Jonathan A Fridell

Publications (76) View all

• Article: Impact of Tacrolimus-Sirolimus Maintenance Immunosuppression on Proteinuria and Kidney Function in Pancreas Transplant Alone Recipients.

  Praveen Kandula, Jonathan Fridell, Tim E Taber, Asif Sharfuddin, Muhammad S Yaqub, Carrie L Phillips, Jeannie Chen, Muhammad Mujtaba
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  ABSTRACT: BACKGROUND: Nephrotoxicity is a major complication with immunosuppression regimens used in transplantation. Calcineurin inhibitor-sparing or reduction regimens using sirolimus (SRL) have shown variable success in kidney transplantation. There is limited data on the role of SRL on native kidney function in pancreas transplantation. METHODS: All patients undergoing pancreas transplantation from 2003 to 2010 were enrolled in this study (n=65). Patient demographic characteristics were identified and divided into two groups: those receiving tacrolimus (Tac) in combination with mycophenolate mofetil (MMF) and those maintained on a regimen of Tac and SRL with or without MMF. The slopes for estimated glomerular filtration rate (eGFR), serum creatinine level (sCr), and proteinuria changes over time were assessed between groups. Urine protein and creatinine ratio (uPr/uCr) was used to assess proteinuria. RESULTS: There was no difference in baseline demographic characteristics. Patients were followed for a median of 3 years. Baseline sCr and eGFR were similar between groups. Differences in uPr/uCr and rate of change in sCr and eGFR were not significant between the groups overall or for any specific time. There was worsening of sCr, eGFR, and uPr/uCr within the groups over the period of study. There were no significant differences when groups were split by age or gender or when the SRL group was split further based on MMF inclusion. CONCLUSIONS: Our study findings suggest that using a Tac-SRL regimen in patients with pancreas alone transplantation is a safe approach and may not lead to worsening proteinuria and kidney function when compared with regimens using Tac with MMF.
  Transplantation 10/2012; · 4.00 Impact Factor
• Article: Impact of Positive Flow Cytometry Crossmatch on Outcomes of Intestinal/Multivisceral Transplantation: Role Anti-IL-2 Receptor Antibody.

  Chandrashekhar A Kubal, Richard S Mangus, Rodrigo M Vianna, Andrew Lobashevsky, Mohammad A Mujtaba, Nancy Higgins, Thiago Beduschi, Jonathan A Fridell, A Joseph Tector
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  ABSTRACT: BACKGROUND: Positive crossmatch may be associated with an increased risk of acute rejection (AR) and worse overall outcomes after intestinal/multivisceral (MV) transplantation. However, the evidence from published studies in this setting is sparse and contradictory. This study reports the impact of positive flow cytometry crossmatch on clinical outcomes after intestinal/MV transplantation and the use of anti-interleukin (IL)-2 receptor antibody as a maintenance immunosuppressant. METHODS: Records of all intestinal/MV transplants from 2003 to 2010 were reviewed. Flow cytometry was used to evaluate T- and B-cell crossmatch status. Standard immunosuppression included rabbit anti-thymocyte globulin-rituximab induction with tacrolimus and steroid maintenance. From 2008 onwards (second era), monthly anti-IL-2 receptor antibody was added to the maintenance immunosuppression in patients receiving liver-excluding transplants. RESULTS: Of 131 intestinal/MV transplants, 27 (21%) had a positive crossmatch. Positive crossmatch was not associated with an increased incidence of AR and graft loss (30% and 37% vs. 29% and 47%; P=0.94 and 0.35, respectively). This effect was maintained in liver-excluding transplants. Overall rate of AR decreased from 39% to 22% in the second era. In liver-excluding transplants, there was a significant decrease in AR from 75% to 44% with the use of anti-IL-2 receptor antibody therapy. CONCLUSIONS: With rabbit anti-thymocyte globulin-rituximab induction, positive crossmatch status is not associated with worse outcomes after intestinal/MV transplantation. Use of anti-IL-2 receptor antibody as a part of maintenance immunosuppression may be beneficial in liver-excluding transplants.
  Transplantation 02/2013; · 4.00 Impact Factor
• Article: Impact of recipient age on whole organ pancreas transplantation.

  Ashesh P Shah, Richard S Mangus, John A Powelson, Kannan P Samy, Tim E Taber, Michelle L Goble, Jonathan A Fridell
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  ABSTRACT: AIM: The goal of this study was to assess the impact of recipient age on post-transplant outcome. METHODS: All pancreas transplants performed at Indiana University between 2003 and 2011 were reviewed. Demographic data were compared using standard chi-square and ANOVA testing. Standard Cox regression survival analysis was performed using a direct entry method for covariates. RESULTS: Patients (n = 405) were divided by decade: <30 yr (n = 37), 30-39 (n = 109), 40-49 (n = 156), 50-59 (n = 85), and ≥60 yr of age (n = 18). Group demographics did not differ except for median ischemia time, which was between 7.0 and 8.5 h (p = 0.02). Early graft loss and one yr graft and patient survival were similar between the groups. Long-term patient survival demonstrated a trend toward decreased five-yr survival with increasing recipient age (p = NS). Graft survival at five yr by Cox regression was the lowest for the <30 yr group (74%), while all other groups were similar around 80% (p = NS). CONCLUSION: No statistically significant differences in pancreas transplant outcomes were demonstrated when recipients were stratified by recipient age. These results suggest that older recipients can successfully undergo pancreas transplantation and expect five-yr outcomes similar to those seen in younger recipients.
  Clinical Transplantation 12/2012; · 1.67 Impact Factor
• Article: Early findings of prospective anti-HLA donor specific antibodies monitoring study in pancreas transplantation: Indiana University Health Experience.

  Muhammad A Mujtaba, Jonathan A Fridell, Nancy Higgins, Asif A Sharfuddin, Muhammad S Yaqub, Praveen Kandula, Jeanne Chen, Dennis P Mishler, Andrew Lobashevsky, Benita Book, John Powelson, Tim E Taber
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  ABSTRACT: The significance of donor-specific antibodies (DSA) is not well known in the setting of pancreas transplantation. Since December 2009, we prospectively followed pancreas transplant patients with single-antigen-luminex-bead testing at one, two, three, six, and then every six months for the first two yr. Thirty-five of the 92 patients that underwent pancreas transplantation (13 pancreas-alone [PTA], 20 with a kidney [SPK], and two after a kidney [PAK]) agreed to participate in study. Median age at transplant was 45 yr and follow-up was 23 months. Majority were Caucasian (n = 33) and male (n = 18). Rabbit anti-thymocyte globulin induction was used. Median HLA-mismatch was 4.2 ± 1.1. Eight patients (7SPK, 1PAK) developed post-transplant DSA at median follow-up of 76 d (26-119), 1 SPK had pre-formed DSA. Seven patients had both class I and class II DSA, one with class I and one with class II only. Mean peak class I DSA-MFI was 3529 (±1456); class II DSA-MFI was 5734 (±3204) whereas cumulative DSA MFI (CI + CII) was 9264 (±4233). No difference was observed in the patient and donor demographics among patients with and without DSA. One patient in non-DSA group developed acute cellular rejection of pancreas. From our data it appears that post-transplant DSA in pancreas allograft recipients may not impact the early-pancreatic allograft outcomes. The utility of prospective DSA monitoring in pancreatic transplant patients needs further evaluation and long-term follow-up.
  Clinical Transplantation 09/2012; 26(5):E492-9. · 1.67 Impact Factor
• Article: Pancreas transplantation in the new millennium: the Indiana University experience.

  Jonathan A Fridell, Richard S Mangus, John A Powelson, Muhammad A Mujtaba, Jeanne M Chen, Tim E Taber
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  ABSTRACT: Pancreas transplantation is one of the great challenges of modern abdominal transplantation. Success relies on a dedicated group of individuals, working together at all levels of care, to demonstrate experience and expertise from the pre-transplant evaluation to long-term followup. The pancreas transplant program at Indiana University is currently one of the most active in the Nation. With increased activity, we have begun to accept more complicated recipients including older and more obese individuals, retransplant candidates, and recipients with atherosclerotic diseases. We have been able to modify the operation in order to make it safer for recipients and we have documented our complications in the literature along with strategies and suggestions to avoid and manage them. Overall, we have found this to be an extremely grateful patient population and a very rewarding experience.
  Clinical transplants 01/2011;