Publications by authors named "Mary Ann Lim"

19 Publications

  • Page 1 of 1

Ex-vivo Repair of Complex Hilar Renal Artery Aneurysms and Auto-transplantation of Solitary Kidney.

Ann Vasc Surg 2021 Apr 5. Epub 2021 Apr 5.

Division of Transplant Surgery, Hospital of the University of Pennsylvania, 3400 Spruce St. Philadelphia, PA 19104. Electronic address:

Renal artery aneurysms (RAA) are rare and challenging to repair. We present a case of a 48-year-old female with solitary right kidney who had complex aneurysms near the renal hilum. CT angiogram showed fibromuscular dysplasia (FMD) features of the renal artery and 2 saccular aneurysms measuring 2.3 cm and 1 cm. An additional small lower pole renal artery added to the complexity of the case. Ex-vivo aneurysm repair was performed after the kidney was removed and flushed with preservation solution. This was followed by auto-transplantation to the right external iliac vessels. The patient did well postoperatively without need for dialysis with serum creatinine returning to normal 5 weeks after.
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http://dx.doi.org/10.1016/j.avsg.2021.01.122DOI Listing
April 2021

Medical Therapies to Reduce Delayed Graft Function and Improve Long-Term Graft Survival: Are We Making Progress?

Clin J Am Soc Nephrol 2020 01 16;15(1):13-15. Epub 2019 Dec 16.

Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

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http://dx.doi.org/10.2215/CJN.13961119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946075PMC
January 2020

Class and Kinetics of Weakly Reactive Pretransplant Donor-specific HLA Antibodies Predict Rejection in Kidney Transplant Recipients.

Transplant Direct 2019 Aug 25;5(8):e478. Epub 2019 Jul 25.

Department of Surgery, University of Pennsylvania, Philadelphia, PA.

Background: The clinical impact of weakly reactive pretransplant donor-specific antibody (DSA) in kidney transplantation is controversial. While some evidence suggests that weakly reactive DSA can lead to rejection, it is unclear which patients are at risk for rejection and whether posttransplant changes in weakly reactive DSA are clinically meaningful.

Methods: We retrospectively studied 80 kidney transplant recipients with weakly reactive pretransplant DSA between 2007 and 2014. We performed a multivariate Cox regression analysis to identify immunologic factors most associated with risk of biopsy-proven rejection.

Results: Biopsy-proven rejection occurred in 13 of 80 (16%) patients. The presence of both class I and II DSA before transplant (hazards ratio 17.4, < 0.01) and any posttransplant increase in DSA reactivity above a mean fluorescence intensity of 3000 (hazards ratio 7.8, < 0.01) were each significantly associated with an increased risk of rejection, which primarily occurred within the first 18 months.

Conclusions: Pretransplant DSA class and DSA kinetics after transplantation are useful prognostic indicators in patients with weak DSA reactivity. These results identify a small, high-risk patient group that warrants aggressive posttransplant DSA monitoring and may benefit from alternative donor selection.
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http://dx.doi.org/10.1097/TXD.0000000000000926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708635PMC
August 2019

Initial skin cancer screening for solid organ transplant recipients in the United States: Delphi method development of expert consensus guidelines.

Transpl Int 2019 Dec 8;32(12):1268-1276. Epub 2019 Oct 8.

Department of Dermatology, University of California San Francisco, San Francisco, CA, USA.

Skin cancer is the most common malignancy affecting solid organ transplant recipients (SOTR), and SOTR experience increased skin cancer-associated morbidity and mortality. There are no formal multidisciplinary guidelines for skin cancer screening after transplant, and current practices are widely variable. We conducted three rounds of Delphi method surveys with a panel of 84 U.S. dermatologists and transplant physicians to establish skin cancer screening recommendations for SOTR. The transplant team should risk stratify SOTR for screening, and dermatologists should perform skin cancer screening by full-body skin examination. SOTR with a history of skin cancer should continue regular follow-up with dermatology for skin cancer surveillance. High-risk transplant patients include thoracic organ recipients, SOTR age 50 and above, and male SOTR. High-risk Caucasian patients should be screened within 2 years after transplant, all Caucasian, Asian, Hispanic, and high-risk African American patients should be screened within 5 years after transplant. No consensus was reached regarding screening for low-risk African American SOTR. We propose a standardized approach to skin cancer screening in SOTR based on multidisciplinary expert consensus. These guidelines prioritize and emphasize the need for screening for SOTR at greatest risk for skin cancer.
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http://dx.doi.org/10.1111/tri.13520DOI Listing
December 2019

Bariatric surgery before and after kidney transplantation: long-term weight loss and allograft outcomes.

Surg Obes Relat Dis 2019 Jun;15(6):935-941

Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

Background: Severe obesity is frequently a barrier to kidney transplantation, and kidney transplant recipients often have significant weight gain following transplantation.

Objectives: The goals of this study were to evaluate the long-term risks and benefits of bariatric surgery before and after kidney transplantation.

Setting: University Hospital, United States.

Methods: We performed a retrospective cohort study of 43 patients who had pretransplantation bariatric surgery and 21 patients who had posttransplantation bariatric surgery from 1994 to 2017 with propensity-score matching to identify matched controls using national registry data.

Results: Body mass index at the time of transplantation was similar in patients who underwent bariatric surgery before versus after transplantation (32 versus 34 kg/m, P = .172). There was no significant difference in body mass index in the 5 years after bariatric surgery among patients who underwent bariatric surgery before versus after kidney transplantation (36 versus 32 kg/m, P = 0.814). Compared with matched controls, bariatric surgery before (n = 38) and after (n = 18) kidney transplantation was associated with a decreased risk of allograft failure (hazard ratio .31 [95% confidence interval .29-0.33] and .85 [95% confidence interval .85-.86] for pre- and posttransplant, respectively) and mortality (hazard ratio .57 [95% confidence interval .53-.61] and .80 [95% confidence interval .79-.82] for pre- and posttransplant, respectively).

Conclusions: Bariatric surgery before and after kidney transplantation results in similar maintenance of weight loss and improved long-term allograft survival compared with matched controls. Bariatric surgery appears to be a safe and reasonable approach to weight loss both before and after transplantation.
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http://dx.doi.org/10.1016/j.soard.2019.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6690384PMC
June 2019

Safety, Effectiveness, and Tolerability of Patiromer in Kidney Transplant Recipients.

Transplantation 2019 09;103(9):e281-e282

Renal, Electrolyte, Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

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http://dx.doi.org/10.1097/TP.0000000000002829DOI Listing
September 2019

Single-center, real-world experience with granulocyte colony-stimulating factor for management of leukopenia following kidney transplantation.

Clin Transplant 2019 06 11;33(6):e13541. Epub 2019 Apr 11.

Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

Background: Leukopenia is a frequent complication following kidney transplantation. Granulocyte colony-stimulating factor (G-CSF) has been used to accelerate white blood cell (WBC) count recovery; however, published experience in kidney transplantation is limited.

Methods: We retrospectively reviewed our kidney transplant recipients from January 2012 to September 2016 with a G-CSF order to evaluate leukopenia management (defined as WBC <3000 cells/μL).

Results: Thirty-six recipients were included. On average, G-CSF treatment began at 98 ± 38 days. At G-CSF initiation, mean WBC count was 1240 ± 420 cells/μL and absolute neutrophil count (ANC) was 653 ± 368 cells/μL. Mean G-CSF dose was 4.6 ± 1.2 mcg/kg/dose (total 11.8 ± 9.0 mcg/kg), 77.8% of recipients were prescribed G-CSF as outpatients, and overall, median time to WBC count recovery was 9 (IQR 4-14) days. Changes in immunosuppression and prophylaxis regimens for leukopenia were also common. Within 1 month following leukopenia onset, no patients experienced acute rejection and 5 (14%) developed infection requiring hospitalization or opportunistic infection.

Conclusion: In kidney recipients with leukopenia, G-CSF may be helpful to achieve WBC count recovery in addition to changes in immunosuppression and prophylaxis medications. Prospective, randomized data are still needed to determine optimal G-CSF dosing in this population.
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http://dx.doi.org/10.1111/ctr.13541DOI Listing
June 2019

Safety and Feasibility of Outpatient Rabbit Antithymocyte Globulin Induction Therapy Administration in Kidney Transplant Recipients.

Pharmacotherapy 2018 06;38(6):620-627

Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

Background: Kidney transplant induction therapy often includes inpatient administration of rabbit antithymocyte globulin (rATG) over multiple days. To reduce hospital length of stay (LOS) and drug expenditures, the rATG induction course was completed in the outpatient setting via peripheral intravenous administration. The present study assesses early readmission trends ascribable to an outpatient rATG administration protocol to ensure initial reduction in hospital LOS is sustained early after discharge.

Methods: This was a retrospective study of kidney recipient outcomes for patients transplanted between January 1, 2008, and February 29, 2016, immediately following implementation of an outpatient rATG protocol. Readmission data within 7 days of outpatient rATG administration were collected. The relatedness of rATG administration to an adverse drug reaction resulting in readmission was determined by the World Health Organization-Uppsala Monitoring Centre Causality Assessment Scale and the Naranjo Adverse Drug Reaction Probability Scale.

Results: A total of 1104 patients received outpatient doses of rATG and were included. An upward trend in kidney transplant volume and outpatient rATG administrations per year was found from 2008-2015. Following protocol implementation, the percentage of overall readmissions ranged from 9% to just over 12% from 2008-2014 and remained less than 10% for 2014 through 2016. The percentage of outpatient rATG infusions that potentially led to rATG-related readmissions was less than 4% per year over the study period. A total of 1124 hospital days were saved, 125 days per year on average.

Conclusions: Outpatient administration of rATG is feasible, safe, and did not increase readmissions in the period directly following administration. The findings of this analysis support our continued use of the outpatient rATG protocol at our institution.
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http://dx.doi.org/10.1002/phar.2116DOI Listing
June 2018

Results of ASERTAA, a Randomized Prospective Crossover Pharmacogenetic Study of Immediate-Release Versus Extended-Release Tacrolimus in African American Kidney Transplant Recipients.

Am J Kidney Dis 2018 03 20;71(3):315-326. Epub 2017 Nov 20.

Renal Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address:

Background: Differences in tacrolimus dosing across ancestries is partly attributable to polymorphisms in CYP3A5 genes that encode tacrolimus-metabolizing cytochrome P450 3A5 enzymes. The CYP3A5*1 allele, preponderant in African Americans, is associated with rapid metabolism, subtherapeutic concentrations, and higher dose requirements for tacrolimus, all contributing to worse outcomes. Little is known about the relationship between CYP3A5 genotype and the tacrolimus pharmacokinetic area under the curve (AUC) profile in African Americans or whether pharmacogenetic differences exist between conventional twice-daily, rapidly absorbed, immediate-release tacrolimus (IR-Tac) and once-daily extended-release tacrolimus (LifeCycle Pharma Tac [LCPT]) with a delayed absorption profile.

Study Design: Randomized prospective crossover study.

Setting & Participants: 50 African American maintenance kidney recipients on stable IR-Tac dosing.

Intervention: Recipients were randomly assigned to continue IR-Tac on days 1 to 7 and then switch to LCPT on day 8 or receive LCPT on days 1 to 7 and then switch to IR-Tac on day 8. The LCPT dose was 85% of the IR-Tac total daily dose.

Outcomes: Tacrolimus 24-hour AUC (AUC), peak and trough concentrations (C and C), time to peak concentration, and bioavailability of LCPT versus IR-Tac, according to CYP3A5 genotype.

Measurements: CYP3A5 genotype, 24-hour tacrolimus pharmacokinetic profiles.

Results: ∼80% of participants carried the CYP3A5*1 allele (CYP3A5 expressers). There were no significant differences in AUC or C between CYP3A5 expressers and nonexpressers during administration of either IR-Tac or LCPT. With IR-Tac, tacrolimus C was 33% higher in CYP3A5 expressers compared with nonexpressers (P=0.04): With LCPT, this difference was 11% (P=0.4).

Limitations: This was primarily a pharmacogenetic study rather than an efficacy study; the follow-up period was too short to capture clinical outcomes.

Conclusions: Achieving therapeutic tacrolimus trough concentrations with IR-Tac in most African Americans results in significantly higher peak concentrations, potentially magnifying the risk for toxicity and adverse outcomes. This pharmacogenetic effect is attenuated by delayed tacrolimus absorption with LCPT.

Trial Registration: Registered at ClinicalTrials.gov, with study number NCT01962922.
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http://dx.doi.org/10.1053/j.ajkd.2017.07.018DOI Listing
March 2018

Patient and Kidney Allograft Survival in Recipients With End-Stage Renal Disease From Amyloidosis.

Transplantation 2018 02;102(2):300-309

Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

Background: Outcomes after kidney transplantation for patients with amyloidosis-associated end-stage renal disease (ESRD) have not been well characterized.

Methods: We performed a retrospective propensity score matched cohort study with Cox proportional hazards modeling using data from the United Network of Organ Sharing including patients transplanted from 1987 to 2015 (N = 310 629).

Results: Amyloidosis patients (N = 576) had higher rates of death (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.28-1.95) and graft loss (HR, 1.49; 95% CI, 1.19-1.87) compared with nonamyloidosis patients. The results were similar when the cohort was restricted to patients transplanted on or after 2001 (HR, 1.72; 95% CI, 1.31-2.26 for death; HR, 1.77; 95% CI, 1.35-2.33 for graft loss). However, there was no significant difference in risk of death or graft loss when amyloidosis patients were compared with those with diabetes-associated ESRD (mortality: HR, 0.99; 95% CI, 0.84-1.17; allograft loss: HR, 1.00; 95% CI, 0.84-1.20), or when compared with elderly patients (age, >65 years at the time of transplant) (mortality: HR, 0.99; 95% CI, 0.81-1.21; graft loss: HR, 1.02; 95% CI, 0.82-1.26).

Conclusions: For patients with amyloidosis-associated ESRD deemed suitable for transplantation, patient and graft survivals are diminished compared to kidney transplant recipients overall, but are comparable to other high-risk subgroups.
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http://dx.doi.org/10.1097/TP.0000000000001930DOI Listing
February 2018

Immunosuppression for kidney transplantation: Where are we now and where are we going?

Transplant Rev (Orlando) 2017 01 11;31(1):10-17. Epub 2016 Oct 11.

Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address:

Advances in immunosuppression have propelled kidney transplantation from a scientific curiosity to the optimal treatment for patients with end stage kidney disease. Declining rates of acute rejection have led to improvements in short term kidney transplant survival, culminating in incrementally better long term patient and allograft outcomes. Contextualized around established immune-suppressing drug targets, this review summarizes the history of the clinical science and highlights the pivotal trials that have led to present-day treatment standards at the level of both individual agents and multidrug regimens for kidney recipients. Finally, recently approved and emerging therapies are discussed, with an emphasis on challenges faced by clinicians managing this increasingly complex patient population.
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http://dx.doi.org/10.1016/j.trre.2016.10.006DOI Listing
January 2017

Comparing Outcomes between Antibody Induction Therapies in Kidney Transplantation.

J Am Soc Nephrol 2017 Jul 20;28(7):2188-2200. Epub 2017 Mar 20.

Renal Electrolyte and Hypertension Division, Department of Medicine, and

Kidney transplant recipients often receive antibody induction. Previous studies of induction therapy were often limited by short follow-up and/or absence of information about complications. After linking Organ Procurement and Transplantation Network data with Medicare claims, we compared outcomes between three induction therapies for kidney recipients. Using novel matching techniques developed on the basis of 15 clinical and demographic characteristics, we generated 1:1 pairs of alemtuzumab-rabbit antithymocyte globulin (rATG) (5330 pairs) and basiliximab-rATG (9378 pairs) recipients. We used paired Cox regression to analyze the primary outcomes of death and death or allograft failure. Secondary outcomes included death or sepsis, death or lymphoma, death or melanoma, and healthcare resource utilization within 1 year. Compared with rATG recipients, alemtuzumab recipients had higher risk of death (hazard ratio [HR], 1.14; 95% confidence interval [95% CI], 1.03 to 1.26; <0.01) and death or allograft failure (HR, 1.18; 95% CI, 1.09 to 1.28; <0.001). Results for death as well as death or allograft failure were generally consistent among elderly and nonelderly subgroups and among pairs receiving oral prednisone. Compared with rATG recipients, basiliximab recipients had higher risk of death (HR, 1.08; 95% CI, 1.01 to 1.16; =0.03) and death or lymphoma (HR, 1.12; 95% CI, 1.01 to 1.23; =0.03), although these differences were not confirmed in subgroup analyses. One-year resource utilization was slightly lower among alemtuzumab recipients than among rATG recipients, but did not differ between basiliximab and rATG recipients. This observational evidence indicates that, compared with alemtuzumab and basiliximab, rATG associates with lower risk of adverse outcomes, including mortality.
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http://dx.doi.org/10.1681/ASN.2016070768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491281PMC
July 2017

Histopathologic changes in anti-angiotensin II type 1 receptor antibody-positive kidney transplant recipients with acute rejection and no donor specific HLA antibodies.

Hum Immunol 2017 Apr 8;78(4):350-356. Epub 2017 Mar 8.

Clinical Immunology and Histocompatibility Laboratory, Perelman School of Medicine, Philadelphia, PA, United States.

Objective: To determine the association of antibodies against angiotensin II type 1 receptor (AT1R Ab) and histopathologic changes seen in patients with kidney allograft rejection and negative donor specific HLA antibodies (DSA).

Methods: Stored sera from 27 patients who had biopsy-proven rejection in the absence of DSA were tested for AT1R Ab. Biopsy slides of all patients were re-examined and classified according to Banff 2013 criteria. Histopathologic changes were compared between AT1R positive and negative patients.

Results: 75% of patients with positive pre-transplant AT1R Ab had antibody mediated rejection (AMR) compared to 37% of AT1R Ab-negative patients. A trend towards increased interstitial inflammation was observed in the AT1R Ab positive group (p=0.08). More patients in the AT1R Ab positive group had microcirculation inflammation (88% vs 58% with glomerulitis scores ≥1; 75% vs 58% with peritubular capillaritis scores ≥1).

Conclusion: In kidney transplant recipients with rejection and no DSA, a higher incidence of AMR and worse inflammation scores are observed in the presence of positive pre-transplant AT1R antibodies.
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http://dx.doi.org/10.1016/j.humimm.2017.03.004DOI Listing
April 2017

Development of proteinuria and focal segmental glomerulosclerosis during direct-acting antiviral therapy for hepatitis C virus infection.

Hepatology 2017 08 22;66(2):658-660. Epub 2017 Jun 22.

Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

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http://dx.doi.org/10.1002/hep.29125DOI Listing
August 2017

Should living kidney donors with hypertension be considered for organ donation?

Curr Opin Nephrol Hypertens 2015 Nov;24(6):594-601

aDepartment of Medicine, Perelman School of Medicine bDepartment of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.

Purpose Of Review: The large number of end-stage kidney disease patients waiting for a kidney transplant often means years of delay before a suitable organ becomes available. Living kidney donors are one way to circumvent such long waiting times, and the desire to increase the pool of living kidney donors has allowed the selection of donors with hypertension.

Recent Findings: Hypertensive kidney donors, despite having larger glomeruli, and fewer glomeruli, particularly when over the age of 50 years, do well in follow-up. The data are mainly in white living kidney donors whose preexisting hypertension has been well controlled [blood pressure (BP) <140/90 mmHg] on one or two antihypertensive medications. Those selected for donation do as well as nonhypertensive donors as long they are older (age >50 years), nonobese (BMI 26-30 kg/m), and have no evidence of end-organ damage prior to donation.

Summary: Although the data supporting long-term safety of nephrectomy in hypertensive donors are modest, small studies with short-term follow-up suggest no increase in the incidence of kidney disease or worsening of the control of hypertension in donors with a history of high BP.
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http://dx.doi.org/10.1097/MNH.0000000000000169DOI Listing
November 2015

The chaperone protein clusterin may serve as a cerebrospinal fluid biomarker for chronic spinal cord disorders in the dog.

Cell Stress Chaperones 2014 May 29;19(3):311-20. Epub 2013 Aug 29.

School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Bearsden Road, Glasgow, G61 1QH, UK.

Chronic spinal cord dysfunction occurs in dogs as a consequence of diverse aetiologies, including long-standing spinal cord compression and insidious neurodegenerative conditions. One such neurodegenerative condition is canine degenerative myelopathy (DM), which clinically is a challenge to differentiate from other chronic spinal cord conditions. Although the clinical diagnosis of DM can be strengthened by the identification of the Sod1 mutations that are observed in affected dogs, genetic analysis alone is insufficient to provide a definitive diagnosis. There is a requirement to identify biomarkers that can differentiate conditions with a similar clinical presentation, thus facilitating patient diagnostic and management strategies. A comparison of the cerebrospinal fluid (CSF) protein gel electrophoresis profile between idiopathic epilepsy (IE) and DM identified a protein band that was more prominent in DM. This band was subsequently found to contain a multifunctional protein clusterin (apolipoprotein J) that is protective against endoplasmic reticulum (ER) stress-mediated apoptosis, oxidative stress, and also serves as an extracellular chaperone influencing protein aggregation. Western blot analysis of CSF clusterin confirmed elevated levels in DM compared to IE (p < 0.05). Analysis of spinal cord tissue from DM and control material found that clusterin expression was evident in neurons and that the clusterin mRNA levels from tissue extracts were elevated in DM compared to the control. The plasma clusterin levels was comparable between these groups. However, a comparison of clusterin CSF levels in a number of neurological conditions found that clusterin was elevated in both DM and chronic intervertebral disc disease (cIVDD) but not in meningoencephalitis and IE. These findings indicate that clusterin may potentially serve as a marker for chronic spinal cord disease in the dog; however, additional markers are required to differentiate DM from a concurrent condition such as cIVDD.
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http://dx.doi.org/10.1007/s12192-013-0457-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3982024PMC
May 2014

Determinants of the decision to accept a kidney from a donor at increased risk for blood-borne viral infection.

Clin J Am Soc Nephrol 2010 May 25;5(5):917-23. Epub 2010 Mar 25.

University of Pennsylvania, Renal Division, Department of Medicine, Philadelphia, PA, USA.

Background And Objectives: The use of kidneys from donors at increased risk for viral infections (DIRVI) such as HIV could increase the number of transplants and decrease waiting times. This study aimed to identify the proportion of kidney transplant candidates that would accept a kidney from a DIRVI and the factors that influenced this decision.

Design, Setting, Participants, & Measurements: Conjoint analysis was used to assess the conditions in which renal transplant candidates would accept a DIRVI kidney. Candidates completed 12 scenarios in which the waiting time for a kidney, the donor age as a surrogate for kidney quality, and the risk of contracting HIV were systematically varied.

Results: Among 175 respondents, 42 (24.0%) rejected DIRVI kidneys under all conditions, 103 (58.9%) accepted DIRVI kidneys under some conditions, and 31 (17.7%) always accepted DIRVI kidneys. In multivariable logistic regression, patients were more likely to accept a DIRVI kidney when waiting time was longer, the donor was younger, and HIV risk was lower (P < 0.01 for each variable). Patients on dialysis (P < 0.01) and older patients (P = 0.04) more commonly accepted DIRVI kidneys, but self-rated sense of health was not associated with DIRVI kidney acceptance.

Conclusions: Most renal transplant candidates would accept a DIRVI kidney under some circumstances. These findings suggest that recipients can be allowed to make prospective choices regarding DIRVI kidney acceptance without hindering placement of these organs.
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http://dx.doi.org/10.2215/CJN.08251109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2863986PMC
May 2010

Arterial compliance in the elderly: its effect on blood pressure measurement and cardiovascular outcomes.

Clin Geriatr Med 2009 May;25(2):191-205

Renal Electrolyte and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania, 1 Founders Building, 3400 Spruce Street, Philadelphia, PA 19104, USA.

The loss of arterial compliance as a result of the aging of human vasculature is thought to contribute to the age dependent rise in isolated systolic hypertension, and is an independent predictor of all cause mortality and cardiovascular outcomes. In this article, the author's we begin by providing a brief historical perspective of the study of the pulse wave. The author's then review the physiology of the normal arterial system, the effects of aging on the arterial system and the different measures of arterial stiffness. Finally, the author's review the different studies that look at arterial stiffness in the elderly, its impact on hypertension and cardiovascular outcome, and what is currently known on how to prevent vascular stiffness.
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http://dx.doi.org/10.1016/j.cger.2009.01.001DOI Listing
May 2009

Effects of warfarin on blood pressure in men with diabetes and hypertension--a longitudinal study.

J Clin Hypertens (Greenwich) 2007 Apr;9(4):256-8

Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA.

Warfarin causes extensive vascular calcification leading to increased systolic blood pressure and pulse pressure in rats, may be associated with increased valvular and coronary calcifications in man, and possibly worsens hypertension in high-risk patients, particularly in those with diabetes mellitus or uncontrolled hypertension. The authors evaluated blood pressure and intensity of antihypertensive therapy over 36 months in a cohort of 58 patients with diabetes and hypertension on warfarin and 58 control subjects with diabetes and hypertension not on warfarin. The results demonstrate that warfarin therapy at conventional doses does not increase systolic blood pressure or pulse pressure in patients with diabetes and hypertension.
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http://dx.doi.org/10.1111/j.1524-6175.2007.06383.xDOI Listing
April 2007