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Ng MSY, Jones AT, Mallett AJ, Marie O'Shaughnessy M. Better kidney allograft survival despite higher-risk donor and recipient characteristics between 1995-2014. Nephrol Dial Transplant 2024:gfae081. [PMID: 38573827 DOI: 10.1093/ndt/gfae081] [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: 04/06/2024] Open
Abstract
BACKGROUND AND HYPOTHESIS Advances in organ procurement, surgical techniques, immunosuppression regimens and prophylactic antibiotic therapies have dramatically improved short term kidney transplant graft failure. It is unclear how these interventions have affected longer term graft failure. It is hypothesised that graft failure has improved over the last 20 years. METHODS Data on all first kidney transplants from 1995-2014 were extracted from the Australia and New Zealand Dialysis and Transplant Registry with follow-up as of 31 December, 2021. Primary exposure was transplant era, classified into 5-year intervals. Primary outcome was all-cause 5-year graft failure. Secondary outcomes included all-cause 10-year graft failure and cause-specific graft failure. Kaplan Meier curves and multivariable Cox Proportional Hazards Regression models were used to assess trends in all-cause graft failure. Fine-Gray subdistribution hazard models verified that changes in death rates were not biasing the Cox Proportional Hazards Regression models. Cumulative incidence functions were used to assess temporal trends in cause-specific graft failure. RESULTS Across 10 871 kidney transplants, there was a shift towards transplanting more recipients aged over 45 years old, with more comorbidities, longer dialysis vintage, body mass index greater than 30 kg/m2 and greater human leukocyte antigen mismatches. Donor age has increased but no clear shift in donor source was observed. Compared to 1995-1999 (reference), the adjusted hazard ratio for 5-year graft failure was 0.78 (95% CI 0.67-0.91), 0.70 (95% CI 0.59-0.83) and 0.60 (95% CI 0.50-0.73) for 2000-2004, 2005-2009, and 2010-2014, respectively. Ten-year graft failure similarly reduced from 0.83 (95% CI 0.74-0.93) for 2000-04 to 0.78 (95% CI 0.68-0.89) for 2010-14, compared to 1995-99. CONCLUSION Medium and long term all-cause graft failure has improved steadily since 1995-99. Significant reductions in graft failure due to rejection and vascular causes were observed at 5 years, and due to rejection, vascular causes, death and glomerular disease at 10 years.
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Affiliation(s)
- Monica Suet Ying Ng
- Kidney Health Service, Royal Brisbane And Women's Hospital, Brisbane, Australia
- Faculty of Medicine, University Of Queensland, Brisbane, Australia
- Conjoint Internal Medicine Laboratory, Chemical Pathology, Pathology Queensland, Brisbane, Australia
| | - Andrew Thomas Jones
- Queensland Cyber Infrastructure Foundation, Brisbane, Australia
- Centre for Health Services Research, Faculty of Medicine, University Of Queensland, Brisbane, Australia
| | - Andrew John Mallett
- Faculty of Medicine, University Of Queensland, Brisbane, Australia
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Institute of Molecular Biosciences, University Of Queensland, Brisbane, Australia
- Department of Renal Medicine, Townsville University Hospital, Townsville, Queensland, Australia
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Han HY, Vangaveti V, Jose M, Ng MSY, Mallett AJ. People with genetic kidney diseases on kidney replacement therapy have different clinical outcomes compared to people with other kidney diseases. Sci Rep 2024; 14:6746. [PMID: 38509220 PMCID: PMC10954746 DOI: 10.1038/s41598-024-57273-x] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/15/2024] [Indexed: 03/22/2024] Open
Abstract
Despite increasing awareness of genetic kidney disease prevalence, there is limited population-level information about long term outcomes of people with genetic kidney disease receiving kidney replacement therapy. This analysis included people who commenced kidney replacement therapy between 1989 and 2020 as recorded in the Australian and New Zealand Dialysis and Transplant registry. Genetic kidney diseases were subclassified as majority and minority monogenic. Non-genetic kidney diseases were included as the comparator group. Primary outcome measures were 10-year mortality and 10-year graft failure. Cox proportional hazard regression were used to calculate unadjusted and adjusted hazard ratios (AHRs) for primary outcomes. There were 59,231 people in the dialysis subgroup and 21,860 people in the transplant subgroup. People on dialysis with genetic kidney diseases had reduced 10-year mortality risk (majority monogenic AHR: 0.70, 95% CI 0.66-0.76; minority monogenic AHR 0.86, 95% CI 0.80-0.92). This reduced 10-year mortality risk continued after kidney transplantation (majority monogenic AHR: 0.82, 95% CI 0.71-0.93; minority monogenic AHR 0.80, 95% CI 0.68-0.95). Majority monogenic genetic kidney diseases were associated with reduced 10-year graft failure compared to minority monogenic genetic kidney diseases and other kidney diseases (majority monogenic AHR 0.69, 95% CI 0.59-0.79). This binational registry analysis identified that people with genetic kidney disease have different mortality and graft failure risks compared to people with other kidney diseases.
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Affiliation(s)
- Helen Y Han
- School of Medicine, The University of Tasmania, Hobart, TAS, Australia
- Kidney Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia
| | - Venkat Vangaveti
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- Townsville Institute of Health Research and Innovation, Townsville University Hospital, Douglas, QLD, Australia
| | - Matthew Jose
- Hobart Clinical School, University of Tasmania, Hobart, TAS, Australia
| | - Monica Suet Ying Ng
- Kidney Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia.
- Conjoint Internal Medicine Laboratory, Chemical Pathology, Health Support Queensland Pathology Queensland, Brisbane, QLD, Australia.
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
- Institute for Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia.
| | - Andrew John Mallett
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- Townsville Institute of Health Research and Innovation, Townsville University Hospital, Douglas, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
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Fisher M, Aklilu AM, Ng MSY, Spires DR, Bigotte Vieira M. A Glimpse into an Editorial Training Program: From the Kidney360 Editorial Program Trainees. Kidney360 2024; 5:117-120. [PMID: 37982594 PMCID: PMC10833592 DOI: 10.34067/kid.0000000000000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/08/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Molly Fisher
- Division of Nephrology, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York
| | - Abinet M. Aklilu
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Monica Suet Ying Ng
- Kidney Health Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Conjoint Internal Medicine Laboratory, Chemical Pathology, Pathology Queensland, Herston, Queensland, Australia
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Denisha R. Spires
- Department of Physiology, Augusta University, Medical College of Georgia, Augusta, Georgia
| | - Miguel Bigotte Vieira
- Nephrology Department, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
- Nova Medical School, Lisboa, Portugal
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Yu D, Malacova E, Hurst C, Ng MSY, Mallett AJ. Association of Primary Kidney Disease Type and Donor Relatedness With Live Donor Kidney Transplant Outcomes: An Analysis of ANZDATA. Am J Kidney Dis 2023; 82:569-580.e1. [PMID: 37385397 DOI: 10.1053/j.ajkd.2023.04.004] [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] [Received: 07/21/2022] [Accepted: 04/21/2023] [Indexed: 07/01/2023]
Abstract
RATIONALE & OBJECTIVE There is limited information about the association between primary kidney disease and donor relatedness with transplant outcomes. This study addresses this gap by evaluating clinical outcomes after kidney transplantation in recipients of living donor kidneys as a function of primary kidney disease type and donor relatedness in Australia and New Zealand. STUDY DESIGN Retrospective observational study. SETTING & PARTICIPANTS Kidney transplant recipients who received allografts from living donors between January 1, 1998, and December 31, 2018, as recorded in the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). EXPOSURES Primary kidney disease type categorized as majority monogenic, minority monogenic, or other primary kidney disease based on disease heritability as well as donor relatedness. OUTCOME Primary kidney disease recurrence, graft failure. ANALYTICAL APPROACH Kaplan-Meier analysis and Cox proportion hazards regression to generate hazard ratios for primary kidney disease recurrence, allograft failure, and mortality. Partial likelihood ratio test was used to examine possible interactions between primary kidney disease type and donor relatedness for both study outcomes. RESULTS Among 5,500 live donor kidney transplant recipients, majority monogenic (adjusted HR, 0.58, P<0.001) and minority monogenic primary kidney diseases (adjusted HR, 0.64, P<0.001) were associated with reduced primary kidney disease recurrence compared with other primary kidney diseases. Majority monogenic primary kidney disease was also associated with reduced allograft failure (adjusted HR, 0.86, P=0.04) compared with other primary kidney diseases. Donor relatedness was not associated with primary kidney disease recurrence nor graft failure. No interaction was detected between primary kidney disease type and donor relatedness for either study outcome. LIMITATIONS Potential misclassification of primary kidney disease type, incomplete ascertainment of primary kidney disease recurrence, unmeasured confounding. CONCLUSIONS Monogenic primary kidney disease is associated with lower rates of primary kidney disease recurrence and allograft failure. Donor relatedness was not associated with allograft outcomes. These results may inform pretransplant counseling and live donor selection. PLAIN-LANGUAGE SUMMARY There are theoretical concerns that live-donor kidney transplants may be associated with increased risks of kidney disease recurrence and transplant failure due to unmeasurable shared genetic factors between the donor and the recipient. This study analyzed data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry and showed that, although disease type was associated with the risk of disease recurrence and transplant failure, donor relatedness did not impact transplant outcomes. These findings may inform pretransplant counseling and live donor selection.
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Affiliation(s)
- Dong Yu
- Faculty of Medicine, Herston; Princess Alexandra Hospital, Woolloongabba
| | - Eva Malacova
- University of Queensland, QIMR Berghofer Medical Research Institute, Herston; Faculty of Health, Queensland University of Technology, Brisbane
| | - Cameron Hurst
- School of Public Health, Herston; University of Queensland, QIMR Berghofer Medical Research Institute, Herston; Molly Wardaguga Research Centre, Charles Darwin University, Brisbane
| | - Monica Suet Ying Ng
- Kidney Health Service, Royal Brisbane and Women's Hospital, Herston; Conjoint Internal Medicine Laboratory, Chemical Pathology, Pathology Queensland, Health Support Queensland, Herston; Nephrology Department, Woolloongabba; Institute for Molecular Biosciences, University of Queensland, Brisbane.
| | - Andrew John Mallett
- Faculty of Medicine, Herston; Institute for Molecular Biosciences, University of Queensland, Brisbane; Department of Renal Medicine, Townsville University Hospital, Townsville, Australia; College of Medicine and Dentistry, James Cook University, Townsville, Australia.
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Ng MSY, Hay K, Choy J, Middelburg RA, Tung JP, Fraser JF. Fresh frozen plasma and platelet concentrate storage duration not associated with in hospital mortality risk. Vox Sang 2019; 114:835-841. [PMID: 31452207 DOI: 10.1111/vox.12838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/03/2019] [Accepted: 07/26/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES To date, the effects of FFP and PC storage duration on mortality have only been studied in a few studies in limited patient subpopulations. The aim of the current study was to determine whether FFP and PC storage duration is associated with increased in hospital mortality risk across cardiac surgery, acute medicine, ICU and orthopaedic surgery patients. MATERIALS AND METHODS Two-stage individual patient data meta-analyses were performed to determine the effects of FFP and PC storage duration on in hospital mortality. Preset random effects models were used to determine pooled unadjusted and adjusted (adjusted for age, gender and units of product transfused) effect estimates. RESULTS The FFP storage duration analysis included 3625 patients across four studies. No significant association was observed between duration of storage and in hospital mortality in unadjusted analysis, but after adjusting for patient age, gender and units of product a small increased risk of in hospital mortality was observed for each additional month of storage (OR: 1·05, 95% CI: 1·01-1·08). This effect was no longer statistically significant when donor ABO blood group was incorporated into the random effects model on post hoc analyses. A total of 547 patients across five studies were incorporated in the PC storage duration analysis. No association was observed between PC storage duration and odds of in hospital morality (adjusted OR: 0·94, 95% CI: 0·79-1·11). CONCLUSIONS There is insufficient evidence to support shortening FFP or PC shelf life based on in hospital mortality.
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Affiliation(s)
- Monica Suet Ying Ng
- Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia.,Faculty of Medicine, Oral Health Centre, University of Queensland, Herston, QLD, Australia.,Research and Development, Australian Red Cross Blood Service, Kelvin Grove, QLD, Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Joleen Choy
- Faculty of Medicine, Oral Health Centre, University of Queensland, Herston, QLD, Australia.,Royal Brisbane & Women's Hospital, Herston, QLD, Australia
| | - Rutger A Middelburg
- Centre for Clinical Transfusion Research, Sanquin Research, Leiden, Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - John-Paul Tung
- Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia.,Faculty of Medicine, Oral Health Centre, University of Queensland, Herston, QLD, Australia.,Research and Development, Australian Red Cross Blood Service, Kelvin Grove, QLD, Australia
| | - John Francis Fraser
- Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia.,Faculty of Medicine, Oral Health Centre, University of Queensland, Herston, QLD, Australia
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Ng MSY, Francis L, Pillai E, Mallett AJ. Paraneoplastic immunoglobulin A nephropathy and associated focal segmental glomerulosclerosis in asymptomatic low volume B-cell lymphoma - a case report. BMC Nephrol 2018; 19:224. [PMID: 30200898 PMCID: PMC6131739 DOI: 10.1186/s12882-018-1034-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/07/2018] [Accepted: 09/02/2018] [Indexed: 11/25/2022] Open
Abstract
Background Paraneoplastic glomerulonephritis is rare in haematological malignancies and tends to manifest as minimal change disease, membranous glomerulonephritis or membranoproliferative glomerulonephritis. We present the first report of immunoglobulin A nephropathy and associated focal segmental glomerulosclerosis in a patient with asymptomatic low grade B-cell lymphoma. Case presentation A 53 year old gentleman presented with nephrotic range proteinuria (urine protein creatinine ratio of 662 mg/mmol) on a background of type 2 diabetes mellitus (glycosylated haemoglobin: < 6%), hypertension, obesity (body mass index: 47.6 kg/m2) and degenerative spine disease. Bone marrow biopsy diagnosed a low grade B-cell lymphoma and renal biopsy was consistent with immunoglobulin A nephropathy. Lymphoma treatment with six cycles of cyclophosphamide/ rituximab/ prednisolone led to normalisation of urinary protein excretion (urine protein creatinine ratio: 14 mg/mmol at 26 months post-chemotherapy). Conclusion Paraneoplastic immunoglobulin A nephropathy can occur with a broad range of haematological malignancies regardless of stage. This case illustrates the importance of meticulous haematological system work-up for patients presenting with immunoglobulin A nephropathy. Recognition of paraneoplastic immunoglobulin A nephropathy and early diagnosis of associated malignancy can be life-saving.
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Affiliation(s)
- Monica Suet Ying Ng
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - Leo Francis
- Department of Anatomical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Elango Pillai
- Haematology and Bone Marrow Transplantation Service, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Andrew John Mallett
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Ng MSY, Tung JP, Fraser JF. Platelet Storage Lesions: What More Do We Know Now? Transfus Med Rev 2018; 32:S0887-7963(17)30189-X. [PMID: 29751949 DOI: 10.1016/j.tmrv.2018.04.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 12/20/2022]
Abstract
Platelet concentrate (PC) transfusions are a lifesaving adjunct to control and prevent bleeding in cancer, hematologic, surgical, and trauma patients. Platelet concentrate availability and safety are limited by the development of platelet storage lesions (PSLs) and risk of bacterial contamination. Platelet storage lesions are a series of biochemical, structural, and functional changes that occur from blood collection to transfusion. Understanding of PSLs is key for devising interventions that prolong PC shelf life to improve PC access and wastage. This article will review advancements in clinical and mechanistic PSL research. In brief, exposure to artificial surfaces and high centrifugation forces during PC preparation initiate PSLs by causing platelet activation, fragmentation, and biochemical release. During room temperature storage, enhanced glycolysis and reduced mitochondrial function lead to glucose depletion, lactate accumulation, and product acidification. Impaired adenosine triphosphate generation reduces platelet capacity to perform energetically demanding processes such as hypotonic stress responses and activation/aggregation. Storage-induced alterations in platelet surface proteins such as thrombin receptors and glycoproteins decrease platelet aggregation. During storage, there is an accumulation of immunoactive proteins such as leukocyte-derive cytokines (tumor necrosis factor α, interleukin (IL) 1α, IL-6, IL-8) and soluble CD40 ligand which can participate in transfusion-related acute lung injury and nonhemolytic transfusion reactions. Storage-induced microparticles have been linked to enhanced platelet aggregation and immune system modulation. Clinically, stored PCs have been correlated with reduced corrected count increment, posttransfusion platelet recovery, and survival across multiple meta-analyses. Fresh PC transfusions have been associated with superior platelet function in vivo; however, these differences were abrogated after a period of circulation. There is currently insufficient evidence to discern the effect of PSLs on transfusion safety. Various bag and storage media changes have been proposed to reduce glycolysis and platelet activation during room temperature storage. Moreover, cryopreservation and cold storage have been proposed as potential methods to prolong PC shelf life by reducing platelet metabolism and bacterial proliferation. However, further work is required to elucidate and manage the PSLs specific to these storage protocols before its implementation in blood banks.
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Affiliation(s)
- Monica Suet Ying Ng
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia; Research and Development, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia.
| | - John-Paul Tung
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia; Research and Development, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia.
| | - John Francis Fraser
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.
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