Variations in Center-level Practices Across US Transplant Centers Are Associated With Time to Relisting and Retransplantation in Patients With Graft Failure.

Rationale & Objective: There is known variability in the management of kidney transplant recipients facing graft failure. We hypothesized that variations in the timing of care transitions, immunosuppression weaning, and re-evaluation processes would be associated with differential access to retransplantation and relisting.

Study Design: An observational study.

Probable reactivation from latency of multi-drug resistant cytomegalovirus in a lung transplant recipient: a case report.

Whether ganciclovir-resistant cytomegalovirus (ganR-CMV) can establish latency and reactivate absent any selective drug pressure is unknown and has implications for selecting empiric antiviral therapy in patients with prior ganR-CMV. A CMV-seronegative patient underwent bilateral lung transplant from a CMV-seropositive donor and developed biopsy-confirmed CMV colitis with ganR-CMV (UL97 genotype: M460I, A594E; UL54 genotype: F412L, E756D) four years post-transplant despite prolonged valganciclovir prophylaxis. Foscarnet therapy led to CMV DNAemia clearance and disease resolution.

Malakoplakia among kidney transplant recipients: case series and literature review.

We report two cases of malakoplakia after kidney transplant, a rare granulomatous condition that occurs primarily in immunocompromised patients and his thought to occur due to incomplete clearance of phagocytized bacterial residue by macrophages. Both patients were at heightened immunological risk due to being highly sensitized or prior episodes of rejection, both experienced infections in the first 4 months after transplant, and both presented with granulomatous masses that were biopsied and confirmed to be malakoplakia. Both were treated with suppressive antibiotics and required urinary drainage of the transplant kidney, resulting in improvements in the size of the mass on imaging.

Pediatric Nephrology Workforce and Access of Children with Kidney Failure to Transplantation in the United States.

Key Points: Pediatric nephrologists play a critical role in evaluating children with kidney failure for transplant candidacy. Nephrology is one of the pediatric subspecialties with the greatest workforce shortage in the United States. Children residing in states with the highest density of pediatric nephrologists had better access to waitlisting and deceased donor transplantation.

Living Donor Candidates' Self-reported Health and Health Perceptions and Completion of Donor Evaluation: A Cohort Study.

Rationale & Objective: Given the organ shortage in the United States, increasing living donation is vital to improving access to kidney transplantation, but many donor candidates do not complete the donor evaluation. Our objective was to understand potential living donors' perceived health and its association with the likelihood of completing the donor evaluation process.

Study Design: Potential donors' self-reported health was ascertained using the Patient Reported Outcomes Measurement Information System (PROMIS) global physical and mental health and the Davies and Ware Health Perceptions surveys.

Rurality of patient residence and access to transplantation among children with kidney failure in the United States.

Background: Residence in rural areas is often a barrier to health care access. To date, differences in access to kidney transplantation among children who reside in rural and micropolitan areas of the US have not been explored.

Methods: A retrospective cohort study of children < 18 years who developed kidney failure between 2000 and 2019 according to the United States Renal Data System (USRDS).

Kidney transplant candidacy evaluation and waitlisting practices in the United States and their association with access to transplantation.

There are limited data on the degree of variability in practices surrounding prioritization of referrals for transplant evaluation and criteria for transplant candidacy and their association with transplantation rates. We surveyed transplant programs across the United States between January 2020 and May 2020 to determine current pre-transplantation practices. We examined the relation between these reported practices and the outcomes of waitlisted patients at responding programs between January 2015 and March 2021 using Scientific Registry of Transplant Recipients data.

Association between Longer Travel Distance for Transplant Care and Access to Kidney Transplantation and Graft Survival in the United States.

Background: Transplant candidates may gain an advantage by traveling to receive care at a transplant center that may have more favorable characteristics than their local center. Factors associated with longer travel distance for transplant care and whether the excess travel distance (ETD) is associated with access to transplantation or with graft failure are unknown.

Methods: This study of adults in the United States wait-listed for kidney transplantation in 1995-2015 used ETD, defined as distance a patient traveled beyond the nearest transplant center for initial waiting list registration.

Weighing the waitlist: Weight changes and access to kidney transplantation among obese candidates.

High body mass index is a known barrier to access to kidney transplantation in patients with end-stage kidney disease. The extent to which weight and weight changes affect access to transplantation among obese candidates differentially by race/ethnicity has received little attention. We included 10 221 obese patients waitlisted for kidney transplantation prior to end-stage kidney disease onset between 1995-2015.

Longer Distance From Dialysis Facility to Transplant Center Is Associated With Lower Access to Kidney Transplantation.

Unlabelled: Rates of kidney transplantation vary substantially across dialysis facilities in the United States. Whether distance between the dialysis facility and transplant center associates with variations in transplantation rates has not been examined.

Methods: We performed a retrospective study of adults treated with dialysis between 2005 and 2015, according to the US Renal Data System.