2022
Blood Transcriptomes of SARS-CoV-2–Infected Kidney Transplant Recipients Associated with Immune Insufficiency Proportionate to Severity
Sun Z, Zhang Z, Banu K, Al Azzi Y, Reghuvaran A, Fredericks S, Planoutene M, Hartzell S, Kim Y, Pell J, Tietjen G, Asch W, Kulkarni S, Formica R, Rana M, Maltzman JS, Zhang W, Akalin E, Heeger PS, Cravedi P, Menon MC. Blood Transcriptomes of SARS-CoV-2–Infected Kidney Transplant Recipients Associated with Immune Insufficiency Proportionate to Severity. Journal Of The American Society Of Nephrology 2022, 33: 2108-2122. PMID: 36041788, PMCID: PMC9678030, DOI: 10.1681/asn.2022010125.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseCOVID-19CytokinesHumansImmunosuppressive AgentsKidney TransplantationRNASARS-CoV-2TranscriptomeTransplant RecipientsConceptsKidney transplant recipientsImmune activation pathwaysImmunosuppressant useKTR cohortAcute illnessBlood transcriptomeAcute casesT cellsCOVID-19Most kidney transplant recipientsPost-acute COVID-19Adaptive immune system activationManagement of immunosuppressionReinstitution of immunosuppressionAcute COVID-19Serum inflammatory cytokinesCOVID-19 severity scoreCOVID-19 infectionImmune system activationUpregulation of neutrophilActivation pathwayTransplant recipientsChart reviewImmune signaturesLymphocyte count
2021
Genetic and Epidemiologic Analyses of an Outbreak of Pneumocystis jirovecii Pneumonia Among Kidney Transplant Recipients in the United States
Azar MM, Cohen E, Ma L, Cissé OH, Gan G, Deng Y, Belfield K, Asch W, Grant M, Gleeson S, Koff A, Gaston DC, Topal J, Curran S, Kulkarni S, Kovacs JA, Malinis M. Genetic and Epidemiologic Analyses of an Outbreak of Pneumocystis jirovecii Pneumonia Among Kidney Transplant Recipients in the United States. Clinical Infectious Diseases 2021, 74: 639-647. PMID: 34017984, PMCID: PMC9012955, DOI: 10.1093/cid/ciab474.Peer-Reviewed Original ResearchMeSH KeywordsDisease OutbreaksHumansKidney TransplantationMultilocus Sequence TypingPneumocystis cariniiPneumonia, PneumocystisTransplant RecipientsUnited StatesConceptsKidney transplant recipientsCases of PCPPneumocystis pneumoniaClinic visitsRisk factorsClinic exposureLow absolute lymphocyte countRisk of PCPAbsolute lymphocyte countFrequent clinic visitsPneumocystis jirovecii pneumoniaStrong risk factorNon-white raceCase-control analysisBelatacept groupMonthly infusionsTransplant recipientsBaseline characteristicsJirovecii pneumoniaLymphocyte countMultilocus sequence typingInterhuman transmissionRespiratory specimensUnivariate analysisEpidemiologic dataQuantifying Risk Tolerance Among Potential Living Kidney Donors With the Donor-Specific Risk Questionnaire
Thiessen C, Gannon J, Li S, Skrip L, Dobosz D, Gan G, Deng Y, Kennedy K, Gray D, Mussell A, Reese PP, Gordon EJ, Kulkarni S. Quantifying Risk Tolerance Among Potential Living Kidney Donors With the Donor-Specific Risk Questionnaire. American Journal Of Kidney Diseases 2021, 78: 246-258. PMID: 33508397, DOI: 10.1053/j.ajkd.2020.11.028.Peer-Reviewed Original ResearchConceptsKidney failure riskKidney failureDonor evaluationRisk QuestionnaireGreater patient-centered carePotential Living Kidney DonorsRisk estimatesKidney transplant centersKidney donor evaluationMultivariable logistic regressionLiving Kidney DonorsTime of enrollmentPatient-centered careTransplant centersTransplant teamKidney donorsRisk groupsPatient engagementAbstractTextLogistic regressionStudy designLongitudinal mixed-methods studyRecipientsMixed-methods studyRisk thresholdLeveling-up versus leveling-down to address health disparities in transplantation
Kulkarni S, Ladin K. Leveling-up versus leveling-down to address health disparities in transplantation. American Journal Of Transplantation 2021, 21: 917-918. PMID: 33326686, PMCID: PMC7986107, DOI: 10.1111/ajt.16458.Peer-Reviewed Original ResearchMeSH KeywordsHumansKidneyKidney TransplantationRacial GroupsTissue and Organ ProcurementTissue Donors
2019
Outcomes From Right Versus Left Deceased-Donor Kidney Transplants: A US National Cohort Study
Kulkarni S, Wei G, Jiang W, Lopez LA, Parikh CR, Hall IE. Outcomes From Right Versus Left Deceased-Donor Kidney Transplants: A US National Cohort Study. American Journal Of Kidney Diseases 2019, 75: 725-735. PMID: 31812448, PMCID: PMC7288694, DOI: 10.1053/j.ajkd.2019.08.018.Peer-Reviewed Original ResearchConceptsAdjusted hazard ratioDeath-censored graft failureRight kidneyGraft failureKidney sideLeft kidneyUS national cohort studyDeceased donor kidney transplantCause graft failureCold ischemia timeDeceased donor kidneysNational cohort studyConditional logistic regressionProportional hazards modelGraft functionGraft lossPosttransplantation outcomesTransplant eraCohort studyHazard ratioKidney transplantCardiac deathIschemia timeSurgical considerationsRecipient pairsPeritransplant eculizumab does not prevent delayed graft function in deceased donor kidney transplant recipients: Results of two randomized controlled pilot trials
Schröppel B, Akalin E, Baweja M, Bloom RD, Florman S, Goldstein M, Haydel B, Hricik DE, Kulkarni S, Levine M, Mehrotra A, Patel A, Poggio ED, Ratner L, Shapiro R, Heeger PS. Peritransplant eculizumab does not prevent delayed graft function in deceased donor kidney transplant recipients: Results of two randomized controlled pilot trials. American Journal Of Transplantation 2019, 20: 564-572. PMID: 31452319, DOI: 10.1111/ajt.15580.Peer-Reviewed Original ResearchConceptsDeceased donor kidney transplant recipientsDonor kidney transplant recipientsKidney transplant recipientsGraft functionTransplant recipientsDeceased donor kidney transplantationDeceased donor kidney transplantAnti-C5 monoclonal antibodyDeceased donor recipientsRabbit antithymocyte globulinRate of DGFSerum creatinine reductionAdverse event incidenceDelayed graft functionDonor kidney transplantationDonor kidney transplantsIschemia-reperfusion injuryHigh-risk populationSafety/efficacyObservational human dataAntithymocyte globulinDGF rateKidney transplantationDonor recipientsKidney transplantAssociation of Racial Disparities With Access to Kidney Transplant After the Implementation of the New Kidney Allocation System
Kulkarni S, Ladin K, Haakinson D, Greene E, Li L, Deng Y. Association of Racial Disparities With Access to Kidney Transplant After the Implementation of the New Kidney Allocation System. JAMA Surgery 2019, 154: 618-625. PMID: 30942882, PMCID: PMC6583835, DOI: 10.1001/jamasurg.2019.0512.Peer-Reviewed Original ResearchConceptsDeceased donor transplantsKidney allocation systemDonor transplantsKidney transplantTransplant probabilityDeath/Race/ethnicityHispanic individualsWhite individualsOrgan procurementBlack individualsNew kidney allocation systemRetrospective cohort studyWait-listed patientsKidney transplant databaseStatus changesAntibody categoriesLevel of sensitizationInactive statusInactive patientsTransplant databaseTransplant outcomesCohort studyMedian ageAntibody group
2018
Race, Risk, and Willingness of End-Stage Renal Disease Patients Without Hepatitis C Virus to Accept an HCV-Infected Kidney Transplant
McCauley M, Mussell A, Goldberg D, Sawinski D, Molina RN, Tomlin R, Doshi SD, Abt P, Bloom R, Blumberg E, Kulkarni S, Esnaola G, Shults J, Thiessen C, Reese PP. Race, Risk, and Willingness of End-Stage Renal Disease Patients Without Hepatitis C Virus to Accept an HCV-Infected Kidney Transplant. Transplantation 2018, 102: e163-e170. PMID: 29346260, DOI: 10.1097/tp.0000000000002099.Peer-Reviewed Original ResearchConceptsHepatitis C virusHCV cure ratesCure rateC virusUninfected kidneyEnd-stage renal disease patientsHCV-negative patientsPrior transplant recipientsRenal disease patientsHigh cure ratesEffective antiviral treatmentKidney recipientsTransplant recipientsKidney transplantMost patientsOlder patientsAntiviral treatmentWhite patientsDeceased donorsAllograft qualityFuture trialsBlack raceDisease patientsPatient acceptanceYoung donors
2017
Transition probabilities between changing sensitization levels, waitlist activity status and competing-risk kidney transplant outcomes using multi-state modeling
Kulkarni S, Hall I, Formica R, Thiessen C, Stewart D, Gan G, Greene E, Deng Y. Transition probabilities between changing sensitization levels, waitlist activity status and competing-risk kidney transplant outcomes using multi-state modeling. PLOS ONE 2017, 12: e0190277. PMID: 29287087, PMCID: PMC5747475, DOI: 10.1371/journal.pone.0190277.Peer-Reviewed Original ResearchConceptsTransplant probabilityTransplant outcomesActivity statusKidney transplant outcomesKAS implementationPost-KASWaitlist mortalityPatient characteristicsOPTN databaseMulti-state modelingStatistical differenceSensitization levelOutcomesTransplantCohortImpact outcomesCPRAStatus combinationsStatusMortalityWhitesSensitizationAllograft transmission of hepatitis C during the window period: Weighing the new risks and costs in the era of donor shortage
Choe J, Merola J, Kulkarni S, Mulligan DC. Allograft transmission of hepatitis C during the window period: Weighing the new risks and costs in the era of donor shortage. Clinical Transplantation 2017, 31 PMID: 28643333, DOI: 10.1111/ctr.13022.Peer-Reviewed Original ResearchOpting out: a single-centre pilot study assessing the reasons for and the psychosocial impact of withdrawing from living kidney donor evaluation
Thiessen C, Jaji Z, Joyce M, Zimbrean P, Reese P, Gordon EJ, Kulkarni S. Opting out: a single-centre pilot study assessing the reasons for and the psychosocial impact of withdrawing from living kidney donor evaluation. Journal Of Medical Ethics 2017, 43: 756. PMID: 28258071, DOI: 10.1136/medethics-2016-103512.Peer-Reviewed Original ResearchConceptsSingle-center pilot studyKidney donor evaluationUS transplant centersPotential living donorsPostoperative periodTransplant centersDonor evaluationLiving donorsKidney donationModifiable barriersPsychosocial impactStudy participantsPilot studyDonor advocateFinancial burdenDonor autonomyQualitative studyDonationIndividualsParticipantsVaried reasons
2016
A Call for Research on Individuals Who Opt Out of Living Kidney Donation
Thiessen C, Kulkarni S, Reese PP, Gordon EJ. A Call for Research on Individuals Who Opt Out of Living Kidney Donation. Transplantation 2016, 100: 2527-2532. PMID: 27495760, DOI: 10.1097/tp.0000000000001408.Peer-Reviewed Original ResearchParathyroidectomy prior to kidney transplant decreases graft failure
Callender GG, Malinowski J, Javid M, Zhang Y, Huang H, Quinn CE, Carling T, Tomlin R, Smith JD, Kulkarni S. Parathyroidectomy prior to kidney transplant decreases graft failure. Surgery 2016, 161: 44-50. PMID: 27863776, DOI: 10.1016/j.surg.2016.10.003.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overCohort StudiesConfidence IntervalsDatabases, FactualFemaleGraft RejectionGraft SurvivalHumansHyperparathyroidismKidney Failure, ChronicKidney TransplantationMaleMiddle AgedOdds RatioParathyroid HormoneParathyroidectomyPreoperative CareRetrospective StudiesRisk AssessmentTreatment OutcomeConceptsYear post-kidney transplantationPost-kidney transplantationDelayed graft functionGraft failureKidney transplantationGraft functionParathyroid hormoneUremic hyperparathyroidismKidney diseaseFirst year post-kidney transplantationSerum parathyroid hormone levelsCurrent Kidney DiseaseGlobal Outcomes (KDIGO) guidelinesParathyroid hormone levelsSerum parathyroid hormoneAdult patientsKidney transplantOutcomes guidelinesRetrospective reviewSingle institutionCurrent guidelinesHormone levelsSurvival 1ParathyroidectomyTransplantationBelatacept and Eculizumab for Treatment of Calcineurin Inhibitor-induced Thrombotic Microangiopathy After Kidney Transplantation: Case Report
Merola J, Yoo PS, Schaub J, Smith JD, Rodriguez-Davalos MI, Tichy E, Mulligan DC, Asch W, Formica R, Kashgarian M, Kulkarni S. Belatacept and Eculizumab for Treatment of Calcineurin Inhibitor-induced Thrombotic Microangiopathy After Kidney Transplantation: Case Report. Transplantation Proceedings 2016, 48: 3106-3108. PMID: 27932157, DOI: 10.1016/j.transproceed.2016.04.005.Peer-Reviewed Original ResearchConceptsCalcineurin inhibitorsHemolytic uremic syndromeThrombotic microangiopathyKidney transplantationUremic syndromeMinimization of CNIsAtypical hemolytic uremic syndromeWithdrawal of tacrolimusEarly graft lossFavorable clinical courseGraft dysfunctionGraft lossImmunosuppression strategiesUsual therapyClinical courseCase reportCTLA-4Endothelial reactionFrequent causeChallenging causeUncontrolled activationMonoclonal antibodiesCellular destructionMicroangiopathyComponent C5Perioperative outcomes of coronary artery bypass graft in renal transplant recipients in the United States: results from the Nationwide Inpatient Sample
Tooley JE, Bohl DD, Kulkarni S, Rodriguez‐Davalos M, Mangi A, Mulligan DC, Yoo PS. Perioperative outcomes of coronary artery bypass graft in renal transplant recipients in the United States: results from the Nationwide Inpatient Sample. Clinical Transplantation 2016, 30: 1258-1263. PMID: 27440000, DOI: 10.1111/ctr.12816.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overCoronary Artery BypassCoronary Artery DiseaseDatabases, FactualFemaleHospital CostsHospital MortalityHumansKidney TransplantationLength of StayLinear ModelsLogistic ModelsMaleMiddle AgedPostoperative ComplicationsRenal DialysisRenal Insufficiency, ChronicRetrospective StudiesTreatment OutcomeUnited StatesYoung AdultConceptsChronic kidney diseaseNationwide Inpatient SampleLength of stayCKD patientsCABG surgeryHospital mortalityPerioperative outcomesInpatient SampleCardiovascular diseaseCoronary artery bypass graftKidney transplant patientsRenal transplant recipientsRetrospective cohort studyArtery bypass graftRate of complicationsTotal hospital chargesBetter perioperative outcomesCause of morbidityCost of hospitalizationNumber one causeGraft lossPerioperative complicationsTransplant patientsTransplant recipientsCohort studyEculizumab Therapy for Chronic Antibody‐Mediated Injury in Kidney Transplant Recipients: A Pilot Randomized Controlled Trial
Kulkarni S, Kirkiles‐Smith N, Deng YH, Formica RN, Moeckel G, Broecker V, Bow L, Tomlin R, Pober JS. Eculizumab Therapy for Chronic Antibody‐Mediated Injury in Kidney Transplant Recipients: A Pilot Randomized Controlled Trial. American Journal Of Transplantation 2016, 17: 682-691. PMID: 27501352, DOI: 10.1111/ajt.14001.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAntibodies, Monoclonal, HumanizedChronic DiseaseComplement C5Complement Inactivating AgentsEarly Intervention, EducationalFemaleFollow-Up StudiesGlomerular Filtration RateGraft RejectionGraft SurvivalHumansIsoantibodiesKidney Failure, ChronicKidney Function TestsKidney TransplantationLiving DonorsMaleMiddle AgedPilot ProjectsPrognosisRisk FactorsTissue DonorsTransplant RecipientsYoung AdultConceptsDe novo donor-specific antibodiesComplement inhibitionTreatment groupsNovo donor-specific antibodiesAntibody-Mediated InjuryC1q-positive patientsDonor-specific antibodiesKidney transplant recipientsPrimary end pointEndothelial cell injuryMo of observationEculizumab therapyEculizumab treatmentHumoral injuryTransplant recipientsKidney transplantRenal functionKidney functionChronic settingEGFR trajectoriesTreatment periodCell injuryPatientsEnd pointPercentage changeDe Novo Belatacept in a Human Immunodeficiency Virus–Positive Kidney Transplant Recipient
Cohen E, Mulligan D, Kulkarni S, Tichy E. De Novo Belatacept in a Human Immunodeficiency Virus–Positive Kidney Transplant Recipient. American Journal Of Transplantation 2016, 16: 2753-2757. PMID: 27137752, DOI: 10.1111/ajt.13852.Peer-Reviewed Original ResearchConceptsRenal transplant recipientsTransplant recipientsHuman immunodeficiency virus–positive kidney transplant recipientHIV-positive renal transplant recipientsPositive renal transplant recipientsHIV-positive Black menActive antiretroviral agentsKidney transplant recipientsNew-onset diabetesHuman immunodeficiency virusImmunosuppressive regimensFirst transplantAntiretroviral agentsCalcineurin inhibitorsImmunodeficiency virusKidney donorsDrug interactionsTransplantRecipientsBlack menSuccessful casesDe novoBelataceptHypertensionHyperlipidemia
2015
Novel Once-Daily Extended-Release Tacrolimus Versus Twice-Daily Tacrolimus in De Novo Kidney Transplant Recipients: Two-Year Results of Phase 3, Double-Blind, Randomized Trial
Rostaing L, Bunnapradist S, Grinyó J, Ciechanowski K, Denny J, Silva H, Budde K, Group E, Denny J, Kulkarni S, Hricik D, Bresnahan B, Bunnapradist S, El-Sabrout R, Chan L, Ciancio G, El-Ghoroury M, Goldstein M, Gaston R, Gohh R, Killackey M, King A, Knight R, Kore A, Sudan D, Friedmann J, Mulgaonkar S, Nolan C, Pankewycz O, Pirsch J, Schaefer H, Steinberg S, Gelb B, True K, West-Thielke P, Waybill M, Wolf J, Ketel B, Harland R, Shihab F, Cassuto E, Le Meur Y, Rostaing L, Mariat C, Grinyó J, Puig J, Seron D, Tisone G, Ciechanowski K, Foroncewicz B, Wlodarczyk Z, Budde K, Witzke O, Mondragon G, Urrea E, Gomez J, Acevedo R, del Carmen Rial M, Novoa P, Silva H, Garcia V, Carvalho D, Saber L, Contieri F, Bastos M, Manfro R, Kanellis J, Eris J, O’Connell P, Hughes P, Russ G, Pidgeon G, Dittmer I, Kee T, Vathsala A, Naumovic R, Mitic I, Parmjeet R. Novel Once-Daily Extended-Release Tacrolimus Versus Twice-Daily Tacrolimus in De Novo Kidney Transplant Recipients: Two-Year Results of Phase 3, Double-Blind, Randomized Trial. American Journal Of Kidney Diseases 2015, 67: 648-659. PMID: 26717860, DOI: 10.1053/j.ajkd.2015.10.024.Peer-Reviewed Original ResearchConceptsTotal daily doseDe novo kidney transplant recipientsNovo kidney transplant recipientsKidney transplant recipientsIR-TacKidney transplantationTransplant recipientsAdverse eventsTreatment failureDaily extended-release tacrolimusDe novo kidney transplantationMean total daily doseLower total daily doseExtended-release tacrolimusOnce-Daily ExtendedTarget trough rangesTwice-Daily TacrolimusNew-onset diabetesSafety end pointSerious adverse eventsPhase 3 trialImmediate-release tacrolimusParticipant eligibility criteriaTwo-year resultsImproved bioavailabilityDuration of Prophylaxis against Fungal Infection in Kidney Transplant Recipients
Guerra CM, Formica RN, Kulkarni S, Asch WS, Tichy EM. Duration of Prophylaxis against Fungal Infection in Kidney Transplant Recipients. Progress In Transplantation 2015, 25: 311-315. PMID: 26645924, DOI: 10.7182/pit2015929.Peer-Reviewed Original ResearchConceptsKidney transplant recipientsTransplant recipientsDuration of admissionCandida esophagitisFungal infectionsAdult kidney transplant recipientsEpisodes of thrushDuration of prophylaxisRetrospective chart reviewPrimary outcome measureFisher's exact testAdministration of nystatinStudent's t-testChart reviewOutcome measuresExact testEsophagitisProphylaxisRecipientsInfectionProtocol changesT-testAdmissionTransplantP-value
2014
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. Opting out: confidentiality and availability of an ‘alibi’ for potential living kidney donors in the USA. Journal Of Medical Ethics 2014, 41: 506. PMID: 25368413, DOI: 10.1136/medethics-2014-102184.Peer-Reviewed Original ResearchMeSH KeywordsConfidentialityConsent FormsHumansKidney TransplantationLiving DonorsTissue and Organ Procurement