1
|
Barry JM. Invited Commentary: Kidney Transplantation and Obesity: Are There Any Differences in Outcomes? World J Surg 2023; 47:519. [PMID: 36376591 DOI: 10.1007/s00268-022-06831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Affiliation(s)
- John M Barry
- Departments of Surgery and Urology, Oregon Health & Science University, 3303 S. Bond Ave., Portland, OR, 97236, USA.
| |
Collapse
|
2
|
Jiang DD, Chakiryan NH, Gillis KA, Hedges JC, Barry JM. Educational value of the transplant experience in urology residency. Can J Urol 2021; 28:10783-10787. [PMID: 34378516] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
UNLABELLED INTRODUCTION To evaluate the educational value of transplant rotation in urology residency. In the United States, exposure to kidney transplantation during urology residency has declined significantly over the past few decades. At our institution, transplantation has been a core component of urology residency since its inception in 1959. MATERIALS AND METHODS A 15-question anonymous survey was developed. The first 8 questions queried demographics and the last 7 were a set of questions with a Likert Scale response. The survey was electronic- mailed to past and current urology residents who had completed the transplant rotation, dating back to 1972. RESULTS A total of 61 out of 98 (62%) individuals responded. The majority (59%) were general urologists, and one (2%) had completed a transplant fellowship. In their practices, 17% performed kidney transplants and 28% performed donor nephrectomies. Overall, 100% responded that the skills learned on the transplant rotation were beneficial for urology training, 100% had learned valuable vascular surgical techniques, and 93% felt that urology residents should have clinical transplant experience during their training. There was no statistical difference between the younger and older graduates in Likert scale responses. CONCLUSION The majority of graduates did not perform transplants in their practice, yet, all of responders agreed that the skills learned on the transplant rotation were beneficial and 93% expressed that urology residents should have clinical transplant experience during residency. Kidney transplantation should be an integral part of urology residency training.
Collapse
Affiliation(s)
- Da David Jiang
- Department of Urology, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | | | | |
Collapse
|
3
|
Dunne EC, Quinn EM, Stokes M, Barry JM, Kell M, Flanagan F, Kennedy MM, Walsh SM. Upgrade rates and outcomes of screen-detected atypical intraductal epithelial proliferation (AIDEP) diagnosed on core needle biopsy. Breast Dis 2021; 40:155-160. [PMID: 33749633 DOI: 10.3233/bd-201031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Atypical intraductal epithelial proliferation (AIDEP) is a breast lesion categorised as "indeterminate" if identified on core needle biopsy (CNB). The rate at which these lesions are upgraded following diagnostic excision varies in the literature. Women diagnosed with AIDEP are thought to be at increased risk of breast cancer. Our aim was to identify the rate of upgrade to invasive or in situ carcinoma in a group of patients diagnosed with AIDEP on screening mammography and to quantify their risk of subsequent breast cancer. METHODS We conducted a retrospective review of a prospectively maintained database containing all patients diagnosed with AIDEP on CNB between 2005 and 2012 in an Irish breast screening centre. Basic demographic data was collected along with details of the original CNB result, rate of upgrade to carcinoma and details of any subsequent cancer diagnoses. RESULTS In total 113 patients were diagnosed with AIDEP on CNB during the study period. The upgrade rate on diagnostic excision was 28.3% (n = 32). 6.2% (n = 7) were upgraded to invasive cancer and 22.1% (n = 25) to DCIS. 81 patients were not upgraded on diagnostic excision and were offered 5 years of annual mammographic surveillance. 9.88% (8/81) of these patients went on to receive a subsequent diagnosis of malignancy. The mean time to diagnosis of these subsequent cancers was 65.41 months (range 20.18-145.21). CONCLUSION Our data showing an upgrade rate of 28% to carcinoma reflects recently published data and we believe it supports the continued practice of excising AIDEP to exclude co-existing carcinoma.
Collapse
Affiliation(s)
- Emma C Dunne
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Edel M Quinn
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Maurice Stokes
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John M Barry
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Malcolm Kell
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Fidelma Flanagan
- Department of Breast Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Margaret M Kennedy
- Department of Cellular Pathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Siun M Walsh
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| |
Collapse
|
4
|
Boland PA, Ali Beegan A, Stokes M, Kell MR, Barry JM, O'Brien A, Walsh SM. Management and outcomes of phyllodes tumours - 10 year experience. Breast Dis 2021; 40:171-176. [PMID: 33749634 DOI: 10.3233/bd-201059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Phyllodes tumours represent 0.3-1% of breast tumours, typically presenting in women aged 35-55 years. They are classified into benign, borderline and malignant grades and exhibit a spectrum of features. There is significant debate surrounding the optimal management of phyllodes tumour, particularly regarding appropriate margins. METHODS This is a retrospective review of a prospectively maintained database of patients who underwent surgical management for phyllodes tumours in a single tertiary referral centre from 2007-2017. Patient demographics, tumour characteristics, surgical treatment and follow-up data were analysed. Tumour margins were classified as positive (0 mm), close (≤2 mm) and clear (>2 mm). RESULTS A total of 57 patients underwent surgical excision of a phyllodes tumour. The Mean age was 37.7 years (range: ages 14-91) with mean follow-up of 38.5 months (range: 0.5-133 months). There were 44 (77%) benign, 4 (7%) borderline and 9 (16%) malignant phyllodes cases. 54 patients had breast conserving surgery (BCS) and 3 underwent mastectomy. 30 (53%) patients underwent re-excision of margins. The final margin status was clear in 32 (56%), close in 13 (23%) and positive in 12 (21%). During follow-up, 4 patients were diagnosed with local recurrence (2 malignant, 1 borderline and 1 benign pathology on recurrence samples). CONCLUSION There are no clear guidelines for the surgical management and follow-up of phyllodes tumours. This study suggests that patients with malignant phyllodes and positive margins are more likely to develop local recurrence. There is a need for large prospective studies to guide the development of future guidelines.
Collapse
Affiliation(s)
- Patrick A Boland
- Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Azlena Ali Beegan
- Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Maurice Stokes
- Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Malcolm R Kell
- Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John M Barry
- Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Angela O'Brien
- Department of Breast Radiology, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Siun M Walsh
- Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| |
Collapse
|
5
|
Kelly BD, Sorin GM, Barry JM, Whiston L, Donnelly-Swift E, Darker C. Community-based, cross-sectional study of self-reported health in post-recession Ireland: what has changed? QJM 2018; 111:555-559. [PMID: 29860494 DOI: 10.1093/qjmed/hcy113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Health has a complex relationship with economic conditions. Ireland's economic recession (2008-13) and sharp recovery (from 2014 onwards) offer a valuable opportunity to study self-reported health and its correlates in the context of rapid economic change. AIM To assess the correlates of self-reported health in Dublin, Ireland after the economic recession of 2008-13. DESIGN Cross-sectional, face-to-face household survey using random cluster sampling. METHODS Self-reported health and its correlates were assessed in randomly selected households in Tallaght (a suburb of Dublin) and results were compared with a similar survey in 2014. RESULTS Five hundred and eighty-three eligible households were invited to participate and interviews were completed in 351 (response rate: 60.2%). The proportion of respondents rating their health as 'very good' or 'good' was 71.8%, essentially unchanged from four years earlier (70.8%). In 2018, better self-reported health was associated with less stress, holding private health insurance, not living with a person with a disability or chronic illness, and greater education; taken together, these factors explained 39.4% of variation in self-reported health. Unlike 2014, self-reported health in 2018 was no longer directly associated with employment status. CONCLUSIONS Self-reported health has stabilized in Ireland since the end of the economic recession, but its correlates have shifted. Stress and carer burden are now among the strongest correlates of poor self-reported health in Ireland.
Collapse
Affiliation(s)
- B D Kelly
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland
| | - G M Sorin
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland
| | - J M Barry
- Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Tallaght Cross, Dublin, Ireland
| | - L Whiston
- School of Nursing and Human Sciences, Faculty of Science and Health, Dublin City University, Dublin, Ireland
| | - E Donnelly-Swift
- Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Tallaght Cross, Dublin, Ireland
| | - C Darker
- Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Tallaght Cross, Dublin, Ireland
| |
Collapse
|
6
|
Barry JM. Editorial Comment on: Learning Curves and Timing of Surgical Trials: Robotic Kidney Transplantation with Regional Hypothermia by Ahlawat et al. (From: Ahlawat RK, Tugcu V, Arora S, et al. J Endourolo 2018;32:1160-1165; DOI: 1089/end.2017.0697). J Endourol 2018; 32:1166. [PMID: 29905082 DOI: 10.1089/end.2018.0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- John M Barry
- Department of Urology, Oregon Health and Science University , Portland, Oregon
| |
Collapse
|
7
|
Burg JM, Scott DL, Roayaie K, Maynard E, Barry JM, Enestvedt CK. Impact of center volume and the adoption of laparoscopic donor nephrectomy on outcomes in pediatric kidney transplantation. Pediatr Transplant 2018; 22:e13121. [PMID: 29392867 DOI: 10.1111/petr.13121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 11/28/2022]
Abstract
Reports for pediatric kidney transplant recipients suggested better outcomes for ODN compared to LDN. Contemporary outcomes stratified by donor type and center volume have not been evaluated in a national dataset. UNOS data (2000-2014) were analyzed for pediatric living donor kidney transplant recipients. The primary outcome was GF; secondary outcomes were DGF, rejection, and patient survival. Live donor nephrectomies for pediatric recipients decreased 30% and transitioned from ODN to LDN. GF rates did not differ for ODN vs LDN (P = .24). GF was lowest at high volume centers (P < .01). Donor operative approach did not contribute to GF. LDN was associated with less rejection than ODN (OR 0.66, CI 0.5-0.87, P < .01). Analysis of the 0- to 5-yr recipient group showed no effect of ODN vs LDN on GF or rejection. For the contemporary era, there was no association between DGF and LDN in the 0- to 5-yr group (OR 1.12, CI 0.67-1.89, P = .67). Outcomes of kidney transplants in pediatric recipients following LDN have improved since its introduction and LDN should be the approach for live donor nephrectomy regardless of recipient age. The association between case volume and improved outcomes highlights future challenges in organ transplantation.
Collapse
Affiliation(s)
- Jennifer M Burg
- Division of Abdominal Organ Transplantation/Hepatobiliary Surgery, Oregon Health and Science University, Portland, OR, USA
| | - David L Scott
- Division of Abdominal Organ Transplantation/Hepatobiliary Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Kayvan Roayaie
- Division of Abdominal Organ Transplantation/Hepatobiliary Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Erin Maynard
- Division of Abdominal Organ Transplantation/Hepatobiliary Surgery, Oregon Health and Science University, Portland, OR, USA
| | - John M Barry
- Department of Urology, Oregon Health and Science University, Portland, OR, USA
| | - C Kristian Enestvedt
- Division of Abdominal Organ Transplantation/Hepatobiliary Surgery, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
8
|
Werntz RP, Shoureshi P, Gillis K, Kapadia A, Jiang D, Amling C, Barry JM. A Simple Neobladder Using a Porcine Model: The Double Limb U-Pouch. Urology 2017; 114:198-201. [PMID: 29203191 DOI: 10.1016/j.urology.2017.11.031] [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] [Received: 10/25/2017] [Revised: 11/16/2017] [Accepted: 11/21/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To create a simple neobladder and determine whether the double-limb U-Pouch (D-LUP) has the same capacity and compliance as a Studer or Camey I neobladder. To develop an orthotopic diversion that can be applied to robotic surgery with laboratory data supporting the concept. MATERIALS AND METHODS Kidneys, ureters, bladders, and small intestine were obtained from pigs at the time of scheduled autopsy after completion of institutionally approved investigational trauma protocols. A Camey I neobladder, spherical neobladder, and D-LUP, were constructed from 40-cm segments of small intestine. They were compared for capacity, compliance, and pouch-to-urethra anastomotic distance. RESULTS The cystometric capacity at 30 cm H2O for the Camey I, Studer, and D-LUP neobladders were 250 mL, 350 mL, and 430 mL, respectively. The pouch-to-urethra anastomotic distance was 0 cm for the Camey I, 10 cm for the spherical reservoir, and 0 cm for the D-LUP. Compliance was 10 mL/cm H20 for the Camey 1, 15 mL/cm H2O for the sphere, and 16 mL/cm H20 for the D-LUP. CONCLUSION The D-LUP neobladder was simple to construct, had a more dependent ileo-urethrostomy site, larger capacity, and similar compliance when compared with a spherical neobladder.
Collapse
Affiliation(s)
| | | | - Kyle Gillis
- Oregon Health and Science University, Portland, OR
| | | | - David Jiang
- Oregon Health and Science University, Portland, OR
| | | | - John M Barry
- Oregon Health and Science University, Portland, OR
| |
Collapse
|
9
|
Affiliation(s)
- John M Barry
- Department of Urology and Surgery, Oregon Health and Science University, Portland, OR, USA. E-mail:
| |
Collapse
|
10
|
Affiliation(s)
- John M Barry
- Urology, CH1OU Center for Health and Healing, The Oregon Health Sciences University, Portland, OR
| |
Collapse
|
11
|
Affiliation(s)
- John M Barry
- Division of Abdominal Organ Transplantation, The Oregon Health & Science University, Portland, Oregon
| |
Collapse
|
12
|
Duty BD, Barry JM. Diagnosis and management of ureteral complications following renal transplantation. Asian J Urol 2015; 2:202-207. [PMID: 29264146 PMCID: PMC5730752 DOI: 10.1016/j.ajur.2015.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 07/15/2015] [Accepted: 08/07/2015] [Indexed: 12/14/2022] Open
Abstract
When compared with maintenance dialysis, renal transplantation affords patients with end-stage renal disease better long-term survival and a better quality of life. Approximately 9% of patients will develop a major urologic complication following kidney transplantation. Ureteral complications are most common and include obstruction (intrinsic and extrinsic), urine leak and vesicoureteral reflux. Ureterovesical anastomotic strictures result from technical error or ureteral ischemia. Balloon dilation or endoureterotomy may be considered for short, low-grade strictures, but open reconstruction is associated with higher success rates. Urine leak usually occurs in the early postoperative period. Nearly 60% of patients can be successfully managed with a pelvic drain and urinary decompression (nephrostomy tube, ureteral stent, and indwelling bladder catheter). Proximal, large-volume, or leaks that persist despite urinary diversion, require open repair. Vesicoureteral reflux is common following transplantation. Patients with recurrent pyelonephritis despite antimicrobial prophylaxis require surgical treatment. Deflux injection may be considered in recipients with low-grade disease. Grade IV and V reflux are best managed with open reconstruction.
Collapse
Affiliation(s)
- Brian D Duty
- Department of Urology, Oregon Health & Science University, Portland, OR, USA
| | - John M Barry
- Department of Urology, Oregon Health & Science University, Portland, OR, USA.,Department of Surgery, Division of Abdominal Organ Transplantation, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
13
|
Cowan NG, Banerji JS, Johnston RB, Duty BD, Bakken B, Hedges JC, Kozlowski PM, Hefty TR, Barry JM. Renal Autotransplantation: 27-Year Experience at 2 Institutions. J Urol 2015; 194:1357-61. [PMID: 26055825 DOI: 10.1016/j.juro.2015.05.088] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Renal autotransplantation is an infrequently performed procedure. It has been used to manage complex ureteral disease, vascular anomalies and chronic kidney pain. We reviewed our 27-year experience with this procedure. MATERIALS AND METHODS This is a retrospective, observational study of 51 consecutive patients who underwent renal autotransplantation, including 29 at Oregon Health and Science University between 1986 and 2013, and 22 at Virginia Mason Medical Center between 2007 and 2012. Demographics, indications, operative details and followup data were collected. Early (30 days or less) and late (greater than 30 days) complications were graded according to the Clavien-Dindo system. Factors associated with complications and pain recurrence were evaluated using a logistic regression model. RESULTS The 51 patients underwent a total of 54 renal autotransplants. Median followup was 21.5 months. The most common indications were loin pain hematuria syndrome/chronic kidney pain in 31.5% of cases, ureteral stricture in 20.4% and vascular anomalies in 18.5%. Autotransplantation of a solitary kidney was performed in 5 patients. Laparoscopic nephrectomy was performed in 23.5% of cases. Median operative time was 402 minutes and median length of stay was 6 days. No significant difference was found between preoperative and postoperative plasma creatinine (p = 0.74). Early, high grade complications (grade IIIa or greater) developed in 14.8% of patients and 12.9% experienced late complications of any grade. Two graft losses occurred. Longer cold ischemia time was associated with complications (p = 0.049). Of patients who underwent autotransplantation for chronic kidney pain 35% experienced recurrence and 2 underwent transplant nephrectomy. No predictors of pain recurrence were identified. CONCLUSIONS The most common indications for renal autotransplantation were loin pain hematuria syndrome/chronic kidney pain, ureteral stricture and vascular anomalies in descending order. Kidney function was preserved postoperatively and 2 graft losses occurred. At a median followup of 13 months pain resolved in 65% of patients who underwent the procedure. Complication rates compared favorably with those of other major urological operations and cold ischemia time was the only predictor of postoperative complications.
Collapse
Affiliation(s)
- Nick G Cowan
- Department of Urology, Oregon Health and Science University, Portland
| | - John S Banerji
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
| | - Richard B Johnston
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
| | - Brian D Duty
- Department of Urology, Oregon Health and Science University, Portland
| | - Bjørn Bakken
- Department of Urology, Oregon Health and Science University, Portland
| | - Jason C Hedges
- Department of Urology, Oregon Health and Science University, Portland.
| | - Paul M Kozlowski
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
| | - Thomas R Hefty
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
| | - John M Barry
- Department of Urology, Oregon Health and Science University, Portland
| |
Collapse
|
14
|
Cullen TJ, McCarthy MP, Lasarev MR, Barry JM, Stadler DD. Body Mass Index and the Development of New-Onset Diabetes Mellitus or the Worsening of Pre-Existing Diabetes Mellitus in Adult Kidney Transplant Patients. J Ren Nutr 2014; 24:116-22. [DOI: 10.1053/j.jrn.2013.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 11/01/2013] [Accepted: 11/12/2013] [Indexed: 11/11/2022] Open
|
15
|
Sung J, Barry JM, Jenkins R, Rozansky D, Iragorri S, Conlin M, Al-Uzri A. Alemtuzumab induction with tacrolimus monotherapy in 25 pediatric renal transplant recipients. Pediatr Transplant 2013; 17:718-25. [PMID: 24164824 DOI: 10.1111/petr.12159] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2013] [Indexed: 12/12/2022]
Abstract
ALA induction in transplantation has been shown to reduce the need for maintenance immunosuppression. We report the outcome of 25 pediatric renal transplants between 2007 and 2010 using ALA induction followed by tacrolimus maintenance monotherapy. Patient ages were 1-19 yr (mean 14 ± 4.1 yr). Time of follow-up was 7-51 months (mean 26 ± 13 months). Tacrolimus monotherapy was maintained in 48% of patients, and glucocorticoids were avoided in 80% of recipients. Mean plasma creatinine and GFR at one yr post-transplant were 0.88 ± 0.3 mg/dL and 104.4 ± 25 mL/min/1.73m(2) , respectively. One, two, and three-yr actuarial patient and graft survival rates were 100%. The incidence of early AR (<12 months after transplantation) was 12%, while the incidence of late AR (after 12 months) was 16%. Forty-four percent of the recipients recovered normal, baseline renal function after an episode of AR, and 44% had persistent renal dysfunction (plasma creatinine 1.0-1.8 mg/dL). One graft was lost four yr after transplantation due to medication non-compliance. Four (16%) patients developed BK or CMV infection. In our experience, ALA induction with tacrolimus monotherapy resulted in excellent short- and mid-term patient and graft survival in low-immunologic risk pediatric renal transplant recipients.
Collapse
Affiliation(s)
- Jennifer Sung
- Department of Urology, Oregon Health and Science University, Portland, OR, USA
| | | | | | | | | | | | | |
Collapse
|
16
|
|
17
|
Ganz PA, Barry JM, Burke W, Col NF, Corso PS, Dodson E, Hammond ME, Kogan BA, Lynch CF, Newcomer L, Seifter EJ, Tooze JA, Viswanath K, Wessells H. National Institutes of Health State-of-the-Science Conference: role of active surveillance in the management of men with localized prostate cancer. Ann Intern Med 2012; 156:591-5. [PMID: 22351514 PMCID: PMC4774889 DOI: 10.7326/0003-4819-156-8-201204170-00401] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
National Institutes of Health (NIH) Consensus and State-of-the-Science Statements are prepared by independent panels of health professionals and public representatives on the basis of 1) the results of a systematic literature review prepared under contract with the Agency for Healthcare Research and Quality, 2) presentations by investigators working in areas relevant to the conference questions during a 2-day public session, 3) questions and statements from conference attendees during open discussion periods that are part of the public session, and 4) closed deliberations by the panel during the remainder of the second day and morning of the third. This statement is an independent report of the panel and is not a policy statement of NIH or the U.S. government. The statement reflects the panel’s assessment of medical knowledge available at the time the statement was written. Thus, it provides a “snapshot in time” of the state of knowledge on the conference topic. When reading the statement, keep in mind that new knowledge is inevitably accumulating through medical research. The following statement is an abridged version of the panel’s report, which is available in full at http://consensus.nih.gov/2011/prostatefinalstatement.htm
Collapse
Affiliation(s)
- Patricia A Ganz
- University of California, Los Angeles, Schools of Medicine and Public Health, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Ganz PA, Barry JM, Burke W, Col NF, Corso PS, Dodson E, Hammond ME, Kogan BA, Lynch CF, Newcomer L, Seifter EJ, Tooze JA, Viswanath KV, Wessells H. NIH State-of-the-Science Conference Statement: Role of active surveillance in the management of men with localized prostate cancer. NIH Consens State Sci Statements 2011; 28:1-27. [PMID: 23392076] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To provide healthcare providers, patients, and the general public with a responsible assessment of currently available data on the use of active surveillance and other observational management strategies for low-grade, localized prostate cancer. PARTICIPANTS A non-U.S. Department of Health and Human Services, nonadvocate 14-member panel representing the fields of cancer prevention and control, urology, pathology, epidemiology, genetics, transplantation, bioethics, economics, health services research, shared decisionmaking, health communication, and community engagement. In addition, 22 experts from pertinent fields presented data to the panel and conference audience. EVIDENCE Presentations by experts and a systematic review of the literature prepared by the Tufts Evidence-based Practice Center, through the Agency for Healthcare Research and Quality (AHRQ). Scientific evidence was given precedence over anecdotal experience. CONFERENCE PROCESS The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. CONCLUSIONS Prostate cancer screening with prostate-specific antigen (PSA) testing has identified many men with low-risk disease. Because of the very favorable prognosis of low-risk prostate cancer, strong consideration should be given to modifying the anxiety-provoking term "cancer" for this condition. Treatment of low-risk prostate cancer patients with radical prostatectomy or radiation therapy leads to side effects such as impotence and incontinence in a substantial number. Active surveillance has emerged as a viable option that should be offered to patients with low-risk prostate cancer. More than 100,000 men a year diagnosed with prostate cancer in the United States are candidates for this approach. However, there are many unanswered questions about active surveillance strategies and prostate cancer that require further research and clarification. These include: • Improvements in the accuracy and consistency of pathologic diagnosis of prostate cancer • Consensus on which men are the most appropriate candidates for active surveillance • The optimal protocol for active surveillance and the potential for individualizing the approach based on clinical and patient factors • Optimal ways to communicate the option of active surveillance to patients • Methods to assist patient decisionmaking • Reasons for acceptance or rejection of active surveillance as a treatment strategy • Short- and long-term outcomes of active surveillance. Well-designed studies to address these questions and others raised in this statement represent an important health research priority. Qualitative, observational, and interventional research designs are needed. Due to the paucity of evidence about this important public health problem, all patients being considered for active surveillance should be offered participation in multicenter research studies that incorporate community settings and partners.
Collapse
Affiliation(s)
- Patricia A Ganz
- Health Services and Medicine, School of Public Health and David Geffen School of Medicine, University of California, Los Angeles, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Glina S, Barry JM, Hackett GI, Sadeghi-Nejad H. Nocturnal Penile Tumescence Monitoring with Stamps—Barry JM, Blank B, and Boileau M. J Sex Med 2011; 8:1296-8. [DOI: 10.1111/j.1743-6109.2011.02272.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
|
21
|
|
22
|
Barry JM. John M. Barry: distinguished scholar at the Center for Bioenvironmental Research, Tulane and Xavier Universities. [Interview by Madeline Drexler]. Biosecur Bioterror 2009; 7:127-33. [PMID: 19485709 DOI: 10.1089/bsp.2009.0951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
23
|
Barry JM. Legends in urology. Can J Urol 2009; 16:4802-4805. [PMID: 19796454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- John M Barry
- Divisions of Urology and Abdominal Organ Transplantation, The Oregon Health and Science University, Portland, Oregon, USA
| |
Collapse
|
24
|
Abstract
As bodies piled up, the United States' response to the 'Spanish flu' was to tell the public that there was no cause for alarm. The authority figures who glossed over the truth lost their credibility, says John M. Barry.
Collapse
Affiliation(s)
- John M Barry
- Center for Bioenvironmental Research of Tulane and Xavier Universities, New Orleans, Louisiana 70112, USA.
| |
Collapse
|
25
|
Daneshmand S, Conlin MJ, Barry JM. OPERATIVE EXPERIENCE OF U.S. UROLOGY RESIDENTS WITH OPEN AND LAPAROSCOPIC RENAL SURGERY. J Urol 2009. [DOI: 10.1016/s0022-5347(09)62282-5] [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: 10/21/2022]
|
26
|
Barry JM, Viboud C, Simonsen L. Cross-protection between successive waves of the 1918-1919 influenza pandemic: epidemiological evidence from US Army camps and from Britain. J Infect Dis 2008; 198:1427-34. [PMID: 18808337 PMCID: PMC3206319 DOI: 10.1086/592454] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [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: 11/03/2022] Open
Abstract
BACKGROUND The current worst-case scenario for pandemic influenza planning is based on the catastrophic 1918-1919 pandemic. In this article, we examine the strength of cross-protection between successive waves of the 1918-1919 pandemic, which has remained a long-standing issue of debate. METHOD We studied monthly hospitalization and mortality rates for respiratory illness in 37 army camps, as well as the rates of repeated episodes of influenza infection during January-December 1918 in 8 military and civilian settings in the United States and Britain. RESULTS A first wave of respiratory illness occurred in US Army camps during March-May 1918 and in Britain during May-June, followed by a lethal second wave in the fall. The first wave was characterized by high morbidity but had a lower fatality rate than the second wave (1.1% vs. 4.7% among hospitalized soldiers; P < .001). Based on repeated illness data, the first wave provided 35%-94% protection against clinical illness during the second wave and 56%-89% protection against death (P < .001). CONCLUSION Exposure to influenza in the spring and summer of 1918 provided mortality and morbidity protection during the fall pandemic wave. The intensity of the first wave may have differed across US cities and countries and may partly explain geographical variation in pandemic mortality rates in the fall. Pandemic preparedness plans should consider that immune protection could be naturally acquired during a first wave of mild influenza illnesses.
Collapse
Affiliation(s)
- John M Barry
- Center for Bioenvironmental Research, Tulane Universities, New Orleans, Louisiana 70112, USA.
| | | | | |
Collapse
|
27
|
|
28
|
Barry JM. Pandemic flu update: are you ready? MLO Med Lab Obs 2007; 39:28-30. [PMID: 18018681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- John M Barry
- Center for Bioenvironmental Research, Tulane University, New Orleans, USA
| |
Collapse
|
29
|
Wagner MD, Prather JC, Barry JM. Selective, concurrent bilateral nephrectomies at renal transplantation for autosomal dominant polycystic kidney disease. J Urol 2007; 177:2250-4; discussion 2254. [PMID: 17509331 DOI: 10.1016/j.juro.2007.01.146] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Indexed: 01/22/2023]
Abstract
PURPOSE An algorithm was developed for performing bilateral nephrectomies for specific indications before or at renal transplantation in patients with autosomal dominant polycystic kidney disease. Outcomes for the living donor arm of the algorithm are reported. MATERIALS AND METHODS Patients with autosomal dominant polycystic kidney disease and end stage renal disease were evaluated for transplantation. Patients with recurrent pyelonephritis, hemorrhage, pain, early satiety or kidneys that extended into the true pelvis underwent bilateral nephrectomies. Bilateral nephrectomies with concurrent renal transplantation were performed if a living renal donor was identified. If no living donor was identified, pre-transplantation bilateral nephrectomies were done and the patients were listed for cadaveric donor renal transplantation. The living renal donor arm of the algorithm was evaluated by comparing certain parameters for 15 and 17 patients with autosomal dominant polycystic kidney disease who underwent pre-transplantation and concurrent bilateral nephrectomies, respectively, including patient and graft survival, delayed graft function, graft function, length of stay for each surgery, transfusions and complications. RESULTS No deaths, graft failures or delayed graft function occurred. In the delayed renal transplant group median time from nephrectomy to living donor transplantation was 124 days. Serum creatinine at discharge home and 1 year after transplantation for the pre-transplantation nephrectomy cohort was 2.0 and 1.3 mg/dl, respectively. Seven of the 17 patients with concurrent nephrectomy underwent transplantation before starting renal replacement therapy. A longer mean total hospital stay in the pre-transplantation nephrectomy cohort was the only statistically significance outcome variable. CONCLUSIONS Selective bilateral nephrectomies at living donor renal transplantation results in decreased total length of stay without compromising patient or graft outcomes and it allows preemptive renal transplantation. Concurrent nephrectomy is safe and it further validates the algorithm for selective, concurrent bilateral nephrectomies for patients with autosomal dominant polycystic kidney disease who undergo living donor renal transplantation.
Collapse
Affiliation(s)
- Matthew D Wagner
- Division of Urology and Renal Transplantation, Oregon Health and Sciences University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
| | | | | |
Collapse
|
30
|
Wagner MD, Daneshmand S, Sokoloff M, Barry JM. Re: Prediagnosis Prostate Specific Antigen Velocity is Associated With Risk of Prostate Cancer Progression Following Brachytherapy and External Beam Radiation Therapy. J Urol 2007; 177:2396; author reply 2396-7. [PMID: 17509368 DOI: 10.1016/j.juro.2007.01.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Indexed: 10/23/2022]
|
31
|
Affiliation(s)
- John M Barry
- Division of Urology and Renal Transplantation, The Oregon Health & Science University, Portland, OR, USA.
| |
Collapse
|
32
|
Abstract
Erectile dysfunction is common in male kidney transplant recipients. Interference with the physiology of erections can be attributed to recipient co-morbidities, the renal transplant operation, medication adverse effects, relationship problems and changes in mental health. A treatment-oriented evaluation of erectile dysfunction allows the development of treatment plans that are patient-specific. Hypo-gonadal men whose hormone parameters do not improve after renal transplantation may respond to testosterone replacement therapy. Use of recommended doses of the phosphodiesterase-5 inhibitor sildenafil does not significantly modify trough concentrations of the calcineurin inhibitors ciclosporin and tacrolimus or result in impaired renal allograft function. Tacrolimus has been shown to increase the peak concentration and prolong the elimination half-life of sildenafil in kidney transplant recipients. Daily administration of sildenafil has resulted in decreased blood pressure in kidney transplant recipients with treated hypertension and tacrolimus immunosuppression. Intracavernosal injections of alprostadil, with or without papaverine and phentolamine, are effective treatments for erectile dysfunction after renal transplantation and have not resulted in alterations of ciclosporin concentrations or in deterioration of renal function. Penile prostheses can be successfully implanted after pelvic organ transplantation without significant risk of infection.
Collapse
Affiliation(s)
- John M Barry
- Division of Urology and Renal Transplantation, The Oregon Health and Science University, Portland, Oregon 97239, USA.
| |
Collapse
|
33
|
Affiliation(s)
- John M. Barry
- Division of Urology and Renal Transplantation, Oregon Health and Science University, Portland, Oregon
| |
Collapse
|
34
|
Affiliation(s)
- John M Barry
- Division of Urology and Renal Transplantation, The Oregon Health & Science University, Portland, OR 97239, USA.
| | | |
Collapse
|
35
|
Barry JM. What the 1918 flu pandemic teaches us. Yesterday's lessons inform today's preparedness. MLO Med Lab Obs 2006; 38:26, 28. [PMID: 17024929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- John M Barry
- Center for Bioenvironmental Research of Tulane, USA
| |
Collapse
|
36
|
Rosenblatt GS, Jenkins RD, Barry JM. Treatment of primary hyperoxaluria type 1 with sequential liver and kidney transplants from the same living donor. Urology 2006; 68:427.e7-8. [PMID: 16904473 DOI: 10.1016/j.urology.2006.02.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Accepted: 02/17/2006] [Indexed: 11/17/2022]
Abstract
Alanine-glyoxalate aminotransferase deficiency occurs in patients with primary hyperoxaluria type 1. Increased hepatic oxalate production leads to high urine concentrations of glycolate and oxalate. Calcium oxalate nephrolithiasis and nephrocalcinosis occur, and renal function progressively declines until patients develop end-stage renal disease. Renal transplantation alone is inadequate therapy because the primary enzyme deficiency remains. We report what we believe to be the second-youngest recipient to undergo successful sequential liver and kidney transplantation from a single living-related donor for treatment of primary hyperoxaluria type 1. We also discuss the changes in this patient's serum oxalate levels after transplantation.
Collapse
Affiliation(s)
- Gregory S Rosenblatt
- Department of Surgery, Division of Urology and Renal Transplantation, Oregon Health and Science University, Portland, Oregon 97239-3098, USA.
| | | | | |
Collapse
|
37
|
Rosenblatt GS, Conlin MJ, Soule JL, Rayhill SC, Barry JM. Right Renal Vein Extension with Recipient Left Renal Vein after Laparoscopic Donor Nephrectomy. Transplantation 2006; 81:135-6. [PMID: 16421492 DOI: 10.1097/01.tp.0000189715.48613.9b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
38
|
Abstract
There is an insufficient supply of deceased donor kidneys for transplantation. One solution is to increase the number of living donor kidney transplants. Our kidney transplant database was reviewed for 3 periods of 12 months each, separated by 5 years, to show the trends in kidney transplant donor sources and the influence of biologically unrelated living renal donors, minimally invasive living renal donor surgery, transplantation of ABO-incompatible kidneys from living donors, and transplantation in spite of positive cross-matches on the numbers of renal transplants and 1-year kidney transplant survival rates at our center. When results for 1993 were compared with 2003, the annual number of living donor renal transplants increased from 25 to 86, and the annual number of deceased donor renal transplants decreased from 108 to 63. The total number of kidney transplants increased by 12%. However, 1-year living donor kidney transplant survivals were not significantly different (94% for transplants done in 1993 vs 98% for transplants done in 2003). The strategies of living donor renal transplants from genetically unrelated donors, ABO-incompatible donors, and cross-match positive donors as well as the introduction of hand-assisted laparoscopic donor nephrectomy increased the number of living renal donor renal transplants at our center without compromising short-term kidney transplant survival rates.
Collapse
Affiliation(s)
- John M Barry
- Division of Urology and Renal Transplantation, Department of Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA.
| | | | | | | |
Collapse
|
39
|
Barry JM. Lessons from the 1918 flu. Time 2005; 166:96. [PMID: 16270747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
|
40
|
Affiliation(s)
- John M Barry
- The Oregon Health & Science University, Portland, Oregon, USA.
| |
Collapse
|
41
|
Wagner M, Loos J, Weksler N, Gantner M, Corless CL, Barry JM, Beer TM, Garzotto M. Resistance of prostate cancer cell lines to COX-2 inhibitor treatment. Biochem Biophys Res Commun 2005; 332:800-7. [PMID: 15907789 DOI: 10.1016/j.bbrc.2005.05.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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] [Received: 04/30/2005] [Accepted: 05/03/2005] [Indexed: 10/25/2022]
Abstract
Targeting of cyclooxygenase-2 (COX-2) for cancer chemoprevention is well supported for several tumor types, most notably colon cancer. In contrast, the data for its role in prostate cancer carcinogenesis are correlative only. Thus, we compared the COX-2 expression, activity, and effects of inhibition in prostate cancer cells on COX-2-dependent colon cancer cells. COX-2 levels in benign and malignant human prostate tissue were determined by immunohistochemistry. Compared to colon cancer cells, prostate cancer cells expressed lower levels of COX-2, produced less PGE2, and were resistant to selective COX-2 inhibition. Examination of benign prostatic epithelium from prostatectomy samples demonstrated rare foci of COX-2. Whereas, human prostate cancer sections were uniformly negative for COX-2. In conclusion, these studies indicate the lack of a putative role for COX-2 in prostate cancer development. Direct evidence for the involvement of COX-2 in prostate cancer carcinogenesis is desperately needed.
Collapse
Affiliation(s)
- Matthew Wagner
- Division of Urology and Renal Transplantation, Oregon Health and Science University, Oregon Cancer Institute, Portland, OR, USA
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
PURPOSE Living, genetically unrelated donor renal transplantation (LURT) is being performed with increasing frequency. We evaluated our single center experience with LURT and compared this to a cohort of living related donor renal transplants (LRT) to evaluate the short-term success of LURT at our center. MATERIALS AND METHODS We identified 99 consecutive patients who underwent LURT at our center and had at least 1 year of followup data. A control cohort of 99 patients who underwent LRT at our center matched for age, number of transplants and date of transplant was also identified. One-year graft and patient survival, and serum creatinine levels at 1, 3, 6 and 12 months were compared between the groups. Our data were compared with national and international data. RESULTS At our center 1-year graft survival was 95% in the LURT and LRT cohorts. One-year LURT patient survival was 99% compared with 97% in the LRT group and the serum creatinine levels were not significantly different. CONCLUSIONS Patients undergoing LURT at our center have excellent 1-year graft and patient survival compared with LRT performed at our center, and national and international LURT. Genetically unrelated kidney donors should continue to be used to expand the kidney donor pool.
Collapse
Affiliation(s)
- Gregory S Taylor
- Division of Urology and Renal Transplantation, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA.
| | | | | | | | | | | | | |
Collapse
|
43
|
de Mattos AM, Olyaei AJ, Prather JC, Golconda MS, Barry JM, Norman DJ. Autosomal-dominant polycystic kidney disease as a risk factor for diabetes mellitus following renal transplantation. Kidney Int 2005; 67:714-20. [PMID: 15673321 DOI: 10.1111/j.1523-1755.2005.67132.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [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 Posttransplant diabetes mellitus is an important complication of renal transplantation that is associated with a significant impact on quality of life and an increase in long-term morbidity and mortality. Autosomal-dominant polycystic kidney disease (ADPKD) is a hereditary disease that commonly leads to end-stage renal disease (ESRD) in adulthood. The association between ADPKD and posttransplant diabetes mellitus has not been previously studied in a large cohort of patients. METHODS To address this question, we studied a cohort of 135 patients with ADPKD who received a first renal-only transplant between January 1985 and December 1999. An age, race, and date of transplant-matched cohort of 135 non-ADPKD subjects were used as the control population. RESULTS The cohorts were similar at baseline for gender distribution, body mass index (BMI), proportion of obese subjects (BMI greater than 30 kg/m(2)), family history of diabetes mellitus, and type of donor (deceased or living). At 12 months, the incidence of posttransplant diabetes mellitus was significantly higher in patients with ADPKD when compared to the controls (17% vs. 7.4%) (P= 0.016), despite no significant differences in the BMI, percent increase in BMI, number of acute rejections, prednisone dose at 3 and 6 months, use of diuretics or beta blockers, delayed graft function, or serum creatinine levels. The proportion of subjects requiring insulin was significantly higher in the ADPKD group (11.1% vs. 3%) (P= 0.009). Variables significantly associated with posttransplant diabetes mellitus at 1 year by bivariate analyses were the diagnosis of ADPKD (P= 0.02), BMI at transplant (P= 0.04), obesity at 12 months (P= 0.01), and delayed graft function (P= 0.02). Gender of recipient (P= 0.9), family history of diabetes (P= 0.3), prednisone dose at 3 months (P= 0.9) and 6 months (P= 0.7), acute rejection (P= 0.9), use of beta blockers or tacrolimus (P= 0.8), deceased donor transplant (P= 0.2), and serum creatinine at 1 year (P= 0.5) were not associated with posttransplant diabetes mellitus. A trend toward increased incidence of posttransplant diabetes mellitus was found with the use of diuretics post transplant (P= 0.054). By multivariable analyses, in patients with ADPKD, the adjusted (by all the variables listed above) relative risk for development of posttransplant diabetes mellitus was 2.87 (95% CI = 1.24-6.65) (P= 0.014). Only the diagnosis of ADPKD (RR = 2.9) (P= 0.01), obesity at 1 year (RR 2.5) (P= 0.017), and delayed graft function (RR 2.4) (P= 0.03) contributed significantly to the fit of a stepwise logistic regression model. Patient survival was significantly worse in the cohort of patients who developed posttransplant diabetes mellitus (median survival 109.3 vs. 121 months) (P= 0.008). CONCLUSION In our study patients with ADPKD were at a threefold increased risk for development of posttransplant diabetes mellitus within the first year following renal transplantation. Development of posttransplant diabetes mellitus was associated with a significant detrimental impact on patient survival. Further studies are needed to provide insight into the mechanisms of the association between ADPKD and posttransplant diabetes mellitus.
Collapse
Affiliation(s)
- Angelo M de Mattos
- Renal Transplant Program, Oregon Health & Science University, Portland, Oregon, USA.
| | | | | | | | | | | |
Collapse
|
44
|
Marr L, Cox B, Barry JM, Parra RO. 1539: Incidence of de Novo Urinary Tract Malignancies in Renal Transplant Recipients: A 10-Year Experience in 1230 Patients. J Urol 2005. [DOI: 10.1016/s0022-5347(18)35673-8] [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: 10/17/2022]
|
45
|
Affiliation(s)
- John M Barry
- Division of Urology and Renal Transplantation, The Oregon Health & Science University, Portland, Oregon 97239, USA.
| |
Collapse
|
46
|
Abstract
Radical prostatectomy is a standard treatment option for many patients with clinically localized prostate cancer; however, little information about its safety and efficacy is available to help guide patients who have undergone prior organ transplantation. We present 2 cases of patients with prior hepatic transplantation who each subsequently underwent radical prostatectomy. In each case, the prostate tumor was organ confined, and both patients were biochemically free of disease at last follow-up.
Collapse
Affiliation(s)
- Aaron Bayne
- Division of Urology and Renal Transplantation, Oregon Health and Science University, Portland, Oregon, USA
| | | | | |
Collapse
|
47
|
Barry JM. Viruses of mass destruction. Fortune 2004; 150:74, 76. [PMID: 15543821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
|
48
|
Abstract
An abnormal urinary bladder is no longer a contra-indication to renal transplantation. A normal urinary bladder stores urine at low pressure, does not leak, and empties completely by natural voiding. In contrast, an abnormal urinary bladder stores urine at high pressure, leaks, or does not empty completely by natural voiding. A variety of procedures have been devised to change the abnormal bladder into a continent low-pressure reservoir. Knowledge of these bladder modifications and their management should allow successful transplantation in patients with abnormal bladders and provide outcomes that match or approach those achieved in patients with a normal bladder.
Collapse
Affiliation(s)
- John M Barry
- Division of Urology and Renal Transplantation, The Oregon Health and Science University, Portland, OR 97239, USA.
| |
Collapse
|
49
|
Barry JM. The site of origin of the 1918 influenza pandemic and its public health implications. J Transl Med 2004; 2:3. [PMID: 14733617 PMCID: PMC340389 DOI: 10.1186/1479-5876-2-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2004] [Accepted: 01/20/2004] [Indexed: 11/20/2022] Open
Affiliation(s)
- John M Barry
- Distinguished Visiting Scholar, the Center for Bioenvironmental Research of Tulane and Xavier Universities, New Orleans, Louisiana, USA.
| |
Collapse
|
50
|
|