@article{Shah2024,

title = {Cost-effectiveness of Accepting Kidneys From Deceased Donors With Common Cancers—A Modeling Study},

author = {Karan K. Shah and James A. Hedley and Kristy P. Robledo and Melanie Wyld and Angela C. Webster and Rachael L. Morton},

doi = {10.1097/tp.0000000000004984},

issn = {0041-1337},

year  = {2024},

date = {2024-03-19},

urldate = {2024-03-19},

publisher = {Ovid Technologies (Wolters Kluwer Health)},

abstract = {<jats:sec>

            <jats:title>Background.</jats:title>

            <jats:p>The disparity between the demand for and supply of kidney transplants has resulted in prolonged waiting times for patients with kidney failure. A potential approach to address this shortage is to consider kidneys from donors with a history of common cancers, such as breast, prostate, and colorectal cancers.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Methods.</jats:title>

            <jats:p>We used a patient-level Markov model to evaluate the outcomes of accepting kidneys from deceased donors with a perceived history of breast, prostate, or colorectal cancer characterized by minimal to intermediate transmission risk. Data from the Australian transplant registry were used in this analysis. The study compared the costs and quality-adjusted life years (QALYs) from the perspective of the Australian healthcare system between the proposed practice of accepting these donors and the conservative practice of declining them. The model simulated outcomes for 1500 individuals waitlisted for a deceased donor kidney transplant for a 25-y horizon.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Results.</jats:title>

            <jats:p>Under the proposed practice, when an additional 15 donors with minimal to intermediate cancer transmission risk were accepted, QALY gains ranged from 7.32 to 20.12. This translates to an approximate increase of 7 to 20 additional years of perfect health. The shift in practice also led to substantial cost savings, ranging between $1.06 and $2.3 million.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Conclusions.</jats:title>

            <jats:p>The proposed practice of accepting kidneys from deceased donors with a history of common cancers with minimal to intermediate transmission risk offers a promising solution to bridge the gap between demand and supply. This approach likely results in QALY gains for recipients and significant cost savings for the health system.</jats:p>

          </jats:sec>},

keywords = {MODUS, Nephrology, Transplantation},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Relative survival in patients with cancer and kidney failure},

author = {Laia Oliveras and Brenda Maria Rosales and Nicole De La Mata and Claire Vajdic and Nuria Montero and Josep Cruzado and Angela Webster },

doi = { https://doi.org/10.1093/ndt/gfae046},

year  = {2024},

date = {2024-02-21},

urldate = {2024-02-21},

journal = {Nephrology Dialysis Transplantation},

keywords = {Cancer Research, Nephrology, Other CODE work},

pubstate = {published},

tppubtype = {article}

}

@article{Lees2023,

title = {Sex differences in associations between creatinine and cystatin C-based kidney function measures with stroke and major bleeding},

author = {Jennifer Susan Lees and Nicole L De La Mata and Michael K Sullivan and Melanie L Wyld and Brenda M Rosales and Rachel Cutting and James Alan Hedley and Elaine Rutherford and Patrick Barry Mark and Angela C Webster},

doi = {10.1177/23969873231173282},

issn = {2396-9881},

year  = {2023},

date = {2023-09-00},

urldate = {2023-09-00},

journal = {European Stroke Journal},

volume = {8},

number = {3},

pages = {756--768},

publisher = {SAGE Publications},

abstract = {<jats:sec><jats:title>Purpose:</jats:title><jats:p> We sought to explore whether adding kidney function biomarkers based on creatinine (eGFR<jats:sub>Cr</jats:sub>), cystatin C (eGFR<jats:sub>Cys</jats:sub>) or a combination of the two (eGFR<jats:sub>Cr-Cys</jats:sub>) could improve risk stratification for stroke and major bleeding, and whether there were sex differences in any additive value of kidney function biomarkers. </jats:p></jats:sec><jats:sec><jats:title>Method:</jats:title><jats:p> We included participants from the UK Biobank who had not had a previous ischaemic or haemorrhagic stroke or major bleeding episode, and who had kidney function measures available at baseline. Cause-specific Cox proportional hazards models tested associations between eGFR<jats:sub>Cr</jats:sub>, eGFR<jats:sub>Cys</jats:sub> and eGFR<jats:sub>Cr-Cys</jats:sub> (mL/min/1.73 m<jats:sup>2</jats:sup>) with ischaemic and haemorrhagic stroke, major bleeding (gastrointestinal or intracranial, including haemorrhagic stroke) and all-cause mortality. </jats:p></jats:sec><jats:sec><jats:title>Findings:</jats:title><jats:p> Among 452,879 eligible participants, 246,244 (54.4%) were women. Over 11.5 (IQR 10.8–12.2) years, there were 3706 ischaemic strokes, 795 haemorrhagic strokes, 26,025 major bleeding events and 28,851 deaths. eGFR<jats:sub>Cys</jats:sub> was more strongly associated with ischaemic stroke than eGFR<jats:sub>Cr</jats:sub>: an effect that was more pronounced in women (men – HR: 1.16, 95% CI: 1.12–1.19; female to male comparison – HR: 1.11, 95% CI: 1.05–1.16, per 10 mL/min/1.73 m<jats:sup>2</jats:sup> decline in eGFR<jats:sub>Cys</jats:sub>). This interaction effect was also demonstrated for eGFR<jats:sub>Cr-Cys</jats:sub>, but not eGFR<jats:sub>Cr</jats:sub>. eGFR<jats:sub>Cys</jats:sub> and eGFR<jats:sub>Cr-Cys</jats:sub> were more strongly associated with major bleeding and all-cause mortality than eGFR<jats:sub>Cr</jats:sub> in both men and women. Event numbers were small for haemorrhagic stroke. </jats:p></jats:sec><jats:sec><jats:title>Discussion:</jats:title><jats:p> To a greater degree than is seen in men, eGFR<jats:sub>Cr</jats:sub> underestimates risk of ischaemic stroke and major bleeding in women compared to eGFR<jats:sub>Cys</jats:sub>. The difference between measures is likely explained by non-GFR biology of creatinine and cystatin C. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> Enhanced measurement of cystatin C may improve risk stratification for ischaemic stroke and major bleeding and clinical treatment decisions in a general population setting, particularly for women. </jats:p></jats:sec>},

keywords = {Cardiology and Cardiovascular Medicine, Neurology (clinical), SHE-ROCKS},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Sex differences in the diagnosis of advanced cancer and subsequent outcome in people with chronic kidney disease: an analysis of a national population cohort},

author = {R Shemilt and MK Sullivan and P Hanlon and B Jani and N De La Mata and B Rosales and BMP Elyan and M Wyld and JA Hedley and R Cutting and DA McAllister and AC Webster and PB Mark and JS Lees},

doi = {https://doi.org/10.1101/2023.08.22.23294412},

year  = {2023},

date = {2023-08-22},

urldate = {2023-08-22},

journal = {Nephrology Dialysis Transplantation},

keywords = {Cancer Research, Nephrology, SHE-ROCKS},

pubstate = {published},

tppubtype = {article}

}

@article{Hedley2023,

title = {Cost-effectiveness of Interventions to Increase Utilization of Kidneys From Deceased Donors With Primary Brain Malignancy in an Australian Setting},

author = {James A. Hedley and Patrick J. Kelly and Melanie Wyld and Karan Shah and Rachael L. Morton and Juliet Byrnes and Brenda M. Rosales and Nicole L. De La Mata and Kate Wyburn and Angela C. Webster},

doi = {10.1097/txd.0000000000001474},

issn = {2373-8731},

year  = {2023},

date = {2023-00-00},

urldate = {2023-00-00},

volume = {9},

number = {5},

publisher = {Ovid Technologies (Wolters Kluwer Health)},

abstract = {<jats:sec>

            <jats:title>Background.</jats:title>

            <jats:p>Kidneys from potential deceased donors with brain cancer are often foregone due to concerns of cancer transmission risk to recipients. There may be uncertainty around donors’ medical history and their absolute transmission risk or risk-averse decision-making among clinicians. However, brain cancer transmissions are rare, and prolonging waiting time for recipients is harmful.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Methods.</jats:title>

            <jats:p>We assessed the cost-effectiveness of increasing utilization of potential deceased donors with brain cancer using a Markov model simulation of 1500 patients waitlisted for a kidney transplant, based on linked transplant registry data and with a payer perspective (Australian government). We estimated costs and quality-adjusted life-years (QALYs) for three interventions: decision support for clinicians in assessing donor risk, improved cancer classification accuracy with real-time data-linkage to hospital records and cancer registries, and increased risk tolerance to allow intermediate-risk donors (up to 6.4% potential transmission risk).</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Results.</jats:title>

            <jats:p>Compared with current practice, decision support provided 0.3% more donors with an average transmission risk of 2%. Real-time data-linkage provided 0.6% more donors (1.1% average transmission risk) and increasing risk tolerance (accepting intermediate-risk 6.4%) provided 2.1% more donors (4.9% average transmission risk). Interventions were dominant (improved QALYs and saved costs) in 78%, 80%, and 87% of simulations, respectively. The largest benefit was from increasing risk tolerance (mean +18.6 QALYs and AU$2.2 million [US$1.6 million] cost-savings).</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Conclusions.</jats:title>

            <jats:p>Despite the additional risk of cancer transmission, accepting intermediate-risk donors with brain cancer is likely to increase the number of donor kidneys available for transplant, improve patient outcomes, and reduce overall healthcare expenditure.</jats:p>

          </jats:sec>},

keywords = {MODUS, Transplantation},

pubstate = {published},

tppubtype = {article}

}

@article{Wyld2023,

title = {Life Years Lost in Children with Kidney Failure: A Binational Cohort Study with Multistate Probabilities of Death and Life Expectancy},

author = {Melanie L. Wyld and Nicole L. De La Mata and James Hedley and Siah Kim and Patrick J. Kelly and Angela C. Webster},

doi = {10.1681/asn.0000000000000118},

issn = {1533-3450},

year  = {2023},

date = {2023-00-00},

urldate = {2023-00-00},

journal = {JASN},

volume = {34},

number = {6},

pages = {1057--1068},

publisher = {Ovid Technologies (Wolters Kluwer Health)},

abstract = {<jats:sec><jats:title>Significance Statement</jats:title><jats:p>In children with kidney failure, little is known about their treatment trajectories or the effects of kidney failure on lifetime survival and years of life lost, which are arguably more relevant measures for children. In this population-based cohort study of 2013 children who developed kidney failure in Australia and New Zealand, most children were either transplanted after initiating dialysis (74%) or had a preemptive kidney transplant (14%). Life expectancy increased with older age at kidney failure, but more life years were spent on dialysis than with a functioning transplant. The expected (compared with the general population) number of life years lost ranged from 16 to 32 years, with female patients and those who developed kidney failure at a younger age experiencing the greatest loss of life years.</jats:p></jats:sec><jats:sec><jats:title>Background</jats:title><jats:p>Of the consequences of kidney failure in childhood, those rated as most important by children and their caregivers are its effects on long-term survival. From a life course perspective, little is known about the experience of kidney failure treatment or long-term survival.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>To determine expected years of life lost (YLL) and treatment trajectory for kidney failure in childhood, we conducted a population-based cohort study of all children aged 18 years or younger with treated kidney failure in Australia (1980–2019) and New Zealand (1988–2019).We used patient data from the CELESTIAL study, which linked the Australian and New Zealand Dialysis and Transplant registry with national death registers. We estimated standardized mortality ratios and used multistate modeling to understand treatment transitions and life expectancy.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 394 (20%) of 2013 individuals died over 30,082 person-years of follow-up (median follow-up, 13.1 years). Most children (74%) were transplanted after initiating dialysis; 14% (18% of male patients and 10% of female patients) underwent preemptive kidney transplantation. Excess deaths (compared with the general population) decreased dramatically from 1980 to 1999 (from 41 to 22 times expected) and declined more modestly (to 17 times expected) by 2019. Life expectancy increased with older age at kidney failure, but more life years were spent on dialysis than with a functioning transplant. The number of YLL ranged from 16 to 32 years, with the greatest loss among female patients and those who developed kidney failure at a younger age.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Children with kidney failure lose a substantial number of their potential life years. Female patients and those who develop kidney failure at younger ages experience the greatest burden.</jats:p></jats:sec>},

keywords = {General Medicine, Nephrology, Other CODE work},

pubstate = {published},

tppubtype = {article}

}

@article{Shah2023,

title = {Cost-effectiveness of Kidney Transplantation From Donors at Increased Risk of Blood-borne Virus Infection Transmission},

author = {Karan K. Shah and Melanie Wyld and James A. Hedley and Karen M.J. Waller and Nicole De La Mata and Angela C. Webster and Rachael L. Morton},

doi = {10.1097/tp.0000000000004632},

issn = {0041-1337},

year  = {2023},

date = {2023-00-00},

urldate = {2023-00-00},

volume = {107},

number = {9},

pages = {2028--2042},

publisher = {Ovid Technologies (Wolters Kluwer Health)},

abstract = {<jats:sec>

            <jats:title>Background.</jats:title>

            <jats:p>Demand for donor kidneys outstrips supply. Using kidneys from selected donors with an increased risk of blood-borne virus (BBV) transmission (hepatitis B virus and hepatitis C virus [HCV], human immunodeficiency virus) may expand the donor pool, but cost-effectiveness of this strategy is uncertain.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Methods.</jats:title>

            <jats:p>A Markov model was developed using real-world evidence to compare healthcare costs and quality-adjusted life years (QALYs) of accepting kidneys from deceased donors with potential increased risk of BBV transmission, because of increased risk behaviors and/or history of HCV, versus declining these kidneys. Model simulations were run over a 20-y time horizon. Parameter uncertainty was assessed through deterministic and probabilistic sensitivity analyses.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Results.</jats:title>

            <jats:p>Accepting kidneys from donors at increased risk of BBVs (2% from donors with increased-risk behaviors and 5% from donors with active or past HCV infection) incurred total costs of 311 303 Australian dollars with a gain of 8.53 QALYs. Foregoing kidneys from these donors incurred total costs of $330 517 and a gain of 8.44 QALYs. A cost-saving of $19 214 and additional 0.09 QALYs (~33 d in full health) per person would be generated compared with declining these donors. Increasing the availability of kidneys with increased risk by 15% led to further cost-savings of $57 425 and additional 0.23 QALY gains (~84 d in full health). Probabilistic sensitivity analysis using 10 000 iterations showed accepting kidneys from donors at increased risk led to lower costs and higher QALY gains.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Conclusions.</jats:title>

            <jats:p>Shifting clinical practice to accept increased BBV risk donors would likely produce lower costs and higher QALYs for health systems.</jats:p>

          </jats:sec>},

keywords = {MODUS, Transplantation},

pubstate = {published},

tppubtype = {article}

}

@article{Campbell2022,

title = {Interventions for improving health literacy in people with chronic kidney disease},

author = {Zoe C Campbell and Jessica K Dawson and Suzanne M Kirkendall and Kirsten J McCaffery and Jesse Jansen and Katrina L Campbell and Vincent WS Lee and Angela C Webster},

editor = { },

doi = {10.1002/14651858.cd012026.pub2},

issn = {1465-1858},

year  = {2022},

date = {2022-12-00},

urldate = {2022-12-00},

volume = {2022},

number = {12},

publisher = {Wiley},

keywords = {Other CODE work, Pharmacology (medical)},

pubstate = {published},

tppubtype = {article}

}

@article{Thomson2022,

title = {Potential organ donors with primary brain tumours: missed opportunities for donation and transplantation identified in Australian cohort study 2010–2015},

author = {Imogen K. Thomson and James Hedley and Brenda M. Rosales and Kate Wyburn and Michael J. O'Leary and Angela C. Webster},

doi = {10.1111/ans.18037},

issn = {1445-2197},

year  = {2022},

date = {2022-11-00},

urldate = {2022-11-00},

journal = {ANZ Journal of Surgery},

volume = {92},

number = {11},

pages = {2996--3003},

publisher = {Wiley},

abstract = {<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Potential organ donors with primary brain tumours (PBT) frequently donate, however some may be declined due to uncertainty about tumour classification or transmission risk to transplant recipients. We sought to describe transmission risk and donation outcome of potential donors with PBT, including identifying missed opportunities for transplantation, and any PBT transmission events.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We undertook a population‐based cohort study in NSW of all potential donors 2010–2015. PBT potential donors were characterized according to tumour grade and transmission risk, and whether they donated organs. Data linkage was used to determine agreement of risk assessment of potential donors to that in the Biovigilance Register, and to identify any PBT transmissions.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 2957 potential donors, 76 (3%) had PBTs. There was agreement of risk assessment in 44 (58%) cases. PBT potential donors had fewer comorbidities (1.6 vs. 2.1, <jats:italic>P</jats:italic> = 0.006) than non‐PBT potential donors. Forty‐eight (63%) potential donors were declined for non‐PBT reasons, 18 (24%) were declined because of perceived PBT transmission risk and 10 (13%) donated. All PBT donors had WHO‐I or ‐II tumours, and none had a ventriculo‐pertioneal shunt. No transmission events occurred.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Donors with WHO‐I/II PBT appear to have minimal risk of tumour transmission in solid organ transplantation; it is reassuring that no PBT transmission occurred. There is evidence of risk aversion to referrals with WHO‐III/IV tumours. There exists opportunity to improve potential donor risk assessment at the time of referral using integrated data sets, and to increase organ donation and transplantation rates through greater utilization of PBT referrals.</jats:p></jats:sec>},

keywords = {General Medicine, MODUS, Surgery},

pubstate = {published},

tppubtype = {article}

}

@article{Rosales2022,

title = {Cancer Mortality in People Receiving Dialysis for Kidney Failure: An Australian and New Zealand Cohort Study, 1980-2013},

author = {Brenda M. Rosales and Nicole De La Mata and Claire M. Vajdic and Patrick J. Kelly and Kate Wyburn and Angela C. Webster},

doi = {10.1053/j.ajkd.2022.03.010},

issn = {0272-6386},

year  = {2022},

date = {2022-10-00},

urldate = {2022-10-00},

journal = {American Journal of Kidney Diseases},

volume = {80},

number = {4},

pages = {449--461},

publisher = {Elsevier BV},

keywords = {CELESTIAL, Nephrology},

pubstate = {published},

tppubtype = {article}

}

@article{Cutting2022,

title = {AcceSS and Equity in Transplantation (ASSET) New Zealand: Protocol for population-wide data linkage platform to investigate equity in access to kidney failure health services in New Zealand},

author = {Rachel B. Cutting and Angela C. Webster and Nicholas B. Cross and Heather Dunckley and Ben Beaglehole and Ian Dittmer and John Irvine and Curtis Walker and Merryn Jones and Melanie Wyld and Patrick J. Kelly and Kate Wyburn and Nicole L. De La Mata},

editor = {Justyna Gołębiewska},

doi = {10.1371/journal.pone.0273371},

issn = {1932-6203},

year  = {2022},

date = {2022-08-25},

urldate = {2022-08-25},

journal = {PLoS ONE},

volume = {17},

number = {8},

publisher = {Public Library of Science (PLoS)},

abstract = {<jats:sec id="sec001">

<jats:title>Background</jats:title>

<jats:p>Kidney transplantation is considered the ideal treatment for most people with kidney failure, conferring both survival and quality of life advantages, and is more cost effective than dialysis. Yet, current health systems may serve some people better than others, creating inequities in access to kidney failure treatments and health outcomes. AcceSS and Equity in Transplantation (ASSET) investigators aim to create a linked data platform to facilitate research enquiry into equity of health service delivery for people with kidney failure in New Zealand.</jats:p>

</jats:sec>

<jats:sec id="sec002">

<jats:title>Methods</jats:title>

<jats:p>The New Zealand Ministry of Health will use patients’ National Health Index (NHI) numbers to deterministically link individual records held in existing registry and administrative health databases in New Zealand to create the data platform. The initial data linkage will include a study population of incident patients captured in the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), New Zealand Blood Service Database and the Australia and New Zealand Living Kidney Donor Registry (ANZLKD) from 2006 to 2019 and their linked health data. Health data sources will include National Non-Admitted Patient Collection Data, National Minimum Dataset, Cancer Registry, Programme for the Integration of Mental Health Data (PRIMHD), Pharmaceutical Claims Database and Mortality Collection Database. Initial exemplar studies include 1) kidney waitlist dynamics and pathway to transplantation; 2) impact of mental illness on accessing kidney waitlist and transplantation; 3) health service use of living donors following donation.</jats:p>

</jats:sec>

<jats:sec id="sec003">

<jats:title>Conclusion</jats:title>

<jats:p>The AcceSS and Equity in Transplantation (ASSET) linked data platform will provide opportunity for population-based health services research to examine equity in health care delivery and health outcomes in New Zealand. It also offers potential to inform future service planning by identifying where improvements can be made in the current health system to promote equity in access to health services for those in New Zealand.</jats:p>

</jats:sec>},

keywords = {ASSET NZ, Multidisciplinary},

pubstate = {published},

tppubtype = {article}

}

@article{Waller2022,

title = {Notifiable Infectious Diseases Among Organ Transplant Recipients: A Data-Linked Cohort Study, 2000–2015},

author = {Karen M J Waller and Nicole L De La Mata and Kate R Wyburn and James A Hedley and Brenda M Rosales and Patrick J Kelly and Vidiya Ramachandran and Karan K Shah and Rachael L Morton and William D Rawlinson and Angela C Webster},

doi = {10.1093/ofid/ofac337},

issn = {2328-8957},

year  = {2022},

date = {2022-08-02},

urldate = {2022-08-02},

volume = {9},

number = {8},

publisher = {Oxford University Press (OUP)},

abstract = {<jats:title>Abstract</jats:title>

               <jats:sec>

                  <jats:title>Background</jats:title>

                  <jats:p>Infections, including common communicable infections such as influenza, frequently cause disease after organ transplantation, although the quantitative extent of infection and disease remains uncertain.</jats:p>

               </jats:sec>

               <jats:sec>

                  <jats:title>Methods</jats:title>

                  <jats:p>A cohort study was conducted to define the burden of notifiable infectious diseases among all solid organ recipients transplanted in New South Wales, Australia, 2000–2015. Data linkage was used to connect transplant registers to hospital admissions, notifiable diseases, and the death register. Standardized incidence ratios (SIRs) were calculated relative to general population notification rates, accounting for age, sex, and calendar year. Infection-related hospitalizations and deaths were identified.</jats:p>

               </jats:sec>

               <jats:sec>

                  <jats:title>Results</jats:title>

                  <jats:p>Among 4858 solid organ recipients followed for 39 183 person-years (PY), there were 792 notifications. Influenza was the most common infection (532 cases; incidence, 1358 [95% CI, 1247–1478] per 100 000 PY), highest within 3 months posttransplant. Next most common was salmonellosis (46 cases; incidence, 117 [95% CI, 87–156] per 100 000 PY), then pertussis (38 cases; incidence, 97 [95% CI, 71–133] per 100 000 PY). Influenza and invasive pneumococcal disease (IPD) showed significant excess cases compared with the general population (influenza SIR, 8.5 [95% CI, 7.8–9.2]; IPD SIR, 9.8 [95% CI, 6.9–13.9]), with high hospitalization rates (47% influenza cases, 68% IPD cases) and some mortality (4 influenza and 1 IPD deaths). By 10 years posttransplant, cumulative incidence of any vaccine-preventable disease was 12%, generally similar by transplanted organ, except higher among lung recipients. Gastrointestinal diseases, tuberculosis, and legionellosis had excess cases among transplant recipients, although there were few sexually transmitted infections and vector-borne diseases.</jats:p>

               </jats:sec>

               <jats:sec>

                  <jats:title>Conclusions</jats:title>

                  <jats:p>There is potential to avoid preventable infections among transplant recipients with improved vaccination programs, health education, and pretransplant donor and recipient screening.</jats:p>

               </jats:sec>},

keywords = {Infectious Diseases, Oncology, SAFEBOD},

pubstate = {published},

tppubtype = {article}

}

@article{Hedley2022,

title = {Patient and kidney transplant survival in type 1 diabetics after kidney transplant alone compared to simultaneous pancreas‐kidney transplant},

author = {James A. Hedley and Patrick J. Kelly and Angela C. Webster},

doi = {10.1111/ans.17663},

issn = {1445-2197},

year  = {2022},

date = {2022-07-00},

urldate = {2022-07-00},

journal = {ANZ Journal of Surgery},

volume = {92},

number = {7-8},

pages = {1856--1862},

publisher = {Wiley},

abstract = {<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Donor and other differences mean understanding drivers of transplant survival for type 1 diabetics is challenging. We aimed to compare outcomes of simultaneous pancreas‐kidney transplant over kidney transplant alone for people with end‐stage kidney disease (ESKD) and type 1 diabetes.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We performed a population‐based cohort study comparing outcomes from kidney alone and kidney‐pancreas transplants using registry data. Our study population was people in Australia and New Zealand with type 1 diabetes and ESKD who received a kidney transplant in 1984–2016. Primary outcomes were time to kidney transplant failure and all‐cause death. Secondary outcomes were time to cardiovascular and non‐cardiovascular death. We compared adjusted survival using Cox regression (hazard ratio HR and 95% confidence intervals CI).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 1295 type 1 diabetics receiving a transplant, 430 (33%) received deceased donor kidney, 172 (13%) received living donor kidney, and 693 (54%) received pancreas‐kidney transplant. Compared to deceased donor kidney, pancreas‐kidney recipients had 40% lower rate of kidney transplant failure (adjusted HR 0.60; 95% CI 0.45–0.81; <jats:italic>p</jats:italic> = 0.001) and 34% lower mortality (adjusted HR 0.66; 95% CI 0.53–0.83; <jats:italic>p</jats:italic> < 0.001), driven by 49% reduction in cardiovascular mortality (adjusted HR 0.51; 95% CI 0.36–0.72; <jats:italic>p</jats:italic> < 0.001). Pancreas‐kidney recipients had similar reductions in transplant failure and mortality compared to living kidney recipients, after adjusting for transplant timing.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>For people with type 1 diabetes, pancreas‐kidney transplant provides improved transplant and overall survival compared to deceased donor kidney alone. Living donor kidneys may perform just as well as pancreas‐kidney transplant if waiting times are short.</jats:p></jats:sec>},

keywords = {General Medicine, Other CODE work, Surgery},

pubstate = {published},

tppubtype = {article}

}

@article{Khou2022,

title = {Epidemiology of cardiovascular death in kidney failure: An Australian and New Zealand cohort study using data linkage},

author = {Victor Khou and Nicole L. De La Mata and Patrick J. Kelly and Philip Masson and Emma O'Lone and Rachael L. Morton and Angela C. Webster},

doi = {10.1111/nep.14020},

issn = {1440-1797},

year  = {2022},

date = {2022-05-00},

urldate = {2022-05-00},

journal = {Nephrology},

volume = {27},

number = {5},

pages = {430--440},

publisher = {Wiley},

abstract = {<jats:title>Abstract</jats:title><jats:sec><jats:title>Aim</jats:title><jats:p>Cardiovascular mortality risk evolves over the lifespan of kidney failure (KF), as patients develop comorbid disease and transition between treatment modalities. Absolute cardiovascular death rates would help inform clinical practice and health‐care provision, but are not well understood across a continuum of dialysis and transplant states. We aimed to characterize cardiovascular death across the natural history of KF using a lifespan approach.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We performed a population‐based cohort study of incident patients commencing kidney replacement therapy in Australia and New Zealand. Cardiovascular deaths were identified using data linkage to national death registers. We estimated the probability of death and kidney transplant using multi‐state models, and calculated rates of graft failure and cardiovascular death across demographic factors and comorbidities.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among 60 823 incident patients followed over 381 874 person‐years, 25% (8492) of deaths were from cardiovascular disease. At 15 years from treatment initiation, patients had a 15.2% probability of cardiovascular death without being transplanted, but only 2.3% probability of cardiovascular death post‐transplant. Females had a 3% lower probability of cardiovascular death at 15 years (15.3% vs. 18.6%) but 4% higher probability of non‐cardiovascular death (54.5% vs. 50.8%). Within the first year of dialysis, cardiovascular mortality peaked in the second month and showed little improvement across treatment era.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Despite improvements over time, cardiovascular death remains common in KF, particularly among the dialysis population and in the first few months of treatment. Multi‐state models can provide absolute measures of cardiovascular mortality across both dialysis and transplant states.</jats:p></jats:sec>},

keywords = {CELESTIAL, General Medicine, Nephrology},

pubstate = {published},

tppubtype = {article}

}

@article{Hedley2022b,

title = {Perceived Versus Verified Cancer History and Missed Opportunities for Donation in an Australian Cohort of Potential Deceased Solid Organ Donors},

author = {James A. Hedley and Patrick J. Kelly and Karen M.J. Waller and Imogen K. Thomson and Nicole L. De La Mata and Brenda M. Rosales and Kate Wyburn and Angela C. Webster},

doi = {10.1097/txd.0000000000001252},

issn = {2373-8731},

year  = {2022},

date = {2022-00-00},

urldate = {2022-00-00},

volume = {8},

number = {2},

publisher = {Ovid Technologies (Wolters Kluwer Health)},

abstract = {<jats:sec>

            <jats:title>Background.</jats:title>

            <jats:p>There is an imperative to maximize donation opportunities given ongoing organ shortages, but donor suitability assessments can be challenging.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Methods.</jats:title>

            <jats:p>We analyzed an Australian cohort of potential deceased donors 2010 to 2013 to explore misclassification of cancer risk and potential strategies for improvement (decision support, real-time data linkage to existing data sets, and increasing risk tolerance). Cancer history perceived at referral was compared with verified cancer history in linked health records. Transmission risks were based on clinical guidelines. Potential donors declined due to cancer but verified low risk were missed opportunities; those accepted but verified high risk were excess-risk donors.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Results.</jats:title>

            <jats:p>Among 472 potentially suitable donor referrals, 132 (28%) were declined because of perceived transmission risk and 340 (72%) donated. Assuming a low-risk threshold, there were 38/132 (29%) missed opportunities and 5/340 (1%) excess-risk donors. With decision support, there would have been 5 (13%) fewer missed opportunities and 2 (40%) more excess-risk donors; with real-time data linkage, 6 (16%) fewer missed opportunities and 2 (40%) fewer excess-risk donors; and with increased risk tolerance, 6 (16%) fewer missed opportunities and 11 (220%) more excess-risk donors.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Conclusions.</jats:title>

            <jats:p>Potential donors’ cancer history is typically incomplete at referral. There are missed opportunities where decision support or more accurate cancer history could safely increase organ donors.</jats:p>

          </jats:sec>},

keywords = {SAFEBOD, Transplantation},

pubstate = {published},

tppubtype = {article}

}

@article{Waller2022b,

title = {Characteristics and Donation Outcomes of Potential Organ Donors Perceived to Be at Increased Risk for Blood-borne Virus Transmission: An Australian Cohort Study 2010–2018},

author = {Karen M.J. Waller and Nicole L. De La Mata and Brenda M. Rosales and James A. Hedley and Patrick J. Kelly and Imogen K. Thomson and Michael J. O’Leary and Elena Cavazzoni and Vidiya Ramachandran and William D. Rawlinson and Kate R. Wyburn and Angela C. Webster},

doi = {10.1097/tp.0000000000003715},

issn = {0041-1337},

year  = {2022},

date = {2022-00-00},

urldate = {2022-00-00},

volume = {106},

number = {2},

pages = {348--357},

publisher = {Ovid Technologies (Wolters Kluwer Health)},

abstract = {<jats:sec>

            <jats:title>Background.</jats:title>

            <jats:p>Safely increasing organ donation to meet need is a priority. Potential donors may be declined because of perceived blood-borne virus (BBV) transmission risk. With hepatitis C (HCV) curative therapy, more potential donors may now be suitable. We sought to describe potential deceased donors with increased BBV transmission risk.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Methods.</jats:title>

            <jats:p>We conducted a cohort study of all potential organ donors referred in NSW, Australia, 2010–2018. We compared baseline risk potential donors to potential donors with increased BBV transmission risk, due to history of HIV, HCV or hepatitis B, and/or behavioral risk factors.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Results.</jats:title>

            <jats:p>There were 624 of 5749 potential donors (10.9%) perceived to have increased BBV transmission risk. This included 298 of 5749 (5.2%) with HCV (including HBV coinfections) and 239 of 5749 (4.2%) with increased risk behaviors (no known BBV). Potential donors with HCV and those with increased risk behaviors were younger and had fewer comorbidities than baseline risk potential donors (<jats:italic toggle="yes">P</jats:italic> < 0.001). Many potential donors (82 with HCV, 38 with risk behaviors) were declined for donation purely because of perceived BBV transmission risk. Most were excluded before BBV testing. When potential donors with HCV did donate, they donated fewer organs than baseline risk donors (median 1 versus 3, <jats:italic toggle="yes">P</jats:italic> < 0.01), especially kidneys (odds ratio 0.08, <jats:italic toggle="yes">P</jats:italic> < 0.001) and lungs (odds ratio 0.11, <jats:italic toggle="yes">P</jats:italic> = 0.006).</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Conclusions.</jats:title>

            <jats:p>Many potential donors were not accepted because of perceived increased BBV transmission risk, without viral testing, and despite otherwise favorable characteristics. Transplantation could be increased from potential donors with HCV and/or increased risk behaviors.</jats:p>

          </jats:sec>},

keywords = {MODUS, Transplantation},

pubstate = {published},

tppubtype = {article}

}

@article{Rosales2021,

title = {Prevalence of anal cytological abnormalities and high‐risk human papillomavirus prevalence in kidney transplant recipients: A cross‐sectional study},

author = {Brenda M. Rosales and Julian Langton‐Lockton and James Hedley and Alyssa M. Cornall and Jennifer M. Roberts and Suzanne M. Garland and Patrick J. Kelly and Richard J. Hillman and Angela C. Webster},

doi = {10.1111/ctr.14476},

issn = {1399-0012},

year  = {2021},

date = {2021-12-00},

urldate = {2021-12-00},

journal = {Clinical Transplantation},

volume = {35},

number = {12},

publisher = {Wiley},

abstract = {<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Transplant recipients are at high‐risk of anal squamous cell cancer. We aimed to estimate the prevalence of high‐risk human papillomavirus (HPV) and high‐grade squamous intraepithelial lesion (HSIL) and assess characteristics associated with results</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We recruited kidney transplant recipients in a single‐center, 2015–2018. Participants completed a clinical questionnaire and received an anal‐swab sent for HPV‐DNA and cytological testing</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 97 (74%) of 125 recipients approached consented to participate. Participants were median 47 (IQR 40–55) years, 60% male and median 4.5 (IQR .9‐13) months‐since‐transplant. Of 86 assessable samples, at least one HPV genotype was detected in 15 (17%) participants; 1 (1%) HPV16, 8 (9%) other high‐risk HPV. Of 76 assessable cytology samples, 9 (12%) showed evidence of abnormality; 1 (1%) HSIL, 1 (1%) atypical‐squamous‐cells, cannot exclude HSIL. Both HSIL recipients had high‐risk HPV and biopsy confirmed HSIL. High‐risk HPV was detected in six (9%) recipients with normal cytology. History of sexually transmitted infection, and abnormal cervical pap smear in women, was associated with high‐risk HPV and HSIL</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>High‐risk HPV and HSIL testing may identify kidney transplant recipients at higher risk of anal cancer. Longitudinal studies are needed to describe the natural history of anal cancer in transplant recipients.</jats:p></jats:sec>},

keywords = {Other CODE work, Transplantation},

pubstate = {published},

tppubtype = {article}

}

@article{DeLaMata2021,

title = {Sex differences in mortality among binational cohort of people with chronic kidney disease: population based data linkage study},

author = {Nicole L De La Mata and Brenda Rosales and Grace MacLeod and Patrick J Kelly and Philip Masson and Rachael L Morton and Kate Wyburn and Angela C Webster},

doi = {10.1136/bmj-2021-068247},

issn = {1756-1833},

year  = {2021},

date = {2021-11-16},

urldate = {2021-11-16},

journal = {BMJ},

publisher = {BMJ},

abstract = {<jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>To evaluate sex differences in mortality among people with kidney failure compared with the general population.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Population based cohort study using data linkage.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>The Australian and New Zealand Dialysis and Transplant Registry (ANZDATA), which includes all patients receiving kidney replacement therapy in Australia (1980-2019) and New Zealand (1988-2019). Data were linked to national death registers to determine deaths and their causes, with additional details obtained from ANZDATA.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Of 82 844 people with kidney failure, 33 329 were female (40%) and 49 555 were male (60%); 49 376 deaths (20 099 in female patients; 29 277 in male patients) were recorded over a total of 536 602 person years of follow-up.</jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p>Relative measures of survival, including standardised mortality ratios, relative survival, and years of life lost, using general population data to account for background mortality (adjusting for country, age, sex, and year). Estimates were stratified by dialysis modality (haemodialysis or peritoneal dialysis) and for the subpopulation of kidney transplant recipients.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Few differences in outcomes were found between male and female patients with kidney failure. However, compared with the general population, female patients with kidney failure had greater excess all cause deaths than male patients (female patients: standardised mortality ratio 11.3, 95% confidence interval 11.2 to 11.5, expected deaths 1781, observed deaths 20 099; male patients: 6.9, 6.8 to 6.9, expected deaths 4272, observed deaths 29 277). The greatest difference was observed among younger patients and those who died from cardiovascular disease. Relative survival was also consistently lower in female patients, with adjusted excess mortality 11% higher (95% confidence interval 8% to 13%). Average years of life lost was 3.6 years (95% confidence interval 3.6 to 3.7) greater in female patients with kidney failure compared with male patients across all ages. No major differences were found in mortality by sex for haemodialysis or peritoneal dialysis. Kidney transplantation reduced but did not entirely remove the sex difference in excess mortality, with similar relative survival (P=0.83) and years of life lost difference reduced to 2.3 years (95% confidence interval 2.2 to 2.3) between female and male patients.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Compared with the general population, female patients had greater excess deaths, worse relative survival, and more years of life lost than male patients, however kidney transplantation reduced these differences. Future research should investigate whether systematic differences exist in access to care and possible strategies to mitigate excess mortality among female patients.</jats:p></jats:sec>},

keywords = {CELESTIAL, General Earth and Planetary Sciences, General Environmental Science},

pubstate = {published},

tppubtype = {article}

}

@article{Hedley2021,

title = {Cancer transmissions and non‐transmissions from solid organ transplantation in an Australian cohort of deceased and living organ donors},

author = {James A. Hedley and Claire M. Vajdic and Melanie Wyld and Karen M.J. Waller and Patrick J. Kelly and Nicole L. De La Mata and Brenda M. Rosales and Kate Wyburn and Angela C. Webster},

doi = {10.1111/tri.13989},

issn = {1432-2277},

year  = {2021},

date = {2021-09-00},

urldate = {2021-09-00},

journal = {Transpl Int},

volume = {34},

number = {9},

pages = {1667--1679},

publisher = {Frontiers Media SA},

keywords = {SAFEBOD, Transplantation},

pubstate = {published},

tppubtype = {article}

}

@article{Khou2020,

title = {Cause of death for people with end-stage kidney disease withdrawing from treatment in Australia and New Zealand},

author = {Victor Khou and Nicole L De La Mata and Rachael L Morton and Patrick J Kelly and Angela C Webster},

doi = {10.1093/ndt/gfaa105},

issn = {1460-2385},

year  = {2021},

date = {2021-07-23},

urldate = {2021-07-23},

volume = {36},

number = {8},

pages = {1527--1537},

publisher = {Oxford University Press (OUP)},

abstract = {<jats:title>Abstract</jats:title>

               <jats:sec>

                  <jats:title>Background</jats:title>

                  <jats:p>Withdrawal from renal replacement therapy is common in patients with end-stage kidney disease (ESKD), but end-of-life service planning is challenging without population-specific data. We aimed to describe mortality after treatment withdrawal in Australian and New Zealand ESKD patients and evaluate death-certified causes of death.</jats:p>

               </jats:sec>

               <jats:sec>

                  <jats:title>Methods</jats:title>

                  <jats:p>We performed a retrospective cohort study on incident patients with ESKD in Australia, 1980–2013, and New Zealand, 1988–2012, from the Australian and New Zealand Dialysis and Transplant registry. We estimated mortality rates (by age, sex, calendar year and country) and summarized withdrawal-related deaths within 12 months of treatment modality change. Certified causes of death were ascertained from data linkage with the Australian National Death Index and New Zealand Mortality Collection database.</jats:p>

               </jats:sec>

               <jats:sec>

                  <jats:title>Results</jats:title>

                  <jats:p>Of 60 823 patients with ESKD, there were 8111 treatment withdrawal deaths and 26 207 other deaths over 381 874 person-years. Withdrawal-related mortality rates were higher in females and older age groups. Rates increased between 1995 and 2013, from 1142 (95% confidence interval 1064–1226) to 2706/100 000 person-years (95% confidence interval 2498–2932), with the greatest increase in 1995–2006. A third of withdrawal deaths occurred within 12 months of treatment modality change. The national death registers reported kidney failure as the underlying cause of death in 20% of withdrawal cases, with other causes including diabetes (21%) and hypertensive disease (7%). Kidney disease was not mentioned for 18% of withdrawal patients.</jats:p>

               </jats:sec>

               <jats:sec>

                  <jats:title>Conclusions</jats:title>

                  <jats:p>Treatment withdrawal represents 24% of ESKD deaths and has more than doubled in rate since 1988. Population data may supplement, but not replace, clinical data for end-of-life kidney-related service planning.</jats:p>

               </jats:sec>},

keywords = {CELESTIAL, Nephrology, Transplantation},

pubstate = {published},

tppubtype = {article}

}

@article{Wyld2020,

title = {Cardiac Mortality in Kidney Transplant Patients: A Population-based Cohort Study 1988–2013 in Australia and New Zealand},

author = {Melanie L.R. Wyld and Nicole L. De La Mata and Philip Masson and Emma O’Lone and Patrick J. Kelly and Angela C. Webster},

doi = {10.1097/tp.0000000000003224},

issn = {0041-1337},

year  = {2021},

date = {2021-00-00},

urldate = {2021-00-00},

volume = {105},

number = {2},

pages = {413--422},

publisher = {Ovid Technologies (Wolters Kluwer Health)},

abstract = {<jats:sec>

            <jats:title>Background.</jats:title>

            <jats:p>Transplant recipients experience excess cardiac mortality. We compared circulatory death rates in Australian and New Zealand kidney transplant recipients to the general population and identified risk factors for circulatory death in kidney transplant recipients.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Methods.</jats:title>

            <jats:p>The primary cause of death for kidney transplant recipients aged ≥18 was established through ICD-10-AM codes using data linkage between the Australia and New Zealand dialysis and transplant registry and national death registers. We estimated standardized mortality ratios (SMRs) and developed a Fine–Gray competing risks model to determine risk factors for cardiac mortality.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Results.</jats:title>

            <jats:p>Of 5089 deaths in 16 329 kidney transplant recipients (158 325 person-years), 918 (18%) were cardiac. An increased risk of circulatory death was associated with older age (<jats:italic toggle="yes">P</jats:italic> < 0.001), male sex (<jats:italic toggle="yes">P</jats:italic> < 0.001), longer dialysis duration (<jats:italic toggle="yes">P</jats:italic> = 0.004), earlier era of transplantation (<jats:italic toggle="yes">P</jats:italic> < 0.001), ever graft failure (<jats:italic toggle="yes">P</jats:italic> < 0.001), known coronary artery disease (<jats:italic toggle="yes">P</jats:italic> = 0.002), and kidney failure from diabetes or hypertension (<jats:italic toggle="yes">P</jats:italic> < 0.001). The cardiac SMR was 5.4 [95% confidence interval (CI): 5.0-5.8], falling from 8.0 (95% CI: 4.9-13.1) in 1988 to 5.3 (95% CI: 4.0-7.0) in 2013 (<jats:italic toggle="yes">P</jats:italic> < 0.001). Females, particularly young ones, had significantly higher relative cardiac mortality than men. In recipients aged 40 years, the cardiac SMR was 26.5 (95% CI: 15.0-46.6) in females and 7.5 (95% CI: 5.0-11.1) for males.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Conclusions.</jats:title>

            <jats:p>Cardiac risks remain elevated in kidney transplant recipients and may be under-recognized, and prevention and treatment interventions less accessed, less effective or even harmful in female recipients.</jats:p>

          </jats:sec>},

keywords = {CELESTIAL, Transplantation},

pubstate = {published},

tppubtype = {article}

}

@article{Waller2020,

title = {New blood‐borne virus infections among organ transplant recipients: An Australian data‐linked cohort study examining donor transmissions and other HIV, hepatitis C and hepatitis B notifications, 2000‐2015},

author = {Karen M. J. Waller and Nicole L. De La Mata and James A. Hedley and Brenda M. Rosales and Michael J. O'Leary and Elena Cavazzoni and Vidiya Ramachandran and William D. Rawlinson and Patrick J. Kelly and Kate R. Wyburn and Angela C. Webster},

doi = {10.1111/tid.13437},

issn = {1399-3062},

year  = {2020},

date = {2020-12-00},

urldate = {2020-12-00},

journal = {Transplant Infectious Dis},

volume = {22},

number = {6},

publisher = {Wiley},

abstract = {<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Blood‐borne viral infections can complicate organ transplantation. Systematic monitoring to distinguish donor‐transmitted infections from other new infections post transplant is challenging. Administrative health data can be informative. We aimed to quantify post‐transplant viral infections, specifically those transmitted by donors and those reactivating or arising new in recipients.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We linked transplant registries with administrative health data for all solid organ donor‐recipient pairs in New South Wales, Australia, 2000‐2015. All new recipient notifications of hepatitis B (HBV), C (HCV), or human immunodeficiency virus (HIV) after transplant were identified. Proven/probable donor transmissions within 12 months of transplant were classified using an international algorithm.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 2120 organ donors, there were 72 with a viral infection (9/72 active, 63/72 past). These 72 donors donated to 173 recipients, of whom 24/173 already had the same infection as their donor, and 149/173 did not, so were at risk of donor transmission. Among those at risk, 3/149 recipients had proven/probable viral transmissions (1 HCV, 2 HBV); none were unrecognized by donation services. There were no deaths from transmissions. There were no donor transmissions from donors without known blood‐borne viruses. An additional 68 recipients had new virus notifications, of whom 2/68 died, due to HBV infection.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>This work confirms the safety of organ donation in an Australian cohort, with no unrecognized viral transmissions and most donors with viral infections not transmitting the virus. This may support targeted increases in donation from donors with viral infections. However, other new virus notifications post transplant were substantial and are preventable. Data linkage can enhance current biovigilance systems.</jats:p></jats:sec>},

keywords = {Infectious Diseases, MODUS, Transplantation},

pubstate = {published},

tppubtype = {article}

}

@article{Waller2020b,

title = {Effect of language and country of birth on the consent process and medical suitability of potential organ donors; a linked-data cohort study 2010–2015},

author = {Karen M.J. Waller and James A. Hedley and Brenda M. Rosales and Nicole L. De La Mata and Imogen K. Thomson and John Walker and Patrick J. Kelly and Michael J. O'Leary and Elena Cavazzoni and Kate R. Wyburn and Angela C. Webster},

doi = {10.1016/j.jcrc.2020.01.025},

issn = {0883-9441},

year  = {2020},

date = {2020-06-00},

urldate = {2020-06-00},

journal = {Journal of Critical Care},

volume = {57},

pages = {23--29},

publisher = {Elsevier BV},

abstract = {Australia has unmet need for transplantation. We sought to assess the impact of cultural and linguistic diversity (CALD) on family consent and medical suitability for organ donation.

Cohort study of New South Wales donor referrals, 2010–2015. Logistic regression estimated effects of primary language other than English and birthplace outside Australia (odds ratios OR, with 95% confidence intervals, 95%CI). Outcomes were whether families were asked for consent to donation, provided consent for donation, and whether the referral was medically suitable for donation.

Of 2977 organ donor referrals, a similar proportion of families had consent for donation was sought between non-English speakers and English speakers (p = .07), and between overseas-born compared to Australian-born referrals (p = .3). However, consent was less likely to be given for both non-English speakers than English speakers (OR 0.44, 95%CI:0.29–0.67), and those overseas-born than Australian-born (OR 0.54, 95%CI:0.41–0.72). For referrals both overseas-born and non-English speaking, families were both less likely to be asked for consent (OR 0.67; 95%CI:0.49–0.91) or give consent (OR 0.24; 95%CI0.16–0.37). There was no difference in medical suitability between English speakers and non-English speakers (p = .6), or between Australian-born and overseas-born referrals (p = .6).

Intervention to improve consent rates from CALD families may increase donation.},

keywords = {Critical Care and Intensive Care Medicine, SAFEBOD},

pubstate = {published},

tppubtype = {article}

}

@article{Rosales2019,

title = {Cancer mortality in kidney transplant recipients: An Australian and New Zealand population‐based cohort study, 1980–2013},

author = {Brenda M. Rosales and Nicole De La Mata and Claire M. Vajdic and Patrick J. Kelly and Kate Wyburn and Angela C. Webster},

doi = {10.1002/ijc.32585},

issn = {1097-0215},

year  = {2020},

date = {2020-05-15},

urldate = {2020-05-15},

journal = {Intl Journal of Cancer},

volume = {146},

number = {10},

pages = {2703--2711},

publisher = {Wiley},

abstract = {<jats:p>Cancer burden is increasing in kidney transplant recipients, but differences in mortality compared to the general population remain unclear. We sought to compare cancer mortality in paediatric and adult kidney transplant recipients with the general population and describe any differences, by site, age and sex, country and over time. We included kidney transplant recipients from the Australian and New Zealand Dialysis and Transplantation Registry, 1980–2013. Date of death and underlying cause of death were ascertained by data‐linkage and classified using ICD10AM codes. Indirect standardisation was used to estimate standardised mortality ratios (SMR). There were 5,284 deaths in 17,628 kidney transplant recipients over 175,084 person‐years of observation, including 1,061 (20%) cancer deaths. Relative cancer mortality was higher than the general population for all‐site (SMR 2.9, 95% CI 2.7–3.1) cancer and highest for nonmelanoma skin cancer (SMR 50.9, 95% CI 43.5–59.6) and lymphoma (SMR 42.2, 95% CI 35.3–50.5). Relative cancer mortality decreased with increasing age in men (<jats:italic>p</jats:italic> < 0.001) and women (<jats:italic>p</jats:italic> = 0.001) but never reached parity with the general population. Relative mortality did not change with age for skin and lip, or colorectal cancers (<jats:italic>p</jats:italic>‐value >0.1). Only relative colorectal cancer mortality increased over time (<jats:italic>p</jats:italic> = 0.002). Our study shows cancer mortality in kidney transplant recipients was higher than expected in the general population. The magnitude of excess mortality varied by cancer site, age and sex. Further evidence is needed to identify whether this variation is due to differences at diagnosis or access and effectiveness of cancer treatments in this population.</jats:p>},

keywords = {Cancer Research, CELESTIAL, Oncology},

pubstate = {published},

tppubtype = {article}

}

@article{DeLaMata2020,

title = {Survival in Living Kidney Donors: An Australian and New Zealand Cohort Study Using Data Linkage},

author = {Nicole L. De La Mata and Philip A. Clayton and Patrick J. Kelly and Stephen McDonald and Steven Chadban and Kevan R. Polkinghorne and Angela C. Webster},

doi = {10.1097/txd.0000000000000975},

issn = {2373-8731},

year  = {2020},

date = {2020-00-00},

urldate = {2020-00-00},

volume = {6},

number = {3},

publisher = {Ovid Technologies (Wolters Kluwer Health)},

abstract = {<jats:sec>

            <jats:title>Background.</jats:title>

            <jats:p>Living kidney donors are a highly selected healthy population expected to have high survival postdonation, but mortality studies are limited. Our study aimed to compare mortality in living kidney donors with the general population in Australia and New Zealand, hypothesizing that donor survival would exceed average survival.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Methods.</jats:title>

            <jats:p>All living kidney donors in Australia, 2004–2013, and New Zealand, 2004–2012, from the Australian and New Zealand Living Kidney Donor Registry were included. We ascertained primary cause of death from data linkage with national death registers. Standardized mortality ratios and relative survival were estimated, matching on age, sex, calendar year, and country.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Results.</jats:title>

            <jats:p>Among 3253 living kidney donors, there were 32 deaths over 20 331 person-years, with median follow-up 6.2 years [interquartile range: 3.9–8.4]. Only 25 donors had diabetes-fasting blood sugar level predonation, of which 3 had impaired glucose tolerance. At discharge, the median creatinine was 108 µmol/L and estimated glomerular filtration rate was 58 mL/min/1.72 m<jats:sup>2</jats:sup>. Four deaths occurred in the first year: 2 from immediate complications of donation, and 2 from unrelated accidental causes. The leading cause of death was cancer (n = 16). The crude mortality rate was 157 (95% confidence interval [CI], 111-222)/100 000 person-y, and the standardized mortality ratio was 0.33 (95% CI, 0.24-0.47). The 5-year cumulative relative survival was 1.019 (95% CI, 1.014-1.021), confirming that the survival probability in living kidney donors was 2% higher relative to the general population.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Conclusions.</jats:title>

            <jats:p>As expected, mortality in living kidney donors was substantially lower than the general population and is reassuring for potential donor counseling. The Living Donor Registry only captured a third of the deaths, highlighting the benefit of data linkage to national death registries in the long-term follow-up of living kidney donors.</jats:p>

          </jats:sec>},

keywords = {ORCHARD},

pubstate = {published},

tppubtype = {article}

}

@article{Rosales2020,

title = {Safety and Biovigilance in Organ Donation (SAFEBOD): Protocol for a Population-Based Cohort Study},

author = {Brenda Rosales and James Hedley and Nicole De La Mata and Claire M Vajdic and Patrick Kelly and Kate Wyburn and Angela C Webster},

doi = {10.2196/18282},

issn = {1929-0748},

year  = {2020},

date = {2020-00-00},

urldate = {2020-00-00},

journal = {JMIR Res Protoc},

volume = {9},

number = {10},

publisher = {JMIR Publications Inc.},

abstract = {<jats:sec>

            <jats:title>Background</jats:title>

            <jats:p>Tension lies between the need to increase access to organ transplantation and the equally urgent need to prevent inadvertent transmission of infectious diseases or cancer from organ donors. Biovigilance, or the evaluation of potential donors, is often time-pressured and may be based on incomplete information.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Objective</jats:title>

            <jats:p>The Safety and Biovigilance in Organ Donation (SAFEBOD) study aims to improve estimates of infection and cancer transmission risk and explore how real-time data access could support decision-making.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Methods</jats:title>

            <jats:p>We will link existing donor referral, actual donor, recipient, and health-outcome data sets from 2000-2015 in New South Wales. Organ donor data sets will include the Organ Donor Characterizing Risk-Profile of Donors Study, the National Organ Matching System, the Australian and New Zealand Organ Donor Register, and the Australian and New Zealand Living Donor Kidney Register. Recipient data sets will include the Australian and New Zealand Dialysis and Transplant Register, the Australian and New Zealand Cardiothoracic Register, the Australian and New Zealand Islet and Pancreas Register, and the Australian and New Zealand Liver Transplant Register. New South Wales health outcome data sets will include HIV and AIDS Notifications and Surveillance Data, the Notifiable Conditions Information Management System, Admitted Patient Data Collection, Emergency Department Data Collection, the Central Cancer Registry, and the Cause of Death Data Collection. We will link organ donors to transplant recipients and health outcomes data sets using probabilistic data-matching based on personal identifiers. Transmission and nontransmission events will be determined by comparing previous cases in donors and posttransplant cases in recipients. We will compare the perceived-risk at referral with the verified risk from linked health outcome data sets and the odds of cancer or contracting an infectious disease in organ recipients from donors based on their transmission-risk profile and estimate recipient survival by donor transmission risk group.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Results</jats:title>

            <jats:p>Data were requested from each of the listed registries in September 2018, and data collection is ongoing. Linked data from all listed data sets are expected to be complete in September 2020.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Conclusions</jats:title>

            <jats:p>The SAFEBOD study will overcome current limitations in organ donation by accessing comprehensive information on referred organ donors and recipients in existing data sets. The study will provide robust estimates of disease transmission and nontransmission events based on recent data. It will also describe the agreement between perceived risk estimated at the time of referral and verified risk when all health outcome data are accessible. The improved understanding of transmission and nontransmission events will inform clinical decisions and highlight where current policies can be revised to broaden the acceptance of deceased donors.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>International Registered Report Identifier (IRRID)</jats:title>

            <jats:p>DERR1-10.2196/18282</jats:p>

          </jats:sec>},

keywords = {General Medicine, SAFEBOD},

pubstate = {published},

tppubtype = {article}

}

@article{DeLaMata2019,

title = {Excess Stroke Deaths in Kidney Transplant Recipients: A Retrospective Population-based Cohort Study Using Data Linkage},

author = {Nicole L. De La Mata and Patrick J. Kelly and Melanie Wyld and Philip Masson and Rustam Al-Shahi Salman and Angela C. Webster},

doi = {10.1097/tp.0000000000003091},

issn = {0041-1337},

year  = {2020},

date = {2020-00-00},

urldate = {2020-00-00},

volume = {104},

number = {10},

pages = {2129--2138},

publisher = {Ovid Technologies (Wolters Kluwer Health)},

abstract = {Kidney transplant recipients are thought to experience a high risk of stroke; however, little data exist. We aimed to compare the stroke deaths in kidney transplant recipients with the general population and identify risk factors for stroke death in kidney transplant recipients.

Cause of death was established using data linkage between the Australian and New Zealand Dialysis and Transplant Registry and national death registers: Australia, 1980–2013, and New Zealand, 1988–2012. We estimated standardized mortality ratios (SMR) and used competing risks models to identify risk factors. Subanalysis explored those with polycystic kidney disease.

Among 17 628 kidney transplant recipients, there were 158 stroke deaths and 5126 nonstroke deaths in 175 084 person-years. Those aged 30–49 years experienced more stroke deaths than expected, especially women (SMR in females: 19.7 [95% confidence interval, 12.9-30.3] and males: 9.1 [95% confidence interval, 5.6-14.6]). Higher risk of stroke death was associated with older age at transplant, ever graft failure, earlier era of transplant, preexisting cerebrovascular disease, and no previous malignancy. Polycystic kidney disease did not result in different SMR.

Kidney transplant recipients had excess stroke deaths, particularly at younger ages and women. Preexisting cerebrovascular disease was a potentially modifiable risk factor for stroke death, suggesting further studies of secondary stroke prevention for kidney transplant recipients.},

keywords = {CELESTIAL, Transplantation},

pubstate = {published},

tppubtype = {article}

}

@article{DeLaMata2020b,

title = {Survival in Living Kidney Donors: An Australian and New Zealand Cohort Study Using Data Linkage},

author = {Nicole L. De La Mata and Philip A. Clayton and Patrick J. Kelly and Stephen McDonald and Steven Chadban and Kevan R. Polkinghorne and Angela C. Webster},

doi = {10.1097/txd.0000000000000975},

issn = {2373-8731},

year  = {2020},

date = {2020-00-00},

urldate = {2020-00-00},

volume = {6},

number = {3},

publisher = {Ovid Technologies (Wolters Kluwer Health)},

abstract = {Living kidney donors are a highly selected healthy population expected to have high survival postdonation, but mortality studies are limited. Our study aimed to compare mortality in living kidney donors with the general population in Australia and New Zealand, hypothesizing that donor survival would exceed average survival.

All living kidney donors in Australia, 2004–2013, and New Zealand, 2004–2012, from the Australian and New Zealand Living Kidney Donor Registry were included. We ascertained primary cause of death from data linkage with national death registers. Standardized mortality ratios and relative survival were estimated, matching on age, sex, calendar year, and country.

Among 3253 living kidney donors, there were 32 deaths over 20 331 person-years, with median follow-up 6.2 years [interquartile range: 3.9–8.4]. Only 25 donors had diabetes-fasting blood sugar level predonation, of which 3 had impaired glucose tolerance. At discharge, the median creatinine was 108 µmol/L and estimated glomerular filtration rate was 58 mL/min/1.72 m<jats:sup>2</jats:sup>. Four deaths occurred in the first year: 2 from immediate complications of donation, and 2 from unrelated accidental causes. The leading cause of death was cancer (n = 16). The crude mortality rate was 157 (95% confidence interval [CI], 111-222)/100 000 person-y, and the standardized mortality ratio was 0.33 (95% CI, 0.24-0.47). The 5-year cumulative relative survival was 1.019 (95% CI, 1.014-1.021), confirming that the survival probability in living kidney donors was 2% higher relative to the general population.

As expected, mortality in living kidney donors was substantially lower than the general population and is reassuring for potential donor counseling. The Living Donor Registry only captured a third of the deaths, highlighting the benefit of data linkage to national death registries in the long-term follow-up of living kidney donors.},

keywords = {CELESTIAL, Transplantation},

pubstate = {published},

tppubtype = {article}

}

@article{Waller2019,

title = {Residual risk of infection with blood‐borne viruses in potential organ donors at increased risk of infection: systematic review and meta‐analysis},

author = {Karen MJ Waller and Nicole L De La Mata and Patrick J Kelly and Vidiya Ramachandran and William D Rawlinson and Kate R Wyburn and Angela C Webster},

doi = {10.5694/mja2.50315},

issn = {1326-5377},

year  = {2019},

date = {2019-11-00},

urldate = {2019-11-00},

journal = {Medical Journal of Australia},

volume = {211},

number = {9},

pages = {414--420},

publisher = {Wiley},

keywords = {General Medicine, MODUS},

pubstate = {published},

tppubtype = {article}

}

@article{Hedley2019,

title = {Weekend effect: analysing temporal trends in solid organ donation},

author = {James A. Hedley and Nicholas Chang and Patrick J. Kelly and Brenda M. Rosales and Kate Wyburn and Michael O'Leary and Elena Cavazzoni and Angela C. Webster},

doi = {10.1111/ans.15015},

issn = {1445-2197},

year  = {2019},

date = {2019-09-00},

urldate = {2019-09-00},

journal = {ANZ Journal of Surgery},

volume = {89},

number = {9},

pages = {1068--1074},

publisher = {Wiley},

abstract = {<jats:sec><jats:title>Background</jats:title><jats:p>Research suggests patients treated over weekends experience poorer outcomes. Only one US‐based study explored this weekend effect in organ donation, specifically the kidney discard rate. In Australia potential donors are referred to a donation service, and donation proceeds if family consent is granted and the donor is deemed medically suitable to donate. Organ procurement occurs when utilization is almost certain hence discard rates are much lower than in the USA. We aimed to characterize the effect of weekend referral on organ donation in Australia.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We retrospectively reviewed all New South Wales Organ and Tissue Donation Service logs from 2010 to 2016. Our primary outcome was progression to organ procurement, and secondary outcomes were family consent and meeting medical suitability thresholds. We used logistic regression with random effects adjusting for clustering of referral hospitals.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 3496 potential donors referred for consideration, 694 (20%) progressed to organ procurement. There were fewer referrals on weekends (average 415 versus 588 for weekdays). However, donation rates were no lower for weekend compared to weekday referrals (adjusted OR 1.17; 95% CI 0.95, 1.44). Family consent (adjusted OR 1.20; 95% CI 1.00, 1.44) and medical suitability (adjusted OR 1.15; 95% CI 0.96, 1.38) were not lower for weekend compared to weekday referrals. Similar results were found for all sensitivity analyses conducted.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In Australia, the donation pathway operates consistently throughout the week, with donation no less likely to proceed on weekends and holidays. This finding contrasts with findings in the USA.</jats:p></jats:sec>},

keywords = {ORCHARD},

pubstate = {published},

tppubtype = {article}

}

@article{Hedley2019b,

title = {Weekend effect: analysing temporal trends in solid organ donation},

author = {James A. Hedley and Nicholas Chang and Patrick J. Kelly and Brenda M. Rosales and Kate Wyburn and Michael O'Leary and Elena Cavazzoni and Angela C. Webster},

doi = {10.1111/ans.15015},

issn = {1445-2197},

year  = {2019},

date = {2019-09-00},

urldate = {2019-09-00},

journal = {ANZ Journal of Surgery},

volume = {89},

number = {9},

pages = {1068--1074},

publisher = {Wiley},

abstract = {Research suggests patients treated over weekends experience poorer outcomes. Only one US‐based study explored this weekend effect in organ donation, specifically the kidney discard rate. In Australia potential donors are referred to a donation service, and donation proceeds if family consent is granted and the donor is deemed medically suitable to donate. Organ procurement occurs when utilization is almost certain hence discard rates are much lower than in the USA. We aimed to characterize the effect of weekend referral on organ donation in Australia.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We retrospectively reviewed all New South Wales Organ and Tissue Donation Service logs from 2010 to 2016. Our primary outcome was progression to organ procurement, and secondary outcomes were family consent and meeting medical suitability thresholds. We used logistic regression with random effects adjusting for clustering of referral hospitals.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 3496 potential donors referred for consideration, 694 (20%) progressed to organ procurement. There were fewer referrals on weekends (average 415 versus 588 for weekdays). However, donation rates were no lower for weekend compared to weekday referrals (adjusted OR 1.17; 95% CI 0.95, 1.44). Family consent (adjusted OR 1.20; 95% CI 1.00, 1.44) and medical suitability (adjusted OR 1.15; 95% CI 0.96, 1.38) were not lower for weekend compared to weekday referrals. Similar results were found for all sensitivity analyses conducted.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In Australia, the donation pathway operates consistently throughout the week, with donation no less likely to proceed on weekends and holidays. This finding contrasts with findings in the USA.</jats:p></jats:sec>},

keywords = {General Medicine, Other CODE work, Surgery},

pubstate = {published},

tppubtype = {article}

}

@article{Thomson2019,

title = {Epidemiology and Comorbidity Burden of Organ Donor Referrals in Australia: Cohort Study 2010–2015},

author = {Imogen K. Thomson and Brenda M. Rosales and Patrick J. Kelly and Kate Wyburn and Karen M.J. Waller and Daniel Hirsch and Michael J. O’Leary and Angela C. Webster},

doi = {10.1097/txd.0000000000000938},

issn = {2373-8731},

year  = {2019},

date = {2019-00-00},

urldate = {2019-00-00},

volume = {5},

number = {11},

publisher = {Ovid Technologies (Wolters Kluwer Health)},

abstract = {Increasing organ donation rates in Australia have been exceeded by a rise in potential donor referrals not proceeding to donate. Referral evaluation is resource-intensive. We sought to characterize organ donor referrals in New South Wales, Australia, and identify predictors of referrals not proceeding to donation.

We performed a cohort study of NSW Organ and Tissue Donation Service logs 2010–2015, describing the prevalence and impact of comorbidities on referral outcome. Logistic regression was used to identify comorbidities influencing outcome and predict probability of donation.

Of 2977 referrals, 669 (22%) donated and 2308 (78%) did not. Despite increasing donation rates, the proportion proceeding to donate declined 2010–2015. Among referrals, the prevalence of all comorbidities except cerebrovascular disease increased and was higher among nondonors. History of cardiac disease, ≥65 years of age, chronic kidney or liver disease, malignancy, and absence of cerebrovascular disease were all significantly (P< 0.01) associated with non donation. Hypertension and diabetes did not significantly impact outcome. Predicted probability of donation varied from <1% to 54% depending on comorbidity burden of the referral.

Comorbidity burden among donor referrals is increasing. The presence of particular comorbidities may significantly impact referral outcome. A better understanding of referral characteristics associated with non donation may improve the efficiency of the referral process in the context of encouraging routine referrals.},

keywords = {ORCHARD, Transplantation},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {[No title]},

doi = { https://doi.org/10.1093/ndt/gfae046},

keywords = {},

pubstate = {published},

tppubtype = {article}

}