@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 = {Transmission and Non-transmission of Melanoma From Deceased Solid Organ Donors to Transplant Recipients: Risks and Missed Opportunities},

author = {Rosales BM, Hedley J, De La Mata N, Cavazzoni E, Vajdic CM, Thompson JF, Kelly PJ, Wyburn K, Webster AC},

doi = {10.1097/TP.0000000000004961},

year  = {2024},

date = {2024-02-29},

keywords = {MODUS, SAFEBOD, Transplantation},

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{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{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{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{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{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}

}