Search

BACKGROUND: Kidney transplant (KT) candidates with HIV face higher mortality on the waitlist compared with candidates without HIV. Because the HIV Organ Policy Equity (HOPE) Act has expanded the donor pool to allow donors with HIV (D + ), it is crucial to understand whether this has impacted transplant rates for this population. METHODS: Using a linkage between the HOPE in Action trial (NCT03500315) and Scientific Registry of Transplant Recipients, we identified 324 candidates listed for D + kidneys (HOPE) compared with 46 025 candidates not listed for D + kidneys (non-HOPE) at the same centers between April 26, 2018, and May 24, 2022. We characterized KT rate, KT type (D + , false-positive [FP; donor with false-positive HIV testing], D - [donor without HIV], living donor [LD]) and quantified the association between HOPE enrollment and KT rate using multivariable Cox regression with center-level clustering; HOPE was a time-varying exposure. RESULTS: HOPE candidates were more likely male individuals (79% versus 62%), Black (73% versus 35%), and publicly insured (71% versus 52%; P

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.

BackgroundOrgan transplantation from donors with human immunodeficiency virus (HIV) to recipients with HIV (HIV D+/R+) presents risks of donor-derived infections. Understanding clinical, immunologic, and virologic characteristics of HIV-positive donors is critical for safety.MethodsWe performed a prospective study of donors with HIV-positive and HIV false-positive (FP) test results within the HIV Organ Policy Equity (HOPE) Act in Action studies of HIV D+/R+ transplantation (ClinicalTrials.gov NCT02602262, NCT03500315, and NCT03734393). We compared clinical characteristics in HIV-positive versus FP donors. We measured CD4 T cells, HIV viral load (VL), drug resistance mutations (DRMs), coreceptor tropism, and serum antiretroviral therapy (ART) detection, using mass spectrometry in HIV-positive donors.ResultsBetween March 2016 and March 2020, 92 donors (58 HIV positive, 34 FP), representing 98.9% of all US HOPE donors during this period, donated 177 organs (131 kidneys and 46 livers). Each year the number of donors increased. The prevalence of hepatitis B (16% vs 0%), syphilis (16% vs 0%), and cytomegalovirus (CMV; 91% vs 58%) was higher in HIV-positive versus FP donors; the prevalences of hepatitis C viremia were similar (2% vs 6%). Most HIV-positive donors (71%) had a known HIV diagnosis, of whom 90% were prescribed ART and 68% had a VL

Incompatible living donor kidney transplant recipients (ILDKTr) have pre-existing donor-specific antibody (DSA) that, despite desensitization, may persist or reappear with resulting consequences, including delayed graft function (DGF) and acute rejection (AR). To quantify the risk of DGF and AR in ILDKT and downstream effects, we compared 1406 ILDKTr to 17 542 compatible LDKT recipients (CLDKTr) using a 25-center cohort with novel SRTR linkage. We characterized DSA strength as positive Luminex, negative flow crossmatch (PLNF); positive flow, negative cytotoxic crossmatch (PFNC); or positive cytotoxic crossmatch (PCC). DGF occurred in 3.1% of CLDKT, 3.5% of PLNF, 5.7% of PFNC, and 7.6% of PCC recipients, which translated to higher DGF for PCC recipients (aOR = 1.03 1.682.72 ). However, the impact of DGF on mortality and DCGF risk was no higher for ILDKT than CLDKT (p interaction > .1). AR developed in 8.4% of CLDKT, 18.2% of PLNF, 21.3% of PFNC, and 21.7% of PCC recipients, which translated to higher AR (aOR PLNF = 1.45 2.093.02 ; PFNC = 1.67 2.403.46 ; PCC = 1.48 2.243.37 ). Although the impact of AR on mortality was no higher for ILDKT than CLDKT (p interaction = .1), its impact on DCGF risk was less consequential for ILDKT (aHR = 1.34 1.621.95 ) than CLDKT (aHR = 1.96 2.292.67 ) (p interaction = .004). Providers should consider these risks during preoperative counseling, and strategies to mitigate them should be considered.

BACKGROUND: Desensitization protocols for HLA-incompatible living donor kidney transplantation (ILDKT) vary across centers. The impact of these, as well as other practice variations, on ILDKT outcomes remains unknown. METHODS: We sought to quantify center-level variation in mortality and graft loss following ILDKT using a 25-center cohort of 1358 ILDKT recipients with linkage to Scientific Registry of Transplant Recipients for accurate outcome ascertainment. We used multilevel Cox regression with shared frailty to determine the variation in post-ILDKT outcomes attributable to between-center differences and to identify any center-level characteristics associated with improved post-ILDKT outcomes. RESULTS: After adjusting for patient-level characteristics, only 6 centers (24%) had lower mortality and 1 (4%) had higher mortality than average. Similarly, only 5 centers (20%) had higher graft loss and 2 had lower graft loss than average. Only 4.7% of the differences in mortality (P < 0.01) and 4.4% of the differences in graft loss (P < 0.01) were attributable to between-center variation. These translated to a median hazard ratio of 1.36 for mortality and 1.34 of graft loss for similar candidates at different centers. Post-ILDKT outcomes were not associated with the following center-level characteristics: ILDKT volume and transplanting a higher proportion of highly sensitized, prior transplant, preemptive, or minority candidates. CONCLUSIONS: Unlike most aspects of transplantation in which center-level variation and volume impact outcomes, we did not find substantial evidence for this in ILDKT. Our findings support the continued practice of ILDKT across these diverse centers.

Systemic gender inequality and sexual discrimination continues across a wide spectrum of social, political, and economic fields. Using three key feminist curriculum and pedagogy principles (decentering norms, centering difference, distributing leadership) we employ feminist pedagogy by facilitating curriculum development and implementation that is empowering for not only junior high school students but also preservice teachers, and the collaboration between a junior high school teacher and university preservice educators. We introduce artists that use 3D printing in ways that embody feminist principles and social justice activism to inspire preservice teachers to develop feminist curricula and pedagogy that includes 3D printing. By introducing the artists, we highlight why and how feminist content is part of feminist pedagogy, and how feminist pedagogy works to challenge feminist concerns. Given that most preservice teachers did not experience feminist art pedagogy in preK-16, we designed opportunities to experience feminist art pedagogy in teaching junior high school art classes. As teachers (and students) create feminist curriculum to use and share with others, they gain political power as engineers of progressive educational change towards ending sexism. WTF? (Where's the feminism?) is about our (re)searching feminist pedagogy in a junior high school context through a collaborative form of distributed leadership.

The first sustained increase in live kidney donation in the United States in 15 years was observed from 2017 to 2019. To help sustain this surge, we studied 35 900 donors (70.3% white, 14.5% Hispanic, 9.3% black, 4.4% Asian) to understand the increase in 2017-2019 vs 2014-2016 using Poisson regression. Among biologically related donors aged

Background In March 2020, COVID-19 infections began to rise exponentially in the USA, placing substantial burden on the healthcare system. As a result, there was a rapid change in transplant practices and policies, with cessation of most procedures. Our goal was to understand changes to pediatric kidney transplantation (KT) at the national level during the COVID-19 epidemic. Methods Using SRTR data, we examined changes in pediatric waitlist registration, waitlist removal or inactivation, and deceased donor and living donor (DDKT/LDKT) events during the start of the disease transmission in the USA compared with the same time the previous year. Results We saw an initial decrease in DDKT and LDKT by 47% and 82% compared with expected events and then a continual increase, with numbers reaching expected prepandemic levels by May 2020. In the early phase of the pandemic, waitlist inactivation and removals due to death or deteriorating condition rose above expected values by 152% and 189%, respectively. There was a statistically significant decrease in new waitlist additions (IRR .sub.0.49 0.65 .sub.0.85) and LDKT (IRR .sub.0.17 0.38 .sub.0.84) in states with high vs. low COVID activity. Transplant recipients during the pandemic were more likely to have received a DDKT, but had similar calculated panel-reactive antibody (cPRA) values, waitlist time, and cause of kidney failure as before the pandemic. Conclusions The COVID-19 pandemic initially reduced access to kidney transplantation among pediatric patients in the USA but has not had a sustained effect., Author(s): Olga Charnaya [sup.1] , Teresa Po-Yu Chiang [sup.2] , Richard Wang [sup.3] , Jennifer D. Motter [sup.2] , Brian J. Boyarsky [sup.2] , Elizabeth A. King [sup.2] , William [...]

This study uses a national registry study to characterize temporal trends in perioperative mortality in donors and risk factors associated with this event. [ABSTRACT FROM AUTHOR]

Redefining the educational model of science, technology, engineering, and math curriculum (STEM) to also include art to become STEAM (Fournier, 2013; Guyotte, Sochacka, Constantino, Walther, & Kellam, 2014) is a current method to encourage students to actively participate in 21st-century learning (Saxena, 2014). The skills emphasized for 21st-century learning include critical thinking and problem solving; collaboration and communication; and creativity and innovation (Partnership for 21st Century Skills, 2007). For art educators using a project-based approach to active learning through hands-on digital art projects can directly show links between STEM knowledge and art to create a STEAM curriculum, offering students a way to see how a well-rounded education builds connections across disciplines, individuals, and the world around them (Jolly, 2014). To spark the interest of girls, especially minority girls, as creators of technology, Penn State's 2010-2011 Tech Savvy Girl's camp focused on digital artmaking to develop middle school girls' 21st-century skills. Girls from rural central Pennsylvania and inner-city Philadelphia participated in the camp to directly engage with the knowledge and skills necessary for STEM-related careers. The courses described in this article, Digital Stories taught by Jennifer Motter, My Avatar Movie and My Avatar Games taught by Christine Liao, and Games 4 Girls taught by Ryan Patton, encouraged girls to create with technology and explore different forms of digital artmaking through activities tied to storytelling, personal experience, and technology literacy by making animations, machinimas, and video games. Through their examples, the authors propose a STEAM curriculum framework with digital artmaking at the center. Creating animations and games are two strategies in this curriculum framework. By highlighting how the course content and activities engage students in 21st-century learning and analyzing learning outcomes through our survey, their goal in this article is to show how creating digital media enables girls to learn essential skills for the 21st century and see the creative possibilities in pursuing STEM-related careers.

PostSecret (www.postsecret.com) is a transitional space where the in-betweenness of public and private exists. Within this space, peer public pedagogy occurs through critical participatory democratic interactions of community participants. Integrating PostSecret into the art education curriculum can offer the potential for generative knowledge formed through participant collaboration in this informal learning site. In this article, the author discusses PostSecret's affordance for "peer public pedagogy". Next, she contextualizes postcards and analyzes them as "currere". She then argues that PostSecret fosters informal art education and online feminist pedagogy by exploring her integration of PostSecret in the graduate art education curriculum. She then examines Aoki's (2003) "curriculum-as-lived" theory, its application to PostSecret, and PostSecret's empowerment potentials. She concludes by recommending that art educators consider PostSecret as an informal approach to art education. (Contains 7 figures and 1 note.)