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Jenkins JA, Verdiner R, Omar A, Farina JM, Wilson R, D’Cunha J, Reck Dos Santos PA. Donor and recipient risk factors for the development of primary graft dysfunction following lung transplantation. Front Immunol 2024; 15:1341675. [PMID: 38380332 PMCID: PMC10876853 DOI: 10.3389/fimmu.2024.1341675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/22/2024] [Indexed: 02/22/2024] Open
Abstract
Primary Graft Dysfunction (PGD) is a major cause of both short-term and long-term morbidity and mortality following lung transplantation. Various donor, recipient, and technical risk factors have been previously identified as being associated with the development of PGD. Here, we present a comprehensive review of the current literature as it pertains to PGD following lung transplantation, as well as discussing current strategies to mitigate PGD and future directions. We will pay special attention to recent advances in lung transplantation such as ex-vivo lung perfusion, thoracoabdominal normothermic regional perfusion, and up-to-date literature published in the interim since the 2016 ISHLT consensus statement on PGD and the COVID-19 pandemic.
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Affiliation(s)
- J. Asher Jenkins
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Ricardo Verdiner
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Ashraf Omar
- Division of Pulmonology and Critical Care Medicine, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Juan Maria Farina
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Renita Wilson
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Jonathan D’Cunha
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ, United States
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Raza Abidi SS, Naqvi A, Worthen G, Vinson A, Abidi S, Kiberd B, Skinner T, West K, Tennankore KK. Multiview Clustering to Identify Novel Kidney Donor Phenotypes for Assessing Graft Survival in Older Transplant Recipients. KIDNEY360 2023; 4:951-961. [PMID: 37291713 PMCID: PMC10371275 DOI: 10.34067/kid.0000000000000190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023]
Abstract
Key Points An unsupervised machine learning clustering algorithm identified distinct deceased kidney donor phenotypes among older recipients. Recipients of certain donor phenotypes were at a relatively higher risk of all-cause graft loss even after accounting for recipient factors. The use of unsupervised clustering to support kidney allocation systems may be an important area for future study. Background Older transplant recipients are at a relatively increased risk of graft failure after transplantation, and some of this risk may relate to donor characteristics. Unsupervised clustering using machine learning may be a novel approach to identify donor phenotypes that may then be used to evaluate outcomes for older recipients. Using a cohort of older recipients, the purpose of this study was to (1 ) use unsupervised clustering to identify donor phenotypes and (2 ) determine the risk of death/graft failure for recipients of each donor phenotype. Methods We analyzed a nationally representative cohort of kidney transplant recipients aged 65 years or older captured using the Scientific Registry of Transplant Recipients between 2000 and 2017. Unsupervised clustering was used to generate phenotypes using donor characteristics inclusive of variables in the kidney donor risk index (KDRI). Cluster assignment was internally validated. Outcomes included all-cause graft failure (including mortality) and delayed graft function. Differences in the distribution of KDRI scores were also compared across the clusters. All-cause graft failure was compared for recipients of donor kidneys from each cluster using a multivariable Cox survival analysis. Results Overall, 23,558 donors were separated into five clusters. The area under the curve for internal validation of cluster assignment was 0.89. Recipients of donor kidneys from two clusters were found to be at high risk of all-cause graft failure relative to the lowest risk cluster (adjusted hazards ratio, 1.86; 95% confidence interval, 1.69 to 2.05 and 1.73; 95% confidence interval, 1.61 to 1.87). Only one of these high-risk clusters had high proportions of donors with established risk factors (i.e. , hypertension, diabetes). KDRI scores were similar for the highest and lowest risk clusters (1.40 [1.18–1.67] and 1.37 [1.15–1.65], respectively). Conclusions Unsupervised clustering can identify novel donor phenotypes comprising established donor characteristics that, in turn, may be associated with different risks of graft loss for older transplant recipients.
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Affiliation(s)
- Syed Sibte Raza Abidi
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Lilley CM, Picken MM. Novel Histopathologic and Ultrastructural Findings in Renal Allografts From Patients With Size and Age Mismatches: A Case Series. Cureus 2023; 15:e34510. [PMID: 36874348 PMCID: PMC9984201 DOI: 10.7759/cureus.34510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
While reports on the long-term pathology in mismatched allografts have been focused on the donor and recipient body surface area, evidence is emerging to support donor-recipient age difference as an additional prognostic factor. Most reports are based on pediatric recipients receiving older/bigger allografts. Here, we describe three cases with age mismatch including two cases of adult patients receiving pediatric allografts and a third case of a younger patient receiving an allograft from an older donor exhibiting findings not described in extant literature. Each of these cases exhibits unique changes seen in mismatched donor-recipient size/age post-transplant pathology. These non-rejection changes should be suspected in cases of donor-recipient size/age mismatch. In cases of allograft function decline, a full biopsy workup, including electron microscopy, should be considered.
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Affiliation(s)
- Cullen M Lilley
- Department of Pathology, Loyola University Medical Center, Maywood, USA
| | - Maria M Picken
- Department of Pathology, Loyola University Medical Center, Maywood, USA
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Takahashi K, Furuya K, Gosho M, Usui J, Kimura T, Hoshi A, Hashimoto S, Nishiyama H, Oda T, Yuzawa K, Yamagata K. Prediction of early graft function after living donor kidney transplantation by quantifying the "nephron mass" using CT-volumetric software. Front Med (Lausanne) 2022; 9:1007175. [PMID: 36388906 PMCID: PMC9649930 DOI: 10.3389/fmed.2022.1007175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/10/2022] [Indexed: 08/30/2023] Open
Abstract
Early renal function after living-donor kidney transplantation (LDKT) depends on the "nephron mass" in the renal graft. In this study, as a possible donor-recipient size mismatch parameter that directly reflects the "nephron mass," the cortex to recipient weight ratio (CRWR) was calculated by CT-volumetric software, and its ability to predict early graft function was examined. One hundred patients who underwent LDKT were enrolled. Patients were classified into a developmental cohort (n = 79) and a validation cohort (n = 21). Using the developmental cohort, the correlation coefficients between size mismatch parameters, including CRWR, and the posttransplantation estimated glomerular filtration rate (eGFR) were calculated. Multiple regression analysis was conducted to define a formula to predict eGFR 1-month posttransplantation. Using the validation cohort, the validity of the formula was examined. The correlation coefficient was the highest for CRWR (1-month r = 0.66, p < 0.001). By multiple regression analysis, eGFR at 1-month was predicted using the linear model: 0.23 × donor preoperative eGFR + 17.03 × CRWR + 8.96 × preemptive transplantation + 5.10 (adjusted coefficient of determination = 0.54). In most patients in the validation cohort, the observed eGFR was within a 10 ml/min/1.73 m2 margin of the predicted eGFR. CRWR was the strongest parameter to predict early graft function. Predicting renal function using this formula could be useful in clinical application to select proper donors and to avoid unnecessary postoperative medical interventions.
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Affiliation(s)
- Kazuhiro Takahashi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Kinji Furuya
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Masahiko Gosho
- Department of Biostatistics, University of Tsukuba, Tsukuba, Japan
| | - Joichi Usui
- Department of Nephrology, University of Tsukuba, Tsukuba, Japan
| | - Tomokazu Kimura
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | - Akio Hoshi
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | - Shinji Hashimoto
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Tsukuba, Japan
| | | | - Tatsuya Oda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Kenji Yuzawa
- Department of Transplant Surgery, Mito Medical Center, Mito, Japan
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Jarrar F, Tennankore KK, Vinson AJ. Combined Donor-Recipient Obesity and the Risk of Graft Loss After Kidney Transplantation. Transpl Int 2022; 35:10656. [PMID: 36247488 PMCID: PMC9556700 DOI: 10.3389/ti.2022.10656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022]
Abstract
Background: As the prevalence of obesity increases globally, appreciating the effect of donor and recipient (DR) obesity on graft outcomes is of increasing importance.Methods: In a cohort of adult, kidney transplant recipients (2000–2017) identified using the SRTR, we used Cox proportional hazards models to examine the association between DR obesity pairing (body mass index (BMI) >30 kg/m2), and death-censored graft loss (DCGL) or all-cause graft loss, and logistic regression to examine risk of delayed graft function (DGF) and ≤30 days graft loss. We also explored the association of DR weight mismatch (>30 kg, 10-30 kg (D>R; D<R) and <10 kg (D = R)) with each outcome, stratifying by DR obesity pairing.Results: Relative to non-obese DR, obese DR were highest risk for all outcomes (DCGL: HR 1.26, 95% CI 1.22–1.32; all-cause graft loss: HR 1.09, 95% CI 1.06–1.12; DGF: OR 1.98, 95% CI 1.89–2.08; early graft loss: OR 1.34, 95% CI 1.19–1.51). Donor obesity modified the risk of recipient obesity and DCGL [p = 0.001] and all-cause graft loss [p < 0.001] but not DGF or early graft loss. The known association of DR weight mismatch with DCGL was attenuated when either the donor or recipient was obese.Conclusion: DR obesity status impacts early and late post-transplant outcomes.
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Affiliation(s)
- Faisal Jarrar
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Karthik K. Tennankore
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Division of Nephrology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Amanda J. Vinson
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Division of Nephrology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
- *Correspondence: Amanda J. Vinson,
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The Role of Donor Sex in Females Undergoing Repeat Kidney Transplant: Does Prior Donor Sex Matter? Transplant Direct 2022; 8:e1352. [PMID: 37077730 PMCID: PMC10109158 DOI: 10.1097/txd.0000000000001352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/11/2022] [Accepted: 05/25/2022] [Indexed: 11/26/2022] Open
Abstract
Female recipients of male donor kidneys are at increased risk for graft failure because of the HY antigen effect. However, whether prior transplant with a male donor impacts subsequent transplant outcomes is unknown. Therefore, the purpose of this study was to determine whether prior male-current male donor sex is associated with an increased risk of graft failure in female recipients. Methods We performed a cohort study of adult female recipients undergoing a second kidney transplant (2000-2017), identified using the Scientific Registry of Transplant Recipients. Using multivariable Cox models, we analyzed the risk of death-censored graft loss (DCGL) if the second transplant was from a male versus female kidney donor, conditional on donor sex at the time of the first transplant. In a secondary analysis, we stratified results by recipient age (>50 or ≤50 y) at the time of retransplant. Results Of 5594 repeat kidney transplants, 1397 (25.0%) developed DCGL. Overall, there was no association between first and second donor sex pairing and DCGL. A prior and current female donor (FD1FD2) posed a higher risk for DCGL in recipients aged >50 y at second transplant (hazard ratio,≤0.67, confidence interval 0.46-0.98, for all other donor combinations), but posed a lower risk if aged ≤50 y at retransplant (hazard ratio, ≥1.37, confidence interval 1.04-1.80, for all other donor combinations). Conclusions Overall, past-current donor sex pairing was not associated with DCGL in female recipients undergoing second kidney transplant; however, the risk with a past and current female donor was increased in older, and decreased in younger, female recipients at retransplant.
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Jan MY, Yaqub MS, Adebiyi OO, Taber TE, Anderson MD, Mishler DP, Burney HN, Li Y, Li X, Sharfuddin AA. Non-Directed Living Kidney Donation and Recipient Outcomes in the United States: a 20 year Review. Kidney Int Rep 2022; 7:1289-1305. [PMID: 35685320 PMCID: PMC9171626 DOI: 10.1016/j.ekir.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/19/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022] Open
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Barriers to the donation of living kidneys for kidney transplantation. Sci Rep 2022; 12:2397. [PMID: 35165350 PMCID: PMC8844293 DOI: 10.1038/s41598-022-06452-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 01/31/2022] [Indexed: 12/17/2022] Open
Abstract
Since the waiting time for deceased donor kidney transplantation continues to increase, living donor kidney transplantation is an important treatment for end stage kidney disease patients. Barriers to living kidney donation have been rarely investigated despite a growing interest in the utilization of living donor transplantation and the satisfaction of donor safety. Here, we retrospectively analyzed 1658 potential donors and 1273 potential recipients who visited the Seoul National University Hospital for living kidney transplantation between 2010 and 2017 to study the causes of donation discontinuation. Among 1658 potential donors, 902 (54.4%) failed to donate kidneys. The average number of potential donors that received work-up was 1.30 ± 0.66 per recipient. Among living donor kidney transplant patients, 75.1% received kidneys after work-up of the first donor and 24.9% needed work-up of two or more donors. Donor-related factors (49.2%) were the most common causes of donation discontinuation, followed by immunologic or size mismatches between donors and recipients (25.4%) and recipient-related factors (16.2%). Interestingly, withdrawal of donation consent along with refusal by recipients or family were the commonest causes, suggesting the importance of non-biomedical aspects. The elucidation of the barriers to living kidney donation could ensure more efficient and safer living kidney donation.
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Nguyen T, Sise ME, Delgado C, Williams W, Reese P, Goldberg D. Race, Education, and Gender Disparities in Transplantation of Kidneys From Hepatitis C Viremic Donors. Transplantation 2021; 105:1850-1857. [PMID: 33141804 PMCID: PMC8842824 DOI: 10.1097/tp.0000000000003511] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Transplantation of kidneys from hepatitis C virus (HCV)-viremic donors into HCV-negative patients followed by direct-acting antiviral therapy was an important breakthrough to increase the number of life-saving kidney transplants. Data suggest that these transplants offer several benefits; however, it is unknown whether adoption of this practice has been shared equitably, especially among disadvantaged groups. METHODS We evaluated United Network for Organ Sharing data on HCV-seronegative adult deceased-donor kidney transplant recipients from January 1, 2017, to June 12, 2020. We compared recipients of a kidney from an HCV antibody- (Ab-)/nucleic acid test- (NAT-), HCV Ab+/NAT-, and HCV NAT+ donor. The primary covariates were as follows: (1) race/ethnicity; (2) female sex; and (3) highest level of education. Models included variables associated with being offered an HCV NAT+ kidney. We fit mixed-effects multinomial logistic regression models with the center as a random effect to account for patient clustering. RESULTS Of 48 255 adult kidney-alone deceased-donor kidney transplant HCV-seronegative recipients, 1641 (3.4%) donors were HCV NAT+-, increasing from 0.3% (January 2017-June 2017) to 6.9% (January 2020-June 2020). In multivariable models, racial/ethnic minorities, women, and those with less education were significantly less likely to receive a kidney from an HCV NAT+ donor relative to an HCV Ab-/NAT- and HCV Ab+/NAT- donor. The disparities were most pronounced among Hispanic and Asian patients with less educational attainment (grade school, high school, or some college/tech school). CONCLUSIONS Despite an increase in transplants from HCV NAT+ donors, we found substantial racial/ethnic disparities in transplantation of these kidneys. These data highlight how the benefits of a scientific breakthrough are often made less available to disadvantaged patients.
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Affiliation(s)
- Tiffany Nguyen
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Meghan E. Sise
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School
| | - Cindy Delgado
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Winfred Williams
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School
| | - Peter Reese
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David Goldberg
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
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Vinson AJ, Tennankore KK, Kiberd BA. Donor-Recipient Matching in Kidney Transplant: We're Not There Yet. Transplant Proc 2021; 53:1909-1914. [PMID: 34272053 DOI: 10.1016/j.transproceed.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/20/2021] [Accepted: 05/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Strategic organ allocation is expected to prolong patient and graft survival after transplant. This study explored differences in graft survival when kidneys are allocated based on strategic donor-recipient (D-R) pairing vs with the existing Kidney Allocation System (KAS). METHODS Using the Scientific Registry of Transplant Recipients from 2000 to 2014, we used a multivariable Cox model to assess the hazard ratios (HRs) for death or graft failure among 3 hypothetical donor kidneys transplanted into 3 hypothetical recipients, relative to an ideally matched D-R pair. Median predicted survival for each of the 9 possible D-R pairing combinations was determined, and outcomes for strategic D-R pairing were compared with those obtained using the KAS for allocation. RESULTS A total of 31,607 patients (29.7%) died or developed graft loss over the study period. Strategic allocation of kidneys resulted in HRs for graft loss of 1.74 (95% confidence interval [CI], 1.41-2.14), 1.82 (95% CI, 1.46-2.26), and 1.74 (95% CI 1.38-2.19) for recipients 1, 2 and 3 respectively, whereas by following the KAS, HRs were 1.93 (95%, CI 1.63-2.28), 2.06 (95% CI, 1.74-2.44), and 1.93 (95% CI, 1.58-2.37); corresponding to 3.84, 11.39, and 7.40 months longer predicted patient or graft survival for recipients 1, 2 and 3 with strategic D-R pairing compared with the KAS. CONCLUSIONS Allocation of kidneys by strategic D-R pairing may improve graft survival relative to allocation using the KAS.
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Affiliation(s)
- A J Vinson
- (a)Division of Nephrology, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - K K Tennankore
- (a)Division of Nephrology, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - B A Kiberd
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Vinson A, Skinner T, Kiberd B, Clark D, Tennankore K. The differential impact of size mismatch in live versus deceased donor kidney transplant. Clin Transplant 2021; 35:e14310. [PMID: 33818840 DOI: 10.1111/ctr.14310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/03/2021] [Accepted: 03/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The impact of weight mismatch between donors and recipients (D-R) undergoing living-donor kidney transplant (LDKT) versus weight-matched deceased donor kidney transplant (DDKT) is not established. AIM To determine whether absolute weight mismatch between D-R affects graft survival following LDKT and how this relates to graft outcomes with DDKT when D-R are weight matched. MATERIALS & METHODS We used multivariable Cox proportional hazards models and the Scientific Registry of Transplant Recipients to determine the association of weight-mismatched D-R (>50 kg, 30-50 kg or 10-30 kg ((D < R); (D > R) and <10 kg (D = R)) with death-censored graft failure in US LDKT recipients from 2006 to 2017. We also explored outcomes relative to weight-matched DDKT and finally, the impact of combined D-R weight-sex mismatch. RESULTS In LDKT, the risk of graft loss was highest in the setting of D < R (HR 1.28, 95% CI 1.05-1.56 for >50 kg difference relative to D = R); however, this was still lower risk than weight-matched DDKT. D-R sex and combined weight-sex mismatch were only important for male recipients (HR 1.47, 95% CI 1.27-1.71 for a male recipient >30 kg larger than their female donor, relative to weight-matched male donor-male recipient). This remained superior to weight-sex-matched DDKT however. CONCLUSION D-R weight-sex mismatch is important in LDKT; however, graft survival remains superior to proceeding with matched DDKT. Optimizing D-R matching in LDKT could be facilitated through a national kidney-paired donation registry. LDKT weight-sex mismatch should not be deferred in favor of DDKT.
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Affiliation(s)
- Amanda Vinson
- Division of Nephrology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Tom Skinner
- Department of Urology, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Bryce Kiberd
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - David Clark
- Division of Nephrology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Karthik Tennankore
- Division of Nephrology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
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Risk factors for delayed graft function and their impact on graft outcomes in live donor kidney transplantation. Int Urol Nephrol 2021; 53:439-446. [PMID: 33394282 DOI: 10.1007/s11255-020-02687-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/14/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Delayed graft function (DGF) is a manifestation of acute kidney injury uniquely framed within the transplant process and a predictor of poor long-term graft function1. It is less common in the setting of living donor (LD) kidney transplantation. However, the detrimental impact of DGF on graft survival is more pronounced in LD2. PURPOSE To study the effects of DGF in the setting of LD kidney transplantation. METHODS We performed a retrospective analysis of LD kidney transplantations performed between 2010 and 2018 in the UNOS/OPTN database for DGF and its effect on graft survival. RESULTS A total of 42,736 LD recipients were identified, of whom 1115 (2.6%) developed DGF. Recipient dialysis status, male gender, diabetes, end-stage renal disease, donor age, right donor nephrectomy, panel reactive antibodies, HLA mismatch, and cold ischemia time were independent predictors of DGF. Three-year graft survival in patients with and without DGF was 89% and 95%, respectively. DGF was the greatest predictor of graft failure at three years (hazard ratio = 1.766, 95% CI: 1.514-2.059, P = 0.001) and was associated with higher rates of rejection (9% vs. 6.28%, P = 0.0003). Among patients with DGF, the graft survival rates with and without rejection were not different. CONCLUSION DGF is a major determinant of poor graft functional outcomes, independent of rejection.
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Xin Z, Wu L, Zhou J, Zhuang J, Peng W, Song T, Lin T, Lu X, Ying B. Analysis of Factors Influencing Kidney Function of Recipients After Renal Transplantation in Southwestern China: A Retrospective Study. Front Med (Lausanne) 2020; 7:519582. [PMID: 33282882 PMCID: PMC7689199 DOI: 10.3389/fmed.2020.519582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 10/19/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Factors influencing the kidney function of patients after renal transplantation include both recipient-related factors and donor-related factors. To gain a better understanding of these factors and to improve clinical decision-making, we performed a retrospective study of southwestern Chinese people receiving kidney transplantation. Methods: In this retrospective analysis, a total of 2,462 recipients receiving allogeneic kidney transplantation in West China Hospital of Sichuan University from December 13, 2008 to January 10, 2018 were included. Data on recipient and donor characteristics were extracted from the Transplant Center Database and stratified by discrete time points after kidney transplantation. Univariate and multivariate logistic regression analyses were carried out on the study variables, and kidney function of postoperative patients was monitored using cystatin C (CysC) as the outcome indicator. Results: From the univariate analysis, several factors showed statistically significant short-term impact on kidney function based on CysC after kidney transplantation, including age, ethnicity, body mass index (BMI), and HLA A-B-DR-DQ loci mismatch. Gender of recipients and gender-consistency between donors and recipients revealed both short-term and long-term influence. Younger donors had significantly better medium-and-long-term influence on kidney function. From the multivariate logistic regression analysis, recipient gender, ethnicity, BMI, and donor age were independent factors affecting postoperative CysC recovery at discrete time points. Conclusion: Several factors of recipients related to renal function after kidney transplantation, such as gender, ethnicity, BMI and donor's age should be paid more attention to. Moreover, female and non-Han recipients decreased the risk of poor outcome during postoperative kidney function recovery while large BMI of recipients and higher donor age increased the risk. It is useful to predict the postoperative renal function earlier according to corresponding factors, and improve the patient's quality of life.
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Affiliation(s)
- Zhaodan Xin
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Lijuan Wu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Juan Zhou
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Zhuang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Wu Peng
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Turun Song
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Lin
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaojun Lu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xiaojun Lu
| | - Binwu Ying
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
- Binwu Ying
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Donor-recipient Sex Differences Do Not Affect Survival Outcomes After Kidney Transplantation: A Population Cohort Study. Transplantation 2020; 104:1033-1040. [PMID: 31415037 DOI: 10.1097/tp.0000000000002915] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Donor factors can influence decision making for organ utilization for potential kidney transplant candidates. Prior studies exploring the effect of donor-recipient sex matching on kidney transplant outcomes have reported heterogenous and conflicting results. The aim of this contemporary population-cohort analysis was to explore the effect of donor-recipient sex matching on kidney transplant outcomes in the United Kingdom. METHODS In this retrospective, observational study, we analyzed all patients receiving kidney-alone transplants between 2003 and 2018 using UK Transplant Registry data. Stratified by recipient sex, outcomes were compared between male and female donors with univariable/multivariable analyses. RESULTS Data were analyzed for 25 140 recipients. Of these, 13 414 (53.4%) of kidneys were from male donors and 15 690 (62.4%) of recipients were male. The odds of initial graft dysfunction (delayed graft function/primary nonfunction) were significantly lower for female donor kidneys transplanted into both male (adjusted odds ratio = 0.89, 95% confidence interval [CI] = 0.80-0.98, P = 0.019) and female (adjusted odds ratio = 0.81, 95% CI = 0.71-0.93, P = 0.003) recipients. Male recipients of female donor kidneys had creatinine levels at 1 year that were 6.3% higher (95% CI = 4.8%-7.7%, P < 0.001) than male recipients of male donor kidneys, with a similar sex difference of 4.1% (95% CI = 2.1%-6.1%, P < 0.001) observed within female recipients. However, neither patient nor graft survival was found to differ significantly by donor sex on either univariable or multivariable analysis. CONCLUSIONS Our data provide contemporary data on sex mismatch for recipient counseling and reassurance with regards to equivalent long-term clinical outcomes based upon donor sex.
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Graňák K, Kováčiková L, Skálová P, Vnučák M, Miklušica J, Laca Ľ, Mokáň M, Dedinská I. Kidney Transplantation and "Sex Mismatch": A 10-Year Single-Center Analysis. Ann Transplant 2020; 25:e921117. [PMID: 32675801 PMCID: PMC7386832 DOI: 10.12659/aot.921117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The effect of a relative disproportion in the size of a transplanted kidney (KT) on graft function and survival is well documented. However, the importance of the H-Y antigen (male donor and female recipient) has not been unambiguously confirmed. Material/Methods Our retrospective analysis consists of 230 deceased donor/recipient pairs. The aim of the study was to determine the effect of sex mismatch between donors and recipients on the function of the graft and the graft and patient survival. Results In the group of male donors, a statistically significantly lower value of the eGFR (estimated glomerular filtration rate) was recorded for female recipients in the fifth year after the KT (=0.0047). The male donor/female recipient group was an independent risk factor for: eGFR (<60 ml/min (CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration) in the third year after KT [HR 0.1618; (P=0.0004)], acute rejection in the first year after KT [HR 1.8992; (P=0.0387)], and the 5-year graft survival was significantly worse in this group. By adjusting the results for age and induction, this group was at significantly higher risk for decreased graft function (eGFR <30 ml/min) if the age of the donor was ≤50 years old and the recipient was >45 years old in the fifth year [HR 11.1676; (P=0.0139)], the age of the donor was ≤50 years old/recipient was ≤45 years old in the third year [HR 1.2500; (P=0.0050)], and also in the fifth year after KT [HR 8.1993; (P=0.0183)]. Conclusions Based on our analysis, the differences in the incidence of acute rejection episodes as well as in graft survival among the different groups of patients were confirmed. The group with the highest risk, in cases of an acute rejection episode, is a male donor/female recipient.
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Affiliation(s)
- Karol Graňák
- Department of Surgery and Transplantation Center, University Hospital Martin, Jessenius Medical Faculty of Comenius University, Martin, Slovakia
| | - Lea Kováčiková
- Department of Surgery and Transplantation Center, University Hospital Martin, Jessenius Medical Faculty of Comenius University, Martin, Slovakia
| | - Petra Skálová
- Department of Surgery and Transplantation Center, University Hospital Martin, Jessenius Medical Faculty of Comenius University, Martin, Slovakia
| | - Matej Vnučák
- Department of Surgery and Transplantation Center, University Hospital Martin, Jessenius Medical Faculty of Comenius University, Martin, Slovakia
| | - Juraj Miklušica
- Department of Surgery and Transplantation Center, University Hospital Martin, Jessenius Medical Faculty of Comenius University, Martin, Slovakia
| | - Ľudovít Laca
- Department of Surgery and Transplantation Center, University Hospital Martin, Jessenius Medical Faculty of Comenius University, Martin, Slovakia
| | - Marián Mokáň
- 1st Department of Internal Diseases, University Hospital Martin, Jessenius Medical Faculty of Comenius University, Martin, Slovakia
| | - Ivana Dedinská
- Department of Surgery and Transplantation Center, University Hospital Martin, Jessenius Medical Faculty of Comenius University, Martin, Slovakia
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Tafulo S, Malheiro J, Dias L, Lobato L, Ramalhete L, Martinho A, Bolotinha C, Costa R, Ivo M. Improving HLA matching in living donor kidney transplantation using kidney paired exchange program. Transpl Immunol 2020; 62:101317. [PMID: 32634478 DOI: 10.1016/j.trim.2020.101317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The inclusion of compatible pairs within kidney paired exchange programs has been described as a way to enhance these programs. Improved immunological matching for the recipient in compatible pair has been described to be a possible benefit. METHODS The main purpose of our study was to determine if the introduction of compatible pairs in the Portuguese kidney paired exchange program would result in a better match for these patients, but also to assess if this strategy would increase the number of incompatible pairs with a possible match. We included 17 compatible pairs in kidney paired exchange pool of 35 pairs and performed an in-silico simulation determining HLA eplet mismatch load between the co-registered and matched pairs using HLA MatchMaker, version 3.0. RESULTS Our study showed that the inclusion of fully HLA-A, -B, -DR mismatched compatible pairs within the national Portuguese KEP increased matched rate within ICP (0.71%) and improved HLA eplet matching within compatible pairs. 16 of 17 (94.12%) of the CP obtained one or more transplants possibilities and 13 (81.25%) would have been transplanted with significantly lower HLA class I and class II total and antibody-verified eplet mismatch load (83.9 ± 16.9 vs. 59.8 ± 12.2, P = .002 and 30.1 ± 5.5 vs. 21.2 ± 3.0, P = .003, respectively). CONCLUSIONS This strategy is a viable alternative for compatible pairs seeking a better matched kidney and Portuguese KEP program should allow them this possibility.
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Affiliation(s)
- Sandra Tafulo
- Blood and Transplantation Center of Porto, Instituto Português do Sangue e da Transplantação, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal.
| | - Jorge Malheiro
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal; Department of Nephrology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Portugal
| | - Leonídio Dias
- Department of Nephrology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Portugal
| | - Luísa Lobato
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal; Department of Nephrology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Portugal
| | - Luís Ramalhete
- Blood and Transplantation Center of Lisbon, Instituto Português do Sangue e da Transplantação, Lisbon, Portugal
| | - António Martinho
- Blood and Transplantation Center of Coimbra, Instituto Português do Sangue e da Transplantação, Coimbra, Portugal
| | - Catarina Bolotinha
- National Transplantation Coordination, Instituto Português do Sangue e da Transplantação, Lisbon, Portugal
| | - Rita Costa
- National Transplantation Coordination, Instituto Português do Sangue e da Transplantação, Lisbon, Portugal
| | - Margarida Ivo
- National Transplantation Coordination, Instituto Português do Sangue e da Transplantação, Lisbon, Portugal
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Park WY, Kim JH, Ko EJ, Min JW, Ban TH, Yoon HE, Kim YS, Jin K, Yang CW, Han S, Chung BH. Impact of Kidney Donor Profile Index Scores on Post-Transplant Clinical Outcomes Between Elderly and Young Recipients, A Multicenter Cohort Study. Sci Rep 2020; 10:7009. [PMID: 32332846 PMCID: PMC7181596 DOI: 10.1038/s41598-020-64055-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/02/2020] [Indexed: 12/17/2022] Open
Abstract
We investigated if clinical outcomes after kidney transplantation (KT) from deceased donors (DDs) with high Kidney Donor Profile Index (KDPI) can be different according to the age of KT recipients (KTRs). Six-hundred fifty-seven KTRs from 526 DDs were included from four transplant centers. We divided KTRs into elderly-KTR and young-KTR groups based on age 60 and each group was subdivided into high- or low-KDPI subgroup based on KDPI score of 65%. We compared short-term and long-term clinical outcomes among those four subgroups (low KDPI-young KTR, low KDPI-elderly-KTR, high KDPI-young-KTR, high KDPI-elderly-KTR). In short-term outcomes including acute rejection, BK virus and CMV infection, there was no significant difference among the four subgroups. In the long-term outcomes, the development of cardiovascular disease was higher in the high KDPI-elderly-KTR group than the other groups. In comparison of allograft survival rate, the high KDPI-young KTR subgroup showed highest risk for allograft failure and there was significant interaction between high-KDPI donors and young-KTR on allograft survival rate (P = 0.002). However, there was no significant difference in comparison of the patient survival rate. In conclusion, clinical impact of high-KDPI in DDs on post-transplant allograft survival may be less significant in elderly-KTR than in young-KTR.
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Affiliation(s)
- Woo Yeong Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea.,Keimyung University Kidney Institute, Daegu, Republic of Korea
| | - Jeong Ho Kim
- Division of Nephrology, Department of Internal Medicine, Daejeon St. Mary's hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Eun Jung Ko
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji-Won Min
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Tae Hyun Ban
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye-Eun Yoon
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Young Soo Kim
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Uijeongbu St. Mary's hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Kyubok Jin
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea.,Keimyung University Kidney Institute, Daegu, Republic of Korea
| | - Chul Woo Yang
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seungyeup Han
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea. .,Keimyung University Kidney Institute, Daegu, Republic of Korea.
| | - Byung Ha Chung
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. .,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Abou-Jaoude MM, El-Helou E, Nasser HA, Kansoun AH. The impact of gender matching between donor and recipient on the outcome of kidney transplant patients: A retrospective study. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 30:1254-1265. [PMID: 31929272 DOI: 10.4103/1319-2442.275469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The influence of donor and recipient gender on patients postkidney transplant (KT) is still controversial, and literature data do not present unanimous conclusions. We were concerned with the gender impact on the outcome of kidney transplantation at the level of acute rejection (AR), graft function represented by serum creatinine level, delayed graft function (DGF), graft survival, and infection rate. The impact of gender matching between donors and recipients was studied in 299 KT recipients performed in the Transplantation Unit, Middle East Institute of Health, Bsalim, Lebanon, between November 1998 and September 2014. The patients were divided into the following groups: Group I (131 patients, male donor to male recipient), Group II (55 patients, male donor to female recipient), Group III (88 patients, female donor to male recipient), and Group IV (25 patients, female donor to female recipient). AR and DGF were not statistically different among the four groups. Moreover, all groups showed excellent graft survival with no statistical difference. Interestingly, human leukocyte antigen AB-DR matching (P < 0.001) and sensitization were statistically different among the four groups (P = 0.05). The number of patients with infections was statistically significantly lower in Group I (35.4%) and Group III (37.5%) (P = 0.35). Most importantly, graft function, represented by serum creatinine, showed a statistically significant difference among the four groups (P <0.004), with Group II (male to female) and Group IV (female to female) showing the best improvement in five-year survival. However, Group III (female to male) had the worst posttransplant graft function. These results revealed that gender impacts graft function, and Group II, male donor to female recipient, had the best 5-year graft function. This emphasizes that gender should be regarded as a determinant for the success of kidney transplantation.
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Affiliation(s)
- Maroun M Abou-Jaoude
- Transplantation Unit, Department of General Surgery, Middle East Institute of Health, Bsalim; Department of General Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Etienne El-Helou
- Department of General Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Haydar A Nasser
- Department of General Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Alaa H Kansoun
- Department of General Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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19
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Demeter J, Buck B, Zimmerman A, Mitro G, Rees M, Ortiz J. Alemtuzumab Induction Reduces Early Rejection in Female Renal Allograft Recipients: A Single Center Study. EXP CLIN TRANSPLANT 2019; 17:739-748. [DOI: 10.6002/ect.2017.0225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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Impact of adjusted kidney volume measured in the bench surgery on one-year renal function in kidney transplantation. PLoS One 2019; 14:e0224364. [PMID: 31682607 PMCID: PMC6827889 DOI: 10.1371/journal.pone.0224364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/13/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Kidney transplantation is the treatment of choice in patient with end stage chronic kidney disease, offering the best long term survival and greater Quality of Life in this group of patients. Graft volume was correlated with improved renal function in living donor transplantations. The primary aim of this study was to correlate renal volume adjusted to body surface area with renal function one year (estimated glomerular filtration rate; eGFR) after kidney transplantation. METHODS This single-center, prospective cohort study included 256 patients who underwent kidney transplantation from January 2011 through December 2015 at Hospital das Clínicas de Botucatu-UNESP. We evaluated three kidney measurements during the bench surgery; the final graft volume was calculated using the ellipsoid formula and adjusted to body surface area. RESULTS In the living donors there was positive correlation between adjusted graft volume and eGFR (r = 0.311, p = 0.008). Multivariate analysis revealed that low rejection rate and increased adjusted graft volume were independent factors correlated with eGFR. In deceased donors, there was no correlation between adjusted kidney volume and eGFR (r = 0.08, p = 0.279) in univariate analysis, but a multivariate analysis indicated that lower kidney donor profile index (KDPI), absence of rejection and high adjusted kidney volume were independent factors for better eGFR. CONCLUSION Adjusted kidney volume was positively correlated with a satisfactory eGFR at one year after living donor and deceased donor transplantations.
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21
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Coruh AG, Uzun C, Akkaya Z, Gulpinar B, Elhan A, Tuzuner A. Is There a Correlation with Pre-donation Kidney Volume and Renal Function in the Renal Transplant Recipient?: A Volumetric Computed Tomography Study. Transplant Proc 2019; 51:2312-2317. [DOI: 10.1016/j.transproceed.2019.02.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/01/2019] [Accepted: 02/17/2019] [Indexed: 01/28/2023]
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Effect of recipient-donor sex and weight mismatch on graft survival after deceased donor renal transplantation. PLoS One 2019; 14:e0214048. [PMID: 30925158 PMCID: PMC6440625 DOI: 10.1371/journal.pone.0214048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/06/2019] [Indexed: 12/05/2022] Open
Abstract
This study evaluated the combined effect of recipient-to-donor weight and sex mismatch after deceased-donor renal transplantation in a German transplant cohort and the evolution of recipient-to-donor weight difference over a 13-year observation period. The association of absolute weight and sex difference with graft failure was explored in an outpatient cohort of deceased-donor transplant recipients who underwent kidney transplantation between 2000 and 2012. Graft failure was defined as repeated need for dialysis or death with a functioning graft. Recipient and donor sex pairings were classified as sex concordant (MDMR/FDFR) or discordant (MDFR/FDMR). These classes were further stratified into four groups according to recipient-to-donor weight mismatch ≥10 kg (recipient > donor) or <10 kg (recipient < donor). Multivariable Cox proportional hazards models were applied to evaluate the time to graft loss adjusting for donor, immunologic, surgical, organizational, and recipient predictors. Sex-concordant transplant pairings <10 kg weight difference served as the reference group. Among 826 transplant recipients, 154 developed graft failure (18.6%). Median graft survival time was 3.9 years; first quartile (0.2–1.2), second quartile (1.2–2.9), third quartile (2.9–5.8), and fourth quartile (5.8–12.4). After multivariable adjustment, the highest relative hazard for graft failure was observed for sex-discordant transplant pairings with a ≥10 kg weight difference between recipient and donor (compared to the reference group MDMR/FDFR with weight difference <10 kg, MDMR/FDFR with weight difference ≥10 kg, hazard ratio 1.86, 95% confidence interval 1.07–3.32—p = 0.029; MDFR/FDMR with weight difference <10 kg, hazard ratio 1.14, 95% confidence interval 0.78–1.68—p = 0.507, and MDFR/FDMR with weight difference ≥10 kg, hazard ratio 2.00, 95% confidence interval 1.15–3.48—p = 0.014). A recipient-to-donor weight mismatch of ≥10 kg was associated with an increased risk of graft loss or recipient death with a functioning graft. Concurrent sex discordance seemed to enhance this effect as indicated by an increase in the hazard ratio. We detected no significant tendency for increasing recipient-to-donor weight differences from 2000 to 2012.
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Abstract
Abstract
Background: Chronic kidney disease represents a world-wide health problem affecting approximately 195 million women around the world. Risk of development of chronic kidney disease is greater in women; therefore, the World Kidney Day 2018 was dedicated to kidney disease, treatment options, and its specifics in female patients.
Materials and Methods: We retrospectively analysed a cohort of 1,457 patients after kidney transplantation from all transplant centres in Slovakia over a period of ten years from 2005 – 2015.The parameters taken into account were cause of end-stage renal disease (ESRD), outcome of transplantation in a context of differences between the genders.
Results: During the ten-year period there were 557 transplanted women vs. 900 men. Among female recipient the dominant cause of ESRD was tubulointerstitial nephritis (males 22.3% vs. females 32.1%, p < 0.0001), other causes of ESRD where females were significantly more represented than men included polycystic kidney disease (males 11.6% vs. females 17.6%, p = 0.0013) and systemic lupus erythematosus (males 0.2% vs. females 2.3 %, p = 0.0001). There was no significant difference in 12-month, 5-year, and 10-year both graft and patient survival rates between men and women. Female recipients wait for kidney transplantation significantly longer in spite of comparable time spent on dialysis (males 32.9 months vs. females 39.4 months, p < 0.0001).
Conclusion: Despite comparable patient and graft survival rates in male and female recipients in our study there are other studies showing that gender as well as gender mismatch significantly influence the outcomes of transplantation.
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Nonimmunologic Donor-Recipient Pairing, HLA Matching, and Graft Loss in Deceased Donor Kidney Transplantation. Transplant Direct 2018; 5:e414. [PMID: 30656212 PMCID: PMC6324912 DOI: 10.1097/txd.0000000000000856] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/05/2018] [Accepted: 11/10/2018] [Indexed: 12/31/2022] Open
Abstract
Background In kidney transplantation, nonimmunologic donor-recipient (D-R) pairing is generally not given the same consideration as immunologic matching. The aim of this study was to determine how nonimmunologic D-R pairing relates to independent donor and recipient factors, and to immunologic HLA match for predicting graft loss. Methods Seven D-R pairings (race, sex, age, weight, height, cytomegalovirus serostatus, and HLA match) were assessed for their association with the composite outcome of death or kidney graft loss using a Cox regression-based forward stepwise selection model. The best model for predicting graft loss (including nonimmunologic D-R pairings, independent D-R factors, and/or HLA match status) was determined using the Akaike Information Criterion. Results Twenty three thousand two hundred sixty two (29.9%) people in the derivation data set and 9892 (29.7%) in the validation data set developed the composite outcome of death or graft loss. A model that included both independent and D-R pairing variables best predicted graft loss. The c-indices for the derivation and validation models were 0.626 and 0.629, respectively. Size mismatch (MM) between donor and recipient (>30 kg [D < R} and >15 cm [D < R]) was associated with poor patient and graft survival even with 0 HLA MM, and conversely, an optimal D-R size pairing mitigated the risk of graft loss seen with 6 HLA MM. Conclusions D-R pairing is valuable in predicting patient and graft outcomes after kidney transplant. D-R size matching could offset the benefit and harm seen with 0 and 6 HLA MM, respectively. This is a novel finding.
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Avery LM, Fominaya CE, Crawford RC, Pleasants KP, Taber DJ. Characterization of Potentially Unsafe Ambulatory Antibiotic Use and Associated Outcomes in an Adult Kidney Transplant Population. Ann Pharmacother 2018; 52:974-982. [PMID: 29770702 DOI: 10.1177/1060028018776606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Antibiotics are frequently prescribed to kidney transplant (KTX) recipients in the outpatient setting, but there are limited data assessing the safety and outcomes associated with this practice. OBJECTIVE The primary objective of this study was to describe ambulatory antibiotic prescribing in a large cohort of adult KTX recipients. The secondary objective was to assess the outcomes associated with potentially unsafe antibiotic use in this population. METHODS National Veterans Health Administration data compiled between 2001 and 2010 were used to conduct a pharmacovigilance assessment of antibiotic prescribing, excluding intravenous agents, antifungals, antivirals, and prophylactic regimens. Multivariable Cox proportional hazard regression was used to determine the impact of safe and potentially unsafe antibiotic use on time to event for graft loss. RESULTS Among 5130 KTX recipients and 30 127 patient-years of follow-up, 14 259 antibiotic courses were prescribed at a rate of 0.47 courses per patient-year. Transplant or nephrology providers prescribed 24.8% of courses. Overall, 608 courses (4.3%) in 311 patients (6.1%) were considered potentially unsafe for dosages in disagreement with recommended adjustments for renal function, interaction with immunosuppressive regimens, and other pertinent safety concerns. After adjusting for baseline characteristics, unsafe antibiotic use was associated with a 40% higher risk of graft loss (adjusted hazard ratio = 1.40; 95% CI = 1.03-1.89; P = 0.030) compared with safe use. CONCLUSIONS AND RELEVANCE Although unsafe antibiotic prescribing was uncommon, it was associated with increased risk of graft loss. Prospective research is needed to elucidate whether the driver of poor outcomes is the safety of the antibiotic prescription or fragmented care.
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Affiliation(s)
| | | | - Rena C Crawford
- 1 Ralph H. Johnson VA Medical Center, Charleston, SC, USA.,2 Medical University of South Carolina, Charleston, SC, USA
| | | | - David J Taber
- 1 Ralph H. Johnson VA Medical Center, Charleston, SC, USA.,2 Medical University of South Carolina, Charleston, SC, USA
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26
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Wong L, Counihan A, O'Kelly P, Sexton DJ, O'Seaghdha CM, Magee C, Little D, Conlon PJ. The impact of donor and recipient weight incompatibility on renal transplant outcomes. Int Urol Nephrol 2017; 50:551-558. [PMID: 29139038 DOI: 10.1007/s11255-017-1745-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/06/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Donor/recipient size mismatching and correlation to allograft outcome remains poorly defined. This study assessed the impact of donor body weight (DBW) to recipient body weight (RBW) ratio on allograft function and survival. METHODS A total of 898 deceased donor renal transplant recipients were included in the study. Patients were divided into quartiles depending on the ratio of DBW/RBW: Q1 (≤ 0.88), Q2 (0.89-1.00), Q3 (1.01-1.22) and Q4 (> 1.22). Donor and recipient characteristics were obtained from the national kidney transplant service database. Serum creatinine and estimated glomerular filtration rate (eGFR) at 1 and 5 years after transplant were compared. RESULTS Q4 patients had a higher eGFR 1 year post-transplant (median 59.5 ml/min, IQR 46.8-76.2) compared to Q1-Q3 which had median eGFRs of 54.3, 54.8 and 55.3 ml/min, respectively (p < 0.001). At 5 years post-transplant, there were modest differences in the eGFR across the four quartiles, Q1-4 with median eGFRs of 56.9, 61.1, 61.2 and 58.6 ml/min, respectively (p = 0.02). However, there were no significant differences in 1- and 5-year allograft survival between groups. CONCLUSIONS In the setting of deceased donor renal transplantation, mismatching of donor to recipient weight had no impact on 5-year allograft survival, but a low DBW/RBW ratio is modestly associated with lower eGFR.
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Affiliation(s)
- Limy Wong
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin 9, Ireland.
| | - Aileen Counihan
- Department of Transplantation and Urology, Beaumont Hospital, Dublin, Ireland
| | - Patrick O'Kelly
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin 9, Ireland
| | - Donal J Sexton
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin 9, Ireland
| | - Conall M O'Seaghdha
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin 9, Ireland
| | - Colm Magee
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dilly Little
- Department of Transplantation and Urology, Beaumont Hospital, Dublin, Ireland
| | - Peter J Conlon
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
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Wang L, Wang X, Qu HY, Jiang S, Zhang J, Fu L, Buggs J, Pang B, Wei J, Liu R. Role of Kidneys in Sex Differences in Angiotensin II-Induced Hypertension. Hypertension 2017; 70:1219-1227. [PMID: 29061720 DOI: 10.1161/hypertensionaha.117.10052] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/10/2017] [Accepted: 09/26/2017] [Indexed: 12/31/2022]
Abstract
The significance of kidneys in regulation of sodium and water balance and hemodynamics has been demonstrated both in patients and animal models. In the present study, we tested our hypothesis that kidneys play an essential role in control of sex differences in angiotensin II (Ang II)-dependent hypertension. Kidney transplantations (KTXs) were performed between male (M) and female (F) C57BL/6 mice (donor→recipient: F→F, M→M, F→M, and M→F). Radiotelemetry transmitters were implanted for measurement of mean arterial pressure during the infusion of Ang II (600 ng·kg-1·min-1). Gene expressions and inflammatory responses in the transplanted grafts were assessed. We found that same-sex-KTX mice still exhibited sex differences in Ang II-dependent hypertension (31.3±0.8 mm Hg in M→M versus 12.2±0.6 mm Hg in F→F), which were reduced between males and females when they received kidneys of the opposite sex (32.9±1 mm Hg in M→F versus 22.3±0.7 mm Hg in F→M). The sex differences in gene expressions, including AT1R (angiotensin II receptor, type 1), AT1R/AT2R, ET-1 (endothelin-1), ETA (endothelin receptor type A), NHE3 (sodium-hydrogen exchanger 3), α-ENaC (α-epithelial sodium channel), and γ-ENaC, were unaltered in same-sex KTXs and much lessened in cross-sex KTXs. In addition, the cross-sex KTXs exhibited more robust inflammatory responses reflected by higher expression of IL-6 (interleukin 6), TNFα (tumor necrosis factor α), and KC (keratinocyte-derived chemokine) than same-sex KTX. Our results indicate that kidneys play an essential role in sex differences of Ang II-dependent hypertension. KTX of male kidneys to females augmented the blood pressure response, whereas KTX of female kidneys to males attenuated the blood pressure response. The host's extrarenal systems modulate expressions of many genes and inflammatory response, which may also contribute to the sex differences in blood pressure regulation.
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Affiliation(s)
- Lei Wang
- From the Department of Molecular Pharmacology and Physiology, University of South Florida College of Medicine, Tampa (L.W., X.W., H.Y.Q., S.J., J.Z., B.P., J.W., R.L.); and Pathology (L.F.) and Tampa General Medical Group Transplant Surgery (J.B.), Tampa General Hospital, FL.
| | - Ximing Wang
- From the Department of Molecular Pharmacology and Physiology, University of South Florida College of Medicine, Tampa (L.W., X.W., H.Y.Q., S.J., J.Z., B.P., J.W., R.L.); and Pathology (L.F.) and Tampa General Medical Group Transplant Surgery (J.B.), Tampa General Hospital, FL
| | - Helena Y Qu
- From the Department of Molecular Pharmacology and Physiology, University of South Florida College of Medicine, Tampa (L.W., X.W., H.Y.Q., S.J., J.Z., B.P., J.W., R.L.); and Pathology (L.F.) and Tampa General Medical Group Transplant Surgery (J.B.), Tampa General Hospital, FL
| | - Shan Jiang
- From the Department of Molecular Pharmacology and Physiology, University of South Florida College of Medicine, Tampa (L.W., X.W., H.Y.Q., S.J., J.Z., B.P., J.W., R.L.); and Pathology (L.F.) and Tampa General Medical Group Transplant Surgery (J.B.), Tampa General Hospital, FL
| | - Jie Zhang
- From the Department of Molecular Pharmacology and Physiology, University of South Florida College of Medicine, Tampa (L.W., X.W., H.Y.Q., S.J., J.Z., B.P., J.W., R.L.); and Pathology (L.F.) and Tampa General Medical Group Transplant Surgery (J.B.), Tampa General Hospital, FL
| | - Liying Fu
- From the Department of Molecular Pharmacology and Physiology, University of South Florida College of Medicine, Tampa (L.W., X.W., H.Y.Q., S.J., J.Z., B.P., J.W., R.L.); and Pathology (L.F.) and Tampa General Medical Group Transplant Surgery (J.B.), Tampa General Hospital, FL
| | - Jacentha Buggs
- From the Department of Molecular Pharmacology and Physiology, University of South Florida College of Medicine, Tampa (L.W., X.W., H.Y.Q., S.J., J.Z., B.P., J.W., R.L.); and Pathology (L.F.) and Tampa General Medical Group Transplant Surgery (J.B.), Tampa General Hospital, FL
| | - Bo Pang
- From the Department of Molecular Pharmacology and Physiology, University of South Florida College of Medicine, Tampa (L.W., X.W., H.Y.Q., S.J., J.Z., B.P., J.W., R.L.); and Pathology (L.F.) and Tampa General Medical Group Transplant Surgery (J.B.), Tampa General Hospital, FL
| | - Jin Wei
- From the Department of Molecular Pharmacology and Physiology, University of South Florida College of Medicine, Tampa (L.W., X.W., H.Y.Q., S.J., J.Z., B.P., J.W., R.L.); and Pathology (L.F.) and Tampa General Medical Group Transplant Surgery (J.B.), Tampa General Hospital, FL
| | - Ruisheng Liu
- From the Department of Molecular Pharmacology and Physiology, University of South Florida College of Medicine, Tampa (L.W., X.W., H.Y.Q., S.J., J.Z., B.P., J.W., R.L.); and Pathology (L.F.) and Tampa General Medical Group Transplant Surgery (J.B.), Tampa General Hospital, FL
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Impact and Application of Donor/Recipient Body Surface Area on Kidney Transplantation from Pediatric Donor to Adult Recipient. Transplant Proc 2017; 48:3274-3278. [PMID: 27931568 DOI: 10.1016/j.transproceed.2016.09.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 08/05/2016] [Accepted: 09/14/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Insufficient nephron dosing is closely associated with poor graft function and graft loss. Donor/recipient body surface area (D/R BSA) has been proven to be one of the useful predictors for sufficient nephron dosing. However, little is known regarding the impact and application of D/R BSA on kidney transplantation from pediatric donor to adult recipient. METHODS We retrospectively analyzed 26 cases of kidney transplantations from pediatric donors to adult recipients, which were performed in our center from 2010 through 2014. Patients were divided into 2 groups based on D/R BSA: group A, <0.8; and group B, ≥0.8. All recipients received a single kidney. Demographics of donors and recipients, early postoperative complications, estimated glomerular filtration rate (eGFR), and short-term (≤1 y) graft survival were compared between groups to evaluate the impact of D/R BSA on kidney transplantations from pediatric donors. RESULTS All demographics and early postoperative complications of group A were similar to those of group B (P > .05). eGFR in group A and group B at 1, 3, 6, and 12 months after transplantation were: 63.2 ± 5.0 vs 74.0 ± 7.6 (P = .008), 66.2 ± 4.9 vs 75.8 ± 5.9 (P = .004), 69.0 ± 4.8 vs 79.0 ± 6.3 (P = .004), and 69.4 ± 7.9 vs 79.2 ± 8.4 (P = .033). Short-term graft survival of group A was inferior to that of group B (62.5% vs 94.4%; P = .042). CONCLUSIONS We conclude that recipients with high D/R BSA are more likely to have better graft function. It is possible to make optimal allocation of pediatric donor kidneys on the basis of D/R BSA ≥0.8.
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Miller AJ, Kiberd BA, Alwayn IP, Odutayo A, Tennankore KK. Donor-Recipient Weight and Sex Mismatch and the Risk of Graft Loss in Renal Transplantation. Clin J Am Soc Nephrol 2017; 12:669-676. [PMID: 28360198 PMCID: PMC5383387 DOI: 10.2215/cjn.07660716] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 01/03/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Relatively smaller kidney donor to recipient size is proposed to result in higher graft loss due to nephron underdosing and hyperfiltration injury, but the potentially additive effect of sex and weight mismatch has not been explored in detail. The purpose of this study was to determine if concurrent donor and recipient absolute weight and sex mismatch was associated with graft loss in a cohort of deceased donor kidney transplant recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The association of kidney donor and recipient absolute weight and sex difference with death-censored graft loss was explored using a cohort of United States deceased donor recipients between 2000 and 2014 through the Scientific Registry of Transplants Recipients. Donor-recipient sex pairings (male donor-male recipient; female donor-female recipient; male donor-female recipient; female donor-male recipient) were further stratified by donor and recipient absolute weight difference (>30 or 10-30 kg [donorrecipient] or <10 kg [donor=recipient]) resulting in 20 weight and sex pairings. Time to death-censored graft loss for each pairing was evaluated using multivariable Cox proportional hazards models adjusting for donor, immunologic, surgical, and recipient predictors of graft loss compared with the reference group of male donor-male recipients with no weight mismatch (<10 kg difference). RESULTS Of 115,124 kidney transplant recipients, 21,261 developed death-censored graft failure (median graft survival time was 3.8 years; quartile 1 to 3, 0.0 to 14.8 years). After multivariable adjustment, the highest relative hazards for graft failure were observed for female recipients of male donor kidneys and male recipients of female donor kidneys in situations where the recipient was >30 kg larger than donor (hazard ratio, 1.50; 95% confidence interval, 1.32 to 1.70; hazard ratio, 1.35; 95% confidence interval, 1.25 to 1.45, respectively). CONCLUSIONS A concurrent mismatch in donor-recipient weight (donor
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Affiliation(s)
| | | | - Ian P. Alwayn
- Department of General Surgery, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and
| | - Ayo Odutayo
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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Saadi MG, El-Khashab SO, Mahmoud RMA. Study of graft survival rates of renal transplants in Cairo University Hospitals. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2016. [DOI: 10.4103/1110-7782.203296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Goryainov VA, Kaabak MM, Babenko NN, Morozova MM, Platova EN, Agureeva LI, Dymova OV, Panin VV. [The effect of gender on the results of related kidney transplantation]. Khirurgiia (Mosk) 2016:62-67. [PMID: 27296125 DOI: 10.17116/hirurgia2016662-67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIM To define the effect of donor and recipient gender on the results of kidney transplantation from living related donor. MATERIAL AND METHODS Group of 271 patients who underwent kidney transplantation from living related donor was analyzed. There were 115 women and 156 men. Age varied from 1 to 63 years (mean 21.30±12.32). There were 127 children aged 1-18 years (mean 11.28±4.63) and 144 adults aged 19-63 years (mean 29.81±11.24). Donors included 162 women and 109 men. Overall survival was calculated using Kaplan-Mayer. Mortality and incidence of transplants failure were determined using Fisher's exact test. RESULTS All patients were divided into 2 groups depending on recipients' gender and then into 4 subgroups depending on gender of donors and recipients. Comparative statistical analysis showed that transplants survival was higher in women vs. men (T=2.7, p=0.007). Survival of patients was similar in both groups. Moreover it was the best in subgroup of recipients-women with kidneys from donors-men. Difference was statistically significant (T=2.16, p=0.03). There was no significant difference in all other cases. CONCLUSION The results of kidney transplantation are better in recipients-women than in men.
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Affiliation(s)
- V A Goryainov
- B.V. Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - M M Kaabak
- B.V. Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - N N Babenko
- B.V. Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - M M Morozova
- B.V. Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - E N Platova
- B.V. Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - L I Agureeva
- B.V. Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - O V Dymova
- B.V. Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - V V Panin
- B.V. Petrovsky Russian Research Center of Surgery, Moscow, Russia
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Puoti F, Ricci A, Nanni-Costa A, Ricciardi W, Malorni W, Ortona E. Organ transplantation and gender differences: a paradigmatic example of intertwining between biological and sociocultural determinants. Biol Sex Differ 2016; 7:35. [PMID: 27471591 PMCID: PMC4964018 DOI: 10.1186/s13293-016-0088-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/19/2016] [Indexed: 11/20/2022] Open
Abstract
Organ transplantation, e.g., of the heart, liver, or kidney, is nowadays a routine strategy to counteract several lethal human pathologies. From literature data and from data obtained in Italy, a striking scenario appears well evident: women are more often donors than recipients. On the other hand, recipients of organs are mainly males, probably reflecting a gender bias in the incidence of transplant-related pathologies. The impact of sex mismatch on transplant outcome remains debated, even though donor-recipient sex mismatch, due to biological matters, appears undesirable in female recipients. In our opinion, the analysis of how sex and gender can interact and affect grafting success could represent a mandatory task for the management of organ transplantation.
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Affiliation(s)
- Francesca Puoti
- National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Andrea Ricci
- National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | | | - Walter Ricciardi
- National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy ; Section of Gender Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Walter Malorni
- Section of Gender Medicine, Istituto Superiore di Sanità, Rome, Italy ; Department of Therapeutic Research and Medicine Evaluation, Section of Cell Aging and Degeneration, Istituto Superiore di Sanità, viale Regina Elena 299, 00161, Rome, Italy
| | - Elena Ortona
- Section of Gender Medicine, Istituto Superiore di Sanità, Rome, Italy
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Aufhauser DD, Wang Z, Murken DR, Bhatti TR, Wang Y, Ge G, Redfield RR, Abt PL, Wang L, Svoronos N, Thomasson A, Reese PP, Hancock WW, Levine MH. Improved renal ischemia tolerance in females influences kidney transplantation outcomes. J Clin Invest 2016; 126:1968-77. [PMID: 27088798 DOI: 10.1172/jci84712] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 02/05/2016] [Indexed: 01/25/2023] Open
Abstract
Experimentally, females show an improved ability to recover from ischemia-reperfusion injury (IRI) compared with males; however, this sex-dependent response is less established in humans. Here, we developed a series of murine renal ischemia and transplant models to investigate sex-specific effects on recovery after IRI. We found that IRI tolerance is profoundly increased in female mice compared with that observed in male mice and discovered an intermediate phenotype after neutering of either sex. Transplantation of adult kidneys from either sex into a recipient of the opposite sex followed by ischemia at a remote time resulted in ischemia recovery that reflected the sex of the recipient, not the donor, revealing that the host sex determines recovery. Likewise, renal IRI was exacerbated in female estrogen receptor α-KO mice, while female mice receiving supplemental estrogen before ischemia were protected. We examined data from the United Network for Organ Sharing (UNOS) to determine whether there is an association between sex and delayed graft function (DGF) in patients who received deceased donor renal transplants. A multivariable logistic regression analysis determined that there was a greater association with DGF in male recipients than in female recipients. Together, our results demonstrate that sex affects renal IRI tolerance in mice and humans and indicate that estrogen administration has potential as a therapeutic intervention to clinically improve ischemia tolerance.
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Jinfeng L, Jia L, Tao G, Wenjun S, Xinlu P, Yonghua F, Guiwen F. Donor kidney glomerular filtration rate and donor/recipient body surface area ratio influence graft function in living related kidney transplantation. Ren Fail 2015; 37:576-81. [PMID: 25644971 DOI: 10.3109/0886022x.2015.1007805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study seeks to account for the possibility that single kidney glomerular filtration rate (SKGFR) and donor/recipient (D/R) body surface area (BSA) ratio could act as cofactors for evaluating potential living related donors. METHODS The study population included 204 cases of LKRs with a functional graft that were regularly followed up for more than 2 years. Based on SKGFR and D/R BSA ratio, the recipients were divided into six groups: group A (SKGFR < 40 mL/min, D/R BSA ratio ≤ 0.8), group B (SKGFR < 40 mL/min, 0.8 < D/R BSA ratio < 1.2), group C (SKGFR < 40 mL/min, D/R BSA ratio ≥ 1.2), group D (SKGFR ≥ 40 mL/min, D/R BSA ratio ≤ 0.8), group E (SKGFR ≥ 40 mL/min, 0.8 < D/R BSA ratio < 1.2), and group F (SKGFR ≥ 40 mL/min, D/R BSA ratio ≥ 1.2). The database included donor, recipient, and transplant variables. Renal function of the recipients was recorded at 1 week, 2 weeks, 1 month, 3 months, 6 months, 12 months, and 24 months post-transplantation, respectively. RESULTS The declining rate of SCr and graft eGFR in stable periods post-transplantation in group A were always worse than the other five groups, and the difference was statistically significant (p < 0.05). The declining rate of SCr and graft eGFR in stable periods post-transplantation in groups C and F were always better than the other four groups, and the difference was statistically significant (p < 0.05). CONCLUSIONS Both SKGFR and D/R BSA ratio should be considered for choosing potential living related donors. Donors with SKGFR < 40 mL/min and D/R BSA ratio ≤ 0.8 should be carefully selected. Satisfactory graft function in donors with SKGFR < 40 ml could be achieved if their D/R BSA ratio is >0.8.
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Affiliation(s)
- Li Jinfeng
- Kidney Transplantation Center, the First Affiliated Hospital of Zhengzhou University, Key Disciplines Laboratory Clinical-Medicine Henan , Zhengzhou , People's Republic of China and
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Chen PD, Tsai MK, Lee CY, Yang CY, Hu RH, Lee PH, Lai HS. Gender differences in renal transplant graft survival. J Formos Med Assoc 2013; 112:783-8. [PMID: 24246256 DOI: 10.1016/j.jfma.2013.10.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 09/17/2013] [Accepted: 10/04/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND/PURPOSE A long-term retrospective study was conducted to assess the risk factors of renal transplant graft failure focusing on the effects of gender of both the donor and the recipient. METHODS Medical records of primary renal transplantation performed in a single transplant hospital were reviewed. Cases of ABO incompatibility, positive cross-matches, or multiple organ transplants were excluded. A total of 766 patient records were reviewed, and variables were analyzed with Kaplan-Meier survival curves and Cox regression to determine the independent factors associated with graft survival. RESULTS The overall 5-year graft and patient survival rates were 84.7% and 92.2%, respectively. Univariate analysis showed significantly poorer prognosis in male patients and in those with acute rejection, delayed function, or more mismatches in human lymphocyte antigens. Multivariate analysis with step-wise regression identified three independent prognostic factors for poor graft survival (male gender, acute rejection, and delayed function). The 5-year graft survival rates for female and male patients were 87.9% and 81.3%, respectively. The risk ratio of graft failure for male renal transplant recipients was 1.3732, when compared with that for female patients. The risk ratios for those with acute rejection and delayed function were 1.8330 and 1.5422, respectively. CONCLUSION Male gender, in addition to acute rejection and delayed function, was found to be an independent prognostic factor for poor renal transplant survival in this long-term retrospective study.
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Affiliation(s)
- Po-Da Chen
- Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Meng-Kun Tsai
- Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Chih-Yuan Lee
- Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Ching-Yao Yang
- Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Rey-Heng Hu
- Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Po-Huang Lee
- Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Hong-Shiee Lai
- Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
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Donor and recipient size mismatch in adolescents undergoing living-donor renal transplantation affect long-term graft survival. Transplantation 2013; 96:555-9. [PMID: 23838999 DOI: 10.1097/tp.0b013e31829d672c] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Controversies exist in the adult literature regarding the use of kidneys from small donors into larger recipients. Little is known regarding this issue in pediatric kidney transplantation. To assess the impact of donor/recipient size mismatch on long-term renal graft survival in pediatric patients undergoing living-donor renal transplantation. METHODS We reviewed the United Network for Organ Sharing database from 1987 to 2010 for adolescent (11-18 years old) patients who underwent primary living-donor renal transplantation. According to donor/recipient body surface area (BSA) ratio, patients were stratified into two categories: BSA ratio <0.9 and ≥0.9. Graft survival rates were compared between these two groups using Kaplan-Meier survival curves and Cox proportional hazards models. RESULTS Of the 1880 patients identified, 116 (6.2%) had a donor/recipient BSA ratio <0.9 and 1764 (93.8%) had a donor/recipient BSA ratio ≥0.9 group. BSA ratio <0.9 conferred an increased risk of graft loss (adjusted hazard ratio, 1.61; 95% confidence interval, 1.13-2.27; P=0.008). Patients with a donor/recipient BSA ratio ≥0.9 group had a significantly longer graft survival compared with those with a donor/recipient BSA ratio <0.9 after adjustment for donor age and gender, recipient age, gender, ethnicity, cause of renal failure, as well as clinical factors, such as cold and warm ischemia time and HLA mismatch. CONCLUSION We conclude that low donor/recipient BSA ratio was associated with an increased risk of graft loss. Appropriate size matching conferred better long-term graft survival in adolescents receiving live-donor kidney transplants.
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Zhou JY, Cheng J, Huang HF, Shen Y, Jiang Y, Chen JH. The effect of donor-recipient gender mismatch on short- and long-term graft survival in kidney transplantation: a systematic review and meta-analysis. Clin Transplant 2013; 27:764-71. [PMID: 23879398 DOI: 10.1111/ctr.12191] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is no limitation of gender matching in renal transplantation. This study was intended to evaluate its effect on short- and long-term graft survival. METHODS PubMed, the Web of Knowledge, Medline, the Cochrane Library, and two additional Chinese databases were searched. The data were then abstracted and meta-analyzed. RESULTS 14 studies involving 445 279 patients were included. Each study reported data on the four gender matches (male donor-male recipient, MDMR; male donor-female recipient, MDFR; female donor-male recipient, FDMR; female donor-female recipient, FDFR). The pooled risk ratios (RRs) for 0.5-, 1-, 2-, 3-, 5-, and 10-yr graft survival rates showed that the FDMR group had the worst outcomes, and when recipients were female, short-term graft survival was worse, but long-term graft survival was better. The differences between groups changed with time. CONCLUSIONS FDMR patients showed poor graft survival. The female recipients had worse short-term graft survival but the best long-term graft survival. This study introduces an important consideration into donor-recipient matching in renal transplantation.
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Affiliation(s)
- Jing-Yi Zhou
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Alvarez A, Moreno P, Illana J, Espinosa D, Baamonde C, Arango E, Algar FJ, Salvatierra A. Influence of donor-recipient gender mismatch on graft function and survival following lung transplantation. Interact Cardiovasc Thorac Surg 2013; 16:426-35. [PMID: 23322094 DOI: 10.1093/icvts/ivs570] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES In current practice, donors and recipients are not matched for gender in lung transplantation. However, some data have suggested a possible effect of gender combinations on lung transplant outcomes. We examined whether donor-recipient (D/R) gender mismatch is related to adverse outcomes after lung transplantation in terms of early and long-term graft function and survival. METHODS We reviewed 256 donors and lung transplant recipients over a 14-year period. Patients were distributed into four groups: Group A (D/R: female/female), Group B (D/R: male/male), Group C (D/R: female/male), Group D (D/R: male/female). Donor and recipient variables were compared among groups, including early graft function, 30-day mortality, freedom from bronchiolitis obliterans syndrome (BOS), and long-term survival. RESULTS Group A: 57 (22%), Group B: 99 (39%), Group C: 62 (24%), Group D: 38 (15%) transplants (P = 0.001). Donor age was 29 ± 14, 27 ± 12, 33 ± 13 and 23 ± 12 years for Groups A, B, C and D, respectively (P = 0.004). Recipient age was 31 ± 15, 44 ± 17, 42 ± 16 and 30 ± 16 years for Groups A, B, C and D, respectively (P = 0.000). PaO2/FiO2 (mmHg) 24 h post-transplant was: Group A: 276 ± 144, Group B: 297 ± 131, Group C: 344 ± 133 and Group D: 238 ± 138 (P = 0.015). Primary graft dysfunction developed in 23, 14, 17 and 21% of recipients from Groups A, B, C and D, respectively (P = 0.45). Operative mortality was 4.4, 6.5, 5.2 and 2%, for recipients from Groups A, B, C and D, respectively (P = 0.66). Freedom from BOS was 73, 59 and 36% for gender-matched transplants vs 76, 67 and 40% for gender-mismatched transplants at 3, 5 and 10 years, respectively (P = 0.618), without differences among groups. A non-significant survival benefit was observed for female recipients, irrespective of the donor gender. CONCLUSIONS Donor-recipient gender mismatch does not have a negative impact on early graft function and mortality following lung transplantation. There is a trend towards a survival benefit for female recipients, irrespective of the donor gender.
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Affiliation(s)
- Antonio Alvarez
- Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofía, Córdoba, Spain.
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Liu G, Li X, Liu T, Zhao X, Zhang S, Wang J, Ji C, Gan W, Guo H. Gender disparity of living donor renal transplantation in East China. Clin Transplant 2012; 27:98-103. [PMID: 22931405 DOI: 10.1111/ctr.12003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2012] [Indexed: 11/29/2022]
Abstract
Gender disparity among living kidney donors is common world wide, which demonstrates different social and economic problems in different countries. However, few data are available for China. Therefore, we retrospectively analyzed all 139 living donor renal transplants performed in our center between 2003 and 2010. The annual number of living donor renal transplants increased from six to 26 cases per year during the observation period. Among them, 69.2% of all kidney donors were females, whereas 79.5% of the recipients were male. The average age of recipients was 34.1 ± 7.6 yr and 94% (110/117) were younger than 44 yr. In contrast, 53% (62/117) of all donors were "middle-aged" (45-59 yr) with an average donor age of 47.8 ± 9.2 yr. The first-degree relatives accounted for the majority of the donor pool, as the most common donor-recipient combination consisted of mother to son. In conclusion, there was a male and young preponderance among recipients, and a female and middle-aged one among donors of living kidney transplants in our transplant center, which might be related to socio-cultural as well as economic factors.
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Affiliation(s)
- Guangxiang Liu
- Department of Urology and Kidney Transplant Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Pabón M, Navarro C, Martin R, Rodríguez M, Martin I, Gaitán L, Gómez A, Lozano E. Minor Histocompatibility Antigens as Risk Factor for Poor Prognosis in Kidney Transplantation. Transplant Proc 2011; 43:3319-23. [DOI: 10.1016/j.transproceed.2011.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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