Clinically adjudicated deceased donor acute kidney injury and graft outcomes

Background: Acute kidney injury (AKI) in deceased donors is not associated with graft failure (GF). We hypothesize that hemodynamic AKI (hAKI) comprises the majority of donor AKI and may explain this lack of association. Methods: In this ancillary analysis of the Deceased Donor Study, 428 donors with available charts were selected to identify those with and without AKI. AKI cases were classified as hAKI, intrinsic (iAKI), or mixed (mAKI) based on majority adjudication by three nephrologists. We evaluated the associations between AKI phenotypes and delayed graft function (DGF), 1-year eGFR and GF. We also evaluated differences in urine biomarkers among AKI phenotypes. Results: Of the 291 (68%) donors with AKI, 106 (36%) were adjudicated as hAKI, 84 (29%) as iAKI and 101 (35%) as mAKI. Of the 856 potential kidneys, 669 were transplanted with 32% developing DGF and 5% experiencing GF. Median 1-year eGFR was 53 (IQR: 41-70) ml/min/1.73m2. Compared to non-AKI, donors with iAKI had higher odds DGF [aOR (95%CI); 4.83 (2.29, 10.22)] and had lower 1-year eGFR [adjusted B coefficient (95% CI): -11 (-19, -3) mL/min/1.73 m2]. hAKI and mAKI were not associated with DGF or 1-year eGFR. Rates of GF were not different among AKI phenotypes and non-AKI. Urine biomarkers such as NGAL, LFABP, MCP-1, YKL-40, cystatin-C and albumin were higher in iAKI. Conclusion: iAKI was associated with higher DGF and lower 1-year eGFR but not with GF. Clinically phenotyped donor AKI is biologically different based on biomarkers and may help inform decisions regarding organ utilization

Inclusion of 1,3-dimethylxanthine improved quality parameters of bull semen

Methylxanthines are a unique class of drug, derived from the purine base xanthine and 1,3-dimethylxanthine (Theophylline) is the most commonly used methyl xanthine. The present study was conducted to study the effect of supplementation of 1,3-dimethylxanthine in semen extender on sperm motility and morphological parameters of semen. A total of 15 semen ejaculates were collected from three adult cattle bulls. Each ejaculate was divided into five groups. First group was kept as control (C) in which samples were diluted with Tris-egg yolk-glycerol extender and samples of other 4 groups (T-5, T-10, T-20 and T-40) were supplemented with 1,3-dimethylxanthine at a dose rate of 5, 10, 20 and 40 mM respectively. The diluted semen samples were incubated at 37°C in water bath and evaluated for various seminal parameters at 15 and 30 min of incubations. Sperm motility, sperm kinetic parameters and sperm abnormalities of semen of all groups were assessed using computer assisted sperm analyser (CASA). Morphological parameters of spermatozoa of control and supplemented groups were also evaluated. The results revealed that 1,3-dimethylxanthine supplementation resulted in significant increase in motile sperm concentration, kinematic parameters, sperm viability, sperms with intact plasma membrane as compared to other groups. However, sperm abnormalities viz., bent tail, coiled tail, distal droplet and distal midpiece reflex varied non-significantly in all groups. Thus, it can be concluded that 1,3-dimethylxanthine (Theophylline) inclusion at 10 mM concentration in semen extender improved the quality of semen

Telemedicine services for living kidney donation: A US survey of multidisciplinary providers.

Individuals considering living kidney donation face geographic, financial, and logistical challenges. Telemedicine can facilitate healthcare access/care coordination. Yet difficulties exist in telemedicine implementation and sustainability. We sought to examine centers practices and providers attitudes toward telemedicine to improve services for donors. We surveyed multidisciplinary providers from 194 active adult US living donor kidney transplant centers; 293 providers from 128 unique centers responded to the survey (center representation rate = 66.0%), reflecting 83.9% of practice by donor volume and 91.5% of US states/territories. Most centers (70.3%) plan to continue using telemedicine beyond the pandemic for donor evaluation/follow-up. Video was mostly used by nephrologists, surgeons, and psychiatrists/psychologists. Telephone and video were mostly used by social workers, while video or telephone was equally used by coordinators. Half of respondent nephrologists and surgeons were willing to accept a remote completion of physical exam; 68.3% of respondent psychiatrists/psychologists and social workers were willing to accept a remote completion of mental status exam. Providers strongly agreed that telemedicine was convenient for donors and would improve the likelihood of completing donor evaluation. However, providers (65.5%) perceived out-of-state licensing as a key policy/regulatory barrier. These findings help inform practice and underscore the instigation of policies to remove barriers using telemedicine to increase living kidney donation