The incidence of certain malignancies is significantly higher after organ transplant. However, th... more The incidence of certain malignancies is significantly higher after organ transplant. However, there are rare reports of chronic myeloid leukemia in the posttransplant setting. The average reported interval between a transplant and the diagnosis of chronic myeloid leukemia is 44 months (range, 10- 96 mo). We report 2 patients with chronic myeloid leukemia within 1 year of a kidney transplant, which is significantly shorter than those previously reported. Both patients were receiving mycophenolate mofetil and tacrolimus for immunosuppression. They were treated with imatinib for chronic myeloid leukemia, and both patients demonstrated an isolated elevation of serum alkaline phosphatase that was directly correlated with imatinib. Despite a potential interaction between the 2 drugs, blood levels of tacrolimus and imatinib were not elevated during the course of treatment. Isolated elevation of alkaline phosphatase in this particular setting has not been reported previously.
We assessed hypertensive control after native nephrectomy and renal transplantation in patients w... more We assessed hypertensive control after native nephrectomy and renal transplantation in patients with autosomal dominant polycystic kidney disease. Blood pressure control was studied retrospectively in 118 patients with autosomal dominant polycystic kidney disease who underwent renal transplantation between 2003 and 2013. Overall 54 patients underwent transplantation alone (group 1) and 64 underwent transplantation with concurrent ipsilateral nephrectomy (group 2). Of these 64 patients 32 underwent ipsilateral nephrectomy only (group 2a) and 32 underwent eventual delayed contralateral native nephrectomy (group 2b). The number of antihypertensive drugs and defined daily dose of each antihypertensive was recorded at transplantation and up to 36-month followup. Comparing preoperative to postoperative medications at 12, 24 and 36-month followup, transplantation with concurrent ipsilateral nephrectomy had a greater decrease in quantity (-1.2 vs -0.5 medications, p=0.008; -1.1 vs -0.3, p=0.007 and -1.2 vs -0.4, p=0.03, respectively) and defined daily dose of antihypertensive drug (-3.3 vs -1.0, p=0.0008; -2.9 vs -1.0, p=0.006 and -2.7 vs -0.6, p=0.007, respectively) than transplantation alone at each point. Native nephrectomy continued to be a predictor of hypertensive requirements on multivariable analysis (p <0.0001). The mean decrease in number of medications in group 2b from after ipsilateral nephrectomy to 12 months after contralateral nephrectomy was -0.6 (p=0.0005) and the mean decrease in defined daily dose was -0.6 (p=0.009). In patients with autosomal dominant polycystic kidney disease undergoing renal transplantation, concurrent ipsilateral native nephrectomy is associated with a significant decrease in the quantity and defined daily dose of antihypertensive drugs needed for hypertension control. Delayed contralateral native nephrectomy is associated with improved control of blood pressure to an even greater degree.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2011
The incidence of certain malignancies is significantly higher after organ transplant. However, th... more The incidence of certain malignancies is significantly higher after organ transplant. However, there are rare reports of chronic myeloid leukemia in the posttransplant setting. The average reported interval between a transplant and the diagnosis of chronic myeloid leukemia is 44 months (range, 10- 96 mo). We report 2 patients with chronic myeloid leukemia within 1 year of a kidney transplant, which is significantly shorter than those previously reported. Both patients were receiving mycophenolate mofetil and tacrolimus for immunosuppression. They were treated with imatinib for chronic myeloid leukemia, and both patients demonstrated an isolated elevation of serum alkaline phosphatase that was directly correlated with imatinib. Despite a potential interaction between the 2 drugs, blood levels of tacrolimus and imatinib were not elevated during the course of treatment. Isolated elevation of alkaline phosphatase in this particular setting has not been reported previously.
Renal transplantation is nowadays accepted as the treatment of choice for patients with end-stage... more Renal transplantation is nowadays accepted as the treatment of choice for patients with end-stage renal disease. However, despite progress in immunosuppression and surgical techniques, various complications still can occur. Complications vary from vascular disorders and urologic diseases to parenchymal and immunologically related complications. The clinician evaluating the recipient with graft dysfunction has the option of choosing among a variety of imaging modalities including ultrasonography, nuclear medicine, computed tomography, and magnetic resonance imaging to start or continue the diagnostic work-up. In this article, we discuss the evaluation of the kidney transplant recipient using these imaging procedures, emphasizing the clinical diagnostic utility and role of each modality.
Kidney dysfunction is a recognized complication after non-renal solid organ transplantation, part... more Kidney dysfunction is a recognized complication after non-renal solid organ transplantation, particularly after intestinal transplant. In our study, we reviewed data on 33 multivisceral transplant (MVT)- and 15 isolated small bowel (ISB)-transplant patients to determine risk factors for kidney dysfunction. Kidney function was estimated by modified diet in renal disease (MDRD) and Schwartz formula for adults and children, respectively. Acute kidney injury (AKI) was defined as an increase in the serum Cr (sCr) greater than twofold. Kidney function declined significantly at one yr after transplantation with 46% of subjects showing an estimated GFR (eGFR) <60 mL/min. Patients with an episode of AKI were more likely to have reduced eGFR than those without AKI (p < 0.025). In linear regression analyses, age, pre-transplant sCr, eGFR at postoperative day (POD) 30, 90, 180, 270, and tacrolimus level at POD 7 showed significant correlation with one yr post-transplant eGFR (p < 0.05). Pediatric patients and patients with MVT had lesser decline in kidney function compared with adults or patients with ISB. In conclusion, risk factors for post-transplant kidney dysfunction in intestinal transplantation included age, pre-transplant sCr, AKI episode, eGFR at POD 30, 90, 180, 270, and tacrolimus level at POD 7.
A n 11-year-old girl at-tended the Memorial Hermann Children's Hospital Pediatric Gastro... more A n 11-year-old girl at-tended the Memorial Hermann Children's Hospital Pediatric Gastroenterol-ogy, Hepatology & Nutrition Clinic because of epigastric pain for 3 months. She described the pain as epigastric pressure and burning radiating to the chest se-vere ...
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, Jan 15, 2016
Our objective was to study the outcomes of hepatitis C-positive renal transplant recipients compa... more Our objective was to study the outcomes of hepatitis C-positive renal transplant recipients compared with hepatitis C-negative renal transplant recipients. We reviewed the outcomes of hepatitis C-positive kidney transplant recipients compared with hepatitis C virus-negative recipients from the United Network for Organ Sharing/Organ Procurement and Transplantation Network database for transplants from 2000 to 2004 with follow-up until 2012. Of 61 775 recipients, 3334 were hepatitis C positive at time of transplant. Hepatitis C-positive recipient status was significantly associated with male gender (70.1% vs 58.6%), deceased donor type (73.9% vs 56.6%), African American race (55.7% vs 26.8%), recipient age, increased duration of pretransplant dialysis (mean 724 days vs 624), previous transplant (19.4% vs 11.5%), donor hepatitis C positivity, delayed graft function (23.9% vs 16.0%), and all-cause hospitalizations. All-cause unadjusted, death-censored graft survival and patient survival...
The aim of this study was to evaluate the utility of donor-specific antibodies (DSA) and flow cyt... more The aim of this study was to evaluate the utility of donor-specific antibodies (DSA) and flow cytometry crossmatch (FCCM) as tools for predicting antibody-mediated rejection (AMR) in desensitized kidney recipients. Sera from 44 patients with DSA at the time of transplant were reviewed. Strength of DSA was determined by single antigen Luminex bead assay and expressed as mean fluorescence intensity (MFI). T- and B-cell FCCM results were expressed as mean channel shift (MCS). AMR was diagnosed by C4d deposition on biopsy. Incidence of early AMR was 31%. Significant differences in the number of DSAs (p = 0.0002), cumulative median MFI in DSA class I (p = 0.0004), and total (class I + class II) DSA (p < 0.0001) were found in patients with and without AMR. No significant difference was seen in MCS of T and B FCCM (p = 0.095 and p = 0.307, respectively). The three-yr graft survival in desensitized patients with DSA having total MFI < 9500 was 100% compared to 76% with those having total MFI > 9500 (p = 0.022). Desensitized kidney transplant recipients having higher levels of class I and total DSA MFI are at high risk for AMR and poor graft survival. Recipient DSA MFI appears to be a more reliable predictor of AMR than MCS of FCCM.
Indiana University&am... more Indiana University's kidney transplant program has undergone changes in the program's approach to immunosuppression. This change in philosophy has moved the program away from multiple chronic maintenance immunosuppression strategies with corticosteroids to steroid-free maintenance immunosuppressive strategies for both adults and pediatric recipients. Anti-thymocyte globulin induction (beginning pre-reperfusion) has allowed for the rapid post-transplant withdrawal of corticosteroids. Steroid-free maintenance immunosuppression has been achieved with excellent patient and graft survival as well as lower rejection rates in the first posttransplant year. Desensitized recipients can also be safely included in steroid-free protocols. The administration of anti-thymocyte globulin prereperfusion combined with pulsatile perfusion storage of deceased donor kidneys has led to an extremely low delayed graft function rate.
Outcomes of kidney Re-Transplant Recipients (RTR) were compared to Primary Recipients (FTR) from ... more Outcomes of kidney Re-Transplant Recipients (RTR) were compared to Primary Recipients (FTR) from paired donor kidneys. OPTN database was used to identify deceased donors (n=6,266) who donated one kidney to a RTR and the mate kidney to a FTR between January 2000 to December 2010. As compared to FTR, RTR were younger (45 vs 52 years, p<0.001) and had higher proportion of PRA >80 (25% vs 7%, p<0.001). There were higher 0 mismatches in RTR (19% vs 16%, p<0.001). There were more pre-emptive transplants in RTR (24% vs 21%, p=0.002). Delayed graft function (28% vs 25%, P=0.007) was higher in RTR. Patient survival was similar in FTR and RTR groups at 1, 3 and 5 years (95.7%, 90.2% and 82.5% vs 95.2%, 89.8% and 82.7%). Allograft survival rates were higher in FTR group compared to RTR group at 1, 3 and 5 years (91.1%, 82.4% and 70.9% vs 87.8%, 77.4% and 66.1% p<0.001). Death-censored allograft survival rates were higher in FTR group at 1, 3 and 5 years (91.3%, 82.7% and 71.4% v...
Discussion continues about right versus left donor nephrectomy. Left side is preferred due to lon... more Discussion continues about right versus left donor nephrectomy. Left side is preferred due to longer renal vein while right side has been associated with renal vein thrombosis and shorter vessels. A retrospective analysis of UNOS database for adult living donor transplants between January 1(st) 2000 to December 31(st) 2009. We identified 58,599 living donor transplants, of which 86.1% were LDN. There were no significant differences between the recipients or donors demographics. There were higher rates of DGF in RDN recipients with a hazard risk of 1.38 (95% CI 1.24-1.53; p<0.0001). Primary failure rates were similar. In the RDN group, graft thrombosis as cause of graft failure was statistically higher with a hazard ratio of 1.48 (95% CI 1.18-1.86, p=0.0004), graft survival was significantly inferior (p=0.006 log-rank test). For living donors outcomes, the conversion from laparoscopic to open was higher in the RDN group with an odds ratio of 2.02 (95% CI 1.61-2.52; p<0.00001). ...
The incidence of certain malignancies is significantly higher after organ transplant. However, th... more The incidence of certain malignancies is significantly higher after organ transplant. However, there are rare reports of chronic myeloid leukemia in the posttransplant setting. The average reported interval between a transplant and the diagnosis of chronic myeloid leukemia is 44 months (range, 10- 96 mo). We report 2 patients with chronic myeloid leukemia within 1 year of a kidney transplant, which is significantly shorter than those previously reported. Both patients were receiving mycophenolate mofetil and tacrolimus for immunosuppression. They were treated with imatinib for chronic myeloid leukemia, and both patients demonstrated an isolated elevation of serum alkaline phosphatase that was directly correlated with imatinib. Despite a potential interaction between the 2 drugs, blood levels of tacrolimus and imatinib were not elevated during the course of treatment. Isolated elevation of alkaline phosphatase in this particular setting has not been reported previously.
We assessed hypertensive control after native nephrectomy and renal transplantation in patients w... more We assessed hypertensive control after native nephrectomy and renal transplantation in patients with autosomal dominant polycystic kidney disease. Blood pressure control was studied retrospectively in 118 patients with autosomal dominant polycystic kidney disease who underwent renal transplantation between 2003 and 2013. Overall 54 patients underwent transplantation alone (group 1) and 64 underwent transplantation with concurrent ipsilateral nephrectomy (group 2). Of these 64 patients 32 underwent ipsilateral nephrectomy only (group 2a) and 32 underwent eventual delayed contralateral native nephrectomy (group 2b). The number of antihypertensive drugs and defined daily dose of each antihypertensive was recorded at transplantation and up to 36-month followup. Comparing preoperative to postoperative medications at 12, 24 and 36-month followup, transplantation with concurrent ipsilateral nephrectomy had a greater decrease in quantity (-1.2 vs -0.5 medications, p=0.008; -1.1 vs -0.3, p=0.007 and -1.2 vs -0.4, p=0.03, respectively) and defined daily dose of antihypertensive drug (-3.3 vs -1.0, p=0.0008; -2.9 vs -1.0, p=0.006 and -2.7 vs -0.6, p=0.007, respectively) than transplantation alone at each point. Native nephrectomy continued to be a predictor of hypertensive requirements on multivariable analysis (p &amp;amp;amp;amp;amp;amp;lt;0.0001). The mean decrease in number of medications in group 2b from after ipsilateral nephrectomy to 12 months after contralateral nephrectomy was -0.6 (p=0.0005) and the mean decrease in defined daily dose was -0.6 (p=0.009). In patients with autosomal dominant polycystic kidney disease undergoing renal transplantation, concurrent ipsilateral native nephrectomy is associated with a significant decrease in the quantity and defined daily dose of antihypertensive drugs needed for hypertension control. Delayed contralateral native nephrectomy is associated with improved control of blood pressure to an even greater degree.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2011
The incidence of certain malignancies is significantly higher after organ transplant. However, th... more The incidence of certain malignancies is significantly higher after organ transplant. However, there are rare reports of chronic myeloid leukemia in the posttransplant setting. The average reported interval between a transplant and the diagnosis of chronic myeloid leukemia is 44 months (range, 10- 96 mo). We report 2 patients with chronic myeloid leukemia within 1 year of a kidney transplant, which is significantly shorter than those previously reported. Both patients were receiving mycophenolate mofetil and tacrolimus for immunosuppression. They were treated with imatinib for chronic myeloid leukemia, and both patients demonstrated an isolated elevation of serum alkaline phosphatase that was directly correlated with imatinib. Despite a potential interaction between the 2 drugs, blood levels of tacrolimus and imatinib were not elevated during the course of treatment. Isolated elevation of alkaline phosphatase in this particular setting has not been reported previously.
Renal transplantation is nowadays accepted as the treatment of choice for patients with end-stage... more Renal transplantation is nowadays accepted as the treatment of choice for patients with end-stage renal disease. However, despite progress in immunosuppression and surgical techniques, various complications still can occur. Complications vary from vascular disorders and urologic diseases to parenchymal and immunologically related complications. The clinician evaluating the recipient with graft dysfunction has the option of choosing among a variety of imaging modalities including ultrasonography, nuclear medicine, computed tomography, and magnetic resonance imaging to start or continue the diagnostic work-up. In this article, we discuss the evaluation of the kidney transplant recipient using these imaging procedures, emphasizing the clinical diagnostic utility and role of each modality.
Kidney dysfunction is a recognized complication after non-renal solid organ transplantation, part... more Kidney dysfunction is a recognized complication after non-renal solid organ transplantation, particularly after intestinal transplant. In our study, we reviewed data on 33 multivisceral transplant (MVT)- and 15 isolated small bowel (ISB)-transplant patients to determine risk factors for kidney dysfunction. Kidney function was estimated by modified diet in renal disease (MDRD) and Schwartz formula for adults and children, respectively. Acute kidney injury (AKI) was defined as an increase in the serum Cr (sCr) greater than twofold. Kidney function declined significantly at one yr after transplantation with 46% of subjects showing an estimated GFR (eGFR) &lt;60 mL/min. Patients with an episode of AKI were more likely to have reduced eGFR than those without AKI (p &lt; 0.025). In linear regression analyses, age, pre-transplant sCr, eGFR at postoperative day (POD) 30, 90, 180, 270, and tacrolimus level at POD 7 showed significant correlation with one yr post-transplant eGFR (p &lt; 0.05). Pediatric patients and patients with MVT had lesser decline in kidney function compared with adults or patients with ISB. In conclusion, risk factors for post-transplant kidney dysfunction in intestinal transplantation included age, pre-transplant sCr, AKI episode, eGFR at POD 30, 90, 180, 270, and tacrolimus level at POD 7.
A n 11-year-old girl at-tended the Memorial Hermann Children&#x27;s Hospital Pediatric Gastro... more A n 11-year-old girl at-tended the Memorial Hermann Children&#x27;s Hospital Pediatric Gastroenterol-ogy, Hepatology &amp; Nutrition Clinic because of epigastric pain for 3 months. She described the pain as epigastric pressure and burning radiating to the chest se-vere ...
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, Jan 15, 2016
Our objective was to study the outcomes of hepatitis C-positive renal transplant recipients compa... more Our objective was to study the outcomes of hepatitis C-positive renal transplant recipients compared with hepatitis C-negative renal transplant recipients. We reviewed the outcomes of hepatitis C-positive kidney transplant recipients compared with hepatitis C virus-negative recipients from the United Network for Organ Sharing/Organ Procurement and Transplantation Network database for transplants from 2000 to 2004 with follow-up until 2012. Of 61 775 recipients, 3334 were hepatitis C positive at time of transplant. Hepatitis C-positive recipient status was significantly associated with male gender (70.1% vs 58.6%), deceased donor type (73.9% vs 56.6%), African American race (55.7% vs 26.8%), recipient age, increased duration of pretransplant dialysis (mean 724 days vs 624), previous transplant (19.4% vs 11.5%), donor hepatitis C positivity, delayed graft function (23.9% vs 16.0%), and all-cause hospitalizations. All-cause unadjusted, death-censored graft survival and patient survival...
The aim of this study was to evaluate the utility of donor-specific antibodies (DSA) and flow cyt... more The aim of this study was to evaluate the utility of donor-specific antibodies (DSA) and flow cytometry crossmatch (FCCM) as tools for predicting antibody-mediated rejection (AMR) in desensitized kidney recipients. Sera from 44 patients with DSA at the time of transplant were reviewed. Strength of DSA was determined by single antigen Luminex bead assay and expressed as mean fluorescence intensity (MFI). T- and B-cell FCCM results were expressed as mean channel shift (MCS). AMR was diagnosed by C4d deposition on biopsy. Incidence of early AMR was 31%. Significant differences in the number of DSAs (p = 0.0002), cumulative median MFI in DSA class I (p = 0.0004), and total (class I + class II) DSA (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) were found in patients with and without AMR. No significant difference was seen in MCS of T and B FCCM (p = 0.095 and p = 0.307, respectively). The three-yr graft survival in desensitized patients with DSA having total MFI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 9500 was 100% compared to 76% with those having total MFI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 9500 (p = 0.022). Desensitized kidney transplant recipients having higher levels of class I and total DSA MFI are at high risk for AMR and poor graft survival. Recipient DSA MFI appears to be a more reliable predictor of AMR than MCS of FCCM.
Indiana University&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;am... more Indiana University&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s kidney transplant program has undergone changes in the program&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s approach to immunosuppression. This change in philosophy has moved the program away from multiple chronic maintenance immunosuppression strategies with corticosteroids to steroid-free maintenance immunosuppressive strategies for both adults and pediatric recipients. Anti-thymocyte globulin induction (beginning pre-reperfusion) has allowed for the rapid post-transplant withdrawal of corticosteroids. Steroid-free maintenance immunosuppression has been achieved with excellent patient and graft survival as well as lower rejection rates in the first posttransplant year. Desensitized recipients can also be safely included in steroid-free protocols. The administration of anti-thymocyte globulin prereperfusion combined with pulsatile perfusion storage of deceased donor kidneys has led to an extremely low delayed graft function rate.
Outcomes of kidney Re-Transplant Recipients (RTR) were compared to Primary Recipients (FTR) from ... more Outcomes of kidney Re-Transplant Recipients (RTR) were compared to Primary Recipients (FTR) from paired donor kidneys. OPTN database was used to identify deceased donors (n=6,266) who donated one kidney to a RTR and the mate kidney to a FTR between January 2000 to December 2010. As compared to FTR, RTR were younger (45 vs 52 years, p<0.001) and had higher proportion of PRA >80 (25% vs 7%, p<0.001). There were higher 0 mismatches in RTR (19% vs 16%, p<0.001). There were more pre-emptive transplants in RTR (24% vs 21%, p=0.002). Delayed graft function (28% vs 25%, P=0.007) was higher in RTR. Patient survival was similar in FTR and RTR groups at 1, 3 and 5 years (95.7%, 90.2% and 82.5% vs 95.2%, 89.8% and 82.7%). Allograft survival rates were higher in FTR group compared to RTR group at 1, 3 and 5 years (91.1%, 82.4% and 70.9% vs 87.8%, 77.4% and 66.1% p<0.001). Death-censored allograft survival rates were higher in FTR group at 1, 3 and 5 years (91.3%, 82.7% and 71.4% v...
Discussion continues about right versus left donor nephrectomy. Left side is preferred due to lon... more Discussion continues about right versus left donor nephrectomy. Left side is preferred due to longer renal vein while right side has been associated with renal vein thrombosis and shorter vessels. A retrospective analysis of UNOS database for adult living donor transplants between January 1(st) 2000 to December 31(st) 2009. We identified 58,599 living donor transplants, of which 86.1% were LDN. There were no significant differences between the recipients or donors demographics. There were higher rates of DGF in RDN recipients with a hazard risk of 1.38 (95% CI 1.24-1.53; p<0.0001). Primary failure rates were similar. In the RDN group, graft thrombosis as cause of graft failure was statistically higher with a hazard ratio of 1.48 (95% CI 1.18-1.86, p=0.0004), graft survival was significantly inferior (p=0.006 log-rank test). For living donors outcomes, the conversion from laparoscopic to open was higher in the RDN group with an odds ratio of 2.02 (95% CI 1.61-2.52; p<0.00001). ...
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