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Perspective
Moving Boundaries — The Nightingale Twins and Transplantation Science
Johanna Rempel and Lana Blatz sat on either side of Dr. Joseph Murray in the reception room of the Transplant Surgery Division at Brigham and Women's Hospital one May morning in 2011. The 63-year-old identical twins had made the trip from Alberta, Canada, to Boston to meet with the Nobel-honored…
- April 26, 2012
- Tullius S.G., Rudolf J.A., Malek S.K.
- N Engl J Med 2012; 366:1564-1565
In 1960, a kidney from 12-year-old Lana Nightingale was transplanted into her twin sister Johanna — now the longest surviving kidney-transplant recipient. Their story reminds us that, like the physicians who care for them, patients help in advancing medicine.
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Correspondence
Resolution of Recurrent Focal Segmental Glomerulosclerosis after Retransplantation
To the Editor: Recurrent primary focal segmental glomerulosclerosis (FSGS) develops in over 40% of renal-transplant recipients and presents a major therapeutic challenge. The first marker of disease recurrence is often proteinuria in the nephrotic range that can appear 2 to 3 days after…
- April 26, 2012
- N Engl J Med 2012; 366:1648-1649
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The authors of this letter describe the successful retransplantation of an allograft that was failing in its first recipient owing to recurrent primary focal segmental glomerulosclerosis. In the second recipient, all evidence of the nephrotic syndrome resolved.
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Correspondence
Machine Perfusion or Cold Storage in Deceased-Donor Kidney Transplantation
To the Editor: In 2009, we reported the results of an international randomized, controlled trial in which hypothermic machine perfusion of deceased-donor kidneys significantly reduced the risk of delayed graft function, as compared with cold-storage preservation. We also observed that graft…
- February 23, 2012
- N Engl J Med 2012; 366:770-771
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Kidneys donated after brain death were associated with a better survival rate after machine perfusion than after cold storage. However, perfused kidneys donated after circulatory death did not have such an advantage; this suggests different mechanisms within the donor groups.
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Perspective
Penny Wise, Pound Foolish? Coverage Limits on Immunosuppression after Kidney Transplantation
As a treatment for end-stage renal disease (ESRD), kidney transplantation is superior to dialysis for improving patient survival rates and quality of life. Its long-term success, however, requires ongoing treatment with immunosuppressive drugs. Ironically, although many of the pivotal discoveries…
- February 16, 2012
- Gill J.S. and Tonelli M.
- N Engl J Med 2012; 366:586-589
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Since U.S. kidney-transplant recipients don't benefit from a coherent funding policy for immunosuppressive drugs, thousands of them are at risk for allograft failure and premature death. Ensuring lifetime access to these medications would save lives and money.
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Correspondence
Induced Immune Tolerance for Kidney Transplantation
To the Editor: Recipients of kidney transplants require the lifelong use of immunosuppressive drugs to prevent graft rejection, but immunosuppressive medications are associated with cumulative side effects, including increased risks of heart disease, infection, cancer, and diabetes. Despite…
- October 6, 2011
- N Engl J Med 2011; 365:1359-1360
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In this study, patients who received HLA-matched kidney transplants received a donor-cell infusion of highly enriched CD34+ hematopoietic progenitor cells mixed with CD3+ T cells, and a conditioning regimen of total lymphoid irradiation and anti–T-cell antibodies.
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Correspondence
Kidney Paired Donation — The Next Step
To the Editor: There is a worldwide shortage of kidneys for renal transplantation. In the United States, the number of patients on the deceased-donor waiting list now exceeds 88,000. However, additional donations of living-donor kidneys can be facilitated by means of a strategy of simple…
- September 1, 2011
- N Engl J Med 2011; 365:868-869
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This letter proposes that kidney paired donation, a method by which donors who are incompatible with their intended recipients swap kidneys, which can involve many pairs, may be a vehicle by which to develop international channels of exchange.
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Original Article
Desensitization in HLA-Incompatible Kidney Recipients and Survival
Renal-replacement therapy can be achieved by means of transplantation or dialysis. Transplantation offers clear benefits in terms of longevity, lifestyle, and savings in health care costs.– However, organs are scarce, and the rate of death among patients on the kidney-transplant waiting list is…
- July 28, 2011
- Montgomery R.A., Lonze B.E., King K.E., et al.
- N Engl J Med 2011; 365:318-326
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- CME
Investigators used plasmapheresis and low-dose intravenous immune globulin to desensitize HLA-incompatible patients before transplantation and compared their survival rate with that of controls. Live-donor transplantation after desensitization provided a survival benefit.
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Editorial
Alemtuzumab in Kidney-Transplant Recipients
Over the past decade, the use of induction therapy in organ-transplant recipients to intensify immunosuppression during the peritransplantation period has contributed to a reduction in early rejection rates and graft loss in the first year after transplantation. It is now common practice to select…
- May 19, 2011
- Markmann J.F. and Fishman J.A.
- N Engl J Med 2011; 364:1968-1969
Over the past decade, the use of induction therapy in organ-transplant recipients to intensify immunosuppression during the peritransplantation period has contributed to a reduction in early rejection rates and graft loss in the first year after ...
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Original Article
Alemtuzumab Induction in Renal Transplantation
In the United States between 1998 and 2007, a total of 78% of renal-transplant recipients received antibody induction therapy. The most frequently used agents have been rabbit antithymocyte globulin (Thymoglobulin, Genzyme), a lymphocyte-depleting polyclonal antibody, and basiliximab (Simulect,…
- May 19, 2011
- Hanaway M.J., Woodle E.S., Mulgaonkar S., et al.
- N Engl J Med 2011; 364:1909-1919
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Renal-transplant recipients were given alemtuzumab induction therapy or conventional induction therapy as part of a program of early glucocorticoid withdrawal. Acute rejection was less frequent with alemtuzumab during the first year.
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Perspective
Improving the Allocation System for Deceased-Donor Kidneys
On February 16, 2011, the Organ Procurement and Transplantation Network (OPTN), the federal contractor responsible for overseeing solid-organ allocation in the United States, released for public comment three proposed concepts for the allocation of kidneys from deceased donors: using a Kidney Donor…
- April 7, 2011
- Leichtman A.B., McCullough K.P., Wolfe R.A.
- N Engl J Med 2011; 364:1287-1289
The Organ Procurement and Transplantation Network has proposed new concepts for the allocation of kidneys from deceased donors that would introduce an element of matching of the estimated future survival of transplanted kidneys and with that of recipients.
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Correspondence
Kidney Allocation and the Aging Immune Response
To the Editor: Organ allocation is a critical component in the success of transplantation. The increasing discrepancy between supply and demand is one of the most important problems in renal transplantation. Despite intensive efforts, donation rates have not increased recently. Moreover,…
- April 7, 2011
- N Engl J Med 2011; 364:1369-1370
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To the Editor: Organ allocation is a critical component in the success of transplantation. The increasing discrepancy between supply and demand is one of the most important problems in renal transplantation. Despite intensive efforts, donation rates have ...
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Perspective
Risk, Prognosis, and Unintended Consequences in Kidney Allocation
The gap between the supply and demand of transplantable kidneys is growing, leaving policymakers eager to maximize the benefit of every kidney transplanted. Recently, a proposal for changing the way kidneys from deceased donors are allocated was proffered for public comment by the Kidney Committee…
- April 7, 2011
- Hippen B.E., Thistlethwaite J.R., Ross L.F.
- N Engl J Med 2011; 364:1285-1287
Proposed changes to the allocation system for deceased-donor kidneys rely on unvalidated models that may unfairly reduce transplantation opportunities for some patients, inappropriately benefit others, and have unintended consequences for donation by living donors.
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Review Article
Mechanisms of Disease: Hypoxia and Inflammation
Mammals have oxygen-sensing mechanisms that help them adapt quickly to hypoxia by increasing respiration, blood flow, and survival responses. If an inadequate supply of oxygen persists, additional mechanisms attempt to restore oxygenation or help the body adapt to hypoxia. These other mechanisms…
- February 17, 2011
- Eltzschig H.K. and Carmeliet P.
- N Engl J Med 2011; 364:656-665
This review deals with emerging evidence of an association between systemic or local hypoxia and inflammation in a variety of diseases. The evidence points to new ways of treating inflammatory disorders or conditions such as certain cancers with intralesional hypoxia.
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Original Article
Outcomes of Kidney Transplantation in HIV-Infected Recipients
An increasing number of persons living with human immunodeficiency virus (HIV) infection who have end-stage renal disease (ESRD) are seeking renal transplantation. Despite the efficacy of highly active antiretroviral therapy (HAART) in reducing the risk of HIV-related renal disease, the incidence…
- November 18, 2010
- Stock P.G., Barin B., Murphy B., et al.
- N Engl J Med 2010; 363:2004-2014
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- CME
In this trial of kidney transplantation involving HIV-infected patients, rates of patient and graft survival were high at 1 and 3 years, with no HIV-associated complications. However, unexpectedly high rejection rates were an important concern.
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Editorial
Tackling the Unknowns in HIV-Related Kidney Diseases
The advancements that have been made in the treatment of human immunodeficiency virus (HIV) infection over the past three decades are nothing short of astounding. In a search of medical history, one would be hard-pressed to find an area that has developed as rapidly as the treatment of HIV–AIDS.…
- November 18, 2010
- Szczech L.A.
- N Engl J Med 2010; 363:2058-2059
The advancements that have been made in the treatment of human immunodeficiency virus (HIV) infection over the past three decades are nothing short of astounding. In a search of medical history, one would be hard-pressed to find an area that has developed ...
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Review Article
Mechanisms of Disease: Rejection of the Kidney Allograft
The science of kidney transplantation has progressed considerably in the past half-century largely because of an improved understanding of the role of the immune system in allograft rejection, the disentanglement of the molecular mechanisms underlying graft failure, and better management of…
- October 7, 2010
- Nankivell B.J. and Alexander S.I.
- N Engl J Med 2010; 363:1451-1462
- CME
This review gives an account of our current understanding of the mechanisms of rejection of renal allografts. New immunosuppressive agents show promise, but graft survival beyond 5 years has not improved substantially.
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Correspondence
Kidney Paired Donation in Live-Donor Kidney Transplantation
To the Editor: An estimated 6000 patients on the waiting list for kidney transplantation in the United States have suitable living donors who are not immunologically compatible. Both kidney paired donation (KPD) and desensitization are options for patients with incompatible donors. KPD, which…
- September 9, 2010
- N Engl J Med 2010; 363:1091-1092
- Free Full Text
To the Editor: An estimated 6000 patients on the waiting list for kidney transplantation in the United States have suitable living donors who are not immunologically compatible.¹ Both kidney paired donation (KPD) and desensitization are options for ...
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Correspondence
Mortality among Living Kidney Donors and Comparison Populations
To the Editor: In an article published in the Journal this past year, Ibrahim et al. (Jan. 29, 2009, issue) provide important, much needed data about long-term outcomes of living kidney donors. For a comparison group, the investigators used rates of death in the general population, which included…
- August 19, 2010
- N Engl J Med 2010; 363:797-798
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To the Editor: In an article published in the Journal this past year, Ibrahim et al. (Jan. 29, 2009, issue)¹ provide important, much needed data about long-term outcomes of living kidney donors. For a comparison group, the investigators used rates of ...
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Original Article
Racial Variation in Medical Outcomes among Living Kidney Donors
Living kidney transplantation is considered to offer patients with end-stage renal disease the best opportunity for dialysis-free survival. In 2006, approximately 27,000 transplantations from registered living kidney donors were performed worldwide, and living donors supplied nearly 40% of kidney…
- August 19, 2010
- Lentine K.L., Schnitzler M.A., Xiao H., et al.
- N Engl J Med 2010; 363:724-732
- Free Full Text
This retrospective study linking two databases shows that both black and Hispanic living kidney donors had a higher relative risk of hypertension, drug-treated diabetes mellitus, and chronic kidney disease after donation than did white donors, similar to the risks in the general U.S. population. Increased attention to health outcomes among demographically diverse living kidney donors is indicated.
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Correspondence
PLA2R Autoantibodies and Recurrent Membranous Nephropathy after Transplantation
To the Editor: Membranous nephropathy is a leading cause of the nephrotic syndrome in adults. One third of patients have a progressive loss of renal function and reach end-stage renal disease. Membranous nephropathy recurs in up to 40% of patients after renal transplantation. Recently, Beck et al.…
- July 29, 2010
- N Engl J Med 2010; 363:496-498
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To the Editor: Membranous nephropathy is a leading cause of the nephrotic syndrome in adults. One third of patients have a progressive loss of renal function and reach end-stage renal disease.¹ Membranous nephropathy recurs in up to 40% of patients after ...
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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