Introduction Postoperative atrial fibrillation is an arrhythmia that may complicate postsurgical care in kidney transplant recipients and is associated with longer hospitalizations, postsurgical complications, and increased in-hospital mortality. Pathophysiology is not well understood but is thought to be multifactorial. Iatrogenic hypervolemia may contribute to the incidence of postoperative atrial fibrillation. Project Aims The program evaluation aim was to evaluate the effects of furosemide concentration on reducing volume overload, and subsequently postoperative atrial fibrillation incidence. Design This was a single-center, retrospective, cohort study that analyzed kidney transplant recipients during index hospitalization. Recipients receiving furosemide infusions of 500 mg/50 mL between June 2022 and May 2023 were considered the concentrated group and recipients receiving infusions of 500 mg/250 mL between January 2013 and December 2017 were the dilute group. Results There was no difference identified in atrial fibrillation rates when using concentrated versus dilute furosemide infusions (7.7% vs 12.4%; P = .101). When excluding those with immediate graft function, there was a lower incidence in the concentrated group (9.3% vs 22.0%, P = .031) compared to slow/delayed graft function. Recipients in the concentrated infusion group had higher rates of high (11.7% vs 35.1%) and very high (3.0% vs 14.9%) cardiovascular risk ( P < .001). Recipients receiving concentrated infusions had improvement in net fluid balance (0.4 L vs 1.4 L; P < .001) with higher furosemide exposure (2.3 g vs 1.4 g; P < .001). Conclusions Postoperative atrial fibrillation rates were similar between groups, Recipients with slow/delayed graft function had lower rates of postoperative atrial fibrillation with concentrated furosemide.

BACKGROUND:Hypoparathyroidism is a relatively rare endocrine disorder defined as inadequate parathyroid hormone (PTH) secretion leading to a clinical syndrome characterized by hyperphosphatemia and hypocalcemia. This condition has high morbidity; patients present with a heterogeneous range of emotional, mental, and physical symptoms. We present our experience with PTH transplantation, using parathyroid glands surgically removed in the setting of secondary hyperparathyroidism, with a description of the clinical course, immunosuppressive management, and surgical technique.METHODS:Between 2017 and 2021, 3 patients underwent parathyroid allotransplantation at the University of Illinois at Chicago. The 2 outcomes of interest were (1) symptomatic relief and improvement in calcium levels and (2) time to graft failure, defined as the presence of undetectable PTH levels.RESULTS:All 3 patients experienced dramatic improvement in their debilitating symptoms, even though 2 patients required repeated PTH transplantation procedures. One patient had a remarkable course with symptom resolution, normalization of PTH levels, and a great reduction in calcium supplementation.CONCLUSION:The use of hyperplastic glands from patients with secondary hyperparathyroidism undergoing 4-gland parathyroidectomy with autotransplantation represents an important source. However, a uniform definition of graft viability and prospective studies with long follow-ups are needed to address how much parathyroid tissue is optimally transplanted and the need for immunosuppression. Most patients affected by hypoparathyroidism are successfully managed by medical treatment; however, some do not respond to therapy and present debilitating symptoms related to hypocalcemia. This subgroup may benefit from parathyroid allotransplantation. Our 3 patients had remarkable improvement in their symptoms with the adoption of hyperplastic glands. Two out of 3 patients required multiple procedures to sustain symptom control.

IntroductionThis study evaluated the effect of a surgical opioid-avoidance protocol (SOAP) on postoperative pain scores. The primary goal was to demonstrate that the SOAP was as effective as the pre-existing non-SOAP (without opioid restriction) protocol by measuring postoperative pain in a diverse, opioid-naive patient population undergoing inpatient surgery across multiple surgical services.MethodsThis prospective cohort study was divided into SOAP and non-SOAP groups based on surgery date. The non-SOAP group had no opioid restrictions (n=382), while the SOAP group (n=449) used a rigorous, opioid-avoidance order set with patient and staff education regarding multimodal analgesia. A non-inferiority analysis assessed the SOAP impact on postoperative pain scores.ResultsPostoperative pain scores in the SOAP group compared with the non-SOAP group were non-inferior (95% CI: −0.58, 0.10; non-inferiority margin=−1). The SOAP group consumed fewer postoperative opioids (median=0.67 (IQR=15) vs 8.17 morphine milliequivalents (MMEs) (IQR=40.33); p<0.01) and had fewer discharge prescription opioids (median=0 (IQR=60) vs 86.4 MMEs (IQR=140.4); p<0.01).DiscussionThe SOAP was as effective as the non-SOAP group in postoperative pain scores across a diverse patient population and associated with lower postoperative opioid consumption and discharge prescription opioids.

Background: Pain, a common debilitating symptom among kidney transplant recipients (KTRs), is among the most common and undertreated symptoms after kidney transplantation.Aims: Characterize associations between gut microbiome features and pain interference before and after kidney transplantation. Design: Longitudinal, repeated measures study, collecting fecal specimens and pain interference data pretransplant and 3 months posttransplant.Setting: Participants were recruited at the kidney transplant clinic at the University of Illinois Hospital & Health Sciences System. Participants/subjects: 19 living donor kidney transplant recipients. Methods: We assessed fecal microbial community structure with shotgun metagenomic sequencing; we used pain interference scores derived from the Patient-Reported Outcomes Measurement Information System-57.Results: We measured a reduction in the Shannon diversity index in both groups after transplantation but observed no significant differences between groups at either time point. We did observe significant differences in fecal microbial Bray-Curtis similarity index among those reporting pain interference pre -transplant versus no pain interference at 3-months posttransplant ( R = .306, p = .022), and between pain interference groups at posttransplant ( R = .249, p = .041). Pairwise models showed significant differences between groups posttransplant in relative abundances of several taxa, including a 5-fold reduction in Akkermansia among those with pain interference and a higher relative abundance of taxa associated with chronic inflammation in those with pain interference posttransplant. Functional gene analysis identified two features that were significantly enriched in those with pain interference, including a peptide trans-port system gene.Conclusions: Gut microbiota community structure differs between groups with and without pain inter-ference at 3 months after kidney transplantation. Several taxa involved in intestinal barrier integrity and chronic inflammation were associated with posttransplant pain. (c) 2022 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

BACKGROUND:There remains a paucity of modern data comparing early steroid withdrawal (ESW) versus chronic corticosteroid (CCS) immunosuppression in simultaneous pancreas kidney (SPK) transplant recipients with long-term follow-up. Therefore, the purpose of this study is to assess the effectiveness and tolerability of ESW compared to CCS post-SPK. METHODS:This was a retrospective single-center matched comparison with the International Pancreas Transplant Registry (IPTR). Patients from University of Illinois Hospital (UIH) represented the ESW group and were compared to those matched CCS patients from the IPTR. Included patients were adult recipients of a primary SPK transplant between 2003 and 2018 within the US receiving rabbit anti-thymocyte globulin induction. Patients were excluded if they had early technical failures, missing IPTR data, graft thrombosis, re-transplant, or positive crossmatch SPK. RESULTS:A total of 156 patients were matched and included in the analysis. Patients were predominantly African American (46.15%) males (64.1%) with Type 1 diabetes etiology (92.31%). Overall pancreas allograft survival (hazard ratio [HR] = .89, 95% confidence interval [CI] .34-2.30, p = .81) and kidney allograft survival (HR = .80, 95%CI .32-2.03, p = .64) were similar between the two groups. Immunologic pancreas allograft loss was statistically similar at 1-year (ESW 1.3% vs. CCS 0%, p = .16), 5-year (ESW 1.3% vs. CCS 7.7%, p = .16), and 10-year (ESW 11.0% vs. CCS 7.7%, p = .99). The 1-year (ESW 2.6% vs. CCS 0%, p > .05), 5-year (ESW 8.3% vs. CCS 7.0%, p > .05), and 10-year (ESW 22.7% vs. CCS 9.9%, p = .2575) immunologic kidney allograft loss were also statistically similar. There was no difference in 10-year overall patient survival (ESW 76.2% vs. CCS 65.6%, p = .63). CONCLUSIONS:No differences were found between allograft or patient survival post-SPK when comparing an ESW or CCS protocol. Future assessment is needed to determine differences in metabolic outcomes.