Aimee K. Sundberg

Bio: Aimee K. Sundberg is an academic researcher from Wake Forest Baptist Medical Center. The author has contributed to research in topics: Kidney transplantation & Transplantation. The author has an hindex of 10, co-authored 14 publications receiving 563 citations. Previous affiliations of Aimee K. Sundberg include University of Wisconsin-Madison.

Increased Kidney Transplantation Utilizing Expanded Criteria Deceased Organ Donors with Results Comparable to Standard Criteria Donor Transplant

Abstract: Objective:To compare outcomes in recipients of expanded criteria donor (ECD) versus standard criteria donor (SCD) kidneys at a single center using a standardized approach with similar immunosuppression.Summary Background Data:Expanded criteria deceased organ donors (ECD) are a source of kidneys that

Intermediate-term outcomes with expanded criteria deceased donors in kidney transplantation: a spectrum or specter of quality?

Abstract: The burgeoning crisis in organ supply challenges the transplant community to maximize and optimize the use of organs from all consented donors. According to United Network for Organ Sharing (UNOS) data, in 2005, more than 60,000 candidates were on the active waiting list for kidney transplantation in the United States, while less than 15,000 kidney transplants were performed in 2004.1 Depending on blood type, median waiting times for a kidney transplant in the United States currently range from 2 to 6 years and continue to increase. Only 25% of active wait-list candidates are transplanted in a given year, and the chance of receiving a deceased donor kidney transplant within 1 year of listing is less than 10%. The waiting list has become a “waiting to die” list, as 6% of patients on the kidney waiting list (10% of diabetic patients) die each year awaiting a potential life-enhancing and life-prolonging transplant.1 The scarcity of available donor kidneys is a pervasive problem and mandates an ongoing reappraisal of the limits of acceptability when accepting kidney offers from deceased donors (DDs). The escalating disparity between organ supply and demand fuels initiatives not only to increase but also to optimize the utilization of available organs. Similar to trends in the overall U.S. general population, there has been an increasing yet disproportionate shift toward increasing numbers of older donors and recipients in kidney transplantation. In the last decade, the proportion of DDs older than 50 years of age has increased from 21% to 31%.2 Cerebrovascular events are now the leading cause of brain death culminating in deceased organ donation.3 Because of the convergence of demographic inevitability and medical advances in the aged, the use of kidneys from older donors has become generally, albeit reluctantly, accepted.4 Expanded criteria deceased donors (ECDs) over age 60 years and those aged 50 to 59 years with additional risk factors accounted for 177 kidney transplants nationally in 1988 and more than 1300 in 2004.1 However, the value of transplanting ECD kidneys has been questioned because of concerns over diminished graft survival and predicted poorer intermediate-term outcomes.4–6 Because it is our contention that ECD kidneys are defined by suboptimal nephron mass, we think that appropriate donor and recipient profiling and selection may maximize and optimize the use of this scarce and controversial resource.7 The purpose of this study was to review retrospectively our intermediate-term single center outcomes in ECD versus concurrent standard criteria deceased donor (SCD) kidney transplantation in adult patients receiving similar immunosuppression and management algorithms implemented to reduce renal injury and preserve nephron function.7

A randomized trial of alemtuzumab vs. anti-thymocyte globulin induction in renal and pancreas transplantation.

Abstract: The role of alemtuzumab as an immunosuppressive agent is evolving. We conducted a prospective randomized trial comparing alemtuzumab and rabbit anti-thymocyte globulin (rATG) induction in adult kidney and pancreas transplantation using similar maintenance immunosuppression. Between February 1, 2005 and June 15, 2006 (median follow-up six months), 98 patients were randomized either to alemtuzumab (n = 48) or to rATG (n = 50) induction; 77 (79%) underwent kidney alone (KA) transplant, 17 (17%) pancreas-kidney transplant, and four (4%) pancreas after kidney transplant. Of 77 KA transplants, 66 (86%) were from deceased donors and 31 (40%) from expanded criteria donors (ECD). Re-transplantation, HLA-match, antibody titer, ECD, race, cytomegalovirus status, steroid use, delayed graft function, preservation time, and immunological risk were similar between the two induction groups. Patient, kidney, and pancreas graft survival rates were 100%, 96%, and 95%, respectively. Survival, initial length of stay, delayed graft function, and overall acute rejection rates were similar between alemtuzumab and rATG groups, but acute rejection occurred in nine (20%) rATG patients compared with zero (0%) alemtuzumab patients who received KA transplants (p = 0.007). Mean induction costs differed in the alemtuzumab ($1474) and rATG ($4996, p < 0.001) groups. In the short term after kidney and pancreas transplantation, alemtuzumab and rATG induction therapies are similarly safe and effective.

Mycophenolate mofetil versus enteric-coated mycophenolate sodium: a large, single-center comparison of dose adjustments and outcomes in kidney transplant recipients.

Abstract: Background. Although enteric-coated mycophenolate sodium (EC-MPS) was developed to reduce gastrointestinal (GI) side effects in kidney transplantation, a multicenter clinical trial of patients undergoing de novo renal transplantation found that efficacy failure and adverse GI event rates for EC-MPS were comparable with mycophenolate mofetil (MMF). A common strategy to mitigate mycophenolic acid-related GI adverse events includes dose manipulations such as split dosing, dose reduction, and discontinuation. Several studies have demonstrated that dose alterations with MMF are associated with poorer graft outcomes. Methods. To determine whether there was a clinically significant difference in dose alterations and outcomes with EC-MPS compared with MMF, we conducted a retrospective study comparing MMF and EC-MPS in all consecutive kidney transplants (n= 1709) between 2000 and 2006. Results. Graft survival between MMF and EC-MPS patients was not different during the study period (P= 0.9928). The incidence of biopsy-proven acute rejection at 2 years was higher in the MMF group (30.2% MMF vs. 21.9% EC-MPS, P=0.0004). The adjusted risk of dose reductions was significantly higher in MMF-treated patients (hazard ratio=1.703, P<0.0001). Similarly, the adjusted risk of drug discontinuation was higher in the MMF group (hazard ratio= 1.507, P=0.0002). EC-MPS patients also demonstrated a trend toward a lower incidence of infections and a significantly lower incidence of fungal infections. Conclusion. EC-MPS was associated with fewer dose reductions or discontinuations, which may have translated into the observed significantly lower incidence of biopsy-proven rejection. EC-MPS has become the mycophenolic acid agent of choice at this large center.

Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis

Abstract: Objectives To develop recommendations for the management of adult and paediatric lupus nephritis (LN).

Association between delayed graft function and allograft and patient survival: a systematic review and meta-analysis

Abstract: Background Delayed graft function (DGF) is a common complication of renal transplantation. The short-term consequences of DGF are well known, but the long-term relationship between DGF and patient and graft survival is controversial in the published literature. We conducted a systematic review and meta-analysis to precisely estimate these relationships. Methods We performed a literature search for original studies published through March 2007 pertaining to long-term (>6 months) outcomes of DGF. The primary outcome was graft survival. Secondary outcomes were patient survival, acute rejection and kidney function. Results When compared to patients without DGF, patients with DGF had a 41% increased risk of graft loss (RR 1.41, 95% CI 1.27-1.56) at 3.2 years of follow-up. There was no significant relationship between DGF and patient survival at 5 years (RR 1.14, 95% CI 0.94-1.39). The mean creatinine in the non-DGF group was 1.6 mg/dl. Patients with DGF had a higher mean serum creatinine (0.66 mg/dl, 95% CI 0.57-0.74) compared to patients without DGF at 3.5 years of follow-up. DGF was associated with a 38% relative increase in the risk of acute rejection (RR 1.38, 95% CI 1.29-1.47). Conclusion The results of this meta-analysis emphasize and quantify the long-term detrimental association between DGF and important graft outcomes like graft survival, acute rejection and renal function. Efforts to prevent and treat DGF should be aggressively investigated in order to improve graft survival given the deficit in the number of kidney donors.

Rejection of the kidney allograft.

Abstract: This review gives an account of our current understanding of the mechanisms of rejection of renal allografts. New immunosuppressive agents show promise, but graft survival beyond 5 years has not improved substantially.

Marked variation in the definition and diagnosis of delayed graft function: a systematic review

Abstract: Background. The term delayed graft function (DGF) is commonly used to describe the need for dialysis after receiving a kidney transplant. DGF increases morbidity after transplantation, prolongs hospitalization and may lead to prematuregraftfailure.VariousdefinitionsofDGFareused in the literature without a uniformly accepted technique to identify DGF. Methods. We performed a systematic review of the literaturetoidentifyallofthedifferentdefinitionsanddiagnostic techniques to identify DGF. Results. We identified 18 unique definitions for DGF and 10 diagnostic techniques to identify DGF. Conclusions. The utilization of heterogeneous clinical criteria to define DGF has certain limitations. It will lead to delayedandsometimesinaccuratediagnosisofDGF.Hence a diagnostic test that identifies DGF reliably and early is necessary. Heterogeneity, in the definitions used for DGF, hinders the evolution of a diagnostic technique to identify DGF, which requires a gold standard definition. We are in need of a new definition that is uniformly accepted across the kidney transplant community. The new definition will behelpfulinpromotingbettercommunicationamongtransplant professionals and aids in comparing clinical studies of diagnostic techniques to identify DGF and thus may facilitate clinical trials of interventions for the treatment of DGF.