Patient Oriented Research in Kidney Disease and Transplant Surgery

总结 在美国，超过60万成年人患有ESRD。对于合适的患者，肾移植（KT） 降低死亡率，提高生活质量，并节省大量的医疗保险资金。然而，选择患者 对于KT可能是具有挑战性的，特别是在某些亚群中，如老年人，目前的指标是 在告知临床决策方面的效用有限。此外，一旦选择KT，患者面临类似的 在考虑已故捐赠者的提议或决定是否允许朋友或家人把自己 作为活体捐献者的风险预测哪些患者将从KT中受益，并将其最佳匹配到 正确的供体是患者、移植医生和转诊肾病学家最关心的问题之一。 这是一个K24中期职业生涯研究者奖的建议Dorry Segev，医学博士，博士，副教授 约翰霍普金斯大学的外科和流行病学教授。塞格夫医生负责三个主要的R 01资助的病人 为解决ESRD和KT临床决策的挑战而进行的研究工作：（1）前瞻性 老年透析患者和肾移植受者的虚弱和风险预测研究;（2）A 不相容性活体供肾的长期预后和生存获益的回顾性研究 移植;（3）肾脏捐献长期后遗症的多中心纵向研究。此外 为了实现个别赠款的目的，这些研究为辅助研究提供了丰富的基础， 学员，包括参与几个队列的数千名患者，以及许多机会， 先进的方法训练。Segev博士积极指导学生，居民，研究员和初级教师 在一个令人兴奋的，多学科的环境。 这个K24将为未来的学员提供利用Segev博士丰富的正在进行的研究组合的机会， 以下新目标：（1）更好地了解对老年人重要的透析和KT结局;（2） 量化不相容KT方案的次要风险;（3）阐明家族、遗传和非肾脏风险 （4）设计模型，协助幼稚园候选人作出器官捐赠的决定;及（5） 扩大Segev博士的能力，通过追求指导ESRD和KT的下一代临床科学家 在指导的正式培训，从JHU的专家学习领导技能，继续培养多学科 整个机构的合作，与来自全国各地的导师和学员联系，以及 改进课程，向外科医生和其他临床医生教授以病人为导向的研究

Summary Over 600,000 adults in the US suffer from ESRD. For the appropriate patients, kidney transplantation (KT) reduces mortality, improves quality of life, and saves substantial Medicare dollars. However, selecting patients for KT can be challenging, particularly among certain subgroups such as older adults, and current metrics are of limited utility in informing clinical decision-making. Furthermore, once selected for KT, patients face similar challenges when considering deceased donor offers or deciding if to allow friends or family to put themselves at risk as living donors. Predicting which patients would benefit from KT, and optimally matching them to the right donor, is one of the most critical concerns for patients, transplant physicians, and referring nephrologists. This is a proposal for a K24 Midcareer Investigator Award for Dorry Segev, MD, PhD, an Associate Professor of Surgery and Epidemiology at Johns Hopkins University. Dr. Segev leads three major R01-funded patient- oriented research efforts to address the challenges of ESRD and KT clinical decision-making: (1) A prospective study of frailty and risk prediction among older dialysis patients and kidney transplant recipients; (2) A retrospective study of long-term outcomes and survival benefit from incompatible live donor kidney transplantation; and (3) A multi-center longitudinal study of long-term sequelae of kidney donation. In addition to addressing the aims of the individual grants, these studies provide rich substrate for ancillary studies by mentees, including thousands of patients engaged in several cohorts, as well as many opportunities for advanced methodologic training. Dr. Segev is actively mentoring students, residents, fellows, and junior faculty in an exciting, productive multidisciplinary environment. This K24 will afford future mentees the opportunity to leverage Dr. Segev's rich ongoing research portfolio with the following new aims: (1) To better understand dialysis and KT outcomes important to older adults; (2) To quantify secondary risks of incompatible KT protocols; (3) To elucidate familial, genetic, and non-renal risks after kidney donation; (4) To design models to assist KT candidates with organ offer decisions; and (5) To expand Dr. Segev's capacity to mentor the next generation of clinician-scientists in ESRD and KT by pursuing formal training in mentoring, learning leadership skills from experts at JHU, continuing to foster multidisciplinary collaborations across the institution, connecting with mentors and mentees from across the country, and refining a curriculum for teaching patient-oriented research to surgeons and other clinicians