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De Marco E, Corona D, Origlio F, Giuffrida G, Gioco R, Palermo C, Privitera F, Giaquinta A, Ilari A, D'Errico S, Pinto F, Carbone F, Carbonaro A, Veroux P, Veroux M. Impact of Incidental Findings During the Evaluation of Live Kidney Donors on Post-Transplant Outcomes: A Single Center Analysis. Transplant Proc 2019; 51:2906-2909. [PMID: 31543275 DOI: 10.1016/j.transproceed.2019.04.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND A careful assessment of a living donor is mandatory to minimize the short- and long-term risk related to kidney donation. In this study, we evaluated the incidence of incidental findings (IFs) in a large population of potential living kidney donors. Moreover, this study evaluated if the presence of IFs could influence the chance of living kidney donation and post-transplant outcomes. METHODS One hundred and sixty consecutive potential prospective living kidney transplant donors, who underwent a multidetector computed tomography angiography (MDCTA), were included in the study. An IF was defined as an incidentally discovered mass or lesion, detected by computed tomography angiography during the imaging evaluation of potential living donors. Clinical outcomes of living donors with IF were compared with those without IF. RESULTS In 10 patients (6.2%) an incidental finding was detected at MDCTA assessment. Among the 10 patients presenting with an IF, 7 patients (4.3%) were excluded from the living donation: 2 patients with an adrenal lesion, 3 patients with cancer, and 2 patients with a large (>8 cm) renal cyst. Graft and patient survival of kidney transplant recipients of donors with IFs were not significantly different to those receiving a kidney from living donors without IFs. CONCLUSIONS Incidental findings are frequently discovered during living kidney donor evaluation. Whereas most are asymptomatic or not clinically relevant, predonation screening could identify potentially life-threatening diseases at an earlier stage, allowing for a more radical treatment.
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Affiliation(s)
- Ester De Marco
- Organ Transplant Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Daniela Corona
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Flavio Origlio
- Organ Transplant Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | | | - Rossella Gioco
- Organ Transplant Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Chiara Palermo
- Organ Transplant Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Francesca Privitera
- Endocrine Surgery Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Alessia Giaquinta
- Organ Transplant Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Alba Ilari
- Endocrine Surgery Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Sara D'Errico
- Endocrine Surgery Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Flavia Pinto
- Endocrine Surgery Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Fausto Carbone
- Organ Transplant Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Anna Carbonaro
- Organ Transplant Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Pierfrancesco Veroux
- Organ Transplant Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Massimiliano Veroux
- Organ Transplant Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy; Endocrine Surgery Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy.
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Braga LSDS, Moratelli L, Carminatti M, Marsicano EO, Colugnati FAB, Sanders-Pinheiro H. Low-Activity Kidney Transplant Center, A Single-Center Experience: Early Care as a Major Challenge. EXP CLIN TRANSPLANT 2016; 14. [PMID: 27364327 DOI: 10.6002/ect.2015.0345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES In many countries, some kidney transplants are performed in small centers, from which clinical data are rarely specifically reported. The aim of this study was to describe patient and graft survival rates and their correlates in a low-activity kidney transplant center. MATERIALS AND METHODS We performed a retrospective cohort study of all patients who underwent transplant between January 2002 and May 2012 at a university hospital. Patient, graft, and death-censored graft survival rates were assessed with Kaplan-Meier analyses and compared by log-rank test, with associated factors analyzed by Cox proportional hazards modeling. RESULTS Among a total of 162 patients, the mean age was 41.8 ± 13.5 years, and 92% received a living-donor graft. At 1, 3, and 5 years, patient survival was 88.6%, 86%, and 82.9%. Graft survival was 86.9%, 83%, and 77%, and death-censored graft survival was 98.1%, 96.6%, and 92.9% at the same time points. Most graft losses were due to patient death from infection and occurred within the first year after transplant. After adjustment, age over 42 years (hazard ratio of 3.94; 95% confidence interval, 1.39-11.13), deceased donor graft (hazard ratio of 11.41; 95% confidence interval, 1.2-108.35), and higher average education (hazard ratio of 4.96; 95% confidence interval, 1.01-24.32) were independently associated with graft loss. CONCLUSIONS The observed patient and graft survival rates were similar to those described in large databases; however, early mortality remains a major challenge. Improving posttransplant care is a key issue to increasing survival in small transplant centers.
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Affiliation(s)
- Luciane Senra de Souza Braga
- From the Division of Nephrology, Federal University of Juiz de Fora Hospital, and the Interdisciplinary Center for Studies and Research in Nephrology (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
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Garg AX, Muirhead N, Knoll G, Yang RC, Prasad GVR, Thiessen-Philbrook H, Rosas-Arellano MP, Housawi A, Boudville N. Proteinuria and reduced kidney function in living kidney donors: A systematic review, meta-analysis, and meta-regression. Kidney Int 2006; 70:1801-10. [PMID: 17003822 DOI: 10.1038/sj.ki.5001819] [Citation(s) in RCA: 262] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
We reviewed any study where 10 or more healthy adults donated a kidney, and proteinuria, or glomerular filtration rate (GFR) was assessed at least 1 year later. Bibliographic databases were searched until November 2005. 31 primary authors provided additional information. Forty-eight studies from 27 countries followed a total of 5048 donors. An average of 7 years after donation (range 1-25 years), the average 24 h urine protein was 154 mg/day and the average GFR was 86 ml/min. In eight studies which reported GFR in categories, 12% of donors developed a GFR between 30 and 59 ml/min (range 0-28%), and 0.2% a GFR less than 30 ml/min (range 0-2.2%). In controlled studies urinary protein was higher in donors and became more pronounced with time (three studies totaling 59 controls and 129 donors; controls 83 mg/day, donors 147 mg/day, weighted mean difference 66 mg/day, 95% confidence interval (CI) 24-108). An initial decrement in GFR after donation was not accompanied by accelerated losses over that anticipated with normal aging (six studies totaling 189 controls and 239 donors; controls 96 ml/min, donors 84 ml/min, weighted mean difference 10 ml/min, 95% CI 6-15; difference not associated with time after donation (P=0.2)). Kidney donation results in small increases in urinary protein. An initial decrement in GFR is not followed by accelerated losses over a subsequent 15 years. Future studies will provide better estimates, and identify those donors at least risk of long-term morbidity.
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Affiliation(s)
- A X Garg
- Division of Nephrology, University of Western Ontario, London, Ontario, Canada.
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Srivastava A, Sinha T, Varma PP, Karan SC, Sandhu AS, Sethi GS, Khanna R, Talwar R, Narang V. Experience with marginal living related kidney donors: Are they becoming routine or are there still any doubts? Urology 2005; 66:971-5. [PMID: 16286105 DOI: 10.1016/j.urology.2005.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Revised: 04/11/2005] [Accepted: 05/05/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To analyze donor and recipient outcome of grafts from marginal kidney donors (ie, elderly or suffering from some anomaly). METHODS We had 81 marginal donors from July 1996 to July 2004; 46 were older than 60 years, and 39 had renal or nonrenal anomaly. The donors and recipients were evaluated for morbidity, graft and recipient survival, and the number of rejection episodes. RESULTS The mean (+/- standard deviation) age of elderly donors was 62.2 +/- 3.1 years. Follow-up ranged from 6 months to 50 months (mean 21.15 +/- 0.9 months). Actuarial 1-year and 3-year graft survival rates were 95% and 81%, respectively. Twenty-six percent of recipients maintained serum creatinine levels less than 1.4 mg/dL. The mean age of hypertensive donors was 46.2 years, and blood pressure was controlled with one drug. Serum creatinine levels in the recipients were less than 1.4 mg/dL in 10 and less than 2.5 mg/dL in the rest. Eleven percent of hypertensive donors required an increase in their antihypertensive medication. All donors showed a 15% to 20% increase in their glomerular filtration rate. Donors underwent simultaneous surgery when indicated. CONCLUSIONS Criteria to reject donors need to be reviewed periodically. The elderly and donors with other anomalies are consistently showing acceptable results. Hypertensive donors require assessment with awake ambulatory blood pressure monitoring.
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Affiliation(s)
- Anand Srivastava
- Department of Urology, Army Hospital (Research & Referral), Delhi, India.
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