About

Fuad Shihab, MD, is a Professor of Medicine at the University of Utah who is actively involved in transplant research and frequently speaks at a national level in these areas. He has received multiple scholastic recognitions including Who’s Who in America and America’s Top Doctor in US News and World Report, as well as Faculty Teaching Awards from the School of Medicine. Dr. Shihab received his medical degree from the American University of Beirut, completed his Nephrology fellowship training at the University of Pennsylvania, and a Transplantation Medicine fellowship at Oregon Health and Science University. He is board certified in Internal Medicine and Nephrology. His clinical practice accepts patients with all kinds of renal disease, and he specializes in kidney and hypertension-related conditions, including dialysis, Polycystic Kidney Disease, Lipopheresis, and Plasmapheresis. Dr. Shihab is involved in various national societies, including the American Society of Transplantation, where he has chaired several committees, and he is a board member of the American Foundation for Donation and Transplantation. He is a Fellow of the American College of Physicians, the American Society of Nephrology, the National Kidney Foundation, and the American Society of Transplantation.

Research topics

• Medicine
• Internal medicine
• Pathology
• Gastroenterology
• Biology
• Dermatology
• Urology
• Immunology
• Neuroscience

Selected publications

• Associations between donor-derived cell-free DNA dynamics and clinical outcomes after kidney allograft rejection: A prospective, multicenter study

  American Journal of Transplantation · 2025-07-23 · 6 citations

  articleOpen access

  <h2>ABSTRACT</h2> Active rejection (AR) remains a major risk factor for graft dysfunction and loss. Donor-derived cell-free DNA (dd-cfDNA) is a dynamic, noninvasive biomarker for AR. We hypothesized that dd-cfDNA monitoring post-rejection may enable physicians to stratify patients into those with more and less favorable prognoses. This prospective multi-center study of kidney transplant recipients (KTR) with biopsy proven AR (BPAR) monitored dd-cfDNA for eight weeks following diagnosis and recorded clinical outcomes at 12 months. Patients were classified using dd-cfDNA trends; trends were then associated with outcomes. Negative outcomes comprised: graft loss, subsequent BPAR, post-biopsy donor specific antibody, and/or lack of resolution of renal dysfunction. Of 488 KTR, 66 with BPAR were analyzed (TCMR: n=37; ABMR: n=24; Mixed: n=5). 76% experienced negative outcomes, 24% positive outcomes. Four distinct dd-cfDNA trends were identified: two with favorable prognosis (n=25), two with unfavorable prognosis (n=41). Among patients with favorable prognosis, the odds of experiencing positive outcomes were 60x higher (p=3.18x10-7), and of experiencing resolving kidney dysfunction at one year were 13x higher (p=2.15x10-5). Among KTR with BPAR, post-rejection dd-cfDNA trends were statistically associated with outcomes, suggesting dd-cfDNA may help physicians manage patients post-BPAR.

  PublisherOA PDFDOI

• Use of LCP-Tacrolimus (LCPT) in Kidney Transplantation: A Delphi Consensus Survey of Expert Clinicians

  Annals of Transplantation · 2024-02-19 · 6 citations

  articleOpen access

  BACKGROUND LCPT (Envarsus XR®) is a common once-daily, extended-release oral tacrolimus formulation used in kidney transplantation. However, there are minimal evidence-based recommendations regarding optimal dosing and treatment in the de novo and conversion settings. MATERIAL AND METHODS Using Delphi methodology, 12 kidney transplantation experts with LCPT experience reviewed available data to determine potential consensus topics. Key statements regarding LCPT use were generated and disseminated to the panel in an online Delphi survey. Statements were either accepted, revised, or rejected based on the level of consensus, perceived strength of evidence, and alignment with clinical practice. Consensus was defined a priori as ≥75% agreement. RESULTS Twenty-three statements were generated: 14 focused on de novo LCPT use and 9 on general administration or LCPT conversion use. After 2 rounds, consensus was achieved for 11/14 of the former and 7/9 of the latter statements. In a de novo setting, LCPT was recognized as a first-line option based on its safety and efficacy compared to immediate-release tacrolimus. In particular, African Americans and rapid metabolizer populations were identified as preferred for first-line LCPT therapy. In a conversion setting, full consensus was achieved for converting to LCPT to address neurological adverse effects related to immediate-release tacrolimus and for the time required (approximately 7 days) for steady-state LCPT trough levels to be reached. CONCLUSIONS When randomized clinical trials do not replicate current utilization patterns, the Delphi process can successfully generate consensus statements by expert clinicians to inform clinical decision-making for the use of LCPT in kidney transplant recipients.

  PublisherOA PDFDOI

• Use of an LCP Tacrolimus (LCPT) in Kidney Transplantation: A Delphi Consensus Survey of Expert Clinicians

  Journal of the American Society of Nephrology · 2023-11-01

  article
  PublisherDOI

• Throwing stones: kidney stone incidence in living kidney donor candidates with increased metabolic risk

  Renal Failure · 2023-06-25 · 1 citations

  articleOpen access

  Throwing stones: kidney stone incidence in living kidney donor candidates with increased metabolic risk

  PublisherOA PDFDOI

• 216.4: Wide Spectrum of Molecular Injury Highlights Heterogeneity of Banff Tubulitis and Interstitial Inflammation Lesions

  Transplantation · 2022 · 1 citations

  1st authorCorresponding
  • Medicine
  • Internal medicine
  • Gastroenterology

  Introduction: The pathological definition and clinical significance of borderline T cell-mediated rejection (BL-TCMR) remains an area of active debate, leading to inconsistencies in therapeutic strategy. Previously published data suggests that donor-derived cell-free DNA (dd-cfDNA) levels at the time of BL-TCMR diagnosis may identify patients at risk of adverse long-term outcomes. We characterized dd-cfDNA levels associated with BL-TCMR among patients enrolled in the Kidney allograft Outcomes AlloSure Registry (KOAR, NCT03326076). Methods: Patients with BL-TCMR findings (Banff 2019) on either for-cause or surveillance biopsy and a dd-cfDNA result within 30 days were included in the analysis. Patients with biopsies showing isolated tubulitis or interstitial inflammation without tubulitis were also analyzed. Results: We identified 56 cases of BL-TCMR with paired dd-cfDNA results (obtained within 30 days); median dd-cfDNA among these patients was 0.34% (IQR:0.17 - 1.00) (Figure 1a). The differences in dd-cfDNA among individual BL-TCMR combinations (t1/i1, t2/i1, t3/i1, t1/i2, t1/i3) were not significant, though the number of t3/i1 (n = 3, dd-cfDNA = 0.04%, 4.85%, 9.06%) and t1/i3 (n = 1, dd-cfDNA = 3.03%) cases was small. No differences were observed between biopsies with BL-TCMR and those with isolated tubulitis (t1/i0, t2/i0) or isolated inflammation without tubulitis (t0/i1) (Figure 1b). 31 of 56 BL-TCMR cases had prior dd-cfDNA measurement, with median result of 0.24% (IQR: 0.20 - 0.37) obtained 63 (IQR: 53.5 - 100) days before the index biopsy. The median percent increase between these sequential results was 55% (IQR: -9 - 235%). Conclusions: Substantial heterogeneity is observed both with regards to dd-cfDNA levels at the time of BL-TCMR and the trajectory of dd-cfDNA preceding index biopsy. More importantly, no differences in dd-cfDNA are observed between BL-TCMR and t/i lesions not presently included in Banff criteria for BL-TCMR. These findings suggest that BL-TCMR, isolated tubulitis, and isolated inflammation without tubulitis represent a spectrum of molecular injury that may be further.

  PublisherDOI

• Wide Spectrum of Molecular Injury Highlights Heterogeneity of Banff Tubulitis and Interstitial Inflammation Lesions

  Journal of the American Society of Nephrology · 2022-11-01

  articleSenior author
  PublisherDOI

• Dihydroxyadenine Crystals Leading to Renal Graft Loss

  Journal of the American Society of Nephrology · 2021-10-01

  articleSenior author

  Introduction: Adenine phosphoribosyltransferase (APRT) deficiency is an autosomal recessive disease which leads to excessive production and renal excretion of poorly soluble 2,8-dihydroxyadenine (DHA). This causes crystal-induced acute kidney injury and progressive chronic kidney disease (CKD). We describe a case of DHA nephropathy in a renal transplant recipient leading to graft failure. Case Description: A 69 year old female with ESRD secondary to recurrent nephrolithiasis underwent a deceased donor kidney transplant. The stone composition was previously unknown but she underwent genetic testing and was found to be homozygous for APRT c.81-3C>G mutation which was reported as a variant of uncertain significance. Following transplantation, she was started on allopurinol for stone prevention and an APRT activity level was checked and was within normal range. As a result, allopurinol was stopped. Her serum creatinine which was 1.6 mg/dl started to gradually increase to 5.5 mg/dL. She underwent a kidney biopsy which showed extensive tubular cytoplasmic and luminal 2,8-DHA crystal deposits. Despite restarting allopurinol, renal function continued to worsen and she developed uremic symptoms. She was initiated on hemodialysis. Discussion: APRT deficiency is a rare condition and novel mutations are being reported. It is likely that the mutation of unknown significance which our patient has might be another novel mutation associated with APRT deficiency. DHA stone formation can occur even when APRT levels are normal or detectable. It is of utmost importance to continue allopurinol in patients with known DHA stones as genetic testing and APRT level may be misleading and stopping allopurinol will result in irreversible kidney damageIntratubular and cytoplasmic DHA crytals.

  PublisherDOI

• Kidney transplantation from SARS-CoV-2–positive deceased donor

  American Journal of Transplantation · 2021-12-03 · 16 citations

  letterOpen access

  To the Editor: To expand the available donor pool, many organ procurement organizations and transplant programs have begun to consider severe acute respiratory syndrome coronavirus (SARS-CoV-2) nucleic acid test positive candidates.1Organ Procurement and Transplantation Network: Summary of Current Evidence and Information– Donor SARS-CoV-2 Testing & Organ Recovery from Donors with a History of COVID-19. 2021.Google Scholar It is becoming increasingly clear that not all donors with a positive nucleic acid amplification test for SARS-CoV-2 are contagious, and some of these organs can be transplanted with careful selection.2Kute VB Fleetwood VA Meshram HS Guenette A Lentine KL. Use of organs from SARS-CoV-2 infected donors: is it safe? a contemporary review.Curr Transplant Rep. 2021; : 1-12Google Scholar,3Koval CE Poggio ED Lin YC Kerr H Eltemamy M Wee A. Early success transplanting kidneys from donors with new SARS-CoV-2 RNA positivity: a report of 10 cases.Am J Transplant. 2021; 21: 3743-3749Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar Data from 31 kidney transplants from living donors with resolved COVID-19 in India showed the safety of this approach.4Kute VB Godara S Guleria S et al.Is it safe to be transplanted from living donors who recovered from COVID-19? Experience of 31 kidney transplants in a multicenter cohort study from India.Transplantation. 2021; 105: 842-850Crossref PubMed Scopus (36) Google Scholar However, it is unknown whether kidneys from donors with active COVID-19 can also be safely transplanted.3Koval CE Poggio ED Lin YC Kerr H Eltemamy M Wee A. Early success transplanting kidneys from donors with new SARS-CoV-2 RNA positivity: a report of 10 cases.Am J Transplant. 2021; 21: 3743-3749Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar,5Ali H Mohamed M Molnar MZ Krishnan N. Is it safe to receive kidneys from deceased kidney donors tested positive for COVID-19 infection?.Ren Fail. 2021; 43: 1060-1062Crossref PubMed Scopus (5) Google Scholar Beyond the “active” infection designation, it is clinically possible to risk stratify donors with COVID-19 based on additional parameters such as clinical history and radiologic or laboratory findings. Here we present a case and 210-day outcome of a successful kidney transplantation from otherwise medically suitable SARS-CoV-2 PCR–positive deceased donors. The donor was a 48-year-old man who had been admitted to the intensive care unit (ICU) with worsening SARS-CoV-2 pneumonia. Urinalyses showed minimal or no proteinuria. On hospital days 20 and 28, he tested negative for COVID-19 by nasopharyngeal (NP) swab PCR; however, PCR testing was again positive on day 29 with a cycle threshold (Ct) of 38. The donor received remdesivir treatment during the hospital stay. The donor primary cause of death was COVID-19 pneumonia secondary to severe worsening hypoxemic respiratory failure. Only kidneys were recovered for transplantation. The mate kidney of this offer was not placed. The recipient was a 48-year-old Hispanic man with a history of end-stage kidney disease (ESKD) from presumed hypertensive nephrosclerosis (Table 1). He had no personal history of COVID-19 and had received a second shot of COVID-19 vaccination (BNT162b2 vaccine) 14 days before this preemptive kidney transplantation. Despite a long cold ischemia time, he never required dialysis after transplantation but had slow graft function and was discharged on post-operative day (POD) 4 on belatacept, mycophenolate mofetil, and prednisone for maintenance immunosuppression. He reported a low-grade fever (#POD7) but denied any cough, shortness of breath, or gastrointestinal symptoms. He tested negative for SARS-CoV-2 via nasal swab PCR. He underwent a kidney graft biopsy for prolonged slow graft function. The biopsy showed moderate acute tubular injury, glomerular basement membrane thickening, and mesangial expansion, no rejection. Serum creatinine continued to trend down, and by POD#210, he had excellent stable graft function with a serum creatinine of 1.39 mg/dl and no proteinuria (Table 1).TABLE 1Donor, recipient, and transplant characteristicsCaseDonor characteristicsHistory of COVID before admissionNoReason for hospital/ICU admissionCOVID pneumoniaSARS-CoV−2 PCR result #1PositiveTime since symptoms (days)0 dayTime before transplantation (days)31 daysSourceNP swabCycle thresholdNo dataSARS-CoV−2 PCR result #2NegativeTime since symptoms (days)20 daysTime before transplantation (days)11 daysSourceNP swabCycle thresholdNo dataSARS-CoV−2 PCR result #3NegativeTime since symptoms (days)28 daysTime before transplantation (days)3 daysSourceNP swabCycle thresholdNo dataSARS-CoV−2 result #4PositiveTime since symptoms (days)29 daysTime before transplantation (days)2 daysSourceNP swabCycle threshold38Age, years48GenderMaleRace/EthnicityWhite/HispanicKDPI65%DCDYesKidney sideLeftCause of deathAnoxiaHistory of hypertensionNoHistory of diabetesYes, >10 yearsPeak serum creatinine1.38 mg/dlTerminal serum creatinine0.25 mg/dlBiopsyLeft kidney biopsy revealed 75 glomeruli, minimal inflammation, no arterial sclerosis, no interstitial fibrosis/tubular atrophyRecipient characteristicsAnti-spike IgG index before transplant (reference range; ≥1.1 is considered positive)>20SARS-CoV−2 PCR before transplantationNegativeTime since vaccination completed14 daysHistory of COVID infectionNoAge50 yearsGenderMaleRace/EthnicityWhite/HispanicCause of ESKDHypertensive Nephrosclerosis (not biopsy proven)Dialysis vintagePreemptive transplantcPRA0%Transplantation related dataCold ischemia time37 hours 37 minutesDelayed Graft FunctionNoHLA mismatches2/6 (0 DR)CrossmatchB and T cell negativeType and dose of inductionrATG 4.5 mg/kgTransplantation outcomeLength of hospital stay4 daysSerum creatinine at POD#711.5 mg/dlSerum creatinine at POD#147.22 mg/dlSerum creatinine at POD#302.28 mg/dlSerum creatinine at POD#451.66 mg/dlSerum creatinine at POD#901.63 mg/dlSerum creatinine at POD#2101.39 mg/dlSARS-Cov−2 PCR after transplantationNegative (POD#11)Anti-spike IgG index after transplant (reference range; ≥1.1 is considered positive)>20 (at POD#19)Post-transplant hospitalizations in the first monthNone Open table in a new tab We report a successful kidney transplant from SARS-CoV-2 nucleic acid test positive deceased donors who were admitted with COVID pneumonia and tested PCR positive 29 days after admission and 2 days before donation. This case demonstrates these transplants can be performed safely without viral transmission to the recipient. Currently, there is a lack of bigger cohort data of these transplants which would be able to assess long-term outcome and potential unexpected complication of these transplants such as the potential higher risk of thromboembolic complication and worse graft function in long-term as described after SARS-CoV-2 infection. The development of registry of organ transplantation from SARS-CoV-2 NAT positivity donors is highly warranted to answer these questions. The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

  PublisherOA PDFDOI

• Bilateral Pyomyositis in a Kidney Transplant Patient

  Journal of the American Society of Nephrology · 2021-10-01

  article

  Introduction: Immunocompromised hosts are susceptible to infectious complications including pyomyositis, a purulent bacterial infection of deep skeletal muscle that most commonly affects lower extremities (LE) and is acquired through hematogenous spread, trauma or injections. Case Description: A 30-year-old man who received a kidney transplant in 2015 for ESRD due to congenital obstructive uropathy presented to an outside hospital with dysuria, bilateral LE pain, leukocytosis to 18.9 k/uL, and an elevated serum creatinine of 4.7 mg/dL. He was treated with intravenous (IV) antibiotics and his dysuria resolved but bilateral LE pain persisted and he was unable to ambulate. He denied recent vigorous exercise, trauma to his calves or history of IV drug use. Leukocytosis persisted at 20.2 k/uL and he had elevated CRP at 7.5 mg/dL. Ultrasound showed no venous thrombi but was notable for avascular fluid collections in the bilateral medial calves. MRI showed a 2.1 x 3.6 x 7.1 cm fluid collection centered in the gastrocnemius with marked muscle edema, and a similar fluid collection in the contralateral LE at the same location (Figure 1). On further questioning, the patient admitted that two months prior he injected B12, that he had purchased online, into his bilateral calves. Incisions and drainage yielded turbid-looking fluid. Bacterial and fungal cultures showed no growth. Acid-fast stain was negative. The patient's antimicrobial treatment was broadened and he rapidly improved leaving the hospital shortly thereafter.Figure 1Discussion: This is a rare case of bilateral pyomyositis in a kidney transplant patient. The inability to culture an organism is likely due to preceding IV antibiotic treatment. This case underscores the importance of keeping a broad differential diagnosis and obtaining a detailed history when treating immunosuppressed patients.

  PublisherDOI

• Phase 3 Study of Maribavir (MBV) vs. Investigator-Assigned Therapy (IAT) for Refractory/Resistant (R/R) Cytomegalovirus (CMV) Infection Post-Transplant: Analysis of Kidney Recipients and Renal Safety

  Journal of the American Society of Nephrology · 2021-10-01

  article1st authorCorresponding
  PublisherDOI

Frequent coauthors

• William M. Bennett

  35 shared

• Takeshi F. Andoh

  33 shared

• Alexander S. Goldfarb‐Rumyantzev

  Harvard University

  31 shared

• James K. Koford

  University of Utah

  23 shared

• Hongying Tang

  Xiangya Hospital Central South University

  20 shared

• Madhukar Chelamcharla

  20 shared

• Hong Yi

  Northeastern University

  18 shared

• Abdou Salam Guèye

  World Health Organization Regional Office for Africa

  18 shared

Education

• M.D.

  American University of Beirut

• Other, Nephrology

  University of Pennsylvania

• Other, Transplantation Medicine

  Oregon Health and Sciences University

Awards & honors

• Who’s Who in America
• America’s Top Doctor in US News and World Report
• Faculty Teaching Awards from the School of Medicine