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Early Referral, Living Donation, and Preemptive Kidney Transplant. Transplant Proc 2022; 54:615-621. [PMID: 35246327 DOI: 10.1016/j.transproceed.2021.11.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/16/2021] [Accepted: 11/18/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Preemptive kidney transplant (PKT) is recognized as the most beneficial and cost-effective form of renal replacement therapy among patients with end-stage renal disease. Despite optimal outcomes and improved quality of life associated with PKT, its use as a first renal replacement therapy remains low among patients with end-stage renal disease. The goal of this retrospective cohort study was to compare, among adult kidney transplant recipients, characteristics across PKT status. METHODS We compared the characteristics of patients who did and did not have a PKT over 5 years, from 2010 to 2014, using the electronic health records of Kaiser Permanente Mid-Atlantic States. RESULTS A total of 233 patients received a kidney-alone transplant, and, of these, 44 patients (19%) were PKT and 189 patients (81%) were non-PKT. Of the patients in the PKT group, 43% received a kidney from a deceased donor. PKT recipients were more often White, had polycystic kidney disease or glomerulonephritis, received a living donor organ, and were transplanted at certain transplant centers. Estimated glomerular filtration rate on listing for those who received a deceased donor transplant was higher in PKT than non-PKT patients listed pre-dialysis. CONCLUSIONS PKT was associated with having a living kidney donor and with having a higher estimated glomerular filtration rate at listing for deceased donor recipients.
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Michelet D, Brasher C, Marsac L, Zanoun N, Assefi M, Elghoneimi A, Dauger S, Dahmani S. Intraoperative hemodynamic factors predicting early postoperative renal function in pediatric kidney transplantation. Paediatr Anaesth 2017; 27:927-934. [PMID: 28736994 DOI: 10.1111/pan.13201] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The anesthetic management of kidney transplantation in children remains somewhat empirical. The goal of the present study was to investigate intraoperative hemodynamic factors affecting posttransplantation kidney function. METHODS We performed a retrospective analysis of data from patients undergoing kidney transplantation in our pediatric teaching hospital from 2000 to 2014. Data collected included: donor and recipient demographic data, recipient comorbidities, fluids administered intraoperatively, and intraoperative blood pressure and central venous pressure. The main outcome of the study was the creatinine clearance at day 1 corrected to a body surface area of 1.73 m². Analysis was performed using Classification Tree Analysis with 10-fold cross-validation. RESULTS One hundred and two patients were included. The following predictors of increased postoperative creatinine clearance at day 1 were identified: decreasing recipient weight, mean blood pressure-to-weight ratio 10 minutes after reperfusion, reduced cold ischemia duration, and increased intraoperative albumin infusion. Increased creatinine clearance was observed when mean blood pressure-to-weight ratio 10 minutes after reperfusion was ≥4.3 in patients weighing 13-21 kg and ≥2.5 in those ≥22 kg. Overall, the model explained 64% (and at cross-validation 60%) of creatinine clearance variability at day 1. CONCLUSION Intraoperative hemodynamics during kidney transplantation should be optimized in order to increase mean blood pressure according to values indicated by our analyses. Cold ischemia duration should be shortened as far as possible.
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Affiliation(s)
- Daphné Michelet
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France
| | - Christopher Brasher
- Department of Anesthesia & Pain Management, Royal Children's Hospital, Melbourne, Australia.,Anesthesia and Pain Management Research Group, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Lucile Marsac
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France
| | - Nabil Zanoun
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France
| | - Mona Assefi
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France
| | - Alaa Elghoneimi
- Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France.,Department of general and urological surgery, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,DHU PROTECT, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Stephane Dauger
- Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France.,DHU PROTECT, INSERM U1141, Robert Debré University Hospital, Paris, France.,Departement of Paediatric Intensive Care, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France
| | - Souhayl Dahmani
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France.,DHU PROTECT, INSERM U1141, Robert Debré University Hospital, Paris, France
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Bozkurt B, Kumru AÖ, Dumlu EG, Tokaç M, Koçak H, Süleymanlar G, Dinçkan A. Patient and graft survival after pre-emptive versus non-pre-emptive kidney transplantation: a single-center experience from Turkey. Transplant Proc 2013; 45:932-4. [PMID: 23622591 DOI: 10.1016/j.transproceed.2013.02.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We sought to report the graft and patients survival of pre-emptive and non-pre-emptive kidney transplantations performed in our center. METHODS The 859 subjects showed a mean age of 36.1 years and included 64.6%; males, who received grafts from living (n = 665) or deceased (n = 194) donors between January 2008 and June 2011. We reviewed their medical records retrospectively, to separately pre-emptive versus non-pre-emptive recipients for year transplant outcomes. RESULTS Among the 859 patients, 153 (17.8%) underwent pre-emptive and 706 (82.2%), non-pre-emptive kidney transplantations. The rate of living donors was higher in the pre-emptive group (97.4% vs 73%, respectively). The 1-year graft survivals were 99.3% and 95.8% in pre-emptive and non-pre-emptive transplantation groups, respectively (P > .05). There was no significant difference between groups with respect to patient survival at 1 year (P > .05). CONCLUSION In conclusion, graft and patient survival rates between pre-emptive and non-pre-emptive kidney transplantation cases were comparable at 1 year. Pre-emptive kidney transplantation, which eliminates hemodialysis costs and complications, should be preferred as the optimal renal replacement therapy for end-stage renal disease patients.
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Affiliation(s)
- B Bozkurt
- Atatürk Training and Research Hospital, Clinic of Surgery, Organ Transplantation Center, Ankara, Turkey.
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Luo M, Qiu F, Wang Y, Zhou Z. Preemptive deceased-donor renal transplant in adults: single-center experience and outcome. EXP CLIN TRANSPLANT 2012; 10:101-4. [PMID: 22432751 DOI: 10.6002/ect.2011.0094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Preemptive renal transplant has been associated with better survival of both the allograft and the recipient than has conventional renal transplant. It remains unclear, however, whether preemptive transplant is optimal for renal replacement therapy. We describe our experience with preemptive renal transplant. MATERIALS AND METHODS We retrospectively analyzed 32 preemptive and 132 nonpreemptive deceased-donor renal transplants performed in our center between January 2006 and January 2008. RESULTS The mean follow-up was 47.44 ± 11.92 months in the preemptive group, compared with 47.49 ± 14.87 months in the nonpreemptive group. The 1-, 3-, and 5-year patient survival rates were 93.8%, 90.6%, and 90.6% in the preemptive group, and 92.4%, 90.9%, and 87.6% in the nonpreemptive group; and the 1-, 3-, and 5-year graft survival rates were 93.8%, 93.8%, and 93.8% in the preemptive, and 89.4%, 85.6%, and 73.8% in the nonpreemptive group. None of these differences was statistically significant. Rates of acute rejection (P = .04) and delayed graft function (P = .03) were significantly lower in the preemptive group. The mean plasma creatinine levels at 1 day before transplant and at 1 and 12 months after transplant were 715.16 ± 114.92 μmol/L, 113.15 ± 29.17 μmol/L, and 94.59 ± 18.56 μmol/L in the preemptive group, and 772.62 ± 111.38 μmol/L, 118.46 ± 30.94 μmol/L, and 100.78 ± 15.03 μmol/L in the nonpreemptive group. None of these differences was statistically significant. CONCLUSIONS Preemptive transplant can yield outcomes comparable to those of renal transplant after dialysis, and result in better quality of life for patients with end-stage renal disease, as well as reduced cost. Preemptive transplant is a better choice for renal replacement therapy, if possible.
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Affiliation(s)
- Ming Luo
- Transplantation Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Coritsidis GN, Linden E, Stern AS. The role of the primary care physician in managing early stages of chronic kidney disease. Postgrad Med 2011; 123:177-85. [PMID: 21904100 DOI: 10.3810/pgm.2011.09.2473] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Recent increases in obesity, diabetes, and hypertension, along with the aging of the US population, are driving a dramatic rise in the prevalence of chronic kidney disease (CKD). Despite this increase, the majority of Americans with early-stage CKD remain unaware of their disease. Primary care physicians are at the forefront of efforts for early recognition of CKD and management to control its progression. Patients with CKD should be referred to nephrologists no later than the point at which their estimated glomerular filtration rate reaches 30 mL/min. Nephrology evaluation at this point is essential to facilitate timely preparation for care of end-stage renal disease through preemptive transplantation or planned transition to dialysis. In addition to stringent control of underlying hypertension and/or diabetes, mineral metabolic parameters (serum parathyroid hormone, phosphorus, calcium, and bicarbonate) in patients with advancing CKD should be managed closely to avoid adverse effects on the cardiovascular and skeletal systems.
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