John S Gill

University of British Columbia - Vancouver, Vancouver, British Columbia, Canada

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Publications (149)1017.13 Total impact

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    ABSTRACT: The Canadian Society of Transplantation and Canadian Blood Services conducted a consensus forum on combined renal/nonrenal transplants, as they are not part of Canadian organ-specific allocation models at present. The purpose of this initiative was to make recommendations, develop eligibility criteria, and a decision-making model on listing and allocation. Forty-two participants with expertise in combined transplantation participated in the consensus forum. The United States and Canadian data were reviewed. The consensus forum made recommendations regarding the following: (1) investigation of etiology, severity, duration, and level of renal dysfunction; (2) documentation of degree of nonreversible kidney injury; (3) eligibility for combined (either simultaneous or staged) transplantation; (4) research. Key recommendations were: (1) patients with end-stage nonrenal disease with estimated glomerular filtration rate less than 30 mL/min per 1.73 m for longer than 1 month or on dialysis less than 3 months, who fulfill criteria for nonreversibility of renal dysfunction (by level and duration of renal dysfunction, imaging, and pathology findings), would be eligible for combined renal/nonrenal transplantation; (2) patients on dialysis longer than 3 months would be eligible for combined renal/nonrenal transplantation; (3) staged renal after nonrenal transplantation with subsequent prioritized allocation of renal transplant was endorsed in selected cases. The validation and impact of these recommendations on allocation will require further studies.
    Transplantation 11/2015; DOI:10.1097/TP.0000000000000963 · 3.83 Impact Factor
  • Krista L Lentine · John Gill · David Axelrod ·

    American Journal of Kidney Diseases 10/2015; 66(5):738-741. DOI:10.1053/j.ajkd.2015.07.004 · 5.90 Impact Factor
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    ABSTRACT: Background: Development of strategies to increase deceased organ donation is dependent on timely, accurate information regarding the number of potential deceased organ donors. Our objective was to estimate the number of potential deceased organ donors in Canada. Methods: This was a retrospective analysis of information captured from hospital separations in Canadian provinces with the exception of Quebec between 2005 and 2009. We studied individuals 70 years or younger who died in hospital. Our primary outcome measure was potential deceased organ donors (identified by the presence of diagnostic codes compatible with donation, the absence of contraindications to donation defined by Canadian Standards, and the use of mechanical ventilation). Results: Among 335 793 hospital deaths, 8274 potential donors were identified. The study method was 81% sensitive and 93% specific for identification of potential donors, and overestimated potential donors by a factor of 1.6- to 2.1-fold when compared to information from chart audits. After accounting for this overestimation, there are conservatively 400 unrecognized potential deceased donors in Canada annually. Conclusions: These findings suggest there may be significant potential to increase deceased organ donations in Canada. Further studies to fully characterize the number of potential donors identified by the study method are needed.
    Transplantation 10/2015; DOI:10.1097/TP.0000000000000947 · 3.83 Impact Factor

  • The Lancet Diabetes & Endocrinology 10/2015; DOI:10.1016/S2213-8587(15)00368-X · 9.19 Impact Factor
  • John S. Gill · Francis L. Delmonico ·
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    ABSTRACT: Watch a video presentation of this article Watch the interview with the author Answer questions and earn CME
    Clinical Liver Disease 10/2015; 6(4):90-91. DOI:10.1002/cld.503

  • Transplantation 08/2015; DOI:10.1097/TP.0000000000000890 · 3.83 Impact Factor
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    ABSTRACT: There has been little research exploring the experience of dialysis therapy for people living in remote communities. Remote residence location has previously been associated with excess mortality in hemodialysis (HD) patients, suggesting that relocation to a referral center might improve outcomes. It is unknown whether patients view this approach as acceptable. We studied 121 remote-dwelling chronic HD patients using the time trade-off method applied to hypothetical scenarios. Participants indicated that they would trade a median of 6 years of life in their current location (including current social supports) (95% CI 2.25-7) for 10 years of life in a referral center without any of their existing social supports (meaning they would be willing to forgo 4 years of life to remain in their current residence location). When current social supports were assumed to continue in both locations, people were only willing to forego a median of 2 years of life (95% CI 1-4) to remain in their current location. Older participants were much less willing to accept relocation than younger participants; the median time trade-off associated with relocation and without social supports was 2 years for participants aged <50 years, 3 years for those aged 50-69.9 years and 9 years for those aged ≥70 years. Hemodialysis patients currently living remotely were willing to forgo much of their remaining life expectancy rather than relocate-especially among older participants. These findings suggest that decisions about relocation should be accompanied by discussion of anticipated changes in quality of life and life expectancy. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
    Nephrology Dialysis Transplantation 06/2015; 30(10). DOI:10.1093/ndt/gfv112 · 3.58 Impact Factor
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    ABSTRACT: The unmet demand for kidney transplantation has generated intense controversy about introducing incentives for living kidney donors to increase donation rates. Such debates may affect public perception and acceptance of living kidney donation. This study aims to describe the range and depth of public opinion on financial reimbursement, compensation, and incentives for living kidney donors. Twelve focus groups were conducted with 113 participants recruited from the general public in three Australian states in February 2013. Thematic analysis was used to analyze the transcripts. Five themes were identified: creating ethical impasses (commodification of the body, quandary of kidney valuation, pushing moral boundaries), corrupting motivations (exposing the vulnerable, inevitable abuse, supplanting altruism), determining justifiable risk (compromising kidney quality, undue harm, accepting a confined risk, trusting protective mechanisms, right to autonomy), driving access (urgency of organ shortage, minimizing disadvantage, guaranteeing cost-efficiency, providing impetus, counteracting black markets), and honoring donor deservingness (fairness and reason, reassurance and rewards, merited recompense). Reimbursement and justifiable recompense are considered by the Australian public as a legitimate way of supporting donors and reducing disadvantage. Financial payment beyond reimbursement is regarded as morally reprehensible, with the potential for exploitative commercialism. Some contend that regulated compensation could be a defensible strategy to increased donation rates provided that mechanisms are in place to protect donors. The perceived threat to community values of human dignity, goodwill, and fairness suggests that there could be strong public resistance to any form of financial inducements for living kidney donors. Policy priorities addressing the removal of disincentives may be more acceptable to the public. Copyright © 2015 by the American Society of Nephrology.
    Clinical Journal of the American Society of Nephrology 04/2015; 10(7). DOI:10.2215/CJN.10821014 · 4.61 Impact Factor
  • Caren Rose · Elke Schaeffner · Ulrich Frei · Jagbir Gill · John S Gill ·
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    ABSTRACT: Strategies to increase expanded criteria donor (ECD) transplantation are needed. We quantified the extent to which ECD kidneys provide recipients with a lifetime of allograft function by determining the difference between patient survival and death-censored allograft survival (graft survival). Initial analyses compared 5-year outcomes in the Eurotransplant Senior Program (European) and the United States Renal Data System. Among European recipients ≥65 years, patient survival exceeded graft survival, and ECD recipients returned to dialysis for an average of 5.2 months after transplant failure. Among United States recipients ≥60 years, graft survival exceeded patient survival. Although patient survival in elderly recipients in the United States was low (49% at 5 years), the average difference in patient survival at 10 years in elderly recipients in the United States with an ECD versus non-ECD transplant was only 7 months. The probability of patient survival with a functioning allograft at 5 years was higher with ECD transplantation within 1 year after activation to the waiting list than with delayed non-ECD transplantation ≥3 years after activation to the waiting list. Subsequent analyses demonstrated that ECD transplants do not provide a lifetime of allograft function in recipients <50 years in the United States. These findings should encourage ECD transplantation in patients ≥60 years, demonstrate that rapid ECD transplantation is superior to delayed non-ECD transplantation, and challenge the policy in the United States of allowing patients <50 years to receive an ECD transplant. Copyright © 2015 by the American Society of Nephrology.
    Journal of the American Society of Nephrology 03/2015; 26(10). DOI:10.1681/ASN.2014080771 · 9.34 Impact Factor
  • Alissa J Wright · John S Gill ·

    Journal of the American Society of Nephrology 03/2015; 26(9). DOI:10.1681/ASN.2015010059 · 9.34 Impact Factor
  • John S Gill · Greg A Knoll · Atul Humar ·

    JAMA The Journal of the American Medical Association 03/2015; 313(11):1165-1166. DOI:10.1001/jama.2015.1058 · 35.29 Impact Factor
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    ABSTRACT: Participation of compatible living donors and recipients in kidney paired donation (KPD) could double the number of KPD transplants. We determined the willingness of previous directed donors and their recipients to participate in KPD and identified the association of various factors, including financial incentives, with willingness to participate. Survey of previous directed living kidney donors and their recipients in a single Canadian center between 2001 and 2009. Among 207 of 222 eligible living donors contacted, 86 (42%) completed the anonymous survey: 93% (78/86) of donors indicated willingness to participate in KPD if this option had been provided at the time of donation. An increased willingness to participate was reported among the majority of respondents if reimbursements for lost wages and travel expenses were provided; however, cash payments between $5000 and $50,000 had little impact on willingness. Willingness was also increased with an advantage to the recipient (younger donor or better human leukocyte antigen match), whereas delays beyond 3 months and donor travel were associated with reduced willingness to participate. Among 38 recipients approached during routine clinical follow-up visits over a 3-month period, 100% completed the survey, and 36 of 38 (92%) reported they would have been willing to participate in KPD. Over 90% of directed donors and recipients were willing to participate in KPD. Reimbursement for the costs of participation and improved efficiency of KPD (i.e., eliminating travel and reducing transplant times), but not cash payments, may increase participation of compatible donors and recipients in KPD.
    Transplantation 02/2015; Online First(9). DOI:10.1097/TP.0000000000000533 · 3.83 Impact Factor
  • S Barbour · J S Gill ·
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    ABSTRACT: Recent advances in the understanding of the role of complement in glomerular disease allow for more accurate assessment of the risk of disease recurrence after transplantation, and inform the development of targeted treatment strategies to overcome specific defects in the alternate pathway of the complement system. These advances along with remaining knowledge deficits are reviewed with specific relevance to membranoproliferative glomerulonephritis (MPGN) and C3 glomerulopathy, a heterogenous group of diseases with a high rate of recurrence leading to allograft failure. Recommendations to establish an accurate diagnosis and inform therapeutic decision making in transplant candidates with a histologic diagnosis of MPGN are provided. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.
    American Journal of Transplantation 02/2015; 15(2):312-9. DOI:10.1111/ajt.13042 · 5.68 Impact Factor
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    ABSTRACT: To provide an overview of the transplant component of the Canadian Organ Replacement Register (CORR). CORR is the national registry of organ failure in Canada. It has existed in some form since 1972 and currently houses data on patients with end-stage renal disease and solid organ transplants (kidney and/or non-kidney). The transplant component of CORR receives data on a voluntary basis from individual transplant centres and organ procurement organizations across the country. Coverage for transplant procedures is comprehensive and complete. Long-term outcomes are tracked based on follow-up reports from participating transplant centres. The longitudinal nature of CORR provides an opportunity to observe the trajectory of a patient's journey with organ failure over their life span. Research studies conducted using CORR data inform both practitioners and health policy makers alike. The importance of registry data in monitoring and improving care for Canadian transplant candidates/recipients cannot be over-stated. This paper provides an overview of the transplant data in CORR including its history, data considerations, recent findings, new initiatives, and future directions.
    12/2014; 1(1):31. DOI:10.1186/s40697-014-0031-8
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    ABSTRACT: Importance BK virus infection is a significant complication of modern immunosuppression used in kidney transplantation. Viral reactivation occurs first in the urine (BK viruria) and is associated with a high risk of transplant failure. There are currently no therapies to prevent or treat BK virus infection. Quinolone antibiotics have antiviral properties against BK virus but efficacy at preventing this infection has not been shown in prospective controlled studies.Objective To determine if levofloxacin can prevent BK viruria in kidney transplant recipients.Design, Setting, and Participants Double-blind, placebo-controlled randomized trial involving 154 patients who received a living or deceased donor kidney-only transplant in 7 Canadian transplant centers between December 2011 and June 2013.Interventions Participants were randomly assigned to receive a 3-month course of levofloxacin (500 mg/d; n = 76) or placebo (n = 78) starting within 5 days after transplantation.Main Outcomes and Measures The primary outcome was time to occurrence of BK viruria (detected using quantitative real-time polymerase chain reaction) within the first year after transplantation. Secondary outcomes included BK viremia, peak viral load, rejection, and patient and allograft survival.Results The mean follow-up time was 46.5 weeks in the levofloxacin group and 46.3 weeks in the placebo group (27 patients had follow-up terminated before the end of the planned follow-up period or development of viruria because the trial was stopped early owing to lack of funding). BK viruria occurred in 22 patients (29%) in the levofloxacin group and in 26 patients (33.3%) in the placebo group (hazard ratio, 0.91; 95% CI, 0.51-1.63; P = .58). There was no significant difference between the 2 groups in regard to any of the secondary end points. There was an increased risk of resistant infection among isolates usually sensitive to quinolones in the levofloxacin group vs placebo (14/24 [58.3%] vs 15/45 [33.3%], respectively; risk ratio, 1.75; 95% CI, 1.01-2.98) as well as a nonsignificant increased risk of suspected tendinitis (6/76 [7.9%] vs 1/78 [1.3%]; risk ratio, 6.16; 95% CI, 0.76-49.95).Conclusions and Relevance Among kidney transplant recipients, a 3-month course of levofloxacin initiated early following transplantation did not prevent BK viruria. Levofloxacin was associated with an increased risk of adverse events such as bacterial resistance. These findings do not support the use of levofloxacin to prevent posttransplant BK virus infection.Trial Registration Identifier: NCT01353339
    JAMA The Journal of the American Medical Association 11/2014; DOI:10.1001/jama.2014.14721 · 35.29 Impact Factor
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    ABSTRACT: Background: Young women wishing to become living kidney donors frequently ask whether nephrectomy will affect their future pregnancies. Methods: We conducted a retrospective cohort study of living kidney donors involving 85 women (131 pregnancies after cohort entry) who were matched in a 1:6 ratio with 510 healthy nondonors from the general population (788 pregnancies after cohort entry). Kidney donations occurred between 1992 and 2009 in Ontario, Canada, with follow-up through linked health care databases until March 2013. Donors and nondonors were matched with respect to age, year of cohort entry, residency (urban or rural), income, number of pregnancies before cohort entry, and the time to the first pregnancy after cohort entry. The primary outcome was a hospital diagnosis of gestational hypertension or preeclampsia. Secondary outcomes were each component of the primary outcome examined separately and other maternal and fetal outcomes. Results: Gestational hypertension or preeclampsia was more common among living kidney donors than among nondonors (occurring in 15 of 131 pregnancies [11%] vs. 38 of 788 pregnancies [5%]; odds ratio for donors, 2.4; 95% confidence interval, 1.2 to 5.0; P=0.01). Each component of the primary outcome was also more common among donors (odds ratio, 2.5 for gestational hypertension and 2.4 for preeclampsia). There were no significant differences between donors and nondonors with respect to rates of preterm birth (8% and 7%, respectively) or low birth weight (6% and 4%, respectively). There were no reports of maternal death, stillbirth, or neonatal death among the donors. Most women had uncomplicated pregnancies after donation. Conclusions: Gestational hypertension or preeclampsia was more likely to be diagnosed in kidney donors than in matched nondonors with similar indicators of baseline health. (Funded by the Canadian Institutes of Health Research and others.).
    New England Journal of Medicine 11/2014; 372(2). DOI:10.1056/NEJMoa1408932 · 55.87 Impact Factor
  • John S. Gill · Randall Morris ·

    American Journal of Kidney Diseases 11/2014; 64(5):818. DOI:10.1053/j.ajkd.2014.06.034 · 5.90 Impact Factor
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    ABSTRACT: The Canadian Organ Replacement Register (CORR) is the only Canadian information system on kidney and extra-kidney organ failure and transplantation in Canada. CORR's mandate is to record and analyze the level of activity and outcomes of vital organ transplantation and treatment of end stage kidney disease using dialysis, either hemodialysis or peritoneal dialysis, activities across Canada. The Canadian Organ Replacement Register was officially launched in 1987, and it included transplantation of extra-renal vital organs (liver, heart, lung, pancreas, bowel), in addition to renal transplantation and replacement therapy, with new financial support from the provinces. This manuscript describes the process of data acquisition and reporting, focusing on the patients with end stage kidney disease on dialysis, with data reported from the 2014 CORR Annual Data Report and the Center-Specific Reports on Clinical Measures. CORR is currently housed in the Canadian Institute for Health Information and collects data from hospital dialysis programs, regional transplant programs, organ procurement organizations and kidney dialysis services offered at independent health facilities. Data on patients is collected by completion of survey forms for each patient at the start of dialysis or receiving a transplant, using the Initial Registration form, and yearly follow up forms, which collects data on the status of the patient as of October 31(st). The incident rate per million population (RPMP) has remained stable with the exception of the 65+ age group with has experience a modest decrease since 2001. However, there has been an increasing prevalence of ESKD diagnoses, with the highest rate per million population (RPMP) amongst the age group 65+ years. This is likely attributed to gradual improving patient survival. Between 2003 and 2012, nearly 90% of dialysis patients younger than <18 and 26% of patients 75+ years survived for at least five years. As the number of people treated for end-stage organ failure grows, so does the importance of understanding their treatment and outcomes. In 2014, CORR continues to evolve and support the important information need to advance ESRD research and clinical practice.
    10/2014; 1(1):1. DOI:10.1186/s40697-014-0026-5
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    ABSTRACT: Background: Establishment of a national kidney paired donation (KPD) program represents a unique achievement in Canada's provincially organized health care system. Methods: Key factors enabling program implementation included consultation with international experts, formation of a unique organization with a mandate to facilitate interprovincial collaboration, and the volunteer efforts of members of the Canadian transplant community to overcome a variety of logistical barriers. Results: As of December 2013, the program had facilitated 240 transplantations including 10% with Calculated panel reactive antibody (cPRA) ≥97%. Unique features of the Canadian KPD program include participation of n = 55 nondirected donors, performance of only donor specific antibody negative transplants, the requirement for donor travel, and nonuse of bridge donors. Conclusion: The national KPD program has helped maintain the volume of living kidney donor transplants in Canada over the past 5 years and serves as a model of inter-provincial collaboration to improve the delivery of health care to Canadians.
    Transplantation 10/2014; 99(5). DOI:10.1097/TP.0000000000000455 · 3.83 Impact Factor

  • Transplantation 08/2014; 98(4):365-369. DOI:10.1097/TP.0000000000000251 · 3.83 Impact Factor

Publication Stats

3k Citations
1,017.13 Total Impact Points


  • 2005-2015
    • University of British Columbia - Vancouver
      • Division of Nephrology
      Vancouver, British Columbia, Canada
  • 2002-2014
    • St. Paul's Hospital
      Saskatoon, Saskatchewan, Canada
    • New England Baptist Hospital
      Boston, Massachusetts, United States
  • 2013
    • University of Manitoba
      Winnipeg, Manitoba, Canada
  • 2005-2012
    • The University of Calgary
      • • Department of Medicine
      • • Department of Community Health Sciences
      Calgary, Alberta, Canada
  • 2011
    • University of Minnesota Duluth
      Duluth, Minnesota, United States
  • 2005-2010
    • Tufts University
      Бостон, Georgia, United States
  • 2009
    • Vancouver General Hospital
      • Division of Nephrology (UBC)
      Vancouver, British Columbia, Canada
    • University of Toronto
      • Division of Neurology
      Toronto, Ontario, Canada
  • 2008-2009
    • University of California, Los Angeles
      Los Ángeles, California, United States
  • 2006-2007
    • University of Alberta
      • Department of Medicine
      Edmonton, Alberta, Canada
  • 2002-2003
    • Tufts Medical Center
      • Division of Nephrology
      Boston, Massachusetts, United States
  • 2001
    • Dalhousie University
      • Department of Medicine
      Halifax, Nova Scotia, Canada