Adina Landsberg’s research while affiliated with University of Calgary and other places

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Publications (5)


Follow‐up biopsies identify high rates of persistent rejection in pediatric kidney transplant recipients after treatment of T cell‐mediated rejection
  • Article

September 2023

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33 Reads

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4 Citations

Pediatric Transplantation

Adina Landsberg

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S. Sikandar Raza

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Background Incomplete resolution of T cell‐mediated rejection (TCMR) after treatment may not be detected with serum creatinine monitoring and is associated with donor‐specific antibodies and chronic rejection. We evaluate the utility of follow‐up biopsies (FUB) to identify and characterize rates of persistent TCMR after treatment in pediatric kidney transplant patients. Methods Patients from two pediatric transplant centers performing standard of care FUB at 1.5–2 months after treatment for TCMR were included. FUB were evaluated for extent of rejection resolution (complete vs. incomplete) and grade. Clinical data at time of FUB and later were reported, where available. Results Fifty‐eight patients underwent FUB, at mean of 1.7 months (SD 0.7) post‐index biopsy. Rejection grade on index biopsy was Banff borderline (≥i1t1 and <i2t2) in 59% and Banff ≥1A (≥i2t2) in 41%. Acute rejection was persistent in 32 (55%) of FUB. Borderline rejection had higher rates of complete resolution of rejection compared to grade ≥1A (53% vs. 33%, p = .033). Incomplete resolution of rejection on FUB was re‐treated in 25 (78%) of cases. Change in eGFR from index to FUB did not differ between those with complete and incomplete resolution (5.7 ± 32.2 vs. 13.1 ± 51.3, p = .28) and was not a sensitive marker of identifying persistent rejection. Conclusions FUB were effective at detecting persistent rejection, which was common among pediatric transplant patients after standard TCMR treatment. Until more effective rejection treatments or sensitive biomarkers are available, FUB may be effectively utilized to identify patients with ongoing rejection who would benefit from further treatment.


Yield and utility of surveillance kidney biopsies in pediatric kidney transplant recipients at various time points post‐transplant

October 2020

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9 Reads

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6 Citations

Pediatric Transplantation

Background: Due to a lack of consensus on SB for pediatric kidney transplant recipients, we evaluated the yield and clinical utility of SB findings at various time points post-transplant. Methods: Patients transplanted at a single institution between 2014 and 2020 with at least one SB at 1.5, 3, 6, 12, and 24 months post-transplant were included. Additional biopsies were done for indication (IB). TCMR was classified by Banff criteria (score ≥i1t1). Results: Forty-seven patients had 142 biopsies (SB = 113, IB = 29); 19 (40.4%) of whom experienced at least one TCMR episode in the first-year post-transplant. The greatest SB yield of any pathologic abnormality was at 6 months (57.1%; P < .001). Six months also had the highest yield for TCMR (42.9%), compared with 3.3%, 20.8%, 15.0%, and 9.1% at 1.5, 3, 12 months, and 24 months, respectively (P = .003). SB instigated intensification of immunosuppression (28.3% cases), reduction of immunosuppression (2.7% cases), and other non-immunosuppressant changes (1.8% cases). The 6-month SB led to the greatest number of changes in management (53.6%), compared with 1.5, 3, 12, and 24 months (13.3, 20.8, 25.0, and 36.4%, respectively; P = .012). There were no major biopsy-related complications. Conclusions: SBs identify an important burden of subclinical rejection and other pathology leading to changes in clinical management. The greatest yield was at 6 months, whereas the least utility was at the 1.5 months. Selection of SB timing may be tailored such that the optimal yield is balanced against the procedural risk.


Non‐invasive staging of chronic kidney allograft damage using urine metabolomic profiling

May 2018

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43 Reads

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19 Citations

Pediatric Transplantation

Adina Landsberg

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[...]

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Chronic kidney allograft damage is characterized by IFTA and GS. We sought to identify urinary metabolite signatures associated with severity of IFTA and GS in pediatric kidney transplant recipients. Urine samples (n = 396) from 60 pediatric transplant recipients were obtained at the time of kidney biopsy and assayed for 133 metabolites by mass spectrometry. Metabolite profiles were quantified via PLS‐DA. We used mixed‐effects regression to identify laboratory and clinical predictors of histopathology. Urine samples (n = 174) without rejection or AKI were divided into training/validation sets (75:25%). Metabolite classifiers trained on IFTA severity and %GS showed strong statistical correlation (r = .73, P < .001 and r = .72; P < .001, respectively) and remained significant on the validation sets. Regression analysis identified additional clinical features that improved prediction: months post‐transplant (GS, IFTA); and proteinuria, GFR, and age (GS only). Addition of clinical variables improved performance of the %GS classifier (AUC = 0.9; 95% CI = 0.85‐0.96) but not for IFTA (AUC = 0.82; 95% CI = 0.71‐0.92). Despite the presence of potentially confounding phenotypes, these findings were further validated in samples withheld for rejection or AKI. We identify urine metabolite classifiers for IFTA and GS, which may prove useful for non‐invasive assessment of histopathological damage.


Criminalizing Sex Work Clients and Rushed Negotiations among Sex Workers Who Use Drugs in a Canadian Setting

May 2017

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101 Reads

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27 Citations

Journal of Urban Health

Previous research indicates that criminalization of sex work is associated with harms among sex workers. In 2013, the Vancouver Police Department changed their sex work policy to no longer target sex workers while continuing to target clients and third parties in an effort to increase the safety of sex workers (similar to "end-demand sex work" approaches being adopted in a number of countries globally). We sought to investigate the trends and correlates of rushing negotiations with clients due to police presence among 359 sex workers who use drugs in Vancouver before and after the guideline change. Data were derived from three prospective cohort studies of people who use drugs in Vancouver between 2008 and 2014. We used sex-stratified multivariable generalized estimating equation models. The crude percentages of sex workers who use drugs reporting rushing client negotiations changed from 8.9% before the guideline change to 14.8% after the guideline change among 259 women, and from 8.6 to 7.1% among 100 men. In multivariable analyses, there was a significant increase in reports of rushing client negotiation after the guideline change among women (p = 0.04). Other variables that were independently associated with increased odds of rushing client negotiation included experiencing client-perpetrated violence (among both men and women) and non-heterosexual orientation (among women) (all p < 0.05). These findings indicate that despite the policing guideline change, rushed client negotiation due to police presence appeared to have increased among our sample of female sex workers who use drugs. It was also associated with client-perpetrated violence and other markers of vulnerability. These findings lend further evidence that criminalizing the purchase of sexual services does not protect the health and safety of sex workers.


Figure 1. Rates of reporting confiscation of drug user paraphernalia and physical violence by the police among PWID in Vancouver, Canada (n 0 2193). 
Table 1 . Baseline sample characteristics stratified by reports of confiscation of drug use paraphernalia and physical violence by the police in the previous six months among PWID in Vancouver, Canada (n 0 2193)
Declining trends in exposures to harmful policing among people who inject drugs in Vancouver, Canada
  • Article
  • Full-text available

July 2016

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53 Reads

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16 Citations

Introduction In 2006, the Vancouver Police Department (VPD) developed an organization-wide drug policy approach, which included endorsing harm reduction strategies for people who inject drugs (PWID). We sought to examine rates of potentially harmful policing exposures and associated HIV risk behaviour among PWID in Vancouver, Canada before and after the VPD policy change. Methods Data were derived from two prospective cohort studies of PWID. Multivariable generalized estimating equation models were used to examine changes in the risk of confiscation of drug use paraphernalia and physical violence by the police, as well as changes in the relationship between exposures to the two policing practices and sharing of drug use paraphernalia, before and after the policy change. Results Among 2193 participants, including 757 (34.5%) women, the rates of experiencing police confiscation of drug use paraphernalia declined from 22.3% in 2002 to 2.8% in 2014, and the rates of reporting experiencing physical violence by the police also declined from 14.1% in 2004 to 2.9% in 2014. In multivariable analyses, the post-policy change period remained independently and negatively associated with reports of confiscation of drug use paraphernalia (adjusted odds ratio (AOR): 0.25; 95% confidence interval (CI): 0.21 to 0.31) and reported physical violence by the police (AOR: 0.76; 95% CI: 0.63 to 0.91). However, experiencing both confiscation of drug use paraphernalia and physical violence by the police (AOR: 1.92; 95% CI: 1.10 to 3.33) and experiencing only confiscation of drug use paraphernalia (AOR: 1.71; 95% CI: 1.34 to 2.19) remained independently and positively associated with sharing of drug use paraphernalia during the post-policy change period. Conclusions In our study, two policing practices known to increase HIV risk among PWID have declined significantly since the local police launched an evidence-based drug policy approach. However, these practices remained independently associated with elevated HIV risk after the post-policy change. Although there remains a continued need to ensure that policing activities do not undermine public health efforts, these findings demonstrate that a major shift towards a public health approach to policing is possible for a municipal police force.

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Citations (4)


... Re-treatment with pulsed steroids and/or ATG occurred in 25 of the 32 children (78%) with incomplete resolution of TMR. There was however no significant difference in graft function at 12 months irrespective of whether complete histological resolution of acute TMR had been achieved [48]. This interesting study raises a number of questions. ...

Reference:

Acute kidney injury in paediatric kidney transplant recipients
Follow‐up biopsies identify high rates of persistent rejection in pediatric kidney transplant recipients after treatment of T cell‐mediated rejection
  • Citing Article
  • September 2023

Pediatric Transplantation

... (Sophia, UK, independent) Street-based sex workers are particularly vulnerable to non-payment for services, as they rely on cash from the client, often once they've completed the sexual service. When they or their clients are criminalised, they cannot take the time to negotiate for too long before getting in the car, in case they are spotted by police (Amnesty International, 2016b; Krüsi, 2014;Landsberg et al., 2017;Östergren, 2006). Clients also try to negotiate the price down, knowing that sometimes the sex worker might be desperate. ...

Criminalizing Sex Work Clients and Rushed Negotiations among Sex Workers Who Use Drugs in a Canadian Setting
  • Citing Article
  • May 2017

Journal of Urban Health

... Participants suggested officers largely supported SCSs and expected PWUD to use these services (Urbanik et al. 2022: 5). In Vancouver, where many Canadian harm reduction programs originated, there is evidence of a decline in harmful policing practices directed at PWUD (Landsberg et al. 2016). In Durban, South Africa, Marks et al. (2020) connected such shifts to changes in police culture, demonstrating how officers' ongoing interactions with PWUD and direct observations of the benefits of harm reduction services resulted in their growing support for both-concluding that 'changes in the structural field that the police operate in can bring about significant changes in their response, and this, in turn, can transform habitual sense-making' (Marks et al. 2020: 59). ...

Declining trends in exposures to harmful policing among people who inject drugs in Vancouver, Canada