Francesca Jackson-Spence - Academia.edu (original) (raw)
Papers by Francesca Jackson-Spence
Expert Review of Anticancer Therapy, Jan 20, 2022
ABSTRACT Introduction Outcomes for patients with advanced or metastatic urothelial carcinoma (UC)... more ABSTRACT Introduction Outcomes for patients with advanced or metastatic urothelial carcinoma (UC) remain poor. Targeting the programmed death ligand-1 (PD-(L)1) immune checkpoint pathway has emerged as a useful target in patients with UC. Avelumab is a PD-L1 inhibitor, resulting in restoration of a cytotoxic, antitumor T cell response. Results from the JAVELIN bladder 100 trial has resulted in a new standard of care of platinum-based chemotherapy sequenced by maintenance avelumab in advanced or metastatic UC. Areas covered This review covers the clinical evidence for avelumab in UC. This includes the maintenance approach with avelumab, which has become the standard of care, following platinum-based chemotherapy. Expert opinion Immune checkpoint inhibitor treatment in metastatic UC holds much promise, but has not been optimized. First-line maintenance avelumab is an attractive option for these patients. Future research will significantly change the landscape of treatment in the near future.
Cancer
There have been significant advances in the treatment of urology cancers, with a number of practi... more There have been significant advances in the treatment of urology cancers, with a number of practice‐changing treatments. There is now greater clarity on the role of the use of immunotherapies in renal cell carcinoma. The use of triplet combinations with immune checkpoint inhibition with anti‐vascular endothelial growth factor tyrosine kinase inhibitors in the front‐line setting for metastatic disease (COSMIC313) has been explored. The use of adjuvant therapy has been complicated by a series of negative immune therapy trials. Promising results with the HIF‐2α transcription factor inhibitor, belzutifan, alone or in combination with other agents, have been reported. Antibody drug conjugates, including enfortumab vedotin and sacituzumab govitecan, have continued to show activity in urothelial cancer with promising clinical outcomes. This has led to further exploration of the combination of these novel agents with immunotherapy and accelerated Food and Drug Administration approvals. Data...
Journal of Clinical Oncology
e24086 Background: Immune checkpoint inhibitors (ICIs) are well established in the treatment of m... more e24086 Background: Immune checkpoint inhibitors (ICIs) are well established in the treatment of metastatic renal cell (mRCC) and urothelial carcinomas (mUC). The profile of ICI immune-related adverse events (irAEs) is well described, however, data on timings of toxicity and irAEs occurring at ≥12 months are lacking. Methods: A single-site retrospective audit of mRCC and mUC patients receiving ICI-based therapy for ≥12 months between January 2014 and December 2022. ICI-based therapies included monotherapy and combination therapy with other ICIs or anti-VEGF tyrosine kinase inhibitors (TKIs). Best response to ICI-based therapy and irAEs were described. Results: 199 patients received ICI-based therapy, of which 34% (68/199) received treatment for ≥12 months. Of those on therapy for ≥12 months, 44% (30/68), 25% (17/68), and 31% (21/68) were treated with ICI monotherapy, combination with other ICIs, and TKIs, respectively. At data cut-off, 69% (47/68) were alive. 26% (18/68), 59% (40/68)...
Future Oncology
The standard-of-care for muscle-invasive bladder cancer is radical surgery with neoadjuvant cispl... more The standard-of-care for muscle-invasive bladder cancer is radical surgery with neoadjuvant cisplatin-based chemotherapy. Despite curative intent from these interventions, relapse rates post-surgery remain high, with approximately 50% of patients developing local or distant recurrence within 2 years of surgery and a 5-year survival of only 50–60%. Identifying patients who are high risk for relapse post-surgery is a priority. Monitoring patients for circulating tumor DNA (ctDNA) is a minimally invasive approach that appears attractive for selecting patients potentially suitable for adjuvant treatment with checkpoint inhibitors. IMvigor011 (NCT04660344) is a global, double-blind, randomized phase III study assessing the efficacy of atezolizumab (anti-PD-L1) versus placebo in patients with high-risk muscle-invasive bladder cancer who are ctDNA positive post-cystectomy. The primary end point is disease-free survival in participants who are ctDNA positive within 20 weeks of cystectomy.
Journal of Clinical Oncology
725 Background: The characterisation of DNA alternations in papillary renal cancer (PRC) is uncle... more 725 Background: The characterisation of DNA alternations in papillary renal cancer (PRC) is unclear. The CALYPSO trial (NCT02819596) prospectively evaluated combination therapy of savolitinib (MET inhibitor) and durvalumab (PD-L1 inhibitor) in PRC. The trial showed high response rates (RR) in the MET-driven population. Here we explore the relationship between MET, PD-L1 and TMB in these tumours and the relevance of other biomarkers including PIK3CA, PTEN and KRAS. Methods: FoundationOne analysis from 41 samples of PRC patients enrolled on the CALYPSO trial was performed. The relevance of co-positivity between MET/PD-L1 and MET/TMB as well as analysis of other DNA alterations such as PIK3CA, PTEN and KRAS was explored. Outcome parameters were correlated with RR, PFS and OS. Results: 41% of patients were MET-driven, 66% were PD-L1+ (vCPS≥1) and 3% were TMB >10mut/Mb. Further testing used TMB ≥ median (2.52mut/Mb) 32% of patients were both MET-driven and PD-L1+. 17% of patients were...
Clinical Genitourinary Cancer
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2018
OBJECTIVES Donor kidney measurements may affect outcomes of transplanted allografts. We tested al... more OBJECTIVES Donor kidney measurements may affect outcomes of transplanted allografts. We tested allograft and recipient measurements on kidney allograft outcomes. In this study, we compared the effects of kidney allograft volumes, which were measured using computed tomographic angiography before transplant, and allograft weight, which was measured during surgery, in relation to the recipient's body weight and body mass index on kidney function at 6 and 12 months after transplant. MATERIAL AND METHODS We included 74 patients (40 female and 34 male patients, mean age of 50.42 ±; 9.75 y) in this study. RESULTS Intraoperative allograft weight was 182.68 ± 40.33 g (range, 104-266 g). The allograft volume measured using computed tomographic angiography scanning was 123.34 ± 24.26 mL (range, 78-181 mL). The estimated glomerular filtration rates of the recipients at 6 and 12 months after transplant correlated negatively with age and recipient body mass index but correlated positively wit...
Cancer Medicine, 2018
Administrative data are frequently used for epidemiological studies but its usefulness to analyze... more Administrative data are frequently used for epidemiological studies but its usefulness to analyze cancer epidemiology after kidney transplantation is unclear. In this retrospective population‐based cohort study, we identified every adult kidney‐alone transplant performed in England (2003–2014) using administrative data from Hospital Episode Statistics. Results were compared to the hospitalized adult general population in England to calculate standardized incidence and mortality ratios. Data were analyzed for 19,883 kidney allograft recipients, with median follow‐up 6.0 years' post‐transplantation. Cancer incidence was more common after kidney transplantation compared to the general population in line with published literature (standardized incidence ratio 2.47, 95% CI: 2.34–2.61). In a Cox proportional hazards model, cancer development was associated with increasing age, recipients of deceased kidneys, frequent readmissions within 12 months post‐transplant and first kidney recip...
Experimental and Clinical Transplantation, 2019
OBJECTIVES Historical data have suggested that donor smoking is associated with detrimental clini... more OBJECTIVES Historical data have suggested that donor smoking is associated with detrimental clinical outcomes for recipients of kidneys from deceased donors. However, the effects of smoking status of a kidney donor on the outcomes of the recipient in a contemporary setting of immunosuppression and transplant practice have not yet been ascertained. MATERIALS AND METHODS This retrospective, population-cohort study analyzed data of all deceased-donor kidney-alone transplant procedures performed in the United Kingdom between April 2001 and April 2013. Our study included 11?199 deceased-donor kidney allograft recipients, with median follow-up of 46 months posttransplant. RESULTS In our cohort, 5280 deceased donors (47.1%) had a documented history of smoking. Deceased donors with versus those without smoking history were more likely to be younger (mean age of 48 vs 50 years; P < .001), be of white ethnicity (96.6% vs 95.3%; P < .001), and have brain death before donation (77.1% vs 74.9%; P = .006). On unadjusted survival analyses, overall patient survival was significantly shorter in patients who received kidney allografts from deceased donors with smoking history (hazard ratio of 1.12, 95% confidence interval, 1.00-1.25; P = .044). No significant association was seen for death-censored or overall graft survival. Our multivariate survival analyses showed that, after accounting for confounding factors, the effects of donor smoking status remained significant for patient survival (hazard ratio of 1.16, 95% CI, 1.03-1.29; P =.011) but not graft survival. CONCLUSIONS This population-cohort study suggests that deceased-donor kidneys from smokers contribute to an increased risk of death for kidney allograft recipients. These study findings imply donor smoking history should be factored into the risk stratification decision for recipient selection to optimize decision making; however, further clarification and validation of these data are warranted.
Journal of Renal Care, 2019
SUMMARYBackgroundRecipients with failing kidney transplants (RFKTs) may receive sub‐optimal care ... more SUMMARYBackgroundRecipients with failing kidney transplants (RFKTs) may receive sub‐optimal care compared with patients with native kidney disease. The aim of this study is to compare the outcomes of RFKTs managed in a dedicated low clearance transplant clinic (LCTC) compared with those attending a general transplant clinic.MethodsWe undertook a retrospective analysis of patients with failing kidney transplants comparing two clinics—a LCTC versus a general transplant clinic. Kidney transplant recipients with an eGFR < 20 ml/min were included. A cross‐sectional analysis was undertaken of all patients with two consecutive follow‐up visits between the dates of January and July 2016 in either clinic, with follow‐up to event or December 2017.ResultsData were analysed for 141 kidney transplant recipients; 60 in the LCTC and 81 in the general transplant clinic. More patients in the LCTC cohort were non‐white and early transplant recipients. A significantly greater proportion of LCTC ver...
Archives of Renal Diseases and Management, 2017
Background: Language barriers are associated with worse health outcomes in the general population... more Background: Language barriers are associated with worse health outcomes in the general population but data in kidney transplantation is lacking. This study tested the hypothesis that non-native English speakers using interpreters have poorer outcomes after kidney transplantation compared to native English speakers. Methods: A single-center retrospective study analyzing all kidney allograft recipients transplanted between 2007-2015, with data linkage between various electronic patient records to create a comprehensive database. Results: Data was extracted for 1,140 patients, with median follow up 4.4 years' post-transplantation. Ethnicity breakdown was; Caucasian (72.1%), black (5.5%), south Asian (17.6%) and other (4.7%). Interpreters had been requested for 40 kidney allograft recipients, with the commonest language required being Urdu/Punjabi (n=25). Patients requiring interpreting services were more likely to be of south Asian ethnicity (80.0% of users versus 15.4% of non-users, p<0.001) and female (60.0% of users versus 39.5% of non-users, p=0.008). Recipients using versus not using interpreters had less kidney allograft rejection (2.5% versus 14.8% respectively, p=0.014). There was no difference between groups for development of post-transplant diabetes, cardiac events, cerebrovascular accidents, and cancer or patient/graft survival. Conclusion: Kidney allograft recipients with poor English skills who require interpreting services do not suffer adverse patient or kidney allograft outcomes.
Diabetic Medicine, 2017
• Rejection of the kidney allograft is the most feared complication after kidney transplantation ... more • Rejection of the kidney allograft is the most feared complication after kidney transplantation from a patient perspective, but it is unclear if patients with diabetes have an increased risk of this complication. • In this study, in the context of contemporary immunosuppression, we show that people with diabetes have an elevated risk of cellular rejection after kidney transplantation, but that this does not translate into adverse short-to-medium term kidney allograft outcomes. • Our data allow targeted risk counselling for people with diabetes who are awaiting kidney transplantation.
BMJ Open, 2017
Objectives Inferior outcomes for black kidney transplant recipients in the USA may not be general... more Objectives Inferior outcomes for black kidney transplant recipients in the USA may not be generalisable elsewhere. In this population cohort analysis, we compared outcomes for black kidney transplant patients in England versus New York State. Design Retrospective, comparative, population cohort study utilising administrative data registries. Settings and participants English data were derived from Hospital Episode Statistics, while New York State data were derived from Statewide Planning and Research Cooperative System. All adults receiving their first kidney-alone allograft between 2003 and 2013 were eligible for inclusion. Measures The primary outcome measure was mortality post kidney transplantation (including inhospital death, 30-day mortality and 1-year mortality). Secondary outcome measures included postoperative admission length of stay, risk of rehospitalisation, development of cardiac events, stroke, cancer or fracture and finally transplant rejection/failure. Cox proportional hazards regression was used to investigate relationship between ethnicity, country and outcome. Results Black patients comprised 6.5% of the English cohort (n=1215/18 493) and 23.0% of the New York State cohort (n=2660/11 602). Compared with New York State, black kidney transplant recipients in England were more likely younger, male, living-donor kidney recipients and had dissimilar medical comorbidities. Inpatient mortality was not statistically different, but death within 30 days, 1 year or kidney transplant rejection/failure was lower among black patients in England versus black patients in New York State. In adjusted regression analysis, with black ethnicity the reference group, white patients had reduced risk for 30day mortality (OR 0.62 (95% CI 0.44 to 0.86)) and 1-year mortality (OR 0.79 (95% CI 0.63 to 0.99)) in New York State but no difference was observed in England. Compared with England, black kidney transplant patients in New York State had increased HR for kidney transplant rejection rejection/ failure by median follow-up (HR 2.15, 95% CI 1.91 to 2.43). Conclusions Outcomes after kidney transplantation for black patients may not be translatable between countries.
European Geriatric Medicine, 2017
The proportion of older patients with end-stage kidney disease (ESKD) undergoing renal replacemen... more The proportion of older patients with end-stage kidney disease (ESKD) undergoing renal replacement therapy (RRT) is steadily increasing. National registry data consistently shows a trend towards increasing median ages for patients both starting dialysis and awaiting kidney transplantation on deceased-donor waiting lists. For example, national audit data from the UK Renal Registry demonstrates the median age for all incident patients commencing RRT was 64.8 years [1]. Data from the UK Transplant Registry reports 28% of transplant recipients receiving a deceased-donor kidney allograft in the last year were aged 60 and over, while 32% of the active kidney transplant waiting list is aged 60 and over [2]. With chronic kidney disease increasingly recognized as a public health epidemic, the long-term prospects are of an ESKD population with increasing age requiring kidney allografts. While mortality risk is accepted as higher for older versus younger kidney transplant recipients [3], kidney transplantation remains the gold-standard RRT for all age groups. Despite this, older adults with ESKD have a skewed risk-versus-benefit ratio comparing kidney transplantation versus dialysis and questions the optimal RRT for older adults with ESKD [4]. However, older candidates for transplantation may be unfairly disadvantaged by receiving standard post-transplant immunosuppression which is not attenuated or tailored to their individualized risks. Older kidney transplant recipients have increased risk for infections and cancers, but decreased risk for rejection, which likely relates to age-related immunosenescence [5]. Tailored immunosuppression for older transplant recipients could attenuate post-transplant complications and improve overall graft survival [6] but no European Geriatric Medicine xxx (2016) xxx-xxx
European Urology Supplements, 2017
Expert Review of Anticancer Therapy, Jan 20, 2022
ABSTRACT Introduction Outcomes for patients with advanced or metastatic urothelial carcinoma (UC)... more ABSTRACT Introduction Outcomes for patients with advanced or metastatic urothelial carcinoma (UC) remain poor. Targeting the programmed death ligand-1 (PD-(L)1) immune checkpoint pathway has emerged as a useful target in patients with UC. Avelumab is a PD-L1 inhibitor, resulting in restoration of a cytotoxic, antitumor T cell response. Results from the JAVELIN bladder 100 trial has resulted in a new standard of care of platinum-based chemotherapy sequenced by maintenance avelumab in advanced or metastatic UC. Areas covered This review covers the clinical evidence for avelumab in UC. This includes the maintenance approach with avelumab, which has become the standard of care, following platinum-based chemotherapy. Expert opinion Immune checkpoint inhibitor treatment in metastatic UC holds much promise, but has not been optimized. First-line maintenance avelumab is an attractive option for these patients. Future research will significantly change the landscape of treatment in the near future.
Cancer
There have been significant advances in the treatment of urology cancers, with a number of practi... more There have been significant advances in the treatment of urology cancers, with a number of practice‐changing treatments. There is now greater clarity on the role of the use of immunotherapies in renal cell carcinoma. The use of triplet combinations with immune checkpoint inhibition with anti‐vascular endothelial growth factor tyrosine kinase inhibitors in the front‐line setting for metastatic disease (COSMIC313) has been explored. The use of adjuvant therapy has been complicated by a series of negative immune therapy trials. Promising results with the HIF‐2α transcription factor inhibitor, belzutifan, alone or in combination with other agents, have been reported. Antibody drug conjugates, including enfortumab vedotin and sacituzumab govitecan, have continued to show activity in urothelial cancer with promising clinical outcomes. This has led to further exploration of the combination of these novel agents with immunotherapy and accelerated Food and Drug Administration approvals. Data...
Journal of Clinical Oncology
e24086 Background: Immune checkpoint inhibitors (ICIs) are well established in the treatment of m... more e24086 Background: Immune checkpoint inhibitors (ICIs) are well established in the treatment of metastatic renal cell (mRCC) and urothelial carcinomas (mUC). The profile of ICI immune-related adverse events (irAEs) is well described, however, data on timings of toxicity and irAEs occurring at ≥12 months are lacking. Methods: A single-site retrospective audit of mRCC and mUC patients receiving ICI-based therapy for ≥12 months between January 2014 and December 2022. ICI-based therapies included monotherapy and combination therapy with other ICIs or anti-VEGF tyrosine kinase inhibitors (TKIs). Best response to ICI-based therapy and irAEs were described. Results: 199 patients received ICI-based therapy, of which 34% (68/199) received treatment for ≥12 months. Of those on therapy for ≥12 months, 44% (30/68), 25% (17/68), and 31% (21/68) were treated with ICI monotherapy, combination with other ICIs, and TKIs, respectively. At data cut-off, 69% (47/68) were alive. 26% (18/68), 59% (40/68)...
Future Oncology
The standard-of-care for muscle-invasive bladder cancer is radical surgery with neoadjuvant cispl... more The standard-of-care for muscle-invasive bladder cancer is radical surgery with neoadjuvant cisplatin-based chemotherapy. Despite curative intent from these interventions, relapse rates post-surgery remain high, with approximately 50% of patients developing local or distant recurrence within 2 years of surgery and a 5-year survival of only 50–60%. Identifying patients who are high risk for relapse post-surgery is a priority. Monitoring patients for circulating tumor DNA (ctDNA) is a minimally invasive approach that appears attractive for selecting patients potentially suitable for adjuvant treatment with checkpoint inhibitors. IMvigor011 (NCT04660344) is a global, double-blind, randomized phase III study assessing the efficacy of atezolizumab (anti-PD-L1) versus placebo in patients with high-risk muscle-invasive bladder cancer who are ctDNA positive post-cystectomy. The primary end point is disease-free survival in participants who are ctDNA positive within 20 weeks of cystectomy.
Journal of Clinical Oncology
725 Background: The characterisation of DNA alternations in papillary renal cancer (PRC) is uncle... more 725 Background: The characterisation of DNA alternations in papillary renal cancer (PRC) is unclear. The CALYPSO trial (NCT02819596) prospectively evaluated combination therapy of savolitinib (MET inhibitor) and durvalumab (PD-L1 inhibitor) in PRC. The trial showed high response rates (RR) in the MET-driven population. Here we explore the relationship between MET, PD-L1 and TMB in these tumours and the relevance of other biomarkers including PIK3CA, PTEN and KRAS. Methods: FoundationOne analysis from 41 samples of PRC patients enrolled on the CALYPSO trial was performed. The relevance of co-positivity between MET/PD-L1 and MET/TMB as well as analysis of other DNA alterations such as PIK3CA, PTEN and KRAS was explored. Outcome parameters were correlated with RR, PFS and OS. Results: 41% of patients were MET-driven, 66% were PD-L1+ (vCPS≥1) and 3% were TMB >10mut/Mb. Further testing used TMB ≥ median (2.52mut/Mb) 32% of patients were both MET-driven and PD-L1+. 17% of patients were...
Clinical Genitourinary Cancer
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2018
OBJECTIVES Donor kidney measurements may affect outcomes of transplanted allografts. We tested al... more OBJECTIVES Donor kidney measurements may affect outcomes of transplanted allografts. We tested allograft and recipient measurements on kidney allograft outcomes. In this study, we compared the effects of kidney allograft volumes, which were measured using computed tomographic angiography before transplant, and allograft weight, which was measured during surgery, in relation to the recipient's body weight and body mass index on kidney function at 6 and 12 months after transplant. MATERIAL AND METHODS We included 74 patients (40 female and 34 male patients, mean age of 50.42 ±; 9.75 y) in this study. RESULTS Intraoperative allograft weight was 182.68 ± 40.33 g (range, 104-266 g). The allograft volume measured using computed tomographic angiography scanning was 123.34 ± 24.26 mL (range, 78-181 mL). The estimated glomerular filtration rates of the recipients at 6 and 12 months after transplant correlated negatively with age and recipient body mass index but correlated positively wit...
Cancer Medicine, 2018
Administrative data are frequently used for epidemiological studies but its usefulness to analyze... more Administrative data are frequently used for epidemiological studies but its usefulness to analyze cancer epidemiology after kidney transplantation is unclear. In this retrospective population‐based cohort study, we identified every adult kidney‐alone transplant performed in England (2003–2014) using administrative data from Hospital Episode Statistics. Results were compared to the hospitalized adult general population in England to calculate standardized incidence and mortality ratios. Data were analyzed for 19,883 kidney allograft recipients, with median follow‐up 6.0 years' post‐transplantation. Cancer incidence was more common after kidney transplantation compared to the general population in line with published literature (standardized incidence ratio 2.47, 95% CI: 2.34–2.61). In a Cox proportional hazards model, cancer development was associated with increasing age, recipients of deceased kidneys, frequent readmissions within 12 months post‐transplant and first kidney recip...
Experimental and Clinical Transplantation, 2019
OBJECTIVES Historical data have suggested that donor smoking is associated with detrimental clini... more OBJECTIVES Historical data have suggested that donor smoking is associated with detrimental clinical outcomes for recipients of kidneys from deceased donors. However, the effects of smoking status of a kidney donor on the outcomes of the recipient in a contemporary setting of immunosuppression and transplant practice have not yet been ascertained. MATERIALS AND METHODS This retrospective, population-cohort study analyzed data of all deceased-donor kidney-alone transplant procedures performed in the United Kingdom between April 2001 and April 2013. Our study included 11?199 deceased-donor kidney allograft recipients, with median follow-up of 46 months posttransplant. RESULTS In our cohort, 5280 deceased donors (47.1%) had a documented history of smoking. Deceased donors with versus those without smoking history were more likely to be younger (mean age of 48 vs 50 years; P < .001), be of white ethnicity (96.6% vs 95.3%; P < .001), and have brain death before donation (77.1% vs 74.9%; P = .006). On unadjusted survival analyses, overall patient survival was significantly shorter in patients who received kidney allografts from deceased donors with smoking history (hazard ratio of 1.12, 95% confidence interval, 1.00-1.25; P = .044). No significant association was seen for death-censored or overall graft survival. Our multivariate survival analyses showed that, after accounting for confounding factors, the effects of donor smoking status remained significant for patient survival (hazard ratio of 1.16, 95% CI, 1.03-1.29; P =.011) but not graft survival. CONCLUSIONS This population-cohort study suggests that deceased-donor kidneys from smokers contribute to an increased risk of death for kidney allograft recipients. These study findings imply donor smoking history should be factored into the risk stratification decision for recipient selection to optimize decision making; however, further clarification and validation of these data are warranted.
Journal of Renal Care, 2019
SUMMARYBackgroundRecipients with failing kidney transplants (RFKTs) may receive sub‐optimal care ... more SUMMARYBackgroundRecipients with failing kidney transplants (RFKTs) may receive sub‐optimal care compared with patients with native kidney disease. The aim of this study is to compare the outcomes of RFKTs managed in a dedicated low clearance transplant clinic (LCTC) compared with those attending a general transplant clinic.MethodsWe undertook a retrospective analysis of patients with failing kidney transplants comparing two clinics—a LCTC versus a general transplant clinic. Kidney transplant recipients with an eGFR < 20 ml/min were included. A cross‐sectional analysis was undertaken of all patients with two consecutive follow‐up visits between the dates of January and July 2016 in either clinic, with follow‐up to event or December 2017.ResultsData were analysed for 141 kidney transplant recipients; 60 in the LCTC and 81 in the general transplant clinic. More patients in the LCTC cohort were non‐white and early transplant recipients. A significantly greater proportion of LCTC ver...
Archives of Renal Diseases and Management, 2017
Background: Language barriers are associated with worse health outcomes in the general population... more Background: Language barriers are associated with worse health outcomes in the general population but data in kidney transplantation is lacking. This study tested the hypothesis that non-native English speakers using interpreters have poorer outcomes after kidney transplantation compared to native English speakers. Methods: A single-center retrospective study analyzing all kidney allograft recipients transplanted between 2007-2015, with data linkage between various electronic patient records to create a comprehensive database. Results: Data was extracted for 1,140 patients, with median follow up 4.4 years' post-transplantation. Ethnicity breakdown was; Caucasian (72.1%), black (5.5%), south Asian (17.6%) and other (4.7%). Interpreters had been requested for 40 kidney allograft recipients, with the commonest language required being Urdu/Punjabi (n=25). Patients requiring interpreting services were more likely to be of south Asian ethnicity (80.0% of users versus 15.4% of non-users, p<0.001) and female (60.0% of users versus 39.5% of non-users, p=0.008). Recipients using versus not using interpreters had less kidney allograft rejection (2.5% versus 14.8% respectively, p=0.014). There was no difference between groups for development of post-transplant diabetes, cardiac events, cerebrovascular accidents, and cancer or patient/graft survival. Conclusion: Kidney allograft recipients with poor English skills who require interpreting services do not suffer adverse patient or kidney allograft outcomes.
Diabetic Medicine, 2017
• Rejection of the kidney allograft is the most feared complication after kidney transplantation ... more • Rejection of the kidney allograft is the most feared complication after kidney transplantation from a patient perspective, but it is unclear if patients with diabetes have an increased risk of this complication. • In this study, in the context of contemporary immunosuppression, we show that people with diabetes have an elevated risk of cellular rejection after kidney transplantation, but that this does not translate into adverse short-to-medium term kidney allograft outcomes. • Our data allow targeted risk counselling for people with diabetes who are awaiting kidney transplantation.
BMJ Open, 2017
Objectives Inferior outcomes for black kidney transplant recipients in the USA may not be general... more Objectives Inferior outcomes for black kidney transplant recipients in the USA may not be generalisable elsewhere. In this population cohort analysis, we compared outcomes for black kidney transplant patients in England versus New York State. Design Retrospective, comparative, population cohort study utilising administrative data registries. Settings and participants English data were derived from Hospital Episode Statistics, while New York State data were derived from Statewide Planning and Research Cooperative System. All adults receiving their first kidney-alone allograft between 2003 and 2013 were eligible for inclusion. Measures The primary outcome measure was mortality post kidney transplantation (including inhospital death, 30-day mortality and 1-year mortality). Secondary outcome measures included postoperative admission length of stay, risk of rehospitalisation, development of cardiac events, stroke, cancer or fracture and finally transplant rejection/failure. Cox proportional hazards regression was used to investigate relationship between ethnicity, country and outcome. Results Black patients comprised 6.5% of the English cohort (n=1215/18 493) and 23.0% of the New York State cohort (n=2660/11 602). Compared with New York State, black kidney transplant recipients in England were more likely younger, male, living-donor kidney recipients and had dissimilar medical comorbidities. Inpatient mortality was not statistically different, but death within 30 days, 1 year or kidney transplant rejection/failure was lower among black patients in England versus black patients in New York State. In adjusted regression analysis, with black ethnicity the reference group, white patients had reduced risk for 30day mortality (OR 0.62 (95% CI 0.44 to 0.86)) and 1-year mortality (OR 0.79 (95% CI 0.63 to 0.99)) in New York State but no difference was observed in England. Compared with England, black kidney transplant patients in New York State had increased HR for kidney transplant rejection rejection/ failure by median follow-up (HR 2.15, 95% CI 1.91 to 2.43). Conclusions Outcomes after kidney transplantation for black patients may not be translatable between countries.
European Geriatric Medicine, 2017
The proportion of older patients with end-stage kidney disease (ESKD) undergoing renal replacemen... more The proportion of older patients with end-stage kidney disease (ESKD) undergoing renal replacement therapy (RRT) is steadily increasing. National registry data consistently shows a trend towards increasing median ages for patients both starting dialysis and awaiting kidney transplantation on deceased-donor waiting lists. For example, national audit data from the UK Renal Registry demonstrates the median age for all incident patients commencing RRT was 64.8 years [1]. Data from the UK Transplant Registry reports 28% of transplant recipients receiving a deceased-donor kidney allograft in the last year were aged 60 and over, while 32% of the active kidney transplant waiting list is aged 60 and over [2]. With chronic kidney disease increasingly recognized as a public health epidemic, the long-term prospects are of an ESKD population with increasing age requiring kidney allografts. While mortality risk is accepted as higher for older versus younger kidney transplant recipients [3], kidney transplantation remains the gold-standard RRT for all age groups. Despite this, older adults with ESKD have a skewed risk-versus-benefit ratio comparing kidney transplantation versus dialysis and questions the optimal RRT for older adults with ESKD [4]. However, older candidates for transplantation may be unfairly disadvantaged by receiving standard post-transplant immunosuppression which is not attenuated or tailored to their individualized risks. Older kidney transplant recipients have increased risk for infections and cancers, but decreased risk for rejection, which likely relates to age-related immunosenescence [5]. Tailored immunosuppression for older transplant recipients could attenuate post-transplant complications and improve overall graft survival [6] but no European Geriatric Medicine xxx (2016) xxx-xxx
European Urology Supplements, 2017