1
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Phillips B, Asgari E, Berry M, Callaghan C, Cerisuelo MC, Johnson P, Karydis N, Nasralla D, Nutu A, Oniscu G, Perera T, Sinha S, Sutherland A, Van Dellen D, Watson C, White S, O'Neill S. British Transplantation Society guidelines on abdominal organ transplantation from deceased donors after circulatory death. Transplant Rev (Orlando) 2024; 38:100801. [PMID: 37840003 DOI: 10.1016/j.trre.2023.100801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023]
Abstract
The British Transplantation Society (BTS) 'Guideline on transplantation from deceased donors after circulatory death' has recently been updated and this manuscript summarises the relevant recommendations in abdominal organ transplantation from Donation after Circulatory Death (DCD) donors, encompassing the chapters on liver, kidney, pancreas and islet cell transplantation.
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Affiliation(s)
- Benedict Phillips
- Specialty Registrar in Transplant Surgery, Guy's Hospital, London, United Kingdom
| | - Ellie Asgari
- Consultant Nephrologist, Guy's Hospital, London, United Kingdom
| | - Miriam Berry
- Consultant Nephrologist, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Chris Callaghan
- Consultant Transplant Surgeon, Guy's Hospital, London, United Kingdom
| | | | - Paul Johnson
- Consultant Paediatric Surgeon, John Radcliffe Hospital, Oxford, United Kingdom
| | - Nikolaos Karydis
- Consultant Transplant Surgeon, Guy's Hospital, London, United Kingdom
| | - David Nasralla
- Consultant Transplant Surgeon, Royal Free Hospital, London, United Kingdom
| | - Anisa Nutu
- Transplant Fellow, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Gabi Oniscu
- Consultant Transplant Surgeon, Royal Infirmary, Edinburgh, United Kingdom
| | - Thamara Perera
- Consultant Transplant Surgeon, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Sanjay Sinha
- Consultant Transplant Surgeon, Churchill Hospital, Oxford, United Kingdom
| | - Andrew Sutherland
- Consultant Transplant Surgeon, Royal Infirmary, Edinburgh, United Kingdom
| | - David Van Dellen
- Consultant Transplant Surgeon, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Chris Watson
- Consultant Transplanxt Surgeon, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Steve White
- Consultant Transplant Surgeon, Freeman Hospital, Newcastle, United Kingdom
| | - Stephen O'Neill
- Consultant Transplant Surgeon, Belfast City Hospital, Belfast, United Kingdom.
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2
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Andrian T, Siriteanu L, Covic AS, Ipate CA, Miron A, Morosanu C, Caruntu ID, Covic A. Non-Traditional Non-Immunological Risk Factors for Kidney Allograft Loss-Opinion. J Clin Med 2023; 12:jcm12062364. [PMID: 36983364 PMCID: PMC10051358 DOI: 10.3390/jcm12062364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/16/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Rates of late allograft loss have improved slowly in the last decades. Well described traditional risk factors that influence allograft survival include cardiovascular events, rejection, infections and post-transplant neoplasia. Here, we critically evaluate the influence of several non-immunological, non-traditional risk factors and describe their impact on allograft survival and cardiovascular health of kidney transplant recipients. We assessed the following risk factors: arterial stiffness, persistent arteriovenous access, mineral bone disease, immunosuppressive drugs residual levels variability, hypomagnesemia, glomerular pathological alterations not included in Banff criteria, persistent inflammation and metabolic acidosis.
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Affiliation(s)
- Titus Andrian
- Nephrology Clinic, Dialysis and Renal Transplant Center, C. I. Parhon University Hospital, 700503 Iasi, Romania
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine, 700115 Iasi, Romania
| | - Lucian Siriteanu
- Nephrology Clinic, Dialysis and Renal Transplant Center, C. I. Parhon University Hospital, 700503 Iasi, Romania
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine, 700115 Iasi, Romania
| | - Andreea Simona Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center, C. I. Parhon University Hospital, 700503 Iasi, Romania
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine, 700115 Iasi, Romania
| | - Cristina Alexandra Ipate
- Nephrology Clinic, Dialysis and Renal Transplant Center, C. I. Parhon University Hospital, 700503 Iasi, Romania
| | - Adelina Miron
- Nephrology Clinic, Dialysis and Renal Transplant Center, C. I. Parhon University Hospital, 700503 Iasi, Romania
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine, 700115 Iasi, Romania
| | - Corneliu Morosanu
- Nephrology Clinic, Dialysis and Renal Transplant Center, C. I. Parhon University Hospital, 700503 Iasi, Romania
| | - Irina-Draga Caruntu
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine, 700115 Iasi, Romania
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center, C. I. Parhon University Hospital, 700503 Iasi, Romania
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine, 700115 Iasi, Romania
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3
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Ayorinde JOO, Citterio F, Landrò M, Peruzzo E, Islam T, Tilley S, Taylor G, Bardsley V, Liò P, Samoshkin A, Pettigrew GJ. Artificial Intelligence You Can Trust: What Matters Beyond Performance When Applying Artificial Intelligence to Renal Histopathology? J Am Soc Nephrol 2022; 33:2133-2140. [PMID: 36351761 PMCID: PMC9731632 DOI: 10.1681/asn.2022010069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Although still in its infancy, artificial intelligence (AI) analysis of kidney biopsy images is anticipated to become an integral aspect of renal histopathology. As these systems are developed, the focus will understandably be on developing ever more accurate models, but successful translation to the clinic will also depend upon other characteristics of the system.In the extreme, deployment of highly performant but "black box" AI is fraught with risk, and high-profile errors could damage future trust in the technology. Furthermore, a major factor determining whether new systems are adopted in clinical settings is whether they are "trusted" by clinicians. Key to unlocking trust will be designing platforms optimized for intuitive human-AI interactions and ensuring that, where judgment is required to resolve ambiguous areas of assessment, the workings of the AI image classifier are understandable to the human observer. Therefore, determining the optimal design for AI systems depends on factors beyond performance, with considerations of goals, interpretability, and safety constraining many design and engineering choices.In this article, we explore challenges that arise in the application of AI to renal histopathology, and consider areas where choices around model architecture, training strategy, and workflow design may be influenced by factors beyond the final performance metrics of the system.
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Affiliation(s)
- John O O Ayorinde
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | | | | | | | | | | | | | - Victoria Bardsley
- Department of Histopathology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Pietro Liò
- Department of Computer Science and Technology, University of Cambridge, Cambridge, United Kingdom
| | - Alex Samoshkin
- Office for Translational Research, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Gavin J Pettigrew
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
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4
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Sharif A. Deceased Donor Characteristics and Kidney Transplant Outcomes. Transpl Int 2022; 35:10482. [PMID: 36090778 PMCID: PMC9452640 DOI: 10.3389/ti.2022.10482] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022]
Abstract
Kidney transplantation is the therapy of choice for people living with kidney failure who are suitable for surgery. However, the disparity between supply versus demand for organs means many either die or are removed from the waiting-list before receiving a kidney allograft. Reducing unnecessary discard of deceased donor kidneys is important to maximize utilization of a scarce and valuable resource but requires nuanced decision-making. Accepting kidneys from deceased donors with heterogenous characteristics for waitlisted kidney transplant candidates, often in the context of time-pressured decision-making, requires an understanding of the association between donor characteristics and kidney transplant outcomes. Deceased donor clinical factors can impact patient and/or kidney allograft survival but risk-versus-benefit deliberation must be balanced against the morbidity and mortality associated with remaining on the waiting-list. In this article, the association between deceased kidney donor characteristics and post kidney transplant outcomes for the recipient are reviewed. While translating this evidence to individual kidney transplant candidates is a challenge, emerging strategies to improve this process will be discussed. Fundamentally, tools and guidelines to inform decision-making when considering deceased donor kidney offers will be valuable to both professionals and patients.
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Affiliation(s)
- Adnan Sharif
- Department of Nephrology and Transplantation, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Adnan Sharif,
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5
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Stewart DE, Foutz J, Kamal L, Weiss S, McGehee HS, Cooper M, Gupta G. The Independent Effects of Procurement Biopsy Findings on Ten-Year Outcomes of Extended Criteria Donor Kidney Transplants. Kidney Int Rep 2022; 7:1850-1865. [PMID: 35967103 PMCID: PMC9366372 DOI: 10.1016/j.ekir.2022.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/23/2022] [Indexed: 11/01/2022] Open
Abstract
Introduction Methods Results Conclusion
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6
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Barreda Monteoliva P, Redondo-Pachón D, Miñambres García E, Rodrigo Calabia E. Kidney transplant outcome of expanded criteria donors after circulatory death. Nefrologia 2022; 42:135-144. [PMID: 36153910 DOI: 10.1016/j.nefroe.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/31/2021] [Indexed: 06/16/2023] Open
Abstract
The increase in the number of patients on the kidney transplant waiting list has led to an attempt to increase the number of potential donors by incorporating candidates that previously would not have been considered optimal, including donors after cardiac death (DCD) and those with "expanded" criteria (ECD). Recipients of controlled DCD (cDCD) grafts suffer more delayed graft function (DGF), but have a long-term evolution comparable to those of brain-dead donors, which has allowed an increase in the number of cDCD transplants in different countries in recent years. In parallel, the use of cDCD with expanded criteria (cDCD/ECD) has increased in recent years in different countries, allowing the waiting list for kidney transplantation to be shortened. The use of these grafts, although associated with a higher frequency of DGF, offers similar or only slightly lower long-term graft survival than those of brain death donors with expanded criteria. Different studies have observed that cDCD/ECD graft recipients have worse kidney function than cDCD/standard and DBD/ECD. Mortality associated with cDCD/ECD graft transplantation mostly relates to the recipient age. Patients who receive a cDCD/≥60 graft have better survival than those who continue on the waiting list, although this fact has not been demonstrated in recipients of cDCD/>65 years. The use of this type of organ should be accompanied by the optimization of surgical times and the shortest possible cold ischemia.
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Affiliation(s)
- Paloma Barreda Monteoliva
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla/IDIVAL, Universidad de Cantabria, Santander, Spain
| | | | - Eduardo Miñambres García
- Coordinación de trasplantes, Hospital Universitario Marqués de Valdecilla/IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Emilio Rodrigo Calabia
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla/IDIVAL, Universidad de Cantabria, Santander, Spain.
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7
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Zagni M, Croci GA, Cannavò A, Passamonti SM, De Feo T, Boggio FL, Cribiù FM, Maggioni M, Ferrero S, Gobbo AD, Gianelli U. Histological evaluation of ischaemic alterations in donors after cardiac death: A useful tool to predict post‐transplant renal function. Clin Transplant 2022; 36:e14622. [DOI: 10.1111/ctr.14622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Moreno Zagni
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Giorgio Alberto Croci
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
- Department of Pathophysiology and Transplantation University of Milan Medical School Fondazione IRCCS Ca' Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Antonino Cannavò
- North Italy Transplant program (NITp) UOC Coordinamento Trapianti Fondazione IRCCS Ca' Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Serena Maria Passamonti
- North Italy Transplant program (NITp) UOC Coordinamento Trapianti Fondazione IRCCS Ca' Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Tullia De Feo
- North Italy Transplant program (NITp) UOC Coordinamento Trapianti Fondazione IRCCS Ca' Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Francesca Laura Boggio
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Fulvia Milena Cribiù
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Marco Maggioni
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Stefano Ferrero
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
- Department of Biomedical Surgical and Dental Sciences University of Milan Milan Italy
| | - Alessandro Del Gobbo
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Umberto Gianelli
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
- Department of Pathophysiology and Transplantation University of Milan Medical School Fondazione IRCCS Ca' Granda ‐ Ospedale Maggiore Policlinico Milan Italy
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8
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Reschke M, DiRito JR, Stern D, Day W, Plebanek N, Harris M, Hosgood SA, Nicholson ML, Haakinson DJ, Zhang X, Mehal WZ, Ouyang X, Pober JS, Saltzman WM, Tietjen GT. A digital pathology tool for quantification of color features in histologic specimens. Bioeng Transl Med 2022; 7:e10242. [PMID: 35111944 PMCID: PMC8780932 DOI: 10.1002/btm2.10242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/14/2021] [Accepted: 07/18/2021] [Indexed: 11/12/2022] Open
Abstract
In preclinical research, histological analysis of tissue samples is often limited to qualitative or semiquantitative scoring assessments. The reliability of this analysis can be impaired by the subjectivity of these approaches, even when read by experienced pathologists. Furthermore, the laborious nature of manual image assessments often leads to the analysis being restricted to a relatively small number of images that may not accurately represent the whole sample. Thus, there is a clear need for automated image analysis tools that can provide robust and rapid quantification of histologic samples from paraffin-embedded or cryopreserved tissues. To address this need, we have developed a color image analysis algorithm (DigiPath) to quantify distinct color features in histologic sections. We demonstrate the utility of this tool across multiple types of tissue samples and pathologic features, and compare results from our program to other quantitative approaches such as color thresholding and hand tracing. We believe this tool will enable more thorough and reliable characterization of histological samples to facilitate better rigor and reproducibility in tissue-based analyses.
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Affiliation(s)
- Melanie Reschke
- Department of Molecular Biophysics & BiochemistryYale UniversityNew HavenConnecticutUSA
| | - Jenna R. DiRito
- Department of SurgeryYale School of MedicineNew HavenConnecticutUSA
| | - David Stern
- Department of SurgeryYale School of MedicineNew HavenConnecticutUSA
| | - Wesley Day
- Department of Biomedical EngineeringYale UniversityNew HavenConnecticutUSA
| | - Natalie Plebanek
- Department of Biomedical EngineeringYale UniversityNew HavenConnecticutUSA
| | - Matthew Harris
- Department of SurgeryYale School of MedicineNew HavenConnecticutUSA
| | | | | | | | - Xuchen Zhang
- Department of PathologyYale School of MedicineNew HavenConnecticutUSA
| | - Wajahat Z. Mehal
- Section of Digestive Diseases, Department of Internal MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Xinshou Ouyang
- Section of Digestive Diseases, Department of Internal MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Jordan S. Pober
- Department of ImmunobiologyYale UniversityNew HavenConnecticutUSA
| | - W. Mark Saltzman
- Department of Biomedical EngineeringYale UniversityNew HavenConnecticutUSA
| | - Gregory T. Tietjen
- Department of SurgeryYale School of MedicineNew HavenConnecticutUSA
- Department of Biomedical EngineeringYale UniversityNew HavenConnecticutUSA
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9
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Phillips BL, Ibrahim M, Greenhall GHB, Mumford L, Dorling A, Callaghan CJ. Effect of delayed graft function on longer-term outcomes after kidney transplantation from donation after circulatory death donors in the United Kingdom: A national cohort study. Am J Transplant 2021; 21:3346-3355. [PMID: 33756062 DOI: 10.1111/ajt.16574] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/16/2021] [Accepted: 03/14/2021] [Indexed: 01/25/2023]
Abstract
Kidneys from donation after circulatory death (DCD) donors are utilized variably worldwide, in part due to high rates of delayed graft function (DGF) and putative associations with adverse longer-term outcomes. We aimed to determine whether the presence of DGF and its duration were associated with poor longer-term outcomes after kidney transplantation from DCD donors. Using the UK transplant registry, we identified 4714 kidney-only transplants from controlled DCD donors to adult recipients between 2006 and 2016; 2832 recipients (60·1%) had immediate graft function and 1882 (39·9%) had DGF. Of the 1847 recipients with DGF duration recorded, 926 (50·1%) had DGF < 7 days, 576 (31·2%) had DGF 7-14 days, and 345 (18·7%) had DGF >14 days. After risk adjustment, the presence of DGF was not associated with inferior long-term graft or patient survivals. However, DGF duration of >14 days was associated with an increased risk of death-censored graft failure (hazard ratio 1·7, p = ·001) and recipient death (hazard ratio 1·8, p < ·001) compared to grafts with immediate function. This study suggests that shorter periods of DGF have no adverse influence on graft or patient survival after DCD donor kidney transplantation and that DGF >14 days is a novel early biomarker for significantly worse longer-term outcomes.
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Affiliation(s)
- Benedict L Phillips
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Maria Ibrahim
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Statistics and Clinical Studies, National Health Service Blood and Transplant (NHSBT), Bristol, UK
| | - George H B Greenhall
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, London, UK.,Department of Statistics and Clinical Studies, National Health Service Blood and Transplant (NHSBT), Bristol, UK
| | - Lisa Mumford
- Department of Statistics and Clinical Studies, National Health Service Blood and Transplant (NHSBT), Bristol, UK
| | - Anthony Dorling
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Chris J Callaghan
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK
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10
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Luque Y, Jamme M, Aubert O, Roux A, Martinez F, Amrouche L, Tinel C, Galmiche L, Duong Van Huyen JP, Audenet F, Legendre C, Anglicheau D, Rabant M. A kidney discard decision strategy based on zero-time histology analysis could lead to an unjustified increase in the organ turndown rate among ECD. Transpl Int 2021; 34:1506-1516. [PMID: 34097778 DOI: 10.1111/tri.13933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/15/2021] [Accepted: 05/30/2021] [Indexed: 12/01/2022]
Abstract
The utility of zero-time kidney biopsies (KB) in deciding to accept expanded criteria donor (ECD) kidneys remains controversial. However, zero-time histology is one of the main causes for discarding kidneys in the United States. In a single-centre study, we examined the utility and impact on outcome of the use of frozen section zero-time KB among ECD. Ninety-two zero-time KB were analysed for accept/discard decision between 2005 and 2015 among ECD. 53% of kidneys were rejected after zero-time KB analysis; there was no difference in individual clinical and biological data between accepted/rejected groups. However, histology of rejected kidneys showed more sclerotic glomeruli (20% vs. 8%; P < 0.001), increased interstitial fibrosis (1.25 ± 0.12 vs. 0.47 ± 0.09; P < 0.0001), more arteriosclerosis (2.14 ± 0.17 vs. 1.71 ± 0.11; P = 0.0032) and arteriolar hyalinosis (2.15 ± 0.12 vs. 1.55 ± 0.11; P = 0.0006). Using propensity score matching, we generated a group of 42 kidney allograft recipients who received a transplant matched for donor zero-time histology and clinical characteristics with donors whose kidneys were rejected. Interestingly, their 1- and 5-year graft survival and function were similar to the global cohort of ECD recipients. In conclusion, when performed, zero-time KB was a decisive element for kidney discard decision. However, adverse zero-time histology was not associated with poorer graft survival and kidney function among ECD.
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Affiliation(s)
- Yosu Luque
- Department of Pathology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Renal Emergencies and Kidney Transplantation Department, Tenon Hospital, Assistance Publique - Hôpitaux de Paris, Inserm, UMR_S1155, Sorbonne Université, Paris, France
| | - Matthieu Jamme
- Intensive care Unit, Poissy-Saint-Germain-en-Laye hospital, Poissy, France
| | - Olivier Aubert
- UMR_S970, Paris Translational Research Center for Organ Transplantation, Inserm, Paris, France.,Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France
| | - Arthur Roux
- Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France
| | - Frank Martinez
- Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France
| | - Lucile Amrouche
- Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France
| | - Claire Tinel
- Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France
| | - Louise Galmiche
- Department of Pathology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - François Audenet
- Urology Department, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Legendre
- Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France
| | - Dany Anglicheau
- Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France.,Necker-Enfants Malades Institute, French National Institute of Health and Medical Research U1151, Paris, France
| | - Marion Rabant
- Department of Pathology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Necker-Enfants Malades Institute, French National Institute of Health and Medical Research U1151, Paris, France
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11
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Barreda Monteoliva P, Redondo-Pachón D, Miñambres García E, Rodrigo Calabria E. Kidney transplant outcome of expanded criteria donors after circulatory death. Nefrologia 2021; 42:S0211-6995(21)00104-1. [PMID: 34154848 DOI: 10.1016/j.nefro.2021.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/30/2021] [Accepted: 01/31/2021] [Indexed: 10/21/2022] Open
Abstract
The increase in the number of patients on the kidney transplant waiting list has led to an attempt to increase the number of potential donors by incorporating candidates that previously would not have been considered optimal, including donors after cardiac death (DCD) and those with "expanded" criteria (ECD). Recipients of controlled DCD (cDCD) grafts suffer more delayed graft function (DGF), but have a long-term evolution comparable to those of brain-dead donors, which has allowed an increase in the number of cDCD transplants in different countries in recent years. In parallel, the use of cDCD with expanded criteria (cDCD/ECD) has increased in recent years in different countries, allowing the waiting list for kidney transplantation to be shortened. The use of these grafts, although associated with a higher frequency of DGF, offers similar or only slightly lower long-term graft survival than those of brain death donors with expanded criteria. Different studies have observed that cDCD/ECD graft recipients have worse kidney function than cDCD/standard and brain death/ECD. Mortality associated with cDCD/ECD graft transplantation mostly relates to the recipient age. Patients who receive a cDCD/≥60 graft have better survival than those who continue on the waiting list, although this fact has not been demonstrated in recipients of cDCD/>65 years. The use of this type of organ should be accompanied by the optimization of surgical times and the shortest possible cold ischemia.
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Affiliation(s)
- Paloma Barreda Monteoliva
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla/IDIVAL, Universidad de Cantabria, Santander, España
| | | | - Eduardo Miñambres García
- Coordinación de trasplantes, Hospital Universitario Marqués de Valdecilla/IDIVAL, Universidad de Cantabria, Santander, España
| | - Emilio Rodrigo Calabria
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla/IDIVAL, Universidad de Cantabria, Santander, España.
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12
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Richards J, Gimson A, Joh Y, Watson CJE, Neuberger J. Trials & Tribulations of Liver Transplantation- are trials now prohibitive without surrogate endpoints? Liver Transpl 2021; 27:747-755. [PMID: 33462951 DOI: 10.1002/lt.25988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 01/13/2023]
Abstract
During the past 5 decades, liver transplantation has moved from its pioneering days where success was measured in days to a point where it is viewed as a routine part of medical care. Despite this progress, there are still significant unmet needs and outstanding questions that need addressing in clinical trials to improve outcomes for patients. The traditional endpoint for trials in liver transplantation has been 1-year patient survival, but with rates now approaching 95%, this endpoint now poses a number of significant financial and logistical barriers to conducting trials because of the large numbers of participants required to demonstrate only an incremental improvement. Here, we suggest the following solutions to this challenge: adoption of validated surrogate endpoints; bigger and better collaborative multiarm, multiphase studies; recognition by funders and institutions that work on larger collaborative research projects is potentially more important than smaller, self-led bodies of work; ringfenced areas of research within trial frameworks where individuals can take a lead; and fair funding structures using both industry and public sector money across national and international borders.
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Affiliation(s)
- James Richards
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- The National Institute of Health Research Blood and Transplant Research Unit at the University of Cambridge in collaboration with Newcastle University and in partnership with National Health Service Blood and Transplant, Cambridge, UK
- The National Institute of Health Research Cambridge Biomedical Research Centre, Cambridge, UK
| | - Alex Gimson
- The National Institute of Health Research Cambridge Biomedical Research Centre, Cambridge, UK
- Department of Medicine, Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK
| | - Yexin Joh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Christopher J E Watson
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- The National Institute of Health Research Blood and Transplant Research Unit at the University of Cambridge in collaboration with Newcastle University and in partnership with National Health Service Blood and Transplant, Cambridge, UK
- The National Institute of Health Research Cambridge Biomedical Research Centre, Cambridge, UK
| | - James Neuberger
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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13
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Hemming K, Taljaard M. Reflection on modern methods: when is a stepped-wedge cluster randomized trial a good study design choice? Int J Epidemiol 2021; 49:1043-1052. [PMID: 32386407 PMCID: PMC7394949 DOI: 10.1093/ije/dyaa077] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/08/2020] [Indexed: 12/25/2022] Open
Abstract
The stepped-wedge cluster randomized trial (SW-CRT) involves the sequential transition of clusters (such as hospitals, public health units or communities) from control to intervention conditions in a randomized order. The use of the SW-CRT is growing rapidly. Yet the SW-CRT is at greater risks of bias compared with the conventional parallel cluster randomized trial (parallel-CRT). For this reason, the CONSORT extension for SW-CRTs requires that investigators provide a clear justification for the choice of study design. In this paper, we argue that all other things being equal, the SW-CRT is at greater risk of bias due to misspecification of the secular trends at the analysis stage. This is particularly problematic for studies randomizing a small number of heterogeneous clusters. We outline the potential conditions under which an SW-CRT might be an appropriate choice. Potentially appropriate and often overlapping justifications for conducting an SW-CRT include: (i) the SW-CRT provides a means to conduct a randomized evaluation which otherwise would not be possible; (ii) the SW-CRT facilitates cluster recruitment as it enhances the acceptability of a randomized evaluation either to cluster gatekeepers or other stakeholders; (iii) the SW-CRT is the only feasible design due to pragmatic and logistical constraints (for example the roll-out of a scare resource); and (iv) the SW-CRT has increased statistical power over other study designs (which will include situations with a limited number of clusters). As the number of arguments in favour of an SW-CRT increases, the likelihood that the benefits of using the SW-CRT, as opposed to a parallel-CRT, outweigh its risks also increases. We argue that the mere popularity and novelty of the SW-CRT should not be a factor in its adoption. In situations when a conventional parallel-CRT is feasible, it is likely to be the preferred design.
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Affiliation(s)
- Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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14
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Pearson R, Asher J, Jackson A, Mark PB, Shumeyko V, Clancy MJ. Viability assessment and utilization of declined donor kidneys with rhabdomyolysis using ex vivo normothermic perfusion without preimplantation biopsy. Am J Transplant 2021; 21:1317-1321. [PMID: 33021059 DOI: 10.1111/ajt.16329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 01/25/2023]
Abstract
The role of ex vivo normothermic perfusion (EVNP) in both organ viability assessment and reconditioning is increasingly being demonstrated. We report the use of this emerging technology to facilitate the transplantation of a pair of donor kidneys with severe acute kidney injury (AKI) secondary to rhabdomyolysis. Donor creatinine was 10.18 mg/dl with protein (30 mg/dl) present in urinalysis. Both kidneys were declined by all other transplantation units and subsequently accepted by our unit. The first kidney was perfused with red cell-based perfusate at 37°C for 75 min, mean renal blood flow was 110 ml/min/100 g and produced 85 ml of urine. Having demonstrated favorable macroscopic appearance and urine output, the kidney was transplanted into a 61-year-old peritoneal dialysis dependent without complication. Given the reassuring information from the first kidney provided by EVNP, the second kidney was not perfused with EVNP and was directly implanted to a 64-year-old patient. The first kidney achieved primary function and the second functioned well after delayed graft function. Recipient eGFR have stabilized at 88.5 and 55.3, respectively (ml/min/1.73 m2 ), at 2 months posttransplant.
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Affiliation(s)
| | - John Asher
- Queen Elizabeth University Hospital, Glasgow, UK
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15
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Reese PP, Aubert O, Naesens M, Huang E, Potluri V, Kuypers D, Bouquegneau A, Divard G, Raynaud M, Bouatou Y, Vo A, Glotz D, Legendre C, Lefaucheur C, Jordan S, Empana JP, Jouven X, Loupy A. Assessment of the Utility of Kidney Histology as a Basis for Discarding Organs in the United States: A Comparison of International Transplant Practices and Outcomes. J Am Soc Nephrol 2021; 32:397-409. [PMID: 33323474 PMCID: PMC8054891 DOI: 10.1681/asn.2020040464] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/28/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Many kidneys donated for transplant in the United States are discarded because of abnormal histology. Whether histology adds incremental value beyond usual donor attributes in assessing allograft quality is unknown. METHODS This population-based study included patients who received a deceased donor kidney that had been biopsied before implantation according to a prespecified protocol in France and Belgium, where preimplantation biopsy findings are generally not used for decision making in the allocation process. We also studied kidneys that had been acquired from deceased United States donors for transplantation that were biopsied during allocation and discarded because of low organ quality. Using donor and recipient characteristics, we fit multivariable Cox models for death-censored graft failure and examined whether predictive accuracy (C index) improved after adding donor histology. We matched the discarded United States kidneys to similar kidneys transplanted in Europe and calculated predicted allograft survival. RESULTS In the development cohort of 1629 kidney recipients at two French centers, adding donor histology to the model did not significantly improve prediction of long-term allograft failure. Analyses using an external validation cohort from two Belgian centers confirmed the lack of improved accuracy from adding histology. About 45% of 1103 United States kidneys discarded because of histologic findings could be accurately matched to very similar kidneys that had been transplanted in France; these discarded kidneys would be expected to have allograft survival of 93.1% at 1 year, 80.7% at 5 years, and 68.9% at 10 years. CONCLUSIONS In this multicenter study, donor kidney histology assessment during allocation did not provide substantial incremental value in ascertaining organ quality. Many kidneys discarded on the basis of biopsy findings would likely benefit United States patients who are wait listed.
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Affiliation(s)
- Peter P. Reese
- Université de Paris, Institut National de la Santé et de la Recherche Médicale U970, Paris Translational Research Centre for Organ Transplantation, Paris, France,Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Olivier Aubert
- Université de Paris, Institut National de la Santé et de la Recherche Médicale U970, Paris Translational Research Centre for Organ Transplantation, Paris, France,Department of Kidney Transplantation, Necker Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Maarten Naesens
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Edmund Huang
- Division of Nephrology, Department of Medicine, Comprehensive Transplant Center, Cedars Sinai Medical Center, West Hollywood, California
| | - Vishnu Potluri
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dirk Kuypers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Antoine Bouquegneau
- Department of Nephrology, Dialysis and Transplantation, Centre Hospitalier Universitaire de Liege, Liege, Belgium
| | - Gillian Divard
- Université de Paris, Institut National de la Santé et de la Recherche Médicale U970, Paris Translational Research Centre for Organ Transplantation, Paris, France
| | - Marc Raynaud
- Université de Paris, Institut National de la Santé et de la Recherche Médicale U970, Paris Translational Research Centre for Organ Transplantation, Paris, France
| | - Yassine Bouatou
- Université de Paris, Institut National de la Santé et de la Recherche Médicale U970, Paris Translational Research Centre for Organ Transplantation, Paris, France
| | - Ashley Vo
- Division of Nephrology, Department of Medicine, Comprehensive Transplant Center, Cedars Sinai Medical Center, West Hollywood, California
| | - Denis Glotz
- Université de Paris, Institut National de la Santé et de la Recherche Médicale U970, Paris Translational Research Centre for Organ Transplantation, Paris, France,Department of Nephrology and Kidney Transplantation, Saint-Louis Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Christophe Legendre
- Université de Paris, Institut National de la Santé et de la Recherche Médicale U970, Paris Translational Research Centre for Organ Transplantation, Paris, France,Department of Kidney Transplantation, Necker Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Carmen Lefaucheur
- Université de Paris, Institut National de la Santé et de la Recherche Médicale U970, Paris Translational Research Centre for Organ Transplantation, Paris, France,Department of Nephrology and Kidney Transplantation, Saint-Louis Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Stanley Jordan
- Division of Nephrology, Department of Medicine, Comprehensive Transplant Center, Cedars Sinai Medical Center, West Hollywood, California
| | - Jean-Philippe Empana
- Université de Paris, Institut National de la Santé et de la Recherche Médicale U970, Paris Translational Research Centre for Organ Transplantation, Paris, France
| | - Xavier Jouven
- Université de Paris, Institut National de la Santé et de la Recherche Médicale U970, Paris Translational Research Centre for Organ Transplantation, Paris, France,Cardiology and Heart Transplant Department, Pompidou Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Alexandre Loupy
- Université de Paris, Institut National de la Santé et de la Recherche Médicale U970, Paris Translational Research Centre for Organ Transplantation, Paris, France,Department of Kidney Transplantation, Necker Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
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16
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Lung T, Si L, Hooper R, Di Tanna GL. Health Economic Evaluation Alongside Stepped Wedge Trials: A Methodological Systematic Review. PHARMACOECONOMICS 2021; 39:63-80. [PMID: 33015754 DOI: 10.1007/s40273-020-00963-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Recently, there has been an increase in use of the stepped wedge trial (SWT) design in the context of health services research, due to its pragmatic and methodological advantages over the parallel group design. OBJECTIVE Our objective was to summarise the statistical methods used when conducting economic evaluations alongside SWTs. METHODS A systematic literature search extending to February 2020 was conducted in the PubMed, Scopus, Cochrane and National Health Service Economic Evaluation Database (NHS-EED) databases to find and evaluate studies where there was an intention to conduct an economic evaluation alongside an SWT. Studies were assessed for their eligibility, findings, reporting of statistical methods and quality of reporting. RESULTS Of the 586 studies retrieved from the literature search, 69 studies were identified and included in this systematic review. A total of 54 studies were published protocols, with eight economic evaluations and seven studies reporting full trial results. Included studies varied in terms of their reporting of statistical methods, in both detail and methodology. There were 34 studies that did not report any statistical methods for the economic evaluation, and only 16 studies reported appropriate methods, mainly using some form of mixed/multilevel model, and two used seemingly unrelated regression. Twelve studies reported the use of generic bootstrap methods and other modelling techniques, whilst the remaining studies failed to appropriately account for clustering, correlation or adjustment for time. CONCLUSIONS The use of appropriate statistical methods that account for time, clustering and correlation between costs and outcomes is an important part of SWT health economics analysis, one that will benefit from an effort to communicate the methods available and their performance.
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Affiliation(s)
- Thomas Lung
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, 2042, Australia
- Faculty of Medicine and Health, School of Public Health, Edward Ford Building A27, University of Sydney, Sydney, NSW, 2006, Australia
| | - Lei Si
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, 2042, Australia
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China
| | - Richard Hooper
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Gian Luca Di Tanna
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, 2042, Australia.
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17
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Ibrahim M, Greenhall GHB, Summers DM, Mumford L, Johnson R, Baker RJ, Forsythe J, Pettigrew GJ, Ahmad N, Callaghan CJ. Utilization and Outcomes of Single and Dual Kidney Transplants from Older Deceased Donors in the United Kingdom. Clin J Am Soc Nephrol 2020; 15:1320-1329. [PMID: 32690721 PMCID: PMC7480543 DOI: 10.2215/cjn.02060220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Kidneys from elderly deceased donors are often discarded after procurement if the expected outcomes from single kidney transplantation are considered unacceptable. An alternative is to consider them for dual kidney transplantation. We aimed to examine the utilization of kidneys from donors aged ≥60 years in the United Kingdom and compare clinical outcomes of dual versus single kidney transplant recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data from the United Kingdom Transplant Registry from 2005 to 2017 were analyzed. We examined utilization rates of kidneys retrieved from deceased donors aged ≥60 years, and 5-year patient and death-censored graft survival of recipients of dual and single kidney transplants. Secondary outcomes included eGFR. Multivariable analyses and propensity score analysis were used to correct for differences between the groups. RESULTS During the study period, 7841 kidneys were procured from deceased donors aged ≥60 years, of which 1338 (17%) were discarded; 356 dual and 5032 single kidneys were transplanted. Donors of dual transplants were older (median, 73 versus 66 years; P<0.001) and had higher United States Kidney Donor Risk Indices (2.48 versus 1.98; P<0.001). Recipients of dual transplants were also older (64 versus 61 years; P<0.001) and had less favorable human leukocyte antigen matching (P<0.001). After adjusting for confounders, dual and single transplants had similar 5-year graft survival (hazard ratio, 0.81; 95% CI, 0.59 to 1.12). No difference in patient survival was demonstrated. Similar findings were observed in a matched cohort with a propensity score analysis method. Median 12-month eGFR was significantly higher in the dual kidney transplant group (40 versus 36 ml/min per 1.73 m2; P<0.001). CONCLUSIONS Recipients of kidneys from donors aged ≥60 years have similar 5-year graft survival and better graft function at 12 months with dual compared with single deceased donor kidney transplants.
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Affiliation(s)
- Maria Ibrahim
- Department of Nephrology and Transplantation, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom .,National Health Service Blood and Transplant, Bristol, United Kingdom.,Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - George H B Greenhall
- Department of Nephrology and Transplantation, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom.,National Health Service Blood and Transplant, Bristol, United Kingdom.,Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Dominic M Summers
- Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Lisa Mumford
- National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Rachel Johnson
- National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Richard J Baker
- Department of Nephrology, St James's University Hospital, The Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
| | - John Forsythe
- National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Gavin J Pettigrew
- Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Niaz Ahmad
- Department of Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Chris J Callaghan
- Department of Nephrology and Transplantation, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom.,National Health Service Blood and Transplant, Bristol, United Kingdom
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18
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Moris D, Schmitz R, Dimitrokallis N, Schmidt T, Vernadakis S. The Paradox of Increasing Waiting List Mortality and Declining Utilization of Deceased Donor Grafts in Kidney Transplant. EXP CLIN TRANSPLANT 2020; 19:92-93. [PMID: 32490764 DOI: 10.6002/ect.2019.0427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pancreatic neuroendocrine tumors are a rare type of tumor with malignant potential, characterized by slowgrowth, frequent hepatic metastatic lesions that usually stay contained within the liver. In patients with unresectable liver metastatic pancreatic neuroendocrine tumors, liver transplant is the only treatment available. Insulinomas are the most common pancreatic neuroendocrine tumors, and 5% to 10% of insulinomas are malignant. We herein report a case of a living-donor liver transplant with distal pancreatectomy for a patient with hepatic metastatic pancreatic insulinoma with a 13-year postoperative survival.
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Affiliation(s)
- Dimitrios Moris
- From the Duke Surgery, Duke University Medical Center, Durham, North Carolina, USA; and the Transplant Unit, Laikon General Hospital, Athens, Greece.,From the Transplant Unit, Laikon General Hospital, Athens, Greece
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19
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Hemming K, Kasza J, Hooper R, Forbes A, Taljaard M. A tutorial on sample size calculation for multiple-period cluster randomized parallel, cross-over and stepped-wedge trials using the Shiny CRT Calculator. Int J Epidemiol 2020; 49:979-995. [PMID: 32087011 PMCID: PMC7394950 DOI: 10.1093/ije/dyz237] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/11/2019] [Indexed: 11/14/2022] Open
Abstract
It has long been recognized that sample size calculations for cluster randomized trials require consideration of the correlation between multiple observations within the same cluster. When measurements are taken at anything other than a single point in time, these correlations depend not only on the cluster but also on the time separation between measurements and additionally, on whether different participants (cross-sectional designs) or the same participants (cohort designs) are repeatedly measured. This is particularly relevant in trials with multiple periods of measurement, such as the cluster cross-over and stepped-wedge designs, but also to some degree in parallel designs. Several papers describing sample size methodology for these designs have been published, but this methodology might not be accessible to all researchers. In this article we provide a tutorial on sample size calculation for cluster randomized designs with particular emphasis on designs with multiple periods of measurement and provide a web-based tool, the Shiny CRT Calculator, to allow researchers to easily conduct these sample size calculations. We consider both cross-sectional and cohort designs and allow for a variety of assumed within-cluster correlation structures. We consider cluster heterogeneity in treatment effects (for designs where treatment is crossed with cluster), as well as individually randomized group-treatment trials with differential clustering between arms, for example designs where clustering arises from interventions being delivered in groups. The calculator will compute power or precision, as a function of cluster size or number of clusters, for a wide variety of designs and correlation structures. We illustrate the methodology and the flexibility of the Shiny CRT Calculator using a range of examples.
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Affiliation(s)
- Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jessica Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Richard Hooper
- Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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20
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Kidney transplantation following uncontrolled donation after circulatory death. Curr Opin Organ Transplant 2020; 25:144-150. [DOI: 10.1097/mot.0000000000000742] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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21
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Ayorinde JOO, Hamed M, Goh MA, Summers DM, Dare A, Chen Y, Saeb‐Parsy K. Development of an objective, standardized tool for surgical assessment of deceased donor kidneys: The Cambridge Kidney Assessment Tool. Clin Transplant 2020; 34:e13782. [DOI: 10.1111/ctr.13782] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/05/2020] [Accepted: 01/08/2020] [Indexed: 11/26/2022]
Affiliation(s)
- John O. O. Ayorinde
- Department of Surgery Addenbrooke's Hospital University of Cambridge Cambridge UK
| | - Mazin Hamed
- Department of Surgery Addenbrooke's Hospital University of Cambridge Cambridge UK
| | - Mingzheng Aaron Goh
- Department of Surgery Addenbrooke's Hospital University of Cambridge Cambridge UK
| | - Dominic M. Summers
- Department of Surgery Addenbrooke's Hospital University of Cambridge Cambridge UK
| | - Anna Dare
- Department of Surgery Addenbrooke's Hospital University of Cambridge Cambridge UK
| | - Yining Chen
- Department of Statistics London School of Economics London UK
| | - Kourosh Saeb‐Parsy
- Department of Surgery Addenbrooke's Hospital University of Cambridge Cambridge UK
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22
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Stevenson K. Renal transplant surgery: important things a nephrologist should know. Nephrol Dial Transplant 2020; 36:gfz253. [PMID: 31919529 DOI: 10.1093/ndt/gfz253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Karen Stevenson
- Department of Renal Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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