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Heart Transplant: A Slightly More Level Playing Field Under New UNOS System

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“Recent changes to U.S. donor heart allocation were followed by a narrowing of racial disparities in listing and transplant, though much more work remains to eliminate inequality, researchers warned.

Black patients listed for cardiac transplantation in 2011-2020 were less likely than white peers to die while waiting (adjusted HR 0.88, 95% CI 0.78-0.98). However, they ultimately had lower odds of undergoing transplant (adjusted HR 0.87, 95% CI 0.84-0.90) and a higher risk of post-transplant death (adjusted HR 1.14, 95% CI 1.04-1.24), reported P. Elliott Miller, MD, of Yale School of Medicine in New Haven, Connecticut, and colleagues.”

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For 2 Ga. Couples, a Transplant Created an Unbreakable Bond: ‘We’re the Kidney Warrior Family’

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“Tia Wimbush and Susan Ellis were coworkers for years at Children’s Healthcare of Atlanta, and while friendly to each other at work, they rarely interacted in the large IT department. But in March, the two became bonded for life when Tia donated her kidney to Susan’s husband Lance, and Susan donated her kidney to Tia’s husband Rodney.   

It all began with a chance encounter in the company restroom, and an introduction through another woman at work who knew that Tia’s husband Rodney had experienced sudden kidney failure in 2019 and that Susan’s husband Lance, who had long battled the disease, was in the same situation. Soon, they began to share what Ellis calls “a connection of sisterhood” after learning both their husbands had end-stage kidney disease and were on dialysis.”

Read full story, here.

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FDA OKs New Drug for CKD-Related Pruritus

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“The FDA approved difelikefalin (Korsuva) on Monday for treating pruritus in chronic kidney disease (CKD) patients, Cara Therapeutics and Vifor Pharma announced.

Difelikefalin is a first-in-class kappa opioid receptor (KOR) agonist that targets the peripheral nervous system, according to the two companies. Administered as an injection (0.5 μg/kg three times per week), the drug is indicated for moderate-to-severe pruritus in CKD patients on hemodialysis — the first therapy approved in this setting.”

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Can Liver Donor Biomarker Predict Liver Transplant Rejection?

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“The biomarker, class I human leukocyte antigen (HLA) evolutionary divergence (HED), was tied to liver transplant rejection in adults and children, French researchers found.

In a retrospective study, adult-donor class I HED was associated with acute liver transplant rejection (HR 1.09, 95% CI 1.03-1.16) and chronic rejection (HR 1.20, 95% CI 1.10-1.31), in addition to 50% or greater ductopenia (HR 1.33, 95% CI 1.09-1.62), reported Cyrille Feray, MD, PhD, of the Hôpital Paul-Brousse in Villejuif, France, and colleagues.”

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The Science Supporting the U.S. Case for COVID Boosters

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“U.S. health officials laid out the scientific rationale for a third dose of the COVID-19 mRNA vaccines for all U.S. adults on Wednesday, relying on published and unpublished CDC data, as well as a preprint study.

Overall, they said that there is evidence that vaccine effectiveness against infection — both symptomatic and asymptomatic — has been decreasing over time, but that protection against severe disease, hospitalization, and death remains relatively high.

In anticipation of further waning of immunity amid the ongoing Delta variant-fueled surge — which is posing additional challenges — pulling the trigger on booster shots could help the U.S. stay ahead of the virus, they said.”

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Kidney Transplant Outcomes Improved Over Past Quarter-Century

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“Things have looked up for U.S. kidney transplant recipients over the past few decades, according to a review article.

In adult kidney transplant recipients, the total number of transplants from living and deceased donors in the U.S. jumped from 45,008 in 1996-1999 up to 76,885 in 2016-2019, reported Sundaram Hariharan, MD, of the University of Pittsburgh School of Medicine, and colleagues.

This uptick was largely driven by a rise in the number of transplants from deceased kidney donors, from 29,823 in 1996 to 53,139 in 2019, they stated in the New England Journal of Medicine.”

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Equity means providing a transplant for every single patient that needs one

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“Recently, I joined UNOS President-Elect Jerry McCauley, M.D. at a meeting organized by the National Academies of Sciences, Engineering and Medicine (NASEM) focused on equity. We were honored to share UNOS’ work in this space and lend our voices to this vital national discussion – a discussion we look forward to continuing.

UNOS is acutely attuned to issues of equity. As the mission-driven non-profit serving as the nation’s transplant system, we work with our community partners to ensure equitable policies and outcomes in multiple ways, including:”

Read the full article, here.

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Despite COVID-19, Cedars-Sinai Hits New Transplant Record

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“This spring, anesthesiologist Jennifer Cutler, MD, was looking forward to a weekend relaxing with her husband and two teenaged children when she got the call – she was urgently needed to oversee anesthesiology for not one, but two, liver transplants at Cedars-Sinai.

Cutler, who enjoys spending her weekends going on long runs, catching up on her to-do list and savoring family dinners, dropped everything to come in to work. She wasn’t “on call,” per se, but Cutler said that when she and her fellow anesthesiologists are needed for a transplant surgery, they go.

“Even when we’re not on call, we just all pitch in and get the cases done,” Cutler said. “We have always had an attitude of teamwork.”

That weekend, surgeons from the Cedars-Sinai Comprehensive Transplant Center and Smidt Heart Institute performed a whopping 11 transplant surgeries in a single weekend. They performed one heart transplant, two liver transplants, two dual kidney/pancreas transplants, and six kidney transplants (including one pediatric kidney transplant).”

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Could Nixing Race-Adjustments for eGFR Harm Black Cancer Patients?

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“Removing race from estimated glomerular filtration rate (eGFR) equations would result in fewer Black patients being eligible for certain anticancer drugs, researchers have demonstrated.

Their analysis showed that for Black patients, removing race from the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation reduced median eGFR from 103 mL/min to 89 mL/min. In addition, removing the race factor doubled the percentage of black patients with an eGFR under 60 mL/min — a clinically relevant cut-off below which many drugs have recommended changes to dosage and eligibility, reported Thomas D. Nolin, PharmD, PhD, of the University of Pittsburgh School of Pharmacy, and colleagues.”

Learn more here.

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Weight Cycling Linked With Poor Outcomes in Chronic Kidney Disease

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“Large fluctuations in body mass index (BMI) over time — otherwise known as weight cycling — were associated with poorer outcomes in patients with chronic kidney disease (CKD), according to an observational study.

In 84,636 predialysis patients with CKD followed for a median of 4 years, those in the highest quartile of BMI variability had an increased risk for all-cause mortality compared with the lowest quartile (HR 1.66, 95% CI 1.53-1.81, P<0.001), reported Dong Ki Kim, MD, PhD, of Seoul National University College of Medicine in South Korea, and colleagues.”

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