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Sapir-Pichhadze R, Laprise C, Beauchamp ME, Kaouache M, Zhang X, Della Vecchia A, Azoulay L, Franco EL, Abrahamowicz M, Nicolau B. Immunosuppression and cancer risk in kidney transplant recipients: A retrospective cohort study. Int J Cancer 2024; 154:2043-2053. [PMID: 38345158 DOI: 10.1002/ijc.34875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 04/14/2024]
Abstract
We assessed whether contemporary immunosuppression agents were associated with cancer among kidney transplant recipients (KTR), and if this association varied by age and sex. We studied a retrospective province-wide cohort of primary KTR (1997-2016). Employing multivariable Cox models, we estimated associations of cumulative doses of prednisone, mycophenolate and tacrolimus administered over the past 10 years, lagged by 2 years, with the incidence of primary malignant neoplasms (PMN). We assessed interactions with age and sex. To assess the impact of exposure recency, we used weighted cumulative exposure (WCE) modeling. Among 1064 KTR, 108 (10.2%) developed PMN over median follow-up of 73 months (interquartile range: 32-120). Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of 0.96 (0.64-1.43), 1.34 (0.96-1.86), and 1.06 (0.88-1.29) were estimated for cumulative daily doses of prednisone (5 mg), mycophenolate (1000 mg), and tacrolimus (2 mg) administered continuously over the past 10 years, respectively. PMN risk associated with cumulative tacrolimus exposure was modified by age (interaction p = .035) and was more pronounced in 15-year and 30-year-old KTR (aHRs of 1.57 [1.08-2.28] and 1.31 [1.03-1.66], respectively) in comparison to older KTR. PMN risk increase associated with higher cumulative mycophenolate dose was more pronounced in females (aHR = 1.86 [1.15-3.00]) than in males (aHR = 1.16 [0.74-1.81]; interaction p = .131). WCE analyses suggested increased PMN risk the higher the mycophenolate doses taken 5-10 years ago. A trend toward increased PMN risk with long-term mycophenolate exposure, particularly in females, and more pronounced risk with long-term tacrolimus exposure in younger KTR, identify opportunities for tailored immunosuppression to mitigate cancer risk.
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Affiliation(s)
- Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montreal, Quebec, Canada
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Claudie Laprise
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Marie-Eve Beauchamp
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Mohammed Kaouache
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Alexia Della Vecchia
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Laurent Azoulay
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Eduardo L Franco
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montreal, Quebec, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Michal Abrahamowicz
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Belinda Nicolau
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montreal, Quebec, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
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Melk A, Sugianto RI, Zhang X, Dahhou M, Döhler B, Süsal C, Sapir-Pichhadze R, Wong G, Foster BJ. Influence of donor sex and age on graft outcome in kidney transplantation. Nephrol Dial Transplant 2024; 39:607-617. [PMID: 37596063 DOI: 10.1093/ndt/gfad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND There is a known recipient sex-dependent association between donor sex and kidney transplant survival. We hypothesized that donor age also modifies the association between donor sex and graft survival. METHODS First, deceased donor kidney transplant recipients (1988-2019, n = 461 364) recorded in the Scientific Registry of Transplant Recipients, the Australia and New Zealand Dialysis and Transplant Registry and the Collaborative Transplant Study were analyzed. We used multivariable Cox regression models to estimate the association between donor sex and death censored graft loss, accounting for the modifying effects of recipient sex and donor age; donor age was categorized as 5-19, 20-34, 35-49, 50-59 and ≥60 years. Results from cohort-specific Cox models were combined using individual patient data meta-analysis. RESULTS Among female recipients of donors aged <60 years, graft loss hazards did not differ by donor sex; recipients of female donors ≥60 years showed significantly lower graft loss hazards than recipients of male donors of the same age [combined adjusted hazard ratio (aHR) 0.90, 95% CI 0.86-0.94]. Among male recipients, female donors aged <50 years were associated with significantly higher graft loss hazards than same-aged male donors (5-19 years: aHR 1.11, 95% CI 1.02-1.21; 20-34 years: aHR 1.08, 95% CI 1.02-1.15; 35-49 years: aHR 1.07, 95% CI 1.04-1.10). There were no significant differences in graft loss by donor sex among male recipients of donors aged ≥50 years. CONCLUSION Donor age modifies the association between donor sex and graft survival. Older female donors were associated with similar or lower hazards of graft failure than older male donors in both male and female recipients, suggesting a better functional reserve of older female donor kidneys.
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Affiliation(s)
- Anette Melk
- Children's Hospital, Hannover Medical School, Hannover, Germany
| | | | - Xun Zhang
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, QC, Canada
| | - Mourad Dahhou
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, QC, Canada
| | - Bernd Döhler
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Caner Süsal
- Transplant Immunology Research Center of Excellence, Koç University, Istanbul, Turkey
| | - Ruth Sapir-Pichhadze
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, QC, Canada
- Department of Medicine, Division of Nephrology, McGill University, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Bethany J Foster
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada
- Department of Pediatrics, Division of Nephrology, McGill University, Montréal, QC, Canada
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Vinson AJ, Zhang X, Dahhou M, Süsal C, Döhler B, Melk A, Sapir-Pichhadze R, Cardinal H, Wong G, Francis A, Pilmore H, Grinspan LT, Foster BJ. Differences in excess mortality by recipient sex after heart transplant: An individual patient data meta-analysis. J Heart Lung Transplant 2024:S1053-2498(24)01536-5. [PMID: 38522764 DOI: 10.1016/j.healun.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/07/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Identification of differences in mortality risk between female and male heart transplant recipients may prompt sex-specific management strategies. Because worldwide, males of all ages have higher absolute mortality rates than females, we aimed to compare the excess risk of mortality (risk above the general population) in female vs male heart transplant recipients. METHODS We used relative survival models conducted separately in SRTR and CTS cohorts from 1988-2019, and subsequently combined using 2-stage individual patient data meta-analysis, to compare the excess risk of mortality in female vs male first heart transplant recipients, accounting for the modifying effects of donor sex and recipient current age. RESULTS We analyzed 108,918 patients. When the donor was male, female recipients 0-12 years (Relative excess risk (RER) 1.13, 95% CI 1.00-1.26), 13-44 years (RER 1.17, 95% CI 1.10-1.25), and ≥45 years (RER 1.14, 95% CI 1.02-1.27) showed higher excess mortality risks than male recipients of the same age. When the donor was female, only female recipients 13-44 years showed higher excess risks of mortality than males (RER 1.09, 95% CI 1.00-1.20), though not significantly (p = 0.05). CONCLUSIONS In the setting of a male donor, female recipients of all ages had significantly higher excess mortality than males. When the donor was female, female recipients of reproductive age had higher excess risks of mortality than male recipients of the same age, though this was not statistically significant. Further investigation is required to determine the reasons underlying these differences.
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Affiliation(s)
- Amanda J Vinson
- Department of Medicine, Nephrology Division, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Xun Zhang
- Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Mourad Dahhou
- Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Caner Süsal
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany; Transplant Immunology Research Center of Excellence, Koç University, Istanbul, Turkey
| | - Bernd Döhler
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Anette Melk
- Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Ruth Sapir-Pichhadze
- Department of Medicine, Division of Nephrology, McGill University, Montreal, Quebec, Canada
| | - Heloise Cardinal
- Department of Medicine, Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anna Francis
- School of Clinical Medicine, University of Queensland, Brisbane, Australia; Department of Nephrology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Helen Pilmore
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Lauren T Grinspan
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bethany J Foster
- Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Pediatrics, Division of Nephrology, McGill University Faculty of Medicine, Montreal, Quebec, Canada
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Naesens M, Roufosse C, Haas M, Lefaucheur C, Mannon RB, Adam BA, Aubert O, Böhmig GA, Callemeyn J, Clahsen-van Groningen M, Cornell LD, Demetris AJ, Drachenberg CB, Einecke G, Fogo AB, Gibson IW, Halloran P, Hidalgo LG, Horsfield C, Huang E, Kikić Ž, Kozakowski N, Nankivell B, Rabant M, Randhawa P, Riella LV, Sapir-Pichhadze R, Schinstock C, Solez K, Tambur AR, Thaunat O, Wiebe C, Zielinski D, Colvin R, Loupy A, Mengel M. The Banff 2022 Kidney Meeting Report: Reappraisal of microvascular inflammation and the role of biopsy-based transcript diagnostics. Am J Transplant 2024; 24:338-349. [PMID: 38032300 DOI: 10.1016/j.ajt.2023.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/04/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
The XVI-th Banff Meeting for Allograft Pathology was held at Banff, Alberta, Canada, from 19th to 23rd September 2022, as a joint meeting with the Canadian Society of Transplantation. To mark the 30th anniversary of the first Banff Classification, premeeting discussions were held on the past, present, and future of the Banff Classification. This report is a summary of the meeting highlights that were most important in terms of their effect on the Classification, including discussions around microvascular inflammation and biopsy-based transcript analysis for diagnosis. In a postmeeting survey, agreement was reached on the delineation of the following phenotypes: (1) "Probable antibody-mediated rejection (AMR)," which represents donor-specific antibodies (DSA)-positive cases with some histologic features of AMR but below current thresholds for a definitive AMR diagnosis; and (2) "Microvascular inflammation, DSA-negative and C4d-negative," a phenotype of unclear cause requiring further study, which represents cases with microvascular inflammation not explained by DSA. Although biopsy-based transcript diagnostics are considered promising and remain an integral part of the Banff Classification (limited to diagnosis of AMR), further work needs to be done to agree on the exact classifiers, thresholds, and clinical context of use.
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Affiliation(s)
- Maarten Naesens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
| | - Candice Roufosse
- Department of Immunology and Inflammation, Faculty Medicine, Imperial College London, London, UK.
| | - Mark Haas
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Carmen Lefaucheur
- Université Paris Cité, INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, France & Department of Nephrology and Transplantation, Saint-Louis Hospital, Paris, France
| | | | - Benjamin A Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Olivier Aubert
- Université Paris Cité, INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, France & Department of Transplantation, Necker Hospital, Paris, France
| | - Georg A Böhmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Jasper Callemeyn
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Marian Clahsen-van Groningen
- Department of Pathology and Clinical Bioinformatics, Erasmus University Center Rotterdam, Rotterdam, The Netherlands, Institute of Experimental Medicine and Systems Biology, RWTH Aachen University, Aachen, Germany
| | - Lynn D Cornell
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anthony J Demetris
- UPMC Hepatic and Transplantation Pathology, Pittsburgh, Pennsylvania, USA
| | | | - Gunilla Einecke
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Agnes B Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ian W Gibson
- Department of Pathology, University of Manitoba, Winnipeg, Canada
| | - Philip Halloran
- Department of Medicine, Alberta Transplant Applied Genomics Centre, Heritage Medical Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Luis G Hidalgo
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | | | - Edmund Huang
- Department of Medicine, Division of Nephrology, Cedars-Sinai Medical Center, West Hollywood, California, USA
| | - Željko Kikić
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | - Brian Nankivell
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Marion Rabant
- Pathology department, Necker-Enfants Malades Hospital, Paris, France
| | - Parmjeet Randhawa
- Department of Pathology, Thomas E. Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Leonardo V Riella
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ruth Sapir-Pichhadze
- Division of Nephrology & Multi-Organ Transplant Program, McGill University, Montreal, Quebec, Canada
| | - Carrie Schinstock
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Kim Solez
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Anat R Tambur
- Comprehensive Transplant Center, Northwestern University, Chicago, Illinois, USA
| | - Olivier Thaunat
- Department of Transplantation Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Chris Wiebe
- Department of Medicine and Department of Immunology, University of Manitoba, Winnipeg, Canada
| | - Dina Zielinski
- Université Paris Cité, INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, France & Department of Transplantation, Necker Hospital, Paris, France
| | - Robert Colvin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandre Loupy
- Université Paris Cité, INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, France & Department of Transplantation, Necker Hospital, Paris, France
| | - Michael Mengel
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
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Roufosse C, Naesens M, Haas M, Lefaucheur C, Mannon RB, Afrouzian M, Alachkar N, Aubert O, Bagnasco SM, Batal I, Bellamy COC, Broecker V, Budde K, Clahsen-Van Groningen M, Coley SM, Cornell LD, Dadhania D, Demetris AJ, Einecke G, Farris AB, Fogo AB, Friedewald J, Gibson IW, Horsfield C, Huang E, Husain SA, Jackson AM, Kers J, Kikić Ž, Klein A, Kozakowski N, Liapis H, Mangiola M, Montgomery RA, Nankinvell B, Neil DAH, Nickerson P, Rabant M, Randhawa P, Riella LV, Rosales I, Royal V, Sapir-Pichhadze R, Sarder P, Sarwal M, Schinstock C, Stegall M, Solez K, van der Laak J, Wiebe C, Colvin RB, Loupy A, Mengel M. The Banff 2022 Kidney Meeting Work Plan: Data-driven refinement of the Banff Classification for renal allografts. Am J Transplant 2024; 24:350-361. [PMID: 37931753 DOI: 10.1016/j.ajt.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023]
Abstract
The XVIth Banff Meeting for Allograft Pathology was held in Banff, Alberta, Canada, from September 19 to 23, 2022, as a joint meeting with the Canadian Society of Transplantation. In addition to a key focus on the impact of microvascular inflammation and biopsy-based transcript analysis on the Banff Classification, further sessions were devoted to other aspects of kidney transplant pathology, in particular T cell-mediated rejection, activity and chronicity indices, digital pathology, xenotransplantation, clinical trials, and surrogate endpoints. Although the output of these sessions has not led to any changes in the classification, the key role of Banff Working Groups in phrasing unanswered questions, and coordinating and disseminating results of investigations addressing these unanswered questions was emphasized. This paper summarizes the key Banff Meeting 2022 sessions not covered in the Banff Kidney Meeting 2022 Report paper and also provides an update on other Banff Working Group activities relevant to kidney allografts.
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Affiliation(s)
- Candice Roufosse
- Department of Immunology and Inflammation, Faculty Medicine, Imperial College London, London, UK.
| | - Maarten Naesens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
| | - Mark Haas
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Carmen Lefaucheur
- Université Paris Cité, INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, France & Department of Nephrology and Transplantation, Saint-Louis Hospital, Paris, France
| | - Roslyn B Mannon
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Marjan Afrouzian
- Department of Pathology, University of Texas Medical Branch at Galveston, Texas, USA
| | - Nada Alachkar
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Olivier Aubert
- Université Paris Cité, INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, France & Department of Transplantation, Necker Hospital, Paris, France
| | - Serena M Bagnasco
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ibrahim Batal
- Pathology & Cell Biology, Columbia University Irving Medical Center, New York, USA
| | | | - Verena Broecker
- Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Klemens Budde
- Department of Nephrology, Charité Universitätsmedizin, Berlin, Germany
| | - Marian Clahsen-Van Groningen
- Department of Pathology and Clinical Bioinformatics, Erasmus University Center Rotterdam, Rotterdam, Netherlands; Institute of Experimental Medicine and Systems Biology, RWTH Aachen University, Aachen, Germany
| | - Shana M Coley
- Transplant Translational Research, Arkana Laboratories, Arkansas, USA
| | - Lynn D Cornell
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Darshana Dadhania
- Department Medicine, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Anthony J Demetris
- UPMC Hepatic and Transplantation Pathology, Pittsburg, Pennsylvania, USA
| | - Gunilla Einecke
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Germany
| | - Alton B Farris
- Department of Pathology and Laboratory Medicine, Emory University, USA
| | - Agnes B Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John Friedewald
- Comprehensive Transplant Center, Northwestern University, USA
| | - Ian W Gibson
- Department of Pathology, University of Manitoba, Winnipeg, Canada
| | | | - Edmund Huang
- Department of Medicine, Division of Nephrology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Syed A Husain
- Division of Nephrology, Columbia University, New York, New York, USA
| | | | - Jesper Kers
- Department of Pathology, Leiden University Medical Center, Netherlands; Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Željko Kikić
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | | | - Helen Liapis
- Ludwig Maximillian University Munich, Nephrology Center, Germany
| | | | | | - Brian Nankinvell
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Desley A H Neil
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Peter Nickerson
- Department of Medicine and Department of Immunology, University of Manitoba, Winnipeg, Canada
| | - Marion Rabant
- Pathology department, Necker-Enfants Malades Hospital, Paris, France
| | - Parmjeet Randhawa
- Pathology, Thomas E. Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Leonardo V Riella
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ivy Rosales
- Immunopathology Research Laboratory, Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Virginie Royal
- Maisonneuve-Rosemont Hospital, University of Montreal, Quebec, Canada
| | - Ruth Sapir-Pichhadze
- Division of Nephrology & Multiorgan Transplant Program, McGill University, Montreal, Quebec, Canada
| | - Pinaki Sarder
- Department of Medicine-Quantitative Health, University of Florida College of Medicine, Florida, USA
| | - Minnie Sarwal
- Division of MultiOrgan Transplantation, UCSF, San Francisco, California, USA
| | - Carrie Schinstock
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark Stegall
- Department Transplantation Surgery, Mayo Clinic, Rochester, Massachusetts, USA
| | - Kim Solez
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | | | - Chris Wiebe
- Department of Medicine and Department of Immunology, University of Manitoba, Winnipeg, Canada
| | - Robert B Colvin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandre Loupy
- Université Paris Cité, INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, France & Department of Transplantation, Necker Hospital, Paris, France
| | - Michael Mengel
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
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6
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Vulesevic B, Lauscher D, Kumar D, Sapir-Pichhadze R, Tchervenkov J, Angel JB, Wolfe C, Costiniuk CT. Policies and practice of solid organ donation amongst people living with HIV in Canada: time for education and re-evaluation. HIV Res Clin Pract 2024; 25:2323848. [PMID: 38529910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
The numbers of organ donors in Canada and the USA fall short of increasing demand, resulting in increased morbidity, poor health outcomes, higher medical costs and death of many individuals waitlisted for transplantation. In the US, since 2013 when the US HIV Organ Policy Equity (HOPE) Act lifted the ban on organ donation between people living with HIV, the option of using organs from People with HIV became a reality. In Canada, HIV diagnosis was an exclusion criterion to organ donation until 2017, when permission was granted if requirements for 'exceptional distribution' could be met. Still, donation of organs from people with HIV poses challenges. Herein, we overview policies involving donors with HIV in Canada in order to inform healthcare providers, researchers and the community. We also advocate for the need to reassess these policies, highlight educational needs and engage interest in advancing research to inform policy reforms.
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Affiliation(s)
- Branka Vulesevic
- Division of Infectious Diseases and Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC, Canada
| | - Darren Lauscher
- CIHR Canadian HIV Trials Network, University of British Columbia, Vancouver, BC, Canada
| | - Deepali Kumar
- Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montreal, QC, Canada
- Division of Nephrology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Jean Tchervenkov
- Multiorgan Transplant Program, Departments of Medicine and Surgery, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Jonathan B Angel
- Division of Infectious Diseases, Ottawa Hospital-General Campus, Ottawa, ON, Canada
| | - Cameron Wolfe
- Division Division of Transplant Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Cecilia T Costiniuk
- Division of Infectious Diseases and Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Medicine, McGill University Health Centre, Montreal, QC, Canada
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Murdoch B, Sapir-Pichhadze R, de Chickera SN, Caulfield T. Communicating About Precision Transplantation Tools. Can J Kidney Health Dis 2024; 11:20543581241228737. [PMID: 38328390 PMCID: PMC10848791 DOI: 10.1177/20543581241228737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/12/2023] [Indexed: 02/09/2024] Open
Abstract
Purpose of review Precision tools that ensure molecular compatibility can help prevent rejection and improve kidney transplantation outcomes. However, these tools will generate controversy because they are perceived to and can in fact impact equity in the ethics of allocation. They may also affect the extent to which physicians can advocate for their patient fiduciaries, as generally required by Canadian professional ethics and law. Sources of information Electronic databases such as Google Scholar and PubMed were searched for peer-reviewed literature, and Google search engine was used to identify the news articles, jurisprudence, legal information, and other relevant websites cited. Methods We discuss controversies precision transplantation tools will likely generate, consider what challenges will arise from their implementation, and provide recommendations of avenues and content for communication to address these issues. Key findings Communication about the translation of new precision tools will be challenging as media portrayals of transplantation often focus on individual narratives about access to transplantation and fail to center the issues of utility, allocation, and rejection. Incomplete portrayals of this nature will need to be countered with explanations of how new precision tools can be of net benefit when implemented equitably, as maintaining trust in the donation and transplantation system is key. Limitations Our manuscript focuses on precision medicine applications pertaining to the implementation of molecular compatibility in transplantation. Distinct communication content and avenues may need to be considered in other contexts. Implications Clear, accurate, and strategic communication is key to managing translation of precision medicine tools. For this purpose, we provide detailed recommendations for stakeholder engagement, content, and avenues for communicating about precision transplantation tools.
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Affiliation(s)
- Blake Murdoch
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Canada
| | | | | | - Timothy Caulfield
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Canada
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8
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Vinson AJ, Zhang X, Dahhou M, Süsal C, Döhler B, Sapir-Pichhadze R, Cardinal H, Melk A, Wong G, Francis A, Pilmore H, Foster BJ. A Multinational Cohort Study Examining Sex Differences in Excess Risk of Death With Graft Function After Kidney Transplant. Transplantation 2024:00007890-990000000-00640. [PMID: 38277260 DOI: 10.1097/tp.0000000000004915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND Kidney transplant recipients show sex differences in excess overall mortality risk that vary by donor sex and recipient age. However, whether the excess risk of death with graft function (DWGF) differs by recipient sex is unknown. METHODS In this study, we combined data from 3 of the largest transplant registries worldwide (Scientific Registry of Transplant Recipient, Australia and New Zealand Dialysis and Transplant Registry, and Collaborative Transplant Study) using individual patient data meta-analysis to compare the excess risk of DWGF between male and female recipients of a first deceased donor kidney transplant (1988-2019), conditional on donor sex and recipient age. RESULTS Among 463 895 individuals examined, when the donor was male, female recipients aged 0 to 12 y experienced a higher excess risk of DWGF than male recipients (relative excess risk 1.68; 95% confidence interval, 1.24-2.29); there were no significant differences in other age intervals or at any age when the donor was female. There was no statistically significant between-cohort heterogeneity. CONCLUSIONS Given the lack of sex differences in the excess risk of DWGF (other than in prepubertal recipients of a male donor kidney) and the known greater excess overall mortality risk for female recipients compared with male recipients in the setting of a male donor, future study is required to characterize potential sex-specific causes of death after graft loss.
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Affiliation(s)
- Amanda Jean Vinson
- Nephrology Division, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Xun Zhang
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Mourad Dahhou
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Caner Süsal
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
- Transplant Immunology Research Center of Excellence, Koç University, Istanbul, Turkey
| | - Bernd Döhler
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ruth Sapir-Pichhadze
- Department of Medicine, Division of Experimental Medicine, McGill University, QC, Canada
| | - Heloise Cardinal
- Division of Nephrology, Department of Medicine, Centre Hospitalier de l'Université de Montreal, Montreal, QC, Canada
| | - Anette Melk
- Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Anna Francis
- School of Clinical Medicine, University of Queensland, QLD, Australia
- Department of Medicine, Division of Nephrology, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Helen Pilmore
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Bethany J Foster
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Division of Nephrology, Department of Pediatrics, McGill University Faculty of Medicine, QC, Canada
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9
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Affdal A, Ballesteros F, Malo MF, Sancho C, Cochran-Mavrikakis SL, Bryan S, Keown P, Sapir-Pichhadze R, Fortin MC. Canadian Kidney Transplant Professionals' Perspectives on Precision Medicine and Molecular Matching in Kidney Allocation. Transplant Direct 2024; 10:e1565. [PMID: 38111837 PMCID: PMC10727564 DOI: 10.1097/txd.0000000000001565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/29/2023] [Accepted: 10/20/2023] [Indexed: 12/20/2023] Open
Abstract
Background Antibody-mediated rejection is an important cause of kidney transplant loss. A new strategy requiring application of precision medicine tools in transplantation considers molecular compatibility between donors and recipients and holds the promise of improved immunologic risk, preventing rejection and premature graft loss. The objective of this study was to gather Canadian transplant professionals' perspectives on molecular compatibility in kidney transplantation. Methods Seventeen Canadian transplant professionals (14 nephrologists, 2 nurses, and 1 surgeon) participated in semistructured interviews in 2021. The interviews were digitally recorded, transcribed, and analyzed using the qualitative description approach. Results Participants identified fair access to transplantation as the most important principle in kidney allocation. Molecular compatibility was viewed as a promising innovation. However, participants were concerned about increased waiting times, negative impact on some patients, and potential problems related to the adequacy of information explaining this new technology. To mitigate the challenges associated with molecular matching, participants suggested integrating a maximum waiting time for molecular-matched kidneys and expanding the program nationally/internationally. Conclusions Molecular matching in kidney transplantation is viewed as a promising technology for decreasing the incidence of antibody-mediated rejection and improving graft survival. Further studies are needed to determine how to ethically integrate this technology into the kidney allocation algorithm.
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Affiliation(s)
- Aliya Affdal
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Bioethics Program, École de santé publique de l’Université de Montréal, Montréal, Canada
| | - Fabian Ballesteros
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Marie-Françoise Malo
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Bioethics Program, École de santé publique de l’Université de Montréal, Montréal, Canada
| | - Carina Sancho
- Bioethics Program, École de santé publique de l’Université de Montréal, Montréal, Canada
| | | | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver,Canada
| | - Paul Keown
- Division of Nephrology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ruth Sapir-Pichhadze
- Canadian Donation and Transplantation Research Program, Canada
- Division of Nephrology, Faculty of Medicine, McGill University, Montréal, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Canadian Donation and Transplantation Research Program, Canada
- Division of Nephrology, Faculty of Medicine, Université de Montréal, Montréal, Canada
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10
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Schapranow MP, Bayat M, Rasheed A, Naik M, Graf V, Schmidt D, Budde K, Cardinal H, Sapir-Pichhadze R, Fenninger F, Sherwood K, Keown P, Günther OP, Pandl KD, Leiser F, Thiebes S, Sunyaev A, Niemann M, Schimanski A, Klein T. NephroCAGE-German-Canadian Consortium on AI for Improved Kidney Transplantation Outcome: Protocol for an Algorithm Development and Validation Study. JMIR Res Protoc 2023; 12:e48892. [PMID: 38133915 PMCID: PMC10770792 DOI: 10.2196/48892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Recent advances in hardware and software enabled the use of artificial intelligence (AI) algorithms for analysis of complex data in a wide range of daily-life use cases. We aim to explore the benefits of applying AI to a specific use case in transplant nephrology: risk prediction for severe posttransplant events. For the first time, we combine multinational real-world transplant data, which require specific legal and technical protection measures. OBJECTIVE The German-Canadian NephroCAGE consortium aims to develop and evaluate specific processes, software tools, and methods to (1) combine transplant data of more than 8000 cases over the past decades from leading transplant centers in Germany and Canada, (2) implement specific measures to protect sensitive transplant data, and (3) use multinational data as a foundation for developing high-quality prognostic AI models. METHODS To protect sensitive transplant data addressing the first and second objectives, we aim to implement a decentralized NephroCAGE federated learning infrastructure upon a private blockchain. Our NephroCAGE federated learning infrastructure enables a switch of paradigms: instead of pooling sensitive data into a central database for analysis, it enables the transfer of clinical prediction models (CPMs) to clinical sites for local data analyses. Thus, sensitive transplant data reside protected in their original sites while the comparable small algorithms are exchanged instead. For our third objective, we will compare the performance of selected AI algorithms, for example, random forest and extreme gradient boosting, as foundation for CPMs to predict severe short- and long-term posttransplant risks, for example, graft failure or mortality. The CPMs will be trained on donor and recipient data from retrospective cohorts of kidney transplant patients. RESULTS We have received initial funding for NephroCAGE in February 2021. All clinical partners have applied for and received ethics approval as of 2022. The process of exploration of clinical transplant database for variable extraction has started at all the centers in 2022. In total, 8120 patient records have been retrieved as of August 2023. The development and validation of CPMs is ongoing as of 2023. CONCLUSIONS For the first time, we will (1) combine kidney transplant data from nephrology centers in Germany and Canada, (2) implement federated learning as a foundation to use such real-world transplant data as a basis for the training of CPMs in a privacy-preserving way, and (3) develop a learning software system to investigate population specifics, for example, to understand population heterogeneity, treatment specificities, and individual impact on selected posttransplant outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48892.
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Affiliation(s)
- Matthieu-P Schapranow
- Hasso Plattner Institute for Digital Engineering, University of Potsdam, Potsdam, Germany
| | - Mozhgan Bayat
- Hasso Plattner Institute for Digital Engineering, University of Potsdam, Potsdam, Germany
| | - Aadil Rasheed
- Hasso Plattner Institute for Digital Engineering, University of Potsdam, Potsdam, Germany
| | - Marcel Naik
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Verena Graf
- Geschäftsbereich IT, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Danilo Schmidt
- Geschäftsbereich IT, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Héloïse Cardinal
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Ruth Sapir-Pichhadze
- Division of Nephrology and Multi-Organ Transplant Program, Department of Medicine and Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Franz Fenninger
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Karen Sherwood
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paul Keown
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Konstantin D Pandl
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Florian Leiser
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Scott Thiebes
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Ali Sunyaev
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
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11
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Lemieux W, Richard L, Nunes JM, Sanchez-Mazas A, Renaud C, Sapir-Pichhadze R, Lewin A. A registry-based population study of the HLA in Québec, Canada. HLA 2023; 102:671-689. [PMID: 37439270 DOI: 10.1111/tan.15154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/15/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023]
Abstract
As part of the worldwide effort to better characterize HLA diversity in populations, we have studied the population of Québec in Canada. This province has been defined by a complex history with multiple founder effects and migration patterns. We analyzed the typing data of 3806 individuals registered in Héma-Québec's Registry, which covered most administrative regions in Québec. Typing information was resolved at the second field level of resolution by next-generation sequencing (NGS) or by Sanger sequencing. We used the HLA-net.eu GENE[RATE] tools to estimate allele and two-locus haplotype frequencies for HLA-A, -B, -C, -DRB1, -DQB1, and -DPB1, as well as Hardy-Weinberg equilibrium (HWE), selective neutrality, and linkage disequilibrium. The chord genetic distance was also calculated between administrative regions and was visualized using non-metric multidimensional scaling (NMDS) analysis. While most individual regions were in HWE, HWE was rejected for the province considered as a whole. Some regions exhibited signatures of selection, mostly toward an excess of heterozygotes. Allele and haplotype frequencies revealed outlier regions that strongly differed from the other regions. NMDS plots also showed differences between regions. The administrative regions of the province of Québec displayed heterogeneity in their HLA profiles. This heterogeneity was attributable to differing allele and haplotype specificities by region. In particular, regions 02-Saguenay-Lac-Saint-Jean and 01-Bas-St-Laurent diverged from the rest of the regions. The urban regions 06-Montréal and 13-Laval were very diversified in their HLA profiles. Together, these results will help optimize donor recruitment strategies in Québec.
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Affiliation(s)
- William Lemieux
- Medical Affairs & Innovation, Héma-Québec, Montréal, Quebec, Canada
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of McGill University Health Centre, Montréal, Quebec, Canada
| | - Lucie Richard
- Transfusion Medicine/Reference Laboratory, Héma-Québec, Montréal, Quebec, Canada
| | - José Manuel Nunes
- Laboratory of Anthropology, Genetics and Peopling history, Department of Genetics and Evolution, University of Geneva and Institute of Genetics and Genomics in Geneva (IGE3), Geneva, Switzerland
| | - Alicia Sanchez-Mazas
- Laboratory of Anthropology, Genetics and Peopling history, Department of Genetics and Evolution, University of Geneva and Institute of Genetics and Genomics in Geneva (IGE3), Geneva, Switzerland
| | - Christian Renaud
- Medical Affairs & Innovation, Héma-Québec, Montréal, Quebec, Canada
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of McGill University Health Centre, Montréal, Quebec, Canada
- Division of Nephrology and the Multi-Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montréal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - Antoine Lewin
- Medical Affairs & Innovation, Héma-Québec, Montréal, Quebec, Canada
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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12
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Carrigan I, Mathur S, Bourgeois N, Dieudé M, Fantus D, Gongal P, Halpin A, Hirji A, Mansell H, Piotrowski C, Sapir-Pichhadze R, Vinson AJ. Updates in Kidney Transplantation From the 2022 Banff-Canadian Society of Transplantation Joint Meeting: Conference Report. Can J Kidney Health Dis 2023; 10:20543581231209185. [PMID: 38020483 PMCID: PMC10644765 DOI: 10.1177/20543581231209185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose of the Conference The 2022 Banff-Canadian Society of Transplantation Meeting in Banff, Alberta, brought together transplant professionals to review new developments across various aspects of solid organ transplantation (SOT) in Canada. Sources of Information Presentations included consensus recommendations from expert-led forums; experiences with new procedures and legislation; reports from public health data repositories; original clinical and laboratory research; and industry updates regarding novel technologies. Speakers referenced articles and reports published in peer-reviewed journals and online, and unpublished data and preliminary findings. Methods All authors attended presentations in-person or virtually. Recordings of select presentations were available for later review. Summaries emphasize concepts indicated by speakers as new and clinically relevant. Key Findings The COVID-19 pandemic disproportionately affected solid organ transplant recipients (SOTRs), who experience worse outcomes of COVID-19 infection than the general population. Vaccinations demonstrate an attenuated immunological response in SOTRs yet provide meaningful protection. Monoclonal antibodies are effective for both passive immunization and treatment of COVID-19 in SOTRs. Infection control protocols have driven the development of virtual methods for clinical research, such as using home blood draws and virtual follow-up to evaluate vaccine efficacy in SOTRs; and patient care delivery, such as employing telerehabilitation post transplant. Access to living kidney donation is limited by various disincentives experienced by potential donors, which may be overcome by more efficient evaluations including a One-Day Living Kidney Donor Assessment Clinic. The International Donation and Transplantation Legislative and Policy Forum provided a means of establishing consensus guidance for organ donation and transplantation (ODT) program policy to standardize delivery across jurisdictions. The implementation of a deemed consent model for organ and tissue donation in Nova Scotia may provide insight as to whether this model indeed improves access to organs. Canada's Indigenous population experiences unique barriers to transplantation, prompting efforts for more inclusive ODT policy-making. The Pan-Canadian ODT Data and Performance Reporting System Project has defined performance quality indicators, of which iTransplant and other point-of-care software solutions may facilitate collection; however, these endeavors ultimately require information technology infrastructure that exceeds the capabilities of the existing Canadian Organ Replacement Register and Canadian Transplant Registry. Pig-to-human xenotransplantation requires genetic modification of pigs and xenoantibody testing in recipients but may yet prove viable. Serum cell-free DNA, urine biomarkers, and genetic markers offer an alternative to routine biopsy for identifying subclinical rejection. Modified perfusion temperatures and perfusion solutions with hydrogen sulfide donor compounds may improve organ preservation. Molecular compatibility tools provide another means of improving SOTR outcomes, and the Genome Canada Transplant Consortium has been examining important considerations of their implementation. Limitations We were unable to capture all presentations and topics at the meeting due to the sizable quantity and variety. Topics ultimately excluded from this summary include those in pathology including Banff Classification updates; those unique to extra-renal SOT; as well as numerous abstract and poster presentations, allied health provider forums, and business meetings. A portion of the material was presented by speakers prior to peer-review or publication. Implications The various conference presentations summarized in this report identify methods by which individual clinicians and provincial ODT programs may improve access, delivery, and quality of SOT care in Canada, while additionally identifying gaps in the literature that investigators are encouraged to pursue.
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Affiliation(s)
- Ian Carrigan
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Sunita Mathur
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | | | - Mélanie Dieudé
- Department of Microbiology, Infectious Diseases, and Immunology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Daniel Fantus
- Centre de Recherche de Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Division of Nephrology, Department of Medicine, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Patricia Gongal
- Canadian Donation and Transplantation Research Program, Alberta Transplant Institute, University of Alberta, Edmonton, AB, Canada
| | - Anne Halpin
- Alberta Precision Laboratories, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Alim Hirji
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Caroline Piotrowski
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ruth Sapir-Pichhadze
- Department of Medicine, Division of Experimental Medicine, McGill University, Montréal, QC, Canada
| | - Amanda J. Vinson
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
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Sugianto RI, Saenger T, Ahn C, Chong AS, Goldberg AM, Grabitz C, Mannon RB, Marson L, Memaran N, Sapir-Pichhadze R, Tullius SG, von der Born J, West LJ, Foster BJ, Lerminiaux L, Wong G, Melk A. State-of-the-art Meeting on Sex and Gender in Transplantation: The Female Perspective. Transplantation 2023; 107:1865-1869. [PMID: 37101316 DOI: 10.1097/tp.0000000000004609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- Rizky Indrameikha Sugianto
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Thorsten Saenger
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Curie Ahn
- Division of Nephrology, National Medical Center, Seoul, South Korea
| | - Anita S Chong
- Department of Surgery, University of Chicago, Chicago, IL
| | - Aviva M Goldberg
- Section of Pediatric Nephrology, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Carl Grabitz
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Roslyn B Mannon
- Division of Nephrology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Lorna Marson
- The Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Nima Memaran
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | | | - Stefan G Tullius
- Division of Transplant Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jeannine von der Born
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Lori J West
- Departments of Pediatrics, Surgery, Medical Microbiology/Immunology and Laboratory Medicine/Pathology, University of Alberta, Alberta Transplant Institute, Edmonton, AB, Canada
| | - Bethany J Foster
- Department of Pediatrics, Montreal Children's Hospital of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Germaine Wong
- Division of Nephrology, Department of Medicine, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
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Getchell LE, Reich M, Allu S, Woods C, Atkinson T, Beaucage M, Stalker L, Sparkes D, Turner C, L'Esperance A, Burns K, Elliott MJ, Chiu H, Rosenblum ND, Sapir-Pichhadze R. Storytelling for impact: the creation of a storytelling program for patient partners in research. Res Involv Engagem 2023; 9:57. [PMID: 37491345 PMCID: PMC10369735 DOI: 10.1186/s40900-023-00471-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023]
Abstract
Storytelling is a powerful means to evoke empathy and understanding among people. When patient partners, which include patients, family members, caregivers and organ donors, share their stories with health professionals, this can prompt listeners to reflect on their practice and consider new ways of driving change in the healthcare system. However, a growing number of patient partners are asked to 'share their story' within health care and research settings without adequate support to do so. This may ultimately widen, rather than close, the gap between healthcare practitioners and people affected by chronic disease in this new era of patient and public involvement in research. To better support patient partners with storytelling in the context of a patient-oriented research network, Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network adapted an existing in-person storytelling workshop for patient educators within a hospital setting. The result is a 6-week virtual program called Storytelling for Impact, which guides patients, family members, caregivers and organ donors in developing impactful stories and sharing them at health care and research events, e.g., conferences. The online series of synchronous workshops is co-facilitated by story coaches, who are program alumni and Can-SOLVE CKD staff with trained storytelling experience. Each story follows a structure that includes a call to action, which aims to positively impact the priority-setting and delivery of care and research in Canada. The program has been a transformational process for many who have completed it, and numerous other health organizations have expressed interest in sharing this tool with their own patient partners. As result, we have also created an asynchronous online program that can be used by other interested parties outside our network. Patient partners who share their stories can be powerful mediators for inspiring changes in the health care and research landscape, with adequate structured support. We describe two novel programs to support patient partners in impactful storytelling, which are applicable across all health research disciplines. Additional resources are required for sustainability and scale up of training, by having alumni train future storytellers.
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Affiliation(s)
| | | | | | | | | | - Mary Beaucage
- Can-SOLVE CKD Network, Vancouver, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | | | | | | | - Audrey L'Esperance
- Health and Social Services Management, École nationale d'administration publique (ENAP), Quebec City, Canada
| | - Kevin Burns
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | | | - Helen Chiu
- Can-SOLVE CKD Network, Vancouver, Canada
- BC Renal, Vancouver, Canada
| | - Norman D Rosenblum
- Division of Nephrology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montreal, QC, Canada
- Division of Nephrology, Department of Medicine, McGill University, Montreal, QC, Canada
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15
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Edwards L, Bentley C, Burgess M, Sapir-Pichhadze R, Hartell D, Keown P, Bryan S. Adding epitope compatibility to deceased donor kidney allocation criteria: recommendations from a pan-Canadian online public deliberation. BMC Nephrol 2023; 24:165. [PMID: 37296384 PMCID: PMC10255937 DOI: 10.1186/s12882-023-03224-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The widening supply-demand imbalance for kidneys necessitates finding ways to reduce rejection and improve transplant outcomes. Human leukocyte antigen (HLA) epitope compatibility between donor and recipient may minimize premature graft loss and prolong survival, but incorporating this strategy to deceased donor allocation criteria prioritizes transplant outcomes over wait times. An online public deliberation was held to identify acceptable trade-offs when implementing epitope compatibility to guide Canadian policymakers and health professionals in deciding how best to allocate kidneys fairly. METHODS Invitations were mailed to 35,000 randomly-selected Canadian households, with over-sampling of rural/remote locations. Participants were selected for socio-demographic diversity and geographic representation. Five two-hour online sessions were held from November-December 2021. Participants received an information booklet and heard from expert speakers prior to deliberating on how to fairly implement epitope compatibility for transplant candidates and governance issues. Participants collectively generated and voted on recommendations. In the final session, kidney donation and allocation policymakers engaged with participants. Sessions were recorded and transcribed. RESULTS Thirty-two individuals participated and generated nine recommendations. There was consensus on adding epitope compatibility to the existing deceased donor kidney allocation criteria. However, participants recommended including safeguards/flexibility around this (e.g., mitigating declining health). They called for a transition period to epitope compatibility, including an ongoing comprehensive public education program. Participants unanimously recommended regular monitoring and public sharing of epitope-based transplant outcomes. CONCLUSIONS Participants supported adding epitope compatibility to kidney allocation criteria, but advised safeguards and flexibility around implementation. These recommendations provide guidance to policymakers about incorporating epitope-based deceased donor allocation criteria.
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Affiliation(s)
- Louisa Edwards
- School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada.
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada.
| | | | - Michael Burgess
- School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
- W. Maurice Young Centre for Applied Ethics, UBC, Vancouver, Canada
| | - Ruth Sapir-Pichhadze
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Vancouver, Canada
| | | | - Paul Keown
- Department of Medicine, UBC, Vancouver, Canada
- Immune Centre of BC, Vancouver Coastal Health, Vancouver, Canada
| | - Stirling Bryan
- School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
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16
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Vinson AJ, Zhang X, Dahhou M, Süsal C, Döhler B, Melk A, Sapir-Pichhadze R, Cardinal H, Wong G, Francis A, Pilmore H, Foster BJ. A multinational cohort study uncovered sex differences in excess mortality after kidney transplant. Kidney Int 2023; 103:1131-1143. [PMID: 36805451 DOI: 10.1016/j.kint.2023.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/14/2023] [Accepted: 01/19/2023] [Indexed: 02/21/2023]
Abstract
Worldwide and at all ages, males have a higher mortality risk than females. This mortality bias should be preserved in kidney transplant recipients unless there are sex differences in the effects of transplantation. Here we compared the excess risk of mortality (risk above the general population) in female versus male recipients of all ages recorded in three large transplant databases. This included first deceased donor kidney transplant recipients and accounted for the modifying effects of donor sex and recipient age. After harmonization of variables across cohorts, relative survival models were fitted in each cohort separately and results were combined using individual patient data meta-analysis among 466,892 individuals (1988-2019). When the donor was male, female recipients 0-12 years (Relative Excess Risk 1.54, 95% Confidence Interval 1.20-1.99), 13-24 years (1.17, 1.01-1.34), 25-44 years (1.11, 1.05-1.18) and 60 years and older (1.05, 1.02-1.08) showed higher excess mortality risks than male recipients of the same age. When the donor was female, the Relative Excess Risk for those over 12 years were similar to those when the donor was male. There is a higher excess mortality risk in female than male recipients with differences larger at younger than older ages and only statistically significant when the donor was male. While these findings may be partly explained by the known sex differences in graft loss risks, sex differences in the risks of death with graft function may also contribute. Thus, higher risks in females than males suggest that management needs to be modified to optimize transplant outcomes among females.
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Affiliation(s)
- Amanda J Vinson
- Department of Medicine, Nephrology Division, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Xun Zhang
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, Québec, Canada
| | - Mourad Dahhou
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, Québec, Canada
| | - Caner Süsal
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany; Transplant Immunology Research Center of Excellence, Koç University, Istanbul, Turkey
| | - Bernd Döhler
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Anette Melk
- Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Ruth Sapir-Pichhadze
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, Québec, Canada; Department of Medicine, Division of Nephrology, McGill University, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Heloise Cardinal
- Department of Medicine, Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anna Francis
- School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Nephrology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Helen Pilmore
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Bethany J Foster
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada; Department of Pediatrics, Division of Nephrology, McGill University Faculty of Medicine, Montréal, Québec, Canada.
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17
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Slomp C, Edwards L, Burgess M, Sapir-Pichhadze R, Keown P, Bryan S. Public values and guiding principles for implementing epitope compatibility in kidney transplantation allocation criteria: results from a Canadian online public deliberation. BMC Public Health 2023; 23:844. [PMID: 37165330 PMCID: PMC10170053 DOI: 10.1186/s12889-023-15790-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 04/30/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Epitope compatibility in deceased donor kidney allocation is an emerging area of precision medicine (PM), seeking to improve compatibility between donor kidneys to transplant candidates in the hope of avoiding kidney rejection. Though the potential benefits of using epitope compatibility are promising, the implied modification of deceased organ allocation criteria requires consideration of significant clinical and ethical trade-offs. As a matter of public policy, these trade-offs should consider public values and preferences. We invited members of the Canadian public to participate in a deliberation about epitope compatibility in deceased donor kidney transplantation; to identify what is important to them and to provide recommendations to policymakers. METHODS An online public deliberation was conducted with members of the Canadian public, in which participants were asked to construct recommendations for policymakers regarding the introduction of epitope compatibility to kidney allocation criteria. In the present paper, a qualitative analysis was conducted to identify the values reflected in participants' recommendations. All virtual sessions were recorded, transcribed, and analyzed using NVivo 12 software. RESULTS Thirty-two participants constructed nine recommendations regarding the adoption of epitope compatibility into deceased donor kidney allocation. Five values were identified that drove participants' recommendations: Health Maximization, Protection/Mitigation of Negative Impacts, Fairness, Science/Evidence-based Healthcare, and Responsibility to Maintain Trust. Conflicts between these values were discussed in terms of operational principles that were required for epitope compatibility to be implemented in an acceptable manner: the needs for Flexibility, Accountability, Transparent Communication and a Transition Plan. All nine recommendations were informed by these four principles. Participant deliberations were often dominated by the conflict between Health Maximization and Fairness or Protection/Mitigation of Negative Impacts, which was discussed as the need for Flexibility. Two additional values (Efficient Use of Resources and Logic/Rationality) were also discussed and were reasons for some participants voting against some recommendations. CONCLUSIONS Public recommendations indicate support for using epitope compatibility in deceased donor kidney allocation. A flexible approach to organ allocation decision-making may allow for the balancing of Health Maximization against maintaining Fairness and Mitigating Negative Impacts. Flexibility is particularly important in the context of epitope compatibility and other PM initiatives where evidence is still emerging.
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Affiliation(s)
- Caitlin Slomp
- BC Children's Hospital Research Institute, 938 W 28th Ave, BC, V5Z 4H4, Vancouver, Canada.
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.
| | - Louisa Edwards
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Michael Burgess
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- W. Maurice Young Centre for Applied Ethics, University of British Columbia, Vancouver, Canada
| | - Ruth Sapir-Pichhadze
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Paul Keown
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Immune Centre of BC, Vancouver Coastal Health, Vancouver, Canada
| | - Stirling Bryan
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
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18
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Sapir-Pichhadze R, Oertelt-Prigione S. P3 2: a sex- and gender-sensitive model for evidence-based precision medicine: from knowledge generation to implementation in the field of kidney transplantation. Kidney Int 2023; 103:674-685. [PMID: 36731608 DOI: 10.1016/j.kint.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 02/01/2023]
Abstract
Precision medicine emerged as a promising approach to identify suitable interventions for individual patients with a particular health concern and at various time points. Technology can enable the acquisition of increasing volumes of clinical and "omics" data at the individual and population levels and support advanced clinical decision making. However, to keep pace with evolving societal realities and developments, it is important to systematically include sex- and gender-specific considerations in the research process, from the acquisition of knowledge to implementation. Building on the foundations of evidence-based medicine and existing precision medicine frameworks, we propose a novel evidence-based precision medicine framework in the form of the P32model, which considers individual sex-related (predictive [P1], preventive [P2], and personalized [P3] medicine) and gender-related (participatory [P4], psychosocial [P5], and percipient [P6] medicine) domains and their intersection with ethnicity, geography, and other demographic and social variables, in addition to population, community, and public dimensions (population-informed [P7], partnered with community [P8], and public-engaging [P9] medicine, respectively). Through its ability to contextualize and reflect on societal realities and developments, our model is expected to promote consideration of diversity, equity, and inclusion principles and, thus, enrich science, increase reproducibility of research, and ensure its social impact.
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Affiliation(s)
- Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands; AG10 Sex- and Gender-Sensitive Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany.
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19
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Vaisbourd Y, Dahhou M, Zhang X, Sapir-Pichhadze R, Cardinal H, Johnston O, Blydt-Hansen TD, Tibbles LA, Hamiwka L, Urschel S, Birk P, Bissonnette J, Matsuda-Abedini M, BScPhm JH, Schiff J, Phan V, De Geest S, Allen U, Avitzur Y, Mital S, Foster BJ. Differences in medication adherence by sex and organ type among adolescent and young adult solid organ transplant recipients. Pediatr Transplant 2023; 27:e14446. [PMID: 36478059 DOI: 10.1111/petr.14446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Identification of differences in medication adherence by sex or organ type may help in planning interventions to optimize outcomes. We compared immunosuppressive medication adherence between males and females, and between kidney, liver and heart transplant recipients. METHODS This multicenter study of prevalent kidney, liver and heart transplant recipients 14-25 years assessed adherence 3 times (0, 3, 6 months post-enrollment) with the BAASIS self-report tool. At each visit, participants were classified as adherent if they missed no doses in the prior 4 weeks and non-adherent otherwise. Adherence was also assessed using the coefficient of variation (CV) of tacrolimus trough levels; CV < 30% was classified as adherent. We used multivariable mixed effects logistic regression models adjusted for potential confounders to compare adherence by sex and by organ. RESULTS Across all visits, males (n = 150, median age 20.4 years, IQR 17.2-23.3) had lower odds of self-reported adherence than females (n = 120, median age 19.8 years, IQR 17.1-22.7) (OR 0.41, 95% CI 0.21-0.80) but higher odds of adherence by tacrolimus CV (OR 2.50, 95% CI 1.30-4.82). No significant differences in adherence (by self-report or tacrolimus CV) were noted between the 184 kidney, 58 liver, and 28 heart recipients. CONCLUSION Females show better self-reported adherence than males but greater variability in tacrolimus levels. Social desirability bias, more common in females than males, may contribute to better self-reported adherence among females. Higher tacrolimus variability among females may reflect biologic differences in tacrolimus metabolism between males and females rather than sex differences in adherence. There were no significant differences in adherence by organ type.
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Affiliation(s)
| | - Mourad Dahhou
- Research Institute of The McGill University Health Centre, Quebec, Canada
| | - Xun Zhang
- Research Institute of The McGill University Health Centre, Quebec, Canada
| | - Ruth Sapir-Pichhadze
- Research Institute of The McGill University Health Centre, Quebec, Canada.,Department of Medicine, McGill University, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
| | | | - Olwyn Johnston
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lee Anne Tibbles
- Department of Medicine and Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lorraine Hamiwka
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon Urschel
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Patricia Birk
- Section of Pediatric Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Mina Matsuda-Abedini
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Harrison BScPhm
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Ajmera Transplant Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jeffrey Schiff
- Ajmera Transplant Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Sabina De Geest
- Department Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Department of Primary Care and Public Health, Academic Center of Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Upton Allen
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Yaron Avitzur
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Seema Mital
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Bethany J Foster
- Department of Pediatrics, McGill University, Quebec, Canada.,Research Institute of The McGill University Health Centre, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
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20
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Wong P, Cina DP, Sherwood KR, Fenninger F, Sapir-Pichhadze R, Polychronakos C, Lan J, Keown PA. Clinical application of immune repertoire sequencing in solid organ transplant. Front Immunol 2023; 14:1100479. [PMID: 36865546 PMCID: PMC9971933 DOI: 10.3389/fimmu.2023.1100479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
Background Measurement of T cell receptor (TCR) or B cell receptor (BCR) gene utilization may be valuable in monitoring the dynamic changes in donor-reactive clonal populations following transplantation and enabling adjustment in therapy to avoid the consequences of excess immune suppression or to prevent rejection with contingent graft damage and to indicate the development of tolerance. Objective We performed a review of current literature to examine research in immune repertoire sequencing in organ transplantation and to assess the feasibility of this technology for clinical application in immune monitoring. Methods We searched MEDLINE and PubMed Central for English-language studies published between 2010 and 2021 that examined T cell/B cell repertoire dynamics upon immune activation. Manual filtering of the search results was performed based on relevancy and predefined inclusion criteria. Data were extracted based on study and methodology characteristics. Results Our initial search yielded 1933 articles of which 37 met the inclusion criteria; 16 of these were kidney transplant studies (43%) and 21 were other or general transplantation studies (57%). The predominant method for repertoire characterization was sequencing the CDR3 region of the TCR β chain. Repertoires of transplant recipients were found to have decreased diversity in both rejectors and non-rejectors when compared to healthy controls. Rejectors and those with opportunistic infections were more likely to have clonal expansion in T or B cell populations. Mixed lymphocyte culture followed by TCR sequencing was used in 6 studies to define an alloreactive repertoire and in specialized transplant settings to track tolerance. Conclusion Methodological approaches to immune repertoire sequencing are becoming established and offer considerable potential as a novel clinical tool for pre- and post-transplant immune monitoring.
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Affiliation(s)
- Paaksum Wong
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Davide P Cina
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Karen R Sherwood
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Franz Fenninger
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ruth Sapir-Pichhadze
- Department of Medicine, Division of Nephrology, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Constantin Polychronakos
- Department of Pediatrics, The Research Institute of the McGill University Health Centre and the Montreal Children's Hospital, Montreal, QC, Canada
| | - James Lan
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paul A Keown
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
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21
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Yaghoubi M, Cressman S, Edwards L, Shechter S, Doyle-Waters MM, Keown P, Sapir-Pichhadze R, Bryan S. A Systematic Review of Kidney Transplantation Decision Modelling Studies. Appl Health Econ Health Policy 2023; 21:39-51. [PMID: 35945483 DOI: 10.1007/s40258-022-00744-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Genome-based precision medicine strategies promise to minimize premature graft loss after renal transplantation, through precision approaches to immune compatibility matching between kidney donors and recipients. The potential adoption of this technology calls for important changes to clinical management processes and allocation policy. Such potential policy change decisions may be supported by decision models from health economics, comparative effectiveness research and operations management. OBJECTIVE We used a systematic approach to identify and extract information about models published in the kidney transplantation literature and provide an overview of the status of our collective model-based knowledge about the kidney transplant process. METHODS Database searches were conducted in MEDLINE, Embase, Web of Science and other sources, for reviews and primary studies. We reviewed all English-language papers that presented a model that could be a tool to support decision making in kidney transplantation. Data were extracted on the clinical context and modelling methods used. RESULTS A total of 144 studies were included, most of which focused on a single component of the transplantation process, such as immunosuppressive therapy or donor-recipient matching and organ allocation policies. Pre- and post-transplant processes have rarely been modelled together. CONCLUSION A whole-disease modelling approach is preferred to inform precision medicine policy, given its potential upstream implementation in the treatment pathway. This requires consideration of pre- and post-transplant natural history, risk factors for allograft dysfunction and failure, and other post-transplant outcomes. Our call is for greater collaboration across disciplines and whole-disease modelling approaches to more accurately simulate complex policy decisions about the integration of precision medicine tools in kidney transplantation.
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Affiliation(s)
- Mohsen Yaghoubi
- Department of Pharmacy Practice, Mercer University College of Pharmacy, Atlanta, USA
| | - Sonya Cressman
- Faculty of Health Sciences, Simon Fraser University, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Louisa Edwards
- School of Population and Public Health, University of British Columbia, Vancouver, V6T 1Z3, Canada
| | - Steven Shechter
- Sauder School of Business, University of British Columbia, Vancouver, Canada
| | - Mary M Doyle-Waters
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
| | - Paul Keown
- Department of Medicine, Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | | | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, V6T 1Z3, Canada.
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22
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Hall VG, Solera JT, Al-Alahmadi G, Marinelli T, Cardinal H, Poirier C, Huard G, Prasad GR, De Serres SA, Isaac D, Mainra R, Lamarche C, Sapir-Pichhadze R, Gilmour S, Humar A, Kumar D. Gravité de la COVID-19 chez les receveurs d’une transplantation d’organe plein au Canada, 2020–2021 : étude de cohorte prospective multicentrique. CMAJ 2022; 194:E1578-E1586. [DOI: 10.1503/cmaj.220620-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 01/08/2023] Open
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23
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Lemieux W, Fleischer D, Yang AY, Niemann M, Oualkacha K, Klement W, Richard L, Polychronakos C, Liwski R, Claas F, Gebel HM, Keown PA, Lewin A, Sapir-Pichhadze R. Dissecting the impact of molecular T-cell HLA mismatches in kidney transplant failure: A retrospective cohort study. Front Immunol 2022; 13:1067075. [PMID: 36505483 PMCID: PMC9730505 DOI: 10.3389/fimmu.2022.1067075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Kidney transplantation is the optimal treatment in end-stage kidney disease, but de-novo donor specific antibody development continues to negatively impact patients undergoing kidney transplantation. One of the recent advances in solid organ transplantation has been the definition of molecular mismatching between donors and recipients' Human Leukocyte Antigens (HLA). While not fully integrated in standard clinical care, cumulative molecular mismatch at the level of eplets (EMM) as well as the PIRCHE-II score have shown promise in predicting transplant outcomes. In this manuscript, we sought to study whether certain T-cell molecular mismatches (TcEMM) were highly predictive of death-censored graft failure (DCGF). Methods We studied a retrospective cohort of kidney donor:recipient pairs from the Scientific Registry of Transplant Recipients (2000-2015). Allele level HLA-A, B, C, DRB1 and DQB1 types were imputed from serologic types using the NMDP algorithm. TcEMMs were then estimated using the PIRCHE-II algorithm. Multivariable Accelerated Failure Time (AFT) models assessed the association between each TcEMM and DCGF. To discriminate between TcEMMs most predictive of DCGF, we fit multivariable Lasso penalized regression models. We identified co-expressed TcEMMs using weighted correlation network analysis (WGCNA). Finally, we conducted sensitivity analyses to address PIRCHE and IMGT/HLA version updates. Results A total of 118,309 donor:recipient pairs meeting the eligibility criteria were studied. When applying the PIRCHE-II algorithm, we identified 1,935 distinct TcEMMs at the population level. A total of 218 of the observed TcEMM were independently associated with DCGF by AFT models. The Lasso penalized regression model with post selection inference identified a smaller subset of 86 TcEMMs (56 and 30 TcEMM derived from HLA Class I and II, respectively) to be highly predictive of DCGF. Of the observed TcEMM, 38.14% appeared as profiles of highly co-expressed TcEMMs. In addition, sensitivity analyses identified that the selected TcEMM were congruent across IMGT/HLA versions. Conclusion In this study, we identified subsets of TcEMMs highly predictive of DCGF and profiles of co-expressed mismatches. Experimental verification of these TcEMMs determining immune responses and how they may interact with EMM as predictors of transplant outcomes would justify their consideration in organ allocation schemes and for modifying immunosuppression regimens.
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Affiliation(s)
- William Lemieux
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of McGill University Health Centre, Montréal, QC, Canada,Medical Affairs & Innovation, Héma-Québec, Montréal, QC, Canada
| | - David Fleischer
- Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| | - Archer Yi Yang
- Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| | | | - Karim Oualkacha
- Department of Mathematics, Université du Québec à Montreal, Montreal, QC, Canada
| | - William Klement
- Division of Organ Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Lucie Richard
- Transfusion medicine/Reference Laboratory, Héma-Québec, Montréal, QC, Canada
| | - Constantin Polychronakos
- Department of Pediatrics, The Research Institute of the McGill University Health Centre and the Montreal Children’s Hospital, Montréal, QC, Canada
| | - Robert Liwski
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Frans Claas
- Department of Immunology, Leiden University Medical Centre, Leiden, Netherlands
| | - Howard M. Gebel
- Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
| | - Paul A. Keown
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Antoine Lewin
- Medical Affairs & Innovation, Héma-Québec, Montréal, QC, Canada,Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of McGill University Health Centre, Montréal, QC, Canada,Division of Nephrology and the Multi-Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada,*Correspondence: Ruth Sapir-Pichhadze,
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Lemieux W, Richard L, Fournier D, Joron S, Sapir-Pichhadze R, Lewin A. Abstract 28 Comparative Analysis of the Cord Blood Bank in Quebec. Stem Cells Transl Med 2022. [PMCID: PMC9446901 DOI: 10.1093/stcltm/szac057.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction In the context of the regional diversity observed in the population of Quebec, the Héma-Québec Cord Blood Bank (HQ CBB) representation differs from that of the Héma-Québec Stem Cell Registry (HQ Registry). The Bank encourages registrants of non-European descent to promote diversity, and only collects from health centers around Montreal and Quebec cities because of proximity concerns. Objective In this study, we aimed to analyze allele frequencies in the HQ CBB to assess similarities and differences in reference to the HQ Registry. Methods The HQ Registry was previously typed using high-resolution genotyping. For the HQ CBB, ambiguous two-field HLA-A, -B, -C, and -DRB1 typing data were obtained from cord blood units. Statistical analyses were performed using the GENE[RATE] population analysis tools to estimate allele and haplotype frequencies by administrative region determined by registered postal codes. Hardy-Weinberg equilibrium was verified by the nested likelihood procedure. Finally, genetic distance was compared between the HQ Registry and the HQ CBB by region using Non-metric Multi-dimensional Scaling (NMDS). Results Because of the small sample size in certain regions, HLA frequency was analyzed for 7 of the 17 regions within the HQ CBB with typings from 11,472 cord blood units. The HLA allele frequencies were previously assessed for the Registry, with 3,806 donors originating from 14 administrative regions. The Hardy-Weinberg equilibrium was rejected at least in relation to one locus in 3 regions (Capitale-Nationale, Montreal, and Laval), which differs from the results obtained from the Registry, in which the equilibrium was rejected only for Montreal. As in the Registry, allele frequencies in the HQ CBB varied by region but had limited overlap with the HQ Registry. Two regions (Chaudière-Appalaches and Laval) demonstrated significant differences in allele frequencies as represented in the HQ Registry versus the HQ CBB. Discussion We observed differences in the Quebec population representation between the HQ CBB and the HQ Registry. This probably represents selection bias related to recruitment strategies and inclusion criteria. Importantly, the complementarity of these two stem cell sources could allow for a more diverse donor pool, and this understanding could also guide the recruitment strategies.
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Affiliation(s)
- William Lemieux
- Héma-Québec , Québec , Canada
- Research Institute of McGill University Health Centre , Montreal, Québec , Canada
| | | | | | | | - Ruth Sapir-Pichhadze
- Research Institute of McGill University Health Centre , Montreal, Québec , Canada
- McGill University Health Centre , Montreal, Québec , Canada
- McGill University , Montreal, Québec , Canada
| | - Antoine Lewin
- Héma-Québec , Québec , Canada
- Université de Sherbrooke , Québec , Canada
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Lim WH, Ho J, Kosmoliaptsis V, Sapir-Pichhadze R. Editorial: Future challenges and directions in determining allo-immunity in kidney transplantation. Front Immunol 2022; 13:1013711. [PMID: 36119031 PMCID: PMC9473680 DOI: 10.3389/fimmu.2022.1013711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Wai H. Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
- *Correspondence: Wai H. Lim,
| | - Julie Ho
- Department of Internal Medicine University of Manitoba, Winnipeg, MB, Canada
- Department of Immunology, University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba Adult Kidney Program, Transplant Manitoba, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Vasilis Kosmoliaptsis
- Department of Surgery, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge, United Kingdom
- Blood and Transplant Research Unit in Organ Donation and Transplantation, National Institute for Health Research, University of Cambridge, Cambridge, United Kingdom
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Division of Nephrology and Multi-Organ Transplant Program, Department of Medicine, McGill University, Montreal, QC, Canada
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Hall VG, Solera JT, Al-Alahmadi G, Marinelli T, Cardinal H, Poirier C, Huard G, Prasad GVR, De Serres SA, Isaac D, Mainra R, Lamarche C, Sapir-Pichhadze R, Gilmour S, Humar A, Kumar D. Severity of COVID-19 among solid organ transplant recipients in Canada, 2020–2021: a prospective, multicentre cohort study. CMAJ 2022; 194:E1155-E1163. [PMID: 36302101 PMCID: PMC9435532 DOI: 10.1503/cmaj.220620] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 11/04/2022] Open
Abstract
Background: Severe COVID-19 appears to disproportionately affect people who are immunocompromised, although Canadian data in this context are limited. We sought to determine factors associated with severe COVID-19 outcomes among recipients of organ transplants across Canada. Methods: We performed a multicentre, prospective cohort study of all recipients of solid organ transplants from 9 transplant programs in Canada who received a diagnosis of COVID-19 from March 2020 to November 2021. Data were analyzed to determine risk factors for oxygen requirement and other metrics of disease severity. We compared outcomes by organ transplant type and examined changes in outcomes over time. We performed a multivariable analysis to determine variables associated with need for supplemental oxygen. Results: A total of 509 patients with solid organ transplants had confirmed COVID-19 during the study period. Risk factors associated with needing (n = 190), compared with not needing (n = 319), supplemental oxygen included age (median 62.6 yr, interquartile range [IQR] 52.5–69.5 yr v. median 55.5 yr, IQR 47.5–66.5; p < 0.001) and number of comorbidities (median 3, IQR 2–3 v. median 2, IQR 1–3; p < 0.001), as well as parameters associated with immunosuppression. Recipients of lung transplants (n = 48) were more likely to have severe disease with a high mortality rate (n = 15, 31.3%) compared with recipients of other organ transplants, including kidney (n = 48, 14.8%), heart (n = 1, 4.4%), liver (n = 9, 11.4%) and kidney–pancreas (n = 3, 12.0%) transplants (p = 0.02). Protective factors against needing supplemental oxygen included having had a liver transplant and receiving azathioprine. Having had 2 doses of SARS-CoV-2 vaccine did not have an appreciable influence on oxygen requirement. Multivariable analysis showed that older age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02–1.07) and number of comorbidities (OR 1.63, 95% CI 1.30–2.04), among other factors, were associated with the need for supplemental oxygen. Over time, disease severity did not decline significantly. Interpretation: Despite therapeutic advances and vaccination of recipients of solid organ transplants, evidence of increased severity of COVID-19, in particular among those with lung transplants, supports ongoing public health measures to protect these at-risk people, and early use of COVID-19 therapies for recipients of solid organ transplants.
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Affiliation(s)
- Victoria G Hall
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Javier T Solera
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Ghadeer Al-Alahmadi
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Tina Marinelli
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Heloise Cardinal
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Charles Poirier
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Geneviève Huard
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - G V Ramesh Prasad
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Sacha A De Serres
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Debra Isaac
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Rahul Mainra
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Caroline Lamarche
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Ruth Sapir-Pichhadze
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Susan Gilmour
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Atul Humar
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Deepali Kumar
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta.
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Hall VG, Al-Alahmadi G, Solera JT, Marinelli T, Cardinal H, Prasad GVR, De Serres SA, Isaac D, Mainra R, Lamarche C, Sapir-Pichhadze R, Gilmour S, Matelski J, Humar A, Kumar D. Outcomes of SARS-CoV-2 Infection in Unvaccinated Compared With Vaccinated Solid Organ Transplant Recipients: A Propensity Matched Cohort Study. Transplantation 2022; 106:1622-1628. [PMID: 35502801 PMCID: PMC9311277 DOI: 10.1097/tp.0000000000004178] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/17/2022] [Accepted: 04/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Solid organ transplant (SOT) recipients are at high risk for complications from coronavirus disease 2019 (COVID-19). Vaccination may mitigate this risk; however, immunogenicity appears to be significantly impaired, with reports of increased risk of breakthrough infection. It is unknown if vaccine breakthrough infections are milder or as severe as infections in unvaccinated patients. METHODS We performed a multicenter matched cohort study between March 2020 and September 2021 to assess influence of COVID-19 vaccination on outcomes of COVID-19 infection. Treatment characteristics and disease severity outcomes were compared on the basis of vaccine status; breakthrough infections versus unvaccinated infections. Variable ratio propensity score matching based on age, sex, transplant type, and number of comorbidities, was used to develop the analytic cohort. Logistic regression was used to assess the influence of vaccination status on the selected outcomes. RESULTS From a cohort of 511 SOT patients with COVID-19, we matched 77 partially or fully vaccinated patients with 220 unvaccinated patients. Treatment characteristics including use of dexamethasone, remdesivir, and antibiotics did not differ. Vaccinated participants were more likely to receive tocilizumab, 15 of 77 (19.5%) versus 5 of 220 (2.3%), P < 0.001. Disease severity outcomes including oxygen requirement, mechanical ventilation, and mortality were similar among medically attended vaccine breakthroughs compared with unvaccinated patients. CONCLUSIONS SOT recipients who develop medically attended COVID-19 following 1- or 2-dose vaccination seem to have similar disease severity to unvaccinated patients who develop infection. This is consistent with the requirement that SOT recipients need 3 or more vaccine doses and emphasizes the importance of alternate strategies for this population.
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Affiliation(s)
- Victoria G. Hall
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Ghadeer Al-Alahmadi
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Javier T. Solera
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Tina Marinelli
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Heloise Cardinal
- Department of Medicine, University of Montreal, Montreal, QC, Canada
| | - G. V. Ramesh Prasad
- Kidney Transplant Program, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Sacha A. De Serres
- Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Debra Isaac
- Division of Transplant Medicine, University of Calgary, Calgary, AB, Canada
| | - Rahul Mainra
- Saskatchewan Transplant Program, Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Saskatchewan, Saskatoon, SK, Canada
| | - Caroline Lamarche
- Hôpital Maisonneuve-Rosemont Research Institute, Université de Montréal, Montréal, QC, Canada
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Division of Nephrology, Department of Medicine, McGill University, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montreal, QC, Canada
| | - Susan Gilmour
- Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Atul Humar
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Deepali Kumar
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
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28
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Cozzi E, Álvarez M, Carmona M, Mahíllo B, Forsythe J, Lomero M, López-Fraga M, Sapir-Pichhadze R, Cardillo M, Domínguez-Gil B. An Analysis by the European Committee on Organ Transplantation of the Council of Europe Outlining the International Landscape of Donors and Recipients Sex in Solid Organ Transplantation. Transpl Int 2022; 35:10322. [PMID: 35928348 PMCID: PMC9343585 DOI: 10.3389/ti.2022.10322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/06/2022] [Indexed: 11/23/2022]
Abstract
Discrepancies in donation and transplantation by sex and gender have previously been reported. However, whether such differences are invariably the inevitable, unintended outcome of a legitimate process has yet to be determined. The European Committee on Organ Transplantation of the Council of Europe (CD-P-TO) is the committee that actively promotes the development of ethical, quality and safety standards in the field of transplantation in Europe. Whilst the ultimate objective is to shed light on the processes underlying potential gender inequities in transplantation, our initial goal was to represent the distribution by sex among organ donors and recipients in the CD-P-TO Member States and observer countries. Our survey confirms previous evidence that, in most countries, men represent the prevalent source of deceased donors (63.3% in 64 countries: 60.7% and 71.9% for donation after brain and circulatory death, respectively). In contrast, women represent the leading source of organs recovered from living kidney and liver donors (61.1% and 51.2% in 55 and 32 countries, respectively). Across countries, most recovered organs are transplanted into men (65% in 57 countries). These observations may be explained, at least in part, by the higher burden of certain diseases in men, childbearing related immune sensitization in women, and donor-recipient size mismatch. Future research should establish whether gender-related socially-constructed roles and socioeconomic status may play a detrimental role reducing the access of women to transplantation.
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Affiliation(s)
- Emanuele Cozzi
- Centro Nazionale Trapianti-Istituto Superiore di Sanità (CNT-ISS), Rome, Italy
- Department of Cardiac, Thoracic and Vascular Sciences, Transplant Immunology Unit, Padua University Hospital, University of Padua, Padua, Italy
- *Correspondence: Emanuele Cozzi,
| | - Marina Álvarez
- Organizacion Nacional de Trasplantes (ONT), Madrid, Spain
| | - Mar Carmona
- Organizacion Nacional de Trasplantes (ONT), Madrid, Spain
| | | | - John Forsythe
- NHS Blood and Transplant (NHSBT), Bristol, United Kingdom
| | - Mar Lomero
- European Directorate for the Quality of Medicines & HealthCare (EDQM), Council of Europe, Strasbourg, France
| | - Marta López-Fraga
- European Directorate for the Quality of Medicines & HealthCare (EDQM), Council of Europe, Strasbourg, France
| | - Ruth Sapir-Pichhadze
- Division of Nephrology and Multi-Organ Transplant Program, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Massimo Cardillo
- Centro Nazionale Trapianti-Istituto Superiore di Sanità (CNT-ISS), Rome, Italy
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Vinson AJ, Zhang X, Dahhou M, Süsal C, Döhler B, Sapir-Pichhadze R, Cardinal H, Melk A, Wong G, Francis A, Pilmore H, Foster BJ. Age-dependent Sex Differences in Graft Loss After Kidney Transplantation. Transplantation 2022; 106:1473-1484. [PMID: 34974454 DOI: 10.1097/tp.0000000000004026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sex differences in kidney graft loss rates were reported in the United States. Whether these differences are present in other countries is unknown. METHODS We estimated the association between recipient sex and death-censored graft loss in patients of all ages recorded in the Scientific Registry of Transplant Recipients, Australia and New Zealand Dialysis and Transplant Registry, and Collaborative Transplant Study registries who received a first deceased donor kidney transplant (1988-2019). We used multivariable Cox regression models, accounting for the modifying effects of donor sex and recipient age, in each registry separately; results were combined using individual patient data meta-analysis. RESULTS We analyzed 438 585 patients. Young female patients 13-24 y old had the highest crude graft loss rates (female donor: 5.66; male donor: 5.50 per 100 person-years). Among young recipients of male donors, females showed higher graft loss risks than males (0-12 y: adjusted hazard ratio [aHR] 1.42, (95% confidence interval [CI], 1.17-1.73); 13-24 y: 1.24 (1.17-1.32); 25-44 y: 1.09 (1.06-1.13)). When the donor was female, there were no significant differences by recipient sex among those of age <45 y; however, the aHR for females was 0.93 (0.89-0.98) in 45-59 y-old and 0.89 (0.86-0.93) in ≥ 60 y-old recipients. Findings were similar for all 3 registries in most age intervals; statistically significant heterogeneity was seen only among 13-24-y-old recipients of a female donor (I2 = 71.5%, P = 0.03). CONCLUSIONS There is an association between recipient sex and kidney transplantation survival that is modified by recipient age and donor sex.
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Affiliation(s)
- Amanda J Vinson
- Nephrology Division, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Xun Zhang
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Mourad Dahhou
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Caner Süsal
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Bernd Döhler
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ruth Sapir-Pichhadze
- Department of Medicine, Division of Experimental Medicine, McGill University, QC, Canada
| | - Heloise Cardinal
- Department of Medicine, Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Anette Melk
- Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Anna Francis
- School of Clinical Medicine, University of Queensland, QLD, Australia
- Department of Nephrology, Queensland Children's Hospital, Brisbane, Australia
| | - Helen Pilmore
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Bethany J Foster
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Department of Pediatrics, Division of Nephrology, McGill University Faculty of Medicine, QC, Canada
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Getchell LE, Fowler E, Reich M, Allu S, Boucher C, Burns K, Desjarlais A, L’Esperance A, Elliott M, Robinson-Settee H, Chiu HHL, Rosenblum ND, Settee C, Murdoch A, Dew S, Green A, Franson L, Bernstein E, Sparkes D, Turner C, Fernandez N, Sapir-Pichhadze R. Program Report: Can-SOLVE CKD Network Presents an Inclusive Method for Developing Patient-Oriented Research Tools. Can J Kidney Health Dis 2022; 9:20543581221074566. [PMID: 35173970 PMCID: PMC8842461 DOI: 10.1177/20543581221074566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/09/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose of program: Given the growing interest in patient-oriented research (POR) initiatives, there is a need to provide relevant training and education on how to engage with patients as partners on research teams. Sources of information: As part of its mandate to develop appropriate training materials, the patient-oriented renal research network, Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD), established a training and Mentorship Committee (TMC). Methods: The committee brings together a unique combination of Indigenous and non-Indigenous patient partners (including caregivers, family members, and living donors), researchers, as well as patient engagement and knowledge translation experts, combining a multitude of perspectives and expertise. Following an assessment of training needs within the network, the TMC undertook the co-development of 5 learning modules to address the identified gaps. Subsequently, the committee divided into working groups tasked with developing content using a consultive and iterative approach informed by the DoTTI framework for building web-based tools for patients. In addition, the TMC embodied the guiding principles of inclusiveness, support, mutual respect, and co-building as set out by the Patient Engagement Framework through the Strategy for Patient-Oriented Research (SPOR) of the Canadian Institutes of Health Research. Key findings: The 5 new modules include: A Patient Engagement Toolkit, Storytelling for Impact, Promoting Kidney Research in Canada (KidneyPRO), Wabishki Bizhiko Skaanj Learning Pathway, and Knowledge Translation. The TMC’s approach to developing these modules demonstrates how a diverse group of stakeholders working together can create tools to support high-quality POR. This also provides a roadmap for other health research entities interested in developing similar tools within their unique domains. Limitations: The landscape of patient engagement in research is constantly evolving. This underscores the need for sustained resources to keep POR tools and training relevant and up-to-date. Sustaining such resources may not be feasible for all research entities. Implications: Collaborative approaches integrating patients in the development of POR tools ensure the content is relevant and meaningful to patients. Broader adoption of such approaches has great potential to address existing gaps and enhance the Canadian POR landscape.
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Affiliation(s)
| | | | | | - Selina Allu
- Can-SOLVE CKD Network, Vancouver, BC, Canada
- University of Calgary, Medicine, AB, Canada
| | | | - Kevin Burns
- Can-SOLVE CKD Network, Vancouver, BC, Canada
- Department of Nephrology, The Ottawa Hospital, ON, Canada
| | | | - Audrey L’Esperance
- Can-SOLVE CKD Network, Vancouver, BC, Canada
- Centre of Excellence on Partnership With Patients and the Public, Quebec, QC, Canada
| | - Meghan Elliott
- Can-SOLVE CKD Network, Vancouver, BC, Canada
- University of Calgary, Medicine, AB, Canada
| | | | - Helen Hoi-Lun Chiu
- Can-SOLVE CKD Network, Vancouver, BC, Canada
- BC Renal, Vancouver, BC, Canada
| | - Norman D. Rosenblum
- Can-SOLVE CKD Network, Vancouver, BC, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Simone Dew
- Can-SOLVE CKD Network, Vancouver, BC, Canada
| | | | | | | | | | | | - Nicolas Fernandez
- Can-SOLVE CKD Network, Vancouver, BC, Canada
- Department of Family Medicine and Emergency Medicine, Université de Montréal, QC, Canada
| | - Ruth Sapir-Pichhadze
- Can-SOLVE CKD Network, Vancouver, BC, Canada
- Division of Nephrology and Multiorgan Transplant Program, Department of Medicine, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
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31
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Dziarmaga R, Ke D, Sapir-Pichhadze R, Cardinal H, Phan V, Piccirillo CA, Mazer B, Foster BJ. Age- and sex-mediated differences in T lymphocyte populations of kidney transplant recipients. Pediatr Transplant 2022; 26:e14150. [PMID: 34569133 DOI: 10.1111/petr.14150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Graft failure rates increase through childhood and adolescence, decline in adulthood, and are higher in female than male kidney transplant recipients (KTR) until middle age. We aimed to describe age- and sex-related differences in T-cell subsets among KTR to determine which differences may help to explain the differences in kidney graft failure rates. METHODS Effector T (Teff)-cell and regulatory T (Treg)-cell phenotypes in PBMCs from healthy controls and KTR, who were at least 1 year post-transplant with stable graft function under immunosuppression, were analyzed by flow cytometry. The effects of age, sex, and status (KTR or control) were analyzed using linear regressions. RESULTS We enrolled 20 male and 21 female KTR and 20 male and 20 female controls between 3 and 29 years of age. CD3+ T-cell frequencies were not associated with age or sex but were higher in KTR than controls. There were no differences in CD4+ and CD8+ frequencies. Th1 (IFNγ+ IL-4- IL-17A-) and Th17 (IL-17A+) frequencies within the CD4+ T-cell population were higher at older ages. The frequencies of FOXP3 + Helios + Treg cells in CD4+ CD25+ CD127- T cells were lower in females than males and in KTR than controls. CONCLUSIONS Increasing frequencies of Th1 and Th17 cells with increasing age mirrors the increasing graft failure rates from childhood to young adulthood. Importantly, sex differences in frequencies of circulating Treg cells may suggest a role in the sex differences in graft failure rates.
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Affiliation(s)
- Robert Dziarmaga
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Danbing Ke
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Ruth Sapir-Pichhadze
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Division of Nephrology and Multi-Organ Transplant Program, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Héloïse Cardinal
- Département de Médecine, Université de Montréal, Montreal, Quebec, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Véronique Phan
- Département de Pédiatrie, Université de Montréal, Montreal, Quebec, Canada.,Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Ciriaco A Piccirillo
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Bruce Mazer
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.,Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Bethany J Foster
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Department of Pediatrics, McGill University, Montreal, Quebec, Canada
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Foster BJ, Cardinal H, Sapir-Pichhadze R. Caution when using publicly available datasets. Am J Transplant 2022; 22:662-663. [PMID: 34390175 DOI: 10.1111/ajt.16799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Bethany J Foster
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Pediatrics, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Heloise Cardinal
- Département de Médecine, Université de Montréal, Montreal, Quebec, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Ruth Sapir-Pichhadze
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
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Sherwood K, Tran J, Günther O, Lan J, Aiyegbusi O, Liwski R, Sapir-Pichhadze R, Bryan S, Caulfield T, Keown P. Genome Canada precision medicine strategy for structured national implementation of epitope matching in renal transplantation. Hum Immunol 2022; 83:264-269. [DOI: 10.1016/j.humimm.2022.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/12/2021] [Accepted: 01/05/2022] [Indexed: 02/08/2023]
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Dabirzadeh A, Dahhou M, Zhang X, Sapir-Pichhadze R, Cardinal H, White M, Johnston O, Blydt-Hansen TD, Tibbles LA, Hamiwka L, Urschel S, Birk P, Bissonnette J, Matsuda-Abedini M, Harrison J, Schiff J, Phan V, De Geest S, Allen U, Mital S, Foster BJ. Care processes and structures associated with higher medication adherence in adolescent and young adult transplant recipients. Pediatr Transplant 2021; 25:e14106. [PMID: 34339090 DOI: 10.1111/petr.14106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aimed to identify care processes and structures that were independently associated with higher medication adherence among young transplant recipients. METHODS We conducted a prospective, observational cohort study of 270 prevalent kidney, liver, and heart transplant recipients 14-25 years old. Patients were ≥3 months post-transplant, ≥2 months post-discharge, and followed in one of 14 pediatric or 14 adult transplant programs in Canada. Patients were enrolled between June 2015 and March 2018 and followed for 6 months. Adherence was assessed at baseline, 3, and 6 months using the BAASIS© self-report tool. Patients were classified as adherent if no doses were missed in the prior 4 weeks. Transplant program directors and nurses completed questionnaires regarding care organization and processes. RESULTS Of the 270 participants, 99 were followed in pediatric programs and 171 in adult programs. Median age was 20.3 years, and median time since transplant was 5 years. At baseline, 71.5% were adherent. Multivariable mixed effects logistic regression models with program as a random effect identified two program-level factors as independently associated with better adherence: minimum number of prescribed blood draws per year for those >3 years post-transplant (per 1 additional) (OR 1.12 [95% CI 1.00, 1.26]; p = .047), and average time nurses spend with patients in clinic (per 5 additional minutes) (OR 1.15 [1.03, 1.29]; p = .017). CONCLUSION Program-level factors including protocols with a greater frequency of routine blood testing and more nurse time with patients were associated with better medication adherence. This suggests that interventions at the program level may support better adherence.
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Affiliation(s)
| | - Mourad Dahhou
- Research Institute of The McGill University Health Centre, Montreal, QC, Canada
| | - Xun Zhang
- Research Institute of The McGill University Health Centre, Montreal, QC, Canada
| | - Ruth Sapir-Pichhadze
- Research Institute of The McGill University Health Centre, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Heloise Cardinal
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Michel White
- Institut de Cardiologie, Université de Montréal, Montreal, QC, Canada
| | - Olwyn Johnston
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Lee Anne Tibbles
- Department of Medicine and Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lorraine Hamiwka
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Simon Urschel
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Patricia Birk
- Section of Pediatric Nephrology, University of Manitoba, Winnipeg, MB, Canada
| | | | - Mina Matsuda-Abedini
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, ON, Canada
| | - Jennifer Harrison
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Multi-Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - Jeffrey Schiff
- Multi-Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - Veronique Phan
- CHU Ste-Justine, Université de Montréal, Montréal, QC, Canada
| | - Sabina De Geest
- Department Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Academic Center of Nursing and Midwifery, Department of Primary Care and Public Health, KU Leuven, Leuven, Belgium
| | - Upton Allen
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, ON, Canada
| | - Seema Mital
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, ON, Canada
| | - Bethany J Foster
- Research Institute of The McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Pediatrics, McGill University, Montreal, QC, Canada
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Zahran S, Bourdiec A, Zhang X, Sapir-Pichhadze R. Not all eplet mismatches are created equal - A cohort study illustrating implications to long-term graft outcomes. Hum Immunol 2021; 83:225-232. [PMID: 34844785 DOI: 10.1016/j.humimm.2021.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/29/2021] [Accepted: 11/16/2021] [Indexed: 01/09/2023]
Abstract
We assessed implications of various eplet-compatibility strategies to death-censored graft failure (DCGF), defined as return to dialysis or re-transplantation, in a base-case scenario from the Scientific Registry of Transplant Recipients. To inform personalized care, we evaluated how recipient, donor, and transplant characteristics affect DCGF by ascending categories of eplet mismatches (EMM), and derived adjusted hazard ratios (HR). The base-case analysis demonstrated 15-year estimated survival probabilities of 77.1%, 75.4%, 73.6%, 72.2%, 74.9%, and 73.5% for the lowest EMM categories (complete epitype: 0-19, antibody-verified (AbVer) epitype and class II eplets: 0-9, class II AbVer eplets: 0-4, 55 high-risk eplets associated with DCGF: 0-3, and subset of 15 high-risk eplets validated in an independent subcohort: 0 EMM, respectively). Beyond the lowest EMM categories, the Epi15 strategy allowed better differentiation of change in DCGF risk per EMM, with additional 5.2%, 3.9% and 4.1% decrease in estimated graft survival for each additional EMM (1, 2, and ≥ 3, respectively). Recipients < 25 years, donors > 55 years, and immunosuppression regimens excluding calcineurin inhibitors and steroids, demonstrated higher HR for DCGF. High-risk EMM allowed better differentiation between DCGF probabilities per EMM, suggesting that recipients at higher risk for graft failure could benefit most from allocation schemes ensuring compatibility on these eplets.
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Affiliation(s)
- Somaya Zahran
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Amelie Bourdiec
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Canada; Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montreal, Quebec, Canada.
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Vinson AJ, Chong AS, Clegg D, Falk C, Foster BJ, Halpin A, Mannon RB, Oertelt-Prigione S, Palmer BF, Sapir-Pichhadze R, West LJ, Wong G. Incorporation of Sex and Gender Guidelines Into Transplantation Literature. Transplantation 2021; 105:e261-e262. [PMID: 34593746 DOI: 10.1097/tp.0000000000003967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Amanda J Vinson
- Division of Nephrology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Anita S Chong
- Department of Surgery, University of Chicago, Chicago, IL
| | - Deborah Clegg
- Department of Medicine, College of Nursing and Health Professionals, Drexel University, Philadelphia, PA
| | - Christine Falk
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | - Bethany J Foster
- Department of Pediatrics, Montreal Children's Hospital of the McGill University Health Centre, Montreal, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Anne Halpin
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Department of Pediatrics and Laboratory Medicine, University of Alberta, Edmonton, AB, Canada
- Alberta Precision Laboratories, Edmonton, AB, Canada
- Alberta Transplant Institute, Edmonton, AB, Canada
| | - Roslyn B Mannon
- Department of Medicine and Nephrology, University of Nebraska Medical Center, Omaha, NE
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
| | - Biff F Palmer
- Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
| | - Ruth Sapir-Pichhadze
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Division of Nephrology, Department of Medicine, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Lori J West
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Alberta Transplant Institute, Edmonton, AB, Canada
- Department of Pediatrics and Surgery, University of Alberta, Edmonton, AB, Canada
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Germaine Wong
- Division of Nephrology, Department of Medicine, School of Public Health, University of Sydney, Sydney, NSW, Australia
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Weiss MJ, Hornby L, Foroutan F, Belga S, Bernier S, Bhat M, Buchan CA, Gagnon M, Hardman G, Ibrahim M, Luo C, Luong ML, Mainra R, Manara AR, Sapir-Pichhadze R, Shalhoub S, Shaver T, Singh JM, Srinathan S, Thomas I, Wilson LC, Wilson TM, Wright A, Mah A. Clinical Practice Guideline for Solid Organ Donation and Transplantation During the COVID-19 Pandemic. Transplant Direct 2021; 7:e755. [PMID: 34514110 PMCID: PMC8425831 DOI: 10.1097/txd.0000000000001199] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 12/15/2022] Open
Abstract
The coronavirus 2019 (COVID-19) pandemic has disrupted health systems worldwide, including solid organ donation and transplantation programs. Guidance on how best to screen patients who are potential organ donors to minimize the risks of COVID-19 as well as how best to manage immunosuppression and reduce the risk of COVID-19 and manage infection in solid organ transplant recipients (SOTr) is needed. METHODS Iterative literature searches were conducted, the last being January 2021, by a team of 3 information specialists. Stakeholders representing key groups undertook the systematic reviews and generation of recommendations using a rapid response approach that respected the Appraisal of Guidelines for Research and Evaluation II and Grading of Recommendations, Assessment, Development and Evaluations frameworks. RESULTS The systematic reviews addressed multiple questions of interest. In this guidance document, we make 4 strong recommendations, 7 weak recommendations, 3 good practice statements, and 3 statements of "no recommendation." CONCLUSIONS SOTr and patients on the waitlist are populations of interest in the COVID-19 pandemic. Currently, there is a paucity of high-quality evidence to guide decisions around deceased donation assessments and the management of SOTr and waitlist patients. Inclusion of these populations in clinical trials of therapeutic interventions, including vaccine candidates, is essential to guide best practices.
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Affiliation(s)
- Matthew J Weiss
- Transplant Québec, Montréal, QC, Canada
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, QC, Canada
- Canadian Donation and Transplantation Research Program (CDTRP), Ottawa, ON, Canada
| | - Laura Hornby
- Canadian Donation and Transplantation Research Program (CDTRP), Ottawa, ON, Canada
- System Development - Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Farid Foroutan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, Toronto, ON, Canada
| | - Sara Belga
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Mamatha Bhat
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Multiorgan Transplant Program, University Health Network, University of Toronto, Toronto, ON, Canada
| | - C Arianne Buchan
- Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michael Gagnon
- Division of Nephrology and Multi-Organ Transplant Program, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Gillian Hardman
- National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Maria Ibrahim
- National Health Service Blood and Transplant, Bristol, United Kingdom
- Kings College, London, United Kingdom
| | - Cindy Luo
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Me-Linh Luong
- Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montréal, QC, Canada
| | - Rahul Mainra
- Division of Nephrology, University of Saskatchewan, Saskatoon, SK, Canada
- St. Paul's Hospital, Saskatchewan Transplant Program, Saskatoon, SK, Canada
| | - Alex R Manara
- National Health Service Blood and Transplant, Bristol, United Kingdom
- Department of Intensive Care Medicine, Southmead Hospital, Bristol, United Kingdom
| | - Ruth Sapir-Pichhadze
- Division of Nephrology and Multi-Organ Transplant Program, Department of Medicine, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Sarah Shalhoub
- Division of Infectious Diseases, Department of Medicine, Western University, London, ON, Canada
| | - Tina Shaver
- Southern Alberta Organ and Tissue Donation Program, Calgary, AB, Canada
| | - Jeffrey M Singh
- Department of Medicine, University of Toronto, Toronto, Ontario, ON, Canada
- Trillium Gift of Life Network, Toronto, ON, Canada
| | - Sujitha Srinathan
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ian Thomas
- National Health Service Blood and Transplant, Bristol, United Kingdom
- Department of Intensive Care Medicine, Southmead Hospital, Bristol, United Kingdom
| | - Lindsay C Wilson
- System Development - Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - T Murray Wilson
- Transplant Research Foundation of British Columbia, Vancouver, BC, Canada
- Patient Partner, Canadian Donation and Transplantation Research Program
- The Alberta ORGANization Group, Edmonton, AB, Canada
| | - Alissa Wright
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Allison Mah
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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38
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Yanev I, Gagnon M, Cheng MP, Paraskevas S, Kumar D, Dragomir A, Sapir-Pichhadze R. Kidney Transplantation in Times of Covid-19: Decision Analysis in the Canadian Context. Can J Kidney Health Dis 2021; 8:20543581211040332. [PMID: 34540237 PMCID: PMC8447095 DOI: 10.1177/20543581211040332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/26/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic impacted transplant programs across Canada. OBJECTIVE We evaluated the implications of delays in transplantation among Canadian end-stage kidney disease (ESKD) patients to allow pretransplant vaccination. DESIGN We used a Markov microsimulation model and ESKD patient perspective to study the effectiveness (quality-adjusted life years [QALY]) of living (LD) or deceased donor (DD) kidney transplantation followed by 2-dose SARS-CoV-2 vaccine versus delay in LD ("Delay LD") or refusal of DD offer ("Delay DD") to receive 2-dose SARS-CoV-2 vaccine pretransplant. SETTING Canadian dialysis and transplant centers. PATIENTS We simulated a 10 000-waitlisted ESKD patient cohort, which was predictively modeled for a lifetime horizon in monthly cycles. MEASUREMENTS Inputs on patient and graft survival estimates by patient, LD or DD characteristics, were extracted from the Treatment of End-Stage Organ Failure in Canada, Canadian Organ Replacement Register, 2009 to 2018. In addition, a literature review provided inputs on quality of life, SARS-CoV-2 transmissibility, new variants of concern, mortality risk, and antibody responses to 2-dose SARS-CoV-2 mRNA vaccines. METHODS We conducted base case, scenario, and sensitivity analyses to illustrate the impact of patient, donor, vaccine, and pandemic characteristics on the preferred strategy. RESULTS In the average waitlisted Canadian patient, receiving 2-dose SARS-CoV-2 vaccine post-transplant provided an effectiveness of 22.32 (95% confidence interval: 22.00-22.7) for LD and 19.34 (19.02-19.67) QALYs for DD. Delaying transplants for 6 months to allow 2-dose SARS-CoV-2 vaccine before LD and DD transplant yielded effectiveness of 22.83 (21.51-23.14) and 20.65 (20.33-20.96) QALYs, respectively. Scenario analysis suggested a benefit to short delays in DD transplants to receive 2-dose SARS-CoV-2 vaccine in waitlisted patients ≥55 years. Two-way sensitivity analysis suggested decreased effectiveness of the strategy prioritizing 2-dose SARS-CoV-2 vaccine prior to DD transplant the longer the delay and the higher the Kidney Donor Risk Index of the eventual DD transplant. When assessing the impact of SARS-CoV-2 variants of concern (infection rates ≥10-fold and associated mortality ≥3-fold vs base case), we found short delays to allow 2-dose SARS-CoV-2 vaccine administration pretransplant to be preferable. LIMITATIONS Risks associated with nosocomial exposure of LDs were not considered. There was uncertainty regarding input parameters related to SARS-CoV-2 infection, new variants, and COVID-19 severity in ESKD patients. Given rollout of population-level SARS-CoV-2 vaccination, we assumed a linear decrease in infection rates over 1 year. Proportions of patients mounting an antibody response to 2-dose SARS-CoV-2 mRNA vaccines were considered in lieu of data on vaccine efficacy in dialysis and following transplantation. Non-age-stratified annual mortality rates were used for waitlisted candidates. CONCLUSIONS Our analyses suggest that short delays allowing pretransplant vaccination offered comparable to greater effectiveness than pursuing transplantation without delay, proposing transplant candidates should be prioritized to receive at least 2 doses of SARS-CoV-2 vaccine. Our scenario and sensitivity analyses suggest that caution must be exercised when declining DD offers in patients offered low risk DD and who are likely to incur significant delays in access to transplantation. While population-level herd immunity may decrease infection risk in transplant patients, more data are required on vaccine efficacy against SARS-CoV-2 and variants of concern in ESKD, and how efficacy may be modified by a third vaccine dose, maintenance immunosuppression and timing of induction and rejection therapies.
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Affiliation(s)
- Ivan Yanev
- Centre for Outcomes Research and
Evaluation, The Research Institute of the McGill University Health Centre, Montreal,
QC, Canada
| | - Michael Gagnon
- Division of Nephrology and Multi-Organ
Transplant Program, Department of Medicine, McGill University, Montreal, QC,
Canada
| | - Matthew P. Cheng
- Division of Infectious Diseases,
Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
- Division of Medical Microbiology,
Department of Laboratory and Pathology Medicine, McGill University Health Centre,
Montréal, QC, Canada
| | - Steven Paraskevas
- Division of General Surgery and
Multi-Organ Transplant Program, Department of Surgery, McGill University Health
Centre, Montréal, QC, Canada
| | - Deepali Kumar
- Transplant Infectious Diseases and
Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Alice Dragomir
- Centre for Outcomes Research and
Evaluation, The Research Institute of the McGill University Health Centre, Montreal,
QC, Canada
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and
Evaluation, The Research Institute of the McGill University Health Centre, Montreal,
QC, Canada
- Division of Nephrology and Multi-Organ
Transplant Program, Department of Medicine, McGill University, Montreal, QC,
Canada
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Gaussen A, Hornby L, Rockl G, O'Brien S, Delage G, Sapir-Pichhadze R, Drews SJ, Weiss MJ, Lewin A. Evidence of SARS-CoV-2 Infection in Cells, Tissues, and Organs and the Risk of Transmission Through Transplantation. Transplantation 2021; 105:1405-1422. [PMID: 33724248 DOI: 10.1097/tp.0000000000003744] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus responsible for the coronavirus disease 2019 (COVID-19) pandemic has raised concerns for programs overseeing donation and transplantation of cells, tissues, and organs (CTO) that this virus might be transmissible by transfusion or transplantation. Transplant recipients are considered particularly vulnerable to pathogens because of immunosuppression, and SARS-CoV-2 is likely to generate complications if contracted. Several signs and symptoms observed in COVID-19 positive patients reflect damage to multiple organs and tissues, raising the possibility of extrapulmonary SARS-CoV-2 infections and risk of transmission. At the beginning of the pandemic, a consensus has emerged not to consider COVID-19 positive patients as potential living or deceased donors, resulting in a global decrease in transplantation procedures. Medical decision-making at the time of organ allocation must consider safely alongside the survival advantages offered by transplantation. To address the risk of transmission by transplantation, this review summarizes the published cases of transplantation of cells or organs from donors infected with SARS-CoV-2 until January 2021 and assesses the current state of knowledge for the detection of this virus in different biologic specimens, cells, tissues, and organs. Evidence collected to date raises the possibility of SARS-CoV-2 infection and replication in some CTO, which makes it impossible to exclude transmission through transplantation. However, most studies focused on evaluating transmission under laboratory conditions with inconsistent findings, rendering the comparison of results difficult. Improved standardization of donors and CTO screening practices, along with a systematic follow-up of transplant recipients could facilitate the assessment of SARS-CoV-2 transmission risk by transplantation.
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Affiliation(s)
- Amaury Gaussen
- Medical Affairs and Innovation, Héma-Québec, Québec, QC, Canada
| | - Laura Hornby
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Canadian Blood Services, Ottawa, ON, Canada
| | - Gary Rockl
- Medical Affairs and Innovation, Héma-Québec, Québec, QC, Canada
| | | | - Gilles Delage
- Medical Affairs and Innovation, Héma-Québec, Saint-Laurent, QC, Canada
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of McGill University Health Centre, Montréal, QC, Canada
- Division of Nephrology and the Multi Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
| | - Steven J Drews
- Canadian Blood Services, Edmonton, AB, Canada
- Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Matthew J Weiss
- Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec, Université Laval Research Center, Québec, QC, Canada
- Pediatrics Department, Intensive Care Division, Faculté de Médecine, Université Laval, Québec, QC, Canada
- Transplant Québec, Montréal, QC, Canada
| | - Antoine Lewin
- Medical Affairs and Innovation, Héma-Québec, Saint-Laurent, QC, Canada
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
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40
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Schinstock CA, Askar M, Bagnasco SM, Batal I, Bow L, Budde K, Campbell P, Carroll R, Clahsen-van Groningen MC, Cooper M, Cornell LD, Cozzi E, Dadhania D, Diekmann F, Hesselink DA, Jackson AM, Kikic Z, Lower F, Naesens M, Roelofs JJ, Sapir-Pichhadze R, Kraus ES. A 2020 Banff Antibody-mediatedInjury Working Group examination of international practices for diagnosing antibody-mediated rejection in kidney transplantation - a cohort study. Transpl Int 2021; 34:488-498. [PMID: 33423340 DOI: 10.1111/tri.13813] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 11/24/2020] [Accepted: 01/02/2021] [Indexed: 12/24/2022]
Abstract
The Banff antibody-mediated rejection (ABMR) classification is vulnerable to misinterpretation, but the reasons are unclear. To better understand this vulnerability, we evaluated how ABMR is diagnosed in practice. To do this, the Banff Antibody-Mediated Injury Workgroup electronically surveyed an international cohort of nephrologists/surgeons (n = 133) and renal pathologists (n = 99). Most providers (97%) responded that they use the Banff ABMR classification at least sometimes, but DSA information is often not readily available. Only 41.1% (55/133) of nephrologists/surgeons and 19.2% (19/99) of pathologists reported that they always have DSA results when the biopsy is available. Additionally, only 19.6% (26/133) of nephrologists/surgeons responded that non-HLA antibody or molecular transcripts are obtained when ABMR histologic features are present but DSA is undetected. Several respondents agreed that histologic features concerning for ABMR in the absence of DSA and/or C4d are not well accounted for in the current classification [31.3% (31/99) pathologists and 37.6% (50/133) nephrologist/surgeons]. The Banff ABMR classification appears widely accepted, but efforts to improve the accessibility of DSA information for the multidisciplinary care team are needed. Further clarity is also needed in Banff ABMR nomenclature to account for the spectrum of ABMR and for histologic features suspicious for ABMR when DSA is absent.
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Affiliation(s)
- Carrie A Schinstock
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
| | - Medhat Askar
- Baylor University Medical Center, Dallas, TX, USA.,Texas A&M Health Science Center Collect of Medicine, Bryan, TX, USA
| | - Serena M Bagnasco
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ibrahim Batal
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Laurine Bow
- Department of Transplantation Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Klemens Budde
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Patricia Campbell
- Department of Medicine and Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada
| | - Robert Carroll
- Transplantation Immunogenetics Service, Australian Red Cross Blood Service Melbourne, Melbourne, Vic., Australia.,University of South Australia, Adelaide, SA, Australia
| | | | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Washington, DC, USA
| | - Lynn D Cornell
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Emanuele Cozzi
- Transplant Immunology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua University Hospital, Padua, Italy
| | - Darshana Dadhania
- Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, NY, USA
| | - Fritz Diekmann
- Kidney Transplant Unit, Institut d'Incestigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain
| | - Dennis A Hesselink
- Department of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Zeljko Kikic
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Fritz Lower
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY, USA
| | - Maarten Naesens
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.,Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Joris J Roelofs
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research & Evaluation Research Institute, McGill University Health Center, Montreal, QC, Canada
| | - Edward S Kraus
- Division of Nephrology/Transplant Nephrology, Johns Hopkins University, Baltimore, MD, USA
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Tran JN, Günther OP, Sherwood KR, Fenninger F, Allan LL, Lan J, Sapir-Pichhadze R, Duquesnoy R, Claas F, Marsh SGE, McMaster WR, Keown PA. High-throughput sequencing defines donor and recipient HLA B-cell epitope frequencies for prospective matching in transplantation. Commun Biol 2021; 4:583. [PMID: 33990681 PMCID: PMC8121953 DOI: 10.1038/s42003-021-01989-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
Compatibility for human leukocyte antigen (HLA) genes between transplant donors and recipients improves graft survival but prospective matching is rarely performed due to the vast heterogeneity of this gene complex. To reduce complexity, we have combined next-generation sequencing and in silico mapping to determine transplant population frequencies and matching probabilities of 150 antibody-binding eplets across all 11 classical HLA genes in 2000 ethnically heterogeneous renal patients and donors. We show that eplets are more common and uniformly distributed between donors and recipients than the respective HLA isoforms. Simulations of targeted eplet matching shows that a high degree of overall compatibility, and perfect identity at the clinically important HLA class II loci, can be obtained within a patient waiting list of approximately 250 subjects. Internal epitope-based allocation is thus feasible for most major renal transplant programs, while regional or national sharing may be required for other solid organs. Tran et al. combine high throughput sequencing, structural biology and computational simulation to determine the HLA allele and antibody-defined epitope frequencies in renal transplant patients and donors. These results demonstrate the feasibility of HLA epitope matching using data from a national transplantation program.
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Affiliation(s)
- Jenny N Tran
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Karen R Sherwood
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Franz Fenninger
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lenka L Allan
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - James Lan
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Rene Duquesnoy
- Department of Pathology, University of Pittsburgh, Pennsylvania, PA, USA
| | - Frans Claas
- Department of Immunohematology and Blood Transfusion, University of Leiden, Leiden, Netherlands
| | - Steven G E Marsh
- Anthony Nolan Research Institute and UCL Cancer Institute, Royal Free Campus, London, UK
| | - W Robert McMaster
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.,Infection and Immunity Research Centre, University of British Columbia, Vancouver, BC, Canada
| | - Paul A Keown
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada. .,Department of Medicine, University of British Columbia, Vancouver, BC, Canada. .,Infection and Immunity Research Centre, University of British Columbia, Vancouver, BC, Canada.
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42
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Karpen SR, Klein A, Alloway RR, Albrecht R, Belen O, Campbell M, Kluetz P, Minasian LM, Mitchell SA, O'Doherty I, Papadopoulos E, Sapir-Pichhadze R, Spear N, van Gelder T, Velidedeoglu E, Page CA, Everly MJ. The Role of Patient-reported Outcomes and Medication Adherence Assessment in Patient-focused Drug Development for Solid Organ Transplantation. Transplantation 2021; 105:941-944. [PMID: 33901129 DOI: 10.1097/tp.0000000000003556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Rita R Alloway
- Division of Nephrology, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Ozlem Belen
- U.S. Food and Drug Administration, Silver Spring, MD
| | | | - Paul Kluetz
- U.S. Food and Drug Administration, Silver Spring, MD
| | - Lori M Minasian
- National Institutes of Health, National Cancer Institute, Bethesda, MD
| | - Sandra A Mitchell
- National Institutes of Health, National Cancer Institute, Bethesda, MD
| | | | | | | | | | - Teun van Gelder
- Departments of Hospital Pharmacy and Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - C Alex Page
- University of Arizona College of Pharmacy, Tucson, AZ
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43
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Alqallaf A, Alam A, Sapir-Pichhadze R, Ghali P, Cantarovich M. Pretransplant Use of the Chronic Kidney Disease Epidemiology Collaboration Equation (CKD-EPI) to Estimate Glomerular Filtration Rate Predicts Outcomes in Liver Transplant Recipients. EXP CLIN TRANSPLANT 2021; 19:231-236. [PMID: 33719946 DOI: 10.6002/ect.2020.0557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Kidney dysfunction is common in liver transplant candidates and is a well-established predictor of increased mortality after liver transplant. However, the best method for determination of the glomerular filtration rate before liver transplant remains unclear. MATERIALS AND METHODS We analyzed the performance of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and the Modification of Diet in Renal Disease (MDRD) Study equation, before liver transplant, compared with radionuclide glomerular filtration rate and examined the association of the 2 equations with a composite outcome of stage 4 chronic kidney disease, initiation of chronic dialysis, or patient death. RESULTS We studied 426 consecutive adult liver transplant recipients from 1990 to 2014. The correlation coefficient of the radionuclide glomerular filtration rate with the Chronic Kidney Disease Epidemiology Collaboration equation was 0.61 and with the Modification of Diet in Renal Disease Study equation was 0.58. The Modification of Diet in Renal Disease Study equation showed a bias of -4.7 mL/min and precision of 32.9 mL/min, whereas the Chronic Kidney Disease Epidemiology Collaboration equation showed a bias of -11.1 mL/min but was more precise (28.1 mL/min). Only the Chronic Kidney Disease Epidemiology Collaboration equation remained significantly associated with the composite outcome in the multivariable analysis. CONCLUSIONS The use of the Chronic Kidney Disease Epidemiology Collaboration equation in the period before liver transplant provided independent prognostic information regarding long-term outcomes after liver transplant.
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Affiliation(s)
- Ahmed Alqallaf
- From the Division of Nephrology and Multi-Organ Transplant Program, McGill University Health Center, Montreal, Quebec, Canada
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44
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Krahn T, Martel M, Sapir-Pichhadze R, Kronfli N, Falutz J, Guaraldi G, Lebouche B, Klein MB, Wong P, Deschenes M, Ghali P, Sebastiani G. Nonalcoholic Fatty Liver Disease and the Development of Metabolic Comorbid Conditions in Patients With Human Immunodeficiency Virus Infection. J Infect Dis 2021; 222:787-797. [PMID: 32249283 DOI: 10.1093/infdis/jiaa170] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/02/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiovascular and liver disease are main causes of death in people with human immunodeficiency virus (HIV) (PWH). In HIV-uninfected patients, nonalcoholic fatty liver disease (NAFLD) is associated with incident metabolic complications. We investigated the effect of NAFLD on development of metabolic comorbid conditions in PWH. METHODS We included PWH undergoing a screening program for NAFLD using transient elastography. NAFLD was defined as a controlled attenuation parameter ≥248 dB/m with exclusion of other liver diseases. Incident diabetes, hypertension, dyslipidemia, and chronic kidney disease were investigated using survival analysis and Cox proportional hazards. RESULTS The study included 485 HIV-monoinfected patients. During a median follow-up of 40.1 months (interquartile range, 26.5-50.7 months), patients with NAFLD had higher incidences of diabetes (4.74 [95% confidence interval, 3.09-7.27] vs 0.87 [.42-1.83] per 100 person-years) and dyslipidemia (8.16 [5.42-12.27] vs 3.99 [2.67-5.95] per 100 person-years) than those without NAFLD. With multivariable analysis, NAFLD was an independent predictor of diabetes (adjusted hazard ratio, 5.13; 95% confidence interval, 2.14-12.31) and dyslipidemia (2.35; 1.34-4.14) development. CONCLUSIONS HIV-monoinfected patients with NAFLD are at higher risk of incident diabetes and dyslipidemia. Early referral strategies and timely management of metabolic risk may improve outcomes.
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Affiliation(s)
- Thomas Krahn
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Myriam Martel
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ruth Sapir-Pichhadze
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nadine Kronfli
- Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Julian Falutz
- Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Bertrand Lebouche
- Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.,Department of Family Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marina B Klein
- Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Philip Wong
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marc Deschenes
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Peter Ghali
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.,Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
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45
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Getchell L, Bernstein E, Fowler E, Franson L, Reich M, Sparkes D, Desjarlais A, Banai S, Pollock G, Lord-Fontaine S, Settee C, Robinson-Settee H, Murdoch A, Fernandez N, Sapir-Pichhadze R. Program Report: KidneyPRO, a Web-based Training Module for Patient Engagement in Kidney Research. Can J Kidney Health Dis 2021; 7:2054358120979255. [PMID: 33425371 PMCID: PMC7755936 DOI: 10.1177/2054358120979255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/29/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose of report: Over the recent years, there has been increasing support and traction for patient-oriented research (POR). Such an approach ensures that health research is focused on what matters most: improving outcomes for patients. Yet the realm of health research remains enigmatic for many patients in Canada who are not familiar with research terms and practices, highlighting the need for focused capacity-building efforts, including the development of novel educational tools to support patients to meaningfully engage in the research enterprise. The need for disease-specific training in POR was identified by the network dedicated to advancing patient-oriented kidney research in Canada, Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD), during the early years of the network’s inception. In this report, we describe the development of KidneyPRO, an online learning module that orients patients and families to kidney research in Canada, and outlines ways to get involved. In line with the Patient Engagement framework of the Strategy for Patient Oriented Research, KidneyPRO was co-developed with the network’s patient partners. Sources of information: The need for KidneyPRO was identified through a review of feedback from network participants of Canadian Institutes of Health Research’s (CIHR) Foundations in Patient-Oriented Research Module 2—Health Research in Canada and a network-wide survey of Can-SOLVE CKD that was conducted in June 2017 and assessed training needs of key stakeholders. This 2017 survey ranked the need for tools providing introductory knowledge on Canadian kidney research as third in the network’s top 5 capacity-building priorities. Methods: At Can-SOLVE CKD, a dedicated multi-stakeholder team was formed from the Training & Mentorship Committee (the network’s core infrastructure for POR capacity building) to determine the learning objectives, content, and user interface. The team consisted of 3 patient partners, Director of Research for the Kidney Foundation of Canada, a kidney clinician-scientist, the network’s Patient Partnerships & Training Lead, Can-SOLVE CKD’s Indigenous People’s Engagement and Research Council Coordinator, and a project coordinator. With permission, content from CIHR’s Foundations in Patient-Oriented Research, along with resources from the Kidney Foundation of Canada’s research arm and network project teams, was used to form the basis of the tool. The working group adapted a DoTTI (Design and develOpment, Testing early iterations, Testing for Effectiveness, Integration, and implementation) framework and iteratively identified, created, and refined the content and user interface in consultation with the Training and Mentorship Committee and the Can-SOLVE CKD Patient Governance Circle. Key findings: In this article, we describe the development, deployment, and evaluation of KidneyPRO, a web-based training module that helps patients understand general, patient-oriented, and kidney-specific research within Canada. KidneyPRO aims to support patient engagement in studies as partners and/or participants and empower them to take part in the research process in an active and meaningful way. It was co-designed and vetted by patients, which helps to ensure clear, useful content and a user-friendly interface. In addition, the module includes links to kidney research opportunities within the Can-SOLVE CKD Network and beyond. A literature review established that KidneyPRO fills an important gap in kidney-specific POR. Ongoing collection of website metrics and postcompletion surveys from users will be used to evaluate the effectiveness of the tool. Limitations: As an online tool, people who do not have adequate Internet access will not be able to use KidneyPRO. Currently, the tool is not compliant with all Web Content Accessibility Guidelines. Given how the landscape of patient partnership in research is constantly evolving, the content in KidneyPRO needs to be updated on a regular basis. Implications: Canadians with or at high risk of CKD now have access to an educational tool when seeking to engage as partners and/or participants in innovative kidney research.
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Affiliation(s)
| | | | | | | | | | | | | | - Sara Banai
- Can-SOLVE CKD Network, Vancouver, BC, Canada
| | | | | | | | | | | | - Nicolas Fernandez
- Can-SOLVE CKD Network, Vancouver, BC, Canada.,Department of Family Medicine and Emergency Medicine, University of Montreal, QC, Canada
| | - Ruth Sapir-Pichhadze
- Can-SOLVE CKD Network, Vancouver, BC, Canada.,Division of Nephrology and Multi-Organ Transplant Program, Department of Medicine, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
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46
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Lemieux W, Mohammadhassanzadeh H, Klement W, Daniel C, Sapir-Pichhadze R. Matchmaker, matchmaker make me a match: Opportunities and challenges in optimizing compatibility of HLA eplets in transplantation. Int J Immunogenet 2021; 48:135-144. [PMID: 33426788 DOI: 10.1111/iji.12525] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/12/2020] [Accepted: 12/20/2020] [Indexed: 12/20/2022]
Abstract
The development of donor-specific antibodies (DSAs) is a major complication in transplantation, which is associated with inferior graft survival, impaired quality of life, and increased healthcare costs. DSA develop upon recognition of nonself HLA by the recipient's immune system. HLA molecules contain epitopes, which are the surface regions of HLA molecules recognized by antibodies. HLAMatchmaker is an algorithm for assessing donor:recipient HLA compatibility at the level of structurally defined HLA targets called eplets. The consideration of eplets, rather than the whole HLA molecule, could offer some advantages when classifying the immune risk associated with particular donor:recipient pairs. Assessing compatibility at the level of HLA eplets could decrease misclassification of post-transplant immune risk by improving specificity, when antibodies are confirmed to be directed against donor eplets missing from the recipient's repertoire of eplets. Consideration of eplets may also increase the sensitivity of immune risk assessment, when identifying mismatched eplets that could give rise to new, not previously detected, donor-specific antibodies post-transplant. Eplet matching can serve as a rational strategy for immune risk mitigation. Herein, we review the evolution of HLA (in) compatibility assessment for organ allocation. We outline challenges in the implementation of eplet-based donor:recipient matching, including unavailability of allele-level donor genotypes for 11 HLA loci at the time of organ allocation and difficulty in assessing the hierarchy of immune risk associated with particular HLA eplet mismatches. Opportunities to address some of the current shortcomings of donor genotyping and HLAMatchmaker are also discussed. While there is a demonstrated benefit in the application of HLAMatchmaker for donor: recipient HLA (in)compatibility assessment, evolving long-read genotyping methods, compilation of large data sets with allele-level genotypes, and standardization of methods to verify eplets as determinants of immune-mediated injuries are required before HLA eplet matching is implemented in organ allocation to improve upon transplant outcomes.
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Affiliation(s)
- William Lemieux
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of McGill University Health Centre, Montréal, QC, Canada
| | - Hossein Mohammadhassanzadeh
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of McGill University Health Centre, Montréal, QC, Canada
| | - William Klement
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of McGill University Health Centre, Montréal, QC, Canada.,Canadian Blood Services, Ottawa, Ontario, Canada
| | - Claude Daniel
- Division of Hematology, McGill University Health Centre, Montréal, QC, Canada
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of McGill University Health Centre, Montréal, QC, Canada.,Division of Nephrology and the Multi-Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
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47
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Vinson AJ, Chong AS, Clegg D, Falk C, Foster BJ, Halpin A, Mannon RB, Palmer BF, Oertelt-Prigione S, West LJ, Wong G, Sapir-Pichhadze R. Sex matters: COVID-19 in kidney transplantation. Kidney Int 2021; 99:555-558. [PMID: 33412163 PMCID: PMC7783460 DOI: 10.1016/j.kint.2020.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/24/2020] [Accepted: 12/04/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Amanda J Vinson
- Division of Nephrology, Department of Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Anita S Chong
- Department: Surgery, University of Chicago, Chicago, Illinois, USA
| | - Deborah Clegg
- College of Nursing and Health Professionals, Drexel University, Philadelphia, Pennsylvania, USA
| | - Christine Falk
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | - Bethany J Foster
- Department of Pediatrics, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada; Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Anne Halpin
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada; Department of Laboratory Medicine, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Alberta Precision Laboratories, Edmonton, Alberta, Canada; Alberta Transplant Institute, Edmonton, Alberta, Canada
| | - Roslyn B Mannon
- Department of Medicine/Nephrology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Biff F Palmer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lori J West
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada; Alberta Transplant Institute, Edmonton, Alberta, Canada; Department of Pediatrics and Surgery, University of Alberta, Edmonton, Alberta, Canada; Department of Medical Microbiology/Immunology, University of Alberta, Edmonton, Alberta, Canada; Department of Laboratory Medicine/Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ruth Sapir-Pichhadze
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada; Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada.
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48
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Lepeytre F, Delmas-Frenette C, Zhang X, Larivière-Beaudoin S, Sapir-Pichhadze R, Foster BJ, Cardinal H. Donor Age, Donor-Recipient Size Mismatch, and Kidney Graft Survival. Clin J Am Soc Nephrol 2020; 15:1455-1463. [PMID: 32843375 PMCID: PMC7536765 DOI: 10.2215/cjn.02310220] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Small donor and/or kidney sizes relative to recipient size are associated with a higher risk of kidney allograft failure. Donor and recipient ages are associated with graft survival and may modulate the relationship between size mismatch and the latter. The aim of this study was to determine whether the association between donor-recipient size mismatch and graft survival differs by donor and recipient age. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENT We performed a retrospective cohort study of first adult deceased donor kidney transplantations performed between 2000 and 2018 recorded in the Scientific Registry of Transplant Recipients. We used multivariable Cox proportional hazards models to assess the association between donor-recipient body surface area ratio and death-censored graft survival, defined as return to dialysis or retransplantation. We considered interactions between donor-recipient body surface area ratio and each of recipient and donor age. RESULTS Among the 136,321 kidney transplant recipients included in this study, 23,614 (17%) experienced death-censored graft loss over a median follow-up of 4.3 years (interquartile range, 1.9-7.8 years). The three-way donor-recipient body surface area ratio by donor age by recipient age interaction was statistically significant (P=0.04). The magnitude of the association between severe size mismatch (donor-recipient body surface area ratio <0.80 versus ≥1.00) and death-censored graft survival was stronger with older donor age and recipient age. In all recipient age categories except the youngest (18-30 years), 5- and 10-year graft survival rates were similar or better with a size-mismatched donor aged <40 years than a nonsize-mismatched donor aged 40 years or older. CONCLUSIONS The association of donor-recipient size mismatch on long-term graft survival is modulated by recipient and donor age. Size-mismatched kidneys yield excellent graft survival when the donor is young. Donor age was more strongly associated with graft survival than size mismatch.
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Affiliation(s)
- Fanny Lepeytre
- Immunopathology Division, Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Catherine Delmas-Frenette
- Immunopathology Division, Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation (CORE), McGill University Health Centre, Montréal, Quebéc, Canada
| | - Stéphanie Larivière-Beaudoin
- Immunopathology Division, Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation (CORE), McGill University Health Centre, Montréal, Quebéc, Canada.,Division of Nephrology and the Multi Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Bethany J Foster
- Centre for Outcomes Research and Evaluation (CORE), McGill University Health Centre, Montréal, Quebéc, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montréal, Québec, Canada
| | - Héloïse Cardinal
- Immunopathology Division, Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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49
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Saha-Chaudhuri P, Rabin C, Tchervenkov J, Baran D, Morein J, Sapir-Pichhadze R. Predicting Clinical Outcome in Expanded Criteria Donor Kidney Transplantation: A Retrospective Cohort Study. Can J Kidney Health Dis 2020; 7:2054358120924305. [PMID: 32637142 PMCID: PMC7315672 DOI: 10.1177/2054358120924305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/30/2020] [Indexed: 11/15/2022] Open
Abstract
Background: The gaps in organ supply and demand necessitate the use of expanded criteria donor (ECD) kidneys. Objective: To identify which pre-transplant and post-transplant predictors are most informative regarding short- and long-term ECD transplant outcomes. Design: Retrospective cohort study. Setting: Single center, Quebec, Canada. Patients: The patients were 163 consecutive first-time ECD kidney only transplant recipients who underwent transplantation at McGill University Health Centre (MUHC) between January 1, 2008 and December 31, 2014 and had frozen section wedge procurement biopsies. Measurements: Short-term graft outcomes, including delayed graft function and 1-year estimated glomerular filtration rate (eGFR), as well as long-term outcomes including all-cause graft loss (defined as return to dialysis, retransplantation, and death with function). Methods: Pre-transplant donor, recipient, and transplant characteristics were assessed as predictors of transplant outcomes. The added value of post-transplant predictors, including longitudinal eGFR, was also assessed using time-varying Cox proportional hazards models. Results: In univariate analyses, among the pre-transplant donor characteristics, histopathologic variables did not show evidence of association with delayed graft function, 1-year post-transplant eGFR or all cause graft loss. Recipient age was associated with all-cause graft loss (hazard ratio: 1.038 [95% confidence interval: 1.002-1.075] and the model produced only modest discrimination (C-index: 0.590; standard error [SE]: 0.045). Inclusion of time-dependent post-transplant eGFR improved the model’s prediction accuracy (C-index: 0.711; SE = 0.047). Pre-transplant ECD characteristics were not associated with long-term survival, whereas post-transplant characteristics allowed better model discrimination. Limitations: Single-center study, small sample size, and potential incomplete capture of all covariate data. Conclusions: Incorporation of dynamic prediction models into electronic health records may enable timely mitigation of ECD graft failure risk and/or facilitate planning for renal replacement therapies. Histopathologic findings on preimplantation biopsies have a limited role in predicting long-term ECD outcomes. Trial registration: Not applicable.
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Affiliation(s)
- Paramita Saha-Chaudhuri
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, QC, Canada
| | - Carly Rabin
- Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | | | - Dana Baran
- Division of Nephrology and the Multi Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada
| | - Justin Morein
- Department of Medicine, University of Western Ontario, London, ON, Canada
| | - Ruth Sapir-Pichhadze
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, QC, Canada.,Division of Nephrology and the Multi Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada.,Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
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50
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Caulfield T, Murdoch B, Sapir-Pichhadze R, Keown P. Policy Challenges for Organ Allocation in an Era of "Precision Medicine". Can J Kidney Health Dis 2020; 7:2054358120912655. [PMID: 32231786 PMCID: PMC7088188 DOI: 10.1177/2054358120912655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/29/2020] [Indexed: 12/27/2022] Open
Abstract
There is increasing interest in the use of precision medicine tools and evidence-based outcome measures for donor-recipient matching to optimize transplant outcomes. Although the shift toward greater precision can provide health and resource benefits, it may be perceived as conflicting with both established equity-focused organ allocation norms and the legal and ethical obligations of health care providers and related institutions. With increasing evidence that various forms of human leukocyte antigen (HLA) mismatch and/or prognostic biomarkers can affect outcomes, the tension between maximizing utility and ensuring equity seems likely to intensify. In Canada, health care providers are generally required by law to put the interests of their patient, such as access to an organ, above the needs of the health care system and other patients. In addition, transplantation right of access lawsuits, which have been successful in the past, could affect the implementation of precision approaches. These legal tensions could be further heightened by media representations, which have historically favored strong rights of access. When implementing new precision technologies in organ allocation, there will be a recurrent need for policymakers to revisit the balance of equity and utility and to assess how to craft rules that reflect our society’s conception of a fair allocation system.
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Affiliation(s)
- Timothy Caulfield
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Canada
| | - Blake Murdoch
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Canada
| | | | - Paul Keown
- Faculty of Medicine, The University of British Columbia, Vancouver, Canada
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