EVALUATION OF DELAYED GRAFT FUNCTION TESTIMONIAL By Patrick O. Gee. Evaluated by Jim Myers

 EVALUATION OF DELAYED GRAFT FUNCTION TESTIMONIAL By Patrick O. Gee.

Evaluated by Jim Myers

1. Introduction

I have been asked to review a study entitled, "Religion and Spirituality by Patrick O. Gee (PhD, JLC, Patient-partner and Minister, Founder/CEHD; advocate, Inc.), for the GET ON TRACK Study Group. I am not quantified to intelligently comment on the body of the article, however; I believe I was retained to comment on the TESTIMONIAL concerning his kidney transplant and the Delayed Graft Function (Sleepy Kidney). I believe I am qualified to do that.

In the interest of full disclosure, Patrick and I are friends and we act as kidney advocates for many of the same kidney advocacy and chronic diseases organizations. I believe this to be an objective evaluation of his kidney transplant testimonial.

2. Patrick's Story

I have heard Patrick tell his kidney story many times before, but this is the most detailed l have ever encountered.

• He began peritoneal dialysis on December 1, 2013.
• He received his kidney transplant from a deceased donor April 21, 3rd 2017.
• As Patrick notes, "When I woke up from the surgery, the organ did not."
• His transplant physician informed him that it is not uncommon that there is a delayed graft function (sleepy kidney)occurring with a deceased donor kidney and so the doctor ordered a 24 hour-a-day regimen of hemodialysis every other day to wake the kidney up.
• 5 days after receiving his kidney, Patrick was informed that he had a blood clot in his neck and he would need surgery to remove it.
• Three days after the blood clot removal, he was informed that he was bleeding internally and would need additional surgery.
• Seventeen days after the third surgery, he would need a 4th surgery to create a small-sized laparoscopic hole in his abdomen to drain a lymph fluid buildup caused by the kidney transplant surgery.
• 47 days after kidney transplant surgery, the new kidney finally woke up! He notes in the piece that there is biblical significance to the number 40 (representing trials, tribulations & probation), while the number 7 represents completion and perfection.
• According to Patrick, a then Minister in Traning, "God used my MISERY to launch his MINISTRY, God had tested his faith and spiritual perseverance.
To learn more about Patrick's Kidney Journey check here:

• https://youtu.be/f-Opyzt-ujQ
• (Kidney Story, including kidney transplant story)
• https://youtu.be/o9eHgXghixY
• (Transplant Story and Apollo Steering Committee Experience)
General Information about Patrick:

https://m.youtube.com/watch?v=JQ4g5kiYWvs&feature=youtu.be#dialog
(Motivational Mondays]

https://www.asn-online.org/about/bio.aspx?ID=3911168

https://cdi.washington.edu/people/patrick-o-gee-sr-phd/

https://chronicdiseasecoalition.org/patient-advocate-spotlight-patrick-ogee/

https://aakp.org/aakp-2019-national-patient-meeting-meet-the-planning-committee-patrick-gee/

https://www.donatelifevirginia.org/lifeline/2020/03/minister-grateful-for-his-second-chance-at-life/

https://www.antidote.me/blog/after-a-surprise-kidney-disease-diagnosis-this-patient-turned-to-education-and-advocacy

3. Delayed Graft Response (Sleepy Kidney)

"Delayed graft function (DGF) refers to the acute kidney injury that occurs in the first week of kidney transplantation, which necessitates dialysis intervention. DGF is associated with higher rates of acute cellular rejection and shorter graft survivals."
https://www.karger.com/Article/FullText/491558.
It is marked by the use of dialysis within 8 days of a kidney transplant to help revive and 'jumpstart' the newly transplanted kidney.

The usual time course of DGF is 10 to 14 days, and patients may require supportive dialysis therapy for management of fluid and electrolyte disturbances.

"DGF is a major obstacle for allograft survival as it can be compounded by acute rejection and chronic allograft nephropathy (CAN). Patients with both DGF and acute rejection had a 5-year survival rate of 34% in U.S. transplant patients between 1985 and 1992 (13). A meta-analysis of 34 studies from 1988 through 2007 concluded that patients with DGF had a 49% pooled incidence of acute rejection compared to 35% incidence in non-DGF patients."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280444/.

The consequences on the immediate post-TX period are prolongs hospitalizations and increased potential morbidity and health care costs. The major concern for transplant recipients with DGF is the potential for early acute rejection.

Factors for potential DGF include:
• Expanded criteria donor;
• Donors over the age of 55;
• Cold ischemic time,
• Receipt of a DCD kidney,
• Body mass index (BMI),
• Terminal creatinine level,
• Anoxic or cerebrovascular cause of death,
• A history of hypertension, &
• Greater HLA mismatch.
https://www.sciencedirect.com/topics/medicine-and-dentistry/delayed-graft-function.

There are some Recipient Criteria as well:
• Male sex,
• Black race,
• History of diabetes,
• Longer time on dialysis,
• Increased BMI,
• Frailty,
• Elevated Panel Reactive Antibody (PRA), 
• Prior transplant,
• Previous blood transfusions,
• Elevated pretransplant phosphate levels, and
• A mismatch in body size between the donor and the recipient.

Early Course of the Patient With a Kidney Transplant by Paul M. Schroder, ... Stuart J. Knechtle, inKidney Transplantation - Principles and Practice (Eighth Edition), 2019.

4. Conclusion
This is a terrific piece about an all to common occurrence, 'Sleepy Kidney', but seldom mentioned issue. The mental strain of receiving a potentially dead on arrival kidney is made vivid by Patrick's story. For the kidney transplant recipient is an important topic for discussion and it is very well done here.

• Relevance of Content
The content here is entirely relevant and fresh. This is an important topic for any kidney transplant patient.

• Usefulness of Content
The content is extremely useful. The period of adjustments statements give hope to the initially concerned kidney transplant patient.

• Clarity of Content
The content here is crystal clear and simple, comprehensivable explanations of a difficult topic are given here.

• Applicability of Information
The information is very applicable to every kidney transplant patient.

My overall assessment is this is a meaningful article with essential information for kidney transplant patients.