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Wojtaszek E, Małyszko J, Nazarewski S, Grochowiecki T, Macech M, Głogowski T, Kaszczewski P, Gałązka Z. Effect of Pretransplant Dialysis Method and Vintage on Early Clinical Outcomes of Kidney Transplantation. Transplant Proc 2024; 56:948-952. [PMID: 38729829 DOI: 10.1016/j.transproceed.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Pre-transplantation dialysis duration and modality may affect patients' long-term (mortality and graft failure) and short-term (delayed graft function) outcomes after kidney transplantation. We aimed to assess the impact of the method and duration of dialysis therapy on the graft function in the first 6 months post-transplant. METHODS The analysis included 122 kidney transplant patients (109 from a deceased donor and 13 from a living donor). Before transplantation, 91 were on hemodialysis (HD), 19 were on peritoneal dialysis (PD), and 9 received preemptive transplants. The incidence of delayed graft function (DGF) and creatinine levels at discharge and 6 months after transplantation were assessed. RESULTS PD and HD patients did not differ in age, number of mismatches, and cold ischemia time (CIT), but they had a significantly shorter dialysis vintage (18.3 ± 25.7 vs 39.6 ± 34.3 months, P = .01) and a lower incidence of DGF (5% vs 37%, P = .006). The duration of hospitalization and creatinine concentration at discharge and after 6 months were similar. Preemptively transplanted patients had a significantly shorter CIT (ND vs DO - 576 ± 362 vs 1113 ± 574, P = .01; ND vs HD - 576 ± 362 vs 1025 ± 585 minutes, P = .01). DGF did not occur in any of the patients transplanted preemptively. They had slightly shorter hospitalization times and, compared to HD, better graft function at discharge. After 6 months, creatinine levels were comparable to HD and PD. Patients dialyzed for less than 12 months, regardless of the method, had a lower incidence of DGF. CONCLUSIONS Peritoneal dialysis and a short duration of pre-transplant dialysis may improve the early results of kidney transplantation.
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Affiliation(s)
- Ewa Wojtaszek
- Department of Nephrology, Dialysis & Internal Diseases, The Medical University of Warsaw.
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis & Internal Diseases, The Medical University of Warsaw
| | - Sławomir Nazarewski
- Department of General, Vascular, Endocrine & Transplant Surgery, The Medical University of Warsaw
| | - Tadeusz Grochowiecki
- Department of General, Vascular, Endocrine & Transplant Surgery, The Medical University of Warsaw
| | - Michał Macech
- Department of General, Vascular, Endocrine & Transplant Surgery, The Medical University of Warsaw
| | - Tomasz Głogowski
- Department of Nephrology, Dialysis & Internal Diseases, The Medical University of Warsaw
| | - Piotr Kaszczewski
- Department of General, Vascular, Endocrine & Transplant Surgery, The Medical University of Warsaw
| | - Zbigniew Gałązka
- Department of General, Vascular, Endocrine & Transplant Surgery, The Medical University of Warsaw
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Peritoneal dialysis catheter removal at the time or after kidney transplantation: a systematic review and meta-analysis. Langenbecks Arch Surg 2022; 407:2651-2662. [PMID: 35945300 PMCID: PMC9640428 DOI: 10.1007/s00423-022-02637-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 07/31/2022] [Indexed: 11/24/2022]
Abstract
Purpose An increasing number of patients treated with peritoneal dialysis eventually undergo kidney transplantation. Owing to opposing reports, we aimed to find evidence about the best time for peritoneal dialysis catheter removal in transplant patients. Methods We conducted a systematic review and random effects meta-analysis of non-randomized studies of intervention comparing patients with peritoneal dialysis catheters left in place or removed during kidney transplantation in regard to the need for dialysis and occurrence of catheter-related complications. We searched (last update on 8 December 2021) PubMed, Embase, Scopus, and Web of Science for eligible studies. ROBINS-I tool and funnel plot asymmetry analysis were used to assess the quality of included articles. Results Eight observational studies were evaluated. Five of them, which involved 338 patients, were included in a meta-analysis. All were at moderate to serious risk of bias. The odds of needing dialysis are more than twice as high for patients with peritoneal dialysis catheters left in situ (pooled odds ratio, 2.21; 95% confidence interval [CI], 1.03 to 4.73; I2 = 0%). No statistically significant difference was noted when adult and pediatric subgroups were compared (Q = 0.13, P = .720). More individuals with catheters left in place required dialysis (pooled prevalence, 20.9%; 95% CI, 13.6 to 30.7%; I2 = 59% vs. 12.4%; 95% CI, 5.6 to 25.2%; I2 = 0%) and experienced catheter-related infections. Conclusion Available evidence is scarce. Unless new data from a randomized controlled trial are available, the dilemma of peritoneal dialysis catheter removal cannot be solved. Trial registration PROSPERO Protocol ID: CRD42020207707. Graphical abstract ![]()
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Gardezi AI, Aziz F, Parajuli S. The Role of Peritoneal Dialysis in Different Phases of Kidney Transplantation. KIDNEY360 2022; 3:779-787. [PMID: 35721606 PMCID: PMC9136899 DOI: 10.34067/kid.0000482022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/23/2022] [Indexed: 04/28/2023]
Abstract
The utilization of peritoneal dialysis (PD) has been increasing in the past decade owing to various government initiatives and recognition of benefits such as better preservation of residual renal function, quality of life, and lower cost. The Advancing American Kidney Health initiative aims to increase the utilization of home therapies such as PD and kidney transplantation to treat end stage kidney disease (ESKD). A natural consequence of this development is that more patients will receive PD, and many will eventually undergo kidney transplantation. Therefore, it is important to understand the effect of pretransplant PD on posttransplant outcomes such as delayed graft function (DGF), rejection, thrombosis, graft, and patient survival. Furthermore, some of these patients may develop DGF, which raises the question of the utility of PD during DGF and its risks. Although transplant is the best renal replacement therapy option, it is not everlasting, and many transplant recipients must go on dialysis after allograft failure. Can PD be a good option for these patients? This is another critical question. Furthermore, a significant proportion of nonrenal solid organ transplant recipients develop ESKD. Is PD feasible in this group? In this review, we try to address all of these questions in the light of available evidence.
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Affiliation(s)
- Ali I. Gardezi
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Issa N, Lakhani L. Peritoneal Dialysis for Delayed Graft Function After Kidney Transplantation: To Do or Not to Do? Kidney Int Rep 2021; 6:1494-1496. [PMID: 34169188 PMCID: PMC8207459 DOI: 10.1016/j.ekir.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Naim Issa
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - Laila Lakhani
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Gardezi AI, Muth B, Ghaffar A, Aziz F, Garg N, Mohamed M, Foley D, Kaufman D, Djamali A, Mandelbrot D, Parajuli S. Continuation of Peritoneal Dialysis in Adult Kidney Transplant Recipients With Delayed Graft Function. Kidney Int Rep 2021; 6:1634-1641. [PMID: 34169204 PMCID: PMC8207463 DOI: 10.1016/j.ekir.2021.03.899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/11/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Peritoneal dialysis (PD) has been used increasingly in past decade. Many of these patients undergo transplantation and may require dialysis for delayed graft function (DGF). The outcomes of DGF based on the post-transplantation dialysis modality are not well known. METHODS We retrospectively reviewed all adult kidney transplant recipients (KTRs) from the University of Wisconsin School of Medicine and Public Health who developed DGF between November 2015 and April 2019. Patients were divided into those who received hemodialysis (HD) or PD during the DGF period. Immediate graft explant, DGF among living donor KTRs, or those requiring just a single dialysis treatment were excluded. RESULTS Of 224 KTRs with DGF during the study period, 167 fulfilled our selection criteria. There were 16 patients in the PD and 151 in the HD group. Baseline characteristics were similar between the two groups, except diabetes was more prevalent in the HD group. Five of 16 PD patients had to be transitioned to HD. There was no difference in DGF duration, hospital length of stay, infectious or surgical complications, rejection at various time periods, graft function at last follow-up, or graft failure. In multivariate analysis, only rejection within the first year of transplantation (hazard ratio [HR]: 4.26; 95% confidence interval [CI]: 1.20-15.08; P = 0.02) and post-surgical complications (HR: 3.79; 95% CI: 1.03- 13.91; P = 0.04) were associated with death-censored graft failure (DCGF). The use of PD for treatment of DGF was not associated with DCGF. CONCLUSIONS In carefully selected patients, PD can be continued safely for DGF without any effect on short-term or long-term transplant outcomes.
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Affiliation(s)
- Ali I. Gardezi
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Brenda Muth
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Adil Ghaffar
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Fahad Aziz
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Neetika Garg
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Maha Mohamed
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - David Foley
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Dixon Kaufman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Arjang Djamali
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Didier Mandelbrot
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sandesh Parajuli
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Etta P. Automated peritoneal dialysis is a superior option for the management of postrenal transplant delayed graft function. INDIAN JOURNAL OF TRANSPLANTATION 2020. [DOI: 10.4103/ijot.ijot_43_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jain D, Haddad DB, Goel N. Choice of dialysis modality prior to kidney transplantation: Does it matter? World J Nephrol 2019. [DOI: 10.5527/wjn.v8.i1.0000] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Jain D, Haddad DB, Goel N. Choice of dialysis modality prior to kidney transplantation: Does it matter? World J Nephrol 2019; 8:1-10. [PMID: 30705867 PMCID: PMC6354079 DOI: 10.5527/wjn.v8.i1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/05/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
The population of patients with end stage renal disease (ESRD) is increasing, lengthening waiting lists for kidney transplantation. Majority of the patients are not able to receive a kidney transplant in timely manner even though it is well established that patient survival and quality of life after kidney transplantation is far better when compared to being on dialysis. A large number of patients who desire a kidney transplant ultimately end up needing some form of dialysis therapy. Most of incident ESRD patients choose hemodialysis (HD) over peritoneal dialysis (PD) as the modality of choice in the United States, even though studies have favored PD as a better choice of pre-transplant dialysis modality than HD. PD is largely underutilized in the United States due to variety of reasons. As a part of the decision making process, patients are often educated how the choice regarding modality of dialysis would fit into their life but it is not clear and not usually discussed, how it can affect eventual kidney transplantation in the future. In this article we would like to discuss ESRD demographics and outcomes, modality of dialysis and kidney transplant related events. We have summarized the data comparing PD and HD as the modality of dialysis and its impact on allograft and recipient outcomes after kidney transplantation.
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Affiliation(s)
- Deepika Jain
- Nephrology and Internal Medicine, New Jersey Kidney Care, Jersey city, NJ 07305, United States
| | - Danny B Haddad
- Nephrology and Internal Medicine, New Jersey Kidney Care, Jersey city, NJ 07305, United States
- Department of Internal Medicine, Division of Nephrology, RWJ-Jersey City Medical Center, Jersey city, NJ 07305, United States
| | - Narender Goel
- Nephrology and Internal Medicine, New Jersey Kidney Care, Jersey city, NJ 07305, United States
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Yan T, Peng W, Lv J, Wu J, Chen J. Hemodialysis or Peritoneal Dialysis, Which Is Better for Patients with Delayed Graft Function? Kidney Blood Press Res 2018; 43:1813-1821. [PMID: 30504705 DOI: 10.1159/000495639] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Hemodialysis (HD) or peritoneal dialysis (PD) is an important renal replacement method in patients with delayed graft function (DGF) after kidney transplantation; however, it is not clear which dialysis modality is superior. This study determined the impact of different dialysis modalities on patients with DGF. METHODS It was a single-center, retrospective and descriptive study. We performed 673 kidney transplants from donors after cardiac death (DCD) between January 2010 and December 2016 at our center and 138 (20.5%) recipients developed DGF after transplantation. We classified the recipients into two groups according to post-transplant dialysis: DGF-HD (n=96) and DGF-PD (n=42). We analyzed the outcomes of the different dialysis modalities 30 days and 1 year post-transplantation. RESULTS There were no differences in baseline factors between patients with post-transplant HD (n = 96) or PD (n = 42). There were 10 patients with conversion from PD to HD during DGF. The DGF-PD patients had a higher rate of treatment failure than the DGF-HD patients (23.8% vs. 0%, p < 0.001), peritonitis (7.1% vs. 0%, p = 0.027), and longer duration of dialysis dependence (10.5 vs. 9 days, p = 0.003). There was no statistically significant difference between both groups with respect to acute rejection, hemorrhage, and patient and graft survival at 1 year. CONCLUSION In renal transplant recipients with DGF, post-transplant PD led to increased treatment failure. PD did not result in rapid recovery of transplanted renal function, and had a high probability of peritonitis.
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Affiliation(s)
- Ting Yan
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China
| | - Wenhan Peng
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China, .,Key Laboratory of Nephropathy, Hangzhou, China, .,National Key Clinical Department of Kidney Diseases, Hangzhou, China,
| | - Junhao Lv
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, China
| | - Jianyong Wu
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China
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Pampa-Saico S, Caravaca-Fontán F, Burguera-Vion V, Nicolás VD, Yerovi-León E, Jimenez-Álvaro S, Fernández-Rodríguez A, Marcén R, Rivera-Gorrín M. Outcomes of Peritoneal Dialysis Catheter Left In Place after Kidney Transplantation. Perit Dial Int 2017; 37:651-654. [PMID: 29123003 DOI: 10.3747/pdi.2017.00031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
No clear consensus has been reached regarding the optimal time to remove the peritoneal dialysis catheter (PDC) after kidney transplantation (KT). This retrospective observational study, conducted in a single peritoneal dialysis (PD) unit including all PD patients who received a KT between 1995 - 2015, was undertaken to evaluate the clinical outcomes and potential complications associated with a PDC left in place after KT. Of the 132 PD patients who received a KT, 20 were excluded from the study. Of the remaining, 112 (85%) patients with functioning KT were discharged with their PDC left in place and had it removed in a mean interval of 5 ± 3 months after KT, after achieving optimal graft function. During this follow-up period, 7 patients (6%) developed exit-site infection and there were 2 cases (2%) of peritonitis; all of them were successfully treated. Delayed PDC removal after KT is associated with low complication rates, although regular examination is needed so that mild infections can be detected early and therapy promptly instituted.
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Affiliation(s)
- Saúl Pampa-Saico
- Department of Nephrology, Hospital Universitario Ramón y Cajal (HURyC), Madrid, Spain .,Instituto Ramón y Cajal de Investigación Sanitaria (IRyCis), RedinRenISCIII (ERC 10 RD12/0021/0020), Madrid, Spain
| | - Fernando Caravaca-Fontán
- Department of Nephrology, Hospital Universitario Ramón y Cajal (HURyC), Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRyCis), RedinRenISCIII (ERC 10 RD12/0021/0020), Madrid, Spain
| | - Víctor Burguera-Vion
- Department of Nephrology, Hospital Universitario Ramón y Cajal (HURyC), Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRyCis), RedinRenISCIII (ERC 10 RD12/0021/0020), Madrid, Spain
| | - Víctor Diéz Nicolás
- Department of Urology, Hospital Universitario Ramón y Cajal (HURyC), Madrid, Spain
| | - Estefanía Yerovi-León
- Department of Nephrology, Hospital Universitario Ramón y Cajal (HURyC), Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRyCis), RedinRenISCIII (ERC 10 RD12/0021/0020), Madrid, Spain
| | - Sara Jimenez-Álvaro
- Department of Nephrology, Hospital Universitario Ramón y Cajal (HURyC), Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRyCis), RedinRenISCIII (ERC 10 RD12/0021/0020), Madrid, Spain
| | - Ana Fernández-Rodríguez
- Department of Nephrology, Hospital Universitario Ramón y Cajal (HURyC), Madrid, Spain.,Facultad de Medicina, Universidad de Alcalá, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRyCis), RedinRenISCIII (ERC 10 RD12/0021/0020), Madrid, Spain
| | - Roberto Marcén
- Department of Nephrology, Hospital Universitario Ramón y Cajal (HURyC), Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRyCis), RedinRenISCIII (ERC 10 RD12/0021/0020), Madrid, Spain
| | - Maite Rivera-Gorrín
- Department of Nephrology, Hospital Universitario Ramón y Cajal (HURyC), Madrid, Spain.,Facultad de Medicina, Universidad de Alcalá, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRyCis), RedinRenISCIII (ERC 10 RD12/0021/0020), Madrid, Spain
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Choe YM, Park KM, Jeon Y, Cho S, Hong K, Shin W, Song J. Enterobacter cloacae –Related Necrotizing Fasciitis After Peritoneal Dialysis in Delayed Graft Function: A Case Report. Transplant Proc 2017; 49:1189-1191. [DOI: 10.1016/j.transproceed.2017.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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