Aisling E Courtney

Belfast Healthy Cities, Béal Feirste, Northern Ireland, United Kingdom

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Publications (9)22.47 Total impact

  • Agnes Masengu · Aisling Courtney
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    ABSTRACT: Atypical hemolytic uraemic syndrome (aHUS) is characterized by mutations in the alternative complement pathway. It is associated with a 50% rate of mortality/dialysis dependence at 5 years. A recurrence rate >80% following renal transplantation has historically discouraged kidney-alone transplantation. Eculizumab, a monoclonal antibody to C5 has caused a paradigm shift in the management of these patients [1]. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Transplant International 03/2015; 28(8). DOI:10.1111/tri.12566 · 3.16 Impact Factor
  • J. A. McCaughan · A. E. Courtney
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    ABSTRACT: There is a growing population of kidney transplant recipients who have survived 20 years with a functioning graft. This study identified the factors associated with prolonged survival and described the clinical course of recipients after two decades of transplant function. All recipients transplanted in Northern Ireland between 1968 and 1993 were included (n = 706) and data were collected prospectively. At 20 years, 25% had a functioning transplant; in multivariate analysis younger recipient age and living donation were associated with 20-year survival. The median recipient survival beyond two decades was 13.3 years; cancer was the commonest cause of death. De novo malignancy developed in 37% of recipients and cardiovascular disease in 27% after 20 years of graft function. The median graft survival after 20 years was 9.3 years; 69% of graft loss was due to death with a functioning transplant. Advances in kidney transplantation have improved the long-term survival of both graft and recipient. After two decades the majority of patients die with a functioning graft. The focus of management in long-term survivors may need to be on the prevention of cancer and cardiovascular disease to allow further improvements in graft and recipient survival. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.
    American Journal of Transplantation 02/2015; 15(3). DOI:10.1111/ajt.13041 · 6.19 Impact Factor
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    ABSTRACT: Background The failure of a kidney transplant is now a common reason for initiation of dialysis therapy. Kidney transplant recipients commencing dialysis have greater morbidity and mortality than transplant-naïve, incident dialysis patients. This study aimed to identify variables associated with survival after graft failure. Methods All recipients of first, deceased donor kidney transplants performed in Northern Ireland between 1986 and 2005 who had a functioning graft at 12 months were included (n = 585). Clinical and blood-derived variables (age, gender, primary renal disease, diabetic status, smoking status, human leukocyte antigen (HLA) mismatch, acute rejection episodes, immunosuppression, cardiovascular disease, graft survival, haemoglobin, albumin, phosphate, C reactive protein, estimated glomerular filtration rate (eGFR), rate of eGFR decline, dialysis modality, and access) were collected prospectively and investigated for association with re-transplantation and survival. The association between re-transplantation and survival was explored by modelling re-transplantation as a time-dependent covariate. Results Median follow-up time was 12.1 years. Recipients with a failing graft (158/585) demonstrated rapid loss of eGFR prior to graft failure, reducing the time available to plan for alternative renal replacement therapy. Median survival after graft failure was 3.0 years. In multivariate analysis, age and re-transplantation were associated with survival after graft failure. Re-transplantation was associated with an 88% reduction in mortality. Conclusions Optimal management of kidney transplant recipients with failing grafts requires early recognition of declining function and proactive preparation for re-transplantation given the substantial survival benefit this confers. The survival benefit associated with re-transplantation persists after prolonged exposure to immunosuppressive therapy.
    09/2014; 3(1):18. DOI:10.1186/2047-1440-3-18
  • Siddhesh M Prabhavalkar · Aisling E Courtney
    Transplant International 11/2013; 27(2). DOI:10.1111/tri.12231 · 3.16 Impact Factor
  • Mary-Jo McLaughlin · Aisling E Courtney
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    ABSTRACT: Chronic kidney disease (CKD) is efined as a reduction in estimated glomerular filtration rate (eGFR) for three consecutive months, or evidence of kidney damage alone with preserved renal function. CKD affects 8.5% of the UK population. Early recognition allows intervention that may delay or avoid progression to end-stage disease and modify the cardiovascular risk associated with CKD. CKD is classified into five stages and the majority of individuals have stages 1-3, many of these will never progress to end-stage renal disease. A decline in with age is expected. The most frequent specific renal diseases resulting in progressive CKD in the UK are: diabetes mellitus, atheromatous renal vascular disease, glomerulonephritis, chronic pyelonephritis and inherited renal disease. Laboratories in the UK now routinely provide an eGFR with a serum creatinine value in all adult patients. This estimation is based on serum creatinine, age, gender, and ethnicity. Baseline assessment in a patient with newly diagnosed CKD should include: blood pressure, dipstick urinalysis, urine ACR or PCR, glucose, lipid profile and a full blood count. Fluctuation in renal function is common, particularly in elderly patients with CKD. A fall in eGFR can result from any intercurrent illness, medication, or volume depletion. Proteinuria is a very important prognostic marker in CKD, ACR is the preferred measure as it has greater sensitivity for lower levels of proteinuria and is the recommended method in those with diabetes. The potential health problems associated with CKD can be divided into two main categories: risk of progressive renal disease with the development of renal bone disease and renal anaemia, and risk of overt cardiovascular disease.
    The Practitioner 02/2013; 257(1758):13-7, 2.
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    ABSTRACT: Acute kidney injury (AKI) is a recognised complication of intravenous pentamidine therapy. A direct nephrotoxic effect leading to acute tubular necrosis has been postulated. We report a case of severe renal allograft dysfunction due to nebulised pentamidine. The patient presented with repeated episodes of AKI without obvious cause and acute tubular necrosis only on renal histology. Nebulised pentamidine was used monthly as prophylaxis for Pneumocystis jirovecii pneumonia, and administration preceded the creatinine rise on each occasion. Graft function stabilised following discontinuation of the drug. This is the first report of nebulized pentamidine-induced reversible nephrotoxicity in a kidney allograft. This diagnosis should be considered in a case of unexplained acute renal allograft dysfunction.
    01/2013; 2013:907593. DOI:10.1155/2013/907593
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    ABSTRACT: BACKGROUND: HLA sensitization in potential renal transplant recipients hinders opportunities of receiving suitable organs. To alleviate this, we sought to determine if supplying closely HLA Class I matched leukodepleted blood would minimize sensitization. METHODS: Patients received HLA selected or random units of packed red cells. Selected units were sourced from blood donors included in the British Bone Marrow Registry and had no HLA-A and HLA-B mismatches where available, or alternatively, no HLA antigens with more than five immunogenic triplet mismatches as determined by the HLAMatchmaker algorithm. Posttransfusion antibody screening confirmed development of de novo Class I and Class II HLA-specific IgG antibody(s) or increases in preexisting antibody levels of at least 20%. RESULTS: Thirty-seven and 31 patients received HLA selected (mean, 2.5 units) and random (mean, 3.4 units) blood, respectively. A total of 20 of 37 (54.1%) patients receiving selected units and 10 of 31 (32.3%) patients receiving random units were previously sensitized. No patient receiving HLA selected units demonstrated any change in antibody levels. In patients who received random units, 7 of 31 demonstrated changes in antibody levels with three developing de novo HLA-specific antibodies and four an increase in panel reactive antibody (PRA) of at least 20% (P=0.002). CONCLUSIONS: The risk of developing HLA-specific antibody is significantly reduced in renal patients awaiting transplantation when transfused with HLA selected units of blood compared with random units. With planning, access to HLA typed blood is achievable as many blood transfusion centers recruit donors for stem cell donor registries.
    Transplantation 10/2012; 94(11). DOI:10.1097/TP.0b013e318271d776 · 3.78 Impact Factor
  • Agnes Masengu · Aisling E Courtney
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    ABSTRACT: Polycystic kidney disease and Alport's syndrome are the most common causes of inherited renal disease in the UK. An average GP practice is likely to have at least six patients with autosomal dominant polycystic kidney disease (ADPKD). The disorder is characterised by the formation of fluid-filled cysts in the kidneys resulting in progressive renal impairment. Mutations in two genes have been identified. The PKD1 gene abnormality is responsible for 85% of cases of ADPKD, patients with PKD2 mutations typically present later and progress more slowly. Patients with ADPKD can present with a positive family history, hypertension, flank pain, haematuria, renal insufficiency or proteinuria. The diagnosis has traditionally been based on ultrasound imaging. Screening will reduce the incidence of a late diagnosis when renal disease is advanced but a normal ultrasound scan in those under 30 years old is not conclusive. It is not recommended that children are screened. The key to minimising the rate of progressive disease is tight BP control. ACE inhibitors are recommended as the initial antihypertensive agent unless contraindicated. Alport's syndrome is a disorder characterised by abnormal type IV collagen which is found in the kidney, eyes, skin and ears. Around one in ten practices are likely to have a patient with Alport's syndrome. Eighty per cent of patients have the X-linked form of the disease. All first-degree relatives of a patient with confirmed Alport's syndrome should be offered screening. The combination of reduced hearing and urinary abnormalities in a young boy should alert GPs to consider this as a possible diagnosis and initiate referral. Diagnosis can be confirmed by renal or skin biopsy.
    The Practitioner 02/2012; 256(1748):17-20, 2-3.
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    J.A. McCaughan · D M O'Rourke · A.E. Courtney
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    ABSTRACT: Dense deposit disease is a rare glomerulonephritis caused by uncontrolled stimulation of the alternative complement pathway. Allograft survival after kidney transplantation is significantly reduced by the high rate of disease recurrence. No therapeutic interventions have consistently improved outcomes for patients with primary or recurrent disease. This is the first reported case of recurrent dense deposit disease being managed with eculizumab. Within 4 weeks of renal transplantation, deteriorating graft function and increasing proteinuria were evident. A transplant biopsy confirmed the diagnosis of recurrent dense deposit disease. Eculizumab was considered after the failure of corticosteroid, rituximab and plasmapheresis to attenuate the rate of decline in allograft function. There was a marked clinical and biochemical response following the administration of eculizumab. This case provides the first evidence that eculizumab may have a place in the management of crescentic dense deposit disease. More information is necessary to clarify the effectiveness and role of eculizumab in dense deposit disease but the response in this patient was encouraging. The results of clinical trials of eculizumab in this condition are eagerly awaited.
    American Journal of Transplantation 01/2012; 12(4):1046-51. DOI:10.1111/j.1600-6143.2011.03923.x · 6.19 Impact Factor