidates with organs from deceased donors.

The new approach is projected to increase equity in transplant access for candidates nationwide. It replaces distribution based on donation service area (DSA) and OPTN region with a more consistent measure of distance between the donor hospital and the transplant hospital for each candidate. This will further ensure the right organ gets to the right patient at the right time based on medical need rather than geography.

The policy was developed over nearly three years by organ donation and transplant experts, organ recipients and donor families from around the country, and input from thousands of people during three public comment cycles.

Kidney and pancreas offers will be offered first to candidates listed at transplant hospitals within 250 nautical miles of the donor hospital. Offers not accepted for any of these candidates will then be made for candidates beyond the 250 nautical mile distance.

Candidates also will receive proximity points based on the distance between their transplant program and the donor hospital. Proximity points are intended to improve the efficiency of organ placement by adding priority for candidates closer to the donor hospital. Candidates within the initial 250 nautical mile radius will receive a maximum of two proximity points, while those outside the initial circle will receive a maximum of four proximity points. The point assignment will be highest for those closest to the donor hospital and will decrease as the distance increases.”

Read all about the new policy, here.

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Immunocompromised And Concerned About The Vaccine? Here’s What You Need To Know

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“Lots of people have questions about getting vaccinated against COVID-19. That includes the millions of Americans with weakened immune systems that put them at higher risk of severe disease if they do get infected with the coronavirus.

“Patients want to know whether it’s safe to get it and, if they do get it, which one should they get? And of course, they also have concerns about how it can affect their own condition as well,” says Dr. Sharon Dowell, a rheumatologist at Howard University Hospital in Washington, D.C., who says she has been getting a barrage of questions from patients lately.

People can be immunocompromised for a wide range of reasons. Some are being treated with immunosuppressive medications for conditions such as rheumatoid arthritis, lupus, Crohn’s disease or psoriasis. Others are organ transplant recipients on powerful anti-rejection medications or cancer patients receiving chemotherapy.

Dowell and other doctors say vaccinating immunocompromised patients is especially important. But it also raises special considerations that these patients should discuss with their doctor beforehand. Here’s what you need to know.”

Read the full article, here.

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Outcomes among Transplant Recipients Hospitalized Due to COVID-19

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“Due to chronic immunosuppression as well as the presence of numerous comorbidities, the risk of developing severe COVID-19 may be high in kidney transplant recipients. Researchers in the United States, Italy, and Spain conducted a retrospective cohort study to examine the clinical outcomes among kidney transplant recipients to identify predictors of poor clinical outcomes. Results of the study were reported in the American Journal of Transplantation [2020;20(11):3140-3148].

The study was led by Paolo Cravedi, MD, PhD, division of nephrology, department of medicine, Icahn School of Medicine at Mount Sinai, New York, New York. The cohort included 144 kidney transplant recipients who were hospitalized due to COVID-19 at 12 transplant centers in North America and Europe. The 12 centers were participating in the TANGO International Transplant Consortium. All kidney transplant recipients ≥18 years of age with a functioning allograft who were admitted to a hospital between March 2 and May 15, 2020, were included.”

Read the full study, here.

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Cancer Patients and Transplant Recipients Need Both COVID-19 Vaccine Doses

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“Natural immunity and vaccine responses may be weaker in people with immune suppression, so they should get their second dose promptly

A majority of people with cancer and organ transplant recipients are capable of mounting an immune response to the SARS-CoV-2 coronavirus and can gain immunity from COVID-19 vaccines, according to recent research. But people with immune suppression may have slower and weaker responses to natural infection or vaccination, so it is especially important that they get their second dose on schedule.

People with serious immune suppression are at risk for more severe complications and death due to COVID-19. This group includes cancer patients who use immune-suppressing therapy, transplant recipients who take immunosuppressive drugs to prevent organ rejection and people with AIDS (advanced, uncontrolled HIV disease).

It is well known that immunosuppressed people can have weaker immune responses to natural infection and vaccination, but SARS-CoV-2 immunity in this population is not well understood. What’s more, cancer patients on treatment and other people with advanced immune suppression were generally excluded from COVID-19 vaccine trials (though people with well-controlled HIV could enroll).”

Read the full article, here.

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