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Punukollu R, Ryan M, Misra S, Budhiraja P, Ohara S, Kumm K, Guerra G, Reddy KS, Heilman R, Jadlowiec CC. Past, Current, and Future Perspectives on Transplanting Acute Kidney Injury Kidneys. Clin Pract 2023; 13:944-958. [PMID: 37623267 PMCID: PMC10453697 DOI: 10.3390/clinpract13040086] [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: 05/10/2023] [Revised: 07/24/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background: Acute kidney injury (AKI) kidneys have high non-utilization rates due to concerns regarding unfavorable outcomes. In this paper, we aimed to review the past, present, and future opinions on AKI kidneys. (2) Methods: A PubMed search was conducted for topics relevant to AKI kidney transplantation. (3) Results: Current short- and long-term data on AKI kidneys have demonstrated good outcomes including favorable graft function and survival. The role of procurement biopsies is controversial, but they have been shown to be beneficial in AKI kidneys by allowing clinicians to differentiate between reversible tubular injury and irreversible cortical necrosis. Machine perfusion has also been applied to AKI kidneys and has been shown to reduce delayed graft function (DGF). The incidence of DGF increases with AKI severity and its management can be challenging. Strategies employed to counteract this have included early initiation of dialysis after kidney transplantation, early targeting of adequate immunosuppression levels to minimize rejection risk, and establishment of outpatient dialysis. (4) Conclusions: Despite good outcomes, there continue to be barriers that impact AKI kidney utilization. Successful strategies have included use of procurement biopsies or machine perfusion and expectant management of DGF. With increasing experience, better use of AKI kidneys can result in additional opportunities to expand the donor pool.
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Affiliation(s)
- Rachana Punukollu
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Margaret Ryan
- Division of Anatomic Pathology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Suman Misra
- Division of Nephrology, Mayo Clinic, Phoenix, AZ 85054, USA
| | | | - Stephanie Ohara
- Division of Surgery, Valleywise Health Medical Center, Creighton University, Phoenix, AZ 85008, USA
| | - Kayla Kumm
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Giselle Guerra
- Division of Nephrology, Miami Transplant Institute, Miami, FL 33136, USA
| | - Kunam S. Reddy
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
| | | | - Caroline C. Jadlowiec
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
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2
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Kidney Donation after circulatory death: The Veneto Region experience in Italy. TRANSPLANTATION REPORTS 2023. [DOI: 10.1016/j.tpr.2023.100129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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3
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Zagni M, Croci GA, Cannavò A, Passamonti SM, De Feo T, Boggio FL, Cribiù FM, Maggioni M, Ferrero S, Gobbo AD, Gianelli U. Histological evaluation of ischaemic alterations in donors after cardiac death: A useful tool to predict post‐transplant renal function. Clin Transplant 2022; 36:e14622. [DOI: 10.1111/ctr.14622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Moreno Zagni
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Giorgio Alberto Croci
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
- Department of Pathophysiology and Transplantation University of Milan Medical School Fondazione IRCCS Ca' Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Antonino Cannavò
- North Italy Transplant program (NITp) UOC Coordinamento Trapianti Fondazione IRCCS Ca' Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Serena Maria Passamonti
- North Italy Transplant program (NITp) UOC Coordinamento Trapianti Fondazione IRCCS Ca' Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Tullia De Feo
- North Italy Transplant program (NITp) UOC Coordinamento Trapianti Fondazione IRCCS Ca' Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Francesca Laura Boggio
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Fulvia Milena Cribiù
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Marco Maggioni
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Stefano Ferrero
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
- Department of Biomedical Surgical and Dental Sciences University of Milan Milan Italy
| | - Alessandro Del Gobbo
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Umberto Gianelli
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
- Department of Pathophysiology and Transplantation University of Milan Medical School Fondazione IRCCS Ca' Granda ‐ Ospedale Maggiore Policlinico Milan Italy
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Liapis H, Gaut JP, Klein C, Bagnasco S, Kraus E, Farris AB, Honsova E, Perkowska‐Ptasinska A, David D, Goldberg J, Smith M, Mengel M, Haas M, Seshan S, Pegas KL, Horwedel T, Paliwa Y, Gao X, Landsittel D, Randhawa P. Banff Histopathological Consensus Criteria for Preimplantation Kidney Biopsies. Am J Transplant 2017; 17:140-150. [PMID: 27333454 PMCID: PMC6139430 DOI: 10.1111/ajt.13929] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 01/25/2023]
Abstract
The Banff working group on preimplantation biopsy was established to develop consensus criteria (best practice guidelines) for the interpretation of preimplantation kidney biopsies. Digitally scanned slides were used (i) to evaluate interobserver variability of histopathologic findings, comparing frozen sections with formalin-fixed, paraffin-embedded tissue of wedge and needle core biopsies, and (ii) to correlate consensus histopathologic findings with graft outcome in a cohort of biopsies from international medical centers. Intraclass correlations (ICCs) and univariable and multivariable statistical analyses were performed. Good to fair reproducibility was observed in semiquantitative scores for percentage of glomerulosclerosis, arterial intimal fibrosis and interstitial fibrosis on frozen wedge biopsies. Evaluation of frozen wedge and core biopsies was comparable for number of glomeruli, but needle biopsies showed worse ICCs for glomerulosclerosis, interstitial fibrosis and tubular atrophy. A consensus evaluation form is provided to help standardize the reporting of histopathologic lesions in donor biopsies. It should be recognized that histologic parameters may not correlate with graft outcome in studies based on organs deemed to be acceptable after careful clinical assessment. Significant limitations remain in the assessment of implantation biopsies.
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Affiliation(s)
- H. Liapis
- Department of Pathology & ImmunologyWashington University School of MedicineSt LouisMO,NephropathLittle RockAR
| | - J. P. Gaut
- Department of Pathology & ImmunologyWashington University School of MedicineSt LouisMO
| | | | - S. Bagnasco
- Department of Pathology & Internal MedicineJohns Hopkins University HospitalBaltimoreMD
| | - E. Kraus
- Department of Pathology & Internal MedicineJohns Hopkins University HospitalBaltimoreMD
| | | | | | | | - D. David
- University of Sao PauloRenal Transplant ServiceSao PauloBrazil
| | - J. Goldberg
- INCUCAI (Argentinian Nacional Institute for procurement and Implants) and CUCAIBA (Buenos Aires Inst of procurement and implants)Buenos AiresArgentina
| | | | - M. Mengel
- Department of PathologyUniversity of AlbertaAlbertaCanada
| | - M. Haas
- Cedars‐Sinai Medical CenterDepartment of Pathology & Lab MedicineLos AngelesCA
| | - S. Seshan
- Department of PathologyCornell UniversityNew YorkNY
| | - K. L. Pegas
- Santa Casa de Misericordia de Porto Alegre Hospital and Universidade Federal de Ciências da Saúde de Porto AlegreRio Grande do SulBrazil
| | - T. Horwedel
- Department of PharmacyBarnes‐Jewish HospitalSaint LouisMO
| | - Y. Paliwa
- Department of PathologyUniversity of PittsburghThomas E Starzl Transplant InstitutePittsburghPA
| | - X. Gao
- Department of PathologyUniversity of PittsburghThomas E Starzl Transplant InstitutePittsburghPA
| | - D. Landsittel
- Department of PathologyUniversity of PittsburghThomas E Starzl Transplant InstitutePittsburghPA
| | - P. Randhawa
- Department of PathologyUniversity of PittsburghThomas E Starzl Transplant InstitutePittsburghPA
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Matos AC, Câmara NO, REQUIãO-MOURA LR, Tonato EJ, Filiponi TC, SOUZA-DURãO M, Malheiros DENISEM, Fregonesi M, Borrelli M, Pacheco-Silva A. Presence of arteriolar hyalinosis in post-reperfusion biopsies represents an additional risk to ischaemic injury in renal transplant. Nephrology (Carlton) 2016; 21:923-929. [DOI: 10.1111/nep.12699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/16/2015] [Accepted: 12/07/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Ana Cristina Matos
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Niels O Câmara
- Nephrology Department; Federal University of São Paulo; São Paulo Brazil
- Immunology Department; São Paulo University; São Paulo Brazil
| | - Lúcio R REQUIãO-MOURA
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Eduardo J Tonato
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Thiago C Filiponi
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Marcelino SOUZA-DURãO
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - DENISE M Malheiros
- Pathology Department; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Maurício Fregonesi
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Milton Borrelli
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Alvaro Pacheco-Silva
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
- Nephrology Department; Federal University of São Paulo; São Paulo Brazil
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Wang CJ, Wetmore JB, Crary GS, Kasiske BL. The Donor Kidney Biopsy and Its Implications in Predicting Graft Outcomes: A Systematic Review. Am J Transplant 2015; 15:1903-14. [PMID: 25772854 DOI: 10.1111/ajt.13213] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 01/06/2015] [Accepted: 01/07/2015] [Indexed: 01/25/2023]
Abstract
Despite a growing organ shortage in the United States, many deceased donor kidneys removed for transplantation are discarded. Kidney biopsy findings often play a role in these discards, although it is not clear whether biopsies reliably inform acceptance decisions. Therefore, we carried out a systematic review of the medical literature on the utility of both procurement and implantation biopsies for predicting posttransplant outcomes. Between January 1, 1994 and July 1, 2014, 47 studies were published in the English language literature that examined the association between pretransplant donor biopsy findings from 50 or more donors (with more than half being from deceased donors) and either posttransplant graft failure, delayed graft function, or graft function. In general, study quality was poor. All were retrospective or did not indicate if they were prospective. Results were heterogeneous, with authors as often as not concluding that biopsy results did not predict posttransplant outcomes. The percent glomerular sclerosis was most often examined, and failed to predict graft failure in 7 of 14 studies. Of 15 semiquantitative scoring systems proposed, none consistently predicted posttransplant outcomes across studies. Routine use of biopsies to help determine whether or not to transplant a kidney should be reexamined.
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Affiliation(s)
- C J Wang
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - J B Wetmore
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - G S Crary
- Department of Pathology, Hennepin County Medical Center, Minneapolis, MN
| | - B L Kasiske
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
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Pre-implant biopsy predicts outcome of single-kidney transplantation independent of clinical donor variables. Transplantation 2014; 97:426-32. [PMID: 24285339 DOI: 10.1097/01.tp.0000437428.12356.4a] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pre-implant biopsy findings account for the discard of many donor kidneys although their clinical value is not fully understood. We retrospectively investigated the predictive value of pre-implant histology, which in our center was obtained for protocol purposes, not for transplant decisions, on long-term allograft and recipient outcome after single-kidney transplantation. METHODS This single-center study included 628 consecutive adult recipients of 174 Expanded Criteria Donor (ECD) and 454 Standard Criteria Donor kidneys. Chronic donor organ injury was assessed applying a chronic lesion score differentiating between mild, moderate, and severe histologic organ injury based on the integration of glomerular, vascular, tubular, and interstitial lesions. Recipients were followed over a median time of 7.8 years. RESULTS Donor kidneys exhibiting mild or moderate chronic lesions yielded almost identical graft and recipient survival independent of ECD status or other clinical covariables (HR 1.20, 95% CI 0.83-1.74, P=0.326, and HR 1.27, 95% CI 0.83-1.95, P=0.274, respectively). However, if allograft injury was severe, occurring in 3% of transplanted kidneys, graft and recipient survival was significantly reduced (HR 3.13, 95% CI 1.61-6.07, P<0.001 and HR 2.42, 95% CI 1.16-5.04, P=0.005, respectively). CONCLUSION The results suggest that donor kidneys displaying moderate chronic injury can safely be transplanted as single kidneys, while organs displaying severe injury should be discarded. Thus, pre-implant biopsy might offer an effective approach to increase the utilization of renal donor organs, especially from ECD and donors with cerebrovascular accident as cause of death, and to improve overall graft outcome.
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Kasiske BL, Stewart DE, Bista BR, Salkowski N, Snyder JJ, Israni AK, Crary GS, Rosendale JD, Matas AJ, Delmonico FL. The role of procurement biopsies in acceptance decisions for kidneys retrieved for transplant. Clin J Am Soc Nephrol 2014; 9:562-71. [PMID: 24558053 DOI: 10.2215/cjn.07610713] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES There is a shortage of kidneys for transplant, and many patients on the deceased donor kidney transplant waiting list would likely benefit from kidneys that are currently being discarded. In the United States, the most common reason given for discarding kidneys retrieved for transplant is procurement biopsy results. This study aimed to compare biopsy results from discarded kidneys with discard attributed to biopsy findings, with biopsy results from comparable kidneys that were successfully transplanted. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this retrospective, observational, case-control study, biopsy reports were examined from 83 kidneys discarded in 2010 due to biopsy findings (cases), 83 contralateral transplanted kidneys from the same donor (contralateral controls), and 83 deceased donors randomly matched to cases by donor risk profile (randomly matched controls). A second procurement biopsy was obtained in 64 of 332 kidneys (19.3%). RESULTS The quality of biopsy reports was low, with amounts of tubular atrophy, interstitial inflammation, arteriolar hyalinosis, and acute tubular necrosis often not indicated; 69% were wedge biopsies and 94% used frozen tissue. The correlation between first and second procurement biopsies was poor; only 25% of the variability (R(2)) in glomerulosclerosis was explained by biopsies being from the same kidney. The percentages of glomerulosclerosis overlapped substantially between cases, contralateral controls, and randomly matched controls: 17.1%±15.3%, 9.0%±6.6%, and 5.0%±5.9%, respectively. Of all biopsy findings, only glomerulosclerosis>20% was independently correlated with discard (cases versus contralateral controls; odds ratio, 15.09; 95% confidence interval, 2.47 to 92.41; P=0.003), suggesting that only this biopsy result was used in acceptance decisions. One-year graft survival was 79.5% and 90.7% in contralateral and randomly matched controls, respectively, versus 91.6% among all deceased donor transplants in the Scientific Registry of Transplant Recipients. CONCLUSIONS Routine use of biopsies could lead to unnecessary kidney discards.
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Affiliation(s)
- Bertram L Kasiske
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota;, †Department of Medicine and, ¶Department of Laboratory Medicine and Pathology, Hennepin County Medical Center, Minneapolis, Minnesota;, ‡Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, Virginia;, §Departments of Medicine and, *Surgery, and, ‖Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, ††New England Organ Bank, Waltham, Massachusetts
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Abstract
PURPOSE OF REVIEW To provide an up-to-date overview about the assessment of donor biopsies and to discuss the current problems and chances of preimplantation biopsies for transplant allocation with a focus on the technical work up and the histological variables scored. RECENT FINDINGS Preimplantation biopsy results are the major reason for discarding procured extended donor criteria kidneys in the USA. There is neither a consensus on the work up, nor the reporting of preimplantation donor biopsies, nor the importance of the biopsy findings in the process of allocation. The best available data have been collected in the context of single vs. double kidney transplantation. A clinical risk factor score may help to define kidneys when a preimplantation biopsy is warranted. Punch biopsies using a skin punch device appear to be a reasonable alternative for surgeons fearing needle biopsies. SUMMARY Donor biopsies are very useful as zero-hour biopsies establishing baseline information for comparison with subsequent transplant biopsies. As none of the histological variables and scores provides perfect prediction, preimplantation biopsy results have to be interpreted in the context of all available donor and recipient information.
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Scian MJ, Maluf DG, Archer KJ, Turner SD, Suh JL, David KG, King AL, Posner MP, Brayman KL, Mas VR. Identification of biomarkers to assess organ quality and predict posttransplantation outcomes. Transplantation 2012; 94:851-8. [PMID: 22992769 PMCID: PMC3927314 DOI: 10.1097/tp.0b013e318263702b] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
UNLABELLED The increased disparity between organ supply and need has led to the use of extended criteria donors and donation after cardiac death donors with other comorbidities. METHODS We have examined the preimplantation transcriptome of 112 kidney transplant recipient samples from 100 deceased-donor kidneys by microarray profiling. Subject groups were segregated based on estimated glomerular filtration rate (eGFR) at 1 month after transplantation: the GFR-high group (n=74) included patients with eGFR 45 mL/min per 1.73 m(2), whereas the GFR-low group (n=35) included patients with eGFR 45 mL/min or less per 1.73 m(2). RESULTS Gene expression profiling identified higher expression of 160 probe sets (140 genes) in the GFR-low group, whereas expression of 37 probe sets (33 genes) was higher in the GFR-high group (P<0.01, false discovery rate <0.2). Four genes (CCL5, CXCR4, ITGB2, and EGF) were selected based on fold change and P value and further validated using an independent set of samples. A random forest analysis identified three of these genes (CCL5, CXCR4, and ITGB2) as important predictors of graft function after transplantation. CONCLUSIONS Inclusion of pretransplantation molecular gene expression profiles in donor quality assessment systems may provide the necessary information for better donor organ selection and function prediction. These biomarkers would further allow a more objective and complete assessment of procured renal allografts at pretransplantation time.
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Affiliation(s)
- Mariano J Scian
- Division of Transplantation, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908-0679, USA
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Singh P, Farber JL, Doria C, Francos GC, Gulati R, Ramirez CB, Maley WR, Frank AM. Peritransplant kidney biopsies: comparison of pathologic interpretations and practice patterns of organ procurement organizations. Clin Transplant 2012; 26:E191-9. [PMID: 22283182 DOI: 10.1111/j.1399-0012.2011.01584.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The preimplantation kidney biopsy affects utilization by diagnosing glomerulosclerosis, interstitial fibrosis (IF), arteriosclerosis, and arteriolar hyalinosis. Organ procurement organizations (OPOs) determine whether a donor warrants this biopsy and the donor hospital pathologists (DHPs) report on an OPO-specific pathology interpretation form. Biopsy slides from 40 deceased donor kidneys transplanted at our institution were used to compare interpretations between our transplant pathologist and the DHPs. Thirty-three of these kidneys also had post-perfusion biopsies (PPB). All 58 OPOs were queried for criteria used to request a preimplantation biopsy, and their pathology interpretation forms were also analyzed. The transplant and DHPs had substantial agreement for percent glomerulosclerosis with 75% of biopsies being interpreted within five percentage points. Concordance for IF was poor. The DHP rarely reported arterial pathology. Seventy percent of preimplantation and PPB were read similarly for glomerulosclerosis; concordance for other lesions was weaker. There were no cues for arterial disease on our OPO's pathology interpretation form. Criteria for obtaining a preimplantation biopsy lacked uniformity for the 21 OPOs with a self-generated policy. The pathology interpretation forms varied widely among the OPOs. Current OPO practices with regard to the preimplantation biopsy should be improved.
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Affiliation(s)
- Pooja Singh
- Division of Nephrology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
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12
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Karatzas T, Bokos J, Katsargyris A, Diles K, Sotirchos G, Barlas A, Theodoropoulou E, Boletis J, Zavos G. Advanced Donor Age Alone Is Not a Risk Factor for Graft Survival in Kidney Transplantation. Transplant Proc 2011; 43:1537-43. [DOI: 10.1016/j.transproceed.2011.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 03/01/2011] [Indexed: 11/27/2022]
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13
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Karatzas T, Gompou A, Bokos J, Dimitroulis D, Boletis J, Kostakis A, Kouraklis G, Zavos G. Optimal utilization of expanded criteria deceased donors for kidney transplantation. Int Urol Nephrol 2011; 43:1211-9. [DOI: 10.1007/s11255-011-9930-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 02/16/2011] [Indexed: 10/18/2022]
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Kahu J, Kyllönen L, Räisänen-Sokolowski A, Salmela K. Donor risk score and baseline biopsy CADI value predict kidney graft outcome. Clin Transplant 2011; 25:E276-83. [DOI: 10.1111/j.1399-0012.2011.01401.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mueller TF, Solez K, Mas V. Assessment of kidney organ quality and prediction of outcome at time of transplantation. Semin Immunopathol 2011; 33:185-99. [PMID: 21274534 DOI: 10.1007/s00281-011-0248-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 01/13/2011] [Indexed: 12/13/2022]
Abstract
The critical importance of donor organ quality, i.e., number of surviving nephrons, ability to withstand injury, and capacity for repair in determining short- and long-term outcomes is becoming increasingly clear. This review provides an overview of studies to assess donor kidney quality and subsequent transplant outcomes based on clinical pathology and transcriptome-based variables available at time of transplantation. Prediction scores using clinical variables function when applied to large data sets but perform poorly for the individual patient. Histopathology findings in pre-implantation or post-reperfusion biopsies help to assess structural integrity of the donor kidney, provide information on pre-existing donor disease, and can serve as a baseline for tracking changes over time. However, more validated approaches of analysis and prospective studies are needed to reduce the number of discarded organs, improve allocation, and allow prediction of outcomes. Molecular profiling detects changes not seen by morphology or captured by clinical markers. In particular, molecular profiles provide a quantitative measurement of inflammatory burden or immune activation and reflect coordinated changes in pathways associated with injury and repair. However, description of transcriptome patterns is not an end in itself. The identification of predictive gene sets and the application to an individualized patient management needs the integration of clinical and pathology-based variables, as well as more objective reference markers of transplant function, post-transplant events, and long-term outcomes.
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Affiliation(s)
- Thomas F Mueller
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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16
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The Prognostic Utility of Deceased Donor Implantation Biopsy in Determining Function and Graft Survival After Kidney Transplantation. Transplantation 2010; 89:559-66. [DOI: 10.1097/tp.0b013e3181ca7e9b] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Re L, Curcio D, Rial M, Goldberg J, Casadei D. Results of a prospective allocation policy of expanded criteria donors kidneys based on clinical parameters. Clin Transplant 2009; 24:229-35. [DOI: 10.1111/j.1399-0012.2009.01053.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Fibrous Intimal Thickening at Implantation Adversely Affects Long-Term Kidney Allograft Function. Transplantation 2009; 87:72-8. [DOI: 10.1097/tp.0b013e31818bbe06] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Pascual J, Zamora J, Pirsch JD. A systematic review of kidney transplantation from expanded criteria donors. Am J Kidney Dis 2008; 52:553-86. [PMID: 18725015 DOI: 10.1053/j.ajkd.2008.06.005] [Citation(s) in RCA: 226] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 06/04/2008] [Indexed: 12/14/2022]
Abstract
BACKGROUND During the past few years, there has been renewed interest in the use of expanded criteria donors (ECD) for kidney transplantation to increase the numbers of deceased donor kidneys available. More kidney transplants would result in shorter waiting times and limit the morbidity and mortality associated with long-term dialysis therapy. STUDY DESIGN Systematic review of the literature. SETTING & POPULATION Kidney transplantation population. SELECTION CRITERIA FOR STUDIES Studies were identified by using a comprehensive search through MEDLINE and EMBASE databases. Inclusion criteria were case series, cohort studies, and randomized controlled trials assessing kidney transplantation in adult recipients using ECDs. PREDICTOR A special focus was given to studies comparing the evolution of kidney transplantation between standard criteria donors (defined as a donor who does not meet criteria for donation after cardiac death or ECD) and ECDs (defined as any brain-dead donor aged > 60 years or a donor aged > 50 years with 2 of the following conditions: history of hypertension, terminal serum creatinine level >or= 1.5 mg/dL, or death resulting from a cerebrovascular accident). OUTCOMES Criteria used to define and select ECDs, practice patterns, long-term outcomes, early complications, and some patient issues, such as selection criteria and immunosuppressive management. RESULTS ECD kidneys have worse long-term survival than standard criteria donor kidneys. The optimal ECD kidney for donation depends on adequate glomerular filtration rate and acceptable donor kidney histological characteristics, albeit the usefulness of biopsy is debated. LIMITATIONS This review is based mainly on data from observational studies, and varying amounts of bias could be present. We did not attempt to quantitatively analyze the effect of ECD kidneys on kidney transplantation because of the huge heterogeneity found in study designs and definitions of ECD. CONCLUSIONS Based on the available evidence, we conclude that patients younger than 40 years or scheduled for kidney retransplantation should not receive an ECD kidney. Patients 40 years or older, especially with diabetic nephropathy or nondiabetic disease, but a long expected waiting time for kidney transplantation, show better survival receiving an ECD kidney than remaining on dialysis therapy.
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Affiliation(s)
- Julio Pascual
- Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, Spain
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Vasculopathy in the Kidney Allograft at Time of Transplantation: Impact on Later Function of the Graft. Transplantation 2008; 85:S10-8. [DOI: 10.1097/tp.0b013e318169c311] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Donor biopsy and kidney transplant outcomes: an analysis using the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) database. Transplantation 2008; 84:1399-405. [PMID: 18091515 DOI: 10.1097/01.tp.0000282868.86529.31] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although the degree of glomerulosclerosis on pretransplant donor biopsy is one criterion used in the decision to accept a deceased donor kidney, its relationship with graft survival remains controversial. This study compared graft survival with the degree of glomerulosclerosis found on donor biopsy. We also examined the agreement in degree of glomerulosclerosis between paired kidneys. METHODS Biopsy results from 12,129 adult deceased donor transplants between January 1, 2000 and December 31, 2005 were identified in the Organ Procurement and Transplantation Network/United Network for Organ Sharing data, as of September 11, 2006. Of these, 2696 donors had both kidneys biopsied and subsequently transplanted. RESULTS Among the groups with greater than 5% glomerulosclerosis, there was no statistically significant difference in graft survival rates (log-rank, P=0.44). The overall graft survival rates of the 0-5% group were significantly superior to those of the >5% groups (1-, 3-, and 5-year rates: 85.9%, 72.4%, and 59.0% for 0-5% group vs. 81.6%, 68.1%, and 53.6% for >5% group, log-rank P<0.001). Agreement between paired kidneys from the same donor was highest for the 0-5% glomerulosclerosis groups (90.6% for pairs with 0-5% glomerulosclerosis in the left kidney vs. 42.5% for pairs with >5% glomerulosclerosis in the left kidney). CONCLUSION Donor kidneys with less than 6% glomerulosclerosis were associated with better graft outcomes and intrapair agreement in the degree of glomerulosclerosis. Among kidneys with greater than 5% glomerulosclerosis, the degree of glomerulosclerosis did not help predict graft outcomes. Sampling error may contribute to the lack of outcome differences seen among these kidneys, given the low intrapair agreement.
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El-Husseini A, Sabry A, Zahran A, Shoker A. Can donor implantation renal biopsy predict long-term renal allograft outcome? Am J Nephrol 2007; 27:144-51. [PMID: 17308376 DOI: 10.1159/000099944] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Accepted: 01/12/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Donor kidney implantation biopsy (IB) is performed on a regular basis, particularly as part of clinical studies. OBJECTIVE To determine the utility of donor implantation renal biopsy to predict the long-term renal allograft outcome. METHODS A Medline search for studies in English was performed with the following key words: implantation biopsy, renal transplantation and long-term outcome. RESULTS Sixteen trials involving 8,122 kidney transplants were identified, of which 6 were prospective studies. The histological abnormalities were scored mainly by the Banff schema and the graft outcome was defined either by delineating the delta changes in the pathology score or glomerular filtration rate. Normal histology with a well-functioning renal allograft had a favorable outcome. The extent to which the baseline tubular atrophy, interstitial fibrosis, glomerulosclerosis and vascular changes had on the long-term outcome varied from one study to another. CONCLUSION Abnormal IB has a better chance of predicting early graft outcome. The review questions the current wisdom for routine IB on all donors. In some donor kidneys, a biopsy provides significant prognostic information, such as older donor kidney, those with history of hypertension, diabetes, cardiovascular disease, and kidneys with abnormal creatinine. Future research on IB is necessary to find a more useful method to predict the long-term transplant outcome.
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Affiliation(s)
- Amr El-Husseini
- Department of Nephrology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Lubuska L, Bachleda P, Tichy T, Lubusky M, Utikal P, Hrabalova M, Chudacek J, Janout V. Assessment of renal graft function depending on pre-transplant morphology. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2006; 150:171-7. [PMID: 16936922 DOI: 10.5507/bp.2006.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Histopathological assessment of kidney prior to transplantation is a part of the comprehensive information gathered on the transplanted organ. In our study we monitor the influence of individual morphological findings (glomeruli, arteries, arterioles, interstitium, tubules) and degree of histopathological changes in the kidney function after transplantation. METHODS From 1994 to 1997, 117 cadaveric kidneys were histopathologically examined and subsequently transplanted. Biopsy in a form of wedge excision was obtained during the organ procurement after in situ kidney perfusion and its removal from donor's body. Evaluated were glomerulosclerosis, intimal fibrosis of arteries, arteriolar hyalinization, interstitial fibrosis and tubular changes (vacuolar dystrophy of tubular epithelium, desquamation of tubular epithelium, brush border of proximal tubules, tubular dilatation, haemoglobin cylinders in distal tubules). Kidney recipients were monitored both for immediate function of transplanted organ and long-term kidney function for a period of five years following. RESULTS In our group of patients, no unambiguously negative influence of histopathological change in individual morphologies was found either in the immediate or in the long-term function of the transplanted kidney. CONCLUSION It is possible to transplant kidneys and attain satisfactory results even with these types of histopathological changes: glomerulosclerosis greater or equal to 20 %, mild degree of arterial lesion, moderate arteriolar lesions, moderate lesions of interstitial fibrosis and tubular lesions. The degree of arterial lesions, arteriolar lesions and the degree of interstitial fibrosis closely correlate to the donor's age, hypertension and nontraumatic cerebrovascular accident as the cause of death. Same outcomes were also confirmed with glomerulosclerosis, with the exception of the influence of the donor's age.
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Affiliation(s)
- Lucie Lubuska
- Department of Intensive Care in Surgery Branches, Palacký University, University Hospital, Olomouc, Czech Republic.
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Re L, Cicora F, Petroni J, Goldberg J, Rial MC, Casadei D. Comparison Between Clinical and Histopathological Scoring in Cadaveric Kidney Transplantation and Its Correlation With Posttransplant Evolution. Transplant Proc 2006; 38:903-4. [PMID: 16647504 DOI: 10.1016/j.transproceed.2006.02.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION There are several scoring systems, both clinical (Deceased Donor Score [DDS]) and histopathological (Remuzzi [REM]), that attempt to determine acceptability criteria for deceased donor kidney transplant. A retrospective study was performed among a group of kidney transplant recipients to evaluate posttransplant evolution with clinical and histopathological scores. MATERIALS AND METHODS Among 107 first deceased donor kidney transplant patients, 95 had undergone a pretransplant biopsy. Donor age was 38.46 +/- 16.9 years; recipient age: 49.2 +/- 16.3 years; DDS was 15.58 +/- 7.29. REM was 2.89 +/- 1.7. Delayed graft function was 64.2%. Induction therapy was administered to 49.5%. Cold ischemia time (CIT) was 1364 +/- 348 minute. Time on dialysis was 2275 +/- 1501 days. Induction therapy, immunosuppressive regimens, CIT, and time on dialysis were not significantly different among the groups. One-year patient and graft survival were 94.5% and 86%, respectively and 2-year values, 92.6% and 81%, respectively. CONCLUSION DDS showed a significant correlation with serum creatinine values over 1 and 2 years. REM did not show a significant association with any events. The differences were sustained after adjusting for other variables. Graft survival maintained a strong correlation with DDS categories and no association with REM. The clinical characteristics of a deceased donor appeared to be of greater importance than the biopsy findings in terms of posttransplant events.
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Affiliation(s)
- L Re
- Instituto de Nefrología De Buenos Aires, Buenos Aires, Argentina.
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Nishikido M, Noguchi M, Koga S, Kanetake H, Harada T, Taguchi T, Watanabe J, Matsuya F, Hayashi M. Different clinicopathological courses of two recipients of kidneys retrieved from the same non-heart beating donor. Clin Transplant 2004; 18 Suppl 11:54-60. [PMID: 15191375 DOI: 10.1111/j.1399-0012.2004.00249.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report the clinicopathological courses of two recipients of kidneys retrieved from the same non-heart beating donor (NHBD). A 52-year-old man received a renal transplant from an NHBD. The donor was a 66-year-old woman who died of subarachnoid haemorrhage. The recipient was immunosuppressed by basiliximab, tacrolimus (TAC), mycophenolate mofetil (MMF), methyl prednisolone (MP), and antilymphocyte globulin (ALG). On post-operative day (POD) 21, haemodialysis therapy was withdrawn, however, their serum creatinine (s-Cr) level failed to improve. Four transplant biopsies were performed (1 h and POD 46, 74, and 114). The biopsy showed tubular degeneration but no evidence of TAC nephrotoxicity. The last biopsy after discontinuation of TAC demonstrated acute rejection of borderline grade. The s-Cr level at discharge was 5.0 mg/dL. The contra-lateral kidney was transplanted into a 31-year-old female and showed early functioning, with an s-Cr level at discharge of 1.8 mg/dL. Biopsy examination on POD 38 showed a recovery of tubular degeneration. The causes of delayed graft function and persistently high level of s-Cr in Case 1 remain unclear. Various factors, including donor-related factors, recipient-related factors, TAC nephrotoxicity, acute rejection, and urinary tract infection could all be associated with this condition.
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Affiliation(s)
- M Nishikido
- Department of Urology, Nagasaki University School of Medicine, Sakamoto, Nagasaki City, Japan.
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Stratta RJ, Rohr MS, Sundberg AK, Armstrong G, Hairston G, Hartmann E, Farney AC, Roskopf J, Iskandar SS, Adams PL. Increased kidney transplantation utilizing expanded criteria deceased organ donors with results comparable to standard criteria donor transplant. Ann Surg 2004; 239:688-95; discussion 695-7. [PMID: 15082973 PMCID: PMC1356277 DOI: 10.1097/01.sla.0000124296.46712.67] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare outcomes in recipients of expanded criteria donor (ECD) versus standard criteria donor (SCD) kidneys at a single center using a standardized approach with similar immunosuppression. SUMMARY BACKGROUND DATA Expanded criteria deceased organ donors (ECD) are a source of kidneys that permit more patients to benefit from transplantation. ECD is defined as all deceased donors older than 60 years and donors older than 50 years with 2 of the following: hypertension, stroke as the cause of death, or pre-retrieval serum creatinine (SCr) greater than 1.5 mg/dl. METHODS We retrospectively studied 90 recipients of adult deceased donor kidneys transplanted from October 1, 2001 to February 17, 2003, including 37 (41%) from ECDs and 53 (59%) from SCDs. ECD kidneys were used by matching estimated renal functional mass to recipient need, including the use of dual kidney transplants (n = 7). ECD kidney recipients were further selected on the basis of older age, HLA-matching, low allosensitization, and low body mass index. All patients received a similar immunosuppressive regimen. Minimum follow up was 9 months. RESULTS There were significant differences in donor and recipient characteristics between ECD and SCD transplants. Patient (99%) and kidney graft survival (88%) rates and morbidity were similar between the 2 groups, with a mean follow-up of 16 months. Initial graft function and the mean 1-week and 1-, 3-, 6-, 12-, and 18-month SCr levels were similar among groups. CONCLUSIONS The use of ECD kidneys at our center effectively doubled our transplant volume within 1 year. A systematic approach to ECD kidneys based on nephron mass matching and nephron sparing measures may provide optimal utilization with short-term outcomes and renal function comparable to SCD kidneys.
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Affiliation(s)
- Robert J Stratta
- Department of General Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Howie AJ, Ferreira MAS, Lipkin GW, Adu D. MEASUREMENT OF CHRONIC DAMAGE IN THE DONOR KIDNEY AND GRAFT SURVIVAL. Transplantation 2004; 77:1058-65. [PMID: 15087772 DOI: 10.1097/01.tp.0000120177.44144ff] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND So-called marginal kidneys are used increasingly in renal transplantation, but features of marginal kidneys are disputed. METHODS To help define marginal, a morphometric measure, the index of chronic damage, was applied retrospectively to 500 implantation biopsy specimens of cadaveric grafts, and death-censored graft survival was calculated, up to 14 years after transplantation. RESULTS An index of 0% (n=242) was associated with better survival than 1%, with little difference between 1% and 39% (n=249). An index of 40% or more (n=9) was associated with the worst survival (chi=14.2, 2 df, P <0.001). After controlling for donor age, the only values of the index related to survival were 40% and above (hazard ratio, 2.96; P =0.01). Donor age group 10 to 39 years old (n=238) had better survival than 1 to 9 years old (n=26) and 40 to 73 years old (n=236) (hazard ratios, 2.83 and 2.06, respectively; P <0.001). An early episode of acute rejection affected survival even at 6 years and later after transplantation (hazard ratio, 1.94; P <0.04). CONCLUSIONS Marginal kidneys are identified using the index of chronic damage, but they are so rare that measurement is not necessary on every graft. After routine graft allocation and in the absence of acute rejection, a kidney from virtually any donor in an age group has the same potential as a graft from nearly all others in that group.
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Affiliation(s)
- Alexander J Howie
- Department of Pathology, University of Birmingham, Birmingham, United Kingdom.
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Papadimitriou JC, Coale R, Farney A, Schweitzer E, Foster C, Campos L, Bartlett S. Biopsy of the marginal kidney donor: correlation of histology with outcome. Transplant Proc 2004; 36:742-4. [PMID: 15110648 DOI: 10.1016/j.transproceed.2004.03.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J C Papadimitriou
- Departments of Pathology and Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
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López-Navidad A, Caballero F. Extended criteria for organ acceptance. Strategies for achieving organ safety and for increasing organ pool. Clin Transplant 2003; 17:308-24. [PMID: 12868987 DOI: 10.1034/j.1399-0012.2003.00119.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The terms extended donor or expanded donor mean changes in donor acceptability criteria. In almost all cases, the negative connotations of these terms cannot be justified. Factors considered to affect donor or organ acceptability have changed with time, after showing that they did not negatively affect graft or patient survival per se or when the adequate measures had been adopted. There is no age limit to be an organ donor. Kidney and liver transplantation from donors older than 65 years can have excellent graft and patient actuarial survival and graft function. Using these donors can be from an epidemiological point of view the most important factor to esablish the final number of cadaveric liver and kidney transplantations. Organs with broad structural parenchyma lesion with preserved functional reserve and organs with reversible functional impairment can be safely transplanted. Bacterial and fungal donor infection with the adequate antibiotic treatment of donor and/or recipient prevents infection in the latter. The organs, including the liver, from donors with infection by the hepatitis B and C viruses can be safely transplanted to recipients with infection by the same viruses, respectively. Poisoned donors and non-heart-beating donors, grafts from transplant recipients, reuse of grafts, domino transplant and splitting of one liver for two recipients can be an important and safe source of organs for transplantation.
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Affiliation(s)
- Antonio López-Navidad
- Department of Organ & Tissue Procurement for Transplantation, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Abstract
BACKGROUND Dual-kidney transplantation, where two usually aged adult kidneys are placed into an adult recipient, is one way to help alleviate the continuing disparity between the number of patients on the kidney transplant waiting list and those who receive kidney transplants each year. The Dual Kidney Registry was developed to analyze donor and recipient data and outcomes at several centers. METHODS Two hundred eighty-seven patients who have undergone transplantation since 1994 have been entered into the relational database. The patients were followed yearly after initial entry into the database. RESULTS The mean donor age was 58+/-13 years and the mean terminal creatinine clearance was 77+/-40 mL/min. The mean glomerular sclerosis on procurement biopsy was 16+/-13%. Delayed graft function (DGF), defined as dialysis in the first 7 days after transplantation, was a predictor of poor outcome, and increased cold storage time was a predictor of DGF. The overall incidence of DGF was 27%. In recipients with prompt graft function (PGF), the mean cold storage time was 22+/-9 hr versus 29+/-10 hr in recipients with DGF (P<0.001). The overall 1- and 5-year graft survival was 86% and 69%, respectively. The 1- and 5-year graft survival rates were significantly better in recipients with PGF (90% and 74%) versus DGF (79% and 54%) (P<0.002). CONCLUSIONS Cold storage time and DGF have a significant impact on the 1- and 5-year graft survival in recipients of dual-kidney transplants. The 5-year graft survival in recipients of dual-kidney transplants is excellent.
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Affiliation(s)
- Edward J Alfrey
- Department of Surgery, Penn State University, Hershey, PA 17033, USA. ejalfrey@ psu.edu
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Roodnat JI, Mulder PGH, Van Riemsdijk IC, IJzermans JNM, van Gelder T, Weimar W. Ischemia times and donor serum creatinine in relation to renal graft failure. Transplantation 2003; 75:799-804. [PMID: 12660505 DOI: 10.1097/01.tp.0000056632.00848.8d] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The results of renal transplantation are dependent on many variables. To simplify the decision process related to a kidney offer, the authors wondered which variables had the most important influence on the graft failure risk. METHODS All transplant patients (n=1,124) between January 1981 and July 2000 were included in the analysis (2.6% had missing values). The variables included were donor and recipient age and gender, recipient original disease, race, donor origin, current smoking, cardiovascular disease, body weight, peak and current panel reactive antibody (PRA), number of preceding transplants, type and duration of renal replacement therapy, and time since failure of native kidneys. Also, human leukocyte antigen (HLA) identity or not, first and second warm and cold ischemia times, left or right kidney and fossa, donor kidney anatomy, donor serum creatinine and proteinuria, and transplantation year were included. RESULTS In a multivariate model, cold ischemia time and its time-dependent variable significantly influenced the graft failure risk censored for death (P<0.0001) independent of any of the other risk factors. The influence primarily affected the risk in the first week after transplantation; thereafter, it gradually disappeared during the first year after transplantation. Donor serum creatinine also significantly influenced the graft failure risk in a time-dependent manner (P<0.0001). The risk of a high donor serum creatinine is already enlarged in the immediate postoperative phase and increases thereafter; the curve is closely related to the degree of the elevation. The other variables with a significant influence on the graft failure rate were, in order of decreasing significance, recipient age, donor gender, donor age, HLA identity, transplantation year, preceding transplantations, donor origin, and peak PRA. CONCLUSIONS Donor serum creatinine and cold ischemia time are important time-dependent variables independently influencing the risk of graft failure censored for death. The best strategy for improving the results of cadaveric transplantations is to decrease the cold ischemia time and to allocate kidneys from donors with an elevated serum creatinine to low-risk recipients.
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Affiliation(s)
- J I Roodnat
- Department of Internal Medicine, University Hospital Rotterdam-Dijkzigt, Rotterdam, The Netherlands.
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Affiliation(s)
- Vivette D D'Agati
- Columbia University College of Physicians and Surgeons, New York, NY, USA
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Escofet X, Osman H, Griffiths DFR, Woydag S, Adam Jurewicz W. The presence of glomerular sclerosis at time zero has a significant impact on function after cadaveric renal transplantation. Transplantation 2003; 75:344-6. [PMID: 12589156 DOI: 10.1097/01.tp.0000044361.74625.e7] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim was to determine the impact of donor glomerulosclerosis on allograft outcome. METHODS The percentage of glomerular sclerosis (%GS) was calculated in protocol biopsies taken at engraftment. Clinical variables were obtained from the Welsh Transplantation Research Group (WTRG) database. RESULTS Of 210 allografts, 129 showed %GS=0, but 81 kidneys showed %GS between 1 and 60. Patients with %GS=0 had the highest glomerular filtration rate (GFR) at 1 year (62.0 mL/min) and the slowest deterioration of function (-3.8 mL/min per year). Patients with %GS greater than 20 had the lowest GFR at 1 year (36.0 mL/min) and the steepest rate of deterioration (-9.0 mL/min per year). The %GS of 10 alone can reduce GFR at 4 years by 8 mL/min, a similar reduction to a single rejection episode or an increase in donor age of 30 years. Actuarial 5-year graft survival for %GS=0 was 80%, and for %GS greater than 20 was 35% ( P=0.04). CONCLUSION The findings indicate that a biopsy taken at procurement will provide information for the most appropriate allocation of a kidney.
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Affiliation(s)
- Xavier Escofet
- Welsh Transplantation Research Group, University of Wales College of Medicine, Cardiff, United Kingdom
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Gurkan A, Tuncer M, Yücetin L, Colak T, Erdogan O, Demirbas A, Akaydin M, Yakupoglu G. Effects of donor age on renal transplant outcome. Transplant Proc 2002; 34:2019-20. [PMID: 12270297 DOI: 10.1016/s0041-1345(02)02835-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- A Gurkan
- Akdeniz University Medical School Transplantation Center, Department of Nephrology, Antalya, Turkey.
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