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| 1 | Histopathological characteristics and causes of kidney graft failure in the current era of immunosuppression显示文摘BACKGROUND The histopathological findings on the failing kidney allograft in the modern era is not well studied. In this study, we present our experience working with kidney transplant recipients with graft failure within one year of the biopsy.AIM To report the histopathological characteristics of failed kidney allografts in the current era of immunosuppression based on the time after transplant, cause of the end-stage renal disease and induction immunosuppressive medications.METHODS In a single-center observational study, we characterized the histopathological findings of allograft biopsies in kidney transplant recipients with graft failure within one year after the biopsy.RESULTS We identified 329 patients with graft failure that met the selection criteria between January 1, 2006 and December 31, 2016. The three most common biopsy findings were interstitial fibrosis and tubular atrophy(IFTA, 53%), acute rejection (AR, 43%) and transplant glomerulopathy(TG, 33%). Similarly, the three most common causes of graft failure based on the primary diagnosis were AR(40%),TG(17%), and IFTA(13%). Most grafts failed within two years of post-transplant(36%). Subsequently, approximately 10%-15% of grafts failed every two years: >2-4 years(16%), > 4-6 years(13%), > 6-8 years(11%), > 8-10 years(9%) and > 10 years(16%). AR was the most common cause of graft failure in the first six years(48%), whereas TG was the most prevalent cause of graft failure after 6 years(32%) of transplant.CONCLUSION In the current era of immunosuppression, AR is still the most common cause of early graft failure, while TG is the most prevalent cause of late graft failure. | Sandesh Parajuli Fahad Aziz Neetika Garg Sarah E Panzer Emily Joachim Brenda Muth Maha Mohamed Justin Blazel Weixiong Zhong Brad C Astor Didier A Mandelbrot Arjang Djamali | 2019 | World Journal of Transplantation2019，9，6： | 2 |
| 2 | Impacts and challenges of United States medical students during the COVID-19 pandemic显示文摘The delivery of medical student education has changed rapidly during the coronavirus disease 2019(COVID-19)pandemic.Students in their pre-clinical years have transitioned to online courses and examinations.Students in their clinical years are not permitted on clinical rotations,and face uncertainties in career exploration and the residency application process.Medical students in all stages of training are volunteering and helping their communities.The future presence of COVID-19 throughout the United States is unknown,and medical students are eager to return to their training.This paper outlines current challenges in medical student education and the various responses that have been adopted.We also discuss possible future directions for students through involvement in telemedicine,outpatient clinic visits,and non-respiratory inpatient care tasks as adequate personal protective equipment,COVID-19 testing,and resources become more widely available. | Stacey Rolak Alexis M Keefe Emily L Davidson Prabesh Aryal Sandesh Parajuli | 2020 | World Journal of Clinical Cases2020，8，15： | 2 |
| 3 | Role of novel biomarkers in kidney transplantation显示文摘Clinical application of biomarkers is an integral component of transplant care.Clinicians and scientists alike are in search of better biomarkers than the current serologic(serum creatinine,donor-specific antibodies),urine-derived(urinalysis,urine protein),and histologic ones we now use.The science behind recent biomarker discovery spans across multiple molecular biologic disciplines,including transcriptomics,proteomics,and metabolomics.Innovative methodology and integration of basic and clinical approaches have allowed researchers to unearth molecular phenomena preceding clinical disease.Biomarkers can be classified in several ways.In this review,we have classified them via their origin and outcome:Primarily immunologic,i.e.,representative of immune regulation and dysfunction and non-immunologic,pertaining to delayed graft function,cardiovascular events/mortality,infection,malignancy,posttransplant diabetes,graft,and patient survival.Novel biomarker uses to guide the diagnosis and management of transplant-related outcomes is a promising area of research.However,the use of biomarkers to predict outcomes after kidney transplantation is not well studied.In this review,we summarize the recent studies illustrating biomarker use and transplant outcomes. | Kurtis J Swanson Fahad Aziz Neetika Garg Maha Mohamed Didier Mandelbrot Arjang Djamali Sandesh Parajuli | 2020 | World Journal of Transplantation2020，10，9： | 1 |
| 4 | Hyperkalemia:Major but still understudied complication among heart transplant recipients显示文摘Hyperkalemia is a recognized and potentially life-threatening complication ofheart transplantation. In the complex biosystem created by transplantation,recipients are susceptible to multiple mechanisms for hyperkalemia which arediscussed in detail in this manuscript. Hyperkalemia in heart transplantationcould occur pre-transplant, during the transplant period, or post-transplant. Pretransplantcauses of hyperkalemia include hypothermia, donor heart preservationsolutions, conventional cardioplegia, normokalemic cardioplegia, continuouswarm reperfusion technique, and ex-vivo heart perfusion. Intra-transplant causesof hyperkalemia include anesthetic medications used during the procedure,heparinization, blood transfusions, and a low output state. Finally, post-transplantcauses of hyperkalemia include hemostasis and drug-induced hyperkalemia.Hyperkalemia has been studied in kidney and liver transplant recipients, butthere is limited data on the incidence, causes, management, and prevention inheart transplant recipients. Hyperkalemia is associated with an increased risk ofhospital mortality and readmission in these patients. This review describes thecurrent literature pertaining to the causes, pathophysiology, and treatment ofhyperkalemia in patients undergoing heart transplantation and focuses primarilyon post-heart transplantation. | Jagmeet Singh Asim Kichloo Navya Vipparla Michael Aljadah Michael Albosta Shakeel Jamal Sindhura Ananthaneni Sandesh Parajuli | 2021 | World Journal of Transplantation2021，11，6： | 1 |
| 5 | Post-transplant erythrocytosis after kidney transplantation:A review显示文摘Post-transplant erythrocytosis(PTE)is defined as persistently elevated hemoglobin>17 g/dL or hematocrit levels>51%following kidney transplantation,independent of duration.It is a relatively common complication within 8 months to 24 months post-transplantation,occurring in 8%-15%of kidney transplant recipients.Established PTE risk factors include male gender,normal hemoglobin/hematocrit pre-transplant(suggestive of robust native kidney erythropoietin production),renal artery stenosis,patients with a well-functioning graft,and dialysis before transplantation.Many factors play a role in the development of PTE,however,underlying endogenous erythropoietin secretion pre-and post-transplant is significant.Other contributory factors include the renin-angiotensin-aldosterone system,insulin-like growth factors,endogenous androgens,and local renal hypoxia.Most patients with PTE experience mild symptoms like malaise,headache,fatigue,and dizziness.While prior investigations showed an increased risk of thromboembolic events,more recent evidence tells a different story-that PTE perhaps has lessened risk of thromboembolic events or negative graft outcomes than previously thought.In the evaluation of PTE,it is important to exclude other causes of erythrocytosis including malignancy before treatment.Angiotensin converting enzyme inhibitors(ACE-I)and angiotensin receptor blockers(ARBs)are the mainstays of treatment.Increased ACE-I/ARB use has likely contributed to the falling incidence of erythrocytosis.In this review article,we summarize the current literature in the field of post-transplant erythrocytosis after kidney transplantation. | Beyann Alzoubi Abish Kharel Rushad Machhi Fahad Aziz Kurtis J Swanson Sandesh Parajuli | 2021 | World Journal of Transplantation2021，11，6： | 1 |
| 6 | Blessing and a curse of outpatient management of delayed graft function显示文摘Delayed graft function (DGF) is a common complication occurring most often after deceased donor kidney transplant with several donor characteristics as well as immunologic factors that lead to its development post-transplant.These patients require dialysis and close kidney function monitoring until sufficient allograft function is achieved.This has resulted in limited options for DGF management,either prolonged hospitalization until graft function improves to the point where dialysis is no longer needed or discharge back to their home dialysis unit with periodic follow up in the transplant clinic.DGF is associated with a higher risk for acute rejection,premature graft failure,and 30-d readmission;therefore,these patients need close monitoring,immunosuppression management,and prompt allograft biopsy if prolonged DGF is observed.This may not occur if these patients are discharged back to their home dialysis unit.To address this issue,the University of Wisconsin-Madison created a clinic in 2011 specialized in outpatient DGF management.This clinic was able to successfully reduce hospital length of stay without an increase in 30-d readmission,graft loss,and patient death. | Justin W Blazel Jennifer A Turk Brenda L Muth Sandesh Parajuli | 2019 | World Journal of Transplantation2019，9，4： | 0 |
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