Nicola Kumar

Imperial College London, Londinium, England, United Kingdom

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Publications (3)11.77 Total impact

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    ABSTRACT: Corticosteroid use after transplantation is associated with an increased incidence of cardiovascular events and death. Cerebrovascular disease is a common cause of morbidity and mortality post renal transplantation however a dedicated analysis of cerebrovascular disease in recipients of a steroid sparing protocol has not been reported. The aim of this study is to examine the incidence, risk factors and outcomes of CVA in transplant recipients receiving a steroid sparing protocol.We retrospectively analysed 1237 patients who received a kidney alone or a simultaneous pancreas and kidney [SPK] transplant. 56/1237[4.53%] patients had a CVA post-transplant. All-cause mortality was significantly higher in the CVA group compared with the non CVA group, OR: 3.4[1.7-7.0], p<0.001. Factors found to be associated with increased risk of CVA by multivariate analysis were older age, HR: 1.07[1.04-1.09], p<0.001; diabetes at the time of transplantation, HR: 2.83[1.42-5.64], p=0.003; corticosteroid use pre-transplant, HR: 3.27[1.29-8.27], p=0.013 and recipients of a SPK, HR: 4.03[1.85-8.79], p<0.001.This article is protected by copyright. All rights reserved.
    Clinical Transplantation 10/2014; · 1.63 Impact Factor
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    ABSTRACT: Recent interest has focused on wait listing patients without pretreating coronary artery disease to expedite transplantation. Our practice is to offer coronary revascularization before transplantation if indicated. Between 2006 and 2009, 657 patients (427 men, 230 women; ages, 56.5 ± 9.94 years) underwent pretransplant assessment with coronary angiography. 573 of 657 (87.2%) patients were wait listed; 247 of 573 (43.1%) patients were transplanted during the follow-up period, 30.09 ± 11.67 months. Patient survival for those not wait listed was poor, 83.2% and 45.7% at 1 and 3 years, respectively. In wait-listed patients, survival was 98.9% and 95.3% at 1 and 3 years, respectively. 184 of 657 (28.0%) patients were offered revascularization. Survival in patients (n = 16) declining revascularization was poor: 75% survived 1 year and 37.1% survived 3 years. Patients undergoing revascularization followed by transplantation (n = 51) had a 98.0% and 88.4% cardiac event-free survival at 1 and 3 years, respectively. Cardiac event-free survival for patients revascularized and awaiting deceased donor transplantation was similar: 94.0% and 90.0% at 1 and 3 years, respectively. Our data suggest pre-emptive coronary revascularization is not only associated with excellent survival rates in patients subsequently transplanted, but also in those patients waiting on dialysis for a deceased donor transplant.
    Clinical Journal of the American Society of Nephrology 08/2011; 6(8):1912-9. · 5.07 Impact Factor
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    ABSTRACT: Preemptive transplantation is ideal for patients with advanced chronic kidney disease (CKD). The practice has been to perform coronary angiography (CA) on all patients aged >50, all diabetics, and all patients with cardiac symptoms or disease with a view to revascularization before transplantation. Historically patients have delayed CA until established on renal replacement therapy due to concerns of precipitating the need for chronic dialysis. The objectives of this study were to establish the risk of contrast nephropathy in patients with advanced CKD who undergo screening CA, and to determine whether or not preemptive transplantation is achievable. This retrospective analysis included 482 patients with stage IV/V CKD seen in West London predialysis clinics from 2004 to 2007. Seventy-six of 482 (15.8%) patients considered as potential transplant recipients met the authors' criteria for coronary angiography. Modification of Diet in Renal Disease (MDRD) GFR measurements were recorded for the 12 mo preceding and 12 mo following CA unless a defined endpoint was reached (transplantation, dialysis, or death). Mean MDRD GFR at CA was 12.51 +/- 3.51 ml/min. The trend was not significantly different 6 mo pre- and postangiography. Cumulative dialysis-free survival was 89.1% 6 mo postangiography. Twenty-three of 76 (30.3%) patients had flow-limiting coronary artery disease. Twenty-five of 76 (32.9%) patients underwent transplantation with 22 of 25 (88.0%) transplants being performed preemptively. The data suggest CA screening does not accelerate the decline in renal function for patients with advanced CKD, facilitating a safe preemptive transplant program.
    Clinical Journal of the American Society of Nephrology 10/2009; 4(12):1907-13. · 5.07 Impact Factor

Publication Stats

20 Citations
11.77 Total Impact Points

Institutions

  • 2014
    • Imperial College London
      Londinium, England, United Kingdom
  • 2011
    • Imperial College Healthcare NHS Trust
      Londinium, England, United Kingdom
  • 2009
    • Nottinghamshire Healthcare NHS Trust
      Nottigham, England, United Kingdom