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Significant variation in both patient case mix and the structure of care in kidney transplantation has been previously described in the United States.
The objective of our study was to characterize patient case mix, patterns of care, and inpatient outcomes across 5 kidney transplant centers in the province of Ontario, Canada.
This was a retrospective population-based cohort study using health care administrative databases.
The setting is Ontario, Canada.
We included adult (≥18 years) transplant recipients who received a primary, solitary kidney between January 1, 2000, and December 31, 2013 (N = 5037).
Using linked administrative health care databases, we characterized kidney transplant recipient and donor factors, center characteristics, provider characteristics, and inpatient outcomes across transplant centers in Ontario. To compare case mix-adjusted differences in length of stay across centers, multivariable Cox proportional hazards regression was used to obtain hazard ratios (HRs) for each center relative to the average across all centers. Center volume and provider characteristics were added to the models to examine whether these factors explain differences in length of stay across centers.
We noted significant differences across transplant centers in patient race, cause of end-stage renal disease, body mass index, comorbidities, time on dialysis, and donor type. Mean annual transplant center volumes during the study period ranged between 51.5 (9.3) and 101.7 (23.9) transplants/year across centers (P < .0001). Physician specialty most responsible for in-hospital transplant care varied significantly across centers with the most common combination being nephrologist and urologist. Less than 31 deaths occurred in hospital during the index transplant admission but mortality risk did not differ significantly between centers. Overall, 25.1% of recipients required dialysis in hospital post transplantation (range across centers 18.3%-33.5%, P < .0001) and 24.7% of recipients spent time in the intensive care unit (ICU; range across centers: 5.7%-58.0%, P < .0001). The proportion of participants requiring dialysis did not change with time (P = .12), whereas the proportion staying in the ICU increased steadily over time (P < .0001). The median length of stay in hospital after transplantation ranged from 7 to 9 days across centers (P < .0001) and decreased significantly over time. After adjusting for patient case mix as well as center and provider factors, HRs for length of stay censored at the time of death ranged between 0.75 (95% confidence interval [CI]: 0.69-0.82) and 1.29 (95% CI: 1.20-1.38) across centers. Center volume and provider experience were not independently associated with length of hospital stay. Limitations: Data were missing (0.8%-18.4%) for certain covariates of interest. Conclusions: This study found significant heterogeneity across kidney transplant centers in case mix, practice patterns, and inpatient outcomes. Future studies are needed to examine the influence of length of stay and practice patterns on long-term outcomes such as patient/graft survival and quality of life.
kidney transplantation, center variation, health services delivery, in-hospital outcomes
Case Mix, Patterns of Care, and Inpatient Outcomes Among Ontario Kidney Transplant Centers: A Population-Based Study
Anne Tsampalieros,1,2 Greg A. Knoll,1,3 Stephanie Dixon,4,5 Shane English,1,6 Douglas Manuel,7 Carl Van Walraven,1,8,9 Monica Taljaard,1,10 and Dean Fergusson1
In contrast to the highly labile mitochondrial (mt) genomes of vascular plants, the architecture and composition of mt genomes within the main lineages of bryophytes appear stable and invariant. The available mt genomes of 18 liverwort accessions representing nine genera and five orders are syntenous except for Gymnomitrion concinnatum whose genome is characterized by two rearrangements. Here, we expanded the number of assembled liverwort mt genomes to 47, broadening the sampling to 31 genera and 10 orders spanning much of the phylogenetic breadth of liverworts to further test whether the evolution of the liverwort mitogenome is overall static.
Liverwort mt genomes range in size from 147 Kb in Jungermanniales (clade B) to 185 Kb in Marchantiopsida, mainly due to the size variation of intergenic spacers and number of introns. All newly assembled liverwort mt genomes hold a conserved set of genes, but vary considerably in their intron content. The loss of introns in liverwort mt genomes might be explained by localized retroprocessing events. Liverwort mt genomes are strictly syntenous in genome structure with no structural variant detected in our newly assembled mt genomes. However, by screening the paired-end reads, we do find rare cases of recombination, which means multiple concurrent genome structures may exist in the vegetative tissues of liverworts. Our phylogenetic analyses of the nuclear encoded double stand break repair protein families revealed liverwort-specific subfamilies expansions.
The low repeat recombination level, selection, along with the intensified nuclear surveillance, might together shape the structural evolution of liverwort mt genomes.
Bryophytes, recombination, structural evolution, repeats, introns
Mitochondrial genomes of the early land plant lineage liverworts (Marchantiophyta): conserved genome structure, and ongoing low frequency recombination
Shanshan Dong,1,2 Chaoxian Zhao,1,3 Shouzhou Zhang,1 Li Zhang,1 Hong Wu,2 Huan Liu,4 Ruiliang Zhu,3 Yu Jia,5 Bernard Goffinet,6 and Yang Liucorresponding author1,4
The two new tetrakis-substituted pyrazines, 1,1′,1′′,1′′′-(pyrazine-2,3,5,6-tetrayl) tetrakis(N,N-dimethylmethanamine), C16H32N6, (I) and N,N′,N′′,N′′′-[pyrazine-2,3,5,6-tetrayltetrakis(methylene)]tetrakis(N-methylaniline), C36H40N6, (II), both crystallize with half a molecule in the asymmetric unit; the whole molecules are generated by inversion symmetry. There are weak intramolecular C—H⋯N hydrogen bonds present in both molecules and in (II) the pendant N-methylaniline rings are linked by a C—H⋯π interaction. The degredation product, N,N′-[(6-phenyl-6,7-dihydro-5H-pyrrolo[3,4-b]pyrazine-2,3-diyl)bis(methylene)]bis(N-methylaniline), C28H29N5, (III), was obtained several times by reacting (II) with different metal salts. Here, the 6-phenyl ring is almost coplanar with the planar pyrrolo[3,4-b]pyrazine unit (r.m.s. deviation = 0.029 a), with a dihedral angle of 4.41 (10)° between them. The two N-methylaniline rings are inclined to the planar pyrrolo[3,4-b]pyrazine unit by 88.26 (10) and 89.71 (10)°, and to each other by 72.56 (13)°. There are also weak intramolecular C—H⋯N hydrogen bonds present involving the pyrazine ring and the two N-methylaniline groups. In the crystal of (I), there are no significant intermolecular contacts present, while in (II) molecules are linked by a pair of C—H⋯π interactions, forming chains along the c-axis direction. In the crystal of (III), molecules are linked by two pairs of C—H⋯π interactions, forming inversion dimers, which in turn are linked by offset π-π interactions [intercentroid distance = 3.8492 (19) a], forming ribbons along the b-axis direction.
crystal structure, pyrazine, tetrakis-substituted, C—H⋯π interactions, offset π-π interactions, Hirshfeld surface analysis
Crystal structures and Hirshfeld surface analyses of two new tetrakis-substituted pyrazines and a degredation product
Ana Tesouro Vallinaa and Helen Stoeckli-Evansb,*
2020 Mar 1;