Suchergebnisse

IntroductionFemale life expectancies consistently exceed males in the general population. Yet, this survival advantage may not persist in the presence of a chronic disease due to biological differences or healthcare inequities.
Objectives and ApproachWe aimed to explore sex differences in mortality among people with end-stage kidney disease (ESKD). T he entire ESKD population in Australia, 1980-2013, and New Zealand,1988-2012, were included from the Australian and New Zealand Dialysis and Transplant Registry. Data linkage to national death registers was undertaken to ascertain deaths and their causes. We estimated relative measures of survival, including standardized mortality ratios (SMR), relative survival and expected life years lost, using general population data to account for background mortality, adjusting for country, age, sex and year.
ResultsOf 60,823 ESKD patients, there were 25,042 females (41%) and 35,781 males (59%). Mortality sex differences within the ESKD population were minor, but once compared to the general population, female ESKD patients had more excess deaths, worse relative survival and greater life years lost compared to male ESKD patients. Females had 11.5 SMR (95%CI:11.3-11.7) and males had 6.7 SMR (95%CI:6.7-6.8), with greater disparity among younger ages and from certain causes. Relative survival was consistently lower in females, with adjusted excess mortality 9% higher (95%CI:7-12%) in ESKD females. Average life years lost was 4-5 years greater in ESKD females compared to males across all ages. Kidney transplantation reduced the sex differences in excess mortality, with similar relative survival (p=0.42) and average life years lost reduced to 3-4 years for females.
Conclusion / ImplicationsThe impact of ESKD is more profound for women than men with greater excess mortality, however kidney transplantation attenuates these differences. Our findings show that chronic diseases and sex can compound to produce worse outcomes where women lose their survival advantage in the presence of ESKD.

IntroductionDonor suitability assessment is often time-sensitive, with imperfect information available at referral. Opportunities for donation may be missed if donors are rejected based on inaccurate information.
Objectives and ApproachWe sought to compare assessment of cancer transmission risk based on information available at referral (perceived) versus subsequently obtained (verified) detailed medical history, and to identify any missed opportunities for donation. We used data from the NSW Biovigilance Register, a cohort study of deceased organ donor referrals in New South Wales (NSW) 2010-2015. Referrals from NSW who had consent and were otherwise suitable for donation (except for perceived or verified tumour) were analysed. Perceived tumour details were obtained from NSW Organ and Tissue Donation Service referral logs, while verified details were based on the Central Cancer Registry and Admitted Patient Data Collection. Cancer transmission risk was graded using Transplantation Society of Australia and New Zealand guidelines.
ResultsAmong 772 referrals otherwise suitable for donation, 601 (78%) had accurately classified cancer transmission risk (κ=0.59). Overall, 53 suitable referrals were rejected due to cancer transmission risk (missed opportunities), including 49 (92%) with overestimated risk (perceived high, verified low/none), and 4 (8%) due to excessive risk aversion (perceived and verified low risk). Missed opportunities had overestimated transmission risk for tumours including leukaemia (8, 16%), lung (8, 16%), melanoma (7, 14%), brain (6, 12%), and breast (6, 12%).
Conclusion / ImplicationsDespite time pressure and limited information availability, there is moderate agreement between perceived and verified cancer transmission risk. Nevertheless, improved information availability (e.g. via data linkage) could meaningfully increase the number of actual donors.

IntroductionSolid organ transplant recipients are at risk of infections, which may be either derived through transplantation or acquired later. Blood-borne viruses (BBV) are a particular concern for donor-derived transmissions. There is an increasing emphasis on biovigilance – monitoring the safety of donated organs. However, systematic surveillance to distinguish donor-transmitted infection from de novo post-transplant infection is challenging. Additional information can be obtained through linkage of administrative health data.
Objectives and ApproachWe aimed to identify donor-transmitted and de novo BBV infections among organ transplant recipients. We conducted a cohort study of all solid organ donor-recipient pairs in New South Wales, Australia, 2000-2015. Donor and recipient BBV infections were identified by linking transplant registries with administrative health data. Proven/probable donor-transmissions were identified among new recipient infections within 12 months of transplant, classified according to an international algorithm. All other new BBV infections were classified as de novo infections.
ResultsAmong 2,120 organ donors, 73 had a BBV infection (11/73 active, 62/73 past). Donors with BBV donated to 176 recipients, of whom 24/176 had the same BBV as their donor, and 152/176 did not; these 152 recipients were at risk of donor-transmission. Among those at risk, there were 3/152 proven/probable BBV transmissions (1 hepatitis C, 2 hepatitis B [HBV]) and 149/152 recipients with non-transmissions. All donor-transmissions were previously recognised by donation services, and were from donors with known BBV. There were no deaths from transmissions. There were 70 recipients with de novo BBV; 2/70 died from new HBV.
Conclusion / ImplicationsThis work confirms the safety of Australian organ donation, with no unrecognised BBV transmissions and many non-transmissions from donors with BBV. This may support increasing targeted donation from donors with BBV. However, de novo BBV infections were substantial and preventable. Data-linkage may be a useful adjunct to current biovigilance systems.