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Erica L. Hartmann

Bio: Erica L. Hartmann is an academic researcher from Wake Forest University. The author has contributed to research in topics: Transplantation & Kidney transplantation. The author has an hindex of 22, co-authored 37 publications receiving 1559 citations. Previous affiliations of Erica L. Hartmann include Wake Forest Baptist Medical Center.

Papers
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Journal ArticleDOI
TL;DR: Kidney transplantation from donation after cardiac death donors: lack of impact of delayed graft function on post‐transplant outcomes and the need for further research into this issue.
Abstract: Singh RP, Farney AC, Rogers J, Zuckerman J, Reeves-Daniel A, Hartmann E, Iskandar S, Adams P, Stratta RJ. Kidney transplantation from donation after cardiac death donors: lack of impact of delayed graft function on post-transplant outcomes. Clin Transplant 2011: 25: 255–264. © 2010 John Wiley & Sons A/S. Abstract: Introduction: Delayed graft function (DGF) is more common in recipients of kidney transplants from donation after cardiac death (DCD) donors compared to donation after brain death (DBD) donors. Methods: Single-center retrospective study to evaluate the impact of DGF on controlled (Maastricht category III) DCD donor kidney transplant outcomes. Results: From 10/01 to 6/08, 578 adult deceased donor kidney transplants were performed including 70 (12%) from DCD and 508 (88%) from DBD donors. Mean follow-up was 36 months. DCD donor kidney transplants had significantly greater rates of DGF (57% DCD vs. 21% DBD, p < 0.0001)) and acute rejection (29% DCD vs. 16% DBD, p = 0.018) compared to DBD donor kidney transplants, but patient and graft survival rates were similar. DBD donor kidney transplants with DGF (n = 109) had significantly greater rates of death-censored graft loss (12.5% DCD vs. 31% DBD), primary non-function (0 DCD vs. 10% DBD) and higher 2 year mean serum creatinine levels (1.4 DCD vs. 2.7 mg/dL DBD) compared to DCD donor kidney transplants with DGF (n = 40, all p < 0.04). On univariate analysis, the presence of acute rejection and older donor age were the only significant risk factors for death-censored graft loss in DCD donor kidney transplants, whereas DGF was not a risk factor. Conclusion: Despite higher rates of DGF and acute rejection in DCD donor kidney transplants, subsequent outcomes in DCD donor kidney transplants with DGF are better than in DBD donor kidney transplants experiencing DGF, and similar to outcomes in DCD donor kidney transplants without DGF.

128 citations

Journal ArticleDOI
TL;DR: Survition, initial length of stay, and maintenance immunosuppression were similar between alemtuzumab and rATG groups, but biopsy-proven acute rejection (BPAR) episodes occurred in 16 (14%) alem TZU patients compared with 28 (26%) rAT G patients, and alem tzimab was associated with less BPAR.
Abstract: BACKGROUND.: Alemtuzumab and rabbit antithymocyte globulin (rATG) are commonly used for induction of immunsuppression for kidney and pancreas transplantation, but the two agents have not been compared directly. METHODS.: We conducted a prospective randomized single-center trial comparing alemtuzumab and rATG induction in adult kidney and pancreas transplantation in patients treated with similar maintenance immunosuppression. RESULTS.: Between February 1, 2005, and September 1, 2007, 222 patients randomly received either alemtuzumab (n=113) or rATG (n=109) induction; 180 (81%) underwent kidney alone, 38 (17%) simultaneous pancreas-kidney, and 4 (2%) pancreas after kidney transplants. Of 180 kidney-alone transplants, 152 (84%) were from deceased donors, including 61 (34%) from expanded criteria donors. Retransplantation, human leukocyte antigen match, antibody titer, expanded criteria donors, race, cytomegalovirus status, delayed graft function, and immunologic risks were similar between the two induction groups. With a median follow-up of 2 years (minimum 1 year), overall patient, kidney, and pancreas graft survival rates were 96%, 89%, and 90%, respectively. Survival, initial length of stay, and maintenance immunosuppression (including early steroid elimination) were similar between alemtuzumab and rATG groups, but biopsy-proven acute rejection (BPAR) episodes occurred in 16 (14%) alemtuzumab patients compared with 28 (26%) rATG patients (P=0.02). Late BPAR (>12 months after transplant) occurred in 1 (8%) alemtuzumab patient and 3 (11%) rATG patients (P=NS). Infections and malignancy were similar between the two induction arms. CONCLUSION.: Alemtuzumab and rATG induction therapies were equally safe, but alemtuzumab was associated with less BPAR.

125 citations

Journal ArticleDOI
TL;DR: The use of ECD kidneys at the authors' center effectively doubled their transplant volume within 1 year, and a systematic approach to E CD kidneys based on nephron mass matching and nephrons sparing measures may provide optimal utilization with short-term outcomes and renal function comparable to SCD kidneys.
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

124 citations

Journal ArticleDOI
TL;DR: By appropriate donor and recipient profiling and the use of management algorithms to project and protect renal function, excellent intermediate-term outcomes can be achieved with ECD kidneys transplants that are comparable to SCD kidney transplants.
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

124 citations

Journal ArticleDOI
TL;DR: A recent trans‐disciplinary workshop held by ASP is summarized to address issues related to kidney, liver, lung, or heart transplantation in older adults and to propose a research agenda in these areas.

117 citations


Cited by
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01 Jan 1980

1,523 citations

Journal ArticleDOI
TL;DR: 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.
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.

643 citations

Journal ArticleDOI
TL;DR: Future success in suppressing the development of DGF will require a concerted effort to anticipate and treat tissue injury throughout the arc of the transplantation process.

614 citations

Journal ArticleDOI
TL;DR: This review gives an account of the current understanding of the mechanisms of rejection of renal allografts, and new immunosuppressive agents show promise, but graft survival beyond 5 years has not improved substantially.
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.

534 citations

Journal ArticleDOI
TL;DR: A systematic review of the literature identified 18 unique definitions for DGF and 10 diagnostic techniques to identify DGF, which is in need of a new definition that is uniformly accepted across the kidney transplant community.
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.

334 citations