Abstract 17014: Cardiologist Assessment and Approval Was the Primary Predictor of Kidney Transplant Candidacy and Transplantation Among Patients With Reduced Left Ventricular Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michelle Madden ◽  
Rory Gallen ◽  
Lisa LeMond ◽  
D Eric Steidley ◽  
Mira Keddis
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Univariate Analysis ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Selection Committee ◽  
Ventricular Ejection Fraction ◽  
Esrd Patients ◽  
Primary Predictor

Introduction: End stage renal disease (ESRD) patients with concomitant heart failure (HF) are often denied kidney transplantation (KTx). The aims of this study were to explore factors predictive of suitability for KTx and to assess cardiovascular (CV) outcomes in patients with impaired left ventricular ejection fraction (LVEF) presenting for KTx evaluation. Methods: We evaluated 109 consecutive adults with LVEF≤40% at the time of initial KTx evaluation between 2013 and 2018. Post-transplant CV outcomes were defined as non-fatal MI, admission for HF, CV death and all-cause mortality. Results: Mean age was 58.2 years (SD11.9), 78% were male, 58% had diabetes, 70% had history of CV events and 42% had ischemic cardiomyopathy. Mean LVEF was 31.5% (SD 6.47). Eighty patients had nuclear stress imaging; 10% were positive for reversible ischemia and 43% for prior infarct. Mean VO2max was 14.4(SD 5.71)ml/kg/min (31 patients). A cardiologist evaluated 93% of patients and was present at 58% of selection committee meetings. Twenty-four patients (22%) were denied by a cardiologist for KTx and 59 (54%) were denied by the selection committee, of whom 43 were due to CV risk. On univariate analysis, the variables associated with denial for KTx were: cardiologist denial, denial due to CV risk, Native American race (6% of cohort), higher NT-pro-BNP, prior MI, coronary intervention, positive stress study, anemia, lower EF and lower VO2max (all p<0.05). On multivariate analysis, cardiologist denial was the only significant predictor of denial for KTx (OR: 29.4, p=0.0007). At median follow-up of 15 months, 5 (5%) suffered non-fatal MI, 13 (12%) were hospitalized for HF exacerbation and 17 (16%) died. Only 22 (20%) underwent KTx. Post-KTx, there was one death, one non-fatal MI and 3 hospitalizations for HF. Mean LVEF improvement was 16% (SD12.9). Conclusions: Only 38% of ESRD patients with LVEF≤40% presenting for KTx evaluation were approved and of those, only 52% received KTx. Cardiologist approval was the primary predictor of suitability for KTx. Despite careful selection, prevalence of CV events and mortality after KTx was 23%. There is need for a consistent multidisciplinary approach during KTx evaluation, including cardiologist input, to improve CV outcomes.

Why Not Me?

2021 ◽  
pp. 11-22
Author(s):  
Martha Gershun ◽  
John D. Lantos
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Transplantation ◽  
Kidney Disease ◽  
Mayo Clinic ◽  
Kansas City ◽  
Living Donors ◽  
Insulin Dependent Diabetes ◽  
Kidney Donor ◽  
Selection Committee ◽  
Insulin Dependent

This chapter discusses a system for screening living donors. The chapter begins with a narrative of the author as she was anxiously waiting to hear whether the Transplant Selection Committee at the Mayo Clinic in Rochester, Minnesota, was going to approve her as a kidney donor. It then recounts the author's decision to donate one of her kidneys to a stranger. A few months earlier, she had read an article in the Kansas City Jewish Chronicle about a woman who needed a kidney. The article detailed how Deb Porter Gill had been diagnosed with insulin dependent diabetes and developed unrelated chronic kidney disease. The chapter narrates the reasons why Deb's story tugged at the author. Ultimately, the chapter looks at the importance of the whole series of evaluation and screening in kidney transplantation.

Appointing Arab Judges to the Courts in Israel, 1948–1969

2019 ◽  
Vol 34 (1) ◽  
pp. 47-66
Author(s):  
Guy Lurie
Keyword(s):  
Selection Committee ◽  
Judicial Selection ◽  
History Of ◽  
The 1960S ◽  
Merit System

This article unveils a virtually unknown chapter in the history of judicial diversity in Israel. During its first 20 years of existence, between 1948 and 1968, only three Arab judges were appointed. Then, within two years, between 1968 and 1969, Israel appointed three additional Arab judges. Two interconnected changes account for this small increase in judicial diversity. First, in the 1960s, the Arab legal elite began to exert pressure on Israeli officials to appoint Arab judges. Second, perhaps partly due to this pressure, the Judicial Selection Committee made having a diverse judiciary a top priority. This historical example teaches us that without outside pressure, the Judicial Selection Committee does not look on diversity as an important consideration, using the merit system of appointment as an excuse for its failure. Indeed, up to the present day, the Israeli judiciary has relatively few Arab judges.

When Demand Exceeds Supply: Second-Order Criteria Used by Graduate School Selection Committees

1994 ◽  
Vol 21 (2) ◽  
pp. 79-81 ◽  
Author(s):  
Patricia Keith-Spiegel ◽  
Barbara G. Tabachnick ◽  
Gary B. Spiegel
Keyword(s):  
Undergraduate Research ◽  
Research Experience ◽  
Graduate Record Examination ◽  
Faculty Advising ◽  
Selection Committee ◽  
Grade Point ◽  
Clinical Counseling ◽  
Experience Good ◽  
Level Of Selection ◽  
School Selection

The three primary criteria used to evaluate applicants by doctoral selection committees—grade point average, Graduate Record Examination scores, and letters of recommendation—may fail to narrow the field to the small number of slots available. A survey of doctoral selection committee members identified the relative importance of the next level of selection criteria. Among the most important are research experience, “good match” factors, and writing skills. Among the least important are ability to speak a language other than English, geographical origins of applicants, and “legacy.” Few differences were found between selection committee members from clinical/counseling programs and experimental programs, underscoring the importance of undergraduate research opportunities and adequate faculty advising.

The Monograph Tradition and Chinese Scholarship: Beginning with the “Best Young Scholar’s Monograph Prize in the Social Sciences of Practice”

Rural China ◽  
2019 ◽  
Vol 16 (2) ◽  
pp. 334-344
Author(s):  
Philip C. C. Huang
Keyword(s):  
Social Sciences ◽  
International Law ◽  
Selection Committee ◽  
Case Examples ◽  
Late Qing ◽  
The Social ◽  
Late Qing China ◽  
Peasant Worker ◽  
China Today ◽  
Identity Production

This article first explains why our “Best Young Scholar’s Monograph Prize in the Social Sciences of Practice” selection committee has chosen the three books International Law and Late Qing China: Texts, Events, and Politics, Rural Development in Contemporary China: Micro Case Examples and Macro Changes, and Urbanizing Children: Identity Production and Political Socialization of Peasant-Worker Sons and Daughters for the award, and then goes on to discuss how monograph production is faced with deeply contradictory forces in the scholarly environment of China today when compared with the American scholarly environment, to explain the purpose of the prize.

Business Game as a Tool to Check the Level of Preparedness of the Secretariat of the Selection Committee for Interaction with Applicants

2018 ◽  
Vol 7 (2) ◽  
pp. 33-36
Author(s):  
Андрей Зубрилин ◽  
Andrey Zubrilin ◽  
Юлия Шукшина ◽  
Yulia Shukshina ◽  
Мария Зубрилина ◽  
...  
Keyword(s):  
Russian Federation ◽  
Game Form ◽  
Selection Committee ◽  
Normative Documents ◽  
Business Game ◽  
The Russian Federation ◽  
Gaming Environment ◽  
The University

The article substantiates the need to prepare the secretariat of the admissions committee (responsible and technical secretaries of the faculties) of the university to fulfi ll their professional duties, primarily related to the organization of interaction with applicants and their legal representatives, and counseling. The procedure for checking the preparedness of the secretaries of the selection committee through a game form is described. A fragment of the business game is given, by means of which verifi cation is realized through game situations. The components of the business game are singled out — the gaming environment, roles, storyline, rules, the course of the game, game situations. The game situations are developed with the support of normative documents regulating the admission of entrants to the universities of the Russian Federation. It shows how this game can be modernized or by analogy to refi ne the situational tasks taking into account the characteristics of the university.

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