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Introduction: There is limited experience transplanting kidneys from either expanded criteria donors (ECD) or donation after circulatory death (DCD) deceased donors with terminal acute kidney injury (AKI). Methods: AKI kidneys were defined by a donor terminal serum creatinine level >2.0 mg/dL whereas non‐ideal deceased donor (NIDD) kidneys were defined as AKI/DCD or AKI/ECDs. Results: From February 2007 to March 2023, we transplanted 266 single AKI donor kidneys including 29 from ECDs, 29 from DCDs (n = 58 NIDDs), and 208 from brain‐dead standard criteria donors (SCDs). Mean donor age (43.7 NIDD vs. 33.5 years SCD), KDPI (66% NIDD vs. 45% SCD), and recipient age (57 NIDD vs. 51 years SCD) were higher in the NIDD group (all p <.01). Mean waiting times (17.8 NIDD vs. 24.2 months SCD) and dialysis duration (34 NIDD vs. 47 months SCD) were shorter in the NIDD group (p <.05). Delayed graft function (DGF, 48%) and 1‐year graft survival (92.7% NIDD vs. 95.9% SCD) was similar in both groups. Five‐year patient and kidney graft survival rates were 82.1% versus 89.9% and 82.1% versus 75.2% (both p = NS) in the NIDD versus SCD groups, respectively. Conclusions: The use of kidneys from AKI donors can be safely liberalized to include selected ECD and DCD donors. [ABSTRACT FROM AUTHOR]

South Africa's #FeesMustFall protests have widely been seen as a reckoning with the limitations of post‐apartheid citizenship and young people's frustrations over the slow pace of socio‐economic transformation. This paper seeks to analyse how working‐class students from one township community interpreted these protests. It argues that the protests reflected collective aspirations toward social mobility among working‐class students and concerns over the threat that high levels of future debt posed to this mobility. It contributes to geographical research on young people's experiences of debt by highlighting how the burden of debt intersects with experiences of racialised poverty and inequality. It suggests that young people's aspirations, even in the context of neoliberalism, frequently focused on collective social mobility and family well‐being. Finally, it proposes global comparative research on young people's experiences of debt and economic uncertainty in order to understand this increasingly globalised phenomenon and its political consequences. This article seeks to analyze how working‐class students from one township community interpreted South Africa's #FeesMustFall protests. It argues that the protests reflected collective aspirations toward social mobility among working‐class students and concerns over the threat that high levels of future debt posed to this mobility. It contributes to geographic research on young people's aspirations and experiences of debt in contexts of economic uncertainty and inequality. [ABSTRACT FROM AUTHOR]

Objective This study examined the role of expertise in clinicians' memory for case details. Clinicians' diagnostic formulations may afford mechanisms for retaining and retrieving information. Method Experts ( N = 41; 47.6% males, 23.8% females; 28.6% did not report gender; age: mean [ M] = 54.69) were members of the American Board of Professional Psychologists. Lay judges ( N = 156; 25.4% males, 74.1% females; age: M = 18.85) were undergraduates enrolled in general psychology. Three vignettes were presented to each group, creating a 2 (group: expert, lay judge) x 3 (vignettes: simple, complex-coherent, complex-incoherent) mixed factorial design. Recall accuracy for vignette details was the dependent variable. Results Data analyses used multivariate analyses of variance to detect group differences among multiple continuous variables. Experts recalled more information than lay judges, overall. However, experts also exhibited more false memories for the complex-incoherent case because of their schema-based knowledge. Conclusions This study supported clinical expertise as beneficial. Nonetheless, negative influences from experts' schema-based knowledge, as exhibited, could adversely affect clinical practices. [ABSTRACT FROM AUTHOR]

Background: Plasma exchange (PLEX) therapy is indicated for several disorders. The 5% albumin is often used as a sole replacement fluid during most PLEX. However, each 1.0 plasma volume exchange depletes coagulation factors by ~65%. Although most coagulation factors recover to hemostatic levels within 24 h post‐PLEX, fibrinogen requires 48–72 h to recover. Fibrinogen is the key coagulation protein for hemostasis. Therefore, fibrinogen is often monitored during the acute course of PLEX, and plasma is supplemented to prevent bleeding if fibrinogen is <100 mg/dL. Study Design and Methods: We conducted a prospective, single‐center, observational study to evaluate bleeding risk in adults who received an acute course of PLEX with a fibrinogen level of 80–100 mg/dL without plasma supplementation during the procedure or before central venous catheter removal. The study group was compared to patients with plasma fibrinogen >100 mg/dL. Results: Among the 275 patients who received 1406 PLEXes, 62 patients (23%) who underwent 323 PLEXes met the inclusion criteria, and only 2 (3%) patients had bleeding while on oral anticoagulants. In contrast, out of 275 patients, 143 (52%) with fibrinogen levels >100 mg/dL received 751 PLEX treatments, and bleeding occurred in 2 (1%) while on low‐molecular‐weight heparin. Conclusions: Our findings suggest that a pre‐procedure fibrinogen threshold of 80–100 mg/dL without plasma supplementation does not increase bleeding risk unless patients were on anticoagulation. See editorial on page 959–962, in this issue [ABSTRACT FROM AUTHOR]

Background: Some patients with end stage renal disease are or will become narcotic‐dependent. Chronic narcotic use is associated with increased graft loss and mortality following kidney transplantation. We aimed to compare the efficacy of continuous flow local anesthetic wound infusion pumps (CFLAP) with patient controlled analgesia pumps (PCA) in reducing inpatient narcotic consumption in patients undergoing kidney transplantation. Materials and Methods: In this single‐center, retrospective analysis of patients undergoing kidney transplantation, we collected demographic and operative data, peri‐operative outcomes, complications, and inpatient oral morphine milligram equivalent (OME) consumption. Results: Four hundred and ninety‐eight patients underwent kidney transplantation from 2020 to 2022. 296 (59%) historical control patients received a PCA for postoperative pain control and the next 202 (41%) patients received a CFLAP. Median age [53.5 vs. 56.0 years, p =.08] and BMI [29.5 vs. 28.9 kg/m2, p =.17] were similar. Total OME requirement was lower in the CFLAP group [2.5 vs. 34 mg, p <.001]. Wound‐related complications were higher in the CFLAP group [5.9% vs. 2.7%, p =.03]. Two (.9%) patients in the CFLAP group experienced cardiac arrhythmia due to local anesthetic toxicity and required lipid infusion. Conclusions: Compared to PCA, CFLAP provided a 93% reduction in OME consumption with a small increase in the wound‐related complication rate. The utility of local anesthetic pumps may also be applicable to patients undergoing any unilateral abdominal or pelvic incision. [ABSTRACT FROM AUTHOR]

Aim: The influence of dialysis modality and duration on outcomes following simultaneous pancreas‐kidney transplantation (SPKT) remains uncertain. Methods: We performed a single‐center retrospective review in 255 SPKT recipients according to dialysis modality (55 preemptive/no dialysis‐ND, 70 peritoneal dialysis–PD, 130 hemodialysis–HD) and duration (55 none, 137 < 2 years, 41 2‐4 years, 22 > 4 years). Results: Mean follow‐up was 9.4 years (median 9.2 years). Early (3‐month) relaparotomy rate (20% ND vs. 36% PD/HD, p =.03) was lower in ND patients. There were no differences in early graft loss, patient survival, overall or death‐censored kidney or pancreas graft survival rates (GSR) at 1 or 10 years follow‐up. When analyzing dialysis duration, there were no differences in rates of pancreas thrombosis or early pancreas graft loss. Kidney delayed graft function (DGF) was lower in the ND/short dialysis groups combined (1.0%), compared to the intermediate/long dialysis groups combined (9.5%, p =.003). Early relaparotomy rates were higher with longer duration of dialysis (p =.045 between ND and >4 years of dialysis). Patient survival in the long dialysis group was 50% compared to 69.5% in the other three groups combined (p =.09). However, both overall and death‐censored kidney and pancreas GSR were comparable. Conclusions: Preemptively transplanted patients had a lower incidence of kidney DGF and relaparotomy whereas patient survival was slightly lower with longer dialysis vintage prior to SPKT. Dialysis modality and duration did not influence either overall or death‐censored pancreas or kidney GSR in patients with short waiting times, low KDPI donor organs, and dialysis duration up to 4 years. [ABSTRACT FROM AUTHOR]

Introduction: Long‐term outcomes of kidney transplantation from deceased donors (DDKTs) with terminal acute kidney injury (AKI) are not well defined. Methods: Single center retrospective review of DDKTs from 1/31/07‐12/31/19. AKI kidneys were defined by a doubling of the donor's admission serum creatinine (SCr) level AND a terminal SCr ≥2.0 mg/dl. Results: A total of 188 AKI DDKTs were performed, including 154 from brain‐dead standard criteria donors (SCD). Mean donor age was 36 years and mean Kidney Donor Profile Index was 50%; mean admission and terminal SCr levels were 1.3 and 3.1 mg/dl, respectively. With a mean follow‐up of 94 months (median 89 months), overall patient (both 71.3%) and graft survival (54% AKI vs. 57% non‐AKI) rates were comparable to concurrent DDKTs from brain‐dead non‐AKI SCDs (n = 769). Delayed graft function (DGF) was higher in AKI kidney recipients (47% vs. 20% non‐AKI DDKTs, p <.0001). DGF was associated with lower graft survival in recipients of both AKI and non‐AKI SCD kidneys but the impact was earlier and more pronounced in non‐AKI recipients. Conclusions: Despite having more than twice the incidence of DGF, kidneys from deceased donors with terminal AKI have long‐term outcomes comparable to non‐AKI SCD kidneys and represent a safe and effective method to expand the donor pool. [ABSTRACT FROM AUTHOR]

RESULTS SGS-GPA cohort and characteristics There were 27 patients managed for SGS-GPA in the joint ENT vasculitis clinic between 1 January 2000 and 2 November 2020. Keywords: granulomatosis with polyangiitis; immunosuppression; subglottic dilatations; subglottic stenosis EN granulomatosis with polyangiitis immunosuppression subglottic dilatations subglottic stenosis 351 356 6 02/17/22 20220301 NES 220301 Key points Subglottic stenosis (SGS) is the commonest tracheobronchial manifestation of granulomatosis with polyangiitis (GPA), with early recognition and treatment key to preventing its vasculitic progression and fibrosis. Our management strategy emphasised rapid SGS-GPA treatment with limited surgical manipulation of the airway and systemic immunosuppression (IS) to prevent evolution of SGS and concurrent systemic vasculitic relapse. [Extracted from the article]