Background and objectivesThere are no standardized benchmarks to measure productivity and compensation of transplant nephrologists in the United States, and consequently, criteria set for general nephrologists are often used.Design, setting, participants, & measurementsA web-based survey was sent to 809 nephrologists who were members of the American Society of Transplantation to gather data on measures of productivity, compensation, and job satisfaction. Factors associated with higher total compensation and job satisfaction were examined.ResultsOf 365 respondents, 260 were actively practicing in the United States and provided data on compensation. Clinical productivity was assessed variably, and although 194 (76%) had their work relative value units (wRVUs) reported to them, only 107 (44%) had an established RVU target; 234 (90%) had fixed base compensation, and 172 (66%) received a bonus on the basis of clinical workload (68%), academic productivity (31%), service (32%), and/or teaching responsibility (31%). Only 127 respondents (49%) filled out time studies, and 92 (35%) received some compensation for nonbillable transplant activity. Mean total compensation (base salary and bonus) was $274,460±$91,509. The unadjusted mean total compensation was higher with older age and was higher for men; Hispanic and White respondents; adult care transplant nephrologists; residents of the western United States; US medical school graduates; nonuniversity hospital employees; and those with an administrative title, higher academic rank, and a higher number of years in practice. Two hundred and nine respondents (80%) thought their compensation was unfair, and 180 (70%) lacked a clear understanding of how they were compensated. One hundred forty-five respondents (55%) reported being satisfied or highly satisfied with their job. Job satisfaction was greater among those with higher amounts of compensation and US medical school graduates.ConclusionsWe report significant heterogeneity in the assessment of productivity and compensation for transplant nephrologists and the association of compensation with job satisfaction.
Background: Diagnosis of rejection has continued to be problematic in pancreas transplantation (PT). In 2007, we innovated a new surgical technique for PT, portal-endocrine and gastric exocrine drainage (P-G) technique, where the end of allograft jejunum was anastomosed to the anterior aspect of the stomach, facilitating endoscopic access to duodenum/pancreas allograft. Objective: The aim of our study was to evaluate the safety, measure allograft rejection, and calculate graft and patient survival in patients who underwent PT with the P-G technique. Method: This was a retrospective review study of 127 PT patients with the P-G technique from Sep 2007 to Dec 2021 at our center. 113 simultaneous kidneypancreas transplants (SKPT), 10 pancreas-alone transplants, and 4 pancreasafter-kidney transplants were performed. Baseline demographics, OR time, estimated blood loss (EBL), cold ischemic time (CIT) for kidney and pancreas allografts, length of hospital stay (LOS), complications, number of patients with endoscopy, number of patients with allograft rejection, death-censored 5-year kidney and pancreas graft survival, and 5-year patient survival were calculated. Results: Table 1 summarizes baseline demographics and Table 2 highlights complications and outcomes. Perioperative complications included 8 postoperative bleeds and 7 vascular thromboses. Patients with vascular thrombosis had subsequent transplant pancreatectomies within 6 weeks. During the study period, 51 transplant patients underwent upper GI endoscopy. Duodenum/pancreas allograft rejection was found in 26 patients. The deathcensored 5-year graft survival for pancreas and kidney were 83.5 % and 84.6 %, respectively. Patient survival was 87.4%. Figure 1 shows the Kaplan-Meier curves for pancreas graft, kidney graft, and patient survival. Conclusion: This P-G drainage technique for PT has proven to be safe with comparable graft and patient outcomes. Access to donor duodenum and pancreas allograft via endoscopy is unique to this technique and provides the added advantage of life-long easy access to the allograft.
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