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Abstract
Polycystic ovary syndrome (PCOS), characterized by abnormal menstrual periods, elevated androgen levels and polycystic ovary morphology on ultrasound, is the most common endocrine disorder among females. PCOS is associated with cardiovascular disease (CVD) risk factors including diabetes, obesity, metabolic syndrome, adverse pregnancy outcomes such as pre-eclampsia and psychosocial distress including depression. Previous evidence on the association between PCOS and CVD is inconclusive but the latest 2023 International Evidence-Based PCOS Guideline identifies PCOS as a risk factor for CVD. This review will discuss the relationship between PCOS and CVD along with current direction for CVD screening and prevention among individuals with PCOS.
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Affiliation(s)
- J L Benham
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - A Goldberg
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - H Teede
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - C T Tay
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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2
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Li H, Upreti T, Do V, Dance E, Lewis M, Jacobson R, Goldberg A. Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints. Med Teach 2024; 46:82-101. [PMID: 37405740 DOI: 10.1080/0142159x.2023.2231625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
PURPOSE Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary. METHODS Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed. RESULTS 221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once. CONCLUSIONS Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.
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Affiliation(s)
- Henry Li
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Tushar Upreti
- Max Rady College of Medicine, Faculty of Health Sciences, University of Manitoba Rady, Winnipeg, Canada
| | - Victor Do
- Department of Pediatrics, Faculty of Medicine, University of Toronto Temerty, Toronto, Canada
| | - Erica Dance
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Melanie Lewis
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Ryan Jacobson
- Office of Advocacy and Wellbeing, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Aviva Goldberg
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba Rady, Winnipeg, Canada
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3
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Wiebe C, Balshaw R, Gibson IW, Ho J, Shaw J, Karpinski M, Trachtenberg A, Pochinco D, Goldberg A, Birk P, Pinsk M, Rush DN, Nickerson PW. A rational approach to guide cost-effective de novo donor-specific antibody surveillance with tacrolimus immunosuppression. Am J Transplant 2023; 23:1882-1892. [PMID: 37543094 DOI: 10.1016/j.ajt.2023.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023]
Abstract
De novo donor-specific antibody (dnDSA) after renal transplantation has been shown to correlate with antibody-mediated rejection and allograft loss. However, the lack of proven interventions and the time and cost associated with annual screening for dnDSA are difficult to justify for all recipients. We studied a well-characterized consecutive cohort (n = 949) with over 15 years of prospective dnDSA surveillance to identify risk factors that would help institute a resource-responsible surveillance strategy. Younger recipient age and HLA-DR/DQ molecular mismatch were independent predictors of dnDSA development. Combining both risk factors into recipient age molecular mismatch categories, we found that 52% of recipients could be categorized as low-risk for dnDSA development (median subclinical dnDSA-free survival at 5 and 10 years, 98% and 97%, respectively). After adjustment, multivariate correlates of dnDSA development included tacrolimus versus cyclosporin maintenance immunosuppression (hazard ratio [HR], 0.37; 95% CI, 0.2-0.6; P < .0001) and recipient age molecular mismatch category: intermediate versus low (HR, 2.48; 95% CI, 1.5-4.2; P = .0007), high versus intermediate (HR, 2.56; 95% CI, 1.6-4.2; P = .0002), and high versus low (HR, 6.36; 95% CI, 3.7-10.8; P < .00001). When combined, recipient age and HLA-DR/DQ molecular mismatch provide a novel data-driven approach to reduce testing by >50% while selecting those most likely to benefit from dnDSA surveillance.
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Affiliation(s)
- Chris Wiebe
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada; Shared Health Services Manitoba, Winnipeg, Manitoba, Canada.
| | - Rob Balshaw
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ian W Gibson
- Shared Health Services Manitoba, Winnipeg, Manitoba, Canada; Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julie Ho
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada; Shared Health Services Manitoba, Winnipeg, Manitoba, Canada
| | - Jamie Shaw
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Martin Karpinski
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Aaron Trachtenberg
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Aviva Goldberg
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Patricia Birk
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maury Pinsk
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David N Rush
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Shared Health Services Manitoba, Winnipeg, Manitoba, Canada
| | - Peter W Nickerson
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada; Shared Health Services Manitoba, Winnipeg, Manitoba, Canada
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Goldberg A. COVID-19 vaccine mandates in pediatric transplantation-why can we not agree? Pediatr Transplant 2023; 27:e14512. [PMID: 36939207 DOI: 10.1111/petr.14512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/21/2023]
Affiliation(s)
- Aviva Goldberg
- Department of Pediatrics and Child Health, University of Manitoba Max Rady College of Medicine, Winnipeg, Canada
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Jennison T, MacGregor A, Goldberg A. Hip arthroplasty practice across the Organisation for Economic Co-operation and Development (OECD) over the last decade. Ann R Coll Surg Engl 2023; 105:645-652. [PMID: 37652085 PMCID: PMC10471436 DOI: 10.1308/rcsann.2022.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION There are large variations in the number of hip replacements performed between countries, demonstrating large health inequalities; however, there has been limited research on this variation. The aims of this paper were to compare rates of hip replacements using Organisation for Economic Co-operation and Development (OECD) data for the period 2008-2018. The study also compared changes in the number of hip replacements in the total population and in only those aged over 65, and looked for a correlation of health expenditure and gross domestic product (GDP) with rates of hip replacements. METHODS The OECD collects annual data from all member countries on the numbers of hip replacements, healthcare expenditure and GDP. Data analysis was undertaken using STATA. Descriptive statistics and Pearson's correlation coefficient were performed. RESULTS The mean number of hip replacements performed in OECD countries in 2018 was 191.5 per 100,000 population per year. The largest number was 310.6 in Germany and the lowest was 8.6 in Mexico. There has been a 21.7% increase in the mean number of hip replacements across OECD countries. There was a moderate and significant Pearson coefficient of 0.468 (p = 0.009) between the number of hip replacements performed per 100,000 population in 2018 and GDP per person, and a strong and significant correlation with health expenditure (R = 0.784, p < 0.001). There was a moderate correlation (R = 0.645, p = 0.003) between the percentage change in the number of hip replacements performed per 100,000 population and the percentage change in healthcare expenditure per person between 2008 and 2018. CONCLUSIONS There is 36-fold variation in the practice of hip replacements across the OECD and the number of hip replacements has increased by more than 20% over the past decade. The number of hip replacements performed appears to be correlated with health expenditure in each country and may indicate a need that can only be met by increasing health expenditure.
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Affiliation(s)
- T Jennison
- Cardiff and Vale University Health Board, UK
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Gardiner D, McGee A, Simpson C, Ahn C, Goldberg A, Kinsella A, Nagral S, Weiss MJ. Baseline Ethical Principles and a Framework for Evaluation of Policies: Recommendations From an International Consensus Forum. Transplant Direct 2023; 9:e1471. [PMID: 37138553 PMCID: PMC10150897 DOI: 10.1097/txd.0000000000001471] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 11/26/2022] [Accepted: 12/15/2022] [Indexed: 05/05/2023] Open
Abstract
To maintain public trust and integrity in organ and tissue donation and transplantation (OTDT), policymakers, governments, clinical leaders, and decision-makers must ensure that policies proposed to increase donation and transplant activity satisfy baseline ethical principles established by international agreement, declaration, and resolution. This article describes the output of the Baseline Ethical Domain group of an international forum designed to guide stakeholders in considering these aspects of their system. Methods This Forum was initiated by Transplant Québec and co-hosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. The domain working group members included administrative, clinical, and academic experts in deceased and living donation ethics and 2 Patient, Family, and Donor partners. Identification of internationally accepted baseline ethical principles was done after literature reviews performed by working group members, and a framework for consideration of existing or novel policies was completed over a series of virtual meetings from March to September 2021. Consensus on the framework was achieved by applying the nominal group technique. Recommendations We used the 30 baseline ethical principles described in World Health Organization Guiding Principles, Declaration of Istanbul, and Barcelona Principles to generate an ethical framework-presented graphically as a spiral series of considerations-designed to assist decision makers in incorporating these ethical principles into practice and policy. We did not seek to determine what is ethical but instead described a method of evaluation for policy decisions. Conclusions The proposed framework could be applied to new or existing OTDT policy decisions to facilitate the transformation of widely accepted ethical principles into practical evaluations. The framework includes adaptation for local contexts and could be applied broadly internationally.
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Affiliation(s)
- Dale Gardiner
- Medical Directorate, NHS Blood and Transplant, Nottingham, United Kingdom
| | - Andrew McGee
- Australian Centre for Health Law Research, QUT, Brisbane, Australia
- Faculty of Business and Law, QUT, Brisbane, Australia
| | - Christy Simpson
- Australian Centre for Health Law Research, QUT, Brisbane, Australia
- Department of Bioethics, Dalhousie University, Halifax, Canada
- Canadian Blood Services, Ottawa, Canada
| | - Curie Ahn
- Division of Nephrology, National Medical Center, Seoul, South Korea
| | - Aviva Goldberg
- Department of Pediatric Nephrology, University of Manitoba, Winnipeg, Canada
| | - Austin Kinsella
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Sanjay Nagral
- Department of Surgical Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India
- Co-chair: Declaration of Istanbul Custodian Group
| | - Matthew J. Weiss
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
- Transplant Québec, Montréal, Québec, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Québec, Québec, Canada
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Charnaya O, Zeiser L, Yisar D, Goldberg A, Segev DL, Massie A, Garonzik-Wang J, Verghese P. The unfinished journey toward transplant equity: an analysis of racial/ethnic disparities for children after the implementation of the Kidney Allocation System in 2014. Pediatr Nephrol 2023; 38:1275-1289. [PMID: 35816202 PMCID: PMC10848995 DOI: 10.1007/s00467-022-05676-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Disparities in pediatric kidney transplantation (KT) result in reduced access and worse outcomes for minority children. We assessed the impact of recent systems changes on these disparities. METHODS This is a retrospective cohort study of pediatric patients utilizing data from the US Renal Data System (n = 7547) and Scientific Registry of Transplant Recipients (n = 6567 waitlisted and n = 6848 transplanted patients). We compared access to transplantation, time to deceased donor kidney transplant (DDKT), and allograft failure (ACGF) in the 5 years preceding implementation of the Kidney Allocation System (KAS) to the 5 years post-KAS implementation 2010-2014 vs. 2015-2019, respectively. RESULTS Compared to the pre-KAS era, post-KAS candidates were more likely to be pre-emptively listed (26.8% vs. 38.1%, p < 0.001), pre-emptively transplanted (23.8% vs. 28.0%, p < 0.001), and less likely to have private insurance (35.6% vs. 32.3%, p = 0.01), but these were not uniform across racial groups. Compared to white children, Black and Hispanic children had a lower likelihood of transplant listing within 2 years of first dialysis service (aHR 0.590.670.76 and 0.730.820.92, respectively) in the post-KAS era. Time to DDKT was comparable across all racial groups in the post-KAS era. Compared to white children, Black DDKT recipients have more 5-year ACGF (aHR 1.001.432.06 p = 0.05) while there was no difference in 3- or 5-year ACGF among LDKT recipients. CONCLUSIONS After KAS implementation, there is equity in time to DDKT. Pre-KAS increased hazard of ACGF among Black children has decreased in the post-KAS era; however, persistent disparities exist in time to transplant listing among Black and Hispanic children when compared to white children. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Olga Charnaya
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Laura Zeiser
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Dolev Yisar
- Medical School for International Health, Ben-Gurion University of the Negev, Be-er Sheva, Israel
| | - Aviva Goldberg
- Department of Pediatric Nephrology, University of Manitoba, Winnipeg, Canada
| | - Dorry L Segev
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Scientific Registry of Transplant Recipients, Minneapolis, MN, USA
| | - Allan Massie
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Jacqueline Garonzik-Wang
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Priya Verghese
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL, USA
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8
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Waissengrin B, Zahavi T, Salmon-Divon M, Goldberg A, Wolf I, Rubinek T, Winkler T, Farkash O, Grinshpun A, Zubkov A, Khatib M, Shachar S, Keren N, Carmi-Levy I, Ben-David U, Sonnenblick A. The effect of non-oncology drugs on clinical and genomic risk in early luminal breast cancer. ESMO Open 2022; 7:100648. [PMID: 36462463 PMCID: PMC9808449 DOI: 10.1016/j.esmoop.2022.100648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND An effect of non-oncology medications on cancer outcome has been proposed. In this study, we aimed to systematically examine the impact of commonly prescribed non-oncology drugs on clinical risk and on the genomic risk [based on the Oncotype DX recurrence score (RS)] in early breast cancer (BC). EXPERIMENTAL DESIGN We collected data on clinical risk (stage and grade), genomic risk (Oncotype DX RS), and on non-oncology medications administered to 1423 patients with estrogen receptor-positive human epidermal growth factor receptor 2-negative BC during the month of their surgery. The influence of various medications on clinical and genomic risks was evaluated by statistical analysis. RESULTS Out of the multiple drugs we examined, levothyroxine was significantly associated with a high Oncotype DX RS (mean 24.78; P < 0.0001) and metformin with a low Oncotype DX RS (mean 14.87; P < 0.01) compared with patients not receiving other non-oncology drugs (mean 18.7). By contrast, there were no differences in the clinical risk between patients receiving metformin, levothyroxine, or no other non-oncology drugs. Notably, there was no association between the consumption of levothyroxine and metformin and proliferation marker (Ki67) levels, but both drugs were significantly associated with progesterone-related features, suggesting that they influence genomic risk through estrogen-dependent signaling. CONCLUSIONS The results of this study indicate a significant impact of metformin and levothyroxine on clinical decisions in luminal BC, with potential impact on the clinical course of these patients.
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Affiliation(s)
- B. Waissengrin
- The Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv,Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - T. Zahavi
- Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel
| | - M. Salmon-Divon
- Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel
| | - A. Goldberg
- Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel
| | - I. Wolf
- The Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv,Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - T. Rubinek
- The Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv,Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - T. Winkler
- Department of Human Molecular Genetics & Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O. Farkash
- The Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv
| | - A. Grinshpun
- Breast Oncology Center, Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - A. Zubkov
- Pathology Department, Pathology Institute, Tel Aviv Medical Center, Tel Aviv
| | - M. Khatib
- Division of General Surgery, Tel Aviv Medical Center, Tel Aviv
| | - S.S. Shachar
- The Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv,Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - N. Keren
- The Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv,Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | | | - U. Ben-David
- Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - A. Sonnenblick
- The Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv,Sackler School of Medicine, Tel Aviv University, Tel Aviv,Correspondence to: Dr Amir Sonnenblik, MD, Tel Aviv Sourasky Medical Center, 6 Waizman Street, Tel Aviv 64239, Israel; Tel: +972-3-6972446
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9
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Wiberg-Itzel E, Sterpu I, Goldberg A, Patavoukas E, Hertting E. 112 Are there different forms of dystocia? should they be treated differently in clinical practice? Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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10
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Rampersad C, Balshaw R, Gibson IW, Ho J, Shaw J, Karpinski M, Goldberg A, Birk P, Rush DN, Nickerson PW, Wiebe C. The negative impact of T cell-mediated rejection on renal allograft survival in the modern era. Am J Transplant 2022; 22:761-771. [PMID: 34717048 PMCID: PMC9299170 DOI: 10.1111/ajt.16883] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 01/25/2023]
Abstract
The prevalence and long-term impact of T cell-mediated rejection (TCMR) is poorly defined in the modern era of tacrolimus/mycophenolate-based maintenance therapy. This observational study evaluated 775 kidney transplant recipients with serial histology and correlated TCMR events with the risk of graft loss. After a ~30% incidence of a first Banff Borderline or greater TCMR detected on for-cause (17%) or surveillance (13%) biopsies, persistent (37.4%) or subsequent (26.3%) TCMR occurred in 64% of recipients on follow-up biopsies. Alloimmune risk categories based on the HLA-DR/DQ single molecule eplet molecular mismatch correlated with the number of TCMR events (p = .002) and Banff TCMR grade (p = .007). Both a first and second TCMR event correlated with death-censored and all-cause graft loss when adjusted for baseline covariates and other significant time-dependent covariates such as DGF and ABMR. Therefore, a substantial portion of kidney transplant recipients, especially those with intermediate and high HLA-DR/DQ molecular mismatch scores, remain under-immunosuppressed, which in turn identifies the need for novel agents that can more effectively prevent or treat TCMR.
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Affiliation(s)
| | - Robert Balshaw
- George and Fay Yee Centre for Healthcare InnovationUniversity of ManitobaWinnipegManitobaCanada
| | - Ian W. Gibson
- Shared Health Services ManitobaWinnipegManitobaCanada,Department of PathologyUniversity of ManitobaWinnipegManitobaCanada
| | - Julie Ho
- Department of MedicineUniversity of ManitobaWinnipegManitobaCanada,Shared Health Services ManitobaWinnipegManitobaCanada,Department of ImmunologyUniversity of ManitobaWinnipegManitobaCanada
| | - Jamie Shaw
- Department of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Martin Karpinski
- Department of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Aviva Goldberg
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegManitobaCanada
| | - Patricia Birk
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegManitobaCanada
| | - David N. Rush
- Department of MedicineUniversity of ManitobaWinnipegManitobaCanada,Shared Health Services ManitobaWinnipegManitobaCanada
| | - Peter W. Nickerson
- Department of MedicineUniversity of ManitobaWinnipegManitobaCanada,Shared Health Services ManitobaWinnipegManitobaCanada,Department of ImmunologyUniversity of ManitobaWinnipegManitobaCanada
| | - Chris Wiebe
- Department of MedicineUniversity of ManitobaWinnipegManitobaCanada,Shared Health Services ManitobaWinnipegManitobaCanada,Department of ImmunologyUniversity of ManitobaWinnipegManitobaCanada
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11
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Trachtenberg AJ, Goldberg A. Patients with kidney failure who cannot access dialysis in rural and remote areas of Canada should be prioritized for kidney transplantation. CMAJ 2021; 193:E1772-E1773. [PMID: 34810166 PMCID: PMC8608455 DOI: 10.1503/cmaj.211020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Aaron J Trachtenberg
- Department of Medicine (Trachtenberg) and of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.
| | - Aviva Goldberg
- Department of Medicine (Trachtenberg) and of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man
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12
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Ibrahim B, Dawson R, Chandler JA, Goldberg A, Hartell D, Hornby L, Simpson C, Weiss MJ, Wilson LC, Wilson TM, Fortin MC. The COVID-19 pandemic and organ donation and transplantation: ethical issues. BMC Med Ethics 2021; 22:142. [PMID: 34674700 PMCID: PMC8528937 DOI: 10.1186/s12910-021-00711-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/13/2021] [Indexed: 12/24/2022] Open
Abstract
Background The COVID-19 pandemic has had a significant impact on the health system worldwide. The organ and tissue donation and transplantation (OTDT) system is no exception and has had to face ethical challenges related to the pandemic, such as risks of infection and resource allocation. In this setting, many Canadian transplant programs halted their activities during the first wave of the pandemic. Method To inform future ethical guidelines related to the COVID-19 pandemic or other public health emergencies of international concern, we conducted a literature review to summarize the ethical issues. Results This literature review identified three categories of ethical challenges. The first one describes the general ethical issues and challenges reported by OTDT organizations and transplantation programs, such as risks of COVID-19 transmission and infection to transplant recipients and healthcare professionals during the transplant process, risk of patient waitlist mortality or further resource strain where transplant procedures have been delayed or halted, and resource allocation. The second category describes ethical challenges related to informed consent in the context of uncertainty and virtual consent. Finally, the third category describes ethical issues related to organ allocation, such as social considerations in selecting transplant candidates. Conclusion This literature review highlights the salient ethical issues related to OTDT during the current COVID-19 pandemic. As medical and scientific knowledge about COVID-19 increases, the uncertainties related to this disease will decrease and the associated ethical issues will continue to evolve.
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Affiliation(s)
| | | | - Jennifer A Chandler
- Faculty of Law, University of Ottawa, Ottawa, ON, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Aviva Goldberg
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.,Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Laura Hornby
- Canadian Blood Services, Ottawa, ON, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Christy Simpson
- Canadian Blood Services, Ottawa, ON, Canada.,Faculty of Medicine, Department of Bioethics, Dalhousie University, Halifax, NS, Canada
| | - Matthew-John Weiss
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.,CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Quebec, QC, Canada.,Transplant Québec, Montreal, QC, Canada
| | | | - T Murray Wilson
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Marie-Chantal Fortin
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada. .,Centre de Recherche du CHUM, Room R12-418, 900 rue St-Denis, Montreal, QC, H2X 0A9, Canada. .,Faculté de Médecine, Université de Montreal, Montreal, QC, Canada.
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13
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Greenberg R, Goldberg A, Anthony S, Buchman DZ, Delaney S, Gruben V, Holdsworth S, Le Foll B, Leung M, Lien D, Lynch MJ, Selzner N, Chandler JA, Fortin MC. Canadian Society of Transplantation White Paper: Ethical and Legal Considerations for Alcohol and Cannabis Use in Solid Organ Listing and Allocation. Transplantation 2021; 105:1957-1964. [PMID: 33587429 PMCID: PMC8376271 DOI: 10.1097/tp.0000000000003618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 11/26/2022]
Abstract
Alcohol and cannabis use as a contraindication to organ transplantation is a controversial issue. Until recently, patients in Canada with alcohol-associated liver disease were required to demonstrate abstinence for 6 mo to receive a liver transplant. There is no equivalent rule that is applied consistently for cannabis use. There is some evidence that alcohol and cannabis use disorder pretransplant could be associated with worse outcomes posttransplantation. However, early liver transplantation for patients with alcohol-associated liver disease in France and in the United States has led to challenges of the 6-mo abstinence rule in Canada in the media. It has also resulted in several legal challenges arguing that the rule violates human rights laws regarding discrimination in the provision of medical services and that the rule is also unconstitutional (this challenge is still before the court). Recent legalization of cannabis use for adults in Canada has led to questions about the appropriateness of limiting transplant access based on cannabis use. The ethics committee of the Canadian Society of Transplantation was asked to provide an ethical analysis of cannabis and alcohol abstinence policies. Our conclusions were as follows: neither cannabis use nor the 6-mo abstinence rule for alcohol use should be an absolute contraindication to transplantation, and transplant could be offered to selected patients, further research should be conducted to ensure evidence-based policies; and the transplant community has a duty not to perpetuate stigma associated with alcohol and cannabis use disorders.
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Affiliation(s)
- Rebecca Greenberg
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Aviva Goldberg
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Samantha Anthony
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, ON, Canada
| | - Daniel Z. Buchman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | | | - Vanessa Gruben
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Sandra Holdsworth
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Bernard Le Foll
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Dale Lien
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Marie-Josee Lynch
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Research Institute, Toronto, ON, Canada
| | - Nazia Selzner
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Toronto General Research Institute, Toronto, ON, Canada
| | - Jennifer A. Chandler
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Marie-Chantal Fortin
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Centre de recherche du CHUM, Montreal, QC, Canada
- Faculty of Medicine, University of Montreal, QC, Canada
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14
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Tennankore KK, Klarenbach S, Goldberg A. Perspectives on Opt-Out Versus Opt-In Legislation for Deceased Organ Donation: An Opinion Piece. Can J Kidney Health Dis 2021; 8:20543581211022151. [PMID: 34188947 PMCID: PMC8212358 DOI: 10.1177/20543581211022151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Karthik K Tennankore
- Department of Medicine (Division of Nephrology), Dalhousie University, Halifax, NS, Canada
| | | | - Aviva Goldberg
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
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15
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Anthony SJ, Young K, Pol SJ, Selkirk EK, Blydt-Hansen T, Boucher S, Goldberg A, Hamiwka L, Haverman L, Mitchell J, Urschel S, Santana M, Stinson J, Sutherland K, West LJ. Patient-reported outcome measures in pediatric solid organ transplantation: Exploring stakeholder perspectives on clinical implementation through qualitative description. Qual Life Res 2021; 30:1355-1364. [PMID: 33447959 PMCID: PMC8068689 DOI: 10.1007/s11136-020-02743-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/05/2022]
Abstract
PURPOSE Patient-reported outcome measures (PROMs) are standardized instruments used to collect data about the subjective assessment of medical care from the patient perspective. Implementing PROMs within pediatric clinical settings has gained increasing importance as health services prioritize patient-centred pediatric care. This study explores the perspectives of pediatric solid organ transplant patients, caregivers, and healthcare practitioners (HCPs) on implementing PROMs into clinical practice. METHODS Qualitative description methods were used to elicit stakeholder perspectives. Semi-structured interviews were conducted across five Canadian transplant centres. Purposive sampling was used to obtain maximum variation across age, gender, and transplant program for all participants, as well as discipline for HCPs. RESULTS The study included a total of 63 participants [patients (n = 20), caregivers (n = 22) and HCPs (n = 21)]. Nearly all participants endorsed the implementation of PROMs to enhance pediatric transplant clinical care. Three primary roles for PROMs emerged: (1) to bring a transplant patient's overall well-being into the clinical care conversation; (2) to improve patient communication and engagement; and, (3) to inform the practice of clinical pediatric transplant care. Insights for effective implementation included completing electronic PROMs remotely and prior to clinical appointments by patients who are eight to 10 years of age or older. CONCLUSIONS This study contributes to current research that supports the use of PROMs in clinical pediatric care and guides their effective implementation into practice. Future directions include the development, usability testing, and evaluation of a proposed electronic PROM platform that will inform future research initiatives.
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Affiliation(s)
- Samantha J Anthony
- Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
- Canadian Donation and Transplantation Research Program, Edmonton, Canada.
| | - Katarina Young
- Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Sarah J Pol
- Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Enid K Selkirk
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Tom Blydt-Hansen
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
- British Columbia Children's Hospital, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Suzanne Boucher
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
| | - Aviva Goldberg
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
- Health Science Centre Winnipeg, Winnipeg, Canada
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Lorraine Hamiwka
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
- Alberta Children's Hospital, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Lotte Haverman
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Psychosocial, Amsterdam, The Netherlands
| | - Joanna Mitchell
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
| | - Simon Urschel
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
- Stollery Children's Hospital, Edmonton, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Maria Santana
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jennifer Stinson
- Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Katie Sutherland
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
| | - Lori J West
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
- Stollery Children's Hospital, Edmonton, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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16
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Lamarche C, Sharma AK, Goldberg A, Wang L, Blydt-Hansen TD. Biomarker implementation: Evaluation of the decision-making impact of CXCL10 testing in a pediatric cohort. Pediatr Transplant 2021; 25:e13908. [PMID: 33155737 DOI: 10.1111/petr.13908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/13/2020] [Accepted: 10/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children are at high risk for subclinical rejection, and kidney biopsy is currently used for surveillance. Our objective was to test how novel rejection biomarkers such as urinary CXCL10 may influence clinical decision-making to indicate need for a biopsy. METHODS A minimum dataset for standard decision-making to indicate a biopsy was established by an expert panel and used to design clinical vignettes for use in a survey. Pediatric nephrologists were recruited to review the vignettes and A) estimate rejection risk and B) decide whether to biopsy; first without and then with urinary CXCL10/Cr level. Accuracy of biopsy decisions was then tested against the biopsy results. IRA was assessed by Fleiss Kappa (κ) for binary choice and ICC for probabilities. RESULTS Eleven pediatric nephrologists reviewed 15 vignettes each. ICC of probability assessment for rejection improved from poor (0.28, P < .01) to fair (0.48, P < .01) with addition of CXCL10/Cr data. It did not, however, improve the IRA for decision to biopsy (K = 0.48 and K = 0.43, for the comparison). Change in clinician estimated probability of rejection with additional CXCL10/Cr data was correlated with CXCL10/Cr level (r2 = 0.7756, P < .0001). Decision accuracy went from 8/15 (53.3%) cases to 11/15 (73.3%) with CXCL10/Cr, although improvement did not achieve statistical significance. Using CXCL10/Cr alone would have been accurate in 12/15 cases (80%). CONCLUSION There is high variability in decision-making on biopsy indication. Urinary CXCL10/Cr improves probability estimates for risk of rejection. Training may be needed to assist nephrologists in better integrate biomarker information into clinical decision-making.
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Affiliation(s)
- Caroline Lamarche
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Atul K Sharma
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Aviva Goldberg
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Li Wang
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tom D Blydt-Hansen
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Teoh CW, Gaudreault-Tremblay MM, Blydt-Hansen TD, Goldberg A, Arora S, Feber J, Langlois V, Ruhl M, Phan V, Morgan C, Acott P, Hamiwka L. Management of Pediatric Kidney Transplant Patients During the COVID-19 Pandemic: Guidance From the Canadian Society of Transplantation Pediatric Group. Can J Kidney Health Dis 2020; 7:2054358120967845. [PMID: 33240516 PMCID: PMC7672730 DOI: 10.1177/2054358120967845] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE OF THE PROGRAM To provide guidance on the management of pediatric kidney transplant patients during the COVID-19 pandemic. SOURCES OF INFORMATION Program-specific documents, preexisting, and related to COVID-19; documents from provincial, national, and international kidney transplant societies/agencies and organ procurement agencies; national and international webinars, including webinars that we hosted for input and feedback; with additional information from formal and informal review of published academic literature. METHODS Challenges in the care of pediatric kidney transplant patients during the COVID-19 pandemic were highlighted within the Canadian Society of Transplantation (CST) Pediatric Group. It identified pediatric kidney transplant nephrologists (including a pediatric nephrologist ethicist) across the country and formed a workgroup. The initial guidance document was drafted and members of the workgroup reviewed and discussed all suggestions in detail via e-mail and virtual meetings. Disagreements were resolved by consensus. The document was reviewed by the CST Kidney Transplant Working Group, by the Canadian Society of Nephrology (CSN) COVID-19 Rapid Response Team (RRT), and an infectious disease expert. The suggestions were presented at an interactive webinar sponsored by CSN in collaboration with the CST and Canadian Association of Pediatric Nephrologists (CAPN), and attended by pediatric kidney health care professionals for further peer input. Final revisions were made based on feedback received. CJKHD editors reviewed the parallel process peer review and edited the manuscript for clarity. KEY FINDINGS We identified 8 key areas of pediatric kidney transplant care that may be affected by the COVID-19 pandemic: (1) transplant activity, (2) outpatient clinic activity, (3) monitoring, (4) multidisciplinary care, (5) medications (immunosuppression and others), (6) patient/family education/support, (7) school and employment, and (8) management of pediatric kidney transplant patients who are COVID-19 positive. We make specific suggestions for each of these areas. LIMITATIONS A full systematic review of available literature was not undertaken for the sake of expediency in development of this guideline. There is a paucity of literature to support evidence-based recommendations at this time. Instead, these guidelines were formulated based on expert opinion derived from available knowledge/experience and are subject to the biases associated with this level of evidence. The parallel review process that was created to expedite the publication of this work may not be as robust as standard arms' length peer review processes. IMPLICATIONS These recommendations are meant to serve as a guide to pediatric kidney transplant directors, clinicians, and administrators for providing the best patient care in the context of limited resources while protecting patients and health care providers wherever possible by limiting exposure to COVID-19. We recognize that recommendations may not be applicable to all provincial/local health authority practices and that they may not be delivered to all patients given the time and resource constraints affecting the individual provincial/local health jurisdiction.
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Affiliation(s)
- Chia Wei Teoh
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
- Transplant & Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, ON, Canada
| | | | - Tom D. Blydt-Hansen
- Division of Nephrology, BC Children’s Hospital, Vancouver, Canada
- Department of Paediatrics, The University of British Columbia, Vancouver, Canada
| | - Aviva Goldberg
- Division of Nephrology, The Children’s Hospital of Winnipeg, MB, Canada
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Steven Arora
- Division of Nephrology, McMaster Children’s Hospital, Hamilton, ON, Canada
- Department of Paediatrics, McMaster University, Hamilton, ON, Canada
| | - Janusz Feber
- Division of Nephrology, Children’s Hospital of Eastern Ontario, Ottawa, Canada
- Department of Paediatrics, University of Ottawa, ON, Canada
| | - Valerie Langlois
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
- Transplant & Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, ON, Canada
| | - Michelle Ruhl
- Division of Nephrology, Jim Pattison Children’s Hospital, Saskatoon, SK, Canada
- Department of Paediatrics, University of Saskatchewan, Saskatoon, Canada
| | - Veronique Phan
- Division of Nephrology, CHU Sainte-Justine, Montreal, QC, Canada
- Department of Paediatrics, University de Montreal, QC, Canada
| | - Catherine Morgan
- Division of Nephrology, Stollery Children’s Hospital, Edmonton, AB, Canada
- Department of Paediatrics, University of Alberta, Edmonton, Canada
| | - Philip Acott
- Division of Nephrology, IWK Health Centre, Halifax, NS, Canada
- Department of Paediatrics, Dalhousie University, Halifax, NS, Canada
| | - Lorraine Hamiwka
- Division of Nephrology, Alberta Children’s Hospital, Calgary, Canada
- Department of Paediatrics, University of Calgary, AB, Canada
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18
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Wiebe C, Rush DN, Gibson IW, Pochinco D, Birk PE, Goldberg A, Blydt‐Hansen T, Karpinski M, Shaw J, Ho J, Nickerson PW. Evidence for the alloimmune basis and prognostic significance of Borderline T cell-mediated rejection. Am J Transplant 2020; 20:2499-2508. [PMID: 32185878 PMCID: PMC7496654 DOI: 10.1111/ajt.15860] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [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] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/05/2020] [Accepted: 03/07/2020] [Indexed: 02/06/2023]
Abstract
Prognostic biomarkers of T cell-mediated rejection (TCMR) have not been adequately studied in the modern era. We evaluated 803 renal transplant recipients and correlated HLA-DR/DQ molecular mismatch alloimmune risk categories (low, intermediate, high) with the severity, frequency, and persistence of TCMR. Allograft survival was reduced in recipients with Banff Borderline (hazard ratio [HR] 2.4, P = .003) and Banff ≥ IA TCMR (HR 4.3, P < .0001) including a subset who never developed de novo donor-specific antibodies (P = .002). HLA-DR/DQ molecular mismatch alloimmune risk categories were multivariate correlates of Banff Borderline and Banff ≥ IA TCMR and correlated with the severity and frequency of rejection episodes. Recipient age, HLA-DR/DQ molecular mismatch category, and cyclosporin vs tacrolimus immunosuppression were independent correlates of Banff Borderline and Banff ≥ IA TCMR. In the subset treated with tacrolimus (720/803) recipient age, HLA-DR/DQ molecular mismatch category, and tacrolimus coefficient of variation were independent correlates of TCMR. The correlation of HLA-DR/DQ molecular mismatch category with TCMR, including Borderline, provides evidence for their alloimmune basis. HLA-DR/DQ molecular mismatch may represent a precise prognostic biomarker that can be applied to tailor immunosuppression or design clinical trials based on individual patient risk.
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Affiliation(s)
- Chris Wiebe
- Department of MedicineUniversity of ManitobaWinnipegCanada
- Shared Health Services ManitobaWinnipegCanada
- Department of ImmunologyUniversity of ManitobaWinnipegCanada
| | - David N. Rush
- Department of MedicineUniversity of ManitobaWinnipegCanada
| | - Ian W. Gibson
- Shared Health Services ManitobaWinnipegCanada
- Department of PathologyUniversity of ManitobaWinnipegCanada
| | | | - Patricia E. Birk
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegCanada
| | - Aviva Goldberg
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegCanada
| | - Tom Blydt‐Hansen
- Department of PediatricsUniversity of British ColumbiaWinnipegCanada
| | | | - Jamie Shaw
- Department of MedicineUniversity of ManitobaWinnipegCanada
| | - Julie Ho
- Department of MedicineUniversity of ManitobaWinnipegCanada
- Department of ImmunologyUniversity of ManitobaWinnipegCanada
| | - Peter W. Nickerson
- Department of MedicineUniversity of ManitobaWinnipegCanada
- Shared Health Services ManitobaWinnipegCanada
- Department of ImmunologyUniversity of ManitobaWinnipegCanada
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19
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Charnaya O, Verghese P, Goldberg A, Ladin K, Porteny T, Lantos JD. Access to Transplantation for Undocumented Pediatric Patients. Pediatrics 2020; 146:peds.2019-3692. [PMID: 32591437 DOI: 10.1542/peds.2019-3692] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2019] [Indexed: 11/24/2022] Open
Abstract
Clinicians in the United States today regularly face dilemmas about health disparities. Many patients and families cannot afford the medical care that doctors recommend. These problems are most stark when the medical care that is needed is lifesaving and expensive and involves scarce resources. Transplants are the best example of this. The most ethically disturbing situations occur when an undocumented immigrant child needs a transplant. We present such a case and analyze the ethical, legal, and policy issues that arise.
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Affiliation(s)
- Olga Charnaya
- Division of Pediatric Nephrology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Priya Verghese
- Division of Pediatric Nephrology, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Aviva Goldberg
- Section of Nephrology, Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Keren Ladin
- Research on Ethics, Aging, and Community Health Lab and.,Departments of Occupational Therapy and Community Health, School of Arts and Sciences, Tufts University, Medford, Massachusetts; and
| | | | - John D Lantos
- Bioethics Center, Children's Mercy Hospital, Kansas City, Missouri
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20
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Anthony S, Young K, Pol S, Blydt-Hansen T, Goldberg A, Hamiwka L, Urschel S, Santana M, Stinson J, West L. Improving the Care for Pediatric Transplant Patients through Integration of Patient-Reported Outcome Measures into Clinical Practice. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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21
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Downar J, Shemie SD, Gillrie C, Fortin MC, Appleby A, Buchman DZ, Shoesmith C, Goldberg A, Gruben V, Lalani J, Ysebaert D, Wilson L, Sharpe MD. Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy. CMAJ 2020; 191:E604-E613. [PMID: 31160497 DOI: 10.1503/cmaj.181648] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- James Downar
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont.
| | - Sam D Shemie
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Clay Gillrie
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Marie-Chantal Fortin
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Amber Appleby
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Daniel Z Buchman
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Christen Shoesmith
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Aviva Goldberg
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Vanessa Gruben
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Jehan Lalani
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Dirk Ysebaert
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Lindsay Wilson
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Michael D Sharpe
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
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Wiebe C, Kosmoliaptsis V, Pochinco D, Gibson IW, Ho J, Birk PE, Goldberg A, Karpinski M, Shaw J, Rush DN, Nickerson PW. HLA-DR/DQ molecular mismatch: A prognostic biomarker for primary alloimmunity. Am J Transplant 2019; 19:1708-1719. [PMID: 30414349 PMCID: PMC6563434 DOI: 10.1111/ajt.15177] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/11/2018] [Accepted: 11/04/2018] [Indexed: 01/25/2023]
Abstract
Alloimmune risk stratification in renal transplantation has lacked the necessary prognostic biomarkers to personalize recipient care or optimize clinical trials. HLA molecular mismatch improves precision compared to traditional antigen mismatch but has not been studied in detail at the individual molecule level. This study evaluated 664 renal transplant recipients and correlated HLA-DR/DQ single molecule eplet mismatch with serologic, histologic, and clinical outcomes. Compared to traditional HLA-DR/DQ whole antigen mismatch, HLA-DR/DQ single molecule eplet mismatch improved the correlation with de novo donor-specific antibody development (area under the curve 0.54 vs 0.84) and allowed recipients to be stratified into low, intermediate, and high alloimmune risk categories. These risk categories were significantly correlated with primary alloimmune events including Banff ≥1A T cell-mediated rejection (P = .0006), HLA-DR/DQ de novo donor-specific antibody development (P < .0001), antibody-mediated rejection (P < .0001), as well as all-cause graft loss (P = .0012) and each of these correlations persisted in multivariate models. Thus, HLA-DR/DQ single molecule eplet mismatch may represent a precise, reproducible, and widely available prognostic biomarker that can be applied to tailor immunosuppression or design clinical trials based on individual patient risk.
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Affiliation(s)
- Chris Wiebe
- Department of MedicineUniversity of ManitobaWinnipegManitobaCanada,Shared Health Services ManitobaWinnipegManitobaCanada
| | - Vasilis Kosmoliaptsis
- Department of SurgeryUniversity of CambridgeAddenbrooke's HospitalCambridgeUK,NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation at the University of CambridgeCambridgeUK,The NIHR Cambridge Biomedical Research CentreCambridgeUK
| | | | - Ian W. Gibson
- Shared Health Services ManitobaWinnipegManitobaCanada,Department of PathologyUniversity of ManitobaWinnipegManitobaCanada
| | - Julie Ho
- Department of MedicineUniversity of ManitobaWinnipegManitobaCanada,Department of ImmunologyUniversity of ManitobaWinnipegManitobaCanada
| | - Patricia E. Birk
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegManitobaCanada
| | - Aviva Goldberg
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegManitobaCanada
| | - Martin Karpinski
- Department of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Jamie Shaw
- Department of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - David N. Rush
- Department of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Peter W. Nickerson
- Department of MedicineUniversity of ManitobaWinnipegManitobaCanada,Shared Health Services ManitobaWinnipegManitobaCanada,Department of ImmunologyUniversity of ManitobaWinnipegManitobaCanada
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Braaten K, Janiak E, Fulcher I, Cotrill A, Fortin J, Goldberg A. Surgical abortion in patients with opioid dependence: Disparities in demographic factors, procedural pain, and post-abortion contraception. Contraception 2019. [DOI: 10.1016/j.contraception.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Goldberg A, Lokireddy S, Kim H, Kuo C, VerPlank J. NEW INSIGHTS INTO THE PROTEASOME FUNCTION AND DEGRADATION OF MISFOLDED PROTEINS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Goldberg
- Department of Cell Biology Harvard Medical School, Boston, Massachusetts, United States
| | - S Lokireddy
- Oncosimis Biotech Private Limited, Hyderabad, India
| | - H Kim
- Department of Cell Biology, Harvard Medical School, Boston, MA, USA
| | - C Kuo
- Department of Cell Biology, Harvard Medical School, Boston, MA, USA
| | - J VerPlank
- Department of Cell Biology, Harvard Medical School, Boston, MA, USA
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Mastey N, Roe A, Maurer R, Goldberg A. Postabortion long-acting reversible contraceptive uptake among opioid-dependent patients. Contraception 2018. [DOI: 10.1016/j.contraception.2018.07.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Welck MJ, Singh D, Cullen N, Goldberg A. Evaluation of the 1st metatarso-sesamoid joint using standing CT - The Stanmore classification. Foot Ankle Surg 2018; 24:314-319. [PMID: 29409245 DOI: 10.1016/j.fas.2017.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/08/2017] [Accepted: 03/14/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Little is understood about the role that relative sesamoid displacement and chondral wear have on outcome after hallux valgus (HV) surgery. All existing methods to evaluate relative sesamoid displacement have limitations and furthermore, there have been no radiographic studies evaluating metatarso-sesamoid joint wear. Standing CT scan circumvents many of the existing problems in evaluation of relative sesamoid displacement, and also enables the first radiographic study assessing metatarso-sesamoid joint wear. METHODS Fifty feet (in 43 patients) with symptomatic HV (Group A) were compared with a control group of 50 feet (50 patients) (Group B). All images were standardised to enable reproducible measurements. The hallux valgus angle, Intermetatarsal angle, sesamoid rotation angle, sesamoid position and metatarso-sesamoid joint space were measured in all patients. RESULTS The intra and inter-observer reliability correlation showed that the standing CT assessment of sesamoid position (1.000), rotation (0.991) and metatarso-sesamoid joint space (0.960) were highly reproducible. There was a highly significant difference (p<0.0001) in sesamoid position, sesamoid rotation and metatarso-sesamoid joint space between Group A and Group B. CONCLUSIONS Standing CT has been shown to be a reproducible and accurate method of assessing the relative sesamoid displacement and metatarso-sesamoid joint space narrowing. The results have been used to propose a novel standing CT based classification of hallucal sesamoids, considering the degree of displacement and wear. This classification may ultimately facilitate research to provide new insight into the effect relative sesamoid displacement and chondral wear have on outcomes from hallux valgus surgery.
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Affiliation(s)
- M J Welck
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom.
| | - D Singh
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom
| | - N Cullen
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom
| | - A Goldberg
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom
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Abstract
Children with severe intellectual disability have historically been excluded from solid organ transplantation. The purpose of this article was to review the arguments for excluding this population, including claims of poorer recipient and graft survival, a lower QoL as pediatric recipients become adults, and poorer outcomes for other, more deserving pediatric transplant candidates, and make the case that these arguments are no longer persuasive. We will argue that pediatric transplant centers for reasons of social justice, value of relationships, power differential, and fairness should generally not consider intellectual ability or disability as a criterion when making decisions regarding organ transplant eligibility.
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Affiliation(s)
- Aaron Wightman
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, WA, USA
| | - Aviva Goldberg
- Department of Pediatrics, University of Manitoba College of Medicine, Winnipeg, MB, Canada
| | - Douglas Diekema
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, WA, USA
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DeMaria S, Berman DJ, Goldberg A, Lin HM, Khelemsky Y, Levine AI. Team-based model for non-operating room airway management: validation using a simulation-based study. Br J Anaesth 2018; 117:103-8. [PMID: 27317709 DOI: 10.1093/bja/aew121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Non-operating room (non-OR) airway management has previously been identified as an area of concern because it carries a significant risk for complications. One reason for this could be attributed to the independent practice of residents in these situations. The aim of the present study was to ascertain whether differences in performance exist between residents working alone vs with a resident partner when encountering simulated non-OR airway management scenarios. METHODS Thirty-six anaesthesia residents were randomized into two groups. Each group experienced three separate scenarios (two scenarios initially and then a third 6 weeks later). The scenarios consisted of one control scenario and two critical event scenarios [i.e. asystole during laryngoscopy and pulseless electrical activity (PEA) upon post-intubation institution of positive pressure ventilation]. One group experienced the simulated non-OR scenarios alone (Solo group). The other group consisted of resident pairs, participating in the same three scenarios (Team group). RESULTS Although the time to intubation did not differ between the Solo and Team groups, there were several differences in performance. The Team group received better overall performance ratings for the asystole (8.5 vs 5.5 out of 10; P<0.001) and PEA (8.5 vs 5.8 out of 10; P<0.001) scenarios. The Team group was also able to recognize asystole and PEA conditions faster than the Solo group [10.1 vs 23.5 s (P<0.001) and 13.3 vs 36.0 s (P<0.001), respectively]. CONCLUSIONS Residents who performed a simulated intubation with a second trained provider had better overall performance than those who practised independently. The residents who practised in a group were also faster to diagnose serious complications, including peri-intubation asystole and PEA. Given these data, it is reasonable that training programmes consider performing all non-OR airway management with a team-based method.
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Affiliation(s)
- S DeMaria
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1010, New York, NY 10029, USA
| | - D J Berman
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1010, New York, NY 10029, USA
| | - A Goldberg
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1010, New York, NY 10029, USA
| | - H-M Lin
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1010, New York, NY 10029, USA
| | - Y Khelemsky
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1010, New York, NY 10029, USA
| | - A I Levine
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1010, New York, NY 10029, USA
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Wightman A, Diekema D, Goldberg A. Consideration of children with intellectual disability as candidates for solid organ transplantation-A practice in evolution. Pediatr Transplant 2018; 22. [PMID: 29218833 DOI: 10.1111/petr.13091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 11/27/2022]
Abstract
Children with intellectual disability were historically excluded from consideration as recipients of solid organ transplants. In light of an evolution in provider practices, this commentary will define intellectual disability and review the relevant provider attitudes and guidelines and known outcomes of solid organ transplant in this population.
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Affiliation(s)
- Aaron Wightman
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, WA, USA
| | - Douglas Diekema
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, WA, USA
| | - Aviva Goldberg
- Department of Pediatrics, University of Manitoba College of Medicine, Winnipeg, MB, Canada
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Bromiker R, Goldberg A, Kaplan M. Israel transcutaneous bilirubin nomogram predicts significant hyperbilirubinemia. J Perinatol 2017; 37:1315-1318. [PMID: 29192695 DOI: 10.1038/jp.2017.127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 06/10/2017] [Accepted: 07/05/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We constructed a transcutaneous bilirubin (TcB) nomogram to represent major sectors of the Israeli population. We studied the risk of hyperbilirubinemia, defined as meeting the requirements for phototherapy, per percentile risk category. STUDY DESIGN Newborns ⩾36 weeks gestation were tested daily for TcB, using Drager JM-103 devices, during birth hospitalization. A nomogram was constructed and divided into four risk groups and validated by calculating the need for phototherapy for each group. RESULTS A total of 3303 measurements were performed on 1059 consecutive newborns including Ashkenazi, Sephardic and mixed Ashkenazi/Sephardic Jews, Arab and Ethiopian Jewish. Phototherapy risk increased progressively and more than 100-fold, from 0/225 in the <40th percentile group through 27/120 (22.5%) for those >95th percentile (relative risk (95% confidence interval) 102 (6 to 1669) for those >95th percentile compared with those <40th percentile). The optimal risk for discriminating the need for phototherapy was >75th percentile (sensitivity 93.33, specificity 59.47). CONCLUSION The risk of significant hyperbilirubinemia increased progressively with increasing percentile. Newborns >75th percentile groups are at high risk for phototherapy and should be closely monitored.
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Affiliation(s)
- R Bromiker
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - A Goldberg
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - M Kaplan
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
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Wiebe C, Rush DN, Nevins TE, Birk PE, Blydt-Hansen T, Gibson IW, Goldberg A, Ho J, Karpinski M, Pochinco D, Sharma A, Storsley L, Matas AJ, Nickerson PW. Class II Eplet Mismatch Modulates Tacrolimus Trough Levels Required to Prevent Donor-Specific Antibody Development. J Am Soc Nephrol 2017; 28:3353-3362. [PMID: 28729289 DOI: 10.1681/asn.2017030287] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [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: 03/15/2017] [Accepted: 05/15/2017] [Indexed: 11/03/2022] Open
Abstract
Despite more than two decades of use, the optimal maintenance dose of tacrolimus for kidney transplant recipients is unknown. We hypothesized that HLA class II de novo donor-specific antibody (dnDSA) development correlates with tacrolimus trough levels and the recipient's individualized alloimmune risk determined by HLA-DR/DQ epitope mismatch. A cohort of 596 renal transplant recipients with 50,011 serial tacrolimus trough levels had HLA-DR/DQ eplet mismatch determined using HLAMatchmaker software. We analyzed the frequency of tacrolimus trough levels below a series of thresholds <6 ng/ml and the mean tacrolimus levels before dnDSA development in the context of HLA-DR/DQ eplet mismatch. HLA-DR/DQ eplet mismatch was a significant multivariate predictor of dnDSA development. Recipients treated with a cyclosporin regimen had a 2.7-fold higher incidence of dnDSA development than recipients on a tacrolimus regimen. Recipients treated with tacrolimus who developed HLA-DR/DQ dnDSA had a higher proportion of tacrolimus trough levels <5 ng/ml, which continued to be significant after adjustment for HLA-DR/DQ eplet mismatch. Mean tacrolimus trough levels in the 6 months before dnDSA development were significantly lower than the levels >6 months before dnDSA development in the same patients. Recipients with a high-risk HLA eplet mismatch score were less likely to tolerate low tacrolimus levels without developing dnDSA. We conclude that HLA-DR/DQ eplet mismatch and tacrolimus trough levels are independent predictors of dnDSA development. Recipients with high HLA alloimmune risk should not target tacrolimus levels <5 ng/ml unless essential, and monitoring for dnDSA may be advisable in this setting.
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Affiliation(s)
- Chris Wiebe
- Departments of Medicine, .,Diagnostic Services of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | - Tom Blydt-Hansen
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ian W Gibson
- Diagnostic Services of Manitoba, Winnipeg, Manitoba, Canada.,Pathology, and
| | | | - Julie Ho
- Departments of Medicine.,Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | | | - Arthur J Matas
- Surgery, University of Minnesota, Minneapolis, Minnesota; and
| | - Peter W Nickerson
- Departments of Medicine.,Diagnostic Services of Manitoba, Winnipeg, Manitoba, Canada.,Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
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Shuler K, Sucic J, Talley S, Goldberg A. STEPPING PERFORMANCE IN OLDER ADULTS: ASSOCIATION WITH THE ACE GENE INSERTION/DELETION POLYMORPHISM. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K. Shuler
- University of Michigan-Flint, Flint, Michigan
| | - J.F. Sucic
- University of Michigan-Flint, Flint, Michigan
| | - S.A. Talley
- University of Michigan-Flint, Flint, Michigan
| | - A. Goldberg
- University of Michigan-Flint, Flint, Michigan
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Abstract
For patients on dialysis, 1 frequent cause of death is their voluntary decision to discontinue dialysis. Such decisions raise complex questions when the patient is a competent adult. The decisions are even more complex when the patient is an adolescent. In this article, we present a case in which a 17-year-old adolescent decided that she no longer wished to undergo dialysis through her fistula. Her doctors thought that dialysis using any other technique would be too dangerous. Four experts in pediatric nephrology, bioethics, and palliative care discuss this decision and the different ways that the health care team might respond.
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Affiliation(s)
- Tyler Tate
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, Washington
| | - Aviva Goldberg
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; and
| | - Aaron Wightman
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, Washington
| | | | - John D Lantos
- Center for Bioethics, Children's Mercy Kansas City, Kansas City, Missouri
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36
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Hunter S, Katz D, Goldberg A, Lin HM, Pasricha R, Benesh G, Le Grand B, DeMaria S. Use of an anaesthesia workstation barrier device to decrease contamination in a simulated operating room. Br J Anaesth 2017; 118:870-875. [DOI: 10.1093/bja/aex097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 12/12/2022] Open
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Wiebe C, Gareau AJ, Pochinco D, Gibson IW, Ho J, Birk PE, Blydt-Hansen T, Karpinski M, Goldberg A, Storsley L, Rush DN, Nickerson PW. Evaluation of C1q Status and Titer of De Novo Donor-Specific Antibodies as Predictors of Allograft Survival. Am J Transplant 2017; 17:703-711. [PMID: 27539748 DOI: 10.1111/ajt.14015] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [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: 05/02/2016] [Revised: 08/09/2016] [Accepted: 08/13/2016] [Indexed: 01/25/2023]
Abstract
De novo donor-specific antibodies (dnDSAs) that develop after renal transplantation are independent predictors of allograft loss. However, it is unknown if dnDSA C1q status or titer at the time of first detection can independently predict allograft loss. In a consecutive cohort of 508 renal transplant recipients, 70 developed dnDSAs. Histologic and clinical outcomes were correlated with the C1q assay or dnDSA titer. C1q positivity correlated with dnDSA titer (p < 0.01) and mean fluorescence intensity (p < 0.01) and was more common in class II versus class I dnDSAs (p < 0.01). C1q status correlated with tubulitis (p = 0.02) and C4d status (p = 0.03) in biopsies at the time of dnDSA development, but not T cell-mediated rejection (TCMR) or antibody-mediated rejection (ABMR). De novo DSA titer correlated with Banff g, i, t, ptc, C4d scores, TCMR (p < 0.01) and ABMR (p < 0.01). Post-dnDSA graft loss was observed more frequently in recipients with C1q-positve dnDSA (p < 0.01) or dnDSA titer ≥ 1:1024 (p ≤ 0.01). However, after adjustment for clinical phenotype and nonadherence in multivariate models, neither C1q status nor dnDSA titer were independently associated with allograft loss, questioning the utility of these assays at the time of dnDSA development.
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Affiliation(s)
- C Wiebe
- Department of Medicine, University of Manitoba, Winnipeg, Canada.,Diagnostic Services of Manitoba, Winnipeg, Canada
| | - A J Gareau
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - D Pochinco
- Diagnostic Services of Manitoba, Winnipeg, Canada
| | - I W Gibson
- Diagnostic Services of Manitoba, Winnipeg, Canada.,Department of Pathology, University of Manitoba, Winnipeg, Canada
| | - J Ho
- Department of Medicine, University of Manitoba, Winnipeg, Canada.,Department of Immunology, University of Manitoba, Winnipeg, Canada
| | - P E Birk
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - T Blydt-Hansen
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - M Karpinski
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - A Goldberg
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - L Storsley
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - D N Rush
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - P W Nickerson
- Department of Medicine, University of Manitoba, Winnipeg, Canada.,Diagnostic Services of Manitoba, Winnipeg, Canada.,Department of Immunology, University of Manitoba, Winnipeg, Canada
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Ely K, Stafflinger J, Goldberg A. Efficacy of the Routine Postoperative Visit in Benign Gynecologic Ambulatory Procedures. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pocius K, Bartz D, Maurer R, Stenquist A, Fortin J, Goldberg A. Serum human chorionic gonadotropin (hCG) trend within the first few days after medication abortion: a prospective study. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Horwitz G, Roncari D, Braaten K, Maurer R, Fortin J, Goldberg A. BMI as predictor of adverse outcomes with moderate intravenous sedation during surgical abortion. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ngo L, Braaten K, Eichen E, Fortin J, Maurer R, Goldberg A. Naproxen sodium for pain control with intrauterine device insertion: a randomized controlled trial. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- A Goldberg
- University Department of Medicine, Gardiner Institute, Western Infirmary, Glasgow
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Dunleavy K, Kava K, Goldberg A, Malek M, Talley S, Tutag-Lehr V, Hildreth J. Comparative effectiveness of Pilates and yoga group exercise interventions for chronic mechanical neck pain: quasi-randomised parallel controlled study. Physiotherapy 2016; 102:236-42. [DOI: 10.1016/j.physio.2015.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 06/02/2015] [Indexed: 10/23/2022]
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Wiebe C, Gareau A, Pochinco D, Gibson I, Ho J, Birk P, Blydt-Hansen T, Karpinski M, Goldberg A, Storsley L, Rush D, Nickerson P. P044 C1q status and titer of de novo donor specific antibodies are not predictors of allograft survival. Hum Immunol 2016. [DOI: 10.1016/j.humimm.2016.07.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Harfouche M, Maher Z, Krowsoski L, Goldberg A. Global surgical electives in residency: the impact on training and future
practice at Temple University Hospital. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Affiliation(s)
- M. R. Moore
- University Department of Medicine, Western Infirmary Divisions of Paediatrics and Obstetrics and Gynaecology, Stobhill General Hospital and Strathclyde Water Department, Balmore Road, Glasgow
| | - A. Goldberg
- University Department of Medicine, Western Infirmary Divisions of Paediatrics and Obstetrics and Gynaecology, Stobhill General Hospital and Strathclyde Water Department, Balmore Road, Glasgow
| | - W. M. Fyfe
- University Department of Medicine, Western Infirmary Divisions of Paediatrics and Obstetrics and Gynaecology, Stobhill General Hospital and Strathclyde Water Department, Balmore Road, Glasgow
| | - R. A. Low
- University Department of Medicine, Western Infirmary Divisions of Paediatrics and Obstetrics and Gynaecology, Stobhill General Hospital and Strathclyde Water Department, Balmore Road, Glasgow
| | - W. N. Richards
- University Department of Medicine, Western Infirmary Divisions of Paediatrics and Obstetrics and Gynaecology, Stobhill General Hospital and Strathclyde Water Department, Balmore Road, Glasgow
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Abstract
It has been shown that there is a high incidence of latent iron deficiency (sideropenia) in the female population. To assess the role of this deficiency as a cause of symptoms a double blind trial of iron and placebo therapy was carried out on 20 sideropenic women presenting with symptoms. The incidence of all the symptoms studied fell and there was no significant difference between iron and placebo in producing improvement. A significant rise in haemoglobin level occurred only in response to iron therapy and this was reversed on cessation of iron. No significant changes in haemoglobin occurred in response to the placebo. It has been concluded that while iron has no specific effect on the symptoms associated with sideropenia, it will produce a significant rise in haemoglobin level, reverse biochemical defects and, in a minority, prevent development of iron deficiency anaemia.
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Affiliation(s)
- J. J. Morrow
- University Department of Medicine, Gardiner Institute, Western Infirmary, Glasgow
| | - J. H. Dagg
- University Department of Medicine, Gardiner Institute, Western Infirmary, Glasgow
| | - A. Goldberg
- University Department of Medicine, Gardiner Institute, Western Infirmary, Glasgow
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Affiliation(s)
- F. B. McGillion
- University Department of Materia Medica, Stobhill General Hospital, Glasgow
| | - M. R. Moore
- University Department of Materia Medica, Stobhill General Hospital, Glasgow
| | - A. Goldberg
- University Department of Materia Medica, Stobhill General Hospital, Glasgow
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Affiliation(s)
- A. Goldberg
- University Department of Medicine, Western Infirmary, Glasgow
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