760 RENAL TRANSPLANTATION

reproductive function, and the authors correlated these findings with reported methods of emptying,
and degree of continence or dryness. To assess for sexual function, the survey included the Female
Sexual Function Index.
Of 108 respondents 29% were treated for uterine prolapse and 57% required surgery in order to use
tampons or to have penetrative intercourse. Over half (55.4%) reported some degree of dissatisfaction
with the appearance of their external genitalia. Of 47 women who reported pregnancies, 32 reported
complications with pregnancy including miscarriage/abortion in 41%, preterm vaginal delivery (3%)
and pre per term cesarean section delivery (35%). Complications following pregnancy were reported
at higher rates in women who had catheterizable channels than in those who voided volitionally or
catheterized per urethra. Of 125 women who completed the Female Sexual Function Index, mean
score was 20.1 compared to 30.5 noted in published controls. Those who catheterized per stoma had
slightly worse scores than those who catheterized via urethra or voided. Only 19.2% reported voli-
tional voiding and those women tended to be slightly less continent than those who catheterized.
When asked what topics the respondents suggested for future study, the women identified sexual
function, fertility and body image as areas that should be researched further.
We are not there yet in the surgical reconstruction of this most complex pediatric urological
problem. As techniques improve to provide volitional voiding and reduce the need for continent
stomas while preserving improved physical appearance, patient reported outcomes should improve.

Douglas A. Canning, MD

Renal Transplantation

Re: A Prospective Multicenter Pilot Study of HIV-Positive Deceased

Donor to HIV-Positive Recipient Kidney Transplantation: HOPE in
Action
C. M. Durand, W. Zhang, D. M. Brown, S. Yu, N. Desai, A. D. Redd, S. M. Bagnasco,
F. F. Naqvi, S. Seaman, B. L. Doby, D. Ostrander, M. G. Bowring, Y. Eby, R. E. Fernandez,
R. Friedman-Moraco, N. Turgeon, P. Stock, P. Chin-Hong, S. Mehta, V. Stosor, C. B. Small,
G. Gupta, S. A. Mehta, C. R. Wolfe, J. Husson, A. Gilbert, M. Cooper, O. Adebiyi,
A. Agarwal, E. Muller, T. C. Quinn, J. Odim, S. Huprikar, S. Florman, A. B. Massie,
A. A. R. Tobian and D. L. Segev; HOPE in Action Investigators
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, Department of Surgery, Johns Hopkins University School
of Medicine, Baltimore, Maryland, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health,
Bethesda, Maryland, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, Department of Medicine, Emory
University, Atlanta, Georgia, Department of Surgery, Emory University, Atlanta, Georgia, Department of Surgery, Dell Medical School, University of
Texas, Austin, Texas, Department of Medicine, University of California, San Francisco, California, Section of Transplant Nephrology, University of
Alabama at Birmingham, Birmingham, Alabama, Department of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, North-
western University, Chicago, Illinois, Department of Medicine/Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, Depart-
ment of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, NYU Langone Transplant Institute, New York University Grossman
School of Medicine, New York, New York, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, Institute of Human
Virology, University of Maryland School of Medicine, Baltimore, Maryland, Medstar Georgetown Transplant Institute, Georgetown University School of
Medicine, Washington, D.C., Department of Medicine, Indiana University Health Hospital, Indianapolis, Indiana, Department of Surgery, University of
Virginia Medical Center, Charlottesville, Virginia, Department of Surgery, University of Cape Town, Cape Town, South Africa, Division of Allergy,
Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, and Recanati-
Miller Transplantation Institute, Mount Sinai Hospital, New York, New York
Am J Transplant 2021; 21: 1754e1764.

Editorial Comment: The HIV Organ Policy Equity (HOPE) Act passed in 2015, permitting the use
of HIV positive donor organs for transplant into HIV positive recipients. The law specifies that this
needs to be done in the context of research to ensure safety. Twenty-five patients received HIVþ
donors and 50 received HIV donor transplants. Twenty-two of the HIV donors were determined
to have false-positive HIV testing. Seventy percent of HIVþ donors were on anti-retroviral
therapy. Recipients had undetectable HIV viral load on therapy, and CD4 counts averaged 528
cells/microliter. Overall, results look favorable. Graft and patient survival are similar. There were
no deaths. HIV breakthrough infection rates were low with no difference between groups. Those
 SOCIOECONOMIC FACTORS, UROLOGICAL EPIDEMIOLOGY AND PRACTICE PATTERNS 761

who received HIVþ donors had higher rates of rejection. All this is favorable for HIV Dþ/Rþ
transplantation.
As a newly minted MD in the mid-1980s, the time when the HIV story was unfolding, the progress
in care for HIV infected patients is astonishing. The transplant community awaits more experience
through the HOPE studies to assess best practices.

Re: Simultaneous Robotic Kidney Transplantation and Bariatric Surgery for

Morbidly Obese Patients with End-Stage Renal Failure
M. Spaggiari, P. Di Cocco, K. Tulla, K. B. Kaylan, M. A. Masrur, C. Hassan, J. A. Alvarez,
E. Benedetti and I. Tzvetanov
Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, College of Medicine, University of Illinois at
Chicago, Chicago, Illinois, and Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago,
Chicago, Illinois
Am J Transplant 2021; 21: 1525e1534.

Editorial Comment: The authors have previously reported techniques, short-term results and long-
term results for obese patients undergoing robotic kidney transplantation (RKT). They identify that
this approach offers greater opportunity for transplant to an underserved population and avoids the
wound morbidity of the open approach. They now extend their approach to using sleeve gastrectomy
(SG) with transplant as a way to treat both renal failure and obesity in one procedure. For 20
candidates, 11 were randomized to SGþRKT and 9 to RKT alone. The combined procedure took
longer (2.3 hours longer) but reported outcomes were similar. The patients who underwent
SGþRKT had considerable postoperative weight loss compared to the RKT alone group. The
authors report that the procedure has a reasonable safety profile and benefit. Understand that
there may well be just a subset of the obese wait list patients that may be suitable candidates for
this approach. Early results here are promising for those centers comfortable with advanced
robotic techniques.

David A. Goldfarb, MD

Socioeconomic Factors, Urological Epidemiology and Practice

Patterns

Re: Needlestick and Sharps Injuries among Resident Physicians

N. Ugonabo, P. Shah, P. Adotama and J. G. Zampella
The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
JAMA Surg 2021; 156: 96e97.

Editorial Comment: Needlestick and other sharps injuries (NSIs) are a common occupational
hazard among surgeons, carrying risk of transmission of bloodborne pathogens. While the risk of NSI
is theoretically higher among surgical trainees, there are few data which characterize the relation-
ship between experience and NSI risk. Using de-identified data from the New York University
Langone Health Occupational Health Service, this study reports the landscape of NSI among
resident physicians and the relationship between monthly NSI rates by month. Investigators found
the rate of NSI to be 4.7 and 9.4 events per 10 individuals in medical and surgical specialties,
respectively. Interestingly, the highest NSI incidence rates were observed among urology house
staff (16.0 events per 10 individuals), orthopedic surgery (14.1 events per 10 individuals), and
general surgery (14.0 events per 10 individuals). While the greatest number of injuries occurred in
October, the largest month-to-month increase occurred between June and July, an increase that
was only observed among house staff.