Rethinking performance benchmarks in kidney transplantation

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145501/1/ajt14947_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145501/2/ajt14947.pd

Authors' Response: The Riskiest Job in Medicine: Transplant Surgeons and Organ Procurement Travel

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78645/1/j.1600-6143.2010.03015.x.pd

Increased risk donor criteria: The time for change is now

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155965/1/ctr13879.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155965/2/ctr13879_am.pd

Wow, that portal vein is small: Preventing portal vein thrombosis in liver transplantation for small children

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107365/1/lt23865.pd

Going the distance for procurement of donation after circulatory death livers for transplantation—Does reimbursement reflect reality?

Donation after circulatory death (DCD) liver transplantation (LT) has increased slowly over the past decade. Given that transplant surgeons generally determine liver offer acceptance, understanding surgeon incentives and disincentives is paramount. The purpose of this study was to assess aggregate travel distance per successful DCD versus deceased after brain death (DBD) liver procurement as a surrogate for surgeon time expenditure and opportunity cost. All consecutive liver offers made to Michigan Medicine from 2006 to 2017 were analyzed. Primary outcome was the summative travel distance (spent on all attempted procurements) per successful liver procurement that resulted in LT. Donation after circulatory death liver offer acceptance was lower than DBD liver offers, as was proportion of successful procurements among accepted offers. Overall, 10 275 miles were travelled for accepted DCD liver offers, resulting in 23 successful procurements (mean 447 miles per successful DCD liver procurement). For accepted DBD liver offers, 197 299 miles were travelled, resulting in 863 successful procurements (mean 229 miles per successful DBD liver procurement). On average, each successful DCD liver procurement required 218 more miles of travel than each successful DBD liver procurement. Current reimbursement policies poorly reflect increased surgeon travel (and time) expenditures between DCD and DBD liver offers.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154400/1/ctr13780_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154400/2/ctr13780.pd

Comparison of Histidine-Tryptophan-Ketoglutarate and University of Wisconsin Preservation in Renal Transplantation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72258/1/j.1600-6143.2007.02065.x.pd

Using analytic morphomics to describe body composition associated with post‐kidney transplantation diabetes mellitus

BackgroundBetter risk assessment tools are needed to predict post‐transplantation diabetes mellitus (PTDM). Using analytic morphomic measurements from computed tomography (CT) scans, we aimed to identify specific measures of body composition associated with PTDM.MethodsWe retrospectively reviewed 99 non‐diabetic kidney transplant recipients who received pre‐transplant CT scans at a single institution between 1/2005 and 5/2014. Analytic morphomic techniques were used to measure abdominal adiposity, abdominal size, and psoas muscle area and density, standardized by gender. We measured the associations of these morphomic factors with PTDM.ResultsOne‐year incidence of PTDM was 18%. The morphomic factors significantly associated with PTDM included visceral fat area (OR=1.84 per standard deviation increase, P=.020), body depth (OR=1.79, P=.035), and total body area (OR=1.67, P=.049). Clinical factors significantly associated with PTDM included African American race (OR=3.01, P=.044), hypertension (OR=2.97, P=.041), and dialysis vintage (OR=1.24 per year on dialysis, P=.048). Body mass index was not associated with PTDM (OR=1.05, P=.188). On multivariate modeling, visceral fat area was an independent predictor of PTDM (OR=1.91, P=.035).ConclusionsAnalytic morphomics can identify pre‐transplant measurements of body composition that are predictive of PTDM in kidney transplant recipients. Pre‐transplant imaging contains a wealth of underutilized data that may inform PTDM prevention strategies.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138207/1/ctr13040.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138207/2/ctr13040_am.pd

Addition of adult-to-adult living donation to liver transplant programs improves survival but at an increased cost

Using outcomes data from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study, we performed a cost-effectiveness analysis exploring the costs and benefits of living donor liver transplantation (LDLT). A multistage Markov decision analysis model was developed with treatment, including medical management only (strategy 1), waiting list with possible deceased donor liver transplantation (DDLT; strategy 2), and waiting list with possible LDLT or DDLT (strategy 3) over 10 years. Decompensated cirrhosis with medical management offered survival of 2.0 quality-adjusted life years (QALYs) while costing an average of $65,068, waiting list with possible DDLT offered 4.4-QALY survival and a mean cost of$151,613, and waiting list with possible DDLT or LDLT offered 4.9-QALY survival and a mean cost of $208,149. Strategy 2 had an incremental cost-effectiveness ratio (ICER) of$35,976 over strategy 1, whereas strategy 3 produced an ICER of $106,788 over strategy 2. On average, strategy 3 cost$47,693 more per QALY than strategy 1. Both DDLT and LDLT were cost-effective compared to medical management of cirrhosis over our 10-year study period. The addition of LDLT to a standard waiting list DDLT program is effective at improving recipient survival and preventing waiting list deaths but at a greater cost. Liver Transpl 15:148–162, 2009. © 2009 AASLD.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/61905/1/21671_ftp.pd

Clinical and Economic Outcomes of Rabbit Antithymocyte Globulin Induction in Adults Who Received Kidney Transplants from Living Unrelated Donors and Received Cyclosporine‐Based Immunosuppression

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90167/1/phco.29.10.1166.pd

There is plenty for everyone: Transection of the infracardiac inferior vena cava during organ recovery

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90551/1/23404_ftp.pd