Publications by authors named "Sile Yu"

9 Publications

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Long-term kidney function and survival in recipients of allografts from living kidney donors with hypertension: a national cohort study.

Transpl Int 2021 Jun 15. Epub 2021 Jun 15.

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Allografts from living kidney donors with hypertension may carry subclinical kidney disease from the donor to the recipient and, thus, lead to adverse recipient outcomes. We examined eGFR trajectories and all-cause allograft failure in recipients from donors with versus without hypertension, using mixed-linear and Cox regression models stratified by donor age. We studied a US cohort from 1/1/2005 to 6/30/2017; 49 990 recipients of allografts from younger (<50 years old) donors including 597 with donor hypertension and 21 130 recipients of allografts from older (≥50 years old) donors including 1441 with donor hypertension. Donor hypertension was defined as documented predonation use of antihypertensive therapy. Among recipients from younger donors with versus without hypertension, the annual eGFR decline was -1.03 versus -0.53 ml/min/m (P = 0.002); 13-year allograft survival was 49.7% vs. 59.0% (adjusted allograft failure hazard ratio [aHR] 1.23; 95% CI 1.05-1.43; P = 0.009). Among recipients from older donors with versus without hypertension, the annual eGFR decline was -0.67 versus -0.66 ml/min/m (P = 0.9); 13-year allograft survival was 48.6% versus 52.6% (aHR 1.05; 95% CI 0.94-1.17; P = 0.4). In secondary analyses, our inferences remained similar for risk of death-censored allograft failure and mortality. Hypertension in younger, but not older, living kidney donors is associated with worse recipient outcomes.
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http://dx.doi.org/10.1111/tri.13947DOI Listing
June 2021

Development of a Patient Reported Measure of Experimental Transplants with HIV and Ethics in the United States (PROMETHEUS).

J Patient Rep Outcomes 2021 Mar 18;5(1):28. Epub 2021 Mar 18.

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Background: Transplantation of HIV-positive (HIV+) donor organs for HIV+ recipients (HIV D+/R+) is now being performed as research in the United States, but raises ethical concerns. While patient-reported outcome measures are increasingly used to evaluate clinical interventions, there is no published measure to aptly capture patients' experiences in the unique context of experimental HIV D+/R+ transplantation. Therefore, we developed PROMETHEUS (patient-reported measure of experimental transplants with HIV and ethics in the United States). To do so, we created a conceptual framework, drafted a pilot battery using existing and new measures related to this context, and refined it based on cognitive and pilot testing. PROMETHEUS was administered 6-months post-transplant in a clinical trial evaluating these transplants. We analyzed data from the first 20 patient-participants for reliability and validity by calculating Cronbach's alpha and reviewing item performance characteristics.

Results: PROMETHEUS 1.0 consisted of 29 items with 5 putative subscales: Emotions; Trust; Decision Making; Transplant; and Decision Satisfaction. Overall, responses were positive. Cronbach's alpha was > 0.8 for all subscales except Transplant, which was 0.38. Two Transplant subscale items were removed due to poor reliability and construct validity.

Conclusions: We developed PROMETHEUS to systematically capture patient-reported experiences with this novel experimental transplantation program, nested it in an actual clinical trial, and obtained preliminary data regarding its performance.
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http://dx.doi.org/10.1186/s41687-021-00297-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7973329PMC
March 2021

A prospective multicenter pilot study of HIV-positive deceased donor to HIV-positive recipient kidney transplantation: HOPE in action.

Am J Transplant 2021 05 8;21(5):1754-1764. Epub 2020 Aug 8.

Department of Surgery, University of Cape Town, Cape Town, South Africa.

HIV-positive donor to HIV-positive recipient (HIV D+/R+) transplantation is permitted in the United States under the HIV Organ Policy Equity Act. To explore safety and the risk attributable to an HIV+ donor, we performed a prospective multicenter pilot study comparing HIV D+/R+ vs HIV-negative donor to HIV+ recipient (HIV D-/R+) kidney transplantation (KT). From 3/2016 to 7/2019 at 14 centers, there were 75 HIV+ KTs: 25 D+ and 50 D- (22 recipients from D- with false positive HIV tests). Median follow-up was 1.7 years. There were no deaths nor differences in 1-year graft survival (91% D+ vs 92% D-, P = .9), 1-year mean estimated glomerular filtration rate (63 mL/min D+ vs 57 mL/min D-, P = .31), HIV breakthrough (4% D+ vs 6% D-, P > .99), infectious hospitalizations (28% vs 26%, P = .85), or opportunistic infections (16% vs 12%, P = .72). One-year rejection was higher for D+ recipients (50% vs 29%, HR: 1.83, 95% CI 0.84-3.95, P = .13) but did not reach statistical significance; rejection was lower with lymphocyte-depleting induction (21% vs 44%, HR: 0.33, 95% CI 0.21-0.87, P = .03). In this multicenter pilot study directly comparing HIV D+/R+ with HIV D-/R+ KT, overall transplant and HIV outcomes were excellent; a trend toward higher rejection with D+ raises concerns that merit further investigation.
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http://dx.doi.org/10.1111/ajt.16205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8073960PMC
May 2021

Early steroid withdrawal in HIV-infected kidney transplant recipients: Utilization and outcomes.

Am J Transplant 2021 02 13;21(2):717-726. Epub 2020 Aug 13.

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Kidney transplant (KT) outcomes for HIV-infected (HIV+) persons are excellent, yet acute rejection (AR) is common and optimal immunosuppressive regimens remain unclear. Early steroid withdrawal (ESW) is associated with AR in other populations, but its utilization and impact are unknown in HIV+ KT. Using SRTR, we identified 1225 HIV+ KT recipients between January 1, 2000, and December 31, 2017, without AR, graft failure, or mortality during KT admission, and compared those with ESW with those with steroid continuation (SC). We quantified associations between ESW and AR using multivariable logistic regression and interval-censored survival analysis, as well as with graft failure and mortality using Cox regression, adjusting for donor, recipient, and immunologic factors. ESW utilization was 20.4%, with more zero HLA mismatch (8% vs 4%), living donors (26% vs 20%), and lymphodepleting induction (64% vs 46%) compared to the SC group. ESW utilization varied widely across 129 centers, with less use at high- versus moderate-volume centers (6% vs 21%, P < .001). AR was more common with ESW by 1 year (18.4% vs 12.3%; aOR: 1.61 , P = .04) and over the study period (aHR: 1.39 , P = .03), without difference in death-censored graft failure (aHR 0.91 , P = .33) or mortality (aHR: 1.15 , P = .45). To reduce AR after HIV+ KT, tailoring of ESW utilization is reasonable.
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http://dx.doi.org/10.1111/ajt.16195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927911PMC
February 2021

Survival benefit of accepting kidneys from older donation after cardiac death donors.

Am J Transplant 2021 03 17;21(3):1138-1146. Epub 2020 Sep 17.

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Kidneys from older (age ≥50 years) donation after cardiac death (DCD50) donors are less likely to be transplanted due to inferior posttransplant outcomes. However, candidates who decline a DCD50 offer must wait for an uncertain future offer. To characterize the survival benefit of accepting DCD50 kidneys, we used 2010-2018 Scientific Registry for Transplant Recipients (SRTR) data to identify 92 081 adult kidney transplantation candidates who were offered a DCD50 kidney that was eventually accepted for transplantation. DCD50 kidneys offered to candidates increased from 590 in 2010 to 1441 in 2018. However, 34.6% of DCD50 kidneys were discarded. Candidates who accepted DCD50 offers had 49% decreased mortality risk (adjusted hazard ratio [aHR] 0.51 , cumulative mortality at 6-year 23.3% vs 34.0%, P < .001) compared with those who declined the same offer (decliners). Six years after their initial DCD50 offer decline, 43.0% of decliners received a deceased donor kidney transplant (DDKT), 6.3% received living donor kidney transplant (LDKT), 22.6% died, 22.0% were removed for other reasons, and 6.0% were still on the waitlist. Comparable survival benefit was observed even with DCD donors age ≥60 (aHR: 0.52 , P < .001). Accepting DCD50 kidneys was associated with a substantial survival benefit; providers and patients should consider these benefits when evaluating offers.
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http://dx.doi.org/10.1111/ajt.16198DOI Listing
March 2021

The first increase in live kidney donation in the United States in 15 years.

Am J Transplant 2020 12 17;20(12):3590-3598. Epub 2020 Jul 17.

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

The first sustained increase in live kidney donation in the United States in 15 years was observed from 2017 to 2019. To help sustain this surge, we studied 35 900 donors (70.3% white, 14.5% Hispanic, 9.3% black, 4.4% Asian) to understand the increase in 2017-2019 vs 2014-2016 using Poisson regression. Among biologically related donors aged <35, 35-49, and ≥50 years, the number of donors did not change across race/ethnicity but increased by 38% and 29% for Hispanic and black ≥50. Among unrelated donors <35, 35-49, and ≥50, white donors increased by 18%, 14%, and 27%; Hispanic donors <35 did not change but increased by 22% and 35% for 35-49 and ≥50; black donors <35 declined by 23% and did not change for 35-49 and ≥50; Asian donors did not change. Among kidney paired donors <35, 35-49, and ≥50, white donors increased by 42%, 50%, and 68%; Hispanic donors <35 and 35-49 increased by 36% and 55% and did not change for ≥50; black donors did not change; Asian donors <35 did not change but increased by 107% and 82% for 35-49 and ≥50. The increase in donation was driven predominantly by unrelated and paired white donors. Donation among unrelated black individuals should be promoted.
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http://dx.doi.org/10.1111/ajt.16136DOI Listing
December 2020

Road safety risk factors for non-motorised vehicle users in a Chinese city: an observational study.

Inj Prev 2020 04 29;26(2):116-122. Epub 2019 Mar 29.

Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

Objective: The objective of this study is to describe and analyse the prevalence of speeding, helmet use and red-light running among riders of non-motorised vehicles (NMVs) in Shanghai, China, with a focus on electric bikes (ebikes).

Methods: Observational studies were conducted in eight randomly selected locations in Shanghai. Descriptive statistics and a Cox proportional hazard (PH) model were used in the analyses.

Findings: A total of 14 828 NMVs were observed in November 2017. At the free flow sites, the average speed was 22.5 km/hour for ebikes and 13.4 km/hour for bicycles. 95.5% of ebikes run above 15 km/hour, the legal speed limit for NMVs in China and 83.8% above 20 km/hour, the maximum design speed for ebikes. Helmet wearing rate was 13.5% for ebike drivers and 9.4% for passengers. Riders of commercial ebikes were nearly three times more likely to wear a helmet than personal ebikes. 22.4% of ebikes were observed to run a red light. The Cox PH model showed that ebikes (vs bicycles), males (vs females), clear weather (vs cloudy, rainy and snowy), helmet users (vs nonusers) are associated with a higher hazard for running a red light.

Conclusion: To our knowledge, this study is among the first comprehensive evaluation of road user behaviours for NMVs in China. An effective intervention package including regulating ebike production to national standards, strengthening speed enforcement and passing legislation on mandatory helmet use for ebike users may be able to help.
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http://dx.doi.org/10.1136/injuryprev-2018-043071DOI Listing
April 2020

The changing landscape of live kidney donation in the United States from 2005 to 2017.

Am J Transplant 2019 09 3;19(9):2614-2621. Epub 2019 May 3.

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

The number of live kidney donors has declined since 2005. This decline parallels the evolving knowledge of risk for biologically related, black, and younger donors. To responsibly promote donation, we sought to identify declining low-risk donor subgroups that might serve as targets for future interventions. We analyzed a national registry of 77 427 donors and quantified the change in number of donors per 5-year increment from 2005 to 2017 using Poisson regression stratified by donor-recipient relationship and race/ethnicity. Among related donors aged <35, 35 to 49, and ≥50 years, white donors declined by 21%, 29%, and 3%; black donors declined by 30%, 31%, and 12%; Hispanic donors aged <35 and 35 to 49 years declined by 18% and 15%, and those aged ≥50 increased by 10%. Conversely, among unrelated donors aged <35, 35 to 49, and ≥50 years, white donors increased by 12%, 4%, and 24%; black donors aged <35 and 35 to 49 years did not change but those aged ≥50 years increased by 34%; Hispanic donors increased by 16%, 21%, and 46%. Unlike unrelated donors, related donors were less likely to donate in recent years across race/ethnicity. Although this decline might be understandable for related younger donors, it is less understandable for lower-risk related older donors (≥50 years). Biologically related older individuals are potential targets for interventions to promote donation.
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http://dx.doi.org/10.1111/ajt.15368DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6711793PMC
September 2019
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