SlideShare una empresa de Scribd logo
1 de 38
Raj Kiran Medapalli, MD, MPH.  Nephrology Fellow January 5 th  2011 Mount Sinai School of Medicine Division of Nephrology Journal Club
Transplant Nephrectomy Improves Survival following a Failed Renal Allograft . JASN 21: 374–380, 2010. Journal Club  January 5 th  2011 Raj Kiran Medapalli, MD, MPH.
Failed renal allograft - Disease burden ,[object Object],[object Object],[object Object]
Prognosis after failed primary renal allograft ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Death after primary renal allograft loss 78564 pts who underwent primary renal transplant  between 1988-1998; 10 yr follow-up. USRDS In comparison, annual death rate on renal transplant waiting list is  6.33% per 100-pt-years (9.27% for diabetics) Annual adjusted death rates per 100 pt-years Death with functioning transplant Death after graft loss N Annual rate % N Annual rate % Overall 10816 2.81 4712 9.42 Cardio-vasc 3402 0.69 2252 4.31 Infectious 1856 0.37 879 1.63 Malignancy 808 0.19 122 0.11
Source: Kaplan and Meier-Kriesche. AJT 2002; 2: 970-74
Potential explanations for high mortality in patients with allograft failure ,[object Object],[object Object],[object Object]
Allograft nephrectomy after transplant failure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Allograft nephrectomy after transplant failure (US)
Allograft nephrectomy & repeat transplantation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Usual indications for transplant nephrectomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Withdrawal of immunosuppression after allograft failure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Study Design - 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Study Design - 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Study outcomes & Statistical analysis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Propensity Scores ,[object Object],[object Object],[object Object],[object Object]
Propensity Scores ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Propensity Scores ,[object Object],[object Object],[object Object],[object Object],[object Object]
Results ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
b Defined as need for dialysis before hospital discharge after transplantation.
 
d Coded during any hospitalization occurring after return to dialysis after failed kidney transplant.
 
Unadjusted Rates (1994-2004) All-cause mortality Total N=10,951 32 vs. 36 per 100 Person Years (p=0.0324) Repeat transplantation Total N=10,951  10% vs. 4.1% (p<0.001)
Adjusted for : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Adjusted rates + Sensitivity Analysis
Results summary ,[object Object],[object Object],[object Object],[object Object],[object Object]
Study strengths ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Study weaknesses ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
My Conclusions - 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],My Conclusions - 2
My conclusions - 3 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]

Más contenido relacionado

La actualidad más candente

No evidence of ccsvi in multiple sclerosis
No evidence of ccsvi in multiple sclerosisNo evidence of ccsvi in multiple sclerosis
No evidence of ccsvi in multiple sclerosisuvcd
 
Jose Maria Morales - Spain - Tuesday 29 - HLA for Renal Allocation
Jose Maria Morales - Spain - Tuesday 29 - HLA for Renal AllocationJose Maria Morales - Spain - Tuesday 29 - HLA for Renal Allocation
Jose Maria Morales - Spain - Tuesday 29 - HLA for Renal Allocationincucai_isodp
 
Journal club NEJM kidney transplantation IDES 2017
Journal club NEJM kidney transplantation IDES 2017Journal club NEJM kidney transplantation IDES 2017
Journal club NEJM kidney transplantation IDES 2017CHAKEN MANIYAN
 
Journal club SMART trial NEJM
Journal club  SMART trial NEJM Journal club  SMART trial NEJM
Journal club SMART trial NEJM CHAKEN MANIYAN
 
4 5764843123465258464
4 57648431234652584644 5764843123465258464
4 5764843123465258464amarewoldie1
 
Preparation of case for living related renal transplant in pakistan
Preparation of case for living related renal transplant in pakistanPreparation of case for living related renal transplant in pakistan
Preparation of case for living related renal transplant in pakistanDr. Muhammad Saifullah
 
Evaluation of kidney donor sudan 2017
Evaluation of kidney donor sudan 2017Evaluation of kidney donor sudan 2017
Evaluation of kidney donor sudan 2017FarragBahbah
 
Traitement de la FA vu par le chirurgien cardiaque : state of the art. (Dr J....
Traitement de la FA vu par le chirurgien cardiaque : state of the art. (Dr J....Traitement de la FA vu par le chirurgien cardiaque : state of the art. (Dr J....
Traitement de la FA vu par le chirurgien cardiaque : state of the art. (Dr J....Brussels Heart Center
 
Utilizing Doppler Flow to Investigate the Hemodynamic Effects of Anti-Cancer ...
Utilizing Doppler Flow to Investigate the Hemodynamic Effects of Anti-Cancer ...Utilizing Doppler Flow to Investigate the Hemodynamic Effects of Anti-Cancer ...
Utilizing Doppler Flow to Investigate the Hemodynamic Effects of Anti-Cancer ...Scintica Instrumentation
 
Induction treatment in Kidney transplantation chaken 2017
Induction treatment in Kidney transplantation chaken 2017 Induction treatment in Kidney transplantation chaken 2017
Induction treatment in Kidney transplantation chaken 2017 CHAKEN MANIYAN
 
Transcatheter intraarterial infusion of rt pa for
Transcatheter intraarterial infusion of rt pa forTranscatheter intraarterial infusion of rt pa for
Transcatheter intraarterial infusion of rt pa forHans Garcia
 
Basics of immunosuppression in kidney transplantation
Basics of immunosuppression in kidney transplantationBasics of immunosuppression in kidney transplantation
Basics of immunosuppression in kidney transplantationFarragBahbah
 
Treatment and early outcome of 11 children with hepatoblastoma.
Treatment and early outcome of 11 children with hepatoblastoma.Treatment and early outcome of 11 children with hepatoblastoma.
Treatment and early outcome of 11 children with hepatoblastoma.Dr./ Ihab Samy
 
ABO incompatible living donor kidney transplantation - REVIEW in living donor...
ABO incompatible living donor kidney transplantation - REVIEW in living donor...ABO incompatible living donor kidney transplantation - REVIEW in living donor...
ABO incompatible living donor kidney transplantation - REVIEW in living donor...Maarten Naesens
 
Deceased donor kidney transplantation-Recipient care.
Deceased donor kidney transplantation-Recipient care.Deceased donor kidney transplantation-Recipient care.
Deceased donor kidney transplantation-Recipient care.Vishal Golay
 
Management of Renal Transplant Patients
Management of Renal Transplant PatientsManagement of Renal Transplant Patients
Management of Renal Transplant Patientsdrsanjaymaitra
 

La actualidad más candente (20)

No evidence of ccsvi in multiple sclerosis
No evidence of ccsvi in multiple sclerosisNo evidence of ccsvi in multiple sclerosis
No evidence of ccsvi in multiple sclerosis
 
Jose Maria Morales - Spain - Tuesday 29 - HLA for Renal Allocation
Jose Maria Morales - Spain - Tuesday 29 - HLA for Renal AllocationJose Maria Morales - Spain - Tuesday 29 - HLA for Renal Allocation
Jose Maria Morales - Spain - Tuesday 29 - HLA for Renal Allocation
 
Journal club NEJM kidney transplantation IDES 2017
Journal club NEJM kidney transplantation IDES 2017Journal club NEJM kidney transplantation IDES 2017
Journal club NEJM kidney transplantation IDES 2017
 
Journal club SMART trial NEJM
Journal club  SMART trial NEJM Journal club  SMART trial NEJM
Journal club SMART trial NEJM
 
4 5764843123465258464
4 57648431234652584644 5764843123465258464
4 5764843123465258464
 
Preparation of case for living related renal transplant in pakistan
Preparation of case for living related renal transplant in pakistanPreparation of case for living related renal transplant in pakistan
Preparation of case for living related renal transplant in pakistan
 
Evaluation of kidney donor sudan 2017
Evaluation of kidney donor sudan 2017Evaluation of kidney donor sudan 2017
Evaluation of kidney donor sudan 2017
 
Traitement de la FA vu par le chirurgien cardiaque : state of the art. (Dr J....
Traitement de la FA vu par le chirurgien cardiaque : state of the art. (Dr J....Traitement de la FA vu par le chirurgien cardiaque : state of the art. (Dr J....
Traitement de la FA vu par le chirurgien cardiaque : state of the art. (Dr J....
 
Utilizing Doppler Flow to Investigate the Hemodynamic Effects of Anti-Cancer ...
Utilizing Doppler Flow to Investigate the Hemodynamic Effects of Anti-Cancer ...Utilizing Doppler Flow to Investigate the Hemodynamic Effects of Anti-Cancer ...
Utilizing Doppler Flow to Investigate the Hemodynamic Effects of Anti-Cancer ...
 
Induction treatment in Kidney transplantation chaken 2017
Induction treatment in Kidney transplantation chaken 2017 Induction treatment in Kidney transplantation chaken 2017
Induction treatment in Kidney transplantation chaken 2017
 
Transcatheter intraarterial infusion of rt pa for
Transcatheter intraarterial infusion of rt pa forTranscatheter intraarterial infusion of rt pa for
Transcatheter intraarterial infusion of rt pa for
 
Basics of immunosuppression in kidney transplantation
Basics of immunosuppression in kidney transplantationBasics of immunosuppression in kidney transplantation
Basics of immunosuppression in kidney transplantation
 
Treatment and early outcome of 11 children with hepatoblastoma.
Treatment and early outcome of 11 children with hepatoblastoma.Treatment and early outcome of 11 children with hepatoblastoma.
Treatment and early outcome of 11 children with hepatoblastoma.
 
Kidney Donor evaluation
Kidney Donor evaluationKidney Donor evaluation
Kidney Donor evaluation
 
Lack of evidence in carotid stenosis
Lack of evidence in carotid stenosisLack of evidence in carotid stenosis
Lack of evidence in carotid stenosis
 
Enigma trial
Enigma trialEnigma trial
Enigma trial
 
ABO incompatible living donor kidney transplantation - REVIEW in living donor...
ABO incompatible living donor kidney transplantation - REVIEW in living donor...ABO incompatible living donor kidney transplantation - REVIEW in living donor...
ABO incompatible living donor kidney transplantation - REVIEW in living donor...
 
Deceased donor kidney transplantation-Recipient care.
Deceased donor kidney transplantation-Recipient care.Deceased donor kidney transplantation-Recipient care.
Deceased donor kidney transplantation-Recipient care.
 
Renal transplantation ROX
Renal transplantation ROXRenal transplantation ROX
Renal transplantation ROX
 
Management of Renal Transplant Patients
Management of Renal Transplant PatientsManagement of Renal Transplant Patients
Management of Renal Transplant Patients
 

Similar a Transplant Nephrectomy Improves Survival following a Failed Renal Allograft (Journal Club)

Overview of kidney transplant
Overview of kidney transplantOverview of kidney transplant
Overview of kidney transplantDr. Lalit Agarwal
 
Banff 2011 liver transplant pathology summary session
Banff 2011 liver transplant pathology summary sessionBanff 2011 liver transplant pathology summary session
Banff 2011 liver transplant pathology summary sessionKim Solez ,
 
Cardiovascular risk evaluation and management before renal transplantation sl...
Cardiovascular risk evaluation and management before renal transplantation sl...Cardiovascular risk evaluation and management before renal transplantation sl...
Cardiovascular risk evaluation and management before renal transplantation sl...Christos Argyropoulos
 
RENAL TRANSPLANTATION AN OVERVIEW.ppt
RENAL TRANSPLANTATION AN OVERVIEW.pptRENAL TRANSPLANTATION AN OVERVIEW.ppt
RENAL TRANSPLANTATION AN OVERVIEW.pptLolakshiBR
 
Carotid revascularization in cad patients
Carotid revascularization in cad patientsCarotid revascularization in cad patients
Carotid revascularization in cad patientsDIPAK PATADE
 
Seminar on treatment of renal artery stenosis
Seminar on treatment of renal artery stenosisSeminar on treatment of renal artery stenosis
Seminar on treatment of renal artery stenosisAbid_Kuchay
 
11 surgical bleeding and transfusions
11 surgical bleeding and transfusions11 surgical bleeding and transfusions
11 surgical bleeding and transfusionsDang Thanh Tuan
 
DANISH trial (Cardiology)
 DANISH trial (Cardiology) DANISH trial (Cardiology)
DANISH trial (Cardiology)PRAVEEN GUPTA
 
Membranous Nephropathy
Membranous NephropathyMembranous Nephropathy
Membranous Nephropathyedwinchowyw
 
Recurrent glomerulonephritis after kidney transplantation
Recurrent glomerulonephritis after kidney transplantationRecurrent glomerulonephritis after kidney transplantation
Recurrent glomerulonephritis after kidney transplantationscienthiasanjeevani1
 
Pancreas transplantation
Pancreas transplantationPancreas transplantation
Pancreas transplantationOther Mother
 
kidney Transplant in lupus nephritis
kidney Transplant in lupus nephritiskidney Transplant in lupus nephritis
kidney Transplant in lupus nephritisPediatric Nephrology
 

Similar a Transplant Nephrectomy Improves Survival following a Failed Renal Allograft (Journal Club) (20)

Overview of kidney transplant
Overview of kidney transplantOverview of kidney transplant
Overview of kidney transplant
 
Banff 2011 liver transplant pathology summary session
Banff 2011 liver transplant pathology summary sessionBanff 2011 liver transplant pathology summary session
Banff 2011 liver transplant pathology summary session
 
Cardiovascular risk evaluation and management before renal transplantation sl...
Cardiovascular risk evaluation and management before renal transplantation sl...Cardiovascular risk evaluation and management before renal transplantation sl...
Cardiovascular risk evaluation and management before renal transplantation sl...
 
RENAL TRANSPLANTATION AN OVERVIEW.ppt
RENAL TRANSPLANTATION AN OVERVIEW.pptRENAL TRANSPLANTATION AN OVERVIEW.ppt
RENAL TRANSPLANTATION AN OVERVIEW.ppt
 
Renal transplantation
Renal transplantationRenal transplantation
Renal transplantation
 
Carotid revascularization in cad patients
Carotid revascularization in cad patientsCarotid revascularization in cad patients
Carotid revascularization in cad patients
 
Seminar on treatment of renal artery stenosis
Seminar on treatment of renal artery stenosisSeminar on treatment of renal artery stenosis
Seminar on treatment of renal artery stenosis
 
11 surgical bleeding and transfusions
11 surgical bleeding and transfusions11 surgical bleeding and transfusions
11 surgical bleeding and transfusions
 
Emergency cabg .pptx
Emergency cabg .pptxEmergency cabg .pptx
Emergency cabg .pptx
 
DANISH trial (Cardiology)
 DANISH trial (Cardiology) DANISH trial (Cardiology)
DANISH trial (Cardiology)
 
Membranous Nephropathy
Membranous NephropathyMembranous Nephropathy
Membranous Nephropathy
 
Recurrent glomerulonephritis after kidney transplantation
Recurrent glomerulonephritis after kidney transplantationRecurrent glomerulonephritis after kidney transplantation
Recurrent glomerulonephritis after kidney transplantation
 
Pancreas transplantation
Pancreas transplantationPancreas transplantation
Pancreas transplantation
 
Dr sudhir vydehi final
Dr sudhir vydehi finalDr sudhir vydehi final
Dr sudhir vydehi final
 
kidney Transplant in lupus nephritis
kidney Transplant in lupus nephritiskidney Transplant in lupus nephritis
kidney Transplant in lupus nephritis
 
Acute Kidney Injury in the Cardiac Surgery Patient
Acute Kidney Injury in the Cardiac Surgery PatientAcute Kidney Injury in the Cardiac Surgery Patient
Acute Kidney Injury in the Cardiac Surgery Patient
 
Aki cticu final
Aki cticu finalAki cticu final
Aki cticu final
 
Articulo arritmia
Articulo arritmiaArticulo arritmia
Articulo arritmia
 
Cytoreductive nephrectomy
Cytoreductive nephrectomyCytoreductive nephrectomy
Cytoreductive nephrectomy
 
Management of interstitial fibrosis and tubular atrophy
Management of interstitial fibrosis and tubular atrophyManagement of interstitial fibrosis and tubular atrophy
Management of interstitial fibrosis and tubular atrophy
 

Último

Call Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls ServiceCall Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls Servicesonalikaur4
 
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original PhotosBook Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photosnarwatsonia7
 
VIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service Mumbai
VIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service MumbaiVIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service Mumbai
VIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service Mumbaisonalikaur4
 
Call Girls Service in Bommanahalli - 7001305949 with real photos and phone nu...
Call Girls Service in Bommanahalli - 7001305949 with real photos and phone nu...Call Girls Service in Bommanahalli - 7001305949 with real photos and phone nu...
Call Girls Service in Bommanahalli - 7001305949 with real photos and phone nu...narwatsonia7
 
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original PhotosCall Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original Photosnarwatsonia7
 
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service ChennaiCall Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service ChennaiNehru place Escorts
 
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment BookingCall Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Bookingnarwatsonia7
 
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdfHemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdfMedicoseAcademics
 
Aspirin presentation slides by Dr. Rewas Ali
Aspirin presentation slides by Dr. Rewas AliAspirin presentation slides by Dr. Rewas Ali
Aspirin presentation slides by Dr. Rewas AliRewAs ALI
 
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowSonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowRiya Pathan
 
Housewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment Booking
Housewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment BookingHousewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment Booking
Housewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment Bookingnarwatsonia7
 
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...Miss joya
 
Low Rate Call Girls Mumbai Suman 9910780858 Independent Escort Service Mumbai
Low Rate Call Girls Mumbai Suman 9910780858 Independent Escort Service MumbaiLow Rate Call Girls Mumbai Suman 9910780858 Independent Escort Service Mumbai
Low Rate Call Girls Mumbai Suman 9910780858 Independent Escort Service Mumbaisonalikaur4
 
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...Miss joya
 
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service JaipurHigh Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipurparulsinha
 
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Call Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
Call Girl Lucknow Mallika 7001305949 Independent Escort Service LucknowCall Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
Call Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknownarwatsonia7
 
See the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy PlatformSee the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy PlatformKweku Zurek
 

Último (20)

Call Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls ServiceCall Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls Service
 
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original PhotosBook Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
 
VIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service Mumbai
VIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service MumbaiVIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service Mumbai
VIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service Mumbai
 
Call Girls Service in Bommanahalli - 7001305949 with real photos and phone nu...
Call Girls Service in Bommanahalli - 7001305949 with real photos and phone nu...Call Girls Service in Bommanahalli - 7001305949 with real photos and phone nu...
Call Girls Service in Bommanahalli - 7001305949 with real photos and phone nu...
 
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original PhotosCall Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
 
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service ChennaiCall Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
 
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment BookingCall Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
 
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdfHemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
 
Aspirin presentation slides by Dr. Rewas Ali
Aspirin presentation slides by Dr. Rewas AliAspirin presentation slides by Dr. Rewas Ali
Aspirin presentation slides by Dr. Rewas Ali
 
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
 
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowSonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
 
Housewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment Booking
Housewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment BookingHousewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment Booking
Housewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment Booking
 
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
 
Escort Service Call Girls In Sarita Vihar,, 99530°56974 Delhi NCR
Escort Service Call Girls In Sarita Vihar,, 99530°56974 Delhi NCREscort Service Call Girls In Sarita Vihar,, 99530°56974 Delhi NCR
Escort Service Call Girls In Sarita Vihar,, 99530°56974 Delhi NCR
 
Low Rate Call Girls Mumbai Suman 9910780858 Independent Escort Service Mumbai
Low Rate Call Girls Mumbai Suman 9910780858 Independent Escort Service MumbaiLow Rate Call Girls Mumbai Suman 9910780858 Independent Escort Service Mumbai
Low Rate Call Girls Mumbai Suman 9910780858 Independent Escort Service Mumbai
 
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
 
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service JaipurHigh Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
 
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
 
Call Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
Call Girl Lucknow Mallika 7001305949 Independent Escort Service LucknowCall Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
Call Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
 
See the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy PlatformSee the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy Platform
 

Transplant Nephrectomy Improves Survival following a Failed Renal Allograft (Journal Club)

  • 1. Raj Kiran Medapalli, MD, MPH. Nephrology Fellow January 5 th 2011 Mount Sinai School of Medicine Division of Nephrology Journal Club
  • 2. Transplant Nephrectomy Improves Survival following a Failed Renal Allograft . JASN 21: 374–380, 2010. Journal Club January 5 th 2011 Raj Kiran Medapalli, MD, MPH.
  • 3.
  • 4.
  • 5. Death after primary renal allograft loss 78564 pts who underwent primary renal transplant between 1988-1998; 10 yr follow-up. USRDS In comparison, annual death rate on renal transplant waiting list is 6.33% per 100-pt-years (9.27% for diabetics) Annual adjusted death rates per 100 pt-years Death with functioning transplant Death after graft loss N Annual rate % N Annual rate % Overall 10816 2.81 4712 9.42 Cardio-vasc 3402 0.69 2252 4.31 Infectious 1856 0.37 879 1.63 Malignancy 808 0.19 122 0.11
  • 6. Source: Kaplan and Meier-Kriesche. AJT 2002; 2: 970-74
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.  
  • 14.
  • 15.  
  • 16.  
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.  
  • 24.  
  • 25. b Defined as need for dialysis before hospital discharge after transplantation.
  • 26.  
  • 27. d Coded during any hospitalization occurring after return to dialysis after failed kidney transplant.
  • 28.  
  • 29. Unadjusted Rates (1994-2004) All-cause mortality Total N=10,951 32 vs. 36 per 100 Person Years (p=0.0324) Repeat transplantation Total N=10,951 10% vs. 4.1% (p<0.001)
  • 30.
  • 31. Adjusted rates + Sensitivity Analysis
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37.
  • 38.