North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) 2005 Annual Report. Renal Transplantation. Chronic Renal Insufficiency

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) 2005 Annual Report. Renal Transplantation. Chronic Renal Insufficiency"

Transcription

1 North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) 2005 Annual Report Renal Transplantation Dialysis Chronic Renal Insufficiency This is a privileged communication not for publication.

2 This study is sponsored by major grants from: Novartis Pharmaceutical Corporation AMGEN Inc. Genentech, Inc. NAPRTCS also thanks the following contributors: Roche Laboratories, Inc. Wyeth Research Watson Pharmaceuticals

3 North American Pediatric Renal Transplant Cooperative Study Clinical Coordinating Center Data Coordinating Center William Harmon, M.D. Donald Stablein, Ph.D. NAPRTCS Lynya Talley, Ph.D. 1 Autumn Street The EMMES Corporation 5th Floor 401 N. Washington Street, Suite 700 Boston, Massachusetts Rockville, Maryland Board Members William Harmon, MD (President) Richard Fine, MD (Vice President/Treasurer) Steven Alexander, MD (Secretary) Bradley Warady, MD (Member at Large) Mark Benfield, MD (Member at Large) Stuart Goldstein, MD (Chair, PCC) Ruth McDonald, MD (Chair, Special Studies Committee and Vice-Chair, PCC)

4 This report was developed under the auspices of the Operations Committee and prepared by Lynya Talley, Ph.D. and Donald M. Stablein, Ph.D. With assistance from Data Coordinating Center Staff Stuart Berlin Angela Norman Kumar Thotapally Danielle Weidenhamer-Quarles

5 TABLE OF CONTENTS PAGE I INTRODUCTION 1 II TRANSPLANTATION Section 1: Transplant Patient Characteristics 1-1 Section 2: Donor History and Antigen Mismatches 2-1 Section 3: Therapy 3-1 Section 4: Rejection 4-1 Section 5: Graft Function 5-1 Section 6: Growth 6-1 Section 7: Morbidity, Malignancy, and Mortality 7-1 III DIALYSIS Section 8: Dialysis Patient Characteristics 8-1 Section 9: Dialysis Access Data 9-1 Section 10: Erythropoietin Use in Dialysis Patients 10-1 Section 11: Dialysis Follow-up 11-1 Section 12: Growth 12-1 IV CHRONIC RENAL INSUFFICIENCY Section 13: CRI Patient Demographics 13-1 Section 14: Termination of Chronic Renal Insufficiency Status 14-1 Section 15: CRI Follow-up Data 15-1 V APPENDICES Appendix A: Participating Centers and Contact Physicians A-1 Appendix B: Bibliography C B-1 Appendix C: Special Studies and Analyses C-1 i

6 LIST OF EXHIBITS Section 1 Exhibit 1.1 Patient Registrations, Transplants, and Selected Characteristics, by Year of Registration 1-4 Exhibit 1.2 Recipient and Index Transplant Characteristics 1-5 Exhibit 1.3 Transplant Characteristics 1-6 Exhibit 1.4 Age at Transplantation 1-7 Exhibit 1.5 Age at Index Transplant, by Patient's Sex, Race, and Diagnosis 1-8 Exhibit 1.6 Sex, Race, and Biopsy Distributions, by Primary Renal Diagnosis 1-9 Exhibit 1.7 Primary Diagnosis by Age 1-10 Section 2 Exhibit 2.1 Donor Information 2-3 Exhibit 2.2 Use Over Time of Donor-Specific and Random Blood Transfusions 2-4 Exhibit 2.3 Percent HLA Mismatches 2-5 Exhibit 2.4 Age at Transplant and Donor Source 2-6 Section 3 Exhibit 3.1 Medication Data First 30 Days, Transplants after Exhibit 3.2 Week 1 Calcineurin Inhibitor Use, by Induction Antibody 3-6 Exhibit 3.3 Induction Antibody Use, by Year 3-6 Exhibit 3.4 Exhibit 3.5 Exhibit 3.6 Exhibit 3.7 Mean (SE) Daily Drug Dosages, by Drug Combination and Year Post-Transplant 3-7 Percent of Patients with Functioning Grafts Receiving Immunosuppressive Medication 30 Days Post Transplant, by Year of Transplant 3-8 Percentage of Patients Receiving Designated Maintenance Immunosuppression Regimens, by Donor Source and Time of Follow-up 3-9 Percentage of Patients Receiving Concomitant Medications, by Donor Source and Time Post-Transplantation 3-10 ii

7 Section 4 Exhibit 4.1A Frequency of Acute Rejections 4-4 Exhibit 4.1B Acute Rejection Ratios 4-4 Exhibit 4.2 Time to First Rejection Episode, by Allograft Source and Transplant Year 4-5 Exhibit 4.3A Exhibit 4.3B Relative Hazard (RH) of First Rejection Episode, First Transplant, Relative Hazard (RH) of First Rejection Episode, First Transplant, Exhibit 4.4 Time to First Rejection Episode, by Selected Characteristics 4-8 Exhibit 4.5A Rejection Reversal Outcome by Selected Characteristics 4-10 Exhibit 4.5B Rejection Reversal Outcome by Selected Characteristics for First Acute Rejection Episode Only 4-11 Exhibit 4.6 Rejection Reversal Outcome by Transplant Year 4-12 Exhibit 4.7 Summary of Late First Rejections, by Selected Characteristics 4-13 Section 5 Exhibit 5.1 Causes of Graft Failure 5-7 Exhibit 5.2 Percent Graft Survival by Allograft Source 5-8 Exhibit 5.3 Graft Failure Summary, by Allograft Source and Transplant Characteristics 5-9 Exhibit 5.4 Percent Graft Survival for Recipients of Living Donor Source Allografts 5-11 Exhibit 5.5 Percent Graft Survival for Recipients of Cadaver Donor Source Allografts 5-12 Exhibit 5.6 Percent Graft Survival for Annual Cohort Group 5-14 Exhibit 5.7 Graft Survival by Donor Source and HLA-Antigen Disparity 5-15 Exhibit 5.8 Percent Graft Survival, by Donor Source and Diagnosis 5-16 Exhibit 5.9 Exhibit 5.10 Exhibit 5.11 Post Week 1 Graft Survival by Donor Source and Acute Tubular Necrosis Status 5-17 Serial Serum Creatinine and Calculated Creatinine Clearance Measures for Functioning Grafts, by Age at Transplant 5-18 Serial Serum Creatinine for Functioning Grafts, by Race and Induction Antibody Therapy 5-19 iii

8 Exhibit 5.12 Exhibit 5.13 Exhibit 5.14 Graft Function, i.e. Graft Survival and Mean Calculated Clearance at Annual Follow-up, by Donor Source 5-20 Graft Function, i.e. Graft Survival and Mean Calculated Clearance at Annual Follow-up, by Donor Source and Initial Use of Antibody Preparations 5-21 Graft Function, i.e. Graft Survival and Mean Calculated Clearance at Annual Follow-up, by Donor Source and Race 5-22 Section 6 Exhibit 6.1 Exhibit 6.2 Exhibit 6.3 Exhibit 6.4 Mean (with SE) Standardized Height and Weight Scores, by Selected Characteristics and Times Post-Transplantation 6-3 Mean Change from Baseline (with SE) in Standardized Height and Weight Scores in Subjects with Graft Function, by Age at Transplant 6-4 Mean (with SE) of Standardized Height at Time of Initial Transplant, by Year of Transplant 6-5 Mean (with SE) of Standardized Height at Initial Transplant Over Time, by Year of Transplant and Age at Transplant 6-6 Section 7 Exhibit 7.1 Hospitalization Days During the First Post-Transplant Month, by Year of Transplantation and Donor Source 7-4 Exhibit 7.2A Transplant Month Hospitalization 7-5 Exhibit 7.2B Transplant ( ) Month Hospitalization 7-6 Exhibit 7.2C Transplant ( ) Month Hospitalization 7-7 Exhibit 7.3A Exhibit 7.3B Hospitalization Results for Patients with Functioning Grafts in Specified Follow-up Periods (Living Donor Transplants) 7-8 Hospitalization Results for Patients with Functioning Grafts in Specified Follow-up Periods (Cadaver Donor Transplants) 7-9 Exhibit 7.4 Selected Characteristics of Transplants with Malignancy 7-10 Exhibit 7.5A Percent Patient Survival, by Primary Allograft Source 7-11 Exhibit 7.5B Percent Patient Survival, by Era and Primary Allograft Source 7-11 Exhibit 7.6A Exhibit 7.6B Percent Patient Survival of Primary Transplants, by Age at Transplantation Living Donor 7-12 Percent Patient Survival of Primary Transplants, by Age at Transplantation Cadaver Donor 7-12 Exhibit 7.7 Causes of Death Following Index Renal Transplantation 7-13 iv

9 Section 8 Exhibit 8.1 Dialysis Patient Demographics 8-4 Exhibit 8.2 Number and Percent Distributions of Patient Race/Ethnicity, by Dialysis Modality and Age at Initiation 8-7 Exhibit 8.3 Post Initiation (1 Month and 12 Months) Concomitant Drug Therapy 8-8 Exhibit 8.4 Post Initiation (24 Months and 36 Months) Concomitant Drug Therapy 8-9 Exhibit 8.5 Baseline Education Status 8-10 Exhibit 8.6 Baseline Education Status, by Race 8-11 Exhibit 8.7 Baseline Education Status, by Age 8-12 Exhibit 8.8 Percent Full-Time School Attendance 8-13 Exhibit 8.9 Percent Patient Survival, by Age at Dialysis Initiation 8-14 Exhibit 8.10 Causes of Death Following the Index Course of Dialysis 8-15 Section 9 Exhibit 9.1A Modality Initiation and Termination 9-4 Exhibit 9.1B Termination Reasons for Non-Transplanted Patients by Vintage 9-5 Exhibit 9.2A Peritoneal Dialysis Access 9-6 Exhibit 9.2B Peritoneal Access Data by Vintage 9-7 Exhibit 9.3 Catheter Characteristics for Peritoneal Dialysis Accesses 9-8 Exhibit 9.4A Hemodialysis Access 9-9 Exhibit 9.4B Hemodialysis Access Data by Vintage 9-10 Exhibit 9.5 Frequency Distribution of Dialysis Access Status, by Selected Characteristics 9-11 Exhibit 9.6 Reasons for Change of Modality, by Selected Characteristics 9-12 Exhibit 9.7 Time to Dialysis Termination for Index Cases 9-13 Exhibit 9.8 Exhibit 9.9 Time to Dialysis Termination for Index Cases, by Age and Race/Ethnicity 9-14 Time to Dialysis Termination for Index Cases, by PD Catheter Characteristics 9-15 Exhibit 9.10 Time to Dialysis Termination for Index Cases, by HD Access 9-16 v

10 Exhibit 9.11 Time to Dialysis Termination for Index Cases, by Reason for Termination 9-17 Exhibit 9.12 Selected CAPD and APD Patient Demographics 9-18 Exhibit 9.13 Exhibit 9.14 Exhibit 9.15 Time to Dialysis Termination for Selected CAPD/APD Cases, by Modality 9-19 Time to Transplantation and Change of Modality for Selected CAPD/APD Cases, by Modality 9-20 Time to First Peritonitis Episode For Selected CAPD/APD Cases, by Modality 9-21 Section 10 Exhibit 10.1 Percent EPO Use, by Months on Dialysis 10-3 Exhibit 10.2 Percent EPO Use at Baseline (Day 30) 10-4 Exhibit 10.3 Route and Frequency of EPO Administrations 10-5 Exhibit 10.4 Mean EPO Dose (Units/Kg/Week) 10-6 Exhibit 10.5 EPO Frequency (%) at 6 Months, by Modality and Age at Dialysis Initiation 10-7 Exhibit 10.6 Distribution of Hematocrit at 6 Months, by EPO Use 10-7 Exhibit 10.7 Mean and Median Hematocrit Levels at 6 Months, by EPO Use 10-7 Section 11 Exhibit 11.1 Peritoneal Dialysis at Follow-up 11-4 Exhibit 11.2 Number and Percent of Peritonitis Episodes, by Age 11-5 Exhibit 11.3 Peritonitis Infection Rates, by Age and Catheter Characteristics 11-6 Exhibit 11.4 Time to First Peritonitis Infection 11-7 Exhibit 11.5 Time to First Peritonitis Infection, by Age at Peritoneal Dialysis Initiation 11-7 Exhibit 11.6 Time to First Peritonitis Infection, by Catheter Access Characteristics 11-8 Exhibit 11.7 Peritoneal Dialysis Access Revision Exhibit 11.8 Hemodialysis at Follow-up Exhibit 11.9 Hemodialysis Access Revision vi

11 Exhibit Time to Cadaver Transplantation, by Era Exhibit Time to Cadaver Transplantation, by Age Exhibit KT/V by Modality, Age, Race, Visit and Baseline BMI Exhibit URR for Hemodialysis Patients by Age, Race, Visit and Baseline BMI Section 12 Exhibit 12.1 Exhibit 12.2 Exhibit 12.3 Exhibit 12.4 Mean (SE) Height Z-Scores, by Selected Characteristics and Times Following Dialysis Initiation 12-3 Mean (SE) Weight Z-Scores, by Selected Characteristics and Times Following Dialysis Initiation 12-4 Mean Change from Baseline (with SE) in Standardized Height and Weight Scores, by Age, at Times Following Dialysis Initiation Month Growth Data, for rhgh-treated and Untreated Short Control (z < -1.88) and All Control Patients by Age 12-7 Section 13 Exhibit 13.1A CRI Patient Characteristics 13-3 Exhibit 13.1B CRI Diagnoses 13-4 Exhibit 13.1C CRI Diagnoses by Race and Gender 13-5 Exhibit 13.1D CRI Patient Education Status 13-6 Exhibit 13.2 Age at CRI Registration 13-7 Exhibit 13.3 Primary Diagnosis, by Race and Age 13-8 Exhibit 13.4 Percent Distribution of Baseline Tanner Stage, by Age at CRI Registration 13-9 Exhibit 13.5 Mean Baseline Laboratory Measurements Exhibit 13.6 Exhibit 13.7 Exhibit 13.8 Mean Baseline Laboratory Measurements, by Year of CRI Registration Baseline Concomitant Drug Therapy, by Year of CRI Registration Baseline Medical Events History, by Year of CRI Registration (Percent) Exhibit 13.9 Baseline Renal Function, by Age at CRI Registration Exhibit Mean (and SE) Baseline Height, Weight, SDS and BMI vii

12 Exhibit 13.11A Baseline Height SDS, by Age at CRI Registration Exhibit 13.11B Baseline Weight SDS, by Age at CRI Registration Exhibit Baseline Renal Function, by Height Z-Score Exhibit Baseline Renal Function, by Height Z-Score and Age at Entry Exhibit Baseline Renal Function, by Height SDS and Age at Entry Section 14 Exhibit 14.1 CRI Termination Summary 14-3 Exhibit 14.2 Frequency and Percent CRI Termination, and Reason for Termination by Selected Patient Characteristics 14-4 Exhibit 14.3 Risk of Progression to ESRD (Transplant and Dialysis Initiation) 14-6 Exhibit 14.4 Progression to ESRD 14-7 Exhibit 14.5 Exhibit 14.6 Progression to ESRD, by Baseline Calculated Creatinine Clearance (ml/min/1.73 m 2 ) 14-7 Progression to ESRD, by Race, Gender, Age at Entry, Primary Diagnosis, and Baseline Laboratory Results 14-8 Exhibit 14.7 Progression to ESRD Due to Transplantation and Dialysis Initiation Section 15 Exhibit 15.1 CRI Follow-up Data 15-5 Exhibit 15.2 Exhibit 15.3 Exhibit 15.4 Exhibit 15.5 Exhibit 15.6A Mean (+SE) Height Z-Score, by CRI Visit and Selected Baseline Characteristics 15-6 Mean Change from Baseline (+SE) in Height Z-Score, by CRI Visit and Selected Baseline Characteristics 15-7 Mean (+SE) Weight Z-Score, by CRI Visit and Selected Baseline Characteristics 15-8 Mean Change from Baseline (+SE) in Weight Z-Score, by CRI Visit and Selected Baseline Characteristics 15-9 Serum Creatinine (mg/dl) and Calculated Creatinine Clearance (ml/min/1.73 m 2 ): Means and Changes from Baseline (+SE), by Age at Entry Exhibit 15.6B Schwartz Calculated Clearance by Primary Diagnosis Exhibit 15.6C Delta Schwartz Calculated Creatinine Clearance by Primary Diagnosis viii

13 Exhibit 15.7A Exhibit 15.7B Exhibit 15.8A Exhibit 15.8B Exhibit 15.9 Exhibit Exhibit Month Growth Data and Renal Function Data, for rhgh Treated and Untreated Short Control (z < -1.88) and Control Patients Month Growth Data and Renal Function Data, for rhgh Treated and Untreated Short Control (z < -1.88) and Control Patients Excluding 0-1 Year Old Patients Month Growth and Renal Function Data, for rhgh Treated and Untreated Short Control (z < -1.88) and Control Patients Month Growth and Renal Function Data, for rhgh Treated and Untreated Short Control (z < -1.88) and Control Patients Excluding 0-1 Year Old Patients Growth Hormone Utilization for All Age-Sex-Appropriate CRI Patients with Height Z-Score of or Worse, and Tanner Stage I, II, III at the Baseline, or 6-Month, or 12-Month Visit Growth Hormone Utilization for All Age-Sex-Appropriate CRI Patients with Height SDS of or Worse, and Tanner Stage I, II, III at the Baseline, and 6-Month, and 12-Month Visits Growth Hormone Utilization for Current Age-Sex-Appropriate CRI Patients with Height SDS of or Worse, and Tanner Stage I, II, III at the Most Recent Completed Visit in ix

14

15 I. INTRODUCTION

16

17 Introduction INTRODUCTION The North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) is a research effort organized in At the outset of the study, the operational objective of this group was to obtain the voluntary participation of all renal transplant centers in the United States and Canada in which multiple (>4) pediatric patients received renal allografts annually. Scientific objectives included capture of information about current practice and trends in immunosuppressive therapy with an ultimate goal of improving care of pediatric renal allograft recipients in North America. In 1992, the study was expanded to include pediatric patients who receive maintenance hemodialysis or peritoneal dialysis therapy. In 1994, data collection began on patients with chronic renal insufficiency (CRI), defined as a Schwartz calculated creatinine clearance 75 ml/min/1.73 m 2. Now, not only do we hope to register and follow greater than 80% of the children receiving renal allografts in the United States and Canada, but to study the clinical course and natural history of patients with renal dysfunction and to continue following these patients as they move among the end-stage renal disease (ESRD) therapeutic modalities, thus allowing the NAPRTCS to become a complete ESRD patient data system. The NAPRTCS has three functioning organizational bodies: the Clinical Coordinating Center, the Data Coordinating Center, and the participating Clinical Centers. Appendix A details the structure and members of the Coordinating Centers and the participating Clinical Centers are listed in Appendix B. This report summarizes data received at the Data Coordinating Center through December 15, We continue to be particularly pleased and grateful for the enthusiastic response of the volunteer clinical centers, without which this project could not be successful. At the outset of NAPRTCS, "children" were defined as patients who had not yet attained their 18th birthday at the time of their index transplant. The index transplant is defined as the first transplant reported to NAPRTCS during the study period. When the study expanded in 1992 to include maintenance dialysis patients, the age criterion was expanded to include patients who had not yet attained their 21st birthday at the time of index transplant or at the time of index initiation of dialysis, whichever came first. The expanded age criterion was adopted for CRI patients. Data submission for the study is organized to enable analysis of both patient and event characteristics. Among transplant patients, for example, we are interested in graft survival, 1

18 Introduction morbidity, and the relationships that these endpoints have to patient characteristics such as race/ethnicity, sex, and primary renal disease, and to transplant (i.e., event) characteristics such as age at transplantation, donor source, immunosuppressive treatment, and HLA antigen mismatches. Analogous patient and event characteristics are defined in both the CRI and dialysis populations. As data have matured, it has been our intent to design special studies that focus on issues such as quality of life, rehabilitation, physical and mental development, and other questions of interest for particular patient subgroups. In this manner, the study has served and continues to serve as a resource to investigators whose research activities are consistent with the goals and objectives of the program. A list of special studies and analyses is shown in Appendix C. Transplantation follow-up status forms are submitted 6 months following transplant and every 6 months thereafter. For dialysis, follow-up status forms are submitted 30 days after initiation, 6 months after initiation, and every 6 months thereafter. CRI follow-up status forms are submitted at 6-month intervals following the initial reported clinic visit. As of database closure for this report, over 14,500 patients had been registered in NAPRTCS, as shown in the table below. Of these patients, data have been reported to all three registries (CRI, dialysis, and transplantation) for 684. Registry-specific sample sizes can be determined by summing the subgroup totals. For example, the number of transplant patients 8,435 is given by 4, , These data do not necessarily represent a complete accounting of a patient s clinical course: a patient may have received care for his CRI at a NAPRTCS center, received maintenance dialysis at a non-naprtcs center, and rejoined the study when transplantation was performed at a NAPRTCS center. NAPRTCS PATIENT REGISTRATIONS N % All Patients 14, CRI only Dialysis only Transplant only CRI and dialysis CRI and transplant Dialysis and transplant 3,971 1,641 4, , CRI, dialysis, and transplant

19 Introduction Forms have been submitted for 9,243 renal transplants: 8,435 are for index transplants (i.e., first transplant reported to registry) while 808 represent additional reported transplants in the same patient since the study's start on January 1, The 8,435 index transplants are comprised of 4,181 cases where transplantation was the initial reported modality and 4,254 cases where transplantation occurred subsequent to an initial report of patient registration in the dialysis (n=2,833) or CRI (n=1,421) registries. Modality initiation forms have been submitted for 7,357 independent courses of dialysis. An independent course of dialysis therapy is defined to have occurred when a patient is maintained on a given modality for 30 or more days. Of these, 5,641 represent index initiations and 1,717 are for initiations subsequent to the index course. The 5,641 index dialysis courses are comprised of 3,910 cases where dialysis is reported as the initial therapy and 1,731 cases of dialysis initiation subsequent to failure of the index graft (n=638) or termination of CRI status (n=1,136). Initial CRI status forms have been submitted for 5,927 patients. In NAPRTCS, patients are eligible for the chronic renal insufficiency component if, at the first reported clinic visit, the Schwartz calculated creatinine clearance is 75 ml/min/1.73 m 2 or lower. In total, we have received a CRI Termination Form for 2,534 of the 5,927 CRI patients. This report summarizes both patient-level and therapy-level data. In general, descriptive information will focus on the transplant or dialytic modality as the unit of observation. Variables pertinent to the patient (e.g., sex, race, primary diagnosis) will use the number of patients as the denominator. Formal analysis of failure times patient and graft survival and rejection-free intervals include only the first transplant during the study period (the index transplant) for each patient. Occasional missing information on individual characteristics results in the analysis of slightly different subgroups. Continued capture of this information is part of the ongoing data collection process. In addition to the registry components, NAPRTCS initiated its first randomized prospective clinical trial (Protocol IN01) in 1995, the first ever controlled clinical trial of OKT3 induction therapy in children and adolescents. Nested within the primary random assignment to the OKT3 or No OKT3 groups, patients were randomized to receive either Sandimmune or Neoral maintenance cyclosporine therapy. Randomized prospective trials of growth hormone have been performed: one was designed to evaluate the post transplant use of recombinant human growth hormone (rhgh) therapy and the second was a study of rhgh therapy in pediatric dialysis patients. In the transplant 3

20 Introduction study, patients were randomized to standard dose (.05/mg/kg/day) therapy or a delayed treatment control group. After the initial no treatment period of 12 months, control group patients received rhgh therapy for the duration of the study which is a total of 42 months. In the dialysis study, all patients receive standard dose rhgh therapy during the first 12 months, after which patients are randomized either to continue on standard dose therapy or to receive a double dose (.10/mg/kg/day). Patients continued on their "randomized" dose for an additional 12 months. Through the collaborative Clinical Trials in Pediatric Transplantation effort sponsored by the NIAID, NAPRTCS sites have completed enrollment into a large double-blind, randomized trial to evaluate potential to withdraw steroid therapy in transplant patients. Increased accrual to such studies is an important current group objective. 4

21 II. TRANSPLANTATION

22

23 Transplant SECTION 1: TRANSPLANT PATIENT CHARACTERISTICS Patient and transplant characteristics are summarized in Exhibit 1.1 for the 18-year history of the cooperative study. Because of reporting lags, annual accrual totals are still likely to increase, particularly for the later years. The number of transplants for 2004 however has increased by 530 since the previous year s report. As of database closure for this report, 9,243 renal transplants had been reported for 8,435 pediatric patients. This represents 530 new transplants and 496 patients with their first registry transplant since the last report. The percentage of males in the registry, about 59%, has been relatively constant over time. White patients comprise 62% of the cohort, black patients 16%, and Hispanic patients 16%. The percentage of white patients in a given year has decreased from a high of 72% in 1987 to under 55% in There had been a steady increase in the percent of living donors: in 1998, living donation has accounted for about 58% of transplants with living donations peaking at 64% in 2002, compared to 43% in the first four years of the registry. However, the percentage has been under 60% in the last 2 years. Fifty-two percent of all allografts have come from a living donor. Since the study s initiation, fewer transplants have been reported over time that involve young recipients (<6 years old) or young cadaver donors (<10 years old). While the percentage decrease in recipients <6 years old has been gradual in 2000 and 2001 young recipients accounted for 18% and 21% of all transplants, compared to 25% in 1987 the decline in the use of young donors (<10 years old) has been more precipitous, resulting in a percentage point decrease from 38% in 1988 to 14% in 1999 and 6% in Recipient history is further characterized in Exhibit 1.2. The most common primary diagnoses remain as obstructive uropathy and aplastic/hypoplastic/dysplastic kidneys, each present in about 16% of patients. Focal segmental glomerulosclerosis (FSGS) is the third most common (11%) and continues to be the most prevalent acquired renal disease. The five most frequent diagnoses, excluding unknown and other diagnoses, total 52% of the cases, while the remaining diagnoses are each present in no more than 3% of patients. A diagnosis was established for 94% of patients, while biopsy or nephrectomy confirmation of diagnosis is known not to have occurred in 44% of patients. The distributions of the five most prevalent diagnoses vary between black and white patients. For blacks, FSGS is most prevalent (23%), followed by obstructive uropathy (15%), aplasia/hypoplasia/dysplasia (14%), chronic glomerulonephritis (GN) (4%), and SLE nephritis (4%). The prevalences of cystinosis, reflux nephropathy, and hemolytic uremic syndrome were under 2% among black transplant patients. Among whites, however, the order of the five most prevalent 1-1

24 Transplant diagnoses is: obstructive uropathy (17%), aplasia/hypoplasia/dysplasia (17%), FSGS (9%), reflux nephropathy (6%), and medullary cystic disease (4%). The relative order of these prevalent primary diagnoses among Hispanics is similar to that for white patients. At the time of their index transplant, 10% (827/8,435) of patients were receiving their second (or greater) transplant. Twenty-five percent of primary transplants were preemptive, as these patients had never received maintenance dialysis (Exhibit 1.3). The rate of preemptive transplantation differs significantly (p<0.001) between recipients of living (33%) and cadaver (13%) source organs; between males (28%) and females (20%); among age groups, with rates of 20%, 24%, 28%, 23%, and 21% for recipients 0-1, 2-5, 6-12, 13-17, and years old; and across races with whites, blacks, Hispanics, and other races having preemptive transplantation rates of 30%, 14%, 16%, and 16%, respectively. Immediately prior to the primary transplant, the percentages of patients maintained exclusively on hemodialysis and peritoneal dialysis were 29.8% and 39.4%. At the time of primary transplant few spleens had been removed (<1%) and all native renal tissue had been removed in 23% of patients; transplanted grafts have been removed in 37.1% of the index nonprimary transplants (Exhibit 1.3). Exhibit 1.4 details recipient age at transplant. Of the 89 transplants occurring in children younger than 12 months old, there were 5, 21, and 61 transplants, respectively, within the 3-5, 6-8 and 9-11 months age categories, and two were less than 3 months. Only 29 infant transplants have been performed since 1996, six in 1996, three in 1997, three in 1998, five in 1999, one in 2000, four in 2001, six in 2002 and one in 2004 although these numbers may increase as enrollment reports increase. In Exhibit 1.5, it is observed that the sex distribution is most unbalanced in the youngest age groups where 70% of 0-1 and 66% of 2-5 year old patients are male; the distribution is more even among adolescents. This is due to the fact that males comprise the majority of the aplasia/hypoplasia/dysplasia (62%) and obstructive uropathy (86%) diagnoses (see Exhibit 1.6) and the relative incidence of these diagnoses decreases with age. Forty percent of male patients fall into these two diagnostic categories, compared to 21% of females. The contrast is particularly steep in the obstructive uropathy group, a diagnosis shared by 23% of the males, but only 6% of females. Exhibit 1.6 provides for each primary diagnosis the percentages of patients who are male, white race, and known not to have had a biopsy or nephrectomy confirmation of diagnosis. Of transplant registrants with FSGS, 51% are white. Systemic lupus erythematosis is predominantly a disease of females (82%) with the female-specific race distribution given by 25% white, 39% black, and 25% 1-2

25 Transplant Hispanic. The percentages of patients without a histologically confirmed tissue diagnosis are 71%, 69%, and 69% in aplastic/hypoplastic/dysplastic, obstructive uropathy, and reflux nephropathy patients, respectively. The comparable rates for FSGS, hemolytic uremic syndrome, and lupus nephritis are 6%, 47%, and 4%. Exhibit 1.7 categorizes primary diagnoses as either FSGS, GN, structural or other and demonstrates how these distributions differ according to age at transplant. GN is comprised of the following primary diagnoses (chronic glomerulonephritis, idiopathic crescentic glomerulonephritis, mebranoproliferative glomerulonephritis Type I and Type II, SLE nephritis, Henoch-Schonlein nephritis, Berger s (IgA) nephritis, Wegener s granulomatosis, and membranous nephropathy. Structural diagnoses (prune belly, reflux nephropathy and aplasia/hypoplasia/displasias) account for the largest proportion of primary diagnoses among children ages 5 and under; whereas, GN diagnoses are more prevalent with increasing age. 1-3

26 Transplant EXHIBIT 1.1 PATIENT REGISTRATIONS, TRANSPLANTS, AND SELECTED CHARACTERISTICS, BY YEAR OF REGISTRATION %Male %White %Living Donor %Recipient age <6 yrs %CAD donor age <10 yrs PERCENT TRANSPLANT YEAR 1987 '88 ' '91 '92 '93 '94 '95 '96 '97 '98 ' '01 '02 '03 '04 Total No. of Pts No. of Tx

27 Transplant EXHIBIT 1.2 RECIPIENT AND INDEX TRANSPLANT CHARACTERISTICS N (8435) % (100.0) Sex Male Female Race White Black Hispanic Other Primary Diagnosis Obstructive uropathy Aplasia/hypoplasia/dysplasia Focal segmental glomerulosclerosis Reflux nephropathy Chronic glomerulonephritis Polycystic disease Medullary cystic disease Hemolytic uremic syndrome Prune Belly Congenital nephrotic syndrome Familial nephritis Cystinosis Idiopathic crescentic glomerulonephritis Membranoproliferative glomerulonephritis - Type I Pyelo/interstitial nephritis SLE nephritis Renal infarct Berger's (IgA) nephritis Henoch-Schonlein nephritis Membranoproliferative glomerulonephritis - Type II Wilms tumor Drash syndrome Wegener's granulomatosis Oxalosis Membranous nephropathy Other systemic immunologic disease Sickle cell nephropathy Diabetic glomerulonephritis Other Unknown

28 Transplant EXHIBIT 1.3 TRANSPLANT CHARACTERISTICS N % Total Transplants Index Transplants Primary Transplants Repeat Transplant Maintenance Dialysis Immediately Prior to Transplant Hemodialysis only Peritoneal dialysis only Primary Transplant Preemptive Splenectomy Naive Tissue Removed Index Non-primary Transplants Prior Transplants Removed

29 Transplant EXHIBIT 1.4 AGE AT TRANSPLANTATION N (9243) % (100) Age at Transplantation Age Grouping >

30 Transplant EXHIBIT 1.5 AGE AT INDEX TRANSPLANT BY PATIENT'S SEX, RACE, AND DIAGNOSIS [Numbers in Table are Percents] Age at Index Transplantation Total (N=8435) 0-1 (N=474) 2-5 (N=1276) 6-12 (N=2871) (N=3251) >17 (N=560) Gender Male Female Race White Black Hispanic Other Diagnosis Renal plasias Obstructive uropathy Other Focal segmental glomerulosclerosis

31 Transplant EXHIBIT 1.6 SEX, RACE, AND BIOPSY DISTRIBUTIONS, BY PRIMARY RENAL DIAGNOSIS Diagnosis N % Not % Male % White Biopsied Total Diagnosis Obstructive uropathy Aplasia/hypoplasia/dysplasia Focal segmental glomerulosclerosis Reflux nephropathy Chronic glomerulonephritis Polycystic disease Medullary cystic disease Hemolytic uremic syndrome Prune Belly Congenital nephrotic syndrome Familial nephritis Cystinosis Idiopathic crescentic glomerulonephritis Membranoproliferative glomerulonephritis - Type I Pyelo/interstitial nephritis SLE nephritis Renal infarct Berger's (IgA) nephritis Henoch-Schonlein nephritis Membranoproliferative glomerulonephritis - Type II Wilms tumor Drash syndrome Wegener's granulomatosis Oxalosis Membranous nephropathy Other systemic immunologic disease Sickle cell nephropathy Diabetic glomerulonephritis Other Unknown

32 Transplant EXHIBIT 1.7 PRIMARY DIAGNOSIS BY AGE FSGS GN Other Structural Percent >

33 SECTION 2: DONOR HISTORY AND ANTIGEN MISMATCHES NAPRTCS 2005 Transplant As described in Exhibit 2.1, 48% of all transplants have involved a cadaver source, 42% came from a parent, with the remaining 10% coming from other living donors. Parents comprise 81% of living donors: a cross-classification of parent and child sexes (n=3,569 pairs with complete data) reveals that mothers comprise the majority of parent-donors (56%), fathers donate to sons 63% of the time, while mothers make 60% of their donation to sons (p=0.044). There have been 335 transplants between siblings, and 163 live-donor grafts have been from donors under the age of 21. Thirteen living donors were under 18 years of age: 12 were transplants between siblings and 1 was a transplant from parent to child. Between siblings, the numbers of 3-, 4-, 5-, and 6-antigen matches were 1, 2, 2, and 7, respectively. The number of unrelated living donors has increased from an average of 3 per year in to 17 per year since then. Among cadaver transplants, 67 (1.6%) have come from donors less than 24 months old and 1063 (23.9%) from donors who were between 2 and 12 years of age; the use of cadaver donors <10 years old has declined since the study s start (see Exhibit 1.1). Prior to 1992, infant donors comprised 2.9% (42/1,466) of cadaver donor sources, compared to 0.9% (25/2,711) in transplants between 1991 and Thirteen percent of cadaver allografts were preserved by machine perfusion and 69% had cold ischemia times of 24 hours or less, with 17 (0.3%) exceeding 48 hours. The maximum cold time was 64.5 hours. Donor-specific transfusions were performed in 7% of living donor grafts but this procedure has been used only occasionally since The total number of random transfusions given to recipients differed by donor type: 48% of living donor graft recipients and 32% of cadaver graft recipients had zero previous transfusions, while 14% and 29%, respectively, had more than five transfusions. The percent of patients without prior random transfusions has increased from 17% in 1987 (27% living and 10% cadaver donor recipients) to 65% in 2004 (67% living and 62% cadaver). Time trends in the utilization of donor-specific and random transfusions are provided in Exhibit 2.2. To date, there have been 34 confirmed transplants across ABO blood group compatibility barriers out of 8,564 transplants with complete blood group data; there are 25 O recipient/a donor pairs, 2 O recipient/b donor pair, 4 B recipient/a donor pairs, 1 B recipient/ab donor pair, and 2 A recipient/b donor pair. A special analysis of an early cohort of these patients concluded that pediatric kidney transplantation across ABO compatibility barriers is an uncommon practice, but suggested based on preliminary experience that such transplants involving recipients whose anti-a titer history is 2-1

34 Transplant low (1:4) are associated with satisfactory graft outcome and are deserving of further study. Overall, 88% (7,501/8,564) of donor and recipient blood types were identical. Whereas blood group O is present in 56% of donors and 47% of recipients, blood group AB is present in 1.4% of donors and 4.0% of recipients. Histocompatibility antigen data are shown in Exhibit 2.3. We count an allele as matching only if identical known alleles are reported for both donor and recipient. Among the living donor transplants, 76% had at least one match at each of the A, B, and DR loci, and there were mismatches at all 6 A, B, and DR loci for 13% of cases. No matches in either the B or DR loci occurred in 36% of the transplants from cadaver source donors; a single locus match (of B and DR) occurred in 32%. Known matches of all 6 A, B and DR alleles occurred in 2.5% of cadaver source transplants and in 3.5% of living donor source transplants. Exhibit 2.4 compares donor sources with varying ages at transplant. Children under 5 years of age are more likely to receive a transplant from a living donor rather than a cadaver donor. For children ages 6-12, the proportion receiving living donor transplants is similar to the proportion receiving cadaver donor transplants. However, children 13 years of age are more likely to receive a cadaver donor transplant. 2-2

35 Transplant EXHIBIT 2.1 DONOR INFORMATION N (9243) % (100.0) Donor Source Live donor/parent Live donor/sibling Live donor/other related Live donor/unrelated Cadaver Donor Age Living Cadaver > Cadaver Source Transplants Machine Perfusion Used Cold Ischemia Time < 24 hours > 24 hours

36 Transplant EXHIBIT 2.2 USE OVER TIME OF DONOR-SPECIFIC AND RANDOM BLOOD TRANSFUSIONS Living Donor 0 Random transfusions 1-5 Random transfusions >5 Random transfusions Donor-specific transfusions PERCENT TRANSPLANT YEAR Cadaver Donor 0 Random transfusions 1-5 Random transfusions >5 Random transfusions PERCENT TRANSPLANT YEAR 2-4

37 Transplant EXHIBIT 2.3 PERCENT HLA MISMATCHES HLA-A Living (n=4801) Donor Source Cadaver (n=4427) HLA-B HLA-DR HLA-B and -DR HLA-A, -B, and -DR

38 Transplant EXHIBIT 2.4 AGE AT TRANSPLANT AND DONOR SOURCE PERCENT Living Donor Cadaver Donor > 17 AGE (years) 2-6

39 Transplant SECTION 3: THERAPY The NAPRTCS collects information on post-transplant immunosuppressive medications and dosages at Day 30, Month 6, and every six months thereafter. In addition, a record of the date of initiation and dosages of immunosuppressive medication used during the first post-transplant month is collected. Detailed description of pre-operative immunosuppressive therapy is not collected, but it was employed in 50% of living donor transplants. The frequency of use among all recipients had decreased from 48% in 2001 to 40% in Because of the changes in therapy in recent years, analyses are restricted to more recent transplant (>1995). Exhibit 3.1 details immunosuppressive medication data for transplants in 1996 and beyond for the first 30 days post-transplant therapy. Note that the frequency of use of various drugs ranges from 9% (of transplants) for sirolimus to 91% for prednisone. Methylprednisolone and azathioprine, when used, were typically initiated on the day of operation. Polyclonal antibody ATG was used in 16% of living donor and 25% of cadaver source transplants, while the respective rates of monoclonal antibody usage are 40% and 45%. Cyclosporine was used for 63% of transplants and, of those, 21% began cyclosporine on Day 0, 24% on Day 1, and 40% during Days 2-6. Although early graft failures decrease the number of patients still available for immunosuppressive therapy by Day 30, the percentages being treated with prednisone is relatively stable. Over the month, median doses of prednisone decreased to approximately 1/3 of the initial amount and, median doses of cyclosporine increased by 1.0 mg/kg. The median ATG/ALG course was 7 days. For monoclonal antibody, the median length of course of OKT3 was 9 days; for basiliximab patients, it was 2 days; and for daclizumab recipients, the median course was 5 days. Exhibit 3.2 shows the percentage of week 1 calcineurin inhibitor use by type of induction antibody while Exhibit 3.3 presents the induction antibody use from 1996 to The rate of induction antibody use at transplant or one day post transplant, by transplantation year was as follows: 3-1

40 Transplant PERCENT INDUCTION ANTIBODY, AT TRANSPLANT OR ON 1 DAY POST TRANSPLANT 1996 (n=585) 1997 (n=568) 1998 (n=510) 1999 (n=513) 2000 (n=419) 2001 (n=451) 2002 (n=397) 2003 (n=284) 2004 (n=142) None OKT Basiliximab Daclizumab ATG/ALG Exhibit 3.4 presents immunosuppressive therapy dosages for patients with functioning grafts for selected drug combinations after Median daily prednisone doses decrease over the first 2 years after transplantation, while the percentage of transplanted patients receiving alternate day therapy increases from 6.1% at Month 6 to 13.6%, 25.9%, and 33.0% at Months 12, 24, and 48, respectively. Continued slow increases in alternate day steroid use are observed at 6 years (40%). At 5 years post transplant, 32.7% of living donor versus 40.2% of cadaver donor transplants are reported to receive alternate day steroids. Note that there is little change in the proportion of patients receiving prednisone, cyclosporine, and azathioprine at each time point. Among those receiving cyclosporine, the mean and standard error of the daily milligram per kilogram doses are 7.7±0.09, 6.9±0.09, 6.0±0.08, and 4.6±0.12 at Months 6, 12, 24, and 60, respectively. Exhibit 3.5 shows the marked changes in day 30 post transplant dosing strategies that have been observed in the past years. These are substantially caused by the introduction of new drugs such as mycophenolate mofetil and tacrolimus. Although it has substantially effected the later cohort years, the whole experience of the registry has been minimally affected. Use at Day 30 of combination cyclosporine, prednisone, and azathioprine has declined since , from 30% of living donor and 27% of cadaver organ recipients, to 2% and 1% of transplants, respectively, in The regimen of prednisone, tacrolimus, and mycophenolate mofetil has become more popular. It is used in 39% of living donor and 43% of cadaver organ transplant in , compared to about 9.5% of all transplants in

41 Transplant Approximately 80% of patients receive 3-drug therapy at 6 months post transplant with mycophenolate mofetil replacing azathioprine in recent cohorts. Among transplanted grafts with 30 days function that have occurred since 1996, the following drug utilization rates were observed: PERCENT DRUG UTILIZATION - DAY 30 POST TRANSPLANT 1997 (n=568) 1998 (n=510) 1999 (n=513) 2000 (n=419) 2001 (n=451) 2002 (n=397) 2003 (n=284) 2004 (n=142) Cyclosporine Tacrolimus Mycophenolate Azathioprine Sirolimus Substantial increases in tacrolimus, mycophenolate mofetil, and sirolimus usage are observed, with a significant decrease in azathioprine usage. Azathioprine usage has decreased sharply from 60% in 1996 to 3% in The majority of sirolimus therapy (87%) was initiated within the first two days post-transplant. The mean and median dosages were 4.7 and 4.0 mg/m 2, respectively. Cyclosporine was used in 82% of the 1996 transplants at Day 30, and it continues to show a decline in utilization. Of cyclosporine recipients since 1996 with known formulation, 84% reported use of Neoral. Exhibit 3.6 displays the percentage of patients at selected follow-up time points who were receiving the six most common maintenance regiments since 1995, by graft donor source. Through 3 years, about 35% of the patients received combination immunosuppressives with prednisone, cyclosporine, and MMF, compared to approximately 22% of patients with prednisone, cyclosporine and azathioprine. Note that therapy strategies appear similar for cadaver recipients and live donor recipients. For example, dual therapy with prednisone and cyclosporine or prednisone and tacrolimus is received by similar percentages of recipients from living and cadaver graft donors. Because of the differential graft survival in black and non-black patients, cyclosporine blood levels have been examined. At Day 30 mean median values are within 9 ng/ml for two of the most common measurement methods, HPLC and TDX. For black patients, at 1-year post transplant, 3-3

42 Transplant mean cyclosporine level was 183 ng/ml (versus 168 ng/ml for others); cyclosporine blood levels are shown in the table below. MEDIAN / MEAN ± SE ONE YEAR BLOOD LEVELS (NG/ML) BY RACE/ETHNICITY Method Black Other Cyclosporine HPLC 123/152± /130±2.1 TDX 215/239± /234±3.6 Monoclonal RIA-specific 156/189± /169±3.2 TAC HPLC 5.7/6.3± /10.6±2.5 IMX 5.9/6.2± /6.2±0.3 The percentage of patients receiving concomitant anti-hypertensive, prophylactic antibiotic, and anti-convulsant medications, by donor source, are displayed in Exhibit 3.7. A substantial percentage of transplanted children receive anti-hypertensives and antibiotics throughout the followup period. During the first 3 years, an absolute difference in anti-hypertensive medication usage of about 5 percentage points is observed between cadaver and living donor source recipients. Although the percentage receiving such therapy decreases in the first few years of follow-up, over half of the children are receiving anti-hypertensives throughout the period. Prophylactic antibiotic use decreases for both donor source groups during the first 12 months after transplant. At one year, prophylactic antibiotics are used in 49% of living donor and 44% of cadaver donor source recipients with minimal decreases thereafter. At one year, prophylactic antibiotics are used in 37% of hemolytic uremic syndrome patients and in 37% of those with focal segmental glomerulosclerosis, versus 55% of patients diagnosed with reflux nephropathy and 61% with obstructive uropathy. An anti-convulsant medication was given initially to 7% of the transplant recipients, with a greater frequency observed among recipients of cadaver organs (9.0% vs. 6.0%). 3-4

43 Transplant EXHIBIT 3.1 MEDICATION DATA - FIRST 30 DAYS TRANSPLANTS AFTER 1995 Therapy Percent Treated (n=4010) Median Day of Initiation Median Initial Dose (mg/kg/d) Percent Treated Day 30 (n=3869) Median Day 30 Dose (mg/kg/d) Prednisone Methylprednisolone Cyclosporine Azathioprine Tacrolimus Mycophenolate Mofetil* ATG/ALG Monoclonal Antibody 34 0 OKT Basiliximab Daclizumab Sirolimus** *Median initial and Day 30 daily dose in mg per body surface area were and mg/m 2 /Day respectively. **Median initial dose in mg per body surface area was 3.1 mg/m

44 Transplant EXHIBIT 3.2 WEEK 1 CALCINEURIN INHIBITOR USE, BY INDUCTION ANTIBODY Neither Cyclosporine Tacrolimus PERCENT None OKT3 Basiliximab Daclizumab ATG/ALG EXHIBIT 3.3 INDUCTION ANTIBODY USE, BY YEAR PERCENT None OKT3 Basiliximab Daclizumab ATG/ALG TRANSPLANT YEAR 3-6

NAPRTCS Annual Transplant Report

NAPRTCS Annual Transplant Report North American Pediatric Renal Trials and Collaborative Studies NAPRTCS 2014 Annual Transplant Report This is a privileged communication not for publication. TABLE OF CONTENTS PAGE II TRANSPLANTATION Section

More information

Chapter 8: ESRD Among Children, Adolescents, and Young Adults

Chapter 8: ESRD Among Children, Adolescents, and Young Adults Chapter 8: ESRD Among Children, Adolescents, and Young Adults The number of children beginning end-stage renal disease (ESRD) care decreased by 6% in 2014, totaling 1,398 (Figure 8.1.a). 9,721 children

More information

USRDS UNITED STATES RENAL DATA SYSTEM

USRDS UNITED STATES RENAL DATA SYSTEM USRDS UNITED STATES RENAL DATA SYSTEM Chapter 8: Pediatric ESRD 1,462 children in the United States began end-stage renal disease (ESRD) care in 2013. 9,921 children were being treated for ESRD on December

More information

Access Revision (ACC)

Access Revision (ACC) North American Pediatric Renal Trials Collaborative Studies Production Release 14.0 [$sitecode] User: Registry Sequence: Date of Access Revision: Access Revision (ACC) Web Version: 1.0; 1.3; 06-20-13 HEMODIALYSIS

More information

ESRD Mortality. Causes of CKD in Children. Causes of Late Graft Failure. 5-Year Allograft Survival. All-cause mortality rates, 2005, by age

ESRD Mortality. Causes of CKD in Children. Causes of Late Graft Failure. 5-Year Allograft Survival. All-cause mortality rates, 2005, by age North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) Causes of CKD in Children Founded in 1992 78 participating centers in Canada & U.S. 16,339 CKD patients age 0 18 years 9,506 renal

More information

Chapter IX. Pediatric End Stage Renal Disease. Incidence of Reported Pediatric ESRD

Chapter IX. Pediatric End Stage Renal Disease. Incidence of Reported Pediatric ESRD Annual Data Report Chapter IX T his chapter examines the incidence, prevalence, modalities of treatment, and survival outcomes specific to the national pediatric ESRD population. Children with advanced

More information

Epidemiology of CKD in Children

Epidemiology of CKD in Children Epidemiology of CKD in Children Ali Düzova, M.D. Hacettepe University Faculty of Medicine Pediatric Nephrology and Rheumatology Unit Ankara CKD Course 03 June 2011, İstanbul Aim & Plan Causes of CKD in

More information

Pharmacology notes Interleukin-2 receptor-blocking monoclonal antibodies: evaluation of 2 new agents

Pharmacology notes Interleukin-2 receptor-blocking monoclonal antibodies: evaluation of 2 new agents BUMC Proceedings 1999;12:110-112 Pharmacology notes Interleukin-2 receptor-blocking monoclonal antibodies: evaluation of 2 new agents CHERYLE GURK-TURNER, RPH Department of Pharmacy Services, BUMC wo mouse/human

More information

Chapter 6: Idiopathic focal segmental glomerulosclerosis in adults Kidney International Supplements (2012) 2, ; doi: /kisup.2012.

Chapter 6: Idiopathic focal segmental glomerulosclerosis in adults Kidney International Supplements (2012) 2, ; doi: /kisup.2012. http://www.kidney-international.org chapter 6 & 2012 KDIGO Chapter 6: Idiopathic focal segmental glomerulosclerosis in adults Kidney International Supplements (2012) 2, 181 185; doi:10.1038/kisup.2012.19

More information

Kidney Transplant. Description

Kidney Transplant. Description Section: Surgery Effective Date: October 15, 2015 Subject: Kidney Transplant Page: 1 of 9 Last Review Status/Date: September 2015 Kidney Transplant Description A kidney transplant involves the surgical

More information

Transplantation in Australia and New Zealand

Transplantation in Australia and New Zealand Transplantation in Australia and New Zealand Matthew D. Jose MBBS (Adel), FRACP, FASN, PhD (Monash), AFRACMA Professor of Medicine, UTAS Renal Physician, Royal Hobart Hospital Overview CKD in Australia

More information

CHAPTER 5 RENAL TRANSPLANTATION. Editor: Rosnawati Yahya. Expert Panels: Hooi Lai Seong Ng Kok Peng Suryati Binti Yakaob Wong Hin Seng.

CHAPTER 5 RENAL TRANSPLANTATION. Editor: Rosnawati Yahya. Expert Panels: Hooi Lai Seong Ng Kok Peng Suryati Binti Yakaob Wong Hin Seng. CHAPTER 5 Editor: Roswati Yahya Expert Panels: Hooi Lai Seong Ng Kok Peng Suryati Binti Yakaob Wong Hin Seng Contents 5. Stock and Flow of Rel Transplantation Stock and Flow Transplant Rates 5.2 Recipients

More information

Case Presentation Turki Al-Hussain, MD

Case Presentation Turki Al-Hussain, MD Case Presentation Turki Al-Hussain, MD Director, Renal Pathology Chapter Saudi Society of Nephrology & Transplantation Consultant Nephropathologist & Urological Pathologist Department of Pathology & Laboratory

More information

Health technology Two prophylaxis schemes against organ rejection in renal transplantation were compared in the study:

Health technology Two prophylaxis schemes against organ rejection in renal transplantation were compared in the study: An economic and quality-of-life assessment of basiliximab vs antithymocyte globulin immunoprophylaxis in renal transplantation Polsky D, Weinfurt K P, Kaplan B, Kim J, Fastenau J, Schulman K A Record Status

More information

James E. Cooper, M.D. Assistant Professor, University of Colorado at Denver Division of Renal Disease and Hypertension, Kidney and PancreasTransplant

James E. Cooper, M.D. Assistant Professor, University of Colorado at Denver Division of Renal Disease and Hypertension, Kidney and PancreasTransplant James E. Cooper, M.D. Assistant Professor, University of Colorado at Denver Division of Renal Disease and Hypertension, Kidney and PancreasTransplant Program Has no real or apparent conflicts of interest

More information

Takashi Yagisawa 1,2*, Makiko Mieno 1,3, Norio Yoshimura 1,4, Kenji Yuzawa 1,5 and Shiro Takahara 1,6

Takashi Yagisawa 1,2*, Makiko Mieno 1,3, Norio Yoshimura 1,4, Kenji Yuzawa 1,5 and Shiro Takahara 1,6 Yagisawa et al. Renal Replacement Therapy (2016) 2:68 DOI 10.1186/s41100-016-0080-9 POSITION STATEMENT Current status of kidney transplantation in Japan in 2015: the data of the Kidney Transplant Registry

More information

RENINE Annual Report 2015

RENINE Annual Report 2015 RENINE Annual Report 2015 T. Hoekstra, M.H. Hemmelder, F.J. van Ittersum In cooperation with the sectie Registratie (Registration division) of the Nederlandse Federatie voor Nefrologie (NfN; Dutch federation

More information

State Profile for FY 2018 for Dialysis Patients and Facilities - STATE SAMPLE

State Profile for FY 2018 for Dialysis Patients and Facilities - STATE SAMPLE Dear State Surveyor: State Profile for FY 2018 for Dialysis Patients and Facilities - STATE SAMPLE This report is designed to provide a comparative summary of treatment patterns and patient outcomes for

More information

RaDaR Inclusion and Exclusion Criteria. Diagnosis Inclusion Criteria Exclusion Criteria. Alport Syndrome definite or probable

RaDaR Inclusion and Exclusion Criteria. Diagnosis Inclusion Criteria Exclusion Criteria. Alport Syndrome definite or probable Alport Syndrome and Type IV collagenopathies APRT Deficiency Alport Syndrome definite or probable Alport carrier definite or probable Thin basement membrane nephropathy APRT Deficiency confirmed Abolished

More information

FULFILLMENT OF K/DOQI GUIDELINES 92 anemia treatment dialysis therapy vascular access

FULFILLMENT OF K/DOQI GUIDELINES 92 anemia treatment dialysis therapy vascular access INTRODUCTION ANEMIA TREATMENT hemoglobin levels epo treatment iron treatment FULFILLMENT OF K/DOQI GUIDELINES 2 anemia treatment dialysis therapy vascular access EPO DOSING PATTERNS 4 epo dosing per kg

More information

Atypical IgA Nephropathy

Atypical IgA Nephropathy Atypical IgA Nephropathy Richard J. Glassock, MD, MACP Geffen School of Medicine at UCLA XXXIII Chilean Congress of Nephrology, Hypertension and Transplantation Puerto Varas, Chile October 6, 2016 IgA

More information

Chapter six Outcomes: hospitalization & mortality. There is an element of death in life, and I am astonished

Chapter six Outcomes: hospitalization & mortality. There is an element of death in life, and I am astonished INTRODUCTION 1 OVERALL HOSPITALIZATION & MORTALITY 1 hospital admissions & days, by primary diagnosis & patient vintage five-year survival mortality rates, by patient vintage expected remaining lifetimes

More information

Chapter 4: Steroid-resistant nephrotic syndrome in children Kidney International Supplements (2012) 2, ; doi: /kisup.2012.

Chapter 4: Steroid-resistant nephrotic syndrome in children Kidney International Supplements (2012) 2, ; doi: /kisup.2012. http://www.kidney-international.org & 2012 KDIGO Chapter 4: Steroid-resistant nephrotic syndrome in children Kidney International Supplements (2012) 2, 172 176; doi:10.1038/kisup.2012.17 INTRODUCTION This

More information

Solid Organ Transplantation 1. Chapter 55. Solid Organ Transplant, Self-Assessment Questions

Solid Organ Transplantation 1. Chapter 55. Solid Organ Transplant, Self-Assessment Questions Solid Organ Transplantation 1 Chapter 55. Solid Organ Transplant, Self-Assessment Questions Questions 1 to 9 are related to the following case: A 38-year-old white man is scheduled to receive a living-unrelated

More information

Lupus Related Kidney Diseases. Jason Cobb MD Assistant Professor Renal Division Emory University School of Medicine October 14, 2017

Lupus Related Kidney Diseases. Jason Cobb MD Assistant Professor Renal Division Emory University School of Medicine October 14, 2017 Lupus Related Kidney Diseases Jason Cobb MD Assistant Professor Renal Division Emory University School of Medicine October 14, 2017 Financial Disclosures MedImmune Lupus Nephritis Kidney Biopsy Biomarkers

More information

Renal transplantation

Renal transplantation NEPHROLOGY 2008; 13, S37 S43 doi:10.1111/j.1440-1797.2008.00996.x Renal transplantation Date written: November 2006 Final submission: July 2007 Author: Nigel Toussaint GUIDELINES No recommendations possible

More information

Supplementary appendix

Supplementary appendix Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Lefaucheur C, Loupy A, Vernerey D, et al. Antibody-mediated

More information

Pancreas and Pancreas-Kidney Transplantation By: Kay R. Brown, CLCP

Pancreas and Pancreas-Kidney Transplantation By: Kay R. Brown, CLCP Pancreas and Pancreas-Kidney Transplantation By: Kay R. Brown, CLCP Pancreas transplant recipients are usually under age 50. The majority of pancreas transplants are performed on diabetics, who are generally

More information

Public Assessment Report. EU worksharing project paediatric data. Valcyte. Valganciclovir

Public Assessment Report. EU worksharing project paediatric data. Valcyte. Valganciclovir Public Assessment Report EU worksharing project paediatric data Valcyte Valganciclovir Currently approved indication(s): Pharmaceutical form(s) affected by this project: Strength(s) affected by this variation:

More information

Infectious Complications in Living-Donor Kidney Transplant Recipients Undergoing Multi-Modal Desensitization

Infectious Complications in Living-Donor Kidney Transplant Recipients Undergoing Multi-Modal Desensitization SURGICAL INFECTIONS Volume 15, Number 3, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/sur.2012.231 Surgical Infection Society Articles Infectious Complications in Living-Donor Kidney Transplant Recipients

More information

Nephrotic syndrome minimal change disease vs. IgA nephropathy. Hadar Meringer Internal medicine B Sheba

Nephrotic syndrome minimal change disease vs. IgA nephropathy. Hadar Meringer Internal medicine B Sheba Nephrotic syndrome minimal change disease vs. IgA nephropathy Hadar Meringer Internal medicine B Sheba The Case 29 year old man diagnosed with nephrotic syndrome 2 weeks ago and complaining now about Lt.flank

More information

Recent advances in management of Pulmonary Vasculitis. Dr Nita MB

Recent advances in management of Pulmonary Vasculitis. Dr Nita MB Recent advances in management of Pulmonary Vasculitis Dr Nita MB 23-01-2015 Overview of the seminar Recent classification of Vasculitis What is new in present classification? Trials on remission induction

More information

Lothar Bernd Zimmerhackl

Lothar Bernd Zimmerhackl What works in current paediatric practice of off-label dose adjustment of adult doses? Lothar Bernd Zimmerhackl Medical University Innsbruck Austria AGAH Workshop: Pediatric Investigation Plan. Bonn 13-14.1.

More information

Desensitization in Kidney Transplant. James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver

Desensitization in Kidney Transplant. James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver Desensitization in Kidney Transplant James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver Organ Shortage Currently there are >90,000 patients on the kidney

More information

Narender Goel et al. Middletown Medical PC, Montefiore Medical Center & Albert Einstein College of Medicine, New York

Narender Goel et al. Middletown Medical PC, Montefiore Medical Center & Albert Einstein College of Medicine, New York Narender Goel et al. Middletown Medical PC, Montefiore Medical Center & Albert Einstein College of Medicine, New York 4th International Conference on Nephrology & Therapeutics September 14, 2015 Baltimore,

More information

THIS chapter presents basic information about

THIS chapter presents basic information about II. Incidence and Prevalence of ESRD INDEX WORDS: Cause of ESRD; diabetic ESRD; dialysis patient counts; ESRD growth rates; ESRD incidence; ESRD Medical Evidence Form 2728; ESRD Medicare; ESRD prevalence;

More information

Steroid Resistant Nephrotic Syndrome. Sanjeev Gulati, Debashish Sengupta, Raj K. Sharma, Ajay Sharma, Ramesh K. Gupta*, Uttam Singh** and Amit Gupta

Steroid Resistant Nephrotic Syndrome. Sanjeev Gulati, Debashish Sengupta, Raj K. Sharma, Ajay Sharma, Ramesh K. Gupta*, Uttam Singh** and Amit Gupta Steroid Resistant Nephrotic Syndrome Sanjeev Gulati, Debashish Sengupta, Raj K. Sharma, Ajay Sharma, Ramesh K. Gupta*, Uttam Singh** and Amit Gupta From the Departments of Nephrology, Pathology* and Biostatistics**,

More information

Supplementary Appendix

Supplementary Appendix Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Loupy A, Lefaucheur C, Vernerey D, et al. Complement-binding

More information

Transplant in Pediatric Heart Failure

Transplant in Pediatric Heart Failure Transplant in Pediatric Heart Failure Francis Fynn-Thompson, MD Co-Director, Center for Airway Disorders Surgical Director, Pediatric Mechanical Support Program Surgical Director, Heart and Lung Transplantation

More information

Many patients receiving renal allografts become identified simply

Many patients receiving renal allografts become identified simply Recurrent Disease in the Transplanted Kidney Jeremy B. Levy Many patients receiving renal allografts become identified simply as recipients of kidney transplantation. All subsequent events involving changes

More information

Transplant Nephrology Update: Focus on Outcomes and Increasing Access to Transplantation

Transplant Nephrology Update: Focus on Outcomes and Increasing Access to Transplantation Transplant Nephrology Update: Focus on Outcomes and Increasing Access to Transplantation Titte R Srinivas, MD, FAST Medical Director, Kidney and Pancreas Transplant Programs Objectives: Describe trends

More information

Barriers to Transplantation

Barriers to Transplantation Barriers to Transplantation Ruth McCarrell RN BSN CNeph(C) Clinical Nurse Leader Kidney transplant Program St. Paul s Hospital Email: rmccarrell@providencehealth.bc.ca Overview Transplant Basics Living

More information

BK Virus (BKV) Management Guideline: July 2017

BK Virus (BKV) Management Guideline: July 2017 BK Virus (BKV) Management Guideline: July 2017 BK virus has up to a 60-80% seroprevalence rate in adults due to a primary oral or respiratory exposure in childhood. In the immumocompromised renal transplant

More information

Cigarette Smoking in Renal Transplant Recipients

Cigarette Smoking in Renal Transplant Recipients Cigarette Smoking in Renal Transplant Recipients J Am Soc Nephrol 11: 753 759, 2000 BERTRAM L. KASISKE and DAGMAR KLINGER Department of Medicine, Division of Nephrology, Hennepin County Medical Center,

More information

Renal Transplantation in the First Year of Life: The Treatment of Choice for Infants With End-Stage Renal Disease

Renal Transplantation in the First Year of Life: The Treatment of Choice for Infants With End-Stage Renal Disease Renal Transplantation in the First Year of Life: The Treatment of Choice for Infants With End-Stage Renal Disease John S. Najarian,1 P. Stephen Almond, Michael Mauer, Blanche Chavers, Thomas Nevins, Clifford

More information

Glossary. Anesthesiologist A doctor who puts you or parts of your body to sleep during surgery.

Glossary. Anesthesiologist A doctor who puts you or parts of your body to sleep during surgery. 1-Glossary Glossary Acute rejection A type of rejection that occurs when immune cells from your body attack the transplanted organ(s). Acute rejection may occur at any time after a transplant. But it usually

More information

Additional file 2: Details of cohort studies and randomised trials

Additional file 2: Details of cohort studies and randomised trials Reference Randomised trials Ye et al. 2001 Abstract 274 R=1 WD=0 Design, numbers, treatments, duration Randomised open comparison of: (45 patients) 1.5 g for 3, 1 g for 3, then 0.5 to 0.75 g IV cyclophosphamide

More information

Liver Transplant Immunosuppression

Liver Transplant Immunosuppression Liver Transplant Immunosuppression Michael Daily, MD, MS, FACS Surgical Director, Kidney and Pancreas Transplantation University of Kentucky Medical Center Disclosures No financial disclosures I will be

More information

Five years of living donor kidney transplantation at University clinical center Tuzla, Bosnia and Herzegovina, from 1999 through 2004

Five years of living donor kidney transplantation at University clinical center Tuzla, Bosnia and Herzegovina, from 1999 through 2004 Clinical Science Five years of living donor kidney transplantation at University clinical center Tuzla, Bosnia and Herzegovina, from 1999 through 2004 Senaid Trnačević 1, Goran Imamović 2, Mustafa Bazardžanović

More information

04 Chapter Four Treatment modalities. Experience does not err, it is only your judgement that errs in expecting from her what is not in her power.

04 Chapter Four Treatment modalities. Experience does not err, it is only your judgement that errs in expecting from her what is not in her power. Chapter Four Treatment modalities Experience does not err, it is only your judgement that errs in expecting from her what is not in her power. LEONARDO da Vinci Vol 2 esrd Ch pg 29 Contents 22 Incident

More information

Chapter 22: Hematological Complications

Chapter 22: Hematological Complications Chapter 22: Hematological Complications 22.1: Perform a complete blood count at least (Not Graded): daily for 7 days, or until hospital discharge, whichever is earlier; two to three times per week for

More information

Donation and Transplantation Kidney Paired Donation Program Data Report

Donation and Transplantation Kidney Paired Donation Program Data Report Donation and Transplantation Kidney Paired Donation Program Data Report 2009-2013 Extracts of the information in this report may be reviewed, reproduced or translated for educational purposes, research

More information

Section K. Economic costs of ESRD. Vol 3 esrd. pg 731. K tables

Section K. Economic costs of ESRD. Vol 3 esrd. pg 731. K tables Section K Economic costs of ESRD Vol 3 esrd pg 731 Table K.1 733 Total costs ($) of reported ESRD per calendar year all ESRD with at least one claim, & Table K.2 734 Total costs ($) of reported ESRD :

More information

Lupus and Your Kidneys. Michael P. Madaio, MD Professor of Medicine Chairman of Medicine Medical College of Georgia Augusta, Georgia

Lupus and Your Kidneys. Michael P. Madaio, MD Professor of Medicine Chairman of Medicine Medical College of Georgia Augusta, Georgia Lupus and Your Kidneys Michael P. Madaio, MD Professor of Medicine Chairman of Medicine Medical College of Georgia Augusta, Georgia Kidney Inflammation and Abnormal Function as a Result of Lupus (Lupus

More information

Transplantation: Year in Review

Transplantation: Year in Review Transplantation: Year in Review Alexander Wiseman, MD Medical Director, Kidney and Pancreas Transplant Program Associate Professor, Division of Renal Diseases and Hypertension University of Colorado Outline:

More information

Kerry Cooper M.D. Arizona Kidney Disease and Hypertension Center April 30, 2009

Kerry Cooper M.D. Arizona Kidney Disease and Hypertension Center April 30, 2009 Kerry Cooper M.D. Arizona Kidney Disease and Hypertension Center April 30, 2009 DR. KERRY COOPER IS ON THE SPEAKER BUREAU OF AMGEN, ABBOTT, GENZYME, SHIRE, AND BMS DR. COOPER IS ALSO INVOLVED IN CLINICAL

More information

APHERESIS FOR DESENSITIZATION OF NON-RENAL TRANSPLANTS

APHERESIS FOR DESENSITIZATION OF NON-RENAL TRANSPLANTS APHERESIS FOR DESENSITIZATION OF NON-RENAL TRANSPLANTS GOW AREPALLY, MD MEDICAL DIRECTOR DUKE THERAPEUTIC APHERESIS SERVICE ASSOCIATE PROFESSOR, MEDICINE AMERICAN SOCIETY FOR APHERESIS MAY 25 TH 2013 OVERVIEW

More information

DRUG LEVEL MONITORING AND ADJUSTMENT Silvio Sandrini, Brescia, Italy Chairs: Ryszard Grenda, Warsaw, Poland Julio Pascual, Barcelona, Spain

DRUG LEVEL MONITORING AND ADJUSTMENT Silvio Sandrini, Brescia, Italy Chairs: Ryszard Grenda, Warsaw, Poland Julio Pascual, Barcelona, Spain DRUG LEVEL MONITORING AND ADJUSTMENT Silvio Sandrini, Brescia, Italy Chairs: Ryszard Grenda, Warsaw, Poland Julio Pascual, Barcelona, Spain Prof. Silvio Sandrini Division and Chair of Nephrology University

More information

Renal Data from the Arab World

Renal Data from the Arab World Saudi J Kidney Dis Transpl 2011;22(4):818-824 2011 Saudi Center for Organ Transplantation Saudi Journal of Kidney Diseases and Transplantation Renal Data from the Arab World Why does Kidney Allograft Fail?

More information

ANNUAL REPORT The Norwegian Renal Registry. (Norsk Nyreregister)

ANNUAL REPORT The Norwegian Renal Registry. (Norsk Nyreregister) ANNUAL REPORT 2016 The Norwegian Renal Registry (Norsk Nyreregister) This report will also be available on: http://www.nephro.no/registry.html Registry Chairperson: Anna V. Reisæter (areisate@ous-hf.no)

More information

Should Pediatric Patients Wait for HLA-DR-Matched Renal Transplants?

Should Pediatric Patients Wait for HLA-DR-Matched Renal Transplants? American Journal of Transplantation 2008; 8: 2056 2061 Wiley Periodicals Inc. C 2008 The Authors Journal compilation C 2008 The American Society of Transplantation and the American Society of Transplant

More information

Year 2004 Paper one: Questions supplied by Megan

Year 2004 Paper one: Questions supplied by Megan QUESTION 53 Endothelial cell pathology on renal biopsy is most characteristic of which one of the following diagnoses? A. Pre-eclampsia B. Haemolytic uraemic syndrome C. Lupus nephritis D. Immunoglobulin

More information

Update on Kidney Allocation

Update on Kidney Allocation Update on Kidney Allocation 23rd Annual Conference Association for Multicultural Affairs in Transplantation Silas P. Norman, M.D., M.P.H. Associate Professor Division of Nephrology September 23, 2015 Disclosures

More information

Introduction to Volume 2: ESRD in the United States

Introduction to Volume 2: ESRD in the United States Introduction to Volume 2: ESRD in the United States Introduction Volume 2 of the USRDS Annual Data Report (ADR) offers a detailed descriptive epidemiology of end-stage renal disease (ESRD) in the United

More information

ABO mismatched Renal Transplants

ABO mismatched Renal Transplants ABO mismatched Renal Transplants Nicos Kessaris Renal Transplant Surgeon St George s Hospital, London 7 th March 2012 Why? Protocol Risks Experience abroad Experience in UK Experience at St George s Conclusions

More information

KDOQI US Commentary on the 2009 KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

KDOQI US Commentary on the 2009 KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients VOL 56, NO 2, AUGUST 2010 KDOQI COMMENTARY KDOQI US Commentary on the 2009 KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients Margaret Bia, MD, 1 Deborah B. Adey, MD, 2 Roy

More information

Chapter VII. Renal Transplantation: Access and Outcomes. Methods. Key Words: Gender in transplantation

Chapter VII. Renal Transplantation: Access and Outcomes. Methods. Key Words: Gender in transplantation Annual Data Report Renal Transplantation: Access and Outcomes Chapter VII Renal Transplantation: Access and Outcomes D Key Words: Cadaveric renal transplants Living related renal transplants Transplant

More information

Kidney Transplantation in Korea

Kidney Transplantation in Korea 2017.5.3 KSN 2017 KDIGO-KSN Joint Symposium Kidney Transplantation in Korea Byung Ha Chunga,b, Chul Woo Yanga,b atransplant bdivision Research Center of Nephrology, Department of Internal Medicine, The

More information

Name of the study: INDIAN PEDIATRIC CHRONIC KIDNEY DISEASE REGISTRY. Dr Arvind Bagga, All India Institute of Medical Sciences, New Delhi

Name of the study: INDIAN PEDIATRIC CHRONIC KIDNEY DISEASE REGISTRY. Dr Arvind Bagga, All India Institute of Medical Sciences, New Delhi Name of the study: INDIAN PEDIATRIC CHRONIC KIDNEY DISEASE REGISTRY Convener: Dr Arvind Bagga, All India Institute of Medical Sciences, New Delhi Co- Convener o Dr Rajiv Sinha, Institute of Child Health,

More information

NATIONAL QUALITY FORUM Renal EM Submitted Measures

NATIONAL QUALITY FORUM Renal EM Submitted Measures NATIONAL QUALITY FORUM Renal EM Submitted Measures Measure ID/ Title Measure Description Measure Steward Topic Area #1662 Percentage of patients aged 18 years and older with a diagnosis of CKD ACE/ARB

More information

ABO blood group-incompatible living donor kidney transplantation: a prospective, single-centre analysis including serial protocol biopsies

ABO blood group-incompatible living donor kidney transplantation: a prospective, single-centre analysis including serial protocol biopsies Nephrol Dial Transplant (2009) 24: 298 303 doi: 10.1093/ndt/gfn478 Advance Access publication 26 August 2008 Original Article ABO blood group-incompatible living donor kidney transplantation: a prospective,

More information

TRENDS IN RENAL REPLACEMENT THERAPY IN BOSNIA AND HERZEGOVINA

TRENDS IN RENAL REPLACEMENT THERAPY IN BOSNIA AND HERZEGOVINA & TRENDS IN RENAL REPLACEMENT THERAPY IN BOSNIA AND HERZEGOVINA 2002-2008 Halima Resić* 1, Enisa Mešić 2 1 Clinic for Hemodialysis, University of Sarajevo Clinics Centre, Bolnička 25, 71000 Sarajevo, Bosnia

More information

Records. Adult Kidney Pancreas Transplant Recipient Registration Worksheet. Recipient Information. Provider Information.

Records. Adult Kidney Pancreas Transplant Recipient Registration Worksheet. Recipient Information. Provider Information. Records Adult Kidney Pancreas Transplant Recipient Registration Worksheet FORM APPROVED: O.M.B. NO. 0915 0157 Expiration Date: 07/31/2020 Note: These worksheets are provided to function as a guide to what

More information

valganciclovir, 450mg tablets, 50mg/ml powder for oral solution (Valcyte ) SMC No. (662/10) Roche Products Ltd

valganciclovir, 450mg tablets, 50mg/ml powder for oral solution (Valcyte ) SMC No. (662/10) Roche Products Ltd valganciclovir, 450mg tablets, 50mg/ml powder for oral solution (Valcyte ) SMC No. (662/10) Roche Products Ltd 17 December 2010 The Scottish Medicines Consortium (SMC) has completed its assessment of the

More information

The Kidney Allocation System Changed in a Substantive Way on December 5, Your Patients Have Been, and Will Be, Affected by These Changes

The Kidney Allocation System Changed in a Substantive Way on December 5, Your Patients Have Been, and Will Be, Affected by These Changes The Kidney Allocation System Changed in a Substantive Way on December 5, 2014 Your Patients Have Been, and Will Be, Affected by These Changes 1 The New Kidney Allocation System Terms of Importance Pediatric

More information

NATIONAL TRANSPLANT SURGERY FELLOWSHIP CURRICULUM. Table of Contents. Unit 1: Immunobiology & Transplantation Research...2

NATIONAL TRANSPLANT SURGERY FELLOWSHIP CURRICULUM. Table of Contents. Unit 1: Immunobiology & Transplantation Research...2 NATIONAL TRANSPLANT SURGERY FELLOWSHIP CURRICULUM Table of Contents Unit 1: Immunobiology & Transplantation Research...2 Unit 2: Pharmacology & Immunosuppression...8 Unit 3: Organ Procurement...16 Unit

More information

AAll s well that ends well; still the fine s the crown; Whate er the course, the end is the renown. WILLIAM SHAKESPEARE, All s Well That Ends Well

AAll s well that ends well; still the fine s the crown; Whate er the course, the end is the renown. WILLIAM SHAKESPEARE, All s Well That Ends Well AAll s well that ends well; still the fine s the crown; Whate er the course, the end is the renown. WILLIAM SHAKESPEARE, All s Well That Ends Well mthree TrEATMENT MODALITIES 7 ž 21 ATLAS OF ESRD IN THE

More information

APPENDIX B BIBLIOGRAPHY

APPENDIX B BIBLIOGRAPHY APPENDIX B BIBLIOGRAPHY - 1988-2006 PUBLICATIONS 1. Alexander SR, Arbus GS, Butt KMH, et al. The 1989 Report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 4:542-553,

More information

Post Transplant Management for Sickle Cell. Title

Post Transplant Management for Sickle Cell. Title Post Transplant Management for Sickle Cell Title Kimberly Kasow, DO October 14, 2016 Thank you for this opportunity to present this information I have no financial interests to disclose. Goal of Transplant

More information

Long-Term Survival of Children with End-Stage Renal Disease

Long-Term Survival of Children with End-Stage Renal Disease The new england journal of medicine original article Long-Term of Children with End-Stage Renal Disease Stephen P. McDonald, Ph.D., and Jonathan C. Craig, Ph.D., for the Australian and New Zealand Paediatric

More information

Transplant Hepatology

Transplant Hepatology Transplant Hepatology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified

More information

Novel Therapies in Autoimmune Hepatitis

Novel Therapies in Autoimmune Hepatitis Novel Therapies in Autoimmune Hepatitis Paul W. Rassam,MD Ass. Clinical Professor of Medicine Div. of Gastroenterology and Hepatology St George Hospital University Medical Center University of Balamand

More information

AJNT. Special Article. Renal Replacement Therapy in Sudan, Sarra Elamin 1*, Wafaa Obeid 2, Hasan Abu-Aisha 1. Abstract

AJNT. Special Article. Renal Replacement Therapy in Sudan, Sarra Elamin 1*, Wafaa Obeid 2, Hasan Abu-Aisha 1. Abstract . 2010 May;3(2):31-6 Special Article AJNT Renal Replacement Therapy in Sudan, 2009 Sarra Elamin 1*, Wafaa Obeid 2, Hasan Abu-Aisha 1 1. Sudan Peritoneal Dialysis program, Sudan 2. National center for kidney

More information

Proteinuria Nephrotic syndrome

Proteinuria Nephrotic syndrome Proteinuria Nephrotic syndrome Pathophysiology & management Miriam Davidovits, MD Institute of Nephrology Schneider Children s Medical Center of Israel 1 Abnormal excretion of protein into the urine is

More information

Serologic Markers CONVENTIONAL ANTIBODIES ANTIBODIES UNCONVENTIONAL. AIH Type I

Serologic Markers CONVENTIONAL ANTIBODIES ANTIBODIES UNCONVENTIONAL. AIH Type I Autoimmune Hepatitis By Thomas Frazier Objective What we need to know about AIH Diagnosis Treatment Difficulties in both Liver transplantation concerns AASLD Guidelines: Hepatology. 2010 Jun;51(6):2193-213.

More information

Kidneytransplant pathologyrelatedto immunosuppressiveagents

Kidneytransplant pathologyrelatedto immunosuppressiveagents Kidneytransplant pathologyrelatedto immunosuppressiveagents Helmut Hopfer Pathologie Women, 53 years old. 16 months after kidney transplantation for diabetic nephropathy. Metabolicsyndromeandcoronaryheartdisease.

More information

ANNUAL REPORT The Norwegian Renal Registry. (Norsk Nefrologiregister)

ANNUAL REPORT The Norwegian Renal Registry. (Norsk Nefrologiregister) Vedlegg 1 ANNUAL REPORT 25 The Norwegian Renal Registry (Norsk Nefrologiregister) This report will also be available on: http://www.nephro.no/registry.html Correspondence to: Overlege dr.med Torbjørn Leivestad

More information

Treatment of Chronic Graft versus Host Disease. Daniel Weisdorf MD University of Minnesota

Treatment of Chronic Graft versus Host Disease. Daniel Weisdorf MD University of Minnesota Treatment of Chronic Graft versus Host Disease Daniel Weisdorf MD University of Minnesota October 2013 Infections Transplant Events d-8 0 1mo 3mo 6mo Conditioning Transplant Engraftment Mucositis Organ

More information

Renal transplantation in children less than

Renal transplantation in children less than Archives of Disease in Childhood, 980, 55, 532-536 Renal transplantation in children less than 5 years of age GIANFRANCO RIZZONI, MOHAMMAD H MALEKZADEH, ALFRED J PENNISI, ROBERT B ETTENGER, CHRISTEL H

More information

GOOD MORNING. Welcome Applicants! Friday, October 31, (Happy Halloween!)

GOOD MORNING. Welcome Applicants! Friday, October 31, (Happy Halloween!) GOOD MORNING Welcome Applicants! Friday, October 31, 2014 (Happy Halloween!) PREP QUESTION A 14-year-old girl has had 3 days of new, unremitting headache associated with vomiting and awakening from sleep

More information

FIRST RENAL REPLACEMENT

FIRST RENAL REPLACEMENT FIRST RENAL REPLACEMENT THERAPY SELECTION IN DIABETIC PATIENTS Dr Cécile Couchoud (REIN registry, France) Davide Bolignano (ERBP, Italy) European Renal Best Practice Prof. Wim Van Biesen Chairman of ERBP

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES OMB No

DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES OMB No CENTERS FOR MEDICARE & MEDICAID SERVICES OMB No. 0938-0046 END STAGE RENAL DISEASE MEDICAL EVIDENCE REPORT MEDICARE ENTITLEMENT AND/OR PATIENT REGISTRATION A. COMPLETE FOR ALL ESRD PATIENTS Check one:

More information

Living Donor Renal Transplantation Using Alemtuzumab Induction and Tacrolimus Monotherapy

Living Donor Renal Transplantation Using Alemtuzumab Induction and Tacrolimus Monotherapy American Joumal of Transplantation 26; 6: 249-2417 Blackwell Munksgaard 26 The Authors Journal compilation 26 The American Society of Transplantation and the American Society of Transplant Surgeons doi:

More information

Annual Statistics on Organ Replacement in Canada

Annual Statistics on Organ Replacement in Canada CIHI Snapshot December 2017 Annual Statistics on Organ Replacement in Canada Dialysis, Transplantation and Donation, 2007 to 2016 This summary document provides key findings from the latest annual statistics

More information

The addition of anti-cd25 antibody induction to standard immunosuppressive therapy for kidney transplant recipients GUIDELINES SEARCH STRATEGY

The addition of anti-cd25 antibody induction to standard immunosuppressive therapy for kidney transplant recipients GUIDELINES SEARCH STRATEGY nep_2.fm Page 5 Friday, January 26, 200 6:46 PM Blackwell Publishing AsiaMelbourne, AustraliaNEPNephrology120-558 2006 The Author; Journal compilation 2006 Asian Pacific Society of Nephrology? 20012S1584MiscellaneousCalcineurin

More information