Transplant Outcomes and Living Donation
Nephrology Fellowship, Stanford University; Transplant Research Fellowship, Washington University in St. Louis; Masters’ in Clinical Epidemiology, Stanford University; PhD in Public Health, Saint Louis University
Professor of Medicine with tenure, and Director of Living Donation, SSM Saint Louis University Transplant Center
My current projects include NIH-funded collaborations related to improving health outcomes of African American living donors, and balancing efficacy and morbidity in immunosuppression choices. Foundation funding (Mid-America Transplant) supports work to reduce organ discards, including appropriate use of organs from Hepatitis C-positive donors. In partnership with Dan Brennan, I am Co-PI of one of 13 clinical consortia in the NIH-sponsored “APOL1 Long-term Kidney Transplantation Outcomes” (APOLLO) U01. I am ex-officio chair of the OPTN/UNOS Living Donor Committee, and participate on the AST LDCOP executive committee, the SRTR “Living Donor Collective” steering committee, the ASN Quality Committee, and KDIGO and AHA work groups. I am an associate editor for AJT and section editor for Current Transplantation Reports.
What made you decide to work in transplantation?:
Upon moving to St. Louis during my nephrology fellowship and masters’ training in clinical epidemiology 15 years ago, I was privileged to receive transformative exposure to the profound impact of transplantation and organ donation on patients’ lives. The complimentary mentorship of Dan Brennan and Mark Schnitzler combined clinical insights with an opportunity to learn to apply “big data” to help optimize the use and outcomes of donated organs as a public trust. A memorable spark for my clinical focus on living donation came during my first clinic as an attending, when I was tasked with performing a living donor evaluation and struck by the paucity of outcomes data, policy and guidelines to inform myself and the donor candidate. Over the ensuing decade and half, I continue to be inspired to address such knowledge gaps by mentors and role models across transplant disciplines (incl. Bert Kasiske, Dorry Segev, Amit Garg, Dave Axelrod, Andy Levey, Bob Gaston, Christie Thomas, Matt Weir, Chuck Herzog) and by wonderful, talented collaborators I need an appendix to thank! The rapid pace of evolving clinical needs in our field challenges me to pursue new ways to help advance clinical and cost-effective care for the patients we serve.
What do you find to be the most valuable aspect of your work?:
I am sustained by the unique opportunity to leverage a national transplant registry in combination with other electronic health information sources as a methodological approach to impactful clinical science. Participation in grassroots self-governance through OPTN/UNOS committees has been an honor that grounds my perspective in policy implications of research and practice innovation. I have grown through work on professional society committees (e.g., AST, ASN, NKF, AHA). Immersion in a KDIGO living donation guideline workgroup was defining, as the process draws on international collaboration and public comment to ensure broad stakeholder engagement. Working in our field provides opportunities to travel and learn from colleagues across the country and the world. But what motivates me daily is the privilege of interacting with living donors, transplant patients and families in clinical settings, and through committees and advocacy groups, as reminders of the awe-inspiring altruism of organ donors and the courage, hope and gratitude of those who seek and receive transplants.