Article en vedette dans Transplant International : Dre Amanda Vinson
Le PRDTC tient à féliciter la Dre Amanda Vinson, professeure adjointe de néphrologie et de transplantation rénale à Halifax, pour sa récente publication intitulée Representation of Women in Contemporary Kidney Transplant Trials (Représentation des femmes dans les essais contemporains de transplantation rénale) dans le journal Transplant International !
Nous avons posé à Amanda quelques questions sur l’étude que vous pouvez lire ci-dessous.
Quelles sont les principales conclusions de l’étude sur la représentation des femmes dans les essais de transplantation rénale ?
Cette étude montre que, dans l’ensemble, les femmes sont apparemment mieux représentées dans les essais de transplantation rénale que dans d’autres domaines de la médecine. 33,7 % des participants aux essais étaient des femmes, mais si l’on tient compte du fait que près de 60 % des greffés du rein dans le monde sont des hommes, cela équivaut à une participation appropriée aux essais par rapport à la prévalence des greffes de rein chez les femmes. Toutefois, si l’on examine la représentation en fonction de l’objet de l’essai, les femmes restent sous-représentées dans les essais portant sur l’immunosuppression ou le rejet de la greffe.
Quel est l’impact de la sous-représentation des femmes dans les essais cliniques sur la qualité des soins et les résultats pour les patientes ?
Malheureusement, en l’absence d’une représentation adéquate des femmes dans les essais de transplantation rénale portant sur l’immunosuppression ou le risque de rejet de la greffe, nous ne pouvons pas être certains que les résultats des essais sont appropriés pour les femmes. Les hommes et les femmes (mâles et femelles) ont une réponse immunitaire très différente à la transplantation rénale et métabolisent différemment les immunosuppresseurs. Par conséquent, l’extrapolation de données générées dans une population majoritairement masculine pour les appliquer aux femmes ayant subi une transplantation peut ne pas être appropriée.
Quelles sont les implications des résultats de l’étude pour les chercheurs, les cliniciens et les décideurs politiques travaillant dans le domaine de la transplantation rénale ?
Je pense que cette étude met en évidence le fait que, bien que nous fassions apparemment mieux pour inclure les femmes dans les essais de transplantation rénale dans leur ensemble, il y a encore du travail à faire. Afin de produire des données probantes sur les patients ayant subi une transplantation rénale qui s’appliquent à la fois aux hommes et aux femmes, les participants de tous les sexes doivent être représentés dans les essais cliniques de transplantation, avec une stratification appropriée par sexe dans l’analyse et la communication des résultats.
Comment les chercheurs peuvent-ils garantir une représentation égale des femmes et des minorités dans les essais cliniques afin de recueillir des données qui reflètent la diversité de la population traitée ?
Certaines stratégies visant à améliorer la représentation des femmes dans les essais de transplantation rénale peuvent inclure l’utilisation d’outils de recrutement et de communication sensibles au genre, le recrutement ciblé de femmes et de participants de sexe différent, et l’inclusion d’un plus grand nombre de femmes et de chercheurs de sexe différent dans les équipes d’étude, les conseils consultatifs de patients, et dans les postes de direction des agences réglementaires et des sociétés pharmaceutiques.
Quelles sont les prochaines étapes et comment le PRDTC pourrait-il soutenir les orientations futures de ces travaux ?
Je pense que la chose la plus importante à faire est de s’assurer que les chercheurs sont conscients de la sous-représentation des femmes dans les essais de transplantation rénale, en particulier dans les domaines examinant l’immunosuppression ou le risque de rejet. Cette prise de conscience peut conduire à des efforts plus ciblés pour inclure les femmes dans les futures études de recherche. Même si des difficultés subsistent malgré des efforts de recrutement accrus, les chercheurs devraient s’efforcer d’inclure des analyses stratifiées par sexe dans toutes les études, le cas échéant. Je pense que le PRDTC a été un excellent soutien pour les femmes dans le domaine de la transplantation. Par exemple, vous m’avez accordé une subvention non liée pour examiner l’accès à la transplantation pour les femmes en Nouvelle-Écosse/Canada et vous vous intéressez clairement à l’équité entre les sexes en tant que programme. Il est excellent de demander aux candidats à une subvention de préciser les implications en termes de genre/sexe (comme vous le faites actuellement). Je pense que l’orientation future passe vraiment par l’éducation et la sensibilisation, ce à quoi vous contribuez en publiant des billets d’information comme celui-ci.
Résumé (en anglais)
Women are often underrepresented in clinical trials. It is unclear if this applies to trials in kidney transplant (KT) and whether the intervention or trial focus influences this. In this study, the weighted participation-to-prevalence ratio (PPR) for women enrollees in KT trials was determined for leading medical transplant or kidney journals between 2018 and 2023 using meta-regression overall and in three sensitivity analyses by: 1) Whether the intervention involved immunosuppression; 2) Area of trial focus; rejection, cardiometabolic, infection, lifestyle, surgical; 3) Whether the intervention was medical/surgical or social/behavioral. Overall, 33.7% of participants in 24 trials were women. The overall pooled PPR for the included trials was 0.80, 95% CI 0.76–0.85, with significant heterogeneity between trials (I2 56.6%, p-value < 0.001). Women had a lower PPR when the trial involved immunosuppression (PPR 0.77, 95% CI 0.72–0.82) than when it did not (PPR 0.86, 95% CI 0.80–0.94) and were less likely to participate in trials with a medical/surgical versus behavioral intervention; the lowest PPR for women was in studies examining rejection risk (PPR 0.75, 95% CI 0.70–0.81). There is better representation of women in KT trials compared to other medical disciplines, however women remain underrepresented in transplant trials examining immunosuppression and rejection.
À propos de la Dre Amanda Vinson
La Dre Amanda Vinson est professeure adjointe de néphrologie et de transplantation rénale à Halifax, en Nouvelle-Écosse. Elle a obtenu son diplôme de médecine à l’université de Colombie-Britannique et a suivi des cours de médecine interne, de néphrologie et de transplantation rénale à l’université Dalhousie. Elle a ensuite obtenu une maîtrise en épidémiologie clinique à la Harvard Chan School of Public Health de Boston, MA. Sa thèse portait sur l’appariement donneur-receveur de rein et les résultats post-transplantation associés. La Dre Vinson a rejoint la division de néphrologie de Dalhousie en 2017 en tant que clinicienne-chercheuse. Ses recherches portent sur l’étude des prédicteurs de la survie des greffons rénaux et des patients après la transplantation, en mettant l’accent sur l’appariement stratégique des donneurs et des receveurs de rein afin de maximiser les résultats. Elle s’intéresse particulièrement aux disparités dans l’accès aux soins et aux effets du sexe et du genre dans la transplantation rénale. Elle a participé à des groupes d’experts et a été invitée à donner des conférences sur le sujet au niveau national et international.
ity of Alberta and has received training in patient-oriented research through the University of Calgary’s PACER (Patient and Community Engagement Research) Program. He is the Patient, Family, and Donor Partnerships & Education Manager with the Canadian Donation and Transplantation Research Program. In this role, Manuel builds relationships patient partners with investigators and strengthens capacity among CDTRP patient partners.
Anders Billström 
Gareth Wiltshire
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Sherrie Logan 
born and raised in Edmonton, AB. With a degree in Music Performance (saxophone performance) and Education, Lindsey has taught for over a decade in the Edmonton Public School system. When she is not teaching, she is very involved in the music community, performing in the Edmonton Winds, conducting her own community ensemble (The Beer League Band) and on numerous musical boards across the province. For the past 5 years, Lindsey has had to take a break from teaching after having her amazing son, George. Maternity leave did not goes as expected as George was diagnosed with Dilated Cardiomyopathy at 5 months old and required 2 heart transplants before the age of 4. During this time, Lindsey has also began to dedicate her time building and expanding her charity: Big Gifts for Little Lives, where they raise money to fund Pediatric Heart Transplant research at the Stollery.
Dr. Caigan Du is a scientist at the Vancouver Coastal Health Research Institute and an assistant professor in the Department of Urologic Sciences at the University of British Columbia. He received a Ph.D. degree in Biochemistry in UK and postdoctoral training in Immunology in USA. He is interested in the pathogenesis of kidney ischemia-reperfusion injury and transplant rejection, and molecular control of urinary malignancies. He has been studying the impact of kidney donor-derived factors on renal allograft rejection, and the molecular pathways of kidney injury and regeneration in experimental models. He is also interested in developing medical solution including drugs made from natural compounds for all kinds of health problems, including immune disorders, organ preservation, kidney failure and urinary cancer. He is the PI of many grant supports from the Kidney Foundation of Canada and the Canadian Institutes of Health Research.
Heather Badenoch is a non-directed living liver donor and communications strategist. As the president of Village PR, she provides strategic communications direction and training to not-for-profit clients in community and health. An active transplant volunteer, Heather helps transplant candidates find living donors by running their public appeals, small and large, pro-bono. She also mentors potential living donors on the path to living donation. Heather is a volunteer with the UHN Centre for Living Organ Donation and the Canadian Donation and Transplant Research Program. She and her spouse adopt rescue dogs and volunteer together with Community Veterinary Outreach, a group providing free veterinary care to the pets of people who are homeless.
Sean Dicks is a clinical psychologist who has 20 years’ experience supporting both families of organ donors and transplant recipients. While it is rare for him to have contact with a donor family and recipient linked to the same organ donation-transplantation event, his contact with families who have lived experience with organ donation on the one hand, and patients who have received transplants on the other hand has provided opportunities to explore how their journeys become linked when they attempt to make sense of and find meaning in their respective crises.
Terri Hansen-Gardiner is a Cree speaking Metis woman from Northern Saskatchewan as well as a 10 year Breast Cancer Survivor. Her tireless spirit and dedication to her community is undeniable. Terri is a cancer survivor who travels around the province to provide assistance, information, and support to Indigenous patients who are trying to access and navigate the cancer care system.
Dr. Golnaz Karoubi is Assistant Scientist at the Toronto General HospitalResearch Institute and principal investigator in the Latner Thoracic Research Labs. She currently holds an Assistant Professor appointment in the department of Laboratory Medicine and Pathobiology and a cross-appointment in the department of Mechanical and Industrial Engineering at the University of Toronto. Dr. Karoubi received her PhD in Applied Science and Engineering at the University of Toronto and joined the Lung Regenerative Medicine Program in the Department of Clinical Research in Berne University, Switzerland for a post-doctoral research fellowship. She stayed on as a Group Leader in 2008 to direct the basic and transitional science as related to Cancer Stem Cell and Lung Regenerative Medicine in the Department of Biomedical Research at the University of Berne until 2012. In early 2012, she joined the team of Dr. Tom Waddell at the Toronto General Hospital Research Institute as a Senior Scientific Associate and was appointed to Assistant Scientist at the Toronto General Hospital Research Institute (University Health Network) in November 2019 and to Assistant Professor in the Department of Laboratory Medicine and Pathobiology in July 2020.
Dr. Haykal graduated from the University of Ottawa Faculty of Medicine in2007 as class valedictorian and silver medalist, and subsequently completed her residency training in Plastic and Reconstructive Surgery at the University of Toronto in 2016. During her residency, she completed a four-year Doctorate of Philosophy (PhD) in tissue engineering, regenerative medicine and immunology with a focus on tracheal reconstruction. She obtained numerous grants and awards including a CIHR Vanier Scholarship. Dr. Haykal then pursued fellowship training in microsurgical reconstruction at the Albany Medical Centre in New York. Dr. Haykal joined the University Health Network and the Toronto General Hospital in 2018. Her clinical focus is on complex oncological reconstruction and microsurgical reconstruction of the breast, head and neck and extremity. She started a lymphedema program in 2019 where she offers microsurgical techniques for the treatment of lymphedema.
Dr. Ahmed is a Professor in the Cumming School of Medicine at the University of Calgary. The recipient of the 2022 Hypertension Canada Senior Investigator Award, she is a nephrologist and clinician-scientist with a focus on sex and gender differences in human cardiovascular/kidney physiology and clinical outcomes. Dr. Ahmed is the Vice Chair (Research) for the Department of Medicine, Lead of the Libin Institute Women’s Cardiovascular Health Research Initiative at the University of Calgary and Lead of the Alberta Strategy for Patient Oriented Research Capacity Development Platform. Dr. Ahmed is an Advisory Board member for the Canadian Institutes of Health Research Institute of Gender and Health, a member of the Canadian Medical Association Journal Governing Council and the President-Elect for the Organization for the Study of Sex Differences.
r. Christopher Nguan is an Associate Professor at the University of British Columbia in the Department of Urological Sciences, Surgical Head of Kidney Transplantation at Vancouver General Hospital and the Director of the Surgical Technologies Experimental Laboratory & Advanced Robotics (STELLAR) facility at Vancouver General Hospital.
r Caroline Lamarche is a clinician scientist and transplant nephrologist at Maisonneuve-Rosemont Hospital. She is an assistant clinical professor at the Université de Montréal. After her nephrology training at the Université de Montréal (2015), she completed a Master degree on the use of adoptive immunotherapy to treat/prevent BK nephropathy in kidney transplant recipients. She then pursued a post-doctoral fellowship with Dr. Megan Levings at the University of British Columbia on the use of chimeric antigen receptor (CAR) regulatory T cells (Tregs) to induce transplant tolerance. Her lab is working on the development of adoptive immunotherapy in nephrology and understanding Treg dysfunction.
Dr. Tandon is an Associate Professor of Medicine, Co-Director of the Cirrhosis Care Clinic, Transplant Hepatologist and lead of the Cirrhosis Care Alberta quality improvement program. She obtained her training at the University of Alberta, the Hospital Clinic in Barcelona and Yale University. Her clinical practice and research are focused on cirrhosis with research interests including cirrhosis related complications, malnutrition, frailty, exercise therapy, palliative care, integrative health approaches such as meditation and knowledge translation. It is her career goal to provide wholistic, interdisciplinary, evidence based, patient-centered care through education, empowerment, engagement and team-work.
Emily is a PhD student at the University of Alberta, where she completed her Master of Science (MSc) degree in medicine. With a passion for patient-oriented research and a commitment to improving health outcomes, Emily’s doctoral project focuses on EMPOWER, a 12-week online mind-body wellness program designed for adults living with chronic health conditions.
Dr Basil S. Nasir, M.B.B.Ch
Dr. Victor Ferreira is an Assistant Scientist in the Ajmera Transplant Centre at the University Health Network (UHN) and the Toronto General Hospital Research Institute (TGHRI). He is also an Assistant Professor at the University of Toronto in the Department of Laboratory Medicine and Pathobiology (LMP). He completed his PhD in Medical Sciences – Infection and Immunity Specialization at McMaster University in 2014 and post-doctoral training at UHN. His research program is focused on three pillars: I) using systems vaccinology to reveal insights into vaccine responses in immunocompromised individuals like transplant recipients; II) characterizing the impact of chronic viral infection on host immune responses; and III) developing novel methods for eliminating latent viruses in human organs. His work has been cited >2,500 times and is published in journals including the New England Journal of Medicine, Nature Immunology, the Lancet Infectious Diseases, Clinical Infectious Diseases, the American Journal of Transplantation and Journal of Infectious Diseases.