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Pereira LDNG, Nogueira PCK. Non-standard criteria donors in pediatric kidney transplantation. Pediatr Transplant 2019; 23:e13452. [PMID: 31066489 DOI: 10.1111/petr.13452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/20/2019] [Accepted: 03/22/2019] [Indexed: 12/21/2022]
Abstract
KT remains the treatment of choice for ESRD in children. However, the demand for kidney transplants continues to outstrip supply, even in the pediatric scenario. We reviewed the applicability of nonSCDs for pediatric KT. There is a lack of studies analyzing this modality among pediatric donors and recipients, where most conclusions are based on predictions from adult data. Nevertheless, marginal donors might be a reasonable option in selected cases. For example, the use of older LDs is an acceptable option, with outcomes comparable to SCDs. Organs donated after cardiac death represent another possibility, albeit with logistic, ethical, and legal limitations in some countries. AKI donors also constitute an option in special situations, although there are no pediatric data on these transplants. Likewise, there are no data on the use of expanded criteria donors in pediatric patients, but this appears not to be a good option, considering the compromised long-term survival.
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Affiliation(s)
| | - Paulo Cesar Koch Nogueira
- Pediatric Nephrology Division, Pediatric Department, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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2
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Eccher A, Cima L, Ciangherotti A, Montin U, Violi P, Carraro A, Tedeschi U, Nacchia F, Fior F, Rostand M, Boschiero L, D'Errico A, Scarpa A, Casartelli-Liviero M, Ferrari G, Rodini V, Tomaselli E, Zampicinini L, Vanzo F, Bovo C, Feltrin G, Neil D, Brunelli M. Rapid screening for malignancy in organ donors: 15-year experience with the Verona “Alert” protocol and review of the literature. Clin Transplant 2017; 31:e13045. [DOI: 10.1111/ctr.13045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Albino Eccher
- Pathology Unit; Department of Diagnostics and Public Health; University and Hospital Trust of Verona; Verona Italy
| | - Luca Cima
- Pathology Unit; Department of Diagnostics and Public Health; University and Hospital Trust of Verona; Verona Italy
| | - Andrea Ciangherotti
- Department of Surgical Science; General and Hepatobiliary Surgery; University and Hospital Trust of Verona; Verona Italy
| | - Umberto Montin
- Liver Transplant Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Paola Violi
- Liver Transplant Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Amedeo Carraro
- Liver Transplant Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Umberto Tedeschi
- Liver Transplant Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Francesco Nacchia
- Department of Surgical Science; Kidney Transplant Center; University and Hospital Trust of Verona; Verona Italy
| | - Francesca Fior
- Department of Surgical Science; Kidney Transplant Center; University and Hospital Trust of Verona; Verona Italy
| | - Momo Rostand
- Department of Surgical Science; Kidney Transplant Center; University and Hospital Trust of Verona; Verona Italy
| | - Luigino Boschiero
- Department of Surgical Science; Kidney Transplant Center; University and Hospital Trust of Verona; Verona Italy
| | - Antonietta D'Errico
- Pathology Unit; Department of Specialised; Experimental and Diagnostic Medicine; S. Orsola-Malpighi University Hospital of Bologna; Bologna Italy
| | - Aldo Scarpa
- Pathology Unit; Department of Diagnostics and Public Health; University and Hospital Trust of Verona; Verona Italy
| | - Marilena Casartelli-Liviero
- Neurosurgery and Intensive Care Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Giuseppe Ferrari
- Neurosurgery and Intensive Care Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Viviana Rodini
- Neurosurgery and Intensive Care Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Elisabetta Tomaselli
- Neurosurgery and Intensive Care Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Laura Zampicinini
- Neurosurgery and Intensive Care Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Francesca Vanzo
- Arsenàl, Veneto's Research Center for eHealth Innovation; Veneto Italy
| | - Chiara Bovo
- Medical Direction; University and Hospital Trust of Verona; Verona Italy
| | - Giuseppe Feltrin
- Transplant Regional Center; Veneto Region; Hospital Trust of Padova; Padova Italy
| | - Desley Neil
- Pathology Unit; Department of Histopathology; Queen Elizabeth Hospital Birmingham; Birmingham UK
| | - Matteo Brunelli
- Pathology Unit; Department of Diagnostics and Public Health; University and Hospital Trust of Verona; Verona Italy
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Thuret R, Kleinclauss F, Terrier N, Timsit MO. [Deceased donation in renal transplantation]. Prog Urol 2016; 26:909-939. [PMID: 27727092 DOI: 10.1016/j.purol.2016.08.021] [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: 08/23/2016] [Accepted: 08/23/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To review epidemiologic data's and medical results of deceased donation in renal transplantation. MATERIAL AND METHODS Relevant publications were identified through Medline (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) database using the following keywords, alone or in association, "brain death; cardiac arrest; deceased donation; organ procurement; transplantation". Articles were selected according to methods, language of publication and relevance. The reference lists were used to identify additional historical studies of interest. Both prospective and retrospective series, in French and English, as well as review articles and recommendations were selected. In addition, French national transplant and health agencies (http://www.agence-biomedecine.fr and http://www.has-sante.fr) databases were screened using identical keywords. A total of 2498 articles, 8 official reports and 17 newspaper articles were identified; after careful selection 157 publications were eligible for our review. RESULTS Deceased donation may involve either brain death or non-heartbeating donors (NHBD). Organ shortage led to the procurement of organs from expanded-criteria donors, with an increased age at donation and extended vascular disease, leading to inferior results after transplantation and underlining the need for careful donor management during brain death or cardiac arrest. Evolution of French legislation covering bioethics allowed procurement from Maastricht categories II and recently III non-heartbeating donors. CONCLUSION The increase of organ shortage emphasizes the need for a rigorous surgical technique during procurement to avoid loss of transplants. A history or current neoplasm in deceased-donors, requires attention to increase the pool of organs without putting the recipients at risk for cancer transmission. French NHBD program, especially from Maastricht category III, may stand for a potential source of valuable organs.
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Affiliation(s)
- R Thuret
- Service d'urologie et transplantation rénale, CHU de Montpellier, 34090 Montpellier, France; Université de Montpellier, 34090 Montpellier, France.
| | - F Kleinclauss
- Service d'urologie et transplantation rénale, CHRU de Besançon, 25030 Besançon, France; Université de Franche-Comté, 25030 Besançon, France; Inserm UMR 1098, 25030 Besançon, France
| | - N Terrier
- Service d'urologie et transplantation rénale, CHU de Grenoble, 38000 Grenoble, France
| | - M O Timsit
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, 75006 Paris, France
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Kaltenborn A, Nolte A, Schwager Y, Littbarski SA, Emmanouilidis N, Arelin V, Klempnauer J, Schrem H. Identification of patients at risk for renal impairment after living donor kidney transplantation. Langenbecks Arch Surg 2016; 401:1219-1229. [PMID: 27502290 DOI: 10.1007/s00423-016-1492-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 07/29/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE Outcome after living donor kidney transplantation is highly relevant, since recipient and donor were exposed to notable harm. Reliable identification of risk factors is necessary. METHODS Three hundred sixty-six living donor kidney transplants were included in this observational retrospective study. Relevant risk factors for renal impairment 1 year after transplantation and delayed graft function were identified with univariable and multivariable binary logistic regression and ordinal regression analysis. RESULTS Eighty-four patients (26.6 %) suffered from renal impairment KDIGO stage ≥4 1 year post-transplant; median estimated glomerular filtration rate was 35.3 ml/min. In multivariable ordinal regression, male recipient sex (p < 0.001), recipient body mass index (p = 0.006), donor age (p = 0.002) and high percentages of panel reactive antibodies (p = 0.021) were revealed as independent risk factors for higher KDIGO stages. After adjustment for post-transplant data, recipient male sex (p < 0.001), donor age (p = 0.026) and decreased early renal function at the first post-transplant outpatient visit (p < 0.001) were identified as independent risk factors. Delayed graft function was independently associated with long stay on the waiting list (p = 0.011), high donor body mass index (p = 0.043), prolonged warm ischemic time (p = 0.016) and the presence of preformed donor-specific antibodies (p = 0.043). CONCLUSIONS Broadening the donor pool with non-blood related donors seems to be legitimate, although with respect to careful medical selection, since donor age in combination with male recipient sex were shown to be risk factors for decreased graft function. Warm ischemic time and waiting time need to be kept as short as possible to avoid delayed graft function. Transplantation across HLA and ABO borders did not affect outcome significantly.
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Affiliation(s)
- Alexander Kaltenborn
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany. .,Department of Trauma and Orthopaedic Surgery, Federal Armed Forces Hospital Westerstede, Westerstede, Germany.
| | - Almut Nolte
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.,Ministry of Defence, Bonn, Germany
| | - Ysabell Schwager
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Simon A Littbarski
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Nikos Emmanouilidis
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Viktor Arelin
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.,Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Jürgen Klempnauer
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Harald Schrem
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.,Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
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Skalski M, Gierej B, Ziarkiewicz-Wróblewska B, Hołówko W, Krawczyk M. Prostate Cancer in Deceased Liver Donors. Transplant Proc 2016; 48:1378-80. [DOI: 10.1016/j.transproceed.2016.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/16/2016] [Accepted: 03/01/2016] [Indexed: 11/30/2022]
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Ogawa Y, Kojima K, Mannami R, Mannami M, Kitajima K, Nishi M, Ito S, Mitsuhata N, Afuso H. Transplantation of Restored Kidneys From Unrelated Donors After Resection of Renal Cell Carcinoma: Results From 10 Patients. Transplant Proc 2016; 47:1711-9. [PMID: 26293039 DOI: 10.1016/j.transproceed.2015.06.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/02/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE To relieve the chronic shortage of donor kidneys, we conducted a prospective kidney transplantation trial using kidneys removed from 10 unrelated patients (51 to 79 years of age) who had undergone nephrectomy for small renal cell carcinoma (1.5 to 3.9 cm) of low-to-moderate complexity based on RENAL (radius, exophytic/endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior/posterior location relative to polar lines) nephrometry (objective description helpful for operative indication and planning). METHODS Donors were selected from among 15 patients who opted to undergo nephrectomy for small renal cell carcinoma. A total of 76 dialysis patients 34 to 85 years of age who agreed to undergo restored kidney transplantation were recruited as transplant candidates. RESULTS In stage 1 (5 cases), high-risk patients were selected without human leukocyte antigen testing, and accelerated acute rejection occurred in 4 of 5 recipients. This trial was subsequently extended with human leukocyte antigen testing, and an additional 5 patients were enrolled in stage 2. Eight recipients, including 4 recipients with a history of renal transplantation, experienced rejection; 1 patient resumed dialysis 35 months after transplantation. The most recent serum creatinine levels ranged from 1.10 to 3.19 mg/dL in the 9 recipients with functioning grafts and from 0.84 to 4.68 mg/dL in the 10 donors. No tumor recurrence was noted at 32 to 58 months after surgery in either the recipients or the donors. CONCLUSIONS Restored kidney transplantation using kidneys with a small renal tumor seems suitable for carefully selected high-risk recipients and, in particular, elderly kidneys can also function well. Avoiding cancer transmission, fair recipient selection, close follow-up, and a well-organized tracking system warrant further study.
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Affiliation(s)
- Y Ogawa
- Department of Urology, Tokyo-West Tokushukai Hospital, Akishima-city, Tokyo-to, Japan.
| | - K Kojima
- Department of Urology, Uwajima Tokushukai Hospital, Uwajima-city, Japan
| | - R Mannami
- Department of Urology, Uwajima Tokushukai Hospital, Uwajima-city, Japan
| | - M Mannami
- Department of Urology, Uwajima Tokushukai Hospital, Uwajima-city, Japan
| | - K Kitajima
- Department of Urology, Kagoshima Tokushukai Hospital, Kagoshima-city, Japan
| | - M Nishi
- Department of Urology, Saint Martin's Hospital, Sakaide-city, Japan
| | - S Ito
- Department of Urology, Kure-Kyosai Hospital, Kure-city, Japan
| | - N Mitsuhata
- Department of Urology, Kure-Kyosai Hospital, Kure-city, Japan
| | - H Afuso
- Department of Urology, Okinawa Chubu Tokushukai Hospital, Okinawa-city, Japan
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Murthy RK, Chisolm SS, Stoff BK. A pigmented lesion on a brain-dead organ donor: Should the dermatologist intervene before transplant? J Am Acad Dermatol 2015; 73:1062-5. [PMID: 26568341 DOI: 10.1016/j.jaad.2015.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 07/25/2015] [Accepted: 08/14/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Rajini K Murthy
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Sarah S Chisolm
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Benjamin K Stoff
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Department of Dermatology, The Emory Center for Ethics, Atlanta, Georgia.
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