G.R. Roll

University of California, San Francisco

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Peter G. Stock

University of California, San Francisco

Ryutaro Hirose

Hennepin Healthcare Research Institute

Andrew M. Posselt

University of California, San Francisco

⋅K

⋅Sang-Mo Kang

Kyungpook National University

Sandy Feng

University of California, San Francisco

Chris E. Freise

University of California, San Francisco

Steven A. Wisel

Cedars-Sinai Medical Center

Jack W. Harbell

Mayo Clinic in Florida

Charles E. McCulloch

University of California, San Francisco

Terence W. Friedlander

UCSF Helen Diller Family Comprehensive Cancer Center

Cooperative Institutions

University of California, San Francisco

University of California San Francisco Medical Center

City College of San Francisco

UCSF Helen Diller Family Comprehensive Cancer Center

American Society of Transplantation

University of California System

University of California, San Diego

University of Wisconsin–Madison

Cancer Research And Biostatistics

Stanford University

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Ingenol mebutate 0·015% gel is safe for short‐term treatment of actinic keratoses on the face in solid organ transplant recipients

British Journal of Dermatology (2020)

Lauren Crow Joyce T. Yuan Christine Aroyan Amanda R. Twigg Jonathan P. Singer

Actinic Keratoses

10.1111/bjd.19050

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Citations (2)

Metastatic Donor-derived Malignancies Following Simultaneous Pancreas-kidney Transplant: Three Case Reports and Management Strategies

Transplantation Direct (2020)

Dominic Amara Steven A. Wisel Hillary J. Braun Eric A. Collisson Terence W. Friedlander

Stopping immunosuppression in a transplant patient with donor-derived malignancy offers the theoretical benefit that reconstitution of the patient's immune system will allow "rejection" of the malignancy, as the malignancy also originates from allogeneic tissue. However, this option exists with the caveat that the patient's allograft(s) will likely be rejected too. In simultaneous pancreas-kidney (SPK) recipients, the normal continued functioning and possible absence of malignancy in either the unaffected kidney or pancreas further complicate this decision.The charts of 3 patients with donor-derived metastatic malignancies after SPK were retrospectively reviewed in detail. We provide treatment and management recommendations based on successful outcomes and a review of the existing literature.Consistent with a broad review of the literature, in all 3 cases, complete immunosuppression cessation, removal of both grafts, and in 1 case treatment with an immune checkpoint inhibitor to augment the immune response was successful. One patient is doing well 1 year after successfully undergoing kidney retransplantation, while a second patient is active on the waitlist for SPK retransplantation after no evidence of metastatic disease for 2 years.The successful management of metastatic donor-derived malignancies requires allograft removal, immunosuppression cessation, and adjuvant therapy that includes occasional use of checkpoint inhibitors to augment the immune response.

Immunosuppression

Kidney cancer

10.1097/txd.0000000000001090

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Citations (6)

Failure to Achieve Normal Metabolic Response in Non-Obese Diabetic Mice and Streptozotocin-Induced Diabetic Mice After Transplantation of Primary Murine Hepatocytes Electroporated With the Human Proinsulin Gene (p3MTChins)

Transplantation Proceedings (2014)

Ryan Lee G.R. Roll Vy Nguyen Holger Willenbring Qizhi Tang

Proinsulin

Ratón

Xenotransplantation

10.1016/j.transproceed.2014.05.068

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Citations (0)

Case Report of Intestinal Tuberculosis 6 Years After Simultaneous Pancreas and Kidney Transplant

Transplantation Proceedings (2014)

Jesus G. Ulloa Justin Parekh Christopher M. Hope G.R. Roll

Perforation

10.1016/j.transproceed.2014.03.007

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Citations (8)

Splenic Vein Thrombosis Following Pancreas Transplantation: Identification of Factors That Support Conservative Management

American Journal of Transplantation (2017)

Jack W. Harbell Tara A. Morgan Vickie A. Feldstein G.R. Roll Andrew M. Posselt

Prophylaxis for graft portal/splenic venous thrombosis following pancreas transplant varies between institutions. Similarly, treatment of venous thrombosis ranges from early re-exploration to conservative management with anticoagulation. We wished to determine the prevalence of graft splenic vein (SV) thrombosis, as well as the clinical significance of non-occlusive thrombus observed on routine imaging. Records of 112 pancreas transplant recipients over a 5-year period at a single center were reviewed. Venous thrombosis was defined as absence of flow or presence of thrombus identified in any part of the graft SV on ultrasound. Thirty patients (27%) had some degree of thrombus or absence of flow in the SV on postoperative ultrasound. There were 5 graft losses in this group. Four were due to venous thrombosis, and occurred within 20 days of transplant. All patients with non-occlusive partial SV thrombus but normal arterial signal on Doppler ultrasound were successfully treated with IV heparin followed by warfarin for 3-6 months, and remained insulin independent. Findings of arterial signal abnormalities, such as absence or reversal of diastolic flow within the graft, require urgent operative intervention since this finding can be associated with more extensive thrombus that may lead to graft loss.

Splenic vein

Pancreas transplantation

10.1111/ajt.14428

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Citations (26)

Trends in Living Donation by Race and Ethnicity Among Children With End-stage Renal Disease in the United States, 1995–2015

Transplantation Direct (2020)

Sandra Amaral Charles E. McCulloch E. G. Black Erica Winnicki Brian Lee

Background. Living donor kidney transplants have declined among adults with end-stage renal disease (ESRD), with increases in racial/ethnic disparities over time. Secular trends in racial/ethnic disparities in living donor kidney transplantation have not been well studied in children. Methods. Using multivariable Cox modeling, we examined changes in living donor kidney transplant rates over time and probability of receiving living donor kidney transplantation within 2 years of incident ESRD by race/ethnicity among 19 772 children in the US Renal Data System, 1995–2015. We also examined racial/ethnic concordance between donors and recipients. Results. Overall, living donor kidney transplant rates declined by 3% annually since 1995 for all racial/ethnic groups except Asians for whom living donor kidney transplant rates remained stable; however, disparities persist. Compared with non-Hispanic white children, Hispanics were 42% less likely (adjusted hazard ratio: 0.58; 95% confidence interval: 0.49-0.67), Asians 39% less likely (0.61; 0.47-0.79), and blacks 66% less likely (0.34; 0.28-0.42) to receive living kidney donor transplantation within 2 years, even when accounting for deceased donor transplantation as a competing risk. Additionally, while 95% of non-Hispanic white children had non-Hispanic white donors, only 56% of Asian recipients had Asian donors ( P < 0.001). Asian recipients were more likely to have nonrelated donors ( P < 0.001). Conclusions. There are ongoing declines in living donation for children with ESRD for uncertain reasons, and minority populations experience significantly reduced access to timely living donor transplant, even when accounting for changes in deceased donation and donor-recipient relationships.

Kidney donation

10.1097/txd.0000000000001008

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Citations (14)

BETA CELL REPLACEMENT THERAPY IN FIVE HIV INFECTED PATIENTS WITH RENAL FAILURE SECONDARY TO TYPE I DIABETES MELLITUS

Transplantation (2010)

G.R. Roll Andrew M. Posselt Chris E. Freise Sang‐Mo Kang Ryutaro Hirose

Roll, G. R.1; Posselt, A. M.2; Freise, C. E.3; Kang, S.4; Hirose, R.5; Szot, G.6; Feng, S.5; Stock, P.6 Author Information

BETA (programming language)

Renal replacement therapy

10.1097/00007890-201007272-00735

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Pancreas-After-Islet Transplantation in Nonuremic Type 1 Diabetes: A Strategy for Restoring Durable Insulin Independence

American Journal of Transplantation (2017)

Steven A. Wisel James M. Gardner G.R. Roll Jack W. Harbell Chris E. Freise

Islet transplantation offers a minimally invasive approach for β cell replacement in diabetic patients with hypoglycemic unawareness. Attempts at insulin independence may require multiple islet reinfusions from distinct donors, increasing the risk of allogeneic sensitization. Currently, solid organ pancreas transplant is the only remaining surgical option following failed islet transplantation in the United States; however, the immunologic impact of repeated exposure to donor antigens on subsequent pancreas transplantation is unclear. We describe a case series of seven patients undergoing solid organ pancreas transplant following islet graft failure with long-term follow-up of pancreatic graft survival and renal function. Despite highly variable panel reactive antibody levels prior to pancreas transplant (mean 27 ± 35%), all seven patients achieved stable and durable insulin independence with a mean follow-up of 6.7 years. Mean hemoglobin A1c values improved significantly from postislet, prepancreas levels (mean 8.1 ± 1.5%) to postpancreas levels (mean 5.3 ± 0.1%; p = 0.0022). Three patients experienced acute rejection episodes that were successfully managed with thymoglobulin and methylprednisolone, and none of these preuremic type 1 diabetic recipients developed stage 4 or 5 chronic kidney disease postoperatively. These results support pancreas-after-islet transplantation with aggressive immunosuppression and protocol biopsies as a viable strategy to restore insulin independence after islet graft failure. Islet transplantation offers a minimally invasive approach for β cell replacement in diabetic patients with hypoglycemic unawareness. Attempts at insulin independence may require multiple islet reinfusions from distinct donors, increasing the risk of allogeneic sensitization. Currently, solid organ pancreas transplant is the only remaining surgical option following failed islet transplantation in the United States; however, the immunologic impact of repeated exposure to donor antigens on subsequent pancreas transplantation is unclear. We describe a case series of seven patients undergoing solid organ pancreas transplant following islet graft failure with long-term follow-up of pancreatic graft survival and renal function. Despite highly variable panel reactive antibody levels prior to pancreas transplant (mean 27 ± 35%), all seven patients achieved stable and durable insulin independence with a mean follow-up of 6.7 years. Mean hemoglobin A1c values improved significantly from postislet, prepancreas levels (mean 8.1 ± 1.5%) to postpancreas levels (mean 5.3 ± 0.1%; p = 0.0022). Three patients experienced acute rejection episodes that were successfully managed with thymoglobulin and methylprednisolone, and none of these preuremic type 1 diabetic recipients developed stage 4 or 5 chronic kidney disease postoperatively. These results support pancreas-after-islet transplantation with aggressive immunosuppression and protocol biopsies as a viable strategy to restore insulin independence after islet graft failure.

Immunosuppression

Pancreas transplantation

Thymoglobulin

10.1111/ajt.14344

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Citations (15)