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Wirken L, van Middendorp H, Hooghof CW, Sanders JS, Dam R, van der Pant KAMI, Wierdsma J, Wellink H, Ulrichts P, Hoitsma AJ, Hilbrands LB, Evers AW. Combining transplant professional's psychosocial donor evaluation and donor self-report measures to optimise the prediction of HRQoL after kidney donation: an observational prospective multicentre study. BMJ Open 2022; 12:e045249. [PMID: 35236728 PMCID: PMC8895930 DOI: 10.1136/bmjopen-2020-045249] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Living donor kidney transplantation is currently the preferred treatment for patients with end-stage renal disease. The psychosocial evaluation of kidney donor candidates relies mostly on the clinical viewpoint of transplant professionals because evidence-based guidelines for psychosocial donor eligibility are currently lacking. However, the accuracy of these clinical risk judgements and the potential added value of a systematic self-reported screening procedure are as yet unknown. The current study examined the effectiveness of the psychosocial evaluation by transplant professionals and the potential value of donor self-report measures in optimising the donor evaluation. Based on the stress-vulnerability model, the predictive value of predonation, intradonation and postdonation factors to impaired longer term health-related quality of life (HRQoL) of kidney donors was studied. DESIGN An observational prospective multicentre study. SETTING Seven Dutch transplantation centres. PARTICIPANTS 588 potential donors participated, of whom 361 donated. Complete prospective data of 230 donors were available. Also, 1048 risk estimation questionnaires were completed by healthcare professionals. METHODS Transplant professionals (nephrologists, coordinating nurses, social workers and psychologists) filled in risk estimation questionnaires on kidney donor candidates. Furthermore, 230 kidney donors completed questionnaires (eg, on HRQoL) before and 6 and 12 months after donation. PRIMARY AND SECONDARY OUTCOME MEASURES HRQoL, demographic and preoperative, intraoperative and postoperative health characteristics, perceived support, donor cognitions, recipient functioning and professionals risk estimation questionnaires. RESULTS On top of other predictors, such as the transplant professionals' risk assessments, donor self-report measures significantly predicted impaired longer term HRQoL after donation, particularly by poorer predonation physical (17%-28% explained variance) and psychological functioning (23%). CONCLUSIONS The current study endorses the effectiveness of the psychosocial donor evaluation by professionals and the additional value of donor self-report measures in optimising the psychosocial evaluation. Consequently, systematic screening of donors based on the most prominent risk factors provide ground for tailored interventions for donors at risk.
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Affiliation(s)
- Lieke Wirken
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Medical Psychology, Radboudumc, Nijmegen, The Netherlands
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Medical Psychology, Radboudumc, Nijmegen, The Netherlands
| | | | - Jan-Stephan Sanders
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Ruth Dam
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Karlijn A M I van der Pant
- Department of Internal Medicine/Nephrology, Renal Transplant Unit, Amsterdam UMC, Amsterdam, The Netherlands
| | - Judith Wierdsma
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hiske Wellink
- Department of Nephrology, Amsterdam UMC VUMC Site, Amsterdam, The Netherlands
| | - Philip Ulrichts
- Department of Internal Medicine/Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Andrea W Evers
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Medical Psychology, Radboudumc, Nijmegen, The Netherlands
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2
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Keijbeck A, Veenstra R, Pol RA, Konijn C, Jansen N, van Goor H, Hoitsma AJ, Peutz-Kootstra CJ, Moers C. Authors' Response to Odugoudar et al: Poor Kidney Transplant Outcomes and Higher Organ Discard Rate Secondary to Macroscopic Arteriosclerosis of Renal Artery: More Evidence Needed to Prove Correlation. Transplantation 2022; 106:e172. [PMID: 35100231 PMCID: PMC8843362 DOI: 10.1097/tp.0000000000003704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Anke Keijbeck
- Department of Pathology, Maastricht University Medical Center, University of Maastricht, Maastricht, the Netherlands
| | - Rob Veenstra
- Department of Surgery-Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Robert A. Pol
- Department of Surgery-Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Cynthia Konijn
- Dutch Transplantation Foundation, Leiden, the Netherlands
| | - Nichon Jansen
- Dutch Transplantation Foundation, Leiden, the Netherlands
| | - Harry van Goor
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Carine J. Peutz-Kootstra
- Department of Pathology, Maastricht University Medical Center, University of Maastricht, Maastricht, the Netherlands
| | - Cyril Moers
- Department of Surgery-Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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3
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Wirken L, van Middendorp H, Hooghof CW, Sanders JSF, Dam RE, van der Pant KAMI, Wierdsma JM, Wellink H, van Duijnhoven EM, Hoitsma AJ, Hilbrands LB, Evers AWM. Psychosocial consequences of living kidney donation: a prospective multicentre study on health-related quality of life, donor-recipient relationships and regret. Nephrol Dial Transplant 2020; 34:1045-1055. [PMID: 30544241 DOI: 10.1093/ndt/gfy307] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 11/06/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous studies have indicated decreased health-related quality of life (HRQoL) shortly after kidney donation, returning to baseline in the longer term. However, a subgroup of donors experiences persistent HRQoL problems. To identify which HRQoL aspects are impacted most by the donation and to identify at-risk donors, more specific insight into psychosocial donation consequences is needed. METHODS The current study examined the HRQoL course, donor-perceived consequences of donation for donors, recipients and donor-recipient relationships, and regret up to 12 months post-donation in donors from seven Dutch transplantation centres. Kidney donor candidates (n = 588) completed self-report questionnaires early in the screening procedure, of which 361 (61%) donated their kidney. RESULTS Data for 230 donors (64%) with complete assessments before donation and 6 and 12 months post-donation were analysed. Results indicated that donor physical HRQoL was comparable at all time points, except for an increase in fatigue that lasted up to 12 months post-donation. Mental HRQoL decreased at 6 months post-donation, but returned to baseline at 12 months. Donors reported large improvements in recipient's functioning and a smaller influence of the recipient's kidney disease or transplantation on the donor's life over time. A subgroup experienced negative donation consequences with 14% experiencing regret 12 months post-donation. Predictors of regret were more negative health perceptions and worse social functioning 6 months post-donation. The strongest baseline predictors of higher fatigue levels after donation were more pre-donation fatigue, worse general physical functioning and a younger age. CONCLUSIONS Future research should examine predictors of HRQoL after donation to improve screening and to provide potential interventions in at-risk donors.
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Affiliation(s)
- Lieke Wirken
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.,Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henriët van Middendorp
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.,Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christina W Hooghof
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Jan-Stephan F Sanders
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ruth E Dam
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Karlijn A M I van der Pant
- Division of Nephrology, Department of Internal Medicine, Renal Transplant Unit, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Judith M Wierdsma
- Department of Nephrology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Hiske Wellink
- Department of Nephrology, VU Medical Center, Amsterdam, The Netherlands
| | - Elly M van Duijnhoven
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Andries J Hoitsma
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Andrea W M Evers
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.,Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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4
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Bruintjes MHD, d'Ancona FCH, Zhu X, Hoitsma AJ, Warlé MC. An Update on Early Urological Complications in Kidney Transplantation: A National Cohort Study. Ann Transplant 2019; 24:617-624. [PMID: 31792196 PMCID: PMC6909919 DOI: 10.12659/aot.920086] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
<strong>BACKGROUND</strong> This study aimed to provide an update on the occurrence of early urological complications in living-donor and deceased-donor kidney transplantation (KTX). <strong>MATERIAL AND METHODS</strong> Data on all kidney transplant recipients in the Netherlands between January 2005 and December 2015 were retrieved from the prospectively collected Dutch National Organ Transplant Registry Database (NOTR). We assessed the incidence of major urological complications (MUCs) within 3 months after KTX, defined as urinary leakage and ureteral obstruction. Outcomes of living donor and deceased donor kidney transplants were compared. We performed regression analysis to identify predictive factors of urological complications and studied the influence of early urological complications on graft and patient survival. We performed an additional sub-study to explore the influence of preservation of the peri-ureteric connective tissue in living-donor KTX on the occurrence of urological complications. <strong>RESULTS</strong> Among 3329 kidney transplant recipients, urological complications occurred in 208 patients (6.2%) within 3 months after surgery. There were no significant differences in complication rates between recipients from living donors and deceased donors. Multiple regression analysis showed that older donor age and previous cardiac events of the recipient were predictors for the development of urological complications. Graft and patient survival were not affected by early MUCs. The additional sub-study showed that preservation of peri-ureteric tissue within living-donor KTX was not independently associated with urological complications. <strong>CONCLUSIONS</strong> Many living- and deceased-donor KTX recipients have early urological complications. MUCs did not affect long-term graft or patient survival.
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Affiliation(s)
- Moira H D Bruintjes
- Department of Surgery, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands.,Department of Urology, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Frank C H d'Ancona
- Department of Urology, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Xiaoye Zhu
- Department of Urology, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Andries J Hoitsma
- Department of Nephrology, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Michiel C Warlé
- Department of Surgery, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
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5
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Ergün M, Özdemir-van Brunschot DMD, Donders RART, Hilbrands LB, Hoitsma AJ, Warlé MC. Prolonged Duration of Brain Death was Associated with Better Kidney Allograft Function and Survival: A Prospective Cohort Analysis. Ann Transplant 2019; 24:147-154. [PMID: 30872563 PMCID: PMC6434611 DOI: 10.12659/aot.913869] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Brain death initiates hemodynamic, immunological, and hormonal changes that potentially compromise organ quality for transplantation. Therefore, it is generally believed that organs should be procured as soon as possible after the declaration of brain death. However, conflicting data exist regarding the impact of brain death duration on long-term graft function and survival. MATERIAL AND METHODS The effect of duration of brain death on graft survival and function of 1869 adult transplant recipients receiving kidneys from deceased donors after brain death was analyzed, using relevant donor and recipient characteristics and allograft related factors. RESULTS Duration of brain death was a significant predictor for long-term graft survival, whilst there was no significant effect of duration of brain death on the incidence of delayed graft function or acute graft rejection after kidney transplantation. After dividing the study population into a "short durBD" (<10.6 hours) group and a "long durBD" (>10.6 hours) group, the 15-year graft survival estimates were significantly higher and the serum creatinine at 3 months after transplantation was significantly lower in the "long durBD" group. CONCLUSIONS Duration of brain death does not affect the incidence of delayed graft function or acute rejection after kidney transplantation. However, longer duration of brain death is associated with better kidney allograft function and survival.
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Affiliation(s)
- Mehmet Ergün
- Department of Surgery, Division of Vascular and Transplant Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Rogier A R T Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Andries J Hoitsma
- Department of Nephrology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Michiel C Warlé
- Department of Surgery, Division of Vascular and Transplant Surgery, Radboud University Medical Center, Nijmegen, Netherlands
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6
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Hemke AC, Heemskerk MBA, van Diepen M, Kramer A, de Meester J, Heaf JG, Abad Diez JM, Torres Guinea M, Finne P, Brunet P, Vikse BE, Caskey FJ, Traynor JP, Massy ZA, Couchoud C, Groothoff JW, Nordio M, Jager KJ, Dekker FW, Hoitsma AJ. Performance of an easy-to-use prediction model for renal patient survival: an external validation study using data from the ERA-EDTA Registry. Nephrol Dial Transplant 2018; 33:1786-1793. [PMID: 29346645 DOI: 10.1093/ndt/gfx348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 11/15/2017] [Indexed: 11/12/2022] Open
Abstract
Background An easy-to-use prediction model for long-term renal patient survival based on only four predictors [age, primary renal disease, sex and therapy at 90 days after the start of renal replacement therapy (RRT)] has been developed in The Netherlands. To assess the usability of this model for use in Europe, we externally validated the model in 10 European countries. Methods Data from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry were used. Ten countries that reported individual patient data to the registry on patients starting RRT in the period 1995-2005 were included. Patients <16 years of age and/or with missing predictor variable data were excluded. The external validation of the prediction model was evaluated for the 10- (primary endpoint), 5- and 3-year survival predictions by assessing the calibration and discrimination outcomes. Results We used a data set of 136 304 patients from 10 countries. The calibration in the large and calibration plots for 10 deciles of predicted survival probabilities showed average differences of 1.5, 3.2 and 3.4% in observed versus predicted 10-, 5- and 3-year survival, with some small variation on the country level. The concordance index, indicating the discriminatory power of the model, was 0.71 in the complete ERA-EDTA Registry cohort and varied according to country level between 0.70 and 0.75. Conclusions A prediction model for long-term renal patient survival developed in a single country, based on only four easily available variables, has a comparably adequate performance in a wide range of other European countries.
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Affiliation(s)
- Aline C Hemke
- Dutch Transplant Foundation, Organ Centre, Leiden, The Netherlands.,Dutch Renal Replacement Registry, Leiden, The Netherlands
| | | | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anneke Kramer
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Johan de Meester
- Department of Nephrology, Dialysis, and Hypertension, AZ Nikolaas, Sint-Niklaas, Belgium
| | - James G Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | | | | | - Patrik Finne
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Finnish Registry for Kidney Diseases, Helsinki, Finland
| | - Philippe Brunet
- Centre de Nephrologie et Transplantation Renale, Hospital de la Conception, Aix Marseille Université, AP-HM, Marseille, France
| | - Bjørn E Vikse
- Department of Medicine, Haugesund Hospital, Haugesund, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Fergus J Caskey
- UK Renal Registry, Southmead Hospital, Bristol, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jamie P Traynor
- Scottish Renal Registry, Information Services Division Scotland, Glasgow, UK
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, Paris, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Research Centre in Epidemiology and Population Health (CESP) Team 5, University of Paris Ouest-Versailles-St Quentin-en-Yveline, Villejuif, Paris, France
| | - Cécile Couchoud
- Renal Epidemiology and Information Network (REIN) Registry, French Biomedical Agency, Saint-Denis-la-Plaine, France
| | - Jaap W Groothoff
- Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Maurizio Nordio
- Veneto Dialysis and Transplantation Registry, Regional Epidemiology System, Padua, Italy.,Nephrology and Dialysis Unit, AULSS 6, Padua, Italy
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Andries J Hoitsma
- Dutch Transplant Foundation, Organ Centre, Leiden, The Netherlands.,Division of Nephrology, University Nijmegen Medical Centre, Nijmegen, The Netherlands
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7
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Kamburova EG, Wisse BW, Joosten I, Allebes WA, van der Meer A, Hilbrands LB, Baas MC, Spierings E, Hack CE, van Reekum FE, van Zuilen AD, Verhaar MC, Bots ML, Drop ACAD, Plaisier L, Seelen MAJ, Sanders JS, Hepkema BG, Lambeck AJA, Bungener LB, Roozendaal C, Tilanus MGJ, Voorter CE, Wieten L, van Duijnhoven EM, Gelens MACJ, Christiaans MHL, van Ittersum FJ, Nurmohamed SA, Lardy NM, Swelsen W, van der Pant KAMI, van der Weerd NC, Ten Berge IJM, Bemelman FJ, Hoitsma AJ, van der Boog PJM, de Fijter JW, Betjes MGH, Heidt S, Roelen DL, Claas FH, Otten HG. Pretransplant C3d-Fixing Donor-Specific Anti-HLA Antibodies Are Not Associated with Increased Risk for Kidney Graft Failure. J Am Soc Nephrol 2018; 29:2279-2285. [PMID: 30049681 DOI: 10.1681/asn.2018020205] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 02/22/2018] [Accepted: 06/13/2018] [Indexed: 11/03/2022] Open
Abstract
Background Complement-fixing antibodies against donor HLA are considered a contraindication for kidney transplant. A modification of the IgG single-antigen bead (SAB) assay allows detection of anti-HLA antibodies that bind C3d. Because early humoral graft rejection is considered to be complement mediated, this SAB-based technique may provide a valuable tool in the pretransplant risk stratification of kidney transplant recipients.Methods Previously, we established that pretransplant donor-specific anti-HLA antibodies (DSAs) are associated with increased risk for long-term graft failure in complement-dependent cytotoxicity crossmatch-negative transplants. In this study, we further characterized the DSA-positive serum samples using the C3d SAB assay.Results Among 567 pretransplant DSA-positive serum samples, 97 (17%) contained at least one C3d-fixing DSA, whereas 470 (83%) had non-C3d-fixing DSA. At 10 years after transplant, patients with C3d-fixing antibodies had a death-censored, covariate-adjusted graft survival of 60%, whereas patients with non-C3d-fixing DSA had a graft survival of 64% (hazard ratio, 1.02; 95% confidence interval, 0.70 to 1.48 for C3d-fixing DSA compared with non-C3d-fixing DSA; P=0.93). Patients without DSA had a 10-year graft survival of 78%.Conclusions The C3d-fixing ability of pretransplant DSA is not associated with increased risk for graft failure.
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Affiliation(s)
| | | | - Irma Joosten
- Laboratory Medicine, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences and
| | - Wil A Allebes
- Laboratory Medicine, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences and
| | - Arnold van der Meer
- Laboratory Medicine, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences and
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Departments of
| | - Marije C Baas
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Departments of
| | | | | | | | | | | | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | | | - Bouke G Hepkema
- Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annechien J A Lambeck
- Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Laura B Bungener
- Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Caroline Roozendaal
- Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Lotte Wieten
- Department of Transplantation Immunology, Tissue Typing Laboratory and
| | - Elly M van Duijnhoven
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mariëlle A C J Gelens
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maarten H L Christiaans
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frans J van Ittersum
- Department of Nephrology, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Shaikh A Nurmohamed
- Department of Nephrology, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Neubury M Lardy
- Department of Immunogenetics, Sanquin, Amsterdam, The Netherlands
| | - Wendy Swelsen
- Department of Immunogenetics, Sanquin, Amsterdam, The Netherlands
| | - Karlijn A M I van der Pant
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Neelke C van der Weerd
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Ineke J M Ten Berge
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Frederike J Bemelman
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Andries J Hoitsma
- Dutch Organ Transplant Registry, Dutch Transplant Foundation, Leiden, The Netherlands; Departments of
| | | | | | - Michiel G H Betjes
- Internal Medicine and.,Nephrology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sebastiaan Heidt
- Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands; and Departments of
| | - Dave L Roelen
- Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands; and Departments of
| | - Frans H Claas
- Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands; and Departments of
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8
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Ismail SY, Kums E, Mahmood SK, Hoitsma AJ, Jansen NE. Increasing Consent and Assent Rate for Organ and Tissue Donation: Communication About Donation-Telephone Advice by Psychologist. Transplant Proc 2018; 50:3017-3024. [PMID: 30577161 DOI: 10.1016/j.transproceed.2018.06.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/27/2018] [Indexed: 11/18/2022]
Abstract
A high percentage of family refusal is found for several outcomes in the Donor Register. Misconceptions and concerns regarding donation impede next of kin from making a well-considered decision. The donation request is the moment in which such concerns should be addressed by the requestor. The Communication about Donation-Telephone Advice by Psychologist (CaD-TAP) is a direct telephone intervention for requestors who are about to request the relatives for donation. The aim of this intervention is to improve requestors' communication skills regarding the donation request and thereby increase the consent rate for organ and/or tissue donation. The intervention started on the April 1, 2014, and lasted until December 31, 2014. To determine the effects, the consent and assent rates were compared between requestors who received the CaD-TAP intervention and those who did not. The requestors who received the CaD-TAP intervention (N = 141) had a significantly (P < .001) higher consent rate (58%) compared with the group who did not receive the intervention (N = 1563, consent rate: 34%). More tissue donor requestors received the intervention (74%) and most interventions took place outside office hours (82%). No significant difference was found in the effect of the intervention with regard to type of donation, time, or day. Furthermore, the intervention increased requestors' self-confidence in requesting for donation (P < .001), and a higher self-confidence indicated a significant association with increased consent rate. The intervention is unanimously experienced as positive and valuable by users. Based on these results the intervention is effective in increasing the consent rate for organ and tissue donation.
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Affiliation(s)
- S Y Ismail
- Erasmus Medical Center, Psychiatry-Medical Psychology and Psychotherapy, Rotterdam, The Netherlands.
| | - E Kums
- Dutch Transplant Foundation, Leiden, The Netherlands
| | - S K Mahmood
- Erasmus Medical Center, Psychiatry-Medical Psychology and Psychotherapy, Rotterdam, The Netherlands
| | - A J Hoitsma
- Dutch Transplant Foundation, Leiden, The Netherlands
| | - N E Jansen
- Dutch Transplant Foundation, Leiden, The Netherlands
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9
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Wirken L, van Middendorp H, Hooghof CW, Bremer TE, Hopman SPF, van der Pant KAMI, Hoitsma AJ, Hilbrands LB, Evers AWM. Development and feasibility of a guided and tailored internet-based cognitive-behavioural intervention for kidney donors and kidney donor candidates. BMJ Open 2018; 8:e020906. [PMID: 29961018 PMCID: PMC6042571 DOI: 10.1136/bmjopen-2017-020906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Living donor kidney transplantation is currently the preferred treatment for patients with end-stage renal disease. A subgroup of the kidney donor population experiences adjustment problems during or after the donation procedure (eg, anxiety or fatigue). There is a need for evidence-based interventions that decrease donation-related difficulties before or after donation. In the current study, a guided and tailored internet-based cognitive-behavioural therapy (ICBT) intervention for donors and donor candidates was developed and the feasibility and perceived effectiveness were evaluated. DESIGN Pilot study including qualitative and quantitative research methods for intervention development and evaluation. SETTING Living kidney donor population of two Dutch transplantation centres. PARTICIPANTS Donors and healthcare professionals participated in focus group interviews conducted to identify intervention themes and to map attitudes towards internet-based interventions. In a pilot feasibility study, 99 donors and donor candidates participated, of whom 38 completed the screening. Eight donors or donor candidates with a risk profile (ie, impaired mental health-related quality of life (HRQoL)) received and evaluated the intervention. INTERVENTIONS A guided and tailored ICBT intervention for donors and donor candidates was developed. Donation-related treatment modules, assignments and psychoeducation were integrated within an existing disease-generic ICBT intervention. OUTCOME MEASURES HRQoL, anxiety and depression were assessed before and after the ICBT intervention. Additional questionnaires were included to identify specific problem areas of donor functioning to tailor the ICBT intervention to the donor's needs. RESULTS Different intervention themes were derived from the focus group interviews (eg, physical limitations, and donation-specific emotional and social-relational problems). Participants were satisfied about the intervention content (7.7±0.8 on a 0-10 scale) and the therapeutic relationship (4.4±0.6 on a 1-5 scale), and indicated an improvement on domains of their treatment goals (3.2±0.7 on a 1-4 scale). CONCLUSION This study showed positive evaluations concerning both feasibility and perceived effectiveness of the tailored ICBT intervention in kidney donors and donor candidates, in line with previous studies using comparable ICBT treatment protocols in other populations. Future research should examine the possibilities of integrating the intervention into psychosocial care for kidney donors.
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Affiliation(s)
- Lieke Wirken
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
| | - Henriët van Middendorp
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
| | - Christina W Hooghof
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - Tamara E Bremer
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
| | - Sabine P F Hopman
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - Karlijn A M I van der Pant
- Department of Internal Medicine/Nephrology, Renal Transplant Unit, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Andries J Hoitsma
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - Andrea W M Evers
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
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10
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Wirken L, van Middendorp H, Hooghof CW, Sanders JS, Dam RE, van der Pant KAMI, Berendsen ECM, Wellink H, Dackus HJA, Hoitsma AJ, Hilbrands LB, Evers AWM. Pre-donation cognitions of potential living organ donors: the development of the Donation Cognition Instrument in potential kidney donors. Nephrol Dial Transplant 2017; 32:573-580. [PMID: 28160472 DOI: 10.1093/ndt/gfw421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 08/23/2016] [Accepted: 11/07/2016] [Indexed: 11/12/2022] Open
Abstract
Background Cognitions surrounding living organ donation, including the motivation to donate, expectations of donation and worries about donation, are relevant themes during living donor evaluation. However, there is no reliable psychometric instrument assessing all these different cognitions. This study developed and validated a questionnaire to assess pre-donation motivations, expectations and worries regarding donation, entitled the Donation Cognition Instrument (DCI). Methods Psychometric properties of the DCI were examined using exploratory factor analysis for scale structure and associations with validated questionnaires for construct validity assessment. Results From seven Dutch transplantation centres, 719 potential living kidney donors were included. The DCI distinguishes cognitions about donor benefits, recipient benefits, idealistic incentives, gratitude and worries about donation (Cronbach's alpha 0.76-0.81). Scores on pre-donation cognitions differed with regard to gender, age, marital status, religion and donation type. With regard to construct validity, the DCI was moderately correlated with expectations regarding donor's personal well-being and slightly to moderately to health-related quality of life. Conclusions The DCI is found to be a reliable instrument assessing cognitions surrounding living organ donation, which might add to pre-donation quality of life measures in facilitating psychosocial donor evaluation by healthcare professionals.
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Affiliation(s)
- Lieke Wirken
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden, The Netherlands.,Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henriët van Middendorp
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden, The Netherlands.,Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christina W Hooghof
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Stephan Sanders
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ruth E Dam
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Karlijn A M I van der Pant
- Department of Internal Medicine/Nephrology, Renal Transplant Unit, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Elsbeth C M Berendsen
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hiske Wellink
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands
| | - Henricus J A Dackus
- Department of Internal Medicine/Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Andries J Hoitsma
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrea W M Evers
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden, The Netherlands.,Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
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11
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van Ittersum FJ, Hemke AC, Dekker FW, Hilbrands LB, Christiaans MHL, Roodnat JI, Hoitsma AJ, van Diepen M. Increased risk of graft failure and mortality in Dutch recipients receiving an expanded criteria donor kidney transplant. Transpl Int 2017; 30:14-28. [PMID: 27648731 DOI: 10.1111/tri.12863] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 02/05/2016] [Revised: 03/04/2016] [Accepted: 09/12/2016] [Indexed: 12/28/2022]
Abstract
Survival of expanded criteria donor (ECD) kidneys and their recipients has not been thoroughly evaluated in Europe. Therefore, we compared the outcome of ECD and non-ECD kidney transplantations in a Dutch cohort, stratifying by age and diabetes. In all first Dutch kidney transplants in recipients ≥18 years between 1995 and 2005, both relative risks (hazard ratios, HR) and adjusted absolute risk differences (RD) for ECD kidney transplantation were analysed. In 3062 transplantations [recipient age 49.0 (12.8) years; 20% ECD], ECD kidney transplantation was associated with graft failure including death [HR 1.62 (1.44-1.82)]. The adjusted HR was lower in recipients ≥60 years of age [1.32 (1.07-1.63)] than in recipients 40-59 years [1.71 (1.44-2.02) P = 0.12 for comparison with ≥60 years] and recipients 18-39 years [1.92 (1.42-2.62) P = 0.03 for comparison with ≥60 years]. RDs showed a similar pattern. In diabetics, the risks for graft failure and death were higher than in the nondiabetics. ECD kidney grafts have a poorer prognosis than non-ECD grafts, especially in younger recipients (<60 years), and diabetic recipients. Further studies and ethical discussions should reveal whether ECD kidneys should preferentially be allocated to specific subgroups, such as elderly and nondiabetic individuals.
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Affiliation(s)
- Frans J van Ittersum
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Joke I Roodnat
- Department of Nephrology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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12
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Hinten F, Hilbrands LB, Meeuwis KAP, IntHout J, Quint WGV, Hoitsma AJ, Massuger LFAG, Melchers WJG, de Hullu JA. Reactivation of Latent HPV Infections After Renal Transplantation. Am J Transplant 2017; 17:1563-1573. [PMID: 28009475 DOI: 10.1111/ajt.14181] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 07/12/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 01/25/2023]
Abstract
Female renal transplant recipients (RTRs) have an increased risk for developing human papillomavirus (HPV)-related (pre)malignant lesions of the genital tract. This study aims to assess the genital prevalence of HPV before and after renal transplantation (RT). In female patients who were counseled for RT at the Radboud University Medical Center Nijmegen, the Netherlands, gynecological examination was performed at first visit, and 1 and 2 years later. HPV self-sampling and questionnaires on sexual behavior were performed every 3 months. In 65 patients who underwent RT, the high-risk human papillomavirus (hrHPV) prevalence as assessed with the highly sensitive SPF10 -LiPA25 test increased significantly from 19% before to 31% after RT (p = 0.045). Based upon the clinically validated Cobas 4800 HPV test, the hrHPV prevalence increased from 10% before to 14% after RT (p = 0.31). During follow-up, no changes in sexual behavior were reported. Thirty-three patients who did not undergo RT showed a hrHPV prevalence of 21% at study entry and of 27% after 12 months with the sensitive test, and a stable prevalence of 16% with the clinically validated test. The results of this study indicate that activation of latent HPV infections may contribute to the increased risk of HPV-related (pre)malignant lesions in female RTRs.
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Affiliation(s)
- F Hinten
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - K A P Meeuwis
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J IntHout
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - W G V Quint
- Delft Diagnostic Laboratory, Rijswijk, the Netherlands
| | - A J Hoitsma
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L F A G Massuger
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - W J G Melchers
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J A de Hullu
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
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13
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Dobrowolski LC, van Huis M, van der Lee JH, Peters Sengers H, Liliën MR, Cransberg K, Cornelissen M, Bouts AH, de Fijter JW, Berger SP, van Zuilen A, Nurmohamed SA, Betjes MHG, Hilbrands L, Hoitsma AJ, Bemelman FJ, Paul Krediet CT, Groothoff JW. Epidemiology and management of hypertension in paediatric and young adult kidney transplant recipients in The Netherlands. Nephrol Dial Transplant 2017; 32:402. [PMID: 28186547 DOI: 10.1093/ndt/gfw449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Linn C Dobrowolski
- Department of Internal Medicine: Nephrology and Kidney Transplantation, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands
| | - Maike van Huis
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center at the University of Amsterdam, AZ Amsterdam, The Netherlands
| | - Johanna H van der Lee
- Pediatric Clinical Research Office, Emma Children's Hospital, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands
| | - Hessel Peters Sengers
- Department of Internal Medicine: Nephrology and Kidney Transplantation, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands
| | - Marc R Liliën
- Department of Pediatric Nephrology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karlien Cransberg
- Department of Pediatric Nephrology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marlies Cornelissen
- Department of Pediatric Nephrology, St Radboud University Medical Center, Nijmegen, The Netherlands
| | - Antonia H Bouts
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center at the University of Amsterdam, AZ Amsterdam, The Netherlands
| | - Johan W de Fijter
- Department of Internal Medicine: Nephrology and Kidney Transplantation, Leiden University Medical Center, Leiden, The Netherlands
| | - Stefan P Berger
- Department of Internal Medicine: Nephrology and Kidney Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjan van Zuilen
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Shaikh A Nurmohamed
- Department of Nephrology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Michiel H G Betjes
- Department of Internal Medicine: Nephrology and Kidney Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Luuk Hilbrands
- Department of Internal Medicine: Nephrology and Kidney Transplantation, St Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Frederike J Bemelman
- Department of Internal Medicine: Nephrology and Kidney Transplantation, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands
| | - C T Paul Krediet
- Department of Internal Medicine, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap W Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center at the University of Amsterdam, AZ Amsterdam, The Netherlands
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14
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Haase-Kromwijk BJJM, Heemskerk MBA, Weimar W, Berger SP, Hoitsma AJ. [Waiting list registration for kidney transplants must improve]. Ned Tijdschr Geneeskd 2017; 161:D812. [PMID: 28378695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate how the composition of the waiting list for postmortem kidney transplant has developed, and whether the waiting list reflects actual demand. DESIGN Retrospective research and cohort study. METHOD We used data from the period 2000-2014 from the Dutch Transplant Foundation, 'RENINE' and Eurotransplant. This concerned data on postmortem kidney donation, live donor transplants, the waiting list and kidney transplantation. RESULTS The postmortem kidney transplant waiting list included transplantable (T) and non-transplantable (NT) patients. The number of T-patients declined from 1271 in 2000 to 650 in 2014, and the median waiting time between the start of dialysis and postmortem kidney transplant decreased from 4.1 years in 2006 to 3.1 years in 2014. The total number of patients on the waiting list, however, increased from 2263 in 2000 to 2560 in 2014 and in the same period the number of new patient registrations increased from 772 to 1212. In about 80% of the NT-patients the reason for their NT status was not registered. A cohort analysis showed that NT-patients have a 2-times lower chance of a postmortem kidney transplant and a 2-times higher chance of leaving the waiting list without transplantation or of live-donor transplantation. CONCLUSION The demand for donor kidneys remains high. The increased number of transplants resulted in a declining waiting list for T-patients while the total waiting list is getting longer. Waiting list registration and maintenance need to be improved, to give better insight into the real demand.
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15
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Dobrowolski LC, van Huis M, van der Lee JH, Peters Sengers H, Liliën MR, Cransberg K, Cornelissen M, Bouts AH, de Fijter JW, Berger SP, van Zuilen A, Nurmohamed SA, Betjes MH, Hilbrands L, Hoitsma AJ, Bemelman FJ, Krediet P, Groothoff JW. Epidemiology and management of hypertension in paediatric and young adult kidney transplant recipients in The Netherlands. Nephrol Dial Transplant 2016; 31:1947-1956. [DOI: 10.1093/ndt/gfw225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/18/2016] [Indexed: 12/16/2022] Open
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16
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Wirken L, van Middendorp H, Hooghof CW, Rovers MM, Hoitsma AJ, Hilbrands LB, Evers AWM. The Course and Predictors of Health-Related Quality of Life in Living Kidney Donors: A Systematic Review and Meta-Analysis. Am J Transplant 2015; 15:3041-54. [PMID: 26414703 DOI: 10.1111/ajt.13453] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 07/05/2015] [Accepted: 07/06/2015] [Indexed: 01/25/2023]
Abstract
A better understanding of the course and risk factors for impaired long-term health-related quality of life (HRQoL; ie, physical, psychological, and social-relational functioning) after kidney donation might help clinicians improve the care of live kidney donors. This systematic review and meta-analysis summarizes prospective studies about the course and predictors of HRQoL in living kidney donors. Studies indicate that shortly after donation, donors have lower HRQoL, with minor to moderate changes in psychological and social-relational functioning and major changes in physical functioning. At 3-12 months after donation, HRQoL returned to baseline or was slightly reduced, particularly for fatigue, but scores were still comparable to general population norms. Results were mainly robust across surgery techniques. A limited number of studies examined risk factors for impaired HRQoL, with low psychological functioning before donation as the most consistent predictor. Based on these results, clinicians can inform potential donors that, on average, kidney donors have high long-term HRQoL; however, donors with low psychological functioning at baseline are those most at risk of impaired long-term HRQoL. Future studies should focus on other potentially relevant predictors of postdonation HRQoL, including donor eligibility criteria and donor-recipient relationships, to optimize screening and interventions for donors at risk.
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Affiliation(s)
- L Wirken
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden, The Netherlands.,Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
| | - H van Middendorp
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden, The Netherlands.,Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
| | - C W Hooghof
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - M M Rovers
- Radboud Institute of Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - A J Hoitsma
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - L B Hilbrands
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - A W M Evers
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden, The Netherlands.,Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
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17
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Hemke AC, Heemskerk MBA, van Diepen M, Dekker FW, Hoitsma AJ. Improved Mortality Prediction in Dialysis Patients Using Specific Clinical and Laboratory Data. Am J Nephrol 2015; 42:158-67. [PMID: 26406283 DOI: 10.1159/000439181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 07/29/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Risk prediction models can be used to inform patients undergoing renal replacement therapy about their survival chances. Easily available predictors such as registry data are most convenient, but their predictive value may be limited. We aimed to improve a simple prediction model based on registry data by incrementally adding sets of clinical and laboratory variables. METHODS Our data set includes 1,835 Dutch patients from the Netherlands Cooperative Study on the Adequacy of Dialysis. The potential survival predictors were categorized on availability. The first category includes easily available clinical data. The second set includes laboratory values like albumin. The most laborious category contains glomerular filtration rate (GFR) and Kt/V. Missing values were substituted using multiple imputation. Within 1,225 patients, we recalibrated the registry model and subsequently added parameter sets using multivariate Cox regression analyses with backward selection. On the other 610 patients, calibration and discrimination (C-index, integrated discrimination improvement (IDI) index and net reclassification improvement (NRI) index) were assessed for all models. RESULTS The recalibrated registry model showed adequate calibration and discrimination (C-index=0.724). Adding easily available parameters resulted in a model with 10 predictors, with similar calibration and improved discrimination (C-index=0.784). The IDI and NRI indices confirmed this, especially for short-term survival. Adding laboratory values resulted in an alternative model with similar discrimination (C-index=0.788), and only the NRI index showed minor improvement. Adding GFR and Kt/V as candidate predictors did not result in a different model. CONCLUSION A simple model based on registry data was enhanced by adding easily available clinical parameters.
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Affiliation(s)
- Aline C Hemke
- Dutch Transplant Foundation, Organ Centre, Leiden, The Netherlands
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18
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Brunschot DMDÖV, Hoitsma AJ, van der Jagt MFP, d'Ancona FC, Donders RART, van Laarhoven CJHM, Hilbrands LB, Warlé MC. Nighttime kidney transplantation is associated with less pure technical graft failure. World J Urol 2015; 34:955-61. [PMID: 26369548 PMCID: PMC4921110 DOI: 10.1007/s00345-015-1679-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 04/17/2015] [Accepted: 08/28/2015] [Indexed: 01/06/2023] Open
Abstract
Purpose To minimize cold ischemia time, transplantations with kidneys from deceased donors are frequently performed during the night.
However, sleep deprivation of those who perform the transplantation may have adverse effects on cognitive and psychomotor performance and may cause reduced cognitive flexibility. We hypothesize that renal transplantations performed during the night are associated with an increased incidence of pure technical graft failure. Methods A retrospective analysis of data of the Dutch Organ Transplant Registry concerning all transplants from deceased donors between 2000 and 2013 was performed. Nighttime surgery was defined as the start of the procedure between 8 p.m. and 8 a.m. The primary outcome measure was technical graft failure, defined as graft loss within 10 days after surgery without signs of (hyper)acute rejection. Results Of 4.519 renal transplantations in adult recipients, 1.480 were performed during the night. The incidence of pure technical graft failure was 1.0 % for procedures started during the night versus 2.6 % for daytime surgery (p = .001). In a multivariable model, correcting for relevant donor, recipient and graft factors, daytime surgery was an independent predictor of pure technical graft failure (p < .001). Conclusions Limitation of this study is mainly to its retrospective design, and the influence of some relevant variables, such as the experience level of the surgeon, could not be assessed. We conclude that nighttime surgery is associated with less pure technical graft failures. Further research is required to explore factors that may positively influence the performance of the surgical team during the night.
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Affiliation(s)
- Denise M D Özdemir-van Brunschot
- Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Center Nijmegen, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Andries J Hoitsma
- Department of Nephrology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Michel F P van der Jagt
- Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Center Nijmegen, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Frank C d'Ancona
- Department of Urology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Rogier A R T Donders
- Department of Health Evidence, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Cees J H M van Laarhoven
- Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Center Nijmegen, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Michiel C Warlé
- Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Center Nijmegen, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
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19
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Koopman JJE, Rozing MP, Kramer A, Abad JM, Finne P, Heaf JG, Hoitsma AJ, De Meester JMJ, Palsson R, Postorino M, Ravani P, Wanner C, Jager KJ, van Bodegom D, Westendorp RGJ. Calculating the Rate of Senescence From Mortality Data: An Analysis of Data From the ERA-EDTA Registry. J Gerontol A Biol Sci Med Sci 2015; 71:468-74. [PMID: 25887122 DOI: 10.1093/gerona/glv042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 01/29/2014] [Accepted: 03/19/2015] [Indexed: 11/13/2022] Open
Abstract
The rate of senescence can be inferred from the acceleration by which mortality rates increase over age. Such a senescence rate is generally estimated from parameters of a mathematical model fitted to these mortality rates. However, such models have limitations and underlying assumptions. Notably, they do not fit mortality rates at young and old ages. Therefore, we developed a method to calculate senescence rates from the acceleration of mortality directly without modeling the mortality rates. We applied the different methods to age group-specific mortality data from the European Renal Association-European Dialysis and Transplant Association Registry, including patients with end-stage renal disease on dialysis, who are known to suffer from increased senescence rates (n = 302,455), and patients with a functioning kidney transplant (n = 74,490). From age 20 to 70, senescence rates were comparable when calculated with or without a model. However, when using non-modeled mortality rates, senescence rates were yielded at young and old ages that remained concealed when using modeled mortality rates. At young ages senescence rates were negative, while senescence rates declined at old ages. In conclusion, the rate of senescence can be calculated directly from non-modeled mortality rates, overcoming the disadvantages of an indirect estimation based on modeled mortality rates.
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Affiliation(s)
- Jacob J E Koopman
- Department of Gerontology and Geriatrics, Leiden University Medical Center, the Netherlands. Leyden Academy on Vitality and Ageing, the Netherlands.
| | | | - Anneke Kramer
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center Amsterdam, the Netherlands
| | - José M Abad
- Renal Registry of Aragon, Health Planning Department, Health and Consumers Affairs Department Aragon, Zaragoza, Spain
| | - Patrik Finne
- Finnish Registry for Kidney Diseases, Helsinki, Finland. Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
| | - James G Heaf
- Department of Nephrology B, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Andries J Hoitsma
- Department of Nephrology, Radboud University Nijmegen Medical Centre, the Netherlands
| | - Johan M J De Meester
- Department of Nephrology, Dialysis and Hypertension, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Runolfur Palsson
- Division of Nephrology, Landspitali-The National University Hospital of Iceland and Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Maurizio Postorino
- Nephrology, Dialysis and Transplantation Unit, Azienda Ospedaliera di Reggio Calabria, Reggio Calabria, Italy
| | - Pietro Ravani
- Division of Nephrology, Department of Medicine, University of Calgary, Canada
| | - Christoph Wanner
- Division of Nephrology, Department of Internal Medicine I, University of Würzburg, Germany
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center Amsterdam, the Netherlands
| | - David van Bodegom
- Department of Gerontology and Geriatrics, Leiden University Medical Center, the Netherlands. Leyden Academy on Vitality and Ageing, the Netherlands
| | - Rudi G J Westendorp
- Department of Gerontology and Geriatrics, Leiden University Medical Center, the Netherlands. Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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20
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Meeuwis KAP, Hilbrands LB, IntHout J, Slangen BFM, Hendriks IMP, Hinten F, Christiaans MHL, Quint WGV, van de Kerkhof PCM, Massuger LFAG, Hoitsma AJ, van Rossum MM, Melchers WJG, de Hullu JA. Cervicovaginal HPV infection in female renal transplant recipients: an observational, self-sampling based, cohort study. Am J Transplant 2015; 15:723-33. [PMID: 25675976 DOI: 10.1111/ajt.13053] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 05/05/2014] [Revised: 09/21/2014] [Accepted: 10/04/2014] [Indexed: 01/25/2023]
Abstract
Immunosuppressive treatment of organ transplant recipients is associated with an increase in the occurrence of human papillomavirus (HPV) related anogenital (pre)malignancies. This cohort study investigated the genotype-specific prevalence of HPV infections in a large cohort of female renal transplant recipients (RTRs). Participants self-collected a cervicovaginal sample for detection and genotyping of HPV. Besides, they completed a questionnaire regarding sociodemographic variables, medical data and sexual behavior. Anogenital screening was offered to all HPV-positive participants. A total number of 218 female RTRs was included. The prevalence of mucosal HPV infections was 27.1% and 17.4% for high risk HPV in particular. The studied cohort showed a broad range of HPV genotypes and multiple HPV genotypes were found in 27.1% of HPV-positive patients. Seven participants were identified with occult premalignant anogenital lesions. In conclusion, this study shows a high point-prevalence of HPV in female RTRs (age-matched West-European general population: 9-10%) with a shift in the distribution of genotypes as compared with the general population. Moreover, a substantial number of patients with occult premalignancies was identified. The introduction of self-sampling for HPV positivity can help in early detection of (pre)malignant anogenital lesions in this vulnerable population.
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Affiliation(s)
- K A P Meeuwis
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, The Netherlands; Department of Dermatology, Radboud university medical center, Nijmegen, The Netherlands
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21
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van Dijk PR, Kramer A, Logtenberg SJJ, Hoitsma AJ, Kleefstra N, Jager KJ, Bilo HJG. Incidence of renal replacement therapy for diabetic nephropathy in the Netherlands: Dutch diabetes estimates (DUDE)-3. BMJ Open 2015; 5:e005624. [PMID: 25636789 PMCID: PMC4316478 DOI: 10.1136/bmjopen-2014-005624] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Describe the incidence, prevalence and survival of patients needing renal replacement therapy (RRT) for end-stage renal disease (ESRD) due to diabetes mellitus (DM)-related glomerulosclerosis or nephropathy (diabetic nephropathy, DN) in the Netherlands. DESIGN Using the national registry for RRT (RENINE-registry), data of all Dutch individuals initiating RRT for ESRD and having DN as primary diagnosis in the period 2000-2012 were obtained. SETTING Observational study in the Netherlands. PATIENTS Patients with ESRD needing RRT for DN. OUTCOME MEASUREMENTS Age and gender adjusted incidence and prevalence of RRT for DN in the period 2000-2012. In addition, trends in time and patient's survival were examined. RESULTS The prevalence of DM in the general population increased from approximately 466 000 in 2000 to 815 000 in 2011. The number of individuals who started RRT with DN as primary diagnosis was 17.4 per million population (pmp) in 2000 and 19.1 pmp in 2012, with an annual percentage change (APC) of 0.8% (95% CI -0.4 to 2.0). For RRT due to type 1 DN, the incidence decreased from 7.3 to 3.5 pmp (APC -4.8%, 95% CI -6.5 to -3.1) while it increased for type 2 DN from 10.1 to 15.6 pmp (APC 3.1%, 95% CI 1.3 to 4.8). After 2009, the prevalence of RRT for DN remained stable (APC 1.0%, 95% CI -0.4 to 2.5). Compared to the period 2000-2004, patients initiating RRT and dialysis in 2005-2009 had better survival, HRs 0.8 (95% CI 0.7 to 0.8) and 0.8 (95% CI 0.7 to 0.9), respectively, while survival after kidney transplantation remained stable, HR 0.8, 95% CI 0.5 to 1.1). CONCLUSIONS Over the last decade, the incidence of RRT for DN was stable, with a decrease in RRT due to type 1 DN and an increase due to type 2 DN, while survival increased.
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Affiliation(s)
| | - Anneke Kramer
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, ERA-EDTA Registry, Amsterdam, The Netherlands
| | - Susan J J Logtenberg
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Andries J Hoitsma
- Department of Nephrology, Radboud University Medical Centre, Nijmegen, The Netherlands
- RENINE Registry, Leiden, The Netherlands
| | - Nanne Kleefstra
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kitty J Jager
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, ERA-EDTA Registry, Amsterdam, The Netherlands
| | - Henk J G Bilo
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Internal Medicine, Isala, Zwolle, The Netherlands
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22
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Hoogendijk-van den Akker JM, Warlé MC, van Zuilen AD, Kloke HJ, Wever KE, d'Ancona FCH, Ӧzdemir DMD, Wetzels JFM, Hoitsma AJ. Urinary biomarkers after donor nephrectomy. Transpl Int 2015; 28:544-52. [PMID: 25581388 DOI: 10.1111/tri.12523] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 04/04/2014] [Accepted: 01/04/2015] [Indexed: 11/27/2022]
Abstract
As the beginning of living-donor kidney transplantation, physicians have expressed concern about the possibility that unilateral nephrectomy can be harmful to a healthy individual. To investigate whether the elevated intra-abdominal pressure (IAP) during laparoscopic donor nephrectomy causes early damage to the remaining kidney, we evaluated urine biomarkers after laparoscopic donor nephrectomy. We measured albumin and alpha-1-microglobulin (α-1-MGB) in urine samples collected during and after open and laparoscopic donor nephrectomy and laparoscopic cholecystectomy and colectomy. Additionally, kidney injury molecule 1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) were measured in urine samples collected during and after laparoscopic donor nephrectomy and colectomy. The same biomarkers were studied in patients randomly assigned to standard or low IAP during laparoscopic donor nephrectomy. We observed a peak in urinary albumin excretion during all procedures. Urine α-1-MGB rose in the postoperative period with a peak on the third postoperative day after donor nephrectomy. Urine α-1-MGB did not increase after laparoscopic cholecystectomy and colectomy. After laparoscopic nephrectomy, we observed slight increases in urine KIM-1 during surgery and in urine NGAL at day 2-3 after the procedure. After laparoscopic colectomy, both KIM-1 and NGAL were increased in the postoperative period. There were no differences between the high- and low-pressure procedure. Elevated urinary α-1-MGB suggests kidney damage after donor nephrectomy, occurring irrespective of IAP during the laparoscopic procedure.
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Affiliation(s)
- Judith M Hoogendijk-van den Akker
- Department of Nephrology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands; Department of Nephrology, Isala Zwolle, Zwolle, The Netherlands
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23
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Wühl E, van Stralen KJ, Wanner C, Ariceta G, Heaf JG, Bjerre AK, Palsson R, Duneau G, Hoitsma AJ, Ravani P, Schaefer F, Jager KJ. Renal replacement therapy for rare diseases affecting the kidney: an analysis of the ERA-EDTA Registry. Nephrol Dial Transplant 2014; 29 Suppl 4:iv1-8. [PMID: 25165174 DOI: 10.1093/ndt/gfu030] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In recent years, increased efforts have been undertaken to address the needs of patients with rare diseases by international initiatives and consortia devoted to rare disease research and management. However, information on the overall prevalence of rare diseases within the end-stage renal disease (ESRD) population is limited. The aims of this study were (i) to identify those rare diseases within the ERA-EDTA Registry for which renal replacement therapy (RRT) is being provided and (ii) to determine the prevalence and incidence of RRT for ESRD due to rare diseases, both overall and separately for children and adults. METHODS The Orphanet classification of rare disease was searched for rare diseases potentially causing ESRD, and these diagnosis codes were mapped to the corresponding ERA-EDTA primary renal disease codes. Thirty-one diagnoses were defined as rare diseases causing ESRD. RESULTS From 1 January 2007 to 31 December 2011, 7194 patients started RRT for a rare disease (10.6% children). While some diseases were exclusively found in adults (e.g. Fabry disease), primary oxalosis, cystinosis, congenital anomalies of the kidney and urinary tract (CAKUT) and medullary cystic kidney disease affected young patients in up to 46%. On 31 December 2011, 20 595 patients (12.4% of the total RRT population) were on RRT for ESRD caused by a rare disease. The point prevalence was 32.5 per million age-related population in children and 152.0 in adults. Only 5.8% of these patients were younger than 20 years; however, 57.7% of all children on RRT had a rare disease, compared with only 11.9% in adults. CAKUT and focal segmental glomerulosclerosis were the most prevalent rare disease entities among patients on RRT. CONCLUSIONS More than half of all children and one of nine adults on RRT in the ERA-EDTA Registry suffer from kidney failure due to a rare disease, potentially with a large number of additional undiagnosed or miscoded cases. Comprehensive diagnostic assessment and the application of accurate disease classification systems are essential for improving the identification and management of patients with rare kidney diseases.
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Affiliation(s)
- Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Karlijn J van Stralen
- ERA-EDTA Registry and ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Christoph Wanner
- Department of Internal Medicine I, Division of Nephrology, University of Würzburg, Würzburg, Germany
| | - Gema Ariceta
- Servicio de Nefrología Pediátrica y Hemodiálisis, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, Spain
| | - James Goya Heaf
- Department of Nephrology, Copenhagen University Hospital at Herlev, Herlev, Denmark
| | - Anna K Bjerre
- Department of Pediatrics, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Runolfur Palsson
- Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Gabrielle Duneau
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Andries J Hoitsma
- Department of Nephrology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Pietro Ravani
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Kitty J Jager
- ERA-EDTA Registry and ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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24
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Otten HG, Joosten I, Allebes WA, van der Meer A, Hilbrands LB, Baas M, Spierings E, Hack CE, van Reekum F, van Zuilen AD, Verhaar MC, Bots ML, Seelen MAJ, Sanders JSF, Hepkema BG, Lambeck AJ, Bungener LB, Roozendaal C, Tilanus MGJ, Vanderlocht J, Voorter CE, Wieten L, van Duijnhoven E, Gelens M, Christiaans M, van Ittersum F, Nurmohamed A, Lardy NM, Swelsen WT, van Donselaar-van der Pant KAMI, van der Weerd NC, Ten Berge IJM, Bemelman FJ, Hoitsma AJ, de Fijter JW, Betjes MGH, Roelen DL, Claas FHJ. The PROCARE consortium: toward an improved allocation strategy for kidney allografts. Transpl Immunol 2014; 31:184-90. [PMID: 25258025 DOI: 10.1016/j.trim.2014.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Kidney transplantation is the best treatment option for patients with end-stage renal failure. At present, approximately 800 Dutch patients are registered on the active waiting list of Eurotransplant. The waiting time in the Netherlands for a kidney from a deceased donor is on average between 3 and 4 years. During this period, patients are fully dependent on dialysis, which replaces only partly the renal function, whereas the quality of life is limited. Mortality among patients on the waiting list is high. In order to increase the number of kidney donors, several initiatives have been undertaken by the Dutch Kidney Foundation including national calls for donor registration and providing information on organ donation and kidney transplantation. The aim of the national PROCARE consortium is to develop improved matching algorithms that will lead to a prolonged survival of transplanted donor kidneys and a reduced HLA immunization. The latter will positively affect the waiting time for a retransplantation. The present algorithm for allocation is among others based on matching for HLA antigens, which were originally defined by antibodies using serological typing techniques. However, several studies suggest that this algorithm needs adaptation and that other immune parameters which are currently not included may assist in improving graft survival rates. We will employ a multicenter-based evaluation on 5429 patients transplanted between 1995 and 2005 in the Netherlands. The association between key clinical endpoints and selected laboratory defined parameters will be examined, including Luminex-defined HLA antibody specificities, T and B cell epitopes recognized on the mismatched HLA antigens, non-HLA antibodies, and also polymorphisms in complement and Fc receptors functionally associated with effector functions of anti-graft antibodies. From these data, key parameters determining the success of kidney transplantation will be identified which will lead to the identification of additional parameters to be included in future matching algorithms aiming to extend survival of transplanted kidneys and to diminish HLA immunization. Computer simulation studies will reveal the number of patients having a direct benefit from improved matching, the effect on shortening of the waiting list, and the decrease in waiting time.
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Affiliation(s)
- H G Otten
- UMC Utrecht, Laboratory for Translational Immunology, The Netherlands
| | - I Joosten
- Radboudumc, Dept. of Laboratory Medicine, The Netherlands
| | - W A Allebes
- Radboudumc, Dept. of Laboratory Medicine, The Netherlands
| | - A van der Meer
- Radboudumc, Dept. of Laboratory Medicine, The Netherlands
| | | | - M Baas
- Radboudumc, Dept. of Nephrology, The Netherlands
| | - E Spierings
- UMC Utrecht, Laboratory for Translational Immunology, The Netherlands
| | - C E Hack
- UMC Utrecht, Laboratory for Translational Immunology, The Netherlands
| | - F van Reekum
- UMC Utrecht, Dept. of Nephrology and Hypertension, The Netherlands
| | - A D van Zuilen
- UMC Utrecht, Dept. of Nephrology and Hypertension, The Netherlands
| | - M C Verhaar
- UMC Utrecht, Dept. of Nephrology and Hypertension, The Netherlands
| | - M L Bots
- UMC Utrecht, Julius Center for Health Sciences and Primary Care, The Netherlands
| | | | | | - B G Hepkema
- UMCG, Dept. of Laboratory Medicine, The Netherlands
| | - A J Lambeck
- UMCG, Dept. of Laboratory Medicine, The Netherlands
| | - L B Bungener
- UMCG, Dept. of Laboratory Medicine, The Netherlands
| | - C Roozendaal
- UMCG, Dept. of Laboratory Medicine, The Netherlands
| | - M G J Tilanus
- Maastricht UMC, Transplantation Immunology, The Netherlands
| | - J Vanderlocht
- Maastricht UMC, Transplantation Immunology, The Netherlands
| | - C E Voorter
- Maastricht UMC, Transplantation Immunology, The Netherlands
| | - L Wieten
- Maastricht UMC, Transplantation Immunology, The Netherlands
| | | | - M Gelens
- Maastricht UMC, Dept. of Nephrology, The Netherlands
| | - M Christiaans
- Maastricht UMC, Dept. of Nephrology, The Netherlands
| | | | | | - N M Lardy
- Sanquin, Dept. of Immunogenetics, The Netherlands
| | - W T Swelsen
- Sanquin, Dept. of Immunogenetics, The Netherlands
| | | | | | - I J M Ten Berge
- AMC Renal Transplant Unit, Dept. of Nephrology, The Netherlands
| | - F J Bemelman
- AMC Renal Transplant Unit, Dept. of Nephrology, The Netherlands
| | | | | | - M G H Betjes
- Erasmus MC, Dept. of Nephrology, The Netherlands
| | - D L Roelen
- LUMC, Immunohematology and Blood Transfusion, The Netherlands
| | - F H J Claas
- LUMC, Immunohematology and Blood Transfusion, The Netherlands
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25
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Dobrowolski LC, Bemelman FJ, van Donselaar-van der Pant KAMI, Hoitsma AJ, ten Berge IJM, Krediet CTP. Treatment efficacy of hypertension in kidney transplant recipients in the Netherlands. Neth J Med 2014; 72:258-263. [PMID: 24930459] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Hypertension in kidney transplant recipients jeopardises graft and patient survival. Guidelines suggest blood pressure targets of ≤130/80 mmHg and sodium intake <90 mmol/day. METHODS Since the efficacy of antihypertensive treatment among kidney transplant recipients is unknown, we analysed data on office-based blood pressure and use of antihypertensive drugs from the Netherlands Organ Transplant Registry on 5415 kidney transplant recipients. Additionally, we studied dosages, prevalence of treatment-resistant hypertension and 24-hour sodium excretion in 534 kidney transplant recipients from our centre to explore possibilities for therapy optimisation. RESULTS In patients registered in the Netherlands Organ Transplant Registry, median blood pressure was 134/80 mmHg (interquartile range 122-145/70-85). In 77.2%, the blood pressure was ≥130/80 mmHg; of these patients 10.4% had no registered use, 30.0% used one and 25.9% used ≥3 classes of antihypertensive agents. Parameters from our centre were comparable: 78.7% had a median blood pressure of ≥130/80 mmHg of whom 14.5% had no registered use of antihypertensives and 26.4% used ≥3 classes. Sub-maximal dosages were prescribed in 74.0% of the kidney transplant recipients with a blood pressure of ≥130/80 mmHg while using at least one antihypertensive agent. Treatment-resistant hypertension was present in 7.7%. Median 24-hour sodium excretion was 147 mmol/day (interquartile range 109-195). CONCLUSIONS This study suggests that therapeutic optimisation of antihypertensive treatment in kidney transplant recipients is, in theory, frequently possible by intensifying pharmacological treatment and by providing more advice on dietary sodium restrictions.
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Affiliation(s)
- L C Dobrowolski
- Department of Internal Medicine, Division of Nephrology - Renal Transplant Unit, Academic Medical Centre, Amsterdam, the Netherlands
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26
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Hemke AC, Heemskerk MBA, van Diepen M, Weimar W, Dekker FW, Hoitsma AJ. Survival prognosis after the start of a renal replacement therapy in the Netherlands: a retrospective cohort study. BMC Nephrol 2013; 14:258. [PMID: 24256551 PMCID: PMC4225578 DOI: 10.1186/1471-2369-14-258] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 01/29/2013] [Accepted: 11/06/2013] [Indexed: 11/21/2022] Open
Abstract
Background There is no single model available to predict the long term survival for patients starting renal replacement therapy (RRT). The available models either predict survival on dialysis until transplantation, survival on the transplant waiting list, or survival after transplantation. The aim of this study was to develop a model that includes dialysis survival and survival after an eventual transplantation. Methods From the Dutch renal replacement registry, patients of 16 years of age or older were included if they started RRT between 1995 and 2005, still underwent RRT at baseline (90 days after the start of RRT) and were not registered at a non-renal organ transplant waiting list (N = 13868). A prediction model of 10-year patient survival after baseline was developed through multivariate Cox regression analysis, in one half of the research group. Age at start, sex, primary renal disease (PRD) and therapy at baseline were included as possible predictors. A sensitivity analysis has been performed to determine whether listing on the transplant waiting list should be added. The predictive performance of the model was internally validated. Calibration and discrimination were computed in the other half of the research group. Another sensitivity analysis was to assess whether the outcomes differed if the model was developed and tested in two geographical regions, which were less similar than the original development and validation group. No external validation has been performed. Results Survival probabilities were influenced by age, sex, PRD and therapy at baseline (p < 0.001). The calibration and discrimination both showed very reasonable results for the prediction model (C-index = 0.720 and calibration slope for the prognostic index = 1.025, for the 10 year survival). Adding registration on the waiting list for renal transplantation as a predictor did not improve the discriminative power of the model and was therefore not included in the model. Conclusions With the presented prediction model, it is possible to give a reasonably accurate estimation on the survival chances of patients who start with RRT, using a limited set of easily available data.
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Affiliation(s)
- Aline C Hemke
- Organ Centre, Dutch Transplant Foundation, Leiden, the Netherlands.
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27
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Goedendorp MM, Hoitsma AJ, Bloot L, Bleijenberg G, Knoop H. Severe fatigue after kidney transplantation: a highly prevalent, disabling and multifactorial symptom. Transpl Int 2013; 26:1007-15. [PMID: 23952141 DOI: 10.1111/tri.12166] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 04/20/2013] [Accepted: 07/21/2013] [Indexed: 11/29/2022]
Abstract
Fatigue is a common symptom of patients with chronic kidney disease, but seldom investigated after transplantation. We determined the prevalence, impact and related factors of severe fatigue in kidney transplant recipients (KTRs). Medical records and questionnaires were used to assess kidney function, donor characteristics, fatigue (Checklist Individual Strength), functional impairments (Sickness Impact Profile), work status, body mass index (BMI), pain, depressive symptoms, social support and sleeping problems in 180 participating KTRs. KTRs were compared with sex- and age-matched population-based controls. KTRs were significantly more often severely fatigued (39%) compared to matched controls (22%; P = 0.001). Severely fatigued KTRs had significantly more functional impairments than nonseverely fatigued recipients (effect size ≥ 0.7) P < 0.001, and less often a paid job (27% vs. 48%, P = 0.005). Univariate analysis showed that severely fatigued KTRs received more often a kidney from a deceased donor, had a higher BMI, more pain, discrepancy in social support, depressive symptoms and sleeping problems. In a multivariate analysis (n = 151) the latter two associations remained significant. Severe fatigue is a highly prevalent and disabling symptom in KTRs. Moreover, severe fatigue after kidney transplantation is more strongly related to behavioural and psychosocial factors than specific transplantation-related factors. Findings have implications for fatigue management.
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Affiliation(s)
- Martine M Goedendorp
- Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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28
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Warlé MC, Berkers AW, Langenhuijsen JF, van der Jagt MF, Dooper PM, Kloke HJ, Pilzecker D, Renes SH, Wever KE, Hoitsma AJ, van der Vliet JA, D'Ancona FCH. Low-pressure pneumoperitoneum during laparoscopic donor nephrectomy to optimize live donors' comfort. Clin Transplant 2013; 27:E478-83. [PMID: 23795745 DOI: 10.1111/ctr.12143] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2013] [Indexed: 11/30/2022]
Abstract
Nowadays, laparoscopic donor nephrectomy (LDN) has become the gold standard to procure live donor kidneys. As the relationship between donor and recipient loosens, it becomes of even greater importance to optimize safety and comfort of the surgical procedure. Low-pressure pneumoperitoneum has been shown to reduce pain scores after laparoscopic cholecystectomy. Live kidney donors may also benefit from the use of low pressure during LDN. To evaluate feasibility and efficacy to reduce post-operative pain, we performed a randomized blinded study. Twenty donors were randomly assigned to standard (14 mmHg) or low (7 mmHg) pressure during LDN. One conversion from low to standard pressure was indicated by protocol due to lack of progression. Intention-to-treat analysis showed that low pressure resulted in a significantly longer skin-to-skin time (149 ± 86 vs. 111 ± 19 min), higher urine output during pneumoperitoneum (23 ± 35 vs. 11 ± 20 mL/h), lower cumulative overall pain score after 72 h (9.4 ± 3.2 vs. 13.5 ± 4.5), lower deep intra-abdominal pain score (11 ± 3.3 vs. 7.5 ± 3.1), and a lower cumulative overall referred pain score (1.8 ± 1.9 vs. 4.2 ± 3). Donor serum creatinine levels, complications, and quality of life dimensions were not significantly different. Our data show that low-pressure pneumoperitoneum during LDN is feasible and may contribute to increase live donors' comfort during the early post-operative phase.
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Affiliation(s)
- M C Warlé
- Division of Vascular- and Transplant Surgery, Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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van den Hoogen MWF, Kho MML, Abrahams AC, van Zuilen AD, Sanders JS, van Dijk M, Hilbrands LB, Weimar W, Hoitsma AJ. Effect of a single intraoperative high-dose ATG-Fresenius on delayed graft function in donation after cardiac-death donor renal allograft recipients: a randomized study. EXP CLIN TRANSPLANT 2013; 11:134-41. [PMID: 23431996 DOI: 10.6002/ect.2012.0220] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Reducing the incidence of delayed graft function after transplant with donation after cardiac death donor renal allografts would facilitate managing recipients during their first weeks after a transplant. To reduce this incidence, in most studies, induction therapy with depleting anti-T-lymphocyte antibodies is coupled with a reduction of the dosage of the calcineurin inhibitor. The separate effect of anti-T-cell therapy on the incidence and duration of delayed graft function is therefore difficult to assess. PATIENTS AND METHODS We performed a randomized study to evaluate the effect of a single intraoperative high-dose of anti-T-lymphocyte immunoglobulin (ATG)-Fresenius (9 mg/kg body weight) on the incidence of delayed graft function. Eligible adult recipients of a first donation after cardiac death donor renal allograft were randomly assigned to ATG-Fresenius or no induction therapy. Maintenance immunosuppression consisted of tacrolimus, in an unadjusted dose, mycophenolate mofetil, and steroids. RESULTS The study was prematurely terminated because of a lower-than-anticipated inclusion rate. Baseline characteristics were comparable in the ATG-Fresenius group (n=28) and the control group (n=24). Twenty-two patients in the ATG-Fresenius group (79%) had delayed graft function, compared with 13 in the control group (54%; P = .06). Allograft and patient survival were comparable in both groups. Serious adverse events occurred more frequently in the ATG-Fresenius group than they did in the control group (57% vs 29%; P < .05). CONCLUSIONS Intraoperative administration of a single high-dose of ATG-Fresenius in donation after cardiac death donor renal allograft recipients, followed by triple immunosuppression with an unadjusted tacrolimus dose, seems ineffective to reduce the incidence of delayed graft function. Moreover, this was associated with a higher rate of serious adverse events (EudraCT-number, 2007-000210-36.).
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Hoogendijk-van den Akker JM, Harden PN, Hoitsma AJ, Proby CM, Wolterbeek R, Bouwes Bavinck JN, de Fijter JW. Two-year randomized controlled prospective trial converting treatment of stable renal transplant recipients with cutaneous invasive squamous cell carcinomas to sirolimus. J Clin Oncol 2013; 31:1317-23. [PMID: 23358973 DOI: 10.1200/jco.2012.45.6376] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE In light of the significant morbidity and mortality of cutaneous invasive squamous cell carcinomas (SCCs) in renal transplant recipients, we investigated whether conversion to sirolimus-based immunosuppression from standard immunosuppression could diminish the recurrence rate of these skin cancers. PATIENTS AND METHODS In a 2-year randomized controlled trial, 155 renal transplant recipients with at least one biopsy-confirmed SCC were stratified according to age (< 55 v ≥ 55 years) and number of previous SCCs (one to nine v ≥ 10) and randomly assigned to conversion to sirolimus (n = 74) or continuation of their original immunosuppression (n = 81). Development of a new SCC within 2 years after random assignment was the primary end point. RESULTS After 2 years of follow-up, the risk reduction of new SCCs in the multivariable analysis was not significant, with a hazard ratio (HR) of 0.76 (95% CI, 0.48 to 1.2; P = .255), compared with a non-sirolimus-based regimen. After the first year, there was a significant 50% risk reduction, with an HR of 0.50 (95% CI, 0.28 to 0.90; P = .021) for all patients together and an HR of 0.11 (95% CI, 0.01 to 0.94; P = .044) for patients with only one previous SCC. The tumor burden of SCC was reduced during the 2-year follow-up period in those receiving sirolimus (0.82 v 1.38 per year; HR, 0.51; 95% CI, 0.32 to 0.82; P = .006) if adjusted for the number of previous SCCs and age. Twenty-nine patients stopped taking sirolimus because of various adverse events. CONCLUSION Conversion to sirolimus-based immunosuppression failed to show a benefit in terms of SCC-free survival at 2 years.
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Ocak G, van Stralen KJ, Rosendaal FR, Verduijn M, Ravani P, Palsson R, Leivestad T, Hoitsma AJ, Ferrer-Alamar M, Finne P, De Meester J, Wanner C, Dekker FW, Jager KJ. Mortality due to pulmonary embolism, myocardial infarction, and stroke among incident dialysis patients. J Thromb Haemost 2012; 10:2484-93. [PMID: 22970891 DOI: 10.1111/j.1538-7836.2012.04921.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND It is has been suggested that dialysis patients have lower mortality rates for pulmonary embolism than the general population, because of platelet dysfunction and bleeding tendency. However, there is limited information whether dialysis is indeed associated with a decreased mortality risk from pulmonary embolism. OBJECTIVE The aim of our study was to evaluate whether mortality rate ratios for pulmonary embolism were lower than for myocardial infarction and stroke in dialysis patients compared with the general population. METHODS Cardiovascular causes of death for 130,439 incident dialysis patients registered in the ERA-EDTA Registry were compared with the cardiovascular causes of death for the European general population. RESULTS The age- and sex-standardized mortality rate (SMR) from pulmonary embolism was 12.2 (95% CI 10.2-14.6) times higher in dialysis patients than in the general population. The SMRs in dialysis patients compared with the general population were 11.0 (95% CI 10.6-11.4) for myocardial infarction, 8.4 (95% CI 8.0-8.8) for stroke, and 8.3 (95% CI 8.0-8.5) for other cardiovascular diseases. In dialysis patients, primary kidney disease due to diabetes was associated with an increased mortality risk due to pulmonary embolism (HR 1.9; 95% CI 1.0-3.8), myocardial infarction (HR 4.1; 95% CI 3.4-4.9), stroke (HR 3.5; 95% CI 2.8-4.4), and other cardiovascular causes of death (HR 3.4; 95% CI 2.9-3.9) compared with patients with polycystic kidney disease. CONCLUSIONS Dialysis patients were found to have an unexpected highly increased mortality rate for pulmonary embolism and increased mortality rates for myocardial infarction and stroke.
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Affiliation(s)
- G Ocak
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
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Temme J, Kramer A, Jager KJ, Lange K, Peters F, Müller GA, Kramar R, Heaf JG, Finne P, Palsson R, Reisæter AV, Hoitsma AJ, Metcalfe W, Postorino M, Zurriaga O, Santos JP, Ravani P, Jarraya F, Verrina E, Dekker FW, Gross O. Outcomes of male patients with Alport syndrome undergoing renal replacement therapy. Clin J Am Soc Nephrol 2012; 7:1969-76. [PMID: 22997344 DOI: 10.2215/cjn.02190312] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients with the hereditary disease Alport syndrome commonly require renal replacement therapy (RRT) in the second or third decade of life. This study compared age at onset of RRT, renal allograft, and patient survival in men with Alport syndrome receiving various forms of RRT (peritoneal dialysis, hemodialysis, or transplantation) with those of men with other renal diseases. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Patients with Alport syndrome receiving RRT identified from 14 registries in Europe were matched to patients with other renal diseases. A linear spline model was used to detect changes in the age at start of RRT over time. Kaplan-Meier method and Cox regression analysis were used to examine patient and graft survival. RESULTS Age at start of RRT among patients with Alport syndrome remained stable during the 1990s but increased by 6 years between 2000-2004 and 2005-2009. Survival of patients with Alport syndrome requiring dialysis or transplantation did not change between 1990 and 2009. However, patients with Alport syndrome had better renal graft and patient survival than matched controls. Numbers of living-donor transplantations were lower in patients with Alport syndrome than in matched controls. CONCLUSIONS These data suggest that kidney failure in patients with Alport syndrome is now being delayed compared with previous decades. These patients appear to have superior patient survival while undergoing dialysis and superior patient and graft survival after deceased-donor kidney transplantation compared with patients receiving RRT because of other causes of kidney failure.
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Affiliation(s)
- Johanna Temme
- Dept Nephrology&Rheumatology, University Medical Center Göttingen, Göttingen, Germany
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Jansen NE, de Groot YJ, van Leiden HA, Haase-Kromwijk BJJM, Kompanje EJO, Hoitsma AJ. Imprecise definitions of starting points in retrospectively reviewing potential organ donors causes confusion: call for a reproducible method like ‘imminent brain death’. Transpl Int 2012; 25:830-7. [DOI: 10.1111/j.1432-2277.2012.01505.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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van den Hoogen MWF, Hoitsma AJ, Hilbrands LB. Anti-T-cell antibodies for the treatment of acute rejection after renal transplantation. Expert Opin Biol Ther 2012; 12:1031-42. [DOI: 10.1517/14712598.2012.689278] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Stel VS, Kramar R, Leivestad T, Hoitsma AJ, Metcalfe W, Smits JM, Ravani P, Jager KJ. Time trend in access to the waiting list and renal transplantation: a comparison of four European countries. Nephrol Dial Transplant 2012; 27:3621-31. [PMID: 22555254 DOI: 10.1093/ndt/gfs089] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [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] Open
Abstract
BACKGROUND To examine the time trend and international differences in access to the waiting list and renal transplantation of patients with end-stage kidney disease. METHODS We included all patients (n = 30 961) from Austria, Norway, the Netherlands and Scotland who started renal replacement therapy (RRT) between 1995 and 2003 with their kidney transplant waiting list data (until 31 December 2005) and follow-up data on RRT and mortality (until 31 December 2007). The outcome measure was access to the waiting list within 2 years and to a first renal transplant within 4 years from the start of RRT, expressed as incidence per million age-related population (p.m.a.r.p.) per year. To estimate trends over time, mean percentage annual change (MPAC) and 95% confidence interval (CI) were calculated. RESULTS In each country, the number of patients starting RRT > 65 years increased significantly over time, whereas the number of renal transplants did not increase to the same extent. Only in Norway were almost all patients on the waiting list transplanted within 4 years of RRT start if they were < 65 years. In patients who started RRT > 65 years, the access to renal transplantation was high in Norway (49 p.m.a.r.p.) and low in Austria ( < 26 p.m.a.r.p.), the Netherlands and Scotland (both < 10 p.m.a.r.p.) but increased significantly in Austria (MPAC = 9.8%; 95% CI = 3.9-16.9) and the Netherlands (MPAC = 9.0%; 95% CI = 3.2-15.0). CONCLUSION Only in Norway, virtually all patients on the waiting list < 65 years received a transplant within 4 years after the start of RRT and, remarkably, also most of those > 65 years of age.
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Affiliation(s)
- Vianda S Stel
- ERA–EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Hemke AC, Dekker FW, Bos WJW, Krediet RT, Heemskerk MBA, Hoitsma AJ. [Causes of decreased use of peritoneal dialysis as a kidney replacement therapy in the Netherlands]. Ned Tijdschr Geneeskd 2012; 156:A3871. [PMID: 22617065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To study the extent and causes of the declining use of peritoneal dialysis (PD) as kidney replacement therapy in patients with end-stage renal disease in the Netherlands. DESIGN Retrospective cohort study. METHOD The prevalence and incidence of various kidney replacement therapies in the Netherlands from 1995 to 2010 were analysed. Also the 5-year outflow of patients on PD or haemodialysis (HD) from 1995 to 2006 was analysed using the cumulative incidence competing risks method and Cox regression analysis. RESULTS The absolute number of patients starting PD between 1995 and 2008 was stable at about 400 per year. There was a relative decline in the use of PD in the total dialysis population from 15% in 1995 to 8% in 2010. This decrease was seen in both large and small centres and was related to a relative increase in the numbers undergoing HD (67% before 2001, 74% in 2009), and kidney transplantation before dialysis (3% before 2002, 9% in 2009), as well as a decrease in change of therapy from HD to PD. The increased number starting on HD was associated with the growth of the incident patient group aged 65 years or older, most of whom (80-85%) underwent HD. Within the younger group (0-65 years) there was an increase in numbers on HD and in the number of pre-emptive transplantations. CONCLUSION The decline in the prevalence of PD was partly explained by the relative increase in numbers starting HD, associated with an ageing patient population, fewer people changing from HD to PD therapy, and the increased number of kidney transplantations before dialysis in younger patients. The increasing prevalence of HD has been made possible by growth of the HD capacity.
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Affiliation(s)
- Aline C Hemke
- Nederlandse Transplantatie Stichting, afd. Orgaancentrum, Leiden
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Carrero JJ, de Jager DJ, Verduijn M, Ravani P, De Meester J, Heaf JG, Finne P, Hoitsma AJ, Pascual J, Jarraya F, Reisaeter AV, Collart F, Dekker FW, Jager KJ. Cardiovascular and noncardiovascular mortality among men and women starting dialysis. Clin J Am Soc Nephrol 2011; 6:1722-30. [PMID: 21734088 DOI: 10.2215/cjn.11331210] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Although women have a survival advantage in the general population, women on dialysis have similar mortality to men. We hypothesized that this paired mortality risk during dialysis may be explained by a relative excess of cardiovascular-related mortality in women. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We compared 5-year age-stratified cardiovascular and noncardiovascular mortality rates, relative risks, and hazard ratios in a European cohort of incident adult dialysis patients (European Renal Association-European Dialysis and Transplant Association [ERA-EDTA] Registry) with the European general population (Eurostat). Cause of death was recorded by ERA-EDTA codes in dialysis patients and by International Statistical Classification of Diseases codes in the general population. RESULTS Overall, sex did not have a predictive effect on outcome in dialysis. Stratification into age categories and causes of death showed greater noncardiovascular mortality in young women (<45 years). In other age categories (45 to 55 and >55 years), women presented lower cardiovascular mortality. This cardiovascular benefit was, however, smaller than in the general population. Stratification by diabetic nephropathy showed that diabetic women in all age categories remained at increased mortality risk compared with men, an effect mainly attributed to the noncardiovascular component. CONCLUSIONS Mortality rates and causes of death in men and women on dialysis vary with age. Increased noncardiovascular mortality may explain the loss of the survival advantage of women on dialysis. Both young and diabetic women starting dialysis are at a higher mortality risk than equal men.
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Affiliation(s)
- Juan J Carrero
- Division of Renal Medicine, Centre for Molecular Medicine and Centre for Gender Medicine, Karolinska Institutet, Stockholm, Sweden.
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Abstract
AIM To determine to what extent current cold ischemia times (CITs) affect the results of renal transplantation in the Netherlands. METHODS Retrospective survey of the Dutch Organ Transplant Registry concerning transplants from deceased donors between 1990 and 2007. RESULTS A total of 6322 recipients were identified, of whom 5306 received a kidney from deceased heartbeating (HBD) and 1016 from donors after cardiac death (DCD). Mean CIT was 24.0 ± 7.9 h in HBD and 21.6 ± 6.7 h in DCD. The percentage delayed graft function (DGF) was 12.3 and 50.4, respectively (p < 0.001). Primary non-function (PNF) occurred in, respectively, 1.7% and 5.0% (p < 0.001). Serum creatinine after three months was 166 μM in HBD and 213 μM in DCD (p < 0.001). Five-yr graft survival was 79.5% and 78.3%, respectively (p = ns). In multivariate analysis, CIT proved to be an independent risk factor for DGF and PNF. Shorter CIT was associated with better graft survival in both groups with a hazard ratio of 1.024 (1.011-1.037, 95% CI)/h. CIT <20 h was associated with a graft survival benefit of 3% after five yr in HBD and CIT of <16 h with a benefit of 10% in DCD. CONCLUSIONS Longer CITs are associated with the occurrence of DGF, PNF and decreased graft survival in the Netherlands.
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Affiliation(s)
- J Adam van der Vliet
- Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Hoitsma AJ, Woodle ES, Abramowicz D, Proot P, Vanrenterghem Y. FTY720 combined with tacrolimus in de novo renal transplantation: 1-year, multicenter, open-label randomized study. Nephrol Dial Transplant 2011; 26:3802-5. [DOI: 10.1093/ndt/gfr503] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jansen NE, van Leiden HA, Haase-Kromwijk BJJM, van der Meer NJM, Kruijff EV, van der Lely N, van Zon H, Meinders AJ, Mosselman M, Hoitsma AJ. Appointing 'trained donation practitioners' results in a higher family consent rate in the Netherlands: a multicenter study. Transpl Int 2011; 24:1189-97. [PMID: 21902727 DOI: 10.1111/j.1432-2277.2011.01326.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The consent process for organ and tissue donation is complex, both for families and professionals. To help professionals in broaching this subject we performed a multicenter study. We compared family consent to donation in three hospitals between December 2007 and December 2009. In the intervention hospital, trained donation practitioners (TDP) guided 66 families throughout the time in the ICU until a decision regarding donation had been reached. In the first control hospital, without any family guidance or training, 107 families were approached. In the second control hospital 'hostesses', who were not trained in donation questions, supported 99 families during admittance. A total of 272 families were requested to donate. We primarily compared consent rates, but also asked families about their experiences through a questionnaire. Family consent rate was significantly higher in the intervention hospital: 57.6% (38/66), than in the control hospitals: 34.6% (37/107) and 39.4% (39/99). The 69% response rate to the questionnaire -~5 months after death - showed no confounding variables that could have influenced the consent rate. Appointing TDPs in the intervention hospital to guide families during admittance and the donation decision-making process, results in higher family consent rates.
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Wind J, Snoeijs MGJ, van der Vliet JA, Winkens B, Christiaans MHL, Hoitsma AJ, van Heurn LWE. Preservation of kidneys from controlled donors after cardiac death. Br J Surg 2011; 98:1260-6. [PMID: 21656512 DOI: 10.1002/bjs.7543] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2011] [Indexed: 01/27/2023]
Abstract
BACKGROUND Donation after cardiac death (DCD) expands the pool of donor kidneys, but is associated with warm ischaemic injury. Two methods are used to preserve kidneys from controlled DCD donors and reduce warm ischaemic injury: in situ preservation using a double-balloon triple-lumen catheter (DBTL) inserted via the femoral artery and direct cannulation of the aorta after rapid laparotomy. The aim of this study was to compare these two techniques. METHODS This was a retrospective cohort study of 165 controlled DCD procedures in two regions in the Netherlands between 2000 and 2006. RESULTS There were 102 donors in the DBTL group and 63 in the aortic group. In the aortic group the kidney discard rate was lower (4·8 versus 28·2 per cent; P < 0·001), and the warm (22 versus 27 min; P < 0·001) and the cold (19 versus 24 h; P < 0·001) ischaemia times were shorter than in the DBTL group. Risk factors for discard included preservation with the DBTL catheter (odds ratio (OR) 5·19, 95 per cent confidence interval 1·88 to 14·36; P = 0·001) and increasing donor age (1·05, 1·02 to 1·07; P < 0·001). Warm ischaemia time had a significant effect on graft failure (hazard ratio 1·04, 1·01 to 1·07; P = 0·009), and consequently graft survival was higher in the aortic cannulation group (86·2 per cent versus 76·8 per cent in the DBTL group at 1 year; P = 0·027). CONCLUSION In this retrospective study, direct aortic cannulation appeared to be a better method to preserve controlled DCD kidneys.
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Affiliation(s)
- J Wind
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Aalten J, Peeters SA, van der Vlugt MJ, Hoitsma AJ. Is standardized cardiac assessment of asymptomatic high-risk renal transplant candidates beneficial? Nephrol Dial Transplant 2011; 26:3006-12. [PMID: 21321004 DOI: 10.1093/ndt/gfq822] [Citation(s) in RCA: 13] [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: 12/13/2022] Open
Abstract
BACKGROUND Perioperative cardiovascular events in renal transplantation are common and non-invasive cardiac stress tests are recommended in high-risk renal transplant candidates. In 2004, we introduced a standardized preoperative cardiac risk assessment programme with the aim of reducing perioperative cardiac events. METHODS Since 2004, all asymptomatic high-risk renal transplant candidates had to undergo non-invasive cardiac stress testing. Patients with a positive stress test went for a coronary angiography and if indicated for revascularization. The incidence of perioperative cardiac events (≤30 days of transplantation) was analysed in all high-risk patients who received a transplantation (screening group) and compared with high-risk renal transplant recipients evaluated in the 4 years before the introduction of the cardiac assessment programme (historical control group). RESULTS Since 2004, 227 of 349 asymptomatic high-risk renal transplant candidates underwent non-invasive cardiac stress testing. In 15 patients (6.6%), significant ischaemia was found. Ten of these 15 patients underwent coronary angiography (eight patients had significant coronary artery disease and in five patients, percutaneous coronary intervention was performed). One hundred and sixty of 349 renal transplant candidates have received renal transplantation so far (screening group). In the screening group, 6 perioperative cardiac events (3.8%) occurred compared to 13 perioperative events (7.6%) in the historical control group (n = 172) (P = 0.136). CONCLUSIONS The incidence of significant cardiac ischaemia in high-risk renal transplant patients was low and was followed by revascularization in a small percentage of patients. No significant decrease in perioperative cardiac events was observed after the introduction of the standardized cardiac assessment programme.
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Affiliation(s)
- Jeroen Aalten
- Department of Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Schaafsma M, van der Deijl W, Smits JM, Rahmel AO, de Vries Robbé PF, Hoitsma AJ. Decision tables and rule engines in organ allocation systems for optimal transparency and flexibility. Transpl Int 2011; 24:433-40. [PMID: 21291498 DOI: 10.1111/j.1432-2277.2011.01221.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Organ allocation systems have become complex and difficult to comprehend. We introduced decision tables to specify the rules of allocation systems for different organs. A rule engine with decision tables as input was tested for the Kidney Allocation System (ETKAS). We compared this rule engine with the currently used ETKAS by running 11,000 historical match runs and by running the rule engine in parallel with the ETKAS on our allocation system. Decision tables were easy to implement and successful in verifying correctness, completeness, and consistency. The outcomes of the 11,000 historical matches in the rule engine and the ETKAS were exactly the same. Running the rule engine simultaneously in parallel and in real time with the ETKAS also produced no differences. Specifying organ allocation rules in decision tables is already a great step forward in enhancing the clarity of the systems. Yet, using these tables as rule engine input for matches optimizes the flexibility, simplicity and clarity of the whole process, from specification to the performed matches, and in addition this new method allows well controlled simulations.
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Hoitsma AJ. [A higher place on the waiting list for kidney transplantation after earlier donation: a matter of give and take]. Ned Tijdschr Geneeskd 2011; 155:A3562. [PMID: 21586187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In May 2011 the Dutch Health Council released an advice regarding living kidney donors who developed end-stage renal disease (ESRD) after donation. These donors with ESRD will have a high priority when they are on the waiting list for kidney transplantation. With this new rule the former donors will be transplanted within 6 weeks and transplantation can preferably be performed preemptively. It is expected that this measure shall prolong the waiting list for a donor kidney for the remaining patients with end stage renal disease by 6 days at most, on a total average waiting period of 4 years.
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Snoeijs MG, Schaubel DE, Hené R, Hoitsma AJ, Idu MM, Ijzermans JN, Ploeg RJ, Ringers J, Christiaans MH, Buurman WA, van Heurn LWE. Kidneys from donors after cardiac death provide survival benefit. J Am Soc Nephrol 2010; 21:1015-21. [PMID: 20488954 DOI: 10.1681/asn.2009121203] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The continuing shortage of kidneys for transplantation requires major efforts to expand the donor pool. Donation after cardiac death (DCD) increases the number of available kidneys, but it is unknown whether patients who receive a DCD kidney live longer than patients who remain on dialysis and wait for a conventional kidney from a brain-dead donor (DBD). This observational cohort study included all 2575 patients who were registered on the Dutch waiting list for a first kidney transplant between January 1, 1999, and December 31, 2004. From listing until the earliest of death, living-donor kidney transplantation, or December 31, 2005, 459 patients received a DCD transplant and 680 patients received a DBD transplant. Graft failure during the first 3 months after transplantation was twice as likely for DCD kidneys than DBD kidneys (12 versus 6.3%; P=0.001). Standard-criteria DCD transplantation associated with a 56% reduced risk for mortality (hazard ratio 0.44; 95% confidence interval 0.24 to 0.80) compared with continuing on dialysis and awaiting a standard-criteria DBD kidney. This reduction in mortality translates into 2.4-month additional expected lifetime during the first 4 years after transplantation for recipients of DCD kidneys compared with patients who await a DBD kidney. In summary, standard-criteria DCD kidney transplantation associates with increased survival of patients who have ESRD and are on the transplant waiting list.
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Affiliation(s)
- Maarten G Snoeijs
- Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, Netherlands.
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de Groot YJ, Jansen NE, Bakker J, Kuiper MA, Aerdts S, Maas AIR, Wijdicks EFM, van Leiden HA, Hoitsma AJ, Kremer BHPH, Kompanje EJO. Imminent brain death: point of departure for potential heart-beating organ donor recognition. Intensive Care Med 2010; 36:1488-94. [PMID: 20232039 PMCID: PMC2921050 DOI: 10.1007/s00134-010-1848-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [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: 08/24/2009] [Accepted: 01/15/2010] [Indexed: 01/09/2023]
Abstract
PURPOSE There is, in European countries that conduct medical chart review of intensive care unit (ICU) deaths, no consensus on uniform criteria for defining a potential organ donor. Although the term is increasingly being used in recent literature, it is seldom defined in detail. We searched for criteria for determination of imminent brain death, which can be seen as a precursor for organ donation. METHODS We organized meetings with representatives from the field of clinical neurology, neurotraumatology, intensive care medicine, transplantation medicine, clinical intensive care ethics, and organ procurement management. During these meetings, all possible criteria were discussed to identify a patient with a reasonable probability to become brain dead (imminent brain death). We focused on the practical usefulness of two validated coma scales (Glasgow Coma Scale and the FOUR Score), brain stem reflexes and respiration to define imminent brain death. Further we discussed criteria to determine irreversibility and futility in acute neurological conditions. RESULTS A patient who fulfills the definition of imminent brain death is a mechanically ventilated deeply comatose patient, admitted to an ICU, with irreversible catastrophic brain damage of known origin. A condition of imminent brain death requires either a Glasgow Coma Score of 3 and the progressive absence of at least three out of six brain stem reflexes or a FOUR score of E(0)M(0)B(0)R(0). CONCLUSION The definition of imminent brain death can be used as a point of departure for potential heart-beating organ donor recognition on the intensive care unit or retrospective medical chart analysis.
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Affiliation(s)
- Yorick J de Groot
- Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Meeuwis KAP, van Rossum MM, van de Kerkhof PCM, Hoitsma AJ, Massuger LFAG, de Hullu JA. Skin cancer and (pre)malignancies of the female genital tract in renal transplant recipients. Transpl Int 2010; 23:191-9. [DOI: 10.1111/j.1432-2277.2009.00975.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Warlé MC, Cheung CLSS, Teerenstra S, Hoitsma AJ, van der Vliet JAD. [Cold ischaemia time and outcome of renal transplantation]. Ned Tijdschr Geneeskd 2010; 154:B539. [PMID: 20298635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To determine the effect of cold ischaemia time (CIT) on the outcome of cadaveric renal transplantation in the Netherlands. DESIGN Retrospective, comparative. METHODS We studied data from the Netherlands organ transplant registry of cadaveric renal transplants from 1990-2007. RESULTS 6322 cadaveric renal transplant recipients were studied, of whom 5306 were from heart-beating donors (HBD) and 1016 from non-heart-beating donors (NHBD). The mean CIT was 24.0 h in the HBD group and 21.6 h in the NHBD group. The rate of delayed graft function (DGF) was 12.3% in the HBD group and 50.4% in the NHBD group. Multivariate analysis showed that prolonged CIT was an independent risk factor for graft failure. Prolonged CIT was also associated with the more frequent occurrence of DGF and primary non-function (PNF). Recipients of renal allografts from HBD with CIT <or= 20 hours showed a 3% higher 5-year graft survival rate than in recipients of kidneys with longer CIT. In recipients of NHBD kidneys with CIT < 16 hours, the 5-year graft survival rate was 10% higher than in recipients of kidneys with a longer CIT. CONCLUSION Prolonged cold ischaemia times are related to a more frequent occurrence of DGF, PNF and decreased graft survival after kidney transplantation. These results underline the need to reduce cold ischaemia times in the Netherlands.
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Affiliation(s)
- Michiel C Warlé
- Universitair Medisch Centrum St Radboud, Afd. Heelkunde, Nijmegen, The Netherlands
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Jansen NE, Haase-Kromwijk BJJM, van Leiden HA, Weimar W, Hoitsma AJ. A plea for uniform European definitions for organ donor potential and family refusal rates. Transpl Int 2009; 22:1064-72. [DOI: 10.1111/j.1432-2277.2009.00930.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Aalten J, Bemelman FJ, van den Berg-Loonen EM, Claas FH, Christiaans MH, de Fijter JW, Hepkema BG, Hené RJ, van der Heide JJH, van Hooff JP, Lardy NM, Lems SP, Otten HG, Weimar W, Allebes WA, Hoitsma AJ. Pre-kidney-transplant blood transfusions do not improve transplantation outcome: a Dutch national study. Nephrol Dial Transplant 2009; 24:2559-66. [PMID: 19474284 DOI: 10.1093/ndt/gfp233] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Female renal transplant candidates are prone to be sensitized by prior pregnancies, and undetected historical sensitization might decrease transplantation outcome. Hypothesis of our study was that pre-transplant blood transfusions (PTFs) can elucidate historical sensitization and that the avoidance of the associated antigens can improve transplantation outcome. METHODS Data from all female non-immunized renal transplant candidates who received a random PTF (rPTF) (n = 620), matched PTF (mPTF) (one HLA-A and B and one HLA-DR match) (n = 86) or donor-specific blood transfusion (DST) (n = 100) between 1996 and 2006 were collected. Complement-dependent cytoxicity was used to detect anti-HLA antibodies. Sensitization and transplantation outcomes after a PTF were analyzed. Non-immunized female renal transplant recipients who did not receive a PTF were used as the control group. RESULTS In 165 patients, anti-HLA antibodies (IgG) were detected after the PTF. Both historical and primary sensitizations were found. A DST induced donor-specific anti-HLA antibodies in 25% of the DST recipients. Our policy did not improve transplantation outcome in recipients of a kidney from a deceased donor (n = 368) or in recipients of a living donor [DST (n = 49) and mPTF (n = 66)]. CONCLUSIONS A PTF did elucidate historical sensitization but induce primary sensitization as well. No beneficial effect of PTFs on transplantation outcome was found, and PTFs with the intention to detect historical sensitization are therefore not suggested.
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Affiliation(s)
- Jeroen Aalten
- Department of Nephrology, University Medical Center Radboud, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
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