| Autor: |
Rennie, Trijntje, Rennie, Trijntje Jacqueline Willemijn |
| Přispěvatelé: |
Phelan, Paul, Turner, Neil |
| Jazyk: |
angličtina |
| Rok vydání: |
2021 |
| Předmět: |
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| Popis: |
BACKGROUND: In the era of ageing populations, the proportion of older patients reaching End Stage Renal Disease is on the rise and an increasing proportion of patients require a second or subsequent transplant during their lifetime. In kidney transplantation this means that high-risk patients in terms of sensitisation history, age and/or co-morbidities who would previously not have been considered for transplantation are currently being wait-listed. AIMS: The aim of this study was to characterise the modern, complex transplant recipient in Scotland, and to identify risk factors for adverse outcomes in an attempt to individualise management for certain patient groups which may improve outcome. The thesis specifically focusses on 1) the tolerability of the current immunosuppression regime in elderly recipients; 2) the risk / benefit profile of CMV prophylaxis with valganciclovir in recipients at varying risk of CMV infection post-transplantation; 3) the effect of pre-existing donor-specific antibodies on transplant and patient outcomes and lastly 4) the significance of denatured HLA (dHLA) antibodies in highly sensitised patients. METHODS: Data were collected across all Scottish renal units, who collaboratively form the SCOT-network (Scottish Clinical Outcomes following kidney Transplantation). Three Scottish kidney transplant cohorts were formed. The first cohort included all patients transplanted between 01-01-2015 and 31-12-2016. The second cohort consisted of all patients that received an HLA incompatible transplant between 2011 and 2017, who were matched at a 1:2 ratio with patients from the first cohort. HLA antibody analysis of a third cohort of highly sensitised patients on the kidney transplant waiting list was performed in collaboration with the histocompatibility and immunogenetics laboratory within the Scottish Blood Transfusion Service at the Royal Infirmary of Edinburgh. RESULTS: Between 1996 and 2016, 6743 patients aged ≥60 years started renal replacement therapy (RRT) in Scotland, 727 patients (11%) were listed for transplantation during the same time period and subsequently half of them received a transplant. The proportion of listed patients that received a transplant decreased with advancing age. A Scottish multicentre retrospective analysis included all kidney transplant recipients transplanted in 2015 and 2016. Of the 490 patients, 26% were aged ≥60 years. Acute rejection (AR) rates at 1 year were 15% in recipients |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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