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
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.
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
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
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.
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.
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
Interest in nephrology as a career among United States medical graduates (USMGs) is declining—and has been on the decline for the better part of a decade. From 2002 to 2009, all internal medicine subspecialties increased the number of available positions, with the exception of geriatric medicine (which shrank overall) (1, 2). Yet, in 2009, nephrology was the only internal medicine specialty to attract fewer USMGs than in 2002, the result of a steady seven-year decrease in the number of USMGs entering the renal field (Figure 2.1). During that time, the number of USMGs in
The workforce crisis hitting the field of nephrology extends beyond physicians to nurses, nurse practitioners, and physician assistants (PAs), who are often on the front lines in the battle against kidney disease. Nurses and nurse practitioners provide essential services to patients with kidney disease, working in hospitals, dialysis centers, and homes. They help bridge the growing gap between the number of patients with kidney disease and the availability of nephrologists.
Despite the essential role of nurses in caring for patients, the future of nursing is less than certain. In 2008, the average age for nurses reached 46, reflective of an
In contrast to adult nephrology, pediatric nephrology significantly increased its number of USMG fellows in recent years (1, 2). From 2002 to 2009, the number of pediatric nephrology fellows grew from 65 to 123, and the number of USMGs in pediatric nephrology fellowships jumped from 31 to 71, bringing USMGs up to 57.7 percent of the total from 47.4 percent.
During this time, more women also entered the specialty. In 2002, 34 pediatric nephrology fellows were women (53.3 percent); in 2009, 83 were women (67.5 percent). Yet pediatric nephrology may not be the bright spot it