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Ibrahim M, Mehew J, Martin K, Forsythe J, Johnson RJ, Callaghan C. Outcomes of Declined Deceased Donor Kidney Offers That Are Subsequently Implanted: A UK Registry Study. Transplantation 2023; 107:1348-1358. [PMID: 36706063 DOI: 10.1097/tp.0000000000004467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Deceased donor kidneys are often declined for ≥1 patients but then implanted into another. Studies are needed to guide transplant clinicians and patients, especially given the increasing age and comorbidity of donors. This study compares outcomes of recipients of transplanted kidneys that were initially declined with outcomes of patients who remained on the waiting list. METHODS This UK Transplant Registry study examined named-patient, adult donation after brain death donor single kidney-only offers that were declined for donor- or organ-related reasons (DORRs), in which the kidney was subsequently transplanted from January 1, 2010, to December 31, 2018. Outcomes included graft function and survival of kidneys transplanted following DORR decline, survival and transplant status of patients who had a kidney declined, and intercenter decline rates. RESULTS A total of 4722 kidneys declined for DORRs, which eventually resulted in single kidney-only transplants, were examined. One year after the offer decline, 35% of patients for whom the organ was declined remained on the list, 55% received a deceased donor transplant at a median of 174 d after the initial offer decline, and 4% had been removed or died. For patients transplanted following offer decline, there was no significant difference in 5-y graft survival when comparing the outcomes to those recipients who received the declined kidney. There was significant variation in DORR decline rates between UK transplant units (17%-54%). CONCLUSIONS This study shows reasonable outcomes of kidneys previously declined for DORRs and supports the utilization of those considered to be of higher risk for carefully selected recipients.
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Affiliation(s)
- Maria Ibrahim
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- NHS Blood and Transplant, Stoke Gifford, Bristol, United Kingdom
| | - Jennifer Mehew
- NHS Blood and Transplant, Stoke Gifford, Bristol, United Kingdom
| | - Kate Martin
- NHS Blood and Transplant, Stoke Gifford, Bristol, United Kingdom
| | - John Forsythe
- NHS Blood and Transplant, Stoke Gifford, Bristol, United Kingdom
| | - Rachel J Johnson
- NHS Blood and Transplant, Stoke Gifford, Bristol, United Kingdom
| | - Chris Callaghan
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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2
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Hosgood SA, Callaghan CJ, Wilson CH, Smith L, Mullings J, Mehew J, Oniscu GC, Phillips BL, Bates L, Nicholson ML. Normothermic machine perfusion versus static cold storage in donation after circulatory death kidney transplantation: a randomized controlled trial. Nat Med 2023; 29:1511-1519. [PMID: 37231075 PMCID: PMC10287561 DOI: 10.1038/s41591-023-02376-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/28/2023] [Indexed: 05/27/2023]
Abstract
Kidney transplantation is the optimal treatment for end-stage renal disease, but it is still severely limited by a lack of suitable organ donors. Kidneys from donation after circulatory death (DCD) donors have been used to increase transplant rates, but these organs are susceptible to cold ischemic injury in the storage period before transplantation, the clinical consequence of which is high rates of delayed graft function (DGF). Normothermic machine perfusion (NMP) is an emerging technique that circulates a warmed, oxygenated red-cell-based perfusate through the kidney to maintain near-physiological conditions. We conducted a randomized controlled trial to compare the outcome of DCD kidney transplants after conventional static cold storage (SCS) alone or SCS plus 1-h NMP. A total of 338 kidneys were randomly allocated to SCS (n = 168) or NMP (n = 170), and 277 kidneys were included in the final intention-to-treat analysis. The primary endpoint was DGF, defined as the requirement for dialysis in the first 7 d after transplant. The rate of DGF was 82 of 135 (60.7%) in NMP kidneys versus 83 of 142 (58.5%) in SCS kidneys (adjusted odds ratio (95% confidence interval) 1.13 (0.69-1.84); P = 0.624). NMP was not associated with any increase in transplant thrombosis, infectious complications or any other adverse events. A 1-h period of NMP at the end of SCS did not reduce the rate of DGF in DCD kidneys. NMP was demonstrated to be feasible, safe and suitable for clinical application. Trial registration number: ISRCTN15821205 .
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Affiliation(s)
- Sarah A Hosgood
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
| | - Christopher J Callaghan
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Colin H Wilson
- Freeman Hospital, Institute of Transplantation, Newcastle upon Tyne Hospitals NHS Trust and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Smith
- NHS Blood and Transplant (NHSBT) Clinical Trials Unit, NHSBT Stoke Gifford, Bristol, UK
| | - Joanne Mullings
- NHS Blood and Transplant (NHSBT) Clinical Trials Unit, NHSBT Stoke Gifford, Bristol, UK
| | - Jennifer Mehew
- NHS Blood and Transplant (NHSBT) Clinical Trials Unit, NHSBT Stoke Gifford, Bristol, UK
| | - Gabriel C Oniscu
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Benedict L Phillips
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Lucy Bates
- Freeman Hospital, Institute of Transplantation, Newcastle upon Tyne Hospitals NHS Trust and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Michael L Nicholson
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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3
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Oniscu GC, Mehew J, Butler AJ, Sutherland A, Gaurav R, Hogg R, Currie I, Jones M, Watson CJE. Improved Organ Utilization and Better Transplant Outcomes With In Situ Normothermic Regional Perfusion in Controlled Donation After Circulatory Death. Transplantation 2023; 107:438-448. [PMID: 35993664 DOI: 10.1097/tp.0000000000004280] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND . We evaluated whether the use of normothermic regional perfusion (NRP) was associated with increased organ recovery and improved transplant outcomes from controlled donation after circulatory death (cDCD). METHODS . This is a retrospective analysis of UK adult cDCD donors' where at least 1 abdominal organ was accepted for transplantation between January 1, 2011, and December 31, 2019. RESULTS . A mean of 3.3 organs was transplanted when NRP was used compared with 2.6 organs per donor when NRP was not used. When adjusting for organ-specific donor risk profiles, the use of NRP increased the odds of all abdominal organs being transplanted by 3-fold for liver ( P < 0.0001; 95% confidence interval [CI], 2.20-4.29), 1.5-fold for kidney ( P = 0.12; 95% CI, 0.87-2.58), and 1.6-fold for pancreas ( P = 0.0611; 95% CI, 0.98-2.64). Twelve-mo liver transplant survival was superior for recipients of a cDCD NRP graft with a 51% lower risk-adjusted hazard of transplant failure (HR = 0.494). In risk-adjusted analyses, NRP kidneys had a 35% lower chance of developing delayed graft function than non-NRP kidneys (odds ratio, 0.65; 95% CI, 0.465-0.901)' and the expected 12-mo estimated glomerular filtration rate was 6.3 mL/min/1.73 m 2 better if abdominal NRP was used ( P < 0.0001). CONCLUSIONS . The use of NRP during DCD organ recovery leads to increased organ utilization and improved transplant outcomes compared with conventional organ recovery.
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Affiliation(s)
- Gabriel C Oniscu
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, United Kingdom
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer Mehew
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - Andrew J Butler
- University of Cambridge Department of Surgery, Addenbrooke's Hospital, Cambridge, the National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre and the NIHR Blood and Transplant Research Unit (BTRU) at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT), London, United Kingdom
- Cambridge Transplant Unit, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Bristol, United Kingdom
| | - Andrew Sutherland
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, United Kingdom
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, United Kingdom
| | - Rohit Gaurav
- Cambridge Transplant Unit, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Bristol, United Kingdom
| | - Rachel Hogg
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - Ian Currie
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, United Kingdom
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark Jones
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - Christopher J E Watson
- University of Cambridge Department of Surgery, Addenbrooke's Hospital, Cambridge, the National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre and the NIHR Blood and Transplant Research Unit (BTRU) at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT), London, United Kingdom
- Cambridge Transplant Unit, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Bristol, United Kingdom
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Mehew J, Johnson R, Roberts D, Griffiths A, Harvala H. Convalescent plasma for
COVID
‐19: Donor demographic factors associated high neutralising antibody titres. Transfus Med 2022; 32:327-337. [PMID: 35434868 PMCID: PMC9115414 DOI: 10.1111/tme.12868] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/27/2022] [Accepted: 04/03/2022] [Indexed: 01/08/2023]
Abstract
Background Convalescent plasma containing high levels of SARS‐CoV‐2 antibodies has been studied as a possible treatment for COVID‐19. Better understanding of predictors of high antibody levels is needed for improving supply of high‐quality therapeutic plasma. Aims We have evaluated demographic and clinical factors associated with the probability of a convalescent plasma donor having high SARS‐CoV‐2 IgG antibody levels. Methods A total of 29,585 convalescent plasma donors employed during the first and second waves of the COVID‐19 pandemic in England were included in this study. All had been tested for SARS‐CoV‐2 IgG antibodies by EUROimmun ELISA. A multivariable logistic regression model was used to quantify the association of the demographic and clinical factors with high (EUROimmun S/Co>6.0) SARS‐CoV‐2 IgG antibody level. Results Most of the donors were male (23,024; 78%), with white ethnic background (24,598;83%) and had not been tested for SARS‐CoV‐2 (15,266; 52%).Overall, less than 20% of convalescent plasma donors with confirmed or suspected SARS‐CoV‐2 infection harboured high SARS‐CoV‐2 antibody levels (n = 4,978). We found that older male donors who had been hospitalised with COVID‐19 were most likely to harbour high levels of antibodies. White donors were less likely to have high SARS‐CoV‐2 antibody levels than donors with Asian orblack ethnic backgrounds residing in affluent areas likely reflecting ethnic inequality previously associated with SARS‐CoV‐2 infection. Discussion In a time of great uncertainty, and predicted new waves associated with newly emerging SARS‐CoV‐2 variants, these results will help us to target future convalescent plasma collections.
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Affiliation(s)
- Jennifer Mehew
- Statistics and Clinical Studies, NHS Blood and Transplant Bristol UK
| | - Rachel Johnson
- Statistics and Clinical Studies, NHS Blood and Transplant Bristol UK
| | - David Roberts
- Clinical, Research and Development, NHS Blood and Transplant Oxford UK
- Radcliffe Department of Medicine and BRC Haematology Theme University of Oxford, John Radcliffe Hospital Oxford UK
| | - Alex Griffiths
- Statistics and Clinical Studies, NHS Blood and Transplant Bristol UK
| | - Heli Harvala
- Microbiology Services NHS Blood and Transplant London UK
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5
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Mehew J, Johnson R, Roberts D, Harvala H. Convalescent plasma for COVID-19: male gender, older age and hospitalisation associated with high neutralising antibody levels, England, 22 April to 12 May 2020. Euro Surveill 2020; 25:2001754. [PMID: 33183404 PMCID: PMC7667632 DOI: 10.2807/1560-7917.es.2020.25.45.2001754] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/09/2020] [Indexed: 12/20/2022] Open
Abstract
We analysed factors associated with neutralising antibody levels in 330 convalescent plasma donors. Women and younger donors were more likely not to have measurable neutralising antibodies, while higher antibody levels were observed in men, in older donors and in those who had been hospitalised. These data will be of value in the timely recruitment of convalescent plasma donors most likely to have high levels of neutralising antibodies for ongoing studies investigating its effectiveness.
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Affiliation(s)
- Jennifer Mehew
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - Rachel Johnson
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - David Roberts
- NHS Blood and Transplant, Oxford, United Kingdom
- Radcliffe Department of Medicine and BRC Haematology Theme, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Heli Harvala
- Microbiology Services, NHS Blood and Transplant, London, United Kingdom
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6
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Harvala H, Mehew J, Robb ML, Ijaz S, Dicks S, Patel M, Watkins N, Simmonds P, Brooks T, Johnson R, Gopal R, Roberts DJ, Zambon M. Convalescent plasma treatment for SARS-CoV-2 infection: analysis of the first 436 donors in England, 22 April to 12 May 2020. Euro Surveill 2020; 25:2001260. [PMID: 32700670 PMCID: PMC7376844 DOI: 10.2807/1560-7917.es.2020.25.28.2001260] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/16/2020] [Indexed: 12/29/2022] Open
Abstract
Serological reactivity was analysed in plasma from 436 individuals with a history of disease compatible with COVID-19, including 256 who had been laboratory-confirmed with SARS-CoV-2 infection. Over 99% of laboratory-confirmed cases developed a measurable antibody response (254/256) and 88% harboured neutralising antibodies (226/256). Antibody levels declined over 3 months following diagnosis, emphasising the importance of the timing of convalescent plasma collections. Binding antibody measurements can inform selection of convalescent plasma donors with high neutralising antibody levels.
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Affiliation(s)
- Heli Harvala
- Microbiology Services, NHS Blood and Transplant, London, United Kingdom
| | - Jennifer Mehew
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - Matthew L Robb
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - Samreen Ijaz
- Virology Reference Department, National Infection Service, Public Health England, Colindale Avenue, London, United Kingdom
| | - Steven Dicks
- Microbiology Services, NHS Blood and Transplant, London, United Kingdom
- Virology Reference Department, National Infection Service, Public Health England, Colindale Avenue, London, United Kingdom
| | - Monika Patel
- High Containment Microbiology, National Infection Service, Public Health England, Colindale Avenue, London, United Kingdom
| | | | - Peter Simmonds
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Tim Brooks
- Rare & Imported Pathogens Laboratory, Public Health England, Porton Down, United Kingdom
| | - Rachel Johnson
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - Robin Gopal
- High Containment Microbiology, National Infection Service, Public Health England, Colindale Avenue, London, United Kingdom
| | - David J Roberts
- NHS Blood and Transplant, Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- Radcliffe Department of Medicine and BRC Haematology Theme, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Maria Zambon
- Virology Reference Department, National Infection Service, Public Health England, Colindale Avenue, London, United Kingdom
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Kourliouros A, Hogg R, Mehew J, Al-Aloul M, Carby M, Lordan J, Thompson R, Tsui S, Parmar J. Factors Influencing Outcomes from Listing for Lung Transplantation in the UK. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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8
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Page A, Wong E, Rushton S, Mehew J, Berman M, Tsui S. Changing Trends in Acceptance Criteria for Cardiac Donors: 15 Year UK Experience. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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