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2. COVID-19 in pediatric kidney transplantation: a follow-up report of the Improving Renal Outcomes Collaborative

Author

Varnell, Charles, Harshman, Lyndsay A, Liu, Chunyan, Smith, Laurie, Al-Akash, Samhar, Barletta, Gina-Marie, Brakeman, Paul, Chaudhuri, Abanti, Fadakar, Paul, Galea, Lauren, Garro, Rouba, Gluck, Caroline, Kershaw, David B, Matossian, Debora, Patel, Hiren P, Peterson, Caitlin, Pruette, Cozumel, Ranabothu, Saritha, Rodig, Nancy, Singer, Pamela, Sebestyen VanSickle, Judith, Weng, Patricia L, Danziger-Isakov, Lara, Seifert, Michael E, and Hooper, David K

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Transplantation, Clinical Trials and Supportive Activities, Clinical Research, Pediatric, Patient Safety, Organ Transplantation, Kidney Disease, 2.4 Surveillance and distribution, Aetiology, Renal and urogenital, Good Health and Well Being, Humans, Child, Kidney Transplantation, COVID-19, COVID-19 Testing, Follow-Up Studies, Prospective Studies, Improving Renal Outcomes Collaborative, Kidney transplant, Paediatrics and Reproductive Medicine, Urology & Nephrology, Clinical sciences, Paediatrics
Abstract

BackgroundWe report follow-up data from an ongoing prospective cohort study of COVID-19 in pediatric kidney transplantation through the Improving Renal Outcomes Collaborative (IROC).MethodsPatient-level data from the IROC registry were combined with testing, indication, and outcomes data collected to describe the epidemiology of COVID testing, treatment, and clinical outcomes; determine the incidence of a positive COVID-19 test; describe rates of COVID-19 testing; and assess for clinical predictors of a positive COVID-19 test.ResultsFrom September 2020 to February 2021, 21 centers that care for 2690 patients submitted data from 648 COVID-19 tests on 465 patients. Most patients required supportive care only and were treated as outpatients, 16% experienced inpatient care, and 5% experienced intensive care. Allograft complications were rare, with acute kidney injury most common (7%). There was 1 case of respiratory failure and 1 death attributed to COVID-19. Twelve centers that care for 1730 patients submitted complete testing data on 351 patients. The incidence of COVID-19 among patients at these centers was 4%, whereas the incidence among tested patients was 19%. Risk factors to predict a positive COVID-19 test included age > 12 years, symptoms consistent with COVID-19, and close contact with a confirmed case of COVID-19.ConclusionsDespite the increase in testing and positive tests over this study period, the incidence of allograft loss or death related to COVID-19 remained extremely low, with allograft loss or death each occurring in

Published
2023

3. COVID-19 in pediatric kidney transplantation: The Improving Renal Outcomes Collaborative.

Author

Varnell, Charles, Harshman, Lyndsay, Smith, Laurie, Liu, Chunyan, Chen, Shiran, Al-Akash, Samhar, Barletta, Gina-Marie, Belsha, Craig, Brakeman, Paul, Chaudhuri, Abanti, Fadakar, Paul, Garro, Rouba, Gluck, Caroline, Goebel, Jens, Kershaw, David, Matossian, Debora, Nailescu, Corina, Patel, Hiren, Pruette, Cozumel, Ranabothu, Saritha, Rodig, Nancy, Smith, Jodi, Sebestyen VanSickle, Judith, Weng, Patricia, Danziger-Isakov, Lara, Hooper, David, and Seifert, Michael

Subjects
clinical research/practice, epidemiology, health services and outcomes research, infection and infectious agents, infectious disease, kidney transplantation/nephrology, pediatrics, COVID-19, Child, Humans, Incidence, Kidney Transplantation, Prospective Studies, SARS-CoV-2
Abstract

There are limited data on the impact of COVID-19 in children with a kidney transplant (KT). We conducted a prospective cohort study through the Improving Renal Outcomes Collaborative (IROC) to collect clinical outcome data about COVID-19 in pediatric KT patients. Twenty-two IROC centers that care for 2732 patients submitted testing and outcomes data for 281 patients tested for SARS-CoV-2 by PCR. Testing indications included symptoms and/or potential exposures to COVID-19 (N = 134, 47.7%) and/or testing per hospital policy (N = 154, 54.8%). Overall, 24 (8.5%) patients tested positive, of which 15 (63%) were symptomatic. Of the COVID-19-positive patients, 16 were managed as outpatients, six received non-ICU inpatient care and two were admitted to the ICU. There were no episodes of respiratory failure, allograft loss, or death associated with COVID-19. To estimate incidence, subanalysis was performed for 13 centers that care for 1686 patients that submitted all negative and positive COVID-19 results. Of the 229 tested patients at these 13 centers, 10 (5 asymptomatic) patients tested positive, yielding an overall incidence of 0.6% and an incidence among tested patients of 4.4%. Pediatric KT patients in the United States had a low estimated incidence of COVID-19 disease and excellent short-term outcomes.

Published
2021

4. The learning health system for pediatric nephrology: building better systems to improve health

Author

Varnell, Charles D., Margolis, Peter, Goebel, Jens, and Hooper, David K.

Subjects
Quality management, Methods, Pediatric research, Continuous improvement (Management) -- Methods, Health services administration -- Quality management, Nephrology -- Quality management
Abstract

Author(s): Charles D. Jr Varnell [sup.1] [sup.2] [sup.3] , Peter Margolis [sup.1] [sup.3] , Jens Goebel [sup.4] [sup.5] , David K. Hooper [sup.1] [sup.2] [sup.3] Author Affiliations: (1) grid.24827.3b, 0000 [...], Learning health systems (LHS) align science, informatics, incentives, and culture for continuous improvement and innovation. In this organizational system, best practices are seamlessly embedded in the delivery process, and new knowledge is captured as an integral byproduct of the care delivery experience aimed to transform clinical practice and improve patient outcomes. The objective of this review is to describe how building better health systems that integrate clinical care, improvement, and research as part of an LHS can improve care within pediatric nephrology. This review will provide real-world examples of how this system can be established in a single center and across multiple centers as learning health networks.

Published
2023
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5. Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

Author

Geetha, Duvuru, Kronbichler, Andreas, Rutter, Megan, Bajpai, Divya, Menez, Steven, Weissenbacher, Annemarie, Anand, Shuchi, Lin, Eugene, Carlson, Nicholas, Sozio, Stephen, Fowler, Kevin, Bignall, Ray, Ducharlet, Kathryn, Tannor, Elliot K., Wijewickrama, Eranga, Hafidz, Muhammad I. A., Tesar, Vladimir, Hoover, Robert, Crews, Deidra, Varnell, Charles, Danziger-Isakov, Lara, Jha, Vivekanand, Mohan, Sumit, Parikh, Chirag, and Luyckx, Valerie

Published
2022
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9. Predicting acute rejection in children, adolescents, and young adults with a kidney transplant by assessing barriers to taking medication

Author

Varnell, Charles D., Rich, Kristin L., Zhang, Bin, Carle, Adam C., Pai, Ahna L. H., Modi, Avani C., and Hooper, David K.

Subjects
Drug therapy, Complications and side effects, Usage, Research, Risk factors, Behavior, Pediatric research, Young adults -- Drug therapy -- Behavior, Youth -- Drug therapy -- Behavior, Patient compliance -- Research, Kidney transplantation -- Complications and side effects, Immunosuppressive agents -- Usage, Graft rejection -- Risk factors, Kidneys -- Transplantation, Teenagers -- Drug therapy -- Behavior
Abstract

Author(s): Charles D. Jr Varnell [sup.1] [sup.2] [sup.3] , Kristin L. Rich [sup.3] [sup.4] , Bin Zhang [sup.3] [sup.5] , Adam C. Carle [sup.2] [sup.6] , Ahna L. H. Pai [...], Background Nonadherence to immunosuppression is common among pediatric, adolescent, and young adult kidney transplant recipients and a leading cause of graft loss. Assessing barriers to medication adherence in clinical practice may identify patients at risk for rejection and provide therapeutic targets. Methods Kidney transplant patients and/or their caregivers were assessed for 14 barriers to medication adherence using the barriers assessment tool. We compared rejection rates between patients with at least one reported adherence barrier to those without reported adherence barriers using a Kaplan-Meier estimator and Cox proportional hazard models to adjust for other mediators of acute rejection at 2 years following barriers assessment. Results Ninety-eight patients were assessed for barriers to adherence. Over the 2-year observation period, 22 patients developed biopsy-proven acute rejection (BPAR). Kaplan-Meier estimates show that patients with an identified barrier to adherence were more likely to have BPAR (p = 0.02) than patients without an identified barrier in the 24 months following barriers assessment. The median time to rejection for patients who experienced acute rejection was 175.5 days (IQR 63-276 days) from the time of barriers assessment. An identified barrier to adherence remained the only statistically significant predictor of BPAR with Cox modeling (HR 2.6, p = 0.04), after accounting for age, sex, and race. Conclusions Pediatric and adolescent kidney transplant recipients with identified adherence barriers are at increased risk for acute rejection. Barriers to adherence provide a potentially modifiable therapeutic target that can be assessed in clinic to guide targeted interventions.

Published
2021
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11. Author Correction: Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

Author

Geetha, Duvuru, Kronbichler, Andreas, Rutter, Megan, Bajpai, Divya, Menez, Steven, Weissenbacher, Annemarie, Anand, Shuchi, Lin, Eugene, Carlson, Nicholas, Sozio, Stephen, Fowler, Kevin, Bignall, Ray, Ducharlet, Kathryn, Tannor, Elliot K., Wijewickrama, Eranga, Hafidz, Muhammad I. A., Tesar, Vladimir, Hoover, Robert, Crews, Deidra, Varnell, Charles, Danziger-Isakov, Lara, Jha, Vivekanand, Mohan, Sumit, Parikh, Chirag, and Luyckx, Valerie

Published
2022
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16. Development and Testing of a Digitally Enabled Adherence Platform

Author

Abelson, Elana, Hooper, David, Varnell, Charles, Streat, Derek, Sharma, Gunjan, Gavandi, Sid, and Modi, Avani C.

Abstract

Objective: To develop a digitally enabled adherence platform (DEAP) using evidence-based adherence promotion strategies through iterative testing with patients, design specialists, and adherence experts.Method: Adolescents and young adults (AYAs) with a kidney transplant from a large, midwestern transplant program were recruited to participate in this study. Through an iterative process, we conducted focus groups, individual interviews, empathy interviews/mapping, and usability testing and evaluation to develop and refine the initial version of DEAP.Results: Three empathy maps were created to assess the unique needs of patients, caregivers, and healthcare providers. Eleven patients were then recruited to participate in usability testing of the platform. Platform engagement was high with nine of the 11 participants viewing their initial messages/surveys, usability was rated as high (M= 81.88, SD= 9.61, range = 67.5–95.0), and user-friendliness was rated as excellent (M= 5.88, SD= 0.74, range = 5.0–7.0). Participants also noted multiple opportunities for improving the look and design of DEAP.Conclusions: Engaging with multiple stakeholders and piloting a small usability study have demonstrated support for the acceptability and usability of DEAP, a mobile health platform to address barriers to taking immunosuppression medication for AYAs who have received kidney transplants. Future work is planned to develop a better patient and clinician user experience, increase personalization, and facilitate patient–clinician engagement using this platform.Implications for Impact Statement Up to 40% of adolescents and young adults (AYAs) who have undergone kidney transplants do not take their immunosuppression medication as prescribed, which can lead to devastating consequences including organ rejection. DEAP (digitally enabled adherence platform), a web-based system, was designed using an iterative process with input from key stakeholders with features to assess adherence barriers and provide solutions through problem-solving. Preliminary usability testing suggests it is acceptable and easy to use, demonstrating its potential to address suboptimal adherence and improve health outcomes.

Published
2024
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18. Contributors

Author

Abzug, Mark J., Acharya, Krishna K., Adams, Denise M., Adelson, Stewart, Adrian, Molly C., Ahlfeld, Shawn K., Aiken, John J., Akdis, Cezmi A., Albokhari, Daniah, Alderman, Elizabeth M., Ali, Omar, Allen-Rhoades, Wendy A., Almutlaq, Nourah N., Amos, Louella B., Anari, Jason B., Anderson, Karl E., Anupindi, Sudha A., Appleby, Brian S., Ardoin, Stacy P., Arkader, Alexandre, Armangué, Thaís, Arndt, Carola A.S., Arnold, Danielle E., Artis, Adrianne R., Asher, David M., Asselin, Barbara L., Astley, Christina M., Atkinson, Norrell K., Augustine, Erika F., Augustyn, Marilyn C., Bacharier, Leonard B., Bacino, Carlos A., Bailey, Zinzi D., Balamuth, Frances B., Baldassano, Robert N., Baldwin, Keith D., Bales, Christina B., Balistreri, William F., Balwani, Manisha, Bamba, Vaneeta, Banerji, Aleena, Bang, Janet Y., Barai, Nikita, Baranowski, Katherine, Barclay, Sarah F., Barkoudah, Elizabeth, Barrero-Castillero, Alejandra, Barrett, Katherine J., Barron, Karyl S., Basel, Donald, Bass, Dorsey M., Bassett, Mary T., Bassiri, Hamid, Baum, Rebecca A., Behrens, Edward M., Bell, Michael J., Benjamin, Daniel K., Jr., Bennett, Amanda E., Bergerson, Jenna R.E., Bernstein, Daniel, Bernstein, Henry H., Bice-Urbach, Brittany J., Bielory, Brett P., Bielory, Leonard, Blanchard, Samra S., Blanchette, Eliza, Blatter, Joshua A., Bleyer, Archie, Boas, Steven R., Bock, Margret E., Boggs, Sarah R., Boivin, Michael J., Bonn, Julie, Bonthius, Daniel J., Boppana, Suresh B., Bordini, Brett J., Borst, Alexandra J., Bosse, Kristopher R., Boyer, Kenneth M., Brady, Patrick W., Brady, Rebecca C., Brady, Samuel L., Branchford, Brian R., Brandow, Amanda M., Brandsma, Erik, Breault, David T., Breuner, Cora Collette, Bridgemohan, Carolyn F., Britt, William J., Brower, Laura, Brown, Maria D., Brownell, Jefferson N., Browning, Meghen B., Brunetti-Pierri, Nicola, Bunyavanich, Supinda, Burstein, Danielle S., Bustinduy, Amaya L., Buyon, Jill P., Cabada, Miguel M., Cada, Michaela, Cairo, Mitchell S., Calello, Diane P., Cameron, Lindsay H., Campbell, Angela J.P., Candelaria, Margo, Cannon, Laura, Carlin, Rebecca F., Carlucci, James G., Carr, Michael R., Carrigan, Robert B., Carter, Rebecca G., Carter-Hamilton, Gail V., Case, Abigail, Chang, Pearl W., Chelimsky, Gisela G., Chelimsky, Thomas, Chemaitilly, Wassim, Chiotos, Kathleen, Chiu, Yvonne E., Chong, Hey Jin, Chou, Stella T., Christ, Lori A., Christenson, John C., Chugh, Ankur A., Cieslak, Theodore J., Claes, Donna J., Coates, Thomas D., Sánchez Códez, María I., Coffin, Susan E., Cohen, Mitchell B., Cohen, Susan S., Cole, F. Sessions, III, Collaco, J. Michael, Collins, James W., Jr., Congeni, Joseph A., Conrad, Máire A., Corcoran, Justin N., Corley, Alexandra M.S., Cox, Amanda L., Coyle, Anne M., Coyne-Beasley, Tamera, Craig, Sansanee S., Creighton, Sarah M., Crigger, Chad B., Crowe, James E., Jr., Culbert, Gabriel, Czinn, Steven J., Dalal, Aarti S., Dalmau, Josep, D’Andrea, Lynn A., Danziger-Isakov, Lara A., Darville, Toni, David, Richard J., Davidoff, Katharine, Davidson, Loren T., Davidson, Richard S., Davies, H. Dele, Davis, Stephanie D., Davis-Kankanamge, Christina, Daw, Najat C., Dean, Shannon L., DeBiasi, Roberta L., Delair, Shirley, DeLaroche, Amy M., De León-Crutchlow, Diva D., Oquendo Del Toro, Helen M., Del Valle Mojica, Coralee, DeMaso, David R., Dendrinos, Melina L., Dent, Arlene E., Desnick, Robert J., Deterding, Robin R., Devarajan, Prasad, deVeber, Gabrielle A., Dhar, Vineet K., Dhossche, Julie M., Diab, Liliane K., Di Carlo, Heather N., Dietz, Harry C., III, Dietze-Fiedler, Megan L., DiMeglio, Linda A., Dixon, Bradley P., DiVasta, Amy D., Dlamini, Nomazulu, Dobbs, Katherine R., Dodhia, Sonam N., Doerholt, Katja, Dolin, Cara D., Dominguez, Samuel R., Donohoue, Patricia A., Dow, Jennifer, Downes, Kevin J., Doyle, Daniel A., Doyle, Jefferson J., Dror, Yigal, Dubowitz, Howard, Dumler, J. Stephen, Duncan, Andrea F., Durant, Nefertiti H., Dvergsten, Jeffrey A., Earing, Michael G., Eberly, Col. Matthew D., Egan, Marie E., Eichenwald, Eric C., Elkadri, Abdul-Aziz K., Englander, Elizabeth, Ericson, Jessica E., Erkan, Elif, Etzel, Ruth A., Evans, Sarah Helen, Faherty, Erin, Falk, Marni J., Familiar-Lopez, Itziar, Fargo, John H., Feemster, Kristen A., Fehnel, Katie P., Feigelman, Susan, Feldman, Amy G., Feldman, Heidi M., Fels, Edward C., Felner, Eric I., Feng, Sing-Yi, Ferkol, Thomas W., Jr., Finberg, Karin E., Finder, Jonathan D., Fiorino, Kristin N., Fischer, Philip R., Fitzpatrick, Anne M., Flannery, Dustin D., Fleming, Nicholas L., Flood, Veronica H., Flores, Francisco X., Flynn, Joseph T., Flynn, Patricia M., Foglia, Elizabeth E., Forkey, Heather C., Forman, Joel A., Freeman, Alexandra F., Friedman, Deborah M., Friedman, Susan A., Friehling, Erika D., Fritz, Stephanie A., Frush, Donald P., Fuleihan, Ramsay L., Gahagan, Sheila, Gallagher, Patrick G., Galloway, David P., Gans, Hayley A., Garber, Andrea K., Gardiner, Paula M., Garibaldi, Luigi R., Gauthier, Gregory M., Gerber, Jeffrey S., Gershon, Anne A., Ghadersohi, Saied, Gibbs, Kathleen A., Gibson, Mark, Gigante, Joseph, Gigliotti, Francis, Gilley, Stephanie P., Gilliam, Walter S., Ginde, Salil, Girotto, John A., Goldfarb, Samuel B., Goldman, David L., Goldman, Stanton C., Gómez-Duarte, Oscar G., Good, Misty, Goodbody, Christine M., Goodman, Denise M., Goodman, Tracey, Goodyer, William R., Gordon, Catherine M., Gordon, Leslie B., Gordon, Rebecca J., Gordon-Lipkin, Eliza, Gorelik, Michael, Gower, W. Adam, Graber, Evan G., Graff, Zachary T., Graham, Robert J., Green, Cori M., Green, Michael, Greenbaum, Larry A., Greenbaum, V. Jordan, Greiner, Mary V., Griffiths, Anne G., Grizzle, Kenneth L., Groner, Judith A., Grumach, Anete Sevciovic, Gueye-Ndiaye, Seyni, Guz-Mark, Anat, Haamid, Fareeda, Haddad, Gabriel G., Haddad, Joseph, Jr., Haemer, Matthew A., Hagan, Joseph F., Jr., Haider, Suraiya K., Hakim, Hana, Haldeman-Englert, Chad R., Halstead, Scott B., Hamie, Lamiaa, Hammerschlag, Margaret R., Hammershaimb, E. Adrianne, Hampton, Elisa, Hamvas, Aaron, Hanchard, Neil A., Hanley, Patrick C., Hanna, Melisha G., Harijan, Pooja D., Harrison, Douglas J., Harstad, Elizabeth B., Haslam, David B., Hauck, Fern R., Havers, Fiona P., Hayes, Ericka V., Heard-Garris, Nia J., Hedrick, Holly L., Hemingway, Cheryl, Heneghan, Chelsea, Hernandez, Michelle L., Hernandez-Trujillo, Vivian P., Hernandez Tejada, Fiorela N., Herrick, Heidi M., Hershey, Andrew D., Herzog, Cynthia E., Heston, Sarah M., Hijazi, Ghada, Hill, Samantha V., Hochberg, Jessica, Hodes, Deborah, Hoefgen, Holly R., Holinger, Lauren D., Holland-Hall, Cynthia M., Hollenbach, Laura L., Holler-Managan, Yolanda F., Hooper, David K., Hooven, Thomas A., Hoover-Fong, Julie E., Hopper, Rachel K., Hord, Jeffrey D., Horn, B. David, Horstmann, Helen M., Hotez, Peter J., House, Samantha A., Howard, Ashley C., Howard, Mary Beth, Hsu, Evelyn K., Hsu, Katherine, Huddleston, Heather G., Huh, Winston W., Humphrey, Stephen R., Hunstad, David A., Hunger, Stephen P., Hunt, Carl E., Huppert, Stacey S., Huppler, Anna R., Hurt, Hallam, Izumi, Kosuke, Jackson, Allison M., Jackson, Mary Anne, Jaffe, Ashlee M., James, Kiera M., Janowski, Andrew B., Jenssen, Brian P., Jinnah, H.A., John, Chandy C., Johansen, Kari, Johnson, Susan L., Johnston, Brian D., Jongco, Artemio M., III, Josephson, Cassandra D., Joyce, Joel C., Jyonouchi, Soma, Kabbany, Mohammad Nasser, Kabbouche, Marielle, Kacperski, Joanne, Kadry, Nadia A., Kaj-Carbaidwala, Batul, Kalish, Jennifer M., Kamat, Deepak, Kansra, Alvina R., Kanter, David M., Kao, Carol M., Kapavarapu, Prasanna K., Kattan, Jacob, Kelly, Andrea, Kelly, Desmond P., Kelly, Matthew S., Kelly, Michael E., Kendi, Sadiqa, Kerem, Eitan, Kerr, Julie M., Khan, David A., Khan, Seema, Khatami, Ameneh, Khaytin, Ilya, Kier, Catherine, Kilinsky, Alexandra, Kim, Chong-Tae, Kim, Jung Won, Kim, Rosa K., King, J. Michael, Kirschen, Matthew P., Kishnani, Priya S., Klawonn, Meghan A., Klein, Bruce L., Klein, Bruce S., Kliegman, Alison S., Kliegman, Robert M., Kneyber, Martin C.J., Koch, William C., Kochanek, Patrick M., Kodish, Eric, Kohlhoff, Stephan A., Kortepeter, Mark G., Kotloff, Karen L., Koumbourlis, Anastassios C., Krause, Peter J., Krebs, Nancy F., Kreipe, Richard E., Krug, Steven E., Kwiatkowski, Janet L., Kwon, Jennifer M., Ladisch, Stephan, Lakser, Oren J., Lalor, Leah, Lam, Simon, Lambert, Michele P., Lampe, Christina, Landry, Gregory L., Lane, Wendy G., Larson, A. Noelle, LaRussa, Phillip S., Lawrence, J. Todd R., Lee, Brendan, Lee, Erica H., Leiding, Jennifer W., Lemmon, Monica E., Lesser, Daniel J., Lestrud, Steven O., Leung, Donald Y.M., Levas, Michael N., Liacouras, Chris A., Lipkin, Paul H., Liptzin, Deborah R., Liu, Andrew H., Lo, Mindy S., Lo, Stanley F., Long, Sarah S., Lord, Katherine, Macias, Charles G., Macias, Michelle M., Macumber, Ian R., Magnusson, Mark R., Magoulas, Pilar L., Maguire, Kathleen J., Mahajan, Prashant V., Majzoub, Joseph A., Mamula, Petar, Manak, Colleen K., Mangus, Courtney W., Manoli, Irini, Manzur, Adnan Y., Maqbool, Asim, Maranich, Col. Ashley M., Margetts, Miranda, Margolis, David, Marin, Mona, Marini, Joan C., Markowitz, Morri, Maroushek, Stacene R., Marsh, Justin D., Marshall, Trisha L., Martin, Kari L., Masson, Vicki K., Matalon, Dena R., Matalon, Reuben K., Mathijssen, Irene M.J., Reddy Matta, Sravan Kumar, Maxwell, Elizabeth C., Maybank, Aletha, McCabe, Megan E., McCain, Darla H., McColley, Susanna A., McConnico, Neena, McCormick, Elizabeth M., McDonald, Christine M., McGovern, Margaret M., McGrath-Morrow, Sharon A., McInerney, Alissa, McKinney, Jeffrey S., McLeod, Rima, McVay-Gillam, Marcene R., Meade, Julia C., Meehan, William P., III, Mejias, Asuncion, Melby, Peter C., Melzer-Lange, Marlene D., Merves, Jamie F., Messacar, Kevin B., Michaels, Marian G., Michniacki, Thomas F., Mikati, Mohamad A., Miller-Handley, Hilary E., Mink, Jonathan W., Mirasola, Karolyn, Mistovich, R. Justin, Mohr, Emma L., Montoya-Williams, Diana, Moon, Rachel Y., Morava, Eva, Moreno, Megan A., Morgan, Ryan W., Morrison, Peter E., Morrison, Wynne, Mukhopadhyay, Sagori, Munoz, Flor M., Munson, David A., Murphy, Timothy F., Murray, Karen F., Murray, Thomas S., Mutlu, Levent, Nagata, Jason M., Narula, Sona, Nataro, James P., Navsaria, Dipesh, Nduati, Ruth W., Nehus, Edward J., Nelson, Maureen R., Neri, Caitlin M., Nevin, Mary A., Newburger, Jane W., Newmark, Jonathan, Nield, Linda S., Niermeyer, Susan, Nocton, James J., Nogee, Lawrence M., Noje, Corina, Nowak-Wegrzyn, Anna H., Obaro, Stephen K., Obeid, Makram M., O’Callaghan, Kevin P., Oleszek, Joyce L., Olitsky, Scott E., Olsson, John M., O’Neill, Meghan E., Onigbanjo, Mutiat T., Opoka, Robert O., Orenstein, Walter A., Orkin, Sarah H., Orscheln, Rachel C., Ortega, Camile, O’Toole, Timothy R., Owens, Judith A., Ozen, Seza, Pach, Sophie, Pachter, Lee M., Padhye, Amruta, Pandurangi, Sindhu, Pak-Gorstein, Suzinne, Palla, John, Palmieri, Tina L., Palmieri, Jessica M., Pappas, Diane E., Parent, John J., Parga-Belinkie, Joanna J., Parikh, Bijal A., Parker, Alasdair P.J., Partridge, Emily A., Patel, Ami B., Patel, Trusha, Patrick, Stephen W., Patterson, Briana C., Pelosi, Emanuele, Permar, Sallie R., Perry, Michael, Perry, Tamara T., Peters, Mark J., Peters, Timothy R., Peterson, Stacy J.B., Phelan, Rachel A., Pinto, Anna L., Pipan, Mary, Player, Brittany, Prince, William Benjamin, Proctor, Mark R., Prozora, Stephanie, Pryor, Howard I., II, Pyles, Lee A., Quinn, Molly M., Quint, Elisabeth H., Rabinovich, C. Egla, Raffini, Leslie J., Ragoonanan, Dristhi S., Rahman, Shamima, Ralston, Shawn L., Ram, Sanjay, Ramilo, Octavio, Ramirez, Kacy A., Rand, Casey M., Rasmussen, Sonja A., Rathke, Kevin M., Ratner, Adam J., Ratner, Lee, Reed, Ann M., Reich, Patrick J., Reif, Shimon, Reller, Megan E., Remick, Katherine E., Remiker, Allison S., Reyes, Jorge D., Richardson, Katherine M., Rintoul, Natalie E., Ritchey, A. Kim, Robinson, Angela Byun, Rodrigues, Kristine Knuti, Rogers, Michael E., Romano, Mary E., Roosevelt, Genie E., Roper, Stephen M., Rosenthal, Stephen M., Ross, A. Catharine, Rossano, Joseph W., Rothman, Jennifer A., Rotta, Alexandre T., Rozenfeld, Ranna A., Russo, Michael E., Ryan, Kelsey S., Ryan, Monique M., Ryu, Julie, Sabbagh, Sara E., Sachdev, H.P.S., Sadarangani, Manish, Sadun, Rebecca E., Sahin, Mustafa, Saint-Cyr, Martine, Salata, Robert A., Salazar, José H., Salvana, Edsel Maurice T., Samelson-Jones, Benjamin J., Sammons, Julia S., Sampson, Hugh A., Samsel, Chase B., Sandora, Thomas J., Sankar, Wudbhav N., Sarnaik, Ashok P., Sato, Alice I., Satter, Lisa Forbes, Scaggs Huang, Felicia A., Schaffzin, Joshua K., Schechter, Michael S., Schilling, Samantha, Schleiss, Mark R., Schluter, W. William, Schondelmeyer, Amanda C., Schroeder, James W., Jr., Schulte, Elaine E., Schuster, Jennifer E., Schuster, Marcy, Schuster, Mark A., Scott, Daryl A., Scott, John P., Seaborg, Kristin A., Seed, Patrick C., Serwint, Janet R., Shah, Dheeraj, Shah, Samir S., Shah, Shivang S., Shamir, Raanan, Shanti, Christina M., Shapiro, Bruce K., Shaywitz, Bennett A., Shaywitz, Sally E., Shchelochkov, Oleg A., Shulman, Stanford T., Sicherer, Scott H., Simmons, Jeffrey M., Simões, Eric A.F., Simonsen, Kari A., Simpson, Tess S., Sinclair-McBride, Keneisha R., Singh, Arunjot, Sink, Jacquelyn R., Sisk, Bryan A., Sivaraman, Vidya, Slattery, Susan M., Slavotinek, Anne M., Smith, Jessica R., Smith-Whitley, Kim, Solensky, Roland, Son, Mary Beth F., Soranno, Danielle E., Sosa, Tina K., Soto-Rivera, Carmen L., Sosinsky, Laura Stout, Souder, Emily E., Souverbielle, Cristina Tomatis, Spearman, Paul, Spiegel, David A., Spinks-Franklin, Adiaha I.A., Sprecher, Alicia J., Squires, James E., Srivastava, Siddharth, St. Geme, Joseph W., III, St. John, Rachel D., Stambough, Kathryn C., Stanberry, Lawrence R., Starke, Jeffrey R., Starr, Taylor B., Steenhoff, Andrew P., Stein, Ronen E., Steinbach, William J., Stillwell, Terri L., Stone, Deborah L., Su, Stefani, Sucato, Gina S., Suchy, Frederick J., Sullivan, Kathleen E., Swami, Sanjeev K., Szafron, Vibha A., Szilagyi, Moira, Taha, Dalal, Tan, Libo, Tantisira, Kelan G., Taylor, Alex M., Tchapyjnikov, Dmitry, Tesini, Brenda L., Theobald, Jillian L., Thielen, Beth K., Thom, Christopher S., Thornburg, Courtney D., Tieder, Joel S., Tissières, Pierre, Tolentino, Victorio R., Jr., Topjian, Alexis A., Tower, Richard L., Trachtman, Rebecca, Triebwasser, Jourdan E., Trowbridge, Sara K., Truglio, Joseph M., Tubergen, David G., Turk, Margaret A., Tymon-Rosario, Joan R., Ufberg, Paul J., Ullrich, Christina, Ullrich, Nicole, Valika, Taher S., Van Hare, George F., Van Mater, Heather A., Varnell, Charles D., Jr., Vash-Margita, Alla, Vece, Timothy J., Vemana, Aarthi P., Venditti, Charles P., Vepraskas, Sarah, Verbsky, James W., Vermilion, Jennifer A., Vickery, Brian P., Vockley, Jerry, Voynow, Judith A., Walch, Abby, Waldrop, Stephanie W., Walker, David M., Walkovich, Kelly J., Walter, Heather J., Wambach, Jennifer A., Wamithi, Susan, Wang, Julie, Wang, Marie E., Wangler, Michael F., Ware, Stephanie M., Washam, Matthew C., Wasserman, Jonathan D., Wassner, Ari J., Watson, Andrew M., Wattier, Rachel L., Weber, David R., Webster, Jennifer, Weese-Mayer, Debra E., Weinberg, Jason B., Weinman, Jason P., Weisman, Steven J., Weiss, Anna K., Weiss, Scott L., Weiss, Pamela F., Weitzman, Carol C., Wells, Lawrence, Wen, Jessica W., Wendel, Danielle R., Werlin, Steven L., Wexler, Isaiah D., Whitaker, Alexander S., White, A. Clinton, Jr., White, Perrin C., Willoughby, Rodney E., Jr., Wilschanski, Michael, Wiley, Susan E., Williams, Brendan A., Wilson, Karen M., Wilson, Pamela E., Winell, Jennifer J., Witters, Peter, Wolf, Joshua, Wolfe, Joanne, Wolfgram, Peter M., Woods, Brandon T., Wright, Benjamin L., Wright, Terry W., Wu, Eveline Y., Yagupsky, Pablo, Yang, Edward, Yang, Kesi C., Yang, Ming, Yaron, Michael, Younger, Sarah B., Yuskaitis, Christopher J., Zachariah, Philip, Zafar, Muhammad S., Zahler, Stacey G., Zajac, Lauren M., Zaky, Wafik, Zaspel, Jennifer A., Zerra, Patricia E., Zhou, Amy, Zuckerman, Barry S., and Zur, Karen B.

Published
2025
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20. Mycophenolate mofetil-related leukopenia in children and young adults following kidney transplantation: Influence of genes and drugs

Author

Varnell, Charles D., Fukuda, Tsuyoshi, Kirby, Cassie L., Martin, Lisa J., Warshaw, Barry L., Patel, Hiren P., Chand, Deepa H., Barletta, Gina-Marie, Van Why, Scott K., VanDeVoorde, Rene G., Weaver, Donald J., Wilson, Amy, Verghese, Priya S., Vinks, Alexander A., Greenbaum, Larry A., Goebel, Jens, and Hooper, David K.

Published
2017
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22. COVID-19 in pediatric kidney transplantation: a follow-up report of the Improving Renal Outcomes Collaborative

Author

Varnell, Charles, primary, Harshman, Lyndsay A., additional, Liu, Chunyan, additional, Smith, Laurie, additional, Al-Akash, Samhar, additional, Barletta, Gina-Marie, additional, Brakeman, Paul, additional, Chaudhuri, Abanti, additional, Fadakar, Paul, additional, Galea, Lauren, additional, Garro, Rouba, additional, Gluck, Caroline, additional, Kershaw, David B., additional, Matossian, Debora, additional, Patel, Hiren P., additional, Peterson, Caitlin, additional, Pruette, Cozumel, additional, Ranabothu, Saritha, additional, Rodig, Nancy, additional, Singer, Pamela, additional, Sebestyen VanSickle, Judith, additional, Weng, Patricia L., additional, Danziger-Isakov, Lara, additional, Seifert, Michael E., additional, and Hooper, David K., additional

Published
2022
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27. Electronic Monitoring of Adherence in Clinical Care: Ethical and Practical Considerations

Author

Plevinsky, Jill M., Carmody, Julia K., Young, Melissa A., Rich, Kristin Loiselle, Pai, Ahna L. H., Varnell, Charles D., Hooper, David K., Eckhardt, Chad, and Modi, Avani C.

Abstract

Objective:Adherence to prescribed medical regimens is a key behavior for managing disease burden and progression. Despite the importance of understanding a child’s adherence, many evidence-based assessment strategies have not been implemented into subspecialty clinical practice. The aim of this article was to highlight the potential ethical and regulatory challenges of using electronic monitoring (EM) of adherence in clinical care and offer practical solutions. Methods:Relevant ethical and legal standards were researched and summarized as applicable to EM of adherence. Results:Issues related to Human Relations, Privacy and Confidentiality, Record Keeping, and Assessment all apply to EM of adherence. Conclusions:Clinicians should be mindful and seek to proactively address issues related to informed consent, autonomy, privacy, and equity before starting an EM program of adherence. Multidisciplinary teams should thoroughly consider the ethical and legal aspects of implementing this form of adherence assessment into clinical practice.Implications for Impact Statement This topical review is the first to describe the practical implications of utilizing electronic monitoring of adherence in a clinical care setting with a multidisciplinary medical team. This is an important reference for any pediatric psychologist or practitioner who wants to be fully informed about the potential ethical and legal ramifications of using this technology with youth.

Published
2022
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31. Colaboradores

Author

Abidi, Nadia Y., Abzug, Mark J., Adams, David R., Adams, Nicholas S., Adelson, Stewart L., Ahlfeld, Shawn K., Ahmad, Osman Z., Aiken, John J., Akdis, Cezmi A., Alessandrini, Evaline A., Alexander, Michael A., Ali, Omar, Anderson, Karl E., Anthony, Kelly K., Antoon, Alia Y., Apkon, Susan D., Ardoin, Stacy P., Arkader, Alexandre, Armangué, Thaís, Arndt, Carola A.S., Aronson, Paul L., Asher, David M., Ashworth, Ann, Assa, Amit, Asselin, Barbara L., Astley, Christina M., Ater, Joann L., Atkinson, Norrell, Augustine, Erika U., Augustyn, Marilyn C., Avitzur, Yaron, Bacino, Carlos A., Bailey, Zinzi D., Balakrishnan, Binod, Balamuth, Frances B., Baldassano, Robert N., Baldwin, Keith D., Bales, Christina, Balistreri, William F., Ballantine, Allison, Baltimore, Robert S., Balwani, Manisha, Bamba, Vaneeta, Banwell, Brenda L., Barclay, Sarah F., Barnes-Davis, Maria E., Barron, Karyl S., Basel, Donald, Bass, Dorsey M., Bassett, Mary T., Bauerfeld, Christian P., Baum, Rebecca A., Bell, Michael J., Bender, Nicole R., Benjamin, Daniel K., Jr, Bennett, Michael J., Bernstein, Daniel, Bernstein, Henry H., Bharucha-Goebel, Diana X., Biggs, Holly M., Blanchard, Samra S., Blatter, Joshua A., Bleyer, Archie, Blum, Nathan J., Boas, Steven R., Bockting, Walter O., Boguniewicz, Mark, Boivin, Michael J., Bonthius, Daniel J., Bordini, Brett J., Bosse, Kristopher R., Bostwick, Bret L., Boyer, Kenneth M., Brady, Jennifer M., Brady, Patrick W., Brady, Rebecca C., Brady, Samuel L., Brandow, Amanda M., Breault, David T., Breuner, Cora Collette, Bridgemohan, Carolyn, Britt, William J., Brower, Laura, Brown, Rebeccah L., Brownell, J. Naylor, Browning, Meghen B., Brunetti-Pierri, Nicola, Bryant, Phillip R., Buckley, Rebecca H., Budek, Cynthia Etzler, Bunyavanich, Supinda, Burnham, Carey-Ann D., Burstein, Gale R., Bustinduy, Amaya L., Buyon, Jill P., Cabada, Miguel M., Cada, Michaela, Caglar, Derya, Cairo, Mitchell S., Calello, Diane P., Camarda, Lauren E., Cameron, Lindsay Hatzenbuehler, Camitta, Bruce M., Campbell, Angela J.P., Carlin, Rebecca F., Carr, Michael R., Carrigan, Robert B., Carroll, Michael S., Carter, Rebecca G., Caserta, Mary T., Chapman, Jennifer I., Cheifetz, Ira M., Chelimsky, Gisela G., Chelimsky, Thomas C., Chemaitilly, Wassim, Chen, Yuan-Tsong, Chiriboga, Jennifer A., Chiu, Yvonne E., Cho, Christine B., Chong, Hey Jin, Chou, Stella T., Christenson, John C., Chun, Robert H., Chusid, Michael J., Cieslak, Theodore J., Claes, Donna J., Clark, Jeff A., Clemens, John David, Coates, Thomas D., Coffin, Susan E., Cohen, Joanna S., Cohen, Mitchell B., Cohen-Wolkowiez, Michael, Colbert, Robert A., Cole, F. Sessions, III, Collaco, J. Michael, Colombo, John L., Congeni, Joseph A., Conner, Lindsay N., Creighton, Sarah M., Crowe, James E., Jr, Czinn, Steven J., Dalal, Aarti S., Dalmau, Josep O., Danziger-Isakov, Lara A., Darville, Toni, Daum, Robert S., Davidson, Loren T., Davidson, Richard S., Davies, H. Dele, Daw, Najat C., Dean, Shannon L., Toro, Helen M. Oquendo Del, DeMaso, David R., Denison, Mark R., Dent, Arlene E., Desnick, Robert J., Deterding, Robin R., Devarajan, Prasad, deVeber, Gabrielle A., Dhar, Vineet, Dhawan, Anil, Dick, André A.S., Dietz, Harry C., III, Diiorio, Daren A., DiMeglio, Linda A., Dixon, Bradley P., Dlamini, Nomazulu, Dodhia, Sonam N., Donohoue, Patricia A., Downes, Kevin J., Doyle, Alexander J., Doyle, Daniel A., Doyle, Jefferson J., Dreskin, Stephen C., Driscoll, Sherilyn W., Dror, Yigal, D'souza, Jill N., Dubowitz, Howard, Dumler, J. Stephen, Duncan, Janet, Dvergsten, Jeffrey A., Earing, Michael G., Eberly, Matthew D., Eddy, S. Derrick, Egan, Marie E., Elder, Jack S., Englander, Elizabeth, Enlow, Elizabeth, Eppes, Stephen C., Ericson, Jessica, Erkan, Elif, Ermias, Yokabed, Eskew, Ashley M., Etzel, Ruth A., Fahrenkopf, Matthew P., Falk, Marni J., Faria, John J., Fargo, John H., Feemster, Kristen A., Feigelman, Susan, Feinstein, Jeffrey A., Feldman, Amy G., Felner, Eric I., Fels, Edward C., Feng, Sing-Yi, Ferkol, Thomas W., Jr, Finberg, Karin E., Finder, Jonathan D., Finkelstein, Laura H., Fiorino, Kristin N., Fischer, Philip R., Fisher, Brian T., Flood, Veronica H., Flores, Francisco X., Flynn, Joseph T., Flynn, Patricia M., Forman, Joel A., Frank, Michael M., Frenck, Robert W., Jr, Friedman, Deborah M., Friehling, Erika, Fritz, Stephanie A., Frush, Donald P., Gadomski, Anne M., Gaensbauer, James T., Gahagan, Sheila, Gahl, William A., Gallagher, Patrick G., Gans, Hayley A., Garcia-mauriño, Cristina, Gardiner, Paula M., Garibaldi, Luigi R., Gauthier, Gregory M., Gerber, Jeffrey S., Gershon, Anne A., Ghadersohi, Saied, Gibson, Mark, Gigliotti, Francis, Gilliam, Walter S., Ginde, Salil, Girotto, John A., Goldfarb, Samuel B., Goldman, David L., Goldman, Stanton C., Goldstein, Neal D., Goldstein, Stuart L., Gonzalez-Heydrich, Joseph, Goodman, Denise M., Goodman, Tracy S., Gordon, Catherine M., Gordon, Leslie B., Goto, Collin S., Gower, W. Adam, Goyal, Neera K., Goyeneche, Nicholas P., Graepel, Kevin W., Graham, Robert J., Greally, John M., Green, Cori M., Green, Michael, Greenbaum, Larry A., Greenbaum, V. Jordan, Greenberg, James M., Griffiths, Anne G., Grizzle, Kenneth L., Groner, Judith A., Guarino, Alfredo, Gurria, Juan P., Guz-Mark, Anat, Haddad, Gabriel G., Haddad, Joseph, Jr, Hagan, Joseph F., Jr, Hagood, James S., Haider, Suraiya K., Haliloglu, Goknur, Halstead, Scott B., Hammer, Allison R., Hammerschlag, Margaret R., Hamvas, Aaron, Harris, James C., Harrison, Douglas J., Hartman, Corina, Hartman, Mary E., Haslam, David B., Hassan, H. Hesham Abdel-Kader, Hauck, Fern R., Havers, Fiona P., Hayes, Ericka V., Hecht, Jacqueline T., Heidemann, Sabrina M., Heimall, Jennifer R., Hemingway, Cheryl, Hendley, J. Owen, Hernandez, Michelle L., Hershey, Andrew D., Herzog, Cynthia E., Hirner, Jesse P., Hochberg, Jessica, Hodes, Deborah, Hoefgen, Holly R., Holinger, Lauren D., Holland-Hall, Cynthia M., Hooper, David K., Hoover-Fong, Julie E., Hord, Jeffrey D., Horn, B. David, Horstmann, Helen M., Horton, William A., Hotez, Peter J., House, Samantha A., Hsu, Evelyn, Hsu, Katherine, Huang, Felicia A. Scaggs, Huddleston, Heather G., Huepenbecker, Sarah P., Huff, Vicki, Huh, Winston W., Humphrey, Stephen R., Hunger, Stephen P., Hunstad, David A., Hunt, Carl E., Huppert, Stacey S., Huppler, Anna R., Ibeziako, Patricia I., Ibrahim, Samar H., Jackson, Allison M., Jackson, Elizabeth C., Jackson, Mary Anne, Jaffe, Ashlee, Janowski, Andrew B., Jatlaoui, Tara C., Jelsing, Elena J., Jensen, M. Kyle, Jenssen, Brian P., Jerardi, Karen E., John, Chandy C., Johnston, Brian D., Johnston, Michael V., Johnston, Richard B., Jr, Jones, Bridgette L., Joselow, Marsha, Josephson, Cassandra D., Jospe, Nicholas, Joyce, Joel C., Kabbouche, Marielle A., Kacperski, Joanne, Kamat, Deepak, Kamath-Rayne, Beena D., Kansra, Alvina R., Kanter, David M., Karlin, Aaron M., Kattan, Jacob, Kazura, James W., Kearns, Gregory L., Kelly, Andrea, Kelly, Desmond P., Kelly, Kevin J., Kelly, Matthew S., Kelly, Michael, Ken, Kimberly M., Kennedy, Melissa A., Kerem, Eitan, Kerschner, Joseph E., Khan, Seema, Khatami, Ameneh, Khatua, Soumen, Kilinsky, Alexandra, Kim, Chong-Tae, Kim, Wendy E., King, Charles H., Kingma, Paul S., Kinsman, Stephen L., Kishnani, Priya S., Klein, Bruce L., Klein, Bruce S., Kliegman, Robert M., Koch, William C., Kochanek, Patrick M., Kodish, Eric, Kohlhoff, Stephan A., Kostic, Mark A., Kotloff, Karen L., Krane, Elliot J., Krause, Peter J., Kreipe, Richard E., Krug, Steven E., Kwiatkowski, Janet L., Kwon, Jennifer M., Lachenauer, Catherine S., Ladisch, Stephan, Lakser, Oren J., Landrigan, Philip J., Landry, Gregory L., Lane, Wendy G., Larson, A. Noelle, LaRussa, Phillip S., Lawrence, J. Todd R., Lee, Brendan, Lee, K. Jane, Leeder, J. Steven, Leiding, Jennifer W., Lentze, Michael J., Lestrud, Steven O., Leung, Donald Y.M., Levas, Michael N., Levy, Rona L., Li, B U.K., Liacouras, Chris A., Liebig, Christopher W., Lipkin, Paul H., Liptzin, Deborah R., Liu, Andrew H., Lo, Lucinda, Lo, Stanley F., Long, Kathleen A., Long, Sarah S., Lopez, Anna Lena, Lopez, Santiago M.C., Lossef, Steven V., Lowry, Jennifer A., Macumber, Ian R., Magnusson, Mark R., Magoulas, Pilar L., Mahajan, Prashant V., Majzoub, Joseph A., Mann, Robert J., Manoli, Irini, Maqbool, Asim, Maranich, Ashley M., Marcantuono, Nicole, Margolis, David, Marin, Mona, Marini, Joan C., Markello, Thomas C., Markowitz, Morri, Maroushek, Stacene R., Marsh, Justin D., Martin, Kari L., Martinez, Maria G., Mason, Wilbert H., Maalon, Reuben K., Matta, Sravan Kumar Reddy, Maybank, Aletha, Mazor, Robert L., McAllister, Jennifer, McCabe, Megan E., McClean, Megan E., McColley, Susanna A., McGann, Patrick T., McGovern, Margaret M., McGrath-Morrow, Sharon A., McKinney, Jeffrey S., McLaughlin, Matthew J., McLeod, Rima, Mejias, Asuncion, Melby, Peter C., Melzer-Lange, Marlene D., Merguerian, Matthew D., Merhar, Stephanie L., Merritt, Diane F., Messacar, Kevin, Michaels, Marian G., Michniacki, Thomas F., Mikati, Mohad A., Milgrom, Henry, Mink, Jonathan W., Mistovich, R. Justin, Mitchell, Jonathan A., Mitsnefes, Mark M., Mohandas, Sindhu, Moon, Rachel Y., Moran, Joan P., Morava, Eva, Moreno, Megan A., Morgan, Esi, Morrison, Peter E., Moseley, Lovern R., Mozer-Glassberg, Yael, Muglia, Louis J., Murphy, Kevin P., Murphy, Timothy F., Murray, Karen F., Murray, Thomas S., Narula, Sona, Natale, Mindo J., Nathan, Amy T., Navsaria, Dipesh, Neal, William A., Nehme, Grace, Nehus, Edward J., Nelson, Maureen R., Neri, Caitlin M., Neuman, Mark I., Nevin, Mary A., Newburger, Jane W., NewMark, Jonathan, Nield, Linda S., Niss, Omar, Noah, Zehava L., Nocton, James J., Nogee, Lawrence M., Noje, Corina, Norton, Laura E., Nowak-Węgrzyn, Anna, Obaro, Stephen K., Obeid, Makram M., O’Brien, Hope L., Okwo-Bele, Jean-Marie, Oleszek, Joyce L., Olitsky, Scott E., Olsson, John M., Ombrello, Amanda K., O’Neill, Meghan E., Onigbanjo, Mutiat T., Orenstein, Walter A., Orscheln, Rachel C., Osorio, Marisa, Otto, Christian A., Owens, Judith A., Özen, Seza, Pachter, Lee M., Padhye, Amruta, Pak-Gorstein, Suzinne, Panganiban, Jennifer, Pappas, Diane E., Parent, John J., Parker, Alasdair P.J., Parks, Elizabeth Prout, Patterson, Briana C., Patterson, Maria Jevitz, Peters, Anna L., Peters, Timothy R., Phelan, Rachel A., Pinto, Anna, Poindexter, Brenda B., Pollard, Andrew J., Preciado, Diego, Proctor, Mark R., II, Howard I. Pryor, Pyles, Lee A., Quinn, Molly, Quint, Elisabeth H., Rabatin, Amy E., Rabinovich, C. Egla, Raffini, Leslie J., Ralston, Shawn L., Ram, Sanjay, Ramilo, Octavio, Ramirez, Kacy A., Rand, Casey M., Ratner, Adam J., Ratner, Lee, Raymond, Gerald V., Reed, Ann M., Reif, Shimon, Reller, Megan E., Reuter, Caroline H., Reyes, Jorge D., Rinawi, Firas, Ritchey, A. Kim, Rivara, Frederick P., Robinette, Eric, Robinson, Angela Byun, Rodrigues, Kristine Knuti, Rodriguez-Buritica, David F., Rodríguez-Fernández, Rosa, Roosevelt, Genie E., Rosenberg, David R., Roskind, Cindy Ganis, Ross, A. Catharine, Rossano, Joseph W., Rothman, Jennifer A., Rozenfeld, Ranna A., Ryan, Colleen A., Ryan, Monique M., Ryu, Julie, Sachdev, H.P.S., Sadarangani, Manish, Sadun, Rebecca E., Sahin, Mustafa, Sainath, Nina N., Salata, Robert A., Salvana, Edsel Maurice T., Sampson, Hugh A., Samsel, Chase B., Sandora, Thomas J., Sandritter, Tracy L., Sankar, Wudbhav N., Sarkissian, Eric J., Sarnaik, Ajit A., Sarnaik, Ashok P., Sarnat, Harvey B., Schaffzin, Joshua K., Schanberg, Laura E., Schechter, Michael S., Schleiss, Mark R., Schor, Nina F., Schroeder, James W., Jr, Schulte, Elaine E., Schuster, Mark A., Scott, Daryl A., Scott, J. Paul, Scott, John P., Seed, Patrick C., Serwint, Janet R., Shah, Apurva S., Shah, Dheeraj, Shah, Samir S., Shaikhkhalil, Ala, Shamir, Raanan, Shanti, Christina M., Shapiro, Bruce K., Shaughnessy, Erin E., Shaywitz, Bennett A., Shaywitz, Sally E., Shchelochkov, Oleg A., Sheanon, Nicole M., Shneider, Benjamin L., Shulman, Stanford T., Sicherer, Scott H., Simms, Mark D., Simmons, Jeffery M., Simões, Eric A.F., Simonsen, Kari A., Sinclair-McBride, Keneisha, Sivaraman, Vidya, Slavotinek, Anne M., Smith, Jessica R., Smith, Stephanie H., Smith-Whitley, Kim, Son, Mary Beth F., Sosinsky, Laura Stout, Souder, Emily, Spahn, Joseph D., Spearman, Paul, Sperling, Mark A., Spiegel, David A., Spitzer, Jaclyn B., Spranger, Jürgen W., Squires, James E., Srivastava, Siddharth, Geme, Joseph W. St, III, Stallings, Amy P., Stallings, Virginia A., Stambough, Kathryn C., Stanberry, Lawrence R., Stanley, Charles A., Starke, Jeffrey R., Starr, Taylor B., Steenhoff, Andrew P., Stein, Ronen E., Steinbach, William J., Stewart, Janet, Storch, Gregory A., Strauss, Ronald G., Sucato, Gina S., Suchy, Frederick J., Suhrie, Kristen R., Sullivan, Kathleen E., Szilagyi, Moira, Tabbah, Sammy M., Tanz, Robert R., Tarango, Cristina, Tarek, Nidale, Tasker, Robert C., Tchapyjnikov, Dmitry, Tesini, Brenda L., Theobald, Jillian L., Thielen, Beth K., Thomas, Anita A., Thomas, Cameron W., Thornburg, Courtney D., Tieder, Joel S., Tifft, Cynthia J., Todd, James K., Tolentino, Victor R., Jr, Toro, Camilo, II, Richard L. Tower, Trapasso, Joseph M., Troncone, Riccardo, Tsao, Elaine, Tubergen, David G., Tuchman, Lisa K., Turk, Margaret A., Turner, David A., Ullrich, Christina, Ullrich, Nicole, Upadhya, Krishna K., Urion, David K., Valika, Taher, Van Hare, George F., Van Mater, Heather A., Varnell, Charles D., Jr, Vaughan, Ana M., Vece, Timothy J., Vemana, Aarthi P., Venditti, Charles P., Vepraskas, Sarah, Verbsky, James W., Vermilion, Jennifer A., Vickery, Brian P., Vitola, Bernadette E., Voynow, Judith A., Wagner, Jonathan B., Waguespack, Steven G., Walker, David M., Walkovich, Kelly J., Walter, Heather J., Wambach, Jennifer A., Wang, Julie, Wangler, Michael F., Ware, Russell E., Ware, Stephanie M., Washam, Matthew C., Wassner, Ari J., Wattier, Rachel, Weber, David R., Weese-Mayer, Debra E., Weinberg, Jason B., Weinman, Jason P., Weise, Kathryn L., Weiss, Anna K., Weiss, Pamela F., Weitzman, Carol, Welebir, Morgan P., Wells, Lawrence, Wen, Jessica W., Wendel, Danielle, Werlin, Steven L., Wessels, Michael R., Wetmore, Ralph F., Wexelblatt, Scott L., Wexler, Isaiah D., Clinton White, A., Jr, White, Perrin C., Williams, John V., Willoughby, Rodney E., Jr, Wilschanski, Michael, Wilson, Karen M., Wilson, Pamela, Winell, Jennifer J., Winnie, Glenna B., Wissow, Lawrence, Witters, Peter, Wolf, Joshua, Wolfgram, Peter M., Wolfe, Joanne, Woods, Brandon T., Wright, Benjamin L., Wright, Joseph L., Wright, Terry W., Wu, Eveline Y., Yagupsky, Pablo, Yeh, E. Ann, Yeshokumar, Anusha K., Zaky, Wafik, Zapata, Lauren B., Zeltzer, Lonnie K., Zhou, Amy, and Zuckerman, Barry S.

Published
2020
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36. Primary cilia regulate the osmotic stress response of renal epithelial cells through TRPM3.

Author

Siroky, Brian J., Kleene, Nancy K., Kleene, Steven J., Varnell, Charles D., Comer, Raven G., Liu, Jialiu, Lu, Lu, Pachciarz, Nolan W., Bissler, John J., and Dixon, Bradley P.

Abstract

Pri-mary cilia sense environmental conditions, including osmolality, butwhether cilia participate in the osmotic response in renal epithelialcells is not known. The transient receptor potential (TRP) channelsTRPV4 and TRPM3 are osmoresponsive. TRPV4 localizes to cilia incertain cell types, while renal subcellular localization of TRPM3 is notknown. We hypothesized that primary cilia are required for maximalactivation of the osmotic response of renal epithelial cells and thatciliary TRPM3 and TRPV4 mediate that response. Ciliated [murineepithelial cells from the renal inner medullary collecting duct(mIMCD-3) and 176-5] and nonciliated (176-5Δ) renal cells ex-pressedTrpv4andTrpm3. Ciliary expression of TRPM3 was observedin mIMCD-3 and 176-5 cells and in wild-type mouse kidney tissue.TRPV4 was identified in cilia and apical membrane of mIMCD-3cells by electrophysiology and in the cell body by immunofluores-cence. Hyperosmolal stress at 500 mOsm/kg (via NaCl addition)induced the osmotic response genes betaine/GABA transporter (Bgt1)and aldose reductase (Akr1b3) in all ciliated cell lines. This inductionwas attenuated in nonciliated cells. A TRPV4 agonist abrogatedBgt1andAkr1b3induction in ciliated and nonciliated cells. A TRPM3agonist attenuatedBgt1andAkr1b3induction in ciliated cells only.TRPM3 knockout attenuatedAkr1b3induction. Viability under os-motic stress was greater in ciliated than nonciliated cells.Akr1b3induction was also less in nonciliated than ciliated cells when man-nitol was used to induce hyperosmolal stress. These findings suggestthat primary cilia are required for the maximal osmotic response inrenal epithelial cells and that TRPM3 is involved in this mechanism.TRPV4 appears to modulate the osmotic response independent ofcilia. [ABSTRACT FROM AUTHOR]

Published
2017
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37. Predicting Health Care Utilization and Charges Using a Risk Score for Poor Adherence in Pediatric Kidney Transplant Recipients

Author

McGrady, Meghan, Rich, Kristin Loiselle, Modi, Avani C., Mara, Constance, Pai, Ahna L. H., Varnell, Charles D., Turnier, Luke, Huber, John, and Hooper, David K.

Abstract

Pediatric kidney transplant recipients must follow a complicated regimen of timely adherence to immunosuppressant medication, routine blood work, and medical follow-up visits. Failure to adhere to the recommended regimen can result in medical complications and costly treatment. We developed a novel risk score to identify patients at risk for poor adherence behaviors and evaluated whether it would predict future health care utilization and charges. Our risk stratification score combined three simple pass/fail metrics of adherence derived directly from the electronic health record including standard deviation of immunosuppression drug levels, timely laboratory monitoring, and timely clinic visits as indicated by our clinical protocol. Risk for poor adherence was assessed over a three-month period. Linear regression was used to predict subsequent health care charges and utilization. Greater than 75% of patients had some degree of nonadherence risk during the study period, but there were no significant differences found on any outcomes for the overall score. However, when the individual components of the overall risk score were evaluated independently, patients with tacrolimus drug level standard deviation =2 (e.g., a marker of poor adherence) had greater health care utilization (e.g., hospitalizations) and increased total charges. Additionally, patients who did not follow up in clinic at least every 4 months had more ED visits and ED-related charges, but fewer hospitalizations. Regular clinic visits and minimizing drug level variation may deter future costly ED visits and hospitalizations.Implications for Impact Statement Nonadherence to immunosuppression medication is costly in terms of impact on health and financially. Having an easy-to-use system to quickly identify patients at risk for nonadherence at the point of care has clinical utility. Intervening on kidney transplant recipients who have high drug level variation or miss clinic visits may deter future costly medical care.

Published
2018
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39. Hypervitaminosis A in Pediatric Patients with Advanced Chronic Kidney Disease

Author

Harris, Meredith, Varnell, Charles, Taylor, Veronica, Nehus, Susan Tulley, Zhang, Bin, and Erkan, Elif

Abstract

Hypervitaminosis A is well described but overlooked in chronic kidney disease (CKD) and has been associated with hypercalcemia, contributing to bone mineral disease. Our objective is to assess prevalence of hypervitaminosis A and its association with bone health in an advanced CKD population.

Published
2021
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40. A Medication Adherence Promotion System to Reduce Late Kidney Allograft Rejection: A Quality Improvement Study

Author

Hooper, David K., Varnell, Charles D., Rich, Kristin, Carle, Adam, Huber, John, Mostajabi, Farida, Dahale, Devesh, Pai, Ahna L.H., Goebel, Jens, and Modi, Avani C.

Abstract

Adolescent and young adult kidney transplant recipients have high risk of rejection related to suboptimal adherence. Multi-component interventions improve adherence in controlled trials, but clinical implementation is lacking. We describe an initiative to reduce allograft rejection using evidence-based adherence promotion clinical strategies.

Published
2021
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41. Barriers to Taking Medication Predict Acute Rejection in Children and Adolescents with a Kidney Transplant

Author

Varnell, Charles D., Jr.

Subjects
Surgery, adherence, kidney transplant, medication, rejection
Abstract

Background: Nonadherence to immunosuppression is common among pediatric and young adult kidney transplant recipients and a leading cause of graft loss. Barriers to adherence are tightly linked with medication adherence and clinical outcomes across chronic conditions, including rejection in solid organ transplantation. Assessing barriers to adherence (e.g., difficulty swallowing pills, dislikes taste) in clinical practice may identify patients at risk for allograft rejection and provide therapeutic targets.Design/Methods: Patients and their caregivers were assessed for 14 barriers to adherence using the barriers assessment tool (BAT) during post-transplant clinic visits from January 2015 through August 2016 and followed from time of assessment through December 2016 for subsequent biopsy-proven acute cellular or antibody-mediated rejection. For patients < 10 years old, only caregivers completed the BAT; for patients > 10 years old, both patient and a caregiver (if present) completed the BAT. We compared rejection rates between patients and caregivers who reported at least one adherence barrier and those who did not using univariate analysis. Multivariable logistic regression was used to identify predictors for acute rejection. Data were also analyzed separately for patients and caregiver groups. Results: Sixty-one patients and 82 caregivers completed the BAT. Twenty-six (43%) patients and 28 (34%) caregivers identified at least 1 barrier to adherence. Twenty-three of 75 patients (31%) experienced acute rejection following barriers assessment. Twelve of 33 patients (36%) with an identified barrier by patient or caregiver report experienced rejection compared to 11 of 65 patients (17%) who did not identify a barrier (RR= 2.2; 95% CI 1.06 – 4.34; p = 0.032). Multivariable logistic regression revealed that the presence of adherence barriers was the only statistically significant predictor for acute rejection [OR 2.92 (95% CI 1.01 – 8.76); p=0.049]. Subgroup analyses indicated no significant differences in acute rejection between those who endorsed versus did not endorse adherence barriers when patients and caregivers were analyzed separately. However, the caregiver group approached significance (p = 0.053).Conclusions: Pediatric and young adult kidney transplant recipients with at least one barrier to adherence are at increased risk for subsequent acute rejection. This provides a potential therapeutic target that can be assessed in the clinic that may be amenable to barrier-specific interventions. These interventions present an opportunity to address medication adherence in clinic with the aim to decrease acute rejection.

Published
2018

42. Ionized Magnesium Correlates With Total Blood Magnesium in Pediatric Patients Following Kidney Transplant.

Author

Hasson DC, Mohan S, Rose JE, Merrill KA, Goldstein SL, Benoit SW, and Varnell CD

Subjects
Humans, Child, Magnesium, Retrospective Studies, Prospective Studies, Kidney, Kidney Transplantation adverse effects
Abstract

Background: Abnormal serum magnesium (Mg) concentrations are common and associated with worse mortality in kidney-transplant recipients. Many kidney and transplant-related factors affect Mg homeostasis. The concentration of the active form, ionized Mg (iMg), is not measured clinically, and total Mg (tMg) and iMg correlations have conflicted. We hypothesized that iMg and tMg concentrations show poor categorical agreement (i.e., low, normal, and high) in kidney-transplant recipients but that ionized calcium (iCa) correlates with iMg., Methods: We retrospectively evaluated hypomagnesemia in kidney-transplant recipients over a 2-yr period. We prospectively collected blood at 0-28 days post-transplant to measure correlations between iMg and iCa/tMg. iMg and iCa concentrations in the reference ranges of 0.44-0.65 and 1.0-1.3 mmol/L, respectively, were considered normal. Fisher's exact test and unweighted kappa statistics revealed category agreements. Pearson's correlation coefficients and linear regression measured correlations., Results: Among 58 retrospective kidney-transplant recipients, 54 (93%) had tMg<0.66 mmol/L, 28/58 (48%) received Mg supplementation, and 20/28 (71%) had tacrolimus dose adjustments during supplementation. In 13 prospective transplant recipients (N=43 samples), iMg and tMg showed strong category agreement ( P =0.0003) and correlation (r=0.71, P <0.001), whereas iMg and iCa did not ( P =0.7; r=-0.25, P =0.103, respectively)., Conclusions: tMg and iMg exhibited strong correlation following kidney transplantation. However, iCa may not be an accurate surrogate for iMg. Determining the effect of Mg supplementation and the Mg concentration where supplementation is clinically necessary are important next steps.

Published
2024
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43. Bleeding Complications after Pediatric Kidney Biopsy: A Systematic Review and Meta-Analysis.

Author

Varnell CD Jr, Stone HK, and Welge JA

Subjects
Adolescent, Child, Child, Preschool, Humans, Infant, Infant, Newborn, Young Adult, Biopsy adverse effects, Blood Transfusion statistics & numerical data, Reoperation statistics & numerical data, Hematoma etiology, Kidney pathology, Kidney Diseases diagnosis, Kidney Diseases pathology, Postoperative Complications epidemiology, Postoperative Complications etiology
Abstract

Background and Objectives: Kidney biopsy is an essential tool for the diagnosis and treatment of patients with kidney disease; however, because of its invasive nature, bleeding complications may arise., Design, Setting, Participants, & Measurements: We performed a meta-analysis of prospective or retrospective observational studies and randomized, controlled trials in pediatric patients undergoing native or transplant kidney biopsy in an inpatient or outpatient setting in MEDLINE-indexed studies from January 1998 to November 1, 2017 to determine the proportion of patients who develop hematoma, need blood transfusion, or need an additional intervention due to a complication after kidney biopsy., Results: Twenty-three studies of 5504 biopsies met inclusion criteria. The proportion of patients developing hematoma after biopsy was between 11% (95% confidence interval, 7% to 17%) and 18% (95% confidence interval, 9% to 35%) using two analyses that included different time periods. The proportion needing blood transfusion was 0.9% (95% confidence interval, 0.5% to 1.4%). The proportion needing an additional intervention due to postbiopsy complication was 0.7% (95% confidence interval, 0.4% to 1.1%). Secondary analysis was not possible due to lack of data in the original manuscripts on laboratory values, needle gauges, number of needle passes, age of patient, or performer (attending versus trainee). Analysis with metaregression found that use of real-time ultrasound during biopsy did not modify the risk for hematoma, requirement of a blood products transfusion, or requirement of an additional procedure after biopsy. Analysis with metaregression comparing native biopsies with transplant biopsies did not reveal that biopsy type (native kidney biopsy versus transplant kidney biopsy) was associated with the need for a blood transfusion or requirement of an additional intervention after biopsy., Conclusions: The development of perinephric hematoma after kidney biopsy is not an infrequent finding. The proportion of patients requiring blood transfusion or needing an additional intervention as a result of kidney biopsy in pediatric patients is significantly smaller., (Copyright © 2019 by the American Society of Nephrology.)

Published
2019
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