Impact of Acute Rejection on Kidney Allograft Outcomes in Recipients on Rapid Steroid Withdrawal

Background. Our aim was to study the impact of clinical acute rejection (CR) and subclinical rejection (SR) on outcomes in kidney transplant recipients treated with rapid steroid withdrawal (RSW). Methods. All patients who received a living or deceased donor kidney transplant and were treated with RSW were included. The primary outcome was death-censored graft survival. Biopsies with Banff borderline changes were included with the rejection groups. Results. 457 kidney transplant recipients treated with RSW were included; 46 (10%) experienced SR, and 36 (7.8%) had CR. Mean HLA mismatch was significantly higher in the CR group. The Banff grade of rejection was higher in the CR group. There was a larger proportion of patients in both rejection groups with the combination of IFTA and persistent inflammation on the follow-up protocol biopsy done at 1 year. The estimated 5-year death-censored graft survival was 81% in SR, 78% in CR, and 97% in the control group (P < .0001). Significant differences were observed in allograft survival between the CR and control group (HR 9.06, 95% CI 3.39–24.2) and between the SR and control group (HR 4.22, 95% CI 1.30–13.7). Conclusion. Both SR and CR are associated with an inferior graft survival in recipients on RSW

Successful Transplantation of a Split Crossed Fused Ectopic Kidney into a Patient with End-Stage Renal Disease

Potential donors with congenital renal anomalies but normal renal function are often overlooked because of a possible increase in technical difficulty and complications associated with the surgery. However, as the waiting list for a deceased donor kidney transplant continues to grow, it is important to consider these kidneys for potential transplant. This paper describes the procurement of a crossed fused ectopic kidney, and subsequent parenchymal transection prior to transplantation as part of a combined simultaneous kidney pancreas transplant. The transplant was uncomplicated, and the graft had immediate function. The patient is now two years from transplant with excellent function

Plasma Electronics

Contains research objectives and reports on ten research projects.National Science Foundation (Grant GK-57)United States Atomic Energy Commission under Contract AT(30-1)-322

Chronic kidney disease after liver, cardiac, lung, heart–lung, and hematopoietic stem cell transplant

Patient survival after cardiac, liver, and hematopoietic stem cell transplant (HSCT) is improving; however, this survival is limited by substantial pretransplant and treatment-related toxicities. A major cause of morbidity and mortality after transplant is chronic kidney disease (CKD). Although the majority of CKD after transplant is attributed to the use of calcineurin inhibitors, various other conditions such as thrombotic microangiopathy, nephrotic syndrome, and focal segmental glomerulosclerosis have been described. Though the immunosuppression used for each of the transplant types, cardiac, liver and HSCT is similar, the risk factors for developing CKD and the CKD severity described in patients after transplant vary. As the indications for transplant and the long-term survival improves for these children, so will the burden of CKD. Nephrologists should be involved early in the pretransplant workup of these patients. Transplant physicians and nephrologists will need to work together to identify those patients at risk of developing CKD early to prevent its development and progression to end-stage renal disease

Vibrations and Some Electronic Excitations of Adsorbed Alkali Metal Monolayers

We discuss briefly data obtained for adsorbed alkali metal monolayers with three different techniques (HREELS, UPS and SHG). The vibrational spectra provide support for the traditional picture of a fractionally charged adsorbate at low coverage and a neutral one at high coverage. We ascribe a vibrational overtone reported in previous work to contamination due to residual water vapour. UPS, uncharacteristically, gives little information of interest for low coverages except for substrates with a band gap and with a surface state in the gap. For Na on Si(100) we monitor the metallization of the surface region in the monolayer coverage range and observe metal induced gap states at higher coverages. For Cs on Cu(111) the optical second harmonic generation (SHG) shows a strong monolayer coverage dependence which we ascribe to optical transitions between surface bands and to surface barrier photoabsorption indicating the potential of SHG as a probe of the details of the surface electronic structure

Relationship of big five personality traits and future specialty preference among undergraduate medical students: a cross-sectional study

Abstract Background The precise choice of specialty is of paramount importance in a physician’s career. Several factors play a role in deciding the specialty, such as intelligence, motivation, clinical experience, personality, and socioeconomic factors. Our hypothesis is whether personality profiles differ based on specialty choice. Therefore, we investigated the association between personality traits and specialty choice. Results A cross-sectional study was conducted among 379 undergraduate medical students. Big five personality inventory was used to determine the personality traits among medical students. The most chosen speciality among both male and females was Surgery. Comparing the groups depending on their preferred specialties revealed no differences in three of five personality traits of Big five personality inventory. Students who selected psychiatry specialty scored highest on openness (p = 0.007) and lowest on extraversion (p = 0.018), indicating a substantial difference between the traits of extraversion and openness to experience. Conclusions The differences in personality features could not be attributed to a predilection for a particular speciality. However, medical students who scored higher on openness (intellect/imagination) and less on extraversion scales were more likely to choose psychiatric specialty. Numerous other factors affect specialization preference even if there are no differences in personality features between various specialties

Clinical Study Impact of Acute Rejection on Kidney Allograft Outcomes in Recipients on Rapid Steroid Withdrawal

Background. Our aim was to study the impact of clinical acute rejection (CR) and subclinical rejection (SR) on outcomes in kidney transplant recipients treated with rapid steroid withdrawal (RSW). Methods. All patients who received a living or deceased donor kidney transplant and were treated with RSW were included. The primary outcome was death-censored graft survival. Biopsies with Banff borderline changes were included with the rejection groups. Results. 457 kidney transplant recipients treated with RSW were included; 46 (10%) experienced SR, and 36 (7.8%) had CR. Mean HLA mismatch was significantly higher in the CR group. The Banff grade of rejection was higher in the CR group. There was a larger proportion of patients in both rejection groups with the combination of IFTA and persistent inflammation on the follow-up protocol biopsy done at 1 year. The estimated 5-year death-censored graft survival was 81% in SR, 78% in CR, and 97% in the control group (P &lt; .0001). Significant differences were observed in allograft survival between the CR and control group (HR 9.06, and between the SR and control group (HR 4.22, 95% CI 1.30-13.7). Conclusion. Both SR and CR are associated with an inferior graft survival in recipients on RSW