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Publication Risk factors associated with COVID-19 severity among patients on maintenance haemodialysis: a retrospective multicentre cross-sectional study in the UK(BMJ Publishing Group, 2022-05-30) Selvaskandan, Haresh; Hull, Katherine L; Adenwalla, Sherna; Ahmed, Safa; Cusu, Maria-Cristina; Graham-Brown, Matthew; Gray, Laura; Hall, Matt; Hamer, Rizwan; Kanbar, Ammar; Kanji, Hemali; Lambie, Mark; Lee, Han Sean; Mahdi, Khalid; Major, Rupert; Medcalf, James F; Natarajan, Sushiladevi; Oseya, Boavojuvie; Stringer, Stephanie; Tabinor, Matthew; Burton, James; University Hospitals of Leicester NHS Trust; University of Leicester; University Hospitals Coventry and Warwickshire NHS Trust; Northampton General Hospital NHS Trust; Nottingham University Hospitals NHS Trust; Royal Stoke University Hospital; Keele University; Lincoln County Hospital; University Hospitals Birmingham NHS Foundation Trust; Hamer, Rizwan; Hamer, Rizwan; Kanji, HemaliObjectives: To assess the applicability of risk factors for severe COVID-19 defined in the general population for patients on haemodialysis. Setting: A retrospective cross-sectional study performed across thirty four haemodialysis units in midlands of the UK. Participants: All 274 patients on maintenance haemodialysis who tested positive for SARS-CoV-2 on PCR testing between March and August 2020, in participating haemodialysis centres. Exposure: The utility of obesity, diabetes status, ethnicity, Charlson Comorbidity Index (CCI) and socioeconomic deprivation scores were investigated as risk factors for severe COVID-19. Main outcomes and measures: Severe COVID-19, defined as requiring supplemental oxygen or respiratory support, or a C reactive protein of ≥75 mg/dL (RECOVERY trial definitions), and its association with obesity, diabetes status, ethnicity, CCI, and socioeconomic deprivation. Results: 63.5% (174/274 patients) developed severe disease. Socioeconomic deprivation associated with severity, being most pronounced between the most and least deprived quartiles (OR 2.81, 95% CI 1.22 to 6.47, p=0.015), after adjusting for age, sex and ethnicity. There was no association between obesity, diabetes status, ethnicity or CCI with COVID-19 severity. We found no evidence of temporal evolution of cases (p=0.209) or clustering that would impact our findings. Conclusion: The incidence of severe COVID-19 is high among patients on haemodialysis; this cohort should be considered high risk. There was strong evidence of an association between socioeconomic deprivation and COVID-19 severity. Other risk factors that apply to the general population may not apply to this cohort.Publication Transplant Trial Watch.(Frontiers Media, 2024-07-22) Knight, Simon; Fallon, John; O'Callaghan, John; University Hospitals Coventry and Warwickshire NHS Trust; Renal Transplant; Medical and Dental; O'Callaghan, Johnno abstract availablePublication Live-donor kidney transplant outcome prediction (L-TOP) using artificial intelligence(Organ Predict, 2024-04-29) Ali, Hatem; Mohammed, Mahmoud; Molnar, Miklos Z; Fülöp, Tibor; Burke, Bernard; Shroff, Sunil; Shroff, Arun; Briggs, David; Krishnan, Nithya; Hatem Ali, Mahmoud Mohammed, Miklos Z Molnar, Tibor Fülöp, Bernard Burke, Sunil Shroff, Arun Shroff, David Briggs, Nithya Krishnan; Medical and DentalNo AbstractPublication Transplant Trial Watch.(Frontiers Media, 2023-09-27) Knight, Simon; O'Callaghan, John; Surgical Services; Medical and Dental; O'Callaghan, JohnNo abstract availablePublication Transplant Trial Watch.(Frontiers Media, 2023-07-27) O'Callaghan, John Matthew; Surgical Services; Medical and Dental; O'Callaghan, JohnNo abstract availablePublication Reduced functional measure of cardiovascular reserve predicts admission to critical care unit following kidney transplantation(Public Library of Science, 2013-05-27) Ting, Stephen M S; Iqbal, Hasan; Hamborg, Thomas; Hewins, Susan; Banerjee, Prithwish; Bland, Rosemary; imray, chris; Zehnder, Daniel; Higgins, Robert; Surgical Services; Medical and Dental; Ting, Stephen; Iqbal, Hasan; Hamborg, Thomas; imray, chris; Hewins, Susan; Banerjee, Prithwish; Bland, Rosemary; Higgins, Robert; Zehnder, DanielBackground: There is currently no effective preoperative assessment for patients undergoing kidney transplantation that is able to identify those at high perioperative risk requiring admission to critical care unit (CCU). We sought to determine if functional measures of cardiovascular reserve, in particular the anaerobic threshold (VO₂AT) could identify these patients.Publication Functional cardiovascular reserve predicts survival pre-kidney and post-kidney transplantation(ASN Publications, 2013-11-14) Ting, Stephen M S; Iqbal, Hasan; Kanji, Hemali; Hamborg, Thomas; Krishnan, Nithya; Banerjee, Prithwish; Bland, Rosemary; Higgins, Robert; imray, chris; Zehnder, Daniel; aldridge, nicolas; Surgical Services; Medicine; Core Services; Medical and Dental; Nursing and Midwifery Registered; imray, chris; Zehnder, Daniel; Ting, Stephen; Kanji, Hemali; aldridge, nicolas; Krishnan, Nithya; Banerjee, Prithwish; Bland, Rosemary; Higgins, RobertExercise intolerance is an important comorbidity in patients with CKD. Anaerobic threshold (AT) determines the upper limits of aerobic exercise and is a measure of cardiovascular reserve. This study investigated the prognostic capacity of AT on survival in patients with advanced CKD and the effect of kidney transplantation on survival in those with reduced cardiovascular reserve. Using cardiopulmonary exercise testing, cardiovascular reserve was evaluated in 240 patients who were waitlisted for kidney transplantation between 2008 and 2010, and patients were followed for ≤5 years. Survival time was the primary endpoint. Cumulative survival for the entire cohort was 72.6% (24 deaths), with cardiovascular events being the most common cause of death (54.2%). According to Kaplan-Meier estimates, patients with AT <40% of predicted peak VO2 had a significantly reduced 5-year cumulative overall survival rate compared with those with AT ≥40% (P<0.001). Regarding the cohort with AT <40%, patients who underwent kidney transplantation (6 deaths) had significantly better survival compared with nontransplanted patients (17 deaths) (hazard ratio, 4.48; 95% confidence interval, 1.78 to 11.38; P=0.002). Survival did not differ significantly among patients with AT ≥40%, with one death in the nontransplanted group and no deaths in the transplanted group. In summary, this is the first prospective study to demonstrate a significant association of AT, as the objective index of cardiovascular reserve, with survival in patients with advanced CKD. High-risk patients with reduced cardiovascular reserve had a better survival rate after receiving a kidney transplant.Publication Reduced Cardiovascular Reserve in Chronic Kidney Failure: A Matched Cohort Study.(Elsevier, 2015-04-18) Ting, Stephen M S; Hamborg, Thomas; Oxborough, David; Lim, Kenneth; Koganti, Sudheer; Bland, Rosemary; Fletcher, Simon; Krishnan, Nithya S; Higgins, Robert M; Townend, Jonathan; Banerjee, Prithwish; imray, chris; Zehnder, Daniel; McGregor, Gordon; aldridge, nicolas; Surgical Services; Medicine; Core Services; Allied Health Professional; Medical and Dental; Nursing and Midwifery Registered; Ting, Stephen; McGregor, Gordon; Koganti, Sudheer; aldridge, nicolas; imray, chris; Fletcher, Simon; Krishnan, Nithya; Higgins, Robert; Banerjee, Prithwish; Zehnder, DanielBackground: Patients with chronic kidney failure (CKF) experience impaired functional cardiovascular reserve with reduced oxygen consumption at peak exercise (VO(2peak)). No studies have examined whether this is related to impaired cardiovascular compliance as a consequence of loss of adaptive structural alterations, resulting from chronic uremia or hypertension.Publication Pregnancy-induced HLA antibodies respond more vigorously after renal transplantation than antibodies induced by prior transplantation(Elsevier, 2015-06-24) Lowe, David; Daga, Sunil; Hathaway, Mark; Williams, C; Kashi, Habib; Tan, Lam Chin; Fletcher, Simon; Hart, Pat; Briggs, David; Higgins, Robert; Lam, ForTai; Krishnan, Nithya; Zehnder, Daniel; Zehnder, Daniel; imray, chris; Surgical Services; Medical and Dental; imray, chris; Lam, ForTai; Higgins, Robert; Zehnder, Daniel; Krishnan, Nithya; Daga, Sunil; Kashi, Habib; Lam, Chin Tan; Fletcher, Simon; Hart, PatAcute antibody mediated rejection after HLA-specific antibody incompatible renal transplantation is related to donor specific HLA antibody (DSA) levels. DSA levels may rise sharply after transplant, and aim of this study was to examine changes in DSA levels, particularly according to the primary sensitising event. Changes in 220 HLA specificities in 64 patients over the first 30days after transplantation were evaluated using microbead assays. The greatest increase from pre-treatment to peak DSA levels was seen in pregnancy-stimulated specificities, median (IQR) increase in MFI of 1981 (94-5870). The next highest increase was for those sensitised by transplant with repeat HLA epitope mismatch, at 546 (-308-2698) (p<0.01). The difference was especially marked when the pre-treatment antibody level was low; with pre-treatment MFI <1000, peak level was >1000 in 19/26 (73%) of pregnancy stimulated specificities, compared with 9/29 (31%) for all others (p<0.001). DSA production to specificities stimulated by previous pregnancy was marked, even from very low pre-transplant levels. By contrast, there was a lower rate of antibody resynthesis to specificities repeated from previous transplants, both at antigen and epitope levels.Publication Conversion from tacrolimus to cyclosporine in stable renal transplant patients: safety, metabolic changes, and pharmacokinetic comparison(Wolters Kluwer, 2000-04) Higgins, R M; Hart, P; Lam, F T; Kashi, H; Lam, ForTai; Surgical Services; Medical and Dental; Lam, ForTai; Higgins, Robert; Kashi, Habib; Hart, PAlthough conversion between tacrolimus and cyclosporine has been performed when indicated for rejection or adverse effects, the safety and metabolic outcome of elective conversion from tacrolimus to cyclosporine has not previously been examined.Publication Double filtration plasmapheresis in antibody-incompatible kidney transplantation(2010) Higgins R; Lowe D; Hathaway M; Lam, ForTai; Kashi H; Tan LC; imray, chris; Fletcher S; Chen K; Krishnan N; Hamer R; Zehnder D; Briggs DPublication C3d-positive donor-specific antibodies have a role in pretransplant risk stratification of cross-match-positive HLA-incompatible renal transplantation: United Kingdom multicentre study(2020) Babu A; Khovanova N; Shaw O; Griffin S; Briggs D; Krishnan NS; Fletcher S; Imray C; Seitz A; Baker R; Wellberry-Smith M; Clarke B; Cullen K; Rees T; Edwards F; Burrows E; Howe L; Martin C; Dorling A; Zehnder D; Higgins RM; Mitchell DA; Daga SPublication Soluble CD30 and Cd27 levels in patients undergoing HLA antibody-incompatible renal transplantation(2010) Hamer R; Roche L; Smillie D; Harmer A; Mitchell D; Molostvov G; Lam FT; Kashi H; Tan LC; Imray C; Fletcher S; Briggs D; Lowe D; Zehnder D; Higgins RPublication Human leukocyte antigen antibody-incompatible renal transplantation: excellent medium-term outcomes with negative cytotoxic crossmatch(2011) Higgins R; Lowe D; Hathaway M; Williams C; Lam FT; Kashi H; Tan LC; Imray C; Fletcher S; Chen K; Krishnan N; Hamer R; Daga S; Edey M; Zehnder D; Briggs DPublication The histological development of acute antibody-mediated rejection in HLA antibody-incompatible renal transplantation(2010) Higgins R; Zehnder D; Chen K; Lowe D; McKinnell J; Lam FT; Kashi H; Tan LC; Imray C; Fletcher S; Krishnan N; Hamer R; Briggs DPublication Rises and falls in donor-specific and third-party HLA antibody levels after antibody incompatible transplantation(2009) Higgins R; Lowe D; Hathaway M; Lam F; Kashi H; Tan LC; Imray C; Fletcher S; Chen K; Krishnan N; Hamer R; Zehnder D; Briggs DPublication Application of flow cytometry to monitor antibody levels in ABO incompatible kidney transplantation(2008) Krishnan NS; Fleetwood P; Higgins RM; Hathaway M; Zehnder D; Mitchell; Hamer R; Fletcher S; Lam, ForTai; Kashi H; Tan LC; imray, chris; Briggs D; Krishnan, Nithya S; imray, chrisPublication Behaviour of non-donor specific antibodies during rapid re-synthesis of donor specific HLA antibodies after antibody incompatible renal transplantation(2013) Krishnan NS; Zehnder D; Daga S; Lowe D; Lam FT; Kashi H; Tan LC; Imray C; Hamer R; Briggs D; Raymond N; Higgins RMPublication Blood levels of donor-specific human leukocyte antigen antibodies after renal transplantation: resolution of rejection in the presence of circulating donor-specific antibody(2007) Higgins R; Hathaway M; Lowe D; Lam F; Kashi H; Tan LC; Imray C; Fletcher S; Zehnder D; Chen K; Krishnan N; Hamer R; Briggs DPublication HLA Antibody Incompatible Renal Transplantation: Long-term Outcomes Similar to Deceased Donor Transplantation.(Wolters Kluwer, 2021-07-19) Krishnan, Nithya; Abimbola, Aisha; Machan, Nandhini; Daga, Sunil; Gopalakrishnan, Kishore; Lam, ForTai; Tan, LamChin; Kashi, Habib; Zehnder, Daniel; Collins, Claire; Curtis, Rebecca; Higgins, Robert; Khovanova, Natasha; Briggs, David; imray, chris; Surgical Services; Medical and Dental; Krishnan, Nithya; imray, chris; Gopalakrishnan, Kishore; Lam, ForTai; Tan, LamChin; Kashi, Habib; Higgins, RobertThe overall patient survival was 95%, 90%, and 81%; and graft survival was 95%, 85%, and 70% at 1, 5, and 10 y, respectively. This was similar to the first-time deceased donor transplant cohort. The graft survival for pretreatment cytotoxic-dependent crossmatch (CDC) positive crossmatch group was significantly low at 83%, 64%, and 40% at 1, 5, and 10 y, respectively, compared with other groups (Bead/CDC, P = 0.007; CDC/Flow, P = 0.001; and microbead assay/flow cytometry crossmatch, P = 0.837), although those with a low CDC titer (<1 in 2) have comparable outcomes to the CDC negative group. Female patients in general fared worse in both patient and graft survival outcomes in each of the 3 groups based on pretreatment crossmatch, although this did not reach statistical significance. Antibody-mediated rejection was the most frequent type of rejection with significant decline in graft survival by 10 y when compared with no rejection (P < 0.001). Rejection that occurred or continued to occur after the first 2 wk of transplantation caused a significant reduction in graft survivals (P < 0.001), whereas good outcomes were seen in those with a single early rejection episode.