The Experts below are selected from a list of 117 Experts worldwide ranked by ideXlab platform
Nancy Durning - One of the best experts on this subject based on the ideXlab platform.
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identification and utilization of pre search killer cell immunoglobulin type receptor kir b x unrelated donors improves the selection of kir favorable donors the Transplant Coordinator perspective
Biology of Blood and Marrow Transplantation, 2020Co-Authors: Barbara Adlerbrecher, Katayoon Modjarradshaw, Angelica Panganiban, Dawn Wakefield, Claritza Sanabria, Maridel Tenned, Jacklyn Russo, Ann Ferolinocot, Gabrielle Marczewski, Nancy DurningAbstract:Background KIR B(x) haplotype donors have been reported to improve outcomes in patients (pts) receiving unrelated donors (URD) for myeloid malignancies, non-Hodgkin's lymphoma (NHL) and multiple myeloma (MM). Donors are categorized as KIR “Best” or “Better”. Our center performs donor KIR genotyping and haplotype assignment routinely as part of our URD evaluation for pts undergoing Transplantation for myeloid disorders, NHL and MM. When presented with multiple equivalently HLA matched URDs, our physicians will prioritize KIR B(X) donors over KIR A/A donors. Weisdorf et. al. (BBMT 2018) suggested that pre-search donor KIR genotyping would accelerate/optimize donor selection. Since 2015, donor KIR genotyping data for > 3 million donors from the DKMS registry is available. We investigated our ability to enhance KIR-favorable donor selections using the DKMS pre-search KIR. Methods In 2018 we requested access to individual KIR donor typing through the National Marrow Donor Program (NMDP) Scientific Services for donors registered by DKMS Germany, DKMS Poland and obtained access to the DKMS Donor Navigator website. Pts with multiple suitable donors were sorted for KIR, if registered by DKMS. Up to 6 donors per patient were selected from the pre-search KIR B(x) donors who ranked KIR “Best”, “Better” and “Neutral”. For pts whose pre-search screen did not identify an adequate number of KIR B(x) informative donors we selected additional donors (KIR unknown) for confirmatory typing. Results Thirty-five pts had informative KIR B(x) pre-search donors identified. There were 1-27 KIR B(x) available donors per pt. The online KIR B Content Calculator ranked these donors as KIR “Best”, “Better”, or “Neutral”. Donors were selected by the physicians, who were unaware of the pre-search ranking. As of Oct 2019, 23 pts were Transplanted, 4 are pending. Of these 27 donors selected, 18 were identified in the pre-search group. Six donors (33%) were ranked KIR B “Best”, 10 (55%) “Better”, and 2 (11%) “Neutral”. Nine pts used donors without a pre-search. Five pts did not proceed to an URD Transplant, and 3 pts have ongoing searches. Using the pre-search information, 66% of pts received a KIR B(x) donor and we were able to enrich KIR B(x) “Best” and “Better” donor options. Based on registry data, approximately 11%, 20% and 69% of donors randomly selected from a donor registry will be ranked KIR “Best”, “Better” and “Neutral “respectively. For our pt population, we were able to more than double the selection of KIR “Best” and “Better” donors for Transplantation. Conclusion The inclusion of KIR donor genotyping on donor registries enriches the number of preferred KIR B (x) donors available and allows a more efficient selection of KIR “Best” and “Better” donors.
Franco Innocenti - One of the best experts on this subject based on the ideXlab platform.
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prioritization for liver Transplantation using the meld score in chile inequities generated by meld exceptions a collaboration between the chilean liver Transplant programs the public health institute and the national Transplant Coordinator
Annals of Hepatology, 2019Co-Authors: Luis Antonio Diaz, Blanca Norero, Barbara Lara, Camila Robles, Susana Elgueta, R Humeres, Jaime Poniachik, Guillermo Silva, Rodrigo Wolff, Franco InnocentiAbstract:Abstract Introduction and aim The MELD score has been established as an efficient and rigorous prioritization system for liver Transplant (LT). Our study aimed to evaluate the effectiveness of the MELD score as a system for prioritization for LT, in terms of decreasing the dropout rate in the waiting list and maintaining an adequate survival post-LT in Chile. Materials and methods We analyzed the Chilean Public Health Institute liver Transplant registry of candidates listed from October 15th 2011 to December 31st 2014. We included adult candidates (>15 years old) listed for elective cadaveric LT with a MELD score of 15 or higher. Statistical analysis included survival curves (Kaplan–Meier), log-rank statistics and multivariate logistic regression. Results 420 candidates were analyzed. Mean age was 53.6 ± 11.8 years, and 244 were men (58%). Causes of LT included: Liver cirrhosis without exceptions (HC) 177 (66.4%); hepatocellular carcinoma (HCC) 111 (26.4%); cirrhosis with non-HCC exceptions 102 (24.3%) and non-cirrhotic candidates 30 (7.2%). LT rate was 43.2%. The dropout rate was 37.6% at 1-year. Even though the LT rate was higher, the annual dropout rate was significantly higher in cirrhotic candidates (without exceptions) compared with cirrhotics with HCC, and non-HCC exceptions plus non-cirrhotic candidates (47.9%; 37.2% and 24.2%, respectively, with p = 0.004). Post-LT survival was 84% per year, with no significant differences between the three groups (p = 0.95). Conclusion Prioritization for LT using the MELD score system has not decreased the dropout rate in Chile (persistent low donor's rate). Exceptions generate inequities in dropout rate, disadvantaging patients without exceptions.
Joseph Mcguirk - One of the best experts on this subject based on the ideXlab platform.
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initiating the conversation of oncofertility the creation of a dedicated bmt oncofertility nurse Coordinator in the Transplant and cellular therapy patient population
Biology of Blood and Marrow Transplantation, 2020Co-Authors: Kara Armato, Erin Winters, Caroline Strohm, Liza Rodriguez, Joanne Wilson, Joseph McguirkAbstract:Topic Significance & Study Purpose/Background/Rationale Patients undergoing hematopoietic stem cell Transplantation face a high risk of infertility. Despite existing ASCO, ASRM and NCCN fertility preservation guidelines, as many as 68% of oncology patients report that fertility was not discussed prior to or during therapy. Since infertility in survivorship is known to increase distress and contribute to decreased quality of life, upfront oncofertility discussions must be more embedded into our programmatic education. To increase the prevalence and depth of fertility preservation counseling among Blood and Marrow Transplant (BMT) and cellular therapy patients, the BMT oncofertility Coordinator role was developed. Methods, Intervention, & Analysis Two BMT advance practice providers and one Transplant Coordinator completed the ECHO (Enriching Communication Skills for Health Professionals in Oncofertility) training program through the Moffitt Cancer Center to deepen knowledge of oncofertility in our patient population. Through multidisciplinary working groups with institutional fertility specialists, the BMT team developed an algorithm and standardized workflow. A BMT oncofertility Coordinator role was developed to ensure each BMT patient of reproductive age receives individual reproductive counseling, options to preserve, a same day referral to reproductive endocrinology, and support through complex coordination of care and financial support services once a fertility treatment option has been determined. If fertility preservation is not possible, the Coordinator provides the information and counseling that increase patients' quality of life before, during and after cancer treatment. Findings & Interpretation Between September 2018 and September 2019, in the first year of this service the oncofertility Coordinator has consulted with 102 patients of reproductive age. This role has assisted in addressing critical timeframes ensuring prompt referral to fertility preservation, access to fertility resources, as well as ensuring documentation of fertility preservation discussions in the medical record. Discussion & Implications The role of the BMT oncofertility Coordinator has increased access to supportive oncofertility care at the time of cancer diagnosis for both BMT patients and patients across the health system as other clinics have begun consulting the BMT oncofertility Coordinator. Increased awareness of the oncofertility services available is needed to ensure all patients of reproductive age are aware of their options for fertility preservation and are given the opportunity to have the family they may desire.
Barbara Adlerbrecher - One of the best experts on this subject based on the ideXlab platform.
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identification and utilization of pre search killer cell immunoglobulin type receptor kir b x unrelated donors improves the selection of kir favorable donors the Transplant Coordinator perspective
Biology of Blood and Marrow Transplantation, 2020Co-Authors: Barbara Adlerbrecher, Katayoon Modjarradshaw, Angelica Panganiban, Dawn Wakefield, Claritza Sanabria, Maridel Tenned, Jacklyn Russo, Ann Ferolinocot, Gabrielle Marczewski, Nancy DurningAbstract:Background KIR B(x) haplotype donors have been reported to improve outcomes in patients (pts) receiving unrelated donors (URD) for myeloid malignancies, non-Hodgkin's lymphoma (NHL) and multiple myeloma (MM). Donors are categorized as KIR “Best” or “Better”. Our center performs donor KIR genotyping and haplotype assignment routinely as part of our URD evaluation for pts undergoing Transplantation for myeloid disorders, NHL and MM. When presented with multiple equivalently HLA matched URDs, our physicians will prioritize KIR B(X) donors over KIR A/A donors. Weisdorf et. al. (BBMT 2018) suggested that pre-search donor KIR genotyping would accelerate/optimize donor selection. Since 2015, donor KIR genotyping data for > 3 million donors from the DKMS registry is available. We investigated our ability to enhance KIR-favorable donor selections using the DKMS pre-search KIR. Methods In 2018 we requested access to individual KIR donor typing through the National Marrow Donor Program (NMDP) Scientific Services for donors registered by DKMS Germany, DKMS Poland and obtained access to the DKMS Donor Navigator website. Pts with multiple suitable donors were sorted for KIR, if registered by DKMS. Up to 6 donors per patient were selected from the pre-search KIR B(x) donors who ranked KIR “Best”, “Better” and “Neutral”. For pts whose pre-search screen did not identify an adequate number of KIR B(x) informative donors we selected additional donors (KIR unknown) for confirmatory typing. Results Thirty-five pts had informative KIR B(x) pre-search donors identified. There were 1-27 KIR B(x) available donors per pt. The online KIR B Content Calculator ranked these donors as KIR “Best”, “Better”, or “Neutral”. Donors were selected by the physicians, who were unaware of the pre-search ranking. As of Oct 2019, 23 pts were Transplanted, 4 are pending. Of these 27 donors selected, 18 were identified in the pre-search group. Six donors (33%) were ranked KIR B “Best”, 10 (55%) “Better”, and 2 (11%) “Neutral”. Nine pts used donors without a pre-search. Five pts did not proceed to an URD Transplant, and 3 pts have ongoing searches. Using the pre-search information, 66% of pts received a KIR B(x) donor and we were able to enrich KIR B(x) “Best” and “Better” donor options. Based on registry data, approximately 11%, 20% and 69% of donors randomly selected from a donor registry will be ranked KIR “Best”, “Better” and “Neutral “respectively. For our pt population, we were able to more than double the selection of KIR “Best” and “Better” donors for Transplantation. Conclusion The inclusion of KIR donor genotyping on donor registries enriches the number of preferred KIR B (x) donors available and allows a more efficient selection of KIR “Best” and “Better” donors.
Luis Antonio Diaz - One of the best experts on this subject based on the ideXlab platform.
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prioritization for liver Transplantation using the meld score in chile inequities generated by meld exceptions a collaboration between the chilean liver Transplant programs the public health institute and the national Transplant Coordinator
Annals of Hepatology, 2019Co-Authors: Luis Antonio Diaz, Blanca Norero, Barbara Lara, Camila Robles, Susana Elgueta, R Humeres, Jaime Poniachik, Guillermo Silva, Rodrigo Wolff, Franco InnocentiAbstract:Abstract Introduction and aim The MELD score has been established as an efficient and rigorous prioritization system for liver Transplant (LT). Our study aimed to evaluate the effectiveness of the MELD score as a system for prioritization for LT, in terms of decreasing the dropout rate in the waiting list and maintaining an adequate survival post-LT in Chile. Materials and methods We analyzed the Chilean Public Health Institute liver Transplant registry of candidates listed from October 15th 2011 to December 31st 2014. We included adult candidates (>15 years old) listed for elective cadaveric LT with a MELD score of 15 or higher. Statistical analysis included survival curves (Kaplan–Meier), log-rank statistics and multivariate logistic regression. Results 420 candidates were analyzed. Mean age was 53.6 ± 11.8 years, and 244 were men (58%). Causes of LT included: Liver cirrhosis without exceptions (HC) 177 (66.4%); hepatocellular carcinoma (HCC) 111 (26.4%); cirrhosis with non-HCC exceptions 102 (24.3%) and non-cirrhotic candidates 30 (7.2%). LT rate was 43.2%. The dropout rate was 37.6% at 1-year. Even though the LT rate was higher, the annual dropout rate was significantly higher in cirrhotic candidates (without exceptions) compared with cirrhotics with HCC, and non-HCC exceptions plus non-cirrhotic candidates (47.9%; 37.2% and 24.2%, respectively, with p = 0.004). Post-LT survival was 84% per year, with no significant differences between the three groups (p = 0.95). Conclusion Prioritization for LT using the MELD score system has not decreased the dropout rate in Chile (persistent low donor's rate). Exceptions generate inequities in dropout rate, disadvantaging patients without exceptions.
