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Palace Z.J.,Hebrew Home at Riverdale | Bologa R.,Rogosin Institute
Annals of Long-Term Care

Patients with end-stage renal disease in a skilled nursing facility typically receive hemodialysis, a time-intensive procedure that is commonly performed off-site, necessitating travel to and from the facility and time missed from skilled rehabilitation and therapeutic activities. Peritoneal dialysis is an alternative available to patients requiring renal replacement therapy, as it can be performed at the bedside during the night, requires no travel to an off-site dialysis center, and can help to maintain continuity in the patient's on-site routines. As the authors present in this case report, development of a peritoneal dialysis program within the skilled nursing facility can, therefore, be a more convenient measure that may help to maintain or enhance quality of life for patients with end-stage kidney failure. Source

Levine D.M.,Rogosin Institute | Maine G.T.,Abbott Laboratories | Armbruster D.A.,Abbott Laboratories | Mussell C.,LGC Ltd. | And 5 more authors.
Clinical Chemistry

BACKGROUND: Owing to the lack of an internationally recognized tacrolimus reference material and reference method, current LC-MS and immunoassay test methods used to monitor tacrolimus concentrations in whole blood are not standardized. The aim of this study was to assess the need for tacrolimus assay standardization. METHODS: We sent a blinded 40-member whole-blood tacrolimus proficiency panel (0-30 μg/L) to 22 clinical laboratories in 14 countries to be tested by the following assays: Abbott ARCHITECT (n = 17), LC-MS (n = 9), and Siemens Dade Dimension (n = 5). Selected LC-MS laboratories (n = 4) also received a common calibrator set. We compared test results to a validated LC-MS method. Four samples from the proficiency panel were assigned reference values by using exact-matching isotope-dilution mass spectrometry at LGC. RESULTS: The range of CVs observed with the tacrolimus proficiency panel was as follows: LC-MS 11.4%-18.7%, ARCHITECT 3.9%-9.5%, and Siemens Dade 5.0%-48.1%. The range of historical within-site QC CVs obtained with the use of 3 control concentrations were as follows: LC-MS low 3.8%-10.7%, medium 2.0%-9.3%, high 2.3%-9.0%; ARCHITECT low 2.5%-9.5%, medium 2.5%-8.6%, high 2.9%-18.6%; and Siemens/Dade Dimension low 8.7%-23.0%, medium 7.6%-13.2%, high 4.4%-10.4%. Assay bias observed between the 4 LC-MS sites was not corrected by implementation of a common calibrator set. CONCLUSIONS: Tacrolimus assay standardization will be necessary to compare patient results between clinical laboratories. Improved assay accuracy is required to provide optimized drug dosing and consistent care across transplant centers globally. © 2011 American Association for Clinical Chemistry. Source

Matignon M.,New York Presbyterian Hospital Weill Cornell Medical Center | Matignon M.,Institut Universitaire de France | Muthukumar T.,New York Presbyterian Hospital Weill Cornell Medical Center | Muthukumar T.,Weill Cornell Medical Center | And 6 more authors.

BACKGROUND: Identification of risk factors for renal allograft failure after an episode of acute antibody-mediated rejection (AMR) may help the outcome of this difficult-to-treat complication. METHODS: During December 2003 to February 2011, 833 kidney graft recipients underwent 1120 clinically indicated biopsies at our center. We reviewed the biopsy results and identified 87 biopsy specimens from 87 patients positive for the degradation product of complement component 4 (C4d) and acute AMR. We generated Kaplan-Meier survival curves and performed a multivariable analysis using the Cox proportional hazards regression model to identify risk factors for allograft failure after C4d+ acute AMR. RESULTS: Among the 87 patients, 26 had a diagnosis of acute AMR according to the Banff '09 classification schema, 29 had acute AMR and chronic active AMR, 18 had acute AMR and acute T-cell mediated rejection (TCMR), and 14 had acute AMR, chronic active AMR, and acute TCMR. Kaplan-Meier survival estimates showed that concurrent acute TCMR (P=0.001, Mantel-Cox log-rank test), concurrent chronic active AMR (P=0.03), and time to biopsy (P=0.04) are associated with graft survival. The Cox proportional hazards regression analysis identified that concurrent acute TCMR (hazard ratio, 2.59 [95% confidence interval, 1.21-5.55]; P=0.01) and estimated glomerular filtration rate (hazard ratio, 0.65 [95% confidence interval, 0.48-0.88]; P=0.01) are independent risk factors for allograft loss. Concurrent chronic active AMR or time to biopsy was not associated with graft failure by the multivariable Cox analysis. CONCLUSIONS: Our single-center study has elucidated that concurrent acute TCMR in kidney transplant recipients with C4d+ acute AMR is an independent risk factor for graft failure. Level of allograft function at the time of diagnosis was also an independent predictor of graft loss. Copyright © 2012 by Lippincott Williams & Wilkins. Source

Maningat P.,Rockefeller University | Gordon B.R.,Rogosin Institute | Breslow J.L.,Rockefeller University
Current Atherosclerosis Reports

Statins are highly effective drugs prescribed to millions of people to lower LDL-cholesterol and decrease cardiovascular risk. The benefits of statin therapy seen in randomized clinical trials will only be replicated in real-life if patients adhere to the prescribed treatment regimen. But, about half of patients discontinue statin therapy within the first year, and adherence decreases with time. Patient, physician and healthcare system-related factors play a role in this problem. Recent studies have focused more on the patients' perspectives on non-adherence. Adverse events are cited as the most common cause of statin discontinuation; thus, the healthcare provider must be willing to ally and dialogue with patients to address concerns and assess the risks and benefits of continued statin therapy. © 2012 Springer Science+Business Media New York. Source

Aull M.J.,New York Presbyterian Weill Cornell Medical Center | Afaneh C.,New York Presbyterian Weill Cornell Medical Center | Charlton M.,New York Presbyterian Weill Cornell Medical Center | Serur D.,Rogosin Institute | And 5 more authors.
American Journal of Transplantation

Few prospective, randomized studies have assessed the benefits of laparoendoscopic single site donor nephrectomy (LESS-DN) over laparoscopic donor nephrectomy (LDN). Our center initiated such a trial in January 2011, following subjects randomized to LESS-DN versus LDN from surgery through 5 years postdonation. Subjects complete recovery/satisfaction questionnaires at 2, 6 and 12 months postdonation; transplant recipient outcomes are also recorded. One hundred subjects (49 LESS-DN, 51 LDN) underwent surgery; donor demographics were similar between groups, and included a predominance of female, living-unrelated donors, mean age of 47 years who underwent left donor nephrectomy. Operative parameters (overall time, time to extraction, warm ischemia time, blood loss) were similar between groups. Conversion to hand-assist laparoscopy was required in 3 LESS-DN (6.1%) versus 2 LDN (3.9%; p-=-0.67). Questionnaires revealed that 97.2% of LESS-DN versus 79.5% of LDN (p-=-0.03) were 100% recovered by 2 months after donation. No significant difference was seen in satisfaction scores between the groups. Recipient outcomes were similar between groups. Our randomized trial comparing LESS donor nephrectomy to LDN confirms that LESS-DN offers a safe alternative to conventional LDN in terms of intra- and post-operative complications. LDN and LESS-DN offer similar recovery and satisfaction after donation. In a randomized, prospective, parallel group study of laparoscopic versus laparoendoscopic single site donor nephrectomy in 100 kidney donors, the authors find that laparoendoscopic single site donor nephrectomy offers a safe alternative to conventional laparoscopic donor nephrectomy, with similar recovery and satisfaction after donation. © Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons. Source

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