The Human Kidney Graft: Article Analysis and Evaluation of Research Ethics Essay

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Table of Contents

Summary
Ethical Considerations
References

Summary

Article Citation and Permalink (APA format)	Ellingsen, A. R., Jørgensen, K. A., Østerby, R., Petersen, S. E., Juul, S., Marcussen, N., & Nyengaard, J. R. (2021). Human kidney graft survival correlates with structural parameters in baseline biopsies: a quantitative observational cohort study with more than 14 years of follow-up. Virchows Archiv: An International Journal of Pathology, 478(4), 659–668. Web.
Point	Description
Broad Topic Area/Title	The human kidney graft survival correlation with structural parameters in baseline biopsies (p. 659).
Problem Statement (What is the problem research is addressing?)	Deterioration of long-term kidney function after transplantation remains a problem (p. 659).
Purpose Statement (What is the purpose of the study?)	The study evaluates associations between structural and ultrastructural parameters in baseline biopsies from human kidney transplants and long-term graft survival after more than 14 years of follow-up (p. 660).
Research Questions (What questions does the research seek to answer?)	Is long-term kidney graft survival related to structural parameters in baseline biopsies?
Define Hypothesis (Or state the correct hypothesis based upon variables used)	The hypothesis of this study is that structural deviations in implantation kidney biopsies have a prognostic impact on long-term graft function (p. 662).
Identify Dependent and Independent Variables and Type of Data for the Variables	Dependent Variables: Years after transplantation. Independent Variables: Percent surviving, Percentage functioning Categorical Variable: Gender, Native kidney disease Continuous Variables: Age, Human leukocyte antigen-mismatches; Biopsies fulfilling Banff criteria, Light microscopy Banff scores; Light microscopy, Structural factors; Electron microscopy, Structural factors. (found on pages 665 and 666)
Population of Interest for Study	Patients who received a kidney transplant from September 1997 to November 1998 in the Kidney Transplantation Center in Aarhus, Denmark (p. 661).
Sample	54 kidney transplantation recipients and donors. Four clinical endpoint groups were defined: recipient alive with kidney function, recipient alive without kidney function due to transplantation or return to dialysis, recipient died with kidney function, and recipient died without kidney function (p. 661).
Sampling Method	Quantitative, cohort study with more than 14 years of follow-up (p. 659).
Identify Data Collection Identify how data were collected	Clinical control and standard clinical assessments were performed.
Summarize Data Collection Approach	The data was collected by obtaining clinical statistics, biopsies, and measurements by light microscopy and electron microscopy (p. 662).
Discuss Data Analysis Include what types of statistical tests were used for the variables.	Kaplan-Meier plots and Cos proportional hazards regression; creatinine values; abbreviated MDRD equation (eGFR); The paraffin-embedded biopsy was scored by an experienced renal pathologist (NM) (p. 662).
Summarize Results of Study	The study’s main finding is that the Banff score for arteriolar hyaline thickening (“ah” score) is the single factor with the greatest impact on long-term graft survival. Clinical implications: Early morphological signs, which point to later development of reduced graft function, were discovered in this study. The discovery should encourage the investigation of therapeutic targets and the introduction of further preventive therapies (p. 667).
Summary of Assumptions and Limitations Identify the assumptions and limitations from the article. Report other potential assumptions and limitations of your review not listed by the author.	The researchers assumed that the long-term kidney graft survival is related to structural parameters. The study was limited in the number of patients due to patients dying with functioning grafts contributed to a reduction in the number of patients for long-term follow-up. The authors mention the usage of Denmark’s nationwide system of all patients’ data. As such, the research cannot be applied to counties without a similar system due to a possible lack of the necessary data (p. 667).

Ethical Considerations

The authors of the research managed to conduct a cohort study with more than 14 years of follow-up, examining various data from more than 50 kidney transplantation recipients and their donors. The research was approved by the Central Denmark Region Committees on Health Research Ethics and the Danish Data Protection Agency. As such, the study is considered to follow ethical guidelines and regulations. In addition, the researchers address a cause for the potential negative selection of donors upon the publication of the study. They render the issue improbable due to the possible implementation of fibrosis-inhibiting drugs and renal protective treatments for risk groups of kidney graft recipients. However, the success of the study significantly benefits from the country in which it was conducted. The Danish healthcare system contains detailed biological and clinical information available on patients (Arendt et al., 2020). In contrast, the clinical information system of American healthcare can be considered insufficient (Amelung, 2019). Thus, the research is beneficial only to such countries, like Denmark, with sufficient clinical and biological data systems. In conclusion, the research shows that the baseline biopsies from human kidney grafts contain useful information on long-term graft survival. With the possibility of the introduction of further preventive therapies and the implementation of renal protective treatments, the process of vascular damage can be delayed. However, the research can prove to be of no use to the countries with insufficient clinical information on patients. The presence of a nationwide system of collected data can significantly benefit the assessment of donors and graft survival.

References

Amelung, V. E. (2019). Healthcare management. Springer Berlin Heidelberg.

Arendt, J., Hansen, A. T., Ladefoged, S. A., Sørensen, H. T., Pedersen, L., & Adelborg, K. (2020). Existing data sources in clinical epidemiology: Laboratory information system databases in Denmark. Clinical Epidemiology, 12, 469–475. Web.

Ellingsen, A. R., Jørgensen, K. A., Østerby, R., Petersen, S. E., Juul, S., Marcussen, N., & Nyengaard, J. R. (2021). Human kidney graft survival correlates with structural parameters in baseline biopsies: a quantitative observational cohort study with more than 14 years’ follow-up. Virchows Archiv: An International Journal of Pathology, 478(4), 659–668. Web.

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