Category Archives: Kidney

100 percent success rate for baby kidney transplants at U of M – KMSP-TV

This was originally published on this site

– Three-year-old London Hall has no problems keeping up with her brothers now, but as an infant it quickly became clear her twin brother was reaching milestones she wasn’t.

“[She was] three months old or so when we first started noticing that maybe when they were laying the floor she wasn’t moving her legs and arm quite as much,” said Gloria Hall, London’s mom.

Later when London struggled to eat and keep food down, her parents learned they were both carriers of a rare gene mutation, which was now preventing London’s kidney from processing proteins properly and she needed a transplant. At 17 months old, London received her mother’s kidney.

“I remember someone saying that you gave life to her twice: birth and then donating a kidney,” said Branden Hall, London’s dad.

London’s story is similar to the many success stories Dr. Srinath Chinnakotla from the University of Minnesota’s Amplatz Children’s Hospital recently researched. He studied pediatric kidney transplants at the U of M going back to the 1960’s and discovered most recently those performed on children under two years old have a 100 percent success rate after one year and five years. That’s better than any other age group.

“When a child has kidney failure and you put them on dialysis, the dialysis only purifies about 10 percent of the blood, so those children don’t develop well,” said Dr. Chinnakotla. “They have growth failure and they have problems in achieving milestones as well. The studies we’ve done at our institution show once you do the kidney transplant, boy, they quickly grow like a weed.”

Dr. Chinnakotla points out the U of M is a longtime pioneer of living donor transplants. He says transplant teams nationwide typically wait until a child is at least two years old. The Halls agree with Dr. Chinnakotla’s philosophy – some kids can’t afford to wait.

“I do feel like there is a little bit of a different connection there, you really would do anything for your kid,” said Gloria.

March 9 happens to be World Kidney Day. According to the National Kidney Foundation, there are an estimated 400,000 people living with kidney disease in Minnesota alone and nearly 9,000 are on either dialysis or the transplant wait list. Doctor Chinnakotla says roughly 10 percent of patients on that wait list are children.

Patient and Doctor Celebrate 50th Anniversary of Kidney Transplant – Rare Disease Report

This was originally published on this site

Fifty years ago, 6-year-old Tommy Hoag underwent a kidney transplant. It was February 1967 and pediatric nephrologist Richard Fine, MD at Children’s Hospital Los Angeles (CHLA) thought a kidney transplant was the only option for Tommy who had developed glomerulonephritis following a bout with Scarlet fever. 
 
At that time, kidney transplants had only been performed a few times in children and mostly in twins. The doctors were cautiously optimistic that the transplant would succeed and give Tommy a few more years of life. 
 
This week, Tommy and Dr Fine reunited for a special celebration at CHLA to celebrate the 50th anniversary of the transplant.
 
Tommy is 56 years old and still has that original transplanted kidney. Dr Fine is professor of Clinical Pediatrics at the Keck School of Medicine of USC.
 
In the audience for the celebration was 14-year-old Gemma Lafontant, CHLA’s most recent kidney transplant patient. Gemma has chronic kidney disease and received a pre-emptive donor kidney 3 weeks ago.

Let’s Get This Done

Tommy’s donor was his father. In recalling the 1967 operation, Tommy said “I remember being wheeled into the operating room and [my father] was already there and he was happy to see me.”
 
Tommy added, “My dad was a baseball fan, a die-hard Dodgers fan, and also a Babe Ruth fan. When he saw me, he said, ‘Come on in, Bambino! Let’s get this done!'”
 
Tommy’s transplanted kidney is, if not the longest, one of the longest functioning live donor kidneys in U.S. history.
 
Dr Fine commented, “Seeing Tommy here today, seeing how well he’s done for such a long period of time, I think, is one of the highlights of my career. We had no idea 50 years ago that we could accomplish having someone survive with one kidney for 50 years.”
 
During a press conference, Tommy was asked what the transplant meant to him and he responded, “I’ve lived my life. I’ve played baseball and golfed and went on vacations. Fifty years – there is a lot of stuff to do.”

About Glomerulonephritis

Glomerulonephritis is a type of kidney disease in which the part of the kidneys that filter waste and fluids from the blood is damaged. It may be acute or chronic (coming on gradually), and may occur on its own (primary) or be caused by another condition (secondary).
 
Symptoms
General symptoms include Blood in the urine (dark, rust-colored, or brown urine), foamy urine (due to excess protein in the urine) and swelling of the face, eyes, ankles, feet, legs, or abdomen. Abdominal pain, blood in the vomit or stools, cough and shortness of breath, diarrhea, fever and nosebleeds may occur.
 
Treatment
Treatment depends on the cause of the disorder, and the type and severity of symptoms. Controlling high blood pressure is usually the most important part of treatment. A procedure called plasmapheresis may sometimes be used for glomerulonephritis caused by immune problems. The fluid part of the blood that contains antibodies is removed and replaced with intravenous fluids or donated plasma (that does not contain antibodies). Removing antibodies may reduce inflammation in the kidney tissues. Patients with this condition should be closely watched for signs of kidney failure. Dialysis or a kidney transplant may eventually be needed.
 

Research provides insights on antibody-mediated rejection in kidney transplant patients – News-Medical.net

This was originally published on this site

New research provides insights on transplant recipients’ antibody responses against donor kidneys and how the timing of those responses can have important implications. The findings appear in an upcoming issue of the Journal of the American Society of Nephrology (JASN).

An antibody response against donor organs is the main cause of kidney rejection following transplantation. Antibodies can occur in 2 scenarios: before transplantation (pre-existing donor-specific antibodies) and after transplantation (de novo donor-specific antibodies). Little is known about how these processes compare.

Understanding the role of antibodies in transplant rejection is needed to guide matching of donors and recipients and to better prevent rejection. A team led by Alexandre Loupy, MD, PhD, Olivier Aubert, MD (INSERM U 970, Paris Translational Research Center for Organ Transplantation, in France), and Phil Halloran, MD, PhD (Alberta Transplant Applied Genomics Centre, in Canada) studied 205 patients who experienced antibody-mediated rejection following kidney transplantation: 103 patients had pre-existing donor-specific antibodies and 102 patients had de novo donor-specific antibodies.

There were various differences between patients with pre-existing vs. de novo donor-specific antibodies, but the most striking was the superior kidney survival experienced by the pre-existing group compared with the de novo group (63% vs. 34% at 8 years after rejection, respectively), regardless of treatment.

“Our study highlights that rejection due to antibodies that were present before transplantation is linked with a significantly better outcome that rejection due to de novo donor-specific antibodies,” said Dr. Aubert.

“Our results encourage the transplantation of patients who have antibodies before transplant. These patients would not normally have been considered as good candidates for transplantation and would have stayed on dialysis because of a high level of sensitization that prevents from finding a compatible kidney,” said Dr. Loupy. The findings also indicate the need to closely monitor patients for the development of de novo donor-specific antibodies so that therapies can be initiated to preserve kidney function.

Young children experience better long-term kidney transplant success than adults, study finds – News-Medical.net

This was originally published on this site

The success of kidney transplants has vastly improved for children over the past half-century, with young children now experiencing better long-term transplant success than adults, according to study results from a large pediatric transplant center. These findings are published online as an “article in press” on the Journal of the American College of Surgeons website in advance of print publication.

“The outlook for infants and children with end-stage kidney disease was once dismal, with poor survival rates after transplant,” said study principal investigator Srinath Chinnakotla, MD, FACS, an associate professor in the Department of Surgery at the University of Minnesota Masonic Children’s Hospital in Minneapolis, where the study was performed. “There has been great progress in pediatric kidney transplantation, and now the patient survival rate is almost 100 percent.”

Compared with the hospital’s one-year survival rate of 97 percent since 2002, only 85 percent of pediatric kidney transplant recipients were still alive one year after their transplant 40 to 50 years ago, the study data showed.

In this new analysis of medical records of 1,056 pediatric kidney transplants performed at the children’s hospital between June 1963 and October 2016, the researchers evaluated differences in rates of patient survival and other patient outcomes between three eras. Era 1 consisted of the early years of pediatric kidney transplantation, 1963 through 1983; Era 2 was from 1984 to 2001; and Era 3 encompassed 2002 to 2016.

Also improved over time is graft survival–continued function of the transplanted kidney–the investigators reported. In the first Era, only 42 percent of transplant recipients still had graft survival at 10 years, a statistic that improved to about 58 percent in Era 2 and 70 percent in Era 3.

“Thanks to advances in immunosuppressive [antirejection] medications including steroid-free drugs, better surgical technique, and improved management of infections after kidney transplant, children ages 10 years and younger now have the best long-term graft survival of all ages,” Dr. Chinnakotla said.

He added that kidney transplant is far less common in infants and children than in adults. Fewer than 720 of the nearly 18,600 kidney transplants performed in 2015 were in patients younger than 18 years, the Organ Procurement and Transplant Network (OPTN) reported.

Living-Donor Kidney Transplants

In this study, two transplant characteristics lowered the risk of graft loss (also called graft failure), which occurs when the donor kidney stops functioning. One characteristic was having a “preemptive” kidney transplant, meaning before the child started kidney dialysis. The other was when the donor kidney came from a living donor rather than a deceased donor. For the latter, the investigators reported the following:

  • In the current Era, the 10-year graft survival rate was 78 percent for living-donor transplants compared with 57 percent for kidneys from deceased donors.
  • Half of all living-donor transplants in Era 3 are projected to still be functioning (called the graft half-life) at 25 years, whereas half of deceased-donor grafts have a projected survival of 19 years.
  • Living-donor graft survival was superior even when the donor was not related to the transplant recipient.

“For children with end-stage kidney disease,” Dr. Chinnakotla said, “kidney transplant is the only therapy that offers them the long-term possibility of a near-normal life, and a living-donor graft is their best option.”

Nationwide, however, fewer young patients are benefiting from living-donor kidney transplant. Among all pediatric kidney transplants, the percentage that were living-donor grafts dropped from 50.1 percent in 2004 to 33.7 percent in 2015, per the OPTN. In the study by Dr. Chinnakotla’s group, the proportion of living donors was higher, at 65 percent in Era 3 but still lower than the 70 percent in Era 2.

“The declining rates of living donation for children are concerning,” he said. “Living donation should be encouraged for all patients with kidney failure, especially small children.”

Recent North American data show that infants do worse than older children do after a deceased-donor kidney transplant. However, in this new study from the University of Minnesota, infants reportedly had outcomes similar to those in older children throughout all three Eras. Dr. Chinnakotla attributed their success to their surgical technique, which he said allows them to transplant adult kidneys into babies and small children; an experienced transplant team; and careful patient monitoring after transplant.

Most of their patients were white, a race known to have better transplant success than blacks. Yet, Dr. Chinnakotla said he believes that Hispanic and black children at their institution also fare better after kidney transplant today compared with years ago.

Reasons for Transplant

The three most common diseases causing kidney failure and requiring a transplant were the same in all three Eras, according to the researchers. These conditions were congenital kidney anomalies (abnormally developed kidneys at birth), obstructive uropathy (blockage by a valve of the passage of urine from the kidneys to the bladder), and congenital nephrotic syndrome (an inherited disorder in which protein develops in the urine and the baby’s body swells).

Causes of death of pediatric transplant recipients did change over the years, as reported in the article. In Era 1, the primary cause of death was infection, which Dr. Chinnakotla said rarely causes post-transplant death today because of advances in infection prevention and treatment. In Era 3, children were most likely to die of sudden unknown causes in the first year after transplant, and after the first year, due to motor vehicle crashes or other types of trauma.

Some Improvements Needed

Some challenges remain in pediatric kidney transplantation nationwide, according to Dr. Chinnakotla. Compared with younger children, patients ages 11 to 18 years have greater odds of their new kidney failing (1.4 times the odds of younger children in their study). Preteens and teens tend to have worse results after transplant largely because they are more likely to not adhere to taking their medications as instructed, he said.

Another problem is sensitization, in which harmful antibodies develop after transplant that attack foreign tissue and make the body more likely to reject another kidney transplant. In other patients, kidney disease can recur after a transplant.

“These [problems] all deserve our special attention if further progress is to be made,” the authors wrote in their article.

Tucson teen needing transplant hopes to inspire others – KVOA | KVOA.com | Tucson, Arizona – KVOA Tucson News

This was originally published on this site

Kristi’s Kids has some promising news about a Tucson girl, with serious medical issues. She’s not letting anything get her down, or hold her back.

Stephanie Roat,13, has been through a lot in her young life, and she’s preparing for, perhaps, her biggest challenge yet. All the while, she’s hoping to inspire others to have strength too.

Stephanie is no stranger to surgery. In fact, she’s had five. That’s more than most people have in a lifetime.

“She was born at 28-weeks, and she was only one-pound, 12-ounces when she was born,” Stephanie’s dad, James Roat, told Kristi’s Kids.

Stephanie spent the first three months of her life at Phoenix Children’s Hospital. She was born with one kidney, and a bladder that didn’t develop properly. Doctors say she needs a kidney transplant.

“Things come up, and you kind of have to adjust, and roll with it and then there’s just, we like to say ok it’s the new normal,” Stephanie’s mom, Karen Roat, told Kristi’s Kids.

Stephanie just learned her cousin is a donor match. The family’s bond has never been stronger; neither has their faith.

“We definitely believe that’s what saved her, and brought her through, and helped her get through all this,” James told Kristi’s Kids.

Stephanie is like most 13-year-olds. She enjoys spending time with her big sister, and living life to the fullest.

“I like to play video games a lot. It helps me to de-stress with everything going on. I like to do theater, to sing and dance and act,” Stephanie told Kristi’s Kids.

The road ahead is long and bumpy, but Stephanie stays strong, and wants other kids to do the same.

“Don’t even think of it as it defines you. It doesn’t define you. It just a part of your life, and it isn’t you,” Stephanie said.

For now, Stephanie is focused on the immediate future. Her mom is a teacher, and dad is a Pima County Sheriff’s sergeant, but Stephanie isn’t sure what she wants to be yet.

I’m young, so I have a lot of life ahead of me to figure it out,” Stephanie told Kristi’s Kids.

As you might expect, the Roat’s expenses are piling-up. You can help by checking out Stephanie’s GoFundMe page by clicking here.

Preschool teacher, 4-year-old recovering after ‘perfect kidney’ transplant – Channel3000.com – WISC-TV3

This was originally published on this site

MADISON, Wis. – Doctors said a 4-year-old girl who underwent a lifesaving transplant Wednesday received the “perfect kidney” from her donor, with whom she shares a special connection.

News 3 first told you about Lyla Carreyn and her need for a kidney transplant last September.

She has a rare autoimmune disorder that caused her kidneys to fail.

A nationwide search for a suitable donor turned up nothing, but her perfect match ended being right next to her in a Madison preschool classroom.

Her teacher, Beth Battista, surprised the family last fall, saying she would donate her kidney to Lyla.

On Wednesday, the two underwent surgery.

“It’s such a joyful day,” Lyla’s mom, Dena Carreyn, said. “We’re so thankful for the gift that Lyla is getting and hoping that this is a fresh start and hoping it is the miracle we’ve been waiting for.”

Battista was out of surgery and doing well Wednesday afternoon.

Carreyn posted on Facebook on Wednesday night, saying Lyla was out of surgery and resting comfortably.

“We’re incredibly relieved and grateful that today’s surgeries went smoothly,” Carreyn said on Facebook. “Fingers crossed for an easy, restful night for both Lyla and Beth.”

Teacher, student kidney transplant set for Wednesday – News8000.com – WKBT

This was originally published on this site

Teacher, student kidney transplant…

MADISON, Wis. – After a year-and-a-half long mission to save the life of 4-year-old Lyla Carreyn, is nearing an end. 

On Wednesday morning, doctors at the American Family Children’s Hospital will give the little girl a life-saving kidney transplant.

“I can’t wait to see all of the milestones she gets to have now,” says Beth Battista, Lyla’s living donor.

A year and a half ago, Lyla became sick at school and her mother, Dena Carreyn, took her to urgent care.

Within minutes, they found themselves in an ambulance and a difficult journey in life.

“Within 15 minutes we were in an ambulance and on our way to Children’s Hospital.  The ambulance driver radioed in that they had a 3-year-old in renal failure and that was the first time I knew it was very serious,” says Carreyn.

A nationwide search for suitable kidney donor turned up nothing.

What they didn’t know was the perfect match was sitting across the table from Lyla at school–her teacher.

Battista saw a post on Facebook asking individuals to consider being tested to find a donor match for Lyla.  

“Something immediately inside me just said that I need to call in,” says Battista, who tests showed was a match.

“It is a miracle.  She was put in my classroom and I was put at this school and it was meant to be,” says Battista.

Lyla was admitted to American Family Children’s Hospital today in advance of Wednesday’s transplant. 

But she didn’t get there without some challenges.  Last week, she was admitted to the hospital with an infection.

 
“The last four or five days have been a nightmare,” says Carreyn.

Fortunately, doctors were able to treat Lyla, get her better so she could be cleared for the transplant.
For her mom, the transplant represents a chance her daughter to realize a dream.

“Maybe to see her go to college, maybe see her get married, see grandkids,” says Carreyn.

 “To get to have that dream back for her is really huge.”

To learn more about becoming a living donor, visit:  www.uwhealth.org/livingdonor.

 To become a registered organ donor visit:  www.donatelifewisconsin.org

Dual live-donor transplant surgery conducted on 2-year-old – Times of India

This was originally published on this site

KOCHI: Grandmother donated her kidney and father donated his liver to save a two-year-old girl who weighed 7 kg, making her the smallest child in the world to have successfully undergone dual live-donor transplant.Doctors who performed the transplant at Aster Medcity said that the organ transplant manual states that a child should weigh at least 10kg for a transplant. Parvathy MS from Kodakara in Thrissur suffered from a rare congenital condition called primary hyperoxaluria type -1, in which the deficiency of a liver enzyme leads to abnormal spike in blood oxalate levels that permanently damage the kidneys.

“There is evidence of successful dual transplant being done on a child weighing 9 kg. But till date, no one has performed transplant on a child weighing 7 kg,” said Dr Mathew Jacob, consultant liver and abdominal multi-organ transplant surgeon, Aster Medcity.

However, the decision for transplant surgery was not immediate. “We wanted to wait till the child’s weight touched 10 kg. But when we realised that we would be risking her life if we waited, we discussed with the girl’s family and decided to go for transplant,” said Dr V Narayanan Unni, senior nephrologist, Aster Medcity.

Explaining their ordeal, Parvathy’s mother Saritha MS said that their daughter was first put on daily peritoneal dialysis when she was four months old. “The dialysis lasted for nearly 20 hours each day. After a year, she had to be put on ventilator and needed daily hemodialysis. But soon doctors said that transplant was the only option and they couldn’t wait longer,” said Saritha.

However, getting a donor, the baby’s size and age was not easy. Therefore, it was decided to take her grandmother’s kidney. But that had its own complications. While the adult kidney is nine and half to 11 cm, that of a child is 4 cm. Also almost half litre blood flows in the adult kidney in an hour, that’s the amount of blood flown in a child’s body. “The solution was to remove her damaged right kidney and place the new kidney. The blood volume in her kidney too had to be increased using highly specialised techniques,” added Dr Jacob.

“Post-transplant surgery in November 2016, the child was in the hospital for 51 days. She has recovered well and now weighs 10.4 kg,” said consultant paediatric intensivist Dr Rajappan Pillai.

Her grandmother, 53-yeear-old Sathi Raghavan added, “I told my son and daughter-in-law that I had to do this for my granddaughter. I am happy now as she able to move and breathe without much pain”.

Stay updated on the go with Times of India News App. Click here to download it for your device.

Language barriers may block access to kidney transplant waiting list – KFGO

This was originally published on this site

By Carolyn Crist

(Reuters Health) – Kidney transplant candidates who live in ZIP codes with more non-English speakers are less likely to make it onto the U.S. active waiting list, according to a recent study.

Those with linguistic barriers – especially in Hispanic and Asian households – also wait longer for a transplant evaluation or never complete one at all.

“The problem likely extends further than merely language. Cultural and educational barriers likely also play a role,” said senior study author Edmund Huang of the Kidney Transplant Program at Cedars-Sinai Medical Center in Los Angeles, California.

“Transplant centers and referring nephrologists should recognize that these populations may need additional attention in guiding them through the evaluation process,” he told Reuters Health.

The Organ Procurement and Transplantation Network currently has more than 98,000 candidates on the kidney transplant waiting list. Typically, a third of these patients are listed as inactive due to an incomplete transplant evaluation, and about a third of inactive candidates never become active. Figuring out why candidates remain inactive and how to move them to active status could reduce health disparities in underserved communities, the study authors write in the Clinical Journal of the American Society of Nephrology.

Huang and colleagues looked at nationwide organ transplant data, along with ZIP code data from the 2000 United States census, for more than 84,000 kidney transplant candidates from 2004-2012.

They defined a household as “linguistically isolated” if all members over age 14 spoke a language other than English and spoke English less than “very well.” The researchers then categorized neighborhoods where transplant candidates lived into one of five groups based on the percentage of households that were linguistically isolated: less than 1 percent, between 1 and 5 percent, between 5 and 10 percent, between 10 and 20 percent or more than 20 percent.

During the study, more than 70 percent of candidates moved to active status. These candidates were more often younger, male, more educated and more likely to have private health insurance. Inactive candidates generally lived in communities with lower education and more poverty. Although Hispanic, Asian and black candidates were all less likely to achieve active status, Hispanic and Asian candidates were more likely to live in areas with the highest levels of linguistic isolation.

Overall, 78 percent of candidates who lived in communities with less than 1 percent of linguistic isolation converted to active status. In communities that were more than 20 percent linguistically isolated, 69 percent converted to active status, researchers found.

“Despite our best efforts to make kidney transplantation accessible to all suitable patients with end-stage renal disease, there are barriers,” Huang said.

Although the nationwide kidney allocation policy changed in 2014 to reduce racial and ethnic disparities in kidney transplantation, the problem starts sooner than allocation, Huang added.

“When people need a transplant, they want to be sure that kidneys are allocated because of medical necessity and that they are not disadvantaged because of their social status,” said Alicia Fernandez of the University of California at San Francisco, who was not involved in the study.

“Kidney transplant is a scarce resource, and it is important that scarce medical resources be distributed fairly,” said Fernandez, who has studied language barriers in healthcare, particularly for Latinos with diabetes. “That has generally been understood to mean without unduly valuing social factors, such as wealth or race,” she said by email.

One limitation of the study is that although language barriers are likely tied to education and income barriers, the study authors can’t say for sure. Other systemic biases could prevent patients from completing evaluations or joining the waitlist, said Leah Karliner of the University of California at San Francisco, who wasn’t involved with the study but has studied language barriers to healthcare access and how professional interpreters may help.

“It is unclear how many of these patients had access to professional interpretation in their health care settings and for navigating the complex health care system to complete their evaluation,” she told Reuters Health by email. “An important starting place would be ensuring access to professional interpretation for all patients.”

SOURCE: http://bit.ly/2lj3DDZ Clinical Journal of the American Society of Nephrology, online February 9, 2017.

Language barriers may interfere with access to kidney transplantation – NephrologyNews.com

This was originally published on this site
Getty Images/iStockphoto/ThinkStock
Getty Images/iStockphoto/ThinkStock
Language barriers may hinder U.S. kidney transplant candidates’ access to transplantation, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN).

The findings suggest that patients who primarily speak a language other than English may face disparities that keep them from completing their kidney transplant evaluation and ultimately receiving a kidney transplant.

A team led by Ed Huang, MD (Cedars-Sinai Medical Center) and Efrain Talamantes, MD (University of California Davis School of Medicine) looked to see if language barriers, or linguistic isolation, might impact access to the active transplant waiting list.

The researchers merged Organ Procurement and Transplantation Network/United Network for Organ Sharing data with 5-digit zip code socioeconomic data from the 2000 United States census. They then determined the cumulative incidence of conversion to active waitlist status, death, and delisting before conversion among 84,783 temporarily inactive adult kidney candidates from 2004-2012.

A household was determined to be linguistically isolated if all members >14 years old speak a non-English language and also speak English less than “very well.”

Across all racial/ethnic groups, progressively higher degrees of linguistic isolation were linked with a lower likelihood of transitioning from inactive to active status on the kidney transplant waiting list and with incomplete transplant evaluations.

Candidates living in a community with >20% linguistically isolated households were 29% less likely to achieve active waitlist status than those residing in a community with <1% linguistically isolated households.

The associations of linguistic isolation and other socioeconomic factors appeared to be most influential among Hispanic candidates.

“Our data suggest that language barriers may limit an individual’s ability to receive a kidney transplant. We recommend that patients with limited English proficiency who are in need of a kidney transplant use patient advocates who are English-proficient during transplant clinic visits and always use interpreters to get all of their questions answered,” said Dr. Huang. “Further, transplant centers and healthcare providers should actively address potential communication barriers when recommending testing for transplant evaluation.”