Patrick O'Kelly

A population‐based study of skin cancer incidence and prevalence in renal transplant recipients

Background  Cancers occurring following solid organ transplantation are a rapidly growing public health concern. Defining the extent of the problem has been limited by surveillance systems with incomplete registration of cases and the paucity of reliable national incidence data.

The natural history of surgically treated but radiotherapy‐naïve nonfunctioning pituitary adenomas

Background and objectives  Transsphenoidal surgery is indicated for patients with nonfunctioning pituitary adenomas (NFPAs) causing compressive symptoms. Previous studies attempting to define the rate of recurrence/regrowth of surgically treated but radiation‐naïve NFPAs were somewhat limited by selection bias and/or small numbers and/or lack of consistency of findings between studies. A better understanding of the natural history of this condition could allow stratification of recurrence risk and inform future management. We aimed to define the natural history of a large, mainly unselected cohort with surgically treated, radiotherapy (RT)‐naïve NFPAs and to try to identify predictors of recurrence/regrowth.

Photoprotective behaviour and sunscreen use: impact on vitamin D levels in cutaneous lupus erythematosus

Background: Sun exposure of the skin, independent of dietary sources, may provide sufficient vitamin D in healthy individuals. A recent study of patients with cutaneous lupus erythematosus concluded that over 70% of them restrict their sun exposure.

The impact of skin disease following renal transplantation on quality of life.

Background  The immunosuppressive therapy a patient requires to sustain a functioning renal allograft in the long term is associated with various skin complications. While quality of life (QoL) after renal transplantation has been studied, no publications document the effect of post‐transplant dermatological complications on QoL.

Improved patient survival in recipients of simultaneous pancreas-kidney transplant compared with kidney transplant alone in patients with type 1 diabetes mellitus and end-stage renal disease

There are emerging data that simultaneous pancreas–kidney transplant (SPK) prolongs life compared with kidney transplant alone (KTA) in type 1 diabetics with end‐stage renal disease. This study was a retrospective comparison of SPK with KTA in patients with type 1 diabetes.

A Comparison of Long‐Term Graft Survival Rates Between the First and Second Donor Kidney Transplanted—The Effect of a Longer Cold Ischaemic Time for the Second Kidney

Prolonged cold ischaemic time (CIT) is associated with delayed initial graft function and may also have a negative impact on long‐term graft outcome. We carried out a study comparing the long‐term graft survival rates between those recipients who received the first of a pair of donor kidneys versus the recipient of the second graft.

Conventional glucocorticoid replacement overtreats adult hypopituitary patients with partial ACTH deficiency

background  Glucocorticoid therapy is associated with potentially serious side‐effects, but there is no information available regarding glucocorticoid requirement in adult hypopituitary patients with partial ACTH deficiency.

MDRD-Estimated GFR at One Year Post-Renal Transplant Is a Predictor of Long-Term Graft Function

Renal transplantation is the optimal mode of renal replacement. Improvements in graft survival and acute rejection rates have made these outcomes less useful for prognostication and as end-points in clinical trials; accurate surrogate markers of long-term graft outcome are therefore increasingly important. This study examines the relationship between both serum creatinine (SCr1yr) and MDRD estimated glomerular filtration rate measured at one year (eGFRMDRD1yr) as predictors of graft survival. Data on 1,110 patients who received a renal transplant between 1989 and 2005 were extracted from the Irish Renal Transplant Registry. The study group was divided into quartiles of patient numbers according to SCr1yr and eGFRMDRD1yr. Kaplan-Meier estimates of the primary end-point graft survival were constructed for each quartile. Additionally, a Cox Regression restricted cubic spline model was performed for both eGFRMDRD1yr and SCr1yr. Both overall graft outcome and outcome censored for death with a functioning graft (CDWFG) were used as endpoints. Cox regression analysis was performed along with tests for the proportionality assumption to compare the predictive value of eGFRMDRD1yrand SCr1yr. Both eGFRMDRD1yr and SCr1yr were independently associated with long-term renal transplant survival. eGFRMDRD1yr and SCr1yr had similarly strong associations with long-term outcome when the quartile variables were compared using the Bayesian Information Criterion method. The Cox regression restricted cubic spline modeling demonstrated that an eGFRMDRD1yr value < 27 mLs/min/1.73m2 and a SCr1yr value > 229 μmol/L were associated with poor graft survival.

Polymorphic light eruption and skin cancer prevalence: is one protective against the other?

Background  Ultraviolet (UV) radiation (UVR) interacts with chromophores in cutaneous cells with consequent antigenicity. The normal response to this is a downregulation of immune responsiveness. Failure of the immune system to downregulate and to ignore transient photoantigens in human skin results in polymorphic light eruption (PLE), the commonest of the photodermatoses. UVR initiates and promotes skin cancer (SC): UV‐induced immunosuppression permits the expansion of UV‐mutated clones of cells which ultimately lead to SC.

Warfarin use in hemodialysis patients: what is the risk?

BACKGROUND There is a paucity of data concerning the risks associated with warfarin in hemodialysis (HD) patients. We compared major bleeding episodes in this group with HD patients not receiving warfarin and with a cohort of non-HD patients receiving warfarin. METHODS A retrospective review of 141 HD patients on warfarin (HDW), 704 HD patients not on warfarin (HDNW) and 3,266 non-dialysis warfarin patients (NDW) was performed. Hospital admissions for hemorrhagic events and ischemic strokes were examined as was hospital length of stay and blood product use. INR variability was also assessed. RESULTS The incidence rates for major hemorrhage per 100 patient years was 10.8 in the HDW group as compared to 8.0 in the HDNW (p = 0.593) and 2.1 in the NDW (p < 0.001) groups. Mean units of red blood cell transfusions required was higher in patients on dialysis with no significant difference between HDW and HDNW groups. The risk of ischemic stroke per 100 patient years was 1.7 in the HDW group as compared to 0.7 in the HDNW groups (p = 0.636) and 0.4 in the NDW (p = 0.003). The HDW group had higher inter-measurement INR variability compared to the NDW group (p = 0.034). In patients with atrial fibrillation, HDW group had a higher incidence of ischemic stroke than the NDW group (2.2 versus 0.4 events per 100 patient years; p = 0.024). CONCLUSIONS This study confirms the higher bleeding risk associated with HD/ESRD but suggests that warfarin use in these patients may not add significantly to this risk. We also demonstrated high rates of ischemic stroke in HD patients despite warfarin use. SUMMARY Our study compares the frequency of major hemorrhage and secondarily, ischemic stroke in HD patients receiving or not receiving warfarin, with non-HD patients receiving warfarin. The major finding was that frequency of hemorrhage was higher in HD patients receiving warfarin than in non-HD patients receiving warfarin, but not different in HD patients with or without warfarin. A secondary finding was that INR variability was significantly higher in HD patients than non-HD patients on warfarin.