Priorities for 2023 Include Transplantation, Nephrology Training, and Environmental Sustainability

Michelle A. Josephson Michelle A. Josephson, MD, FASN, is Professor of Medicine and Surgery, University of Chicago, IL, and is ASN President.

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Thank you to Anupam Agarwal and Susan Quaggin for their outstanding service to ASN. The entire kidney community owes them a debt of gratitude for their skilled and transformative leadership in 2020, 2021, and 2022. During their tenure, ASN accomplished an impressive number of meaningful achievements, some of which I have outlined in Table 1.

Table 1

Selected list of ASN’s recent accomplishments

Table 1

ASN was fortunate to have Anupam and Sue in charge during these challenging times. While bringing us through a pandemic, handling the tragic loss of our colleague and dear friend Barbara Murphy, and moving ASN forward, they served additional years and gave of themselves with grace, humility, and wisdom. The success of ASN Kidney Week 2022—our first in-person annual meeting since 2019—is a testament to how well they guided ASN while always keeping the needs of our patients and members as priorities. Anupam and Sue set a high bar, and they are hard acts to follow.

I recognize that you may not know me, so I thought it would be helpful to share a bit about myself. Starting at the beginning, I was born in Brooklyn (one of the five boroughs that form New York City) and mostly grew up there. My father was an allergist and immunologist who loved all aspects of his work in academic medicine: caring for his patients, conducting research, and teaching the next generation. His enthusiasm for the profession was so infectious that I became a physician, my younger brother is a hematologist-oncologist, and my younger sister is a physician’s assistant who works with patients on peritoneal dialysis.

My father worked at the State University of New York Downstate Health Sciences University, where his friend and colleague, nephrologist Eli Friedman, worked as well. My mother, initially a nurse by training, became an epidemiologist, in large part inspired by working with Dr. Friedman on hepatitis B prevalence and transmission in dialysis patients (1). I started in the nephrology world working with Dr. Friedman on animal models he had developed to study diabetic nephropathy as well as participating in meetings to design a dialysis machine that could be carried around in a suitcase (2). During a summer spent at The Jackson Laboratory in Bar Harbor, ME, I was exposed to life as a bench science immunologist.

Perhaps it was these early experiences that helped me decide on a career in nephrology when, as a medicine resident, I was encouraged by Fredric Coe, Susan Fellner, Marshall Lindheimer, Mark Richter, and Gary Toback. During fellowship, I fell in love with transplant for the benefits it provided patients, the immunologic challenges, the medical complexities, and the multidisciplinary nature of the field. Transplant nephrology was not an area of focus for the University of Chicago (UC) nephrology faculty at the time, and patients were managed by the transplant surgeons. With that post-transplant care model, I saw the opportunity to make a difference in patient outcomes and address nonsurgical issues faced by our transplant recipients.

Although there were leading bench immunologists at UC, the challenge for me at the start of my career was a lack of clinical transplant nephrologists to create a program. This lack of on-site transplant nephrology propelled me to reach out to the relatively small group of transplant nephrologists nationwide at the time. They welcomed me into the transplant nephrology world, providing mentorship and opportunities as well as generously sharing their experience and expertise.

At the end of fellowship, I readily accepted an opportunity to stay as the first official UC transplant nephrologist and founded the Clinical Transplant Nephrology Program. By accepting this position, my home became the city of Chicago, where I now live with my husband, Stephen Daiter, a photography dealer who runs a gallery and, when home from school, our daughter, Maya, as well as our dog, Ursa.

Over time, the one-person transplant nephrology program grew. I was able to recruit wonderful colleagues who have worked with me at different points, including James Chon, Amishi Desai, Pradeep Kadambi, Sambhavi Krishnamoorthy, Yousuf Kyeso, Basit Javaid, and Pratik Shah. I also started a transplant nephrology fellowship and have helped train more than 20 fellows (and counting!) who have contributed to several aspects of nephrology, making our field that much better. I could not be prouder of each of them.

On the national front, I worked closely with a number of groups besides ASN, including the American Board of Internal Medicine, American Society of Transplantation (AST), Kidney Disease: Improving Global Outcomes, National Kidney Foundation, and Women in Nephrology. After I had the honor of serving on the AST Board of Directors, ASN became my professional home, where I’ve worked closely with the dedicated members and staff on several initiatives and committees.

What is my focus for 2023? To start, I will continue to center any plans based on the four priorities outlined in the We’re United 4 Kidney Health campaign (3). The campaign’s four priorities provide direction while leaving room for all of us to find connection and meaning in our work, be it to intervene earlier to prevent, diagnose, coordinate care, and educate; transform transplant and increase access to donor kidneys; accelerate innovation and expand patient choice; or achieve equity and eliminate disparities. Progress in any of these domains is a win for our patients and for our specialty.

As a personal interest, as well as what would have been a focus of Barbara Murphy’s tenure as ASN President in 2022, I enthusiastically embrace the opportunity to emphasize We’re United 4 Kidney Health’s second priority: transforming transplant. I see 2023 as a chance to build bridges between general nephrology and transplant nephrology. At times, our existing system does not serve patients as well as it could, making transplant more of a privilege than an equitably accessible treatment. As a community, we should strive for a transplant system that maximizes patients’ access to a kidney transplant—no matter their means, their background, or where they live.

As a community, we should strive for a transplant system that maximizes patients’ access to a kidney transplant.

With bipartisan, bicameral interest in government to improve the transplant system, focusing on transplant is timely. Transplant is not a new emphasis for ASN, which has been helping to shape policy in this arena for years, including working closely with three consecutive presidential administrations. We are drafting several guiding principles that will underpin the transplant policy work for next year including: affirm that kidney transplant is the optimal therapy for kidney failure, articulate that the goal of the kidney transplant ecosystem should be to maximize access to a kidney transplant, and acknowledge that many simultaneous changes to the current approach to kidney transplant must occur urgently to achieve this goal.

With these principles forming the foundation, five objectives will guide everything we will do to transform transplant:

  1. Expedite reforms necessary to maximize patient access to transplant.

  2. Enable the use of more organs to allow more patients to receive a transplant.

  3. Establish transparency to improve patient access to transplant and address barriers in the kidney transplant ecosystem.

  4. Encourage investment in transplant-related research and innovation.

  5. Embrace modern technology to increase every patient’s access to transplant.

In addition to these principles and objectives, I am also passionate about finding ways to ensure we provide appropriate long-term care for transplant recipients. The COVID-19 pandemic exposed the many challenges faced by people who are immunosuppressed. Focusing on the health of transplant recipients will enhance their quality and length of life, reduce the need for new transplants, and increase the number of organs available for transplant (4).

During the next year, I will focus on advancing training, certification, and overall acknowledgment of transplant nephrology as an important part of medical care. This specific goal dovetails well with ongoing efforts to examine and reinvigorate nephrology training. In its final report, the ASN Task Force on the Future of Nephrology proposed three levels of training and competencies (5). The task force’s 10 recommendations align with ASN’s efforts to articulate the value of nephrology. Under Mark Rosenberg’s leadership as the task force’s chair, the final report is visionary, focusing on the “why” and the “what.” Now is time for us to begin the “how.” Implementation will be a multi-year process that starts today.

Another priority for 2023 is related to supporting several upcoming transitions. ASN’s peer-reviewed journals (JASN, CJASN, and Kidney360) are migrating from an in-house operation to a commercial publisher (Wolters Kluwer), and this transition must go as smoothly as possible. By the end of this year, Josie Briggs and Rajnish Mehrotra, the editors-in-chief of JASN and CJASN, respectively, will complete their terms. For nearly a decade, Josie, Raj, and their editorial teams have expertly led the journals in publishing impactful scientific, clinical, and policy articles that shaped and reflected the high caliber of nephrology scholarship and discourse. Starting in 2024, with the guidance of the ASN leadership, the journal relationships will be restructured, with JASN serving as the “flagship journal” and its editor-in-chief working closely with the editors-in-chief of CJASN and Kidney360 to produce the publications as a portfolio of journals.

On January 1, 2023, Uptal Patel succeeded Raymond Harris as chair of the Kidney Health Initiative (KHI) Board of Directors. A partnership between ASN and the US Food and Drug Administration (FDA), KHI includes more than 100 stakeholder members. Under Ray’s deft leadership, KHI continued its momentum through the COVID-19 pandemic by increasing virtual connections with the member community. KHI has published 42 total manuscripts, including nine manuscripts in 2021 and six manuscripts in 2022. KHI’s portfolio expanded across FDA centers by launching projects in xenotransplantation, initiating the first collaboration between KHI and FDA’s Center for Biologics Evaluation and Research, and starting efforts to incorporate the input of care partners and people with kidney diseases through Patient Preferences, Patient-Reported Outcome Measures, and Human Centered Design tools.

ASN and the rest of the kidney community must concentrate on environmental sustainability at every level. This goal fits well with the recommendations of the ASN Task Force on the Future of Nephrology and provides an opportunity to work with other kidney organizations globally, particularly the European Renal Association (ERA) and the International Society of Nephrology (ISN). Last year, ASN issued a position statement on climate change (6) and published “Policy and Kidney Community Engagement to Advance toward Greener Kidney Care” (7). ASN, ERA, and ISN could partner to “support people with kidney diseases to survive climate change, diminish the contribution of kidney care to climate change, and advocate for public policy to address climate change as a contributor to kidney health” (6).

While I used this column to describe several of my priorities, they barely scratch the surface of what we must do together in 2023. Serving as ASN President is a once-in-a-lifetime opportunity, endeavor, and privilege. I look forward to working with you—the ASN membership, my fellow ASN Councilors (ASN Past President Sue Quaggin; President-Elect Deidra Crews; Secretary Prabir Roy-Chaudhury; Treasurer Keisha Gibson; and Councilors-at-Large: Jeffrey Berns, Linda Fried, Crystal Gadegbeku, and Patrick Nachman), and the ASN staff—to accomplish much this year. I wish you a happy, fulfilling, and successful 2023. Now let’s get started!