There is a paucity of studies describing malignancy-related mortality after kidney transplantation. To help quantify this, we extracted data for all kidney-alone transplant procedures performed in England between April 2001 and March 2012. Data linkage analysis was performed between Hospital Episode Statistics and the Office for National Statistics to identify all deaths occurring in this cohort. Among 19,103 kidney transplant procedures analyzed (median follow-up 4.4 years), 2085 deaths occurred, of which 376 (18.0%) were due to malignancy (crude mortality rate 361 malignancy-related deaths per 100,000 person-years). Common sites of malignancy-related death were lymphoma (18.4%), followed by lung (17.6%) and renal (9.8%), with 14.1% unspecified. The risk of malignancy-related death increased with age: under 50 (0.8%), 50-59 (2.5%), 60-69 (4.8%), 70-79 (6.5%) and over 80 years (9.1%). Age- and gender-stratified malignancy-related mortality risk difference was higher in the transplant compared with the general population. Cox proportional hazard models identified increased age, pretransplant history of malignancy and deceased-donor kidney transplantation to be independently associated with risk for post-transplant death from malignancy. Thus, malignancy as a cause of post-kidney transplantation death is common and requires heightened surveillance.

Increasing age is a strong, independent risk factor for death after kidney transplantation. Although lower mortality was observed with living kidney transplantation among elderly recipients, living-donor rates decrease with increasing recipient age. Pretransplant counseling and posttransplant tailored immunosuppression should be explored, the latter requiring targeted clinical trials.

SummaryThe risk of death within the first year postkidney transplantation is not well described in the contemporary era. We extracted data on all kidney transplant procedures performed in England between April 2001 and March 2012. Data linkage analysis was performed between Hospital Episode Statistics and the Office for National Statistics to identify all deaths. Cox proportional hazard models were performed to identify factors associated with 1-year mortality. 566 deaths (3.0%) occurred within the first year post-transplant (from 19 103 kidney transplant procedures analysed). Infection, cardiovascular events and malignancy were classified in 21.6%, 18.3% and 7.4% of death certificates, respectively. Among recipients with prior myocardial infarct history who died within the first year, 38.8% of deaths were attributed to a cardiac-related event. Malignancy-related death was responsible for 61.5% of 1-year mortality for allograft recipients with pretransplant cancer history. 22.1% of deaths included kidney failure as a contributory factor on the death certificate (3.3% specifically stated allograft failure). Variables associated with 1-year mortality included deceased-donor kidney, increasing age, residence in socioeconomically deprived area and history of select medical comorbidities pre-operatively. We conclude 1-year mortality postkidney transplantation is low, but in select allograft recipients, the risk of death increases considerably.

The islands composing the Maltese archipelago (Central Mediterranean) are characterized by a four-layer sequence of limestones and clays. A common feature found in the western half of the archipelago is Upper Coralline Limestone (UCL) plateaus and hillcaps covering a soft Blue Clay (BC) layer which can be up to 75 m thick. The BC layer introduces a velocity inversion in the stratigraphy, implying that the V S30 (traveltime average sear wave velocity (V S ) in the upper 30 m) parameter is not always suitable for seismic microzonation purposes. Such a layer may produce amplification effects, however might not be included in the V S30 calculations. In this investigation, V S profiles at seven sites characterized by such a lithological sequence are obtained by a joint inversion of the single-station Horizontal-to-Vertical Spectral Ratios (H/V or HVSR) and effective dispersion curves from array measurements analysed using the Extended Spatial Auto-Correlation technique. The lithological sequence gives rise to a ubiquitous H/V peak between 1 and 2 Hz. All the effective dispersion curves obtained exhibit a 'normal' dispersive trend at low frequencies, followed by an inverse dispersive trend at higher frequencies. This shape is tentatively explained in terms of the presence of higher mode Rayleigh waves, which are commonly present in such scenarios. Comparisons made with the results obtained at the only site in Malta where the BC is missing below the UCL suggest that the characteristics observed at the other seven sites are due to the presence of the soft layer. The final profiles reveal a variation in the V S of the clay layer with respect to the depth of burial and some regional variations in the UCL layer. This study presents a step towards a holistic seismic risk assessment that includes the implications on the site effects induced by the buried clay layer. Such assessments have not yet been done for Malta.

S U M M A R YAnchor Bay and surrounding regions are located on the northwest coast of the island of Malta, Central Mediterranean. The area is characterized by a coastal cliff environment having an outcropping layer of hard coralline limestone (UCL) resting on a thick (up to 50 m) layer of clays and marls (Blue Clay, BC). This configuration gives rise to coastal instability effects, in particular lateral spreading phenomena and rock falls. Previous and ongoing studies have identified both lateral spreading rates and vertical motions of several millimetres per year. The area is an interesting natural laboratory as coastal detachment processes in a number of different stages can be identified and are easily accessible. We investigate the site dynamic characteristics of this study area by recording ambient noise time-series at more than 30 points, over an area of 0.07 km 2 , using a portable three-component seismograph. The timeseries are processed to give both horizontal-to-vertical spectral ratio graphs (H/V) as well as frequency-dependent polarisation analysis. The H/V graphs illustrate and quantify aspects of site resonance effects due both to underlying geology as well as to mechanical resonance of partly or wholly detached blocks. The polarization diagrams indicate the degree of linearity and predominant directions of vibrational effects. H/V curves closer to the cliff edge show complex responses at higher frequencies, characteristic of the dynamic behaviour of individual detached blocks. Particle motion associated with the higher frequencies shows strongly directional polarization and a high degree of linearity at well-defined frequencies, indicative of normalmode vibration. The stable plateau areas, on the other hand, show simple, single-peak H/V curves representative of the underlying stratification and no predominant polarization direction. These results, which will be compared with those from other experiments in the area, have important implications for the understanding of ongoing processes in geologically active and unstable coastal environments.