1
|
Lim WH, Wong G. "Heart" Outcome in Organ Transplant Recipients With Diabetes: Is GLP-1-RA the Leader of the Pack? Transplantation 2024:00007890-990000000-00737. [PMID: 38644532 DOI: 10.1097/tp.0000000000005045] [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] [Indexed: 04/23/2024]
Affiliation(s)
- Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia
| |
Collapse
|
2
|
Moll G, Lim WH, Penack O. Editorial: Emerging talents in alloimmunity and transplantation: 2022. Front Immunol 2024; 15:1393026. [PMID: 38558808 PMCID: PMC10978591 DOI: 10.3389/fimmu.2024.1393026] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Guido Moll
- BIH Center for Regenerative Therapies (BCRT) and Berlin-Brandenburg School for Regenerative Therapies (BSRT), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
- Department of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Wai H. Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Olaf Penack
- Department of Hematology, Oncology and Tumorimmunology, Charité Universitätsmedizin Berlin, Berlin, Germany
- BIH Biomedical Innovation Academy, Charité Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
3
|
Samarasinghe A, Wong G, Teixeira-Pinto A, Johnson DW, Hawley C, Pilmore H, Mulley WR, Roberts MA, Polkinghorne KR, Boudville N, Davies CE, Viecelli AK, Ooi E, Larkins NG, Lok C, Lim WH. Association between diabetic status and risk of all-cause and cause-specific mortality on dialysis following first kidney allograft loss. Clin Kidney J 2024; 17:sfad245. [PMID: 38468698 PMCID: PMC10926326 DOI: 10.1093/ckj/sfad245] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Indexed: 03/13/2024] Open
Abstract
Background Diabetes mellitus (DM) is associated with a greater risk of mortality in kidney transplant patients, primarily driven by a greater risk of cardiovascular disease (CVD)-related mortality. However, the associations between diabetes status at time of first allograft loss and mortality on dialysis remain unknown. Methods All patients with failed first kidney allografts transplanted in Australia and New Zealand between 2000 and 2020 were included. The associations between diabetes status at first allograft loss, all-cause and cause-specific mortality were examined using competing risk analyses, separating patients with diabetes into those with pre-transplant DM or post-transplant diabetes mellitus (PTDM). Results Of 3782 patients with a median (IQR) follow-up duration of 2.7 (1.1-5.4) years, 539 (14%) and 390 (10%) patients had pre-transplant DM or developed PTDM, respectively. In the follow-up period, 1336 (35%) patients died, with 424 (32%), 264 (20%) and 199 (15%) deaths attributed to CVD, dialysis withdrawal and infection, respectively. Compared to patients without DM, the adjusted subdistribution HRs (95% CI) for pre-transplant DM and PTDM for all-cause mortality on dialysis were 1.47 (1.17-1.84) and 1.47 (1.23-1.76), respectively; for CVD-related mortality were 0.81 (0.51-1.29) and 1.02 (0.70-1.47), respectively; for infection-related mortality were 1.84 (1.02-3.35) and 2.70 (1.73-4.20), respectively; and for dialysis withdrawal-related mortality were 1.71 (1.05-2.77) and 1.51 (1.02-2.22), respectively. Conclusions Patients with diabetes at the time of kidney allograft loss have a significant survival disadvantage, with the excess mortality risk attributed to infection and dialysis withdrawal.
Collapse
Affiliation(s)
- Amali Samarasinghe
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Germaine Wong
- School of Public Health, Faculty of Medicine and Health, Sydney University, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Department of Renal Medicine and National Pancreas Transplant Unit, Westmead Hospital, Sydney, Australia
| | - Armando Teixeira-Pinto
- School of Public Health, Faculty of Medicine and Health, Sydney University, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - David W Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Queensland, Australia
- Australasian Kidney Trials Network, University of Queensland, Queensland, Australia
- Translational Research Institute, Queensland, Australia
| | - Carmel Hawley
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Queensland, Australia
- Australasian Kidney Trials Network, University of Queensland, Queensland, Australia
- Translational Research Institute, Queensland, Australia
| | - Helen Pilmore
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
- Department of Medicine, Auckland University, Auckland, New Zealand
| | - William R Mulley
- Department of Nephrology, Monash Medical Centre, Melbourne, Australia
- Department of Medicine, Monash University, Melbourne, Australia
| | - Matthew A Roberts
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Kevan R Polkinghorne
- Department of Nephrology and Medicine, Monash Medical Centre, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Neil Boudville
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- Internal Medicine, University of Western Australia Medical School, Perth, Australia
| | - Christopher E Davies
- Faculty of Health and Medical Science, Adelaide University Medical School, South Australia, Australia
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Andrea K Viecelli
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Queensland, Australia
- Australasian Kidney Trials Network, University of Queensland, Queensland, Australia
| | - Esther Ooi
- School of Biomedical Sciences, University of Western Australia, Western Australia, Australia
| | - Nicholas G Larkins
- Department of Nephrology, Perth Children's Hospital, Perth, Western Australia, Australia
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Charmaine Lok
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Nephrology, Department of Medicine, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- Internal Medicine, University of Western Australia Medical School, Perth, Australia
| |
Collapse
|
4
|
Vijayan K, Schroder HJ, Hameed A, Hitos K, Lo W, Laurence JM, Yoon PD, Nahm C, Lim WH, Lee T, Yuen L, Wong G, Pleass H. Kidney Transplantation Outcomes From Uncontrolled Donation After Circulatory Death: A Systematic Review and Meta-analysis. Transplantation 2024:00007890-990000000-00659. [PMID: 38361237 DOI: 10.1097/tp.0000000000004937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Uncontrolled donation after circulatory death (uDCD) is a potential additional source of donor kidneys. This study reviewed uDCD kidney transplant outcomes to determine if these are comparable to controlled donation after circulatory death (cDCD). METHODS MEDLINE, Cochrane, and Embase databases were searched. Data on demographic information and transplant outcomes were extracted from included studies. Meta-analyses were performed, and risk ratios (RR) were estimated to compare transplant outcomes from uDCD to cDCD. RESULTS Nine cohort studies were included, from 2178 uDCD kidney transplants. There was a moderate degree of bias, as 4 studies did not account for potential confounding factors. The median incidence of primary nonfunction in uDCD was 12.3% versus 5.7% for cDCD (RR, 1.85; 95% confidence intervals, 1.06-3.23; P = 0.03, I2 = 75). The median rate of delayed graft function was 65.1% for uDCD and 52.0% for cDCD. The median 1-y graft survival for uDCD was 82.7% compared with 87.5% for cDCD (RR, 1.43; 95% confidence intervals, 1.02-2.01; P = 0.04; I2 = 71%). The median 5-y graft survival for uDCD and cDCD was 70% each. Notably, the use of normothermic regional perfusion improved primary nonfunction rates in uDCD grafts. CONCLUSIONS Although uDCD outcomes may be inferior in the short-term, the long-term outcomes are comparable to cDCD.
Collapse
Affiliation(s)
- Keshini Vijayan
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Hugh J Schroder
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Ahmer Hameed
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Kerry Hitos
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Warren Lo
- Institute of Urology and Nephrology, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Jerome M Laurence
- Central Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Peter D Yoon
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Christopher Nahm
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Taina Lee
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Lawrence Yuen
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Germaine Wong
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia
| | - Henry Pleass
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| |
Collapse
|
5
|
Smith C, Sim M, Dalla Via J, Gebre AK, Zhu K, Lim WH, Teh R, Kiel DP, Schousboe JT, Levinger I, von Haehling S, Woodman R, Coats AJS, Prince RL, Lewis JR. Extent of Abdominal Aortic Calcification Is Associated With Incident Rapid Weight Loss Over 5 Years: The Perth Longitudinal Study of Ageing Women. Arterioscler Thromb Vasc Biol 2024; 44:e54-e64. [PMID: 38095109 PMCID: PMC10832333 DOI: 10.1161/atvbaha.123.320118] [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: 09/11/2023] [Accepted: 11/27/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Abdominal aortic calcification (AAC), a marker of vascular disease, is associated with disease in other vascular beds including gastrointestinal arteries. We investigated whether AAC is related to rapid weight loss over 5 years and whether rapid weight loss is associated with 9.5-year all-cause mortality in community-dwelling older women. METHODS Lateral spine images from dual-energy x-ray absorptiometry (1998/1999) were used to assess AAC (24-point AAC scoring method) in 929 older women. Over 5 years, body weight was assessed at 12-month intervals. Rapid weight loss was defined as >5% decrease in body weight within any 12-month interval. Multivariable-adjusted logistic regression was used to assess AAC and rapid weight loss and Cox regression to assess the relationship between rapid weight loss and 9.5-year all-cause mortality. RESULTS Mean±SD age of women was 75.0±2.6 years. During the initial 5 years, 366 (39%) women presented with rapid weight loss. Compared with women with low AAC (24-point AAC score 0-1), those with moderate (24-point AAC score 2-5: odds ratio, 1.36 [95% CI, 1.00-1.85]) and extensive (24-point AAC score 6+: odds ratio, 1.59 [95% CI, 1.10-2.31]) AAC had higher odds for presenting with rapid weight loss. Results remained similar after further adjustment for dietary factors (alcohol, protein, fat, and carbohydrates), diet quality, blood pressure, and cholesterol measures. The estimates were similar in subgroups of women who met protein intake (n=599) and physical activity (n=735) recommendations (extensive AAC: odds ratios, 1.81 [95% CI, 1.12-2.92] and 1.58 [95% CI, 1.02-2.44], respectively). Rapid weight loss was associated with all-cause mortality over the next 9.5 years (hazard ratio, 1.49 [95% CI, 1.17-1.89]; P=0.001). CONCLUSIONS AAC extent was associated with greater risk for rapid weight loss over 5 years in older women, a risk for all-cause mortality. Since the association was unchanged after taking nutritional intakes into account, these data support the possibility that vascular disease may play a role in the maintenance of body weight.
Collapse
Affiliation(s)
- Cassandra Smith
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia (C.S., M.S., J.D.V., A.K.G., J.R.L.)
- Medical School, The University of Western Australia, Perth (C.S., M.S., K.Z., W.H.L., R.T., R.L.P., J.R.L.)
| | - Marc Sim
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia (C.S., M.S., J.D.V., A.K.G., J.R.L.)
- Medical School, The University of Western Australia, Perth (C.S., M.S., K.Z., W.H.L., R.T., R.L.P., J.R.L.)
- Royal Perth Hospital Research Foundation, Western Australia (M.S.)
| | - Jack Dalla Via
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia (C.S., M.S., J.D.V., A.K.G., J.R.L.)
| | - Abadi K Gebre
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia (C.S., M.S., J.D.V., A.K.G., J.R.L.)
| | - Kun Zhu
- Medical School, The University of Western Australia, Perth (C.S., M.S., K.Z., W.H.L., R.T., R.L.P., J.R.L.)
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia (K.Z., R.L.P.)
| | - Wai H Lim
- Medical School, The University of Western Australia, Perth (C.S., M.S., K.Z., W.H.L., R.T., R.L.P., J.R.L.)
- Renal Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia (W.H.L.)
| | - Ryan Teh
- Medical School, The University of Western Australia, Perth (C.S., M.S., K.Z., W.H.L., R.T., R.L.P., J.R.L.)
- Fiona Stanley Hospital, Murdoch, Western Australia (R.T.)
| | - Douglas P Kiel
- Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.P.K.)
| | - John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, Minneapolis, MN (J.T.S.)
- Division of Health Policy and Management, University of Minnesota, Minneapolis (J.T.S.)
| | - Itamar Levinger
- Institute for Health and Sport, Victoria University, Melbourne, Australia (I.L.)
- Australian Institute for Musculoskeletal Science, University of Melbourne and Western Health, St Albans (I.L.)
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Germany (S.v.H.)
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.v.H.)
| | - Richard Woodman
- Flinders Health and Medical Research Institute-Cancer Program, Flinders University, Bedford Park, South Australia (R.W.)
| | | | - Richard L Prince
- Medical School, The University of Western Australia, Perth (C.S., M.S., K.Z., W.H.L., R.T., R.L.P., J.R.L.)
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia (K.Z., R.L.P.)
| | - Joshua R Lewis
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia (C.S., M.S., J.D.V., A.K.G., J.R.L.)
- Medical School, The University of Western Australia, Perth (C.S., M.S., K.Z., W.H.L., R.T., R.L.P., J.R.L.)
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Australia (J.R.L.)
| |
Collapse
|
6
|
Saleem N, Nash DM, Au E, Luo B, Craig JC, Garg AX, McArthur E, Dixon SN, Teixeira-Pinto A, Lim WH, Wong G. Breast Cancer Screening, Incidence, and Mortality in Women Treated With Maintenance Dialysis: A Population-Based Cohort Study in Ontario, Canada. Kidney Int Rep 2024; 9:171-176. [PMID: 38312783 PMCID: PMC10831342 DOI: 10.1016/j.ekir.2023.10.007] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/09/2023] [Indexed: 02/06/2024] Open
Affiliation(s)
- Nida Saleem
- College of Medicine and Public Health, Flinders University
- Center for Kidney Research, Kids Research Institute, The Children’s Hospital at Westmead, New South Wales, Australia
- Department of Renal and Transplantation Medicine, Westmead Hospital, New South Wales, Australia
| | - Danielle M. Nash
- ICES, Ontario, Canada
- Lawson Health Research Institute and London Health Sciences Center, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Eric Au
- Sydney School of Public Health, University of Sydney, New South Wales, Australia
- The Alfred Hospital, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Bin Luo
- ICES, Ontario, Canada
- Lawson Health Research Institute and London Health Sciences Center, London, Ontario, Canada
| | | | - Amit X. Garg
- ICES, Ontario, Canada
- Lawson Health Research Institute and London Health Sciences Center, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Eric McArthur
- ICES, Ontario, Canada
- Lawson Health Research Institute and London Health Sciences Center, London, Ontario, Canada
| | - Stephanie N. Dixon
- ICES, Ontario, Canada
- Lawson Health Research Institute and London Health Sciences Center, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, University of Sydney, New South Wales, Australia
- Center for Kidney Research, Kids Research Institute, The Children’s Hospital at Westmead, New South Wales, Australia
| | - Wai H. Lim
- Sir Charles Gairdner Hospital Perth, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, New South Wales, Australia
- Center for Kidney Research, Kids Research Institute, The Children’s Hospital at Westmead, New South Wales, Australia
- Department of Renal and Transplantation Medicine, Westmead Hospital, New South Wales, Australia
| |
Collapse
|
7
|
McMullen L, Drak D, Basu G, Coates PT, Goodman DJ, Graver A, Isbel N, Lim WH, Luxton G, Sciberras F, Toussaint ND, Wong G, Gracey DM. Kidney transplantation in people living with human immunodeficiency virus: An overview of the Australian experience. Nephrology (Carlton) 2024; 29:34-38. [PMID: 37605476 DOI: 10.1111/nep.14229] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023]
Abstract
Kidney transplantation in people living with HIV (PLWHIV) is occurring with increasing frequency. Limited international data suggest comparable patient and graft survival in kidney transplant recipients with and without HIV. All PLWHIV aged ≥18 years who received a kidney transplant between 2000 and 2020 were identified by retrospective data initially extracted from Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), with additional HIV-specific clinical data extracted from linked local health-care records. Twenty-five PLWHIV and kidney failure received their first kidney transplant in Australia between January 2000 and December 2020. Majority were male (85%), with median age 54 years (interquartile range, IQR 43-57). Focal segmental glomerulosclerosis was the most common primary kidney disease (20%), followed by polycystic kidney disease (16%). 80% of patients underwent induction with basiliximab and none with anti-thymocyte globulin (ATG). Participants were followed for median time of 3.5 years (IQR 2.0-6.5). Acute rejection occurred in 24% of patients. Two patients lost their allografts and three died. Virological escape occurred in 28% of patients, with a maximum viral load of 190 copies/mL. In conclusion, kidney transplantation in PLWHIV in Australia is occurring with increasing frequency. Acute rejection is more common than in Australia's general transplant population, but this does not appear to be associated with higher rates of graft failure or mortality out to four years.
Collapse
Affiliation(s)
- Lucy McMullen
- Renal Medicine Unit, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Douglas Drak
- Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Gopal Basu
- Renal Medicine Unit, The Alfred, Melbourne, Victoria, Australia
- Monash University (Central Clinical School), Melbourne, Victoria, Australia
| | - P Toby Coates
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - David J Goodman
- Department of Nephrology, St Vincent's Hospital, Fitzroy, Australia
| | - Alison Graver
- Kidney Transplant Service, Department of Nephrology, Austin Health, Heidelberg, Australia
| | - Nicole Isbel
- Department of Kidney Medicine, Princess Alexandra Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Wai H Lim
- Medical School, University of Western Australia, Perth, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Grant Luxton
- Department of Nephrology, Prince of Wales Hospital, Sydney, Australia
| | - Frederika Sciberras
- Western Renal Services, Western Sydney Local Health District, Sydney, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine (RMH), University of Melbourne, Parkville, Victoria, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - David M Gracey
- Renal Medicine Unit, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| |
Collapse
|
8
|
Fernando SC, Polkinghorne KR, Lim WH, Mulley WR. Early Versus Late Acute AMR in Kidney Transplant Recipients-A Comparison of Treatment Approaches and Outcomes From the ANZDATA Registry. Transplantation 2023; 107:2424-2432. [PMID: 37322595 DOI: 10.1097/tp.0000000000004700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Antibody-mediated rejection (AMR) is a major cause of kidney allograft failure and demonstrates different properties depending on whether it occurs early (<6 mo) or late (>6 mo) posttransplantation. We aimed to compare graft survival and treatment approaches for early and late AMR in Australia and New Zealand. METHODS Transplant characteristics were obtained for patients with an AMR episode reported to the Australia and New Zealand Dialysis and Transplant Registry from January 2003 to December 2019. The primary outcome of time to graft loss from AMR diagnosis, with death considered a competing risk, was compared between early and late AMR using flexible parametric survival models. Secondary outcomes included treatments used, response to treatment, and time from AMR diagnosis to death. RESULTS After adjustment for other explanatory factors, late AMR was associated with twice the risk of graft loss relative to early AMR. The risk was nonproportional over time, with early AMR having an increased early risk. Late AMR was also associated with an increased risk of death. Early AMR was treated more aggressively than late with more frequent use of plasma exchange and monoclonal/polyclonal antibodies. There was substantial variation in treatments used by transplant centers. Early AMR was reported to be more responsive to treatment than late. CONCLUSIONS Late AMR is associated with an increased risk of graft loss and death compared with early AMR. The marked heterogeneity in the treatment of AMR highlights the need for effective, new therapeutic options for these conditions.
Collapse
Affiliation(s)
- Sanduni C Fernando
- Department of Nephrology, Monash Medical Centre, Clayton, VIC, Australia
- Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Medical Centre, Clayton, VIC, Australia
- Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
| | - William R Mulley
- Department of Nephrology, Monash Medical Centre, Clayton, VIC, Australia
- Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, VIC, Australia
| |
Collapse
|
9
|
Wong G, Lim WH. Prior cancer history and suitability for kidney transplantation. Clin Kidney J 2023; 16:1908-1916. [PMID: 37915927 PMCID: PMC10616492 DOI: 10.1093/ckj/sfad141] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Indexed: 11/03/2023] Open
Abstract
Kidney transplantation is the optimal treatment for most patients with kidney failure. For patients with a prior history of treated cancers, listing and transplant eligibility decisions are complex. Patients and health professionals are obliged to consider the time-periods between cancer cure and transplantation, the risk of cancer recurrence under the influence of immunosuppression and anti-cancer treatment options if the disease recurs. Cancer recurrence is associated with a high mortality rate, thus potentially reduces the projected survival benefit of transplantation, and dampens the utility of scarce organs. In view of the uncertain risk of harms, clinicians may consider transplantation for candidates with prior cancer history only after an extended period of cancer-free interval, as the fear of disease recurrence and shortened life expectancy may outweigh the benefits of receiving a kidney transplant compared with dialysis. Over the past decade, the evolution of novel anti-cancer therapies coupled with improved understanding of cancer genomics have led to considerable improvement in cancer-free survival. It is therefore justifiable to make individualized transplant suitability decisions based the joint effects of cancer biology, available therapeutic options and prognostic covariates on clinical outcomes. In this review, we first summarized the cancer epidemiology in kidney transplant recipients. We then explored how the probability of cancer cure, risk of recurrence and outcomes in candidates with a prior cancer history may influence the decisions to transplant. Finally, the role of shared decision-making between health professionals and patients regarding the optimal management options, and considerations of patients' preferences and values are discussed.
Collapse
Affiliation(s)
- Germaine Wong
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, NSW, Sydney, Australia
- Centre for Kidney and Transplantation Research, Westmead Hospital, NSW, Sydney, Australia
| | - Wai H Lim
- Department of Renal and Transplantation Medicine, Sir Charles Gairdner Hospital, WA, Perth, Australia
| |
Collapse
|
10
|
Chong CH, Au EH, Davies CE, Jaure A, Howell M, Lim WH, Craig JC, Teixeira-Pinto A, Wong G. Long-term Trends in Infection-Related Mortality in Adults Treated With Maintenance Dialysis. Am J Kidney Dis 2023; 82:597-607. [PMID: 37330132 DOI: 10.1053/j.ajkd.2023.03.018] [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: 09/27/2022] [Accepted: 03/28/2023] [Indexed: 06/19/2023]
Abstract
RATIONALE & OBJECTIVE Infection is 1 of the top 3 causes of death in patients receiving maintenance dialysis. We evaluated the trends over time and risk factors for infection-related deaths among people receiving dialysis. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS We included all adults who began dialysis between 1980 and 2018 in Australia and New Zealand. EXPOSURE Age, sex, dialysis modality, and dialysis era. OUTCOME Infection-related death. ANALYTICAL APPROACH Incidence was described and standardized mortality ratios (SMR) calculated for infection-related death. Fine-Gray subdistribution hazards models were fitted, with non-infection-related death and kidney transplantation treated as competing events. RESULTS The study comprised 46,074 patients who received hemodialysis and 20,653 who were treated with peritoneal dialysis who were followed for 164,536 and 69,846 person-years, respectively. There were 38,463 deaths during the follow-up period, 12% of which were ascribed to infection. The overall rate of mortality from infection (per 10,000 person-years) was 185 and 232 for patients treated with hemodialysis and peritoneal dialysis, respectively. The rates were 184 and 219 for males and females, respectively; and 99, 181, 255, and 292 for patients aged 18-44, 45-64, 65-74, 75 years and over, respectively. The rates were 224 and 163 for those commencing dialysis in years 1980-2005 and 2006-2018, respectively. The overall SMR declined over time, from 37.1 (95% CI, 35.5-38.8) in years 1980-2005 to 19.3 (95% CI, 18.4-20.3) in years 2006-2018, consistent with the declining 5-year SMR trend (P<0.001). Infection-related mortality was associated with being female, older age, and Aboriginal and/or a Torres Strait Islander or Māori. LIMITATIONS Mediation analyses defining the causal relationships between infection type and infection-related death could not be undertaken as disaggregating the data was not feasible. CONCLUSIONS The excess risk of infection-related death in patients on dialysis has improved substantially over time but remains more than 20 times higher than in the general population.
Collapse
Affiliation(s)
- Chanel H Chong
- School of Public Health, University of Sydney, Sydney; Centre for Kidney Research, the Children's Hospital at Westmead, Sydney.
| | - Eric H Au
- School of Public Health, University of Sydney, Sydney; Centre for Kidney Research, the Children's Hospital at Westmead, Sydney; Centre for Transplant and Renal Research, Westmead Hospital, Sydney
| | - Christopher E Davies
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Allison Jaure
- School of Public Health, University of Sydney, Sydney; Centre for Kidney Research, the Children's Hospital at Westmead, Sydney
| | - Martin Howell
- School of Public Health, University of Sydney, Sydney; Centre for Kidney Research, the Children's Hospital at Westmead, Sydney
| | - Wai H Lim
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia; Department of Renal Medicine, Sir Charles Gairdner Hospital Unit, Perth, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Armando Teixeira-Pinto
- School of Public Health, University of Sydney, Sydney; Centre for Kidney Research, the Children's Hospital at Westmead, Sydney
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney; Centre for Kidney Research, the Children's Hospital at Westmead, Sydney; Centre for Transplant and Renal Research, Westmead Hospital, Sydney
| |
Collapse
|
11
|
Bauer C, Sim M, Prince RL, Zhu K, Lim EM, Byrnes E, Pavlos N, Lim WH, Wong G, Lewis JR, Levinger I. Circulating lipocalin-2 and features of metabolic syndrome in community-dwelling older women: A cross-sectional study. Bone 2023; 176:116861. [PMID: 37524293 DOI: 10.1016/j.bone.2023.116861] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/02/2023]
Abstract
Lipocalin-2 (LCN2) is released by several cell types including osteoblasts and adipocytes and has been suggested as a marker of renal dysfunction, metabolic syndrome (MetS) and type 2 diabetes (T2D). Whether LCN2 is linked to these diseases in older women remains unknown. This study investigated whether LCN2 is related to features of MetS and T2D in older women. This cross-sectional study included 705 non-diabetic women (mean age 75.1 ± 2.6 years) for MetS analysis and 76 women (mean age 75.4 ± 2.8 years) with T2D. Total circulating LCN2 levels were analysed using a two-step chemiluminescent microparticle monoclonal immunoassay. MetS was determined by a modified National Cholesterol Education Program Adult Treatment Panel III classification. Multivariable-adjusted logistic regression analysis was used to assess odds ratios between LCN2 quartiles and MetS. Women in the highest LCN2 quartile had approximately 3 times greater risk for MetS compared to women in the lowest quartile (OR 3.05; 95%CI 1.86-5.02). Women with T2D or MetS scores of ≥ 3 had higher LCN2 levels compared to women with a MetS score of 0 (p < 0.05). Higher LCN2 correlated with higher body mass index, fat mass, triglycerides and glycated haemoglobin and lower high-density lipoprotein cholesterol and estimated glomerular filtration rate (p < 0.05). Higher circulating levels of LCN2 are associated with worsened cardio-metabolic risk factors and increased odds of MetS and T2D in older women. Whether it can be used as a biomarker for identifying those at risk for MetS and T2D should be explored further.
Collapse
Affiliation(s)
- Carlie Bauer
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Marc Sim
- Nutrition & Health Innovation Research Institute, Edith Cowan University, Joondalup, Australia; Medical School, University of Western Australia, Perth, Australia
| | - Richard L Prince
- Medical School, University of Western Australia, Perth, Australia
| | - Kun Zhu
- Medical School, University of Western Australia, Perth, Australia; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - Ee M Lim
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia; PathWest, QEII Medical Centre, Perth, Australia
| | | | - Nathan Pavlos
- School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - Wai H Lim
- Medical School, University of Western Australia, Perth, Australia; Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Germaine Wong
- Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Joshua R Lewis
- Nutrition & Health Innovation Research Institute, Edith Cowan University, Joondalup, Australia; Medical School, University of Western Australia, Perth, Australia; Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Itamar Levinger
- Institute for Health and Sport, Victoria University, Melbourne, Australia; Australian Institute for Musculoskeletal Science, Victoria University, University of Melbourne, Western Health, St Albans, VIC, Australia.
| |
Collapse
|
12
|
Lim WH, Au E, Teixeira-Pinto A, Ooi E, Opdam H, Chapman J, Johnson DW, Kanellis J, Davies CE, Wong G. Donors With a Prior History of Cancer: Factors of Non-Utilization of Kidneys for Transplantation. Transpl Int 2023; 36:11883. [PMID: 38020745 PMCID: PMC10643206 DOI: 10.3389/ti.2023.11883] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
Cancer transmission from deceased donors is an exceedingly rare but potentially fatal complication in transplant recipients. We aimed to quantify the likelihood of non-utilization of kidneys for transplantation from donors with a prior cancer history. We included all intended and actual deceased donors in Australia and New Zealand between 1989 and 2017. Association between prior cancer history and non-utilization of donor kidneys was examined using adjusted logistic regression. Of 9,485 deceased donors, 345 (4%) had a prior cancer history. Of 345 donors with a prior cancer history, 197 (57%) were utilized for transplantation. Donor characteristics of age, sex and comorbidities were similar between utilized and non-utilized donors with prior cancer. The time from cancer to organ donation was similar between utilized and non-utilized donors, irrespective of cancer subtypes. Donors with a prior cancer history were less likely to be utilized [adjusted OR (95% CI) 2.29 (1.68-3.13)] than donors without prior cancer. Of all actual donors, the adjusted OR for non-utilization among those with prior cancer was 2.36 (1.58-3.53). Non-melanoma skin cancer was the most frequent prior cancer type for utilized and non-utilized potential donors. Donors with prior cancers were less likely to be utilized for transplantation, with no discernible differences in cancer characteristics between utilized and non-utilized donors.
Collapse
Affiliation(s)
- Wai H. Lim
- Medical School, University of Western Australia, Perth, WA, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Eric Au
- Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Kids Research Institute, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Esther Ooi
- Medical School, University of Western Australia, Perth, WA, Australia
- School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Helen Opdam
- DonateLife, Organ and Tissue Authority, Canberra, NSW, Australia
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
| | - Jeremy Chapman
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
| | - David W. Johnson
- Princess Alexandra Hospital, Metro South Integrated Nephrology and Transplant Services, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - John Kanellis
- Department of Nephrology, Monash Health, Melbourne, VIC, Australia
- Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia
| | - Christopher E. Davies
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Germaine Wong
- Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Kids Research Institute, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| |
Collapse
|
13
|
Cooper TE, Dalton A, Kieu A, Gately R, Bourke MJ, Craig JC, Khalid R, Lim WH, Scholes-Robertson N, Teixeira-Pinto A, Jaure A, Wong G, Howell M. Patient Preferences for the Management of Gastrointestinal Symptoms in Kidney Transplantation: a Discrete Choice Experiment. Kidney Int Rep 2023; 8:1978-1988. [PMID: 37850002 PMCID: PMC10577360 DOI: 10.1016/j.ekir.2023.07.034] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction Gastrointestinal (GI) symptoms in kidney transplant are common and debilitating. We aimed to ascertain patients' preferences for GI symptom management options to help future interventions align with treatment priorities. Methods A discrete choice experiment was conducted with kidney transplant recipients in 3 Australian nephrology units. A multinomial logit model was used to quantify the preferences and trade-offs between 5 characteristics: cost, formulation, symptom burden, dietary changes, and medication quantities. Results Seventy patients participated (mean age ± SD: 47 ± 15 years, 56% female), 57% had GI symptoms. Patients preferred interventions that will achieve complete resolution of GI symptoms compared to no improvement (odds ratio [95% confidence interval]: 15.3 [1.80, 129.50]), were delivered as a tablet rather than a sachet (1.6 [1.27, 2.08]), retained their current diet compared to eliminating food groups (6.0 [2.19, 16.27]), reduced medication burden (1.4 [1.06, 1.79]), and had lower costs (0.98 [0.96, 1.00]). Participants would be willing to pay AUD$142.20 [$83.90, $200.40] monthly to achieve complete resolution of GI symptoms or AUD$100.90 [$9.60, $192.10] to have moderate improvement in symptoms. Conclusions Interventions that are highly effective in relieving all GI symptoms without the need for substantive dietary changes, and in tablet form, are most preferred by kidney transplant recipients.
Collapse
Affiliation(s)
- Tess E. Cooper
- Cochrane Kidney and Transplant, The Children's Hospital at Westmead, Australia
- Sydney School of Public Health, The University of Sydney, Australia
- Center for Kidney Research, The Children’s Hospital at Westmead, Australia
| | - Amy Dalton
- Sydney School of Public Health, The University of Sydney, Australia
- Center for Kidney Research, The Children’s Hospital at Westmead, Australia
| | - Anh Kieu
- Cochrane Kidney and Transplant, The Children's Hospital at Westmead, Australia
- Center for Kidney Research, The Children’s Hospital at Westmead, Australia
| | - Ryan Gately
- Princess Alexandra Hospital, Australia
- School of Medicine, The University of Queensland, Australia
| | - Michael J. Bourke
- Westmead Hospital, Australia
- Sydney Medical School, The University of Sydney, Australia
| | - Jonathan C. Craig
- Cochrane Kidney and Transplant, The Children's Hospital at Westmead, Australia
- College of Medicine and Public Health, Flinders University, Australia
| | - Rabia Khalid
- Sydney School of Public Health, The University of Sydney, Australia
- Center for Kidney Research, The Children’s Hospital at Westmead, Australia
| | - Wai H. Lim
- Sir Charles Gairdner Hospital, Australia
- School of Medicine, University of Western Australia, Australia
| | - Nicole Scholes-Robertson
- Cochrane Kidney and Transplant, The Children's Hospital at Westmead, Australia
- Sydney School of Public Health, The University of Sydney, Australia
- Center for Kidney Research, The Children’s Hospital at Westmead, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Australia
- Center for Kidney Research, The Children’s Hospital at Westmead, Australia
| | - Allison Jaure
- Sydney School of Public Health, The University of Sydney, Australia
- Center for Kidney Research, The Children’s Hospital at Westmead, Australia
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Australia
- Center for Kidney Research, The Children’s Hospital at Westmead, Australia
- Westmead Hospital, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Australia
- Center for Kidney Research, The Children’s Hospital at Westmead, Australia
| |
Collapse
|
14
|
Collins MG, Fahim MA, Pascoe EM, Hawley CM, Johnson DW, Varghese J, Hickey LE, Clayton PA, Dansie KB, McConnochie RC, Vergara LA, Kiriwandeniya C, Reidlinger D, Mount PF, Weinberg L, McArthur CJ, Coates PT, Endre ZH, Goodman D, Howard K, Howell M, Jamboti JS, Kanellis J, Laurence JM, Lim WH, McTaggart SJ, O'Connell PJ, Pilmore HL, Wong G, Chadban SJ. Balanced crystalloid solution versus saline in deceased donor kidney transplantation (BEST-Fluids): a pragmatic, double-blind, randomised, controlled trial. Lancet 2023; 402:105-117. [PMID: 37343576 DOI: 10.1016/s0140-6736(23)00642-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [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: 12/13/2022] [Revised: 03/10/2023] [Accepted: 03/23/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Delayed graft function (DGF) is a major adverse complication of deceased donor kidney transplantation. Intravenous fluids are routinely given to patients receiving a transplant to maintain intravascular volume and optimise graft function. Saline (0·9% sodium chloride) is widely used but might increase the risk of DGF due to its high chloride content. We aimed to test our hypothesis that using a balanced low-chloride crystalloid solution (Plasma-Lyte 148) instead of saline would reduce the incidence of DGF. METHODS BEST-Fluids was a pragmatic, registry-embedded, multicentre, double-blind, randomised, controlled trial at 16 hospitals in Australia and New Zealand. Adults and children of any age receiving a deceased donor kidney transplant were eligible; those receiving a multi-organ transplant or weighing less than 20 kg were excluded. Participants were randomly assigned (1:1) using an adaptive minimisation algorithm to intravenous balanced crystalloid solution (Plasma-Lyte 148) or saline during surgery and up until 48 h after transplantation. Trial fluids were supplied in identical bags and clinicians determined the fluid volume, rate, and time of discontinuation. The primary outcome was DGF, defined as receiving dialysis within 7 days after transplantation. All participants who consented and received a transplant were included in the intention-to-treat analysis of the primary outcome. Safety was analysed in all randomly assigned eligible participants who commenced surgery and received trial fluids, whether or not they received a transplant. This study is registered with Australian New Zealand Clinical Trials Registry, (ACTRN12617000358347), and ClinicalTrials.gov (NCT03829488). FINDINGS Between Jan 26, 2018, and Aug 10, 2020, 808 participants were randomly assigned to balanced crystalloid (n=404) or saline (n=404) and received a transplant (512 [63%] were male and 296 [37%] were female). One participant in the saline group withdrew before 7 days and was excluded, leaving 404 participants in the balanced crystalloid group and 403 in the saline group that were included in the primary analysis. DGF occurred in 121 (30%) of 404 participants in the balanced crystalloid group versus 160 (40%) of 403 in the saline group (adjusted relative risk 0·74 [95% CI 0·66 to 0·84; p<0·0001]; adjusted risk difference 10·1% [95% CI 3·5 to 16·6]). In the safety analysis, numbers of investigator-reported serious adverse events were similar in both groups, being reported in three (<1%) of 406 participants in the balanced crystalloid group versus five (1%) of 409 participants in the saline group (adjusted risk difference -0·5%, 95% CI -1·8 to 0·9; p=0·48). INTERPRETATION Among patients receiving a deceased donor kidney transplant, intravenous fluid therapy with balanced crystalloid solution reduced the incidence of DGF compared with saline. Balanced crystalloid solution should be the standard-of-care intravenous fluid used in deceased donor kidney transplantation. FUNDING Medical Research Future Fund and National Health and Medical Research Council (Australia), Health Research Council (New Zealand), Royal Australasian College of Physicians, and Baxter.
Collapse
Affiliation(s)
- Michael G Collins
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia; Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia.
| | - Magid A Fahim
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia; Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia; Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia; Translational Research Institute, Brisbane, QLD, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia; Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia; Translational Research Institute, Brisbane, QLD, Australia
| | - Julie Varghese
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
| | - Laura E Hickey
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
| | - Philip A Clayton
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Kathryn B Dansie
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | | | - Liza A Vergara
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
| | - Charani Kiriwandeniya
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
| | - Donna Reidlinger
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
| | - Peter F Mount
- Department of Nephrology, Austin Health, Melbourne, VIC, Australia; Department of Medicine (Austin), University of Melbourne, Melbourne, VIC, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
| | - Colin J McArthur
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - P Toby Coates
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Zoltan H Endre
- Department of Nephrology, Prince of Wales Hospital, Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - David Goodman
- Department of Nephrology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Menzies Centre for Health Policy and Economics, University of Sydney, Sydney, NSW, Australia
| | - Martin Howell
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Menzies Centre for Health Policy and Economics, University of Sydney, Sydney, NSW, Australia
| | - Jagadish S Jamboti
- Department of Nephrology and Renal Transplantation, Fiona Stanley Hospital, Murdoch, WA, Australia; School of Medicine, University of Western Australia, Perth, WA, Australia
| | - John Kanellis
- Department of Nephrology, Monash Health, Melbourne, VIC, Australia; Centre for Inflammatory Diseases, Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Jerome M Laurence
- Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Wai H Lim
- School of Medicine, University of Western Australia, Perth, WA, Australia; Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Steven J McTaggart
- Child and Adolescent Renal Service, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Philip J O'Connell
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia; Department of Renal and Transplantation Medicine, Westmead Hospital, Sydney, NSW, Australia
| | - Helen L Pilmore
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Germaine Wong
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Centre for Transplant and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia; Department of Renal and Transplantation Medicine, Westmead Hospital, Sydney, NSW, Australia
| | - Steven J Chadban
- Kidney Node, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia; Department of Renal Medicine, Kidney Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| |
Collapse
|
15
|
Phillips J, Chan DT, Chakera A, Swaminathan R, Patankar K, Boudville N, Lim WH. Haemodialysis vascular catheter-related blood stream infection: Organism types and clinical outcomes. Nephrology (Carlton) 2023; 28:249-253. [PMID: 36715242 DOI: 10.1111/nep.14147] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/15/2022] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
Catheter-related bloodstream infection (CRBI) is an important complication of catheter use for haemodialysis, but it remains unclear whether clinical outcomes following CRBI are influenced by organism type. This study aims to compare clinical outcomes following CRBI from Gram-positive and non-Gram-positive organisms. This was a retrospective cohort study of patients with kidney failure receiving haemodialysis (HD) via vascular catheters who had a documented episode of CRBI in Western Australia between 2005 and 2018. The associations between organism type, likelihood of hospitalization, catheter removal and death from CRBI were examined using adjusted logistic regression models. There were 111 episodes of CRBI in 99 patients (6.1 episodes per 1000-catheter-days at risk). Of the study cohort, 53 (48%) were male and 38 (34%) identified as Aboriginal or Torres Strait Islander. Gram-positive organisms were identified in 73 (66%) CRBI episodes, most commonly Staphylococcus aureus. Of those with non-Gram-positive CRBI, 9 (24%) were attributed to Pseudomonas aeruginosa. One-hundred and two (92%) episodes of CRBI required hospitalization and 15 (13%) patients died from CRBI. Compared with non-Gram-positive CRBI, Gram-positive CRBI was associated with an increased risk of hospitalization and catheter removal, with adjusted odds ratio of 9.34 (95% CI 1.28-68.03) and 3.47 (95% CI 1.25-9.67), respectively. There was no association between organism type and death from CRBI. Staphylococcus aureus remains the most common organism causing CRBI in HD patients. CRBI is associated with substantial morbidity, particularly CRBI attributed to Gram-positive organisms.
Collapse
Affiliation(s)
- Jessica Phillips
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Doris T Chan
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Aron Chakera
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | | | - Khalil Patankar
- Department of Renal Medicine, Royal Perth Hospital, Perth, Australia
| | - Neil Boudville
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- Medical School, University of Western Australia, Perth, Australia
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- Medical School, University of Western Australia, Perth, Australia
| |
Collapse
|
16
|
Halimi JM, Al-Dakkak I, Anokhina K, Ardissino G, Licht C, Lim WH, Massart A, Schaefer F, Walle JV, Rondeau E. Clinical characteristics and outcomes of a patient population with atypical hemolytic uremic syndrome and malignant hypertension: analysis from the Global aHUS registry. J Nephrol 2023; 36:817-828. [PMID: 36152218 PMCID: PMC10090001 DOI: 10.1007/s40620-022-01465-z] [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: 03/30/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Atypical hemolytic uremic syndrome (aHUS) is a rare form of thrombotic microangiopathy (TMA) often caused by alternative complement dysregulation. Patients with aHUS can present with malignant hypertension (MHT), which may also cause TMA. METHODS This analysis of the Global aHUS Registry (NCT01522183) assessed demographics and clinical characteristics in eculizumab-treated and not-treated patients with aHUS, with (n = 71) and without (n = 1026) malignant hypertension, to further elucidate the potential relationship between aHUS and malignant hypertension. RESULTS While demographics were similar, patients with aHUS + malignant hypertension had an increased need for renal replacement therapy, including kidney transplantation (47% vs 32%), and more pathogenic variants/anti-complement factor H antibodies (56% vs 37%) than those without malignant hypertension. Not-treated patients with malignant hypertension had the highest incidence of variants/antibodies (65%) and a greater need for kidney transplantation than treated patients with malignant hypertension (65% vs none). In a multivariate analysis, the risk of end-stage kidney disease or death was similar between not-treated patients irrespective of malignant hypertension and was significantly reduced in treated vs not-treated patients with aHUS + malignant hypertension (adjusted HR (95% CI), 0.11 [0.01-0.87], P = 0.036). CONCLUSIONS These results confirm the high severity and poor prognosis of untreated aHUS and suggest that eculizumab is effective in patients with aHUS ± malignant hypertension. Furthermore, these data highlight the importance of accurate, timely diagnosis and treatment in these populations and support consideration of aHUS in patients with malignant hypertension and TMA. TRIAL REGISTRATION DETAILS Atypical Hemolytic-Uremic Syndrome (aHUS) Registry. Registry number: NCT01522183 (first listed 31st January, 2012; start date 30th April, 2012).
Collapse
Affiliation(s)
- Jean-Michel Halimi
- Service de Néphrologie-Hypertension Artérielle, Dialyses, Transplantation Rénale, CHRU Tours, Tours, France.
- University of Tours, Equipe d'Accueil 4245 (EA4245), Tours, France.
| | | | | | - Gianluigi Ardissino
- Center for HUS Control, Prevention and Management, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Christoph Licht
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- Medical School, University of Western Australia, Perth, Australia
| | - Annick Massart
- Department of Nephrology and Hypertension, Antwerp University Hospital, Edegem, Belgium
| | - Franz Schaefer
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Johan Vande Walle
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Eric Rondeau
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Paris, France
| |
Collapse
|
17
|
Lin Y, Teixeira-Pinto A, Craig JC, Opdam H, Chapman JC, Pleass H, Carter A, Rogers NM, Davies CE, McDonald S, Yang J, Lim WH, Wong G. Trajectories of systolic blood pressure decline in kidney transplant donors prior to circulatory death and delayed graft function. Clin Kidney J 2023. [DOI: 10.1093/ckj/sfad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Abstract
Background
Kidneys donated after circulatory death suffer a period of functional warm ischemia before death, which may lead to early ischemic injury. Effects of hemodynamic trajectories during the agonal phase on delayed graft function (DGF) is unknown. We aimed to predict the risk of DGF using patterns of trajectories of systolic blood pressure declines in Maastricht category 3 kidney donors.
Methods
Cohort study of all kidney transplant recipients in Australia who have received kidneys from donation after circulatory death donors, divided into a derivation (transplants between 9th April 2014 and 2nd Jan 2018 [462 donors]) and validation cohort (transplants between 6th Jan 2018 and 24th December 2019 [324 donors]). Patterns of systolic blood pressure decline using latent class models were evaluated against the odds of DGF using two-stage linear mixed-effect models.
Results
In the derivation cohort, 462 donors were included in the latent class analyses, 379 donors in the mixed effects model. Of the 696 eligible transplant recipients, 380 (54.6%) experienced DGF. Ten different trajectories, with distinct patterns of systolic blood pressure decline were identified. Compared to recipients of donors with the slowest decline in systolic blood pressure after withdrawal of cardio-respiratory support, the adjusted odds ratio (95%CI) for DGF was 5.5 (1.38–28.0) for recipients of donors with a steeper decline and lowest systolic blood pressure (mean [SD]: 49.5 [12.5] mmHg) at the time of withdrawal. For every 1 mmHg per minute reduction in the rate of decline of systolic blood pressure, the respective adjusted odds ratios (95%CI) for DGF were 0.95 (0.91–0.99) and 0.98 (0.93–1.0) in the random forest and least absolute shrinkage and selection operator models. In the validation cohort, the respective adjusted odds ratios were 0.95 (0.91–1.0) and 0.99 (0.94–1.0).
Conclusion
Trajectories of systolic blood pressure decline, and their determinants are predictive of DGF. These results support a trajectory-based assessment of hemodynamic changes in donors after circulatory death during the agonal phase for donor suitability and post-transplant outcomes.
Collapse
Affiliation(s)
- Yingxin Lin
- Sydney School of Public Health, University of Sydney , Sydney, Australia
- Faculty of Science, School of Mathematics and Science, University of Sydney , Sydney, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, University of Sydney , Sydney, Australia
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead , Sydney, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University , Adelaide, Australia
| | - Helen Opdam
- DonateLife, Organ and Tissue Authority , Canberra, Australia
| | - Jeremy C Chapman
- Centre for Transplant and Renal Research, Westmead Hospital , Sydney, Australia
| | - Henry Pleass
- Centre for Transplant and Renal Research, Westmead Hospital , Sydney, Australia
- Specialty of Surgery, University of Sydney , Sydney, Australia
| | - Angus Carter
- Intensive Care Unit, Cairns Hospital , Cairns , Australia
| | - Natasha M Rogers
- Centre for Transplant and Renal Research, Westmead Hospital , Sydney, Australia
| | - Christopher E Davies
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute , Adelaide, Australia
- Adelaide Medical School, University of Adelaide , Adelaide, Australia
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute , Adelaide, Australia
- Adelaide Medical School, University of Adelaide , Adelaide, Australia
| | - Jean Yang
- Faculty of Science, School of Mathematics and Science, University of Sydney , Sydney, Australia
| | - Wai H Lim
- Faculty of Health and Medical Science, University of Western Australia , Perth , Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital , Perth , Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney , Sydney, Australia
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead , Sydney, Australia
- Centre for Transplant and Renal Research, Westmead Hospital , Sydney, Australia
| |
Collapse
|
18
|
Lim WH, Chen JHC, Minas K, Johnson DW, Ladhani M, Ooi E, Boudville N, Hawley C, Viecelli AK, Roberts M, Wyburn K, Walker R, Borlace M, Pilmore H, Davies CE, Lok CE, Teixeira-Pinto A, Wong G. Sex Disparity in Cause-Specific and All-Cause Mortality Among Incident Dialysis Patients. Am J Kidney Dis 2023; 81:156-167.e1. [PMID: 36029966 DOI: 10.1053/j.ajkd.2022.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/01/2022] [Accepted: 07/14/2022] [Indexed: 01/25/2023]
Abstract
RATIONALE & OBJECTIVE Early mortality rates of female patients receiving dialysis have been, at times, observed to be higher than rates among male patients. The differences in cause-specific mortality between male and female incident dialysis patients with kidney failure are not well understood and were the focus of this study. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Incident patients who had initiated dialysis in Australia and New Zealand in 1998-2018. EXPOSURE Sex. OUTCOMES Cause-specific and all-cause mortality while receiving dialysis, censored for kidney transplant. ANALYTICAL APPROACH Adjusted cause-specific proportional hazards models, focusing on the first 5 years following initiation of dialysis. RESULTS Among 53,414 patients (20,876 [39%] female) followed for a median period of 2.8 (IQR, 1.3-5.2) years, 27,137 (51%) died, with the predominant cause of death attributed to cardiovascular disease (18%), followed by dialysis withdrawal (16%). Compared with male patients, female patients were more likely to die in the first 5 years after dialysis initiation (adjusted hazard ratio [AHR], 1.08 [95% CI, 1.05-1.11]). Even though female patients experienced a lower risk of cardiovascular disease-related mortality (AHR, 0.93 [95% CI, 0.89-0.98]) than male patients, they experienced a greater risk of infection-related (AHR, 1.20 [95% CI, 1.10-1.32]) and dialysis withdrawal-related (AHR, 1.19 [95% CI, 1.13-1.26]) mortality. LIMITATIONS Possibility of residual and unmeasured confounders. CONCLUSIONS Compared with male patients, female patients had a higher risk of all-cause mortality in the first 5 years after dialysis initiation, a difference driven by higher rates of mortality from infections and dialysis withdrawals. These findings may inform the study of sex differences in mortality in other geographic settings.
Collapse
Affiliation(s)
- Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia; Internal Medicine, University of Western Australia Medical School, Perth, Western Australia.
| | - Jenny H C Chen
- School of Medicine, University of New South Wales, Sydney, New South Wales; Department of Renal Medicine, Wollongong Hospital, Wollongong, New South Wales
| | - Kimberley Minas
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland; Australasian Kidney Trials Network, University of Queensland, Woolloongabba, Queensland; Translational Research Institute, Woolloongabba, Queensland
| | - Maleeka Ladhani
- Faculty of Health and Medical Science, Adelaide University Medical School, Adelaide, South Australia; Central and Northern Adelaide Renal and Transplantation Services, Lyell McEwin Hospital, Elizabeth Vale, South Australia
| | - Esther Ooi
- School of Biomedical Sciences, University of Western Australia, Perth, Western Australia
| | - Neil Boudville
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia; Internal Medicine, University of Western Australia Medical School, Perth, Western Australia
| | - Carmel Hawley
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland; Australasian Kidney Trials Network, University of Queensland, Woolloongabba, Queensland; Translational Research Institute, Woolloongabba, Queensland
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland; Australasian Kidney Trials Network, University of Queensland, Woolloongabba, Queensland
| | - Matthew Roberts
- Eastern Health Integrated Renal Service and Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Kate Wyburn
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales; Charles Perkins Centre Kidney Node, University of Sydney, Camperdown, New South Wales
| | | | - Monique Borlace
- Central and Northern Adelaide Renal and Transplantation Services, Lyell McEwin Hospital, Elizabeth Vale, South Australia
| | - Helen Pilmore
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand; Department of Medicine, Auckland University, Auckland, New Zealand
| | - Christopher E Davies
- Faculty of Health and Medical Science, Adelaide University Medical School, Adelaide, South Australia; Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Charmaine E Lok
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada
| | - Armando Teixeira-Pinto
- School of Public Health, Faculty of Medicine and Health, Sydney University, Sydney, New South Wales
| | - Germaine Wong
- School of Public Health, Faculty of Medicine and Health, Sydney University, Sydney, New South Wales; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales; Department of Renal Medicine and National Pancreas Transplant Unit, Westmead Hospital, Sydney, New South Wales
| |
Collapse
|
19
|
Bin Mohamed Ebrahim ME, Singla A, Yao J, Laurence JM, Wong G, Lau H, Lee T, Yuen L, Lim WH, Pleass H. Outcomes of live renal donors with a history of nephrolithiasis; A systematic review. Transplant Rev (Orlando) 2023; 37:100746. [PMID: 36587468 DOI: 10.1016/j.trre.2022.100746] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
The clinical outcomes of kidney donors with a prior history of nephrolithiasis are poorly defined. We conducted a systematic review assessing the post-donation clinical outcomes of kidney donors with a history of nephrolithiasis. Electronic databases (Ovid and Embase) were searched between 1960 and 2021 using key terms and Medical Subject Headings (MeSH) - nephrolithiasis, renal stones, renal transplantation and renal graft. Articles included conference proceedings and journal articles and were not excluded based on patient numbers. Primary outcome was donor stone-related event. Secondary outcomes were renal function upon follow-up or post-operative nephrectomy complications. In summary, 340 articles were identified through database search. We identified 14 studies (16 cohorts) comprising 432 live donors followed up for a median of 26 months post live kidney donation. Six donors donated the stone-free kidney whilst 23 live donors had bilateral stones. Mean stone size was 4.2 ± 1.4 mm (1-16) with average follow up duration of 21.1 months (1-149). Twelve studies provided primary outcome (n = 138 patients) and eight (n = 348) for secondary outcomes. One donor had a stone-related event upon follow up. A total of 195 patients had eGFR <60 upon follow up. However, they were not significantly different when compared to renal function of live donors that didn't have pre-donation nephrolithiasis. Many of the studies couldn't provide long term follow up, coupled with limited data regarding the nature of the pre-donation stone disease. In conclusion, this systematic review shows that we have very limited information upon which to base recommendation regarding pre-donation risk of post-donation complications. Longer term follow up is required and lifelong follow up with live donor registries will aid further understanding.
Collapse
Affiliation(s)
- Mohamed Eftal Bin Mohamed Ebrahim
- Department of Surgery, Royal North Shore Hospital, Sydney, NSW 2065, Australia; Specialty of Surgery, FMH, University of Sydney, Sydney, NSW 2000, Australia; Department of Surgery, Westmead Hospital, Sydney, NSW 2145, Australia.
| | - Animesh Singla
- Specialty of Surgery, FMH, University of Sydney, Sydney, NSW 2000, Australia; Department of Vascular Surgery, Royal North Shore Hospital, NSW 2065, Australia
| | - Jinna Yao
- Specialty of Surgery, FMH, University of Sydney, Sydney, NSW 2000, Australia; National Pancreas Transplant Unit, Westmead Hospital, Sydney, NSW 2145, Australia; Department of Urology, Westmead Hospital, Sydney, NSW 2145, Australia
| | | | - Germaine Wong
- Renal Transplant Unit, Westmead Hospital, Sydney, NSW 2145, Australia; University of Sydney, Sydney, NSW 2000, Australia
| | - Howard Lau
- Department of Surgery, Westmead Hospital, Sydney, NSW 2145, Australia; Western Sydney University, Sydney, NSW 2000, Australia
| | - Taina Lee
- Specialty of Surgery, FMH, University of Sydney, Sydney, NSW 2000, Australia; Department of Surgery, Westmead Hospital, Sydney, NSW 2145, Australia
| | - Lawrence Yuen
- Specialty of Surgery, FMH, University of Sydney, Sydney, NSW 2000, Australia; Department of Surgery, Westmead Hospital, Sydney, NSW 2145, Australia
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA 6009, Australia; School of Medicine, University of Western Australia, Perth, WA 6009, Australia
| | - Henry Pleass
- Specialty of Surgery, FMH, University of Sydney, Sydney, NSW 2000, Australia; Department of Surgery, Westmead Hospital, Sydney, NSW 2145, Australia
| |
Collapse
|
20
|
Lim OZH, Chen Y, Dimmeler S, Yong AWJ, Singh H, Sim MLE, Kong G, Lim WH, Low TT, Park DW, Chew NWS, Foo R. Disparity in female and Asian representation amongst cardiology journal editorial boards members: a call for empowerment. QJM 2022; 115:830-836. [PMID: 35866641 DOI: 10.1093/qjmed/hcac176] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND While progress is evident in gender and ethnic representation in the workplace, this disparity remains prevalent in academic positions. OBJECTIVES We examined gender and Asian ethnic representation in editorial boards of cardiology journals. METHODS A cross-sectional analysis was conducted using publicly available data on Cardiology and Cardiovascular medicine journals in the first quartile of the 2020 Scimago Journal & Country Rank indicator. The proportions of female and Asian editorial board members, associate editors and editors-in-chief were assessed. Subgroup analyses were conducted based on the journal's geographical origin, subspecialty and demographic of the editor-in-chief. RESULTS Seventy-six cardiology journals, involving 8915 editorial board members, were included. Only 19.6% of editorial board members were female, 20.8% Asians and 4.0% Asian females. There were less female representation amongst editors-in-chief (9.9%) compared to associate editors (22.3%). European (18.1%) and North American-based journals (21.1%) had higher female representation compared to Asian-based journals (8.7%). There was lower Asian representation in European (18.1%) and North American-based journals (19.9%) compared to Asian-based journals (72.3%). Females were underrepresented in interventional (14.5%) journals, while Asians were underrepresented in general cardiology (18.3%) and heart failure (18.3%) journals. Journals led by female editors-in-chief had significantly higher female representation compared to male-led ones, while journals with Asian editors-in-chief had greater Asian representation compared to non-Asian led ones. CONCLUSION This study highlights the female and Asian ethnic underrepresentation in academic roles in cardiology journal editorial boards. Further analysis is needed for other ethnicities, while the community pushes towards gender-balanced and ethnic diversity across editorial boards.
Collapse
Affiliation(s)
- O Z H Lim
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Y Chen
- Department of Cardiology, First Medical Centre of Chinese People's Liberation Army (PLA) General Hospital, Wanshoulu, 100036 Beijing, China
| | - S Dimmeler
- Institute for Cardiovascular Regeneration, Goethe University, Theodor-Stern-Kai 7 60590 Frankfurt am Main, Germany
| | - A W J Yong
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - H Singh
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - M L E Sim
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - G Kong
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - W H Lim
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - T T Low
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
- Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - D-W Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
| | - N W S Chew
- Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - R Foo
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
- Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Cardiovascular Diseases Translational Research Programme, National University Health Systems, 1E Kent Ridge Rd, Singapore 119228, Singapore
| |
Collapse
|
21
|
Prunster J, Wong G, Larkins N, Wyburn K, Francis R, Mulley WR, Ooi E, Pilmore H, Davies CE, Lim WH. Kidney Donor Profile Index and allograft outcomes: interactive effects of estimated post-transplant survival score and ischaemic time. Clin Kidney J 2022; 16:473-483. [PMID: 36865004 PMCID: PMC9972806 DOI: 10.1093/ckj/sfac243] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background The Kidney Donor Profile Index (KDPI) is routinely reported by the donation agencies in Australia. We determined the association between KDPI and short-term allograft loss and assessed if this association was modified by the estimated post-transplant survival (EPTS) score and total ischaemic time. Methods Using data from the Australia and New Zealand Dialysis and Transplant Registry, the association between KDPI (in quartiles) and 3-year overall allograft loss was examined using adjusted Cox regression analysis. The interactive effects between KDPI, EPTS score and total ischaemic time on allograft loss were assessed. Results Of 4006 deceased donor kidney transplant recipients transplanted between 2010 and 2015, 451 (11%) recipients experienced allograft loss within 3 years post-transplant. Compared with recipients of kidneys with a KDPI of 0-25%, recipients who received donor kidneys with a KDPI >75% experienced a 2-fold increased risk of 3-year allograft loss {adjusted hazard ratio [HR] 2.04 [95% confidence interval (CI) 1.53-2.71]}. The adjusted HRs for kidneys with a KDPI of 26-50% and 51-75% were 1.27 (95% CI 0.94-1.71) and 1.31 (95% CI 0.96-1.77), respectively. There were significant interactions between KDPI and EPTS scores (P-value for interaction <.01) and total ischaemic time (P-value for interaction <.01) such that the associations between higher KDPI quartiles and 3-year allograft loss were strongest in recipients with the lowest EPTS scores and longest total ischaemic time. Conclusion Recipients with higher post-transplant expected survival and transplants with longer total ischaemia who received donor allografts with higher KDPI scores experienced a greater risk of short-term allograft loss compared with those recipients with reduced post-transplant expected survival and with shorter total ischemia.
Collapse
Affiliation(s)
| | - Germaine Wong
- School of Public Health, Faculty of Medicine and Health, Sydney University, Sydney, NSW, Australia,Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia,Department of Renal Medicine and National Pancreas Transplant Unit, Westmead Hospital, Sydney, NSW, Australia
| | - Nicholas Larkins
- Department of Nephrology, Perth Children's Hospital, Perth, WA, Australia,School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
| | - Kate Wyburn
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia,Charles Perkins Centre Kidney Node, University of Sydney, Sydney, NSW, Australia
| | - Ross Francis
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - William R Mulley
- Department of Nephrology, Monash Medical Centre, Melbourne, VIC, Australia,Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Esther Ooi
- Medical School, University of Western Australia, Perth, WA, Australia,School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Helen Pilmore
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand,Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Christopher E Davies
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia,Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia,Internal Medicine, University of Western Australia Medical School, Perth, WA, Australia
| |
Collapse
|
22
|
Chew N, Ng CH, Kong G, Chin YH, Lim O, Lim WH, Dalakoti M, Khoo CM, Kong W, Poh KK, Foo R, Lee CH, Chan MY, Muthiah M, Loh PH. Metabolic associated fatty liver disease increases risk of adverse events after acute coronary syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Abstract
Abstract
Metabolic Associated Fatty Liver Disease (MAFLD) was recently introduced as an alternative definition for fatty liver, that has been linked to an increased risk of systemic end-organ damage. However, current studies have not examined the impact of MAFLD on patients presenting with acute coronary syndrome (ACS). Here, we present a retrospective analysis on the short and long-term outcomes of ACS patients with MAFLD.
Methods
A retrospective analysis was conducted in a tertiary care centre. Hepatic steatosis and fibrosis was examined with hepatic steatosis index and fibrosis-4 (FIB-4) index. The primary and secondary outcomes of the analysis were long term all-cause mortality, and in-hospital all-cause mortality, stroke, heart failure and cardiogenic shock respectively. Adjusted analysis was conducted for primary and secondary outcomes with covariates including age, sex, race, type of ACS and previous myocardial infarction.
Results
A total of 5770 patients were included in the analysis, and 21% of ACS patients had concomitant MAFLD. MAFLD resulted in a 23% increase in long-term all-cause mortality compared to non-MAFLD (HR: 1.230, CI: 1.065 to 1.420, p=0.005). MAFLD increased the risk of in-hospital mortality, stroke, heart failure and cardiogenic shock compared to non-MAFLD. A sensitivity analysis conducted based on MAFLD with advance fibrosis, chronic kidney disease and diabetes also demonstrated significantly increased effect size magnitude of all-cause mortality, compared to non-MAFLD.
Conclusion
MAFLD represents an encapsulation of metabolism dysregulation and has been associated with increased risk of systematic disease. The present study shows that MAFLD is associated with significantly increased adverse prognostic outcomes after ACS compared to non-MAFLD. An increase in awareness of MAFLD is required beyond the field of hepatology for improvements in multidisciplinary care and management.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- N Chew
- National University Heart Centre , Singapore , Singapore
| | - C H Ng
- National University Health System , Singapore , Singapore
| | - G Kong
- National University Health System , Singapore , Singapore
| | - Y H Chin
- National University Health System , Singapore , Singapore
| | - O Lim
- National University of Singapore , Singapore , Singapore
| | - W H Lim
- National University of Singapore , Singapore , Singapore
| | - M Dalakoti
- National University of Singapore , Singapore , Singapore
| | - C M Khoo
- National University Health System , Singapore , Singapore
| | - W Kong
- National University Heart Centre , Singapore , Singapore
| | - K K Poh
- National University Heart Centre , Singapore , Singapore
| | - R Foo
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
| | - M Muthiah
- National University Health System , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| |
Collapse
|
23
|
Chew NWS, Ng CH, Kong G, Tan D, Lim WH, Kofidis T, Yip J, Loh PH, Chan KH, Low A, Lee CH, Yeo TC, Tan HC, Chan MY. Reconstructed meta-analysis of percutaneous coronary intervention versus coronary artery bypass grafting for left main disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/12/2022] Open
Abstract
Abstract
Background
Randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) with drug-eluting stents and coronary artery bypass grafting (CABG) for patients with left main coronary artery disease (LMCAD) have reported conflicting results.
Objectives
We performed a systematic review from inception to 23 May 2021 and one-stage reconstructed individual-patient data meta-analysis (IPDMA) that included 10-year mortality outcomes.
Methods
The primary outcome was 10-year all-cause mortality. Secondary outcomes included myocardial infarction (MI), stroke and unplanned revascularization at 5 years. We did IPDMA using published Kaplan-Meier curves to provide individual data points in coordinates and numbers at risk were used to increase the calibration accuracy of the reconstructed data. Shared frailty model or, when proportionality assumptions were not met, a restricted mean survival time model were fitted to compare outcomes between treatment groups.
Results
Of 583 articles retrieved, 5 RCTs were included. A total of 4595 patients from these 5 RCTs were randomly assigned to PCI (N=2297) or CABG (N=2298). The cumulative 10-year all-cause mortality after PCI and CABG was 12.0% versus 10.6% respectively (HR 1.093, 95% CI: 0.925–1.292; p=0.296). PCI conferred similar time-to-MI (RMST ratio 1.006, 95% CI: 0.992–1.021, p=0.391) and stroke (RMST ratio 1.005, 95% CI: 0.998–1.013, p=0.133) at 5 years. Unplanned revascularization was more frequent following PCI compared with CABG (HR 1.807, 95% CI: 1.524–2.144, p<0.001) at 5 years.
Conclusion
This meta-analysis using reconstructed participant-level time-to-event data showed no statistically significant difference in cumulative 10-year all-cause mortality between PCI versus CABG in the treatment of LMCAD.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- N W S Chew
- National University Heart Centre , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - D Tan
- National University of Singapore , Singapore , Singapore
| | - W H Lim
- National University of Singapore , Singapore , Singapore
| | - T Kofidis
- National University Heart Centre , Singapore , Singapore
| | - J Yip
- National University Heart Centre , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| | - K H Chan
- National University Heart Centre , Singapore , Singapore
| | - A Low
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre , Singapore , Singapore
| | - H C Tan
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
| |
Collapse
|
24
|
Sim M, Strydom A, Blekkenhorst LC, Bondonno NP, McCormick R, Lim WH, Zhu K, Byrnes E, Hodgson JM, Lewis JR, Prince RL. Dietary Vitamin K1 intake is associated with lower long-term fracture-related hospitalization risk: the Perth longitudinal study of ageing women. Food Funct 2022; 13:10642-10650. [PMID: 36169025 DOI: 10.1039/d2fo02494b] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This study examined the association between dietary Vitamin K1 intake with fracture-related hospitalizations over 14.5 years in community-dwelling older Australian women (n = 1373, ≥70 years). Dietary Vitamin K1 intake at baseline (1998) was estimated using a validated food frequency questionnaire and a new Australian Vitamin K nutrient database, which was supplemented with published data. Over 14.5 years, any fracture (n = 404, 28.3%) and hip fracture (n = 153, 10.7%) related hospitalizations were captured using linked health data. Plasma Vitamin D status (25OHD) and the ratio of undercarboxylated osteocalcin (ucOC) to total osteocalcin (tOC) from serum was assessed at baseline. Estimates of dietary Vitamin K1 intake were supported by a significant inverse association with ucOC : tOC; a marker of Vitamin K status (r = -0.12, p < 0.001). Compared to women with the lowest Vitamin K1 intake (Quartile 1, <61 μg d-1), women with the highest Vitamin K1 intake (Quartile 4, ≥99 μg d-1) had lower hazards for any fracture- (HR 0.69 95%CI 0.52-0.91, p < 0.001) and hip fracture-related hospitalization (HR 0.51 95%CI 0.32-0.79, p < 0.001), independent of 25OHD levels, as part of multivariable-adjusted analysis. Spline analysis suggested a nadir in the relative hazard for any fracture-related hospitalizations at a Vitamin K1 intake of approximately 100 μg day-1. For hip fractures, a similar relationship was apparent. Higher dietary Vitamin K1 is associated with lower long-term risk for any fracture- and hip fracture-related hospitalizations in community-dwelling older women.
Collapse
Affiliation(s)
- Marc Sim
- Nutrition & Health Innovation Research Institute, School of Health and Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia. .,Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia
| | - Andre Strydom
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Lauren C Blekkenhorst
- Nutrition & Health Innovation Research Institute, School of Health and Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia. .,Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia
| | - Nicola P Bondonno
- Nutrition & Health Innovation Research Institute, School of Health and Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia. .,Danish Cancer Society, Copenhagen, Denmark
| | - Rachel McCormick
- Nutrition & Health Innovation Research Institute, School of Health and Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia.
| | - Wai H Lim
- Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Kun Zhu
- Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Elizabeth Byrnes
- Department of Clinical Biochemistry, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Australia
| | - Jonathan M Hodgson
- Nutrition & Health Innovation Research Institute, School of Health and Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia. .,Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia
| | - Joshua R Lewis
- Nutrition & Health Innovation Research Institute, School of Health and Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia. .,Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard L Prince
- Nutrition & Health Innovation Research Institute, School of Health and Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia. .,Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Curtin University, School of Public Health, Perth, Western Australia, Australia
| |
Collapse
|
25
|
Porter T, Sim M, Prince RL, Schousboe JT, Bondonno C, Lim WH, Zhu K, Kiel DP, Hodgson JM, Laws SM, Lewis JR. Abdominal aortic calcification on lateral spine images captured during bone density testing and late-life dementia risk in older women: A prospective cohort study. Lancet Reg Health West Pac 2022; 26:100502. [PMID: 36213133 PMCID: PMC9535408 DOI: 10.1016/j.lanwpc.2022.100502] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Dementia after the age of 80 years (late-life) is increasingly common due to vascular and non-vascular risk factors. Identifying individuals at higher risk of late-life dementia remains a global priority. METHODS In prospective study of 958 ambulant community-dwelling older women (≥70 years), lateral spine images (LSI) captured in 1998 (baseline) from a bone density machine were used to assess abdominal aortic calcification (AAC). AAC was classified into established categories (low, moderate and extensive). Cardiovascular risk factors and apolipoprotein E (APOE) genotyping were evaluated. Incident 14.5-year late-life dementia was identified from linked hospital and mortality records. FINDINGS At baseline women were 75.0 ± 2.6 years, 44.7% had low AAC, 36.4% had moderate AAC and 18.9% had extensive AAC. Over 14.5- years, 150 (15.7%) women had a late-life dementia hospitalisation (n = 132) and/or death (n = 58). Compared to those with low AAC, women with moderate and extensive AAC were more likely to suffer late-life dementia hospitalisations (9.3%, 15.5%, 18.3%, respectively) and deaths (2.8%, 8.3%, 9.4%, respectively). After adjustment for cardiovascular risk factors and APOE, women with moderate and extensive AAC had twice the relative hazards of late-life dementia (moderate, aHR 2.03 95%CI 1.38-2.97; extensive, aHR 2.10 95%CI 1.33-3.32), compared to women with low AAC. INTERPRETATION In community-dwelling older women, those with more advanced AAC had higher risk of late-life dementia, independent of cardiovascular risk factors and APOE genotype. Given the widespread use of bone density testing, simultaneously capturing AAC information may be a novel, non-invasive, scalable approach to identify older women at risk of late-life dementia. FUNDING Kidney Health Australia, Healthway Health Promotion Foundation of Western Australia, Sir Charles Gairdner Hospital Research Advisory Committee Grant, National Health and Medical Research Council of Australia.
Collapse
Key Words
- AAC, abdominal aortic calcification
- AAC24, abdominal aortic calcification 24 scale scores
- AD, Alzheimer's disease
- APOE, apolipoprotein E
- ASVD, atherosclerotic vascular disease
- AUC, area under the curve
- Aging
- CAC, coronary artery calcification
- CVD, cardiovascular disease
- DXA, dual-energy X-ray absorptiometry
- Dementia
- Epidemiology
- FRS, Framingham General Cardiovascular Risk Scores
- IDI, integrated discrimination improvement
- Imaging
- LSI, lateral spine imaging
- NRI, net reclassification improvement
- ROC, receiver operator characteristics
- Vascular disease
Collapse
Affiliation(s)
- Tenielle Porter
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia
- Collaborative Genomics and Translation Group, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
| | - Marc Sim
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
| | - Richard L. Prince
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
| | - John T. Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners, Minneapolis, MN, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Catherine Bondonno
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
| | - Wai H. Lim
- Medical School, University of Western Australia, Crawley, WA, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Kun Zhu
- Medical School, University of Western Australia, Crawley, WA, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Douglas P. Kiel
- Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine Beth, Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Jonathan M. Hodgson
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
| | - Simon M. Laws
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia
- Collaborative Genomics and Translation Group, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
| | - Joshua R. Lewis
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, the University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
26
|
Lim WH, Ho J, Kosmoliaptsis V, Sapir-Pichhadze R. Editorial: Future challenges and directions in determining allo-immunity in kidney transplantation. Front Immunol 2022; 13:1013711. [PMID: 36119031 PMCID: PMC9473680 DOI: 10.3389/fimmu.2022.1013711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Wai H. Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
- *Correspondence: Wai H. Lim,
| | - Julie Ho
- Department of Internal Medicine University of Manitoba, Winnipeg, MB, Canada
- Department of Immunology, University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba Adult Kidney Program, Transplant Manitoba, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Vasilis Kosmoliaptsis
- Department of Surgery, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge, United Kingdom
- Blood and Transplant Research Unit in Organ Donation and Transplantation, National Institute for Health Research, University of Cambridge, Cambridge, United Kingdom
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Division of Nephrology and Multi-Organ Transplant Program, Department of Medicine, McGill University, Montreal, QC, Canada
| |
Collapse
|
27
|
Gebre AK, Lewis JR, Leow K, Szulc P, Scott D, Ebeling PR, Sim M, Wong G, Lim WH, Schousboe JT, Kiel DP, Prince RL, Rodríguez AJ. Abdominal aortic calcification, bone mineral density and fractures: a systematic review and meta-analysis of observational studies. J Gerontol A Biol Sci Med Sci 2022:6674525. [PMID: 36000920 DOI: 10.1093/gerona/glac171] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Abdominal aortic calcification (AAC) has been inconsistently associated with skeletal health. We aimed to investigate the association of AAC with bone mineral density (BMD) and fracture risk by pooling the findings of observational studies. METHODS Medline, EMBASE, Web of Science and Google Scholar were searched (August 2021). All clinical studies that assessed the association between AAC and BMD or fracture were included. AAC was categorized into any/advanced (all higher reported groups) vs no/less advanced (lowest reported group). Pooled standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (CI) were determined for BMD and fracture, respectively, using random-effects models. RESULTS Of 2,192 articles screened, 86 (61,553 participants) were included in the review, while 42 provided data for meta-analysis. AAC was associated with lower BMD at the total hip [SMD=-1.05 (95%CI: -1.47 to -0.63); 16 studies], femoral neck [-0.25 (-0.46 to - 0.04); 10] and lumbar spine [-0.67 (-1.21 to -0.12); 20]. AAC was associated with a greater risk of any fracture [RR= 1.73 (95%CI: 1.48 to 2.02); 27]. AAC was also associated with vertebral, non-vertebral and hip fractures. In dose-response analysis, the highest AAC group had greater risks of any, vertebral and non-vertebral fractures. CONCLUSIONS AAC is associated with lower BMD and increased fracture risk at multiple sites, underscoring the potential importance of vascular disease on skeletal health. Detection of AAC at the time of BMD testing may provide clinicians with prognostic information about bone health to enhance osteoporosis screening programs and fracture risk prediction.
Collapse
Affiliation(s)
- Abadi K Gebre
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray
| | - Joshua R Lewis
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Medical School, University of Western Australia, Perth, Australia.,Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Kevin Leow
- Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Pawel Szulc
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, Lyon, France
| | - David Scott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.,Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Peter R Ebeling
- Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Marc Sim
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Medical School, University of Western Australia, Perth, Australia
| | - Germaine Wong
- Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Wai H Lim
- Medical School, University of Western Australia, Perth, Australia.,Department of Renal Medicine, Sir Charles Gairdner Hospital, Western Australia, Australia
| | - John T Schousboe
- Park Nicollet Osteoporosis Center and HealthPartners Institute, HealthPartners, Minneapolis, MN 55416, USA, and Division of Health Policy and Management, University of Minnesota, Minneapolis, MN 55455, USA
| | - Douglas P Kiel
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard L Prince
- Medical School, University of Western Australia, Perth, Australia
| | - Alexander J Rodríguez
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| |
Collapse
|
28
|
Gebre AK, Prince RL, Schousboe JT, Kiel DP, Thompson PL, Zhu K, Lim WH, Sim M, Lewis JR. Calcaneal quantitative ultrasound is associated with all-cause and cardiovascular disease mortality independent of hip bone mineral density. Osteoporos Int 2022; 33:1557-1567. [PMID: 35147712 PMCID: PMC9187548 DOI: 10.1007/s00198-022-06317-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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 01/20/2022] [Indexed: 11/26/2022]
Abstract
UNLABELLED Osteoporosis has been linked with increased risk of cardiovascular disease previously. However, few studies have detailed bone and vascular information. In a prospective study of older women, we demonstrated heel quantitative ultrasound measures were associated with increased cardiovascular and all-cause mortality, independent of established cardiovascular risk factors. INTRODUCTION Osteoporosis and low bone mineral density (BMD) have been previously linked to cardiovascular disease (CVD) and mortality. Calcaneal quantitative ultrasound (QUS) is used to evaluate bone material properties, especially in older women. However, it is uncertain whether it is related to risk of mortality. This study was aimed to investigate the association between calcaneal QUS measurements and 15-year all-cause and CVD mortality in 1404 older women (mean age 75.2 ± 2.7 years). METHODS One thousand four hundred four older women, participants of Calcium Intake Fracture Outcome study (CAIFOS), had calcaneal bone measured at baseline (1998) and followed for 15 years. The primary outcomes, any deaths, and deaths attributable to cardiovascular causes ascertained by using linked data were obtained from Western Australia data linkage system. RESULTS Over the 15 years of follow-up (17,955 person years), 584 of the women died, and 223 from CVD. For every standard deviation (SD), reduction in broadband ultrasound attenuation (BUA) in minimally and multivariable-adjusted model including cardiovascular risk factors increased relative hazards for all-cause (multivariable-adjusted HR 1.15; 95%CI: 1.06-1.26, p = 0.001) and CVD mortality (multivariable-adjusted HR 1.20; 95%CI: 1.04-1.38, p = 0.010). Such relationships also persisted when hip BMD was included in the model (all-cause mortality HR 1.19; 95%CI: 1.07-1.33, p = 0.002; CVD mortality HR 1.28; 95%CI: 1.07-1.53, p = 0.008). CONCLUSION BUA is associated with all-cause and CVD mortality in older women independent of BMD and established CVD risk factors. Understanding why and how these are related may provide further insights about the bone-vascular nexus as well as therapeutic targets benefiting both systems.
Collapse
Affiliation(s)
- A K Gebre
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, 6027, Australia
- School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - R L Prince
- Medical School, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - J T Schousboe
- Park Nicollet Osteoporosis Center and HealthPartners Institute, HealthPartners, Minneapolis, MN, 55416, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, 55455, USA
| | - D P Kiel
- Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - P L Thompson
- Medical School, The University of Western Australia, Perth, Australia
- Department of Cardiology, Sir Charles Gairdner Hospital, Perth, Australia
| | - K Zhu
- Medical School, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - W H Lim
- Medical School, The University of Western Australia, Perth, Australia
- Renal Department, Sir Charles Gairdner Hospital, Perth, Australia
| | - M Sim
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, 6027, Australia
- Medical School, The University of Western Australia, Perth, Australia
| | - J R Lewis
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, 6027, Australia.
- Medical School, The University of Western Australia, Perth, Australia.
- Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
| |
Collapse
|
29
|
Lim WH, Dominguez-Gil B. Ethical Issues Related to Donation and Transplantation of Donation After Circulatory Determination of Death Donors. Semin Nephrol 2022; 42:151269. [PMID: 36577644 DOI: 10.1016/j.semnephrol.2022.07.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
With the continuing disparity between organ supply to match the increasing demand for kidney transplants in patients with renal failure, donation after the circulatory determination of death (DCDD) has become an important and increasing global source of kidneys for clinical use. The concern that the outcomes of controlled DCDD donor kidney transplants were inferior to those obtained from donors declared dead by neurologic criteria has largely diminished because large-scale registry and single-center reports consistently have reported favorable outcomes. For uncontrolled DCDD kidney transplants, outcomes are correspondingly acceptable, although there is a greater risk of primary nonfunction. The potential of DCDD remains unrealized in many countries because of the ethical concerns and resource implications in the utilization of these donor kidneys for transplantation. In this review, we discuss the origin and definitions of DCDD donors, and examine the long-term outcomes of transplants from DCDD donor kidneys. We discuss the controversies, challenges, and ethical and legal barriers in the acceptance of DCDD, including the complexities of implementing and sustaining controlled and uncontrolled DCDD donor programs. The lessons learned from global leaders will assist a wider international recognition, acceptance, and development of DCDD transplant programs that will noticeably facilitate and address the global shortages of kidneys for transplantation, and ensure the opportunity for people who had indicated their desires to become organ donors fulfill their final wishes.
Collapse
Affiliation(s)
- Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia; Internal Medicine, University of Western Australia Medical School, Perth, Australia.
| | | |
Collapse
|
30
|
Larkins NG, D’Orsogna L, Taverniti A, Sharma A, Chakera A, Chan D, Krishnan A, Wong G, Lim WH. The Accuracy of Sequence-Specific Oligonucleotide and Real-Time Polymerase Chain Reaction HLA Typing in Determining the Presence of Pre-Transplant Donor-Specific Anti-HLA Antibodies and Total Eplet Mismatches for Deceased Donor Kidney Transplantation. Front Immunol 2022; 13:844438. [PMID: 35799779 PMCID: PMC9253866 DOI: 10.3389/fimmu.2022.844438] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
High resolution human leukocyte antigen (HLA) typing is important in establishing eplet compatibility and the specificity of donor-specific anti-HLA antibodies (DSA). In deceased donor kidney transplantation, high resolution donor HLA typing may not be immediately available, leading to inaccuracies during the organ allocation process. We aimed to determine the concordance and agreement of HLA-Class I and II eplet mismatches calculated using population frequency based allelic haplotype association (linkage disequilibrium, LD) from sequence-specific oligonucleotide (SSO) and real-time polymerase chain reaction (rtPCR) donor HLA typing (available at time of donor kidney allocation) compared to high-resolution Next Generation Sequencing (NGS) donor typing. NGS high resolution HLA typing were available for all recipients prior to donor kidney allocation. A cohort of 94 deceased donor-recipient pairs from a single Western Australian center were included (77 individual donors typed, 55 local and 22 interstate). The number of class I (HLA-A+B+C) and class II (HLA-DRB1+DRB3/4/5+DQB1+DQA1+DPB1+DPA1) eplet mismatches were calculated using HLAMatchmaker, comparing LD- and NGS-HLA typing. The accuracy in assigning pre-transplant DSA was compared between methods. The concordance correlation coefficient (95%CI) for HLA-class I and II eplet mismatches were 0.994 (0.992 to 0.996) and 0.991 (0.986 to 0.993), respectively. The 95% limits of agreement for class I were -1.3 (-1.6 to -1.1) to 1.4 (1.2 to 1.7) and -4.8 (-5.7 to -3.9) to 5.0 (4.1 to 5.9) for Class II. Disagreement between the two methods were present for 11 and 37 of the Class I and II donor/recipient pairs. Of which, 5 had a difference of ≥5 class II eplet mismatches. There were 34 (36%) recipients with potential pre-transplant DSA, of which 8 (24% of recipients with DSA) had indeterminate and ultimately false positive DSA assigned by donor LD-typing. While the concordance between NGS- and LD-typing was high, the limits of agreement suggest meaningful differences between these two techniques. The inaccurate assignment of DSA from donor LD-typing may result in associated HLA being considered unacceptable mismatches, inappropriately precluding candidates’ access to transplantation. Accurate imputation of two-field HLA alleles based on LD from SSO and rtPCR HLA typing remains a substantial challenge in clinical practice in-lieu of widely available, rapid, high-resolution methods.
Collapse
Affiliation(s)
- Nicholas G. Larkins
- Department of Nephrology, Perth Children’s Hospital, Perth, WA, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
- *Correspondence: Nicholas G. Larkins,
| | - Lloyd D’Orsogna
- Department of Clinical Immunology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Anne Taverniti
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Ankit Sharma
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, NSW, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Department of Renal Medicine and National Pancreas Transplant Unit, Westmead Hospital, Sydney, NSW, Australia
| | - Aron Chakera
- Department of Renal Medicine, Sir Charles Gardiner Hospital, Perth, WA, Australia
| | - Doris Chan
- Department of Renal Medicine, Sir Charles Gardiner Hospital, Perth, WA, Australia
| | - Anoushka Krishnan
- Department of Renal Medicine, Royal Perth Hospital, Perth, WA, Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, NSW, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Department of Renal Medicine and National Pancreas Transplant Unit, Westmead Hospital, Sydney, NSW, Australia
| | - Wai H. Lim
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Renal Medicine, Sir Charles Gardiner Hospital, Perth, WA, Australia
| |
Collapse
|
31
|
Lim WH, Ooi E, Pankaj A, Teixeira-Pinto A, Lin Y, Johnson DW, Hawley CM, Viecelli AK, Pilmore H, Roberts MA, Davies CE, Krishnan A, Wong G. The incidence of cancer recurrence and new cancer following commencement of dialysis in patients with prior cancers. Clin Kidney J 2022; 15:1770-1781. [PMID: 36003660 PMCID: PMC9394713 DOI: 10.1093/ckj/sfac124] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background Patients with kidney failure have a higher cancer risk compared with the age-matched general population. However, the outcomes of incident dialysis patients with a prior cancer history are unknown. Methods Using Australia and New Zealand Dialysis and Transplant Registry data (2000–2019), the outcomes and survival probabilities of incident dialysis patients with prior cancers and having experienced a cancer recurrence or having developed a new cancer after dialysis commencement were described. Results Of 4912 patients with prior cancers before dialysis commencement, 323 (7%) and 343 (7%) patients experienced cancer recurrence or developed new cancers after dialysis initiation, respectively. The median time from dialysis commencement to cancer recurrence was 1.2 years [interquartile range (IQR) 0.5–2.8] and was 2.0 years (IQR 0.7–4.0) for new cancer occurrence. Of those with cancer recurrence, 80% presented with metastatic disease and one in two patients died from cancer, with a median time from cancer recurrence to death of 0.5 years (IQR 0.2–1.7). Of those who developed new cancer, urinary tract and respiratory cancers were the most frequent cancer types, with a median time from new cancer diagnosis to death of 1.3 years (IQR 0.4–3.1). The 3-year survival probabilities on dialysis following cancer recurrence and new cancer were 19% [95% confidence interval (CI) 15–24] and 41% (35–47), respectively. Conclusion Among incident dialysis patients with a prior cancer history, 14% experienced cancer recurrence or developed a new cancer. Patients who experienced cancer recurrence or developed new cancer have poor outcomes, with ˂50% surviving beyond 3 years. These findings suggest the need to have a greater understanding of the characteristics, cancer screening, treatment responses and reasons for commencing dialysis in patients with kidney failure and prior cancer history, which may help in the shared clinical decision-making process when considering dialysis for these patients.
Collapse
Affiliation(s)
- Wai H Lim
- Medical School, University of Western Australia , Perth , Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital , Perth , Australia
| | - Esther Ooi
- Medical School, University of Western Australia , Perth , Australia
- School of Biomedical Sciences, University of Western Australia , Perth , Australia
| | - Aashi Pankaj
- School of Biomedical Sciences, University of Western Australia , Perth , Australia
| | - Armando Teixeira-Pinto
- School of Public Health, Faculty of Medicine and Health, Sydney University , Sydney, Australia
| | - Yingxin Lin
- School of Public Health, Faculty of Medicine and Health, Sydney University , Sydney, Australia
- Faculty of Science, School of Mathematics and Science, University of Sydney , Sydney, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital , Queensland , Australia
- Australasian Kidney Trials Network, University of Queensland , Queensland , Australia
- Translational Research Institute , Brisbane , Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital , Queensland , Australia
- Australasian Kidney Trials Network, University of Queensland , Queensland , Australia
- Translational Research Institute , Brisbane , Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital , Queensland , Australia
- Australasian Kidney Trials Network, University of Queensland , Queensland , Australia
| | - Helen Pilmore
- Department of Renal Medicine, Auckland City Hospital , Auckland , New Zealand
- Department of Medicine, Auckland University , Auckland , New Zealand
| | - Matthew A Roberts
- Eastern Health Clinical School, Monash University , Victoria , Australia
| | - Christopher E Davies
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute , Adelaide, Australia
- Adelaide Medical School, University of Adelaide , Adelaide, Australia
| | - Anoushka Krishnan
- Department of Renal Medicine, Royal Perth Hospital , Perth , Australia
| | - Germaine Wong
- School of Public Health, Faculty of Medicine and Health, Sydney University , Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead , Sydney, Australia
- Department of Renal Medicine and National Pancreas Transplant Unit, Westmead Hospital , Sydney, Australia
| |
Collapse
|
32
|
Krishnan A, Wong G, Teixeira-Pinto A, Lim WH. Incidence and Outcomes of Early Cancers After Kidney Transplantation. Transpl Int 2022; 35:10024. [PMID: 35592449 PMCID: PMC9110645 DOI: 10.3389/ti.2022.10024] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 04/05/2022] [Indexed: 11/13/2022]
Abstract
Outcomes of early cancers after kidney transplantation are not well-understood. We included recipients of first live and deceased donor kidney transplants who developed de novo cancers in Australia and New Zealand between 1980–2016. We compared the frequency and stage of specific cancer types that developed early (≤12-months) and late (>12-months) post-transplantation. Risk factors for death were evaluated using multivariable Cox regression analyses. Of 2,759 recipients who developed de novo cancer, followed-up for 40,035 person-years, 243 (8.8%) patients were diagnosed with early cancer. Post-transplant lymphoproliferative disease, urinary cancers and melanoma were the most common cancer types (26%, 18%, and 12%) and the majority were either in-situ or locally invasive lesions (55%, 84%, and 86%). Tumors arising early from the gastrointestinal and respiratory systems were uncommon but aggressive, with 40% presenting with metastatic disease at time of diagnosis. Overall, 32% of patients with early cancers died within a median of 4.7 months (IQR:0.6–16) post-diagnosis and 91% were cancer-related deaths. Older recipient and donor age were associated with an increased risk of all-cause death. Early cancers, though infrequent in kidney transplant recipients, are associated with poor outcomes, as nearly 1 in 3 died from cancer-related death; with majority of deaths occurring within 12-months of cancer diagnosis.
Collapse
Affiliation(s)
- A Krishnan
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - G Wong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - A Teixeira-Pinto
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - W H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Medicine, University of Western Australia, Perth, WA, Australia
| |
Collapse
|
33
|
Wong G, Lim WH, Hughes JT. Breaking Down the Silence: Call for Action to Address Access Disparities to Transplantation in Indigenous Māori Peoples With Kidney Failure. American Journal of Kidney Diseases 2022; 80:4-6. [DOI: 10.1053/j.ajkd.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 02/24/2022] [Indexed: 11/11/2022]
|
34
|
Chen JHC, Lim WH, Howson P. Changing landscape of dialysis withdrawal in patients with kidney failure: Implications for clinical practice. Nephrology (Carlton) 2022; 27:551-565. [PMID: 35201646 PMCID: PMC9315017 DOI: 10.1111/nep.14032] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/09/2022] [Accepted: 02/19/2022] [Indexed: 11/29/2022]
Abstract
Dialysis withdrawal has become an accepted treatment option for patients with kidney failure and is one of the leading causes of death in patients receiving dialysis in high-income countries. Despite its increasing acceptance, dialysis withdrawal currently lacks a clear, consistent definition. The processes and outcomes of dialysis withdrawal have wide temporal and geographical variability, attributed to dialysis patient selection, influence from cultural, religious and spiritual beliefs, and availability of kidney replacement therapy and conservative kidney management. As a complex, evolving process, dialysis withdrawal poses an enormous challenge for clinicians and healthcare teams with various limitations precluding a peaceful and smooth transition between active dialysis and end-of-life care. In this review, we examine the current definitions of dialysis withdrawal, the temporal and geographical patterns of dialysis withdrawal, international barriers in the decision-making process (including dialysis withdrawal during the COVID-19 pandemic), and gaps in the current dialysis withdrawal recommendations for clinical consideration and future studies.
Collapse
Affiliation(s)
- Jenny H C Chen
- Faculty of Medicine, University of Wollongong, Wollongong, Australia.,Wollongong Hospital, Wollongong, Australia
| | - Wai H Lim
- Department of Nephrology, Sir Charles Gairdner Hospital, Perth, Australia.,Faculty of Medicine, University of Western Australia, Perth, Australia
| | - Prue Howson
- Department of Nephrology, Sir Charles Gairdner Hospital, Perth, Australia
| |
Collapse
|
35
|
Chen JHC, Brown MA, Jose M, Brennan F, Johnson DW, Roberts MA, Wong G, Hassan HC, Kennard A, Walker R, Davies CE, Boudville N, Borlace M, Hawley C, Lim WH. Erratum to: Temporal changes and risk factors for death from early withdrawal within 12 months of dialysis initiation-a cohort study. Nephrol Dial Transplant 2022; 37:1000. [PMID: 35137911 PMCID: PMC9035349 DOI: 10.1093/ndt/gfab282] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Jenny H C Chen
- School of Medicine, University of Wollongong, Wollongong, Australia.,Depatment of Renal Medicine, Wollongong Hospital, Wollongong, Australia
| | - Mark A Brown
- Department of Nephrology, St George Hospital, Sydney, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
| | - Matthew Jose
- School of Medicine, The University of Tasmania, Hobart, Australia.,Department of Nephrology, Royal Hobart Hospital, Hobart, Australia
| | - Frank Brennan
- Department of Nephrology, St George Hospital, Sydney, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Centre for Health Services Research, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Australasian Kidney Trials Network, Brisbane, Australia
| | - Matthew A Roberts
- School of Medicine, Monash University, Melbourne, Australia.,Renal Service, Eastern Health, Melbourne, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia
| | - Hicham Cheikh Hassan
- School of Medicine, University of Wollongong, Wollongong, Australia.,Depatment of Renal Medicine, Wollongong Hospital, Wollongong, Australia
| | - Alice Kennard
- School of Medicine, Australian National University, Canberra, Australia.,Department of Nephrology, Canberra Hospital, Canberra, Australia
| | - Rachael Walker
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,School of Nursing, Eastern Institute of Technology, Napier, New Zealand
| | - Christopher E Davies
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Neil Boudville
- Medical School, University of Western Australia, Perth, Australia.,Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Monique Borlace
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Carmel Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Centre for Health Services Research, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Australasian Kidney Trials Network, Brisbane, Australia
| | - Wai H Lim
- Medical School, University of Western Australia, Perth, Australia.,Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| |
Collapse
|
36
|
Lim WH, Ooi E, Pilmore HL, Johnson DW, McDonald SP, Clayton P, Hawley C, Mulley WR, Francis R, Collins MG, Jaques B, Larkins NG, Davies CE, Wyburn K, Chadban SJ, Wong G. Interactions Between Donor Age and 12-Month Estimated Glomerular Filtration Rate on Allograft and Patient Outcomes After Kidney Transplantation. Transpl Int 2022; 35:10199. [PMID: 35185379 PMCID: PMC8842263 DOI: 10.3389/ti.2022.10199] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/12/2022] [Indexed: 11/25/2022]
Abstract
Reduced estimated glomerular filtration rate (eGFR) at 12-months after kidney transplantation is associated with increased risk of allograft loss, but it is uncertain whether donor age and types modify this relationship. Using Australia and New Zealand registry data, multivariable Cox proportional modelling was used to examine the interactive effects between donor age, types and 12-month eGFR on overall allograft loss. We included 11,095 recipients (4,423 received live-donors). Recipients with lowest 12-month eGFR (<30 ml/min/1.73 m2) experienced the greatest risk of allograft loss, with adjusted HR [95% CI) of 2.65 [2.38–2.95] compared to eGFR of 30–60 ml/min/1.73 m2; whereas the adjusted HR for highest eGFR (>60 ml/min/1.73 m2) was 0.67 [0.62–0.74]. The association of 12-month eGFR and allograft loss was modified by donor age (but not donor types) where a higher risk of allograft loss in recipients with lower compared with higher 12-month eGFR being most pronounced in the younger donor age groups (p < 0.01). Recipients with eGFR <30 ml/min/1.73 m2 12-months after transplantation experienced ≥2.5-fold increased risk of overall allograft loss compared to those with eGFR of >60 ml/min/1.73 m2, and the magnitude of the increased risk is most marked among recipients with younger donors. Careful deliberation of other factors including donor age when considering eGFR as a surrogate for clinical endpoints is warranted.
Collapse
Affiliation(s)
- Wai H. Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
- *Correspondence: Wai H. Lim,
| | - Esther Ooi
- Medical School, University of Western Australia, Perth, WA, Australia
- School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Helen L. Pilmore
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - David W. Johnson
- Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - Stephen P. McDonald
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
- Central and Northern Adelaide Renal and Transplantation Services, Adelaide, SA, Australia
- South Australia Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Philip Clayton
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
- Central and Northern Adelaide Renal and Transplantation Services, Adelaide, SA, Australia
- South Australia Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Carmel Hawley
- Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - William R. Mulley
- Department of Nephrology, Monash Medical Centre, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Ross Francis
- Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia
| | - Michael G. Collins
- School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Bryon Jaques
- Western Australia Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Nicholas G. Larkins
- Medical School, University of Western Australia, Perth, WA, Australia
- Department of Nephrology, Perth Children’s Hospital, Perth, WA, Australia
| | - Christopher E. Davies
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
- South Australia Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Kate Wyburn
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Steve J. Chadban
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Germaine Wong
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, NSW, Australia
- Department of Renal Medicine and National Pancreas Transplant Unit, Westmead Hospital, Sydney, NSW, Australia
| |
Collapse
|
37
|
Lim WH, Adams B, Alexander S, Bouts AHM, Claas F, Collins M, Cornelissen E, Dunckley H, de Jong H, D’Orsogna L, Francis A, Heidt S, Herman J, Holdsworth R, Kausman J, Khalid R, Kim JJ, Kim S, Knops N, Kosmoliaptsis V, Kramer C, Kuypers D, Larkins N, Palmer SC, Prestidge C, Prytula A, Sharma A, Shingde M, Taverniti A, Teixeira-Pinto A, Trnka P, Willis F, Wong D, Wong G. Improve in-depth immunological risk assessment to optimize genetic-compatibility and clinical outcomes in child and adolescent recipients of parental donor kidney transplants: protocol for the INCEPTION study. BMC Nephrol 2021; 22:416. [PMID: 34923958 PMCID: PMC8684542 DOI: 10.1186/s12882-021-02619-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Parental donor kidney transplantation is the most common treatment option for children and adolescents with kidney failure. Emerging data from observational studies have reported improved short- and medium-term allograft outcomes in recipients of paternal compared to maternal donors. The INCEPTION study aims to identify potential differences in immunological compatibility between maternal and paternal donor kidneys and ascertain how this affects kidney allograft outcomes in children and adolescents with kidney failure.
Methods
This longitudinal observational study will recruit kidney transplant recipients aged ≤18 years who have received a parental donor kidney transplant across 4 countries (Australia, New Zealand, United Kingdom and the Netherlands) between 1990 and 2020. High resolution human leukocyte antigen (HLA) typing of both recipients and corresponding parental donors will be undertaken, to provide an in-depth assessment of immunological compatibility. The primary outcome is a composite of de novo donor-specific anti-HLA antibody (DSA), biopsy-proven acute rejection or allograft loss up to 60-months post-transplantation. Secondary outcomes are de novo DSA, biopsy-proven acute rejection, acute or chronic antibody mediated rejection or Chronic Allograft Damage Index (CADI) score of > 1 on allograft biopsy post-transplant, allograft function, proteinuria and allograft loss. Using principal component analysis and Cox proportional hazards regression modelling, we will determine the associations between defined sets of immunological and clinical parameters that may identify risk stratification for the primary and secondary outcome measures among young people accepting a parental donor kidney for transplantation. This study design will allow us to specifically investigate the relative importance of accepting a maternal compared to paternal donor, for families deciding on the best option for donation.
Discussion
The INCEPTION study findings will explore potentially differential immunological risks of maternal and paternal donor kidneys for transplantation among children and adolescents. Our study will provide the evidence base underpinning the selection of parental donor in order to achieve the best projected long-term kidney transplant and overall health outcomes for children and adolescents, a recognized vulnerable population.
Trial registration
The INCEPTION study has been registered with the Australian New Zealand Clinical Trials Registry, with the trial registration number of ACTRN12620000911998 (14th September 2020).
Collapse
|
38
|
Sim M, Dalla Via J, Scott D, Lim WH, Hodgson JM, Zhu K, Daly RM, Duque G, Prince RL, Lewis JR. Creatinine to cystatin C ratio, a biomarker of sarcopenia measures and falls risk in community-dwelling older women. J Gerontol A Biol Sci Med Sci 2021; 77:1389-1397. [PMID: 34907424 DOI: 10.1093/gerona/glab369] [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: 07/15/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The ratio of creatinine to cystatin C (Cr:Cyc) has been proposed as a biomarker of sarcopenia, as greater Cr:Cyc is typically associated with greater muscle mass. We examined the relationship between Cr:Cyc with individual sarcopenia measures, 5 y self-reported falls and 12 y fall-related hospitalizations in a prospective cohort study of 1,118 community-dwelling older women (mean age 75.2 ± 2.7 y). METHODS Serum Cr:Cyc, hand grip strength and timed-up-and-go (TUG) performance were assessed at baseline (1998), while dual-energy X-ray absorptiometry (DXA) derived ALM/Height (m) 2 was obtained in a subset of women at baseline and 1 year (n=334). Incident 5 y self-reported falls and 12-year falls-related hospitalizations were considered. RESULTS In a multivariable-adjusted model, women with the lowest Cr:Cyc (Quartile [Q] 1) had 5% (1.0 kg) weaker grip strength, as well as 3.7% (0.22 kg/m 2) and 5.5% (0.031) lower ALM adjusted for height 2 or BMI, respectively, compared to women in Q4 (all p<0.05). 329 women reported an incident fall over 5 years, and 326 fall-related hospitalizations were recorded over 12 years. Women in Q1 of Cr:Cyc had a greater relative hazard for a fall over 5 years (HR 1.50 95%CI 1.11-2.01) and fall-related hospitalization over 12 years (HR 1.53 95%CI 1.13-2.07) compared to Q4 in the multivariable-adjusted model. CONCLUSION These findings support further investigation into the use of Cr:Cyc as a muscle biomarker to help clinicians identify individuals at risk of falls for early inclusion into evidence-based primary prevention programs targeting improvements to diet and exercise.
Collapse
Affiliation(s)
- Marc Sim
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,Medical School, University Western Australia, Perth, WA, Australia.,Royal Perth Hospital Research Foundation, Perth, WA, Australia
| | - Jack Dalla Via
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - David Scott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.,Bone and Muscle Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC Australia
| | - Wai H Lim
- Medical School, University Western Australia, Perth, WA, Australia.,Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Jonathan M Hodgson
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,Medical School, University Western Australia, Perth, WA, Australia
| | - Kun Zhu
- Medical School, University Western Australia, Perth, WA, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC Australia.,Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Richard L Prince
- Medical School, University Western Australia, Perth, WA, Australia.,Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Joshua R Lewis
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,Medical School, University Western Australia, Perth, WA, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
39
|
Cooper TE, Dalton A, Kieu A, Howell M, Jayanti S, Khalid R, Lim WH, Scholes-Robertson N, Craig JC, Teixeira-Pinto A, Bourke MJ, Tong A, Wong G. The CKD bowel health study: understanding the bowel health and gastrointestinal symptom management in patients with chronic kidney disease: a mixed-methods observational longitudinal study (protocol). BMC Nephrol 2021; 22:388. [PMID: 34802445 PMCID: PMC8606224 DOI: 10.1186/s12882-021-02600-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/30/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Gastro-intestinal (GI) intolerance is a frequently reported outcome in patients with kidney failure receiving maintenance dialysis and those who have received kidney transplants. Symptoms of GI intolerance (diarrhoea, constipation, bloating, abdominal pain, heart burn, and reflux) are associated with significant reduction in quality of life, morbidity, and increased used of healthcare resources. Having chronic kidney disease (CKD), together with related changes in diet and medication, may alter the gut microbiota and the microbial-derived uraemic metabolites that accumulate in kidney failure, and contribute to various complications including chronic diarrhoea, opportunistic infections, and drug-related colitis. Despite the high disease burden among patients with kidney replacement therapies, GI symptoms are often under-recognised and, consequently limited resources and strategies are devoted to the management of gastrointestinal complications in patients with CKD. METHODS The CKD Bowel Health Study is a multi-centre mixed-methods observational longitudinal study to better understand the bowel health and GI symptom management in patients with CKD. The program comprises of a longitudinal study that will assess the burden and risk factors of GI intolerance in patients treated with maintenance dialysis; a semi-structured interview study that will describe experiences of GI intolerance (including symptoms, treatment, self-management) in transplant candidates and recipients; and a discrete choice experience to elicit patient preferences regarding their experiences and perspectives of various intervention strategies for the management of GI symptoms after kidney transplantation. DISCUSSION This proposed program of work aims to define the burden the GI intolerance in patients with kidney failure and generate evidence on the patients' experiences of GI intolerance and their perspectives on their clinical and own management strategies of these symptoms, ensuring a patient-centred approach to guide clinical decision making and to inform the best study design for intervention trials. TRIAL REGISTRATION This study is registered on the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000548831 . This study has been approved by the Western Sydney Local Health District Human Research Ethics Committee of New South Wales Health (HREC ETH03007). This study is supported by a National Health and Medical Research Council (NHMRC) Australia Investigator Grant (APP1195414), and an NHMRC Australia Postgraduate Scholarship (APP2005244).
Collapse
Affiliation(s)
- Tess E Cooper
- Cochrane Kidney and Transplant, The Children's Hospital at Westmead, Westmead, Australia. .,Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia. .,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.
| | - Amy Dalton
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Anh Kieu
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | | | - Rabia Khalid
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Wai H Lim
- Sir Charles Gairdner Hospital, Nedlands, Australia.,School of Medicine, University of Western Australia, Perth, Australia
| | - Nicole Scholes-Robertson
- Cochrane Kidney and Transplant, The Children's Hospital at Westmead, Westmead, Australia.,Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Jonathan C Craig
- Cochrane Kidney and Transplant, The Children's Hospital at Westmead, Westmead, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Michael J Bourke
- Westmead Hospital, Westmead, Australia.,School of Medicine, The University of Sydney, Sydney, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.,Westmead Hospital, Westmead, Australia
| |
Collapse
|
40
|
Misal M, Behbehani S, Bindra V, Girardo M, Hoffman MR, Lim WH, Martin CB, Mehta SK, Nensi A, Soares TR, Taylor D, Wagner S, Wright KN, Wasson MN. Evaluating Surgical Complexity of Endoscopic Hysterectomy: An Inter-Rater Agreement Study for Novel Scoring Tool. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.453] [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: 10/20/2022]
|
41
|
Chew N, Tan EX, Tan CH, Lim WH, Xiao JL, Chin YH, Syn N, Low TT, Wong R, Yip J, Siddiqui MS, Muthiah M. A network meta-analysis on the vasomodulators for portopulmonary hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Abstract
Abstract
Background
In patients with portopulmonary hypertension (PoPH) who are eligible and awaiting liver transplant, guidelines recommend lowering pulmonary pressures with vasomodulators as a bridge to transplant. However, efficacy of each vasomodulator class as a bridge to transplant remains unknown.
Purpose
This review compares the use of endothelin receptor antagonists (ERA), phosphodiesterase type-5 inhibitors (PDE5-I), prostacyclin (PC) and combination therapy in its pulmonary pressure-lowering effects and pre-transplant mortality in this strictly selected subset of patients.
Methods
A search conducted on Medline and Embase on articles relating to vasomodulator use in PoPH for pulmonary pressure-lowering effects and mortality. Network analysis was conducted to summarize the evidence. Surface under the cumulative ranking curve (SUCRA) was used to rank treatments.
Results
Ten studies with 180 patients were included. SUCRA analysis demonstrated largest mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) lowering effects in ERA and combination therapy, followed by PDE5-I and PC. mPAP-lowering effects were largest in ERA (MD −19.440, CI: −62.280 to 23.400) and combination therapy (MD −18.223, CI: −29.677 to −6.770) when compared to PDE5-I (table 1). Pre-transplant mortality were comparable between ERA, PDE5-I and combination therapy. Both ERA (RR:0.349. CI: 0.137–0.891) and PDE5-I (RR: 0.279, CI: 0.091–0.854) had significantly lower mortality than PC (table 2).
Conclusion
This meta-analysis provides preliminary evidence that ERA have shown larger pulmonary pressure-lowering effects than PDE5-I in PoPH patients who were eligible for LT. Both ERA and PDE5-I have comparable mortality outcomes, with unfavorable outcomes in PC users.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- N Chew
- National University Health System, Singapore, Singapore
| | - E X Tan
- National University Hospital, Division of Gastroenterology and Hepatology, Singapore, Singapore
| | - C H Tan
- National University of Singapore, Singapore, Singapore
| | - W H Lim
- National University of Singapore, Singapore, Singapore
| | - J L Xiao
- National University of Singapore, Singapore, Singapore
| | - Y H Chin
- National University of Singapore, Singapore, Singapore
| | - N Syn
- National University of Singapore, Singapore, Singapore
| | - T T Low
- National University Heart Centre, Singapore, Singapore
| | - R Wong
- National University Heart Centre, Singapore, Singapore
| | - J Yip
- National University Heart Centre, Singapore, Singapore
| | - M S Siddiqui
- Virginia Commonwealth University, Division of Gastroenterology and Hepatology, Richmond, United States of America
| | - M Muthiah
- National University Hospital, Division of Gastroenterology and Hepatology, Singapore, Singapore
| |
Collapse
|
42
|
Ethier I, Cho Y, Hawley C, Pascoe EM, Roberts MA, Semple D, Nadeau-Fredette AC, Wong G, Lim WH, Sypek MP, Viecelli AK, Campbell S, van Eps C, Isbel NM, Johnson DW. Multicenter registry analysis comparing survival on home hemodialysis and kidney transplant recipients in Australia and New Zealand. Nephrol Dial Transplant 2021; 36:1937-1946. [PMID: 32879952 DOI: 10.1093/ndt/gfaa159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/06/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the era of organ shortage, home hemodialysis (HHD) has been identified as the possible preferential bridge to kidney transplantation. Data are conflicting regarding the comparability of HHD and transplantation outcomes. This study aimed to compare patient and treatment survival between HHD patients and kidney transplant recipients. METHODS The Australia and New Zealand Dialysis and Transplant Registry was used to include incident HHD patients on Day 90 after initiation of kidney replacement therapy and first kidney-only transplant recipients in Australia and New Zealand from 1997 to 2017. Survival times were analyzed using the Kaplan-Meier product-limit method comparing HHD patients with subtypes of kidney transplant recipients using the log-rank test. Adjusted analyses were performed with multivariable Cox proportional hazards regression models for time to all-cause mortality. Time-to-treatment failure or death was assessed as a composite secondary outcome. RESULTS The study compared 1411 HHD patients with 4960 living donor (LD) recipients, 6019 standard criteria donor (SCD) recipients and 2427 expanded criteria donor (ECD) recipients. While LD and SCD recipients had reduced risks of mortality compared with HHD patients [LD adjusted hazard ratio (HR) = 0.57, 95% confidence interval (CI) 0.46-0.71; SCD HR = 0.65 95% CI 0.52-0.79], the risk of mortality was comparable between ECD recipients and HHD patients (HR = 0.90, 95% CI 0.73-1.12). LD, SCD and ECD kidney recipients each experienced superior time-to-treatment failure or death compared with HHD patients. CONCLUSIONS This large registry study showed that kidney transplant offers a survival benefit compared with HHD but that this advantage is not significant for ECD recipients.
Collapse
Affiliation(s)
- Isabelle Ethier
- Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Carmel Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Matthew A Roberts
- Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - David Semple
- Department of Renal Medicine, Auckland District Health Board, Auckland, New Zealand.,School of Medicine, University of Auckland, Auckland, New Zealand
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Hôpital Maisonneuve-Rosemont and Research Center, Université de Montréal, Montréal, Canada
| | - Germaine Wong
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, Australia
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.,School of Medicine, University of Western Australia, Perth, Australia
| | - Matthew P Sypek
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Scott Campbell
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Carolyn van Eps
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Nicole M Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| |
Collapse
|
43
|
Au EH, Wong G, Howard K, Chapman JR, Castells A, Roger SD, Bourke MJ, Macaskill P, Turner R, Lim WH, Lok CE, Diekmann F, Cross N, Sen S, Allen RD, Chadban SJ, Pollock CA, Tong A, Teixeira-Pinto A, Yang JY, Kieu A, James L, Craig JC. Factors Associated With Advanced Colorectal Neoplasia in Patients With CKD. Am J Kidney Dis 2021; 79:549-560. [PMID: 34461168 DOI: 10.1053/j.ajkd.2021.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/16/2021] [Indexed: 12/19/2022]
Abstract
RATIONALE & OBJECTIVE The risk of developing colorectal cancer in patients with chronic kidney disease (CKD) is twice that of the general population, but the factors associated with colorectal cancer are poorly understood. The aim of this study was to identify factors associated with advanced colorectal neoplasia in patients with CKD. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS Patients with CKD stages 3-5, including those treated with maintenance dialysis or transplantation across 11 sites in Australia, New Zealand, Canada, and Spain, were screened for colorectal neoplasia using a fecal immunochemical test (FIT) as part of the Detecting Bowel Cancer in CKD (DETECT) Study. EXPOSURE Baseline characteristics for patients at the time of study enrollment were ascertained, including duration of CKD, comorbidities, and medications. OUTCOME Advanced colorectal neoplasia was identified through a 2-step verification process with colonoscopy following positive FIT and 2-year clinical follow-up for all patients. ANALYTICAL APPROACH Potential factors associated with advanced colorectal neoplasia were explored using multivariable logistic regression. Sensitivity analyses were performed using grouped LASSO (least absolute shrinkage and selection operator) logistic regression. RESULTS Among 1,706 patients who received FIT-based screening-791 with CKD stages 3-5 not receiving kidney replacement therapy (KRT), 418 receiving dialysis, and 497 patients with a functioning kidney transplant-117 patients (6.9%) were detected to have advanced colorectal neoplasia (54 with CKD stages 3-5 without KRT, 34 receiving dialysis, and 29 transplant recipients), including 9 colorectal cancers. The factors found to be associated with advanced colorectal neoplasia included older age (OR per year older, 1.05 [95% CI, 1.03-1.07], P<0.001), male sex (OR, 2.27 [95% CI, 1.45-3.54], P<0.001), azathioprine use (OR, 2.99 [95% CI, 1.40-6.37], P=0.005), and erythropoiesis-stimulating agent use (OR, 1.92 [95% CI, 1.22-3.03], P=0.005). Grouped LASSO logistic regression revealed similar associations between these factors and advanced colorectal neoplasia. LIMITATIONS Unmeasured confounding factors. CONCLUSIONS Older age, male sex, erythropoiesis-stimulating agents, and azathioprine were found to be significantly associated with advanced colorectal neoplasia in patients with CKD.
Collapse
Affiliation(s)
- Eric H Au
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia.
| | - Germaine Wong
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jeremy R Chapman
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia
| | - Antoni Castells
- Gastroenterology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Simon D Roger
- Department of Renal Medicine, Gosford Hospital, Gosford, Australia
| | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Westmead, Australia
| | - Petra Macaskill
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Robin Turner
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Biostatistics Unit, Dunedin School of Medicine, Otago University, Christchurch, New Zealand
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Charmaine E Lok
- Department of Medicine, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada
| | - Fritz Diekmann
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Nicholas Cross
- Department of Nephrology and Kidney Transplantation, Christchurch Hospital, Otago University, Christchurch, New Zealand
| | - Shaundeep Sen
- Department of Renal Medicine, Concord Repatriation General Hospital, Concord, Australia
| | - Richard D Allen
- Department of Renal Medicine, Royal Prince Alfred Hospital, and Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Steven J Chadban
- Department of Renal Medicine, Royal Prince Alfred Hospital, and Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Carol A Pollock
- Department of Medicine, Northern Clinical School, Kolling Institute of Medical Research, Sydney, Australia
| | - Allison Tong
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Jean Y Yang
- School of Mathematics and Statistics, University of Sydney, Sydney, Australia
| | - Anh Kieu
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Laura James
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| |
Collapse
|
44
|
Phillips J, Chen JHC, Ooi E, Prunster J, Lim WH. Global Epidemiology, Health Outcomes, and Treatment Options for Patients With Type 2 Diabetes and Kidney Failure. Front Clin Diabetes Healthc 2021; 2:731574. [PMID: 36994340 PMCID: PMC10012134 DOI: 10.3389/fcdhc.2021.731574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/29/2021] [Indexed: 12/15/2022]
Abstract
The burden of type 2 diabetes and related complications has steadily increased over the last few decades and is one of the foremost global public health threats in the 21st century. Diabetes is one of the leading causes of chronic kidney disease and kidney failure and is an important contributor to the cardiovascular morbidity and mortality in this population. In addition, up to one in three patients who have received kidney transplants develop post-transplant diabetes, but the management of this common complication continues to pose a significant challenge for clinicians. In this review, we will describe the global prevalence and temporal trend of kidney failure attributed to diabetes mellitus in both developing and developed countries. We will examine the survival differences between treated kidney failure patients with and without type 2 diabetes, focusing on the survival differences in those on maintenance dialysis or have received kidney transplants. With the increased availability of novel hypoglycemic agents, we will address the potential impacts of these novel agents in patients with diabetes and kidney failure and in those who have developed post-transplant diabetes.
Collapse
Affiliation(s)
- Jessica Phillips
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- *Correspondence: Jessica Phillips,
| | - Jenny H. C. Chen
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Depatment of Nephrology, Wollongong Hospital, Wollongong, NSW, Australia
| | - Esther Ooi
- School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Janelle Prunster
- Department of Renal Medicine, Cairns Hospital, Cairns, QLD, Australia
| | - Wai H. Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
| |
Collapse
|
45
|
Wong YHS, Wong G, Johnson DW, McDonald S, Clayton P, Boudville N, Viecelli AK, Lok C, Pilmore H, Hawley C, Roberts MA, Walker R, Ooi E, Polkinghorne KR, Lim WH. Socioeconomic disparity, access to care and patient relevant outcomes after kidney allograft failure. Transpl Int 2021; 34:2329-2340. [PMID: 34339557 DOI: 10.1111/tri.14002] [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: 11/17/2020] [Revised: 06/16/2021] [Accepted: 07/11/2021] [Indexed: 11/28/2022]
Abstract
Social disparity is a major impediment to optimal health outcomes after kidney transplantation. In this study, we aimed to define the association between socioeconomic status (SES) disparities and patient-relevant outcomes after kidney allograft failure. Using data from the Australia and New Zealand Dialysis and Transplant registry, we included patients with failed first kidney allografts in Australia between 2005-2017. The association between residential postcode-derived SES in quintiles (quintile 1-most disadvantaged areas, quintile 5-most advantaged areas) with uptake of home dialysis (peritoneal or home haemodialysis) within the first 12-months post-allograft failure, repeat transplantation and death on dialysis were examined using competing-risk analysis. Of 2175 patients who had experienced first allograft failure, 417(19%) and 505(23%) patients were of SES quintiles 1 and 5, respectively. Compared to patients of quintile 5, quintile 1 patients were less likely to receive repeat transplants (adjusted subdistributional hazard ratio [SHR] 0.70,95%CI 0.55-0.89) and were more likely to die on dialysis (1.37[1.04-1.81]), but there was no association with the uptake of home dialysis (1.02[0.77-1.35]). Low SES may have a negative effect on outcomes post-allograft failure and further research is required into how best to mitigate this. However, small-scale variation within SES cannot be accounted for in this study.
Collapse
Affiliation(s)
- Yun Hui Sheryl Wong
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Germaine Wong
- University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.,Department of Renal Medicine and National Pancreas Transplant Unit, Westmead Hospital, Sydney, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Queensland, Australia.,University of Queensland, Queensland, Australia.,Translational Research Institute, Brisbane, Australia
| | - Stephen McDonald
- South Australian Health and Medical Research Institute, ANZDATA Registry, Adelaide, Australia.,University of Adelaide, Adelaide, Australia.,Royal Adelaide Hospital, Adelaide, Australia
| | - Philip Clayton
- South Australian Health and Medical Research Institute, ANZDATA Registry, Adelaide, Australia.,University of Adelaide, Adelaide, Australia.,Royal Adelaide Hospital, Adelaide, Australia
| | - Neil Boudville
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.,Medical School, University of Western Australia, Perth, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Queensland, Australia.,University of Queensland, Queensland, Australia
| | - Charmaine Lok
- Division of Nephrology, Department of Medicine, University Health Network-Toronto General Hospital, Toronto, Canada.,The University of Toronto, Toronto, Canada
| | - Helen Pilmore
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand.,Department of Medicine, Auckland University, Auckland, New Zealand
| | - Carmel Hawley
- Department of Nephrology, Princess Alexandra Hospital, Queensland, Australia.,University of Queensland, Queensland, Australia.,Translational Research Institute, Brisbane, Australia
| | - Matthew A Roberts
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | | | - Esther Ooi
- Medical School, University of Western Australia, Perth, Australia.,School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Medical Centre, Victoria, Australia.,Department of Medicine, Monash University, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.,Medical School, University of Western Australia, Perth, Australia
| |
Collapse
|
46
|
Abstract
PURPOSE OF REVIEW This review will provide a practical approach in the assessment of kidney failure patients with primary glomerulonephritides (GN) being considered for kidney transplantation, focusing on high-risk subtypes of immunoglobulin A nephropathy, focal segmental glomerulosclerosis, idiopathic membranous glomerulonephritis and membranoproliferative glomerulonephritis. RECENT FINDINGS Recurrent glomerulonephritis remains one of the most common causes of allograft loss in kidney transplant recipients. Although the epidemiology and clinical outcomes of glomerulonephritis recurrence occurring after kidney transplantation are relatively well-described, the natural course and optimal treatment strategies of recurrent disease in kidney allografts remain poorly defined. With a greater understanding of the pathophysiology and treatment responses of patients with glomerulonephritis affecting the native kidneys, these discoveries have laid the framework for the potential to improve the management of patients with high-risk glomerulonephritis subtypes being considered for kidney transplantation. SUMMARY Advances in the understanding of the underlying immunopathogenesis of primary GN has the potential to offer novel therapeutic options for kidney patients who develop recurrent disease after kidney transplantation. To test the efficacy of novel treatment options in adequately powered clinical trials requires a more detailed understanding of the clinical and histological characteristics of kidney transplant recipients with recurrent glomerulonephritis.
Collapse
Affiliation(s)
- Laura De Souza
- Department of Renal Medicine, Cairns Hospital, Cairns North, Queensland
| | - Janelle Prunster
- Department of Renal Medicine, Cairns Hospital, Cairns North, Queensland
| | - Doris Chan
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth
| | - Aron Chakera
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| |
Collapse
|
47
|
Larkins NG, Wong G, Alexander SI, McDonald S, Prestidge C, Francis A, Le Page AK, Lim WH. Survival and transplant outcomes among young children requiring kidney replacement therapy. Pediatr Nephrol 2021; 36:2443-2452. [PMID: 33649894 DOI: 10.1007/s00467-021-04945-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/22/2020] [Accepted: 01/11/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Young children starting kidney replacement therapy (KRT) suffer high disease burden with unique impacts on growth and development, timing of transplantation and long-term survival. Contemporary long-term outcome data and how these relate to patient characteristics are necessary for shared decision-making with families, to identify modifiable risk factors and inform future research. METHODS We examined outcomes of all children ≤ 5 years enrolled in the Australia and New Zealand Dialysis and Transplant Registry, commencing KRT 1980-2017. Primary outcomes were patient and graft survival. Final height attained was also examined. We used generalized additive modelling to investigate the relationship between age and graft loss over time post-transplant. RESULTS In total, 388 children were included, of whom 322 (83%) received a kidney transplant. Cumulative 1-, 5- and 10-year patient survival probabilities were 93%, 86% and 83%, respectively. Death censored graft survival at 1, 5 and 10 years was 93%, 87% and 77%, respectively. Most children were at least 10 kg at transplantation (n = 302; 96%). A non-linear relationship between age at transplantation and graft loss was observed, dependent on time post-transplant, with increased risk of graft loss among youngest recipients both initially following transplantation and subsequently during adolescence. Graft and patient survival have improved in recent era. CONCLUSIONS Young children commencing KRT have good long-term survival and graft outcomes. Early graft loss is no reason to postpone transplantation beyond 10 kg, and among even the youngest recipients, late graft loss risk in adolescence remains one of the greatest barriers to improving long-term outcomes.
Collapse
Affiliation(s)
- Nicholas G Larkins
- Department of Nephrology and Hypertension, Perth Children's Hospital, 15 University Ave, Nedlands, WA, 6009, Australia.
- School of Medicine, University of Western Australia, Perth, WA, Australia.
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia.
| | - Germaine Wong
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
- Department of Nephrology, Westmead Hospital, Sydney, NSW, Australia
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Stephen I Alexander
- School of Public Health, University of Sydney, Sydney, NSW, Australia
- Department of Nephrology, Westmead Children's Hospital, Westmead, NSW, Australia
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Royal Adelaide Hospital, Adelaide, SA, Australia
- Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | | | - Anna Francis
- Child and Adolescent Renal Service, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Amelia K Le Page
- Department of Nephrology, Monash Children's Hospital, Clayton, VIC, Australia
| | - Wai H Lim
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Nephrology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| |
Collapse
|
48
|
Chen JHC, Brown MA, Jose M, Brennan F, Johnson DW, Roberts MA, Wong G, Cheikh Hassan H, Kennard A, Walker R, Davies CE, Boudville N, Borlace M, Hawley C, Lim WH. Temporal changes and risk factors of death from early withdrawal within 12 months of dialysis initiation - a cohort study. Nephrol Dial Transplant 2021; 37:760-769. [PMID: 34175956 PMCID: PMC8951200 DOI: 10.1093/ndt/gfab207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background Mortality risk is high soon after dialysis initiation in patients with kidney failure, and dialysis withdrawal is a major cause of early mortality, attributed to psychosocial or medical reasons. The temporal trends and risk factors associated with cause-specific early dialysis withdrawal within 12 months of dialysis initiation remain uncertain. Methods Using data from the Australia and New Zealand Dialysis and Transplant Registry, we examined the temporal trends and risk factors associated with mortality attributed to early psychosocial and medical withdrawals in incident adult dialysis patients in Australia between 2005 and 2018 using adjusted competing risk analyses. Results Of 32 274 incident dialysis patients, 3390 (11%) experienced death within 12 months post-dialysis initiation. Of these, 1225 (36%) were attributed to dialysis withdrawal, with 484 (14%) psychosocial withdrawals and 741 (22%) medical withdrawals. These patterns remained unchanged over the past two decades. Factors associated with increased risk of death from early psychosocial and medical withdrawals were older age, dialysis via central venous catheter, late referral and the presence of cerebrovascular disease; obesity and Asian ethnicity were associated with decreased risk. Risk factors associated with early psychosocial withdrawals were underweight and higher socioeconomic status. Presence of peripheral vascular disease, chronic lung disease and cancers were associated with early medical withdrawals. Conclusions Death from dialysis withdrawal accounted for >30% of early deaths in kidney failure patients initiated on dialysis and remained unchanged over the past two decades. Several shared risk factors were observed between mortality attributed to early psychosocial and medical withdrawals.
Collapse
Affiliation(s)
- Jenny H C Chen
- School of Medicine, University of Wollongong, Wollongong, Australia
- Depatment of Renal Medicine, Wollongong Hospital, Wollongong, Australia
- Correspondence to: Jenny H.C. Chen; E-mail:
| | - Mark A Brown
- Department of Nephrology, St George Hospital, Sydney, Australia
- School of Medicine, University of New South Wales, Sydney, Australia
| | - Matthew Jose
- School of Medicine, The University of Tasmania, Hobart, Australia
- Department of Nephrology, Royal Hobart Hospital, Hobart, Australia
| | - Frank Brennan
- Department of Nephrology, St George Hospital, Sydney, Australia
- School of Medicine, University of New South Wales, Sydney, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Australasian Kidney Trials Network, Brisbane, Australia
| | - Matthew A Roberts
- School of Medicine, Monash University, Melbourne, Australia
- Renal Service, Eastern Health, Melbourne, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia
| | - Hicham Cheikh Hassan
- School of Medicine, University of Wollongong, Wollongong, Australia
- Depatment of Renal Medicine, Wollongong Hospital, Wollongong, Australia
| | - Alice Kennard
- School of Medicine, Australian National University, Canberra, Australia
- Department of Nephrology, Canberra Hospital, Canberra, Australia
| | - Rachael Walker
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- School of Nursing, Eastern Institute of Technology, Napier, New Zealand
| | - Christopher E Davies
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Neil Boudville
- Medical School, University of Western Australia, Perth, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Monique Borlace
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Carmel Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Australasian Kidney Trials Network, Brisbane, Australia
| | - Wai H Lim
- Medical School, University of Western Australia, Perth, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| |
Collapse
|
49
|
Hu A, Stewart C, Craig JC, Wyburn K, Pleass H, Kanellis J, Lim WH, Yang J, Wong G. Jurisdictional inequalities in deceased donor kidney allocation in Australia. Kidney Int 2021; 100:49-54. [PMID: 33961869 DOI: 10.1016/j.kint.2021.04.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/28/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Anne Hu
- Faculty of Science, School of Mathematics and Science, University of Sydney, Sydney, Australia
| | - Cameron Stewart
- Sydney Law School, University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kate Wyburn
- Department of Renal and Transplantation Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Henry Pleass
- Faculty of Health and Medical Science, University of Western Australia, Perth, Australia
| | - John Kanellis
- Department of Nephrology, Monash Health and Centre for Inflammatory Diseases, Melbourne, Australia; Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Wai H Lim
- Specialty of Surgery, University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | - Jean Yang
- Faculty of Science, School of Mathematics and Science, University of Sydney, Sydney, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia; Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales, Australia.
| |
Collapse
|
50
|
Wong C, Lim WH, Jain SR, Ng CH, Tai CH, Devi MK, Samarasekera DD, Iyer SG, Chong CS. 46 The Hidden Truth About Gender Bias in Surgery. A Systematic Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Gender discrimination remains pervasive in surgery, significantly impacting current and future surgeons and population health. This study analyses the gender barriers and critical retention factors for female surgeons and trainees in surgery.
Method
Five electronic databases were searched till May 2020. Titles and abstracts were sieved, followed by a full text review. Data synthesis and inductive thematic analysis were conducted using the Thomas and Harden methodology.
Result
14 articles were included, involving 528 participants. Four themes were generated–unfavourable working environment, male-dominated culture, societal pressures and progress towards gender equality. Females in surgery often faced harassment, disrespect and perceptions of incompetence, resulting in hostile work conditions, which were aggravated by the inadequate support and mentorship. The persistence of male-dominated cultures was observed, with females facing prejudice and exclusion from professional and social circles. Differential treatment and higher expectations of female surgeons also arose from entrenched societal pressures. Despite these, increased acceptance of motherhood and greater recognition of contributions by female surgeons were reported, indicating some progress in gendered culture.
Conclusions
There is a need to increase female surgical leadership and allocate resources to address the deep-rooted causes of biased surgical culture and ingrained perceptions, to achieve greater gender equality in surgery.
Collapse
Affiliation(s)
- C Wong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - W H Lim
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - S R Jain
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - C H Ng
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - C H Tai
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - M K Devi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - D D Samarasekera
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - S G Iyer
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
- Liver Transplantation, National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore
| | - C S Chong
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| |
Collapse
|