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Your search keyword '"Sunil S. Karhadkar"' showing total 4 results
Start Over Author "Sunil S. Karhadkar" Journal transplantation proceedings
4 results on '"Sunil S. Karhadkar"'

1. Renal Cell Carcinoma in Kidney Transplant Candidates

Author

Sunil S. Karhadkar, Kwan Nang Lau, Konstantinos A. Zorbas, and A. Di Carlo

Subjects
Adult, Male, medicine.medical_specialty, Pathology, medicine.medical_treatment, Population, 030232 urology & nephrology, 030204 cardiovascular system & hematology, Malignancy, Nephrectomy, 03 medical and health sciences, 0302 clinical medicine, Renal Dialysis, Renal cell carcinoma, Preoperative Care, Carcinoma, Humans, Medicine, education, Carcinoma, Renal Cell, Kidney transplantation, Retrospective Studies, Transplantation, education.field_of_study, business.industry, Incidence, Middle Aged, medicine.disease, Kidney Transplantation, Kidney Neoplasms, Kidney Failure, Chronic, Female, Surgery, Hemodialysis, Radiology, Tomography, X-Ray Computed, business
Abstract

Background An increased incidence of renal cell carcinoma (RCC) has been observed in patients with end-stage renal disease. However, the incidence of this pathological condition has not been studied adequately in kidney transplant candidates. The aim of this study was to examine the incidence of RCC and the clinical, imaging, and pathological characteristics in this population. Methods At our institution, the majority of kidney transplant candidates undergo a non-contrast abdominal computerized tomography (CT) scan as a pre-transplant screening evaluation method. We retrospectively reviewed the medical data from 637 patients who were referred to our institution for kidney transplant evaluation during a period of 2 years. Of these, 174 were found ineligible and were excluded from the study; the final population consisted of 463 patients. Radical nephrectomy was proposed and performed in all the patients with findings highly suspicious of malignancy. Results A total of 20 patients had findings suspicious for kidney malignancy on non-contrast CT scan and underwent a total nephrectomy before transplantation. At the pathological examination, 13 patients had malignant lesions and 4 patients had benign lesions. All patients with malignancy were male, and 9 of 13 patients with malignancy had papillary RCC. Conclusions This study confirms the increased incidence of RCC in kidney transplant candidates and underlines the utility of non-contrast CT scan without an intravenous contrast agent as a very useful screening tool in the pre-operative evaluation of kidney transplant candidates. Hence, we recommend the implementation of routine screening with non-contrast CT scan in all kidney transplant candidates who undergo hemodialysis.

Published
2017
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2. Outcomes of Older Patients in the Recent Era of Heart Kidney Transplantation

Author

Swati Rao, Mythili Ghanta, Rene Alvarez, Lynn R. Punnoose, and Sunil S. Karhadkar

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Cohort Studies, Young Adult, Older patients, Internal medicine, medicine, Humans, Registries, Renal Insufficiency, Young adult, Kidney transplantation, Dialysis, Aged, Retrospective Studies, Heart Failure, Transplantation, business.industry, Patient Selection, Age Factors, Retrospective cohort study, Middle Aged, medicine.disease, Comorbidity, Kidney Transplantation, Treatment Outcome, Cohort, Heart Transplantation, Surgery, Female, business, Cohort study
Abstract

Variable age thresholds are often used at transplant centers for simultaneous heart and kidney transplantation (HKT). We hypothesize that selected older recipients enjoy comparable outcome to younger recipients in the current era of HKT.We performed a retrospective analysis of HKT outcomes in the United Network for Organ Sharing (UNOS) registry from 2006 to 2018, classifying patients by age at transplant as ≥ 65 or 65 years. The primary outcome was patient death. Secondary outcomes included all-cause kidney graft failure and death-censored kidney allograft failure.Of 973 patients, 774 (80%) were younger than 65 years (mean 52 ± 10 years) and 199 (20%) were 65 years or older (mean 67 ± 2 years). The older HKT cohort had fewer blacks (22% vs 35%, P = .01) and women (12 vs 18%, P = .04). Fewer older patients received dialysis (30% vs 54%, P .001) and mechanical support (36% vs 45%, P = .03) before HKT. Older recipients received organs from slightly older donors. The median follow-up time was shorter for patients 65 years or older than for the younger group (2.3 vs 3.3 years, P .001). Patient survival was similar between the groups (mean 8.8 vs 9.8 years, P = .3), with the most common causes of death being cardiovascular (29%) and infectious complications (28%). There was no difference in all-cause kidney graft survival (mean 8.7 vs 9.3 years, P = .8). Most commonly, recipients died with a functional renal allograft (59.8%), and this occurred more commonly in older patients (81.4% vs 54.8%, P = .001). Cox proportional hazard modeling showed that higher donor age (hazard ratio [HR] 1.015, P = .01; HR 1.022, P = .02) and use of pre-transplant dialysis (HR 1.5, P = .004; HR 1.8, P = .006) increased the risk for both all-cause and death-censored kidney allograft failure, respectively.Our study showed that carefully selected older patients have outcomes similar to those of a younger cohort and argues for comprehensive evaluation of the recipients with age as part of comorbidity assessment rather than use of an arbitrary age threshold for candidacy.

Published
2019

3. Longevity Matching for Living Donor Renal Transplantation.

Author

Dawes J, Gregor A, Kolansky J, Wirshup K, Di Carlo A, and Karhadkar S

Subjects
Humans, Living Donors, Regression Analysis, Graft Survival, Kidney, Kidney Transplantation adverse effects, Tissue and Organ Procurement
Abstract

Introduction: This study identifies the effect of individual donor and recipient characteristics on graft survival in living-donor kidney transplantation (LDKT) using a recently described novel measure, kidney life years (KLYs)., Materials and Methods: The Organ Procurement and Transplantation Network/United Network for Organ Sharing database was used to identify first-time kidney-only LDKT recipients between 1987 and 2020 who did not experience death with a functioning graft (DWFG) and were not missing relevant information (n = 87,290). Patient characteristics were evaluated using Cox and multiple regression analyses, with the dependent variable being KLYs. An equation for expected KLYs based on patient characteristics was created using regression coefficients. The equation was validated using bootstrapped Pearson correlations and then applied to the DWFG group for comparison., Results: Based on statistical significance from Cox and multiple linear regression analyses, 9 of the original 18 variables were selected for inclusion in the equation. Variables with notable impact included HLA match points (0.021 KLYs; 95% CI: [0.019,0.024]; P ≤ .001), Donor Age (-0.030 KLYs; 95% CI: [-0.035,-0.025]; P ≤ .001), and Donor African American Ethnicity (-2.356 KLYs; 95% CI: [-2.552,-2.159]; P ≤ .001). Equation validation was supported, given a negative correlation (r = -0.071; P ≤ .001) between expected KLY change and observed graft failure. Expected KLY change was found to be greater in those who eventually DWFG when compared with all other LDKTs (t = -5.735, P ≤ .001)., Conclusions: Increasing HLA match points may be more beneficial for graft longevity than minimizing donor age in comparisons using realistic between-donor differences. Additionally, greater average expected KLYs in those who ultimately DWFG may illustrate an opportunity for improved donor-recipient matching., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Published
2024
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4. Deciphering the True Immunologic Risk in Renal Transplantation in Patients With HIV.

Author

Kahler D, Curtis H, Zhao H, Diamond A, Di Carlo A, and Karhadkar S

Subjects
Humans, Living Donors, Kidney, Transplantation, Homologous, Graft Survival, Graft Rejection, Kidney Transplantation adverse effects, HIV Infections complications
Abstract

Since 1995, rates of end-stage renal disease have risen dramatically in patients living with HIV infection. However, given the concern for higher rates of acute rejection in this patient population, the immunologic threat posed by HIV infection is a specter clinicians must continually confront. Living donor transplantation may negate this risk; this study aims to assess the benefit of living donor transplantation in this population and to ascertain the immunologic risk faced by patients who are HIV-infected. The 2021 UNOS database was queried, and all HIV-infected kidney transplant recipients since 1987 were identified. Recipients were stratified based on deceased (DDKT) vs living (LDKT) donor status. Overall survival, allograft survival, acute rejection, panel reactive antibody (PRA) percentage, and crossmatch positivity were compared between groups. One thousand two hundred twenty-six patients underwent DDKT, and 304 patients underwent LDKT. Living donor kidney transplantation demonstrated greater overall survival (P = .045) and graft survival (P < .001). However, no difference in acute rejection was noted between the cohorts, and no difference in overall or graft survival was evident based on PRA percentage. Crossmatch positive status did not negatively affect graft survival. Patients with HIV undergoing LDKT fared better than those undergoing DDKT. Nevertheless, patients at higher immunologic risk-elevated PRA% and crossmatch positivity-did not experience graft loss at a higher rate than patients at lower immunologic risk. These results were valid in both DDKT and LDKT cohorts. These findings suggest that infection with HIV does not overtly increase patients' immunologic risk, and concerns surrounding transplantation in this population may be overestimated., Competing Interests: Declaration of Competing Interest All the authors declare no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Published
2023
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