scholarly journals The Drug Overdose Epidemic and Deceased-Donor Transplantation in the United States

2018 ◽  
Vol 168 (10) ◽  
pp. 702 ◽  
Author(s):  
Christine M. Durand ◽  
Mary G. Bowring ◽  
Alvin G. Thomas ◽  
Lauren M. Kucirka ◽  
Allan B. Massie ◽  
...  
Keyword(s):  
United States ◽  
Drug Overdose ◽  
Deceased Donor ◽  
The United States

Effect of the Opioid Crisis on the Donor Pool for Kidney Transplantation: An Analysis of National Kidney Deceased Donor Trends from 2010–2016

2018 ◽  
Vol 47 (2) ◽  
pp. 84-93 ◽  
Author(s):  
Donald F. Chute ◽  
Meghan E. Sise
Keyword(s):  
United States ◽  
Kidney Transplant ◽  
Drug Overdose ◽  
Organ Procurement ◽  
Deceased Donor ◽  
The United States ◽  
Hcv Infection ◽  
Kidney Donor ◽  
Donor Pool ◽  
Opioid Crisis

Background: The opioid crisis has led to a dramatic increase in the number of drug overdose deaths in the United States. Little is known about the effect of the opioid crisis on the kidney transplant donor pool, particularly on hepatitis C virus (HCV)-infected donors. Methods: This is a retrospective analysis of the data from the Organ Procurement and Transplantation Network from 2010 to 2016. We determined the changes in characteristics of kidney transplant donors and evaluated which changes may be directly related to the opioid crisis. Results: Between 2010 and 2016, we found a 26% increase in overall donors, including a 277% increase in the number of donors who died from drug overdose. Nineteen percent of donors who died of drug overdose had HCV infection. Donors who die from drug overdose and donors with HCV infection are younger, less likely to have diabetes or hypertension, and have favorable kidney donor profile index scores compared to average donors. Despite these favorable characteristics, HCV-infected donors appear to be notably underutilized, with substantially lower kidneys per donor being transplanted compared to HCV uninfected donors. Conclusion: The opioid crisis in the United States has substantially altered the kidney donor pool. Strategies to increase utilization of all potentially viable kidneys for transplant are needed, particularly in this era of new, highly effective, direct-acting antiviral therapy for HCV infection.

scholarly journals What Is Driving the Drug Overdose Epidemic in the United States?

2020 ◽  
Vol 61 (3) ◽  
pp. 274-274
Author(s):  
Ryan P. Thombs ◽  
Dennis L. Thombs ◽  
Andrew K. Jorgenson ◽  
Taylor Harris Braswell
Keyword(s):  
United States ◽  
Drug Overdose ◽  
The United States

scholarly journals Regional Disparities in Transplantation With Deceased Donor Kidneys With Kidney Donor Profile Index Less Than 20% Among Candidates With Top 20% Estimated Post Transplant Survival

2019 ◽  
Vol 29 (4) ◽  
pp. 354-360 ◽  
Author(s):  
S. Ali Husain ◽  
Kristen L. King ◽  
Geoffrey K. Dube ◽  
Demetra Tsapepas ◽  
David J. Cohen ◽  
...  
Keyword(s):  
United States ◽  
Research Question ◽  
Deceased Donor ◽  
The United States ◽  
Strongly Correlated ◽  
Kidney Donor ◽  
Donor Kidney ◽  
Transplant Survival ◽  
Post Transplant ◽  
Deceased Donor Kidney

Introduction: The Kidney Allocation System in the United States prioritizes candidates with Estimated Post-Transplant Survival (EPTS) ≤20% to receive deceased donor kidneys with Kidney Donor Profile Index (KDPI) ≤20%. Research Question: We compared access to KDPI ≤ 20% kidneys for EPTS ≤ 20% candidates across the United States to determine whether geographic disparities in access to these low KDPI kidneys exist. Design: We identified all incident adult deceased donor kidney candidates wait-listed January 1, 2015, to March 31, 2018, using United Network for Organ Sharing data. We calculated the proportion of candidates transplanted, final EPTS, and KDPI of transplanted kidneys for candidates listed with EPTS ≤ 20% versus >20%. We compared the odds of receiving a KDPI ≤ 20% deceased donor kidney for EPTS ≤ 20% candidates across regions using logistic regression. Results: Among 121 069 deceased donor kidney candidates, 28.5% had listing EPTS ≤ 20%. Of these, 16.1% received deceased donor kidney transplants (candidates listed EPTS > 20%: 17.1% transplanted) and 12.3% lost EPTS ≤ 20% status. Only 49.4% of transplanted EPTS ≤ 20% candidates received a KDPI ≤ 20% kidney, and 48.3% of KDPI ≤ 20% kidneys went to recipients with EPTS > 20% at the time of transplantation. Odds of receiving a KDPI ≤ 20% kidney were highest in region 6 and lowest in region 9 (odds ratio 0.19 [0.13 to 0.28]). The ratio of KDPI ≤ 20% donors per EPTS ≤ 20% candidate and likelihood of KDPI ≤ 20% transplantation were strongly correlated ( r 2 = 0.84). Discussion: Marked geographic variation in the likelihood of receiving a KDPI ≤ 20% deceased donor kidney among transplanted EPTS ≤ 20% candidates exists and is related to differences in organ availability within allocation borders. Policy changes to improve organ sharing are needed to improve equity in access to low KDPI kidneys.

Both Alcoholic and Nonalcoholic Steatohepatitis Is an Emerging Indication for Liver Transplantation in the United States

2020 ◽  
Vol 04 (02) ◽  
pp. 223-234
Author(s):  
Danielle Fritze ◽  
Amandeep Singh ◽  
Eric Lawitz ◽  
Kris V. Kowdley ◽  
Glenn Halff ◽  
...  
Keyword(s):  
United States ◽  
Liver Transplantation ◽  
Graft Survival ◽  
Nonalcoholic Steatohepatitis ◽  
Multivariable Analysis ◽  
Deceased Donor ◽  
The United States ◽  
Hispanic Males ◽  
Patient And Graft Survival ◽  
United Network

Abstract Background Nonalcoholic steatohepatitis (NASH) and alcoholic liver disease (ALD) are now the most common indications for liver transplantation (LT) in the United States. A subset of patients have both alcoholic and nonalcoholic steatohepatitis (BASH). This study characterizes patients with BASH requiring LT and assesses changes in the prevalence of BASH as an indication for LT. Methods The United Network for Organ Sharing database was analyzed for all patients ≥ 18 years of age who received their first deceased donor LT from 2002 to 2016 for ALD, NASH, or BASH. Baseline demographics, clinical parameters, and LT outcomes were compared between groups. Results Since 2002, 85,448 patients underwent LT:15,327 had ALD, 9,971 had NASH, and 2,779 had BASH. The prevalence of BASH as an indication for LT increased from 0.5% in 2002 to 5% in 2016. Compared with patients with NASH, those with BASH were significantly more likely to be male (85.6 vs. 57%), younger (mean 56.4 vs. 58.6 years), and Hispanic (22.2 vs. 13.6%) (p < 0.001 for all). While indication for transplant was not significantly associated with transplant outcomes on multivariable analysis, patient and graft survival curves do differ significantly by indication for transplant, with worse outcomes for patients with BASH (patient survival at 5 years: NASH 78.1%, ALD 77.2%, BASH 73.5%, p = 0.013; graft survival at 5 years: NASH 75.3%, ALD 74.0%, BASH 70.8%, p = 0.046). Conclusions BASH is a rising indication for LT, especially for Hispanic males, due to the increasing prevalence of ALD and NASH in the United States.

A Framework for Conducting Deceased Donor Research in the United States

2015 ◽  
Vol 99 (11) ◽  
pp. 2252-2257 ◽  
Author(s):  
Alexandra K. Glazier ◽  
Kate Gallin Heffernan ◽  
James R. Rodrigue
Keyword(s):  
United States ◽  
Deceased Donor ◽  
The United States

scholarly journals New National Allocation Policy for Deceased Donor Kidneys in the United States and Possible Effect on Patient Outcomes

2014 ◽  
Vol 25 (8) ◽  
pp. 1842-1848 ◽  
Author(s):  
Ajay K. Israni ◽  
Nicholas Salkowski ◽  
Sally Gustafson ◽  
Jon J. Snyder ◽  
John J. Friedewald ◽  
...  
Keyword(s):  
United States ◽  
Patient Outcomes ◽  
Deceased Donor ◽  
The United States ◽  
Allocation Policy

scholarly journals A case of a mixed overdose involving kratom (Mitragyna speciosa) leading to serotonin syndrome

2021 ◽  
Vol 8 (12) ◽  
pp. 689-691
Author(s):  
H. Reid Zweifel ◽  
Jonathan Browne ◽  
Jeffrey M Levine
Keyword(s):  
United States ◽  
Drug Overdose ◽  
Serotonin Syndrome ◽  
The United States ◽  
Opiate Withdrawal ◽  
The Past ◽  
Mitragyna Speciosa ◽  
Overdose Deaths ◽  
Acute Intake ◽  
Μ Receptor

Objective: Drug overdose deaths have risen precipitously over the past two years in the United States. Polysubstance overdose with opiates and amphetamines have been of particular concern. Kratom (Mitragyna speciosa) is an unregulated widely available herb with both stimulant and opiate μ-receptor activity. Studies suggest that its use is quickly increasing. Case: We describe a patient who presented to a psychiatric hospital with a mixed toxic syndrome due to chronic kratom and prescribed SSRI use compounded by acute intake of methamphetamine. The patient displayed psychosis, tremulousness, myoclonus, and extreme anxiety. Her clinical picture was consistent with both serotonin syndrome and opiate withdrawal. Conclusion: We call attention to this case because polysubstance overdoses are common, and kratom is widely available. Complex toxic presentations that involve kratom are likely to be increasingly encountered.

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