2023
Honoring the gift: The transformative potential of transplant-declined human organs
Albert C, Harris M, DiRito J, Shi A, Edwards C, Harkins L, Lysyy T, Kulkarni S, Mulligan D, Hosgood S, Watson C, Friend P, Nicholson M, Haakinson D, Saeb-Parsy K, Tietjen G. Honoring the gift: The transformative potential of transplant-declined human organs. American Journal Of Transplantation 2023, 23: 165-170. PMID: 36695696, DOI: 10.1016/j.ajt.2022.11.015.Peer-Reviewed Original Research
2022
Blood Transcriptomes of SARS-CoV-2–Infected Kidney Transplant Recipients Associated with Immune Insufficiency Proportionate to Severity
Sun Z, Zhang Z, Banu K, Al Azzi Y, Reghuvaran A, Fredericks S, Planoutene M, Hartzell S, Kim Y, Pell J, Tietjen G, Asch W, Kulkarni S, Formica R, Rana M, Maltzman JS, Zhang W, Akalin E, Heeger PS, Cravedi P, Menon MC. Blood Transcriptomes of SARS-CoV-2–Infected Kidney Transplant Recipients Associated with Immune Insufficiency Proportionate to Severity. Journal Of The American Society Of Nephrology 2022, 33: 2108-2122. PMID: 36041788, PMCID: PMC9678030, DOI: 10.1681/asn.2022010125.Peer-Reviewed Original ResearchConceptsKidney transplant recipientsImmune activation pathwaysImmunosuppressant useKTR cohortAcute illnessBlood transcriptomeAcute casesT cellsCOVID-19Most kidney transplant recipientsPost-acute COVID-19Adaptive immune system activationManagement of immunosuppressionReinstitution of immunosuppressionAcute COVID-19Serum inflammatory cytokinesCOVID-19 severity scoreCOVID-19 infectionImmune system activationUpregulation of neutrophilActivation pathwayTransplant recipientsChart reviewImmune signaturesLymphocyte countEthical analysis examining the prioritisation of living donor transplantation in times of healthcare rationing
Kulkarni S, Flescher A, Ahmad M, Bayliss G, Bearl D, Biondi L, Davis E, George R, Gordon E, Lyons T, Wightman A, Ladin K. Ethical analysis examining the prioritisation of living donor transplantation in times of healthcare rationing. Journal Of Medical Ethics 2022, 49: 389-392. PMID: 34983855, PMCID: PMC10314075, DOI: 10.1136/medethics-2021-107574.Peer-Reviewed Original ResearchConceptsTransplant communityDonor transplantsTransplant hospitalsSARS-CoV-2 infectionHealth systemEnd-stage liverSARS-CoV-2Exposure riskDonor transplantationTransplant proceduresUnited NetworkKidney diseaseDialysis centersElective proceduresPatient preparednessTransplantEarly detectionCOVID-19 pandemicRiskHospitalRecipientsTier 3BAcceptable riskCareImportant option
2021
Inactive status is an independent predictor of liver transplant waitlist mortality and is associated with a transplant centers median meld at transplant
Merola J, Gan G, Stewart D, Noreen S, Mulligan D, Batra R, Haakinson D, Deng Y, Kulkarni S. Inactive status is an independent predictor of liver transplant waitlist mortality and is associated with a transplant centers median meld at transplant. PLOS ONE 2021, 16: e0260000. PMID: 34793524, PMCID: PMC8601542, DOI: 10.1371/journal.pone.0260000.Peer-Reviewed Original ResearchConceptsDonor service areasWaitlist mortalityTransplant centersMedian MELDHigh mortalityStatus changesLiver transplant waitlist mortalityDeceased donor transplantsInactive statusTransplant probabilityInactive patientsMELD scoreDonor transplantsHazard ratioIndependent predictorsTransplant ratesCare coordinationMortalityPatientsTransplantLevel cohortsTertileSignificant differencesCohortMELDGenetic and Epidemiologic Analyses of an Outbreak of Pneumocystis jirovecii Pneumonia Among Kidney Transplant Recipients in the United States
Azar MM, Cohen E, Ma L, Cissé OH, Gan G, Deng Y, Belfield K, Asch W, Grant M, Gleeson S, Koff A, Gaston DC, Topal J, Curran S, Kulkarni S, Kovacs JA, Malinis M. Genetic and Epidemiologic Analyses of an Outbreak of Pneumocystis jirovecii Pneumonia Among Kidney Transplant Recipients in the United States. Clinical Infectious Diseases 2021, 74: 639-647. PMID: 34017984, PMCID: PMC9012955, DOI: 10.1093/cid/ciab474.Peer-Reviewed Original ResearchConceptsKidney transplant recipientsCases of PCPPneumocystis pneumoniaClinic visitsRisk factorsClinic exposureLow absolute lymphocyte countRisk of PCPAbsolute lymphocyte countFrequent clinic visitsPneumocystis jirovecii pneumoniaStrong risk factorNon-white raceCase-control analysisBelatacept groupMonthly infusionsTransplant recipientsBaseline characteristicsJirovecii pneumoniaLymphocyte countMultilocus sequence typingInterhuman transmissionRespiratory specimensUnivariate analysisEpidemiologic dataQuantifying Risk Tolerance Among Potential Living Kidney Donors With the Donor-Specific Risk Questionnaire
Thiessen C, Gannon J, Li S, Skrip L, Dobosz D, Gan G, Deng Y, Kennedy K, Gray D, Mussell A, Reese PP, Gordon EJ, Kulkarni S. Quantifying Risk Tolerance Among Potential Living Kidney Donors With the Donor-Specific Risk Questionnaire. American Journal Of Kidney Diseases 2021, 78: 246-258. PMID: 33508397, DOI: 10.1053/j.ajkd.2020.11.028.Peer-Reviewed Original ResearchConceptsKidney failure riskKidney failureDonor evaluationRisk QuestionnaireGreater patient-centered carePotential Living Kidney DonorsRisk estimatesKidney transplant centersKidney donor evaluationMultivariable logistic regressionLiving Kidney DonorsTime of enrollmentPatient-centered careTransplant centersTransplant teamKidney donorsRisk groupsPatient engagementAbstractTextLogistic regressionStudy designLongitudinal mixed-methods studyRecipientsMixed-methods studyRisk thresholdLeveling-up versus leveling-down to address health disparities in transplantation
Kulkarni S, Ladin K. Leveling-up versus leveling-down to address health disparities in transplantation. American Journal Of Transplantation 2021, 21: 917-918. PMID: 33326686, PMCID: PMC7986107, DOI: 10.1111/ajt.16458.Peer-Reviewed Original Research
2020
Reply to “Ethical principles governing organ transplantation apply to paired exchange programs”
Ladin K, Kulkarni S. Reply to “Ethical principles governing organ transplantation apply to paired exchange programs”. American Journal Of Transplantation 2020, 20: 1758-1759. PMID: 32337792, DOI: 10.1111/ajt.15945.Peer-Reviewed Original ResearchEthical principles governing organ transplantation apply to paired exchange programs
Kulkarni S, Ladin K. Ethical principles governing organ transplantation apply to paired exchange programs. American Journal Of Transplantation 2020, 20: 1223-1224. PMID: 32022980, PMCID: PMC7217160, DOI: 10.1111/ajt.15807.Peer-Reviewed Original ResearchDeceased donors: Defining drug‐related deaths
Cmunt K, Danovitch G, Delmonico F, Fynn‐Thompson F, Glazier A, Grandas J, Gunderson S, Jendrisak M, Johnson HK, Kulkarni S, Lipkowitz G, Meyer K, Mulligan D, Nathan H, Mone T, Moritz M, O'Connor K, Payne W, Souter M, Wood RP. Deceased donors: Defining drug‐related deaths. Clinical Transplantation 2020, 34: e13800. PMID: 32077534, DOI: 10.1111/ctr.13800.Peer-Reviewed Original Research
2019
Outcomes From Right Versus Left Deceased-Donor Kidney Transplants: A US National Cohort Study
Kulkarni S, Wei G, Jiang W, Lopez LA, Parikh CR, Hall IE. Outcomes From Right Versus Left Deceased-Donor Kidney Transplants: A US National Cohort Study. American Journal Of Kidney Diseases 2019, 75: 725-735. PMID: 31812448, PMCID: PMC7288694, DOI: 10.1053/j.ajkd.2019.08.018.Peer-Reviewed Original ResearchConceptsAdjusted hazard ratioDeath-censored graft failureRight kidneyGraft failureKidney sideLeft kidneyUS national cohort studyDeceased donor kidney transplantCause graft failureCold ischemia timeDeceased donor kidneysNational cohort studyConditional logistic regressionProportional hazards modelGraft functionGraft lossPosttransplantation outcomesTransplant eraCohort studyHazard ratioKidney transplantCardiac deathIschemia timeSurgical considerationsRecipient pairsPeritransplant eculizumab does not prevent delayed graft function in deceased donor kidney transplant recipients: Results of two randomized controlled pilot trials
Schröppel B, Akalin E, Baweja M, Bloom RD, Florman S, Goldstein M, Haydel B, Hricik DE, Kulkarni S, Levine M, Mehrotra A, Patel A, Poggio ED, Ratner L, Shapiro R, Heeger PS. Peritransplant eculizumab does not prevent delayed graft function in deceased donor kidney transplant recipients: Results of two randomized controlled pilot trials. American Journal Of Transplantation 2019, 20: 564-572. PMID: 31452319, DOI: 10.1111/ajt.15580.Peer-Reviewed Original ResearchConceptsDeceased donor kidney transplant recipientsDonor kidney transplant recipientsKidney transplant recipientsGraft functionTransplant recipientsDeceased donor kidney transplantationDeceased donor kidney transplantAnti-C5 monoclonal antibodyDeceased donor recipientsRabbit antithymocyte globulinRate of DGFSerum creatinine reductionAdverse event incidenceDelayed graft functionDonor kidney transplantationDonor kidney transplantsIschemia-reperfusion injuryHigh-risk populationSafety/efficacyObservational human dataAntithymocyte globulinDGF rateKidney transplantationDonor recipientsKidney transplantAssociation of Racial Disparities With Access to Kidney Transplant After the Implementation of the New Kidney Allocation System
Kulkarni S, Ladin K, Haakinson D, Greene E, Li L, Deng Y. Association of Racial Disparities With Access to Kidney Transplant After the Implementation of the New Kidney Allocation System. JAMA Surgery 2019, 154: 618-625. PMID: 30942882, PMCID: PMC6583835, DOI: 10.1001/jamasurg.2019.0512.Peer-Reviewed Original ResearchConceptsDeceased donor transplantsKidney allocation systemDonor transplantsKidney transplantTransplant probabilityDeath/Race/ethnicityHispanic individualsWhite individualsOrgan procurementBlack individualsNew kidney allocation systemRetrospective cohort studyWait-listed patientsKidney transplant databaseStatus changesAntibody categoriesLevel of sensitizationInactive statusInactive patientsTransplant databaseTransplant outcomesCohort studyMedian ageAntibody group
2018
Race, Risk, and Willingness of End-Stage Renal Disease Patients Without Hepatitis C Virus to Accept an HCV-Infected Kidney Transplant
McCauley M, Mussell A, Goldberg D, Sawinski D, Molina RN, Tomlin R, Doshi SD, Abt P, Bloom R, Blumberg E, Kulkarni S, Esnaola G, Shults J, Thiessen C, Reese PP. Race, Risk, and Willingness of End-Stage Renal Disease Patients Without Hepatitis C Virus to Accept an HCV-Infected Kidney Transplant. Transplantation 2018, 102: e163-e170. PMID: 29346260, DOI: 10.1097/tp.0000000000002099.Peer-Reviewed Original ResearchConceptsHepatitis C virusHCV cure ratesCure rateC virusUninfected kidneyEnd-stage renal disease patientsHCV-negative patientsPrior transplant recipientsRenal disease patientsHigh cure ratesEffective antiviral treatmentKidney recipientsTransplant recipientsKidney transplantMost patientsOlder patientsAntiviral treatmentWhite patientsDeceased donorsAllograft qualityFuture trialsBlack raceDisease patientsPatient acceptanceYoung donors
2017
Transition probabilities between changing sensitization levels, waitlist activity status and competing-risk kidney transplant outcomes using multi-state modeling
Kulkarni S, Hall I, Formica R, Thiessen C, Stewart D, Gan G, Greene E, Deng Y. Transition probabilities between changing sensitization levels, waitlist activity status and competing-risk kidney transplant outcomes using multi-state modeling. PLOS ONE 2017, 12: e0190277. PMID: 29287087, PMCID: PMC5747475, DOI: 10.1371/journal.pone.0190277.Peer-Reviewed Original ResearchConceptsTransplant probabilityTransplant outcomesActivity statusKidney transplant outcomesKAS implementationPost-KASWaitlist mortalityPatient characteristicsOPTN databaseMulti-state modelingStatistical differenceSensitization levelOutcomesTransplantCohortImpact outcomesCPRAStatus combinationsStatusMortalityWhitesSensitizationAssessing Living Donor Priorities Through Nominal Group Technique
Dorflinger LM, Kulkarni S, Thiessen C, Klarman S, Fraenkel L. Assessing Living Donor Priorities Through Nominal Group Technique. Progress In Transplantation 2017, 28: 29-35. PMID: 29243533, PMCID: PMC5735019, DOI: 10.1177/1526924817746682.Peer-Reviewed Original ResearchConceptsImpact of donationMost salientDonation decisionsNominal group techniquePersonal benefitsFuture researchAddress factorsMost peopleParticipantsAltruismLifestyle factorsTransplant programsNumber of donorsFuture healthCampaign effortsIndividualsPotential donorsKidneyPublic campaignsSupportGroup techniqueSalientLack of knowledgeDonationDecisionsBeing Thoughtful about Desensitization
Formica RN, Kulkarni S. Being Thoughtful about Desensitization. Clinical Journal Of The American Society Of Nephrology 2017, 12: 1878-1880. PMID: 28974523, PMCID: PMC5672977, DOI: 10.2215/cjn.09000817.Peer-Reviewed Original ResearchAllograft transmission of hepatitis C during the window period: Weighing the new risks and costs in the era of donor shortage
Choe J, Merola J, Kulkarni S, Mulligan DC. Allograft transmission of hepatitis C during the window period: Weighing the new risks and costs in the era of donor shortage. Clinical Transplantation 2017, 31 PMID: 28643333, DOI: 10.1111/ctr.13022.Peer-Reviewed Original ResearchOpting out: a single-centre pilot study assessing the reasons for and the psychosocial impact of withdrawing from living kidney donor evaluation
Thiessen C, Jaji Z, Joyce M, Zimbrean P, Reese P, Gordon EJ, Kulkarni S. Opting out: a single-centre pilot study assessing the reasons for and the psychosocial impact of withdrawing from living kidney donor evaluation. Journal Of Medical Ethics 2017, 43: 756. PMID: 28258071, DOI: 10.1136/medethics-2016-103512.Peer-Reviewed Original ResearchConceptsSingle-center pilot studyKidney donor evaluationUS transplant centersPotential living donorsPostoperative periodTransplant centersDonor evaluationLiving donorsKidney donationModifiable barriersPsychosocial impactStudy participantsPilot studyDonor advocateFinancial burdenDonor autonomyQualitative studyDonationIndividualsParticipantsVaried reasons
2016
A Call for Research on Individuals Who Opt Out of Living Kidney Donation
Thiessen C, Kulkarni S, Reese PP, Gordon EJ. A Call for Research on Individuals Who Opt Out of Living Kidney Donation. Transplantation 2016, 100: 2527-2532. PMID: 27495760, DOI: 10.1097/tp.0000000000001408.Peer-Reviewed Original Research