Lakshman Gunaratnam

Lakshman Gunaratnam

An international panel of transplant nephrologists used a structured survey process to develop standardized recommendations for managing immunosuppression in kidney transplant recipients who develop skin cancer. The experts reached a consensus on when to modify medications based on the severity and frequency of squamous cell carcinoma and prioritized the adjustment of specific drugs like azathioprine. These guidelines aim to reduce the variation in clinical practice and improve the prevention of further skin cancers while maintaining the health of the transplanted kidney.

Louise MoistDervla ConnaughtonMatthew WeirSusan HuangAndrew HouseLakshman GunaratnamArsh JainAmit GargAndrea CowanPavel RoshanovPeter Blake

In a study of 125 adults aged 50 and older with chronic kidney disease, researchers found that genetic testing identified a specific cause of disease in 38% of patients. The highest success rate for diagnosis occurred in those aged 50 to 54, with various forms of glomerular disease being the most common findings. These genetic results led to changes in medical treatment and clinical management, suggesting that age alone should not be a barrier to accessing genetic testing for kidney disease.

Louise MoistDervla ConnaughtonMatthew WeirAndrew HouseLakshman GunaratnamArsh JainAndrea CowanPavel Roshanov

Researchers evaluated the impact of a specialized kidney genetics clinic in Canada by providing genetic testing to 300 patients with chronic kidney disease who met specific referral criteria. The study found that using a standardized testing process identified a genetic cause for kidney disease in one-third of the families, with results typically delivered within three months of assessment. These genetic findings frequently led to changes in clinical management, though the researchers noted a significant delay of over ten years between a patient's initial kidney disease diagnosis and their eventual genetic evaluation.

Lakshman Gunaratnam

The Canadian Highly Sensitized Patient Program was established to improve transplant opportunities for patients who are difficult to match with deceased kidney donors due to high levels of antibodies. An analysis of the first 1000 transplants facilitated by the program showed that while it successfully enabled access to surgery for many, those with the highest sensitivity levels faced significantly longer wait times and more frequent interprovincial organ sharing. This national initiative demonstrates that sharing a larger pool of donors across provinces can provide life-saving options for patients who might otherwise never receive a compatible organ.

Lakshman Gunaratnam

Researchers compared three Canadian provincial health systems to understand why some regions perform more living donor kidney transplants than others. The study found that provinces with centralized coordination and formal resource sharing, such as British Columbia and Ontario, were more effective at delivering transplant services than decentralized systems. These findings suggest that better coordination between governing health organizations can improve access to living donor kidney transplantation and help reduce the burden of kidney failure.

Lakshman Gunaratnam

This study explored how kidney tubular cells protect themselves from damage caused by natural killer cells, which are immune cells that contribute to injury during kidney transplantation and periods of restricted blood flow. Researchers discovered that tubular cells express specific proteins that act as "off switches" for natural killer cells, and that removing these proteins significantly increased immune cell attacks on the kidney cells. These findings suggest that these proteins serve as a natural defense system to limit organ damage during inflammation and could be a target for future therapies to improve transplant outcomes.

Dervla ConnaughtonMatthew WeirSusan HuangAndrew HouseLakshman GunaratnamPavel Roshanov

Researchers analyzed genetic data from patients with chronic kidney disease to investigate why many develop severe hardening of the arteries, known as vascular calcification. They identified specific mutations in the ABCC6 gene in several families, suggesting that inherited genetic factors may directly contribute to this cardiovascular complication. Identifying these genetic causes early could eventually help doctors use targeted therapies to prevent vascular damage and reduce the risk of death in kidney disease patients.

Lakshman Gunaratnam

Researchers discovered that a family of proteins called calmodulin-dependent protein kinases interacts with key cell death regulators to cause heart transplant injury and rejection in mice. By blocking these proteins, the investigators were able to maintain healthy cell function and significantly extend the survival of the transplanted hearts. These findings suggest that targeting these specific pathways could eventually help prevent organ rejection in transplant recipients.

Lakshman Gunaratnam

Kidney injury molecule-1 is a well-known indicator of kidney damage, but it also plays a vital role in how the body identifies and clears away dying cells. This protein is found on the surface of injured kidney cells and various immune cells, where it helps regulate inflammation and immune responses by binding to specific markers on apoptotic or necrotic cells. Understanding the biological functions and genetic variations of this molecule may lead to its use as both a diagnostic tool and a target for new treatments in inflammatory and kidney diseases.

Lakshman Gunaratnam

Researchers used advanced computer algorithms to group kidney transplant candidates into three distinct categories based on shared health and frailty characteristics. By analyzing data from multiple transplant centres, the study identified specific patterns of health deficits that define different types of frailty in this population. This clustering approach provides a more detailed way to understand the diverse health profiles of patients waiting for a kidney transplant.

Andrew HouseLakshman Gunaratnam

Researchers at a Canadian transplant centre found that kidney transplant recipients who experienced delayed graft function were more likely to develop late-onset cytomegalovirus infections. These infections significantly increased the risk of transplant failure, particularly in patients whose new kidney did not function immediately after surgery. The study suggests that closer monitoring of immune responses to the virus might help improve long-term outcomes for these high-risk patients.

Lakshman Gunaratnam

Clinical domain: The study focuses on patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis who have reached kidney failure and require dialysis. - What investigators did: They performed a systematic search and pooled data from existing studies to calculate rates of death, infection, and disease relapse. - Methodological features: The study is a meta-analysis of existing observational data.

Lakshman Gunaratnam

This study protocol describes an ongoing project to identify health system factors that influence the rates of living donor kidney transplantation across different Canadian provinces. Researchers are conducting interviews and focus groups with stakeholders to compare how high-performing and low-performing provincial systems manage the transplant process. The findings aim to inform policy changes and interventions that could help increase the number of living donor transplants across the country.

Lakshman Gunaratnam

Researchers found that patients with advanced knee osteoarthritis have an accumulation of dead cells in their joint lining compared to healthy individuals. This buildup occurs because specialized immune cells called macrophages, which normally clear away dead cells through a process called efferocytosis, are significantly less effective in patients with osteoarthritis. The study also demonstrated that fluid from osteoarthritic joints can directly impair this clearing function in healthy immune cells, particularly during early stages of the disease when pain and inflammation are high.

Lakshman Gunaratnam

The first Molecules and Mechanisms Mediating Kidney Health and Disease meeting was held to unite Canadian researchers focused on the fundamental biology of kidney development and disease. Participants identified key barriers to scientific progress and proposed strategies for improvement, including the creation of a national research network and better integration between basic science and clinical nephrology. This report outlines the meeting outcomes and emphasizes the need for regular collaboration to accelerate the translation of laboratory findings into improved patient care.

Lakshman Gunaratnam

Researchers in Nova Scotia, Canada, studied whether measuring C-peptide levels before a kidney transplant could predict the development of diabetes after the procedure. They found that patients with high pre-transplant C-peptide levels had a nearly 20-fold higher risk of developing post-transplant diabetes within one year, even when accounting for body mass index. This suggests that testing C-peptide levels before surgery could help identify high-risk patients who might benefit from early preventative care.

Lakshman Gunaratnam

This publication explores the ethical considerations surrounding policies that require patients on the kidney transplant waitlist to receive the SARS-CoV-2 vaccine. The authors examine the balance between individual patient autonomy and the collective responsibility of transplant centres to ensure the best possible outcomes for donated organs. The discussion highlights the complexities of mandating medical interventions in the context of life-saving organ transplantation.