MedicalResearch.com Interview with:
Dr. Christina Lee Chung, MD Associate Professor Department of Dermatology Drexel University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In early 2016, five years after the inception of our specialty medical-surgical transplant dermatology center, we realized our nonwhite transplant patients were developing skin cancer at higher rates and found interesting trends. These data were published in a previous manuscript. One of the more striking findings was that these patients were developing a high proportion of skin cancer in non-sun-exposed areas such as the genital region. There are no standard guidelines regarding genital skin evaluation and it is unclear how often it is performed in any capacity amongst dermatologists, including practitioners in our center, quite frankly. Our group was concerned that we could be missing skin cancers in this “hidden” area in our high-risk organ transplant population so we launched a quality improvement initiative that incorporated thorough genital skin evaluation as a standard part of post-transplant skin cancer screening.
Fifteen months after we started this modified screening process, we decided to evaluate the results. To account for any variation in examination, we looked at the findings of a single practitioner. We found that genital lesions are common in the transplant population and include high rates of genital warts and skin cancer. However, patient awareness of the presence of genital lesions was alarmingly low. Nonwhite transplant patients, Black transplant recipients in particular, were disproportionately affected by both genital warts and genital skin cancer in our cohort. Similar to cervical cancer, high-risk HPV types were closely associated with genital squamous cell carcinoma development in our transplant population. (more…)
- Our study was motivated by the fact that we know live donor kidney transplants are associated with longer life expectancy and higher quality of life than deceased donor kidney transplants or long-term dialysis treatment. We also know that Black and Hispanic adults are more likely than White adults to have end-stage kidney disease but are less likely than White patients to receive live donor kidney transplants.
- Over the last 2 decades, there have been several transplant education programs implemented within transplant centers and dialysis centers, and legislative policies enacted to improve overall access to live donor kidney transplants for patients. We wanted to see whether these programs and policies resulted in narrowed racial and ethnic disparities in access to live donor kidney transplants in the United States.
- Advanced age (25.7%)
- Perceived poor health (12.0%)
- Comfortable with current modality (12.0%)
- Uninterested in further surgeries (11.9%)
- 13.2% of patients not interested in transplant indicated that “other” factors were responsible for their lack of interest. At the time of the study, we didn’t have any further insight into what might account for these “other” factors.
- Older (21.4% < 60 years vs 64.6%)
- More likely to be female (47.7% vs 36.6%)
- More likely to be white (43.9% vs 30.4%) and less likely to be Hispanic (14.7% vs 22.2%)
- More likely to be receiving in-center hemodialysis (92.0% vs 73.7%)
- More likely to have Medicare/Medicaid as primary insurance (91.3% vs. 77.3%)
- clinical remission induction (ie resolution of symptoms) and
- endoscopic remission or response (ie either healing or significant improvement of the bowel lining)
- N= 345 patients
- Brown: N=166
- IU: N=179
- Average age: 62 years
- Females: 72%
- IBD: 18%
- Immunosuppression: 24%
- Indication for FMT
- Recurrent CDI: 74%
- Refractory CDI: 26%
- Severe/complicated CDI: 13%
- Inpatient FMT: 17%
- Patient directed donor: 40%