• Calcineurin inhibitor sparing with mycophenolate in kidney transplantation: a systematic review and meta-analysis.

      Moore, Jason; Middleton, Lee; Cockwell, Paul; Adu, Dwomoa; Ball, Simon; Little, Mark A; Ready, Andrew; Wheatley, Keith; Borrows, Richard; Department of Nephrology and Kidney Transplantation, Renal Institute of Birmingham, University Hospital Birmingham, Edgbaston, Birmingham, United Kingdom. j.moore.3@bham.ac.uk (Transplantation, 2009-02-27)
      Limiting the exposure of kidney transplant recipients to calcineurin inhibitors (CNIs) has potential merit, but there is no clear consensus on the utility of current strategies. In an attempt to aid clarification, we conducted a systematic review and meta-analysis of randomized trials that assessed CNI sparing (minimization or elimination) with mycophenolate as sole adjunctive immunosuppression.
    • Comparison of the predictive performance of eGFR formulae for mortality and graft failure in renal transplant recipients.

      He, Xiang; Moore, Jason; Shabir, Shazia; Little, Mark A; Cockwell, Paul; Ball, Simon; Liu, Xiang; Johnston, Atholl; Borrows, Richard; Department of Clinical Pharmacology, Barts and The London School of Medicine and Dentistry, London, United Kingdom. (Transplantation, 2009-02-15)
      To date, efforts have focused on assessing estimated glomerular filtration rate (eGFR) formulae against measured GFR. However, a more appropriate clinical gold standard is one conveying a defined clinical disadvantage. In renal transplantation, these measures are mortality and graft failure.
    • Development and evaluation of a composite risk score to predict kidney transplant failure.

      Moore, Jason; He, Xiang; Shabir, Shazia; Hanvesakul, Rajesh; Benavente, David; Cockwell, Paul; Little, Mark A; Ball, Simon; Inston, Nicholas; Johnston, Atholl; et al. (American journal of kidney diseases : the official journal of the National Kidney Foundation, 2011-05)
      Although risk factors for kidney transplant failure are well described, prognostic risk scores to estimate risk in prevalent transplant recipients are limited.
    • Identification of the optimal donor quality scoring system and measure of early renal function in kidney transplantation.

      Moore, Jason; Ramakrishna, Satish; Tan, Kay; Cockwell, Paul; Eardley, Kevin; Little, Mark A; Rylance, Paul; Shivakumar, Kunigal; Suresh, Vijayan; Tomlinson, Kerry; et al. (Transplantation, 2009-02-27)
      The early identification of kidney allografts at risk of later dysfunction has implications for clinical practice. Donor quality scoring systems (preoperative) and measures of early allograft function (first week postoperative) have previously shown practical utility. This study aimed to determine the optimal parameter(s) (preoperative and postoperative) with greatest predictive power for the development of subsequent allograft dysfunction.
    • The impact of hemoglobin levels on patient and graft survival in renal transplant recipients.

      Moore, Jason; He, Xiang; Cockwell, Paul; Little, Mark A; Johnston, Atholl; Borrows, Richard; Department of Nephrology and Renal Transplantation, University Hospital Birmingham, Edgbaston, Birmingham B15 2TH, United Kingdom. (Transplantation, 2008-08-27)
      It remains unclear whether low hemoglobin levels are associated with increased mortality or graft loss after renal transplantation. This study assessed the relationship of hemoglobin levels with patient and graft survival in 3859 patients with functioning renal transplants more than 6-months posttransplantation.
    • Peritoneal dialysis in an ageing population: a 10-year experience.

      Smyth, Andrew; McCann, Evonne; Redahan, Lynn; Lambert, Barbara; Mellotte, George J; Wall, Catherine A; Department of Nephrology, Adelaide & Meath Hospital, Dublin 24, Tallaght, Ireland. andrewsmyth@physicians.ie (2012-02)
      Chronic kidney disease (CKD) is becoming increasingly prevalent and there are increasing numbers of older patients with advanced CKD. Peritoneal dialysis (PD) is a potential treatment. This study aims to compare PD outcomes in age-defined populations in the largest PD centre in the Republic of Ireland over 10 years.
    • Renal transplantation in systemic vasculitis: when is it safe?

      Little, Mark A; Hassan, Basma; Jacques, Steve; Game, David; Salisbury, Emma; Courtney, Aisling E; Brown, Catherine; Salama, Alan D; Harper, Lorraine; Renal Institute of Birmingham, School of Immunity, Infection and Inflammation, University of Birmingham, Birmingham, UK. (Nephrology, dialysis, transplantation : official publication of the European, 2009-10)
      There are no clear guidelines on renal transplantation in patients with antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis.
    • Technetium myocardial perfusion scanning in prerenal transplant evaluation in the United kingdom.

      Wong, C F; Little, M A; Vinjamuri, S; Hammad, A; Harper, J M; Department of Nephrology and Transplantation, Royal Liverpool University Hospital, Liverpool, United Kingdom. chriswong@doctors.org.uk (Transplantation proceedings, 2008-06)
      Because death with a functioning graft remains one of the most important causes of long-term renal transplant failure, cardiac risk stratification and screening for coronary artery disease are essential components of pretransplant assessment. Pretransplant screening for occult coronary artery disease in a subset of these patients may improve outcome. The UK follows the European Best practice guideline 1.5.5 E. Although echocardiography, thallium myocardial perfusion scanning (MPS), dobutamine stress echocardiography, and coronary angiography have been suggested as means of cardiovascular assessment, the best means of assessment remains undetermined. Therefore, we investigated the role of 99m technetium sestamibi myocardial perfusion scanning as an assessment tool for identifying those patients with end-stage renal failure at high risk of cardiovascular death after renal transplantation. Retrospectively, we studied 126 patients that had a MPS as part of their pretransplant assessment. Overall unadjusted survival was 65% at 3 years. Twelve deaths resulted from cardiovascular causes. A reversible defect on MPS was associated with a fatal cardiac event and all-cause mortality. The unadjusted hazard ratio of cardiac event with reversible defect on MPS was 3.1 (95% confidence interval, 1.1 to 18.2) and hazard ratio of death with reversible defect on MPS was 1.92 (95% confidence interval, 1.1 to 4.4). Thus, MPS may be a useful tool in cardiac risk stratification and in selecting patients with a favorable outcome after renal transplantation. Our patients with a reversible defect in particular have increased cardiac mortality. This group may benefit from coronary angiography.