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Dr. Bruce Kaplan, Executive Editor, Transplantation

Does Racial Disparity in Kidney Transplant Waitlisting Persist After Accounting for Social Determinants of Health?

Ng Y, Pankratz SV, Leyva Y, et al
Transplantation: July 2020 - Volume 104 - Issue 7 - p 1445-1455

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Dr. Bruce Kaplan, Executive Editor, Transplantation

Racial and Ethnic Disparities in Kidney Transplant Access Within a Theoretical Context of Medical Eligibility

Ku E, Lee BK, McCulloch CE, et al.
Transplantation: : July 2020 - Volume 104 - Issue 7 - p 1437-1444

Racial disparity in access to renal transplantation has been a topic of research, discussion, and consternation for years. Differences in access have been ascribed to underlying co-morbidities, social constraints as well as bias. Regardless of the cause, this disparity exists and is in need of greater understanding as to its causes. These two papers, along with the commentary accompanying them, are a step forward in our understanding of this issue. The paper by Ku et al rather convincingly concluded that the decrease in access to the kidney transplant waitlist could not be ascribed to the differences in co-morbidities. In the the single center study by Ng, it was concluded that social determinants could not fully explain this disparity either. The study by Ng et al did in fact show some subtle differences in insurance status and candidly offered a caveat regarding the single center nature of this study. That said, the studies data is supportive of its main conclusion that social determinants do not fully explain the differences noted. These two studies taken together strongly indicate we need a fresh and innovative approach to this long standing and regrettable problem.

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WEBINAR: AASLD-NASPGHAN-SPLIT COVID-19 & THE LIVER: PEDIATRIC PERSPECTIVE

As the COVID-19 pandemic continues to evolve, it is important for the pediatric hepatology community to understand the liver manifestations in children with SARS-COV2 infection and Multi-System Inflammatory Syndrome in children (MIS-C). In addition, there may be unique susceptibilities in children with chronic liver disease and liver transplantation.

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Multisystem Inflammatory Syndrome in U.S. Children and Adolescents

L.R. Feldstein, E.B. Rose, S.M. Horwitz, J.P. Collins, M.M. Newhams, M.B.F. Son, J.W. Newburger, L.C. Kleinman, S.M. Heidemann, A.A. Martin, A.R. Singh, S. Li, K.M. Tarquinio, P. Jaggi, M.E. Oster, S.P. Zackai, J. Gillen, A.J. Ratner, R.F. Walsh, J.C. Fitzgerald, M.A. Keenaghan, H. Alharash, S. Doymaz, K.N. Clouser, J.S. Giuliano, Jr., A. Gupta, R.M. Parker, A.B. Maddux, V. Havalad, S. Ramsingh, H. Bukulmez, T.T. Bradford, L.S. Smith, M.W. Tenforde, C.L. Carroll, B.J. Riggs, S.J. Gertz, A. Daube, A. Lansell, A. Coronado Munoz, C.V. Hobbs, K.L. Marohn, N.B. Halasa, M.M. Patel, and A.G. Randolph, for the Overcoming COVID-19 Investigators and the CDC COVID-19 Response Team

New England J Med; DOI: 10.1056/NEJMoa2021680

This article reports 186 previously healthy children and adolescents with multisystem inflammatory syndrome and its temporal association with Covid-19. Organ-system involvement included the gastrointestinal system in 171 patients (92%), cardiovascular in 149 (80%), hematologic in 142 (76%), mucocutaneous in 137 (74%), and respiratory in 131 (70%). 148 patients (80%)received intensive care, 37 (20%) received mechanical ventilation, 90 (48%) received vasoactive support, and 4 (2%) died. Kawasaki’s disease–like features were documented in 74 (40%).

Kidney allograft recipients, immunosuppression, and coronavirus disease-2019: a report of consecutive cases from a New York City transplant center

Michelle Lubetzky, Meredith J Aull, Rebecca Craig-Schapiro, John R Lee, Jehona Marku-Podvorica, Thalia Salinas, Laura Gingras, Jun B Lee, Samuel Sultan, Rosy Priya Kodiyanplakkal, Choli Hartono, Stuart Saal, Thangamani Muthukumar, Sandip Kapur, Manikkam Suthanthiran, Darshana M Dadhania

Nephrol Dial Transplant 2020 Jul 17; doi: 10.1093/ndt/gfaa154

This article reports 54 kidney transplant recipients, 39 with moderate to severe symptoms requiring hospital admission and 15 with mild symptoms managed in the ambulatory setting. Graft failure requiring hemodialysis occurred in 3 of 39 hospitalized patients (8%) and 7 patients died, resulting in a case fatality rate of 13% among Covid-19-positive patients and 18% among hospitalized Covid-19-positive patients.

Early National and Center-level Changes to Kidney Transplantation in the United States During COVID-19 Epidemic

Brian J. Boyarsky MD (1), William A. Werbel MD (2), Christine M. Durand MD (2), Robin K. Avery MD (2), Kyle R. Jackson MD PhD (1), Amber B. Kernodle MD MPH (1), Jon Snyder PhD (4), Ryutaro Hirose MD PhD (5), Indraneel M. Massie (6), Jacqueline M. Garonzik-Wang MD PhD (1), Dorry L. Segev MD PhD (1,3,4), Allan B. Massie PhD MHS (1,2)

American J of Transplantation; doi: 10.1111/ajt.16167

Using SRTR data, this article compared data on observed waitlist registrations, waitlist mortality, living-donor and deceased-donor kidney transplants (LDKT/DDKT) March 15-April 30, 2020 to expected events calculated from pre-epidemic data January 2016- February 2020. Only 12 centers performed LDKT March 15-31; by April 30, 40 centers had resumed LDKT. The number of waitlist deaths was 2.2-fold higher than expected in the five states with highest COVID-19 burden. DCD DDKT and regional/national imports declined nationwide, but most steeply in states with the highest COVID19 burden.

Identifying scenarios of benefit or harm from kidney transplantation during the COVID-19 pandemic: A stochasticsimulation and machine learning study

Allan B. Massie, Brian J. Boyarsky, William A. Werbel, Sunjae Bae, Eric K. H. Chow, Robin K. Avery, Christine M. Durand, Niraj Desai, Daniel Brennan, Jacqueline M. Garonzik-Wang, Dorry L. Segev

American Journal of Transplantation, DOI: 10.1111/ajt.16117

This article conducted a simulation study of immediate kidney transplantation vs delay until after pandemic for different patient phenotypes under a variety of potential COVID-19 scenarios. A calculator was implemented (http://www.trans plant models.com/covid_sim), and machine learning approaches were used to evaluate the important aspects of the modeling. The simulations suggest that kidney transplantation could be beneficial in many centers if local resources allow, and the calculator can help identify patients who would benefit most.

July 13- Injured and unusable lungs were restored with respirators and pig blood. The procedure one day may increase the supply of organs for transplant.

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July 16 - Akihiro Tsuchimoto, Masaaki Tone and Seiji Takashima of Shinshu University transplanted testis tissue to observe its effectiveness as a treatment for male infertility. When just the sperm stem cells are transplanted, the germ cells of the recipient (individual who is being treated) needs to be depleted to ensure engraftment and growth of the transplanted stem cells. However, contrary to their expectation, depletion of recipient germ cells actually worsened sperm production in transplanted tissues. They set out to find out why.

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July 13 - Biologists and bioengineers at EPFL have designed a new method for growing simplified human mini-livers. Their process is a potentially important breakthrough in the quest for transplantable lab-grown tissues. In the shorter term, the miniaturized organs will serve as a platform for trialing treatments against non-alcoholic fatty liver disease, the most common liver disorder in the developed world. Their findings have been published in the journal Nature Communications.

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July 14 - New research has demonstrated that kidneys can be revived prior to transplantation by delivering a cell therapy directly to the organ.

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July 13 - When a human organ is donated to a patient for transplant, it has to move between people. But that also requires a longer trip between cities, in which organs travel in a variety of vehicles, from car and train, plane, helicopter or perhaps more increasingly in the near future, drone. It’s the logistics behind these trips that is being tackled by a new Baltimore venture.

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In accordance with the TTS By-Laws, a Business Meeting will be held shortly after the close of the TTS 2020 Virtual Congress. The meeting will be help on Sunday, September 20, at 8 AM Montreal time and will last approximately one hour. The agenda will include an update on the TTS finances, the announcement of the TTS 2024 Congress location, a presentation for the TTS 2022 Congress in Buenos Aires, the announcement of the 2020-2022 Councilors and Officers and the official change of TTS Presidency. All members are invited to participate.

As this meeting will be virtually, we will send all members a link to join this meeting shortly before the meeting takes place.

Sincerely,

John Fung
Secretary, The Transplantation Society

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