Delivery of Health Care; Kidney; Kidney Failure, Chronic; Liver; Nephrology; Risk; Transplantation; Living Donors
Public Health Interests
Health care delivery; Health Care Management; Health Disparities; Health risk behaviors; Kidney Disease; Psychosocial risk factors
Increasing living donation in a safe and effective manner is the only solution to the organ shortage. My research examines how kidney donors assess risk and how this information can be better used by transplant centers when they evaluate possible living donors. Carrie Thieseen MD PhD (Yale) and I are currently conducting a multicenter study and are in the analysis phase of this project, which is funded by the Greenwall Foundation.
I am also conducting a clinical study that tests an FDA approved system Airseal (Surgiquest, Inc.) to determine if we can reduce pain from the kidney donor surgery. There is a known association between intra-abdominal hypertension and kidney dysfunction, thus, successfully performing donor nephrectomies at low-pressure may benefit both donors and recipients, as well as, providing important mechanistic insights into the mechanisms of intra-abdominal hypertension induced kidney injury.
Unfortunately, kidneys don't last forever. There are new medications that may help some kidney transplant patients keep their kidney longer. We are conducting a clinical study using a complement inhibitor, eculizumab, to determine if we can stop antibodies from injuring kidneys. The study was recently completed and the results are available at the American Journal of Transplantation website under early view publications and at clinicaltrials.gov.
Specialized Terms: The role of complement inhibition in kidney and liver transplantation; Methods to decrease pain for living kidney donors; UNOS & CMS regulations and compliance; Living donor risks and perceptions.
Extensive Research Description
I am interested in the role of complement inhibition in both kidney and liver transplantation. We are conducting an industry-sponsored study to assess if complement inbhibition with eculizumab can reduce antibody-mediated injury seen in kidney patients with donor-specific antibodies. I work with Jordan Pober MD PhD (Yale Immunobiology) on this study to assess what affect complement inhibition will have on graft endothelial cells. Given that donor specific antibodies may increase markers of endothelial cell activation, we are testing if complement inhibition will reduce activation and thus preserve graft function.
Living donation is a principal interest of mine, both clincally and academically. Previous work on living donor consenting practices and the need for better structured alibi's for donor has lead to a greater question on how transplant centers evaluate and approve living donors. We examine if a greater participation of donor's wishes should translate into a rebalancing of donor autonomy and maleficence.
1. Inhibition of Complement in Chronic Allograft Injury & its affect on Circulating Endothelial Cells.
2. Randomized Controlled Trial of Reducing Operative & Post-Operative Morbidity in Living Kidney Donors Utilizing Low Pressure, Limited Variability Pneumoperitoneum.
3. Burden of Illness in Highly Sensitized ESRD Patients & Patients Who Experience Acute Antibody-Mediated Rejection.
4. Balancing non-maleficence and autonomy in living kidney donors.
Eculizumab Therapy for Chronic Antibody-Mediated Injury in Kidney Transplant Recipients: A Pilot Randomized Controlled Trial.
Kulkarni S, Kirkiles-Smith NC, Deng YH, Formica RN, Moeckel G, Broecker V, Bow L, Tomlin R, Pober JS. American Journal of Transplantation 2016. [epub ahead of print]
The Long-Term Follow-up and Support for Living Organ Donors: A Center-Based Initiative Founded on Developing a Community of Living Donors.
Kulkarni S, Thiessen C, Formica RN, Schilsky M, Mulligan D, D'Aquila R. American Journal of Transplantation 2016. [epub ahead of print]
Development of a Donor-Centered Approach to Risk Assessment: Rebalancing Nonmaleficence and Autonomy.
Thiessen C, Gordon EJ, Reese PP, Kulkarni S. American Journal of Transplantation 2015;15(9):2314-2323.
Opting out: confidentiality and availability of an 'alibi' for potential living kidney donors in the USA.
Thiessen C, Kim YA, Formica R, Bia M, Kulkarni S. Journal of Medical Ethics. 2015 Jul;41(7):506-10.
Written informed consent for living liver donor evaluation: compliance with Centers for Medicare and Medicaid Services and Organ Procurement and Transplantation Network Guidelines and alibi offers.
Thiessen C, Kim YA, Yoo PS, Rodriguez-Davalos M, Mulligan D, Kulkarni S. Liver Transpl. 2014 Apr;20(4):416-24
Written informed consent for living kidney donors: practices and compliance with CMS and OPTN requirements.
Thiessen C, Kim YA, Formica R, Bia M, Kulkarni S. American Journal of Transplantatation. 2013 Oct;13(10):2713-21.
Retrocaval renal artery bifurcation is not a contraindication to laparoscopic right donor nephrectomy.
Gandelman JA, Yoo PS, Kulkarni S. Journal of the American College of Surgeons 2013 Sep;217(3):406-11.