The short period of 2020 to 2022 has felt like its own era in the field of kidney transplantation, with significant advances in the field on various fronts. The next two editions of Kidney News will highlight some of these advances in kidney transplantation, which push the barriers of science and society. This first and current edition will focus on racial inequities in transplantation and measures to address them, the new kidney transplant allocation system, updates from the Apolipoprotein L1 (APOL1) Long-term Kidney Transplantation Outcomes (APOLLO) study, and groundbreaking advances in xenotransplantation and finally,
The kidney allocation policy within the United States was initially established in 1987 to promote the equitable and utilitarian distribution of deceased donor kidneys (1). The policy, managed by the United Network for Organ Sharing (UNOS)/Organ Procurement and Transplantation Network (OPTN), was extensively revised in 2014 to increase the utilization of available kidneys, reduce regional variability in access to transplantation, and improve posttransplant outcomes. Major changes at the time included the introduction of the Kidney Donor Profile Index (KDPI) and Estimated Post Transplant Survival (EPTS) scores as estimates of kidney quality and projected recipient survival, respectively, and also
Oxalate or oxalic acid is a dicarboxylic acid formed in the human body from exogenous dietary sources and endogenous metabolism of ascorbic acid and some amino acids. It is essentially a terminal metabolic product that is produced by the liver, absorbed by the intestine from dietary sources, and freely filtered by the kidneys (Figure 1) (1). There is no human enzyme that can degrade it further.
Regional disparity in deceased donor kidney transplant rates
Hepatic metabolism and dietary oxalate absorption generate plasma oxalate, which is then primarily excreted by kidneys into urine.
During the past few months, I have participated in several meetings that included in-depth discussions about the future of the health care workforce in the United States. Each time, the discussion started with predictions about shortages of every kind of health professional—from physicians to nurses to physician assistants/associates to other clinicians—and then shifted to concerns about the ability to provide high-quality patient care in the future as a result.
Although this editorial will focus on the future of nephrologists in the United States, I recognize that the situation is dire throughout the world, particularly for nurses. Earlier this year, the
The ASN Task Force on the Future of Nephrology was charged in April 2022 to reconsider all aspects of the future of nephrology and determine how to best prepare nephrology fellows for the challenges and opportunities the future will bring. Consisting of a diverse cross-section of ASN members, the task force will provide recommendations to the ASN Council by September 2022. The timeline will meet the commitment made by ASN to the American Board of Internal Medicine (ABIM) and the Accreditation Council for Graduate Medical Education (ACGME), as these organizations determine what changes should be made to nephrology certification and
Structural racism is a root cause of health inequities. The term structural racism refers to differential access by racial group to opportunities, resources, and societal well-being and is mediated through complex health care systems (1). To undergo kidney transplant, patients must navigate a multistep, conditional process that requires multiple health system and clinician interactions. This process exerts a differential burden on patients from marginalized groups. Studies in recent decades have demonstrated that racial minority groups experience lower rates of kidney transplant listing and transplant compared with patients of White race (2, 3). Patients of
Two recent studies published in CJASN address different aspects of the COVID-19 pandemic in adults with advanced kidney diseases: one examines whether prior COVID-19 vaccination affected the outcomes of individuals on dialysis who became infected with SARS-CoV-2 (1), and the other assesses the pandemic's impact on treatment decision-making for older patients with chronic kidney disease (CKD) (2).
People with CKD or other severe chronic medical conditions are at higher risk for more serious COVID-19 illness, and patients with kidney failure who rely on in-center hemodialysis face an elevated risk of becoming exposed to the
A. Cozette Killian, Paige M. Porrett, Jayme E. Locke, and Vineeta Kumar
In 1964, the first kidney xenotransplant from a chimpanzee to human was performed successfully (1). Although the recipient survived 9 months, subsequent animal-to-human transplants were limited by immunologic barriers and the need for a sustainable organ source (2). Pigs soon became the ideal organ source because they produce large litters and mature rapidly, and availability is virtually unlimited (2, 3). Pigs have organs comparable in size and function with humans and lower risk of zoonoses, and their hormones and tissues are already used, suggesting positive public opinion (2, 3
ASN is retaining complete control over editorial content, strategy, and decisions while gaining technical, editorial, sales, and financial support. ASN will continue publishing cutting-edge nephrology science.
In a letter to HRSA, ASN emphasized the need for separating the technology portion of the OPTN contract as a stand-alone contract, requiring OPTN contractors to have complete and accurate data, and the enforcement of separate governance boards.