The influence of socioeconomic deprivation on outcomes in pancreas transplantation in England; Registry Data Analysis

Socioeconomic deprivation is associated with poorer outcomes in chronic diseases. The aim of this study was to investigate the effect of socioeconomic deprivation on outcomes following pancreas transplantation among patients transplanted in England. We included all 1270 pancreas recipients transplanted between 2004 and 2012. We used the English Index of Multiple Deprivation (EIMD) score to assess the influence of socioeconomic deprivation on patient and pancreas graft survival. Higher scores mean higher deprivation status. Median EIMD score was 18.8, 17.7 and 18.1 in patients who received SPK, PAK and PTA respectively (p=0.56). Pancreas graft (censored for death) survival was dependent on the donor age (p=0.08), CIT (p=0.0001), the type of pancreas graft (SPK vs. PAK or PTA, p=0.0001), and EIMD score (p=0.02). The 5-year pancreas graft survival of the most deprived patient quartile was 62% compared to 75% among the least deprived (p=0.013), and it was especially evident in the SPK group. EIMD score also correlated with patient survival (p=0.05). Looking at the impact of individual domains of deprivation, ‘Environment’ (p=0.037) and ‘Health and Disability’ (p=0.035) domains had significant impact on pancreas graft survival. Socioeconomic deprivation, as expressed by the EIMD is an independent factor for pancreas graft and patient survival

Effect of degree of obesity on renal transplant outcome

Obesity in renal transplantation has proven to affect both patient and graft survival. The scientific community seems to be split into 2 groups: one claims similar outcomes among obese and nonobese, showing only marginally increased postoperative complications; whereas the other group report a higher rate of complications, including graft loss and mortality. These results did not provide sufficient evidence to be applied in practice. In this study we analyzed the outcomes of obese recipients of renal transplant in our institution. One hundred fourteen renal transplantations were performed between January 1993 and December 2003. To estimate the impact of various degrees of obesity, the patients were allocated into 2 cohorts: Group A (body mass index [BMI] 30–34.9) and Group B (BMI 35 and greater). We analyzed patient and donor characteristics. Wound infection rates were similar in the 2 groups. The aggregate Group A and B patient survival rate was 95.6% at 1 year and 93% at 5 years. Graft survival rate was 93.9% at 1 year and 88% at 5 years. However, the analysis of the outcomes in the 2 groups with different degrees of obesity showed that the patient survival rate at 1 year in Group A was 98.9% (1 death) and 95.6% at 5 years (4 deaths). In Group B the patient survival rate at 1 year was 87.5% (3 deaths; P = .007) and at 5 years was 79.2% (P = .006). Graft survival rate in Group A was 98.9% (1 graft loss) at 1 year and 94.5% (5 graft losses) at 5 years; in Group B the graft survival rate was 75% (6 graft loss) at 1 year and 63% (9 graft losses) at 5 years (P 30. The overall patient and graft survival did not show particularly different results from already published studies claiming similar outcomes. However, this series showed different outcomes when we divided them into 2 groups by BMI. There was a remarkable difference between moderate obese (Group A) and morbid obese (Group B) recipients as regards patient and graft survival. It is possible that the excellent outcome in Group A may be the result of super-selection and stringent cardiovascular risk screening that is implemented for this category of potential recipients. Obese recipients with a BMI of >35 are a high-risk category. Because of the difference in the outcomes of the 2 groups, it does not seem reasonable to address obese recipients as a single group. We believe that obese patients should not be discriminated simply on the basis of the BMI. A strict evaluation should be performed before denying the opportunity to receive a renal transplant to these patients. Obesity was described by the World Health Organization as a “global epidemic.” It has also been proven to be an important independent risk factor for cardiovascular disease. It is defined as a chronic condition characterized by excessive body fat. To quantify obesity tends to be a difficult task. Calculation of the body mass index (BMI) is an efficient, easy way to estimate various degrees of body weight according to the individual's body surface area (kg/m2) (Table 1). However, it is not the most accurate measurement; it does not take into account the proportion between lean and adipose mass

Monthly variance in United Kingdom renal transplantation activity: a national retrospective cohort study

OBJECTIVE:To identify whether renal transplant activity varies in a reproducible manner across the year. DESIGN:Retrospective cohort study using NHS Blood and Transplant data. SETTING:All renal transplant centres in the UK. PARTICIPANTS:A total of 24 270 patients who underwent renal transplantation between 2005 and 2014. PRIMARY OUTCOME:Monthly transplant activity was analysed to see if transplant activity showed variation during the year. SECONDARY OUTCOME:The number of organs rejected due to healthcare capacity was analysed to see if this affected transplantation rates. RESULTS:Analysis of national transplant data revealed a reproducible yearly variance in transplant activity. This activity increased in late autumn and early winter (p=0.05) and could be attributed to increased rates of living (October and November) and deceased organ donation (November and December). An increase in deceased donation was attributed to a rise in donors following cerebrovascular accidents and hypoxic brain injury. Other causes of death (infections and road traffic accidents) were more seasonal in nature peaking in the winter or summer, respectively. Only 1.4% of transplants to intended recipients were redirected due to a lack of healthcare capacity, suggesting that capacity pressures in the National Health Service did not significantly affect transplant activity. CONCLUSION:UK renal transplant activity peaks in late autumn/winter in contrast to other countries. Currently, healthcare capacity, though under strain, does not affect transplant activity; however, this may change if transplantation activity increases in line with national strategies as the spike in transplant activity coincides with peak activity in the national healthcare system