@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{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{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}

}