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Daniel M. Keller

Even with protocols in place to improve compliance, many kidney transplant patients did not achieve risk factor targets for cardiovascular disease, a leading cause of graft failure and of death after transplantation, according to study results presented at the American Transplant Congress in Philadelphia in early May. But as time went on after transplantation, the modifiable risk factors of hypertension, hyperlipidemia, and diabetes mellitus could become better controlled, said lead author Rakesh Kumar, MD, of the State University of New York at Buffalo.

Although advances in immunosuppressive therapy can prevent immune-mediated damage to transplanted kidneys and improve short-term allograft survival,

Chronic use of opioids (COU) before kidney transplantation may be associated with an increased risk of early graft loss and higher mortality after transplant, according to a retrospective study from the University of Michigan presented at the American Transplant Congress in Philadelphia in May.

Of the 1064 adult patients who received a kidney graft at the university between 2004 and 2008, 42.5 percent reported that they had chronic pain and 10.2 percent reported that they had used opioids on a chronic basis before their transplants. The patients were followed up until the end of 2010. These figures are in line

Daniel M. Keller

Delays and errors in communication from donor organ centers to recipient centers frequently contribute to the transmission of infections. Rachael Miller, MD, presented the results of a study of potential donor-derived infections reported between January 2008 and June 2010 to the Ad Hoc Disease Transmission Advisory Committee (DTAC) of the Organ Procurement and Transplantation Network, administered by the United Network for Organ Sharing (UNOS). Miller is clinical professor in infectious diseases at the University of Iowa Carver College of Medicine in Iowa City.

Communication gaps occur at multiple levels and have been associated with adverse outcomes in organ recipients, but

Daniel M. Keller

Older patients receiving pancreas transplants have lower rates of acute rejection and total complications than their younger counterparts. With improvements in the management of diabetes, more older patients are presenting for transplantation of pancreases and kidneys. Previous registry data suggested that older patients did not do as well as younger ones, but modern induction and maintenance immunosuppressive therapy has changed the picture for the better for older patients, according to study results presented at the American Transplant Congress in Philadelphia in May.

Through a retrospective chart review of 139 consecutive pancreas transplant patients over a 15-year period at New York–Presbyterian

Daniel M. Keller

The proteasome inhibitor bortezomib reverses early and late antibody-mediated rejection (AMR), a major cause of solid organ transplant loss. The drug opens up a new avenue for specifically targeting plasma cells, the cells that produce antibodies.

Speaking at the American Transplant Congress in Philadelphia in May, Steve Woodle, MD, professor and chairman of surgery and chief of the division of transplant surgery at the University of Cincinnati in Ohio, explained that AMR affects all solid organ transplants. “If you look at the reasons why people lose their grafts, there’s evidence to suggest that the predominant mechanism is antibody-mediated,” he said.

Daniel M. Keller

Sexually transmitted infection (STI) could be considered a high-risk category for HIV transmission through organ donation. But hemophilia should now be dropped as a risk category, given the low incidence of HIV in that population, according to a study presented at the American Transplant Congress in Philadelphia in May.

The U.S. Centers for Disease Control and Prevention (CDC) issued classifications of high-risk organ donors in 1994, but the epidemiology of certain infections has changed since then. Current evidence shows that STI could now be considered a high-risk category, given the high incidence and prevalence of HIV among this population. But

Daniel M. Keller

Early withdrawal of corticosteroids after kidney transplantation was associated with a lower rate of cardiovascular (CV) events compared with long-term corticosteroid administration, according to a study presented at the American Transplant Congress, held in Philadelphia from April 30 to May 4. Lead author Nicole Schmidt, PharmD, of the University of Cincinnati in Ohio, said that the decrease in CV events became apparent 3–4 years after transplant in the group of patients with early withdrawal, even though these patients had more coronary artery disease before transplant. There were no differences in overall patient survival or in CV-related deaths between the early

Evelyn Shapiro

Responding to concerns about the future of the nephrology workforce, the ASN is currently establishing a Workforce Committee. “A key goal of the ASN Strategic Plan is to advance patient care and research in kidney disease by strengthening the pipeline of clinicians, researchers, and educators,” explains ASN President Joseph V. Bonventre, MD, PhD, FASN.

The ASN Workforce Committee will help the society meet this goal by

Implementing a strategy (based on the Final Report of the ASN Task Force on Increasing Interest in Nephrology Careers) to increase interest in nephrology careers, which includes promoting diversity within the nephrology workforce.

Making

Rachel Shaffer and Mark G. Parker

As is the case with many chronic diseases in the United States, chronic kidney disease (CKD) is on the rise. The recent recognition of CKD as a public health problem may be driving patients to nephrologists at earlier stages. At least 26 million Americans have some stage of CKD (Figure 3.1), and minority populations are disproportionately affected. Minorities constitute an increasingly greater portion of the United States population, and incident rates of end stage renal disease (ESRD) among African Americans and Hispanics are nearly four times and 1.5 times greater, respectively, than in whites.

Percent, U.S.

Bruce A. Molitoris

As mounting evidence makes the waning interest in nephrology obvious to all of us, we must ask, “Why have we been asleep behind the wheel?” The accompanying articles in this special issue of ASN Kidney News detail many of the problems that have finally gotten our attention.

For instance, why were our colleagues in Australia the first to raise similar concerns about the nephrology workforce (1)? Why did the nephrology leaders in the United States not notice that the majority of medical students in this country do not take electives in nephrology? This decision means that