Browse Ideas with tag 'transplant':

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  HYPERTENSION »

  Elective allograft nephrectomy & events after failed transplant

  Patients who return to dialysis after a failed renal transplant have a markedly increased risk for death and other adverse outcomes. The retained allograft serves as a nidus for excess inflammation that could contribute to cardiovascular and other clinical events. Other than repeat transplant, few effective options exist for reducing the risk of premature mortality. Observational data suggest a possible benefit of allograft ...more »

  Patients who return to dialysis after a failed renal transplant have a markedly increased risk for death and other adverse outcomes. The retained allograft serves as a nidus for excess inflammation that could contribute to cardiovascular and other clinical events. Other than repeat transplant, few effective options exist for reducing the risk of premature mortality. Observational data suggest a possible benefit of allograft nephrectomy, but those studies are limited by selection bias and potential residual confounding. A randomized controlled trial of elective allograft nephrectomy on the risks of death, other clinically relevant events & resource utilization in patients returning to dialysis after allograft failure would provide the evidence needed to determine whether this would be a therapeutic option for these high-risk patients. Other therapeutic approaches could be layered on to such a trial using a factorial design as well.

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  Submitted by Alan Go 2 years ago

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  TRANSPLANTATION »

  Addressing Ethnic/Race Disparities in Access to Transplantation

  Despite significant work documenting stark race disparities in access to transplantation, there is little research identifying strategies (at patient, provider, and system levels) that are effective in narrowing disparities. Studies of interventions to improve attitudes, behaviors, and practice patterns that have been linked to disparities are needed.

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  Submitted by Ebony Boulware 2 years ago

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  TRANSPLANTATION »

  Mechanism of BK Virus Infection in Transplanted Kidneys

  Based on recent FDA warnings about the link between immunosuppressant drugs and BK virus infection in transplanted kidneys, it seems prudent to conduct research into the mechanistic causes of BK-induced nephropathy in transplant patients so that appropriate and standardized prevention and treatment measures, and potentially a cure, can be developed. Does BK infection originate from the allograft, the environment, or both? ...more »

  Based on recent FDA warnings about the link between immunosuppressant drugs and BK virus infection in transplanted kidneys, it seems prudent to conduct research into the mechanistic causes of BK-induced nephropathy in transplant patients so that appropriate and standardized prevention and treatment measures, and potentially a cure, can be developed.

  Does BK infection originate from the allograft, the environment, or both? What tests can be developed to better detect BK in a donor kidney? Are there any lifestyle changes that the transplant recipient can make to reduce the chances of BK infection? What is the likelihood that a patient who has lost an allograft to BK will contract the virus in a second transplant?

  There is evidence that the initially prescribed dose of mycophenolate mofetil is too high in some patients and that it acts as a gateway to BK. Blood tests for MMF levels are contraindicated because they are so expensive. Why are tacrolimus levels followed very closely after transplant while MMF levels are not? The FDA has issued warnings about the link between both these drugs and BK.

  Many transplant centers do not routinely analyze the blood/urine of transplant patients for BK, so it is often not detected until significant damage has been done. Are routine analyses needed? How can biopsies of the allograft be prescribed and analyzed to better detect BK early?

  Currently, there is conflicting information regarding treatment -- do high doses of steroid help or hinder? Which immunosuppressants should be reduced (and by exactly how much) or stopped altogether? Can an antiviral medication be developed to cure BK infection?

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  Submitted by Kristina Paquette 2 years ago

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  TRANSPLANTATION »

  Pathogenesis of donor specific antibodies

  Why do we accomodate to some forms of donor specific anti-HLA antibodies but not to others? Increased research should focus on the pathogenic requirements on the ability of antibodies to fix complement, on the importance of binding affinity/avidity and on the identification/definition of pathogenic thresholds of antibody and strategies to normalize testing across different centers/platforms.

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  Submitted by Kenneth Kokko 2 years ago

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