Stephen C. Jensik

Rush University Medical Center, Chicago, Illinois, United States

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Publications (38)81.7 Total impact

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    ABSTRACT: IntroductionThe decision for isolated kidney transplant (KT) versus combined liver-kidney transplant (CLKT) in patients with end stage renal disease (ESRD) with compensated cirrhosis remains controversial. We sought to determine outcomes of patients requiring listing for a liver transplant (LT) following either a cadaveric or living donor kidney transplant and compare these outcomes to similar patients receiving a CLKT.Methods Our dataset included the UNOS/STAR kidney files from 1987-2012 after being joined with the liver files from 2002-2012. Outcomes of patients who received a CLKT with an INR ≤ 1 and Total Bilirubin ≤ 1 were compared to patients who received a primary KT and subsequently required listing for LT between 0-5 years or after 5 years.ResultsFor the three groups, 244 patients had a CLKT, 216 were waitlisted for LT between 0-5 years after KT (0-5WL), and 320 were waitlisted 5 years after KT (+5WL). From the time of KT, the 0-5WL group had significantly worse survival than the CLKT group and the +5WL group. The +5WL had the best survival of all groups. For the 0-5WL group, 45% underwent LT and 40% died while waiting compared to the +5WL group with 53% having LT and 26% died while waiting. At the time of LT, the 0-5WL group had a higher MELD score, higher incidence of being in the ICU at the time of transplant, and higher incidence of requiring life support. From the time of LT, the CLKT trended towards better survival (p=0.0549) than both the 0-5WL and +5WL groups, which had equivalent survival.Conclusion The 0-5 WL group is a higher risk group with poorer survival due to a higher incidence of dying on the waitlist. Better identification of patients with a high risk for hepatic decompensation following KT and agreement for regional exception for LT in the event of decompensation may improve utilization of organs and better survival for those patients.This article is protected by copyright. All rights reserved.
    Clinical Transplantation 11/2014; 29(1). DOI:10.1111/ctr.12484 · 1.52 Impact Factor
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    ABSTRACT: This study explored the safety and efficacy of recombinant type I pancreatic elastase (PRT-201) topically applied once to the external surface of an arteriovenous fistula. This was a randomized, double-blind, placebo-controlled trial. Adults with kidney disease undergoing creation of a radiocephalic fistula (RCF) or brachiocephalic fistula were randomized to treatment with placebo (n = 51), PRT-201 at 10 μg (n = 51), or PRT-201 at 30 μg (n = 49). The primary efficacy measure was unassisted primary patency (PP) over 1 year. Secondary efficacy measures were secondary patency (SP), unassisted maturation by ultrasound interrogation, use for hemodialysis, and hemodynamically significant lumen stenosis. Median PP was 224 days for placebo and >365 days for the PRT-201 groups. At 1 year, 45%, 54%, and 53% of placebo, 10-μg, and 30-μg patients retained PP. The risk of PP loss was nonsignificantly reduced for 10 μg (hazard ratio [HR], 0.69; P = .19) and 30 μg (HR, 0.67; P = .17) vs placebo. In the subset (44% of patients) with a RCF, the median PP was 125 days for placebo and >365 days for the PRT-201 groups. At 1 year, 31%, 50%, and 63% of placebo, 10-μg, and 30-μg RCFs retained PP. The risk of RCF PP loss was nonsignificantly reduced by 10 μg (HR, 0.59; P = .18) and significantly reduced by 30 μg (HR, 0.37; P = .02) vs placebo. At 1 year, 77%, 81%, and 83% of placebo, 10-μg, and 30-μg patients retained SP. The risk of SP loss was nonsignificantly reduced for 10 μg (HR, 0.79; P = .61) and 30 μg (HR, 0.76; P = .55) vs placebo. In the subset with RCFs, 65%, 82%, and 90% of placebo, 10-μg, and 30-μg patients retained SP at 1 year. The risk of RCF SP loss was nonsignificantly reduced for 10 μg (HR, 0.45; P = .19) and 30 μg (HR, 0.27; P = .08) vs placebo. At month 3, 67%, 87% (P = .03), and 92% (P < .01) of the placebo, 10-μg, and 30-μg group fistulas had unassisted maturation by ultrasound interrogation. At month 3 in the subset with an RCF, 47%, 74% (P = .17), and 93% (P < .01) of placebo, 10-μg, and 30-μg group fistulas had unassisted maturation by ultrasound interrogation. Adverse event reports were not meaningfully different between groups. PRT-201 appeared safe. The primary efficacy end point was not met. However, both PRT-201 doses were associated with improved unassisted maturation. The 30-μg dose was associated with increased PP in the subset with RCF.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 03/2014; 60(2). DOI:10.1016/j.jvs.2014.02.037 · 3.02 Impact Factor
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    ABSTRACT: A modified technique for placement of the venous outflow component (VOC) of the Hemodialysis Reliable Outflow (HeRO) device (Hemosphere Inc, Minneapolis, Minn) is described. The purpose of the technique is to improve the system's trackability and facilitate device insertion in patients with central venous occlusion. Device preparation requires placement of a 6-mm × 4-cm angioplasty balloon within the leading end of the VOC. The leading 2 cm of the balloon are placed just distal to the radiopaque marker of the VOC. The balloon is inflated to profile and locked in this position within the leading end of the VOC. The VOC and balloon combination is advanced over the wire through the 20F peel-away sheath provided by the manufacturer. The described technique was used to successfully implant the HeRO device in 12 patients with central venous occlusion. This technique is recommended for placement of the VOC of the HeRO device in patients with central venous occlusions.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 05/2013; 58(4). DOI:10.1016/j.jvs.2013.03.011 · 3.02 Impact Factor
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    ABSTRACT: Aim To investigate the case of a potential Living Donor Renal Transplant with Negative CDC-AHG and Positive Flow cross match with diluted serum sample having high to moderate levels of multiple Class I and Class II DSAs. Methods Both Patient and living related donor were HLAtyped for A, B, C, DR, DQ, DP by reverse SSOP-PCR.ClassI and ClassII HLA specific antibodies were determined by Luminex based single antigen bead assay. Serum samples before and after plasmapheresis/IVIG were tested for antibodies with and without OTTtreatment. One of the current serum samples was also tested for HLA-Specific IgM antibodies, and Clq binding antibodies. T and Bcell cross matches were performed on pronase treated cells by Flow cytometry using serum samples with and without OTTtreatment. The CDCAHG assay was performed on serum samples with and without OTT treatment. Results The patient consistently had both Class I and Class II DSAs against A74, Cw2, Cw4, DRl3, DR1S, DRS1, and DRS2 on serum samples collected in March 2012, and July 2012. After 2 rounds of plasmapheresis and IVIG treatment in the last week of July 2012, the DSA levels remained high, although the MFI values of some of the DSAs dropped insignificantly. The flow cytometry cross match was negative with untreated serum before plasmapheresis and was positive on NHS mixed serum (which is a 1:2 dilution), and in serum diluted 1:2 using PBSindicating a slight prozone effect. The CDC-AHG and CDCAmos cross matches with T and B cells were positive on untreated pre-plasmapheresis serum sample. However, after Dn treatment, the CDC-AHG and CDC-Amos cross matches were negative for both T and B cells indicating the CDC reactivity in untreated serum sample was due to IgM antibodies. It is to be noted that this same serum sample had multiple Class I and Class II DSAs detected by the Luminex SAB assay using anti-lgG as secondary antibodies. In order to determine the complement activating function of these DSAs, the pre-plasmapheresis serum sample was tested by C1qbinding assay and it turns out that there were no DSAs that reacted in the C1q binding assay. We also tested this pre-plasmapheresis serum for IgM class of HLA Class I & II antibodies, and only 4 Class I and 2 Class II antibodies were identified-none were DSAs; however the IgM class of HLA-A23 antibody could have clones that might react with the 9p public Epitope on the Donor’s HLA-A 2. And the Cw1 antibody could cross react with the donor’s Cw4 which might have contributed for the allo CDCT and B cell cross match reaction with untreated serum. Two serum samples were tested after plasmapheresis for DSAs, T and B cell flow and CDC-AHG cross match and the reaction pattern remained the almost the same except that the Flow cytometry cross match was positive on undiluted serum sample as well and CDC-AHG was positive with B cells using untreated serum, and negative when tested with Dn treated serum. In general, it appears that the patient has high levels of DSAs likely to be of the non-complement binding or weakly complement binding class of IgG antibodies namely, IgG2/4 subtypes. The Clinical implications of these indings will be discussed.

  • Journal of Vascular and Interventional Radiology 03/2012; 23(3):S42-S43. DOI:10.1016/j.jvir.2011.12.138 · 2.41 Impact Factor

  • Human Immunology; 10/2011
  • D Mital · R Nubani · S Jensik · S Saltzberg · M DyLiacco · E Chan · F Dodson ·

    Transplantation 07/2008; 86(Supplement). DOI:10.1097/ · 3.83 Impact Factor

  • Human Immunology - HUM IMMUNOL; 10/2007
  • K C Latchamsetty · D Mital · S Jensik · C L Coogan ·
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    ABSTRACT: Reports in the literature suggest the incidence of vesicoureteral reflux (VUR) in transplanted kidneys to range from 2-79%. Collagen injections have been used with reported success rates of up to 65% to prevent VUR into native orifices in children, but have not been studied in transplant neo-orifices. We evaluated the use of collagen injections in seven patients with transplant kidney neo-orifices who displayed grades II-IV VUR and seemed to be related to symptomatic urinary tract infections (UTIs). Postoperative VCUGs obtained at 2 months showed improvement in the grade of reflux in four of seven (57.1%) patients; one (14.3%), no change; and two (28.6%), worse reflux. All patients also redeveloped symptomatic UTIs after collagen injection. We conclude that the use of collagen injections in kidney transplant neo-orifices did not prevent VUR. Although prevention of VUR may have been achieved short term, VCUG examinations 2 months after initial injection revealed persistent reflux. Etiologies for failure to prevent VUR may be the readily absorbable nature of collagen, technical aspects of the procedure, the degree of reflux, and anatomic differences between native orifices (which lie on a well-supported trigone) and transplant neo-orifices (which lie on the posterior wall with less support).
    Transplantation Proceedings 07/2003; 35(4):1378-80. DOI:10.1016/S0041-1345(03)00448-2 · 0.98 Impact Factor
  • D Mital · C L Coogan · S C Jensik ·

    Transplantation Proceedings 04/2003; 35(2):835-7. DOI:10.1016/S0041-1345(02)04021-6 · 0.98 Impact Factor
  • D Mital · W Podlasek · S C Jensik ·

    Transplantation Proceedings 09/2002; 34(5):1709-10. DOI:10.1016/S0041-1345(02)02992-5 · 0.98 Impact Factor
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    ABSTRACT: Leflunomide (Arava), a drug widely used for treatment of rheumatoid arthritis, has a very promising background in experimental transplantation. Its activity in experimental models of chronic rejection, its synergy with calcineurin phosphatase inhibitors, and its inhibitory effects on herpes virus replication are compelling reasons to pursue its clinical evaluation in transplantation. We report the use of this drug over the past 3 years in various clinical situations. A retrospective review was performed in 53 liver and kidney transplant recipients receiving Arava. A single-dose pharmacokinetic (PK) study was first performed in stable, renal transplant recipients, and an initially targeted serum level of 100 microg/mL (300 microM) was calculated to require a loading dose of 1200-1400 mg over a 7-day period. We correlate the appearance of toxicity with serum levels of active drug and review the outcomes in patients whose clinical condition required dose reductions of conventional immune suppressive drugs. Fifty-three patients received leflunomide from 5 days to more than 430 days, and 37 patients received the drug for more than 60 days. The primary toxicity was anemia in the renal transplant patients and elevation of liver enzymes in the liver transplant patients. At comparable oral doses, serum levels were substantially lower and anemia more common in patients with serum creatinine >3 mg/dL. In liver and renal recipients with serum creatinine <3 mg/dL, the drug was well tolerated and dose-limiting side effects occurred in less than 15% when drug serum levels were less than 80 microg/ml. Patients with serum creatinine >3 mg/dL often required serum levels of active drug reduced to <60 microg/mL. In 12 of 18 renal patients treated for 200 days or more, the dose of cyclosporine or Prograf was reduced by a mean of 38.5% and stopped in one patient. The prednisone dose was reduced by a mean of 25% in these same 13 patients. Cyclosporine or FK506 was stopped completely in four liver recipients and reduced by 65% in another patient. No evidence of acute rejection developed in any of these liver or kidney transplant patients. Leflunomide seems to possess substantial immune suppressive potency in renal and liver transplant recipients and may be safely dosed for more than 300 days. The data suggest that calcineurin phosphatase inhibitors and prednisone can be safely reduced in patients with serum levels of active drug above 50 microg/mL. Because of a wide inter-patient range of active metabolite terminal half-life (>300%), monitoring of serum levels would seem to be an important part of its evaluation.
    Transplantation 02/2002; 73(3):358-66. DOI:10.1097/00007890-200202150-00008 · 3.83 Impact Factor

  • Transplantation 04/2000; 69(Supplement):S182. DOI:10.1097/00007890-200004271-00263 · 3.83 Impact Factor
  • Z Guo · B J Hering · D Mital · Y Huang · J Shen · T Wu · S C Jensik · H J Zhang · D ER Sutherland · J W Williams ·

    Transplantation 05/1999; 67(9). DOI:10.1097/00007890-199905150-00054 · 3.83 Impact Factor

  • Transplantation 04/1999; 67(7). DOI:10.1097/00007890-199904150-00525 · 3.83 Impact Factor
  • Z Guo · J Shen · D Mital · Y Hong · S.C. Jensik · R Alemany · W W Zhong · J.W. Williams ·

    Transplantation Proceedings 02/1999; 31(1-2):794. DOI:10.1016/S0041-1345(98)01772-2 · 0.98 Impact Factor
  • Z Guo · J Shen · D Mital · Y Hong · S C Jensik · J W Williams ·

    Transplantation Proceedings 02/1999; 31(1-2):622. DOI:10.1016/S0041-1345(98)01584-X · 0.98 Impact Factor
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    ABSTRACT: Chronic allograft rejection remains a major barrier to successful long-term allograft transplantation in humans. Chronic allograft rejection is characterized by the appearance of arterial lesions with concentric intimal thickening. This study investigates the development and control of chronic rejection in hamster cardiac xenografts transplanted into Lewis rats. Chronic rejection in the xenograft model involves transplantation of hamster hearts into Lewis rats treated with leflunomide (Lef) continuously at 15 mg/kg/day. The allograft model involves transplantation of Lewis hearts into Fisher-334 rats treated with cyclosporine (CsA) at 2.5 mg/kg for 5 days. The average scores of arterial intimal thickening on day 45 after transplantation were 1.89+/-0.43 in the xenograft and 2.50+/-0.72 in the allograft. The basic pathology of both xenografts and allografts undergoing chronic rejection was arterial intimal thickening comprising smooth muscle cell proliferation, mononuclear cell infiltration, and fibrosis. The majority of cells infiltrating the arterial intima and myocardium were T cells and macrophages. Compared with the allograft, intimal edema, matrix deposition and fibrinoid necrosis were specifically presented in the xenografts and generally involved the larger arteries. The predominant isotype of antibody deposited was IgM in xenografts and IgG in allografts. When combined Lef and CsA therapy was initiated on day 45 after transplantation, the changes of chronic rejection were reversed in both xenografts and allografts by day 90. The scores of intimal thickening were significantly reduced to 0.97+/-0.45 and 1.48+/-0.56, respectively. We conclude that chronic rejection can be induced in xenografts under conditions of inadequate immunosuppression. Chronic rejection in xenografts involves arterial lesions that bear some histological similarities to, as well as differences from, those observed in chronically rejected allografts. Finally, combination therapy with CsA and Lef reduced the incidence and severity of the intimal lesions in both chronically rejecting xenografts and allografts.
    Transplantation 10/1998; 66(6):692-8. DOI:10.1097/00007890-199809270-00002 · 3.83 Impact Factor

  • Transplantation 10/1998; 66(8):S4. DOI:10.1097/00007890-199810270-00046 · 3.83 Impact Factor
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    ABSTRACT: Although adenoviral vector-mediated gene transfer has significant potential for gene therapy, host immune responses to virally expressed proteins and small insert capacity may limit its clinical application. In order to overcome these disadvantages, a new adenoviral vector that lacks all viral genes has been developed. Using the green fluorescent (GFP) gene as a reporter gene, we investigated the efficiency of gene transfer by this all-viral-genes-deleted and minimal cis-element remaining adenoviral vector (miniAd-GFP) in islets in vitro and ex vivo, and compared it with the E1-deleted adenoviral vector (E1-GFP). One day after in vitro infection, GFP was expressed in both miniAd-GFP- and E1-GFP-infected islets. The percentage of GFP-positive single cells was not significantly different between miniAd-GFP-infected islets and E1-GFP-infected islets. When these islets were transplanted into syngeneic diabetic mice, both miniAd-GFP- and E1-GFP-infected islet grafts reversed diabetes, and normal blood glucose levels were maintained for over 20 weeks posttransplantation. Mild lymphocyte infiltration was found in all E1-GFP-infected islet grafts at all time points. However, this was not seen in most miniAd-GFP-infected islet grafts. Our results indicate that gene transfer by an adenoviral vector that lacks all viral genes is as efficient as E1-deleted adenoviral vector-mediated gene transfer in islets. Furthermore, this adenoviral vector might be less immunogeneic than the E1-deleted adenoviral vector.
    Cell Transplantation 10/1998; 8(6):661-71. DOI:10.1097/00007890-199810270-00190 · 3.13 Impact Factor

Publication Stats

424 Citations
81.70 Total Impact Points


  • 2007-2014
    • Rush University Medical Center
      • Department of Pathology
      Chicago, Illinois, United States
  • 2002
    • University of Chicago
      • Department of Surgery
      Chicago, Illinois, United States
  • 1999
    • University of Minnesota Duluth
      Duluth, Minnesota, United States
  • 1998
    • University of Illinois at Chicago
      • Division of Transplantation
      Chicago, Illinois, United States
  • 1997
    • Rush Medical College
      Chicago, Illinois, United States