NephMadness Choosing Wisely Campaign: Kidney Donor Risk vs Virally Infected Kidneys (#TransplantRegion)
The first matchup in the #TransplantRegion leaves us with two tantalizing options: "Kidney Donor Risk" and "Virally Infected Kidneys". How does one possibly choose between the bold risk one takes when choosing to save a life and the now possible but previously unimaginable transplantation of kidneys infected with Human Immunodeficiency Virus (HIV) the curable Hepatitis C (HCV)?Let's take a quick look at team #KidneyDonorRisk. Why should we care about kidney donor risk? Well, even the first kidney donor in 1954 ultimately progressed to end stage renal disease (ESRD)...https://twitter.com/Maximal_Change/status/975775639604219909Since 1954, we have developed new tools to better quantify a potential kidney donor's ESKD risk, like this calculator - which can be used to calculate any donor's pre-donation 15 year and life time ESKD risk. In addition, 2-time APOL1 champion may easily carry this team to the saturated 16. Would you advise kidney donation to a patient with 2 APOL1 risk alleles, given that 2 out of 19 patients developed ESKD after a median follow up of one year in one small study? If you're still not convinced, take another look at @KristaLentine's support of this team as the winner of not only this matchup, but also of the entire #TransplantRegion. She emphasizes the importance of the understanding of donor risk and transparency of communicating this risk.If #KidneyDonorRisk isn't your thing, maybe you're a believer in the #VirallyInfectedKidneys.https://twitter.com/Collinsmichaelg/status/976601011459522560And why wouldn't you be? The THINKER trial showed us that HCV + kidneys can now be transplanted into HCV - recipients, with successful treatment of HCV post transplantation. A limited kidney donor pool may ultimately be significantly expanded, if HCV+ kidneys are no longer discarded. Similarly, the HOPE (HIV Organ Policy Equity) Act has resulted in the transplantation of HIV+ organs and promising overall and graft survival rates.Now what? You've read @paulphel's comprehensive scouting report and seen enough visual abstracts, but all that really matters is the Blue Ribbon Panel. I predict team #KidneyDonorRisk to win this matchup, and here are the 5 of 9 Blue Ribbon Panelists that I'm most confident will help advance it to the next round:
- @FionaCLoud: She's a kidney transplant recipient and fierce advocate. It seems likely that she'll keep #KidneyDonorRisk in her bracket.
- @DrDeidraCrews: She researches the impact of racial disparities on chronic kidney disease, and has published on the disparities in access to kidney transplantation.
- @Mike_J_Choi: He's an author on a 2013 NEJM study describing APOL1 risk variants, race, and progression of CKD. I don't expect him to forget about APOL1 so quickly.
- Tazeen Jafar - She has studied predictors of low eGFR after kidney donation, in a Southeast population from Singapore.
- @medicalaxioms - He probably cares about the #KidneyDonorRisk. The tweet below says it all:
https://twitter.com/medicalaxioms/status/944217619166400513Ready to make your pick? Submit your bracket here.Samira Farouk, NSMC Intern 2018 @ssfarouk