Imperial College London

DrRichardSzydlo

Faculty of MedicineDepartment of Immunology and Inflammation

Medical Statistician
 
 
 
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Contact

 

+44 (0)20 3313 2170r.szydlo Website

 
 
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Location

 

4N7Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Publication Type
Year
to

382 results found

Lomax-Browne HJ, Medjeral-Thomas NR, Barbour SJ, Gisby J, Han H, Bomback AS, Fervenza FC, Cairns TH, Szydlo R, Tan S-J, Marks SD, Waters AM, Appel GB, D'Agati VD, Sethi S, Nast CC, Bajema I, Alpers CE, Fogo AB, Licht C, Fakhouri F, Cattran DC, Peters JE, Cook HT, Pickering MCet al., 2022, Association of Histologic Parameters with Outcome in C3 Glomerulopathy and Idiopathic Immunoglobulin-Associated Membranoproliferative Glomerulonephritis, CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, Vol: 17, Pages: 994-1007, ISSN: 1555-9041

Journal article

Medjeral-Thomas N, Barbour S, Gisby J, Han H, Bomback A, Fervenza F, Cairns T, Szydlo R, Tan S-J, Marks S, Waters A, Appel G, D'Agati V, Sethi S, Nast C, Bajema I, Alpers C, Fogo A, Licht C, Fakhouri F, Cattran D, Peters J, Terence C, Lomax-Browne H, Pickering Met al., 2022, Histological predictors of outcome in C3 glomerulopathy and idiopathic immunoglobulin-associated membranoproliferative glomerulonephritis, Clinical Journal of the American Society of Nephrology, ISSN: 1555-9041

Background and objectivesC3 glomerulopathy and idiopathic immunoglobulin-associated membranoproliferative glomerulonephritis (Ig-MPGN) are kidney diseases characterised by abnormal glomerular complement C3 deposition. These conditions are heterogeneous in outcome, but approximately 50% of patients reach end stage kidney disease within 10 years. Design, setting, participants and measurementsTo improve identification of patients with poor prognosis we performed a detailed analysis of percutaneous kidney biopsies in a large cohort of patients. Using a validated histological scoring system, we analysed 156 native diagnostic kidney biopsies from a retrospective cohort of 123 patients with C3 glomerulopathy and 33 patients with Ig-MPGN. We used linear regression, survival analysis and Cox proportional hazards models to assess the relationship between histological and clinical parameters with outcome. ResultsFrequent biopsy features were mesangial expansion and hypercellularity, glomerular basement membrane (GBM) double contours and endocapillary hypercellularity. Multivariable analysis showed negative associations between estimated glomerular filtration rate (eGFR) and crescents, interstitial inflammation, and interstitial fibrosis and tubular atrophy (IFTA). Proteinuria positively associated with endocapillary hypercellularity and GBM double contours. Analysis of second native biopsies did not demonstrate associations between immunosuppression treatment and improvement in histology. Using a composite outcome, risk of progression to kidney failure associated with eGFR and proteinuria at time of biopsy, and cellular/fibrocellular crescents, segmental sclerosis and IFTA scores. ConclusionsOur detailed assessment of kidney biopsy data indicated that cellular/fibrocellular crescents and IFTA scores were significant determinants of deterioration in kidney function.

Journal article

Little C, Odho Z, Szydlo R, Aw T-C, Laffan M, Arachchillage DRJet al., 2022, Impact of aspirin on bleeding and blood product usage in off-pump and on-pump coronary artery bypass graft surgery., EJHaem, Vol: 3, Pages: 317-325

Major bleeding is linked to poorer outcomes following cardiac surgery. Current guidelines recommend continuation of aspirin prior to coronary artery by-pass graft (CABG) but the effect of continuing aspirin in patients with prior indication for aspirin, in particular during off-pump CABG (OPCABG), has not been systematically assessed. In this study, we analysed the effect of continuing aspirin prior to OPCABG and on-pump CABG with respect to bleeding and blood product usage. We compared propensity-matched cohorts of patients who continued aspirin until the day of OPCABG or CABG to controls (no antiplatelet) and to patients discontinuing aspirin 5-7 days prior. Length of hospital stay, 30-day mortality and thromboembolism rates were similar for both OPCABG and CABG. During OPCABG, aspirin-continued patients received more intraoperative red cell units compared to controls without difference in bleeding. Aspirin-continued patients received more blood products perioperatively and bled more than aspirin-discontinued patients undergoing OPCABG. The only difference during CABG was a small increase in the volume of cells salvaged among aspirin-continued patients compared to controls. Current guidelines on the continuation of aspirin prior to CABG and OPCABG are safe. Continuation of aspirin prior to OPCABG may result in more bleeding and blood product usage.

Journal article

Ros-Soto J, Snowden JA, Szydlo R, Nicholson E, Madrigal A, Easdale S, Potter M, Ethell M, Anthias Cet al., 2022, Outcomes After Donor Lymphocyte Infusion in Patients With Hematological Malignancies: Donor Characteristics Matter, TRANSPLANTATION AND CELLULAR THERAPY, Vol: 28, ISSN: 2666-6375

Journal article

Trasanidis N, Katsarou A, Ponnusamy K, Shen Y-A, Kostopoulos I, Bergonia B, Keren K, Reema P, Xiao X, Szydlo RM, Sabbattini PMR, Roberts IAG, Auner HW, Naresh KN, Chaidos A, Wang T-L, Magnani L, Caputo VS, Karadimitris Aet al., 2022, Systems medicine dissection of chr1q-amp reveals a novel PBX1-FOXM1 axis for targeted therapy in multiple myeloma, BLOOD, Vol: 139, Pages: 1939-1953, ISSN: 0006-4971

Journal article

Dominy KM, Claudiani S, O'Hare M, Szydlo R, Gerrard G, Foskett P, Foroni L, Milojkovic D, Apperley JF, Khorashad Jet al., 2022, Assessment of quantitative polymerase chain reaction for BCR-ABL1 transcripts in chronic myeloid leukaemia: Are improved outcomes in patients with e14a2 transcripts an artefact of technology?, BRITISH JOURNAL OF HAEMATOLOGY, Vol: 197, Pages: 52-62, ISSN: 0007-1048

Journal article

Arachchillage DJ, Rajakaruna I, Scott I, Gaspar M, Odho Z, Banya W, Vlachou A, Isgro G, Cagova L, Wade J, Fleming L, Laffan M, Szydlo R, Ledot S, Jooste R, Vuylsteke A, Yusuff Het al., 2021, Impact of major bleeding and thrombosis on 180-day survival in patients with severe COVID-19 supported with veno-venous extracorporeal membrane oxygenation in the United Kingdom: a multicentre observational study, BRITISH JOURNAL OF HAEMATOLOGY, Vol: 196, Pages: 566-576, ISSN: 0007-1048

Journal article

Arachchillage DJ, Rajakaruna I, Odho Z, Crossette-Thambiah C, Nicolson PLR, Roberts LN, Allan C, Lewis S, Riat R, Mounter P, Lynch C, Langridge A, Oakes R, Aung N, Drebes A, Dutt T, Raheja P, Delaney A, Essex S, Lowe G, Sutton D, Lentaigne C, Sayar Z, Kilner M, Everington T, Shapiro S, Alikhan R, Szydlo R, Makris M, Laffan Met al., 2021, Clinical outcomes and the impact of prior oral anticoagulant use in patients with coronavirus disease 2019 admitted to hospitals in the UK - a multicentre observational study, BRITISH JOURNAL OF HAEMATOLOGY, Vol: 196, Pages: 79-94, ISSN: 0007-1048

Journal article

Iskander D, Wang G, Heuston EF, Christodoulidou C, Psaila B, Ponnusamy K, Ren H, Mokhtari Z, Robinson M, Chaidos A, Trivedi P, Trasanidis N, Katsarou A, Szydlo R, Palii CG, Zaidi MH, Al-Oqaily Q, Caputo VS, Roy A, Harrington Y, Karnik L, Naresh K, Mead AJ, Thongjuea S, Brand M, de la Fuente J, Bodine DM, Roberts I, Karadimitris Aet al., 2021, Single-cell profiling of human bone marrow progenitors reveals mechanisms of failing erythropoiesis in Diamond-Blackfan anemia, SCIENCE TRANSLATIONAL MEDICINE, Vol: 13, ISSN: 1946-6234

Journal article

Innes AJ, Mullish BH, Ghani R, Szydlo RM, Apperley JF, Olavarria E, Palanicawandar R, Kanfer EJ, Milojkovic D, McDonald JAK, Brannigan ET, Thursz MR, Williams HRT, Davies FJ, Marchesi JR, Pavlu Jet al., 2021, Fecal microbiota transplant mitigates adverse outcomes in patients colonized with multidrug-resistant organisms undergoing allogeneic hematopoietic cell transplantation, Frontiers in Cellular and Infection Microbiology, Vol: 11, Pages: 1-8, ISSN: 2235-2988

The gut microbiome can be adversely affected by chemotherapy and antibiotics prior to hematopoietic cell transplantation (HCT).This affects graft success and increases susceptibility to multidrug-resistant organism (MDRO) colonization and infection. Weperformed an initial retrospective analysis of our use of fecal microbiota transplantation (FMT) from healthy donors as therapy forMDRO-colonized patients with hematological malignancy. FMT was performed on eight MDRO-colonized patients pre-HCT (FMT-MDROgroup), and outcomes compared with 11 MDRO colonized HCT patients from the same period. At 12 months, survival wassignificantly higher in the FMT-MDRO group (70% versus 36% p = 0.044). Post-HCT, fewer FMT-MDRO patients required intensivecare (0% versus 46%, P = 0.045) or experienced fever (0.29 versus 0.11 days, P = 0.027). Intestinal MDRO decolonization occurred in25% of FMT-MDRO patients versus 11% non-FMT MDRO patients. Despite the significant difference and statistically comparablepatient/transplant characteristics, as the sample size was small, a matched-pair analysis to non-MDRO colonized control cohorts(2:1 matching) was performed. At 12 months, the MDRO group who did not have an FMT had significantly lower survival (36.4%versus 61.9% respectively, p=0.012), and higher non relapse mortality (NRM; 60.2% versus 16.7% respectively, p=0.009) than theirpaired non-colonized cohort. There was no difference in survival (70% versus 43.4%, p=0.14) or NRM (12.5% versus 31.2%respectively, p=0.24) between the FMT-MDRO group and their paired cohort. Negative outcomes, including mortality associatedwith MDRO colonization, may be ameliorated by pre-HCT FMT, despite lack of intestinal decolonization. Further work is needed toexplore the observed benefit.

Journal article

Toulza F, Dominy K, Beadle J, Willicombe M, Cook T, Mclean A, Szydlo R, Roufosse Cet al., 2021, GENE EXPRESSION ANALYSIS USING QRT-PCR IN THE DIAGNOSIS OF ANTIBODY-MEDIATED REJECTION IN RENAL TRANSPLANT BIOPSIES, Publisher: WILEY, Pages: 290-290, ISSN: 0934-0874

Conference paper

Roufosse C, Cook H, Dominy K, Willicombe M, Beadle J, Szydlo R, McLean A, Toulza Fet al., 2021, Diagnostic application of transcripts associated with antibody-mediated rejection in kidney transplant biopsies, Nephrology Dialysis Transplantation, ISSN: 0931-0509

BackgroundThe diagnosis of antibody-mediated rejection (AMR) is reached using the Banff Classification for Allograft Pathology, which now includes gene expression analysis. In this study, we investigate the application of “Increased Expression Of Thoroughly Validated Gene Transcripts/Classifiers Strongly Associated With AMR” as a diagnostic criteria.MethodWe used qRT-PCR for 10 genes associated with AMR in a retrospective cohort of 297 transplant biopsies, including biopsies that met the full diagnostic criteria for AMR, even without molecular data (AMR, n = 27); biopsies that showed features of AMR, but that would only meet criteria for AMR with increased transcripts (AMRsusp, n = 49) and biopsies that would never meet criteria for AMR (No-AMR, n = 221).ResultsA 10-gene AMR score trained by a receiver-operating characteristic to identify AMR found 16 cases with a high score amongst the AMRsusp cases (AMRsusp-high) that had significantly worse graft survival than those with a low score (AMRsusp-low) (n = 33). In both univariate and multivariate Cox regression analysis, the AMR 10-gene score was significantly associated with an increased hazard ratio for graft loss in the AMRsusp group (HR 1.109, p = 0.004 and HR 1.138, p = 0.012), but not in the whole cohort. Net reclassification index and integrated discrimination improvement analyses demonstrated improved risk classification and superior discrimination respectively for graft loss when considering the gene score in addition to histological and serological data, but only in the AMRsusp group, not the whole cohort.ConclusionsThis study provides evidence that a gene score strongly associated with AMR helps identify cases at higher risk of graft loss in biopsies that are suspicious for AMR but don’t meet full criteria.

Journal article

Zhang S, Asquith B, Szydlo R, Tregoning J, Pollock Ket al., 2021, Peripheral T cell lymphopenia in COVID-19: potential mechanisms and impact, Immunotherapy Advances, Vol: 1, Pages: 1-18, ISSN: 2732-4303

Immunopathogenesis involving T lymphocytes, which play a key role in defence against viral infection, could contribute to the spectrum of COVID-19 disease and provide an avenue for treatment. To address this question, are view of clinical observational studies and autopsy data in English and Chinese languages was conducted with a search of registered clinical trials. Peripheral lymphopenia affecting CD4 and CD8 T cells was a striking feature of severe COVID-19 compared with non-severe disease. Autopsy data demonstrated infiltration of T cells into organs, particularly the lung. 74 clinical trials are on-going that could target T cell-related pathogenesis, particularly IL-6 pathways. SARS-CoV-2 infection interrupts T cell circulation in patients with severe COVID-19. This could be due to redistribution of T cells into infected organs, activation induced exhaustion, apoptosis or pyroptosis. Measuring T cell dynamics during COVID-19 will inform clinical risk-stratification of hospitalised patients and could identify those who would benefit most from 66treatments that target T cells

Journal article

Geva M, Pryce A, Shouval R, Fein JA, Danylesko I, Shem-Tov N, Yerushalmi R, Shimoni A, Szydlo R, Pavlu J, Nagler Aet al., 2021, High lactate dehydrogenase at time of admission for allogeneic hematopoietic transplantation associates to poor survival in acute myeloid leukemia and non-Hodgkin lymphoma, BONE MARROW TRANSPLANTATION, Vol: 56, Pages: 2690-2696, ISSN: 0268-3369

Journal article

Pryce A, Zoubek E, O'Leary A, Szydlo R, Li Y, Kelly H, Harvey C, Balassa K, Pawson R, Danby R, Mir Fet al., 2021, The Impact of Covid-19 on Unrelated And Donor Cord Provision To UK Transplant Centres During The 1st Wave of The Pandemic: UK Aligned Registry Study, Publisher: SPRINGERNATURE, Pages: 175-175, ISSN: 0268-3369

Conference paper

Mullish BH, Innes AJ, Ghani R, Szydlo R, Williams HR, Thursz MR, Marchesi J, Davies F, Pavlu Jet al., 2021, FECAL MICROBIOTA TRANSPLANT PRIOR TO ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT IN PATIENTS COLONIZED WITH MULTI-DRUG RESISTANT ORGANISMS IS ASSOCIATED WITH IMPROVED SURVIVAL, Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: S168-S169, ISSN: 0016-5085

Conference paper

Ghani R, Mullish B, Innes A, Szydlo RM, Apperley JF, Olavarria E, Palanicawandar R, Kanfer E, Milojkovic D, McDonald JAK, Brannigan E, Thursz MR, Williams HRT, Davies FJ, Pavlu J, Marchesi Jet al., 2021, Faecal microbiota transplant (FMT) prior to allogeneic haematopoietic cell transplantation (HCT) in patients colonised with multidrug-resistant organisms (MDRO) results in improved survival, ECCMID

Conference paper

Salisbury RA, Curto-Garcia N, OSullivan J, Chen F, Polzella P, Godfrey AL, Russell J, Knapper S, Willan J, Frewin R, Joshi S, Arami S, Burns S, Teh CH, Wadelin F, Dhanapal J, Neelakantan P, Milojkovic D, Psaila B, Szydlo R, Francis S, Cargo C, Jain M, McGregor A, Wallis L, Duncombe A, Hussein H, Dyer P, Munro L, Bond L, McMullin MF, Somervaille TCP, Garg M, Sekhar M, Harrison C, Mead AJ, Innes AJet al., 2021, Results of a national UK physician reported survey of COVID-19 infection in patients with a myeloproliferative neoplasm, Leukemia, Vol: 35, Pages: 2424-2430, ISSN: 0887-6924

Journal article

Bedwani NARH, Kelada M, Smart N, Szydlo R, Patten DK, Bhargava Aet al., 2021, Glue versus mechanical mesh fixation in laparoscopic inguinal hernia repair: meta-analysis and trial sequential analysis of randomized clinical trials, BRITISH JOURNAL OF SURGERY, Vol: 108, Pages: 14-23, ISSN: 0007-1323

Journal article

Claudiani S, Apperley JF, Szydlo R, Khan A, Nesr G, Hayden C, J Innes A, Dominy K, Foskett P, Foroni L, Khorashad J, Milojkovic Det al., 2020, TKI dose reduction can effectively maintain major molecular remission in patients with chronic myeloid leukaemia, BRITISH JOURNAL OF HAEMATOLOGY, Vol: 193, Pages: 346-355, ISSN: 0007-1048

Journal article

Innes AJ, Ghani R, Mullish BH, Szydlo R, Palanicawandar R, Olavarria E, Apperley JF, Thursz MR, Williams HR, Marchesi JR, Davies F, Pavlu Jet al., 2020, O105. Faecal microbiota transplant (FMT) can reduce the high NRM associated with multi-drug resistant organism (MDRO) colonisation prior to allogeneic HCT., The 46th Annual Meeting of the European Society for Blood and Marrow Transplantation, Publisher: Springer Nature [academic journals on nature.com], Pages: 122-122, ISSN: 0268-3369

Conference paper

Soto JR, Snowden JA, Szydlo R, Nicholson E, Madrigal A, Easdale S, Ethell M, Potter M, Anthias Cet al., 2020, Donor Factors Influence Outcomes of Patients Receiving Donor Lymphocyte Infusion for Mixed Chimerism after Reduced Intensity Conditioning Allogeneic Stem Cell Transplantation, Publisher: SPRINGERNATURE, Pages: 551-551, ISSN: 0268-3369

Conference paper

Zoubek E, Ros-Soto J, Szydlo R, Watson A, Burtlon C, Johnson P, O'Leary A, Anthias Cet al., 2020, Bone Marrow Donor Characteristics: Influence on Harvest Yield and Donor Recovery, Publisher: SPRINGERNATURE, Pages: 694-695, ISSN: 0268-3369

Conference paper

Gallanagh M, Brown A, Pryce A, Szydlo R, Morris S, Palanicawandar R, Kanfer Eet al., 2020, Allogeneic Stem Cell Transplant with minimal-intensity Conditioning in Patients with Cutaneous T-cell Lymphoma. A Single Centre Retrospective Review, Publisher: SPRINGERNATURE, Pages: 282-282, ISSN: 0268-3369

Conference paper

Cuadrado MM, Anthias C, Fernando R, Szydlo RM, Marsh SGE, Mayor NP, Chakraverty R, Madrigal JA, Latham Ket al., 2020, Impact of Donor-Directed HLA Allo-Antibodies on Primary Graft Failure After Unrelated Donor Allogeneic Haematopoietic Cell Transplantation, Publisher: SPRINGERNATURE, Pages: 133-134, ISSN: 0268-3369

Conference paper

Iskander D, Wang G, Heuston EF, Christodoulidou C, Psaila B, Robinson ME, Chaidos A, Trivedi P, Trasanidis N, Katsarou A, Szydlo R, Al-Oqaily Q, Caputo VS, Ponnusamy K, Roy A, Karnik L, Naresh K, Mead AJ, Thongjuea S, Brand M, De la Fuente J, Bodine DM, Roberts Iet al., 2020, Single-Cell Transcriptional Landscapes of Human Bone Marrow Reveal Distinct Erythroid Phenotypes Underpinned By Genotype in Diamond-Blackfan Anemia, Publisher: AMER SOC HEMATOLOGY, ISSN: 0006-4971

Conference paper

Cuadrado MM, Szydlo RM, Watts M, Patel N, Renshaw H, Dorman J, Lowdell M, Ings S, Anthias C, Madrigal A, Mackinnon S, Kottaridis P, Carpenter B, Hough R, Morris E, Thomson K, Peggs KS, Chakraverty Ret al., 2020, Predictors of recovery following allogeneic CD34(+)-selected cell infusion without conditioning to correct poor graft function, HAEMATOLOGICA, Vol: 105, Pages: 2639-2646, ISSN: 0390-6078

Journal article

Cuadrado MM, Szydlo RM, Watts M, Patel N, Renshaw H, Dorman J, Lowdell M, Ings S, Anthias C, Madrigal A, Mackinnon S, Kottaridis P, Carpenter B, Hough R, Morris E, Thomson K, Peggs KS, Chakraverty Ret al., 2020, Predictors of recovery following allogeneic CD34+-selected cell infusion without conditioning to correct poor graft function., Haematologica, Vol: 105, Pages: 2639-2646

Poor graft function is a serious complication following allogeneic hematopoietic stem cell transplantation. Infusion of CD34+-selected stem cells without pre-conditioning has been used to correct poor graft function, but predictors of recovery are unclear. We report the outcome of 62 consecutive patients who had primary or secondary poor graft function who underwent a CD34+-selected stem cell infusion from the same donor without further conditioning. Forty-seven of 62 patients showed hematological improvement and became permanently transfusion and growth factor-independent. In multivariate analysis, parameters significantly associated with recovery were shared CMV seronegative status for recipient/donor, the absence of active infection and matched recipient/donor sex. Recovery was similar in patients with mixed and full donor chimerism. Five -year overall survival was 74.4% (95% CI 59-89) in patients demonstrating complete recovery, 16.7% (95% CI 3-46) in patients with partial recovery and 22.2% (CI 95% 5-47) in patients with no response. In patients with count recovery, those with poor graft function in 1-2 lineages had superior 5-year overall survival (93.8%, 95% CI 82-99) than those with tri-lineage failure (53%, 95% CI 34-88). New strategies including cytokine or agonist support, or second transplant need to be investigated in patients who do not recover.

Journal article

Layton D, Piel F, Telfer P, 2020, Real-time national survey of COVID-19 in hemoglobinopathy and rare inherited anemia patients, Haematologica: the hematology journal, Vol: 105, Pages: 2651-2654, ISSN: 0390-6078

Journal article

Little C, Szydlo R, Aw TC, Laffan M, Arachchillage DRJet al., 2020, Effect of direct-acting oral anticoagulants (DOACs) on bleeding and blood product usage in cardiac surgery compared to warfarin and controls, British Journal of Haematology, Vol: 190, Pages: 284-293, ISSN: 0007-1048

In this retrospective, single-centre, observational study, we assessed (i) use of anticoagulant and antiplatelet (AP) therapy, (ii) the duration of direct-acting oral anticoagulant (DOAC) discontinuation, (iii) renal function and (iv) PT and APTT as predictors of bleeding and blood product usage; in adults (>18 years) undergoing major cardiac surgery from 01.01.2015 to 31.12.2018. Comparisons were made between each treatment group (warfarin, DOAC and DOAC + AP) and untreated controls, and between warfarin and DOAC. A total of 2928 patients were included for analysis. Median (range) of DOAC discontinuation prior to surgery was five days (1-22) for DOAC and five days (2-7) for DOAC + AP. There were no differences in bleeding between anticoagulant groups versus control, or DOAC versus warfarin. There were no differences in blood product use between DOAC and warfarin patients. The duration of DOAC discontinuation but not the creatinine clearance influenced bleeding and blood products use. Thrombosis occurred in 0·7% and 3·1% in controls and patients on warfarin respectively (P = 0·099) with none among patients on DOAC or DOAC + AP. The PT/APTT had no predictive value. Median five-day discontinuation of DOAC +/- AP irrespective of renal function prevents an increase in bleeding compared to patients on warfarin or controls with no increase in thrombosis.

Journal article

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