Publications by authors named "Lisa Burnapp"

24 Publications

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The Impact of Cold Ischaemia Time On Outcomes of Living Donor Kidney Transplantation in the UK Living Kidney Sharing Scheme.

Ann Surg 2021 Jul 29. Epub 2021 Jul 29.

Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK NHS Blood and Transplant, Bristol, UK Department of Surgery & Cancer, Imperial College London, London, UK.

Objective: To assess the impact of cold ischaemia time (CIT) on living donor kidney transplantation (LDKT) outcomes in the UK living kidney sharing scheme (UKLKSS) versus outside the scheme.

Background: LDKT provides the best treatment option for end-stage kidney disease (ESKD) patients. ESKD patients with an incompatible living donor still have an opportunity to be transplanted through Kidney Exchange Programmes (KEP). In KEPs where kidneys travel rather than donors, CIT can be prolonged.

Methods: Data from all UK adult LDKT between 2007 and 2018 were analysed.

Results: 9969 LDKT were performed during this period, of which 1396 (14%) were transplanted through the UKLKSS, which we refer to as KEP. Median CIT was significantly different for KEP versus non-KEP (339 versus 182 minutes, p < 0.001). KEP LDKT had a higher incidence of delayed graft function (DGF) (4.08% versus 6.97%, p < 0.0001), lower 1-year (eGFR 57.90 versus 55.25 ml/min, p = 0.04) and 5-year graft function (eGFR 55.62 versus 53.09 ml/min, p = 0.01) compared to the non-KEP group, but 1- and 5-year graft survival were similar. Within KEP, a prolonged CIT was associated with more DGF (9.26% versus 4.80%, p = 0.03), and lower graft function at 1-year and 5-years (eGFR = 55 vs 50 ml/min, p = 0.02), but had no impact on graft survival.

Conclusion: Whilst CIT was longer in KEP, associated with more DGF and lower graft function, excellent 5-year graft survival similar to non-KEP was found.
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http://dx.doi.org/10.1097/SLA.0000000000005123DOI Listing
July 2021

Pre-emptive live donor kidney transplantation-moving barriers to opportunities: An ethical, legal and psychological aspects of organ transplantation view.

World J Transplant 2021 Apr;11(4):88-98

Imperial College Renal and Transplant Centre, Hammersmith Hospital, London W2 1NY, United Kingdom.

Live donor kidney transplantation (LDKT) is the optimal treatment modality for end stage renal disease (ESRD), enhancing patient and graft survival. Pre-emptive LDKT, prior to requirement for renal replacement therapy (RRT), provides further advantages, due to uraemia and dialysis avoidance. There are a number of potential barriers and opportunities to promoting pre-emptive LDKT. Significant infrastructure is needed to deliver robust programmes, which varies based on socio-economic standards. National frameworks can impact on national prioritisation of pre-emptive LDKT and supporting education programmes. Focus on other programme's components, including deceased kidney transplantation and RRT, can also hamper uptake. LDKT programmes are designed to provide maximal benefit to the recipient, which is specifically true for pre-emptive transplantation. Health care providers need to be educated to maximize early LDKT referral. Equitable access for varying population groups, without socio-economic bias, also requires prioritisation. Cultural barriers, including religious influence, also need consideration in developing successful outcomes. In addition, the benefit of pre-emptive LDKT needs to be emphasised, and opportunities provided to potential donors, to ensure timely and safe work-up processes. Recipient education and preparation for pre-emptive LDKT needs to ensure increased uptake. Awareness of the benefits of pre-emptive transplantation require prioritisation for this population group. We recommend an approach where patients approaching ESRD are referred early to pre-transplant clinics facilitating early discussion regarding pre-emptive LDKT and potential donors for LDKT are prioritized for work-up to ensure success. Education regarding pre-emptive LDKT should be the norm for patients approaching ESRD, appropriate for the patient's cultural needs and physical status. Pre-emptive transplantation maximize benefit to potential recipients, with the potential to occur within successful service delivery. To fully embrace preemptive transplantation as the norm, investment in infrastructure, increased awareness, and donor and recipient support is required.
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http://dx.doi.org/10.5500/wjt.v11.i4.88DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058646PMC
April 2021

Changing patterns of clinical decision making: are falling numbers of antibody incompatible transplants related to the increasing success of the UK Living Kidney Sharing Scheme? A national cohort study.

Transpl Int 2021 01 20;34(1):153-162. Epub 2020 Nov 20.

Renal and Transplant Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.

Antibody incompatibility is a barrier to living kidney transplantation; antibody incompatible transplantation (AIT) is an accepted treatment modality, albeit higher risk. This study aims to determine changes to clinical decision making and access to AIT in the UK. An electronic survey was sent to all UK renal transplant centres (n = 24), in 2014, and again in 2018. Questions focused on entry & duration in the UKLKSS for HLA and ABO-incompatible pairs, Can and provision of direct AIT transplantation within those centres. Between 2014 & 2018, the duration recommended for patients in the UKLKSS increased. In 2014, 34.8% of centres reported leaving HLA-i pairs in the UKLKSS indefinitely, or reviewing on a case by case basis, by 2018 this increased to 61%. Centres offering direct HLA-i transplantation reduced from 58% to 37%. For low titre (1:8) ABO-i recipients, 66% of centres recommended at least 9 months (3 matching runs) in the UKLKSS scheme in 2018, compared to 47% in 2014, 50% fewer units consider direct ABO-i transplantation for unsuccessful pairs with high ABO titres (>1:512). Over time, clinicians appear to be facilitating more conservative management of AIT patients, potentially limiting access to living donor transplantation.
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http://dx.doi.org/10.1111/tri.13776DOI Listing
January 2021

SARS-CoV-2 infection and early mortality of waitlisted and solid organ transplant recipients in England: A national cohort study.

Am J Transplant 2020 11 16;20(11):3008-3018. Epub 2020 Sep 16.

Medical Director, NHS Blood and Transplant, Bristol, UK.

Patients waitlisted for and recipients of solid organ transplants (SOT) are perceived to have a higher risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and death; however, definitive epidemiological evidence is lacking. In a comprehensive national cohort study enabled by linkage of the UK transplant registry and Public Health England and NHS Digital Tracing services, we examined the incidence of laboratory-confirmed SARS-CoV-2 infection and subsequent mortality in patients on the active waiting list for a deceased donor SOT and recipients with a functioning SOT as of February 1, 2020 with follow-up to May 20, 2020. Univariate and multivariable techniques were used to compare differences between groups and to control for case-mix. One hundred ninety-seven (3.8%) of the 5184 waitlisted patients and 597 (1.3%) of the 46 789 SOT recipients tested positive for SARS-CoV-2. Mortality after testing positive for SARS-CoV-2 was 10.2% (20/197) for waitlisted patients and 25.8% (154/597) for SOT recipients. Increasing recipient age was the only variable independently associated with death after positive SARS-CoV-2 test. Of the 1004 transplants performed in 2020, 41 (4.1%) recipients have tested positive for SARS-CoV-2 with 8 (0.8%) deaths reported by May 20. These data provide evidence to support decisions on the risks and benefits of SOT during the coronavirus disease 2019 pandemic.
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http://dx.doi.org/10.1111/ajt.16247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436919PMC
November 2020

Has the UK living kidney donor population changed over time? A cross-sectional descriptive analysis of the UK living donor registry between 2006 and 2017.

BMJ Open 2020 06 15;10(6):e033906. Epub 2020 Jun 15.

Renal Department, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK

Background: A living-donor kidney transplant is the best treatment for most people with kidney failure. Population cohort studies have shown that lifetime living kidney donor risk is modified by sex, age, ethnicity, body mass index (BMI), comorbidity and relationship to the recipient.

Objectives: We investigated whether the UK population of living kidney donors has changed over time, investigating changes in donor demographics.

Design: We undertook a cross-sectional analysis of the UK living kidney donor registry between January 2006 to December 2017. Data were available on living donor sex, age, ethnicity, BMI, hypertension and relationship to recipient.

Setting: UK living donor registry.

Participants: 11 651 consecutive living kidney donors from January 2006 to December 2017.

Outcome Measures: Living kidney donor demographic characteristics (sex, age, ethnicity, BMI and relationship to the transplant recipient) were compared across years of donation activity. Donor characteristics were also compared across different ethnic groups.

Results: Over the study period, the mean age of donors increased (from 45.8 to 48.7 years, p<0.001), but this change appears to have been limited to the White population of donors. Black donors were younger than White donors, and a greater proportion were siblings of their intended recipient and male. The proportion of non-genetically related non-partner donations increased over the 12-year period of analysis (p value for linear trend=0.002).

Conclusions: The increasing age of white living kidney donors in the UK has implications for recipient and donor outcomes. Despite an increase in the number of black, Asian and minority ethnic individuals waitlisted for a kidney transplant, there has been no increase in the ethnic diversity of UK living kidney donors. Black donors in the UK may be at a much greater risk of developing kidney failure due to accumulated risks: whether these risks are being communicated needs to be investigated.
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http://dx.doi.org/10.1136/bmjopen-2019-033906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299046PMC
June 2020

Raising awareness of unspecified living kidney donation: an ELPAT view.

Clin Kidney J 2020 Apr 15;13(2):159-165. Epub 2019 Jun 15.

Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College, London, UK.

Background: Living donor kidney transplantation (LDKT) is the preferred treatment for patients with end-stage renal disease and unspecified living kidney donation is morally justified. Despite the excellent outcomes of LDKT, unspecified kidney donation (UKD) is limited to a minority of European countries due to legal constraints and moral objections. Consequently, there are significant variations in practice and approach between countries and the contribution of UKD is undervalued. Where UKD is accepted as routine, an increasing number of patients in the kidney exchange programme are successfully transplanted when a 'chain' of transplants is triggered by a single unspecified donor. By expanding the shared living donor pool, the benefit of LDKT is extended to patients who do not have their own living donor because a recipient on the national transplant list always completes the chain. Is there a moral imperative to increase the scope of UKD and how could this be achieved?

Methods: An examination of the literature and individual country practices was performed to identify the limitations on UKD in Europe and recommend strategies to increase transplant opportunities.

Results: Primary limitations to UKD, key players and their roles and responsibilities were identified.

Conclusions: Raising awareness to encourage the public to volunteer to donate is appropriate and desirable to increase UKD. Recommendations are made to provide a framework for increasing awareness and engagement in UKD. The public, healthcare professionals, policy makers and society and religious leaders have a role to play in creating an environment for change.
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http://dx.doi.org/10.1093/ckj/sfz067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7147300PMC
April 2020

Donating a Kidney to a Stranger: A Review of the Benefits and Controversies of Unspecified Kidney Donation.

Ann Surg 2020 07;272(1):45-47

Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.

Of Background Data: Unspecified kidney donation (UKD) describes living donation of a kidney to a stranger. The practice is playing an increasingly important role within the transplant programme in the United Kingdom, where these donors are commonly used to trigger a chain of transplants; thereby amplifying the benefit derived from their donation. The initial reluctance to accept UKD was in part due to uncertainty about donor motivations and whether the practice was morally and ethically acceptable.

Objectives: This article provides an overview of UKD and answers common questions regarding the ethical considerations, clinical assessment, and how UKD kidneys are used to maximize utility. Existing literature on outcomes after UKD is also discussed, along with current controversies.

Conclusions: We believe UKD is an ethically acceptable practice which should continue to grow, despite its controversies. In our experience, these donors are primarily motivated by a desire to help others and utilization of their kidney as part of a sharing scheme means that many more people seek to benefit from their very generous donation.
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http://dx.doi.org/10.1097/SLA.0000000000003855DOI Listing
July 2020

Building Kidney Exchange Programmes in Europe-An Overview of Exchange Practice and Activities.

Transplantation 2019 07;103(7):1514-1522

Prince Mohammad Bin Salman College, King Abdullah Economic City, Kingdom of Saudi Arabia.

Background: Considerable differences exist among the living donor Kidney Exchange Programmes (KEPs) that are in use and being built in Europe, contributing to a variation in the number of living donor transplants (Newsletter Transplant; International figures on donation and transplantation 2016). Efforts of European KEPs to exchange (best) practices and share approaches to address challenges have, however, been limited.

Methods: Experts from 23 European countries, collaborating on the European Network for Collaboration on Kidney Exchange Programmes Cooperation on Science and Technology Action, developed a questionnaire to collect detailed information on the functioning of all existing KEPs in Europe, as well as their opportunities and challenges. Following a comparative analysis, results were synthesized and interpreted by the same experts.

Results: The practices, opportunities and challenges reported by 17 European countries reveal that some of the 10 operating programs are mature, whereas others are in earlier stages of development. Over 1300 transplants were performed through existing KEPs up to the end of 2016, providing approximately 8% of their countries' living kidney donations in 2015. All countries report challenges to either initiating KEPs or increasing volumes. Some challenges are shared, whereas others differ because of differences in context (eg, country size, effectiveness of deceased donor program) and ethical and legal considerations (eg, regarding living donation as such, nonrelated donors, and altruistic donation). Transnational initiatives have started in Central Europe, Scandinavia, and Southern Europe.

Conclusions: Exchange of best practices and shared advancement of national programs to address existing challenges, aided by transnational exchanges, may substantially improve access to the most (cost) effective treatment for the increasing number of patients suffering from kidney disease.
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http://dx.doi.org/10.1097/TP.0000000000002432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613834PMC
July 2019

Understanding barriers and outcomes of unspecified (non-directed altruistic) kidney donation from both professional's and patient's perspectives: research protocol for a national multicentre mixed-methods prospective cohort study.

BMJ Open 2017 Sep 21;7(9):e015971. Epub 2017 Sep 21.

Department of Renal Transplantation, Guy's and St. Thomas' NHS Foundation Trust/King's College London, London, UK.

Introduction: Living donation accounts for over one-third of all kidney transplants taking place in the UK. The concept of anonymously donating a kidney to a stranger (non-directed altruistic or unspecified kidney donation (UKD)) remains uncomfortable for some clinicians, principally due to concerns about the motivations and long-term physical and psychological outcomes in this donor group.

Aims: The research programme aims to provide a comprehensive assessment of the unspecified donor programme in the UK. It aims to identify reasons for variations in practice across centres, explore outcomes for donors and ascertain barriers and facilitators to UKD, as well as assess the economic implications of unspecified donation.

Methods: The research programme will adopt a mixed-methods approach to assessing UKD nationally using focus groups, interviews and questionnaires. Two study populations will be investigated. The first will include transplant professionals involved in unspecified kidney donation. The second will include a 5-year prospective cohort of individuals who present to any of the 23 UK transplant centres as a potential unspecified living kidney donor. Physical and psychological outcomes will be followed up to 1 year following donation or withdrawal from the donation process. A matched sample of specified donors (those donating to someone they know) will be recruited as a control group. Further qualitative work consisting of interviews will be performed on a purposive sample of unspecified donors from both groups (those who do and do not donate).

Dissemination: The findings will be reported to NHS Blood and Transplant and the British Transplant Society with a view to developing national guidelines and a protocol for the management of those presenting for unspecified donation.

Trial Registration Number: ISRCTN23895878, Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2017-015971DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623565PMC
September 2017

Summary of the British Transplantation Society UK Guidelines for Living Donor Liver Transplantation.

Transplantation 2016 Jun;100(6):1184-90

1 University of Newcastle Upon Tyne and Newcastle NHS Trust, United Kingdom. 2 NHS Blood and Transplant, Bristol, United Kingdom. 3 SW Thames Renal & Transplantation Unit, St. Helier Hospital, Surrey, United Kingdom.

The British Transplantation Society Guidelines for Living Donor Liver Transplantation was published in July 2015 and is the first national guideline in the field of living donor liver transplantation. The guideline aims to review the evidence relating to the evaluation process of both recipient and donor candidates; address the moral and ethical issues surrounding the procedure; outline the technical aspects of the procedure, including the middle hepatic vein controversy and the "small for size syndrome"; review donor and recipient outcomes and complications including donor mortality; and examine evidence relating to the advantages and disadvantages of living donor liver transplantation. In line with previous guidelines published by the BTS, the guideline has used the Grading of Recommendations Assessment, Development and Evaluation system to rate the strength of evidence and recommendations. This article summarizes the Statements of Recommendation contained in the guideline, which provide a framework for the delivery of living liver donation in the United Kingdom and may be of wide international interest. It is recommended that the full guideline document is consulted for details of the relevant references and evidence base. This may be accessed at http://www.bts.org.uk/BTS/Guidelines_Standards/Current/BTS/Guidelines_Standards/Current_Guidelines.aspx?hkey=e285ca32-5920-4613-ac08-fa9fd90915b5.
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http://dx.doi.org/10.1097/TP.0000000000001128DOI Listing
June 2016

The Relevance of Directive 2010/53/EU for Living Organ Donation Practice: An ELPAT View.

Transplantation 2015 Oct;99(10):2215-22

1 Department of Philosophy and Moral Sciences, Bioethics Institute Ghent, Ghent University, Ghent, Belgium. 2 The Transplant Centre, Sahlgrenska University Hospital, Göteborg, Sweden. 3 Institute of Health and Care Sciences, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden. 4 Department of Transplantation, Guy's Hospital, London, United Kingdom. 5 Department of Surgery, Catholic University, Rome, Italy. 6 Department of Philosophy, Babes-Bolyai University, Cluj, Romania; The Academic Society for the Research of Religions and Ideologies, Cluj, Romania. 7 Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, Rotterdam, the Netherlands. 8 Lead Nurse, Living Donation, NHS Blood and Transplant, London, United Kingdom. 9 Living Donor Kidney Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. 10 Division of Transplant Surgery, Department of Surgery, Erasmus MC, Rotterdam, the Netherlands.

With the recent transposition of Directive 2010/53/EU into the transplant regulation of EU Member States, the time is right to have a closer look at its implications for living organ donation practice. We first discuss the relevance of the Action Plan which forms the basis for the policy of the European Commission in the field of organ donation and transplantation. We then analyze the impact of Directive 2010/53/EU which was adopted to support the implementation of the Priority Actions set out in the Action Plan. We more specifically focus on the obligations of transplant centers engaged in living organ donation and highlight their significance for clinical practice. Finally, we point out some strengths and weaknesses of the Directive in addressing living organ donation.
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http://dx.doi.org/10.1097/TP.0000000000000670DOI Listing
October 2015

Dealing With Public Solicitation of Organs From Living Donors--An ELPAT View.

Transplantation 2015 Oct;99(10):2210-4

1 Department of Philosophy, Babes-Bolyai University, Cluj, Romania; SACRI (The Academic Society for the Research of Religions and Ideologies), Cluj, Romania. 2 Bioethics Institute Ghent, Ghent University, Ghent, Belgium. 3 The Transplant Center, Sahlgrenska University Hospital, Gothenburg, Sweden. 4 Institute of Health and Care Sciences, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. 5 Department of Surgery, Catholic University Rome, Italy. 6 Department of Transplantation, Guys Hospital, London, United Kingdom. 7 Division of Nephrology, Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. 8 National Health Service (NHS) Blood and Transplant, Bristol, United Kingdom. 9 Division of HPB & Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.

Although transplant professionals have initially been reluctant to perform transplants after public solicitation of organs from living donors, nowadays these transplants are increasingly being performed and reported. After clarifying the existing terminology, we elaborate an operational definition of public solicitation that is consistent with the Ethical, Legal, and Psychosocial Aspects of Transplantation classification for living organ donation. Our aim is to critically assess this phenomenon, from a legal, moral, and practical perspective, and to offer some recommendations. From a legal point of view, we analyze the current situation in the Europe and the United States. From a moral perspective, we evaluate the various arguments used in the literature, both in favor and against. Finally, we offer a set of recommendations aimed at maximizing the organ donor pool while safeguarding the interests of potential living donors.
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http://dx.doi.org/10.1097/TP.0000000000000669DOI Listing
October 2015

Comparison of estimated GFR and measured GFR in prospective living kidney donors.

Int Urol Nephrol 2015 Jan 6;47(1):201-8. Epub 2014 Nov 6.

MRC Centre for Transplantation and Renal Unit, Guy's and St. Thomas' NHS Foundation Trust, King's College Academic Health Partners, London, UK.

Purpose: The aim of this study was to examine the usefulness of three GFR-estimating equations (eGFR) compared with measured GFR (mGFR) in potential living kidney donors.

Methods: We compared the performance of the MDRD, CKD-Epi and Cockcroft-Gault equations with mGFR measured using (51)Cr-EDTA in 508 consecutive potential living kidney donors. Each equation was assessed for bias, precision and accuracy compared with mGFR, and the sensitivity and specificity for the identification of donors with mGFR<80 mL/min/1.73 m2 was evaluated.

Results: Two hundred and forty-four subjects were male, 398 Caucasian, 60 Afro-Caribbean and 50 from other ethnic groups. Median age and mGFR were 44.1 year and 91.7 mL/min/1.73 m2, respectively. Spearman correlation coefficients between eGFR and mGFR were in the range R s=0.520-0.593. Median bias (eGFR-mGFR) for the MDRD, CKD-Epi and Cockcroft-Gault equations were -1.0 (p=0.98), +8.8 (p<0.0001) and +11.1 (p<0.0001) mL/min/1.73 m2, respectively. Significant differences in bias between Afro-Caribbean and Caucasian subjects were found. The sensitivity (specificity) for the MDRD, CKD-Epi and Cockcroft-Gault equations for identifying subjects with mGFR<80 mL/min/1.73 m2 was 60 (83), 39 (95) and 44% (95%), respectively.

Conclusions: The level of agreement between mGFR and all three eGFR values was poor, with the MDRD equation performing best. We conclude that reliance on creatinine-based eGFR values is unsatisfactory for the evaluation of potential living kidney donors.
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http://dx.doi.org/10.1007/s11255-014-0859-yDOI Listing
January 2015

Motivations, outcomes, and characteristics of unspecified (nondirected altruistic) kidney donors in the United Kingdom.

Transplantation 2014 Dec;98(11):1182-9

1 Department of Transplantation, Guy's Hospital, London, United Kingdom. 2 Health Psychology Section, Institute of Psychiatry, King's College London, Guy's Hospital, London, United Kingdom. 3 NHS Blood and Transplant, Organ Donation and Transplantation Directorate, Stoke Gifford, Bristol, United Kingdom. 4 Queen Alexandra Hospital, Hampshire, United Kingdom. 5 South London and Maudsley NHS Foundation Trust, York Clinic, Guy's Hospital, London, United Kingdom. 6 Address correspondence to: Nizam Mamode, F.R.C.S., Department of Transplantation, 6th Floor Renal Offices, Borough Wing, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom.

Background: Unspecified (nondirected altruistic) kidney donation is becoming increasingly common in the United Kingdom. Questions regarding motivation and characteristics of these donors persist, alongside concerns about regret and long-term psychosocial outcomes. The aims of this study were to compare psychosocial and physical outcomes in unspecified kidney donors (UKDs) versus specified kidney donors (SKDs).

Methods: We performed a cross-sectional study, in which a detailed assessment of psychosocial outcomes was made using validated questionnaires. Additional questions specific to donation were also asked, including questions regarding motivation, regret, and anonymity.

Results: One hundred ninety responses were received from 296 participants studied (110 UKDs [74.3%] vs. 80 SKDs [54.1%], P<0.001). Unspecified kidney donors were older (54 years vs. 44 years; P<0.001), predominantly white (99.1% vs. 78.5%; P<0.001), and donated more recently (1.3 years vs. 2.6 years; P<0.001). There was no difference in psychiatric history or personality type, or current depression, anxiety, stress, self-esteem, or well-being between the groups (P>0.05). Unspecified kidney donors were more engaged in other altruistic behaviours (P<0.001). There was no difference in physical outcomes, although UKDs recovered quicker (P<0.001). Regret was low (3.7% UKDs vs. 7.5% SKDs; P=0.078).

Conclusion: This study has demonstrated that UKDs have comparable physical and psychosocial outcomes to SKDs. These favorable outcomes may be, in part, because of the rigorous evaluation process which currently includes a mental health assessment. We conclude that the program can continue to expand safely across the United Kingdom.
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http://dx.doi.org/10.1097/TP.0000000000000340DOI Listing
December 2014

Organ donation and transplantation in europe: the highlights.

Authors:
Lisa Burnapp

J Ren Care 2014 Jun;40(2):87

Consultant Nurse, Living Donor Kidney Transplantation, Guy's & St. Thomas' NHS Foundation Trust, London; Lead Nurse-Living Donation, NHS Blood and Transplant, London.

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http://dx.doi.org/10.1111/jorc.12074DOI Listing
June 2014

Summary of the British Transplantation Society guidelines for transplantation from donors after deceased circulatory death.

Transplantation 2014 Feb;97(3):265-70

1 Chair of BTS Standards Committee and Consultant Nephrologist, SW Thames Renal & Transplantation Unit, Surrey, UK. 2 Lead Nurse Living Donation, NHS Blood and Transplant, Hertfordshire, UK. 3 Professor of Transplantation, University of Newcastle upon Tyne and Newcastle NHS Trust, UK. 4 Address correspondence to: Dr. Peter A Andrews, Consultant Nephrologist & Clinical Director, SW Thames Renal & Transplantation Unit, St Helier Hospital, Surrey SM5 1AA, UK.

The second edition of the British Transplantation Society Guidelines for Transplantation from Donors after Deceased Circulatory Death was published in June 2013. The guideline has been extensively revised since the previous edition in 2004 and has used the GRADE system to rate the strength of evidence and recommendations. This article summarizes the Statements of Recommendation contained in the guideline, which provide a framework for transplantation after deceased circulatory death in the U.K. and may be of wide international interest. It is recommended that the full guideline document is consulted for details of the relevant references and evidence base. This may be accessed at: http://www.bts.org.uk/MBR/Clinical/Guidelines/Current/Member/Clinical/Current_Guidelines.aspx.
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http://dx.doi.org/10.1097/01.TP.0000438630.13967.c0DOI Listing
February 2014

Glomerular filtration rate in prospective living kidney donors.

Int Urol Nephrol 2013 Oct 6;45(5):1445-52. Epub 2013 Mar 6.

Department of Nuclear Medicine, Guy's and St. Thomas NHS Foundation Trust, King's College Academic Health Partners, London, UK,

Purpose: Measurements of glomerular filtration rate (GFR) are frequently interpreted assuming a linear variation with age. Nonlinear relationships may give a better representation of the changes associated with normal ageing.

Methods: This was a retrospective study of 904 subjects (468 women, 436 men; age range 18-84 years) undergoing assessment as prospective living kidney donors. GFR was evaluated from (51)Cr-EDTA plasma clearance using blood samples taken at 2, 3 and 4 h. The slope-intercept GFR was corrected for body surface area (BSA) using the Haycock formula and for the fast exponential using the Brochner-Mortensen equation. The relationship between age, gender and GFR was examined using best-fit curve analysis. Nonlinear relationships with age were explored using fractional polynomials.

Results: There was no gender difference in BSA-corrected GFR over five decades of age (P = 0.40). However, female donors with a body mass index >30 kg/m(2) had a statistically significantly lower GFR than nonobese women (P < 0.01). The best-fit relationship between age and GFR was nonlinear and described using a fractional polynomial model of degree 1 (GFR = 103.9-0.0061 × Age(2) mL/min/1.73 m(2)) with a root mean standard error of 12.9 mL/min/1.73 m(2). The residual variance for this model was significantly smaller than for the best-fit linear model (P = 0.006).

Conclusions: GFR measurements in prospective living kidney donors are best corrected for age using a nonlinear relationship.
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http://dx.doi.org/10.1007/s11255-013-0408-0DOI Listing
October 2013

Summary of the British Transplantation Society/Renal Association U.K. guidelines for living donor kidney transplantation.

Transplantation 2012 Apr;93(7):666-73

SW Thames Renal & Transplantation Unit, Surrey, UK.

The third edition of the joint British Transplantation Society/Renal Association guidelines for living donor kidney transplantation was published in May 2011. The guideline has been extensively revised since the previous edition in 2005 and has used the GRADE system to rate the strength of evidence and recommendations. This article summarizes the statements of recommendation contained in the guideline, which provide a framework for the delivery of living kidney donation in the United Kingdom and may be of wide international interest. It is recommended that the full guideline document is consulted for details of the relevant references and evidence base. This may be accessed at http://www.bts.org.uk/transplantation/standards-and-guidelines/ and http://www.renal.org/clinical/OtherGuidelines.aspx (transplantation is welcome to add a web link in this article to/through its own Web site to increase traffic).
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http://dx.doi.org/10.1097/TP.0b013e318247a7b7DOI Listing
April 2012

Multidisciplinary insights into optimizing adherence after solid organ transplantation.

Transplantation 2010 Mar;89(5):627-32

Institute of Liver Studies, King's College Hospital, London, United Kingdom.

Background: Nonadherence to medical treatment in transplant recipients is a major risk factor for graft rejection episodes, and it has significant financial implications. Despite its importance, there is a lack of common understanding across the disciplines involved of the key issues driving nonadherence.

Methods: A qualitative study, comprising a multidisciplinary workshop, followed by a consultation exercise to validate its outcomes, was initiated to gain further insight into nonadherence behavior and to identify priorities for optimizing adherence to posttransplantation regimens.

Results: Eight statements relating to actions necessary to maximize adherence to posttransplantation medication were developed and offered for validation. All but one of these attracted a median score of 9 on an agreement scale of 1 to 10, where 10 was the highest level of agreement.

Conclusion: The outcomes generate a structure that will facilitate communication and understanding and informing clinical practice and future research.
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http://dx.doi.org/10.1097/TP.0b013e3181ca87b0DOI Listing
March 2010

Caring for patients after kidney transplantation.

Nurs Stand 2009 Jan 14-20;23(19):49-57; quiz 58

Queen Elizabeth Hospital, Birmingham.

This article examines the care and management of patients following solid organ transplantation. It focuses on kidney transplantation and the nursing role in optimising long-term patient outcomes and quality of life.
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http://dx.doi.org/10.7748/ns2009.01.23.19.49.c6744DOI Listing
June 2009

Human Tissue Act 2004 comes into force.

Br J Nurs 2006 Aug 10-Sep 13;15(15):804

Nottingham University Hospital.

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http://dx.doi.org/10.12968/bjon.2006.15.15.21684DOI Listing
October 2006

Natural killer-cell activity after human renal transplantation in relation to killer immunoglobulin-like receptors and human leukocyte antigen mismatch.

Transplantation 2003 Oct;76(8):1220-8

Department of Nephrology and Transplantation, Guy's Hospital, London, United Kingdom.

Background: Natural killer (NK) cells use killer immunoglobulin-like receptors (KIR) that bind to self-class I major histocompatibility complex (MHC) molecules to prevent killing of autologous cells. Mismatched allografts, which do not express recipient MHC class I molecules, can therefore be potential targets for NK-cell killing. In our living related-unrelated renal transplantation program, donor-recipient pairs vary in the amount of both HLA and KIR genes they share. This provides us with a unique opportunity to dissect the influence of KIR on NK-cell function after transplantation.

Methods: Recipient NK cells were used in a cytotoxicity assay against donor peripheral blood mononuclear cells 2 days before, on the day of, and 3 days after transplantation. Results were correlated to HLA-KIR compatibility between donor and recipient.

Results: NK killing, in a direct ex vivo setting, was demonstrated to be HLA mismatch dependent. Recipient NK antidonor cytotoxicity was unaltered despite having received 2 days' treatment with cyclosporine A before transplantation. However, cytotoxicity increased 3 days after transplantation in 71% of recipients. Recipients exhibiting increased NK cytotoxicity against their donors after transplantation were found to possess more activating KIR genes specific for donor class I MHC molecules than those in whom killing activity did not increase (P<0.04).

Conclusions: NK cells are activated after transplantation despite quadruple immunosuppression, suggesting that recipient NK-cell cytotoxicity against the donor may be a previously unrecognized area of the rejection process, especially in poorly matched donor-recipient pairs where the recipient may not express the correct repertoire of inhibitory receptors to prevent killing of donor cells.
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http://dx.doi.org/10.1097/01.TP.0000083896.91215.C7DOI Listing
October 2003
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