Suman Mohanty
MD Student with Scholarly Concentration in Health Services & Policy Research, expected graduation Spring 2030
All Publications
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Correlates of Pretransplant Outcomes in United States Kidney Transplant Programs, 2015 to 2020.
Kidney international reports
2026; 11 (7): 106570
Abstract
Increasing access to kidney transplantation for patients with end-stage renal disease is a high priority in the United States. Recent policy changes to promote this include establishment of performance metrics examining the pretransplant performance of kidney transplant programs, but little is known about transplant program practices associated with these performance metrics. Our goal is to characterize waitlist attributes associated with the newly established pretransplant performance metrics at adult kidney transplant programs.We conducted a retrospective cohort analysis using completed case national data from the Scientific Registry of Transplant Recipients (SRTR). Exposures included deceased donor kidney waitlist attributes such as waitlist prevalence, waitlist incidence, percentage of incidence patients who are made status active, and transplant priority scores at key points including activation. Outcomes included pretransplant mortality rate ratio (PMRR) and organ acceptance rate ratio (OARR), as defined by the Organ Procurement Transplant Network (OPTN) Membership and Professional Standards Committee, for each transplant program-year.Our study included 1268 transplant program-years from 2015 to 2020, representing 220 unique adult kidney transplant programs. Higher offer acceptance was associated with fewer patients on the waitlist (1.4% increase per every 100-patient decrease) and a higher percentage of patients receiving an offer within 90 days of activation (24.0% increase per 10% increase in the percent of patients receiving offers). Lower pretransplant mortality was associated with fewer patients on the waitlist (1.4% decrease per 100-patient decrease).A larger waitlist was associated with both higher pretransplant mortality and lower offer acceptance. Transplant programs behaviors underlying waitlist attributes associated with better or worse outcomes warrant additional investigation.
View details for DOI 10.1016/j.ekir.2026.106570
View details for PubMedID 42254852
View details for PubMedCentralID PMC13235351
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The Medical Costs of Determining Eligibility and Waiting for a Kidney Transplantation.
Medical care
2024
Abstract
Recent efforts to increase access to kidney transplant (KTx) in the United States include increasing referrals to transplant programs, leading to more pretransplant services. Transplant programs reconcile the costs of these services through the Organ Acquisition Cost Center (OACC).The aim of this study was to determine the costs associated with pretransplant services by applying microeconomic methods to OACC costs reported by transplant hospitals.For all US adult kidney transplant hospitals from 2013 through 2018 (n=193), we crosslinked the total OACC costs (at the hospital-fiscal year level) to proxy measures of volumes of pretransplant services. We used a multiple-output cost function, regressing total OACC costs against proxy measures for volumes of pretransplant services and adjusting for patient characteristics, to calculate the marginal cost of each pretransplant service.Over 1015 adult hospital-years, median OACC costs attributable to the pretransplant services were $5 million. Marginal costs for the pretransplant services were: initial transplant evaluation, $9k per waitlist addition; waitlist management, $2k per patient-year on the waitlist; deceased donor offer management, $1k per offer; living donor evaluation, procurement and follow-up: $26k per living donor. Longer time on dialysis among patients added to the waitlist was associated with higher OACC costs at the transplant hospital.To achieve the policy goals of more access to KTx, sufficient funding is needed to support the increase in volume of pretransplant services. Future studies should assess the relative value of each service and explore ways to enhance efficiency.
View details for DOI 10.1097/MLR.0000000000002028
View details for PubMedID 38889200
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Emerging Evidence on Coronary Heart Disease Screening in Kidney and Liver Transplantation Candidates: A Scientific Statement From the American Heart Association: Endorsed by the American Society of Transplantation
CIRCULATION
2022; 146 (21): E299-E324
Abstract
Coronary heart disease is an important source of mortality and morbidity among kidney transplantation and liver transplantation candidates and recipients and is driven by traditional and nontraditional risk factors related to end-stage organ disease. In this scientific statement, we review evidence from the past decade related to coronary heart disease screening and management for kidney and liver transplantation candidates. Coronary heart disease screening in asymptomatic kidney and liver transplantation candidates has not been demonstrated to improve outcomes but is common in practice. Risk stratification algorithms based on the presence or absence of clinical risk factors and physical performance have been proposed, but a high proportion of candidates still meet criteria for screening tests. We suggest new approaches to pretransplantation evaluation grounded on the presence or absence of known coronary heart disease and cardiac symptoms and emphasize multidisciplinary engagement, including involvement of a dedicated cardiologist. Noninvasive functional screening methods such as stress echocardiography and myocardial perfusion scintigraphy have limited accuracy, and newer noninvasive modalities, especially cardiac computed tomography-based tests, are promising alternatives. Emerging evidence such as results of the 2020 International Study of Comparative Health Effectiveness With Medical and Invasive Approaches-Chronic Kidney Disease trial emphasizes the vital importance of guideline-directed medical therapy in managing diagnosed coronary heart disease and further questions the value of revascularization among asymptomatic kidney transplantation candidates. Optimizing strategies to disseminate and implement best practices for medical management in the broader end-stage organ disease population should be prioritized to improve cardiovascular outcomes in these populations.
View details for DOI 10.1161/CIR.0000000000001104
View details for Web of Science ID 000886687700001
View details for PubMedID 36252095
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Coronary Computed Tomography Angiography in Diagnosing Obstructive Coronary Artery Disease in Patients with Advanced Chronic Kidney Disease: A Systematic Review and Meta-Analysis.
Cardiorenal medicine
2020: 1–8
Abstract
Coronary computed tomography angiography (CCTA) is emerging as an important noninvasive testing modality for coronary angiography. The performance characteristic of CCTA in patients with advanced kidney disease is unknown.We performed a systematic review and meta-analysis of studies specifically investigating the sensitivity and specificity of CCTA compared to coronary angiogram as a reference standard in patients with advanced kidney disease, defined as dialysis dependence or nearing kidney transplantation. Two independent investigators assessed studies for inclusion/exclusion, quality, and characteristics, while a third investigator adjudicated.We identified 4 studies including a total of 217 patients, of whom 159 were dialysis dependent. Three of the 4 studies had a high risk of bias in patient selection and study flow, while 1 study rated low in all areas of bias. The studies were heterogeneous in their patient selection and CCTA protocol but consistent in their definition of obstructive coronary artery disease. The pooled sensitivity and specificity for CCTA were 0.96 (0.87-0.99) and 0.66 (0.57-0.74), respectively. When we restricted the analysis to dialysis-dependent patients, the pooled sensitivity and specificity for CCTA were 0.99 (0.74-1.00) and 0.67 (0.49-0.82), respectively.Based on limited data, CCTA appears to have comparable sensitivity but lower specificity relative to the non-kidney disease population.
View details for DOI 10.1159/000510402
View details for PubMedID 33321489