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Hakeem AR, Asthana S, Johnson R, Brown C, Ahmad N. Impact of Asian and Black Donor and Recipient Ethnicity on the Outcomes After Deceased Donor Kidney Transplantation in the United Kingdom. Transpl Int 2024; 37:12605. [PMID: 38711816 PMCID: PMC11070942 DOI: 10.3389/ti.2024.12605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/09/2024] [Indexed: 05/08/2024]
Abstract
Patients of Asian and black ethnicity face disadvantage on the renal transplant waiting list in the UK, because of lack of human leucocyte antigen and blood group matched donors from an overwhelmingly white deceased donor pool. This study evaluates outcomes of renal allografts from Asian and black donors. The UK Transplant Registry was analysed for adult deceased donor kidney only transplants performed between 2001 and 2015. Asian and black ethnicity patients constituted 12.4% and 6.7% of all deceased donor recipients but only 1.6% and 1.2% of all deceased donors, respectively. Unadjusted survival analysis demonstrated significantly inferior long-term allograft outcomes associated with Asian and black donors, compared to white donors. On Cox-regression analysis, Asian donor and black recipient ethnicities were associated with poorer outcomes than white counterparts, and on ethnicity matching, compared with the white donor-white recipient baseline group and adjusting for other donor and recipient factors, 5-year graft outcomes were significantly poorer for black donor-black recipient, Asian donor-white recipient, and white donor-black recipient combinations in decreasing order of worse unadjusted 5-year graft survival. Increased deceased donation among ethnic minorities could benefit the recipient pool by increasing available organs. However, it may require a refined approach to enhance outcomes.
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Affiliation(s)
- Abdul Rahman Hakeem
- Division of Surgery, Department of Transplantation, St. James’s University Hospital, Leeds, United Kingdom
| | - Sonal Asthana
- Division of Surgery, Department of Transplantation, St. James’s University Hospital, Leeds, United Kingdom
| | - Rachel Johnson
- National Health Service Blood and Transplant (NHSBT), Bristol, United Kingdom
| | - Chloe Brown
- National Health Service Blood and Transplant (NHSBT), Bristol, United Kingdom
| | - Niaz Ahmad
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
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Reed RD, Locke JE. Mitigating Health Disparities in Transplantation Requires Equity, Not Equality. Transplantation 2024; 108:100-114. [PMID: 38098158 PMCID: PMC10796154 DOI: 10.1097/tp.0000000000004630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Despite decades of research and evidence-based mitigation strategies, disparities in access to transplantation persist for all organ types and in all stages of the transplant process. Although some strategies have shown promise for alleviating disparities, others have fallen short of the equity goal by providing the same tools and resources to all rather than tailoring the tools and resources to one's circumstances. Innovative solutions that engage all stakeholders are needed to achieve equity regardless of race, sex, age, socioeconomic status, or geography. Mitigation of disparities is paramount to ensure fair and equitable access for those with end-stage disease and to preserve the trust of the public, upon whom we rely for their willingness to donate organs. In this overview, we present a summary of recent literature demonstrating persistent disparities by stage in the transplant process, along with policies and interventions that have been implemented to combat these disparities and hypotheses for why some strategies have been more effective than others. We conclude with future directions that have been proposed by experts in the field and how these suggested strategies may help us finally arrive at equity in transplantation.
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Affiliation(s)
- Rhiannon D. Reed
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL
| | - Jayme E. Locke
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL
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Lv K, Wu Y, Lai W, Hao X, Xia X, Huang S, Luo Z, Lv C, Qing Y, Song T. Simpson's paradox and the impact of donor-recipient race-matching on outcomes post living or deceased donor kidney transplantation in the United States. Front Surg 2023; 9:1050416. [PMID: 36700016 PMCID: PMC9869683 DOI: 10.3389/fsurg.2022.1050416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/15/2022] [Indexed: 01/11/2023] Open
Abstract
Background Race is a prognostic indicator in kidney transplant (KT). However, the effect of donor-recipient race-matching on survival after KT remains unclear. Methods Using the United Network for Organ Sharing (UNOS) database, a retrospective study was conducted on 244,037 adults who received first-time, kidney-alone transplantation between 2000 and 2019. All patients were categorized into two groups according to donor-recipient race-matching, and the living and deceased donor KT (LDKT and DDKT) were analyzed in subgroups. Results Of the 244,037 patients, 149,600 (61%) were race-matched, including 107,351 (87%) Caucasian, 20,741 (31%) African Americans, 17,927 (47%) Hispanics, and 3,581 (25%) Asians. Compared with race-unmatching, race-matching showed a reduced risk of overall mortality and graft loss (unadjusted hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.84-0.87; and unadjusted HR 0.79, 95% CI: 0.78-0.80, respectively). After propensity score-matching, donor-recipient race-matching was associated with a decreased risk of overall graft loss (P < 0.001) but not mortality. In subgroup analysis, race-matching was associated with higher crude mortality (HR 1.12, 95% CI: 1.06-1.20 in LDKT and HR 1.11, 95% CI: 1.09-1.14 in DDKT). However, race-matching was associated with a decreased risk of graft loss in DDKT (unadjusted HR 0.97, 95% CI: 0.96-0.99), but not in LDKT. After propensity score-matching, race-matching had better outcomes for LDKT (patient survival, P = 0.047; graft survival, P < 0.001; and death-censored graft survival, P < 0.001) and DDKT (death-censored graft survival, P = 0.018). Nonetheless, race-matching was associated with an increased adjusted mortality rate in the DDKT group (P < 0.001). Conclusion Race-matching provided modest survival advantages after KT but was not enough to influence organ offers. Cofounding factors at baseline led to a contorted crude conclusion in subgroups, which was reversed again to normal trends in the combined analysis due to Simpson's paradox caused by the LDKT/DDKT ratio.
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Affiliation(s)
- Kaikai Lv
- Department of Urology, The Third Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,Medical School of Chinese People’s Liberation Army (PLA), Beijing, China
| | - Yangyang Wu
- Department of Urology, The Third Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,Medical School of Chinese People’s Liberation Army (PLA), Beijing, China
| | - Wenhui Lai
- Department of Postgraduate, Hebei North University, Zhangjiakou, China
| | - Xiaowei Hao
- Department of Urology, The Third Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,Medical School of Chinese People’s Liberation Army (PLA), Beijing, China
| | - Xinze Xia
- Department of Urology, Shanxi Medical University, Taiyuan, China
| | - Shuai Huang
- Department of Postgraduate, Hebei North University, Zhangjiakou, China
| | - Zhenjun Luo
- Affililated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Chao Lv
- Medical School of Chinese People’s Liberation Army (PLA), Beijing, China
| | - Yuan Qing
- Department of Urology, The Third Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,Medical School of Chinese People’s Liberation Army (PLA), Beijing, China,Correspondence: Tao Song Qing Yuan
| | - Tao Song
- Department of Urology, The Third Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,Medical School of Chinese People’s Liberation Army (PLA), Beijing, China,Correspondence: Tao Song Qing Yuan
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Yang Z, Takahashi T, Terada Y, Meyers BF, Kozower BD, Patterson GA, Nava RG, Hachem RR, Witt CA, Byers DE, Kulkarni HS, Guillamet RV, Yan Y, Chang SH, Kreisel D, Puri V. A comparison of outcomes after lung transplantation between European and North American centers. J Heart Lung Transplant 2022; 41:1729-1735. [PMID: 35970646 PMCID: PMC10305841 DOI: 10.1016/j.healun.2022.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/19/2022] [Accepted: 07/14/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND With advancements in basic science and clinical medicine, lung transplantation (LT) has evolved rapidly over the last three decades. However, it is unclear if significant regional variations exist in long-term outcomes after LT. METHODS To investigate potential differences, we performed a retrospective, comparative cohort analysis of adult patients undergoing deceased donor single or double LT in North America (NA) or Europe between January 2006 and December 2016. Data up to April 2019 were abstracted from the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Organ Registry. We compared overall survival (OS) between North American and European LT centers in a propensity score matched analysis. RESULTS In 3,115 well-matched pairs, though 30-day survival was similar between groups (NA 96.2% vs Europe 95.4%, p = 0.116), 5-year survival was significantly higher in European patients (NA 60.1% vs Europe 70.3%, p < 0.001). CONCLUSIONS This survival difference persisted in a sensitivity analysis excluding Canadian patients. Prior observations suggest that these disparities are at least partly related to better access to care via universal healthcare models prevalent in Europe. Future studies are warranted to confirm our findings and explore other causal mechanisms. It is likely that potential solutions will require concerted efforts from healthcare providers and policymakers.
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Affiliation(s)
- Zhizhou Yang
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri
| | - Tsuyoshi Takahashi
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri.
| | - Yuriko Terada
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri
| | | | - Ruben G Nava
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri
| | - Ramsey R Hachem
- Division of Pulmonology and Critical Care, Washington University, St. Louis, Missouri
| | - Chad A Witt
- Division of Pulmonology and Critical Care, Washington University, St. Louis, Missouri
| | - Derek E Byers
- Division of Pulmonology and Critical Care, Washington University, St. Louis, Missouri
| | - Hrishikesh S Kulkarni
- Division of Pulmonology and Critical Care, Washington University, St. Louis, Missouri
| | | | - Yan Yan
- Division of Public Health Sciences, Washington University, St. Louis, Missouri
| | - Su-Hsin Chang
- Division of Public Health Sciences, Washington University, St. Louis, Missouri
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri
| | - Varun Puri
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri
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Choi H, Lee W, Lee HS, Kong SG, Kim DJ, Lee S, Oh H, Kim YN, Ock S, Kim T, Park MJ, Song W, Rim JH, Lee JH, Jeong S. The risk factors associated with treatment-related mortality in 16,073 kidney transplantation-A nationwide cohort study. PLoS One 2020; 15:e0236274. [PMID: 32722695 PMCID: PMC7386583 DOI: 10.1371/journal.pone.0236274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/01/2020] [Indexed: 02/07/2023] Open
Abstract
Mortality at an early stage after kidney transplantation is a catastrophic event. Treatment-related mortality (TRM) within 1 or 3 months after kidney transplantation has been seldom reported. We designed a retrospective observational cohort study using a national population-based database, which included information about all kidney recipients between 2003 and 2016. A total of 16,073 patients who underwent kidney transplantation were included. The mortality rates 1 month (early TRM) and 3 months (TRM) after transplantation were 0.5% (n = 74) and 1.0% (n = 160), respectively. Based on a multivariate analysis, older age (hazard ratio [HR] = 1.06; P < 0.001), coronary artery disease (HR = 3.02; P = 0.002), and hemodialysis compared with pre-emptive kidney transplantation (HR = 2.53; P = 0.046) were the risk factors for early TRM. Older age (HR = 1.07; P < 0.001), coronary artery disease (HR = 2.88; P < 0.001), and hemodialysis (HR = 2.35; P = 0.004) were the common independent risk factors for TRM. In contrast, cardiac arrhythmia (HR = 1.98; P = 0.027) was associated only with early TRM, and fungal infection (HR = 2.61; P < 0.001), and epoch of transplantation (HR = 0.34; P < 0.001) were the factors associated with only TRM. The identified risk factors should be considered in patient counselling, selection, and management to prevent TRM.
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Affiliation(s)
- Hyunji Choi
- Department of Laboratory Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Woonhyoung Lee
- Department of Laboratory Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Ho Sup Lee
- Department of Hematology-Oncology, Kosin University College of Medicine, Busan, South Korea
| | - Seom Gim Kong
- Department of Pediatrics, Kosin University College of Medicine, Busan, South Korea
| | - Da Jung Kim
- Department of Hematology-Oncology, Kosin University College of Medicine, Busan, South Korea
| | - Sangjin Lee
- Graduate School, Department of Statistics, Pusan National University, Busan, South Korea
| | - Haeun Oh
- Department of Laboratory Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Ye Na Kim
- Department of Nephrology, Kosin University College of Medicine, Busan, South Korea
| | - Soyoung Ock
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Taeyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Min-Jeong Park
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, South Korea
| | - Wonkeun Song
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, South Korea
| | - John Hoon Rim
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Medicine, Physician-Scientist Program, Yonsei University Graduate School of Medicine, Seoul, South Korea
| | - Jong-Han Lee
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Seri Jeong
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, South Korea
- * E-mail:
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Sexton DJ, O'Kelly P, Williams Y, Plant WD, Keogan M, Khalib K, Doyle B, Dorman A, Süsal C, Unterrainer C, Forde J, Power R, Smith G, Mohan P, Denton M, Magee C, de Freitas DG, Little D, O'Seaghdha CM, Conlon PJ. Progressive improvement in short‐, medium‐ and long‐term graft survival in kidney transplantation patients in Ireland – a retrospective study. Transpl Int 2019; 32:974-984. [DOI: 10.1111/tri.13470] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 11/23/2018] [Accepted: 06/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Donal J. Sexton
- National Kidney Transplant Service Department of Nephrology and Kidney Transplantation Beaumont Hospital Dublin Ireland
| | - Patrick O'Kelly
- National Kidney Transplant Service Department of Nephrology and Kidney Transplantation Beaumont Hospital Dublin Ireland
| | - Yvonne Williams
- National Kidney Transplant Service Department of Nephrology and Kidney Transplantation Beaumont Hospital Dublin Ireland
- Department of Transplant Urology Beaumont Hospital Dublin Ireland
| | - William D. Plant
- The National Renal Office Health Service Executive of Ireland Cork University Hospital University College Cork Cork Ireland
| | - Marie Keogan
- Department of Immunology Beaumont Hospital Dublin Ireland
| | - Khairin Khalib
- Department of Immunology Beaumont Hospital Dublin Ireland
| | - Brendan Doyle
- Department of Pathology Beaumont Hospital Dublin Ireland
| | - Anthony Dorman
- Department of Pathology Beaumont Hospital Dublin Ireland
| | - Caner Süsal
- Collaborative Transplant Study Institute of Immunology Heidelberg University Heidelberg Germany
| | - Christian Unterrainer
- Collaborative Transplant Study Institute of Immunology Heidelberg University Heidelberg Germany
| | - James Forde
- Department of Transplant Urology Beaumont Hospital Dublin Ireland
| | - Richard Power
- Department of Transplant Urology Beaumont Hospital Dublin Ireland
| | - Gordon Smith
- Department of Transplant Urology Beaumont Hospital Dublin Ireland
| | - Ponnusamy Mohan
- Department of Transplant Urology Beaumont Hospital Dublin Ireland
| | - Mark Denton
- National Kidney Transplant Service Department of Nephrology and Kidney Transplantation Beaumont Hospital Dublin Ireland
| | - Colm Magee
- National Kidney Transplant Service Department of Nephrology and Kidney Transplantation Beaumont Hospital Dublin Ireland
| | - Declan G. de Freitas
- National Kidney Transplant Service Department of Nephrology and Kidney Transplantation Beaumont Hospital Dublin Ireland
| | - Dilly Little
- Department of Transplant Urology Beaumont Hospital Dublin Ireland
| | - Conall M. O'Seaghdha
- National Kidney Transplant Service Department of Nephrology and Kidney Transplantation Beaumont Hospital Dublin Ireland
| | - Peter J. Conlon
- National Kidney Transplant Service Department of Nephrology and Kidney Transplantation Beaumont Hospital Dublin Ireland
- Royal College of Surgeons in Ireland Dublin Ireland
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7
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Favi E, Puliatti C, Sivaprakasam R, Ferraresso M, Ambrogi F, Delbue S, Gervasi F, Salzillo I, Raison N, Cacciola R. Incidence, risk factors, and outcome of BK polyomavirus infection after kidney transplantation. World J Clin Cases 2019; 7:270-290. [PMID: 30746369 PMCID: PMC6369392 DOI: 10.12998/wjcc.v7.i3.270] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/08/2018] [Accepted: 12/12/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Polyomavirus-associated nephropathy is a leading cause of kidney allograft failure. Therapeutic options are limited and prompt reduction of the net state of immunosuppression represents the mainstay of treatment. More recent application of aggressive screening and management protocols for BK-virus infection after renal transplantation has shown encouraging results. Nevertheless, long-term outcome for patients with BK-viremia and nephropathy remains obscure. Risk factors for BK-virus infection are also unclear.
AIM To investigate incidence, risk factors, and outcome of BK-virus infection after kidney transplantation.
METHODS This single-centre observational study with a median follow up of 57 (31-80) mo comprises 629 consecutive adult patients who underwent kidney transplantation between 2007 and 2013. Data were prospectively recorded and annually reviewed until 2016. Recipients were periodically screened for BK-virus by plasma quantitative polymerized chain reaction. Patients with BK viral load ≥ 1000 copies/mL were diagnosed BK-viremia and underwent histological assessment to rule out nephropathy. In case of BK-viremia, immunosuppression was minimized according to a prespecified protocol. The following outcomes were evaluated: patient survival, overall graft survival, graft failure considering death as a competing risk, 30-d-event-censored graft failure, response to treatment, rejection, renal function, urologic complications, opportunistic infections, new-onset diabetes after transplantation, and malignancies. We used a multivariable model to analyse risk factors for BK-viremia and nephropathy.
RESULTS BK-viremia was detected in 9.5% recipients. Initial viral load was high (≥ 10000 copies/mL) in 66.7% and low (< 10000 copies/mL) in 33.3% of these patients. Polyomavirus-associated nephropathy was diagnosed in 6.5% of the study population. Patients with high initial viral load were more likely to experience sustained viremia (95% vs 25%, P < 0.00001), nephropathy (92.5% vs 15%, P < 0.00001), and polyomavirus-related graft loss (27.5% vs 0%, P = 0.0108) than recipients with low initial viral load. Comparison between recipients with or without BK-viremia showed that the proportion of patients with Afro-Caribbean ethnicity (33.3% vs 16.5%, P = 0.0024), panel-reactive antibody ≥ 50% (30% vs 14.6%, P = 0.0047), human leukocyte antigen (HLA) mismatching > 4 (26.7% vs 13.4%, P = 0.0110), and rejection within thirty days of transplant (21.7% vs 9.5%; P = 0.0073) was higher in the viremic group. Five-year patient and overall graft survival rates for patients with or without BK-viremia were similar. However, viremic recipients showed higher 5-year crude cumulative (22.5% vs 12.2%, P = 0.0270) and 30-d-event-censored (22.5% vs 7.1%, P = 0.001) incidences of graft failure than control. In the viremic group we also observed higher proportions of recipients with 5-year estimated glomerular filtration rate < 30 mL/min than the group without viremia: 45% vs 27% (P = 0.0064). Urologic complications were comparable between the two groups. Response to treatment was complete in 55%, partial in 26.7%, and absent in 18.3% patients. The nephropathy group showed higher 5-year crude cumulative and 30-d-event-censored incidences of graft failure than control: 29.1% vs 12.1% (P = 0.008) and 29.1% vs 7.2% (P < 0.001), respectively. Our multivariable model demonstrated that Afro-Caribbean ethnicity, panel-reactive antibody > 50%, HLA mismatching > 4, and rejection were independent risk factors for BK-virus viremia whereas cytomegalovirus prophylaxis was protective.
CONCLUSION Current treatment of BK-virus infection offers sub-optimal results. Initial viremia is a valuable parameter to detect patients at increased risk of nephropathy. Panel-reactive antibody > 50% and Afro-Caribbean ethnicity are independent predictors of BK-virus infection whereas cytomegalovirus prophylaxis has a protective effect.
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Affiliation(s)
- Evaldo Favi
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Carmelo Puliatti
- Renal Transplantation, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, United Kingdom
| | - Rajesh Sivaprakasam
- Renal Transplantation, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, United Kingdom
| | - Mariano Ferraresso
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
| | - Serena Delbue
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan 20100, Italy
| | - Federico Gervasi
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
| | - Ilaria Salzillo
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Nicholas Raison
- MRC Centre for Transplantation, King’s College London, London WC2R 2LS, United Kingdom
| | - Roberto Cacciola
- Renal Transplantation, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, United Kingdom
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8
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Williams A, Richardson C, McCready J, Anderson B, Khalil K, Tahir S, Nath J, Sharif A. Black Ethnicity is Not a Risk Factor for Mortality or Graft Loss After Kidney Transplant in the United Kingdom. EXP CLIN TRANSPLANT 2018; 16:682-689. [PMID: 30295582 DOI: 10.6002/ect.2018.0241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES There are conflicting reports in the literature regarding outcomes after kidney transplant for patients of black ethnicity. To investigate further, we compared outcomes for black versus white kidney transplant recipients in a single UK transplant center. MATERIALS AND METHODS We analyzed 1066 kidney transplant recipients (80 black patients, 986 white patients) within a single-center cohort (2007-2017) in the United Kingdom, with cumulative 4446 patient-year follow-up. Data were electronically extracted from the Department of Health Informatics database for every study recruit, with manual data linkage to the UK Transplant Registry (for graft survival, delayed graft function, and rejection data) and Office for National Statistics (for mortality data). Primary outcomes of interest were graft/patient survival. RESULTS Black recipients have increased baseline risk profiles with longer wait times, difficulty in matching, worse HLA matching, more socioeconomic deprivation, and lower rates of living kidney donors. Postoperatively, black versus white recipients had increased risk for delayed graft function (34.3% vs 10.2%; P < .001), increased 1-year rejection (16.7% vs 7.3%; P = .012), higher 1-year creatinine levels (166 vs 138 mmol/L; P = .003), and longer posttransplant length of stay (14.5 vs 9.5 days; P = .020). Although black recipients did not have increased risk of death versus white recipients (10.0% vs 11.0%, respectively; P = .486), they did have increased risk for death-censored graft loss (23.8% vs 11.1%; P = .002). However, in an adjusted Cox regression model, black ethnicity was not associated with increased risk for death-censored graft loss (hazard ratio of 1.209, 95% confidence interval, 0.660-2.216; P = .539). CONCLUSIONS Black kidney transplant recipients in the United Kingdom have increased risk of adverse graft-related outcomes due to high-risk baseline variables rather than their black ethnicity per se.
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Affiliation(s)
- Aimee Williams
- From the Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom
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9
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Two-year management after renal transplantation in 2013 in France: Input from the French national health system database. Nephrol Ther 2018; 14:207-216. [PMID: 29477277 DOI: 10.1016/j.nephro.2017.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/10/2017] [Accepted: 11/19/2017] [Indexed: 11/23/2022]
Abstract
The objective of this study was to describe the management of patients undergoing renal transplantation in 2013 and over the following two years on the basis of healthcare consumption data. The National Health Insurance Information System was used to identify 1876 general scheme beneficiaries undergoing a first isolated renal transplantation (median age: 53 years; men 63%). Overall, 1.2% of patients died during the transplantation hospital stay (>65 years 3.3%) and 87% of patients had a functional graft at 2 years. Thirty-three percent of patients were readmitted to hospital for 1 day or longer during the first month, 73% the first year and 55% the second year. At least 10% of patients were hospitalised for antirejection treatment during the first quarter after renal transplantation, 16% the first year and 9% the second year. The first year, 32% of patients were hospitalised for renal disease (12% the second year), 14% were hospitalised for cardiovascular disease (9% the second year), 13% for infectious disease (5% the second year) and 2% for a malignant tumour (2% the second year). Almost 80% of patients consulted their general practitioner each year (almost 50% consulted every quarter). During the second year, 83% of patients were taking antihypertensives, 45% lipid-lowering drugs, 26% antidiabetic drugs, 77% tacrolimus, 18% ciclosporin, 88% mycophenolic acid and 69% corticosteroids. This study highlights the important contribution of healthcare consumption data to a better understanding of the modalities of management of renal transplant recipients in France, allowing improvement of this management in line with guidelines.
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