UH Physicians Contribute to the Field of Transplant Surgery Through Research and Publications
University Hospitals Transplant Institute surgeons and physicians are contributing to the field of transplant surgery through their latest research and other published works. Our physicians not only strive to provide the very best medical care for both organ recipients and donors, but are actively working to improve patient care through leading-edge research that touches all areas of transplant surgery, such as donor selection, surgical techniques, and post-transplant care.
To learn more about the latest news and research from UH Transplant Institute, view our most recent publications:
- Woodside KJ, Schirm ZW, Noon KA, Huml AM, Padiyar A, Sanchez EQ, Sarabu N, Hricik DE, Schulak JA, Augustine JJ Fever, infection, and rejection after kidney transplant failure. Transplantation 97:648-53, 2014
This article examined the high rates of hospitalization with fever in patients with recent kidney transplant failure and return to dialysis therapy. Although fever is typically associated with infection, the majority of patients who had discontinued immunosuppressive therapy had no infection but rather symptomatic rejection of the transplanted kidney. When rejection is severe, symptoms including fever may present along with pain over the transplanted kidney and blood in the urine. Most patients initially receive antibiotics, but once infection is ruled out, the majority of patients require surgical removal of the transplanted kidney to alleviate symptoms. Such symptoms can be avoided in most patients by maintaining immunosuppressive therapy after transplant failure, but our paper also demonstrates that patients who remain on immunosuppression are more likely to present with actual infection. Furthermore, hospitalization with infection was associated with patient death. In summary, this paper illustrates the challenges of managing patients safely in the early months after kidney transplant failure. Strategies such as a slow, gradual taper of immunosuppression or early surgical removal of the transplanted kidney may reduce the high rates of hospitalization with fever after transplant failure. Avoidance of dialysis catheters and early preparation for dialysis is critical as well, as catheters were the most common source of infection overall.
- Woodside KJ, Merion RM, Leichtman AB, de los Santos R, Arrington CJ, Rao PS, Sung RS. Utilization of kidneys with similar Kidney Donor Risk Index values from standard versus expanded criteria donors. Am J Transplant 2012; 12: 2106-2114.
There are not enough organs from deceased donors to transplant everyone who is listed for kidney transplantation. To meet the need for transplantable kidneys, older donor kidneys are increasingly utilized. These kidneys, called expanded criteria donor (ECD) kidneys, are from deceased donors over 60 years old, or from deceased donors over 50 years old with at least 2 of the following conditions: hypertension, a somewhat elevated creatinine, or stroke. Using data from the nation-wide Scientific Registry of Transplant Recipients (SRTR), we sought to determine if the ECD label itself had any effect on the chances of a given kidney being recovered and utilized, when compared to kidneys of similar risk that did not meet the ECD criteria and did not have the ECD label. We also examined the outcomes from the ECD kidneys and compared them to kidneys of similar risk that were not considered ECD. While the non-ECD kidneys had somewhat better outcomes overall, when ECD kidneys were compared to non-ECD kidneys of similar risk profile, outcomes were similar at the national level. Similarly, the ECD label did not significantly affect the likelihood of organ recovery or utilization when compared to non-ECD kidneys of similar risk at the national level.
Dr. Ken Woodside is an Associate Professor of Surgery at Case Western Reserve University and the Director of the Living Kidney Donor Program at the Transplant Institute of University Hospitals Cleveland Medical Center.