Kidney Transplantation Clinical outcomes related research
1)Chronic kidney disease among transplant recipients
The traditional focus of clinical research in kidney transplant recipients has been the reduction of acute rejection and prolongation of allograft survival. In contrast, my research has focused on the importance of premature patient death among transplant recipients. My research has highlighted a need for a paradigm shift in the management of these patients based on the concept that chronic kidney disease is not cured by transplantation and aggressive treatment of chronic kidney disease before, during and after transplantation is required to improve patient outcomes. My research has challenged the transplant community to abandon the treatment modality based categorization of patients as dialysis dependent, transplant and failed transplant in favor of a holistic approach that considers transplant recipients as patients with a chronic condition that requires an aggressive continuum of care.
2) Access to kidney transplantation
My research in this area has focused on defining the negative impact of waiting times on clinical outcomes after kidney transplantation. We have demonstrated that patients continue to achieve a substantial benefit from transplantation with waiting times of up to three years. We have also studied access to transplantation in specific patient groups. We recently reported a low rate of transplantation among Canadians of Aboriginal ethnicity. Other studies in this area have addressed access to transplantation among the elderly, American Veterans, and access to preemptive transplantation among patients in the United States.
3) Quantification of allograft function
My research in this area has stressed the need to move beyond serum creatinine measurements alone as a marker of allograft function. Serum creatinine measurements alone are not an accurate measure of allograft function. Using glomerular filtration prediction equations I have published on the level of allograft function achieved after transplantation and the subsequent rate of allograft decline. Key contributions in this area include highlighting the fact that most transplant recipients only achieve a modest level of allograft function and that the subsequent decline in allograft function among long-term transplant recipients is slow. These findings have disproved the long held assumption that kidney transplant recipients are at high risk for kidney function decline. Further these studies have shown that therapeutic strategies to improve baseline allograft survival may be more beneficial that strategies to slow the progression of allograft decline.
- •Gill JS, Gill J, Rose C, Zalunardo N, Landsberg D. The older living kidney donor: Part of the solution to the organ shortage. Transplantation. 2006 Dec 27;82(12):1662-6.
- •Gill JS, Potential Advantages and Limitations of Applying The Chronic Kidney Disease Classification to Kidney Transplant Recipients. American Journal of Transplantation December 2006 6 (12) Page 2821-2826.
- •Tonelli M, Klarenbach S, Manns B, Culleton BF, Hemmelgarn B, Bertazzon S, Wiebe N and Gill JS. Association between residence location and likelihood of kidney transplantation in Aboriginal patients. Kidney Int. Kidney International Advance online publication June 21, 2006.
- •Tonelli M, Klarenbach S, Manns B, Culleton B, Hemmelgarn B, Bertazzon S, Wiebe N, Gill JS. Association between residence location and likelihood of kidney transplanation. 2006 CMAJ Aug 29;175(5):478-82.
- •Hemmelgarn BR, Chou S, Wiebe N, Culleton BF, Manns BJ, Klarenbach S, Khan NA, Gourishankar S, Yeates KE, Gill JS, Tonelli M. Differences in use of peritoneal dialysis and survival among East Asian, Indo Asian, and white ESRD patients in Canada. Am J Kidney Dis. 2006 Dec;48(6):964-71. Erratum in: Am J Kidney Dis. 2007 Feb;49(2):348.
- •Garcia-Garcia G, Briseño-Rentería G, Luquín-Arellano V. H., Gao Z , Gill JS, Tonelli M. Survival among patients with kidney failure in Jalisco, Mexico. Journal of the American Society of Nephrology. 2007 (In press).
- •Gill JS, Hussain, S, Rose C, Hariharan, S, Tonelli, M Access to kidney transplantation among patients insured by the United States Department of Veterans’ Affairs. Journal of the American Society of Nephrology. 2007 (in press).
- •”Gill JS, Rose C, Pereira B, Tonelli M. The importance of transitions between dialysis and transplantation in the care of end-stage renal disease patients.
- •Kidney Int. 2007 Mar;71(5):442-7.”
- •Johnston O, Rose C, Landsberg D, Gourlay W, Gill JS. Nephrectomy after transplant failure: Current Practice and Outcomes. American Journal Of Transplantation 2007 (in press).
- •”Johnston O, Zalunardo N, Rose C, Gill JS. Prevention of Sepsis during the Transition to Dialysis May Improve the Survival of Transplant Failure Patients.
- •J Am Soc Nephrol. 2007 Apr;18(4):1331-7.”
- •Solid C, Foley RN, Gill JS, Collins AJ. Epoetin use and Kidney Disease Outcomes Quality Initiative hemoglobin targets in patients returning to dialysis with failed renal transplants. Kidney Int. 2007 Mar;71(5):425-30.
- •Young A, Nevis IFP, Geddes C, Gill JS, Boudville N, Storlsey L, Garg AX. Do biochemical measures changed in living donors? A systematic review. Nephron. 2007 (in press).
- •”Barraclough KA, Landsberg DN, Shapiro RJ, Gill JS, Li G, Balshaw RF, Chailimpamontree W, Keown PA. A matched cohort pharmacoepidemilogical analysis of steroid free immunosuppression in renal transplantation. Transplantation. 2009 Mar 15;87(5):672-80. Provided input into data interpretation, and manuscript writing
- •10% contribution.”
- •Chailimpamontree W, Dmitrienko S, Li G, Balshaw, Magil A, Shapiro RJ, Landsberg D, Gill J, Keown PA. Probability, predictors and prognosis of postransplantation glomerulonephritis. JASN 2009 Apr;20(4):843-51. Contributed data, interpreted analysis, revised manuscript. 10% contribution.
- •”Tonelli M, Klarenbach S, Wiebe N, Rose C, Gill JS. Access to kidney transplantation among remote- and rural-dwelling patients with kidney failure in the United States
- •JAMA 2009 Apr 22;301(16):1681-90. Designed and Oversaw analyses, interpreted data, input in writing and revision of manuscript. 33% contribution.”
- •Tonelli M, Wiebe N, Hemmelgarn B, Klarenbach S, Field C, Manns B, Thadhani R, Gill J; Alberta Kidney Disease Network. Trace elements in hemodialysis patients: a systematic review and meta-analysis. BMC Medicine. 2009 May 19; 7-25. Provided input into data interpretation, and manuscript writing. 10% contribution.
- •Kim SJ, Gill JS. H-Y Incompatability Predicts Short Term Outcomes For Kidney Transplant Recipients. J Am Soc Nephrol. 2009 June 18; Epub ahead of print. Provided input into study design, data interpretation and manuscript writing and revision. 35% contribution.
- •Bromberg J, Gill J. Heavy LYFTing: KASting pearls before swine. Am J Transplant. 2009 Jul;9(7):1489-90. Revised original draft and edited manuscript. 40% Contribution.
- •Gill JS, Zalunardo N, Rose C, Tonelli M. The pregnancy rate and live birth rate in kidney transplant recipients. Am J Transplant. 2009 July;9(7): 1541-9. Conceived study, oversaw analysis, interpreted data, wrote manuscript, corresponding author. 60% contribution.
- •Iordanous Y, Seymour N, Young A, Johnson J, Iansavichus AV, Cuerden MS, Gill JS, Poggio E, Garg AX; for the Donor Nephrectomy Outcomes Research (DONOR) Network. Recipient outcomes for expanded criteria living donors: The disconnect between current evidence and practice. Am J Transplant. 2009 July;9(7):1558-73. Provided input into study design, data interpretation, and manuscript writing. 10% contribution.
- •”Yeates K, Wiebe N, Gill J, Sima C, Schaubel D, Holland D, Hemmelgarn B, Tonelli M
- •Similar outcomes among black and white renal allograft recipients. JASN. 2009 Jan;20(1):172-9. Provided input into study design, analyses, data interpretation and manuscript editing 0% contribution.”
- •Kiberd B, Rose C, Gill JS. Cancer Mortality in Kidney Transplant Recipients. Am J Transplant. 2009 August;9(8):1868-75. Designed and oversaw analysis, interpreted data, input into writing and revision of manuscript. 30% contribution.
- •Pauly R, Gill JS, Rose C, Reem A., Chery A, Pierratos A, Chan CT. Survival among nocturnal home hemodialysis patients compared to kidney transplant recipients. Nephrology Dial Transplantation. 2009 Sept;24(9):2915-9. Oversaw study design, all aspect of statistical analysis, review and edit of manuscript. 25% contribution.
- •”Johnston O, Jaswal D, Gill JS, Doucette S, Fergusson DA, Knoll GA. Treatment of Polyomavirus Infection in Kidney Transplant Recipients: A Systematic Review
- •Transplantation. 2010 Jan 19. [Epub ahead of print]. Reviewed and edited manuscript 10% contribution.”
- •”Gill JS, Landsberg D, Johnston O, Shapiro RJ, Magil A, Wu, V, Tincham K, Keown P
- •Screening for de-novo anti-HLA antibodies in non-sensitized kidney transplant recipients does not predict acute rejection. Transplantation. 2010 Jan 27;89(2):178-84
- •Conceived Study, conducted study, analyzed data, wrote manuscript 70% contribution.”
- •Ommen E, Gill JS. The System of Health Insurance for Living Donors is a Disincentive for Live Donation. Am J Transplant. 2010 Jan 29. [Epub ahead of print]. Co authored this peer reviewed opinion piece. 50% contribution.