351
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Schold J, Arrington C, Levine G. Significant alterations in reported clinical practice associated with increased oversight of organ transplant center performance. Prog Transplant 2010. [DOI: 10.7182/prtr.20.3.bj6mh237p6912251] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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352
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Impact of obesity on urologic complications among unrelated living donor kidney transplants. Indian J Surg 2010; 72:211-4. [PMID: 23133249 DOI: 10.1007/s12262-010-0055-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Accepted: 01/17/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Although obesity has been associated with improved survival on dialysis, its effects on renal transplantation outcomes remain unclear. Herein we aimed to evaluate the effect of obesity on posttransplantation complications. PATIENTS AND METHODS A retrospective analysis of consecutive renal transplant recpients from un related living donors was undertaken from 2006 to 2008. RESULTS We included 180 patients, 34 (18%) were obese (body mass index >30 kg/m(2)) and 146 were lean. Obese patients were more likely to develope renal artery stenosis (17.6% vs 2.8%, p < 0.001), hematoma (47.9% vs 17.6, p = 0.009), wound complications (64.7% vs 9.6%, P < 0.001) and renal vein thrombosis(2% vs 0%, p < 0.001). Urologic complications consisting ureteral, ureteropelvic and ureterovesicular junction stenosis, wound bleeding, urinary leakage and renal artery thrombosis and also hospitalization time were found similar between the two groups. 2 year patiets and graft survival were not statististically different. CONCLUSIONS Renal transplantation could be performed with reasonable urologic complications in obese patients.
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353
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Donor characteristics associated with reduced survival of transplanted kidney grafts in Korea. Transplant Proc 2010; 42:778-81. [PMID: 20430169 DOI: 10.1016/j.transproceed.2010.02.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Certain donor characteristics are known to be associated with increased graft failure in kidney transplantation. METHODS We analyzed donor and recipient characteristics among deceased donor kidney transplantations performed from 1995 to 2008, excluding multiorgan, pediatric, and retransplantation cases. RESULTS The 299 cases underwent analysis of donor characteristics including age, sex, cause of brain death, history of hypertension, cardiac arrest, length of intensive care unit (ICU) stay, last serum creatinine before organ donation, and change in creatinine during ICU stay. Cox regression analysis identified two factors that independently predicted a greater risk of graft failure. The factors were cerebrovascular accident (CVA) as the cause of brain death and a history of hypertension. Compared with donors with causes of brain death other than CVA, the adjusted hazard ratios for graft failure (GF) of kidneys from donors with CVA were 2.37 (1.34-4.19, P=.003). The hazard ratio for GF was 2.42 (1.34-4.37, P=.003) for kidneys from those with a history of hypertension. Donors meeting the criteria of CVA as the cause of brain death or history of hypertension comprised 43% of transplantation cases (128/299). Donor age and last serum creatinine level, which were identified in previous studies to show higher risks of graft failure, did not apply in our patients. CONCLUSION Donor history of hypertension and CVA as the cause of brain death were significant determinants of reduced graft survival after DDKT in Korea.
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354
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Deulofeu R, Bodí M, Twose J, López P. How to Achieve More Accurate Comparisons in Organ Donation Activity: Time to Effectiveness Indicators. Transplant Proc 2010; 42:1432-8. [DOI: 10.1016/j.transproceed.2009.12.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Accepted: 12/07/2009] [Indexed: 11/25/2022]
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355
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Brown KL, Doshi MD, Singh A, Mehta K, Morawski K, Cincotta E, West MS, Gruber SA. Does donor race still make a difference in deceased-donor African-American renal allograft recipients? Am J Surg 2010; 199:305-9; discussion 309. [PMID: 20226900 DOI: 10.1016/j.amjsurg.2009.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 08/24/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prior studies have demonstrated that African-American (AA) donor kidneys are independently associated with an increased risk for graft loss. METHODS We examined outcomes in comparable groups of AA deceased-donor (DD) kidney transplant patients receiving an AA donor (n=35) versus a Caucasian donor (C group; n=150) organ. RESULTS There were no differences between AA and C groups in patient survival, new-onset diabetes, or BK nephropathy. The AA group demonstrated a significantly higher 6-month and overall incidence of acute rejection (AR), increased cytomegalovirus (CMV) infection, and decreased graft survival. Recurrent or de novo focal segmental glomerulosclerosis (FSGS) accounted for a significantly higher fraction of graft losses in the AA versus C group. CONCLUSIONS AA DD renal allograft recipients have equivalent patient but decreased graft survival when transplanted with an AA versus C kidney using current immunosuppression. This may be the result of increased AR, CMV infection, and recurrence/development of FSGS.
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Affiliation(s)
- Kristian L Brown
- Section of Transplant Surgery, Department of Surgery, Wayne State University School of Medicine, and Pharmacy Department, Harper University Hospital, Detroit, MI, USA
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356
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Heuer M, Zeiger A, Kaiser GM, Mathé Z, Goldenberg A, Sauerland S, Paul A, Treckmann JW. Use of marginal organs in kidney transplantation for marginal recipients: too close to the margins of safety? Eur J Med Res 2010; 15:31-4. [PMID: 20159669 PMCID: PMC3351845 DOI: 10.1186/2047-783x-15-1-31] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective Due to organ shortage, average waiting time for a kidney in Germany is about 4 years after start of dialysis. Number of kidney grafts recovered can only be maintained by accepting older and expanded criteria donors. The aim of this study was to analyse the impact of donor and recipient risk on kidney long-term function. Methods All deceased kidney transplantations were considered. We retrospectively studied 332 patients between 2002 and 2006; divided in 4 groups reflecting donor and recipient risk. Results Non-marginal recipients were less likely to receive a marginal organ (69 of 207, 33%) as compared to marginal recipients, of whom two-thirds received a marginal organ (p < 0.0001). Graft function significantly differed between the groups, but detrimental effect of marginal recipient status on eGFR after 12 months (-6 ml/min/1.73 qm, 95% CI -2 to -9) was clearly smaller than the effect of marginal donor status (-10 ml/min/1.73 qm, 95% CI -7 to -14). Conclusions As we were able to show expanded criteria donor has a far bigger effect on long-term graft function than the "extra risk" recipient. Although there have been attempts to define groups of recipients who should be offered ECD kidneys primarily the discussion is still ongoing.
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Affiliation(s)
- M Heuer
- Department of General-, Visceral- and Transplantation Surgery, University Hospital of Essen, 45122 Essen, Germany
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357
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Grams ME, Womer KL, Ugarte RM, Desai NM, Montgomery RA, Segev DL. Listing for expanded criteria donor kidneys in older adults and those with predicted benefit. Am J Transplant 2010; 10:802-809. [PMID: 20148808 PMCID: PMC3146063 DOI: 10.1111/j.1600-6143.2010.03020.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Certain patient groups are predicted to derive significant survival benefit from transplantation with expanded criteria donor (ECD) kidneys. An algorithm published in 2005 by Merion and colleagues characterizes this group: older adults, diabetics and registrants at centers with long waiting times. Our goal was to evaluate ECD listing practice patterns in the United States in terms of these characteristics. We reviewed 142 907 first-time deceased donor kidney registrants reported to United Network for Organ Sharing (UNOS) between 2003 and 2008. Of registrants predicted to benefit from ECD transplantation according to the Merion algorithm ('ECD-benefit'), 49.8% were listed for ECD offers ('ECD-willing'), with proportions ranging from 0% to 100% by transplant center. In contrast, 67.6% of adults over the age of 65 years were ECD-willing, also ranging from 0% to 100% by center. In multivariate models, neither diabetes nor center waiting time was significantly associated with ECD-willingness in any subgroup. From the time of initial registration, irrespective of eventual transplantation, ECD-willingness was associated with a significant adjusted survival advantage in the ECD-benefit group (HR for death 0.88, p < 0.001) and in older adults (HR 0.89, p < 0.001), but an increased mortality in non-ECD-benefit registrants (HR 1.11, p < 0.001). In conclusion, ECD listing practices are widely varied and not consistent with published recommendations, a pattern that may disenfranchise certain transplant registrants.
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Affiliation(s)
- M. E. Grams
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - K. L. Womer
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - R. M. Ugarte
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - N. M. Desai
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - R. A. Montgomery
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - D. L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD,Corresponding author: Dorry Segev,
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358
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Minnee RC, Lardy N, Ajubi N, Idu MM, Kock RV, Legemate DA, van Donselaar-van der Pant KAMI, Bemelman FJ. Ten-yr results of the trans-Atlantic kidney transplant airlift between the Dutch Caribbean and the Netherlands. Clin Transplant 2010; 25:302-7. [PMID: 20331691 DOI: 10.1111/j.1399-0012.2010.01239.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The prevalence of end-stage renal failure in Curaçao (Dutch Caribbean) is one of the highest in the world. In 1998, the St. Elisabeth Hospital started a unique trans-Atlantic collaboration with the Academic Medical Center in Amsterdam, the Netherlands, and the Eurotransplant Foundation. The partnership aimed to achieve a structured transplantation program for patients in the Dutch Caribbean, who otherwise would need lifelong dialysis. This study is an analysis of the 10-yr transplantation results of this trans-Atlantic program. In 41 consecutive transplantations performed between January 1998 and April 2007, one-yr graft survival and complication rates were retrospectively studied. Twenty-four men and 17 women with a median age of 54 were transplanted. The median dialysis period prior to transplantation was 6.8 yr. The one-yr graft survival rate was 69% (95% confidence interval: 52-80%). Initially 28 grafts functioned (68%); four grafts showed primary non-function (10%) and delayed graft function developed in nine patients (22%). Ten recipients had 16 post-operative complications. Our trans-Atlantic program affords patients with end-stage renal failure, who otherwise would need lifelong dialysis, a chance to be transplanted.
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Affiliation(s)
- Robert C Minnee
- Renal Transplant Unit, Department of Nephrology, Academic Medical Center, Amsterdam, the Netherlands
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359
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The Prognostic Utility of Deceased Donor Implantation Biopsy in Determining Function and Graft Survival After Kidney Transplantation. Transplantation 2010; 89:559-66. [DOI: 10.1097/tp.0b013e3181ca7e9b] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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360
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Diet C, Audard V, Roudot-Thoraval F, Matignon M, Lang P, Grimbert P. Immunological risk in recipients of kidney transplants from extended criteria donors. Nephrol Dial Transplant 2010; 25:2745-53. [PMID: 20220203 DOI: 10.1093/ndt/gfq114] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Determining if a kidney from a marginal donor is likely to elicit a strong and specific immune response, leading to an increased risk of acute rejection, is of importance in renal transplantation. METHODS In this study, we analysed the effect of extended criteria donor (ECD) on the incidence of biopsy-proven acute rejection (BPAR) and the effect of immunological risk factors on graft outcome in a large cohort of kidney transplant recipients (n = 2121 patients) grafted with ECD (n = 656 patients) or optimal donor (OD) (n = 1465 patients). RESULTS The incidence of BPAR was not statistically different between the ECD group recipients (105/656, 16%) and the OD group recipients (251/1465, 17%) (P = 0.52). These values remained similar after adjustment for immunological risk [defined as retransplantation and/or panel-reactive antibody (PRA) level >20%] (P = 0.92 for patients with immunological risk and P = 0.47 for patients without immunological risk). We next analysed the death-censored graft survival data for OD and ECD groups, as a function of immunological status, and found that the immunological risk factor did not affect graft survival in ECD transplant recipients (P = 0.64). CONCLUSION Although our groups were not homogenous, our study did not reveal an increased risk of acute rejection in recipients of ECD allograft.
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Affiliation(s)
- Carine Diet
- Nephrology and Renal Transplantation Department, Henri Mondor Hospital, AP-HP and Paris XII University, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, France
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361
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Catalá V, Martí T, Diaz JM, Cordeiro E, Samaniego J, Rosales A, De La Torre P. Use of Multidetector CT in Presurgical Evaluation of Potential Kidney Transplant Recipients. Radiographics 2010; 30:517-31. [DOI: 10.1148/rg.302095080] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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362
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Cassini M, Cologna A, Tucci S, Reis R, Rodrigues A, Suaid H, Martins A. Why Not to Use Kidney Grafts From Elderly Donors. Transplant Proc 2010; 42:417-20. [DOI: 10.1016/j.transproceed.2010.01.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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363
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Imamovic S, Ljuca F, Imamovic G, Iljazagic Halilovic F, Krdzalic A, Hasukic S, Mesic D, Zerem E. Influence of donor age on renal graft function in first seven post transplant days. Bosn J Basic Med Sci 2010; 10:73-7. [PMID: 20192936 PMCID: PMC5596616 DOI: 10.17305/bjbms.2010.2741] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Increasing gap between demand and availability of human kidneys for transplantation has forced a re-evaluation of the limits on donor age acceptability. The present study included 74 patients who underwent kidney transplantation in University Clinical Centre Tuzla. In an observational cohort study we assessed impact of donor age on post transplant renal function by analyzing following parameters: 24 hour urine output, creatinine clearance (Cr Cl) and glomerular filtration rate (GFR). Depending on donor age recipients were allocated in to two groups. Group I included patients who received renal graft from donors age up to 55 years, and Group II encountered recipients who received renal graft from donors older than 55 years. Our goal was to determine whether donor age over 55 years significantly diminishes renal graft function in first seven post transplant days. No statistically significant difference was found between Group I and II regarding 24 hour urine output. From second to fifth postoperative day creatinine clearance values were higher in the group of patients who received kidney from donors older than 55 years (47+/-19, 1 vs. 44, 4+/-20, 8). On the fifth, sixth and seventh post operative day GFR was significantly higher in patients who received renal graft from donors age up to 55 years (p<0, 0161). Our data showed no significant difference in observed variables between the two groups, thus indicating that utilization of renal grafts from donors' age > 55 years is acceptable and may considerably expand the donor pool.
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Affiliation(s)
- Semir Imamovic
- Clinic for of Anaesthesiology and Reanimatology, University Clinical Centre Tuzla, Trnovac bb, 75 000 Tuzla, Bosnia and Herzegovina
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364
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365
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Bang K, Kim MG, Byeon N, Kim Y, Jeong JC, Ro H, Oh YK, Min SI, Ha J, Cho W, Yang J, Ahn C. Current Management for Patients on the Waiting List of Deceased Donor Kidney Transplantation in Korea. ACTA ACUST UNITED AC 2010. [DOI: 10.4285/jkstn.2010.24.4.272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Kitae Bang
- Department of Internal Medicine, Eulji University of Medicine, Daejeon, Korea
| | - Myung-gyu Kim
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
| | - Nyeonim Byeon
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
| | - Yoonjung Kim
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
| | - Jong Cheol Jeong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Han Ro
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Kyu Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-il Min
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jongwon Ha
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - WonHyun Cho
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Jaeseok Yang
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
- Transplantation Research Institute, Seoul National University, Seoul, Korea
| | - Curie Ahn
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Transplantation Research Institute, Seoul National University, Seoul, Korea
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366
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BÅogowski W. Facial transplantation as an option in reconstructive surgery: no mountains too high? ANZ J Surg 2009; 79:892-7. [DOI: 10.1111/j.1445-2197.2009.05140.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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367
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Abstract
This brief survey presents data on renal transplantation in Slovenia, a country with a population of 2 million, which has one renal transplant center. The establishment of an appropriate national transplantation organization resulted in an increase in transplantations and the acceptance of Slovenia into Eurotransplant (ET) at the beginning of 2000. Current immunosuppression is composed of cyclosporine microemulsion (Neoral), mycophenolate mofetil, methylprednisolone, and anti-interleukin-2 receptor monoclonal antibodies. By the end of 2008, 766 renal transplantations had been performed, and from 1970 to 2007, 125 patients had been transplanted from living related donors. From 1986 to 1999, 239 patients received renal grafts from deceased donors. From 2000 to 2008, 402 patients were transplanted from deceased donors. In 2004, 55 renal transplantations were done. Two hundred and twenty-eight (56.7%) renal grafts were shipped from other ET countries. The HLA-antigen mismatch of 2.7 +/- 1.1 was not significantly different to that before 2000. From 2000 to 2008, the one- and five-year patient survival rates were 98.2% and 95.2%, respectively. The concomitant graft survival rates were 94.4% and 90.9%, respectively. In the ET era, the number of deceased donor renal transplants per year was 2.6 times higher than in the 14 years before. In 2004 we reached the average number of deceased donor renal transplants per million population of ET. Short- and medium-term results of the last nine-year period have been very good and entirely comparable to those in large reports.
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Affiliation(s)
- Aljosa Kandus
- Department of Nephrology, University Medical Center Ljubljana, SI-1000 Ljubljana, Slovenia.
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368
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Abbadie O, Lobbedez T, Ficheux M, El Haggan W, Chatelet V, Levaltier B, Henri P, Ryckelynck JP, Hurault de Ligny B. Le seul jugement clinique peut-il être utilisé pour accepter un greffon marginal ? Expérience d’un centre de transplantation. Nephrol Ther 2009; 5:559-67. [DOI: 10.1016/j.nephro.2009.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 05/28/2009] [Accepted: 05/28/2009] [Indexed: 10/20/2022]
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369
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Naesens M, Lerut E, de Jonge H, Van Damme B, Vanrenterghem Y, Kuypers DRJ. Donor age and renal P-glycoprotein expression associate with chronic histological damage in renal allografts. J Am Soc Nephrol 2009; 20:2468-80. [PMID: 19762492 PMCID: PMC2799173 DOI: 10.1681/asn.2009020192] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 07/03/2009] [Indexed: 01/04/2023] Open
Abstract
The contributions of donor kidney quality (partially determined by donor age), allograft rejection, and calcineurin inhibitor nephrotoxicity on the progression of histologic damage of renal allografts are not completely defined. Moreover, the determinants of individual susceptibility to calcineurin inhibitor nephrotoxicity are not known but may include variability in drug transport and metabolism. In a prospective cohort of 252 adult renal allograft recipients treated with a combination of tacrolimus, mycophenolate mofetil, and corticosteroids, we studied 744 renal allograft biopsies obtained regularly from time of transplantation for 3 yr. We assessed determinants of histologic evolution, including tacrolimus exposure, renal P-glycoprotein (ABCB1) expression, and polymorphisms in the CYP3A4, CYP3A5, and ABCB1 genes. Within the first 3 yr after transplantation, we noted a progressive increase in interstitial fibrosis, tubular atrophy, glomerulosclerosis, and vascular intimal thickening. Older donor age, absence of P-glycoprotein expression at the apical membrane of tubular epithelial cells, and combined donor-recipient homozygosity for the C3435T variant in ABCB1 significantly associated with increased susceptibility to chronic allograft damage independent of graft quality at implantation. Changes in graft function over time reflected these associations with donor age and ABCB1 polymorphisms, but it was acute T cell-mediated and antibody-mediated rejection that determined early graft survival. In conclusion, the effects of older donor age reach beyond the quality of the allograft at implantation and continue to be important for histologic evolution in the posttransplantation period. In addition, ABCB1 genotype and expression of P-glycoprotein in renal tubular epithelial cells determine susceptibility to chronic tubulointerstitial damage of transplanted kidneys.
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Affiliation(s)
- Maarten Naesens
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
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370
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Bittar J, Arenas P, Chiurchiu C, de la Fuente J, de Arteaga J, Douthat W, Massari PU. Renal transplantation in high cardiovascular risk patients. Transplant Rev (Orlando) 2009; 23:224-34. [DOI: 10.1016/j.trre.2009.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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371
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Reese PP, Feldman HI, Asch DA, Halpern SD, Blumberg EA, Thomasson A, Shults J, Bloom RD. Transplantation of kidneys from donors at increased risk for blood-borne viral infection: recipient outcomes and patterns of organ use. Am J Transplant 2009; 9:2338-45. [PMID: 19702645 PMCID: PMC3090728 DOI: 10.1111/j.1600-6143.2009.02782.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Kidney transplantation from deceased donors classified as increased risk for viral infection by the Centers for Disease Control (CDC) is controversial. Analyses of Organ Procurement and Transplantation Network (OPTN) data from 7/1/2004 to 7/1/2006 were performed. The primary cohort included 48 054 adults added to the kidney transplant wait list. Compared to receiving a standard criteria donor (SCD) kidney or remaining wait-listed, CDC recipients (HR 0.80, p = 0.18) had no significant difference in mortality. In a secondary cohort of 19 872 kidney recipients at 180 centers, SCD (reference) and CDC (HR 0.91, p = 0.16) recipients had no difference in the combined endpoint of allograft failure or death. Among centers performing >10 kidney transplants during the study period, the median proportion of CDC transplants/total transplants was 7.2% (range 1.1-35.6%). Higher volume transplant centers were more likely to use CDC kidneys compared to low and intermediate volume centers (p < 0.01). An analysis of procured kidneys revealed that 6.8% of SCD versus 7.8% of CDC (p = 0.13) kidneys were discarded. In summary, center use of CDC kidneys varied widely, and recipients had good short-term outcomes. OPTN should collect detailed data about long-term outcomes and recipient viral testing so the potential risks of CDC kidneys can be fully evaluated.
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Affiliation(s)
- P. P. Reese
- Department of Medicine, Renal Division, University of Pennsylvania, Philadelphia, PA,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA,Corresponding author: Peter P. Reese,
| | - H. I. Feldman
- Department of Medicine, Renal Division, University of Pennsylvania, Philadelphia, PA,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - D. A. Asch
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA,Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA
| | - S. D. Halpern
- Department of Medicine, Renal Division, University of Pennsylvania, Philadelphia, PA,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - E. A. Blumberg
- Department of Medicine, Infectious Diseases Division, University of Pennsylvania, Philadelphia, PA
| | - A. Thomasson
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - J. Shults
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - R. D. Bloom
- Department of Medicine, Renal Division, University of Pennsylvania, Philadelphia, PA
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372
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Rao PS, Ojo A. The alphabet soup of kidney transplantation: SCD, DCD, ECD--fundamentals for the practicing nephrologist. Clin J Am Soc Nephrol 2009; 4:1827-31. [PMID: 19808229 DOI: 10.2215/cjn.02270409] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
There is significant variability in the quality of deceased-donor kidneys that are used for transplantation. The quality of the donor kidney has a direct effect on important clinical outcomes such as acute rejection, delayed graft function, and patient and allograft survival. Expanded-criteria donors (ECDs) refer to older kidney donors (> or =60 yr) or donors who are aged 50 to 59 yr and have two of the following three features: Hypertension, terminal serum creatinine >1.5 mg/dl, or death from cerebrovascular accident. By definition, ECD kidneys have a 70% greater likelihood of failure compared with one from a 35-yr-old male donor who died from a motor vehicle accident. Donation after cardiac death (DCD) is a small but rapidly growing fraction of donors. An ECD kidney transplant recipient has a projected average added-life-years of 5.1 yr compared with 10 yr for a kidney recipient from a standard-criteria donor. Kidney transplantation from DCD seems to have similar allograft and patient survival compared with kidney from donation after brain death; however DCD transplantation has a 42 to 51% risk for delayed graft function (need for at least one dialysis treatment during the first week after transplantation) compared with 24% in an standard-criteria donor kidney transplant. Familiarity with the comprehensive allocation rules governing different categories of deceased-donor kidneys by the nephrologists and dialysis team providers is essential to maximizing patient autonomy and to improve the outcomes of kidney transplantation.
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Affiliation(s)
- Panduranga S Rao
- Department of Medicine, University of Michigan, Ann Arbor, Michigan 48109-5364, USA
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373
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Fabrizi F, Messa P, Martin P. Current status of renal transplantation from HCV-positive donors. Int J Artif Organs 2009; 32:251-61. [PMID: 19569034 DOI: 10.1177/039139880903200502] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hepatitis C virus (HCV) infection remains frequent among renal transplant (RT) recipients and has a detrimental effect on patient and graft survival. accelerated progression of liver disease due to HCV has been implicated in increased mortality after kidney transplantation but additional outcomes have been related to HCV after RT. all HCV-infected kidney transplant candidates should be considered for liver biopsy before RT. HCV infection should not be considered an absolute contraindication to renal transplantation, although the course of HCV-related liver disease is often progressive. Numerous organ procurement organizations have introduced the policy of accepting kidneys from HCV-positive donors for HCV-positive recipients, but this is still controversial. Single-center experiences have not reported adverse effects on the short-term patient and graft survival, however information from large databases has suggested that RT recipients of HCV-positive donors are independently at risk of mortality even in the modern era of immunosuppression. Renal transplantation should be considered using HCV-seropositive grafts for qualified patients with chronic kidney disease (CKD) stage 5 and HCV infection since good information indicates that the transplantation of kidneys from HCV-infected donors results in improved survival compared to wait-listed and dialysis-dependent candidates. a potential risk related to the use of donor HCV-positive kidneys cannot be excluded, and kidneys from HCV-infected donors should be restricted to recipients with evidence of active viremia at the time of kidney transplantation.
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Affiliation(s)
- Fabrizio Fabrizi
- Division of Nephrology and Dialysis, Maggiore Hospital, IRCCS Foundation, Milan, Italy.
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374
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Gueye AS, Baird BC, Shihab F, Koford JK, Barenbaum AL, Leviatov A, Goldfarb-Rumyantzev AS. The role of the economic environment in kidney transplant outcomes. Clin Transplant 2009; 23:643-52. [DOI: 10.1111/j.1399-0012.2009.01024.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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375
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Dale-Shall AW, Smith JM, McBride MA, Hingorani SR, McDonald RA. The relationship of donor source and age on short- and long-term allograft survival in pediatric renal transplantation. Pediatr Transplant 2009; 13:711-8. [PMID: 19207226 DOI: 10.1111/j.1399-3046.2008.01054.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Limited pediatric data on allograft survival from advanced aged kidney donors exist. To determine the influence of donor source and age on allograft survival in pediatric renal transplant recipients, we analyzed the OPTN database. Allograft survival for 7291 pediatric renal transplants was evaluated. Up to five yr post-transplantation, graft survival was higher for LD vs. DD recipients. At seven yr, allograft survival was 71% in 18-54 yr-old LD recipients, 59.1% in >or=55 yr-old LD, and 45.1% in >or=50 yr-old DD recipients. An approximate 35% improvement in allograft survival in 18-54 yr-old LD recipients was observed. Multivariate results showed that recipients of LD 35-49 (aRR 0.66, 95% CI 0.55-0.80) and LD 50-54 (aRR 0.65, 95% CI 0.45-0.94) have a graft survival advantage over the ideal DD. In LD >or=55 yr, no improvement in graft survival was observed when compared with the 18-34 yr-old DD. In summary, we observed in a pediatric population, <55 yr-old LD kidneys afford improved long-term allograft survival when compared with DD kidney recipients. Increasing awareness of the long-term graft survival advantage for children receiving an LD kidney, even from older donors, should be a priority.
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Affiliation(s)
- A W Dale-Shall
- Division of Pediatric Nephrology, Levine Children's Hospital at Carolinas Medical Center, Charlotte, NC, USA
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376
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Re L, Curcio D, Rial M, Goldberg J, Casadei D. Results of a prospective allocation policy of expanded criteria donors kidneys based on clinical parameters. Clin Transplant 2009; 24:229-35. [DOI: 10.1111/j.1399-0012.2009.01053.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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377
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378
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Resende L, Guerra J, Santana A, Mil-Homens C, Abreu F, da Costa AG. Impact of donor age on renal allograft function and survival. Transplant Proc 2009; 41:794-6. [PMID: 19376354 DOI: 10.1016/j.transproceed.2009.01.064] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The lack of cadaveric donors coupled with a rapidly growing number of potential recipients have stimulated the implementation of several strategies, including the acceptance of older donors, to increase the organ pool and reduce the waiting list for kidney transplantation. However several studies have demonstrated higher incidences of delayed graft function and poor graft outcomes among kidneys harvested from older donors. OBJECTIVE The objective of this study was to evaluate the influence of donor age on the function and long-term survival of renal allografts. PATIENTS We performed a retrospective review of the clinical data from 441 adult kidney transplantation from cadaveric heart-beating donors performed in our unit from May 1989 to May 2007. RESULTS Recipients of kidney allografts from older donors were significantly older (49.2 vs 43.7 years; P < .0001) and had a higher incidence of delayed graft function (15.1% vs 5.4%; P = .005). Renal function was superior following kidney transplantation using younger donors not only at 3 months (P < .0001) and 12 months (P < .0001) posttransplantation, but also upon long-term follow-up at 60 months (P < .0001) and 96 months (P = .030). Allograft survival censored for death with a functioning graft and patient survival were not different when comparing older versus younger donors. Multivariate analysis confirmed the lack of correlation between donor age and allograft failure. CONCLUSION Donor age showed no influence on allograft survival. However, kidney allografts from older donors displayed lower first year and long-term renal function.
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Affiliation(s)
- L Resende
- Department of Nephrology, Hospital Central do Funchal, Funchal, Portugal.
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379
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Impact of Deceased Donor Diabetes Mellitus on Kidney Transplant Outcomes: A Propensity Score-Matched Study. Transplantation 2009; 88:251-60. [DOI: 10.1097/tp.0b013e3181ac68a9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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380
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Martín Navarro J, Ortega M, Gutiérrez M, García Martín F, Alcázar J, Morales J, Andrés A, Praga M. Survival of Patients Older Than 60 Years With Kidneys Transplanted From Spanish Expanded Criteria Donors Versus Patients Continued on Hemodialysis. Transplant Proc 2009; 41:2376-8. [DOI: 10.1016/j.transproceed.2009.06.176] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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381
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Mistretta A, Veroux M, Grosso G, Contarino F, Biondi M, Giuffrida G, Gagliano M, Giaquinta A, Zerbo D, Tallarita T, Corona D, Veroux P. Role of Socioeconomic Conditions on Outcome in Kidney Transplant Recipients. Transplant Proc 2009; 41:1162-7. [DOI: 10.1016/j.transproceed.2009.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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382
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Pretagostini R, Lai Q, Poli L, Levi Sandri G, Travaglia D, Rossi M, Berloco P. Predictive Characteristics of Delayed Graft Function After Expanded and Standard Criteria Donor Kidney Transplantations. Transplant Proc 2009; 41:1149-51. [DOI: 10.1016/j.transproceed.2009.02.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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383
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Delayed Graft Function Decreases Early and Intermediate Graft Outcomes After Expanded Criteria Donor Kidney Transplants. Transplant Proc 2009; 41:1145-8. [DOI: 10.1016/j.transproceed.2009.02.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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384
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Outcome of Third Renal Allograft Retransplants Versus Primary Transplants from Paired Donors. Transplantation 2009; 87:1214-20. [DOI: 10.1097/tp.0b013e31819f0f5c] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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385
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Outcomes of Transplantation Using Kidneys From Donors Meeting Expanded Criteria in Australia and New Zealand, 1991 to 2005. Transplantation 2009; 87:1201-9. [DOI: 10.1097/tp.0b013e31819ec3a6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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386
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Hassanain M, Tchervenkov J, Cantarovich M, Metrakos P, Paraskevas S, Keith D, Baran D, Fernandez M, Mangel R, Chaudhury P. Delayed graft function has an equally bad impact on deceased donor renal graft survival in both standard criteria donors and expanded criteria donors. Transplant Proc 2009; 41:133-4. [PMID: 19249497 DOI: 10.1016/j.transproceed.2008.10.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 10/06/2008] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The use of expanded criteria donors (ECDs) is still limited because of inferior graft survival compared to standard criteria donors (SCDs). We assessed the impact of immediate graft function (IGF) on renal graft survival among recipients of SCD and ECD grafts to determine whether these kidneys performed equally well under "ideal" conditions favoring IGF. METHODS We included all cadaveric renal transplants performed from 1990 to 2002 (n = 335). Delayed graft function (DGF) was defined as the need for dialysis in the first 7 days posttransplant. Slow graft function (SGF) and IGF were defined as a serum creatinine fall by <20% versus >20% in the first 24 hours posttransplant, respectively. Non-death censored actual graft survivals are reported herein. RESULTS Seventy-two of the 335 subjects (21.5%) received organs from ECDs and displayed IGF in 54.7%, SGF 16.2%, and DGF 29.1%. Among SCDs, the SGF and DGF rates were 15.3% and 23.4%, respectively. In ECD, the SGF and DGF rates were 19.4% and 50% (P < .02). Actual graft survivals at 1 and 5 years was 86.3% and 70.4%, respectively. Patients with IGF had higher actual graft survival at 5 years compared to SGF and DGF (83.5% vs 74.1% vs 45.4%). DGF had an equally bad impact on actual 5-year graft survival in SCDs and ECDs (42.6% vs 50%). CONCLUSION DGF has a strong detrimental impact on 5-year graft survival. There is a higher rate of DGF in ECD versus SCD kidneys. The detrimental impact on 5-year actual graft survival is equal in SCD and ECD kidneys. Minimizing DGF should be our goal.
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Affiliation(s)
- M Hassanain
- Department of Surgery, McGill University, Montreal, Quebec, Canada.
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387
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Resende L, Guerra J, Santana A, Mil-Homens C, Abreu F, da Costa A. First Year Renal Function as a Predictor of Kidney Allograft Outcome. Transplant Proc 2009; 41:846-8. [DOI: 10.1016/j.transproceed.2009.01.066] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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388
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Schaubel DE, Guidinger MK, Biggins SW, Kalbfleisch JD, Pomfret EA, Sharma P, Merion RM. Survival benefit-based deceased-donor liver allocation. Am J Transplant 2009; 9:970-81. [PMID: 19341419 PMCID: PMC2895923 DOI: 10.1111/j.1600-6143.2009.02571.x] [Citation(s) in RCA: 233] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Currently, patients awaiting deceased-donor liver transplantation are prioritized by medical urgency. Specifically, wait-listed chronic liver failure patients are sequenced in decreasing order of Model for End-stage Liver Disease (MELD) score. To maximize lifetime gained through liver transplantation, posttransplant survival should be considered in prioritizing liver waiting list candidates. We evaluate a survival benefit based system for allocating deceased-donor livers to chronic liver failure patients. Under the proposed system, at the time of offer, the transplant survival benefit score would be computed for each patient active on the waiting list. The proposed score is based on the difference in 5-year mean lifetime (with vs. without a liver transplant) and accounts for patient and donor characteristics. The rank correlation between benefit score and MELD score is 0.67. There is great overlap in the distribution of benefit scores across MELD categories, since waiting list mortality is significantly affected by several factors. Simulation results indicate that over 2000 life-years would be saved per year if benefit-based allocation was implemented. The shortage of donor livers increases the need to maximize the life-saving capacity of procured livers. Allocation of deceased-donor livers to chronic liver failure patients would be improved by prioritizing patients by transplant survival benefit.
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Affiliation(s)
- D E Schaubel
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA.
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389
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Al-Massarani G, Vacher-Coponat H, Paul P, Arnaud L, Loundou A, Robert S, Moal V, Berland Y, Dignat-George F, Camoin-Jau L. Kidney transplantation decreases the level and procoagulant activity of circulating microparticles. Am J Transplant 2009; 9:550-7. [PMID: 19260834 DOI: 10.1111/j.1600-6143.2008.02532.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Microparticles (MP) are important players in cardiovascular disorders. Renal transplantation significantly improves the survival of hemodialyzed patients, in part because cardiovascular disease (CVD) progression is lessened. We hypothesized that the beneficial effect of renal transplantation on cardiovascular outcome might involve decreased levels of circulating MP. We evaluated the kinetics of MP subpopulations and their procoagulant activity (MP-PCA) in 52 patients before and 3, 6, 9 and 12 months after graft with reference to 50 healthy controls and we evaluated the impact of cardiovascular complications. During the follow-up, the increased levels of MP observed before graft were significantly decreased and reached normal values with different kinetics according to their cellular origin whereas MP-PCA remained significantly higher than in controls. From multivariate analysis, the levels of MP were negatively correlated with renal function. At 12 months, the decrease in MP and MP-PCA was more pronounced in patients without history of CVD than those with. In conclusion, we demonstrated that renal graft is associated with decreased levels of MP levels and MP-PCA, even more pronounced so in patients without history of CVD. Therefore, we suggest that MP lowering could be involved in the vascular dysfunction improvements reported after transplantation.
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Affiliation(s)
- G Al-Massarani
- UMR-S 608 INSERM-Université de Méditerranée, Aix-Marseille 2, Laboratoire d'Hématologie et d'Immunologie, UFR de Pharmacie, Marseille, France
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390
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391
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392
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Histogenomics: association of gene expression patterns with histological parameters in kidney biopsies. Transplantation 2009; 87:290-5. [PMID: 19155987 DOI: 10.1097/tp.0b013e318191b4c0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Several studies investigated the association of histologic scores of donor kidney biopsies obtained before engraftment with posttransplant outcomes. Discrimination and goodness of fit of these scores, however, is low. METHODS Thus, we sought to identify and elucidate the performance of molecular rather than histologic markers for this purpose using whole genome gene expression microarray experiments. RESULTS We identified 80 unique differentially regulated genes in 82 samples, showing no histologic damage versus those with histologic damage, based on the Chronic Allograft Damage Index (CADI) and acute tubular injury. Main biological categories enriched with up-regulated genes in damaged tissue were "immunity and defense," "cell communication," or "apoptosis." Interestingly, genes involved in cell structure, cell adhesion, and protein trafficking were specific for tubular atrophy. Histology (CADI score) explained only 14% of the variability of 1 year creatinine (adjusted R2 for panel-reactive antibodies, biopsy confirmed acute rejection, and sum of human leukocyte antigen mismatches) whereas a combination of three biomarkers without clinical covariables explained 28%. The three molecular markers are the NLR family, pyrin domain containing 2 (NLRP2), immunoglobulin J polypeptide, and the regulator of G-protein signaling 5. CONCLUSION In summary, we identified biomarkers in transplant kidney biopsies, which are predictive for medium-term allograft function.
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393
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The Pivotal Impact of Center Characteristics on Survival of Candidates Listed for Deceased Donor Kidney Transplantation. Med Care 2009; 47:146-53. [DOI: 10.1097/mlr.0b013e31818475c9] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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394
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Pavlakis M. Can cardiac troponin T level be used to predict survival of patients awaiting renal transplantation? Nat Rev Nephrol 2009; 5:124-5. [PMID: 19174769 DOI: 10.1038/ncpneph1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 12/16/2008] [Indexed: 11/09/2022]
Abstract
Cardiac troponin T (cTnT) levels are often elevated in chronic kidney disease and correlate with survival of patients receiving dialysis. This commentary discusses a recent paper by Hickson et al. that investigated whether a single cTnT measurement can predict survival of patients on the waiting list for renal transplantation. Elevated cTnT levels (>0.01 ng/ml) were associated with left ventricular hypertrophy, reduced left ventricular ejection fraction and ischemia or resting ventricular wall motion abnormalities on dobutamine stress echocardiography, and also predicted mortality independently of age, diabetes or history of heart disease. Although the authors recommend intensive cardiac evaluation in patients with high cTnT levels on transplantation waiting lists, predicting who is at highest risk of dying on the waiting list has no practical utility unless an intervention can reliably lower that risk. Until then, the time patients spend on dialysis should be minimized by rapid referral for transplantation, prompt and appropriate waitlisting and widespread encouragement of living donation.
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Affiliation(s)
- Martha Pavlakis
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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395
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396
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Maximizing the Kidney Donor Pool: Role of Expanded Criteria. APOLLO MEDICINE 2008. [DOI: 10.1016/s0976-0016(11)60156-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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397
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Caillard S, Inhoff O, Moulin B. [Transplantation of patients with cardiovascular risk]. Nephrol Ther 2008; 4 Suppl 3:S218-22. [PMID: 19000891 DOI: 10.1016/s1769-7255(08)74239-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Transplantation of patients with cardiovascular risk is becoming more frequent because of the recent changes in the characteristics of hemodialysis patients. Improvement in patient survival after transplantation has been reported in the whole cohort and is probably applicable to cardiovascular risk patients. Nevertheless, cardiovascular mortality is the leading cause of death after transplantation. Systematic screening of patients before transplantation and adapted treatment after transplantation are needed. After transplantation, immunosuppressive treatment should be tailored to the patient's profile and cardiovascular risk factors should be managed cautiously.
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Affiliation(s)
- S Caillard
- Service de Néphrologie-Transplantation, Hôpitaux Universitaires de Strasbourg, 1, place de l'Hôpital 67091 Strasbourg, France.
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398
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Renal transplantation in the elderly. Int Urol Nephrol 2008; 41:195-210. [PMID: 18989746 DOI: 10.1007/s11255-008-9489-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 10/06/2008] [Indexed: 12/31/2022]
Abstract
Elderly patients are increasingly being considered for kidney transplantation due to a global explosion of the aging population with end-stage renal disease (ESRD). However, mounting scarcity of available organs for transplant has led to a wider disparity between organ supply and demand. Consequently, the criteria for accepting kidneys for transplantation have been extended in an attempt to allow the use of organs from elderly donors or those with significant co-morbidities, so-called "expanded criteria donor" (ECD) kidneys. Excellent outcomes have been achieved from ECD kidneys with appropriate donor and recipient profiling and selection. With increasing recovery efforts directed at older donors, the concept of age-matching is becoming more accepted as a method of optimizing utilization of organs in elderly donors and recipients. Utilization of pulsatile perfusion has further improved ECD outcomes and helped the decision-making process for the UNOS (United Network for Organ Sharing) offer. However, age-related immune dysfunction and associated co-morbidities make the elderly transplant recipients ever more susceptible to complications associated with immunosuppressive agents. Consequently, the elderly population is at a higher risk to develop infections and malignancy in the post-transplant period notwithstanding improved transplant outcomes. Appropriate immunosuppressive agents and dosages should be selected to minimize adverse events while reducing the risk of acute rejections and maximizing patient and renal allograft survival.
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399
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Buchanan PM, Lentine KL, Burroughs TE, Schnitzler MA, Salvalaggio PR. Association of lower costs of pulsatile machine perfusion in renal transplantation from expanded criteria donors. Am J Transplant 2008; 8:2391-401. [PMID: 18925906 PMCID: PMC2596761 DOI: 10.1111/j.1600-6143.2008.02412.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Pulsatile machine perfusion (PMP) has been shown to reduce delayed graft function (DGF) in expanded criteria donor (ECD) kidneys. Here, we investigate whether there is a cost benefit associated with PMP utilization in ECD kidney transplants. We analyzed United States Renal Data System (USRDS) data describing Medicare-insured ECD kidney transplant recipients in 1995-2004 (N = 5840). We examined total Medicare payments for transplant hospitalization and annually for 3 years posttransplant according to PMP utilization. After adjusting for other recipient, donor and transplant factors, PMP utilization was associated with a $2130 reduction (p = 0.007) in hospitalization costs. PMP utilization was also associated with lower DGF risk (p < 0.0001). PMP utilization did not predict differences in rejection, graft survival, patient survival, or costs at 1, 2 and 3 years posttransplant. PMP utilization is correlated with lower costs for the transplant hospitalization, which is likely due to the associated reduction in DGF among recipients of PMP kidneys. However, there is no difference in long-term Medicare costs for ECD recipients by PMP utilization. A prospective trial is necessary as it will help determine if the associations seen here are due to PMP utilization and not differences in the population studied.
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Affiliation(s)
- Paula M. Buchanan
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
| | - Krista L. Lentine
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, Division of Nephrology, Saint Louis University School of Medicine, St. Louis, MO
| | - Thomas E. Burroughs
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
| | - Mark A. Schnitzler
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
| | - Paolo R. Salvalaggio
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO
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400
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Bitransplantation rénale : expérience du protocole lyonnais de l’hôpital E.-Herriot. Prog Urol 2008; 18:678-84. [DOI: 10.1016/j.purol.2008.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Accepted: 03/12/2008] [Indexed: 11/21/2022]
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