Delivery of Health Care; Kidney; Kidney Failure, Chronic; Liver; Nephrology; Risk; Transplantation; Living Donors
Public Health Interests
Health care delivery; Health Care Management; Health Disparities; Health risk behaviors; Kidney Disease; Psychosocial risk factors
Increasing living donation in a safe and effective manner is the only solution to the organ shortage. My research trys to examine how kidney donors assess risk and how this information can be better used by transplant centers when they evaluate possible living donors. Carrie Thieseen MD PhD (Yale) and I are currently conducting a muticenter study and are actively recruiting potential living donors.
I am also conducting a clinical study that tests an FDA approved system Airseal (Surgiquest, Inc.) to determine if we can reduce pain from the kidney donor surgery. The study in currently uderway and actively recruiting patients.
Unfortunately, kidneys don't last forever. There are new medications that may help some kidney transplant patients keep their kidney longer. We are conducting a clinical study using a complement inhibiator, eculizumab, to determine if we can stop antibodies from injuring kidneys. The study is still active, though it is closed to the recruitment of new patients.
Specialized Terms: The role of complement inhibition in kidney and liver transplantation; Methods to decrease pain for living kidney donors; UNOS & CMS regulations and compliance; Living donor risks and perceptions.
Extensive Research Description
I am interested in the role of complement inhibition in both kidney and liver transplantation. We are conducting an industry-sponsored study to assess if complement inbhibition with eculizumab can reduce antibody-mediated injury seen in kidney patients with donor-specific antibodies. I work with Jordan Pober MD PhD (Yale Immunobiology) on this study to assess what affect complement inhibition will have on graft endothelial cells. Given that donor specific antibodies may increase markers of endothelial cell activation, we are testing if complement inhibition will reduce activation and thus preserve graft function.
Living donation is a principal interest of mine, both clincally and academically. Previous work on living donor consenting practices and the need for better structured alibi's for donor has lead to a greater question on how transplant centers evaluate and approve living donors. Clearly, this requires a balance between donor autonomy and center malefiecne. I am working with Carrie Thiessen MD PhD (Yale) whose experience in normative research methods has resulted in a multicenter portocol designed to assess risk perception in living kidney donors.
1. Inhibition of Complement in Chronic Allograft Injury & its affect on Circulating Endothelial Cells.
2. Randomized Controlled Trial of Reducing Operative & Post-Operative Morbidity in Living Kidney Donors Utilizing Low Pressure, Limited Variability Pneumoperitoneum.
3. Burden of Illness in Highly Sensitized ESRD Patients & Patients Who Experience Acute Antibody-Mediated Rejection.
4. Balancing non-maleficence and autonomy in living kidney donors.
- Kulkarni S, Emre S, Arvelakis A, Bia M, Asch W, Formica and Isreal G. Multidector CT Angiography in Living Donor Kidney Transplantation: Accuracy and Discrepancies in Right Venous Anatomy. Clinical Transplantation 2010, January 12.
- Fromica RN, Barrantes F, Asch WS, Bia M, Coca S, Kalyesubula R, McCloskey B, Leary T, Arvelakis A, Stint K and Kulkarni S. A One-Day Centralized Work-up for Kidney Transplant Recipient Candidates: A Quality Improvement Report. American Journal of Kidney Disease 2012;60(2):288-294.
- Gandelman J, Yoo P and Kulkarni S. Retrocaval arterial bifurcation is not a contraindication to laparoscopic right donor nephrectomy. Journal of the American College of Surgeons 2013:217(3):406-411.
- Thiessen C, Kim YA, Yoo PS, Rodriguez-Davalos M, Mulligan D and Kulkarni S. Written informed consent for living liver donor evaluation: Compliance with CMS & OPTN guidelines and alibi offers. Liver Transplantation 2014;20(4):416-424
- Thiessen C, Kim YA, Formica R, Bia M and Kulkarni S. Confidentiality and availability of an “alibi” for potential living kidney donors in the United States. Journal of Medical Ethics 2015:41(7):506-510.
- Thiessen C, Gordon EJ, Reese PP, Kulkarni S. Development of a Donor-Centered Approach to Risk Assessment: Rebalancing Non-maleficence and Autonomy. American Journal of Transplantation 2015;15(9):2314-2323.