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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 45 Research Studies DisplayedFeldman AG, Marsh R, Kempe A
Barriers to pretransplant immunization: a qualitative interview study of pediatric solid organ transplant stakeholders.
Investigators described the experiences and beliefs of pediatric transplant stakeholders regarding factors that contribute to low pre-transplant immunization rates. Five central themes emerged: gaps in knowledge about timing and safety of pre-transplant immunizations; lack of communication, coordination, and follow-up between team members; lack of centralized immunization records; subspecialty clinics functioning as the medical home for transplant candidates, but not able to provide all needed immunizations; and differences between organ type in prioritization and completion of pre-transplant immunization. The authors recommended new tools to overcome these barriers and to increase immunization rates in transplant candidates.
AHRQ-funded; HS026510.
Citation: Feldman AG, Marsh R, Kempe A .
Barriers to pretransplant immunization: a qualitative interview study of pediatric solid organ transplant stakeholders.
J Pediatr 2020 Dec;227:60-68. doi: 10.1016/j.jpeds.2020.07.038..
Keywords: Children/Adolescents, Transplantation, Surgery, Healthcare Delivery, Healthcare Utilization
Feldman AG, Adams MA, Wachs ME
Successful non-directed living liver donor transplant for an infant with biliary atresia during the COVID-19 pandemic.
This case study describes a successful non-directed living liver donor transplant for an infant with biliary atresia that occurred during the COVID-19 pandemic. Careful preoperative planning was used to prevent infection pre- and post-cooperatively, and robust telehealth technology use both in and out of the hospital.
AHRQ-funded; HS026510.
Citation: Feldman AG, Adams MA, Wachs ME .
Successful non-directed living liver donor transplant for an infant with biliary atresia during the COVID-19 pandemic.
Pediatr Transplant 2020 Dec;24(8):e13816. doi: 10.1111/petr.13816..
Keywords: Newborns/Infants, COVID-19, Transplantation, Surgery, Case Study
Edwards GC, Shipe ME, Smith L
Exploring patient willingness to accept hepatitis C-infected kidneys for transplantation.
The objective of this study was to explore patient willingness to accept a kidney from Hepatitis C virus-infected donors compared to donors with active intravenous drug use and donors with longstanding diabetes and hypertension. Using electronic surveys, results showed that utilization of kidneys from Hepatitis C virus-infected donors to expand the donor pool appeared to be an acceptable option to patients.
AHRQ-funded; HS026122.
Citation: Edwards GC, Shipe ME, Smith L .
Exploring patient willingness to accept hepatitis C-infected kidneys for transplantation.
BMC Nephrol 2020 Nov 10;21(1):473. doi: 10.1186/s12882-020-02114-y..
Keywords: Hepatitis, Kidney Disease and Health, Transplantation
Kemme S, Sundaram SS, Curtis DJ
A community divided: post-transplant live vaccine practices among Society of Pediatric Liver Transplantation (SPLIT) centers.
The goal of this study was to assess current post-transplant live vaccine practices at individual pediatric liver transplant centers following the updated AST guidelines. Using email surveys with a 93% response rate, findings showed that only 29% of centers offered live vaccines post-transplant, with each center using different eligibility criteria for live vaccines. The main reasons for a center not offering post-transplant live vaccines were safety concerns and inability to reach group consensus.
AHRQ-funded; HS026510.
Citation: Kemme S, Sundaram SS, Curtis DJ .
A community divided: post-transplant live vaccine practices among Society of Pediatric Liver Transplantation (SPLIT) centers.
Pediatr Transplant 2020 Aug 26:e13804. doi: 10.1111/petr.13804..
Keywords: Children/Adolescents, Transplantation, Surgery, Vaccination, Practice Patterns
Shen NT, Bray J, Wahid NA
Evaluation of alcohol taxes as a public health opportunity to reduce liver transplant listings for alcohol-related liver disease.
Alcohol-related liver disease (ALD) is a leading indication for liver transplantation. In this study, the investigators evaluated alcohol taxes as a public health opportunity to reduce liver transplant listings for alcohol-related liver disease. The investigators concluded that transplant listings for ALD were directly associated with spirit consumption and inversely associated with spirits excise taxes. They indicate that these findings suggest a possible public health benefit of increasing excise taxes for spirits.
AHRQ-funded; HS000066.
Citation: Shen NT, Bray J, Wahid NA .
Evaluation of alcohol taxes as a public health opportunity to reduce liver transplant listings for alcohol-related liver disease.
Alcohol Clin Exp Res 2020 Nov;44(11):2307-15. doi: 10.1111/acer.14454..
Keywords: Alcohol Use, Policy, Transplantation
Mogul DB, Perito ER, Wood N
Impact of acuity circles on outcomes for pediatric liver transplant candidates.
In December 2018, UNOS approved an allocation scheme based on recipients' geographic distance from a deceased donor ("acuity circles"). Previous analyses suggested acuity circles (AC) would reduce waitlist mortality overall, but their impact on pediatric subgroups was not considered. In this study, the investigators applied Scientific Registry of Transplant Recipients data from 2011-2016 towards the Liver Simulated Allocation Model (LSAM) to compare outcomes by age and illness severity for the UNOS-approved AC and the existing Donor Service Area (DSA)/Region-based allocation schemes.
AHRQ-funded; HS023876.
Citation: Mogul DB, Perito ER, Wood N .
Impact of acuity circles on outcomes for pediatric liver transplant candidates.
Transplantation 2020 Aug;104(8):1627-32. doi: 10.1097/tp.0000000000003079..
Keywords: Children/Adolescents, Transplantation, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice, Registries, Surgery, Access to Care
Covarrubias K, Luo X, Massie A
Determinants of length of stay after pediatric liver transplantation.
In this study, the investigators sought to identify factors that were associated with LOS following pediatric (<18 years) liver transplantation in order to provide personalized counseling and discharge planning for recipients and their families. They concluded that while center-level practices accounted for substantial variation in LOS, consideration of donor and recipient factors could help clinicians provide more personalized counseling for families of pediatric liver transplant candidates.
AHRQ-funded; HS023876.
Citation: Covarrubias K, Luo X, Massie A .
Determinants of length of stay after pediatric liver transplantation.
Pediatr Transplant 2020 Jun;24(4):e13702. doi: 10.1111/petr.13702..
Keywords: Children/Adolescents, Transplantation
Brown CS, Wakam GK, Englesbe MJ
Increased-risk donors and solid organ transplantation: current practices and opportunities for improvement.
This study looked at recent developments in decision making for use of CDC-labeled increased-risk donor (IRD) use for solid organ transplantation. The implementation of nucleic acid testing for HIV and hepatitis C virus has resulted in decreasing risk of window-period infection often by an order of magnitude or more. However, surgeons still are hesitant to utilize IRD organs. The authors conclude that rate of transmission of window-period infection from IRD organs is exceptionally low and the harms regarding the increased risk classification outweigh the benefits for patients who need organ transplantation.
AHRQ-funded; HS000053.
Citation: Brown CS, Wakam GK, Englesbe MJ .
Increased-risk donors and solid organ transplantation: current practices and opportunities for improvement.
Curr Opin Organ Transplant 2020 Apr;25(2):139-43. doi: 10.1097/mot.0000000000000735..
Keywords: Transplantation, Surgery, Risk
Ingraham NE, Tignanelli CJ, Menk J
Pre- and peri-operative factors associated with chronic critical illness in liver transplant recipients.
This study examined whether patients with end-stage liver failure undergoing liver transplant would be at high risk for developing chronic critical illness (CCI). They looked at pre- and perioperative factors associated with CCI. This retrospective cohort study was performed at a large academic transplant center and included all adult liver transplant patients from 2011 to 2017. CCI was defined as the need for mechanical ventilation for seven days or more post-transplant. Recipients who had re-transplantation, acute rejection, or who died during transplant surgery were excluded. They identified 382 transplant recipients, and out of that cohort 45 (11.8%) developed CCI. Eight independent factors were associated with CCI including previous liver transplant, acute renal failure, frailty, lower albumin level, higher international normalized ratio, need for mechanical ventilation and higher systolic pulmonary artery pressure. A higher pre-transplant Model for End-Stage Liver Disease (MELD) score was associated with protection against CCI.
AHRQ-funded; HS026379.
Citation: Ingraham NE, Tignanelli CJ, Menk J .
Pre- and peri-operative factors associated with chronic critical illness in liver transplant recipients.
Surg Infect 2020 Apr;21(3):246-54. doi: 10.1089/sur.2019.192..
Keywords: Chronic Conditions, Transplantation, Surgery, Outcomes
Muzaale AD, Massie AB, Al Ammary F
Donor-recipient relationship and risk of ESKD in live kidney donors of varied racial groups.
Risk factors for kidney failure are the basis of live kidney donor candidate evaluation. In this retrospective cohort study, the investigators quantified risk for end-stage kidney disease (ESKD) by the biological relationship of the donor to the recipient, a risk factor that is not addressed by current clinical practice guidelines. The investigators found that marked differences in risk for ESKD across types of donor-recipient relationship were observed for Asian, black, and white donors.
AHRQ-funded; HS024600.
Citation: Muzaale AD, Massie AB, Al Ammary F .
Donor-recipient relationship and risk of ESKD in live kidney donors of varied racial groups.
Am J Kidney Dis 2020 Mar;75(3):333-41. doi: 10.1053/j.ajkd.2019.08.020..
Keywords: Transplantation, Kidney Disease and Health, Racial and Ethnic Minorities, Risk, Registries
Bowring MG, Massie AB, Chu NM
Projected 20- and 30-year outcomes for pediatric liver transplant recipients in the United States.
Researchers aimed to use national registry data and parametric models to project 20- and 30-year post-transplant outcomes for recently transplanted pediatric liver transplant (LT) recipients. Using Scientific Registry of Transplant Recipients data, they found that projected long-term outcomes for recently transplanted pediatric LT recipients are excellent, reflective of substantial improvements in medical care, and informative for physician-patient education and decision making in the current era.
AHRQ-funded; HS023876.
Citation: Bowring MG, Massie AB, Chu NM .
Projected 20- and 30-year outcomes for pediatric liver transplant recipients in the United States.
J Pediatr Gastroenterol Nutr 2020 Mar;70(3):356-63. doi: 10.1097/mpg.0000000000002592..
Keywords: Children/Adolescents, Transplantation, Patient-Centered Outcomes Research, Outcomes, Surgery, Registries, Evidence-Based Practice
Schaffhausen CR, Bruin MJ, Chu S
Tool to aid patients in selecting a liver transplant center.
Variations in candidate and donor acceptance criteria may influence access and mortality for liver transplantation. In this study, the investigators sought to understand how recipient and donor characteristics varied across centers and how patients interpreted this information. The data was then used to develop a tool to provide tailored information to candidates seeking a center.
AHRQ-funded; HS024527; HS026379.
Citation: Schaffhausen CR, Bruin MJ, Chu S .
Tool to aid patients in selecting a liver transplant center.
Liver Transpl 2020 Mar;26(3):337-48. doi: 10.1002/lt.25715..
Keywords: Transplantation, Shared Decision Making
Shen NT, Wu A, Farrell K
Patient perspectives of high-quality care on the liver transplant waiting list: a qualitative study.
The prevalence of advanced liver disease and listing for liver transplantation is increasing. Prior assessments of quality of care neither incorporate nor emphasize the patient perspective on quality of care, which may impact clinical outcomes. In this study the investigators aimed to identify patients' perceptions on what constitutes high quality of care, comparing the findings to existing frameworks and assessments to determine if a patient-derived tool assessing quality of care could facilitate efforts to improve health care.
AHRQ-funded; HS000066.
Citation: Shen NT, Wu A, Farrell K .
Patient perspectives of high-quality care on the liver transplant waiting list: a qualitative study.
Liver Transpl 2020 Feb;26(2):238-46. doi: 10.1002/lt.25645..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Transplantation, Quality of Care, Healthcare Delivery, Patient Experience
Schaffhausen CR, Bruin MJ, Chu S
Comparing pretransplant and posttransplant outcomes when choosing a transplant center: focus groups and a randomized survey.
In response to calls for an increased focus on pretransplant outcomes and other patient-centered metrics in public reports of center outcomes, this mixed methods study evaluated how the content and presentation style of new information influenced decision-making. This mixed methods design utilized qualitative and quantitative phases where the strengths of one method helped address limitations of the other, and multiple methods facilitated comparing results. The authors concluded that the presentation of public reports influenced decision-making behavior.
AHRQ-funded; HS026379; HS024527.
Citation: Schaffhausen CR, Bruin MJ, Chu S .
Comparing pretransplant and posttransplant outcomes when choosing a transplant center: focus groups and a randomized survey.
Transplantation 2020 Jan;104(1):201-10. doi: 10.1097/tp.0000000000002809..
Keywords: Transplantation, Shared Decision Making, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Feldman AG, Hsu EK, Mack CL
The importance of prioritizing pre and posttransplant immunizations in an era of vaccine refusal and epidemic outbreaks.
This paper discusses the prevalence of vaccine-preventable outbreaks occurring both nationally and internationally. Rates of vaccine hesitancy and refusal have been increasing which leads to decreased herd immunity. This poses greater risk to immunosuppressed transplant recipients, and currently 1 in 6 pediatric solid organ transplant recipients are hospitalized with a vaccine-preventable infection in the first 5 years posttransplant. This often results in significant morbidity, mortality, and increased hospitalization costs. Surprisingly, many transplant recipients are not up-to-date on age appropriate immunizations at the time of transplant and thereafter. The authors feel that immunizations must be prioritized in both pre and posttransplant care. They call for more research to understand how to monitor immune response to vaccines in immunosuppressed patients and when to optimally immunize patients posttransplant. They also recommend reexamination of the administration of live vaccines posttransplant.
AHRQ-funded; HS026510.
Citation: Feldman AG, Hsu EK, Mack CL .
The importance of prioritizing pre and posttransplant immunizations in an era of vaccine refusal and epidemic outbreaks.
Transplantation 2020 Jan;104(1):33-38. doi: 10.1097/tp.0000000000002936..
Keywords: Vaccination, Medication, Emergency Preparedness, Public Health, Transplantation
Feldman AG, Curtis DJ, Moore SL
Under-immunization of pediatric transplant recipients: a call to action for the pediatric community.
This article is a call to action for pediatric solid organ transplant recipients to receive their recommended immunizations. Vaccine-preventable infections (VIPs) occur in 1 in 6 pediatric transplant recipients and these hospitalizations result in significant morbidity, mortality, graft injury, and cost. There has been an increase in the overall population in non-medical vaccine exemptions, which reduces herd immunity and creates greater risk for patients undergoing or already having received transplants.
AHRQ-funded; HS026510.
Citation: Feldman AG, Curtis DJ, Moore SL .
Under-immunization of pediatric transplant recipients: a call to action for the pediatric community.
Pediatr Res 2020 Jan;87(2):277-81. doi: 10.1038/s41390-019-0507-4..
Keywords: Children/Adolescents, Transplantation, Vaccination, Adverse Events, Patient Safety
Feldman AG, Atkinson K, Wilson K
Underimmunization of the solid organ transplant population: An urgent problem with potential digital health solutions.
This paper describes ways that digital health technologies may help solid organ transplant recipients stay free from vaccine-preventable infections so they are not underimmunized at the time of transplant and thereafter. Due to vaccine hesitancy and refusal in the general population, recipients can no longer rely on herd immunity to protect them. Digital health technologies can provide accurate information about vaccine safety, efficacy and timing in the pre- and post-transplant periods; make complete immunization records universally available and easily accessible; enable communication between patients and multiple providers; and provide automated vaccine reminders to both patients and providers.
AHRQ-funded; HS026510.
Citation: Feldman AG, Atkinson K, Wilson K .
Underimmunization of the solid organ transplant population: An urgent problem with potential digital health solutions.
Am J Transplant 2020 Jan;20(1):34-39. doi: 10.1111/ajt.15605..
Keywords: Transplantation, Surgery, Healthcare Utilization, Infectious Diseases, Telehealth, Health Information Technology (HIT), Vaccination
Almasri J, Tello M, Benkhadra R
A systematic review for variables to be collected in a transplant database for improving risk prediction.
This study is a systematic review that was commissioned to identify new variables associated with transplant outcomes that are not currently collected by the Organ Procurement and Transplantation Network. They identified 81 unique studies including almost 1.2 million patients with median follow-up of 36 months posttransplant. A total of 108 unique risk factors were reported with most (104) recipient related and only 4 donor related. Most risk factors were small to moderate (ranging between 1.0 and 2.0). There were four relative association measures that were the strongest: 1) heart transplant recipients with a previous Fontan operation (8.6); 2) kidney transplant recipients with sickle cell nephropathy as primary cause of end-stage renal disease (2.8); 3) liver transplant recipients with serum ferritin >500 microg/L (14.3); and 4) lung transplant recipients with Burkholderia cepacia complex infection for 1 year or less (63.). These four risk factors were considered candidates for collection in databases and registries.
AHRQ-funded; HS024527.
Citation: Almasri J, Tello M, Benkhadra R .
A systematic review for variables to be collected in a transplant database for improving risk prediction.
Transplantation 2019 Dec;103(12):2591-601. doi: 10.1097/tp.0000000000002652..
Keywords: Transplantation, Risk, Shared Decision Making
Montgomery JR, Waits SA, Dimick JB
Risks of bariatric surgery among patients with end-stage renal disease.
Pretransplant morbid obesity among patients with end-stage renal disease (ESRD) is a significant predictor of delayed access to transplant and inferior posttransplant patient and kidney allograft outcomes. In this study, the authors performed an analysis of perioperative safety of bariatric surgery in obese patients with ESRD using a national registry capturing greater than 95% of bariatric operations.
AHRQ-funded; HS025778.
Citation: Montgomery JR, Waits SA, Dimick JB .
Risks of bariatric surgery among patients with end-stage renal disease.
JAMA Surg 2019 Dec;154(12):1160-62. doi: 10.1001/jamasurg.2019.2824..
Keywords: Surgery, Obesity, Obesity: Weight Management, Kidney Disease and Health, Transplantation, Risk, Chronic Conditions
Feldman AG, Sundaram SS, Beaty BL
Immunization status at the time of liver transplant in children and adolescents.
In this research letter, the authors quantified the percentage of patients at Society of Pediatric Liver Transplantation centers who were up to date for their age on immunizations at the time of transplant, and determined whether demographic and clinical factors were associated with immunization status at the time of transplant. They concluded that further research is needed to understand barriers to immunization in the pediatric transplant population and called for novel tools that provide pretransplant vaccine education and enhance communication between primary care and subspecialty clinicians.
AHRQ-funded; HS026510.
Citation: Feldman AG, Sundaram SS, Beaty BL .
Immunization status at the time of liver transplant in children and adolescents.
JAMA 2019 Nov 12;322(18):1822-24. doi: 10.1001/jama.2019.14386..
Keywords: Transplantation, Children/Adolescents, Vaccination, Surgery
DiBrito SR, Bowring MG, Holscher CM
Acute care surgery for transplant recipients: a national survey of surgeon perspectives and practices.
This study is a survey of acute care surgeons (ACS) and transplant surgeons on their attitudes as to who would feel comfortable operating on transplant patients for nontransplant-related issues. The researchers conducted a national survey of ACS and transplant surgeons and obtained 230 ACS responses and 240 from transplant surgeons. While both ACS and transplant surgeons felt care is better at transplant centers and if the patient requires acute surgery they should be transferred to a transplant center, the ACS still felt comfortable operating and performing laparoscopy on transplant recipients.
Citation: DiBrito SR, Bowring MG, Holscher CM .
Acute care surgery for transplant recipients: a national survey of surgeon perspectives and practices.
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Keywords: Transplantation, Surgery, Provider: Physician, Provider, Practice Patterns
Luo X, Mogul DB, Massie AB
Predicting chance of liver transplantation for pediatric wait-list candidates.
The authors sought to predict the chance of receiving a deceased donor liver transplant (DDLT) for pediatric patients. Their model accurately predicted chance of transplant and was able to predict DDLT at specific follow-up times. They conclude that their model can serve as the basis for an online tool that would provide useful information for pediatric wait-list candidates.
AHRQ-funded; HS023876.
Citation: Luo X, Mogul DB, Massie AB .
Predicting chance of liver transplantation for pediatric wait-list candidates.
Pediatr Transplant 2019 Nov;23(7):e13542. doi: 10.1111/petr.13542..
Keywords: Children/Adolescents, Transplantation, Healthcare Delivery, Access to Care
Mogul DB, Fredericks EM, Brady TM
Digital wings: innovations in transition readiness for adolescent and young adult transplant recipients.
This article reports on two multi-stakeholder symposia organized by The Johns Hopkins University School of Medicine on February 2, 2018, and January 11, 2019, to address the problem of high graft failure in adolescent and young adult solid organ transplant recipients. Additionally, data collected from recipients demonstrated a substantial gap in how this population uses technologies for health-related activities, alongside an increased interest in an app to help them manage their transplant.
AHRQ-funded; HS023876.
Citation: Mogul DB, Fredericks EM, Brady TM .
Digital wings: innovations in transition readiness for adolescent and young adult transplant recipients.
Transplantation 2019 Oct;103(10):1970-74. doi: 10.1097/tp.0000000000002749..
Keywords: Transplantation, Children/Adolescents, Young Adults, Surgery, Patient-Centered Outcomes Research, Evidence-Based Practice
Purnell TS, Luo X, Crews DC
Neighborhood poverty and sex differences in live donor kidney transplant outcomes in the United States.
Neighborhood poverty has been associated with worse outcomes after live donor kidney transplantation (LDKT), and prior work suggests that women with kidney disease may be more susceptible to the negative influence of poverty than men. As such, our goal was to examine whether poverty differentially affects women in influencing LDKT outcomes. The investigators concluded that given their findings that poverty was more strongly associated with graft loss in women, targeted efforts are needed to specifically address mechanisms driving these disparities in LDKT outcomes.
AHRQ-funded; HS024600.
Citation: Purnell TS, Luo X, Crews DC .
Neighborhood poverty and sex differences in live donor kidney transplant outcomes in the United States.
Transplantation 2019 Oct;103(10):2183-89. doi: 10.1097/tp.0000000000002654.
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Keywords: Transplantation, Kidney Disease and Health, Patient-Centered Outcomes Research, Disparities, Women, Sex Factors, Low-Income, Outcomes
Stepkowski SM, Mierzejewska B, Fumo D
The 6-year clinical outcomes for patients registered in a multiregional United States Kidney Paired Donation program - a retrospective study.
This retrospective study examined 6-year clinical outcomes for patients registered in a multiregional US Kidney Paired Donation (KPF) program. A total of 1121 end-stage renal disease patients who registered with their willing/incompatible living donors for kidney exchange were followed. Out of the 1121, 65% were transplanted with 37% of them in kidney paired donations, 10% with compatible live donors, and 18% with deceased donors. The remaining patients withdrew due to illness or death, or were still waiting (20%). There were similar survival rates with the different donor methods.
AHRQ-funded; HS020610.
Citation: Stepkowski SM, Mierzejewska B, Fumo D .
The 6-year clinical outcomes for patients registered in a multiregional United States Kidney Paired Donation program - a retrospective study.
Transpl Int 2019 Aug;32(8):839-53. doi: 10.1111/tri.13423..
Keywords: Kidney Disease and Health, Mortality, Outcomes, Transplantation