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ABSTRACT: Chronic kidney disease is associated with increased mortality among nonrenal organ transplant recipients. End-stage renal disease (ESRD) is a serious complication after orthotopic liver transplantation (OLT). It is unclear if the outcomes of these individuals are different from nontransplant patients requiring dialysis or a kidney transplant.
We report the incidence of ESRD in OLT recipients and compare their outcomes to matched dialysis controls. We analyzed 4186 patients who received an OLT in Canada between January 1981 and December 2002 and 228 matched, nontransplant, chronic dialysis controls.
The incidence of ESRD after OLT was 2.9% (n=120). The unadjusted mortality rate for those who required chronic dialysis was 49.2% compared with 26.8% in those who did not develop kidney failure (P<0.0001). The survival of OLT recipients on dialysis was lower than the matched chronic dialysis cohort (log-rank test, P=0.01). A kidney transplant was performed in 24% of the OLT recipients and 21% of the matched dialysis cohort, and their overall survival was similar. The OLT patients who remained on dialysis had a significantly lower survival when compared with matched dialysis patients who did not receive a kidney transplant (log-rank test, P=0.0002).
Mortality was greater for OLT recipients on dialysis than would be expected from a matched, nontransplant, dialysis cohort. Kidney transplantation may abrogate some of this increased mortality risk.
Transplantation 05/2008; 85(9):1277-80. · 4.00 Impact Factor
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ABSTRACT: Optimizing organ utilization from consented donors is a critical need, given a static organ donation rate. We report changes in the characteristics of donors and organ utilization patterns in Canada over a ten-year period.
For the decade spanning the years 1993-2002, data were extracted from the Canadian Organ Replacement Register (CORR), the national transplant registry. A donor was defined as a deceased person from whom at least one vital organ was retrieved and transplanted.
The donor pool is aging (median age of donors increased eight years over the decade), with proportionately fewer donors dying from head trauma (motor vehicle collisions) and proportionately more from cerebrovascular accidents. At least four organs were utilized from approximately half the donors. These donors were significantly younger every year over the sampling period when compared with donors where < or = three organs were utilized. In 2002, utilization rates were: 87.0% (kidneys), 85.0% (livers), 42.2% (hearts), 30.6% (pancreata), 28.3% (lungs), and < or = 1% (intestines). There was increased utilization of donor pancreata, lungs and liver over the decade, but a flat utilization pattern for hearts, and a small decline in kidney utilization. Utilization rates vary from province to province.
Trends in the Canadian organ donor pool are characterized by an increasing age and a shift towards cerebrovascular diseases as primary causes of death. In order to improve organ utilization and understand regional variability, the scope of data provided to the national registry requires enhanced detail to address the factors that lead to non-utilization. Addressing the low utilization rates for hearts and lungs is especially critical, given the need for thoracic transplantation in Canada.
Canadian Journal of Anaesthesia 08/2006; 53(8):838-44. · 2.35 Impact Factor
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ABSTRACT: Studies from the United States have shown that renal allograft failure is associated with a high mortality rate. The purpose of this study was to determine whether transplant failure was associated with survival in a recent cohort of kidney transplant recipients with different characteristics and a distinct health care system from the United States. Cox regression was used to model allograft loss as a time-dependent variable with patient survival as the primary outcome in 4743 kidney transplant recipients from the Canadian Organ Replacement Register. During follow-up 607 (12.8%) patients had allograft failure and 411 (8.7%) died. Patients with a functioning transplant had an unadjusted death rate of 2.06 per 100 patient years that increased to 5.14 per 100 patient years following allograft failure. After controlling for important confounding variables, allograft failure was found to increase the risk of death by over threefold compared to patients who maintained transplant function (adjusted hazard ratio, 3.39; 95% CI, 2.75-4.16; p < 0.0001). In conclusion, this analysis has shown that kidney transplant failure is an independent predictor of mortality following renal transplantation in a Canadian population. This finding supports the premise that it is the loss of transplant function, rather than patient or system-related issues, that is the main factor contributing to outcome.
American Journal of Transplantation 08/2005; 5(7):1719-24. · 6.39 Impact Factor
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Ross A Davies, Kim Badovinac,
Haissam Haddad,
Paul J Hendry,
Roy G Masters,
Christine Struthers,
John P Veinot,
Stuart Smith,
Tofy V Mussivand,
Thierry Mesana,
Wilbert J Keon
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ABSTRACT: Heart transplantation has been carried out in 340 patients in Ottawa, including seventy-one who required mechanical circulatory support as a bridge to transplant. Survival in Ottawa was compared with other Canadian centers based on data from the Canadian Organ Replacement Register up to the year 2000 and with the International Society of Heart and Lung Transplantation (ISHLT) registry 2001. For survival analysis, the number of adult patients at risk at year 0 was 303 (87 transplanted from 1985 to 1990, 105 from 1990 to 1994, and 111 from 1995 to 2000). The Statistical Analysis System (SAS) life test procedure was used. Survival was not adjusted for comorbidities or heart failure class. For the year of transplant 1985-1989, one-, five-, and ten-year patient survival in Ottawa was 83%, 70%, and 60%, respectively, compared to 82%, 71%, and 54%, respectively, for Canada (Wilcoxon test, P = 0.71), and compared to one- and five-year survival for ISHLT from 1980 to 1987 at 76% and 60%, respectively. For 1990-1994, one-, five-, and ten-year patient survival in Ottawa was 88%, 81%, and 74%, respectively, compared to 80%, 71%, and 61%, respectively, for Canada (P = 0.05), and compared to one- and five-year survival for ISHLT from 1998 to 1992 at 80% and 68%, respectively. For 1995-2000, one- and five-year patient survival in Ottawa was 90% and 82%, respectively, compared to 85% and 76%, respectively, for Canada (P = 0.09), and compared to one- and five-year survival for ISHLT from 1993 to 1996 at 82% and 68%, respectively. Survival after heart transplantation in Ottawa compares favorably with Canadian and international data.
Artificial Organs 03/2004; 28(2):166-70. · 2.00 Impact Factor
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Ross A. Davies, Kim Badovinac,
Haissam Haddad,
Paul J. Hendry,
Roy G. Masters,
Christine Struthers,
John P. Veinot,
Stuart Smith,
Tofy V. Mussivand,
Thierry Mesana,
Wilbert J. Keon
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ABSTRACT: Heart transplantation has been carried out in 340 patients in Ottawa, including seventy-one who required mechanical circulatory support as a bridge to transplant. Survival in Ottawa was compared with other Canadian centers based on data from the Canadian Organ Replacement Register up to the year 2000 and with the International Society of Heart and Lung Transplantation (ISHLT) registry 2001. For survival analysis, the number of adult patients at risk at year 0 was 303 (87 transplanted from 1985 to 1990, 105 from 1990 to 1994, and 111 from 1995 to 2000). The Statistical Analysis System (SAS) life test procedure was used. Survival was not adjusted for comorbidities or heart failure class. For the year of transplant 1985–1989, one-, five-, and ten-year patient survival in Ottawa was 83%, 70%, and 60%, respectively, compared to 82%, 71%, and 54%, respectively, for Canada (Wilcoxon test, P = 0.71), and compared to one- and five-year survival for ISHLT from 1980 to 1987 at 76% and 60%, respectively. For 1990–1994, one-, five-, and ten-year patient survival in Ottawa was 88%, 81%, and 74%, respectively, compared to 80%, 71%, and 61%, respectively, for Canada (P = 0.05), and compared to one- and five-year survival for ISHLT from 1998 to 1992 at 80% and 68%, respectively. For 1995–2000, one- and five-year patient survival in Ottawa was 90% and 82%, respectively, compared to 85% and 76%, respectively, for Canada (P = 0.09), and compared to one- and five-year survival for ISHLT from 1993 to 1996 at 82% and 68%, respectively. Survival after heart transplantation in Ottawa compares favorably with Canadian and international data.
Artificial Organs 02/2004; 28(2):166 - 170. · 2.00 Impact Factor
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ABSTRACT: The descriptive analyses presented in this chapter provide a brief overview of transplant activity in Canada. While Canada's cadaveric organ donation rate has remained static, between 13-14 per million population, transplant rates increased from 1992-2001. This growth was due to more organs being retrieved per cadaveric donor and increased rates of living donor transplants for kidney, most notably, but also liver. The steady climb of the transplant waiting list continued to outstrip the number of patients transplanted on an annual basis. In 2002, 237 people died will waiting for an organ transplant. Canada is a net importer of organs from the US, particularly hearts and lungs. Heart transplantation activity has varied least of all organ transplant types from 1992-2001, reflecting in large part the stagnant cadaveric donation rate and the fact that fewer than 40% of hearts were retrieved and transplanted from the available cadaveric donors. Liver, lung, most notably double lung, and pancreas/kidney-pancreas transplant activity all grew significantly from 1992-2001. Accumulated expertise in the surgical realm combined with improved donor management and organ preservation techniques have facilitated this growth. Patient and graft survival continue to increase in Canada both for patients who are very ill at the time of their transplant, and those not as ill. Future growth areas for transplantation in Canada will likely be in the area of living kidney and liver donation, continued kidney-pancreas transplantation and islet cell transplantation. Without significant improvements in cadaveric organ donation rates in Canada, exploration of expanded donation criteria like non-heartbeating donors as well as continued improvements in donor management for the purposes of increased organ retrieval, the transplantation rates for hearts, livers, and lungs are not expected to increase, and the gap between the number of patients waiting for a transplant and the number of patients transplanted will widen.
Clinical transplants 02/2003;
