Study ID
Date of Transplant
Age
Gender
Race
Hispanic Origin
Organ Source
Age of Donor
Race of Donor
Sex of Donor
Donor ABO Status
Donor Rh Status
Donor Cytomegalovirus (CMV) Status
Donor HLA-A Allele 1
Donor HLA-A Allele 2
Donor HLA-B Allele 1
Donor HLA-B Allele 2
Donor HLA-DR Allele 1
Donor HLA-DR Allele 2
Cold Ischemia Time (mins)
Warm Ischemia Time (mins)
Underlying Medical Condition
Other Comorbidities (separated by commas)
RRT at time of transplant?
Height
Weight
BMI
Number of Prior Transplants
ABO Status
Rh Antigen
Cytomegalovirus status
HLA-A Allele 1
HLA-A Allele 2
HLA-B Allele 1
HLA-B Allele 2
HLA-DR Allele 1
HLA-DR Allele 2
Solid Phase HLA, SAG I %
Solid Phase HLA, SAG II %
Solid Phase HLA, PRA I %
Solid Phase HLA, PRA II %
Induction Immune Suppression
Dose rATG in mg/kg
Delayed Graft Function
Surgical Complication (choice=Allograft vessel complication)
Surgical Complication (choice=Allograft ureter or stent complication)
Surgical Complication (choice=Wound infection)
Surgical Complication (choice=Urinary infection)
Surgical Complication (choice=Pneumonia)
Surgical Complication (choice=Other infection)
Surgical Complication (choice=Seroma)
Surgical Complication (choice=Return to OR)
Surgical Complication (choice=Other complication)
Type of infection
Type of complication
AKI
Cause of AKI (choice=Volume Depletion (ie Pre-renal))
Cause of AKI (choice=CNI toxicity)
Cause of AKI (choice=Infection)
Cause of AKI (choice=ATN)
Cause of AKI (choice=Obstruction)
Cause of AKI (choice=Disease Recurrence)
Cause of AKI (choice=Rejection - Humoral)
Cause of AKI (choice=Rejection - Cellular)
Cause of AKI (choice=Other)
Cause of AKI
Additional IS for treatment
DSA Present
DSA Class
Tacrolimus
Tacrolimus Trough Level
Sirolimus (rapamune)?
Sirolimus Trough Levels
Mycophenolate Mofetil (Cellcept)
Mycophenolate Mofetil daily dosage (mg)
Azathioprine?
Azathioprine Daily Dosage (mg)
Prednisone?
Prednisone Daily Dosage (mg)
Cyclosporine?
Cyclosporine Daily Dosage
Additional Immnosupressive Drugs?
Additional Immunosupressants
Leflunomide?
Leflunomide Daily Dosage
Cidofovir?
Cidofovir Dosage (mg)?
Ganciclovir?
Ganciclovir Dosage (mg)
Valganciclovir (Valcyte)?
Valganciclovir (Valcyte) Dosage (mg)
WBC (K/uL)
Hemoglobin (g/dL)
Hematocrit (%)
Creatinine Level (mg/dL)
Estimated Glomerular Filtration Rate (eGFR)
Protein:Creatinine
Urine RBC
Urine WBC
Viral Infection?
BK Virus?
BK Virus Testing Method
BK Viral Load
Virus?
Viral Load
Other Cause
Additional Immune Suppression
New DSA
HLA Class (choice=HLA Class I)
HLA Class (choice=HLA Class II)
Reason
Days Post Transplant
BK Peptide- single stimulation
BK Peptide Double Stimulation
BK Peptide Single Stimulation
No Peptide Tetramer Response
CMV Tetramer Response
p44 Tetramer Response
p108 Tetramer Response
BKV Urine QPCR (Copies/reaction)
BKV Blood QPCR (copies/reaction)
Comments:
JCV Mean
JCV Status
BKV I Mean
BKV I Status
BKV IV Mean
BKV IV Status
%Lymphocytes
%CD3+ cells
%CD4+ cells
%CD4+ and CD45RO-/CD27-
%CD38+
%CD38+/PD1+
%HLA-DR+
%HLA-DR+/PD1+
%PD1+
%CD4+ and CD45RO+/CD27-
%CD4+ and CD45RO+/CD27+
%CD4+ and CD45RO-/CD27+
%CD8+ cells
%CD8+ and CD45RO-/CD27-
%CD8+ and CD45RO+/CD27-
%CD8+ and CD45RO+/CD27+
%CD8+ and CD45RO-/CD27+
BK Viruria
Months from Transplant:
BK Viremia
Months From Transplant
BK Nephropathy
Rejection
Month
HLA Match
BKV Status
Viremia cat
reactivation cat
RECODE of cmv (Cytomegalovirus status)